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[Health] - Californiaäó»s Health - Biennial Report, 1966-1968
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[Health] - Californiaäó»s Health - Biennial Report, 1966-1968
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Ronald Reagan Presidential Library
Digital Library Collections
This is a PDF of a folder from our textual collections.
Collection: Reagan, Ronald: Gubernatorial Papers,
1966-74: Press Unit
Folder Title: [Health] - California's Health - Biennial Report,
1966-1968
Box: P37
To see more digitized collections visit:
https://reaganlibrary.gov/archives/digital-library
To see all Ronald Reagan Presidential Library inventories visit:
https://reaganlibrary.gov/document-collection
Contact a reference archivist at: [email protected]
Citation Guidelines: https://reaganlibrary.gov/citing
National Archives Catalogue: https://catalog.archives.gov/
California's_Health
1966-1968
STATE OF CALIFORNIA DEPARTMENT OF PUBLIC HEALTH
STATE OF CALIFORNIA
RONALD REAGAN, Governor
HUMAN RELATIONS AGENCY
SPENCER WILLIAMS,
Secretary
"The State Board of Public Health
consists of the Director of Public Health
and nine other members. The board shall
advise the director in the performance of
President Egeberg, 1965-68
President Herrick
his duties and formulate general policies
affecting public health. It shall have power
to adopt, promulgate, repeal and amend
rules and regulations consistent with law
for the protection of the public health.
"It shall issue licenses and permits as
prescribed by law and by rules and regula-
tions of the board. It may hold hearings
and subpena witnesses and documents pur-
suant to Article 2 of Chapter 2, Part 1,
Division 3, Title 2 of the Government
Code. The board shall have no administra-
tive or executive functions other than those
set forth in this code."
-Health and Safety Code
STATE BOARD OF PUBLIC HEALTH
WILLIAM C. HERRICK, MD
HUGO M. KULSTAD, DDS
ROGER O. EGEBERG, MD
La Mesa
Bakersfield
President, Los Angeles
MARCO R. RAGO, MD
ALBERT A. MARINO, RS
MRS. HUBERT C. WYCKOFF
Beverly Hills
Auburn
Vice President, Watsonville
ALEX A. ROGER, MD
WILLIAM F. McCOLL, MD
JAMES L. DEPUY, MD
Los Angeles
West Covina
Watsonville
LOUIS F. SAYLOR, MD
Director, State Department of Public
Health, and Executive Officer of the
Board, Berkeley
CONTENTS
Page
26-27
Alcoholism: a million problem
32
Indian health: a new rural health
drinkers
project
Cover
Board of Health
42-44
Laboratories: the little picture-
OF
PUBLIC
48
California 2000 A.D.
viral and rickettsial. diseases, clini-
HEALTH
16
California's "Playground" counties
cal chemistry, microbial diseases
38-41
Chronic Diseases: all of us are po-
20-21
The Mentally Retarded: society must
STATE
or
tential victims
create special learning situations
17
Community Health Services and
32
Nurses are always needed
Resources: 197,000 beds
28
Nutrition: poor diets-brain dam-
December 1968
18-19
No Communicable Disease has been
age-shortened lives
Vol. 26, 6-7
conquered
14-15
Occupational Health: plastics, pesti-
24-25
Crippled Children Services:
cides, pressure
65 thousand important futures
2
Organization chart
3
Director's page: "To die young-
36-37
Public Health Social Work: train-
but as late as possible"
ing the poor to help the poor
29
Dental Health: three million adults
10-11
Solid Waste: 70 million tons a year
have lost their teeth
46-47
Special Services: record to read-out
28
Drug Abuse
in record time
9
Ear Pollution: unwanted noise
45
Training: competent professionals
6-7
Environmental Health: NO, NO, a
30
Tuberculosis Control: the bacillus is
thousand times NO
becoming drug-resistant
22-23
Family planning for all who wish it
11
34-35
Farm Workers Health Service
Vectors spread diseases
4-5
Food and Drug Program: protecting
31
Venereal Diseases: the tip of the
the consumers
iceberg
45
Health Education: an informed
46-47
Vital Statistics: keeping tabs
public
12-13
X-rays, isotopes, chemistry
33
Immunization Assistance: children
and water that's pure
-reservoirs of epidemics
The staff-(inside back cover)
Organization chart photo by V. D. Sutcher.
California's Health is published monthly by the State Department of Public Health, except when two issues are replaced by the Biennial
Report issue (December, 1968-January, 1969). Requests for single copies or for placement on the mailing list may be made by writing
to the address below. Entered as second-class matter, August 15, 1965, at the Post Office in Sacramento, California, under the Act of
August 24, 1912. Acceptance for mailing at the special rate approved in Section 1102, Act of October 3, 1917. Address all communica-
tions to the editor, State Department of Public Health, Bureau of Health Education, 2151 Berkeley Way, Berkeley, California 94704.
1
STATE OF CALIFORNIA DEPARTMENT OF PUBLIC HEALTH
COMPREHENSIVE
HEALTH PLANNING
DIRECTOR'S OFFICE
STATE BOARD OF
PUBLIC HEALTH
COUNCIL
OFFICE OF FISCAL
OFFICE OF
OFFICE OF
AND MANAGEMENT
COMPREHENSIVE
SPECIAL SERVICES
SERVICES
HEALTH PLANNING
BUREAU OF
BUREAU OF
BUREAU OF
BUREAU OF
BUREAU OF
HEALTH
REVIEW AND
DATA
BUREAU OF
FISCAL AND
PROGRAM AND
MANPOWER
ADMINISTRATIVE
BUDGETING
VITAL STATISTICS
STATISTICAL
INTELLIGENCE
EVALUATION
PROCESSING
ACCOUNTING
MANAGEMENT
SERVICES
SERVICES
SERVICES
REGISTRATION
SERVICES
UNIT
SERVICES
CENTER
AND DEVELOPMENT
ENVIRONMENTAL
COMMUNITY HEALTH
HEALTH AND
PREVENTIVE
SERVICES AND
CONSUMER
MEDICAL
RESOURCES
PROTECTION
PROGRAM
PROGRAM
PROGRAM
LABORATORY
SERVICES
BUREAU OF
BUREAU OF
BUREAU OF
HEALTH FACILITIES
HEALTH FACILITIES
BUREAU OF
FOOD AND DRUG
MICROBIAL
ADULT HEALTH
DISEASE
PLANNING AND
LICENSING AND
FOOD AND DRUG
LABORATORY
AND
LABORATORY
CHRONIC DISEASES
CONSTRUCTION
CERTIFICATION
BUREAU OF
SANITATION
VIRAL AND
BUREAU OF
BUREAU OF
BUREAU OF
RICKETTSIAL
COMMUNICABLE
RADIOLOGICAL
AND RADIATION
HEALTH EDUCATION
NURSING
DISEASE
DISEASE
HEALTH
LABORATORY
LABORATORY
CONTROL
BUREAU OF
BUREAU OF
BUREAU OF
PUBLIC HEALTH
BUREAU OF
VECTOR CONTROL
LABORATORY
BUREAU OF
CONTRACT COUNTY
PUBLIC HEALTH
MENTAL
AND SOLID WASTE
SOUTHERN
NUTRITION
RETARDATION
SERVICES
SOCIAL WORK
CALIFORNIA
SERVICES
MANAGEMENT
BUREAU OF OCCU-
AIR AND
BUREAU OF
BUREAU OF
PATIONAL HEALTH
INDUSTRIAL
CRIPPLED
MATERNAL AND
& ENVIRONMENTAL
HYGIENE
CHILDREN
EPIDEMIOLOGY
LABORATORY
SERVICES
CHILD HEALTH
BUREAU OF
BUREAU OF
DIVISION OF
DIVISION OF
SANITARY
AIR SANITATION
ALCOHOLISM
DENTAL HEALTH
ENGINEERING
Frank W, Pusey Co,
REAL ESTATE
UCG
"To die young-but as late as possible"
Twenty million people now live in Cali-
possible throughout our complex, many-
fornia, clustered or scattered over much of
layered human ecology. State, county and
the state's 158,000 square miles. Some areas
city health departments are pledged to help
are SO sparsely settled that the nearest
provide our people with clean air; safe,
neighbor is a mile distant; in some cities
good-tasting water; practical but not un-
people are packed and stacked by the mil-
sightly disposal methods for solid wastes;
lion.
protection from the din of man-made
Each individual interacts with his en-
noises; fewer occupational hazards in fields
vironment, with his neighbor, and his com-
and factories, and much more.
munity. How these interactions occur, and
These health objectives, many of them
under what circumstances, determines to a
closely interlaced, are broad and long-range.
large extent the quality of life he enjoys,
Fortunately, California has a well-estab-
and the life style he shares with others.
lished, broad-based mechanism for solving
It has been said that man's aim should be
statewide health problems and reaching
"To die young, but as late as possible."
goals for better living-the California Con-
Health is no longer narrowly defined as
ference of Local Health Officers. The State
only the absence of disease. Our goal in
Department of Public Health assists and
public health is to provide the means to
cooperates with the leaders of local health
robust good living, for all the years possi-
departments in our 58 counties. This grass
ble to the individual. This ideal is modified
roots" fabric, woven from the threads of
by the quality of the environment and the
State-local understanding and shared re-
DAGGETT
availability and application of health pro-
sponsibilities, is perhaps unique in the
tection and medical care.
Nation.
Today Californians of all generations are
Many of California's public health pro-
moving into the mainstream of health and
grams-and problems-are described in the
medical care under the Federal Medicare
following pages of this Report. Wherever
and State Medi-Cal programs. Millions who
possible we have attempted to give the
less than a decade ago had expected to go
reader a glimpse of people helping people,
through life without ever seeing a physi-
which basically is what public health is all
about.
cian except in dire emergency, are now re-
ceiving the regular preventive medical at-
tention that will measurably lengthen their
life spans and make living more zestful.
Good physical and mental health are sus-
tained by a healthful environment. Public
health workers are committed to maintain-
LOUIS F. SAYLOR, M.D.
ing-or regaining-the highest standards
Director
3
Protecting the consumers
A healthful environment in a modern so-
vitamin pills for quinidine tablets SO that
ciety is one in which the individual citizen
he could sell the valuable heart drug on the
can buy, with reasonable assurance, foods
black market, Department inspectors had to
that are wholesome, drugs that are effective,
sift through the firm's entire quinidine sup-
cosmetics that are safe, and household aids
ply to insure its efficacy.
that are properly labeled.
Recent inspections have turned up food
The Department's Food and Drug Pro-
labeled safe for diabetics which contained
gram was established to protect the con-
over 30 percent sugar
misused pesticide
sumer against tainted or adulterated prod-
in processed frozen vegetables
a "hair
ucts, unsafe manufacturing or handling
restoring" compound which did not, as
practices, misuse through mislabeling, and
claimed, cure baldness
and repackaged
fraud. This, in turn, benefits the honest, con-
sample drugs diverted from normal chan-
scientious businessman.
nels and sold after the word "complimen-
Through its staff of technically trained
tary" was erased from each capsule.
field personnel, the Department annually
The Department's Food & Drug Labora-
surveys more than 3,200 food and drug man-
tory in Berkeley and the Branch Public
ufacturing firms; issues 1,000 new licenses;
Health Laboratory in Southern California
supervises the destruction or reconditioning
provide the essential analytical assistance to
of nearly 4 million pounds of food exposed
carry out these activities.
to fires, floods, or unsound conditions; main-
The laboratory chemists have also assem-
tains daily inspection of 135 licensed can-
bled data and conducted toxicological
Salvage for con
neries producing 66 million cases of canned
studies upon which a nationwide tolerance
goods; removes $200,000 worth of defective
level for DDT-pesticides in milk and dairy
drugs and 3,800 tons of tainted fish from the
products was established. And they con-
market; causes nearly 1,800 corrective ac-
tinue to work with other arms of the State
tions to be taken and suggests another 3,000
Health Department, such as the Bureau of
voluntary compliances; and investigates
Vector Control, for which they recently de-
more than 100 fraud cases, about a quarter
veloped a pesticide spraying pattern that
of which end up in court.
would control encephalitis-carrying mosqui-
For example, when a Southern California
toes without causing dangerous chemical
drug plant manager was caught substituting
build-up.
