Book Review

A History of Public Health

N Engl J Med 1994; 330:1024April 7, 1994

Article

A History of Public Health
Expanded edition. By George Rosen. 535 pp. Baltimore, Johns Hopkins University Press, 1993. $19.95. ISBN: 0-8018-4645-5

George Rosen's History of Public Health is a classic. As Elizabeth Fee implies in her thoughtful and perceptive comments, it is a classic because it presents an unclouded vision of the objectives of public health itself, as seen from the mid-20th century (it was originally published in 1958).

For Rosen, historical scholarship performed a social task, helping to mold the collective consciousness of humans:

A meaningful understanding of the present requires that it be seen in the light of the past from which it has emerged, of the future which it is bringing forth. . . . [t]he way in which we act in a given situation is, in large measure, determined by the mental image of the past that we have.

Rosen himself was a rare combination of public health practitioner, educator, and scholar of medical and public health history. He founded and edited the Journal of the History of Medicine and Allied Sciences and was also a long-time editor of the American Journal of Public Health, the main professional journal in the field. He was successively a medical practitioner, an administrator in the public and private sectors of public health, and a professor, in the field of public health practice (at Columbia) and later in the history of medicine (at Yale). He wrote with a deep commitment to historical scholarship informed by real-world experience.

The years that separate us from Rosen's writing were eventful, comprising most of the civil rights movement, the turmoil surrounding the war in Vietnam and the student movement, the women's movement, the AIDS epidemic, gay liberation, and much more. Little or nothing is made in his book of race, imperialism, or sexual preference. Much is made of class, and that too might seem a bit dated to some (although not to me). Classic or not, why would anyone find a 35-year-old history of public health of interest now?

For once, the devil is not in the details. The organizing principle of Rosen's exposition is his axiom that we are social beings and as a species have come to realize “the signal importance of community action in the promotion of health and the prevention and treatment of disease. This recognition is summed up in the concept of public health.” This belief is shared by most public health practitioners in some form or other, and his synthesis of how we arrived at this point makes important reading for all who would confront a future of rapid change without sacrificing these values.

The intrinsic value of Rosen's sweeping and comprehensive survey (which still has no competition) is greatly enhanced in this edition by Fee's introductory essay and bibliographic notes, which point the reader to the large body of specialized literature written since 1958 on the history of public health. It is supplemented by an extensive and up-to-date bibliography by Edward T. Morman of primary and major book-length English-language works on topics treated in the original edition, along with an informative and sympathetic biographical sketch of Rosen. These will be of much value to interested students and historians, but above all this is a book for anyone interested in where we are going. It is for us that Rosen wrote about where we have been.

David Ozonoff, M.D., M.P.H.
Boston University School of Public Health, Boston, MA 02118