Similarly, increased attention to domestic and municipal sanitation and to the provision of a pure and adequate milk supply, the health teaching given by public health nurses, and the prompt medical and hygienic guidance at Child Welfare Centres are having an important influence in the same direction. Work on these medical and sanitary lines, for both adults and children, comes legitimately within the sphere of the work of Public Health Authorities, provided out of rates and taxes.
It may be urged that such provision, after all, means supplementation of the family income at the public expense. It is more properly to be regarded as a measure of insurance against contingencies by which every member of the community is benefited; for we are each and all concerned in the efficiency of every other member of the community. We are members one of another. The objection stated above has no greater validity than an argument similarly advanced against the provision of police protection or of sanitary measures out of public funds.
Elementary, and to some extent secondary and university, education are regarded as not only the legitimate subjects of communal provision, but also as incapable of being provided satisfactorily by each individual family; and this view applies with even greater force to the provision of hospitals and expert medical assistance, of nursing assistance, and of such additional occasional domestic service as is required to maintain the functional integrity of the family.
I have given the above as a special instance of the contention that poverty is a complex, including a number of elements, and that it is our duty to ascertain in each area by careful local inquiry what are these constituent elements, and if practicable their relative weight; and then to apply the most urgently needed remedies, not contenting ourselves with the relatively useless generalisation that the evils we see are ascribable to poverty.
I lay special stress on the provision of skilled medical advice and treatment, and of nursing assistance at the public expense, which at present are sorely deficient for the vast majority of the population, and perhaps for none more so than for the less well-to-do people who receive salaries and not weekly wages. This assistance possesses the special advantage previously pointed out, that it does not tend to create a demand for further assistance, when such assistance is not required.
The greatest bulk of poverty is due directly to sickness. A vast mass of sickness still occurs, which is not owing to lack of family or communal means, but is due to ignorance or neglect on the part of the individual, of the responsible owners of houses, of the employers of work-people, and still more of the members of local authorities or state legislatures. Typhoid fever still commonly prevails as the result of neglected sanitation; hookworm disease still causes incapacity of hundreds of thousands for the same reason; malaria, still one of the greatest scourges of humanity, might be reduced to a fraction of its present amount if each community and each person would carry out available simple preventive measures; tuberculosis is still spread throughout every civilized community chiefly because indiscriminate expectoration is unregulated, and satisfactory and acceptable hospital treatment is not provided for all those who need it. And so we continue to allow avoidable poverty to be perpetuated, and to impose not only on the sick poor themselves, but also on the efficient and solvent part of the community a heavy burden, the removal of which would, to an almost incredible extent, increase the general happiness of mankind.
The relief of poverty is at the best an inefficient and expensive remedy. It is seldom adequate, and it has few preventive elements. The prevention of poverty by prevention of the illness causing it, and by early and satisfactory treatment of such illness as fails to be prevented is the only efficient, as well as in the long run the only economical plan of campaign. Money insurance against sickness has its place as a means of alleviating the results of poverty. But it is not an aid to its prevention; under any existing system of insurance the money payment is insufficient and definitely limited in duration. Although such relief is useful, it is totally unsatisfactory when not linked up with a complete system of hygienic measures, and when not associated with adequate medical treatment and nursing. For the linking of treatment provided largely out of public funds with insurance there is no justification, and it is contrary to the public interest; and it is unfortunate that monetary insurance has been provided in England for a section of the population under these unsatisfactory conditions, thus diverting expenditure from the public health services in which it was urgently needed, and in which its use would at once have been fruitful in increased health and happiness.
FOOTNOTES:
[16] An address to the Political Economy Club, Johns Hopkins University, Jan. 19, 1920.