Making the case for "indigenous wisdom": comparing historical and modern health recommendations.
Abstract: Has public health and medical research over the last century resulted in a new understanding of what behaviors are needed for "healthy living" or has it confirmed what was already known through "indigenous wisdom"? Of the 129 historical recommendations identified in the text books published in the 1920s, 1930s, and 1940s only seven (5.43%) were categorized as inconsistent with or opposed to current recommendations. One hundred twenty-two (94.57%) were categorized as consistent with or neutral with regard to current recommendations. These historical recommendations were gathered from decades and sometimes centuries of observations and passed down from generation to generation. This "indigenous wisdom" should not be quickly disregarded.
Subject: Public health
Authors: Kelley, R. Mark
Clerc, Jeanne
Wen, Mei
Moore, Susan
Pub Date: 06/22/2012
Publication: Name: American Journal of Health Studies Publisher: American Journal of Health Studies Audience: Professional Format: Magazine/Journal Subject: Health Copyright: COPYRIGHT 2012 American Journal of Health Studies ISSN: 1090-0500
Issue: Date: Summer, 2012 Source Volume: 27 Source Issue: 3
Product: Product Code: 8000120 Public Health Care; 9005200 Health Programs-Total Govt; 9105200 Health Programs NAICS Code: 62 Health Care and Social Assistance; 923 Administration of Human Resource Programs; 92312 Administration of Public Health Programs
Accession Number: 308741524
Full Text: INTRODUCTION

"What has been will be again, what has been done will be done again; there is nothing new under the sun. Is there anything of which one can say, 'Look! This is something new?' It was here already, long ago; it was here before our time." Thus reflects an ancient writer (Ecclesiastes 1:9-10 NIV). In more recent times, the lead author of this paper reflected on the health habits implemented by his paternal grandparents and found it to be consistent with the nutritional and physical activity patterns he sought inculcate into his family and students. At the home of the paternal grandparents, meal time had specific requirements. Breakfast consisted of oatmeal, toast, often an egg prepared in various ways, and a glass of milk. At lunch and dinner one was required to eat at least three vegetables, a serving of meat, a serving of bread, and drink at least one glass of milk and/or water: then, and only then could one potentially partake of a small or moderate portion of a homemade dessert. Snack consisted of two cookies and a glass of milk or water. The majority of the food consumed was grown and processed on the family farm and contained none of the preservatives that commonly are included in foods today. In the maintenance of the farm and employment, several hours each day were spent in activities that are currently classified by the CDC as "moderate physical activity" (CDC, 2011). These grandparents put in to practice behavioral patterns that are consistent with what is recognized today as "healthy living" and lived into their late 80s and early 90s in states of health that the authors hope to emulate. But how did they know to do those things? They did not have access to the current research base which has accumulated in the last century of public health and medical research.

In a general sense, current recommendations for health include eating lots of vegetables especially fresh and deeply colored; eating meat, eggs, and other sources of protein in moderation; limiting consumption of processed foods when possible; drinking lots of water and a couple of glasses of milk, limiting the consumption of sweets; and being active and moving at every opportunity (US Dept. of Health & Human Services, 2008; US Dept. of Agriculture, 2010; National Institute for Diabetes and Digestive and Kidney Disease, n.d.). These recommendations are very consistent with the lifestyles adopted and promoted by the authors' grandparents. These reflections and the collection of health texts published in the 1920s, 1930s, and 1940s in the department's library led the authors to seek to determine if the ancient writer's summation of "It was here already, long ago; it was here before our time" could appropriately be applied to current health knowledge.

This paper asks the reader to consider the possibility that public health and medical research conducted through the last century has, in large part, resulted in the confirmation and explanation of the "indigenous wisdom" rather than the synthesis of new knowledge that supplants the "indigenous wisdom." As part of the exploration of this question, the authors reviewed a selection of middle school targeted health texts from 1920-1944 to compare their recommendations for healthy living with those current recommendations.

METHODS

The historical text books reviewed for this research ranged in publication date from 1920 to 1944. The textbooks are located in the department in which the authors are faculty members. All the textbooks were designed to be used with upper elementary and middle school aged children. Most were published in a series with slightly different foci and were selected because of their availability. For example, the Healthy Life Series published by the John C. Winston Company in 1936 and 1940 contained volumes entitled Healthy Body (1936), Success Through Health (1940), and Healthy Growing (1936 & 1940).

