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
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
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美国农村的公共卫生人员：农村卫生工作者的需求与洛克菲勒基金会国际卫生委员会的专家培训愿景之间的差异，1900-1932 年
DOI：
10.11380/americanreview.56.0_49
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发表时间：
2022
期刊：
影响因子：
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通讯作者：
平体由美
中科院分区：
文献类型：
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作者：
Seto Junji;Aoki Yoko;Komabayashi Kenichi;Yamada Keiko;Ishikawa Hitoshi;Ichikawa Tomoo;Ahiko Tadayuki;Mizuta Katsumi;平野葉一;大城房美;日比野愛子;袴田玲;Robert Jacobs;河上麻由子;一戸渉;伊久間洋光;吉岡克己;守屋友江;杉本バウエンス ジェシカ;山田順;Robert Jacobs;一戸渉;河上麻由子;山田望;野澤恵;Mai Suzuki;平体由美
约翰霍普金斯大学卫生与公共卫生学院成立于1916年，是根据韦尔奇-罗斯提交给洛克菲勒基金会国际卫生委员会（IHB）的报告的建议建立的，目的是使公共卫生教育现代化。这所研究型研究生院不仅培养了著名的科学家，而且成为其他大学的典范；然而，它并没有直接促进农村卫生的改善。该报告的撰稿人之一威克利夫·罗斯（Wickliffe Rose）有一个愿景，即培训人员成为农村地区的公共卫生官员，监督和教育人们改善农村卫生。由于IHB对罗斯的偏见，罗斯没有在韦尔奇-罗斯报告中推广他的想法，但他的想法被传递给了IHB主任约翰·a·法雷尔（John a . Ferrell），后者坚信每个县都必须有一个卫生委员会，配备一名熟练的公共卫生官员。20世纪20年代初，费雷尔在农村县发起了一场运动，并从IHB那里获得了预算，以支持当地的卫生委员会，并诱使公共卫生专业的学生申请实习。各县和镇对公共卫生人员的需求日益增长，但由于预算短缺，许多县和镇无法雇用卫生官员。优秀学校的毕业生并没有被这种低薪、不稳定、前途渺茫的工作所吸引。与此同时，公共卫生护士和学校护士填补了当地卫生工作者和受过个人卫生、营养和儿童保育教育的家庭的角色，为更有组织的社区卫生机构铺平了道路。南部和西部山区护士的存在鼓励妇女进入医学界，但使公共卫生工作边缘化。在费雷尔看来，农村地区仍然需要一名卫生官员来管理广泛的卫生工作——与当地政府、法院、医生和民间组织合作——这是护士无法胜任的角色。1935年的《社会保障法》为农村公共卫生工作提供联邦补贴；然而，直到20世纪50年代，各县对实地卫生工作者的要求与国家卫生和卫生局对专家的科学培训之间的差距继续影响着农村公共卫生结构。
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.