Meat 
and 
Food 
Sanltatloi 
ENVIRONMENTAL SANITATION SECTION 
Milk 
Sanl ta- 
tlon 
Bedding 
and 
Up hoi stery 
DIVISIONS 
I 
OREGON STATE DEPARTMENT OF PUBLIC HEALTH 
Rodent 
Control 
Plumbing 
Health 
Educ at Ion 
STATE BOARD OF HEALTH 
Camp s 
and 
Resorts 
LOCAL HEALTH SERVICES SECTION 
ASSISTANT STATE HEALTH OFFICER 
CONSULTING ADVISOR? FIELD STAFF 
STATE HEALTH OFFICER 
ADMINISTRATION SECTION 
public 
Heal th 
Engineering 
Labora- 
tories 
DIVISIONS 
Statistics 
and 
Records 
Mental 
Hyglene 
General 
Adroinls- 
tratlon 
Adul t 
Heal th 
and 
Indus trlid. 
Hyglene 
PREVENTIVE MEDICAL SERVICES SECTION 
Oral 
Health 
DIVISIONS 
Public 
Heal th 
Nursing 
Maternal 
and 
Child Health; 
Crlppled 
Chll dren; 
Nutrltlon 
Disease 
Control 
Accidents 
Oonmunl cable 
dlseases, 
tuberculosis, 
venereal 
dlseases, 
cancer. THE OREGON STATE BOARD OF HEALTH 
Its Policies, Programs, and Needs 
SCOPE AND SPONSORSHIP OP STUDY 
The study of which this is a report was made by the 
American Public Health Association, through its field 
director,* at the request of the state health officer,** 
v/ith the authorization of the Oregon State Board of Health. 
This is one of a series of state health studies financed 
by a grant to the American Public Health Association by the 
Commonwealth Fund of New York. These studies, carried on 
under the sponsorship of the Committee on State Health 
Administration,*** a sub-committee of the Committee on 
Administrative Practice of the American Public Health Asso- 
ciation, are granted only on request to a few selected states 
which have demonstrated to the satisfaction of the Committee 
that (a) there is a need for the study and (b) that there is 
sufficient interest and public health leadership in the state 
to justify the conclusion that effective use of the survey’s 
findings and recommendations will be made. Other states and 
provinces included in the series of studies financed by the 
Commonwealth Fund are Oklahoma, Michigan, Florida, Manitoba, 
Illinois, Washington, and California. 
Although sponsored by the American Public Health Associ- 
ation and more specifically by its Subcommittee on State 
Health Administration, the statements in this report are 
those of the field director and do not necessarily represent 
the opinion of the American Public Health Association, or 
its Subcommittee on State Health Administration. 
This is essentially an administrative study designed 
to suggest a simplification of administration and a more 
effective approach to the problem of encouraging and imple- 
menting local full-time health programs geared to meet local 
needs. It makes no effort to evaluate the details of pro- 
fessional or technical procedures. 
The surveyor is deeply grateful for the interest and 
splendid cooperation of the State Board of Health, the State 
Health Officer and all members of the staff of the State 
Board of Health, County and City Health Officers and of the 
Oregon Tuberculosis Association. Corrections to be made in the Oregon Report 
Page 19 - Recommendation No. 8 after the words "State 
Medical and Dental Associations insert "perhaps the City of 
Portland and Multnomah County Health Departments", and then 
go on with the Oregon TBC Association etc. 
Page 20 - First paragraph - next to last line after the 
word "housekeeping" insert in parenthesis (maintenance of 
building including janitor, maid, linen and other services 
incident to the upkeep of the building.) 
Page 26 - Following Recommendation 30 - Change wording 
concerning University of California, etc. to read, "Such a 
course is already available at the University of California. 
Perhaps the Oregon State College would be interested in 
establishing a course for sanitarians". 
Page 30 - This was indeed a serious omission on my part.' 
On the lower half of the page after "a" insert new "b" to read, 
"One or more well qualified generalized ptiblic health advisory 
nurses". Then change "b" to "c" and "c"f to "d" . 
Page 31 - Next to last paragraph - Cross out the words 
"the pediatrician". 2 
Major Observations and Hocoiranondations 
Observations 
Viewed in tho light of the foregoing aims and principles 
one finds that tho Oregon program subscribes to and promotes 
them. This does not moan that all the objectives of tho pro- 
gram have been achieved; it does mean that tho principles adopt- 
ed are in keeping with good administrative practice. The 
Oregon program has boon developed gradually and perhaps somewhat 
conservatively but what has been and is being done is sound. 
What errors may have been made arc errors of omission rather 
then commission. 
Some phases of Oregon’s program are strong, others are weak, 
nearly all need further implementation, and a few have hardly 
boon started. Certain observations and recommendations will, it 
is hoped, clarify these strengths and weaknesses. 
Strengths 
Tho policies of the Oregon State Board of Health have been 
and are sound as judged by policies in effect throughout tho 
coun try• 
The Oregon State Board of Health has been fortunate in 
having had continued leadership in tho person of but a single 
health officer for over twenty years. 
Its programs have been planned in cooperation with the 
state medical and dental associations. 
Nearly all of the Divisions of tho State Board of Health 
(State Department of Health in most states) arc in charge of 
capable well-trained professional j^orsons. 
The Assistant State Health Officer is also tho Director 
of Local Health Service, which is in keeping with good admini- 
strative practice. 
Tho Oregon health program is fortunate in having an un- 
usually strong and effective State Tuberculosis Association 
with County Ilo-alth Associations in each of the state fs 36 
COWJti.es* 3 
The Venereal Disease program is well planned and capably 
administered. It is gratifying to note that a state wide treat- 
ment center for both sexes is soon to be established. 
While there is no division of health education there has 
been some effective work in this field. 
The Division of Public Health Nursing has an unusually well 
trained staff, has a long heritage of capable leadership and is 
a strong division. 
The Division of Maternal and Child Health is capably 
administered and has done and is doing particularly good work in 
tho protection and promotion of maternal and infant health. 
The Division of Tuberculosis Control seems to be planning 
wisely, but its program is too new to evaluate it at this time. 
The same remark applies to tho programs in Industrial 
Hygiene and Vital Statistics. 
Tho Division of Mental Hygiene apparently made an auspicious 
start but had to discontinue its activities because of tho war. 
