Examples of Benefits in Public Health Issues

In addition to health pamphlets as a tool for advancing public health, Dr. Frankel of the Metropolitan Life Insurance Company devised an even more dramatic and effective method – that of the town health demonstration. The attention of a whole nation was thus focused upon a small community, which served as the laboratory for testing the efficiency of public health measures.

His first major undertaking of this type was in 1916, when the company launched a demonstration to show how a typical community with an average tuberculosis problem could bring the disease under control through the acceptance of reasonable rules of health, periodic examinations, and a second treatment where necessary. The 17,000 citizens of Framingham, Mass., and the National Tuberculosis Association joined the company in carrying out this public health demonstration.

Dr. Donald B. Armstrong, a young physician trained in public health work, was in charge of the experiment. His management was so admirable that soon after the close of the demonstration Dr. Frankel invited him to come as his assistant with the company. The Framingham project lasted seven years, and its cost of $200,000 was largely borne by the Metropolitan. In the 10 years before the demonstration (1907 - 1916), the city's death rate from tuberculosis had averaged 121 deaths per 100,000 people.

By 1923, when the project closed, the tuberculosis mortality had been cut 68 percent to 38.2 per 100,000. As a secondary result the infant mortality and general death rate were sharply decreased in the same period. The public spirited citizens of Framingham kept at the job, and in following years Framingham boasted a death rate from tuberculosis which was extraordinarily low for an industrial community of that size. The tuberculosis problem in the town was virtually solved.

Out of this demonstration came a new and fully implemented conception as to how a community could organize itself effectively to fight tuberculosis and hundreds of communities throughout the country used it and benefited. Thetford Mines, Quebec, was the scene of another notable test of the demonstration method. This French-Canadian community was in an area where infant mortality was extremely high.

The company set out to show how it might be reduced by educating the mothers in a few simple rules of sanitation and nutrition. At the end of three years the infant mortality rate had dropped from 300 per thousand live births to 96 per thousand. Largely because of the success of this demonstration, the Provincial Government of Quebec appropriated $500,000 for similar child welfare work in other communities, where the infant mortality rate was high.

This demonstration method proved so effective that it was adopted widely in the fight on other diseases. A very considerable part of the company's welfare work was carried out anonymously, so to speak, in cooperation with civic agencies, health departments, medical societies, parents' associations, and social groups. Managers, agents, and nurses were active participants and often the key figures in initiating or spurring on the local effort.

The Framingham project lasted seven years, and its cost of $200,000 was largely borne by the Metropolitan. In the 10 years before the demonstration (1907 - 1916), the city's death rate from tuberculosis had averaged 121 deaths per 100,000 people.