Community Health in Rural America During the Mid-20th Century

The Council on Rural Health (1945-1975) of the American Medical Association (AMA) collaborated with domestic health care organizations in the mid-20th century to improve access to health care in rural areas. This council promoted health and farm safety education, public health measures, insurance plans, and construction of health facilities. It also lobbied state and county medical societies to form rural health committees. AMA archive materials document these activities and demonstrate physicians' involvement and investment in the communities they served.

A History of Social Work in Public Health

Social work is a core health profession with origins deeply connected to the development of contemporary public health in the United States. Today, many of the nation's 600 000 social workers practice broadly in public health and in other health settings, drawing on a century of experience in combining clinical, intermediate, and population approaches for greater health impact. Yet, the historic significance of this long-standing interdisciplinary collaboration-and its current implications-remains underexplored in the present era. This article builds on primary and contemporary sources to trace the historic arc of social work in public health, providing examples of successful collaborations. The scope and practices of public health social work practice are explored, and we articulate a rationale for an expanded place for social work in the public health enterprise.

Award for Distinguished Senior Career Contributions to Psychology in the Public Interest: Faye Z. Belgrave

The APA Awards for Distinguished Contributions to Psychology in the Public Interest recognize persons who have advanced psychology as a science and/or profession by a single extraordinary achievement or a lifetime of outstanding contributions in the public interest. The 2016 recipient of the Award for Distinguished Senior Career Contributions to Psychology in the Public Interest is Faye Z. Belgrave. She was selected for her "extensive service contributions to her profession, her university, and the community," evidenced in her "focused research agenda that informs and shapes her teaching, her mentoring, and the community programs, workshops, and trainings she has designed." Dr. Belgrave's award citation, biography, and a selected bibliography are presented here. (PsycINFO Database Record

Improving care delivery at the community level: an examination of the AF4Q legacy

OBJECTIVE

Aligning Forces for Quality (AF4Q) was the Robert Wood Johnson Foundation's nearly 10-year, multicomponent initiative to create meaningful and sustainable change in 16 communities. Our purpose was to describe the likely legacy of the care delivery component of AF4Q among participating communities and the factors that influenced the legacy.

METHODS

We used a multiple-case study approach. Our analysis relied on 3 key documents for each community, based on key informant interviews conducted between 2006 and 2015: (1) a summary of the community's care delivery activities under AF4Q, (2) a summary of the community's experience in the AF4Q program, and (3) a summary of the characteristics of each community and the multi-stakeholder alliance that led local efforts under AF4Q. We used a team-based consensual approach to analysis.

RESULTS

We identified 3 types of legacies: (1) in 3 communities, there appear to be sustained infrastructures or wide-reaching activities attributable to AF4Q; (2) in 5 communities, AF4Q participation was used to advance preexisting activities; and (3) in 8 communities, the care delivery legacy is likely to be limited, because the local alliance focused on performance measurement instead of care delivery or the care delivery activities had limited reach and sustainability. Community contextual factors (eg, availability of other grant support) and alliance characteristics (eg, areas of expertise) greatly influenced the AF4Q care delivery legacy.

CONCLUSION

AF4Q appears to have created meaningful and sustained change in care delivery in half of the participating communities. Among the other communities, the considerable financial support and technical assistance provided by RWJF was not enough to overcome some of the contextual barriers that often hamper quality-improvement efforts.

The success factors of scaling-up Estonian sexual and reproductive health youth clinic network--from a grassroots initiative to a national programme 1991-2013

BACKGROUND

A growing number of middle-income countries are scaling up youth-friendly sexual and reproductive health pilot projects to national level programmes. Yet, there are few case studies on successful national level scale-up of such programmes. Estonia is an excellent example of scale-up of a small grassroots adolescent sexual and reproductive health initiative to a national programme, which most likely contributed to improved adolescent sexual and reproductive health outcomes. This study; (1) documents the scale-up process of the Estonian youth clinic network 1991-2013, and (2) analyses factors that contributed to the successful scale-up. This research provides policy makers and programme managers with new insights to success factors of the scale-up, that can be used to support planning, implementation and scale-up of adolescent sexual and reproductive health programmes in other countries.

METHODS

Information on the scale-up process and success factors were collected by conducting a literature review and interviewing key stakeholders. The findings were analysed using the WHO-ExpandNet framework, which provides a step-by-step process approach for design, implementation and assessment of the results of scaling-up health innovations.

