schools. This is one of the major projects of the Demonstration. Fortunately we have been able to secure the hearty support of the local educational authorities. They have appointed the director of health education of the Demonstration to the same official position in the schools. This will enable us to provide the content of health courses, to assist in training the present teacher to teach these courses, and to stimulate the normal schools to include such training in their courses for future teachers. In other words, we have set up the machinery which will make it possible to deliver the accumulated experience of our health educators to the local community.

The foregoing description covers the origin, policies, and preliminary steps which have been taken to place the Demonstration on a sound working basis. It is planned to gradually add to the program the contributions of the mental and social hygiene groups. At the same time we are endeavoring to play our part in the development of the correlated social agencies of the community. While it is too early to speak of definite results, we have every reason to be hopeful that out of the Demonstration will come ways and means whereby the resources of the entire health field can be successfully delivered to the local community.

DISCUSSION

Bernard W. Carey, Deputy Commissioner of Public Health, Massachusetts State Board of Health, Boston

The basic principle of community health demonstrations, be they directed to the development of one special field of public health endeavor as of child welfare or to the more general field caring for all the public health problems which may arise in any given community, is to be found in health knowledge.

Granting this premise, it behooves us to carefully examine into our program to ascertain if it contains all of the elements necessary for the successful transmission of knowledge on matters pertaining to community health.

It is well known that mere grouping of people will not make up a family, nor, likewise, grouping of families will not make up a community. However, these respective groups with the addition of one element, true interest in collective welfare prompting voluntary sacrifice that a unit of the family life may have special favor or that the greatest good for the greater number of the community may be achieved, may be fused into one. This furnishes the unit for the dissemination of our health knowledge and the obligation is placed upon us to be certain that our program is that which is best fitted for the community needs. This obligation becomes more marked, more sacred, when we realize that demonstrations have as their end the continuation by local endeavor of the program which has been carefully planned and executed in their midst.

It has been said that the most striking development of the public health movement of the present day is the health center, and to this might well be added that no other public health moveme with it greater responsibilities.

To those of us whose privilege it has been to help interest local communities in esta center or a community health project, this sense of responsibility has been markedly question of whether or not we were justifying the increased cost of public health activities in local people was constantly before us as well as the necessity of doing such a good piece of w we retired after our period of demonstration the work would be continued by local endeavor. From a practical, administrative viewpoint we have not accomplished our end nor justified the iture unless we by demonstration have proved our case and have made our service indispensabl future well-being of the community.

It appears that there is no place in public health activity of th vision of his achievement beyond the pale of jealousy and it is ever this nature where lessons are to be taught by precept and e must ever be turned aside by evidences of singleness of purpose for In the final analysis of our achievements one cannot but vi endowment far in excess of actual need compared with the outline in of the continuance of the program for the years to come.

The responsibility for such demonstration lies solely with the deme the desired end results, once the community has wholeheartedly participo failure in the special effort but in dire harm to the future of public health

cannot plac monstration

h of criticis

CO-ORDINATION IN VOLUNTARY HEALTH WORK

STATE VOLUNTARY HEALTH CO-ORDINATION

Walter D. Thurber, Executive Secretary, Maine Public Health Association, Augusta

There are arguments both for and against co-ordination of state-wide volunteer health work. Many are predicting that this co-ordination would immeasurably broaden the scope of the work, eliminate much overhead expense, and do away with duplication of effort. Others believe that intensive interest in the general subject of public health could not be as effectively maintained as is being maintained in the fight against specific diseases, such as tuberculosis, cancer, etc. These point out that interest in specified health work, tuberculosis, for instance, is often promoted by personal experience, either a death in the family, a recovery, or by some other personal

reason.

The experiences of the Maine Public Health Association do not prove or disprove one argument or the other, but the manner in which Maine capitalized both points of view may be found more or less interesting.

For several years the Maine Anti-Tuberculosis Association had been doing most effective work, largely as a result of which the death-rate from tuberculosis in our state had been reduced one half. For some time the need for health work along other lines had been apparent. Deaths from cancer were rapidly on the increase, infant mortality was high, there was a great need for a program of dental hygiene, and so on. Maine had seen various state-wide organizations for fighting specific diseases spring up in other states. The field was yet clear in its own territory and so the Maine AntiTuberculosis Association decided to take time by the forelock and reorganize itself as the Maine Public Health Association. It was planned to accomplish a broad inclusive program of health promotion, while working at the same time against specific diseases through separate divisions headed by specially trained men. These divisions include tuberculosis prevention, conservation of vision, cancer control, child hygiene, public health nursing, dental hygiene, social hygiene and mental hygiene, each division with a separate program of work but correlated with the general program, directed from one executive office and by one executive committee.

