It was during the 1960’s that Podiatric Medicine began its public health involvement with projects in Philadelphia. The US Public Health Service funded Keep Them Walking with the Philadelphia Department of Health, the Washington DC Health Department Community Clinical Podiatry Program, the Minnesota Department of Health’s Nursing Home Study, and the New York City Department of Health’s Queensbridge Health Maintenance Project. A special program, Disaster Preparedness for Podiatrists was developed by Arthur E. Helfand, DPM, for the American Podiatric Medical Association, Division of Health Mobilization (USPHS), and the Office of Emergency Planning.
During 1961 White House Conference on Aging Dr. Edward L. Tarara recognized the need to expand public health and aging as a key future program. In 1965, John R. Carson served as a Special Assistant on Health and Aging to the Governor of the State of Nebraska. He met and discussed the need for foot health with Drs. Tarara, Shapiro, and Helfand during the 1966 Traineeship Program in Long Term Care at the University of Nebraska. The program developed by Mr. Carson for the University of Nebraska and the Nebraska Podiatric Medical Association was the first such program funded in relation to foot health by the US Public Health Service. This encounter would help mold the future of podiatric public health and aging. As a result of this initial effort, additional traineeships were conducted in Toledo and Philadelphia and initiated the public health approach to aging.
In 1961, Eugene A. Gillis, MD, Commissioner of Health for the City of Philadelphia and Norman R. Ingrham, MD, Deputy Commissioner, visited England to discover that the podiatric services was incorporated into the British Health System, due to the need for foot care for older citizens. Together with Catherine B. Hess, MD, Chief of Chronic Disease for the Philadelphia Department of Health and James C. Giuffre’, MD, Medical Director and Chief of Surgery at St. Luke’s and Children’s Medical Center, submitted a proposal for a demonstration project in Philadelphia to demonstrate the importance of foot care in an older population
In 1962, the American Podiatric Medical Association established a Council on Public Health to encompass all of the above Committees and added a Committee on Footwear and a Liaison Committee to the United State Public Health Service. This Council began to formulate the germination of the Podiatric Health Section and the relationship between the podiatric medical profession and the American Public Health Association.
In 1962, the United States Public Health Service, Division of Chronic Diseases, funded the first podiatric project in Philadelphia, called “Keep Them Walking”. The program was designed to provide foot health information, education, screening, assessment, and referral for foot care. The service was offered to all senior centers and housing projects in Philadelphia. Although no treatment was planned during the initial project, care programs were developed with the podiatry clinic at St. Luke’s and then at seven of the Philadelphia Department of Health’s neighborhood health centers. It is important to note that podiatric care within the Philadelphia Department of Health continues today, as it has for the past forty-three years. The project existed between 1962 and 1965, providing services to over 16,000 residents, and developed data to demonstrate need and program operations. The data from this three-year study later would furnish the documentation for podiatric medicine’s eventual inclusion in Medicare in 1967.
During this same decade, three other public health projects developed that helped establish a podiatric presence, particularly in the fields of community health and aging. The first was the Queensbridge Health Maintenance Project, in New York City. This clinical program at a housing authority development provided a focus on foot care for an older population. This was at a time prior to Medicare and other reimbursement programs for the older individuals who were living below the poverty level. This is perhaps not different than the millions of poor uninsured and uncovered individuals in our society today.
The second was a program in the District of Columbia Department of Health to establish podiatric clinics within Department Health Centers to provide care to an economically disadvantaged population that was unable to obtain foot care services. The third project was a Minnesota Nursing Home Survey that screened patients in the State’s nursing homes for foot problems.
What is important to note is that all four projects and studies developed data that demonstrated the high prevalence of undiagnosed and untreated foot problems in both an older and health limited population, ambulatory and institutionalized, and demonstrated a need for education, prevention, assessment, and care, if the precepts of public health were to be maintained.
In 1963, the APMA developed an exhibit for the APHA meeting in Kansas City called “Keep Them Walking”. This was a cooperative effort involving APMA, the Philadelphia Department of Public Health, and St. Luke’s and Children’s Medical Center. It was the first showing of this exhibit and project and included a clinical slide presentation demonstrating the common disorders and diseases involving the human foot. This exhibit activity has been carried on at every APHA Annual Meeting.
It was also in 1963, that podiatric medicine was added to the Health Manpower Legislation that provided funding for special projects and new construction for all of the five Colleges of Podiatric Medicine. That inclusion was the direct result of a true public health effort between the late Irving Yale, DPM and William Kissick, MD, who headed this new US Public Health Service effort. Dr. Kissick’s recognition of the need for podiatric medicine as an equal partner in the health care system was bold and visionary at that time and laid the cornerstone for the future of podiatric public health.
