INDIRECT RELATION TO NUTRITION

Housing has another relationship to health in general and to tuberculosis in particular that is frequently overlooked. Intelligent parents in the unskilled wage-earner group know perfectly well what slums do to their children. They know it so well that in order to take their children out of slums into decent homes, some of them pay too much of their income for rent-sometimes from 30 to 50 percent. That means that the family cuts down dangerously on other necessities, especially on food. Decent housing is important to health, but proper nutrition is infinitely more so. Yet in these situations, nutrition is adversely affected by the fact that adequate homes are not available in our metropolitan areas at prices the unskilled wage earner can pay without tragic sacrifice.

RELATION TO MENTAL HEALTH

The evidence as to the relation between housing in the broad sense and mental health is limited, but many health authorities believe the effects on human behavior and mental stability are greater than on organic health. It requires no accumulation of statistical data to convince reasonable people that slum conditions offer nothing that is conducive to mental poise or adjustment. When five or six people have to carry on all the intimate functions of life in three shabby, poorly lighted tenement rooms, with no chance for privacy; no sanitary convenience in the flat except a cold water sink; in a rundown neighborhood with a saloon on one corner and a cheap dance hall on the other; with no park or playground within a mile; noisy and hot in summer and cold and stuffy in winter, there is little in the environment that promotes feelings of security or selfassurance. Indeed, the preschool youngster who has no place to play and the school-age child who has no chance for quiet home study grow up under major handicaps. That so many of these children escape an overpowering sense of shame and inferiority in such an environment and that so many develop into useful, efficient citizens is a tribute to the toughness of human fiber, not to the wisdom of modern society that tolerates such conditions.

TUBERCULOSIS

Dr. Floyd P. Allen, research director of the Public Health Federation, made a study of mortality for Cincinnati by geographical and economic areas (1929-31). That study showed that during this 3-year period the tuberculosis death rate among Negroes was highest in the Basin area, where income is lowest and housing and congestion worst-465 per 100,000 of the Negro population. In the Walnut Hills section, where income was somewhat higher and housing conditions somewhat better, the Negro rate was less than one-half as high-195 per 100,000. In Madisonville, where a much higher income prevails and where Negro families live in single family homes, complying with a reasonably good standard of housing, the tuberculosis rate among Negroes was strikingly low for people of that race-79 per 100,000 of the population. Negroes in the most favorable living environment had a rate less than one-fifth of that in the worst area.

In a more recent mortality study (1939-41) soon to be published, Dr. Allen reveals the significant fact that there is still a marked difference in rates in these areas. The Negro rate in the Basin (256), however, has shown relatively greater improvement than in the Walnut Hills area (127.5). The Basin rate declined 45 percent while the Walnut Hills rate declined only 34.6 percent. We do not know the explanation for this more rapid decline in the Basin. However, two factors do appear-one, that the public-housing projects have rehoused some of the Basin Negro population, though not a large percentage, and another, that an intensive program of tuberculosis education, case finding, and medical service has been going on in the Basin under the auspices of the Cincinnati Health Department and the Anti-Tuberculosis League, while very little has been done along the line of tuberculosis prevention or improved housing in the Walnut Hills area.

A considerable body of medical opinion points to the probability that Negroes have less resistance to tuberculosis. There seems no doubt that the disease develops more suddenly in the Negro and pursues a more rapid course. Certainly, we do not have as much success in finding early cases among them. Studies made by William S. Groom, president of the Public Health Federation, show that in Cincinnati the ratio of active cases of pulmonary tuberculosis reported to the health department, compared to deaths, is 10 to 1 for whites and

21⁄2 to 1 for Negroes. The ratio of admissions to our tuberculosis hospital to deaths is 4 to 1 for whites and 12 to 1 for Negroes.

On the other hand, Dr. Allen shows in his Cincinnati studies two significant findings:

1. That there is in our city proportionately as great a difference between the rate of dying among badly housed Negroes of low income compared with the rate among the most-favored Negro group (5% to 1) as there is between the white and the Negro rates (6 to 1).

2. That vigorous public-health measures can lower tuberculosis mortality in spite of adverse economic status and bad environment.

The gap between rates among white people of the lowest economic status occupying the worst housing compared with the rates for those of the highest economic status occupying the best housing is greater now than it was 10 years ago. In 1930 the white tuberculosis death rate for the lowest economic group was two and one-half times as high as for the highest economic group. In 1940 it was three times as high. Commenting on these findings, Dr. Allen states: "It is conceivable that by a persistent campaign, increased health forces, and vast expenditures of money, the rate of life losses from tuberculosis among people in the slums could be brought nearer to a par with that for the most privileged classes, though during the decade there was no progress in that direction. But where would be the wisdom of lavishing effort and funds on the effect when so little is being done to remedy important contributing causes-slum conditions and submarginal income?"

