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Health planning in this paper is considered as a developmental process in which different types of planning appear at different times. These types are discussed and the place in the complex health care system developing in the United States is assessed. [ABSTRACT FROM AUTHOR]

An introduction to the journal's supplement, which focuses on a unified research approach for minority health and health disparities is presented.

Abstract: One of the 1990 Health Objectives established by the U.S. Department of Health and Human Services is for 60 per ¢ of adults 18-65 years of age to be participating regularly in vigorous physical exercise. Unfortunately, no valid and practical measurement system is available that will allow assessment of leisure lime physical activity participation of large populations. Consequently, not only is it difficult to assess progress toward the 1990 goal, an accurate baseline from which to measure potential progress does not exist. This paper presents a time diary technique for measuring aggregate population physical activity participation and utilizes actual time diaries collected from adults by the Institute for Social Research in 1981 to arrive at a possible baseline. The results indicated that time diaries are a viable method for assessing aggregate physical activity behavior of large populations. American Adults were quite sedentary in 1981. Over a period of one week, 31% undertook no leisure time physical activity. Only 14 per ¢ expended more than 1600 kcals/week in leisure time physical activity, and 10 per ¢ met the DHHS physical activity requirements. (Am J Public Health 1987:77:455-460.) [ABSTRACT FROM AUTHOR]

The World Health Organization's goal of Health for All by the Year 2000 (HFA) has become a major force in national and international health policies. This paper deals with some of the historical roots of HFA and describes ways in which the major components of the health sector--health services, manpower, and universities--have evolved and should evolve in the future if they are to support the idea of HFA. One conclusion is that the changes called for in relation to HFA are not simply incremental extensions of previous values, structures, and functions. Rather a radical break with the past is often required. To expect otherwise is to misunderstand how fundamentally the concepts of HFA differ from values that have governed the health sector in the past. A second conclusion is that recent decades have seen a remarkable progression of new ideas and changes in the health sector, so much so that the changes called for by HFA are not so improbable as one might otherwise think. (Am J Public Health 1984: 74:714-719.) [ABSTRACT FROM AUTHOR]

During the past two years we have studied the characteristics of state and territorial public health laboratories in an attempt to develop guidelines for considering reorganization of laboratory services in Massachusetts. Only a few recent monographs have dealt with this topic and, to our knowledge, the functional and organizational characteristics of these laboratories have not been reviewed. The state public health laboratory system affords an excellent example of applied laboratory science or technology organized to provide basic public health services. In this paper the programs and organization of the state public health laboratory are reviewed, and a functional basis more responsive to society's current needs is suggested. INSET: Cheap Bubble Fountains. [ABSTRACT FROM AUTHOR]

This paper endeavors to overcome one difficulty in health planning, namely, the transformation of general goals and ideas into operational objectives for programs. A method is developed to be used for generating such program objectives. [ABSTRACT FROM AUTHOR]

This paper emphasizes the need to bring environmental health into the framework of comprehensive health planning. The author discusses how this can be done. [ABSTRACT FROM AUTHOR]

The article comments on the public health promotion policy in the U.S. proposed by J. B. Richmond and M. Kotelchuck in their paper titled "Coordination and Development of Strategies and Policy for Public Health Promotion in the United States," that was published in the book "Oxford Textbook of Public Health." According to the authors, the health policy model devised by Richmond and Kotelchuck posits that there are three necessary ingredients that make preventive action happen, namely, the knowledge base; the political will to support change; and a social strategy to accomplish change.

The article presents a position paper from the American Public Health Association relative to the improvement of health care in prisons, jails, and youth detention centers in the U.S. The association backs the recommendation for a federal strategy to help improve health care these centers as structured by the report of General Accounting Office to U.S. Congress. It also supports the Health Services Administration's Prison Health Initiative aimed to assign National Health Service Corps staff to prisons and jails. In addition, the group urges the development of periodic and independent medical audit reviews to check that standards are being met and quality care provided. Other significant decisions of the group are presented.