In 1964, the “Keep Them Walking” exhibit was expanded for the APHA Annual Meeting in New York. Several members of the United States Public Health Service, Division of Chronic Diseases recognized the importance of foot health, particularly in older patients and those with chronic diseases. Some of those individuals included Austin B. Chinn, MD, Chief of Aging; Donald P. Conwell, MD, Chief of Long-Term Care; Earl Simmons, MD, Chief of Peripheral Vascular Diseases; and Glen W. McDonald, MD, Chief of Diabetes. They helped the podiatric profession gain visibility for the Keep Them Walking project. In addition, the Gerontological Society of America added Podiatric Medicine to the “Working With Older People” Project that created the first major geriatric curriculum and developed. This effort led to the inclusion of podiatric medicine and foot health in the majority of geriatric texts in the future.
On January 23, 1965, the American Podiatric Medical Association’s Board of Trustees and Council on Podiatric Medical Education approved and published “Podiatry in Public Health” as policy. The document was prepared by an Ad Hoc Committee on Podiatric Public Health Qualifications of the Council on Public Health. The Committee included Arthur E. Helfand, DPM, Chair; Marvin W. Shapiro, DPM, APMA Past President; Edward L. Tarara, DPM, Mayo Clinic; Martin Mussman, DPM, Department of Veterans Affairs; Pierce B. Nelson, Dean, California College of Podiatric Medicine; and William H. Woolf, DPM, CDR, USNR, MSC. This initial document provided the foundation for the development of the Podiatric Health Section and the special area of podiatric medical practice know as podiatric public Health. Podiatry in Public Health was subsequently published in the Journal of the American Podiatric Medical Association (Volume 57, Number 7, July 1967, pp 338-343).
The concepts of this initial document have been updated, restructured, refined, expanded, and developed and published as follows:
• Functions and Educational Qualifications for Podiatrists in Public Health, prepared by the Podiatric Health Section of the APHA, Committee on Professional Educational Qualifications (1973-1974); Arthur E. Helfand, DPM, Chair; Irvin O. Kanat, DPM, Darrel Darby, DPM; Clarence Bookbinder, DPM; Jerome Shapiro, DPM; Robert A. Heil, MA; Richard H. Baerg, DPM, MPH; David J. Rubensetin, DPM; Anthony McNevin, MA; Theodore H. Clarke, DPM; and Gerald A. Gorecki, DPM, MPH; and published in the American Journal of Public Health, September 1975, Volume 65, Number 9, pp 967-971.
Podiatric Public Health, Arthur E. Helfand, DPM, Public Health and Podiatric Medicine, Chapter 1, Williams and Wilkins, Baltimore, MD, 1987, pp 1-31.
• Podiatric Medicine and Public Health – Concepts and Scope, Arthur E. Helfand, DPM, The Lower Extremity, Volume 1, Number 4, December 1994, pp 259-271.
• Podiatric Medicine and Public Health – Concepts and Scope – Function and Educational for Podiatrists in Public Health, Special Commission of the Podiatric Health Section, American Public Health Association, as a Special Report; Arthur E. Helfand, DPM, Chair; David I. Arlen, DPM, MPH; Lelia F. Banks, DPM; James R. Black, DPM, MPH; Kenneth C. Canter, DPM; Gerald A. Gorecki, DPM, MPH; Melvyn Grovit, DPM, MS, CDE; Robert Guytine, DPM; Howard G. Malin, DPM; Kathryn M. Moss, DPM; Jeffrey R. Robbins, DPM; Michael A. Robinson, DPM, MPH; and Marco Rubio-Ardila, DPM, MPH, 1998, Podiatric Health Section, APHA.
• Podiatric Medicine and Public Health – Concepts and Perspectives, Executive Summary, Special Commission of the Podiatric Health Section of the American Public Health Association, Arthur E. Helfand, DPM, Chair, Special Communication, Journal of the American Podiatric Medical Association, Volume 88, Number 7, July 1998, pp 353-359.
Podiatric Public Health – Overview, Arthur E. Helfand, DPM, Public Health and Podiatric Medicine – Principles and Practice, Second Edition, In Press, 2006, APHA Press, American Public Health Association.
Over the past forty years, the basic structure for public health and podiatric medicine evolved as a policy statement, and has undergone eight revisions. The policy has been published with the approval and acceptance of the respective associations and professions involved in providing care to the publics we serve.
From the time of Dr. Shapiro’s Presidency of the American Podiatric Medical Association, those Presidents who followed during this formative period, continued to recognize the need for podiatric involvement in both public health and the American Public Health Association (APHA). The former Executive Director of the APMA, the late Seward P. Nyman, DPM, began to develop discussions with and established a formal liaison with the American Public Health Association. A series of meetings were held between the two Associations and there was agreement to continue the exhibit program and to plan for the eventual development of a Podiatric Health Section within APHA.
In 1968, during the presidential term of the late Clarence Bookbinder, DPM, the APMA Board recognized the need for staff for both public health and governmental affairs. In truth, the two areas of policy needed to work in concert, given the recent inclusion of podiatric medicine in the Medicare statute. John R. Carson joined the APMA staff in 1969 and had public health as one of his primary responsibilities. With the support of Executive Director, Dr. Seward P. Nyman, and the APMA Board, the association invested its talent to bring its message to the public health community. When the records and history are written, John R. Carson’s dedication and integrity will clearly surface and demonstrate that he was the catalyst that brought about the relationships that were to follow.
