U.S. National Library of Medicine

Introduction to Health Services Research : A Self-Study Course

Module 2: Brief History of Health Services Research (Page 14 of 40)

Public Health Becomes Increasingly Important - Local Health Departments

The Social Security Act (1935) generated the formation of local health departments.

APHA's Work in Public Health

The American Public Health Association (APHA), founded in 1872, examined the need for coordination of local departments to guarantee coverage of the entire country.

The American Public Health Association (APHA), founded in 1872, examined the need for coordination of these local departments to guarantee coverage of the entire country.

The Association conducted a needs assessment and endorsed the core public health services of vital statistics, communicable disease control, environmental sanitation, maternal child health, and public health education.

Grants Support Local Health Jurisdictions

This was also the year that the federal government considered how to coordinate public health services with hospital facilities. It distributed grants to support the expansion and improvement of the state and local health departments.

These grants later became the disease-oriented categorical grants, such as federal appropriations for breast cancer or diabetes (Flook, 1973).

The Work of J. Allison Glover

J. Allison Glover (1876-1963) documented variations in tonsillectomy rates in England in various articles during the 1930s. In 1938 Glover described how the rates of tonsillectomies varied significantly between several geographic regions. His work is referred to as The Glover Phenomenon and is an early example of what we now call small area variation. (White, 1992)

Health Services Studies

Important health services studies, such as the National Health Survey in 1935-1936 and the Department of Labor, Division of Cost of Living surveys correlated disparities in income with disparities in health status and access to quality medical care.

The government programs of the New Deal changed the locus of responsibility for many social programs from private, charitable organizations and local governments to the federal government. However, health insurance remained an individual concern.

View Key Projects and Milestones in Health Services Research.

Discussion Questions

1. Why are public health important when considering health services research issues?
2. Why is the National Health Interview Survey (NHIS) and related NCHS surveys important to health services researchers?
3. How much of the NHIS survey instrument, the coding content and related documents do those working with health services researchers need to know about?
4. Are the disease-oriented categorical grants discussed above still important to health services researchers? For librarians to know about? Discuss why or why not.