Celebrating 100 Years 1911–2011

ON ITS 100TH ANNIVERSARY, the American Journal of Public Health becomes its own feature, a fascinating public health entity in its own right. Over the century, the Journal has moved with the American Public Health Association (APHA) from Boston, to New York, to Washington, DC, trying on different looks, making treasured friends, and revealing its personality.

EDITORIAL INDEPENDENCE

In 1912, the title change from the Journal of the American Public Health Association to the American Journal of Public Health¹ set the tone for a tradition of editorial independence, which has persisted over these last 100 years.² Since its inception, the Journal was intended to stand alone—published by the APHA, but separate from the association. Over the years, the Journal gradually veered away from functioning as an organ for association news. First, from 1933 to 1945, the bulk of association business was compiled in yearbooks published as supplements. Then, in 1971, The Nation's Health, a Chicago periodical absorbed by the Journal in 1928,³ split off to become APHA's official newspaper.⁴ Thus freed of its past duties, the Journal could become almost exclusively focused on its professional and scientific goals. ⁵

CONTENT, WRITING STYLE, AND CULTURAL SENSITIVITY

The content of the Journal has reflected the movements of 20th century public health: sanitation, bacteriology, health behaviors and lifestyle, environmental factors, and health disparities have all been featured.⁶ Today, the Journal focuses more on chronic diseases, mirroring a trend seen in other journals.⁷ Likewise, the writing style has evolved through the years. When perusing past articles, readers will come upon viewpoints and phrases steeped in the biases and prejudices of the time. In an article published in 1934 on Germany's sterilization program, Peter, who had been traveling through Germany meeting with health officials, stated:

If the objective of eliminating parenthood by those unfit is actually achieved in a thorough but legally and scientifically fair way, Germany will be the first modern nation to have reached a goal toward which other nations are just looking, or approaching at a snail's pace. What will actually happen remains to be seen.^8(p187)

Another example is seen in a 1940 article on the Navajo Indian, in which Gerken explained that

in dealing with primitive people, it is necessary to disregard everything but the most basic fundamentals and, therefore, needs and relationships are more clearly perceived than in programs dealing with a more complex culture.^9(p915)

Can we condemn the Journal for this lack of political foresight and cultural sensitivity? Theodore Brown, coeditor of the Journal's history departments, states,

Any journal reflects its cultural moment to some extent. Every journal of that period was shaped by the contemporary cultural understanding and language forms, so I wouldn't single out AJPH for being somehow retrograde rather than reflective of its time and circumstances.

NEWSWORTHY, CUTTING EDGE, ENDURING

As a monthly peer-reviewed publication, the Journal has stayed timely, but in a more reflective fashion than have newspapers and weekly publications. For instance, the United States entered World War II on December 8, 1941, and the cover of the January 1942 issue displayed a statement from the US Surgeon General regarding the role of public health workers in a time of war. The Journal also has capitalized on many opportunities to comment on the controversial issues of its day. A 1983 editorial, Can Reagan be indicted for betraying public health?, discussed what was happening to the 15 health priorities under Reagan's administration, namely that;

the WIC (Women, Infants and Children), school lunches, and other child nutrition efforts have been cut by one-third, and, if Congress had followed the Administration's proposals, would have been down another third with school children eating ketchup and relish as vegetables.^10(p12)

In this manner, the Journal highlighted a governmental policy that was failing the public's health.

In a more recent example of this willingness to comment on controversial issues, over the last two decades the Journal has steadily published research on the benefits of needle exchange programs in reducing the spread of HCV and HIV/AIDS. At the close of 2009, the US Congress finally lifted the ban on federal funds being used toward this purpose.¹¹ In another, but similar vein, a 2009 article presented a study on the mortality of partners in same-sex marriages in Denmark, the first country to legalize homosexual partnerships in 1989.¹²

Over the years the Journal has proven to be enduring in its choice of articles. Jay Glasser, past president of the association and a 41-year member, recently described a game he sometimes plays with association audiences. He reads them a selection of quotes from the Journal to see if they can guess the year. Because some public health issues either cycle back around or never leave the table, many past articles could have been written today. For example, the recent outbreak of H1N1 put handwashing on everyone's mind, and so it was in 1914 as well, when the Journal featured a piece entitled On Washing Hands. In a 1938 piece entitled An Equal Opportunity for Health, Lehman quotes a 1913 statement:

Were the health of the people made a question of public and not of party policy, only a skilled expert could possibly be appointed as a public health officer, not, as is now so often the case, the man with the political pull.¹³

ABOVE: For almost 30 years (1928-1957), readers recognized the Journal by its trademark orange cover. The choice of orange in 1928 presaged the Journal's impending rise in status over the next decade under the leadership of Mazÿck Ravenel, editor from 1924 to 1940. The seal and motto of the American Public Health Association started being featured prominently during World War II.

