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The American Women’s Hospitals at Home: Public Health in Depression-Era Appalachia

Teaching Guide

This guide accompanies the primary source set for The American Women’s Hospitals at Home: Public Health in Depression-Era Appalachia »


This story dives into the public health work of the American Women’s Hospitals in rural Appalachia. The pamphlets, photographs, and reports featured provide a “boots on the ground” view of public health in the 1930s. The records of their efforts offer one answer to the question of how Americans attempted to address the problems facing individual communities that were caused or exacerbated by the Great Depression. This story may be integrated into a broader evaluation of how the circumstances of the Depression led to a call for both private and public welfare programs throughout the United States.


Suggested classroom activities

  1. Ask students to evaluate this month's lunch menu at their school for pellagra protection, using the information provided in the “Protect yourself from pellagra” pamphlet.
  2. Have your students make a list of the actions taken to improve the health of the community using the Annual Report of AWH Whitley County Health Unit.  Then ask them to visit a local community center or public health department's website and compare the health initiatives undertaken by their community to those of the AWH in Whitley County.  Ask them to find equivalent programs for each action listed on their first list, as well as one program the AWH did not have an equivalent for.
  3. Ask students to write a short letter to a lawmaker in the 1930s as an AWH physician explaining the importance of their work in Appalachia. Using specific evidence from the story’s sources, they should describe the problems faced by Whitley county and what the AWH is doing to address them- with a goal to persuade the lawmaker to whom they are writing to include funding for the AWH as a part of a New Deal relief package.

Lesson plans

      Coming soon

Discussion questions

  1. Why is pellagra not still discussed as a major health issue? What is an equivalent health problem today that many Americans face?
  2. Do you see more public health programs today run by private organizations or the government? Which do you think would be more effective?
  3. Evaluate the images included in the fundraising pamphlets (1, 2). Who was the intended audience for these pamphlets? What would have made the images they included effective?
    • What circumstances might have contributed to the American Women's Hospitals having difficulty funding their work?
  4. In the AWH Annual Report for Whitley County- which of the actions that they took addressed the unique needs of a rural community? Were they more focused on long term solutions or addressing short term needs?

Additional resources

  • "Echoes of the 1930s in Health Care Debate." John McDonough. All Things Considered. National Public Radio. Washington, D.C. August 28, 2009. 
    • Helpful context about the larger debates surrounding public health in the 1930s, with a focus on the national government’s role in the healthcare industry. Explores how people then addressed questions of the larger society’s role in preserving the health of individuals.
  • "Pellagra in the United States: A Historical Perspective." Kumaravel Rajakumar. Southern Medical Journal 93, no. 3 (2000).
    • Provides more information about pellagra as a disease, as well as some historical context for the pellagra epidemic in the South in the early 1900s
  • "On Government and Capitalism." Franklin D. Roosevelt. Radio address, September 30, 1934. Miller Center.
    • The AWH's work in Appalachia was just one of the ways Americans tried to address the problems caused and/or exacerbated by the Great Depression.  The AWH was a private organization, but the major force in this effort was the federal government, in the form of the National Recovery Administration.
    • Discussion of some New Deal administration- illustrative of the growing number of private and public welfare programs created to help communities
    • "I prefer and I am sure you prefer that broader definition of Liberty under which we are moving forward to greater freedom, to greater security for the average man than he has ever known before in the history of America."
  • More stories from the American Women's Hospitals: