~o~ ‘preparation, study. and field service." whe original coumittee had 8 members, of whom 6 are of an Appraisal fora for the quantitative measur A Decade of Progress. /730 ommittee on Aduinistrative Proctice | eieunns of public | ctan S Yale Sehool of Medic ine Just a decade 0s in the your 1920, the Auericun Public Health Avsoctation appointed a Committee on Maniei ped Health Depo rtacnt Practiced, for “the dardization and presentation of selentifie public : health procedures, by the colleetion of informtion in regard to current : administrative health pmetice, the anslysis of the snterial obtained to derive ctandards of organisation and achievement and the translation of these standanie into terms of | onerete achievement through an information — still on ite active roll and the initiattor by a generous gift of 10,000 a your from the Metropolitan Life Insurance jompany. This was the entire anmal budget of the Gommittee for ite firat of ite work was mde possible quinguennium. | , » yours later (in July, 1925) our first aystematic study of the genleabion of the 83 largest cities of the United States, in ecogemtion with the U.S.Pablie Health Service and ether interested aguuahits was gublished as Bulletin 156 of the United States Public Health Service. | This volume wes not only the first qmanaansiee comparative review of health | practice in the world but it included also the first attempt at an outline | of the essentials of an tdend eity health sseustaation, ih this sane yoar, Dre .S«Rankin became Sela director of the Committee and began the preparation — performance. in servies) and initieted ite survey Gltles. in 1925 the name of the aomuittce wae changed to Coamittee a correspond with the broadening of ite intereste to include state its work. Dr,Haven Emerson served av chairmen for the year 19252 DrsWaF Walker was appointed Field Director Seytesber 1, 1926, It is with deep 0 DeeBalkerte resignation te take effect next April. His five yor 2 and to the eawe which it las at heart ani credit for the resent aceomplishsents Assoetati on made publication of ite Surve the 100 largest oltice of the United States and the Gomnitt invaluable volume on dome madty Health Ory anlantion by Profcesor 1, V Hlecowk, efforte at active development of public interest in Laproved adatnistrative yoo™N health prictice began at thie time in cooperetion with the Federation of ntative Appraieal Yorn for rural areas was lewaeds 1 $7500 from the Milbank and paid field service had so developed thet the Committee budge’ Form for Clty Health Work which wae ieeued Jenusry 1,1929 with the inmelucion of cancer and heart The task of 1920 wae the revielon of the Appraisi wl diseace at major setivities ami with a new acor ing plan (to encourage « gonparigen by setivities rather than by total scores) ae well as many minor improvements, In this year, too, the State Health Departme nte of Mascachnestt s, Michigan and Ohie were surveyed and a study of rural health practice wae — Hd, the budge’ ched with a grant from the Commonvealth F ag 16,000. Thie was the last of the sight years for which the | Metropolitan Life Insurance so generously contributed te the work of the Financed by a group of insur cities, sponsored by the U,5.Chamber of Comic TOs » mee conwmies and conducted under the technical direetion of the Coumittee on Adainietrative Preetice. The budget of the Tommittce wae tnereaged to $65,000 ineluding ae major items $29,000 fr Commonwonlth Pund for the rural study, nearly $21,000 from payments for field 020,000 from the Che 0 er of Commerce for teehnical ateletance in the Health Conservation Contest and $1e 509 from the Milbank Fund. During the carrent year (1950), with a budget of nearly $99, 9, the Comalttee hea eontimed ite etedies of rural hoo lth practice and ite cooperation in the Healta Gonservation Contest. It has undertaken a questionaire analysis — Child Health ami Welfare. | "his wrief review of the major activities of the Comittee on Adminietrative Practice as a whole would be most tnoomplet to the work of ite subcomaittees which have ande eontritutions of the first — importance in their special fields, The first of tenes subeoundtteee commit teer aa fol lowe: Subsomaittee on Record Formas. G.C.Ruhland, Ghairmar abcomnittee on Organised Cave of the Sicks M.il,Davis, Chairmen subcommittee on Rural Health Work. “E,l.Bishop, Chairman ubecumlttee on State Studies, ¥.P. Draper, Chainenn Subcomalttee on &ppraisal Form for City Health Work. ¢.7,.Palmer, Chairman | Wonoal of Administration. 4.%.Veughan, Chairaan oumittee on Howlth Conservation Contest. lel, Diblin,Chalrmar beoamittee on Nursing. Sophie Nelson, Chaiman - malty Health Organimations ly I.Dubling «Chad Subcommittees on Health Department Reports, J, leRies, Chai rean sub@omalttee on Evaluation of Public Health Activities. Haven gmerson, Every one of these subcommittees ie active and functioning and as ivan of the general qmuittee for nine of ite ten years of Life, the writer mst pay a tribute to the colleagues who have curried a major ehare ittee on Adainistrative Practice is sul generis in aging devotion of ite meabers to the solution of their Common problemss The mjor enterprise of our Committee during ite ten years of service has, of course, been the development of a model plan for manieipal misation (ae embodied in our 1923 report ond in ty Health Organization) ani the preparation ef the Appraisal form for the