HEALTH OF THE NATION

LOWEST DEATH-RATE. LENGTHENED SPAN OF LIFE.

Many striking and encouraging facts emerge from the comprehensive review of the national health embodied in the annual report of Sir George Newman, chief medical officer of the Health Ministry. It is a record of continued progress and ever-widening activities on the part of the public health services. Much has been achieved in the domain of preventive medicine; the ravages of disease have been lessened; the rate of mortality has been substantially lowered, and the span of life has appreciably increased. But there is still a vast mass of largely preventable invalidity which seriously impairs the physical capacity of the industrial population, and constitutes one of the most important factors in the national health problem. Dealing with the objects and the organisation of preventive medicine, Sir George emphasises that the function of the Health Ministry is to supervise and co-ordinate; the main business of the execution of a national health practice rests with the local authorities. Maternity, child welfare, industrial hygiene, and sanitary environment, the prevention and cure of disease, the education of the public – these matters can only be dealt with directly where the people live. In England, much is also accomplished by a vast output of voluntary effort. It is invaluable.

STRICT ECONOMY.

In this sphere there has been since the war an enormous development incomparably greater than anything like it in the past, and to this must be attributed in large degree the insistent demand for efficiency of the public medical services. If the nation desires to secure a high measure of public health it is obvious that we must pay for it. For public health is purchasable. It is also clear that in the present state of national finance the expenditure cannot be allowed to increase indefinitely, and that the very strictest and most rigid economy must be practised. The public expenditure in dealing with tuberculosis, venereal diseases and maternity and child welfare has inevitably grown to serious proportions, and, though relatively small (only 1 per cent. of local rates), as compared with that of other services, it is absolutely essential that no money should be laid out which is not immediately necessary in the interest of the public health.

In a true sense the nation can buy health, but the “goods” are not delivered on the date of payment. Public expenditure on national health is like expenditure on a lifeboat or a fire engine; even more, it is like a long-term investment. It yields its interest with absolute certainty a thousandfold, but only in the course of years, and sometimes only in the course of generations. It is money hidden in maternity, in good schools, in pure food, in clean streets, in sanitary houses, in an abundant water supply, in dispensaries, hospitals, and sanatoria, and in the vast network of a sanitary and protective cordon in every village and city in the land. Its efforts are unappreciated until they are withdrawn. Yet without this investment the nation is bankrupt. Sometimes one hears the idle question, “What is the use of all our expenditure on health?” It is often asked by persons who do not reflect that their welcome presence among us, alive, alert, and competent, is itself the answer. They might probably not be here if it were not for the expenditure of the sanitary rate. In point of fact, millions of persons are not here in the world to-day. They died in 1921 because there was no sanitary service in Russia and elsewhere available to save them. The conquests of preventive medicine are among the greatest victories of man’s mind. Even the pages of this brief report tell a wonderful story of saved lengthened days undreamt of by our forefathers. We must conserve and retrench and economise at every turn; but we must not be so unwise as to spare the money necessary to the vitality, virility, and capacity of the nation.

LOWEST MORTALITY.

There were 848,814 births in England and Wales in 1921, yielding a rate of 22.4 per 1,000 of population, a decline on 1920 of 3.1. Deaths numbered 458,629, representing a rate of 12.1 per 1,000, against 12.4 in the previous year. This is the lowest rate on record. As in former years, the principal causes of mortality have been diseases of the heart, diseases of the nervous system, cancer, pneumonia, bronchitis, and tuberculosis. Whooping cough was slightly more fatal, while measles and diphtheria caused fewer deaths than in 1920. As many as 187,050 deaths, or 40.8 per cent. of the total, were of persons under the age of 45. The decline in infant mortality to 83 per 1,000 births in England and Wales in 1921, and to 88 per 1,000 births for the quinquennial period 1917-1921 is regarded as remarkable. The figures mean that (calculated on the average infant mortality of 1901-10) there was in 1921 a further saving of 38,000 infant lives. They also imply a better physical condition in children from 1 to 5 years of age and a more enlightened understanding of private and public hygiene. There is, however, still room for further reduction before a reasonable standard has been reached. Discussing the effect on the average length of life of the declining death rate, which has been falling for more than a generation, the report states: According to the English life tables the average lifetime of a population which died out at the rates experienced between 1838 and 1854 would be nearly 40 years for males and just under 42 years for females. According to the mortality of 1910-12, the average lifetime (or “expectation of life” at birth, as it is called) would be 51.5 years for males and 55.35 years for females. This is a great difference – 11 years increase of life for males and 12 for females – and the improvement between 1901-10 and 1910-12 was more than in the twenty years between 1871-80 and 1891-1900. This is a very satisfactory general result. It is not perhaps strictly accurate to say that on the average a baby born now will live 12 years longer than his grandfather, but the statement is certainly not wide of the truth.