IMMIGRANT HEALTH

AND THE COMMUNITY

I

THEORIES VERSUS PEOPLE

"THE healthy know not of their health, but only the sick." With the advance of medical science this saying of the nineteenth century should be changed by the twentieth century to, "The healthy learn to promote their health; the sick wish they had." If a town is stricken with typhoid fever it must no longer blame Providence, but itself. Health can no longer be regarded as a negative or passive state, the mere absence of disease. Health is a positive quantity, an ideal of individual or community life, capable of being realized by methods which are more or less known.

This spread of knowledge has led in recent years to aggressive, organized movements for the care of illness and the promotion of health. The medical investigator, the executive officer of the health department, the hospital, the dispensary, the publichealth nurse, the social worker, are all concerned with the study of medical methods and the application to

the care and prevention of disease. Much of this study has to do with technique, such as periods and modes of quarantine, organization of hospitals, clinics, or sanatoriums, methods of prenatal care or of baby feeding. A large part of medical and health work depends for its effectiveness upon the careful, continuous study of just such impersonal matters of technique.

Without underestimating the value and necessity of technique, it must, nevertheless, be pointed out that effective medical and health work must take into account yet another element. The aim of medical and health work is to secure practical results in curing disease, reducing morbidity and mortality, promoting wholesome and efficient living. Work for these aims involves two fields of human knowledge. One is physiology, taken in the broad sense of that word. Medicine and its related sciences, such as bacteriology and chemistry, aim to ascertain the reactions of the human organism to various conditions of activity, climate, infection, and so forth. This constitutes what may be called the physiological field.

PSYCHOLOGICAL FACTORS IN HEALTH WORK

The other field is psychological or social. Medical and health work involves the application of science, or a group of sciences, to groups of human beings in both their individual and collective relationships. It deals with people and is administered by people. What the executives and field workers, what their patients and their public, think and feel about such work is fundamental in determining its extent and effectiveness at any given period.

The study of people is as important a factor in its success as are the nonhuman elements of technique. The health officer, the hospital superintendent, the public-health nurse, and the social worker, all being members of the human family, consider this human element in a more or less conscious way during their daily work. The extent to which they do this is a measure of what we commonly call their wisdom and tact. But beyond these individual considerations of personality, the sciences of psychology, economics, and sociology have a definite application to medical and health work. Inexact as these sciences are called, they yet bear lessons of importance for the physician or health worker. Conscious and deliberate research in this direction is urgently needed and will repay serious attention.

There are thirteen million foreign-born persons in the United States, and about twenty million more of foreign-born or mixed parentage. These people, because of their racial inheritance and their position as immigrants, have developed a psychology and live under social and economic conditions very different from those of the native born. For these reasons the problem of the human factor is intensified in medical and health work with the foreign element in our population. Also, they suffer more than the native born from failure to consider this factor, for American medical and health methods grew out of native conditions and so fit them at least approximately. The study of health problems among the foreign born here in the United States is, therefore, a necessary part of the investigation of Americanization methods, as well as a method of approaching the study of the

DIAGRAM I.-COMPARISON FOR EACH MOTHER TONGUE OF FOREIGN BORN IN THE UNITED STATES IN 1910 AND THE NET INCREASE TO JULY, 1919, ACCORDING TO THE U. S. BUREAU OF IMMIGRATION REPORTS

human element in health technique within a field sufficiently definite and limited to be practicable. Obviously the Italian, the Jew, the Scandinavian,

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the Pole, and the Syrian are not all alike. They differ in various physical characteristics, in language and traditions. They are human varieties, we may say. But is not health a problem of the human species? Have these human varieties, along with their admitted differences, any characteristically different problems of health or disease? In health matters, do they as a group differ from that other human variety known as native-born Americans?

These questions are partly answered by comparative statistical studies of sickness or mortality among different peoples here and abroad. In large part, however, they are answered by other kinds of data. Psychological and social differences between "races" or national groups, as contrasted with one another and with the native-born American, may be found to create the need for different methods of medical or health work.

This is the general problem. We deal with the specific situation in America. We seek to discover how far the foreign born present distinctive problems of health and disease and how our methods of medical and health work need to be adapted to the foreign born in order to secure the best results.

The characteristic qualities of different groups of our foreign born, and their condition in the United States, must be briefly reviewed, so that we may have a background of customs and traditions to which to relate matters of health and disease. The conditions and problems which are faced by those interested in medical and health work must be illustrated by field studies. Health departments, antituberculosis associations, industrial or commercial establishments doing