The purely economic aspects of sickness and disease have been a potent factor in the health movement, particularly in cities. The vast sums invested in life insurance have led progressive insurance companies into extensive campaigns for promoting public health so that their risks may be reduced. Vast quantities of the best health literature have been distributed by some of the industrial insurance companies and they have done much to demonstrate the value of public health nursing by employing nurses who visit their policy holders. The extension of the insurance method to health insurance, and the adoption of insurance by large corporations for their employees has furthered this general movement, and has revealed the tremendous economic losses due to preventable sickness and disease. The farmer has failed to appreciate the purely economic handicap under which he labors as a result of sickness and the lack of adequate medical service and efficient public health administration such as cities enjoy, because the cost of sickness is distributed and is borne by each family and he has no means of knowing the aggregate cost for the whole community. Were it possible for a rural community to secure and have brought to its attention the total economic loss due to sickness in a given year and the proportion which might be preventable with a reasonable expenditure for better health facilities, its people would doubtless become as interested in better health administration as does the employer in a large city industry, and the true economy of better health facilities would be apparent.
Few concrete studies of the losses occasioned by sickness in rural communities have been made, but one of Dutchess County,[54] New York, in 1915 well illustrates the conditions which would doubtless be found in many another rural county. This survey covered five districts of the county with an aggregate population of about 11,800--most of which was rural territory. 1,600 cases of serious illness were found to have occurred during the year. "Some 9,000 days were lost by men and women of working age (15 to 54 years). Children lost 13,700 school days. On the average this cost the community for each child at least 33 cents a day for which it received no return. These two items safely represent a money loss of $20,000 to $25,000." As a result of the study it was estimated that the total money loss occasioned by sickness in a year within the whole county would be at least $412,000. "Of the 1,600 patients whose care has been analyzed in this report, 72 percent could have been cared for adequately in their own homes had there been available medical and nursing service. The remaining 28 percent (442 patients) could not have been cared for adequately in their own homes ... 24 percent of the patients secured no medical care. Many startling instances of unnecessary and indefensible suffering and misery were found.... Of the 113 women who went through childbirth in their homes, only one had the continuous care of a graduate nurse, and only 18 had any service whatever from graduate visiting nurses. 35 percent of the children born came into the world under unfit conditions and surroundings." Largely as a result of this study, Dutchess County now has an efficient county health association through which a number of public health nurses are employed, who visit all districts of the county.