A HEALTH EDUCATION SYMPQSIU M 
DEPARTMENT OF HEALTH 
CITY OF NEW YORK 
(Being a series of papers given at 
the 70th annual meeting of the 
American Public Health Association 
in tiio Health Education Institute 
at Atlantic City, Hew Jersey, 
October 11 and 12, 1941.) 
District Health Education Demonstration 
October, 1941 FOREWORD 
Almost a yccxr ago the Demonstration invited the health officers 
of Now York City's thirty health districts to join in exploring together 
the materials and methods which were being used to educate the city's 
7,000,000 to ways of health. Encouraged by the Director of the Bureau 
of District Health Administration, Dr. Margaret L• Barnard, the coopera- 
( ‘ 
tive venture took the form of committee work. 
Five committees were formed, each of which concentrated its 
efforts on one of the following activities; editing a monograph series, 
defining the relationship between the health officer and the schools, 
evaluating types of meetings, evaluating visual adds and exhibits, and 
appraising the literature that the department used in its work. 
The reports on progress made by these committees constitute 
the major part of this symposium. Two other reports have been included, 
however, because of their intrinsic value to health education. One is an 
account of how the Mothers Health Organization in the Lower East Side come 
into existence. The other describes an educational venture in tuberculosis 
prevention carried out by a health officer and the faculty of one of the 
city's largest high schools. 
The Demonstration, sponsored by the Now York Foundation and the 
Hoffhoimcr Foundation, appreciates the collaborative effort which the 
district health officers have given. If our health education work in 
the city continues to establish sounder foundations because of it, the 
credit belongs to them. 
Dorothy B, Nyswandor, Director 
District Health Education Demonstration 2 
A Health Department’s Appraisal of Its Educational Materials and Methods 
Presiding; 
Margaret Witter Barnard, M.D., 
Consultant in Local Administration, 
Department of Health, City of Nov/ York. 
The Eighth Institute on Public Health Education 
American Public Health Association Meeting 
Atlantic City - October 1941# 
Health education is an ever increasingly important part of 
a health officer *s program* Fundamentally, probably 90 per cent of our 
publi^health work becomes effective only as the people themselves take 
action. How to get people to take action - to avail themselves of ser- 
vices, to put into effective Use the preventive measures wo now know, 
to think in broad terms of health for themselves, their families and 
their communities - is the responsibility of health education. During 
the past few months defense has emphasized anew the importance of health 
for the entire population and has deepened our Sense of responsibility in 
this field. 
It is a time when official agencies must give serious atten- 
tion to developing leadership in their communities in health education# 
During the past year, wo in New York City have begun to analyze our own 
program# To do this, the district health officers upon whom falls the 
responsibility for leadership in their districts, have worked in groups 
or committees on various phases of the health education program# We are 
presenting to you today, some of the results of the "thinking through” 
which has been done by these health officers committees. Health officers too often have regarded health education as 
something to be carried out by a subordinate member of the staff - giving 
out literature or organizing meetings on a rather routine level# We be- 
lieve that it is the health officer himself who should be the loader of 
the program, decide its basic content and emphasis and relate these to 
the action which he as health officer believes to be most needed at a 
given time. 
The health officer must learn to think in terms of cost. We 
spend three hours in preparing a speech, two hours or more in travel 
time, and two hours at the meeting itself. Perhaps a staff member assists 
by showing films or slides involving staff time and transportation. Must 
wo not question critically what the health department gets out of that ex- 
pensive procedure? Did wg really accomplish anything for the community 
or was it a polite gesture? For what kind of audience is so much expendi- 
ture worthwhile? This is the kind of questioning wo have been doing# Wo 
have tried to train ourselves to be analytical - we may appear today very 
critical. We believe it has been good for us to be critical of ourselves. 
In Now York City we have at present three main divisions of 
our health education organization# At the top is the Bureau of Health 
Education, under the leadership of its director, Dr, Bolduan, responsible 
for the policies and the city wide program. Out in the firing line in 
each district, comparable to a middle size city, is the health officer 
who must put those policies into the type of program which will v/ork 
with his special community and fit the needs of his particular program. 
And as a source of advice and guidance in the development of new philosophies and techniques, wo have a special District Health Education 
Demonstration financed by outside funds with Dr. Uyswander as director. 
Today we present to you representatives of those three main divisions, 
who in turn will share with you some of our thinking not only on the 
troubles and the headaches, but also the possibilities of health 
education for a community from the viewpoint of an official agency. I. DISTRICT HEALTH OFFICER COMMITTEE REPORTS 
A. Evaluation of Pamphlets 
The first committee reporting is that on tho evaluation of 
literature. Today there is available to every health officer a ready 
supply of health education literature - bewildering in its very amount. 
Local health departments. State and Federal offices, insurance companies 
and voluntary health organizations, all contribute to the supply. After 
these pamphlets are neatly stacked on tho shelves of our supply cupboards, 
what happens? Yilhy does tho supply of one always run short while another 
one stays on the shelves undisturbed for long periods of time? Do wo 
know the content of each one and the purpose it would best serve? Are 
we using those aids to the best advantage? Reports of ’’literature 
♦ 
distributed” mean little - 100 pieces of this, 25 copies of that, 200 
copies of another. So tho health officer committee addressed itself to 
the task of evaluating literature available to them - to setting our 
literature house in order with definite recommendations - republish as is - 
revise - destroy. 
Because of tho close tie-up of tho recommendations of this 
committee with Department administrative matters. Deputy Commissioner 
George T. Palmer was asked to give guidance as chairman of this group. Tho health officers participating wore; 
Dr. Michael Antoll - Richmond Health District 
Staten Island 
Dr. Eugene 0. Chimone- Corona Health District 
Quo ons 
Dr« Franklin M. Foote- Kips Bay - Yorkville Health District 
Manhattan 
Dr, James F, Morrison- Fort Greene Health District 
Brooklyn 
Dr. Leopold Rohr - Brownsville Health District 
Brooklyn 
Mr. S. S, Lifson, Soc’y, - Staff Assistant, District Health 
Education Demonstration 
Dr. Eugene Chimenc of tho Corona Health District will report 
for this committee. The Report of the Committee on 
Evaluation of Pamphlets 
Eugene 0, Chimono, M. D. 
District Health Officer 
Corona Health District 
Hero is a letter which was received recently: 
"Board of Health 
City of Nov/ York 
Dear Sirs : 
Please send mo all the information you have on raising children. 
Very truly yours, 
it 
No doubt you as health educators have received numerous such 
requests asking for information on all varieties of health subjects. 
Obviously, wo have here a large ..rder, in fact one impossible to fill 
without knowing more about the specific needs of the writer. Upon first 
thought, one might be tempted to send a carefully selected bibliography 
of good books and recent scientific journal articles on the general subject, 
but this idea is discarded upon the realization that the necessary library 
facilities would not bo available. 
Your shelves perhaps groan with the stacks of literature you 
have collected from a'wide variety of sources on a diversity of health 
topics, yet a nice discrimination must be made if your selection is to fit the needs of the particular- request# Some' of the material you have is old, 
perhaps even a little sheIf-worn, some contain statements that are not 
scientifically accurate; some are excellent but written exclusively in 
polysyllables meaningless to the average laymen; others suggest procedures 
contrary to the policy of your organization; still another would be just 
the thing -were it not printed in such minute type that you fear that its 
perusal would not only endanger the readerfs eyesight but also produce 
such mental fatigue after the first few pages that the reader's interest 
would be lost* And so you go on through your stock trying to find just 
the bit of information which vail meet the needs of a particular indivi- 
dual in a particular situation, for you know from long experience the 
great significance the average layman attaches to the printed worft, and 
you do seek through the use of your pamphlets to reinforce the teaching 
done by word-of-mouth day after day by all the staff members of your 
organization# 
With such considerations as these in mind, the Department of 
Health of the City of How York has been critically reviewing its stock of 
pamphlets available for public distribution# Working under the chairman- 
ship and guidance of Dr# George T# Palmer, Deputy Commissioner, a committee 
of district health officers in close cooperation with the District Health 
Education Demonstration, has undertaken this task* 
As a preliminary step, the secretary of the committee collect- 
ed about two hundred different pamphlets currently being distributed by 
health officers, nurses, health education assistants, and other personnel in the various districts* Some of this material had been prepared by the 
department itself; a large portion had been supplied to the department 
through welfare divisions of insurance companies; many of the highly 
specialized commercial publications had been donated by food associations, 
dairy councils and similar organizations* It was felt by the committee 
that regardless of the source, any pamphlet used by tho department should 
be appraised as to its merits and usefulness* 
Certain critical standards were formulated and adopted by the 
group, and in accordance with these standards each member of the committee 
wrote his frank appraisal of orch pamphlet, indicating whether in his 
opinion that particular piece of educational material should be continued, 
revised or discontinued, and at the some time substantiating his decision 
by details as to scientific accuracy, stylo, format and suitability for 
tho specific groups to be reached* At frequent intervals committee 
meetings wore hold, appraisals discussed, summarized, and joint recommenda- 
tions formulated. Never for a moment presume that all of the appraisals 
were in agreement, for in many instances individual opinions wore stoutly 
defended, and as a consequence many of tho final joint recommendations 
represent this divided opinion. For example, on a nutrition pamphlet 
seme members felt that the content was too brief and did not tell its 
message convincingly* Tho committee, however, finally agreed that since 
tho idea of tho leaflet was good, it should be available from headquarters 
upon request. Only in this way could the recommendations represent tho 
work of the committee as a whole* As the review of each group of pamphlets was completed, a 
copy of the committee’s recommendations was sent to each health officer 
with the request that ho review them and note any disagreement ho might 
wish to bring to the attention of the committee. He was also asked to 
discuss these recommendations with his nursing personnel so that he 
might submit their comments along with his own. 
Then, at a subsequent meeting, the committee was able to re- 
view the recommendations in the light of the comments made by the health 
officers, and to forward these revised recommendations to the bureau 
director most concerned with the subject covered by that group of pamph- 
lets, Upon receipt of the bureau directors’ comments, the committee was 
then in a position to send specific recommendations to the Bureau of 
Health Education advising that certain pamphlets bo continued, discontinued 
or revised. 
Not only did the committee include in its recommendations 
statements as to the scientific accuracy and form of the pamphlet, but 
careful consideration was given to the audience the pamphlet was intended 
to roach. Some of the material was found more suitable for distribution 
through the offices of private physicians in the district; some would 
serve their purpose best if distributed through local automobile dealers; 
others would reach their best audience through drug stores, food estab- 
lishments and other local commercial outlets; many attain their most 
effective appeal when handed directly to the person interested at that 
moment in the specific topic dealt with in the pamphlet, for here is the 
ideal opportunity for workers in child health stations, in schools, in chost clinics and in other services, to effectively utilize printed mater- 
ial* For example, after considering a pamphlet on appendicitis, the 
committee recommended that it be continued, with the suggestion that it 
bo given only to specially interested groups, and that it should not bo 
stocked regularly in the health centers, but ordered by the health 
officer as needed. The committee also felt that this pamphlet was more 
suitable for distribution by private physicians rather than by the Health 
Department• 
Three pamphlets on safe driving were recommended for direct 
distribution by owners of large truck fleets, garages, gas stations, or 
police precinct stations who could secure a sufficient supply from their 
district health officer. He, in turn, would not stock these pamphlets in 
the health center but would make known their availability to the proper 
outlets in his district and secure an adequate supply from headquarters as 
the need arose# 
Certain pamphlets apparently are useful source material for 
elementary school teachers, and in such instances, the committee recom- 
mended this material not only be brought to the attention of the teachers, 
but that we learn from them just what use they make of it# 
A pamphlet on common colds was recommended to bo discontinued 
because it included a discussion of too many different diseases,which 
made the oamphlet too long and not adapted for discriminate distribution# 
Moreover, other more attractive pamphlets on this topic arc available. 12 
Certain food pamphlets were found objectionable because they 
stressed disproportionately the product of the producer* Other pamphlets 
of comparable merit not used as advertising media are available* 
Although the entire job has not been completed, one hundred 
throe (103) pamphlets hive already been appraised by the committee. Of 
this group, one-fourth wore published by the Health Departmentj half of 
them were supplied to the Department by six insurance companies, and the 
remaining one-fourth came from eleven commercial organizations* 
Upon analyzing our recommendations we note that about three 
out of four pamphlets are to bo continued* Of those, about one-third are 
suitable for general distribution and about one-fourth should be given to 
individuals desiring information on a definite subject* Revision is 
needed for about every seventh pamphlet, although the committee was willing 
to utilize, meanwhile, the present stocks on hand, A small group, com- 
prising only throe per cent of those recommended pamphlets, should reach 
the public through the office of the private physician rather than come 
directly from the Department of Health* 
From the standpoint of usefulness and suitability, the rating 
of pamphlets produced by the insurance companies and the Department of 
Health wore equal, and somewhat exceeded in this respect those issued by 
the miscellaneous group of commercial organizations* However, the need 
for revision was found to be ton times as groat for the Health Department 
pamphlets as compared with those supplied by outside agencies* On tho other hand, about a third of the pamphlets produced by 
these outside agencies wore not suited for general distribution, which 
greatly limits tho quantity the Health Department is able to distribute* 
The work of tho committee emphasizes the need for discriminate requesting 
of those special pamphlets based on the use for which they are designed* 
For one reason or another, about every fifth pamphlet appraised 
was recommended for discontinuance by the committee. Fifteen per cent of 
tho Health Department productions, twenty-three per cent of the insurance 
companies' pamphlets and twenty-five percent of those supplied by the mis- 
cellaneous commercial firms were in this category. 
