Reports & Studies

Committee on Economic Security (CES)

Volume VIII. Committee Activities

D. ADVISORY COUNCIL

Advisory Council Conference

CONFERENCE ON ECONOMIC SECURITY

Table of Contents

November 14, 1934

Morning Session

GENERAL OPENING MEETING
Frank P. Graham

ROUND TABLE CONFERENCE ON CHILD WELFARE
Homer Folk
Clifford G. Grulee, M.D.
Mrs. Harris T. Baldwin
Mrs. W.T. Bannerman

Discussion

ROUND TABLE CONFERENCE ON UNEMPLOYMENT INSURANCE
Chairman Joseph H. Willits
H.W. Story
Mary K. Simkhovitch
Paul H. Douglas
Thomas Kennedy
Miss Josephine Goldmark

Discussion

Luncheon Session

Chairman Paul S. Kellogg
Harold B. Butler
Harry L. Hopkins

Afternoon Session

ROUND TABLE CONFERENCE ON PROVISION OF EMPLOYMENT
Chairman William Haber
John Carmody
Frederic A. Delano
Mayor LaGuardia
Jacob Baker
Roger F. Evans

Discussion

ROUND TABLE CONFERENCE ON OLD AGE SECURITY
Chairman Mary W. Dewson
I.M. Rubinow
Lester H. Loble
Royal Meeker
Abraham Epstein

Discussion

Afternoon Session (Continued)

ROUND TABLE CONFERENCE ON MEDICAL CARE
Chairman Livingston Farrand
Dr. Henry A. Luce
Dr. Van Etten
Dr. George E. Follansbee
Dr. Michael M. Davis

Discussion

WHITE HOUSE AUDIENCE
Hon. Frank P. Graham
President Franklin D. Roosevelt
Dinner Meeting
Toastmaster John Stewart Bryan
Hon. Daniel C. Roper
Hon. Frances Perkins

WEDNESDAY MORNING SESSION

November 14, 1934

The General Opening Meeting of the National Conference on Economic Security, held in the Hotel Mayflower, Washington, D.C., in the Chinese Room, convened at ten-thirty o'clock, Mr. Frank P. Graham, Chairman of the Advisory Council on Economic of the Advisory Council on Economic Security, presiding.

CHAIRMAN GRAHAM: The meeting will please come to order.

On behalf of the Cabinet Committee, the staff, the Technical Board, and the Advisory Council, we wish to welcome you to this Conference.

Some of you have come from as far away as California. Your presence here gives welcome to the idea back of this Conference. That is the idea of providing for social security.

This conference is an expression of an increasing interest not only in the economic recovery of the nation, but also in the economic security of the individual human beings for whose life, liberty, and happiness the nation was founded and continues to exist. Without less emphasis on the imperative need for economic recovery we must, along with national economic recovery, lay the foundation for individual economic security. Without any let-up in the efforts in behalf of the more decent conditions of work and a fairer return for those who are doing the work of the world, the people all over America, we believe, wish to make more intelligent provision for the economic security of underprivileged children, the sick, and disabled, the unemployed, and the old. It is a shallow recovery that would sacrifice the security of millions of people. The economic security of the individual contributes to the recovery and the well-being of the nation, and the recovery of the nation contributes to the security and well-being of the individual. The security of the individual contributes to the security of recovery.

With partial recovery there has come in the states and nation something more of security to the homes, savings, farms, forests, schools, work, and hopes of the people - but not enough. With more recovery should come more security to human beings everywhere - in childhood, youthful education and opportunity, adult work and savings, sickness, and old age.

A few of the American people desire present economic recovery without any fundamental social repairs or reconstruction. A few call for a violent reconstruction regardless of present recovery. Others consider that a sound reconstruction is the only basis for a real recovery. Others consider that a sound reconstruction is the only basis for a real recovery. Most of our people are opposed to a mere recovery of the old regime and a false prosperity which would bring on another cruel collapse. The President and the Congress could not have allowed the country to remain as it was. Economic society had broken down and had to be mended or it would have tended to crash in its own ruins. This conference is called to consider ways and means of further mending so as to insure more intelligent security against the hazards of modern society.

This security is not to be achieved through tyranny and the regimentation of a dictatorship. It is not the security of the complacent privilege and power of the few, but the shared security of the many. It is to be a constitutional and lawful security through the cooperation of the government management, and labor. Real security never comes at the sacrifice of real liberty. The people must preserve the substance and spirit of the old liberties through a new security. An increase in economic security should mean an advance in human liberty and social well-being. Human beings in cooperating to win security against wild animals, the elements, and the wilderness did not thereby destroy their individual initiative and daring enterprise, but rather liberated for higher reaches the mind and spirit of men. With cooperation for social insurance will come a higher level of economic security. A higher level of economic security should mean a higher level of human liberty. Raising the levels of economic security widens the areas of intellectual enterprise and spiritual aspirations of the whole human personality. The road from savagery to civilization has been marked by victories for security against the hazards of the jungle and organized society.

By the nineteenth century, man had won a large measure of security in his home, fields, workshop, savings, and in his almost self-sufficient local community. With the coming of the power engine, his standard of living was, in many respects, raised, and his independence and security in some respects advanced, but on an unstable basis. Caught in the mechanical processes and social incidence of industrial society, whose unfeeling heart is the mighty power engine, are millions of helpless human beings. Industrial civilization depends on the dependence of human beings. The human casualty of an industrial society is unable alone to provide for his own security. Labor unions, fraternal organizations, and cooperative societies are necessary. Social legislation is required for minimum wage and maximum hours. But social insurance is indispensable to security against unemployment, sickness, and old age. These millions of human beings provide the life and labor necessary to industrial civilization, but our modern civilization, with its fragmentary view of human beings and human society, makes but little provision for the security of their labor, sickness, and old age.

The American people, in response to a gallant but patient leadership, propose to win this security for themselves without the illusions of a return to the old regime and its false prosperity, and without a resort to revolution, dictatorship, and the false security of tyranny. Neither do they propose to drift along.

The old drift of society and the nations led to the following results: the insecurity of peace in a world of armaments; the loss of homes in a society built upon homes; wide hunger in a land of plenty; child labor and sweatshops in the midst of unemployment; vast unemployment in a time of universal need; poverty and dependence after lives of faithful work; and disillusionment and despair in a world of youth and opportunity. The old social drift of a more static society does not need the human needs of a more dynamic society.

The steam, gas, electric, and oil power engines, together with the world war, the world moral confusion, the world depression, and the European revolutions, have accumulated such deep moving forces as to be the focus of a great historic transition with swift repercussions around the earth. From this earth much security has gone. Earlier historic transitions have been more regional in their processes of generations and slow centuries. Social drift did not then, as now, mean swift and wide social tragedy. The vast and dynamic mechanical framework now flung around the earth gathers up wars, revolution, depressions, and unemployment anywhere and implicates men everywhere. The pull of a trigger in a remote village or the press of a button in a financial capital may release pent-up forces that go on the wires of the world and engulf mankind in international murder or vast unemployment. Either we are to master our great industrial civilization and give human beings security, or we are to see it drift into unregulated self-destruction. Americans who, with scientific knowledge and mechanical device, have won a physical mastery of this great continent, will not long stand baffled and afraid along the social frontiers of a civilization which has not yet mastered the hazards of modern society.

To understand and to propose provisions for security against these social hazards is the purpose of this conference. As Director Witte has said, "We have no cut-and-dried program and no specific formula." We vitally need the information and views of the people in attendance. We especially need the study and thought of the invited guests, chosen for their special knowledge of the problems involved in proposals for social insurance against unemployment, sickness, and old age. We bring, we trust, minds open for the facts and the experience of states nations. The Advisory Council seeks to learn before advising. We will keep our feet on the ground in the valleys of our day's work even while we look into the hills yet to be climbed. We must preserve and carry on the good in the old society. We need to be patient for facts and fair to all interests and groups. We must work and think from day to day in a world of insecurity and grim realities and dream a bit sometime that the old society may yet become the great society of liberty and opportunity, security and happiness for more and more of the people of America and the world.

MR. EDWIN E. WITTE: I have some announcements to make regarding the events of the day.

. . . Announcements . . .

CHAIRMAN GRAHAM: The meeting is adjourned.

. . . The session adjourned at eleven o'clock . . .

WEDNESDAY MORNING SESSION

November 14, 1932

The Round Table Conference on Child Welfare, of the National Conference on Economic Security, held in the Garden Room of the Mayflower Hotel, Washington, D.C. , convened at 11:15 o'clock, Miss Grace Abbott, of the University of Chicago, presiding.

CHAIRMAN ABBOTT: The meeting will please come to order.

I think most of us who are here for this particular side of the program will have arrived out of the other room, and as long as we are all ready, and we are quite a little late, I am going to begin without any remarks on my part at all, except to say that we hope for a very full and free discussion of what are the needs of the children at this time.

I am going to reverse the order a little bit, and call on Mr. Homer Folks first.

MR. HOMER FOLKS: Madam Chairman and members of this section: no social worker and thoughtful citizen would have lived through the distressing experiences of the past five years, which have piled load after load, and yet more loads of trouble, on helpless people without arriving by this time, and long before this time, at a very deep interest in the subject matter of this conference, namely, "Economic or Social Security."

And, therefore, from the first announcement by the President of his intention to take up this subject, we all have followed it with the greatest possible interest.

