AMERICAN FEDERATION OF WOMEN'S AUXILIARIES OF LABOR, Hon. JAMES E. MURRAY, Chairman Committee on Education and Labor, Senate Office Building, Washington 25, D. C. DEAR SENATOR MURRAY: I am grateful for your invitation to submit the enclosed statement to the Senate Committee on Education and Labor in support of the National Health Act, S. 1606. Very sincerely yours, Mrs. HERMAN H. LOWE. STATEMENT OF MRS. HERMAN H. LOWE, PRESIDENT OF THE AMERICAN FEDERATION OF WOMEN'S AUXILIARIES OF LABOR In support of the National Heath Act (S. 1606) April 16, 1946 Mr. Chairman and gentlemen of the committee: In appealing to you for favorable consideration of the National Health Act (S. 1606), I am cognizant of the fact that I am unqualified to delve into the technicalities of the legislation. However, the need for such health protective measures, as the bill offers, is so great for the nation as a whole and wage earners and their families in particular, speaking as president of the American Federation of Women's Auxiliaries of Labor (A. F. of L.), I should like to call your attention to a few reasons why the enactment of this measure is imperative. As wives, mothers, sisters, and daughters of wage earners, it falls our lot to watch the family budget and the family's health. It is we who, all too often, diagnose Jimmy's or Susie's childish ailments as measles, croup, or a cold and proceed to doctor according to our most successful methods, because the budget does not permit professional diagnosis and medical treatment at the hands of a physician. We know, of course, that there are many pitfalls in doing the family ailment labeling. For instance what yesterday seemed to be only a bad headache for Jimmy may be polio by tomorrow-Susie's cold may already be pneumonia or the early stages of tuberculosis, grandma's pain in the chest or left arm may be a slight or acute heart trouble, the lump we massage as a possible bruise or superficial enlargement of a muscle may be a breast cancer or the violent stomach ache of the husband, we doctor with laxatives and hot and cold packs, may be a ruptured appendix. The homemaker is, for the most part, versatile. Proficient in many details besides the duties of what the word homemaker implies, including home nursing, but there never was a wife or mother who did not realize at times that her homenursing ability was far from adequate to match the gravity of certain situations. Yet, because physicians have to be paid for their services, which is right, and hospital bills must be met, which is as it should be, the homemaker takes a look at the family till when sickness strikes her family and decides to exhaust every known remedy before calling the doctor and perhaps visiting a loan shark for funds with which to pay the bills. A little set aside from the weekly pay envelope to provide for health insurance would eliminate many anxious moments when sickness invades the home and make possible ready funds for hospitalization when special treatment is indicated. We of this Nation are proud to say we are all Americans, regardless of race, creed, color, or social standing. Likewise, we are all human beings by the handiwork of nature, regardless of race, creed, color, or social position-subject to the same ills and body weaknesses. America, as a nation, can be no stronger than its people are physically. It is unjust for a small percentage of our people to have access to the best medical and hospital care simply because they can afford it, while the majority have to jeopardize their well-being by shopping around for a doctor whose services they can afford and be forced to forego proper hospitalization for the same reason. Under the provisions of S. 1606 truly we could say, "We are all Americans." It is not my purpose to place undue blame on those of the medical profession for existing laxities, but I know of a number of instances of child-birth cases, in low-wage families, where we are forced to admit that instead of making health progress we are reverting to the midwife era. Cases where mothers have not been admitted to a hospital until a few minutes before delivery occurred-allowed to remain in the hospital for 3 days, sent home where there was no one to wait on either mother or baby except the father and the other children. The physi cians did not see mothers or babies after leaving the hospital. I know of other cases where physicians did not keep in close enough touch with prospective mothers to prevent babies from being born en route to hospitals or before leaving home, where nothing was in readiness for such an event. Yet another practice which would be funny if it were not so ridiculous; prospective mothers are rushed to a clinic-baby delivered-rushed home again without so much as seeing, let alone occupying a hospital bed. All told, less time was given to the borning of these future presidents than to people who have funds for the strapping of a sprained ankle and much less time than for an ordinary tonsillectomy. Another story of what happens to those unable to pay for hospitalization is that of a grandfather who was hospitalized for prostate gland treatment. A large catheter was inserted through the abdomen, with a process of irrigation necessary as daily treatment. When he reached the limit of his ability to pay. grandpa was sent home with only neighbors available to do the nursing-irrigating and dressing of the incision. The man lived about 6 weeks. Had he been able to afford it, doubtless, hospital care would have prolonged his life. Simmered down, the adage money talks is a profound truth where the Nation's health is concerned. I know a 10-year-old boy who can't run or play with other boys any more because his father couldn't afford a second operation. The lad was accidently shot in the stomach while hunting with some other boys, too young to know how to use guns. Removing the bullet was a difficult job and complications developed. A metal plate was inserted in the boy's middle and he was sent home because the father couldn't afford the second operation to correct the trouble. The boy now