7 8 8 9 9 10

1 . PUBLIC ATTITUDE ON PERSONAL HEALTH SINCE THE WAR

An introductory question (Q.1) asked informants how their present health compared with their health in peace time. It is obvious that answers to such a question can have no absolute value, on the other hand, the result provides a case line on which to assess subsequent changes in attitude.

The replies to this question were grouped as follows:

There appears to be an emphatic weighting of opinion in the direction of worse or slightly worse.

A Regional analysis shows a statistically significant difference in the proportions saying that health was slightly worse between Southern England (31%) and the Northern and Midland Regions (22% and 20%). If the categories “worse” and “slightly worse” are combined, the regional difference is not appreciable.

Women too, seem somewhat less cheerful about their health than men

The upper social groups (A and b) seem somewhat more cheerful about their health than C and D groups.

Indoor workers have a larger proportion saying that their health is worse or slightly worse than outdoor workers.

There are no significant differences in the replies from urban and rural informants.

REASONS GIVEN FOR CHANGES

The main reasons given for feeling in better or worse health are given in total; then they are analysed by the various groups interviewed.

Reasons for saying health was better or slightly bette r. (10% per sample)

The only notable proportion is the 4% who said that they were more active and had less time to worry.

Reasons for saying health was worse or slightly worse. (37% of sample)

23% of the whole sample mentioned worry and nervous strain, whilst another 9% said that they were tired, overworked and felt the strain of increased responsibility.

12% spoke of undernourishment and worries about food and

11% mentioned a specific illness.

It is an interesting sidelight on those who said their health was worse that rather more members of this group than of those not complaining took special care over their diet, sleep, and clothing.

Men and Women

There were no marked differences between the reasons given by the men and. women who said that their health was better or slightly better.

The main reasons given by those who said that their health was worse than in peace time were:

It will be seen that more women than men complain of strain.

Social Classes

The main differences in reasons, given by those in the social groups, who said their health was better or slightly better, were:

The main reasons given by those who said that their health was worse or slightly worse were:-

Age Groups

There are no marked differences between the reasons given in the three age groups by those who said that their health was better or slightly better.

The main reasons given by those who said, that their health was worse or slightly worse were:

Indoor and Outdoor Workers

There are no marked differences in the reasons given by those who said that their health was better or slightly better.

The main reasons given by those who said their health, was worse or slightly worse were:

Further evidence on this matter was provided by replies to Question 2, which asked how present weight compared with weight a year ago.

As with Question 1, the replies here are subjective rather than an objective record, since few people weigh themselves regularly. The results are set alongside comparable analyses of replies to Question 1. In making such a comparison, it must be remembered that in one case the reply compares the present with pre-war and in the other the present with last year.

The total replies to both questions correspond fairly closely if the “Don’t know” results are combined with those who think their weight remained the same. That is to say, the proportions saying health is better or worse and the proportions saying they have gained or lost weight, are similar.

The same correspondence is seen for Men and Women, except for slightly increased proportion of women saying that they gained weight.

There is rough correspondence in the replies from the different Social Groups, but here the C and D’s have an increased proportion saying that they gained weight and the A and B’s an increased proportion saying that they lost weight. This divergence might be expected from the replies to Question 1, since it is shown in the detailed answers to Question 1 that the A and B groups tend to regard decreased weight as an indication of better health. And C and D groups have a significantly greater proportion not knowing their weight.

There is close correspondence between the replies to both questions by informants in urban and rural districts, but an increased proportion of outdoor workers saying that they had lost weight and an increased proportion of indoor workers saying either that their weight had remained the same or that they didn’t know it

In the table below, the detailed replies to Question 1a are analysed.

QUESTION 1 a: REASONS FOR SAYING HEALTH HAS IMPROVED OR WORSENED

Reasons for saying health better or slightly better (% ages)

These percentages total more than 100% because many informants gave more than one answer.

