HEALTH AND THE NEW DEAL

Social Reform

Franklin Delano Roosevelt's inaugural speech on 4 March 1933 set the tone for the early months of what would come to be called the New Deal. The Depression affected the priorities of social reform in the United States. The consequences of the sudden, enormous unemployment after 1929 fell first on local governments, which, as they always had, retained primary responsibility for relief of the poor. But relief payments were pitiful, and private agencies also could not cope with the massive unemployment and suffering. By 1932 even President Hoover had to admit that Americans needed federal help. During earlier eras in U.S. history, health insurance was the top item after workmen's compensation. European countries typically developed health insurance from a system of insurance against industrial accidents. Old-age pensions were next, and unemployment insurance came last. But in America, with millions out of wwk, unemployment insurance became the leading priority. Roosevelt told the American people that "fear itself was the chief danger and proposed programs to ease the economic hardships suffered by millions with relief measures that would put jobless people to work and lead to economic recovery. Through New Deal programs, the federal government came to play such an unprecedented part in people's daily lives that its critics decried it as "socialism."

Contributions to the Nation's Health

Even though it appeared that national health insurance would have to wait, almost every New Deal agency, temporary or permanent, made some contribution to the nation's health. As early as June 1933 the Federal Emergency Relief Administration used some of its funds for medical care, nursing, and emergency dental work, and Civilian Conservation Corps workers received medical care as part of their benefits. The Civil Works Administration promoted rural sanitation and helped control malaria; and both the Works Progress Administration and the Public Works Administration built hospitals, sewer plants, and other public health projects.

The Social Security Act of 1935

The Social Security Act had far-reaching consequences for American life. Even though other nations had adopted systems of health insurance for their citizens and social security for the unemployed, the handicapped, and the aged, the United States had left such social problems to the individual to solve. The Social Security Act established a system of unemployment insurance, set up a pension scheme for retired people over sixty-five and their survivors, and provided federal funds to the states to aid them in caring for the blind and for destitute children. It extended the government's role in public health by providing states funds on a matching basis for maternal and infant care, rehabilitation of crippled children, and general public health work.

Significance for Health

While the Social Security bill itself included only one minor reference to health insurance, it was of special significance, since it established a permanent machinery for distributing federal funds for health purposes and recognized special needs in allocating these funds. Appropriations for health under the Social Security Administration grew rapidly in the late 1930s. A National Health Survey in 1935-1936 confirmed that the lowest economic groups were at the greatest risk for sickness and disability, while receiving the least medical care. The survey aroused public awareness of health problems, and in 1939 the Wagner bill was introduced into Congress to establish a national health program. But President Roosevelt's preoccupation with the fascist aggression, the opposition of organized medicine including the AMA, and other factors prevented its passage.

THE RURAL NURSE

The Frontier Nursing Service nurse provided medical services including handing swaddled newborn babies—"least-uns"—to their mothers after riding to their mountain cabins on horseback. Rural eastern Kentucky in 1937 had seven hundred square miles of mountainous land with no railroad, only twenty-four miles of gravel road, and one hospital with eighteen beds. Frontier nurses rode horses, mules, or flat boats to assist in childbirth, give inoculations against communicable diseases, and wage a vigorous campaign against the diseases of rural poverty—trachoma and hookworm.

Patients paid according to their means—the mother of the new "least-un" who rarely had thirty dollars a year might pay only a dime. A bill of five dollars was likely to be paid in goods—three shoats, a rifle, two split-bottom chairs, or a load of hay.

Source:

"Frontier Nurse," Literary Digest (28 August 1937): 12.

Sources:

John Duffy, The Healers: The Rise of the Medical Establishment (New York: McGraw-Hill, 1976), p. 317;

Michael B. Katz, In the Shadow of the Poorhouse. A Social History of Welfare in America (New York: Basic Books, 1986);

Paul Starr, The Social Transformation of American Medicine (New York: Basic Books, 1982), pp. 266-270.