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Portland State UniversityPDXScholar
Dissertations and Theses Dissertations and Theses
1972
An Approach to the Decentralization of Health Care Services inMultnomah County OregonStephen L R CookPortland State University
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Recommended CitationCook Stephen L R An Approach to the Decentralization of Health Care Services in Multnomah County Oregon (1972)Dissertations and Theses Paper 1603
1015760etd1602
AN APPROACH TO THE DECENTRALIZATION
OF HEALTH CARE SERVICES
IN MULTNOMAH COUNTY OREGON
by
STEPHEN LR COOK
and
ROGER GEORGE PHILIPPI
A report submittedtn partial fulfillment of the requirements for the degree of
MASTER OF SOCIAL WORK
Portland state University 1972
ERRATUM
AZZ pages are intact but foZZowing Page 57 the
pagination is in error due to omission of the
number 58 in the series
I bull
TABLE OF CONTENTS
INfROOOCTION 1
PART I 5
Tbe Concept of Compreheuiva Health Care 6
ThemiddotCoapreheDsiwmiddotXeigbborhood Health Center 9
Efficient Use ofmiddot Scarcemiddot Resources 19
SUmmary aDd Conclusions 26
PART II 34
Demographic Data 37
Per Capita Incoe by CensuS Tract 38
Mental Health 40
Family Pleuning 41
Pub11c Health Hurs1Dg Vjsits 43
VanerealDisease 44
Tuberculosis 45
CHARTS 48
~ 65
)
JNIRODUCTION
In the past several years the subje~t of health care
delivery has assumed increasing importance asa public issue
Congressional hearings public and private commissions and
task forces have investigated the functioning of the health
care system in depth reporting that access to the system
is impeded by financial barriers and by inefficiency of the
delivery system (8p1) 1 Medicare and lled1caid have
attempted to surmount the financial barriers for some segshy
ments of the population and more inclusive health insurshy
ance proposals are being considered in Congress The
Healthright program tmd~r the Economic Opportunity Act
has stimulat~d efforts to improve the delivery system as it
relates to low income persons and some of the health
insurance proposals also have the goal of improving the
delivery system
The Task Force on Organization of Community Health
Services in Health Admin1stration and Organization in the
Decade Ahead (25p13) briefly presents four interrelated
concepts which form a framework for looking at health as a
l Numbers in parentheses refer to bibliography at tne
end of Part I
2
middot$
contemporary policy issue
1 Health is a resource for the social and economiC development of the nation as a mole
2 The healthand social needs of the indishyvidual in modern society are Ulti~atelyinseparable thus the presence of indenti shy
tiable poverty as an adverse influence on health progress and improvement and equally the condition of 111 health will tend to interfere with the individualts ability to function and beproductive~
3 The concept of public health in today s world has begun to expand markedly moving in the direction of convergence withprivate medicine and voluntary efforts these spheresbeing included in the broader term ttcommushynity health
4 Thereex1sts aninescapable interdependence-shycommunity state and national--in the adminishystration and organization of community health services
Obviously the health care system is one 1hich has
many aspects bull Although these aspects--financing manshy
pow~r service delivery~are interrelated we intend in
this report to deal specifically with one facet This is
the decentralization of health care facilities to provide
comprehensive health care services at the local level
The report is presented in two parts The first
part will examine the literature relating to the developshy
ment of the comprehensive neighborhood health care center
as a means for the delivery ofmed1cal care services An
attempt will be made to determine from the health literashy
ture criteria for the evaluation of medical care systems
and further revie of the literature 1111 attempt to
3
determine how these criteria can best be met in a
decentralized medical care delivery system
The second part of the report will examine the health
needs of Multnomah County Oregon with the goal of
providing information about theseneecis for use in health
serv1cemiddotplanning particularly in relation to the
decentralization of health care services
I ltllYd
-
5
~E
Evaluating the Health em Sxatem
~ (8 pp1-2) has 1nc11cateda number of the weakshy
nessea of thepreaent health care system in this nat1on
She c1 tes risDs coats iDadequate pooriy distributed
and 1rietf1ciently utilized manpower andtrapented
service delivery a8 ma3or problema and state that The
systeiD 1swaste1ll otreaourcea andfunctions W1th too
11ttl reprd tor U1ci8Dcy aDd aCoDOIIIY
Shepo1Dts out
hoWever tbattbere are tour points regard1ns reform Upon
which there is widespread agreement Firat she states
IIaccesstoneede4 health emces must not be 1mpeded by
t1DaDcial barriers II BersecODd POint1s that bull bull the
continuoua health sernceare eftryw2ere ava1iable under
cond1t1ons that are physically conveDient comfortable
anclnot destructi to the d1lD1ty or selt-respectof the
recip1ent b1rd it is essential that the health care
syst8lll Iie due reprd to ecODOIIIY 1D the use of scarce
resources providtDg services with eff1ciency Finally
the system must be accoUDtab1e to those who tiDance it
and to those who 11IIe 1t and in particular must be highly
responsiva to the interests of coD8Ulll8rs II
Gre8Dlick (18 p756) also prQPoses a set of princ1shy
ples which can be used to naluate the ed1cal care
system ae states tint that bull bull all those who need
medical care shouldhave equal access to 1t second
(
6
bull bull the sernce prortded ahould be precisely approshy
priate to the pat1entl1eedemiddot ft and tb1rd bull bull the
med1cal care ayatea ahould provide the lOst eff1cient
and econoa1C8l use of scarce IIe41Cal resources
orthepurpoesof tb18 report certa1not these
crtteXaw1l1bestreaae4 lION tbaD others The rema1llder
of PaXt I Will renew the l1teraturerelating to the issuee
ofcomprehenaivene8sof ervice access1b111ty ot serv1ces
aDdett1c1ency oten1ces 111 tbedel1very ofdecentralized
medical car
ratCopcept of C_ Beal1h care Asd1oal tecmolol1 bas advanced a process of
evolution basoccurred inthe aed1cal and health t1elds
As JOhDsoD (21 pp~361-363) etamptsmiddot bull the goal of
healtb carelD our society baa evolve4trom rel1ef of
ajmptolU to ~ otdi toex1steDce in a potent1ally
diseaselessstate C1t1Dl tbelJm1 tat10DS in health care
resources and presenttechnololY he cont1nues to state
that The resulting cbal18D1e facing the Amer1can health
serncesystem is to provide each 1D41Y1dual with the
sreatest possible opporturnty toach1eve an optimum level
of phys1cal Jl8Dtal amd so()1alwall be1Dg
to
reter to the type othe81th care aystemwh1ch attempts to
answer tb1s cba]] and fult111 the three principles of
1
access1b11it Prov1UOI1ot appropriate services and
eff1cient use ot middotre80urc He state that a IYStem ot
comprehensive healthmiddotmiddot care 1DmiddotoXder to apIo middottbe stated
principles fD lleetiDlita 1Oalttst havemiddot certain
attributes
1 middoteare utdbeollW~ItaC1~orpn1zatlOM]ec ~ bull p~~ol1calbarriers IlU8t be removedbull
2 bull Care abould ace he~ecl1merlt8 ot distance residttiiCemiddot tille must be removed
middotcare8ho1ll411eC-r0WIZ the Ufemiddot span it diseases eapec ychronic are to be controlled betoretheybecome disabling or lite threateD1Dg
4 CeresboUd be~teJ1nCludlJ1C p~vention cure ma1ntiDiiCeand rehabI11tation
5 Care aho11l4be~i9_ttIa1t1ephyaiolol1ca1 aD4 pay1Fci1~cTrIS-ticot the pat~ent
6 Care aboul4 middotbe9L~ tJwrefore shouldbebu11t aro~ middotslJOc1al1natltutloDs which relate to the patients Way of lite suCh as middotthe home school and place of work
7 bull Carellbolld be m-ar and therefore shoUld bemiddot provIded ~Wliils where responsishybiUty tor the patient bas beendetem1nedauthority has been delqated and a communishycation syst_ provided
s care slIould 1Ie HIl 1nclud1Dg theintesratlon ottac1~1ts~ ~prsOllDel neceaary tor modern medical care
9 bull care dbe Of hip ~ eresboul Th ahouldbe aD adequate audit 0 care pee~ reviewcoDtlDUDI naluatioDBnd research intomiddot adequacy aDd quality
Ult1ately as 1Dd1cate4by the Nat10Dal CollllDisshy
8
sion on ColDJIIUUity Health Service (26 pp 1~20) the
c1evelopmezat of a ampyt of comprehensive health care is
a cOlDJIIUUityw14ere8pODSibilit1 1nvolviDS the integrashy
tion of all the health care facilitie and programs in
the cOlDJIIUUity or the c0arcm1ty8 healthc~ system
the PamprqlOIIlt goal ~
PrQv11~ of a ~rehive ~e 9tcoaaun1ty health aervicea
2 Ma1DteIlace ot aD a4equateqUaDtity ot al~requ1re4 health care facilities
Iritsrat~oDof ~v1c1ualUD1ta and s1steas ot bealth aerviceinto a coordishy
natedpattem ot continuous care tor theindiVidual
HoWYer aYerby (37 t pp71-72) 1Dd1cate the
med1cal and health care 81atmiddotaa it ball t1nct1oned haa
not facil~tate4 the delivery ot COap~usive middothealth
care IDcl1Y1c1ualhealth care facilitie themaelve havemiddot
notg8D8nally tuDcU0Af4tOach1eve tbi810al pUblic
health departaent 11) prond1q prev_tive services and
$1Ch trea~t activities aa are involved in venereal
disease or tuberculois control have in general avoided
1Dvad1Ds the curativedoma1Dotprivate mediCine Th1s
haa even been cabullbull1DareaawherelI~cal care is not
readily availa)le except throUlh hoepital outpatient departshy
lDent8~ Aa he 81IIet mothealth departaaents have tailed
to proVide an adequate _try point for the patient 1Dtothe
diapoatic and curative a bull t of tile health care aystell
This may be particularly true tor the pOOr patient who may
9
b_dloallYUDaoptdatlcaW4lberefore th past decade
babullbullbull~ bull lIOYeaeftt to evolve DfW torms ot health care
and new types ot health oare institutloDS providing
comprehensive oDlOiDI care rather thaD trapented care
There seems to be little dispute in the health
aboe requ1res both an lDtesratloD ofprev1ously uncoo~
ditultec1 health care ervlcbullbull brlDSins tolether into one
alency what Johnaon (21 p362) reterred to as bullbullbull the
concepts ot cOllPrehms1veIled1C1ne andpos1tlve health
andaporpph1cclecctrailzat1on ot ervlce dellvery
he NatlODal CoimD18810D0D CouD1ty H_81th Services
report Health Care gilitis (26 p37) suggests
proYic11Dl compreheDaive health care services by centrashy
llz1Da a varlet ot publlc and prlvate healthcare
tacllities 1ntohealtb campuses However as Kahn
(22 pp274) states amppeskin ot soclal servlces in genshy
eral bullbull bull if the loal ls to develop a service-delivery
approach that improves access taclltates teedback 80 as
toadapt to user preterence8nd prlorlty and maximizes
case 1nteptatlon aDd accountabl11ty the base of the
total 80clal service system Should be tnthe nelSbborhood
Dec~tral1zatloD not only makes services IIOre accesslble
but allows therv1ce to be tailored to the Deeds of the
10
areaDe Diaz (14 p3) indicates the importance of
being aware of groups in the neighborhood with special
health problems such as elderly people or large families
witb yOlmg children This means that it is important
in planning to be aware of the demographic features of the patient population This will be considered more
thoroughly inPart II of this report
Kahn (22 p275) continues however to indicate
that more than the improvement of service usage is I
involved in decentralization and that decentralization
ot service delivery also represents part of tI a general
search to break down cities to human scale for some
purposes on the assumption that people find it easier toshy
relate to a neighborhood orsection and to its populationbull
bull bull bull Thus the organization of services at the neighshy
borhood level bas the added purpose of contributing to
the search tor neighborhood n He adds that this process
i8 more relevant it there is a measure of local control
over as well as local availability of services
Kahn indicates that decentralization is not a
viable goal in some circumstances These include situashy
tiona in wh1chthe need for a particular service is too
TJI t
-
11
little to justityits proVision in a l()calun1t where
skills or resources are too rare to be provided locally
or where the costs ot decentralization vastly outweigh
the benefits He Visualizestheult1mate emergence ofa
h1erarcb1c81 patternofserv1ce delivery tnwhichcertain
services andresp0D81bilities are middot1ntegrat8d1Dto the
collimun1ty at thelooal level Other more specialized
services relate to larpr un1ts of the colDlllUD1ty such as
eomb1nationa ot neigbborhooc18 Veryspecialized services
are to be delivered at city countystateop regional
level8 fh1slevel would al80 be the seat ot prosram
coord1zaat1on staDdardprotection and evaluation 811
of which call for cons1deZable centraliZation for overall
program adm1 nlatrat1on(22 p275) AlthoughKahnt s
model was not developed specltlCally tor health care services 1t1s quite relevant- and appliCable to health
care service delivery systems
Omiddot Donnell (27 p3) reviewing the 1iterat~e on
service delivery and social action through neighborhood
service centers preseJJbB a list of characteristics
generallydesirable in ~eighbOrhood service delivery
centers Firsthe states that the center should be
accessible It should be in a physically convenient
location and should be open evenings and weekends as
well as providing at least em~rg8ncy telephone coverage
t
~ II
12
24 hours a day
The center should als~ be irDmed1ate in 1ts funcshy
tioning That is the centermust have the capacity to
provide prOmpt efficient service and should be able to bullrespond to problems middotwithout long hours ofwalt1ng and
many rounds of apPointments
The centexsservices should be 6omprehensive liThe
center should offer a full range ofusable oil-the-spot
services or easyaccess to other resources by available
transportation It should gear itself to the needs that
peoplehaV8-especially poor people-and provide for the
slmultaneoushar1d11ng of problems were possible
SerVices should 8180 b 1J1tegrated and coordinated so
thatseMces can more effectively be provided
The operation of the service center should fInally
be responsive to the needs and desir-es of the neighborshy
hood It should provide ways in which reSidents can
shape th~ program and continue to contribute to its course
and development It should be relevant and ready to
respond to changing needs II
The concept of the comprehensive neighborhood health
center developed by OEO (31 p324) has been described by
severalwriters Yarby (37 p73) describes it as an
outpatient racility which has certain def~n1te characshy
teristiCS middot1 Accessible to a poPulat1on concentration
bull 13
2 Open 24 hours a day seven days a week 3 Family-centered c~e by a team of lnteniists pediatricians clinical and publichealthnurses and social workers 4 Availability ot frequently~requ1redspecialist in such fieldsaspsycbiatryobstetrics gynecology surgerY5 Con~1nu1tyof doctor-patient relationshyship 6 Family records with social and medical ~raquomDaries of relevant information about each family member 7 Basic diagnosticlaboramptoryand x-raytacl1itles and drugs and biologicalsavailable atthe center 8 Directline (1)y center-controlledambushy
lance when-necessary) to ateach1nghospltaifor cl1agnostic ~d therapeutic servlcf)srequiring the fa011itlesandpersonnel of thehospltal 9 Patient-cantered and eommUn1ty-oriented -
The range ot services in the comprehens1venelghborshy
hood health center shouldbe as complete as possible
inCluding preventivediagnost10 treatment and rehabi-
litative services and Sbouldbe deslgnedto eliminate
episodioandfragmented services (31 pp324-325) Schorr
and English (33p291) add as additional characteristics
ot the compr8henslveneighborhood health cent~r that it
should ~ve intensive participation by and involvement
of the population to be served both in policy making and
as employees and that it should be fully integrated with
the existing health care system The Office of Economic
Opportunity (28 p63) stresses the potential for easing
health manpowershortage$by trairiing local neighborhood
reSidents as non-professional health aides at the same
time creating new job and careeropportunitles As
14
Gordon (16 p bull 422) indicates Many of the outstanding
problems in medical practice todayrevolve around
effectively motivating the patient and the prospective
patient to be concerned with his health This is
especially true in a deprived environment The community
health center with its technique ot consumer partici
pation maybe a way to create this cooperation effectvely
It is important to note at this point that the
comprehensive neiShborhood health center haaas its
constituency an integratedmiddot community r~ther than a
particular segment It should haveas Blum and Levy
(6 pp~5) indicate a horizontal rather than a vertical
relationship with the commuriitybull The vertical relatlonshy
ship they state is characteristic ot those service
organizations wh1chapproach the community only in terms
of their own fUnction Tbey see only their relationship
with the users of their service and assume that problems
of accountability will be handled by these consumers
However they pOintout this ienot likely as a vertical
approach creates dependency onthe institution Agencies
in a horizontal relationBhllp recognizetha1 they have
both acommunityand a consumer to serve The horizontal
approach places the matter of accoUltability on a broader
basis than just the involvement of the consumer De Diaz
(14 p4) speaks otthe need to ~develop a community
facility which difters from a clinic for low income
1ji ~
15
people in that it should serve an economically integrated
community The reason for this is that a wide variation
of consumers may assure a better quality of care
The advantages of the comprehensive neighborhood t
health center over traditional systems of providing
commuruty health services are numerous Hospital outshy
patient departments a major traditional source of ambushy
latory health c8refor poor patients have been indicted
for neglecting preventive health care ~romoting fragshy
mentedeare and subjecting patients to degrading and
impersonal conditions to mention only a few of the major
defects (31 p324) Another defect has been the
tendency to shunt low income patients back and forth
between different cliniCS often at different locations
arid with differel)t open hours for different treatments
or tests in regard to the same lllness(26 p63)
The comprehensive neighborhood health programs that
have been organized present a great variety of organishy
zationalpatterns one area of difference 1s in the
emphasis placed upon making each faci1ity comprehensive
in the services it provides to the patient population
In the Montefieri Hospital Neighborhood Medical Care
Demonstration program in New York City services have
been made available through a central health center and
two store frontsatellites the center to be the base
bull
Li
l of opratiol18 of ta1lJpIlflicl- ancl the satellite
center the ba of oparat1oDa of public heaJth nurses
an4 nllbborbood amp1 be satellite centers wereto
proVide preVentift tutaltll bullbulln1c1-m1zaticms w811shy
baby care per1od1c ~ectiland tJle central health
center to proViAle care tor illnes If (36 p299)
bis propWI VUDOt ~ttullytunct10DIDI at the t1JDe
it d1cu8ae4 18 tbe Uterature aDd all aernce Were
be1Dl provided 1D_~terBowever itwould ae
tbat the ntua1pro~ as aY1ioae4by its plmmers
would boclJ aoaeot bull 4efeot~ otthe current lud1cal
ccde teaIt pObullbulllne_t coorctJl8td admSDtshy
etration eD4 well 4eftlopecl refelTal procedtlreacould
1I1a~ thecOllDeCticmof t~_t8 withappropr1ate preTellshy
t1 aD4 therapeu1ampcaen1cbullbull aV81lable 111 diffrent
locationa Bowner tile barrieraottiaeaDdUatanc
between center and truaraUon tor the UDSopb1aticated
patieatlook1Dl tor 1her1~pJce too tor ~1CU-
larhalth serfplusmnQewoGl4~to JJa1t tbbll1ty o~
tb18 ~811D to provide iaaiYCOliprelleU1P18hboltleod
health servicebullbull III tactmiddot tappeareto coDtlict with
tbepro own taW cOfdotpro-1~a tam1ly
mecl1cal careprogru 111 wIa10h pre-teAtlYe aDd therapeutic
health erY1cecan be proY-lW to all IIl81Ibers of
tamily in the coure of aaSDll vi8it (36 PP301-3(2)
Dle Delmtr Coloradoprepa11ke the Montet1ori
LI
17
prograJlut111zbullbull abe1rarcJly ot SlDa11 aatellItestations
andlerer IIOreceDtallzedtac11It1es It 41ffers
howeverill tbcolap~81vene80f the services avail shy
able Inthe 4ecentraUzed facIJJtiesIt resembles very
clc)sely the IOdel ~ordecentral1zed social servicedell shy
very developed by 1ahII~ Which was 41sCussed above he
SIlall neImiddotgbborhoodmiddot c8Dt~aw1tb1n walkl distance of
most of the populatiotl havebeendesilDedto take care
of allthenorllalhealth probl of 3000-5000 patJentsshy
check-ups IlzatiOZl8s1Jlpl laboratory testa and
treataentand iaecucatlol18 (d1apeued by phyS1cians) for
IIOst DODCrltIcal 1l11le PatIent 1d1Oneed IIOrespecIal-
Ized care are reterrecttobacJalp facilities BaCkup
support tor themiddot~t1oDa are the tWo l8rsernelshborhood
health C8Dter8~ttr1Dl aCOglete~e of out-patient
serneeaDd three part1clpat1q hoap1iampl bull bullbull which
proVide1Dpat18Dt~t andcoDSUltatlve services
(13 p1028) Intb1a prosrama coaprehens1ve range of
prevent1ve aDd trea1aeDt serric 18 aVailable throughout
the decentraUzed middotta The CoapreheulY8 ReIgbborhood Hea1~ Service Project
otKa1er iC)UDdatlcm HOspitals 111 Portlan4 OreOD 1s
s1ll11arto th DenVer prosraa 1D thata comprehensive range
ot out-patientmiddot services 1D prov14e4 in each of 1ts 10cashy
t1oDa althoUlhmiddotmiddot tbe oentera are larger and l bullbulls DDIerous
than 1nth DenverproPUh (12 p6)
Li i
18
In order that a comprehensive neighborhood health
care center be able to proVide continuity of care it
must have arrangements for hospital services integrated
into th system Yarby (37 p73) as quoted above
states that it 1s characteristic of the neighborhood
health center to be directly connected with a teaching
hospital However De Diaz (14p3) indicates that it
may be advantageous for purposes of service delivery not
to havemiddotthe center affiliated with a teaching hospital
She feels that such anaft11iation may lead to asltuation
in which policies might be determined more by the teaching
needs of a medical school than by the service needs of
the patient
middotThe Nat10nalmiddotCommissionmiddoton Community Health Services
(25 p69) states that such a system of comprehensive
health care integrat1na ~e servicmiddotes of several health
and roedical agencies snould utilize Itas much single or
unified management as possible Neighborhood health
centers have been operated under a variety of auspices
but several writers have pointed out the advantages in
termsof coordinated prOvision of servictts management by
the hospital of the neighborhood health center For
instancethisfac111tates the keeping of unified medical
records of all the care a patient Msrecelved either at
the neighborhood health center or _le hospitalized
(12p6) ~ermore a3 Young (38 p1741) points out
19
direct operationot the u1sbborhood health oenter by
the hoSpital canll8lceaftilable to the center expertise lt bull
in sOlle aapcta 0 Operation that m18ht not be aa readily
available otherwie
Relardlebullbull of wbetberthe hospital and the neighborshy
hoodhealtbcent8r haVe a cOJIIIOaadmjntstration they
IIlU8thaVealTlved at a str1Dsent delineation of IDUtUal
role and reSpoDBlbilltiebullbull All OOIIpoienta ot the care
yst IIlWStQlarify and understand one anothers position
In the syatem and acree on objeCtive ancimethOds
(26 pp16-17p31) SODae areas of iDUtUalconcemare
reterral procedures record keepiDg aDC1 mutual use of
facilit1es statt1Dl i8 anotb8r ~ ot coaaon conc~
Ditt1cultift have u-laeniD the pastiD cOllprehensive bull t bull
healtbc~ prosraumiddot 1d11ch were batil plauned in wb1ch
all of the health canter phy1C~1IDa did DOt bavetatf
privilege at all ot thebackuJlhospltala (29 p21)
SUch a8ituat10n i8 1Dampcceptablelt inpatient care i8 to
continue to be p4by the pat1eatmiddot health center
physician and it cont1Du1ty ot care 18 to be maintained
Hoapital and health center1lUSt laav 301nt responsibility
tor the recruitaentot physicians
VticlentU IPan BJcNrcu Much otwhat haa b8ea sUd has stre88e4 at leastmiddot
iJlplicit17tbaD8ed tor tM etticit middotprovision ot8emcea
20
There appears to be two aspects of efficiency which are
discussed by writers on the su~3ect of the comprehensive
neighborhood health care centef one of these is the
need to organize) services to make the most efficient and
economical use of scarce medical care resources The
other closelyrelat8d in realIty is the need to help
the public use services in the most efficient manner
The comprehensive neighborhood health center concept
1s lhherentlymiddot efficient in that preventive curative and
rehabilitative health ~are programs are coordinated under
one roof with integrated a~stration Furthermore
theempbasLson prevention health education and early
disease detectionis eftic1ent troJll~estandpoint of
the health care system as well as beneficial to the patient
(18 p760) HQwever ~ue tothe scarcity of health care
personnel thecoiDprehensive neighborhood health center
mustbe an arena tor eXperimentation with new staffing
patterns~ The Kaiser program is indicative of the way
in which health care systems must begin to operate in
that appropr1ate ancillary personnel are used Wherever
possible to perform functions that do not need to be
carried out by the physician As Saward (32 p42)
states
1hroughou10ur organ1zat1on~ there are many of the customary experiments be1ngmade-shyJse of speciallr trained nurses for well-baby care under the SUpervision of the pedi9trlcianexperiments with routine prenatal care by
w ~
21
middotSPC1a1l~t~JlUrbullbull per8ema_1 bullJmdlJleu y our fuDotlou are auoh that DOtb1Da 18 dorutbYtbe phY8iCianstbat doe DOt vet to be done by the
phys1c111U1fhe other aldlle4 person- Del-nurse middotreC~0D18t the appo1ntshymeDt center or clerical praormelshyaremiddot there to free h1amiddotto use his spec1al sk111
Awell lmoWn treDd1D the area of eaaiDI health
c8re JII8DPOY8rShortagjs bas middotbe thetrend toward tra1nshy
1DB poverty area rea1deats as DOD~pro~eaionalmiddoth8lth
aide and nepborboocl health workeramiddot (28 p63) This
bas the effectofmiddotmiddot1J)creaa1q II8DPOWrand 8180 can help
bridle the cuJ~ cap betweenprondera and colllUmers
of aen1C8s This attarD at least tlleoretically
createa a situation 1D WIa1ch providers andcoD8Ullers can
be educated to UDderatad OD88DOtber and interactJlore
ettectlvely~ HoWever amiddotpltt8ll has beeD themiddot tel14ency in
801D8 oamp8e8 tomiddot us aidesmiddot ssale8lllcw t~r the center
alJDOatexclwdY811rathertbaD ua1Dltheal to protide the
health care for wh1ch ~ were trained (29 pp3B-39)
1bat ismiddotmiddot vh1~e the a14e Yalue in ~~m1catiDI with
low 1nCOlMt patieata haa beeR recoSD1zed and stressed
their role ashealtb carepersoDDelhil been slighted 1n )
any 1Dstancea
Anotber step 1d11Ob bullbull been taken to provide 8rY1ces
more efficiently eUeot1ftlybas beenmiddot theorgan1zation
of per8ODDeliDto IIllt141sc1pl1Dary teamaaaa means ot
proYid1DgmiddotCOQrd1DatedserY1ce SUch te8lll8 sen_rally
~
hf
~
22
include PhYsiciaQs nursbullbullbullbull soc1al workers and outreach
workers Conceptually th8y fmlct10n to me~ the intershy
relate lled1cal and social needs ot the families sened
Hor there are a number ot barriers to the etfectve
tlmctiOD1nlof lIuchte8ll8 SODieot these are heavy caseshy
loads the inordiDate amount ot tille consumed by multlshy
prOblem tamtliethel1m1ted tra1n1 ngmiddotmiddotand laCk of tnterest
on tile part ot aoae tebers in examinJng aspects of
problems out14e~lr oWn areaaotcolIPetencemiddot and
~ourdcation prc)blell8 between proteasioDala and nonshy
prot81~s (10ppa-10) middotrurtbemOre as De Diaz
(14 middotp6)1nd1cate tbel8 maybe a teDdency tor vertical
dp8rtmental lines of auperv1810nto become paramount
over the team coDamloation syst lead1ngto conflIcts
in determ1niDI the ro1ea ot solie team bers particularly
the DOD-prote81011alaInauch exper1l1enta Witb new
~t1Dlpatterna it 1s bullbullaentialtbat line of authority
roles aDd NsP0D81bll1tlea be made explicit and that there
beJDechaD 8IUI tor relUlar evaluat1onotfunctlorUng
Another way inwb1ch health care sernee delivery can
be made more ett1cl8Dt is to proVide servicea dur1DC the
hours whentbey aremiddot -ostnee4ed As reQo_ded by Yarby
(37p1) serY1ce can bemadelIOre accesslble by making
themava1lable 24 hours a day seven days a week If
rg8l1Cy service are aft11ab1e aroua4-tbe-cloek at ~
nil1iborhood health center the continuity ot tbepat1ent ts
23
careiamaiDtalDedand meatry point into the
cOIIPre~i health care 8 be made available
tothe patient who aoZMllyU8ea ozilymiddot emergency care in
tille of med1cal criais More 8isDificantly ava11ab1-
lity of a tull rase of bullbullrv1c8 tor seVeral hours 11the
eVerlna aI1Cl On ~ prevent the los ot earn1JiSs
involved if th patierat 1IU8tt8cet1me oftfroawork dur1q
the d8y for aed1Cal oare bull his can be an eSpecially
importantc0J1814eration tor lo1aCOlleDUUg1nally qloYEtd
patient aa4caJla18o PIOJIOtet1)e 0Da01Dl use othealth
servicebullbull
exper1eDO ot tbeKa1er prosraa in tb1s~reprdAs
Greenl1clt(19 p10) states wA lllNt 8ip1flcant
proportion ot the abulatory care 8n1cp~Y1dd tor ~
total popUlatiC)U ~ ~ after clWc hours and this
Deed i8 apParenUyaoN prODGUDced tor aJl8d1cally
iDCust population On the other hand the bulk ot all
aabulatory med1cal cu 88l91ce are performed dur1nS
regular cl1D1c hour eVen when services are available 24
hours a dayJ day bull week W
It has ~ the experi8D~eof a ftIDber ot ne1g1lboXshy
hooct hea1tbcentere _t a_jor obstacle to efficient
proViSion ot anicbullbullhas beentbe teD4eDcy of medically
1ncl1pnt patieats to utilize the center oa a walk-in
baais tor epi8od1ccr181or1entect bullbullrv1cea rather than
4)i
h~ ~~f ~~ L
24
to make appoJlltaeata tor ODIo1qprevmt1ve treataent
and rehebl11tat1Ye care ad ampl1O to bave a blah failure
to Show rat_for tbe appo1DtaeDts that they dO make
Atone center 628 of appo1Dtments made were kept
while 3Oottbepati_ta een were ~1n patients
AlthoUP fewer patiets were actually 88811 by the cater
1D middottb1s 1Datance thaathe -bervholuidmadeappointshy
mta the walk-iD patlat required an iDord1nate amount
ot staff t1ae tor aCreeDiaaacl ~trral to pplOprlate
~ttor caregt (9 pgg) Arraquotbr1llpl1catjo~ of the
plOVidedto valk-iD patient by other thaD their
(19 p12)rurtbermore
when patients uti11ze Wlk-1Il er181 centered care
athelr ODlf tona ot ootact with the _d1~ care
ay_ta fUilycentered care the treata_t of tUl11y
bers
a a UD1t 11
dlarupted
hewalk-1Dphenoaaencm appear to barelated to
diUerence between soclal clase in the style of Dlaking
contactJt1th the a11oal C~ay8t As Greenlick f ~
(19 p11)1Dd1oate8 thepheDOaenOn ot INater usage of shy
walk-in ervice by aed10ally middot1Jid11ent patient thaD by
others baa otte been attr1buted to a stoical att1tude
tQward 1llDe8 em the~ ot poor people leacl1D8 to a
~
25
greaterdelay1n tbe k i Dlofa8d1cal care These
patients wppoedlyeelcmiddotcareODlymiddotwIleD tbeirmiddotillDess
becOlles1Dtolerable resultiDSin middotthMr appeariDS withshy
outnot1ce1o rece1ve oareHlwever Greenlicks
r8aearcbbaa cut doubt on the existence ot tb1delay
111 report1Dg middot8J1IPtoJumiddotOfDeW 11laessand seek1ng care
Be bas tcrQDd 1bat s1ll11ar peze_tases of dioally
1nd1sent 8DClJ1on-aed1cally 1Dd1PD~ pat1enta seek care
on the aue daytbat aptou tirstaPPear
1fb11e GrHDllclc 1nd1cat tbat the reasonator the
greatertendeDCY of low 1Do~e pat18Ilta to 1$8 walk-in I
serY1ces are notlcDo1rAmiddotmiddot tbe7 _ be rel~tedto a tendency
ot lower aocio-ecaaaoclaa patieota to preter face-toshy ~
face contacts with II841cal persoDl181posslbly because
such contacts areft coatortiDS an4reasauriDS to
patients who are hJpotbeafzed to bave a dependent attltude
toward IIed1Cal care perS0Jm81 (30 p161)
It a8 itmiddot baa pnerally beenhld the appointment
s1stemts the most efficient Ileana of dellveriDS
comprehenSive oODtllluiDlh-lth care (9~100)1t is
necessary that educaUoraalmiddotbulltfort be taken to proaote the
use ot middotappo1ntaents8DClmiddot tQrec1ucethe fa111re to appe~
ratB4uOatioaalwhlQb baft~utl11zedhave been
IJ
26
1Dten1ews with walk-in patients home Vi8its and group 4i
meetiDp1D8D attemptto1Dierpret1o the patients
the value of rtitgular ppo1ntmentamp andot con~in~
c~1ve care rather than epiI041c care (9 p1OO)
h1s 1safuD~tioD torwhtch nOl~prot81QDal colDlllUD1ty
YOrkersllaY bebe~r8U11ed tban other statf H()wever
euch aD ~ucat1oaal propul __~ ~e related to the senUiDe
capacity otth health oenter to provide comprehensivebull gt
ervice8 to1tpat1_t~odoD aD app01ntment bas18 It
1amp pos8ibleo~rw1 tor educa110Dal ttorts to result
LD a~8JImCl tor ltPP01ntaen~8 at a ratewb1ohi8beyond
the capacity ot thee_tar to t without uareaaoDably
1_ wa1t1Dlprio4a QOBt1nuad use Ot the center on a
wallt-in bU1 _1tbeoosiItpos81ble to et an appoint-
met anc11nCreued pit1entcoJaplampia1a bull Therew111 of
course always be a need and demand tor acute ep1so~c
Care -ci the health centerDlWlt be planned with the capashy
billty ot bullbullbullt1D8 tb1aneed wh1~ cont1Du1nI to stress
aDd educate the patient to utillze oDlOinI comprehensive
faa11y middotc~te~d Cflre (9p 100l
att g4 CODClva1opa
In order to bea4equate any coJlltemporary health care SY8tem muat bullbulletcerta1D interrelated criteria he
IJ
27
minimum criteria areaccessability of services to those
who need them compr8heX1siveness and appropriatness of
services and efficIency 1nthft utilizat~on of SCarce
health care personnel and resources The scareity of
pex-sonnel andtbe need for h1gh quality ongoinghealth
care services
aJIlong the
populationdemanci the most effishy
cientprovision of services
Services must be made accessible to the population
They mustmiddotbe geosraPh1cally accessible to remove the PhysicalmiddotbaTiers betWeen peopleandthem$d1calcare
system They mUst otter their services dur1ngthe
hours when people can make the moat use ofthemA~ it
makes little sense to concentrate services geographically
where they will not be uSed to their fUllest extent it
also is wasteful to provide serv1cesonlydur1righours when
many people are employed his not only presents a hard
ship middotto the consUmer lnrt wastes resources if for instance
the unavailability of preventive services during the hours
when people Can use them causes a need for treatment
services later on
Health carbull sEtrvices must be comprehensive including
prevention treatmcmtand re)abimiddot11tation Ambulatory I
healtbcare facilities wh1cQ are orienteciexclusively
toward either prevept1on or trea1mentare no longer accepshy
table for they are lneft1c1entln their use of resources
and in their prov1s1on of health care to the patient
w ~~
28
If prevent10n1s notmiddot stressed treatment serv1ces that
could have beenavoidedY1l~ be required If prevention
1s the sole focus of the health care facility sick
patients who present themselves must be referred elseshy
where for treatment andsllch referx-als may be taken as
reject1onsor not followed through with until illness
becomes unbearable
The instltutlontbat meets these requirements Is
the comprehensive neighborhood health center It 1s a
local decentralized outpatient facilityprOVld1ng a
fUll range of ambulatoJY health care services It has
a linkage to ahospitalbackUp facilityforlnpatient
treatment and hiihlY apclalized outpatient care
The neighborhood health center must be a fac11ity
planned with an awareness of the needs of the conSUtller
and coDitnUn1ty It must have the r~Ul0urces to provide the
services people need mere they can use them and when
they can use them It must uti11ze the part1cipation of
the community to develop this awareness Not only must
the cen~er beset up to be Amctional for the consumers
but efforts must bemadeaga1n with commun1ty partici shy
pation to help the consumers utilize medical care
services effectively The center muetmake efforts to
educate the community about the valueot regUlar health
care of preventive servicesand of the use of planned
IJ
29
medical appointments ratherthanorisis centered walk-
incare Therealit1es of the existing health care
system have not taught the patient particularly the low
income patienthow to use services effectively
The helthcenterilUst also bea laboratory for
experiments in easing the health caJepersonnel shortage
and c60rd1Datingcare~ A major difficultY iri-exper1shy
menting with neW rolesis freeing staff of old preconshy
ceptions
CoDlprehensiva neighborhood health dare centers have
been developed under a variety ot alisplces including
medicalsociet1es hoSP1talsmiddot(36p299 group pr~ct1ces
(29 p6- 12 117) health departments (13 p1027) and
ne1gbbothoodassoc1ations(14) The literature indicates
somevalues nthe management ot the health center by plusmnts
hospital backup faCility Whatever the auspices many
adm1nistrative fuDctions such as program coordination
standard pr9tectionand evaluation call for considerable
c~tralization of adm1nistration city-wide or coU)tyshy
wide At the same time other aspects hours of servlce
for examPle~ cuI f~radm1nistrative fUnctions made atmiddot
more local levels Each neighborhood center must be
free to adapt its functioning to itscominunity thi-ough
the mechanism otcODlllUl11~ participation inmiddot policy making
Obviouslythe prerogatives and responsibilities of each level must be negotiated and made explic1t
t4~
JJ
BIBLIOGRAPHY 30
1 American Rehabilitation Foundation ~ealth Services Research Center The Health Maintenance Strategy mimeo 1971
2 Anderson Nancy N Comprehensive Health Planning in the States A Study and Critical Analysis Institute for Interdisciplinary Studies American Rehab ilitation Foundation 1958
3 Andrus Len Hughes Comprehensive Health Planning Through Community Demonstration Health Projects mimeo1967
4 Barry Mildred CandCecil G Sheps A New Model for Community Health Planning unpublished paper presented to the American
Public Health Aseociation1967
5 Blum HenrikL Fred Wahl Genelle M Lemon Robert Jorulin and Glen W Kent The Multipurpose Worker and the Neighborhood Multiservice Center InitialImplications and EJeperiences of the Rodeo CommunityService CenterAmerican Journal of Public Health58 (Mar 168) pp 458-468 shy
6 Blum MichaelD and Soloman L Levy A Design for Service Delivery that Reinforces Constructive Tension Between a Health Center and Its (sic) ConSUDlers and Supports Community Power unpUblished paper presented to the American Public Health Asaociatiltn 1968
7 Brielaud Donald Comm~ity Advisory Boards and Maximum Feasible Participation American Journal of Public Health 61 (Feb 1971) pp 292-296 shy
8 Burns Eveline M Health Insurance Not If or When But What Kind Madison Wisco~sin University of WisconsinScllool of Soci~l Work 1971
9 Campbell John Working ~elationships Between Providers and Conshysumers in a Neighborhood Health CenterU American Journal2 Public Health 61 (Jan 1971) pp 97-103
10 Caxr Willene Neighborhood Health Centers Funded by the Office of Economic Opportunity mimeo 1970~
11 Colombo Theodore J Ernest W Sawardand Merwyn R Greenlick The Integration of an OEO Health Program into a Prepaid Comrehensive Group Practice Plan American Journal of Public Health 59 (April 1969) pp 641-650~ -
12 Comprehensive Neighborhood Health Services Projectof Kaiser FoundatioIl Hospital~ Prcgtgram YearE grant renewal proposal mimeo~1971 bull
13 CowenDavidL~ Denvers Neighborhood Health Program Public Health Reports 84 (Dec 1969) pp 1027-1031
IJ
14 De Diaz Sharon Daniel Beyond Rhetoric The NENA Health31 Center After One Year unpublished paper pres~rited to the American Public Health Association 1970
15middot Gerrie NorrrianF and RichardH~ Ferraro Organizing a Program for Dental Care in a Neighborhood Health Center Public Health Reports 8 (Aug 1968) pp 419-428
16 Gordon JeoffreyB~ The Politics of Community Medicine Projects A Conflict Analysis Medical Care 7 (Nov -Dec 1969) pp 419-428 shy
17 Greely David The Neighborhood Health Center Program and Its Implication(3 for Medical Care H~alth Forum of the Welfare Council of Metropolitan Chicago (mimeo) 1967
18 Greenlick Merwyn R Newgtimensions in Health Care American JOurnal of Pharmacentical Education 34 (Dec 1970) pp 754-4
19 GreenlickMerwyn R Donald K Freeborn TheodoreJbull Colombo Jeffrey Abull Pruesin and Erne$t W saw~d Comparing the
Use of Medical Care Services by a Medically Indigent and a General MemberShip Population in a Comprehensive Prepaid Group Practice Prosram II unpublished paper presented to the AmericanPublic Aesociation1970
20 H~tadoArJiloldVMerllYll RGreenlick and TheodoreJ Colombo Determinants of Medical Care Utilization Failure to Keep Appointments unpublished paper presented to the American Public Health Association 1971
21 Johnson Richard E and Merwyn R Greenlick Comprehensive Medical Care A Problem and Cballengeto Pharmacy ff AJilericanJournal of PbarmacenticalEducation 33 (Aug 1969) pp 361-367 -
22 Kahn Alfred J Studiee Social Policy and Planning New York Russell Sage Foundation 1969
23 Kotler Milton Neyhborhood Government Local Foundations 2 Political~New York The BobbsMerrill Company 1969
24 NationalCommisaion on CommunityHealthSfrvic~sActionPlanniriamp for Community SetithServices~ashington p C Public Affairs-Press 19t7
25 National Commission on C~mmunity Health Services Health Adminishysration andOrMPization l the Decade Ali9$-d Washington D C Public Affairs Press 1967
26 NationalCornmiesion onqomm1Jllity Health Servicesbull Health ~ Facilities Washington D C PUblic Affairs Press 1967 bull
~ n
32 27 ODonnell Edward J and Marilyn M Sullivan ServiceDelivery
and Social Action Through the Neighborhood Center A Review of Research tt Welfare ~ Review 7 (Nov~Dec 1969) pp 112
28 Office of Economic Opportunity Second Annual Report Washington D C~ U S Government Printing Office 1966
29 Office of EConomic Opportunity and the Medical Foundation of Be~laire Ohio Eighth Report 2l ~ Committee2a Governshy
ment OperatiOll~ Va8hiiiSton D C Government Printing Office 1969
30 Pope Clyde R Samuel S Yoshioka and Merwyn R Greenlick Determinants of Medical Care Utilization nhe Use of the Telephone for ReportiDg Symptons Journal of Health and SocialBebavior12 (June 1971) pp155-162 shy
31 RenthalA Gerald nComprehensive Health Centers in Large US Cities American Journal of Public Health 61 (Feb 1971) pp 324-336 shy
32 Saward Ernest W The Relevance of Prepaid Group Practice to the Effective Delivery ofHealthServicestt The New Physician 18 (Jan 1969) pp39-44 - shy
33bull Schorr Lisbeth Bamberger and Joseph T English Background Content and Significant IssUes in Neighborhood Health
Center Programs Milbank Memorial ~ Quarterly 46 July 1968) part 1pp 289-296
34 Weiss James E and Merwyn RGreenlick UDeterminants of MedioalCareUtilization The Effects of Social Class and Distance on Contacts With the Medical Care System Medical~ 8 (Nov-Dec 1970 pp 456-462
35 Weiss James E MerwynR Greenlick and Joseph F Jones Determinants of Medical Care Utilization The Impact of Ecological Factorstt unpublished paper presented to the American Public Health Association 1970
