The People Win for Public Health
in Colorado’
FLORENCE R. SABIN, M.D.

Chair

man, Subcommittee on Health, Colorado Post-War Planning Committee,

Denver, Colo.

\VQO years ago the State Government

in Colorado had only one interest
‘nits Division of Public Health;
namely, that it was one more place in
which to try to force political appoint-
ments. Moreover, the Denver city
machine had had a remarkably suc-
cessful record in defeating health bills
in the legislature. The machine had only
to pass the word down the line to kill
health bills, and they were killed.

Now, what a change! There is a new
Governor, Lee Knous, who campaigned
for good government and specifically
for a health program, and is enthusiasti-
cally carrying out his pledges. On May

20, 1947, an election in Denver brought _

into office a new Mayor-elect, Quigg
Newton, a young man who ran, without
benefit of party, against government by
political machines. He won more votes
than all four other candidates together.
He understands the fundamental prin-
ciples of the movement; he wants, just
as eagerly as informed citizens, a mod-
ern, professionally staffed health depart-
ment, and a strengthened medical school
for training physicians for both curative
and preventive medicine—indeed a true
medical center for the Rocky Mountain
region. No wonder Coloradoans walk
on air and talk of health to match their
mountains! They have won the decisive
battles of their campaign and now have
only to get on with the business of pub-

 

the woe at the Fourteenth Annual Meeting of
ne estern Branch, American Public Health Asso-
‘ation, San Francisco, May 28, 1947.

lic health in Colorado. As a matter of
fact, recent history has even more
significance than any one cause, how-
ever vital, for it has shown that under
our American form of government when-
ever our people really want good govern-

ment they can have it.

The story of the health program is as
follows: In 1945 the Governor of Colo-
rado appointed a Health Committee as
part of a post-war planning program
and was then persuaded by this com-
mittee, by. the State Division of Public
Health, and the Colorado Public Health
Association, to ask for a health survey -
of the state. By great good fortune, the
American Public Health Association
was able to undertake a survey through
a grant from the Commonwealth Fund,
and its Field Director, Dr. Carl E.
Buck, came to study conditions.

Dr. Buck made a masterly report. He
studied the vital statistics of the State
Health Division, analyzed and arranged
the data until they told a vivid story
of the state’s health deficiencies. He
found that the State Health Division
was badly placed in the government,
being a division under the Governor in-
stead of a department, and that it had
been subject to repeated attempts. at
political control. He found that the
division had an able director and a
small but well. chosen professional staff;
however, state appropriations were piti-
fully small—less than 10 cents per per-
son per year—so that the division would
have had almost nothing had it not been

£1311]
1312

for generous federal grants; that the
City of Denver, by a curious archaic
charter, was a. so-called “Home Rule
City” beyond the reach of modernizing
influences from the state; and that of
the 63 counties only 4 had full-time
health services. Dr. Buck’s report re-
vealed the short-comings, pointed out
the reasons for them, and made what
proved to be expert recommendations
for their correction,

Two different types of work were then
started, both closely correlated with
each other; first, the organization of an
executive committee for intensive study
of the report and for drawing up the
bills to be presented to the legislature;
and second, the carrying of Dr. Buck’s
report and of all the Health Committee’s
plans as they developed directly to the
people of the state.

An executive committee, authorized
by the large general committee, had
many long conferences. Most of them
were at dinner meetings. At each
meeting were invited guests who were
either representatives of groups that
would be affected by the proposed de-
velopment of health services, or experts
who could help with special knowledge
and advice. Thus opposition was fore-
stalled in advance. Civil Service Com-
missioners were also invited to discuss
common interests.

One of the outstanding achievements
of the program was the full coéperation
between the State Medical Society,
reaching all the doctors in the state, and
the various public health agencies. Two
members of the Public Policy Committee
of the State Medical Society became
members of the Health Committee and
made a liaison between the two groups.
Common bills were presented to the
legislature, jointly drawn and jointly
sponsored. Indeed the Medical Society
gave up its tax-exempt status and in-
creased its dues that it might support
an active lobby.