THE FUTURE CHALLENGE IN TUBERCULOSIS CONTROL

Our challenge in the battle against tuberculosis today is quite different from what it was at the turn of the century. This disease is now a relatively minor cause of death among white people of moderate and better circumstances. In fact, the average white rate for 13 large American cities for 1939-41 was under 38 a relatively low rate. But during the same years the average Negro rate was 166-almost the same as the combined Negro-white rate 40 years ago.

What we accomplish from now on in bringing down our losses from tuberculosis will depend largely on what we do to the rate of dying among Negroes, and that, in turn, will depend more and more on what we do to take Negroes out of slums and to make it possible for them to earn enough to sustain a healthful standard of living.

THE CASE OF PROPER HOUSING

The accumulated experience of mankind amply demonstrates that housing and environment vitally affect health-mental and physical. The case for proper housing for our people, however, does not depend upon scientific evidence that the provision of good homes in good neighborhoods lowers death rates or reduces sickness. Entirely aside from that, it has ample justification in the democratic principle that people are entitled to an opportunity for decent homes just as they are entitled to an opportunity for education, and to the indisputable fact that substandard housing areas are an economic and social burden upon any community.

MEASURING SPECIFIC EFFECTS

Therefore, what we need is not more evidence that housing affects health. We have enough already. What we need is exact knowledge as to precisely how and to what extent it affects health. Until comparatively recent years, projects that provided good homes in a good neighborhood were few. Now, we have many such public projects for low-income familities as well as some private developments. This offers the alluring prospect of trying to determine whether removing low-income families from slums into good housing has specific effects on morbidity and mortality, or on both. To say that to isolate the factor of housing and physical environment from the multitude of other factors-income, education, occupation, recreational facilities, health habits-affecting health is difficult is an understatement. It is almost unbelievably complicated. Some careful thought has been given to the subject, and one or two scientifically based studies of limited scope have been attempted but none has so far succeeded in demonstrating the specific effects of housing and environment alone.

A joint committee of the American Public Health Association and the National Association of Housing Officials is now engaged in an effort to outline the 80525 46-pt. 1--31

techniques by which such an appraisal can be made as to the specific effects of housing on organic health-and on behavior and mental health, too, provided suit. able measurements of the latter are available.

It is not now possible to measure the specific effects of housing on health. We must have new tools. The question is not likely to be answered until this has been done, nor indeed until a study using tried and accepted techniques has been made. That will take time and many thousands of dollars. No less scientific, thorough, and objective approach will give the answer. Search for knowledge here, as in every other area of human experience, usually follows an intricate and tortuous course, costly and time-consuming. There are no short cuts.

The CHAIRMAN. Mr. Farr.

STATEMENT OF NEWTON C. FARR, CHICAGO, ILL., REPRESENTING THE NATIONAL ASSOCIATION OF REAL ESTATE BOARDS

Mr. FARR. Senator, I appreciate very much having the opportunity to be heard now, and I will try to be as brief as possible. I will read the statement, a copy of which you have.

The CHAIRMAN. Yes.

Mr. FARR. My name is Newton C. Farr. I live in Chicago. For 33 years I have been in the real-estate business, and I have handled all phases of that business-buying, selling, managing, financing, and building.

I appear here today as spokesman for the National Association of Real Estate Boards, of which I am a past president and a member of its board of directors. I am also president of the Urban Land Institute, a private research organization in the field of city planning, and although I do not speak officially for that group here at this time, what I have to say reflects the thinking of that organiza

tion.

I want to thank this committee for the opportunity you have graciously given our association to present its ideas on this legisla tion. While you have not always agreed with our point of view, and we have differed with some of the findings of your group, we appreciate the courtesy and the thoughtful consideration you have always accorded our suggestions. It is in that spirit of cooperative helpfulness that I appear before you today, and I hope that such comment as we can offer will be constructive and helpful to you and your colleagues in deliberations on this measure.

The bill before you deserves careful analysis and close study, involving as it does momentous questions of public policy. In a sense. it offers a new road down which the Nation might travel, but if we take that road, it will be difficult to turn back. For it sets up programs that will be operating for close to half a century and involves the payment of many billion dollars of public money for the housing of a relatively small proportion of the people. For that reason, the proposals, programs, ideas, and implications embodied in this measure ought to be fully understood by the public. I hope that this will be the case.