36 Wise Harold B Montefiore Hospital Neighborhood Medical Demonstration A Case StudyMilbaDkMemorial Fund Quarterly46 (July 1968) part 1 pp297-308~
37 Yerby Alonzo S ttHealth Departments Hospital and Health Services Medica1~5 (March-April 1967) pp 70-74
38 Young M M~ Chatanooga IS Experience with Reorganization fOr Delivery of Health Services ttAmerican Journ8l of Public Health60 (Sept 1970) pp 1739-1748
f or l
II bull 11 Y d
II
IJ
34
ThepurposeOfPart II of th1aa paper1atod1scuas
elected Speclfic needs ofecltlc areas within Multnomah
County A8P01ll~oUt 1D ~ I of t1a1bullpapermiddot Ita nelgbshy
borhood health oare cater IlU8t be a facl1lty plaDlled with
aD awarenes of the neeels of the oODllUller and collllUDity
Part II of this paper nIl Show 80e of thoe speclflc
needs
he1DforutiOD tor t1li Portlon of the report
obta1nec1 troll tbroupout tbe follow1Dl threepUb11catloDS
1gr~e_tiMshylIPrIxaiidOreson JuDe 1963
2 1~_middot_sectSI8e~ected1teai c-ua 0 S 8 e first count coaputer tape Coluab a_lion AssocshylatloD of QoveraMD-8 Jlme 1971
3 Jtu1tDoab County Oreaon BDY1roDlHtlltal SurveyEarly 1971
The JIultDOIIIlb COUDty OrttIOD BDv1roDllfmtal Surley
Barly 1971 1s bull stat1stical report of the activ1tles of
theentlreMultDOIIIl2 CcNDty Health Dep~t during the
year of 1970 Die speclflc 1nd1cs elected from tb1s
study amprejMental aealtll Publlc Health N~s1D1 vlslts
FaJUly ~ Veaereal])1 ~ ~rcul081
Throush tie use of cUrts and mapa ODe CaD roup these i
speclflc ~oea to ahcnr the healthneedsof speclfic I
census trtcta aD4 then the health needs of iarer neIghshy
borhooda 1m4 o~ Uebullbull
Rf)~UP1Dl of areu was accompllshed in thefolloWinl I
JJ ~
35
he MiltDoIliahCountY oregon BDViromaental SUrvey
early 1971 isamp statistical report ot tbeaotivities ot
the entire MultDolllh COUDty Health ])epartiDent dur1nl the
year ot1970 he specitic 1Dd1C8S selected frOm this
aUy are 1Il8Dtal health public healthDurs8s visits
fUl1ly pia waereal elisease aDd tuberculosia
Tbroq11the Wle otcbart aDd mapa aDecm szoup these
specific indic to show the health Deeds ofapecitic
ccmaua tracts aDdtIum th8health neecla of larsr ~eilh-
bOrhooda and co8I13 tlbullbullbull
RegroupiDI ot areas waa accoap118hed1D the
tollOWiDl lIIIIm1er~ A bullbullcifie 1ndex 8selectcl auch as
venereal di8bullbulle or tuberculo8i~ he total number ot
cs was then deterll1ne4 for each census tract Through
the use of the maber ot cRbullbullbull tor a 11Yen cenaus tract
aDd tbe population ot thattractaltrateot1lla1ampmcper
100OOOpopUlaticm wu cleteXll1ned for each census tract
This was ~e to starl4ard1ze the population ditterence
amongOeD8U8 -tracts 1he rate of incidence toreaob
cenauatract was then llstedby rank position on a chart
In rank poition1DI any cen8Wl tracts haviDg equal
rates ot1l1c1dence are assipe4tbe iaDk posttiona
Beeauseot the abo fact tbAt cbarta w111 vary in length
neveltbAtlea eacb cbart will 1Dclu4eall census tracts
inMullnoaah Couaty Atter the census tracts bave been
listed accord1q to raalcth1s list will bediv1ded into
IJ
36 three levelsotinc14ence he three levels are
1~ The upper 14 of1DcldenCe
2 Thelower 14 ot incidence
middot3 The ILld 12 of incidence
Tlles three srouplqa are then used in compiling a map ~f
Mu1tnOmahCountyfor ach apecltictop1cbull TIle maps are
uaefuJliD tbatthey V1suallycoJib1De 1Dd1v1Clualproblem
census tracts into larger problem nellhbOrhooc1s
The 1960 statistical iDtormatloD was Used in a similar
liIaDDr to tbatexpla1Dedabove 1Dthe4evelopaent of a
chartmiddot and map 1Ihow1DI e cOllpampriSOr1 of per capita lncolle
tor ttaCh ceDsua tJact aDdmiddot combiDed census middotmiddottract areas
he 1910 aDd 1960 statlstlcal iDtOrllatl0D was combined
lna map and chart he purpose of this and chart is
to d8aonatrate the e cl1stributloa1DeachceD8U8 tract
and middot1ndlcatbull tuture ace populatlon treD4a bull
When one be middotbullbullbullbullbullHdth ne8cts ot an area and has
declded to establlsh a cl1D1c to serve that area the
physical location otthat cl1D1c IllU8t be consldered In
order to coapreb8ll81vel develop an area cl1n1c one should
conslder thepre88Dttraftlc middot~ytaa an4tranaportatlon
systems Thecl1D1cahoUld be located close enoUlh to
major arterlals to giva asy access from the total area
be_ ervecl by this cliD1c At the t1ll8they should
be tar eo away froll thesarterlals to all8Y1ate traffic
CODCell18 andpark1D8 conpstlon By traff1c concerns I
IJ
37
lIlan one lUSt consider thertarro1fne8S of streets whether
streets are oD8--C)r two-way iqres8 and egress to parking
amp0111tie eros tratflC) spedof trattJQ children 1n
ll8a traffic i1lht Vislon re8tr1ctionS etc
BwstraDsportat1onshould alao be central in this area
as maay people ~U f1Df1 1tD8Cessary to use this form of
transportatlon
~e tutqredlopHQt of bull treewa systems should be
c0J1S1dered soastolesen thecumce ofmiddot future roada
cutt1DSotltbe cl1D1c llte line
nrrph1c middotDampta
It is 1JDportaDtto kDOw the demosraphic distribution
characteristics of the oUenteltbat i8 to be served by
localized health cl1D1cs
Acl1D1c which erves8J1 area where1D the prepondershy
ance of persona arecrter 65 years of mayf1nd that these
people rely more on pUblic transportation call for more
home- services and haV4t 110ft ChroD1c and debilitating
types of disorders (b1_ blood pressure poor heariDg and
eyesight) tbaD do8 an area ot a YOUDIer population On
the other hand thL area of older residents may have little
need for family plabDlng cllni08
In order to better ~Ybullbull the 4eaoraphic population
of each CeD8U8 tract the 1970 CeD8U8 iatormation was viewed
and two specific catelOri8 considered These two cat
IJ
38
lori8S woUld be the perc_tap ot population under 19
year of ase and the percentase ot each oensuetractover
65 years of age he 1960 1Dtormatlon tor eaCh tract was
then compared witbthe 1970 intormation and a percentage
ofincreaae or4ecreamp8 tormiddot e~chtract1n each category
cOJlputecland achartma4e By the use of this chart one
18 able to View tJleap populat1odiatr1but10n of census
tract and at the _ t1lle accesa middottrencl Por example
let us choose census tract 601 W see 40-4 otthe
population is under 19 years ot and that ODly82 1s
over 65 years ot middotAtthe e tille the percentage of
youth bas ~ed ODly 1_ intbe laSt teD year whilethe
percentale over 65 year ot middotbas stayedmiddotthe same With
this in mJnc1 ODe ~ 1DfItr libat ol1D1o aerviDg this
area WOuld bellQre conq~w1th the problems of a
YOUQier populat1on and that _ would probably be true foJ
some t1aein tbefuture On the other hand CeDSU8 tract 54
has only 2 ollt population UDder 19 yel1s ot age and
this has decreased by 1 over the last ten years middotwhile at
the same time 32-377 ot the populat1on 18 over 65 years of
age A ol1D1C ___ this area should be or1eJ1ted toward
tbespecttic problema otthe ampledbull
PerCapia __ bY gsa neat
WhaD cona1der1qlooat10D1 tor health cl1n1cs one
shoUld take the 1DC01Ieot areas into consideration Areas
IJ
39
of lowiDcome would not 11kel~be 8erved more by localized
cl1D1cs tbaD would are of hilbincome It 18 likely
people haYiq a hip iDeoll8would preter to be aeenby a
chosen ~r1vatephylc1a1l tban at a local cl1D1cwhere
10Dier waits y beraceaaampryand leas personal attention
gl_
The 19701ncOII81atoWampt10n tor MultnomahC~ty was
not available at the tille thi8report W88 made The 1Dto~shy
tiOD Was taken ~adtro tbe1960 census publlcation
his woUld ~8Il thea tbat ral1I8 OD the chart ynot 1raquoe
completely accurate hi writer telthatthe areas most
affected by tb8 1I8eof the older 1Dco1DtOlaat1oDWOuld be
those tracts wh1ch baYebad a rapid 1ncreaae1n populatlon
over the past tfmyHr8 bullbullbull tracts would include tracts
nUmbered 104 9897 96 aDd 95 be perc~ita 1Dcome
referredto1il-tb1a Paper18the lIean 1DCo per person per
census tract
Attar the iDeoeper census tract was listed on a chart
a map was de 1D41catiDg those census tracts belonging to
the lower 14 ot income tor all censue tracts in Multnomah
COlDltytbose beloqins to the upper 14 ot income tor all
census tract 111 MultnolUlhCounty and those belonging to
the mid 12 ot 1I1coaetor all oeuuetracts in Multnomah
C01mty
In yiew1Dg the _p 1t caa be seen that the low income
area seautotollow aloas the at aide ot the Wl1lamette
IJ
40
R1ver the full length of Kultnomah County A second low
income area follows the south edge of the Columbia from
the northwest corner of Multnomah County easterly to 148 St
A third problem area seems to be on the east bank of the
Willamette River with the Union Pacific Railroad being
about the center of this tract The extreme loutheast
corner of Multnomah COUDty appears to be a low income area
but as this area bas bad rapid grouth in the last ten years
this could be erroneous
Mental Health
be first ~ecific indica to be selected from the
Multnomah County envirollllental survey of early 1971 and
to be considered in this paper i8 that of Mental Health
At the present for mental health purposes Multnomah
County is divided into five catchmentareas with a mental
health cl1n1cin each area These clinics are Model
Citles Delaunay ADkeny street Office Hansen Health
Building end Southeast Clinic
All lIlental health cl1n1cslcept statlstlcal information
on all patients visiting their cl1n1cs this included the
address of the patient hese addresses were then listed
upon the approprlate C8D8US tract Each census tract was
then ranked on a chart according to the nUllber of mental
health patients who reslde ln thatCeDSUS tract attending
any of the above listed ental health clinics This chart
IJ
41
wasttum d1v14ed1ato proper quartile bbullbullbull
quartile vereUs to dne10 u appropl1ate Multnoh
County _tal health ItLa middotmiddotmiddotthelipO~a1bl by lOoJcJIUE
at the UDtal health _to uteN1De which ueu have the
lars-t use otCOllDty 1alh~th faci11t1Rot
1Ilclu4ecl 111 tbia woUld tber otpeopleYia1t1Da
pr1vat patch1atriata aDd pr1_t _ntalhealtb cl1D1c8
WheDtbe M1 18Yienclmiddot Itmiddotmiddotmiddotmiddot~middotbe~_ tbat ~rtt
appears to lMt fourmiddotmiddot-al are iii _oil the nuaber ot
lIental healthcl1D1c na1t toM tbjh1sheat 1he
tour areaa woUld be tollows
1ttrea Ore to~Blo Drimiddot ~tb Burrus14e aDd tIMtmiddot Colb1a Riftr H1gbwyaeri1Dla th nortllra boundaryshy
2 bull ProII 82D4 1_~ 10 20th streetwitil the ra1lMd Mu the north ltouadary
3 ~ et et tUgl_b1bull MYel froamiddot the Clackaaa COUDty l1ae aorth to Dln8lon stret
4 beDOlvt1ttfe-t ~efllt4 COatytrca Jle1aware streetmiddot toR1C1a11oDd wlth Colubla Blvd heiDI tbAtnorth bouaclary_
It ODe coapareatbiap to th iDeobullbullmiddotp 1t can be
eamiddotthat lIOat ot the c tracts baY1Dg bllh v1i11tatlcma
middottfl public tal health cJ1rUc8 ~ 111 t13e low ~ aid
1DcOile SroupiDIOJa1y of til 25 tracta llsted as
haviDlbip aental Maltll nlltatlou are ~ the1g60 hip
iDeo arebullbullbull
17 Plpn
42
amily PlellnSDI ]Jlce Metal Health i8 an 1nd1ce of
use Theperson 111 ordertobavebe_ 1Dcluclecl 1n this
atu4ywouldhave tohaft Ue4 ataa11y plaDI cl1D1c
tacilities of soaetype It 41fter troll tile _tal health
study1nthat i t1Jicludestatist1catrollbotb public and
privateclJD1os
The iDformation tor the iak orurcbart 8Dd map of
t8ll111 plenn1 na ob1a1De4 by cOIIblnlDlthe mabel of
1rlcuv1duals bullbull_ attbe tbreellUltrampo-ti Coatyhll11y
PlalJQllIl C11ll10s 111til tbo at the Planned PareDthood
Association CliD1C8 be tbree -JIultDouh Couaty r8ldly
PlamSq Cl1D1c are Solrtbweatth Col_bla 1111- a114
HaDsell Health BWlcl1Dl CllD1cbi middot1Dtormat1oD vas then
bullbullbullesed tomiddot detellWMt l10w people troll eacb c8IUIUS
chart wastben Mele IUs oIIart jn 4iY1ded to show
the censuS tracts lIaYiDlmiddottIle h1t1iest qUart1le of incidence
of use lowest quartile of 1Qc1deao ot use Jlid 12 of
incidence of Wle an4 a map sprepared troll thts 1Dto~
mation
The C8U118 tractsbelOJISnl to the h1lhestquartile of
use appear to be 1lO~ 8catt~ on tbipwas true ot
either the _p ot aental health cl1D1c uaageor ot the map
abow1DI per capita 1I1COM Iaere40 to be three
d18t1nct areas of UIIaP beJ woul4 be
1
IJ
43
t10D of BurD81cl and the W11lallette River 4
2 S~t Portland 8Otth otmiddot the ra11shyrcaadand alona the W11lamette River
lIortbeaat Portl8D4 between MisSiss1pp1 and 24tbStreet the northbouBclary be1DgColwb1aBlvd
Pylzl1c BMltl IrpI Y11ta
Publlc Healtil nur81D1Y1s1t nclud8 an vists to
theholles of client by PubUc Health Nurbullbullbullbull his shows
visits to bull f8Jl1ly fer aDY purpos SUCh aatuberculolJ1s
het1Dl tem1tyaeatalu4 8IiOt10D8l cODd1t1ona etc
he atat18t1C~ 1fele C()4ed accord1Dg tomiddot the 1llli301fOCUS
of the Y18lt tt doe DOt 1D41cate the Dmlber of holies or
f8ll11lev181tecl or 1D41Y14ual Y1a1ted more tban oDcein
the propwl It dobullbull I1ve 80M 1D41cat1on by coaparlshy
OD ot the 8JIoUDt of aedlcal problema 1n eachcen8WI tract
Ap1nmiddot the _p abowa 8 scatter patteraof probl_
areas althoUSh there appear to be a sroup1Dl of hiSh J
l8aIeccmaus tract 1ntlut extreme southeast part of tbe
County other areu uIriaI any nura1Dl contacts are
1 bull he 801lth-oa-al CO1Dty on eaCh 814 of 82nd Av from Clackallaa County north to Dinloa
2 ear bullbullbullt 814e aroUDd Preacottand Misaisippi
Dowatom Bunul14eonboth 1de of the river
44
V_real Pis The iDfomatloil uaec1 to tabulate the Venereal
disease chart includes all the ooab1ned case otmiddotODormea
and syphilIs reported by bothmiddot publIc and prIvate physicIans
dur1nl 1970 There were 3602 caes ot IOnorrhea reported
dur1nl 1970 While ODly 17 cabullbullsot ayphilimiddot were reported
A chart was prepUed aDd att8llPt wasmiddotmiddot de tomiddot
determ1De Wh_therVttDereal 41ease was more p~vaJent in
areas othigb or lowmiddot proportIon ot youth hi waadone
bymiddotdetemlna a 1leaD prceiltacmiddotmiddotmiddottor the population ot
resld~ts UDder19 years ot (34) middotA mean ratemiddot per
100000 popUlatIon al80c1ttem1Ded tor the middotoccurreDCe
ot venereal dieae This was et at 390 oass Areas
hav1nl a population 1n which leiS than 34 were lmder 19
years ot ampIe were called low- yOuth abOve tbl percentaae
hiSh youth The aaa waatrue ot the occurrence oivenershy
eal disea_ per CeD8UStract It the rate waacomputed
as 1I0re than 390 cases per 100000 it was called hiah
venerealdiaeasei it less than thia tisure low venereal
disease It was tound that 1D Multn~ COmlty there sems
to be poSitive OOlatI0n(x21S19gt between low youth
and hipmiddot venereal diseaand hip youth and low venereal
diseasebull
RaDk ordr Iitot all c traot middottbAm made
Th1s was done byt1Ddlna the ratepr 100000 populatIon
of venereal disator all census tracts in the County bull
45
These were thenlisted from h1lhto low (sreatest to
least) in a rank order The l1sting was then divided
into Upperandlower 14 aDd listed on the MUltnomah
Countymiddot up
The areas of b1gh venereal disease se8ll18to
roup thBl~8 middotin a very tllht area ~oq both 1des
of thell18l8~ R1 w1th BurDaldeS~et being
~bout theceDter qf tbi8IZ9uping This area woUld
appear to be m ldeal spot for the denlopment of a
locallzed venereal d1sbullbullbullbull cl1D1c
UbepoundCUlO1s
In this report bull tube1C1llosls caS8S refrred
to include alltbobullbull cabullbulls ontubercUlo8is follow-up
rather middotthan just new C Accord1Ds to the Multnomah
County Health SUrvey of early 1971 this would include
all ca repOrte4 over thelaat three years The
total number of tuberculosi8 cabullbullbull usedin this study
was 666 lh1 included 128 new cabullbullbullbull
A rate per 100000 of tuberculosis for each
census tract wa- then computed and the c~us tracts
listed by rank order be b11h Qartlle mel low
quartl1 were then reoordd on a Multnomah CoUnty map
TWo genral areaa baY1Dg a hip mcldencaot tubercu~
losiare 1D41cated heyare
1 Both middotsld ot theWilla11lette River
Ll -
46
with Burns1de about thecnter
2 he extrea Northebullbullt comer of the County bull
By coap8r1ng the tuberculois an4ven8real
diseae maps ODe can 8ee that the downtown areas ot
hiSh 1nc1denceare alIIo8t 1c1eDt1cal on ach map
This WOuld 1nd1cate that 1t would be of value to
bullbulltab11sh acl1D1c 111 th1aampreatbat would provide
bothtuberCulos1s 8Dd ytmereal 418ase srvicbullbullbull
Thchart aDd 1181gt8 are wsfuln 11v1DI
1Ddicat10DS tor the type aDd placemeototlocal
health cl1n1c8 tbro1qhout tbe MultnomahCounty area
A cOllpar1on of the mapa help one to dec1dewhether
to provide a aulti-8ervice cl1D1c or spec1f1c type of
cliD1c As stated in Part I of thi paprserv1ces
shouldhaYe both treatlieDt and prfMmt10n cOmponents
As he been stated fta ne1lbborhood health care
Qenter muat be a fac111tY plazme4 with an aamesa
ot the neds of the consumer and the c01llll1m1tybull
Part II of this rport haa been an attaapt to indicate
and clarify 8011 ottheae coDlllUDity neds This has
been done through8elect10n of apc1f1c problems
The indic were then visuallyrecorded through the
use of ups and charta ODe dan asseS8 thedsreeof
1DIportance of certain concems to spec~t1c areaa by
comparinl the chart aDd maps Prom this oDeean
41 dec1de which are48 vb1chcUD1c-or indeed if
the need a clinic at all However further factors
should be considered hebullbull include
a The amount of fuDd1 available
b What 18 the percentage ot peopleineoh ceaaua tract tbat would actually us such cl1n1cIl
c Wbat 1 tbeco--1tymiddot 8 IeeliDashyreaardtDI particular cl1D1c8 Would this dcrebullbullbullmiddot the ettctiveness ot thse cl1n1ca
IJ
li
D_OlraphicPopulatLon Challie 1960 to 1970 48
Cen8U8 1 of Pop 1 Cbaqemiddot 1 Change1 ofPopTract Under 19 Yr8 Over 65 Yrs1960-70 1960-70
middot1Q701Q70
1 319 -12 171 -H) 1
2722 215-27 +68 301 366 -22 127 +35 302 371 +19 111 -04
311middot401 144-41 +29 402 321 13~7-39 +24 501 356 124-08 -02 5~O2 351 133-23 +12
405601 82-10 -02 394602 103-01 -06
701 275 149-76 +56 702 361 +01 121 -07
+10middot801 326 140-22 802 321 middot127
(
-29 -03 9~01 342 124 -H) 6-18 902 294 128 -H) 3-24
10middotmiddot -14312 140 -17 1101 182 +25 -23197
2411102 186-59 +29 1201 226 169-17 -41
31middot01202 +11 182 -05 295 -H) 81301 208 -H) 4
1302 331 +08 197 +04
14 323 +15 middot185 -08 middotmiddot15 329 +16 16~5 -13
-28middot 1601 332 131 +12
1602 356 98 +24middot-39 middot3101701 161-33 +21
1702 370 -15 85 +02 +19 1801 264 151middot-50
185middot1802 256 +47-58
IJ ~
D_raphlc Population Change 1960 to 1970middot 49 (Contd)
4io
Census Tract
of pop Uncter 19 Yra
1Q1n
1Cha1l8e 1960-70
of PopOver 65 Yra
lQO Change
1960-70
19 389 +29 141 -24 20 223 -13 206 +18
21 227 +08 194 -36 2201 356 -27 112 +05
2202 290 -18 ll~9 -29 2301 356 -03 154 +24 2302 260 -37 245 +97
2401 410 +6~1 123 -31 2402 163 -80 320 +99 2501 381 +13 140 -01 25()2 237 31 lil +02 26 343 +25 186 +149 2701 370 +29 1S5 -01 2702 249 -44 304 +98 2801 337 +19 187 +09 2802 306 -10 156 +31 2901 304 -38 142 +24 2902 i 307 -32 146 t3~9
30 29~0 -48 16~2 +51
31 355 +30 160 +01 32 370 +48 148 -13 3301 395 +45 130 -20 3302 368 +06 138 -02 3401 386 +16 117 000
3402
400 +32 92 -26 3501 304 -07 115 +35
3502 344 000 140 -13
3601
36~02 357 -04 132 +32
3603 30~1 42 149 -67 3701 342 +28 152 +19
1
IJ
Jianolraphic Population Chan 1960 to 1970 50 (Contd)
Census Tract
of Pop Under 19 Yrs
JJl7J
middotChanae 1960-70
middotofmiddotpop Over 65 Yrs
1c~7n
Change 196070
3702 409 +39 122 -11 3801 308 -11 151 +29 3802 275 -35 180 +46 3803 282 -32 192 +54 3901 376 ~13 100 +17 3902 296 -03 177 +29 4001 438 -11 84 +13 4002 353 -21 115 +20
4101 397 11 9middot0 +11 4102 346 -19 120 +03 42 331 +19 11 bull 3 -16 43 347 -72 105 +31 44 113 +84 183 +154 4S 33~9 +07 110 -06 4601 2501 22 193 +38 4602 332 +59 126 -29 47middot 161middot 000 211 +01 48 103 -26 302 +59 49 138 +1 bull 3 252 +09 50 141 -26 204 -12 51 12 -39 257 +07 52 47 -61 351 +48 53 89 +49 314 -30 54 25 l1li15 327 -17 55 131 -17 115 -121 56 198 +93 227 -47 57 71 102 189 -88 58 240 ~middot41 16~1 +55 59 322 +25 142 +06middot 6001 264 95 132 +50
6002 328 -31middot 89 +07
JJ
Demographic Population Change 1960 to 1970 51 (Contd)
Census 1 ofPop lChange of Pop bull ChangeTract Under 19 Yrbullbull 1960-70 Over 65 Yrs 1960-70
1970 1970
61 355 -58 85 +39
62 328 39 110 +18
63 414 04 73 10
64 382 -22 72 +04
6501 383 02 67 -20
6502 329 -56 96 +09
6601 391 +13 88 -03
6602 319 -59 97 +06
6701 327 71 145 +72
6702 331 ~67 83 +1-0
6801 365 -66 49 +01
6802 388 4bull3 54 +06
69 354 -41 80 +23
70 400 -23 68 -06
71 359 -48 72 +05
72 255 -88 82 +11
73 346 -39 91 +25
74 313middot -63 105 +24
75 329 -42 129 +37
76 336 -52 85 +21
77 370 -10 69 +05
78 309 -10 120 +21
79 325 -56 87 +10
8001 358 -81 57 +12
8002 391 ~81 76 +12
81 315 -76 108 +21
8201 403 -23 64 +08
8202 392 23 65 +08
83 357 -34 120 +31
84 402 -18 73 +16
85 413 -06 76 -09
r
Demographic Population Change 1960 to 1970 52 (Contd)
Census Tract
t of Pop Uncler 19 Yrs
1970
Change 1960-70
1 of Pop OVer 65 Yrs
1970
ex Change 196070
86
87
88
89
90
91 9201
9202
93
94
95
9601
9602
9701
9702
9801
9802
99
100 I
101
102
103
10401
10402
lOS
368
351
379
391
391
413
379
433
372
429
414
432
419
439
~32
377
457 420
378 41middot7
345
360 417
417
412
-04
-02
-35
-26
-28
-11
-64
-20
-S9
-39
-32
-21
-34
-40
-47
-lO~7middot
-27middot +04
+56
+07
-34 01
+04
+04
+10
103
128
97
11il3 99
69
79
42
77
46
34 38
44
40
54
111
51middot
81
133
59
74
140
63
87
76
-08
-06
+04
+08
+17
-05
+3S -02
+1~4
+19
+33
-14
-08
+12
+26
+71
+11
-16 -34
-20
-19 +37
-49
-2S +15
NOte The The
Taken frOi
averageullder averageabove
middotUSCensus ---shy -
19 years == 6S years ==
figures 197
32r 13(14
p a~d 1960
--
Rank
1
2
3
4
5
6
7
8
9
10
11 12 -_
13
14
15
16
17
18
Tract
69 46
60
58
- 68
61
302
2501
67
63
19
62
26
94
3603
3902
64
30 -----~-
Rank
19
20
21 -
22
23-shy
24
25
26
27
28
29
30
31
32
33
34
35
36 -
Ranking of Per Capita Income by Census Tract
Tract
65
2701
- 15
1601
701
66
93
82
2903
3602
30
2502
80
2401
81
- 70
91 shy
4001
High
Rank Tractshy
-32shy37
38 97
120239
7840
41 ~ _2_1__ 42 31
43 2501
44 18
45 98
46 37
47 3803
1702
49
48
1602 92 2702
I
50 89
51 901
52 801
Ra_
53
54
55
56
57
58
59
60
61
62
63
64
6S
66
67
68
TractTract Ra~
74692
170196 70 I
401 71 90
72 1037J
79 70273
3802 74 601
24024102 75
85 76 101
77 9023901
7699 78 100 4101 79
3601 I
380180
458140~ t---- _ - - shy83 82 42
888384
59843501
4777 8~
502
Low
802 86
Rank Tract
87 shy
--88
89
90
91
92
93
94
- 95
96
97
middot98
99
100
101
102
103
104
1201
14
49
72
73
43
87
3502
105
1
52
86
71
1
501
10
3301
104 tf
Rank
105
106
107
108
109
110
III
112
113
114
115
116
117
118
119
120
121
Ranking of Per Capitalucoae by Census Tract
(Contd)
Tract Rank
4001 122--shy602
13
1102 2302
3302
55
3401
48
21
56
50
3402
lL01
2202
2301
53
2201
-shy
Tract Rank Tract Rank T~aet Rank
57 I-----
Imiddote
bull
Tract
- Low -k Note Information taken from 1960 U SCensus
Rank Tract
I ~
Ie
Imiddot
~
----
----
--
--
Rank
1
2
3
4
5
6
1
8
9
10
11
i-
-Tract
391 922 921
972 971
100
132 131 121
962 961
822 821 401
982 981
20 111
47 10 1
412
High
Total Number of Henta1 Health Visits
Ranked by Census Tract High to Low
TractTract RankTractRank Rnk
12 182 22 78 29 87 76 381 73181 ~------- 1913 371 8538230162372 271 2616-121 8272 2
14 80~2 31 94 7923 84801 59 15251362 4232 15 52 _ 32 103 8924 651 17240216 652
_ 91 351 33 341 23117 83 122 25 25 48 1123921418 34 shy61 86 661
19 662 6493 81 26 91 8153 49 50 55 41383 71 27 51 3120 90 672241 35shy 104167162 461
I 411 46211121 28 88342 I
2502 36 69 54 5251 50 272
-Ra
37
38
39
_ 40
_ 41 Ishy
I
42 I
-I 43 44
45
shy
Tract
~ --- shy 95 56
45 292 242
102 62 352 291y
92
101 281
99 72 63 601 60~ 42 2201
77 74 61 57
363 232
70
32 31
11 44 282 2202
Low l
- Tract
46 682 681 I 331 30
r~$ 47 1042 332
48 102_41_
11
~
Visits to Family Planning Clinics Ranked by Census Tract High to Low
Rank Tract Rank Tract Rankmiddot Tract Rank Tract Rank Tract Rank Tract
1
2
3
4
5
6
7
8
9
10
11
12
13middot
14
15
16
17
361
56
401
341
48
59 121
20
55
342
10
31
58
93 21
241 132
331
53
461 462
18
19
20-shy21
22
23
24
25
26
27middot
28
29
30
31
32
33
391
32
middot47 I-i-_-shy _ -
231 111
332
972 1
372 371
52
89
32
92
82
100 31
182
30 242
402
34
35
36
37
38
39
40
41
42
43
44
45
42
1714 i 661 221
78 362 2
90 602 601 352
63 251
105 921
971 351
73 42 292 232
411 51
662
81 45 52
46
47
48
49shy
50
51
52
53
54
55
56
961
801
49 81 72 71
19
9~1
172
68 2 57 162 14 112
91 75 681
381 42
3~3
83 161
57 f
58
59
60
61shy
62 Imiddot
63
Imiddot 64
65
66
64 62 36~3 252
74 652 SO 392 291
651 6bull 2
79 271
r-- ---- shy981 222
672 671
821 272
94 87
281
382
67
68
69
70
71
72
73
74
75
76
77
78
981 26 12~2
IS 61
85 82~2 69
61 43
101 86 84 282
76
131
51 72
1041 962 88 70
99 922 77
103
95 802 181
i
~
Low High
RankRank Tract
5479
4480
81 1042 ~) middot102
71 - - + ~ - ~
Visits to Family Planning Clinics
(Contd)
Tract Rank
I
Tract llaDk l
RankTract Tract Rank Tract
~
I
~
J1 ~
Low
Total Number of public Health Nursing Visits
Ranked by Census TractsHigh to Low
TractTract RankTractRank RankRank TractTractRankTractRank
25249 71 79 17249 8033 6586 99189711 84 2915072 34 661 76 66 811519512
402 5035 51 161 2518220 122 1713423 352 55801 7120 6752 2 149814 41236 83 2662 38 94 6821 53 2924015 362 37 32 42 75 69 281 84 63
546 8822 54 222 85 3925431 70383417 3818223 6439 4386652 718 21 55 103332 8924 232 87 19 271729219619 24156 16211140 382 628825 10523110 112 73411 10141-- ----shy 89 363 4457 8126 16111 221 74 9142 90 46158331 53 671279012 46243 48 59 351 3837528 1083 9313 91 5844 59 -_242 76 1----- shy60 272 72 74104114 60145 42 9287 7729 92 6151 8215 57371 934630 91 307762 12113116 282 619447 41391 9531 78100 63 7378 ~95 681 6945 32 5632 798517 6448 47 52 181
High ~ Low
Rank Tract Rank
96 31 132 70
97 102
98 182 372middot 602 651 662
- -shy
~72 682 802
822 922 962 972 982
1042 ----shy
Low
Total Number of Public Health Nursing Visits
(Contd)
Rank Rank Rank TractTract Tract
I
I lt
I
Tract Rank Tract
[
~~~-
I
~
IJilfimiddot ~
j
Ranking of VD Caea According to Census Tracts 61 By High and LOll Youth Itatio
A media~ of 34 5 was determined Any tract having greater
than 34 5~ of popu1tionunde~ 19 years of age -High~
Any tract having l8S than 345 of population under 19
years == Low
Any tract having rate less than 390 =Low
Any tract having rate more than 390 == HLgl4
YOUTH
LOW HIGH
L
0
12 402 1801 1802 343 2801 2802 29023603
54 6001 600262 66~02 72 74 75 76
78 79 81 t02 65 1202
W
(25)
VD
H
I
G
H
401 701 801802 901 902 10 1101 241 1201 1301 132 14 15 1601 1701 20~ 21 2202 2j02 2402 2502 2702 2901 303501 3502 34023801 3802 383 3902 42 44 45 4601 4602 47 48 49 SO 51~2 53 55 56 57 58 S9 6701 6702 73 95
3~02 7021702 19 25~01 2701 4102 4101 63 64601 ~601 6801 680270 7l 77 8001 80~02 8201 8202 83 84
85 86 87 88~ 90 91 9202 920193 94 9601 9602~ 9701 9102 9801 9802 99 100 101 103 10402 105 6501 10401
(47)
301 501 502 601 1602 2401 2301 2201 31 32 3301 3302 3401 3402~ 3602 3702 3901 400140 02 43 61 69 B(
(53) (23)
~ ~gt
Ranking of VD by Rate Per 100000 By Census Tract
~
Rank Tract Rank Tract Rank Tract Rank Tract llank Tract Rank Tract Rank Tract
1 2202 21 S6 40 902 58 1602 74 75
90-shy 64 107 26 --~-
2 3402 22 45 41 10 59 902 75 78 91 54 108 61
3 2301 23 3502 42 2502 60 602 76 6802 92 402 109 87
4 3302 24 49 43 1102 61 501 17 2 93 94 110 90
5 50 25 52 44 6702 62 14 78 8202 94 97 02 III 76
6 2201 26 20 6701 63 4002 8201 2501
9701 41~02 112 91
7 44 27 48 45 401 64 3802 2902 95 63 113 62
8 3301 28 1701 46 502 65 30 79 83 74 96 9602 114 71
9 55 29 47 47 42 66 3803 80 2801 96Q1 115 85 10
11
12
13
14
15
16
17
18
3401
53
2302
2401
57
21
2402
1101
51
30-shy31
32
33
34
35
36
37
3701 - -~ 1201
3702
89
43
132 131
3602
4001
48
49
50
51
52
53
54
55
58
1601
601
4602 4601
69
701
31
3901
67
68
69
70
71
72
2901
801
39021~ 802
6502 6501 122
702
41~01
81
82
83
84
85
86
87
88
19
1
1702
2802
79
93
100 6801 6602
81
97
98
99
100
101
102
103
104
9201 9202
9802 9801
77
302
79
86
72
84
116
117
118
119
120
121
3603
8002 8001
101
99
95
10401
105 10402 103 102
19
20
59
32
38
39
2702
3501
56
57
301
3801
73 1802 1801
89 6002 6001
105
106
2701
88
High Low
-- -----
Rank OrdermiddotTuberclosis Cases by Rate Per 100000 Ranked by Census Tract High to Low
Tract TractRankTractRank Rank TractRaukTractRankTractRank
801
79 9601501411 52 6835340120511 I 960269 903603532036 $-~~F130221542 4366 311301 70 68~013802 _ I- _ 4001_37213 3921201 6802802 H71523822024 22 54 193302 3802 80 8958 I37139535 70155 9801 I60123 72 6702 98023914011016 6701250124 10 56
81 94 401r 7 154152 73 7057 2625 122 92028
90242 162312301 92~158 86 7172434526509 82 79160159 74 100 87412240227220110 6502836960 75 30 8317244 6501782801285711 61 901 42765645 84 66021459294912 9701 660146 171 302 9702 47
6235023033113 85 822821182 917755 16335013110214 841814832 78 103 938564 324815 86 1057940149272 38036523216 10401 87 2902241 725Q 10402360266340217middot IF88 88 9937233 282 51 218 101 01102 46016234
I)167 2901460219 47
High ~ Low ~
- -
TractRank
9S89
6490
8191 8001 8002
63 61 60middot01 6002 44 2701
92
J
2502 402 --- ----shy
I
Rank
Rank Order Tuberculosis Cases by Rate per 100000
(Coutd)
Tract Rank Tract ~nk
I
Tract Ballk Tract Rank
Imiddot
Tract
Imiddot
1~
t 1I i Pi i l I
o
1 -1shyL I
I J
8 40 icO ~ I -lt 0
-t (1) I
i I
r o E
II
a
I
r--i
shy
I
~
I (
Jgt
(011 fi(
Ggt
I II ~j
()
(f 0
~ ()
I
11
f9
r
II 99
o ~
Ggt r
~ __-J~ I t I ~ I
r--J l I
~ _ __ J
) 1
fTl
1gt
r I
()
r
()
lt en -i en
()
I1l
(J)
(J)
-i
P ()
19
r o ~
r G1 I
I
c
~
o I 89
--- -I-shy
r-r I
1- 0 _~ _ _--J E
G1 I I I
i i
I 1-1-1 ~ _J ~2 ~ II
II
()
1 I I I 1
id i bullbull
~
A n 69
r 1shy
- 0 Gl
l--~ ~ I
~ II
II )
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IA Ol
AN APPROACH TO THE DECENTRALIZATION
OF HEALTH CARE SERVICES
IN MULTNOMAH COUNTY OREGON
by
STEPHEN LR COOK
and
ROGER GEORGE PHILIPPI
A report submittedtn partial fulfillment of the requirements for the degree of
MASTER OF SOCIAL WORK
Portland state University 1972
ERRATUM
AZZ pages are intact but foZZowing Page 57 the
pagination is in error due to omission of the
number 58 in the series
I bull
TABLE OF CONTENTS
INfROOOCTION 1
PART I 5
Tbe Concept of Compreheuiva Health Care 6
ThemiddotCoapreheDsiwmiddotXeigbborhood Health Center 9
Efficient Use ofmiddot Scarcemiddot Resources 19
SUmmary aDd Conclusions 26
PART II 34
Demographic Data 37
Per Capita Incoe by CensuS Tract 38
Mental Health 40
Family Pleuning 41
Pub11c Health Hurs1Dg Vjsits 43
VanerealDisease 44
Tuberculosis 45
CHARTS 48
~ 65
)
JNIRODUCTION
In the past several years the subje~t of health care
delivery has assumed increasing importance asa public issue
Congressional hearings public and private commissions and
task forces have investigated the functioning of the health
care system in depth reporting that access to the system
is impeded by financial barriers and by inefficiency of the
delivery system (8p1) 1 Medicare and lled1caid have
attempted to surmount the financial barriers for some segshy
ments of the population and more inclusive health insurshy
ance proposals are being considered in Congress The
Healthright program tmd~r the Economic Opportunity Act
has stimulat~d efforts to improve the delivery system as it
relates to low income persons and some of the health
insurance proposals also have the goal of improving the
delivery system
The Task Force on Organization of Community Health
Services in Health Admin1stration and Organization in the
Decade Ahead (25p13) briefly presents four interrelated
concepts which form a framework for looking at health as a
l Numbers in parentheses refer to bibliography at tne
end of Part I
2
middot$
contemporary policy issue
1 Health is a resource for the social and economiC development of the nation as a mole
2 The healthand social needs of the indishyvidual in modern society are Ulti~atelyinseparable thus the presence of indenti shy
tiable poverty as an adverse influence on health progress and improvement and equally the condition of 111 health will tend to interfere with the individualts ability to function and beproductive~
3 The concept of public health in today s world has begun to expand markedly moving in the direction of convergence withprivate medicine and voluntary efforts these spheresbeing included in the broader term ttcommushynity health
4 Thereex1sts aninescapable interdependence-shycommunity state and national--in the adminishystration and organization of community health services
Obviously the health care system is one 1hich has
many aspects bull Although these aspects--financing manshy
pow~r service delivery~are interrelated we intend in
this report to deal specifically with one facet This is
the decentralization of health care facilities to provide
comprehensive health care services at the local level
The report is presented in two parts The first
part will examine the literature relating to the developshy
ment of the comprehensive neighborhood health care center
as a means for the delivery ofmed1cal care services An
attempt will be made to determine from the health literashy
ture criteria for the evaluation of medical care systems
and further revie of the literature 1111 attempt to
3
determine how these criteria can best be met in a
decentralized medical care delivery system
The second part of the report will examine the health
needs of Multnomah County Oregon with the goal of
providing information about theseneecis for use in health
serv1cemiddotplanning particularly in relation to the
decentralization of health care services
I ltllYd
-
5
~E
Evaluating the Health em Sxatem
~ (8 pp1-2) has 1nc11cateda number of the weakshy
nessea of thepreaent health care system in this nat1on
She c1 tes risDs coats iDadequate pooriy distributed
and 1rietf1ciently utilized manpower andtrapented
service delivery a8 ma3or problema and state that The
systeiD 1swaste1ll otreaourcea andfunctions W1th too
11ttl reprd tor U1ci8Dcy aDd aCoDOIIIY
Shepo1Dts out
hoWever tbattbere are tour points regard1ns reform Upon
which there is widespread agreement Firat she states
IIaccesstoneede4 health emces must not be 1mpeded by
t1DaDcial barriers II BersecODd POint1s that bull bull the
continuoua health sernceare eftryw2ere ava1iable under
cond1t1ons that are physically conveDient comfortable
anclnot destructi to the d1lD1ty or selt-respectof the
recip1ent b1rd it is essential that the health care
syst8lll Iie due reprd to ecODOIIIY 1D the use of scarce
resources providtDg services with eff1ciency Finally
the system must be accoUDtab1e to those who tiDance it
and to those who 11IIe 1t and in particular must be highly
responsiva to the interests of coD8Ulll8rs II
Gre8Dlick (18 p756) also prQPoses a set of princ1shy
ples which can be used to naluate the ed1cal care
system ae states tint that bull bull all those who need
medical care shouldhave equal access to 1t second
(
6
bull bull the sernce prortded ahould be precisely approshy
priate to the pat1entl1eedemiddot ft and tb1rd bull bull the
med1cal care ayatea ahould provide the lOst eff1cient
and econoa1C8l use of scarce IIe41Cal resources
orthepurpoesof tb18 report certa1not these
crtteXaw1l1bestreaae4 lION tbaD others The rema1llder
of PaXt I Will renew the l1teraturerelating to the issuee
ofcomprehenaivene8sof ervice access1b111ty ot serv1ces
aDdett1c1ency oten1ces 111 tbedel1very ofdecentralized
medical car
ratCopcept of C_ Beal1h care Asd1oal tecmolol1 bas advanced a process of
evolution basoccurred inthe aed1cal and health t1elds
As JOhDsoD (21 pp~361-363) etamptsmiddot bull the goal of
healtb carelD our society baa evolve4trom rel1ef of
ajmptolU to ~ otdi toex1steDce in a potent1ally
diseaselessstate C1t1Dl tbelJm1 tat10DS in health care
resources and presenttechnololY he cont1nues to state
that The resulting cbal18D1e facing the Amer1can health
serncesystem is to provide each 1D41Y1dual with the
sreatest possible opporturnty toach1eve an optimum level
of phys1cal Jl8Dtal amd so()1alwall be1Dg
to
reter to the type othe81th care aystemwh1ch attempts to
answer tb1s cba]] and fult111 the three principles of
1
access1b11it Prov1UOI1ot appropriate services and
eff1cient use ot middotre80urc He state that a IYStem ot
comprehensive healthmiddotmiddot care 1DmiddotoXder to apIo middottbe stated
principles fD lleetiDlita 1Oalttst havemiddot certain
attributes
1 middoteare utdbeollW~ItaC1~orpn1zatlOM]ec ~ bull p~~ol1calbarriers IlU8t be removedbull
2 bull Care abould ace he~ecl1merlt8 ot distance residttiiCemiddot tille must be removed
middotcare8ho1ll411eC-r0WIZ the Ufemiddot span it diseases eapec ychronic are to be controlled betoretheybecome disabling or lite threateD1Dg
4 CeresboUd be~teJ1nCludlJ1C p~vention cure ma1ntiDiiCeand rehabI11tation
5 Care aho11l4be~i9_ttIa1t1ephyaiolol1ca1 aD4 pay1Fci1~cTrIS-ticot the pat~ent
6 Care aboul4 middotbe9L~ tJwrefore shouldbebu11t aro~ middotslJOc1al1natltutloDs which relate to the patients Way of lite suCh as middotthe home school and place of work
7 bull Carellbolld be m-ar and therefore shoUld bemiddot provIded ~Wliils where responsishybiUty tor the patient bas beendetem1nedauthority has been delqated and a communishycation syst_ provided
s care slIould 1Ie HIl 1nclud1Dg theintesratlon ottac1~1ts~ ~prsOllDel neceaary tor modern medical care
9 bull care dbe Of hip ~ eresboul Th ahouldbe aD adequate audit 0 care pee~ reviewcoDtlDUDI naluatioDBnd research intomiddot adequacy aDd quality
Ult1ately as 1Dd1cate4by the Nat10Dal CollllDisshy
8
sion on ColDJIIUUity Health Service (26 pp 1~20) the
c1evelopmezat of a ampyt of comprehensive health care is
a cOlDJIIUUityw14ere8pODSibilit1 1nvolviDS the integrashy
tion of all the health care facilitie and programs in
the cOlDJIIUUity or the c0arcm1ty8 healthc~ system
the PamprqlOIIlt goal ~
PrQv11~ of a ~rehive ~e 9tcoaaun1ty health aervicea
2 Ma1DteIlace ot aD a4equateqUaDtity ot al~requ1re4 health care facilities
Iritsrat~oDof ~v1c1ualUD1ta and s1steas ot bealth aerviceinto a coordishy
natedpattem ot continuous care tor theindiVidual
HoWYer aYerby (37 t pp71-72) 1Dd1cate the
med1cal and health care 81atmiddotaa it ball t1nct1oned haa
not facil~tate4 the delivery ot COap~usive middothealth
care IDcl1Y1c1ualhealth care facilitie themaelve havemiddot
notg8D8nally tuDcU0Af4tOach1eve tbi810al pUblic
health departaent 11) prond1q prev_tive services and
$1Ch trea~t activities aa are involved in venereal
disease or tuberculois control have in general avoided
1Dvad1Ds the curativedoma1Dotprivate mediCine Th1s
haa even been cabullbull1DareaawherelI~cal care is not
readily availa)le except throUlh hoepital outpatient departshy
lDent8~ Aa he 81IIet mothealth departaaents have tailed
to proVide an adequate _try point for the patient 1Dtothe
diapoatic and curative a bull t of tile health care aystell
This may be particularly true tor the pOOr patient who may
9
b_dloallYUDaoptdatlcaW4lberefore th past decade
babullbullbull~ bull lIOYeaeftt to evolve DfW torms ot health care
and new types ot health oare institutloDS providing
comprehensive oDlOiDI care rather thaD trapented care
There seems to be little dispute in the health
aboe requ1res both an lDtesratloD ofprev1ously uncoo~
ditultec1 health care ervlcbullbull brlDSins tolether into one
alency what Johnaon (21 p362) reterred to as bullbullbull the
concepts ot cOllPrehms1veIled1C1ne andpos1tlve health
andaporpph1cclecctrailzat1on ot ervlce dellvery
he NatlODal CoimD18810D0D CouD1ty H_81th Services
report Health Care gilitis (26 p37) suggests
proYic11Dl compreheDaive health care services by centrashy
llz1Da a varlet ot publlc and prlvate healthcare
tacllities 1ntohealtb campuses However as Kahn
(22 pp274) states amppeskin ot soclal servlces in genshy
eral bullbull bull if the loal ls to develop a service-delivery
approach that improves access taclltates teedback 80 as
toadapt to user preterence8nd prlorlty and maximizes
case 1nteptatlon aDd accountabl11ty the base of the
total 80clal service system Should be tnthe nelSbborhood
Dec~tral1zatloD not only makes services IIOre accesslble
but allows therv1ce to be tailored to the Deeds of the
10
areaDe Diaz (14 p3) indicates the importance of
being aware of groups in the neighborhood with special
health problems such as elderly people or large families
witb yOlmg children This means that it is important
in planning to be aware of the demographic features of the patient population This will be considered more
thoroughly inPart II of this report
Kahn (22 p275) continues however to indicate
that more than the improvement of service usage is I
involved in decentralization and that decentralization
ot service delivery also represents part of tI a general
search to break down cities to human scale for some
purposes on the assumption that people find it easier toshy
relate to a neighborhood orsection and to its populationbull
bull bull bull Thus the organization of services at the neighshy
borhood level bas the added purpose of contributing to
the search tor neighborhood n He adds that this process
i8 more relevant it there is a measure of local control
over as well as local availability of services
Kahn indicates that decentralization is not a
viable goal in some circumstances These include situashy
tiona in wh1chthe need for a particular service is too
TJI t
-
11
little to justityits proVision in a l()calun1t where
skills or resources are too rare to be provided locally
or where the costs ot decentralization vastly outweigh
the benefits He Visualizestheult1mate emergence ofa
h1erarcb1c81 patternofserv1ce delivery tnwhichcertain
services andresp0D81bilities are middot1ntegrat8d1Dto the
collimun1ty at thelooal level Other more specialized
services relate to larpr un1ts of the colDlllUD1ty such as
eomb1nationa ot neigbborhooc18 Veryspecialized services
are to be delivered at city countystateop regional
level8 fh1slevel would al80 be the seat ot prosram
coord1zaat1on staDdardprotection and evaluation 811
of which call for cons1deZable centraliZation for overall
program adm1 nlatrat1on(22 p275) AlthoughKahnt s
model was not developed specltlCally tor health care services 1t1s quite relevant- and appliCable to health
care service delivery systems
Omiddot Donnell (27 p3) reviewing the 1iterat~e on
service delivery and social action through neighborhood
service centers preseJJbB a list of characteristics
generallydesirable in ~eighbOrhood service delivery
centers Firsthe states that the center should be
accessible It should be in a physically convenient
location and should be open evenings and weekends as
well as providing at least em~rg8ncy telephone coverage
t
~ II
12
24 hours a day
The center should als~ be irDmed1ate in 1ts funcshy
tioning That is the centermust have the capacity to
provide prOmpt efficient service and should be able to bullrespond to problems middotwithout long hours ofwalt1ng and
many rounds of apPointments
The centexsservices should be 6omprehensive liThe
center should offer a full range ofusable oil-the-spot
services or easyaccess to other resources by available
transportation It should gear itself to the needs that
peoplehaV8-especially poor people-and provide for the
slmultaneoushar1d11ng of problems were possible
SerVices should 8180 b 1J1tegrated and coordinated so
thatseMces can more effectively be provided
The operation of the service center should fInally
be responsive to the needs and desir-es of the neighborshy
hood It should provide ways in which reSidents can
shape th~ program and continue to contribute to its course
and development It should be relevant and ready to
respond to changing needs II