Another important success in the

AMERICAN JOURNAL

oF PuBLic HEALTH Oct., 1947
health program is that support of the
dairy industry was won for health in.
spection. Like the dairy group in some
other states, the group in this state had
long feared and fought health inspection
of its industry. Many conferences were
held with them which were indeed in.
itiated at a luncheon to which they in.
vited the Health Chairman. She was
bumptious enough to ask them why they
fought the program, and invited them
to have a representative on the Health
Conimittee. He gave much help and
arranged conferences with members of
the Dairy Association, and with all the
experts on the subject of milk in Colo-
rado, both from the federal and state
groups. Full agreement was reached on
the need for higher standards and im.
proved practices for production and for
processing of milk and milk products,
but the dairy industry wanted to have
it designated by law that a dairyman
must be on the Board of Health to ‘ep:
resent the industry. The Health Conr
mittee refused to accept the principle of
representation of any group by law. The
point was won in the legislature, much

‘to the committee’s surprise. The con

mittee was not opposed to the choice of
a dairyman for the Board of Health—
indeed the Governor appointed both a
producer and a processor. Now the Suvte
Department of Health and the dairy
dustry will work together with good will
to a common purpose. This is an inter
esting example of a method of dealing
with a controversial issue of long
standing; namely, extended discussion
to separate the many details on whi
adjustments can be made from the er
few principles, or perhaps only one. "
critical for compromise.
When the committee é
the study of the report and its
mendations, it started to formulate os
proposed bills. Fortunately able 47 wrt
perienced legislators and attorneys had
members of the committee. It alse “
the invaluable aid of an ator’.

had completed
recom:
e the
pa

Hubert Henry, Chairman on Health of
vne Interim Committee of the Legisla-
ne together with the help of the able
ae tar of the: Legislative Reference
reat, Clair Sippel. The bills were
drawn in advance So that preliminary
nies could be sent to the county chair-
nen and so that they could be intro-
uced early jn the session.

The winning of popular support for
the program was crucial to its success.
since this was a state program, popular
education was started in the counties.
ir. Buck helped to organize the first

inter-county meeting. Indeed, every .

county, meeting drew its audience from
at least two or more counties. This was
always highlighted by definite identifi-
cation of each county group. It will be
remembered that distances are great in
Colorado; people drove 75 to 100 miles
to meetings. They had been shocked by
the complete defeat of the health bills
in the last session of the legislature and
so were ready to listen. At the early
meetings, Dr. Buck with the help of a
blickboard, let the facts about the ap-
palling death rates from preventable
and controllable disease sink in as the
audience listened to the speakers. He
showed how essential participation by
the audience was to a program.

The committee had no state appro-
priation for its work but the Division
of Health received the approval of Dr.
red T. Foard, Regional Director of the
U.S. Public Health Service, to use fed-
eral funds, This, together with a grant
from the Colorado State Tuberculosis
Association, enabled the committee to
have an executive secretary. Herbert
Moe organized the meetings and was
always able to attract an audience eager
to hear the story of Colorado’s public
health. One member of the committee
had wide acquaintance all over the state
and was able to find local citizens who
could lead their communities. Persons
Were chosen as individuals rather than
as Tepresentatives of organizations. At

. Pustic HEALTH IN COLORADO

1313

first each name had to be submitted to
the Governor, but he was finally per-
suaded to give the committee a free
hand. Teams recruited from the State
Division of Public Health, the medical
school, the public health physicians of
the public schools, and other groups were
provided for each meeting. Dr. Roy L.
Cleere, Director of the State Division,
took to each county data concerning
the local problems, and showed how
close should be the codperation between
state and county health services. There
were no prepared speeches but new data
as developed in the executive committee,
were taken to each meeting. A second
meeting in a given place always brought
the comment, “How your program is
growing.”

