On the Association between Health and Social Problems in the Population: I. Methods and Preliminary Findings

Abstract

The purpose of this first paper is to describe the statistical design and some findings of an investigation aimed at measuring the degree of association between (a) the health status of the families of a community, and (b) the number and kinds of their social and welfare problems that have required attention by community agencies. That a relationship exists between health and “socio-economic” status is inferred from the many studies which indicate that, (1) some illnesses are found more frequently, have longer duration of disability in one or the other social or economic segments of the population, (2) a large proportion of persons on public assistance has health problems. The meaning of this relationship requires considerable clarification if it is to serve as a basis for community action. The fact that a large proportion of persons on public assistance manifests chronic diseases may be due to the general age incidence of the diseases and may have little bearing on the welfare status of the individuals. On the other hand, certain chronic diseases may be contributory factors to the development of a need for public assistance. Finally, the same factor, let us say a disabling injury, may have contributed to both the welfare status and disease condition. Community action or actions will differ considerably depending on which type of relationship occurs. Such actions will also differ depending on the intensity of this relationship. If only 1 per cent of blind persons require vocational guidance the problem is very unlike that in which 100 per cent of the blind need such guidance. To clarify further the relationship between social and health characteristics, the specific factors which are involved in this relationship should be identified and their mode of operation determined. If poverty is associated with the higher incidence of a disease, the factor may be over-crowding, lack of medical care, lack of food, or some other condition. In turn any one of these factors may contribute to diverse disease reactions in several ways. Over-crowding may affect the spread of tuberculosis in a family by increased person-to-person contact; lack of medical care may produce a similar effect through delay in diagnosis and care of the ill person. In sum, the association of poverty with tuberculosis acquires real meaning only when it becomes possible to specify the pertinent factors which affect the onset or the progress of the disease. A similar degree of specification is required to uncover the real significance of any association between any aspect of health and social characteristics of the population. These considerations have guided us in planning a series of studies aimed at determining how often illnesses and certain economic or social characteristics are found together in a population; and how often, and under what conditions variations in specific aspects of health or disease precede or follow variations in specific aspects of economic or social status. The current investigation is part of that series, and is limited to the measurement of the association between health and those economic and social traits of the population which are of concern to the social-welfare agencies of Pittsburgh. In this and the following papers we shall report systematically the steps followed in the study. The complexity of the problem is well recognized and because of it, we present, whenever feasible, the full details of the several methods of approach employed and of the results obtained, of the gaps in our data and of the assumptions which underlie our conclusions. In this first paper, we shall describe the general design of the study, the collection of the data, a tentative method of classifying families according to health and social-welfare status; the variations in health and social-welfare status in relation to race-color, size of family, age, marital status, occupation and education of the head of the household; the crude association between health status of families and their social-welfare status.