RESULTS

The scale-up was divided into two main phases: (1) planning the scale-up strategy 1991-1995 and (2) managing the scaling-up 1996-2013. The planning phase analysed innovation, user organizations (youth clinics), environment and resource team (a national NGO and international assistance). The managing phase examines strategic choices, advocacy, organization, resource mobilization, monitoring and evaluation, strategic planning and management of the scale-up.

CONCLUSIONS

The main factors that contributed to the successful scale-up in Estonia were: (1) favourable social and political climate, (2) clear demonstrated need for the adolescent services, (3) a national professional organization that advocated, coordinated and represented the youth clinics, (4) enthusiasm and dedication of personnel, (5) acceptance by user organizations and (6) sustainable funding through the national health insurance system. Finally, the measurement and recognition of the remarkable improvement of adolescent SRH outcomes in Estonia would not have been possible without development of good reporting and monitoring systems, and many studies and international publications.

Modernization and rural health in Mexico: the case of the Tepalcatepec Commission

Mexican policymakers instituted community-based health programs in the 1940s and 1950s to encourage rural participation in state-sponsored health and economic development initiatives. The Tepalcatepec Commission (1947-1961) united previously independent government programs into a multi-tiered collaboration that addressed regional development through national, state, and local networks. While national policymakers and state officials designed plans to improve agricultural production, promote industrialization, utilize the area's natural resources, and expand communication channels, health workers established unprecedented relationships with indigenous community members by introducing the Commission's projects in culturally relevant ways. They used their on-the-ground experiences to learn local languages, customs, and beliefs, and incorporated these factors into their health education and disease treatment campaigns. The result serves as an example of short-term cooperative relationships between healthcare workers and indigenous groups that not only reduced the major health risks in the area, but also paved the way for collective economic development.

Questions and answers: Some questions discussed at one of the round tables held at Chicago Institute with public health nurses

There were a number of issues confronting public health nurses in 1919, including the differentiation of practice between visiting nurses and public health nurses, use of community partnerships when developing a new nursing service in a community, and standards of nursing work. Other issues included the focus of nursing work at the community/population versus individual level, how to balance the work load where there was only one nurse in a community, and educating the public about the value of public health nursing to the community. In this excerpt from the original publication, Ella Phillips Crandall responded to questions raised at a round table session held in Chicago in 1919 as a part of a Public Health Nursing Forum, and then published in the October 1919 issue of The Public Health Nurse. While the social context in which PHNs worked in 1919 were significantly different from those nurses face today, these insights are prescient to the issues faced by PHNs today as the profession continues to address issues related to standards of practice, role development, and educational preparation for both entry level and advanced practice.

Early initiation of community-based programmes in Nepal: a historic reflection

Community-based programmes have long been an integral part of Nepal's health sector strategy and has contributed to the progress seen in maternal and child health. This paper reviews three early community-based programmes - the acute respiratory infection programme and its evolution to the fully scaled-up community-based integrated management of childhood illness programme, the national vitamin A programme and the female community health volunteer programme - and how the Government of Nepal rapidly accepted them to address pressing maternal and child health issues in an evidence-informed manner, moving rapidly from research to feasibility studies, to implementation and scale-up.

Feeding the family during times of stress: experience and determinants of food insecurity in an Inuit community

This paper uses a mixed methods approach to characterise the experience of food insecurity among Inuit community members in Igloolik, Nunavut, and examine the conditions and processes that constrain access, availability, and quality of food. We conducted semi-structured interviews (n= 66) and focus groups (n= 10) with community members, and key informant interviews with local and territorial health professionals and policymakers (n= 19). The study indicates widespread experience of food insecurity. Even individuals and households who were food secure at the time of the research had experienced food insecurity in the recent past, with food insecurity largely transitory in nature. Multiple determinants of food insecurity operating over different spatial-temporal scales are identified, including food affordability and budgeting, food knowledge and preferences, food quality and availability, environmental stress, declining hunting activity, and the cost of harvesting. These determinants are operating in the context of changing livelihoods and climate change, which in many cases are exacerbating food insecurity, although high-order manifestations of food insecurity (that is, starvation) are no longer experienced.

An evaluation of the policy on community health organizations in China: will the priority of new healthcare reform in China be a success?

OBJECTIVES

The objective of this paper is to assess historical and recent health reform efforts in China. We provide a brief history of the Chinese healthcare system since 1949 as context for the current healthcare; examine the factors that led to recent efforts to reestablish community-based care in China; and identify the challenges associated with attaining a sustainable and quality community healthcare system.

METHODS

Based on literature review and publicly available data in China, the paper will present a historical case study analysis of health policy change of CHOs in China and provide policy evaluation, and the paper provided policy suggestions.