It was also during the 1960s that the first members of the profession received their Master of Public Health Degrees. Another forceful former APMA President, the late Irving Yale, DPM, keep podiatric public health as a key issue for the profession. He frequently quoted the English author Joseph Malines, who wrote: “Better put a stronger fence round the top of the cliff then an ambulance down in the valley”. A public health direction has clearly been defined for the future.
APMA expanded its efforts to include not only an exhibit, but also scientific programs at APHA meetings. Additionally, APMA sponsored a series of meetings and receptions to honor APHA’s leadership at annual meetings in Houston and Minneapolis. Many past APMA presidents were just a few of the leaders who lent their active support for an APHA section as a high priority issue for the profession. In 1969, Dr. Charles R. Turchin, identified public health as one of his primary program objectives as he assumed the presidency of the APMA. In 1970, during the installation of Lawrence G. Lefler, DPM as President of the APMA, Dr. Walter Purdom (deceased), President of the American Public Health Association, joined the APMA in San Francisco to expand the cooperative role between the two associations and move towards section development.
Three additional public health programs also were recorded during the 1970s. They included the establishment of a formal podiatric program in the US Air Force, compatible with the programs in the Army and Navy; the placement of podiatric medicine under Title 38 of the Department of Veterans Affairs; the participation in the National Health Service Corps with 135 scholarships being granted to podiatric medical students; and the cooperative effort to establish a podiatric service in the USPHS Indian Health Service. Added to these significant accomplishments was the establishment of public health and community podiatry to the National Board of Podiatric Medical Examiners and departments and programs at the schools/colleges of podiatric medicine.
In 1971 and 1972, APMA Presidents, Ernest M. Weiner, DPM (deceased) and E Dalton McGlamry, DPM, a formal proposal was placed before the APMA Board of Trustees. During the Association Mid-Winter Board Meeting in January 1972, the Council on Public Health of the American Podiatric Medical Association, Chaired by Irvin O. Kanat, DPM, then First Vice President of the APMA, a Resolution that a Podiatric Health Section be established within APHA.
The proposal identified the two special foot health conferences that were conducted in conjunction with the APHA at its annual meetings in Houston in 1970 and Minneapolis in 1971. A similar program had also been planned for the 100th annual APHA meeting in Atlantic City in 1972. It should be noted, that since the initial foot health conference in Houston in 1970, there has been a Podiatric Health Section sponsored program at every Annual APHA Meeting for the past thirty-five years. The proposal outlined the increase in podiatric membership within APHA, with most practitioners being a part of the Medical Care Section. The Council on Public Health of the APMA unanimously endorsed a recommendation to seek the establishment of a “Podiatric Health Section” in APHA on January 19, 1972. The APMA Board of Trustees endorsed the Council’s recommendation on January 21, 1972 and transmitted the Resolution to the Executive Board of APHA. Such a Section would also permit all APHA members to select Podiatric Health as a primary or secondary section, thus developing a true interdisciplinary approach to health care, education, and preventive services.
In addition the American Podiatric Medical Association through its Council on Public Health offered to guide the proposed new Section’s organizational efforts. Inasmuch as there had been a steady increase in podiatric membership within APHA, there were sufficient numbers to support the development and operation of a new section. The expansion of public health efforts at this time identified four objectives to guide program development.
• Stimulate podiatric involvement and participation particularly at state and community levels, in programs of public health;
• Extend efforts to increase podiatric representation, at both administrative and advisory levels, among public health programs at the national level;
• Encourage and provide support for podiatrists who desire to pursue graduate opportunities in public health; and
• Reassess on a continuous basis, the professions public health posture and recommend needed programs to improve the foot health of the American population.
The APMA Board and its Council recognized at that time that considerable progress has been made in the field of public health but that the surface had merely been scratched. It also recognized that the assurance of quality foot health and foot care could not be developed in a vacuum and that a strong relationship with the American Public Health Association would support the concept that the “whole” of a community was more important than its “individual” parts and that podiatric medicine could more effectively and officially contribute to the “totality” of community heath working with and for the American Public Health Association.
In February 1972, the Executive Board of the American Public Health Association approved a recommendation that the establishment of a Podiatric Health Section be recommended to the APHA Governing Council for action at the 1972 Annual Meeting of the Association.
In 1972, at the 100th APHA Annual Meeting in Atlantic City, November 12-15, 1972, the Association’s Governing Council created the Podiatric Health Section, as Agenda Item 7.02. Arthur E Helfand, DPM was elected and installed as the first Section chairperson. The Section was granted three seats in APHA’s Governing Council for the 1973 APHA Annual Meeting, and active podiatric medical participation has remained constant ever since.
