The Legacy of Neglect

...An additional 125,000 are mentally retarded...

...In 1950 the nonwhite infant death rate was sixty-six per cent greater than for whites...

...The poor have a high incidence of nervous tension, back trouble, ulcers, headaches, sore throats, bad coughs, indigestion, constipation, and exhaustion...

...You are two and a half times more likely to live in dilapidated housing units and three times more likely to be grossly overcrowded than whites who pay the same rent...

...The gap between need and availability of services prevails in all areas of health care...

...The PROGRESSIVE Madison, Wisconsin 53703 eral Hospital, has said: "We know that poverty breeds physical, mental or social disease...

...His article is adapted from The Quality of Mercy: A Report on the Critical Condition of Hospital and Medical Care in America, to be published this month by Atheneum Publishers...

...In one county in Pennsylvania the rate for whites is ten for each 1,000 births...

...The Negro death rate from tuberculosis is almost four times as high...

...A study of infant mortality made in New York a few years ago held that forty-two per cent of the deaths could have been prevented...

...Their rate of orthopedic impairments is more than twice the national average...

...In homes so grossly lacking in the elementary essentials of daily living, children also are apt to suffer emotional damage...

...The incidence of tuberculosis is six and one-half times the average for the city...

...Deaths in the first year of life are twenty times more common among premature infants than normal-term ones...

...It is a mockery of American tradition and our national honor that only forty per cent of poor children with handicapping conditions are getting the required care," Dr...

...And since nowhere is race or class discrimination more conspicuous than in the psychiatric field, the poor are less likely to get timely and adequate help and more likely to wind up in the desolate warrens of the state mental hospitals...

...Nutritional surveys have found alarming rates of malnutrition in some poverty areas, with a grim chain of ill-nourished mothers giving birth to ill-nourished children with a high risk of mental retardation...

...Now it is nearly ninety per cent greater—38.8 per 1,000 live births as against 20.6 for whites...

...By the time these children reach the age of thirteen, nine per cent will be retarded...

...The growth of the mind requires nutrition in the form of experience, language, and ideas...

...But of every 1,000 Negroes in this age group, ten will die...

...Why should nearly seventy-five per cent of honwhite children not be getting dental care, although conservative estimates show that ninety-seven per cent of all children require some dental care...

...Leon Eisenberg said it another way: "What one generation does—or fails to do—plagues its children...

...H. Jack Geiger, acting chairman of the Department of Preventive Medicine of Tufts University School of Medicine, has put it this way: "There is just no point in treating rat bites—and ignoring the rats...

...John H. Knowles, general director of Massachusetts Genmoving...

...Prematurity holds many hazards for babies...

...Among the poor, the incidence of such chronic conditions as heart disease, high blood pressure, arthritis, and visual impairments is four to eight times as high as among higher-income people...

...They also result in complications of pregnancy and childbirth that can inflict irreversible damage on the offspring and sometimes kill the mothers...

...In the seventeen states with the lowest per-capita income the rates are forty per cent above the national average...

...The adults those children become are adults warped by the childhood experience afforded them...

...The Department of Health, Education and Welfare compiled several years ago a shocking review of the prevalence of handicapping conditions among the young...

...This stinging excerpt from a recent talk by the chief of psychiatry at Massachusetts General Hospital and a noted authority on the psychology of childhood development is all the more poignant in the context of the appalling waste of human potential in the richest country in the world...

...Not only do we owe it to ourselves to create a just society in our time: we owe it to our children and our children's children...

...They also have a higher mortality of cancer of the cervix, a malignancy almost entirely curable with early diagnosis and treatment...

...The figure is only 2.9 visits when family income is under $3,000...

...Six out of ten said that, despite the much advertised availability of free medical care in an emergency, they were worried over whether or not it would really be there when they needed it...

...The urgency upon us is greatest on behalf of those who even now are growing into persons less than they might have been—for want of food, for want of health, for want of dignity, for want of love...

...Alonzo S. Yerby, a distinguished Negro physician and former New York City hospital commissioner who is now associate dean of the Harvard School of Public Health, has described the health care of low-income Americans as "a national disgrace...

...There are wide disparities in infant mortality between states, counties, and sections of the same city...

...and there is no health in us.' " Many of our doctors may be the best in the world...

...Geiger has said...

...Racism takes its toll early, through class-related malnutrition and poor prenatal care...

...Particularly startling were the survey's findings about psychosomatic conditions...

...But you learn the meaning of blackness soon enough in the crowded slum when you try to grow...

