HEALTH OF NATIONS.

Star (Christchurch), Volume LXVI, Issue 20221, 3 February 1934, Page 23 (Supplement)

HEALTH OF NATIONS.

Lower Incomes Cause Increase in Illness. RISE IN DEATH RATE FEARED. The writer of the following- article is director of public health activities of the Milbank Memorial Fund, and is statistical consultant to the United States Public Health Service and the New York State Charities Aid Association. He also founded the statistical work of the international health organisation of the League of Nations. (By DR EDGAR SYDENSTRICKER). NEW YORK, January 13. JN 1929, a year that now seems as unreal as a fantastic dream, the average annual income of a representative group of wage-earning families in the United States was 1700 dollars. In 1932 these same families averaged only 900 dollars. In 1929 only a third of the families had incomes of less than 1200 dollars; in 1932 three-fourths of them had less than this amount. About a fifth were actually on relief. Many others had almost no means of support. These figures are based on surveys made of 3000 working men’s families in Cleveland, Syracuse and Baltimore. There is no reason to believe they are not fairly typical of what has happened generally through the country, although they may be somewhat changed when the tabulation of surveys in other cities is completed. W hat is the significance of this tremendous change in economic condition and standard of living from the point of view of vitality and health? Previous experience has abundantly shown that poverty breeds disease, sickness and impaired vitality. One of the tragic consequences of the World War, for example, was the great increase in'mortality due to privation in many European cities. The possible consequences of the depression in the United States were therefore viewed with grave apprehension. Would this rapid plunge of millions of families into destitution result in damages to health ? How effective could be the efforts to counteract the inevitable consequences of poverty? It is too early to give a complete answer, but already some highly significant bits of evidence are at hand. Each of these must be considered carefully as to its true bearing and meaning.

The gross death rate—the barometer of ill-health generally used because of the lack of a more sensitive one—has not only failed to increase in the United States since 1929, but actually has gone down. Infant and tuberculosis mortality, more delicate indices than the gross death rate, have also decreased. These facts must be accepted as encouraging signs in that they are indubitable evidence that the four years of depression have not. so far, killed very many of the population. How long • the death rate will continue on a low level is a question impossible to answer just now.

There are already disquieting indications in some areas of large cities and in some sections of the country. In the first half of 1933, about half of the twenty-eight States for which information is available exhibited increases in the general death rate, in infant mortality, and in deaths from intestinal diseases among young children. The urban death rate in the latter half of 1933 apparently has not continued to decline.

The death rate, however, is not a very sensitive measure of the extent of ill-health and does not promptly reveal decreased resistance to disease. Moreover, we have advanced in our conception of health beyond the stage where we are concerned only with the postponement of death; we want not only to stay alive but to enjoy healthful and efficient living. The modern sanitarian, therefore, no longer depends upon death rates alone when he attempts to appraise the health situation, he employs more delicate indices, such as records of actual illness and of medical examinations. So, to ascertain the state of health of that part of the population which probably suffered most severely from the depression, and to evaluate efforts to maintain health, the United States Public Health Service and the Milbank Foundation in 1933 undertook extensive surveys of sample population groups in ten cities. About 15,000 wage-earning families were canvassed carefully to obtain a record of their economic history and mortality in 1929-1932, and on the occurrence of illness from various causes during a three months’ period in 1933. Special examinations were made of school children in two cities to determine nutritional status in relation to changes in the families’ economic condition. A study of the diets of 1200 families in ten cities was included in the survey. The highly significant fact was revealed by these surveys that the sickness rate in 1933 was more than 50 per cent higher in families whose incomes had dropped most sharply during the preceding four years than in families with low incomes throughout this period. The illness rate was also found to be relatively great in families without employed workers, less in families with part-time workers only, and still less in families with full-time workers. These illness rates were based upon disabling sicknesses occurring in the late spring of 1933, excluding sicknesses beginning before that time: they had little if any connection with any illhealth that caused unemployment in earlier years. In fact, ill-health as a cause of unemployment was relatively unimportant after the depression began. Illness Attends Income Cuts. The higher illness rate among families whose incomes were most seriously affected, and in which unemployment was longest and most severe, properly can be interpreted as an indication that the health of these families is being affected. I low large a proportion of the total population of the United States is involved cannot now be estimated since the results of the survey have not been completely tabulated.

The food supply of wage-earning families with low incomes due to the depression was found to be considerably under the minimum recommended by most nutritional authorities. Families on “ relief ” had supplies more adequate in energy value and in nutritional balance than those with inadequate incomes not receiving relief.

Carefully conducted medical examinations of 514 school children from families in areas severely affected by the depression in New York City and Pittsburgh showed there was a direct association between malnutrition and low income and drop in income. In New York, children from families receiving “ home relief ” had somewhat higher nutrition ratings than those from families receiving other types of relief or having low incomes from sources other than relief. This is especially significant in view of the fact that families on “ home relief ” received food orders issued in accordance with dietary standards. These studies as well as other evidence have so far demonstrated that social efforts have been effective in direct ratio to the extent and quality of their application. The indications that on the whole the death rates, especially from tuberculosis and among infants, have not yet greatly increased, that the. sickness rate has not increased, and that malnutrition has not been more widespread than it is, are a tribute to the efficiency of social work and public health.

But there are warning signs that cannot be overlooked. In spite of all of our efforts, a considerable moiety of the urban population at least has not received adequate relief and medical care. The sudden change from comfort to relative poverty experienced by so many families inevitably has been accompanied by failures to readjust the standard of living to the bare essentials of life. These essentials are being sacrificed in a struggle to maintain something of the former standard. It is in these groups that we find the most definite evidence of increased sickness and malnutrition—forerunners of impaired health and of a higher death rate unless the programmes of relief, medical care, and public health are not only maintained but also enlarged. (Copyright, 1934, by the “ Christchurch Star ” and the North American Newspaper Alliance, Inc.)