The National Association of Real Estate Boards cannot endorse this We in the real-estate business, whose job it is to provide the commodity of housing-to plan it, finance it, build it, and operate it-are keenly aware of the multiplicity of problems involved in the subiect of shelter. We have ever been hopeful that answers could be found to the complex and difficult questions revolving around the

rescue of our cities from slums and blight, and in the provision of more good housing to more of our families at lower costs. We would like to see every family in this country well housed. We would like to see the blight that is eating out the heart of our municipalities stopped. We would like to see every returning veteran coming back to a home of his own, where he can shelter his family and raise his children. We would like to see every other family that needs a dwelling find it. But we do not think that this bill can accomplish these things. I realize that it was the hope of the sponsors of this legislation that the programs proposed in the measure would accomplish these objectives. I am afraid, however, that these hopes would not materialize.

I will not take up your time with a point-by-point analysis of the bill. The various features will be amply covered by the many witnesses you are hearing. Therefore, I wish simply to state that we cannot endorse the measure and to prevent the principal points of our objections.

In general, we feel that with the Nation facing the most critical housing shortage in our history every possible effort ought to be concentrated by the Federal Government on clearing the way for production of houses and apartments. By that I mean it should direct intensive effort to eliminating the bottlenecks in production of materials, in price and wage disputes, in manpower, in ceilings, and similar matters. Every element necessary for opening up a truly big-scale home-building program to meet the extraordinary need is present and available except abundant materials and labor. Both of those things are complicated by various problems that demand coordinated action that can be given only by the Federal Government. The Government could encourage the building of vast numbers of dwellings by stimulating the faster production of materials; by settling labor disputes; by helping recruit manpower; by encouraging cities to put their building codes and zoning requirements on a reasonable basis; by crystallizing its attitude toward the construction industry so that industry will know where it stands and with what it must contend, and by holding consistently to a helpful policy. It would even restrict its own construction activities to only such public works or health projects as are absolutely essential, so that more materials could be channeled to the building of houses. In that way we could speed the production of housing. That is the real job that ought to be done. Even the most helpful provisions that have been included in this bill with respect to lower cost financing, for aid to rental projects, the streamlining amendments for the Federal Housing Administration and the Home Loan Bank Board will be absolutely meaningless unless the preceding things I have mentioned are done. The most favorable financing in the world will not of itself build housing if bottlenecks exist in labor, prices, and materials. All agencies must cooperate in helping the builder get under way.

It would not be exaggeration to say that this bill could well be laid aside for an interim period while all possible effort is directed toward production of housing right now. It has been said that this bill is one which will help relieve the housing shortage; that it is the answer to the grevious veteran housing problem. We cannot see that it will relieve the shortage in the slightest nor provide a single home for a

veteran. Its effect would not be apparent on the housing supply for more than a year at the earliest, and then it will be negligible indeed unless the immediate barricades that are holding up production first are wiped out of the way. You can't legislate houses into existence. They must be produced. If this committee concentrated its able efforts on the production problem, it could do the country an inestimable service.

We feel that instead of doing that you are studying long-range social problems. A program to meet those problems will not meet the immediate crisis we have on our hands today. Essentially this legislation is primarily a public housing bill with provision for general urban redevelopment. We should not be driving to put that kind of a program across under the circumstances. The veterans who have pitched tents in our cities, who are sleeping in automobiles in parking lots, are not going to be aided by the long-range social programs in this bill. What they need is houses now.

That is one general idea. Another is that this measure proposes to spend somewhere in the neighborhood of 512 billion dollars at a time when we can't balance the Budget and have little prospect of doing so. I believe the distinguished sponsors of this measure estimated that it will cost the Federal Government $133,000,000 a year. That is a lot of money, especially if extended over a period of 45 years. Fiscally, we feel this bill is extravagant.

A third general point we make is that in spite of the precautions written into the measure to secure local initiative, we feel that the bill can only insure Federal domination of our municipalities. The redevelopment programs it would create are federally dominated programs, even though the cities may initiate action themselves in accordance with the clear direction. Our cities would be in bond to the Government for years to come, whether they used the redevelopment sections or the public-housing provisions.

We feel that there is nothing in the Washington atmosphere which enables men in Washington to spend the funds of a local community and to direct the programs of a locality, better than those who live and do business in that local community. Yet the inevitable trend of the bill is in precisely that direction, no matter how many safeguarding provisions you can write in. If programs such as proposed in the redevelopment, public housing, and research sections are financed by the Federal Government, they will be operated under Federal direction. Let's not kid ourselves about that."

We do not believe it sound to increase Federal domination over local communities through strong central controls and programs.

Now let me be more specific about a number of the items in the bill. Senator ELLENDER. Would you permit me to interrupt you, sir? Mr. FARR. Yes, sir.

Senator ELLENDER. I notice a quotation that I have in my hand here from the National Association of Real Estate Boards. That is you, isn't it?

Mr. FARR. That is correct.

Senator ELLENDER. "Headlines" of February 23, 1942, stated [reading]:

The urgent need of coordinated Federal housing agencies was high lighted last week in hearings before the Senate Committee on Education and Labor when