The healing power of data: Florence Nightingale’s true legacy
When you’re in a medical emergency, you don’t typically think of calling a statistician. However, the COVID-19 outbreak has shown just how necessary a clear understanding of data and modelling is to help prevent the spread of disease.
One person understood this a long time ago. Were she alive today, Florence Nightingale would understand the importance of data in dealing with a public health emergency.
Nightingale is renowned for her career in nursing, but less well known for her pioneering work in medical statistics. But it was actually her statistical skills that led to Nightingale saving many more lives.
An early spark
Nightingale was one of the first female statisticians. She developed an early passion for statistics. As a child she collected shells and supplemented her collection with tables and lists. Nightingale was home-schooled by her father but insisted on learning maths from a mathematician before she trained as a nurse.
Upon arriving at the British military hospital in Turkey in 1856, Nightingale was horrified at the hospital’s conditions and a lack of clear hospital records.
Even the number of deaths was not recorded accurately. She soon discovered three different death registers existed, each giving a completely different account of the deaths among the soldiers. Using her statistical skills, Nightingale set to work to introduce new guidelines on how to record sickness and mortality across military hospitals.
This helped her better understand both the numbers and causes of deaths. Now, worldwide, there are similar standards for recording diseases, such as the International Classification of Diseases.
The ability to compare datasets from different places is critical to understanding outbreaks. One of the challenges in monitoring the COVID-19 pandemic has been the lack of standardised datasets experts can compare on the number of people infected. This is due to differences in testing rules in different countries.
More than 150 years after Nightingale pointed out the need to standardise datasets before comparing them, we are certain she would have something to say about this.
With her improved data, Nightingale put her statistical skills to use. She discovered deaths due to disease were more than seven times the number of deaths due to combat, because of unsanitary hospital conditions.
However, knowing numbers alone have limited persuasive powers, Nightingale used her skills in statistical communication to convince the British parliament of the need to act. She avoided the dry tables used by most statisticians of the time, and instead devised a novel graph to illustrate the impact of hospital and nursing practice reform on army mortality rates.