There is a very great amount of poverty and overcrowding in [New York City]… . In many parts housing is still most unsanitary; … furthermore, there was up to the time of [World War I] an unending stream of immigrants arriving, so that the task of educating them was never done, those who were educated to our health standards being continually replaced by others who were not. Again, the climate is most trying.

In all large communities, the poorer element of the foreign-born population presents the greatest problem encountered in municipal health work. Diversified in their habits, often superstitious and resentful of any interference with their mode of life, oppressed by poverty, frequently ignorant or neglectful of the simplest sanitary requirements, their assimilation as citizens of their adopted country comes only as result of education—persistent, inclusive, and never-ending… . Lectures, printed instructions, and publicity in all its forms are used, but the most valuable and effective form is found in individual instruction in the home… . We have found the employment of trained nurses for this purpose of inestimable value.

Health education is the method through which the [New York City] Health Department … enlightens people and induces them to act in a manner that will conserve their health… . The idea of promoting public health by education … goes back to the nineties when the New York City Department of Health first applied it to tuberculosis. Subsequently it was successfully used to combat infant mortality, diphtheria and other communicable diseases. Today the entire Health Department is an educational undertaking.