You may well ask what use tho Department of Health intends to 
make of this critical review and resulting recommendations* In the first 
place, it will clear the shelves of those pamphlets which definitely 
should not be distributed. It is so easy to avoid the trouble of clean- 
ing house and let matters continue as they are. It will also serve as a 
basis for a manual which will be prepared for the health officers, de- 
tailing tho merits and limitation of such printed materials available to 
the Department* This will facilitate a more effective selection of 
material to meet specific needs of individuals and groups whom tho health 
officer is endeavoring to roach with his health education program; it will 
obviate much waste of supplies; by selecting tho best available literature 
it will make for bettor teaching; it will enable tho field staff to become 
familiar with all of its pamphlet resources* Through this critical analysis wo now know not only what wo 
have, but also what wo lack, for after the rocommondations wore summarized 
it was quite evident that for certain phases of public health promotion 
thcro are no satisfactory pamphlets available to the Health Department at 
the present time* 
The Department staff itself must produce suitable teaching 
material with which to toll both the lay and professional public about the 
work of the various health centers in order to stimulate active participa- 
tion of all citizens in the program for community health conservation, 
and to emphasize to all the people how they may best utilize the many and 
varied opportunities offered by the Department for their health protection 
and guidance« 
It is further hoped that the recommendations and comments of 
tho committee will bo of assistance to outside agencies, so that in the 
future preparation or revision of their own health education material 
they may, if they so desire, have tho benefit of the group thinking of 
the health officers, nurses and others actually using this material in 
tho ficldo 
On behalf of our committee, I present this report to you as 
an illustration of democratic planning within an agency. While the com- 
mittee realizes that an appraisal such as it has made is vastly more time 
consuming than would bo an executive order covering tho same field, the 
intangible values arising from participation in such departmental planning 
by the administrative and field staff more than compensate for the time 
gain that might be secured by any other course of action# As you well know, most committees tend to perpetuate them- 
selves, and this one is no exception, lie feel that the work is of such 
evident value that the Department should maintain a permanent committee 
so that future new printed materials might bo submitted to the same 
careful group scrutiny which we have given to the pamphlets wg now are 
using. B. Exhibits and Visual Aids 
Perhaps it was the competition of the World’s Fair with its 
beautiful professional and commercial exhibits that made us in the health 
field become suddenly aware of the possibilities which exhibits and 
visual aids offered in our problem of merchandizing health. When a group 
of health officers sat down to consider what kinds of visual aids they 
really wanted and what kinds were possible, a bewildering number of 
avenues of thought presented themselves. There, was never any lack of 
material for discussion in that group. The committee still considers 
this problem as "unfinished business" but it can present today some of 
its conclusions. 
The group consisted of: 
Dr. Frank A. Caldorone - Lower East Side Health District 
Manhattan 
Dr* Jacob Landes - Williamsburg Health District 
Brooklyn 
Dr. John B. West - Central Harlem Health District 
Manhattan 
Dr. Joseph Weinstein - Westchester Health District 
Bronx 
Mr. S. S. Lifson, Soc’y. - Staff Assistant, District 
Health Education Demonstration. The Report of the Committee on 
Exhibits and Visual Aids 
John B, West, M. D. 
Medical Director, Provident Hospital, Chicago 
Formerly District Health Officer 
Central Harlem Health District 
In tackling this problem of visual aids and exhibits, it seemed 
to the committee that the health officer needs such aids for two main 
purposes. One type of visual aid material must be suited to catch the 
attention of the person who has some other main objective at the moment 
and to whom a special health subject is then of secondary importance. 
The man hurrying along the street to an appointment takes time to glance 
only casually at displays in windows - but if a display is striking his 
attention will focus on it and he carries away the idea. If it is really 
of interest or different in some way, even the busy passerby mil linger 
a moment for closer inspection. If an interesting exhibit is located in 
some dace where this person must wait a bit, ho will probably be glad to 
spend some time in studying it more closely. 
One such short impact is not enough to produce much understand- 
ing or long memory. But if we can keep on hitting, a lasting dent will be 
made. Posters and exhibits seem to bo the best for this purpose. 
The second place whore a health officer can effectively utilize 
visual aids is in connection with a meeting - to liven up a lecture, 
illustrate certain points to make them more clear, and supplement the 
content of the spoken word. Here it is that devices prove useful,such 
as illustrated pamphlets, teaching charts, storeopticon slides, strip 
films, portable exhibits and movies. What are some of tho guide linos that will help the health 
officer to chooso wisely among tho visual aids at his disposal? First 
of all ho must bo clear in his own mind as to what he wishes to accomplish# 
To interest the general public as it passes by, health material must have 
tho wide appeal of general subjects which will strike the attention of 
Mr# or Mrs# Public because it might happen to them or their families# 
For a meeting the aids must be more specialized in interest# They must 
always add to and clarify the content of the main program - never detract 
or switch the attention of the audience. 
Having oriented itself somewhat as tothe usefulness of visual 
aids in general, the committee has explored tho possibilities and the 
problems connected with different types of exhibits and visual aids. 
Probably tho one most used is tho poster* Commercial adver- 
tising has made us aware of tho necessity of good design, and simplicity, 
the putting across of one idea only, and tho values of utilizing color# 
But aside from this, the health officer must decide questions about the 
effective distribution of posters# 
Shall he flood the area with many copies of the same poster? 
Shall ho use fewer copies of several posters on the same subject? - or is 
* 
it better to advertise a variety of health subjects at the same time? Or 
should tho health officer use large general posters? The committee 
believes that again the answer depends on the objective# To announce a 
single event - say a meeting - largo numbers of the same poster must 
bo used. But these should be low cost - cheap paper, a minimum of art 
work - for their usefulness is limited to a short time# Posters advertising a month’s campaign must be more durable to last the month. 
They rate somewhat more elaborate art work. The committee believes 
that it is more effective to have one good poster designed to focus the 
attention on the campaign so that over and over again the passerby sees 
the same picture until it becomes familiar to him. If the design is so 
arranged that a blank space is left at the bottom, this can be 
effectively utilized to announce local events connected with the campaign. 
Then there is the poster which carries an "iiryportant general message" - 
good at any time. To be effective this poster must have more careful 
design and construction, more expensive art work. The committee be- 
lieves that such posters should be so constructed that they can be 
shown over a long time and moved from one location to another. This 
repeated use would offset the greater cost. In other words, a poster 
is not just a poster. It is an attention getting device which must be 
designed to meet a particular purpose and used with discrimination. 
It is a short step from the poster carrying a general message 
to the exhibit. Sometimes a poster design grows into the more permanent 
form by using raised letters or cut-out figures. Those are comparatively 
inexpensive and durable and attract more interest than the flat poster. 
Exhibits, perhaps more than any other type of visual aid, call for 
judgment on the part of tho health education administrator. They are 
costly in their construction and in their use. After a period of enthusiasm engendered by tho beautiful design 
and workmanship of some of the large exhibits available to them, the health 
officers’ committee has come to tho conclusion that the usefulness of those 
exhibits is so limited that their cost may not bo justified. Their very 
size raises problems of proper space for display and the cost of time, 
man-power and transportation involved in taking them down and setting thorn 
up in new locations and storage space between times. Usually such exhibits 
arc complex so that to bo fully appreciated they must bo really studied. 
It is our experience that the busy public rarely stops in tho lobby of a 
public building or passing by a store to really study the display. Only 
if a big exhibit is located in a place where people will bo waiting, will 
they spend the timo really to inspect it. From this point of view tho 
waiting room of a clinic is preferable to the lobby of tho health center. 
However, most waiting rooms are crowded and little spade is available for 
largo exhibits, 
Tho health officers find of much greater usefulness tho small 
, i - 
exhibits that can bo easily moved from place to place - that give a now 
i 
clear punch to a health concept they wish to merchandize. The&e can be 
used in a variety of ways at little cost - to give emohasis during a 
campaign, to form a helpful display at a small meeting on the particular 
subject, to bo studied in a clinic waiting room, 
Another point raised by tho committee is that it seems to them 
a mistake in utilizing exhibits in clinics always to confine tho subject 
to the specialty of that clinic, -Patients in tho tuberculosis clinic are already getting instruction about their disease. They may even bo slightly 
bored with tuberculosis and turn as a welcome relief to an exhibit on an 
allied subject - say nutrition. Or mothers in the child health station 
will be interested in an exhibit on safety in the home. 
In their discussions of aids for group meetings, the committee 
has thought of them in two classes* There are the teaching charts and 
statistical presentations which seem to us most effectively utilized by a 
speaker with a group because they need interpretation and teaching of the 
material for its clear understanding. Few, if any, of the general public 
are able to get the full significance and implications from just reading 
a complicated chart. The other group are those aids which will help the 
speaker to got his message across more effectively. 
It is difficult for a speaker, unless ho be very experienced, 
to hold the attention of an audience by a straight lecture. This is 
especially true of the very mixed audiences which wc encounter in health 
work - of varying levels of interest and education and often with language 
difficulties. Showing slides, or a related movie at the end of a speech are 
old techniques. However, the health officers feel a lack of quite the 
right content in seme of those materials which are available. The question 
of getting together a scries of slides taken, for example, from a Health 
Department child health station in operation, led into a discussion of cost. 
Good slides can be made but there must be availsble a projector and operator. 
This led the committee to explore the usefulness of the smaller projecting 
units which can be used for small slides or strip films. Those can bo easily carried to the meeting by the speaker himself. Ho can then informally operate 
the machine as he talks, or the mechanism is so simple that any member of the 
audience can be asked to run the machine. A number of these could be bought 
for the same cost as a larger projector, making them widely available. Vie 
then experimented with a strip film made in a child health station to acc- 
ompany a talk on child care. Although the photographs were made by an 
excellent photographer they turned out to be too obviously "stills". 
“Wo did not got the sense of action and continuity which we wanted. Also 
our "canned talk" to go with the film was not too good; the film and the 
talk never seemed to get together. So we have a hurdle to get over - 
to become more professional in our technique. Vie still believe it can bo 
done • 
Another device which has interested us is the development of 
small portable exhibits which can be shown by the speaker as he goes along 
with his talk. Many speakers do bettor if they can pick up an object and by 
some manipulation illustrate a point. It servos also to catch the atten- 
tion of the audience and relieves the monotony of just listening. 
