Issuu

~~.

Prelimina_r•_y Report FAMILY HEALTH SURVEY BAYAN~N DISTRICT HOSPITAL REGION PUERTO RICO, 1955 Condected Under the Direction of DR. KURT BACK

Preliminary Report

FAMILY HEALTH SURVEY BAYAMÓN DISTRICT HOSPITAL REGION PUERTO RICO, 1955

Conducted Under the Direction of

KURT BACK

Social Sciences Research Center University of Puerto Rico

An Appendix to Accompany

HEALTH SURVEY OF SEVENTEEN MUNICIPALITIES SERVED BY THE BAYAMÓN DISTRICT HOSPITAL OF PUERTO RICO

TABT,F OF CONTENTS

Page I II

INTRODUCTION

SOCIAL

•

O..

CHARACTERISTICS

1. 2. 3. 4.

III.

0 0..

0 0 0.

O O O O.

O...

O O.

O O G O O O

G O O

Y O G

O O O G O C O

00.... o...0.,..0...0.,0 5 0.,.,.o o

.00....

4 4 4 5

HOTJSING AND LIVING CONDITIONS .....00a.,,...o..,,.o ,.,,.,.,,...

8 8 8 10

FAMILY DIETS AND FOOD EXPENSFS .,, O p e.,oe. ,aoOe000.,..,.aoo ,,,.

Milk Consumption 0.001,. Meat Consumption ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, Adequacy of Protein Diet 010100000 Food Expenses .,,..,<<..,

KNOWT,FDGE OF MEDICAL INF(.RMATION a SERVICFR AND FACILITIES 00,000

1. When to See the Doctor ...,.o..,,,,,,.. 2. Advice on Health Matters .,..,,..< .. .................. 3. Location of Nearest Hospital 4. Location of Public Health IJnit . ..,,~ ................. 5. Superstition ...........

1.8 21 21 22 22

HEALTH AND MEDICAL CARE SERVICES, USE; OPINION 000000000000000,0

,.,..,,.,,... 1. Public Health Units ... 2 .. 3. Public Welfare Services ............................o..

25 26 26

.,. .r .,.,.0,000c o0oo00.,>o.......0oo0o.......

VI.

VII.

12 12 13 14 15 16 17

1. 2 3. 4. 5. 6.

Educa.tional Level ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,000OO Breadwinner's job status " .,.,.,.... Total annual income of family Size of family or of Household

1. Size of Homes ........ 2. Sanitary Facilities .............. 3. Possession of Refrigerators

IV.

Fresh Fruit Consumption ...,,,...,,0.,.,.,.,.o.,..,.... Egg

Consumption

Hospitals

MEDICAL EXPENSFS

0000000

000000004000000S0000000000flOJOO

0.....

i. i

O G O O.

O O O..

O.,

O O.

0 0 0

0 0

VIII.

INCIDENCE AND TREATMENT OF SYMPTONZS

.o.,o.,o,.0...OO.,O,

G Y O D O O.

l.` Eyes - Adults ....................................... 2 3. Adults - Symptoms Other Than Eyes and Teeth . 4. Children - Symptoms Other Than Eyes and Teeth Adults

......................o..

............O

MENTAL AND CHRONIC ILLNESS AND SYMPTOMS

...............O. ...........a..o...00....

.....,.,.o.o...

RATES

.o......o...o....0.o...aoo..o0O..n AND

BIRTH

ili

29 30

30 32

ILLNESS

BED DEATH

IX.

Teeth

...............00.aoo

Page 29

LIST OF TABLES

PAGE

TABLE

TOTAL ANNUAL FAMILY INCOME: 1946, 1954

NO. OF ROOMS IN HOUSE BY NO. OF PERSONS IN FAMILY

FAMILIES USING LATRINE BY ANNUAL INCOME

POSSESSION OF REFRIGERATOR BY RESIDENCE AND INCOME

POSSESSION OF REFRIGERATION, 1946, and 1955

Pitt CENT OF ABSENCE OF EGG CONSUMPTION BY AREA, 1946 and 1955

PER CENT OF ABSENCE OF EGG CONSUMPTION BY INCOME, 1946 and 1955

PER PERSON PER DAY MILK CONSUMPTION, 1946 and 1955

PERCENTAGE OF PEOPLE WHO CONSUME OVER PINT A DAY PiJt PERSON, 1946 and 1955

MEDICAL KNOWLEDGE

"YES, BELIEVE A PERSON SHOULD SEE DOCTOR"

"NO, DO NOT BELIEVE A BABY SHOULD BE BROUGHT TO DOCTOR IF IT IS WELL OR SICK"

SOURCE OF MEDICAL INFORMATION

SUPERSTITION RATES

PAGE

TABLE

ANNUAL MEDICAL EXPENSES OVER $50, 1955

DURATION OF BED ILLNESS, 1935 and 1955

BED ILLNESS RATES BY INCOME, 1935 and 1955

BED ILLNESS RATES BY RESIDENCE, 1955

BED ILLNESS RATES BY AGE AND RESIDENCE, 1935 and 1955

I, INTRODUCTION

This survey of Puerto Rican families, representative of the population in the municipalities served by the Bayamón District Hospital during 1955, was conducted to learn more about the health and health hazards of the resident population. health services in the future. much of the data collected

This information may help in planning

This preliminary report of the study omits

it can only highlight some of the more sig-

nificant findings. The project focused primarily on the medical problems of the sample populations

illness, treatment of symptoms, use of hospitals and

doctors, medical expenditures (including medicines), insurance, debts, and the like.

Since the field of public health is so closely related

to the living conditions and attitudes of people, other aspects were also explored for any relevance they might have,

For example, besides glean-

ing the obvious information on income, job status, and education, the field interviewers secured data on housing conditions, sanitation, family diets, living conditions, and the extent of superstition on questions relating to health. Breakdowns were made on the rural versus urban and metropolitan residents, and according to family educational and income levels.

In this

preliminary report both the rural-urban and the income differentials will be emphasized since these two factors are the most suggestive of differences among the sample population as a whole. Studies by Mountin and co-workers in 1935 and Roberts and Stefani in 1946 have been used in trying to define trends in health and health care services, It is realized that this study in the main can be interpreted only as the answers given to ten different interviewers by the heads of 700 households in response to questions which could have been interpreted differently by the interviewers as well as the persons interviewed.

The

information thus obtained can be used only with the utmost care and even then needs to be corroborated with other data, if available, or through additional study,

The sample population of 700 families, with a total of 4,061 individuals, was selected on a random basis, assigning weights to each "pueblo" or "municipio" in the district hospital region according to relative size in the recent census figures.

Seventeen municipalities

were sampledl, comprising three types of residential areas.

Of the 700

families in the study, 38 per cent are rural residents, 9 per cent are urban dwellers-residents of a small town or city, and the remaining half -

53 per cent are metropolitan residents, that is, live in the metropolitan San Juan area. Since over half the families live in metropolitan San Juan, the sample reflects a higher income and educational level than would be found on the island as a whole2.

