UCLA Public Health Magazine - Winter 1980

Winterl980 Magazine of the UCLA School of Public Health and the UCLA School of Public Health Alumni Association

B~IA

Publie Heal~h

In this issue

The second pJblic health revolution

Surgeon General's report sets stage The Surgeon General's Report on Health Promotion and Disease Prevention sets the stage for a "second public health revolution."

Released last August amidst the confusion of HEW Secretary Califano's resignation, the report did not receive wide public exposure because it was not circulated to the news media in traditional fashion.

Among other conclusions, the report states that improvement in the general health of U.S. citizens "will not be made predominantly through the treatment of disease, but rather through prevention,'' and goes on to cite specific goals for prevention. According to an HEW source, this is quite a departure from recent HEW thinking, and promises to generate controversy over the governmental role in changing citizens' health habits. The major proposed goals include the following: (1) Reduce infant mortality by at least 35 percent by 1990 with emphasis on congenital disorders.

(2) Improve adolescent health habits with emphasis on roadway safety, smoking, drugs and alcohol, nutrition, exercise, family planning, venereal disease, immunization, and mental health; and decrease deaths in the 15- 24 age bracket by 20 percent by 1990.

(3) Reduce deaths among adults ages 25- 64 by 25 percent by 1990, with special emphasis on reducing heart attacks and cancer. The causative factors of smoking, hypert ension, improper diet, and lack of exercise are focal points here.

(4) Improve the health and quality of life for older adults age 65 and over, and by 1990 reduce the number of days of restricted activity due to acute and chronic conditions by 20 percent, to fewer than 30 days per year.

HEW (to become the Department of Health and Human Services) will detail the final goals by the end of January.

4

Waxman urges

health revolution Congressman Henry A. Waxman (D-Calif.) has joined those calling for a "public health revolution, focusing on the concept of prevention" that would include adoption of new national health priorities and passage of the Kennedy-Waxman

"Health for All Americans Act." "Victory is more attainable by prevention than by cure," said Waxman, in delivering the School of Public Health's 1979 Distinguished Lecture. A prevention campaign. that will reach all citizens is possible by streamlining the current system and pursuing new goals."

Citing the Surgeon General's /1

Congressman Henry A. Waxman delivered the SPH Alumni A ssociation's 1979 Distinguish ed Lecture.

recent Report on Health Promotion and Disease Prevention, Waxman, chairman of the House Subcommittee on Health and the Environment, said the proposed goals for lowering morbidity and mortality were attainable and should be adopted.

In support of his pending national health insurance legislation, Waxman said that escalating medical costs must be curbed and that national health insurance would curtail spiraling prices.

"Very few people realize how gargantuan the system has become," he said, "but health costs today represent eight percent of the GNP and are doubling every five years. Further, medical costs are now hidden everywhere- for example, $162 in a new General Motors car can be attributed to medical costs."

The third-term Congressman blasted the health care system's lack of progress in meeting U.S. health needs. "Fourteen countries have lower infant death rates than we do; ten have higher life expectancies," he said. "Why can't we look to the government for good alternatives for the inequities of our own health care system- and also to contain costs?"

The "Health for All Americans Act," co-authored by Waxman and Sen. Edward Kennedy (D-Mass.) is the national health insurance plan the two lawmakers say will increase accessibility and efficiency of health care, while controlling overall costs. " This bill is not a luxury," Waxman continued. "More than 24 million citizens have no health insurance, 60 million have inadequate coverage, and 83 million are unprotected against large medical bills." He proposed a national health budget ceiling by way of "prospective budgeting" as part of the bill that would cut inefficiencies and hold down inflation.

"For many, access to care is determined by their pocketbook," Waxman said firmly, "but medical costs are closer to all of us now, and if costs continue to go out of

reason, we will soon be forced to reform the system.

"I hope this bill will pass the Congress," he added. "While some feel that national health insurance has no grass roots support in this country, I can only say that American taxpayers form our largest constituency, and they are the ones who must pay the ever-increasing costs."

(Waxman answered questions from students, alumni, and faculty in the audience. Following is a summary of key issues raised.)

Q: Will this Congress see the enactment of national health insurance!

A: The Kennedy-Carter political activities will bring national health insurance to the forefront of public attention. This, combined with the increasing conservative mood in the country to limit our budget deficit, will bring additional pressure to enact national health insurance.

Q: What are your thoughts on current health planning legislation!

A: Health planning has been a struggle. However, it is an area still worthy of further work. Many Health Service Agencies have been formed successfully and are in the full force of meeting their responsibilities. HSA's are important local decision-making bodies which can develop plans and control costs by reducing unnecessary duplication of facilities.

Congress will be looking at the planning legislation with the intent to pinpoint areas for constructive change. In the past, legislation has been enacted to address physician shortages and maldistribution. Now we must define our objectives once again.

Q: How will the government finance the Kennedy-Waxman "Health for All Americans Act"!

A: The government will not be paying for the cost of the overall population. It will continue to pay for those already covered by existing Medicare and Medicaid programs. Under the Act, the government's share and private

monies would combine to finance an insurance consortium for various plans, which would be administered privately.

Roybal urges public health lobby On the heels of the Carter Administration's hospital cost containment defeat, Representative Edward Roybal (D-Los Angeles) urged SPH students to "become public health activists" and to help form a nationwide public health coalition lobby.

Visiting UCLA to accept an SPH award for "outstanding public service in health promotion and disease prevention,'' Congressman Roybal addressed students on several public health issues, repeatedly voicing a call for activism in the legislative process.

Roybal called aational health insurance "the largest single issue" in the 1980 election and challenged students to exert political pressure on public officials to insure adoption of a quality plan.

"We [elected officials] know voting trends and believe that if you base your political support on quality legislation, you will be heard," he said.

Perhaps the Congressman's most fervent remarks concerned public health funding appropriations by the federal government and the need for public involvement in the appropriations forum.

Roybal, who has served on the powerful House Appropriations Committee for 18 years, said that funds are based largely on the members' interests and lobbyists' pressures. He said that public pressure is crucial to "push" the funding priorities of the committee.

"This project should not be funded by federal monies and should be a network of complete cooperation between those in the medical, public health, and the health field in general to form an effective lobbying group," he stated.

5

A reeducation for health

C. '1ter for Health Enhancement participant checks pulse during exercise to see if desired target rate has been achieved.

Ho¡.v does lifestyle affect physical well-being?

There's increasing evidence that proper nutrition and exercise, stress control, and elimination of risk factors such as obesity, high cholesterol, and smoking play a vital role in "lasting well-being."

The new UCLA Center for HMlth Enhancement Education and Research is developing further evidence on these matters through scientific research.

At the same time, it is reeducating people who seek to improve 6

their health. In doing so, it assists physicians in the care of difficult cases.

The Center's residential program is the only one of its kind in a university. It's operated by a team of UCLA physicians, public health specialists, nurses, nutritionists, exercise physiologists, and physicians, under the direction of Dr. Charles R. Kleeman, Factor Family Foundation professor of medicine and nephrology at UCLA, and his co-director, Dr. Jonathan E. Fielding, professor of pediatrics and

public health.

