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Volume
2:
Special Issue, November 2005
FROM THE EDITOR IN CHIEF
Health Education From 1775 to 2005
Lynne S. Wilcox, MD, MPH
Suggested citation for this article: Wilcox LS. Health education
from 1775 to 2005. Prev Chronic Dis [serial online] 2005 Nov [date cited].
Available from: URL: http://www.cdc.gov/pcd/issues/2005/
nov/05_0134.htm.
Health education is an innate aspect of public health practice and
difficult to discuss as a separate entity. Nevertheless, this special issue of
Preventing Chronic Disease provides in-depth examinations of the
purposes and uses of health education programs. We thank Neil Hann of the
Oklahoma State Department of Health and Carol Russell of the Directors of
Health Promotion and Education for serving as guest editors for this issue.
Among the earliest recorded health education programs in the United States
were those related to military troops of the 18th century during
the Revolutionary War. These programs are distinguished by their recognition
of a “community,” determined as much by membership in a common group as by
geopolitical boundaries. Soldiers were more likely to die of infectious
diseases than of battle wounds; camp hygiene was thus a critical aspect of an
officer’s duties. One of George Washington’s first general orders, dated
July 4, 1775, states, “All officers are required and expected to pay
diligent Attention to keep their Men neat and clean . . . and inculcate upon
them the necessity of cleanliness. . . . They are also to take care that Necessarys [latrines] be provided in the camps” (1).
Several programs discussed in this issue highlight health education in communities. A
report from Texas describes the certification of promotores to serve as
community health educators in neighborhoods (2). Oregon has developed
a partnership between state public health and Medicaid agencies to encourage
its community of health care providers to address the impact of tobacco on
asthma morbidity (3). Colorado conducted an assessment of the costs and
savings of community fluoridation programs within the state, providing useful
information to policymakers on the importance of water fluoridation
(4). North Carolina provided microgrants to empower local communities to
select and implement their own health promotion projects (5), and in another
program, encouraged local health departments to use policy-change and
environmental-change strategies to address community risk factors (6).
One of the most remarkable reports on public health in the 19th
century was the Report of the Sanitary Commission of Massachusetts 1850,
also called the Shattuck Report after the chairman of the commission, Lemuel
Shattuck (7). This document is considered the first scientific report in the
United States describing the health of a population using birth and death
rates, comparisons with the rates of other communities, and additional data to
support its comprehensive recommendations on protecting the health of
Massachusetts citizens.
One of the recommendations of the Shattuck Report addressed school health
education: “Every thing connected with wealth, happiness and long life
depends upon health. . . . This matter has been too little regarded in
the education of the young. Intellectual culture has received too much and
physical training too little attention. . . . By adopting [the
recommendation], many and many a life would annually be saved in this
Commonwealth, and the general health of the rising generation would be greatly
improved” (7).
The health of school-aged and preschool-aged children receives noteworthy attention
in this issue. Rhode Island surveyed school principals to assess current
health promotion programs and then investigated the use of the School
Health Index to improve school programs (8). Wisconsin established a
resource guide for schools and families who care for children with diabetes
(9). And Maine assessed the challenges of changing food options in school
vending machines and cafeterias to improve student nutrition habits (10).
The Shattuck Report also recommended that “open spaces be reserved, in
cities and villages, for public walks; that wide streets be laid out; and that
both be ornamented with trees.” The primary reason for this
recommendation was to purify the air, but the report stated, “Open spaces
also would afford to the artizan and the poorer classes the advantages of
fresh air and exercise, in their occasional hours of leisure” (7).
In this issue, West Virginia describes a physical activity promotion
project that encouraged schools, students, and communities to conduct small
research programs in physical activity (11). Many of these emphasized walking
routes and trails, providing the “fresh air and exercise” mentioned in the
Shattuck Report.
Early in the 20th century, the Children’s Bureau, a unit within the federal
Labor Department, embarked on a massive media campaign, distributing 3 million
pamphlets on infant care between 1914 and 1925 and responding to up to 125,000
letters each year from mothers (12). These communications extended to women of
all races, classes, and regions, particularly poor rural women. One mother’s
letter noted, “Naturally I am much interested in the things being done for
children. . . . In the course of a few years the Babies of today will be
directing affairs.”
Media campaigns continue to be an important aspect of health education.
Oregon analyzed data from the Behavioral Risk Factor Surveillance System to identify whether at-risk
Oregonians
knew they were at high risk for developing diabetes (13). Knowledge gained from this
survey will pave the way toward designing effective public health messages.
