History of AAPHP – The First Ten Years 1954-1964

The early 1950's were a golden age for clinicians and a turbulent time for public health physicians. Physicians directed almost all hospitals and health departments. The process by which physicians were to be replaced by non-physicians was clearly evident. A chasm was growing between clinicians and public health physicians, and ever-stronger AMA opposition to “socialized medicine” was distancing the medical profession from what otherwise could and should have been strong community allies. Through all this, the public health physicians saw community organization, wellness, leadership skills, the need for an evidence base for public health policy, problems of aging, the need for lifelong physician education, the failure of medical schools to interest students in public health, and the limitations of conventional approaches to health education very much the same way that we see these issues today. The myth that “businessmen” can run healthcare facilities better than physicians is an issue worthy of reconsideration today.

In a note apparently written by Ben Freedman, MD, MPH, long-term Editor of the AAPHP Bulletin, Ben reflected on the origin of AAPHP in the following words:

When the AAPHP was organized, the problems were:

•  The growing estrangement of public health physicians from private practitioners

•  The pressure for admission of non-medical administrators to the Health Officers Section of APHA.

•  The changes in medical practice in the United States post World War II:

•  Rapid increase in the incomes of private practitioners in relation to public health physicians

•  Public health physicians who went to the army did not return to public health because of this income difference.

•  The DHEW pressure for Deprofessionalization

•  The tremendous increase in non-medical people in APHA

•  The increasing fragmentation of public health programs (this note appears to reflect the trend to place public hospitals and clinics under the leadership of non-public-health agencies at state and local levels).

In the mid-1950's, AAPHP dues were $5 per year, and, when pleading for adequate pay for public health staff, Dr. L.L. Fatheree (Health Director, Joliette, IL) urged a salary in the amount of $15,000 for physician directors of health departments and salaries of $5,000 to $6,000 per year for the chief public health nurse and public health engineer.

Today, those dues and salaries seem quaint and anachronistic. When it comes to the major policy issues they were facing, however, many of their perceptions and policy recommendations would seem avant-garde, even today. Two examples follow:

In a 1956 article written by Dr. E.R. Krumbeigel (Commissioner of Health, Milwaukee, WI and 1955 President of AAPHP) entitled “A Philosophical Consideration of Leadership in Public Health.” In this paper Dr. K explored the difficulty of a public health officer torn between the need to prioritize a limited number of programs vs the need to address a wide range of public health issues. The paper, however, is most notable for his words re the importance of citizen participation and partnership in setting public health priorities – a statement which was 40 years ahead of its time:

The major problem confronting the local public health physician is the difficult but interesting task of organizing a community environment (emphasis added by JLN) in which people may jointly engage in an inquiry of their own unique health problems and evaluation of potential solutions to them. To the uninitiated, this approach may loom like a long end run to the solution of any single problem but, from a long range community health program viewpoint, it is the shortest distance between two points. It is the most productive method for overcoming the common hostilities among our “local publics” which often serve to delay or prevent initiation of public health action programs.

The May 1956 AAPHP Bulletin featured a thoughtful and provocative essay by Dr. Herbert Ratner (Health Officer, Oak Park , IL , and then Editor of the Bulletin) entitled “Is Preventive Medicine the Ultimate Goal of Public Health.” In this essay he excoriates public health physicians from focusing on the negative “preventive medicine,” and not focusing on what he called “perfective medicine” – what we now call “wellness” --- pursuit of optimal physical and mental health.

After reviewing these historical materials, I (JLN) wonder – have we learned fundamentally new these past 50 years? By not knowing our history, are we condemned to repeat it?

Joel L. Nitzkin, MD, MPH, DPA, Past President AAPHP
Co-Chair, History & Archives Initiative Committee

AAPHP Articles of Incorporation.pdf