betterment of life insurance S>erbtce 
 
 NEED FOR 
 
 BETTER VITAL STATISTICS 
 
 Report of Health Committee 
 Association of Life Insurance Presidents 
 
 “ Public Hygiene is built upon and directed by, 
 and is everlastingly in debt to vital statistics. 
 . . . Every wheel that turns in the service ot 
 public health must be belted to this shaft.” 
 
 T)r. John S. Fulton of Maryland 
 
 Secretary General 15th International Congress 
 of Hygiene and Demography 
 
 Submitted at the Sixth Annual Meeting of 
 
 Association of Life Insurance Presidents 
 
 at New York, Dec. 5, 1912 
 
NEED FOR BETTER VITAL STATISTICS 
 
 To the Association of Life Insurance Presidents: 
 
 Your Health Committee respectfully submits the following report: 
 
 One of the most important and world-wide movements of the 
 present day is the concerted attack on uncleanliness and disease. It 
 is not limited to our own country and people; it is directed against 
 no one disease, but against all the ailments which flesh is heir to. 
 It is all the more irresistible because it comes from so many different 
 angles. This war is being waged with constantly increasing energy. 
 The medical profession has worthy allies in many other branches of 
 science, in philanthropy and among business men and business 
 institutions. 
 
 Diseases which a few years ago constituted well-grounded 
 cause for alarm because of their contagious character and high mor¬ 
 tality, have been brought under subjection and practically eradicated. 
 
 . Medical science has discovered new methods of treating still other 
 ; diseases so as greatly to reduce their severity and consequent high 
 death rate. 
 
 From a layman’s, as well as from an economic view-point, the most 
 interesting and important achievements have been the discoveries for 
 the prevention of disease. 
 
 It has been the ambition of this Association to bear a modest part 
 in this great movement and to lend a helping hand toward the con¬ 
 servation of human life. While the Association is not organized 
 primarily for such purposes, yet every thinking person must admit 
 that they have a direct relationship to the business in which the mem¬ 
 bers of the Association are engaged; and consequently are proper 
 subjects for the consideration of the Association itself. 
 
 Every policyholder is directly interested in the actual mortality 
 experienced by his Company; and is indirectly interested in the 
 hygienic condition of the communities in which all the policyholders 
 live, and from which future accessions to membership must be 
 1^5 obtained. 
 
 The National Government, many State Governments, National, 
 State, County and local organizations, civic and social clubs and 
 
 i 
 
r / 
 
 societies, special exhibits and special trains, are contributing largely 
 and successfully to the work of general and special hygiene and to 
 the prevention and eradication of disease. This Association so far 
 has contributed its mite largely through a campaign of publicity and 
 education. Some of the foremost specialists in their particular 
 branches have delivered addresses which have been given very wide 
 publicity. Many of our members little realize how widely these ad¬ 
 dresses and the press notices of them have been disseminated. Ad¬ 
 ditional impetus has been given also to the work by our individual 
 members and by their officers and directors, both by bulletins, Com¬ 
 pany publications, and personal addresses before local organizations. 
 
 One of the serious questions which we have repeatedly asked our¬ 
 selves has been, “What can we do best and how can we best do it?” 
 Some of our members have thought that a general campaign of ed¬ 
 ucation by the way of public addresses and through the public press 
 was about all that we could do. Others have suggested that the 
 Association should apply itself more particularly to the betterment 
 of local hygienic conditions; taking some particular place or places 
 as typical of others in which to make the initial move; still others 
 have thought that the Association should select some disease, as 
 typhoid fever, and for the time being concentrate all our batteries 
 on it. 
 
 When there is so much to be done, and so great a field in which 
 to do it, it is a most difficult task to determine what to attempt first. 
 It matters not how much the National and State Governments and 
 independent societies and organizations may do; the actual results, 
 whether applied to the cleaning up of towns and cities, the furnish¬ 
 ing of water and milk to the individual consumer free from bacteria 
 and harmful germs, or to the prevention or healing of diseases, must 
 be local in character and must be brought about largely through 
 local sentiment, working through local people. 
 
