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some measure of such planning as a requisite to urban redevelopment grants by the Federal Government; modification of the equivalent elimination provisions of the National Housing Act of 1937; encouragement to mutual and cooperative housing companies.
Now I want to discuss very briefly-and I am coming to the endsome suggestions with regard to the present bill. There is one provision about it that we are disturbed about, and that relates to section 701, the 20-percent gap between private and public housing. This section now requires "that a gap of at least 20 percent" be left between the upper rental limits for admission to the proposed low-rent housing and the lowest rents at which private enterprise is providing "through new construction and existing structures" a substantial supply of decent, safe, and sanitary housing.
This section seems to mean that there can be no public housing in this 20-percent gap if a substantial-but not necessarily an adequatesupply of existing housing at moderate rentals is available. It is not required that any new housing at such rents be provided, if we read it correctly. Under this limitation it seems to us this gap will exist almost indefinitely and that the needs in this sphere will go unmet. If a gap is to be required, at least the gap should be between the lowest rents provided in a substantial amount of new private housing and the highest rents in public housing.
Even if so modified, we cannot agree that this requirement that a gap must be left is sound. In our view, a comprehensive program for the Nation should aim to meet the needs of all the families-not preclude one-fifth of our people. Our contention is that the rent ceiling of public housing should be the floor of rents in new private construction. This would be a variable criterion. As soon as private enterprise achieves lower rents, then public housing would have to limit itself to a correspondingly lower income group. The present provision necessitates a permanent and continuing 20-percent gap. That in our judgment is not wise public policy.
At the end of 5 years after the bill has been enacted, if it has this provision, certainly private enterprise will have had ample opportunity to demonstrate its ability, with substantial Federal aids, to produce housing for lower-income groups. At that time the council gives notice that if a gap provision is incorporated in the final bill, it will urge with all the force at its command that any gap be completely eliminated.
Another suggestion: At present the National Housing Act of 1937 requires that to be eligible for public housing, families must be in the low-income group and must be living in substandard housing. We believe this act should be amended to provide that families of low income, if they are paying too large a percentage of their income for rent-say 30 percent or more-should be eligible as public-housing tenants even though they are living in standard housing. 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. And you will see that from figures submitted by Mr. Blandford's office. Now I am speaking as a health person. 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. In other words, if I had to choose as to whether a family had to live in a bad house or on a substandard diet, I would let them live in the bad house because the substandard diet is more fundamental and will more quickly cause deterioration in health. Yet in these situations that I am referring to, 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.
In conclusion: The housing councils, we believe, represent the conscience of the thoughful, civic-minded citizens of their communities in housing matters.
Experience through the years amply demonstrates that our efforts to solve our housing problems at the community level cannot succeed. We concur in the view that the initiative and the responsibility should rest with local communities, but they must have the kind of Federal assistance proposed in the general housing bill of 1945.
And the communities represented in the Ohio Housing Council and the Citizens Housing Councils are Cincinnati, Boston, Baltimore, Detroit; Rochester, N. Y.; New York City; Chicago, Pittsburgh, Philadelphia, and Washington, D. C.
Thank you very much. If there are questions, I shall be glad to answer them.
The CHAIRMAN. Any questions?
Senator MITCHELL. You have made a fine statement.
The CHAIRMAN. Yes. Thanks a lot. Very informative. We are mighty glad to have heard from you, Mr. Marquette. (Mr. Marquette withdrew from the committee table.) (The matter referred to is as follows:)
THE INFLUENCE OF HOUSING ON HEALTH
(By Bleecker Marquette, fellow, American Public Health Association, and member of its committee on the hygiene of housing; executive secretary, Cincinnati Public Health Federation; chairman, joint committee on health and housing, American Public Health Association and National Association of Housing Officials)
(Presented at hearing on S. 1592 before the United States Senate Committee on Banking and Currency, December 5, 1945)
In considering the question of health and housing relationships, perhaps the first essential is to define terms.
The objective of the housing movement today is more than sanitary shelter. It is the provision of good homes-meeting the requirements of healthful, safe, and comfortable living-in a wholesome physical environment providing openness, indoor and outdoor space for recreation and play, and other essential amenities, and with freedom from excessive noise, dust, and traffic hazards.
Likewise, the objective of the public-health movement is broader than the prevention and cure of disease. It embraces also the promotion of physical and mental well-being and efficiency.
Looked at thus, in the broad view, the relation of housing and physical environmen to physical and mental health is too obvious to require statistical proof. Probably no public-health authority of standing would question it. Every dictate of common sense and experience indicates it. The committee on the hygiene of housing in its Essentials of Healthful Housing has indeed set forth 30 ways in which housing does affect health, together with specific recommendations as to how essential health principles can be achieved in the provision of housing.
"There can be no question that bad housing contributes to our health problems," Dr. Carl A. Wilzbach, health commissioner of Cincinnati, stated in a recent paper. "Tuberculosis, for example, and other contagious diseases, are spread from person to person, and room overcrowding certainly facilitates the procedure. The newer knowledge of droplet infection and the spread of virus diseases are proof of the danger of air-borne disease," he states.
"The value of sunlight as an aid to health and the prevention of disease, both mental and organic, is well established and beyond question. It is lacking in much of our old housing.
"Bad plumbing, including cross connections, broken pipes, back syphonage, and insanitary toilets have all been known to spread disease.
