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The neglect of public health legislation
Public Health THE
JOURNAL
OF
The Society of Medical Officers of Health. No. 6.
MARCH, 1918
THE NEGLECT O F PUBLIC HEAI,TH I,EGISLATION.
THE Report
of the Poor Law Committee of the Ministry of Reconstruction--agreed to b y representatives of the majority and the minority of the Poor Law Commission, the Local Government Board, the Insurance Commissioners, and the Local Authorities-raised hopes that the difficulties previously in the way had been overcome and that practical public health legislation would be immediately undertaken. These hopes have not been realised, and the new Parliamentary Session is now advanced without any news being forthcoming as to the proposals of the Government on these vital issues.. The passage of the necessary Bills during the present session is gravely imperilled b y the delay, and the public is perplexed b y this hesitation in formulating any practical policy of public health, and its suspicions are aroused b y the rumours of intrigues of departments and personages, and of controversies between the v a r i o u s interests affected. There is little doubt that these are the obstacles accounting for the delay of two years t h a t has occurred, b u t the appearance of the Poor Law Report encouraged the belief that these jealousies had been, or could be, settled. T h e Government must understand clearly that the mere shuffling or combining of central departments, with the sticking of a new label o n o n e of them (or a combination of them, or even a newly-created one), and calling it a " Ministry of Health," will not, of itself, have any appreciable effect on the public welfare. This is the least important of all the essential public health legislative needs of the: moment, and its result would be merely comparable to the oiling of a machine without paying any attention to the raw material that feeds it, and .with a similar disregard of the quality or cost
VOL. XXXI.
of its product. No central shuffling or rearrangement will be of practical effect unless accompanied by drastic alteration and revision of Local Authorities. In our issue of February we urged that the first and essential step, and the most pressing of all public health reforms, was the passing of the half-a-dozen or so clauses required f o r the abolition of Boards of Guardians and the distribution of their work among the councils of counties, county boroughs, and the larger urban districts. The existence of Boards of Guardians constitutes the obstacle to all reform in public health. Surely. it should not be beyond the power of the Minister for Reconstruction to persuade the Government to act at once on the admirable report and recommendations of his Department on this subject. Another extraordinary circumstance is the continued hanging up of the Bill giving additional powers for maternity and infant welfare. We have no patience with the claim that by the mere passing of such a Bill some fifty thousand babies would be saved every y e a r - - i t is easy for politicians or even for central departments to make such statements, and to call upon medical officers of health to deliver the g o o d s T b u t we agree that these additional powers are urgently needed if a serious decrease in t h e population is to be averted. Already in several areas the number of deaths is exceeding the number of births. It would be mere folly, however, t o give these powers to the 1,8oo public health authorities, the majority of which cannot and will not do efficient health work. There s h o u l d be no great diffieulty in adding this Work to that which will fall upon the larger authorities on the abolition of Boards of Guardians, and in dealing with both matters in the same measure. The introduction of such a Bill, with or without the establishment of a Ministry of Health, is the need of the moment.
62
Included in these legislative changes there should be a carefully devised and liberal s y s t e m of grants in aid b y means of which all authorities m a y be s t i m u l a t e d to u n d e r t a k e t h e w o r k , and encouraged to do it efficiently, and b y the withholding of which a n y slackness m a y be punished. Legislation on the above lines would enable the public to look forward with confidence to those vast i m p r o v e m e n t s in the national health m a c h i n e r y which are not only necessary to enable it to m e e t the serious_ difficulties resulting from the war, b u t are essential if it is to s t a n d t h e still more severe strain resulting u p o n demobilisation.
PUBLIC
MARCH,
PUBLIC HEALTH.
HEALTH
IN COUNTY AREAS.
AT
the Annual Meeting of the County Councils Association, held in February, some interesting suggestions were made by Mr. G. Montague Harris, the Secretary of the Association, concerning the future organisation of Public Health work in the counties. Additional interest i s given to the opinions expressed by Mr. Harris by the fact that he was a member of the Special Committee which recently reported to the Ministry of Reconstruction on the Poor Law. The suggestions made by Mr. Harris may be smnmarised as follows :....... I. That the policy should be continued of making the County Council, as a general rule, the authority for the administrative county in respect of public health services which involve the maintenance of institutions or which for other reasons are more conveniently administered over large areas.
