Document wrN71bd5wBMZpz9RppwqOQ3d4

REPORT OK HEALTH ASP WELFARE SERVICES _r " - A ?L*3*F Xf A * MWBT Of. .fffittffl WP WATOS ggPUSSS WL \ >9^?' iryi 1WM~ ll V^WPWyatgBIg COSTEITI Topic Pg* I. XI. III. If. f. TI. fix. fXXI. IX. z. XI. XIX. XIIX. Hf. IT. xn. Xfll. X7IIX m. Costs Main Quantitative Data. Hortality sad Statistical Buroau Katarials Nursing Literature - Preparation and Distribution Exhibits Films Caspalgns and Cooperation with Field Staff Schools Industrial Hygiene Safety Done Economics Accounting Serrlee Office Ksaafeaent cod Personnel Pacific Coast and Canada Research and Deconstraticn Archives and Library Major Staff Changes 1941 - i - ' ^i 1 1 1 a 5 6 T 9 1C 11 12 12 13 u 15 if c 1A ` i * i * ' V'c* . - 'ftfeVV It is our privilegs to promt below a giuary of tho principal nativities and quantitative measurements of the Health end Welfare eervicee in 1947* I. Coots (More deteila in certain regard* are to to found in the budget report and in the monthly cumulative summary statement.) 1. 1947 total costs are aa indicated below, representing an increase of 115 over 1946 costs. Curative lid gwrtl X&Si Easters Office *2,755,093 *1,340,603 *4,095,696 Pacific Coast Head Office 333,969 73,971 407,940 Canadian Head Office 377,261 62,913 440,174 Entire Company 3,466,323 1,477,487 4,943,810 * 2* This total expense for 1947 is-.04$ loss then the 1947 budget which, totaled *4,945,668. 3. The budget aa submitted and approved for 1948 totaled *4,980,223* When submitted this was *7$ below the 1947 expense# eetinated on a nine months1 basis. It is *7$ over the final 1947 expenses. 4. The 1947 costs are estimated as 1*095 of the Industrial premium income ee regarde Industrial charges. The 1948 budget la 1*0775 of anticipated income. XI. Main Quantitative Beta 1. Hurslng visits in 1947 totaled 1,76$,342 - a 25 increase over 1946) total visits acounted on January 1st to 100,936,127. 2. Literature distribution amounted to 28,322,615, a 35 increase, entirely due to the growth in Group use* The total for literature distribution to date is 1,391,770,435* Film attendance amounted to 4,474,552, a 935 increase over 1946) total film attendance to data is 141,670, 1(7*. . * Jt * # * . III. Mortality and Btstistlcsl gureaugsterlala -A,ys in.dicated byotat Lstiesi Bureau reports^ 1947 was an outsl rrV'e\r ?\ . g year as regards mortality in all departments* Certain death rates in tho Industrial Department, aa contrasted with earlier years, particularly for conditions against ^bich the Company, with cooperating agendas, has carried on extensive educational and preventive cupaigns, are shown in the following tablet r \ -2- Death Bates per 100,000 froo Certain Specific Cause* in 1947 and Earlier Tears - Weekly Prealue-Paylng Industrial Business Death Pate per 100.030 .1. Puerperal Diseases 2 Tuberculosis It Start S? Jffl.fr. 1911 - 19.8 1947 - 3.1 1911 - 224.6 1947 - 33.8 Ieproveeei 84.3 85.0 3. Typhoid Fever 1911 - 22.8 1947 - 0.2 99.1 4. Communicable Disessos of Childhood* 1911 - 58.9 1947 - 1.3 97.8 .5. Diarrhea and Enteritis 6 Diphtheria 1911 - 27.9 1947 - 2.8 1925 - 10.6 1947 - 0.5 90.0 95.3 7. Appendicitis 1933 - 13.2 1947 - 3.1 76.5 ...8. Rotor fehiele Accidents 9. Hone Accidents 10 PneuBOuie 11 Syphilis 12 Diabetes 1934 - 1934 1936 1940 - 1940 - 22.2 14.9 69.8 12.0 29.8 1947 - 15.7 1947 - 9.4 1947 - 22.6 1947 - 7.7 1947 - 26.7 29.3 36.9 r. 6 35.8 10.4 13. Occupational Accidents 1942 - 7.1 1947 - 5.2 26.8 etfeasles. Scarlet Fever* Whooping Cough* Diphtheria .It of course'`goes without saying that the intonation ssseebled and often )?#' printed froe the Statistical Bulletin* the Statistical Bureau's Ingenuity and skill in preparing charts sad exhibits* its statistical facilities for the analysis of our nursing records and for planning studies in the nursing or safety* or other fields* continue to be of inestimable value in our nursing progres* our oorresfondence, in literature preparation* in lay and profeaelonal educational prograns, in special studies, ar.d in the interpretation of results or findings. IF, ggifaut 1* Tlsits by office end department, cases by Belsried service end affiliations* costa and coat per visit* end certain other items are indicated in the tabulation below. Fislte . 1*765,342 Bp Office By. Department Eastern Office 1,402*139 Induetrial .... 1,655,011 Pacific Coast ... 122,366 Canada.................. 234^*35 Intercediate .. Group ......... 41*740 68*591 Cases ...................... ....................... ................................ . 435,050 V.It.I. Co. Salaried Service .... 