While there arc some weaknesses and seme omissions, the 
public health laws, rules, and regulations of the State Board of 
Health are on the whole good. 
While only twenty-one of tho state’s thirty-six counties 
are covered with full-time health -departments they represent 
over 90 per cent of the total population. 
Weaknesses 
The most Important weakness in Oregon’s health program is a 
serious shortage of trained public health personnel, particularly 
sanitary officers and public health nurses. Three of the 19 
full-time county or multiple county health departments are at 
present without a full-time health officer. Of the 19 full-time 
local health departments (exclusive of the City of Portland) 
only seven or 37 per cent have a sanitary officer. There are at 
present about 15 public health nursing vacancies in full-time 
health, departments. 
This shortage of trained public health personnel--!ar more 
serious than the shortages to be found in many other states-- 
seems clue to tv/o factors, (a) low salaries, particularly of 
health officers and sanitarians, and (b) an apparent lack of 
understanding or appreciation on the part of the people of 
Oregon that a public health position on the home front is an u. 
important part of tho war effort and is just as much entitled 
to consideration and recognition as active service. 
The responsibility for the control and supervision of milk, 
meat and other foods end food products and food handling 
establishments is (except for federal inspection of interstate 
moats) vested solely in tho State Department of Agriculture. 
While tho Department of Agriculture does and should have a 
vitally Important interest in these ficlds--animol husbandry 
and the promotion, development and protection of tho farmers* 
intorests--tho public health aspects of these fields are also of 
far reaching importance and should unquestionably bo tho 
responsibility of full-time health departments. Milk, meat and 
other foods and food products can and have, when inadequately 
controlled and supervised, resulted in serious epidemics. Not 
to place tho public health aspects of their control and super- 
vision in full-time local health departments (which are tho only 
agencies equipped to deal with these problems satisfactorily) is 
nothing short of folly. 
The State Board of Health is composed solely of professional 
persons; there is no provision for lay representation. While 
this situation is not unique, the tendency is distinctly toward 
providing lay representation on state boards of health. 
While at present tho State Board of Health is fortunate in 
having as State Health Officer a man of long experience in public 
health, tho law does not prescribe any special public health 
qualifications for the state health officer. This is a serious 
omission. 
Tho State Board of Health (State Department of Health in 
most states) consists of some 14 more or loss autonomous 
divisions whose activities arc coordinated only through tho 
person of the State Health Officer. This is an unwieldy and 
unsound plan of organization. It is not a plan which will lend 
Itself to simplicity and facility of administration. 
Tho Director of Local Health Service who is also the 
Assistant State Health Officer is a capable well trained man, 
but he has no staff to carry on much needed field service. There 
is no consultation-advisory field staff in tho Division of Local 
Health Service. 
There is need for a more effectively coordinated planned 
program of education in the fiold of social hygiene. 
Tho State Board of Health has no epidemiologist or director 
of communicable disease control. There is a pressing need fer a capable well trained 
director for the Division of Laboratories. 
There is no Division of Health Education. 
The amount of financial support for public health through 
state funds is exceptionally low in Oregon, Appropriations 
(for 1942-1943) for public health by the state legislature total 
4.5 cents per capita (based on an estimated population of 
1,191,229) which is one of the lowest per capita health 
appropriations of any state in the Union, 
While the total number of beds for the care cf the 
tuberculous is reasonably adequate, a considerable number of bods 
are not at present in use--bccauso of man power shortogos--and 
there arc no facilities for the enforced hospitalization of the 
recalcitrant ease and inadequate facilities for the domiciliary 
care of tuberculosis patients who would not bo particularly 
benefited by modern sanatorium treatment. 
Neither the state or local health officer is specifically 
authorized to hospitalize cases of tuberculosis. While complete 
figures are not available it seems safe to say that at least 50, 
probably more, cases cf tuberculosis are at home who should be 
hospitalized, 
There are in the Oregon State Board of Health too many one 
man divisions, that is divisions in which there is only one 
professionally trained person. This is unsound for a state the 
size and importance of Oregon in that it makes one man responsi- 
ble- for not only the planning end administration of the program, 
but also for the field work with local health departments which 
is more than one man can carry satisfactorily. Venereal Disease, 
Tuberculosis, Local Health Service, and Vital Statistics are all 
one man divisions os far as professional personnel is concerned. 
There is no legislation which legalizes the formation of 
multiple county city-county health departments and provides 
for a single board of health and a single fiscal agent for such 
departments. 
The Oregon State Board of Health is altogether too reliant 
upon the U. S. Public Health Service for professional leader- 
ship, Three important divisions. Tuberculosis, Venereal Disease, 
and Industrial Hygiene arc not only largely financed by but also 
almost if not entirely staffed by persons loaned from the U. S, 
Public Health Service. The persons now occupying these positions 
of divisionol directors arc well trained excellent men, but if it 
became necessary for the Public Health Service to more them 
(which might happen at any time), the Oregon State Board of 
Health would bo sadly and seriously depleted. 
The present quarters of the State* Board of Health are 
inadequate and will not permit needed expansion. 6 
MAJOR RECOMMENDATIONS 
The following recommendations are made with a view nf correcting 
the weaknesses spoken of in preceding paragraphs# It is recommended: 
(1) THAT, THE AGENCY NOW KNOWN AS THE OREGON STATE BOARD OF 
HEALTH CHANGE ITS NAME TO THE OREGON STATE DEPARTMENT OF 
PUBLIC HEALTH. 
(2) THAT, THE OREGON STATE DEPARTMENT OF PUBLIC HEALTH (FORM- 
ERLY THE OREGON STATE BOARD OF HEALTH) CONSIST OF TWO 
BRANCHES; 
(a) THE STATE BOARD OF HEALTH AS THE ADVISORY, 
JUDICIARY, POLICY FORMING BUT NOT EXECU- 
TIVE BRANCH OF THE DEPARTMENT, AND 
(b) THE STATE HEALTH OFFICER AND HIS STAFF AS 
THE EXECUTIVE, ADMINISTRATIVE BRANCH OF THE 
DEPARTMENT• 
It is further recommended: 
(3) THAT THE STATE BOARD OF HEALTH BE COMPOSED OF FIVE DOCTORS 
OF MEDICINE AND FOUR PERSONS FROM OTHER WALKS OF LIFE. 
