The Health bulletin [serial] - University of North Carolina at Chapel Hill

March. 1951The Health Bulletintime. Of course many of the 1200 coimtleswithout such service are small, butmany of them are not, and of the 1900counties with the coverage, relativelyfew meet minimimi standards of adequacyas to numbers and qualificationsof personnel. Moreover nearly a thirdat last reports had a vacancy in theposition for health oflBcer.In North Carolina we are somewhatbetter off than the country as a whole.We have health departments coveringthe entire 100 counties. However, ourratio of public health nurses to populationis only a little more than half ofapproved standards, 1 to 9,000 as againsta standard of 1 to 5,000, and there arenine health officer vacancies, affecting13 counties.Next let us look at the physical facilitiesof health care: hospitals and healthcenters. The United States has arounda million and a half hospital beds of allkinds. Approximately 44% of these aregeneral beds, the balance being formental, tuberculosis and chronic patients.Nearly a third of these are unsatisfactoryby the standards establishedby the Public Health Service imder theHospital Construction Act, so that it wasestimated by the National Health Assemblyin 1948 that a total of 900,000new and replacement beds were needed.Some progress, of course, has been madeunder the Hospital Construction Act,but making up a deficit of this magnitudewill be a matter of years, sinceboth personnel and construction are involved.In North Carolina we have a total of27,400 beds of all types, of which 13,500,or about half are general beds. Thesegeneral beds comprise 74% of those weneed according to P.H.S. standards. Wewill, when present construction is completed,meet the required number of bedsfor tuberculosis, but we have only 54%of the needed beds for mental patientsand only 3% of the needed beds forchronic patients. As to this deficit ofmental beds the view has been expressedthat the standard for mental patientsis too high if adequate personnel andfacilities are provided so that all patientsare cured or improved who aresusceptible of cure or improvement. Inother words, it will not take as manybeds if our mental hospitals can providereal therapeutic services rather thanthe largely custodial care they have beenproviding. I am inclined to agree withthis point of view, which would reduceour deficit of mental beds to around 28%.With respect to health centers, thestandards as to the number needed arenot very satisfactory. Certainly, however,we can figure at least one percounty. Both in the country as a wholeand in North Carolina we have madebut a beginning on these facilities. Whenprojects already approved in NorthCarolina are completed we will have thehealth departments in 25 of our 100counties housed in reasonably adequatehealth centers, the other 75 being housedin quarters inadequate in size or appointments,or in imsatisfactory locations.The National Health Assembly madethe point that effective and economicalhealth service will require a great dealbetter integration than exists at presentof the facilities within a given commimityand the facilities within aregion. This is one of the more difficultproblems we face but it is of vital importancethat we begin giving it veryserious attention because without properintegration we will not get the serviceto which we are entitled for the investmentwe are making.The third element in health and medicalservices is personnel. In estimatingpersonnel needs I have used 1960 as thedate of reference since that is the dateon which the National Health Assemblyand several recent studies of nursingneeds have based their estimate. Thefigiu-es quoted represent the more conservativeof the available estimates.As to physicians, the present annualrate of graduation nationally is 1500 lessthan will be required to give us thenumber of physicians we will need by1960. It is likely that the deficiencywill not be quite so great as this figiu-ewould indicate, since there are severalnew medical schools in prospect—includingour own at the University—butit promises to be of significant proportionsnevertheless. Of perhaps greatersignificance than the deficit in numbers