seems doomed to wearing his armor-plate for the rest of his life for his father died last year from blood poisoning, following a pricked finger accident on his job. He couldn't afford medical care, so he doctored his finger himself until it swelled out of all proportions and he could do nothing to decrease his intense temperature. He visited a physician then-but it was too late. Here's a broken family, an American family, for your consideration. A father who could still be alive and a young son who would be able to run and play like other boys if the provisions of S. 1606 had been in existence. Numerous other cases among low-income groups, the country over, could be presented in support of the dire need for the acceptance of President Truman's plea for the enactment of the National Health Act, but the cited instances herein presented are sufficient to show that a sad lack of health provisions exists. For the security, peace of mind and well-being of all Americans, I urge your most sincere consideration of and favorable action for the enactment of S. 1000, thus giving all the citizens of the Nation a chance to keep physically fit. The CHAIRMAN. Dr. W. Montague Cobb is the next witness. Dr. Cobb, will you state your full name and the organization that you represent, for the purpose of the record? STATEMENT OF DR. W. MONTAGUE COBB, REPRESENTING THE NATIONAL MEDICAL COMMITTEE OF THE NATIONAL ASSOCIATION FOR THE ADVANCEMENT OF COLORED PEOPLE Dr. COBB. My name is William Montague Cobb. I am a physician, professor of anatomy in the School of Medicine of Howard University, president of the Medico-Chirurgical Society of the District of Columbia, and I am appearing as a member of the National Medical Committee of the National Association for the Advancement of Colored People. The CHAIRMAN. You may proceed with your statement. ENDORSEMENT OF S. 1606 Dr. Cовв. Mr. Chairman and members of the committee: It is my honor to represent, as a member of its national medical committee, the National Association for the Advancement of Colored People, in support of the national health bill, S. 1606. The national association, founded in 1909, has over 520,000 members, organized into 1,200 branches, youth councils and college chapters in 43 States. It is the oldest and largest organization devoted to the securing of equal rights and opportunities for the more than 14,000,000 citizens who constitute America's most disadvantaged tenth. In its constant attention to the job for which it was organized and to which it is unswervingly committed, the NAACP knows it is safeguarding the democratic privileges of all American citizens, and at the same time is defining America in terms of democracy to the rest of the world. The association approaches the problem of health in the interest of the common welfare. Numerous comprehensive and detailed studies have adequately defined, proved and stressed the urgent need of proper medical care for all Americans. No program previously proposed or instituted has indicated ability to close the gap between advances in medical technology, on the one hand, and the social and economic arrangements by which medical services are made available, on the other. President Truman's message to Congress of November 19, 1945, marked the first time in our history that a full length presidential message has been devoted exclusively to the subject of health. This message reflected significantly both the importance of the problem and the exhaustive consideration which all its aspects had received. The President recommended legislation embodied in the present bill. This association is most acutely aware of the need for such legislation in respect to that segment of the population which it primarily represents. It cannot be overemphasized, however, that health is not a racial problem, that the health conditions of Negroes are largely a reflection of their socio-economic circumstances, and that poor health in any segment of the population is a hazard to the Nation as a whole. In the 7 years since February 1939 when the first national health bill, S. 1620, was introduced in the Senate, the salient facts about all phases of our national health have become public knowledge, so that topical reference to a few items will suffice to establish background for the national association's advocacy of the present bill. HEALTH PROBLEMS OF THE NEGRO Even though health conditions in the country as a whole are far from satisfactory, the plight of the Negro is worse than that of the white. In 1940, the latest census year, the standardized death rate for the country was 8.2 per 1,000 for whites and 14.0 for Negroes, a mortality rate 71 percent higher than the white. In 1930 the Negro excess was 82 percent. In that year, the Negro mortality in the registration States was 81 percent higher than the white in rural areas and 95 percent higher in cities, a fact of especial significance in view of the continued urban migration of Negroes. In 1940 the life expectation of Negroes at birth was about 10 years. less than that of whites, the expectancy being for males, 52.26 years in Negroes and 62.81 years in whites, and for females, 55.56 years in Negroes and 67.29 years in whites. The consistent population increase shown by the Negro in spite of the high mortality and morbidity he has suffered has been due chiefly to his high birth rate which in 1942 was 23.3 as compared with 20.7 for the white. But the reproductive process in the Negro is attended with almost double the rate of casualties that prevails in the white. In 1942 the Negro maternal death rate was 5.5 and the white 2.2; the Negro infant mortality rate was 64.2 and the white 37.6; and the stillbirth rate was 50.5 in the Negro and 25.5 in the white. In retrospect, this approximately current unfavorable health pieture shows considerable improvement over the past. The Negro mortality rate has declined from 24.1 in 1910 to 14.8 in 1943. Since 1910 Negro life expectancy has increased about 10 years or 25 percent. There has been significant decrease also in reproductive mortality. Under similar