The Chairs of the Podiatric Health Section since its inception have included the following:
• 1972, 73, 74 Arthur E. Helfand, DPM
• 1975, 76 Leonard A. Levy, DPM, MPH
• 1977, 78 Richard H Baerg, DPM, MPH
• 1979 Joseph A. Addante, DPM
• 1980, 81 Joseph S. Fox, DPM, MPH
• 1982, 83, 84 Craig S. Gastwirth, DPM
• 1985, 86 Irving H. Block, DPM
• 1987, 88 R. Bryan Patterson, DPM, MSPH
• 1989, 90 Barry S. Collet, DPM, MPH
• 1991 Marvin Waldman, DPM, MPH
• 1992, 93, 94 Richard H Baerg, DPM, MPH
• 1995, 96 David I. Arlen, DPM, MPH
• 1997, 98 Michael A. Robinson, DPM, MPH
• 1999, 2000 Jeffrey M. Robbins, DPM
• 2001, 02 Lawrence A. Lavery, DPM, MPH
• 2003, 04 Chester A. Evans, DPM, MPH
• 2005, 06 Patricia A. Moore, DPM
2007-08 Christian R. Robertozzi, DPM
2009-10 Janet Simon DPM
The Mission of the American Public Health Association has been defined as: “To improve the public’s health, promote the scientific and professional foundation of public health practice and policy, advocate the conditions for a healthy society emphasize prevention and enhance the ability of members to promote and protect environmental and community health”.
The Mission of the Podiatric Health Section has been defined as: “To advocate a national, preventive foot health strategy; ensures consideration of podiatric concerns in the formation of public health policy”, as a means to augment the APHA Mission’s Statement.
Prior to the establishment of the Podiatric Health Section, two important milestones occurred that established the need for the section. They were:
• 1965 – American Podiatric Medical Association, Board of Trustees and Council on Podiatric Education approves Podiatry in Public Health
• 1967 – Journal of the American Podiatric Medical Association publishes Podiatry in Public Health – Council on Public Health
Since the establishment of the Podiatric Health Section, there have been several important milestones. The primary issues include but are not limited to the following:
- • 1972 – Governing Council of the American Public Health Association approves the establishment of the Podiatric Health Section
- • 1973 – Governing Council of the American Public Health Association approves Foot Health and Public Policy
- • 1973 – The special training program for educators who teach public health at the health professional institutions, such as medicine and dentistry, conducted by the University of Michigan, School of Public Health, and the American Public Health Association accepts faculty from the schools of podiatric medicine for the first time.
- • 1974 – American Public Health Association funds the development of Big Foot for Children’s Foot Health Education
- • 1975 – Governing Council of the American Public Health Association approves Podiatric Education, Research, and Health Programs in Occupational Settings
- • 1975 – American Public Health Association – Association of Schools of Public Health – Approves the DPM Degree as an Equivalent Doctoral Degree for Admission to Schools of Public Health
- • 1975 – American Journal of Public Health publishes Functional and Educational Qualifications of Podiatrists in Public Health – Podiatric Health Section
- • 1977 – A Podiatric Health Section Past Chair, Arthur E. Helfand, DPM, assumes the Chair of the APHA Special Task Force on Malpractice
- 1978 – Governing Council of the American Public Health Association approves Study of a Fatigue and Accident Reducing Floor Surface Methodology
- • 1981 – Governing Council of the American Public Health Association approves Hospital Privileges and Postgraduate Training in Podiatric Medicine
- • 1994 – Podiatric Medicine and Public Health – Concepts and Scope published in The Lower Extremity
- • 1996 – American Public Health Association funds the development of Podiatric Medicine and Public Health – Concepts and Scope – Functions and Educational Qualifications for Podiatrists in Public Health
- • 1997 – American Public Health Association, Podiatric Health Section – Special Commission on Podiatric Public Health publishes its Report – Podiatric Medicine and Public Health – Concepts and Scope – Functions and Educational Qualifications for Podiatrists in Public Health
- • 1998 – Journal of the American Podiatric Medical Association publishes Podiatric Medicine and Public Health – Concepts and Perspectives as an Executive Summary of the Special Commission of the Podiatric Health Section of the American Public Health Association
- • 2000 – Governing Council of the American Public Health Association approves Reducing the Incidence of Blindness, Lower Extremity Amputation, and Oral Health Complications in Minority Population Due to Diabetes
- • 2002 – Arthur E. Helfand, DPM joins the APHA Task Force on Aging and Podiatric Medicine is added to the Scope of Public Health and Aging Policy Statement
With the recognition of the DPM degree as an equivalent health professional degree, a number of the members of the podiatric medical profession have gone on for advanced public health degrees. The Association of Schools of Public Health approved that important recognition. In addition, a dual degree program has been established in some of the Schools and/or Colleges of Podiatric Medicine that are a part of university programs that permit students to earn their DPM and MPH degrees during the same time period. Specially modified programs have been developed to accommodate this effort. In addition the courses in Community Health as a part of podiatric medical education have been granted graduate credit, equating podiatric education with graduate education.
