Address
Dr. Florence R. Sabin, Chairman
Health Committee
Colorado State Post-War Planning Committee
delivered
Illinois Statewide Public Health Committee meeting
Stevens Hotel, Chicago, September 5, 1947

I think no one in your audience this afternoon enjoyed
herself as much as I did. I was so astonished at your progress,
I head long known of it and my first informant was none other than
Dr, Carl Buck. When he was making our survey in Colorado he
told of your committee and what you had done and I remember think-
ing--I wonder if we can follow in ise footsteps.

You are five years old. Our law was passed last Merch
so we are just five monthe old and that is a tremendous gap in
age and I beg you to keep it in mind and Pinta surprised at
the feebleness of our progress.

Think of the assets that you had, You had, in the
first place, @ strong public health department and a very able
leader. You hed, I am told, a Governor who was sympathetic with
the idea of public health for your state. You hed also, I am
told, a Mayor who was favorable to your progress.

We had in Colorado, in the first place, just one of
those assets. We had a strong and able man at the head of our
health department, Dr. Roy Cleere but he was woefully supported

yan the state. He had such an antagonistic government behind
him 1t was almost impossible to do say ching.

Wao Ww Ue ler
Our Governor disitked the ides pa f public | health so

ao C Cert. wrr_lleg.
he appointed "ne old lady" because he whe thought nothing would be

done, He appointed her to a post-war planning committees which
had_one meeting and then I thtnk-no more, I Wifht -heve—known-es
 

passive individual and just didn't want anything changed.
We had a Mayor in the city of Denver, eai@ Ben Stapleton,
who wae not & passive individusl. At the last legislature I was

told by one of the senators that old Ben had passed the word down
to kill the health bilis and they were killed. I heave never heard
him say why he was ageinst them. He wanted every single appoint-
ment for a politician and iée-heed-ef the so-called Denver Health
pi Seemed bt ¥wa38-manweo didn't even rate a mumber in the |
The Dees Dincelon OH ta dtl Ber ha velreg Jenene d
telephone directory. die -encws nothing about medicine in any
of its branches and that is what our city health department was.
Well, we had also another disadvantage. I am amazed
at your wealth. You are the seventh state in wealth. We are
not & poor state, we are just a little below average, but we hed
almost nothing to spend for publie health. We couldn't spend
money for a survey and it was most humiliating to have to ask for
an appropriation for a survey by Dr. Carl Buck. We had to have
outside money because we had so little interest in public health.
| What about our assets? In the first place, defeat
stirred people so they were interested to start and then we had
the report of Dr. Buck. I was told by ome of the civil service
commissioners that the report was destined to a bottom drawer in
a desk. We got several thousand copies mimeographed. The
governor said he never received one but the second me took

oO
with my own hands so I know that he did. Many people sew’ the

report so it waa no longer a secret.
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nr follows low

The principles you mentioned today, -- we sought
Qed Setunred —
leadership, we get, & very strong central executive committee.

f A fg Mehl aco
On this committee we had two senators and one representative, very
able lawyers, doctors, business men and women. We found one of
these members had a Vexfy wide acquaintance throughout the state
and he told us the people who had leadership in the different
areas, We went to them with our reports and asked them to
organize thelr communities. We gave no special instructions, but

oe be Wwe

We cave them material and made them quite independent in their
orreni zation.

We had one asset which I wish to stress for the moment.
This afternoon the question was bronent UE up: How far does the

Support Ruths tiatlts Lernrcig? bar Us
medical profession gs witkh-thie-tdes? In Colorado we had one

an tdienk frrtdeinn Wk Oe env @s proof of-wheat—the medical progfession
things, that I will tell y,ou-ebout, and that ts, the State Medical
Seciety raised its dues to a quite hendsome sum to fight for
the health services. How was this won? By the freest and

ote Cre Mme ~
in—some—of the -couns; p

frankest and-—open discussions
At one meeting, in order to get the discussions going, a leader
asked "What are the legitimate functions of a health department?
What can a health department do to establish an immunization

prorram?"” A doctor quickly arose and said “I knew what this

i nett

was about, its nothing but socialized medicine." The heetth ori fa,

haw i
commissioner addressed him saying: "Now Jack, you, just eame Corece-
into this meeting and I urge you to listen before forming an

opinion. I have listened to the whole story and in my opinion
~h

this ts what you ought to back as a buffer against socialized
tt
medicine. #hrte—tse-the-enswer.—t think you should know the

Whole § history,*

I remember in the early days when we first trained
public health officers back in 1917, many of them came back end
said the doctors don't want to have the reporting of tuberculosts
and you see how it came about, but that has gone and with us now
the doctors are proud of this specialty within their profession
and when they cease to say “your bills" and instead say “our
bills" we knew that the idea had been won.

