Senator MORSE. I'm also going to insert in the record at this time that portion of the 1959 state of the Nation's Capital message dealing with health, welfare, recreation, and education. (The material referred to is as follows:) SECTION 4. HEALTH, WELFARE, RECREATION As the central city of a large metropolitan area, the District of Columbia typically provides numerous services in the areas of public health, welfare and recreation. Since the District's land area has been built up to the extent that it is not possible to generate much additional living space within the city and since annexation of surrounding areas has never been a practicable means of expansion for the District, it must solve its midtown problems without the revenue support which many cities can insure through the annexation of suburbs. Characteristic of a midtown in general and of Washington, D.C., in particular is the erosion of the income-producing age group to the suburbs, the relatively large proportion of low income and indigent persons remaining, and the large population in the very young and very old categories. This situation generates corresponding needs for intensive public health activities, for broad and expensive coverage of public assistance programs and for those activities which serve to enrich the lives of residents of the community and which at the same time are preventive of delinquency and crime. LOW INCOME PERSONS A significant index to the extent of health, welfare and recreation needs in the District is the personal income structure of the community. In this connection, a reference to personal income trends in the District with the trends in other jurisdictions of the Washington Metropolitan area will be illuminating. Within the other jurisdictions the rate of personal income growth between 1947 and 1958 exceeded 10 percent in every jurisdiction except Montgomery County, where it was 7.1 percent. By contrast, the rate of personal income growth in the District was less than 1 percent. Corresponding with this slight rate of growth has been a parallel decline in the number of persons categorized as low income. (Low-income persons are defined as those who are presumptively eligible for public assistance under criteria used by the Department of Public Welfare, for example, a budget for a family of four is $2,000 per year.) This situation is illustrated by the fact that since 1949, when the percentage of low-income persons to the total population was 16.8, the number of these persons has decreased by 50 percent, so that they now represent 8.4 of the total population. Although the decrease in the number of low-income persons has helped the District's overall economic position the 8.4 percent of the population considered low income represents 69,000 people-a significant portion of the total population. (See chart 4-A.) Of this 69,000, 52,000 or 75.3 percent are nonwhite. In any community, it is well known that the low-income group generates multiple problems and requires intensive services in the areas of health, welfare and recreation, as well as in those of education and law enforcement. District programs directed toward the correction and prevention of disease, delinquency and crime are, therefore, of vital import to the health and welfare of the city. BIRTHS Many District problems, and programs designed to cope with them, have resulted from the high birthrate. As noted in section 2, "Population," a major portion of the newborn is concentrated in the low income and indigent segment of the population. This fact has occasioned serious health and welfare needs. Illustrative of this type of need is the present situation in the District with respect to prenatal care. Beginning in 1939, the Department of Public Health operated prenatal clinics in seven locations throughout the city. However, in 1953 because of limited funds, prenatal care was discontinued in the neighborhood clinics, thereby leaving the D.C. General Hospital clinic as the only public health facility for prenatal care. Subsequently, it was observed that there was an increasing number of deliveries at D.C. General Hospital with no prenatal care. In 1952, a study was made classifying 15,284 births in the community according to whether the mothers had or had not received prenatal care. Table 4-1 shows the findings of that study. 20 D.C. POPULATION WITH LOW INCOMES AND ON PUBLIC "People with low income are defined as those who receive an amount insufficient to Source: D.C. Government CHART 4-A TABLE 4-1.-Rates for infant deaths, stillborn, and premature infants, classified according to whether or not mothers received prenatal care for period from July 1, 1952, to Dec. 31, 1952 Summarizing the data contained in table 4-1, it is apparent that without prenatal care the infant death rate was 4 times, the stillbirth death 2.4 times, and the premature birth rate was 2.5 times greater than were the rates for mothers who had received prenatal care. It is believed that a significant decrease will result in the rates for infant deaths, fetal deaths, and premature births if all mothers are provided with adequate prenatal care. One neighborhood prenatal clinic was reestablished in June 1957; as funds become available it is planned to reestablish additional prenatal clinics in those neighborhoods where the need is greatest. The problem of illegitimacy is a significant one in the District. Table 4-2 shows the incidence and rates of such births from 1946. TABLE 4-2.-Ratio and number of illegitimate resident live births, by race, District of Columbia, 1946-56 Source: Department of Health, Education, and Welfare, District of Columbia government. The high rate of illegitimacy constitutes not only a moral threat to this community but also a significant financial drain. Under the aid to dependent children program of the Department of Public Welfare, for example, one-half of the 3,200 families comprising the total caseload include at least 1 child born out of wedlock. Of these, 700 mothers were never married and 900 mothers are or have been married and have at least 1 illegitimate child. Under the Children Born Out of Wedlock Act, approximately 80 new paternity cases are filed at juvenile court each month. Court orders in these cases require the adjudicated father to provide for the maintenance and education of the children. Social work services are provided to illegitimate children or to their parents only when very serious social problems are unearthed in the course of financial collection. As of June 30, 1958, this group of probationers numbered 3,100—or an average caseload of over 400 for each probation officer. HOSPITAL CARE Services in the area of public health also have required intensification and expansion as a result of the District's midtown character. The amount which the government of the District of Columbia is now spending for hospital care in municipal, Federal, and voluntary (private) institutions is approximately $26.6 million a year. This is double the amount as compared with the figure spent 10 years ago. (See chart 4-B.) The increase is due to a number of factors. Among them are the changing characteristics of the District's population, spiraling hospital costs, and the upward trend and improvements in the level of hospital operation and patient treatment. (See table 4-3 on following page.) TUBERCULOSIS Tuberculosis continues to be a major problem in the District of Columbia. For the first 10 months of 1958, 1,049 new cases were reported as compared to 641 cases for a similar period of 1957, an increase of 63.7 percent. Projecting for the remaining 2 months of 1958, it is estimated there will be 1,200 to 1,300 new cases reported for the year. Total newly reported cases, and particularly active cases for 1958, will in all probability be higher than for the 3 previous years. This 10month case rate indicates that the District will probably rank first for 1958 in comparison with other cities over 500,000 population. DISTRICT FINANCED HOSPITAL PATIENT CARE INCREASED COSTS PER PATIENT HAVE BEEN THE MORE IMPORTANT FACTOR IN The increase in the number of new tuberculosis cases reported as well as the increase in hospital admissions probably was largely due to high incidence of upper respiratory infection associated with the Asian influenza epidemic which occurred during the latter months of 1957 and the first few months of 1958. During this same period, undoubtedly more effective casefinding also contributed to the greater number of cases reported. There was also a significant increase in hospital admissions for tuberculosis due both to the increase in the number of cases and to the forced hospitalization of recalcitrant, infectious cases. During the first few months of 1958 there was a significant increase in tuberculosis deaths. |