This recommendation is made in the firm conviction that 
since public health services are for all persons, the people, 
that is the consumer, should have reasonable representation 
on the Board which is to formulate plans and policies for 
providing health services. Beyond the proviso that the Board 
should have reasonable medical representation, which will 
assure professional guidance, wo do not believe that the 
appointing power should bo any further limited. 
It is further recommended; 
(i;) THAT, THE STATE HEALTH OFFICER WHO IS APPOINTED BY THE BOARD 
OP HEALTH, MAY ACT AS SECRETARY OF THE BOARD OF HEALTH BUT 
SHOULD NOT BE A VOTING MEMBER. 7 
It is also strongly recommended: 
(5) THAT NO PERSON SHALL BE ELIGIBLE TO APPOINTMENT AS 
STATE HEALTH OFFICER UNLESS SUCH PERSON SHALL BE A 
DOCTOR OF MEDICINE FROM A GRADE A MEDICAL SCHOOL 
AND SHALL HAVE FAD AT LEAST ONE YEAR OF SPECIAL 
POST GRADUATE TRAINING IN A RECOGNIZED SCHOOL OF 
PUBLIC HEALTH AND AT LEAST THREE YEARS EXPERIENCE 
IN A FULL-TIME HEALTH DEPARTMENT OR AGENCY OR IN 
LIEU OF SUCH POST GRADUATE TRAINING IN PUBLIC HEALTH 
HE SHALL HAVE HAD AT LEAST FIVE YEARS EXPERIENCE IN 
AN ADMINISTRATIVE POSITION IN A FULL-TIME HEALTH 
DEPARTMENT . 
As a means of bringing about a more effective 
coordination of the present fourteen relatively 
uncoordinated divisions, or preventing vertical 
administration, and of making possible the 
administration of the entire department through four well 
qualified executives, it is recommended: 
(6) THAT, THE PRESENT, AND ANY FUTURE CONTEMPLATED 
DIVISIONS OF THE DEPARTMENT BE PLACED IN FOUR MAJOR 
SECTIONS TO BE KNOWN AS THE SECTIONS OF .ADMINISTRATION, 
PREVENTIVE MEDICAL SERVICES, ENVIRONMENTAL SANITATION, 
AND LOCAL HEALTH SERVICE., AND THAT THE ATTACHED 
ORGANIZATIONAL CHART BE ADOPTED. 
The several advantages of this plan of organization are:- 
(a) It enables the State Health Officer to administer his 
entire department through a small number of executive 
officers • 
(b) It avoids a large number of Independent administrative 
units and enables the State Health Officer to correlate 
the work of the Department more effectively. 
(c) It defines clearly the chain of responsibility of the 
directors of the several sections and division of the 
Department 
(d) It centralizes the direction of divisions having close 
inter-relationships by placing administrative 
responsibility in the office of a single section 
director who in turn interprets the program and needs 
of these divisions to the State Health Officer. 
Organization 
of 
Department 8. 
(e) It provides a clear cut channel to the field, through the Sec- 
tion of Local Health Service, for translating into effective 
local action the policies and techniques as worked out by tho 
various divisions and approved by the State Health Officer# 
It is further recommended:- 
(6a) THAT, IN ADOPTING THE PLAN OF ORGANIZATION THE ADMINISTRATIVE 
RESPONSIBILITIES OF EACH SECTION, DIVISION OR SUB-DIVISION 
DIRECTOR BE CLEARLY DEFINED INCLUDING THE ADMINISTRATIVE PRO- 
CEDURES TO BE ADOPTED BY SECTION OR DIVISIONAL DIRECTORS IN 
DEALING WITH EACH OTHER. 
(6b) THAT, THE FUNCTIONAL RESPONSIBILITIES OF KICK SECTION AND DI- 
VISION DIRECTOR BE CEARLY DEFINED. (6c) THAT, A MANUAL OF PROCEDURE FOR THE STATE DEPARTMENT 
OF PUBLIC HEALTH BE PUBLISHED EMBODYING THE PLAN OF 
ORGANIZATION AND DEFINING BOTH ADMINISTRATIVE AND 
FUNCTIONAL RESPONSIBILITIES. 
(6d) THAT, IT BE CLEARLY UNDERSTOOD BY THE DEPARTMENT OF 
PUBLIC HEALTH AND THE MERIT SYSTEM THAT THE PLACEMENT 
OF ANY EXECUTIVE PERSON (SECTION, DIVISION OR SUB- 
DIVISION DIRECTOR) IN A CERTAIN POSITION ON A 
DIADRAMATIC CHART OF ORGANIZATION MERELY DEFINES 
ADMINISTRATIVE RESPONSIBILITY. IT DOES NOT INDICATE 
FUNCTIONAL RESPONSIBILITY AND THE DIAGRAMATIC OR 
ADMINISTRATIVE PLACEMENT SHOULD HAVE NO RELATIONSHIP 
TO THE SALARY SCALE WHICH SHOULD BE ADOPTED FOR THAT 
POSITION. 
Attention has already been called to the serious shortage 
of trained public health personnel in Oregon. This shortage is 
duo in part at least to totally inadequate salary schedules. 
As an essential basis to the effective recruitment and retention 
in service of trained public health personnel, it is recommended: 
(7) THAT A CAREFUL REVIEW AND STUDY OF THE PRESENT OR 
CONTEMPLATED MERIT SYSTEM BE MADE WITH A VIEW OF 
BRINGING ABOUT A MORE EQUITABLE SYSTEM OF CLASSI- 
FICATION (PARTICULARLY IN CERTAIN FIELDS SUCH AS 
VITAL STATISTICS) AND A DEFINITE REVISION UPWARDS 
OF PROFESSIONAL SALARIES. SUCH STUDY SHOULD ALSO 
CONTEMPLATE THE ESTABLISHMENT OF SOME RETIREMENT 
PLAN . 
# 
Except for public health nurses salaries for 
professional public health personnel in Oregon are 
exceptionally low. Many capable public health people 
have left Oregon to take positions elsewhere because 
of the low salaries here. Oregon cannot hope to 
recruit and retain the best type of public health 
personnel unless it raises its salaries. No merit 
system can hope to be successful in the long run 
unless it has an adequate retirement plan. 
