Public health

The field of public health encompasses efforts by governmental agencies to ensure conditions in which individuals can be healthy for the benefit of the wider society. Between 1948 and 1968, the United States made unprecedented gains in public health due to the efforts of public health practitioners and policies and revolutionary advances in technology such as the development of penicillin in 1941; the virtual eradication of infectious diseases; a decrease in the rates of fatal heart disease and other once-common killers; higher life expectancy; lower infant and maternal mortality; and an increased public awareness of the role of nutrition, exercise, and healthy life choices.

After 1935, the federal government vastly expanded its involvement in public health. The Great Depression marked a pivotal change in societal attitudes about the role of federal government in maintaining the general welfare—economic and social—of its citizens. In the wake of the depression, the Franklin Delano Roosevelt administration’s New Deal sought to create both jobs and a social safety net, which included public health measures and aid. The 1944 Public Health Services Act distributed federal grants to private biomedical research facilities, including universities. In 1946, Congress passed the Hill-Burton Act, which funded hospital construction across the nation. The National Institutes of Health (NIH) became the primary arm of the federal government’s public health apparatus.

By World War II, concern for epidemic outbreaks among soldiers fighting and training on the European front and domestic military bases further spurred the number of new or newly federalized public health agencies. The Centers for Disease Control (CDC) were established in 1946 in response to a malaria outbreak at a basic training facility outside of Atlanta. By 1949, the CDC established its Epidemiologic Intelligence Service. The CDC’s many groundbreaking achievements include the 1957 development of the flu vaccine and smallpox vaccination methods that helped to eradicate that disease globally by 1977.

In addition to the war and the depression, Franklin Roosevelt himself was highly influential in raising awareness of public health and pouring federal resources into it. Until the late 1940s and early 1950s, infantile paralysis, or poliomyelitis, had been regarded as a disease that thrived in crowded, unhygienic, impoverished areas. FDR’s affliction and later repeated outbreaks of polio in the early 1950s among middle-class suburban and rural children and adolescents changed perceptions and helped spark a race for a vaccine. The private National Foundation for Infantile Paralysis (also known as the March of Dimes) awarded grants to several university research centers. The vaccine race was won by Jonas Salk of the University of Pittsburgh. Although not the only polio vaccine under development, Salk’s vaccine was the first to be successfully tested on a massive scale. The Salk polio vaccine trials of 1954 were the largest medical experiment in U. S. history; the National Foundation inoculated more than 1 million elementary school children across the United States. In the decades since, polio has been eradicated in the United States and virtually everywhere else across the globe.

The United States experienced many significant, if less sensational, advances in public health in the two decades following World War II. The NIH and the CDC eradicated malaria, smallpox, and most types of tuberculosis, and developed vaccines for most other once-common childhood diseases. Other initiatives proved more controversial. The cavity-preventing benefits of fluoride had been discovered in 1930, and in 1948 Surgeon General Leonard Scheele advocated the fluoridation of the nation’s water supply to prevent dental cavities. Although fluoridation

Magazine advertisement for Lucky Strike cigarettes, 1964

(Getty Images) was endorsed by the American Dental Association and the American Medical Association, and widely adopted in the second half of the 20th century, it remained controversial. Critics claimed that fluoridation caused more harm than good, contributing to a variety of ailments. Scientific evidence of such harmful effects remained inconclusive, but some communities continued to fight fluoridation.

Attempts to further expand the federal government’s role in public health by providing universal health insurance were also defeated. In the early 1950s, President Harry S. Truman’s proposal for a National Health Insurance Act was quashed by the powerful American Medical Association lobby, which labeled the plan “socialized medicine.” National health insurance was abandoned as politically unfeasible until almost a decade later when President Lyndon B. Johnson succeeded in enacting the Medicaid and Medicare programs, which provided government health insurance only to the most vulnerable—the elderly and the poor. Though limited, these programs improved the health of hundreds of thousands of

Americans who otherwise would have suffered and even died of easily preventable diseases by providing them access to basic care.

President DwiGHT D. Eisenhower’s 1956 executive order creating the President’s Council on Physical Fitness proved far less controversial. Prompted by a disturbing 1953 report published in the Journal of the American Association for Health revealing that American children lagged far behind their European peers in physical fitness and muscular development, Eisenhower charged the council with promoting and helping to fund physical fitness initiatives in communities and schools. The President’s Council especially focused on better physical education programs in public schools and developed standardized fitness guidelines and curricula.

One of the most remarkable public health achievements of the late 20th century was the antismoking movement. In 1964, Surgeon General Luther Terry issued a report on cigarette smoking that definitively linked smoking to lung cancer, concluding, “cigarette smoking is a health hazard of sufficient importance in the United States to warrant remedial action.” Terry’s report was also the first public health action to chip away at smoking’s glamorous image. In 1960s America, smoking was simultaneously perceived as a harmless and mundane habit and the mark of the sophisticated and cultured. Movies, television, and extensive marketing by tobacco companies inspired and reinforced these attitudes. Subsequent surgeons general’s reports raised the awareness of addictive properties of nicotine, further cancer-causing effects of smoking, and the related hazards of secondhand smoke. These findings led to warning labels on cigarettes, class-action suits against cigarette companies for knowingly marketing a carcinogenic product, smoking bans in public places, decreased rates of new smokers, and increased numbers of people quitting smoking.

Between 1948 and 1968, the federal government became increasingly involved in developing and administering public health policies and programs. Some of the most notable achievements were increased life expectancy, decreased infant and maternal mortality, and the virtual eradication of most deadly infectious diseases. By putting the resources of the federal government behind emerging technologies and research, the United States dramatically improved the public health of the nation.

Further reading: John Duffy, The Sanitarians: A History of American Public Health (Urbana and Chicago: University of Illinois Press, 1990); David Oshinsky, Polio: An American Story (New York: Oxford University Press, 2005); Bernard J. Turnock, Public Health: What It Is and How It Works (Gaithersburg, Md.: Aspen Publishers, 2001).

—Melissa M. Mandell