For four weeks, people from all walks of life- who have only in common a desire for better health - learn the why's and how-to's of diet, exercise, and smoking cessation. They attend lectures, workshops, and group discussions, while practicing their new skills under supervision. Skills are taught for maintaining behavioral changes after the return home.

The 26-day reeducation for health is centered in a hotel just a few doors away from the UCLA

Hospital. Participants may enter with any kind of health statusfrom no symptoms or risk factors at all to severe heart disease.

Dramatic reductions have been recorded in cholesterol levels and blood pressures over the four-week period, and weight reduction for the obese has been significant. Participants talk enthusiastically about their increased energy and overall euphoria, not only while in the program, but for months after leaving it.

The program begins with physical, psychosocial, and lab examinations, which provide a baseline profile against which progress can be judged. These results, together with the participant's own medical history and exercise habits, are used to create a personalized "exercise prescription" which is modified as capacity is increased.

Diet is also individualized.

Meals are prepared within the cen-

ter's guidelines for a low sodium, low fat, high fiber diet. All foods are considered healthful: vegetables, fruits, cereals, breads, and low-fat dairy products, with a small amount of lean meat, fish, or fowl. The amounts and kinds of foods selected are determined by the participant with a registered dietitian during an interview at the beginning of the program.

In addition to learning basic nutritional information, participants get a thorough grounding in understanding food labels, selecting items from restaurant menus, planning for entertaining, and adapting favorite recipes to conform to healthful diet practices.

The Center also offers specific training in a variety of relaxation techniques to help the participants learn how control stress. Smokers are encouraged but not forced to participate in the center's smoking cessation program, based on recognized behavioral principles.

All participants take part in group experiences intended to provide behavioral skills which will help them maintain the new lifestyle, after leaving the Center, when the pressures of everyday life begin to reassert themselves. The four-week course is emphasized as only the beginning of a permanent new way of life.

After completing the live-in program, participants return to their physicians with in-depth reports, which support the physician's encouragement of permanent lifestyle changes. It is intended that a long-term relationship be established between the doctor, the participant, and the Center.

Follow-up sessions are scheduled for participants over a period of five years, and alumni of the program get together in groups which provide mutual support and reinforcement.

Most students in the health professions today receive their train"'~ ing in teaching hospitals, where ~ the emphasis is on the treatment ~ of disease. The Center for Health ~ Enhancement Education and Rea ¡--------------~ ~ search, by contrast, provides stu-

dents of the UCLA schools of medicine, public health, and nursing, and the departments of kinesiology and psychology with a rare opportunity to learn methods of disease prevention and techniques of "wellness." Residents from the School of Medicine and graduate students in nutrition, kinesiology, and other specialties have served one-month internships caring for participants and helping staff with research.

Community goals of the Center include service to physicians and other health professionals and dissemination of news of its research findings to the general public.

There exist scores of pseudoscientific institutions and individuals, each advertising its own particular program of diet, exercise, relaxation, or other panacea.

The Center and the University intend to replace the questionable claims of advocates and zealots of health fads with objective scientific evidence about what works and what doesn't.

7

A Chinese doctor enrolls at SPB

Peking physician Dr. Chang Kung-Lai is enrolled this year as a student in epidemiology.

by Tom Arant

In the People's Republic of China, heart disease, cancer, and other chronic diseases are growing problems. Dr. Chang Kung-Lai, a physician from China, has come to the School of Public Health as a student to learn the epidemiological methodology that he thinks could positively affect the health of tens of thousands of his fell ow citizens.

Dr. Chang served as interpreter for Dean Lester Breslow who visited Peking last January. That experience, plus sponsorship by the 8

World Health Organization, led Dr. Chang to request admission to UCLA's School of Public Health.

Currently enrolled in the Division of Epidemiology, Dr. Chang is studying the epidemiological methodology of chronic diseases and expects to be here for a year.

"In my country, we lack the tools and know-how to analyze and cope with the problems of chronic disease," he says. "Because w e hope to isolate the causative agents for these diseases, I have much to learn at UCLA, both about biostastics and the methodological design for chronic disease investigation."

After graduating from Peking

Medical College in 1956, Dr. Chang completed graduate study in hygiene at Szechuan Medical College, later returning to Peking as professor of epidemiology.

Shortly after his arrival at UCLA last fall, he talked about China's public health system and health care in the future. He explained that since the 1949 "Liberation" (when the Chinese Communist Party assumed control), Chinese public health has focused chiefly on infectious diseases and has given chronic illnesses low priority.

"We are now quite experienced in infectious disease control," he says. "We have 'antiepidemic' sta-

tions all across China, each similar to your U.S. Center for Disease Control. Each of these stations is responsible for mandatory immunizations, environmental hygiene, and children's and industrial health in its respective province or county. Of course, with a population of more than 900 million, it's apparent why we must have such a system."

In 1978, China did experience brief rural epidemics of dysentery and salmonella, but these episodes were efficiently contained by a nationwide system of reporting and follow-up procedures .

However, except in the case of cancer, the People's Republic has virtually no system for determining the morbidity of chronic diseases, and rates are therefore uncertain. In Dr. Chang's opinion, Chinese public health must now set its sights on the control of cancer and heart disease, the two chief known chronic offenders.

In China, cancers of the stomach, esophagus, and lungs are the most prevalent, but there is not enough evidence to name the sources. Dr. Chang underscores the idea that what causes disease in the U .S. may not in China, due to the differences in environmental conditions, such as air quality, lifestyle, weather, and diet. Therefore, he believes, it is essential to apply research and epidemiology's universal laws.

Chinese physicians believe that stomach cancer may be caused by fungus, nitrosamines, or nitrates, says Dr. Chang, who has studied stomach cancer for many years.

But without any systematic epidemiological design, no correlations have positively been made. If his time at UCLA should permit, he will embark on such a study with Dean Breslow and Dr. Rol.:!nd Amijo of the SPH faculty.

Dr. Chang explains that the Chinese health care system is made up of the Academy of Medical Science and the Institute of Hygiene (which combined are similar to our NIH), five major medical university research and

hospital complexes, several thousand antiepidemic stations, about 100 medical colleges, and local hospitals and medical clinics.

The fundamental health worker in China is the "barefoot doctor," an unusual Chinese adaptation of the field-trained para-professional.

These barefoot doctors treat minor injuries and illnesses, referring more severe medical problems to the college-trained physicians.

Other paraprofessionals in the system include clinic-trained specialists in nutritional environmental hygiene, family planning, industrial hygiene, children's health, and general medicine nursing.

Most of them are schooled for one or two years in local clinics, hospitals, and antiepidemic stations .

About half of China's physicians are women and this percentage is roughly the same for paraprofessionals. In terms of " prestige," physicians, engineers, and college teachers share the highest ranking in China. Because only five to ten percent of Chinese high school graduates are able to attend college, physicians are understandably in short supply.