4
3
STAFF PHOTO
family spends nearly a quar-
on food, drugs, medical de-
and household chemicals.
ousewife's confidence in the
buying lies the work of State
inspectors, like the agent
testing maraschino cher-
with laboratory chemists like
viewing an inspector's report
suspect drug compounds.
NO, NO, a thousand times NO
and NO2 and O3 and hydrocarbons and lead
Smog. An ugly, choking, eye-stinging
work (SCAN), and collects and analyzes
pall hanging over our freeways, drifting in
data-some 2 million readings yearly-
foul wisps among the buildings of our
from 60 locations at which continuous meas-
cities, blotting out our scenery and turning
urement of air quality is being conducted.
our suburban gardens brown.
Expansion of the network into unmonitored
Californians have become increasingly
areas for truly thorough coverage is now
familiar with this spreading blight. It has
underway.
cost us dearly in agricultural loss and ill
During the past two years the Depart-
health. It frays our tempers and dirties our
ment has aided 18 rural counties where
collars. New evidence suggests it may con-
lumber and pulp mills, alfalfa dryers, dust,
tribute to auto accidents, cause harmful
odors and toxic exhausts have presented
substances to accumulate in our bodies and,
serious problems. Cheaper and more effi-
most importantly, directly shorten our
cient ways to burn wood wastes have been
lives.
developed in cooperation with the lumber
Since 1954, the Department has been at
industry, and local agencies have been as-
work to learn more about air pollution and
sisted to define and control air pollution in
how to combat it. Giant strides have been
their communities.
made. Based on Department research, Cali-
Under contract with the State Air Re-
fornia has adopted the world's first air
sources Board, the Department has begun
quality standards to define the limits at
a massive inventory of pollutant emission
which alien substances in the atmosphere
sources in each of California's 11 air
become a significant threat. Motor vehicle
basins.
emission standards have been enacted to
muffle the flow of contaminants from this
The Department has continued to update
major source. New techniques have been
motor vehicle emission and air quality
developed to analyze the contents of pol-
standards. Recently, exhaust standards for
luted air, and to find out what effects the
hydrocarbons - hydrocarbons interacting
pollutants have on the lungs and bodies of
with oxides of nitrogen (NO and NO2) in
people who must breathe them.
sunlight are the cause of smog-were re-
But step outside, and you'll see that it's
defined on a weight basis, making the
only a beginning.
standards more equitable for small cars.
The Bureau of Air Sanitation was estab-
A report on lead pumped into the atmos-
lished in 1955 to bring the resources of
phere from auto exhaust was compiled in
State government to bear on this growing
1967, work which may result in a standard
problem. The Bureau administers a 16-city
for this potentially dangerous pollutant,
Statewide Cooperative Air Monitoring Net-
and limits on its use as a gasoline additive.
6
make life nasty and,
To accomplish this mission, the labora-
tory must often develop new air sampling
and analysis techniques, and must under-
take research into the relatively uncharted
fields of air chemistry and biological effects
of airborne contaminants.
During the past two years, the labora-
tory's chemists have studied-and gained
SAWARA
pioneering insights into-the impact of in-
haled nitrogen dioxide and ozone (O₃) (two
major ingredients of photochemical smog)
on lung tissues. They have found that ani-
mals exposed to these pollutants show
changes in the lung similar to those pro-
duced by aging.
They have also developed new methods
for examining damaged cells in the breath-
ing passages, and for detecting the presence
of inhaled lead in the body.
It's bad when you not only have to breathe it, but see it as well
At the same time, the laboratory has
worked on techniques to measure a variety
of subtle air pollutants found in Califor-
nia's industrial and community atmos-
The Department is currently working
phere: nitric oxides, mercury vapor, tetra-
with California education officials to design
ethyllead vapors, hydrocarbons, organic
courses which will acquaint students with
carbonyl compounds, organic sulfur com-
the air pollution problem, and with their
pounds, tiny irritating and light-dimming
duty as good citizens to aid in its preven-
particles called aerosols.
tion.
This work has, for example, enabled the
The Air and Industrial Hygiene Labora-
Department to close an industrial waste
tory analyzes the air Californians breathe,
dump in which lead fumes caused a health
both in their communities and in special-
hazard to workers and nearby residents,
ized industrial situations, to determine
and has provided a means to gauge ob-
whether it is polluted, how it is polluted,
jectively-and thus limit-the foul odors in
and what effect the contaminants may have
communities where paper-producing wood
on the health and welfare of the people.
pulp mills operate.
Continued
7
maybe, short
STAFF PHOTO
A major weapon in the Department's
tribution of other types of contaminated
attack on air pollution has been epidemio-
air is under scrutiny.
logic research-the study of how pollutants
Recently, Department statisticians have
affect the health of the broad population.
invented new "temporo-spatial" strategies
Although among the most difficult of
to compare events in several locations over
sciences-it may, for example, require more
long periods of time. These have been used
than 20 years' data to detect a rise in
to analyze, for example, the association
chronic emphysema rates, and only then
between Los Angeles smog levels and traffic
can researchers begin to analyze possible
accidents, and the relationship between car-
causes-epidemiologists in the Depart-
bon monoxide in the air and heart attack
ment's Environmental Hazards Evaluation
deaths.
Unit have been pacesetters in defining the
Because of its experience, the Depart-
health effects of contaminated air, and in
ment has prepared a report for the U.S.
devising statistical methods for health sur-
Public Health Service from which national
veillance of large population groups.
air quality standards for ozone and oxi-
Currently the Department is studying
dants may be derived. A preliminary report
daily deaths reported by Los Angeles and
has been completed on carbon monoxide,
other metropolitan county health depart-
and the Department has participated in
ments-a way to determine the impact of
compiling reports on sulfur oxides and air-
smog. This augments research on the 1967
borne dusts. These publications, widely dis-
daily workload of the Los Angeles County
cussed by scientists, are the basis on which
Coroner's Office, and nearly 14 years' data
control programs will ultimately be de-
on deaths and hospitalizations of elderly
signed.
Los Angeles nursing home residents.
The information, techniques and exper-
Since chronic lung diseases are particu-
tise gained in the assault on air pollution
larly likely to be affected by atmospheric
are now being applied to other environ-
Structural lung fibers exposed to nitro-
pollutants, they have been an object of
mental hazards facing the people of Cali-
gen dioxide begin to unravel-a phe-
nomenon scientists believe is important
special concern to Department epidemiolo-
fornia: drinking water polluted with dan-
in the origin of lung disorders like em-
gists. Studies show that emphysema is now
gerous inorganic substances like arsenic
physema. The lung collagen fiber at lower
right is still healthy. The two at center
among the 10 major killers of mature peo-
and nitrates; the mountains of solid waste
are starting to unwind. The fiber at left
ple in the State, and one of the most
produced by our urban society; housing
is almost completely disintegrated. The
process is shown at great magnification
rapidly increasing causes of death in the
and planning for comprehensive health
under a Department electron microscope.
past 10 years. The causative role of ciga-
care; and the growing abuse of dangerous
rette smoking is becoming clear. The con-
drugs throughout the population.
8
day
and
Noise. We can't see it, but we can feel
life. Yet it exerts many overt and subtle
it. We are becoming immersed in unwanted
side effects which are both unpleasant and
sound which pollutes our environment as
unnecessary. The Department is committed
effectively as smog, garbage or bacteria.
to the reduction of noise from all sources
Ear pollution is becoming a major public
to comfortable levels as a component of
health problem in California. On-the-job
environmental health. Shown here are three
exposure to excessive noise can result in
permanent hearing loss. Noise below the
kinds of ear pollution the average city
damaging level we consider a nuisance, to
dweller cannot avoid. The fourth we can
be tolerated as an accepted fact of modern
escape if we wish, but the drummer can't.
Ear pollution
Eight to four
9
70 million tons of solid wastes a year
During the next 35 years Californians
and the techniques developed will provide
will throw away-somewhere-nearly 21
valuable tools in accomplishing eventual
billion tons of solid waste. If, in one of
regional solutions.
those dramatic gestures beloved to statis-
Recently, the initial phase of another
ticians, it were all to be gathered into a 100-
study covering the entire State was com-
foot wide strip
then beer cans, no-re-
pleted. Some 15,000 pages of basic data
turn bottles, boxes, rusted fenders, left
were compiled. The information will be
shoes and the like would stretch from the
used to develop a recommended program
Oregon border to Mexico, to a depth of 30
plan for statewide solid waste management,
feet. Cost in present terms to collect and
to be published in 1969.
dispose of all that waste: $35 billion.
What are we going to do?
Every year California produces at least
70 million tons of solid wastes. The 58
square miles of land in today's disposal
sites are being used up rapidly. Land which
might be suitable for new sites is dwindling,
swallowed up for other, more economically
and esthetically attractive, purposes.
What are we going to do?
Of the 716 major disposal sites now in
active use, 75 percent are creating problems
of flies, rats, odors, smoke and unsightli-
ness. The 500 supplemental sites are all
open dumps.
What are we going to do?
During the past two years, the Depart-
ment's Bureau of Vector Control and Solid
Basically, the Department in working to
Waste Management has undertaken com-
shift public attitudes toward the view that
prehensive studies of this-quite literally-
solid wastes are a potential resource, sub-
mounting problem. In June, 1968, a re-
jeet to salvage and conversion. Disposal is
search project conducted in collaboration
a negative approach, offering no ultimate
with the Aerojet General Corporation was
solution. Improvements are also needed in
completed, using systems analysis to deline-
refuse storage and collection. Even a COV-
ate the complexities of regional solid waste
ered garbage can may be a "fly factory".
STAFF PHOTO
management. The information obtained
Something better must be done.
10
and vectors to spread disease
Fleas, mosquitoes, midges, domestic flies,
Mosquito resistance to insecticides, how-
gnats, cockroaches, mites, lice, ticks, wasps,
ever, is becoming an acute problem. Thus
snails, venomous snakes, spiders, scorpions,
the Department maintains an intensive
rats, mice, wild rodents
some 1,100 spe-
resistance surveillance program to aid local
cies of insects, reptiles and mammals which
agencies to avoid operational failures. The
transmit disease or discomfort to the public
Department also works to perfect new
in California are known as vectors. Their
spraying techniques. Currently, it is par-
bites and stings can be dangerous. Com-
ticipating in an investigation of airborne
batting this pestilent host is the job of the
insecticide application being conducted by
Department's Bureau of Vector Control
local, industry, university and armed forces
and Solid Waste Management.
experts. If this method-a very low volume
In 1966, the largest outbreak of bubonic
of chemicals dispensed at very high alti-
plague since the 1940's reached its peak in
tudes-can be perfected for general use, it
California. The Department found evidence
will be one of the most important advances
that wood rats had suffered heavily from
in vector control to occur in recent years.
the disease. Some 58 rodent specimens and
For many rural and wilderness vectors
pools of fleas were found to be positive for
control means are still limited. Recently,
plague. (In 1965 a human plague case oc-
experimental tests for yellowjacket control
curred in Shasta County.) More than 400
were conducted on Catalina Island. A study
campgrounds and sites were treated to de-
of scorpions, using ultraviolet light which
stroy disease-bearing fleas, with the result
causes them to fluoresce in the dark, is
that nearby animal populations often re-
underway to find out what species occur in
mained abundant, while rodents in un-
California, and where. A type whose sting
WEBER
treated areas suffered heavy mortality. Re-
can be fatal was discovered in San Bernar-
cently the State Legislature revised laws
dino County. Field and laboratory observa-
for agricultural rodent control and tight-
tions of the brown recluse spider are being
ened those regulating commercial trapping.
made to determine its public health im-
In 1967, the Department's early-warning
portance.
surveillance program detected signs of im-
And vector control specialists, in coop-
minent threat from encephalitis. A State-
eration with other biologists and limnolo-
wide alert brought emergency action by
gists, are at work to develop water manage-
local mosquito abatement agencies. The re-
ment procedures which will rid our lakes
sult was a substantial reduction in mosquito
and streams of insect nuisances without
populations, and a below-normal encepha-
conflict to California's agricultural or con-
litis case rate for the season.
servational interests.
