Chapter XXVI.
PUBLIC HEALTH EDUCATION.
With the cooperation of Ira V. Hiscock, Assistant Professor
of Public Health, Yale School of Medicine.
1. Scope of Health Education. Education of the public in the principles of healthful living is an important function of the health department and of other health agencies of a community. This is one means of establishing a favorable public opinion which is fundamental for success. It is especially important to educate the children of the community in the rules of hygiene so that they may themselves have sound health and thus safeguard the community in the future.
Activities designed for the purpose of teaching the children these fundamentals have been described in thc chapter on school health supervision. It was noted that both the Board of Education, and the Board of Health rightly assume considerable responsibility for this work. Experience has shown that the best health teaching programs are those so arranged that the health instruction is correlated with many different courses in the regular curriculum. It is gratifying that more attention is being given to this problem in teacher-training institutions. One of the best means of imparting health education to the community and of health building for the future is through the development of a hygienic conscience in school children, who incidentally in many cases carry the message to their parents. This can only be done through organized, consistent education by teachers, nurses, physicians and other members of the school health supervision staff. It is essential that close cooperation should exist between the departments of health and education in the planning of thc health phase of the school program.
This chapter deals primarily, however, with activities in popular health instruction, although brief consideration will be given to the health education activities (not previously described) of various health and welfare agencies in the city. Dr. Hermann M. Biggs, in 1922 made the followring statement at a conference in Washington: "It seems to me that we have accomplished almost everything by propaganda...The death rate in New York City from preventable diseases has been reduced 50 per cent. This has been by the education, not of the highest class, but of the lowest class...First we educate the tenement-house population and teach the children. They will teach their parents. The parents in turn teach the medical profession. You can teach the mass of the people and they will teach the leaders." The cooperation of an educated people is essential if modern health work is to succeed.
2. Popular Health Education Through the Health Department. In New Haven, as in many other cities, popular health education work in the health department is carried on largely by the health officer with the aid of bureau heads. According to a study of this problem in 1923 by the U. S. Publie Health Service, in cities of a population class similar to that of New Haven, a few exceptions to the above situation were, hovvever, noted. Syracuse charged $5,200 of its total budget to health education supervision, while Lynn expended $2,500. For purposes other than supervision, Chicago expended $38,000 for printing, New York $16,000, and Syracuse, $6,000.
A. The Press. Newspaper articles, lectures, pamphlets, bulletins, and exhibits appear to be the most effective media of popular health education used by municipal health departments. Certainly, one of the most important channels of health instruction is the daily press. The New Haven press cooperates with the health officer in keeping the people informed of the most important health activities and tendencies. Press reporters interview the health officer daily and render a valuable service to the community through the publication of health articles from this source. The local papers also frequently carry summaries of the weekly bulletin of the State Department of Health.
B. Lectures and Conferences. Lectures on various public health topics are given throughout the year by the health officer and members of the staff, reaching civic clubs, and other men's and women's groups of the city. Radio talks are occasionally given. Motion pictures of a health nature are frequently shown in the moving picture theatres.
It is important that the staff should have the benefit of continuing instruction in public health fundamentals and in new developments in preventive medicine. This end is successfully accomplished through weekly staff meetings at which problems of the various departments are discussed and a special topic of timely interest is presented by an outside speaker. Doubtless, a considerable part of the educational work of the health department is effected through the individual contacts of the personnel with the public, as through the home visits and group talks of nurses, the individual and group talks of the dental hygienists, and the various types of inspection services.
C. Pamphlets. The utilization of pamphlets in health education has become popular throughout the country. The value of such pamphlets depends not only upon their subject content, but also upon their attractiveness. Good printing is obviously essential. An excellent diphtheria prevention pamphlet, "One Disease Less," has been prepared and widely circulated by the department. It is also the practice to mail a birthday letter and card from the health officer to each baby on its first birthday, urging among other things that the child be protected from diphtheria. A tuberculosis booklet has recently been prepared in cooperation with Mrs. Violet Hodgson of the Visiting Nurse Association. Health publications of the State Department of Health and of the Federal bureaus are also utilized.
