Official proceedings of the annual meeting: 1923

DISEASE AS A FACTOR IN POVERTY-BURRITT

8I

tical report of the Association for Improving the Condition of the Poor for the six
months' period ending March 31, I923. The visitors and nurses of the association, in
their reports, indicate what are discovered as the leading health and social problems in
the families under their care. Inasmuch as poverty is seldom the result of a single
factor alone in any given family, one may find several health problems as well as several
social problems as accompanying factors in each family. As a matter of fact, in dealing
with 3,875 families that were under care during this six months' period, there were
5,613 separate important health problems listed by visitors, and 3,643 different important social problems. Tuberculosis was listed, for example, 839 times in the 3,875
families, meaning that tuberculosis was present as a complicating factor in 539 of the
families. Cardiac problems were listed in I63 of these families; venereal disease, in
268 families; definite mental or nervous disease or mental defectiveness, in 299 families.
Blindness appeared as a problem in 84 families; paralysis or crippled condition, in 9I
families; rickets, in 236 families; convalescence, in II6 families; acute physical disability, exclusive of the general disabilities already referred to, in 8I5 families; and so on
through the whole list of health problems.
Similarly, under social problems, widows with dependent children appeared as a
social problem in 444 problems; old age, in 206 families; unemployment, in 471 families; desertion, in 212 families; non-support, in II8 families; death of the wage-earner
other than husband, in 75 families; and so on with a group of social problems.
Similarly, in listing the health services rendered during this six months' period,
there were 6,524 definite health services rendered, as compared with 2,940 social services rendered. These health services included diagnostic clinic examinations; physical treatment at hospital, sanitarium, out-patient department, preventorium, or by
private physician; or maternity care, nutritional care, dental care, convalescent care,
and so forth.
It is not intended by citing these figures to balance the one group of health factors
carefully against the other group of social factors, because it is readily realized that one
health problem may be ten times as important as another health problem or may be
more important or less important than one of the social problems involved in a given
family, but a careful examination of the whole statistical report does give one clearly
the picture that health problems are of fundamental importance in the work of any
family-welfare association; indeed, they seem to the writer to be of much more significance than is recognized in current practice in dealing with poverty problems.
Responsibility of family-welfare agencies.-If these data mean anything, for example, they would mean that the further reduction of mortality and the accompanying
reduction in morbidity from tuberculosis would be of the greatest significance for familywelfare work. When we realize that the tuberculosis death rate in New York City
has been more than cut in half in the last two decades, and bearing in mind what I
have said about the relation between tuberculosis and the necessity for relief, we appreciate that already family-welfare organizations in New York City, public and private,
are, by the very fact of the decline in the tuberculosis death rate alone, made more able
to deal with the existing poverty that is left than they were in I903. I cite tuberculosis
because it is probably still the major health problem involved in poverty. It is a
disease of long duration, in which the bread-winner has a protracted period of chronic
illness before his death. It takes a family with exceptionally stable, economic background to be able to withstand the economic effects of a two- or three-year period of
continuous illness of its bread-winner without any income from this source. A very