Part 3 of the 90th Anniversary for the Health Department

This article is Part III of the 90th Anniversary of the Cattaraugus County Health Department Series.

Year 2013 marks the 90th Anniversary for the Cattaraugus County Health Department, the first organized county health department in New York State. It has been our privilege to share a brief history with the public, most of which is taken from C.E.A. Winslow’s Health on the Farm and in the Village: A Review and Evaluation of the Cattaraugus County Health Demonstration with Special Reference to Its Lessons for Other Rural Areas, 1931.

(Parts I and II were published in August and October)

In the 30 years preceding the end of World War II, local and state health departments and the United States Public Health Service grew and flourished as guardians of the people’s health.” Milton Terris, 1976

Most county health departments were established with outside support, often by way of funding from private foundations. In his 1929 report, L.L. Lumsden estimated that of the 467 national county rural health departments, 88% received outside assistance. Among those foundations first to take a significant interest in rural public health, and subsequently to provide seed funding for county health units, was the Rockefeller Foundation. In 1909 the foundation organized the Sanitary Commission to Exterminate Hookworm Disease and conducted community-level surveys in nine states to assess the extent of the disease. The commission found infection rates as high as 43% among the 404,000 children inspected but was particularly surprised to find that the majority of homes and schools did not have privies. Between 1910 and 1913, the Rockefeller Foundation developed health programs in rural counties, which often led to the development of full-time county health units in three successive stages. First, counties were funded to educate medical professionals and the public about the importance, prevalence, diagnosis and treatment of hookworm disease; secondly, funds were provided to sanitize communities to protect against hookworm, typhoid fever, and other diseases; and finally, funds were then provided for the employment of full-time personnel within counties to enable continued work. In 1916, the Rockefeller Foundation began contributing directly to the budgets of county health departments. Other foundations helped establish county health departments in rural areas during this time including the Milbank Memorial Fund, which in 1922 provided funds that helped establish a rural health department in Cattaraugus County in 1923.

The importance of the Cattaraugus demonstration project was eloquently summed up by John A. Kingsbury, secretary of the Milbank Memorial Fund, who was quoted in the May 26, 1931 issue of the Olean Evening Times as saying, “green pastures, sunshine and rolling meadows apparently have little to do with the health of the individual. At any rate, they constitute less protection in the way of adequate rural health administration than the effective sanitation, clinical facilities, and hygienic measures available in congested streets and bleak tenement house districts of large cities. With few exceptions, rural communities have lamentably inadequate public health provisions. The Cattaraugus County Demonstration offers testimony of what can be accomplished by the intelligent and coordinated effort of public and private agencies in the alleviation of human misery.”

The Milbank Memorial Fund in its centennial report noted the following results from Cattaraugus County: deaths from tuberculosis declined more quickly in Cattaraugus County than in comparison counties, from

55 per 100,000 people in 1929 to 25 in 1930; the infant mortality rate also fell more quickly; and the Demonstration Project launched a successful countywide school health service. The report goes on to note that other rural counties launched their own health departments based upon the success of this demonstration. Further, in a report commissioned by the Fund twenty-five years following the demonstration, Yale University researchers noted that “the entire progress made in the United States in developing health services for rural areas owes its inception to Cattaraugus County.”

As county health departments rapidly expanded public health services into rural areas, services provided by public health nurses were gradually brought under the umbrella of the county units and nurses comprised the core programmatic staffing of many of these agencies. The county health unit initiatives funded by the Rockefeller Foundation, the U.S. Public Health Service, the Milbank Fund and others relied heavily upon public health nurses.

Despite the rapid increase in the number of health departments across the country, it was estimated in 1929 that 77% of rural Americans still lacked access to public health services.

Congratulations again to the Cattaraugus County Health Department, its past and present employees, for 90 years of ongoing efforts to protect the health and well-being of county residents.

One final chapter of the Department’s Anniversary will be presented next month.

Submitted on November 7, 2013 by Debra J. Nichols, Public Health Educator