In campus health centers, Heather Munro Prescott sees much more than places to promote student health. Their history reflects important societal values on the evolution of higher education in the United States, about the education of women, and about some of the most controversial social issues of the day. Prescott's new book, Student Bodies: The Influence of Health Services in American Society and Medicine, is just out from the University of Michigan Press. Prescott, professor of history at Central Connecticut State University, responded to e-mail questions about the themes of the book.
Q: What led you to want to study student health services?
A: My interest in this subject in some ways dates back to my undergraduate years at the University of Vermont, where I was a premedical student as well as a frequent consumer of medical and counseling services. During the fall 1983 semester, when I was a sophomore, I took a course on the work of Michel Foucault, who spent part of that semester in residence in a faculty apartment in my dormitory. I was also a resident assistant on the same floor as members of the UVM rugby team. So I found myself trying to be an authority figure, while at the same time reading critiques of institutions of social control! This was also the early years of the AIDS epidemic and as you know Foucault died of that disease the following year.
By the time I finished my B.A. I had decided I wanted to do graduate work in the history of medicine rather than attend medical school. Although I did a graduate seminar paper on a typhoid epidemic at Cornell in the early 1900s, my dissertation and first book was on the subject of adolescent medicine. S tudent Bodies is an extension of my interest in the health care of young people in the college age group.
Q: The early history of student health services seems at times to be as much about keeping students out as promoting health. Why was that?
A: Some of this has to do with the origins and evolution of higher education in the United States. Initially college education was limited to the small percentage of white males who intended to go into clergy, law, medicine, and other elite male professions. Excluding the "unfit" -- e.g. women, African-Americans, Jewish persons, those with chronic illnesses and disabilities -- was a way to preserve the status of these prestigious institutions of higher education. Medical theories seemed to "confirm" that these groups could not withstand the pressures of collegiate education. For example, physicians such as Dr. Edward Clarke argued that women's brains were less highly evolved than men's, and that advanced study robbed women's reproductive organs of energy needed for healthy development and function. Other scientific experts made similar cases about African-Americans and other racial and ethnic minorities.
Q: How does the early history of student health services reflect evolving attitudes in academe about women as students and medical professionals?
A: Since the beginnings of our country, women have received mixed messages about their proper roles in society. The political rhetoric of the Early Republic, for example, included the ideology of "Republican Motherhood" or the notion that women, as the first educators within the home, played a vital role in ensuring that their children -- especially their sons -- were thoroughly educated to be good democratic citizens. This ideal of Republican Motherhood was a powerful incentive for educating women. In addition, the expansion of public primary and secondary education created a need for a cheap, abundant labor force to staff the nation's public schools. Finally, there were forward-thinking advocates of female higher education, such as Matthew Vassar, who believed women simply deserved the same education as men.
At the same time, some male physicians continued to warn of the dangers of higher education to female brains and bodies. Even the most strident supporters of women's higher education could not ignore this, so they hired women physicians to take care of female students and to teach courses in hygiene and physiology. Due to sexism and discrimination in the medical profession, women physicians had limited employment opportunities. At the same time, women physicians argued that it was inappropriate for male physicians to care for female patients. So, women physicians carved out a professional niche for themselves.
Q: What about the attitudes over time about male college students?
A: Men's colleges did not ignore the fact that male undergraduate life was unhealthy -- there are numerous reports of excessive drinking and other "bad habits" -- including having prostitutes in dorms and masturbation -- but after widespread student riots in the early to mid-19th century, most men's colleges gave up trying to supervise student life. It's only the early 20th century, when some parents started demanding that colleges and universities adopt some of the same responsibilities in loco parentis towards their sons as they did toward female students, that this changed.
Q: Was there a key turning point in student health services moving toward a more progressive idea of serving student-patients as opposed to just institutional interests?
A: I would say that the turning point was student activism in the 1960s, which switched the emphasis away from an "in loco parentis" model and more towards one that treated students as clients and partners in their own health care. I think this also reflected a generational shift in the medical profession, and of course, some of the student protesters went on to medical school and other health professions and changed the field even further.
Q: Student health services continue to be places where social issues play out (providing the morning after pill, sexual health generally, etc.). What do you see as the most difficult issues ahead?
A: The most difficult issue I see is ahead is funding for health services. College students are among the most underinsured individuals in the nation: Recent estimates indicated that between 20-30 percent lack any sort of health insurance coverage. Meanwhile, the cost of health care continues to rise. Some colleges and universities have simply passed this cost along to the students through increased health services fees. This puts additional burdens on lower income students, making it less likely that they will be able to attend college in the future.
Q: Are there key lessons from the history of student health for those in the field today?
A: One of the major arguments I make in the book is that the history of student health services is part of a longer history of diversity in higher education. Building on Paula Fass' work, I argue that the body has been a locus through which educational reformers have attempted to open higher education to outsiders. I think today professionals in college health continue to reiterate this connection between health services and equality of access to higher education. I also think that both historically and today, health programs in higher education are most successful when students are included in health service planning. This notion of student involvement is relatively recent since the origins of health services for students were rooted in the belief that colleges and universities had a responsibility in loco parentis. Students in the 1960s and early 1970s rebelled against this "institutionalized paternalism" which prompted campus health centers and the American College Health Association to create student health advisory divisions.
Finally, I think it's important to link college health programs with the larger history of public health and preventive medicine in the United States. Since the early 20th century, professionals involved in college health programs have sided with larger social movements for universal health care, arguing that health care is a right and not a privilege. So, in addition to providing health care for individual students, I would like to see student health services continue to be advocates for improving public health for the nation as a whole.
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