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508 ;•4•_: tf, ..iul as a part of a medical group, to utilize and .:. !.' th< ...•.•c,rtunities he has for teaching should become an i: •, •• 1-•iji t.•,:d in lay. education. Other professional medical t- 1, :,:c the American Academy of Pediatrics and the ~. o+ ta•;:cral Practice also support this trend throtiigh tt.• i, activities, journals and meetings. i•-a throuRh Industrial Programs. With the growth oi i+rtustri.•a s+edical- progras+s, the interest of industrial Nt,y:.[c~au. i+ti che cardiovascular disease problem has also g+..~~. lw"Lo.iness;'organizations where an employee medical c:ists,' early diagnosis'of a cardiovascular problem is :.cr.•ssol through periodic.health examinations and important h.alti. co.a+ssling is frequently.given to employees who may have he:t4t :isCs.: or whosc family history or medical examination m-+y its latent possibility.l`' '<In some companies, the c,~:,=2op: r w;t;,aztne may carry an" article on some aspect of car- di.x: :.cul:t. dGseasc,', and pamphlet tnateriaT is made available tcb i at rrested employceg rv`. 1t1c'?'K 3ica: Fonndatibn; Inc.; a voluntary organization 1-st'+t+t tiai+,_.t~,n~-1957'`l # has~developed •services to provide health .~w •,iva~.,-ams~pon~Zi~quest in"the~businesses' nd indus- tri. r oC;Ett.c gt'catcr-"Boston and Nev England areas:~6 A pro- Sr~tt La.,"1.,•.c+i available4ori*;!'Your Aeatt:: A'Perpetual Motion k..•,i: • that b.zs `involved botli management' and employee part ici- patic.n and t6- use"bf-a~variety;of!:teaching tools. There are oti..•rs scbedutcd dealing;with heart.di'sease as it relates to nutriticm an.+ physical fitness. ;Evaluation of these activities is• p.:rt of Ttio; Medical Foundationts responsibility, and ques- tiot.i..,ires',h;+vc been worked up as"baselines for pre and post ccst m.asure+~nts.' tTae of,the most-:valuable developtnents of the late fifties ks i..-en th; fiirther establishment and use of Cardiac Work Evaluation,;Ilnits.: The first-of_these_"clinics" was set up as carly as'.1941 -;:Today there are'about'36 Heart Association- sp..nsorcd Units'rrhose fundamental purpose is education - of the emi;,loyer as;well as'the employee-patient - to help pro- ductivelyin the rehabilitation'of 'the patient to full or part tiur useful employment. -Published evidence, however, sug,gosts that.these units are'not used sufficiently.17 It should be noted, too, that the AM''has continued to stiwnlate interest :n the nee:: and problems of the cardiac- in-industry through sponsorship of meetings and state wide conferences such as those held annually in Chicago coeanencing in 1952 and the one held in Harrisburg, Pennsylvania in 1960. R 50327 3090 509 Additional study of the problem is indicated, however, and the full cooperation of manage:ment, unions and the medical prufv:.- sion is needed. Other Organized Efforts. As has been noted, during thc late fifties educational efforts have focused on helping the heart patient and his family understan,•d the problem, scck pro- per care, and follow a regimen most conducive to normal wid intelligent daily living. The Health Insurance Plan of Crcater New York, frequently referred to as HIP, has carried out .+ program of health education for subscribers (approximately 700,000) which has often considered the heart and circulatory system, and the related role of doctor and patient.18 Worning through the 1,000 physicians organized into 32 medical groups affiliated with HIP, the program has been carried out maittly through subscriber group meetings using large group lectures (average reported attendance 250) and small group discussions. Summaries of these meetings and original articles by 1111' physicians and staff, pamphlet reviews and other cardiovascular items also appear in the quarterly health education bulletins mailed to all subscribers. The life,insurance industry has a well recognized stake in the cardiovascular disease problem. In the area of lay education, the Metropolitan Life Insurance Company has bc.•n a pioneer. For many years the Company has made available to the public and community agencies a comprehensive boolcl::t on the circulatory system and hi:art disease as well as sYecial leaflets on rheumatic fevck and coronary heart disease. "ilow to Control Your Weight" and "Your Guide to Good Health" have been two additional ublications used in urging intelligent 'health maintenance.l~ From 1950 to 1963, the Metropolita« placed 22 different public service messages on cardiovascular diseases alone in national magazines. During the same titnc period, similar niessages were carried over radio networks. In keeping with the general trend in cardiovascular intoru:ation for the public, the Company's messages included fPctuat in- formation about heart research, the circulatory system, and common misconceptions; and focused on such preventive measures as periodic check-ups, knowledge of warning signals, avoidance of stress, weight control, regular exercise, and a daily rou- tine of healthful living. Both the Prudential Insurance Company of America and the John Hancock Life Insurance Company are others in the insur- ance industry who have made heart disease informatioa avail- able to the public although on a much more limited scale than Metropolitan. The Prudential has published "It's Your Hcart"

