PHS Dietitians and Nutritionists History
NOTE: The history of the PHS Dietitians and
Nutritionists is an ongoing process. The PAC welcomes
submissions of additional information, by sending the edited version to
D/N PAC Chairperson.
INTRODUCTION |
The United States Public Health Service
(PHS) celebrated its bicentennial year in 1998. Its mission is to
promote the health of the nation, understand and prevent disease,
assure safe and effective drugs and devices, deliver health care
services, and supply health expertise in time of national
emergencies. Whether serving as either Civil Servants or Commissioned Officers, dietitians
and public health nutritionists play an integral part in the mission
of this distinguished service.
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BEGINNING |
During the late nineteenth century, records
indicate that proper nutrition and nourishment of hospitalized
patients were regulated under the direction of a hospital steward.
By 1902, preparation and food service responsibilities were charged
to pharmacists, the only professional personnel other than the
medical officers attached to the hospitals. The importance of
nutrition and dietetics in the provision of health care quickly
became recognized as a required component of hospital care.
The service of dietitians and nutritionists in the PHS dates back
to the year 1919. During that year, the first dietetic section was
organized in the PHS Division of Hospitals which operated a medical
care program for American seamen. These hospitals were primarily
located in port cities with in-patient capacities ranging from about
100 to 1,000 beds.
Ms Hallie Corsette, the first dietitian employed by the PHS, was
accorded the title Superintendent of Dietitians. She supervised this
newly created dietetic section of the Division of Hospitals. The
dietitians were placed under the organizational structure of the
medical officer in charge of a facility. Ms. Corsette spent the
majority of her time planning dietary departments and recruiting
dietitians for the hospitals. By the close of 1919, there were
approximately 85 dietitians in the Division of Hospitals; that
number doubled over the next two years. During those early years, a
dietitian's duties were focused chiefly on the purchase, preparation
and delivery of food.
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WARTIME
EFFORTS |
In 1919, the PHS was charged with the
responsibility of furnishing medical and hospital care to sick and
disabled veterans of World War I. In 1922 the Veterans Bureau was
established to provide on-going medical care to war veterans. As a
result, the responsibility for supervising many of the Public Health
Service Hospitals was transferred to the Veterans Bureau, later
known as the Veterans
Administration. Over 145 PHS dietitians were transferred to
those facilities to care for disabled war veterans. The remaining
PHS dietitians were placed under the general direction of the Office
of Nursing, Division of Hospitals. Although the dietetic section was
abolished as a result of the transfers, dietitians continued with
their primary duties of food service administration and took on the
additional role of providing patient nutrition education.
During the Second World War, PHS dietitians worked as part of the
Civil Defense Mobilization Program. They were responsible for
developing recommendations for foods, food storage, equipment and
service that could be used if communities suffered bombing attacks.
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PROGRAMS
OF THE 1940s |
The functions and responsibilities of the
PHS expanded rapidly during the late 1930s and the early 1940s.
Likewise, the role of dietitians within the PHS continued to expand
beyond the hospital setting as dietitians were hired by state and
local health departments. The creation of the Children's Bureau in
1912 provided states with grant-in-aid for Maternal and Child
Health, Crippled Children's Services (Title V) and Child Welfare
(Title IV). Subsequently, in 1936 Ms Marjorie M. Heseltine was
employed as the first nutrition consultant in the Children's Bureau.
Five years later, the Bureau hired a second consultant, Ms Helen
Stacey.
In 1942 the PHS established mobile field units to conduct
nutrition appraisals in selected states. A medical officer was also
assigned to work as a nutrition consultant for public health
officials. Nutrition clinics were developed in a few state and local
health departments. Today, both the Maternal and Child Health Bureau
and the Centers for Disease Control
and Prevention still continue to play a vital role in providing
nutrition leadership and expertise to the state and local health
departments.
As the work of the PHS expanded and the science of public health
developed, the need for collaboration between related professionals
in the public health field became evident. With the passage of the
Public Health Service Act in 1944, a series of laws were passed
which significantly affected the nation's medical research, training
efforts and increased health services in the United States. The
expansion of the PHS required people with additional specialized
skills that could be rapidly deployed in response to public health
emergencies. The Regular Commissioned Corps was expanded to include
dietitians, nurses, veterinarians, scientists, physical therapists,
and sanitarians, and other health professionals.