Using an adaptation of the General Inductive Approach described by Thomas (2006), each of the historical texts was reviewed multiple times to identify recommendations for healthy living related to physical activity, nutrition, substance use and abuse, and disease prevention. These recommendations were then inductively analyzed for themes/categories which were then described and named. Overlap and redundancy between the categories was reduced through duplicate review and analyses by multiple researchers. The categories of recommendations were identified and specific recommendations were reduced to common language. Each recommendation was evaluated with regard to its consistency with current recommendations for healthy living. Each historical recommendation was evaluated and classified as being either (+) consistent with current recommendations, (-) inconsistent with or opposed to current recommendations, or (~) neutral with regard to current recommendations. The primary source for current recommendations for physical activity was the 2008 Physical Activity Guidelines for Americans (US DHHS, 2008) and for nutrition, the Dietary Guidelines for Americans 2010 (US Dept. of Agriculture, 2010) and Take charge of your health: A guide for teenagers (NIDDKD, n.d.).

RESULTS

A total of 129 historical recommendations were identified and assessed with 93 (72.1%) being categorized as consistent with current recommendations. Twenty-nine (22.5%) were categorized as neutral with regard to current recommendations and seven (5.4%) were categorized as inconsistent with or opposed to current recommendations.

NUTRITION RECOMMENDATIONS

In the area of nutrition, thirty-five historical recommendations were identified. Twenty-seven (77.1%) were consistent, five (14.3%) were neutral, and three (8.6%) were inconsistent with/opposed to current recommendations. The themes identified in the historical recommendations for nutrition were:

* milk is good for the body,

* eat fresh vegetables,

* eat fruits,

* sources of protein are important and are foods for strength/energy eat a balanced diet,

* timing of meals is important,

* drink water every day, and

* minimize sweets.

Recommendations regarding milk and protein

Examples of historical recommendations regarding the benefits of milk and protein consumption that were consistent (+) with current recommendations (NICHHD, n.d.) include: milk helps the bones and the teeth to get stronger (Fowlkes, Jackson, & Jackson, 1936a); every child should drink at least a glass of milk each day (Fowlkes, Jackson, & Jackson, 1936b; Winslow & Camp, 1920); and, proteins are the building materials from which new cells are made for the body and old cells are renewed and repaired (Fowlkes, Jackson & Jackson, 1940a; Fowlkes, Jackson & Jackson, 1940b; Fowlkes, Jackson & Jackson, 1940e). Examples of historical recommendations regarding the benefits of milk and protein consumption that were inconsistent (-) with or opposed to current recommendations include: milk is the most perfect food we have for it contains all the different kinds of nourishment our bodies require; the most important of all foods for a growing child (Winslow & Camp, 1920); and, every child should eat an egg each day (Fowlkes, Jackson & Jackson, 1940b).

Recommendations for vegetables and fruits

Examples of recommendations regarding the consumption of vegetables and fruits that were consistent with current recommendations include that leafy vegetables such as spinach, cabbage, chard, cauliflower, brussel sprouts, turnip and beet tops, dandelion and water-cress are particularly important (Winslow & Camp, 1920) and that fresh fruit should be eaten every day (Burkard, Chamber & Maroney, 1936; Fowlkes, Jackson & Jackson, 1940b; Witcomb, Beveridge McCrory, 1932). No recommendations regarding the consumption of vegetables and fruits were found to be either neutral or inconsistent with or opposed to current recommendations.

Recommendations regarding drinking water and consuming sweets

The historical texts present a variety of recommendations regarding the consumption of water, all of which emphasized the importance of drinking water but all of which recommended slightly less water consumption than do current recommendations. These were categorized as consistent with or neutral with regard to current recommendations. Some make the recommendation of four to six glasses of water per day (Newmayer & Broome, 1928b; Burkhard, Chamber & Maroney, 1936); others recommend four to five glasses per day (Fowlkes, Jackson & Jackson, 1936a; Witcomb, Beveridge & McCrory, 1932); and, one recommended at least three glasses per day with more needed in hot weather (Winslow & Camp, 1920).

Regarding sweets, the common recommendation is to minimize consumption. For example, Burkard, Chamber & Maroney (1936) indicate that candy is made mostly of sugar which provides energy to the body and nothing else. These statements are consistent with current recommendations.