The concept of the comprehensive neighborhood health
center developed by OEO (31 p324) has been described by
severalwriters Yarby (37 p73) describes it as an
outpatient racility which has certain def~n1te characshy
teristiCS middot1 Accessible to a poPulat1on concentration
bull 13
2 Open 24 hours a day seven days a week 3 Family-centered c~e by a team of lnteniists pediatricians clinical and publichealthnurses and social workers 4 Availability ot frequently~requ1redspecialist in such fieldsaspsycbiatryobstetrics gynecology surgerY5 Con~1nu1tyof doctor-patient relationshyship 6 Family records with social and medical ~raquomDaries of relevant information about each family member 7 Basic diagnosticlaboramptoryand x-raytacl1itles and drugs and biologicalsavailable atthe center 8 Directline (1)y center-controlledambushy
lance when-necessary) to ateach1nghospltaifor cl1agnostic ~d therapeutic servlcf)srequiring the fa011itlesandpersonnel of thehospltal 9 Patient-cantered and eommUn1ty-oriented -
The range ot services in the comprehens1venelghborshy
hood health center shouldbe as complete as possible
inCluding preventivediagnost10 treatment and rehabi-
litative services and Sbouldbe deslgnedto eliminate
episodioandfragmented services (31 pp324-325) Schorr
and English (33p291) add as additional characteristics
ot the compr8henslveneighborhood health cent~r that it
should ~ve intensive participation by and involvement
of the population to be served both in policy making and
as employees and that it should be fully integrated with
the existing health care system The Office of Economic
Opportunity (28 p63) stresses the potential for easing
health manpowershortage$by trairiing local neighborhood
reSidents as non-professional health aides at the same
time creating new job and careeropportunitles As
14
Gordon (16 p bull 422) indicates Many of the outstanding
problems in medical practice todayrevolve around
effectively motivating the patient and the prospective
patient to be concerned with his health This is
especially true in a deprived environment The community
health center with its technique ot consumer partici
pation maybe a way to create this cooperation effectvely
It is important to note at this point that the
comprehensive neiShborhood health center haaas its
constituency an integratedmiddot community r~ther than a
particular segment It should haveas Blum and Levy
(6 pp~5) indicate a horizontal rather than a vertical
relationship with the commuriitybull The vertical relatlonshy
ship they state is characteristic ot those service
organizations wh1chapproach the community only in terms
of their own fUnction Tbey see only their relationship
with the users of their service and assume that problems
of accountability will be handled by these consumers
However they pOintout this ienot likely as a vertical
approach creates dependency onthe institution Agencies
in a horizontal relationBhllp recognizetha1 they have
both acommunityand a consumer to serve The horizontal
approach places the matter of accoUltability on a broader
basis than just the involvement of the consumer De Diaz
(14 p4) speaks otthe need to ~develop a community
facility which difters from a clinic for low income
1ji ~
15
people in that it should serve an economically integrated
community The reason for this is that a wide variation
of consumers may assure a better quality of care
The advantages of the comprehensive neighborhood t
health center over traditional systems of providing
commuruty health services are numerous Hospital outshy
patient departments a major traditional source of ambushy
latory health c8refor poor patients have been indicted
for neglecting preventive health care ~romoting fragshy
mentedeare and subjecting patients to degrading and
impersonal conditions to mention only a few of the major
defects (31 p324) Another defect has been the
tendency to shunt low income patients back and forth
between different cliniCS often at different locations
arid with differel)t open hours for different treatments
or tests in regard to the same lllness(26 p63)
The comprehensive neighborhood health programs that
have been organized present a great variety of organishy
zationalpatterns one area of difference 1s in the
emphasis placed upon making each faci1ity comprehensive
in the services it provides to the patient population
In the Montefieri Hospital Neighborhood Medical Care
Demonstration program in New York City services have
been made available through a central health center and
two store frontsatellites the center to be the base
bull
Li
l of opratiol18 of ta1lJpIlflicl- ancl the satellite
center the ba of oparat1oDa of public heaJth nurses
an4 nllbborbood amp1 be satellite centers wereto
proVide preVentift tutaltll bullbulln1c1-m1zaticms w811shy
baby care per1od1c ~ectiland tJle central health
center to proViAle care tor illnes If (36 p299)
bis propWI VUDOt ~ttullytunct10DIDI at the t1JDe
it d1cu8ae4 18 tbe Uterature aDd all aernce Were
be1Dl provided 1D_~terBowever itwould ae
tbat the ntua1pro~ as aY1ioae4by its plmmers
would boclJ aoaeot bull 4efeot~ otthe current lud1cal
ccde teaIt pObullbulllne_t coorctJl8td admSDtshy
etration eD4 well 4eftlopecl refelTal procedtlreacould
1I1a~ thecOllDeCticmof t~_t8 withappropr1ate preTellshy
t1 aD4 therapeu1ampcaen1cbullbull aV81lable 111 diffrent
locationa Bowner tile barrieraottiaeaDdUatanc
between center and truaraUon tor the UDSopb1aticated
patieatlook1Dl tor 1her1~pJce too tor ~1CU-
larhalth serfplusmnQewoGl4~to JJa1t tbbll1ty o~
tb18 ~811D to provide iaaiYCOliprelleU1P18hboltleod
health servicebullbull III tactmiddot tappeareto coDtlict with
tbepro own taW cOfdotpro-1~a tam1ly
mecl1cal careprogru 111 wIa10h pre-teAtlYe aDd therapeutic
health erY1cecan be proY-lW to all IIl81Ibers of
tamily in the coure of aaSDll vi8it (36 PP301-3(2)
Dle Delmtr Coloradoprepa11ke the Montet1ori
LI
17
prograJlut111zbullbull abe1rarcJly ot SlDa11 aatellItestations
andlerer IIOreceDtallzedtac11It1es It 41ffers
howeverill tbcolap~81vene80f the services avail shy
able Inthe 4ecentraUzed facIJJtiesIt resembles very
clc)sely the IOdel ~ordecentral1zed social servicedell shy
very developed by 1ahII~ Which was 41sCussed above he
SIlall neImiddotgbborhoodmiddot c8Dt~aw1tb1n walkl distance of
most of the populatiotl havebeendesilDedto take care
of allthenorllalhealth probl of 3000-5000 patJentsshy
check-ups IlzatiOZl8s1Jlpl laboratory testa and
treataentand iaecucatlol18 (d1apeued by phyS1cians) for
IIOst DODCrltIcal 1l11le PatIent 1d1Oneed IIOrespecIal-
Ized care are reterrecttobacJalp facilities BaCkup
support tor themiddot~t1oDa are the tWo l8rsernelshborhood
health C8Dter8~ttr1Dl aCOglete~e of out-patient
serneeaDd three part1clpat1q hoap1iampl bull bullbull which
proVide1Dpat18Dt~t andcoDSUltatlve services
(13 p1028) Intb1a prosrama coaprehens1ve range of
prevent1ve aDd trea1aeDt serric 18 aVailable throughout
the decentraUzed middotta The CoapreheulY8 ReIgbborhood Hea1~ Service Project
otKa1er iC)UDdatlcm HOspitals 111 Portlan4 OreOD 1s
s1ll11arto th DenVer prosraa 1D thata comprehensive range
ot out-patientmiddot services 1D prov14e4 in each of 1ts 10cashy
t1oDa althoUlhmiddotmiddot tbe oentera are larger and l bullbulls DDIerous
than 1nth DenverproPUh (12 p6)
Li i
18
In order that a comprehensive neighborhood health
care center be able to proVide continuity of care it
must have arrangements for hospital services integrated
into th system Yarby (37 p73) as quoted above
states that it 1s characteristic of the neighborhood
health center to be directly connected with a teaching
hospital However De Diaz (14p3) indicates that it
may be advantageous for purposes of service delivery not
to havemiddotthe center affiliated with a teaching hospital
She feels that such anaft11iation may lead to asltuation
in which policies might be determined more by the teaching
needs of a medical school than by the service needs of
the patient
middotThe Nat10nalmiddotCommissionmiddoton Community Health Services
(25 p69) states that such a system of comprehensive
health care integrat1na ~e servicmiddotes of several health
and roedical agencies snould utilize Itas much single or
unified management as possible Neighborhood health
centers have been operated under a variety of auspices
but several writers have pointed out the advantages in
termsof coordinated prOvision of servictts management by
the hospital of the neighborhood health center For
instancethisfac111tates the keeping of unified medical
records of all the care a patient Msrecelved either at
the neighborhood health center or _le hospitalized
(12p6) ~ermore a3 Young (38 p1741) points out
19
direct operationot the u1sbborhood health oenter by
the hoSpital canll8lceaftilable to the center expertise lt bull
in sOlle aapcta 0 Operation that m18ht not be aa readily
available otherwie
Relardlebullbull of wbetberthe hospital and the neighborshy
hoodhealtbcent8r haVe a cOJIIIOaadmjntstration they
IIlU8thaVealTlved at a str1Dsent delineation of IDUtUal
role and reSpoDBlbilltiebullbull All OOIIpoienta ot the care
yst IIlWStQlarify and understand one anothers position
In the syatem and acree on objeCtive ancimethOds
(26 pp16-17p31) SODae areas of iDUtUalconcemare
reterral procedures record keepiDg aDC1 mutual use of
facilit1es statt1Dl i8 anotb8r ~ ot coaaon conc~
Ditt1cultift have u-laeniD the pastiD cOllprehensive bull t bull
healtbc~ prosraumiddot 1d11ch were batil plauned in wb1ch
all of the health canter phy1C~1IDa did DOt bavetatf
privilege at all ot thebackuJlhospltala (29 p21)
SUch a8ituat10n i8 1Dampcceptablelt inpatient care i8 to
continue to be p4by the pat1eatmiddot health center
physician and it cont1Du1ty ot care 18 to be maintained
Hoapital and health center1lUSt laav 301nt responsibility
tor the recruitaentot physicians
VticlentU IPan BJcNrcu Much otwhat haa b8ea sUd has stre88e4 at leastmiddot
iJlplicit17tbaD8ed tor tM etticit middotprovision ot8emcea
20
There appears to be two aspects of efficiency which are
discussed by writers on the su~3ect of the comprehensive
neighborhood health care centef one of these is the
need to organize) services to make the most efficient and
economical use of scarce medical care resources The
other closelyrelat8d in realIty is the need to help
the public use services in the most efficient manner
The comprehensive neighborhood health center concept
1s lhherentlymiddot efficient in that preventive curative and
rehabilitative health ~are programs are coordinated under
one roof with integrated a~stration Furthermore
theempbasLson prevention health education and early
disease detectionis eftic1ent troJll~estandpoint of
the health care system as well as beneficial to the patient
(18 p760) HQwever ~ue tothe scarcity of health care
personnel thecoiDprehensive neighborhood health center
mustbe an arena tor eXperimentation with new staffing
patterns~ The Kaiser program is indicative of the way
in which health care systems must begin to operate in
that appropr1ate ancillary personnel are used Wherever
possible to perform functions that do not need to be
carried out by the physician As Saward (32 p42)
states
1hroughou10ur organ1zat1on~ there are many of the customary experiments be1ngmade-shyJse of speciallr trained nurses for well-baby care under the SUpervision of the pedi9trlcianexperiments with routine prenatal care by
w ~
21
middotSPC1a1l~t~JlUrbullbull per8ema_1 bullJmdlJleu y our fuDotlou are auoh that DOtb1Da 18 dorutbYtbe phY8iCianstbat doe DOt vet to be done by the
phys1c111U1fhe other aldlle4 person- Del-nurse middotreC~0D18t the appo1ntshymeDt center or clerical praormelshyaremiddot there to free h1amiddotto use his spec1al sk111
Awell lmoWn treDd1D the area of eaaiDI health
c8re JII8DPOY8rShortagjs bas middotbe thetrend toward tra1nshy
1DB poverty area rea1deats as DOD~pro~eaionalmiddoth8lth
aide and nepborboocl health workeramiddot (28 p63) This
bas the effectofmiddotmiddot1J)creaa1q II8DPOWrand 8180 can help
bridle the cuJ~ cap betweenprondera and colllUmers
of aen1C8s This attarD at least tlleoretically
createa a situation 1D WIa1ch providers andcoD8Ullers can
be educated to UDderatad OD88DOtber and interactJlore
ettectlvely~ HoWever amiddotpltt8ll has beeD themiddot tel14ency in
801D8 oamp8e8 tomiddot us aidesmiddot ssale8lllcw t~r the center
alJDOatexclwdY811rathertbaD ua1Dltheal to protide the
health care for wh1ch ~ were trained (29 pp3B-39)
1bat ismiddotmiddot vh1~e the a14e Yalue in ~~m1catiDI with
low 1nCOlMt patieata haa beeR recoSD1zed and stressed
their role ashealtb carepersoDDelhil been slighted 1n )
any 1Dstancea
Anotber step 1d11Ob bullbull been taken to provide 8rY1ces
more efficiently eUeot1ftlybas beenmiddot theorgan1zation
of per8ODDeliDto IIllt141sc1pl1Dary teamaaaa means ot
proYid1DgmiddotCOQrd1DatedserY1ce SUch te8lll8 sen_rally
~
hf
~
22
include PhYsiciaQs nursbullbullbullbull soc1al workers and outreach
workers Conceptually th8y fmlct10n to me~ the intershy
relate lled1cal and social needs ot the families sened
Hor there are a number ot barriers to the etfectve
tlmctiOD1nlof lIuchte8ll8 SODieot these are heavy caseshy
loads the inordiDate amount ot tille consumed by multlshy
prOblem tamtliethel1m1ted tra1n1 ngmiddotmiddotand laCk of tnterest
on tile part ot aoae tebers in examinJng aspects of
problems out14e~lr oWn areaaotcolIPetencemiddot and
~ourdcation prc)blell8 between proteasioDala and nonshy
prot81~s (10ppa-10) middotrurtbemOre as De Diaz
(14 middotp6)1nd1cate tbel8 maybe a teDdency tor vertical
dp8rtmental lines of auperv1810nto become paramount
over the team coDamloation syst lead1ngto conflIcts
in determ1niDI the ro1ea ot solie team bers particularly
the DOD-prote81011alaInauch exper1l1enta Witb new
~t1Dlpatterna it 1s bullbullaentialtbat line of authority
roles aDd NsP0D81bll1tlea be made explicit and that there
beJDechaD 8IUI tor relUlar evaluat1onotfunctlorUng
Another way inwb1ch health care sernee delivery can
be made more ett1cl8Dt is to proVide servicea dur1DC the
hours whentbey aremiddot -ostnee4ed As reQo_ded by Yarby
(37p1) serY1ce can bemadelIOre accesslble by making
themava1lable 24 hours a day seven days a week If
rg8l1Cy service are aft11ab1e aroua4-tbe-cloek at ~
nil1iborhood health center the continuity ot tbepat1ent ts
23
careiamaiDtalDedand meatry point into the
cOIIPre~i health care 8 be made available
tothe patient who aoZMllyU8ea ozilymiddot emergency care in
tille of med1cal criais More 8isDificantly ava11ab1-
lity of a tull rase of bullbullrv1c8 tor seVeral hours 11the
eVerlna aI1Cl On ~ prevent the los ot earn1JiSs
involved if th patierat 1IU8tt8cet1me oftfroawork dur1q
the d8y for aed1Cal oare bull his can be an eSpecially
importantc0J1814eration tor lo1aCOlleDUUg1nally qloYEtd
patient aa4caJla18o PIOJIOtet1)e 0Da01Dl use othealth
servicebullbull
exper1eDO ot tbeKa1er prosraa in tb1s~reprdAs
Greenl1clt(19 p10) states wA lllNt 8ip1flcant
proportion ot the abulatory care 8n1cp~Y1dd tor ~
total popUlatiC)U ~ ~ after clWc hours and this
Deed i8 apParenUyaoN prODGUDced tor aJl8d1cally
iDCust population On the other hand the bulk ot all
aabulatory med1cal cu 88l91ce are performed dur1nS
regular cl1D1c hour eVen when services are available 24
hours a dayJ day bull week W
It has ~ the experi8D~eof a ftIDber ot ne1g1lboXshy
hooct hea1tbcentere _t a_jor obstacle to efficient
proViSion ot anicbullbullhas beentbe teD4eDcy of medically
1ncl1pnt patieats to utilize the center oa a walk-in
baais tor epi8od1ccr181or1entect bullbullrv1cea rather than
4)i
h~ ~~f ~~ L
24
to make appoJlltaeata tor ODIo1qprevmt1ve treataent
and rehebl11tat1Ye care ad ampl1O to bave a blah failure
to Show rat_for tbe appo1DtaeDts that they dO make
Atone center 628 of appo1Dtments made were kept
while 3Oottbepati_ta een were ~1n patients
AlthoUP fewer patiets were actually 88811 by the cater
1D middottb1s 1Datance thaathe -bervholuidmadeappointshy
mta the walk-iD patlat required an iDord1nate amount
ot staff t1ae tor aCreeDiaaacl ~trral to pplOprlate
~ttor caregt (9 pgg) Arraquotbr1llpl1catjo~ of the
plOVidedto valk-iD patient by other thaD their
(19 p12)rurtbermore
when patients uti11ze Wlk-1Il er181 centered care
athelr ODlf tona ot ootact with the _d1~ care
ay_ta fUilycentered care the treata_t of tUl11y
bers
a a UD1t 11
dlarupted
hewalk-1Dphenoaaencm appear to barelated to
diUerence between soclal clase in the style of Dlaking
contactJt1th the a11oal C~ay8t As Greenlick f ~
(19 p11)1Dd1oate8 thepheDOaenOn ot INater usage of shy
walk-in ervice by aed10ally middot1Jid11ent patient thaD by
others baa otte been attr1buted to a stoical att1tude
tQward 1llDe8 em the~ ot poor people leacl1D8 to a
~
25
greaterdelay1n tbe k i Dlofa8d1cal care These
patients wppoedlyeelcmiddotcareODlymiddotwIleD tbeirmiddotillDess
becOlles1Dtolerable resultiDSin middotthMr appeariDS withshy
outnot1ce1o rece1ve oareHlwever Greenlicks
r8aearcbbaa cut doubt on the existence ot tb1delay
111 report1Dg middot8J1IPtoJumiddotOfDeW 11laessand seek1ng care
Be bas tcrQDd 1bat s1ll11ar peze_tases of dioally
1nd1sent 8DClJ1on-aed1cally 1Dd1PD~ pat1enta seek care
on the aue daytbat aptou tirstaPPear
1fb11e GrHDllclc 1nd1cat tbat the reasonator the
greatertendeDCY of low 1Do~e pat18Ilta to 1$8 walk-in I
serY1ces are notlcDo1rAmiddotmiddot tbe7 _ be rel~tedto a tendency
ot lower aocio-ecaaaoclaa patieota to preter face-toshy ~
face contacts with II841cal persoDl181posslbly because
such contacts areft coatortiDS an4reasauriDS to
patients who are hJpotbeafzed to bave a dependent attltude
toward IIed1Cal care perS0Jm81 (30 p161)
It a8 itmiddot baa pnerally beenhld the appointment
s1stemts the most efficient Ileana of dellveriDS
comprehenSive oODtllluiDlh-lth care (9~100)1t is
necessary that educaUoraalmiddotbulltfort be taken to proaote the
use ot middotappo1ntaents8DClmiddot tQrec1ucethe fa111re to appe~
ratB4uOatioaalwhlQb baft~utl11zedhave been
IJ
26
1Dten1ews with walk-in patients home Vi8its and group 4i
meetiDp1D8D attemptto1Dierpret1o the patients
the value of rtitgular ppo1ntmentamp andot con~in~
c~1ve care rather than epiI041c care (9 p1OO)
h1s 1safuD~tioD torwhtch nOl~prot81QDal colDlllUD1ty
YOrkersllaY bebe~r8U11ed tban other statf H()wever
euch aD ~ucat1oaal propul __~ ~e related to the senUiDe
capacity otth health oenter to provide comprehensivebull gt
ervice8 to1tpat1_t~odoD aD app01ntment bas18 It
1amp pos8ibleo~rw1 tor educa110Dal ttorts to result
LD a~8JImCl tor ltPP01ntaen~8 at a ratewb1ohi8beyond
the capacity ot thee_tar to t without uareaaoDably
1_ wa1t1Dlprio4a QOBt1nuad use Ot the center on a
wallt-in bU1 _1tbeoosiItpos81ble to et an appoint-
met anc11nCreued pit1entcoJaplampia1a bull Therew111 of
course always be a need and demand tor acute ep1so~c
Care -ci the health centerDlWlt be planned with the capashy
billty ot bullbullbullt1D8 tb1aneed wh1~ cont1Du1nI to stress
aDd educate the patient to utillze oDlOinI comprehensive
faa11y middotc~te~d Cflre (9p 100l
att g4 CODClva1opa
In order to bea4equate any coJlltemporary health care SY8tem muat bullbulletcerta1D interrelated criteria he
IJ
27
minimum criteria areaccessability of services to those
who need them compr8heX1siveness and appropriatness of
services and efficIency 1nthft utilizat~on of SCarce
health care personnel and resources The scareity of
pex-sonnel andtbe need for h1gh quality ongoinghealth
care services
aJIlong the
populationdemanci the most effishy
cientprovision of services
Services must be made accessible to the population
They mustmiddotbe geosraPh1cally accessible to remove the PhysicalmiddotbaTiers betWeen peopleandthem$d1calcare
system They mUst otter their services dur1ngthe
hours when people can make the moat use ofthemA~ it
makes little sense to concentrate services geographically
where they will not be uSed to their fUllest extent it
also is wasteful to provide serv1cesonlydur1righours when
many people are employed his not only presents a hard
ship middotto the consUmer lnrt wastes resources if for instance
the unavailability of preventive services during the hours
when people Can use them causes a need for treatment
services later on
Health carbull sEtrvices must be comprehensive including
prevention treatmcmtand re)abimiddot11tation Ambulatory I
healtbcare facilities wh1cQ are orienteciexclusively
toward either prevept1on or trea1mentare no longer accepshy
table for they are lneft1c1entln their use of resources
and in their prov1s1on of health care to the patient
w ~~
28
If prevent10n1s notmiddot stressed treatment serv1ces that
could have beenavoidedY1l~ be required If prevention
1s the sole focus of the health care facility sick
patients who present themselves must be referred elseshy
where for treatment andsllch referx-als may be taken as
reject1onsor not followed through with until illness
becomes unbearable
The instltutlontbat meets these requirements Is
the comprehensive neighborhood health center It 1s a
local decentralized outpatient facilityprOVld1ng a
fUll range of ambulatoJY health care services It has
a linkage to ahospitalbackUp facilityforlnpatient
treatment and hiihlY apclalized outpatient care
The neighborhood health center must be a fac11ity
planned with an awareness of the needs of the conSUtller
and coDitnUn1ty It must have the r~Ul0urces to provide the
services people need mere they can use them and when
they can use them It must uti11ze the part1cipation of
the community to develop this awareness Not only must
the cen~er beset up to be Amctional for the consumers
but efforts must bemadeaga1n with commun1ty partici shy
pation to help the consumers utilize medical care
services effectively The center muetmake efforts to
educate the community about the valueot regUlar health
care of preventive servicesand of the use of planned
IJ
29
medical appointments ratherthanorisis centered walk-
incare Therealit1es of the existing health care
system have not taught the patient particularly the low
income patienthow to use services effectively
The helthcenterilUst also bea laboratory for
experiments in easing the health caJepersonnel shortage
and c60rd1Datingcare~ A major difficultY iri-exper1shy
menting with neW rolesis freeing staff of old preconshy
ceptions
CoDlprehensiva neighborhood health dare centers have
been developed under a variety ot alisplces including
medicalsociet1es hoSP1talsmiddot(36p299 group pr~ct1ces
(29 p6- 12 117) health departments (13 p1027) and
ne1gbbothoodassoc1ations(14) The literature indicates
somevalues nthe management ot the health center by plusmnts
hospital backup faCility Whatever the auspices many
adm1nistrative fuDctions such as program coordination
standard pr9tectionand evaluation call for considerable
c~tralization of adm1nistration city-wide or coU)tyshy
wide At the same time other aspects hours of servlce
for examPle~ cuI f~radm1nistrative fUnctions made atmiddot
more local levels Each neighborhood center must be
free to adapt its functioning to itscominunity thi-ough
the mechanism otcODlllUl11~ participation inmiddot policy making
Obviouslythe prerogatives and responsibilities of each level must be negotiated and made explic1t
t4~
JJ
BIBLIOGRAPHY 30
1 American Rehabilitation Foundation ~ealth Services Research Center The Health Maintenance Strategy mimeo 1971
2 Anderson Nancy N Comprehensive Health Planning in the States A Study and Critical Analysis Institute for Interdisciplinary Studies American Rehab ilitation Foundation 1958
3 Andrus Len Hughes Comprehensive Health Planning Through Community Demonstration Health Projects mimeo1967
4 Barry Mildred CandCecil G Sheps A New Model for Community Health Planning unpublished paper presented to the American
Public Health Aseociation1967
5 Blum HenrikL Fred Wahl Genelle M Lemon Robert Jorulin and Glen W Kent The Multipurpose Worker and the Neighborhood Multiservice Center InitialImplications and EJeperiences of the Rodeo CommunityService CenterAmerican Journal of Public Health58 (Mar 168) pp 458-468 shy
6 Blum MichaelD and Soloman L Levy A Design for Service Delivery that Reinforces Constructive Tension Between a Health Center and Its (sic) ConSUDlers and Supports Community Power unpUblished paper presented to the American Public Health Asaociatiltn 1968
7 Brielaud Donald Comm~ity Advisory Boards and Maximum Feasible Participation American Journal of Public Health 61 (Feb 1971) pp 292-296 shy
8 Burns Eveline M Health Insurance Not If or When But What Kind Madison Wisco~sin University of WisconsinScllool of Soci~l Work 1971
9 Campbell John Working ~elationships Between Providers and Conshysumers in a Neighborhood Health CenterU American Journal2 Public Health 61 (Jan 1971) pp 97-103
10 Caxr Willene Neighborhood Health Centers Funded by the Office of Economic Opportunity mimeo 1970~
11 Colombo Theodore J Ernest W Sawardand Merwyn R Greenlick The Integration of an OEO Health Program into a Prepaid Comrehensive Group Practice Plan American Journal of Public Health 59 (April 1969) pp 641-650~ -
12 Comprehensive Neighborhood Health Services Projectof Kaiser FoundatioIl Hospital~ Prcgtgram YearE grant renewal proposal mimeo~1971 bull
13 CowenDavidL~ Denvers Neighborhood Health Program Public Health Reports 84 (Dec 1969) pp 1027-1031
IJ
14 De Diaz Sharon Daniel Beyond Rhetoric The NENA Health31 Center After One Year unpublished paper pres~rited to the American Public Health Association 1970
15middot Gerrie NorrrianF and RichardH~ Ferraro Organizing a Program for Dental Care in a Neighborhood Health Center Public Health Reports 8 (Aug 1968) pp 419-428
16 Gordon JeoffreyB~ The Politics of Community Medicine Projects A Conflict Analysis Medical Care 7 (Nov -Dec 1969) pp 419-428 shy
17 Greely David The Neighborhood Health Center Program and Its Implication(3 for Medical Care H~alth Forum of the Welfare Council of Metropolitan Chicago (mimeo) 1967
18 Greenlick Merwyn R Newgtimensions in Health Care American JOurnal of Pharmacentical Education 34 (Dec 1970) pp 754-4
19 GreenlickMerwyn R Donald K Freeborn TheodoreJbull Colombo Jeffrey Abull Pruesin and Erne$t W saw~d Comparing the
Use of Medical Care Services by a Medically Indigent and a General MemberShip Population in a Comprehensive Prepaid Group Practice Prosram II unpublished paper presented to the AmericanPublic Aesociation1970
20 H~tadoArJiloldVMerllYll RGreenlick and TheodoreJ Colombo Determinants of Medical Care Utilization Failure to Keep Appointments unpublished paper presented to the American Public Health Association 1971
21 Johnson Richard E and Merwyn R Greenlick Comprehensive Medical Care A Problem and Cballengeto Pharmacy ff AJilericanJournal of PbarmacenticalEducation 33 (Aug 1969) pp 361-367 -
22 Kahn Alfred J Studiee Social Policy and Planning New York Russell Sage Foundation 1969
23 Kotler Milton Neyhborhood Government Local Foundations 2 Political~New York The BobbsMerrill Company 1969
24 NationalCommisaion on CommunityHealthSfrvic~sActionPlanniriamp for Community SetithServices~ashington p C Public Affairs-Press 19t7
25 National Commission on C~mmunity Health Services Health Adminishysration andOrMPization l the Decade Ali9$-d Washington D C Public Affairs Press 1967
26 NationalCornmiesion onqomm1Jllity Health Servicesbull Health ~ Facilities Washington D C PUblic Affairs Press 1967 bull
~ n
32 27 ODonnell Edward J and Marilyn M Sullivan ServiceDelivery
and Social Action Through the Neighborhood Center A Review of Research tt Welfare ~ Review 7 (Nov~Dec 1969) pp 112
28 Office of Economic Opportunity Second Annual Report Washington D C~ U S Government Printing Office 1966
29 Office of EConomic Opportunity and the Medical Foundation of Be~laire Ohio Eighth Report 2l ~ Committee2a Governshy
ment OperatiOll~ Va8hiiiSton D C Government Printing Office 1969
30 Pope Clyde R Samuel S Yoshioka and Merwyn R Greenlick Determinants of Medical Care Utilization nhe Use of the Telephone for ReportiDg Symptons Journal of Health and SocialBebavior12 (June 1971) pp155-162 shy
31 RenthalA Gerald nComprehensive Health Centers in Large US Cities American Journal of Public Health 61 (Feb 1971) pp 324-336 shy
32 Saward Ernest W The Relevance of Prepaid Group Practice to the Effective Delivery ofHealthServicestt The New Physician 18 (Jan 1969) pp39-44 - shy
33bull Schorr Lisbeth Bamberger and Joseph T English Background Content and Significant IssUes in Neighborhood Health
Center Programs Milbank Memorial ~ Quarterly 46 July 1968) part 1pp 289-296
34 Weiss James E and Merwyn RGreenlick UDeterminants of MedioalCareUtilization The Effects of Social Class and Distance on Contacts With the Medical Care System Medical~ 8 (Nov-Dec 1970 pp 456-462
35 Weiss James E MerwynR Greenlick and Joseph F Jones Determinants of Medical Care Utilization The Impact of Ecological Factorstt unpublished paper presented to the American Public Health Association 1970
36 Wise Harold B Montefiore Hospital Neighborhood Medical Demonstration A Case StudyMilbaDkMemorial Fund Quarterly46 (July 1968) part 1 pp297-308~
37 Yerby Alonzo S ttHealth Departments Hospital and Health Services Medica1~5 (March-April 1967) pp 70-74
38 Young M M~ Chatanooga IS Experience with Reorganization fOr Delivery of Health Services ttAmerican Journ8l of Public Health60 (Sept 1970) pp 1739-1748
f or l
II bull 11 Y d
II
IJ
34
ThepurposeOfPart II of th1aa paper1atod1scuas
elected Speclfic needs ofecltlc areas within Multnomah
County A8P01ll~oUt 1D ~ I of t1a1bullpapermiddot Ita nelgbshy
borhood health oare cater IlU8t be a facl1lty plaDlled with
aD awarenes of the neeels of the oODllUller and collllUDity
Part II of this paper nIl Show 80e of thoe speclflc
needs
he1DforutiOD tor t1li Portlon of the report
obta1nec1 troll tbroupout tbe follow1Dl threepUb11catloDS
1gr~e_tiMshylIPrIxaiidOreson JuDe 1963
2 1~_middot_sectSI8e~ected1teai c-ua 0 S 8 e first count coaputer tape Coluab a_lion AssocshylatloD of QoveraMD-8 Jlme 1971
3 Jtu1tDoab County Oreaon BDY1roDlHtlltal SurveyEarly 1971
The JIultDOIIIlb COUDty OrttIOD BDv1roDllfmtal Surley
Barly 1971 1s bull stat1stical report of the activ1tles of
theentlreMultDOIIIl2 CcNDty Health Dep~t during the
year of 1970 Die speclflc 1nd1cs elected from tb1s
study amprejMental aealtll Publlc Health N~s1D1 vlslts
FaJUly ~ Veaereal])1 ~ ~rcul081
Throush tie use of cUrts and mapa ODe CaD roup these i
speclflc ~oea to ahcnr the healthneedsof speclfic I
census trtcta aD4 then the health needs of iarer neIghshy
borhooda 1m4 o~ Uebullbull
Rf)~UP1Dl of areu was accompllshed in thefolloWinl I
JJ ~
35
he MiltDoIliahCountY oregon BDViromaental SUrvey
early 1971 isamp statistical report ot tbeaotivities ot
the entire MultDolllh COUDty Health ])epartiDent dur1nl the
year ot1970 he specitic 1Dd1C8S selected frOm this
aUy are 1Il8Dtal health public healthDurs8s visits
fUl1ly pia waereal elisease aDd tuberculosia
Tbroq11the Wle otcbart aDd mapa aDecm szoup these
specific indic to show the health Deeds ofapecitic
ccmaua tracts aDdtIum th8health neecla of larsr ~eilh-
bOrhooda and co8I13 tlbullbullbull
RegroupiDI ot areas waa accoap118hed1D the
tollOWiDl lIIIIm1er~ A bullbullcifie 1ndex 8selectcl auch as
venereal di8bullbulle or tuberculo8i~ he total number ot
cs was then deterll1ne4 for each census tract Through
the use of the maber ot cRbullbullbull tor a 11Yen cenaus tract
aDd tbe population ot thattractaltrateot1lla1ampmcper
100OOOpopUlaticm wu cleteXll1ned for each census tract
This was ~e to starl4ard1ze the population ditterence
amongOeD8U8 -tracts 1he rate of incidence toreaob
cenauatract was then llstedby rank position on a chart
In rank poition1DI any cen8Wl tracts haviDg equal
rates ot1l1c1dence are assipe4tbe iaDk posttiona
Beeauseot the abo fact tbAt cbarta w111 vary in length
neveltbAtlea eacb cbart will 1Dclu4eall census tracts
inMullnoaah Couaty Atter the census tracts bave been
listed accord1q to raalcth1s list will bediv1ded into
IJ
36 three levelsotinc14ence he three levels are
1~ The upper 14 of1DcldenCe
2 Thelower 14 ot incidence
middot3 The ILld 12 of incidence
Tlles three srouplqa are then used in compiling a map ~f
Mu1tnOmahCountyfor ach apecltictop1cbull TIle maps are
uaefuJliD tbatthey V1suallycoJib1De 1Dd1v1Clualproblem
census tracts into larger problem nellhbOrhooc1s
The 1960 statistical iDtormatloD was Used in a similar
liIaDDr to tbatexpla1Dedabove 1Dthe4evelopaent of a
chartmiddot and map 1Ihow1DI e cOllpampriSOr1 of per capita lncolle
tor ttaCh ceDsua tJact aDdmiddot combiDed census middotmiddottract areas
he 1910 aDd 1960 statlstlcal iDtOrllatl0D was combined
lna map and chart he purpose of this and chart is
to d8aonatrate the e cl1stributloa1DeachceD8U8 tract
and middot1ndlcatbull tuture ace populatlon treD4a bull
When one be middotbullbullbullbullbullHdth ne8cts ot an area and has
declded to establlsh a cl1D1c to serve that area the
physical location otthat cl1D1c IllU8t be consldered In
order to coapreb8ll81vel develop an area cl1n1c one should
conslder thepre88Dttraftlc middot~ytaa an4tranaportatlon
systems Thecl1D1cahoUld be located close enoUlh to
major arterlals to giva asy access from the total area
be_ ervecl by this cliD1c At the t1ll8they should
be tar eo away froll thesarterlals to all8Y1ate traffic
CODCell18 andpark1D8 conpstlon By traff1c concerns I
IJ
37
lIlan one lUSt consider thertarro1fne8S of streets whether
streets are oD8--C)r two-way iqres8 and egress to parking
amp0111tie eros tratflC) spedof trattJQ children 1n
ll8a traffic i1lht Vislon re8tr1ctionS etc
BwstraDsportat1onshould alao be central in this area
as maay people ~U f1Df1 1tD8Cessary to use this form of
transportatlon
~e tutqredlopHQt of bull treewa systems should be
c0J1S1dered soastolesen thecumce ofmiddot future roada
cutt1DSotltbe cl1D1c llte line
nrrph1c middotDampta
It is 1JDportaDtto kDOw the demosraphic distribution
characteristics of the oUenteltbat i8 to be served by
localized health cl1D1cs
Acl1D1c which erves8J1 area where1D the prepondershy
ance of persona arecrter 65 years of mayf1nd that these
people rely more on pUblic transportation call for more
home- services and haV4t 110ft ChroD1c and debilitating
types of disorders (b1_ blood pressure poor heariDg and
eyesight) tbaD do8 an area ot a YOUDIer population On
the other hand thL area of older residents may have little
need for family plabDlng cllni08
In order to better ~Ybullbull the 4eaoraphic population
of each CeD8U8 tract the 1970 CeD8U8 iatormation was viewed
and two specific catelOri8 considered These two cat
IJ
38
lori8S woUld be the perc_tap ot population under 19
year of ase and the percentase ot each oensuetractover
65 years of age he 1960 1Dtormatlon tor eaCh tract was
then compared witbthe 1970 intormation and a percentage
ofincreaae or4ecreamp8 tormiddot e~chtract1n each category
cOJlputecland achartma4e By the use of this chart one
18 able to View tJleap populat1odiatr1but10n of census
tract and at the _ t1lle accesa middottrencl Por example
let us choose census tract 601 W see 40-4 otthe
population is under 19 years ot and that ODly82 1s
over 65 years ot middotAtthe e tille the percentage of
youth bas ~ed ODly 1_ intbe laSt teD year whilethe
percentale over 65 year ot middotbas stayedmiddotthe same With
this in mJnc1 ODe ~ 1DfItr libat ol1D1o aerviDg this
area WOuld bellQre conq~w1th the problems of a
YOUQier populat1on and that _ would probably be true foJ
some t1aein tbefuture On the other hand CeDSU8 tract 54
has only 2 ollt population UDder 19 yel1s ot age and
this has decreased by 1 over the last ten years middotwhile at
the same time 32-377 ot the populat1on 18 over 65 years of
age A ol1D1C ___ this area should be or1eJ1ted toward
tbespecttic problema otthe ampledbull
PerCapia __ bY gsa neat
WhaD cona1der1qlooat10D1 tor health cl1n1cs one
shoUld take the 1DC01Ieot areas into consideration Areas
IJ
39
of lowiDcome would not 11kel~be 8erved more by localized
cl1D1cs tbaD would are of hilbincome It 18 likely
people haYiq a hip iDeoll8would preter to be aeenby a
chosen ~r1vatephylc1a1l tban at a local cl1D1cwhere
10Dier waits y beraceaaampryand leas personal attention
gl_
The 19701ncOII81atoWampt10n tor MultnomahC~ty was
not available at the tille thi8report W88 made The 1Dto~shy
tiOD Was taken ~adtro tbe1960 census publlcation
his woUld ~8Il thea tbat ral1I8 OD the chart ynot 1raquoe
completely accurate hi writer telthatthe areas most
affected by tb8 1I8eof the older 1Dco1DtOlaat1oDWOuld be
those tracts wh1ch baYebad a rapid 1ncreaae1n populatlon
over the past tfmyHr8 bullbullbull tracts would include tracts
nUmbered 104 9897 96 aDd 95 be perc~ita 1Dcome
referredto1il-tb1a Paper18the lIean 1DCo per person per
census tract
Attar the iDeoeper census tract was listed on a chart
a map was de 1D41catiDg those census tracts belonging to
the lower 14 ot income tor all censue tracts in Multnomah
COlDltytbose beloqins to the upper 14 ot income tor all
census tract 111 MultnolUlhCounty and those belonging to
the mid 12 ot 1I1coaetor all oeuuetracts in Multnomah
C01mty
In yiew1Dg the _p 1t caa be seen that the low income
area seautotollow aloas the at aide ot the Wl1lamette
IJ
40
R1ver the full length of Kultnomah County A second low
income area follows the south edge of the Columbia from
the northwest corner of Multnomah County easterly to 148 St
A third problem area seems to be on the east bank of the
Willamette River with the Union Pacific Railroad being
about the center of this tract The extreme loutheast
corner of Multnomah COUDty appears to be a low income area
but as this area bas bad rapid grouth in the last ten years
this could be erroneous
Mental Health
be first ~ecific indica to be selected from the
Multnomah County envirollllental survey of early 1971 and
to be considered in this paper i8 that of Mental Health
At the present for mental health purposes Multnomah
County is divided into five catchmentareas with a mental
health cl1n1cin each area These clinics are Model
Citles Delaunay ADkeny street Office Hansen Health
Building end Southeast Clinic
All lIlental health cl1n1cslcept statlstlcal information
on all patients visiting their cl1n1cs this included the
address of the patient hese addresses were then listed
upon the approprlate C8D8US tract Each census tract was
then ranked on a chart according to the nUllber of mental
health patients who reslde ln thatCeDSUS tract attending
any of the above listed ental health clinics This chart
IJ
41
wasttum d1v14ed1ato proper quartile bbullbullbull
quartile vereUs to dne10 u appropl1ate Multnoh
County _tal health ItLa middotmiddotmiddotthelipO~a1bl by lOoJcJIUE
at the UDtal health _to uteN1De which ueu have the
lars-t use otCOllDty 1alh~th faci11t1Rot
1Ilclu4ecl 111 tbia woUld tber otpeopleYia1t1Da
pr1vat patch1atriata aDd pr1_t _ntalhealtb cl1D1c8
WheDtbe M1 18Yienclmiddot Itmiddotmiddotmiddotmiddot~middotbe~_ tbat ~rtt
appears to lMt fourmiddotmiddot-al are iii _oil the nuaber ot
lIental healthcl1D1c na1t toM tbjh1sheat 1he
tour areaa woUld be tollows
1ttrea Ore to~Blo Drimiddot ~tb Burrus14e aDd tIMtmiddot Colb1a Riftr H1gbwyaeri1Dla th nortllra boundaryshy
2 bull ProII 82D4 1_~ 10 20th streetwitil the ra1lMd Mu the north ltouadary
3 ~ et et tUgl_b1bull MYel froamiddot the Clackaaa COUDty l1ae aorth to Dln8lon stret
4 beDOlvt1ttfe-t ~efllt4 COatytrca Jle1aware streetmiddot toR1C1a11oDd wlth Colubla Blvd heiDI tbAtnorth bouaclary_
It ODe coapareatbiap to th iDeobullbullmiddotp 1t can be
eamiddotthat lIOat ot the c tracts baY1Dg bllh v1i11tatlcma
middottfl public tal health cJ1rUc8 ~ 111 t13e low ~ aid
1DcOile SroupiDIOJa1y of til 25 tracta llsted as
haviDlbip aental Maltll nlltatlou are ~ the1g60 hip
iDeo arebullbullbull
17 Plpn
42
amily PlellnSDI ]Jlce Metal Health i8 an 1nd1ce of
use Theperson 111 ordertobavebe_ 1Dcluclecl 1n this
atu4ywouldhave tohaft Ue4 ataa11y plaDI cl1D1c
tacilities of soaetype It 41fter troll tile _tal health
study1nthat i t1Jicludestatist1catrollbotb public and
privateclJD1os
The iDformation tor the iak orurcbart 8Dd map of
t8ll111 plenn1 na ob1a1De4 by cOIIblnlDlthe mabel of
1rlcuv1duals bullbull_ attbe tbreellUltrampo-ti Coatyhll11y
PlalJQllIl C11ll10s 111til tbo at the Planned PareDthood
Association CliD1C8 be tbree -JIultDouh Couaty r8ldly
PlamSq Cl1D1c are Solrtbweatth Col_bla 1111- a114
HaDsell Health BWlcl1Dl CllD1cbi middot1Dtormat1oD vas then
bullbullbullesed tomiddot detellWMt l10w people troll eacb c8IUIUS
chart wastben Mele IUs oIIart jn 4iY1ded to show
the censuS tracts lIaYiDlmiddottIle h1t1iest qUart1le of incidence
of use lowest quartile of 1Qc1deao ot use Jlid 12 of
incidence of Wle an4 a map sprepared troll thts 1Dto~
mation
The C8U118 tractsbelOJISnl to the h1lhestquartile of
use appear to be 1lO~ 8catt~ on tbipwas true ot
either the _p ot aental health cl1D1c uaageor ot the map
abow1DI per capita 1I1COM Iaere40 to be three
d18t1nct areas of UIIaP beJ woul4 be
1
IJ
43
t10D of BurD81cl and the W11lallette River 4
2 S~t Portland 8Otth otmiddot the ra11shyrcaadand alona the W11lamette River
lIortbeaat Portl8D4 between MisSiss1pp1 and 24tbStreet the northbouBclary be1DgColwb1aBlvd
Pylzl1c BMltl IrpI Y11ta
Publlc Healtil nur81D1Y1s1t nclud8 an vists to
theholles of client by PubUc Health Nurbullbullbullbull his shows
visits to bull f8Jl1ly fer aDY purpos SUCh aatuberculolJ1s
het1Dl tem1tyaeatalu4 8IiOt10D8l cODd1t1ona etc
he atat18t1C~ 1fele C()4ed accord1Dg tomiddot the 1llli301fOCUS
of the Y18lt tt doe DOt 1D41cate the Dmlber of holies or
f8ll11lev181tecl or 1D41Y14ual Y1a1ted more tban oDcein
the propwl It dobullbull I1ve 80M 1D41cat1on by coaparlshy
OD ot the 8JIoUDt of aedlcal problema 1n eachcen8WI tract
Ap1nmiddot the _p abowa 8 scatter patteraof probl_
areas althoUSh there appear to be a sroup1Dl of hiSh J
l8aIeccmaus tract 1ntlut extreme southeast part of tbe
County other areu uIriaI any nura1Dl contacts are
1 bull he 801lth-oa-al CO1Dty on eaCh 814 of 82nd Av from Clackallaa County north to Dinloa
2 ear bullbullbullt 814e aroUDd Preacottand Misaisippi
Dowatom Bunul14eonboth 1de of the river
44
V_real Pis The iDfomatloil uaec1 to tabulate the Venereal
disease chart includes all the ooab1ned case otmiddotODormea
and syphilIs reported by bothmiddot publIc and prIvate physicIans
dur1nl 1970 There were 3602 caes ot IOnorrhea reported
dur1nl 1970 While ODly 17 cabullbullsot ayphilimiddot were reported
A chart was prepUed aDd att8llPt wasmiddotmiddot de tomiddot
determ1De Wh_therVttDereal 41ease was more p~vaJent in
areas othigb or lowmiddot proportIon ot youth hi waadone
bymiddotdetemlna a 1leaD prceiltacmiddotmiddotmiddottor the population ot
resld~ts UDder19 years ot (34) middotA mean ratemiddot per
100000 popUlatIon al80c1ttem1Ded tor the middotoccurreDCe
ot venereal dieae This was et at 390 oass Areas
hav1nl a population 1n which leiS than 34 were lmder 19
years ot ampIe were called low- yOuth abOve tbl percentaae
hiSh youth The aaa waatrue ot the occurrence oivenershy
eal disea_ per CeD8UStract It the rate waacomputed
as 1I0re than 390 cases per 100000 it was called hiah
venerealdiaeasei it less than thia tisure low venereal
disease It was tound that 1D Multn~ COmlty there sems
to be poSitive OOlatI0n(x21S19gt between low youth
and hipmiddot venereal diseaand hip youth and low venereal
