Public health and insurance: American addresses

by Sir Arthur Newsholme

The onlooker, then, has his duty to perform as well as the administrator. He cannot do his duty unless he intelligently studies local administration, even though he takes no part in it. A chief need is this interested study of the phases of local administration by the general inhabitants of each district. Happily there are indications of the increasing local patriotism which such study implies. The exact knowledge thus acquired is the best means of neutralising much of the ill-natured, because ill-informed, criticism with which the founts of local administration are too often fouled. A high moral ideal on the part of onlookers as well as of administrators is needed if we are to secure that high standard of social efficiency which is an indispensable condition of the further triumphs of preventive medicine now waiting to be secured.

Ideals

In my discussion of the difficulties of health progress, I have evidently encroached here and there on the second division of my lay sermon. Let me now attempt to state more systematically some ideals of health and means for their realisation.

Intelligent human society, permeated more than we realise by the essentials of Christianity, has already gone far in securing remedies, notwithstanding the too frequent other-worldliness or lack of vision of those who should have been foremost in rebuilding Jerusalem in this green and pleasant land. Industrialism no sooner huddled together labourers and their families in the courts and alleys of insanitary towns and overworked them for scanty wages, than the voices of such philanthropists as Percival, Oastler, Shaftesbury, Owen, and of many others were heard in favour of interference with that freedom (!) of contract between workers and employers, which the professors of the dismal science regarded as a fundamental principle in political economy. And so gradually, too slowly, regulated industry, improved sanitation, better housing, the isolation and hospitalisation of infectious cases, the readier access than in rural districts of all sick to skilled treatment, higher wages, better food began to counteract the evils of industrialism and urbanization. Communal action was taken in the regulation of industry, in the promotion of sanitation, in providing elementary education; and the result is seen in the remarkable fact that, notwithstanding its enormous handicap, urban life has become almost as safe as rural life, so far as life itself is concerned, though not in standard of health.

The first lesson, then, which has already been partially learnt, is that no member of a community can live to himself. We now believe in the solidarity of society; that the sores of one section of it means peril for all. And we are gradually learning to appreciate that this is true not only in respect of the acute infectious diseases, and of chronic infectious diseases, such as tuberculosis and syphilis, but of every disease and of every other factor in life which causes individual inefficiency, and which consequently inflicts additional burdens on the competent section of the community. I do not wish to underestimate the basic self-centredness, if not actual selfishness, which, to a varying extent, is part of the nature of all of us; but in industrial, as in other social problems, whatever may be the intermediate turmoil and misunderstandings and disturbance which appear to loom so threateningly, it is plain that the mere cash nexus of relationship is becoming more and more entangled in a moral nexus; and that a prophet’s vision is scarcely needed to forecast a future of consolidation and conformity of efforts of employers and employed such as has never yet been generally realised. In such a consolidation the idea of servitude will disappear, and mutual service will take its place. This will happen by the growth of an idealistic standpoint; even more, perhaps through motives of community self-defence.

Secondly, the Great War, though the most terrible calamity to humanity of the ages, has brought out a most comforting and elevating thought. Our brothers and our sons,—and our daughters also in a multitude of munition and other works,—have proved that, under the overwhelming moral compulsion of national need, they are willing and ready to lay down their lives for great impersonal things, and in their hundreds of thousands they have done so. Coincidently with this, a great impetus has been given to work for the health and welfare of the civilian population, and especially of mothers and their children. The removable horrors and losses of peace, in the aggregate, are greater than those of war. Cannot an equal spirit of sacrifice be induced against these? Is it not possible to evoke a like devotion to secure the triumph of good over evil, of clean administration over political pull, of fair dealing over industrial exploitation, of adequate output over “slacking,” of determination to spend and be spent to secure the welfare of all, in peace as in war?

Thirdly, prior to the war, for years, many among us had been realising to an increasing extent the supreme importance of the Mother and the Child, in safeguarding family life, and in securing the beginnings of personal and national health. In past years medical officers of health have been busily occupied in struggling to overcome epidemic diseases, and in attacking the circumstances favouring their prevalence. But for twenty years, at least, the outlook has widened; the physiological as well as the pathological aspects of hygiene have received attention; and it has been realised, more and more, that in the conservation and upbuilding of the health of the infant and the pre-school child rests the chief hope of the future; and somewhat more recently, public health policy has directed itself to the protection of motherhood, on which depends essentially the welfare of the child.

This can only be done by ensuring, chiefly through its mother, for every newcomer on the stage of life, in all essential points, a footing of equality of opportunity, physical, mental, and moral, with all others.

The ideal that every child should have equality of opportunity is really part of a general upward movement in our national ethical life.

The thoughts of men are widened with the process of the suns.