than mere academic preparation continues to be rediscovered, and today's renewed efforts in school health could be regarded as not new in concept but simply updated to reflect the needs of the times. There is a parallel, for example, between today's HIV (human immunodeficiency virus) and AIDS (acquired immunodeficiency syndrome) instruction and yesteryear's curriculum in physiology and hygiene, today's school-based clinics and yesteryear's medical inspections, and today's family services programs and yesteryear's of visiting teachers home visits to immigrants in urban tenements.

History also shows that controversy is not new to school health programs. Today's issues of local control of education and resistance to well-intended mandates imposed from above were also prominent a century ago. For example, at the turn of the twentieth century when the New York State Legislature proposed a bill to provide for sanitation, ventilation, and fire protection in schoolhouses in cities with populations of more than 5,000, the bill was easily defeated with charges that "it smacked of interference and paternalism in local affairs" (Duffy, 1974). These charges are echoed today as some individuals and communities resist directives about school health programs imposed from above, especially directives pertaining to such controversial aspects of programs as sex education or mental health counseling.

Other conflicts mirroring contemporary issues have surfaced periodically over the years. The New York free lunch program of the early twentieth century was criticized for the "hysterical sentimentality" over needy children, and later budgetary cuts led to farming out the lunch program to concessionaires whose sole motivation was making a profit. When free dental care for New York children was advocated in the early 1900s, the New York Times argued that this tendency toward "free everything" would only lead to socialism. Some considered the mandatory inspections of children at the turn of the century immoral and a violation of personal liberty. The debate about the proper role of the schools in providing primary care, begun in the 1920s during the period of the NEA–AMA collaboration, continues into this era of managed care.

The problems that confronted school health programs a hundred or more years ago—disease, physical defects, poor sanitation, inadequate nutrition, poverty, parental illiteracy, exploitation of children—were as critical in their time as current problems are today. However, yesterday's problems lent themselves more readily to well-defined permanent solutions—immunizations, eyeglasses, better personal health habits and nutrition, improved sanitary conditions, child labor laws. In contrast, many of today's new social morbidities are amorphous, chronic rather than acute, mental as much as physical. Individual behavior and societal norms have replaced disease pathogens and sanitation as major contributors to



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