Meit Michael, Knudson Alana
NORC at University of Chicago, Walsh Center for Rural Health Analysis, Bethesda, Maryland, USA.
J Public Health Manag Pract. 2009 May-Jun;15(3):185-90. doi: 10.1097/PHH.0b013e3181a117b4.
Public health in the United States began as a largely urban phenomenon, dating back to the late 1700s. In those days, public health was mostly concerned with issues such as sanitation and communicable diseases, which were of greater concern in areas with higher population density. By the late 1800s, however, it was apparent that the country's population was becoming more mobile and communicable diseases were beginning to spread from urban dwellers to rural dwellers, creating a need for rural public health services. Beginning in 1908, local governmental public health began to expand its reach into rural areas, with county health departments developing rapidly until the mid-1940s. Following the passage of the Hill-Burton Act in 1945, which funded the construction of community hospitals, rural health focus shifted almost exclusively to ensuring access to healthcare services. This article provides a historical context for rural public health service delivery and a beginning discussion of implications for contemporary rural public health practice.
美国的公共卫生事业最初主要是一种城市现象，可追溯到18世纪后期。在那个时期，公共卫生主要关注诸如卫生设施和传染病等问题，这些问题在人口密度较高的地区更为受关注。然而，到19世纪后期，很明显该国人口流动性增强，传染病开始从城市居民传播到农村居民，这就产生了对农村公共卫生服务的需求。从1908年开始，地方政府的公共卫生部门开始将其服务范围扩展到农村地区，县卫生部门迅速发展，一直到20世纪40年代中期。1945年《希尔-伯顿法案》通过后，该法案为社区医院建设提供资金，农村卫生工作重点几乎完全转向确保获得医疗服务。本文提供了农村公共卫生服务提供的历史背景，并初步讨论了其对当代农村公共卫生实践的影响。