Certainly, national health insurance and hospital cost containment are not factors in China's health care system, as they are in the United States, but prnblems do exist. "Our standards of living and health care are lower than yours," says Dr. Chang, "so we in China have a long way to go."

The Chinese government's Minister of Health has set priorities for health care in the '80's with four primary progressive national health policies. Roughly, these goals are to (1) serve the people, (2) use preventive medicine as the first line of defense, (3) unite Chinese and Western physicians, whenever possible, to improve medical practices, and (4) assure that health care will be in harmony with "mass movement."

The fourth policy refers to massive public health education projects, such as a recent campaign mounted by the Minister to fight rats, flies, and mosquitoes. Televi-

sion, radio, factory lectures, newspapers, and medical channels took the message to the people.

Another vehicle for channeling preventive methods and information to the public is the Committee of the Patriotic Health Campaign, a voluntary group similar to the American Red Cross.

In China, medical treatment is provided without charge to working and retired citizens. Minimal charges are collected for treatment in rural area clinics and for children's services. Most hospitalbased physicians even make house calls in cases of chronic illness.

To a casual observer, the government's health care design may appear to be quite progressive and efficient, but according to Dr. Chang, many improvements must take place if the nation's future health needs are to be met.

He emphasized the need to import modern, Western medical utilities, such as the medical electronics, computers, and laboratory equipment that have been standard in U.S . hospitals for years. In addition to equipment, new facilities and refurbishment of many existing facilities are badly needed because of increasing bed needs, said Dr. Chang.

"At present, we have medicallytrained administrators for clinics and hospitals, but to improve our efficiency we really should have managers who are trained in health administration." He believes, however, that insufficient expertise in health administration education within China dictates the need for Western training. And although he thinks this training of future managers would benefit Chinese health care, Dr. Chang also believes that his opinion is in the minority and that changes will probably come slowly.

In the meantime, at least until his return home, Dr. Chang will continue to study American health care and American life. He only hopes that what he learns here may ultimately have some impact on the health of the people of China.

9

Hospice care in England

by Paul R. Torrens,

M.D., M.PH. Professor of Health Services One of the most interesting and encouraging developments in health care in the United States in recent years has been the growth of interest in the care of the dying.

Much of this interest has centered around the development of "hospice" programs, special units established specifically for the care of the dying.

As recently as five years ago, there were only three hospice programs in the United States, but since that time there has been an explosive growth in interest and in programs. At the present time, there are probably more than 500 such programs in the United States and Canada, forty in California alone; of these, twenty are located in Southern California, all started within the last three years.

The rapid growth of these important new programs has not been without its problems and its concerns for the future. Basic questions such as how many such programs does the country need and where should they be located, where will we find the necessary professional staff to operate them, and how will they be financed and paid remain unanswered thus far.

Since the hospice movement began in England more than twenty years ago, it seemed appropriate to me to review the English experience at length, to see what could be learned and applied to the United States situation. To this end, I spent the spring and summer quarters of 1979 in England studying hospice programs.

Based in the Department of Community Health at the London School of Hygiene and Tropical Medicine and operating with the support of a World Health Organization travelling fellowship, I IO

St. Christopher's Hospice near London, England.

visited more than thirty hospice programs in England, Scotland, and Wales and talked extensively with leaders in the Hospice movement throughout the British Isles. I also spoke at length with officials of the British National Health Service, to see how the new programs have been integrated into the already-existing health services in the country and to obtain their views on future development. During the course of my travels, I also met with many medical and nursing leaders to learn how their particular professional groups felt about the hospice experience in England and what they would do differently if given the chance to begin again.

I found widespread agreement that these programs are valuable additions to the British health care system and that they were providing very important services to the dying. There was also widespread agreement that the development of these programs has stimulated a broad re-examination of the purposes of m edicine in an increasingly impersonal and technological age.

Unfortunately, there was absolutely no agreement at all on the key questions of planning, financing, and staffing these programs-

the issues that I went to England to study. Each person had his or her own idea of what should be done with regard to these matters; and just as here, many of these points of view were diametrically opposed.

Within the central administration of the National Health Service in London, I found strong general support for the hospice idea, but the actual decisions about implementing such programs had been left to the fourteen regions which compose the Service. As a result, widely different patterns of support for hospice programs exist from one region to the next, and even within the same region, from one Area Health Authority to the next. Among other things, these findings certainly dispelled the myth of the National Health Service as a single, tightly-controlled, highly-centralized health care system, as many Americans believe it to be.

I was very impressed with the wide variety of programs that have been developed to provide special care for the dying in England, some of which are called "hospices" but most of which go by other names. The most impressive of these, St. Christopher's Hospice on

Elderly patient is comforted by English-hospice attendant.

the outskirts of London, is the acknowledged leader in the field and has given guidance and encouragement to the others developing thoughout the country in a rather remarkable way. By sponsoring conferences, conducting training programs, and welcoming visitors from the British Isles and abroad in great numbers, it has become the visible center of the hospice movement in the world.

A large, free-standing facility located on its own grounds, St. Christopher's represents the traditional hospice model. Several others have developed along similar lines, notably St. Luke's in Sheffield and St. Columba's in Edinburgh, but the more common model recently has been the spe-

cial unit developed on the grounds of a general hospital or actually within the same building as the hospital itself. The Michael Sobell House at Oxford and the Countess Mountbatten Home in Southampton are actually located on the grounds of large teaching hospitals and work very closely with the hospital staff and its affiliated medical school.

Another model is that of the "Symptom Control Team" currently being utilized at St. Thomas's Hospital in London, just across the Thames from the Parliament. Here there is neither a separate free-standing building nor a separate part of the hospital for the program. Instead, there is a staff of physicians and nurses who

provide their services and consultation to the staff and patients throughout the hospital in their own wards. This team works together with the patient's regular medical and nursing staff to see that the patient's needs are met within the structures of the usual patient care systems, and where this is not enough, the team tries to obtain necessary services in the community.

A slightly different model is presented by the MacMillan Home Care Units being developed at several hospitals and nursing homes throughout the country. These units take on the total medical, nursing, and social care of the patients after they leave the hospital and provide the equivalent of a 11

hospice's services to the patients right in their own home. No permanent hospice facility as such is used, although the units often use a hospital or nursing home as a base of operations. Financed generally by grants from the National Society for Cancer Relief, these units represent yet another important type of program for the care of the dying.

Most people in England still die at home, however, cared for by their general practitioners, who despite changes in medical practice in other parts of the world, still make house calls on their patients. Many of the newer efforts at improving care of the dying in England are now aimed at strengthening and supporting the general practitioner in this work, rather than developing entirely new programs. Specially-trained nurses have been assigned by various hospices to work with and assist general practitioners in the care of their patients, thereby allowing the G .P.'s to draw on the accumulated knowledge and experience of the hospices. Special beds have been set aside in several of the smaller, general practitioner hospitals in various parts of the country, particularly in Wales, in order to further explore the role of the G.P. in the care of the dying.