quantitative messurement of the services rendered by such on organization, It took considerable courage to undertake such an | enterprise eight x APS aS05 There wae a good chance thet the attempt would be regarded as agadenie and Saneaetiont and would die aborning; and there | vad an altornstive poosibility that, if sesepted, 1t might lead to the over~staniardisation which is om of our characteristic national vices, Our venture of faith has, we believe, been more than justified by ite resulte. The plan of Som nity health orgs nization presented in 1923 bae been accepted az generally sound hovever, it omy be modified te eult speeial lemi circumstances. The buiget of 2.36 per capita worked out at that time closely approximates the actual practice of the best organised ¢ommnitics today. The Appraisal yorm has proved iteelf beyond any queetion a generally sound measure of quantitative performance. the dang | or of oversstabilization has been mot by providing for revision of the Appraisal Yorm every three or five years, & revision whieh, like a Republican revision of the tariff, iv always in an upward direction. the standaniigations gation plan for n gense of the health officers hae prevented undus they have uaed the Appraisal Form and the model organi self-appraicel to cheek up on the balance of their programe, for the interpretation of those programs to the public and as powerful arguments for needed expansion, We can speak of these results without undue vanity for after 411] it ie the health officers of the country who have supplied coeemreiasiciierecueemmemnanciriescreeeeueren ueiries ee a the smteriale for the model hea - fetrative health preetice through ith program and appraieal and it is ‘the health officers who have used these instruments with such effect. The enntetes on Adminietrative Pract the health officers have pooled theiy reservoirs of experience, It is these health offieers who have been the real forees in trative health practice froma haphazard political expericent to a standurdined selentifie procedure during the pact ten years, +Glesely allied with the Gevelopment of the plan fer model health organtsation and of the Appraisal oma, has been the service rendered by Dre Talker and hie staff in the provigion at cost of speeial intensive ee Committee, carrying ite infiuence from Quiney,Mase. to South Paeadena, Oslif, and from Marlon County, Oregon and Hone lulu,?.B, Pus, the Comalttes has moved rather eteséily forvard in ite teske of eolleeting : yenetiene of deriving therefrom standards of organisation and ach levement and translating these standards into terms of eonerete achtevenont through ite information and tleld service. are in the liet ae well ae Montreal, Aenads and analysing material in regard te current administrative A Subsidiary and sompuhat different type of responsibility has, through force of ciroumetances, been forced upon the Committee during the past four years. The efforte onde by this association to mise the level of edmin~ out the country attracted the interest not only of the insuranee companies and the foundations but of powerful national so agencies interested in civic vettersent. In 1926 Dr-Valker was able to enlist the active eupport of the General Federation of Yomen's Clube and of the UsS Chamber of Commerce 1» Both theee organisations have taken at active part in promoting the cause we have at heart and beth have initiated * eompetitions in the field of local health mong their constituent group Progress « Dr. Dabl in will describe the cutetanding success of the Health Conservation Contest in whieh 108 ¢ities took part laet year, and which has already led to an increase in local chambers with active health committees from 100 to 226, Tt is difficult to eetiate the value to the health officer of euch a mobilisation of support as is here represented, The opportunity offered and the work had to be done; and, although particular programs wore so elesely tied up with the technical problens fe outside the priaary functions of the Gomalttee, these vey and appraisal that we have been fe reed to ear ty them forward, ef the Gomaittee on Administrative Practice then involves She continuation of three major old activities as foll@rne: fae The continued study of current municipal health practice with a view to the imeediat uheomaittees on Record Porm, on Orgenised Care of the Sick, on Manual of Administration, on Health pepartaent Reporte and the like, ig lon, at cost, of survey and eonsultation service to individual comaunt ties with regard to their specific problems. @. The provision of teehnical aid in th promotional activities unde extaken se of Commered, ia qoperation with the General Federaticn and the CGhamb Pee nigh we hope and believe the Comittee can attack during the degade w sigh ie to com. The first of these fs the oroblem of rural hygiene. During the past fifty yesrs health hes cone to the eity and death rates in the crowded tenements have been cut aluost in half. On the farm and in the village , gh the splendid efforts ugh maixmecle hee occurred. [6 Le trus timt throu of the United States Public Health Service, the State health officers and the Rockefeller Youndation we have 500 full tive county hoalth unite in : nities are, however, without operation in the United States, The other 2000 cov any effective health oach foundatione have been leid. Most of these fall time eunties work with a lic health nurse eorvi