162*11$ T.K.A. Affiliations J6,9)5 Cost #3*466*323 Percent of Industrial Expense * *Cost per visit ........................ ....... *. ^ >A-.,:1.96 getropolitan Salaried Rursing 8taff ............................ 4U Automobiles Operated by Salaried Staff ... 352 Affiliated Public Health Rursing Organisations ................. 768 Cities and Towns Covered for Rursing Service 7*381 Oases Surged PeT 1,000 Polioles 19* Average Tisits Per Case 4*1 Estimated r * as -> 2. The roluae of vi*Lts, considerably in excess of 1946 earlier in the year owing to the birth rate, finally exceeded 1946 by only 2$. Maternity visits shoved en excess of 29$, visile general visits had a decrease of 11$. 3. Toward the end of the year the trend was definitely downward. In Ceceaber various wits shoved decreases under last Deeeaber as follows! Maternity .......................... ........... General............................. Salaried Service* .................. Association* Tbtal.......... ......................................... 20$ 9$ 20$ 12$ 15$ In fact, Decaaber presented the lonest total for that eonth for aany yeara. The birth rate ia beginning to deoline, end very good health conditions prevail everywhere, with the exception of aild but extensive influence outbreaks in California. 4. The distribution of nursing cases by classes of disease and condition, in contrast with twenty years ego, brings out the shift in service froa acute infections to the chronic, older age degenerative ooeditions. The increase in maternity and newborn reflects the high postwar birth rate. a*wi .?f Pimttf. Communicable Mon-communicable Maternity Hevbom Injuries and All Others 23L 45.5$ 5*1$ 22.1$ 16.5$ 11.0$ mz. 12.6$ 20.5$ 29.4$ 26.3$ 11.2$ 5. Special efforts at economy one featuring the last year, and the other going beck over a deeadet A. Illalnation of high coat, low inforce services* This was one of our principal Interests during 1947. fith the cooperation of our Territorial nursing Supervisors and our Field, stiffs, considerable progress has bean Bade, to be eaxried for ward aggressively in 1948. During 1547 we succeeded in dosing $1 such sertievs. It also eliminated certain nurses in aultiple staff locations, resulting in the discontinuance of a total of 61 salaried nursing positions. This is reflected in an over-all reduction of total ffelfart staff positions. Homo and Hoed Offioes, including Field, and also in cluding approved vacancies, froa 672 to 632. Several seal! nursing unite have been transferred froa a salaried to ba affiliation basis. At the ssxe tins we have terminated 28 smell and inactive affiliations. o Th net reduction in cost in 194? from this offort amounted to 199,000. It is estimated that the 1947 terminations will hare the affeot of reducing cur net coete in the calendar year 1948 by $176,400. It is alao roughly estimated that we should be successful with additional terminations in 1948 to ' the extent of a further saving of $100,000, making the combined two-year total from this effort 375,400. B. Control of Group nursing costs. A little over a decade ago our nursing volume in insured Groups was high and still expanding. A study indicated that a large fraction of it resulted from the inappropriate use of nursing service for non-professional purposes. An earnest and persistent effort has been carried out to eliminate this factor, with the complete cooperation of the Group Division, including the Hone Office executives and its field staff. Kiss gtriegel, our Group Nursing Assistant, has been particularly active and successful with this program. The results statistically may be indicated as follows! In 1937 we eade 145,216 Group nursing visits, while in 1947 this figure eas 68,591. During this same period the Group certificate inforce, I sm told, bee increased from 1,974,286 to 3,124,616 as of November 30, 1947. The accumulative saving in visits and ooata represents a very substantial sum. In feot, if visits in 1947 had been made at the visit rate of 1937, on a basis of the current certificate holder exposure, they would have totaled approximately 229,800, or 161,200 in excess of the actual 1947 figure. At the present cost per visit ($1.95), this excess would have meant an outlay of over $314,400. The acouaulative saving over the deeade would certainly be in exoess of a million dollars. At the .same time we are noe, more than ever before, giving real nursing cere to actually sick csrtifleate holders, who need, want, and value the service. 