Unfortunately, there has been very little effort to document the outcomes of these various approaches and very few attempts to compare one with another. The first large-scale survey of hospice programs in England is only now being carried out by researchers at the University of Southampton Medical School, with tentative plans being made to duplicate the study among hospice programs in the United States and Canada in the near future. I have been involved in the development of both studies.

The result of my findings and observations will be published later this year in a monograph, Hospice Programs in England and the United States: Implications for Public Policy.

12

Co1n1nunity center for ho1ne births

by Tandy Parks

M.P.H. '79 What can you really do with an M.P.H., once you're on the "outside?" Three alumni of UCLA's School of Public Health- Gary Richwald, M.D., M.P.H. '78, Susan Stuart M.P.H. '78, and I-discovered that our backgrounds, interests, and degrees were ideal to fill roles at the Los Angeles Childbirth Center in Venice.

This is a community clinic staffed by physicians, midwives, nurses, and childbirth educators working together to educate and care for women who want to give birth to their children at home.

The Center provides safe and comfortable home births with wellplanned hospital and obstetric back-up, in addition to childbirth education and quality prenatal care and guidence. The Center's emphasis is on providing care responsive to the individual needs and choices of participants.

Eligibility for services depends on several factors. Women with low-risk pregnancies are sought in initial evaluation. Subsequent prenatal visits screen out women who develop risks during pregnan.:y.

Prenatal visits and attendance at childbirth classes are required of all participants in the program.

Not only is the care and education important, but full and regular participation by women and their families provides a measure of their involvement and acceptance of responsibility. This extends to routines of good nutrition, physical exercise, and other beneficial health practices.

Women in the program are expected to have the assured support of a primary partner- a spouse, relative, or friend- who will be

committed to attending childbirth education classes and be available to act as a labor coach and support person before and after the birth.

Participants must live within the geographic boundaries of Brentwood, Venice, Santa Monica, West Los Angeles, Westwood, Marina del Rey, Culver City, Mar Vista, Palms, Topanga, and parts of Inglewood and Malibu.

Recently, the Center has begun offering services to Spanishspeaking families, filling a pressing need on the west side of Los Angeles. The staff now includes both clinicians and educators who speak fluent Spanish and provide care to Hispanic families in their own language.

I serve as the Center's educational coordinator. My job is to plan childbirth education for all participants, teach classes, seek out and distribute appropriate educational materials, and try to make families aware of other educational resources in the community.

The educational phase of the program consists of an early pregnancy class on nutrition, exercise, and the normal progress of pregnancy. An eight-week course covers pregnancy, labor and delivery, relaxation and breathing techniques, the role of the coach, labor complications, postpartum, pediatric care, newborn needs, breastfeeding, and parenting.

As physician and medical director, Gary Richwald is a key member of the clinical team providing care. From a participant's initial evaluation to her baby's birth and the postpartum, Dr. Richwald is available as needed. In addition, he coordinates health services research at the Center, a central aspect of any innovation in a health care system.

Susan Stuart began at the Center

Three SPH alumni (from second, left to right) Tandy Parks, Susan Stuart, and Dr. Gary Richwald staff Los Angeles Childbirth Center in Venice.

as its administrator, a position loosely defined with increasing demands as the Center has grown.

She has handled not only routine organizational tasks, but supervised building renovations, navigated the Center through a lengthy request for a zoning variance, and worked to establish relationships with people and services in the community and a better community outreach. Her second UCLA degree, in Latin American studies, has proved valuable in the Center's new Spanish-speaking community program.

Working in this setting has provided these three UCLA public health graduates with opportunities to utilize skills and interests expanded by the M.P.H. program.

Aware that no health care service is an "island," the Center's young leadership looks toward establishing and increasing liaisons and support systems with other facilities to ensure the highest level of care for mothers, infants, and families. There are still the daily routines of health care delivery, but also a range of exploration and creativity which makes the experience most worthwhile on the professional and personal level.

Father and young child take part in examination of expectant mother by obstetrical nurse at the home birth center. Such participation by spouses, or others close to family, is essential to the center's program.

13

The ne1Ns

fro1n B(¡E)W

Alumni visitor Dr. Mark Chassin of HEW recently conducted a seminar at which he explained the department's ne w structure to a large gath ering of SPH students and fa culty.

14

A visitor to SPH from Washington, D.C., in November was Mark Chassin, M .D. (M.P.H. '78), who's been deputy director of the Health Care Financing Administration's Professional Standards Review Organizations (PSRO) office for the past year.

Dr. Chassin received both his M.D. and M.P.P. degrees from Harvard, and was a Robert Wood Johnson clinical scholar at UCLA, under which auspices he received his M.P.H. He did his internal medicine residency at HarborUCLA Medical Center and has a special clinical interest in emergency medicine, which he continues to practice in non-HCFA hours.

He came to UCLA for a round of meetings and discussions with Dean Breslow, faculty, and students of the school. He spoke to a packed seminar on several matters of wide general interest to public health professionals: the current status of HEW's reorganization and leadership, the PSRO program, and health legislation pending in Congress.

To explain the new organization's complicated structure, he sketched a rough outline showing the relationships of the agencies on the blackboard as he spoke, but given the constraints of time, the dimensions of the blackboard, and the vast complexity of HEW, he could only hit the high spots.

Changes there have been, and many, including the name of HEW itself (now minus education), the department ultimately to be designated Health and Human Services, at least according to present plans.

The structure of the new HHS organization will be detailed in the next issue of UCLA Public Health.

Genetic counseling and birth defects

by Allan J. Ebbin, M.D., M.PH. Department of Pediatrics LAC/USC Medical Center Birth defects are a leading cause of infant mortality. When measured in terms of normal life expectancy, these defects claim 4.5 times as many life years as heart disease, 8 times as many as cancer, and 10 times as many as stroke.

About 30 percent of birth defects are thought to be genetic in origin.

The successful attempts to treat and prevent infectious diseases have led some researchers to devote their careers to the prevention of congenital malformations.

In the past few decades, there have been attempts to utilize genetics for the benefit of man.

Through genetic counseling, the process which brings the advances in medical genetics to the persons who can benefit directly from the information, many families have been helped.

Most of the people who seek genetic counseling discovered that the risk of having a child with an abnormality is less than they believed, and they find that they have more alternatives than they realized. Genetic counseling is defined as a dynamic process involving a discussion of diagnosis, clinical prognosis, risk of occurrence or recurrence of a disorder in a family, and the various ways to deal with that risk. The counselor does not make the decision for the family, but explains the alternatives and then supports the family in the decision it chooses.

The most important advancement in the prenatal diagnosis of birth defects is amniocentesis. In this procedure a small amount of amniotic fluid surrounding a fetus is withdrawn from the uterus by

a needle inserted through the mother's abdominal wall. Cells in the fluid that have been shed by the fetus can then be tested for certain specific genetic defects.