a•Kt the Jahn-; Rstlcack, such ` titles as !'About Your Blood, I' "Foes Ait cr i'orty;°.;ltaistiines,'a and "(uarding"Your- Family's Health." such as the; Equitable Life Assurance Society of the UnitcL' 5tates also provide health education services for the Lul+lic, bot supporting general health maintenance r:a2r,•c• tL..,1 dc~;,liufi with the cardiovascular disease problem Jhi DU. - ,.. . .. . .. .. . l:u s,~:v.cl,_in the Fifties. Throughout the late fifties, sc;.:.ct vrlt.;r:c aud professional health educators responsible for Inui;ra..aiug and the developmeat of informational material acwt t_•:•.au t;; t ools have consistently turned to medical science acwi i;:carch for new knowledge that might profitably be trans- t.itt.••i to an.t interpreted for the public. In turn, research fii.dic•,_s l..av.: provided the.tsain stimulus for changes and trends in 1..: cdu. at ion. ; lr:,•)or d;v.,lopments in heart surgery, and the development of artifivial heart valves and electronic devices such as the havr given new hope'and lif¢ to countless indi- vidc.,.i:: .citli congenital.heart problema.° The mass media has be.n iustrawsinn:al in rcpbrting•these advances to the public. 'Sttalies in hcart sout4d'screening have been carried out by the Ittx:Y in l7,cities involving.150,000 shcool children out of the hslf V.iilion schoo2 population: In such a program, comprehen- sivc public cducation hss.been vital in`providing orientation fox school t.crsonnel; the;children.and their parents in order to win uaJerstwnding'and cooperation.6 Information about con- g,-ttital beart disease has`been incorporated into several pub- l icat ions &+z.to 'avai lable' to the public by the AHA to encourage p.'oi..•r di,1i;cwais and::treatment, and to provide hope for 9:ce dcv4lopmcnr,of efficient drugs to treat hypertension has :ciso given'impetus to cardiovascular disease education in ti.is ar.•a. -Litcrature has been developed by several sc.urccs including IikII and AHA3 to inform the public about blood press..re, signs and symptoms of the disease, and known sx-asures for treatment. Tlse decade of the fifties has.'been witness to remarkable proeress against heart disease in which the role of research bas been paramount. The role of public education has been no less vital, however, for it has been because of education tl>.,t the pui.lic has given tremendous financial support, both thr.,ui;h governwent and private sources, to cardiovascular research and training programs. xnowledge that research and education hold the clues to continued progress against hearfl 1 50327 3091 511 disease in the sixties has hopefully stimulatcd the beginnings of an unusual partnership among physician, educator and laywan. The Sixties: Prevention and the Promise of Research In summary, the late fifties have been characterized as years which gave rise to greater publicc knowledge and optimism about the treatment and management of certain cardiovascular problems and focused more selectively on patient education to influence behavior ard attitudes. Educational programming and teaching tools became more sophisticated; public and private coeanunity services, and industrial health programs continued to expand and provide for lay education; the physician bccar,,c increasingly involved in all areas of public education; and research and education emerged as the determining factors in progress against cardiovascular diseases in the six:ies. Prevention Education. As has been noted, before the 1960's little could be said about prevention of hcart disease, with the exception of rheumatic fever and rehumatic heart d:.sease. By 1960, however, the so-called "risk factors" in cardiovascu- lar disease, the "coronary-prone" individual, and preventive measures which might be taken to protect him were being dis- cussed in common parlance.5 Etiologic research during the fifties, and before, produced findings that suggested that age, sex, geographic'location, obesity, diet, exercise, stress, smoking, and organic malfunctiocis such as diabetes were the major factors related to the onset and development of heart disease. Success at the prevention of occurence level has been limited, and such advances as have occurred in the specific areas of congenital, rheumatic and syphilitic heart disease may merely allow people to live sufficiently long to develop the degenerative cardiovascular diseases of old age. Dietary Fat. In January 1961, the Central Committce for Medical and Community Program of AAA issued a report: "Dietary Fat and Its Relation to Heart Attacks and Strokes."3 Rc::carch suggested that reduction in blood cholesterol by dietary means might lessen the development of atherosclerosis, the number one challenge in heart disease, and thus the risk of heart attacks and strokes. The Committee's report commenced with a general statement that "current available knowledge is suifi- cient to warrant a general statement regarding the relation of diet to the possible prevention of atherosclerosis." however, .<