6. As t9 salaries, the 1946 staff salary inorsases seemed to be adequate, and no change was made in the general salary scale for field staff nurses in 1947. A moderate increaae eas approved, to be effective on -January 1, 1948, in salaries for the supervisory staff. V yfz? H : f- > . r vJM. l-yws^j 1 HS.IWTST^i'^ n HL* vrr -22- office layout, furniture and fixtures, expense controls, etc. It also administers the Division's central filing and m-n service, handles the Company's suggestion program, supervises the Reception Room and the handling of visitors, which number in the neighborhood of 5,000 annually. 2. As regards Home Office payrolls (excluding field nursing), this office processed, in 1950, 14 new inductions; 19 resignations, retire ments, or transfers; and handled personnel arrangements for an active group of 163 - 5 less than in 1949. 3* The following data indicate the number and percentages of changes in staff in the Home and Head offices, central and field, nursing and welfare, in 1950, as compared with 1949* Office Staffs Nursing Bureaus Welfare Bureaus (including Officers) Library and Archives Total 1949 73 l1i0b0 w 96 % Change -% -- Ufa n Field Staffs TJ.S. and Canadian Field Nurses U.S. and Canadian Field Clerks Total 373 341 16 388 35*7 - 95* Total - Health & Welfare Division Employees - all Offices 580fc 541* - 6% The decrease in total staff is chiefly due to resignations and retire ments in the nursing service, with some slight coincident curtailment in clerical office staffs. ****** XVIII. Pacific Coast 1. The work of the Division at the Pacific Coast Head Office under Dr. Shepard has been maintained on a high level, with the assistance of Mrs. Roberts, the Nursing Director, and the Head Office staff. 2. An increased budget for literature and printing in 1949 and 1950 made it possible for the Coast Office to be somewhat more liberal with literature requests from our Field staffs. There was a 2858 increase in literature distribution in 1950 over 1949. Individual requests increased by 51$, due mainly to the radio and advertising programs. Mass tuberculosis chest X-ray surveys in large Coast cities used quantities of an inexpensive leaflet, resulting, in Los Angeles alone, in the filming of 2,000,000 persons. 3. In contrast to Company experience, film showings showed a U% increase over 1949, due mainly to a later date in completing the theater showings for BE YOUR AGE, and in releasing 16 mm. prints of this film to health and educational agencies. -23- 4* In nursing, the program toward liquidation is proceeding on the Coast along lines similar to the Home Office. 2 salaried services have teen closed. 4 nurses have resigned, and 2 will soon retire. Nursing cases decreased by 10?. 5. Dr. Shepard continued his many important outside activities includ ing the Presidency of the American Public Health Association, Clinical Professor of Public Health at Stanford Medical School, Member of the American Board of Preventive Medicine and Public Health, member of the Health Resources Advisory Committee of the National Security Resources Board, etc. XIX. Canada ****** 1. The Health and Welfare Division at the Canadian Head Office will suffer the loss of the services of Dr. Burnette, who retired at the end of the year. Fortunately, arrangements have been made by which Dr. Troup will give part time to the direction of Health and Welfare activities, thus more closely integrating these with the Medical Division interests, and affording experienced medical supervision for Health and Welfare services. Dr. Troup will be ably assisted by Dr. Benson, Assistant Medical Director, who came to the Company with some public health background and experience. 2. Dr. Troup is enlarging the scope of his interests in the public health field, having developed new contacts with the Canadian Health League, the Victorian Order of Nurses, and having joined the Canadian public Health Association. He also became a member of the American Public Health Association. It is anticipated that his leadership will mean a more vigorous use of our educational and health campaign materials and data, perhaps initially in the 1951 Weight Control Campaign, in connection with which medical relation ships are of vital importance. 3. On the educational side, when the new Overweight film is available. Dr. Troup will take steps, for which preliminary plans have already been made, to arrange for joint sponsorship In Canada similar to the set-up in the United States, namely with the Canadian Medical Asso ciation and with the Canadian Federal health authorities. 