Public Health Advisor - History and Purpose

History and Purpose

The United States Public Health Service has historically placed personnel in local areas to assist with disease outbreaks or to advise various public health programs. Medical officers and other personnel such as environmental health officers, nurses or in some cases technical workers like laboratorians would be sent to local and state health departments for temporary assignments. Though the Public Health Advisor is an example of this type of locally placed personnel, it was not until the 1940s that the U.S. federal government placed public health workers to do anything more than advise or assist local public health efforts.

The purpose of the Public Health Advisor, or “PHA,” was to help implement venereal disease “VD” programs (as they were known at the time, now known as STDs for sexually transmitted disease) because the job of controlling VD was not entirely effective. For example, in 1935 U.S. health surveys indicated that at any one time, 683,000 persons were under treatment and observation for syphilis. This same year saw 518,000 new infections, 100,000 of them among persons under twenty years of age. By the end of World War II, it was estimated that one in ten persons would have syphilis in their lifetime. The disease was devastating if untreated, causing more than fifteen percent of all blindness, fifty percent of perinatal blindness, and eighteen percent of deaths from heart disease. In the late 1930s, 60,000 children were born each year with congenital syphilis. Following both World Wars (I and II), syphilis was seeded in the population because the public health infrastructure was not funded well enough to respond to cases of the disease. Physicians were not consistently reporting to the local health authorities when patients were diagnosed with syphilis, and (more importantly), the sexual partners of patients were not being identified or contacted so that they too might be offered curative treatment for syphilis. As such, syphilis was prevalent in the U.S. population, such that the federal government opted to initiate help to local venereal disease programs in states and local areas.

The kind of help needed was more than advice to programs. Advisors had been provided to the state and local public health departments during the 1940s; however, cases of syphilis remained. What was needed was help with the patients themselves – a task called contact epidemiology which involved interviewing people who were newly diagnosed with syphilis, identifying their sexual partners, and then going out into the community to locate these partners and bringing them into the clinic or to their physicians for examination and, if necessary, treatment. This job was the job of the venereal disease investigator; a job that was being done in some of the local areas, but neither uniformly nor effectively.

To meet the need for VD investigators, the VD Division of the U.S. Public Health Service hired a small group of college graduates to work as VD investigators for the federal government. These initial recruits were assigned to work on the Eastern Shore of Maryland.