Death around the Kitchen Table: Inequality, Urban Habitat and Disease Avoidance during a Typhoid Epidemic in a Finnish City, 1916

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

With regular new pandemics, the anatomy of disease outbreaks in urban environments before the era of biomedical responses is a constantly relevant subject. A crucial issue has been the interaction of epidemics with social inequality. E.g. the COVID-19 pandemic of 2020 generated data showing smaller drops in mobility and higher exposure in low-income neighborhoods during lockdowns in cities across the globe, likely due to higher proportions of essential service and production workers. Historical research has so far explored inequality with limited variables like literacy or ethnicity. We use exceptionally multidimensional data on the characteristics, location, physical habitat and self-reported behavior of eventually infected people during a 1916 typhoid epidemic in a city in Finland to identify determinants of early contagion. Applying survival analysis to c. 3000 cases, we are able to show that health-seeking behavior was directly constrained by physical habitat, even in the context of considerable public health effort. Reported drinking of unboiled water declined over the course of the epidemic, but was always systematically higher among those with shared facilities. There were also persistent neighborhood effects that did not disappear when controlling for a broad range of individual, SES or housing variables, or aggregate indicators like neighborhood tax rates or population density. Physical and environmental structures of inequality therefore dominated individual socioeconomic attributes, undermining the attempt by contemporary authorities to contain the epidemic through restrictions and guidelines on behavior.

No extended abstract or paper available

 Presented in Session 59. The Consequences of Epidemics