 The important question then is, “How can local public sentiment be 
 aroused sufficiently to accomplish these results ?” 
 
 A year ago an appropriation was made by the Association 
 to be used in securing additional assistance in connection with 
 the work of its Health Department. In a general survey of so broad 
 and varied a field no one phase of the work appeared to offer an 
 especially favorable opportunity for making a successful attack with 
 the money available. 
 
 The International Congress of Hygiene and Demography held at 
 
 2 
 
Washington, D. C., in September last, seemed to offer a rare oppor¬ 
 tunity for your committee to view the whole subject from many dif¬ 
 ferent angles, and perchance definitely decide along what particular 
 lines the Association can best work in the future. 
 
 A meeting of the Committee was called for the afternoon of the 
 first regular day of the Congress. All of the members, excepting 
 two, were present; one being detained by illness, and the other by an 
 unavoidable business engagement. At such meeting the official pro¬ 
 gram of the Congress and the published abstracts of the addresses 
 to be given were gone over carefully, page by page, and the members 
 of the Committee were assigned to attend different sections of the 
 Congress in its morning, afternoon and evening sessions. Those 
 particular lectures on both hygiene and demography were selected 
 which seemed likely to be most helpful. At the close of the next 
 day your Committee again met and discussed the work of the day, 
 and new assignments were made for the morrow. In this way we 
 were able to get reports from several sessions and from different 
 sections of the Congress. 
 
 Medical and hygienic science have, in recent years, made enor¬ 
 mous strides both in the control and prevention of many forms of 
 disease; yet such scientific knowledge cannot be advantageously 
 made use of without reliable vital statistics. The same principles 
 apply as in private business affairs. If an expert is employed to 
 advise a manufacturer with reference to the condition of his affairs, 
 he will at once ask to see the books. He cannot advise as to the 
 cost of production or manufacture of goods; or as to the actual 
 present financial condition if no books of account have been kept, 
 and if there are no written records showing past transactions and 
 present conditions. A patient cannot be intelligently treated until 
 the physician has an accurate history of the case. A lawyer cannot 
 wisely advise a client until all the facts are furnished him. This is 
 so, and even more so, in the case of communities. In some localities 
 the highest mortality is experienced from those diseases which are 
 now known to be largely preventable. Familiarity seems to breed 
 in this case apathy. 
 
 It is more difficult to get a community to make war against some 
 disease which, notwithstanding its high mortality, has been of long 
 standing than it is to induce the same people to take up arms against 
 an uncommon disease much less dangerous. One mild case of 
 smallpox in an adjoining county will cause more alarm than a dozen 
 
 3 
 
cases of malarial or typhoid fever in the immediate community. In 
 many places, especially in the South, the inhabitants appear to be 
 ignorant of the fact that they unnecessarily suffer severely from 
 malaria and other diseases incident to improper sewerage and im¬ 
 pure drinking water; they are indignant if told that their mortality 
 from such causes is in excess of that in similar communities else¬ 
 where. 
 
 If we can, by official statistics, convince any community that it is 
 an unhealthful place in which to live, and that such fact will be com¬ 
 mon knowledge, the local inhabitants will apply the remedy. 
 Publicity is the most effective weapon that can be employed; it is 
 a greater agent in any reform than mere mandatory legislation. 
 Dr. W. S. Rankin, of the State Board of Health of North Carolina, 
 forcibly demonstrated in his address before the Section on Demog¬ 
 raphy at Washington, the great importance of reliable vital statistics 
 in removing insanitary local conditions. Dr. Rankin has consented to 
 address this meeting, and will furnish you such information at first 
 hand. 
 
 It is to be hoped that every member of this Association will hear 
 or read Dr. Rankin’s address, and also the papers read at Wash¬ 
 ington by Dr. Dowling of the State Board of Health of Louisiana, 
 Dr. Plecker, Director of the Bureau of Vital Statistics of Virginia, 
 and Dr. Snow of the State Board of Health of California. 
 
 The most valuable asset of a man, a family, or a community is 
 good health. 
 