(8) THAT, MORE ADEQUATE HOUSING FACILITIES FOR THE STATE 
HEALTH DEPARTMENT BE PROVIDED. A SINGLE BUILDING 
FOR THE STATE HEALTH DEPARTMENT, WHICH MIGHT ALSO 
PROVIDE QUARTERS FOR THE STATE MEDICAL AND DENTAL 
ASSOCIATIONS, THE OREGON TUBERCULOSIS ASSOCIATION 
AND POSSIBLY OTHER STATE-WIDE HEALTH ORGANIZATIONS, 
WOULD BE HIGHLY DESIRABLE. 10 
(9) THAT, EVERY EFFORT BE MADE TO SECURE ADDITIONAL 
STATE APPROPRIATIONS FOR PUBLIC HEALTH. 
The present state appropriations (1942-1942 
for public health of 4.5 cents per capita is onat 
of the lowest in the country. 
(10) THAT LEGISLATION EE ENACTED PERMITTING THE 
ESTABLISHMENT OF CITY-COUNTY AND MULTIPLE COUNTY 
HEALTH DEPARTMENTS AND PROVIDING FOR A SINGLE 
BOARD OF HEALTH AND A SINGLE FISCAL AGENT FOR 
SUCH DEPARTMENTS. 
ADMINISTRATION 
General Administration 
It is recommended: 
(11) THAT THE DIVISION OF GENERAL ADMINISTRATION 
INCLUDE AT LEAST A PERSONNEL OFFICER AND A BUSINESS 
MANAGER AND FISCAL AGENT. 
The personnel officer in addition to being in 
charge of personnel and personnel recruitment through 
the merit system, should also be in charge of procure- 
ment and assignment of stenographic and clerical 
assistance for the entire department. .The business 
manager and fiscal agent should be responsible for 
housekeeping, purchasing end all fiscal affairs of 
the department. 
The receipt and tabulation of communicable 
disease reports obviously should be transferred to 
the Division of Statistics and Records. 
Statistics and Records 
It is recommended; 
(12) THAT THE NAME AND FUNCTION OF THE DIVISION OF 
VITAL STATISTICS BE CHANGED TO THE TITLE OF AND 
FUNCTIONS OF STATISTICS AND RECORDS. 
This now division should include not only vital 
statistics, as at present, but also morbidity reports 
and analyses and receipt and processing of service 
records, side by side with problem statistics, 
mortality and morbidity statistics to which they 
refer, Health Education 
It is recommended: 
(13) (a) THAT A DIVISION OF HEALTH EDUCATION BE ESTABLISH- 
ED AND THE FUNCTIONS OF THE PERSONS RESPONSIBLE 
FOR IT BE DEFINED AND THAT STATE FUNDS BE SOUGHT 
FOR ITS IMPLEMENTATION. 
(1) One person to he responsible for promotion and 
publicity, as far as the State Board of Health 
is concerned, and for relationships v/ith the press, 
together with such continuing functions as may bo 
indicated in venereal disease education. 
(2) One person to bo responsible for organizing 
community resources for health education including 
group and agency stimulation, interpreting and 
planning, end for providing aid to other 
divisions and local health departments in those 
fields of organization and mass education through 
self initiated projects, 
(b) THAT AN EFFORT BE MADE TO SECURE TWO ADDITIONAL 
PERSONS WELL TRAINED IN MODERN HEALTH EDUCATION 
TO BE ASSIGNED TO COUNTY OR MULTIPLE COUNTY 
HEALTH DEPARTMENTS TO DEMONSTRATE HOW TO MAKE 
THE MOST EFFECTIVE USE OF COMMUNITY RESOURCES, 
Laboratories 
It is strongly recommended: 
(14) THAT, EVERY POSSIBLE EFFORT BE MADE TO SECURE A 
WELL-TRAINED CAPABLE DIRECTOR OF PUBLIC HEALTH 
LABORATORIES AS ONE OF THE MOST IMPORTANT NEEDS 
OF THE STATE DEPARTMENT OF HEALTH. 
Additional quarters will eventually bo 
necessary• 
Preventive Medical Services 
Disease 
Control 
The State Board of Health at present has no 
epidemiologist. Since one of the basic functions of 
any health department is the study, control and 
prevention of disease, it is recommended: 12 
(15) THAT, A PERSON WELL TRAINED AND EXPERIENCED IN 
DISEASE CONTROL AND PREVENTION BE EMPLOYED AS THE 
EPIDEMIOLOGIST OF THE STATE DEPARTMENT OF HEALTH. 
The Tuberculosis Division of the State . 
Board of Health, in common with several other 
divisions, has but a single trained professional 
person. In a state the size of Oregon the place- 
ment of the responsibility for planning, administration, and 
field service in the hands of one person is unsound in that the 
job is more than one person can be expected to carry satisfac- 
torily. 
It is therefore recommended: 
(16) THAT, A PHYSICIAN WELL TRAINED AND EXPERIENCED IN 
TUBERCULOSIS CONTROL AND PREVENTION, PARTICULARLY 
IN THE FAMILY COMMUNITY ASPECTS OF THE PROBLEM, 
BE ADDED TO THE STAFF OF THE TUBERCULOSIS DIVISION. 
(17) THAT, LEGISLATION BE ENACTED AUTHORIZING THE STATE 
HEALTH OFFICER AND ALL FULL-TIME LOCAL HEALTH 
OFFICERS TO HOSPITALIZE ANY CASE OR SUSPECTED CASE 
OF TUBERCULOSIS. 
(18) THAT, AT LEAST 100 ADDITIONAL BEDS BE PROVIDED FOR 
THE CARE OP THE TUBERCULOUS • THESE BEDS SHOULD BE 
AVAILABLE FOR TWO TYPES OF CASES. 
(a) CASES NEEDING CUSTODIAL CARE BUT NOT IN NEED 
OF SANATORIUM CARE, AND 
(b) FOR THE ENFORCED HOSPITALIZATION OF RECALCITRANT 
CASES WHICH REFUSE HOSPITALIZATION OR REFUSE TO 
ABIDE BY THE RULES AND REGULATIONS OP MODERN 
SANATORIUM TREATMENT• 
If possible these beds should be provided as an 
additional wing or pavlllion of the present 
University of Oregon State Tuberculosis Hospital. 
