In her first year at the Bureau of Child Hygiene, Baker sent nurses to the most deadly ward on the Lower East Side. They were to visit every new mother within a day of delivery, encouraging exclusive breast-feeding, fresh air, and regular bathing, and discouraging hazardous practices such as feeding the baby beer or allowing him to play in the gutter. This advice was entirely conventional, but the results were extraordinary: that summer, 1,200 fewer children died in that district compared to the previous year; elsewhere in the city the death rate remained high. The home-visiting program was soon implemented citywide, and in 1910, a network of “milk stations” staffed by nurses and doctors began offering regular baby examinations and safe formula for older children and the infants of women who couldn’t breast-feed. In just three years, the infant death rate in New York City fell by 40 percent, and in December 1911, The New York Times hailed the city as the healthiest in the world. Articles about Baker’s lifesaving campaigns appeared in newspapers from Oklahoma to Michigan to California. In the late 1910s, she and other reformers drafted a bill to create a nationwide network of home-visiting programs and maternal and child health clinics modeled on the programs in New York. But the American Medical Association (AMA)—backed by powerful Republicans averse to spending money on social welfare—claimed the program was tantamount to Bolshevism. The Doctor Who Made a Revolution, Helen Epstein, 'New York Review of Books', 26 SeptemberAnd three generations later?
Today, nearly every other industrialized nation on earth provides some form of guaranteed support to families with young children. That America still does not is considered by many to be a national disgrace.Once ideologues grab the reins of government, any notions of doing the best for society or even of rationality, are liable to be lost for ever. There's no inevitable reason why the aggregated interests of ideologues, corporations or powerful organizations of any kind are going to add up to a society that cares about the well-being of the majority of the population. Perhaps the next stop for the US is a banana republic?
Here's another idea. Instead of making policy on the basis of ideology, or the short-term interests of powerful organizations, why not target outcomes? Outcomes that are meaningful to ordinary people - as people, rather than members of one interest group or another. Explicit, transparent outcomes that we can all understand and all participate in formulating and so buying into. That could be done with Social Policy Bonds, which could target broad, long-term social goals about which we could all be consulted and with much most of us would agree. How these goals were to be achieved would be a matter for motivated investors in the bonds, rather than politicians and their corporate or ideological paymasters. People would be rewarded for achieving social goals, rather than siphoning off government funds for their own narrow, short-term interests at the expense of everyone else.
It's a long way from where we are now, summed up by George Monbiot:
Our elected representatives look increasingly marginalised. Unable or unwilling to assert themselves against corporate power, media magnates and spies, they have been reduced to a class of managers, doing as they are told by their sponsors and lobbyists, seeking to persuade their constituents that what is good for big business and unelected agencies is good for everyone. Law of the landed, 19 September