iiiThe Relation of Housing to the Public Health Movement PSY LAWRENCE VEILLER NationaL Housine Association PuBLicaTions No. 33 Price Five Cents DeEcEMBER, 1915 105 East 22p Street, New York CrryRead before the Public Health Administration Section of the American Public Health Association, Rochester, N. Y., September 8, 1915.Sg aoe ae ma ¢ % 1h dD! $2 The Relation of Housing to the Public Health Movement BY LAWRENCE VEILLER Secretary, National Housing Association, New York City. in these days of progress who should attempt to set limits to the public health movement. When health commissions regulate so many aspects of human welfare from the speed and number of subway trains to the ingredients of proprietary medicines it would surely be unwise to say that any phase of municipal activity is not a proper function of a department of health. When one considers how many health departments have in past years been buried under the mountain of garbage removal it is not strange that there should be a rather insistent demand for a chance to do what is strictly “health work.” But by what touchstone can the ordinary health officer decide what is properly “health work” and what is not? Up to the present, there has been no enunciation of principles by such organizations as this to guide him in his determination. He hasbeen forced in most cases to drift with the current, to develop those activities which ?vhe public has become accustomed to expect. And, let me whisper it, there have been known instances where he has gotten into a rut, and even, some- times, where he has been content to stay there! [T WOULD indeed be a rash man The basis of the complaint against much of the public health-work of the country is that it is purposeless. It lacks cohesiveness. It does not tend anywhere. Few health officers have developed a program of health work for their community. It is a great thing to take time every once in so often to see where the ship is head- ing and to set your course anew, if need be; to correct old conceptions, to discard old theories, to get new vision, to sail among the new cur- rents. There is a great exhilaration in steering for a new land, sometimes on an uncharted sea. It there is as yet no generally accepted standard of what is properly “health work,’ how is the average health officer to guide his course, de- termine the limits of his field? The decision as to what properly is health work is to be reached very much in the same way, as the community itself must reach decisions as to what is properly “municipal work.’? There is no hard and fast line; no acid test; no municipal litmus paper, by which ° each community can be guided. What was “Socialism’’ yesterday, every one today accepts as a matter of course. There are only principles to fall back | upon! The health officer must decide his question on the same principle that thecommunity itself does other munic- ipal ones. It is a very simple one viz: Will it be more beneficial in the long run for the community to do a given piece of work itself or will better results ensue if this particular activity be left to private enterprise. The health officer has to ask himself two questions with regard to any pro- posed activity. (1) Will it promote health? (2) Can some other branch of the government undertake it more appro- priately? You will note that the question as I ask it is not, “Will it promote public health?” but ‘‘ Will it promote health?” The time is rapidly approaching, if it is not already here, when the health official has got to concern himself with private health, the health of the indi- vidual as well as with public health, the health of the community; for the community is nothing more nor less than a collection of individuals. The cell theory applied to civics. This has already been demonstrated by ten years of anti-tuberculosis work, where the education of the individual in the measures necessary to protect his health has been the keystone of the movement. So, too, we see this prin- ciple accepted in the more widely recognized acceptance of the work of health education which has been so fully discussed in this very conference, and lastly in the principle of life exten: sion, which we are also discussing heré: and whose very essence resides in per- sonal hygiene. In the light of these considerations, it is appropriate to ask, ‘“‘What rela- tion has housing reform to the public AAA health movement?’’ ‘The answer to the first of our standard questions, “Does it promote health,” will pro- duce no dissenting opinion. As to the value of housing reform there is no opportunity for discussion, at least among sanitarians, though I know many speculative builders and slum landlords, however, who are still scep- tical about it! Where difference of opinion will arise will be in answer to the second of our questions “‘Can it be undertaken more appropriately by some other branch of the government than the health department?”’ The organization of our municipal government in most communities in the United States follows along such generally uniform lines that we can without serious difficulty generalize on this subject. In most cities we find a health department, a fire department, a police department, a department of public works, a department of educa- tion, a department of parks, of streets, of charities, of correction, of finance. In different cities they sometimes have different names, just as “‘the ocean receives different names on the various shores it washes.’’ Often, too, they are combined in different ways, in some cities several cognate departments are grouped together in one depart- ment of public safety or public works as the case may be. And sometimes they are combined in most remarkable wys apparently without the slightest relation to the appropriateness of their functions. In the larger cities, as municipal government becomes more complex, we find increased specializa- tion and the roster of the variousbranches of the city government in- creases. Thus there is added a depart- ment of buildings, of docks, of bridges, of water supply, of recreation, etc. Efficiency in municipal government, as in business affairs, comes with specialization of function. So we may expect to see new departments emerge as the years go by. As we contemplate this group of branches of municipal government, my hearers will, I am sure, agree with me in saying that their mere enumeration is sufficient in itself to answer the question just asked as to whether any of them can more appropriately undertake the work of housing reform. You would dismiss immediately as a preposterous idea, the suggestion that such work should be undertaken by the department of finance of any city or by its department of education or by its department of streets, or by the police or by the fire department, or by the department of charities, cor- rection or parks. There is an appro- priateness here as in other affairs of man. So, by a process of elimination, we find that housing reform belongs to the health department. If not performed by that branch of the government, it is safe to assume that it will not be looked after by any. There are of course exceptions to every rule. In some cities there may be exceptional conditions which make it advantageous to separate this work from the city’s ordinary health work. But the point I wish to emphasize is that the alternative is not in having this important work an incident to the work of some unrelated branch of the city government where it will be neg- lected, but in vesting these functions in a separate department charged with sole responsibility in this field, where it will be given special attention. New York is a case in point. There fifteen years ago we found a health department buried under the burden of regulating the sanitary condition of 80,000 separate tenement houses, the home of a million and a half of people. As a result, few of its func- tions were adequately performed. Housing conditions suffered, as did the other health work of the city So we freed the health department from its burden, by relieving it of this respon- sibility and established a new branch of the city government—the tenement house department, whose sole function was responsibility for the housing con- ditions of the people. How necessary the establishment of that department was is evidenced by the fact that today it comprises nearly 800 employees and the financial authorities of the city last year appropriated for its work about $800,000. When you come to think of it, it is worth while to look after the home conditions of over three million people. The results of this readjustment of municipal functions has been quite remarkable. The improvement in housing conditions has been little short of revolutionary. From having the worst housing conditions in the world, New York has come to have in some respects the very best. The effect on the health work of the city equally remarkable. Freed from the burden under which it had been struggling for years, the washealth department emerged and under- took some of the work which thereto- fore it had been forced to neglect. From that time, dates its effective work in child hygiene, regulation of the milk supply, medical inspection in the schools, and literally a hundred phases of the work which has made the New York City Health Depart- ment the most efficient in the world. It couldn’t move before. It was tied hand and foot. But New York is an exception to the general rule. I should not urge the establishment of a separate branch of the government to look after housing conditions in many other cities—in fact, in no city of the United States except perhaps in Chicago. The reasons which made this course wise to follow in New York, viz., the existence of 80,000 separate buildings housing 1,500,000 people, are not to be found elsewhere. When they are, the same course can be followed, presumably with equal profit. Although I have said there is no difference of opinion among sani- tarians as to the value of housing reform, it may not be inappropriate to consider for a moment how vital a thing it is. The slightest reflection reminds us at once how closely related it is to practically every other phase of health work. What can be more fundamental than the living conditions of the people? Of what use is it for a city to build tuberculosis hospitals and sanatoria, maintain day camps and dispensaries, employ a corps of visiting nurses and physicians, if all the time tenements with dark unventilated rooms are breeding the disease faster than the medical profession can cope with it? How futile it is to send a man away to a sanatorium for six months, feed him, watch over him, nurse him, care for his family at great expense while he is away, then discharge him as “cured,” to sleep and live in a three-room tenement of which two of the rooms are little better than dark closets without sunlight—dark unventilated breeders of disease. How profitable is it for a city to spend vast sums of money to ensure a supply of pure water to its in- habitants and at the same time to allow barbarous privy vaults, sinks of iniquity, to drain their contents into private wells, still used by “conservative” citizens who cling to them with startling tenacity. Is it more profitable to teach our citizens to “swat the fly”’ or to do away with their breeding places. We carefully watch over the health of our school children while in school, but most cities pay little or no atten- tion to the conditions under which they live. We build open air class- rooms for them