During the 1984 Summer Olympic Games, the Los Angeles County Department of Health Services used its active disease surveillance system to monitor disease occurrence and other health concerns. Reports were collected by telephone three times a week from 198 participating facilities including hospitals, prepaid health plans, private physicians, and Olympic sites. Background data were obtained two months preceding the Olympic events. Less illness was recorded during the Olympics than during the same period for the three preceding years. [ABSTRACT FROM AUTHOR]

The article presents the policy statement of the American Public Health Association concerning medically uninsured citizens' health care initiatives of each state in the country. In response to the fact that there is an increasing number of medically uninsured residents in the country and that most states are exerting effort in addressing their needs, the Association agrees in the need for a high quality, universal national health program which has a comprehensive scope, has state and local administration and is equitably financed. It also reorganizes and encourages state health initiatives for the uninsured population.

Abstract: The Health Care Financing Administration (HCFA) initiated the Medicare Competition Demonstrations in 1982 in anticipation of congressional intent to establish a national program. Interim results on the 1984 service use and cost experience of the health maintenance organizations (HMOs) and competitive medical plans (CMPs) participating in the demonstrations indicate that Medicare enrollees in the demonstration experienced a median of 1,951 hospital days per 1,000 person years, 57 per ¢ of the median of 3,432 days per 1,000 in the local markets from which the plans drew enrollment. Independent practice association (IPA) HMOs experienced higher hospital use rates than staff and group model HMOs. These comparisons are not adjusted for various risk factors, the absence of which were likely to favor the demonstration plans. Plans with lower hospital service use were federally qualified and had been operating for more than five years. The median total annual revenue per enrollee across all plans was $2,312, compared to median annual expenses per enrollee of $2,250. The distribution of median annual expenses per enrollee by major category of expense was: institutional expenses ($1,038/enrollee), medical expenses ($720/enrollee), supplemental services expenses ($154/enrollee), and administrative and other expenses ($295/enrollee). Future analysis, using beneficiary-level data, will examine the impact of the demonstration and the nature and extent of evident biased selection and will compare the quality of care in the demonstrations to that in the fee-for-service sector. (Am J Public Health 1988; 78:937-943. INSET: Joint Federal Effort to Assist Recruitment of Disadvantaged.... [ABSTRACT FROM AUTHOR]

Planning agencies do not have control over health care resources in the community. Resources are concentrated in a number of provider organizations, associations, and government agencies, which have common goals as well as a diversity of individual objectives, and therefore enter into networks of relationships to accomplish their overlapping service missions. Interorganizational research shows that it is important to enhance the interdependence and benefits of cooperation between organizations and at the same time maintain the identity and distinctive qualities of each organization. Thus, in addition to the important role to provide information for decisions, planners have a role to manage the interdependencies and identities among organizations in the health system, Research shows that in situations where only methods, data, and analysis were emphasized by health planners, they had less impact on community decisions than in situations where planners also emphasized the development of the interorganizational system of decision-making. In a neutral position with respect to competing forces, planners can more effectively use their leverage from their information processing role and from their regulatory powers to facilitate the balancing of interorganizational interests and to enhance cooperative benefits to the community. [ABSTRACT FROM AUTHOR]

The article cites a study which examines nine health centers in New Jersey to determine the degree to which original goals of a national health center policy developed during the mid-sixties were met and to suggest areas for future improvement. A self-administered questionnaire followed up by on-site interviews were employed, and data regarding the structure and operations of the nine centers were collected during 1974 for the period 1973. The centers were assessed in terms of their performance toward three major objectives of the dominant OEO-related health center policy. One of the results show that the centers performed poorly in regard to all objectives with no center achieving all of the attributes for any one objective.

A study of all 37 ambulance squads in two Pennsylvania counties (Lehigh and Northampton), an area known to be served largely by volunteer units, was carried out by personal on-site interviews in 1973. The objectives were to determine the structure and functions of the squads and to devise some preliminary estimates of effectiveness as a base for regional planning. Topics examined include population and geographic area served, numbers and training of personnel, vehicles, equipment, record keeping, finances, communications capabilities, and squad organization. The 34 volunteer squads were found to vary greatly in resources and sophistication. The rural squads in particular tended to be underfinanced, to have low call loads and a delayed response to calls. In some squads personnel were inadequate in numbers and training. The advantages and disadvantages of maintaining volunteer services in rural areas are discussed and some possible approaches to the problem of providing high-quality services in rural areas outlined. [ABSTRACT FROM AUTHOR]

The article comments on the potential value conflicts inherent in the health planning priorities in the U.S. Congress has declared that primary care services should be provided for the medically undeserved. This means that the public must find ways to guarantee that those with less than some amount of medical care receive as much as some others who are supposed to be getting an adequate amount. Congress has also stated that more physician assistants and nurse practitioners must be used.

