THE QUESTION OF HEALTH PROTECTION

...Record of Service...

...she is referred for further care to the right social agency or to her own family physician...

...T'HE baby serviee has been established for * about five months...

...There are eleven hundred children of pre-school age in the Mohawk-Brighton district and at present eight hundred of them have had a thorough physical examination and are being followed up in their homes on the basis of the findings at the station...

...It is stated that in New Jersey, out of one hundred and thirty thousand volunteers, sixty-six per cent were rejected because of physical defects...

...School examinations reveal the fact that children develop during the preschool age physical defects which have often reached an advanced stage before the child is examined by a physician...

...One of the first things which these nurses did was to do away with specialized nursing in large areas, divide the district into smaller nursing areas and do one hundred per cent general nursing within them...

...Provision for medical treatment, while an admirable conservation measure, does not prevent ill health and only indirectly gets to the root of causes...

...In this it is particularly significant...

...The Logical Effect IT IS not necessary to point out the logical effect which such a community of effort in the medical field has on the profession and practice of medicine...

...In doing this, they have prevented duplication of effort—the old plan oi having one nurse visit a sick child, another a maternity ease, perhaps all in the same household...

...Question of Health Insurance...

...But good feeling is already established...

...In doing this they have had the co-operation and advice of the Academy of Medicine of Cincinnati, as well as of a special committee of nationally renowned physicians, headed by Dr...

...The growing realization of the gravity of our national health situation is manifest in the Trades Unions towards this sort of legislation...

...The Nurses Council has also revolutionized the matter of public health nursing in this district...

...this Council has not only planned a program but has thrashed out standards and methods until there is a real unanimity of opinion...

...The New York Federation was the tenth to endorse such legislation...

...Perhaps nowhere in the United States is a more courageous and intelligent attempt being made to work out a system of efficient health administration than in the Mohawk-Brighton district of the city of Cincinnati...

...A survey recently made by the Metropolitan Life Insurance Company in Trenton, New Jersey, showed that in the course of a year every person over fifteen years of age was the loser of seven and two-tenths working days because of sickness, which means that in that city alone there was an industrial loss of a year's work of five hundred and forty-five men, between the ages of fifteen and forty-five...

...The baby service revealed the fact that a great percentage of abnormalities were due to pre-natal conditions, and this empirical knowledge led to the establishment of a pre-natal service for expectant mothers, by which they are examined regularly and given expert advice and education, rhis service, difficult to establish in most communities is meeting a very general response here, because the normal facilities for reaching the expectant mother...

...Thus do they profit as well as the community...

...This community is learning the most important lesson of a democracy: that what is good for one group is, in the long run, good for all groups and that the interests of humanity are identical, when one has far enough vision to see it...

...The nurse with the small district for which she is responsible and the neighborly block worker are the agents to approach her and bring home to her the advantages of such a service to herself, her child and her community...

...And the developing need of maximum production in industry to meet abnormal war demands brings home anew the national wast-tage which comes to a nation through poor health...

...The medical administration, in process of reconstruction there, is an integral part of a unique system of community organization which has as its basic idea an attempt to mobilize the expert knowledge of the people and put it at their disposal through small population units...

...and the case is followed up in the home through the nurses council...

...A recess committee of nine members recently appointed from the Massachusetts legislature, however, reports opposition to contributory and compulsory health insurance on the part of employees, employers and physicians...

...Work in New Field...

...That they term doing so enthusiastically is a farther argument for the democracy which carries with it responsibility and power...

...The social significance of the nurse b greatly increased as she comes into more intimate touch with her families, and she has a growing sense of responsibility not only for curing her patients but for nurintaining tha health lew...

...The Question Of Health Protection How One Community Attempts To Solve It By A Detailed Study Of Local Conditions In Each City Block By DOROTHY THOMPSON THE protection of the nation's health has been raised by the war from a matter for the consideration of social worker to one vital to the question of national defense and national efficiency...

...The Medical Council expects to reach at least ninety per cent of the children within the next month...

...A similar survey made in Rochester, New York, indicates that there are at all times in the State of New York, one hundred and fifty thousand persons seriously ill and that wage-earners of the state suffer "forty million dollars a year wage-loss from sickness...

...the announcement made by the Life Extension Institute that diseases of decay were on the increase in America although on the decline in many European countries, significant though these facts were, fell for the most part on deaf ears...

...The functional part of the community administration lies in the Occupational Council, on which is represented the expert social knowledge of the community—that is to say, the Trades Unions, the Business Interests, as well as Nurses, Teachers, Social Workers, Ministers and Physicians...

...As the service expands it will be necessary to call in more and more the other occupational groups—the Trades Unions and the business men for consultation in the plans...

...That these services will be extended as fast as the public sentiment of the community permits, to reach eventually adults, is the belief of the Medical Council...

...This state of affairs has been aptiy described by Miss Lillian Wald who relates the ease of seven nurses meeting in one home...

