Letter to Surgeon General Hugh S. Cumming on the Effect of the Depression on Health Conditions.

Note: Surgeon General Cumming's reply, dated August 18, 1931, follows:
My dear Mr. President:

In response to your request that you be furnished with such data as may be available on the comparative state of the public health during the period of maximum burden of distress and relief, that is, in the early months of 1931, as compared with similar months in 1928, a period of full employment, I have analyzed the existing material on this subject and submit the following for your information:

The most accurate and complete data available on health conditions in the United States are the statistics of mortality. Provisional reports of deaths in certain States are received monthly by the Public Health Service from the respective State health departments at as early a date as the data can be assembled. A compilation of available reports from 13 States (over 43,000,000 population) during the first five months of 1931 shows that the death rate was 12.0 per 1,000 as compared with 13.7 for the same period in 1928 (Table A). Rather large variations in the general death rate from year to year are more frequently due to the prevalence of influenza than to any other single cause. The times of occurrence of influenza epidemics seem to be practically beyond control, and are reflected especially in high death rates from influenza and pneumonia. Since a moderate epidemic occurred late in 1928 and early in 1929, a comparison of mortality from causes other than influenza and pneumonia has been made. The death rate with these two causes excluded was less in 1931 than in any of the three preceding years. (Table A)

It is of interest to note that records from entirely different sources indicate a similar trend. The Division of Vital Statistics of the Bureau of the Census collects statistics of deaths from industrial insurance companies having an aggregate of more than 70,000,000 policies in force. For the first six months of 1931 the death rate among those policyholders was 10.5 per 1,000; in 1928, the rate was 10.6 per 1,000 for the six months. (Table B) The death rates among about 18,000,000 industrial policyholders of the Metropolitan Life Insurance Company were 9.5 for 1931 and 9.9 for 1928 (Table C). When influenza and pneumonia are eliminated, the corresponding rates were 8.2 and 8.4.

Still another source confirms the reports above indicated. A group of large cities reporting currently to the Vital Statistics Division of the Bureau of the Census shows that the rate for the first half of 1931 (13.1 per 1,000) is less than in any of the three preceding years (13.9 for 1928). (Table D.)

Infant mortality is a rather sensitive index of health conditions. It is computed as the number of deaths under one year of age per 1,000 live births. Such rates in a group of seven States, the only ones for which data are available for each of the past four years, show that the rate (71.4) in the first five months of 1931 was less than for 1928, 75.6. (Table E.)

In a group of 13 States, with a population of over 43,000,000, the death rate from tuberculosis has continued to decline, the rate for the first five months of 1931 being only 63.4 per 100,000 against 77.5 for 1928. (Table F.)

For several years the Public Health Service has received reports of illnesses occurring among a group of wage-earner members of sick benefit associations. Sickness rates for the first half of 1931 are 104.2 per 1,000 and for 1928, 117.9, or 71.2 and 82.8, respectively, if influenza and pneumonia are omitted. (Table G.)

The reports of cases of certain communicable diseases made to the Public Health Service by State health officers for the first six months of the year 1931 may also be compared with reports for the same period of 1928. Reported diphtheria incidence during the first six months of 1931 was 26,000. For the same period of 1928, 46,000 cases were reported. For the six month period, 24,000 cases of smallpox were reported in 1931 and 29,000 cases in 1928. 4,500 cases of typhoid fever were reported for the first six months of 1931, as compared with 5,900 cases for 1928. Diphtheria, smallpox and typhoid fever are diseases which can be controlled, and the reports indicate that progress is being made, even though that progress is not as rapid as it might be.

Reports of cases of pellagra for the first six months are available from only seven of the States in which pellagra is prevalent: Virginia, South Carolina, Alabama, Mississippi, Arkansas, Louisiana and Oklahoma. In these States the number of reported cases for the first half of 1931 was 14,333; 1930, 12,203; 1929, 14,612 and 1928, 11,952.
The tables referred to in this letter are attached.

The data from these various sources indicate that 1931 has started out as a comparatively healthy year. The recent economic situation seems to have had no general adverse effect on health and mortality rates. In view of the agitation in general with respect to the effect of economic conditions on health, public health workers have been surprised at the excellent health conditions that are found upon studying the available facts.
Respectfully,
H. S. CUMMING, Surgeon General

[The President, The White House]

Enclosures.

TABLE A--MORTALITY IN 13 STATES* DURING THE FIRST 5 MONTHS OF 1931 WITH
COMPARATIVE DATA FOR THE SAME PERIOD IN THE THREE PRECEDING YEARS

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Death rate per 1,000 population (annual basis)
First 5 months of
All causes All causes except
influenza and pneumonia
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TABLE B--MORTALITY AMONG POLICY-HOLDERS OF INDUSTRIAL INSURANCE COMPANIES FOR
THE FIRST 6 MONTHS OF 1931, WITH COMPARATIVE DATA FOR THE SAME PERIOD IN THE THREE
PRECEDING YEARS. (POPULATION ABOUT 71,000,000 IN 1928 AND ABOUT 75,000,000 IN 1931)

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Death rates per 1,000 policy-holders
First half (annual basis)
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TABLE C--MORTALITY AMONG INDUSTRIAL POLICY-HOLDERS OF THE METROPOLITAN LIFE
INSURANCE COMPANY FOR THE FIRST 6 MONTHS OF 1931 WITH COMPARATIVE DATA FOR THE
SAME PERIOD IN THE THREE PRECEDING YEARS. (POPULATION ABOUT 18,000,000)

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Death rate per 1,000 population (annual basis)
First 5 months of
All causes All causes except
influenza and pneumonia
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TABLE D--MORTALITY IN ABOUT 65 LARGE CITIES OF THE UNITED STATES DURING THE FIRST
HALF OF 1931 WITH COMPARATIVE DATA FOR THE SAME PERIOD IN
THE THREE PRECEDING YEARS

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First half Death rates per 1,000 population
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Data are from the Weekly Health Index of the U.S. Bureau of the Census.

TABLE E--INFANT MORTALITY IN 7 STATES* DURING THE FIRST 5 MOUTHS OF 1931
WITH COMPARATIVE DATA FOR THE SAME PERIOD IN THE THREE PRECEDING YEARS
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First 5 months of Deaths under 1 year per 1,000 live births
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*The States were Alabama, Connecticut, Indiana, Kansas, Pennsylvania, New York and Wisconsin.

TABLE F--MORTALITY FROM TUBERCULOSIS (ALL FORMS) IN 13 STATES* DURING
THE FIRST 5 MONTHS OF 1931 WITH COMPARATIVE DATA FOR THE SAME PERIOD
IN THE THREE PRECEDING YEARS

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First 5 months of Tuberculosis death rate per 100,000
population (annual basis)
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*The States were Alabama, Connecticut, District of Columbia, Indiana, Kansas, Minnesota, New Jersey, North Carolina, New York, Pennsylvania, Tennessee, Wisconsin, and Iowa. Total population in 1931--43,593,000.

TABLE G--FREQUENCY OF DISABILITY LASTING 8 CALENDAR DAYS OR LONGER IN THE FIRST HALF OF 1931 COMPARED WITH THE SAME PERIOD IN THE THREE
PRECEDING YEARS

(Male Sickness Experience is of 16 Industrial Establishments which Reported
Their Cases to the U.S. Public Health Service during all Four Years

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Annual number of 8-day and longer
Average number disabilities per 1,000 men, on account of--
First half of males covered
Sickness* Sickness* exclusive of
influenza and pneumonia
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