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Abstract: This paper reports the home-facility and level of care changes, discharges, and deaths over a five-year period for 1,653 clients newly admitted in 1978 to a long-term care program in British Columbia, Canada. Five years after admission, of clients initially admitted to care at home (N = 1241), 34,3 per ¢ were still in the program (14.5 per ¢ unchanged; 6.7 per ¢ at home but at a higher level of care, and 11.7 per ¢ in facilities). Of the remainder, 38.9 per ¢ had died and 26.8 per ¢ had been discharged. Findings for those initially admitted to care in facilities (N = 412) are remarkably similar. After five years, 28.4 per ¢ of these clients were still in the program; 39.3 per ¢ had died. Moves from facility to home care were few (2.4 per ¢). Despite their advanced age at admission (X = 74.7, S.D. 14.6), one-third were still in the program five years later, some with status virtually unchanged. INSET: Health Implications of Smokeless Tobacco Use. [ABSTRACT FROM AUTHOR]

This paper documents oral health and public health expenditures for fiscal years 1984, 1986, 1988, and 1989, as reported by state health agencies. During this period, reported national expenditures for public and oral health increased 68% and 46%, respectively; between successive fiscal years, fewer states (73%, 67%, 57%) reported increased oral health expenditures, while increasingly more states reported no categorical oral health expenditures. Block grant expenditures for oral health increased overall but decreased as a percentage of total oral health expenditures; 16 stages reported no block grant expenditures for oral health in fiscal year 1989, perhaps reflecting either substantial state support, or marginal to nonexistent oral health programs in these states. [ABSTRACT FROM AUTHOR]

This paper traces the development of the US federal government's program to provide personal and public health services to American Indians and Alaska Natives since the 1940s. Minimal services had been provided since the mid 19th century through the Bureau of Indian Affairs of the Department of the Interior. As a result of attempts by western congressmen to weaken and destroy the bureau during the 1940s, responsibility for health services was placed with the US Public Health Service. The transfer thus created the only US national health program for civilians. providing virtually the full range of personal and public health services to a defined population at relatively low cost. Policy changes since the 1970s have led to an emphasis on self-determination that did not exist during the 1950s and 1960s. Programs administered by tribal governments tend to be more expensive than those provided by the Indian Health Service, but appropriations have not risen to meet the rising costs, nor are the appropriated funds distributed equitably among Indian Health Service regions. The result is likely to be an unequal deterioration in accessibility and quality of care. [ABSTRACT FROM AUTHOR]

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 design of a comprehensive evaluation of subsidized rural primary care programs on a large national scale is described. Its major purpose is to derive data whose analysis will answer major policy questions about the factors influencing the outcome of the major types of such programs in different communities. This first paper also delineates a typology which was developed of five principal organizational forms of these programs. This classification appears to provide suitable operational definitions of forms of rural practice as a basis for evaluating the differential impact of alternative types of primary care programs. [ABSTRACT FROM AUTHOR]

As in the preceding paper, the activities of a consortium in Newark, New Jersey, to develop appropriate programs to meet the needs for health personnel in an urban situation are discussed. [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 offers cross tabulations between parameters on family planning and other health practices. The findings indicate that people who act positively with respect to health practices are similarly motivated in family planning. This point lends support to the policy of integrating family planning services with health services. [ABSTRACT FROM AUTHOR]

This paper offers an overview of the development of services for the aged in Great Britain and suggests parallels with the United States. [ABSTRACT FROM AUTHOR]

Evaluation of health programs is a basic need if their impact is to be determined and to make sound decisions for future action. The papers presented in this group on evaluation deal with the problem from different viewpoints: from that of the executive branch, from the legislative angle, in terms of a specific program and on the local level. [ABSTRACT FROM AUTHOR]

The article offers information on the challenges faced by the American Public Health Association on the development of the association's Medical Care Section in the U.S. On November 10, 1948, the American Public Health Association's Governing Council voted to approve the petition requesting the establishment of a Medical Care Section. In 1972, the association expanded their health services because of the changes on their needs and demands. In 1920, the association created a committee to study the municipal health departments and determine the extent of variation on the health services and procedures offered in a specific community.

