American public health association

The American Public Health Association was founded in 1872 as a professional organization of physicians, nurses, educators, sanitary engineers, environmentalists, social workers, optometrists, podiatrists, pharmacists, dentists, hygienists, and other community health specialists. In pursuit of its goal of protecting and promoting personal and environmental health, the APHA offers services including the promulgation of standards, the establishment of uniform practices and procedures, development of the etiology of communicable diseases, research in public health areas, and the exploration of various types of medical care programs and their relation to pubic health.

The American Public Health Association was founded in 1872 as a professional organization of physicians, nurses, educators, sanitary engineers, environmentalists, social workers, optometrists, podiatrists, pharmacists, dentists, hygienists, and other community health specialists. In pursuit of its goal of protecting and promoting personal and environmental health, the APHA offers services including the promulgation of standards, the establishment of uniform practices and procedures, development of the etiology of communicable diseases, research in public health areas, and the exploration of various types of medical care programs and their relation to pubic health.

The American Public Health Association (A.P.H.A.) Papers were collected by Arthur J. Viseltear while he was conducting research on the development of the A.P.H.A.'s Medical Care Section. The papers, which extend from 1938 to 1972, document A.P.H.A.'s official recognition of medical care as a discipline within the public health profession through the establishment during the 1940s of two successive medical care subdivisions within the organization. The recognition of medical care, though controversial and divisive, represented a critical step in the development of both the A.P.H.A. and the public health profession.

Medical care, which concerns the costs, organization, and delivery of health services, began to develop as a field within public health during the 1920s. C.-E. A. Winslow and other progressive public health leaders recognized that progress in medical science was resulting in increasingly fragmented, costly, and unevenly distributed health services, and they maintained that the traditional division between medicine and public health (which limited the latter field to sanitation, preventive medicine and public health education) was artificial and unrealistic. They further argued that the profession and the A.P.H.A. should play an advocacy role in developing comprehensive national plans for improving and rationalizing the delivery of health services.

Traditionalists within the A.P.H.A. and the profession, for a variety of reasons, opposed the expansion of public health into areas which had been limited to medical practitioners. One of their chief concerns was that partisanship on social issues would dilute the profession's effectiveness and would generate an intense reaction among physicians. Tension between the two groups increased during the 1930s and 1940s as compulsory federal health insurance, which was supported either in whole or in part by many advocates of medical care, became the subject of a heated national debate in Congress and in the press.

The advocates of medical care made halting progress during the 1930s and early 1940s towards making the organization address medical care issues and recognize medical care as a discipline. An important milestone was achieved in early 1944 when the Subcommittee on Medical Care was formed within the Committee on Administrative Practice. During 1944 the subcommittee drafted a report, "Medical Care in a National Health Program," which endorsed the adoption of a comprehensive national health program. After lengthy debate the report was adopted as an official statement of A.P.H.A. policy at the organization's annual meeting in October 1944. In 1945 the Subcommittee on Medical Care began an ambitious program of studies which were largely funded by annual operating grants from the Rockefeller Foundation.

The Subcommittee on Medical Care occupied an anomalous position within the organizational structure of the A.P.H.A. Its scope was broader than that of the Committee on Administrative Practice (C.A.P.), its parent body, yet it could be dissolved at the will of the C.A.P. Therefore, some supporters of medical care sought to achieve a stronger and more secure status for their discipline within the A.P.H.A. hierarchy. In early 1948 the subcommittee chairman appointed a Committee for the Creation of a Medical Care Section (C.C.M.C.S.), and shortly thereafter the committee secretary announced that the establishment of a Medical Care Section would be proposed to the A.P.H.A. Governing Council at the annual meeting scheduled for November. Since the A.P.H.A. sections represented the functional categories into which the public health profession was divided, section status for medical care would give individuals involved in diverse aspects of medical care and social medicine an equal voice with other traditional divisions of the profession.

During the summer and fall the C.C.M.C.S. canvassed unaffiliated members and non-members of the A.P.H.A. and prepared a series of documents supporting the creation of the section. A motion for the creation of a Medical Care Section was presented to the Governing Council during its meeting on November 11, 1948. After lengthy debate, including eloquent presentations by Winslow and Haven Emerson respectively supporting and opposing the motion, it was carried by a vote of 55 to 16. The creation of the section did not eliminate the Subcommittee on Medical Care. The subcommittee, which had both funding and an active program, continued to function until 1957.

By establishing the Medical Care Section, A.P.H.A. officially recognized that the organization, costs, and delivery of health services were within the purview of public health. By so doing, the A.P.H.A. has become a primary organization promoting public health. For a comprehensive history of the development of medical care, see Arthur J. Viseltear, "Emergence of the Medical Care Section of the American Public Health Association, 1926-1948," American Journal of Public Health, vol. 63, No. 11 (Series III, folder 33).