A description is presented of how an urgent need for a specific testing procedure was met by a pooling of laboratory planning resources to coordinate a regional laboratory operation under the auspices of a regional health association. [ABSTRACT FROM AUTHOR]

The article discusses several myths and misconceptions underlying nutritional and health care programs in the U.S. Medical myths have led to the development of health care programs as well as the abolishment of some programs believed to have negative physiological effects. Many health programs developed by the federal government and medical organizations are believed to prevent diseases and responsible for the marked drop in mortality rates and the population boost. However, these myths and misconceptions have greatly affected the design and execution of health programs which has real medical relevance.

This study was made to determine consumer attitudes toward health needs in an Appalachian community, and to find out what are the priorities of such consumers for health care. A gap between the priorities of consumers and those of physicians is discussed and its implications for planning and providing services is stressed. [ABSTRACT FROM AUTHOR]

A suggested strategy for resolving questions relating to the survival of small, high-quality exurban hospitals, for use by areawide comprehensive health planning agencies. [ABSTRACT FROM AUTHOR]

This author argues that health care delivery should continue under voluntary nonprofit auspices as far as possible and that the health system should adopt appropriate modern managerial and organizational approaches to achieve greater economy and effectiveness. Decentralized planning with consumer participation is the preferred approach and must be kept viable. [ABSTRACT FROM AUTHOR]

Poor health and low living standards prevail in Chinese-American communities. This report discusses some social and cultural origins of health needs among Chinese-Americans and describes the role of community participation in health programming for one Chinese community, the Chinatown of Boston. [ABSTRACT FROM AUTHOR]

Monitoring the health status of populations is a core function of all public health agencies but is particularly important at the municipal and community levels, where population health data increasingly are used to drive public health decision making and community health improvement efforts. Unfortunately, most local health jurisdictions lack important data for developing population health profiles, such as data on chronic disease prevalence, quality-of-life measures, functional status, and self-perceptions of health status. In addition, data on important determinants of health, including health behaviors and access to health care services, are rarely available locally. These data frequently are collected in national and state surveys (e,g,, the National Health Interview Survey and the Behavioral Risk Factor Surveillance System) and provide critical information to assess progress toward achieving state and national health objectives. The surveys rarely serve local data needs, however, because of insufficient sample size and lack of flexibility to address local health issues. To address gaps in local health data, in 1997 the Los Angeles County Department of Health Services inaugurated the Los Angeles County Health Survey. [ABSTRACT FROM AUTHOR]

Abstract: Since the migrant farmworker family is a marginal issue among competing priorities for public health services, the logical strategy ought to be the pooling of limited resources at the state and local level to provide maximum benefit for the dollar and the client. A program planning model in inter-agency migrant health services delivery has been developed in Colorado. The model includes tangible evidence of cooperation by front-line service agencies. A task force approach for joint agency programming was initiated at state and local levels, and a structure for accountability was established which was carried out with performance contracts. [ABSTRACT FROM AUTHOR]

The article offers a response to Roger England's commentary on the mythology of international health planning. He points out that England has chosen to argue against his self-selected myths. On the issue of prioritizing the rural areas, he clarifies that the prioritization argument is only a means of redressing existing unequal and inefficient patterns of resource allocation in the health sectors. On the conceptual models of simple prevention and easy treatment, he asserts that the mythology discussion on such models has not been clear enough.

The article focuses on New Mexico Health Day, an annual meeting of communities and health practitioners in New Mexico to help identify issues in recruiting health professional. Despite the opportunities being offered by health care establishments to health care professionals, rural and semi-rural communities still experience difficulty in recruiting medical manpower. Because of the situation, community planning groups have attempted to address health care needs from a health planning perspective. The Health Day has opened effective lines of communication among Health Sciences Center, individuals, and communities in the state. It is pointed out that expanding education perspectives provides an attractive alternative to more traditional methods of hiring health professionals.

