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Fourth International, October 1941

Grace Carlson

Public Health and “National Defense”

From Fourth International, Vol.2 No.8, October 1941, pp.246-250.
Transcription & mark-up: Einde O’Callaghan for ETOL.

Mechanized warfare, with its demands upon the civilian workers in the home factories as well as upon the soldiers at the front, has made the question of public morale an extremely important one to the modern war-makers.

“Wars are won or lost according to the health, courage and calmness of whole populations and their ability to exert themselves to the utmost, and this is particularly true in modern total warfare,” says a report issued May 28th of this year by the National Nutrition Conference for Defense. Called by President Roosevelt, this conference, attended by doctors, nutritionists, agricultural scientists, social service workers, food manufacturers and distributors discussed plans for raising the level of public health by utilizing the findings of the new science of nutrition.

The immediate motivation for the calling of the National Nutrition Conference for Defense was the shocking discovery made by army officials that out of 1,000,000 men examined under the Selective Service Act, 400,000 had been found unfit for general military service. Brigadier General Lewis B. Hershey, deputy director of Selective Service, in speaking of these rejections to the Conference, said: “Probably one-third of these are suffering from disabilities directly or indirectly connected with nutrition.”

When such conditions prevail in the age group covered by the Selective Service Act – 18-35 – it is very clear to the student of public health that the effects of long-continued malnutrition and undernourishment would reveal a far more serious situation in the older age groups not covered by conscription. As a matter of fact, a break-down of the figures given by the army on the rejections will demonstrate this trend.

Thus in the youthful age range of 30 to 36, about two-thirds of the young men of the country were found to be physically unfit. If precise statistics were obtainable for other age groups, including the middle-aged men, a far more devastating picture would be drawn of the effect of the American policy of permitting “one-third of the nation” to continue in an “ill-fed, ill-clothed and ill-housed” condition.

General Hershey confessed to the Nutrition Conference that “we are physically in a condition of which nationally we should be thoroughly ashamed” and that this is a condition “which we should recognize as dangerous and which we should take immediate positive and vigorous measures to correct.”
 

What the Government Already Knew

It may have come as a startling revelation to General Hershey and to other army officials to learn of the appalling condition of the health of the American people, but other departments of the Federal government have had information in their files for many years about the high rate of sickness in the United States.

The United States Public Health Service, for example, conducted a survey of the state of the national health in 1935-36 and reported its findings in a series of bulletins issued in 1938. These reports were based on a house-to-house canvass of some 800,000 families, including 2,800,000 persons from 83 cities and 23 rural areas in 19 states. There was an attempt to obtain a representative sampling of the American people, but it is interesting to note that the final reports include only the findings about the white population of the country. When one learns from other surveys which have been made of the tragically high morbidity and mortality rates among American Negroes, the evidence presented by the National Health Survey appears even more startling.

It estimated that on an average day of the year about five million persons are disabled to such an extent that they cannot go about their usual work or other routine. Of these five million, about half get well sooner or later and resume their ordinary life; about half remain permanently disabled. Among those permanently disabled, nearly two million are less than 65 years of age. Thus, in a year’s time, sickness and disability costs the American people two billion days’ absence from work, school, or household duties.

The explanation for these shockingly high morbidity rates were found in the close relationship which was found between the economic status of the families surveyed and the amount of disabling disease. These facts are brought out clearly in Table I:

In the United States, where 70 per cent of the families live on less than $1500 per year, and where one-third of the families must eke out a living on less than $750 per year, a high rate of sickness is to be expected. Low-income families which cannot obtain enough nourishing food, warm clothing or decent homes for their members cannot withstand the onslaught of disease as can families in the upper-income brackets.

Moreover, such low-income families cannot afford the medical care necessary to handle the greater load of sickness which they bear. Despite the easily-accepted aphorism that “only the very poor and the very rich have proper medical care,” the evidence from the survey shows that close to one-third of the population on relief or in the low-income brackets receives no medical service or inadequate service. Despite the large number of tax-supported medical institutions in the country, families with small incomes still spend larger percentages of their incomes for medical care than do those who are in moderate or comfortable circumstances.

