First group continued 111-11640-D-General agents of War Shipping Administration (east coast) and National Maritime Union, CIO. The companies which are in cluded are-Continued. North Atlantic & Gulf Steamship Co., Inc. Parry Navigation Co., Inc. Polarus Steamship Co. Standard Fruit & Steamship Co. Stockard Steamship Corp. Sword Line, Inc. United Fruit Co. United States Lines Co. West India Steamship Co. Mystic Steamship Division. Eastern Gas & Fuel Associates. A. L. Burbank & Co., Ltd. Cosmopolitan Shipping Co., Inc. Dichmann, Wright & Pugh, Inc. Merchants & Miners Transportation Co. R. A. Nicol & Co., Inc. Norton-Lilly Management Corp. Prudential Steamship Corp. T. J. Stevenson & Co., Inc. 111-15916-D-Pacific American Shipowners Association and Marine Cooks' and Stewards Association, CIO. 111-16461-D-Pacific American Shipowners Association and Marine Firemen, Oilers, Watertenders, and Wipers Association, Inc. 111-11488-D-Waterman Steamship Corp. and Seafarers International Union, AFL. 111-11489-D-South Atlantic Steamship Line and Seafarers International Union, AFL. 111-11490-D-Mississippi Shipping Co. and Seafarers International Union, AFL. 111-11491-D-Smith & Johnson and Seafarers International Union, AFL. 111-11492-D-American Range-Liberty Lines and Seafarers International Union, AFL. 111-11493-D-Overlakes Freight Corp. and Seafarers International Union, AFL. · 111-11494-D-Eastern Steamship Lines and Seafarers International Union, AFL. 111-11495-D-Alcoa Steamship Co. and Seafarers International Union, AFL. 111-11496-D-Seas Shipping Co. and Seafarers International Union, AFL. 111-11497-D-A. H. Bull Steamship Co.; Baltimore Insular Line and Seafarers International Union, AFL. Second group 111-11428-D-Pacific American Shipowners Association and Sailors Union of Pacific AFL. 111-4649-D-General Agents of War Shipping Administration (east coast) and Masters, Mates and Pilots, AFL, and Marine Engineers Beneficial Association, CIO. 111-4932-D and 111-1360-D-General Agents of War Shipping Administration (west coast) and Masters, Mates and Pilots, and Marine Engineers Beneficial Association, CIO. EXHIBIT 5 STATEMENT OF SURG. GEN. THOMAS PARRAN, UNITED STATES PUBLIC HEALTH SERV- Public Health Service with respect to the relationship between income and health. I have not been advised by the Bureau of the Budget as to whether S. 1349 is considered to be in conformity with the program of the President. In your letter, you suggested that I discuss the following points: 1. Effect of low income on health and the purchase of medical services. 2. Relationship of income level to health, as revealed by selective-service re jection rates in the various States, if possible, by industries and States. The data available from the Selective Service System do not provide sufficient pertinent information on the relation of rejection rates to income level. There fore, I shall confine my comments to health and economic status in the general population. The Public Health Service has had long experience in the study of illness in relation to social and economic conditions. We have been impressed with the difficulty of separating from the many factors associated with individual and public health those principally responsible for excessive burdens of illness and premature death. Nevertheless, every statistical study of sickness, made by the Public Health Service and many other agencies, has told the same story: Families of low income have the most illness, and they receive the least medical care. Poverty is both a result and a cause of ill health. Low income and sickness result in a descending spiral of deeper poverty and greater suffering. Although the primary functions of health authorities are to prevent disease and to secure for the people better medical care, we cannot but be impressed with the difficulties in reaching these goals among families whose incomes are too low to provide a sanitary environment, a healthful diet, decent homes, and medical care. I know of no single step which would do more to improve health and nutrition than the assurance to every family of an income adequate for the provision of the minimum essentials of healthful living. Therefore, insofar as S. 1349-if enacted into law-would contribute to a higher standard of individual and community living, its provisions must be considered as contributory to national health. Ill health and poor nutrition always have been close and constant companions of poverty. As early as 1916-17, the late Edgar Sydenstricker, of the Public Health Service, pioneered in the study of social and economic aspects of illness. As a coworker of Joseph Goldberger, he showed that low-income families in southern cotton-mill towns had the highest pellagra rates-and the poorest diets. There followed in the Public Health Service the studies of illness in Hagerstown, Md.