AAPHP celebrated its 50th Anniversary in the spring of 2004. The following narrative is an extract from the history presentation provided at that time. It was edited and presented by Joel L. Nitzkin, MD, largely based on the work of Drs Ben Freedman and Herbert Ratner – Editors and prime contributors to the AAPHP Bulletin, 1954-1963.
A group of state and local health directors gathered together, while attending the annual meeting of the American Public Health Association (APHA) in November of 1951, to discuss the need for a national organization of physician directors of state and local health departments. At that time all known state and local health directors and most hospital administrators were physicians. A major issue in need of advocacy was the question of formation of a federal Department of Health. This issue was pursued through both APHA and AMA leadership over the next two years, until finally settled in 1953 by the Eisenhower administration, with the formation of the federal Department of Health, Education and Welfare. This effort, while disappointing to the physician public health leadership, nevertheless galvanized this group and resulted in the formation of three separate, but related public health physician organizations in 1954. The three were the American Association of Public Health Physicians (AAPHP) – then defined as the voice of physician directors of public health programs and agencies at the national level; the American Board of Preventive Medicine (ABPM) – the organization to develop and manage specialty certification in Public Health and Preventive Medicine; and the American College of Preventive Medicine (ACPM) – to be the organization of physicians so certified.
This same 1951-1954 time period showed the first appointments of non-physicians as directors of state and local health departments and as hospital administrators. It was also a time of growing estrangement of public health physicians and physician administrators from those who saw their roles in purely clinical terms. Over the following decades, DHEW and other forces stimulated replacement of physician agency and hospital directors with non-physician administrators, defining these roles more in terms of finance and management, and less in terms of pursuit of health-related objectives.
At its inception in October 1954, AAPHP had 586 dues paid members, with representation from every state and territory. Dues were $5 per year. Membership peaked at about 740 in 1957. Since then it slowly declined as the numbers of physician directors of federal, state and local public health agencies and programs has dwindled. In response, AAPHP has expanded its membership base to include physicians of any specialty with an interest in addressing health issues at a group or population level. Membership has oscillated in the range of 120 to 200 paid members since the early 1990’s.
Many of the issues facing public health physicians today were apparent in the early days of AAPHP. Examples include the following:
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. Krumbeigel. 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 prioritiesundefineda statement which was 40 years ahead of its time.
The major problems 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?
Then, as now, AAPHP has continued in the role of a small but nimble association of public health physicians dedicated to the enhancement of the health of the American public by means of influencing policy decisions of both larger public health and medical organizations (mainly AMA and APHA) and other activities at the national level. Major topics of interest since the early 1990’s have included but not limited to tobacco control, policy and management training and the funding and role of state and local public health agencies. Throughout it's history, including this past decade, AAPHP has had an impact on national policy deliberations of AMA, APHA, other organizations, and federal agencies far out of proportion to it's small membership size. This is a tradition we intend to continue into the future.
Joel L. Nitzkin, MD, MPH, DPA, Past President AAPHP
Co-Chair, History & Archives Initiative Committee
Presidents of AAPHP