No biological reaction is ever 100% and there is an
occasional doctor in Colorado who is fighting us. One doctor,
in answer to another doctor who was fighting the organization
of county public health units, said: "If we can clean up the
{slends in the Pacific, why not a city in Colorado?"

Now I want to speak of the methods that we used.

At each county meeting, and first I will say we had to organize
the first few county meetings since our counties are small we
made them all district meetings inviting people from adjacent
counties,The first meetings were conducted by Dr. Buck and myself
and then we secured 4 very efficient executive secretary who knew
the state of Colorado like a book who organized the next few
meetings. After that we have not organized meetings only on
invitation of the people themselves, the PIA, AAUW, all women's
clubs, Kiwanis, Lions clubs, in fact all men's clubs, and we have
had so many invitations some of us have spoken three and four

times a day.
.
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There is one fundamental point and that is the nature
of the subject matter. We have found it advisable to take to the
people their own local problems. Dr. Cleere usually took problems
from the record showing what their water or sewage disposal
 deftetencies were; to give you one example: a woman physiclan
eame to the office and asked us to come up and give a talk on

mile as their mayor would not allow pasteurized milk in the town.
We went there and talked about the valve of pasteurized milk.

In another town the women wouldn't use freee milk at

@ll because there was so much dirt in in it. In one county we hed a

. ft i) thew ‘Yaw TP.

prominent club womAn to-come-and see the whole process from the
Us. port” Lek,

cow to the pasteurizing plant. Now it hes two dairies that

send in pasteurized milk and the dairies are now building their
own pasteurizing plants.

Ue Cae ere fre ew ‘ti
teo-ret the week th aws through. Our laws went through with a

ber fee
We Sak people to study their locel problens., ‘medety

good deal of ease. They were prepered in advance, passed early
in the session with relatively little opposition, the-stuate
_health-department setting up strong “lewe-...

Our county health bill differe from yours in that it
is permissive legislation allowing county and multt ple county
units on vote of the county commissioner. If it is a single
county unit, the commissioners appoint @& board of members of
5, while a multiple county unit has a board of 7 members,

We were allowed $150,000 to start county units.

When we started there were just 4 of our 63 counties that had
health units and they had been supported because we had 4 strong
friend of public health in Dr. Fred Ford. Everyone knows of

Dr. Fred Ford in U. 8. Public Health Service. He alloted some
‘a .
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aby

Federal funds to help our county build up their units. How we
have this small sum from the State.

How is that being spent? Now I come to the crux
of our story. What is our method of getting our message across
to the people themselves? We are using the method of demonstration.
In the first place the county health nurse, gé is a key person
in the program. We had had county health nurses, probably just
one per county, but-a-county“heelith-nuree, and we had 12
counties with a county health nurse. Where she has been it is
easy to make people see what can be accomplished. I like to
stress this point because I think nurses in public health have
won for themselves what nurses in private vork have yet to win,
for-themseives.. The nurseg in public health has prestige and
the full backing of the public health officers. They want them
to be well educated. I happen to be on a hospital board where

 

| Bhey/women with judgment, with force, with cheracter, women who

ean work quite independently. There is some difference in the
extent of the duties where a public health nurse has no medical
supervision, without a nurse, without a doctor, without hospital
equipment. It is a great deal better when she works under
direct medical officers.

In our last election, the county where there had been
ny
just one nurse, every single county commissioner voted for the

unit; in the adjacent county, the commissioners were fairly favor-
APE
able, but where they never had a nurse, it was not favorably

”
received.
Our problem is different from yours, You have
fairly uniform land where we have exceedingly different types.
We have mountains, plains, prairies, dry country, cattle ranges,
fruit farming and mining.