Establishment of community stroke programs depend on the solution of many interrelated problems. The development of such programs in North Carolina is explored, and the factors involved are examined. Improved patterns of care are illustrated. [ABSTRACT FROM AUTHOR]

The article discusses various reports published within the March 1993 issue of the "American Journal of Public Health." It introduces two papers that describe the results of experiments testing the efficacy of health promotion programs in the workplace. Moreover, a study that aims to determine the efficacy of a smoking cessation program is mentioned. It addresses the potential of the workplace as a site for delivery of effective health programs and medical services. Furthermore, medical centers should take part in the initiation of a dialogue by inquiring about the issues that are of concern in the workplace.

Objectives. We sought to examine the impact of treatment access on HIV stigma in Botswana 3 years after the introduction of a national program of universal access to antiretroviral therapy. Methods. We studied the prevalence and correlates of HIV stigma in a population-based study of 1268 adults in Botswana in 2004. We used multivariate logistic regression to assess correlates of stigmatizing attitudes and a new measure, anticipated HIV stigma. Results. Overall, 38% of participants had at least 1 stigmatizing attitude: 23% would not buy food from a shopkeeper with HIV; 5% would not care for a relative with HIV. Seventy percent reported at least 1 measure of anticipated stigma: 54% anticipated ostracism after testing positive for HIV, and 31% anticipated mistreatment at work. Perceived access to antiretroviral therapy was strongly and independently associated with decreased odds of holding stigmatizing attitudes (adjusted odds ratio [AOR]=0.42; 95% confidence interval [Cl] = 0.24, 0.74) and of anticipated stigma (AOR=0.09; 95% CI=0.03, 0.30). Conclusions. Our findings suggest that antiretroviral therapy access may be a factor in reducing HIV stigma. Nevertheless, the persistence of stigmatizing attitudes and significant anticipated stigma suggest that HIV stigma must be a target for ongoing intervention. (Am J Public Health. 2008;98:1865-1871. doi: 10.2105/AJPH.2007.122044) [ABSTRACT FROM AUTHOR]

We describe a collaborative approach to reducing health disparities affecting Montana and Wyoming tribal nations while promoting health-protective practices and interventions among these populations. Under the auspices of the Montana-Wyoming Tribal Leaders Council, a consortium has undertaken activities to (1) establish the research infrastructure necessary for conducting ongoing health disparities research, (2) develop a target research agenda that addresses tribally identified priority health issues and tests the feasibility of interventions, (3) develop increased research skills and cultural competency through mentoring activities, and (4) develop effective collaborative relationships. All research projects are user-defined and -authorized, and participation is voluntary. [ABSTRACT FROM AUTHOR]

The history of health determinants in Canada influenced both the direction of data gathering about population health and government policies designed to improve health. Two competing movements marked these changes. The idea of health promotion grew out of the 1974 Lalonde report, which recognized that determinants of health went beyond traditional public health and medical care. and argued for the importance of socioeconomic factors. Research on health inequalities was led by the Canadian Institute for Advanced Research in the 1980s, which produced evidence of health inequalities along socioeconomic lines and argued for policy efforts in early child development. Both movements have shaped current information gathering and the policies that have come to be labeled "population health." (Am J Public Health. 2003;93:388-392) [ABSTRACT FROM AUTHOR]

The author traces the development of the concept of health promotion from 1980s policies of the World Health Organization. Two approaches that signify the modernization of public health are outlined in detail: the European Health for All targets and the settings approach. Both aim to reorient health policy priorities from a risk factor approach to strategies that address the determinants of health and empower' people to participate in improving the health of their communities. These approaches combine classic public health dictums with "new" strategies, some setting explicit goals to integrate public health with general welfare policy. Health for All, health promotion, and population health have contributed to this reorientation in thinking and strategy, but the focus of health policy remains expenditure rather than investment. (Am J Public Health. 2003;93: 383-388) [ABSTRACT FROM AUTHOR]

Progress in public health and community-based interventions has been hampered by the lack of a comprehensive evaluation framework appropriate to such programs. Multilevel interventions that incorporate policy, environmental, and individual components should be evaluated with measurements suited to their settings, goals, and purpose. In this commentary, the authors propose a model (termed the RE-AIM model) for evaluating public health interventions that assesses 5 dimensions: reach, efficacy, adoption, implementation, and maintenance. These dimensions occur at multiple levels (e.g., individual, clinic or organization, community) and interact to determine the public health or population-based impact of a program or policy. The authors discuss issues in evaluating each of these dimensions and combining them to determine overall public health impact. Failure to adequately evaluate programs on all 5 dimensions can lead to a waste of resources, discontinuities between stages of research, and failure to improve public health to the limits of our capacity. The authors summarize strengths and limitations of the REAIM model and recommend areas for future research and application. (Am J Public Health. 1999;89:1322-1327) [ABSTRACT FROM AUTHOR]

