The American Lung Association's mission is to prevent lung disease and promote lung health.
The American Lung Association (ALA) is a non-profit organization dedicated to fighting lung disease. The group's original goal was to combat tuberculosis, an often-fatal respiratory disease that was widespread in the early 20th century. When the severity of the tuberculosis epidemic eased by the 1950s, the organization took on broader goals, working to study and prevent other lung diseases, to combat air pollution, and educate the public about the dangers of cigarette smoking. The ALA operates a national office in New York City and has close to 80 state and local affiliates. The ALA funds research on lung disease and runs public awareness and education campaigns on issues related to lung health. The organization also maintains an office in Washington, D.C., to advocate ALA positions with legislators. The ALA is funded through grants and donations, membership dues, and corporate contributions. It has run a Christmas Seal campaign since 1907, raising money through the sale of special stamps. Contributions to the ALA through the Christmas Seal, Chanukah Seal, and other direct mail campaigns amounted to over $51 million in 2000. The organization is run by a board of directors that coordinates activities at a national level. Staff at the national office coordinate media outreach and public awareness, provide epidemiological data of interest to the medical community, train volunteers, and oversee the group's research funding.
Fighting Tuberculosis in the Early 20th Century
Tuberculosis is a virulent disease of the lungs. It had long been known and studied in Europe, where it went by several names, including phthisis, consumption, and "the white plague." Though it affected people of all ages and social classes, it became a leading killer of the urban poor, particularly after the 1850s. In 1882, the German physician Robert Koch isolated the tubercle bacillus. Until that time, the disease was generally thought to be inherited. Doctors offered little hope to patients diagnosed with tuberculosis. It was often fatal, and the most effective treatment, until drugs were developed in the 1940s, was rest, fresh air, and a change of climate.
In the United States at the end of the 19th century, tuberculosis patients were treated at sanatoriums which were often located in the mountains. Many sanatoriums were private or church supported. The first sanatorium for the poor was opened in 1884 in Saranac Lake, New York, and the state of Massachusetts opened the first state sanatorium in 1898. By 1904, when the organization that became the American Lung Association was founded, tuberculosis was the leading cause of death in the United States, and despite the growth of sanatoriums, treatment was limited and the disease considered incurable. Several organizations had already come together to do something about tuberculosis. There were some two dozen voluntary societies, and influential doctors such as Edward Trudeau, who had founded the Saranac Lake sanatorium, were interested in uniting on a national level for a concerted campaign against the disease.
After several preliminary meetings, a group with over 200 members, almost all of them doctors, formed the National Association for the Study and Prevention of Tuberculosis (NASPT) on June 6, 1904. The group raised money through membership dues as well as donations. The popular cause brought in gifts from the likes of John D. Rockefeller, and by 1905 the group was able to pay its Executive Secretary a $5,000 salary to head the association from New York. The NASPT was the first group of its kind in the United States in that it was made up of volunteers dedicated to fighting one specific disease.
The NASPT affiliated with state and local organizations across the country, at first primarily building awareness of tuberculosis as a contagious disease. The idea that tuberculosis was hereditary still lingered. Another common myth about the disease was that it was incurable, and thus it was a waste to spend money on treatment. The NASPT tried to convince legislators and public health departments to fund sanatoriums so that infected patients could be removed from the community before they spread the disease. In this era, drugs to fight tuberculosis had not yet been developed. The NASPT sponsored programs to educate the public about the disease, as early detection offered patients the best hope of survival. The group also raised money for medical care of indigent patients, as there was no national health insurance system.
