Chapter 20

If we want more evidence-based practice, we need more practice-based evidence.*

Chapter 20
Local Health Organizations, Services and Resources

Table of Contents


REFERENCES - since publication of 8th edition


Community health agencies assume a significant responsibility for the provision of health services which benefit and protect the public. The material presented in this chapter is designed to increase awareness of the array of community health agencies and the diverse programs and services provided by these agencies.


After an initial review and discussion of community health agencies, the focus is broadened to include a survey of sources of public health law, examples of federal support for community health and an inventory of major voluntary health agencies.


Internet Is a Valued Source for Health Seekers.  July 16, 2003

'Video Doctor,' Personalized Feedback Device, Is Always In. July 15, 2003

Mandate on Smallpox to Cut Local Health Services.  (New York Times, January 5, 2003) - Many local health agencies across the country say they will have to cut a number of services including cancer, children's dental exams, and tuberculosis screening in order to meet the needs of President Bush's federal smallpox vaccination program.

Budget Fight Challenges Indian Health Services. (Nation's Health February 1996). IHS that serves 1.2 million American Indians and Alaska Natives relies on Federal money not only to provide direct health care, but to pay service contractors.

When Sweden Stopped Paying Workers for Their First Day of Illness, Absenteeism Dipped 25 per cent. (Globe and Mail 1996).

Getting Better Value for Our Health-Care Dollar. (Financial Post January 21, 1995). It is estimated that $7 billion a year could be saved in Canada without any deterioration in the quality of care.


For related news stories , please click here.



National Association of Local Boards of Health
1840 East Gypsy Lane Road
Bowling Green, OH 43402
Phone:  (419) 353-7714
Fax:  (419) 352-6278

The National Association of Local Boards of Health (NALBOH) represents the interests of local boards of health and assists them in assuring the health of their communities.

American Public Health Association
1015 15th St. N.W.
Washington, DC 20005-2605
Phone: (202) 789-5600
Fax: (202) 789-5661

The multidisciplinary memberships of APHA is concerned with a broad set of issues affecting community, personal and environmental health, pollution control, programs and policies related to chronic and infectious diseases, a smoke-free society by the year 2000, and professional education in public health.

National Audiovisual Center
8700 Edgeworth Drive
Capital Heights, MD 20743-3701
Phone: (800) 788-6282; (301) 763-1891

This program shows how to resolve questions or problems with Medicare quickly through toll-free telephone help numbers and provides valuable information on the latest changes to the program. 10 minutes, color, 1992.

National Consumers League
815 15th Street NW, Suite 516
Washington, DC 20005
Phone: (202) 639-8140

Represents consumers through its legislative actions, research, and program development, including consumer education.

Public Citizen Health Research Group
2000 P Street NW, Suite 700
Washington, DC 20036
Phone: (202) 872-0320

Performs consumer advocacy work in health areas. Monitors work of Federal health-related agencies and advocates their position to industry or other opponents of consumer protection regulations.

National League for Nursing
350 Hudson Street
New York, NY 10014
Phone: (212) 989-9393; (800) 669-1656

 Books and videos available on a wide variety of community health services.

March of Dimes
Birth Defects Foundation
National Office
1275 Mamaroneck Avenue
White Plains, NY 10605

Provides information about how to have a healthy baby and what to do if there is a problem. Provides educational materials on prevention of birth defects.

Red Cross
Contact state or local chapter

The Red Cross is a humanitarian organization led by volunteers and guided by the Fundamental Principles of the International Red Cross Movement. It provides relief to victims of disasters and help people prevent, prepare for, and respond to emergencies. Educational materials and public education resources.

U.S. General Accounting Office
P.O. Box 6015
Gaithersburg, MD 20877
Phone: (202) 275-6241

Materials available on wide variety of topics including health care financing, public health education, substance abuse, veterans affairs, and medicare/medicaid.

Health Administration Press
1021 East Huron Street
Ann Arbor, MI 48104-9990
Phone: (312) 943-0544 ext. 3000

Publishes materials related to health care administration. It is a division of the Foundation of the American College of Health Care Executives.

A New Tool for Costing Health Care in Manitoba
The Home Page for the Manitoba Centre for Health Policy and Evaluation is:


"The Cost List report provide(s) researchers and  others with a tool for estimating the costs associated with all publicly-funded health care in Manitoba."


 Journal References

Diehr, P., Yanez, D., Ash, A., Hornbrook, M., & Lin, D.Y. (1999). Methods for Analyzing Health Care Utilization and Costs. ANNUAL REVIEW OF PUBLIC HEALTH 20: 125-158.
    ABSTRACT/Full-Text: Abstract.

Fisher, L. D. (1999). Advances in Clinical Trails in the Twentieth Century. ANNUAL REVIEW OF PUBLIC HEALTH 20: 109-124.
    ABSTRACT/Full-Text: Abstract.

Ginzberg, E. (1999). US Health Care: A Look Ahead to 2025. ANNUAL REVIEW OF PUBLIC HEALTH 20: 55-66.
    ABSTRACT/Full-Text: Abstract.


