Address, “Human Life as a National Asset”
Mr. Rittenhouse—The National Conservation Congress has been engaged in the noble task of guarding posterity against the waste of our natural resources by the present generation. It has had a most far-reaching influence, for its purposes are in tune with public sentiment, and with the spirit of the age. It has now given another and still more commanding reason for its existence by joining earnestly in the campaign for the conservation of our “human assets.” This is a field of usefulness that will endure for all time. However important the protection of our natural material resources may be, our greatest obligation to posterity is to preserve the health, virility and morality of our race.
The first and most important item in humanity’s Bill of Rights is the right to live.
The primary purpose and function of organized society is to guard the lives of its members from needless destruction. Liberty, education, wealth and other earthly blessings are important—but we must be alive to enjoy them.
The nation with the keenest sense of justice and the highest standard of intelligence and morals—virtues which some of us modestly claim for our people—is the one which should place the highest value upon human life and surround it with the greatest protection.
How would our civilization rank by this method of measurement? What have we already accomplished in preventing life waste? What is our present loss? How can it be reduced?
We may well rejoice over the achievements of the patient heroes of the laboratory and of the unselfish and devoted men of medicine who have provided, disseminated and applied the knowledge of prevention so far as it has gone. To them, to the press, the clergy, and the other good men and women who have helped spread the gospel of disease prevention belong the chief credit for the reduction of the death rate by nearly 25 per cent. in the past thirty years.
To these benefactors of our race is also due the honor of initiating and developing the widespread interest which now prevails throughout our country in the conservation of health and life. They have demonstrated that morbidity and mortality can be reduced—that human life can be prolonged by spreading and applying our present knowledge of the science of disease prevention. At the close of last year we had to the credit of these life savers over 400,000 lives that would have been lost that year if the death rate of 1880 had still prevailed.
If the present thirst for knowledge of health and life conservation continues to increase, it is not only possible, it is reasonably certain that during the next thirty years the present death rate of 15 per 1,000 population in the registered area will be reduced to 10.
While we have every reason to felicitate ourselves upon this wonderful result of the spread of life-saving intelligence, we must not overlook these facts:
1. That this great life-saving movement is still in its infancy.
2. That it has been directed almost wholly against preventable contagious diseases, and that the waste of life from these maladies has only been reduced—the loss is still excessive.
3. That while we have reduced the mortality from these diseases common to infancy and early adult life, the degeneration diseases of middle life and old age, against which we have waged no war, have been steadily increasing.
4. That we have increased the average length of human life only by increasing the proportion of people living in the younger age periods, while the average duration of life of those who pass into middle life and old age has been constantly shortened.
In other words, we are still furiously burning the candle at both ends—slower at one but faster at the other.
It is important that this point should be clearly understood. It is natural to conclude at first glance that if we are saving these lives of the younger age period that naturally there are more older people to die, but that does not follow. In the first place, we are dealing with a death rate, the death rate for 1,000 population not in the bulk, and while it is true that the passing of these lives over into the older age period does affect that rate, it only affects it slightly. It has been asserted also that the lives saved from these communicable diseases have been weakened and that they die early after passing into middle life. It is also true that that does not explain the extraordinary increase in the death rate in the older age period. In England and Wales they have the same reduction in the death rate of communicable diseases common to the earlier age period, but not any increase above forty.
With all its blessings modern civilization has introduced hazards, habits and conditions of life which may not only invite, but which have increased in many ways, physical, mental and moral degeneracy.
What excuse have we Americans to offer for the excessive waste of human efficiency and human life from which the Nation is now suffering?
Surely we can not plead ignorance nor poverty, for we have both the knowledge and the money wherewith to stop this annual sacrifice.
How can we explain our growing contempt for the value and sacredness of human life? There is no other civilized country where this greatest of all assets—the most precious gift of the Almighty,—is held so cheaply as in this glorious land of ours.
And why do we continue to view with indifference the constantly multiplying evidences of the mental and physical degeneracy of our race?
We may agree that in the long run the trend of humanity is ever upward, and that this is but a temporary reaction, but can we afford to rest wholly upon the hope that race deterioration will automatically cease when our people have had time to adjust themselves to modern conditions? Wise men doubt it. This problem will not solve itself; this adverse tendency will be checked only when our people are made to see conditions as they actually exist, and are aroused to the need of correcting them.
This is our task. Let us briefly survey it.
