The Economic Foundations of Ill-Health
Much emphasis has been laid of late years, particularly since the war, on the importance of health education. It is a tragic fact that under the present system it takes a war to reveal the condition of the nation’s health. The Boer War revealed the harm done to the manhood of England by their employment as young children in the factories and mines. Those surviving, whilst fit enough to be alive, were not, curiously enough, sufficiently fit to die for their country. The last great war revealed a high percentage of C3s. Robert Sinclair, in “Metropolitan Man,” states (page 28) : “The position has not substantially changed since the closing year of the war, when the Ministry of National Service compiled a health census of the 2,500,000 young men who then attained their eighteenth birthday. Of this fine flower of the English race, two specimens in every three were unfit.”
Complacency during this war has not been so much disturbed by the prospective fighting men as by the condition of their children. Evacuation of the town populations to the country brought to light some startling facts. Dr. Kenneth Mellanby, quoted in “Our Towns” (page 5), suggests that 50 per cent. of the evacuated children were verminous. Their hostesses were horrified by their condition, but had they become aware of the state of the “homes” from which many had come, their horror would have been better founded.
“The New Survey of London Life and Labour,” quoted in “Our Towns” (page 40), states : “It is the exception rather than rule to have water ready at hand in unlimited quantities. In half the houses investigated water has to be fetched from outside the tenement, often from a tap on the landing, sometimes from across a yard, at others up or down three .flights of stairs; nor is the place for emptying dirty water always where the tap is—it may be yet further away.”
Public health workers, such as health visitors, midwives, school nurses, are expected to be the educators of the working class living in the conditions mentioned above. Under the more passable conditions of some of the working class their advice is welcomed and followed; to those dulled by years of the most brutalising poverty, it fails to register. To the more intelligent among the poorest, however, nothing could be more exasperating. Under hopeless conditions, health talks serve to deepen frustration.
The writer recently attended a lecture on Parentcraft. As he stated his case, the lecturer cited a family of his acquaintance as an example of what parentcraft can do. They appeared to be in the direst poverty, but due to the untiring efforts of the mother, the children had survived. The writer made a reference to “Birth, Poverty and Wealth,” by R. Titmuss, a work showing how descent in the social scale, and the type of work performed by the father, condemned the children to a greater expectation of disease and early death than those of the highest professional groups, and was the greatest factor in the health of the family. The lecturer stated that, whilst he appreciated the effects, he felt that much could be done to ameliorate them by knowledge of parentcraft. What empty hopes! Reminiscent of the boy who, by holding his hand over the hole in the dyke, hoped to stem the flood. Thus do reformers waste their time and energies in trying to alleviate the direct effects of capitalism, instead of striving to abolish the cause.
Health education comprises also a knowledge of food facts. In December, 1937, the Ministry of Health and the British Medical Association worked out budgets in which the amount necessary for food lay between 5s. and 6s. a week per head at the then prevailing prices. Aleck Bourne, commenting on it in “The Health of the Future” (page 81), says : “It may be true that if such a sum were spent by a housewife with a sound practical knowledge of the vitamin and mineral content of the food exposed for sale, she might be able to feed her family without physiologial privation. But this would still not be possible, even though she could buy the food, unless she had been taught how to prepare and cook it, both to preserve the living elements and also to make it palatable and attractive.”
Let us try to imagine the mother of a large family, living, if very fortunate, in a council house; if less fortunate, in a tenement, or even in one room or less, in the worst part of an industrial town. Her vitality is diminished by repeated births and the unending struggles to wash, cook, clean and care for her little ones in surroundings not conducive to the continuance of such activities. Yes, it is very hard to imagine her sitting down and planning the day’s menus in a balanced manner; much easier to imagine her buying fish and chips, bread, marg. and jam, and washing down the mixture with over-sweetened tea as a stimulant. Under such conditions, knowledge, if imparted, could scarcely be made of use. A telling incident is recorded in “Our Towns,” showing how bad housing induces bad eating: “The motives of conduct of poverty are sometimes very far to seek for the well-to-do. An old woman who was bringing up a 10 year old grandson used, when short of money, to give him 2d. to buy two cubes of a proprietary extract. Asked why she did not buy herrings instead, she replied, ‘You see, we’ve only got one room, and the smell of fish frying turns me stomach; and it brings out the mice, and I’m afraid of mice'” (page 41).