4. The nursing liquidation program is going forward satisfactorily in Canada along lines similar to the United States. The Victorian Order of Nurses understands and sympathizes with our objective, and Is cooperating to the full. The organization is represented on our Nursing Advisory Committee and is in close touch with this program. On the salaried nurse side. Miss Girard is taking energetic steps to encourage the development of adequate visiting nurse associations in communities where we have a large salaried staff, particularly Montreal and Quebec City - arrangements which may involve temporary loan of certain members of our salaried staff, as has been done in two or three instances in the United States. -24- XX.Research. Stiiri1.es. and Demonstrations 1. The Company's principal research investment continues to be the $100,000 contribution to the Life Insurance Medical Research Fund for work in the cardiovascular field. 2. A contribution of $7,566 was made to the Public Health Committee of the Canadian Life Insurance Officers Association, largely for research in health and medical problems. 3. In nursing, special studies were made in Philadelphia and New York to determine the approximate loss in Income that is apt to be experienced by visiting nurse associations when our services are withdrawn, as a guide in the planning of these and other associations, community chests, etc. 4. Cooperation was continued with the National Organization for Public Health Nursing in its cost analysis study, and grants were made to this Organization to aid in its development of more adequate local nursing facilities. 5- The Industrial Hygiene Laboratory engaged in a number of studies having to do with toxic industrial hazards, methods of determining air contam ination, etc. 6. The Company continued certain contributions to national agencies, part of which goes to research, including the American Public Health Asso ciation, American Social Hygiene Association, National Safety Council, National Arthritis and Rheumatism Foundation, American Cancer Society, American Heart Association, National Organization for Public Health Nursing, New York Academy of Medicine, etc. ****** XXI. Home Office Health Education 1. This activity was continued, as in recent years, under the auspices of a committee representing the Personnel Division, the Medical Division, the Policyholders Service Bureau, and the Health and Welfare Division, under the chairmanship of Dr. Wheatley. 2. Pamphlets, posters, and exhibits have been made available in various places in the Home Office buildings, accompanied by announcements in Home Office magazines and bulletins. In 1950 the Home Office employees on their own initiative selected and took away for reading 36,456 Company health educational pamphlets, on colds, heart disease, overweight, cancer, safe driving, home safety, vacation hazards, hay fever, child safety, nutrition, diabetes, dental health, and the cook book. 3. Arrangements have been made to introduce some discussion on health and the use of health literature in the training program for super visors as carried out under the supervision of the Personnel Division. A study is also being made of the possibility of a health poster contest to stimulate employee interest and participation. -25- XXEI. Library and Archives Library 1. The Library operates through a number of sections, including the Loan Desk, Research and General Reference, Insurance, Public Health and Medicine, and Cataloguing. 2. In 1950 books circulated by the Home and Head Office Libraries totaled 104,168, as compared frith 104,593 in 1949. At the Home Office, periodicals routed were 78,290, as compared with 76,713 in 1949. There was a falling off in the use of fiction in 1950, but an increase in books for business and for serious personal reading. 3- Concentrations of interest in 1950 were upon atomic bombing effects and pension information. 4. In cataloguing, the Home Office Library added a total of 4,401 items, and discarded 5,552. The total number of books, reports, and pamphlets now in the Library is 99,882. 