Report of the Chairman, 1970 AT the recommendation of the Tech. nical Development Board, the Governing Council has voted to consolidate the Committee on Health Manpower and the Committee on Professional Education to form a Health Manpower Council. Therefore, this will be the final report of the Committee on Health Manpower. It will emphasize recommendations which may aid in the transition to the new organizational structure. Two meetings of the Committee were held since the last annual report-one during the time of the Annual Meeting in Philadelphia, and the other in mid- May of this year. The following is a summary of information presented and actions taken at those meetings with additional notations concerning progress since the time of the last meeting. Liaison Contacts were made by committee members with several major national organizations concerned with problems of health manpower. Detailed reports of the individuals making these contacts are available in the minutes of Committee meetings. Of special interest was the report of Dr. Charles Lewis on his contacts with the American Medical Association and the American Hospital Association. Dr. Lewis attended a meeting of the AMA Council on Health Manpower in January, 1970. His report of that meeting indicates clearly the intense level of activities of the AMA and AHA with respect to health manpower and poses a clear challenge to the APHA to assume a decisive role for itself in this field. At the invitation of the AMA, Dr. 612 Lewis will give one of the three keynote talks at the National Congress on Health Manpower in October, 1970. Also, the AMA Council on Health Manpower has suggested a small conference to determine what kind of legislation may be necessary to facilitate experiments in recruitment and utilization of new kinds of health personnel in the university setting. Following discussion of Dr. Lewis's report, the Committee on Health Manpower agreed that joint action with other major organizations concerned with professional manpower is mandatory for meaningful accomplishments. On an interim basis, it agreed:* (a) that liaison with AMA and AHA be continued by Dr. Lewis; (b) that APHA seek representation on a joint committee recently established by the Association of Schools of Allied Health, the AMA, and the National Commission on Accreditation; (c) that a task force should be established under the auspices of the new Health Manpower Council to make specific recommendations on the structure of the Council's working relationship with AMA, AHA, and other professional organizations, both from the standpoint of broad policy and function. As a means of improving liaison with the Association of Schools of Allied Health Professions, the Committee recommended that APHA seek reciprocal membership with that organization. However, this proposal has been rejected by the Executive Board on the basis that it would set an untenable precedent. Subcommiffee Activities A. Subcommittee on Civil Service Mr. Robert Webster reported to the Committee in some detail on the work VOL. 61. NO. 3. A.J.P.H.
which had been begun by Dr. Lenor Goerke with respect to health manpower and civil service systems. His recommendation and the conclusion of the Committee was that for the near future further work in this area probably should receive a low priority by the new Health Manpower Council. However, it was unanimously agreed that a move toward statewide merit systems would be a big step forward. The Committee recommended the drafting of a resolution in support of such a move for transmittal to the secretaries of the Department of HEW and the Department of Labor. It was believed that once passed by the Governing Council the resolution could be helpful in stimulating the development of model state laws. Dr. Sterner was requested to prepare a draft of the resolution and a supporting statement which would include the beneficial purposes of merit systems. B. Subcommiffee on Financing the Professional Examination Service This Subcommittee continues to examine the financial situation of PES and advises in this area of operations. The Committee recommends to the Health Manpower Council that reciprocal membership with the new Advisory Council of the Professional Examination Service be maintained and further that the director of the Professional Examination Service be invited to attend, or send a representative, to all meetings of the Health Manpower Council. C. Subcommittee on Definition of Community Health (Service) For many months the Committee and this Subcommittee have struggled with the problem of how to establish a functional definition which would help delineate the scope of the Committee's concern with respect to community health manpower. The discussion finally reached a climax at the May meeting with a decision that no specific delineation should be made. Rather, with the continuous evolution of new types of health manpower and the growing concept that health is in great part a function of social and economic factors, the definition sought by the Committee really should be broadly encompassing rather than restrictive. It is felt that the new