Public Health and the State

Public Health and the State constitutes both a fine piece of social history and an ideal model for evaluating our current definition of public health. In this thought-provoking account, Ms. Rosenkrantz perceptively traces the development of the Massachusetts State Board of Health--established in 1869 as the first state institution in the United States responsible for preventing unnecessary mortality and promoting all aspects of public health.

This study describes the areas in which state responsibility for deterring disease assumed increased authority after the Civil War. It begins at a time when the definition of health' implied that it could be achieved, supported by the perfectionist belief that a healthy populace--obedient to the laws of nature--guaranteed a sound society. As rapid urban and industrial growth began to sweep the country, however, there was an expressed concern that this expansion threatened the health and morals of the people. During this period, when the etiology of disease was ascribed to a variety of environmental and behavioral factors, the Massachusetts Board developed a comprehensive program of investigation and advice on such diverse issues as housing, water supplies, slaughterhouse conditions, and the use of alcohol.

Later, as specific medical prophylaxis and therapy came to characterize public health policy, the relationship between sanitary science and social reform was redefined by both professional standards and public expectation. The State Board depended less and less upon its ability to influence individual conduct. Laboratory scientists, chemists, and physicians, who tended to describe disease in biological terms, directed public health toward science.

In view of pressing public health problems posed by such hazards as drug abuse and environmental pollution, Ms. Rosenkrantz warns us that it is as important to identify the origins of the social and scientific assumptions regarding public health as it is to discover the biological etiology of disease. The last chapter of Public Health and the State suggests that the goal of perfect health, based upon the ideal concepts of the past, may no longer be a viable objective. For these reasons she views the development of the Massachusetts State Board of Health as "the story of a successful endeavor that can never be re-enacted."