Statistical Analysis and Public Health

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By Andrew Wehrman

Last week in my class "Red, White, and Blood: The Curious History of American Medicine and Public Health," I lectured about the importance of statistics to improving health. Beginning in the late 1830s reformers in New England started forming Statistical Societies promoting the idea that state and local governments should keep vital statistics. Previously when doctors tried to convince politicians that there was an epidemic or medical crisis, they had to rely on qualitative evidence--word of mouth. Statistics then were needed to compile documentation from different towns, doctors, hospitals, morgues, etc. in order to keep track of illnesses and deaths. Those statistics could then be used to call for political action.

In 1839, Lemuel Shattuk was among the founders of the American Statistical Association (ASA). The goal of the ASA was to use statistical data to enhance human welfare. After an 1849 cholera epidemic in Boston, Lemuel Shattuck wrote a report using these statistics and presented it to the legislature in Massachusetts in 1850. Shattuck's report implored the government to take action. He argued using statistics that governments should build new water and sewer systems and organize city-wide street cleaning and garbage collection. He called for the creation of public health departments with extensive authority during times of epidemic. We hardly think of street cleaning and garbage collection as public health measures, but they absolutely are. Boston, once it implemented Shattuck's recommendations, never experienced another epidemic of cholera.

The organization that Shattuck helped start, the American Statistical Association is the oldest continuously operating professional science society in the United States. It has a membership of about 18,000 people promoting sound statistical practice to inform public policy. The ASA stated in 2016 that "Still after all these deaths and the unconscionable mass shootings in recent decades, little is still known about gun violence primarily due to a lack of federal funding and research on the topic." In 1996 Congress passed the Dickey Amendment which read, "none of the funds made available for injury prevention and control at the Centers for Disease Control and Prevention (CDC) may be used to advocate or promote gun control." Congress then took the $2.6 million that had been spent to study gun violence and reallocated it to the study of traumatic brain injuries. After the Dickey Amendment, and despite the spike in the number of mass shootings in the US, the CDC has provided almost no funds for firearms research, and according to health policy analyst Ted Alcorn, "From 1997 to 2012, the share of scientific publications between firearms and crime or violence fell by some 60%."

The point is that without statistics, we can't properly identify health problems. What we don't know can kill us. It is killing us. And if we deny statistics or we deny the ability to collect statistics, then we cannot solve big problems like the epidemic of gun violence. Last year the American Medical Association declared gun violence a "public health crisis." Let’s take a cue from Shattuck’s example and solve it like one.