Observations on Current Practices in Municipal District Health Administration

Abstract

IN the development of urban health departments, the principle of decentralization-neighborhood health centers-has been casually accepted. In routine fashion, local planning has provided for health officers of urban health districts, tables of organization, and carefully vague limitations on autonomy. Most of the larger cities have now, on paper or in fact, divided the city into health districts, adopted an organizational plan for staffing these districts, and to a greater or lesser degree provided structures for district operations. Philosophically, the stimulus for such programs, and the easy, unquestioning acceptance of the principle, probably stem from American tradition. We remember nostalgically the town meeting and the benefits that accrue from public administration close to the source of responsibility and sensitive to local needs. The great bugbear of political and economic life is centralization, the curse of bigness, monopoly, and impersonal administration. In addition, it is felt that the job to be done, specifically health education in its many manifestations, depends on a homogeneous group. In 1915, in an address