The following is a partial list of indications for referral to one of several genetic centers in the Los Angeles area for prenatal diagnosis: (1) older maternal age (35 years or older), (2) prior child with a chromosome abnormality, (3) parent who is a carrier of a chromosome abnormality, (4) parent who is afflicted with a chromosome abnormality, (5) parents each of whom carries a gene for a detec'table recessive disorder, (6) mother who is a carrier of either a detectable or non-detectable X-linked disorder, (7) previous child or parent with a neural tube defect, (8) significant family history of a neural tube defect.

Questions about genetic counseling may be directed to the Genetics Division at Cedars-Sinai Medical Center, Children's Hospital, City of Hope, Harbor General Hospital, Kaiser Hospital, Martin Luther King General Hospital, Long Beach Memorial Hospital, Los Angeles County-USC Medical Center, and UCLA's Center for Health Sciences.

Some alumni of the UCLA School of Public Health who work in the prevention of birth defects include Tanya Danforth, June Gilman, Allan Ebbin, John Inabe, Sylvia Lee, Rita Monsen, and Nancy Shinne.

Dr. Allan f. Ebbin of LA C /US C Medical Center provides genetic coun seling to young couple.

Chart diagrams genetic fa ctors.

DL Ebbin received his M .P.H. from

the UCLA School of Public Health in 1976.

15

NEWS A report on APBA "Child and Family Health in America" was the theme of the 107th annual meeting of the American Public Health Association held in New York, Nov. 4-8.

Paticia Harris, Secretary of HEW, delivered the keynote address.

Several UCLA School of Public Health faculty members presented recent findings and opinions to their APHA colleagues. Among SPH faculty presentations were special seminars organized by Dr. E. Richard Brown and Dr. Stuart Schweitzer.

Dr. Brown's seminar on "International Transfer of Medical Technology" focused on physician migration from underdeveloped countries, the role of U .S. foreign aid in exporting contraceptive¡ devices, and the inadequacy of U.S. regulation of pharmaceutical exports.

"These programs (physician 'brain drain,' lack of export regulations) don't necessarily serve the health needs of the population; rather, they are shaped by the interests of individual countries and businesses, often for political or economic reasons," said Dr. Brown.

Dr. Schweitzer, who led a seminar in health care cost containment, said that his panel called for planning improvements, reductions in unnecessary duplication of services and equipment, and better capital management in health care.

Asked about his overall impression of the annual meeting, Dr. Schweitzer said that "in addition to a lot of professional interchange, we saw a new impact by public health on other social objectives."

Among other SPH speakers at the meeting were Dean Lester Breslow, Dr. Robert Brook, Dr. Paul Fleiss, Dr. Ralph Frerichs, Dr. Raymond Neutra, and Dr. Milton Roemer.

16

Orientation picnic

Students, faculty, and staff of th e School of Public Health began the academic year with a get-acquainted picnic at Sunset Canyon Recreation Center. Nearly 200 attended the October event to en;oy good food, fun and games, and the company of colleagues etJ offspring. In photos, clock wise from above, left: Dean Lester Breslow romps w i th Professor Susan Scrimshaw's daughter, Cory ... f oya Shtraus, cancer specialist visiting from th e Soviet Union . .. Karin Fielding, wife of Prof. f on athan Fielding . . . student Lisa Marin o's husband, Al, with baby daughter.

Programs encourage minority enrollment An aggressive program launched by the School of Public Health to recruit increased numbers of minority students brought dramatic results in the five-year period 1973-78, qccording to Josephine Q. Alvarez, counselor-recruiter for the School.

Minority applications in this period increased by 36% to 223, admissions by 46% to 92, and new enrollment by 42% to 58.

In 1978-79, recruitment efforts were expanded with the employment of part-time student counselors. However, the increases had leveled off by 1979, when minority applications and admissions remained almost at the same figures as in 1978-although Hispanic enrollees in 1979 did reach a new high, eight percent of all new enrollees. Altogether, minority enrollees accounted for 22 percent of the total in 1979.

A more adequately-funded recruitment program was conducted in 1977 by the California State Department of Health under the Health Professional Career Opportunity Program (HPCOP). The School established during this time the Counseling-Recruitment Office, thus enlarging the minority recruitment base.

Recruitment of all students for UCLA's School of Public Health has followed traditional patterns, along with some new ones. Prime referral sources are still word-ofmouth recommendations from alumni and kindred faculty.

Minority students already enrolled in the School, as well as minority alumni, continued to assume responsibility for vigorous recruiting of minority students.

Applications for admission are stimulated in part by the increasing number of presentations on career opportunities in public health by minority student leaders who talk with high school and college students.

Ms. Alvarez, as the School's re-

cruitment officer, has participated in a variety of organized programs designed to stimulate recruitment and exchange of information.

Among them have been: -Participation in high school and community health fairs and Saturday panels and visits to colleges.

-Open counseling sessions for UCLA students, both in the School's building and also in the Academic Advancement Program housed in Campbell Hall.

-Attendance in statewide minority recruitment meetings within the UC system.

-Planning and organizing conferences for college counselors of Third World students with panel and workshop formats to increase the counselors' information about careers in public health and academic study.

-Participation in recruitment programs sponsored by the Graduate Advancement Program, Medicus, Office of Relations with Schools, and the Admissions Office.

Ms. Alvarez says that far more applicants could be reached with a truly comprehensive and wellfunded recruitment program. She believes that fall 1979 student applicant and enrollment figures would have shown a decline were it not for the foregoing recruitment efforts.

Dr. Jelliffe receives $25,000 Wihuri prize Dr. Derrick B. Jelliffe, professor of public health and pediatrics at the UCLA schools of Public Health and Medicine, has been awarded the 1979 Wihuri Foundation International Prize.

This prestigious honor was bestowed on Dr. Jelliffe for "construetive work in the field of pediatrics for the benefit of mankind and its intellectual and material welfare" by the Helsinki, Finland, faundation. It carries with it a prize of $25,000.

Dr. Jelliffe is internationally known for his work with child nutrition, particularly breast feeding, in developing countries. He is a member of the World Health Organization Panel on Nutrition and chairman of the International Union of Nutritional Sciences Committee on Nutrition in Primary Health Care.

Other honors received by Dr. Jelliffe have included Rosen von Rosenstein Medal of the Swedish Pediatrics Society in 1969 and the Gopalan Medal of the Indian Society of Nutrition in 1976.

The Wihuri Foundation for International Prizes was founded in 1953 by the Finnish industrialist, Antti Wihuri, and his wife, Jenny.

It awards two international prizes every three years. One is in science and the other is in music, the Wihuri Sibelius Prize, named after the composer who received the first Wihuri award.

Kenneth Cooper to visit as Regents' Lecturer Kenneth Cooper, noted scholar and world renowned authority on physical conditioning, will visit the School of Public Health February 4-8 as Regents' Lecturer.

One of the first active proponents of jogging and physical conditioning exercises, Cooper designed the U.S. Air Force Conditioning Program and authored Aerobics. He now serves as director of research and rehabilitation of the Cooper Clinic, Dallas, Tex. and is a member of the White House Commission on Physical Fitness.