Objectives. Expert panels determined the public health goals of Healthy People 2000 subjectively. The present study examined whether data-driven benchmarks provide a better alternative. Methods. We developed the "pared-mean" method to define from data the best achievable health care practices. We calculated the pared-mean benchmark for screening mammography from the 1994 National Health Interview Survey, using the metropolitan statistical area as the "provider" unit. Beginning with the best-performing provider and adding providers in descending sequences, we established the minimum provider subset that included at least 10% of all women surveyed on this question. The pared-mean benchmark is then the proportion of women in this subset who received mammography. Results. The pared-mean benchmark for screening mammography was 71%, compared with the Healthy People 2000 goal of 60%. Conclusions. For Healthy People 2010, benchmarks derived from data reflecting the best available care provide viable alternatives to consensus-derived targets. We are currently pursuing additional refinements to the data-driven pared-mean benchmark approach. [ABSTRACT FROM AUTHOR]

The approach of a millennial passage invites public health to a review of past performance and a preview of future prospects toward assuring a healthy public. Since the 1974 Canadian Lalonde report, the best national plans for health progress have emphasized disease prevention and health promotion. WHO'S multinational Health for All by the Year 2000 promotes basic health services essential to leading a socially and economically productive life. Healthy People 2000, the latest US guide, establishes three goals: increase healthy life span, reduce health disparities, and achieve universal access to preventive services. Its objectives can be used to excite public understanding, equip program development, evaluate progress, and encourage public accountability for health initiatives. Needed is federal leadership in defining requisite action and securing necessary resources. Elsewhere a "new public health" emphasizes community life-style and multisectoral "healthy public policy." In the United States, a national health program is needed to achieve equity in access to personal health care. Even more essential is equitable sharing in basic health determinants in society—nutritious food, basic education, safe water, decent housing, secure employment, adequate income, and peace. Vital to such a future is able and active leadership now from governments and public health professionals. [ABSTRACT FROM AUTHOR]

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 Stales. Project findings suggest that the Model Standards negotiations Could provide stale and local levels of government with a valuable management tool for determining health care priorities and generating objective programmatic data for budget justification. (Am J Public Heath 1982: 72:1230-1237.) [ABSTRACT FROM AUTHOR]

Abstract: In 1976 the Ministry of Health of Nicaragua began a low cost program to deliver simple health services in rural areas through trained traditional birth attendants or "parteras." After two years the program had prepared 768 parteras in a five-day training course. Parlera were equipped with a kit that included oral rehydration salts an antihelminthic multivitamins with iron, aspirin, contraceptives, and obstetrical equipment. The difficulties encountered in implementing this limited set of simple health services illustrate a number of potential obstacles to the achievement of universal, comprehensive primary health care in less developed countries. The most prominent difficulties involved elements of the health service delivery system itself, supervision, the collection and use of management information training partera selection and logistics. The experience also provided examples of issues in the design of delivery system that require specific applied research. [ABSTRACT FROM AUTHOR]

The article discusses specific directions for health promotion in the state of Massachusetts. The first one pertains to the compilation and dissemination of information demonstrating the favorable ratio of benefits to costs for health promotion programs. Another concerns the development of methods that will allow insurance premiums to reflect self-imposed health risks. The last one concerns the development and dissemination of health promoting resources for every town, city, and county. The author emphasizes that adequate data will help convince others the cruciality of health promotion programs. After convincing individuals to take some action, ways of connecting good intention to outside help should also be determined.