PHYSICAL ACTIVITY/EXERCISE RECOMMENDATIONS

In the area of physical activity/exercise, twenty-seven historical recommendations were identified. The themes identified in the historical recommendations for physical activity and exercise were: benefits of exercise; exercise and illness; clothes for physical activity and exercise; and the how and types of physical activity/exercise. Fifteen (55.56%) were consistent with, ten (37.04%) were neutral, and two (7.41%) inconsistent with/opposed to current recommendations.

Benefits of exercise

With regard to the benefits of physical activity/ exercise, seven historical recommendations were categorized as consistent and one was categorized as inconsistent with current recommendations. The inconsistent recommendation was regarding the increased value of outdoor or "fresh air" exercise (Fowlkes, Jackson & Jackson, 1936a) while the consistent recommendations talked about the benefit to a variety of body systems such as the circulatory, respiratory musculo-skeletal, (Newmayer & Broome, 1928a, 1928b; Charters, Smiley & Strang, 1935a, 1935b; Fowlkes, Jackson & Jackson, 1936a, 1940e)

"When", "Where", "How", and "What" recommendations for physical activity and exercise

Thirteen historical recommendations were made regarding the "How", "Where", "When", and "What" of participating in physical activity and exercise of which eight were consistent with and one was inconsistent with or opposed to current recommendations. Examples of recommendations categorized as consistent include playing games or doing useful work at least an hour a day (Charters, Smiley & Strang, 1935b) and by statements that exercise could be in the form of sweeping the snow from the walks, going to the store with mother, playing with the baby, giving the baby a ride, raking the leaves, keeping the lawn in good order, pulling weeds from the garden, running outdoors, playing the ball, etc. (Wood, Phelan, Lerrigo, Lamkin & Rice, 1936). An example of a recommendation categorized to be inconsistent with current recommendations was the caution of "overdoing it," muscle soreness and fatigue as a warning or unwise (Newmayer & Broome, 1928a, Fowlkes, Jackson & Jackson, 1936a, 1936b; Wood, Phelan, Lerrigo, Lamkin & Rice, 1936; Fishbein & Irwin, 1944; Charters, Smiley & Strang, 1935c).

RECOMMENDATIONS REGARDING ALCOHOL, TOBACCO, AND OTHER DRUG USE

In the area of alcohol, tobacco, and other drugs, thirty-four historical recommendations were identified. Twenty-two (64.71%) were consistent with, ten (29.41%) were neutral, and two (5.88%) were inconsistent with/opposed to current recommendations. The themes were identified in the historical recommendations regarding the use of alcohol, tobacco and other drugs (ATOD) included neurological effects, impacts on chronic disease, impacts on driving safety, mental impacts, cost of drugs, benefits of alcohol and tobacco, distasteful social impacts, as well as general recommendations. An example of a historical recommendation categorized as consistent with current recommendations is that a person who has used alcohol in excess have diminished judgment, their inhibitions disappear, and they may become a menace to society (Fowlkes, Jackson & Jackson, 1936b). An example of a historical recommendation categorized as inconsistent with current recommendations is that smoking injures the nervous system (Fishbein & Irwin, 1944).

DISEASE PREVENTION RECOMMENDATIONS

In the area of disease prevention, a total of twenty-three historical recommendations were identified, all of which were categorized as consistent with current recommendations for disease prevention. The themes were identified in the historical recommendations for disease prevention included things boys and girls should do to protect themselves from sicknesses, social distancing, and frequent hand washing. Historical recommendations for disease prevention focused on common current prevention strategies such as washing hands frequently (Charters, Smiley & Strang, 1935a; Fishbein & Irwin, 1944; Charters, Smiley & Strang, 1935b; Fowlkes, Jackson & Jackson, 1940b), limiting contact with persons who may have a disease (Fowlkes, Jackson & Jackson, 1940c), not sharing personal hygiene products such as toothbrushes and washcloths(Charters, Smiley & Strang, 1935d), and covering one's mouth and nose when coughing or sneezing (Charters, Smiley & Strang, 1935b).