Such addition would obviously necessitate a full-time 
well trained medical director. The same contractural 
relationship could be maintained with the University 
of Oregon Medical School. This plan would have the 
distinct advantage of lowering the per diem cost of 
care which at present is apparently unusually high. 
If this recommendation for some reason seems 
unfeasible the 100 beds might be added to the State 
Tuberculosis Sanatorium at Salem. 
Tuberculosis It should be understood that tuberculosis cases 
which are forcibly hospitalized, in the detention 
quarters just suggested, and are of the type which 
could be benefited by modern sanatorium treatment 
should be transferred to sanatorium care if and when 
they have demonstrated their willingness and ability 
to abide by reasonable rules and regulations for 
tuberculosis care and treatment - 
Venereal Disease 
It is recommended: 
(19) THAT, A SECOND PHYSICIAN, TRAINED IN PUBLIC HEALTH 
WITH SPECIAL TRAINING AND EXPERIENCE IN VENEREAL 
DISEASE CONTROL, BE ADDED TO THE STAFF OF THE 
DIVISION OF VENEREAL DISEASE CONTROL TO PERMIT MORE 
FIELD SERVICE THAN IS NOW POSSIBLE. 
(20) THAT, A MORE EFFECTIVELY COORDINATED AND PLANNED STATE- 
’"IDE PROGRAM OF EDUCATION IN SOCIAL HYGIENE BE INSTITUTED. 
The same remarks which were made concerning 
the need for additional professionally trained 
persons in the fields of tuberculosis and venereal 
disease control are applicable to an even greater 
extent to maternal and child health* At present there is only 
one physician in the Division of Maternal and Child Health. At 
one time there were two. The Division should have three 
physicians, the director to plan and administer the program, a 
well trained pediatrician with special training in public health 
to give consultation-advisory service to local health depart- 
ments, and a well trained physician either an obstetrician or 
pediatrician to conduct the very important education program for 
which the licensing of maternity hospitals and homes provides 
the entree. 
It is therefore recommended; 
(21) THAT, TWO PHYSICIANS, BOTH PEDIATRICIANS OR ONE 
PEDIATRICIAN AND ONE OBSTETRICIAN, WITH, IP POSSIBLE 
SPECIAL PUBLIC HEALTH TRAINING, BE ADDED TO THE STAFF 
OF THE DIVISION OF MATERNAL AND CHILD HEALTH. 
For the present it would seem wise to retain 
Nutrition in the Division of Maternal and Child 
Health but it seems probable that eventually there 
should be a separate Division of Nutrition. 
Maternal 
and 
Child Health Public 
Health 
Dentistry 
It is unfortunate that the dental program is not 
at present able to function at full efficiency 
because of the lack of a dentist on the State Board 
of Health Staff, Dentistry has been a part of the 
Division of Maternal and Child Health, This would seem to imply 
that public health dent:' stry did not apply to persons other than 
those Included in the maternal and child health field. This is 
of course not true, for public health dentistry may well function 
in Tuberculosis Control, and in Adult and Industrial Hygiene, 
It is therefore recommended; 
(22) THAT, A DIVISION OF PUBLIC HEALTH DENTISTRY BE 
ESTABLISHED AND THAT STATE FUNDS BE SOUGHT TO 
ASSIST IN ITS SUPPORT. 
At present the program for the care of Crippled 
Children is conducted by the University of Oregon 
Medical School and is without a full-time admini- 
strator. The Crippled Children’s program belongs logically in 
the Division of Maternal and Child Health and certainly needs a 
full-time administrator. 
It is recommended; 
(23) THAT, A FULL-TIME ADMINISTRATOR BE SECURED FOR THE 
CRIPPLED CHILDREN’S PROGRAM AMD THAT IT BE TRANSFERRED 
FROM THE UNIVERSITY OF OREGON MEDICAL SCHOOL TO THE 
DIVISION OF MATERNAL AND CHILD HEALTH OF THE OREGON 
STATE BOARD OF HEALTH. 
The program in Industrial Hygiene seems to be progressing 
satisfactorily and it is gratifying to note that there appear 
to be satisfactory and effective working relationships between 
the Division of Industrial Hygiene and the Industrial Accident 
Commission, The Director of the Division of Industrial Hygiene, 
in keeping with the plans and policies of several other state 
divisions of industrial hygiene, believes that the program, 
using Industrial hygiene as the entree, will eventually develop 
into a broad program of adult health Involving not only the 
worker but his family as well. 
It is recommended; 
(24) THAT, THE NAME OF THE DIVISION OP INDUSTRIAL HYGIENE 
BE CHANGED TO THE DIVISION OF ADULT AND INDUSTRIAL 
HYGIENE AND THAT STATE FUNDS BE SOUGHT TO ASSIST IN 
ITS SUPPORT. 
Crippled 
Children (25) THAT, THE DIVISION OF INDUSTRIAL HYGIENE WORK WITH 
THE INDUSTRIAL ACCIDENT COMISSION TOWARD THE 
DEVELOPMENT OF A PROGRAM DESIGNED TO BRING ABOUT 
STUDY OF AND COMPREHENSIVE APPROACH TO THE WHOLE 
PROBLEM OF OCCUPATIONAL DISEASES. 
The program in mental hygiene apparently had an 
auspicious beginning but unfortunately had to be 
abandoned because of a shortage of psychiatric service 
due to the war. The entire field of rehabilitation including 
mental rehabilitation seems destined to bo one of the most 
important post war problems. It is therefore jto be hoped that 
the Division of Mental Hygiene will be reestablished at the 
earliest possible moment. 
It is recommended: 
(26) THAT, THE DIVISION 0F MENTAL HYGIENE EE REESTABLISHED 
AS SOON AS POSSIBLE AND THAT STATE FUNDS BE SOUGHT TO 
AID IN ITS SUPPORT. 
Public Health Nursing 
It is recommended; 
(26a) THAT, ONE ADDITIONAL WELL TRAINED GENERAL ADVISORY 
PUBLIC HEALTH NURSE WITH SPECIAL TRAINING IN VENEREAL 
DISEASE CONTROL BE EMPLOYED IN THE DIVISION OF PUBLIC 
HEALTH NURSING. 
