VARIATIONS IN THE LEVEL OF HEALTH
Advances in health have not been uniform throughout the country or for different segments of the population. A true picture of variations in mortality and morbidity would involve an exhaustive study of the health of the population within each state by sex, color, and residence classified by size of place. Such a compilation of data has never been made by any government or private agency and is beyond the scope of the present study. A rough approximation of this picture may, however, be derived from a review of existing materials.
The available mortality data are far more comprehensive and reliable than morbidity data, which have not been collected on a broad basis since the National Health Survey of 1935-36. The major portion of this chapter is devoted to maternal and infant mortality rates as general measures of health levels, with special reference to the use of health facilities in childbirth.
As emphasized earlier, a great part of the past fifty years' increase in life expectancy and over-all decrease in death rates has been accounted for by decreased rates in certain controllable and preventable diseases which affected the young, particularly the very young. Since women, regardless of prior state of health, are especially vulnerable to infectious disease during childbirth, maternal mortality has been subject to the same factors as infant mortality, and has in the past fifteen years experienced an even sharper reduction. Because of the nature of the process of childbirth, and of the health problems of the first year of life, maternal and infant mortality statistics are often used as an index to the understanding of health problems and ability to cope with them, and are used to pick out those areas where health services are most lacking in quantity or quality, or where they are not fully used.
We present, first, a summary of the differences in mortality rates between males and females, white and nonwhite segments of the population, urban and rural areas, and among the several states; we then turn to the detailed consideration of maternal and infant mortality; the last part of the chapter is devoted to a brief review of the available morbidity studies.