Now, in following it, I have noticed in passing that the particular subject referred to here, child welfare, did not as such appear in the general discussions of the subject, and not in fact until the announcement of a sub-committee, happily consisting of Miss Abbott and Miss Lenroot, was the child welfare aspect of the matter brought to one's attention, and since that time I have been asking myself, "What has social security to do with the welfare and protection and health of children, and what have they to do with social security?"

The result of a little thinking on the part of anyone, I think, on that particular question, would lead to the conclusion, to which I was led, that the protection of the health and well-being of children is pretty near to the very gist and essence of the subject of social security, and that perhaps we might even consider the various aspects of a general program of social security, which is drawn up in its various sections and packaged and labeled according to the phase or entrance-point, profitably from the point of view of this question:

Do they, each of them within its own particular scope of action, give actually suitable and adequate active protection to the needs of the children of the families within the scope of that particular type of social security?

It doesn't seem to me to be even a difficult test to apply. It raises new thoughts about the subject, but it is quite easy, I think, to apply this test of the effects upon child welfare of the various proposals in relation to social security.

There is a very concrete example, for instance, in the matter of health insurance. It is quite an outstanding fact, speaking in general terms, that many of the continental European countries, in their medical benefit systems, provide medical care not only for the worker but for his wife and his children, as part of the security which is provided by means of the payments made under the health insurance system.

In Great Britain, on the other hand, the medical benefit has been provided from the first only for the worker himself, leaving the wife and the children of the family, so far as medical care is concerned, a subject, still, to all of the hazards and uncertainties of uncertain income and uncertain provision.

It is obvious, I think, from this statement of the facts, that on this test of child welfare, the continental system of health insurance is vastly superior to the British system.

Returning a moment to the general thought-security-I take it that it means security of income and security of resources. Security of resources is primarily for the purpose of the security of the home, of the group, of the family. That is the intent of security, to enable the wage-earner to continue to discharge his obligations toward his family. The chief objectives, so to speak, the central feature of family life is the welfare and the development of the children born to that family.

Now, I think we can also apply the test to the subject of unemployment reserves or insurance. The benefit there is variously determined under various systems, but usually with some relation to the wages which the wage-earner had been earning.

Now, of course, his needs vary greatly, and vary in proportion, in a considerable degree, to the number and ages of his children. In many instances, his wage has been barely sufficient to meet the needs of the family, and in particular the needs of the children.

Now, a percentage of that wage will obviously be insufficient to meet the needs of the family, including the children. The question came to me, in thinking of this subject, "Might we not raise the question, at least for consideration, as to whether the unemployment benefit to be received by an unemployed person under a system of reserves or insurance, takes into the account the number and ages of children in the family as a standard for determining the benefit to be received?"

If it is aimed to provide security, then it must do that, in substance, because a percentage of the previous wage would be insufficient to provide care and protection for the well-being of the children.

I was told that one of the bills which has been widely discussed providing for unemployment reserves contains that provision, that the benefits shall be adjusted according to the number of dependent children in the family, as well as the previous wages.

Now, there is one form of social security or insurance included in the general program, which does seem, on the face of it, to be very specifically addressed to the needs of grown-up people. That is old-age security. On the surface of it, it is, but is you penetrate just a little bit there, even, you will find that it has a very direct relation to child welfare, in a large proportion of instances.

If the person who reaches an age of inability for further employment has no resources of his own, by law and by tradition and by human instinct, he is cared for by his grown children, who in most instances will have children of their own to care for. That is the cause of the unhappy spectacle, (I am almost inclined to say the unconsciously indecent spectacle) of a competition between grandparents and grandchildren for the margin of the time, attention, and income of the grown children of the aged person.

And, conversely, if the grandparents are provided for adequately by some form of social insurance, old age security, or whatever it may be, then the children have first claim and complete claim upon the resources of their parents, and grown-up people do not have to choose between adequate care of their aged parents and adequate care of their young and growing children.

So here I think we can find that the subject of child welfare is directly and intimately related to the subject of social security even for old age.

But security resides not only in the application of the principle of insurance, as we analyze it, of mutualization by payment of insurance, it resides also in the development of direct public services for various social purposes, and when we consider that as a form of security, we enter upon a potentially extremely larger area of possible, and to my mind, highly desirable action.

I suppose the greatest form of what I would call social security for children which has been developed in this country, is the public school system, which provides an opportunity for every child to gain some knowledge of the world in which he is to live, and some poise and some ability to meet the problems he will encounter.

Not only his education but his health is directly concerned in the development of that security for his earning capacity, so we have drawn up, in connection with the schools, under the school authorities, and occasionally under the health authorities, an ambitious scheme on paper for conserving and protecting the health of school children.

This has largely been done by local funds and by local action. In some few instances, with some state aid we have been able to do a little more, thus far with practically no national recognition or participation.

Undoubtedly, some national participation and recognition and guidance will be essential for a real system, that will properly and with reasonable adequacy, protect the health of school children generally. That would be an extremely important form of economic security for those children at the school age and long thereafter.

In fact, it is only a short step from that program to the recognition that all public health activities in their essence contribute most to the protection and care of children. We can hardly think of any important activity in the public health field, to whomsoever it may at the moment be immediately directed, which does not have a direct, vital, and extremely important function in the protection of the welfare of children.

The prevention of tuberculosis, in which such striking progress has been made, is in its essence a campaign for the protection of children-protection from the impairment of their health and the undermining of their earning capacity, from the breakup of their homes, from the incapacity of their parents. Every shot fired in the tuberculosis campaign is one for the protection and the benefit of children, and is actually a definite form of social security for children.

Syphilis is another disease strikingly comparable to tuberculosis in its prevalence, in its serious nature, and in its harmfulness to child life. We are as open to reproach for having done nothing about syphilis as we are to congratulation for having done so much in the field of tuberculosis.

Our efforts in that field certainly are halting and haphazard, lackadaisical, unplanned, and thoroughly inefficient and ineffective, and we shall not arrive at a really serious and substantial effort for the protection of children from that most prevalent, most serious of diseases, without a broad, national planning, participation, and leadership, and undoubtedly a degree of national support.

And so we might go through the other forms of public health work, and primarily, of course, the subject of the protection of maternity and infancy, about which promising beginnings have been made, about which we have pursued, perhaps, too long the slow process of education. What is the use to educate people to the need of proper maternity care, if they can't pay for it? To be logical, to be consistent, to be effective, we must accompany educational measures with the actual provision of the funds whereby that care can be secured.

That is an extremely large area of need, and of opportunity for the protection of children by social action, which, insofar as it is active, brings security.

Then we come to some smaller groups, numerically, but perhaps an even greater need to home security should be provided in much greater degree, with much more certainty than at present.

I think the first of the mother's aid group, the mothers and the families in which the wage-earner has dropped out and for which at the present moment there is no other provision except a form of public relief which we call a pension, whereby we salve the feelings of the participants and permit the special interest in children to have the legitimate and proper scope and effect.

Now, in these years we have not improved our machinery for the protection of children in their homes. In some respects it has lessened its effectiveness and obscured its responsibilities. It too certainly needs a wide area of state-wide participation, which exists in a few states, and very possibly federal leadership and federal support.

In fact, all of the provisions which we have customarily in our national conferences thought of as child welfare, namely the care of particular groups of children away from their homes, or groups of children with special need, are still worked out primarily by local authorities under, in many cases, some degree of state leadership, and with perhaps federal benediction, but nothing more than that. If we are to provide security for our children, we must have a thorough overhauling, building out, or rounding out, state by state, an assurance of proper, adequate, and efficient operation.

Personally, I am a little inclined to say that security resides also in relief, an unacceptable and difficult type of security. Had we not had that, at least, how terrible, how additionally terrible the last five years would have been.

Now looking at this broad movement for social security we must not, of course, delude ourselves with thinking that everybody is going to agree with us, that it is going to be easy to put it over, pell-mell, or en masse. I would just like to raise the question, in bringing my remarks to a termination, that since social security is so largely tied up with, and consists of, the protection and security for children, and since the interest in children is universal, and since it is always relatively easy to secure funds and actions and public interest in children, is it not perhaps possible that child security might be a suitable opening wedge for the entire social security program?

Or I might say more accurately, may it not be that child security is the spearhead behind which the total security program may be driven home to its objective most speedily and most effectively?

CHAIRMAN ABBOTT: We have had Mr. Folks give this broad view of the child in relation to society, we might say, and then those special measures which relate to children individually. Following this I will call on the others who are listed on the program that you have, but I want to say at this point that after we have had those speakers, we want a full discussion by the others gathered here this morning. We hope that it is going to be such a discussion.

I am calling now on Dr. Grulee, who may have many titles given him, but is given on the program the title of Secretary and Treasurer, American Academy of Pediatrics, Chicago. Dr. Grulee!

DR. GRULEE: I wish that there were more men present then I wouldn't feel so alone.

CHAIRMAN ABBOTT: Well, the quality is high.

DR. GRULEE: Very.

I have written down what I wanted to say, for fear that I might talk too long, and since the time allotted is short, I felt that I could get it all in better that way.

The function of a pediatrist in such a meeting as this is, I think, two-fold. First, to present the pediatric viewpoint as he sees it, and second, to outline the resources in his field which would go to consummate any extensive work along the line of child welfare. The pediatric branch of the medical profession has always and increasingly been for preventive measures, much more so than the rest of the medical world. They may be said to have led medicine to this viewpoint. This preventive medicine has been developed as an individual service. Pediatrists of the country are, I am sure, persuaded that the only way to take care of children is as individuals. They feel that much of the propaganda that has gone out has been too generalized and has developed reactions among laymen which were not altogether healthy. The rightness of this position is, I think, justified by the results they have obtained. You may, therefore, be sure that from the standpoint of the good of the child, pediatrists of the country are a unit on this point.

