EXHIBIT 2.-HEALTH PROBLEMS CREATED BY DEFENSE MIGRATION IN MICHIGAN REPORT BY H. ALLEN MOYER, M. D., COMMISSIONER, MICHIGAN DEPARTMENT OF HEALTH, LANSING, MICH. SEPTEMBER 12, 1941. We feel that important problems of health are created by national-defense migration. Jobs in defense industries in our State are responsible for two movements of population: 1. From available information it appears that workers and their families are being attracted to Michigan from other States. 2. Michigan families are leaving home to move into defense areas elsewhere in the State. In some instances, these population movements are under full swing; in others, they seem bound to follow the opening of defense plants now under construction. No local community is equipped to withstand the entire shock and strain of these large migrations, and it is unfair that the national necessity should place excessive burdens upon particular localities. State and Federal funds must be used to meet health problems which are created or greatly aggravated by the movement of workers and their families into industrial defense areas. There are two ways of using State and Federal funds in local health protections. The funds may be allocated to local full-time city, county, or district health departments. Where there is no full-time health unit only limited services can be given by State staff personnel. The principle of extending financial aid to local health departments has been followed in Michigan from the beginning of organized county and district units in 1927. At present, 65 counties out of 83 in the State have full-time health protection, either from single county units or from district health departments. Financial aid to local health units is discussed in more detail elsewhere in this statement. Turning again to the immediate and the prospective health problems related to national-defense migration, we would like to have you consider them in two divisions: First. Those problems related directly to sanitation. Second. Other problems due to communicable diseases resulting from contacts among people. SANITATION Some of the important expansions of defense industry in Michigan are taking place in territory where the sanitation situation was unsatisfactory anyway. As a consequence, the defense migration has simply overwhelmed sanitary facilities, some of which were already inadequate, and has created new sanitation problems where none existed before. Mainly, this is occurring in the Detroit area, particularly in the bordering counties of Oakland and Macomb to the north and in the western part of Wayne County (in which Detroit is located). Briefly the conditions are these: The land is mostly flat, the soil is mostly heavy clay, and thousands of families have their own water supplies and sewage disposal facilities, such as they are. Sewage is running in open roadside ditches, recreational waters are being polluted, water supplies are contaminated or open to pollution (many of them are shallow dug wells), and while no outbreaks of water-borne disease have yet been reported in these areas, we consider that an emergency may be in the making. Some residents worry about the odors. They're often bad enough (for example sewage flows along a road which boys and girls travel in reaching one schoolhouse), but in the State health department we worry not about the smells but about the threat of disease and death. Newspapers have described the conditions repeatedly, by word and by picture. Everyone who is informed on the matter agrees that the situation is bad and getting worse. For jobs continue to multiply and therefore families continue to move in, and just by living there add to the problem. In spite of the fact that in this area are some of the key arsenals of our national defense, not a shovel has been turned to lay a line of sewer to serve the growing population. Some water mains have been extended from the Detroit system, just north of the city, but nothing more. After months of studies and conferences, we still are without a broad program of action. There are many com- As this is written, it is not clear how action will come. munities concerned-townships, villages, cities, counties. authority or organization. Consequently, there is no ready way of arranging for finances. Without any hesitation, we put this problem down as the No. 1 sanitation problem of the State. And even as we say that, it appears that conditions just as intolerable may develop elsewhere; for instance, as the huge bomber plant near Ypsilanti attracts possibly tens of thousands of workers. Pending an adequate program, the Michigan Department of Health has joined with the Michigan Council of Defense in putting the facts squarely before defense workers living in these areas. A folder has been prepared for distribution by the Michigan Council of Defense and its county councils, and a copy is attached as a part of this statement.1 In another part of the State, the sanitation problem connected with migrant labor is well shown in an outbreak of bacillary dysentery. An epidemiological report made by one of our staff is enclosed, but in summary this is what happened.2 A camp for migrant farm laborers, operated by the farmer who employed them, was the scene of an outbreak in June of this year in which 11 cases of Flexner bacillary dysentery were reported, with 1 death. Toilet facilities were so inadequate that the fields were used as much as privies for excreta disposal. The single well serving 20 families was a dug well 17 feet deep. It had a board platform and excess water drained back into the well. Our investigation showed that the whole colony washed dishes, clothes, and diapers and themselves at the well. Our mobile laboratory unit was sent to the colony, and culture studies showed so many possible avenues of infection that no one factor could be singled out as the prime means by which the outbreak developed. Inquiry showed, also, that diarrhea had been prevalent in the nearby village of Keeler during the summer. While in this particular case, the farmer who runs the colony agreed to repair the privies and provide a suitable concrete top for the well, the improvements affect the living of only a few migrant farm laborers and their families. Other situations with the same health hazards are thought to exist in many other localities where truck farmers depend upon migrant labor for field workers. If employment of migrant labor continues as a part of the agricultural methods of Michigan, something must be done to prevent such conditions as those found in Van Buren County. The migrant laborers themselves are relatively helpless to protect themselves and being