diseasebull
RaDk ordr Iitot all c traot middottbAm made
Th1s was done byt1Ddlna the ratepr 100000 populatIon
of venereal disator all census tracts in the County bull
45
These were thenlisted from h1lhto low (sreatest to
least) in a rank order The l1sting was then divided
into Upperandlower 14 aDd listed on the MUltnomah
Countymiddot up
The areas of b1gh venereal disease se8ll18to
roup thBl~8 middotin a very tllht area ~oq both 1des
of thell18l8~ R1 w1th BurDaldeS~et being
~bout theceDter qf tbi8IZ9uping This area woUld
appear to be m ldeal spot for the denlopment of a
locallzed venereal d1sbullbullbullbull cl1D1c
UbepoundCUlO1s
In this report bull tube1C1llosls caS8S refrred
to include alltbobullbull cabullbulls ontubercUlo8is follow-up
rather middotthan just new C Accord1Ds to the Multnomah
County Health SUrvey of early 1971 this would include
all ca repOrte4 over thelaat three years The
total number of tuberculosi8 cabullbullbull usedin this study
was 666 lh1 included 128 new cabullbullbullbull
A rate per 100000 of tuberculosis for each
census tract wa- then computed and the c~us tracts
listed by rank order be b11h Qartlle mel low
quartl1 were then reoordd on a Multnomah CoUnty map
TWo genral areaa baY1Dg a hip mcldencaot tubercu~
losiare 1D41cated heyare
1 Both middotsld ot theWilla11lette River
Ll -
46
with Burns1de about thecnter
2 he extrea Northebullbullt comer of the County bull
By coap8r1ng the tuberculois an4ven8real
diseae maps ODe can 8ee that the downtown areas ot
hiSh 1nc1denceare alIIo8t 1c1eDt1cal on ach map
This WOuld 1nd1cate that 1t would be of value to
bullbulltab11sh acl1D1c 111 th1aampreatbat would provide
bothtuberCulos1s 8Dd ytmereal 418ase srvicbullbullbull
Thchart aDd 1181gt8 are wsfuln 11v1DI
1Ddicat10DS tor the type aDd placemeototlocal
health cl1n1c8 tbro1qhout tbe MultnomahCounty area
A cOllpar1on of the mapa help one to dec1dewhether
to provide a aulti-8ervice cl1D1c or spec1f1c type of
cliD1c As stated in Part I of thi paprserv1ces
shouldhaYe both treatlieDt and prfMmt10n cOmponents
As he been stated fta ne1lbborhood health care
Qenter muat be a fac111tY plazme4 with an aamesa
ot the neds of the consumer and the c01llll1m1tybull
Part II of this rport haa been an attaapt to indicate
and clarify 8011 ottheae coDlllUDity neds This has
been done through8elect10n of apc1f1c problems
The indic were then visuallyrecorded through the
use of ups and charta ODe dan asseS8 thedsreeof
1DIportance of certain concems to spec~t1c areaa by
comparinl the chart aDd maps Prom this oDeean
41 dec1de which are48 vb1chcUD1c-or indeed if
the need a clinic at all However further factors
should be considered hebullbull include
a The amount of fuDd1 available
b What 18 the percentage ot peopleineoh ceaaua tract tbat would actually us such cl1n1cIl
c Wbat 1 tbeco--1tymiddot 8 IeeliDashyreaardtDI particular cl1D1c8 Would this dcrebullbullbullmiddot the ettctiveness ot thse cl1n1ca
IJ
li
D_OlraphicPopulatLon Challie 1960 to 1970 48
Cen8U8 1 of Pop 1 Cbaqemiddot 1 Change1 ofPopTract Under 19 Yr8 Over 65 Yrs1960-70 1960-70
middot1Q701Q70
1 319 -12 171 -H) 1
2722 215-27 +68 301 366 -22 127 +35 302 371 +19 111 -04
311middot401 144-41 +29 402 321 13~7-39 +24 501 356 124-08 -02 5~O2 351 133-23 +12
405601 82-10 -02 394602 103-01 -06
701 275 149-76 +56 702 361 +01 121 -07
+10middot801 326 140-22 802 321 middot127
(
-29 -03 9~01 342 124 -H) 6-18 902 294 128 -H) 3-24
10middotmiddot -14312 140 -17 1101 182 +25 -23197
2411102 186-59 +29 1201 226 169-17 -41
31middot01202 +11 182 -05 295 -H) 81301 208 -H) 4
1302 331 +08 197 +04
14 323 +15 middot185 -08 middotmiddot15 329 +16 16~5 -13
-28middot 1601 332 131 +12
1602 356 98 +24middot-39 middot3101701 161-33 +21
1702 370 -15 85 +02 +19 1801 264 151middot-50
185middot1802 256 +47-58
IJ ~
D_raphlc Population Change 1960 to 1970middot 49 (Contd)
4io
Census Tract
of pop Uncter 19 Yra
1Q1n
1Cha1l8e 1960-70
of PopOver 65 Yra
lQO Change
1960-70
19 389 +29 141 -24 20 223 -13 206 +18
21 227 +08 194 -36 2201 356 -27 112 +05
2202 290 -18 ll~9 -29 2301 356 -03 154 +24 2302 260 -37 245 +97
2401 410 +6~1 123 -31 2402 163 -80 320 +99 2501 381 +13 140 -01 25()2 237 31 lil +02 26 343 +25 186 +149 2701 370 +29 1S5 -01 2702 249 -44 304 +98 2801 337 +19 187 +09 2802 306 -10 156 +31 2901 304 -38 142 +24 2902 i 307 -32 146 t3~9
30 29~0 -48 16~2 +51
31 355 +30 160 +01 32 370 +48 148 -13 3301 395 +45 130 -20 3302 368 +06 138 -02 3401 386 +16 117 000
3402
400 +32 92 -26 3501 304 -07 115 +35
3502 344 000 140 -13
3601
36~02 357 -04 132 +32
3603 30~1 42 149 -67 3701 342 +28 152 +19
1
IJ
Jianolraphic Population Chan 1960 to 1970 50 (Contd)
Census Tract
of Pop Under 19 Yrs
JJl7J
middotChanae 1960-70
middotofmiddotpop Over 65 Yrs
1c~7n
Change 196070
3702 409 +39 122 -11 3801 308 -11 151 +29 3802 275 -35 180 +46 3803 282 -32 192 +54 3901 376 ~13 100 +17 3902 296 -03 177 +29 4001 438 -11 84 +13 4002 353 -21 115 +20
4101 397 11 9middot0 +11 4102 346 -19 120 +03 42 331 +19 11 bull 3 -16 43 347 -72 105 +31 44 113 +84 183 +154 4S 33~9 +07 110 -06 4601 2501 22 193 +38 4602 332 +59 126 -29 47middot 161middot 000 211 +01 48 103 -26 302 +59 49 138 +1 bull 3 252 +09 50 141 -26 204 -12 51 12 -39 257 +07 52 47 -61 351 +48 53 89 +49 314 -30 54 25 l1li15 327 -17 55 131 -17 115 -121 56 198 +93 227 -47 57 71 102 189 -88 58 240 ~middot41 16~1 +55 59 322 +25 142 +06middot 6001 264 95 132 +50
6002 328 -31middot 89 +07
JJ
Demographic Population Change 1960 to 1970 51 (Contd)
Census 1 ofPop lChange of Pop bull ChangeTract Under 19 Yrbullbull 1960-70 Over 65 Yrs 1960-70
1970 1970
61 355 -58 85 +39
62 328 39 110 +18
63 414 04 73 10
64 382 -22 72 +04
6501 383 02 67 -20
6502 329 -56 96 +09
6601 391 +13 88 -03
6602 319 -59 97 +06
6701 327 71 145 +72
6702 331 ~67 83 +1-0
6801 365 -66 49 +01
6802 388 4bull3 54 +06
69 354 -41 80 +23
70 400 -23 68 -06
71 359 -48 72 +05
72 255 -88 82 +11
73 346 -39 91 +25
74 313middot -63 105 +24
75 329 -42 129 +37
76 336 -52 85 +21
77 370 -10 69 +05
78 309 -10 120 +21
79 325 -56 87 +10
8001 358 -81 57 +12
8002 391 ~81 76 +12
81 315 -76 108 +21
8201 403 -23 64 +08
8202 392 23 65 +08
83 357 -34 120 +31
84 402 -18 73 +16
85 413 -06 76 -09
r
Demographic Population Change 1960 to 1970 52 (Contd)
Census Tract
t of Pop Uncler 19 Yrs
1970
Change 1960-70
1 of Pop OVer 65 Yrs
1970
ex Change 196070
86
87
88
89
90
91 9201
9202
93
94
95
9601
9602
9701
9702
9801
9802
99
100 I
101
102
103
10401
10402
lOS
368
351
379
391
391
413
379
433
372
429
414
432
419
439
~32
377
457 420
378 41middot7
345
360 417
417
412
-04
-02
-35
-26
-28
-11
-64
-20
-S9
-39
-32
-21
-34
-40
-47
-lO~7middot
-27middot +04
+56
+07
-34 01
+04
+04
+10
103
128
97
11il3 99
69
79
42
77
46
34 38
44
40
54
111
51middot
81
133
59
74
140
63
87
76
-08
-06
+04
+08
+17
-05
+3S -02
+1~4
+19
+33
-14
-08
+12
+26
+71
+11
-16 -34
-20
-19 +37
-49
-2S +15
NOte The The
Taken frOi
averageullder averageabove
middotUSCensus ---shy -
19 years == 6S years ==
figures 197
32r 13(14
p a~d 1960
--
Rank
1
2
3
4
5
6
7
8
9
10
11 12 -_
13
14
15
16
17
18
Tract
69 46
60
58
- 68
61
302
2501
67
63
19
62
26
94
3603
3902
64
30 -----~-
Rank
19
20
21 -
22
23-shy
24
25
26
27
28
29
30
31
32
33
34
35
36 -
Ranking of Per Capita Income by Census Tract
Tract
65
2701
- 15
1601
701
66
93
82
2903
3602
30
2502
80
2401
81
- 70
91 shy
4001
High
Rank Tractshy
-32shy37
38 97
120239
7840
41 ~ _2_1__ 42 31
43 2501
44 18
45 98
46 37
47 3803
1702
49
48
1602 92 2702
I
50 89
51 901
52 801
Ra_
53
54
55
56
57
58
59
60
61
62
63
64
6S
66
67
68
TractTract Ra~
74692
170196 70 I
401 71 90
72 1037J
79 70273
3802 74 601
24024102 75
85 76 101
77 9023901
7699 78 100 4101 79
3601 I
380180
458140~ t---- _ - - shy83 82 42
888384
59843501
4777 8~
502
Low
802 86
Rank Tract
87 shy
--88
89
90
91
92
93
94
- 95
96
97
middot98
99
100
101
102
103
104
1201
14
49
72
73
43
87
3502
105
1
52
86
71
1
501
10
3301
104 tf
Rank
105
106
107
108
109
110
III
112
113
114
115
116
117
118
119
120
121
Ranking of Per Capitalucoae by Census Tract
(Contd)
Tract Rank
4001 122--shy602
13
1102 2302
3302
55
3401
48
21
56
50
3402
lL01
2202
2301
53
2201
-shy
Tract Rank Tract Rank T~aet Rank
57 I-----
Imiddote
bull
Tract
- Low -k Note Information taken from 1960 U SCensus
Rank Tract
I ~
Ie
Imiddot
~
----
----
--
--
Rank
1
2
3
4
5
6
1
8
9
10
11
i-
-Tract
391 922 921
972 971
100
132 131 121
962 961
822 821 401
982 981
20 111
47 10 1
412
High
Total Number of Henta1 Health Visits
Ranked by Census Tract High to Low
TractTract RankTractRank Rnk
12 182 22 78 29 87 76 381 73181 ~------- 1913 371 8538230162372 271 2616-121 8272 2
14 80~2 31 94 7923 84801 59 15251362 4232 15 52 _ 32 103 8924 651 17240216 652
_ 91 351 33 341 23117 83 122 25 25 48 1123921418 34 shy61 86 661
19 662 6493 81 26 91 8153 49 50 55 41383 71 27 51 3120 90 672241 35shy 104167162 461
I 411 46211121 28 88342 I
2502 36 69 54 5251 50 272
-Ra
37
38
39
_ 40
_ 41 Ishy
I
42 I
-I 43 44
45
shy
Tract
~ --- shy 95 56
45 292 242
102 62 352 291y
92
101 281
99 72 63 601 60~ 42 2201
77 74 61 57
363 232
70
32 31
11 44 282 2202
Low l
- Tract
46 682 681 I 331 30
r~$ 47 1042 332
48 102_41_
11
~
Visits to Family Planning Clinics Ranked by Census Tract High to Low
Rank Tract Rank Tract Rankmiddot Tract Rank Tract Rank Tract Rank Tract
1
2
3
4
5
6
7
8
9
10
11
12
13middot
14
15
16
17
361
56
401
341
48
59 121
20
55
342
10
31
58
93 21
241 132
331
53
461 462
18
19
20-shy21
22
23
24
25
26
27middot
28
29
30
31
32
33
391
32
middot47 I-i-_-shy _ -
231 111
332
972 1
372 371
52
89
32
92
82
100 31
182
30 242
402
34
35
36
37
38
39
40
41
42
43
44
45
42
1714 i 661 221
78 362 2
90 602 601 352
63 251
105 921
971 351
73 42 292 232
411 51
662
81 45 52
46
47
48
49shy
50
51
52
53
54
55
56
961
801
49 81 72 71
19
9~1
172
68 2 57 162 14 112
91 75 681
381 42
3~3
83 161
57 f
58
59
60
61shy
62 Imiddot
63
Imiddot 64
65
66
64 62 36~3 252
74 652 SO 392 291
651 6bull 2
79 271
r-- ---- shy981 222
672 671
821 272
94 87
281
382
67
68
69
70
71
72
73
74
75
76
77
78
981 26 12~2
IS 61
85 82~2 69
61 43
101 86 84 282
76
131
51 72
1041 962 88 70
99 922 77
103
95 802 181
i
~
Low High
RankRank Tract
5479
4480
81 1042 ~) middot102
71 - - + ~ - ~
Visits to Family Planning Clinics
(Contd)
Tract Rank
I
Tract llaDk l
RankTract Tract Rank Tract
~
I
~
J1 ~
Low
Total Number of public Health Nursing Visits
Ranked by Census TractsHigh to Low
TractTract RankTractRank RankRank TractTractRankTractRank
25249 71 79 17249 8033 6586 99189711 84 2915072 34 661 76 66 811519512
402 5035 51 161 2518220 122 1713423 352 55801 7120 6752 2 149814 41236 83 2662 38 94 6821 53 2924015 362 37 32 42 75 69 281 84 63
546 8822 54 222 85 3925431 70383417 3818223 6439 4386652 718 21 55 103332 8924 232 87 19 271729219619 24156 16211140 382 628825 10523110 112 73411 10141-- ----shy 89 363 4457 8126 16111 221 74 9142 90 46158331 53 671279012 46243 48 59 351 3837528 1083 9313 91 5844 59 -_242 76 1----- shy60 272 72 74104114 60145 42 9287 7729 92 6151 8215 57371 934630 91 307762 12113116 282 619447 41391 9531 78100 63 7378 ~95 681 6945 32 5632 798517 6448 47 52 181
High ~ Low
Rank Tract Rank
96 31 132 70
97 102
98 182 372middot 602 651 662
- -shy
~72 682 802
822 922 962 972 982
1042 ----shy
Low
Total Number of Public Health Nursing Visits
(Contd)
Rank Rank Rank TractTract Tract
I
I lt
I
Tract Rank Tract
[
~~~-
I
~
IJilfimiddot ~
j
Ranking of VD Caea According to Census Tracts 61 By High and LOll Youth Itatio
A media~ of 34 5 was determined Any tract having greater
than 34 5~ of popu1tionunde~ 19 years of age -High~
Any tract having l8S than 345 of population under 19
years == Low
Any tract having rate less than 390 =Low
Any tract having rate more than 390 == HLgl4
YOUTH
LOW HIGH
L
0
12 402 1801 1802 343 2801 2802 29023603
54 6001 600262 66~02 72 74 75 76
78 79 81 t02 65 1202
W
(25)
VD
H
I
G
H
401 701 801802 901 902 10 1101 241 1201 1301 132 14 15 1601 1701 20~ 21 2202 2j02 2402 2502 2702 2901 303501 3502 34023801 3802 383 3902 42 44 45 4601 4602 47 48 49 SO 51~2 53 55 56 57 58 S9 6701 6702 73 95
3~02 7021702 19 25~01 2701 4102 4101 63 64601 ~601 6801 680270 7l 77 8001 80~02 8201 8202 83 84
85 86 87 88~ 90 91 9202 920193 94 9601 9602~ 9701 9102 9801 9802 99 100 101 103 10402 105 6501 10401
(47)
301 501 502 601 1602 2401 2301 2201 31 32 3301 3302 3401 3402~ 3602 3702 3901 400140 02 43 61 69 B(
(53) (23)
~ ~gt
Ranking of VD by Rate Per 100000 By Census Tract
~
Rank Tract Rank Tract Rank Tract Rank Tract llank Tract Rank Tract Rank Tract
1 2202 21 S6 40 902 58 1602 74 75
90-shy 64 107 26 --~-
2 3402 22 45 41 10 59 902 75 78 91 54 108 61
3 2301 23 3502 42 2502 60 602 76 6802 92 402 109 87
4 3302 24 49 43 1102 61 501 17 2 93 94 110 90
5 50 25 52 44 6702 62 14 78 8202 94 97 02 III 76
6 2201 26 20 6701 63 4002 8201 2501
9701 41~02 112 91
7 44 27 48 45 401 64 3802 2902 95 63 113 62
8 3301 28 1701 46 502 65 30 79 83 74 96 9602 114 71
9 55 29 47 47 42 66 3803 80 2801 96Q1 115 85 10
11
12
13
14
15
16
17
18
3401
53
2302
2401
57
21
2402
1101
51
30-shy31
32
33
34
35
36
37
3701 - -~ 1201
3702
89
43
132 131
3602
4001
48
49
50
51
52
53
54
55
58
1601
601
4602 4601
69
701
31
3901
67
68
69
70
71
72
2901
801
39021~ 802
6502 6501 122
702
41~01
81
82
83
84
85
86
87
88
19
1
1702
2802
79
93
100 6801 6602
81
97
98
99
100
101
102
103
104
9201 9202
9802 9801
77
302
79
86
72
84
116
117
118
119
120
121
3603
8002 8001
101
99
95
10401
105 10402 103 102
19
20
59
32
38
39
2702
3501
56
57
301
3801
73 1802 1801
89 6002 6001
105
106
2701
88
High Low
-- -----
Rank OrdermiddotTuberclosis Cases by Rate Per 100000 Ranked by Census Tract High to Low
Tract TractRankTractRank Rank TractRaukTractRankTractRank
801
79 9601501411 52 6835340120511 I 960269 903603532036 $-~~F130221542 4366 311301 70 68~013802 _ I- _ 4001_37213 3921201 6802802 H71523822024 22 54 193302 3802 80 8958 I37139535 70155 9801 I60123 72 6702 98023914011016 6701250124 10 56
81 94 401r 7 154152 73 7057 2625 122 92028
90242 162312301 92~158 86 7172434526509 82 79160159 74 100 87412240227220110 6502836960 75 30 8317244 6501782801285711 61 901 42765645 84 66021459294912 9701 660146 171 302 9702 47
6235023033113 85 822821182 917755 16335013110214 841814832 78 103 938564 324815 86 1057940149272 38036523216 10401 87 2902241 725Q 10402360266340217middot IF88 88 9937233 282 51 218 101 01102 46016234
I)167 2901460219 47
High ~ Low ~
- -
TractRank
9S89
6490
8191 8001 8002
63 61 60middot01 6002 44 2701
92
J
2502 402 --- ----shy
I
Rank
Rank Order Tuberculosis Cases by Rate per 100000
(Coutd)
Tract Rank Tract ~nk
I
Tract Ballk Tract Rank
Imiddot
Tract
Imiddot
1~
t 1I i Pi i l I
o
1 -1shyL I
I J
8 40 icO ~ I -lt 0
-t (1) I
i I
r o E
II
a
I
r--i
shy
I
~
I (
Jgt
(011 fi(
Ggt
I II ~j
()
(f 0
~ ()
I
11
f9
r
II 99
o ~
Ggt r
~ __-J~ I t I ~ I
r--J l I
~ _ __ J
) 1
fTl
1gt
r I
()
r
()
lt en -i en
()
I1l
(J)
(J)
-i
P ()
19
r o ~
r G1 I
I
c
~
o I 89
--- -I-shy
r-r I
1- 0 _~ _ _--J E
G1 I I I
i i
I 1-1-1 ~ _J ~2 ~ II
II
()
1 I I I 1
id i bullbull
~
A n 69
r 1shy
- 0 Gl
l--~ ~ I
~ II
II )
I () isect i
en l i
(J)
-t
0
IA Ol
ERRATUM
AZZ pages are intact but foZZowing Page 57 the
pagination is in error due to omission of the
number 58 in the series
I bull
TABLE OF CONTENTS
INfROOOCTION 1
PART I 5
Tbe Concept of Compreheuiva Health Care 6
ThemiddotCoapreheDsiwmiddotXeigbborhood Health Center 9
Efficient Use ofmiddot Scarcemiddot Resources 19
SUmmary aDd Conclusions 26
PART II 34
Demographic Data 37
Per Capita Incoe by CensuS Tract 38
Mental Health 40
Family Pleuning 41
Pub11c Health Hurs1Dg Vjsits 43
VanerealDisease 44
Tuberculosis 45
CHARTS 48
~ 65
)
JNIRODUCTION
In the past several years the subje~t of health care
delivery has assumed increasing importance asa public issue
Congressional hearings public and private commissions and
task forces have investigated the functioning of the health
care system in depth reporting that access to the system
is impeded by financial barriers and by inefficiency of the
delivery system (8p1) 1 Medicare and lled1caid have
attempted to surmount the financial barriers for some segshy
ments of the population and more inclusive health insurshy
ance proposals are being considered in Congress The
Healthright program tmd~r the Economic Opportunity Act
has stimulat~d efforts to improve the delivery system as it
relates to low income persons and some of the health
insurance proposals also have the goal of improving the
delivery system
The Task Force on Organization of Community Health
Services in Health Admin1stration and Organization in the
Decade Ahead (25p13) briefly presents four interrelated
concepts which form a framework for looking at health as a
l Numbers in parentheses refer to bibliography at tne
end of Part I
2
middot$
contemporary policy issue
1 Health is a resource for the social and economiC development of the nation as a mole
2 The healthand social needs of the indishyvidual in modern society are Ulti~atelyinseparable thus the presence of indenti shy
tiable poverty as an adverse influence on health progress and improvement and equally the condition of 111 health will tend to interfere with the individualts ability to function and beproductive~
3 The concept of public health in today s world has begun to expand markedly moving in the direction of convergence withprivate medicine and voluntary efforts these spheresbeing included in the broader term ttcommushynity health
4 Thereex1sts aninescapable interdependence-shycommunity state and national--in the adminishystration and organization of community health services
Obviously the health care system is one 1hich has
many aspects bull Although these aspects--financing manshy
pow~r service delivery~are interrelated we intend in
this report to deal specifically with one facet This is
the decentralization of health care facilities to provide
comprehensive health care services at the local level
The report is presented in two parts The first
part will examine the literature relating to the developshy
ment of the comprehensive neighborhood health care center
as a means for the delivery ofmed1cal care services An
attempt will be made to determine from the health literashy
ture criteria for the evaluation of medical care systems
and further revie of the literature 1111 attempt to
3
determine how these criteria can best be met in a
decentralized medical care delivery system
The second part of the report will examine the health
needs of Multnomah County Oregon with the goal of
providing information about theseneecis for use in health
serv1cemiddotplanning particularly in relation to the
decentralization of health care services
I ltllYd
-
5
~E
Evaluating the Health em Sxatem
~ (8 pp1-2) has 1nc11cateda number of the weakshy
nessea of thepreaent health care system in this nat1on
She c1 tes risDs coats iDadequate pooriy distributed
and 1rietf1ciently utilized manpower andtrapented
service delivery a8 ma3or problema and state that The
systeiD 1swaste1ll otreaourcea andfunctions W1th too
11ttl reprd tor U1ci8Dcy aDd aCoDOIIIY
Shepo1Dts out
hoWever tbattbere are tour points regard1ns reform Upon
which there is widespread agreement Firat she states
IIaccesstoneede4 health emces must not be 1mpeded by
t1DaDcial barriers II BersecODd POint1s that bull bull the
continuoua health sernceare eftryw2ere ava1iable under
cond1t1ons that are physically conveDient comfortable
anclnot destructi to the d1lD1ty or selt-respectof the
recip1ent b1rd it is essential that the health care
syst8lll Iie due reprd to ecODOIIIY 1D the use of scarce
resources providtDg services with eff1ciency Finally
the system must be accoUDtab1e to those who tiDance it
and to those who 11IIe 1t and in particular must be highly
responsiva to the interests of coD8Ulll8rs II
Gre8Dlick (18 p756) also prQPoses a set of princ1shy
ples which can be used to naluate the ed1cal care
system ae states tint that bull bull all those who need
medical care shouldhave equal access to 1t second
(
6
bull bull the sernce prortded ahould be precisely approshy
priate to the pat1entl1eedemiddot ft and tb1rd bull bull the
med1cal care ayatea ahould provide the lOst eff1cient
and econoa1C8l use of scarce IIe41Cal resources
orthepurpoesof tb18 report certa1not these
crtteXaw1l1bestreaae4 lION tbaD others The rema1llder
of PaXt I Will renew the l1teraturerelating to the issuee
ofcomprehenaivene8sof ervice access1b111ty ot serv1ces
aDdett1c1ency oten1ces 111 tbedel1very ofdecentralized
medical car
ratCopcept of C_ Beal1h care Asd1oal tecmolol1 bas advanced a process of
evolution basoccurred inthe aed1cal and health t1elds
As JOhDsoD (21 pp~361-363) etamptsmiddot bull the goal of
healtb carelD our society baa evolve4trom rel1ef of
ajmptolU to ~ otdi toex1steDce in a potent1ally
diseaselessstate C1t1Dl tbelJm1 tat10DS in health care
resources and presenttechnololY he cont1nues to state
that The resulting cbal18D1e facing the Amer1can health
serncesystem is to provide each 1D41Y1dual with the
sreatest possible opporturnty toach1eve an optimum level
of phys1cal Jl8Dtal amd so()1alwall be1Dg
to
reter to the type othe81th care aystemwh1ch attempts to
answer tb1s cba]] and fult111 the three principles of
1
access1b11it Prov1UOI1ot appropriate services and
eff1cient use ot middotre80urc He state that a IYStem ot
comprehensive healthmiddotmiddot care 1DmiddotoXder to apIo middottbe stated
principles fD lleetiDlita 1Oalttst havemiddot certain
attributes
1 middoteare utdbeollW~ItaC1~orpn1zatlOM]ec ~ bull p~~ol1calbarriers IlU8t be removedbull
2 bull Care abould ace he~ecl1merlt8 ot distance residttiiCemiddot tille must be removed
middotcare8ho1ll411eC-r0WIZ the Ufemiddot span it diseases eapec ychronic are to be controlled betoretheybecome disabling or lite threateD1Dg
4 CeresboUd be~teJ1nCludlJ1C p~vention cure ma1ntiDiiCeand rehabI11tation
5 Care aho11l4be~i9_ttIa1t1ephyaiolol1ca1 aD4 pay1Fci1~cTrIS-ticot the pat~ent
6 Care aboul4 middotbe9L~ tJwrefore shouldbebu11t aro~ middotslJOc1al1natltutloDs which relate to the patients Way of lite suCh as middotthe home school and place of work
7 bull Carellbolld be m-ar and therefore shoUld bemiddot provIded ~Wliils where responsishybiUty tor the patient bas beendetem1nedauthority has been delqated and a communishycation syst_ provided
s care slIould 1Ie HIl 1nclud1Dg theintesratlon ottac1~1ts~ ~prsOllDel neceaary tor modern medical care
9 bull care dbe Of hip ~ eresboul Th ahouldbe aD adequate audit 0 care pee~ reviewcoDtlDUDI naluatioDBnd research intomiddot adequacy aDd quality
Ult1ately as 1Dd1cate4by the Nat10Dal CollllDisshy
8
sion on ColDJIIUUity Health Service (26 pp 1~20) the
c1evelopmezat of a ampyt of comprehensive health care is
a cOlDJIIUUityw14ere8pODSibilit1 1nvolviDS the integrashy
tion of all the health care facilitie and programs in
the cOlDJIIUUity or the c0arcm1ty8 healthc~ system
the PamprqlOIIlt goal ~
PrQv11~ of a ~rehive ~e 9tcoaaun1ty health aervicea
2 Ma1DteIlace ot aD a4equateqUaDtity ot al~requ1re4 health care facilities
Iritsrat~oDof ~v1c1ualUD1ta and s1steas ot bealth aerviceinto a coordishy
natedpattem ot continuous care tor theindiVidual
HoWYer aYerby (37 t pp71-72) 1Dd1cate the
med1cal and health care 81atmiddotaa it ball t1nct1oned haa
not facil~tate4 the delivery ot COap~usive middothealth
care IDcl1Y1c1ualhealth care facilitie themaelve havemiddot
notg8D8nally tuDcU0Af4tOach1eve tbi810al pUblic
health departaent 11) prond1q prev_tive services and
$1Ch trea~t activities aa are involved in venereal
disease or tuberculois control have in general avoided
1Dvad1Ds the curativedoma1Dotprivate mediCine Th1s
haa even been cabullbull1DareaawherelI~cal care is not
readily availa)le except throUlh hoepital outpatient departshy
lDent8~ Aa he 81IIet mothealth departaaents have tailed
to proVide an adequate _try point for the patient 1Dtothe
diapoatic and curative a bull t of tile health care aystell
This may be particularly true tor the pOOr patient who may
9
b_dloallYUDaoptdatlcaW4lberefore th past decade
babullbullbull~ bull lIOYeaeftt to evolve DfW torms ot health care
and new types ot health oare institutloDS providing
comprehensive oDlOiDI care rather thaD trapented care
There seems to be little dispute in the health
aboe requ1res both an lDtesratloD ofprev1ously uncoo~
ditultec1 health care ervlcbullbull brlDSins tolether into one
alency what Johnaon (21 p362) reterred to as bullbullbull the
concepts ot cOllPrehms1veIled1C1ne andpos1tlve health
andaporpph1cclecctrailzat1on ot ervlce dellvery
he NatlODal CoimD18810D0D CouD1ty H_81th Services
report Health Care gilitis (26 p37) suggests
proYic11Dl compreheDaive health care services by centrashy
llz1Da a varlet ot publlc and prlvate healthcare
tacllities 1ntohealtb campuses However as Kahn
(22 pp274) states amppeskin ot soclal servlces in genshy
eral bullbull bull if the loal ls to develop a service-delivery
approach that improves access taclltates teedback 80 as
toadapt to user preterence8nd prlorlty and maximizes
case 1nteptatlon aDd accountabl11ty the base of the
total 80clal service system Should be tnthe nelSbborhood
Dec~tral1zatloD not only makes services IIOre accesslble
but allows therv1ce to be tailored to the Deeds of the
10
areaDe Diaz (14 p3) indicates the importance of
being aware of groups in the neighborhood with special
health problems such as elderly people or large families
witb yOlmg children This means that it is important
in planning to be aware of the demographic features of the patient population This will be considered more
thoroughly inPart II of this report
Kahn (22 p275) continues however to indicate
that more than the improvement of service usage is I
involved in decentralization and that decentralization
ot service delivery also represents part of tI a general
search to break down cities to human scale for some
purposes on the assumption that people find it easier toshy
relate to a neighborhood orsection and to its populationbull
bull bull bull Thus the organization of services at the neighshy
borhood level bas the added purpose of contributing to
the search tor neighborhood n He adds that this process
i8 more relevant it there is a measure of local control
over as well as local availability of services
Kahn indicates that decentralization is not a
viable goal in some circumstances These include situashy
tiona in wh1chthe need for a particular service is too
TJI t
-
11
little to justityits proVision in a l()calun1t where
skills or resources are too rare to be provided locally
or where the costs ot decentralization vastly outweigh
the benefits He Visualizestheult1mate emergence ofa
h1erarcb1c81 patternofserv1ce delivery tnwhichcertain
services andresp0D81bilities are middot1ntegrat8d1Dto the
collimun1ty at thelooal level Other more specialized
services relate to larpr un1ts of the colDlllUD1ty such as
eomb1nationa ot neigbborhooc18 Veryspecialized services
are to be delivered at city countystateop regional
level8 fh1slevel would al80 be the seat ot prosram
coord1zaat1on staDdardprotection and evaluation 811
of which call for cons1deZable centraliZation for overall
program adm1 nlatrat1on(22 p275) AlthoughKahnt s
model was not developed specltlCally tor health care services 1t1s quite relevant- and appliCable to health
care service delivery systems
Omiddot Donnell (27 p3) reviewing the 1iterat~e on
service delivery and social action through neighborhood
service centers preseJJbB a list of characteristics
generallydesirable in ~eighbOrhood service delivery
centers Firsthe states that the center should be
accessible It should be in a physically convenient
location and should be open evenings and weekends as
well as providing at least em~rg8ncy telephone coverage
t
~ II
12
24 hours a day
The center should als~ be irDmed1ate in 1ts funcshy
tioning That is the centermust have the capacity to
provide prOmpt efficient service and should be able to bullrespond to problems middotwithout long hours ofwalt1ng and
many rounds of apPointments
The centexsservices should be 6omprehensive liThe
center should offer a full range ofusable oil-the-spot
services or easyaccess to other resources by available
transportation It should gear itself to the needs that
peoplehaV8-especially poor people-and provide for the
slmultaneoushar1d11ng of problems were possible
SerVices should 8180 b 1J1tegrated and coordinated so
thatseMces can more effectively be provided
The operation of the service center should fInally
be responsive to the needs and desir-es of the neighborshy
hood It should provide ways in which reSidents can
shape th~ program and continue to contribute to its course
and development It should be relevant and ready to
respond to changing needs II
The concept of the comprehensive neighborhood health
center developed by OEO (31 p324) has been described by
severalwriters Yarby (37 p73) describes it as an
outpatient racility which has certain def~n1te characshy
teristiCS middot1 Accessible to a poPulat1on concentration
bull 13
2 Open 24 hours a day seven days a week 3 Family-centered c~e by a team of lnteniists pediatricians clinical and publichealthnurses and social workers 4 Availability ot frequently~requ1redspecialist in such fieldsaspsycbiatryobstetrics gynecology surgerY5 Con~1nu1tyof doctor-patient relationshyship 6 Family records with social and medical ~raquomDaries of relevant information about each family member 7 Basic diagnosticlaboramptoryand x-raytacl1itles and drugs and biologicalsavailable atthe center 8 Directline (1)y center-controlledambushy
lance when-necessary) to ateach1nghospltaifor cl1agnostic ~d therapeutic servlcf)srequiring the fa011itlesandpersonnel of thehospltal 9 Patient-cantered and eommUn1ty-oriented -
The range ot services in the comprehens1venelghborshy
hood health center shouldbe as complete as possible
inCluding preventivediagnost10 treatment and rehabi-
litative services and Sbouldbe deslgnedto eliminate
episodioandfragmented services (31 pp324-325) Schorr
and English (33p291) add as additional characteristics
ot the compr8henslveneighborhood health cent~r that it
should ~ve intensive participation by and involvement
of the population to be served both in policy making and
as employees and that it should be fully integrated with
the existing health care system The Office of Economic
Opportunity (28 p63) stresses the potential for easing
health manpowershortage$by trairiing local neighborhood
reSidents as non-professional health aides at the same
time creating new job and careeropportunitles As
14
Gordon (16 p bull 422) indicates Many of the outstanding
problems in medical practice todayrevolve around
effectively motivating the patient and the prospective
patient to be concerned with his health This is
especially true in a deprived environment The community
health center with its technique ot consumer partici
pation maybe a way to create this cooperation effectvely
It is important to note at this point that the
comprehensive neiShborhood health center haaas its
constituency an integratedmiddot community r~ther than a
particular segment It should haveas Blum and Levy
(6 pp~5) indicate a horizontal rather than a vertical
relationship with the commuriitybull The vertical relatlonshy
ship they state is characteristic ot those service
organizations wh1chapproach the community only in terms
of their own fUnction Tbey see only their relationship
with the users of their service and assume that problems
of accountability will be handled by these consumers
However they pOintout this ienot likely as a vertical
approach creates dependency onthe institution Agencies
in a horizontal relationBhllp recognizetha1 they have
both acommunityand a consumer to serve The horizontal
approach places the matter of accoUltability on a broader
basis than just the involvement of the consumer De Diaz
(14 p4) speaks otthe need to ~develop a community
facility which difters from a clinic for low income
1ji ~
15
people in that it should serve an economically integrated
community The reason for this is that a wide variation
of consumers may assure a better quality of care
The advantages of the comprehensive neighborhood t
health center over traditional systems of providing
commuruty health services are numerous Hospital outshy
patient departments a major traditional source of ambushy
latory health c8refor poor patients have been indicted
for neglecting preventive health care ~romoting fragshy
mentedeare and subjecting patients to degrading and
impersonal conditions to mention only a few of the major
defects (31 p324) Another defect has been the
tendency to shunt low income patients back and forth
between different cliniCS often at different locations
arid with differel)t open hours for different treatments
or tests in regard to the same lllness(26 p63)
The comprehensive neighborhood health programs that
have been organized present a great variety of organishy
zationalpatterns one area of difference 1s in the
emphasis placed upon making each faci1ity comprehensive
in the services it provides to the patient population
In the Montefieri Hospital Neighborhood Medical Care
Demonstration program in New York City services have
been made available through a central health center and
two store frontsatellites the center to be the base
bull
Li
l of opratiol18 of ta1lJpIlflicl- ancl the satellite
center the ba of oparat1oDa of public heaJth nurses
an4 nllbborbood amp1 be satellite centers wereto
proVide preVentift tutaltll bullbulln1c1-m1zaticms w811shy
baby care per1od1c ~ectiland tJle central health
center to proViAle care tor illnes If (36 p299)
bis propWI VUDOt ~ttullytunct10DIDI at the t1JDe
it d1cu8ae4 18 tbe Uterature aDd all aernce Were
be1Dl provided 1D_~terBowever itwould ae
tbat the ntua1pro~ as aY1ioae4by its plmmers
would boclJ aoaeot bull 4efeot~ otthe current lud1cal
ccde teaIt pObullbulllne_t coorctJl8td admSDtshy
etration eD4 well 4eftlopecl refelTal procedtlreacould
1I1a~ thecOllDeCticmof t~_t8 withappropr1ate preTellshy
t1 aD4 therapeu1ampcaen1cbullbull aV81lable 111 diffrent
locationa Bowner tile barrieraottiaeaDdUatanc
between center and truaraUon tor the UDSopb1aticated
patieatlook1Dl tor 1her1~pJce too tor ~1CU-
larhalth serfplusmnQewoGl4~to JJa1t tbbll1ty o~
tb18 ~811D to provide iaaiYCOliprelleU1P18hboltleod
health servicebullbull III tactmiddot tappeareto coDtlict with
tbepro own taW cOfdotpro-1~a tam1ly
mecl1cal careprogru 111 wIa10h pre-teAtlYe aDd therapeutic
health erY1cecan be proY-lW to all IIl81Ibers of
tamily in the coure of aaSDll vi8it (36 PP301-3(2)
Dle Delmtr Coloradoprepa11ke the Montet1ori
LI
17
prograJlut111zbullbull abe1rarcJly ot SlDa11 aatellItestations
andlerer IIOreceDtallzedtac11It1es It 41ffers
howeverill tbcolap~81vene80f the services avail shy
able Inthe 4ecentraUzed facIJJtiesIt resembles very
clc)sely the IOdel ~ordecentral1zed social servicedell shy
very developed by 1ahII~ Which was 41sCussed above he
SIlall neImiddotgbborhoodmiddot c8Dt~aw1tb1n walkl distance of
most of the populatiotl havebeendesilDedto take care
of allthenorllalhealth probl of 3000-5000 patJentsshy
check-ups IlzatiOZl8s1Jlpl laboratory testa and
treataentand iaecucatlol18 (d1apeued by phyS1cians) for
IIOst DODCrltIcal 1l11le PatIent 1d1Oneed IIOrespecIal-
Ized care are reterrecttobacJalp facilities BaCkup
support tor themiddot~t1oDa are the tWo l8rsernelshborhood
health C8Dter8~ttr1Dl aCOglete~e of out-patient
serneeaDd three part1clpat1q hoap1iampl bull bullbull which
proVide1Dpat18Dt~t andcoDSUltatlve services
(13 p1028) Intb1a prosrama coaprehens1ve range of
prevent1ve aDd trea1aeDt serric 18 aVailable throughout
the decentraUzed middotta The CoapreheulY8 ReIgbborhood Hea1~ Service Project
otKa1er iC)UDdatlcm HOspitals 111 Portlan4 OreOD 1s
s1ll11arto th DenVer prosraa 1D thata comprehensive range
ot out-patientmiddot services 1D prov14e4 in each of 1ts 10cashy
t1oDa althoUlhmiddotmiddot tbe oentera are larger and l bullbulls DDIerous
than 1nth DenverproPUh (12 p6)
Li i
18
In order that a comprehensive neighborhood health
care center be able to proVide continuity of care it
must have arrangements for hospital services integrated
into th system Yarby (37 p73) as quoted above
states that it 1s characteristic of the neighborhood
health center to be directly connected with a teaching
hospital However De Diaz (14p3) indicates that it
may be advantageous for purposes of service delivery not
to havemiddotthe center affiliated with a teaching hospital
She feels that such anaft11iation may lead to asltuation
in which policies might be determined more by the teaching
needs of a medical school than by the service needs of
the patient
middotThe Nat10nalmiddotCommissionmiddoton Community Health Services
(25 p69) states that such a system of comprehensive
health care integrat1na ~e servicmiddotes of several health
and roedical agencies snould utilize Itas much single or
unified management as possible Neighborhood health
centers have been operated under a variety of auspices
but several writers have pointed out the advantages in
termsof coordinated prOvision of servictts management by
the hospital of the neighborhood health center For
instancethisfac111tates the keeping of unified medical
records of all the care a patient Msrecelved either at
the neighborhood health center or _le hospitalized
(12p6) ~ermore a3 Young (38 p1741) points out
19
direct operationot the u1sbborhood health oenter by
the hoSpital canll8lceaftilable to the center expertise lt bull
in sOlle aapcta 0 Operation that m18ht not be aa readily
available otherwie
Relardlebullbull of wbetberthe hospital and the neighborshy
hoodhealtbcent8r haVe a cOJIIIOaadmjntstration they
IIlU8thaVealTlved at a str1Dsent delineation of IDUtUal
role and reSpoDBlbilltiebullbull All OOIIpoienta ot the care
yst IIlWStQlarify and understand one anothers position
In the syatem and acree on objeCtive ancimethOds
(26 pp16-17p31) SODae areas of iDUtUalconcemare
reterral procedures record keepiDg aDC1 mutual use of
facilit1es statt1Dl i8 anotb8r ~ ot coaaon conc~
Ditt1cultift have u-laeniD the pastiD cOllprehensive bull t bull
healtbc~ prosraumiddot 1d11ch were batil plauned in wb1ch
all of the health canter phy1C~1IDa did DOt bavetatf
privilege at all ot thebackuJlhospltala (29 p21)
SUch a8ituat10n i8 1Dampcceptablelt inpatient care i8 to
continue to be p4by the pat1eatmiddot health center
physician and it cont1Du1ty ot care 18 to be maintained
Hoapital and health center1lUSt laav 301nt responsibility
tor the recruitaentot physicians
VticlentU IPan BJcNrcu Much otwhat haa b8ea sUd has stre88e4 at leastmiddot
iJlplicit17tbaD8ed tor tM etticit middotprovision ot8emcea
20
There appears to be two aspects of efficiency which are
discussed by writers on the su~3ect of the comprehensive
neighborhood health care centef one of these is the
need to organize) services to make the most efficient and
economical use of scarce medical care resources The
other closelyrelat8d in realIty is the need to help
the public use services in the most efficient manner
The comprehensive neighborhood health center concept
1s lhherentlymiddot efficient in that preventive curative and
rehabilitative health ~are programs are coordinated under
one roof with integrated a~stration Furthermore
theempbasLson prevention health education and early
disease detectionis eftic1ent troJll~estandpoint of
the health care system as well as beneficial to the patient
(18 p760) HQwever ~ue tothe scarcity of health care
personnel thecoiDprehensive neighborhood health center
mustbe an arena tor eXperimentation with new staffing
patterns~ The Kaiser program is indicative of the way
in which health care systems must begin to operate in
that appropr1ate ancillary personnel are used Wherever
possible to perform functions that do not need to be
carried out by the physician As Saward (32 p42)
states
1hroughou10ur organ1zat1on~ there are many of the customary experiments be1ngmade-shyJse of speciallr trained nurses for well-baby care under the SUpervision of the pedi9trlcianexperiments with routine prenatal care by
w ~
21
middotSPC1a1l~t~JlUrbullbull per8ema_1 bullJmdlJleu y our fuDotlou are auoh that DOtb1Da 18 dorutbYtbe phY8iCianstbat doe DOt vet to be done by the
phys1c111U1fhe other aldlle4 person- Del-nurse middotreC~0D18t the appo1ntshymeDt center or clerical praormelshyaremiddot there to free h1amiddotto use his spec1al sk111
Awell lmoWn treDd1D the area of eaaiDI health
c8re JII8DPOY8rShortagjs bas middotbe thetrend toward tra1nshy
1DB poverty area rea1deats as DOD~pro~eaionalmiddoth8lth
aide and nepborboocl health workeramiddot (28 p63) This
bas the effectofmiddotmiddot1J)creaa1q II8DPOWrand 8180 can help
bridle the cuJ~ cap betweenprondera and colllUmers
of aen1C8s This attarD at least tlleoretically
createa a situation 1D WIa1ch providers andcoD8Ullers can
be educated to UDderatad OD88DOtber and interactJlore
ettectlvely~ HoWever amiddotpltt8ll has beeD themiddot tel14ency in
801D8 oamp8e8 tomiddot us aidesmiddot ssale8lllcw t~r the center
alJDOatexclwdY811rathertbaD ua1Dltheal to protide the
health care for wh1ch ~ were trained (29 pp3B-39)
1bat ismiddotmiddot vh1~e the a14e Yalue in ~~m1catiDI with
low 1nCOlMt patieata haa beeR recoSD1zed and stressed
their role ashealtb carepersoDDelhil been slighted 1n )
any 1Dstancea
Anotber step 1d11Ob bullbull been taken to provide 8rY1ces
more efficiently eUeot1ftlybas beenmiddot theorgan1zation
of per8ODDeliDto IIllt141sc1pl1Dary teamaaaa means ot
proYid1DgmiddotCOQrd1DatedserY1ce SUch te8lll8 sen_rally
~
hf
~
22
include PhYsiciaQs nursbullbullbullbull soc1al workers and outreach
workers Conceptually th8y fmlct10n to me~ the intershy
relate lled1cal and social needs ot the families sened
Hor there are a number ot barriers to the etfectve
tlmctiOD1nlof lIuchte8ll8 SODieot these are heavy caseshy
loads the inordiDate amount ot tille consumed by multlshy
prOblem tamtliethel1m1ted tra1n1 ngmiddotmiddotand laCk of tnterest
on tile part ot aoae tebers in examinJng aspects of
problems out14e~lr oWn areaaotcolIPetencemiddot and
~ourdcation prc)blell8 between proteasioDala and nonshy
prot81~s (10ppa-10) middotrurtbemOre as De Diaz
(14 middotp6)1nd1cate tbel8 maybe a teDdency tor vertical
dp8rtmental lines of auperv1810nto become paramount
over the team coDamloation syst lead1ngto conflIcts
in determ1niDI the ro1ea ot solie team bers particularly
the DOD-prote81011alaInauch exper1l1enta Witb new
~t1Dlpatterna it 1s bullbullaentialtbat line of authority
roles aDd NsP0D81bll1tlea be made explicit and that there
beJDechaD 8IUI tor relUlar evaluat1onotfunctlorUng
Another way inwb1ch health care sernee delivery can
be made more ett1cl8Dt is to proVide servicea dur1DC the
hours whentbey aremiddot -ostnee4ed As reQo_ded by Yarby
(37p1) serY1ce can bemadelIOre accesslble by making
themava1lable 24 hours a day seven days a week If
rg8l1Cy service are aft11ab1e aroua4-tbe-cloek at ~
nil1iborhood health center the continuity ot tbepat1ent ts
23
careiamaiDtalDedand meatry point into the
cOIIPre~i health care 8 be made available
tothe patient who aoZMllyU8ea ozilymiddot emergency care in
tille of med1cal criais More 8isDificantly ava11ab1-
lity of a tull rase of bullbullrv1c8 tor seVeral hours 11the
eVerlna aI1Cl On ~ prevent the los ot earn1JiSs
involved if th patierat 1IU8tt8cet1me oftfroawork dur1q