11
X-rays, isotopes, chemistry
and water that's pure
When a nuclear bomb is tested in China
During the past two years, nearly 300
-or an underground blast rattles Nevada
radiation emergencies were investigated by
-the Department intensifies its careful
the Department. These ranged from finding
watch of our own environment. During the
tiny-but lethal-radium needles which dis-
past two years, some 30,000 tests for the
appeared in shipment, to aiding a manu-
presence of radioactive contaminants were
facturer in the recall of radiation-leaking
run on 13,000 samples of California air,
tubes in color television sets.
rain, snow, water, sewage, soil, milk and
The Department's Sanitation and Radia-
foods collected by 105 cooperating public
tion Laboratory supports the Bureaus of
and volunteer private organizations. Fortu-
Sanitary Engineering and Radiological
nately, overall contamination levels remain
Health by analyzing water to determine its
very low.
quality, and monitoring the environment to
But watching for fallout and its effects
detect excess radioactivity. In Southern
is only a fraction of the Department's
California, the Department's sanitation
Radiological Health Program, established
testing services are provided by the Branch
in 1960 to guard Californians against the
Public Health Laboratory.
multiplying sources of potentially hazard-
Recent activities of these units have in-
ous ionizing radiation.
cluded studies of waters with high mineral
STAFF PHOTO
Today, more than 25,000 medical, dental
content (the only kind available in some
and industrial X-ray units are registered
communities) to determine composition and
with the Department, and receive periodic
consumer acceptability; identification of oil
safety inspections. Operators are given as-
pollutants in the State's waterways to pin-
sistance in proper use of the equipment.
point the source and aid in prevention; and
About 1,200 facilities-industrial as well
identification of the pesticides which in-
as medical-are licensed by the Department
creasingly foul water in agricultural areas
to possess radioactive materials. Before
(demanding new analytical techniques as
anyone can acquire radioisotopes, his pro-
new forms of pesticide proliferate).
posed use, personnel, equipment, and pro-
Recently, Department chemists have de-
cedures are carefully screened by the De-
veloped sensitive new methods to detect
partment.
methane and silver in water
and a
Sites for nuclear power reactors and
rapid technique for measuring nitrate ions
radioactive waste disposal procedures are
in drinking water
and a special de-
evaluated carefully. And the Department
tector for use in organic pesticide analysis.
conducts a vigorous information and edu-
Additionally, the Department conducts a
cation program.
statewide program of evaluation and ap-
proval to assure the reliability of some 243
local water analysis laboratories.
Water is a precious commodity in Cali-
fornia. We use it to quench our thirst, cook
our food, boat and swim in, harvest our
famous fish and shellfish, nourish our crops
-and receive our wastes and sewage. Prop-
erly controlled, these are not incompatible
uses. Maintaining control is the aim of the
Department's Water Sanitation Program.
Because "fresh" water is precious, every
drop must be stretched. New techniques
allow waste water to be reclaimed quickly
and put to direct use for irrigation and
recreation. The Department recently de-
veloped pioneering sewage reclamation
Raw sewage
standards which safeguard the public while
allowing us to enjoy the benefits of prop-
erly reclaimed water. The standards are the
first of their scope in the Nation.
Activities continue in other areas: con-
Treating sewage
trolling the purity of all the State's water
supplies; assuring the safe disposal of our
sewage to prevent fouling of mountain
streams, lakes and reservoirs; regulating
water treatment processes; specifying how
wells are to be constructed and abandoned;
San Francisco Bay-Sacramento River
and protecting the beds in which shellfish
Delta area, resulting in the first overall
are grown.
prospectus for waste water reuse in that
The Department must also keep pace
rapidly growing section of the State. And
with advancing technology. As the result of
in Orange County, the Department is main-
changes in design, swimming pool regula-
taining public health regulation of experi-
tions have been newly revised. New water
mental methods for controlling sea-water
treatment methods are under study. A com-
intrusion by pumping reclaimed water into
prehensive look was taken at the 13-county
the ground.
Plastics, pesticides, pressure
Nearly every industrial advance has the
over the last two years, there was little or
potential of creating new problems, often
no increase in morbidity and mortality
CRANE SIGNALS
in the field of health. California's 7.5 mil-
among workers using these materials-a
HOIST
LOWER
STOP
lion workers face a complex of old and new
reflection of the impact of the Depart-
occupational health hazards which the De-
ment's educational program and coopera-
partment, through its Bureau of Occupa-
tive efforts of other agencies and the
SWING
BOOM UP
BOOM
DOWN
tional Health staff continually works to
private sector in the safe use of pesticides.
control or eliminate.
Particularly hazardous have been spills of
MAKE
EMERGENCY
MOVEMENT
STOP
These range from such "classic" hazards
toxic pesticides during transportation, in
TRAVEL
SLOWLY
as lead and mercury poisoning, silicosis,
storage, and in fires. These events have a
industrial solvents which produce skin or
SAFETY PAYS
potential for producing unexpected group-
systemic diseases, to permanent hearing
poisoning, as well as harmful contamina-
loss from excessive noise, degenerative dis-
tion of the environment. Accordingly, spe-
eases from vibration exposure, and the bad
cial educational effort was directed to the
effects of working in heat.
prevention of spills. This included the in-
Then there are new health problems such
struction of highway transportation, law-
as those associated with inert gas welding,
lasers, working with exotic metals or with
enforcement and fire-fighting personnel in
plastic materials which, in fabricating
the proper handling of spills and fires and
processes, can be inhaled with permanent
the resulting contamination of persons,
lung damage, pesticides, and hosts of other
materials, and the environment. Physicians
hazards, some of them subtle enough to go
were warned to suspect, recognize and treat
undetected for years.
poisonings, and to insure maintenance of
Despite an estimated increase of 20 per-
adequate supplies of appropriate antidotes
cent in the use of pesticides in California
in all emergency hospitals.
14
Increases in mercury prices which began
in 1963 resulted in greatly increased pro-
duction from California mines. Many
mines were reopened, some of which had
Decompression for sandhogs
been closed for 50 years; and properties
were opened which had never been worked
before. Coincidentally a marked increase
in mercury poisoning cases in both mine
and mill personnel was noted. Department
personnel immediately worked to control
this serious occupational disease. Environ-
mental studies were conducted at 20 mine
and mill operations to identify sources
of mercury exposure and to develop con-
trol measures.
A technical bulletin outlining procedures
and methods for control of mercury ex-
posure in both mine and mill operations
was developed and distributed to all known
producers of mercury. It is still being sent
to newly-opened properties. The medical
staff also issued a bulletin on the medical
supervision of employees engaged in mer-
cury-producing operations. Surveillance of
this expanding industry is continuing.
The Department supported educational
efforts to the local health departments ob-
ligated by law to provide services in occu-
pational health. Technical counsel, advice
and assistance were continued to national,
state and local agencies, professional
groups and individuals, and others con-
cerned with occupational health.
California's "playground" counties
Sewage treatment
a clerk plus office and clinic space and sup-
plant at Lake
County resort.
plies and equipment.
Clear Lake can
This unique State-local partnership has
be seen in back-
ground.
functioned smoothly since its inception. In
1967, the Department was asked to report to
R.E.A.
the State Legislature on alternative plans
The Department's Bureau of Public
for financing public health services in the
Health Contract Services provides basic
rural counties. The report presented seven
public health services to 15 counties, each
different plans with their respective ad-
with a population of less than 40,000: Al-
vantages and disadvantages, and advocated
pine, Amador, Calaveras, Glenn, Lake,
the continuation of the contract services
Lassen, Mariposa, Modoc, Mono, Nevada,
arrangement under Section 1157 of the
Sierra, Siskiyou, Tehama, Trinity and Tu-
Health and Safety Code.
olumne. In July 1967 this was a total of
During the past biennium these trends
220,400, or less than 2 percent of the total
in rural health programs have emerged: The
State population. These 220,400 people live
development and expansion of second-home
in an area that is equivalent to 22 percent
subdivisions have brought the need for
of California's land area-a very important
determining basic minimal water supply
R.E.A.
22 percent because it meets year-round
and sewage disposal facilities. Home health
recreational and "second home" needs of a
agencies have developed in most of the 15
majority in the State.
counties since the advent of Medicare. Since
Services in environmental sanitation,
1966 a central tuberculosis registry has
communicable disease control, school health,
been organized with federal funds. Other
maternal and child health, health education,
accomplishments in this accelerated control
laboratory, and statistics, are supplied by
program have been initiation of additional
professional field staffs in nursing and sani-
chest clinics, consultation and assistance to
tation, working with the counties on a con-
field nurses, improved followup, more skin
tractual basis. This concept of contract
testing programs, all in an effort to eradi-
health services for rural counties, born in
cate tuberculosis from the contracting
1953, allows supervisors in counties with
counties.
populations of less than 40,000 to contract
In addition, field workers continue to
with the State Department of Public
cope with health problems as basic as water
Health to provide local health services,
and sewage, rabies control, incomplete re-
with the stipulation that the local govern-
porting of communicable diseases, handi-
ment financially support the program by a
capped children, maternal and child health,
sum not less than 55 cents per capita per
family planning, chronic diseases, mental
annum. In lieu of cash payments to the
health and the vast gap that exists between
REDWOOD EMPIRE ASSN.
State, most counties agree to furnish the
these problems and the lack of community
services of a part-time health officer and
resources for dealing with them.
197,000 beds
STAFF PHOTO
Existing health care facilities and avail-
facilities in providing the best resources and
able manpower are insufficient to provide
services to meet community needs, and work
California's 20 million people the services
out solutions to changing requirements.
which they require. More facilities and serv-
The Bureau of Health Facilities Plan-
ices are needed to accommodate the annual
population growth of some 600,000. Many of
ning and Construction within the unit de-
the older institutions are becoming inade-
velops state plans for health facilities and
quate and should be modernized or replaced,
administers the grant-in-aid program for
at an estimated cost of two-thirds of a bil-
facility construction and modernization.
lion dollars.
This program has assisted in the construc-
tion of 431 facilities within the State over
High standards for health facilities are
the past two decades.
necessary to protect the health of all citizens
During the 1966-68 Fiscal Years, 96 proj-
and to assure that safe and adequate care is
ects were approved for financial assistance:
available without discrimination. Public
26 general hospitals, 11 public health cen-
and private health care plans and programs
ters, 11 long-term care facilities, 13 diag-
register increasing demands for more high
nostic and treatment centers, 9 rehabilita-
quality specialized services at reasonable
tion centers, 12 facilities for the mentally
cost. Standards for facilities and services
retarded and 14 community mental health
must be continually reviewed and periodi-
centers.
cally updated to recognize and accommodate
advances in health care technology.
The Bureau of Licensing and Certifica-
tion sets and maintains standards for some
Trained manpower in adequate supply is
2,100 health care facilities. More than
needed if facilities and services are to be
162,000 beds in hospitals, nursing homes,
clinics, and establishments for handicapped
CAYTON
available and effective. The health service
industry is the nation's third largest. Short-
persons are licensed. Home Health Agen-
ages of adequately trained professional and
cies, a more recent health service facility,
technical personnel already exist, and in the
are also licensed. State mental hospitals in-
absence of careful planning it does not ap-
cluding 197,000 beds are also certified to
pear that the situation will improve.
participate in the Federal Medicare and the
State Medi-Cal programs. Assistance is pro-
These needs and problems are among the
vided as needed in examining and evaluat-
major concerns of the Department's Pro-
ing staffing patterns, and in providing pro-
gram for Community Health Services and
fessional consultations including medical,
Resources. The Health Resources Unit
hospital administration, nursing, nutrition,
within this program gives direction, coordi-
social services, physical and occupational
nation and consultation to assist health
therapy.