Furthermore, the health conditions of

this district might be somewhat better than in other parts of the island, because of higher incomes, better education, and more adequate and more easily available health services and facilities. Thus a word of caution is necessary.

The study reflects con-

ditions in the Bayamón hospital region only, and inferences regarding the rest of Puerto Rico should be made carefully and with regard to the ruralurban differences to be discussed subsequently.

Aguas Buenas, Aibonito, Barranquitas, Bayamón, Carolina, Cataño, Cidra, Comerio, Corozal, Dorado, Guaynabo, Naranjito, Rio Piedras, San Juan, Toa Alta, Toa Baja, and Trujillo Alto. Contrasted with the 60 per cent rural residents and 40 per cent urban residents of the whole island.

EDUCATIONAL LEVEL 100%

GRADES ATTENDED URBAN a METROPOLITAN

GRADES ATTENDED RURAL 9 -12th a 1-2 3_8th SOME OR LESS COLLEGE

1-2 OR LESS

3_gth

SOME COLLEGE

80%

60%

40%

20%

/// % /40.5%// j 41.3% /

, ~ ! /,;,,,,~

FIGURE I EDUCATIONAL LEVEL OF HEAD OF FAMILY

,////

II,

SOCIAL CHARACTERISTICS

EDUCATIONAL T,FVEL As shown by Figure 1, almost one-fourth of the heads of families

had only first grade education or less, and approximately half had attended grades two to eight.

However, more than one in ten had some college educa-

tion, a high proportion compared to the figure cited by Roberts and Stefani in Patterns of Living in Puerto Rico for 1946.

They reported that only

2 per cent had some college education, and that approximately 4 per cent had some secondary education, (ninth to twelfth grade), as contrasted to our finding of 1.7 per cent. When the rural and metropolitan-urban groups are compared however, sharp differences emerge.

Whereas only about 10 per cent of the

rural heads of families had completed some secondary education (high school or more), over 40 per cent of the urban and metropolitan heads of families had done so, These findings suggest not only that the education level has risen (especiall.y as shown by the 10 per cent of rural residents with some secondary education), but that the educational differential between the rural and urban dweller is of considerable consequence to public health educational programs, 2.

BREADWINNERS JOB STATUS In the sample, 1$ per cent of the main breadwinners were un-

employed or nonemployed, and another 1$ per cent had part-time work only, that is, seasonal jobs or half-time work.

On a regional basis, differences

emerge as the highest rate of seasonal and part-time work (22 per cent) is in the rural area and the lowest in the metropolitan area (14 per cent). Also interesting is the fact that the unemployment rate is highest in the urban area (22 per cent) compared to 1$ per cent for the other two regions, (See Figure 20 ) 3,

TOTAL ANNUAL INCCME OF FAMILY The total annual income of each family in the sample, including

all income sources, was computed for the year 1954.

