Some Issues in Social and Health Policies
An editorial in The Lancet discussing the "underclass" in both England and the United States suggested that "compassion and public policy" once attempted "through such activities as the new deal and the welfare state" to attack the underclass but that declining faith in this viewpoint may be "inflating" the underclass (Anon., 1990). It was also suggested that a "walk about in London" would bring "shame and indignation" regarding the plight of the "underclass." Similar sentiments would be evoked by a visit to many large U.S. cities, especially the older metropolises in parts of the North and Midwest where blacks migrated in large numbers during the early to middle twentieth century.
After visiting London's East End slums, white progressive reformers in Philadelphia around the turn of the twentieth century sponsored Du Bois' research to diagnose and explain the social disease. Sweden was used as an antithetical model ( Lewis, 1993). Du Bois' The Philadelphia Negro ( 1899) painted a grim portrait of the quality of life of many urban blacks, a situation that has endured and even worsened ( Massey and Denton, 1993).
Sweden was used as model for New Dealers and more recently with regard to approaches to the problem of infant mortality ( Najman, 1993; Hogue and Hargreaves, 1993). However, Latin American refugees in Sweden have higher rates of self-reported illness independent of social class and education, probably reflecting "social degradation and a sense of discrimination" resulting from "xenophobia" or fear of foreigners ( Sundquist, 1995). An underprivileged social and health status awaits new immigrants.
In the United States, the "underprivileged" status of the black population in terms of mortality rates ( Kitagawa and Hauser, 1973) persists (Chapter 4), especially in the most highly segregated metropolitan areas (Chapter 5). The tentative conclusion is that the problem of the concentration of blacks in highpoverty areas due to segregation, with its effects on quality of life and health, must be addressed. If the segregation that causes such concentration of blacks is