"Improper heating and ventilation affects health, make certain disease conditions worse, and slow recovery from illness.
"Rats are usually found in far greater numbers in slum areas. Many serious diseases are caused by rats.
"The report of the Cincinnati Department of Health for 1944 showed that out of a total of 373 deaths from tuberculosis in the city, 44 occurred in census tract 5, with a population of about 10,000. (This is the tract with the poorest housing and occupied almost entirely by Negroes.) Other census tracts in the downtown congested sections have high rates. While a number of other factors play a part, there is no doubt that bad housing and room overcrowding contribute to these unfavorable death rates. A recent tour of the congested West End by members of the board of health revealed neighborhoods with rat-infested buildings, scattered refuse, intolerable sanitary conditions, buildings unfit for habitation. Improvement of housing conditions would certainly improve the health of families in these areas."
This is the testimony not of a housing specialist but of a health officer.
As was brought in testimony before the Senate subcommittee, city after city has made studies which show high rates of infant mortality and of mortality from enteritis, communicable diseases, and tuberculosis in areas of bad housing and low income. This does not establish the exact extent of the effects of bad housing in relation to the many other contributing factors that enter into the picture. However, when these two factors are so consistently present in areas where high mortality rates from these diseases prevail, then the presumptive evidence that these factors are contributory causes to the spread of these diseases is very strong indeed. Whether low income or bad housing plays the greater role is something else, and upon that question these studies throw no light.
EVIDENCE FROM THE NATIONAL HEALTH SURVEY
Rollo H. Britten, senior statistician, and Isidor Altman, research analyst, of the United States Public Health Service, in a paper on Illness and Accidents Among Persons Living Under Different Housing Conditions (March 1941), reviewed data from the National Health Survey (1935-36). This Survey accumu lated facts on illness and on housing conditions by means of a house-to-house canvass in 83 cities. Some conclusions from the Britten-Altman analysis I summarize as follows:
1. The percentage of persons disabled annually for a week or longer was higher in crowded households with more than one and a half persons per room than in other households among families on relief and among those with incomes under $1,000 but not on relief.
2. There was a striking increase in the pneumonia rate with increased crowding, especially in the relief group and in the nonrelief group with annual incomes under $1,000.
3. Among families on public or private relief it was noted that the tuberculosis rate rose sharply with increase in crowding despite similar economic status.
4. The rate of certain digestive diseases for persons in households without private inside flush toilets showed a marked increase over the rate for persons in households having such facilities.
5. Frequency of home accidents disabling for a week or longer increased as the rental of the dwelling went down. (Within limits, rents are a useful index to housing conditions.)
"The many complicating factors, the effect of which cannot be eliminated satisfactorily difference of income, race, industrial hazards, educational and intelligence level, housekeeping efficiency, to name but a few-constitute a serious limitation upon the interpretation of the data," the authors properly point out.
"In this report," they state, "an attempt has been made to eliminate the effect of economic differences by making comparisons within certain broad income classes * but the complete isolation of the effect of housing itself has not been possible nor is it possible from any data now available to draw a definite conclusion as to the precise role of housing per se in the illness experience of lowincome families.
"This does not mean that bad housing does not affect health," the report affirms. "It is well recognized that there are certain essentials of a healthful home environment-a sufficient supply of pure water, sanitary sewage disposal, sufficient ventilation and light, proper heat provision and control, space enough for family living, absence of excessive dampness, screening against mosquitoes and flies, freedom from avoidable fire and accident hazards, adequate playgrounds and sunshine for children. They are present only under conditions of good housing." We have enough knowledge right now to blot out tuberculosis as a major enemy of the public health. Our efforts in that direction are greatly impeded so long as people continue to live in slums and on income that is insufficient to permit of a healthful standard of living.
THE INFLUENCE OF OVERCROWDING ON THE INCIDENCE OF PNEUMONIA
In a paper printed in the Ohio State Medical Journal, December 1940 (Drs. Julien E. Benjamin, James W. Reugesser, and Mrs. Fanny A. Senior) on the influence of overcrowding on the incidence of pneumonia the results of a study of pneumonia in Cincinnati with special reference to general hospital cases and a table showing a significant relation between overcrowding and the pneumonia death rates in 19 large cities are presented. The conclusions are stated as follows: "1. From the 107 census tracts composing the population of the city of Cincinnati, the general hospital treated 343 patients with pneumococcus infection in 1935-36, 437 in 1936-37, and 503 in 1937-38.
"2. In the latter period, residents of 17 tracts, representing 25 percent of the total population of the city, accounted for 65 percent (821) of these patients. "3. These tracts represent the area of the city where overcrowded living conditions are greatest.
"4. Overcrowding is considered an important contributing cause of the pneumonias.
"5. A correlation table is presented showing relations between overcrowding and the pneumonia death rates in 19 large cities."
TABLE 3.-Pneumonia and overcrowding (pneumonia studies)
Professor Thomas J. LeBlanc of the department of preventive medicine, college of medicine, University of Cincinnati, constructed a correlation table to determine whether the relation of overcrowding to pneumonia rates was apparent or real. Explaining the correlation table, Dr. LeBlanc is quoted as saying, "From the relative position of the cities arrayed on the basis of their respective consolidated crowding indices, it may be inferred that there is a positive relation between degree of crowding and deaths from pneumonia, or to phrase it another way, the force of mortality from pneumonia seems not to be independent of crowding."
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.
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