Some of the institutions that have granted admission to and granted graduate public health degrees to Doctors of Podiatric Medicine include the following:
• University of Texas Health Science Center, Texas
• University of California at Berkeley, California
• Harvard University, Massachusetts
• Polytechnic University, Brooklyn, New York
• Dartmouth Medical School, New Hampshire
• George Washington University, School of Public Health, Washington, DC
• Loma Linda University, California
• University of Michigan School of Public Health, Michigan
• University of Illinois School of Public Health, Illinois
• Long Island University, New York
• University of Pittsburgh, Pennsylvania
• University of Medicine & Dentistry, New Jersey
• University of Tennessee at Knoxville, Tennessee
• University of Washington, Washington
• Columbia University School of Public Health, New York
• Hunter College School of Health Sciences, New York
• New York Medical College, New York
• University of Missouri at Columbia, Missouri
• University of Hawaii School of Public Health, Hawaii
• University of California at Los Angeles, California
• University of Colorado-Denver, Colorado
• University of Utah, Utah
• Des Moines University, Iowa
• Temple University, Pennsylvania
Over the years, APHA has funded two major podiatric projects. The first, from 1974 to 1976, was “Big Foot”, a health education project for elementary school children. The Section needs to recognize as past Executive Director of the American Public Health Association, Dr. William H. McBeath, for his support, not only of this project, but also for providing the organizational support and stimulus to develop the Podiatric Health Section. Dr. McBeath was a member of the Faculty at the 1972 APHA – Michigan Traineeship and continued to demonstrate his support by recognizing that “there was room under APHA’s tent” for Podiatric Medicine.
The second was funding a Special Commission to re-cast Podiatric Medicine and Public Health – Concepts and Scope – Function and Educational for Podiatrists in Public Health, published in 1998. This special was developed as a Special Report and included the following contributors: Arthur E. Helfand, DPM, Chair; David I. Arlen, DPM, MPH; Lelia F. Banks, DPM; James R. Black, DPM, MPH; Kenneth C. Canter, DPM; Gerald A. Gorecki, DPM, MPH; Melvyn Grovit, DPM, MS, CDE; Robert Guytine, DPM; Howard G. Malin, DPM; Kathryn M. Moss, DPM; Jeffrey R. Robbins, DPM; Michael A. Robinson, DPM, MPH; and Marco Rubio-Ardila, DPM, MPH. This Report was embraced by APMA and APHA as a position paper. No other external organization has opened so many doors for podiatric medicine and made it an equal partner in the development of health policy than has APHA.
During the first twenty-five years of the Section, Podiatric Health sponsored four Resolutions and co-sponsored one Resolution that was all approved by the Governing Council of the American Public Health Association. Those five resolutions included the following:
FOOT HEALTH AND PUBLIC POLICY
Resolution 1973 #03
Comprehensive health care has become the prerogative of every American. If health services delivery systems are to effectively relate to the health care needs of the nation, a comprehensive scope of services will be required. Comprehensive health care ceases to be comprehensive when one significant aspect of the human person is deleted from the provision of services.
Whereas foot health and podiatric services are recognized as an essential service in any comprehensive health care program; and
Whereas the relationship of foot health to general health has been well documented; and
Whereas any legislative attempt to provide comprehensive health services should therefore include podiatric care.
Be it Resolved that the American Public Health Association recommends and urges that any national health legislation providing for comprehensive health services should require that podiatric care be included as an essential service, including legislative proposals for National Health Insurance, Health Maintenance Organizations, or other systems for the delivery and upgrading of health services.
PODIATRIC EDUCATION, RESEARCH, AND HEALTH PROGRAMS IN OCCUPATIONAL SETTINGS
Resolution 1975 #09
Whereas, many if not most occupations require that workers have the ability to work to bear weight upon their pedal extremities and,
Whereas, disorders of the foot and its contiguous structures diminish or even negate the ability of such workers to carry out their occupational activities; and
Whereas, most attention to date concerning occupationally related or affected foot problems have emphasized care and treatment;
Therefore Be It Resolved that the American Public Health Association with the assistance of its Podiatric Health Section and in cooperation with the Occupational Health and Safety Section encourage the initiation of programs of education, research, and safety by Schools of Podiatric Medicine, other health professional schools, industry, and related groups designed to prevent, identify, and reduce the extent of podiatric disorders that relate to employment conditions or affect employment efficiency.
