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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. ==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 health programs.〔Fitzhugh Mullan, ''Plagues and Politics: The Story of the United States Public Health Service'' (New York: Basic Books, 1989)〕 Medical officers and other personnel such as environmental health officers, nurses or in some cases technical workers like laboratorians would be sent to local and state health departments for temporary assignments.〔Elizabeth W. Etheridge, ''Sentinel for Health: A History of the Centers for Disease Control'' (Berkeley: University of California Press, 1992).〕 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.〔Thomas Parran, “Why Don’t We Stamp Out Syphilis?” ''Reader’s Digest'' (July 1936): 65-74.〕 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.〔Thomas Parran, Jr. (1937), ''Shadow on the Land: Syphilis'' (Baltimore, MD: Waverly Press, 1937, 54, 62.〕〔Raymond A. Vonderlehr, Herman N. Bundesen, Lida J. Usilton, et al., “Recommendations for a Venereal Disease Control Program in State and Local Health Departments.” Report of the Advisory Committee to the U.S. Public Health Service. ''Venereal Disease Information'' 17, no. 1, reprint No. 54.〕〔''Journal of the American Medical Association'' 106 (January 1936): 115-117. Washington, January 1936.〕 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.〔〔Lida J. Usilton, “Mortality Trends for Syphilis,” Journal ''of Venereal Disease Information'', 27 (February, 1946): 47-52.〕 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.〔Allan M. Brandt, ''No Magic Bullet: A Social History of Venereal Disease in the United States Since 1880'' (New York: Oxford University Press, 1987). See also Raymond A. Vonderlehr and Lida J. Usilton, “The Extent of the Syphilis Problem at the Beginning of World War II.” ''New York State Journal of Medicine'' 43 (October, 1943): 1825. Also found in ''American Journal of Syphilis, Gonorrhea and Venereal Diseases'', 27 (November 1943): 686.〕 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.〔〔Thomas Parran, “Syphilis: A Public Health Problem,” in ''Syphilis'', ed. Forest Ray Moulton, (Lancaster, PA: The Science Press, 1938), 187-193.〕 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.〔Beth E. Meyerson, Fred A. Martich and Gerald P. Naehr, ''Ready to Go: The History and Contributions of U.S. Public Health Advisors'' (Research Triangle Park: American Social Health Association, 2008).〕〔 抄文引用元・出典: フリー百科事典『 ウィキペディア（Wikipedia）』 ■ウィキペディアで「Public Health Advisor」の詳細全文を読む スポンサード リンク
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