Search

DENTAL public health programs-if they Li are to have any meaning-must be a forceful expression of the interests and the needs of people. They cannot be planned, talked about, or judged apart from the social, intellectual, and economic context in which they exist. Over the last 15 or 20 years that context has been vastly altered. As a result, both the scope and content of dental programs also have changed. .The most important of the broader social trends influencing the dental and public h-ealth professions in both the United States and Canada is, witlhout question, the gradual acceptance of increasing responsibility on the part of government for the health and welfare of its citizens. Evidence of this social movement, which has found expression in a series of legislative proposals and actions, can be seen most clearly in Canada, particularly in its western Provinces. There social legislation affecting health services has been broadened rapidly during the last decade. The Hospital Insurance Act and the Saskatchewan Medical Care Insurance Act are the best known examples. In both countries the influence of community forces on the health professions is increasing steadily. Nothing which has happened in the last 30 years is of greater significance or of more importance to dental public health. This iincreasing influence of community forces clearly means that the public views good health care as a right, not a privilege. It means that oni tllis continent neither the medical nor the dental profession can arbitrarily organize and control its practice without due respect for the wishes and the needs of the community. It means that, inevitably, there will be changes in tlhe methocls of organizing and delivering health services, including dental care. These changes in social philosophy have altered the role of the public health dentist as well as the attitudes of the dental profession toward that role. Where once the public health dentist was looked upon with some suspicion, now he is more likely to be seen by the dental profession as a friend and ally in a rapidly changing world. Thoughtful leaders within the profession realize that the trend toward more formal planning for social purposes is not a plot fabricated by the public health profession but a reflection of a basic change in the attitudes of the people. The public health dentist, with his understanding of professional problems and his competence in community affairs, can be a decisive influence in the development of healtlh programs which serve the best interests of both the public and the dental profession. That is exactly the role that today's public health dentists are trying to assume. Against this background of major change in society's attitude toward government and professional attitude about public health, I should like to review some specific trends in dental Dr. Galagan is chief, Division of Dental Public Health and Resources, Public Health Service. The paper was given as an address at the American Dental Association Pan American Conference on Dental Public Health held in Miami Beach, Fla., on October 27, 1962.

I am glad that the Papers Committee has arranged today's meeting in order to give some emphasis to the international aspects of preventive psychiatry and work for mental health. Faced continually with the pressing needs of our own individual professional tasks, it is wise sometimes to raise our sights and look at some of the problems and activities of our neighbour countries in the world.

D IABETES mellitus as a public health problem has become more important because of the aging of the population. Its importance in public health is clearly illustrated by a survey conducted in Oxford, Massachusetts, where 71 per cent of the total population, 3,516 persons, had urine tests and blood sugar examinations. This study was initiated with the aid of the State and district medical societies, the State and local boards of health, and the local physicians. The study was conducted by personnel assigned by the United States Public Health Service (1). A total of seventy cases of diabetes was discovered in this study. Forty were previously known. The fact that thirty cases were newly discovered indicates the need for public health endeavor in this field. This particular paper presents a description of diabetic persons reported in a sample population observed from two to five years in the Eastern District of Baltimore. These persons are described with respect to position in the household, age and year of diagnosis, and first symptoms or complaints of illness. Severity of illness, medical care, and amount of disability during observation are also described.

As the health services in developed countries continue to expand, their demands increase on skilled and expensively trained manpower. Already they employ approximately six per cent of the total manpower in some countries, ranking as the second or third largest employers. As a matter of fact, at the present rate of growth the health industry could be the biggest employer of labor well before the end of the century. On the one hand, the consumer wishes to have the latest and the best, in the way of treatment and specialties, of the technologic revolution in medicine. On the other, there has been little measurable payoff during the past three decades in terms of reduced death rates in any age group and little evidence of benefit in reduced disability; indeed, often the very advances in biomedical science simply mean that more people survive into old age, frequently on maintenance therapy and at further risk of an even more critical episode. Thus, most developed countries now proclaim a shortage of skilled manpower, some admit to having to ration resources, a few are considering a ceiling on training specialist physicians, and at least the United Kingdom is reducing the supply of acute hospital beds by one-third. In the Liverpool area, the present and related studies have contributed to such a radical redeployment of resources. This paper presents a preliminary budget of investment in the twelve study areas of the World Health Organization/International Collaborative Study of Medical Care Utilization. It gives

