History of the Alamance County Health Department

The history of public health in North Carolina begins long before the establishment of even the United States as a sovereign nation. In 1755, the Assembly of the Colony of North Carolina established quarantine on vessels to prevent malignant and infectious distempers being spread by shipping. While this law was later repealed, other quarantines were set up by the Colonial Assemblies.

In 1802, the State Legislature continued to address the spread of disease from outside the state by allowing Commissioners of Navigation in the seaports around the state to appoint port physicians to enforce quarantines. The Legislature continued to address public health on a situation-by-situation basis for several decades. However, the state’s and the nation’s experience with health management would be changed by the bloodiest war in our nation’s history: the Civil War. Reconstruction ended in 1876, and the year after, North Carolina established a State Board of Health (with a budget of $100) and ordered the establishment of county boards to address local health and sanitation. Two years later, the state empowered local boards to maintain stocks of vaccines against smallpox, to manage the health of prisoners and other inmates, to perform autopsies, to improve sanitation practices, and to address epidemics when they occurred. Over the next few decades, additional powers were granted to allow local health boards to manage sanitation of water supplies.

January 8, 1917. The rest of the world was in the bloodiest conflict up until that time, and the United States is still trying to keep from entering the First World War. Counties were encouraged by the state to take greater local control of public health, and Dr. C. Vernon was appointed by the Alamance County Board of Health to serve as the Superintendent of Health and Quarantine. He would serve in this position for the next 21 years, and would lead a staff of part-time health officers through major health events such as the Great Flu Pandemic of 1918 and the Great Depression. Other major concerns include continuing improvement of sanitation, managing typhoid outbreaks, addressing STDs such as syphilis, monitoring births and deaths, and the promotion of healthy motherhood and infancy. Health education became a larger part of the mission of the local health departments. The average life expectancy for any given person in Alamance County was around 58 years for Whites and 47 years for African-Americans.

During the Great Depression, new concerns began to be addressed by state and local health boards, including the tracking and prevention of occupational diseases, reducing environmental hazards, improving dental care, and tracking and treating cases of children handicapped by diseases like polio. On January 11, 1937, the Alamance County Board of Health adopted a resolution that the county commissioners establish a full time public health department that would meet the growing standards of the state board of health. On July 1, 1938, Dr. P. Y. Greene, a Burlington physician, was elected to the position of Health Officer. He employed two nurses, a sanitarian, a meat inspector, and a clerk, and set up offices on the third floor of the courthouse in Graham, with outlying clinics established in Mebane and other locations in the county. The first project of the new Health Department is to organize STD (then known as VD) clinics at Sellars-Gunn School. Over the next few months, typhoid clinics are established in schools county-wide and smallpox vaccinations are given to more than 10,000 children between the first and sixth grade. In the fall of 1938, the Health Department begins to address tuberculosis by providing follow-up with TB patients. Within a year, a TB Clinic is set up for adults, and a well-baby clinic is sponsored in cooperation with the Service League.

The 1940’s brought the Second World War and an increase in the services and size of the Health Department. By 1943, the department had added a clerk and two STD workers. The Health Department provided blood tests for 40% of the county’s men drafted into military service for the war. A STD clinic was established that treated approximately 300 people every week for sexually transmitted diseases. A general clinic was set up in Saxapahaw, where many mill workers worked and lived, and a milk sanitation program was organized to protect the county’s milk supply. In 1944, Dr. Cook, the new director, set up a pre-school clinic to screen school children for TB. Dr. Cook left in 1946. In the fall of that year, a ringworm epidemic broke out in the county school system, and was addressed by the Health Department, with the assistance of the US Public Health Service. In August 1948, Dr. King, Jr., became the Health Officer, and added a Health Educator, a Nurse Supervisor, an additional nurse (bringing the total to 6), and a part-time nutritionist. The clinic that was previously set up by the Service League was converted to a well-baby clinic. Local pediatricians provide care to approximately 45 babies per week through this clinic; there was not yet a prenatal clinic in the county. The same year, the main office of the Health Department moved to downtown Burlington. In the late 1940’s, Dr. Robert Coker took over as the Health Officer, and remained in the position until the early 1950’s, when the position was filled by Dr. William Norville.

During the 1950’s, as the services that the Health Department provided continued to expand, the offices that housed the department proved to be extremely inadequate. However, as education and treatment of tuberculosis improved, the need for the county sanatorium to house long-term patients had greatly diminished, and in 1954, the Board of Commissioners approved money to remodel the sanatorium building (originally built as a clubhouse for the Carolina Rayon Plant) as the new home for the Health Department. The sanatorium was purchased by Mr. Frances H. Robinson, a relative of Dr. David Robinson, a local physician, who conveyed the property at 209 N. Graham-Hopedale Rd. in Burlington to the county for “any public health purpose.” In 1955, the staff had expanded to include 8 nurses, who provided services for maternal and child health, STD control, TB treatment and prevention, treatment of other communicable diseases, school health, and work with crippled children. These nurses made home visits at the request of physicians to the schools and parents of children to follow up on and educate about childhood diseases such as polio, meningitis, typhoid, and diphtheria.