...The poor are likelier to be sick, and the sick are likelier to be poor," Dr...

...The department said it was estimated that more than 11,400,000 children, or twenty-three per cent of all youngsters, had eye conditions requiring specialist care...

...In Boston as a whole, the birth rate is fifty per cent higher than the death rate...

...But for nearly two out of every three ghetto blacks in the inner city or rural-poverty whites in Appalachia, 'feeling fine' means literally cnot as sick as usual.' " Most Americans are aware of the fact that, generally speaking, each succeeding generation is taller, weighs more, and is in better physical shape than the previous one...

...But from then on there was a sharp drop, and by the third year of life the IQs of the youngsters were down in the eighties...

...These children, like countless thousands of others in urban and rural slums throughout the nation, were paying the penalty of growing up in homes where they had never seen a ball, a rattle, a bell, or a mirror, where sticks and rocks were the only toys, where rags and old clothing served for blankets, and where there were sometimes not even any eating utensils...

...More are thrust forth prematurely, at higher risk of damage to the delicate mechanisms of the brain...

...In families with incomes of $10,000 or more, adults average five physician visits a year...

...thirty-nine per cent reported having difficulties sleeping...

...Since the proportion of low-weight babies is highest among blacks, the increase in the death rate in the first days of life has been considerably greater for nonwhite than white infants...

...Scores of bills proposing a variety of approaches to the crisis of the high cost of medicine await debate and action...

...The deprived young, most of them unable to break out of the vicious cycle of poverty as they grow up, remain the stepchildren of our medical-care system throughout their lives...

...The Progressive has scheduled a series of articles over the entire year exploring various aspects of this basic issue...

...For two out of every three people in the population, when they are 'feeling fine,' it means that nothing is the matter with them...

...That this is no exaggeration may be seen from these facts, all of them culled from official government statistics: The average life expectancy of an American Negro, who is most likely to be economically disadvantaged, is nearly seven years lower than that of a white American...

...In him it may be manifested by high blood pressure...

...The close relationship between race and the risks of childbirth is shown by the fact that in Mississippi the Negro maternal mortality rate is more than six times the white rate...

...Blacks die from influenza and pneumonia at a rate which is more than 100 per cent higher than for whites...

...We produce almost as much retardation as is born, and seventy-five per cent of the mental retardation among children comes from the areas of poverty...

...Not only is hypertension much more common among Negroes, but it is prevalent in a more severe form...

...And a large proportion of the visits paid by the poor to dentists are for extractions, whereas much of the care sought by the more affluent is for examination and cleaning of teeth...

...In some urban ghettos the ratio of infant deaths not infrequently hovers around 100 per 1,000 births...

...Most poor children go without adequate preventive or remedial health care...

...Nationally, the death rates during the first year of life range from 19.3 per 1,000 live births in Utah to 40.4 in Mississippi...

...be sure to give us your old address as well as the new —and please include both ZIP Codes...

...The devastating impact of the combination of poor nutrition and psychological deprivation is strikingly documented in the recent report of a study of black children in Bolivar County, Mississippi, where Boston's Tufts School of Medicine operates the Delta Health Center...

...The prematurity rate, a major consequence of inadequate prenatal care and a leading cause of death shortly after birth, is seventy-five per cent higher for the South End of Boston than for the city as a whole...

...When asked by the survey interviewers to compare the health of their own family with times gone by, three-quarters of the high-income people answered unhesitatingly that their health is better...

...Sixty-seven per cent of the low-income people questioned said they were concerned about where they would get the money to pay a doctor, and sixty per cent expressed open worry over who might take care of them during a serious illness...

...As one of them put it, "I always got a visitation from the miseries...

...We cannot simultaneously have health and Harlems, health and slums, health and racial discrimination, health and a second- or third-class education...

...But to be poor and black is the most difficult combination of all...

...Nor can the medical profession be held solely responsible for the ghetto's legacy of poor health...

...A large proportion of the children are yet to be immunized against common childhood ailments, and a recent survey showed that more than half of the residents had not been to a dentist for at least a year...

...Good nutrition during the first three years of life is therefore particularly important...

...Mental disease not infrequently stems from parental deprivation—a lack of familial interaction with the proper balancing of love, support, and approbation on the one hand with direction, disapproval, and punishment on the other...

...When we know that the end effect of amblyopia [blindness in one eye] is preventable, why should two per cent of all children still suffer from it...

...remain the stepchildren of our medical system throughout their lives/' There is one Mississippi county, on the other hand, with a rate of seventy-six per 1,000 for nonwhites...

