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Tendencies in Health Education*†
BUREAU OF DENTAL HEALTH EDUCATION
TENDENCIES IN HEALTH EDUCATION* By FRANK L. RECTOR,t B. S., M . D., Chicago, 111.
W
H E N the average person ap proaching middle life thinks o f health education, there rises be fore him the memory o f a textbook on physiology in which the various anatomic and physiologic systems were more or less indifferently discussed. A t the end of each chapter was a section on the effect of alcohol and tobacco on the human body, particularly on the grow ing child. Food was usually dismissed with a short para graph, and such questions as fresh air, sleep, diet and personal hygiene were either not discussed at all or mentioned only casually and in most indefinite terms. Personal hygiene discussions were a series o f “ do-nots” rather than positive directions for right living. T oday, this is all changed. N ot only school textbooks but newspapers, maga zines, advertisements and the daily mail are filled with a large and varied assort ment of health education material. T h e w orld was never so well informed-— and misinformed— on health matters as it is today. People in all walks of life, from the highest to the lowest, are appealed to in matters relating to their personal and collective well-being. *R ea d b e fo r e the Section on M ou th H y g ien e and P re v e n tiv e D en tistry at the S ixty-N inth A n n u al Session o f the A m e rica n D en tal A s s o ciation , D e tro it, M ich ., Oct. 25, 1927. fE d ito r , T h e N a tio n ’s H ea lth . Jour. A . D . A ., June,
1928
W h en the modern era o f health educa tion began, there was a gradual change from the enforcement of laws and regu lations applying to the control o f infec tious and contagious diseases, which up to that time had constituted the end and aim o f health work, to an effort to im prove the health of the adult group. Experience soon showed this to be a diffi cult task, as have been all other forms of adult education. By the time maturity is reached, habits o f all kinds are quite firmly fixed, and little progress can be made in changing them. A n adult may change his ways o f living under the stress of an emergency, but, as soon as possible, he w ill revert to his form er mode of life. Next, some sporadic attempts were made to introduce health teaching into colleges and higher classes in public schools. T his was usually tagged with a physical education label and, in many instances, resulted in the development o f a winning athletic team, with the rank and file absorbing their health teaching from the side lines and bleachers. It is only within the past few years that serious effort has been made to in corporate the teaching o f health subjects in the common school curriculum. T o day, hardly more than a beginning has been made, although sufficient evidence has been brought to light to show that even the public school pupils are not the
1153
1154
T h e Journal of the American D en tal Association
ones on whom to concentrate for most effective results. In the preschool groups lies the greatest hope for proper health education. A t least, the w ork must be begun in this group if satisfactory results are to be obtained in the school period. In considering the preschool group, the excellent w ork o f the parent-teacher associations in the summer “ round-up” should be mentioned. T h e objective o f this activity is to see that every child entering school for the first time w ill do so after having a physical examination and as far as possible having all defects corrected. In the entire country, tens o f thousands o f children are now enter ing school in the best possible physical condition, where, a few years ago, no attention was given to their health.
can be taught in reading, writing, arith metic, geography, spelling, history, gram mar, music, draw ing; in fact, no branch o f common school education but lends itself to this application. O ne of the most effective ways o f im pressing health facts on a child’s mind is to have him develop some pictorial scheme o f his idea. T h e poster is one o f the most effective means for driving home health lessons, and, in many cases, most striking health ideas have been devel oped. Posters have the advantage of simplicity and easily available materials for their construction. T h e work of C. Carroll Smith, school dentist of Peoria, 111., in health education by means o f posters is familiar to you all and is worthy of high commendation.
T h e health of the preschool group can be materially affected by prenatal health work. It has been said that health edu cation, to be really effective, must begin with the grandparents. T his w ill not be possible until our present public school group attains to that dignified state. T h e present generation o f parents is too indifferent to health problems to offer much hope and help. T hey belong to the unteachable adult group referred to pre viously. T h eir children are teaching them rather than they teaching their children.