The committee did not itself organize
action in any group but merely pre-
sented data on conditions, local and
state, and showed what public health
services could accomplish. Initiation for
action was left to the people themselves.
As a method, it is the exact opposite to
the building of a political machine; it
leaves one less sure of results, but with
a more lasting foundation. Each local
group took up some problem of its own.
The first response was in a town where
the raw sewage was going into the river
and the Mayor soon started a fund for
a disposal plant.

In one town the women said that they
could see so much dirt in the milk that
they did not use it at all. Within a few
days the very efficient Supervisor of
Nurses and the City Manager of the
town with ten women met with the com-
mittee in Colorado Springs. El Paso
County has an exceptionally efficient
milk inspector, really a public health
educator—and had developed there a
milk supply that is both clean and safe.
The group saw a perfectly run dairy—
run by a woman, I am pleased to say—
and a pasteurizing plant that is the last
word in excellence. As a result, the town
in question now has good pasteurized
1314
milk shipped in by two companies and
a local dairy is putting in a pasteurizing
plant. The dairy industry might take
notice that public health services are
good unpaid advertising agencies, when
milk is made both clean and safe. None
of the groups did just the same type of
work, but all supported the state pro-
gram and all enjoyed the prestige of
working as a Governor’s Committee. One
group worked politically and reported
that all candidates who were against the
health movement were defeated and all
who were for it elected.

Another phase of the work that has
aroused great enthusiasm and rivalry in
the state is the federal hospital pro-
gram. Dr. Foard assigned two members
of his staff, Dr. Le Grand Byington and
Dr. H. T. Wagner, to make a survey
of the hospitals; a medical social worker

.from the State Division of Public
Health, Helen Cannon, visited every
hospital to aid in making out the sched-
ules for the Commission on Hospital
Care.

As evidence of the interest of the
people of Colorado in the health move-
ment, it is now many months since the
committee has itself organized a
meeting. Rather, every meeting has
been on invitation, and speakers have
gone to clubs and other groups all over
the state. Committee members have
spoken, it would seem, to almost every
club in the state, both men’s clubs and
women’s clubs. Many of the women’s
clubs have made the health program
their special work for the year; for ex-
ample, the American Association of Uni-
versity Women and the Parent-Teachers
Association in every town where they
are organized. In addition, the Women’s
City Clubs, political clubs, the League
of Women Voters, and the Federation
of Women’s Clubs have all given skilled
help. The Chambers of Commerce of
the cities have heard about the health
program, as well as many Kiwanis and
Rotary groups. The Junior Chamber of

AMERICAN JOURNAL OF PuBLIC HEALTH

Oct., 1947

Commerce and the Isaac Walton League

“have actively worked for the program.

Groups of lawyers, ministers, college,
university, and church groups have been
addressed. During the weeks before

-election the author spoke about twice

a day, occasionally three times.

Nor has Denver been neglected, nor
have the people of Denver failed to hear
of the deficiencies of their so-called
Health Department. Both newspapers
in Denver, as well as the county papers,
and the radio gave unstinted support
to the new era in health. After election

-it was planned to let every legislator

hear of the health bills in his home town.
The result was summed up in one
sentence by one of the prominent legis-
lators who said, “We all knew in advance
that this time we had to pass the health
bills.” The people of Colorado had
willed it so.

What bills were introduced? Eight
bills in all were presented, each one in-
troduced to the legislature under spon-
sorship of the committee. There were
two groups of bills, five bills setting up
services for health and appropriations
for them, and three bills for controlling
special diseases. The first two bills con-
cerned public health services.