STUDY OF A FATIGUE AND ACCIDENT REDUCING FLOOR SURFACE METHODOLOGY
Resolution 1978 #20
The American Public Health Association,
Recognizing that workers have long sought a method of relieving the fatigue which is concomitant with flat hard surfaces, and that some of these systems have long been known to health professionals who have been interested in preventive or occupational health; and
Observing that significant injury reduction at work sites has been recorded where workers are required to stand for more than four hours when a floor surface designed to meet certain parameters has been provided the workers; and
Noting that research has demonstrated that the foot was designed for the varied terrain of the natural surface of the earth; and
Recognizing that the venous pump system suffers a major disadvantage when the foot is confined to a flat surface and that this condition limits the proper functioning of this system in pumping blood back to the heart from the lower extremities; and
Noting that a methodology has been developed which can meet definite normal physiological parameters,
Supports the further study of methodologies for floor surface systems which are planned changes in environmental surfaces, and which prove to be beneficial in gently stimulating the peripheral venous pump, reducing fatigue, pathology, and accidents.
HOSPITAL PRIVILEGES AND POSTGRADUATE TRAINING IN PODIATRY
Resolution 1981 #22
The American Public Health Association,
Knowing that a shortage of podiatric residency programs currently exists; and
Knowing that almost all physicians serve a one-year or two-year residency after graduating from medical school; and
Knowing that today’s podiatry student acquires skills in addition to palliative care of superficial skin lesions, such as knowledge of drug prescription and medication, surgery on bones and soft tissues, use of X-rays, and other sophisticated techniques; and
Realizing that podiatrists as members of the modern health care team have assumed an important role in the provision of foot care; and
Believing that the podiatrist’s responsibilities include being called upon as the primary care practitioner; and
Knowing that a maldistribution of podiatrists exists nationally, with greater numbers practicing in urban areas; therefore
- Encourages a greater awareness of the need for additional postgraduate training facilities for podiatric graduates;
- Encourages health care institutions to expand their current structure by initiating podiatric residency programs for postgraduate training;
- Requests that health care institutions review their bylaws and amend where necessary any portion which denies or inhibits trained podiatrists from gaining access to their diagnostic and operatory facilities; and
- Requests health care institutions to extend hospital privileges to qualified podiatrists for management of foot pathology.
REDUCING THE INCIDENCE OF BLINDNESS, LOWER EXTREMITY AMPUTATION, AND ORAL HEALTH COMPLICATIONS IN MINORITY POPULATIONS DUE TO DIABETES MELLITUS
Resolution 2000 #02
The American Public Health Association,
Observing that epidemiological studies have shown that the prevalence of diagnosed diabetes has increased dramatically in the last 30 years; and
Noting that diabetes has reached epidemic proportions, with more than 20 million Americans of every age, gender, and race now afflicted; and
Recognizing that diabetes is a serious public health concern, with a prevalence in minority populations of African-Americans, Hispanic-Americans and Native-Americans that is two to three times that of non-Hispanic whites; and
Noting that type 2 diabetes is also emerging as a problem among minority children and adolescents; and
Realizing that the increasing prevalence of diabetes among all groups has lead to an increase in the microvascular and macrovascular complications, including blindness, lower extremity amputation, and destructive periodontitis and tooth loss; and
Understanding that the lower extremity, periodontal and visual complications of diabetes are generally a function of the duration of diabetes and the level of glycemic control; and
Recognizing that approximately 67,000 amputations occur among the diabetic population annually, an incidence of at least 15 times greater than non-diabetic populations; and
Noting that foot ulcers precede amputation in 85 percent of cases; and
Recognizing that the 5-year mortality rate of diabetic patients increases by 39 to 68 percent following lower extremity amputation; and
Understanding that periodontal complications may lead directly to tooth loss and chronic infection. This adversely affects glycemic control; and
Recognizing that diabetic retinopathy is the new leading cause of blindness among working-age Americans, accounting for approximately 8% of all cases of legal blindness and 12% of all new cases of blindness in the United States each year; and
Knowing the health benefit and cost-effectiveness of well established strategies of prevention and treatment in diabetic foot and vision care; and
Knowing that much of the vision loss, periodontal disease, and lower extremity amputation in diabetes mellitus is preventable through early detection and timely treatment; and
Recognizing that annual foot examinations by podiatrists and other foot care providers, vision examinations through a dilated pupil by ophthalmologists and optometrists, and dental examinations by oral health providers are the accepted standards of care for all persons with diabetes; therefore,
The American Public Health Association urges health care professionals to
1. Promote awareness of the need for annual foot screening and examinations for individuals with diabetes and make appropriate referrals to podiatrists and other foot care providers;
2. Promote awareness of the need for annual dilated fundus exams for all individuals with diabetes and to make appropriate referrals to ophthalmologists and optometrists;
3. Promote awareness of the need for at least annual oral health examinations for all individuals with diabetes and to make appropriate referrals to oral health providers; and
4. Encourages federal, state, and privately funded health care organizations to target high-risk minority populations, including African-American, Hispanic-Americans, and Native-Americans, for annual foot and vision care.