...Ease to Reach People...

...They are paid by the hour...

...The figures published prior to the war to the effect that the infant death rate in this country was higher than in Australia, New Zealand, Denmark, Norway and Sweden...

...Franklin H. Martin of the Council of National Defense...

...Organizations like the Association for Labor Legislation have urged the passage of health insurance laws as a primary measure in the conservation of the nation's vital resources, such legislate wage-earners, the insurance to be supported by working men, their employers, and in some cases a part borne by the public...

...It provides remedial measures largely and reaches only one group...

...Through the open-mindedness of Cincinnati's public health agencies, the Anti-Tuberculosis league, the Children's Clinic, and the Visiting Nurse Association have been willing to release their nurses who were operating in the district and permit them to affiliate with the Nurses Council of the Social Unit and cooperate in planning and executing a program...

...The Social Unit nurses have fixed the responsibility of the nurse, not on a specific case but on the health standards of the household...

...Although dependent in the last analysis upon the expert skill of the physician in the actual functioning of any health plan, the program has usually been designed without their co-operation...

...It hag meant that tuberculosis nurses have had to take part of their spare time to attend children's clinics, or clinics in obstetrics...

...A program of community effort along any line is therefore formulated by those of the community whose experience is most valuable and receives the co-operation of all other expert groups, each with a sphere of influence centering around the special interest which they represent, and reaches every man, woman and child for whom it is designed...

...The physicians would be the first to admit that consultation together, the necessity of arriving at certain standards for community work, the neighborhood clinics and the association with physicians from the rest of the country interested in this unique experiment, has elevated the standard of medical work in this district, and is developing a new social conscience and professional pride...

...of her district It is interesting to know that this form of public health nursing, which requires a much higher type of nurse, in that it calls for expertnesa along various lines, was instituted by the nurses themselves, for it la they who formulate the program in conference with the physician...

...Major General Crowdcr's report on the draft in New York State indicates that thirty per cent of New York youth could not meet the draft requirements and in the country as a whole, over a third of the men between the ages of twenty-one and thirty-one, are being found below par by the draft boards...

...Often it meets with opposition, and invariably a lack of agreement on methods prevents standardization and a smooth working out of the system...

...Under this plan, the health administration of the district has been planned by the physicians of the neighborhood...

...A consultation is held with the mother...

...In cooperation with the Federal Children's Bureau the social unit is offering itself as a national laboratory for child care during "Children's Year...

...COMMUNITY programs requiring expert skill are drawn up by the group with knowledge in the particular field, is approved by the Occupational Council as a whole, ratified by the group representing the citizens and put into effect by them, each block representative being able to do a one hundred per cent work with the citizens of her very restricted area...

...BOTH because of the comparative ease of reaching the population through their children and because statistics show the need of such a service to be a first essential, the physicians of this pioneer community have started with the establishment of a baby service...

...IT IS also contended and quite truly that industrial health insurance alone is not sufficient to put the level of the nation's health where it ought to be...

...In that time one hundred per cent of the babies have been reached in their homes by the nurses council and seventy-five per cent of them are coming to the Health Station...

...Is Not Sufficient...

...is brought to the station and examined...

...The work is being financed privately for the first three years as an experiment...

...This service has since been extended to reach all children under six years of age...

...And however the Massachusetts employees may differ from the ranks of their fellows, employers and physicians still present a pretty solid front of opposition to such measures...

...Whereas it was once universally attacked by the Trades Unions as paternalism, state federation after state federation has reversed its attitude within the last few years, perhaps the most notable triumph for such legislation coming when the New York State Federation came out for it and backed the bill introduced at Albany this year...

...Their program has been approved by the Occupational Council of which they are a part, and therefore has the hacking of business, trade union and educational groups in the community...

...To this end, each block in the district, which comprises a population of approximately fifteen thousand, is organized with a block council and a block executive, the executives making up a council of the citizenry...

...THE same report states that there are at all times in the state of New York fifty thousand people too sick to work, but entirely without medical care—a telling comment on our general medical - service...

...The physicians of the district serve at the health station in rotation, each of the thirty-six serving at some time during the year...

...The Federal Children's Bureau reports that the "dangerous age" is not the one covered by industrial insurance, but the first year of a baby's life, when the death rate is higher than at any other time...

...Through the block workers, every child under two years of age is reported to the medical council...

...There is a growing feeling that ultimately the state or municipality must provide some system of health administration which will reach one hundred per cent of its population and be preventative rathei than remedial...

...It took a national draft call and the findings of draft boards all over the country to bring home to the people of America the fact that bad health conditions are bad patriotism and may, in a crisis, prove the undoing of the nation...

...In the Social Unit area, the thirty-six physicians who are operating there have democratically elected a council of nine with an executive...

...It is impossible logically to consider the matter of maximum production in industry and to pass laws compelling men to labor at some gainful occupation and at the same time ignore such a state of affairs as this report indicates in the health standards of the country...