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It may appear that a great deal of public money and manpower are already being devoted
to a somewhat overprivileged generation but such investment in the future is going to determine
the quality of life for all of us in the years to come. One is reminded of the Church Council in
Chingford who proposed to close their youth club because of unruly behaviour. The Vicar, with
greater wisdom, replied that he would agree to close the clubroom when the boys had stopped
breaking the windows.
A healthy community should contain the proper assortment of the different age,
occupational and social class groups. The escalating costs of houses (and land) in the London
area are forcing young couples to move many miles out to new towns and housing estates
leaving an imbalance of older citizens who, as they become aged, will inevitably miss the
support of their sons and daughters whose own children will be deprived of the influence of
effective grandparents. Waltham Forest Council operate a preferential housing scheme for
newly-married couples within the Borough and this is a very positive step towards maintaining
a healthily balanced community and combating the fragmentation of family units with consequent
loss of mutual support and the resulting heavier demands on health and welfare services.
The impact of housing policy upon the health of a community cannot be over-emphasised
and is a matter of great concern to the Community Physician. One aspect alone, the assessment
of priority points for rehousing on medical grounds, calls for the judgment of Solomon and
occupies a great part of the time of a senior medical officer. Some people enjoy living in tower
blocks, some endure it and some declare it is driving them mad. Certainly there is no easy
solution to the problem of providing the total amount and the variety of accommodation suited
to the needs of our community within the limited space available but those charged with the
responsibility of planning for it will have ready help from all sources of information including
those knowledgeable in community health and social welfare needs.
Mental health, one of the most commonly advanced pleas for medical priority rehousing,
is another field in which the Community Physician will have much to offer. Because he will
have a locus in the hospitals and in the home supportive services as well as knowledge and
experience of Local Authority provisions he will be ideally placed to advise on projects
linking the three services, such as the provision of day hospitals and hostels, as well as
ensuring the total continuity of care so facilitating the earlier discharge of patients from
hospital, mental or otherwise.
Working conditions also exercise a profound effect upon the health, both mental and
physical, of a population. Recent legislation, such as the Offices, Shops and Railway Premises
Act, introduced new standards of amenities and working conditions for non-factory workers
similar to those provided under the various Factories Acts. We are all becoming more aware
of the influence of environment upon health but it would seem that these provisions do not go
far enough. Automation and mass production tend to reduce the factory worker's interest and
his identification with the finished product to an extent where the job - especially for young
people - becomes a deadly bore so that they are driven to seek stimulation and excitement
elsewhere in perhaps undesirable ways. The ever-increasing cost of labour has given rise to
much enthusiasm for methods of boosting productivity, often by bonus schemes which encourage
maximum effort throughout the working day. Usually no provision at all is made for workers
who, because of age or infirmity, cannot keep up with the pace of the gang to which they
become a financial liability. Yet unless people who are not fully fit are kept in employment
they must degenerate in idleness at the taxpayers' expense. One hopes that the management
experts will find it possible to include some light duty jobs in their improvement schemes or
even include a Community Physician in their planning team.
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