Public Health Advisor
Encyclopedia
The Public Health Advisor, or “PHA” is a type of public health worker which was established in 1948 by the United States Public Health Service in the Venereal Disease Control Division. Today they are hired primarily by the U.S. Centers for Disease Control and Prevention (CDC) and serve in many public health programs. This type of worker is unique in public health, because they begin their service at the entry level of public health doing what is known as “field work” or “contact epidemiology” which refers to the interviewing and locating of people who have been exposed to an infectious disease so as to offer them treatment and to reduce the epidemic. Following their initial work experiences, PHAs are exposed to a variety of public health programs across the United States, learning to function at all levels of the public health system. During their time of service, PHAs are called upon to respond to public health or humanitarian crisis. This article will briefly describe the history of the Public Health Advisor and will mention a few notable contributions made over the course of their history with the Public Health Service and later with the Centers for Disease Control and Prevention
.
programs. Medical officers and other personnel such as sanitarians, 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.
), PHAs were quickly recognized as an asset to other public health efforts because they were trained in phlebotomy
(drawing of blood through venipuncture
), they knew how to organize mass testing and could investigate diseases, and they could manage public health programs.
Public Health Advisors were soon called upon by the CDC to help with polio efforts in 1961, they built the national Immunization Program following the passage of the Vaccine Assistance Act of 1962, they were soon recruited to work in the Tuberculosis
Program, and by 1992 could be found in virtually all of CDC programs working at local, state and federal levels of the public health system.
In addition to their regular assignments in the public health system, PHAs are called upon to respond to disease outbreaks or health disaster. Establishing a locally trained and geographically varied workforce has allowed CDC to have ready and deployable human resources for emergencies or emerging needs anywhere in the world. PHAs are part of a deployable team that can be credited with the eradication of smallpox, the identification of new strains of disease, and the halting of epidemics. PHAs have been called to respond to outbreaks of disease such as hantavirus
, Lassa fever
, monkeypox
, encephalitis
, tuberculosis
, measles
, AIDS
, smallpox
, polio, Legionnella, Guillain-Barré syndrome
, SARS, syphilis
, PPNG, babesiosis
, and cholera
.
PHAs were assigned to work in health campaigns such as Guinea worm, malaria
, syphilis
, diarrheal diseases, yellow fever
, yaws
, swine flu
, and measles
. PHAs have been sent to respond to major events such as floods, hurricanes, volcanic eruptions, earthquakes, and the anthrax scare in the U.S. They even were assigned to be poll watchers in select Southern states during the 1972 and 1976 presidential elections.
Centers for Disease Control and Prevention
The Centers for Disease Control and Prevention are a United States federal agency under the Department of Health and Human Services headquartered in Druid Hills, unincorporated DeKalb County, Georgia, in Greater Atlanta...
.
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 healthPublic health
Public health is "the science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals" . It is concerned with threats to health based on population health...
programs. Medical officers and other personnel such as sanitarians, 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
Sexually transmitted disease
Sexually transmitted disease , also known as a sexually transmitted infection or venereal disease , is an illness that has a significant probability of transmission between humans by means of human sexual behavior, including vaginal intercourse, oral sex, and anal sex...
) 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
Syphilis
Syphilis is a sexually transmitted infection caused by the spirochete bacterium Treponema pallidum subspecies pallidum. The primary route of transmission is through sexual contact; however, it may also be transmitted from mother to fetus during pregnancy or at birth, resulting in congenital 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
Public health
Public health is "the science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals" . It is concerned with threats to health based on population 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
Epidemiology
Epidemiology is the study of health-event, health-characteristic, or health-determinant patterns in a population. It is the cornerstone method of public health research, and helps inform policy decisions and evidence-based medicine by identifying risk factors for disease and targets for preventive...
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.
Contributions of Public Health Advisors
After their introduction in 1948, the Public Health Advisor became an important part of the public health infrastructure of local and state health departments. In 1957 when the Public Health Service transferred the Venereal Disease Division to the Communicable Disease Center in Atlanta (which later became the Centers for Disease Control and PreventionCenters for Disease Control and Prevention
The Centers for Disease Control and Prevention are a United States federal agency under the Department of Health and Human Services headquartered in Druid Hills, unincorporated DeKalb County, Georgia, in Greater Atlanta...
), PHAs were quickly recognized as an asset to other public health efforts because they were trained in phlebotomy
Phlebotomy
Phlebotomy is the process of making an incision in a vein.It is associated with the following concepts:* Venipuncture, the practice of collecting venous blood samples* The main practice of a phlebotomist, an individual trained to draw blood...
(drawing of blood through venipuncture
Venipuncture
In medicine, venepuncture, venopuncture or venipuncture is the process of obtaining intravenous access for the purpose of intravenous therapy or for blood sampling of venous blood. This procedure is performed by medical laboratory scientists, medical practitioners, some EMTs, paramedics,...
), they knew how to organize mass testing and could investigate diseases, and they could manage public health programs.
Public Health Advisors were soon called upon by the CDC to help with polio efforts in 1961, they built the national Immunization Program following the passage of the Vaccine Assistance Act of 1962, they were soon recruited to work in the Tuberculosis
Tuberculosis
Tuberculosis, MTB, or TB is a common, and in many cases lethal, infectious disease caused by various strains of mycobacteria, usually Mycobacterium tuberculosis. Tuberculosis usually attacks the lungs but can also affect other parts of the body...