Dr, Smillic of Cornell is experimenting with devices of this sort and 
some are on exhibit at this meeting. 
Movies arc a problem: perhaps because the health officer - 
and often the audience - believes the meeting will bo a success if there 
is a movie. The health officer should be very sure of the contents, 
A movie which repeats in (Entertaining visual form the lesson of the meeting 
can add much interest for the whole group. It also clarifies points for those who are not "car-minded”. But a movie which adds too many new ideas 
or at some point disagrees with the speaker may only confuse the audience. 
The health officers also believe that there is more to the 
effective use of movies than the stereotyped formula - "The talk will bo 
followed by a movie". Some of us have used it first to lead into the 
subject of the evening and create interest - arid. then the wiggly children 
can go home and the adults settle down for further learning. Sometimes 
wo can break a long meeting by a short movie in the middle - it rests 
the eyes and ears of the audience. 
The health officers’ committee wishes to continue with its 
exploring of visual aids and exhibits. Me know that we can learn much 
from studying professional and commercial material. It will then be fun 
to exercise our ingenuity in adapting those to our own purposes. 24 
C. Health Education in Cooperation with Schools 
To do offootivc community health education, the health officer 
must find ways of reaching all his families - to deal only with the 
patients who sit on our clinic benches is not enough. Those who do not 
havo that contact vdth Health Department personnel may need educational 
help and guidance even more. An apparently easy and effective way to 
reach parents is through their children - Schools would seem to provide 
easy entrde to the homos. But in practice this is slow and hard to 
achieve, lihy is it so? One group of health officers tried to analyze 
this in the light of 'their own experience with schools in their districts. 
They have come to some definite conclusions. The group consisted of the 
following health officers; 
Dr# Harold H, Mitchell - Astoria Health District 
Queens 
Dr, Sophie Rabinoff - East Harlem Health District 
Manhattan 
Dr, Anna E.Ray Robinson- Bushwick Health District 
Brooklyn 
Mr, S, So Lifson, Sec’y. - Staff Assistant, District 
Health Education Demon- 
stration, 
Dr, Harold H« Mitchell of the Astoria District will present 
this report. Tho Report of tho Committee on 
Health Education in Cooperation ?/ith the Schools 
Harold H. Mitchell, M. D. 
District Health Officer 
Astoria Health District 
The district health officers have found that ’’putting over” a 
health education program in the schools is a slow process* Why is this 
so? The committee which was appointed to study this and related problems 
have reached the conclusion that cooperation means what the word says* It 
does not moan that the Health Department is privileged to use the schools 
for its special purposes* But what arc the ways in which the two depart- 
ments can work together? 
The committee wa.s of the opinion that cooperation with the 
schools in health education would have real significance if the health 
officers concentrated on a few relationships and did those well* They 
felt that first of all, the health officer must analyze what his services 
should be as an advisor to the school personnel % second, that he should 
consider seriously whether or not his personnel is giving useful and timely 
advice to the school people; third, that he should consider whether or not 
the health center is being used intelligently as a supplementary class- 
room in health teaching; and fourth, that he should obtain educational 
guidance before ho sets up in-service training courses in the field of 
health for classroom teachers* Lot us consider those four recommendations: 
1* The health officer as an advi sor to school personnel. 
In Astoria some cooperation was obtained from the schools 
when they were asked to distribute some leaflets and put up some posters 
about the danger of swimming in the East River. It did not seem important 
to school principals because they thought this was some Health Department 
problem which they were being asked to help solve. When the health 
officer took time to explain that this activity was a part of health edu- 
cation which gave teachers a chance to teach judgment and responsibility 
for one’s actions in connection with health knowledge, the teachers came 
back to the health officer asking for more information as to the reasons 
children should not swim in the river. It became a school program and 
he became the specialist to advise. 
For some time in one district we have been promoting a 
dental health education program to encourage more private dental care 
for those who can afford a private dentist. The teachers were easily 
discouraged with this program. Many wore less than half-hearted in 
their interest. They wore tremendously concerned about the children who 
couldn’t afford private care, and lacking dental clinics for them, they 
felt the program was a failure. Here was a situation that called for 
understanding if progress was to bo made. It was found that, to the 
teacher, neglect of the indigent children created economic distinctions. 
They said that education, and also dental care, were for all the children. 
It was clear that renewed effort had to be made to get more free clinic 
service. This was done. After that, the health officer was able to introduco educational objectives hitherto not considered by the teachers, 
namely, that for the children who could afford to pay, the teacher had an 
obligation to teach self reliance and personal responsibility in securing 
dental care. Moreover, as an advisor, he was able to point out that these 
objectives are best taught through giving the child experience ivith the 
use of community dental facilities* 
A third example of the health officer playing the role of 
consultant to the school was reported this morning by Dr* Rabinoff, 
A3.though the syllabus in health education in a largo high school did not 
stress the subject of tuberculosis, the health officer aided in initiating 
an intensive program in that field* The health officer provided the 
essential facts about tuberculosis; the teachers provided the methods and 
techniques of teaching* The cooperation of many different departments 
makes this a good example of an integrated teaching project in health to 
which a health officer made a definite contribution as an advisor* 
Although Commissioner Studobakcr in the United States 
Office of Education has written about tho difficulties, duplications and 
inefficiencies that come out of any attempt to achieve health education 
if health specialists do not have the authority of tho Superintendent of 
( 
Schools back of them, the committee believes that it is not authority wo 
nood so much as a plan for working together* It is not tho domination 
of one will over another but joint planning of tho school program* 
As Dr* Nyswandcr says in her report, "The Astoria School Health Study,” 
"A good program in a school docs not come out of authority; it comes out 
of mutual appreciation of other persons' problems and clear definition 
of what each shall contribute to their solution*” The health officers have been learning that this is true. 
Wo arc finding out how sound the method is# In some districts wo have 
set up school health sub-committees in connection with the District Health 
Committees# They are helpful in providing another way of getting mutual 
appreciation of each other’s problems# Instead of trying to got the 
cooperation of the school people to do what wo think should be done, wo 
are more and more learning to find out what arc the problems of the school 
people and how to discuss their problems with them. 
2# Is our Health Department staff able to give timely advice 
to the school personnel? 
Wo have made a good beginning on this relationship through 
staff training in a twelve week in-service course for modical supervisors 
in the Astoria District, -where special emphasis was given to the interpreta- 
tion of the service to the school personnel and the educational aspects of 
the work of the physician and the nurse in the schools# 
3. Is the health center being wisely used with school children 
from neighboring schools who visit it? 
It has been found that people living in a district in 
which a health center is located, often do not know that such an institu- 
tion exists# By arranging with the teachers for excursions of their 
pupils to the health center the Department can "kill two birds with one 
stone.” (a) It can develop an awareness on the part of the 
pupils for the health center and an understanding 
of what the Department is attempting to do. 
(b) Through the pupils tho adults in the families can 
be made aware of the Health Department facilities 
available for their guidance. 
Tho committee feels that these excursions to the Centers 
should bo well planned and that the learning experience should consist of 
something more than a conducted tour. The teachers should first prepare 
the children in their classrooms which would moan that the teachers 
should visit the Center first, meet with the health officer and learn 
of iho Department’s program. Tho tour should be one to stimulate the 
children to ask questions. In turn, tho children should bo asked ques- 
tions to learn whether or not they understand what they arc seeing. The 
health centers from time to time have exhibits that are on display 
covering many subjects; tuberculosis, cancer, nutrition, child health, 
etc. When these exhibits are available and suitable to an age group 
teachers can bo informed and an excursion arranged. Here again tho 
teacher should prepare her class for the learning experience* The com- 
mittee is of the opinion that unless excursions have boon preceded by 
considerable pre-learning experience and have some follow-up by the 
toachor in the classroom, the efforts of teacher, health officer and chil- 
dren may be wasted. 4. Many health officers arc requested to give in-scrvico 
courses in health subjects to teachers for which tho teachers 
received credit loading to a salary increment# Most of those courses that 
have boon given employed throe typos of teaching techniques; 
(a) More or less formal lectures on the nature, pre- 
vention and euro of specific diseases. 
(b) Lectures on tho diseases and physical defects of 
school children. 
(c) Institutes covering a single field such as nutrition 
or mental hygiene, the subject being considered from 
many angles by leading exports. 
Tho committee raised two questions with regard to the teaching 
methods used in thoso coursos : 
(a) Did tho methods used in the course permit teacher 
participation? 
(b) Did tho teaching methods employed in the course aid 
tho teacher in transferring information from tho 
lecture to helping her with personal problems or to 
improving hor understanding of children’s health 
pr oblcms• 
The committee found that little teacher participation was 
permitted in tho courses, and that practical problems faced by the 
teachers in their classrooms had difficulty in obtaining a hearing. 
Questions at the end of a lecture was tho only device used to get teacher- 
expression. Having available the results of an investigation in which a sampling of teachers had been asked as to types of health courses they 
would prefer taking, a member of the committee volunteered to try out a 
new typo of teacher training course* Ho felt that the coursb must be 
practical and provide the teacher with a background of information to 
assist the teacher in understanding the health problems of the children 
in her classroom. Each session should be built around experiences and 
problems encountered by teachers; therefore the children in each teacherfs 
class would furnish the data for the course. Interesting and varied teach- 
ing techniques would be tried out. Naturally the health officer did not at- 
tempt to give the course alone. He called upon psychiatrists, a psychiatric 
social worker, a psychologist, a pediatrician and two health education 
supervisors to join his medical faculty in formulating tho plans, working 
out the assignments for the teachers and participating in leading the 
sessions. Ho two sessions were alike. The teachers liked the course 
and gave evidence in the written accounts of projects undertaken in their 
classrooms that what they had learned was put into action. The Board of 
Education has expressed its approval of tho course and tho committee has 
now before it the task of putting basic materials from the course into a 
form that will be useful to other health officers. 
The inquiries of tho committee in the field of cooperation 
with the school indicate; 
(a) That the health officer should act as on advisor 
to a school; that ho has a roal job to do with 
principals and teachers learning from them and 
giving to them; that ho may better spend his time working with teachers to imorovo their health 
teaching than deliver speeches in assemblies or 
in the classroom, himself. Further, as an advisor 
ho must remember that he cannot use the schools 
to expedite his omi work. He must make it a vital 
part of a program which the principal and teacher 
regard as sound health education, 
oo If a visit to the health center is to be used for 
acquainting children with Health Department facil- 
ities or special programs, it must be made part of 
an extended learning experience. 
(c) If health officers wish to aid the schools in 
preparing toa.chcrs to do bettor health teaching in 
the schools, they should build a course around the 
health problems of children in each teacher's 
classroom. Furthermore, in developing the course 
the health officer should seek guidance from the 
educational experts in his community. D. Mootings and Community Organization 
Dr. Chimene gave you an example of one type of letter which 
makes the health officer scratch his head. Let me give you another which 
leaves him at a loss. 
"Dear Sir; 
We would appreciate your providing a movie and speaker on 
some health topic at our next meeting, Wednesday evening at 8 P# M* 
Thank you. 
Yours truly, 
Mrs. A. B. Shaw 
Address—-— Telephone '*# 
A committee of health officers addressed themselves to the 
problem - Shall the health officer attempt to fill all such requests, 
thereby achieving perhaps a large, but certainly an unrelated and spotty 
program of health talks throughout his area? Or shall he go more slowly 
to build a carefully organized program with a long term continuity and 
one in which the community itself will participate not just by attending 
the meetings but in planning, organizing and putting them over? 
The health officer group consisted of: 
Dr. Max Bernstein - Lower West Side Health District 
Manhattan 
Dr. Bernard M. Blum - Washington Heights Health District 
Manhattan 
Dr. Louis A. Friedman- Tremont Health District 
Bronx 
Dr. Sidney Wasserstrom-Flatbush Health District 
Brooklyn 
Mr. William A. Ettel, Secfy.- Senior Administrative Assistant 
(Health Education) 
Dr, Max Bernstein of the Lower West Side Health District will 
report for this committee: The Report of the Committee on . 