The authority to commission dietitians as PHS officers was
granted on July 1, 1944. At that time, the dietetic section of the
Division of Hospitals was reestablished. Ms Marjorie Wood, the first
commissioned dietitian and the PHS Commissioned Corps' first Chief
Dietitian, headed the unit. The section was renamed the Dietetic
Branch, Office of Professional Services, and was charged with the
responsibility of developing, establishing and maintaining dietetic
standards in PHS hospitals; a major emphasis was placed on
therapeutic nutrition and teaching programs.
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FIRST
DIETETIC INTERNSHIP |
Ms. Clare Baldauf developed a dietetic
internship to provide a teaching program in the field of dietetics.
The internship was established in 1945 at the PHS Hospital in Staten
Island, New York and approved by the American Dietetic Association.
Twelve interns working under the civil service system were accepted
into the first class. Subsequent classes of interns were comprised
of PHS Commissioned Officers. The internship provided the first
credentialing of PHS dietitians. Miss Baldauf served as the Chief
Dietitian and supervised nine classes of interns. This internship
served as a mechanism to train new college graduates in the
practical aspects of food service administration, therapeutic diet
instruction and community nutrition. The PHS used this internship
program to train young dietitians to serve in the PHS hospitals. The
internship program was discontinued in 1973 with the threat of the
PHS hospital closures.
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NATIONAL
INSTITUTES OF HEALTH CLINICAL CENTER |
Many of the PHS dietitians that have made
significant contributions in nutrition and dietetics have served in
some capacity during their career at the world-renowned National Institutes of Health in
Bethesda, Maryland.
One was CAPT Edith Jones. CAPT Jones was appointed to the
position of Chief Dietitian at the National Institutes for Health in
September 1952. She was charged with developing long range plans for
creating a department of nutrition for the NIH Clinical Center, a
500 bed research hospital which opened in 1953.
CAPT Jones was a leader in the profession of dietetics at the
local, national and international levels. She served as the 38th
President of the American Dietetic Association and the ADA
Foundation's president in 1972. In addition, she served as Chair of
the Fifth International Congress of Dietetics in 1969 and as Chair
of the International Dietetic Committee of Dietetic Associations
from 1965-69.
The American Dietetic Association recognized CAPT Jones for her
vision and courage in pursuit of "professional perfection" in 1971
by awarding her its highest honor, the Marjorie Hulsizer Copher
Award. She received the PHS Meritorious Service Medal for her
exceptional service and leadership in the field of nutrition and
dietetics during her tenure as Chief of the Nutrition Department and
Chief Dietitian.
The Edith A. Jones Scholarship Fund, established in 1993, is
endowed by the ADA Foundation in honor of CAPT Jones' outstanding
accomplishments in the field of dietetics. The recipients of the
scholarship are dietetic interns at the NIH Clinical Center.
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Noteworthy Contributions to the Category
|
Jeanne Tillotson served as Assistant Chief
of Patient Diet Services also at the inception of the NIH Clinical
Center. Later she transferred to the National Heart Lung and
Blood Institute (NHLBI) where she worked as a member of a team
conducting epidemiology studies, including two of the most famous
heart studies: the Framingham Heart Study and the Multiple Risk
Factor Intervention Trial (MR FIT). Ms Tillotson was also involved
in similar studies being conducted in Puerto Rico and Japan.
As the nutrition expert for these studies, Ms Tillotson created
the food composition tables and analyzed the nutrient intake data.
Her innovative nutritional contributions to the MR FIT study helped
to identify dietary intake as an important variable in heart
disease. Ms Tillotson recalls the combined enjoyment and challenge
of using computer programs, still in their infancy, to enter and
analyze her own preliminary study data. With the assistance of
computer programmers, she was able to detect trends and potential
problems in the data by using the most current computer technology.
Her pioneering nutrition contributions were published in the
American Journal of Clinical Nutrition.
CAPT Jeanne Reid worked as a dietitian in the metabolic unit of
the National Institute of
Digestive, Diabetes and Kidney Diseases at NIH. One of the
highlights of her career as a commissioned officer was a detail
assignment with the U.S. space program in Houston, Texas. As part of
the study team under the direction of Dr Donald Wheedon, CAPT Reid
conducted the first studies of the effects of space on minerals,
focusing special attention in the area of calcium retention in bones
of astronauts.
Nancy Ernst came to the NIH Clinical Center Nutrition Department
in August 1966 and became the primary research dietitian for the
lipid service headed by Dr Donald Fredrickson and Robert I. Levy.