Health Manpower Council should conduct its activities on the basis of priorities among health manpower problems and considerations rather than on the basis of indusion or exclusion of particular categories of personnel. With this approach in mind, the Committee accepted a broad composite definition of Community Health (Service) offered by Mr. Ralph Graber: "The art and science of maintaining, protecting, and improving the physical, mental, and social health and well-being of all the people through organized community efforts. This includes the planning, organization, delivery, and evaluation of personal and environmental health services, and it involves official and voluntary agencies, organizations, and institutions; private practitioners; and consumers. It is based on the concept of a 'community of solution'-in this way transcending political jurisdictions." The definition is submitted to the new Health Manpower Council for its consideration. A critique of the definition has been prepared by Dr. Charles Lewis. It was agreed also that pilot studies for the provision of community health services should be promoted similar to those that have been proposed by the Program Area Committee on Child Health, which would assist in determining just what the real personnel needs may be. In the meantime, it was felt that greater attention should be given to the many types of health manpower known to be in short supply. Grave concern was expressed at the failure of the Department of Labor to give sufficient emphasis to this problem. It was recommended that APHA send a letter to the Secretary of Labor calling attention to health manpower needs on MARCH. 1971 613
which it was agreed there should be immediate action. In order that the request be made very specific, Dr. Gallagher agreed to supply APHA staff with a list of types of personnel which have been determined to be in greatest need at the present time. D. Subcommittee on Intelligence Function The matter of whether or not APHA should be extensively involved in gathering and disseminating information on health manpower has been discussed on several occasions. Possibilities for funding such an activity have been explored but without success. Repeatedly, the conclusion has been reached that this function probably would be best performed by the federal government or professional associations other than APHA. But, no doubt, the matter will come up again for consideration by the new Council. Statement on National Clearinghouse Last year, apparently through misunderstanding of the intent, a resolution forwarded to the Committee on Public Policy concerning the establishment of a clearinghouse of information on health manpower by the federal government was not referred to the Governing Council for consideration. This year the resolution is being resubmitted and the Committee urges its endorsement. Commiffee on Professional Education At the May meeting the representative of the Committee on Professional Education reported on that Committee's concern about the lack of consistent policies with respect to qualifications and accreditation in areas such as comprehensive health planning and health administration. He presented a CPE recommendation that "the Executive Board immediately establish an aggresive leadership policy on the need for qualification 614 and accreditation and institute very early negotiations with the National Commission on Accreditation to develop appropriate standards and procedures for areas of professional training which importantly affect the entire range of health services." The Health Manpower Committee voted its endorsement of the recommendation. Minority Groups After a background presentation by Dr. Ralph Hines, the Committee discussed in some depth the problems of education and participation by blacks and other minority groups in health occupations. The Committee made due consideration of the APHA resolution on Equal Rights and Health Manpower adopted at the Philadelphia meeting and of communications from the Association's Committee on Equal Health Opportunities. It was agreed emphatically that the time for more specific action on these problems has come. The Committee recommends: 1. The establishment of a task force a. to investigate the problems of minority group participation in health occupation and make recommendations with respect to increasing special educational programs in medical schools and other schools for health personnel as a means of involving more persons from minority groups; b. to draft a resolution for consideration by the Council which would call for special federal assistance to schools primarily concerned with the education of students from minority groups. 2. That the APHA go on record for maintaining the forgiveness clause in the Student Loan Program and of increasing the availability of funds. 3. That APHA request the federal government to increase special project grant funds and to give priority to projects aimed at improving the educational opportunities for persons from minority groups. As an interim measure a subcommittee was appointed to direct its attention to VOL. 61, NO. 3. A.J.P.H.