In Table 1 these

EMPLOYMENT STATUS I 00%

FULL - TIME

RURAL FAMILIES

TOTAL SAMPLE ~

I 00%

METROPOLITAN FAMILIES

~~~ 63.6% í ,~

URBAN FAMILIES

~~ ;• ~~

: :•.

• '•

~ ~

♦ 1 ~...

♦ í•i...

♦ *. ♦

PA R T - T I M E OR SE A S0N A L

9;0~;••~~~~~~•i•i•i'i ti .'.0 I8.3%❖:•:•' .... O•.O❖ '

UNEMPLOYED OR NON - EMPLOYED

I 8.I%

~..........♦ i.~.~~.~~.~~~~s~y..♦ j~j•~~~í•~.~.~.~.~.~.~.~í•i~.~.ii~•~;í.0;~~~..~•..~~~~~~~~~~~ ,~

• I ~I ~ , ♦~........~..~í~i

O~Oi'i~

•_._.~

; .•

FIGURE 2 BREADWINNER'S JOB STATUS

. 22.2%

•

`~`

; .•

results are compared with those found by Roberts and Stefani in 1946 for the metropolitan area of Puerto Rico, TABT,F 1 TOTAL ANNUAL FAMILY INCOME ≥ METROPOLITA

1946, 1954.

B~YAMON HOSPITAL REGION

AREA

Year 1954

Year 1946 Under $500 aoo..00.000.

1701/

e.000...o..o.o.o.00...,.0 13049%

$500-999 a.oa..e.e.o.o..o.o0

2908J

.o..so.....000.00a..o

17.97%

$1000-1999 o..o.e.e....00.... 23.4%

.~o.o..00.000.....o.o 00 00 29.65/

$2000 and more

~~oeo~a.00000,00.0000

29.7%

OnOn

100%

39098% 100%

From this comparison one can note an increase in 1955 in the proportion. of families with incomes over $29000 and a corresponding decrease in the proportion with less than $1,000, In general, the families in the Bayamón District Hospital region have more money than they did eight years ago.

This is a healthy sign, for although not all have reached the Common-

wealth goal of $2,000 they are approaching a more adequate subsistence level. 40

SIZE OF FAMILY OR OF HOUSEHOLD The number of people in a household average 5.4 persons, the

same figure obtained by Stefani and Roberts for 1946, and comparable to the 1940 census figure of 5.3 persons per household.

Over the past 15

years, family size has remained constant. Residence and education were compared to family size to find to what extent the degree of education and location of residence might contribute to fflmily size, Among rural families almost 60 per cent had over five members in the household, whereas among the urban families the proportion of those with more than five members was 45 per cent; among metropolitan families it was only 33 per cent.

Hence the degree of

urbanization affects family size, with the rural area showing a significantly larger proportion of big families, In comparing the size of household with the educational level of the head of house, it was found that less than a third (32 per cent) of the homes where the head of the family had some secondary education contained more than five persons in a family.

In almost 50 per cent of

the homes where the head of house had less than eighth grade education, there were over five members in the household, Since these results indicate that increased education is correlated with decreased size of household, part of the answer to the population problem may lie in advancing the general educational level, A11)wance must be made for the fact that size of household and size of family are not identical indices,

8 III, HOUSING AND LIVING CONDITIONS

The topic of living styles, though very relevant to the problem of public health, can be treated only briefly in this preliminary report,

Because housing conditions are important indices of styles of

living, a few salient features of the report will be cited, 1, SIZE OF HO

Table 2 exhibits an obvious index of crowded living conditions and it shows that housing conditions deteriorate as the number of persons per household increases,

For example, of those families with six or more

persons in the household, 38 per cent have four or fewer rooms in the house - obviously overcrowded - whereas among families with .five or fewer persons, 41 per cent have four or less rooms in the house, TABLE 2 NOo OF ROOD IN HOUSE BY NOo OF PERSONS IN FAMILY 6 or more persons per family

5 or less persons

Four or fewer rooms in house

But since size of household is related to education and to income, the poor people with the least education tend to have the largest nl7mbe:r° of household members and the least space in which to house them, 2. SANITARY FACILITIES Water Supply Information was secured on the sources from which the families obtained their water supply for drinking and washingl. In this study, 78 per cent of the families had. adequate sanitary sources, 66 per cent obtaining water from an aqueduct.

The remaining 22 per cent had inadequate

adequate sanitary sources Sources were grouped into three categories house Questionable water or an aqueduct, to referred to water tap in sources included those about which it was not possible to learn whether the well was deep or a shallow one subject to contamination, Inadequate water sources referred to river water, obviously unsafe, and to springs, since in the low coastal area springs are not regarded as safe from contamination and since it was not clear whether persons obtained water from springs as its source or not,

or questionable sanitary sources, using rivers, shallow wells, springs, etc,

All the unsanitary or questionable sources were in the rural areas,

none in the urban or metropolitan area.

Of the rural families with in-

adequate sources of water supply, 71.4 per cent had incomes of less than $1,000, and 56,5 per cent of those with questionable sources had incomes of less than $1,000.

Certainly from a public health point of view the

water supply situation in the rural areas remains an important unsolved problem, Waste Disposal Systems Of the total families in the sample, 45 per cent had latrines and 50 per cent had use of a toilet with sewer or septic tank:.

Of the

remaining 5 per cent, over half had no disposal system, and another 2 per cent used the facilities of neighbors or relatives, As would be expected, latrines were located primarily in the rural. areas (68 per cent).

Furthermore, 81 per cent of all rural families

used a latrine as contrasted. to 23 per cent of the metropolitan and urban residents, Size of income was also analyzed to determine whether this factor affected the type of facility used, TABT.F 3 FAMILIES USING LATRINE BY ANNTJAL INCavIE Annual Inc me

~ of Rur, a.:L Families

Under $1,000 $1,000-2,000 $2,000 and. over

87.7% 80.6% 58.8%

% of Metropolit n - T'rban Families 48.8% 35.8% 8.5%

Table 3 indicates that increased income may alter the use of latrine facilities, but that it is not a determining factor.

Of the

high-income group in the rural area, almost 60 per cent use a latrine, but only 8.5 per cent of the urban high-income group. Since the rural residents lack a sewage system, they must go to considerably more expense than an urban dweller to install a toilet,

by building a cesspool., septic tank, etc.

Undoubtedly this fact

accounts for part of the disparity, 3,

PGSSF~.9ION OF REFRIGERATORS Over half the families interviewed had a refrigerator in

their homes.

Of the urban and metropolitan families, three-quarters had

a refrigerator, whereas only one quarter of the rural residents possessed one. (Table 4.) TABLE 4 POSSESSION OF REFRIGERATOR BY RESIDENCE AND INCOME Annual Income

Rural Families

Metropolitan-Urban Families

Under $1,000 $1.,000-2,000 $2,000 and over

7.0%

34.6% 67.6%

33.7% 64.1% 944%

4. With increased income among both rural and urban residents there was an increased possession of refrigerators, although the preponderance of refrigerators (3 per cent) was in the urban-metropolitan areas.

the Roberts and Stefani study the proportion of all families in Puerto Rico possessing a refrigerator was 11 per cent °

3 per cent for rural

residents and 21..9 per cent for urban families. (Table 5.) TABT,F 5 POSSESSION OF REFRIGERATION, 1946 and 1955 Stefani and Roberts

Bayamon District

1946 •

Total of all families .... Rural families o., o.o..... Urban families ...o...,...

11,0% 3,0% 21.9%

55,9% 25.4% 74.7%

~ Since ref:rigeration is important in controlling food spoilage, which for instance contributes to enteritis, it is of interest to public health policy that ownership or possession of refrigerators has increased and tends to rise with income increments, regardless of place of residence.

Undoubtedly some refrigerators are purchased on the installment plan primarily as a "prestige" item by certain low-income groups, but regardless of the reason for possessing a refrigerator, the end-result is a decrease in food contamination and is of beneficial consequences for the illness rate, especially among children,

1.2

IV,

FAMILY DIETS AND FOOD EXPENSES

Certain interesting data were obtained on the kinds of diets used by families in the Bayamón District Hospital region in 1955.

The

results, when compared to the data secured in 1946 by Stefani and Roberts, are encouraging, although the data indicates that poor nutrition is still an important problem for certain groups in the population. In this report only a few of the items in the diet will be analyzed