It should be borne in mind that pediatrists constitute only a minority of the children's physicians. The majority of children in this country are cared for by general practitioners. It has, therefore, been necessary to develop more adequate facilities for the teaching of pediatrics in our medical schools. Within the past few years, efforts along this line have borne fruit, so that in nearly all the first-class medical schools, the pediatric department is not only an independent department, but is also one of the four main departments of the school. Where this is not true, the situation is in nearly every instance on the mend. As a result of this, the men who leave medical schools are much better prepared to look after children than they formerly were, and for these men and also for the men who have graduated in medicine in the last ten or fifteen years, we may say that they are adequately trained not only to care for children when sick, but to protect them when well. The oft-repeated statement that the medical profession does not care to do preventive pediatrics and is not capable of doing it if the chance presents itself, is no longer tenable.

I am quite sure, too, that I voice the feelings of the pediatric profession when I say that there is a vast amount of difference between undernutrition and malnutrition and that it will be necessary to investigate in the individual child which of the conditions is present and treat the case accordingly. In other words, while food, shelter, and clothing are absolute necessities during childhood, as they are during adult life, malnutrition in children is by no means always a result of underfeeding, or improper feeding. This must clearly be borne in mind in any program which has to do with child welfare, under present conditions.

Another viewpoint which I think would be held by this group of members of the profession is that only by definite cooperation of the whole medical profession will we be able to get the results which we desire. Antagonism of the medical profession will absolutely block our program and must be avoided wherever possible. This does not mean that if the occasion demands we cannot go counter to individuals and their ideas, but we must on the whole cooperate with the medical profession if we are to do the things that are necessary. Therefore, the success or failure of child welfare depends to a large extent upon the general measures which are taken towards cooperation with the medical fraternity.

Another point which I would like to bring out is this: if we are to obtain the best results, it is not only necessary to cooperate with the medical group, but it is likewise absolutely necessary that full cooperation with all groups interested in child welfare be brought about. The key-note of a meeting like this, it seems to me, is cooperation. Without such, it will be impossible to obtain the best results, and the best is the only thing which we can consider. Child welfare is not essentially a medical problem, but in pretty nearly every phase of it medical work enters, and it is only by fitting the medical man into his proper place in the organization that we will be able to do so for the children of this country what should be done.

A short survey of what we already know would, I think, not be amiss at this point. While to many the health of the child seems paramount, to those of us who are initiated, it is the infant and especially the newborn infant, which deserves our special attention. While unquestionably pre-natal care has done something to reduce neonatal mortality, still mortality in the first two weeks of life is so great that special emphasis should be laid upon this point. The mortality of the infant is still higher than that of the pre-school child although it has been so remarkably reduced in the last 20 years. It is only when we view the whole problem in a comprehensive way that we will be able to get the final result which we desire. Many of the things which occur at childbirth are irreparable. If we can erase these, or even reduce them, we will do a great deal of good. I have only mentioned this phase because I felt that it was one which a group of this sort might easily neglect, and this, in the opinion of pediatrists, is one of the most important of the problems to be met. I think it should be mentioned here that unless our survey of children's hospitals and pediatric departments of general hospitals is very far wrong, the facilities for education in pediatrics for nurses in this country are entirely inadequate.

I might say that we have finished a survey of the child hospitals. There are but 34 child hospitals in the United States. They give excellent training for nurses and frequently take in nurses from other institutions. We have likewise collected as far as we could the number of hospitals in the United States that have 25 beds or more for children. We felt that anything under that would be entirely inadequate from the standpoint of training, and we find that there are something less than 320 of these hospitals in the United States, and one-fourth of them are in the states of New York and Pennsylvania.

There are something like 6,000 or 7,000 hospitals in the United States, but you can see that the facilities for training nurses are pretty poor in those hospitals.

This from a medical standpoint is of great importance because it means that nurses have not a pediatric viewpoint and a pediatric technique. This is of moment since in many instances their statements regarding child health are received by laymen as authoritative.

I come now to the second of my propositions and that is, what are the pediatrists of this country capable of at the present time? How are they organized and what are they doing? At the time of the recent White House Conference many of us were appalled when we realized that there was such a vast program for betterment of the children of this country and no pediatric group to take advantage of it. Since that time there has been developed an active society in pediatrics consisting of between 700 and 800 members. This society is organized into four regional groups, one in the east, one in the south, one in the middle west, and one in the intermountain region and Pacific coast. These regions in turn are each organized into state groups; each state group has a state chairman. These are at the present time, only three states in the union that have no chairmen, namely, North Dakota, Montana, and Nevada.

Of greater importance to those here is the fact that the basic principles upon which this Society are founded are essentially those which would be of the greatest aid to any child welfare program. In the first place, this organization has been instrumental in raising the standard of pediatric work in the medical schools. In the second place, each chairman has formed a close contact with his state medical society. This has been done with the idea of bringing to the general practitioner the advantage of and necessity for better recognition of the needs of the child. It was a great surprise to me to see how eagerly the general practitioners participated in this effort. There is on their part, I am sure, no lack of interest in just this sort of thing. In many of the states this Society has developed close connection with allied organizations such as parent-teachers organizations, health departments, etc., with the idea of developing the medical side of the programs.

I shall not take up your time to go further into the work of this Society. The mimeographed sheets which are available will give you a much better idea of what has been done. Some of the efforts have been individual state efforts, some have been regional and some have been national. Perhaps the most extensive has been that carried on by the southern region under the direction of Dr. E.C. Mitchell of Memphis. This has resulted in a combining of forces with the Health Departments of all states involved and likewise with the obstetrical groups. I wish to say, however, that these are simply beginnings, but I think I have said enough to indicate to you that the Society in question is willing and able to cooperate with you from the medical standpoint.

In conclusion, I would like to say that cooperation of all branches and all efforts must be the key-note for success in any child welfare movement. The pediatrists of this country are organized for such cooperation and receptive to it. While the scientific knowledge for such a program may be lacking in spots and will always be, there is still sufficient to do a great deal of good from the medical standpoint. Pediatrists can and will help in the various efforts, and frequently their opinion is of value in the spheres where it has not been sought.

I would urge that this group direct its attention not towards emergency problems only, but that the effort be so organized that it will bring about not only temporary good to the child, but develop methods and measures which will be found to be of permanent value. Therefore, it must be an effort not of weeks, or months, but of years.

No plan or plans will be effective in all communities, but general principles and special examples will be most helpful.

What has all this to do with economic security? As to the present, the health of the child is intimately interwoven into the happiness and success of the family. As to the future, the health of the child grown up, which depends so much on the health of the child growing, will not only reduce the cost of living, but will frequently determine whether the individual is to become a useful member of society.

CHAIRMAN ABBOTT: Before we have our general discussion now we are going to hear from two of the many women's organizations that have been interested in the problem of child welfare.

Mrs. Harris T. Baldwin, Vice President of the National League of Women Voters!

MRS. BALDWIN: The National League of Women Voters, through its Department of Government and Child Welfare, is concerned with discovering to what extent the child is cared for and protected by the government, and it is concerned with the problem, with which it is working through public opinion and through legislative action, of securing more adequate child protection.

It is because we have been so concerned with questions of child welfare since our organization in 1920, and because the League is asking for certain lines of legislative action in the coming years that I venture to come to-day before a group of experts.

I am going to read what I wish to say.

Since its organization in 1920, the National League of Women Voters and state and local leagues have dealt continuously with child welfare problems and year after year have sought public action needed in behalf of children. It is our of this experience that I speak to-day.

One of the serious economic hazards of family life is the expense incidental to the birth of children. Under the best of conditions there is the cost of normal medical and nursing care, and in many cases someone must be employed to care for the house and family for two or three weeks.

When things do not go well and the mother or child is ill, or when one or the other dies, there is great additional expense for the husband to meet. These latter hazards can usually be avoided if the mother is given proper pre-natal care, if the mother and child have competent medical and nursing care at the time of the birth and during the post-natal period, and if the mother is properly instructed in the care of her child.

Due to the advance in medical science and to the educational program for mothers and fathers carried on since 1900 there has been a great reduction in the infant mortality rate, that is, the number of babies who die during the first year of life.

The latest Census Bureau report shows that during 1933 the infant mortality rate was 58.2 deaths under one year per 1,000 born. This represents a great gain over 1915 when the infant mortality rate for the birth registration area was 100 deaths per 1,000 live births. However, the real significance in the infant mortality figure for 1933 lies not in the rate for the United States as a whole but in the fact that the rates for the best states ranged from 39 to 48, (Washington 39, Oregon 40, New Jersey 46, and Connecticut, Iowa, Minnesota, and Utah 48), while the highest rates were Texas 76, South Carolina 78, Arizona 111, and New Mexico 136. If the Washington rate of 39 had prevailed throughout the United States there would have been in 1933 almost 40,000 fewer deaths of babies in the United States.

Of even greater economic importance to the individual family is maternal mortality, because the loss of the wife and mother is as serious and sometimes more serious that the loss of the wage-earner. On maternal mortality, there has been some progress but it has not been as rapid as on infant mortality. During 1933, 12,884 women died from causes related to child birth, and the maternal mortality rate was 62 per 10,000 live births, a rate higher than that in most of the other countries.