17
No communicable disease has been conquered
Acute infectious diseases affect almost
propriate age groups, to rapid case finding
every Californian each year. They are a
and treatment of infected persons and con-
major cause of lost time from work, school
tacts, and manipulation of the environment
and enjoyment of life. While about 190,000
to minimize spread of infectious disease
cases of notifiable diseases are reported an-
agents.
nually, these are only a fraction of the total
A majority of infections are of the respi-
illness. Substantial under-reporting occurs,
ratory and gastrointestinal tracts, for which
despite legal requirements, and also most in-
effective control measures don't yet exist.
fections diseases are not usually reported by
Other uncontrolled diseases are German
individuals. Deaths due to infections num-
measles, chicken pox, and a number of fun-
ber over 9,000 a year.
gal diseases. Here our objectives are limited
The primary need is to reduce the inci-
to surveillance of occurrence and further
dence of infectious diseases in the popula-
definition of causes and ways they spread.
tion and hold disability and death from
When effective control becomes possible the
these infections to the lowest possible mini-
information now being gathered will help
mum. No infectious disease of man has as
apply and then evaluate control techniques.
yet been eradicated. In some, a significant
Better diagnostic methods and new immu-
reduction has been achieved (poliomyelitis,
nizing agents are needed before a decrease
measles) in others the incidence is steadily
in diseases not now controlled can be ex-
rising.
pected. Poliomyelitis, diphtheria, whooping
In addition to person-to-person disease
cough, tetanus, measles and smallpox are
transmittal, man shares a large number of
under control, and here the aim is to main-
infections with the animal kingdom: sal-
tain the gains, particularly among newborns
monellosis, psittacosis, rabies, Q fever and
and in-migrants. Tuberculosis, syphilis and
brucellosis can cause illness from mild dis-
gonorrhea are only partly controlled and
ability to death in man.
the objective is to direct control measures
The Department's Bureau of Communi-
to the groups most at risk.
cable Diseases attempts to maintain or erect
A variety of methods are used to reduce
a barrier between the individual with infec-
the incidence of infectious diseases, of which
tious disease and his contacts. Communi-
nearly 40 kinds are reportable. The ap-
cable disease controls begin with continuous
proach depends on the illness, its epidemi-
surveillance of illness and death from all
ologic characteristics and whether or not
significant infectious diseases. Methods
universally applicable means are available
range from the use of immunizations in ap-
to reduce its incidence.
18
Continued
Techniques include universal or selected
immunizations, rapid case finding and treat-
ment of cases and contacts, and prevention
and limitation of spread once outbreaks
have occurred. The creation of a healthful
and sanitary environment as it relates to
animal reservoirs, vector control and items
which affect every person, such as food,
milk and water, further reduces avenues of
spread. To control infectious diseases, it is
imperative to know their causes. The con-
trol program depends on the work of the
State's Microbial Diseases and Viral and
Rickettsial Disease Laboratories, as well as
Consultation is provided to local health
on all Public Health Laboratories of local
departments, individual physicians, hos-
health jurisdictions.
pitals or institutions throughout the year
Information on disease occurrence is ex-
on questions of diagnosis and management
changed with other states and federal
of infectious diseases and their contacts.
health authorities SO that control efforts
Plague or botulism, for instance, which are
can be initiated rapidly and the spread of
seen only rarely by practicing physicians,
dangerous diseases prevented.
require expert assistance and the availa-
Rapid investigation into the circumstan-
bility of special laboratory facilities for
ces surrounding epidemics is required for
diagnosis and control.
effective control. Many local health depart-
The information received from the vari-
ments, especially the smaller ones, require
ous sources is brought together, evaluated,
immediate help from State epidemiologists
analyzed and interpreted. The picture thus
to plan, direct and carry out the investiga-
obtained is summarized and distributed at
tion SO that appropriate steps can be taken
appropriate intervals to local health de-
to prevent spread. Epidemics are by their
partments, other agencies, the medical com-
nature unpredictable and staff members
munity and the public. This objective also
have to be prepared to move rapidly at any
extends to the very important function of
time. Laboratory support for investigation
training local health department and other
of individual cases and outbreak situations
professional personnel immediately in-
is required throughout.
volved in infectious disease control.
1
Society must create special learning situations
Mental retardation is the outward mani-
tiated with Childrens Hospital of Los An-
festation of inadequately developed intelli-
geles to serve residents of that county, and
gence due to a wide variety of causes.
Aid to Retarded Children of San Fran-
Children and adults with mental retarda-
cisco, Inc., to serve residents of Alameda,
tion are significantly impaired in their
Contra Costa, Marin, San Francisco, and
ability to learn and to adapt to the
San Mateo Counties.
demands of society. To cope with this
A Regional Center can provide families
problem a society must create special
with diagnosis, evaluation and counseling,
learning situations, modify its demands on
and purchases community services for the
the individual and provide services di-
retarded when such services will prevent
rected at ameliorating the effects of the
hospitalization. The counselors are sta-
condition. There are about 200,000 individ-
tioned throughout the areas and are readily
uals in California who need this special
available to the retarded and their families.
attention. The number increases at a rate
When a family contacts a Center, they
of 0.8% of the annual net population in-
are immediately referred to a counselor
crease.
who discusses the problem and outlines the
The needs of the retarded and their
services available. If Center services ap-
families are as varied as those of any
pear to be appropriate, an interview is
family group and can be usually met by
scheduled. Often the initial interview re-
the same methods as the non-retarded. The
veals that the family does not need Center
Regional Center program was established
services but can be assisted by another
in 1965 by the Legislature to assist families
agency. These are called "information and
who have special needs because of a re-
inquiry" cases. Approximately two such
tarded family member. It is one of several
cases are assisted for every one that be-
programs directed to this group which
comes an "active" case.
includes care in State hospitals, commu-
After evaluation, an active case is again
nity placement and protective social serv-
reviewed by the staff, a plan for the indi-
ices, special education programs, voca-
vidual developed, and responsibility for
tional training, and others.
continuing care assigned.
The Department's Bureau of Mental
Special services can be purchased if they
Retardation Services contracts with local
are needed by the individual. Two-thirds
agencies for the establishment of a net-
of the Regional Center budget currently is
work of Regional Centers, which will make
used to provide such items as general and
assistance available throughout the State.
specialized medical and dental treatment,
During the biennium contracts were nego-
appliances, drugs, psychological services,
20
physical, occupational and speech therapy,
day and nursery school care, 24-hour resi-
dential care, respite care, preschool train-
TO
ing, nutritional services, workshop and
activity programs, and others.
If no services are required or if another
agency assumes primary responsibility, the
case is inactivated, but if at any time the
individual needs further services, his case
is reactivated.
From March 1966, when the Regional
Center began operation, until June 30,
1968, approximately 2000 mentally re-
tarded persons and families have been
provided Regional Center assistance. Of
these 1,003 have been provided diagnosis,
STATE DEPT. MENTAL HYGIENE
evaluation, and counseling service. Of
these 690 have been assisted in receiving
specialized medical and dental care, day
care, 24-hour residential care, and home
care services.
No one who is referred to or requests
gram, and assist facility staffs in upgrad-
services from the Centers is turned away.
ing services and programs.
Everyone is provided counselor assistance,
which may take considerably more time
We emphasize that this is a report of the
than that provided a client who is on the
developmental period. One of the Centers
active caseload.
did not complete staffing until the end of
1966 and the other has not yet completed
The counselors continue also to interpret
staffing. It is sometimes a matter of two or
the Center program to the community,
three months before a counselor reaches
and participate with local planning bodies
an optimum caseload. Therefore, the sta-
to upgrade, expand and develop services,
tistics during this period are lower than
inform providers of care about the pro-
they will be in subsequent years.
21
Family planning for all who wish it
Family planning was made a required
program in local health departments during
1966-1968. Clinic services are now avail-
able in virtually all of the more populous
areas. The Department's Bureau of Mater-
nal and Child Health jointly with the Uni-
versity of California studied the safety and
effectiveness of the Intrauterine Contra-
ceptive Device; and, with the Inter-agency
Council on Family Planning, started a
statewide plan for extended family plan-
ning services to all women who wish them.
It is estimated that 750,000 women now ob-
tain family planning assistance from all
sources.
A study was undertaken to develop a
standard testing procedure of hearing in
newborn infants, to provide early referral
for those children needing care. The 1955
Department statement on the use of oxygen
for premature infants was amended and
medical and health offices notified. The De-
partment has also supported medical dem-
onstration projects for intrauterine trans-
fusions to prevent Rh iso-immunization,
and in neutralizing the effects of Rh blood
incompatibility on new mothers.
Comprehensive health programs for
mothers and infants, and for children and
youth in urban poverty areas were sup-
ported, bringing full range of health care
services to many families not otherwise able
to obtain them.
22
Continued
A new Therapeutic Abortion Law was
passed in 1967, and the Department was
asked to make an annual statistical report
to the Legislature on the number of abor-
tions performed, and the reasons. During
the first two-month period 439 therapeutic
abortions were performed under the new
law. The next annual report will cover the
first year's experience.
Results of a study of deaths from hemo-
lytic disease of the newborn were published
in California Medicine. Findings indicate a
need for earlier and more comprehensive
use of warning signals, as well as a consis-
tent reappraisal of current technology.
The study results were widely circulated
through professional channels.
The Department cooperating with the
tion carried out by indigenous community
California Medical Association has con-
health aides. Although the project has been
tinued to study maternal deaths related to
in existence for only a few months, it al-
childbirth. Each case is reviewed in depth
ready has demonstrated the value of this
by a committee of medical specialists. Find-
approach to community understanding and
ings are used to determine its cause and
support for local health programs.
then to advise the individual physician and
During the biennium, the program for
the medical profession of the committee's
testing of newborn infants for phenylke-
recommendations.
tonuria (PKU) was continued. A registry
With the support of the Division of In-
of 400 individuals SO afflicted has been es-
dian Health, Public Health Service, a spe-
tablished. The program also provides fol-
cial demonstration project was begun in
lowup for persons with confirmed PKU to
nine isolated rural Indian Reservation
determine that proper diets and adequate
areas in California. The objective is to de-
medical attention are provided. The feasi-
monstrably improve the health status of the
bility of mass screening for other heritable,
rural Indian populations in these nine
preventable disorders leading to mental re-
areas through a program of health educa-
tardation is under consideration.
23
Crippled children services
Each year 20,000 babies are born in Cali-
Certain accidental injuries (spinal cord
fornia with congenital deformities serious
injury, burns) represent the highest cost
enough to endanger life or result in life-
per case-not surprising because of pro-
long disability. Other infants and children
longed and expensive rehabilitation serv-
are severely burned, paralyzed or suffer
ices required.
other accidental injuries. Medical science
Some congenital malformations require
can correct or help most of these handicaps.
long-term-occasionally lifelong-attention,
CCS, through its standards and case
particularly children with spina bifida,
management, promotes services of the high-
hydrocephalus, cleft lip and palate, ab-
65,000 important fu
est quality; CCS assists families who
sence of or deformity of one or more
cannot afford the full costs of private
limbs. Congenital heart disease, fortu-
care.
nately, is now amenable to complete cor-
In the 1966-67 period, 65,210 children
rection, surgically. Some other types of
were served by the CCS program, an
heart disease are significantly benefited by
increase of 3,809 cases over 1965-66. Com-
modern surgical techniques.
bined CCS diagnostic, treatment, and
The number of children with neoplasms
therapy program funds totaling 17.9 mil-
lion dollars provided full or partial service
that qualify for care under the program
remains about the same as in the preceding
for 56,411 children. Of the 65,210 children,
biennium: 947 in 1963-64; 944 in 1966-67.
12,725 were also beneficiaries under the
The cost of care was $354,216 in 1963-64
Medi-Cal program. Medi-Cal funded 8,799
and $559,686 in 1966-67, reflecting advances
of the beneficiaries while both programs
in treatment as well as increasing medical
shared in the cost of the remaining 3,926.
care costs.