I am sure that you w ill all see ready and interesting ways in which the teach ing of health can be applied both in the common school subjects and in original poster w ork as above suggested. T h e greatest drawback to the application of these principles is the lack o f qualified teachers to do the work. Before it will be possible to make proper advancement in health education, it will be necessary to educate the teachers. T hey must be taught health before they can teach it to those under their care. A nd so the most pressing problem in connection with this w ork is to find ways and means o f get ting the necessary health information across to the teachers and those now in preparation for this work. T h e attack should be directed at the normal schools and teachers’ training institutions.
T h ere is a tendency in some educa tional quarters to overemphasize the teaching of health, to set it up as a sepa rate subject in the course o f study and have it presented by a teacher specially trained in the work. T his, I think, is wrong. I f there is anything in the scheme o f education that deserves practical every-day application, it is this subject of health. T here is already too much over crow ding o f the curriculum with spe cialized subjects that should find a place in the usual branches. Health lessons
T h e public has almost a surplus of general and popular information poured into it from every side. Even the profes sional health workers are years behind in putting into effect the information al ready available regarding personal and community health. W h a t is needed is
Bureau o f D ental H ealth Education not more information, but ways and means of applying what we have. In the control of communicable dis eases lies the greatest hope o f health bet terment among children. Smallpox, typhoid and especially diphtheria can be controlled to the point o f practical ex tinction. In some cities, notably Auburn, N . Y ., there has not been a death from diphtheria in more than three years. Other cities have records almost as good. A n intensive effort is being made to rid the State of N ew Y ork o f diphtheria by 1930, and the state health commissioner reports most encouraging progress in this work. Scarlet fever control is apparently just around the corner, using methods com parable to those found so valuable in diphtheria. Measles is being attacked vigorously, with hopeful progress in sev eral laboratories. W e all know that the common con tagious diseases of childhood leave pro longed if not permanent disability in their wake. Heart disease is one o f the more common end results of these infec tions. Just how much cancer, nephritis, cerebral hemorrhage and other degenera tive diseases depend on the common con tagious diseases in early life we do not know. But we are aware o f the fact that if the child is protected from such dis eases in early life, he stands a better chance of living out his allotted span than does the child not so protected. One of the largest problems is to ob tain the fullest possible cooperation of parents in having their children protected against these diseases. Once that is ac complished, the other items on the health education list will be of comparatively easy application. It has been said that “ if we know, we are already half way toward our g o a l;
1155
if we know how to apply what we know, we have traveled three-fourths o f the distance; but unless we are willing to work whole-heartedly we shall never reach the journey’s end.” In no instance does this apply more than in health edu cation work. A w ord about the vast amount o f socalled “ popular” health education may not be amiss. Earlier in this discussion, the use of newspapers, magazines and similar vehicles for the spread of infor mation on health subjects was indicated. M uch of this material is propaganda, often o f a sinister kind. I hesitate to think o f what the human race would come to were we to heed all the advice of renowned “ experts,” many o f whom have responsible scientific and university connections, regarding food, clothing, etc., that is offered for the taking. If we drank all the liquids, from milk to carbonated beverages, if we ate all the varieties of soups, meats, fruits, vege tables, desserts and other foods, if we wore all the types o f under-garments and shoes that are recommended as vitally necessary to continued existence, not only would life be one continued round of tor ment and discomfort, but it would cer tainly be necessary to take the fifty-seven varieties of laxatives and cathartics which greet you from billboard and printed page, in order to maintain a semblance o f normal physiologic function. Then, after all this excellent advice had been follow ed for a sufficient length of time, it would be necessary to call in the family doctor to set you on your feet again. W hat an excellent prospect to contem plate under the guise o f health education ! In this picture, we have left out the marvelous health giving properties of cosmetics and dental preparations. It is a formidable list to contemplate. In fact, it is awe inspiring to see the lengths
1156
T he Journal o f the American D en ta l Association
to which “ health education” has been carried in the commercial world. O n the other hand, it goes to show that the idea of health has taken deep root in our national consciousness; which makes all the more necessary the proper training of our children in this subject. W e are living in an age of speed. Socially and scientifically, we have de veloped much faster and farther than we have biologically. Frederick P. Keppel, president o f the Carnegie Corporation, has asked if man has not “ reached the stage where he has a great deal more knowledge and power over inanimate nature, more power over his environ ment and understanding of his environ ment than he has knowledge o f himself and of his relations among his own kind ?” H e goes on to say: “ I do not think it is a fantastic thing to say that science and industry can hardly dare to go very much farther in wresting the secrets o f nature before we are confident
that mankind as a whole can be trusted with them.” Here, then, is a challenge to health education. I f such mighty forces await domination and use, surely no race of physical or mental weaklings can hope to cope with them successfully. M a n ’s in tellect is what has set him apart from other members of the animal kingdom and made him what he is today. But if his intellectual development has enabled him to discover forces that threaten his physical well-being, it is high time that effort be concentrated on fortifying him against self-destruction. A nd this is what health education does when it is brought into play in its most practical sense. T h e future is bright for a better race. T h e raw material in the shape o f new born lives is a constant supply. T h e satis faction o f having a part in this effort should spur on all those having a real desire to be o f service to their fellow men.
