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The cost to the individual in loss of wages, doctors' bills, and otherwise, is a serious matter, to say nothing of the absolute want to which it reduces many families and the suffering entailed. In addition to this, the country loses the wage earner's production. Sometimes death brings to the family permanent loss of income, and to the nation complete loss of the product of the wage earner's work. The nation spends large sums of money every year in providing for dependent families and individuals.
If each of the 38 million wage earners in the United States in 1910 lost 6 days from work in a year, how many days' work would the nation lose? How many years of work would this amount to?
At $2.50 a day (is this a high wage?) how much would be lost in wages in a year?
Get information regarding the cost of a long case of sickness, such as typhoid fever, in some family of your acquaintance (perhaps your own), including doctor's bills, medicines, time lost from work, etc.
What would such expense mean to a family living on as low wages as those mentioned on page 167?
EDUCATION AND PHYSICAL DEFECTS
Moreover, the nation loses a great deal (how much cannot be calculated) from the physical unfitness of many who keep on working, but who are not fully efficient because of bodily defects or ailments. We see the results of this even in school. Pupils who lag behind their mates in their studies are often suffering from physical defects of which their teachers, and even they themselves, may be unaware. It may be that they are ill-nourished, or that they have defective vision, or hearing, or teeth, or that they sleep in poorly ventilated rooms. The community does not get its money's worth from its schools if its children are not in physical condition to profit by them. In a similar manner earning and productive power are reduced.
PHYSICAL UNFITNESS IN RURAL COMMUNITIES
It has usually been assumed that the people in rural districts are more healthy than those who live in cities; but it has been found that there is as much physical unfitness there as elsewhere. It is true that the records of the war department seem to show fewer men rejected in rural districts as totally unfit for any kind of military service; but evidence of other kinds has been collected that indicates that some kinds of disease, at least, and many physical defects are more prevalent in the country than in the city. In THE LURE OF THE LAND, Dr. Harvey Wiley makes a comparison of the death rate from certain diseases in a few states where the figures are available for both city and country.
[Footnote: Dr. Harvey Wiley, THE LURE OF THE LAND, Chapter VIII, "Health on the Farm," pp. 53-60.]
RURAL AND CITY SCHOOL CHILDREN COMPARED
Studies have been made of the comparative health of city and rural school children, which show results in favor of the former. Of 330,179 children examined in New York City 70 percent were found defective, while of 294,427 examined in 1831 rural districts of Pennsylvania 75 per cent were defective. The preceding chart shows the comparative prevalence of health defects among city and country children.
Investigate the following:
Meaning of "vital statistics." Importance of vital statistics to your community. Where recorded for your county or town. What the vital statistics of your community for the last year show.
Causes of deaths in your community for the last year. The percentage of these deaths that were "preventable." Increase or decrease of death rate in your community during recent years, in your state.
The nature of the prevailing sicknesses in your community during the last year. Per cent of these that were contagious. List of contagious diseases in the order of their prevalence.
Quarantine regulations in your community against contagious diseases. Extent to which they are observed. Who is responsible for their observance? For their enforcement?
Observe condition of sidewalks and other public places with respect to expectoration. Is there a law on the subject in your community'? Is it observed or enforced? Who is responsible? Dangers from expectoration.
Medical inspection in the schools of your county, town, and state. If any, its results. Kinds of defects most commonly found. How is it conducted? Who sends the inspectors? To what extent the homes of the community cooperate with the schools in getting results from medical inspection.
BETTER CONDITIONS IN CITIES DUE TO ORGANIZED TEAM WORK
We may well ask why ill health and physical defects seem to be more prevalent in rural communities than in cities. The answer probably is, simply, that in cities they are PREVENTED more effectively. The chart on page 313 shows that while the death rate in New York City was 20.6 per thousand in 1900, it had declined to 14 per thousand in 1914; while that in the rural districts of New York State remained practically the same during these years (15.5 per thousand in 1900, 15.3 in 1914).
This indicates that health conditions in the city were originally much worse than in the country. They were rapidly improved by organization for health protection. There is not the occasion, in rural communities, for the elaborate health-protecting organization that is now found in all large cities, because the people in rural communities are not so completely dependent upon one another nor at the mercy of conditions over which, as individuals, they have no control. And yet even in rural communities physical well-being depends largely upon organized team work.
SCHOOLS AS AN AGENCY FOR HEALTH CONSERVATION
Cities have used their school organization to combat physical defects and weaknesses of pupils, and that is why they make a better showing than rural communities in such matters as those shown in the table on page 312. Removing such defects from young people means a stronger and more efficient adult population ten or twenty years from now; for these defects are often the causes of more serious illness in later years. The table on page 299, Chapter XIX, shows how much behind cities rural communities have been in the use of their school organization for this purpose. The encouraging thing is, however, that rural communities are beginning to find the means to use their schools in this way. The way has been opened by school consolidation (p. 295), by the grouping of all the small and isolated schools of a county under a central county administration (p. 294), by aid from the state, both in money and in supervision, and by cooperation from the national government.
HEALTH EDUCATION FOR ADULTS IN CITIES
Cities have extended their health-educational work to the adult population. This takes place in part through the schools also. Instruction given to children is of course taken home by them. Visiting nurses employed by the schools visit the homes. Classes for mothers are conducted at the school in the afternoon or evening. But more than this, city boards of health, often in cooperation with the school authorities, conduct educational campaigns by means of literature distributed to the homes through school children, by means of evening lectures and moving pictures, and through the newspapers.
AGENCIES FOR HEALTH EDUCATION IN RURAL COMMUNITIES
Means are not wanting for similar work in rural communities. The homes may be reached by the right kind of instruction in the schools. The classes or clubs for women conducted by women county agents may be, and often are, used as means of health instruction. Public meetings at the "community center" at the schoolhouse may be devoted at times to public health problems, with lectures, moving pictures, and discussions. The local newspapers always afford a channel through which to get matters of this kind before the people. Local and state boards of health, the United States Department of Agriculture, and the Public Health Service may and do use these and other agencies to reach the people.
RESPONSIBILITY OF THE HOME
No matter how much machinery for cooperation we may have in our community, like that described above, it cannot help much unless every family and every citizen cooperates intelligently.
In a large city, a small group of men, constituting the city council, may inaugurate measures which will accomplish sanitary improvements at thousands of homes; but for the accomplishment of sanitary improvements at 1000 farm homes at least 1000 persons ... must be convinced that the sanitary measures are needed, become informed how to apply them, and be willing to put them into operation.
[Footnote: RURAL SANITATION, by L. L. Lumsden, Public Health Bulletin No. 94, United States Public Health Service, p. 10.]
THE IMPORTANCE OF PURE AIR
Pure air is essential to good health. It is not always easy to get in the crowded living and working conditions of cities. There it is necessary to regulate these conditions by law, and factories and tenements are inspected to see that they are properly ventilated and not overcrowded. In rural communities there is less excuse for bad air, and the responsibility for it rests more directly upon the individual, as illustrated on page 112, Chapter X.
BAD AIR AND THE SPREAD OF DISEASE
It might seem that it is nobody's business but our own how we live in our homes or at our work. But bad air lessens vitality and nurtures disease. This reduces productive power. Moreover, colds, influenza, and tuberculosis (of which more than a million people are constantly sick in the United States), all of which are
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