The leading conditions in terms of num-
ber of children treated continued to be for
Efforts continue to provide the medical
congenital malformations (11,287), of
services needed by each child to attain the
which 7,422 were anomalies other than the
maximum benefit possible. Increasing em-
heart and circulatory system, and 3,865
phasis is being placed on case management
were heart and great vessel malformations;
services as the number of severely handi-
cerebral palsy (6,751) ; diseases of the eye
capped children in the program continues
(5,170) ; diseases of the bone and organs
to grow.
of movement (5,048) ; and accidental in-
Expert care is available, but often as-
juries (3,292). These conditions consumed
sistance to the family and to the family's
70 percent of $16,252,909 expended on di-
physician is required if children are to
agnosis and treatment in 1966-67.
obtain the benefits of these varied medical
24
and related services. CCS tries to provide
this much-needed assistance and followup.
Renal dialysis and kidney transplant
were included as services available to chil-
dren with kidney disease in the 1968-69
budget.
The therapy program for cerebral pal-
sied and other orthopedically handicapped
children continued its unique school-based
program in the 65 therapy units. Medical
supervision and therapy services were pro-
vided for 5,277 children in 1966-67.
The next biennium will see major
changes as AB 2024 (Crown) passed by
the 1968 Legislature goes into effect on
July 1, 1969. These include State/county
sharing of all medical care costs; an in-
crease in the State share of matching funds
from 2:1 to 3:1; establishment of a State
contingency fund for emergency cases in
small counties whose funds have been ex-
hausted; placing of responsibility with the
Director of Public Health for determining
which handicapping conditions are to be
included in the program; mandatory use of
a statewide uniform standard for deter-
mining financial eligibility; and, develop-
ment by the State agency of standards for
local CCS administration.
Provision for uniform statewide stand-
ards for financial eligibility was a major
accomplishment. It was done in coopera-
tion with the counties and will ease some
mutual problems in this area.
A million problem drinkers
Most adult Californians drink alcoholic
alcoholism when the McAteer-Rumford-
beverages. The majority drink in modera-
Marks Act was passed in 1965.
tion, but one of every 12 Californians over
In July 1966 a $1.8 million legislative
age 20 is an excessive drinker, facing seri-
appropriation was allocated to health de-
ous physical, financial and other hazards, if
partments in Alameda, Contra Costa, Los
dependence on alcohol continues. The num-
Angeles, Monterey, Sacramento, San Diego,
ber of teenagers who use alcohol to excess
San Francisco, San Joaquin and Santa
is increasing. About 250,000 people are ill
Clara counties, and the cities of Long
enough at any given time to require im-
Beach and Pasadena.
mediate medical and related attention.
Who are the one million "alcoholics"?
The law requires that 5 specific services
be provided to individuals and 5 to the
Three out of four are men. Half attended
community. For the individual: casefind-
or graduated from college and 37 percent
ing; diagnosis, evaluation and referral;
from high school. Nearly half of the "alco-
acute and continuing medical aid and coun-
holics" are employed in a professional or
seling; psychiatric care as indicated, and
managerial capacity. Thirty percent are
vocational rehabilitation and employment.
blue collar workers and 25 percent white
For the community: public information;
collar workers. Only 5 percent are on
training and consultation, and development,
"Skid Row."
coordination and evaluation of alcoholism
Most "alcoholics" are employed and
programs.
function all around us in society.
Under 1967 McAteer Act amendments,
Alcohol is the drug most seriously abused
the Department and a new alcoholic re-
in California. In 1960, an estimated 800,-
habilitation section in the Department of
000 Californians were problem drinkers.
Rehabilitation developed a cooperative pro-
Now they number one million.
gram on alcoholism. Rehabilitation uses
Alcoholism is the tenth leading cause of
Federal vocational rehabilitation funds
death here. One-third of the deaths occur
matched 3:1 with State funds to purchase
in the "prime-of-life" age group-45 to 54
required services for individuals from local
years. Direct and indirect costs to society
McAteer Act programs.
are conservatively estimated at $1 billion a
The Department directly supports local
year in California.
program services to the community, but
After a ten-year preliminary program,
with minimal funding. During the bien-
California initiated a long-range plan for
nium it is seeking more funds for local al-
the prevention, treatment and control of
coholism services, through Comprehensive
26
Health Planning programs and other
sources.
Although the statewide alcoholism rate is
still rising, the increase was smaller in the
seven counties which form the nucleus of
the present program.
While the 1968 U.S. Supreme Court
Powell vs. Texas decision upheld laws al-
lowing conviction and punishment of
chronic alcoholics for public drunkenness,
the Department anticipates eventual trans-
fer of major responsibility for care for
public inebriates from penal to health in-
stitutions. Towards this end the Depart-
ment is working to open up many addi-
tional resources, both public and private.
In January 1968, the Department offered
the Legislature a plan which details specific
mortality, morbidity, social and economic
indexes, to measure progress in decreasing
the incidence and prevalence of alcoholism.
A uniform reporting system has been de-
veloped in the 11 McAteer Act programs.
It will provide two-year follow-up informa-
tion on individuals treated, and indicate
treatment success, with specific data on eco-
nomic and social benefits to California re-
sulting from treatment and rehabilitation
of alcoholics. The Department is working
toward installing a modified version of this
system in other treatment settings, and also
toward installing a uniform system of mon-
itoring the major factors influencing the
prevention and control of problem drink-
ing.
GGETT
Drug abuse
The Department has long been concerned with and
The Department cosponsored a film "festival" of
involved in California's drug abuse problems and is
movies useful in drug abuse education, and then a
cooperating with the State Department of Education
consultant screened 30 additional drug films. These
to study the attitudes, opinions, and knowledge of pri-
reviews are now being published by the Department.
mary and secondary school students and their be-
A task force was organized to review the Depart-
havior regarding drug use.
ment's authorized activities in this area, and has made
Informational panels have been organized for
recommendations which include epidemiologic studies
of the problem and health effects of drug abuse; de-
county supervisors, schools, universities, law enforce-
velopment of informational materials for professional
ment personnel, and voluntary agencies. A special
and general distribution; evaluation of treatment and
issue of California's Health devoted to drug abuse
rehabilitation programs, and continuing analysis of
was printed in 36,000 copies. Educational materials
legislation to insure that it is consistent with health
have been selected, and distributed to local health de-
goals. The State Board of Public Health has asked
partments, and are available for other groups.
the Department to proceed with their implementation.
Poor diets-brain damage-shortened lives
Malnutrition has serious implications
to the effects of poor food selection:
for Californians. It generates increased
such as those in group care, handicapped
susceptibility to disease, decreased recu-
children, and the long-term care patient in
perative powers, higher absenteeism rates,
health care facilities. For those at home
lower productivity, greater medical care
it has focused on the pregnant woman, the
costs, and impaired morale. Early malnu-
preschool child, the obese person and the
trition results in retarded physical growth
chronically ill and aged.
and development and is associated with
The Department holds workshops and
an increase in infectious diseases and high
institutional training programs to upgrade
infant mortality. Recent evidence indicates
skills of food service personnel. It also
that it may also cause permanent brain
furnishes public and voluntary agencies
damage, resulting in impaired learning and
technical consultation. A plan to improve
behavior. Obesity, the common form of
nutrition services for individuals and
overnutrition, is associated with a short-
groups in California's communities also is
ened life span and with an increased inci-
in effect.
dence of heart disease, high blood pressure,
Preliminary planning has beeen under-
and diabetes mellitus.
way to determine the extent of malnutri-
The Department's Bureau of Public
tion and the factors contributing to its
Health Nutrition has directed its efforts
cause. It is anticipated that field studies
to those who are particularly vulnerable
will be in operation early in 1969.
28
Three million adults have lost their teeth
No tissues of the human body are more frequently
dental care between July 1968, and June 1969. In-
or extensively ravaged by disease and destruction
complete care will do little to reduce the further
than those of man's teeth and jaws.
neglect of the needy, the medically indigent, the
The average California child five years old has suf-
aged, and those treated by local, State, or federal
fered decay in 20 percent of his teeth before he enters
agencies and institutions in our State.
school. The average young person, by graduation
Dental diseases are increasing faster than Cali-
from high school, has 12 permanent teeth affected
fornia's present or projected collective financial and
by decay and already has lost at least two of his adult
professional resources can either correct or control.
teeth. It is well-recognized the poor and the less edu-
We have reached a crisis in terms of protecting and
cated among the public suffer more extensively from
promoting oral health among our population.
dental diseases than do those with better educations
During 1967 and 1968, a considerable amount of
and higher incomes.
attention was given to reassessing the relative role
Periodontal disease (infection and resultant de-
and responsibilities of the Department in preserving
struction of gums and supporting jaw bone) affects
and protecting dental health among Californians.
more than 60 percent of California's older youth and
adults.
With the introduction of Comprehensive Health
The annual occurrence of tooth decay and infection
Planning, (Public Law 89-749) much has been ac-
of tissue supporting teeth among both children and
complished to assist the dental profession and their
adults continues to increase with age, often causing
auxiliary personnel to become involved in planning
loss of many teeth in early adulthood and loss of all
for the improvement of dental health services, dental
natural teeth by midlife. More than three million
health manpower resources, and dental health facili-
California adults have lost all their teeth.
ties in our State.
The oral health of 40 percent of our school-age
Of special significance is the formation, with De-
children would be better protected and improved if
partmental assistance, in 1968, of the Dental Health
interceptive orthodontic care were available and could
Council of California, a voluntary non-profit organ-
be provided.
ization composed of interested citizens and represent-
Death rates from oral cancer (buccal cavity, in-
atives of other voluntary organizations incorporated
cluding lip but excluding skin beyond border of lip)
to protect, promote and improve oral health.
have remained essentially constant since 1950. As
During this biennium, the Department's dental
California's population is increasing, SO is the num-
health efforts have resulted in a notable increase in
ber of people dying from oral cancer.
interest and action among the dental profession and
The expense of providing less than complete dental
related professional and voluntary organizations to
care to California's population each year is approxi-
assist and support both community and Statewide en-
mately $500 million. An estimated $45 million of
deavors to expand and improve the effectiveness of
State and federal funds will be spent for incomplete
preventive and restorative dental health services.
29
The bacillus is becoming drug-resistant
Almost twenty years ago drugs were dis-
have organisms resistant to at least one or
covered which made possible specific treat-
more of the primary drugs. New cases de-
ment for tuberculosis. Here and elsewhere
veloping from exposure to those with drug
there had been a rapid decline in the TB
resistant tubercle bacilli will usually have
morbidity and mortality rates. Since much
resistant organisms also.
seemed to be accomplished by the use of
Results of accelerated control programs
these drugs, program efforts were relaxed
in areas having special projects for the past
because TB's conquest seemed imminent.
four years have been impressive. In some,
Between 1953 and 1961, new cases declined
it has been possible to identify needs of
about 5 percent annually. But between 1963
groups of patients and to meet their needs
and 1967 the morbidity and mortality rates
by establishing decentralized chest clinics.
leveled off.
Tuberculin skin testing in children enter-
The number of new cases remained at
ing first grade, those new to school and
some 5,000 each year with about 600 deaths
adolescents is increasing as a better way
annually-alarming evidence of a general
of detecting TB than the low yield mass
breakdown in TB control programs. State-
X-ray surveys. Since the young child has
wide action, in the form of accelerated Tu-
relatively few close contacts, the source
berculosis Control projects, was initiated
case can usually be found.
in 1963 to reduce its current incidence and
There already is evidence of new cases to
prevalance. In 1967 there was a reduction
be found among the older population group.
of 8 percent in newly active cases and 15
In 1967, 47 percent of active, and 49 per-
percent in deaths under the impact of im-
cent of inactive cases were in persons 65
proved control over the past four years.
or older. Indications are that larger pro-
Factors contributing to the maintenance
portions of older people, especially men,
of tuberculosis as a public health problem:
will develop active TB. Government medi-
Seventy-five to 80 percent of all newly
cal care will pay for outpatient clinic serv-
active cases come from the already infected
ices for those over 65 and persons under 65
pool;
who are medically indigent. It is antici-
Reactivation of previously inactive or
pated that eradication can again be set as
quiescent TB cases, especially old cases
an attainable goal.
never treated or inadequately treated with
With the continued support of the Public
antituberculosis drugs, long recognized as
Health Services and the Federal and
a lifetime threat;
State's Medicare programs, the incidence
The development of resistant strains of
and prevalence of tuberculosis will once
tubercle bacilli. About 7 percent of newly
more wane in California and eradication
diagnosed and previously untreated cases
can again be set as an attainable goal.
