"Declaration of War on SARS" uses the 1960s image of the clenched fist in this 21st-century poster.

Her samples came from NLM’s recently acquired Chinese public health collection, a trove of some 7,000 items — including posters, scrolls, pharmaceutical ads and puzzles. The collection is “unique,” Bu said, “and I’ve not seen anything comparable in China, the U.K. or other U.S. collections regarding public health and modernization.

” Since her research is ongoing and the collection is large, so far she’s studied “only” 3,000 items. The posters were designed and printed by Chinese local and central governments and tie public health concerns to political, social, economic and military engagements. Themes include combating disease; linking health to productivity (typically after 1949); knowledge about the body; sanitation; maternal/child health and changing the image of women, e.g., as “barefoot doctors.”

	Dr. Liping Bu, professor of history at Alma College in Alma, Mich., and an NLM visiting scholar.

She found “the techniques of poster design and printing extremely rich,” while noting “a surprising continuity in health education and propaganda from nationalist to socialist governments despite major differences in those systems.”

Perhaps that’s because images work. Posters grab us; they pop. Bu called them “powerful, effective and fast in conveying health information to the illiterate, and vivid in teaching new things. They brand indelible images in the masses’ minds about the causes of diseases, the importance of health and how to do health work.” And compared to books and printed pamphlets, posters are more accessible and less expensive.

Some highlights:

Declaration of War on SARS: Produced in 2003, this poster, said Bu, “is not typical of today’s Chinese society, which is very much about going after money.” She observed how the image of the muscular health worker, fist in the air, dates back to the cultural revolution of the 1960s and “the power of the people.” The depiction of the virus with its bristling corona is fairly realistic (SARS is a coronavirus), but there is one mutation: SARS bugs in the poster have a frowny face, owing to their fear that a People’s War has been declared against them.

Body as Factory: In the 1930s, people were trying to understand the human body and how to depict its inner workings. "One theory," Bu explained, "was that the body is like a factory." Arms appear as winches and cranes, lungs as bellows and the liver as furnace. And the brain? That's where the desk jobs-the executive functions-are.

Americans Dropped Germs: In the early 1950s, during the Korean War, Bu noted, there was a "patriotic public health movement" against germ warfare. Posters produced by the local government of Shandong province (roughly 100 miles from Korea) show bombs accompanied by flies and mosquitoes, obnoxious pests. "This shows," said Bu, "how the enemy is always demonized."

	"Americans Dropped Germs": A Korean War-era poster warns against germ warfare and demonizes the enemy.

Eliminate the Four Pests: A line of advancing workers bears a mosquito net, insecticide sprayer and flyswatter. This is emblematic of a 1960s campaign against “the four pests”—rats, flies, mosquitoes and sparrows.

Facing the Countryside and Serving 500 Million Peasants: In 1965, said Bu, while 85 to 90 percent of the population lived in rural areas, 80 percent of health care workers remained in cities. A massive public health campaign was born, using a three-tiered approach that included “barefoot doctors,” so called because they worked on the communes that supported them. They received a short course in first aid, giving inoculations and performing simple procedures. To be trained, they had to be literate; women’s inclusion was signal. In fact, Bu said, “only 40 percent of barefoot doctors were women, but the public image was female.” This helped to advance the image of women as workers of equal status with men. “As a tool for mass education,” said Bu, “this poster attracts an audience to relate to the barefoot doctor in real life.

” It is difficult to quantify the effect posters had on public health in China. What is true is that they played a key role in educating an illiterate population in a period when “diseases that had plagued China for a long time, such as cholera, typhoid fever and smallpox, were eradicated,” said Bu, while “snail fever, malaria and TB were almost eradicated.” TB is now making a comeback, she noted.

The image’s power to teach is still so robust that every online medical encyclopedia, including NLM’s MedlinePlus, has pictures and diagrams too numerous to count, while NLM’s historical image database includes thousands of contemporary public health posters. In the exchange of information on medicine and health, the image remains indispensable.