Thus, the Interdepartmental Committee to Coordinate Health and Welfare Activities summed up the findings of the National Health Survey as well as results of surveys made by the Department of Labor and other Federal Bureaus in the following words of a report issued in January, 1939:

“Sickness comes oftener and lasts longer and death comes earlier to the homes of the poor than of the well-to-do. It is a plain fact – and a shocking fact – that the chance for health and even for survival is far less among low-income groups than among those who are in moderate or comfortable circumstances .... Among the poor in our large cities, death rates are as high today as were those of the nation 50 years ago before the beginning of the spectacular advance of public health and medical science.”
 

The Reactionary Role of Private Medicine

This committee, more popularly known as the President’s Committee on Health Security, made a number of recommendations for a public health program which would help to alleviate the tragic conditions which it had reported. These recommendations were embodied in the Wagner Health Bill which was before Congress in 1939, but was defeated (smothered in a Senate Committee) through the pressure of the reactionary bureaucrats of the American Medical Association. Although the proposals of the Bill for an extension of the public health services of the country could not have dealt adequately with the tremendous problem of disabling illness and premature death among the low-income groups of the country, they were opposed by the vested interests of private medicine as being “socialistic” and “radical.”

The American Medical Association bureaucrats succeeded thereby in sidetracking further efforts to put over a public

health program which would meet the basic essentials of the nation’s health. None of the prominent public health officials, social workers, child welfare experts, educators or other technicians who had taken part in preparing the recommendations of the Committee on Health Security would risk a head-on collision with the American Medical Association over even so mild an instance of “socialized medicine” as the Wagner Health Bill.

Nor did the American Medical Association offer a counterproposal which could solve the health problems of the American people. All that the official organ of the American Medical Association offered in this controversy was a series of denunciations of governmental control of medicine and warnings against breaking down the so-called “sacred relationship” between the private doctor and his patient. This, despite the fact that the eminent medical historian, Dr. Henry Sigerist, long ago pointed out that the one thing which destroys the relationship between doctor and patient is the doctor’s bill.

American medicine which is today moving at a blitzkrieg pace in the laboratory in its assault on death and disease moves as slowly and as cumbersomely as an oxcart in its social relations. The modern doctor has mastered all of the latest surgical techniques; has devoted himself to the study of the new chemotherapy; can press into service the “miracle” drugs, sulfanilarnide, sulfapyridine, sulfathiazole and the others to defeat diseases which had never yielded to medical treatment before, such as streptococcic meningitis. But he still faces diseases of insufficiency which should have’ been abolished years ago.

Pellagra, rickets, scurvy, tuberculosis and a score of other diseases, caused directly or indirectly by malnutrition and under-nourishment, are social anachronisms. That pellagra, the dread “red death” of the South still exists, years after medical research has demonstrated that it can be prevented if the potential victims are given diets including adequate amounts of vitamin B, found chiefly in meats, is damaging evidence against organized American medicine. It offers conclusive proof that medical men do not know how to build a system of “preventive medicine,” but are forced to take therapeutic measures against diseases which should have been prevented.

Dr. Sigerist has epitomized this paradox in the following words,

“It is a great thing that medical science has discovered that nicotinic acid (part of the Vitamin B complex) will cure pellagra, but it is equally as important to remember that a beefsteak will prevent it.”
 

Tuberculosis, Scourge of the Poor

The terrible death toll from tuberculosis offers even more damaging evidence that private medicine in a dying capitalist system cannot solve the health problems of the people. Tuberculosis is above all a disease of poverty. It could be wiped out if every individual could have enough good, nourishing food, adequate clothing, decent living conditions, proper rest and freedom from worry, and if every person now ill with tuberculosis could be given proper medical care in a sanatorium. And yet in 1939, in the United States, 61,609 people died from tuberculosis. Considerably more than half these individuals were in the age range, 15 to 45, that is, were in the most productive years of life.

A vast amount of evidence has been accumulated by the National Tuberculosis Association to demonstrate that poverty breeds tuberculosis. One of the most graphic pieces of evidence is offered in a study made in Cleveland on Housing and Tuberculosis. The findings are given in Table II.

Five times as many deaths from tuberculosis for those from the undernourished low-income families, who are crowded into unsanitary tenements, where tuberculosis germs are easily spread from person to person and family to family! American doctors, who can devise remarkable therapeutic measures to cure tuberculosis, find themselves helpless in the face of the problem of preventing tuberculosis. For this would be an attack on the capitalist system of poverty, which breeds tuberculosis and a host of other ills.