30
The tip of the iceberg
There were 72,000 reported cases
of venereal disease in California in
1967 (61,000 gonorrhea; 11,000 syph-
ilis). This is the tip of the iceberg.
The venereal diseases are socially
hidden. At least five times as many
cases (250,000) occur in California
each year. Half of the cases involve
persons under 25. The rate increases
each year and now has reached the
level of a public health emergency.
to assure that every known case is
received literature, heard reports and
Effective, rapid cure for both syphi-
treated and the spreading stopped.
held discussions on the burgeoning
lis and gonorrhea has been available
Still, much was accomplished. The
VD problem.
for years, yet VD is the only medical
special program directed against
A special subcommittee on vene-
condition which has a rising inci-
syphilis saw a consistent reduction in
real diseases was organized by the
dence in face of an effective cure.
syphilis throughout California. Dur-
California Medical Association, and
Human suffering from venereal
ing the biennium more than 16,000
a group of public health physicians
disease is inestimable; its cost to the
interviews were held with reported
who direct VD control programs or-
California taxpayer is staggering.
cases of syphilis and gonorrhea to
ganized themselves into the Venereal
Last year more than $3 million was
reach infection sources. Over 58,000
Disease Controllers Association, affil-
spent for institutionalization of syph-
field investigations located previously
iated with the California Conference
ilitics in state mental hospitals, plus
unknown cases. More than 4,100
of Local Health Officers.
an additional $600,000 in welfare for
physicians, who saw many VD cases,
The State Legislature in Novem-
the syphilitic blind. Venereal disease
were personally visited by VD con-
ber 1968 removed a legal stricture
can be controlled by reaching and
trollers. Nearly 155,000 laboratory
that prevented minors from being
treating the cases before further
reports were reviewed from which
treated for VD without the consent
spread is possible. This has been diffi-
17,800 syphilis cases were identified.
of their parents.
Preventive educational programs
It was a busy biennium for State
cult. Many private physicians have an
enlisted nearly 1,000 school adminis-
and local venereal disease control
understandable reluctance to "ex-
trators; 80 courses and workshops
staffs. California's (and the Na-
pose" their patients by reporting them
for high school and college teachers
tion's) VD epidemic threatens to con-
to the appropriate health department.
were attended by 4,000 school teach-
tinue until sufficient resources are
Yet the confidential interviews of pa-
ers, nurses and administrators. Com-
mustered to mount a major attack
tients and their contacts by public
munity and service clubs, PTA lead-
fully supported by an informed
health VD controllers is the only way
ers and medical society members
public.
31
Indian Health
A new California Rural Indian Health
To deal with these and other health
Project is currently operating in 24 In-
problems the 9 project staffs have sought
dian communities in 9 counties. Following
out and received for the Indian people a
6 months of preparation, the project began
great amount of volunteer medical and
with a training session held the first two
dental assistance. They have obtained serv-
weeks in January 1968 for the community
ices for eligible Indians from social agen-
health workers. Upon returning to their
cies and have provided much needed trans-
respective areas the project staffs began
portation to those with no means to get to
acquainting the Indian community with
doctor appointments or to the hospital.
the project goals, and determining existing
Through home visits and community meet-
health problems. They found that rural
ings the project staffs have carried out a
Indians were often prevented from receiv-
program of health education. A detailed
ing adequate health care because of cul-
health survey is also being carried out SO
tural and geographic isolation, paucity of
that a comprehensive assessment of Cali-
medical and dental care, and poor economic
fornia rural Indians' health needs can be
conditions. Many Indians have serious den-
made. The 9 health projects have been
tal and other health problems. The majority
successful enough SO that an extension of
of rural Indians are plagued by inadequate
the project has been granted until June
water and sewage disposal systems.
30, 1969.
More nurses are always needed
ROUCE
Because of the crying need for more
supplied a full-time nurse to assist them in
nurses, a program to reach inactive nurses
returning to their field. Nearly 1,000 nurses
and return them to practice has been de-
now have received refresher training. Fig-
veloped by the Department's Bureau of
ures are not complete yet on how many are
Nursing, with assistance from the Depart-
working in local health facilities.
ments of Employment and Education, the
Because of the need for financial assist-
Board of Nursing Education and Nurse
ance at the Junior level of the Baccalau-
Registration, the California Western Hos-
reate program for registered nurses pre-
pital Association, and the California
paring for leadership, 1967 scholarship
Nurses' Association.
legislation was modified to accept high po-
The group sent letters to the 30,000 in-
tential applicants in the Junior year, and
active nurses in California informing them
15 scholarships were granted in the 1967-
of refresher courses in nursing.
68 academic year. Of the 43 students who
Over 10 percent of the nurses contacted
have received scholarship awards since
indicated interest in attending refresher
1964, 16 are now in the teaching field and 11
STAFF PHOTO
courses. A Public Health Service grant
are in supervision or administration.
32
Children-reservoirs of epidemics
Pre-school children are particularly vul-
Two major factors are now at work in
nerable to diseases of many kinds, and they
measles control: a new State law requires
often are the reservoirs from which epi-
that all children must be vaccinated or have
demics may spread to other population
had measles before school enrollment, and
groups.
a birth certificate follow-up. Three to five
The Department's Immunization Assist-
mailings are sent to 80 percent of the par-
ance Program assists local health depart-
ents of the State's 350,000 annual births.
ments to sustain Statewide maximum
These not only motivate parents to have
control over diphtheria, whooping cough,
children vaccinated, but give local health
tetanus, polio and measles-all diseases
departments opportunity to follow up, as
which can be kept in check through vaccina-
indicated. Physicians in private practice of
tion. It is anticipated that new vaccines
course provide major contributions to the
for mumps and rubella will be available
immunization programs.
soon for wide distribution.
When mumps and rubella vaccines are
The Department staff works with 30 local
available in quantity, it is estimated that
health jurisdictions and 15 contract county
500,000 to 750,000 doses of each will be
health units serving 80 percent of the
given pre-school age children annually. The
State's population. In 1967 over 2.7 mil-
Immunization Assistance Program has
lion immunizations were given, an increase
proven its capability to coordinate such
of 57 percent over 1966.
massive projects in preventive medicine.
The greatest accomplishment was in mea-
sles reduction. Traditionally this has been
one of the most under-reported diseases.
Whole groups of families would become
stricken, recover and carry on, enduring
measles as an almost inevitable nuisance.
Even so, about 20,000 cases were reported
annually in the 15 years before the intro-
duction of measles vaccine in 1963. Since
then, thanks to intensive work by private
physicians, local health departments and
the Department staff, it now is disappear-
ing. The goal of no more than 1,000 cases
Statewide by 1970 is well within reach.
One
diricking
I
usually far beyond the ability of their mar-
ginal incomes to provide. Because most are
migrants, following the crops from home
Farm workers health service
bases outside California, they are normally
ineligible for county health and welfare
services, and are excluded from the medical
When the citrus trees grow heavy with
care benefits of the Federal poverty laws.
fruit and the field crops ripen in the sum-
In 1961, the Department's Farm Work-
mer sun, nearly 200,000 seasonal farm
ers Health Service Program was estab-
workers begin to arrive in California.
lished to upgrade the living and working
They come from all over the United
conditions of these neglected people. During
States, attracted by relatively high-though
the past two years, the emphasis has been
still often meager-wages and the agricul-
on development of direct medical care serv-
tural industry's urgent demand for their
ices-primarily evening clinics at sites of
services.
greatest migratory worker populations. In
With them come nearly a million depend-
a few instances where this is not feasible,
ents-wives, frequently pregnant; children,
a "fee-for-services" arrangement is made.
needing schooling; infants, requiring day
During the 1966-67 harvest season, some
care and good food for growth; aged par-
14,000 individuals paid 34,000 visits to
ents and relatives, too old and often too
medical care clinics operated under the
sick to work. Many of them speak only the
Department's program. The following year,
original language of California's founders.
some 20,000 people made 41,000 clinic visits.
Today that is a handicap.
Emergency dental care was also provided.
All of these people need decent housing
Fee-for-service visits numbered about 2,000
and health care, social and legal services-
during 1967-68.
34
HARAWITE
The elinics have attempted to incorporate
nance at farm labor centers has improved
both preventive and therapeutic medicine.
markedly, and permanent low-rent dwell-
As more people attend, some clinics have
ings are being constructed to replace many
also added specialized maternal clinics on
dilapidated shacks.
separate evenings.
While the Farm Workers Health Serv-
Community health aides help the clinics
ice Program has made inroads into the
reach deeper among the people. Public
problems of migrants, the future is clouded.
health nurses, whose services must fre-
Many counties offer no medical services,
quently be spread over huge geographical
and many migrants cannot reach those ex-
areas, call on families as well as coordinat-
isting. Perhaps 90 percent are still un-
ing the clinic operations. Sanitarians in the
touched by the program.
local projects promote housing improve-
Moreover, funds are drying up. Federal
ment and maintenance of potable water
poverty aid was discontinued in 1968. Other
supply systems, and enforce compliance
with the Food Crop Growing and Harvest-
Federal support to the program makes no
ing Sanitation Law. However, gross sanita-
provision for expansion or extension. The
tion problems like common drinking cups
voices of migrant workers are seldom heard
and lack of toilet and handwashing facili-
in regional health planning councils. The
ties in the fields still exist.
next two years, therefore, may be devoted
Although new temporary housing units
to phasing out of the current program. At-
have been built in recent years, substandard
tempts will be made to mobilize whatever
living quarters remain an overwhelming
other resources are available, in order to
problem to farm workers. Some families
assure some continuity of services.
continue to camp in the orchards, and along
Meanwhile, the workers themselves will
sloughs and riverbanks. However, mainte-
be busy harvesting our desserts and salads.
Training the poor to help the poor
Each day brings new information on the
by-side with a virtual unemployment crisis
mounting social health dilemma of the poor,
among poverty groups. These manpower
the unemployed, the under-employed, the
shortages impair the effectiveness of all
chronically sick and handicapped. Older
health services. The scarcity of social work
health programs have demonstrably out-
personnel is impeding established health
lived their usefulness in today's societal
plans and seriously threatens the newer
terms. With a burgeoning population and
programs. But these lacks must constantly
rapid increases in numbers of patients re-
be viewed against the need to restructure
quiring care, new health facilities and serv-
current jobs to take advantage of econo-
ices are proliferating. Acute social crises
mies in the use of paraprofessional and of
are erupting across the State, many of
professional personnel. Any action to fill
them rooted in the frustrations of trying to
manpower shortages with paraprofessionals
make use of health services with built-in
must also protect the poor from second
deficiencies that obstruct the needy and
class services and the paraprofessionals
are irrelevant to current requirements.
themselves from dead-end jobs.
Social services that forge basic links in
The objective of the Department's Pub-
the medical care system serving the chron-
lic Health Social Work program element is
ically sick and the poor where continuity
to prevent, reduce or eliminate adverse so-
of care and comprehensive, quality, per-
cial factors detrimental to the attainment
sonal health services are critical, represent
and/or maintenance of an optimal level of
still unmet needs in more than 1200 Cali-
health and a decent level of social function-
fornia health institutions. Among these
ing.
with social programming deficits are:
Thus, a primary task of the Bureau is to
health departments, extended care facili-
provide a statewide network of comprehen-
ties, and nursing homes. Some programs
sive social health services, working with
are quite new: neighborhood health centers
federal, state, regional and local health and
and Medicare, each requiring specialized
welfare and related agencies. It includes
social services aimed at bringing at-risk
planning for the distributing, costing and
populations into practical health care solu-
evaluation of action programs.
tions to the problems of dependency, unem-
Opportunities for attack on social health
ployment and neglect.
problems exist uniquely in the Department,
Directly connected with meeting social
where inputs from social work can be com-
health needs is the problem of health man-
bined with other health skills and knowl-
power shortages, a problem that exists side-
edges. The work also strives to make the
36
most of numerous community service in-
puts. Today fragmented social health care
systems are being mobilized, coordinated
and/or combined into a comprehensive pat-
tern of service arrangements, for which the
Department assists to set standards, con-
duct surveillance, program analysis and ap-
praisal. This tends to correct service pro-
gram defects and makes available, where
it is most needed, decisive attention to the
social forces affecting health.