2. That county councillors shouM be ex o~cio members of the Councils of Boroughs or Urban Districts which they represent on the County Council. 3. That the Councils of Boroughs, and of Urban Districts with a population of more than one person to the acre, should retain all the public health powers and duties which t h e y now exercise, other than institutionaI (except in special cases), subject to their keeping the Cotmty Medical Officer of Health fully informed with regard to their administration, and to a power in the County Council to take immediate action in case of default. 4. That in the remainder of the administrative county the County Council should be the public health authority for all purposes, but should work in the urban districts with a population of less than one person to the acre through the District Council, mid elsewhere through District Committees, composed of county councillors and representatives of the Parish Councils or Meetings. The County Council should have power of delegation.
5- T h a t the Parish Councils should be empowered to e x e r c i s e further public health powers at the discretion and subject to the supervision and control of the County Council. 6. That the cotmty medical staff should include district medical officers who should act under the County Medical Officer of Health for the district or districts to which they are assigned in respect of all public health work, including that at present administered by t h e . Rural District Councils, and any that may be transferred from the Boards of.Guardians ; that Urban District Cotmcils which are not in a position themselves to employ a wholetime medical officer of health, should make arrangements with the Cmmty Council for sharing the services of one of their district medical officers " and that all medical Officers of health should be whole time, fully qualified, officials in the employ of one or more local authorities, with security of tenure. 7. That the cost of the public health services administered directly by the County Council should be met by a county rate (general or special as the case may be) on the whole area served, the areas of any minor authorities administering their own services being rated therefor, and all public health rates being relieved by substantial Treasury grants in aid. OBITUARY. D~. J S. CAMERON. The death of Dr. J. S. Cameron, Medical Officer of Health for Leeds from 1889 to 1914, occurred on January 3oth, after a long illness. His public health career commenced in 1877 , when he became Medical Officer of Health for Huddersfield, a position which he held for 12 years. During his 26 years' tenure of office at Leeds he was able to bring about great sanitary improvements in the town, and succeeded in transforming Leeds from one of the most backward of towns in the sanitary sense to one of the most advanced. Dr. Cameron was also Professor of Public Health ill the University of Leeds, and had been a President of the Society of Medical Officers of Health. Throughout his career he occupied a conspicuous position in the Public Health Service, and it is a matter to be regretted that his great services on behalf of the public in Leeds did not meet with the recognition that they deserved. H E N R Y SAXON SNELL PRIZE. The P.oyal Sanitary Institute a n n o u n c e that the prize in I918 will consist of fifty guineas and the medal of the Institute, and is offered for an E s s a y on "Suggestion for Improvements in Apparatus and Appliances for Dealingwith House Refuse."
JOURNAL
OF
The Society of Medical Officers of Health. No. 6.
MARCH, 1918
THE NEGLECT O F PUBLIC HEAI,TH I,EGISLATION.
THE Report
of the Poor Law Committee of the Ministry of Reconstruction--agreed to b y representatives of the majority and the minority of the Poor Law Commission, the Local Government Board, the Insurance Commissioners, and the Local Authorities-raised hopes that the difficulties previously in the way had been overcome and that practical public health legislation would be immediately undertaken. These hopes have not been realised, and the new Parliamentary Session is now advanced without any news being forthcoming as to the proposals of the Government on these vital issues.. The passage of the necessary Bills during the present session is gravely imperilled b y the delay, and the public is perplexed b y this hesitation in formulating any practical policy of public health, and its suspicions are aroused b y the rumours of intrigues of departments and personages, and of controversies between the v a r i o u s interests affected. There is little doubt that these are the obstacles accounting for the delay of two years t h a t has occurred, b u t the appearance of the Poor Law Report encouraged the belief that these jealousies had been, or could be, settled. T h e Government must understand clearly that the mere shuffling or combining of central departments, with the sticking of a new label o n o n e of them (or a combination of them, or even a newly-created one), and calling it a " Ministry of Health," will not, of itself, have any appreciable effect on the public welfare. This is the least important of all the essential public health legislative needs of the: moment, and its result would be merely comparable to the oiling of a machine without paying any attention to the raw material that feeds it, and .with a similar disregard of the quality or cost
VOL. XXXI.
of its product. No central shuffling or rearrangement will be of practical effect unless accompanied by drastic alteration and revision of Local Authorities. In our issue of February we urged that the first and essential step, and the most pressing of all public health reforms, was the passing of the half-a-dozen or so clauses required f o r the abolition of Boards of Guardians and the distribution of their work among the councils of counties, county boroughs, and the larger urban districts. The existence of Boards of Guardians constitutes the obstacle to all reform in public health. Surely. it should not be beyond the power of the Minister for Reconstruction to persuade the Government to act at once on the admirable report and recommendations of his Department on this subject. Another extraordinary circumstance is the continued hanging up of the Bill giving additional powers for maternity and infant welfare. We have no patience with the claim that by the mere passing of such a Bill some fifty thousand babies would be saved every y e a r - - i t is easy for politicians or even for central departments to make such statements, and to call upon medical officers of health to deliver the g o o d s T b u t we agree that these additional powers are urgently needed if a serious decrease in t h e population is to be averted. Already in several areas the number of deaths is exceeding the number of births. It would be mere folly, however, t o give these powers to the 1,8oo public health authorities, the majority of which cannot and will not do efficient health work. There s h o u l d be no great diffieulty in adding this Work to that which will fall upon the larger authorities on the abolition of Boards of Guardians, and in dealing with both matters in the same measure. The introduction of such a Bill, with or without the establishment of a Ministry of Health, is the need of the moment.