Efforts are already being made to fill this 
position which is provided for in the budget. 
At present there are some 15 public health 
nursing vacancies in full-time county health depart- 
ments, Some thirteen nurses are working in 
unorganized health areas, that is areas without 
full-time health service. This situation should bo 
studied carefully to determine whether some of the 
nurses working in unorganized areas could more 
profitably be assigned to fill vacancies in full-time 
health departments. 
Mental 
Hygiene 16, 
ENVIRONMENTAL SANITATION 
Tho important field of environmental sanitation is sadly depleted 
as to personnel at both state and local levels* The Division of Public 
Health Engineering has at present but two engineers and a sanitarian, 
Only 7 of tho nineteen full-time county health departments or 37 per 
cent havo even a single sanitary officer. This is a truly serious sit- 
uation* Tho Divisions of Bedding and Upholstering and Camp and Resort 
Sanitation have only such field service as can bo provided by tho di- 
rectors themselves* 
It is recommended: 
(2?) THAT A SECTION OF ENVIRONMENTAL SANITATION BE ESTABLISHED 
AND THAT IN IT BE PLACED THE ALREADY EXISTANT DIVISIONS OF 
PUBLIC HEALTH ENGINEERING, PLUMBING, CAMP AND RESORT SANI- 
TATION, RODENT CONTROL, AND BEDDING AND UPHOLSTERING TO- 
GETHER WITH TWO NEW DIVISIONS OF MILK, AND MEAT AND OTHER 
FOODS ;ND FOOD PRODUCTS. 
(28) THAT, AT LEAST TWO WELL TRAINED PUBLIC HEALTH ENGINEERS BE 
TO THE Sl'AFF OF THE DIVISION OP PUBLIC HEALTH ENGIN- 
EERING. 
(29) THAT, EVERY EFFORT BE M«DE TO RECRUIT SANITARY OFFICERS FOR 
LOCAL HEALTH DEPARTMENTS, VERY LIKELY THROUGH RETURNED SER- 
VICE MEN, AND THAT A SHORT COURSE IN SANITATION INCLUDING 
THE CONTROL A ND SUPERVISION OF MILK, MEAT AND OTHER FOODS 
AND FOOD PRODUCTS BE ARRANGED. IT IS QUITE POSSIBLE THAT 
THE UNIVERSITY OF CALIFORNIA MIGHT EE ABLE TO PROVIDE SUCH 
A COURSE. 
(30) THAT, A NEW DIVISION OF MILK CONTROL AND SUPERVISION BE ES- 
TABLISHED WITH AT LEAST ONE WELL TRAINED AND EXPERIENCED 
MILK SPECIALIST TO RENDER CONSULTATION ADVISORY SERVICE TO 
LOCAL FULL-TIME HEALTH DEPARTMENTS* 
(31) THAT, A NEW DIVISION OF MEAT AND OTHER FOODS AND FOOD PROD- 
UCTS BE ESTABLISHED WITH AT LEAST TWO PERSONS, ONE A WELL 
TRAINED VETERINARIAN, THE OTHER A PERSON WELL TRAINED IN 
FOOD SANITATION, TO RENDER CONSULTATION ADVISORY SERVICE TO 
FULL-TIME HEALTH DEPARTMENTS• 
(32) THAT, THE DIVISIONS OF CAMP AND RESORT SANITATION AND BEDDING 
AND UPHOLSTERING EACH ADD AT LEAST ONE WELL TRAINED PERSON 
TO THEIR STAFFS IN ORDER TO MAKE POSSIBLE MORE FIELD SERVICE. 1? 
(33) THAT, THE STATE DEPARTMENT OF AGRICULTURE AND THE 
STATE BOARD OF HEALTH AGREE TO A PLAN BY WHICH THE 
DEPARTMENT OF AGRICULTURE WILL CONTINUE TO EXERCISE 
CONTROL AND SUPERVISION OF MILK, MEAT AND OTHER 
FOODS AND FOOD PRODUCTS IN ALL AREAS OF THE STATE 
WHICH DO NOT HAVE FULL-TIME HEALTH DEPARTMENTS BUT 
WILL AUTHORIZE SUCH CONTROL AND SUPERVISION (PERHAPS 
BY DEPUTIZING LOCAL HEALTH OFFICERS OR SANITARIANS) BY 
LOCAL HEALTH DEPARTMENTS IN ALL AREAS HAVING FULL-TIME 
LOCAL HEALTH DEPARTMENTS. 
This is -unquestionably one of the most important 
recommendations of the entire report and every effort 
should be made to secure its adoption. 
Local Health Service 
In many respects the Section of Local Health Service is the 
most important in the entire state health program. As stated 
previously the plan of having the Assistant State Health Officer 
the Director of Local Health Service is in keeping with good 
administrative practice. The weakness of the Division of Local 
Health Service in Oregon is obviously that it has no staff, other 
than the director, to give field service which is its primary 
function • 
In order to understand fully the full importance of the 
Section of Local Health Service it seems wise to review very 
briefly the responsibilities of a state department of health. 
The primary functions of a State Department of Health are; 
(1) To develop broad public health plans and policies 
for the State as a whole avoiding such detail as 
would tend to make it difficult to take into 
consideration local interests, needs and poten- 
tialities, in their local application; 
(2) To translate those state-wide broad plans and 
policies into effective local action wherever 
possible through full-time local health departments 
reserving for direct service only those highly 
professional or technical services which are un- 
feasible or uneconomical of local procurement. 
The functions of the section and division 
chiefs are; 
(1) To develop broad plans and policies 
which when approved by the State Health 
Functions 
of 
Sect ions 
and 
Divisions Officer become the plans and policies for 
the state as a whole as applied to public 
health* 
(2) To render directly those services which 
can not be carried on adequately locally; 
(These should be reduced to a minimum.) 
(5) To furnish intensive field service to those 
areas in which the consultation-advisory 
field staff (hereafter to be discussed) has 
determined a need; 
(4) To render only emergency services in areas 
without full-time health departments; 
(5) To administer the functions referred to. 
