Public health nutrition: a historical perspective.

This historical perspective describes important milestones and selected threads of concern in the development of public health nutrition services. Emphasis is given to nutrition service for mothers, children, and families from the mid-1800s through the 20th century. Efforts in the 1800s were primarily directed to building the foundation for public health nutrition services: organizing state health departments and voluntary health agencies, initiating early nutrition investigations, and establishing milk stations and school lunch programs in large cities to supplement the food of the poor and to combat the high rates of morbidity and mortality of infants and children. During the 20th century, demographic changes; advances in nutrition science and technology; and social, political, and economic changes influenced the growth and development of public health nutrition services. Such changes included the high rates of disease and deaths among mothers and children, foods shortages during the wars; an increasing number of children in day care as more mothers went to work; the development of new programs to serve special groups such as the mentally retarded, chronically ill and handicapped, recent immigrants, and the aged; the continuing presence of poverty and hunger; the rising prevalence of behavior-related problems (eg, adolescent pregnancy and substance abuse); and a greater recognition of the benefits of health promotion and disease prevention. The number of public health nutritionists employed at national, state, and local levels increased to meet the rising demand for nutrition services. Graduate-level training programs and continuing education opportunities were developed and a broad range of nutrition standards and guidelines evolved. Throughout the 20th century, continuing threads of concern included nutrition policy and planning; development and evaluation of public health nutrition programs; organization, administration, and management of programs; quality of public health nutrition services, and the transfer and application of research into public health nutrition practice.