D. Bulletins and Reports. A monthly health bulletin is published which contains short articles of a timely nature, together with outstanding statistics of the previous month. This bulletin reaches a mailing list of 2,000 persons, approximately half of whom are interested lay citizens of New Haven, the others being chiefly health workers, physicians, dentists, and nurses. The health department also publishes an annual report, describing the work of the different departments, which is distributed among city officials and health workers.
E. Exhibits. In the survey of municipal health department practice to which previous reference has been made, it was learned that virtually one half of the 100 departments use some kind of exhibit during the year. Health exhibits are occasionally prepared in New Haven for special purposes, such as food shows, industrial expositions, May Day, and similar occasions. In the department office are displayed a few charts and pin maps indicating the trends of disease or location of cases, as well as one large map showing the sources of the milk supply. Health posters, chiefly designed to teach lessons regarding child hygiene, of tuberculosis and diphtheria prevention and proper food habits, are prominently displayed in the health department offices, in clinics, and in the physicians' and nurses' rooms of schools. An effective float was prepared for one of the street parades during Boys' Week, and this was preceded by a group of boys appropriately clad and organized to represent the health department in miniature.
Possibly one of the most elaborate and at the same time most effective efforts in health education was made at the time of the New Haven Progress Exposition held from January 26 to February 5,1927. Gathered under one roof, in a large six-story Winchester building (each floor having 200,000 square feet of space), were displayed those activities which stand for progress in many phases of New Haven life, including the industries, public utilities, and trades. It was calculated that 225,000 people visited this exhibition.
The health department exhibit was made up of five sections. The first section of the exhibit represented the growth of the department since its creation in 1873. Health departments in miniature were set up for each year selected for demonstration (1873, 1913, 1926) showing population, budget, personnel, activities, prevalent diseases and death rate. The second section on dipetheria had as a background an effective colored poster 20' x 9'. An ingenious flashing sign showed the decrease in cases and deaths from diphtheria since the toxin-antitoxin campaign started. The third section was on milk. A large state map with cows in relief represented the source of milk; there were models of a good and of an unsatisfactory dairy barn; as well as a mechanical book with pictures showing the progress in the milk industry. The fourth section was on tuberculosis. X-ray films of chests were displayed as well as pin maps, graphs, and attractive pictures of State sanatoria. The fifth section was a Bug House, built in a manner to attract attention, in which were displayed by means of microscopes and viewing boxes various bacteria for which examinations are made in the laboratory. Four people were always in attendance to give information and to answer questions. A large amount and variety of health literature was distributed.
The Board of Education also featured health and nutrition as a part of its exhibit at the Progress Exposition and the Public Library made a display of health literature.
F. Appraisal. The appraisal form for city health work allows only 20 points for popular health instruction, distributed as follows: educational health pamphlets, weekly health bulletins and health lectures, 2 points each; monthly health bulletins, 5 points; newspaper publicity, 6 points; showing of motion pictures, 3 points. New Haven received 18 of these 20 points, two points being lost because no weekly health bulletin is published. Only a few cities publish weekly bulletins at present. Considering New Haven's problems as a whole, it is believed that the publication of a weekly bulletin is not feasible, and that the money and time necessary for such work may be more effectively expended along other lines.
G. Needs. With the continued development of health department activities, and the demonstrated opportunities in the field of health education, it would seem desirable to consider expanding the health education program. On account of its intimate connection with department policies, this work should be under the direct supervision of the health officer, and should continue to receive a considerable share of his attention. The routine features of the work, however, might well be discharged by a fulltime assistant versed in public health principles, but particularly experienced in the technique of popular education. Such a man or woman could obtain the necessary technical material from the health officer and his bureau chiefs, in connection with a well conceived educational program. It is also believed that consideration might be given to the possibility of securing for this position a person trained in statistical work. There is greatly needed a systematic and continuing study of the health, sickness, and death records of the city to provide basic data to aid in improving to a still higher degree the health administration work of the city.
