Activity programs designed to improve public health and reform values 1900-1920

Kissick captured the complexity of health care reform when he described three sides of the iron triangle of services: cost, quality and access (1994). Efforts to reduce costs and increase access stimulate initiatives designed to decrease medical interventions. Moving beyond the notion of “fixing” someone's health, providers and third party payers now provide programs that target lifestyle choices. Present day programs may seem new and exciting, but this type of intervention was common in public health from 1900-1920.

This paper will use historiography to describe occupation or goal directed activities that were used by public health advocates to improve the lives of people with mental and physical disabilities. The Emmanuel Church Tuberculosis Class (1908-29), Arequipa Sanatorium for Working Women, (1911-41) and Marblehead Pottery (1907-26) were widely recognized by lay and professional audiences. Physician, nurse and therapy reformers used activities to teach proper living skills that would improve community health if adherence continued. Religious leaders, patients, family members and participants worked in sanatoriums, churches and hospitals with lay health workers to address TB, disabilities, mental illness and fatigue syndrome, using group support and crafts.

The Emmanuel Movement was initiated by Ellwood Worcester, a religious leader and psychologist, who recognized unmet needs and partnered with physician leaders Cabot, Hall and Pratt from Massachusetts General Hospital (MGH). Cabot felt that people received too many drugs and needed a “whole life change” to regain health (1907). Pratt, directed TB classes, prescribed outdoor living and patient activities such as journaling to achieve remarkable improvements. At Marblehead Sanatorium, Hall (1910), used a “work cure” to address the lack of energy and ennui of women suffering from neurasthenia, alternating craft work and rest periods to build habits of responsibility. Brown used similar methods with working-class women with tuberculosis in his sanatorium. All of these programs were designed to reward middle class behavior.

These reformers linked public health and social service initiatives to the expansion of their professional boundaries. Physicians delegated tasks to nurses, social workers, occupational and physical therapists and hospital administrators. Presently, as individuals ponder a plethora of sleekly targeted prevention programs, we might ponder the benefits and shortcomings of programs designed 100 years ago. Health goals were achieved but participants paid a cost such as needing to adopt middle class values if they wanted to continue to receive program benefits. Past ideas can inform the design of programs providing hindsight into benefits and shortfalls.