Ready to Go: The History and Contributions of U.S. Public Health Advisors
"Sneak Peek" of Table of Contents
Chapter one, “I Want One of Those,” opens on the morning of September 11, 2001 as the CDC emergency operations team gathered to watch the second plane hit the World Trade Center. The chapter takes the reader on a tour of work experiences which define the Public Health Advisor – or “one of those.” The chapter is designed to introduce the reader to the breadth of the PHA experience and to provide an introduction to the uniqueness of PHAs.
Chapter two, “The Madam and her Doctor,” describes the historical basis for PHAs and begins with their “cradle”– the Public Health Service Venereal Disease Division. Lida J. Usilton, known as the poker playing Madam to her “boys in the field,” was a strong influence in the development of the future PHA. “Doctor” Johannes Stuart, a PhD economist known for his ingenuity as well as his quirkiness, was the ‘Father’ of the program. Together the Madam and her Doctor began the experiment that would later contribute to the establishment of public health programs world wide and would become a source of expert CDC managers. A history of federal presence in venereal disease control “VD” is discussed as are precursors to PHAs such as the Public Health Commissioned Corps as well as the “New Dealers” who were hired and placed in local areas to mentor local and state efforts in venereal disease control. The chapter answers the question: “why were PHAs needed?”
Chapter three, “The Original Experiment,” tells the story of an upstart and closely cropped group who served as the first “co-ops” in VD investigation on the Eastern Shore of Maryland in 1948. These men were recruited from colleges by the VD Division as an experiment because no one believed that the government could get baccalaureates to do “this kind of dirty work”- or VD patient interviewing and contact epidemiology. Stories from the remaining original PHAs and some of their early colleagues give a sense of the developing professional culture that endures even today.
Chapter four, “The Early Years,” introduces the reader to the early work of the PHA. Venereal disease control work was the original portal for PHA entry into service and remains an important part of the culture of work for PHAs. This chapter describes the nature of early VD control work and how early co-ops and PHAs experienced the job. The reader will also learn how PHAs were soon deployed for various national efforts and research endeavors. It will also describe how the Public Health Advisor made a place for themselves in the state and local public health arena, a working culture that had not previously known such a unique public health professional.
Chapter five, “The Expansion ,” opens in 1957 when the “proud old VD program” moved from Washington, D.C. to the “little and upstart Communicable Disease Center” in Atlanta. Public Health Advisors are soon recognized by CDC as an important contributor to public health after they arrive there, and are quickly recruited to develop and enhance Immunization and Tuberculosis Programs throughout the U.S. This chapter also highlights the expansion of the PHA cadre itself with the transition from an all white male group to a gender, racial and ethnically diverse professional series.
Chapter six, “Winnowing,” describes the central aspects of the unique entry level training for PHAs. The vast majority of Public Health Advisors are the products of years of field work across many programs and in many different geographic locations. Moving frequently within the first several years of employment is a hallmark of the job, and creates a valuable worker with varied experiences. The training regimen, however, is difficult and would prove to be the way to “weed out” those who were not suited for the work. Less than half remained after the initial two years due to the nature of the job with its harsh realities of public need, rapid deployment and frequent moves. The resulting remnant is a group of public health workers and managers who are highly valued by CDC, international organizations as well as state and local health departments.
Chapter seven, “Ready to Go,” is focused on a sampling of the varied and rapid deployments of PHAs. Over the years PHAs were called to respond to outbreaks of disease such as hantavirus, Lassa fever, monkeypox, encephalitis, tuberculosis, measles, AIDS, smallpox, Legionnaires, Guillain-Barre syndrome, SARS, syphilis, PPNG, Babesiosis, and Cholera. PHAs were detailed for health campaigns such as Guinea worm, malaria, syphilis, diarrheal diseases, yellow fever, Yaws, swine flu, polio, malaria control, and measles. They have been detailed in the wake of major events such as floods, hurricanes, volcanic eruptions, earthquakes, and the anthrax scare in the U.S. They were even detailed as poll watchers in select southern states during the 1972 and 1976 presidential elections. PHAs were sent wherever the events occurred in the United States and in every conceivable location: throughout the continent of Africa, South and Central America, and throughout the continent of Asia. The sampling of stories in this chapter gives the reader a sense of the types of deployments experienced by PHAs since the 1950s. They highlight the precise and unique contribution of PHAs to health situations here and abroad: the contribution of one who is a highly skilled, street savvy professional willing to go rapidly into any crisis.
Chapter eight, “The Silverbacks ,” tells about the contributions of PHAs after they have retired from CDC. Consistent with PHA culture, these retired PHAs are not found on the golf course. Instead they are serving international health organizations, state and local health departments, or they are part of the experienced executive management cohort that is standing in a widening human resource gap at CDC. The confluence and impact of events leading to the 1994 decision to discontinue the hiring of entry level Public Health Advisors is examined. The central theme of this chapter is that PHAs are committed by constitution to public health service. Even in their retirement they are serving throughout the world and they are returning to their CDC home to provide mission critical leadership at a time when CDC faces a paucity of experienced and operationally savvy human resources.
Chapter nine, “The New Experiment ,” suggests that there may be a reinvigoration of the proud old series through the new experiment called Public Health Apprentices. The story of this new experiment is told and lessons from PHA history are offered to insure that there be an intentional effort to integrate structurally, culturally, and historically the old and new experiments for the long term benefit of health programs globally and for CDC as an agency. If this new experiment truly proves to be a modern version of the system that provided a wealth of experienced, flexible, capable public health workers and leaders for health and human service efforts throughout the world, then this new cadre of men and women will soon be Ready to Go to contribute mightily to the public’s health today and tomorrow.