We can't organize many units, As I told you we are
only five months old, We have organized two districts, two
units in our five weeks of age. The idea of demonstration was
thought out by Dr. Cleere, to let the people see what can be
done by the county health department. We have divided the state
into seven temporary sanitary districts.

It. is planned that we send the entire staff into a
district for two weeks, a sanitary engineer, a sanitarian and 3
public health nurse, to make a survey of every town it, the farms
too, as far as possible, Now this is 4 big order for just two
weeke, This staff would then report to the people themselves on
the condition of the water supply, seware disposal, restaurenis,
barber shops, milk supply, farms and dairies, and then leave one
sanitarian to go on educating the people.

coe e Kans This plan has been extremely well received. Dr. Cleere
is con his third district eat” the firet—wee-the first one te-”
organize and the people were very much enthused. We have alse
taken all the public health data we kmew for open and frequent
discussion among the people.

I want to take up just one subject which interests me
very much, It is the subject of sanitation of milk. We have had
widespread Bangs disease, lots of brucellosis, and we tried to
put through a bill to prevent the sale of cows that had been
tested and reaction showed they had Bangs disease, Our bill was
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killed by the livestock people. It was referred to the livestock
commission who killed the bill. ‘There was nothing we could do
about it. I think your defeats are more interesting because you
learn more about things. There is a Chinese proverb "Woe unto
him who has never been defeated - - - "

I think we should take a look at this problem not only
from the standpoint of health but from the standpoint of economics.
There is one point that is quite complicated and I think it is a
problem that should be studied not just by us but by all the
American gps peppte. te three groups that deal with covs.

. Aw AE rete Cat OT
e there ane are the range cattle} thet are | ata oe who give
them grain before they go to market. ‘Then, there is the dairy

rrtanal
industry whieh—ts-worth-about-$35;000;806; -and we ba von them
So (bat
over after a long fight emd they were for this bill which was _..
killed by the livestock people. The livestock industry, 1s worth
$175,000,000 as against $35,000 ,000 in the dairy industry.
Le La th ch

~ eethiagting the fmount of milk that a cow loses
with a's disease is 265 pounds. +4 et milk-per-year is
quite a lose of food at a time when food is the most important
problem in the world. ( a comparison was made between Michigan
. and Colorado in the loss of milk -and beef)
We lost 37 million pounds in Colorado. The livestock: people.lost

thousand

leas,-the.loss-in Michigan was.16 mtkkkum pounds. - - - -
If we lose a million pounds of beef a year, at the pkice of meat

on the hoof, that represents quite a large sum.
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at Now the American people are getting public health
minded... From: the health standpoint ofthe number of children
fed with the milk and the number of adults fed with the beef
put I am speaking in the terms of money loss to the livestock
tutuaters You can understand why they would not be for us.

|A problem came to my mind today when Dr, Lindstrom
spoke of poor lands, small farme and large families, It shocked
me to know you had any poor land in Tilinois. The livestock
problem ie this; and I think it is extremely important. The land
for livestock is over-grazed in Colorado. It is largely public
lands and definitely over-grazed. Loss doesn't amount to anything,
already enough cattle per land and that is the economic problem
that should be presented to the American people and that is the
thing we want to make as their own problem,

uncom We were helped by our polio epidemic.
The epidemic had frightened the people. We made no pretence
that the medical profession conquered polio but told of research
and that is fundamentally what helped in waking people up to
this problem, In 1900 I happened to be present at some of the
discussions of a group of doctors, Dr....Weieh~and-Dr..Gibbds ‘were
-there, and their discussions ell centered around this problem.

When the campaign was first started against tuberculosis,
those incharge wondered if the public could become interested
in a disease and they decided to put it to a test. There was in
Baltimore an exhibit that ran all day and evening for & week and
the people responded. The answer was that people are fundamentally
interested in the problem of medicine and that is the real basis
of the work in public health.
-10-

You have accomplished much, we have not accomplished
much in our short existence. We do hav & new Governor, We also
have a new Mayor and that is 8 miracle pet’ nobody dreamed that
our old Mayor would be defeated, He didn't win even one precinct,
and he had been in power for twenty-five years. The new Mayor
is energetic and interested in public health and a miracle has
happened in the city of Denver health department. In these few
weeks since the Mayor has been elected more had been done to
clean up the city of Denver than in the last fifty years.

We haven't accomplished nearly 48 much as you have but we sre

on our Way.