3. Activities of Voluntary Agencies.
A. Chamber of Commerce. As in other phases of public health work discussed in the various chapters of this report, voluntary agencies play an important part in the health education program of New Haven. The valuable services of the Chamber of Commerce in directing a campaign for the prevention of motor vehicle accidents has already been mentioned. The New Haven Automobile Association, through its bulletin and in other ways, is cooperating in this educational campaign. As described elsewhere, the Chamber of Commerce is also conducting an anti-mosquito campaign, and is interesting the public in this matter through the press, bulletins and public meetings.
B. Community Chest. The Community Chest, directly and through its committee on public health, has held several public meetings, at which well known speakers have given addresses on public health topics of interest and value to the community.
C. Medical Societies. In connection with the annual Clinical Congress of the State Medical Society, there is stressed each year the value of annual physical examinations. The importance of periodic health examinations to the general public for the early detection of abnormal physical conditions, many of which can be corrected it discovered early, cannot be too strongly emphasized.
The New Haven Medical Association has recently established a Committee on Public Relations which has, as one of its specific functions, cooperation with the Health Department.
D. Y. M. C. A. The Young Men's Christian Association is known as a recreational, educational, social and religious center for boys and young men from all walks of life. The physical department of the Association aims to promote physical, mental and moral efficiency by means of exercise, recreation and education. A medical and health committee is developing a program which should materially benefit the members of the Y. M. C. A. and industrial and church groups of men and boys. It is the policy to require medical examination of all boys participating in games and athletic contests; and such examinations are recommended to all men using the department. During the year ending September 1, 1927, 421 examinations were made. Gymnasium classes are well organized, with facilities for special instruction and recreational guidance of many different groups.
A commendable effort is being made by the staff and the health committee to develop a practical health program including health education. Bulletins and news letters carrying health articles are issued from time to time. It is believed that certain of the industrial plants, especially, might benefit from wider use of the Y. M. C. A. facilities. A plan for comprehensive industrial health education is being developed, and as occasion offers, special consideration is given to the needs of individual industrial plants. It is noteworthy in this connection that the New York, New Haven and Eartford Railroad Company has developed a program of health and physical education which reaches several thousand employees. The athletic and social activities are carried on through associations and committees of employees. The health phase is at present confined to articles published in the monthly magazine of the Company, and to contacts through first aid and safety first committees.
E. Y. W. C. A. The Young Women's Christian Association, in addition to other activities, offers to girls and young women a program of physical training and recreation, and supervises women's activities in the Industrial Recreation Federation. A committee on health education has developed a program of physical training and health education. A physical director is employed to aid in carrying out the work and is rendering valuable service.
Medical examinations are required of girls before entering gymnasium classes, and an effort is made by the physical director to secure the correction of defects discovered. In 1927 there were 243 examinations made by the medical examiner, Dr. Margaret Tyler. Of the 213 examinations made in 1926, 49 per cent showed underweight, 37 per cent feet defects, and 90 per cent posture defects, in addition to other conditions discovered.
The Weekly News of the Industrial Recreation Federation for Women contains at least one health article. A monthly bulletin is published for the members which also carries an article directing attention to the rules of healthy living. In 1927, a social hygiene program was developed, which included addresses to women and girls by representatives of the American Social Hygiene Association and a course for leaders of girls' groups, also conducted by a member of the staff of that organization. A small library of social hygiene books has been provided and is extensively used.
F. Y. M. and Y. W. H. A. The Young Men's and Young Women's Hebrew Association serves Jewish people of all ages. Educational classes, lectures and community meetings are included in the program. One series of five lectures has dealt with social hygiene problems, while another, consisting of 10 talks to mothers, was on the general subject of "The Child and the Home." Instruction in Junior Clubs, an afternoon recreation school for children ranging in age from 8 to 12 years, and first aid demonstrations, comprise the remainder of the health program of this organization.
G. American Red Cross. The American Red Cross has an active local chapter in New Haven which has developed health and safety activities of an educational and practical nature. Classes in home hygiene and care of the sick are conducted each year at the Dixwell Community House by a graduate nurse who is a member of the Red Cross Nursing Service. In 1926 there were 4 such classes with 70 pupils. These classes are composed largely of housewives, who are taught the principles of sanitation and personal hygiene. Literature is supplied free by national headquarters.
