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health conditions and the means of controlling them. It has given considerable attention to rural sanitation. It issues reports and other publications of great value to the citizen, some of them being listed at the end of this chapter. It has representatives in all important foreign ports, inspects all ships that enter American harbors, and holds them in quarantine until they and their passengers are given a clean bill of health. Cholera and other dangerous diseases have thus been prevented from gaining a foothold on American soil.
HEALTH WORK OF OTHER DEPARTMENTS
The War Department has also waged a relentless warfare against disease, not only in the army itself, but also in the Panama Canal Zone, Cuba, Porto Rico, the Philippines, and other regions occupied by the army. The Department of Labor seeks to improve the physical conditions of labor for both men and women, and its Children's Bureau is charged with a study of all matters pertaining to the welfare of children. In the Department of the Interior the Census Bureau collects national vital statistics; the Bureau of Mines has done valuable work for the prevention of accidents in mines and mining industries; and the Bureau of Education seeks to promote physical education, instruction in home economics, and education in the home relating to the care of children.
STATE RESPONSIBILITY FOR HEALTH PROTECTION
A very large part of the duty of health protection must, however, remain with the states. Every state has its department of health, headed by a state board of health, or a commissioner of health, or both. These departments differ greatly in their organization and in the extent and effectiveness of their work.
NEW YORK STATE ORGANIZATION
One of the best organized state departments of health is that of New York. Among its most important features are (1) a PUBLIC HEALTH COUNCIL which has power to establish a state-wide SANITARY CODE; (2) the concentration of all administrative power in the hands of a single state COMMISSIONER OF HEALTH, who has a staff of experts to direct special lines of health work; and (3) a well- organized scheme of cooperation between the state department and local health authorities.
LOCAL ORGANIZATION FOR HEALTH PROTECTION
The absence or weakness of local organization for health protection has been one of the obstacles to progress in physical well-being in the United States. Driven by an appalling death rate and frequent epidemics, our large cities have developed health departments which in many cases have proved very effective. But in smaller communities, while health departments or health officers usually exist, the organization has for the most part been very ineffective. The people themselves have not been sufficiently aroused to their needs and to methods of meeting them. New York and Massachusetts are among the most progressive states in this matter. Each local community in these states (town, village, or small city) has its board of health and health officer; but these communities are grouped into HEALTH DISTRICTS (8 in Massachusetts, 20 in New York), each district being in charge of a health officer appointed by the state commissioner or board of health. In New York the district health officer, who is there called the SANITARY SUPERVISOR, has the following duties:
To keep informed regarding the work of each local health officer within his sanitary district.
To aid the local health officers in making health surveys of the community under their control.
To aid each local health officer in the performance of his duties, particularly on the appearance of contagious diseases.
To hold conferences of local health officers.
To study the causes of excessive death rates.
To promote efficient registration of births and deaths.
To inspect all labor camps and to enforce in them all public health regulations.
To inspect Indian reservations and to enforce all provisions of the sanitary code in them.
To secure the cooperation of medical organizations for the improvement of the public health.
To promote the information of the public in matters pertaining to the public health.
EXAMPLE OF NORTH CAROLINA
Another type of local health organization and of cooperation between local and state authorities for health protection and promotion has been developed in North Carolina, where 85 per cent of the population is rural. Here the county has been taken as the unit of local organization. Health conditions had been very bad in this state, hookworm disease, tuberculosis, malaria, and other diseases being prevalent. The state board of health, assisted by the Rockefeller Sanitary Commission (see above, page 320, and references below), began an investigation and an educational campaign among the people, with the result that many of the counties of the state now have an organization for health cooperation unsurpassed, perhaps, in any other state. Each county has a health department, which is controlled jointly by the state board of health and a county board of health. The county board of health consists of the mayor of the county seat, the chairman of the board of county commissioners, the county superintendent of schools, and two physicians of the county elected by the other three members. The work of the health department is directed by a county health officer, who is appointed by the state board of health of which he is also a member. He has a staff of trained assistants.
In this plan note the cooperation between state and local communities, between town and county officials, and between the school authorities and the health organization. Note, also, the leadership of specialists in health matters.
Topics for investigation:
Organization of the department of health in your community (both county and town): the board of health; the executive health officer or officers; the kinds of work done.
Amount of money spent by your local health department for all purposes and for each purpose separately. Compare with the amounts spent for roads, for schools, and for other work of the local government.
The interest shown by the people in your community in public health matters.
Some of the more important health problems of your community.
The leadership in your community in health matters.
Cooperation between the state government and your local government in health matters.
The more important local and state laws relating to health in your community.
Organization of your state department of health.
Local health problems that need state control.
State health problems that need local cooperation.
The operation of the Food and Drugs Act in your community.
The work of the Public Health Service.
The extermination of yellow fever in the United States.
The fight against the bubonic plague in California.
The work of the War Department to maintain the health of the soldiers during the recent war. Volunteer agencies that cooperated in this work.
Work done in your community for the promotion of health by the Department of Agriculture and the United States Public Health Service.
The work of the Children's Bureau of the Department of Labor.
The inspection of immigrants.
Reports of local and state boards of health.
Publications of state agricultural college relating to public health.
Publications of the United States Public Health Service, Washington. The following are illustrative:
Federal Public Health Administration: Its Development and Present Status. Reprint No. 112, U. S. Pub. Health Reports, 1913.
Public Health Reports. Issued weekly.
Rural Sanitation, Pub. Health Bulletin No. 94, 1918.
Health Insurance, Pub. Health Reports, vol, 34, No. 16, 1919.
The Nation's Physical Fitness, Pub. Health Reports, vol. 34, No. 13, 1919.
Good Water for Farm Homes, Pub. Health Bulletin No. 70, 1915.
Typhoid Fever: Its Causation and Prevention, Pub. Health Bulletin No. 69, 1915.
Public Health Almanac (for current year).
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