In this way Maine safeguarded herself on both sides of the argument. The cooperation which came from interest in some specific disease, was maintained through the various divisions. At the same time, with the broad general health promotion program, inclusive of all divisions, but not confined to merely the work of those divisions, the group co-operation of practically every important organization in the state was made possible.

In June, 1921, the Maine Public Health Association was incorporated under the state laws. It very soon developed that there were four immediate outstanding tasks to be achieved: first, to secure the earnest and actual co-operation of the medical profession; second, to assure close working relationship with the State Department of Health; third, to secure the popular support and co-operation of the general public; fourth, to capitalize this popular and professional support for the benefit of our local associations.

To bring about the accomplishment of these four immediate tasks, the Maine Public Health Association felt the need of formulating its program of health work so

that it might easily be visualized by everyone-a plan which would be comprehensive of the needs of the various communities and which might easily be expected to result in accomplishment within a three-year period. A plan which would be worded so plainly and simply as to have the popular appeal necessary to procure popular support, a program devoid of technicalities, one that would be inspiring perhaps, but likewise sincere and thoroughly practical, a plan that might be a medium through which to secure the co-operation of the various groups important to the success of the work of the Maine Public Health Association. It was quite natural to think of this plan as the Health Plan for Maine and so it was called.

The first step was a conference with representatives of every important group in the state, the granges, the women's clubs, the labor unions, the industries, the press, the Maine Medical Association, the State Department of Health, the State Department of Education, the State Dental Association, the State Automobile Association, the State Chamber of Commerce, the Women's Christian Temperance Association, the State Nurses Association, bankers, ministers, lawyers, and many others. A Health Plan for Maine was something that none of these organizations could afford to lack interest in. At this conference, these delegates were told that the Maine Public Health Association was formulating a Health Plan for Maine and that we wanted their guidance and sincere co-operation. A tentative three-year plan was submitted for their consideration and many important suggestions and revisions were accepted. The plan, or the program, was then sent broadcast to the local branches of these state-wide organizations, as well as to many other local groups, requesting their thought and welcoming any suggestions they might wish to make. The result of this broadcasting for help and guidance resulted in hundreds of letters from all over the state with valuable suggestions and criticisms. With all this help, the final draft of the Health Plan for Maine was completed and officially announced.

Having created this helpful initial contact with Maine's leaders in all walks of life, we were then in a better position to take up for solution the four organization problems described below.

Medical profession.-Wishing to cement the co-operation already received the organized medical profession in Maine, we requested the Maine to appoint a medical advisory committee to go over the Health the proper medical policy might be preserved. Such a com We also requested that the medical advisory committee adv Public Health Association in all of its medical activities. T mittee has been of invaluable aid in guiding the work of the associatio that the Health Plan has a firm, scientific basis, and they place their Members of the medical profession have spent years in special training for tion of health, and their co-operation in health wor work.

State Department of Health.-We also recogni health agency must not duplicate work of the S activities of the Maine Public Health Association our State Health Department. We are doing things have funds to accomplish for years to come. According Health was asked to become a member of the executive co Health Association, to assist in preventing any duplication

to th

policy of the volunteer organization in its dealings with the official health agency. This has resulted in complete co-operation with the State Department of Health and has prevented many misunderstandings and much confusion in the promotion of the work of each.

Popular support.—The initial interest and co-operation of the scores of important groups in the state such as the clubs, granges, labor unions, commercial organizations, and so forth, had been secured through the medium of the Health Plan. Their delegates "sat in" on the formulation of the plan and it immediately became a personal activity with them. Much publicity was given to these co-operating agencies in the effort to tie them to our project. Popular support was, of course, the one thing upon which success rested. It seemed reasonable to believe that if we could get at the people locally through personal contacts, get them to see the need and value of our work through the personal recommendation of a friend, an official of their own organization, for instance, the appeal might be a stronger one than if it came merely from an association with which they previously had had but little contact. In other words, in interesting the various important state-wide organizations, it was planned to cultivate that interest to the point where each local branch of each state-wide group would also cooperate. This is being accomplished rapidly.