FAR LEFT: During its first year (1911), the Journal was published under a different name: The Journal of the American Public Health Association. From 1911 to 1928, the Journal's cover wavered in the grays and blues with some slight variations in color and design.

Take a guess at the year the following article was published: Public Health a Public Service, Not a Political Football. Reference 14 can be consulted for the answer. The box on page 12 lists further readings on the Journal's history.

Images appeared on the Journal's cover for a brief spell in 1985 to celebrate the Journal's diamond anniversary. The various pictures highlighted certain aspects of 19th and 20th century public health. Cover images, however, were discontinued at the end of that anniversary year. Image source: National Library of Medicine.

GLOBAL REACH AND AUTHORSHIP

The global scope of the Journal has existed from the start, reflecting APHA's structure. APHA's 1911 annual meeting took place in Havana, Cuba,¹⁵ and papers from Mexican, Canadian, and Cuban authors can be found in that first volume. Through the years, the Journal has always contained a number of articles covering public health in other countries. With the advent of the Internet, non-US submissions to the Journal have increased in the last decade.

According to manuscript database tracking system reports, in 2009 approximately 26% of all submissions originated from outside the United States, compared with about 19% in 2002. Even the font choice for the title in the current cover design echoes this trend, by de-emphasizing the US aspect of the Journal content, with “Public Health” printed significantly larger than “American Journal.” Furthermore, the Journal currently boasts 2 international editors, one residing in Brazil and the other in Australia.

Until 1963, an APHA rule required that “all papers presented at the meeting [become] the property of the Association.”^5(p728) After that year, contributed manuscripts submitted to the Journal increased. Authorship has shifted away from government health offices and the medical field to the academic arena. A trend from single authorship to multiple authors has also been noted. These shifts may be connected to “the academic command to publish or perish.”^7(p814)

Over the years, editors have offered guidance for successful articles. In 1928, Editor Mazÿck Ravenel mentioned the danger of a certain type of article:

All editors are pestered by authors who present potboilers, which are usually papers on something new which is proposed, or old material worked over in slightly different form.^16(p140)

A 1994 editorial lists seven fatal flaws to avoid when preparing a manuscript for submission to the Journal. The following three pitfalls rank at the top of this list: (1) “The topic is not of direct public health relevance”; (2) “the paper offers nothing new”; (3) “the subject is of local interest only or is not generalizable.”^17(p718)

ADVERTISEMENTS

Advertising has been a part of the Journal since 1912. To maintain integrity of content, advertisements have always been featured on the outskirts of the Journal's pages, never within the articles themselves. Because advertising generates income for the association, ads sometimes inhabit a difficult gray zone. For example, ads promoting infant formula have been controversial over the years and are no longer accepted in the Journal today, despite the financial incentive to do so. In a 1975 letter to the editor, a nutrition consultant wrote in about his objections to such an ad. In response, an editorial note stated that “[a]cceptance of advertising for this Journal does not indicate or imply endorsement by the Journal or APHA.”^18(p881) Another controversy occurred regarding a 1999 ad promoting a drug for treating uncomplicated gonorrhea. A nurse identified the syringe in the image as being outdated. Because the pharmaceutical company was still under contract with the association, they substituted a picture of an apple in lieu of the syringe for the remaining time the ad was to appear. When their contract ended, they did not renew it. Ashell Alston, APHA's seasoned director of advertising, gave her view on the matter:

Just because APHA accepts an advertisement—and we're careful about what we accept—does not mean APHA endorses the product.¹⁹

EDITORS

An Editor, now referred to as editor-in-chief, has spearheaded the Journal for most of its 100 years. All editors-in-chief through the years seem to share two common qualities: a broad vision of the public health field and a dedicated commitment to the Journal. George Rosen, the editor-in-chief with the longest term, served the Journal for nearly 17 years, from 1957 to 1973. As a medical doctor, he discovered through personal experience that his passion rested in medical history, not in clinical practice. Thus, he returned to school to earn a doctorate in sociology and then a master's degree in public health. After working in the public health field, he found his way into scholarly publishing and finally into a professorship at Yale University. He wrote the definitive volume of public health history in 1957 that persists as the standard to this day. ^20,21

Rosen was preceded by Mazÿck Ravenel, who served as editor from 1924 to 1940. His title changed to Editor in chief for part of his term. A native South Carolinian with French roots,²² he had previously served as president of the association. He has been credited with elevating the Journal in status, as may be inferred from the switch from a blue-gray cover to a bright orange one under his term, a look retained until 1957.⁵ Ravenel's success occurred in part because of his long tenure of nearly 16 years and the stability brought on by a well-loved managing editor,⁵ Reginald Atwater, also known as Rex.²³ C. -E. A. Winslow, already an established titan in the public health arena,⁷ followed Ravenel as editor-in-chief, although not immediately. He was Ravenel's senior in age and also a previous past president of the association. He came to the Journal toward the end of his career, after being an APHA member for 42 years, and served the Journal for over 10 years from 1944 to 1954.⁵

