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HIS study makes use of some of the first results that were tabulated from the 1960 Census to analyze the distribution of persons who had marriages that were disrupted by separation or divorce or who, though young, were not living with both parents. The purpose of the study is to throw light on variations by size of place and region with respect to three measures of marriage instability: a separation ratio, a divorce ratio, and the per cent of young children not living with both parents. The major hypothesis under examination is that all of these measures, which reflect instability in marriage, tend to show more variation between large and small places of residence than among the four census regions. The paper will discuss, first, the levels of the three measures for the country as a whole and for the several sizes of place within each region and, second, the results of an analysis of variance performed on the three measures by size of place and region. Scope and Definitions. Because of wide differences expected for white and nonwhite groups, the statistics for the two color groups are compared. At the time this paper was prepared (spring of 1962), data from the 1960 Census were not available on martial status by age. As an alternative, separation and divorce ratios were computed with the total number of married women (14 years old and over) as the base; by this device, distortions in a given type of area because of a large proportion of young (generally single) persons or of old (gen

Descriptions of the demographic transition frequently mention that urbanization played a role in bringing about the switch from high fertility rates to low fertility rates. It is difficult to be certain how far along in the process of demographic transition is the black population of the United States, but it is clear that fertility rates have changed rapidly. Black women who were born around the middle of the last century completed their childbearing with an average of seven children.1 Women born during the first decade of this century-that is, women who attained childbearing ages during the Depressionaveraged about two and one-half children.2 This downward trend was reversed and the black women born during the 1930's will average about four children.3 For a decade now fertility rates among blacks have fallen and women born during the 1940's have gotten off to a slower start in forming their families than women born during the previous decade, suggesting a downward trend in family size.4 It is not possible, in one paper, to completely specify the consequences of urbanization upon fertility. This paper has two aims. First, trends in the fertility rates of blacks in urban and rural areas are described and, second, factors influencing fertility are examined to account for the observed changes.

IN THE preceding paper of this series2 we examined data on a sample of families in the Arsenal Health District of Pittsburgh to determine the extent to which families with health problems, as defined, have social-welfare problems, i.e., are known to the social agencies of the community. These families had been canvassed in July, 1951, and again in June, 1952. In the total sample of 2,370 families, 231, or nearly 10 per cent, were currently in contact with agencies, i.e., were "active cases" between June, 1950, and December, 1951; 504, or approximately 21 per cent, had had contact with social agencies prior to June, 1950. Among families with reported illnesses, accidental injuries and hospitalizations in both surveys, 12 per cent were currently in contact with social agencies in contrast to only 5 per cent among families with no reported illness, accident, or hospitalization in either survey. When consideration of contact is not limited to active cases, it was found that 43 per cent of the families in the first group were known to the agencies, while in the second group this figure is only 28 per cent. Following our expressed intention to report systematically the steps taken in the study of the problem of association between the health status of the families of a community and the number and kinds of their problems that have required attention by community agencies we shall discuss in this paper data bearing on the nature of these problems. In pursuing further the central question as to whether or not families with health

An examination is made of the relationship between ideology and medi cal care systems. Professionalism not ideology controls the American health care system. The relationship of ideology to health care in this country is weak because: 1) no consensus exists as to the social values to be imposed on health care systems; 2) medical professionalism has excluded the public from various areas of the medical system; and 3) much of the health care system is private and not subject to government control. In China Maoist ideology controls the health care system. Ideology functions in many ways to maintain control over a potentially dissident area of the society the health care system. By "deprofessionalizing" health care the Chinese system makes it possible to impose lay control over the medical workers. All medical failures can be attributed to wrong political thinking. The public can accept in ferior health care without losing faith in Chairman Mao. The Chinese feel personal gratitude toward Mao for their health care. Ill health is felt to be socially undesirable. The system fosters health ethnocentrism and favors comparisons between modern and past China. Health workers and patients are helped in dealing with feelings of inadequacy and/or fear by the psychological behavioral guidelines of Mao. Certain criticisms of the paper were made by Susan Rifkin. These include statements that: 1) the author chose an unrepresentative period in modern Chinese history the Cultural Revolution; 2) those aspects of health care which support the prevailing ideology are being publicized to the exclusion of all others; and 3) the present government has succeeded in delivering good health care services to the people.

