Local Health Programs Research Articles

The context and times at Swampscott: My/story

The decade and a half between the end of World War II and the Swampscott Conference was a time of great ferment in both psychology and mental health. Pioneers, such as David Shakow, had been instrumental in creating the Veterans Administration training program in clinical psychology. The result was a rapid increase in the numbers of clinical psychologists with their doctorates who were moving into newly created state and local mental health programs. The National Institute of Mental Health, under the leadership of Robert Felix, had recruited a cadre of dedicated psychologists both to stimulate program development, training, and research and to be on the lookout for promising initiatives in this emerging field. A number of such initiatives occurred in the years immediately after World War II. Most were fueled by the vision of community-based programs in which prevention and the promotion of mental health were the ultimate aims. Though in most cases the guiding inspiration came from communityoriented psychiatrists, key team members included psychologists and social scientists as well as epidemiologists and other mental health experts. There was a considerable amount of what we today call networking among these groups, much of it stimulated by the Milbank Memorial Fund, which sponsored a series of important working conferences and subsequent publications on mental health and mental disorder. In 1952 the third Milbank Conference was devoted to Interrelations Between the Social Environment and Psychiatric Disorders. It was chaired

State and Local Responses to Children's Injuries: The Massachusetts Statewide Childhood Injury Prevention Program

This paper identifies problems facing effective injury prevention, including the lack of media and professional attention, poor data systems on epidemiology and prevention of injuries, inadequate prevention strategies, and hampered implementation. As a partial solution to these problems, efforts are described for increasing the involvement of agencies at the local, state, and federal levels, especially those devoted to maternal and child health. One program, the Massachusetts Statewide Childhood Injury Prevention Program, is described to illustrate the role of one lead agency for designing and implementing a strategic plan for injury prevention that can overcome the obstacles noted. General perspectives are outlined for approaching injury prevention through state and local maternal and child health programs.

Home Environmental Quality: The Problem, Federal and State Responses, and a New Strategy

j INCE 1970 there has been a massive effort on the part of the federal and state governments to improve environmental quality. This has become necessary because ;F J 5 of pollution levels which have deteriorated environmental quality, injured and killed plants and animals, and adversely affected public health. Though much contamination remains, significant improvements in the environment have been made (1). In contrast, local environmental health programs in many areas have either been preempted by federal and state actions, or degraded and deemphasized in professional stature by local apathy. The contaminated environment, in the eyes of federal and state officials, was considered to be those outdoor areas where people worked, played or traveled. Virtually all the pollution control efforts and resources were directed toward control of ambient air quality, lake and stream water pollution, outdoor noise, and improper use and disposal of toxic products. Little effort was directed toward improving the environmental quality inside the home. There are at least three possible reasons for the past disregard of home environmental quality. One reason mlght have been that no one considered the environmental quality of dwellings to be a problem. Another reason could have been that home environmental health was not considered a problem for government intervention. It may have been believed either that there was no legal authority or that it was inappropriate and politically infeasible to regulate home environmental quality. The third reason was that home environmental quality was considered a problem to be addressed later or through non-intrusive, non-regulatory approaches. Regardless of the reasons for the previous neglect of home environmental quality, it is definitely both appropriate and timely for government to become more actively involved.

The implementation of model standards in local health departments.

Four local health departments in California tested a process of state/local negotiations for the purpose of implementing model standards in community preventive health services. The standards, which covered five program areas, had been developed by a collaborative work group of representatives from the United States Conference of City Health Officers, the National Association of County Health Officials, the Association of State and Territorial Health Officials, the American Public Health Association, and the US Department of Health, Education, and Welfare. Evaluation of the project indicates that the success of the negotiation transactions and results varied, both among local health departments and program areas. A number of factors have been identified as influencing the negotiations, including the availability of baseline data, the extent to which individual programs are currently affected by required standards of performance, and health department attitude toward the project. The future utility of this model is considered within the broader context of changes now occurring in the financing and organization of public health within the United States. Project findings suggest that the Model Standards negotiations could provide state and local levels of government with a valuable management tool for determining health care priorities and generating objective programmatic data for budget justification.