budget of 25 to 60 cents per capita ond with one pub 20,000, 40,000 there are not apre then a desen rural counties in the United Stetes which have such health aachinery as would be considered adequate for an urban areag and yet ve mow that the actwal needs of the form dweller are as great and probably greater than those of his city gousin, The development of modem public health service for the rural areae ie the major health problem of the future,= not only in the United States but It wae this conviction that led us in 1927 to aek the Goomonwealth Fund ‘er a grant to make the flret comprehensive, comparative study of rural health service. The field work of that study is now complete and Dr. Bishop and preFreesan will report te you ite progress, I need ine re Ly add ag Cha trean of the Committee that, if you approve, oe plan te make the furtherance of fural health work a major feature of our program for the fubure, in the belief that the equality of opps rtunity of which Amrican tradition boasts will not of the actual etatietien] rewulte achieved, Present stand be & reality until the child in » rural county bas his @qual chance Pinally, we have a second to believe muy be Thie eegond new task ie the attempt to evaluate the real wignif~ the ease. ieance of cur administrative health procedures vy detailed selentifie study ands of health organisation and appraisal are based upon existing practice, in general upen the practiee of the upper quartile of the cities which have been sur oy de They vest upon the as@umption that the ends surrently sought currently used to attain theese ende are sounds Im wany inetances they surely are. We may be reasonably sure that 1% is well to lemunize children age inet diphtheria and to pasteurise mile Yet even with reapest to euch obvious @lements in our program it would be hard to elite a es y of regulte obtained ties we conclusive ae to convinces the sceptical of the value in varlous comenn! of the measure and to make clear to the health officer the particular admin« ra to many phases of health adainistration we have no exact evidence whatever x pon whieh to justify our empirical practices. istrative procedures mst likely to yield maximum results, With regs «TS may seem a somewhat illogical process te spend ten years in setting staniards and then to try and find out whether thove etandards are seientifi~ Cally justified. Yet I believe it was wise to do just what hae been done. A clear picture of actual adminictretive practice and ite empirical foundatione ‘Was oesential to more refined analysia; and preeticss, for which we convincing statistical jurtifieation ean be adduced but which are indleated as valuable on sound a wierd grounds, Will long eentimue to bulk large in health ~10- inistretion.s It ie full time, however, that & beginning should ve made in laying a flrmer bagie for our work. If you approve, we hope to begin with a few relatively simple problems, such ao scarlet fever isolation (with reayect wh of the ivolation period for eases of various elinteal types) diphtheria immnization (with respect te the wee of toxeid and toxin~a titoxin : at werlour age perlode and under various stakaivtenhios procedures) preneta! service (with the hope of ooneuring the actus tal Clinics ani prenatal mursing and the conditions under which they may be made offs i veeulte sitained by pre tLive) routine inepeetion of echool ¢hildren (with a view in particular te the results of inspections made w doctor, nurse and teacher, reepeetively) and pasteuriaation ef milk (with reference to the actual rezaltes obtained by injstrative procedures). Theee five studies alone will take the greater part of two years and the whole tack stretches inte the indefinite fut aro, Ye believe, however, that it is the next great task which aust be fomoved from a basis of a etrative health practi ioe iss step by step, to be priori empiricism to that of demonatrated eclontific evidente. Thie Le our accounting of our ten years’ stewardship and these ave the poesibiiities we see for future service. If we have in some meagure you it is for four reasons, We have had gensrous financial suppert. $6000 came from the general budget of the Assoctetion and $254,¢ ning of ite work tho Committee hae apent over $660,006 wuranoe companiot, foundations and cities and counties directly served by ute We have had an extraordinary commlttee sembership, sixteen men ani women serving with unparalleled ardor and enthusiasm and gaining in capacity for , service with the experience of each year, %@ have had the splendid leadership members of this astociation and of the health officers of the country. t be done under any system of : We are dealing with essentially research : problems which on freedom to openi the funds we receive for specific a purposes fc 1” those specific purposes aad theough personnel chosen and J ag sOreL ynekted for those specific purposes. So far we have been given euch freetens of the health adminis ‘vesr actual fruit. So far we have hed that support. our work cannot be done without the active interest traters who alone con make our studies ant etaniardes yo O™~ If the Aesoulation feels our task ie done we ghall be clad +. rest from cur labors. If it desires thet thie tack ghell continue, a reasonable measure of autonomy aml a gencrour wesmare of support from the health efficere of the country are essential te the future of the Committee on Aduinietrative Practice.