TRENDS
By JOHN P. HUBBARD, M.D., Contributing Editor
Statements appearing in this column do not necessarily reflect the opinion of the editor nor are they
to be interpreted as the official opinion of the Academy.
THE
MAGNUSON
COMMISSION
RECOMMENDATIONS
FOR
CHILD
HEALTH
T
HE Report of the President’s Commission on the Health Needs of the Nation hasalready received a great deal of attention in both medical journals and the lay press. Its recommendations are far-reaching: federal aid to medical education “to supplement,
not replace, state appropriations and private gifts’ ‘ under conditions in which “the
preservation of the administrative autonomy of the schools must be secured’ ‘; ‘‘an
adequate system of hospitals and related health facilities to serve all of our people in both urban and rural areas’ ‘; federal subsidies for prepayment medical care plans and
the expansion of group practice ; and the creation of a cabinet-rank Department of Health and Security. The report reviews existing health conditions and outlines general and specific proposals aimed at ‘‘the building up of our health resources in terms of training
more health personnel and providing more physical facilities.”
It is not our purpose to review the report as a whole, but more particularly to call
attention to those parts which deal especially with children. At the same time it should be recognized that almost every section of the first volume published under the title of “Building America’s Health” has implications for the health of children. Here are some
of the things the report1 says:
,
‘Today there are more children than at any other time in our history, more than 47million under 18 years of age. During the decade 1940 to 1950, the number of children
under five years of age increased 53 percent. Each year has seen a great improvement in child health. Nevertheless, there remain many deficiencies in health services to the chil-dren of this Nation.
“Enormous gains have been made in the prevention and cure of disease among chil-dren. Child-bearing has never been safer. Many diseases which wer once prevalent in the childhood years have now largely disappeared. In fact, the whole base of medical care for children is now changing from the treatment of disease to the promotion of
health. We are emerging from an era of activity where physicians, nurses and social workers were rushing about taking care of sick children, to an era when knowledge and
time are becoming available to help the well stay well. In short, health care is shifting from the defensive to the offensive.
,
‘From our present vantage point we see many needed steps along the road to the objective of good health services for all mothers and children.‘‘First is the need for more well-trained physicians, dentists, nurses, social workers,
and others who in their professional capacities assume responsibility for the health and
1Building America’s Health, a Report to the President by the President’s Commission on the
Health Needs of the Nation. Findings and recommendations, vol. 1, Washington 25, D.C., U. S.
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welfare of children. All of these disciplines require still greater emphasis upon the
problems peculiar to the emotional and physical growth of children.
‘‘Second is the need to overcome the barriers to good medical care which result from geographic and from economic causes. In those sections of the country where physicians, hospitals, and other health resources are deficient, and where per capita income is low, the quantity and quality of health services for children and mothers are proportionately low. Three measures can do much to remedy these inequities :
(
1)
extension of localpublic health services, (2) provision for special diagnostic and consultation service in
pediatrics and obstetrics for rural communities, and (3) regional planning. The first is
part of the move to establish local health units throughout the Nation. No matter what
other services are included in a local health unit, maternal and child health services invariably receive prominent attention. Regional planning, given special emphasis by the
American Academy of Pediatrics as a result of its nation-wide survey of child health
services, is one means of creating a direct channel between the urban center and the rural services. It brings to the remote areas the benefits of the latest research, new procedures and high quality services of the medical center.
“Third is the need for more research in the field of child life, to improve existing techniques and to raise the standards higher. Particular attention should be given to two
factors which still stand as leading causes of death and disability-premature birth and
accident.
‘‘One long overdue measure for child health is concentrated action directed at the
problem of the distressingly large number of children who are emotionally disturbed,
mentally deficient, mentally ill, or suffering from epilepsy. In no other area of child life
has so little progress been made. The problem does not involve the child alone, but
rather the child as a member of the family unit. The family must be accepted as the
irreducible unit for health service. Unfortunately one out of nine children lives in a
home broken because of divorce, separation, or premature death of parents. Such
dis-rupted families often give rise to emotional abnormalities not only in childhood but also in later life.
‘‘Vast sums of public money are being spent each year on school health examinations.
