University of Virginia Historical Collections at the Claude Moore Health Sciences Library

Metropolitan Life Insurance’s Health Campaign

Business and Public Health: Hygiene Pamphlets and Visiting Nurses

Met Life

In the early 1900s, the Metropolitan Life Insurance Company began an unprecedented campaign to improve the health of its policyholders and poor families in general. As part of the campaign, the company’s agents distributed health information and for more than 40 years helped link the families with visiting nurses.

Insurance companies had traditionally sold insurance aimed at the middle class and well to do. The payments were substantial and the policy was seen as an investment and a way to protect a family from future poverty.

Insurance for the poor. In 1879, Metropolitan Life, then a small New York company, began to sell what was called “industrial insurance,” small policies (usually burial insurance) designed for low-income families. The working poor, especially in major cities, were able to buy these policies. The company’s agents visited the families each week, usually during the day, to collect the small premiums, (3-10¢ per week—the equivalent of 70¢ to $2.35 today). The agent met the mother and younger children and therefore learned of illnesses in the family and saw the conditions of the home.

Many of these were immigrants from Central Europe and Eastern Europe and South Italy. Most of them, in addition to being very poor, had little education and often spoke little or no English. Part of Metropolitan Life’s success lay in hiring agents from these communities.

Promoting cleanliness and health. Metropolitan Life produced a series of pamphlets and booklets on cleanliness and health, written in the immigrants’ languages—German, Italian, French, Spanish, Polish, and Yiddish. The pamphlets taught basic health and hygiene to families who had no previous experience of living in cities and who did not know or did not accept newer scientific information about germs and disease agents. The company also put health and hygiene ads in immigrant newspapers.

Part of the goal—as with many other reforms of the period—was to help the immigrants assimilate to American culture and standards.

Doing Well by Doing Good: Effect of Metropolitan Life’s Health Programs

Metropolitan Life’s Welfare Program illustrates the alliance between private business and public health in the reform era of 1890–1920s. The company moved from being 18th among U.S. companies in 1879, when it began selling industrial insurance, to being the fourth-largest in 1900.

The company invested in the health campaigns because its leaders could see statistically that promoting better health lowered the mortality rates among its policyholders and therefore saved money for the company. Also, the image of Metropolitan Life as “Mother Met,” concerned about the health of the Met family, was a powerful advertising image.

The company’s health and welfare campaigns made it an industry leader, and today MetLife (as it is now known) is the largest life/health insurance company in the United States.

Visiting Nurses

Visiting Nurses were a major part of many public health campaigns of 1880s-1930s. They went into the home not only to care for the sick but also to teach modern hygiene to families. They emphasized cleanliness as essential to good health and taught families how to maintain clean water and food and to keep themselves and their children clean.

Nurses do this same kind of teaching today—they are now called community nurses—in communities around the world. The Public Health Department for the Charlottesville area, for example, has community nurses, as do departments throughout the country.

Metropolitan Life and the Visiting Nurses, 1909-1953

Visiting Nurse

Visiting Nurse. Archives, Metropolitan Life Insurance Company.

In 1909, Metropolitan Life began to provide nursing services for its policyholders. The company entered an experiment with Lillian Wald, the well-known founder of the Henry Street Settlement House on New York ’s Lower East Side, then a huge immigrant slum. (A settlement house was a private, charitable center for providing services to the poor in cities.) Visiting nurses from Henry Street had for many years made house calls and taught about health and hygiene. The company’s agents would notify the Visiting Nurse Association when a family needed help, and the company paid the nursing association 50¢ (in 1909) for each visit ($12 today).

The experiment was a resounding success for both Wald’s Visiting Nurse Association and the company, and Metropolitan Life quickly expanded the program to Washington, D.C., Baltimore, Boston, St. Louis, and Cleveland. Later, the program was available in many areas of the United States and Canada. By 1931, the height of the program, 843 agencies had contracts with the company, which also ran 346 “stations” or clinics staffed by nurses. That year, 35 of every 1,000 policyholders received care from the service. Other insurance companies added similar services.

The U.S. health care system and population had changed dramatically by the years after World War II, and the company ended its Visiting Nurse Services in 1953.

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