Health Scene Research Articles

The changing American health scene. Sometimes things get better

The changing American health scene. Sometimes things get better

The Changing American Health Scene

Since the increased efforts to improve medical care for Americans were initiated 15 years ago, it is generally believed they had little impact on the problems addressed. Review of national data suggests otherwise. American medical care and health status are getting better. We have improved the availability of physician services and largely eliminated the gap between visits made by rich and poor, or white and black citizens. We have greatly expanded the number of health professionals who provide medical care. Better organized programs to provide care to groups with special health problems have reduced both mortality and morbidity. Age-adjusted death rates, infant and maternal mortality, and death rates from coronary artery disease have fallen. While there remains an important agenda for the future, there seems room for cautious optimism about the abilities of American society to make forward progress.

On the Health Scene

Vocational Guidance QuarterlyVolume 24, Issue 3 p. 219-219 On the Health Scene First published: March 1976 https://doi.org/10.1002/j.2164-585X.1976.tb00923.xAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume24, Issue3March 1976Pages 219-219 RelatedInformation

A survey of rural community mental health needs and resources.

The authors conducted a survey of 215 rural community mental health centers across the country to determine their unique problems, needs, and resources. From the 92 responses they received, they formulated a composite description of the rural mental health scene. Their description focuses on services offered, skills required to operate effective rural programs, and problems in the delivery of care and of evaluation. From the responses they also analyzed the extent of inservice training available to rural practitioners, the support systems needed, and the functions a proposed national task force on rural mental health could perform.

The Digby Demonstration Project

The development of the community health nurse in the Digby Demonstration Project has resulted in increased and improved health services to families in the area. A group of qualified public health nurses have found that they make more productive visits because: (a) there is a purpose for the visit that the family can readily identify; (b) the health services are coordinated; and (c) they have the support and cooperation of the family doctor and hospital personnel. More families are referred and, consequently, case finding is easier. There is also more opportunity for the nurses to make independent judgments about the care needed by the family or patient. Less time is spent in the schools, but there are better referrals from the teachers. The public is more aware of nursing services, and people call the office frequently to discuss health problems and obtain information from the nurses. Physicians are most cooperative and helpful. Individual doctors consult with nurses as necessary, about the families under their care. They frequently extend invitations to the nursing staff to attend their continuing medical education programs. The administration and staff of the Digby General Hospital remain interested in the community nursing program and the continuity of care for the patient following discharge. As result of this project, much of the frustration previously experienced by public health nurses, patients, and their families has been eliminated. Planning, communication, and revision in this program is an ongoing process because of the changing health scene and individual needs.

Panel Session 1

DR. Don Seldin, Moderator, University of Texas Health Science Center, Dallas: Last evening and this morning we were confronted with a shattering portrayal of the health scene. We were reminded of the appalling neglect of various segments of the population: people living in the vertical northern slums; those living in sprawling southern slums; people captured in the inner city. We were reminded of how illness and poverty and disenfranchisement were rampant in these areas. The nature of modern science—impersonal, technologic, mechanical—as a dehumanizing setting for fragile human beings was movingly described and movingly condemned. The absence of humane impulses, implicit in the Chinese injunction—service to the people—was by implication a serious indictment of Western society. Irrespective of the truth-value of these indictments, it is critical to take cognizance of the fact that these social and cultural failures are identified as failures in the arena of health care. Of all the

Serve the People: Observations on Medicine in the People's Republic of China

Since 1971, the Sidels have made a number of trips to the People's Republic of China, to study, observe, and understand the monumental changes that have taken place in China's health scene since 1949. Soon after they returned from their first trip, the Sidels, singly and jointly, have written and spoken widely in the United States and elsewhere on their experiences. Some of their observations are now rewritten and published in this volume. In this brief review, it is not possible to cover everything that the Sidels have seen and reported on. Basically, they corroborate many similar enthusiastic responses by Western observers who have been there recently. As far as medicine and public health were concerned, China had never previously used its manpower and health resources to the extent that Chairman Mao was able to harness in recent years. The Sidels report on some of the ways that the government

Editorial: The changing health scene: impact on and problems for nursing.

