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Annual Report of the
Committee on Administrative Practice

1926 ~ 1927

The Committee on Administrative Practice was reorganized and placed
on a permanent basis at the Buffalo meeting of a year ago. It is now com-
posed of twelve members appointed by the President of the American Public
Health Association to serve for four year terms, in overlapping groups, so
that three members are appointed each year; plus the executive secretary of
the Association and the taree officers of the Health Officers! section as
ex officio members, - sixteen members in all.

The committee, as its work has developed during the past five years,
has come (with its Field Staff) to constitute essentially the technical ser-
vice division of the A.P.H.A. organization. It appears to have at the
moment three essential and primary functions. These are:

A. The collection of material in regard to existing health depart~
ment practice by surveys and questionnaires.

B. The critical analysis of the data thus obtained and the formla~

tion of the results of such analysis in the shape of standard forms and

programs.

C. The making available to individual communities of the results of
procedures A and B by operating an information service and by making on re-
quest more or less detailed local surveys and appraisals.

| A fourth function, that of organized publicity to further the
improvement of health department practice by the wider use of the technical
machinery now available, has been more or less forced upon the Committee; but
we believe that mich of this work should be shifted to the recently organized
Promotion Division of the A.P.H.A. office.

We may conveniently review the work of the past year and the plans
for next year under the headings just outlined, although the first two funce-
tions, the collection of data and the development from them of standard forms

and programs, must necessarily be considered together since they are intimately

interlocked.

The most important single task, upon which the Committee is now

engaged is the revision of the Appraisal Form for City Health Service under a

sub-committee cf which Dr. George T. Palmer is chairman. This Appraisal Form,
which was placed in your hands in January 1926 has exhibited a usefulness be-
yond our highest expectations. It has been said, and we believe, with some
justice, that no single factor has ever done more than has the use of this
appraisal form to develop city health department practice in the United States;
and it has been extensively used even in foreign countries. The Committee
has, however, felt from the beginning that there were two very real dangers in
the practical application of the appraisal principle. It might, on the one
hand, invite unjustified and damaging criticism of departments having low
scores, and it might, on the other, lead to undue standardization and to
stagnation on the part of cities having high scores. The first of these

 
hazards has, so far as we are aware, deen completely avoided by the use of
the Appraisal Form in an individual city only with the approval and on the
request of the Health Officer and by the avoidance of any comparison of total
Scores obtained by various cities on a comparative basis. The second hazard,
we have planned to obviate by revision of the Appraisal Form at three year
intervals and the first revision will be completed during the coming year
and presented to you at the 1928 Anmial Meeting. It is plamed, not only to
alter items in the present Form which have been shown to be theoretically and
practically unsound and to increase levels of attainment required for attain-
ment of a perfect score to keep pace with current progress, but also, if
possible to include certain new items not now included at all. Individuals
and organizations interested in Mental Hygiene and in Industrial Hygiene, and
in the control of heart disease, cancer and malaria, will be asked to submit
for their respective fields standard administrative programs with appropriate
numerical ratings of various activities on an objective basis; and if it

proves that such programs and ratings can be prepared they will be included
in the 1929 revision.

A second project, of major importance, is the attempt to extend the
Appraisal principle to cover the health machinery of rural counties. The
sub-committee on this project, under Dr. BE. L. Bishop, has prepared during the
year a tentative Appraisal Form for Rural Health Work which is placed in your
hands at this meeting in printed form. This form was published some time azo
and has already been extensively tested out in practice by the Committee in
Tennessee and to some extent in the states of New York, and Georgia. County
or district health officers from fifteen states have written to us for 402
copies of these forms and up to October 1, 652 copies in all had been distrib.
uted. This Tentative Form will be continued in experimental use till 1929.

In order to proceed soundly with the preparation of programs for
rural health work, it seems to us essential that we should have the samdé broad
basis of kmowledge which was obtained for city health services in the compre-
hensive surveys of 1920 and 1923. Dr. Bishop has therefore prepared a defin-
ite program for a two-year study in which 50 typical counties should be sur-
veyed, covering all sections of the country and all degrees of public health
development. He presented this program at the Surgeon-General's Annual
Conference of State and Territorial Health Officers last spring. The matter
was referred to a Committee of the Conference on Standard Forms for Reporting
County Health Work (Dr. Ss. W. Welch, Chairman). Dr. Bishop's committee and
Dr. Welch's committee are now working on the problem with every prospect of
hearty agreement. It will be necessary, however, to obtain Special funds to
the extent of $25,000 if this work is to be undertaken.

