Housing As a Health Factor

Housing as a Health Factor
A Scottish Medical Officer Finds That Home Conditions Bear on Dental as Well as General Health.

Dr. J. Menzies Campbell, of Glasgow, Scotland, a member of the editorial board of this journal, submitted for possible publication this portion of a report made in 1934 by the Medical Officer of Health for the Counties of Ross and Cromarly, Scotland. The editors believe it is of general interest because it indicates the growing certainly that dental caries and other dental ills are closely associated with systemic conditions and causes that promote systemic ills.
The most potent cause of Rural Depopulation is the disappearance of the peasant class. This has been brought about by the general trend of population to the towns owing to regular employment, higher wages, and gregarious habits of existence. This has meant the gradual disappearance of the so called peasant standard of living and the demand for improved conditions of life. Another cause is the want of any outlet for the young in local industry, owing to the absence of any vocational training in the schools to qualify them for improved service in the vocations which are the basis of trade and prosperity in this community.
With these two causes Public Health is not directly concerned, but it is with the third contributing cause—amenity and housing. The aim of Public Health is the rearing and maintenance of a healthy population, and this may be achieved in two ways.
One is to disregard all laws of hygiene, and trust to the survival of the fittest, allowing all those not strong enough to survive in adverse conditions to fall out of the race. This is repugnant to all modern sentiment, ethical, social and religious. The alternative is to put the population under the best possible conditions, so that those factors which produce and favour disease and maldevelopment are absent or negligible.
The acquirement of a sound knowledge of hygiene, using the term in its broadest sense, should be compulsory in every school curriculum with a position on the time-table, and certificates and examination, that would put it on a par with English or any compulsory subject of a leaving certificate group. Such a training would be of immediate use in preserving health and preventing disease, and not like so many of the subjects of only cultural use, or even less. It is of importance to the nation that the rising generation should have the knowledge necessary to prevent disease and render it capable of making proper use of the other parts of its education, whether cultural or practical, which would otherwise be useless to the sickly unfit child.
In a system of Public Health, the object of which is to build up a healthy population, rural housing is the keystone, because without a healthy home, conditions which promote prevention of disease, the abolition of maldevelopment and malnutrition, with secondary disease and disablement—that is those conditions characteristic of rural life—Fresh air sunshine, and fresh home grown food—are thwarted in their action. To ignore this fact is a round-about and expensive way of improving the health of the public. With the exception of domestic science, a single though important branch of hygiene, anything except the most fragmentary outline is taught solely as a side issue by women’s rural institutes, Red Cross societies and other voluntary organizations.
Education is as necessary as housing, because it is a matter of everyday experience that good houses rapidly become slums in the hands of those who have neither the knowledge nor the incentive to keep them properly. Neither factor without the other will solve the problem. The above is a summary of the problems which confront all areas, rural as well as urban, but in Ross and Cromarty there are other factors which further complicate the issue.
Liability to Tuberculosis depends on two factors: The natural resistance to the disease and prevalence of infection.
The natural resistance depends on two factors, inherited liability and acquired liability. The former was in the past regarded as the more important, but experience and observation seem to indicate that it is much less important than was formerly supposed and in reality depends on unsuitable feeding and unhealthy conditions of living accompanied by carelessness and disregard of the means of preventing infection.
With the limitation of infection the liability of the race to infection by tubercle will increase, rather than diminish, with a lessening of their acquired immunity, unless the general resistance is increased or maintained by improving hygienic conditions, more particularly housing and feeding. With a properly adjusted ante-natal and post-natal diet of properly cooked, fresh vitamin-containing food, such acquired diseases, with a food deficiency basis, as dental caries, tonsillar enlargement and adenoids would become rarer, and, with the improvement of the teeth, the vicious cycle on which depends the present increase of these disease would be interrupted.
The money required to undo the ill health and malnutrition resulting from those disease, caries, superficial glandular enlargement, with all their sequelae, maldevelopment of chest, digestive disturbance and secondarily increased liability go infection by tuberculosis among other things, that money has to be spent because of faults in housing and ignorance through want of instruction in hygiene.
The class, whose teeth fifty years ago were much above the average, instead of living on milk, eggs, oatmeal, fresh fish and vegetables, now barter their oatmeal and eggs for tea, tinned food, preserves with devitaminised white bread stuffs, on which their children are brought up, with results that we see. This state of affairs is due in the first place to ignorance and in the second place to an inertia which makes the opening of a tinned meat can preferable to the making of a pot of broth, because easier and less troublesome.
Diminution in tuberculosis is due to prevention through isolation and a realization of the danger of infection, but where the diminished resistance avoided by the elimination of the stimulus of infection passes off the disease will coeteris paribus probably show an increase, hence the paramount importance of education and housing in combating tuberculosis and the diseases of the formative years of child life.