Cooper will make class presentations and discuss his research in cardiac rehabilitation and physical conditioning in a series of campus programs.

He will offer a general presentation to the campus and community at large on jogging and longevity and will present a special lecture to the School on the topic of motivating the public toward 17

assuming responsibility for its own health.

Plans also call for Cooper to take part in a seminar in the "Law, Medicine, and Society Forum" series, discussing how far a society should go toward legislating good health.

During his visit at UCLA, Cooper will also spend time with participants and staff of the Center for Health Enhancement residential program and will speak to physicians in the community on the latest data on relationships between physical exercise and improved cardiac prospects.

With him will be his wife, Millie, also a noted health professional, who will present a public program in cooperation with the Women's Resource Center on campus, on physical conditioning for women.

The Regents' Lectureship program is funded by the Chancellor to encourage exceptional scholars to visit UC campuses.

Two SPB teams win state policy awards Two teams of UCLA public health researchers have each received $50,000 awards from the California Policy Seminar to help the State plan more effective health care.

One team is assessing the private management of California county hospitals. The other is developing projections for open heart surgery facilities in California.

In recent years, a number of California counties have turned toward private firms to manage their hospitals. Ruth Roemer, research associate in health law, and William Shonick, associate professor of public health, are evaluating the trend to assess whether private management of public facilities decreases county health care expenditures.

Policy makers are also concerned with the resources devoted to cardiovascular surgery. Drs. 18

Shan Cretin, assistant professor of public health, and Nigel Roberts, assistant professor of medicine and pediatrics, are developing guidelines to determine how many centers California needs for congenital heart surgery facilities.

The California Policy Seminar is a joint undertaking of the University and legislature to analyze issues and problems of concern to citizens of California. UCLA received two of the six Universitywide grants awarded this year.

Lectureship renamed after retiring dean The Executive Committee of the School of Public Health Alumni Association has announced that its annual Distinguished Lectureship will now be known as the 11 Lester Breslow Distinguished Lectureship."

The renaming honors Dean Lester Breslow, who will be retiring in June, 1980. It was made possible by a gift from the Raymond and Betty Goodman Foundation, which will support the lectureship in perpetuity and will continue to attract distinguished leaders in health to UCLA. Raymond Goodman, M.D., M.P.H., was the founding president of the School of Public Health Alumni Association and has been one of the most active supporters of its programs.

Field placement sought School of Public Health alumni who would like to provide field placement positions for students of the School are invited to contact Edward S. Nugent, assistant dean, at 825-5140.

Field placement involves eight weeks to nine and a half months working in a health care agency.

All M.P.H. students must fulfill this field placement requirement.

Some positions are paid, others

are voluntary; some are full-time and others part-time. Students may also attend classes during the course of field placement.

Health care agencies in the program may be located anywhere in the United States or overseas, as well as in Los Angeles County, Sacramento, or Washington, D.C.

Accreditation The School of Public Health has received the maximum five-year accreditation from the Council of Education for Public Health. The Council will make its next on-site visit to the UCLA campus during the 1983-84 academic year, according to Assistant Dean Edward S. Nugent.

Plans proceed for new Los Angeles area BSA The Los Angeles County Board of Supervisors has reached an agreement with HEW on how to proceed in selecting a director and developing a new $3-million a year health service planning agency for Los Angeles County.

The new executive director will be hired by the governing body of the new agency, with the L.A. County Supervisors retaining veto power over the selection.

The community has been without a functioning health planning body since the previous HSA closed its doors year ago because its funding was discontinued

by HEW. HSA's were developed from the 1974 National Health Planning and Resources Development Act (PL-93-641), in which local areas were mandated to establish agencies which would plan health facilities. Plans were to be coordinated at the state level but health systems agencies (HSA's) had jurisdiction over the local implementation of the Health Planning Act.

"During the past year, regulation of health care under federal and state law has been under the direction of officials at the Office of Statewide Health Planning and Development, in Sacramento," according to Dr. William Shonick of the SPH. Dr. Shonick added that a technical consulting service to HSA's throughout the United States is being jointly sponsored by the schools of public health at UCLA, UC Berkeley, and the University of Hawaii. It is one of four centers in the United States which provide support to the agencies, and is fully funded by the federal government.

lntemational dinner to be held in March The School of Public Health Alumni Association will once again host the annual International Dinner in March.

The 1979 event was held at the Hong Kong Low Restaurant in Chinatown in April. Some 100 members of the SPH Alumni Association family enjoyed the leisurely ten-course Chinese banquet, at which students, staff, faculty, and alumni joined together to share conversation and sharpen their skills with chopsticks.

Individuals interested in working on plans for the upcoming international dinner in March are invited to call 825-5140.

Highest honors to students, faculty at June '79 social event Nearly 200 faculty, students, and alumni attended the final social event of the 1979 school year on June 8, to participate in the presentation of awards. The program was held'in the James E. West Center on campus.

Virginia Clark, Ph.D., retiring as chairman of the Biostatistics

More than 100 m embers of the SPH famil y en;oyed th e annual International DinneL The 1979 event was held at Hong Kong Low in Chinatown .

Division, was honored with the Distinguished Service Award recognizing her many contributions to the School. She was presented with an engraved plaque.

The highest student honor went to Sandra Harvey, M.P.H., Population and Family Planning. She received the Bronze Medallion as well as the Distinguished Student scroll award for her division from the SPH Alumni Association.

Other scroll recipients were Dina Stolman, Health Services; Martin Lee, Biostatistics; Robert Haile, Epidemiology; Vinette Ramsay, Environmental Health and Nutrition Sciences; and Michelle St. Jean, Behavioral Sciences and Health Education.

Sir George Godber to be SPB visitor One of the world's most distinguished figures in the field of public health will be visiting the UCLA School of Public Health during the week of Feb. 4, presenting a public lecture on Feb. 7.

He is Dr. Sir George Godber, former chief medical officer (for 14

years) of the National Health Service in England and former member of the executive committee of the World Health Organization.

He is especially known for the management of a large system of health care, health promotion, and disease prevention, and as being one of the leaders of anti-smoking efforts all over the world. For information about the lectures, contact the UCLA School of Public Health.

What's new? (with you?)

All alumni of the School of Public Health are encouraged to send news about their professional involvements, research activities, honors, or personal information for inclusion in this new UCLA School of Public Health magazine, UCLA Public Health.

Send all relevant information, including degree, class year, and name of division, to: Barbara Broide SPH Alumni Association UCLA School of Public Health Los Angeles, CA 90024 19

PBS.A-it's off to a running start

Minority Student .Association

NOTES

Sally Simpson, executive director of the Public Health Students Association, is pleased to report an encouraging degree of student involvement this year in PHSA activities. Committees have been organized and are making plans for a variety of projects and events.

This year's Legislation Committee will again focus on efforts to increase student awareness of legislative issues in health and hopes to bring in several speakers throughout the year to speak on timely issues. In addition, the first printing of Legislative Information for Health Professionals, coauthored by last year's committee, was published in mid-November.