-a project that has continued for more than 20 years. The Service also participated in the surveys and analyses of data conducted by the Committee on the Costs of Medical Care. In 1933 we undertook, a study of the effects of economic depression upon health. And in 1935-36 we conducted the largest study of illness and receipt of medical care ever made the National Health Survey. From the data collected in this study, the experience of over 700,000 urban families in 18 States has been analyzed. Significant differences in the amount and duration of illness among the various income groups were revealed by all of these surveys. NATIONAL HEALTH FINDINGS Some of the results of the National Health Survey may be of interest to the committee. In general, these findings show that families with annual incomes of $1,000 or less-whether on relief or not-had nearly 40 percent more total illness than did families with incomes of $2,000 or more; and they had 75 percent more chronic illness. Chronic disability prevents some workers of all income groups from earning a living or even seeking work. Among low-income families the proportion of unemployable workers was three and a half times greater than that among families with incomes of $2,000 or over. Here, again, the vicious circle of poverty and ill health is demonstrated. Illness among the poor is of longer duration than among more fortunate groups. On the average, persons with annual incomes under $1,000 in 1935-36 lost nearly twice as much time from work because of illness as did the average individual in the higher-income groups. Most of the diseases with a large excess of disability in the lower-income brackets are chronic ailments. For example, the time-loss due to hernia in families with annual incomes under $1,000 is more than four times that in the $3,000 income group. Even such diverse conditions as varicose veins, diabetes, blindness, and deafness show disability rates from two to four times higher in the low-income group than in the highest-income group. Acute conditions also-accidents, pneumonia, and other respiratory diseasesshow considerable excesses in the low-income brackets over the rates for the highest-income level. For example, the home accident rate among the poorest families studied in the National Health Survey was nearly 40 percent higher than in families with incomes of $2,000 and over. Presumably housing conditions among the poorest are responsible for some of the excess. TUBERCULOSIS AND PNEUMONIA From the beginning of our modern knowledge of the disease, tuberculosis has been recognized as primarily a disease of the poor. As a cause of death it has been reduced nationally during the present century from first to seventh place; but when we look behind the national average, we find that tuberculosis mortality is much higher in low-income groups. In 1930 it was found that the death rate from tuberculosis among unskilled laborers was seven times that of professional men. In 1943 the tuberculosis death rate among Negroes-who are predominantly in the lowest-income groups-was three and a half times that among whites of all income groups. The National Health Survey also revealed that tuberculosis caused four times as much disability among families with annual incomes under $1,000 as among those with $3,000 or more. Among families on relief, the excess was nearly nine times. Pneumonia also is an important cause of death; death rates from this cause have been reduced dramatically since 1937, when treatment with sulfa drugs was introduced. However, there probably has been no change in the proportionate rates among various income groups. Earlier studies show that the pneumonia death rate among unskilled workers was three and a half times that among professional people; and that time loss due to pneumonia was 20 percent higher in lowest-income groups than in the upper brackets. Even a 20-percent excess of disability from this cause is significant, since doubtless it reflects the results of poor environment and inability to obtain prompt medical attention. MATERNAL AND INFANT MORTALITY Studies extending back as far as 1910 have emphasized the coexistence of high infant mortality with loss income. In 1928, for example, the United States Children's Bureau showed that infants of fathers whose earnings were less than $450 a year died at more than 10 times the rate of those whose fathers earned $1,250 or more. Studies made in Cleveland, Ohio, from 1920 to 1937 reveal interesting facts. In the last year (1937), the infant mortality rate in the lowest economic groups was 50 percent higher than that in the highest levels. In Denver, Colo., in 1931, 16 in every 100 infants born in families with annual incomes of less than $500 died during the first year of life, as compared with 3 infant deaths per 100 live births among Denver families with incomes of $3,000 or more. Infant deaths tend to be higher in the low-income States than in the more fortunate areas. In 1940 the six States with the highest infantry mortality rates were New Mexico, Arizona, South Carolina, Louisiana, Texas, and Alabama— all in the lower half of