People had a vague sense of these inequalities at the time, but it took decades for statisticians to put hard numbers on them. Once they had, they realised that the explanation must lie in differences between human populations – notably, socioeconomic differences.
All over the world, the poor, immigrants and ethnic minorities were more susceptible – not, as eugenicists liked to claim, because they were constitutionally inferior, but because they were more likely to eat badly, to live in crowded conditions, to be suffering from other, underlying diseases, and to have poor access to healthcare.
Previously, social Darwinist – and misguided – thinking about some human "races" or castes being superior to others had mixed insidiously with the insight of Louis Pasteur and others that infectious diseases were preventable. They produced a toxic cocktail of an idea: people who caught infectious diseases only had themselves to blame.
The pandemic revealed the truth: that although the poor and immigrants died in higher numbers, nobody was immune. When it came to contagion, in other words, there was no point in treating individuals in isolation or lecturing them on personal responsibility. Infectious diseases were a problem that had to be tackled at the population level.
Starting in the 1920s, this cognitive shift began to be reflected in changes to public health strategy. Many countries created or re-organised their health ministries, set up better systems of disease surveillance, and embraced the concept of socialised medicine – healthcare for all, free at the point of delivery.
There had been moves in this direction earlier – you don't put a universal healthcare system in place at the drop of a hat – but the pandemic seems to have galvanised governments. In Britain these efforts came to fruition in 1948, with the birth of the National Health Service, but Russia already had a centralised, fully public healthcare system up-and-running by 1920. To begin with only urban folk benefited (rural populations were finally covered in 1969), but it was still a major achievement, and the driving force behind it was Vladimir Lenin.
http://www.bbc.com/future/story/20181016-the-flu-that-transformed-the-20th-century
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