THE NURSE AND TEACHER IN A PUBLIC HEALTH DENTAL PROGRAM* By WILLIAMIR. DAVIS, A .B ., D.D.S.,f Lansing, Mich.
D
U R I N G the past year, as I was filling engagements in various parts of M ichigan, I carried an outfit for making a careful examination, with mouth mirror and explorer, o f one school room in a community. T his pro cedure was valuable for several reasons. *R e a d b e fo re the Section on M ou th H y g ien e and P re v e n tiv e D en tistry at the SixtyN inth A n n u a l Session o f the A m e rica n D en tal A ssociation , D etroit, M ich ., O ct. 26, 1927. fD ir e c to r , B ureau o f M ou th M ich ig a n D ep artm en t o f H ealth.
H ygiene,
It provided the best kind of opportunity to show adults present just what mouth conditions exist and to teach them the facts that they need to know about mouth hygiene. It gave a good crosssection of conditions, and later examina tions w ill show whether our program is accomplishing real results. It also pro vided first hand facts right in their own community to present before organiza tions that we were to address in that community. W e chose second grades because the first permanent molars had erupted, and
TENDENCIES IN HEALTH EDUCATION* By FRANK L. RECTOR,t B. S., M . D., Chicago, 111.
W
H E N the average person ap proaching middle life thinks o f health education, there rises be fore him the memory o f a textbook on physiology in which the various anatomic and physiologic systems were more or less indifferently discussed. A t the end of each chapter was a section on the effect of alcohol and tobacco on the human body, particularly on the grow ing child. Food was usually dismissed with a short para graph, and such questions as fresh air, sleep, diet and personal hygiene were either not discussed at all or mentioned only casually and in most indefinite terms. Personal hygiene discussions were a series o f “ do-nots” rather than positive directions for right living. T oday, this is all changed. N ot only school textbooks but newspapers, maga zines, advertisements and the daily mail are filled with a large and varied assort ment of health education material. T h e w orld was never so well informed-— and misinformed— on health matters as it is today. People in all walks of life, from the highest to the lowest, are appealed to in matters relating to their personal and collective well-being. *R ea d b e fo r e the Section on M ou th H y g ien e and P re v e n tiv e D en tistry at the S ixty-N inth A n n u al Session o f the A m e rica n D en tal A s s o ciation , D e tro it, M ich ., Oct. 25, 1927. fE d ito r , T h e N a tio n ’s H ea lth . Jour. A . D . A ., June,
1928
W h en the modern era o f health educa tion began, there was a gradual change from the enforcement of laws and regu lations applying to the control o f infec tious and contagious diseases, which up to that time had constituted the end and aim o f health work, to an effort to im prove the health of the adult group. Experience soon showed this to be a diffi cult task, as have been all other forms of adult education. By the time maturity is reached, habits o f all kinds are quite firmly fixed, and little progress can be made in changing them. A n adult may change his ways o f living under the stress of an emergency, but, as soon as possible, he w ill revert to his form er mode of life. Next, some sporadic attempts were made to introduce health teaching into colleges and higher classes in public schools. T his was usually tagged with a physical education label and, in many instances, resulted in the development o f a winning athletic team, with the rank and file absorbing their health teaching from the side lines and bleachers. It is only within the past few years that serious effort has been made to in corporate the teaching o f health subjects in the common school curriculum. T o day, hardly more than a beginning has been made, although sufficient evidence has been brought to light to show that even the public school pupils are not the
1153
1154
T h e Journal of the American D en tal Association
ones on whom to concentrate for most effective results. In the preschool groups lies the greatest hope for proper health education. A t least, the w ork must be begun in this group if satisfactory results are to be obtained in the school period. In considering the preschool group, the excellent w ork o f the parent-teacher associations in the summer “ round-up” should be mentioned. T h e objective o f this activity is to see that every child entering school for the first time w ill do so after having a physical examination and as far as possible having all defects corrected. In the entire country, tens o f thousands o f children are now enter ing school in the best possible physical condition, where, a few years ago, no attention was given to their health.