Books and Reviews

Shah, C. P. (1998).  Public Health and Preventive Medicine in Canada, 4th edition. Toronto: University of Toronto Press. ISBN 0-9694044-3-3.
    "...the best known Canadian textbook of public health...has two help readers learn about their role as health care professionals, administrators or policy makers within the health care system...[and to participate] in the ongoing debate on health care issues..." --Review by Clyde Hertzman, Chronic Disease in Canada 20(1), 1999, 41-42.  For the complete review, go to:


Other References

McCraig, L. F. (1999). National Hospital Ambulatory Medical Care Survey: 1997 Outpatient Department Summary. Advance data from vital and health statistics; no. 307. Hyattsville, MD: National Center for Health Statistics.
    Describes ambulatory care visits to hospital outpatient departments in the United States. Presents statistics on selected hospital, clinic, patient, and visit characteristics.

Local Data for Local Decision Making -- Selected Counties, Connecticut, Massachusetts, and New York, 1997. Morbidity and Mortality Weekly Report 47 (38), October 1, 1998.
    Although the delivery of clinical preventive services to adults, such as adult vaccinations and cancer and cardiovascular screening, reduces premature morbidity and mortality (1), such services are underused (1-3). Performance monitoring at the population level plays a critical role in supporting efforts to increase the use of clinical preventive services. However, many communities do not have the capacity to measure prevention activities. Without such information, efforts aimed at improving the county-wide or regional use of clinical preventive services must rely on state or national data. To examine the use of seven clinical preventive services among adults at the county level and to demonstrate how a population-based survey can be used to guide local prevention efforts, a community-based coalition (the Sickness Prevention Achieved through Regional Collaboration [SPARC]), in collaboration with state health departments, peer review organizations, and CDC, conducted a survey in the four-county SPARC region. This report summarizes the results of this analysis, which indicate that clinical preventive services in this region were underused despite high levels of access to medical care.

    Editorial Note: The findings in this report indicate that despite high levels of health-care coverage and access to physicians, adult clinical preventive services in the region are not fully used. These findings are consistent with studies in other populations that indicate patients are often not aware of the need for these services and that clinicians frequently do not recommend preventive services to their patients (4-6). Performance monitoring is an important tool for establishing shared responsibility among  community-level health-care providers (7). A major reason preventive services are not fully used in the United States may be that no defined public or private organization takes responsibility for assuring that all residents in a community are presented with an informed choice and reasonable access to these services. References
1. US Preventive Services Task Force. Guide to clinical preventive services. 2nd ed. Baltimore, Maryland: Williams & Wilkins, 1996.
2. Public Health Service. Healthy people 2000: midcourse review and 1995 revisions. Washington, DC: US Department of Health and Human Services, Public Health Service, 1995.
3. CDC. Use of clinical preventive services by Medicare beneficiaries aged greater than or equal to 65 years--United States, 1995. MMWR 1997;46:1138-43.
4. Lurie N, Manning WG, Peterson C, et al. Preventive care: do we practice what we preach? Am J Public Health 1987;77:801-4.
5. Lemley KB, O'Grady ET, Rauckhorst L, et al. Baseline data on the delivery of clinical preventive services provided by nurse practitioners. Nurs Pract 1994;19:57-63.
6. Rosenblatt RA, Hart LG, Baldwin L, et al. The generalist role of specialty physicians: is there a hidden system of primary care? JAMA 1998;279:1364-70.
7. Durch JS, Bailey LA, Stoto MA. Improving health in the community: a role for performance monitoring. Washington, DC: Institute of Medicine, National Academy Press, 1997.


1. Public health nuisances. The important concept here is the use of regulation to maintain order. The regulation of nuisances, even those of minor health significance, enables corrective measures which have been legitimized by the community. Community health regulations work to protect the safety of the community and attempt to insure the compliance of individuals in violation of the law. Identify a private nuisance, a public nuisance and a mixed nuisance in the community. (Do not use those already defined in the text.) After identification, cite the regulation or statute which declares such a nuisance illegal. Is the regulation a local, state or federal code? Is it really designed to protect public health?

2. Community health services. Select a service division within a city or county health department. Visit the health department and list services provided by the division. How are the services delivered to the community (home care, clinics, media)? Who delivers these services (physicians, nurses, lay professionals)? Consider the impact on the community if one of the services within the division ceased to exist. How do these services compare with those identified in Figure 20-10?

3. Health education. Health education is a critical element of health promotion. Identify and discuss a health education program currently in progress within a specified health agency. The discussion should include the focus of the educational campaign, the intended audience and the method of delivery. A long-term project might involve an evaluation of the educational campaign.

4. Inter-agency cooperation. A number of the annotated readings illustrate the fact that community health agencies do not operate as isolated entities. Meet with a representative of the local health department. Identify other agencies with which the health department interacts. In what way is this interaction beneficial? What sources of conflict arise from this inter-agency contact?

5. Brochures. Select an issue that is of interest to a city or county health department. Prepare an educational brochure for individuals at risk. Identify the health concern, preventive measures or care referral sources.

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