Public Health Personnel in Rural America: A Discrepancy between the Needs of Rural Health Workers and the Rockefeller Foundation International Health Board’s Vision of Specialist Training, 1900–1932

<p>The Johns Hopkins University School of Hygiene and Public Health was founded in 1916 on the recommendation of the Welch-Rose report submitted to the Rockefeller Foundation International Health Board (IHB) to modernize public health education. This research-oriented graduate school not only generated notable scientists but also became a model for other universities; however, it did not directly contribute to the improvement of rural health. Wickliffe Rose, one of the contributors to the report, had had a vision to train personnel as public health officers for rural areas who would supervise and educate people to improve rural health. Rose did not promote his idea in the Welch-Rose report due to the IHB’s bias against him, but his vision was passed on to John A. Ferrell, an IHB director who strongly believed that every county must have a health board with a skilled public health officer. In the early 1920s, Ferrell launched a campaign in rural counties and secured budgets from the IHB to support local health boards and to induce public health students to apply for internships. Counties and towns were experiencing a growing need for public health personnel, but many of them could not employ a health officer because of budget shortfalls. Graduates from best schools were not attracted to such underpaid and unstable jobs with slim future prospects. Meanwhile, public health nurses and school nurses filled the role of local health workers and educated families on personal hygiene, nutrition, and childcare, paving the way for more organized community health institutions. The presence of nurses in the southern and western mountain areas encouraged women to enter medicine but marginalized public health work. To Ferrell, rural counties still needed a health officer to administer broad health-work with the local government, the courts, physicians, and civic organizations—a role nurses would be unable to fill. The Social Security Act of 1935 provided federal subsidies for rural public health work; however, a discrepancy between the counties’ requirement of field-based health workers and the scientific training of specialists promoted by the IHB continued to shape the rural public health structure until the 1950s.</p>