5. Management research and general reference questions totaled 1,966 in 1950. These questions came from nearly all Sections of the Company, listed by frequency of inquiries as follows: Coordination Ordinary Group Health and Welfare Law City Mortgages Treasurer's Field Management Personnel Secretary's Office Actuarial Officers and Administrators Publication Industrial Claims Home Office Buildings Accident and Health Statistical Medical Accounting and Auditing Business Research Purchasing Farm Mortgages Check Writing Gymnasium Housing Projects Investigation Mail Supply Personal Adviser 6. The Library handled a corresponding number of requests from outside agencies, including insured Groups and Individuals. Among these agencies in 1950 were: Consolidated Edison Company General Motors Corporation New York Life Insurance Company Institute of Life Insurance Provident Mutual Life Insurance Company Penn Mutual Life Insurance Company Home Life Insurance Company Life Insurance Adjustment Bureau -26- Ihternational Ladies Garment Workers Union United Nations Headquarters Pittsburgh Glass Company U. S. Children's Bureau Health Insurance Plan of New York City Metropolitan Industrial Bank of Booklyn Time, Incorporated Community Service Society Archives 1. The Archives attendance totaled 3,939, as compared with 5,031 in 1949. It included, however, 950 visitors conducted through the Archives by the Field Management Division, and many Agents and Managers attending Home Office classes. 2. The Archives received a total of 150 reference questions from nearly all Departments of the Company, and 12 from outside agencies, including banks, commercial enterprises, etc. 3. The more important special exhibits prepared during the year included the display for A. M. Best Company, and a holiday attrac tion displaying the Company's Christmas cards dating back to 1886. With Mr. Taylor's assumption of the Presidency, plans are being made for a special case of material concerning his career. 4. One of the most important acquisitions during the year was the report on Metropolitan activities during World War II, coming from Mr. Taylor's office. 5. Hie plan to move the Library and Archives to more adequate end appropriate space in the new unit may possibly facilitate a better display of Archives and may stimulate attendance. ****** XXIII. Staff Changes and Vacancies 1. Dr. Burnette, in charge of Health and Welfare at the Canadian Head Office, retired at the end of the year. As suggested by the under signed several years ago, the general administration of the Health and Welfare activities in Canada has now been assumed by Dr. Troup, with the assistance of Dr. Benson and Miss Girard. 2. No replacement has as yet been made for Dr. Allen, who served in part as an assistant to Dr. Wheatley. It has also been impossible so far to secure an assistant to Miss Craig, to fill a vacancy when Miss Craig succeeded Miss Williamson as Director of the School Health Bureau. 3. Several members of the staff of the Industrial Hygiene Laboratory resigned or were transferred, or are anticipating resigning, incidental to the termination of the Industrial Hygiene Laboratory services. *** -27- 4. Dr. Wheatley's activities at the Home Office and in the field, and his outside public health relationships continue to grow in variety and significance. Notable among his outside contacts are - Chairman, Committee on Rheumatic Fever of the American Heart Association; Chairman, Committee on Accident Prevention of the American Academy of Pediatrics, in liaison with the National Safety Council; Chairman, Executive Committee of the American Council on Rheumatic Fever; member of the Governing Council and the Committee on Professional Education of the American Public Health Association; Chairmen or member of committees for the New York City Board of Education, New York Heart Association, New York County Medical Society, New York City Department of Health, and the New York State Medical Society. ****** XXIV. Aid from Other Divisions The Health and Welfare Division has numerous working contacts with other Divisions of the Company, which have been most effective for the Division activi ties in 1950. Most frequent and essential of these contacts include the follow ing: 1. The Statistical Division - The advice and guidance of Dr. Dublin and his staff, on public health and statistical activities, exhibits, etc. 2. The Medical Division - with the advice of Dr. Bonnett and his staff on research, the aid of Medical Examiners in campaigns, etc. 3. The Coordination and Advertising Division - Patient and helpful assistance in office layouts, moving office units, etc.; and a practically daily check on text for magazine advertisements, radio spot broadcasts, scripts, and other educational materials. 4. The Actuarial Division - Particular aid in working out modified retirement plans and discontinuation allowances pertinent to the nursing and Industrial Laboratory liquidation program. 