Knowledge of the causes of death in a given population depends on the ways in which the death certificates are filled out, collected, and processed. The first two steps are generally responsible for the errors which afflict mortality statistics in Latin America. Factors involved in such errors are probably due more to questions of quantity than of quality; this should be remembered in order to interpret properly the vital statistics of the region. Therefore, death rates in general, and those for certain diseases in particular, tend to be below rather than above the actual figures in Latin America. This, however, does not generally affect the relative importance of each disease in the same country, nor does it make it difficult to judge the weight that each one should have in a public health program. By comparing the available figures of one country with those of another and with those of the more developed countries 30 or 50 years ago, it will be possible to determine the leading diseases that affect health conditions in a given area and the stage of their evolution. To carry out a study of the type presented in this paper, it is necessary to have the figures easily available. Unfortunately, only 10 Latin American countries have tried to supply the data regularly for the yearbook on the subject published by the World Health Organization.1 Chile, Colombia, Costa Rica, El Salvador, Mexico, Guatemala, Nicaragua, Panama, Puerto Rico, and Venezuela publish data by sex and age groups for the different causes of death. Data for other countries have been taken from publications of the Pan American Sanitary Bu

One of the most visible concomitants of economic development is a fall in mortality rates and a rise in the general level of health. Good health and longevity are not only highly desired in themselves but are also important because of their potential contribution to economic welfare. Although some health improvements can exacerbate population problems, better health can also raise the rate of growth of income per capita by reducing population expansion and increasing the stock of human and physical capital per worker.' Despite the potential contribution of health improvements to the over-all process of economic development, economists have generally remained silent on the subject of programmes of health care and disease control in less developed countries.2 In particular, no attempt has been made to extend the methods of economic optimization to the health care sector. Unfortunately, public health administrators also have neither developed any systematic methods of planning nor sought to integrate health care into the broader context of development planning. The choice of health care activities has not reflected a conscious comparison of their multi-faceted benefits with their use of scarce inputs. Instead, public health administrators have often attempted to treat programme choice as a "technical" question, free of value judgments about the relative desirability of different health improvements. One result of this has been a concentration on diseases such as malaria in which complete eradication is technically feasible. A second result has been the use of the infant mortality rate as an "indicator" of the community's general health level. This has led health administrators into the fallacy of assuming that programmes which reduce infant mortality actually raise the entire level of health. Substantial resources have therefore been devoted to decreasing infant mortality, thus increasing population size but not improving health in other age groups. The current paper reports the first step towards the development of a systematic approach to health sector planning capable of integration into a more general programme of economic development. The aim of the present research has been to devise a potentially operational method for allocating the scarce health sector funds, manpower and facilities among different disease control programmes and individual activities in the way which yields the optimum feasible reduction of mortality

In two of his more recent papers, Spiegelman stressed that it was necessary to examine the experience of generations rather than the cross section of period experience to obtain a better understanding of the underlying changes in mortality with advance in age.l 2 As an example of how current life tables can sometimes present a misleading picture, Spiegelman cited the case of tuberculosis: current life tables pointed to a rise in death rates with advancing age whereas generation experience indicates a decline in tuberculosis mortality at the older ages. The age pattern of generation mortality from specific causes of death can differ significantly from that deduced on the basis of current life tables, depending on the trends in the age-specific death rates. In a broader context Spiegelman observed that the mortality experience of white males in the United States has

IN THE United States, growing interest in disability and medical care insurance, as well as group plans for provision of medical service presents an increasing need for statistics on the incidence of illness among persons of opposite sex and of different ages. Since 1920 data of this type have been made available for certain population groups by special morbidity studies of families. One of the studies gives illness rates by sex and age for the population of sample areas in the United States: the Committee on the Costs of Medical Care study of 19281931 (1). Two other studies provide data for local areas in Maryland: one made in Hagerstown from 1921-1924 (2) and the other conducted in the Eastern Health District of Baltimore from 1938-1943. A number of preliminary reports of the study in the Eastern Health District of Baltimore have been published (3, 4). The purpose of the present paper is to make available data from this study on illness by age and sex in more detail than has been given in the past.

