The Community Course
Part 3 - Specific Community Interests
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 17. Community Health

Questions Regarding Health
The writer has had occasion to employ many people on work which required them to take their families to new locations, often to small communities. From this actual experience it has been found that when an intelligent family is considering such a move, the prospect for good health conditions is one of its most serious concerns. Is there a good water supply? Is there good drainage? Is the milk supply safe? Is good medical care available? Is there a good hospital? Is the school house well lighted, heated, and ventilated?

Such questions as these, which people ask when they consider coming to a community, are the same ones that a well managed community will ask about itself. By intelligent planning and consistent effort it often is possible within a few years to change a small community, as regards health conditions, from one which people are anxious to leave, into a community to which people desire to come. Because the matter of community health is so important, a great many public agencies, organizations, and institutions have prepared to give help to communities which desire to improve health conditions.

Studying Community Health
In a study of community health it is necessary to limit attention to matters which are common to the general community and which can be dealt with best by organized community effort, or by other public action. Individual problems, or technical medical problems, should not be included, or the issues will get entirely out of hand. Among community problems appropriate for united action would be protection of water supply, enforcement of quarantine, school lighting, and the question of whether children of low income families should be provided with dental, optometrist, and other health services at public expense. Among questions which would be outside the proper limits of a study of community health would be the best way for physicians to treat particular diseases, or the cause and cure of cancer. There are no clear boundaries between community health problems to be met by community action, and technical medical problems which are the business of the physician or other specialist, or matters of private judgment. For instance, the question of how best to provide well-balanced school lunches is partly a question for specialists and partly a matter of practical community thrift and planning. The solution of such mixed questions requires mutual respect, cooperation, and tolerance.

In so complex a field as public health, specialized counsel and help are needed, both in the development of a general program, and in particular issues under consideration. No adequate discussion of particular problems is possible within the limits of this outline. At best it can make general suggestions and point to qualified sources of assistance.

Developing a Community Health Program
Suppose a local organization, such as a Community Council, or a Parent­ Teachers Association, or a Rotary Club, should wish to undertake a year’s program on the subject of community health; how could it proceed? It might plan its year's program, with the development of a continuing committee, made up of persons most interested and effective to follow up unsettled issues through a period of years. As a guide they might secure a number of copies of the book Your Community, published by the Russell Sage Foundation in New York, chapters 8, 9, and 10 which provide an excellent outline for the study of community health. Another excellent book, Community Health Organization, by Hiscock, published by the Commonwealth Fund of New York, is a very well-thought-out program for public health service for a city of 100,000. The methods it proposes are not in general applicable to small communities, yet an intelligent club or committee, with that book for suggestions, could become aware of needs in its own community, and could devise ways to meet then. For instance the chapter on nursing service might suggest the working out of definite arrangements for making one or more nurses available. The chapter on voluntary health services deals with great organizations which provide research, literature, and facilities. In the small community this subject might suggest planning and forethought whereby the neighborliness and good will in the community could be made fully available in case of need.

Another book, Public Health Administration, by Wilson G. Smillie, professor of public health administration at the Harvard School of Public Health, has a chapter on rural health administration (Chapter XXX), which is an excellent brief treatment of the subject, especially in connection with the general treatment of health in the earlier chapters.

The first book mentioned, Your Community, could be taken as a textbook for a program of study and work in community health. The twelve subjects into which the discussion is divided would provide a twelve month study and activity program in community health, under such headings as "The Community as a Health Environment," “Indices of Community Health," “Health Services for Special Groups," "Aids in Planning the Community’s Health Program,” and “Informing the Public about Health." 

State Health Assistance
In many states there are county health officers who will consult and cooperate with communities in removing the most serious health hazards. Each state has a Department of Public Health with a staff of experts. As a rule those persons can be called on for talks or advice on such problems as water supply, milk supply, quarantine of contagious diseases, or more complete sewage disposal. In most states the state university has  departments, or at least individuals, who are specialists on public health problems. These are to be found in the Department of Rural Sociology, or in a Bureau of Community Planning, or in the Agricultural College, or in the Extension Service. A few letters usually will locate the help needed.

US Government Assistance
The United States government serves community health through many agencies. Chief of these is the United States Public Health Service, with its many activities and publications. Under the Social Security Laws, the Children's Bureau of the Department of Labor makes studies and issues publications, and also makes grants for maternal and children's health services. The United States Office of Education also is concerned with children's health. The Department of Agriculture issues literature on public health, such as its bulletin on Hospitals for Rural Communities. The Farm Security Administration, in association with state medical associations, has develop­ed a far-flung program of rural medical care, especially for Farm Security Adminis­tration borrowers. This program of fixed sum payments for medical care has been organized in more than five hundred counties, and on more than a hundred and fifty homestead projects.

National Organizations
Numerous nation-wide organizations are concerned with community health, among them, The American Public Health Association, the national Red Cross, the American Social Hygiene Association, the American Automobile Association, the National Conference on Street and Highway Safety, the National Safety Council, and the Metropolitan and other life insurance companies.

Foundations
Several large foundations have made studies of community health, or have helped to finance community health projects, and have published books and bulletins on the subject. Among these organizations are the Russel Sage Foundation, the Rockefeller Foundation, the Commonwealth Fund, the Rosenwald Fund, the Duke Endowment, and the Bureau of Cooperative Medicine.

In case a community group working on community health should want guidance on its general program or on particular problems it generally can get needed information - or at least learn where to get it - from one of four sources: its own state department of health, the United States Public Health Service, the American Public Health Association, or one of the foundations, such as the Russell Sage Foundation.

Community Health Support
Most discussions of community health have in mind a citified, commercialized America, from which old fashioned neighborliness has largely disappeared. The advantages of modern medicine and the administration of public health are very great, and should never be lost. Yet in small communities there is very great opportunity for revival of the old-time neighborly qualities. A mother, worn out almost to the breaking point with family illness or other trouble, might get a new lease on life by a week or two of visit and complete rest in a neighbor's home. One of the most socially useful persons we know is a woman who is observant of her neighbors and sometimes says to one of them, “Come home with me and spend a few days in bed.” Or sometimes she takes a baby home for a few days, and gives the mother a rest. Such practices could be encouraged and made a community habit. A community might well have a storage place for things used occasionally in sickness, such as a wheeled chair, bed pans, crutches, a sheepskin with the wool on it for bedridden persons, and a sick-bed table. The old time custom of neighborly nursing back and forth should not disappear. Without questioning the superiority of trained nurses, it must be recognized that friendly, neighborly help is better than the lack of any such help because the cost is prohibitive or the nurse not available.

The modern community should take full advantage of modern science, technology, and organization for community health, but it will make its resources go much further and will add a priceless human quality, if it preserves and develops the friendly helpfulness of pioneer days.