Quantitative Guidelines for Communicable Disease Control Programs

The period since 1940 abounds with successful applications of mathematical modeling techniques to problems of control in engineering and business. 'Feedback Control' and 'Adaptive Systems' are almost household words. The 1950's saw linear programming techniques sweep industry by storm. Techniques allied to the calculus of variations were used to calculate optimal interplanetary trajectories for rockets. Industrial inventories with part numbers running in the hundreds of thousands were managed by principles derived from mathematical modeling. Since most of us are convinced that a science of medicine exists and that a science of the delivery of health services is emerging, one may wonder why no control theories similar to those developed for engineering and industrial management exist for health services delivery. The emergence of the field 'Management Science' leads us to hope that some of the techniques that have been used so successfully can be translated into health. On the surface, it would seem that the problems associated with the delivery of health services are at least as manageable as those of modern industry. The principal uses that have been made of optimization techniques have been to the control of real-time systems and to the allocation of scarce resources among competing requirements. Both of these problems exist in the health field in abundance. Perhaps the most common example of the first class of problems is the health delivery system geared to the elimination of a particular health problem. Stated somewhat more formally, the health delivery team is charged with the task of achieving present health goals with the health delivery system subject to constraints on the total resources that can be expended on this task. With very little change in language, this problem could have been stated as a problem concerned with the control of a chemical processing plant.