The functions of the Section of local Health 
service are: 
(1) To render such consultation-advisory 
field service as will assist local health 
departments in translating the broad 
plans and policies of the State Depart- 
ment of Public Health into effective 
local action taking into full consider- 
ation local interests, needs and poten- 
tialities, In short this is a service 
designed to bring about local health 
programs balanced to meet local problems 
and needs , 
(2) To cooperate with the Division of Health 
Education in the development of a program 
of health education designed to promote 
the establishment of full-time health de- 
partments in areas not now covered by 
full-time service, the boundaries of health 
jurisdiction to follow an economical pre- 
determined plan • 
(See Doctor Haven Emerson’s plan "Units 
of Local Health Service for All the States",* 
Functions 
of 
Local Health 
Service 
*-A Progress Report of the Subcommittee on Local Health Units, of 
the Committee on Administrative Practice, American Public Health 
Ass’n • Tho most important needs of the entire state health program, 
in the opinion of tho surveyor, are for a strong, well- 
developed Section of Local Health Service, with a strong Division 
of Health Education as an Important and necessary adjunct to this 
service • 
Although in charge of a well-trained director, tho present 
Division of Local Health Service, from tho standpoint of per- 
sonnel, is totally incapable of assuming adequately its proper 
functions, and there is no Division of Health Education* 
As an essential means of enabling the Section of 
Local Health Service to assume its responsibility, 
it is recommended; 
(34) (a) THAT A STRONG CONSULTATION-ADVISORY 
FIELD STAFF BE ESTABLISHED IN THE 
SECTION OF LOCAL HEALTH SERVICE. 
The Director of a section or division is appointed to that 
position because of his special training and experience in a 
particular field* As already stated, the principal function of 
the director of any service is to develop plans and policies in 
his or her specialty which, when approved by the State Health 
Officer, become the plans and policies of the Department* It is 
also his function to render directly, from the state level, 
those few services which can not be carried on locally* 
Basically, the essential function of the State Department of 
Public Health, with the advice and assistance of its divisions, 
is to translate approved plans and policies into effective local 
action* To accomplish this, obviously there is need for field 
service* The administrative officers of the Department and the 
divisional directors and their associates are engaged mainly in 
developing plans and policies and in general administrative 
duties* There is little time available for field service* 
At present each of the separate divisions renders some 
service to local areas* The service is spasmodic, and totally 
uncoordinated. In most instances it is furnished upon request 
of the area or in ’’trouble shooting”. In some divisions, the 
field service is truly of a constructive consultation and 
advisory nature. In others it is largely a direct service, and 
in some divisions there is very little field service of any kind* 
The impact of such uncoordinated service on local health officers 
and local health departments can be and often is most unfortunate. 
That it could and often does result in unbalanced local programs 
is evident. 
Consultation- 
Advisory 
Field Staff The eventual evaluation of any state department of health 
depends upon its success in establishing or having established 
full-time local health departments maintaining continually 
progressive programs geared to meet local needs* 
In order to give continuous periodic field service to all 
full-time local health departments, there must be a group of 
professionally trained persons in the field constantly--persons 
who have no central office duties other than to attend periodic 
conferences# In order to present an imbalance of local program 
it would seem entirely logical to place this field staff under 
the administration of the section whose particular function it is 
to translate departmental plans and policies into effective local 
action balanced to meet local needs--namely, the Section of Local 
Health Service# 
The primary objective in establishing such a consultation- 
advisory field staff is to bring about a more effective relation- 
ship between the State Department of Health and local health 
departments through planned periodic visitation by professionally 
trained personnel, and emphasizing balanced local programs by 
obtaining a complete composite picture of strengths and weaknesses 
of a local program. 
The minimum personnel for such a consultation-advisory field 
staff should consist of: 
(a) A person particularly well trained in general 
public health administration, preferably a 
former county or city health officer but, in 
any event, a person with broad administrative 
experience; 
(b) One or more sanitarians with superior 
qualifications; 
(c) At least one or more well trained statistical 
clerks. 
To this group might well be added a representative in health 
education, perhaps a nutritionist, and possibly a public health 
dentist. It will be noted that this minimum contemplated 
personnel does not represent specifically some of the various 
phases of public health such as epidemiology, maternal and child 
health, laboratories, tuberculosis, and venereal diseases. 
While there would seem to be no objection to adding such repre- 
sentatives, they have boon omitted in the thought that since 
the primary objective of this service is to bring about a 
coordinated and balanced program, the public health administra- 
tor should be able to observe the general Interest in and 
adequacy of programs in venereal diseases, tuberculosis, et 
cetera. It will be noted that a sanitarian with superior quali- 
fications rather than a public health engineer has been recommended for this field staff* This has been done in the 
belief that the well qualified sanitarian will always seek, and 
advise the local sanitarian to seek, the advice of'.the public 
health engineer when needed and that the sanitarian is far more 
interested than the engineer in the day to day problems of the 
local sanitary officer and will therefore be of greater help to 
him* 
The public health administrator should have no assignment 
to any division or bureau and should be responsible solely to the 
Director of the Section .of Local Health Service. 
The, nurse, the pediatrician, the sanitarian and the clerk 
should be found, if possible, among the present employees of the 
Department. 
In thinking of the development of this field service, one 
should boar in mind the fact that local health officers end 
other local health personnel will welcome periodic visitations 
only provided the personnel in the field staff has adequate pro- 
fessional training and experience, and provided further that the 
approach of such service is on the basis of a coordinated 
balanced program rather than one of special interest or pressure 
group• 
It should also be borne in mind that this is by no means 
all the field service which is to be rendered by the State Depart- 
ment of Health. In the first place, this field service is for 
the benefit of full-time health areas. Secondly, in spite of the 
fact that it has to some extent specialized trained observers, it 
is a generalized service designed to render periodic rather than 
intensive service and to make possible a composite picture or 
diagnosis of strenths or weaknesses, interest or lack of interest, 
which will point the way for more intensive field service where 
such is needed. 
. This means then that field personnel other than members of 
the Consultation-Advisory Field Staff have four distinct 
functions: 
(a) To render those direct services which can not 
be rendered adequately by the local department; 
(b) To give field service in unorganized areas 
which are unable to carry on generalized 
balanced programs; 
(c) To render service specifically requested by 
local health departments; and, (d) To furnish intensive field service in those 
areas and in those fields in which the 
composite diagnosis of the Consultation- 
Advisory Field Staff has indicated a need. 