5. Promote interdisciplinary diabetes management and appropriately timed referrals.
There have been a number of articles that have been published in the American Journal of Public Health, authored by members of the Podiatric Health Section. Examples include the following:
• Podiatry and Public Health: A 7 – Year Experience in the District of Columbia, J Shapiro, 63: 853-856
• A Podiatric Health Screening in Harlem, DI Rosenstein, R Baerg, G Gastwirth, and J Fox, 65: 634-635
• Functions and Educational Qualifications of Podiatrists in Public Health, Podiatric Health Section, AE Helfand, Chair, 65: 967-971
• Podiatric Medicine – A New Threshold in Health Manpower, GA Gorecki and TP Bzryski, 65: 1212-1216
• Podiatric Health and Jogging, Letter to the Editor, A Stern, 73: 704
• Podiatry: Critical Issues in the 1980’s, JK Skipper, Jr and JE Hughes, 74: 507-508
• Elective Foot Surgery: Relative Roles of Doctors of Podiatric Medicine and Orthopedic Surgeons, JP Weiner, DM Steinwachs, RF Frank, and KJ Schwartz, 77: 987-992
A search of the American Journal of Public Health has identified an additional forty-three articles and reference podiatric medicine as a part of the delivery of health care in public health settings.
In this time of change, the profession has established a national, formal statement that outlines the functions of the doctor of podiatric medicine in the public health sector in order to effectively identify the profession’s roles and responsibilities for the future. APHA is the organization that took the lead in this endeavor, as it has done for all professions involved in public health since the inception of the APHA.
Podiatric medical activities in the field of community or public health span many areas of concern. While maintaining the traditional base of primary care as a major delivery function, the podiatric medical practitioner is also involved in education and prevention efforts, as well as newer methods of administration.
The functions of DPMs in public health can generally be divided into six primary categories: preventive, diagnostic and therapeutic care; program administration; program development and consultation; podiatric health education; professional education; and research. The categories are not mutually exclusive, and each is often related to, and dependent on, one or more of the others. For example, research activities include, but are not limited to, the following areas:
• Methods for the prevention and control of foot and related conditions.
• The social science and educational aspects of achieving better health for individuals and groups in their community setting.
• Effective administrative methods and evaluation programs.
In August 1983, the APMA House of Delegates formally approved podiatric public health as a special area of podiatric medical practice. The first Diplomates of the American Board of Podiatric Public Health were certified in August 1987. The American Board of Podiatric Public Health granted life diplomate emeritus status to all of its existing diplomates on January 31, 1995, certifying all diplomates without any time limitation. Of these diplomates, those who remain continue to serve as the core of the special area of practice.
The American Public Health Association and the Podiatric Health Section also recognized its initial 40 Year Emeritus Members as follows: Arthur E. Helfand, DPM (2001); Harry I. Horowitz, DPM, (Deceased) (2005); Carl C. Sosinski, DPM (2005).
Podiatric public health embraces the concept of total community involvement and care, which has as its aim the prevention and maintenance of a healthy and ambulatory population. Podiatric public health must now look to the future and to the policies relating to the development of health care. Future objectives and goals for this special area of podiatric medical practice are as follows:
• Advocating a national, preventive foot health strategy.
• Ensuring the consideration of podiatric medical concerns in the formation of public health policy.
• Promoting the importance of foot health and increasing the public’s access to foot health prevention and treatment services.
• Monitoring and communicating foot health needs to the public.
• Promoting recognition of the need for an effective, equitable, and affordable foot care system for the public.
• Advising on the organization, delivery and financing of foot care services.
• Promoting public health policy for the prevention and treatment of foot and related conditions.
• Developing public policy positions and guidelines for clinical care.
• Promoting the functions and educational qualifications for podiatric medical physicians in public health.
• Focusing attention on the pedal and related complications of systemic disease and the educational and preventive measures required to reduce disability.
• Working to assure podiatric medical care for the elderly and supporting policies for ambulatory care, long-term care, and mobility.
• Promoting the role of podiatric health in improving health service administration, including cost-benefit and operations research, outcomes measurements, critical pathways, algorithms, and monitoring the organization of health services.
• Advancing health promotion and education.
• Promoting the activities related to training public health professionals.
• Establishing guidelines for podiatric medical care in health care settings.
• Promoting podiatric medical programs in the field of public health.
As a final comment, perhaps the best evaluation of the importance of Podiatric Public Health was contained in a letter dated June 19, 1992 from William H. McBeath, MD, MPH, Executive Director of the American Podiatric Medical Association at that time, to Arthur E. Helfand, DPM, Executive Director of the American Board of Podiatric Public Health. The letter stated the following:
“Congratulations! This year will mark the 20TH anniversary of the Podiatric Health Section of the American Public Health Association (APHA). The Section is the one place where the unique contributions of podiatric medicine to the public health field are clearly rectified. Section members use of scientific and popular public health publications and meetings, not only as a continuing education forum for podiatrists specializing in community health, but also as a platform from which to gain the appreciation and support of the many non-podiatric disciplines for the cause and contributions of podiatric medicine within society. Section participation in the APHA program development and public policy process has resulted in new sensitivity to the perspective of priority foot care concerns in our APHA policy statements, ranging from technical considerations for safe and healthful flooring materials, to equitable inclusion of podiatric services and providers in federal health programs. I smile as I recall the “big foot” project and other worthy and creative public health education initiatives of our podiatrist members which have been recognized by their APHA colleagues for contributions to school health and clinic education programs.”
