-gervice:

PROGRAM FOR 1933

The Committee on Administrative Practice of the American Public
Health Association hopes to carry on the following activities in 1933:

(1) Field Service =
The Commi ttee will during 1933 offer the following types of field

1. Complete or partial health surveys of states, counties,
monicipalities or organizations.

Such surveys involve a complete stock taking of the health
facilities of the organization or area under consideration, a careful analysis
of services rendered in relation to existing problems and cost, and Tfinelly,
® report on findings and recommendations for future program.

2 Consultant service in relation to specific problems. Such
service might include, for example, advice and assistance concerning: the
inauguration of a new division or activity such es child hygiene; record keeping;
how to determine the degree of diphtheria protection among children of different
age groups, etc. }

3. Advice on readjusting health activities or programs to new
conditions precipitated by the necessity for extraordinary economy.

(2)

This Contest sponsored by the United States Chamber of Commerce and
carried on in cooperation with the American Public Health Association has already
proved its usefulness in stimulating health work in terms of actual health
accomplishments (i.e., over 90 per cent of the cities entered for two or more
years obtained higher ratings in 1931 than in any preceding year).

 

It is proposed to carry on the Contest next year in much the same manner
as in preceding years except that with the proffered assistance of several state
health départments it is to be hoped that the scope and therefore the usefulness
of the Contest may be increased (i.e., instead of the comparatively small number
of new entries which it has been possible to include in 1932, it is hoped that
the assistance of state health departments may permit the inclusion of a mech
larger number of cities in 1935 without appreciably increasing the cost of the
Contest).

(3) City Appraisal Form.

The City Appraisal Form is at present being revised and will issue its
fourth revised edition in January 1934. oS

The City Appraisal Form is not only used in the survey work of the
Committee on Administrative Practice but is coming into wider and wider use by
cities as a means of self appraisal. It is obviously importent that the form
and the standards set up therein be changed from time to time to keep pace with

KG

 
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progress in public health practices. In planning and carrying on the work of
revision the volume of information made available through the schedules of the
Health Conservation Contest and the information obtained through the sub- _
Committees on Current Health Department Practices is proving of real value.

(4) Bwaluation Studi es.

Prenatal Care - The studies on the evaluation of prenatal
care, carried on under the direction of Professor Winslow, will have been comleted
by the end of 1932.

foxin-antitoxin and Toxoid = ‘he study of the relative values
of toxin-antitoxin and toxoid as immunizing agents against diphtheria, carried
On by Dr. William H. Park, is practically completed.

Diphtheria Immnization - Studies on the effect of diphtheria
immunization on the incidence of diphtheria are not completed and will be con-
tinued in 1933 under the direction of Dr. Edward S. Godfrey, Jr.

During 1933 it is proposed to study carefully the relationship
between immunization status and diphtheria incidence in those cities having
unusually high incidences of diphtheria in an effort to substantiate or refute
the tentative conclusions thus far reached.

We shall try to arrange with the United States Public Health
Service to wire us, collect, when diphtheria becomes unusually prevalent in any
city. For this purpose we shall probably consider a rise in incidence which
persists for two weeks and is at least twice as high as the normal incidence, ag
evidence of unusual prevalence. In such cities a careful study will be made of
the possible factors involved in the rise and where circumstances warrant more
intensive epidemiological studies will be pursued to determine the respective
roles of the case and the carrier in the spread of the disease,

If diphtheria rises in a city in which there has been little
immunization of the children under five years of age, every effort will be made
to have this group immunized as rapidly as possible and to observe the effect of
such immunization on the outbreak.

Studies will abso be pursued of instances in which sharp declines

in diphtheria incidence have occurred in which immmization has apparently not
been the influencing factor.

Every effort will be made to bring about the cooperation of state
health officers in an effort to obtain more definite and accurate information on
their diphtheria problems, at least from their more important centers of population.

Scarlet Fever - Studies desiged to bring about more scientific
and effective control measures for scarlet fever have been carried on during the
past two years under the directon of Dr. J. E. Gordon and will be pursued in 1933.

Studies in 1953 will attempt to substantiate or refute present
tentative conclusions through data being gathered in Richmond, Va., Syracuse, N.Y.,
Rutherford County, Tenn., Barry and Allegan Counties, Michigan, and we hope in the
Nashoba District. in Massachusetts. |

 
At present studies are being undertaken to sheertske : the Sener
tance of carriers and missed cases in the transmission of scarlet fever. At
the conclusion of these studies and the analysis of data obtained from other
areas, which should be about June 1, 1953, we should have a reasonably complete
picture of the significant factors in scarlet fever control and their relative
significance. The next step will then be to devise and to try in actual
practice administrative methods designed to solve the problems demonstrated by
these studies.

_ While at present the evidence lacks completeness, the conclusion
of the studies will probaly result in:

Le An individual and a shorter period of quarantine based on the.
condition of the patient, his age, the season, and climatic conditions. This
would obviously result in a great economic saving.