the d8y for aed1Cal oare bull his can be an eSpecially
importantc0J1814eration tor lo1aCOlleDUUg1nally qloYEtd
patient aa4caJla18o PIOJIOtet1)e 0Da01Dl use othealth
servicebullbull
exper1eDO ot tbeKa1er prosraa in tb1s~reprdAs
Greenl1clt(19 p10) states wA lllNt 8ip1flcant
proportion ot the abulatory care 8n1cp~Y1dd tor ~
total popUlatiC)U ~ ~ after clWc hours and this
Deed i8 apParenUyaoN prODGUDced tor aJl8d1cally
iDCust population On the other hand the bulk ot all
aabulatory med1cal cu 88l91ce are performed dur1nS
regular cl1D1c hour eVen when services are available 24
hours a dayJ day bull week W
It has ~ the experi8D~eof a ftIDber ot ne1g1lboXshy
hooct hea1tbcentere _t a_jor obstacle to efficient
proViSion ot anicbullbullhas beentbe teD4eDcy of medically
1ncl1pnt patieats to utilize the center oa a walk-in
baais tor epi8od1ccr181or1entect bullbullrv1cea rather than
4)i
h~ ~~f ~~ L
24
to make appoJlltaeata tor ODIo1qprevmt1ve treataent
and rehebl11tat1Ye care ad ampl1O to bave a blah failure
to Show rat_for tbe appo1DtaeDts that they dO make
Atone center 628 of appo1Dtments made were kept
while 3Oottbepati_ta een were ~1n patients
AlthoUP fewer patiets were actually 88811 by the cater
1D middottb1s 1Datance thaathe -bervholuidmadeappointshy
mta the walk-iD patlat required an iDord1nate amount
ot staff t1ae tor aCreeDiaaacl ~trral to pplOprlate
~ttor caregt (9 pgg) Arraquotbr1llpl1catjo~ of the
plOVidedto valk-iD patient by other thaD their
(19 p12)rurtbermore
when patients uti11ze Wlk-1Il er181 centered care
athelr ODlf tona ot ootact with the _d1~ care
ay_ta fUilycentered care the treata_t of tUl11y
bers
a a UD1t 11
dlarupted
hewalk-1Dphenoaaencm appear to barelated to
diUerence between soclal clase in the style of Dlaking
contactJt1th the a11oal C~ay8t As Greenlick f ~
(19 p11)1Dd1oate8 thepheDOaenOn ot INater usage of shy
walk-in ervice by aed10ally middot1Jid11ent patient thaD by
others baa otte been attr1buted to a stoical att1tude
tQward 1llDe8 em the~ ot poor people leacl1D8 to a
~
25
greaterdelay1n tbe k i Dlofa8d1cal care These
patients wppoedlyeelcmiddotcareODlymiddotwIleD tbeirmiddotillDess
becOlles1Dtolerable resultiDSin middotthMr appeariDS withshy
outnot1ce1o rece1ve oareHlwever Greenlicks
r8aearcbbaa cut doubt on the existence ot tb1delay
111 report1Dg middot8J1IPtoJumiddotOfDeW 11laessand seek1ng care
Be bas tcrQDd 1bat s1ll11ar peze_tases of dioally
1nd1sent 8DClJ1on-aed1cally 1Dd1PD~ pat1enta seek care
on the aue daytbat aptou tirstaPPear
1fb11e GrHDllclc 1nd1cat tbat the reasonator the
greatertendeDCY of low 1Do~e pat18Ilta to 1$8 walk-in I
serY1ces are notlcDo1rAmiddotmiddot tbe7 _ be rel~tedto a tendency
ot lower aocio-ecaaaoclaa patieota to preter face-toshy ~
face contacts with II841cal persoDl181posslbly because
such contacts areft coatortiDS an4reasauriDS to
patients who are hJpotbeafzed to bave a dependent attltude
toward IIed1Cal care perS0Jm81 (30 p161)
It a8 itmiddot baa pnerally beenhld the appointment
s1stemts the most efficient Ileana of dellveriDS
comprehenSive oODtllluiDlh-lth care (9~100)1t is
necessary that educaUoraalmiddotbulltfort be taken to proaote the
use ot middotappo1ntaents8DClmiddot tQrec1ucethe fa111re to appe~
ratB4uOatioaalwhlQb baft~utl11zedhave been
IJ
26
1Dten1ews with walk-in patients home Vi8its and group 4i
meetiDp1D8D attemptto1Dierpret1o the patients
the value of rtitgular ppo1ntmentamp andot con~in~
c~1ve care rather than epiI041c care (9 p1OO)
h1s 1safuD~tioD torwhtch nOl~prot81QDal colDlllUD1ty
YOrkersllaY bebe~r8U11ed tban other statf H()wever
euch aD ~ucat1oaal propul __~ ~e related to the senUiDe
capacity otth health oenter to provide comprehensivebull gt
ervice8 to1tpat1_t~odoD aD app01ntment bas18 It
1amp pos8ibleo~rw1 tor educa110Dal ttorts to result
LD a~8JImCl tor ltPP01ntaen~8 at a ratewb1ohi8beyond
the capacity ot thee_tar to t without uareaaoDably
1_ wa1t1Dlprio4a QOBt1nuad use Ot the center on a
wallt-in bU1 _1tbeoosiItpos81ble to et an appoint-
met anc11nCreued pit1entcoJaplampia1a bull Therew111 of
course always be a need and demand tor acute ep1so~c
Care -ci the health centerDlWlt be planned with the capashy
billty ot bullbullbullt1D8 tb1aneed wh1~ cont1Du1nI to stress
aDd educate the patient to utillze oDlOinI comprehensive
faa11y middotc~te~d Cflre (9p 100l
att g4 CODClva1opa
In order to bea4equate any coJlltemporary health care SY8tem muat bullbulletcerta1D interrelated criteria he
IJ
27
minimum criteria areaccessability of services to those
who need them compr8heX1siveness and appropriatness of
services and efficIency 1nthft utilizat~on of SCarce
health care personnel and resources The scareity of
pex-sonnel andtbe need for h1gh quality ongoinghealth
care services
aJIlong the
populationdemanci the most effishy
cientprovision of services
Services must be made accessible to the population
They mustmiddotbe geosraPh1cally accessible to remove the PhysicalmiddotbaTiers betWeen peopleandthem$d1calcare
system They mUst otter their services dur1ngthe
hours when people can make the moat use ofthemA~ it
makes little sense to concentrate services geographically
where they will not be uSed to their fUllest extent it
also is wasteful to provide serv1cesonlydur1righours when
many people are employed his not only presents a hard
ship middotto the consUmer lnrt wastes resources if for instance
the unavailability of preventive services during the hours
when people Can use them causes a need for treatment
services later on
Health carbull sEtrvices must be comprehensive including
prevention treatmcmtand re)abimiddot11tation Ambulatory I
healtbcare facilities wh1cQ are orienteciexclusively
toward either prevept1on or trea1mentare no longer accepshy
table for they are lneft1c1entln their use of resources
and in their prov1s1on of health care to the patient
w ~~
28
If prevent10n1s notmiddot stressed treatment serv1ces that
could have beenavoidedY1l~ be required If prevention
1s the sole focus of the health care facility sick
patients who present themselves must be referred elseshy
where for treatment andsllch referx-als may be taken as
reject1onsor not followed through with until illness
becomes unbearable
The instltutlontbat meets these requirements Is
the comprehensive neighborhood health center It 1s a
local decentralized outpatient facilityprOVld1ng a
fUll range of ambulatoJY health care services It has
a linkage to ahospitalbackUp facilityforlnpatient
treatment and hiihlY apclalized outpatient care
The neighborhood health center must be a fac11ity
planned with an awareness of the needs of the conSUtller
and coDitnUn1ty It must have the r~Ul0urces to provide the
services people need mere they can use them and when
they can use them It must uti11ze the part1cipation of
the community to develop this awareness Not only must
the cen~er beset up to be Amctional for the consumers
but efforts must bemadeaga1n with commun1ty partici shy
pation to help the consumers utilize medical care
services effectively The center muetmake efforts to
educate the community about the valueot regUlar health
care of preventive servicesand of the use of planned
IJ
29
medical appointments ratherthanorisis centered walk-
incare Therealit1es of the existing health care
system have not taught the patient particularly the low
income patienthow to use services effectively
The helthcenterilUst also bea laboratory for
experiments in easing the health caJepersonnel shortage
and c60rd1Datingcare~ A major difficultY iri-exper1shy
menting with neW rolesis freeing staff of old preconshy
ceptions
CoDlprehensiva neighborhood health dare centers have
been developed under a variety ot alisplces including
medicalsociet1es hoSP1talsmiddot(36p299 group pr~ct1ces
(29 p6- 12 117) health departments (13 p1027) and
ne1gbbothoodassoc1ations(14) The literature indicates
somevalues nthe management ot the health center by plusmnts
hospital backup faCility Whatever the auspices many
adm1nistrative fuDctions such as program coordination
standard pr9tectionand evaluation call for considerable
c~tralization of adm1nistration city-wide or coU)tyshy
wide At the same time other aspects hours of servlce
for examPle~ cuI f~radm1nistrative fUnctions made atmiddot
more local levels Each neighborhood center must be
free to adapt its functioning to itscominunity thi-ough
the mechanism otcODlllUl11~ participation inmiddot policy making
Obviouslythe prerogatives and responsibilities of each level must be negotiated and made explic1t
t4~
JJ
BIBLIOGRAPHY 30
1 American Rehabilitation Foundation ~ealth Services Research Center The Health Maintenance Strategy mimeo 1971
2 Anderson Nancy N Comprehensive Health Planning in the States A Study and Critical Analysis Institute for Interdisciplinary Studies American Rehab ilitation Foundation 1958
3 Andrus Len Hughes Comprehensive Health Planning Through Community Demonstration Health Projects mimeo1967
4 Barry Mildred CandCecil G Sheps A New Model for Community Health Planning unpublished paper presented to the American
Public Health Aseociation1967
5 Blum HenrikL Fred Wahl Genelle M Lemon Robert Jorulin and Glen W Kent The Multipurpose Worker and the Neighborhood Multiservice Center InitialImplications and EJeperiences of the Rodeo CommunityService CenterAmerican Journal of Public Health58 (Mar 168) pp 458-468 shy
6 Blum MichaelD and Soloman L Levy A Design for Service Delivery that Reinforces Constructive Tension Between a Health Center and Its (sic) ConSUDlers and Supports Community Power unpUblished paper presented to the American Public Health Asaociatiltn 1968
7 Brielaud Donald Comm~ity Advisory Boards and Maximum Feasible Participation American Journal of Public Health 61 (Feb 1971) pp 292-296 shy
8 Burns Eveline M Health Insurance Not If or When But What Kind Madison Wisco~sin University of WisconsinScllool of Soci~l Work 1971
9 Campbell John Working ~elationships Between Providers and Conshysumers in a Neighborhood Health CenterU American Journal2 Public Health 61 (Jan 1971) pp 97-103
10 Caxr Willene Neighborhood Health Centers Funded by the Office of Economic Opportunity mimeo 1970~
11 Colombo Theodore J Ernest W Sawardand Merwyn R Greenlick The Integration of an OEO Health Program into a Prepaid Comrehensive Group Practice Plan American Journal of Public Health 59 (April 1969) pp 641-650~ -
12 Comprehensive Neighborhood Health Services Projectof Kaiser FoundatioIl Hospital~ Prcgtgram YearE grant renewal proposal mimeo~1971 bull
13 CowenDavidL~ Denvers Neighborhood Health Program Public Health Reports 84 (Dec 1969) pp 1027-1031
IJ
14 De Diaz Sharon Daniel Beyond Rhetoric The NENA Health31 Center After One Year unpublished paper pres~rited to the American Public Health Association 1970
15middot Gerrie NorrrianF and RichardH~ Ferraro Organizing a Program for Dental Care in a Neighborhood Health Center Public Health Reports 8 (Aug 1968) pp 419-428
16 Gordon JeoffreyB~ The Politics of Community Medicine Projects A Conflict Analysis Medical Care 7 (Nov -Dec 1969) pp 419-428 shy
17 Greely David The Neighborhood Health Center Program and Its Implication(3 for Medical Care H~alth Forum of the Welfare Council of Metropolitan Chicago (mimeo) 1967
18 Greenlick Merwyn R Newgtimensions in Health Care American JOurnal of Pharmacentical Education 34 (Dec 1970) pp 754-4
19 GreenlickMerwyn R Donald K Freeborn TheodoreJbull Colombo Jeffrey Abull Pruesin and Erne$t W saw~d Comparing the
Use of Medical Care Services by a Medically Indigent and a General MemberShip Population in a Comprehensive Prepaid Group Practice Prosram II unpublished paper presented to the AmericanPublic Aesociation1970
20 H~tadoArJiloldVMerllYll RGreenlick and TheodoreJ Colombo Determinants of Medical Care Utilization Failure to Keep Appointments unpublished paper presented to the American Public Health Association 1971
21 Johnson Richard E and Merwyn R Greenlick Comprehensive Medical Care A Problem and Cballengeto Pharmacy ff AJilericanJournal of PbarmacenticalEducation 33 (Aug 1969) pp 361-367 -
22 Kahn Alfred J Studiee Social Policy and Planning New York Russell Sage Foundation 1969
23 Kotler Milton Neyhborhood Government Local Foundations 2 Political~New York The BobbsMerrill Company 1969
24 NationalCommisaion on CommunityHealthSfrvic~sActionPlanniriamp for Community SetithServices~ashington p C Public Affairs-Press 19t7
25 National Commission on C~mmunity Health Services Health Adminishysration andOrMPization l the Decade Ali9$-d Washington D C Public Affairs Press 1967
26 NationalCornmiesion onqomm1Jllity Health Servicesbull Health ~ Facilities Washington D C PUblic Affairs Press 1967 bull
~ n
32 27 ODonnell Edward J and Marilyn M Sullivan ServiceDelivery
and Social Action Through the Neighborhood Center A Review of Research tt Welfare ~ Review 7 (Nov~Dec 1969) pp 112
28 Office of Economic Opportunity Second Annual Report Washington D C~ U S Government Printing Office 1966
29 Office of EConomic Opportunity and the Medical Foundation of Be~laire Ohio Eighth Report 2l ~ Committee2a Governshy
ment OperatiOll~ Va8hiiiSton D C Government Printing Office 1969
30 Pope Clyde R Samuel S Yoshioka and Merwyn R Greenlick Determinants of Medical Care Utilization nhe Use of the Telephone for ReportiDg Symptons Journal of Health and SocialBebavior12 (June 1971) pp155-162 shy
31 RenthalA Gerald nComprehensive Health Centers in Large US Cities American Journal of Public Health 61 (Feb 1971) pp 324-336 shy
32 Saward Ernest W The Relevance of Prepaid Group Practice to the Effective Delivery ofHealthServicestt The New Physician 18 (Jan 1969) pp39-44 - shy
33bull Schorr Lisbeth Bamberger and Joseph T English Background Content and Significant IssUes in Neighborhood Health
Center Programs Milbank Memorial ~ Quarterly 46 July 1968) part 1pp 289-296
34 Weiss James E and Merwyn RGreenlick UDeterminants of MedioalCareUtilization The Effects of Social Class and Distance on Contacts With the Medical Care System Medical~ 8 (Nov-Dec 1970 pp 456-462
35 Weiss James E MerwynR Greenlick and Joseph F Jones Determinants of Medical Care Utilization The Impact of Ecological Factorstt unpublished paper presented to the American Public Health Association 1970
36 Wise Harold B Montefiore Hospital Neighborhood Medical Demonstration A Case StudyMilbaDkMemorial Fund Quarterly46 (July 1968) part 1 pp297-308~
37 Yerby Alonzo S ttHealth Departments Hospital and Health Services Medica1~5 (March-April 1967) pp 70-74
38 Young M M~ Chatanooga IS Experience with Reorganization fOr Delivery of Health Services ttAmerican Journ8l of Public Health60 (Sept 1970) pp 1739-1748
f or l
II bull 11 Y d
II
IJ
34
ThepurposeOfPart II of th1aa paper1atod1scuas
elected Speclfic needs ofecltlc areas within Multnomah
County A8P01ll~oUt 1D ~ I of t1a1bullpapermiddot Ita nelgbshy
borhood health oare cater IlU8t be a facl1lty plaDlled with
aD awarenes of the neeels of the oODllUller and collllUDity
Part II of this paper nIl Show 80e of thoe speclflc
needs
he1DforutiOD tor t1li Portlon of the report
obta1nec1 troll tbroupout tbe follow1Dl threepUb11catloDS
1gr~e_tiMshylIPrIxaiidOreson JuDe 1963
2 1~_middot_sectSI8e~ected1teai c-ua 0 S 8 e first count coaputer tape Coluab a_lion AssocshylatloD of QoveraMD-8 Jlme 1971
3 Jtu1tDoab County Oreaon BDY1roDlHtlltal SurveyEarly 1971
The JIultDOIIIlb COUDty OrttIOD BDv1roDllfmtal Surley
Barly 1971 1s bull stat1stical report of the activ1tles of
theentlreMultDOIIIl2 CcNDty Health Dep~t during the
year of 1970 Die speclflc 1nd1cs elected from tb1s
study amprejMental aealtll Publlc Health N~s1D1 vlslts
FaJUly ~ Veaereal])1 ~ ~rcul081
Throush tie use of cUrts and mapa ODe CaD roup these i
speclflc ~oea to ahcnr the healthneedsof speclfic I
census trtcta aD4 then the health needs of iarer neIghshy
borhooda 1m4 o~ Uebullbull
Rf)~UP1Dl of areu was accompllshed in thefolloWinl I
JJ ~
35
he MiltDoIliahCountY oregon BDViromaental SUrvey
early 1971 isamp statistical report ot tbeaotivities ot
the entire MultDolllh COUDty Health ])epartiDent dur1nl the
year ot1970 he specitic 1Dd1C8S selected frOm this
aUy are 1Il8Dtal health public healthDurs8s visits
fUl1ly pia waereal elisease aDd tuberculosia
Tbroq11the Wle otcbart aDd mapa aDecm szoup these
specific indic to show the health Deeds ofapecitic
ccmaua tracts aDdtIum th8health neecla of larsr ~eilh-
bOrhooda and co8I13 tlbullbullbull
RegroupiDI ot areas waa accoap118hed1D the
tollOWiDl lIIIIm1er~ A bullbullcifie 1ndex 8selectcl auch as
venereal di8bullbulle or tuberculo8i~ he total number ot
cs was then deterll1ne4 for each census tract Through
the use of the maber ot cRbullbullbull tor a 11Yen cenaus tract
aDd tbe population ot thattractaltrateot1lla1ampmcper
100OOOpopUlaticm wu cleteXll1ned for each census tract
This was ~e to starl4ard1ze the population ditterence
amongOeD8U8 -tracts 1he rate of incidence toreaob
cenauatract was then llstedby rank position on a chart
In rank poition1DI any cen8Wl tracts haviDg equal
rates ot1l1c1dence are assipe4tbe iaDk posttiona
Beeauseot the abo fact tbAt cbarta w111 vary in length
neveltbAtlea eacb cbart will 1Dclu4eall census tracts
inMullnoaah Couaty Atter the census tracts bave been
listed accord1q to raalcth1s list will bediv1ded into
IJ
36 three levelsotinc14ence he three levels are
1~ The upper 14 of1DcldenCe
2 Thelower 14 ot incidence
middot3 The ILld 12 of incidence
Tlles three srouplqa are then used in compiling a map ~f
Mu1tnOmahCountyfor ach apecltictop1cbull TIle maps are
uaefuJliD tbatthey V1suallycoJib1De 1Dd1v1Clualproblem
census tracts into larger problem nellhbOrhooc1s
The 1960 statistical iDtormatloD was Used in a similar
liIaDDr to tbatexpla1Dedabove 1Dthe4evelopaent of a
chartmiddot and map 1Ihow1DI e cOllpampriSOr1 of per capita lncolle
tor ttaCh ceDsua tJact aDdmiddot combiDed census middotmiddottract areas
he 1910 aDd 1960 statlstlcal iDtOrllatl0D was combined
lna map and chart he purpose of this and chart is
to d8aonatrate the e cl1stributloa1DeachceD8U8 tract
and middot1ndlcatbull tuture ace populatlon treD4a bull
When one be middotbullbullbullbullbullHdth ne8cts ot an area and has
declded to establlsh a cl1D1c to serve that area the
physical location otthat cl1D1c IllU8t be consldered In
order to coapreb8ll81vel develop an area cl1n1c one should
conslder thepre88Dttraftlc middot~ytaa an4tranaportatlon
systems Thecl1D1cahoUld be located close enoUlh to
major arterlals to giva asy access from the total area
be_ ervecl by this cliD1c At the t1ll8they should
be tar eo away froll thesarterlals to all8Y1ate traffic
CODCell18 andpark1D8 conpstlon By traff1c concerns I
IJ
37
lIlan one lUSt consider thertarro1fne8S of streets whether
streets are oD8--C)r two-way iqres8 and egress to parking
amp0111tie eros tratflC) spedof trattJQ children 1n
ll8a traffic i1lht Vislon re8tr1ctionS etc
BwstraDsportat1onshould alao be central in this area
as maay people ~U f1Df1 1tD8Cessary to use this form of
transportatlon
~e tutqredlopHQt of bull treewa systems should be
c0J1S1dered soastolesen thecumce ofmiddot future roada
cutt1DSotltbe cl1D1c llte line
nrrph1c middotDampta
It is 1JDportaDtto kDOw the demosraphic distribution
characteristics of the oUenteltbat i8 to be served by
localized health cl1D1cs
Acl1D1c which erves8J1 area where1D the prepondershy
ance of persona arecrter 65 years of mayf1nd that these
people rely more on pUblic transportation call for more
home- services and haV4t 110ft ChroD1c and debilitating
types of disorders (b1_ blood pressure poor heariDg and
eyesight) tbaD do8 an area ot a YOUDIer population On
the other hand thL area of older residents may have little
need for family plabDlng cllni08
In order to better ~Ybullbull the 4eaoraphic population
of each CeD8U8 tract the 1970 CeD8U8 iatormation was viewed
and two specific catelOri8 considered These two cat
IJ
38
lori8S woUld be the perc_tap ot population under 19
year of ase and the percentase ot each oensuetractover
65 years of age he 1960 1Dtormatlon tor eaCh tract was
then compared witbthe 1970 intormation and a percentage
ofincreaae or4ecreamp8 tormiddot e~chtract1n each category
cOJlputecland achartma4e By the use of this chart one
18 able to View tJleap populat1odiatr1but10n of census
tract and at the _ t1lle accesa middottrencl Por example
let us choose census tract 601 W see 40-4 otthe
population is under 19 years ot and that ODly82 1s
over 65 years ot middotAtthe e tille the percentage of
youth bas ~ed ODly 1_ intbe laSt teD year whilethe
percentale over 65 year ot middotbas stayedmiddotthe same With
this in mJnc1 ODe ~ 1DfItr libat ol1D1o aerviDg this
area WOuld bellQre conq~w1th the problems of a
YOUQier populat1on and that _ would probably be true foJ
some t1aein tbefuture On the other hand CeDSU8 tract 54
has only 2 ollt population UDder 19 yel1s ot age and
this has decreased by 1 over the last ten years middotwhile at
the same time 32-377 ot the populat1on 18 over 65 years of
age A ol1D1C ___ this area should be or1eJ1ted toward
tbespecttic problema otthe ampledbull
PerCapia __ bY gsa neat
WhaD cona1der1qlooat10D1 tor health cl1n1cs one
shoUld take the 1DC01Ieot areas into consideration Areas
IJ
39
of lowiDcome would not 11kel~be 8erved more by localized
cl1D1cs tbaD would are of hilbincome It 18 likely
people haYiq a hip iDeoll8would preter to be aeenby a
chosen ~r1vatephylc1a1l tban at a local cl1D1cwhere
10Dier waits y beraceaaampryand leas personal attention
gl_
The 19701ncOII81atoWampt10n tor MultnomahC~ty was
not available at the tille thi8report W88 made The 1Dto~shy
tiOD Was taken ~adtro tbe1960 census publlcation
his woUld ~8Il thea tbat ral1I8 OD the chart ynot 1raquoe
completely accurate hi writer telthatthe areas most
affected by tb8 1I8eof the older 1Dco1DtOlaat1oDWOuld be
those tracts wh1ch baYebad a rapid 1ncreaae1n populatlon
over the past tfmyHr8 bullbullbull tracts would include tracts
nUmbered 104 9897 96 aDd 95 be perc~ita 1Dcome
referredto1il-tb1a Paper18the lIean 1DCo per person per
census tract
Attar the iDeoeper census tract was listed on a chart
a map was de 1D41catiDg those census tracts belonging to
the lower 14 ot income tor all censue tracts in Multnomah
COlDltytbose beloqins to the upper 14 ot income tor all
census tract 111 MultnolUlhCounty and those belonging to
the mid 12 ot 1I1coaetor all oeuuetracts in Multnomah
C01mty
In yiew1Dg the _p 1t caa be seen that the low income
area seautotollow aloas the at aide ot the Wl1lamette
IJ
40
R1ver the full length of Kultnomah County A second low
income area follows the south edge of the Columbia from
the northwest corner of Multnomah County easterly to 148 St
A third problem area seems to be on the east bank of the
Willamette River with the Union Pacific Railroad being
about the center of this tract The extreme loutheast
corner of Multnomah COUDty appears to be a low income area
but as this area bas bad rapid grouth in the last ten years
this could be erroneous
Mental Health
be first ~ecific indica to be selected from the
Multnomah County envirollllental survey of early 1971 and
to be considered in this paper i8 that of Mental Health
At the present for mental health purposes Multnomah
County is divided into five catchmentareas with a mental
health cl1n1cin each area These clinics are Model
Citles Delaunay ADkeny street Office Hansen Health
Building end Southeast Clinic
All lIlental health cl1n1cslcept statlstlcal information
on all patients visiting their cl1n1cs this included the
address of the patient hese addresses were then listed
upon the approprlate C8D8US tract Each census tract was
then ranked on a chart according to the nUllber of mental
health patients who reslde ln thatCeDSUS tract attending
any of the above listed ental health clinics This chart
IJ
41
wasttum d1v14ed1ato proper quartile bbullbullbull
quartile vereUs to dne10 u appropl1ate Multnoh
County _tal health ItLa middotmiddotmiddotthelipO~a1bl by lOoJcJIUE
at the UDtal health _to uteN1De which ueu have the
lars-t use otCOllDty 1alh~th faci11t1Rot
1Ilclu4ecl 111 tbia woUld tber otpeopleYia1t1Da
pr1vat patch1atriata aDd pr1_t _ntalhealtb cl1D1c8
WheDtbe M1 18Yienclmiddot Itmiddotmiddotmiddotmiddot~middotbe~_ tbat ~rtt
appears to lMt fourmiddotmiddot-al are iii _oil the nuaber ot
lIental healthcl1D1c na1t toM tbjh1sheat 1he
tour areaa woUld be tollows
1ttrea Ore to~Blo Drimiddot ~tb Burrus14e aDd tIMtmiddot Colb1a Riftr H1gbwyaeri1Dla th nortllra boundaryshy
2 bull ProII 82D4 1_~ 10 20th streetwitil the ra1lMd Mu the north ltouadary
3 ~ et et tUgl_b1bull MYel froamiddot the Clackaaa COUDty l1ae aorth to Dln8lon stret
4 beDOlvt1ttfe-t ~efllt4 COatytrca Jle1aware streetmiddot toR1C1a11oDd wlth Colubla Blvd heiDI tbAtnorth bouaclary_
It ODe coapareatbiap to th iDeobullbullmiddotp 1t can be
eamiddotthat lIOat ot the c tracts baY1Dg bllh v1i11tatlcma
middottfl public tal health cJ1rUc8 ~ 111 t13e low ~ aid
1DcOile SroupiDIOJa1y of til 25 tracta llsted as
haviDlbip aental Maltll nlltatlou are ~ the1g60 hip
iDeo arebullbullbull
17 Plpn
42
amily PlellnSDI ]Jlce Metal Health i8 an 1nd1ce of
use Theperson 111 ordertobavebe_ 1Dcluclecl 1n this
atu4ywouldhave tohaft Ue4 ataa11y plaDI cl1D1c
tacilities of soaetype It 41fter troll tile _tal health
study1nthat i t1Jicludestatist1catrollbotb public and
privateclJD1os
The iDformation tor the iak orurcbart 8Dd map of
t8ll111 plenn1 na ob1a1De4 by cOIIblnlDlthe mabel of
1rlcuv1duals bullbull_ attbe tbreellUltrampo-ti Coatyhll11y
PlalJQllIl C11ll10s 111til tbo at the Planned PareDthood
Association CliD1C8 be tbree -JIultDouh Couaty r8ldly
PlamSq Cl1D1c are Solrtbweatth Col_bla 1111- a114
HaDsell Health BWlcl1Dl CllD1cbi middot1Dtormat1oD vas then
bullbullbullesed tomiddot detellWMt l10w people troll eacb c8IUIUS
chart wastben Mele IUs oIIart jn 4iY1ded to show
the censuS tracts lIaYiDlmiddottIle h1t1iest qUart1le of incidence
of use lowest quartile of 1Qc1deao ot use Jlid 12 of
incidence of Wle an4 a map sprepared troll thts 1Dto~
mation
The C8U118 tractsbelOJISnl to the h1lhestquartile of
use appear to be 1lO~ 8catt~ on tbipwas true ot
either the _p ot aental health cl1D1c uaageor ot the map
abow1DI per capita 1I1COM Iaere40 to be three
d18t1nct areas of UIIaP beJ woul4 be
1
IJ
43
t10D of BurD81cl and the W11lallette River 4
2 S~t Portland 8Otth otmiddot the ra11shyrcaadand alona the W11lamette River
lIortbeaat Portl8D4 between MisSiss1pp1 and 24tbStreet the northbouBclary be1DgColwb1aBlvd
Pylzl1c BMltl IrpI Y11ta
Publlc Healtil nur81D1Y1s1t nclud8 an vists to
theholles of client by PubUc Health Nurbullbullbullbull his shows
visits to bull f8Jl1ly fer aDY purpos SUCh aatuberculolJ1s
het1Dl tem1tyaeatalu4 8IiOt10D8l cODd1t1ona etc
he atat18t1C~ 1fele C()4ed accord1Dg tomiddot the 1llli301fOCUS
of the Y18lt tt doe DOt 1D41cate the Dmlber of holies or
f8ll11lev181tecl or 1D41Y14ual Y1a1ted more tban oDcein
the propwl It dobullbull I1ve 80M 1D41cat1on by coaparlshy
OD ot the 8JIoUDt of aedlcal problema 1n eachcen8WI tract
Ap1nmiddot the _p abowa 8 scatter patteraof probl_
areas althoUSh there appear to be a sroup1Dl of hiSh J
l8aIeccmaus tract 1ntlut extreme southeast part of tbe
County other areu uIriaI any nura1Dl contacts are
1 bull he 801lth-oa-al CO1Dty on eaCh 814 of 82nd Av from Clackallaa County north to Dinloa
2 ear bullbullbullt 814e aroUDd Preacottand Misaisippi
Dowatom Bunul14eonboth 1de of the river
44
V_real Pis The iDfomatloil uaec1 to tabulate the Venereal
disease chart includes all the ooab1ned case otmiddotODormea
and syphilIs reported by bothmiddot publIc and prIvate physicIans
dur1nl 1970 There were 3602 caes ot IOnorrhea reported
dur1nl 1970 While ODly 17 cabullbullsot ayphilimiddot were reported
A chart was prepUed aDd att8llPt wasmiddotmiddot de tomiddot
determ1De Wh_therVttDereal 41ease was more p~vaJent in
areas othigb or lowmiddot proportIon ot youth hi waadone
bymiddotdetemlna a 1leaD prceiltacmiddotmiddotmiddottor the population ot
resld~ts UDder19 years ot (34) middotA mean ratemiddot per
100000 popUlatIon al80c1ttem1Ded tor the middotoccurreDCe
ot venereal dieae This was et at 390 oass Areas
hav1nl a population 1n which leiS than 34 were lmder 19
years ot ampIe were called low- yOuth abOve tbl percentaae
hiSh youth The aaa waatrue ot the occurrence oivenershy
eal disea_ per CeD8UStract It the rate waacomputed
as 1I0re than 390 cases per 100000 it was called hiah
venerealdiaeasei it less than thia tisure low venereal
disease It was tound that 1D Multn~ COmlty there sems
to be poSitive OOlatI0n(x21S19gt between low youth
and hipmiddot venereal diseaand hip youth and low venereal
diseasebull
RaDk ordr Iitot all c traot middottbAm made
Th1s was done byt1Ddlna the ratepr 100000 populatIon
of venereal disator all census tracts in the County bull
45
These were thenlisted from h1lhto low (sreatest to
least) in a rank order The l1sting was then divided
into Upperandlower 14 aDd listed on the MUltnomah
Countymiddot up
The areas of b1gh venereal disease se8ll18to
roup thBl~8 middotin a very tllht area ~oq both 1des
of thell18l8~ R1 w1th BurDaldeS~et being
~bout theceDter qf tbi8IZ9uping This area woUld
appear to be m ldeal spot for the denlopment of a
locallzed venereal d1sbullbullbullbull cl1D1c
UbepoundCUlO1s
In this report bull tube1C1llosls caS8S refrred
to include alltbobullbull cabullbulls ontubercUlo8is follow-up
rather middotthan just new C Accord1Ds to the Multnomah
County Health SUrvey of early 1971 this would include
all ca repOrte4 over thelaat three years The
total number of tuberculosi8 cabullbullbull usedin this study
was 666 lh1 included 128 new cabullbullbullbull
A rate per 100000 of tuberculosis for each
census tract wa- then computed and the c~us tracts
listed by rank order be b11h Qartlle mel low
quartl1 were then reoordd on a Multnomah CoUnty map
TWo genral areaa baY1Dg a hip mcldencaot tubercu~
losiare 1D41cated heyare
1 Both middotsld ot theWilla11lette River
Ll -
46
with Burns1de about thecnter
2 he extrea Northebullbullt comer of the County bull
By coap8r1ng the tuberculois an4ven8real
diseae maps ODe can 8ee that the downtown areas ot
hiSh 1nc1denceare alIIo8t 1c1eDt1cal on ach map
This WOuld 1nd1cate that 1t would be of value to
bullbulltab11sh acl1D1c 111 th1aampreatbat would provide
bothtuberCulos1s 8Dd ytmereal 418ase srvicbullbullbull
Thchart aDd 1181gt8 are wsfuln 11v1DI
1Ddicat10DS tor the type aDd placemeototlocal
health cl1n1c8 tbro1qhout tbe MultnomahCounty area
A cOllpar1on of the mapa help one to dec1dewhether
to provide a aulti-8ervice cl1D1c or spec1f1c type of
cliD1c As stated in Part I of thi paprserv1ces
shouldhaYe both treatlieDt and prfMmt10n cOmponents
As he been stated fta ne1lbborhood health care
Qenter muat be a fac111tY plazme4 with an aamesa
ot the neds of the consumer and the c01llll1m1tybull
Part II of this rport haa been an attaapt to indicate
and clarify 8011 ottheae coDlllUDity neds This has
been done through8elect10n of apc1f1c problems
The indic were then visuallyrecorded through the
use of ups and charta ODe dan asseS8 thedsreeof
1DIportance of certain concems to spec~t1c areaa by
comparinl the chart aDd maps Prom this oDeean
41 dec1de which are48 vb1chcUD1c-or indeed if
the need a clinic at all However further factors
should be considered hebullbull include
a The amount of fuDd1 available
b What 18 the percentage ot peopleineoh ceaaua tract tbat would actually us such cl1n1cIl
c Wbat 1 tbeco--1tymiddot 8 IeeliDashyreaardtDI particular cl1D1c8 Would this dcrebullbullbullmiddot the ettctiveness ot thse cl1n1ca
IJ
li
D_OlraphicPopulatLon Challie 1960 to 1970 48
Cen8U8 1 of Pop 1 Cbaqemiddot 1 Change1 ofPopTract Under 19 Yr8 Over 65 Yrs1960-70 1960-70
middot1Q701Q70
1 319 -12 171 -H) 1
2722 215-27 +68 301 366 -22 127 +35 302 371 +19 111 -04
311middot401 144-41 +29 402 321 13~7-39 +24 501 356 124-08 -02 5~O2 351 133-23 +12
405601 82-10 -02 394602 103-01 -06
701 275 149-76 +56 702 361 +01 121 -07
+10middot801 326 140-22 802 321 middot127
(
-29 -03 9~01 342 124 -H) 6-18 902 294 128 -H) 3-24
10middotmiddot -14312 140 -17 1101 182 +25 -23197
2411102 186-59 +29 1201 226 169-17 -41
31middot01202 +11 182 -05 295 -H) 81301 208 -H) 4
1302 331 +08 197 +04
14 323 +15 middot185 -08 middotmiddot15 329 +16 16~5 -13
-28middot 1601 332 131 +12
1602 356 98 +24middot-39 middot3101701 161-33 +21
1702 370 -15 85 +02 +19 1801 264 151middot-50
185middot1802 256 +47-58
IJ ~
D_raphlc Population Change 1960 to 1970middot 49 (Contd)
4io
Census Tract
of pop Uncter 19 Yra
1Q1n
1Cha1l8e 1960-70
of PopOver 65 Yra
lQO Change
1960-70
19 389 +29 141 -24 20 223 -13 206 +18
21 227 +08 194 -36 2201 356 -27 112 +05
2202 290 -18 ll~9 -29 2301 356 -03 154 +24 2302 260 -37 245 +97
2401 410 +6~1 123 -31 2402 163 -80 320 +99 2501 381 +13 140 -01 25()2 237 31 lil +02 26 343 +25 186 +149 2701 370 +29 1S5 -01 2702 249 -44 304 +98 2801 337 +19 187 +09 2802 306 -10 156 +31 2901 304 -38 142 +24 2902 i 307 -32 146 t3~9
30 29~0 -48 16~2 +51
31 355 +30 160 +01 32 370 +48 148 -13 3301 395 +45 130 -20 3302 368 +06 138 -02 3401 386 +16 117 000
3402
400 +32 92 -26 3501 304 -07 115 +35
3502 344 000 140 -13
3601
36~02 357 -04 132 +32
3603 30~1 42 149 -67 3701 342 +28 152 +19
1
IJ
Jianolraphic Population Chan 1960 to 1970 50 (Contd)
Census Tract
of Pop Under 19 Yrs
JJl7J
middotChanae 1960-70
middotofmiddotpop Over 65 Yrs
1c~7n
Change 196070
3702 409 +39 122 -11 3801 308 -11 151 +29 3802 275 -35 180 +46 3803 282 -32 192 +54 3901 376 ~13 100 +17 3902 296 -03 177 +29 4001 438 -11 84 +13 4002 353 -21 115 +20
4101 397 11 9middot0 +11 4102 346 -19 120 +03 42 331 +19 11 bull 3 -16 43 347 -72 105 +31 44 113 +84 183 +154 4S 33~9 +07 110 -06 4601 2501 22 193 +38 4602 332 +59 126 -29 47middot 161middot 000 211 +01 48 103 -26 302 +59 49 138 +1 bull 3 252 +09 50 141 -26 204 -12 51 12 -39 257 +07 52 47 -61 351 +48 53 89 +49 314 -30 54 25 l1li15 327 -17 55 131 -17 115 -121 56 198 +93 227 -47 57 71 102 189 -88 58 240 ~middot41 16~1 +55 59 322 +25 142 +06middot 6001 264 95 132 +50
6002 328 -31middot 89 +07
JJ
Demographic Population Change 1960 to 1970 51 (Contd)
Census 1 ofPop lChange of Pop bull ChangeTract Under 19 Yrbullbull 1960-70 Over 65 Yrs 1960-70
1970 1970
61 355 -58 85 +39
62 328 39 110 +18
63 414 04 73 10
64 382 -22 72 +04
6501 383 02 67 -20
6502 329 -56 96 +09
6601 391 +13 88 -03
6602 319 -59 97 +06
6701 327 71 145 +72
6702 331 ~67 83 +1-0
6801 365 -66 49 +01
6802 388 4bull3 54 +06
69 354 -41 80 +23
70 400 -23 68 -06
71 359 -48 72 +05
72 255 -88 82 +11
73 346 -39 91 +25
74 313middot -63 105 +24
75 329 -42 129 +37
76 336 -52 85 +21
77 370 -10 69 +05
78 309 -10 120 +21
79 325 -56 87 +10
8001 358 -81 57 +12
8002 391 ~81 76 +12
81 315 -76 108 +21
8201 403 -23 64 +08
8202 392 23 65 +08
83 357 -34 120 +31
84 402 -18 73 +16
85 413 -06 76 -09
r
Demographic Population Change 1960 to 1970 52 (Contd)
Census Tract
t of Pop Uncler 19 Yrs
1970
Change 1960-70
1 of Pop OVer 65 Yrs
1970
ex Change 196070
86
87
88
89
90
91 9201
9202
93
94
95
9601
9602
9701
9702
9801
9802
99
100 I
101
102
103
10401
10402
lOS
368
351
379
391
391
413
379
433
372
429
414
432
419
439
~32
377
457 420
378 41middot7
345
360 417
417
412
-04
-02
-35
-26
-28
-11
-64
-20
-S9
-39
-32
-21
-34
-40
-47
-lO~7middot
-27middot +04
+56
+07
-34 01
+04
+04
+10
103
128
97
11il3 99
69
79
42
77
46
34 38
44
40
54
111
51middot
81
133
59
74
140
63
87
76
-08
-06
+04
+08
+17
-05
+3S -02
+1~4
+19
+33
-14
-08
+12
+26
+71
+11
-16 -34
-20
-19 +37
-49
-2S +15
NOte The The
Taken frOi
averageullder averageabove
middotUSCensus ---shy -
19 years == 6S years ==
figures 197
32r 13(14
p a~d 1960
--
Rank
1
2
3
4
5
6
7
8
9
10
11 12 -_
13
14
15
16
17
18
Tract
69 46
60
58
- 68
61
302
2501
67
63
19
62
26
94
3603
3902
64
30 -----~-
Rank
19
20
21 -
22
23-shy
24
25
26
27
28
29
30
31
32
33
34
35
36 -
Ranking of Per Capita Income by Census Tract
Tract
65
2701
- 15
1601
701
66
93
82
2903
3602
30
2502
80
2401
81
- 70
91 shy
4001
High
Rank Tractshy
-32shy37
38 97
120239
7840
41 ~ _2_1__ 42 31
43 2501
44 18
45 98
46 37
47 3803
1702
49
48
1602 92 2702
I
50 89
51 901
52 801
Ra_
53
54
55
56
57
58
59
60
61
62
63
64
6S
66
67
68
TractTract Ra~
74692
170196 70 I
401 71 90
72 1037J
79 70273
3802 74 601
24024102 75
85 76 101
77 9023901
7699 78 100 4101 79
3601 I
380180
458140~ t---- _ - - shy83 82 42
888384
59843501
4777 8~
502
Low
802 86
Rank Tract
87 shy
--88
89
90
91
92
93
94
- 95
96
97
middot98
99
100
101
102
103
104
1201
14
49
72
73
43
87
3502
105
1
52
86
71
1
501
10
3301
104 tf
Rank
105
106
107
108
109
110
III
112
113
114
115
116
117
118
119
120
121
Ranking of Per Capitalucoae by Census Tract
(Contd)
Tract Rank
4001 122--shy602
13
1102 2302
3302
55
3401
48
21
56
50
3402
lL01
2202
2301
53
2201
-shy
Tract Rank Tract Rank T~aet Rank
57 I-----
Imiddote
bull
Tract
- Low -k Note Information taken from 1960 U SCensus
Rank Tract
I ~
Ie
Imiddot
~
----
----
--
--
Rank
1
2
3
4
5
6
1
8
9
10
11
i-
-Tract
391 922 921
972 971
100
132 131 121
962 961
822 821 401
982 981
20 111
47 10 1
412
High
Total Number of Henta1 Health Visits
Ranked by Census Tract High to Low
TractTract RankTractRank Rnk
12 182 22 78 29 87 76 381 73181 ~------- 1913 371 8538230162372 271 2616-121 8272 2
14 80~2 31 94 7923 84801 59 15251362 4232 15 52 _ 32 103 8924 651 17240216 652
_ 91 351 33 341 23117 83 122 25 25 48 1123921418 34 shy61 86 661
19 662 6493 81 26 91 8153 49 50 55 41383 71 27 51 3120 90 672241 35shy 104167162 461
I 411 46211121 28 88342 I
2502 36 69 54 5251 50 272
-Ra
37
38
39
_ 40
_ 41 Ishy
I
42 I
-I 43 44
45
shy
Tract
~ --- shy 95 56
45 292 242
102 62 352 291y
92
101 281
99 72 63 601 60~ 42 2201
77 74 61 57
363 232
70
32 31
11 44 282 2202
Low l
- Tract
46 682 681 I 331 30
r~$ 47 1042 332
48 102_41_
11
~
Visits to Family Planning Clinics Ranked by Census Tract High to Low
Rank Tract Rank Tract Rankmiddot Tract Rank Tract Rank Tract Rank Tract
1
2
3
4
5
6
7
8
9
10
11
12
13middot
14
15
16
17
361
56
401
341
48
59 121
20
55
342
10
31
58
93 21
241 132
331
53
461 462
18
19
20-shy21
22
23
24
25
26
27middot
28
29
30
31
32
33
391
32
middot47 I-i-_-shy _ -
231 111
332
972 1
372 371
52
89
32
92
82
100 31
182
30 242
402
34
35
36
37
38
39
40
41
42
43
44
45
42
1714 i 661 221
78 362 2
90 602 601 352
63 251
105 921
971 351
73 42 292 232
411 51
662
81 45 52
46
47
48
49shy
50
51
52
53
54
55
56
961
801
49 81 72 71
19
9~1
172
68 2 57 162 14 112
91 75 681
381 42
3~3
83 161
57 f
58
59
60
61shy
62 Imiddot
63
Imiddot 64
65
66
64 62 36~3 252
74 652 SO 392 291
651 6bull 2
79 271
r-- ---- shy981 222
672 671
821 272
94 87
281
382
67
68
69
70
71
72
73
74
75
76
77
78
981 26 12~2
IS 61
85 82~2 69
61 43
101 86 84 282
76
131
51 72
1041 962 88 70
99 922 77
103
95 802 181
i
~
Low High
RankRank Tract
5479
4480
81 1042 ~) middot102
71 - - + ~ - ~
Visits to Family Planning Clinics
(Contd)
Tract Rank
I
Tract llaDk l
RankTract Tract Rank Tract
~
I
~
J1 ~
Low
Total Number of public Health Nursing Visits
Ranked by Census TractsHigh to Low
TractTract RankTractRank RankRank TractTractRankTractRank
25249 71 79 17249 8033 6586 99189711 84 2915072 34 661 76 66 811519512
402 5035 51 161 2518220 122 1713423 352 55801 7120 6752 2 149814 41236 83 2662 38 94 6821 53 2924015 362 37 32 42 75 69 281 84 63
546 8822 54 222 85 3925431 70383417 3818223 6439 4386652 718 21 55 103332 8924 232 87 19 271729219619 24156 16211140 382 628825 10523110 112 73411 10141-- ----shy 89 363 4457 8126 16111 221 74 9142 90 46158331 53 671279012 46243 48 59 351 3837528 1083 9313 91 5844 59 -_242 76 1----- shy60 272 72 74104114 60145 42 9287 7729 92 6151 8215 57371 934630 91 307762 12113116 282 619447 41391 9531 78100 63 7378 ~95 681 6945 32 5632 798517 6448 47 52 181
High ~ Low
Rank Tract Rank
96 31 132 70
97 102
98 182 372middot 602 651 662
- -shy
~72 682 802
822 922 962 972 982
1042 ----shy
Low
Total Number of Public Health Nursing Visits
(Contd)
Rank Rank Rank TractTract Tract
I
I lt
I
Tract Rank Tract
[
~~~-
I
~
IJilfimiddot ~
j
Ranking of VD Caea According to Census Tracts 61 By High and LOll Youth Itatio
A media~ of 34 5 was determined Any tract having greater
than 34 5~ of popu1tionunde~ 19 years of age -High~
Any tract having l8S than 345 of population under 19
years == Low
Any tract having rate less than 390 =Low
Any tract having rate more than 390 == HLgl4
YOUTH
LOW HIGH
L
0
12 402 1801 1802 343 2801 2802 29023603
54 6001 600262 66~02 72 74 75 76
78 79 81 t02 65 1202
W
(25)
VD
H
I
G
H
401 701 801802 901 902 10 1101 241 1201 1301 132 14 15 1601 1701 20~ 21 2202 2j02 2402 2502 2702 2901 303501 3502 34023801 3802 383 3902 42 44 45 4601 4602 47 48 49 SO 51~2 53 55 56 57 58 S9 6701 6702 73 95
3~02 7021702 19 25~01 2701 4102 4101 63 64601 ~601 6801 680270 7l 77 8001 80~02 8201 8202 83 84
85 86 87 88~ 90 91 9202 920193 94 9601 9602~ 9701 9102 9801 9802 99 100 101 103 10402 105 6501 10401
(47)
301 501 502 601 1602 2401 2301 2201 31 32 3301 3302 3401 3402~ 3602 3702 3901 400140 02 43 61 69 B(
(53) (23)
~ ~gt
Ranking of VD by Rate Per 100000 By Census Tract
~
Rank Tract Rank Tract Rank Tract Rank Tract llank Tract Rank Tract Rank Tract
1 2202 21 S6 40 902 58 1602 74 75
90-shy 64 107 26 --~-
2 3402 22 45 41 10 59 902 75 78 91 54 108 61
3 2301 23 3502 42 2502 60 602 76 6802 92 402 109 87
4 3302 24 49 43 1102 61 501 17 2 93 94 110 90
5 50 25 52 44 6702 62 14 78 8202 94 97 02 III 76
6 2201 26 20 6701 63 4002 8201 2501
9701 41~02 112 91
7 44 27 48 45 401 64 3802 2902 95 63 113 62
8 3301 28 1701 46 502 65 30 79 83 74 96 9602 114 71
9 55 29 47 47 42 66 3803 80 2801 96Q1 115 85 10
11
12
13
14
15
16
17
18
3401
53
2302
2401
57
21
2402
1101
51
30-shy31
32
33
34
35
36
37
3701 - -~ 1201
3702
89
43
132 131
3602
4001
48
49
50
51
52
53
54
55
58
1601
601
4602 4601
69
701
31
3901
67
68
69
70
71
72
2901
801
39021~ 802
6502 6501 122
702
41~01
81
82
83
84
85
86
87
88
19
1
1702
2802
79
93
100 6801 6602
81
97
98
99
100
101
102
103
104
9201 9202
9802 9801
77
302
79
86
72
84
116
117
118
119
120
121
3603
8002 8001
101
99
95
10401
105 10402 103 102
19
20
59
32
38
39
2702
3501
56
57
301
3801
73 1802 1801
89 6002 6001
105
106
2701
88
High Low
-- -----
Rank OrdermiddotTuberclosis Cases by Rate Per 100000 Ranked by Census Tract High to Low
Tract TractRankTractRank Rank TractRaukTractRankTractRank
801
79 9601501411 52 6835340120511 I 960269 903603532036 $-~~F130221542 4366 311301 70 68~013802 _ I- _ 4001_37213 3921201 6802802 H71523822024 22 54 193302 3802 80 8958 I37139535 70155 9801 I60123 72 6702 98023914011016 6701250124 10 56
81 94 401r 7 154152 73 7057 2625 122 92028
90242 162312301 92~158 86 7172434526509 82 79160159 74 100 87412240227220110 6502836960 75 30 8317244 6501782801285711 61 901 42765645 84 66021459294912 9701 660146 171 302 9702 47
6235023033113 85 822821182 917755 16335013110214 841814832 78 103 938564 324815 86 1057940149272 38036523216 10401 87 2902241 725Q 10402360266340217middot IF88 88 9937233 282 51 218 101 01102 46016234
I)167 2901460219 47
High ~ Low ~
- -
TractRank
9S89
6490
8191 8001 8002
63 61 60middot01 6002 44 2701
92
J
2502 402 --- ----shy
I
Rank
Rank Order Tuberculosis Cases by Rate per 100000
(Coutd)
Tract Rank Tract ~nk
I
Tract Ballk Tract Rank
Imiddot
Tract
Imiddot
1~
t 1I i Pi i l I
o
1 -1shyL I
I J
8 40 icO ~ I -lt 0
-t (1) I
i I
r o E
II
a
I
r--i
shy
I
~
I (
Jgt
(011 fi(
Ggt
I II ~j
()
(f 0
~ ()
I
11
f9
r
II 99
o ~
Ggt r
~ __-J~ I t I ~ I
r--J l I
~ _ __ J
) 1