RESULTS

We find that the government's recent efforts to emphasize the significance of community healthcare services in China have started to change patterns of healthcare use, but many problems still inhibit the development of CHOs, including unsustainable governmental roles, issues of human resource inadequacy and laggard GP practice, poorly designed payment schemes, patient's trust crisis and continue to inhibit the development of community-based primary care.

CONCLUSIONS

Additional policy efforts to help CHOs' development are needed. Recent government investments in public health and primary care alone are not sufficient and could not be sustainable. It will not until long-term self-sustaining mechanisms to relieve an omnipotent government are established, including competent community doctors (GP) system, supportive social insurance reimbursement, appropriate financial incentives to providers, better transparency and accountability, as well as a more regulated referral system, a legitimate, sustainable and quality community health system could be attained.

Comparative efficiency assessment of primary care service delivery models using data envelopment analysis

This paper compares the relative productive efficiencies of four models of primary care service delivery using the data envelopment analysis method on 130 primary care practices in Ontario, Canada. A quality-controlled measure of output and two input scenarios are employed: one with full-time-equivalent labour inputs and the other with total expenditures. Regression analysis controls for the mix of patients in the practice population. Overall, we find that community health centres fare the worst when it comes to relative efficiency scores.

Navigating the AIDS industry: being poor and positive in Tanzania

This article shows how poor people living with HIV/AIDS in Tanzania navigate a myriad of actors, agencies and organizations to obtain the aid they need to survive. It focuses on community-based organizations which establish networks of care through which people obtain care, treatment and financial support. A case study of a roadside town in Tanzania illustrates that these community-based networks of care — essential to the survival of many — are partly the product of the AIDS industry, which encourages the establishment of community-based organizations and voluntary service delivery rather than more formalized systems of care. Community-based organizations, however, are so poorly supported that they often deploy self-destructive strategies. The need to strategically navigate the AIDS industry creates tension and even conflict among HIV-positive activists, the people they represent and the wider community, which undermines rather than strengthens community-based interventions. Whilst the AIDS industry promises inclusion of HIV-positive people in the response to HIV/AIDS, it succeeds only partially, with the result that it may potentially do more harm than good.

Social capital and women's reduced vulnerability to HIV infection in rural Zimbabwe

Social capital—especially through its “network” dimension (high levels of participation in local community groups)—is thought to be an important determinant of health in many contexts. We investigate its effect on HIV prevention, using prospective data from a general population cohort in eastern Zimbabwe spanning a period of extensive behavior change (1998–2003). Almost half of the initially uninfected women interviewed were members of at least one community group. In an analysis of 88 communities, individuals with higher levels of community group participation had lower incidence of new HIV infections and more of them had adopted safer behaviors, although these effects were largely accounted for by differences in socio-demographic composition. Individual women in community groups had lower HIV incidence and more extensive behavior change, even after controlling for confounding factors. Community group membership was not associated with lower HIV incidence in men, possibly refecting a propensity among men to participate in groups that allow them to develop and demonstrate their masculine identities—often at the expense of their health. Support for women's community groups could be an effective HIV prevention strategy in countries with large-scale HIV epidemics.

[Community health and social action in the epidemiologic control of infantile trachoma, Spain (1932-1939)]

Within the context of the endemic trachoma that affected different regions of Spain until the 1960s, this paper analyses the epidemiological determinants of child trachoma and its treatment, based on a preventive care model which incorporated the concept of community health that took shape during the interwar period. Early detection of cases, together with preventive measures, education, therapy and inspections, such as those carried out by visiting nurses, all helped to control the disease. Our results reaffirm the validity of the horizontal intervention strategies used for improving the sanitary conditions and environmental factors responsible for this prevalence of trachoma.

Parallel realities: exploring poverty dynamics using mixed methods in rural Bangladesh

This paper explores the implications of using two methodological approaches to study poverty dynamics in rural Bangladesh. Using data from a unique longitudinal study, we show how different methods lead to very different assessments of socio-economic mobility. We suggest five ways of reconciling these differences: considering assets in addition to expenditures, proximity to the poverty line, other aspects of well-being, household division, and qualitative recall errors. Considering assets and proximity to the poverty line along with expenditures resolves three-fifths of the qualitative and quantitative differences. Use of such integrated mixed-methods can therefore improve the reliability of poverty dynamics research.

Lessons from the evolution of a CBR programme for people affected by leprosy in Northern Nigeria

OBJECTIVE

This paper reviews the 13-year evolution of the social economic activities in Northern Nigeria from a welfare-oriented to a community-centred programme for people affected by leprosy.