DISCUSSION

This paper considers the question of whether public health and medical research conducted through the last century has, in large part, resulted in the confirmation and explanation of the "indigenous wisdom" rather than new knowledge that supplants the "indigenous wisdom". Overwhelmingly, recommendations for healthy living contained in the text books reviewed for this study were consistent with current knowledge and recommendations regarding nutrition; physical activity/exercise; alcohol, tobacco, and other drugs (ATOD); disease prevention and healthy sleep habits. Of the 129 historical recommendations identified in the text books published in the 1920s, 1930s, and 1940s, only seven (5.43%) were categorized as inconsistent with or opposed to current recommendations. One hundred twenty-two (94.57%) were categorized as consistent with or neutral with regard to current recommendations. While much research has been conducted and published over the last 70-90 years, the basics of recommendations for healthy living in the areas of nutrition; physical activity/exercise; alcohol, tobacco and other drugs; disease prevention and sleep have not changed in any significant way. This seems to be especially true in the area of disease prevention, in which all twenty-three of the historical recommendations, which focused on hand washing and social distancing, were consistent with current recommendations.

All of the historical recommendations that were categorized as inconsistent with or opposed to current recommendations were found in the areas of nutrition (n = 3); physical activity/exercise (n = 2) and ATOD (n = 2). In the area of nutrition, the specific recommendations that were categorized as inconsistent with or opposed to current recommendations were two different sources that indicated milk is the perfect food that contains all the different kinds of nourishment for our bodies and a recommendation that cereals, bread and butter give us most of the energy we need for life and growth. In the area of physical activity/exercise, the specific recommendations that were categorized as inconsistent with or opposed to current recommendations were that one should always wear loose clothes when exercising and that late in the day is not a good time to exercise. In the area of ATOD, the maxims that were categorized as inconsistent with or opposed to current recommendations were that smoking dulls the mind and the alcohol makes the heart beat faster.

LIMITATIONS

A limitation of the current study is that the textbooks were selected based on availability as part of the departmental library. The fact that they come from a wide variety of publishers and represent a wide variety of authors is the best evidence that they are representative of the books in use in the 1920s- 1940s. No suggestion is being made that the textbooks reviewed were the most widely used or best known when in use.

IMPLICATIONS

While there are many public health and/ or health education and promotion journals that publish a plethora of manuscripts/articles on a regular basis, this paper has provided evidence that recommendations for what one needs to do to live healthily have not necessarily changed substantially in the past 70-90 years. The textbooks reviewed for this paper did not have access to the body of knowledge that exists today, however, overwhelmingly recommendations they contained were consisted with current recommendations for healthy living. This paper posits that the source of knowledge for these historical recommendations was based in "indigenous wisdom" gathered from decades and sometimes centuries of observations and passed down from generation to generation and argues that the public health and medical professions should not quickly disregard this "indigenous wisdom".

So, what has nearly a century of research contributed to professional literature? The answer to that question seems to be focused in two areas. First, public health and medical research over the last several decades has provided us with a much greater understanding of the physiological mechanisms underlying the common recommendation for healthy living. For example, our "modern" understanding of the antecedents of diabetes provides an explanation of why it is healthy to limit one's consumption of sugar. Second, over the last few decades, public health and medical research has successfully sought to increase our understanding of the behavioral change processes that assist individuals and populations in adopting lifestyles consistent with the "longstanding" recommendations for healthy living. This paper posits that the greatest opportunity for meaningful contributions to the professional knowledge base exists within the body of knowledge regarding the activities or strategies that result in behavioral changes in populations that result in the adoption or acquisition of healthy living habits. While it seems that there may be "nothing new" regarding recommendations for healthy living, there is much room for improvement in the ability of public health and medical professionals in facilitating individuals and populations in making decisions consistent with the recommendations.

REFERENCES

Brownell, C. L., Ireland, A. G., & Giles, H. F., (1935). Health and Safety Series: Everyday Living. New York: rand McNally & Company.

Burkard, W. E., Chamber, R. L., & Maroney, F. W., (1936). Health, Happiness, Success Series: Health by Doing. Chicago: Lyons & Carnahan.

Centers for Disease Control and Prevention. (n.d.). How much physical activity do children need? Retrieved July 18, 2011 from http://cdc.gov/physicalactivity/everyone/guidelines/children.html.

Charters, W. W., Smiley, D. F., & Strang, R. M. (1935a). Health and Growth Series: Good Habits. New York: MacMillan Company.

Charters, W. W., Smiley, D. F., & Strang, R. M. (1935b). Health and Growth Series: Living Healthfully. New York: MacMillan Company.

Charters, W. W., Smiley, D.F., Strang, R. M., (1935c). Health and Growth Series- Adventures in Health. New York: The MacMillan Company.