Meetings and Community Organization 
Max Bernstein, M# D# 
District Health Officer 
Lower TIest Side Health District 
Any organization survives as a going concern only if it has an 
active membership and a program in which the members are interested and at 
\vhich they are willing to work# Our committee believes that this is equally 
true of health education in a community# Interest in health for the com- 
munity is stimulated when the people themselves undertake activities to 
improve their own welfare# One responsibility of the official agency is 
to give leadership - to guide the many varieties of group interests in 
health along sound lines and to assist them in developing programs with 
continuity which will lead to action# How to build a program which will 
spring from the interests and needs of the people instead of being 
imposed on them by the Health Department - how to open avenues for par- 
ticipation by the people - how to make health interesting - these are the 
problems of the health officer# Some vitalizing force is necessary to 
achieve team work# 
The problem, after the health officer is aware of the needs of 
his people, is to find some device through which he can ascertain those 
interests that seem vital to the people themselves# To assist him in 
planning his program, he may call in leaders in the community, arrange for 35 
meetings for organized groups, such as tho Parent-Teacher Association, 
mothers' clubs and schools, churches and members of his Medical Advisory 
Committee. Those organized groups may help him to sponsor public meetings, 
secure audiences and assist at the meetings. 
To publicize his meetings the health officer may use all 
avenues of approach, such as the radio, local or metropolitan press, 
posters, leaflets, and such other media as arc warranted. The meetings 
he arranges may be of various kinds. They may, for example, be part of a 
campaign or panel meetings that cover one or more subjects, or alertness 
courses for teachers and professional groups. The meetings may be hold 
in tho health center where the audience is solicited or they may bo held 
at other quarters whore ready-made audiences are supplied by outside 
cooperating agencies, such as settlement houses, labor groups, schools, 
churches, civic organizations and others. 
The first major problem is concerned with tho typo and calibre 
of speakers available. With tho limited personnel assigned to tho health 
officer this becomes a real problem. Wo have to depend mainly on outside 
sources for our speakers. Since most talks are given by medical men and 
since not all physicians are good speakers or teachers, they are not always 
able to maintain and arouse interest. Also, since speakers are limited, 
we recommend t hat wo have fewer mootings with a higher content of factual 
material properly delivered. Speakers qualified and able to impart tho 
message should be our goal. This committee therefore recommends that wo 
curtail the number of meetings held and that stress be placed rather on tho 
quality than on the number of meetings. Throe or four meetings a month 
with substantial groups and qualified speakers arc preferred to a large number of mootings "spread too thin#" Because of the limitation of staff 
and equipment, the committee also feels that the groups to be reached 
should bo carefully evaluated. Are wo justified in giving a large amount 
of time for planning a meeting for a small civic or social group, rather 
than in devoting the same amount of time to a substantial group of highly 
organized professional workers? Wo fool that empha.sis in most instances 
should bo placed on professional groups. Wo also feel that campaigns, 
such as those on infant mortality, tuberculosis, cancer or other major 
health problems, warrant expenditure of our major time, We do not favor 
a largo number of isolated mootings. With but a limited number of pro- 
jectors, operators and films to work with, we feel that the above con- 
clusion is a proper one. This procedure will allow for more time to bo 
given by the health officer and his limited staff to the propanation of 
the content of the major meetings. 
The number of persons at a meeting do not necessarily spell 
success or fadluro, A small number of representatives of outstanding 
community loaders who can carry the message home to their own groups, 
representatives of such organizations as The League of Women Voters, or 
some major business or labor organization, will usually bo more effective 
than an auditorium filled with persons who are just curious or forced in 
to make a large assembly. 
In selecting subjects and planning meetings, more effective 
work can bo accomplished if sufficient time is allowed beforehand. To plan 
in advance an entire program to cover a whole year, wc believe is poor. V,o prefer to plan from month to month, depending primarily on the needs of 
a particular subject to be stressed. To plan for special campaigns for 
individual months in advance means that the same groups must be contacted 
each month; this necessarily stultifies flexibility of a program and in- 
hibits the working out of special techniques for individual groups. 
We feel that, with the present limitations of staff, the health officers 
may devote their time most effectively in planning courses, panel meet- 
ings and lecture series with groups in the community that come in 
contact with the lay residents of the district. This committee prefers 
programs for informing or enlightening leaders of the community rather 
than an ineffectual hit-or-miss lecture program. 
It is advisable when selecting a subject for a lecture to 
submit in advance to organizations requesting the talks a live list of 
topics which the health officer feels would have current value in improv- 
ing the health in his community. It is our experience that people do not 
come to meetings just because we want them to; there must be something 
stimulating in the announcement and there must be somebody to make 
personal contact with individuals. 
In some districts the health officers have had various groups 
end committees assisting them in their community work. Those have all 
been volunteers with the exception of the few district health secretaries 
provided by private funds. Whore such secretaries have been available 
the community organization has taken on a definite pattern with an 
executive committee and several special committees composed in the main 
of representatives in the fields of medicine, nursing, dentistry, social 
work, business or civic end religious groups. Those committees assist the health officer in sponsoring and developing a series of lectures for 
teachers and other professional groups. The committees meet usually if 
they have a message to deliver or a topic to discuss of vital interest in 
our community program# The committees in the main hold three types of 
meetings: 
1# Small planning conferences. 
2# Full fledged meetings of the committees themselves# 
3. A series of meetings usually called a course or 
institute under committee sponsorship. 
There is one word which describes success of meetings held by 
or under the sponsorship of the committees and that word is PARTICIPATI ON. 
It should spring from a group which has assembled to plan the meeting# 
It should be something that the group wonts. Having conceived and planned 
the meeting, the planning group become the salesmen; the participating 
group act as an enthusiastic nucleus to the meeting and bring their friends, 
fellow-workers, neighbors, etc. 
Some health officers have made use of the organized mothers' 
clubs in their districts# The presidents of the clubs have acted an an 
advisory council to the health officer; thus they were able to reatch 
families in the district in which there arc children who ore attending 
school. Other health officers have not restricted themselves to just 
one particular organized group but have worked with as many groups as 
they thought advisable. 39 
By way of summary, the committee is of tho opinion that meetings 
are an essential part of the community program, of health education and they 
recommend that under existing conditions the health officers place major 
emphasis on developing courses or lecture series for leaders in the 
community. We further recommend that we utilize department personnel 
from the ranks of physicians, dentists and nurses, and that an effort 
be made to provide funds for a paid staff of speakers. 
We who have the responsibility for conducting a community 
health education program, feel strongly that the concepts in this field 
are ever-changing and that out of this evolutionary process is developing 
a plan for increased community participation which is fundamental to tho 
success of a health education program. E. Monographs on Essential District Work 
In a group of health districts, or among various communities, 
one health officer will he attacking a certain problem - trying out new 
methods and techniques, A little later sane other health officer needs 
to attack this same problem in his community. It would be of tremendous 
help to him if he knew what the other follow had already tried - what 
worked, and - equally important - what didn't work. The editorial com- 
mittee of the health officer group undertook to help individual health 
officers prepare for publication as monographs, accounts of worthwhile 
projects which might be of value to other health officers. This group 
consisted of: 
Dr, Arthur I, Blau - Red Hook Health District 
Brooklyn 
Dr. Isadore Cohn - Morrisania Health District 
Bronx 
Dr. Jerome Meyers - Mott Haven Health District 
Bronx 
Dr. William F, Wild - Jamaica Health District 
Queens 
Mr. William A, Ettol, Sec’y. - Senior Administrative 
Assistant (Health Education) 
Dr. Jerome Meyers of the Mott Haven district will report for 
the Editorial Committee, The Report of the Committee on 
Monographs on Essential District Work 
Jerome Meyers, M, D. 
District Health Officer 
Mott Haven Health District 
Early in 1941 an editorial committee composed of four health 
officers and two staff members of the District Health Education Demonstration 
addressed themselves to the task of putting into print some of the health 
education activities that had been or were currently being conducted in 
Now York City. The group recognized that clinical and laboratory inves- 
tigations by physicians and allied workers need to be published not only 
to report such work, but of far greater import, to signalize advances in 
knowledge for the good of the entire profession. The committee took the 
position that the same needs exist for having in permanent form a descrip- 
tion of procedures and conclusions of worthwhile public health education 
projects and health campaigns. The members felt that the Health Department 
should have a publication to meet the needs of workers in public health 
education just as published observations in the purely clinical field 
meet the needs of practicing physicians. 
The committee selected mimeographed monographs as the most 
suitable vehicle for publishing the important and interesting health educa- 
tion projects coming from the various Health Center Districts. Not too 
expensive, the monograph offers a method by which most meter ials can bo reproduced if cuts are added to take care of the illustrations. Thus a 
monograph of 20 pages con. be produced for $18 for one hundred copies, or 
18/ each. The costs included are $12 for labor and $6 for stencils, 
mimeographing, cover stock and staple binding. If a spiral binding is 
used the labor cost is also $12, and stencils, mimeographing, heavier 
cover stock and spirals cost $12, making a total of $24 per 100, or 24/ 
a copy. Of course, if cuts are employed the price per copy will rise 
cons iderably. 
The following criteria have been used by the committee in 
selecting a report for publication: 
1, The work must have some elements of 
novelty; it must not bo mere repetition 
of a fairly well known procedure. 
2, The methods of planning and carrying out 
the project must bo fully described. 
3, An attempt at appraising results which 
indicates the mis-steps as well as the 
successes must be included. 
The committee visualizes the purposes of such a series as 
follows; 
1, As a# demonstration of typos of valuable 
public health education work that can bo 
undertaken in health center districts, 
2, As patterns of successful health education 
projects for other district health officers 
in New York City, 
3, As permanent records of projects and studios 
undertaken, 
4, As valuable reference records for health 
workers and physicians outside of New York 
City, These four points will bear further comment. 
1, As a Demonstration of Types of Valuable Public Health Education Work 
that Can Be Undertaken in Health Center Districts 
Health education in district health centers in Now York City is 
a comparatively new procedure and takes many forms* At present the health 
officer may or may not have a great variety of committees in his district 
to add him in merchandizing facts about health. He has the Bureau of 
Hoadth Education always at hand to give help. Out of the joint effort 
between the health officer and his district committees and the Bureau of 
Health Education have come the first two of the monograph series* One is 
"An Experiment with Health Panel Meetings on the Prevention and Treatment 
of Community Diseases" from the Mott Haven Health Center; the other is 
"A Campaign to Reduce Infant Deaths in a District" from the East Harlem 
Health Center * 
Others selected for immediate publication cane'from practically 
every district in the city# They show groat variety in conception, spon- 
sorship and execution. They include reports on: a Dental Education 
Campaign, an Institute on Nutrition for Profossional Yforkors, a Program 
for Diphtheria. Immunizations, Problems in Mass Education and one on Low- 
Cost Exhibits* 
Twenty-five other studies or projects are listed by the 
Editorial Committee for future consideration# These include A Report 
on Prematures, A Symposium on Syphilis for Professional Workers, An Early 
Registration Campaign, An Exhibit Series, Teaching Socia.1 Hygiene to Adolescents, Health Education in Industry, and a Symposium on The People ’s 
Food, Those reports on district health education work indicate the types 
of experiences that the committee believes should now bo put in permanent 
form, 
2, As Patterns of Successful Health Education Projects for Other District 
Health Officers in New York City 
While it is true that the 30 health center districts of such a 
vast city as Now York differ in economic, social, and nationality composi- 
tion, the fundamental needs for health education cannot bo greatly 
different. Therefore such a scries should servo the purpose of an inter- 
change of idea and method which health officers in other districts may 
duplicate or utilize in a modified form. With tho monograph shewing 
definitely and clearly all the stops of planning and execution, considerable 
and valuable time should bo saved through the original experience. 