consumption of fruit, milk, eggs, and meat.

These were

selected because of their importance in a nutritionally sound diet. FRESH FRUIT CONSUMPTION Over one-quarter of all farm lies ill the sample population eat no fruits, either canned or fresh, Location of residence and income level were used as variable and their relative importance assessed in regard to fruit eating.

It was

assumed that rural people, having more fruit available, would tend to eat more fresh fruit than the urban residents.

However, the opposite result

was found - over 40 per cent of the rural people ate no fruit and only 15.6 per cent of the urban people failed to eat fruit.

With decreasing levels

of income, fruit consumption also decreased, although the difference was most noticeable between the urban lower and upper income groups1

The

rural residents in all income groups ate less fruit than the urban and metropolitan families of similar incomes.

One partial explanation may

be the prejudices against fresh fruit held by rural people, as implied by Roberts' study so that although fresh fruit may be available and cheap they prefer not to eat it. Another 25 per cent

f the families were found to eat fresh

fruit daily, though again the higher proportion of fresh fruit consumers

Thirty-one per cent of the low income group ($1,000 or less) and 5 per cent of those earning $2,000 and more ate no fruits.

13 ~

lived in the urban areas,

In the lowest income group (under $1,000)

among both rural and urban families there was more similarity than between the other income ranges. In the case of the urban lower class, failure to eat fresh fruit daily might be a matter of income because free fruit is not available.

In the rural lower class a combination of prejudice and lack of

income may contribute to their failure to eat fresh fruit daily. 2.

EGG CONSUMPTION A third of the families in the sample ate over three eggs per

person weekly.

Urban residents showed the highest proportion of egg

consumers (42,6 per cent).

Among rural families only 16.3 per cent ate

over three eggs per person weekly.

Egg consumption also increased with

rise in income, but this tendency was most pronounced in the urban area. In the urban families earning $2,000 and more, over 60 per cent ate more than three eggs weekly per person as contrasted to 26 per cent of the rural upper-income group.

The lowest income groups for both residence areas were

most similar in their rate of egg consumption, although all the rural residents were more alike in consumption of eggs than the two upper-income ranges.

This means only that a certain minimum income is necessary to buy

this quantity of eggs per week and that hence the lowest income families could not afford to buy eggs.

Only 14.5 per cent of rural families and

15.1 per cent of urban families in the low-income ranges consumed over three eggs weekly per person.

However, with increased earnings egg con-

sumption does not increase appreciably in the rural area, whereas the opposite is true of the urban families. It is possible to compare the 1.946 figures with these data on the absence of eggs (no eggs eaten) in the family diet. TABT,F 6 PER CENT `JF ABSENCE OF EGG CONSUMPTION BY AREA, 1946 and 1955

195 5

1946 Rural

Urban

Total

Rural

Urban

Total

39.11

49.81

341

11.71

6.01

g.11

1.4 TABT,F 7 PER CENT OF ABSENCE OF EGG CONSUMPTION BY INCOME, 1946 and 1955

1946

19 5 5

Annual Income

$500-999

$1-2,000

3L2%

11.9%

$2,000 and more

Less $1,000

$1-2,000

$2,000 and more

4.8%

18.8%

7.3%

Tables 6 and 7 demonstrate that many more people in 1955 eat more eggs than in 1.946.

The change is most marked among the urban families and

for the Lwo lower-income groups in both areas. 3,

MILK CONSUMPTION Almost half (45 per cent) of the families interviewed consumed

over one pint of milk a day per person.

Compared to the figure found by

Roberts and Stefan in 1946 this represents a remarkable improvement in the last 11 years. TABT,F 8 PER PERSON PER DAY MILK CONSUMPTION, 1946 and 1955

9 4 6

1 9 5 5 Under one pint

Over one pint

Under one pint

Over one pint

TOTAL

73.6%

26.4%

54..5%

Rural Urban/et.

79.8%

20.2%

60.0%

20,0%

65.0%

35.0%

20.0%

60,0%

$500-999

74.0%

26.0%

55.1%

44.9% 66.7%

86.6% 74.7% 38.7%

13.4%

$1,000-2,000 $2,000 & over

45.5%

Under

33.3%

$1,000

25.3%

61.3%

As shown by Table 8, the greatest increase in milk consumption is in the urban areas where milk is probably more available than it was in 1946, and in the income group between $1,000-2,000.

The figures are

not comparable for the lowest income group because the 1946 percentages

are based on $00-999 income range and the 1955 figures are computed for all fsm-ilies earning less than $1,000 a year. When milk consumption is compared for the income ranges within each area the results indicate that urban rather than rural people, irrespective of income, are the high milk consumers.

This result cuts

across income lines, because the proportion of people in each urban income bracket who consume over one pint a day per person is almost double that of the rate in the comparable rural income groups.

Furthermore,

when these rates for rural and urban consumption are compared with those found in Patterns of Livins (Table 9) it is significant that the rural consumption pattern has changed for the worse whereas the urban group now consumes more than it did in 1946,

TABLF 9 PERCENTAGE OF' PEOPLE WHO CONSUME OVER PINT A DAY PER PERSON, 1946 and 1955 Rural 1926

$500-999

22,6%

$1.,000-2,000

3606% 70,6%

$2,000

Rural 1955 Under $1,000

2505% 38,0%

Urban 1946

$500-999 $1.,000•-2,000 $2,000

31,5% 50,0% 6507%

1.3,7%

TJrban 1955 Under $1,000

279%

51,0% 7507%

These .figures highlight the importance of increasing milk consumption in the rural areas where the need may be greatest.

To do so may

involve more emphasis on nutritional educational programs, on milk station programs, and on some plan for distributing dried milk at lower prices, 4.

MEAT CONSTJMPTION Over one-quarter of all families in the sample eat meat (in-

cluding codfish) three or more times weekly.

However, there is a notice-

able disparity in meat consumption between the rural and urban groups, and between lower- and upper-income ranges.

Over 40 per cent of the

urban and metropolitan families eat meat three or more times weekly,

1.6

whereas only 7 per cent of all rural families eat it this frequently, Although there is a sharp increase in the consumption of meat between the families earning $1,000-2,000 and those earning $2,000 and more (6 to 35 per cent for rural and 22,6 to 62°5 per cent for urban), the rural-urban differential seems the most significant, because even among the upperincome groups in the rural area meat consumption is much lower than in the urban upper--income groups, The same variation between rural and urban families and the three income ranges occurs when the index of no-meat consumption is used, Almost 20 per cent of all families consume no meat; 38 per cent of the rural residents and $ per cent of the urban people fail to eat meats However, again the rural group for all income ranges has a much higher proportion of no-meat consumption, indicating that residence rather than income is a more important determinant, In conclusion, a minimum of income is a necessary condition for consumption of meat, but increases in earnings among the rural group do nOt result in the same rise in meat cons>mption as in the urban populations

This

fact indicates the unavailability of meat in rural as contrasted to urban areas, and points out perhaps the need for better distribution in rural areas as well as for education on the importance of protein in the daily diet, 50

ADEQUACY OF PROTEIN DIET An adequate protein diet of 4<5 ounces or more meat per person

per day and over three eggs per week„per person is found in approximately a third of the families in the sample.

About two-thirds of the families

may be said to have a minimum protein diet on a criteria of some meat or eggs daily.

This is in contrast to the low protein diet of nearly three-

quarters of all families in 1946 who subsisted on diets made up predominantly of viandas, :rice, and beans with small and variable supplements of protective foods,

Further breakdowns on adequacy and type of diets must

await the final report, though it is necessary to point out that the data on diet in this study are in no way as detailed or precise as those obtained by Roberts and Stefani in 1946.

In any case, these tentative