Many of these incidents must have occurred within the experience of the average worker, but for a last damning example we will turn to America, that land of the free, and further to South Carolina, that erstwhile home of slavery, where negroes now live under conditions never equalled in the heyday of the “Southern Gentlemen.”
“Look,” an American magazine, in its June 1942 issue, published an article entitled “Parenthood U.S.A., The Story of South Carolina.” It deals with the appalling conditions in Berkeley and Lee counties, which are mainly populated with negroes. “Tucked away in the hot amiable heart of South Carolina are the counties called Berkeley and Lee. Here in two areas, each of 1,200 parched square miles, rural, agricultural, economically impotent, 70 per cent. Negro, exists a public health programme with teeth in it, obstetrical care, infant care and baby spacing are its three main functions. Nowhere in the U.S.A. was there a greater need for such a programme. In 1936, 360 South Carolina mothers died in childbirth; 5,600 infants died in their first year, a higher proportion than in any other state. In 1939, when South Carolina made baby-spacing one of its official public health services, Berkeley County instantly began functioning as an experimental centre. … If the programme works in these impoverished regions, it will work anywhere.”
Graphic descriptions follow. The main diseases rampant include V.D., malaria, rickets, pellegra. Malnutrition is common enough to be almost the rule. The article states in uncompromising terms, “Low incomes mean high infant death rates.” What, then, is the solution to the problem in South Carolina ? The obvious one of raising incomes, or of abolishing the wages system and providing plenty for all? No! what is called baby spacing is alleged to be the panacea for all ills.
Whatever so-called success attends this health drive, it can only constitute a palliative. The malaria may be treated by free quinine, but in such a district, with sanitation almost nil, re-infection will quickly occur. The treatment of syphilis is lengthy, and much of the damage done is irradicable. And the deficiency diseases, what of them ? With smaller families, the wage, such as it is, is divided among fewer mouths. But as the chief occupation is tenant farming in a dry, crop-poor land, reward for hard work is meagre. Many receive what we should term public assistance, and this, we know, maintains life, but not necessarily health. An excellent example this of capitalist reforms; surface scratching, leaving the hard core, the root cause untouched. After all the teaching of parentcraft, birth control and what you will, Berkeley and Lee will remain to their unfortunate inhabitants 2,400 parched square miles where they are compelled to sell their labour power at a bare existence price, or seek some other place. But wherever they go, they will be, whilst working, exploited; if idle, forming part of the industrial reserve army, and, finally, join the scrap heap.
When the worst anomalies are removed, others more subtle become apparent. An excellent exposition of the effects of poverty on the mentality of the school child is given in a work entitled, “A Pen’orth of Chips” by C. S. Regal. This school teacher, working in the Royal Borough of Kensington, found children living in over-crowded surroundings, getting little sleep, and that disturbed, having the well-known diet of bread and marg., getting little fresh air, with a greater preponderance of dullness than those living in less poverty-stricken districts. Dullness is a physical condition that may be inherited, but it may also be acquired. The difference in the stature of the elementary schoolboy and the public schoolboy is well known, but is the difference in the mental stature and its cause so readily appreciated?
It will take more than parentcraft, baby spacing, school meals, etc., to remove the effects of poverty in a world of plenty; it will take a complete change in the social system to bring about production solely for people’s needs, and not in order to make a profit such as obtains to-day. Poverty for the many is inherent in the capitalist system, and we must work for Socialism in order to remove it. By Socialism we do not mean public utility corporations, State control and National Health services, which pass for it with some of our less well informed fellow-workers. By Socialism we mean a system in which all who are able participate in production, and everyone receives what he needs. Only under Socialism can the heart-breaking effects of poverty be removed and all have an opportunity of living the good life as well as enjoying good health.
W. P.