Governmental Role in Public Health

History of U.S. Governmental Public Health

Organized governmental public health activities in the United States date from colonial times. Officials of the Massachusetts and Plymouth colonies mandated the recording of all births and deaths as early as 1639. The Massachusetts Bay Colony passed a law prohibiting the pollution of the Boston Harbor in 1647; other localities similarly created ordinances restricting activities perceived as dangerous to the health of the population, including laws to isolate people with infectious diseases and to quarantine ships in the harbors. However, there were often no effective governmental organizations to enforce the laws that were put in place.

Permanent boards of health were established in cities of the new United States of America as early as 1780, and scientific discoveries about the nature and transmission of disease provided a framework for their decisions to improve community health. However, for many years these boards were voluntary committees with no administrative staff to carry out their mandate to oversee the protection of water supplies and elimination of health hazards. Local health departments with staff began to appear at intervals in the larger cities (Baltimore in 1798, Charleston in 1815, Philadelphia in 1818, Providence in 1832, Cambridge in 1846, New York in 1866, Chicago in 1867, Louisville in 1870, Indianapolis in 1872, Boston in 1873). County health departments, with responsibility for the rural as well as the urban areas, did not begin to appear until 1911.

In 1850, a committee headed by Lemuel Shattuck published the Report of the Sanitary Commission of Massachusetts, calling for the establishment of state boards of health staffed by professional sanitary inspectors. The report also recommended laws and systems to collect data on the population and control the sources of disease transmission, programs to address social problems that affected community health, and improved training of medical personnel. Massachusetts then established the first permanent State Board of Health and State Health Department in 1869.

The earliest federal efforts in public health focused on preventing the transmission of disease via the nation's seaports through a system of Marine Hospitals and a National Quarantine Convention. A National Board of Health was created in 1879, but was only authorized for 4 years and was allowed to expire in 1883. The national Public Health Service was permanently established in 1902, and evolved over the years into the current U.S. Department of Health and Human Services.

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