How often have children and parents been needlessly alarmed because of hasty
mis-interpretation of some innocuous finding by a school physician ? Less time should be
spent on perfunctory annual examinations of school children as they are too often
per-formed today. More time should be devoted to careful health screening and follow-up,
including medical consultation with parents as well as school teachers, and in the
utiliza-tion and development of communky resources for diagnosis and treatment. School health
programs would then become far more productive of good results.
“The goals of child health cannot be met without the co-operative effort of official
and voluntary agencies of the community. To attain these goals will require more money
for more services. But the answer lies also in better use of existing resources. Continuing effort is needed to evaluate the work of the agencies serving children, and to provide them with guides to improve their programs.
‘‘We, therefore recommend that:
‘
,
1. Education of general physicians, dentists, nurses, social workers, teachers, andothers on the health team include a better understanding of the development of the
physical and emotional life of the child and mother. Our general public educational
‘ ‘2. Local public health services be extended to cover the entire country, including
isolated rural sections.
,
‘3. Provision be made for an adequate number of hospital beds and nursing care forchildren of all ages, including special provision for the premature infant.
‘
‘4.
Provision be made for diagnostic and consultative services in pediatrics andobstetrics for rural areas and wherever else needed.
“5. Program for the care and training of children with mental deficiency and epilepsy be strengthened.
‘
‘6.
Research be undertaken into the causes and prevention of childhood accidents;into the effectiveness of health programs for children ; into the causes and prevention of
fetal mortality, premature birth, neonatal mortality, mental deficiency and epilepsy ; and into child development, both emotional and physical.”
The importance of dental disease and defects is emphasized as follows:
“An array of shocking evidence establishes the high priority which dental care
de-serves among the health needs of the American people. Sufficient dental care either is
not available or is not utilized by the American people to a degree even approaching an
adequate level.
“A survey of school children in one city disclosed that 70 percent of those 12 years of age had one or more permanent teeth that needed to be filled and that by age 15 the proportion was 85 percent. A study by the American Dental Association in 1940 revealed
that among young persons 1 5-24 years of age coming from families with an income of $3,000 or more, one-sixth required bridges or dentures. Among older people the prevalence of dental disease and defects is well-nigh universal. This includes a vast amount of disease of the gums and other peridental disease as well as defects of the
teeth themselves.
“Against this evidence of need, it should be noted that less than 40 percent of the American people receive any dental care during the course of a year. These data clearly indicate the large gap between needed dental care and the amount actually provided.
,
‘In large part this gap reflects our past widespread acceptance of dental decay andultimate loss of teeth as inevitable. Until recent times, as a matter of fact, not much was known about the prevention of dental disease and there was little application of this
knowledge. Continuation of a resigned attitude toward dental disease, however, is not
consistent with our present knowledge.
“We now have procedures which, if fully applied, would prevent a great amount of dental disease and correct a large proportion of existing defects.
“Fluoridation of communal water supplies is now in effect for 475 communities with
a combined population of nearly 1 1 million. An additional 353 communities with 17 mu-lion persons have approved this means of preventing dental decay. Excessive indulgence
in refined carbohydrates, as well as deficiency of fluoride in drinking water, may be a significant factor in the poor dental health in this country.
,
‘However, even though a wider application of preventive measures will ultimately reduce the need for dental care among our people, the need for dental care willcon-tinue at a high rate for many years to come.
,
‘Effective use of auxiliary dental personnel would significantly increase the amount of service which dentists could provide. According to a study by the American DentalAssociation, dentisCs with one employee were able to see 37 percent more patients than
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more patients. Yet, only three-fifths of all dentists employ even one full-time dental assistant or dental hygienist.
‘‘We, therefore, recommend that:
,
‘1. Dental care be considered an essential component of comprehensive health service,to be made available for children immediately, and for the entire population as rapidly
as possible.
“2. All communities bring the fluoride content of their communal water supplies up to
an optimum level for the prevention of dental caries, and that individual preventive
dental procedures likewise be promoted.
,
‘3. More efficient methods of dental practice, including the more general use ofdental assistants and dental hygienists, be undertaken.
‘‘4. Increased research into dental disease be supported.”
Attention is also given to childhood accidents. The report states:
‘‘Accidents among children present a growing problem to parents, pediatricians, and
others responsible for the health and welfare of children. Three fatal accidents occur
among children under 15 years of age every two hours throughout the year. The most
frequent cause is motor vehicle accidents, followed by drowning and burns. In the home
poisons taken accidentally cause many deaths. Accidents constitute the greatest single
