September 29, 1967 :
M REVIEW of Opportunities for Programs
by the National Advisory Council

 

REVIEW OF OPPORTUNITIES
FOR REGIONAL MEDICAL PROGRAMS
BY THE NATIONAL ADVISORY COUNCIL OF
THE DIVISION OF REGIONAL MEDICAL PROGRAMS

® During its August 28-29, 1967 meeting, the National Advisory
Council of the Division of Regional Medical Programs received re-
ports from the staff of the Division dealing with a number of major
issues. Two reports were considered of sufficient importance to
warrant special deliberation by sub-committees of the Council. One
of these reports concerned the transition of individual Programs
from planning to operational stages. The other involved the concern
of Regional Medical Programs with metropolitan areas and. the related

urban health problems. The following summaries of the deliberations

are for your consideration.

U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE

-_ a aed A ONNTA
Transition Of Individual Programs @
From Planning Into Operational Stages

The Council recognized that all Programs as they are developed will
have to respond to the ever-changing needs of the Region, and agreed that
fashioning the final form of a Regional Medical Program may actually never
be achieved. However, it also recognized that an orderly and well-planned
sequence is necessary to begin to move Programs from planning into operation
stages, and thence to further development. This will permit all three
elements--planning, operation and evaluation--to proceed in the most
effective possible way.

As a result, the Council expressed its belief that each Program should
be encouraged to move toward its operational phase at the earliest possible
time consistent with its ability to define its goals and develop projects
to achieve them. It was a general opinion that the submission of those }
selected initial projects which will appropriately permit a Region to begin
its transition toward a full scale operative phase will act as a catalyst

toward this end and should be encouraged.

Neither the total number of projects nor a dollar amount to implement
them have been considered as criteria for determining the soundness of such
initial proposals. Rather, their character, the order in which they will
be undertaken, their promise for achieving the defined goals of the Programs

and ability and readiness of that particular Region to implement them will be

   

the deciding factors.

 
The Relationship Of Regional Medical Programs
To Other Agencies And Programs °

During Council deliberations on the general topic of operational
proposals, attention was given to the increased opportunities to relate
substantive proposed projects in heart disease, cancer, and stroke to
existing interests and activities of other organizations and agencies,
both local and national. It was the Council's opinion that a Regional
Medical Program may well benefit from the knowledge and experience of such
established organizations and the best interests of both will be served by
cooperative efforts.

Examples of activities already planned or established by other organi-
zations cited as being of possible interest to individual Regional Medical
Programs are:

Those relating to, research efforts. These would

include such activities as those involved with

clinical trials of chemotherapeutic agents sponsored

by the National Cancer Institute; the studies de-

signed to find more effective ways of screening
populations for stroke susceptibility being encouraged
by the National Institute of Neurological Diseases and
Blindness; the myocardial infarction research program

of the National Heart Institute; studies in the delivery
of health care sponsored by the Bureau of Health Services;
and the categorical disease programs of the Bureau of

Disease Prevention and Environmental Control.
Those relating to education and training programs.

These would include such programs as those established

by a number of components of the Public Health Service,
especially those of the categorical Institutes, the
National Institute of General Medical Sciences, the
Bureau of Health Manpower, the National Library of
Medicine, and the well-established training and educa-
tional programs such as those under the auspices of

the American Heart Association, the American Cancer
Society, the American Medical Association, the American
Academy of General Practice, the American Hospital
Association, and all of the other appropriate professional
and allied health associations and national and local
public, private, and voluntary health organizations,
institutions and agencies.

Those relating to the development of major community
resources. Included would be such activities as the
existing or proposed categorical and non-categorical
research centers of the various Institutes of the National
Institutes of Health, such as the Cancer Research Centers
of the National Cancer Institute, the Cardiovascular
Research and Training Centers of the National Heart
Institute, the out-patient Stroke Research Units of the
National Institute of Neurological Diseases and Blindness,

and resources for radiation therapy of cancer.

-4-
 

An expanded list of similar possibilities could probably be generated

within each Region from its local agencies and organizations.

Development Of Regional Medical Programs
In Metropolitan Areas And
Relationship to Urban Health Problems

The Council gave recognition to the current policy statements concern-
ing the nature of Regional Medical Programs in the following terms:

"The ultimate objective of Regional Medical Programs is clear and
unequivocal. The focus is on the patient. The object is to influence the
present arrangements for health services in a manner that will permit the
best in modern medical care for heart disease, cancer, stroke, and related
diseases to be available to all. The scope of the program is nationwide
encompassing the great cities, suburbia, and the rural areas. The Regional
Medical Programs put into practice the principle that the essential respon-
sibility and power for the improvement of health services should be exercised
locally. The basic policy of the program is designed to encourage innovation,
adaptation, and action at the regional level."

The Council acknowledged that the realization of the goal of Regional
Medical Programs is most difficult and challenging in the metropolitan areas.
Because of the inherent complexities.of our large cities, the slowness of
Program development and action there is understandable. However, the wide-
spread demonstrations and riots in the inner-city of some metropolitan areas _
throughout the country point up the critical need for action to meet some of

the basic problems of people living there. In this connection, it is
recognized that health is not an exclusive factor in the urban problem, but @
is interrelated with economic, social and political elements. Just as the
spectrum of urban problems is broader than health, the spectrum of health

is broader than the focus of the Regional Medical Programs. Nonetheless,

Regional Medical Programs carry a significant relationship and a major re-
sponsibility to contribute to the efforts for solution of the urban problem.
Failure to recognize this fact risks the conclusion by those involved that

the Regional Medical Programs do not have significant relevance in

metropolitan areas.

The Council, therefore, recognized that appropriate action by Regional
Medical Programs in metropolitan areas is critical to their becoming a part
of the total health system. The concept of local initiative, fundamental]
to the Regional Medical Programs from the beginning, requires each area to }
develop its own approach peculiarly suited to its needs and resources.
Whether this be as a contributor to approaches in the development of systems
for the delivery of high quality care in the authorized disease areas, or
more limited prototype experiments in extending specialized services for
heart disease, cancer or stroke, therefore, is dependent upon local deter-
mination in each instance. Since Regional Medical Programs now include
virtually every major metropolitan area of the country, the Council expressed
the belief that all Programs have a responsibility to contribute in their

own way to this particular segment of their Region.
Therefore the Council suggested that Regional Medical Programs...
Actively work with metropolitan planning agencies and
programs ,
Undertake appropriate patient care demonstration or
other projects in inner-city areas,
and that the Division of Regional Medical Programs of the National Institutes
of Health... |
Encourage, develop, publish and promote a series of
pertinent papers on subjects concerning relationships
between Regional Medical Programs and urban problems,
Name and call together appropriate national leaders to
consider how the attention of Regional Medical Programs
can best be focused on the urban health issues in

metropolitan areas and their inner-cities.

Conclusion

As it reviewed the progress of Regional Medical Programs, the Council
continued to express its conviction that the Programs will “encourage and
assist...the medical profession and the medical institutions of the Nation...
in making available to their patients the latest advances in the diagnosis
and treatment of these diseases." The Council recognized that at this point
in time it cannot be sure of the degree to which the opportunities offered
by this program will be fully utilized by the Programs themselves. It also —

recognized that this potential cannot be achieved by a crash program, or