...The U.S...

...But in health we are still a backward country...

...Out of the some 3.5 million births pccurring annually in the United States, at least 500,000 are by women who, according to official government reports, have received inadequate prenatal care or none at all...

...Why should one million poor children who need glasses not have them...

...Of every 1,000 whites in their late forties, five will die in the coming year...

...About one-third of these conditions could be prevented or corrected by case-finding and treatment in early childhood, according to the official report, and nearly two-thirds could be prevented or corrected by appropriate care up to the age of eighteen...

...While this conclusion was based on the widely prevalent complaints of people of all income levels regarding the accessibility and costliness of good health care, the deepest anxieties and frustrations were expressed by the poor...

...Black fetuses are aborted or born dead more often than white ones...

...Mauldin in Chicago Sun-Times But while emotional disorders are widely prevalent among the young in impoverished families, the Joint Commission on the Mental Health of Children set up by the Federal Government estimates that only ten per cent of those who need treatment are receiving it...

...Joseph T, English, former director of the Federal Health Services and Mental Health Administration, has said...

...If a man doesn't have a job, can't get enough food, can't have transportation to reach a job or a hospital clinic, cannot become educated or to see his children being educated adequately, he is in a state of disease...

...Tuberculosis, whose spread is generally attributed to inadequate nutrition and crowded living conditions, has an incidence among blacks more than double that of whites...

...The first of the series is the work of Selig Greenberg, prize-winning writer on medicine for The Providence Journal and Evening Bulletin (Rhode Island...

...Rural-poverty whites expressed the same sense of discouragement over their health by an even more sizable sixty-three to sixteen per cent...

...Without intervention, the poor get sicker and the sick get poorer...

...In New York City the infant death rates run all the way from twelve to forty-seven per 1,000 births, with the mortality incidence in parts of Harlem and the Bed-ford-Stuyvesant section of Brooklyn more than triple that of neighborhoods only a few blocks away...

...The incidence of emotional disorders and mental illness among the poor, who are exposed to numerous stresses, is estimated to be between five and six times greater than for those with higher income...

...Ironically, the expansion of Federal maternal-health programs in the last few years has led to an increase in the prematurity rate and the death rate among such babies...

...George S. Silver, former deputy assistant secretary in the Department of Health, Education and Welfare and now on the faculty of the Yale School of Medicine, has said...

...The unequal toll of disease and death, particularly when racial discrimination is superimposed on the effects of social and economic deprivation, is a standing indictment of our failure to assure equal access not only to health services but also to adequate housing, nutrition, and education...

...A chilling statistic is this: An infant born of poor parents in this country has twice as much risk of dying before his first birthday as does the non-disadvantaged child, and his chance of dying before the age of thirty-five is four times greater...

...Among the causes of inborn retardation, aside from prematurity, are the mother's malnutrition, a variety of virus infections developing during pregnancy, anemia, maternal diabetes or thyroid deficiency, and birth injuries...

...If the brain is dependent for its growth on biologic nourishment, the mind is no less dependent on psychological alimentation...

...Verbal efficiency was found to fall off earliest and most drastically...

...Babies inadequately nourished in the womb or shortly after birth are likely to have impaired behavior and learning ability...

...The deprived young...

...and that 2,150,000 had orthopedic conditions, and 2,130,000 were suffering from hearing impairments, in both cases a little under three per cent of the total...

...But in one section of the South End the death rate actually exceeds the birth rate, despite the fact that the latter is forty-five per cent above the average for the city...

...About 250,000 of the babies born in this country every year are afflicted with congenital defects...

...Authoritative estimates are that about half of the expectant mothers in poor families go through pregnancy without the required medical attention...

...The evidence of the widespread neglect of the health of the young among the at least twenty-five million Americans classified as urban poor and the additional millions of rural poor is distressingly compelling...

...They trail the affluent only in disorders which they cannot afford, notably sunburn and allergies...

...The lack of such care and poor nutrition lead to a high rate of stillbirths and premature births...

...Before you know you are black, you will have experienced what it is to be black...

...The tragedy of retardation at birth is compounded by the mental damage inflicted by the slum environment...

...and we have done those things which we ought not to have done...

...By the end of the second quarter-year of life and through fifteen months of age, their functioning was roughly on a par with white norms...

...that 4,600,000, or 8.5 per cent of the total, were emotionally disturbed...

...An even sharper disparity exists in the frequency of dental care...