fTl
1gt
r I
()
r
()
lt en -i en
()
I1l
(J)
(J)
-i
P ()
19
r o ~
r G1 I
I
c
~
o I 89
--- -I-shy
r-r I
1- 0 _~ _ _--J E
G1 I I I
i i
I 1-1-1 ~ _J ~2 ~ II
II
()
1 I I I 1
id i bullbull
~
A n 69
r 1shy
- 0 Gl
l--~ ~ I
~ II
II )
I () isect i
en l i
(J)
-t
0
IA Ol
I bull
TABLE OF CONTENTS
INfROOOCTION 1
PART I 5
Tbe Concept of Compreheuiva Health Care 6
ThemiddotCoapreheDsiwmiddotXeigbborhood Health Center 9
Efficient Use ofmiddot Scarcemiddot Resources 19
SUmmary aDd Conclusions 26
PART II 34
Demographic Data 37
Per Capita Incoe by CensuS Tract 38
Mental Health 40
Family Pleuning 41
Pub11c Health Hurs1Dg Vjsits 43
VanerealDisease 44
Tuberculosis 45
CHARTS 48
~ 65
)
JNIRODUCTION
In the past several years the subje~t of health care
delivery has assumed increasing importance asa public issue
Congressional hearings public and private commissions and
task forces have investigated the functioning of the health
care system in depth reporting that access to the system
is impeded by financial barriers and by inefficiency of the
delivery system (8p1) 1 Medicare and lled1caid have
attempted to surmount the financial barriers for some segshy
ments of the population and more inclusive health insurshy
ance proposals are being considered in Congress The
Healthright program tmd~r the Economic Opportunity Act
has stimulat~d efforts to improve the delivery system as it
relates to low income persons and some of the health
insurance proposals also have the goal of improving the
delivery system
The Task Force on Organization of Community Health
Services in Health Admin1stration and Organization in the
Decade Ahead (25p13) briefly presents four interrelated
concepts which form a framework for looking at health as a
l Numbers in parentheses refer to bibliography at tne
end of Part I
2
middot$
contemporary policy issue
1 Health is a resource for the social and economiC development of the nation as a mole
2 The healthand social needs of the indishyvidual in modern society are Ulti~atelyinseparable thus the presence of indenti shy
tiable poverty as an adverse influence on health progress and improvement and equally the condition of 111 health will tend to interfere with the individualts ability to function and beproductive~
3 The concept of public health in today s world has begun to expand markedly moving in the direction of convergence withprivate medicine and voluntary efforts these spheresbeing included in the broader term ttcommushynity health
4 Thereex1sts aninescapable interdependence-shycommunity state and national--in the adminishystration and organization of community health services
Obviously the health care system is one 1hich has
many aspects bull Although these aspects--financing manshy
pow~r service delivery~are interrelated we intend in
this report to deal specifically with one facet This is
the decentralization of health care facilities to provide
comprehensive health care services at the local level
The report is presented in two parts The first
part will examine the literature relating to the developshy
ment of the comprehensive neighborhood health care center
as a means for the delivery ofmed1cal care services An
attempt will be made to determine from the health literashy
ture criteria for the evaluation of medical care systems
and further revie of the literature 1111 attempt to
3
determine how these criteria can best be met in a
decentralized medical care delivery system
The second part of the report will examine the health
needs of Multnomah County Oregon with the goal of
providing information about theseneecis for use in health
serv1cemiddotplanning particularly in relation to the
decentralization of health care services
I ltllYd
-
5
~E
Evaluating the Health em Sxatem
~ (8 pp1-2) has 1nc11cateda number of the weakshy
nessea of thepreaent health care system in this nat1on
She c1 tes risDs coats iDadequate pooriy distributed
and 1rietf1ciently utilized manpower andtrapented
service delivery a8 ma3or problema and state that The
systeiD 1swaste1ll otreaourcea andfunctions W1th too
11ttl reprd tor U1ci8Dcy aDd aCoDOIIIY
Shepo1Dts out
hoWever tbattbere are tour points regard1ns reform Upon
which there is widespread agreement Firat she states
IIaccesstoneede4 health emces must not be 1mpeded by
t1DaDcial barriers II BersecODd POint1s that bull bull the
continuoua health sernceare eftryw2ere ava1iable under
cond1t1ons that are physically conveDient comfortable
anclnot destructi to the d1lD1ty or selt-respectof the
recip1ent b1rd it is essential that the health care
syst8lll Iie due reprd to ecODOIIIY 1D the use of scarce
resources providtDg services with eff1ciency Finally
the system must be accoUDtab1e to those who tiDance it
and to those who 11IIe 1t and in particular must be highly
responsiva to the interests of coD8Ulll8rs II
Gre8Dlick (18 p756) also prQPoses a set of princ1shy
ples which can be used to naluate the ed1cal care
system ae states tint that bull bull all those who need
medical care shouldhave equal access to 1t second
(
6
bull bull the sernce prortded ahould be precisely approshy
priate to the pat1entl1eedemiddot ft and tb1rd bull bull the
med1cal care ayatea ahould provide the lOst eff1cient
and econoa1C8l use of scarce IIe41Cal resources
orthepurpoesof tb18 report certa1not these
crtteXaw1l1bestreaae4 lION tbaD others The rema1llder
of PaXt I Will renew the l1teraturerelating to the issuee
ofcomprehenaivene8sof ervice access1b111ty ot serv1ces
aDdett1c1ency oten1ces 111 tbedel1very ofdecentralized
medical car
ratCopcept of C_ Beal1h care Asd1oal tecmolol1 bas advanced a process of
evolution basoccurred inthe aed1cal and health t1elds
As JOhDsoD (21 pp~361-363) etamptsmiddot bull the goal of
healtb carelD our society baa evolve4trom rel1ef of
ajmptolU to ~ otdi toex1steDce in a potent1ally
diseaselessstate C1t1Dl tbelJm1 tat10DS in health care
resources and presenttechnololY he cont1nues to state
that The resulting cbal18D1e facing the Amer1can health
serncesystem is to provide each 1D41Y1dual with the
sreatest possible opporturnty toach1eve an optimum level
of phys1cal Jl8Dtal amd so()1alwall be1Dg
to
reter to the type othe81th care aystemwh1ch attempts to
answer tb1s cba]] and fult111 the three principles of
1
access1b11it Prov1UOI1ot appropriate services and
eff1cient use ot middotre80urc He state that a IYStem ot
comprehensive healthmiddotmiddot care 1DmiddotoXder to apIo middottbe stated
principles fD lleetiDlita 1Oalttst havemiddot certain
attributes
1 middoteare utdbeollW~ItaC1~orpn1zatlOM]ec ~ bull p~~ol1calbarriers IlU8t be removedbull
2 bull Care abould ace he~ecl1merlt8 ot distance residttiiCemiddot tille must be removed
middotcare8ho1ll411eC-r0WIZ the Ufemiddot span it diseases eapec ychronic are to be controlled betoretheybecome disabling or lite threateD1Dg
4 CeresboUd be~teJ1nCludlJ1C p~vention cure ma1ntiDiiCeand rehabI11tation
5 Care aho11l4be~i9_ttIa1t1ephyaiolol1ca1 aD4 pay1Fci1~cTrIS-ticot the pat~ent
6 Care aboul4 middotbe9L~ tJwrefore shouldbebu11t aro~ middotslJOc1al1natltutloDs which relate to the patients Way of lite suCh as middotthe home school and place of work
7 bull Carellbolld be m-ar and therefore shoUld bemiddot provIded ~Wliils where responsishybiUty tor the patient bas beendetem1nedauthority has been delqated and a communishycation syst_ provided
s care slIould 1Ie HIl 1nclud1Dg theintesratlon ottac1~1ts~ ~prsOllDel neceaary tor modern medical care
9 bull care dbe Of hip ~ eresboul Th ahouldbe aD adequate audit 0 care pee~ reviewcoDtlDUDI naluatioDBnd research intomiddot adequacy aDd quality
Ult1ately as 1Dd1cate4by the Nat10Dal CollllDisshy
8
sion on ColDJIIUUity Health Service (26 pp 1~20) the
c1evelopmezat of a ampyt of comprehensive health care is
a cOlDJIIUUityw14ere8pODSibilit1 1nvolviDS the integrashy
tion of all the health care facilitie and programs in
the cOlDJIIUUity or the c0arcm1ty8 healthc~ system
the PamprqlOIIlt goal ~
PrQv11~ of a ~rehive ~e 9tcoaaun1ty health aervicea
2 Ma1DteIlace ot aD a4equateqUaDtity ot al~requ1re4 health care facilities
Iritsrat~oDof ~v1c1ualUD1ta and s1steas ot bealth aerviceinto a coordishy
natedpattem ot continuous care tor theindiVidual
HoWYer aYerby (37 t pp71-72) 1Dd1cate the
med1cal and health care 81atmiddotaa it ball t1nct1oned haa
not facil~tate4 the delivery ot COap~usive middothealth
care IDcl1Y1c1ualhealth care facilitie themaelve havemiddot
notg8D8nally tuDcU0Af4tOach1eve tbi810al pUblic
health departaent 11) prond1q prev_tive services and
$1Ch trea~t activities aa are involved in venereal
disease or tuberculois control have in general avoided
1Dvad1Ds the curativedoma1Dotprivate mediCine Th1s
haa even been cabullbull1DareaawherelI~cal care is not
readily availa)le except throUlh hoepital outpatient departshy
lDent8~ Aa he 81IIet mothealth departaaents have tailed
to proVide an adequate _try point for the patient 1Dtothe
diapoatic and curative a bull t of tile health care aystell
This may be particularly true tor the pOOr patient who may
9
b_dloallYUDaoptdatlcaW4lberefore th past decade
babullbullbull~ bull lIOYeaeftt to evolve DfW torms ot health care
and new types ot health oare institutloDS providing
comprehensive oDlOiDI care rather thaD trapented care
There seems to be little dispute in the health
aboe requ1res both an lDtesratloD ofprev1ously uncoo~
ditultec1 health care ervlcbullbull brlDSins tolether into one
alency what Johnaon (21 p362) reterred to as bullbullbull the
concepts ot cOllPrehms1veIled1C1ne andpos1tlve health
andaporpph1cclecctrailzat1on ot ervlce dellvery
he NatlODal CoimD18810D0D CouD1ty H_81th Services
report Health Care gilitis (26 p37) suggests
proYic11Dl compreheDaive health care services by centrashy
llz1Da a varlet ot publlc and prlvate healthcare
tacllities 1ntohealtb campuses However as Kahn
(22 pp274) states amppeskin ot soclal servlces in genshy
eral bullbull bull if the loal ls to develop a service-delivery
approach that improves access taclltates teedback 80 as
toadapt to user preterence8nd prlorlty and maximizes
case 1nteptatlon aDd accountabl11ty the base of the
total 80clal service system Should be tnthe nelSbborhood
Dec~tral1zatloD not only makes services IIOre accesslble
but allows therv1ce to be tailored to the Deeds of the
10
areaDe Diaz (14 p3) indicates the importance of
being aware of groups in the neighborhood with special
health problems such as elderly people or large families
witb yOlmg children This means that it is important
in planning to be aware of the demographic features of the patient population This will be considered more
thoroughly inPart II of this report
Kahn (22 p275) continues however to indicate
that more than the improvement of service usage is I
involved in decentralization and that decentralization
ot service delivery also represents part of tI a general
search to break down cities to human scale for some
purposes on the assumption that people find it easier toshy
relate to a neighborhood orsection and to its populationbull
bull bull bull Thus the organization of services at the neighshy
borhood level bas the added purpose of contributing to
the search tor neighborhood n He adds that this process
i8 more relevant it there is a measure of local control
over as well as local availability of services
Kahn indicates that decentralization is not a
viable goal in some circumstances These include situashy
tiona in wh1chthe need for a particular service is too
TJI t
-
11
little to justityits proVision in a l()calun1t where
skills or resources are too rare to be provided locally
or where the costs ot decentralization vastly outweigh
the benefits He Visualizestheult1mate emergence ofa
h1erarcb1c81 patternofserv1ce delivery tnwhichcertain
services andresp0D81bilities are middot1ntegrat8d1Dto the
collimun1ty at thelooal level Other more specialized
services relate to larpr un1ts of the colDlllUD1ty such as
eomb1nationa ot neigbborhooc18 Veryspecialized services
are to be delivered at city countystateop regional
level8 fh1slevel would al80 be the seat ot prosram
coord1zaat1on staDdardprotection and evaluation 811
of which call for cons1deZable centraliZation for overall
program adm1 nlatrat1on(22 p275) AlthoughKahnt s
model was not developed specltlCally tor health care services 1t1s quite relevant- and appliCable to health
care service delivery systems
Omiddot Donnell (27 p3) reviewing the 1iterat~e on
service delivery and social action through neighborhood
service centers preseJJbB a list of characteristics
generallydesirable in ~eighbOrhood service delivery
centers Firsthe states that the center should be
accessible It should be in a physically convenient
location and should be open evenings and weekends as
well as providing at least em~rg8ncy telephone coverage
t
~ II
12
24 hours a day
The center should als~ be irDmed1ate in 1ts funcshy
tioning That is the centermust have the capacity to
provide prOmpt efficient service and should be able to bullrespond to problems middotwithout long hours ofwalt1ng and
many rounds of apPointments
The centexsservices should be 6omprehensive liThe
center should offer a full range ofusable oil-the-spot
services or easyaccess to other resources by available
transportation It should gear itself to the needs that
peoplehaV8-especially poor people-and provide for the
slmultaneoushar1d11ng of problems were possible
SerVices should 8180 b 1J1tegrated and coordinated so
thatseMces can more effectively be provided
The operation of the service center should fInally
be responsive to the needs and desir-es of the neighborshy
hood It should provide ways in which reSidents can
shape th~ program and continue to contribute to its course
and development It should be relevant and ready to
respond to changing needs II
The concept of the comprehensive neighborhood health
center developed by OEO (31 p324) has been described by
severalwriters Yarby (37 p73) describes it as an
outpatient racility which has certain def~n1te characshy
teristiCS middot1 Accessible to a poPulat1on concentration
bull 13
2 Open 24 hours a day seven days a week 3 Family-centered c~e by a team of lnteniists pediatricians clinical and publichealthnurses and social workers 4 Availability ot frequently~requ1redspecialist in such fieldsaspsycbiatryobstetrics gynecology surgerY5 Con~1nu1tyof doctor-patient relationshyship 6 Family records with social and medical ~raquomDaries of relevant information about each family member 7 Basic diagnosticlaboramptoryand x-raytacl1itles and drugs and biologicalsavailable atthe center 8 Directline (1)y center-controlledambushy
lance when-necessary) to ateach1nghospltaifor cl1agnostic ~d therapeutic servlcf)srequiring the fa011itlesandpersonnel of thehospltal 9 Patient-cantered and eommUn1ty-oriented -
The range ot services in the comprehens1venelghborshy
hood health center shouldbe as complete as possible
inCluding preventivediagnost10 treatment and rehabi-
litative services and Sbouldbe deslgnedto eliminate
episodioandfragmented services (31 pp324-325) Schorr
and English (33p291) add as additional characteristics
ot the compr8henslveneighborhood health cent~r that it
should ~ve intensive participation by and involvement
of the population to be served both in policy making and
as employees and that it should be fully integrated with
the existing health care system The Office of Economic
Opportunity (28 p63) stresses the potential for easing
health manpowershortage$by trairiing local neighborhood
reSidents as non-professional health aides at the same
time creating new job and careeropportunitles As
14
Gordon (16 p bull 422) indicates Many of the outstanding
problems in medical practice todayrevolve around
effectively motivating the patient and the prospective
patient to be concerned with his health This is
especially true in a deprived environment The community
health center with its technique ot consumer partici
pation maybe a way to create this cooperation effectvely
It is important to note at this point that the
comprehensive neiShborhood health center haaas its
constituency an integratedmiddot community r~ther than a
particular segment It should haveas Blum and Levy
(6 pp~5) indicate a horizontal rather than a vertical
relationship with the commuriitybull The vertical relatlonshy
ship they state is characteristic ot those service
organizations wh1chapproach the community only in terms
of their own fUnction Tbey see only their relationship
with the users of their service and assume that problems
of accountability will be handled by these consumers
However they pOintout this ienot likely as a vertical
approach creates dependency onthe institution Agencies
in a horizontal relationBhllp recognizetha1 they have
both acommunityand a consumer to serve The horizontal
approach places the matter of accoUltability on a broader
basis than just the involvement of the consumer De Diaz
(14 p4) speaks otthe need to ~develop a community
facility which difters from a clinic for low income
1ji ~
15
people in that it should serve an economically integrated
community The reason for this is that a wide variation
of consumers may assure a better quality of care
The advantages of the comprehensive neighborhood t
health center over traditional systems of providing
commuruty health services are numerous Hospital outshy
patient departments a major traditional source of ambushy
latory health c8refor poor patients have been indicted
for neglecting preventive health care ~romoting fragshy
mentedeare and subjecting patients to degrading and
impersonal conditions to mention only a few of the major
defects (31 p324) Another defect has been the
tendency to shunt low income patients back and forth
between different cliniCS often at different locations
arid with differel)t open hours for different treatments
or tests in regard to the same lllness(26 p63)
The comprehensive neighborhood health programs that
have been organized present a great variety of organishy
zationalpatterns one area of difference 1s in the
emphasis placed upon making each faci1ity comprehensive
in the services it provides to the patient population
In the Montefieri Hospital Neighborhood Medical Care
Demonstration program in New York City services have
been made available through a central health center and
two store frontsatellites the center to be the base
bull
Li
l of opratiol18 of ta1lJpIlflicl- ancl the satellite
center the ba of oparat1oDa of public heaJth nurses
an4 nllbborbood amp1 be satellite centers wereto
proVide preVentift tutaltll bullbulln1c1-m1zaticms w811shy
baby care per1od1c ~ectiland tJle central health
center to proViAle care tor illnes If (36 p299)
bis propWI VUDOt ~ttullytunct10DIDI at the t1JDe
it d1cu8ae4 18 tbe Uterature aDd all aernce Were
be1Dl provided 1D_~terBowever itwould ae
tbat the ntua1pro~ as aY1ioae4by its plmmers
would boclJ aoaeot bull 4efeot~ otthe current lud1cal
ccde teaIt pObullbulllne_t coorctJl8td admSDtshy
etration eD4 well 4eftlopecl refelTal procedtlreacould
1I1a~ thecOllDeCticmof t~_t8 withappropr1ate preTellshy
t1 aD4 therapeu1ampcaen1cbullbull aV81lable 111 diffrent
locationa Bowner tile barrieraottiaeaDdUatanc
between center and truaraUon tor the UDSopb1aticated
patieatlook1Dl tor 1her1~pJce too tor ~1CU-
larhalth serfplusmnQewoGl4~to JJa1t tbbll1ty o~
tb18 ~811D to provide iaaiYCOliprelleU1P18hboltleod
health servicebullbull III tactmiddot tappeareto coDtlict with
tbepro own taW cOfdotpro-1~a tam1ly
mecl1cal careprogru 111 wIa10h pre-teAtlYe aDd therapeutic
health erY1cecan be proY-lW to all IIl81Ibers of
tamily in the coure of aaSDll vi8it (36 PP301-3(2)
Dle Delmtr Coloradoprepa11ke the Montet1ori
LI
17
prograJlut111zbullbull abe1rarcJly ot SlDa11 aatellItestations
andlerer IIOreceDtallzedtac11It1es It 41ffers
howeverill tbcolap~81vene80f the services avail shy
able Inthe 4ecentraUzed facIJJtiesIt resembles very
clc)sely the IOdel ~ordecentral1zed social servicedell shy
very developed by 1ahII~ Which was 41sCussed above he
SIlall neImiddotgbborhoodmiddot c8Dt~aw1tb1n walkl distance of
most of the populatiotl havebeendesilDedto take care
of allthenorllalhealth probl of 3000-5000 patJentsshy
check-ups IlzatiOZl8s1Jlpl laboratory testa and
treataentand iaecucatlol18 (d1apeued by phyS1cians) for
IIOst DODCrltIcal 1l11le PatIent 1d1Oneed IIOrespecIal-
Ized care are reterrecttobacJalp facilities BaCkup
support tor themiddot~t1oDa are the tWo l8rsernelshborhood
health C8Dter8~ttr1Dl aCOglete~e of out-patient
serneeaDd three part1clpat1q hoap1iampl bull bullbull which
proVide1Dpat18Dt~t andcoDSUltatlve services
(13 p1028) Intb1a prosrama coaprehens1ve range of
prevent1ve aDd trea1aeDt serric 18 aVailable throughout
the decentraUzed middotta The CoapreheulY8 ReIgbborhood Hea1~ Service Project
otKa1er iC)UDdatlcm HOspitals 111 Portlan4 OreOD 1s
s1ll11arto th DenVer prosraa 1D thata comprehensive range
ot out-patientmiddot services 1D prov14e4 in each of 1ts 10cashy
t1oDa althoUlhmiddotmiddot tbe oentera are larger and l bullbulls DDIerous
than 1nth DenverproPUh (12 p6)
Li i
18
In order that a comprehensive neighborhood health
care center be able to proVide continuity of care it
must have arrangements for hospital services integrated
into th system Yarby (37 p73) as quoted above
states that it 1s characteristic of the neighborhood
health center to be directly connected with a teaching
hospital However De Diaz (14p3) indicates that it
may be advantageous for purposes of service delivery not
to havemiddotthe center affiliated with a teaching hospital
She feels that such anaft11iation may lead to asltuation
in which policies might be determined more by the teaching
needs of a medical school than by the service needs of
the patient
middotThe Nat10nalmiddotCommissionmiddoton Community Health Services
(25 p69) states that such a system of comprehensive
health care integrat1na ~e servicmiddotes of several health
and roedical agencies snould utilize Itas much single or
unified management as possible Neighborhood health
centers have been operated under a variety of auspices
but several writers have pointed out the advantages in
termsof coordinated prOvision of servictts management by
the hospital of the neighborhood health center For
instancethisfac111tates the keeping of unified medical
records of all the care a patient Msrecelved either at
the neighborhood health center or _le hospitalized
(12p6) ~ermore a3 Young (38 p1741) points out
19
direct operationot the u1sbborhood health oenter by
the hoSpital canll8lceaftilable to the center expertise lt bull
in sOlle aapcta 0 Operation that m18ht not be aa readily
available otherwie
Relardlebullbull of wbetberthe hospital and the neighborshy
hoodhealtbcent8r haVe a cOJIIIOaadmjntstration they
IIlU8thaVealTlved at a str1Dsent delineation of IDUtUal
role and reSpoDBlbilltiebullbull All OOIIpoienta ot the care
yst IIlWStQlarify and understand one anothers position
In the syatem and acree on objeCtive ancimethOds
(26 pp16-17p31) SODae areas of iDUtUalconcemare
reterral procedures record keepiDg aDC1 mutual use of
facilit1es statt1Dl i8 anotb8r ~ ot coaaon conc~
Ditt1cultift have u-laeniD the pastiD cOllprehensive bull t bull
healtbc~ prosraumiddot 1d11ch were batil plauned in wb1ch
all of the health canter phy1C~1IDa did DOt bavetatf
privilege at all ot thebackuJlhospltala (29 p21)
SUch a8ituat10n i8 1Dampcceptablelt inpatient care i8 to
continue to be p4by the pat1eatmiddot health center
physician and it cont1Du1ty ot care 18 to be maintained
Hoapital and health center1lUSt laav 301nt responsibility
tor the recruitaentot physicians
VticlentU IPan BJcNrcu Much otwhat haa b8ea sUd has stre88e4 at leastmiddot
iJlplicit17tbaD8ed tor tM etticit middotprovision ot8emcea
20
There appears to be two aspects of efficiency which are
discussed by writers on the su~3ect of the comprehensive
neighborhood health care centef one of these is the
need to organize) services to make the most efficient and
economical use of scarce medical care resources The
other closelyrelat8d in realIty is the need to help
the public use services in the most efficient manner
The comprehensive neighborhood health center concept
1s lhherentlymiddot efficient in that preventive curative and
rehabilitative health ~are programs are coordinated under
one roof with integrated a~stration Furthermore
theempbasLson prevention health education and early
disease detectionis eftic1ent troJll~estandpoint of
the health care system as well as beneficial to the patient
(18 p760) HQwever ~ue tothe scarcity of health care
personnel thecoiDprehensive neighborhood health center
mustbe an arena tor eXperimentation with new staffing
patterns~ The Kaiser program is indicative of the way
in which health care systems must begin to operate in
that appropr1ate ancillary personnel are used Wherever
possible to perform functions that do not need to be
carried out by the physician As Saward (32 p42)
states
1hroughou10ur organ1zat1on~ there are many of the customary experiments be1ngmade-shyJse of speciallr trained nurses for well-baby care under the SUpervision of the pedi9trlcianexperiments with routine prenatal care by
w ~
21
middotSPC1a1l~t~JlUrbullbull per8ema_1 bullJmdlJleu y our fuDotlou are auoh that DOtb1Da 18 dorutbYtbe phY8iCianstbat doe DOt vet to be done by the
phys1c111U1fhe other aldlle4 person- Del-nurse middotreC~0D18t the appo1ntshymeDt center or clerical praormelshyaremiddot there to free h1amiddotto use his spec1al sk111
Awell lmoWn treDd1D the area of eaaiDI health
c8re JII8DPOY8rShortagjs bas middotbe thetrend toward tra1nshy
1DB poverty area rea1deats as DOD~pro~eaionalmiddoth8lth
aide and nepborboocl health workeramiddot (28 p63) This
bas the effectofmiddotmiddot1J)creaa1q II8DPOWrand 8180 can help
bridle the cuJ~ cap betweenprondera and colllUmers
of aen1C8s This attarD at least tlleoretically
createa a situation 1D WIa1ch providers andcoD8Ullers can
be educated to UDderatad OD88DOtber and interactJlore
ettectlvely~ HoWever amiddotpltt8ll has beeD themiddot tel14ency in
801D8 oamp8e8 tomiddot us aidesmiddot ssale8lllcw t~r the center
alJDOatexclwdY811rathertbaD ua1Dltheal to protide the
health care for wh1ch ~ were trained (29 pp3B-39)
1bat ismiddotmiddot vh1~e the a14e Yalue in ~~m1catiDI with
low 1nCOlMt patieata haa beeR recoSD1zed and stressed
their role ashealtb carepersoDDelhil been slighted 1n )
any 1Dstancea
Anotber step 1d11Ob bullbull been taken to provide 8rY1ces
more efficiently eUeot1ftlybas beenmiddot theorgan1zation
of per8ODDeliDto IIllt141sc1pl1Dary teamaaaa means ot
proYid1DgmiddotCOQrd1DatedserY1ce SUch te8lll8 sen_rally
~
hf
~
22
include PhYsiciaQs nursbullbullbullbull soc1al workers and outreach
workers Conceptually th8y fmlct10n to me~ the intershy
relate lled1cal and social needs ot the families sened
Hor there are a number ot barriers to the etfectve
tlmctiOD1nlof lIuchte8ll8 SODieot these are heavy caseshy
loads the inordiDate amount ot tille consumed by multlshy
prOblem tamtliethel1m1ted tra1n1 ngmiddotmiddotand laCk of tnterest
on tile part ot aoae tebers in examinJng aspects of
problems out14e~lr oWn areaaotcolIPetencemiddot and
~ourdcation prc)blell8 between proteasioDala and nonshy
prot81~s (10ppa-10) middotrurtbemOre as De Diaz
(14 middotp6)1nd1cate tbel8 maybe a teDdency tor vertical
dp8rtmental lines of auperv1810nto become paramount
over the team coDamloation syst lead1ngto conflIcts
in determ1niDI the ro1ea ot solie team bers particularly
the DOD-prote81011alaInauch exper1l1enta Witb new
~t1Dlpatterna it 1s bullbullaentialtbat line of authority
roles aDd NsP0D81bll1tlea be made explicit and that there
beJDechaD 8IUI tor relUlar evaluat1onotfunctlorUng
Another way inwb1ch health care sernee delivery can
be made more ett1cl8Dt is to proVide servicea dur1DC the
hours whentbey aremiddot -ostnee4ed As reQo_ded by Yarby
(37p1) serY1ce can bemadelIOre accesslble by making
themava1lable 24 hours a day seven days a week If
rg8l1Cy service are aft11ab1e aroua4-tbe-cloek at ~
nil1iborhood health center the continuity ot tbepat1ent ts
23
careiamaiDtalDedand meatry point into the
cOIIPre~i health care 8 be made available
tothe patient who aoZMllyU8ea ozilymiddot emergency care in
tille of med1cal criais More 8isDificantly ava11ab1-
lity of a tull rase of bullbullrv1c8 tor seVeral hours 11the
eVerlna aI1Cl On ~ prevent the los ot earn1JiSs
involved if th patierat 1IU8tt8cet1me oftfroawork dur1q
the d8y for aed1Cal oare bull his can be an eSpecially
importantc0J1814eration tor lo1aCOlleDUUg1nally qloYEtd
patient aa4caJla18o PIOJIOtet1)e 0Da01Dl use othealth
servicebullbull
exper1eDO ot tbeKa1er prosraa in tb1s~reprdAs
Greenl1clt(19 p10) states wA lllNt 8ip1flcant
proportion ot the abulatory care 8n1cp~Y1dd tor ~
total popUlatiC)U ~ ~ after clWc hours and this
Deed i8 apParenUyaoN prODGUDced tor aJl8d1cally
iDCust population On the other hand the bulk ot all
aabulatory med1cal cu 88l91ce are performed dur1nS
regular cl1D1c hour eVen when services are available 24
hours a dayJ day bull week W
It has ~ the experi8D~eof a ftIDber ot ne1g1lboXshy
hooct hea1tbcentere _t a_jor obstacle to efficient
proViSion ot anicbullbullhas beentbe teD4eDcy of medically
1ncl1pnt patieats to utilize the center oa a walk-in
baais tor epi8od1ccr181or1entect bullbullrv1cea rather than
4)i
h~ ~~f ~~ L
24
to make appoJlltaeata tor ODIo1qprevmt1ve treataent
and rehebl11tat1Ye care ad ampl1O to bave a blah failure
to Show rat_for tbe appo1DtaeDts that they dO make
Atone center 628 of appo1Dtments made were kept
while 3Oottbepati_ta een were ~1n patients
AlthoUP fewer patiets were actually 88811 by the cater
1D middottb1s 1Datance thaathe -bervholuidmadeappointshy
mta the walk-iD patlat required an iDord1nate amount
ot staff t1ae tor aCreeDiaaacl ~trral to pplOprlate
~ttor caregt (9 pgg) Arraquotbr1llpl1catjo~ of the
plOVidedto valk-iD patient by other thaD their
(19 p12)rurtbermore
when patients uti11ze Wlk-1Il er181 centered care
athelr ODlf tona ot ootact with the _d1~ care
ay_ta fUilycentered care the treata_t of tUl11y
bers
a a UD1t 11
dlarupted
hewalk-1Dphenoaaencm appear to barelated to
diUerence between soclal clase in the style of Dlaking
contactJt1th the a11oal C~ay8t As Greenlick f ~
(19 p11)1Dd1oate8 thepheDOaenOn ot INater usage of shy
walk-in ervice by aed10ally middot1Jid11ent patient thaD by
others baa otte been attr1buted to a stoical att1tude
tQward 1llDe8 em the~ ot poor people leacl1D8 to a
~
25
greaterdelay1n tbe k i Dlofa8d1cal care These
patients wppoedlyeelcmiddotcareODlymiddotwIleD tbeirmiddotillDess
becOlles1Dtolerable resultiDSin middotthMr appeariDS withshy
outnot1ce1o rece1ve oareHlwever Greenlicks
r8aearcbbaa cut doubt on the existence ot tb1delay
111 report1Dg middot8J1IPtoJumiddotOfDeW 11laessand seek1ng care
Be bas tcrQDd 1bat s1ll11ar peze_tases of dioally
1nd1sent 8DClJ1on-aed1cally 1Dd1PD~ pat1enta seek care
on the aue daytbat aptou tirstaPPear
1fb11e GrHDllclc 1nd1cat tbat the reasonator the
greatertendeDCY of low 1Do~e pat18Ilta to 1$8 walk-in I
serY1ces are notlcDo1rAmiddotmiddot tbe7 _ be rel~tedto a tendency
ot lower aocio-ecaaaoclaa patieota to preter face-toshy ~
face contacts with II841cal persoDl181posslbly because
such contacts areft coatortiDS an4reasauriDS to
patients who are hJpotbeafzed to bave a dependent attltude
toward IIed1Cal care perS0Jm81 (30 p161)
It a8 itmiddot baa pnerally beenhld the appointment
s1stemts the most efficient Ileana of dellveriDS
comprehenSive oODtllluiDlh-lth care (9~100)1t is
necessary that educaUoraalmiddotbulltfort be taken to proaote the
use ot middotappo1ntaents8DClmiddot tQrec1ucethe fa111re to appe~
ratB4uOatioaalwhlQb baft~utl11zedhave been
IJ
26
1Dten1ews with walk-in patients home Vi8its and group 4i
meetiDp1D8D attemptto1Dierpret1o the patients
the value of rtitgular ppo1ntmentamp andot con~in~
c~1ve care rather than epiI041c care (9 p1OO)
h1s 1safuD~tioD torwhtch nOl~prot81QDal colDlllUD1ty
YOrkersllaY bebe~r8U11ed tban other statf H()wever
euch aD ~ucat1oaal propul __~ ~e related to the senUiDe
capacity otth health oenter to provide comprehensivebull gt
ervice8 to1tpat1_t~odoD aD app01ntment bas18 It
1amp pos8ibleo~rw1 tor educa110Dal ttorts to result
LD a~8JImCl tor ltPP01ntaen~8 at a ratewb1ohi8beyond
the capacity ot thee_tar to t without uareaaoDably
1_ wa1t1Dlprio4a QOBt1nuad use Ot the center on a
wallt-in bU1 _1tbeoosiItpos81ble to et an appoint-
met anc11nCreued pit1entcoJaplampia1a bull Therew111 of
course always be a need and demand tor acute ep1so~c
Care -ci the health centerDlWlt be planned with the capashy
billty ot bullbullbullt1D8 tb1aneed wh1~ cont1Du1nI to stress
aDd educate the patient to utillze oDlOinI comprehensive
faa11y middotc~te~d Cflre (9p 100l
att g4 CODClva1opa
In order to bea4equate any coJlltemporary health care SY8tem muat bullbulletcerta1D interrelated criteria he
IJ
27
minimum criteria areaccessability of services to those
who need them compr8heX1siveness and appropriatness of
services and efficIency 1nthft utilizat~on of SCarce
health care personnel and resources The scareity of
pex-sonnel andtbe need for h1gh quality ongoinghealth
care services
aJIlong the
populationdemanci the most effishy
cientprovision of services
Services must be made accessible to the population
They mustmiddotbe geosraPh1cally accessible to remove the PhysicalmiddotbaTiers betWeen peopleandthem$d1calcare
system They mUst otter their services dur1ngthe
hours when people can make the moat use ofthemA~ it
makes little sense to concentrate services geographically
where they will not be uSed to their fUllest extent it
also is wasteful to provide serv1cesonlydur1righours when
many people are employed his not only presents a hard
ship middotto the consUmer lnrt wastes resources if for instance
the unavailability of preventive services during the hours
when people Can use them causes a need for treatment
services later on
Health carbull sEtrvices must be comprehensive including
prevention treatmcmtand re)abimiddot11tation Ambulatory I
healtbcare facilities wh1cQ are orienteciexclusively
toward either prevept1on or trea1mentare no longer accepshy
table for they are lneft1c1entln their use of resources
and in their prov1s1on of health care to the patient
w ~~
28
If prevent10n1s notmiddot stressed treatment serv1ces that
could have beenavoidedY1l~ be required If prevention
1s the sole focus of the health care facility sick
patients who present themselves must be referred elseshy
where for treatment andsllch referx-als may be taken as
reject1onsor not followed through with until illness
becomes unbearable
The instltutlontbat meets these requirements Is
the comprehensive neighborhood health center It 1s a
local decentralized outpatient facilityprOVld1ng a
fUll range of ambulatoJY health care services It has
a linkage to ahospitalbackUp facilityforlnpatient
treatment and hiihlY apclalized outpatient care
The neighborhood health center must be a fac11ity
planned with an awareness of the needs of the conSUtller
and coDitnUn1ty It must have the r~Ul0urces to provide the
services people need mere they can use them and when
they can use them It must uti11ze the part1cipation of
the community to develop this awareness Not only must
the cen~er beset up to be Amctional for the consumers
but efforts must bemadeaga1n with commun1ty partici shy
pation to help the consumers utilize medical care
services effectively The center muetmake efforts to
educate the community about the valueot regUlar health
care of preventive servicesand of the use of planned
IJ
29
medical appointments ratherthanorisis centered walk-
incare Therealit1es of the existing health care
system have not taught the patient particularly the low
income patienthow to use services effectively
The helthcenterilUst also bea laboratory for
experiments in easing the health caJepersonnel shortage
and c60rd1Datingcare~ A major difficultY iri-exper1shy
menting with neW rolesis freeing staff of old preconshy
ceptions
CoDlprehensiva neighborhood health dare centers have
been developed under a variety ot alisplces including
medicalsociet1es hoSP1talsmiddot(36p299 group pr~ct1ces
(29 p6- 12 117) health departments (13 p1027) and
ne1gbbothoodassoc1ations(14) The literature indicates
somevalues nthe management ot the health center by plusmnts
hospital backup faCility Whatever the auspices many
adm1nistrative fuDctions such as program coordination
standard pr9tectionand evaluation call for considerable
c~tralization of adm1nistration city-wide or coU)tyshy
wide At the same time other aspects hours of servlce
for examPle~ cuI f~radm1nistrative fUnctions made atmiddot
more local levels Each neighborhood center must be
free to adapt its functioning to itscominunity thi-ough
the mechanism otcODlllUl11~ participation inmiddot policy making
Obviouslythe prerogatives and responsibilities of each level must be negotiated and made explic1t
t4~
JJ
BIBLIOGRAPHY 30
1 American Rehabilitation Foundation ~ealth Services Research Center The Health Maintenance Strategy mimeo 1971
2 Anderson Nancy N Comprehensive Health Planning in the States A Study and Critical Analysis Institute for Interdisciplinary Studies American Rehab ilitation Foundation 1958
3 Andrus Len Hughes Comprehensive Health Planning Through Community Demonstration Health Projects mimeo1967
4 Barry Mildred CandCecil G Sheps A New Model for Community Health Planning unpublished paper presented to the American
Public Health Aseociation1967
5 Blum HenrikL Fred Wahl Genelle M Lemon Robert Jorulin and Glen W Kent The Multipurpose Worker and the Neighborhood Multiservice Center InitialImplications and EJeperiences of the Rodeo CommunityService CenterAmerican Journal of Public Health58 (Mar 168) pp 458-468 shy
6 Blum MichaelD and Soloman L Levy A Design for Service Delivery that Reinforces Constructive Tension Between a Health Center and Its (sic) ConSUDlers and Supports Community Power unpUblished paper presented to the American Public Health Asaociatiltn 1968
7 Brielaud Donald Comm~ity Advisory Boards and Maximum Feasible Participation American Journal of Public Health 61 (Feb 1971) pp 292-296 shy
8 Burns Eveline M Health Insurance Not If or When But What Kind Madison Wisco~sin University of WisconsinScllool of Soci~l Work 1971
9 Campbell John Working ~elationships Between Providers and Conshysumers in a Neighborhood Health CenterU American Journal2 Public Health 61 (Jan 1971) pp 97-103
10 Caxr Willene Neighborhood Health Centers Funded by the Office of Economic Opportunity mimeo 1970~
11 Colombo Theodore J Ernest W Sawardand Merwyn R Greenlick The Integration of an OEO Health Program into a Prepaid Comrehensive Group Practice Plan American Journal of Public Health 59 (April 1969) pp 641-650~ -
12 Comprehensive Neighborhood Health Services Projectof Kaiser FoundatioIl Hospital~ Prcgtgram YearE grant renewal proposal mimeo~1971 bull
13 CowenDavidL~ Denvers Neighborhood Health Program Public Health Reports 84 (Dec 1969) pp 1027-1031
IJ
14 De Diaz Sharon Daniel Beyond Rhetoric The NENA Health31 Center After One Year unpublished paper pres~rited to the American Public Health Association 1970
15middot Gerrie NorrrianF and RichardH~ Ferraro Organizing a Program for Dental Care in a Neighborhood Health Center Public Health Reports 8 (Aug 1968) pp 419-428
16 Gordon JeoffreyB~ The Politics of Community Medicine Projects A Conflict Analysis Medical Care 7 (Nov -Dec 1969) pp 419-428 shy
17 Greely David The Neighborhood Health Center Program and Its Implication(3 for Medical Care H~alth Forum of the Welfare Council of Metropolitan Chicago (mimeo) 1967
18 Greenlick Merwyn R Newgtimensions in Health Care American JOurnal of Pharmacentical Education 34 (Dec 1970) pp 754-4
19 GreenlickMerwyn R Donald K Freeborn TheodoreJbull Colombo Jeffrey Abull Pruesin and Erne$t W saw~d Comparing the
Use of Medical Care Services by a Medically Indigent and a General MemberShip Population in a Comprehensive Prepaid Group Practice Prosram II unpublished paper presented to the AmericanPublic Aesociation1970
20 H~tadoArJiloldVMerllYll RGreenlick and TheodoreJ Colombo Determinants of Medical Care Utilization Failure to Keep Appointments unpublished paper presented to the American Public Health Association 1971
21 Johnson Richard E and Merwyn R Greenlick Comprehensive Medical Care A Problem and Cballengeto Pharmacy ff AJilericanJournal of PbarmacenticalEducation 33 (Aug 1969) pp 361-367 -
22 Kahn Alfred J Studiee Social Policy and Planning New York Russell Sage Foundation 1969
23 Kotler Milton Neyhborhood Government Local Foundations 2 Political~New York The BobbsMerrill Company 1969
24 NationalCommisaion on CommunityHealthSfrvic~sActionPlanniriamp for Community SetithServices~ashington p C Public Affairs-Press 19t7
25 National Commission on C~mmunity Health Services Health Adminishysration andOrMPization l the Decade Ali9$-d Washington D C Public Affairs Press 1967
26 NationalCornmiesion onqomm1Jllity Health Servicesbull Health ~ Facilities Washington D C PUblic Affairs Press 1967 bull
~ n
32 27 ODonnell Edward J and Marilyn M Sullivan ServiceDelivery
and Social Action Through the Neighborhood Center A Review of Research tt Welfare ~ Review 7 (Nov~Dec 1969) pp 112
28 Office of Economic Opportunity Second Annual Report Washington D C~ U S Government Printing Office 1966
29 Office of EConomic Opportunity and the Medical Foundation of Be~laire Ohio Eighth Report 2l ~ Committee2a Governshy
ment OperatiOll~ Va8hiiiSton D C Government Printing Office 1969
30 Pope Clyde R Samuel S Yoshioka and Merwyn R Greenlick Determinants of Medical Care Utilization nhe Use of the Telephone for ReportiDg Symptons Journal of Health and SocialBebavior12 (June 1971) pp155-162 shy
31 RenthalA Gerald nComprehensive Health Centers in Large US Cities American Journal of Public Health 61 (Feb 1971) pp 324-336 shy
32 Saward Ernest W The Relevance of Prepaid Group Practice to the Effective Delivery ofHealthServicestt The New Physician 18 (Jan 1969) pp39-44 - shy
33bull Schorr Lisbeth Bamberger and Joseph T English Background Content and Significant IssUes in Neighborhood Health
Center Programs Milbank Memorial ~ Quarterly 46 July 1968) part 1pp 289-296
34 Weiss James E and Merwyn RGreenlick UDeterminants of MedioalCareUtilization The Effects of Social Class and Distance on Contacts With the Medical Care System Medical~ 8 (Nov-Dec 1970 pp 456-462
35 Weiss James E MerwynR Greenlick and Joseph F Jones Determinants of Medical Care Utilization The Impact of Ecological Factorstt unpublished paper presented to the American Public Health Association 1970
36 Wise Harold B Montefiore Hospital Neighborhood Medical Demonstration A Case StudyMilbaDkMemorial Fund Quarterly46 (July 1968) part 1 pp297-308~
37 Yerby Alonzo S ttHealth Departments Hospital and Health Services Medica1~5 (March-April 1967) pp 70-74
38 Young M M~ Chatanooga IS Experience with Reorganization fOr Delivery of Health Services ttAmerican Journ8l of Public Health60 (Sept 1970) pp 1739-1748
f or l
II bull 11 Y d
II
IJ
34
ThepurposeOfPart II of th1aa paper1atod1scuas
elected Speclfic needs ofecltlc areas within Multnomah
County A8P01ll~oUt 1D ~ I of t1a1bullpapermiddot Ita nelgbshy