Under Winslow's term, Leona Baumgartner, the first female associate editor with advanced degrees (MD and PhD), appeared on the masthead. She became president of APHA in 1959. Remembered as a “dynamic [woman] and marvelous at strategy and diplomacy,” she was the first woman commissioner of the New York City's public health department.²⁴ A woman with political clout, President Kennedy charged her with leading the Office of Technical Cooperation and Research at the Agency for International Development (AID) in 1962; thus, she became the highest-ranked woman in the US Government for that time. She delivered a public health broadcast on television for a number of years.²⁵

Between 1957 and 2001, the cover changed 4 times (not including 1985) from teal green to a white cover with multiple variations. In 1991, the Journal adopted a salmon pink border, the color of the public health degree with a standard table-of-contents on the cover. In August 2001, the Journal adopted its current look.

Third in line for longest term as editor-in-chief was Alfred Yankauer, whose tenure spanned from 1975 to 1990. Although biographical information on him is sparse, ^{26, 27} one can glean from his editorials and articles that he was a meticulous man who was unafraid of controversy, was thoughtful in his presentation of issues, and had a fondness for literature, namely for Emily Dickinson's poetry. He was a historian in his own right, penning two articles on the history of the Journal as well as regular editorials reporting on Journal statistics and facts. For the greater part of the 1990s, the Journal was edited by Mervyn Susser. In a written communication dated March 24, 2010, he emphasized “his insistence on quality papers, and the importance of his personal role in ensuring this” during his term.

Further Reading on the History of the American Journal of Public Health

Rosen G. The American Journal of Public Health: antecedents, origin, and evolution. Am J Public Health. 1972;62(5):724–733.

Yankauer A. The American Journal of Public Health: 1957–1973. Am J Public Health. 1979;69:1061–1065.

Yankauer A. The American Journal of Public Health: 1911–85. Am J Public Health. 1986;76:809–815.

Brown TM, Fee E. Birth of the American Journal of Public Health. Am J Public Health. 2010;100(1):66–67.

Mary E. Northridge, the current editor-in-chief and first woman to hold the position, succeeded Mervyn Susser. She has been an avid reader of the Journal since 1986, when she began her graduate studies in public health and joined the association. In 1993, she was hired as assistant editor to Susser while still a doctoral student, and was promoted to deputy editor in 1995. In 1998, she acted as interim editor before accepting the position of editor-in-chief. As she put it, “My careers as both a public health researcher and as an editor of the American Journal of Public Health are completely intertwined.”

IMAGES

The unveiling of a new cover design coincided with the publication of the first online Journal in August of 2001. Images actually first appeared on the cover of the Journal, for the duration of one year, to celebrate its diamond anniversary in 1985.²⁸ But after a vote was taken, the editor-in-chief decided to abide with the preference of the majority, the continuation of a contents-on-the-cover look.²⁹

Fifteen years later, the decision to change from a standard table-of-content cover to a cover with an image was in retrospect a prescient one, and came about after much thoughtful debate. Northridge recalled the discussions, saying

Certain colleagues were not ready for the change. They thought in some way this cover look was too mainstream, that we were lowering the standards for the Journal. Instead, the contemporary image work has been truly groundbreaking and wholeheartedly embraced by our readers, even cherished.

Charlene Bright, who has worked at APHA for 19 years, mentioned her impression of the new design. “The look drew people in. The artwork made you want to read the Journal.” Brown, coeditor of the Journal's history departments, commented on the cover design: “We're really in a very new era. That kind of visual presentation is important.”

NEW CENTURY

The new century ushered in many changes for the Journal: the first female editor-in-chief, a new online Journal, a new online submission system, a new cover look, new departments presented in a new order, international editors, and a brand new editorial team whose expertise reached into many disciplines. Also noteworthy, book reviews—published continuously in the Journal since 1911—disappeared during this past decade. In a recent e-mail, Faye Wong, past Journal Board Chair and past APHA President, recalled spearheading the strategic planning “that resulted in the initiation of the online Journal and redesign of the print Journal.” She noted that “Both decisions significantly increased the value, appeal, reach, and relevancy of the Journal to APHA members and other readers.”

In Editorial Board Chair Hector Balcazar's words:

100 years have passed, and public health remains a vital part of our society, a reminder to all that through our Journal, our collective wisdom and action take shape. As a result, we work diligently towards achieving social justice and human rights for the welfare and well-being of the world we live in.We look forward to many more years of the Journal.