every 1000 of the population). In 1940 the death rate of twenty-seven large 

 American cities v/ith a total population of over twenty-seven million was 

 11.4. In one city the rate was as low as 8.3, while a rate as high as 15.3 was 

 the worst record. The relative magnitudes of the three rates are shown 

 graphically by these three lines: 



11.4 



8.3 



15.3 



A closer measure of a people's health is the number of babies who die 

 before their first birthday for every thousand born. In the same twenty- 

 seven cities the rate varied from a low of 29 to 30 to a high of over 64; and 

 the rate for the total was 38. Ten years earlier the cities with the best records 

 had an infant death rate of 50.0, while the worst of the records stood at about 

 90. There has thus been a consistent decline in the infant death rates, but 

 this decline apparently corresponds to improvements in the care and nutri- 

 tion of children, and in the care of mothers before childbirth. 



Aside from these relatively exact measures of illness, we know that there 

 is a tremendous amount of ailing that never gets into the records. Millions 

 keep right on working with such minor troubles as "common colds", sore 

 joints, stiff backs, or just a miserable feeling. And these ailments vary in 

 amount and in frequency not only among the individuals who suffer, but 

 among whole sections or classes of the population. 



What Makes These Diflferences? Among our own acquaintances some 

 are more "healthy" than others, more vigorous, take punishment more easily, 

 spring back, or recover, quickly when struck in any way. Others are easily 

 upset, lose much time ailing, never quite come up to par in anything. In- 

 dividuals differ in organic vigor and capacity. There are also differences 

 among families. And for that matter, illness strikes unannounced even among 

 people who have excellent health records. Nobody knows who is going to be 

 struck next. But what about differences between one city and another, be- 

 tween one region of the country and another.? Why is it that year after year 

 the health record of some cities or counties is consistently better than the 

 average — or consistently worse? 



Some of the differences among communities, as to death rates, are due to 

 the composition of the population. In some of the Western states, for example, 

 with a large proportion of adult males and relatively few women and children, 

 the death rate is low. In some communities special health risks are associated 

 with local industries. In general, rural life is considered more wholesome than 

 urban life, although health conditions have been improving more rapidly in 

 cities than in rural areas. 



Some of the health differences may be due to the different stocks present 



606 