can be taught in reading, writing, arith metic, geography, spelling, history, gram mar, music, draw ing; in fact, no branch o f common school education but lends itself to this application. O ne of the most effective ways o f im pressing health facts on a child’s mind is to have him develop some pictorial scheme o f his idea. T h e poster is one o f the most effective means for driving home health lessons, and, in many cases, most striking health ideas have been devel oped. Posters have the advantage of simplicity and easily available materials for their construction. T h e work of C. Carroll Smith, school dentist of Peoria, 111., in health education by means o f posters is familiar to you all and is worthy of high commendation.
T h e health of the preschool group can be materially affected by prenatal health work. It has been said that health edu cation, to be really effective, must begin with the grandparents. T his w ill not be possible until our present public school group attains to that dignified state. T h e present generation o f parents is too indifferent to health problems to offer much hope and help. T hey belong to the unteachable adult group referred to pre viously. T h eir children are teaching them rather than they teaching their children.
I am sure that you w ill all see ready and interesting ways in which the teach ing of health can be applied both in the common school subjects and in original poster w ork as above suggested. T h e greatest drawback to the application of these principles is the lack o f qualified teachers to do the work. Before it will be possible to make proper advancement in health education, it will be necessary to educate the teachers. T hey must be taught health before they can teach it to those under their care. A nd so the most pressing problem in connection with this w ork is to find ways and means o f get ting the necessary health information across to the teachers and those now in preparation for this work. T h e attack should be directed at the normal schools and teachers’ training institutions.
T h ere is a tendency in some educa tional quarters to overemphasize the teaching of health, to set it up as a sepa rate subject in the course o f study and have it presented by a teacher specially trained in the work. T his, I think, is wrong. I f there is anything in the scheme o f education that deserves practical every-day application, it is this subject of health. T here is already too much over crow ding o f the curriculum with spe cialized subjects that should find a place in the usual branches. Health lessons
T h e public has almost a surplus of general and popular information poured into it from every side. Even the profes sional health workers are years behind in putting into effect the information al ready available regarding personal and community health. W h a t is needed is
Bureau o f D ental H ealth Education not more information, but ways and means of applying what we have. In the control of communicable dis eases lies the greatest hope o f health bet terment among children. Smallpox, typhoid and especially diphtheria can be controlled to the point o f practical ex tinction. In some cities, notably Auburn, N . Y ., there has not been a death from diphtheria in more than three years. Other cities have records almost as good. A n intensive effort is being made to rid the State of N ew Y ork o f diphtheria by 1930, and the state health commissioner reports most encouraging progress in this work. Scarlet fever control is apparently just around the corner, using methods com parable to those found so valuable in diphtheria. Measles is being attacked vigorously, with hopeful progress in sev eral laboratories. W e all know that the common con tagious diseases of childhood leave pro longed if not permanent disability in their wake. Heart disease is one o f the more common end results of these infec tions. Just how much cancer, nephritis, cerebral hemorrhage and other degenera tive diseases depend on the common con tagious diseases in early life we do not know. But we are aware o f the fact that if the child is protected from such dis eases in early life, he stands a better chance of living out his allotted span than does the child not so protected. One of the largest problems is to ob tain the fullest possible cooperation of parents in having their children protected against these diseases. Once that is ac complished, the other items on the health education list will be of comparatively easy application. It has been said that “ if we know, we are already half way toward our g o a l;
1155