10 11 11 12 12 13

2. KEEPING FIT >

In Question 3 people were asked what they did to keep fit. To most people interviewed this was a difficult question to answer and the difficulty is reflected in the types of answer given. Thus a large proportion of the answers used such phrases as “work hard and keep myself busy” or “I keep active”. It was difficult to distinguish these replies from those who were referring more specifically to taking; exercise as a health measure. It is therefore not possible to give separately the proportion taking exercise, as is suggested by the questionnaire form. The largest proportion of replies (51%) is thus a wide group containing possibly divergent elements.

The next largest group did nothing special or held no views.

23% of the sample said that their main effort was getting fresh air, and 21% mentioned special attention to diet, rest and clothing.

10% of the sample said that they kept fit by taking health salts, patent medicines and vitamin preparations.

Men and Women

More men than women mention keeping active and getting fresh air as their method of keeping fit. More women than men say they do nothing special.

Social Groups

More upper social group informants than lower group give keeping active and getting fresh air as their method of keeping fit. More lower social group informants say that they do nothing special.

Outdoor and Indoor Workers

More outdoor than indoor workers say they keep fit by being active and getting fresh air.

More indoor than outdoor workers either do nothing special or pay special attention to diet, rest and clothing.

QUESTION 3: “WHAT DO YOU DO TO KEEP FIT?”

Replies to Question 3	Total	Men	Women	A and B classes	C and D classes	Outdoor workers	Indoor workers
		%
Get plenty of exercise: work and keep busy	51	57	47	58	49	59	49
Get fresh air	23	31	19	36	20	27	21
Don’t know: nothing special	33	28	36	25	35	27	34
Pay attention to food and diet; drink milk: Have adequate sleep: lead a regular life: dress appropriate to weather	21	22	21	25	20	23	32
Take health salts: tonics and patent medicines: cod liver oil, adexolin and other sources of vitamins	10	8	11	6	9	7	10
Drink beers or spirits	1	1	0.3	0.3	1	1	1
Avoid possible infection: See doctor or visit Clinic regularly: Other answers	2	5	3	3	5	3	5
Total number of interviews =100%	1793	629	1164	347	1426	267	1164

Age groups

More of the under 50’s than of the over 50’s say that they do nothing special.

Regional Groups

More people in the Southern than the other regions mention keeping active, but somewhat larger numbers in the Northern Region than in other regions mention getting fresh air and many more in the Northern Region pay special attention to diet, adequate sleep and clothing.

Replies to Question 3	Total	Up to 29 yrs.	30-49 yrs.	50 yrs. & over	Northern England	Midland and S. Wales	Southern England
		%
Get plenty of exercise: work and keep busy	51	49	52	50	48	46	56
Get fresh air	23	24	23	22	27	20	22
Don’t know: nothing special	33	40	35	28	33	33	33
Pay attention to food and diet; drink milk: have adequate sleep: lead a regular life: dress appropriate to weather	21	20	20	24	34	19	13
Take health salts: tonics and patent medicines: cod liver oil, adexolin and other sources of vitamins	10	7	9	12	11	11	6
Drink beers or spirits	10	7	9	12	11	11	6
Avoid possible infection: See doctor or visit Clinic regularly: Other answers	1	-	1	1	0.2	1	1
Total number of interviews =100%	1793	347	776	660	607	442	746

In both the above tables, informants often mentioned more than one method of keeping fit and percentages thus total more than 100%.

The replies to this question were analysed separately for those saying their present health was better, worse or the same when compared with pre-war health. More of those saying their health was better than of the other groups said that they got sufficient exercise or kept busy. More of those saying their health was the same as pre-war than other groups said that they did nothing special.