Child mortality and fertility in Colombia: Individual and community effects

The education of a mother is strongly and positively correlated with the survival rate of her children. This paper combines household data from the Colombian Census of 1973 and characteristics of the 900 residential areas in Colombia, to test various hypotheses concerning the mechanism by which mother's education and public policies affect child survival and the distribution of health benefits resulting from policy interventions. The hypothesis is advanced that education provides people with skills in acquiring and decoding new information and thus effectively lowers the costs of using more beneficial child health and contraceptive technologies. Since a primary function of health and family planning programs is to disseminate information on these same technologies, the hypothesis is tested that mother's education and these program interventions may substitute for each other in improving child health and reducing family size. The empirical analysis confirms that in urban areas the availability of medical services, family planning activities, transportational infrastructure and climate, in addition to mother's education, are associated with child mortality ratios and fertility within a birth cohort of mothers. The least educated mothers are the most strongly affected, in terms of their reduced fertility and increased child survival rates, by the local urban health programs. The evidence is, thus, consistent with the substitution hypothesis. No effects of program interventions and medical facilities are found on rural populations, though both child mortality ratios and fertility are lower for more educated rural women.

PEOPLE S PARTICIPATION IN RURAL HEALTH SERVICES A Study of Development of the concept

In most developing countries primary health care is not yet a reality; self-reliance and partnership between local communities and governmental agencies are necessary to make health programs successful. The determinants of standards of health include 1) purchasing power (dependent on incomes and prices of goods and services); 2) health environment (both the climate and the standards of public sanitation and the prevalence of communicable disease) and 3) peoples understanding of nutrition health and hygiene. Recently the emphasis has been on a broader approach to health policy including an emphasis on universal low-cost basic health care. 4 key areas that affect human development programs are political support finance administration and demand. The Community Development Programme organized in India is an example of emphasis on community participation in development of health programs and support for agriculture health sanitation and education services. Critical appraisal of the program found it wanting in actually developing educated self-reliant self-stimulating citizens able to make decisions about their future. There seems to be a tendency among villagers toward dependence on offical agencies for the solution of day to day problems. As a result certain principles were adopted by the Development Committee appointed by the government of India: 1) no individual should go without adequate medical care because of inability to pay; 2) health programs must place special emphasis on preventive medicine; 3) to ensure maximum benefit to rural communities health services should be placed as close as possible to the people; and 4) health education should be provided on a wide basis with encouragement of individual participation in local health programs. By choosing villagers for a Village Health Committee and training committee members in individual areas of responsibility such as sanitation registration of villagers and compilation of vital statistics a spirit of self-help is engendered and spread throughout the community.

Federal policies which influence the planning of local community mental health programs.

Federal policies which influence the planning of local community mental health programs.

An Educational Model for Teaching Living Skills to Long-Term Patients

Establishing rehabilitation programs for long-term mental patients outside mental health settings can save mental health funds and further the patients' integration into the community, the author declares. He describes an approach that uses an educational model to teach patients the basic skills of everyday living. As "students," they enroll in a course taught by a credentialed teacher and sponsored by the adult education department of the local high school. Mental health professionals are used only for consultation, and the cost to the local mental health program is minimal. A key element in the course is having the students participate in planning the curriculum.

The carrott and the stick: inducing local programs to serve long-term patients.

Both financial and philosophical considerations have led to the dramatic shift in California of long-term patients from state hospitals to the community. Unfortunately local mental health programs frequently give low priority to the severely and chronically mentally ill. The state chose not only to engage in the wholesale discharge of patients from state hospitals but also to provide a number of financial inducements and penalties to motivate local programs to serve these patients. Although there have been many problems, local programs have developed a wide range of community treatment and rehabilitation programs for long-term patients.

Implications of California's new mental health law.

The author describes the impact that implementation of California's new mental health law and of its amendments has had on the development of community mental health programs. The new legislation has acted as a catalyst to the growth of local mental health programs by providing restrictions on involuntary treatment as well as fiscal incentives for local programs. The effect of the legislation on patients has varied according to patient needs and the resources available in the community. Although the problems and controversies have arisen regarding the placement of chronic patients, impact on law enforcement, and quality of care, the service delivery system developed in response to the new legislation has resulted in a greater emphasis on crisis intervention, greater visibility of direct services, and increased community awareness and concern regarding mental health. The author concludes that mental health laws can become the catalyst for major changes in the mental health services delivery system.

ENVIRONMENTAL HEALTH: PROGRAM PLANNING AND IMPLEMENTATION

Environmental quality problems are interrelated and interdependent on developments and trends in personal health protection as well as social and economic considerations. A carefully planned environmental management program can help optimize a local or national health, social, and economic program, if it becomes an integral part of a total community improvement effort.

Anatomy of a local mental health program: a case history.

The evolution of a local mental health program, of which the author was director from inception in 1963 until 1967, is described. Issues and approaches explored in the effort to develop a sound conceptual and practical basis on which to institute the first component of a comprehensive mental health program are outlined.

Health surveillance of microwave hazards.

