The Roots of Public Health

May 11, 2015

Where did Public Health start? Who were its early champions and practitioners? How did a field with roots in medicine, nursing, and the social sciences grow to become its own profession? These are the questions that intrigue me; I have always been fascinated in the Progressive Era, especially in the birth of professions. As a public health student, I am particularly interested in my own profession’s development and how it came to distinguish itself from medicine and nursing. As a woman, I am interested to learn about the foremothers of public health and how, in defining their own areas of the health field, they created a space for a new profession to be institutionalized.

We often think of public health as a new field, however, it actually began to professionalize during the early 1900s. The road was not easy, though. Public health had to define itself as a profession unique from nursing and medicine at a time when those fields were expanding and changing. In order to understand how challenging it was to separate public health from other existing professions, we have to understand that at the start of the 20th century, “public health” meant something different than what it does today. Early public health practice often referred to the health of poor people or those who did not have regular access to medical care. It is under this early definition that public health was generally practiced by physicians and nurses. Today, however, our understanding of public health goes far beyond that, encompassing bioethics, population and family health, the sociology of medicine, epidemiology, and my own subfield of health policy and management.

In the early years of the 20th century, the era of the country doctor and the visiting nurse who practiced public health began to disappear as the medical and nursing professions became more defined. Medical training became more rigorous, and specialization more common in light of the seminal Flexner Report, a book-length study that indicted the education of medical professionals. Nursing became a popular profession, and as hospitals proliferated, so too did the number of nurses. With traditional practitioners increasingly unavailable outside of hospitals, public health, began to distinguish itself with the help of a few key female visionaries from the fields of medicine and nursing who saw a need for a new field of health care.

Dr. Rosalie Slaughter Morton

Dr. Rosalie Slaughter Morton, was the first female faculty member at Columbia’s College of Physicians and Surgeons. It is hard to imagine the challenges that she must have faced given the era’s opinion of professional women, but Dr. Morton was driven by the feeling that physicians, especially women, needed to serve as educators, as well as providers, of health. She knew that women had unique access to the community through women’s clubs, and worked to establish the Public Health Education committee under the umbrella of the American Medical Association. Initiatives like this were a sign that prevention and education were being recognized as important aspects of health care and deserving of special and distinctive attention.

Lillian D. Wald

Early public health nurses cared for the poor population similarly to how they cared for their hospital-bound patients: they visited bedsides and administered medicines. One of the early pioneers of Public Health Nursing, whose name may be familiar to you if you’ve studied public health, was Lillian D. Wald. Wald was the first president of the National Organization for Public Health Nursing and she pushed for nurses in public schools, sanitation efforts, and education. It’s interesting to think about the populations that she was helping in those days of intense immigration and education boom. I think it is safe to say that many of the challenges she encountered are echoed in today’s public health dialogue. She also helped found Columbia University’s School of Nursing where there’s still a necessary overlap with public health and policy in the curriculum for nursing students. Work like hers reveals an early emphasis on health literacy in the public health community and how environmental factors were seen in relation to health.

Dr. Sara Josephine Baker

In the early 20th century, Sanitation and hygiene efforts were used to clean up the poorest parts of the city and improve living conditions through education. Dr. Sara Josephine Baker was the first woman to ever receive a doctorate in Public Health and was a champion of child hygiene. She went on to consult on the issue to the United States Public Health Service after founding and chairing the American Child Hygiene Association. Her work in New York City centered on poor immigrant mothers and prevention education, causes that many of us now recognize as being very classically public health. As an example of her efficacy as a public health professional, blindness in infants plummeted within a two-year period due to her invention of a single-use eyedropper made of beeswax to administer silver nitrate, which prevented eye infections caused by congenital gonorrhea. Dr. Baker’s work also had a significant effect on the mortality rates of mothers and infants in the city and her model of care was replicated around the country.

In an era where public health was defining itself, Dr. Rosalie Slaughter Morton, Lillian D. Wald, and Dr. Sara Josephine Baker were innovative health workers who pushed the boundaries of medicine and nursing. In doing so, they created a professional space for the field of public health. They typified the Progressive Era’s shift toward establishing women in the workforce. With their female colleagues, they are some of the central architects of what we know as public health. These women spent their lives exploring new areas of healthcare and discovering new ways to bring health to the public. For me, as a Mailman student, young professional, and woman, reading and writing about the history of these visionaries in my field is like tracing a family tree.

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