Meanwhile it has been successfully proved that with proper prenatal care, obstetrical service, and post-natal care, the lives of fully half the mothers who now die might be saved. Last year we read the report published by the New York Academy of Medicine which states that nearly 66 percent of the mothers who died in child birth in New York City in 1930, 1931, and 1932 might have been saved by the application of medical knowledge.

From 1921 to 1929, a great effort was made to promote the hygiene of maternity and infancy in the United States. Federal aid for this purpose was given to the states. Almost every state established a division of child hygiene in its state department of health and local health departments, and doctors and nurses under state supervision sought to educate mothers in the care of themselves and their children and to educate doctors on the latest medical conclusions on the proper care of mothers and babies. Unfortunately, the federal aid ceased just before the period when the depression curtailed state and local tax receipts.

We have watched year by year health appropriations cut and maternity and infant hygiene service by state and local governments curtailed despite protests by the League and other organizations. From 1932 to 1935 state expenditures and appropriations for child health activities showed a net increase in only four states, no change in two, and a net decrease in thirty-seven. Five states had no appropriation for child hygiene in 1932, 1933, and 1934 and four others had none in 1933 and 1934. Fundamental health protection was thus decreased during a period when the economic depression brought new hazards to the health of mothers and children.

We use maternal and infant mortality indexes to measure our progress and we rejoice that knowledge spread during the active period of health education in this field has continued to bring decreases in these mortality rates.

From the economic standpoint, however, illness of the mother and child which does not result in death, often is the more serious financial burden to the family. On the effect of the depression on this, there is only scattering evidence. However, knowing from experience unrelated to the depression, that a large measure of such illness can be avoided, prevention in this field offers a certain return in reducing the economic hazard of families in the low income groups.

The National League of Women Voters seeks federal leadership on this program combined with participation by the states. We need both the aid and stimulation of federal action, and at the same time the states must increasingly carry the actual responsibility of service to the women and children within their borders. It is too important to leave to the action of the states alone. Since there are over 2,000,000 births a year, perhaps no other preventive effort can mean more to so great a number of families.

There are two other phases of economic hazard affecting children on which Leagues of Women Voters have been at work. For the child whose father no longer supports the family the League has sought mothers' aid from the state or county to enable the mother to keep a home for her children. The state laws on this are uneven, the amount of assistance given is often too low, and recently there have not been appropriations even sufficient to pay the small amount allowed under existing laws. Assurance of income for fatherless children to enable the mother to provide adequate food and shelter and to send them to school at least until they are 16, is essential if they are to develop into citizens who will be able to provide for themselves and their own families. The financial support for mothers' pensions must be increased and stabilized so that it will not be subject to sharp shrinkage unrelated to the actual need of the children involved.

The National League of Women Voters has as yet only sought state action on mothers' pensions. We recognize that the need for action is nation-wide and we will study with care any proposal which may involve federal action.

The third economic hazard affecting children involves the group often designated as children in need of special care by the state. It includes child dependents and delinquents and children handicapped physically or mentally. For these children, financial provision is needed either to prevent the cause which necessitates special care or to provide the care which they need. This involves services to the child such as the investigation of his situation and needs, supervision during the periods of experiments and probation, and intelligent use of public agencies and institutions for the child's benefit. The League of Women Voters and others on many fronts have sought to secure public provision for such care for children, but the results are fragmentary. In addition to funds needed for direct service to these children, we need better organized state and local agencies to provide for these services. Here again the League has sought results through state and local government action except that it has urged adequate appropriations for the Children's Bureau in order that the states might have the advantage of federal research and leadership. The next several years are likely to see an increase in the need for this type of welfare service. There has never been greater need for setting our house in order to be able to care for the children handicapped by the depression. This is not a sentimental appeal for helpless children. It is common sense recognition of the fact that if the community helps children in need to-day, those children to-morrow will be able to shoulder their own share of the economic load under which adult citizens carry.

For many years, the public protection of children has been built up brick by brick. The recommendations now in preparation offer the opportunity for a nation-wide program to prevent the unnecessary economic hazards which affect children and to promote aid for children in need of special assistance. We trust that this phase of personal economic security will be given full attention in the final report of the Committee on Economic Security.

CHAIRMAN ABBOTT: : Next is Mrs. W.T. Bannerman, from the National Congress of Parents and Teachers, who will now say a few words. Mrs. Bannerman!

MRS. BANNERMAN: Madam Chairman, the National Congress of Parents and Teachers, too, is not a professional organization, and so my remarks will be confined more largely to the difficulties which we have encountered, and the feeble way in which we have been able to meet them, than to any scientific discussion.

Since its organization on February 17, 1897, the National Congress of Parents and Teachers has grown in membership to more than 1,500,000 comprised of over 20,000 local associations in 48 states, the District of Columbia, Hawaii, and Alaska.

Its objects as set forth in the Constitution are:

1. To promote child welfare in home, school, church and community; to raise the standards of home life; to secure adequate laws for the care and protection of children.

2. To bring into closer relation the home and the school, that parents and teachers may cooperate intelligently in the training of the child, and to develop between educators and the general public such united efforts as will secure for every child the highest advantages in physical, mental, moral, and spiritual education.

Among its policies are that it "shall be non-commercial, non-sectarian, and non-partisan" and that its "purpose shall be educational." While financial support of the public schools, public health, or other tax-supported services and agencies is not included in either its objects or policies, efforts and expenditures to protect children from the devastating effects of economic insecurity for the past three years have been recorded in the reports of practically all of our national officers and committee chairmen. This situation and the spirit in which it has been met are best epitomized in the following excerpts from the 1933-34 annual report of our National President:

"During the year with its momentous changes the National Congress of Parents and Teachers has steadily faced its obligations and opportunities with enthusiasm, zeal, and unselfish effort. In each historical epoch of the nation, the Congress has found its particular phase of service in meeting the paramount needs of childhood during that period.

"So in this, our year of 'recovery', when social educational, and economic forces have reacted against the security and well-being of the child, have come greater opportunities to serve, more accomplishments to record, and many rich rewards in reestablishing the child in his rightful place.

"Home Making. Our opportunities were found in many fields. Many parents in the home, eager to stretch the meager incomes and protect the health of the family, have sought technical advice. They have read carefully the bulletins and articles in our Child Welfare Magazine on nutrition and care of the family; they have used the advice given in leaflets by our specialists. They have learned to conserve health and happiness by more careful consideration of the needs of family life.

"Public Education. Another opportunity came to us as citizens and patrons of the school in protecting our public schools. We have found opportunity to reflect our faith in American education and to defend its support in national, state, and local groups.

"Our rewards have come though seeing school programs suffer a minimum in quality of curriculum and length of school terms. Many states having too little financial support before the crisis, have, through these more dire situations, forced attention in their extremity. Much has already been done through federal relief measures in the reopening of closed schools and aid to college and high school students. Not the least of the good results has been an increasing amount of information to the public concerning schools of the public.

"Community Cooperation. Our members in groups cooperating with others have sought to conserve to the people of all communities, public health services, recreational centers, and library facilities.

"Health conservation has been secured for many children by the cooperation of school officials and parent-teacher workers in serving hot lunches, providing clothing, and obtaining medical and dental clinical services for those who were dependent upon public bounty.

"The Conference on Child Health Recovery called last year by the Honorable Frances Perkins, Secretary of Labor, showed the need for greater concern for malnurtured children. Not only were there startling cases of lack of nutrition in families whose children were not in school, but many children were attempting to attend school without meals, except those furnished by school authorities or parent-teacher associations."

The foregoing statements are not mere generalizations without factual basis. The departure from an exclusively educational program to the performance of essential relief work has led us as a national organization to evaluate with greater care and uniformity our own procedures and activities. In 1932-33, a comprehensive questionnaire was prepared and sent to every local parent-teacher association. As a result 7,803 associations in 28 states reported. These reports indicated that programs and projects in child health, many of them of a relief character, far out-distanced all others.

In 1933-34, a similar questionnaire brought replies from 11,849 local associations (57 per cent) in 46 states. So numerous were the projects of a relief character that three sections of the Annual Summary are devoted to "Emergency Activities."

An outstanding health activity which has been carried on during the summer for several years is known as the Summer Roundup. It consists of a complete health examination of all children entering school (kindergarten or first grade) for the first time, determining what medical care is needed and correcting before school opens all remediable defects. Statistical data compiled show that in 1933, owing largely to financial conditions, less than half of the defects discovered were remedied. This report, together with the General Summary, is submitted with this statement.

Plans for the solution of the problems which these reports reveal are not specifically or completely formulated. They do, however, include adequate appropriations for governmental research agencies which conduct studies related to home making, child health, protection of maternity and infancy, education, and other community services. State congresses of parents and teachers are eager for information concerning the program of social legislation now under consideration, but to do date, owing to lack of adequate knowledge, no action has been taken. In our legislation program, there is also included a larger measure of consideration for the consumer in the field of health, education, and recreation as indicated by our support of the federal food and drug bill, motion picture regulation, election of the Board of Education of the District of Columbia, and emergency federal aid for education in order (1) to keep open schools which otherwise would be closed, (2) to provide buildings for consolidated schools, and (3) to re-finance school indebtedness at lower interest rates. Indirectly, these measures, we believe will tend to democratization and stabilization of support in the particular fields to which they are related as well as contribute in no small measure to the protection of children.