Survey methods offer the possibility of obtaining extensive health information on populations, including the identification of people's health status and the nature of their illnesses. The inadequacy of respondent reports concerning ill health conditions, as a substi- tute for medical diagnoses, has been amply demonstrated. Research has identified many factors that contribute to biased or inadequate reporting. The central problem, however, is a con- ceptual one. Data collection techniques must fit the nature of the problem. Many health relevant questions pertain to the psychosocial experience of health and illness; survey methods are often appropriate for such questions. WITH the popularity of health surveys, and their promise to provide health professionals with information on the health status of populations, a series of questions have been raised concerning the usefulness of such data (l-4). This paper will examine the objectives of sample surveys related to health, the difficulties encountered, remedies proposed to deal with shortcomings, and the central conceptual problem of our approach to health and illness. Survey methods appear to offer a relatively cheap, quick way to obtain large amounts of health-relevant information from any specifiable population. Historically, there appear to be several types of objectives that form the basis for a health survey: 1. Foremost perhaps is the need for basic information on the extent and nature of health problems in a population-we know that many problems are never treated by a physician, that much treatment initiated in response to symptoms is not followed through, and that most medical records are of little value in estimating illness in a group. The rationale behind the National Health Survey referred to the "need for general purpose health information for assessment of national health problems" (5). 2. The administration of health services seems to require knowledge of the people for whom services are to be provided-where are they, what are they like, what they need (6). With the recent emphasis on planning services and on rational decision making in allocating resources, information concerning health needs is in great demand. While health workers may think they know their communities, the fact is they don't. 3. Better understanding of factors related to health problems requires systematic collec- tion of information. There is no question that social and psychological factors are related to the occurrence and progress of diseases, for example, VD or coronary heart disease. Social research in general and survey research in particular seems necessary to identify conditions that contribute to illness and accidents (7). 4. Finally, we want to know what actions people take in response to health problems. Most behavior relative to illness is voluntary or, at least, socially determined. There are both very imperfect records of recommended health behaviors and astonishingly little information on the popular health culture that determines self-medication and lay referral (8). Survey research then has been regarded as an appropriate tool to deal with these kinds

U NTIL recently the studies in differential fertility have been largely descriptions of variations in fertility among significant groups in the population. More recently the emphasis has been upon the quest for predictively useful social and psychological factors affecting family size. To date only socio-economic factors such as education, occupation, income and religion have proved useful predictors.3 At present however, it is being noted that changes are taking place in the traditionally observed inverse relationship of these socio-economic variables and fertility. These recent findings emphasize the importance of understanding not only the dynamics of this relationship but of discovering other variables that in the future may be more crucial in the prediction of fertility behavior. Thus emphasis has shifted toward the development of more inclusive hypotheses that may lead to a better understanding of fertility differentials. This paper reports on an attempt to test one of these more inclusive hypotheses as suggested by Ronald Freedman. The general hypothesis is that "fertility differences are related to differences in the division of labor between the family and other social institutions."4 This hypothesis is based upon

During recent years the high mortality rates once existing in many Latin American countries have undergone extremely rapid declines. At the same time, moderate increases in fertility have occurred in most of these countries.l The question therefore arises as to whether the drastic fall in mortality, quite apart from the associated improvement in health, is tending to increase the fertility of Latin American populations.2 This paper will attempt to answer the question affirmatively by demonstrating that a drop in mortality automatically causes the gross reproduction rate3 to rise. By definition, however, changes in mortality cannot directly affect the gross reproduction rate. The latter is based on the total female population in the reproductive ages and on the number of births within this population. It assumes that a woman lives through the reproductive period. Therefore, when mortality changes, but the age-specific fertility rates remain constant, the gross reproduction rate cannot vary. Yet this theory does not consider the indirect effect of mortality decline on the mating system. If only those women living in unions4 are having children,5 the gross reproduction rate will vary with mortality even though the age-specific fertility within unions remains the same. A decline in mortality has the effect of expanding the lifespan of unions and thus of increasing the proportion of women living in unions. The longevity of the union itself increases and

