"Poverty causes ill health; ill health causes poverty." In these words the late Dr. Rubinow was wont to state what he believed to be one of the few general rules of causal relationship in social life. Since the truth of this "rule" is recognized almost universally, it is surprising to find that medical care for the masses of the population has been so little organized. Here we find laissez faire, not only in theory but in practice, the chief organizing principle with reference to the individual sick human being. Sickness is unpredictable in the life of an individual. When records of sickness experience in the lives of a great many persons are available, the probable number of days of illness per person or the probable number of persons in a million who will suffer an incapacitating illness in a year can be estimated by ordinary statistical methods. But if the individual in the low-income groups has to find medical care where and if he can, it is no practical help to him to know that he or some member of his family will probably be ill once or more during the year--that being, in a million persons, the average probability of incapacitating illness. Any illness which requires a physician or hospital care or both involves an expense which few wage earners and small-salaried people can bear. If they undertake to save after an expensive illness to pay the physician and the hospital even a reduced fee, they are taking money which ought to be used, instead, for a proper supply of food, shelter, and clothing in order to assure physical health and hence to prevent future illness.
Some organized provision has been made for health purposes, but this provision is inadequate and much too limited in scope. It is only recently that we have had sufficient information to determine with reasonable certainty the degree of its inadequacy in the whole country. This was obtained in the National Health Survey of 1935-1936, as described in the following pages.