DESIGN

The review relied on the analysis of policy and strategy documents, programme guidelines and statistical and evaluation reports.

RESULTS

Findings revealed that the transformation among other things, demanded formulation of new programme policies and guidelines; and staff training in CBR principles and practice. Findings also showed that adopting CBR principles and community development projects can stimulate improvements in living conditions, self-esteem and acceptance of people affected by leprosy into the community. Regardless of becoming a more inclusive and participatory programme wherein people affected by leprosy contribute to programme implementation and evaluation; groups affected by leprosy remain economically dependent on the programme and partnership mobilisation is weak. This explains why the priorities for sustaining the processes and impacts generated through CBR in northern Nigeria include: i) empowering groups to access mainline services; ii) working through partners to implement CBR and attract extra funding/ownership of interventions, and iii) promoting human rights of people affected by leprosy and working for a barrier free environment.

CONCLUSIONS

In the absence of an agreeable understanding and method of assessing sustainability in CBR, we recommend the field-testing of a proposal for evaluating sustainability, to determine its utility in different contexts. Such field-tests have the potential of influencing policy and practice in the future.

[Textual research on Capital's Puji Tang (Relief Houses) in the Qing Dynasty]

Puji Tang (Relief Houses) was established in 1706 with the function of helping the poor, comforting and compensating people by medicine, therefore, which was supported by the Emperors of the Qing Dynasty. As a representation of medical relief organization of the Qing Dynasty, Puji Tang was developed from a folk relief organization to a government national organization. Because of the declination of the Qing Empire and the problems within its own organization, Puji Tang changed finally to an organization of reeducation through labor in 1907.

The hill of health: aspects of community at the Waipiata Tuberculosis Sanatorium, 1923-1961

Sanatorium care formed the basis of New Zealand's response to the problem of tuberculosis in the first half of the twentieth century. The dissatisfaction with institutions that arose in the 1960s has coloured the way sanatoria are remembered by portraying them as a misguided predecessor to the drug therapies, which eventually made sanatoria obsolete. Care in the community was assumed to be a more cost-effective and humanitarian option, allowing patients to live 'normal' lives in society. Through a case study of Waipiata Sanatorium, I hope to challenge the belief that sanatorium experiences were usually unpleasant, that community care was more 'humanitarian, 'and that 'institutional' and 'community' are opposing forms of care.

A view from the streets: women and medical work in Elizabethan London

In Elizabethan London, women occupied a significant position in the city's medical marketplace, both as consumers of medical services and as practitioners. Though male medical authors of the period objected to the presence and practices of these women, a very different view of their medical work emerges if we shift our historical vantage point to the streets, houses, churches, and hospitals of the city. Using relatively underutilized sources such as parish records, probate records, lists of immigrants to London, hospital records, and individual manuscripts it is possible to draw a richer, more detailed portrait of how female health-care workers engaged with the business of health and healing. Women emerge from these records as active, prominent, and acknowledged participants in the delivery of services that promoted and preserved the health of many Londoners from cradle to grave. Hired by public institutions such as parishes and hospitals, as well as by private individuals, women were central figures in the delivery of nursing, medical, pharmaceutical, and surgical services throughout the city as part of organized systems of health care. Exploring how Londoners saw female practitioners, and how women played a recognized role within the city's range of health-care options, demonstrates that women were crucial to community health, and were also valued as such by their neighbors and patients.

Indigenous health in a global frame: from community development to human rights

This essay explores the shift from 'human rights' to community development' in the framing of Koori (or Indigenous) health policy research at the University of Melbourne in the 1990s. It provides an overview of the recent history of rights-based discourses in international health, contrasting cosmopolitan claims of rights with older civic reference points for health intervention: such as 'citizenship' and 'community development.' In particular it considers the relations of the conjunction 'health and human rights' to the global emergence during the past twenty years of nongovernmental organisations and their challenge to the power of the nation-state. This account draws heavily on the author's observation of the institutionalisation of rights discourses in health research programs at Melbourne and Harvard, vantage points that provide at best a partial perspective, but one that may nonetheless reveal some salient historical features.

