Public health and insurance: American addresses

by Sir Arthur Newsholme

I do not wish to stress this view of the case; but I have said enough to justify the action of the British Government in deciding during the war—and announcing the fact in more than one official circular issued to all Local Authorities by the Local Government Board—that, next to the active pursuance of war, measures for promoting maternal and child welfare ranked next in importance, and that no efforts must be spared to continue and extend such measures. And the history of the last four years shows that this has been done. The central grants for special maternal and child welfare work undertaken by local authorities and voluntary agencies have increased twelve-fold, the number of health visitors has been more than doubled, and the number of maternity and child welfare centres has increased five-fold; and coincident with these facts, infant mortality, which was falling before the war, has continued to decline steadily during the war,—the corrected figures for the years 1912-17 respectively were 104, 117, 113, 111, 98, and 94—although the number of mothers employed away from home has greatly increased during the same period.

The Work of Voluntary Agencies

I have several times in this address mentioned the valuable work of voluntary health agencies. No official can fail to recognize that pioneer work is commonly started by them; and it has often happened that only when the evidence of its value has become obtrusive has it been taken over by local authorities. This is the true function of voluntary agencies, and will remain so, until local authorities (which after all are manned by voluntary workers) become saturated with the ideals of voluntary workers and of the new women-voters. Local authorities always have one great advantage over voluntary societies, that their action can be supported by legal powers.

The proper attitude of voluntary workers is to initiate and demonstrate the value of reforms, to persuade local authorities to adopt them, themselves to become members of these local authorities to ensure this end, and thus eventually render the voluntary organization for the object in question superfluous. There need be no fear; openings for further desirable voluntary work will always appear, as official work increases. In the main, however, the care of the health of the people is a governmental function, whether it has to do with the prevention of sickness or the satisfactory medical treatment and nursing of the sick.

There is no early prospect of voluntary workers becoming unnecessary; for average human nature, as represented on governmental bodies, is shortsighted and needs much education, morally and intellectually, before it will undertake the whole sphere of work called for in the interest of the welfare of the mother and her child. Hence my plea that the magnificent potentialities of the Red Cross organization should not be allowed to fall into abeyance; that they should replace their relief work by preventive work; that, to use a well-known simile, they should erect a parapet at the top of a dangerous cliff as well as provide ambulances at its foot. In so doing they will, I am confident, not encroach on present successful work of existing bodies concerned with promoting child welfare, or with the prevention of tuberculosis or of venereal diseases, or with existing agencies for providing nurses for the poor. But they can supplement the efforts of these organizations; they can bring monetary as well as personal assistance; and they can, above all, bring a mass of public opinion to bear on local and central governing bodies which will lead to the only real economy, which consists in expenditure on an adequate scale, bringing to the aid of the families of the people the preventive, the medical, and the nursing facilities of which they remain in need.

FOOTNOTES:

[13] An address to the Academy of Medicine, Toronto, June 20, 1919.

CHAPTER VI
The Inter-relation of Various Social Efforts[14]

On examining the local city directory, one cannot but be impressed by the multiplicity of voluntary organizations having for their object the immediate relief of destitution or the social or economic “uplift” of sections of the population. The multiplicity of these agencies becomes more striking when one remembers that probably every one of the hundreds of churches and chapels in the city has its periodical sacramental and other collections for the poor, and may have also a system of parochial district visiting, with such auxiliary assistance as is provided through mothers’ meetings, etc. Nor does this exhaust the possibilities of social help available for the poorer members of society in cities in which there is a satisfactory distribution of rich and poor, that is, in which the segregation of different social strata in separate areas has happily not befallen. There is the further help provided by individual charity, the amount of which in the aggregate probably exceeds beneficence through churches and social agencies.

If these different agencies could pool their resources, while retaining the enthusiasm and driving power of separate organization, what an economy of effort and what increase of efficiency would result, especially if these agencies were also satisfactorily related to the official organizations of local and central governing bodies having the same object!