One of the most visible concomitants of economic development is a fall in mortality rates and a rise in the general level of health. Good health and longevity are not only highly desired in themselves but are also important because of their potential contribution to economic welfare. Although some health improvements can exacerbate population problems, better health can also raise the rate of growth of income per capita by reducing population expansion and increasing the stock of human and physical capital per worker.' Despite the potential contribution of health improvements to the over-all process of economic development, economists have generally remained silent on the subject of programmes of health care and disease control in less developed countries.2 In particular, no attempt has been made to extend the methods of economic optimization to the health care sector. Unfortunately, public health administrators also have neither developed any systematic methods of planning nor sought to integrate health care into the broader context of development planning. The choice of health care activities has not reflected a conscious comparison of their multi-faceted benefits with their use of scarce inputs. Instead, public health administrators have often attempted to treat programme choice as a "technical" question, free of value judgments about the relative desirability of different health improvements. One result of this has been a concentration on diseases such as malaria in which complete eradication is technically feasible. A second result has been the use of the infant mortality rate as an "indicator" of the community's general health level. This has led health administrators into the fallacy of assuming that programmes which reduce infant mortality actually raise the entire level of health. Substantial resources have therefore been devoted to decreasing infant mortality, thus increasing population size but not improving health in other age groups. The current paper reports the first step towards the development of a systematic approach to health sector planning capable of integration into a more general programme of economic development. The aim of the present research has been to devise a potentially operational method for allocating the scarce health sector funds, manpower and facilities among different disease control programmes and individual activities in the way which yields the optimum feasible reduction of mortality

The effects of changes in mortality rates on a population's growth and age composition depend on a number of factors: the initial level of mortality, the magnitude and age pattern of the mortality changes and the levels of fertility prior to and subsequent to the changes. The variety of effects associated with variations in these factors has been studied analytically as well as empirically.l5 In this paper the empirical approach will be stressed, the focus being on the role of mortality in the development of the United States population in the twentieth century.6 Three key generalizations have emerged from viewing the problem analytically. These will prove useful in studying the United States data and the data in turn will serve to illustrate and amplify these points.

A few of the streetcorner men expect to get married sooner or later. A few are married. Most of the men have tried marriage and found it wanting. To be married is to be formally, legally married, to have a marriage certificate, to "have papers." The rights and duties conferred by marriage are clear-cut, unambiguous; they are those rights and duties set forth in the marriage vows and by the courts. Individuals may fail to exercise their rights or neglect their duties but they do not deny them. Men and women are careful to distinguish between marriage on the one hand and "common law," "shacking up," "living with" and other consensual unions on the other. There is, of course, a large overlap. The rights and duties which attach to consensual unions are patterned after those which attach to marriage and, in practice, some consensual unions are publicly indistinguishable from marriage. There are two principal differences. First, the rights and duties of consensual unions generally have less public force behind them. The result is that an act which violates both the marital and consensual union invokes a stronger sanction in the case of marriage. A second difference is that, in consensual unions, rights and duties are less clearly defined, especially at the edges. The result is that while everyone would agree that a given act stands in violation of the marital relationship, there could be-and frequently is-widespread disagreement as to whether the same act stands in violation of a consensual union.

IN THE United States, growing interest in disability and medical care insurance, as well as group plans for provision of medical service presents an increasing need for statistics on the incidence of illness among persons of opposite sex and of different ages. Since 1920 data of this type have been made available for certain population groups by special morbidity studies of families. One of the studies gives illness rates by sex and age for the population of sample areas in the United States: the Committee on the Costs of Medical Care study of 19281931 (1). Two other studies provide data for local areas in Maryland: one made in Hagerstown from 1921-1924 (2) and the other conducted in the Eastern Health District of Baltimore from 1938-1943. A number of preliminary reports of the study in the Eastern Health District of Baltimore have been published (3, 4). The purpose of the present paper is to make available data from this study on illness by age and sex in more detail than has been given in the past.

NUMBER of longitudinal studies of families have been made in order to observe the incidence of illness among their numbers. It is recognized by those who have conducted such studies that the interval between visits to the family has a marked effect upon the accuracy of reporting past illnesses, especially those of a minor nature. Thus, the memory of the informant constitutes an important factor which may influence the level of illness obtained in any morbidity study. The purpose of this paper is to consider some of the effects of the frequency of family visiting upon the accuracy of reporting minor illnesses. The data are limited to acute respiratory diseases because most illnesses in this class are of a minor

Migration is patently more complex than that merely mechanical reshuffling of heads which is assumed by crude economic "push-pull" models. Numerous contemporary studies in Africa, Asia and Latin America pay attention to the sociological factors involved in induction of manpower into growing economies. This paper draws attention to the possibilities of illuminating current problems by historical studies. The vast documentary material on the sociology of migration and labor force reorganization in the past in Europe and North America is largely neglected by current studies. From the standpoint of organization, migration may occur in several ways. Among these are two contrasting extremes: "chain migration" and "impersonally organized migration."l Chain migration can be defined as that movement in which prospective migrants learn of opportunities, are provided with transportation, and have initial accommodation and employment arranged by means of primary social relationships with previous migrants. Chain migration is thus distinct from impersonally organized