borhood health oare cater IlU8t be a facl1lty plaDlled with
aD awarenes of the neeels of the oODllUller and collllUDity
Part II of this paper nIl Show 80e of thoe speclflc
needs
he1DforutiOD tor t1li Portlon of the report
obta1nec1 troll tbroupout tbe follow1Dl threepUb11catloDS
1gr~e_tiMshylIPrIxaiidOreson JuDe 1963
2 1~_middot_sectSI8e~ected1teai c-ua 0 S 8 e first count coaputer tape Coluab a_lion AssocshylatloD of QoveraMD-8 Jlme 1971
3 Jtu1tDoab County Oreaon BDY1roDlHtlltal SurveyEarly 1971
The JIultDOIIIlb COUDty OrttIOD BDv1roDllfmtal Surley
Barly 1971 1s bull stat1stical report of the activ1tles of
theentlreMultDOIIIl2 CcNDty Health Dep~t during the
year of 1970 Die speclflc 1nd1cs elected from tb1s
study amprejMental aealtll Publlc Health N~s1D1 vlslts
FaJUly ~ Veaereal])1 ~ ~rcul081
Throush tie use of cUrts and mapa ODe CaD roup these i
speclflc ~oea to ahcnr the healthneedsof speclfic I
census trtcta aD4 then the health needs of iarer neIghshy
borhooda 1m4 o~ Uebullbull
Rf)~UP1Dl of areu was accompllshed in thefolloWinl I
JJ ~
35
he MiltDoIliahCountY oregon BDViromaental SUrvey
early 1971 isamp statistical report ot tbeaotivities ot
the entire MultDolllh COUDty Health ])epartiDent dur1nl the
year ot1970 he specitic 1Dd1C8S selected frOm this
aUy are 1Il8Dtal health public healthDurs8s visits
fUl1ly pia waereal elisease aDd tuberculosia
Tbroq11the Wle otcbart aDd mapa aDecm szoup these
specific indic to show the health Deeds ofapecitic
ccmaua tracts aDdtIum th8health neecla of larsr ~eilh-
bOrhooda and co8I13 tlbullbullbull
RegroupiDI ot areas waa accoap118hed1D the
tollOWiDl lIIIIm1er~ A bullbullcifie 1ndex 8selectcl auch as
venereal di8bullbulle or tuberculo8i~ he total number ot
cs was then deterll1ne4 for each census tract Through
the use of the maber ot cRbullbullbull tor a 11Yen cenaus tract
aDd tbe population ot thattractaltrateot1lla1ampmcper
100OOOpopUlaticm wu cleteXll1ned for each census tract
This was ~e to starl4ard1ze the population ditterence
amongOeD8U8 -tracts 1he rate of incidence toreaob
cenauatract was then llstedby rank position on a chart
In rank poition1DI any cen8Wl tracts haviDg equal
rates ot1l1c1dence are assipe4tbe iaDk posttiona
Beeauseot the abo fact tbAt cbarta w111 vary in length
neveltbAtlea eacb cbart will 1Dclu4eall census tracts
inMullnoaah Couaty Atter the census tracts bave been
listed accord1q to raalcth1s list will bediv1ded into
IJ
36 three levelsotinc14ence he three levels are
1~ The upper 14 of1DcldenCe
2 Thelower 14 ot incidence
middot3 The ILld 12 of incidence
Tlles three srouplqa are then used in compiling a map ~f
Mu1tnOmahCountyfor ach apecltictop1cbull TIle maps are
uaefuJliD tbatthey V1suallycoJib1De 1Dd1v1Clualproblem
census tracts into larger problem nellhbOrhooc1s
The 1960 statistical iDtormatloD was Used in a similar
liIaDDr to tbatexpla1Dedabove 1Dthe4evelopaent of a
chartmiddot and map 1Ihow1DI e cOllpampriSOr1 of per capita lncolle
tor ttaCh ceDsua tJact aDdmiddot combiDed census middotmiddottract areas
he 1910 aDd 1960 statlstlcal iDtOrllatl0D was combined
lna map and chart he purpose of this and chart is
to d8aonatrate the e cl1stributloa1DeachceD8U8 tract
and middot1ndlcatbull tuture ace populatlon treD4a bull
When one be middotbullbullbullbullbullHdth ne8cts ot an area and has
declded to establlsh a cl1D1c to serve that area the
physical location otthat cl1D1c IllU8t be consldered In
order to coapreb8ll81vel develop an area cl1n1c one should
conslder thepre88Dttraftlc middot~ytaa an4tranaportatlon
systems Thecl1D1cahoUld be located close enoUlh to
major arterlals to giva asy access from the total area
be_ ervecl by this cliD1c At the t1ll8they should
be tar eo away froll thesarterlals to all8Y1ate traffic
CODCell18 andpark1D8 conpstlon By traff1c concerns I
IJ
37
lIlan one lUSt consider thertarro1fne8S of streets whether
streets are oD8--C)r two-way iqres8 and egress to parking
amp0111tie eros tratflC) spedof trattJQ children 1n
ll8a traffic i1lht Vislon re8tr1ctionS etc
BwstraDsportat1onshould alao be central in this area
as maay people ~U f1Df1 1tD8Cessary to use this form of
transportatlon
~e tutqredlopHQt of bull treewa systems should be
c0J1S1dered soastolesen thecumce ofmiddot future roada
cutt1DSotltbe cl1D1c llte line
nrrph1c middotDampta
It is 1JDportaDtto kDOw the demosraphic distribution
characteristics of the oUenteltbat i8 to be served by
localized health cl1D1cs
Acl1D1c which erves8J1 area where1D the prepondershy
ance of persona arecrter 65 years of mayf1nd that these
people rely more on pUblic transportation call for more
home- services and haV4t 110ft ChroD1c and debilitating
types of disorders (b1_ blood pressure poor heariDg and
eyesight) tbaD do8 an area ot a YOUDIer population On
the other hand thL area of older residents may have little
need for family plabDlng cllni08
In order to better ~Ybullbull the 4eaoraphic population
of each CeD8U8 tract the 1970 CeD8U8 iatormation was viewed
and two specific catelOri8 considered These two cat
IJ
38
lori8S woUld be the perc_tap ot population under 19
year of ase and the percentase ot each oensuetractover
65 years of age he 1960 1Dtormatlon tor eaCh tract was
then compared witbthe 1970 intormation and a percentage
ofincreaae or4ecreamp8 tormiddot e~chtract1n each category
cOJlputecland achartma4e By the use of this chart one
18 able to View tJleap populat1odiatr1but10n of census
tract and at the _ t1lle accesa middottrencl Por example
let us choose census tract 601 W see 40-4 otthe
population is under 19 years ot and that ODly82 1s
over 65 years ot middotAtthe e tille the percentage of
youth bas ~ed ODly 1_ intbe laSt teD year whilethe
percentale over 65 year ot middotbas stayedmiddotthe same With
this in mJnc1 ODe ~ 1DfItr libat ol1D1o aerviDg this
area WOuld bellQre conq~w1th the problems of a
YOUQier populat1on and that _ would probably be true foJ
some t1aein tbefuture On the other hand CeDSU8 tract 54
has only 2 ollt population UDder 19 yel1s ot age and
this has decreased by 1 over the last ten years middotwhile at
the same time 32-377 ot the populat1on 18 over 65 years of
age A ol1D1C ___ this area should be or1eJ1ted toward
tbespecttic problema otthe ampledbull
PerCapia __ bY gsa neat
WhaD cona1der1qlooat10D1 tor health cl1n1cs one
shoUld take the 1DC01Ieot areas into consideration Areas
IJ
39
of lowiDcome would not 11kel~be 8erved more by localized
cl1D1cs tbaD would are of hilbincome It 18 likely
people haYiq a hip iDeoll8would preter to be aeenby a
chosen ~r1vatephylc1a1l tban at a local cl1D1cwhere
10Dier waits y beraceaaampryand leas personal attention
gl_
The 19701ncOII81atoWampt10n tor MultnomahC~ty was
not available at the tille thi8report W88 made The 1Dto~shy
tiOD Was taken ~adtro tbe1960 census publlcation
his woUld ~8Il thea tbat ral1I8 OD the chart ynot 1raquoe
completely accurate hi writer telthatthe areas most
affected by tb8 1I8eof the older 1Dco1DtOlaat1oDWOuld be
those tracts wh1ch baYebad a rapid 1ncreaae1n populatlon
over the past tfmyHr8 bullbullbull tracts would include tracts
nUmbered 104 9897 96 aDd 95 be perc~ita 1Dcome
referredto1il-tb1a Paper18the lIean 1DCo per person per
census tract
Attar the iDeoeper census tract was listed on a chart
a map was de 1D41catiDg those census tracts belonging to
the lower 14 ot income tor all censue tracts in Multnomah
COlDltytbose beloqins to the upper 14 ot income tor all
census tract 111 MultnolUlhCounty and those belonging to
the mid 12 ot 1I1coaetor all oeuuetracts in Multnomah
C01mty
In yiew1Dg the _p 1t caa be seen that the low income
area seautotollow aloas the at aide ot the Wl1lamette
IJ
40
R1ver the full length of Kultnomah County A second low
income area follows the south edge of the Columbia from
the northwest corner of Multnomah County easterly to 148 St
A third problem area seems to be on the east bank of the
Willamette River with the Union Pacific Railroad being
about the center of this tract The extreme loutheast
corner of Multnomah COUDty appears to be a low income area
but as this area bas bad rapid grouth in the last ten years
this could be erroneous
Mental Health
be first ~ecific indica to be selected from the
Multnomah County envirollllental survey of early 1971 and
to be considered in this paper i8 that of Mental Health
At the present for mental health purposes Multnomah
County is divided into five catchmentareas with a mental
health cl1n1cin each area These clinics are Model
Citles Delaunay ADkeny street Office Hansen Health
Building end Southeast Clinic
All lIlental health cl1n1cslcept statlstlcal information
on all patients visiting their cl1n1cs this included the
address of the patient hese addresses were then listed
upon the approprlate C8D8US tract Each census tract was
then ranked on a chart according to the nUllber of mental
health patients who reslde ln thatCeDSUS tract attending
any of the above listed ental health clinics This chart
IJ
41
wasttum d1v14ed1ato proper quartile bbullbullbull
quartile vereUs to dne10 u appropl1ate Multnoh
County _tal health ItLa middotmiddotmiddotthelipO~a1bl by lOoJcJIUE
at the UDtal health _to uteN1De which ueu have the
lars-t use otCOllDty 1alh~th faci11t1Rot
1Ilclu4ecl 111 tbia woUld tber otpeopleYia1t1Da
pr1vat patch1atriata aDd pr1_t _ntalhealtb cl1D1c8
WheDtbe M1 18Yienclmiddot Itmiddotmiddotmiddotmiddot~middotbe~_ tbat ~rtt
appears to lMt fourmiddotmiddot-al are iii _oil the nuaber ot
lIental healthcl1D1c na1t toM tbjh1sheat 1he
tour areaa woUld be tollows
1ttrea Ore to~Blo Drimiddot ~tb Burrus14e aDd tIMtmiddot Colb1a Riftr H1gbwyaeri1Dla th nortllra boundaryshy
2 bull ProII 82D4 1_~ 10 20th streetwitil the ra1lMd Mu the north ltouadary
3 ~ et et tUgl_b1bull MYel froamiddot the Clackaaa COUDty l1ae aorth to Dln8lon stret
4 beDOlvt1ttfe-t ~efllt4 COatytrca Jle1aware streetmiddot toR1C1a11oDd wlth Colubla Blvd heiDI tbAtnorth bouaclary_
It ODe coapareatbiap to th iDeobullbullmiddotp 1t can be
eamiddotthat lIOat ot the c tracts baY1Dg bllh v1i11tatlcma
middottfl public tal health cJ1rUc8 ~ 111 t13e low ~ aid
1DcOile SroupiDIOJa1y of til 25 tracta llsted as
haviDlbip aental Maltll nlltatlou are ~ the1g60 hip
iDeo arebullbullbull
17 Plpn
42
amily PlellnSDI ]Jlce Metal Health i8 an 1nd1ce of
use Theperson 111 ordertobavebe_ 1Dcluclecl 1n this
atu4ywouldhave tohaft Ue4 ataa11y plaDI cl1D1c
tacilities of soaetype It 41fter troll tile _tal health
study1nthat i t1Jicludestatist1catrollbotb public and
privateclJD1os
The iDformation tor the iak orurcbart 8Dd map of
t8ll111 plenn1 na ob1a1De4 by cOIIblnlDlthe mabel of
1rlcuv1duals bullbull_ attbe tbreellUltrampo-ti Coatyhll11y
PlalJQllIl C11ll10s 111til tbo at the Planned PareDthood
Association CliD1C8 be tbree -JIultDouh Couaty r8ldly
PlamSq Cl1D1c are Solrtbweatth Col_bla 1111- a114
HaDsell Health BWlcl1Dl CllD1cbi middot1Dtormat1oD vas then
bullbullbullesed tomiddot detellWMt l10w people troll eacb c8IUIUS
chart wastben Mele IUs oIIart jn 4iY1ded to show
the censuS tracts lIaYiDlmiddottIle h1t1iest qUart1le of incidence
of use lowest quartile of 1Qc1deao ot use Jlid 12 of
incidence of Wle an4 a map sprepared troll thts 1Dto~
mation
The C8U118 tractsbelOJISnl to the h1lhestquartile of
use appear to be 1lO~ 8catt~ on tbipwas true ot
either the _p ot aental health cl1D1c uaageor ot the map
abow1DI per capita 1I1COM Iaere40 to be three
d18t1nct areas of UIIaP beJ woul4 be
1
IJ
43
t10D of BurD81cl and the W11lallette River 4
2 S~t Portland 8Otth otmiddot the ra11shyrcaadand alona the W11lamette River
lIortbeaat Portl8D4 between MisSiss1pp1 and 24tbStreet the northbouBclary be1DgColwb1aBlvd
Pylzl1c BMltl IrpI Y11ta
Publlc Healtil nur81D1Y1s1t nclud8 an vists to
theholles of client by PubUc Health Nurbullbullbullbull his shows
visits to bull f8Jl1ly fer aDY purpos SUCh aatuberculolJ1s
het1Dl tem1tyaeatalu4 8IiOt10D8l cODd1t1ona etc
he atat18t1C~ 1fele C()4ed accord1Dg tomiddot the 1llli301fOCUS
of the Y18lt tt doe DOt 1D41cate the Dmlber of holies or
f8ll11lev181tecl or 1D41Y14ual Y1a1ted more tban oDcein
the propwl It dobullbull I1ve 80M 1D41cat1on by coaparlshy
OD ot the 8JIoUDt of aedlcal problema 1n eachcen8WI tract
Ap1nmiddot the _p abowa 8 scatter patteraof probl_
areas althoUSh there appear to be a sroup1Dl of hiSh J
l8aIeccmaus tract 1ntlut extreme southeast part of tbe
County other areu uIriaI any nura1Dl contacts are
1 bull he 801lth-oa-al CO1Dty on eaCh 814 of 82nd Av from Clackallaa County north to Dinloa
2 ear bullbullbullt 814e aroUDd Preacottand Misaisippi
Dowatom Bunul14eonboth 1de of the river
44
V_real Pis The iDfomatloil uaec1 to tabulate the Venereal
disease chart includes all the ooab1ned case otmiddotODormea
and syphilIs reported by bothmiddot publIc and prIvate physicIans
dur1nl 1970 There were 3602 caes ot IOnorrhea reported
dur1nl 1970 While ODly 17 cabullbullsot ayphilimiddot were reported
A chart was prepUed aDd att8llPt wasmiddotmiddot de tomiddot
determ1De Wh_therVttDereal 41ease was more p~vaJent in
areas othigb or lowmiddot proportIon ot youth hi waadone
bymiddotdetemlna a 1leaD prceiltacmiddotmiddotmiddottor the population ot
resld~ts UDder19 years ot (34) middotA mean ratemiddot per
100000 popUlatIon al80c1ttem1Ded tor the middotoccurreDCe
ot venereal dieae This was et at 390 oass Areas
hav1nl a population 1n which leiS than 34 were lmder 19
years ot ampIe were called low- yOuth abOve tbl percentaae
hiSh youth The aaa waatrue ot the occurrence oivenershy
eal disea_ per CeD8UStract It the rate waacomputed
as 1I0re than 390 cases per 100000 it was called hiah
venerealdiaeasei it less than thia tisure low venereal
disease It was tound that 1D Multn~ COmlty there sems
to be poSitive OOlatI0n(x21S19gt between low youth
and hipmiddot venereal diseaand hip youth and low venereal
diseasebull
RaDk ordr Iitot all c traot middottbAm made
Th1s was done byt1Ddlna the ratepr 100000 populatIon
of venereal disator all census tracts in the County bull
45
These were thenlisted from h1lhto low (sreatest to
least) in a rank order The l1sting was then divided
into Upperandlower 14 aDd listed on the MUltnomah
Countymiddot up
The areas of b1gh venereal disease se8ll18to
roup thBl~8 middotin a very tllht area ~oq both 1des
of thell18l8~ R1 w1th BurDaldeS~et being
~bout theceDter qf tbi8IZ9uping This area woUld
appear to be m ldeal spot for the denlopment of a
locallzed venereal d1sbullbullbullbull cl1D1c
UbepoundCUlO1s
In this report bull tube1C1llosls caS8S refrred
to include alltbobullbull cabullbulls ontubercUlo8is follow-up
rather middotthan just new C Accord1Ds to the Multnomah
County Health SUrvey of early 1971 this would include
all ca repOrte4 over thelaat three years The
total number of tuberculosi8 cabullbullbull usedin this study
was 666 lh1 included 128 new cabullbullbullbull
A rate per 100000 of tuberculosis for each
census tract wa- then computed and the c~us tracts
listed by rank order be b11h Qartlle mel low
quartl1 were then reoordd on a Multnomah CoUnty map
TWo genral areaa baY1Dg a hip mcldencaot tubercu~
losiare 1D41cated heyare
1 Both middotsld ot theWilla11lette River
Ll -
46
with Burns1de about thecnter
2 he extrea Northebullbullt comer of the County bull
By coap8r1ng the tuberculois an4ven8real
diseae maps ODe can 8ee that the downtown areas ot
hiSh 1nc1denceare alIIo8t 1c1eDt1cal on ach map
This WOuld 1nd1cate that 1t would be of value to
bullbulltab11sh acl1D1c 111 th1aampreatbat would provide
bothtuberCulos1s 8Dd ytmereal 418ase srvicbullbullbull
Thchart aDd 1181gt8 are wsfuln 11v1DI
1Ddicat10DS tor the type aDd placemeototlocal
health cl1n1c8 tbro1qhout tbe MultnomahCounty area
A cOllpar1on of the mapa help one to dec1dewhether
to provide a aulti-8ervice cl1D1c or spec1f1c type of
cliD1c As stated in Part I of thi paprserv1ces
shouldhaYe both treatlieDt and prfMmt10n cOmponents
As he been stated fta ne1lbborhood health care
Qenter muat be a fac111tY plazme4 with an aamesa
ot the neds of the consumer and the c01llll1m1tybull
Part II of this rport haa been an attaapt to indicate
and clarify 8011 ottheae coDlllUDity neds This has
been done through8elect10n of apc1f1c problems
The indic were then visuallyrecorded through the
use of ups and charta ODe dan asseS8 thedsreeof
1DIportance of certain concems to spec~t1c areaa by
comparinl the chart aDd maps Prom this oDeean
41 dec1de which are48 vb1chcUD1c-or indeed if
the need a clinic at all However further factors
should be considered hebullbull include
a The amount of fuDd1 available
b What 18 the percentage ot peopleineoh ceaaua tract tbat would actually us such cl1n1cIl
c Wbat 1 tbeco--1tymiddot 8 IeeliDashyreaardtDI particular cl1D1c8 Would this dcrebullbullbullmiddot the ettctiveness ot thse cl1n1ca
IJ
li
D_OlraphicPopulatLon Challie 1960 to 1970 48
Cen8U8 1 of Pop 1 Cbaqemiddot 1 Change1 ofPopTract Under 19 Yr8 Over 65 Yrs1960-70 1960-70
middot1Q701Q70
1 319 -12 171 -H) 1
2722 215-27 +68 301 366 -22 127 +35 302 371 +19 111 -04
311middot401 144-41 +29 402 321 13~7-39 +24 501 356 124-08 -02 5~O2 351 133-23 +12
405601 82-10 -02 394602 103-01 -06
701 275 149-76 +56 702 361 +01 121 -07
+10middot801 326 140-22 802 321 middot127
(
-29 -03 9~01 342 124 -H) 6-18 902 294 128 -H) 3-24
10middotmiddot -14312 140 -17 1101 182 +25 -23197
2411102 186-59 +29 1201 226 169-17 -41
31middot01202 +11 182 -05 295 -H) 81301 208 -H) 4
1302 331 +08 197 +04
14 323 +15 middot185 -08 middotmiddot15 329 +16 16~5 -13
-28middot 1601 332 131 +12
1602 356 98 +24middot-39 middot3101701 161-33 +21
1702 370 -15 85 +02 +19 1801 264 151middot-50
185middot1802 256 +47-58
IJ ~
D_raphlc Population Change 1960 to 1970middot 49 (Contd)
4io
Census Tract
of pop Uncter 19 Yra
1Q1n
1Cha1l8e 1960-70
of PopOver 65 Yra
lQO Change
1960-70
19 389 +29 141 -24 20 223 -13 206 +18
21 227 +08 194 -36 2201 356 -27 112 +05
2202 290 -18 ll~9 -29 2301 356 -03 154 +24 2302 260 -37 245 +97
2401 410 +6~1 123 -31 2402 163 -80 320 +99 2501 381 +13 140 -01 25()2 237 31 lil +02 26 343 +25 186 +149 2701 370 +29 1S5 -01 2702 249 -44 304 +98 2801 337 +19 187 +09 2802 306 -10 156 +31 2901 304 -38 142 +24 2902 i 307 -32 146 t3~9
30 29~0 -48 16~2 +51
31 355 +30 160 +01 32 370 +48 148 -13 3301 395 +45 130 -20 3302 368 +06 138 -02 3401 386 +16 117 000
3402
400 +32 92 -26 3501 304 -07 115 +35
3502 344 000 140 -13
3601
36~02 357 -04 132 +32
3603 30~1 42 149 -67 3701 342 +28 152 +19
1
IJ
Jianolraphic Population Chan 1960 to 1970 50 (Contd)
Census Tract
of Pop Under 19 Yrs
JJl7J
middotChanae 1960-70
middotofmiddotpop Over 65 Yrs
1c~7n
Change 196070
3702 409 +39 122 -11 3801 308 -11 151 +29 3802 275 -35 180 +46 3803 282 -32 192 +54 3901 376 ~13 100 +17 3902 296 -03 177 +29 4001 438 -11 84 +13 4002 353 -21 115 +20
4101 397 11 9middot0 +11 4102 346 -19 120 +03 42 331 +19 11 bull 3 -16 43 347 -72 105 +31 44 113 +84 183 +154 4S 33~9 +07 110 -06 4601 2501 22 193 +38 4602 332 +59 126 -29 47middot 161middot 000 211 +01 48 103 -26 302 +59 49 138 +1 bull 3 252 +09 50 141 -26 204 -12 51 12 -39 257 +07 52 47 -61 351 +48 53 89 +49 314 -30 54 25 l1li15 327 -17 55 131 -17 115 -121 56 198 +93 227 -47 57 71 102 189 -88 58 240 ~middot41 16~1 +55 59 322 +25 142 +06middot 6001 264 95 132 +50
6002 328 -31middot 89 +07
JJ
Demographic Population Change 1960 to 1970 51 (Contd)
Census 1 ofPop lChange of Pop bull ChangeTract Under 19 Yrbullbull 1960-70 Over 65 Yrs 1960-70
1970 1970
61 355 -58 85 +39
62 328 39 110 +18
63 414 04 73 10
64 382 -22 72 +04
6501 383 02 67 -20
6502 329 -56 96 +09
6601 391 +13 88 -03
6602 319 -59 97 +06
6701 327 71 145 +72
6702 331 ~67 83 +1-0
6801 365 -66 49 +01
6802 388 4bull3 54 +06
69 354 -41 80 +23
70 400 -23 68 -06
71 359 -48 72 +05
72 255 -88 82 +11
73 346 -39 91 +25
74 313middot -63 105 +24
75 329 -42 129 +37
76 336 -52 85 +21
77 370 -10 69 +05
78 309 -10 120 +21
79 325 -56 87 +10
8001 358 -81 57 +12
8002 391 ~81 76 +12
81 315 -76 108 +21
8201 403 -23 64 +08
8202 392 23 65 +08
83 357 -34 120 +31
84 402 -18 73 +16
85 413 -06 76 -09
r
Demographic Population Change 1960 to 1970 52 (Contd)
Census Tract
t of Pop Uncler 19 Yrs
1970
Change 1960-70
1 of Pop OVer 65 Yrs
1970
ex Change 196070
86
87
88
89
90
91 9201
9202
93
94
95
9601
9602
9701
9702
9801
9802
99
100 I
101
102
103
10401
10402
lOS
368
351
379
391
391
413
379
433
372
429
414
432
419
439
~32
377
457 420
378 41middot7
345
360 417
417
412
-04
-02
-35
-26
-28
-11
-64
-20
-S9
-39
-32
-21
-34
-40
-47
-lO~7middot
-27middot +04
+56
+07
-34 01
+04
+04
+10
103
128
97
11il3 99
69
79
42
77
46
34 38
44
40
54
111
51middot
81
133
59
74
140
63
87
76
-08
-06
+04
+08
+17
-05
+3S -02
+1~4
+19
+33
-14
-08
+12
+26
+71
+11
-16 -34
-20
-19 +37
-49
-2S +15
NOte The The
Taken frOi
averageullder averageabove
middotUSCensus ---shy -
19 years == 6S years ==
figures 197
32r 13(14
p a~d 1960
--
Rank
1
2
3
4
5
6
7
8
9
10
11 12 -_
13
14
15
16
17
18
Tract
69 46
60
58
- 68
61
302
2501
67
63
19
62
26
94
3603
3902
64
30 -----~-
Rank
19
20
21 -
22
23-shy
24
25
26
27
28
29
30
31
32
33
34
35
36 -
Ranking of Per Capita Income by Census Tract
Tract
65
2701
- 15
1601
701
66
93
82
2903
3602
30
2502
80
2401
81
- 70
91 shy
4001
High
Rank Tractshy
-32shy37
38 97
120239
7840
41 ~ _2_1__ 42 31
43 2501
44 18
45 98
46 37
47 3803
1702
49
48
1602 92 2702
I
50 89
51 901
52 801
Ra_
53
54
55
56
57
58
59
60
61
62
63
64
6S
66
67
68
TractTract Ra~
74692
170196 70 I
401 71 90
72 1037J
79 70273
3802 74 601
24024102 75
85 76 101
77 9023901
7699 78 100 4101 79
3601 I
380180
458140~ t---- _ - - shy83 82 42
888384
59843501
4777 8~
502
Low
802 86
Rank Tract
87 shy
--88
89
90
91
92
93
94
- 95
96
97
middot98
99
100
101
102
103
104
1201
14
49
72
73
43
87
3502
105
1
52
86
71
1
501
10
3301
104 tf
Rank
105
106
107
108
109
110
III
112
113
114
115
116
117
118
119
120
121
Ranking of Per Capitalucoae by Census Tract
(Contd)
Tract Rank
4001 122--shy602
13
1102 2302
3302
55
3401
48
21
56
50
3402
lL01
2202
2301
53
2201
-shy
Tract Rank Tract Rank T~aet Rank
57 I-----
Imiddote
bull
Tract
- Low -k Note Information taken from 1960 U SCensus
Rank Tract
I ~
Ie
Imiddot
~
----
----
--
--
Rank
1
2
3
4
5
6
1
8
9
10
11
i-
-Tract
391 922 921
972 971
100
132 131 121
962 961
822 821 401
982 981
20 111
47 10 1
412
High
Total Number of Henta1 Health Visits
Ranked by Census Tract High to Low
TractTract RankTractRank Rnk
12 182 22 78 29 87 76 381 73181 ~------- 1913 371 8538230162372 271 2616-121 8272 2
14 80~2 31 94 7923 84801 59 15251362 4232 15 52 _ 32 103 8924 651 17240216 652
_ 91 351 33 341 23117 83 122 25 25 48 1123921418 34 shy61 86 661
19 662 6493 81 26 91 8153 49 50 55 41383 71 27 51 3120 90 672241 35shy 104167162 461
I 411 46211121 28 88342 I
2502 36 69 54 5251 50 272
-Ra
37
38
39
_ 40
_ 41 Ishy
I
42 I
-I 43 44
45
shy
Tract
~ --- shy 95 56
45 292 242
102 62 352 291y
92
101 281
99 72 63 601 60~ 42 2201
77 74 61 57
363 232
70
32 31
11 44 282 2202
Low l
- Tract
46 682 681 I 331 30
r~$ 47 1042 332
48 102_41_
11
~
Visits to Family Planning Clinics Ranked by Census Tract High to Low
Rank Tract Rank Tract Rankmiddot Tract Rank Tract Rank Tract Rank Tract
1
2
3
4
5
6
7
8
9
10
11
12
13middot
14
15
16
17
361
56
401
341
48
59 121
20
55
342
10
31
58
93 21
241 132
331
53
461 462
18
19
20-shy21
22
23
24
25
26
27middot
28
29
30
31
32
33
391
32
middot47 I-i-_-shy _ -
231 111
332
972 1
372 371
52
89
32
92
82
100 31
182
30 242
402
34
35
36
37
38
39
40
41
42
43
44
45
42
1714 i 661 221
78 362 2
90 602 601 352
63 251
105 921
971 351
73 42 292 232
411 51
662
81 45 52
46
47
48
49shy
50
51
52
53
54
55
56
961
801
49 81 72 71
19
9~1
172
68 2 57 162 14 112
91 75 681
381 42
3~3
83 161
57 f
58
59
60
61shy
62 Imiddot
63
Imiddot 64
65
66
64 62 36~3 252
74 652 SO 392 291
651 6bull 2
79 271
r-- ---- shy981 222
672 671
821 272
94 87
281
382
67
68
69
70
71
72
73
74
75
76
77
78
981 26 12~2
IS 61
85 82~2 69
61 43
101 86 84 282
76
131
51 72
1041 962 88 70
99 922 77
103
95 802 181
i
~
Low High
RankRank Tract
5479
4480
81 1042 ~) middot102
71 - - + ~ - ~
Visits to Family Planning Clinics
(Contd)
Tract Rank
I
Tract llaDk l
RankTract Tract Rank Tract
~
I
~
J1 ~
Low
Total Number of public Health Nursing Visits
Ranked by Census TractsHigh to Low
TractTract RankTractRank RankRank TractTractRankTractRank
25249 71 79 17249 8033 6586 99189711 84 2915072 34 661 76 66 811519512
402 5035 51 161 2518220 122 1713423 352 55801 7120 6752 2 149814 41236 83 2662 38 94 6821 53 2924015 362 37 32 42 75 69 281 84 63
546 8822 54 222 85 3925431 70383417 3818223 6439 4386652 718 21 55 103332 8924 232 87 19 271729219619 24156 16211140 382 628825 10523110 112 73411 10141-- ----shy 89 363 4457 8126 16111 221 74 9142 90 46158331 53 671279012 46243 48 59 351 3837528 1083 9313 91 5844 59 -_242 76 1----- shy60 272 72 74104114 60145 42 9287 7729 92 6151 8215 57371 934630 91 307762 12113116 282 619447 41391 9531 78100 63 7378 ~95 681 6945 32 5632 798517 6448 47 52 181
High ~ Low
Rank Tract Rank
96 31 132 70
97 102
98 182 372middot 602 651 662
- -shy
~72 682 802
822 922 962 972 982
1042 ----shy
Low
Total Number of Public Health Nursing Visits
(Contd)
Rank Rank Rank TractTract Tract
I
I lt
I
Tract Rank Tract
[
~~~-
I
~
IJilfimiddot ~
j
Ranking of VD Caea According to Census Tracts 61 By High and LOll Youth Itatio
A media~ of 34 5 was determined Any tract having greater
than 34 5~ of popu1tionunde~ 19 years of age -High~
Any tract having l8S than 345 of population under 19
years == Low
Any tract having rate less than 390 =Low
Any tract having rate more than 390 == HLgl4
YOUTH
LOW HIGH
L
0
12 402 1801 1802 343 2801 2802 29023603
54 6001 600262 66~02 72 74 75 76
78 79 81 t02 65 1202
W
(25)
VD
H
I
G
H
401 701 801802 901 902 10 1101 241 1201 1301 132 14 15 1601 1701 20~ 21 2202 2j02 2402 2502 2702 2901 303501 3502 34023801 3802 383 3902 42 44 45 4601 4602 47 48 49 SO 51~2 53 55 56 57 58 S9 6701 6702 73 95
3~02 7021702 19 25~01 2701 4102 4101 63 64601 ~601 6801 680270 7l 77 8001 80~02 8201 8202 83 84
85 86 87 88~ 90 91 9202 920193 94 9601 9602~ 9701 9102 9801 9802 99 100 101 103 10402 105 6501 10401
(47)
301 501 502 601 1602 2401 2301 2201 31 32 3301 3302 3401 3402~ 3602 3702 3901 400140 02 43 61 69 B(
(53) (23)
~ ~gt
Ranking of VD by Rate Per 100000 By Census Tract
~
Rank Tract Rank Tract Rank Tract Rank Tract llank Tract Rank Tract Rank Tract
1 2202 21 S6 40 902 58 1602 74 75
90-shy 64 107 26 --~-
2 3402 22 45 41 10 59 902 75 78 91 54 108 61
3 2301 23 3502 42 2502 60 602 76 6802 92 402 109 87
4 3302 24 49 43 1102 61 501 17 2 93 94 110 90
5 50 25 52 44 6702 62 14 78 8202 94 97 02 III 76
6 2201 26 20 6701 63 4002 8201 2501
9701 41~02 112 91
7 44 27 48 45 401 64 3802 2902 95 63 113 62
8 3301 28 1701 46 502 65 30 79 83 74 96 9602 114 71
9 55 29 47 47 42 66 3803 80 2801 96Q1 115 85 10
11
12
13
14
15
16
17
18
3401
53
2302
2401
57
21
2402
1101
51
30-shy31
32
33
34
35
36
37
3701 - -~ 1201
3702
89
43
132 131
3602
4001
48
49
50
51
52
53
54
55
58
1601
601
4602 4601
69
701
31
3901
67
68
69
70
71
72
2901
801
39021~ 802
6502 6501 122
702
41~01
81
82
83
84
85
86
87
88
19
1
1702
2802
79
93
100 6801 6602
81
97
98
99
100
101
102
103
104
9201 9202
9802 9801
77
302
79
86
72
84
116
117
118
119
120
121
3603
8002 8001
101
99
95
10401
105 10402 103 102
19
20
59
32
38
39
2702
3501
56
57
301
3801
73 1802 1801
89 6002 6001
105
106
2701
88
High Low
-- -----
Rank OrdermiddotTuberclosis Cases by Rate Per 100000 Ranked by Census Tract High to Low
Tract TractRankTractRank Rank TractRaukTractRankTractRank
801
79 9601501411 52 6835340120511 I 960269 903603532036 $-~~F130221542 4366 311301 70 68~013802 _ I- _ 4001_37213 3921201 6802802 H71523822024 22 54 193302 3802 80 8958 I37139535 70155 9801 I60123 72 6702 98023914011016 6701250124 10 56
81 94 401r 7 154152 73 7057 2625 122 92028
90242 162312301 92~158 86 7172434526509 82 79160159 74 100 87412240227220110 6502836960 75 30 8317244 6501782801285711 61 901 42765645 84 66021459294912 9701 660146 171 302 9702 47
6235023033113 85 822821182 917755 16335013110214 841814832 78 103 938564 324815 86 1057940149272 38036523216 10401 87 2902241 725Q 10402360266340217middot IF88 88 9937233 282 51 218 101 01102 46016234
I)167 2901460219 47
High ~ Low ~
- -
TractRank
9S89
6490
8191 8001 8002
63 61 60middot01 6002 44 2701
92
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Rank Order Tuberculosis Cases by Rate per 100000
(Coutd)
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I
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JNIRODUCTION
In the past several years the subje~t of health care
delivery has assumed increasing importance asa public issue
Congressional hearings public and private commissions and
task forces have investigated the functioning of the health
care system in depth reporting that access to the system
is impeded by financial barriers and by inefficiency of the
delivery system (8p1) 1 Medicare and lled1caid have
attempted to surmount the financial barriers for some segshy
ments of the population and more inclusive health insurshy
ance proposals are being considered in Congress The
Healthright program tmd~r the Economic Opportunity Act
has stimulat~d efforts to improve the delivery system as it
relates to low income persons and some of the health
insurance proposals also have the goal of improving the
delivery system
The Task Force on Organization of Community Health
Services in Health Admin1stration and Organization in the
Decade Ahead (25p13) briefly presents four interrelated
concepts which form a framework for looking at health as a
l Numbers in parentheses refer to bibliography at tne
end of Part I
2
middot$
contemporary policy issue
1 Health is a resource for the social and economiC development of the nation as a mole
2 The healthand social needs of the indishyvidual in modern society are Ulti~atelyinseparable thus the presence of indenti shy
tiable poverty as an adverse influence on health progress and improvement and equally the condition of 111 health will tend to interfere with the individualts ability to function and beproductive~
3 The concept of public health in today s world has begun to expand markedly moving in the direction of convergence withprivate medicine and voluntary efforts these spheresbeing included in the broader term ttcommushynity health
4 Thereex1sts aninescapable interdependence-shycommunity state and national--in the adminishystration and organization of community health services
Obviously the health care system is one 1hich has
many aspects bull Although these aspects--financing manshy
pow~r service delivery~are interrelated we intend in
this report to deal specifically with one facet This is
the decentralization of health care facilities to provide
comprehensive health care services at the local level
The report is presented in two parts The first
part will examine the literature relating to the developshy
ment of the comprehensive neighborhood health care center
as a means for the delivery ofmed1cal care services An
attempt will be made to determine from the health literashy
ture criteria for the evaluation of medical care systems
and further revie of the literature 1111 attempt to
3
determine how these criteria can best be met in a
decentralized medical care delivery system
The second part of the report will examine the health
needs of Multnomah County Oregon with the goal of
providing information about theseneecis for use in health
serv1cemiddotplanning particularly in relation to the
decentralization of health care services
I ltllYd
-
5
~E
Evaluating the Health em Sxatem
~ (8 pp1-2) has 1nc11cateda number of the weakshy
nessea of thepreaent health care system in this nat1on
She c1 tes risDs coats iDadequate pooriy distributed
and 1rietf1ciently utilized manpower andtrapented
service delivery a8 ma3or problema and state that The
systeiD 1swaste1ll otreaourcea andfunctions W1th too
11ttl reprd tor U1ci8Dcy aDd aCoDOIIIY
Shepo1Dts out
hoWever tbattbere are tour points regard1ns reform Upon
which there is widespread agreement Firat she states
IIaccesstoneede4 health emces must not be 1mpeded by
t1DaDcial barriers II BersecODd POint1s that bull bull the
continuoua health sernceare eftryw2ere ava1iable under
cond1t1ons that are physically conveDient comfortable
anclnot destructi to the d1lD1ty or selt-respectof the
recip1ent b1rd it is essential that the health care
syst8lll Iie due reprd to ecODOIIIY 1D the use of scarce
resources providtDg services with eff1ciency Finally
the system must be accoUDtab1e to those who tiDance it
and to those who 11IIe 1t and in particular must be highly
responsiva to the interests of coD8Ulll8rs II
Gre8Dlick (18 p756) also prQPoses a set of princ1shy
ples which can be used to naluate the ed1cal care
system ae states tint that bull bull all those who need
medical care shouldhave equal access to 1t second
(
6
bull bull the sernce prortded ahould be precisely approshy
priate to the pat1entl1eedemiddot ft and tb1rd bull bull the
med1cal care ayatea ahould provide the lOst eff1cient
and econoa1C8l use of scarce IIe41Cal resources
orthepurpoesof tb18 report certa1not these
crtteXaw1l1bestreaae4 lION tbaD others The rema1llder
of PaXt I Will renew the l1teraturerelating to the issuee
ofcomprehenaivene8sof ervice access1b111ty ot serv1ces
aDdett1c1ency oten1ces 111 tbedel1very ofdecentralized
medical car
ratCopcept of C_ Beal1h care Asd1oal tecmolol1 bas advanced a process of
evolution basoccurred inthe aed1cal and health t1elds
As JOhDsoD (21 pp~361-363) etamptsmiddot bull the goal of
healtb carelD our society baa evolve4trom rel1ef of
ajmptolU to ~ otdi toex1steDce in a potent1ally
diseaselessstate C1t1Dl tbelJm1 tat10DS in health care
resources and presenttechnololY he cont1nues to state
that The resulting cbal18D1e facing the Amer1can health
serncesystem is to provide each 1D41Y1dual with the
sreatest possible opporturnty toach1eve an optimum level
of phys1cal Jl8Dtal amd so()1alwall be1Dg
to
reter to the type othe81th care aystemwh1ch attempts to
answer tb1s cba]] and fult111 the three principles of
1
access1b11it Prov1UOI1ot appropriate services and
eff1cient use ot middotre80urc He state that a IYStem ot
comprehensive healthmiddotmiddot care 1DmiddotoXder to apIo middottbe stated
principles fD lleetiDlita 1Oalttst havemiddot certain
attributes
1 middoteare utdbeollW~ItaC1~orpn1zatlOM]ec ~ bull p~~ol1calbarriers IlU8t be removedbull
2 bull Care abould ace he~ecl1merlt8 ot distance residttiiCemiddot tille must be removed
middotcare8ho1ll411eC-r0WIZ the Ufemiddot span it diseases eapec ychronic are to be controlled betoretheybecome disabling or lite threateD1Dg
4 CeresboUd be~teJ1nCludlJ1C p~vention cure ma1ntiDiiCeand rehabI11tation
5 Care aho11l4be~i9_ttIa1t1ephyaiolol1ca1 aD4 pay1Fci1~cTrIS-ticot the pat~ent
6 Care aboul4 middotbe9L~ tJwrefore shouldbebu11t aro~ middotslJOc1al1natltutloDs which relate to the patients Way of lite suCh as middotthe home school and place of work
7 bull Carellbolld be m-ar and therefore shoUld bemiddot provIded ~Wliils where responsishybiUty tor the patient bas beendetem1nedauthority has been delqated and a communishycation syst_ provided
s care slIould 1Ie HIl 1nclud1Dg theintesratlon ottac1~1ts~ ~prsOllDel neceaary tor modern medical care
9 bull care dbe Of hip ~ eresboul Th ahouldbe aD adequate audit 0 care pee~ reviewcoDtlDUDI naluatioDBnd research intomiddot adequacy aDd quality
Ult1ately as 1Dd1cate4by the Nat10Dal CollllDisshy
8
sion on ColDJIIUUity Health Service (26 pp 1~20) the
c1evelopmezat of a ampyt of comprehensive health care is
a cOlDJIIUUityw14ere8pODSibilit1 1nvolviDS the integrashy
tion of all the health care facilitie and programs in
the cOlDJIIUUity or the c0arcm1ty8 healthc~ system
the PamprqlOIIlt goal ~
PrQv11~ of a ~rehive ~e 9tcoaaun1ty health aervicea
2 Ma1DteIlace ot aD a4equateqUaDtity ot al~requ1re4 health care facilities
Iritsrat~oDof ~v1c1ualUD1ta and s1steas ot bealth aerviceinto a coordishy
natedpattem ot continuous care tor theindiVidual
HoWYer aYerby (37 t pp71-72) 1Dd1cate the
med1cal and health care 81atmiddotaa it ball t1nct1oned haa
not facil~tate4 the delivery ot COap~usive middothealth
care IDcl1Y1c1ualhealth care facilitie themaelve havemiddot
notg8D8nally tuDcU0Af4tOach1eve tbi810al pUblic
health departaent 11) prond1q prev_tive services and
$1Ch trea~t activities aa are involved in venereal
disease or tuberculois control have in general avoided
1Dvad1Ds the curativedoma1Dotprivate mediCine Th1s
haa even been cabullbull1DareaawherelI~cal care is not
readily availa)le except throUlh hoepital outpatient departshy
lDent8~ Aa he 81IIet mothealth departaaents have tailed
to proVide an adequate _try point for the patient 1Dtothe
diapoatic and curative a bull t of tile health care aystell
This may be particularly true tor the pOOr patient who may
9
b_dloallYUDaoptdatlcaW4lberefore th past decade
babullbullbull~ bull lIOYeaeftt to evolve DfW torms ot health care
and new types ot health oare institutloDS providing
comprehensive oDlOiDI care rather thaD trapented care
There seems to be little dispute in the health
aboe requ1res both an lDtesratloD ofprev1ously uncoo~
ditultec1 health care ervlcbullbull brlDSins tolether into one
alency what Johnaon (21 p362) reterred to as bullbullbull the
concepts ot cOllPrehms1veIled1C1ne andpos1tlve health
andaporpph1cclecctrailzat1on ot ervlce dellvery
he NatlODal CoimD18810D0D CouD1ty H_81th Services
report Health Care gilitis (26 p37) suggests
proYic11Dl compreheDaive health care services by centrashy
llz1Da a varlet ot publlc and prlvate healthcare
tacllities 1ntohealtb campuses However as Kahn
(22 pp274) states amppeskin ot soclal servlces in genshy
eral bullbull bull if the loal ls to develop a service-delivery
approach that improves access taclltates teedback 80 as
toadapt to user preterence8nd prlorlty and maximizes
case 1nteptatlon aDd accountabl11ty the base of the
total 80clal service system Should be tnthe nelSbborhood
Dec~tral1zatloD not only makes services IIOre accesslble
but allows therv1ce to be tailored to the Deeds of the
10
areaDe Diaz (14 p3) indicates the importance of
being aware of groups in the neighborhood with special
health problems such as elderly people or large families
witb yOlmg children This means that it is important
in planning to be aware of the demographic features of the patient population This will be considered more
thoroughly inPart II of this report
Kahn (22 p275) continues however to indicate
that more than the improvement of service usage is I
involved in decentralization and that decentralization
ot service delivery also represents part of tI a general
search to break down cities to human scale for some
purposes on the assumption that people find it easier toshy
relate to a neighborhood orsection and to its populationbull
bull bull bull Thus the organization of services at the neighshy
borhood level bas the added purpose of contributing to
the search tor neighborhood n He adds that this process
i8 more relevant it there is a measure of local control
over as well as local availability of services
Kahn indicates that decentralization is not a
viable goal in some circumstances These include situashy
tiona in wh1chthe need for a particular service is too
TJI t
-
11
little to justityits proVision in a l()calun1t where
skills or resources are too rare to be provided locally
or where the costs ot decentralization vastly outweigh
the benefits He Visualizestheult1mate emergence ofa
h1erarcb1c81 patternofserv1ce delivery tnwhichcertain
services andresp0D81bilities are middot1ntegrat8d1Dto the
collimun1ty at thelooal level Other more specialized
services relate to larpr un1ts of the colDlllUD1ty such as
eomb1nationa ot neigbborhooc18 Veryspecialized services
are to be delivered at city countystateop regional
level8 fh1slevel would al80 be the seat ot prosram
coord1zaat1on staDdardprotection and evaluation 811
of which call for cons1deZable centraliZation for overall
program adm1 nlatrat1on(22 p275) AlthoughKahnt s
model was not developed specltlCally tor health care services 1t1s quite relevant- and appliCable to health
care service delivery systems
Omiddot Donnell (27 p3) reviewing the 1iterat~e on
service delivery and social action through neighborhood
service centers preseJJbB a list of characteristics
generallydesirable in ~eighbOrhood service delivery
centers Firsthe states that the center should be
accessible It should be in a physically convenient
location and should be open evenings and weekends as
well as providing at least em~rg8ncy telephone coverage
t
~ II
12
24 hours a day
The center should als~ be irDmed1ate in 1ts funcshy
tioning That is the centermust have the capacity to
provide prOmpt efficient service and should be able to bullrespond to problems middotwithout long hours ofwalt1ng and
many rounds of apPointments
The centexsservices should be 6omprehensive liThe
center should offer a full range ofusable oil-the-spot
services or easyaccess to other resources by available
transportation It should gear itself to the needs that
peoplehaV8-especially poor people-and provide for the
slmultaneoushar1d11ng of problems were possible
SerVices should 8180 b 1J1tegrated and coordinated so
thatseMces can more effectively be provided
The operation of the service center should fInally
be responsive to the needs and desir-es of the neighborshy
hood It should provide ways in which reSidents can
shape th~ program and continue to contribute to its course
and development It should be relevant and ready to
respond to changing needs II
The concept of the comprehensive neighborhood health
center developed by OEO (31 p324) has been described by
severalwriters Yarby (37 p73) describes it as an
outpatient racility which has certain def~n1te characshy
teristiCS middot1 Accessible to a poPulat1on concentration
bull 13
2 Open 24 hours a day seven days a week 3 Family-centered c~e by a team of lnteniists pediatricians clinical and publichealthnurses and social workers 4 Availability ot frequently~requ1redspecialist in such fieldsaspsycbiatryobstetrics gynecology surgerY5 Con~1nu1tyof doctor-patient relationshyship 6 Family records with social and medical ~raquomDaries of relevant information about each family member 7 Basic diagnosticlaboramptoryand x-raytacl1itles and drugs and biologicalsavailable atthe center 8 Directline (1)y center-controlledambushy
lance when-necessary) to ateach1nghospltaifor cl1agnostic ~d therapeutic servlcf)srequiring the fa011itlesandpersonnel of thehospltal 9 Patient-cantered and eommUn1ty-oriented -
The range ot services in the comprehens1venelghborshy
hood health center shouldbe as complete as possible
inCluding preventivediagnost10 treatment and rehabi-
litative services and Sbouldbe deslgnedto eliminate
episodioandfragmented services (31 pp324-325) Schorr
and English (33p291) add as additional characteristics
ot the compr8henslveneighborhood health cent~r that it
should ~ve intensive participation by and involvement
of the population to be served both in policy making and
as employees and that it should be fully integrated with
the existing health care system The Office of Economic
Opportunity (28 p63) stresses the potential for easing
health manpowershortage$by trairiing local neighborhood
reSidents as non-professional health aides at the same
time creating new job and careeropportunitles As
14
Gordon (16 p bull 422) indicates Many of the outstanding
