continued from History of Public Health(part 6)
THE EARLY TWENTIETH CENTURY
Although the Sanitary movement of the nineteenth century and the development of bacteriology substantially lowered death rates from enteric diseases, other serious health problems still existed. One was the appalling and ubiquitous rate of infant mortality. First in Europe, then in Britain and in the United States, maternal and child health programs were initiated with an emphasis on nutrition, medical care, and, eventually, health inspection in schools. Muckraking journalists exposed disgraceful conditions in the food processing industry, leading to the imposition of widespread governmental regulation. High rates of occupational diseases and industrial injuries led to programs for industrial hygiene and occupational health. Mental health was identified as a public health issue, and specific nutritional deficiencies were recognized as risk factors for a spectrum of diseases. Furthermore, pioneering studies of pellagra, a vitamin-deficiency disease, by Joseph Goldberger and Edgar Sydenstricker, revealed the complex environmental, social, and biological interactions responsible for the occurrence and distribution of such diseases.
The growing scope and complexity of public health concerns led to the establishment of academic programs to expand research and train relevant technical personnel. At the University of London, a school of Tropical Medicine was established in 1905 and, in the United States, a School for Health Officers was created jointly by Harvard University and the Massachusetts Institute of Technology in 1913. The first school of public health in the United States was established in 1916 at Johns Hopkins University with a grant of $267,000 from the Rockefeller Foundation. Subsequently, the Foundation supported the establishment of schools of public health at Harvard, the University of Michigan, the University of London, and in several other locations around the world.
By midcentury, the basic activities of public health had been widely recognized in the industrialized world. These components were: communicable diseases control, environmental sanitation, maternal and child health services, health education, occupational and industrial hygiene, nutrition, and, in most developed countries, the provision of medical care. In the United States, only medical care for the indigent, the aged, and for certain diseases (e.g., tuberculosis) were considered within the purview of public health.
An important role has also been played by the philanthropic foundations and voluntary health organizations. For example, the Rockefeller Foundation provided the impetus and financial resources to initiate public health professional education and the Milbank Fund pioneered the establishment of local health departments in New York State by carrying out demonstration projects around the state. Other important foundations include the Julius Rosenwald Fund, the Russell Sage Foundation, and the Twentieth Century Fund.
Voluntary health agencies evolved in the late nineteenth and early twentieth centuries in Europe and North America, growing out of the failure of public health organizations to fully apply knowledge created by the new biomedical sciences, and by the continuing deplorable condition of the urban poor. Organizations like the Pennsylvania Society for the Prevention of Tuberculosis (which evolved into the American Lung Association) took on the task of public education, case counseling, financial aid, and advocacy for relevant legislative action, while organizations like the Henry Street Settlement in New York City and Hull House in Chicago provided social and medical services in slum neighborhoods. By the mid–twentieth century there were more than 20,000 voluntary health agencies in the United States alone.
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