In order to measure the effectiveness of the Nation’s life Conservation work, and the magnitude of the task remaining undone, we must now compare our efforts not with those of the past, nor with those of other communities or countries, but with our present loss from preventable and postponable sickness and mortality.
What are the principal items of life waste?
What evidence have we of degenerate tendencies? Here are some of them—the estimates are from competent sources and are based upon official records.
AN INDICTMENT.
Our birth rate is steadily declining, and at the same time the span of life is steadily shortening.
Twenty-seven per cent. of our annual deaths are of babies under age 5; 200,000 of them die from preventable disease; about 150,000 of these are under age 1.
To offset this waste of life, large families are demanded. Would it not be well to stop this needless destruction of infants before asking for an increase in the supply?
Of the 20,000,000 school children in this country not less than 75 per cent. need attention for physical defects which are prejudicial to health.
Insanity and idiocy are increasing.
Diseases of vice, the most insidious enemy of this and future generations, are spreading rapidly according to medical men. So far we have lacked the moral courage to openly recognize and fight this scourge.
The alcohol and drug habits are constantly adding new victims to the degenerate list and to the death roll.
Suicides are increasing and now reach the enormous total of about 15,000 annually.
Lynchings and burnings-at-the-stake continue, and are common only to our country.
Attempts upon human life by individuals and mobs under trifling provocation, or none at all, are obviously increasing.
Over 9,000 murders are committed every year, and it is estimated that but an average of 116 murderers are executed for these crimes. We have the appalling estimated homicide record of over 100 per million population as against 7 in Canada, 9 in Great Britain and 15 in Italy.
In the United States the death rate above age 40 has increased steadily for years (about 27 per cent. since 1880), while it has remained virtually stationary in England and Wales.
The important organs of the body are wearing out too soon—the diseases of old age are reaching down into the younger age periods.
The death rate from the degenerate diseases of the heart, blood vessels and kidneys, including apoplexy, has increased over 100 per cent. since 1880. These diseases claim over 350,000 lives annually.
The doctors tell us that fully 60 per cent. of these deaths are preventable or postponable if the disease is discovered in time.
Periodical health examinations would detect these chronic diseases in time to check or cure them, but aside from the efforts of the Equitable Life Assurance Society and another smaller company, no public campaign to educate our people to this vital need is being carried on.
All of our money, all of our energy, seem to be directed against diseases that can be communicated. Is not a life lost from Bright’s disease as valuable as one lost by typhoid fever?
The annual loss from pneumonia aggregates 135,000 lives, a large portion of which is due to weakened bodily resistance resulting from these degenerative affections.
Cancer, a baffling disease to which our people in their present physical condition are highly susceptible, claims 75,000 lives annually and is increasing very fast. Deaths from external cancer alone have increased 52 per cent. in ten years.
Pellagra, a deadly plague new to this country, is increasing rapidly in some of our Southern States, and it excites but slight public concern.
Over 150,000 Americans are destroyed annually by tuberculosis. We know how to prevent it, but our taxpayers object to the expense and leave the battle almost wholly to charity.
Nearly a million afflicted people are spreading the poison of tuberculosis to the well, with virtually no official restraint or supervision because of the expense.
Over 25,000 Americans are still sacrificed annually to the preventable filth disease—typhoid fever. About 300,000 suffer from it and are more or less impaired by it.
Other germ diseases are wasting more lives than typhoid and tuberculosis combined. We are warring against them, but compared to the lives still being lost our efforts are feeble and only partially effective.
Over 90,000 Americans are killed annually by accidents and various forms of violence. Our efforts to prevent the steady increase of this waste have failed.
The annual economic loss due to preventable disease and death is conservatively estimated at $1,500,000,000, and our life loss at about $250,000,000.
To prevent fire waste our cities spend through the public service approximately $1.65 per capita, and to prevent life waste, 33 cents per capita.
It is estimated that 1,500,000 of our people are constantly suffering from preventable disease, and that during the next ten years American lives equaling the population of the Pacific Coast and Rocky Mountain States (about 6,000,000) will be needlessly destroyed if the present estimated mortality from preventable and postponable disease continues.
These are the conditions we are asking our people to correct. Is there anything unreasonable in the request?
The money loss is stupendous, but if this does not impress our people, surely they should be stirred to action when they reflect upon the immeasurable sum of sorrow, suffering, poverty, immorality, crime and the hereditary degeneracy which results from this wholesale wrecking and destruction of human life from preventable cause.
RACE SUICIDE.
We are not only reducing the fertility of our race and also shortening the span of life, but we are permitting at least 650,000 lives to be destroyed annually which we could save by the application of simple and well-known precautions.