“An important parallel movement has been the development of the American Board of Podiatric Public Health (ABPPH). Its Diplomates have been prominent leaders and major contributors in both our section and Association life; and more importantly they provide a basic means for bridging the messages and methods of community health with the podiatric medicine profession. APHA has come to view this arrangement (i.e., a disciplines based APHA section and an independent but allied professional organization of the discipline’s public health specialists) as one in which the overlapping interests and concerns of both the discipline and the public health community can be advanced cooperatively. This model has proved particularly effective with strong clinical disciplines active in public health: e.g., allopathic medicine, dentistry, nursing, nutrition, optometry, and podiatric medicine”.
Dr. McBeath’s comments of 1992 are equally valid today and demonstrate how important the relationship is between APHA and the podiatric medical profession. It should also be noted that all of the Executive Directors and Presidents of the American Public Health Association from the inception of podiatric inclusion always believed that there was always room under the tent for podiatric medicine and the need for foot health as an integral component of public health.
The American Public Health Association, through the APHA Press, has scheduled the Second Edition of Public Health – Principles and Practice for publication in 2006. This new public health text will outline the historical importance of podiatric public health and establish guidelines for future programs. The chapter titles include the following:
• Milestones in Podiatric Public:
• A Historical Public Health View of Health Care of the Human Foot
• Podiatric Public Health – Overview
• Podiatric Public Health – A Historical Perspective
• Governmental Programs and Policies
• Podiatric Medicine – Military Services
• Podiatric Medicine – The Historical Development of Programs in the Department of Veterans Affairs
• Podiatric Medicine – Current and Future Programs in the Department of Veterans Affairs
• A Conceptual Guide for Podiatric Public Health Public Health
• Education in Podiatric Medicine
• Public Health Education – Advanced Professional Education
• Legal Considerations in Podiatric Public Health
• Ethical Concerns in Podiatric Medicine
• Epidemiology of Podiatric Medical Diseases and Disorders
• Patient Foot Health Education: Preventive Care
• A Conceptual Model for a Community Podiatric Assessment Program for the Chronically Ill and the Elderly
• Aging and Selected Chronic Diseases
• Health Promotion and Foot Health Considerations Related to Aging and
• Special Health Issues
• Public Health Implications for Early Intervention in Developmental
• Disabilities of the Lower Extremities
• Children’s School Foot Health Programs – A Conceptual Model
• Medicare – An Administrative Perspective
• Medicaid – Conceptual Guidelines for Podiatric Programs
• Occupational Foot Health
• Podiatric Medicine in a Changing Health Care System
• Institutional Podiatric Care – Administration and Organization
• Public Health Considerations Pertaining to Podiatric Services in Long-Term Care Facilities
• Planning Podiatric Community Podiatric Medical Programs
• Radiologic Health Protection for Podiatric Diagnostic Applications
• Disaster Preparedness for Podiatrists – Preparing for Contingencies
• Bioterrorism: A Public Health and Podiatric Medicine:
• Public Health Considerations for AIDS – HIV Infection in Podiatric Medicine
• International Podiatric Medicine
• Planning Podiatric Medical Services for Underserved Populations
• Future Public Health Considerations for Podiatric Medicine – Foot Health Policy
The ability of podiatric medicine to participate as an equal partner in the development of the nation’s health policy has been earned. Recognition of that need is a solid base for the profession as it moves through the next century. The Podiatric Health Section of the American Public Health Association has served and continues to serve as a focus to provide preventive and community health services to our Nation, to establish public foot health policy, and to recognize that health is a basic human right.
1. Rubin A, Editor, Podiatry and Public Health, Journal of the American Podiatric Medical Association, Vol. 43 March 1953, p 57
2. Turchin, C, Inaugural Address, Journal of the American Podiatric Medical Association, Vol. 59, 1969, p 350
3. Yale, I., Inaugural Address, Journal of the American Podiatric Medical Association, Vol. 57, 1967, p 526
Note: The American Podiatric Medical Association prior to 1984 was known as the American Podiatry Association. Prior to 1957, the Association was known as the National Association of Chiropodists. The Journals during these periods represented the particular names of the Association at that time. We have utilized the current name of the American Podiatric Medical Association to provide consistency in current name recognition.
Dedication of the Podiatric Health Section History in Honor of
William H. McBeath, MD, MPH
The record of the development of the Podiatric Health Section of the American Public Health Association to be complete, dedicates this historical review to William H. McBeath, MD, MPH, the retired Executive Director of the American Public Health Association, for his vision, dedication, and years of service to the field of public health and for his belief in the mission of Podiatric Public Health.