Editorial: The changing health scene: impact on and problems for nursing.

Community health nursing in the changing mental health scene.

Community health nursing in the changing mental health scene.

Health in Sweden and the United States

To the Editor.— In answer to the article by Dr. Andrews, Jr., inThe Journal(223:1369, 1973), I believe he should have added the subtitle GruesomeLessons for America. Sweden isnotone of the healthiest nations in the world. Infant survival rate, a minor part of the health scene, is more a social than a medical problem. Then to compare that rate in a homogeneous little country to a heterogenous subcontinent like the United States is like comparing grapes to pumpkins. Compare Sweden to Utah if you wish, (their rates are about the same), or compare United States to Europe, (our rates are rather better), but not Sweden to the United States. Swedish socialists never mention rates that are unfavorable. They have significantly more deaths in Sweden from stomach ulcers and from pneumonia than we do here, but you have to search for these figures. Andrews' economic figures are

Bed Worship — An Ethical Vow for Scientists — Doctor, Please

THE source of the somewhat startling headline, "Bed worship wrong, hospitals told," that recently appeared in a daily newspaper was traced to the journal Hospital Management. In fact the phrase bed worship was extracted from the editorial in an issue devoted to a study of the many new experiments in ward design and patient care that are now taking place. Under the title, "The Quiet Revolution in Hospital Practice,"1 the writer claimed that in the National Health Service there is a growing disinclination to accept that the hospital service should dominate the health scene. The hospital service would still require . . .

The psychotherapy of work

quently asked and immediate means of identifying another person. The fact is that a person’s capacity in the area of work is quickly and often severely limited by psychological problems. Accordingly, decompensation and growth ought to manifest themselves as clearly in work activities as in interpersonal relationships. It is, therefore, conceivable that work activities might be deliberately structured in a fashion analogous to the structuring of social relationships in a therapeutic milieu. so as to constitute themselves a therapeutic modality in a hospital or workshop-type setting. The consultation room bias which ignores work experiences and for the most part typifies the contemporary American mental health scene is fortunately not universally held. An important exception is a pilot study reported by Bernard F. Riess, Ph.D., Research Director of the Postgraduate Center for Mental Health in New York.5 Dr. Riess reports a pilot study of 450 patients of the Mental Health Center who after a median of 57 sessions reported a median weekly income rise of $29 per week, in sharp contrast to a predicted rise of $6 per week based on Department of Labor statistics for a comparable population. The refreshingly direct notion that successful psychotherapy ought to be directly represented in substantially increased earning capacity for wage earners is a notion which Dr. Riess proposes to explore in considerably more detail. In an even more radical development, psychiatry in the Soviet Union and in other communist states has taken the position that work activities constitute an invaluable treatment modaliy.4 Joseph Wortis, M.D., in his book Soviet Psychiatry, describes the efflorescence of occupational psychotherapy programs as resulting from “the fundamental theoretical convictions

Measurement in Relation to Mental Health Programs

contributions to the development of measurement procedures in the school mental health field prior to the years with which this article is concerned (roughly 1962-68), a few initial paragraphs will provide a frame of reference for the organization of this review. The school mental health field prior to the 1960's could be described as an interaction of the school with community mental health personnel and attempts at various applications of treatment and therapeutic procedures developed for the child guidance clinic in the school setting. Views of the role of the school with with with learning and behavior problems, and with the predelinquent and other pupils who could not adjust to the demands of the classroom changed from a focus on discovering and treating the causes of behavioral difficulty of children to specific efforts to increase the child's capacity for adapting to the school setting. Attention gradually became centered on the development of assessments of the child's present adjustment status in the school situation rather than a differential diagnosis of the causes of his behavior problems and attempts to modify the causal factors in the hope of obtaining improved school behavior. The concern of specialists in the school mental health field shifted from efforts to treat the causes of the child's difficulty to the expenditure of energy in studying strategies for increasing the child's competency in the school setting. The outcomes of these prior efforts have been assessment procedures and school mental health programs which seek to tap the school's unique capacity as a primary socializing agent in our society. Observers of the school mental health scene can now perceive the delineation of the school's role in improving the mental health of children, based on the belief that the school has the capacity to promote the positive growth and development of children. Schools now rarely attempt to model their efforts after the clinic in assisting the disturbed or ineffective child to survive in school, but instead have established their own methods of assessment, education, and program evaluation for meeting the challenge of improving the mental health status of children. This is not to say that the methods and processes which are needed to maximize the potential of all the members of the

