The Incidence of Influenza among Persons of Different Economic Status during the Epidemic of 1918

Edgar Sydenstricker (1881–1936) worked in several capacities for the U.S. Public Health Service from 1915 until his death in 1936. Although his formal education was in economics, he served as a statistician and survey designer and manager. He authored or co-authored more than 100 papers and publications, and components of several reports and analyses of public health issues of the time can also be credited to his pen. Today, Sydenstricker’s work is only occasionally cited by researchers and authors exploring various aspects of public health. Many of the survey and analysis techniques he pioneered have become routine methods in epidemiology and public health. Sydenstricker was influential in moving public health from a purely mortality-based data and analysis system to a system that captured socioeconomic status, morbidity, and personal status in addition to the then-traditional way of examining populations. He innovated. Most commentators on Sydenstricker’s contributions focus on his work in interweaving socioeconomic status into public health thinking. While his work is most often observed for its political meaning, Sydenstricker’s approaches should be characterized in a more general manner that reflects his true prescience in public health. Examination of his work shows that the commentators reached reasonable conclusions about its social applicability. The true influence of his contributions, however, becomes clear through a less political perspective. When assessed in more global terms, it is unmistakably centered around the same principles underlying today’s practices of evidence-based medicine and policy making. While the applications of his thinking reflect the time in which he lived and worked—a time when social security and other social programs were taking hold—his arguments remain fresh today. The words of his colleague, Dr. Wade H. Frost, underscore the scientific and evidence-based nature of Sydenstricker’s approach: “Sydenstricker has consistently followed one clear purpose, namely to collect as exactly as possible the kind of facts which are needed to show in a perfectly dispassionate objective way what conditions affecting public health exist in this country and what is being done to meet them.” “The Incidence of Influenza Among Persons of Different Economic Status During the Epidemic of 1918” is a perfect reflection of Sydenstricker’s social concerns and his drive for evidence. Comporting with the best scientific approach, wherein recorded information supports an assertion, Sydenstricker makes one and proceeds to make social inferences. Where there is an “insufficient” fact base, he avoids making conclusions, says so, and refrains from making statements that could lead a reader to believe that a causal relationship exists or that a conclusion is being made. He writes in the style in which any modern evidence-based paper would be written. Although the public health environment in which Sydenstricker’s inquiries were conducted has changed, there is a timelessness to his concerns with assessing and improving the health status of people and communities and with ensuring that factual, evidence-based arguments are made to support decisions and actions. We would all do well to contemplate Sydenstricker’s example and adopt his approach to the social and scientific imperatives of our public health profession. Arthur J. Lawrence is Assistant Surgeon General and Deputy Assistant Secretary for Health (Operations) for the U.S. Public Health Service. A career Commissioned Officer with more than three decades of service, he has held several clinical and leadership positions in the field and in headquarters. He has an avid interest in the history of the Service and public health, and works closely with the U.S. Public Health Service Historian.