 The total population of a Nation is the aggregate of many single 
 units. It follows, therefore, that our problem is with the individual. 
 If he is suffering from a disease, and his neighbors are dying, or 
 have died, from the same cause, we must be able to find him, before 
 we can cure him, or remove the cause. This cannot be done without 
 reliable vital statistics. 
 
 The difficulty of securing necessary legislation in some States is 
 well known. The National Government and the American Medical 
 Association, among other agencies, are striving to secure adequate 
 and uniform laws in all the States. 
 
 In a bulletin recently issued by the American Medical Association, 
 this statement appears— 
 
 “The present condition of the registration of vital statistics in 
 the United States, considering the country as a whole, is not far 
 from constituting a national disgrace. Unlike practically all other 
 
 4 
 
civilized countries, we have no general and thorough system for 
 recording the chief events of human life, and especially the births 
 of our children and the deaths of our people. . . . Honest data, 
 fairly presented, will remove the imputation of unhealthfulness from 
 many localities now tainted by the apprehension of insanitary con¬ 
 ditions in the minds of possible incomers. Intelligent immigration 
 will not go where the conditions of civilization are so slack that no 
 regard is paid to human life, even so much as to record its beginnings 
 and endings.” 
 
 Vital statistics kept by cities and counties, without regard to 
 standard forms making comparisons possible, have proven to be 
 unsatisfactory. It is common knowledge that well-managed life in¬ 
 surance companies will not accept risks in sections known to have 
 excessive mortality. Every company properly spends time and 
 money to determine in advance those parts of the country which 
 have an abnormal death rate. Prior investigation is more economical 
 than the payment of death claims on policies imprudently issued. 
 Reliable information should be available from the public records. 
 
 Some States have no law requiring a registration of vital statis¬ 
 tics ; in other States the laws are inadequate; and in still others the 
 laws so far have not been effectively enforced. Attention is invited 
 to a map in colors printed on the last page of the cover of this report. 
 
 There are sections of the country where the people rebel against 
 a public record being made of the births of their children, and the 
 deaths of their people. They say that they and their ancestors never 
 have been compelled to furnish such information to a curious public, 
 and that they will not do it now; yet these same people will not buy 
 a horse or a cow unless the parentage or pedigree is a matter of 
 record. 
 
 The Director of the Census in a recent publication says— 
 
 “It seems to me that there is almost nothing more important in 
 the entire field of statistics than vital statistics, because of their di¬ 
 rect bearing on the health and consequent welfare of the people. 
 It certainly is both strange and shameful that the United States 
 should be so far behind the other leading countries of the world in 
 the registration of deaths, and even more so in the registration of 
 births.” 
 
 We wish to offer the testimony of three well-known authorities 
 for the purpose of emphasizing the great value of vital statistics to 
 preventive medicine, and for the prolongation of human life. 
 
 5 
 
Assistant Surgeon General Trask, in a recent publication by the 
 United States Government, makes this statement— 
 
 “A community which has no means of knowing with what con¬ 
 tagious diseases it is afflicted, nor how many cases there are, nor 
 where they are, is helpless to protect itself, and unnecessary sickness 
 and death will result.” 
 
 Dr. Wm. H. Allen, in a paper read at Harrisburg a few years ago, 
 said— 
 
 “The earnest, intelligent health officer relies upon statistics for an 
 understanding of his field. A tax collector can not discharge his 
 duties unless he knows the address of every debtor. A police bureau 
 can not protect society unless it knows the character and haunts of 
 the degenerates. A health officer can not execute the law for the 
 protection of society’s health unless he knows the haunts and habits 
 of disease. For this he must look to vital statistics. 
 
 “But the greatest service of vital statistics is their educational 
 influence. . . . Wherever statistics are wanting, sanitary adminis¬ 
 tration is defective. Wherever they are complete, sanitary adminis¬ 
 tration is efficient. Defective vital statistics and low ideals of 
 cleanliness and health go hand in hand.” 
 