the States ranked according to per capita income. The deaths of mothers in the child-bearing process also show a relationship with per capita income of States. In 1940 the rate for the country as a whole was 3.8 maternal deaths per 1,000 live births. Of the 15 States with rates above 4.5 per 1,000, were low-income States except Delaware and Nevada. RECEIPT OF MEDICAL CARE In the National Health Survey, it was found that the proportion of illnesses without medical care was about twice as high in the low as in the upper income groups. This was true in cities of all sizes, although the proportion of unattended illness was greater among all income groups under $3,000 in the small cities of 25,000 population or less. A smaller proportion of the cases among poor families received hospital care than among the higher-income groups. Poor patients remained longer in the hospital than did the more fortunate ones. This fact indicates that conditions were allowed to become more critical among the poverty-stricken before medical attention was sought. Private-duty nursing is almost unknown among the sick poor. Less than 3 percent of the cases were attended by a private nurse, as compared with over 16 percent in families with incomes of $5,000 and over. On the average, the few poor patients who were attended by a nurse received about half as many days of nursing care as did those in the upper income brackets. Families of low income who were not on relief in the survey year received less attention from visting nurses than did families on relief. Only 6 percent of the illnesses among families with income of less than $2,000 received visiting-nurse care, as compared with 12 percent among relief families. This fact reflects the relationship between the adequacy of community provisions for personal health service more than it indicates the relation of individual income to health. At the time of the survey, relief loads were heavy, and understaffed services were unable to meet more than their limited statutory obligations. In 1935-36 families with annual incomes of less than $1,000 spent, on the average, less than $50 a year for their sickness costs; that is, 5 percent or less of income. These figures compare with an average annual expenditure of $900 among the richest families, or about 2 percent of income. INCOME AND HEALTH FACILITIES BY STATES Studies made during the war show the ratio of physicians to population in the several States, grouped according to per capita income. With few variations, the States in the lowest income brackets have the larges populations per active private physician. The average physician in such States as Louisiana, Tennessee, Georgia, and Arkansas, served well over 1,000 persons in 1942, before the withdrawal of physicians by the armed forces had reached the peak. In North Carolina, New Mexico, South Carolina, Mississippi, and Alabama (also low income States) the ratio was over the critical line of 1 doctor per 1,500 persons. Since 1942, the situation has grown more serious in all these States where the ratios are 1 physician per 2,000 to 3,000 population. Where physicians are concentrated, there also are concentrated dentists, nurses, and general hospital beds. The physician-poor States are also poor in other services and facilities essential to health. Congress has recognized the inequality of health services in the underprivileged areas of the country and with foresight and wisdom, has enacted certain health legislation which reduces partially these inequities of opportunity. In the health provisions of the Social Security Act (now the Public Health Service Act), the Venereal Disease Control Act of 1938, and legislation on tuberculosis control, Congress has authorized the Public Health Service to weigh grants-in-aid in favor of those States having low income and those having proportionately more severe health problems. In carrying out the intent of Congress, the Public Health Service has found a close correlation between financial need and extent of health problems among the States. Those States which have received excess allotments on account of low income have also received excess allotment for their intensified health problems. From whatever standpoint one considers the health problems of the Nation, the conclusion is inescapable that in the creation of a healthy and educated citizenry or in the failure to do so-economic factors are extremely important, if indeed not determining. Improvement in the economic status of the poorer families in this Nation, therefore, contributes also to the health status of the Nation. Higher wages in themselves, however, will not solve the problems of individual and public health. A national policy for a minimum wage is contributory to health, as also are national policies for healthful housing, for improved nutrition, for social insurance. But even these do not of themselves constitute a national health program. They must be accompanied by planned advances in the provision