Replies to Question 3	Health better	Health same	Health worse	Total
	%
Get plenty of exercise: work and keep busy	62	52	43	49
Get fresh air	28	23	22	23
Don’t know: nothing special	27	36	29	32
Pay attention to food and diet; drink milk: Have adequate sleep: lead a regular life: dress appropriate to weather	17	15	21	17
Take health salts: tonics and patent medicines: cod liver oil, adexolin and other sources of vitamins	7	8	12	9
Other replies	3	3	6	4
Number of interviews =100%	176	950	666	1792

Further light is thrown on awareness of health as a specific subject by replies to Question 3a; this asked where people sought information on keeping fit.

Some 60% of the sample said simply “Nowhere”, another 11% relied on their “own common sense”.

Only 7% of the sample read literature on the subjects or went to lectures or discussions about it.

15% of the sample said that they went to a doctor or a clinic, but it is probable that a large number of these replies come from people who only go to doctors or clinics to get themselves cured and not to prevent illness.

Many investigators report that this question amazed large sections of the sample, who had simply not conceived of the possibility of preventing illness by taking active measures to keep well, and this is well reflected in the replies noted.

QUESTION 3a: “WHERE DO YOU GO OR LOOK FOR INFORMATION ON HOW TO KEEP FIT?”

Replies to Question 3a	A and B classes	C and D classes	Up to 30 yrs.	30 to 49 yrs.	50 yrs& over	Northern England	Midland & S. Wales	Southern England	Total
	%
Nowhere	58	61	64	59	60	40	62	69	60
Doctor or clinic	15	20	15	19	21	33	11	9	19
Own common sense	16	10	8	10	14	11	12	10	11
Books, Magazines and newspaper articles	8	4	6	6	2	4	5	5	4
Lecturers and discussions: Women’s Guild, Health and Efficiency League, etc.	3	2	3	3	1	3	3	1	3
Wireless	2	2	1	2	2	2	4	1	2
Family, friend and other sources of information	2	3	5	3	1	4	4	2	3
Total number of interviews	336	1353	336	742	621	607	442	746	1689

There are only small and barely significant differences between the replies from various groups on this section with the exception of the regional groups.

Many more in the Midland and Southern region than in the North, said they went “nowhere” for information. Many more in the North than in other regions said they went to a doctor or clinic.

It will be remembered from the analysis of Question 3 that more people in the North said that they kept fit by paying special attention to diet, getting adequate rest and clothing. On the analysis of Question 1 it was shown that rather fewer people in the North than in other areas thought their health was worse or slightly worse.

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3. COUGHS AND COLDS

Informants were next asked in Question if they took any special precautions against catching cold. Of the total sample of 1796, 43% said they did take special precautions, and 57% that they did not. In analyses by sex, social class, age groups, outdoor and indoor occupations and urban and rural districts those proportions remain approximately constant. There is, however, a statistically significant difference between the frequency with which those in Northern and Southern England said that they take precautions: Northern England 49%, Southern England 39%

People who had replied to Question 4 in the affirmative were subsequently asked (4a) what special precautions they took. 16% of the total sample said that they tried to avoid colds by avoiding chills and draughts and keeping themselves, especially their feet, warm and dry. Indoor workers gave this reply significantly more frequently than those working out-of-doors, and people in Southern England noticeably less than those in either of the other regions.

The next most widespread precautions said to be taken were wearing appropriate clothes and adjusting clothing to temperature (12%); avoiding infection from others and getting as much fresh air as possible (11%) and taking proprietary medicines (10%).

Over half (28%) of those taking precautions are thus concerned with keeping warm and dry and wearing garments appropriate to the weather.