Moreover, with the results of the original project noted, results in tho 
other districts can be compared:ivoly studied and checked. In this way 
cvontuaily a. body of authentic experience can be established, a consumma.- 
tion devoutly to bo wished, 
3, As Permanent Records of Projects and Studies Undertaken 
They should be valuable not only for roforonco but as a succinct 
method of demonstrating the scope and value of hea.lth center activities 
to visitors, lay or professional, and to citizens of tho community who 
may bo invited to servo on or to hend health center committees or projects. 
They aro concrete examples of tho activities of various community organiza- 
tions, lay and professional, and of publicity channels approached and 
utilized in planning and execution. Moreover, such monographs should servo cis valuable records for an incoming health officer, giving a review of the 
health educational composition of his district and how it has been pre- 
viously studied and utilized# 
4# As Valuable Reference Records for Health Workers and Physicians Out- 
sido of New York City 
The work done through the New York City Department of Health 
represents a record of health center district effort and results along 
localized lines. It should give a picture to the student or the physician 
as to what activities arc inherent and possible in such work, their 
importance, the.methods of attack, and should stimulate interest in such 
departmental functions# 
In any discussion of essential monographs it is logical to 
raise the question as to what constitutes essential health education in 
district health center work. Such education should concern itself with 
the basic functions and needs of the lives of the men and women of the 
community. It should raise and attempt to answer the following questions 
which have been arranged with regard to the development and life history 
of the individual in his environment; 
1. How well are men and women of the community born 
and what methods and means con be adopted to 
assure more healthy pregnant women, safer labor, 
and healthier infants? 
2# How con we increase their knowledge of food and 
nutrition and better the practical application 
of sue h knowledge? 
3, How can we hotter their environment whether it 
be air or housing or parks? , 4, How can parents bo made cognizant of tho dangers 
of contagious diseases, including a,-oute-rheumatic >fover • 
5, Does the school child start scholastic life with 
as sound a body as possible and how can he be 
kept under medical supervision and correction? 
6, How can adequate correction of dental and eye 
defects in the young be obtained? 
7, How can parents learn the need for vaccination 
and toxoid? 
8, How can parents and adolescents bo informed of 
all the dangers of venereal diseases and their 
proper and adequate treatment? 
9, How can parents and patients and especially 
young girls in their teens be made cognizant 
of the facts concerning tuberculosis? 
10. How can workers in the factory and the office 
gain knowledge of industrial hygiene? 
11. How can the older group bo given information on 
cancer, heart disease, pneumonia., diabetes, 
trichinosis? 
12. How can these members of the community, tho 
physician, the dentist, the medical and dental 
societies, be ma.de valuable agents and adjuncts 
in the spread of all such health education? 
We feel that tho answers to these questions will give us a 
grca.ter insight into tho solution and control of the health needs and 
problems of the community. If this monograph series concerns itself with 
studios attempting to give some answers to these questions, it will serve 
a departmental and a public need. ho hope you have caught in. this session one cf the points 
that makes our work stimulating and fun. he don’t think it is necessary 
for us all to agree - even in public, he have our own points of view 
and we wrangle over them - but we arc going ahead to the important 
thing which is' to get a job done. Only if we can put forward different 
% 
points of view and try out new techniques and remain critically honest 
in our work will we be able to develop in the future a really vital 
program of health education for our community. 48 
11. THE HEALTH OFFICER AS AN EDUCATIONAL LEADER IN .HIS COMMUNITY 
1 Caught in the hurry, complexities and routine of our day-in- 
day-out jobs, it is difficult for the health officer to find time to do 
the careful thinking and objective evaluation which is necessary if he 
is to give leadership in the health education program# We always mean 
to think through this problem, develop this procedure, polish off that 
technique. But we are apt to put it off - unless someone sticks a pin 
in to wake us up and then helps us to do the job. For the past two 
years we have been fortunate in having with us someone skilled in sticking 
in the stimulating pin, and equally skilled in giving help generously 
to develop new procedures and ways and means. Under outside funds 
granted by two foundations, there has been established in the Department 
of Health the District Health Education Demonstration, One phase of the 
work of the Demonstration staff has been to work closely with the health 
officers in developing the district programs for health education. The 
Director of the Demonstration, Dr. Dorothy Nyswander, will discuss the 
Health Officer as an Educational Loader in His Community. The Health Officer as an Educational Loader in His Community 
Dorothy B, Nyswander, Ph, D., Director 
District Health Education Demonstration 
New York City Department of Health 
Being a professionally trained educator in a big health depart- 
ment has been a rare experience. There has not been a dull day. Often, I 
know my colleagues have thought they could not stand my polysyllabic 
chatter another minute. And I confess that their lack of insight into 
the educational paths leading to light a.nd happiness has often caused me 
no end of mental suffering. But here we are - after some five years - 
still friends and collaborators. 
The reason our work has been exciting is because we have worked 
together on problems. As you have gathered from these reports, we have 
taken time out to look at our various jobs - to tear them apart and then 
to speculate and perhaps experiment with some new ways of doing them. 
That is always good fun. 
Thus what I have to say about the educational responsibilities 
of the health officer is with the some "taking apart and looking at it" 
attitude. This is becoming one of our habits. 
Lot us now put newly appointed Dr. John Doe through seme 
educational paces. He has just taken his first job as a health officer. 
Maybe the job is in New York City, and maybe it is in a rural county in Utah. 50 
■'Shat do we expect from Dr. John Doe as an educator? Has his previous 
experience trained him for these tasks? If net, can we assume that his 
formal training in a school of public health has filled in the gaps? 
Dr. Doc knows considerable about one part of his educational 
job; the part that is usually talked about when the subject of public 
health education is mentioned. Thus Dr. Doe expects to give lectures, 
write an occasional radio speech, get a column in the local newspaper and 
work himself almost to death on an immunization campaign. He will talk 
to women’s clubs, to parent-teachers’ associations, to men’s luncheon 
clubs, to women’s auxiliaries and workers in department stores and 
factories. If he follows his adult education program faithfully, he will 
find that most of his health education effort is going into talking at 
meetings and giving out free literature. But even this canmonly accepted 
task may not always be done with maximum educational effectiveness as the 
health officers’ committees have pointed out. First steps are being ma.de 
to learn new techniques of getting audience participation through intro- 
ducing testing techniques and small group discussion methods, and awkward 
but earnest efforts to use pamphlets as a fundamental part of a teaching 
discussion are seen on rare occasions. Too often the pamphlet appears to 
be only a reward for coming to the meeting. Nevertheless an educator would 
predict that Dr, Doe will do a good job in this field especially if he 
uses some of the newer educational techniques for teaching groups. Along other roads of educational leadership, however. Dr# Doe 
may find himself in real difficulty. One of these connects the health 
officer with the principals and teachers in the schools. Dr# Doe wants 
to work with the schools but ho isn't sure of the way to do it# He has 
a friend who takes the attitude that the health officer should leave 
the school people pretty much alone except perhaps as his work relates to 
school medical and nursing services. Such feelings are probably remin- 
iscent of burned fingers and singed eyebrows from past explosions# This 
advice from a more experienced colleague makes Dr# Doe hesitate for ho 
hasn’t yet learned to see the distinction between teaching health to 
children in the classroom and working with principals and teachers to get 
them to do a better job# The first - classroom teaching - is the task of 
the school people# The second - working with teaching staff - is a fruit- 
ful avenue in getting bettor care for children and may properly bo a 
concern of the health officer as part of his city-wide educational 
program# The educator feels that Dr# Doe is responsible for keeping 
principals and teachers informed and aware of current health problems# 
He is expected to give friendly, intelligible interpretations of children’s 
illnesses and health behavior# 
But will Dr. Doe be able to do a satisfactory job in this field? 
Often, perhaps, the health officer finds himself at a serious disadvantage 
when ho confers with school people# However, a part of this difficulty 
seems to be that the health officer doesn’t speak their language# Ho is 
unaware that the concepts and methods of education have changed almost as 
much as those of medicine during the past decade# One example of a mis-step Dr, Doc may make in this field is 
in the kind of course ho may sot up for teaching something about health 
to teachers. He must watch out that his lectures ore not innocent of pro- 
fessional advice' from an educator. Otherwise, the course may be in the 
style of the Gay Nineties period; this in spite of the fact that good 
consultant services can bo procured from universities, and city and state 
departments of education. 
Thus the educator is often discouraged to see courses for 
teachers still being planned by medical ncrscnncl which show that although 
the content has been carefully thought through from the medical viewpoint, 
moans of reaching educations.! objectives are woefully lacking. The 
teacher needs to learn that facts about personal and community hygiene 
can be presented in fascinating fashion. How else will she moke them 
interesting to children? If she is to bo a good teacher of health, she 
needs to understand the health problems she finds in her class. Dis- 
cussions of health unrelated to particular children whom the teacher 
knows something about are not likely to improve her teaching. She needs 
also to see that she is in a privileged position to give health super- 
vision that no one else can do as well, Cooperatively worked out health 
courses for teachers will bring good returns. 
Leadership in educational work with his own staff is the third 
type of educational expertnoss expected of Dr, Doe, This is a precarious 
field even for the initiated. Professional people don’t like being 
"trained,” They don’t like to admit that they need it. Their egos don’t 
like to bo "refreshed" without their full consent. Therefore Dr. Doc needs to be able to work an occasional miracle; ho needs even more to 
hove learned how to solve problems by the group method* ho could profit 
too by a knowledge of workshop techniques in education; in addition, he 
must really believe in the philosophy that the staff who do the work 
should help make some of the plans for the work* Dr. Doe has great need 
for insight into the techniques of understanding these people with whom 
ho works and to whom he wants to give a live sense of their own worth. 
A study of the psychology of personality might hrv e much to offer Dr. Doc 
in helping him keep a heterogeneous staff happy and forward-going in 
their work. 
Finally, the educator expects Dr, Doe to show educational 
leadership in organizing his community for health education. If the ora 
of controlling behavior through compulsion is past, then educating adults 
to cooperate voluntarily in good health practices must bo merchandised by 
the citizens themselves. A health department cannot do the job alone. 
The health officer must reach out into his neighborhoods and bring 
together those people who can do the interpreting job that needs to be 
done. It does not matter here what plan of community organization our 
young health officer uses. The important fact for him to recognize is 
that as in the other educational responsibilities laid at his doorstep 
there is some experimental evidence on the right and wrong ways of doing 
the job. To summarize, perhaps when the job of health officer was first 
conceived years ago, it required few, if any, educational skills. Today, 
however, with public health over widening its bases to serve people bettor, 
the health officer has need of many different kinds of educational arts. 
These calls arc coming for four types of help: first, to improve teaching 
techniques in the ordinary methods of reaching the adult public; second, 
to show Dr, Doe how ho can reach his community through the schools; 
third, to aid Dr, Doe in his staff education program; and fourth, to 
suggest ways to him of getting the community behind his special educa- 
tional programs. 111. FITTING THE BROAD EDUCATIONAL PROGRAM TO LOCAL NEEDS 
The health officer in the district must fit his health 
education program to the needs of his community. He also has one tier 
responsibility - tc bo sure that the urogram is within the policies of 
the broad program of the Deportment. For interpretation of policy, for 
discussion of debatable procedures, for guidance when knotty problems 
arise, as well as for certain material assistance, the District Health 
Officer looks to the Bureau of Health Education. Its director. 
Dr. Bolduan, has for over a quarter of a century watched New York and 
its problems and has carried out an active crusade to teach hea.lth to 
the city’s millions. Dr. Bolduan has seen the small communities merge 
into the greater city and then that city become unwieldy through its 
growth - and now he is helping us think of the city again divided into 
30 districts for health work. When we have a tough problem we find our 
way to Dr, Bolduan’s office. Wo arc honored to have Dr. Bolduan with 
us on this program. Ho will discuss with us how to Fit the Health 
Education Program to Local Needs. Fitting tho Health Education Program to Local Needs 
Charles F. Bolduan, M# D. 