This is the real race suicide problem.
If we would save these lives, they together with their natural offspring would solve the problem of maintaining an adequate surplus of births over deaths. What we need is not necessarily larger families, but more families. A larger number of small families is surely preferable to a smaller number of large families.
THE DOLLAR AND THE DEATH RATE.
The primary duty of conserving our human assets resting with the State, it is obvious that the State must lead in the national movement. It is, therefore, the first duty of every individual and of every unofficial organization interested in this efficiency and life-saving campaign to rally to the support of the public health service.
We must not only teach the individual how to guard his life against preventable disease and accident, we must educate our communities to the need of an effective public health service to enforce sanitary regulations and otherwise guard the health and lives of their members.
But it takes money to carry on a great educational movement, and it takes money to conduct the public health service.
The war against preventable disease and death is therefore in the final analysis, a struggle between the dollar and the death rate.
So far the dollar is ahead. The body politic seems still to prefer a high death rate to a slight and temporary increase in the tax rate.
“How much,” says the American taxpayer, “will it cost to reduce this annoying death rate to the lowest possible limit?”
“About $1.50 per capita at first, much less later on,” answers the health officer, “and you will gain immeasurably by the increase in the wealth and happiness of the community.”
“Very well,” says the taxpayer, “here is 25 cents; we will save two bits’ worth of these lives. The rest will have to die. We have much more important places for our money; we must improve the streets and roads, beautify our cities with much needed parks and public structures. We must improve our harbors and rivers, build canals, and encourage commerce generally. Besides, we are absolutely obliged to use about two and a half billion dollars this year for automobiles, jewelry, candy, alcoholic drinks, tobacco, diamonds and other similar urgent needs of life. What is the loss of a few hundred thousand lives compared to these vital necessities?”
And so the health officer plods along with his two-bit appropriation and naturally runs a two-bit health service. His own fitness and efficiency may be 100 per cent., but the effectiveness of his department only 15 per cent. because of the 25-cent limit.
TRIFLING WITH A SOLEMN DUTY.
National Government.—Of all the money provided by the people for the expenses of the National Government only about 1.3 per cent. is used for the conservation of health and life.
Our national health corps has an international reputation for efficiency and achievement. Although the service is under-manned and its personnel underpaid, the patriotism and high sense of duty of these able and energetic men have spurred them to the performance of the very highest service to their country and to humanity. They have not only jeopardized their lives, but numbers of them have sacrificed health and life in the performance of duty.
Through their discoveries in the science of prevention, they have been the means of saving thousands of lives, not only for one year but for all years to come. They have won the admiration of the American people and deserve their most hearty support.
And yet, when it is proposed to co-ordinate the various public health activities of the Government in order to increase the efficiency and usefulness of this splendid body of men, the interest of our countrymen in this service seems to end with admiration. For notwithstanding our confidence and appreciation we have permitted a small but active body of people who are more concerned in treating disease than in preventing it to block the consummation of this thoroughly sensible and business-like consolidation of the various bureaus under one responsible head.
We have many educational agencies at work throughout the country which are directly or indirectly arousing public interest in health conservation, but this experience emphasizes the need for a permanent central organization to stimulate interested people to back up their judgment with action, and no organization is better fitted to render this invaluable service than this National Conservation Congress.
At the last session of this Congress Dr. Harvey Wiley told you something about the dangers of impure food, drink and drugs, and what was being done to guard the public against them. Your individual interest was excited. How long did it continue? Were any of you inspired to give actual support and assistance in the enforcement of the pure food laws or to any other official public health activity? To be interested and to agree is not enough—again, we must act, individually as well as collectively, and stimulate others to act.
States.—The same lack of practical support of the public life-saving service exists in most of the States. The appropriations for the public health work of our State departments can only be characterized as trifling. The exception is Pennsylvania, which is paving the way for a fully adequate health service, as was explained to you at the third session of this Congress in the able paper of Mr. A. B. Farquhar.
The appropriation for the Pennsylvania State Health Department is about 48 cents per capita. Arkansas makes none at all, the State of New York spends about 1.7 cents; Massachusetts, 4.2; Florida, 10; Indiana, 1.8; Kansas, 2.7; Virginia, 1.9, and so on.
Municipalities.—We have many cities with active and efficient health officers, but there is not a city in this country with an adequately equipped and financed health department. Not one of them has sufficient financial support to successfully perform its task, which must be measured by the preventable sick and death list in each community. And we must not confine this list to contagious affections. It must include an educational campaign against all preventable diseases.
