Edgar Sydenstricker was born into a studious family. His sister Pearl S. Buck, author of the high-school staple The Good Earth, was awarded the Nobel Prize in literature in 1938. His other sister, Grace Yaukey, wrote more than 30 books, including two about Pearl.
Their father was a Presbyterian missionary to China and the author of a book about the idioms of Mandarin.
Sydenstricker would translate the world into numbers. After a brief stint in something like the family business as a journalist in central Virginia, he studied economics at the University of Chicago and Johns Hopkins. They were arguably the best schools in the country at the time to produce a health economist, one the birthplace of modern sociology and the other the birthplace of modern infectious disease research.
Soon he was hired as a special investigator for the U.S. Immigration Commission and the U.S. Commission on Industrial Relations, surveying wages and working conditions, particularly in immigrant-heavy industries. He started this research in 1908, two years after Upton Sinclair published The Jungle, about the immigrant-heavy meatpacking industry in the city Sydenstricker became an economist. Wages and conditions for the population Sydenstricker was studying tended to be bad.
In 1915, he became the PHS’s first statistician, and his first job was to do his last job — study conditions in the New York garment industry, four years after it produced one of the worst and most transformative industrial disasters in U.S. history, the Triangle Shirtwaist Factory fire, in which 146 people, mostly young women, were killed. Conditions were, of course, bad, but “data showing this objectively are rare in the literature,” a colleague wrote by way of introducing Sydenstricker’s work. His survey showed that a quarter of the poorest workers in his sample suffered from “poor” nutrition, with 10% anemic, and 20% mortality among their children.
His next job was to figure out what to do about it.
With Benjamin S. Warren, a surgeon at the PHS who had previously studied the relationship between nutrition and pellagra and would go on to lead the PHS, he produced Health Insurance: Its Relation to the Public Health. Its first line: “The growing realization of the fact that the health of the wage-working population depends on large measure upon economic conditions is leading to the conviction that there is need for more comprehensive measures for the relief and prevention of disease.”
Its second paragraph suggested the measure: “Health insurance has been adopted in many European countries as the remedy for similar conditions and has become an efficient measure for the relief of sickness and an important agency in the prevention of disease. Recent discussions and proposals of health insurance measures are beginning to focus public attention on this subject and to suggest that a governmental system of health insurance is the solution of the problem in America.” (Warren and Sydenstricker also wrote favorably of the concept of a “living wage” as a health policy measure.)
Warren and Sydenstricker identified a number of these economic conditions and their intersection with health. Low wages led to excessive hours in physically demanding industries, but even worse was inconsistent, seasonal piecemeal work, where laborers were paid by the piece instead of by the hour or week, often in short-term gigs, pushing them towards an even greater pace. After the job ended, the money ran out soon enough. Wageworkers would grow old, “in the physiological sense of the term, earlier than persons engaged in other pursuits,” growing less able to perform industrial tasks, and slip down the socioeconomic ladder, worsening their interlocking problems.
The end result? “Modern industry has little use for the man over 45 years of age.”
Warren and Sydenstricker also addressed women as wageworkers, finding greater morbidity — more precarious employment meant they started their days earlier and pushed harder — and an exit from the workplace a decade earlier than men. They concluded that factory work had a negative effect on infant health, but “poverty has a much more deleterious influence, and if by employment poverty can be removed or lessened, such employment is lesser by far of the two evils.”
Poverty wages also created unhealthy living conditions, which would become deadly in the pandemic shortly to come. The U.S. Federal Immigration Commission, where Sydenstricker got his start, found that in nearly a third of newer immigrant households all but one room in their house or apartment was used as a bedroom, and in nearly a third a “separate family existence” was blocked by the need to house lodgers, generally four to 10 among the newest waves of Eastern European immigrants. A literature review found considerably higher death rates from tuberculosis in small and overcrowded homes compared to larger spaces. The worst conditions were found in lodging houses, where a dozen people might live in a small house, or even a room. In New York, the risk of lodging-house residents for tuberculosis was 11 times higher than average.
(Another thing that hasn’t changed much: “The great size of New York City and its proportionally great number of ill-fed and poorly housed working people have naturally concentrated attention on the problem there more than in other centers; but it has been found that living conditions are as bad in smaller industrial centers and in some instances appreciably worse… Furthermore, it should be remembered that the great majority of American wage earners live in the middle-sized and smaller places.” So there.)