Welfare and Health

The public welfare program in Los Angeles County involves an annual expenditure of over $400 million. Administered by the County Bureau of Public Assistance, the program is funded by contributions from the federal government (42%), the state government (39%), and the county (19%). The magnitude of this program can be somewhat better grasped by comparing it with the expenditures under the federal War on Poverty which will amount to roughly $30 million in the Los Angeles area in 1965. In August 1965, approximately 344,000 persons or 5% of the county's population received some form of welfare aid. In the same month 94,000 persons or 14% of the total population of the curfew area as a whole received public assistance. In the Watts area, approximately 24% of the population received such assistance. Six major welfare programs exist in Los Angeles, five financed by the federal, state and county governments (Old Age Security, Aid to the Disabled, Aid to the Blind, Medical Assistance to the Aged, and Aid to Families with Dependent Children), and one financed by the county alone - General Relief. The costliest of these programs are Old Age Security ($125 million per year in 1965) and Aid to Families with Dependent Children (about $95 million per year in 1965). The predominant welfare program in the curfew area is the Aid to Families with Dependent Children program (AFDC). Slightly more than two-thirds of all welfare recipients in the curfew area as a whole, and over 83% of all welfare recipients in the Watts area, received assistance under the AFDC program. Broadly speaking, this program provides for payments to a family with a related child under 18 who has been deprived of support by reason of the absence, incapacity, or unemployment of a father. There are two aspects of the AFDC program - (1) the AFDC-FG (Family Group) program where the family unit is generally headed by a woman and (2) the AFDC-U (Unemployed head) program, authorized by the 1963 legislature to provide for families where there is an unemployed man at the head of the household. Average monthly payments on the AFDC-FG program are $177 per family; on the AFDC-U program, $238 per family. A recent survey indicates that 90% of the AFDC families in the curfew area are Negro. In nine out of 1 0 of these homes, the father is absent. Over 70% of the parents involved were born in the South or Southwest. Seven out of 10 families on AFDC receive aid for one or more illegitimate children. In Los Angeles County as a whole, expenditures for the AFDC program have been increasing dramatically, far outrunning the population trends. Between 1960 and 1964, when county population increased 13%, expenditures for the AFDC program rose by 73%. Between 1963 and 1964, when county population increased 2.5%, AFDC expenditures increased over 14% from $69.4 million to $79.5 million annually. Expenditures for the new AFDC-U program, which amounted to $10.2 million in 1964, are not included in the foregoing computation and, therefore, do not explain the rapid increases. We have no intention of opposing the humanitarian purposes of the welfare program. Nevertheless, we are profoundly disturbed by the accelerating trend of expenditure. Our concern is heightened by the fact that this is occurring, not at a time of economic downturn or depression, but during the present period of unparalleled prosperity for our nation and state. A portion of the rapid increase may be explained by the fact that the Negro and Mexican-American population in Los Angeles is estimated to have increased approximately 40% in the last five years, compared with the general population increase of 13 percent in the same period. Moreover, the high unemployment in this area, referred to early in this report, no doubt has contributed to the increase. However, the increase in AFDC expenditures, coupled with the increase in population, raises a question in the minds of some whether the generosity of the California welfare program compared with those in the southern and southwestern states is not one of the factors causing the heavy immigration of disadvantaged people to Los Angeles.* * A comment regarding this sentence by the Rev. James Edward Jones is set forth at page 87 infra. We are making recommendations in other fields which can assist in lightening the welfare load. The program we are recommending in the field of education will, we believe, have a major impact on unemployment over the long term. We hope our recommendations in the field of employment will have a similar effect in the shorter run. In an important sense, the cost of these programs is justified by their potential for reducing welfare expenses. However, to be successful in doing so, these programs must be accompanied with a recognition that a truly successful welfare program must, wherever feasible, create an initiative and an incentive on the part of the recipients to become independent of state assistance. Otherwise, the welfare program promotes an attitude of hopelessness and permanent dependence. After hearing extensive testimony and studying the reports of our consultants, we are convinced that welfare administrators must make a new and vigorous effort to Create an initiative and an incentive for independence among welfare recipients. There are some encouraging signs that the philosophy of rehabilitation is being accepted. ("We have about 6,000 people, including the general relief program and the AFDC-U, in some kind of training program," said