Health Services for Mothers and Children [antikvár]

FOREWORD So much has been said and written in recent years regarding the aging of the population and the consequent growing importance of the degenerative diseases that many people have failed to realize that concurrendy there has been a striking increase in the proportion of the population that can be classified as children. It is true that during the present century the average life span has increased and that today there is a larger segment of the population in the so-called "golden years of senior citizenship." It is logical, therefore, that public health attention should have been fixed upon the problems of the degenerative years and that those of us in these later years (or about to reach them) should be quite vocal over our immediate or prospective needs. What we often forget, however, is that since 1946 the fairly low birth rates that had characterized the three previous decades have been replaced by rates roughly 50 per cent above those of the preceding years. The high birth rates around the turn of the century had been offset in large part by high infant and childhood mortality rates so that there had been a serious depletion in the ranks of these who are now or soon will be the elder statesmen. Yet no such depleting force has been operating on the ranks of the high post-war rates. The 1900 infant mortality rate of at least 150 per 1000 live births has been replaced by rates of 33.8 in 1946 and only 26.4 in 1959. Equally striking reductions have been achieved in the mortality rates in the later years of childhood. The result of these changes in birth and childhood mortality rates can be expressed very simply, viz., that concomitant with the increase in the older population, there has been an even more striking increase in the number of children. Paradoxically, while the population has been growing older, at the same time it has been growing younger. There is no evidence as yet that these trends will be reversed in the foreseeable future, for the present group of young adults and middle aged who will be the aged of tomorrow represent the low birth rates of a few decades ago. While they will live longer than did their parents, there were fewer of them to start with. As the senior citizens of tomorrow, they will not appreciably be more numerous than our present group of "oldsters" who, though representing higher birth rates, saw so many of their comrades fall by the wayside as victims of the diseases of infancy, childhood and early adult life. On the other hand, the current high birth rates and early ages of marriage show no signs of changing, nor, barring national catastrophe, is there reason to expect a change. The first of our high-birth-rate group have almost reached the age of reproduction. There were more of them to begin with and, thanks to the low child mortality rates of the past decade and a half, fewer have fallen by the wayside. It is inevitable, therefore, that unless there is a sudden and radical change in the marriage pattern, the two or three decades that lie ahead will see an even further increase in the proportion of the popu-