The acceptance of the 1965 lipoprotein typing system precipitated
much interest from physicians and dietitians about the diets that
provided the therapeutic guidelines for clinical management of these
disorders. The experience of the clinical center was translated into
the 1969 publication, The Dietary Management of
Hyperlipoproteinemia. A Handbook for Physicians and Dietitians.
Nancy Ernst - working with Merme Bonnell, then Chief of Patients'
Food Service, and Dr. Robert Levy - developed the diet plans into
guidance that were transferred into nationally applicable
information.
One of the early NIH dissemination activities of their research
in the area of cardiovascular nutrition was the 1973 co-authorship
by Nancy Ernst and Robert Levy of a chapter titled, Diet,
Hyperlipidemia and Atherosclerosis in the fifth edition of
Modern Nutrition in Health and Disease, edited by Robert
Goodhart, M.D., D.M.S. and Maurice E. Shilis, M.D., Sc.D.
In 1970, Nancy Ernst transferred from the Nutrition Department to
the NHLBI Lipid Metabolism Branch assuming the title of Chief
Nutritionist. An initial responsibility was the development of the
diet protocol for NHLBI Type II Coronary Intervention Study. This
trial was one to the earliest studies in the nation to focus on
angiographic evidence of coronary artery disease after cholesterol
lowering. The 143 patients were randomly assigned to lipid lowering
treatment by the drug cholestyramine or placebo. All patients were
counseled by Nancy Ernst, and subsequently by Majorie
Myrianthopoulos, to follow a cholesterol lowering diet; with dietary
intake data collected on all trial participants. The study showed a
non-significant trend toward less progression in coronary plaque in
the coronary arteries.
In 1970, the NHLBI created the Lipid Research Clinics (LRC)
Program. One objective of this program was to determine the
prevalence of different types of dyslipoproteineamia and their
relationship to diet. The LRCs also conducted the Coronary Primary
Prevention Trial (CPPT) to test the effect of cholesterol lowering
on the incidence of Chronic Heart Disease (CHD), using the drug
cholestyramine. The successful completion of this study indicated
that lowering blood cholesterol would lower the risk of CHD and set
the stage for the current major prevention and control programs,
such as the National
Cholesterol Education Program.
Both Virginia Keating and Barbara Dennis transferred from the
Nutrition Department to assume major roles in the Lipid Research
Clinics Program. To assure comparability of dietary data collection
methods across the 12 LRC programs and also with the Multiple Risk
Factor Intervention Study, Ernst and Keating worked with the LRC
Nutrition Committee, and NHLBI's Jeanne Tillotson and the Multiple
Risk Factor Intervention Study nutritionists to establish: (a) a
common dietary intake recall methodology; (b) a training and
certification program to establish standard practices for
interviewing participants and coding dietary recalls; and (c) a
national food and nutrient computer database, that became the
foundation of the University of Minnesota's "Nutrition Coordinating
Center" and the "Nutrition Data System."
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INDIAN
HEALTH SERVICE (IHS) |
In 1955, Congress transferred
responsibility for American Indian and Alaska Native health care
from the Department of the Interior to the PHS. The following year,
Miss Bertlyn Bosley, another distinguished PHS dietitian, became the
first Chief of Nutrition and Dietetics for the Division of Indian
Health (later the Indian Health
Service). At the time of her appointment there were dietitians
working in approximately 11 of the 56 American Indian reservation
hospitals. Ms Bosley was instrumental in incorporating nutrition
education into the health, social and educational programs serving
American Indians and Alaskan Natives. Ms Bosley was also affiliated
with the Pan American Health Organization as a nutrition consultant.
The second Chief of the IHS headquarters Nutrition and Dietetics
Branch, Ms Helen G Olson, recognized a need to train food service
supervisors for the forty-eight IHS hospitals. Due to her persistent
efforts, in 1969 the IHS Foodservice and Nutrition Training Program
opened in Sante Fe, New Mexico. Ms Sallie Mooring, well known
professionally for her interest in training, was recruited and
appointed its first director. To enhance training activities, Ms
Mooring designed and equipped an on-site kitchen laboratory.