Arkansas examined the effects of a radio campaign designed to increase
physical activity among children aged 9 to 13 years (14).
In the 21st century, we continue to face similar challenges on
health education, but we have new tools. Alabama describes an innovative
approach to analyzing cancer data, which uses geocoding, a recently developed information
tool, to identify unique population segments (15). In a collaborative
partnership with state, federal, and private-sector members, the state linked information from the Behavioral Risk Factor
Surveillance System, the U.S. census, health care use data, and marketing
analyses of U.S. lifestyle segmentation clusters. The state
cancer division added geocoding to 7 years of information from its cancer
registry and used techniques developed by the National Cancer Institute’s
cluster-based Consumer Health Profiles. All these data will be used to
identify Alabama's high-risk, underserved communities, develop and implement
cancer programs designed for those communities, and assess the usefulness of
such clustering approaches in cancer prevention and control among Alabama
citizens.
Such a plethora of technical opportunities to collect and combine data was
not available a decade ago. The multiple, unique programs presented in this
issue illustrate the progress of U.S. health education over the past 230
years. While we have not yet achieved the goal of healthy lives for all, we
have good reason to expect additional success in the future.
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References
- Bayne-Jones S. The evolution of preventive medicine in the United States
army, 1607-1939 [Internet]. Washington (DC): Office of the Surgeon General, Office
of Medical History; 1968 [cited 2005 May 13]. Available from: URL: http://history.amedd.army.mil/booksdocs/misc/ evprev/frameindex.html*.
- Nichols DC, Berrios C, Samar H.
Texas’ community health workforce: from state health promotion policy to
community-level practice. Prev Chronic Dis [serial online] 2005 Nov.
- Rebanal RD, Leman R. Collaboration
between Oregon’s chronic disease programs and Medicaid to decrease smoking
among Medicaid-insured Oregonians with asthma. Prev Chronic Dis [serial
online] 2005 Nov.
- O’Connell JM, Brunson D, Anselmo T, Sullivan PW.
Costs and savings associated with
community water fluoridation programs in Colorado. Prev Chronic Dis
[serial online] 2005 Nov.
- Bobbitt-Cooke M. Energizing
community health improvement: the promise of microgrants. Prev Chronic
Dis [serial online] 2005 Nov.
- Plescia M, Young S, Ritzman RL.
Statewide community-based health promotion: a North Carolina model to build
local capacity for chronic disease prevention. Prev Chronic Dis [serial
online] 2005 Nov.
- Shattuck L. Report of a general plan for the promotion of general and
public health devised, prepared and recommended by the commissioners appointed
under a resolve of the legislature of Massachusetts, relating to a sanitary
survey of the state, 1850. Baton Rouge (LA): Louisiana State University, The
Medical and Public Health Law Site [cited 2005 May 9]. Available from: URL:
http://biotech.law.lsu.edu/cphl/history/books/sr/*.
- Pearlman DN, Dowling E, Bayuk C, Cullinen K, Thacher AK.
From concept to practice: using the
School Health Index to create healthy school environments in Rhode Island
elementary schools. Prev Chronic Dis [serial online] 2005 Nov.
- Nimsgern A, Camponeschi J.
Implementing a new diabetes resource for Wisconsin schools and families.
Prev Chronic Dis [serial online] 2005 Nov.
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et al. The Vending and
à la Carte
Policy Intervention in Maine public high schools. Prev Chronic Dis
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- Tompkins NO, Rye JA, Zizzi S, Vitullo E.
Engaging rural youth in physical
activity promotion research in an after-school setting. Prev Chronic Dis
[serial online] 2005 Nov.
- Ladd-Taylor M. Raising a baby the government way: mothers’ letters to
the Children’s Bureau, 1915-1932. New Bruswick (NJ): Rutgers University
Press;1986.
- Kemple AM, Zlot AI, Leman RF.
Perceived likelihood of developing diabetes among high-risk Oregonians.
Prev Chronic Dis [serial online] 2005 Nov.
- Balamurugan A, Oakleaf EJ, Rath D.
Using paid radio advertisements to promote physical activity among Arkansas
tweens. Prev Chronic Dis [serial online] 2005 Nov.
- Miner JW, White A, Lubenow AE, Palmer S.
Geocoding and social marketing in
Alabama’s cancer prevention programs. Prev Chronic Dis [serial online]
2005 Nov.
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*URLs for nonfederal organizations are provided solely as a
service to our users. URLs do not constitute an endorsement of any organization
by CDC or the federal government, and none should be inferred. CDC is
not responsible for the content of Web pages found at these URLs.
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