Charters, W. W., Smiley, D.F., Strang, R. M., (1935d). Health and Growth Series: Health Knowledge. New York: The MacMillan Company.

Fishbein, M., & Irwin, L. W., (1944). Health and First Aid. Chicago: Lyons and Carnahan.

Fowlkes, J. G., Jackson, L. Z., Jackson, A. S., (1936a). The Healthy Life Series: Healthy Body. Philadelphia: John C. Winston.

Fowlkes, J. G., Jackson, L. Z., Jackson, A. S., (1936b). The Healthy Life Series: Healthy Growing. Philadelphia: John C. Winston.

Fowlkes, J.G., Jackson, L. Z., & Jackson, A. S. (1940a). The Healthy Life Series; Healthy Living. Philadelphia: John C Winston.

Fowlkes, J. G., Jackson, L. Z., & Jackson A. S., (1940b). The Healthy Life Series: Success through Health. Philadelphia: John C. Winston.

Fowlkes, J. G., Jackson, L. Z., & Jackson A. S., (1940c). The Healthy Life Series: Keeping Well. Philadelphia: John C. Winston.

Fowlkes, J. G., Jackson, L. Z., Jackson, A. S., (1940d). The Healthy Life Series: Healthy Growing. Philadelphia: John C. Winston.

Fowlkes, J. G., Jackson, L. Z., Jackson, A. S., (1940e). The Healthy Life Series: Keeping Well. Philadelphia: John C. Winston.

National Institute of Child Health & Human Development. (n.d.). Tweens*and teens need calcium now more than ever! Retrieved July 18, 2011 from http://nichd.nih.gov/milk/milk.cfm.

National Institute for Diabetes and Digestive and Kidney Disease. (n.d.). Take charge of your health: A guide for teenagers. Retrieved July 18, 2011 from http://win.niddk.nih.gov/publications/take_charge.htm.

Newmayer, S. W., & Broome, E.C. (1928a). The Health and Happiness Series: The Way to Keep Well. New York: American Book Company.

Newmayer, S. W., & Broome, E.C. (1928b). The Health and Happiness Series: Health Habits. New York: American Book Company.

Thomas, R. (2006). A general inductive approach for analyzing qualitative evaluation data. American Journal of Evaluation, 27(2), 237-246.

US Department of Health and Human Services. 2008 Physical Activity Guidelines for Americans. Retrieved September 29, 2011 from http://health.gov/paguidelines/guidelines/chapter3.aspx.

US Department of Agriculture and Department of Health and Human Services. Dietary Guidelines for Americans, 2010. Retrieved September 29, 2011 from http://health.gov/dietaryguidelines/dga2010/ DietaryGuidelines2010.pdf

Winslow, C. E. A., & Camp, W. (1920). Health Living (Book One): How Children Can Grow Strong for Their Country's Service. New York: Charles E. Merrill.

Witcomb, C. T., Beveridge, J. H., & McCrory, E. T. (1932). My Health Habits (Book Four). New York: Rand McNally.

Wood, T. D., Phelan, A. M., Lerrigo, M. O., Lamkin, N. B., & Rice, T. B. (1936). Adventures in Living: How we live. New York: Thomas Nelson & Sons.

R. Mark Kelley, PhD

Jeanne Clerc, Ed.D

Mei Wen, PhD

Susan Moore, HSD

R. Mark Kelley, PhD, Professor & Chair, Department of Health Sciences, Western Illinois University, Stipes 402, Macomb IL 61455, 309-298-1076, RM-Kelley@wiu.edu, http://www.wiu.edu/users/rmk116/index. htm, Jeanne Clerc, Ed.D., Department of Health Sciences, Western Illinois University, Stipes 402, Macomb IL 61455, 309-298-1076, JM-Clerc@wiu.edu, Mei Wen, PhD, Department of Health Sciences, Western Illinois University, Stipes 402, Macomb IL 61455, 309-298-1076, M-Wen@wiu.edu, Susan Moore, HSD, Department of Health Sciences, Western Illinois University, Stipes 402, Macomb IL 61455, 309-298-1076, SM-Moore@wiu.edu. Corresponding author: R. Mark Kelley, PhD, Professor and Chair, Department of Health Sciences, Stipes 402D, 1University Circle, Macomb, IL 61455, 309-298-1076, RM-Kelley@wiu. edu
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