The State Reorganization Bill created
a new Department of Public Health.
with a Board of Health and an Execu-
tive Division. The Board of Health wa
to be of nine members appointed by the
Governor in such manner that no bus
ness or professional group would con
stitute a majority. This concession was
made by the doctors. The bill gave '°
the new department powers adequate "
meet its responsibilities in improvine
the health of the state. Some opposition
to this bill developed in the Senate. ~
only from a certain group of the ana
arts, who did not so much oppose t .
bill, but sought to place riders 07 ©
to gain advantages or escape pe
tions for their cult. Hard work defeat’
these proposed amendments. The seco
1314

milk shipped in by two companies and
a local dairy is putting in a pasteurizing
plant. The dairy industry might take
notice that public health services are
good unpaid advertising agencies, when
milk is made both clean and safe. None
of the groups did just the same type of
work, but all supported the state pro-
gram and all enjoyed the prestige of
working as a Governor’s Committee. One
group worked politically and reported
that all candidates who were against the
health movement were defeated and all
- who were for it elected.

Another phase of the work that has
aroused great enthusiasm and rivalry in
the state is the federal hospital pro-
gram. Dr. Foard assigned two members
of his staff, Dr. Le Grand Byington and
Dr. H. T. Wagner, to make a survey
of the hospitals; a medical social worker

_from the State Division of Public
Health, Helen Cannon, visited every
hospital to aid in making out the sched-
ules for the Commission on Hospital
Care.

As evidence of the interest of the
people of Colorado in the health move-
ment, it is now many months since the
committee has itself organized a
meeting. Rather, every meeting has
been on invitation, and speakers have
gone to clubs and other groups all over
the state. Committee members have
spoken, it would seem, to almost every
club in the state, both men’s clubs and
women’s clubs. Many of the women’s
clubs have made the health program
their special work for the year; for ex-
ample, the American Association of Uni-
versity Women and the Parent-Teachers
Association in every town where they
are organized. In addition, the Women’s
City Clubs, political clubs, the League
of Women Voters, and the Federation
of Women’s Clubs have all given skilled
help. The Chambers of Commerce of
the cities have heard about the health
program, as well as many Kiwanis and
Rotary groups. The Junior Chamber of

AMERICAN JOURNAL. OF PuBLIC HEALTH

Oct., 1947

Commerce and the Isaac Walton League
have actively worked for the program,
Groups of lawyers, ministers, college,
university, and church groups have been
addressed. During the weeks before
election the author spoke about twice
a day, occasionally three times.

Nor has Denver been neglected, nor
have the people of Denver failed to hear
of the deficiencies of their so-called
Health Department. Both newspapers
in Denver, as well as the county papers.
and the radio gave unstinted support
to the.new era in health. After election

.it was planned to let every legislator

hear of the health bills in his home town.
The result was summed up in one
sentence by one of the prominent lesis-
lators who said, “We all knew in advance
that this time we had to pass the health
bills.” The people of Colorado had
willed it so.

What bills were introduced? Eight
bills in all were presented, each one !n-
troduced to the legislature under spon-
sorship of the committee. There were
two groups of bills, five bills setting Up
services for health and appropriation:
for them, and three bills for controlling
special diseases. The first two bills ¢--
cerned public health services. 4

The State Reorganization Bill creat’
a new Department of Public Health,
with a Board of Health and an Exec
tive Division. The Board of Health «+
to be of nine members appointed by the
Governor in such manner that no a
ness or professional group would oe
stitute a majority. This concession N
made by the doctors. The bill ga"
the new department powers adequate. a
meet its responsibilities in impr”
the health of the state. Some oppo"
to this bill developed in the Seno

: cant
only from a certain group of the et
arts, who did not so much Opp’
bill, but sought to place riders tte
to gain advantages or escape defeat”
tions for their cult. Hard work O° 01
these proposed amendments. The
vel. 37

h bill was permissive legislation for
facilitating setting UP county, city

- and multiple-county health units.
ot these bills passed early in the
” a They were well drawn and are
‘worthy of study.
worth od bill for appropriations and,
is customary, was presented late in
the session with appropriations for all
divisions of government. The requests
were in two parts—one for the State
Department and the other for aiding
county units. These bills were given in-
tensive study by the appropriations
committee and, though no group ob-
tained all it asked for, the Health De-
sartment received funds adequate for
creat improvement of its services. The
erant for state aid to the counties was
raised from nothing to $150,000 for the
biennium.

The fourth bill was an enabling act
to meet the federal requirements for
participating in the new hospital con-
struction program. The fifth bill was
an appropriation bill for the medical
school. Under the new Dean, Dr. Ward
Darley, plans have been developed to
stress public health and the training of
more general practitioners, rather than
specialists. Dr. Darley also plans to have
a two or three year residency with the
last six months to be taken in the new
county hospitals. These plans are an
important advance in medical education
and the committee was glad to endorse
this program.

The three special bills were as fol-
lows: two were to lessen incidence of
tuberculosis, the third was to decrease
Bang’s disease in dairy cattle. The bills
in regard to tuberculosis were drawn by
the State and Denver Tuberculosis
Associations and endorsed by the
Health Committee. An increase in the
per diem allotment to hospitals of from
$4 to $6 for the care of indigent cases
Was obtained. It was hoped to obtain
Money for the construction of a new
Wing of 100 beds at the Colorado Gen-

bealt

as

PusLic HEALTH IN COLORADO

1315

eral Hospital under the direction of the
Medical School, but support was .won
for a 30 bed ward only. This will, how-
ever, aid in the development of chest
surgery in the state, place a number of
tuberculosis patients in a general hos-
pital, and help with the training of med-
ical students in this disease. It is a
minor gain, to be sure, and indicates
hard work ahead during the next session
of the legislature.

. The so-called Cow Health Bill was
the only complete defeat of the com-
mittee. It was drawn by a veterinarian
on the committee to check the sale of
dairy cows that are reactors to Bang’s
disease. It did not include compulsory
testing nor require slaughter, but simply
the quarantining and reporting of in-
fected cows. The bill was killed by the
livestock interests by having it referred
to the Livestock Committee where it
was permanently buried. Colorado’s im-
portant beef and dairy cattle industries
make the eradication of Bang’s disease
unusually difficult. The inter- as well
as intra-state shipment and sale of in-
fected animals complicates control
measures. This disease is a national
problem. Obyiously much study must be
given to the type of legislation needed,
and. much research..is. necessary. How .
do you account for the fact that a cow
may react negatively to the agglutina-
tion test and at the same time show a
positive blood culture? How effective is
calf vaccination? These are some of the
questions needing investigation.

The legislature adjourned in April.
Already the new State Department of
Public Health has been reorganized and

‘strengthened in accordance with mod-

ern practices. The department has been
asked to help four groups of counties to
plan new district health units. This is
entirely on the initiative of the counties
themselves. These are the first fruits of
the program giving the people them-
selves scope for exercising their own
initiative. —. ;
1316 AMERICAN JOURNAL

One of the meetings was especially
interesting. The new law provides that
the units are to be set up by vote of the
county commissioners. The commis-
sioners of five counties were present. All
of those who came from counties where
there had been any public health
nursing were enthusiastically for the
unit. A commissioner from the county
that had never had any service said that
temperamentally he had to express some
opposition against such unanimity of
opinion and for his part he was fearfully
worried lest swarms of public health
workers descend on his county and ask

oF Pusrtic HEeaLtH Oct., 1947
for jobs. He never knew how funny he
was, since the real worry was to find
even one public health worker for his
county. Personnel is now the major
problem in this state as it is everywhere.

All during the war years the now Ex-
Governor refused to authorize the use
of federal grants allotted to the Division
of Health to aid in training public health
workers. Thus we have no backlog of
personnel; we are developing a training
program, but the need is to set up new
services now. The people of Colorado
are enthusiastically for adequate public
health services.