environmental conditions there should be no appre ciable racial differences in mortality or life expectation. The circumstances attending the arrival of the Negro in America as well as those under which he has lived here both connote an inherent constitutional hardihood. Certainly, a people which has contributed Paul Robeson, Jesse Owens, Joe Louis, Henry Armstrong and a galaxy of athletes of similar caliber, cannot be said to be genetically lacking in physical stamina. The NAACP has two chief points of interest in the profile of Negro health just outlined, first, that the excess Negro mortality and concomitant morbidity are due to preventable causes, and second. that as improvements are achieved, the Negro generally lags behind the white, indicating that he does not share as rapidly or as fully in the application of medical advances, even though the general progress is far from optimal due to conditions the present bill is designed to correct. Direases for which the cause and mode of transmission or development are known, and for which a specific control program has been established are preventable. Nearly all diseases showing excess mortality in the Negro fall into this category. High occurrence of these conditions is also associated with any group of low economic status where there is ignorance, overcrowding, poor nutrition, bad sanitation and lack of medical care. The National Health Survey of 1935-36 found that the amount of disability per person due to illnesses which incapacitated for a week or longer was 43 percent higher in the Negro than in the white population. The higher disability rate for Negroes was due chiefly to chronic diseases which disabled the average Negro 8 days per year compared with 5 days for the average white person. The higher rate was observed for all disease groups. Pneumonia was almost twice as frequent in Negroes as in whites, and certain chronic diseases-the cardiovascular-renal group, rheumatism, and asthma, and hay feverwere of significantly higher rate. The survey noted that improvement of standard of living associated with a rising income increased the health status of Negroes as measured by various indicia of illness. The average Negro in the nonrelief class experienced only one-half the disability per year as the Negro on relief. The survey concluded that low economic status. rather than inherent racial characteristics in reaction to disease ap peared to account principally for the higher disability rate in Negroes In the light of these facts, the NAACP has a natural and vital interest in any measures which make for the improvement of the gen eral health, particularly that of the economically poorly circumstanced. The first part of S. 1606, title I, part A, providing for measures against venereal diseases and tuberculosis, deals with preventable conditions associated with law economic status which unduly ravage Negroes. The tuberculosis mortality rate in the Negro is more than three times that in the white. It has been stated that syphilis occurs six times more frequently in Negroes than in whites. Because of the unfortunate tendency on the part of many, including even some health officials, to make invidious racial implications from such data, it is desirable to quote a statement from H. H. Hazen's authoritative monograph, Syphilis in the Negro. The problem transcends racial boundaries. Where the Negro syphilis rate is high, the rate in the white group as well is likely to be unusually high. One finds, by comparison of these areas with those having lower rates for both Negro and white, that a less vigorous effort has been made to control the disease. Treatment facilities in the areas of high prevalence prove to have been inadequate and largely inaccessible. Likewise, the public is not well informed on the value of early and adequate treatment in arresting the disease and in preventing its spread. And he reaches the conclusion that the most outstanding characteristic of these areas of high prevalence is a low economic status in a large proportion of the population * Despite the alliance of syphilis and poverty, syphilis has receded wherever the people have been informed of the methods of prevention, detection, and cure, and meanwhile, provided with facilities for obtaining treatment irrespective of their financial status. The same spirit of cooperation from the people has been manifest in the application of newer techniques for the control of tuberculosis. Communities tend to welcome such measures as mass X-ray surveys when they have been made to understand the objectives. Tuberculosis mortality in white adults has declined at a more rapid pace than the total death rate from the beginning of the century through 1943, the last year of available data. This was true also in Negro adults until 1935. From 1935 through 1937 the rate of decline was essentially the same as that of the total death rate, but beginning with 1938 and for each subsequent year the decline in tuberculosis mortality has been less than that of deaths from all causes. This would indicate that since 1938, progress against tuberculosis mortality in the Negro has not been as satisfactory as against deaths from all other causes combined. Title I, part B, providing for grants to States for maternal and child health services, like part A, deals with a phase of health where the Negro has vital need. In this group, between 1915 and 1942 maternal mortality rate had been reduced from 10.6 to 5.5; infant mortality from 181.2 to 64.2; stillbirths from 73.4 (1922) to 50.5. Yet, as already stated, these final figures are approximately twice the comparable rates for the white. More than four-fifths of Negro babies are born in the Southern States; two-thirds are born in rural areas; four-fifths are born in States where per capita income is below the national average. The wholehearted acceptance by the Negro of health facilities so far made available warrants all possible development and expansion of activities which will bring Negro mothers safely through childbirth and Negro infants safely through the first year of life. |