The duty of the State to teach our people, through the health departments, how to avoid preventable disease of all kinds that they may live healthful and productive lives, is just as imperative as is the duty of teaching them, through our schools, how to avoid illiteracy and how to live intelligent and useful lives.
While health appropriations have increased over former years, all of our cities place the value of property far above that of human life in applying measures to prevent waste. Here are a few examples:
In 1911, fifty of our important American cities, with an annual preventable death list of 117,724 people (which means an economic loss of at least $200,000,000) spent through their public service to prevent life waste, an average of 30 cents per capita, and through their fire departments to prevent fire waste, $1.63 per capita.
Here are a few examples: Providence, R. I., spent for health conservation, 11 cents; for fire prevention, $1.99 per capita; Portland, Ore., health, 13 cents; fire, $1.91; Minneapolis, health, 14 cents; fire, $1.67; Louisville, health, 12 cents; fire, $1.36.
In 1910, 184 American cities could spare but two per cent. of their total public appropriations for the public health service. The average for all expenses was $16.54 per capita. Of this but 33 cents was for the public health. Seventy-one of these 184 cities spent less than 15 cents per capita for the public health, and among these are such cities as Quincy, Ill., 2 cents; Lansing, Mich., 5 cents; Rockford, Ill., 6 cents; Scranton, Pa., 7 cents; Bridgeport, Conn., 9 cents; Portland, Ore., 10 cents; Harrisburg, Pa., 12 cents; Jersey City, N. J., 13 cents; Springfield, Ill., 14 cents.
There are many of our largest cities that are well below the average of 33 cents per capita. Among them: Toledo, 15 cents; St. Paul, 17 cents; Minneapolis, 18 cents; Indianapolis, 20 cents; Kansas City, Mo., 20 cents; Milwaukee, 20 cents; Cincinnati, 21 cents; Chicago, 22 cents; St. Louis, Mo., 26 cents; Buffalo, 27 cents; San Francisco, 28 cents.
The natural result of this sort of economy is that the health laws we have are not properly enforced.
How can we benefit from the pure food laws, for example, while we refuse to provide the means of enforcing them?
The great city of New York has an ably administered health department, but it has only thirty inspectors to supervise over 27,000 food dispensing establishments. The request of the health officer for an inspection force of 209 men has been steadily ignored for years.
How do you suppose the meat ordinances of Philadelphia are enforced where the people allow the health department but seven inspectors to watch over 8,000 meat shops and slaughter houses?
How can the eight pure food inspectors in Kansas be expected to enforce the pure food laws in the drug and grocery stores, the meat shops, bakeries, etc., in 800 towns? These inspections must be made frequently to be of any value.
These are not exceptions, they are examples.
Could anything be more absurd from a business point of view than this record of “economy” in providing for the public life-saving service?
HOW SOME COMMUNITIES SAVE MONEY.
Some prosperous American communities hold human life so cheaply that they maintain no public health service at all. Others—and there are many of them—have a mere skeleton service. The citizens imagine that if they appoint a health board consisting of doctors, all will be well with them. The suggestion that the board be provided with money to carry on its functions would be regarded as wanton extravagance.
There are scores of cities and towns which select a doctor to head the health department and expect him to earn his living by practicing his profession among the very people over whom he is supposed to exercise police authority in enforcing sanitary and other health regulations.
There are cities of from 5,000 to 100,000 population that hire a doctor on the “part time” plan as chief health officer, and pay him a trifling salary. Whether he is a competent sanitarian or in any way skilled in the prevention of disease is a matter of little concern to them. The fact that they are saving a few dollars in his salary fills them with joy and indifference as to the consequences to the community.
I know of a thriving, wealthy young city in the South of 130,000 population with a substantial preventable death rate which saves as much as $800 annually in this way.
I know of a prosperous New England city of 40,000 population with but three people in its health department—two of them are “part time” employes. It is a six cents per capita department and 50 per cent. of the annual deaths in that city are of children under five years of age.
In theory, we must all stand ready to serve the State when called upon, even at personal loss. But does it not seem the height of absurdity to expect a competent professional man to leave his practice to take charge of these under-manned and under-financed health departments at the small salaries which our States and cities offer them? If he does his duty, he is sure to make enemies during his term of service, and if he is an able man he will certainly lose money by leaving his practice.
Surely we offer our health officers every inducement to follow the line of least resistance.
