aid in a campaign to eradicate hookworm. They found little interest in or dedication to public health, leading Wickliffe Rose, the architect and organizer of the commission, to believe that a new profession was needed, composed of men and women who would devote their entire careers to controlling disease and promoting health at a population level. Three possible approaches for public health education were debated—the engineering or environmental, the sociopolitical, and the biomedical.

Rose enlisted Abraham Flexner in the move to establish education for a separate public health career. On October 16, 1914, Flexner brought together 11 public health representatives and 9 Rockefeller trustees and officers for a meeting. It was decided that there were essentially three categories of public health officers: those with executive authority such as city and state health commissioners; the technical experts in specific fields such as bacteriologists, statisticians, and engineers; and the field workers such as local health officials, factory and food inspectors, and public health nurses.

Rose laid out ideas for a system of public health education centered on a university affiliated, research intensive, scientific school, separate from a medical school, whose graduates would be strategically placed throughout the United States. This central scientific school of public health would be linked to a network of state schools that sent extension agents into the field, and emphasized not only public health education, short courses and extension courses to upgrade the skills of health officers in the field, but also demonstrations of best practices. The plan as implemented, however, focused on research and largely ignored public health practice, administration, public health nursing, and health education. The biomedical side of public health was emphasized to the exclusion of its social and economic context and no attention was given to the political sciences or to the need to plan for social or economic reforms.

The Johns Hopkins University School of Hygiene and Public Health became the first endowed school of public health, opening during the influenza epidemic of 1918. Later, Rockefeller Foundation officials agreed to provide funding for additional schools of public health including ones at Harvard and Toronto. These first schools were well-endowed private institutions that favored persons with medical degrees, had curricula that leaned heavily toward the laboratory sciences, and emphasized infectious diseases. Because the Rockefeller Foundation gave fellowships to medical graduates around the world the schools tended to have an international flavor. Programs of field training were not emphasized. By 1930 these first schools were graduating a small number of individuals with sophisticated scientific education but they were not producing the needed large numbers of public health officers, nurses, and sanitarians.



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