these matters and to produce additional specific recommendations for action by the Council on Health Manpower. The subcommittee consists of Dr. Ralph Hines, Chairman, Dr. Joseph Gallagher, and Mr. Ralph Graber. Health Manpower Legislation Following a discussion of existing and pending legislation relating to health manpower, it was concluded that very little progress has been made in this regard and in some respects federal programs are regressing, e.g., elimination of the forgiveness provisions on student loans, inadequate funds for construction and operation of schools, proposed renewal of the allied health legislation in its present form. Because of the continuing and growing importance of legislation related to health manpower, the Committee recommends that the Health Manpower Council consider the establishment of a standing committee on legislation with responsibility for keeping up to date on all legislation affecting health manpower and for stimulating action through letters, resolutions, legislative testimony, and so on, which will help guide the operation of federal programs and promote more effective expenditure of federal funds in this area. Task Force Recommendations It is recommended that the following Task Forces of the Council on Health Manpower be established to continue and expand activities of the former Committee on Health Manpower: 1. Task Force on Medical Practice Acts and Experimental Utilization Programs a. To investigate the present status and needs with respect to Medical Practice Acts and the restrictions which they place on experimentation in expanded utilization of auxiliary health personnel. b. To make recommendations concerning actions with regard to these acts including the development of model laws as may be appropriate. c. Task to be completed within one year. 2. Task Force on Working Relationships with Health Manpower Counterparts of Other Professional Organizations a. To make contact with other major associations of health professionals and determine possible advantageous working relationships for the Health Manpower Council, including the establishment of joint committees or councils. To appraise the resources, attitudes, and progress of these organizations and to make specific recommendations concerning the appropriate role or roles for APHA in the health manpower area for the immediate future. b. Task to be completed within six 3. Task Force on Minority Group Participation in Health Professions a. To investigate the problems of minority group participation in health occupations. b. To make recommendations with respect to increasing special educational programs in medical and other schools for health personnel as a means of involving more persons from minority groups. c. To draft a resolution for consideration by the Council which would call for special federal assistance to schools presently concerned with the education of students from minority groups. d. Task to be completed within six 4. Task Force on Immediate Priorify Needs in Health Manpower Background: The Committee on Health Manpower at its May meeting recom- MARCH, 1971 615
mended that APHA direct a letter to the Secretary of Labor calling his attention to known shortages and needs in health manpower and urging his immediate action in training personnel of types for which there is an immediate need. The letter is to contain a listing of specific shortage categories. a. To follow up on this previous action by studying the health manpower status in the nation, determining additional priority needs, and defining further specific action that can be recommended to the Departments of Labor and HEW or other appropriate agencies. b. Task to be completed within six QUENTIN M. SMITH, D.D.S., 4511 N.W. 14th Place, Gainesville, Fla. 32601, Chairman RALPH H. BOATMAN, Ph.D. Roy J. BOSTON, M.S.S.E. JOSEPH A. GALLAGHER, M.D. RALPH C. GRABER, M.S.S.E. RALPH HINES, Ph.D. WILLIAM McC. HIScOcK, M.A. CHARLES LEWIS, M.D. DARREL J. MASE, Ph.D. WILLIAM FRED MAYES, M.D. MARION MURPHY, Ph.D. DONALD F. SIMPSON, M.A. ROBERT G. WEBSTER, M.P.H. Report of the chairman of the Committee on Health Manpower to the Governing Council of the American Public Health Association at the Ninety-Eighth Annual Meeting in Houston, Texas. October 25, 1970. The Science of Epidemiology "In general, epidemiology is a science of compromises. It is a well-known fact that the most precise and repeatable measurements in any study are those made by a single, highly skilled observer and that the larger the sample studied by an epidemiologist, the more likely his results are to be meaningful. Obviously, these facts are incompatible. A single skilled observer cannot measure hundreds or thousands of people; indeed the larger the sample, the greater the number of observers required and, therefore, the greater the error component in the variance of any measurement." Roy M. Acheson. In: (Otto von Mering and Leonard Kasdan, eds.) Anthropology and the Behavioral and Health Sciences. Pittsburgh: University of Pittsburgh Press, 1970, p. 196. Back to Nature "In the long run, man might be more successful biologically and find greater meaning to life if he tried to collaborate with natural forces instead of conquering them. Ideally, he should try to insert himself into the environment in such a manner that his technologies and ways of life relate him more intimately to nature. He might thereby become once more part of nature instead of its uneasy overlord." Rene Dubos. "Man and Environment: Adaptations and Interactions." In Smithsonian Annual II, The Fitness of Man's Environment. Washington, D. C.: Smithsonian Institution Press, 1968, p. 244. 616 VOL. 61, NO. 3, A.J.P.H.