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9
In connection with the foregoing paragraph, I should like briefly to rofor to the subjeots
of Child Welfare, Infant Mortality and Housing, although further details concerning those
subjects will be found in the body of this report,
St. Pancras has always been a pioneer in work relating to Child Welfare. This work
was initiated and carried on for many years with much energy and enthusiasm by voluntary
workers who equipped welfare centres in many parts of the Borough. When the Maternity
and Child Welfare Act was passed in 1918 these centres and the whole of the staff were taken
over by the Borough Council, which, since that date, has maintained them at an annual estimated
cost of nearly £13,000 (a part of this is repaid by the Ministry of Health). When these centres
were originally started, from 10 to 15 years ago, the number of births in the Borough, each
year, was from 5000 to 6000, equal to a birth-rate of 23 to 24 per 1000 of population. During
reoent years there has been a steady decrease, and last year the number of births was only 3880,
equal to a birth-rate of 17-9 per 1000 of population. Despite this large decrease in the number
of births, the same staff and organization for dealing with the work of Child Welfare is still
maintained. It is therefore obvious that this particular branch of Public Health work is
receiving the very fullest attention. Although St. Pancras is spending so lavishly on Child
Welfare work, probably more lavishly than any other Metropolitan Borough, it is disconcerting
to find that the rate of infantile mortality does not compare favourably with that of London
us a whole, or with the majority of the Metropolitan Boroughs. Last year 18 of the Metropolitan
Boroughs had a lower infantile mortality rate and only 9 a higher rate than St. Pancras.
During the past five years (1921-1925) the average Infantile Mortality rate for St. Pancras
was 72 per 1000 births, the corresponding rate for London as a whole being 71. In
the five preceding years (1916-1920) the average rate for St. Pancras was 91 and for London
as a whole 92 per 1000 births.
As the work of the Centres has been so fully maintained, it would appear that some
adverse factor is present which nullifies the teaching which is given and prevents the improvement
we have a right to expect. Is this adverse factor due to overcrowding, the result of
inadequate housing accommodation? Support is given to this suggestion by the table on page
16 relating to an inquiry into the deaths of children under 5 years of age during the two years
1924-1925. It is there seen that the death rate of children living under overcrowded conditions,
from diseases likely to be accentuated by such conditions, was almost double that of children
who were not living under conditions of overcrowding.
It would therefore appear that the time has arrived when it is desirable (owing to altered
conditions) to revise certain items of Public Health activity in order to obtain a more suitable
proportion in expenditure, and also in the hope of securing better results. The expenditure
on Child Welfare work has been disproportionately great in comparison with the expenditure
on other branches of Public Health work. To some extent this is doubtless due to the popularity
of the subject—the appeal of the child meets with an instant and ready response; but it appears to
be open to criticism to spend, for example, on Tuberculosis only one-fifth of the amount spent on
Child Welfare, when, as a cause of death, Tuberculosis is so important.
I venture to suggest that it is possible to reduce the direct expenditure on the Maternity
and Child Welfare departments without any loss of efficiency, and this view is endorsed by the
recent communication received from the Ministry of Health, which was forwarded after a visit
of inspection and investigation of this work by one of the Medical Officers of the Ministry.
In Public Health, as in any other subject, the aim should be to secure the best possible
results for the money expended, and I would suggest that any money saved as a result of
decreased expenditure on the activities mentioned should be devoted to the provision of housing
accommodation. This would probably do more to promote the public health, to diminish the