The Money Value of Risk: Life Insurance and the Transformation of American Public Health, 1896-1930

This study examines the engagement of the life insurance industry with the emerging field of public health during the Progressive era. By conducting research, promoting hygiene, and providing the services of visiting nurses, firms such as Metropolitan Life and the Prudential transferred their ideologies and methodologies into the wider medical arena. Thus, the collaborations conducted during this period had significant ramifications for the future shape of American public health, which drew methods of risk assessment and a statistical approach to medicine from the alliance. This dissertation asks why the partnerships occurred. Public health and life insurance are not automatic allies, and their cooperation took place in a wider context of economic growth, social upheaval, and changing attitudes toward the management of risk. The study notes the power of life insurance firms as cultural institutions, which derived their commercial success from their ability to harness the social preoccupations of the buying public; the most profitable companies had a history of adjusting their sales rhetoric to anticipate, match, and manipulate public perceptions about which risks were salient and what the best ways to manage them might be. The passage of social insurance legislation in Europe provided a powerful example to reformers, whose structural approach to social betterment favored poverty prevention and legislative change. To prevent such measures from becoming law in the United States, insurance firms engaged in a strategy of political capitalism that included activities promoting public health. By positioning themselves as guardians of the nation's physical vitality (and, by extension, its prosperity), they protected the dominance of the private sector, strongly influenced the nascent field of public health, and created a point of significant methodological transmission to the medical arena