when they have become anemic or tuberculous, but do little or nothing to do away with the dark, damp, air-shaft and base- ment rooms that have helped to make them so. I might go on almost indefinitely with these illustrations, but enough has been said, I am sure, to show the vital necessity for every community to look after its housing conditions. No civilized community can afford to neglect these things. Yet, many that would deeply resent being thoughtnot civilized tolerate most barbarous conditions. I am happy to say a new era is dawning in this respect. We are at last awakening to this state of things and the necessity for action. The fight against unsanitary con- ditions, however, can no more be waged successfully without weapons than can modern warfare be carried on without guns, bombs, shrapnel, barbed wire entanglements, aeroplanes, tools for digging trenches or ammuni- tion. If we are to fight, we must have the tools and engines to fight with. To the sanitarian, the tools are trained men, adequate appropriations, freedom from political interference, security in office. While I would not urge upon any city the establishment of a separate branch of the city government to look after housing conditions, I would urge the creation of a housing bureau in every health department in every city. Until this is done we may expect little progress to be made in housing reform. The work to be done is of sufficient moment to deserve the undivided attention of men especially trained and equipped by experience for it. Without such a bureau neither will adequate funds be provided nor will there be that continuity of service that the subject requires. There is one element in this subject that has not been touched upon which we cannot afford to lose sight of— one which every experienced health officer will recognize with a sympa- thetic heart throb, and which every courageous and forward looking one will go forth valiantly to meet. And that is, that his housing work will produce more friction, encounter more opposition and create more enemies for him than any other phase of his work. I am almost tempted to say than all other phases combined. For, here, he will antagonize not merely one interest; he will touch the pocket nerve of nearly every citizen. He will in addition have to lift a mountain of inertia, to contend against a satisfaction with things as they are and frequently will have to overcome the opposition of the very men to whom he could most naturally look for support. But let him not be downhearted, or falter in his course because of this. The work that has no difficulties attached to it, isn’t worth the attention of a red-blooded man. Let him not be discouraged. In the end he will overcome his difficul- ties. In the recent words of that great statesman Elihu Root: “There never was a reform in administration in this world which did not have to make its way against the strong feeling of good, honest men, concerned in existing methods of administration, and who saw nothing wrong. It is no impeachment of a man’s honesty, his integrity, that he thinks the methods that he is familiar with and in which he is engaged, are all right. But you cannot make any improvement in this world with- out overriding the satisfaction that men have in things as they are, and of which they are a contented and successful part.”NATIONAL HOUSING ASSOCIATION PUBLICATIONS WHAT BAD HOUSING MEANS TO THE COMMUNITY—5ru Enprrion By AtBion Fettows Bacon. Three cents each by the hundred. No. 6 ONE MILLION PEOPLE IN SMALL HOUSES—2p EnirT10on By Heten L. Parrisu. Four cents each in quantities of one hundred or more. No. 7 TEACHING THE TENANT—2p EpitI0n : By JoHaNNA von WaGNeR. Four cents each in quantities of one hundredjor more. No.8 HOUSING AND HEALTH—2p Enition By LAWRENCE VEILLER. Four cents each by the hundred. No. 9 THE SURVEY AND THE SMALLER CITY By Grorce Tuomas Parmer. Three cents each in quantities of one hundred or more. No. 10 A HOUSING PROGRAMME By LAWRENCE VEILLER. Three cents each by the hundred. No. 16 MODEL TOWNS IN AMERICA .. By Grosvenor AtTersury. ‘Ten cents each; nine cents each by the hundred. No. 17 ROOM OVERCROWDING AND THE LODGER EVIL By LawRENCE VeritteR. Three cents each by the hundred. No. 18 HE MENACE OF GREAT CITIES By tar Rigut HonoraBLe JAMES Bryce. Four cents each by the hundred. No. 20 RURAL AND SUBURBAN HOUSING By Exmer S. Forbes. Three cents each by the hundred. No. 21 THE EFFECT OF A HOUSING LAW By Aurrep T. Wuitr. ‘Two cents each by the hundred. No. 22 BUILDING REGULATION BY DISTRICTS—The Lesson of Berlin. By Frank Backus Wiiuisms. Four cents each by the hundred. No. 24 WHAT BAD HOUSING IS By Mitprep Cuapsry. Four cents each by the hundred. No. 25 PROTECTING RESIDENTIAL DISTRICTS By Lawrence VeILueR. No. 26 SMALL HOUSES WITHIN THE CITY LIMITS FOR UNSKILLED WAGE EARNERS—2np EpitTion By Grorce M. Sternserc, M.D., LL.D. No. 27 CITY HOUSING—PAST AND FUTURE By Joun Intprr. Four cents each by the hundred. No. 28 HOW ONE CITY GOT BETTER HOUSING By Lewis T. WitmartH. Four cents each by the hundred. No. 30 WHAT OUR CITIES DO NOT KNOW No. 31 BRIEF LIST OF BOOKS ON HOUSING AND CITY PLANNING Gratis. No. 32 ey Single copies of the above pamphlets may be obtained from the National Housing Association, 105 East 22d Street, New York City, for five cents, except Model Towns in America, ten cents. Other Pamphlets in preparation. HOUSING PROBLEMS IN AMERICA Proceedings of the Second National Conference on Housing in America. Cloth bound. $2.00 postpaid. Proceedings of the Third National Conference on Housing in America. Cloth bound. $2.00 postpaid. Proceedings of the Fourth National Conference on Housing in America. Cloth bound. $1.50 postpaid. Note: Numbers omitted indicate that publication is no longer obtainable.