This study describes the measures being taken by AIDS surveillance offices across the country to ensure the security of information regarding patients with AIDS and HIV infection. Security measures were evaluated according to the cumulative number of AIDS cases reported, whether partner notification services were provided, and whether HIV seropositive reporting by name was also required. This study showed that public health departments have taken extra steps to ensure the security of AIDS and HIV data. [ABSTRACT FROM AUTHOR]

The article presents the policy statement of the American Public Health Association concerning equitable and full employment. The Association believes that employment has an impact on health and poverty that is why it is urging the country's Department of Health and Human Services to include employment availability in its objectives. It also calls for a public employment and wage maintenance program and encourages researches which focus on public health effect of inadequate wages and unemployment.

The article presents the policy statement of the American Public Health Association concerning occupational diseases and injuries surveillance. The Association believes that surveillance of occupational injuries and diseases is vital to the effectiveness of preventive programs and can increase awareness of both the employee and employer about work-related health problems. It is also convincing the Congress to mandate a reporting system for occupational diseases and calls the attention of concerned federal agencies to develop an occupational injury and disease surveillance system.

The article presents the policy statement of the American Public Health Association concerning health hazards brought by naturally occurring radon. The association believes that radon exposure can cause lung cancer that is why it recommends performance of adequate testing for the determination of areas with high level of naturally occurring radon be done by federal and state governments. It also urges state and local governments to provide information and outreach programs regarding radon exposure as well as financial assistance to those households that need remediation and testing activities.

The article presents the policy statement of the American Public Health Association stating its opposition to the revision of the National Family Planning Program, Title X of the Public Health Service Act, while support for the principle of informed consent. The Association believes that revisions in Title X would promote infertility services but no information or counseling related to abortion will be given to the person entitled for the services provided by the Title X. The Association encourages concerned citizens and groups to oppose the regulation as well as the Congress to have commitment to the principle of informed consent.

The article looks at the primary care services in Third World countries. The shift from minor post-operative care for a major operation to major post-operative care for a relatively minor operation reflects the adverse side effects of the growth of hospitals and the advances of science, specifically the discovery of anesthesia and the introduction of aseptic, hemostatic surgery. The feasibility and substantial cost savings of ambulatory surgery is determined.

The article refutes the arguments raised by Oscar Gish concerning the commentary on the mythology of international health planning. The author clarifies that he is concerned with planning as a problem-solving or design process. He adds that his commentary attempts to illustrate how myths prohibit the application of the said problem-solving process. On the issue of medical aids, he emphasizes that Gish has overemphasized the state of affairs in manpower design and performance evaluation. On the issue of compulsory service, he asserts that health can only be improved through the willingness of people to evaluate and discard old concepts and myths.

The article refutes the arguments raised by Nicholas Cunningham concerning the commentary on the mythology of international health planning. The author argues that Cunningham has misrepresented his points. On the issue of rural development, he asserts that development projects invariably operate at levels of resource and skill input. He further contends that the said projects do not constitute development because they do not widely effect distribution. On the issue of prevention, he points out that the cost-effectiveness of measles immunization has been questioned because of its massive expansion without evaluation.

The article focuses on the epidemiologic perspectives and the special program in tropical diseases of the World Health Organization. The epidemiologist dealing with tropical diseases should be familiar with and be able to evaluate the scientific input from a spectrum of related disciplines. Therefore, epidemiologic investigations of tropical diseases are laboratory dependent and their success or failure will depend on the availability of services provided by an essential complementary cadre of laboratory based-experts.

The article presents the policy statement of the American Public Health Association concerning state and local departments programs on injury control. In response to the fact that there is an increase in deaths caused by intentional and unintentional injuries and that these incidences cost the country a lot of money, aside from pain, suffering and grief, the Association urges state legislators and governors to establish programs focusing on injury control. It also encourages engineering and medicine-related schools and institutions to expand their training and research programs on injury epidemiology and control.

The article focuses on the relationship between nurses and physicians in administering health services. Their relationship has varied from dependent to independent and interdependent in their efforts to help those in need of their care. The author points out that one of the implications of their study findings, with respect to future requirements for non-physician providers and physician providers. Competition appears to be developing between nurse practitioners and physicians. There are many who still do not have access to primary health care. The future requirements for nurse practitioners will not and cannot be projected based only on the percentage of patient visits that are delegated to physicians by nurses.