Problems in Public Health Encountered in a New Area

Abstract

Development of Becontree Estate.-Population.-Determination of population. Age distribution of population. Some effects of unusual age distribution.General problems in connection with development.(I) Those arising through rapid growth without preliminary preparation. Resulting difficulties in regard to: (a) Transport; (b) General sanitation, house refuse disposal, sewagedisposal, water supply; (c) Educational facilities; (d) General health services:-(1) Isolation hospital; comparison of home and hospital treatment in relation to spread of infection; (2) General hospitals; (3) Nursing in the home; (e) Itinerant vendors, etc.(II) Those peculiar to this estate; but either avoidable in general or not necessarily occurring in the case of estates attached to stable communities. Shopping centre not provided. Doctors, clergymen, charged economic rent. No provision for growing families.Behaviour of infectious diseases on the estate.-Measles: Absence of evidence of immunizing effect, on susceptibles, of exposure to infection. Tuberculosis: Consideration of benefits to be derived from satisfactory housing. Limitation of use of known statistics for comparative purposes. Presumptive evidence of incidence of tuberculosis in locality being higher than the rate holding for the country as a whole. Scarlet fever and diphtheria: Course of curve of relative incidence of infection in under-15 population over a number of years; demonstration of relatively high incidence of infection over a period. Consideration of possible explanation of high incidence: (a) effect of schools; (b) absence of isolation hospital accommodation resulting in secondary infection; (c) coincidence of occurrence of large population at susceptible ages with epidemic prevalence of infection; (d) immunity index of population rising to limiting figure; (e) alteration in immunity of members of population, due to loss of previously acquired immunity, this loss being due to relative deficiency of immune carriers in the population. Use of Schick reactions to show: (1) slight effect of occurrence of case of diphtheria in house on Schick reaction of remaining occupants; (2) relation between number of immunes in house and Schick reaction of remaining members.General conclusions on effect on health of residence on estate.