The events of the 1940’s and 1950’s occur during the early period of the Civil Rights Movement in the United States, where groups of people, mostly African-American, were denied access to buildings and other services based solely on the color of their skin, especially in southern states such as North Carolina. During this time, however, the Alamance County Health Department provided their services to the residents of the county regardless of skin color. Several efforts were made during these times by the department to improve the health and life expectancy of African-Americans, and to address some of the specific health concerns of these communities. The Health Department recognized that disease and public health knew no racial barriers, even if the culture of the 1940’s and 1950’s did, and they worked to improve the health of all of Alamance County’s citizens.

As the 1950’s drew to a close, the Health Department was offering more programs than ever. Services included a school health program that offered first grade school exams for children not examined prior to entering school, molar examinations for second and fourth graders, physical exams for all students referred by their teachers to the nurse in second through eighth grades, ninth grade health exams, and preschool orientation. TB tests were given to all high school students. The Health Department also offered a sanitation program that included inspection of private sewage disposal systems and water supplies; sampling private water supplies; and inspection of restaurants, schools, meat markets, school cafeterias, abattoirs, packing and poultry plants, food handling schools, inspection of milk production, and processing and distribution plants. The department also began work to increase awareness of mental health and to work with children who had emotional and behavioral problems. Massive polio clinics were held, where approximately 4,000 children received the polio vaccine. The county also maintained a large program to ensure milk safety and sanitation. By the end of the 50’s, the staff had grown to include eleven nurses, a health educator, five clerks, four sanitarians, a nutritionist, and a county veterinarian who supervised the rabies control program and ensured that all slaughtered animals were disease-free.

In the 1960’s, the Health Department’s mission included sanitation services, maternal and child health, vital statistics, communicable and other disease control, health education, school nursing service, and the home visit program. In September 1964, the Birth Control Clinic was started, a clinic that later became known as the Planned Parenthood Clinic (not associated with the national organization), where families could learn about better managing their fertility to be able to care for their children. It is during this time that national health attention began to focus on issues like tobacco use. Locally, the focus of the health department shifted from a treatment to a prevention model as regards to infectious and chronic disease. In 1969, the county opened the first sanitary landfill, and began a state and federally-funded supplemental food program.

The final part of the twentieth century brought about mass measles and rubella clinics for children less than 12 years of age, flu clinics, and family planning clinics. By the early 1970’s, the Planned Parenthood Clinic was considered to be one of the most important services offered by the Health Department. Newer methods of birth control were offered, and over 600 lower income people received care through this clinic. In 1976, the department switched from sterilizing reusable syringes to using disposable syringes for vaccine administration. New diseases, such as AIDS and HIV brought about new approaches to health care throughout the 1980’s and 90’s, including further improvements to sanitation and bloodborne pathogens. In the mid-90’s, the department began offering vaccines for Hepatitis A and B and for varicella (chicken pox), and in the late 1990’s, the Health Department main offices moved to the first floor of the Human Services Center at 319 North Graham-Hopedale Rd. In 2000, the last oral polio vaccine dose was given at the department as recommendations changed to injectable use of polio vaccine.

As the 21st Century began, old health issues continued to need to be addressed, and new health issues came to the forefront of the nation’s attention. Further efforts were made to limit tobacco use, including the adoption of a no-smoking policy in Alamance County government buildings and the establishment of programs to encourage restaurants to go smoke-free. The events of September 2001 focused the nation and the Health Department’s attention on issues like bioterrorism. More vaccines have become available, such as Gardasil and Tdap. Beginning in 2008, 2 doses of measles vaccines will be required by law, and the Tdap vaccine will be required for all sixth graders. Today, the Health Department has grown from its original staff of a Director and five employees to a staff of over 100. New programs are being implemented to combat the problems that 21st Century Alamance County citizens face, including prevention of teen pregnancy, improving infant mortality rates, and addressing the mental health concerns faced by pregnant mothers.

The Health Department has experienced many changes over the years. In the early years, services provided by the department were more limited than they are today. Today, clients can expect a wide variety of services including HIV and AIDS education, testing, and treatment; Baby Love; Child Health; Child Service Coordination, Communicable Disease Prevention and Services; Dental Clinic for Children and Expectant Mothers; Environmental Health; Family Planning; Immunization; Maternal Physical and Mental Health; School Health; STD Prevention, Treatment, and Education; Health Education; and WIC Services.

Since the inception of the Health Department over 75 years ago, some of the infectious diseases faced by the county have been eradicated or nearly eradicated. However, we do face other new and ongoing challenges in the twenty-first century. The Health Department has worked hard to establish a network of communication and cooperation with other health care providers in the community. The Health Department also provides internships and field experience for area university students in the fields of nursing, nutrition, health education, dental health for children, and health policy and administration.