the care of the newbom. The first step is the thorough physical examination

of the child on one or more occasions to determine whether or not it is

normal both physically and, if possible, mentally. Later periodic

examinations serve to decide if the infant is growing satisfactorily.

Arrangements can be made for the child to be protected from major hazards

by, for example, immunization and dietary supplements. Any intercurrent

condition, such as a chest infection or skin disorder, can be detected

early and treated. Throughout the whole of this period mother and child are

together, and particular attention is paid to the education of the mother

for the care of the child.

A pan of the health service available to children in the developed

countries is that devoted to child guidance. This provides psychiatric

guidance to maladjusted children usually through the cooperative work of a

child psychiatrist, educational psychologist, and schoolteacher.

Geriatrics. Since the mid-20th century a change has occurred in the

population structure in developed countries. The proportion of elderly

people has been increasing. Since 1983, however, in most European countries

the population growth of that group has leveled off, although it is

expected to continue to grow more, rapidly than the rest of the population

in most countries through the first third of the 21st century. In the late

20fti century Japan had the fastest growing elderly population.

Geriatrics, the health care of the elderly, is therefore a considerable

burden on health services. In the United Kingdom about one-third of all

hospital beds are occupied by patients over 65; half of these are

psychiatric patients. The physician's time is being spent more and more

with the elderly, and since statistics show that women live longer than

men, geriatric practice is becoming increasingly concerned with the

treatment of women. Elderly people often have more than one disorder, many

of which are chronic and incurable, and they need more attention from

health-care services. In the United States there has been some movement

toward making geriatrics a medical specialty, but it has not generally been

recognized.

Support services for the elderly provided by private or state-subsidized

sources include domestic help, delivery of meals, day-care centres, elderly

residential homes or nursing homes, and hospital beds either in general

medical wards or in specialized geriatric units. The degree of

accessibility" of these services is uneven from country to country and

within countries. In the United States, for instance, although there are

some federal programs, each state has its own elderly programs, which vary

widely. However, as the elderly become an increasingly larger part of the

population their voting rights are providing increased leverage for

obtaining more federal and state benefits. The general practitioner or

family physician working with visiting health and social workers and in

conjunction with the patient's family often form a working team for elderly

care.

In the developing world, countries are largely spared such geriatric

problems, but not necessarily for positive reasons. A principal cause, for

instance, is that people do not live so long. Another major reason is that

in the extended family concept, still prevalent among developing countries,

most of the caretaking needs of the elderly are provided by the family.

Public health practice. The physician working in the field of public health

is mainly concerned with the environmental causes of ill health and in

their prevention. Bad drainage, polluted water and atmosphere, noise and

smells, infected food had housing, and poverty in general are all his

special concern. Perhaps the most descriptive title he can he given is that

of community physician. In Britain he has been customarily known as the

medical officer of health and. in the United Slates, as the health officer.

The spectacular improvement in the expectation of life in the affluent

countries has been due far more to public health measures than to curative

medicine. These public health measures began operation largely in the 19lh

century. At the beginning of that century, drainage and water supply

systems were all more or less primitive; nearly all the cities of that time

had poorer water and drainage systems than Rome had possessed 1,800 years

previously. Infected water supplies caused outbreaks of typhoid, cholera,

and other waterborne infections. By the end of the century, at least in the

larger cities, water supplies were usually safe. Food-home infections were

also drastically reduced by the enforcement of laws concerned with the

preparation, storage, and distribution of food. Insect-borne infections,

such as malaria and yellow fever, which were common in tropical and

semitropical climates, were eliminated by the destruction of the

responsible insects. Fundamental to this improvement in health has been the

diminution of poverty, for most public health measures are expensive. The

peoples of the developing countries fall sick and sometimes die from

infections that are virtually unknown in affluent countries.

Britain. Public health services in Britain are organized locally under the

National Health Service. The medical officer of health is employed by the

local council and is the adviser in health matters. The larger councils

employ a number of mostly full-time medical officers; in some rural areas,

a general practitioner may be employed part-time as medical officer of

health:

The medical officer has various statutory powers conferred by acts of

Parliament, regulations and orders, such as food and drugs acts, milk and

dairies regulations, and factories acts. He supervises the work of sanitary

inspectors in the control of health nuisances. The compulsorily notifiable

infectious diseases are reported to him, and he takes appropriate action.

Other concerns of the medical officer include those involved with the work

of the district nurse, who carries out nursing duties in the home, and the

health visitor, who gives advice on health matters, especially to the

mothers of small babies. He has other duties in connection with infant

welfare clinics, creches, day and residential nurseries, the examination of

schoolchildren, child guidance clinics, foster homes, factories, problem

families, and the care of the aged and the handicapped.

United States. Federal, state, county, and city governments all have public

health futtctions. Under the U.S. Department of Health end Human Services

is the Public Health Service, headed by an assistant secretary for health

and the surgeon general. State health departments are headed by a

commissioner of health, usually a physician, who is often in the governor's

cabinet. He usually has a board of health that adopts health regulations

and holds hearings on their alleged violations. A state's public health

code is the foundation on which all county and city health regulations must

be based. A city health department may be independent of its surrounding

county health department, or there may be a combined city-county health

department. The physicians of the local health departments are usually

called health officers, though occasionally people with this title are not

physicians. The larger departments may have a public health director, a

district health director, or a regional health director.

The minimal complement of a local health department is a health officer, a

public health nurse, a sanitation expert, and a clerk who is also a

registrar of vital statistics. There may also be sanitation personnel,

nutritionists, social workers, laboratory technicians, and others.

Japan. Japan's Ministry of Health and Welfare directs public health

programs at the national level, maintaining close coordination among the

fields of preventive medicine, medical care, and welfare and health

insurance. The departments of health of the prefectures and of the largest

municipalities operate health centres. The integrated community health

programs of the centres encompass maternal and child health, communicable-

disease control, health education, family planning, health statistics, food

inspection, and environmental sanitation. Private physicians, through their

local medical associations, help to formulate and execute particular public

health programs needed by their localities.

Numerous laws are administered through the ministry's bureaus and agencies,

which range from public health, environmental sanitation, and medical

affairs to the children and families bureau. The various categories of

institutions run by the ministry, in addition to the national hospitals,

include research centres for cancer and leprosy, homes for the blind,

rehabilitation centres, for the physically handicapped, and port quarantine

services.

Former Soviet Union. In the aftermath of the dissolution of the Soviet

Union, responsibility for public health fell to the governments of the

successor countries.

The public health services for the U.S.S.R. as a whole were directed by the

Ministry of Health. The ministry, through the 15 union republic ministries

of health, directed all medical institutions within its competence as well

as the public health authorities; and services throughout the country.

The administration was centralized, with little local autonomy. Each of the

15 republics had its own ministry of health, which was responsible for

Страницы: 1, 2, 3, 4, 5, 6, 7, 8