A study of public health statutes of the 50 states identifies 44 specific services or functions that are assigned to local health departments by all or some of the states. Authorizations are most commonly assigned conjointly both to local and state health departments; exceptions are identified. Data suggest striking inconsistencies between what local health departments are authorized to perform and the services they actually render with regard to a selected group of programs that involve personal health services. The full scope of authorizations for local health departments is not revealed by examination of public health statutes. For this reason, among others, development of up-to-date health codes for all states would be beneficial. [ABSTRACT FROM AUTHOR]

A set propositions is offered to provide a frame of reference for proposed strategies to improve healthful behavior by placing personal choice-making in the context of societal option-setting. The health status of populations at a given point in time is seen as a result of customary personal choice-making. These choices in turn are limited by both the perceived and actual options available to individuals, depending on their personal and their community's resources, from which to make choices, Most people, most of the time will make the easiest choices, i.e., will do the things, develop the patterns or life-styles, which seem to cost them less and/or from which they will gain more of what they value in tangible and/or intangible terms. The range of options available to them, and the ease with which they may choose certain ones over others, is typically set by organizations, public and private, formal and informal. The more powerful the organization, i.e., the more effective it is in carrying out its policies, the more it affects the populations, whether or not these effects are immediately perceived by individuals in their day-by-day choicemaking. Implications for health education strategies are noted. [ABSTRACT FROM AUTHOR]

The article discusses the development of the Community Health Orientation Scale for the purpose of understanding common community health concepts as they relate to health care settings and practices. A prolonged examination of the pertinent literature on community health resulted in the initial assembly of 49 declarative statements. The statements were formulated in relation to seven conceptual categories that were felt to be reasonably representative of the key aspects of a community health orientation. The validity of the scale was assessed by comparison with the two scales that were administered in conjunction with it.

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.

The article discusses the potential and role of podiatry in community health programs in the U.S. The author emphasized on the education of the podiatrist, his activities in various health programs and related matters. Podiatry is the smallest of the medical profession categories. However, podiatric education has reacted sharply to societal needs, bringing new emphasis to present health problems. The health system is faced with the necessity for providing both quality and quantity care at a time when trained medical manpower is in short supply.

What is the mission of occupational health? In answer to this question a comprehensive occupational health program is outlined linking services for all job-related illnesses, injuries and hazards to other arrangements providing health care for the worker and his or her family. The significance of this problem makes it a matter of major concern to public health. [ABSTRACT FROM AUTHOR]

The resumption of relations with the People's Republic of China has aroused the interest of health workers in the United States concerning the organization and provision of health care in that country. This comprehensive review of the political, economic, cultural and legal determinants which have molded the Chinese system for the delivery of health care throws light on some aspects, and raises questions requiring more information. [ABSTRACT FROM AUTHOR]

A mail survey dealing with abortion coverage in the United States under Title 19 was conducted with State Commissioners of Health and Welfare of the 55 states and Territories. The results are reported and discussed. [ABSTRACT FROM AUTHOR]

The integration of community mental health with the comprehensive community health center is discussed. Reasons for earlier separation are explained and means for achieving integration are explored. [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]

The National Legal Program on Health Problems of the Poor is discussed in terms of its organization, responsibilities and activities. During its short existence of only a few years it has developed and utilized a number of legal tools and become involved in a wide range of health problems. [ABSTRACT FROM AUTHOR]

In dealing with programs in international health it has become evident that there are certain basic problems to be resolved if health action is to achieve what is desired. These are wasteful use of national resources for health, inaccessibility or absence of an effective delivery system for basic services, and the waste and inefficient use of food energy. The need for practical solutions is underscored. [ABSTRACT FROM AUTHOR]

Three referral patterns in a comprehensive health care delivery program are described and analyzed. Findings are discussed and interpreted. [ABSTRACT FROM AUTHOR]

An account is offered of the development of an educational program in family planning using nurse-teachers. The program was established in a voluntary hospital in a suburban-rural county in New York State. The methodology of program development is presented and the results are discussed. [ABSTRACT FROM AUTHOR]

The article reports on the evaluation of health programs focusing on the disparity between practice and desire in local health departments. According to the author, many persons greet evaluation process with skepticism and impatience and that the results of the evaluation effort could be used for the purpose of a selling job. He notes that the staff in the local health departments are underpaid and overpressured particularly during the recent social turmoil. The steps on how to remove disparity between desire and practice are presented.

The article reports on the evaluation of health programs on the federal level. According to the author, federal health services programs have been started since 1963, comprising a major federal role in the health services arena. He notes that the intense interest in program evaluation has been due to the widespread perception of a crisis in health services delivery, leading to a restless search for answers to the problems of unequal access, rising cost and indeferent quality. He suggests that the federal government should improve the health database which undergrids all evaluation efforts.