This resource booklet was designed to aid professionals in legislative research and is scheduled for use in two School of Public Health courses.

The Social Events Committee is making plans for several wineand-cheese parties throughout the year and also in addition interdivision coffee hours to provide much-needed study breaks.

The Employment Opportunities Committee continues its efforts to encourage the long-awaited hiring of a full-time placement officer at SPH. Other potential activities include job search seminars and invitations extended to alumni to share their post-education experiences with students.

Executive Council plans include the drafting of a response to student problems highlighted in last year's student questionnaire. A student newsletter is a primary objective. The current officers, Elena Rios, Robert Heutch, and Ms. Simpson, are all second-year M.P.H. students.

The Minority Student Association has long been an organization geared toward assisting minority students in their matriculation through Public Health academia.

This year's MSA activities were inaugurated by a pot luck dinner and a student orientation. The experience has proved most beneficial to incoming students as well as second-year students who made presentations.

One of the major goals of the MSA has been to increase educational opportunities for minority students in the field of public health. To that end, MSA is continuing its efforts in the area of recruitment and presentation of public health as a valuable and viable choice for careers to minority applicants.

Students this year, as last, are assisting the office of Josephine Alvarez in recruitment presentations to area colleges. This has been a gratifying experience for participating students as well as offering different perspectives to prospective applicants.

Plans for January, 1980, included seminars to address public health issues as they relate to minority communities. In addition, it is the hope of MSA members to present alumni as speakers on employment opportunities.

For information about MSA, contact the office at Al-277 or phone 825-5064. This year's officers are Earl Alexander Dorsey, president; Elena Rios, vice president; and Debra Ward, secretary.

Alumni

,

20

Neil F. Piland, M.P.H., Dr. P.H., ' 79, is now Project Director in charge of reorganizing health services for the Jicarilla Apache Indian Tribe in Northern New Mexico.

Vinette Ramsey, Dr. P.H., '70, has joined the faculty of California State University, Long Beach.

John Baumbaugh, B.S., '78, is working as Public Health Sanitarian at Los Angeles County Health Service's Redondo Beach office.

Raymond D. Mattingly, M.P.H., '78, is Corporate Director, Management Engineering, for National Medical Enterprises, Inc., Los Angeles.

Cynthia S. Weniger, M.P.H., '78, has joined Cornell University Division of Nutritional Sciences as Nutrition Field Research Specialist.

Lt. Henry S. Chan, M.P.H., '76, is serving as a first lieutenant in the Medical Service Corps, U.S. Army Environment Health Engineering Agency, Japan.

Diane D. Fillhart, M.P.H., '76, is now teaching nursing at Chaffey College, Alta Loma.

Matthew Weintraub, M.P.H., '76, has joined L.A. County Health, Division of Ernergency Medical Systems, as Emergency Aid Program Coordinator.

Kenneth E. Lee, M.S., '75, Health Planning, is now a Senior Associate of Bobrow, Thomas and Associates and will lecture at the American Hospital Association Hospital Management Systems Society, Florida, in February.

Forrest S. Tennant, Jr., M.D., M .P.H., Dr. P.H., '75, is the Executive Director of Community Health Projects, Inc., West Covina, and was named as "Citizen of the Year" by that city's Chamber of Commerce for outstanding achievements in civic affairs.

Larry Portigal, M.S., '74, has joined L.A. County Health Services as Epidemiology Analyst, Acute Communicable Disease Control.

Donald Slymen, M.S., '74, Biostatistics, is currently a consulting biostatistician in the Department of Preventive Medicine and Environmental Health at the University of Iowa. He has just entered the Ph.D . Program in Preventive Medicine specializing in biometry.

Dr. Ronald C. Forgey, D.0., M.P.H., '73, is a staff physician with the Public Health Service Indian Hospital at Pine Ridge Sioux Reservation, South Dakota.

Valerie Jean Hernandez, M.P.H., '73, is now Chief of Contracts and Grants, Los Angeles County Department of Mental Health.

Mrs. V. A. Lewellen, M.P.H., '72, has joined St. Joseph's Hospital, Burbank, as a Lecturer in Continuing Education.

Robert A. Murray, M.P.H., '72, is now a State Epidemiologist with the Californis Department of Health, Berkeley.

Jean E. Scott, Dr.P.H ., '72, has joined Northrap Corporation as Industrial Hygiene and Safety Engineering Specialist. He also teaches Health Science at Chapman College.

Amy Zimmerman, M.P.H., '71, is now Director of Health Education at USC's Student Health Center.

Marc Moser, M.P.H., '71, is Director of Planning and Development at Maxicare.

Charles N. Moss, M.D., Dr.P.H., '70, now serves as a medical consultant to the Los Angeles County Department of Health Services.

Richard A. Glucksman, B.S., D.D.S., '70, is now in private dental practice in Santa Monica.

Leon Bernstein, Dr.P.H., '66, Medical Care Administration, is now Professor and Director of the Health Science and Policy Program, University of Maryland at Baltimore.

Murray D. Buxbaum, M.D., M.P.H., '66, President of Population Communication, Inc., has begun a project in Mexico that includes comprehensive family planning, a community hospital, and outreach program highlighted by radio-dispatched four-wheel drive vehicles that travel to remote areas.

Thomas Heriberto, M.P.H., Ph.D., '64, is now Chief, Genetic Counseling and Education Unit, California State Health Department.

Faculty APPOINTMENTS

E. Richard Brown, assistant professor in Behavioral Sciences and Health Education, holds a Ph.D. from U.C. Berkeley and served as program specialist of the Data Management and Analysis Bureau of the Alameda County Health Care Services Agency, Oakland. Dr. Brown is also the author of a new book, Rockefeller Medicine Men: Medicine and Capitalism in America, published by University of California Press.

Joseph Coyne, assistant professor in residence, Division of Health Services (Health Information Systems), holds a Dr.P.H. from UC Berkeley. He is formerly a Research Fellow at the National Center for Health Services Research, HEW, Hyattsville.

Curtis Eckhert, assistant professor, Environmental Health and Behavioral Sciences is a former NIH fellow in Ophthalmology and Visual Research at Stanford University. He received a Ph.D. from Cornell University.

Jonathan Fielding, professor of pediatrics in the UCLA School of Medicine and professor of Health Services in the School of Public Health, holds an M.A. from Harvard University in the history of science, an M.D. from

Harvard Medical School, an M.P.H. from Harvard School of Public Health, and an M.B.A. from the University of Pennsylvania. He is the former Commissioner of Public Health, Commonwealth of Massachusetts. At UCLA he is co-director of the Center for Health Enhancement, Education and Research project.

Ralph Frerichs, assistant professor of Epidemiology, holds a D.V.M. from the University of Illinois and comes to UCLA from Tulane University's School of Public Health, where he received his Dr.P.H., specializing in tropical medicine.

Mohammad Mustafa, associate professor in Environmental Health and Nutritional Sciences, comes to the School of Public Health from the School of Medicine. He holds a Ph.D. from the State University of New York at Albany.