 Dr. John S. Fulton, Secretary of the State Board of Health of 
 Maryland, in a paper read before the American Medical Association, 
 said— 
 
 “Public hygiene is built upon, is controlled and directed by, and 
 is everlastingly in debt to vital statistics. . . . Every wheel that 
 turns in the service of public health must be belted to this shaft, 
 otherwise preventive medicine must remain invertebrate and unable 
 to realize the profits available from the magnificent offerings of col¬ 
 lateral science.” 
 
 The value of accurate vital statistics to the fundamental principles 
 underlying life insurance is too well known to require mention even, 
 to this audience. 
 
 Your Committee believes that it is within the province and within 
 the power of the Association materially to assist in the passage and 
 enforcement of proper laws for the securing of vital statistics in the 
 United States, and that such work is both tangible and important. 
 
 We believe that the Association should continue its custom of in¬ 
 viting well-known public men and experts to give addresses at our 
 annual meetings on the different phases of health conservation and 
 hygiene; and that wide publicity should be given to the same. 
 
 6 
 
We recommend, however, that for the present the Association 
 give particular attention and such assistance as lies within its power 
 to the passage and enforcement of proper and necessary laws for the 
 registration, preservation, and compilation of vital statistics; and 
 that a reasonable sum of money be expended for such purposes. 
 
 F. W. Jenkins, Chairman, 
 
 President, Security Mutual Life Insurance 
 Company, Binghamton, N. Y. 
 
 J. R. Clark, 
 
 President, Union Central Life Insurance 
 Company, Cincinnati, Ohio. 
 
 W. F. Dix, 
 
 Secretary, The Mutual Life Insurance 
 
 Company, New York City. 
 
 J. L. English, 
 
 Vice-President, ^Etna Life Insurance 
 
 Company, Hartford, Conn. 
 
 John K. Gore, 
 
 Vice-President and Actuary, The Pru¬ 
 dential Insurance Co., Newark, N. J. 
 
 Dr. A. S. Knight, 
 
 Medical Director, Metropolitan Life 
 
 Insurance Company, New York City. 
 
 Edgar S. Scott, 
 
 President, Franklin Life Insurance 
 
 Company, Springfield, Ill. 
 
 Dated December 5th, 1912. 
 
 At the concluding session of the Sixth Annual Convention of the 
 Association of Life Insurance Presidents, held on the afternoon of 
 Friday, December 6, 1912, the following resolution was unanimously 
 adopted: 
 
 “Resolved, That the report of the Health Committee be com¬ 
 mended and its recommendations adopted.” 
 
 7 
 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 ' 
 
 
 
 
 I 
 
 
 
 
 
 
 
 
 
 * 
 
 
 
 
 
 
 . 
 
 
 
 
 

 la .. , , _ 3 0112 105540345 
 
 ^Betterment of ILtfe 3n» U iaiuc *>eroice 
 
 Map Showing Use of 
 
 The Standard Certificate of Death, 1912 
 
 C Prepared by Association of Life Insurance Presidents from data furnished !:v the 
 
 Registration States using the Standard Certificate. 
 
 The United States Standard Certificate of Death was adopted in 1902 ; 
 vised by the American Public Health Association and approved by the U, 
 Bureau of the Census, for use beginning January 1, 1910. 
 
 Prior to the use of the standard blank no two States (and hardly any 
 cities) in the United States had the same forms. No uniform instructions co 
 be given, and exact comparability of returns was impossible. 
 
 Nonregistration States using or recommending the Standard Certificate. 
 
 Registration States that have made no changes in certificates since the adoptitk 
 the Standard Certificate in 1902; they still retain the old blanks (of excel 
 form), but will presumably unite with the States using the Standard Certi 
 when a change is made. 
 
 Nonregistration States that have adopted new blanks since 1902, and have 
 adopted the Standard Certificate. 
 
 
 States left uncolored have no State laws (Arkansas, Georgia, South Carolim 
 laws of such unsatisfactory character that the Standard Certificate could not be u] 
 Registration States are those in which, in the opinion of the Bureau of 
 Census, at least 90^ of all deaths are registered. 
 
 Nonregistration States are those in which the registration is below 90$, 
 which the adoption of the Standard Certificate has been too recent to : 
 judgment as to the completeness of registration.