Citizen participation in decisions on provision of health services is of considerable current interest. This study examines the process of participation to determine the nature of participation and its relationship to various external factors. Preliminary findings are presented and briefly discussed. [ABSTRACT FROM AUTHOR]

Abstract: We assessed the impact of a health education course on infant feeding practices in the West Bank territories by comparing mothers who had attended the course (n = 102) with mothers not exposed to the course (n = 133). After adjustment for child's age, maternal age and education, parity, and birth site, course participants were more likely than non-participants to breastfeed, as well as to start supplementation by semi-solid foods at the recommended time. (Am J Public Health 1990; 80:732-733.) [ABSTRACT FROM AUTHOR]

Abstract: Community-oriented primary care (COPC) represents a specific variation on the general primary care model. Seven case studies from vastly different health care settings were examined and this report describes the diversity of expression of the principles of COPC observed. The results suggest that COPC is not limited to publicly funded programs, but can find expression in the private sector as well. The organization of financing and the lack of feasible quantitative tools hinder the full development of the model. (Am J Public Health 1986; 76:279-281.) INSET: Expanded Nurse Training Program Includes Home Health Care. [ABSTRACT FROM AUTHOR]

The article focuses on dental care programs in schools. Yearly follow- up is considered adequate in a public health program, as the increment in cost needed for more frequent examinations is better spent in providing services to additional children. The combined use of fluoride tablets and fluoride mouthrinse in all non-fluoridated sites in the study would also be an anomaly in public health programs. Since tablets given to 5th graders could affect no developing teeth other than third molars, and those given to first and second graders is the most minimal effect on almost fully developed permanent teeth of the children, the reason for including tablets in the study is to elucidate a research question concerning incremental topical effects in combination with fluoride mouthrinse.

International trends and recently proposed changes risk confining the duties of epidemiologists to support of health services delivery or to serving as functionaries within exclusively clinical departments pose a threat to the future role and training of epidemiologists. It is argued that these attempts would weaken the academic focus for epidemiologists and compromise the system of recognition and rewards available through the hierarchy of the discipline. [ABSTRACT FROM AUTHOR]

The article discusses the study on the training of optometrists in hypertension detection through a successful program, and the preliminary results of screening 14,000 patients. The programs were presented and designed to upgrade their effectiveness in screening for hypertension during the routine care of patients, charge patients with the responsibility for screening for hypertension during routine care and demonstrate that optometrists can be an effective resource in hypertension detection. The program and the preliminary results indicate that optometrists are an underutilized resource and that they can and should screen for hypertension.

Several letters to the editor are presented in response to articles in previous issues including the observations of William J. Curran on the implications of Geduldig v. Aiello with regard to the inclusion of pregnancy and childrenbirth-related benefits under future health programs, "Quality: Medical Care's Answer to Madison Avenue," by Eric Helt and James Pelikan, views of the author about the inadequate knowledge of the use of the insect sting emergency first aid kit.

The article discusses the cooperative efforts of the state and federal animal health officials to combat bovine tuberculosis in the U.S. The government made changes in program in order to prevent the eradication effort from degenerating into a static control program. National program statistics and studies of current outbreaks have shown the need for better surveillance and condemnation of all exposed cattle in herds with spreading infection. It was also mentioned that detailed epidemiological investigations are essential to finding and eliminating the remaining foci of disease.

The role of nurse-midwives in a family planning program is described. Details are given on the program, the training of nurse-midwives to function in it, and its expansion to foreign countries with AID assistance. [ABSTRACT FROM AUTHOR]

This statement calling attention once more to the social causes of disease gets down to fundamentals. It emphasizes the degree to which public health problems are generated by society and can be handled meaningfully by changing social conditions. [ABSTRACT FROM AUTHOR]

Abstract: To test whether the cardiovascular disease declines in North Karella were accompanied by subjective improvements in health, we analyzed responses to two questions about perceived risk of heart disease and health status on independent random population samples surveyed to years apart. Age stratified perceived risk of heart disease declined significantly more (p < .01) and age stratified perceived health status improved significantly more in North Karelia than in the reference area (p < .005). [ABSTRACT FROM AUTHOR]