Highly commendable results are obtained in the Life Saving and First Aid classes. Any local organization or group of individuals having at their disposal a swimming pool, has the privilege of taking the National Red Cross life saving tests. Once a year, or more often if requested, an American Red Cross field representative comes to New Haven to give life saving tests and to instruct the examiners in the latest methods. This information is passed on through the leaders to the candidates for the tests. One week in May is usually devoted to this national representative, and the Yale pool is available at this time.
In 1927 this service reached 600 people, for the preceding year approximately 500 people. Tests are required of all of the girls of the New Haven School of Gymnastics.
There are however no adequate facilities within the city for teaching swimming to women and girls. There are but 2 municipal pools in New Haven, one of which is not usable. The other, the St. John Street bath house, is not modern, and there is no instructor. At Fort Hale and Lighthouse beaches, there are no instructors, although there are three life guards at the latter beach. It is hoped to have instructors at these bathing beaches, and also to provide pools and instructors in the junior high schools.
During 1927 the first aid branch of the Red Cross work reached 320 New Haven people who became qualified "firstaiders". There were 42 lay instructors in industry representing 22 industrial organizations, and 14 other instructors in other local groups such as the Safety Council, Camp Fire Girls, and Boy Scouts. There are at present, however, only about 25 active instructors.
The local Red Cross forms the headquarters through which literature and information from the national organization are distributed. The local chapter of the Red Cross administers the first aid examinations, which are prepared at Washington.
It is proposed to build up a faculty for industry and extend this first aid work. It takes about 20 hours to complete the lay course; which is arranged for ten periods of 2 hours of instruction weekly. This is practically all volunteer service. Eighteen instructors of the New York, New Haven and Hartford Railroad have been trained in the principles of first aid, and they in turn are passing on the information to the workers in this organization. A similar program is carried on in various other industrial concerns.
H. The Public Library. The New Haven Public Library has a good collection of books and pamphlets on personal hygiene and public health which should be of considerable interest and value to the public. A selected list of these books will be furnished to persons interested by the Readers' Adviser of the library, who is prepared to aid those who wish to educate themselves further by reading authoritative health publications.
4. Summary and Recommendations. Certain other educational activities, chiefly related to children of school age, have been discussed in the chapter on school health supervision. The work of popular health instruction has, however, become recognized as one of the essential functions of municipal health service.
On the basis of present knowledge and experience, it is certain that with only a small additional outlay, but with closer coordination of activities, much more can be accomplished in New Haven than at present. "Supervision over health education activities and the responsibility for the successful development of so important a feature of local health service should not be left to the ingenuity or zeal of subordinate positions in the health department. " While it may not be practicable at once to create a separate bureau of health education in the local health department, it does seem essential to employ a competent person to take charge of this work under the general direction of the health officer. It should thus be possible to develop a definite and constructive policy for inaugurating and continuing a far-sighted, city-wide program of popular health education to keep pace with the intellectual capacity of the community and at the same time anticipate its potential possibilities.
Recommendation 95. That a comprehensive program of popular health education for the city as a whole be developed, with a separate allotment in the health department budget for this purpose; that efforts be directed, through conferences or other means, to a closer correlation of the activities of all voluntary agencies in the field of popular health education, under the general leadership of the health department; and that a group of lecturers be organized, consisting of health department employees, members of the local board of health, of the local medical and dental societies, and other appropriate groups, and that systematic measures be developed to make these lecturers available to men's and women's clubs, churches, and fraternal orders, and to the various civic organizations of the city.
It is interesting to notice that Dr. C. A. Lindsley, the first health officer of the city of New Haven, in his second report for the year 1874, discussed as follows the problem with which this chapter is concerned:
"When the public come to comprehend our true official character, as in time they will, we shall be expected not only to supervise and, when possible, direct in matters affecting public health, but also to become a source of information in regard to all questions of public hygiene. We are to know and be able to inform and advise in regard to everything connected with the physical well being of our fellow citizens."
This is an ideal which still remains to be realized.
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