In addition to the appraisal forms which cover in a general way the

whole balanced program of community health service, your committee hag pro~

ceeded actively during the year with the study of certain details of health

department procedure wnich seemed to lend themselves to analysis in the
direction of uniformity of practice. Thus, a Sub-committee on Record Forms, |
with Dr. Geo. C. Ruhland as chairman, has rendered a notable service during
the year in the preparation, after a vast volume of correspondence and
Critical study, of sets of Standard forms to be used in connection with the

communicable disease Service, the laboratory Service, the school medical in-

spection and the nursing service of thé health departments. These four sete

of forms are before you in printed form ag the Second definite evidence of

work completed by the Committee during 1927. Dr. Ruhland's sub-committee is

now proceeding with the preparation of similar forms for use in connection with
tuberculosis and venereal disease.
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Dr. C. Hampson Jones! sub-committee on Standard Health Department
Reports has prepared a preliminary analysis of the functions and contents of
@ model anmial report which will be read before this section by Dr. Jones
and Professor Hiscock, a third concrete result of our sub-committee activities
presented at this convention. Topical outlines for the various sections of
the annual report will be worked out in detail during the coming year.

A sub-committee on Model Ordinances (Dr. H. F. Vaughan, Chairman)
is at work on a schedule of the main essentials which should be the objectives
of a health code and its final report is promised by next spring.

An important special problem, that of the relation between the
health department and the local hospitals has been considered by a sub-
committee of which Mr. Michael Davis is chairman and his very interesting
report based on a questionnaire sent out to 247 health departments and to
1365 hospitals and dispensaries will be read at the meeting.

The problem of the hospital has been forced upon the attention of
your committee, not only as a cooperating agency in the primary activities
of the health department but, as itself, in its very essence a part of the
machinery for community health program. We have been called on during the
year to make special surveys of the hospital situation in St. Louis and
Scranton and have undertaken a Study of the dispensary situation in Cincinnati.

‘In order to meet future demands of this kind the scope of Mr. Davis! sub-

committee has been enlarged and its title changed to Subcommittee on the
Organized Care of the Sick. t[¢ has been asked to prepare a suitable survey
schedule for the study of hospital and dispensary service and to supervise
the field service of the Committee in this important field. ‘the work
projected will continue to be carried on, aS it has during the past year, in
Close cooperation with the officers of the American Hospital Association and

Mention should be made of one other subcommittee, that on Analysis
of Public Health Procedures (Prof. A. TW. Freeman, Chairman) which has not
been active during the past year but from which we hope much in the fature.
It is the function of this subcommittee to attempt, step by step, the
analysis of the demonstrated values of various community health activities in
terms of actual life saving, ~ a problem of enormous difficulty but the solu-
tion of which will alone give us the ultimately sound basis for the standards

and the appraisals now necessarily grounded in the main on group judgment and
empirical experience.

A special subcommittee, with Dr. Haven imerson as chairman, was
appointed as a result of action taken by the American Public Health Associa-
tion at Buffalo to present to the American Medical Association the invitation
to create a joint standing committee of conference between the two organiza—
tions on the inter-relationships between the public health movement and the
medical profession. Conferences on the plan have not yet proceeded far
enough to require any further official action. Your committee desires, how-
ever, to express its feeline that if the American Public Health Association
does take part in any such permanent conference committee it should do so
through a special Committee named by the President for the purpose and not
through tae Committee on Administrative Practice.
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We may now proceed to a consideration of the third primary function
of the committee, the translation of its general program into concrete action
through local surveys and appraisals. It is this work which of course oc-
cupies the major share of the time of our very able staff, including Dr.
Walker, Dr. Drake and Miss Phillips. During the past year we have made more
or less complete surveys and appraisals in Athens and Clarke County, Ga.,
Burbank, Calif., Cattaraugus County, N. Y., Chicago, Ill., Cincinnati, 0.,
Fargo, N.Tak., Glendale, Calif., Hingham, Mags. , Lowell, Mass., Quincy, Mass.,
Rutherford County, Tenn. , Salem, Ore., Scranton, Pa., St. Louis, Mo., and
Syracuse, N. Y., while more or less definite commitments have been made to ll
cities and counties in 7 states and 1 province in Canada for surveys to be
conducted in the near future.

We have been invited by the State Health Departments of Michigan,
Massachusetts and Ohio to undertake studies of their organization and adminis-
tration, an opportunity which we shall welcome if the necessary funds for this
purpose can be obtained.

