Typhoid for All? Survival Analysis of the Social, Spatial and Behavioral Determinants of the Timing of Contagion during the Great Typhoid Epidemic of the City of Tampere, 1916

Sakari Saaritsa, University of Helsinki
Jarmo Peltola, Dr, Senior researcher, Tampere University, Faculty of Social Sciences, History

We use individual level data on a clearly defined, exogenous waterborne health shock in an industrial city in Finland in 1916 to analyze the contribution of complementary factors like type of employment, socioeconomic status and physical habitat in determining the health consequences of a polluted water supply. We are able to link individual hospital records of c. 2 700 patients affected by the epidemic with detailed information of their age, sex, residence, type of water utility, occupation, neighborhood socioeconomic profile, building types, etc., collected from sources including housing surveys, address calendars and urban census statistics. We use survival analysis with time varying coefficients to estimate the effect of variables like age, sex, occupation, housing and neighborhood on the timing of observed contagion among the eventually infected population at different stages of the epidemic. Since the exposure was exogenous, simultaneous and sudden throughout the city, we are able to decompose the mitigating/reinforcing effect of other factors, such as space, income or human capital, on the impact of water quality over the course of the epidemic. In the most recent round of research on the relative contributions of public interventions and private processes to the historical mortality decline, estimating unequal production functions of health within and across populations is becoming central. We offer a detailed, nonlinear analysis of the economic, social and spatial elements of a historical health shock, suggesting overwhelming material constraints to health seeking behavior were often present.

No extended abstract or paper available

 Presented in Session 212. Impact of Public Health Measures in the Twentieth Century