The NASPT had broad aims, but it needed more money to fund its programs. It began raising money through its Christmas Seals program in 1907. Emily P. Bissell was responsible for the first successful Christmas Seals campaign. Bissell was the cousin of a doctor in Wilmington, Delaware, who ran an open-air shelter for tubercular patients. She was also the secretary for the Delaware Red Cross. Bissell had heard of a successful project in Denmark to raise money for the care of tubercular children through the sale of special stamps. She took it on herself to raise money for her cousin's shelter, which was doomed to close if it could not come up with $300. With the permission of the Red Cross and the NASPT, Bissell herself drew the stamp, borrowed money to have 50,000 printed, and began selling them in Wilmington's main post office. The idea was for people to buy the special stamp and put it on their Christmas cards. It was not U.S. postage but a means of raising money and also awareness. The fund-raising campaign brought in only around $25 on their first day, and Bissell doubted they would make the $300 needed to keep the tuberculosis shelter open. So Bissell journeyed to Philadelphia for an interview with the editor of the influential North American, the city's leading paper. The editor was politely uninterested in the Christmas Seals, but Bissell next ran into a columnist for the paper, who thought she had a great idea. The columnist asked her to send the paper all 50,000 stamps, and within a few weeks they were all sold. Bissell's campaign raised about $3,000, enough money to preserve the tuberculosis shelter and to buy land for another, more modern tuberculosis hospital. The next year, the Red Cross sponsored a nationwide sale of Christmas Seals with a stamp designed by the renowned illustrator Howard Pyle. That sale brought in $135,000. The NASPT took over the Christmas Seal sale from the Red Cross in 1910 and in 1919 began using as the seal's symbol the double-barred cross. The NASPT changed its name in 1918 to the National Tuberculosis Association (NTA), and in 1920 the group registered the double-barred cross as its trademark.
By 1920, the NTA had enough financial backing that it could fund research. The NTA backed research that led to improvements in the tuberculin skin test and in the chest x-ray. The association continued to sponsor public health campaigns, for instance going into schools to promote good nutrition, a key to resisting infection. The NTA also had a medical arm, first called the American Sanatorium Association, and in 1939 taking the name the American Trudeau Society (after Dr. Edward Livingston Trudeau). The medical branch supported a variety of research into tuberculosis, set standards for treatment, and met annually to discuss new developments. The prospects for tubercular patients were much better in the 1930s and 1940s. Improved diagnostic techniques meant more people were caught at an earlier stage of the disease. Drugs to fight tuberculosis were developed in the 1940s. The antibiotic streptomycin was developed in 1943, and para-aminosalicyclic acid (PAS) was in clinical trials beginning in 1945. In 1948, the NTA began funding individual physicians and medical students to do research on tuberculosis. Another powerful anti-tubercular drug, isoniazid, debuted in 1952. By 1954, the death rate from tuberculosis in the United States had fallen to one-fiftieth of what it had been when the NTA began in 1904.
Finding a New Mission in the 1950s
By the mid-1950s, the NTA had grown to encompass close to 3,000 state and local affiliates. The NTA's annual income had risen to almost $24 million through fund-raising, donations, and membership. The NTA had had wide influence in getting tuberculosis hospitals and sanatoriums built and in getting hospitals to set aside beds in tuberculosis wards. It had sponsored mass tuberculosis screenings in schools and factories, using portable x-ray machines and chemical tests. The disease was no longer the feared killer it had been at the beginning of the century. It still disproportionately affected the poor, especially people living in hospitals and prisons. However, the worst of the "white plague" seemed to have passed, and the National Tuberculosis Association considered whether it should have a different mission.
The NTA considered a variety of options in the early 1950s. Some members wanted to continue to focus exclusively on tuberculosis, as the disease had not yet been eradicated and in some areas of the country it was still a pressing problem. Other proposals were to merge with the American Heart Association, to disband the organization, or to become a group dedicated to general public health issues. In 1956, the group decided that its best option was to continue to fight tuberculosis, while also funding research and prevention of other lung diseases. Other lung diseases included respiratory infections, asthma, diseases due to air pollution, and respiratory allergies. The association moved slowly into its broadened mission, for example giving grants to doctors and researchers who studied these other lung ailments.
By the early 1960s, the NTA was a major voice in public policy debates on the issues of smoking and air pollution. The NTA board of directors issued a policy statement in 1960 declaring cigarette smoking a major cause of lung cancer, and then prompted President Kennedy to appoint an advisory committee on smoking and health. The NTA began its first public education campaign on the dangers of smoking in 1964, producing an award-winning film. The NTA was a strong anti-smoking lobbyist in Washington, weighing in on issues like cigarette advertising, the Department of Agriculture's support for the tobacco industry, and provisions for warning labels on cigarette packages. The NTA also approached air pollution as a public health issue. Its January 1965 NTA Bulletin was completely devoted to the health effects of air pollution. The NTA began promoting "Cleaner Air Week" in 1961, an event founded in 1949 by another advocacy group, the Air Pollution Control Association (APCA). The event came to be called "Clean Air Week," and the NTA took it over from the APCA altogether in 1975.