[Doctor Bronisław Hager (1890-1969)--doctor and politician]

Doctor Bronisław Hager was born into the family of the Polish intelligentsia. He was brought up according to the Polish tradition with respect for freedom and independence. His father, Maxymilian was a fervent fighter in the struggle for independence of Silesia. His mother was involved in community service. Bronisław Hager finished his medical studies at Collegium Medicum of Jagiellonian University on 27th March 1914. Between World War I and World War II he actively fought for joining Silesia to Poland. During World War II he emigrated to London where he became one of members of the Polish government in exile. At the end of World War II he was a doctor of United Nations in Bavaria. He came back to the country on 22th November 1946. He settled in Tarnowskie Góry and worked at the community health center till 1967. He translated Sir Alexander Fleming's work on the discovery and using of penicillin. He died on 30th June 1969. Bronisław Hager was a good doctor, a great politician, a wonderful speaker and a real Pole.

Local leadership in public health: the role of the medical officer of health in Britain, 1872-1974

The recent policy focus in British public health on the importance of local action invites consideration of historical precedent. The role and achievements of the medical officer of health (MOH), the local government official charged with public health responsibilities, is discussed. The gradual accretion of duties is traced in the first section: the mid-Victorian concern with urban sanitation; the preventive strategies adopted after the bacteriological revolution; the extension of personal health services in the early 20th century; and the more diminished role under the National Health Service (NHS), when infectious diseases retreated. The historical verdicts passed on the MOsH are reviewed in the second section. The leading role of the MOsH in the late 19th-century mortality decline has been reasserted, and although there is some justification in the argument that in the 20th century public health lost its focus, it is important to recall that the extension of personal health services under MOH direction signified a major extension of access to care. Similarly, the charge that MOsH did not redefine their role in the period before their final demise in 1974 is not entirely justified. The emphasis of the NHS on curative rather than preventive medicine, and the economic constraints on local authority health service expansion limited their room for manoeuvre. The history of local leadership in public health may offer some enduring lessons. These include the importance of monitoring local population health, acting as a public interface between medicine and the community, facilitating joined-up working and confronting vested interests.

[Thirty years of family medicine in B&H]

The experience in our surrounding throughout many years, based on Europeans and Worlds standards of health care service, gives the advantage to the Primary Health Care Service, with well educated family doctors and nurses who work in a community and give cheaper and quality health service. The paper presents a view of Family Medicine development in B&H during the last thirty years, and the most important projects realized in that period.

[Community aspects of geriatric dentistry--a literature review: 1975 - 2000]

The world's population is in transition, but there is an inevitable move in all societies towards an aging population. There is an agreement that the ability of the geriatric population to adjust to the "third age" depends on the will of the society and the community to provide services and to support this vulnerable and dependent population. The preponderance of oral health issues and their impact upon general health and quality of life have prompted a variety of geriatric related efforts over the last 20 years. Predoctoral and postdoctoral education and training efforts have been initiated, geriatric research agendas have started to yield important findings, and a few service programs have marginally helped improve dental care access for the geriatric population. Past discoveries have enabled large portions of the world's population to enjoy far better oral health than their forebears a century ago. Although different patterns of dental needs emerge throughout the world, the" silent epidemic" of oral diseases is affecting the most vulnerable parts of the population: the poor children, the elderly and many members of racial and ethnic minority groups. The review of the literature of community aspects of geriatric dentistry in the past twenty five years will be introduced in two articles. The first article summarizes the important issues of demography, oral health condition, changes in attitude towards oral health of the geriatric population, oral health services given in geriatric institutions and mobile dentistry. The issues of law and ethics, development of public and community oral health programs for the geriatric population and plans as well as trends for the future will be discussed in the second article. Setting goals and presenting data are steps in the right direction but are not enough; the success will be measured by the ability to make things happen. The continuing anticipated growth of the geriatric population will, hopefully, be translated into a rising political power and to fruitful and practical health outcomes.

Everyday health histories and the making of place: the case of an English coastal town

During recent years, health geography has focused increasingly on how people's experiences of health and places are interrelated. This has included historical research on a variety of well-known places and remarkable events. In contrast, relatively little attention has been paid to how health and health care can be influential historically to the development, image and identity of 'everyday' and ordinary places. We focus on the case of a small town in Southern England to demonstrate the long and diverse historical connections that exist between health and such places. Using both historical documents and local literature, the paper reviews early invasions and incursions, epidemics of infectious disease, the development of a therapeutic seaside resort, the impacts of the Second World War, and more recent social and economic developments associated with an ageing population. Complex and diverse health-related histories are shown to be interwoven with local and extra-local histories including those of national or international significance. We argue that health histories can be integral to shaping the past and present of places and our broader understandings and interpretations of them. From a disciplinary perspective, we contend that by adopting theoretical perspectives from cultural geography, an enhanced historical geography of health could disentangle these historical strands, tell these important stories and put everyday health histories in their place.