one administrator.) But we are satisfied that the effort must be doubled and redoubled if any real impact is to be made on the rapidly rising rolls. We are assured that many of the present recipients would rather have work than welfare, but the simple arithmetic of the matter makes us uncertain. A job at the minimum wage pays about $220 per month, against which there would be transportation, clothes and other expenses. When the average AFDC family receives from $177 to $238 per month (depending on the program), the financial incentive to find work may be either negative or non-existent. (Indeed, we were told that the 18 year old girl who is no longer eligible for assistance when living with her mother may have considerable incentive to become a mother herself so as to be eligible again as the head of a new family group.) The evidence before us makes it plain that welfare administrators are frequently at odds with other governmental officials and one another. Serious conflicts and paradoxes in statutes, regulations, and interpretations were called to our attention. We have not been able, in the time available, to formulate recommendations regarding these disputes or to attempt to clarify the rules, but we are concerned that energy is being diverted to those non-productive areas. We were also told much about the inaccessibility of welfare offices and the poor physical facilities of some. We have been told by some witnesses and by our consultants that these conditions have produced severe irritations and frustrations among many individuals in south central Los Angeles. Studies on these complicated matters have been made in the past and others are being initiated presently by the state government, which perhaps may help resolve these problems. For the improvement of the welfare picture, to us the most promising prospect is a closer coordination between welfare and related agencies which may provide avenues to independence. We believe that there has not been adequate liaison between welfare workers and government officials involved in employment. (Most welfare recipients are employable, we are told by a welfare administrator, but from an employment official we hear the exact opposite.) Similarly, welfare agencies should be cognizant of the many available training programs. From our study of the matter ' we believe that there is much room for improvement here. We also believe that the use of child care centers to free heads of families for employment or training should be emphasized. ("Down in that area we have about 2,000 mothers who would like to go into our Community Work and Training Programs, but they can't because there is no place to keep their kids," an administrator told us.) In sum, we implore welfare administrators to devote the most serious and pragmatic efforts to create, wherever feasible, additional incentives for welfare recipients to become independent of public aid. Health Problems Statistics indicate that health conditions of the residents of south central Los Angeles are relatively poor and facilities to provide medical care are insufficient. Infant mortality, for example, is about one and one-half times greater than the city-wide average. Life expectancies are considerably shorter. A far lower percentage of the children are immunized against diphtheria, whooping cough, tetanus, smallpox, and poliomyelitis than in the rest of the county. As established by the comprehensive reports of consultants to the Commission, the number of doctors in the southeastern part of Los Angeles is grossly inadequate as compared with other parts of the city. It is reported that there are 106 physicians for some 252,000 people, whereas the county ratio is three times higher. The hospitals readily accessible to the citizens in southeastern Los Angeles are also grossly inadequate in quality and in numbers of beds. Of the eight proprietary hospitals, which have a total capacity of 454 beds, only two meet minimum standards of professional quality. The two large public hospitals, County General and Harbor General, are both distant and difficult to reach. The Commission recognizes that the motivation of patients to take advantage of the available medical facilities is an important factor in health conditions but it appears that the facilities in the area are not even sufficient to care for those who now seek medical attention. In light of the information presented to it, the Commission believes that immediate and favorable consideration should be given to a new, comprehensively-equipped hospital in this area, which is now under study by various public agencies. To that end we strongly urge that a broadly based committee (including citizens of the area and representatives of the Los Angeles County Department of Charities, Los Angeles County Medical Association, the California Medical Association, the State Department of Health, and medical and public health schools) be appointed to study where such a hospital should be located and to make recommendations upon various technical and administrative matters in connection with the hospital. We also believe that the Los Angeles County Health Department should increase the number and services of public health and preventive medical facilities in the area and that similar program improvement should be undertaken by the Los Angeles County Department of Mental Health, the Visiting Nurse Association of Los Angeles, and other voluntary health agencies.

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