NUMBER of longitudinal studies of families have been made in order to observe the incidence of illness among their numbers. It is recognized by those who have conducted such studies that the interval between visits to the family has a marked effect upon the accuracy of reporting past illnesses, especially those of a minor nature. Thus, the memory of the informant constitutes an important factor which may influence the level of illness obtained in any morbidity study. The purpose of this paper is to consider some of the effects of the frequency of family visiting upon the accuracy of reporting minor illnesses. The data are limited to acute respiratory diseases because most illnesses in this class are of a minor

The purpose of this paper is to emphasize outstanding current problems in international education as they relate to medicine and the preservation of health, a task that is easier than offering uniformly feasible solutions. But before becoming involved in current efforts to solve health educational problems on the international level, it would appear desirable to specify objectives and to cite realistic attempts to attain them. It is my opinion that the ultimate objectives of international health education should be directed toward a better economic and health status of our friends abroad as a major contribution toward a safer world. We cannot disregard the marked differences in health, nutritional status, and economic opportunities in countries outside the United States. The problems in health and medical care of the United States are not those of Europe, Asia, Africa, or South America. We are beginning to take health standards and needs pretty much

5T HE morbidity study, conducted from June, 1938 to May, 1943, in the original Eastern Health District of Baltimore, is the first investigation of illness where, due in large part to the method of sampling, families with relatively short periods of observation constitute an important part of the total observed population of families. Preliminary analysis of the morbidity experience of the first year of the study indicated that about one-third of the total families either moved out of or into the study area during that period (1). Movement of families continued throughout the five-year period. This paper presents a study of some of the socio-economic characteristics of the moving and non-moving families-characteristics which form a background for forthcoming analyses of illness. Reed, et al. have presented some general characteristics of the population in the Eastern Health District (Wards 6 and 7) from which the morbidity study population was drawn (2). They found that in 1939, 56 per cent of the white families in the district were home owners. They concluded also that "The population is essentially in the lower middle economic class with a greater proportion of skilled and semi-skilled workers 'relatively' than in the rest of the city."

T HE formal structure and function of Soviet health services have been described abundantly over the last 25 years. As the first fully socialist nation, its approach to problems of health and the organization of medical care has interested hundreds of western observers, and we have available as a result of this interest many excellent and thorough accounts, from the Sigerist volumes of the 1930's to the recent study-tour reports of the World Health Organization and the United States Public Health Service. The excuse for another exposition would not be to add further details to the picture of Soviet medicine. A two-week observation could hardly do that anyway. It is, rather, to attempt to analyze the Soviet health service system in terms of certain key concepts that are of interest in the United States and perhaps in all countries. Under each concept, one may explore the Soviet approach in several of the formal subdivisions of the health services. One need hardly be reminded that the Soviet Union is a huge country-the largest land area of any nation in the world, with a population of 220,000,000. Because it is built from fifteen republics and an enormous diversity of local national and ethnic groups, one should hardly expect a simple, clear picture of uniformity, in the health services or any other aspect of life. This would be true even had the past 40 years since the 1917 revolution been times of quiet social development. But since the overthrow of Czarism, almost half the time has been spent in periods of war and reconstruction. After the First World War the country experienced a period of hostility from the * Based largely on a two-week study-tour made by a party of ten American and British physicians and social scientists in August, 1961. At the time of this study and preparation of this paper, the author was Research Professor of Administrative Medicine at Cornell University. ** Professor of Public Health, University of California, Los Angeles.

T HERE are many problems facing the awakening people of Africa today, but one of the most acute and universal is that of public health. Perhaps more than any other factor, health provides the key to the history of the continent and to the present condition of her people. It may even be safe to say that a solution to Africa's health problems, the current political crisis notwithstanding, is basic to any renascence there. At any rate too little attention has been given to health as a factor in African development, and this paper is, among other things, a call for further research into the matter.

LTHOUGH the problem of age misreporting in the census (and other social surveys) has long been recognized,l few techniques have been developed for estimating and correcting the errors involved. Those techniques which are available for demographic analysis are, for the most part, concerned with digital preferences or five year age distributions;2 as such they are inadequate for determining preferences or avoidances for individual years of age. The method employed in this paper is an attempt to establish the size of error for each year of age, relative to its neighbors, for the native white male and native white female populations enumerated in the United States censuses from 1880 to