In behalf of the National Congress of Parents and Teachers, I appreciate the opportunity extended to our organization to participate in this conference. That the federal government is not unmindful of the difficulties which we have encountered and is studying ways and means of insuring more stable economic security affords us a sense of satisfaction and gratitude and inspires us to continue our activities with renewed enthusiasm. We hope that the time is not far distant when the home-every home-which we recognize as the basic social unit, will enjoy such a measure of economic security as will enable it to assume its proper responsibility, not alone in providing for its own children in the home, but also of participating in the support of those secondary social units, the school, the church, and other community agencies which combined, constitute that larger home which we call "our civilization."

I would like to give some items in this statistical report.

Parent-teacher associations are primarily educational; they are not relief. Yet we have in the last year's report the following items: milk for under-nourished children furnished by 3,683 parent-teacher associations in 41 states; hot lunches furnished by 4,072 local units in 41 states; clothing and shoes furnished by 4,597 local units in 40 states; car fare furnished by 612 units in 31 states, etc.

There are many items, covering both aid of that type and aid for the schools, which are entirely out of our field, purely emergency measures.

CHAIRMAN ABBOTT: The subject of children's needs is at this time open for discussion, and while I think that we had better adhere to the rule of having those who have not spoken speak now, we are a small enough group so that I am sure we can go back to any of those who have, who wish to say something more in view of what has already been said.

I should like to have volunteers now for the discussion.

DR. FRED L. ADAIR (Chicago, Illinois): I suppose that someone has to start the discussion, and it seems appropriate that we might have a discussion relative to motherhood and maternity, which is my main interest in the program of maternity and child welfare.

I think practically all of the remarks that Dr. Grulee made would apply with equal force to the practice of obstetrics. So that with a few exceptions I will not reiterate the ground which he covered.

I was very grateful, indeed, that Mrs. Baldwin stressed the maternity aspect of the child welfare program.

About all I can do is to emit myself the results of some of the thinking which has been gone through past years, and efforts to further the program of maternal welfare.

Personally, and naturally, the stress comes, in my mind on the mother rather than on the child, not that I am oblivious to the interest of the child. So far as the family is concerned it seems to me that the mother is really the keystone of the arch of our social organization, and that the maternal influence on the child, in its formative period in the early years, is really the dominant influence not only during that period but in a major degree through the remaining portion of its life.

Consequently we should stress the end for itself and not only as part of the child welfare program, the welfare of the mother.

The protection of motherhood involves both social and economic features which I am not competent enough to discuss, except with reference to one point, to which I would like to call your attention. The birth rate is continually diminishing-not only the rate, but the actual number of births-so that now our birth rate is practically at a maintenance level.

I am not going to discuss the desirability or undesirability of that fact, but the point is that the child is becoming increasingly more valuable to society, because there are relatively fewer of them. Therefore, the conservation of these child lives is a matter of increasing importance to society. It is also important to the individuals involved.

It has been pointed out that there has been relatively little decrease in our still birth rate, that is, our foetal death rate, and in our near death rate. Most foetal deaths, are, of course a responsibility of the care of the mother. While they could not all be prevented, their reduction is an obstetric problem.

The major portion of deaths occurring in the newly-born period of life is also in a great degree the responsibility of the obstetrician.

Medical care in its relation to the protection of motherhood is the field that I wish particularly to mention, and particularly certain points which I think are worthy of consideration.

When I speak of medical care, I do not limit that to the care of the obstetrician but to all related fields. Including the nursing field and special medical fields which comprise a part of the complete care of the mother.

We are conveniently dividing the care of the mother into the preparation for motherhood, or the pre-conceptional care, the pre-natal care, and the actual care of delivery, the post-parent care, and the post-natal care. All of these must be covered in order to secure the ultimate satisfactory care for the mother. This involves the care in the home, both in urban and rural districts.

Not all confinement cases have been taken care of in the hospital, even if it were desirable that they should, but adequate provisions for hospital accommodations for cases where it is necessary should be made in both rural and urban communities.

It seems to me that the best way to work out a complete program is by the utilization of the resources in individual communities-making the best use of those which already exist and supplementing those which are lacking. This would be a much simpler program than to attempt to work the whole program over.

It seems to me that this involves medical leadership, in cooperation with other agencies, in individual communities; the individual communities present different problems, and the general principles of a program would have to be applied to each community to meet its individual needs.

It has seemed to me that the most vital thing that could be done by agencies outside of a community would be to furnish a catholic action, so that each community would be stimulated to carry out a better program. Financial aid is one of the best stimulants that I know of.

What Dr. Grulee said relative to the inadequacy in the past of medical and nursing education in the field of pediatrics applies equally well to the field of obstetrics. We have improved a great deal in this respect, but there is still much to be done.

There are many service institutions in various communities which are not operating to their capacity, largely due to inadequacy of funds. I happen to be connected with an institution, a maternity hospital in Chicago, in which this condition exists, and which is probably typical of many other institution. We have 160 bed capacity, and our actual occupancy is only about 100. That means that we have an expensive plant, which is being operated at about two-thirds efficiency.

The same thing applies to our home service. We are not able to carry our home delivery service program because of inadequate finances. That, I have no doubt, is typical of similar institutions in other communities where such are present.

Of course, there are any communities, in fact, most communities in the country, which have no adequate provision for maternity hospitals.

In relation to medical provisions, and medical leadership throughout the country, as a whole, I would like to call attention to an organization which has been in formal existence for a number of years, but has recently become more formal in its existence and is representative of all of the leading obstetrical societies, both national and regional in the United States. It seems to me that through this organization, it would be possible to issue a certain amount of propaganda and guidance to various communities throughout the country, so that a much more effective program for maternal welfare could ultimately be carried out.

MR. HARRY L. LURIE (American Association of Social Workers, New York): It seems to me that we are probably all in general agreement, concerning the problems, and the standards of care, and perhaps some other details of the technical and professional services involved. However, we have not as yet given attention to the basic economic problems which underlie the lag in all of these efforts which all of us agree are necessary.

It seems to me that is the question which this Conference on Economic Security needs to consider particularly.

The various discussions we have had indicated the fact that programs already established are lagging because of the lack of financial support, for one reason or another, and we are to discuss some new measures for social insurance.

It seems to me that fundamentally, our problems is to try to devise ways and means whereby these programs for child health, family security, and child welfare in general, can be undertaken by our national community.

On the basis of existing measures, we have fundamentally only two provisions whereby we can bring into effect the various proposals for increased security. One of them is the provision of insurance, which is being discussed largely at the present time on the basis of contributions out of the wages or out of the payrolls, and which will find their way finally into the cost of living. From these contributions we are to derive the resources for maintaining these general programs.

If that is to be the method, I think we should be aware of the fact that such measures, if they are at all extensive, are likely to reduce the general standard of living of families. Distribution of the already low wage level, and the increase in prices brought about by increasing the cost of production through taxes on payrolls, naturally will mean that most of the population for whom we are concerned will bear the cost of these additional measures.

In part, that may be desirable during a period of prosperity, of increasing living standards, but not during a period such as this. It would mean that a large part of our population, by sharing the riches, would sacrifice some of these basic provisions for health and economic security which are provided from the already low wages of a mass of our population.

The other alternative, of course, is the alternative of taxation, and from that point of view it seems to me that we might well go on record as favoring systems of assistance and relief to child welfare which rest upon the obtaining of funds from taxation, from surpluses of production, not from the part of production which naturally goes into wages and is borne by prices. For that reason, a program in which the federal government is particularly involved is desirable, because it is only the federal government, at the present time, that has the authority and the opportunity to get for social usage the surplus of incomes which are now produced, and to stimulate the further production of those incomes represented by goods and services, which are required by children and by families throughout the country.

In this conference, therefore, perhaps this section can sound the general note, that our programs of security should be devised so that they come from the surpluses of production, and stimulate production, rather than as in the past when measures for social purposes have been limited and restricted and have failed to meet basic needs because no effective economic basis has been found for their support.

MR. JACOB KEPECS (Child Welfare League of America, Chicago, Illinois): I would like to discuss for the moment the other phase of this problem Mr. Lurie has developed. I am certainly in agreement on one thing, namely, that you cannot possibly consider the child problem as apart from any of the other categories which are under discussion to-day. As Mr. Folks pointed out, there is even direct relationship between the security of the child and the security of the aged person.

I would like to discuss for a moment the problem of special classes. There are, of course, these two phases of this problem, namely, all children, but particularly the children in the low income families and those in families on the unemployed rolls, and in addition to these, there is a large group in need of special services and special care, whose security is threatened not only on economic grounds but also by certain physical handicaps.

These special cases, as it was pointed out, consist of children in broken homes, children who have lost their father, whose father is away from the family, children who have lost their mother, and those in need of special services-a large group of handicapped children who are not being served at the present time or who are being served only in a small way.

Coming back for a moment to the child who has been deprived of his father, we know that even though in the states with the best provisions care is taken of such children through mothers' assistance and mothers' pension laws, but we know that in most of these states only a comparatively small proportion of children receive those benefits.

Illinois, I believe, is the first state that made provision for such children, but I know that a comparatively small proportion of children are provided in this way in the state of Illinois. It seems to me that we are not going to get very far and we are not going to improve the situation very much in that regard without some assistance from the federal government. I think that it is essential to have the federal government enter into the picture.

