Sickness and the Depression1: A Preliminary Report upon a Survey of Wage‐Earning Families in Birmingham, Detroit, and Pittsburgh

Abstract

The ordinary barometers of ill health—death rates and reports of communicable diseases—do not indicate that harmful effects of the depression upon the health of the population as a whole have taken place. The comfortable conclusion is drawn by many that the physical well-being of the American people not only has not suffered but, in view of the continued decline in mortality, may have been benefited, by the economic catastrophe. Such a conclusion, based upon mortality statistics alone, obviously is open to question. Death rates are not sensitive indices of the immediate effects of deleterious conditions. Even if they were, existing mortality and population records are not available in such form as to yield the very essential information as to whether any economic group has experienced a higher mortality than other groups. What we need, in appraising the depression's cost in ill health, are more efficient indices of physical and mental impairment in order to determine whether or not population groups whose economic status was most severely affected are suffering damages to health and what the nature and extent of these damages are. Only in this way can reasonably accurate appraisal be made. Among the now well recognized indices of ill health are records of sickness. When properly obtained and analyzed, they reveal some of the reactions of human beings to immediate environmental factors in a far more sensitive degree than the gross death rate or even mortality by cause can possibly do. Since no national system for the registration of sickness exists, special records must be collected, a difficulty not without its advantages since it permits information to be obtained for such groups and in such detail as may be desired. One phase of the study of health and the depression by the United States Public Health Service and the Milbank Memorial Fund utilized this method extensively. A sickness and mortality survey was made in 1933 of some 12,000 wage-earning families which had suffered from the depression in varying degrees of severity. Among the more important specific purposes of the survey were the following: To ascertain whether or not there is any association between income changes during the depression and ill health as measured by morbidity and mortality. If such an association exists, to discover what kinds of sickness and causes of death are chiefly responsible for the association. To determine the amount and kinds of medical care received by various economic classes of the people. Ten localities were included in the survey. The present paper gives some of the preliminary results for the first three cities for which tabulations have been made—Birmingham, Detroit, and Pittsburgh.