Discuss the historical evolution of health promotion and disease prevention in the United States.

What will be an ideal response?

• In the 1700s, organized public health efforts were, for the most part, limited to individual cities and were focused on protection of the public from diseases introduced by travelers.
• In the 1840s (the era of “the great sanitary awakening”), problems of local sanitation were identified as a cause of disease, and public health efforts were focused on the improvement of social and environmental conditions; housing, water supply, and sewage disposal were all the focus of organized public health activities.
• In the 1900s, many of the sanitary threats were brought under control, and emphasis shifted to the prevention of disease to individual people; organized public health activities moved away from structural protection of food, water, sewage, and housing toward more personal and individual protection such as the immunization of children.
• As the twentieth century progressed, federal government activities began to grow, particularly with regard to specific health problems of children; the federal government began to take the lead in the development of special programs for children, funded primarily by federal funds but carried out by state health departments.
• In the 1950s, the federal government’s role (and funding supply to the state governments) expanded greatly with the passage of the Medicare and Medicaid programs and with the passage of the comprehensive Health Planning and Resource Development Act of 1974. These various acts shifted the central focus for conceptualizing and planning new public health approaches to the federal government; they also shifted the focus for funding these programs to the federal government and, to some smaller degree, to state governments, with local funding and conceptualizing becoming much less central.