Thus, all of the highly-trained, hard-working, well-meaning American doctors, who are devoting themselves to ending the scourge of tuberculosis are barred from this goal by their lack of social vision They have the techniques of twentieth-century medical sciences but the social philosophy of the nineteenth century, when capitalism and private enterprise were young and vigorous.

Capitalism “in its death agony,” as Leon Trotsky described it in 1938 in the great thesis adopted at the founding convention of the Fourth International, cannot solve the problems of today – neither war, nor fascism, nor poverty, nor unemployment. Dying capitalism cannot guarantee health security to the people. If this objective were a possible one, the United States, the most highly developed and advanced capitalist nation in the world, would have attained it. Two-thirds of the world’s gold is in American vaults; American warehouses bulge with surplus food; American cotton-growers plow under row after row of luxurious cotton plants, but the “ill-fed, ill-clothed, ill-housed third of the nation” struggle and suffer and are driven into early graves.
 

Reformist Gestures Are Futile

In the present “national emergency,” frantic but futile efforts are being made by the war-makers, such as the calling of the National Nutrition Conference for Defense, to solve the health problems of the American people and thus to prepare them better for an “all-out” war effort.

In commenting on the work of this Conference, Walter White, the Executive Secretary of the American Association of Social Workers, pointed out that the emphasis of the Conference on securing a better understanding of the vitamin content of certain diets was purely academic. “It appears that more thought should be given to the stark fact that there are millions of our low-income families, many of whom have been on and off relief during the last ten years who do not have the funds to buy the necessary food items required in a balanced diet,” he went on to say.

Even more academic, ridiculous and futile is the work of the Food Habits Committee of the National Research Council, which has been assigned to find out by means of a public opinion poll whether the faulty diets of Americans are due to ignorance, prejudice or poverty. What every schoolboy in a relief family knows, namely, that relief standards are not adequate and do not permit the purchase of enough, good, wholesome food, the learned gentlemen of the Food Habits Committee must try to discover by means of a public opinion poll.

It certainly cannot be news to these scientists that the United States Government though the AAA has deliberately sought to create a scarcity of certain essential food products, wheat, pork, etc., so as to keep farm prices up. News of the destruction of so-called surplus citrus fruit crops in California have filled the newspapers, but many American children have never seen or tasted oranges and grapefruit, those important sources of Vitamin C. Red Cross workers report that when they furnished food to flood refugees in an isolated region of the South, they found hungry children playing ball with oranges – not knowing what else to do with them. The lack of Vitamin C in the infant diets of 20 years ago is the reason why nearly three times as many men are being rejected for America’s 1940-41 draft army on account of bad teeth as were rejected in 1917, Dr. C.G. King of the University of Pittsburgh charged recently.

The attempt to solve the problem of “want in the midst of plenty” through the distribution of surplus food by means of the food stamp plan has failed dismally. The food stamp plan, at present, after two years of pushing ahead as fast as possible, is available to only about one-half of the families on relief. It will take at least another year, federal authorities estimate, to extend it to all of the relief families, and no such help will be given to the thousands of low-income families, not on relief, who must subsist on relief standards.

No social scientist, who makes an honest analysis of the present and future cost of the defense program can hope that public aid to the needy will be expanded in the coming period.

American capitalism cannot afford to buy health for its people, and at the same time to pay for the greatest and most powerful war machine in the entire world. On the contrary, unemployed workers are being told that in the interests of national defense, WPA and other social security programs must be cut; employed workers are being asked to work longer hours for less pay for the same so-called program of national defense. These workers, already in a notably poor physical condition, are asked to jeopardize their health further by voluntarily accepting still lower standards of living than those which have already undermined their health.

But the organized workers have been resisting these demands and have pointed out that the big industrialists, who have been making fabulous profits in this national “emergency,” should back up their patriotic utterances with full financial support of the defense program. Not only must the workers continue this fight to preserve the living standards which they have won through past struggles, but they must attempt to extend these gains by the establishment of workers’ control of production and a Workers’ and Farmers’ Government in the United States.

Only in a Socialist United States will longer and richer and more abundant lives for all be stressed, because only in the socialist society can plenty for all be achieved; and only a system of socialized medicine can distribute the fruits of twentieth century medical genius “to each according to his needs.” Then, the age-old yearning of the people for the strength, for the happiness and the joy which only abounding health can bring, will be fulfilled. To this cause the Socialist Workers Party has dedicated itself.

 
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