A nutrition technician training program was initiated for
American Indians to work with public health nutritionists to address
nutritional deficiencies in the communities. At a later date, this
technician training program was transferred to the IHS Desert Willow
Training Center in Tucson and modified to train community health
representatives to plan, implement, and evaluate community nutrition
programs. In 1978, both training programs were once again
consolidated in Sante Fe and continue to evolve to meet the changing
needs of American Indians.
Ms Patricia F. Roseleigh, Chief of the Navajo Area Nutrition and
Dietetics Branch, established the initial program sites for the WIC
Program (Special Supplemental Food Program for Women, Infants and
Children) in the Navajo Area. She focused on recruiting and on
planning for new dietary departments in Navajo Area hospitals
scheduled for construction. In 1977, she transferred to IHS
Headquarters as Chief, Nutrition and Dietetics Branch. Ms Roseleigh
served as consultant for the revision of the Civil Service
Classification Standards for dietitians and nutritionists which
positively impacted on PHS's ability to attract qualified
candidates, particularly for IHS remote sites.
While serving as a civilian dietitian, Ms Marguerite M. Smith was
directly involved in the opening of the Gallup Indian Medical Center
in 1961. She was appointed to the PHS Commissioned Corps in October
1962 and joined the Nutrition Department staff at the Clinical
Center of NIH. In 1971, she transferred to the Nutrition and
Dietetics Branch, IHS Headquarters where she was especially
effective in recruiting dietitians and public health nutritionists.
CAPT Smith's other accomplishments included chairing the
Dietitian-Nutritionist Professional Advisory Committee, reviewing
applications for public health nutritionist scholarships,
establishing a computerized nutrition and food cost accounting
system, revising the PHS recruitment brochures for dietitians and
nutritionists, and finally serving as Chief Professional Officer.
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OTHER
DIRECTIONS |
In 1958, the Coast Guard Academy became the
first military training facility to employ a dietitian. CAPT Jane
Davidsaver was detailed to the Academy for nine years where she
played a key role in establishing nutritional standards for the
cadets. She was also instrumental in the design of four new galleys
at the academy.
CAPT Genevieve M. Casalaspro's proudest accomplishment was her
appointment as Clinical Director of the PHS Clinic in Miami,
Florida. She was the first dietitian to serve as a clinical director
in PHS history. CAPT Casalaspro served in Miami from 1977 to 1981.
During this time there was an influx of 135,000 Cuban refugees to
whom the Miami Clinic provided medical care. In 1981, she moved to
Camp Crohm upon the arrival of the Haitian immigrants. There she was
responsible for the medical care and feeding programs for 40,000
Haitian refugees. CAPT Casalaspro was awarded the PHS Distinguished
Service Medal and two Meritorious Service Medals for outstanding
career contributions.
During the late 1970's the National Health Service
Corps became an important entry point for public health
nutritionists, adding significantly to the number of dietitians
serving in the PHS. The majority of these nutritionists worked in
poor rural areas of the U.S., including those areas where there were
large numbers of migrant workers. In addition, these nutritionists
were used to staff remote American Indian reservations. These
assignments broadened the public health mission of the dietitian
category and focused on strengthening health promotion and disease
prevention of underserved populations.
With the closing of the last of the PHS hospitals in 1981, many
PHS dietitians and nutritionists branched out into administrative
and program positions. These positions created new opportunities for
PHS dietitians and nutritionists to serve as food and nutrition
experts for many federal agencies, increasing the public health
impact of the profession.
The PHS Regional Offices are staffed by numerous health
professionals including MCH (Maternal and Child Health) Nutrition
Consultants who provide expert consultation to state nutrition
programs. Prior to the mid-1980s, nutritionists from state health
departments or public health nutrition programs at universities were
invited to fill vacancies at the PHS Regional Offices. However,
during the 1980s, the administration moved to reduce the number of
federal employees, and due to this, Regional Office vacancies could
only be filled by nutritionists who were current federal employees.
Mary Egan, longtime MCH nutritionist in the Health Resources and Services
Administration, noted that many federal employees did not have
the necessary experience to serve as a consultant to state health
departments and therefore, were not fully qualified to fill these
roles. She developed the MCH Residency Program, which was designed
to put federal nutritionists, nurses, and social workers in
positions in state health departments for a one year self-planned
training program. During this one year assignment, the federal
assignees gained needed state-level experience and upon completion
of the program, were able to fill vacant consultant positions. The
MCH Residency Program was active for three years and 6 nutritionists
participated.