To improve and increase health man-
power throughout the health services de-
livery systems and to provide health in-
dustry new careers for the poor, a New
Careers Unit in the Bureau was organized
and personnel secured for field training
in 1966 and since then has worked with
of new careerists in health agencies through
local community agencies, civil service sys-
Department of Labor funds. Liaison was
tems and health institutions to assist in the
maintained with the New York University
identification of needs for new social health
New Careers Development Center, and De-
manpower, to define tasks and roles of
partment staff participated in the first
new careerists and to describe the conse-
meeting of the National Council on New
quent new roles of professionals.
Careers in June 1968. Graduate social
Technical assistance in program develop-
work and medical students were trainees
ment, establishment of guidelines, stand-
in the New Careers Unit. Plans for the use
ards and program models, assistance in ob-
of new careerists within the Department
taining funds, and program evaluation was
and for summer employment of youth as a
given to organizations and agencies in Ala-
part of the Governor's effort at new job
meda, Contra Costa, Los Angeles, Santa
creation in public service for the poor was
Clara, and San Francisco Counties. Inter-
assisted by the Bureau staff who also
organizational steering committees for new
served as part of a statewide committee
careers development were begun in these
planning to implement new legislation re-
and other areas. In 1968 arrangements were
lated to use of subprofessionals and volun-
completed, a training plan was designed,
teers.
37
All of US are potential victims
Chronic diseases cause more than 75 per-
pitals with 50 or more acute general beds
cent of the deaths in California and more
to determine the number of existing and
than 80 percent of the days of disability.
planned Coronary Care Units. Guidelines
With each advance in medical science and
were prepared and distributed to institu-
with the conquest of each cause of child-
tions concerned with training of physicians
hood deaths, a new group is added to the
and nurses in the units.
population with chronic disease or dis-
A blood pressure survey of 2600 Alameda
ability. Every man, woman and child is
County residents was completed to deter-
now a potential victim of chronic diseases.
mine the relationship between socio-en-
To reduce their burden, the Department's
vironmental factors and blood pressure.
Bureau of Chronic Diseases maintains cur-
Also, a fact book Cardiovascular Diseases
rent information on the magnitude of the
in California" was published as a guide for
problem and the effectiveness of control
local health agencies establishing heart dis-
measures; identifies biological, physical and
ease control programs. Vascular lesions of
social conditions responsible for these dis-
the central nervous system are the third
eases; offers advice on current preventive
leading cause of death, but little attention
methods, early detection and treatment;
has been given to the study of their impact
and promotes the development of high qual-
on the community. Data were collected and
ity comprehensive services and facilities to
analysis begun for the Alameda County
cope with chronic diseases. Among them
Stroke Mortality Study. A protocol was be-
are:
gun for a stroke morbidity study in the
Chronic hemodialysis centers, funded by
same area.
the State Departments of Public Health
Multiphasic screening programs in lo-
and Rehabilitation, were established in San
cal health departments were encouraged
Francisco and Los Angeles. Each provides
through workshops and conferences which
treatment for approximately 30 center pa-
placed emphasis on community preparation
tients and 20 home patients. Whenever pos-
and followup. Heart sound screening pro-
sible patients and a family member are
grams were developed jointly with the Cali-
trained SO that home dialysis, less ex-
fornia Heart Association to detect school
pensive and more convenient, is provided.
children with previously unknown heart dis-
Hopefully all suitable candidates will be-
ease; approximately 10,000 were screened.
come recipients of a transplanted kidney.
Cost and yield of such early detection pro-
With the cooperation of the California
grams are under study.
Heart, Hospital, Medical and Nurses Asso-
The California Tumor Registry recorded
ciations, the Department surveyed 312 hos-
approximately 40,000 new cases bringing
38
the total to 315,000 with follow-up informa-
air pollution on incidence of lung cancer.
tion obtained on 140,000 patients. Descrip-
The third found that workers handling
tive surveillance reports were prepared and
asbestos have an excess of lung cancer.
distributed to hospitals participating in the
Local health departments were encour-
registry. Site specific cancer studies and
aged to develop cervical cytology screening
the relationship of social class to survival
programs and were provided financial as-
in cancer patients were studied and the
sistance insofar as possible.
results published. Data on 201,560 cases
Criminal action was brought against 19
were submitted to the National Cancer In-
individuals for cancer quackery with re-
stitutes End Results Group and assistance
sultant convictions; two cases were dis-
was given in the development of a new
missed due to prosecution error; warnings
classification on extent of disease. A mono-
to cease and desist were obtained against
graph presenting 1960-65 incidence data
nine individuals.
from the Alameda County Cancer Registry
The Department collaborated with the
and a booklet, "Trends in Cancer Mortal-
California Medical Association in a study
ity, California, 1910-1965" were published.
of professional and personal attitudes and
Reports of three epidemiologic studies
habits of practicing physicians with respect
of lung cancer were published. The first
to cigarette smoking.
showed that an excess of lung cancer in
In cooperation with the University of
older women born in Mexico could be at-
California San Francisco Medical Center
tributed mainly to cigarette smoking and
and funded by the Public Health Service,
that younger immigrant Mexican women
the Northern California Epilepsy Program
had no excess risk of lung cancer and no
was started to provide comprehensive serv-
unusual smoking habits. The second failed
ices, education and followup of patients
to demonstrate any effect of Los Angeles
with complicated or uncontrolled epilepsy.
Continued
39
Military rejectees
The Health Referral Service Program
residential care needs of severely physically
interviewed 75,734 medical rejectees; 91
handicapped persons of normal mentality.
percent were disqualified for physical rea-
Pilot programs in Long Beach and Sacra-
sons. Of the latter, 27 percent presented
mento evaluated their total living needs
documentation of recent care; however 26
and listed services required for each of
percent were referred to local health agen-
115 project clients. Results and findings
cies for care and followup. Through this
were to be reported to the Legislature in
program 7,007 medical rejectees received
January 1969 with recommendations for
care with 47 percent considered "cured" or
meeting their long-term care.
"improved".
A major activity has been in home health
The Human Population Laboratory con-
services. Sixty-two agencies have been cer-
tinued its long range study of personal
tified since July 1, 1966 bringing the total
characteristics and behavior patterns as
to 121. Consultation services are provided
related to disease and disability. From
to developing and new agencies. Workshops
these observations, three reports were pub-
and training programs are conducted for
lished.
agency personnel. Liaison is maintained
In 1965, the Legislature authorized a
with the fiscal intermediaries, Social Secu-
special Handicapped Persons Pilot Project
rity and other government agencies. Spe-
to find ways to provide for the long-term
cial training programs for nurses were
given in the home management of chronic
respiratory disease patients, heart disease
Cardiac intensive care
patients, in home renal dialysis and re-
habilitation nursing. The number of quali-
fied home health aides has increased from
less than 250 in June 1966 to over 5,000.
Practical nurses and attendants were per-
mitted to qualify as Home Health Aides in
two examinations. After February 1967 all
aides have had to complete approved train-
ing courses to qualify. Home health aides
must be certified by the Department.
Homemaker services are SO intimately
tied up with home care they have become a
major concern to home health agencies.
Department staff and the State Depart-
ment of Social Welfare have jointly devel-
oped a system which can serve as a model
for the management of patients in need of
any degree of personal care services.
Continued
renal dialysis
The little picture
Eight laboratory units provide analytic
In performing this function, the labora-
and research support to the Department's
tory seeks to identify the causative agents
various programs, as well as establishing
in various diseases-for example, the par-
statewide standards for laboratory proce-
ticular type of influenza virus responsible
dure, performing individual tests, and con-
for recent epidemics
or the types of
sulting with and training laboratory staff
cold-causing rhinoviruses such as the four
for local health and clinical agencies.
new types discovered by the laboratory in
The work of four of the Department's
the past two years
or the common mea-
sles virus that was discovered to be the
laboratories-Food and Drug, Sanitation
and Radiation, Branch Public Health, and
agent of a slow, fatal kind of encephalitis
Air and Industrial Hygiene-is discussed
whose cause was previously unknown
in the sections treating the programs they
or the virus-carrying opossums which were
found (after study of 473 other domestic
serve.
and wild animals and more than 5,000 ani-
Viral & Rickettsial Disease Laboratory
mal parasites) to be the source of a long-
Some 150 distinct types of submicro-
standing focus of typhus in Orange County.
scopic disease agents classified as viruses
Once an agent has been pinpointed, the
occur in California. They can cause acute
laboratory may be able to devise a means
respiratory ailments such as influenza,
to attack it-for example, as it did by de-
pneumonia and the common cold; infections
veloping an encephalitis vaccine. for horses
of the central nervous system, such as men-
(which may later be developed for protec-
ingitis and poliomyelitis; rash-type diseases
tion of man).
such as German measles which, in pregnant
mothers, may cause deformed babies; and
Laboratory investigative work often en-
various animal- and insect-borne infections
tails development and refinement of new
of man such as encephalitis and Colorado
methods to detect viral diseases. Among
tick fever. They are known to cause some
these have been an improved blood test to
cancers and are suspected in others. (Rick-
diagnose rubella (German measles) in ex-
ettsiae are slightly larger agents which
pectant mothers
and a quicker and
resemble viruses in many ways, and cause
more sensitive way to diagnose a number of
such diseases as typhus, psittacosis and Q-
zoonotic (animal-transmitted) diseases
fever.)
and a new test by which doctors can
Providing laboratory facilities to diag-
quickly tell smallpox from other viral dis-
eases which resemble it.
nose, control, understand and combat these
illnesses is the function of the Viral &
The laboratory also seeks to gain better
Rickettsial Disease Laboratory.
understanding of the nature of certain vi-
42
stalking viruses, microbes and molecules
ruses in order to find out how they may
In addition, the laboratory has collab-
cause disease. Thus it is conducting re-
orated in a heart disease research study
search into the growth patterns and effects
measuring the serum cholesterol levels in
of some tumor-producing DNA viruses,
some 2,000 Los Angeles civil service em-
and the antibody responses of animals they
ployees; worked to develop a rapid and in-
infect (which could lead to a new blood test
expensive method for screening infants to
for diagnosis of cancer)
and examining
detect congenital adrenocortical hyperpla-
the effects of leukemia viruses on the im-
sia, and evaluated new means to gauge con-
munologic reactions of animals
and
centrations of individual amino acids in
analyzing the way a certain tumorigenic
blood and urine.
virus can be altered genetically SO that its
The laboratory performs regular profi-
offspring no longer cause tumors (which
ciency testing and consultation services
suggests that vaccines might someday be
for some 170 local laboratories engaged in
developed to protect against infection by
California's mandatory screening programs
tumor-causing viral strains).
such as Phenylketonuria (to guard infants
against the inherited disease causing men-
Clinical Chemistry Laboratory
tal defects).
The Clinical Chemistry Laboratory was
Microbial Diseases Laboratory
established in 1966 to provide technical
capabilities in support of programs for
Reported cases of gonorrhea in Cali-
early detection, diagnosis and treatment of
fornia increased by nearly 13,000 from 1966
diseases caused by disorders in the body's
to 1967, for a total of 61,000.
chemistry.
In 1965, only about 6 percent of tubercu-
losis patients showed infection by bacilli
The laboratory has begun a broad pro-
resistant to the standard treatment drugs.
gram relating to the improvement of clin-
By 1967, nearly 13 percent had drug-re-
STAFF PHOTO
ical laboratory services including methods,
sistant infections.