unable to prevent disease in their own ranks they are a threat to whatever community they work in. The Farm Security Administration is willing to help meet this problem, and it seems that new consideration should be given to the erection of Federal labor camps where needed in Michigan. Summarizing the position of the Michigan Department of Health on sanitation: The department does not have and never has had funds for construction of water or sewerage systems. No State agency has had such spending powers since the 1830's and the bankruptcies of those days of "internal improvements." Providing water and sewerage facilities is the normal responsibility of local communities; in approving plans for these facilities, it is the responsibility of the State health department to see that they provide adequately for health protection. In this situation, and with an emergency in prospect, ways must be found for stimulating and aiding the local communities to provide the necessary sanitary facilities. OTHER COMMUNICABLE-DISEASE PROBLEMS Aside from such infections as dysentery and typhoid fever which are directly related to faults in sanitation, migrant labor gives rise to other communicabledisease problems. For example, two diphtheria outbreaks occurred in August in Mexican families who came from Texas for a summer of work with sugar beet, pickle, tomato, berry, and other crops. As it happened, with good luck and quick preventive work, neither outbreak spread to nearby farm or village populations, and both were brought under control in a matter of days. The deaths totaled three-one baby and two children aged 5 and 3. 1 Held in committee files. This report appears in pt. 19 with other material on the subject of agricultural migration into the State of Michigan: One of the diphtheria outbreaks occurred in a colony of 246 persons (including more than 100 children), at Blissfield, in Lenawee County where there is no fulltime health service. The mobile laboratory of the Michigan Department of Health was rushed to the colony and throat cultures were made of every man, woman, and child. Antitoxin was used freely where the diphtheria germ was found, and children were given toxoid as a preventive measure. A camp quarantine was enforced by State police and sheriff's deputies. In the nearby village of Blissfield, toxoid was given to children. In the other outbreak, diphtheria was discovered in four families in Saginaw County, which was a full-time county health unit. The entire group was isolated in emergency quarters in the Saginaw County Hospital, and there was no further spread of the disease. Epidemiological reports of both these diphtheria outbreaks are submitted with this statement. The photographs attached to the studies show in part the crowded conditions in which these Mexican field laborers and their families lived. For example, at Saginaw the 4 families were living in a 1-room house. field, 18 families lived in a barn partitioned into 12 apartments. At Bliss The Blissfield and the Saginaw County diphtheria outbreaks show what can happen and what is necessary to control a communicable disease epidemic among migratory laborers. As you know, the Michigan Department of Health has also had experience in trying to eliminate certain sources of disease among these same Mexican migratory workers before they come to Mighigan. This is the program supported by the sugar beet growers of Michigan, and aimed at screening out individuals with tuberculosis and venereal disease from among those applying for jobs in this State.2 You have had testimony on this preventive program before the House Committee on Interstate Migration of Destitute Citizens. Dr. Koppa testified at Chicago in August of 1940 and gave you figures on the number of persons examined and number rejected for health reasons. The following table will bring the results down to date: We wish to point out that these rates of tuberculosis infection among the Mexican migratory workers are four or five times the rates for industrial groups in Michigan where preemployment examinations are made and also four or five times the tuberculosis rates being found among men called for selective service examinations. We are especially concerned with screening out tuberculous workers migrating to Michigan because our own tuberculosis control program is already burdened. We undertake to hospitalize every person who carries tuberculosis infection, and we have a vigorous case-finding program by X-ray examination to discover such persons even before symptoms are otherwise apparent and before they realize they are ill. All this costs money, although we are satisfied that it is worth all it costs and more. However, when you consider that in matching county funds for the care of tuberculosis patients, the State of Michigan appropriates more than $2,000,000 a year, you appreciate the fact that we are glad to be spared the expense of caring for tuberculous men and women among the Mexican migratory workers. In other areas of public health, the migratory worker makes admittedly difficult problems even more difficult-simply because he is so much on the move. If he is carrying a communicable disease, he may spread infections from one end of the State to the other; for example, from the onion fields in the South to the cherry orchards in the North. We need reinforcements all along the line to meet these health dangers. In the control of venereal disease, we are making the best use we can of Federal funds 1 See pt. 19, Detroit hearings, for both reports and photographs. * See Chicago hearings, pp. 1271-1304; Oklahoma City hearings, pp. 1878-1883, and Washington hearings, pt. 11, pp. 4771-4822. granted to us for this purpose. We are paying for special nurses to aid in follow-up work in order to keep men and women under treatment, and we are supplying drugs out of State funds free to physicians for treatment of syphilis and gonorrhea patients. The treatment can be arranged anywhere in Michigan, for if the patient is unable to pay for his treatment, the cost becomes a county charge. We would like briefly to mention the recent work being done in Michigan on the so-called 5-day (intensive) treatment for syphilis. As you know, this treatment with massive dosage of drugs is a hospital procedure, and is available only in designated centers. This treatment is proving a great help in the control of infectious cases. This type of treatment is especially adapted to transients, therefore is the treatment of choice for this group. In reviewing for you instances of communicable disease outbreaks among migratory workers, we have given you recent experiences with agricultural labor. A