2. A more careful and scientific observation of contacts to dis-
cover carriers and missed cases and regulations governing the control of such __
missed cases and carriers. This will probably involve some added expense in the

discovery and control of such missed cases and carriers but should sufficiently

decrease the incidence of scarlet fever as to effect a considerable net saving
to the community.

3. Possibly more precise regulations with respect to isolation for
contacts under five years of age than for older contacts. If even one-half
of the present cases of scarlet fever among young children under five years of |
age could be prevented the total deaths from the disease could be reduced by one-
quarter.

(5) Current Health Department Practices.

During 1932 an attempt was made to gather pertinent information on |
current health department practices, particularly with respect to expenditures
for specific purposes, and to full-time personnel and salaries, which is up
to date and which can be kept up to date from year to year. At the present
time no orgenization or agency is keeping such current information and it is

‘therefore proposed to continue this work during 1933. A partial integration of

personnel of the three sub-Committees on the Health Conservation Contest, Annual
Health Department Reports, and Current Health Department Practices, has been
effected in order to prevent possible duplication and to insure uniformity of
such information as is common to the work of these three sub-Committees.

(6) Record Forms.

During the past several years the sub-Committee on Record Forms has
been working, often in cooperation with other agencies such as the National
Organization For Public Health Nursing, the National Tuberculosis Association, and
the American Social Hygiene Association, to develop record forms for all major
health activities. It hopes to complete this work in 1933 and to publish a
book which will include the presentation of the philosophy of record keeping
together with suggested forms upon which such records may be kept.

 
(7) Baral Health Work.

 

The sub-Comnittee.on Rural Health Work has during the past year
published a second edition of the Rural Appraisal Form and will, by the end of

the year, have published, through the kindness of the Commonwealth Fund, a book
entitled "The Rural Health Study."

Its work during 1933 will be to stimulate and encourage the wider use
of the Rural Appraisal Form and to gather information on its use and on the
applicability of standards contained therein which will be useful in the future
improvement and revision of the Form. The committee also proposes te consider

the feasibility of publishing a supplement to the Rural Appraisal Form which will

include the definition of special problems and the evaluation of programs desigmed
to meet such special problems as are frequently found in rural areas such as
malaria, typhoid fever, and trachoma control. The comnittee will also continue
its work on the development of record forms for rural areas.

(8) Organized Care of the Sick.

The sub-Committee on Organized Care of the Sick is at present engaged
in the preparation of an appraisal form for hospitals which will include an _
appraisal of the community's facilities for the organized care of the sick. It
is anticipated that this form will permit the appraisal of not only the entire
community bot likewise of the individual units (hospitals, clinics, etc.) which
meke up the whole. Definitions of terms to be included and a skeleton outline

of the form have been completed. The next step is to interject into the form

standards and scoring. It is to be hoped that the form will be completed and

opportunity found to try it out in certain communities during 19383,

(9) Medical Participation.

The sub-Committee on Medical Participation, created in 1932, is interested
in fostering sound programs of cooperation between health agencies and organized
medicine. While health workers insist that all of the people should practice
well established health procedures only a smell percentage is actually reached
through the direct service of health agencies. The remaining portion of the
population, which probably constitutes over 80 per cent of our people, must
receive the services which we advocate, if they receive them at all, from their
own physicians, dentists, nutritionists, etc. The advisability, therefore, of
bringing these professional groups, particularly the pwacticing physicians, into
the picture on some sound basis of participation is obvious. Real interest in
cooperation between health departments and organized medicine is unquestionably
increasing. Much of the interest which is manifest is lost because of inability

to plan a workable program. For 1933 the committee plans a two-fold program

consisting of:

1. A study of notable examples of public health activities which
embody the general principle of a coordination of interest and services between
organized medicine and health departments.

2, The establishment of small demonstration centers under the direction

of a city health department and a county health department sympathetic with the

general idee.

 
Other Sub-Commi ttees.

_ The sub-Commit tees on Annual Health Department Reports, Public
Health Nursing, Vital Statistics, Relationship of Social Workers to Public
Health, and Manual of Administration, will carry on their activities in 1933
although no definitely outlined programs have been developed for them.

5.

 
6.

a

The budgets of the Committee on Administrative Practice have varied
from year to year in accordance with the projects undertaken by it. Budgets
have ranged from $85,121.00 in 1930, to $45,408.00 in 1932.

‘The proposed budget for 1933 totals $57,500.00 and is subdivided
as follows: —

Field Service seeeseeratarn © ee ee $ 4,500.90

Health Conservation Contest ....---csseeee “BL, 000.90

~Evalvation Studies:
Scarlet Fever ......... go ee 5,900.00
‘Diphtheria eee eos eee e sso tease Sosa 5,000.00
a Medical Participation ...2cscc.ccesessess 15,008.00
. City Aporaigal Torn .....cs0.2+5-s> peas 2, 500. 00
Current Health Department Practices ...... 2, 000. 00

Other Sub-Committee Activities ......-+see 2,500.00

~~ . : 7 Total $57,500.00

~~

November 1, 1932.