Changes in the 1970s
By the late 1960s, the National Tuberculosis Association was strongly associated with anti-smoking and anti-pollution campaigns. The group seemed to have made a successful transition from an organization focused on one disease to a broader advocacy group for lung health. In 1967, the board of directors voted to change the name of the group to better reflect its new aims. That year the group became the National Tuberculosis and Respiratory Disease Association (NTRDA). This name was a mouthful, and affiliates at the local level continued under many different names. In 1973, the national board again voted to change the name, this time to the more succinct American Lung Association.
The organization continued to rely on the annual Christmas Seals campaign as its core fund raiser. By the late 1960s, however, the campaign was less able to meet the organization's expenses. National mailings of the stamps were still done manually, and it was a cumbersome job. Some regional affiliates began computerizing their Christmas Seal mailing lists in the early 1970s. The group began considering other ways to raise funds. The ALA had income of $50 million in 1977, and the next year an executive committee set a goal of doubling the group's income by 1983. The percentage of revenue paid to the national organization by local affiliates was increased several times over the 1970s.
The ALA continued to focus on smoking-related issues in the 1970s. It began its first "Kick the Habit" campaign in 1970, encouraging smokers to quit. It also began publicizing the issue of second-hand smoke. Tuberculosis was a highly treatable disease by the early 1970s. A new drug, rifampin, which came out in 1971, could rapidly treat tuberculosis symptoms. Patients could now be cured in weeks, whereas earlier treatments had taken months. At this time, special hospitals for tubercular patients were closed and physicians began to treat tubercular patients in general hospitals.
Focus on New Problems in the 1980s-90s
Combatting smoking continued to be a core mission of the ALA in the 1980s. Throughout that decade, the group put out a range of materials designed to help people quit smoking and alerting women to the dangers of smoking during pregnancy. In 1981, the ALA worked with the American Cancer Society and the American Heart Association to approach the dangers of smoking from a broader perspective. The ALA opened a new office in Washington, D.C., in the early 1980s. Its Government Relations office put it in closer touch with lawmakers and government officials, whose support was key for the ALA's public health initiatives. ALA lobbying brought about some significant changes in the 1980s, including the first ban on smoking on domestic air flights in 1987. This law banned smoking on flights of less than two hours. In 1989, the ALA helped strengthen the law so that smoking was banned on all flights under six hours, which included 99 percent of domestic flights.
Asthma became a principal focus of the ALA during the 1980s. By 1984, some 5.5 million Americans were estimated to have asthma, and the ALA put out its first public information handbook addressing the disease. Asthma became even more prevalent during the 1990s, and it was a growing health issue for children. The ALA began a program called Open Airways for Schools in 1991 that taught elementary school children how to manage their asthma. Over the 1990s, this program reached over 25 percent of elementary schools in the United States. The ALA also continued its work on other diseases of the lungs. The group adopted guidelines for dealing with occupational lung diseases in the early 1980s, and in 1988 the ALA explored issues related to lung disease and AIDS. The ALA was also instrumental in pushing amendments to the Clean Air Act in 1990. The amendments marked the first major changes in air pollution laws in over a decade. Lawsuits filed by the ALA in 1991 and 1993 eventually led to new air quality regulations in 1997.
Going into the 21st century, the ALA found itself faced with many of the same problems it had dealt with in the previous decades: the ever-growing incidence of asthma, a global resurgence of tuberculosis, and the continuing need to educate people about the dangers of smoking and air pollution. Many of these problems disproportionately affected poor and minority communities. Low-income neighborhoods were more prone to indoor air pollutants because of sub-standard housing, and poor indoor air could trigger asthma and allergy attacks. In 2000, ALA affiliates carried out a variety of programs across the country which addressed the particular problems of low-income communities. The ALA began a collaborative effort in 2000 with a group representing the nation's 118 historically African American colleges to help train volunteers and interns for programs on asthma control, tobacco risks, community organizing against environmental hazards, and other outreach efforts.
Approaching the 100-year anniversary of the ALA's founding, the group still found lung disease a formidable foe. The number of asthma cases in the United States had grown to around 26 million by 2000, and this number was expected to grow over the next 20 years. Despite the ALA's many victories in anti-smoking legislation since the 1960s, smoking remained the leading preventable cause of death. The ALA continued to evaluate the nation's air quality. It began an annual "State of the Air" report in 2000 giving data on air quality in communities across the United States. This first report found that the health of some 133 million people was at risk because of poor air quality, as over 120 major metropolitan areas got a failing grade for controlling smog. The organization had grown beyond its original focus on one deadly disease, but still faced a myriad of lung conditions that threatened the nation's well-being.