Varied Attitudes to Community Mental Health

TO the objective observer of the mental health scene, one of its more prominent characteristics is the ever-changing terminology which is used to describe our programs and facilities. In reflecting, for example, upon the name of inpatient facilities over the past century, it is striking how we have moved from such appellations as insane asylum, retreat, psychopathic hospital, and mental hospital to the current term of community mental health center. This newest term is undoubtedly the most voguish at the present time, and in its more general sense has become the subject of considerable controversy regarding whether the change represents positive progress or is merely euphemistic in nature. Community mental health's meaning, history, and characteristics are beclouded with the ambiguity created by such factors as varied conceptual theories, social desirability, bandwagon effects, funding opportunities, and issues of professional domain. From the

Continuous Diabetes Screening in a Rural Area

FOR a chronic disease problem to justify the institution of a public health service program, it must conform to essentially the same criteria as other disease problems: (a) there must be available either a means of prevention or an effective treatment, (b) the problem must be of such a nature that it (or a, significant part of it) cannot be solved by the traditional physician-patient relationship, (c) the problem must affect a significant number of people, and (d) it must have community significance. Casefinding in diabetes mellitus conforms to the above criteria. Although no method of primary prevention is known other than control of heredity (which in our present society is not very practicable), early diagnosis and continuous medical supervision can prevent the early complications of diabetes, and some of the late complications can be avoided or postponed (la). Relatively few people have formed the habit of presenting themselves for routine physical checkups, with the result that no opportunity is presented to diagnose an estimated 50 percent of those who have diabetes. The problem is large; it is estimated that there are over 2 million diabetics in the United States (ib), half of whom are unknown. Finally, the disease has an important degree of significance to the community, as it causes a considerable amount of disability, prema,ture death, loss of productivity, and increased demands on health and welfare facilities (2). Diabetes detection programs have been conducted for some years and are an accepted part of the public health scene. There are many types of programs, which vary, in time, from 1-day drives to year-round activities, and in technique, from rapid screening for sugar in the urine to exact, painstaking, and expensive blood determinations. Justification for thel operation of a diabetes detection program is based on the hypotheses that diabetes mellitus is often unrecognized and asymptomatic in the adult; that early diagnosis and treatment of diabetes improves prognosis and reduces complications; and that it is practical to screen postprandial hyperglycemic individuals from the general population by means of a community-operated clinic seirvice (3). One of the best methods of conducting such a screening program is by means of the test developed by Wilkerson and Heftmann (4), using the clinitron. This apparatus provides a rapid, inexpensive, and reasonably accurate method of screening large groups of people. Permanent, year-round diabetes screening programs using the clinitron seem to have been restricted thus far to urban populations. On March 1, 1958, the Glens Falls District Office of the New York State Health Department began a continuous screening program in a rural section of upstate New York, including Saratoga, Warren, and Washington Counties. Data during the first 10 months of operation are presented in the hope that they will contribute toward closing the gap between urban and rural public health practice in diabetes screening. The population of this tricounty area approximates 177,000, 25 percent of whom live in Dr. Meyer was health officer for the Glens Falls District, New York State Department of Health, at the time this paper was written. He is now director of health in Bucks County, Pa.