Public health and insurance: American addresses

by Sir Arthur Newsholme

TO THE

RIGHT HONOURABLE JOHN BURNS

A LEADER IN PUBLIC HEALTH;
WHO IN PARTICULAR MADE THE PUBLIC REALISE THE
IMPORTANCE OF CONCENTRATING ON THE
Mother and Her Child

PREFACE

After more than three decades of work in preventive medicine and public health, the opportunity has arisen in connection with a year’s visit to America, to take a panoramic view of public health in England, of the progress which has been secured, of the factors which have impeded progress, and of the pressing desiderata for more efficient future action.

During my stay in America I have had the privilege of addressing public audiences in every part, from New Orleans to Toronto, and from New York and Boston to San Francisco and Seattle; as well as more special audiences at Johns Hopkins University, at Saranac and at Harvard, California, Washington, and Yale Universities; and at the request of many friends some of the addresses given to these audiences are now published in volume form. These addresses briefly outline some of the lessons of long experience, and although the conditions under which they were delivered rendered complete exposition impracticable, there are, I think, advantages in not overloading the presentation for public consideration of a many-sided subject.

It will be noted that the same problem may be mentioned in several addresses, though usually from a different angle. The entire avoidance of repetition would have necessitated the abandonment of the lecture form, and would, I believe, have diminished the utility of the volume. The table of contents and index render cross-reference easy.

Those wishing to ascertain fuller details on most of the problems discussed in the present volume may refer, I think with advantage, to my annual reports as Medical Officer of the Local Government Board, England, and to my four special reports on Maternal and Child Mortality, which also were issued as English Government publications.

British experience is only partially applicable in the United States, the almost complete Home Rule in each State creating a new and interesting problem in efficient national public health administration. Nevertheless a review of events in Great Britain cannot fail to be useful in America, which is faced with similar problems. The main lines of public health administration in Great Britain have proved their value by their success. There has been local independence with a minimum of central control, and the people’s representatives in every area have been made to realize their commercial responsibility. The mistakes made in permitting the multiplication of small and inefficient public health authorities, in allowing official medical work to be divided respectively between different local and central authorities, in sanctioning the creation of ad hoc authorities for special work, in associating state medicine with monetary insurance against sickness, and in not securing that insurance shall directly assist the prevention of sickness, have been largely the mistakes of politicians and of central authorities. These mistakes involve the retracing of steps and the undoing of the mischief resulting from ill-advised action. In view of these conflicting events, the marvellous achievements secured by public health authorities are the more noteworthy.

In every American city visited by me I have been struck with the earnest desire of voluntary and official public health and social workers to profit by English experience, to adopt what is good, to secure the abolition of the short tenure of office of competent officers under the present political system, and to introduce civil service conditions for them. There is in many respects a close parallelism between the course of public health on both sides of the Atlantic; in some cities the English hygienist has much to learn in respect of advanced and original work; and in other American cities in which “political pull” continues, there is evidence of the development of a wider interest and a more general sense of communal responsibility; a deeper trend of thought which will make for steadily increasing efficiency in public health work. As this volume discusses public health problems especially from a social viewpoint, it is my earnest hope that it may be useful in this direction.