A SAMPLE GROUP OF CITIES.
An investigation was recently made of forty-four Illinois cities averaging in population about 16,000; fifteen of them had over 20,000 population, and three had over 50,000.
The average salaries paid the chief health officer amounted to the magnificent sum of $300 annually.
Twelve of these cities paid nothing for health protection—and this included three cities of 22,000 population and one of 30,000 population.
One city of 26,000 population employed a layman as a health officer.
In one of 22,000 the police matron served as “health officer” when she was not otherwise engaged.
Twenty-nine of these cities made no pretense of supervising their milk supply.
Only nine of them had isolation hospitals for contagious diseases.
Thirty-one of them kept no mortuary records whatever.
These conditions exist in a prosperous agricultural and manufacturing State—and they can doubtless be found to exist in almost any State in the Union.
AGENCIES THAT CAN HELP.
These are unpleasant facts, but they give us an idea of the way we are performing the primary function of government—the guarding of human life against avoidable destruction.
We have now briefly considered the extent of the waste of the most vital asset of the nation, and how we are conserving it, or rather how we are not conserving it.
Now let us rejoice over the fact that we not only know how to reduce this waste, but that thanks to those who have aroused the life conservation sentiment in this country, a general improvement in the public health service is taking place in many States and cities. The experiment has been successful. We now know what we can do. We have the wealth and knowledge, and the machinery is organized throughout the country to rapidly correct our appalling record of life waste. Our work is to induce our people to use it.
Every business and social organization should do its full share of this work.
The life insurance institutions of this country have a constituency of 25,000,000 policyholders. These policyholders are directly interested in the promotion of longevity, not only from the humanitarian but from the financial viewpoint; for the lower the mortality among policyholders, the greater will be the saving and the larger the dividends to policyholders, which means a reduction in the cost of their life insurance. It is estimated that about $50,000,000 is lost annually by postponable mortality among the insured.
The Equitable Life Assurance Society, with which I have the honor to be connected, is endeavoring to do its part not only in conserving the lives of its policyholders, but in stimulating community action. The Metropolitan Life Insurance Company of New York is also rendering a valuable public service in Conservation along somewhat different lines. Two or three of the small companies, and perhaps the same number of fraternal insurance societies, have also given it attention. Let us hope that the time is near at hand when the other two hundred-odd life insurance companies, and the fraternal societies as well, will also increase their usefulness to their policyholders and the public by joining in this great work.
SOME SUGGESTIONS.
This Congress will be asked to do and to advocate many things, for there are a multitude of independent activities connected directly or indirectly with this general subject. Among others I sincerely trust the following suggestions will be duly considered:
1. To encourage business institutions, civic, social and religious organizations which have influence over any considerable number of people to join in at least some of the many phases of the life conservation campaign.
2. To encourage the education of the individual to adopt healthful habits of life—to avoid the intemperate life, which means excess in eating, drinking, working, playing—and unhealthful indulgence in indolence as well.
3. To encourage communities to establish and maintain ample public health organizations consistent with the magnitude of the work in hand.
4. To advocate the organization of local health leagues as a stimulus to public interest and to give aid and support to the public health service.
5. To encourage the slowly growing sentiment for a rigid supervision (and isolation if necessary) of tubercular victims, which is the only way in which this devastating plague can be stamped out.
6. To advocate the employment of civic nurses in the health service, who may also act as health inspectors and aid in educational work.
7. To advocate the issuance and distribution by the States or municipalities of an official prevention manual to teach the public how to avoid preventable disease.
8. To urge every individual to go to his or her doctor for periodical health inspections to detect disease in time to arrest or cure it.
9. To urge employers of labor to give their employes these examinations free as a part of their efficiency and welfare program.
10. To encourage philanthropy, now so generously contributing for the care of the sick, to also enter the field of disease prevention which it has so far quite generally neglected.
Human life is our paramount asset. Its conservation should be your paramount issue.
President White—The audience is certainly indebted for this great and interesting paper. It is hard to get over stubborn facts and figures, especially where figures are facts.
A great doctor once shocked the people of the country by saying that everybody should be chloroformed when they arrived at the age of sixty. From this paper it would seem we ought at least to reach the age of sixty, the age of being chloroformed, and, better still, we had better so conduct the board of health and so support liberally the board of health in our city that people may just begin to live when they get to be sixty.
I now have the pleasure of introducing Prof. Irving Fisher, of Yale University, who has given this subject many years of study and research and will now speak to you upon the “Public Health Movement.” (Applause.)