results indicate an improvement in the adequacy of diets for 1955, especially among urban families, 6. FOOD EXPENSES The families spending less than $13 a week on food comprise almost half of the sample (47,,

per cent).

income groups is as expected.

of those in the lowest income group, 83

The differences between the

per cent spend less than $13; 51 per cent of the middle income families ($1,0002,000) and 15 per cent of those earning $2,000 spend under $13 weekly,

However, it is interesting to note the difference in food ex-

penses for the rural and urban families.

About 67 per cent of all rural

residents and 35 per cent of the urban families spend less than $13 a week on food,

However, when compared by income groups within each area,

there is a similarity, but with more of the rural lower class spending less on food than is true for the urban lower class, and correspondingly a slightly higher percentage of all urban upper income groups spend more than $13 a week on food than rural upper income groups,

The varia-

tion is too small to suggest much of a difference in food consumption tastes as reflected in the size of food budget, however.

1.8

EXTENT OF MEDICAL KNOWTFDGE, SERVICES AND FACILITIES

1, WHEN TO SEE THE DOCTOR In the survey, several questions were asked relating to the public's knowledge of health,

On all except one question ("What would you

do if you had catarrh?") the results were overwhelmingly in favor of visiting a doctor.

Concerning catarrh, 45 per cent stated they would see a

doctor and 35 per cent said they would use patent medicine,

Over 92 per°

cent of the people stated they would see a dentist if they had a toothache. (See Table 10,) TABLE 10:

MEDICAL KNOWT,FDGE

"What woul.d you do"

Use Home Remedies or Other

If you couldn't sleep at night?

85.6%

1305%

If you had frequent bad indigestion?

82.Oí

3.0%

If you had a backache often?

7200%

23,0% (back .albs)

4, If you had catarrh?

44e8%

1504%

35e2%

5. If you had "la monga"? (tropical flu)

67.0%

1100%

1808%

Consult Doctor

Use .Patent Medicines

14,7%

If your child ha.d "la monga"?

76.7%

904%

10,8%

If you suffered from headaches?

7102%

504%

22,0%

If your oldest boy of 6 wets the bed?

60.0%

13.5% (punish or beat him)

9, If you had a toothache?

10.

11..

92.Oí

To prevent you children from getting diphtheria, typhus, smallpox?

Ways to determine T.B.

Vaccinate

Isolate

Do Nothing

Other

76.3%

8.5%

4.7%

9.8%

Best Informed

Doubtful

Misinformed

70.2%

28.5%

Two of the questions were analyzed more fully to assess the possible influence of education or residence on type of responses

On the

question, "Do you believe or not believe that an adult should go to a doctor regularly even when he is not ill?" over three-quarters of the people replied, "Yes, he should go,"

Of the total number of rural residents, 66

per cent believed in regular visits to a doctor; and of the total urban and metropolitan families, 7908 pear cent replied affirmatively, giving the urban residents a slight margin.

When the answers were related to educa-

tional level, the results were less decisive, though with each rise in education there was a higher proportion of people who believed in regular medical checkups,

Comparing the urban-rural residents by educational groups,

the positive replies of rural residents were consistently lower than among the urban group.

(See Table ii,) TABLE 11

"YES, BELIEVE A PERSON SHOULD REGULARLY SEE DOCTOR" Educational level

Rural Families

Urban Families

2nd grade or less 3rd to 8th grade 9th grade and above

6907% 6507% 7400%

770O% 8105% 8503%

All. Families 7206% 7403% 8308%

On the question, "Do you believe or not believe that a baby must be brought to a doctor if it is sick or well?" 83 per cent believed it was necessary.

When the responses were analyzed according to educational

level and place of residence there was a sharp difference between the replies of rural. and urban residents.

Of all the rural families in the

sample, 27 per cent said they did not believe in taking a baby to a doctor, whereas only 9 per cent of the urban residents agreed with them,

Within

the rural group itself, the proportion of people who did not believe in "well-visits" for babies dropped slightly with each rise in educational. level., but this tendency was not observed among the urban .residents.

brief, location of residence was a more significant variable than education in whether a person believed in the necessity of well-visists for a baby, (See Table 12,)

TABLE 12 "NO, DO NOT BELIEVE A BABY SHOULD BE .BROUGHT TO DOCTOR IF IT IS WELL 0R SICK" % of Rural Families

% of Urban Famillies

32 3% 25xO% 2200/

9o0J 12,5% 603%

2nd grade or less 3rd to gth 9th and above

% of All Families 2200% 1.$ Of o

Education

The results suggest that although for the sample population as a whole there is wide acceptance of public health information, there remains a small rural group of traditionalists who cling to their cod beliefsa Increased education, of course, is part of the answer, although these rural residents might be less receptive to learning than their urban cousins who have cast off some of the old ideas and beliefs. People were also asked where they learned how to keep healthy, to cure illness, and to prevent children from getting sick,

On each question

more than half the respondents replied "doctor," "hospital.," "health unit," or "school," and approximately 40 per cent answered "family" or "friends". (Table 13),

It is interesting to note that about one in ten person replied

they learned their information from the radio, TV, or papers.

The rate

was higher on questions concerning nutrition and "how to keep healthy," about which the persons indicated they had been especially influenced by commercials or advertisements of food products,

Although these replies

constitute a good index of the effect of advertising on consumer's tastes, they are also a good omen for all promoters of public health education who might in the future compete with the appeal of the coaunercials TABLE 13 SOURCE OF MEDICAL, INFORMATION

"Where did you learn"

Doctor, Hospital Health Center, School

Radio, TV, Pager

How to keep healthy?

42e2%

5507%

1407%

What to do to cure illness?

4Oo7%

5904%

90o%

Family or Friends

21 T'ABT 1 1.3 (Continued) "Where dad you learn" ..,..,,

Family or Friends

Doctor, Hospital Health Center, School

Radio, TV, Paper

3. What to do to prevent children from getting sick?

46.79

53,49

7079

4, What food one must eat?

40.4%

59.9

12049 Persons who

know more about it, unspecified 5,

From whom would you ask advice on these matters?

1.5.79

81.59

1.5.79

ADVICE ON HEALTH MATTE.R5

On the question, "From whom would you ask advice on these matters?" over 80 per cent stated "doctor," "hospital," "health unit," or "school" (see item 5, Table 13).

This is, o£ course, a much higher proportion of

people who place reliance on professional advice than in the previous ques~

Lions,

Perhaps s

e persons gave this reply because they f. el.t it was the

right answer, to please or impress the interviewer, But in general the large disparity in sate may be better explained by the fact that the previous questions referred, to past experience ("There did. you learn?") and this one was oriented to their future action, In any case, the result indicates that the sample population as a whole has accepted the validity of professional opinion on health matters and in the future will be mare receptive to health education programs promulgated through official agencies. 3,

LOCATION OF NEAREST HOSPI`.rAl, Respondents were asked if they knew the location of the nearest

hospital.

Almost three-quarters of them were able to cite correctly the

location of the hospital nearest their home and another 18 per cent gave an incorrect answer or did not know, When the replies were related to education and residence it appeared that education was not important, but that place of residence made a. difference,

Fo:r example, only 10 per cent

of the rural residents did not ]mow or cited incorrect location of hospital, whereas 21 per cent of the urban residents were misinformed or uninformed, This situation may be partly due to the fact that in the metropolitan area, where there are many hospita:l.s, the residents are not familiar with the proximity of hospitals to their homes, whereas the rural families have a more restricted choice and it is easier for them to be informed as to the closest oneo

4, LOCATION OF PUBLIC PEAC,TH UNIT A higher proportion of persons ($5.2 per cent) were familiar with the exact location of the "Unidad de Salud," the health center. Although the answers are not yet analyzed by income, it might be expected that the highest income group would be least well-informed on the name of the health center doctor and of a pharmacy (94.1 per cent) for doctor and 97.1 per cent for pharmacy).