Since the early 1940's, industrial use of electronic equipment that emits electromagnetic energy in the microwave region has increased. Concurrent with this growth has been the development of data on the biological effects of this form of radiant energy and the establishment of exposure criteria. Of equal importance in protecting the health of exposed persons is the evaluation, by qualified occupational health personnel, of the electronic equipment as it is used in the workplace by reliable and accepted environmental health techniques. Various, local, state, and federal health programs and survey techniques and instrumentation are reviewed. Standardization of survey techniques is suggested, and recommendations are presented regarding future activities in establishments where persons may be potentially exposed to microwaves from ovens and other commercial and industrial sources of energy.

The veterans administration and community mental health: New approaches in psychiatric rehabilitation

The large government mental institution must become increasingly integrated with local community mental health programs. The Veterans Administration Hospital, Palo Alto, California, provides an example of how one such institution involves its programs with the community. The traditional hospital-based sheltered workshop, when operated as a nonprofit corporation, is especially well suited to the employment of mental patients in workshop-owned enterprises outside the hospital walls. The flexibility of the program is illustrated with case histories. Advantages to the client, the institution, and the community are discussed.

The future of the public mental hospital.

What will be the future of public mental hospitals as community mental health center programs expand? The authors suggest that their emerging role lies in joining the community's network of human services by adapting present organizational structures to permit flexibility and change. Mental hospital staffs can provide leadership and support to local, regional, and state mental health programs if they incorporate current scientific, technological, and social changes in their operations.

Serum cholesterol levels in the medical community

<h3>To the Editor:—</h3> Many investigators^1-5have shown that the risk of a clinical episode of coronary artery disease is closely correlated with serum cholesterol levels. These epidemiologic studies show that the hypercholesterolemic population has a three to five times greater risk of coronary heart disease (CHD) than the normocholesterolemic population. Recognition of this important correlation has generated efforts to screen large population groups for elevated cholesterol levels. It is an interesting observation that physicians and their families are seldom included in local health programs. Because of this it seemed particularly appropriate to carry out a cholesterol-screening program exclusively for physicians and their guests at medical conventions. Accordingly, Flint Laboratories carried out such a program at eight medical meetings, beginning with the American Medical Association convention, 1967, and ending with the AMA convention, 1968. The screening program included 2,973 individuals, who were selected for no reason other than their presence

Serum Cholesterol Levels In the Medical Community

To the Editor:— Many investigators1-5have shown that the risk of a clinical episode of coronary artery disease is closely correlated with serum cholesterol levels. These epidemiologic studies show that the hypercholesterolemic population has a three to five times greater risk of coronary heart disease (CHD) than the normocholesterolemic population. Recognition of this important correlation has generated efforts to screen large population groups for elevated cholesterol levels. It is an interesting observation that physicians and their families are seldom included in local health programs. Because of this it seemed particularly appropriate to carry out a cholesterol-screening program exclusively for physicians and their guests at medical conventions. Accordingly, Flint Laboratories carried out such a program at eight medical meetings, beginning with the American Medical Association convention, 1967, and ending with the AMA convention, 1968. The screening program included 2,973 individuals, who were selected for no reason other than their presence

Data utilization for local mental health program development

The importance of data collection and utilization for program development on the local level is emphasized, and a systematic approach to data collection for planning and evaluation of local mental health services is outlined. Examples of local programs in which such information has been employed are cited. Recommendations are made to facilitate the local planning function.

PUBLIC HEALTH, NURSING, MEDICAL SOCIAL WORK

As a pediatric problem, tuberculosis has undergone striking change in the past decades, yet few diseases have the complicated interrelationship of personal and community significance that is peculiar to tuberculosis. Management of the tuberculous patient has become largely a matter for hospital and specialized outpatient services, and the individual practitioner has been chiefly concerned with case finding in his own practice. Since the tuberculin test is such an important tool in this respect, the editors thought such a review as presented by Dr. Feldmann of particular importance. A number of controversial points are touched on. In any public health procedure a routine screening test has value in relation to the proportion of positives likely to result. A test which results in more than 50% positive is not very helpful. On the other hand, a test with one positive in 1,000 is probably too expensive. Dr. Feldmann points out the cogent reasons for routine tuberculin testing and the pediatrician will need to consider these reasons in the light of the conditions in his community and the relevant local and state health program. Some may be disturbed by the criticism made of the patch test, yet it is important to recognize its limitations. Failure of the patch test to detect all positives has been well known and most pediatricians have thought it useful chiefly as a preliminary test to find the more sensitive reactors.

An experiment in the administration of a local mental health program: the New York Community Mental Health Services Act.

An Experiment in the Administration of a Local Mental Health Program: The New York Community Mental Health Services Act Robert H. Broad CopyRight https://doi.org/10.2105/AJPH.47.5.553 Published Online: August 29, 2011