Program, and by 1992 could be found in virtually all of CDC programs working at local, state and federal levels of the public health system.
Hantavirus
Hantaviruses are negative sense RNA viruses in the Bunyaviridae family. Humans may be infected with hantaviruses through rodent bites, urine, saliva or contact with rodent waste products...
, Lassa fever
Lassa fever
Lassa fever is an acute viral hemorrhagic fever caused by the Lassa virus and first described in 1969 in the town of Lassa, in Borno State, Nigeria, in the Yedseram river valley at the south end of Lake Chad. Clinical cases of the disease had been known for over a decade but had not been connected...
, monkeypox
Monkeypox
Monkeypox also known as cockpox is an exotic infectious disease caused by the monkeypox virus. The disease was first identified in laboratory monkeys, hence its name, but in its natural state it seems to infect rodents more often than primates...
, encephalitis
Encephalitis
Encephalitis is an acute inflammation of the brain. Encephalitis with meningitis is known as meningoencephalitis. Symptoms include headache, fever, confusion, drowsiness, and fatigue...
, tuberculosis
Tuberculosis
Tuberculosis, MTB, or TB is a common, and in many cases lethal, infectious disease caused by various strains of mycobacteria, usually Mycobacterium tuberculosis. Tuberculosis usually attacks the lungs but can also affect other parts of the body...
, measles
Measles
Measles, also known as rubeola or morbilli, is an infection of the respiratory system caused by a virus, specifically a paramyxovirus of the genus Morbillivirus. Morbilliviruses, like other paramyxoviruses, are enveloped, single-stranded, negative-sense RNA viruses...
, AIDS
AIDS
Acquired immune deficiency syndrome or acquired immunodeficiency syndrome is a disease of the human immune system caused by the human immunodeficiency virus...
, smallpox
Smallpox
Smallpox was an infectious disease unique to humans, caused by either of two virus variants, Variola major and Variola minor. The disease is also known by the Latin names Variola or Variola vera, which is a derivative of the Latin varius, meaning "spotted", or varus, meaning "pimple"...
, polio, Legionnella, Guillain-Barré syndrome
Guillain-Barré syndrome
Guillain–Barré syndrome , sometimes called Landry's paralysis, is an acute inflammatory demyelinating polyneuropathy , a disorder affecting the peripheral nervous system. Ascending paralysis, weakness beginning in the feet and hands and migrating towards the trunk, is the most typical symptom...
, SARS, syphilis
Syphilis
Syphilis is a sexually transmitted infection caused by the spirochete bacterium Treponema pallidum subspecies pallidum. The primary route of transmission is through sexual contact; however, it may also be transmitted from mother to fetus during pregnancy or at birth, resulting in congenital syphilis...
, PPNG, babesiosis
Babesiosis
Babesiosis is a malaria-like parasitic disease caused by infection with Babesia, a genus of protozoal piroplasms. After trypanosomes, Babesia are thought to be the second most common blood parasites of mammals and they can have a major impact on health of domestic animals in areas without severe...
, and cholera
Cholera
Cholera is an infection of the small intestine that is caused by the bacterium Vibrio cholerae. The main symptoms are profuse watery diarrhea and vomiting. Transmission occurs primarily by drinking or eating water or food that has been contaminated by the diarrhea of an infected person or the feces...
.
PHAs were assigned to work in health campaigns such as Guinea worm, malaria
Malaria
Malaria is a mosquito-borne infectious disease of humans and other animals caused by eukaryotic protists of the genus Plasmodium. The disease results from the multiplication of Plasmodium parasites within red blood cells, causing symptoms that typically include fever and headache, in severe cases...
, syphilis
Syphilis
Syphilis is a sexually transmitted infection caused by the spirochete bacterium Treponema pallidum subspecies pallidum. The primary route of transmission is through sexual contact; however, it may also be transmitted from mother to fetus during pregnancy or at birth, resulting in congenital syphilis...
, diarrheal diseases, yellow fever
Yellow fever
Yellow fever is an acute viral hemorrhagic disease. The virus is a 40 to 50 nm enveloped RNA virus with positive sense of the Flaviviridae family....
, yaws
Yaws
Yaws is a tropical infection of the skin, bones and joints caused by the spirochete bacterium Treponema pallidum pertenue...
, swine flu
Swine flu
Swine influenza, also called pig influenza, swine flu, hog flu and pig flu, is an infection by any one of several types of swine influenza virus. Swine influenza virus or S-OIV is any strain of the influenza family of viruses that is endemic in pigs...
, and measles
Measles
Measles, also known as rubeola or morbilli, is an infection of the respiratory system caused by a virus, specifically a paramyxovirus of the genus Morbillivirus. Morbilliviruses, like other paramyxoviruses, are enveloped, single-stranded, negative-sense RNA viruses...
. PHAs have been sent to respond to major events such as floods, hurricanes, volcanic eruptions, earthquakes, and the anthrax scare in the U.S. They even were assigned to be poll watchers in select Southern states during the 1972 and 1976 presidential elections.