iiiThe Relation of Housing to the Public
Health Movement

PSY

LAWRENCE VEILLER

NationaL Housine Association PuBLicaTions
No. 33
Price Five Cents
DeEcEMBER, 1915
105 East 22p Street, New York CrryRead before the Public Health Administration Section
of the American Public Health Association,
Rochester, N. Y., September 8, 1915.Sg aoe ae
ma ¢ %
1h dD! $2

The Relation of Housing to the Public
Health Movement

BY LAWRENCE VEILLER

Secretary, National Housing Association, New York City.

in these days of progress who
should attempt to set limits to
the public health movement.

When health commissions regulate
so many aspects of human welfare
from the speed and number of subway
trains to the ingredients of proprietary
medicines it would surely be unwise
to say that any phase of municipal
activity is not a proper function of a
department of health.

When one considers how many
health departments have in past years
been buried under the mountain of
garbage removal it is not strange that
there should be a rather insistent
demand for a chance to do what is
strictly “health work.”

But by what touchstone can the
ordinary health officer decide what is
properly “health work” and what is
not?

Up to the present, there has been
no enunciation of principles by such
organizations as this to guide him in
his determination. He hasbeen forced
in most cases to drift with the current,
to develop those activities which ?vhe
public has become accustomed to
expect. And, let me whisper it, there
have been known instances where he
has gotten into a rut, and even, some-
times, where he has been content to
stay there!

[T WOULD indeed be a rash man

The basis of the complaint against
much of the public health-work of the
country is that it is purposeless. It
lacks cohesiveness. It does not tend
anywhere. Few health officers have
developed a program of health work
for their community. It is a great
thing to take time every once in so
often to see where the ship is head-
ing and to set your course anew, if
need be; to correct old conceptions,
to discard old theories, to get new
vision, to sail among the new cur-
rents. There is a great exhilaration
in steering for a new land, sometimes
on an uncharted sea.

It there is as yet no generally
accepted standard of what is properly
“health work,’ how is the average
health officer to guide his course, de-
termine the limits of his field?

The decision as to what properly is
health work is to be reached very much
in the same way, as the community
itself must reach decisions as to what
is properly “municipal work.’? There
is no hard and fast line; no acid test;
no municipal litmus paper, by which

° each community can be guided. What

was “Socialism’’ yesterday, every one
today accepts as a matter of course.
There are only principles to fall back |
upon!

The health officer must decide his
question on the same principle that thecommunity itself does other munic-
ipal ones. It is a very simple one
viz: Will it be more beneficial in the
long run for the community to do a
given piece of work itself or will better
results ensue if this particular activity
be left to private enterprise.

The health officer has to ask himself
two questions with regard to any pro-
posed activity.

(1) Will it promote health?

(2) Can some other branch of the
government undertake it more appro-
priately?

You will note that the question as I
ask it is not, “Will it promote public
health?” but ‘‘ Will it promote health?”
The time is rapidly approaching, if it
is not already here, when the health
official has got to concern himself with
private health, the health of the indi-
vidual as well as with public health,
the health of the community; for the
community is nothing more nor less
than a collection of individuals. The
cell theory applied to civics. This has
already been demonstrated by ten
years of anti-tuberculosis work, where
the education of the individual in the
measures necessary to protect his
health has been the keystone of the
movement. So, too, we see this prin-
ciple accepted in the more widely
recognized acceptance of the work of
health education which has been so
fully discussed in this very conference,
and lastly in the principle of life exten:

sion, which we are also discussing heré:

and whose very essence resides in per-
sonal hygiene.

In the light of these considerations,
it is appropriate to ask, ‘“‘What rela-
tion has housing reform to the public

AAA

health movement?’’ ‘The answer to
the first of our standard questions,
“Does it promote health,” will pro-
duce no dissenting opinion. As to the
value of housing reform there is no
opportunity for discussion, at least
among sanitarians, though I know
many speculative builders and slum
landlords, however, who are still scep-
tical about it!

Where difference of opinion will
arise will be in answer to the second
of our questions “‘Can it be undertaken
more appropriately by some other
branch of the government than the
health department?”’