5. Equally courteous and generous aid and advice along logical lines from other Divisions, such as Publication, Field Management, Law, Personnel, Group, Accounting and Auditing, and Purchasing. XXV. 1951 * ***-- * 1. The new film on Overweight will constitute a major new educational device for this and subsequent years. This will be launched follow ing the Annual Convention, with the collaboration of the TJ. S. Public Health Service, the American Medical Association, the American Heart Association, and other agencies. It will materially stimulate Company film showings and attendance through theaters, television, and educa tional channels. -28- 1 2. In the educational field, principal campaign interests during 1951 will deal with weight control, in cooperation with the American Medical Association, the U. S. Public Health Service, and other agencies. A special exhibit symposium with these agencies is being developed for the scientific exhibit of the American Medical Asso ciation meeting in Atlantic City in June. The Company's overweight research findings and its plans for lay and professional education will also be presented in a paper at that meeting. 3 The cooperation with the American Red Cross in the promotion of Red Cross home nursing classes will constitute an important nursing staff activity during 1951, possibly of special significance in view of disaster threats. 4- It is anticipated that literature volume will continue on about the present level. New titles were referred to under the "Editorial Bureau," it being anticipated that as older publications are revised more appropriate recognition can be given to the importance of the mental and emotional factors that bear upon physical and general health. 5. In nursing, it is expected that the volume will continue to decline, particularly on the salaried nursing side as members of the staff seek other positions. It is likely that the visiting nurse associa tion volume will show less shrinkage comparatively. 6. Further consideration will be given to other suggestions for new activities when the nursing volume has been markedly reduced, includ ing projects in the industrial hygiene, child and home accident, residual tuberculosis, and other fields. XXVI. 7. The only major staff change contemplated at this time is the retire ment of Miss Crosby, Director of the Social and Health Agencies Bureau, at the end of 1951. It is expected that the activities of this Bureau will then be incorporated partly in the Field Service Bureau and partly in the Editorial Bureau. A member of Miss Crosby's staff is in train ing to fill, in part at least, her most valuable social agency contacts. ****** The National Emergency In the current defense or possible future war situation, whether or not the Company takes any policyholder educational procedures regarding atomic hazards, etc., either by printing or purchase or cooperative distribution, it can be said that most of the Health and Welfare Services now contribute to meeting the national emergency, and can be even more directly shaped to that purpose. -29- Through Dr. Shepard in. the Health Resources Advisory Committee of the National Security Resources Board, we are in close touch with Federal developments. Our nurses, both in the Home and Head Office administra tive units and in the field, are tailing courses dealing with medical and nursing emergency procedures as offered by state and city authorities. The services of our Industrial Health Bureau, especially bearing in mind Dr. McConnell's Army experience in the last war, are being called to the attention of our insured Groups as they may bear upon factory safety and the health of the environment as it affects employees. Our nutrition program, the work of the Group Nursing Consultant, as it bears on nursing in the factory or in the home, and our general health educational facilities are basic to the maintenance of national stamina. Our anticipated new film on Overweight should be a major contribution not only to the preservation of health and a reduction in the burden of unnecessary illness, but also to the conservation and proper utilization of our food resources. Our cooperation with the Red Cross in home nursing class instruction is another very pertinent contribution. Modifications in our program may be necessary. For instance, paper shortages and cost may dictate some further literature curtailment, which will mean the selection of materials that are designed to con tribute most to meeting individual health needs in the national emergency. * -**** * XXVII. Welfare Service Officers and Bureau Heads Aiding the Officers concerned with Health and Welfare Services (Shepard, Troup, Benson, Cole, McConnell, Wheatley, Dublin, and Armstrong) are the following Bureau Heads in the Health and