...The infant death rate of 111.1 per 1,000 live births, or one out of every nine, in this section is five times greater than the national average, more than four times the average for the city of Boston as a whole and more than fifteen times the average for a nearby affluent suburban community which has only 7.2 infant deaths for every 1,000 births...

...Mental retardation occurs ten times more often in very small premature babies than in those born at full term...

...The report of the large-scale public-opinion survey sponsored by the Blue Cross Association concluded that "over one-third of this nation feels ill-cared-for in its medical needs...

...The tragedy is re-enacted for more than the third and fourth generation promised by a vengeful Lord...

...This has contributed to the dismayingly widening differential in infant mortality between the races...

...Since your parents have had less education, your home fewer books, your community fewer educational opportunities, and your parents less know-how in preparing you for school, your development quotient, which at a year (if you were lucky enough to be born at full birth weight) was indistinguishable from that of your white brother, will have fallen well behind by the time you are three, and still farther behind when you start bravely off to school at five...

...It is futile to treat symptoms and then send the patients back to the same degrading environment which helped produce their illnesses and will do so again...

...They do as they were done to...

...And I stress the word 'dis-ease' to mean just exactly what the word means literally: a lack of ease...

...Department of Health, Education and Welfare figures that more than 25,000 babies could be saved every year if the mortality rate in the ten per cent of the counties in the United States with the lowest incidence of such deaths were to prevail through the nation...

...fifty-eight per cent said they were "lonely and depressed...

...In low-income areas," the report said, "between ten and twenty-five per cent of children suffer from one or more untreated chronic conditions...

...It reads: 'We have left undone those things which we ought to have done...

...The death rate from tuberculosis, which with proper treatment is now generally curable, is more than seven times as high...

...In the South End, Boston's worst slum and the site of three outstanding teaching hospitals with a massive pool of medical talent, health conditions are fully as abysmal as in some of the most abject black poverty pockets in Mississippi...

...The cycle of deprivation starts off with the lack of proper health care during pregnancy...

...Eisenberg, a physician who has frequently voiced his passionate concern for removing the impediments to normal development so prevalent in our society, particularly in the wasteland of the Negro ghetto, also said: "To be conceived black means that you are at risk while still inside the womb meant to shelter you...

...But when inner-city blacks or the Appalachian whites were interviewed, the story was the reverse...

...This has happened because many women whose pregnancies formerly terminated in stillbirths are now able to deliver with some improvement in nutrition and obstetric care, but their infants are still too low in weight to survive...

...Copyright © 1971 by Selig Greenberg...

...Geiger said, "that is tragically precise in describing our national performance with respect to the health of the Negro population...

...Living sick' is the prevailing condition of poverty in America today," the survey report said...

...Once born, malnutrition, infection and inadequate health care exact their price in stunting of ultimate stature and in maldevelopment of the central nervous system...

...Nationally, a black mother's chance of dying from the complications of pregnancy is four to five times greater than a white woman's...

...In several other Boston ghetto areas, infant mortality rates run from double to more than three times the city-wide average...

...By fifty-one to twenty-nine per cent, Negro ghetto dwellers said they felt their health has deteriorated and was worse than that of their parents or grandparents...

...Up to the age of thirteen weeks, these infants scored an average intelligence quotient of 117.5 as against a national norm of 100 for white children...

...Dr...

...Sixty-five per cent of those interviewed in the low-income group described themselves as "worried and nervous...

...In alluding to this, Dr...

...This is just one example of how a gap of only a few blocks but of astronomical social and economic proportions in one of the nation's foremost medical centers may doom many to untimely deaths and others to lives of suffering and anguish...

...For the poor, illness is something that is constantly with them, a seemingly permanent condition...

...Five per cent of the children in this country are born mentally retarded," Dr...

...Just as malnutrition during pregnancy and early infancy can produce permanent stunting of the brain, so the lack of intellectual stimulation leads to stunting of the mind...

...Medical care cannot, of course, be considered apart from the crushing numbness of the ghetto life...

...An infant's brain attains eighty per cent of adult weight by the age of three, when the body weight is only about twenty per cent of that at maturity...

...There is a phrase in the Book of Common Prayer," Dr...

...The Editors There is a slum neighborhood in Boston where infant mortality exceeds the level of the Biblical plague inflicted on ancient Egypt, when every tenth newborn child died...

...Even more critical than infant mortality, in the opinion of many authorities, is the problem of the heavy burden of damaged children, many of them with handicaps which could have been prevented with better prenatal care...

...that 2,830,000, or five per cent, had speech disorders...

...Ninety per cent of the 344 infants in the study group were found to be anemic...