The organization of our municipal
government in most communities in
the United States follows along such
generally uniform lines that we can
without serious difficulty generalize on
this subject. In most cities we find a
health department, a fire department,
a police department, a department of
public works, a department of educa-
tion, a department of parks, of streets,
of charities, of correction, of finance.
In different cities they sometimes have
different names, just as “‘the ocean
receives different names on the various
shores it washes.’’ Often, too, they are
combined in different ways, in some
cities several cognate departments
are grouped together in one depart-
ment of public safety or public works
as the case may be. And sometimes
they are combined in most remarkable
wys apparently without the slightest
relation to the appropriateness of their
functions. In the larger cities, as
municipal government becomes more
complex, we find increased specializa-
tion and the roster of the variousbranches of the city government in-
creases. Thus there is added a depart-
ment of buildings, of docks, of bridges,
of water supply, of recreation, etc.

Efficiency in municipal government,

as in business affairs, comes with
specialization of function. So we may
expect to see new departments emerge
as the years go by.
As we contemplate this group of
branches of municipal government, my
hearers will, I am sure, agree with me
in saying that their mere enumeration
is sufficient in itself to answer the
question just asked as to whether
any of them can more appropriately
undertake the work of housing reform.
You would dismiss immediately as a
preposterous idea, the suggestion that
such work should be undertaken by
the department of finance of any city
or by its department of education or
by its department of streets, or by
the police or by the fire department,
or by the department of charities, cor-
rection or parks. There is an appro-
priateness here as in other affairs of
man.

So, by a process of elimination, we
find that housing reform belongs to the
health department.

If not performed by that branch of
the government, it is safe to assume
that it will not be looked after by any.
There are of course exceptions to every
rule. In some cities there may be
exceptional conditions which make it
advantageous to separate this work
from the city’s ordinary health work.
But the point I wish to emphasize is
that the alternative is not in having
this important work an incident to the
work of some unrelated branch of the

   
  
  
  
  
  
  
  
   
    
   
  
 
    
   
  
   
  
  
  
   
  
  
   
  
  
   
   
   
 
  
  
  

city government where it will be neg-
lected, but in vesting these functions
in a separate department charged with
sole responsibility in this field, where
it will be given special attention.

New York is a case in point. There
fifteen years ago we found a health
department buried under the burden
of regulating the sanitary condition
of 80,000 separate tenement houses,
the home of a million and a half of
people. As a result, few of its func-
tions were adequately performed.
Housing conditions suffered, as did the
other health work of the city So we
freed the health department from its
burden, by relieving it of this respon-
sibility and established a new branch
of the city government—the tenement
house department, whose sole function
was responsibility for the housing con-
ditions of the people. How necessary
the establishment of that department
was is evidenced by the fact that today
it comprises nearly 800 employees and
the financial authorities of the city last
year appropriated for its work about
$800,000.

When you come to think of it, it is
worth while to look after the home
conditions of over three million people.

The results of this readjustment of
municipal functions has been quite
remarkable. The improvement in
housing conditions has been little short
of revolutionary. From having the
worst housing conditions in the world,
New York has come to have in some
respects the very best.

The effect on the health work of
the city equally remarkable.
Freed from the burden under which
it had been struggling for years, the

washealth department emerged and under-
took some of the work which thereto-
fore it had been forced to neglect.
From that time, dates its effective
work in child hygiene, regulation
of the milk supply, medical inspection
in the schools, and literally a hundred
phases of the work which has made
the New York City Health Depart-
ment the most efficient in the world.
It couldn’t move before. It was
tied hand and foot.

But New York is an exception to
the general rule. I should not urge
the establishment of a separate branch
of the government to look after
housing conditions in many other
cities—in fact, in no city of the
United States except perhaps in
Chicago. The reasons which made
this course wise to follow in New York,
viz., the existence of 80,000 separate
buildings housing 1,500,000 people,
are not to be found elsewhere. When
they are, the same course can be
followed, presumably with equal profit.

Although I have said there is no
difference of opinion among sani-
tarians as to the value of housing
reform, it may not be inappropriate
to consider for a moment how vital
a thing it is. The slightest reflection
reminds us at once how closely related
it is to practically every other phase
of health work. What can be more
fundamental than the living conditions
of the people?