62
Included in these legislative changes there should be a carefully devised and liberal s y s t e m of grants in aid b y means of which all authorities m a y be s t i m u l a t e d to u n d e r t a k e t h e w o r k , and encouraged to do it efficiently, and b y the withholding of which a n y slackness m a y be punished. Legislation on the above lines would enable the public to look forward with confidence to those vast i m p r o v e m e n t s in the national health m a c h i n e r y which are not only necessary to enable it to m e e t the serious_ difficulties resulting from the war, b u t are essential if it is to s t a n d t h e still more severe strain resulting u p o n demobilisation.
PUBLIC
MARCH,
PUBLIC HEALTH.
HEALTH
IN COUNTY AREAS.
AT
the Annual Meeting of the County Councils Association, held in February, some interesting suggestions were made by Mr. G. Montague Harris, the Secretary of the Association, concerning the future organisation of Public Health work in the counties. Additional interest i s given to the opinions expressed by Mr. Harris by the fact that he was a member of the Special Committee which recently reported to the Ministry of Reconstruction on the Poor Law. The suggestions made by Mr. Harris may be smnmarised as follows :....... I. That the policy should be continued of making the County Council, as a general rule, the authority for the administrative county in respect of public health services which involve the maintenance of institutions or which for other reasons are more conveniently administered over large areas.
2. That county councillors shouM be ex o~cio members of the Councils of Boroughs or Urban Districts which they represent on the County Council. 3. That the Councils of Boroughs, and of Urban Districts with a population of more than one person to the acre, should retain all the public health powers and duties which t h e y now exercise, other than institutionaI (except in special cases), subject to their keeping the Cotmty Medical Officer of Health fully informed with regard to their administration, and to a power in the County Council to take immediate action in case of default. 4. That in the remainder of the administrative county the County Council should be the public health authority for all purposes, but should work in the urban districts with a population of less than one person to the acre through the District Council, mid elsewhere through District Committees, composed of county councillors and representatives of the Parish Councils or Meetings. The County Council should have power of delegation.
5- T h a t the Parish Councils should be empowered to e x e r c i s e further public health powers at the discretion and subject to the supervision and control of the County Council. 6. That the cotmty medical staff should include district medical officers who should act under the County Medical Officer of Health for the district or districts to which they are assigned in respect of all public health work, including that at present administered by t h e . Rural District Councils, and any that may be transferred from the Boards of.Guardians ; that Urban District Cotmcils which are not in a position themselves to employ a wholetime medical officer of health, should make arrangements with the Cmmty Council for sharing the services of one of their district medical officers " and that all medical Officers of health should be whole time, fully qualified, officials in the employ of one or more local authorities, with security of tenure. 7. That the cost of the public health services administered directly by the County Council should be met by a county rate (general or special as the case may be) on the whole area served, the areas of any minor authorities administering their own services being rated therefor, and all public health rates being relieved by substantial Treasury grants in aid. OBITUARY. D~. J S. CAMERON. The death of Dr. J. S. Cameron, Medical Officer of Health for Leeds from 1889 to 1914, occurred on January 3oth, after a long illness. His public health career commenced in 1877 , when he became Medical Officer of Health for Huddersfield, a position which he held for 12 years. During his 26 years' tenure of office at Leeds he was able to bring about great sanitary improvements in the town, and succeeded in transforming Leeds from one of the most backward of towns in the sanitary sense to one of the most advanced. Dr. Cameron was also Professor of Public Health ill the University of Leeds, and had been a President of the Society of Medical Officers of Health. Throughout his career he occupied a conspicuous position in the Public Health Service, and it is a matter to be regretted that his great services on behalf of the public in Leeds did not meet with the recognition that they deserved. H E N R Y SAXON SNELL PRIZE. The P.oyal Sanitary Institute a n n o u n c e that the prize in I918 will consist of fifty guineas and the medal of the Institute, and is offered for an E s s a y on "Suggestion for Improvements in Apparatus and Appliances for Dealingwith House Refuse."