Health promotion and disease prevention has come a long way in the United States over the years. In the early years of this country, prevention was limited to keeping disease out of the country by containing it coming in on ships from other countries. As time progressed, sanitation became the focus on prevention. Americans began to realize that poor sanitation practices were contributing to the spread of infectious diseases. The late nineteenth century and early twentieth century saw a shift in focus of prevention by immunization and vaccinations. There became a desire to prevent individual health problems rather than the general public. Up to this time, the burden of prevention fell to the state and local governments. As the twentieth century