Consider the comparatively large group of children suffering from various physical and mental handicaps. It is, I think, commonly conceded that but a small proportion of these children receive the services which they require through the state and local efforts.

Even deformed children, in whom so many difference organizations are interested, are very often neglected. I think in some states, as in the state of Illinois, it is estimated that only about 20 per cent are being served or are receiving the necessary care, and the same holds true for other handicapped classes. We aren't going to do very much for these classes depending on state aid alone. The federal government may well come into the picture in order to complete or round out the program for these special classes.

There is one other class which we haven't discussed very much, which is coming to the foreground because of the depression. That is the group of children who have reached the school-leaving age, or self-supporting age, of 16 and over. These children are on the labor market at the present time, or most of them are; some of them are at work, but most of them are not; and, of course more and more people are concerned about them. This is not alone an economic problem; it is a problem of morale which is extremely important. Very little attention as yet, in a practical way, has been given to that group locally.

The national government is doing some things for that group, some portions of that group, providing C.C.C. camps for some of the of the boys particularly, and for a few girls in the C.C.C. camps. It also provides some help for that group in the transient service and in other services, but on the whole that group is not served at the present time. It finds its way into what we call in Chicago, "basement clubs," and it is a pathetic group on the whole because it is loose--not in school, not at work. This is a group about which we must concern ourselves.

I read the other day an article on the financial page of a New York paper, and I was surprised that it appeared on the financial page. It was about a youth problem in America. The person who wrote about the youth problem on the financial page is greatly concerned about the youth of America, and claimed that there is more dynamite in that problem than there is in any other social problem that we are faced with to-day. He gives two bits of advice on how to meet that problem, and I am particularly interested in the advice which he gives.

One bit of advice is that employers should be very considerate of the young people who apply for jobs, very polite to them, and that they should not dismiss them abruptly, so that they won't become anti-social. The other bit of advice is that employers should give preference to male applicants over female applicants because of the tradition in America, and because, he says, after all it is a little bit cheaper to maintain girl and women on the relief than it is boys and men. He said that women and girls somehow can manage on less than men and boys can. I think it is rather interesting that this appeared on the financial age, and that this man is talking along the same lines that some other men are. I think that the youth problem is something about which we must concern ourselves, and I do not think that the local or state governments are going to give it very much attention without some impetus from the federal government.

I submit, Madam Chairman, that in this conference when we talk of social security, we include in any kind of a program that group which falls, let's say, between the ages of 16 and 21 or 22, which deserves, I believe, very special consideration in any security program.

CHAIRMAN ABBOTT: Is there someone else who wishes to speak?

MISS WAGGAMAN (Bureau of Labor Statistics): I was very much interested several years ago in an interview with you in New York in which you suggested that the mothers' pension laws should be extended to include families in which the wage earner was unemployed, and I am wondering whether the Committee on Economic Security has considered the question of extending the mothers' pension law to include all families where the wage earner has an inadequate income?

CHAIRMAN ABBOTT: I don't think that it has been done; other inclusions have been lost rather than added.

MISS HAZEL CORBIN (Maternity Association of New York City): I should like to urge the need for the development of maternity welfare committees or commissions throughout the country--state, county, urban or whatnot--to set up standards for maternity care that would be applicable and workable in those communities, and to conduct current studies of morbidity and mortality so that it would be possible to know what was happening, and to work out some measures for preventing the unnecessary morbidity that we have now, and to development methods of teaching the public the need for adequate maternity care, so that the public will more completely avail itself of the facilities that are now available to maternity patients.

I think that one of the other things that this maternity committee should work on is the development of facilities to make adequate maternity care available to every woman at prices she can afford. These facilities would include, I name first what I consider most important, development of institutes for teaching doctors and nurses the most up-to-date methods of giving maternity care. They would include the development and control of safe hospitals for maternity care, the working out of some scheme for properly supervised home medical and nursing care, including some form of supervised household help, the development of dental care that would be available when the mother needed it, and such social service as may be necessary.

I think that the committee should address itself to the working out of some scheme for the regulation of the practice of all who would contribute to the maternity care of all patients.

MR. C.C. CARSTENS (Child Welfare League of America, Inc., New York): I should like to supplement very briefly what has already been said in regard to mother's aid, and particularly in regard to its fragmentariness and the need of having a thoroughgoing program that will be in a sense a national program which will meet the situation.

A good many facts were brought out in the studies that were made for the White House Conference on Child Health and Protection, which haven't come out into print. A bit of information is in my possession that bears out the fragmentariness of mother's aid.

We were able to gather data from quite a number of states, but not from all, on the parental status of all the children being cared for away from home. It was very interesting to find that while in one section of the United States in a group of contiguous states an average of 10 to 12 per cent of the children of families in which the father had died were being cared for away from home, while in another group of contiguous states, those who were being cared for in orphan asylums and children's homes or foster homes, amounted to from 25 to 47 per cent of the children in families where the father had died.

Most of these states of the last group had mother's aid laws, but the inadequacy of care seems to me very striking. I do not believe that such a program as we have now in mother's aid will get very far during the next ten or even twenty years unless we can in some way effect a national effort. We are still, friends, 48 different republics when it comes to child welfare, and I believe then we ought to recognize the fact that it is desirable in many ways to urge a national program of child welfare rather than 48 different state programs, even though there are those of us who do not want to see the powers of the states infringed upon.

The children are the sufferers in an inadequate program.

DR. T.F. ABERCROMBIE (President, Conference of State and Provincial Health Authorities, State Board of Health, Atlanta, Georgia): I want to emphasize particularly what the last speaker has said. I think we need a national leadership more than any other thing, and a national program.

Some of our states are so small in population and financial resources that we can never be able to develop the well-rounded program that we could and should have, without the leadership and financial aid of a national plan.

I wish to give you an idea of some things being done in Georgia, (I am from Georgia) before I mention that I think that sometimes we approach this problem from a specialty standpoint rather than consider the local problem, and from that point the whole picture. We see the problem from pediatrist's or an obstetrician's viewpoint (without taking into consideration the background, the family, the whole picture.

The White House Conference was organized in our state but didn't function very well. We had two or three general meetings which, through the pediatrician's of our state, have been kept up, and an association formed, called the State Association for Child Health and Welfare. It is composed of all of the organizations interested in the child-pediatricians, medical associations, boards of health, women's organizations of all kinds, parent teachers associations, Kiwanis Clubs, in fact, anybody that has a child welfare program.

Now they are organizing county councils, which I think is the secret of the success of the organization. The county council is composed of the same group, but there is somebody in each county who will be responsible for any program. We have nearly 125 councils already organized, ready and willing to effect any program that has for its object the welfare of the community, particularly of the child. What we need most of all is a real program with real leadership.

One other thing that we are doing is rather interesting; we are making a complete physical, mental, and a dental examination of everyone on the relief rolls, through the aid of the Federal Relief Administrator's office in three counties. Georgia is a rural state. We are going to consider the results of these examinations with an open mind, and I believe that they will give us some real basic facts on which to build our relief, rehabilitation, and our welfare program. We have no figures to present yet, but that can be done in cooperation with the medical and dental professions, who are devoting time to it.

If I am not mistaken, it is going to do one of two or three things. It is going to show that a certain group in each community will always be on the relief roll and might as well be planned for, and that another group, by rehabilitation, can be made self-sustaining.

This brings us back to the very thing that we are discussing here. We need national leadership and support from the national government.

CHAIRMAN ABBOTT: Is there someone else?

Don't you want to follow Dr. Abercrombie, Dr. Parran? Dr. Parran is the Health Officer of New York State.

DR. PARRAN: In view of the hour, I think, perhaps, that I shall not discuss the several aspects of the problem, but I should like to elaborate somewhat on one point which has been brought up by Dr. Adair, and that is the economic obstacles to child welfare which surround the maternity functions.

Of course, we recognize that in many instances inadequate medical care is a factor for reasons other than economic barriers, but by and large, I think all of us agreed that the standards of maternity care could be very much elevated if these economic barriers could be, in part at least, removed.

I had a letter from an obstetrician in a city with a population of some 40,000 in New York State. He attends 60 per cent of the births in that city. He said that a woman who becomes pregnant in the city, except for the small percentage who are financially in good circumstances, has just one of three choices. First, she may go to an abortionist; second, she may wait until labor starts and call in the doctor whom she has not paid for the previous delivery; or third, she can take her pride in her hands and go to the welfare officer and get on the relief rolls.

I think that situation exists in many other communities in the state. All of us recognize that in spite of the gratifying declines in infant mortality, we have not brought down the maternal mortality to any significant extent. Dr. Adair has emphasized very properly the fact that it is more than a loss of mothers on account of child bearing; it is a loss of child life in addition which so often results from inadequate attendance at childbirth.

It seems to me that our efforts up to date in most communities of this state have fallen far short. The results are not gratifying, as our maternal mortality rate continues high, and the method of approach has been inadequate to meet the problem.

Of course, we need, through pre-natal clinics, public health nurses, and other facilities to educate mothers and encourage doctors to give a better quality of obstetrical care, but I have seen nowhere on any broad scale a complete follow-through system of care from the beginning of pregnancy, through the birth, to care of the child by competent pediatrists.