In the fourth field of activity, that of propaganda for the advance-
ment of the general cause of improved community health services, the committes
has opened up during the year two very important possibilities of cooperative
effort. The active interest of the Chamber of Commerce of the United States
has been enlisted in this cause and three most helpful bulletins have been
prepared in Dr. Walker's office on Prolonging Life by Community Effort and on
Health and Community Prosperity which have been printed by the Chamber and
distributed to local Chamber of Commerce secretaries and to health officers
throughout the country. Dr. Walker was also invited under the auspices of
the Chamber to deliver a series of lectures on public health before the
National School for Commercial and Trade Organization Executives. We believe
that local healtn officers will find the movement thus actively fostered by
the U. 5. Chamber of Commerce of incalculable value to them in the future.

Continued cooperation has also been maintained with the General
Federation of Women's Clubs in stimulating a health interest on the part of
its constituent organizations. A schedule of community health study was pre-
pared and 3828 copies distributed to the local clubs, of which 93 schedules
were actually filled out by clubs from 13 states. One month's free service
by the Committee on Administrative Practice was promised to the state showing
the largest proportion of communities participating and this’ friendly com-
petition was won by the State of Rhode Island.

The Health Officers! News Letter is issued monthly from the Office
of the Committee and is now sent to all state health officers, to health

officers of cities having a population of over 30, 000 , and to all full-time
county health officers.

The total budget of the Committee for the calendar year is estimated
at $42,000, balanced by an income of about $19,000 from special grants and
general retainers and $21,000 from payment for surveys and appraisals, leaving
a $2000 estimated deficit to be made up by the association. For 1928 we look
forward to a basic budget of $48,000, with $18,000 more needed if the state
and rural surveys are to be undertaken.

The budget of the Committee can conveniently be considered under
three main heads. It includes first of all appraisals and surveys of local
comminities which are normally self-supporting. Of the fifteen cities and

 
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counties surveyed in 1927, 14 were paid for, 5 from municipal funds, 3 from
funds of local voluntary agencies and 6 from funds of outside voluntary
agencies interested in the local health work. This part of our budget takes
care of itself and is likely to amount to about $30,000 a year.

Special studies like the rural health survey and the state health
survey must obviously be supported by special gifts and will only be under-
taken if those gifts are forthcoming.

Finally, there is a basic and essential general service cost of the
work of the Committee which is and ought to be considerable. All the prelim
inary work of accumulating data for the various subcommittees, the prepara-
tion and revision of appraisal forms, the preparation of the News Letter, the
conduct of Information Service, the aid which mst necessarily be furnished
very frequently to health officers unable to pay for it, - all these things ba pceicane
involve a large part of the time of the staff and considerable expenditure
for travelling, postage and printing which brings in no direct financial re-
turn. We have been able to carry this basic service cost during the past year
through a grant of $10,000 from the Metropolitan Life Insurance Company, a
grant of $7500 from the Milbank Fund, a retaining fee for consultation service
of $1000 from the Commonwealth Fund and a similar retaining fee of $400 from
the Department of Health of the City of Detroit. The indefinite continuation
of grants from outside agencies is most unlikely and even with those now
available the powers of the present field staff have been strained far beyond
a Wise and profitable limit. Dr. Walker has rendered to this committee a ser-
vice of a rare and unusual character and hig usefulness grows with the exper-
lence of every year. It would be the poorest policy to break down his health
or to let him slip out of our hands to some more appreciative organization.

We must give him additional assistance wWrich will require more money, not less.

There seem only three ways to finance this general service cost of
ne committee on a permanent basis; by grants from outside agencies, by grants
from the Association or by contributions from local health departments. Out-
side grants cannot be relied upon for an indefinite period and Association
grants of large size are at present beyond our financial resources. It is
really the health departments of the country which profit most directly and
most immediately by the work of the Committee. The logical source of support
would seem to -be contributions from these departments just as the source of
Support for the National Safety Council which renders to the manufacturing
industries a similar service is the contributions of those same industries.
If more cities would follow the example of Detroit and place in its anmal
budget an item of $100 to $500 for consultant service from the Committee on

Administrative Practice, our financial problem would be solved in the one
really satisfactory way.

C.-E. A. Winslow, Chairman A. W. Freeman

Haven Emerson, Vice-Chairman C. Hampson Jones

Louis I. Dublin, Secretary G. D. Lummis

E. L. Bishop G. T. Palmer .
H. N. Calver W. S. Rankin

F. G. Curtis James L. Roberts

Michael Davis G. C. Ruhland

W. F. Draper Henry F. Vaughan