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12
provide comprehensive health and welfare services on a community
basis. Administration and organisation in these fields still tend to be
fragmentary and disorderly because no studies in depth have been
undertaken to examine the inter-relationship and interdependence of
health and wellbeing in the broadest sense with the social milieu.
The tendency has been for curative medicine to proceed in isolation
of prevention and in ignorance of injurious aetiological factors,
mostly of social origin. The result has been the growth of organisations
and departments as separate entities with their own vested
interests, viewing each other with suspicion and at times with
hostility.
This thesis on the merits of integration and interdependence does
not imply that any one profession has the prescriptive right to
domination or to leadership, but it does mean a recognition and an
acceptance by all related disciplines of the fact that the relationship
of the human family one to another and their reaction to their
environment is multi-factorial. It is thus only now that boroughs
with wide health and welfare powers and proper resources can look
objectively at the whole spectrum and decide in the light of modern
thought the practice which will best serve the community needs, and
at the same time will make full use of skilled staff who are in short
supply.
The whole basis of local government organisation and staffing is
now under review by several committees and it is probable that,
valuable as these investigations may be, their individual recommendations
may conflict. The Maud, Mallaby and Seebohm reports are
all awaited with interest, but in the meantime it is important that
attitudes are not frozen and that every effort is made to provide a
balanced service with due regard to economy, with a strict assessment
of priorities at a time when resources are not limitless.
I must now turn to some consideration of the year under review.
There has been a slight reduction in population, births having
declined and deaths having risen slightly. The infant mortality rate
including early neonatal and perinatal is down, but it is significant
that the only rise is in the category of illegitimate infants. This is as
expected and in the future we must try to do more for the unsupported
mother, both in relation to encouraging early and consistent
pre-natal care and in the provision of adequate hostel accommodation
for those in need.
A detailed analysis of causes of death will be found in the main
report. Cardiovascular disease has increased considerably but it is
pleasing to note a decrease in cancer of the lung although it would
be premature to ascribe this to a substantial decline in cigarette
m oking. Nevertheless, I have the feeling that more people are being