Social inequalities and mortality during the 1918 influenza pandemic on the island of Newfoundland

Pandemics are anthropogenic events, and an anthropological perspective can be advantageous for a comprehensive understanding of the impact of the 1918 influenza pandemic. Research on the 1918 influenza pandemic has shown that there are considerable socioeconomic differences in risk for infection and mortality, whereby low socioeconomic status individuals with low nutritional levels, lack of access to medical resources, and crowding are at higher risk of adverse health outcomes. Using a combination of vital statistics, death registers, census data, and historical archives from The Rooms Provincial Archives in Newfoundland and Labrador, as well as supplemental historical qualitative archives from the Memorial University of Newfoundland Special Collections and Digital Archives, this dissertation investigates social inequalities and impacts of the 1918 influenza pandemic on the island of Newfoundland, an independent dominion of the British Empire in the early 20th century. This dissertation is comprised of three journal articles. The first article (Chapter 2) is a broad assessment of how anthropology, specifically the integration of biocultural anthropology and epidemiological transition theory, can encourage a more holistic understanding of human infectious diseases. Through a focus on tuberculosis and its contemporaneous co-morbidities, this review article emphasizes the non-mutually exclusive nature of health conditions and shows how diseases like tuberculosis are wholly entangled in human biological evolution, infectious disease dynamics, and demography. The second article (Chapter 3) investigates whether there is support in Newfoundland for the selective mortality hypothesis of tuberculosis and the 1918 influenza pandemic. This article highlights the inequalities on the region level of the island that contributed to overall post-pandemic tuberculosis dynamics, which were not significantly affected by the severe mortality of the 1918 influenza pandemic. Instead, persistently high tuberculosis prevalence and pre-existing health issues linked to nutritional deficiencies are discussed as context for the lack of significant effects of the pandemic. The third article (Chapter 4) contextualizes the mortality and survivorship of (1) influenza and pneumonia, (2) tuberculosis, and (3) bronchitis, measles, and whooping cough during the 1918 influenza pandemic with those of two surrounding time periods: a pre-pandemic period (1909-1911) and a post-pandemic period (1933-1935). This research compares patterns of mortality and survivorship in the urbanizing region of the island with the more isolated, rural regions, and further emphasizes the importance of broadening the temporal depth of pandemic inquiry to better understand impacts and consequences. The ability to place epidemic patterns in a comprehensive historical and anthropological context alongside an understanding of how culture, history, and biology have shaped the modern world and the health of its people will impact strategies for public health preparedness against inevitable future infectious threats.