Swine Flu and Student Health: Past and Present

Like other members of academic communities, I am anxiously waiting to see what will happen with the swine flu epidemic once students return to campus in the fall. Since I am a historian of medicine, and my most recent work is on the topic of student health services (Student Bodies: the Influence of Student Health Services on American Society), I have been spending my time reflecting on how the past can inform current health care practices on campus.

It is easy to use the 1918-19 influenza pandemic as a point of comparison: as in the case of today’s epidemic thus far, the 1918-19 pandemic was unusual in that it disproportionately affected young people in the prime of life. The degree of preparedness of various colleges and universities at that time varied widely: fewer than 10 percent of institutions of higher education had campus health services equipped to isolate students with contagious diseases and provide inpatient care. Among these was the University of Minnesota, which had established a health service for students in March 1918. In his memoirs, Minnesota President Marion LeRoy Burton recalled, “There seemed something almost providential about getting the Health Service started just in time to serve during that pandemic.” During the 1918-19 academic year, the university health service treated 2,000 cases of influenza, with only twenty deaths, a rate dramatically lower than the estimated national mortality rate of 10 percent.

Yet, it was not simply luck that Minnesota was among the few that had a campus health service: Burton was previously President of Smith College, which, like other elite women’s colleges, instituted student health services when they were created in the late nineteenth century. These women’s colleges were not more enlightened about preventive medicine, though. They were responding to Harvard Medical School professor Dr. Edward Clarke’s best-selling book, Sex in Education, or, A Fair Chance for the Girls (1873), which argued that higher education damaged women’s bodies by drawing nervous energy away from the processes of reproduction. Women who ignored these basic facts of nature by pursuing a college education risked nervous collapse and sterility. These anxieties about the fitness of the female body for advanced study shaped the design of women’s colleges and the female divisions of coeducational institutions. The earliest college health programs emerged in order to address concerns about the impact of higher education on the female body.

These initiatives for women later served as models for further developments in college student health for male students. The trustees of Amherst College, observing that nearby Mount Holyoke Female Seminary excelled in preserving the health of their students, decided to give a fair chance to the boys by creating a Hygiene Department and appointing a college physician in 1860. Most of the other elite men’s colleges followed suit during the late nineteenth and early twentieth centuries. Thus, during the 1918-1919 pandemic, these colleges tended to have much lower incidence of disease and mortality than did other campuses. Princeton escaped relatively unscathed: none of the 192 students who became ill with influenza died. Nevertheless, the Women’s Committee of the Princeton Endowment Fund the campus infirmary could barely contain the number of students who became ill, and began collecting funds to build a new, larger, and more modern facility.

State colleges and universities were slower to create health services, partly for financial reasons, but also because local physicians’ groups and the American Medical Association argued that college health centers, by providing medical services to students for a fixed annual fee, had an unfair monopoly on student health care. The objections of the AMA became even louder following the First World War, when Congress allocated funds to some state colleges and universities to enhance efforts to prevent communicable diseases – especially the dreaded “venereal” diseases that were a more intractable scourge at this time than was influenza. During the 1920s, the AMA launched a successful campaign to convince Congress to abolish “socialized medicine” and the federal funds for college health centers were discontinued. The financial crisis experienced by many public institutions of higher education during the Great Depression of the 1930s led to even more cutbacks in health services to students.

It was not until the period following the Second World War that the majority of colleges and universities established student health services. These efforts were aided by the 1947 report of President Truman’s Commission on Higher Education, Higher Education for American Democracy: The Report of the President’s Commission on Higher Education. In addition to recommending an end to racial and religious discrimination, increases in financial aid programs, and creation of community colleges, the report also stated that promotion of physical and mental health was a central part of the mission of higher education. The emphasis on the prevention of disease and the educational functions of college and university health services eventually led the American Medical Association to accept these centers as a legitimate site of health care delivery.

So, what can we learn from this history? Like the era of the Great Depression, today’s financial problems are leading colleges and universities to cut back on student services like health centers and mental health programs. College students are among the most poorly insured groups in America: 20 to 30 percent lack any form of health insurance. Those who are young and fortunate enough to be insured under their parents’ policies may lose these benefits in the next round of layoffs. Poor health and inadequate medical care create significant barriers to regular college attendance just as surely as do lack of funds. As in the past, attempts at health care reform are encountering fierce opposition from conservatives alleging that President Obama is trying to inflict “socialized medicine” on the American public. Yet, there’s nothing like an epidemic to mobilize the money and will necessary to avert a public health catastrophe at the nation’s institutions of higher education. One can only hope that the same level of commitment to promoting healthy campuses will continue once the current epidemic is over.