These facts certainly demonstrated the ex-

tent of familiarity with the available medical services and facilities of the district. 5. SUPERSTITIONS Several questions were included to determine the extent of superstition among the population.

The highest rates for superstition were

obtained on the questions dealing with the treatment of indigestion (placing a ]mot on the stomach of all ill persons) (43 per cent); and with the reasons for satisfying whims of pregnant women (if whims are unsatisfied the baby will be born with an open or gaping mouth, indicating hunger) (42.5 per cent).

One of 'the lowest rates of superstition related to the cause

of a baby being born abnormal (21.4 per cent).

(The superstition con-

cerned the mother°s relation with an animal or "phenomena,") (See Table 14.) In this preliminary report it is possible to analyze only these three superstitions in any detail.

Location of residence and level of

ed,ica.tion were the two variables used in the analysis.

Both education and,

residence were shown to influence the rate of superstition, although there was a greater difference in rate of superstition according to educational

levels than according to residence,

In other words, the people of similar

educational level were more alike in their beliefs than were the residents of one location, rural or urban alike.

The rural people were consistently

more superstitious than the urban families, and the highest superstition rates were found among the rural people with second grade education or less, For example, 72 per cent of. 811 rural persons with this level of education

hiin

had some degree of superstition regarding the reasons for satisfying of pregnant women,

Contrariwise, the lowest superstition rates were among

the urban persons with some secondary education - ninth grade or more. TABLE 14 SUPERSTITION RATES Some Superstition

Most Superstition

.Any Superstition (Some & most)

Cause of' baby being born who is abnormal?

73e$%

1.704%

700/

21.04%

Causes of death of children?

6$,:1.%

25.5%

6.O%

31±%

Treatment of indigestion?

5507%

210 O%

22.1%

43 1.%

Cause of birth marks?

6900%

1.4.$%

14..$/

2906/

Reasons for satisfying whims of pregnant women?

56.$%

$.5%

34,E

42.5%

Causes of death?

$Oo$%

1L,4%

4,0%

No Superstition

Question

A question was also included, in the interview on whether there was a witch doctor or "curandero" in their "barrio" or district. per cent said "No," indicating at least an unfamiliarity.

Over $0

Almost one-

quarter of all rural persons in the sample knew of a curandero in their district, whereas only 15 per cent of all urban residents were familiar with one,

Furthermore, with increasing education, knowledge of the

24. whereabouts of a curandero decreases,

Of all persons with second. grade

education or less, 22 per cent 1ºiew of a curandero and only 14 per cent of those with some secondary education were so informed. Knowledge of the presence of a curandero and belief in his practices, h-~wever, may gee hand in hand, since almost half (4205 per cent) of those who said that a curandero lived in the barrio had some belief in him, and another 20 per cent did not Jºzow whether° they believed in blm or not, a reply indicating, perhaps, a reluctance to commit themselves publicly, That the number of curanderos and belief in them may be understated can be demonstrated by two facts,

First, almost one in ten families (9,2 per

cent) had someone in the family possessing extraordinary faculties,

Second,

on the question relating to the actual practices of a curandero (treatment of indigestion by certain "magic" fornu.lae)

almost 43 per cent of all

respondents indicated some belief in the superstition or rite.

In summa r°y, however, the public expression of acceptance of superstition remains relatively low and constitutes a public health problem only among the most ignorant or least educated groups in both rural and. urban areas,

HEALTH MU) MEDICAL CARE SERVICES, USE, OPINION

Questions were asked respondents about the location of the doctor they visit and the distance they rnais't travel,

Of a.f families, almost tiro-

thirds (64.2 per cent) visit a private practitioner, :L7 per cent visit a doctor at a public health unit, and about half (49 per cent) see a doctor in a municipal hospital or dispensary,

. lmost three-- quarters of those who

visit a private physician are in the urban areas, but the proportion of those ring

the health unit and municipal hospital are about the same for

rural and urban families Over three-quarters (7$ per cent) of all rural families use the services of a doctor located in the town or barrio in which they reside; the zest visit a doctor in a neighboring towns The distance cf a doctor from patients house was computed in terms of length of time necessary to travel the distance by the quickest and, most available means of transit

bus, car, or walking.

For the rural

families, over one-quarter° needed 40 minutes or more to get to the doctor and another 3$ per cent required between 20 and 45 minutes for traveling. Among urban families, of course, there is no problem of isolation, all. could reach a doctor within approximately 30 minutes 1o

PUBLIC HEALTH U1 II

("Unidad de Sa:Lud Pública," or Medical Center )

Only one-third of the fami lies fail to use any of the services offered by the health centers,

Among the remaining two 4hirds there is

no decisive favorite among the various services used,

The services most

frequently cited. by 'the families in the sample were those for mothers and children, venereal, disease, TB detection, and health. certificates, A. comparison was made of the use of services of the health cen~ ter with the amount of medical expenses the family paid a year,

Of those

who use the various services offered by the "Unidaad., " almost two 4hirds pay medical expenses of $50 a year or more,

For example, 71 per cent

those who use the services for children, 6$ per cent of those who use intestinal parasite service, 73 per cent of those who get health certificates,

and 70 per cent of those who use the contagious disease service pay $50 or more in medical expenses a year.

This proportion is higher than in

the sample as a whole, in which 5S per cent of families pay $50 or more a year, and it may indicate that the bulk of those who use the medical centers are health-oriented,

Their concern for health may have resulted

from past experience of illness and its costs, or the concern for health itself may cause an increase in medical expenses out of proportion to actual illness. On the frequency of use of the public health units, over 45 per cent of all families have gone there four or more times, and another 20 per cent have used its services on three or fewer occasion, Among those who have used the health center, the opinion is overwhelming:l.y in its favor (96,9 per cent say it is good),

The reasons given for approval

are not so much economic (free 21 per cent) as good treatment ("cure disease," "pleasant personnel" - 39 per cent).

Those few who disliked the

medical center had rather vague reasons for their opinion - primarily for inefficiency and "por referencia" unspecified, 2.

HQ.SPITATS Three-quarters of the families in the sample have used the serv-

ices of the closest hospital occasionally, and about 25 per cent contained members who had used it frequently,

Approval of the hospital was high (70

per cent) but not as high á.s for the public health center.

The favorable

reactions consisted of cozrmaents on good services and treatment with some varied comments on type of nursing care and expense, The negative comments concerned haggling over prescriptions, inefficiences, lack of personnel, inadequate nursing care, poor food., and dirt - the typical list of complaints, 3,

PUBLIC WELFARE SE_RVICF.S On the question, "Has some member of your fa,ni 1y obtained help

from Public Welfare?" one-quarter replied "Yes."

Of those persons who

applied for help, 70 per cent were granted help, 19 per cent had cases pending,

27 VII.

MEDICAL EXPENSES

Medical expenses were computed for all families in the sample, and a:l.most 60 per cent were found. to pay $50 a year or more, families, 48 per cent spent $50 or more yearly,

Of the urban

The proportion of people

who spent this amount a year on medical expenses varied dtrectl.y with income, irrespective of residence,

That is, a similar proportion for each

income group spent $50 a year or more on medical expenses (Table 15)0 TABLE 15 ANNUAL MEDICAL EXPENSES OVER $.50, 1955 Income Under $1.,000 $1,000-2,000 ,.,,.,.,,.,,oao.,,. $2,000 or more .~......a.....>..

