The Health bulletin [serial] - University of North Carolina at Chapel Hill

January, 1955 The Health Bulletin 13encountered many unbelievers, and itwas very satisfying to tilt with them.They lost many battles, but they wonall the wars and public health becamea "knight in shining armor." Appropriationsincreased and county healthdepartments multiplied. We got morepersonnel but also more jobs to do.Our reputation for near-miracles becamealmost a handicap, and everysession of Congress and of our statelegislatures gave us new duties andresponsibilities. For some of these,funds were provided, but some we wereexpected to do "in addition to our otherduties." The State Board of Healthin Florida, established in 1889, originallyhad only one duty, to controlcommunicable diseases and among thesemainly yellow fever. By 1950 the listof duties had grown to 84, and severalnew ones have been added since.But many of us nevertheless havean uneasy feeling about the future.One of our difficulties is explaining ourneeds in public health. There are undoubtedlyin this audience plenty ofindividuals who can make a fine tenminuteor hour-long talk on any programthat you have here in NorthCarolina, be it nutrition, industrialwaste disposal, cancer control or infantcare. But I am sure that all ofyou will agree that it is quite difficultto say enough about public health'snumerous present problems in any reasonablelength of time. I know howdifficult (or impossible) it is to do thisbecause I have had the job of tellingwhat the Florida State Board ofHealth does to civic clubs, our statebudget commission, governors and legislativeappropriating bodies in timelimits ranging from ten to thirty minutes.The program chairman casuallysays, "take all the time you want,doctor (up to 30 minutes); that is,tell us everything about public health."This frustrating predicament is facedconstantly by responsible public healthofficials every day on national, stateand local levels of government. Weare favored by an interested and enlightenedpublic, and by and large ourlegislators are sympathetic and far fromparsimonious. They actually want to giveus money to improve health and sanitationand to prevent illness and needlessdeaths. I make this statement in spite ofthe trend in Congress in the past fewyears to reduce appropriations for grantsto states. These reductions were based inpart at least on the philosophy thatthe states are responsible for this importantjob; partly by a swing of interestfrom the types of work that6tate and local health departments doto vocational rehabilitation, to the constructionof hospitals and related institutions,to research, and to medicaland hospital insurance. (In parentheses,I'd like to add that if we do not agreewith these congressional actions andpolicies we should express our viewsto them in every proper manner, byletter, by telegrams and by personalconferences.) However, we should notspend too much of our time lamentingthe whims of the Federal government.Our principal sources of support, financialand otherwise, are our ownstate legislatures and city and countyofficials. I have already touched brieflyon the fact that our principal handicaplies in the difficulty of presentingbriefly and clearly the answer to thesimple question: "What are your problems?"When I was the director ofa state venereal disease control programand had over 30,000 new casesof syphilis reported in a year and over30,000 persons under treatment forthis disease, it was possible to answersuch a question concisely. Now the answeris not easy because you don'tget very far if you answer, "My problemis the need for $2,000,000 to betterhandle ten or twenty or more problems."Sometimes people seem more interestedin buildings than the peopleworking in them. I congratulate youon the new building that you havegotten for the health department herein Raleigh but I know that my oldfriend, Dr. Norton, will agree withthe old Chilean proverb "The bird ismore important than the cage." Theproblem of keeping well trained, experiencedand competent personnel by