Welfare Division, including Dr. McConnell and Mr. Cole in their operating capacities. Mr. Jerome Apfel, Welfare and Nursing Accounting Bureau Miss M. R. Bonnell, Library and Archives Miss A. June Srlcker, Home Economics Bureau Mr. W. Graham Cole, Safety Bureau Miss Marjorie L. Craig, School Health Bureau Miss Helen M. Crosby, Social Agency, Exhibits, Motion Pictures Bureau Miss Ruth Doloboff, Management and Personnel Miss Alma C. Haupt, Nursing Bureau Mr. Arthur Kneerim, Field Service Bureau Dr. William J. McConnell, Industrial Health Bureau Mrs. Dorothy Whyte, Editorial Bureau -30- 1 XXVIII. The Future In medicine, public health, and preventive medicine there is always a changing picture with disappearing, persisting, residual, developing or newly arising problems, affecting the country, and also affecting program and cost factors for the Company itself, in its experience as regards underwriting, insurance coverage, mortality, disability, claims, and educational activities. It is customary to assume that communicable disease problems have been largely conquered, but the mystery of certain virus diseases, such as poliomyelitis, is still with us. Our biological defenses against epidemic influenza are stilj. defective. Other baffling respiratory conditions, such as the common cold, are still costly and uncontrollable. There are residual tuberculosis problems of epidemiological importance, affected by housing, nutritional customs, economic conditions, migrations and population concentrations of non-white groups, etc. In the field of accident and disease, in all areas - childhood, adulthood, and older ages - home, school, and industry, there is one largely unexplored element of great importance, namely the degree to which prevention and control can be influenced by a better understanding of the emotional and psychological factors involved. Accidents as a whole, except in the home area, in spite of n the studies and the efforts by many agencies at control through education, law enforcement, and environmental improvement, reached a peak for all time in 1950, indicating that very much indeed remains to be done to control wastage in this field. The problem of the disabled grows, as the handicapped are ground out by the nations' war machines, or are contributed to by industrial injuries, by neurological diseases, such as polio and multiple sclerosis, by the rheumatic diseases, or by the general process of aging. All of this leads to the need for more knowledge and its application in the field of physiotherapy, and more stress upon the program for rehabilitation. Medical education is another important field, calling for more adequate facili ties, and particularly more emphasis upon preventive medical instruction - an aspect of medicine that is vital to Company interests in its examining procedures, in early disease detection, and in professional health guidance for its policy holders. Basic, too, is more adequate public health machinery for large units of the population, on a state, and particularly on a local basis, where we are at the moment especially concerned with more dependable, permament community nursing facilities, incidental to the Company's nursing withdrawal. Important also is an extension of the principle of insurance coverage for illness and accident, with preventive medical features, and with medical, nursing, and hospitalization benefits, through commercial and voluntary cooperative channels, not only for the protection of an increasing percentage of the population, but also as a measure against the st&teism threat of compulsory regimentation in this field. The aging of the population itself involves the uncovering of new areas calling for health research and preventive medical effort. It involves an inevitable increase in chronic disease, and a growing incidence of cardiovascular, malignant, and diabetic conditions, together with the necessary adaptation of older groups to industry and community life generally. Related to this social change is the -31need for greater guidance in nutrition, in personal health habita, in weight control, and the relation of overweight at older ages to health and disease. Altogether, the situation calls for constant review and evaluation, in order that the Company's program may be kept in balance and in order that we may use our resources for health and welfare most appropriately, and to the best advantage of our staffs, our policyholders, the Company as a whole, and the country at large. k.. Respectfully submitted, D. B. Armstrong, M.D. Second Vice-President, Health and Welfare