We have been faced with a similar problem in other phases of health. We are facing it with tuberculosis, and what did we do about it? We constructed tuberculosis sanatoriums. We made them available at first to the indigent. More recently in vast areas of the country the treatment of tuberculosis is almost as free as public education. It is available to anyone, depending upon medical need, rather that upon the yardstick of a pauper's oath. Yet when it comes to furnishing obstetrical care we still measure the needs by the indigency of the person who needs the care.

I think that we need to change our concept of the maternity function, to recognize that it is of sufficient social importance to society as a whole to necessitate the assumption of whatever proportion of the cost is needed to insure good obstetrics. To that end, I have made the specific recommendation to a number of organizations in our state that the state and local communities, through their taxes, assume whatever proportion of the costs of childbearing--medical and nursing and hospital costs--which is necessary to provide for good medical care for all who need it.

That is putting the medical need ahead of the economic need. In practice, persons well able to pay would not ask for that service, but the marginal patients, who now get a very poor quality of service, would be the persons who would be benefitted. Surprisingly enough the state medical society through its journal has spoken kind words of that program.

Obviously this could not be done by a system of state medicine as ordinarily considered. I am visualizing the rural problem where every physician who is now attending patients during childbirth would be eligible to participate if his work is satisfactory. Physicians would be paid fees for that service just as they are now in our state being paid fees of $25 for attendance upon the delivery of a person upon the relief rolls.

That same plan, I think, can be applied, and needs to be applied to the marginal and lower income groups. It seems to me that it offers a simple method of coming to grips with the central problem in the maternal mortality rate, which up to now has not declined.

CHAIRMAN ABBOTT: I think that is exactly what we have to face, the problem of maternal care throughout the country.

Is there someone else who wishes to speak? We have a few minutes before going to the luncheon meeting but I should be very glad to have everyone feel that they have said what they wanted to on this subject this morning. I know that it limits discussion to be covering so large a subject in so short a time. We can only talk in greatest generalities when we are covering the whole problem of child welfare in a single short session. However, it is important that we convey to the Committee on Economic Security and to the Advisory Council on Economic Security what this group of experts wishes to tell them after this meeting. I should be very glad to have any further discussion.

Have you something you would like to say, Dr. Grulee?

DR. GRULEE: There are one or two things. The problem of syphilis mentioned by Dr. Folks is one which can be practically controlled by pre-natal care. In the county hospital in Chicago they rarely have any congenital syphilis, the only type of syphilis of any moment to children, because all of the women come to the clinics beforehand. A large proportion of those women are negroes, among whom the progress of syphilis is much more rapid, than among white women.

Another thing is that the facilities available to indigents for proper conditions for maternity work should not necessarily be confined to hospitalization. This should be borne in mind very definitely, because in the out-patient departments developing in connection with adequate medical schools, even with only students in attendance, reduction of mortality of children and mothers is very definite. I know of one in which I made a survey of deaths among a total of 10,000 mothers. There were 21 deaths, of which ten were attributable to heart disease, diabetes, etc. Students officiated very largely in that institution.

Another thing I want to say here has a more general application. Many people have talked of the problems of the child, and many people have talked of the problems of their communities, but few have discussed a national plan.

Now I have been connected with an organization which has been nation-wide. I know that these problems are local problems and that the solution of them is not in any general scheme, but a local one which has to be worked out mostly as a state proposition. We should consider these problems more as a state proposition with federal support, than as a general scheme for the whole United States.

For instance, you cannot lay down rules for taking care of children in New York City that will apply to New Mexico; it can't be done. We have to take care of each local problem with certain general standards to maintain.

CHAIRMAN ABBOTT: I think that those of us who have not spoken agree completely to that. I am sure that Dr. Abercrombie doesn't want anybody to tell him what has to be done in detail in Georgia, but he does recognize that the children in Georgia are citizens of the United States. I have had some experience with a national organization, also. I was asked for a formula when going into one community. I said at once that, that community was very unusual and would need individual treatment. I found that the children weren't so unusual, that they were very much alike, and that the problems were very similar, but that the mode of organization for meeting these problems necessarily had to be quite different in the urban and rural communities.

Would some of the others who have already spoken like to say something further in view of the subsequent discussion?

DR. FOLKS: There is just one single word. It would seem to me that if we were trying to sum up our conclusions, this being a conference on economic security, that the two key things have been said by Dr. Laurie and Dr. Parran.

First, in these public health and medical services we should recognize that there are very large sections of the population at present who cannot make provisions for these services without reducing already very low standards of living. Therefore, we would like to see them made available by public provision.

Secondly, Dr. Parran's suggestion was that public provision of public health services and highly specialized services should be available to all desiring to utilize them, that irrespective of economic need, the medical need should prevail. Those able to pay may be expected to pay according to ability, but the services should not be met with the idea that they are restricted to the indigent, but that they are to provide for those in the community needing that particular specialized kind of service under the aegis of health and medical need and not under the aegis of indigency.

MISS EDWARDS (Home Economic Association): Going along with what has been said, should there be a gradation in the character or quality of the service given to people in these different groups? I think that is taken for granted that there would be none, but I think sometimes that possibility enters.

CHAIRMAN ABBOTT: Was there anyone else who had not spoken?

DR. LURIE: All I have to say is in line with what Mr. Folks has said. There has been considerable discussion among social workers as to the crucial problems involved. I think we put our finger on the fact that our lack of progress comes from the fact that basically we are operating all of our social services on the pauper basis.

Social workers, therefore, feel that real progress in human welfare, social security, and child welfare cannot be made unless we can abolish the poor laws and pauper system. All of our problems of care for the security, health, medical, and individual problems of families should be met on the basis of their needs as persons, rather than on the basis of their pauper status. I think that is the task in the present administration.

We must recognize our social services so that these rest not upon benevolence or upon charitable grants but upon the right of individuals to health, welfare, and security. To some extent that involves not merely a governmental system of relief and insurance, but it involves an organization of the local community, perhaps on a basis somewhat similar to some of the European systems in which the public, largely labor, has a real share in the formulation and in the management of the administration of the system of human welfare.

MRS. CHARLES W. SEWELL: (Home and Community Department, American Farm Bureau Federation, Chicago): I have hesitated to speak because this meeting was supposed to be for experts and I certainly can't pose as an expert. I have not heard definitely mentioned, however, the need of the rural children or of the rural mother. I should like to plead that, that be covered in this committee report.

I think, perhaps, it would be difficult for many in the room to realize the primitive necessity with which maternity and infancy are surrounded, not only in the recesses or mountain regions of some of the states, but in the great corn belt, and wherever farm people are making such desperate efforts to keep their heads above water. I think some of you have already seen "Mrs. Wiggs of the Cabbage Patch." If you have, please remember what Jimmy said about pulling against a debt. If we can do something that will reach the rural home, I am sure it would be worth a great deal.

CHAIRMAN ABBOTT: There is no doubt that in those areas that have a small amount of dependency which are largely rural, we have had a sharp reduction in facilities for care, that a great many women are not having a doctor now in childbirth who used to have one. They are doing without doctors and it is, of course, an appalling thing. They are remaining off relief, but it is at a very great cost to them and the children. That we hold the standard of destitution as the basis of relief, which eliminates these families has been the cause of great loss in many of these communities.

Is there someone else who wants to say something? If not, we may adjourn, but there is still time for anyone to send in a statement that occurs to him afterwards, or something that he wants to be sure is presented to the Council. I should be very glad to make sure it is presented to the Council.

I thank you all very much.

. . . The meeting adjourned at one o'clock . . .

The Round Table Conference on Unemployment Insurance, of the National Conference on Economic Security, held in the Chinese Room of the Mayflower Hotel, Washington, D.C., convened at 11:10 o'clock, Mr. Joseph H. Willits, Dean of the Wharton School of Finance and Commerce presiding.

CHAIRMAN WILLITS: I hope the other round table has an adequate audience, because I can't see that we have any less than attended the opening meeting.

I think the least important part of the conference is the remarks by the presiding officer. Since we are already about half an hour late, the remarks will be very brief.

Five years of depression have served to make unemployment insurance, or as I would prefer to say the more precise an exact term, a compulsory pooled unemployment reserve, not merely a subject of academic interest but a subject of practical possibility. The case for reserving some part of the production of prosperous years as a reserve against the lean years is as astonishing now as it was in the days of Egypt.

I think, perhaps, the case for it may be summed up in the observation of a wise and competent friend of mine who reported the result of three trips to England. In 1911, when England was prosperous, he went through the lake and mining regions and observed, in spite of the prosperity, a large amount of destitution. He made two similar trips through the same country in the twenties when England was depressed, and in spite of the fact of the depression he observed less destitution than he had in 1911.

I don't want to commit this group to a particular point of view for I realize there are many different points of view represented, but I feel that for our discussion to-day we might take the strength of the case for granted, and concern ourselves particularly with the problems of how and when. There are grave problems in these areas. Should such a plan be a federal plan with the advantages of lesser costs and greater speed? It also has obvious disadvantages. Or should the plan be one primarily of states, with the disadvantages of slowness in progress, but the advantage that responsibilities do tend, under those circumstances, to root themselves in the communities and insure competent administration?

How are we going to deal with the problem in a part of the country which is not yet established generally, without a civil service? How are we going to maintain the integrity of administration which is essential in a problem of this kind? For how long a period should we provide benefits under such a plan? What funds would be needed? If our accumulation should run up to a total, as some careful students estimate of $4,000,000,000 or $5,000,000,000, how are we going to handle the problem of investment during the boom period?

