The Washington herald., 1914-07-09
The Burden Of III Health.
ny J. w. sCFEREsCHEwslSY,
Surgeon Q. 5. PubIIc Health service.


Surgeon U. s. Public Health Service.
1t is far cry from prehistoric times, when each
human being had to fend for himself to present
social era. The most striking and important aspect
of mans social evolution is the gradual growth of ap
probation of the consequence to and nterdependence
upon each other of the individual members of So
cety In the past mans chief aim was that his own
lot and that of his immediate family groups might be
relatively pleasant That his own fate or social status
could be adversely affected by the misery of an un-
related social unit entirely beyond the scope of
his outlook upon his life The bitter lessons taught
by the ravages of devastating epdemics the
traton of population cities the high degree of pe-
calization in manufactures and similar conditions have
all increasingly emphasized mans dependence upon
his fellow and shown how properly to assess the
value of the individual unit TO society at large.
1t is trrism that the efficiency of the social unit
is conditioned by his physical status than by
any other one factor. That the neficiency due to
i'll health, however constitutes burden to be borne
by the whole of society rather than the individual is
a concept which has been fully recognized only of
recent years.
1t is not the purpose of this paper to discuss the
fiscal aspects of the question. 1t is enough to state
briefly, that since the state the employer and the EN-
poye the beneciaries social justice demands that
the of industrial insurance be borne by all three
on basis of equitable representation.
1t is obvious, however, no matter in what way the
burden Of the cost is divided that the best scheme
of industrial insurance is the one in which an ade-
quate reserve is maintained at a minimum cost
1t is in this respect that the majority if all the
systems now in force, defective in that they con-
template providing for the of sickness physical
disability only after these have become facts The
Al.
after the disease disability has lasted some time.
In other words, existing systems OF industrial in
surance fail TO recognize adequately that great prin-
cple at the root of all present-day campaigns in
the interest OF public health namely that of preven-
ton. Too great attention has been paid to providing
the sick employe with medical attention after he be-
comes entitled to il by of Illness too little to
preventing the illness which entitled him to the benefit
of the insurance. The basic principle of industrial
insurance, therefore, should be prevent Illness
rather than pay the of preventable diseases
and disabilities.
One of the chief objections urged against COM
pulsory industrial sickness insurance has been its cost
Such insurance must indeed be costly long as the
principle OF prevention is not taken into account As
soon however our systems of industrial insurance
are placed upon a preventive basis, we may con-
fdently look for a great reduction in the cost with
the result of widespread adoption of such systems
greatly to the benefit OF society at large.
The primary object of such insurance would be to
detect incpent defects and diseases among workers
to prevent the development of diseased conditions
by proper precautionary measures
1t becomes evident in the course of such inquiries
that not only must bad shop conditions be taken into
account but the conditions of the workers total en-
" nment be subject to scrutiny. In many instances
the origin of the defective state may be the unhygenc
home rather than the unhygienic workshop
This means, in the medical organization of the in
dustria insurance of the future that preventive work
will greatly expand the horizon of our existing ac-
tivtes 1t is needless say that industrial insurance
operated upon this preventive principle should result
in benefits of a far-reaching character.
Moreover. an industrial insurance system, based
upon the preventive work resulting from periodic
physical examinations should effect, to notable de-
gree, the establishment of hygienc standards of lv-
ing throughout the country The reduction in the loss
of working days per employe from illness throughout
the year should be notable In this way great eco
nomic gains with diminished cost OF production would
result.
Finally, the cost of industrial insurance based on
preventive lines should be far below that of system
providing benefits only after the worker has become
ILL.,