The Health Plan for Maine has been the soldering iron, or the forge for welding together the interests of the various groups, not only to the benefit of Maine, but to the benefit of their own groups as well. The industries saw the good business of good health in its relation to production and industry. The granges saw the benefits to be derived by farmers from local lecturers, moving pictures, public health nursing, fresh air schools, literature on health problems in rural districts, etc. The women's clubs, the Women's Christian Temperance Union, and similar organizations composed largely of women, were quick to grasp the importance of our Health Promotion Program. The labor unions saw the value to their men of such educational activities as eye conservation, including prevention of eye accidents in industry, public health nursing, and child hygiene. The American Legion welcomed our program for the welfare of the service men. And so, tied up originally through the personal interest, these organizations came to appreciate the importance of a unified program calculated to promote the health of every man, woman, and child in the state.

Local associations.-The Maine Public Health Association works to a considerable extent through affiliated local societies, which are organized for the most part on a county-wide basis. These local associations presented two major problems: first that of coalescing local activities with the state program, and the state program with theirs, and, second, that of tieing up our newly acquired contacts with clubs, granges, industries, and other organizations, with the local public health association in their respective sections. We solved the first problem, that of adjusting the local activities with those of the state association, and vice versa, by giving each local society direct representation on the board of directors of the Maine Public Health Association. Each local association elects a director, and the board of directors elect the executive committee and the officers, a thoroughly democratic representative organization, financed partly through Christmas seals and partly through volunteer subscriptions. The second of our two major local problems, that of tieing up the local clubs, granges, commercial, and other organizations with our local associations, is accomplished through encouraging the same form of organization as exists in the parent state organization. The local public

health association will have its own local medical advisory committee composed of local physicians. The executive committee, or the general advisory committee, will include representatives from the social, civic, rural, and commercial organizations previously mentioned.

The benefits to both the local health society and the state association to be derived from this form of organization can be quickly grasped. For example, in the statewide seal sale the master of the state grange serving on the advisory committee of the state association addresses a strong letter to the master of each local grange urging that he get his grange behind the seal sale. The local master will do so for two reasons, first, because his state grange is behind it, and second because he himself is a member of the executive committee of the local public health association, which is to benefit largely from the seal sale.

The Health Plan for Maine is mentioned in this paper because it was used as a vehicle for the co-ordination and co-operation in volunteer health work in Maine.

The Health plan for Maine is not considered a panacea for all ills, nor is it so comprehensive in its arrangement that it will be applicable anywhere. It is merely comprehensive of the most immediate of the needs of Maine and the relation of those needs to what might reasonably be anticipated in the way of financial support to so new a project. It is a plan to do those things which seem most needed and to follow along with the other activities in a logical sequence. The plan is elastic, subject to change and to better thought. Under its guidance, the first six months of this program has witnessed many accomplishments not foretold in the plan but accruing as the result of it, and much of the co-ordination and co-operation which the Maine Public Health Association has been enabled to accomplish is due to the existence of the Health Plan for Maine.

Health workers all over the country are fast coming to the realization that the work of special health agencies are interrelated, one with the other, just as the causes of various diseases are interrelated. For instance, anti-tuberculosis workers generally admit that any program for the improving of public health is good anti-tuberculosis work and by the same token, the fight against specific causes of tuberculosis is generally admitted to be good public health work. The progress that has been made in the United States in the control of communicable diseases proves conclusively the value of the work that has been done by the various organizations engaged in the fight. The¦ death-rate from many of these diseases has been tremendously reduced. And the reduced death-rate is only a small gauge of the increased happiness and prosperity that! has come to our people through increased knowledge of matters pertaining to individual and community health. We cannot afford to sacrifice any phase of health work, even though it be found difficult in some states to sufficiently support the many existing volunteer health agencies. Some practical plan of co-operation will be evolved, some plan by which the identity of the specialized volunteer health agency may be maintained, yet operating under a broad keep-well program, inclusive of all the health agencies of the state.

MUNICIPAL VOLUNTARY HEALTH CO-ORDINATION

Bleecker Marquette, Executive Secretary, Public Health Federation, Cincinnati The movement in the field of voluntary health work has for some years been away from centralization. As new needs have been recognized and keener public interest