Outdoor workers appeared markedly less careful than indoor workers about wearing appropriate clothes, and women less careful than men. Women compensated for this by taking proprietary medicines significantly more frequently than men (women 12%: men 7%). Analysis also shows that the A and B classes pay far more attention to avoiding infection from others and to getting fresh air than do then C and D classes (A and B classes 22%: C and D classes 9%). and the people in Northern England appear noticeably more particular in this respect than those in the other two regions (Northern 15% Southern and Midland regions 9%). People in the Northern region also take proprietary medicines much more frequently than those in the other two regions (Northern 13%, Southern and Midland regions 8%)

Gargling, syringing or spraying the throat; taking hot drinks at night; and drinking as much milk as possible were the precautions mentioned with the next highest frequency (7% for both groups of replies): It can be clearly seen here that A and b classes take the precaution of gargling, syringing or spraying the throat more frequently than the poorer people (A and B 13%: C and D 5%0; and that northerners again appear more fastidious about their health, as the frequency with which they said they took hot drinks at night and drank a lot of milk to forestall a cold amounts to 15%, where as the proportions for the regions covering South Wales and the Midlands and Southern England are only 1% and 3% respectively.

Of the total sample, 4% said they took cod liver oil and other sources of vitamins to safeguard themselves from colds. Here, as with gargling and spraying the throat, the A and B classes more often took this precaution than the poorer classes (A and B 9%: C and D 3%). An equal proportion of the total sample (4%) said they tried to ward off colds by being inoculated, resting in the afternoon and by taking various other minor precautions.

Percentages do not add up to 100% because informants gave an average of more than one reply each.

How people think colds are spread

Answers to Question 5 fall into four main categories. 16% of the people interviewed specifically said that colds are spread by germs, those in rural areas tending to be more emphatic about this than town-dwellers.

75% the total sample while not actually attributing colds to germs, gave answers which implied that colds are spread by infection, due to other people coughing, sneezing or spitting nearby, to using other people’s germ-laden belongings or to beings in a stuffy, crowded and over-heated atmosphere in which germs may flourish. Answers amounting to 49% in this total said “By other people coughing and sneezing near you”. Women gave the reply implying that colds are spread by infection more often than men; those under 40 years of age more often than older people; and town dwellers less often than those living in rural districts.

18% of the informants said that colds are spread by catching chills, getting wet feet, and by waiting and queueing outside in bad weather. Men made this suggestion markedly more often than women, and town-dwellers more often than country people. An average of 8% replied that colds are caused by being run-down. 16% said they did not know how colds are spread.

Percentages do not add up to 100% because more than one answer was given on an average.

When asked (Question 6) in what ways they could become more careful about spreading infection when they have colds, 26% of the total answering mentioned the precaution which has been most widely pressed in the Ministry of Health publicity campaign, namely by using a handkerchief when coughing and sneezing, and the added precaution of ceasing to spit. There are no marked differences in the frequency with which this answer was given by the various groups constituting the sample. More than half the informants (53%) said that the best way to stop spreading infection is to keep away from other people or stay in bed, women stressing this more than men, and the A and B classes more than the other two social groups.

A total of 18% said that the spread of infection could he minimised by using disinfectant and keeping things clean and germ-free. Smaller numbers said that they use tissues or burn the rags which they use when they have a cold, are careful to use only their own personal belongings, and do not kiss. 15% of the total sample said they did not know how they could become more careful about spreading infection.

An attempt was made to find to what extent the Coughs and Sneezes publicity had been put into practice by the public. The direct question “Have you become more careful about coughing and sneezing?” could not be asked. The results would be unreliable, as people would almost invariably answer in the affirmative, because of their reluctance to incur social disapproval by admitting carelessness in this respect.

Therefore an attempt was made to find out indirectly whether people actually are taking more care about spreading infection when they sneeze or cough, by asking whether they thought other people are becoming increasingly careful, thus shifting the responsibility to the public at large.

38% of people interviewed did think that others have become more careful about spreading infection, 27% did not think so, and 35% said that they had not noticed. No marked differences are shown in the breakdown by outdoor and indoor occupations, but the regional analysis showed a significantly higher figure for those in the North of England who said they thought greater care was being taken about spreading infection; here again, people in the northern region show signs of greater health consciousness.

In an analysis by sex, a higher proportion of men than women replied that they did not think people were becoming more careful.

