We have seen that children are concentrated in low income families. There are also proportionately more children in the low income States. The 1940 census shows that one-half of the children in the United States live in 32 States which get only one-third of the national income and conversely, half live in the other 16 States that have two-thirds of the national income. These States fall into a pattern of regional differences. About one-quarter (28%) of all children live in the Northeast, which has 40 percent of the national income, while another quarter live in the Southeast, which has only 12 percent of the national income. I have two charts here to illustrate this situation, one that shows per capita income and ratio of children to adults by States and the other by 6 regions in the United States. These are charts 10 and 11. PER CAPITA INCOME AND RATIO OF CHILDREN TO ADULTS In 1941, farm families had 29 percent of the children in the United States but only 11 percent of the income. Their purchasing power in terms of health and medical care for mothers and children has necessarily been low. Federal funds under the Social Security Act, title V, part 1, granted for the purpose of assisting States in carrying out their maternal and child health plans have been sufficient to meet only a very small fraction of the needs of rural mothers and children. Rural areas are particularly at a disadvantage. Many are continuously impoverished. Farm families have the highest ratio of children to adults, approximately twice that of the large cities. You will see this on chart 12, which shows the ratio of children to adults in urban and rural communities in the United States, 1940. Chart 12. 700 Based on data from US Bureau of the Census HEALTH NURSE POPULATION PER PUBLIC Standard I nurse to I nurse to less than 5,000 population I nurse, to 5,000-7,499 population I nurse to 7,500-9,999 population I nurse to 10,000 or more. population U.S.Department of Labor CHILDREN'S BUREAU The public health services which are the basic administrative structure for the maternal and child health program are lacking in many rural areas. In 1942 the State health agencies reported that there was no service from a full-time public health unit in 40 percent of the counties in the United States. This situation must be corrected in the immediate future or we will not be able to develop a sound national health program. There was no public health nurse in one-third of the counties. I have a chart here that shows the discrepancy between States in this matter of public health nurses. Chart 13 shows population per public health nurse. Population data used are estimated by Bureau of Census as of Three out of four rural counties had no regular maternity clinics, and two out of three rural counties had no regular monthly child-health conferences. Rural areas are seriously lacking in professional personnel. It is estimated that there should be the equivalent of one physician including general practitioners and specialists, for each 750 people, no matter where they live. In 1940, a prewar year, there were 1,642 counties which had one doctor for one to two thousand people. In slightly more than 300 counties, the ratio was one doctor to 3,000 or more people. In big cities, there was an average of one doctor for each 650 people. There should be 4.5 general hospital beds per 1,000 population. In 1942, there were two-thirds of the counties in the United States which had 2.1 beds or less per 1,000 population. This picture is typical of practically every kind of health and medical-care service in rural areas. The tendency has been for highly trained personnel, the "experts" and "specialists," to concentrate in urban areas. In 1941, for example, only 4 percent of the certified pediatricians were located in places of less than 10,000 population and in the rural areas where 60 percent. of the children live, while 38 percent were in places of 500,000 or more, where 14 percent of the children live. The opportunity for adequate income for specialists is greater in the city than in the country. Hospital facilities can be had when needed in the larger cities and there is readier access to professional consultation and to the services of other specialists. General medical practitioners and dentists also tend to settle in cities-for the same reasons. The CHAIRMAN. Now, would it be possible to get those hospitals in rural areas, in poorer sections of our rural areas of the country, without this insurance system that we are talking about. Dr. ELIOT. Of course, one of the questions I raised when I was testifying as to that bill, S. 191, was: "Who is going to pay for care in the hospitals?" It is fine to build them, but who is going to get the people into these hospitals? Either a provision has to be made in that bill, or somewhere else, because people simply cannot pay for hospital care needed for children, or for maternity care in many, many instances. We need a lot more professional personnel, and I have listed some of them here. We have about 2,500 padiatricians. We reckon that we ought to have 7,400. We perhaps need 5,000 more obstetricians in the country to do a really good maternity-care job for every mother in the country. We need probably 34,000 dentists trained in children's dentistry. We have now 19,000 public health nurses and we without question, I think, need 50,000 more. We need some 15,000 additional graduate nurses for institutional and private duty. We need some 10,000 additional psychiatrists. That is a round figure, because we do not know how many we will need finally to handle these services for children. For instance, there are 25 States in which there is not a single child guidance clinic in any community in the State. Therefore, there is no question of the need in that area. |