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INFLUENCES OF THE 1960s - 1970s |
During the 1960s, President Johnson's "War
on Poverty" led to the creation of many new health programs targeted
at low-income, high risk populations. As a result, nutrition and
chronic disease prevention programs were created. Nutrition also
became an important subject for research and clinical studies. In
1965 the Head
Start program was established, as well as the Medicare and Medicaid
programs and Community and
Migrant Health Centers. In addition, the Framingham Heart Study,
the National Diet-Heart Study, the Seven Countries Study and the
National Health Examination Surveys were all implemented. The first
White House Conference on Food, Nutrition and Health was held in
1969 and established priorities for nutrition programs which would
be implemented over the next ten years. As a result, the role of
nutrition had been firmly established as an integral part of all
public health programs. Meanwhile a gradual shift was taking place
away from hospital dietetics as the major place of employment for
dietitians, to more diversified roles within all agencies of the
PHS.
During the early 1970s, the Centers
for Disease Control and Prevention emerged as a leader in health
promotion and disease prevention as well as setting a precedent for
several landmark surveys of dietary and nutritional status. These
surveys included: the Ten State Nutrition Survey (1970), the Total
Diet Study, the First National Health and Nutrition Examination
Survey (NHANES) in
1971, and the Pediatric and Pregnancy Nutrition Surveillance Systems
in the States (1972 & 1979). The Center for Chronic
Disease Prevention and Health Promotion was created and provides
technical assistance and expertise to state and local health
departments. The Center supports local health departments through
assembly, analysis and interpretation of data. It also provides
guidance on using data to manage and promote nutrition and health
education programs.
By the late 1970s, then Surgeon General Julius Richmond conceived
a "Second Public Health Revolution" to tackle the agents of
contemporary mortality, namely, smoking, drinking, diet, sedentary
living and poor safety practices. Dr J. Michael McGinnis was
appointed as the Director of the Office of Disease Prevention and
Health Promotion in the PHS. The Surgeon General's Report on
Health Promotion and Disease Prevention, Healthy People,
and Objectives for the Nation which set forth ambitious goals
for all Americans to be achieved by the year 1990 were products of
Dr. McGinnis' tenure. The Food and Drug
Administration also published extensive food labeling
regulations, including voluntary nutrition labeling. In 1977
Dietary Goals for the United States was also published,
establishing distinct standards for nutrition to be followed by all
Americans.
In recent years, great strides have been made in the field of
public health nutrition. Several landmark reports have been released
and several important pieces of legislation impacting nutrition have
been passed by Congress. In 1990 both the Nutrition Labeling and
Education Act (FDA) and the National
Nutrition Monitoring and Related Research Act (National Center
for Health Statistics, CDC) became examples of such legislation.
Dietitians and nutritionists in both agencies played an instrumental
role in the implementation of these new public health laws on a
national scope.
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PRESENT |
Today PHS dietitians and nutritionists may
serve in either the Commissioned Corps or the Civil Service
personnel system. Presently there are approximately 75 Commissioned
Officers and over 400 Civil Service dietitians and nutritionists
serving in the PHS. Regardless of the assignment, their competence
and skills are well utilized in advancing the objectives of the
organizations they serve.
Dietitians and nutritionists continue to serve in a variety of
government agencies such as: Indian Health Service, Food and Drug
Administration, National Institutes of Health, Health Resources and Services
Administration, Centers for Disease Control and Prevention, Bureau of Prisons, and the Centers for Medicare and Medicaid
Services (formerly the Health Care Financing Administration).
Dietitians serving in these organizations are involved in a variety
of areas including research, clinical nutrition, food service
administration, program planning and evaluation, health facility
inspections, regulatory oversight and public health nutrition. In
addition, dietitians and nutritionists are prepared and are ready to
serve in emergency situations, such as the summer Olympic Games in Atlanta,
Georgia and Athens, Greece, 911 Terrorist Attack, Anthrax Attack, G-8 Summitt, Rhode Island Fire,
Kosovo Refugees, and several Hurricanes. As science
continues to substantiate the importance of food and nutrition in
relation to health, dietitians will play an even greater role in the
continuing history of the profession in the United States Public
Health Service.
PHS dietitians and nutritionists have served with distinction,
developing and implementing nutrition-related components for the
many programs they serve. The dietitians and nutritionists proudly
serving under the flag of the United States Public Health Service
have made, and continue to make, major contributions to the health
of the nation.
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Last updated, September 2006 |