17 18 18 19

4. HANDKERCHIEFS

As handkerchiefs play such an important part in fulfilling the advice of the health publicity slogans, people were asked if rationing had made them short of handkerchiefs when they have a cold. Of 1790 who answered this question, 57% said they were not short of handkerchiefs, while 43% said that they were. Analysis shows that more women than men, and more of the C and D than A and B classes find themselves short.

Those who had said they were short of handkerchiefs were subsequently asked what substitutes they used. 26% said they used pieces of rag, this habit being more prevalent with women than men, and in the lower than in the upper classes. A total of 8% said they used tissues - the A and B classes use them more than the other social groups. Investigators noted that many people used rags for hygienic reasons when they had a cold, even when they were not short of proper handkerchiefs.

In question 9, 11.37 women were asked if they use men’s handkerchiefs when they have a cold. 30% replied that they always do, 23% that they sometimes do, and the remaining 47% said that they never do. Analysis by social class shows a significant difference between those in the two groups who said that they never used men’s handkerchiefs (A and B classes 36%: C and D classes 49%). This fairly large difference may have been due in part to a misunderstanding as to the exact meaning of the question, as some investigators reported that informants in the C and D classes often thought that “using” a man’s handkerchief meant “borrowing” a handkerchief which he had already used; they had to be reassured that the question did not mean practising this unhygienic habit.

There are no significant differences between urban and rural areas.

Informants were next asked “Do you think it is really necessary to carry a handkerchief when you haven’t a cold?”. By phrasing the question this way, rather than asking people directly whether they carried a handkerchief, it was hoped to obtain answers as reliable and free from social conditioning as possible. The reliability of the “Yes” answers as an index of the percentage of people who actually do always carry a handkerchief is doubtful, however, owing to the pressure of social approval behind this habit. 93% of the 1760 people who answered this question replied in the affirmative, 2% were non-committal, and only 5 % admitted that they did not always carry a handkerchief.

Social convention may have a stronger influence in the upper classes, since, though both figures are doubtless inflated, the A and B group asserted with significantly greater frequency than the C and D classes that they always took a handkerchief with them (A and B 97%, C and D 92%).

No significant differences between urban and rural areas, or between age groups of men and women.

By qualifying this question with a “Why?”, an attempt was made to ascertain how many people carried a handkerchief for the conscious purpose of smothering their coughs and sneezes. Owing to the nature of the question, there may again be a certain amount of unreliability in the answers.

Of the 1593 people who answered this question, 32% said they carried a handkerchief even when they didn’t actually have a cold, because there was always the possibility of coughing and sneezing; almost an equal proportion (33%) carried one just for decency’s sake and because it’s the “done” thing; and 41% because a handkerchief is always handy to have. Greater social conditioning is again apparent in the answers of the A and B classes, 40% of whom replied that they carried a handkerchief for decency’s sake and because it is the thing to do, as against 31% of the C and D classes giving this reason. As in the first part of the question, there is no significant difference between the answers of men and women.

No significant differences appeared between age groups, outdoor and indoor workers or urban and rural areas.

The last question in this section was addressed to all parents of under 14, who were asked if each of their children carried a handkerchief. Parents were sometimes indignant at being asked this, and as with the previous question the strong conventional flavour of this subject may have precluded reliability in the answers. Investigators reported that often parents replied “Yes” to the question, but in subsequent conversation made such remarks as “I’m sick of giving Johnny handkerchiefs, he always loses them”, which betrayed the inaccuracy of their original answers. 85% of the 559 parents interrogated said that their children always did carry a handkerchief, the percentage of the A and B classes giving this reply again being significantly higher than that of the other two social groups (A and B 94% C and D 84%).

Answers to the second half of this question are probably even more unreliable; 92% of 472 interviewees said that they taught their children to cough and sneeze into their handkerchiefs, but many of them subsequently admitted that in fact they didn’t really know what use their children made of their handkerchiefs; they may well have been equally ignorant as to whether the children actually carried handkerchiefs or not.

The results of both Question 10 and Question 11 must therefore be treated with great reserve.