Health Is Purchasable

Fifty-one and six-tenths cents per capita is what the average American city of 100,000 population or more spends on health--that is, for strictly defined health services, and not including hospitals, morgues, sewerage and sewage disposal, garbage and refuse disposal.* It lavishes $6.11 on education, $1.88 on highways, $1.56 on fire prevention, $1.28 on police protection. And this expenditure for health purposes, parsimonious though it looks, increased 95% on the average between 1910 and 1920, according to a 10-year analysis of the health department budgets of 83 cities (including the 68 with a population of over 100,000, 1920 census, and a few below), just completed as part of the report of the Committee on Municipal Health Department Practice, of the American Public Health Association.

The work of this committee is financed by the Metropolitan Life Insurance Co., a corporation which knows how to mix altruism and business. The committee is composed of such nationally known sanitarians as Dr. Charles-Edward A. Winslow, Chairman, Dr. Charles V. Chapin, Dr. Haven Emerson, Dr. Donald B. Armstrong, Dr. Wade H. Frost, Dr. Allen W. Freeman, Dr. Lewis R. Thompson.

The survey of health department expenditures showed that every city in the list increased its budget between 1910 and 1920. In 24 cities the increase was over 100%. In Milwaukee it was 343%. The greatest average increase was made by cities of 250,000 to 500,000. The per capita expenditures for 1920 ranged from 104.9 cents (Bridgeport) to 11.9 (Scranton). One-half of the cities spent less than 43.9 cents per capita. Twenty-seven cities spent more than the average. They were: Bridgeport 104.9 Memphis 64.7

Yonkers 93.9 Seattle 63.4

Flint 88.2 Rochester 62.9

Pittsburgh 81.3 Grand Rapids... 61.5

Savannah 76.3 San Diego 61.2

Jacksonville .... 74.8 Dallas 59.2

Salt Lake City.. 73.4 Akron 58.2

Detroit 72.3 Schenectady 57.8

Buffalo 71.4 New Bedford 54.5

Milwaukee 69.8 Baltimore 53.1

New York 69.0 Toledo 52.9

Newark 67.3 Tacoma 52.3

Syracuse 66.3 Los Angeles 52.2

Jersey City 65.5

*These functions are, of course, essential to public welfare, but should not legitimately be charged against a modern health department. Its activities should embrace control of communicable diseases, tuberculosis, and venereal diseases, infant welfare, school hygiene, public health nursing, laboratories, food inspection, sanitary inspection, vital statistics, public health education and administration. The organization of these activities varies with different cities. School health supervision, for instance, is administered by the boards of education in many cities.