Director, Bureau of Health Education 
New York City Department of Health 
Tho title of my talk indicates at once that there are two 
important aspects for the health administrator to boor in mind - a program, 
and the community’s needs. The former should, of course, always be 
organized to meet tho latter. 
How can vac find out what those needs are? To illustrate some 
of the necessary stops let us as sumo that a city of about 200,000 popu- 
lation has placed a reform government in power, a>nd that an experienced, 
woll trained health officer has boon brought in from another state to take 
charge of health administration. Obviously ho will want to see what his 
community is like, and ho will do well to drive through tho various parts 
of tho town to see how tho people live and to observe sanitary conditions 
generally. Subsequently, with the cooperation of tho city engineer, he 
will make a closer study of the city’s water supply, sewerage system, 
disposal of garbage and rubbish, street cleaning, housing and other 
sanitary matters. 
With tho aid of census data he will study tho character of 
the city’s population, the age and sox distribution, tho proportion of 
white and colored, the proportion of foreign language groups, etc. Then will come an analysis of tho mortality and morbidity statistics in 
order to discover the major causes of illness and death. With this will 
go a study of medical and hospital services available to tho community. 
Thorough familiarity with all those factual data is necessary 
before attempting to organize an effective program cf health education. 
In the selection of tho subjects to which the educational 
efforts are to be directed, attention must bo given to a number of points. 
Is tho problem something in which the individual citizen must actively 
participate (for example; diphtheria immunization), or is it one to bo 
undertaken by the community as a whole (for example, sewage disposal 
plant)? If the former is tho case, arc there the necessary facilities 
available for people of small incomes? Arc there public clinics? If it 
is a. community matter, can the municipality finance tho undertaking? 
What is tho bonded indebtedness? Have the people boon prepared to 
appreciate tho need of tho financial outlay involved? 
/mother point: Is the condition one for which the health 
officer can give really effective advice? Thus, from a study of the 
mortality tables, the large number of deaths from heart disease and 
cancer might suggest those conditions as important subjects for health 
education. Actually they arc not, because there is so little real help 
which can be given, I realize, to be sure, that considerable attention 
is being devoted to early diagnosis campaigns in an effort to combat 
cancer. It is questionable whether they accomplish much in tho reduction 
of cancer mortality. Similar objections can be made to educational 
efforts to control the spread of influenza, or poliomyelitis, or a number of other infectious diseases* Lot us frankly admit that medical science 
has not yet furnished us with effective preventives for all diseases* 
In teaching the public the value of cleanliness as a valuable 
contribution to the prevention of disease, we very properly emphasize 
thorough washing of the hands after using the toilet, I sometimes wonder 
whta the school children think of this advice when they find no suitable 
washing facilities in school toilets* Is not this matter for the health 
officer to take up with the school authorities in order to make his 
educational efforts more effective? 
Accidents loom large as a cause of injury and death, and a large 
proportion of the victims are children injured while playing in the streets. 
Here too, any educational program against such accidents should be sup- 
plemented by efforts to provide safe playgrounds for children. 
Thus far we have studied the community’s health problems and 
have agreed on a number of subjects suitable for health education. Not 
all of these will be of general importance to the entire community. 
Some, certainly, will be important only for certain groups, either 
geographic, or racial, or language, or vocational. Health Education to 
be effective with these groups must enlist the active cooperation of 
the leaders in these groups, such as editors, influential business men, 
labor leaders, clergymen, school principals, physicians and social service 
workers. Such cooperation is best obtained by having the health officer 
invite these loaders to participate in conferences where all phases of 
the health problem are discussed. 59 
You mil note that I speak of conferences. By that I most 
emphatically do not mean the very common practice of ’’appointing a 
committee,” The best work is rarely done by committees; it is done by 
individuals. Moreover, once a committee has been appointed it is often 
hard to get rid of it. I can. sure most of you are fed up with an intermin- 
able round of committee meetings, with an imposing list of agenda, a lot 
of fruitless discussion often ending with the appointment of a sub-committee 
to consider some detailc ive all know such meetings and regret the waste 
of valuable time which their attendance entails. 
One last word, I urge you not to underta.ke any particular 
program of health education just because ’’all the others are doing it,” 
It may be tempting to climb on the band wagon, but you may have quite 
different and more important health problems in your community and it is 
to these that you should devote most of your attention. Kenneth Peebles, an N. Y. A. employee of the shop at the beginning of 
construction, was promoted to skilled woodworking for Defense. i|e then 
continued as a volunteer to complete the carving and painting of the 
figures. William H. H. Wilkinson, an electrical engineer, now an ad- 
ministrator in the office of the New York State Employment Service, 
volunteered to install the electrical system, including lighting and 
timing. Frank Patten, sign writer from W, P. A., executed all graphs, 
charts and small pictures and designed the lettering. Altogether from 
30 to 40 people gave much time to creating the exhibit. 
Our point is - we did not know this talent was available until we 
had a concrete problem and hunted for ways and means to solve it. By 
utilizing aids from, many sources, an exhibit was produced for a cost 
of $150 which if bought from professional sources, would have been en- 
tirely beyond our means. 
Each panel is a separate unit to provide flexibility in future ex- 
hibits. Other media might be used in the dioramas. 
Mb believe photographs can be used at less cost, although perhaps 
they would not stimulate so much attention as the quaint figures. 
The conraittee believes that the design and lighting technique are 
good. Farther experimenting is needed, however, with subject matter 
which can be adapted to the technique. For this reason we are asking 
at this first showing at the American Public Health Association meet- 
ing that visitors give us their criticisms and suggestions, 
A description of the technique used in building the exhibit, complete 
with plans, is being prepared by Doctor West and may be obtained by 
writing him. 
LET’S BUILD AN EXHIBIT 
"District Health Centers Reduce Infant Mortality" 
The health officer committee on Visual Aids and Exhibits believed 
that an effective exhibit could be made to tell the story of how the 
Department of Health and community agencies together effectively tack- 
led an important health problem in a district. 
The reduction of infant mortality to new low records during the past 
ten years is a story worth telling. The idea of the lighting devices 
was taken from the Russian exhibits at the World* s Fair and seemed to 
offer a new and different method of presentation. At first the cost 
seemed to put the idea far beyond our means. However, by going after 
and securing participation from many sources, the exhibit became a 
reality. 
Older the leadership of Doctor John B. West, then District Health 
Officer of the Central Harlem Health District, the health officer com- 
mittee conceived, planned and designed the exhibit. 
Production was carried out in the Health Education Workshop in 
Central Harlem Health Center. This workshop cane into being in July, 
1939, as a result of the health officer’s interest in utilizing his 
hobby of woodworking to provide productive special opportunities for 
youth training. It is a cooperative enterprise shared in by the New York 
Tuberculosis and Health Association, Greater New York Fund, National 
Youth Administration, Works Projects Administration and the Department 
of Health. 
Doctor West supervised the construction of the exhibit until he left 
the city to assume his new post as Medical Director of Provident Hospi- 
tal and Principal Assistant Bureau Chief of the Board of Health in 
Chicago, After that time Doctor Irving Crain, Acting District Health 
Officer, who had worked closely with Doctor West, supervised the exhib- 
it and brought it to completion. 
Doctor West* s ability and experience in design and technical con- 
struction, together with Doctor Crain* s experience in dramatics and 
piaywriting, gave guidance of professional calibre. Probably the most 
valuable individual was John Paul Davies, an 18 year old N. Y, A. wood- 
worker and cabinet designer. He was responsible for the fine craftsman- 
ship and for many improvements in technical design. Arthur?. Reynolds, 
a W.P.A. employee, served as foreman and produced the jig-saw cutouts LET* S BUILD AN EXHIBIT 
DEPARTMENT OF HEALTH 
CITY OF NEW YORK 
Health Officer Committee on Exhibits: 
Dr. John B. West, Chairman 
Dr. Frank A. Calderone 
Dr. Irving J. Crain 
Dr. Jacob H. Landes 
Dr. Joseph Weinstein 
Secretary, Mr. S. S. Lifson 
Ex-officio, Dr. Dorothy B. Nyswander THE LONER EAST SIDE 
ORGANIZES ITSELF INTO A GOING CONCERN 
FOR COMMUNITY HEALTH 
THE MOTHERS HEALTH ORGANIZATION 
Frank A. Colder one, M. D. 
District Health Officer 
Lower East Side Health Center 
Department of Health 
New York City THE MOTHERS HEALTH ORGANIZATION 
Under the leadership of the district health officer, one 
district has solved the problem of community participation by helping 
its mothers - some seven thousand of them - to form their own Mothers 
Health Organization# The Lower East Side, a fascinating molting pot 
of many nationalities, has for years been the site of interest of some 
of the finest social agencies this era has seen. The questions hero 
seemed to the health officer to be - Why not utilize what we already have? 
Why not implement those ready-made tools for community participation to 
further the health program? Why not make a. program in which each and 
every organization could help its members to share? Next - What program 
could bo initiated which would meet a real need and offer sufficient 
interest to stimulate real work on the part of many people? 
Early in the spring of 1941, Dr, Frank Calderono, the district 
health officer, called a conference of key people in the Lower East Side 
and the group enthusiastically set themselves to work on this problem. 
It was decided that, while by common consent the health officer was 
elected chairman of the committee and while the health center became the 
hub of activities, the organization should be one not of the Department of 
Health but of the members themselves. Gradually ideas crystalized. 
Nutrition was selected as a basic need which could be dealt 
with through this type of program. Throughout the country the defense 
situation was sharpening our thinking about the health needs of the entire •2 
population. Everywhere sound nutrition was being stressed as of the utmost 
importance. Its selection by this group as their initial topic was in 
line v/ith the trend of the times, 
Hho were the members of the community who would bo interested 
in nutrition? Again the answer come easily - the mothers of families - 
the "homo” home economists - the ones who buy, cook and serve the food 
for their families. 
The organization plan was simple. Each participating agency - 
each school, each settlement house, each nursery, each library - knowing 
the women with whom it dealt, selected from among its membership a small 
group of natural leaders. These wore the Key Mothers - so called because 
they were the key to the whole plan. Each Key Mother in turn selected 
from among her own friends living in her own neighborhood, ten other 
mothers who were eager to learn better ways for healthful living. 
Thus each participating agency built up for itself a small 
group of interested mothers and kept a file of their registration cards. 
Each card gives the mother’s name and address, nationality, husband’s 
name and the names and ages of the children. The Key Mother’s card lists 
in addition the names of her own group of ten. Duplicates of these cards 
are on file in the health center available as a source for volunteers in 
time of emergency or as an organization resource as the program continues. 
Over 7,000 families are thus listed. At tho health center the health officer and his executive 
committee carried the burden of planning the program, securing funds, 
making available educational material and securing press and radio 
publicity. The task of being contact person with the participating 
agencies, attending to distribution of supplies, arranging conferences 
and meetings - a full-time job - was assigned to Dr. Mary Steichen, 
Junior Health Officer, Without one such person to keep all the machinery 
rolling smoothly, it would have been practically impossible to carry out 
such a. large program, 
A group of nutritionists from the Community Service Society, 
the New York Chapter of the American Red Cross, the Catholic Charities and 
tho Department of Welfare of New York City collaborated in working out all 
nutrition educational material# 
All educational material was sent to the participating agency 
which in turn distributed it to its Key Mothers and made sure the latter 
understood it. Each Key Mother then called together her group of ton, 
gave out the material and discussed its implications. 