of complete medical and health care to all of the people in all parts of the country. EXHIBIT 6 STATEMENT OF J. W. STUDEBAKER, COMMISSIONER, UNITED STATES OFFICE OF EDUCATION, BEFORE THE SENATE COMMITTEE ON EDUCATION AND LABOR RE S. 1349, A BILL PROVIDING FOR REVISION OF THE FAIR LABOR STANDARDS ACT OF 1938 The testimony which I wish to present to the committee today will be directed solely to the general question of the relationship of family income to opportunities for schooling in the United States. That there is such a relationship has long been evident to educators and to many citizens as they have frequently witnessed the withdrawal from school at an early age of the children of the poor. As a matter of fact, some 1,000,000 young people drop out of school each year. Only about one-half of those enrolled in the fifth grade will remain to be graduated from high school. Corroborative evidence of this relationship is to be found in numerous studies which have been made of the reasons why the youth leave school. One recent summary of a number of such studies indicates that about one-third of youth who leave school do so from economic necessity (29.27 percent of school-leavers). Reasons classified in the category of economic necessity include such items as: Lack of wearing apparel, services needed at home, lack of transportation, help needed on farm, too far to walk, no money for books and clothing, family needed help financially. Other reasons for school withdrawal include: Reason for leaving: Negative attitude toward school. Poor individual health or physical disability. To go to work (seemingly not under economic pressure) Disciplinary trouble.. Marriage Miscellaneous Percentage reporting 18. 21 8.04 5. 19 15.25 11.29 3.6 5.5 3.6 It seems fairly obvious from this summary (which is typical of results of many studies of the reasons why youth leave school) that low family income resulting in economic pressure ranks high among such reasons. Closely related to family income as a reason for early school-leaving is the quality of the school itself. There appears to be a reciprocal relationship between per capita income and school support and between school support and quality of educational services. This is brought out in table I which shows by States the 1940 income payments per capita in relation to the 1942 expenditures per person 5 to 20 years of age for school purposes. Although it may be granted that expenditure per pupil is not a perfect measure of the quality of educational services made available, it is at least roughly symptomatic of the quality of educational opportunity. Looking at table I we note that the 48 States are arranged in order of per capita income from New York, the highest with $592 per per person 5 to 20 years of age, to Mississippi, with $591 per person 5 to 20 years of age. In the second column appears the total current expense for public elementary and secondary education in 1942 per person 5 to 20 years of age. It is very clear from this table that the States whose inhabitants have the greatest per capita income behind each school-age child spend the most for education. Amounts spent range from $20 per person 5 to 20 years of age among States low on the list in income to over $100 per person in this age range among States at the top of the list. We also know that States at the top of the list have fewer children to educate in proportion to total population and generally have lower tax rates for the support of their schools, despite the fact that they spend more per pupil. They have a larger percentage of school-age children in school, a higher percentage of adult literacy and fewer men disqualified for service in the armed forces by reason of their educational deficiencies. States which are rich in numbers of children but poor in income, that is without the financial resources to pay for good schools, provide less adequate levels of expenditure for their schools, and, by and large, are thereby able to achieve less adequate educational results on tax rates which are relatively high as compared with the country as a whole.2 One might suntmarize this income-schooling relationship by saying that, other things being equal, the “holding power” of the school for its pupils varies directly with the quality of the school; and the quality of the school varies directly with the expenditure for the support of schools. Financial pressure on pupils from low-income families to leave school when coupled with schools of low quality results in curtailment of schooling for hosts of American youth. Dailard, Ralph C., An Estimate of the Cost of Making Grades 9 through 12 of the American Common School Effectively Free. Birmingham, Ala. Birmingham Printing Co., 1939, p. 37. 2 Norton, John K., and Lawler, Eugene S., An Inventory of Public School Expenditures in the United States, a Report of the Cooperative Study of Public School Expenditures. Washington, D. C.: American Council on Education, 1944, vol. II, p. 316. |