It should bo emphasized again that the Consultation-Advisory 
Field Staff is not designed to encompass the entire field service; 
it has specific purposes as briefly outlined in preceding 
paragraphs. 
Although the field staff as such v/ould have no specific 
functions in unorganized areas, the general public health admin- 
istrator of the staff plus a well trained representative of 
health education do have an important function to perform in such 
areas • 
Their function, after first having determined the specific 
areas susceptible of local health service development among the 
present unorganized areas, is to develop a program designed to 
bring about full-time county or multiple county health departments 
in such areas. This obviously requires a basic and perhaps 
relatively long term program of health education involving, first, 
a study of health problems, facilities and needs of the proposed 
health area and, second, the development of a sound permanent 
plan for meeting these needs, which is the establishment of a 
full-time department. The role of the health educator in the 
program is to stimulate local groups or agencies to undertake self 
studies of health problems and needs and later to develop a plan 
for their solution. The role of the public health administrator 
is to assist in supplying basic data essential to the study, to 
interpret the study to the group or groups undertaking it and 
later to explain how a full-time local health department can be 
established• 
In order to provide smoothly effective relationships between 
the Section of Local Health Service and the other divisions of the 
Department, with maximum benefit to local health services, it is 
advisable to adopt the following policies and procedures: 
(a) Personnel on the field staff should be 
top-notch people and should be 
acceptable to all bureaus concerned. 
(b) Field schedules for each member of 
the field staff should be prepared a 
month in advance and copies sent by 
the Director of Local Health Service 
to the Administrative Office and to 
all divisional directors. (c) Field personnel must not advocate or 
approve change of policies or tech- 
niques approved by the Department, 
If a change seems desirable in a 
certain area, the suggested change 
must be discussed v/ich the division 
director to whom the policy applies 
and with the Chief of the Division 
of Local Health Service. 
(d) The entire consultation-advisory field 
staff should report at the Central 
Office for regularly assigned periodic 
conferences, at least once each month, 
perhaps more frequently in the early 
developmental stages of the program. 
Notations of such conferences should 
be included in the field schedules sent 
to the administrative office and to 
divisional directors. The conferences 
should be attended by the Director of 
the Section of Local Health Service, 
the general administrative staff, 
the divisional directors, and, ob- 
viously, the field staff. The confer- 
ences should prove invaluable in 
presenting a composite picture of local 
health units by focusing attention 
upon strengths and weaknesses in such 
manner as to Indicate clearly what 
future service is needed, 
(e) If written reports of field personnel 
are required, they should be presented 
to both the Director of Local Health 
Service and the director of the division 
of which the individual is a member. 
Copies of the report of the consultant 
in public health administration should 
be sent to all division directors whose 
specialties are concerned in the report. 
It is urged that this consultation-advisory field staff be 
established immediately. 
At present 15 counties, representing but 
about 10 per cent of the population but 
more nearly 50 per cent of the area of 
the state, do not have full-time health 
departments. Many of these counties are 
too sparsely populated to Justify single county health departments 
Full-time Health 
Services for 
Areas Now Without 
Them A committee of the American Public Health Association* 
recently submitted to each of the states a tentative outline for 
developing full-time health services which would cover the entire 
state. This plan has been reviewed by the State Health Officer 
and the Director of Local Health Service and revised to meet the 
possibilities and needs of Oregon. There is then in the central 
office of the State Department of Public Health a plan for 
developing full-time health service for the entire state. 
This plan can be put into effect if and when the people, 
living in areas not enjoying full-time health service, become 
fully aware of the need for and value of such service and are 
willing to assist in supplying it, A sound program of health edu- 
cation would seem to form the necessary basis for implementing 
the plan. 
It is recommended: 
(55) (b) THAT A WELL QUALIFIED PUBLIC HEALTH 
ADMINISTRATOR AND A WELL QUALIFIED HEALTH 
EDUCATOR DEVELOP A PROGRAM OF HEALTH 
EDUCATION, (IN AREAS NOT NOW HAVING FULL- 
TIME HEALTH SERVICE,) DESIGNED TO BRING 
ABOUT WIDESPREAD UNDERSTANDING OF THE 
NEED FOR AND VALUE OF FULL-TIME HEALTH 
SERVICE AS THE NECESSARY MEANS OF MEETING 
LOCAL HEALTH PROBLEMS EFFECTIVELY. 
(56) THAT, TIE DIVISION OF HEALTH EDUCATION 
WORK CLOSELY WITH TIE OREGON TUBERCULOSIS 
ASSOCIATION AND ITS AFFILIATED COUNTY 
HEALTH ASSOCIATIONS TOWARD TIE IMPLEMEN- 
TATION OF THOSE RECOMMENDATIONS IN THIS 
REPORT FOR WHICH WIDESPREAD PUBLIC UNDER- 
STANDING AND SUPPORT ARE NECESSARY. 
While all of the foregoing recommendations are thought to be 
important, it is the opinion of your surveyor that the most 
important are; 
(1) That a consultation-advisory field staff 
be provided in the Section of Local Health 
Service . 
on Local Health Units, Haven Emerson, M, D,- 
Chalrman. (2) That qualifications be provided for the state 
health officership. 
(3) That a well trained and capable director for 
the laboratory be employed, 
(4) That a Division of Health Education be 
established • 
(5) That more state funds be provided for public 
health protection in Oregon. 
(6) That additional beds for certain types of 
tuberculosis cases be provided, 
(7) That the Division of Health Education work 
closely with the Oregon Tuberculosis Associ- 
ation and its affiliated County Health 
Associations and ether health agencies and 
groups toward the implementation of those 
recommendations in this report for which 
widespread public understanding and support 
are necessary, 
(8) That a careful study of the Merit System be 
made looking toward an upward revision of 
professional salaries and the inclusion of 
some adequate retirement plan. 
(9) That local full-time health departments be 
made responsible for the control and super- 
vision of milk, meat and other foods and food 
products and food handling establishments. 
The Oregon health program is sound, but it has not been 
sufficiently developed to provide the health protection which the 
people need and have a right to expect. If the principal 
recommendations of this report can be put into effect, the Oregon 
program will compare favorably with any of our states. The 
ultimate success of providing adequate health protection services 
will depend upon a well planned continuous program of health 
education,