For four weeks the problem of proper food was thus discussed 
throughout the district. The material was divided into four topics: 
dark breads and cereals; fruits and vegetables; milk; and meat, fish and 
eggs. During the week that each topic was being discussed, leaflets on 
tho same topic were distributed by teachers to the children in 49 schools 
in the Lower East Side district. Often the teachers used the subject for 
a health lesson. Thus in the school and in tho home, for four weeks, chil- 
dren and their mothers discussed food as an important matter for the health 
of the family. During each one of the four weeks a radio broadcast was held 
on the food topic of the week. The technique used was a popular interview 
with o. group of mothers by the health officer, junior health officer, or 
one of the nutritionists. The mothers were all notified of each broadcast 
and listened to them eagerly. 
One thing became clear# Such a community organization could bo 
made very popular and its members had a real pride in it and worked hard. 
At a big community rally an audience of over 2,000 mothers - the housewives 
of the district, listened intently to experts, city officials and to 
Mrs. Roosevelt# Children whose mothers belonged to the Mothers Health 
Organization had buttons to wean and other children teased their mothers 
to join. City papers carried feature stories with pictures of the mothers 
which were proudly read by the Lower East Side# Radio stations gave con- 
siderable time to broadcasts - tho interviews with mothers proving most 
popular• 
It was a hard job and it took imagination but it was successfully 
done# Nov/ the Mothers Health Organization wants more jobs to do* Every 
one of the 7,000 mothers looks with new respect and a. friendly feeling 
toward her Department of Health* The health officer is known by najne to 
thousands of his families as their friendj The Lower East Side has 
organized itself into a going concern for community health. 
How this was all carried out has been compiled by the Russell 
Sage Foundation into a scrap book which is on exhibit at the Eighth >5< 
Institute on Public Health Education in connection with the 70th Annual 
Meeting of the American Public Health Association at Atlantic City, 
October 1941, In this scrap book arc given the details of organization, 
samples of activities carried out, and methods securing publicity. 
Unusually fine through their clearness and simplicity wore the leaflets 
developed by the nutritionists for the Key Mothers, Those deserve special 
attention from those who are interested in similar work. A 
COOPERATIVE 
HEALTH EDUCATION PROJECT 
on 
TUBERCULOSIS 
EAST HARLEM HEALTH CENTER 
and 
BENJAMIN FRANKLIN KICK SCHOOL 
New York City 
Sophie Rahinoff, M. D. 
District Health Officer 
East Harlem Health Center 
Department of Health 
New York City GRATEFUL ACKNOWLEDGMENT IS iiEREWITH GIVEN TO THE FOLLOWING INDIVIDUALS 
WHO HAVE PARTICIPATED AT VARIOUS TLIES IN THE COURSE OF THE PROGRAM, 
DEPARTMENT OF HEALTH 
Dr, Margaret ' • Barnard, Consultant in Local Administration 
Dr, Charles F, Bolduan, Director, Bureau of Health Education 
Dr, Israel l.einstein. Assistant Director, Bureau.of Health Education 
Dr, Herbert R, Edwards, Director, B ureau of Tuberculosis 
Dr, Morton H. Aronsohn, Physician-in-Charge of Chest Clinic, East Harlem 
Health Center 
Dr, Caroline Silberman, Health Officor-in-training 
Mr, Charles T. Griffin, Artist, Bureau of Health Education 
Miss Miriam Friedman, Health Education Assistant, East Harlem Health Center 
BENJAMIN FRANKLIN HIGH SCHOOL 
Dr, Leonard Covello, Principal 
Mr, Emilio L, Guerra, Assistant to Dr, Covello 
Dr, H, S, Dlugatz, Chairman, Science Deportment 
Hr, Samuel Huber, Chairman, Art Department 
Mr, Joseph Gallant, Chairman, English Department 
Mr, Lillian A, Speigel, Chairman, Physical Education Department 
Mr, Michael DeCaesare, Chairman, Italian Department 
Mrs, Lea KAnheimer, Chairman, Spanish Department 
NEW YORK TUBERCULOSIS AND HEALTH ASSOCIATION 
Mrs, Katherine Z, ' • Ahipole, Secretary, Health Education Service 
Miss Martha Shamborgcr, Volunteer in Health Education Service 
DISTRICT HEALTH EDUCATION DEMONSTRATION 
Dr, Dorothy Nyswandor, Director 
Sophie Rabin off, M. D, 
District Health Officer 
9-25-41 HEALTH EDUCATION PROJECT ON TUBERCULOSIS 
BENJAMIN ERANKLIN HIGH SCHOOL 
EALL TERM, 19U0 
Health Education for high school students offers a variety of 
possibilities and a most fertile field for co-operative participation 
by health agencies, teachers and students. In the East Harlem Health 
Center District, the Benjamin Eranklin High School has for some years 
shown an active interest in health education and the local district 
health program. Tuberculosis has been especially emphasized because 
the school is in a district in which the tuberculosis rate is high, 
and as far back as 1937 connection with the "Early Diagnosis Cam- 
paign", films on tuberculosis were shown and literature distributed. 
This was preliminary to a tuberculin testing and x-ray project ini- 
tiated for the entire school by the Department of Health, The Hew 
York Tuberculosis and Health Association supplied films and literature. 
Since then it has been customary each term during the past few 
years for the Health Officer to arrange in co-operation with the 
Science Department Chairman, Dr. H. S. Dlugatz, a special health ed- 
ucation program. This consisted of three assembly programs on various 
health subjects for a period of one week. Speakers were provided and 
films shown, A single evening parents1 meeting was also held each 
term to bring health messages to the parents and adult groups in the 
evening school. 
It was felt, however, that the students would benefit even more 
directly and be more alive to health standards and goals, if they 
participated actively in a program that had some relationship to their 
family and environment. In keeping with the idea of emphasizing active 
rather than passive methods of learning, it was determined to concent- 
rate on one subject. Tuberculosis was selected inasmuch as incidence and mortality rates are high in the East Harlem district, and these 
pupils are in the age group which presents special problems, Eor ex- 
ample, in the five year period 1933-1937* tuberculosis was responsible 
for Ul$ of all deaths in the age group 15-2^.years. To utilize more 
recent figures, on January 1, there were nearly 800 cases of 
tuberculosis known to the Health Department in East Harlem. Because 
of the nature of the disease the material studied offered a wide field 
of interest from both a personal and community aspect. Many day to day 
factors such as personal hygiene, diet, exercise, cleanliness, prepara- 
tion for a livelihood, housing and recreation were broached. It en- 
gendered an awareness of the responsibility of each individual to him- 
self, his family and the community. So too, the program demanded re- 
cognition of early symptoms of tuberculosis to combat the disease in 
its incipient stages as well as a recognition of preventive hygiene. 
The tangible objective of the project was to create posters in 
English, Spanish and Italian based upon the material submitted by the 
students in the form of slogans. Unification of this work demanded 
the fullest cooperation of the chairman of six departments—Physical 
Education, Science, English, Spanish, Italian and lastly, consummation 
in the Art Department. This was attained admirably through the good 
offices and, encouragement of the principal of Benjamin Pranklin High 
School, Dr. Leonard Covello. A conference was arranged early in the 
term attended by the principal, the various heads of the departments, 
the Health Officer and Mrs. K. Z. W, Whipple, in charge of Health Ed- 
ucation at the New York Tuberculosis and Health Association, The latter 
was instrumental in supplying tuberculosis material in the form of 
posters and literature as well as teaching units, and information re- 
garding experience elsewhere in the integration of teaching on tuberculosis into the curriculum, 
7 At this meeting the technique of instructing the student body 
was discussed and a schedule sot up to determine the amount of time 
to be devoted to tuberculosis by each department as well as the stages 
to be followed in order to submit the slogans to the Art Department at 
the beginning of December for their ultimate conversion on posters, 
Mrs. Whipple offered three pamphlets, "Growing Healthfully," "Preventing 
Tuberculosis" a teaching unit and "Guide for Teachers," embodying techn- 
iques and methods for teaching tuberculosis to all instructors partici- 
pating in the project* An interim informal conference was also held 
later with Dr. Covello, Dr. ITyswander, Dr. Dlugatz and the Health Officer 
to consider possible long range planning* 
It may be remarked at this time that a similar program was in- 
stituted at the Benjamin Franklin High School Annex in the Kips Bay 
area. Assembly programs were devoted to tuberculosisk films were shown 
in the study hall and classroom, and individual teachers in the various 
departments previously mentioned led discussions on the subject. In 
addition members of the Science Department both in the main building 
and in the annex were invited to attend a lecture of a semi-technical 
nature by Dr, E. R, Levine on October 1*4, 1940, in order that the in- 
structors might be better oriented on various aspects of tuberculosis. 
Another important feature of this activity which may be mentioned 
at this time regarding the suitability of the subject of tuberculosis, 
and its introduction into the term program is the fact that the Health 
Center has regularly conducted a tuberculosis survey with the necessary 
follow-up for each graduating class. Parenthetically, at one of the 
meetings the wisdom of investigating the status of the graduating 
class only, was questioned by a student and consequently a new policy of administering the tuberculin test to entering students will be 
instituted so that suspicious cases may bo chocked while the boys 
continue under the jurisdiction of the high school. 
As previously mentioned, all the students attended assembly pro- 
grams devoted to tuberculosis with a speaker and film on the subject. 
In order to orient them still further, four films (two each week) wore 
shown regularly each day in the study hall to students having free 
periods. During this interval, each student was enabled to view at 
least two different tuberculosis film. Bulletin board space at stra- 
tegic locations in the school wore utilized for posters and the school 
library also displayed literature relating to tuberculosis. 
Supervised student instruction commenced the beginning of October 
throughout the various departments. The Science Department, for ex- 
ample, devoted one period in each biology class to the use of a set 
of graphic isotype charts which provoked much interest on the part of 
the students. An additional period was devoted to a social study les- 
son and involved the use of appropriate literature. Following these 
preliminaries, class room quizzes were given and the students showed 
a surprising grasp of the subject matter. There was also discussion 
of slogan material; many of the students brought in theirs as part of 
a classroom assignment. Fifteen science students voluntarily submitted 
cartoon posters on the subject, some extremely well executed and of 
high emotional and dramatic value. It may also be noted that, in- 
fluenced by the classroom discussion, students in the various classes 
spontaneously raised the question, (,What can be done about reducing 
the incidence of tuberculosis?n a question which was again raised at 
the Student Council meeting and which will be discussed in the latter 5 
portion of this report. 
A study of the causes of tuberculosis led to the question of 
factors in East Harlem responsible for the widespread occurrence of 
tuberculosis. Inadequate housing, improper diets, unemployment and 
race susceptibilities were offered as contributing causes to the high 
tuberculosis rates. Another important phase of these classroom studies 
was the uprooting of long held misconceptions such as the belief that 
tuberculosis is inherited, transmitted from parents to children. 
A group of students from the science classes was also delegated 
to visit the Health Center on an inspection tour. They were particul- 
arly concerned about the facilities available in the chest clinic and 
entered into a prolonged discussion with the head nurse over the costs 
of x-rays, both paper and celluloid, and various other aspects of med- 
ical care for the tuberculous patient. They also discussed the Health 
Center sot up as a civic function. Hollowing their visit, they made a 
comprehensive report of their experiences to their classmates. 
The English Department approached the subject in a more oblique 
fashion. The students were encouraged to discuss personal experiences 
in some wav related to the problem of tuberculosis and a surprising 
number, it was revealed, had had some contact with tuberculous indivi- 
duals. In these classes another interesting belief was exposed and its 
ghost laid-that people living out of the city, principally farmers, arc 
less apt to fall heir to ills of the flesh. 
Instruction in tuberculosis was not a now problem for the Physical 
Education Department inasmuch as in the Personal Hygiene Class a single 
term required course, the subject is included in the curriculum. In 
fact, it was considered of such importance that throe years ago an entire term consisting of one period a week was devoted to tuberculosis 
instruction. Then too, the students had keen constantly aware of the 
tuberculosis problem through the experiences of graduating students 
who were either x-rayed or given a tuberculin test in their last term 
at school. 