NEWS

Dr. Judith Blake has been elected President of the Population Association of America.

Derrick B. Jelliffe, professor of public health and pediatrics, winner of the 1979 Wihuri Prize (see article this issue), was also presented with the Annual Award of the Caribbean Association of Nutritionists and Dieticians for 1979 at their annual meeting in Curacao, Netherlands Antilles. This was held together with the inauguration of a bi-annual lectureship on child nutrition, to be designated the "Derrick B. Jelliffe Lectureship" and sponsored by the Association.

Dr. Alfred Katz organized and conducted the first International Conference on SelfHelp and Mutual Aid in Contemporary Society, Sept. 10-15, 1979 held at the InterUniversity Centre for Post-Graduate Studies in Dubrovnik, Yugoslavia. As a result of the meeting, the World Health Organization has asked Dr. Katz and two other participants to draw up a document outlining how self-care contributes to primary health care, and a plan for WHO activities in this field. Other follow-up activities in 1980 will include a meeting of U.S. and European self-help researchers and regional meetings in Northern Europe and the South Pacific.

Milton I. Roemer, M.D., professor of public health, Health Services, spent two months in Barbados as a consultant to the government in its planning of a "national health service." Based on his analysis and recommendations, the Cabinet of that country voted to proceed to implement a plan on primary care, as the initial phase of the national health service. Prior to the Barbados trip, Dr. Roemer served as a WHO Consultant in Thailand, where he advised on the reorganization of the teaching of health services administration in Thailand's School of Public Health at Mahidol University. He authored an analysis of the Thai health care system which will be used as a

textbook/manual there. Springer Publishing Company has published Social Medicin e: The Advance of Organized Health Services in America, based on 38 papers written by Dr. Roemer and his colleagues during the 60's and 70's.

Paul R. Torrens, M.D., M.P.H., professor in Health Services, has spent an unusually active year. His sabbatical spent in England, Scotland, and Wales, studying hospice programs, is described in his article elsewhere in this issue. For one month of his sabbatical, he joined UCLA graduate Bill Emmet in Lesotho to help in organizing a rural health program for that country. The project is attempting to develop a health system covering the entire country, utilizing village workers and nurse practitioners as the major personnel. He was involved in the design and planning of regional organizations designed to integrate services in the particular geographic sections of the country.

Additionally, Dr. Torrens is co-editor (with Stephen Williams) of a new textbook, Introduction to Health Services, published

by Wiley in December. A joint venture between UCLA and the University of Washington, his volume includes contributions by Charles Lewis, Robert Brook, Robert Kane, Lester Breslow, and Dr. Torrens of UCLA along with those of an equal number of distinguished UW faculty.

Finally, Dr. Torrens plans to lead a tour of public health professionals to the People's Republic of China in the summer of 1980.

The tour, sponsored by the Harvard School of Public Health Alumni Association (of which Dr. Torrens is president) will visit Peking, Shanghai, Kweilin, Kwangchow, and a number of rural communes. (Alumni who wish to take part should contact Dr. Torrens.)

21

Become a member now!

Dean's Council

The UCLA School of Public Health Alumni Association has become a vital force in the School's activities. It exists to foster a better understanding and to promote fellowship among students, alumni, and the School. Among activities having the purpose of achieving this goal are the following: Distinguished Lectureship, which each year brings to the campus outstanding speakers involved in the health field, whether health professionals, legislators, or others.

Career Day, orientation events, the annual International Dinner, and other professionally-directed or social events, are sponsored by the Association in conjunction with the School.

Outstanding Student Award, presented annually by faculty nomination to the student who, through achievement in the classroom, exhibits promise in the field of public health.

The SPH Alumni Association has contributed substantially to the School since its formation in 1974. Yet much remains to be done if the Association is to assert itself as a strong force in public health affairs. The support of all Outstanding Teacher Award, prealumni is needed to make this possible. sented annually in conjunction with the You are urged to become an active UCLA Alumni Association, to the facmember now. ulty member voted most outstanding Annual membership dues are $10 for by the student body. active members (alumni, faculty, and UCLA Public Health magazine, staff) and $3 for students. Memberpublished periodically for all alumni, ships are renewable annually on students, and faculty.

October 1.

----------------------------, Yes, I would like to join the UCLA School of Public Health Alumni Association.

DIVISION - - - - - - - - - - - - - DEGREE, CLASS YEAR _ _ __ ADDRESS - - - - - - - - - - - - - - - CITY _ _ _ _ _ __ STATE _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ __ _ _ ZIP_ __ _ Encloseg is my check in support of SPH Alumni Association activities for 1980.

Active Member: $ _ _ _ _ Associate Member (student): $ _ _ __ Contribution: $ _ _ __ I'm interested in serving on the SPH Alumni Association Council or Executive Committee.

o Call me at (Phone) _ _ _ _ _ _ _ _ _ _ _ __

_

Please publish the following news notes:

Make checks payable to UCLA School of Public Health Alumni Association.

I

Mail to: Edward S. Nugent, Assistant Dean, UCLA School of Public Health, Los Angeles, CA 90024

"-----------------------------22

I I I I I I I I I I

The School of Public Health acknowledges its gratitude to those friends who have generously responded to the School's needs.

Funds from the Dean's Council enhance the School's educational and professional programs at the UCLA School of Public Health. It is only through the growth of the Dean's Council that the excellence for which UCLA is known worldwide can be maintained now and through the coming years.

It is hoped that you will join in this effort. For further information about the Dean's Council of the School of Public Health, please contact Judith C. Angel at (213) 825-3901, 405 Hilgard Avenue, Los Angeles, CA 90024.

1979 Members Rolando Armijo Ann Bjorklund Lester Breslow John Chapman Portia Choi Virginia Clark William Cumberland Irvin Cushner Brian Dolan James Enstrom Raymond Goodman Carl Hopkins Paul Jarett Derrick Jelliffe Carolbeth Goldman Korn Joel Kovner Frank Jones Massey, Jr. Frank Matricardi Jean Mickey Charles Moss Alfred Neumann Edward Nugent E. J. O'Neill James Palmersheim Jose Quiroga Stanley Rokaw Alan Samuels Marion Swendseid Forrest Tennant Robert E. Tranquada Sue Verity Barbara Visscher

T

he health of the American people has never been better In this century we have witnessed a remarkable reduction in the life-threatening infectious and communicable diseases ... Further improvements in the health of the American people can and will be achieved-not alone through increased medical care and greater health expenditures-but through a renewed national commitment to efforts designed to prevent disease and to promote health ... Some of the recent gains are due to measures people have taken to help themselves-changes in lifestyles ... With the growing understanding of causes and risk factors for chronic diseases, the 1980's present new opportunities for major gains. Prevention is an idea whose time has come.

-from the U.S. Surgeon General's 1979 Report on Health Promotion and Disease Prevention, "Healthy People"

The UCLA Office of Health Sciences Development UCLA School of Public Health 405 Bilgard Avenue Los Angeles, California 90024

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