migration of industrial workers has similar potential hazards, although the continual watchfulness of city health departments helps to hold these dangers in check. Certain questions on the operation of the Michigan Department of Health have been raised with us by your committee staff, and we are submitting brief answers. The financial resources of the department are shown in the following table: Sources of funds for Michigan Department of Health, fiscal year ending June 30, 1941 The total of $2,977,200 in State funds is allocated as follows: Department. Laboratories. Aid to county health units_ Tuberculosis subsidy to counties.. Allocation of Federal funds by sources follows: Available State funds $2,977, 200.00 $247, 500 452, 200 127, 500 2, 150, 000 NOTE. Local health services of one sort or another are provided through funds allocated to bureaus of the Michigan Department of Health. These services include consultation, nursing and other services. The same holds true for State funds; for example, the services of the laboratory reach every part of the State in the furnishing of biologics and in making laboratory examinations. Operation of selective service and calling to service of Reserve officers. Some of our key technical men have been lost, and our bureau heads are apprehensive of more losses from our staff because of military service. It is very difficult to find engineers trained in industrial hygiene, for example, and there is a shortage of trained personnel in tuberculosis hospitals, for another example. Our feeling is that the military services should leave us the personnel needed to carry on health protection services so far as they possibly can. Some of the civilian public health services have military importance, as in training camp areas and in defense-industry areas. You will want to know, too, that for the first time in years, we recently have been unable to find public health nurses to refer to local health departments for permanent positions. In the past, nurses have been obtained from schools of public health at Wayne University, the University of Michigan, and from other universities; from the nurse placement service in Chicago; and from the ranks of nurses who inquire about positions. Effect of Michigan's civil service.-Our bureaus find that civil service is working well, but, of course, if trained personnel is not available, civil service can't refer them to us. We have no suggestions to make so far as civil service is concerned. Some delays in appointments have been experienced, but allowance must be made for the huge job the civil service commission of the State has had in putting the entire State personnel on a merit basis. Industrial hygiene.-The staff of our bureau of industrial hygiene includes one physician, six engineers, and one secretary. We are adding an analytical chemist. The budget for the bureau is $48,630 for which Federal funds total $38,630. At present 80 percent of the work of the bureau is connected with plants having national-defense contracts, either direct contracts or subcontracts. Our bureau now has work ahead for several months, and you will be interested to know that during the past year, Michigan industry spent $400,000 in carrying into effect recommendations of the bureau. Health departments. State aid up to a maximum of $3,000 per unit is given to county or district health departments. Two, three, or four counties are in district units. Organization of such health units is voluntary, and 65 of the State's 83 counties now have full-time services from county or district health departments. Grants from 2 foundations, the children's fund of Michigan and the W. K. Kellogg Foundation, have been of great assistance to local health departments. The plan of organization of county health departments must be approved by the State health commissioner, and staff members must be approved by the State health commissioner. Cities may elect to join with a county unit, and in 1 instance (Kalamazoo City and Kalamazoo County) this has been done. There are 12 city health departments with full-time services. Hospitals.-The Michigan Department of Health has official connections only with tuberculosis sanatoria. We have supervision over 4,891 beds for tuberculosis care in 23 approved sanatoria (State county, city, and private) and 7 subsidiary hospitals in the Detroit system. EXHIBIT 3.-MICHIGAN'S DIRECT RELIEF PROBLEM REPORT BY JOhn d. o'connell, director, State DepartMENT OF SOCIAL WELFARE, LANSING, MICH. Under the Michigan Social Welfare Act (P. A. 280, 1939), Michigan's direct relief responsibilities are shared by both the State and local governmental units. The State Commission allocates to the various counties funds appropriated by the legislature for direct relief purposes, exercises supervision over fiscal policies, and arbitrates disputes among the various counties with respect to matters of legal settlement. The final determination with respect to the granting, form, and amount of direct relief, rests with county social welfare boards. In addition to these directrelief responsibilities, the county boards provide hospitalization for afflicted adults and operate county infirmaries. VOLUME AND COSTS OF DIRECT RELIEF In table I, trends in direct relief caseloads and assistance costs over an 8-year period are presented. During this period, expenditures for direct relief purposes were incurred in an aggregate sum exceeding $235,000,000. blind. Whereas the volume of direct relief recipients appears to have followed a downward trend, it must be borne in mind that a large part of the apparent reductions are due to the inauguration of other public-relief programs such as Work Projects Administration, old-age assistance, aid to dependent children, and aid to the With the inception of the Work Projects Administration program in 1935, employable persons were removed from direct relief rolls as rapidly as possible. The effects of Work Projects Administration employment were evident in a decrease in the average monthly caseload of from 111,273 cases during the fiscal year 1935-36 to 59,826 cases during the fiscal year 1936–37. This reduction in the volume of direct-relief cases was accompanied by a decrease of more than $13,000,000 in the amount of assistance extended. The present State direct relief caseload of 33,232 cases (August 1941) represents the lowest direct relief load since State-wide data have been available. This low level can be attributed in large part to the present increased industrial activity. The probable effects which industrial dislocation attendant to the defense program will have upon direct relief rolls is discussed later. |