Rural

Urban

Total

35.1/ .53.0% 82,3%

33.71 .56.61 85.5%

34.5% 54.9% 84.41

The fact that such a large proportion of even the lowest income groups spend this amount on medical expenses indicates a willingness to pay for some type of medical care.

Furthermore, since so few of the families

have adequate medical coverage now and yet so many pay high medical expenses, there is a possibility of receptivity to health insurance plans, Approximately 16 per cent of all families said they failed to have proper care because of lack of money.

In this regard one in ten

stated they were unable to buy glasses and 6 per cent could not pay for dentures.

Inability to buy medicine because of lack of money was cited

by 13.5 per cent of all families, trict

Both hospitals and doctors in the dis-

may be commended for their sense of responsibility toward patients,

since 100 per cent of all families stated that no hospital had refused to treat them because of lack of money and 99.4 per cent said that no doctor had refused to come to a patients home, Such facts are at least encouraging in terms of the: attitude of the profession, but by no means constitute an argument against the need for more adequate medical coverage. There were various means of payment of medical expenses and for medicine employed by all the families in the sample, some finding several.

different means of paying the expense.

The most frequent means cited

was to pay cash out of one's own pocket - 75 per cent of all families did this for some part of their medical expenses.

Over half the families

obtained some aid or medicines free of charge (53.1 per cent).

Ten per

cent borrowed the money, and 1$ per cent owed everything, paying the debt in installments. Approximately 14 per cent of the families had one person or more who was unable to work or go to school for more than one month because of illness.

In many of these cases the illness created an economic hardship

through the loss of earning power.

Of the total rural families, 16.5 per

cent had some person who could not work or attend school, whereas the proportion was smaller for the urban group (11.7 per cent).

VIII,

INCIDENCE AND TREATMENT OF SYMPT0Iv

Information was secured on the proportion of families having members with some symptoms and on the type of treatment they received. •

Symptoms were termed "neglected" if the person did nothing, "received

•

treatment from a pharmacy only," "used home remedies," or was "treated by a. °curandero,°" a type of witch doctor.

If the person received

medical attention from a doctor or dentist the symptom was classified as "non-neglected," Eye and dental symptoms were classified separately since they received the highest amount of neglect,

Adults and children were analyzed

separately, the age range for children including all those 14 years old and. younger, Since the information on the number of individuals with symptoms and the type of treatment they received is not yet available, this preliminary report can deal only with the proportion of families who had persons with or without symptcsma and the type of treatment they had reO

ceived,

In making generalizations it is necessary to bear in mind that

this data is based on families rather than individuals, 1.

EYES - ADULTS Over 60 per cent of the families (61,5 per cent) had persons

with some eye symptoms.

The rural families, however, had a much lower

proportion (35.4 per cent) with this complaint than the urban and metropolitan families (644 per cent).

Perhaps part of the reason for the higher

incidence of eye symptoms in urban areas is related to occupational demands - more desk jobs and more facotry work requiring close visual attention, When the families with persons having eye symptoms were compared, a higher proportion of neglect appeared among the rural residents (:56 per cent) than among the urban families (20 per cent).

Likewise,

many more person, with eye trouble among the urban families tended to receive treatment: from a doctor than did those who were members of rural homes, Although the incidence of eye symptrma is highest among urban

families, it is also this group which receives the most treatment from a doctor. Of those few families who replied that they could not have proper care because of lack of money, 563 per cent replied that they were unable to afford eye glasses - indicating that income has some relationship to neglect of symptoms. 2.

TEETH - ADULTS In the total sample over half (58.2 per cent) of the families

had some person with dental symptoms, the highest incidence being among the rural families (68 4 per cent),

Of those rural families who had per-

sons with dental symptoms more than a third (376 per cent) neglected their teeth and approximately half of the persons had their teeth pulled only.

Only one in ten went to a dentist and received an examination and

fillings.

As was the case for eye symptoms, the rate of neglect for

dental symptoms was higher among those from rural families than among those in urban homes. The fact that income is related to neglect of teeth was indicated by the response to the question, "Did someone in your family fail to have proper care because of lack of money?"

Of those who re-

plied "Yes," 44.7 per cent answered that they could not buy dentures because of lack of money. Time did not permit an analysis of neglect of dental symptoms according to the income groups of the two residential areas, rural and urban.

3. ADULTS - SiMPTO

OTHER THAN EYES AND TEETH

In the total sample, 84.2 per cent of the adults reported symptoms other than eyes and. teeth

The information on incidence of

symptoms and the type of treatment received was analyzed according to the two residential areas, rural and urban, and according to the income variable..

The relationship of educational level to type of treatment re-

ceived for symptoms will be analyzed in the final report.

At this time

it is only possible to indicate the differential in rate of incidence

among rural and urban groups and the proportion of people in the various subgroups receiving treatment or neglecting their symptoms. The proportion of families having no person with symptoms was •

highest in the urban area, 22 per cent while only 12 per cent of the rural families had no person without any symptoms.

The rate of neglect

of symptoms was also considerably higher in the rural than in the urban area,

Of those rural families who had members with some symptoms, 56

per cent neglected the symptoms,

However, only 39 per cent of the urban

families who had persons with symptoms failed to see a doctor°.

This

higher incidence of neglect of symptoms among rural families also corresponds to the higher incidence of neglect obtained, on treatment of eye and dental symptoms, To determine whether the difference in the rate of neglect be@ tween the urban and rural families was due to factors other than residence, the income variable was related to the data on neglect of symptoms.

When

the rural and urban families were compared by income ranges, it was found •

that the incidence of neglect of symptoms among the lowest income groups was higher for the rural than the urban, and this was also true for the upper-incomme group where the rate was higher for the rural than the urban, However, this pattern was reversed for the middle income group, in which the urban families had the higher rate of neglect of symptoms.

Although

there was a general tendency for neglect symptoms to increase with decrease in income, it appears less decisive than the rural-urban dichotomy. In terms of income, the urban upper°income families have the highest proportion of persons with non-neglected symptoms (61..5 per cent) and the families of the rural lower class have the lowest percentage of persons who have received medical treatment of symptoms (40 per cent), For both rural and urban groups, increases of income seem to account for a slight decline in the neglect of symptoms, though the tendency is most marked for the urban upper-income families. To simmmerize, the data on incidence of symptoms and the type or lack of treatment received indicates that the rural areas are not only the places with the higher rate of incidence of symptom; (other than eye

32 symptoms where the urban areas have the higher incidence) but that there is more neglect

lack of medical treatment - for all symptoms, including

dental and eye symptoms, in the rural than in the urban areas.

Income

differences were not decisive in indicating treatment or lack of it except among the urban upper-class families who consistently had the lowest

4, CHILDREN