Rubella viruses
evaluation and improvement of quality
In 1964, there were only 16 reported
control and proficiency testing procedures
cases of malaria in California. By 1967,
in the areas of clinical chemistry and hema-
with more and more servicemen returning
tology. This program has included ex-
from Southeast Asia, there were 266 cases.
amination of procedures for analyzing
Developing and improving methods to
hyperbilirubinemia in newborn and other
diagnose, prevent and control these fa-
infants, comparisons of methods of anal-
miliar-but still dangerous-infections are
ysis of serum iron, calcium, glucose, choles-
the major functions of the Microbial Dis-
terol and other serum constituents.
eases Laboratory.
Continued
43
with microscope and test tube
In the attack on venereal disease, for
Laboratory Field Services
example, the laboratory has investigated a
Laboratory Field Services is the Depart-
new test for syphilis, the FTA-ABS test,
ment's liaison with hospital, health depart-
and found it sensitive and reliable. Re-
ment and clinical laboratories, blood banks,
search has also been undertaken into the
animal care facilities, tissue banks, and
sequence of antibody development in rab-
biologics producers. The Services act to
bits experimentally infected by syphilis,
maintain high levels of proficiency and
and the effects of treatment on the early
operation in accordance with pertinent
antibody response of humans. Results in-
Federal and State laws.
crease knowledge about the immunology of
the disease and are helping in the inter-
Of some 1,500 licensed clinical labora-
pretation of serologic (blood) tests.
tories in the State, about 600 have been
approved for certification to serve Medi-
The agents of tuberculosis, diphtheria
care patients. These account for more than
and various kinds of food poisoning have
20 percent of all the approved laboratories
become more difficult to recognize as new
in the nation. Some 300 of these were re-
strains develop. (The laboratory has identi-
quired to participate in regular Proficiency
fied three new types of salmonellae, which
Testing Programs authorized by the De-
taint food.) Malaria, a disease once almost
partment.
eradicated in the United States, is on the
Academic requirements for responsible
rise-with consequent risk that cases may
laboratory personnel have been raised, and
go undetected or be misdiagnosed because
their practical training reviewed with
of unfamiliarity.
greater frequency. A master's degree is
Thus a major thrust of the laboratory's
now a licensure requirement for clinical
efforts is aimed at improving the compe-
laboratory bioanalysts.
tence of local laboratories-in identifying
Because viral hepatitis from donated
disease bacteria and in adopting the most
blood is an increasing problem, blood bank
reliable and useful tests and procedures.
methods for questioning prospective donors
However, its main workload consists of
have been tightened. There is no known
reference and consultative services to clin-
test to detect hepatitis carriers. Also Fed-
ical and public health laboratories as well
eral funds have been used to conduct work-
as doctors in thinly populated areas of the
shops to keep technologists up-to-date in
state where public health laboratories are
compatibility testing of blood donors and
not available.
recipients.
Competent professionals
and an informed public
In the pages of a scholarly journal,
the growing demand for skilled pro-
voluntary and private-and the serv-
a scientist reports his subtle new find-
fessionals in California's total public
ices they provide.
ing about the chemical behavior of a
health system.
virus. Within months, other scientists
Education motivates, and its end
use this clue to create a vaccine which
During the past two years, 107,326
product should be action. This may be
may save thousands of lives.
man-hours of training were offered to
a one-time thing, such as receiving an
7,170 California health personnel by
immunization or casting a vote for
Today, the time lag between med-
the Department. In addition to those
fluoridation. Or it may involve a dras-
ical discovery and widespread prac-
programs supported by State funds,
tic change in life-style, such as giving
tical application is shorter than ever.
many were made possible through
up smoking, or abandoning old die-
But ancient diseases will yield to
Federal short-term training project
tary practices, or following the regi-
modern techniques only if the health
funding.
men a doctor has prescribed.
professionals who serve the public
keep pace with advancing knowledge.
A "wonder drug" would be of
The public is continuously bom-
little value if only a handful of doc-
barded by false advertising and the
The Training Office (Bureau of
tors knew it existed. Similarly, what
claims of health quacks. Legislation
Manpower Management and Develop-
is considered by highly trained pro-
alone cannot eliminate these costly
ment) provides training support for
fessionals to be good health practice
frauds. Health education may pro-
all Departmental programs, and works
is of minimal usefulness unless it is
vide the necessary armor of knowl-
to insure effective employee develop-
translated into action by the individ-
edge and motivation.
ment and high morale. A continuing
ual citizen and the community.
training program is conducted to meet
The Department's education activi-
specific needs, to update staff technical
The necessary ingredient to promote
ties fall within five major categories:
competence, and to provide a broad
such action is education. The objective
operation of a communications center;
base for professional growth.
of the Department's Bureau of Health
design of educational components in
Education is to incorporate effective
State health programs; technical as-
The training needs of local health
teaching and communication methods
sistance to local agencies; setting of
departments and related agencies are
into each health program conducted
standards for health education prac-
also determined, and specific pro-
in California.
tice; and promotion of interagency
grams designed to serve their staffs.
coordination and cooperation.
Health education helps Californians
Additionally, the Department must
to use existing resources. It makes
analyze and develop overall Public
understandable to the population the
Health Manpower programs to satisfy
nature of health agencies - official,
45
SPECTRA
WEBER
Record to read-out in record time
Computer circuits in the Data Process-
With the installation of a new, sophisti-
ing Center of the Office of Special Services
cated computer in 1967, the Data Process-
(formerly the Division of Research) hum
ing Center has significantly accelerated its
24 hours a day, recording, sorting and an-
information-handling capabilities. This, in
alyzing the mass of health information
turn, has lowered costs. The Center has
which flows through the Department from
also developed a do-it-yourself computer
every corner of the State. Statisticians and
behavioral scientists from this office are
program which enables statisticians to
tabulate data and edit their files in less
also available to offer technical expertise
than 24 hours-without the assistance of a
in the planning and interpretation of re-
search projects.
programmer.
Recent statistical consultation has ranged
Under the Department's Epidemiology
from preparation of a research proposal
Research Training Project, supported by
for the study of smoking among schoolchil-
funds from the National Institutes of
dren
to analysis of water potability
Health, 62 medical students received sum-
as a function of dissolved mineral salts
mer experience in methods for studying
to a review of methodology in blood pres-
sure studies
the occurrence of disease in the community.
to analysis of electron
microscopic counting procedures.
They were selected competitively from
Behavioral science consultations have in-
more than 600 applicants. Additionally, 18
cluded teaching and assistance in a train-
physicians participated in a Public Health
ing program for Indian community health
Residency Training Program in 1967 under
aides, and help in drawing up a program
which they received supervised experience
to train ministers who must deal with the
in administration in local health depart-
problems of alcoholics.
ments.
Keeping tabs
Registration of the State's vital statistics
is a responsibility of the Department. It is
a duty which, appropriately, can be sum-
marized in statistics:
During 1966 and 1967, some 1,652,000 rec-
ords of births, deaths, fetal deaths, mar-
riages, divorces and annulments were reg-
istered. Another 102,000 ancillary records—
adoptions, name changes, corrections and
the like-were reviewed and accepted for
registration. About 3 million certificates
and verifications were supplied to individ-
uals requesting them from the State and
local offices. More than 500,000 records were
analyzed by qualified investigators. And
some 1.4 million vital events were reported
to the National Center for Health Statistics
for inclusion in national vital statistics.
The 20 million records now on file with
the Department-reaching as far back as
1905-are utilized for a number of impor-
tant health-related studies. Some of the
most recent include:
Analysis of death records from 1959
through 1961 in an attempt to find occupa-
tions carrying high risk of mortality.
Analysis of records of twins born be-
WEBER
tween 1905 and 1964 in search of possible
genetic influences in heart disease and can-
Under a new divorce reporting program
cer.
established in 1966, California now has the
Compilation of a file of births and fetal
most comprehensive basic vital statistics in-
deaths from 1950 to 1964 in which congeni-
formation on divorce in the United States.
tal malformations were reported.
A 200-page description of social and demo-
Matching of current infant death rec-
graphic characteristics of those who seek
ords with their birth records to permit
divorce was published by the Department in
quick follow-up studies.
1967.
47
California 2000 A.D.
Between 36,000,000 and 41,000,000 peo-
ple.
At least 226 for every square mile of
mountain, valley, desert and shore.
Nearly as many as now live in Denmark,
Norway, Sweden, Finland and Canada-
combined.
That, according to State planners, is
what the population of California will be
by the year 2000.
The keys to the State's explosive growth
are migration and fecundity. During the
current five-year span, 1965-70, births are
expected to fall off slightly from the 1.9
million recorded in California from 1960
to 1965. But then they will begin a dra-
matic - and apparently irreversible - ac-
celeration: about 2.4 million new babies
between 1970 and 1975; about 3.2 million
between 1980 and 1985; about 4 million
between 1995 and 2000.
If the influx of migrants lessens, and if
the birth rate can be kept somewhat lower
than this, it may mean a difference of as
many as 5 million people by the turn of
the century.
Nevertheless, even the lowest prediction
calls for California to double its popula-
tion within a scant 35 years. The growth
rate will far exceed that of the rest of the
Nation. By 2000, one of every seven Amer-
icans will live in California (about one in
ten do now).
The estimates, of course, bar earthquake,
deluge, revolution or major war. And they
presume that our already crowded, noisy,
polluted environment will still be worth
living in.
Trying to insure this is what keeps the
Department busy.
THE DEPARTMENT STAFF
Top row: Peter K. Mueller, Ronald M. Wood, Wm. Burton, DDS; John R. Derry, Wm. R. Gaffey, Philip K. Condit, MD; Stephen F. Gibbens, Robert R. Johnson, MD; Edwin W.
Jackson, MD; Thomas H. Milby, MD; Joseph V. Thom, John M. Heslep, Richard F. Peters, Charles R. Gardipee, MD.
O'DELL
Middle row: Loyd Bond, MD; R. L. Magoffin, MD; Paul Shipley, James Bell, Esther Spencer, Edna Brandt, Jessie McClay, Nancy Allen, R. C. Kimball, W. E. Laymance, S.
Kinsman, MD; H. Ongerth, A. E. Greenberg, T. A. Montgomery, MD; R. Paffenbarger, MD.
Bottom row: C. A. Bost, MD; W. H. Clark, MD; W. E. Kendall, G. F. O'Brien, MD; L. Hertz, MD; W.A. Longshore, MD; H. C. Pulley, MD; L. F. Saylor, MD; R. G. Webster,
V. Vandre, H. L. Bodily, H. A. Worley, R. W. Britting, R. H. Smith, F. W. Hartmann.
All photographs in this issue are by Phiz Mozesson, except where otherwise credited.
PHOTO CREDITS: 4, George Steel; 16, Redwood Empire Assn.; 21, State Department of Mental Hygiene;
32, Helen Rouce; 35, Howard Harawitz; 38, Visiting Nurse Assn. of San Francisco; 40-41, S. G. Ehrlich;
46-47, David O. Weber; group photo, Larry O'Dell.
STAFF FOR THIS ISSUE: Emerson Daggett, Managing Editor; Anitra Hurley, Assistant Editor; David
Weber, Editorial Consultant; Bella Cayton, Production; John Baldwin, Hazel Anderholm, Artists; Gladys
Sheppard, Betsy Stewart, Circulation.
Entered as second-class matter August
15, 1965, at the Post Office in Sacra-
mento, California, under the Act of
August 24, 1912. Acceptance (or mail-
ing at the special rate) approved for in
Section 7103, Act of October 3, 1917.
GOVERNORS OFFICE
PRESS SECTY
STATE CAPITOL
25449
SACRAMENTO, CALIF,
95814
Thousands of animal tumor viruses
line up in crystalline array inside the
nucleus of a single infected cell. Having
borrowed the cell's metabolism to repro-
duce, they will ultimately kill it. These
adenoviruses are magnified 29,250 times
under a Department electron microscope
in cancer research.