How is such a plan to be tied up with the relief system? I take it that none of us would feel that any such system is a substitute for a relief system, but that it would be for a limited period of provision, after which the burden would have to be assumed by a relief system, coordinated with the unemployment insurance system. How are we to work out those problems of coordination?

Finally, when will it be wise for us to inaugurate collections under such a plan without retarding recovery? In other words, what degree of recovery do we need before we start collections?

Of course, the fact is that we are collecting vast sums for relief. I am sure those questions are the least important ones as compared with the problems or practical questions of how and when, upon which of those of us who are formulating them very much desire the advice of this group.

I will now turn immediately to the leaders of the discussions and will call first on Mr. H. W. Story, Vice President, Allis-Chalmers Manufacturing Company, Milwaukee.

MR. STORY: Mr. Willits, ladies and gentlemen: You have gone into more detail in your suggestion than I had anticipated.

When Mr. Altmeyer suggested that I make a few remarks here I thought they would be applied to the more fundamental propositions than some which you have indicated. But, at any rate, I will proceed with the few remarks I have to make.

I approach the subject with a great deal of comity before a gathering of real experts. I do not pose in any way as an expert. During my business activities for the past 13 years I have given a great deal of thought to the subject, and I am here to-day merely to record my humble but rather definite views.

Prosperity is merely another name for widespread individual productive effort, which results in the exchange of the fruits of such effort. Thus employment is the key to prosperity and is the remedy for unemployment.

Unfortunately the processes of prosperity are tremendously complicated and finely balanced. For that reason it is exceedingly difficult to correct any maladjustment in them. Some may say that it is impossible for the human mind to determine the cause of the unbalancing of our economic machinery and to apply the proper remedy. I do not subscribe to this theory. Affirmative action, even though not entirely effective, is preferable to hopelessly awaiting the operation of so-called economic laws.

I have listened with much interest to the theories of proponents of pure individualism and with equal attention to the ideas of advocates of pure socialism. I believe that both are wrong. I am much impressed by the logic of the socialists in their advocacy of social justice, but nevertheless, have the definite instinctive feeling that pure socialism can never succeed because it is opposed to the strongest human instinct, namely, selfishness - which is merely a manifestation of the instinct of self-preservation.

On the other hand I do not agree with the rugged individualists who subscribe to the theory "let the devil take the hindmost." I think that both are partly wrong. I think that somewhere on the middle ground is a road which will lead to a sound system of unemployment security.

The foregoing is too abstract to be precisely helpful in the consideration of this subject, but it is presented to convey my thought that nature does not intend us to be soft.

What is the demarkation between a plan which is soft and a plan which is soundly recognizing principles of social justice? That is a matter of very difficult determination, but I will try to show the kind of an unemployment system that I think will meet the requirements.

The first problem we have is the kind of system. I don't know whether you close the door to that discussion, but at any rate we have two types of system, in other words, the European system and the American system. The European system is founded on the payment for enforced idleness. The American system has at least the idea of attempting to provide for a regularization of employment and hence in some extent, prevents unemployment.

Some renowned writers have questioned the principle that employment is the solution of unemployment because they claim it is practically impossible to provide work for all able-bodied persons. They cite the experience of countries which have established the European systems.

If the principle of employment as the correct remedy for unemployment is sound, then let is strive toward that goal. Where would this country be in its national development if the Edisons and Fords had said, " It can't be done?"

That expression had always irked me. It certainly does not represent the philosophy of our President or the American people.

So our problem, it seems to me, is to attempt to find the plan which at least tends to exert pressure toward the prevention of unemployment. Instead of merely adopting it, it gives ideas for paying for enforcement.

The European system contemplates a single fund into which are placed contributions by the state, employers, and employees. Benefits for unemployment are paid to all employees who become unemployed through no fault of their own from the fund. Thus a tax is placed on all employers and employees to set up a fund for the payment of money benefits to the unemployed.

There is certainly nothing in that plan to stimulate or regularize employment. Contrast it with the American system.

The American system, you know, provides for individual reserves under which an employer has the incentive to regularize employment, because when his reserve has been built up his contributions are either cut down or in most cases lost.

Is there anything to this idea of regularization? I don't think anyone can state positively whether it will, in fact, have a tendency to prevent unemployment. In the short experience that I have had with the Wisconsin law I know that employers are considering the unemployment benefits payable from the funds. They are considering it from the standpoint of their productive cost and endeavoring to find ways and means to spread employment, to take cognizance of this situation. It is difficult to tell how far even regularization will go in preventing unemployment because you may have the possibility of creating a full-time force. A full-time force is throwing out of employment a certain per cent of employees who would have otherwise been employed. From a social standpoint it seems to me that a full-time force of workmen is much better than a larger force of part-time workers.

I don't think there can be any questions about that because from the social standpoint continuity of employment promotes the habit of work which is vitally important in the human being.

There is another element, the effect of regularization on expansion. How far that will have a real effect is questionable. Only time can tell. At any rate the theory is at least to keep in mind the problem of prevention of unemployment, to have the urge there, to establish enthusiasm and the incentive, so that there will be the likelihood of some benefit from that source.

How effective it will be Heaven only knows, but remember this, the Wisconsin or the American system is merely an experiment. If it does not prove successful we can always return to the system of merely paying for an enforced idleness.

The next question is, shall the employees be required to contribute to the reserve fund?

Employee contributions are an important element to be considered in view of the fact that we are entering into a period when there is going to be a large charge against the wages of workers for social insurance. Employee contributions toward an old age pension fund is much more logical than toward an unemployment insurance fund. Unemployment may be preventable, but old age is not. Hence it seems to me, instead of splitting the contributions of the employees between the two funds, logically, the full contribution should be made to the old age pension fund.

I feel that the employer should contribute solely to the unemployment insurance fund.

Should the state contribute? The state should assume the cost of administrative of the system but no more. I feel that at this stage of the development of the idea of unemployment insurance in this country, we should keep the state out of the picture as much as possible.

I would like to have it clearly understood that if we need another system, or some supplementary system to work with the American plan, I am for it. I would like to have tried at this time a system which I think travels the middle of the road, but I am just as much in favor of social security for workmen as anyone in this room. I only plead to give the American system a trial.

Should whatever system is adopted be compulsory? There is little use wasting any time on that question. The answer is emphatically "yes." The old human instinct if selfishness will also operate to prevent the voluntary adoption of a plan of this kind to sufficient extent to make it really effective.

Some sort of compulsion, let's say stimulation of interest, is needed in the various states to accomplish individual state enactment. I don't want to go into the type of bill, as that raises legal and psychological questions. I think that the Wagner-Lewis bill, modified to some extent, would be the rather ideal vehicle for putting across the state idea.

I am hopeful that in any plan of federal legislation adopted, Wisconsin will be given a chance to carry out her ideas of unemployment insurance.

There is the question of whether we will be obliged to have supplementary relief to carry on our system, and the advantages or disadvantages of one type of relief and another, and the social implication of one and the other. I think we should look at this problem as one which is going to require much experimentation, and I hope that any federal law will allow wide latitude in selecting the various plans for the individual states.

The last and probably most important question is when to pass any law for the establishment of this system. When should the system become effective? When should contributions be made?

On this, in spite of the fact that we already are making contributions in Wisconsin and would like to have our competitors do likewise, I would urge that the actual effective date be postponed until such time as foreign groups of economists, advising the President, should decide the time is ripe for the institution of such a system.

It seems to me that at the present time any added charge upon industry is a detriment to the progress of recovery.

Thank you.

CHAIRMAN WILLITS: I am very grateful to Mr. Story for so thoughtfully opening up some of the issues involved, and because of his suggestion that employers alone should pay, merely in order to draw an issue.

I am going to read a letter from Mary K. Simkhovitch which Mr. Witte asked me to read sometime during the discussion. The letter is as follows:

"I should like to register my conviction that unemployment insurance legislation ought to call for contributions from the employers, the employees, and the government. I know it is said, and with truth, that employees give their contribution in the form of inadequate wages. Nevertheless, I believe Labor will be vastly more interested and feel it has a definite state in the operation of unemployment insurance legislation, if a direct contribution is made.

"In regard to contributions from the government, it seems to me that the amounts contributed without its participation would not be sufficient to meet the needs which the legislation is created to meet."

Because of the pertinence of that letter to the point which Mr. Story made, I read it here.

We will next hear from Mr. Paul Douglas of the University of Chicago, whose name is known to all of you.

Mr. Kennedy would you mind coming forward at the same time? Miss Goldmark, also?

MR. DOUGLAS: Due to the depression and to the statesmanship of the President, the campaign for unemployment insurance had been pushed down to the five yard line and should go over in the next play or two. There are few political leaders and comparatively few thinking employers who do not recognize the necessity of a more adequate, a more self-respecting and a more certain way of taking care of good men and women who have lost their jobs through no fault of their own. The only way to do this is through insurance against involuntary unemployment. But mere enthusiasm for unemployment insurance is not enough, for we are now in the valley of decision and must determine the kind of insurance which we want. That at least is the question to which I shall address myself.

In the first place, we need to see how unemployment insurance fits into the problem of relief and the degree to which it will lessen the need for the latter. Had insurance been instituted, as some of us urged, a decade age, we would be in a far happier position now, since we would have accumulated reserves which would have greatly lessened the need for relief. But due to unjustifiable self-satisfaction, and to the blind opposition of the then dominant forces in our society, this was not done. We are, therefore, faced with the consequences of these sins of omission. We have come to