rate of neglect of symptoms. SVtPTOV15 OTHER THAN EYES AND TEETH

It is of interest to point out that there is a higher incidence of symptoms among children of rural. families (58 per cent) than among those of urban families in the sample (48 per cent),

When the occurrence

of symptoms is related to income to determine whether this disparity is due to location alone or to differences in earnings, the income variable does not indicate any causal relationship.

For example, the highest

incidence of symptoms among children occurs in the middle-income families earning from $1,000 to $1,999 a year. both rural and urban families.

This pattern is consistent for

However, among both the lower and upper

income groups the incidence of symptoms for children is approximately the same, although the rates remain consistently higher for the rural families It might be assumed that the children of the upper income group would be healthier, have fewer symptoms, than the other income groups because of better care, due to more education, higher income, etc.

However,

this observation is not bovine cut by the data, in which she lowest income class - earning less than $1,000 - also has the lowest rate of incidence of symptoms among children for both the rural and urban families,

It is

difficult to suggest any reason why this is the case, When the data were classified according to the factor of neglect of children°s symptoms, the rural families showed a much higher neglect of the children's symptoms (40,3 per cent) than was true among urban families (26,2 per cent),

The income variable was again used to determine its

possible relationships to the factor of neglect of symptoms.

For the sample

as a whole, the rate of neglect of children°s symptoms decreased with increasing income.

This pattern was also found among urban families, but

33 it was not a definite trend among the urban families, Among the rural families with children with symptnmc there was a slight increase in rate o£ neglect of symptoms from the lower income group (41 per cent).

to the middle income families (ii~4 per cent) and then a drop to 33O3 per cent among the upper-income families with children with neglected symptoms. Hence, the rate of neglect of children's symptoms does not follow a consistent pattern for both the rural and urban families when subdivided according to income,

This suggests that the rural—urban differential may

be more important than the income variable in explaining the difference in rates of neglect. It is important, of course, to mention that the largest proportion of families with children with symptoms surveyed in the Bayamón district gave their children medical attention,

Only one-third of the

families neglected their children°s symptoms and over two-thirds (67.1 per cent) took them to a doctor for medical treatment.

This indicates

that the families give better attention to their children's symptoms than to the adults ° symptoms,for 54 per cent of the families with adults who have symptoms go to a doctor and 46 per cent of them neglect their symptoms.

34 IX.

M.ESS AND 5mIv1FmOIVS MEN'.rAL AND CHRONIC ILLNESS

In the sample it was found that 20 per cent of all families had some person with mental health problems (alcoholics, psychosis, neurotics, delinquents, and persons with extraordinary faculties),

the final report, breakdowns will be made on the proportion ofindividuals with specific symptoms.

On the information presently available the

symptoms are distributed among the families in these proportion,,

one-

quarter have some member or members who have "extraordinary faculties," 42 per cent of them have relatives with psychoneurotic symptoms, and another quarter (23<6 per cent) have some member who is alcoholic, Statistics were also obtained on the number of people suffering from a chronic illness.

The types of illnesses classified as chronic

included the following:

rheumatism, diabetes, heart disease, anemia,

deafness, paralysis, asthma, and varicose veins.

Less than half the

families (45.9 per cent) had some person or persons with a chronic illness.

It should be noted that 4$ per cent of the rural families had

a person with, this type of illness and 42 per cent of the urban fami lies. The income variable was also used to determine its influence on the rate of chronic illness.

This showed for the sample as a whole that with de-

creasing income the chronic illness rate increases.

When the rural and

urban families were compared in terms of income groups, this tendency for chronic illness to rise with a declining income was most evident, among the urban families,

For the rural residents the chronic illness

rate was very similar for the middle and upper income groups,

45 per

cent for upper income and 44 per cent for the middle income group.

However,

among the lower rural class there was a definite increase in rate, 52 per cent, the highest rate of chronic illness for the various subgroups in the sample,

In terms of rate of chronic illness, the difference between

the urban and rural areas seems more mamked than any similarity between the income classes of the areas, particularly when comparing the lowest and upper income ranges for the two residential groups,

BED iLNESS

The bed illness rate per 1,000 population was found to be •

185.

In 1935 Mountin found a rate of 418 for the entire island.

This

decrease in the bed illness rate parallels the decrease in general r

mortality on the island. Mountin in 1935 found bed illness rates to be higher in the rural than in the urban area, 440 and 385 respectively.

A similar re-

lation was found in 1955, the rural rate being 19O and the urban metropolitan combined being 181.0, Ten the urban and metropolitan populations are separated a greater difference is found, the bed illness rate for the urban population being 233 as compared to 172 for the metropolitan. Very small differences were found in the duration of bed illness •

In the present study 41.7 per cent of the illnesses lasted under 7 days, and. 69.5 per cent under 14 days; Mountin found that 25 per cent lasted under

5 days and 65 per cent under 15 days

Table 16).

?:ABLE 16 DURATION OF BED ILLNESS, 1935 and 1955 1935 Under 5 days ...,... 25

Under 7 days ....... 41,7

5].4 days .......... 40

5-14 days ...e...... 27.8

w5--3O days ,........ 15

15-30 days ......... 17.7

over 30 days oo.,... 18

over 30 days

:1.2.8

~ The bed illness rates varied greatly with income in Mountin°s w

study.

It is difficult to compare income in 1935 with income in 1955.

However, bed illness rates for the different income gresups varied very little 17).

in 1955 and in fact were lower for the lower income groups (Table

TABLE 17 BED ILLNESS RATFS BY INCOME, 1935 and 1955 19 3 5 Income Illness Rate Under $100 100-249 250-749 750+

1 9 5 5 Ilness Rate Income Under $1,000 1.,000-1,999 2,000+

444 436 363 297

183 186 187

When the bed illness rates are studied by income and residence greater differences are noted (Table 18), TABLE 18 BED ILLNESS R14TFS BY RESIDENCE, 1955

Under $1,000 1,000-1,999 2,000 and over

Urban and Metropolitan

Rural

165 200 178

191 174 234

The rural residents with higher incomes have the higher rate, while the urban and metropolitan residents in the middle income group have the highest rate.

In interpreting these variations we must consider

actual illness and economic ability to keep away from work, Illness rates are higher for the people over 35 years of age,

children under five years

although in the urban and metropolitan area the highest rate was for In the rural area the rate was highest for

persons from 35 to 60 years of age.

Mountin found in 1935 that illness

rates increased with age, a trend which is much less evident in this survey (Table 19)e

TABT.F 19 BED ILLNFSS RATFS BY AGE AND RFSIDENCE, 1935 and 1955

•

Urban - Meto

1955

1935_

and Rural

Urban & Met.

Age •

Rural

Age

Urban 4~ Rt_al

Under 5

1$$

2O$

166

Under 5

309

5-14 15-34 35-60

159 164 236

179 153 204

139 178 288

5-1.4 15-44 Over 45

327 482 504

Over 60

234

205

279

XI o

DEATH AND BIRTH RATES

The death rate for the sample families of the Bayamón Region was computed as 4,19 deaths per 1,000 persons. •

This is somewhat lower

than the death rate for the whole island for the year 1955 - 7,1 deaths per 1,000 persons, The birth rate in the sample population was 2101$ live birth, per 1,000 persons - a figlare also considerably lower than the birth rate for the island as a whole - 3642 live births per 1,000 persons for 1955. Most surveys of this nature display similar discrepancies of rates o

The

discrepancies in the present study are due to a number of factors which will be discussed in full in the final report.