if we know how to apply what we know, we have traveled three-fourths o f the distance; but unless we are willing to work whole-heartedly we shall never reach the journey’s end.” In no instance does this apply more than in health edu cation work. A w ord about the vast amount o f socalled “ popular” health education may not be amiss. Earlier in this discussion, the use of newspapers, magazines and similar vehicles for the spread of infor mation on health subjects was indicated. M uch of this material is propaganda, often o f a sinister kind. I hesitate to think o f what the human race would come to were we to heed all the advice of renowned “ experts,” many o f whom have responsible scientific and university connections, regarding food, clothing, etc., that is offered for the taking. If we drank all the liquids, from milk to carbonated beverages, if we ate all the varieties of soups, meats, fruits, vege tables, desserts and other foods, if we wore all the types o f under-garments and shoes that are recommended as vitally necessary to continued existence, not only would life be one continued round of tor ment and discomfort, but it would cer tainly be necessary to take the fifty-seven varieties of laxatives and cathartics which greet you from billboard and printed page, in order to maintain a semblance o f normal physiologic function. Then, after all this excellent advice had been follow ed for a sufficient length of time, it would be necessary to call in the family doctor to set you on your feet again. W hat an excellent prospect to contem plate under the guise o f health education ! In this picture, we have left out the marvelous health giving properties of cosmetics and dental preparations. It is a formidable list to contemplate. In fact, it is awe inspiring to see the lengths
1156
T he Journal o f the American D en ta l Association
to which “ health education” has been carried in the commercial world. O n the other hand, it goes to show that the idea of health has taken deep root in our national consciousness; which makes all the more necessary the proper training of our children in this subject. W e are living in an age of speed. Socially and scientifically, we have de veloped much faster and farther than we have biologically. Frederick P. Keppel, president o f the Carnegie Corporation, has asked if man has not “ reached the stage where he has a great deal more knowledge and power over inanimate nature, more power over his environ ment and understanding of his environ ment than he has knowledge o f himself and of his relations among his own kind ?” H e goes on to say: “ I do not think it is a fantastic thing to say that science and industry can hardly dare to go very much farther in wresting the secrets o f nature before we are confident
that mankind as a whole can be trusted with them.” Here, then, is a challenge to health education. I f such mighty forces await domination and use, surely no race of physical or mental weaklings can hope to cope with them successfully. M a n ’s in tellect is what has set him apart from other members of the animal kingdom and made him what he is today. But if his intellectual development has enabled him to discover forces that threaten his physical well-being, it is high time that effort be concentrated on fortifying him against self-destruction. A nd this is what health education does when it is brought into play in its most practical sense. T h e future is bright for a better race. T h e raw material in the shape o f new born lives is a constant supply. T h e satis faction o f having a part in this effort should spur on all those having a real desire to be o f service to their fellow men.
THE NURSE AND TEACHER IN A PUBLIC HEALTH DENTAL PROGRAM* By WILLIAMIR. DAVIS, A .B ., D.D.S.,f Lansing, Mich.
D
U R I N G the past year, as I was filling engagements in various parts of M ichigan, I carried an outfit for making a careful examination, with mouth mirror and explorer, o f one school room in a community. T his pro cedure was valuable for several reasons. *R e a d b e fo re the Section on M ou th H y g ien e and P re v e n tiv e D en tistry at the SixtyN inth A n n u a l Session o f the A m e rica n D en tal A ssociation , D etroit, M ich ., O ct. 26, 1927. fD ir e c to r , B ureau o f M ou th M ich ig a n D ep artm en t o f H ealth.
H ygiene,
It provided the best kind of opportunity to show adults present just what mouth conditions exist and to teach them the facts that they need to know about mouth hygiene. It gave a good crosssection of conditions, and later examina tions w ill show whether our program is accomplishing real results. It also pro vided first hand facts right in their own community to present before organiza tions that we were to address in that community. W e chose second grades because the first permanent molars had erupted, and