The Italian Department, following the accepted classroom procedures, 
devoted two full periods to a discussion of the subject and the students 
supplied slogans in Italian as a homework assignment, 
Dor the Spanish classes a Spanish pamphlet, "La Tuberculosis" issued 
by the National Tuberculosis Association was utilized in the form of oral 
comprehension lessons. When the students presented their slogans, there 
were several suggestions made that when the posters in Spanish were ul- 
timately prepared they be allocated to stores and buildings frequented 
by Spanish individuals so that they might recognize tuberculosis symptoms 
and the need for prompt treatment. It was planned to show the Spanish 
version of the tuberculosis film, "Cloud In The Sky," to the students 
taking Spanish courses but unfortunately the high school machine was out 
of order and it was not feasible to show the film at that time. Undoubt- 
edly the students would have welcomed this particular visual method for 
the information it contained as well as the opportunity to hear collo- 
quially-accepted Spanish, In lieu of it the teachers engaged in Spanish 
conversation with the students, on the subject of tuberculosis, and they 
were encouraged to respond in that language as a form of practice. Ar- 
rangements were made to show this film at a later date. 
It was the task of the Art Department to apply the slogans prepared 
in English, Italian and Spanish to posters and this involved a considerable 
amount of technical preparation, lay-out of posters, preliminary sketches, perhaps four or five for each poster, enlargement, revision for better 
proportion of lettering, etc. Despite the tremendous amount of work 
involved the students apparently enjoyed making these posters and the 
finished productions gave evidence of technical ability, ingenuity of 
thought and skilled appreciation of the points that we had stressed. 
Unfortunately because the time element for completing a single poster 
was so great, and although a full month had been set aside for this 
project, the schedule did not allow for finished posters in Spanish 
or Italian although such slogans had been submitted. These were put 
on display during open school week and were also on view at the Parents’ 
Meeting on January lb, 19*+1. Several of these are reproduced in this 
article. 
Severed sample slogans selected at random are offered at this 
point.* 
ENGLISH* 
SPANISH* 
1-Tackle T. B. before it scores 
a touch-down. 
1-Cuidese hoy, y no sufrira manana. 
2-Combata la tuberculosis con estos 
tros agentes * 
1. Dcscanso 
2. Examen fisico 
3. Buena alimentacibn 
2-A check on T- B*. is a check for 
health. 
3-Fight T. B. 
An x-ray can sec what the human 
eye can't see. 
3-La mejor defense contra la tuber- 
culosis es la rnejor ofensive. 
U-Overcome Tuberculosis as David 
overcame the lion. 
U-Para combatir la tuberculosis, la 
sabiduria es poder. 
5-Suspcnsc is not defense, have 
an x-ray taken. 
5-Con la sobiduric conquiste la 
tuberculosis. 
* For complete list of slogans, see appendix. ITALIAH* 
1- si guarda si salva. 
2- T. B. e nemica andate alia chinica. 
3- danso non e tutto La salute e voro aiuto, 
U-Se T. B. vince, tu perdi, 
5-Cacciate T. B. altpimento T. B, cocera' Voi, 
At the conclusion of all these activities the heads of the De- 
partments, the Health Officer, and Mrs. Whipple of the Hew York Tuber- 
culosis and Health Association were invited to sum up the results of 
this project both from a positive and a negative aspect. Several 
students, executive members of the Benjamin Franklin High School 
General Organization as well as some parents also attended the meet- 
ing. 
The department heads were unanimous in the belief that the pro- 
ject had been most valuable to the students and to the community at 
large and expressed a willingness to cooperate in furthering future 
projects initiated by the Health Center. It was their request, how- 
ever, that programs of this scope should bo better coordinated with 
their term syllabus. It was brought out for example, that the teach- 
ing of tuberculosis in the Physical Education Department at the present 
time was not well correlated with the work of the other departments. 
Other chairmen, although granting the value of tuberculosis instruc- 
tion, felt that because so many demands were made on their regular 
teaching schedule it was well nigh impossible to devote much tine to 
Health Education material without interfering with the regular class- 
room work. It v/as quite obvious from the discussion at the last con- 
ference that if a project of this scope is to be sponsored, there must 
* For complete list of slogans, see appendix. be better coordination with their term teaching syllabus. Although 
the various chairmen encouraged this work and everyone felt it was an 
interesting and worthwhile demonstration, future planning should take 
into consideration the whole teaching program and have this incorpo- 
rated and correlated in the general plan. 
It may be remarked in passing that the instructors were themselves 
influenced by the project and many felt it desirable that they them- 
selves submit to tuberculosis testing. 
It was generally agreed that the students fully recognized the 
objectives of this program. Stimulated by their reading and instruc- 
tion they raised the following valuable points at our final meetings; 
1,-That educational programs consisting of films and speakers be of- 
fered to adults in the community. (Apparently the boys are not fully 
aware of the fact that such work has been carried on regularly in the 
district.) 2.-That educational material in the form of posters and 
booklets both in English and in foreign languages bo distributed to 
adults, 3•“That students entering the high school be x-rayed on ad- 
mission as well as at graduation. U.-That complete physical and dental 
examinations be given to all High School students with some provisions 
for those who cannot afford to pay for professional services. Their 
ardor was evidenced by a petition containing a thousand signatures re- 
questing an x-ray examination of each entering and graduating student 
in the high school. 
To conclude this report it is definitely the feeling that the 
Health Education work done at the Benjamin Eranklin High School has 
evoked the interest of both students and instructors and has served 
to bring to the attention of the student body a disease which takes -10- 
a large toll in East Harlem, The interest of the students was en- 
listed to the extent that they recognized the need for early diagnosis 
and control of this disease and further, as a result of the program, 
carried messages to their families and friends hy way of reports and 
literature. In fact, at the final conference, one of the more alert 
Italian mothers who was present discussed the case of a poverty stricken 
neighborhood youngster who had been told ho had some trouble in his 
lungs. She felt it her duty to escort the boy and his mother (who 
spoke no English) to a clinic for a thorough check-up. This instance 
is undoubtedly typical of the attitude of other parents in the district, 
who have become increasingly aware of the importance of preventive mea- 
sures. 
It is our belief that the program offered at this school is de- 
serving of further development and repetition in the other districts. 
Based on the experience in East Harlem with Benjamin Franklin High 
School, and the fact that they look to us for guidance in their health 
program, it is our intention, to continue this work and hope to de- 
velop it further. 
Appendix follows ■a- 
APPENDIX 
** 
List of Pamphlcts^Distributed 
to Teachers and Students 
in Quantities of 100 or More 
“Tuberculosis Basic Pacts in Picture Language” 
* “Why Sleep” 
“Air and Sunshine” 
“Roentgen1s Ray“ 
“Robert Koch” 
“Laennec, The Listener” 
“What you Should Knov/ About Tuberculosis” 
“Tuberculosis 5 to 20” 
“Landmarks of Progress” 
“What i s Tub erculo s i s?” 
“Climate and Tuberculosis” 
* “A Heart to Heart Talk” 
“La Tuberculosis” — Spanish leaflet 
“Growing Healthfully” 
“Guide for Teachers” 
“Preventing Tuberculosis” a teaching unit for 
Junior and Senior High Schools. (Includes 
list of Reference Material upon which the 
unit is based) 
* Out of print at this time. 
** Published by the National Tuberculosis Association. Slogans Submitted in English, Spanish and Italian. 
1. Tackle T. B. Before it scores a touch-down, 
2. A check on T. B. is a check for HEALTH. 
3. T. B. is the hatter, you're the pitcher. Throw a Bean Ball, 
U. T. B. is our country's problem child. 
5. While the storm clouds gather far across the sea- 
led us pledge allegiencc to get rid of T. B, 
6. Stop tuberculosis Before tuberculosis stops you. 
7. When you have a Bad cough 
Don't delay 
Go to see your doctor 
Right away. 
8. T. B. or not T, 3. its toxin you. 
9. One cannot tell if he has T. B. unless he takes an x-ray. 
10. Eight T. B. 
An x-ray can sec what the human eye5can*t,see, 
11, Our lives are at stake. 
So don't expectorate 
Our lives we adore, 
So don't spit on the floor, 
12, Catch T. B. Before it catches you 
Housing wanted.' But not for T. 3, 
13. Isolate T. B. Before it isolates you 
T. B. is a menace, don't let it menace you. 
lU, With plenty of sunshine and good food to eat you won't have to 
worry about catching T. B, 
15, Overcome Tuberculosis as David, overcame the lion, 
16. Stop T. B. By free examinations 
Got a T. B, examination to catch spread of germ. 
17. Eight T. B. Before it licks you 
Down with T, B.i Public enemy No. 1.' 
18, To rub out the T. B, pest you need rest. 
To cure T. B, you need much rest or T. B, will Best you and 
you'll get your rest. ■O' 
19# Many worry about T. B, - Take care and it may not be* 
20* Plenty of fresh air because it * s always there, will help keep 
away that big T* B* scare. 
Here today, gone tomorrow, T. 3. here today no more tomorrow, 
21, David killed Goliath-why can’t we kill tuberculosis? 
22. Kill T. 3. before it kills you. 
If you don’t kill the T. 3. germ, you surely won’t be hero next term, 
23# Pour o’clock is tea time, T. B. is any time. 
Help fight T. B, 
25# T, B, is a catching disease if you get caught you’ll be deceased. 
T. 5, is caused by a bug, if you get caught a grave will be dug. 
26. If you wait for T. 3, to be old and worn 
Many friends your death shall morn, 
27# Parly to bed and early to rise keeps T. B. doing the jive, 
28, Tubercle Bacillus is always around so let’s kick it off the ground, 
29# Suspense is not defense. Have an x-ray taken. 
30. Travel around with 3 M T but don’t travel with T. B. 
31. T. B, Harlem’s Public Enemy Ho. 1, 
32. T. B. or not T. 3, that is the question, 
CARTOPUS AHD POSTERS (Examples) 
1, David and Goliath, Goliath is T. 3. and David is hitting him 
with rocks from his sling-shot marked Education. 
2, T. 3. on sand and the wave of Education comes to erase him, 
3* Buy a T. 3. stamp to stamp out T. 3. 
U, Har1em’s Publie Enemy Ho. 1. •d- 
SLOGANS IN SPANISH 
✓ „ 
1. Cuidcse hoy, y no sufrira manana, 
2. Conbata la. tuberculosis con eat os trcs a 
1. Descango 
2. Examen fisico 
3. Buena alimentacion 
3. La mejor defensa contra la tuberculosis es la mejor ofensiva, 
U. Para combatir la tuberculosis, la sabiduria es poder, 
5. Con la sabiduria conquiste la tuberculosis, 
6. Luchen contra la tuberculosis antes de que luche contra Eds, 
7. No hay tiempo como el presente para luchar contra la tuberculosis, 
SLOGANS IN ITALIAN 
1. Chi si guarda si salva, (To be cautious is to be wise.) 
2. La T. B, e nernica andate alia chinica, (T. 3, is your enemy. Go 
to the clinic,) 
3. II denso non £ tutto. La salute e vero aiuto, (Wealth is not all. 
Health is the true 
aid.) 
U, Se T. B. vince, tu perdi,’ (If T. B. wins you’re the loserJ) 
5. Cacciate T. B. altrimonte T. 3, cocera* Voi. (Chase T. B, out of your 
life or it will chase 
you out of life,) 
6. Acquistate il francobollo Antitubercolarej (Buy anti-T, B, stamps.) 
7. Prevenire e raeglio che reprimere. (To prevent is better than to 
remedy.) 
S, Con unita uccidercmo la Tubercolosi. (With unity we can slaughter 
T. B.) 
9, Lottate contro la Tubercolose. (Eight vs. T. B.) 
10, Ora e il tempo di narciare contro la tubercolosi. (Now is the time to 
march vs, T. B.) 
11, Aiuta la Bed Cross perche la Red Cross Aiuta la gente T. B, 
(Help the Red Cross. The Red Cross helps the tubercular.) 
12, Chi e Tubercoloso e pcricolosoj (He who is tubercular is in danger.)