Of what use is it for a city to build
tuberculosis hospitals and sanatoria,
maintain day camps and dispensaries,
employ a corps of visiting nurses and
physicians, if all the time tenements
with dark unventilated rooms are

breeding the disease faster than the
medical profession can cope with it?

How futile it is to send a man away
to a sanatorium for six months, feed
him, watch over him, nurse him,
care for his family at great expense
while he is away, then discharge him
as “cured,” to sleep and live in a
three-room tenement of which two
of the rooms are little better than
dark closets without sunlight—dark
unventilated breeders of disease.

How profitable is it for a city to
spend vast sums of money to ensure
a supply of pure water to its in-
habitants and at the same time to
allow barbarous privy vaults, sinks
of iniquity, to drain their contents
into private wells, still used by
“conservative” citizens who cling to
them with startling tenacity.

Is it more profitable to teach our
citizens to “swat the fly”’ or to do
away with their breeding places.

We carefully watch over the health
of our school children while in school,
but most cities pay little or no atten-
tion to the conditions under which
they live. We build open air class-
rooms for them when they have
become anemic or tuberculous, but
do little or nothing to do away with
the dark, damp, air-shaft and base-
ment rooms that have helped to make
them so.

I might go on almost indefinitely
with these illustrations, but enough
has been said, I am sure, to show the
vital necessity for every community
to look after its housing conditions.

No civilized community can afford
to neglect these things. Yet, many
that would deeply resent being thoughtnot civilized tolerate most barbarous
conditions. I am happy to say a
new era is dawning in this respect.
We are at last awakening to this state
of things and the necessity for action.

The fight against unsanitary con-
ditions, however, can no more be
waged successfully without weapons
than can modern warfare be carried
on without guns, bombs, shrapnel,
barbed wire entanglements, aeroplanes,
tools for digging trenches or ammuni-
tion. If we are to fight, we must
have the tools and engines to fight
with. To the sanitarian, the tools are
trained men, adequate appropriations,
freedom from political interference,
security in office.

While I would not urge upon any
city the establishment of a separate
branch of the city government to
look after housing conditions, I would
urge the creation of a housing bureau
in every health department in every
city. Until this is done we may
expect little progress to be made in
housing reform. The work to be
done is of sufficient moment to
deserve the undivided attention of
men especially trained and equipped
by experience for it. Without such
a bureau neither will adequate funds
be provided nor will there be that
continuity of service that the subject
requires.

There is one element in this subject
that has not been touched upon which
we cannot afford to lose sight of—
one which every experienced health
officer will recognize with a sympa-
thetic heart throb, and which every
courageous and forward looking one

    
    
 
   
  
  
  
   
   
   
   
  
  
   
 
  
   
 
 
  
     
 
 
 
 
 
  
 
 
  
 
 

will go forth valiantly to meet. And
that is, that his housing work will
produce more friction, encounter more
opposition and create more enemies
for him than any other phase of his
work. I am almost tempted to say
than all other phases combined. For,
here, he will antagonize not merely
one interest; he will touch the pocket
nerve of nearly every citizen.

He will in addition have to lift
a mountain of inertia, to contend
against a satisfaction with things as
they are and frequently will have to
overcome the opposition of the very
men to whom he could most naturally
look for support.

But let him not be downhearted, or
falter in his course because of this.
The work that has no difficulties
attached to it, isn’t worth the attention
of a red-blooded man.

Let him not be discouraged. In
the end he will overcome his difficul-
ties. In the recent words of that
great statesman Elihu Root:

“There never was a reform in
administration in this world which
did not have to make its way against
the strong feeling of good, honest
men, concerned in existing methods
of administration, and who saw nothing
wrong. It is no impeachment of a
man’s honesty, his integrity, that he
thinks the methods that he is familiar
with and in which he is engaged, are
all right. But you cannot make
any improvement in this world with-
out overriding the satisfaction that
men have in things as they are, and
of which they are a contented and
successful part.”NATIONAL HOUSING ASSOCIATION
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