problems in medical practice todayrevolve around
effectively motivating the patient and the prospective
patient to be concerned with his health This is
especially true in a deprived environment The community
health center with its technique ot consumer partici
pation maybe a way to create this cooperation effectvely
It is important to note at this point that the
comprehensive neiShborhood health center haaas its
constituency an integratedmiddot community r~ther than a
particular segment It should haveas Blum and Levy
(6 pp~5) indicate a horizontal rather than a vertical
relationship with the commuriitybull The vertical relatlonshy
ship they state is characteristic ot those service
organizations wh1chapproach the community only in terms
of their own fUnction Tbey see only their relationship
with the users of their service and assume that problems
of accountability will be handled by these consumers
However they pOintout this ienot likely as a vertical
approach creates dependency onthe institution Agencies
in a horizontal relationBhllp recognizetha1 they have
both acommunityand a consumer to serve The horizontal
approach places the matter of accoUltability on a broader
basis than just the involvement of the consumer De Diaz
(14 p4) speaks otthe need to ~develop a community
facility which difters from a clinic for low income
1ji ~
15
people in that it should serve an economically integrated
community The reason for this is that a wide variation
of consumers may assure a better quality of care
The advantages of the comprehensive neighborhood t
health center over traditional systems of providing
commuruty health services are numerous Hospital outshy
patient departments a major traditional source of ambushy
latory health c8refor poor patients have been indicted
for neglecting preventive health care ~romoting fragshy
mentedeare and subjecting patients to degrading and
impersonal conditions to mention only a few of the major
defects (31 p324) Another defect has been the
tendency to shunt low income patients back and forth
between different cliniCS often at different locations
arid with differel)t open hours for different treatments
or tests in regard to the same lllness(26 p63)
The comprehensive neighborhood health programs that
have been organized present a great variety of organishy
zationalpatterns one area of difference 1s in the
emphasis placed upon making each faci1ity comprehensive
in the services it provides to the patient population
In the Montefieri Hospital Neighborhood Medical Care
Demonstration program in New York City services have
been made available through a central health center and
two store frontsatellites the center to be the base
bull
Li
l of opratiol18 of ta1lJpIlflicl- ancl the satellite
center the ba of oparat1oDa of public heaJth nurses
an4 nllbborbood amp1 be satellite centers wereto
proVide preVentift tutaltll bullbulln1c1-m1zaticms w811shy
baby care per1od1c ~ectiland tJle central health
center to proViAle care tor illnes If (36 p299)
bis propWI VUDOt ~ttullytunct10DIDI at the t1JDe
it d1cu8ae4 18 tbe Uterature aDd all aernce Were
be1Dl provided 1D_~terBowever itwould ae
tbat the ntua1pro~ as aY1ioae4by its plmmers
would boclJ aoaeot bull 4efeot~ otthe current lud1cal
ccde teaIt pObullbulllne_t coorctJl8td admSDtshy
etration eD4 well 4eftlopecl refelTal procedtlreacould
1I1a~ thecOllDeCticmof t~_t8 withappropr1ate preTellshy
t1 aD4 therapeu1ampcaen1cbullbull aV81lable 111 diffrent
locationa Bowner tile barrieraottiaeaDdUatanc
between center and truaraUon tor the UDSopb1aticated
patieatlook1Dl tor 1her1~pJce too tor ~1CU-
larhalth serfplusmnQewoGl4~to JJa1t tbbll1ty o~
tb18 ~811D to provide iaaiYCOliprelleU1P18hboltleod
health servicebullbull III tactmiddot tappeareto coDtlict with
tbepro own taW cOfdotpro-1~a tam1ly
mecl1cal careprogru 111 wIa10h pre-teAtlYe aDd therapeutic
health erY1cecan be proY-lW to all IIl81Ibers of
tamily in the coure of aaSDll vi8it (36 PP301-3(2)
Dle Delmtr Coloradoprepa11ke the Montet1ori
LI
17
prograJlut111zbullbull abe1rarcJly ot SlDa11 aatellItestations
andlerer IIOreceDtallzedtac11It1es It 41ffers
howeverill tbcolap~81vene80f the services avail shy
able Inthe 4ecentraUzed facIJJtiesIt resembles very
clc)sely the IOdel ~ordecentral1zed social servicedell shy
very developed by 1ahII~ Which was 41sCussed above he
SIlall neImiddotgbborhoodmiddot c8Dt~aw1tb1n walkl distance of
most of the populatiotl havebeendesilDedto take care
of allthenorllalhealth probl of 3000-5000 patJentsshy
check-ups IlzatiOZl8s1Jlpl laboratory testa and
treataentand iaecucatlol18 (d1apeued by phyS1cians) for
IIOst DODCrltIcal 1l11le PatIent 1d1Oneed IIOrespecIal-
Ized care are reterrecttobacJalp facilities BaCkup
support tor themiddot~t1oDa are the tWo l8rsernelshborhood
health C8Dter8~ttr1Dl aCOglete~e of out-patient
serneeaDd three part1clpat1q hoap1iampl bull bullbull which
proVide1Dpat18Dt~t andcoDSUltatlve services
(13 p1028) Intb1a prosrama coaprehens1ve range of
prevent1ve aDd trea1aeDt serric 18 aVailable throughout
the decentraUzed middotta The CoapreheulY8 ReIgbborhood Hea1~ Service Project
otKa1er iC)UDdatlcm HOspitals 111 Portlan4 OreOD 1s
s1ll11arto th DenVer prosraa 1D thata comprehensive range
ot out-patientmiddot services 1D prov14e4 in each of 1ts 10cashy
t1oDa althoUlhmiddotmiddot tbe oentera are larger and l bullbulls DDIerous
than 1nth DenverproPUh (12 p6)
Li i
18
In order that a comprehensive neighborhood health
care center be able to proVide continuity of care it
must have arrangements for hospital services integrated
into th system Yarby (37 p73) as quoted above
states that it 1s characteristic of the neighborhood
health center to be directly connected with a teaching
hospital However De Diaz (14p3) indicates that it
may be advantageous for purposes of service delivery not
to havemiddotthe center affiliated with a teaching hospital
She feels that such anaft11iation may lead to asltuation
in which policies might be determined more by the teaching
needs of a medical school than by the service needs of
the patient
middotThe Nat10nalmiddotCommissionmiddoton Community Health Services
(25 p69) states that such a system of comprehensive
health care integrat1na ~e servicmiddotes of several health
and roedical agencies snould utilize Itas much single or
unified management as possible Neighborhood health
centers have been operated under a variety of auspices
but several writers have pointed out the advantages in
termsof coordinated prOvision of servictts management by
the hospital of the neighborhood health center For
instancethisfac111tates the keeping of unified medical
records of all the care a patient Msrecelved either at
the neighborhood health center or _le hospitalized
(12p6) ~ermore a3 Young (38 p1741) points out
19
direct operationot the u1sbborhood health oenter by
the hoSpital canll8lceaftilable to the center expertise lt bull
in sOlle aapcta 0 Operation that m18ht not be aa readily
available otherwie
Relardlebullbull of wbetberthe hospital and the neighborshy
hoodhealtbcent8r haVe a cOJIIIOaadmjntstration they
IIlU8thaVealTlved at a str1Dsent delineation of IDUtUal
role and reSpoDBlbilltiebullbull All OOIIpoienta ot the care
yst IIlWStQlarify and understand one anothers position
In the syatem and acree on objeCtive ancimethOds
(26 pp16-17p31) SODae areas of iDUtUalconcemare
reterral procedures record keepiDg aDC1 mutual use of
facilit1es statt1Dl i8 anotb8r ~ ot coaaon conc~
Ditt1cultift have u-laeniD the pastiD cOllprehensive bull t bull
healtbc~ prosraumiddot 1d11ch were batil plauned in wb1ch
all of the health canter phy1C~1IDa did DOt bavetatf
privilege at all ot thebackuJlhospltala (29 p21)
SUch a8ituat10n i8 1Dampcceptablelt inpatient care i8 to
continue to be p4by the pat1eatmiddot health center
physician and it cont1Du1ty ot care 18 to be maintained
Hoapital and health center1lUSt laav 301nt responsibility
tor the recruitaentot physicians
VticlentU IPan BJcNrcu Much otwhat haa b8ea sUd has stre88e4 at leastmiddot
iJlplicit17tbaD8ed tor tM etticit middotprovision ot8emcea
20
There appears to be two aspects of efficiency which are
discussed by writers on the su~3ect of the comprehensive
neighborhood health care centef one of these is the
need to organize) services to make the most efficient and
economical use of scarce medical care resources The
other closelyrelat8d in realIty is the need to help
the public use services in the most efficient manner
The comprehensive neighborhood health center concept
1s lhherentlymiddot efficient in that preventive curative and
rehabilitative health ~are programs are coordinated under
one roof with integrated a~stration Furthermore
theempbasLson prevention health education and early
disease detectionis eftic1ent troJll~estandpoint of
the health care system as well as beneficial to the patient
(18 p760) HQwever ~ue tothe scarcity of health care
personnel thecoiDprehensive neighborhood health center
mustbe an arena tor eXperimentation with new staffing
patterns~ The Kaiser program is indicative of the way
in which health care systems must begin to operate in
that appropr1ate ancillary personnel are used Wherever
possible to perform functions that do not need to be
carried out by the physician As Saward (32 p42)
states
1hroughou10ur organ1zat1on~ there are many of the customary experiments be1ngmade-shyJse of speciallr trained nurses for well-baby care under the SUpervision of the pedi9trlcianexperiments with routine prenatal care by
w ~
21
middotSPC1a1l~t~JlUrbullbull per8ema_1 bullJmdlJleu y our fuDotlou are auoh that DOtb1Da 18 dorutbYtbe phY8iCianstbat doe DOt vet to be done by the
phys1c111U1fhe other aldlle4 person- Del-nurse middotreC~0D18t the appo1ntshymeDt center or clerical praormelshyaremiddot there to free h1amiddotto use his spec1al sk111
Awell lmoWn treDd1D the area of eaaiDI health
c8re JII8DPOY8rShortagjs bas middotbe thetrend toward tra1nshy
1DB poverty area rea1deats as DOD~pro~eaionalmiddoth8lth
aide and nepborboocl health workeramiddot (28 p63) This
bas the effectofmiddotmiddot1J)creaa1q II8DPOWrand 8180 can help
bridle the cuJ~ cap betweenprondera and colllUmers
of aen1C8s This attarD at least tlleoretically
createa a situation 1D WIa1ch providers andcoD8Ullers can
be educated to UDderatad OD88DOtber and interactJlore
ettectlvely~ HoWever amiddotpltt8ll has beeD themiddot tel14ency in
801D8 oamp8e8 tomiddot us aidesmiddot ssale8lllcw t~r the center
alJDOatexclwdY811rathertbaD ua1Dltheal to protide the
health care for wh1ch ~ were trained (29 pp3B-39)
1bat ismiddotmiddot vh1~e the a14e Yalue in ~~m1catiDI with
low 1nCOlMt patieata haa beeR recoSD1zed and stressed
their role ashealtb carepersoDDelhil been slighted 1n )
any 1Dstancea
Anotber step 1d11Ob bullbull been taken to provide 8rY1ces
more efficiently eUeot1ftlybas beenmiddot theorgan1zation
of per8ODDeliDto IIllt141sc1pl1Dary teamaaaa means ot
proYid1DgmiddotCOQrd1DatedserY1ce SUch te8lll8 sen_rally
~
hf
~
22
include PhYsiciaQs nursbullbullbullbull soc1al workers and outreach
workers Conceptually th8y fmlct10n to me~ the intershy
relate lled1cal and social needs ot the families sened
Hor there are a number ot barriers to the etfectve
tlmctiOD1nlof lIuchte8ll8 SODieot these are heavy caseshy
loads the inordiDate amount ot tille consumed by multlshy
prOblem tamtliethel1m1ted tra1n1 ngmiddotmiddotand laCk of tnterest
on tile part ot aoae tebers in examinJng aspects of
problems out14e~lr oWn areaaotcolIPetencemiddot and
~ourdcation prc)blell8 between proteasioDala and nonshy
prot81~s (10ppa-10) middotrurtbemOre as De Diaz
(14 middotp6)1nd1cate tbel8 maybe a teDdency tor vertical
dp8rtmental lines of auperv1810nto become paramount
over the team coDamloation syst lead1ngto conflIcts
in determ1niDI the ro1ea ot solie team bers particularly
the DOD-prote81011alaInauch exper1l1enta Witb new
~t1Dlpatterna it 1s bullbullaentialtbat line of authority
roles aDd NsP0D81bll1tlea be made explicit and that there
beJDechaD 8IUI tor relUlar evaluat1onotfunctlorUng
Another way inwb1ch health care sernee delivery can
be made more ett1cl8Dt is to proVide servicea dur1DC the
hours whentbey aremiddot -ostnee4ed As reQo_ded by Yarby
(37p1) serY1ce can bemadelIOre accesslble by making
themava1lable 24 hours a day seven days a week If
rg8l1Cy service are aft11ab1e aroua4-tbe-cloek at ~
nil1iborhood health center the continuity ot tbepat1ent ts
23
careiamaiDtalDedand meatry point into the
cOIIPre~i health care 8 be made available
tothe patient who aoZMllyU8ea ozilymiddot emergency care in
tille of med1cal criais More 8isDificantly ava11ab1-
lity of a tull rase of bullbullrv1c8 tor seVeral hours 11the
eVerlna aI1Cl On ~ prevent the los ot earn1JiSs
involved if th patierat 1IU8tt8cet1me oftfroawork dur1q
the d8y for aed1Cal oare bull his can be an eSpecially
importantc0J1814eration tor lo1aCOlleDUUg1nally qloYEtd
patient aa4caJla18o PIOJIOtet1)e 0Da01Dl use othealth
servicebullbull
exper1eDO ot tbeKa1er prosraa in tb1s~reprdAs
Greenl1clt(19 p10) states wA lllNt 8ip1flcant
proportion ot the abulatory care 8n1cp~Y1dd tor ~
total popUlatiC)U ~ ~ after clWc hours and this
Deed i8 apParenUyaoN prODGUDced tor aJl8d1cally
iDCust population On the other hand the bulk ot all
aabulatory med1cal cu 88l91ce are performed dur1nS
regular cl1D1c hour eVen when services are available 24
hours a dayJ day bull week W
It has ~ the experi8D~eof a ftIDber ot ne1g1lboXshy
hooct hea1tbcentere _t a_jor obstacle to efficient
proViSion ot anicbullbullhas beentbe teD4eDcy of medically
1ncl1pnt patieats to utilize the center oa a walk-in
baais tor epi8od1ccr181or1entect bullbullrv1cea rather than
4)i
h~ ~~f ~~ L
24
to make appoJlltaeata tor ODIo1qprevmt1ve treataent
and rehebl11tat1Ye care ad ampl1O to bave a blah failure
to Show rat_for tbe appo1DtaeDts that they dO make
Atone center 628 of appo1Dtments made were kept
while 3Oottbepati_ta een were ~1n patients
AlthoUP fewer patiets were actually 88811 by the cater
1D middottb1s 1Datance thaathe -bervholuidmadeappointshy
mta the walk-iD patlat required an iDord1nate amount
ot staff t1ae tor aCreeDiaaacl ~trral to pplOprlate
~ttor caregt (9 pgg) Arraquotbr1llpl1catjo~ of the
plOVidedto valk-iD patient by other thaD their
(19 p12)rurtbermore
when patients uti11ze Wlk-1Il er181 centered care
athelr ODlf tona ot ootact with the _d1~ care
ay_ta fUilycentered care the treata_t of tUl11y
bers
a a UD1t 11
dlarupted
hewalk-1Dphenoaaencm appear to barelated to
diUerence between soclal clase in the style of Dlaking
contactJt1th the a11oal C~ay8t As Greenlick f ~
(19 p11)1Dd1oate8 thepheDOaenOn ot INater usage of shy
walk-in ervice by aed10ally middot1Jid11ent patient thaD by
others baa otte been attr1buted to a stoical att1tude
tQward 1llDe8 em the~ ot poor people leacl1D8 to a
~
25
greaterdelay1n tbe k i Dlofa8d1cal care These
patients wppoedlyeelcmiddotcareODlymiddotwIleD tbeirmiddotillDess
becOlles1Dtolerable resultiDSin middotthMr appeariDS withshy
outnot1ce1o rece1ve oareHlwever Greenlicks
r8aearcbbaa cut doubt on the existence ot tb1delay
111 report1Dg middot8J1IPtoJumiddotOfDeW 11laessand seek1ng care
Be bas tcrQDd 1bat s1ll11ar peze_tases of dioally
1nd1sent 8DClJ1on-aed1cally 1Dd1PD~ pat1enta seek care
on the aue daytbat aptou tirstaPPear
1fb11e GrHDllclc 1nd1cat tbat the reasonator the
greatertendeDCY of low 1Do~e pat18Ilta to 1$8 walk-in I
serY1ces are notlcDo1rAmiddotmiddot tbe7 _ be rel~tedto a tendency
ot lower aocio-ecaaaoclaa patieota to preter face-toshy ~
face contacts with II841cal persoDl181posslbly because
such contacts areft coatortiDS an4reasauriDS to
patients who are hJpotbeafzed to bave a dependent attltude
toward IIed1Cal care perS0Jm81 (30 p161)
It a8 itmiddot baa pnerally beenhld the appointment
s1stemts the most efficient Ileana of dellveriDS
comprehenSive oODtllluiDlh-lth care (9~100)1t is
necessary that educaUoraalmiddotbulltfort be taken to proaote the
use ot middotappo1ntaents8DClmiddot tQrec1ucethe fa111re to appe~
ratB4uOatioaalwhlQb baft~utl11zedhave been
IJ
26
1Dten1ews with walk-in patients home Vi8its and group 4i
meetiDp1D8D attemptto1Dierpret1o the patients
the value of rtitgular ppo1ntmentamp andot con~in~
c~1ve care rather than epiI041c care (9 p1OO)
h1s 1safuD~tioD torwhtch nOl~prot81QDal colDlllUD1ty
YOrkersllaY bebe~r8U11ed tban other statf H()wever
euch aD ~ucat1oaal propul __~ ~e related to the senUiDe
capacity otth health oenter to provide comprehensivebull gt
ervice8 to1tpat1_t~odoD aD app01ntment bas18 It
1amp pos8ibleo~rw1 tor educa110Dal ttorts to result
LD a~8JImCl tor ltPP01ntaen~8 at a ratewb1ohi8beyond
the capacity ot thee_tar to t without uareaaoDably
1_ wa1t1Dlprio4a QOBt1nuad use Ot the center on a
wallt-in bU1 _1tbeoosiItpos81ble to et an appoint-
met anc11nCreued pit1entcoJaplampia1a bull Therew111 of
course always be a need and demand tor acute ep1so~c
Care -ci the health centerDlWlt be planned with the capashy
billty ot bullbullbullt1D8 tb1aneed wh1~ cont1Du1nI to stress
aDd educate the patient to utillze oDlOinI comprehensive
faa11y middotc~te~d Cflre (9p 100l
att g4 CODClva1opa
In order to bea4equate any coJlltemporary health care SY8tem muat bullbulletcerta1D interrelated criteria he
IJ
27
minimum criteria areaccessability of services to those
who need them compr8heX1siveness and appropriatness of
services and efficIency 1nthft utilizat~on of SCarce
health care personnel and resources The scareity of
pex-sonnel andtbe need for h1gh quality ongoinghealth
care services
aJIlong the
populationdemanci the most effishy
cientprovision of services
Services must be made accessible to the population
They mustmiddotbe geosraPh1cally accessible to remove the PhysicalmiddotbaTiers betWeen peopleandthem$d1calcare
system They mUst otter their services dur1ngthe
hours when people can make the moat use ofthemA~ it
makes little sense to concentrate services geographically
where they will not be uSed to their fUllest extent it
also is wasteful to provide serv1cesonlydur1righours when
many people are employed his not only presents a hard
ship middotto the consUmer lnrt wastes resources if for instance
the unavailability of preventive services during the hours
when people Can use them causes a need for treatment
services later on
Health carbull sEtrvices must be comprehensive including
prevention treatmcmtand re)abimiddot11tation Ambulatory I
healtbcare facilities wh1cQ are orienteciexclusively
toward either prevept1on or trea1mentare no longer accepshy
table for they are lneft1c1entln their use of resources
and in their prov1s1on of health care to the patient
w ~~
28
If prevent10n1s notmiddot stressed treatment serv1ces that
could have beenavoidedY1l~ be required If prevention
1s the sole focus of the health care facility sick
patients who present themselves must be referred elseshy
where for treatment andsllch referx-als may be taken as
reject1onsor not followed through with until illness
becomes unbearable
The instltutlontbat meets these requirements Is
the comprehensive neighborhood health center It 1s a
local decentralized outpatient facilityprOVld1ng a
fUll range of ambulatoJY health care services It has
a linkage to ahospitalbackUp facilityforlnpatient
treatment and hiihlY apclalized outpatient care
The neighborhood health center must be a fac11ity
planned with an awareness of the needs of the conSUtller
and coDitnUn1ty It must have the r~Ul0urces to provide the
services people need mere they can use them and when
they can use them It must uti11ze the part1cipation of
the community to develop this awareness Not only must
the cen~er beset up to be Amctional for the consumers
but efforts must bemadeaga1n with commun1ty partici shy
pation to help the consumers utilize medical care
services effectively The center muetmake efforts to
educate the community about the valueot regUlar health
care of preventive servicesand of the use of planned
IJ
29
medical appointments ratherthanorisis centered walk-
incare Therealit1es of the existing health care
system have not taught the patient particularly the low
income patienthow to use services effectively
The helthcenterilUst also bea laboratory for
experiments in easing the health caJepersonnel shortage
and c60rd1Datingcare~ A major difficultY iri-exper1shy
menting with neW rolesis freeing staff of old preconshy
ceptions
CoDlprehensiva neighborhood health dare centers have
been developed under a variety ot alisplces including
medicalsociet1es hoSP1talsmiddot(36p299 group pr~ct1ces
(29 p6- 12 117) health departments (13 p1027) and
ne1gbbothoodassoc1ations(14) The literature indicates
somevalues nthe management ot the health center by plusmnts
hospital backup faCility Whatever the auspices many
adm1nistrative fuDctions such as program coordination
standard pr9tectionand evaluation call for considerable
c~tralization of adm1nistration city-wide or coU)tyshy
wide At the same time other aspects hours of servlce
for examPle~ cuI f~radm1nistrative fUnctions made atmiddot
more local levels Each neighborhood center must be
free to adapt its functioning to itscominunity thi-ough
the mechanism otcODlllUl11~ participation inmiddot policy making
Obviouslythe prerogatives and responsibilities of each level must be negotiated and made explic1t
t4~
JJ
BIBLIOGRAPHY 30
1 American Rehabilitation Foundation ~ealth Services Research Center The Health Maintenance Strategy mimeo 1971
2 Anderson Nancy N Comprehensive Health Planning in the States A Study and Critical Analysis Institute for Interdisciplinary Studies American Rehab ilitation Foundation 1958
3 Andrus Len Hughes Comprehensive Health Planning Through Community Demonstration Health Projects mimeo1967
4 Barry Mildred CandCecil G Sheps A New Model for Community Health Planning unpublished paper presented to the American
Public Health Aseociation1967
5 Blum HenrikL Fred Wahl Genelle M Lemon Robert Jorulin and Glen W Kent The Multipurpose Worker and the Neighborhood Multiservice Center InitialImplications and EJeperiences of the Rodeo CommunityService CenterAmerican Journal of Public Health58 (Mar 168) pp 458-468 shy
6 Blum MichaelD and Soloman L Levy A Design for Service Delivery that Reinforces Constructive Tension Between a Health Center and Its (sic) ConSUDlers and Supports Community Power unpUblished paper presented to the American Public Health Asaociatiltn 1968
7 Brielaud Donald Comm~ity Advisory Boards and Maximum Feasible Participation American Journal of Public Health 61 (Feb 1971) pp 292-296 shy
8 Burns Eveline M Health Insurance Not If or When But What Kind Madison Wisco~sin University of WisconsinScllool of Soci~l Work 1971
9 Campbell John Working ~elationships Between Providers and Conshysumers in a Neighborhood Health CenterU American Journal2 Public Health 61 (Jan 1971) pp 97-103
10 Caxr Willene Neighborhood Health Centers Funded by the Office of Economic Opportunity mimeo 1970~
11 Colombo Theodore J Ernest W Sawardand Merwyn R Greenlick The Integration of an OEO Health Program into a Prepaid Comrehensive Group Practice Plan American Journal of Public Health 59 (April 1969) pp 641-650~ -
12 Comprehensive Neighborhood Health Services Projectof Kaiser FoundatioIl Hospital~ Prcgtgram YearE grant renewal proposal mimeo~1971 bull
13 CowenDavidL~ Denvers Neighborhood Health Program Public Health Reports 84 (Dec 1969) pp 1027-1031
IJ
14 De Diaz Sharon Daniel Beyond Rhetoric The NENA Health31 Center After One Year unpublished paper pres~rited to the American Public Health Association 1970
15middot Gerrie NorrrianF and RichardH~ Ferraro Organizing a Program for Dental Care in a Neighborhood Health Center Public Health Reports 8 (Aug 1968) pp 419-428
16 Gordon JeoffreyB~ The Politics of Community Medicine Projects A Conflict Analysis Medical Care 7 (Nov -Dec 1969) pp 419-428 shy
17 Greely David The Neighborhood Health Center Program and Its Implication(3 for Medical Care H~alth Forum of the Welfare Council of Metropolitan Chicago (mimeo) 1967
18 Greenlick Merwyn R Newgtimensions in Health Care American JOurnal of Pharmacentical Education 34 (Dec 1970) pp 754-4
19 GreenlickMerwyn R Donald K Freeborn TheodoreJbull Colombo Jeffrey Abull Pruesin and Erne$t W saw~d Comparing the
Use of Medical Care Services by a Medically Indigent and a General MemberShip Population in a Comprehensive Prepaid Group Practice Prosram II unpublished paper presented to the AmericanPublic Aesociation1970
20 H~tadoArJiloldVMerllYll RGreenlick and TheodoreJ Colombo Determinants of Medical Care Utilization Failure to Keep Appointments unpublished paper presented to the American Public Health Association 1971
21 Johnson Richard E and Merwyn R Greenlick Comprehensive Medical Care A Problem and Cballengeto Pharmacy ff AJilericanJournal of PbarmacenticalEducation 33 (Aug 1969) pp 361-367 -
22 Kahn Alfred J Studiee Social Policy and Planning New York Russell Sage Foundation 1969
23 Kotler Milton Neyhborhood Government Local Foundations 2 Political~New York The BobbsMerrill Company 1969
24 NationalCommisaion on CommunityHealthSfrvic~sActionPlanniriamp for Community SetithServices~ashington p C Public Affairs-Press 19t7
25 National Commission on C~mmunity Health Services Health Adminishysration andOrMPization l the Decade Ali9$-d Washington D C Public Affairs Press 1967
26 NationalCornmiesion onqomm1Jllity Health Servicesbull Health ~ Facilities Washington D C PUblic Affairs Press 1967 bull
~ n
32 27 ODonnell Edward J and Marilyn M Sullivan ServiceDelivery
and Social Action Through the Neighborhood Center A Review of Research tt Welfare ~ Review 7 (Nov~Dec 1969) pp 112
28 Office of Economic Opportunity Second Annual Report Washington D C~ U S Government Printing Office 1966
29 Office of EConomic Opportunity and the Medical Foundation of Be~laire Ohio Eighth Report 2l ~ Committee2a Governshy
ment OperatiOll~ Va8hiiiSton D C Government Printing Office 1969
30 Pope Clyde R Samuel S Yoshioka and Merwyn R Greenlick Determinants of Medical Care Utilization nhe Use of the Telephone for ReportiDg Symptons Journal of Health and SocialBebavior12 (June 1971) pp155-162 shy
31 RenthalA Gerald nComprehensive Health Centers in Large US Cities American Journal of Public Health 61 (Feb 1971) pp 324-336 shy
32 Saward Ernest W The Relevance of Prepaid Group Practice to the Effective Delivery ofHealthServicestt The New Physician 18 (Jan 1969) pp39-44 - shy
33bull Schorr Lisbeth Bamberger and Joseph T English Background Content and Significant IssUes in Neighborhood Health
Center Programs Milbank Memorial ~ Quarterly 46 July 1968) part 1pp 289-296
34 Weiss James E and Merwyn RGreenlick UDeterminants of MedioalCareUtilization The Effects of Social Class and Distance on Contacts With the Medical Care System Medical~ 8 (Nov-Dec 1970 pp 456-462
35 Weiss James E MerwynR Greenlick and Joseph F Jones Determinants of Medical Care Utilization The Impact of Ecological Factorstt unpublished paper presented to the American Public Health Association 1970
36 Wise Harold B Montefiore Hospital Neighborhood Medical Demonstration A Case StudyMilbaDkMemorial Fund Quarterly46 (July 1968) part 1 pp297-308~
37 Yerby Alonzo S ttHealth Departments Hospital and Health Services Medica1~5 (March-April 1967) pp 70-74
38 Young M M~ Chatanooga IS Experience with Reorganization fOr Delivery of Health Services ttAmerican Journ8l of Public Health60 (Sept 1970) pp 1739-1748
f or l
II bull 11 Y d
II
IJ
34
ThepurposeOfPart II of th1aa paper1atod1scuas
elected Speclfic needs ofecltlc areas within Multnomah
County A8P01ll~oUt 1D ~ I of t1a1bullpapermiddot Ita nelgbshy
borhood health oare cater IlU8t be a facl1lty plaDlled with
aD awarenes of the neeels of the oODllUller and collllUDity
Part II of this paper nIl Show 80e of thoe speclflc
needs
he1DforutiOD tor t1li Portlon of the report
obta1nec1 troll tbroupout tbe follow1Dl threepUb11catloDS
1gr~e_tiMshylIPrIxaiidOreson JuDe 1963
2 1~_middot_sectSI8e~ected1teai c-ua 0 S 8 e first count coaputer tape Coluab a_lion AssocshylatloD of QoveraMD-8 Jlme 1971
3 Jtu1tDoab County Oreaon BDY1roDlHtlltal SurveyEarly 1971
The JIultDOIIIlb COUDty OrttIOD BDv1roDllfmtal Surley
Barly 1971 1s bull stat1stical report of the activ1tles of
theentlreMultDOIIIl2 CcNDty Health Dep~t during the
year of 1970 Die speclflc 1nd1cs elected from tb1s
study amprejMental aealtll Publlc Health N~s1D1 vlslts
FaJUly ~ Veaereal])1 ~ ~rcul081
Throush tie use of cUrts and mapa ODe CaD roup these i
speclflc ~oea to ahcnr the healthneedsof speclfic I
census trtcta aD4 then the health needs of iarer neIghshy
borhooda 1m4 o~ Uebullbull
Rf)~UP1Dl of areu was accompllshed in thefolloWinl I
JJ ~
35
he MiltDoIliahCountY oregon BDViromaental SUrvey
early 1971 isamp statistical report ot tbeaotivities ot
the entire MultDolllh COUDty Health ])epartiDent dur1nl the
year ot1970 he specitic 1Dd1C8S selected frOm this
aUy are 1Il8Dtal health public healthDurs8s visits
fUl1ly pia waereal elisease aDd tuberculosia
Tbroq11the Wle otcbart aDd mapa aDecm szoup these
specific indic to show the health Deeds ofapecitic
ccmaua tracts aDdtIum th8health neecla of larsr ~eilh-
bOrhooda and co8I13 tlbullbullbull
RegroupiDI ot areas waa accoap118hed1D the
tollOWiDl lIIIIm1er~ A bullbullcifie 1ndex 8selectcl auch as
venereal di8bullbulle or tuberculo8i~ he total number ot
cs was then deterll1ne4 for each census tract Through
the use of the maber ot cRbullbullbull tor a 11Yen cenaus tract
aDd tbe population ot thattractaltrateot1lla1ampmcper
100OOOpopUlaticm wu cleteXll1ned for each census tract
This was ~e to starl4ard1ze the population ditterence
amongOeD8U8 -tracts 1he rate of incidence toreaob
cenauatract was then llstedby rank position on a chart
In rank poition1DI any cen8Wl tracts haviDg equal
rates ot1l1c1dence are assipe4tbe iaDk posttiona
Beeauseot the abo fact tbAt cbarta w111 vary in length
neveltbAtlea eacb cbart will 1Dclu4eall census tracts
inMullnoaah Couaty Atter the census tracts bave been
listed accord1q to raalcth1s list will bediv1ded into
IJ
36 three levelsotinc14ence he three levels are
1~ The upper 14 of1DcldenCe
2 Thelower 14 ot incidence
middot3 The ILld 12 of incidence
Tlles three srouplqa are then used in compiling a map ~f
Mu1tnOmahCountyfor ach apecltictop1cbull TIle maps are
uaefuJliD tbatthey V1suallycoJib1De 1Dd1v1Clualproblem
census tracts into larger problem nellhbOrhooc1s
The 1960 statistical iDtormatloD was Used in a similar
liIaDDr to tbatexpla1Dedabove 1Dthe4evelopaent of a
chartmiddot and map 1Ihow1DI e cOllpampriSOr1 of per capita lncolle
tor ttaCh ceDsua tJact aDdmiddot combiDed census middotmiddottract areas
he 1910 aDd 1960 statlstlcal iDtOrllatl0D was combined
lna map and chart he purpose of this and chart is
to d8aonatrate the e cl1stributloa1DeachceD8U8 tract
and middot1ndlcatbull tuture ace populatlon treD4a bull
When one be middotbullbullbullbullbullHdth ne8cts ot an area and has
declded to establlsh a cl1D1c to serve that area the
physical location otthat cl1D1c IllU8t be consldered In
order to coapreb8ll81vel develop an area cl1n1c one should
conslder thepre88Dttraftlc middot~ytaa an4tranaportatlon
systems Thecl1D1cahoUld be located close enoUlh to
major arterlals to giva asy access from the total area
be_ ervecl by this cliD1c At the t1ll8they should
be tar eo away froll thesarterlals to all8Y1ate traffic
CODCell18 andpark1D8 conpstlon By traff1c concerns I
IJ
37
lIlan one lUSt consider thertarro1fne8S of streets whether
streets are oD8--C)r two-way iqres8 and egress to parking
amp0111tie eros tratflC) spedof trattJQ children 1n
ll8a traffic i1lht Vislon re8tr1ctionS etc
BwstraDsportat1onshould alao be central in this area
as maay people ~U f1Df1 1tD8Cessary to use this form of
transportatlon
~e tutqredlopHQt of bull treewa systems should be
c0J1S1dered soastolesen thecumce ofmiddot future roada
cutt1DSotltbe cl1D1c llte line
nrrph1c middotDampta
It is 1JDportaDtto kDOw the demosraphic distribution
characteristics of the oUenteltbat i8 to be served by
localized health cl1D1cs
Acl1D1c which erves8J1 area where1D the prepondershy
ance of persona arecrter 65 years of mayf1nd that these
people rely more on pUblic transportation call for more
home- services and haV4t 110ft ChroD1c and debilitating
types of disorders (b1_ blood pressure poor heariDg and
eyesight) tbaD do8 an area ot a YOUDIer population On
the other hand thL area of older residents may have little
need for family plabDlng cllni08
In order to better ~Ybullbull the 4eaoraphic population
of each CeD8U8 tract the 1970 CeD8U8 iatormation was viewed
and two specific catelOri8 considered These two cat
IJ
38
lori8S woUld be the perc_tap ot population under 19
year of ase and the percentase ot each oensuetractover
65 years of age he 1960 1Dtormatlon tor eaCh tract was
then compared witbthe 1970 intormation and a percentage
ofincreaae or4ecreamp8 tormiddot e~chtract1n each category
cOJlputecland achartma4e By the use of this chart one
18 able to View tJleap populat1odiatr1but10n of census
tract and at the _ t1lle accesa middottrencl Por example
let us choose census tract 601 W see 40-4 otthe
population is under 19 years ot and that ODly82 1s
over 65 years ot middotAtthe e tille the percentage of
youth bas ~ed ODly 1_ intbe laSt teD year whilethe
percentale over 65 year ot middotbas stayedmiddotthe same With
this in mJnc1 ODe ~ 1DfItr libat ol1D1o aerviDg this
area WOuld bellQre conq~w1th the problems of a
YOUQier populat1on and that _ would probably be true foJ
some t1aein tbefuture On the other hand CeDSU8 tract 54
has only 2 ollt population UDder 19 yel1s ot age and
this has decreased by 1 over the last ten years middotwhile at
the same time 32-377 ot the populat1on 18 over 65 years of
age A ol1D1C ___ this area should be or1eJ1ted toward
tbespecttic problema otthe ampledbull
PerCapia __ bY gsa neat
WhaD cona1der1qlooat10D1 tor health cl1n1cs one
shoUld take the 1DC01Ieot areas into consideration Areas
IJ
39
of lowiDcome would not 11kel~be 8erved more by localized
cl1D1cs tbaD would are of hilbincome It 18 likely
people haYiq a hip iDeoll8would preter to be aeenby a
chosen ~r1vatephylc1a1l tban at a local cl1D1cwhere
10Dier waits y beraceaaampryand leas personal attention
gl_
The 19701ncOII81atoWampt10n tor MultnomahC~ty was
not available at the tille thi8report W88 made The 1Dto~shy
tiOD Was taken ~adtro tbe1960 census publlcation
his woUld ~8Il thea tbat ral1I8 OD the chart ynot 1raquoe
completely accurate hi writer telthatthe areas most
affected by tb8 1I8eof the older 1Dco1DtOlaat1oDWOuld be
those tracts wh1ch baYebad a rapid 1ncreaae1n populatlon
over the past tfmyHr8 bullbullbull tracts would include tracts
nUmbered 104 9897 96 aDd 95 be perc~ita 1Dcome
referredto1il-tb1a Paper18the lIean 1DCo per person per
census tract
Attar the iDeoeper census tract was listed on a chart
a map was de 1D41catiDg those census tracts belonging to
the lower 14 ot income tor all censue tracts in Multnomah
COlDltytbose beloqins to the upper 14 ot income tor all
census tract 111 MultnolUlhCounty and those belonging to
the mid 12 ot 1I1coaetor all oeuuetracts in Multnomah
C01mty
In yiew1Dg the _p 1t caa be seen that the low income
area seautotollow aloas the at aide ot the Wl1lamette
IJ
40
R1ver the full length of Kultnomah County A second low
income area follows the south edge of the Columbia from
the northwest corner of Multnomah County easterly to 148 St
A third problem area seems to be on the east bank of the
Willamette River with the Union Pacific Railroad being
about the center of this tract The extreme loutheast
corner of Multnomah COUDty appears to be a low income area
but as this area bas bad rapid grouth in the last ten years
this could be erroneous
Mental Health
be first ~ecific indica to be selected from the
Multnomah County envirollllental survey of early 1971 and
to be considered in this paper i8 that of Mental Health
At the present for mental health purposes Multnomah
County is divided into five catchmentareas with a mental
health cl1n1cin each area These clinics are Model
Citles Delaunay ADkeny street Office Hansen Health
Building end Southeast Clinic
All lIlental health cl1n1cslcept statlstlcal information
on all patients visiting their cl1n1cs this included the
address of the patient hese addresses were then listed
upon the approprlate C8D8US tract Each census tract was
then ranked on a chart according to the nUllber of mental
health patients who reslde ln thatCeDSUS tract attending
any of the above listed ental health clinics This chart
IJ
41
wasttum d1v14ed1ato proper quartile bbullbullbull
quartile vereUs to dne10 u appropl1ate Multnoh
County _tal health ItLa middotmiddotmiddotthelipO~a1bl by lOoJcJIUE
at the UDtal health _to uteN1De which ueu have the
lars-t use otCOllDty 1alh~th faci11t1Rot
1Ilclu4ecl 111 tbia woUld tber otpeopleYia1t1Da
pr1vat patch1atriata aDd pr1_t _ntalhealtb cl1D1c8
WheDtbe M1 18Yienclmiddot Itmiddotmiddotmiddotmiddot~middotbe~_ tbat ~rtt
appears to lMt fourmiddotmiddot-al are iii _oil the nuaber ot
lIental healthcl1D1c na1t toM tbjh1sheat 1he
tour areaa woUld be tollows
1ttrea Ore to~Blo Drimiddot ~tb Burrus14e aDd tIMtmiddot Colb1a Riftr H1gbwyaeri1Dla th nortllra boundaryshy
2 bull ProII 82D4 1_~ 10 20th streetwitil the ra1lMd Mu the north ltouadary
3 ~ et et tUgl_b1bull MYel froamiddot the Clackaaa COUDty l1ae aorth to Dln8lon stret
4 beDOlvt1ttfe-t ~efllt4 COatytrca Jle1aware streetmiddot toR1C1a11oDd wlth Colubla Blvd heiDI tbAtnorth bouaclary_
It ODe coapareatbiap to th iDeobullbullmiddotp 1t can be
eamiddotthat lIOat ot the c tracts baY1Dg bllh v1i11tatlcma
middottfl public tal health cJ1rUc8 ~ 111 t13e low ~ aid
1DcOile SroupiDIOJa1y of til 25 tracta llsted as
haviDlbip aental Maltll nlltatlou are ~ the1g60 hip
iDeo arebullbullbull
17 Plpn
42
amily PlellnSDI ]Jlce Metal Health i8 an 1nd1ce of
use Theperson 111 ordertobavebe_ 1Dcluclecl 1n this
atu4ywouldhave tohaft Ue4 ataa11y plaDI cl1D1c
tacilities of soaetype It 41fter troll tile _tal health
study1nthat i t1Jicludestatist1catrollbotb public and
privateclJD1os
The iDformation tor the iak orurcbart 8Dd map of
t8ll111 plenn1 na ob1a1De4 by cOIIblnlDlthe mabel of
1rlcuv1duals bullbull_ attbe tbreellUltrampo-ti Coatyhll11y
PlalJQllIl C11ll10s 111til tbo at the Planned PareDthood
Association CliD1C8 be tbree -JIultDouh Couaty r8ldly
PlamSq Cl1D1c are Solrtbweatth Col_bla 1111- a114
HaDsell Health BWlcl1Dl CllD1cbi middot1Dtormat1oD vas then
bullbullbullesed tomiddot detellWMt l10w people troll eacb c8IUIUS
chart wastben Mele IUs oIIart jn 4iY1ded to show
the censuS tracts lIaYiDlmiddottIle h1t1iest qUart1le of incidence
of use lowest quartile of 1Qc1deao ot use Jlid 12 of
incidence of Wle an4 a map sprepared troll thts 1Dto~
mation
The C8U118 tractsbelOJISnl to the h1lhestquartile of
use appear to be 1lO~ 8catt~ on tbipwas true ot
either the _p ot aental health cl1D1c uaageor ot the map
abow1DI per capita 1I1COM Iaere40 to be three
d18t1nct areas of UIIaP beJ woul4 be
1
IJ
43
t10D of BurD81cl and the W11lallette River 4
2 S~t Portland 8Otth otmiddot the ra11shyrcaadand alona the W11lamette River
lIortbeaat Portl8D4 between MisSiss1pp1 and 24tbStreet the northbouBclary be1DgColwb1aBlvd
Pylzl1c BMltl IrpI Y11ta
Publlc Healtil nur81D1Y1s1t nclud8 an vists to
theholles of client by PubUc Health Nurbullbullbullbull his shows
visits to bull f8Jl1ly fer aDY purpos SUCh aatuberculolJ1s
het1Dl tem1tyaeatalu4 8IiOt10D8l cODd1t1ona etc
he atat18t1C~ 1fele C()4ed accord1Dg tomiddot the 1llli301fOCUS
of the Y18lt tt doe DOt 1D41cate the Dmlber of holies or
f8ll11lev181tecl or 1D41Y14ual Y1a1ted more tban oDcein
the propwl It dobullbull I1ve 80M 1D41cat1on by coaparlshy
OD ot the 8JIoUDt of aedlcal problema 1n eachcen8WI tract
Ap1nmiddot the _p abowa 8 scatter patteraof probl_
areas althoUSh there appear to be a sroup1Dl of hiSh J
l8aIeccmaus tract 1ntlut extreme southeast part of tbe
County other areu uIriaI any nura1Dl contacts are
1 bull he 801lth-oa-al CO1Dty on eaCh 814 of 82nd Av from Clackallaa County north to Dinloa
2 ear bullbullbullt 814e aroUDd Preacottand Misaisippi
Dowatom Bunul14eonboth 1de of the river
44
V_real Pis The iDfomatloil uaec1 to tabulate the Venereal
disease chart includes all the ooab1ned case otmiddotODormea
and syphilIs reported by bothmiddot publIc and prIvate physicIans
dur1nl 1970 There were 3602 caes ot IOnorrhea reported
dur1nl 1970 While ODly 17 cabullbullsot ayphilimiddot were reported
A chart was prepUed aDd att8llPt wasmiddotmiddot de tomiddot
determ1De Wh_therVttDereal 41ease was more p~vaJent in
areas othigb or lowmiddot proportIon ot youth hi waadone
bymiddotdetemlna a 1leaD prceiltacmiddotmiddotmiddottor the population ot
resld~ts UDder19 years ot (34) middotA mean ratemiddot per
100000 popUlatIon al80c1ttem1Ded tor the middotoccurreDCe
ot venereal dieae This was et at 390 oass Areas
hav1nl a population 1n which leiS than 34 were lmder 19
years ot ampIe were called low- yOuth abOve tbl percentaae
hiSh youth The aaa waatrue ot the occurrence oivenershy
eal disea_ per CeD8UStract It the rate waacomputed
as 1I0re than 390 cases per 100000 it was called hiah
venerealdiaeasei it less than thia tisure low venereal
disease It was tound that 1D Multn~ COmlty there sems
to be poSitive OOlatI0n(x21S19gt between low youth
and hipmiddot venereal diseaand hip youth and low venereal
diseasebull
RaDk ordr Iitot all c traot middottbAm made
Th1s was done byt1Ddlna the ratepr 100000 populatIon
of venereal disator all census tracts in the County bull
45
These were thenlisted from h1lhto low (sreatest to
least) in a rank order The l1sting was then divided
into Upperandlower 14 aDd listed on the MUltnomah
Countymiddot up
The areas of b1gh venereal disease se8ll18to
roup thBl~8 middotin a very tllht area ~oq both 1des
of thell18l8~ R1 w1th BurDaldeS~et being
~bout theceDter qf tbi8IZ9uping This area woUld
appear to be m ldeal spot for the denlopment of a
locallzed venereal d1sbullbullbullbull cl1D1c
UbepoundCUlO1s
In this report bull tube1C1llosls caS8S refrred
to include alltbobullbull cabullbulls ontubercUlo8is follow-up
rather middotthan just new C Accord1Ds to the Multnomah
County Health SUrvey of early 1971 this would include
all ca repOrte4 over thelaat three years The
total number of tuberculosi8 cabullbullbull usedin this study
was 666 lh1 included 128 new cabullbullbullbull
A rate per 100000 of tuberculosis for each
census tract wa- then computed and the c~us tracts
listed by rank order be b11h Qartlle mel low
quartl1 were then reoordd on a Multnomah CoUnty map
TWo genral areaa baY1Dg a hip mcldencaot tubercu~
losiare 1D41cated heyare
1 Both middotsld ot theWilla11lette River
Ll -
46
with Burns1de about thecnter
2 he extrea Northebullbullt comer of the County bull
By coap8r1ng the tuberculois an4ven8real
diseae maps ODe can 8ee that the downtown areas ot
hiSh 1nc1denceare alIIo8t 1c1eDt1cal on ach map
This WOuld 1nd1cate that 1t would be of value to
bullbulltab11sh acl1D1c 111 th1aampreatbat would provide
bothtuberCulos1s 8Dd ytmereal 418ase srvicbullbullbull
Thchart aDd 1181gt8 are wsfuln 11v1DI
1Ddicat10DS tor the type aDd placemeototlocal
health cl1n1c8 tbro1qhout tbe MultnomahCounty area
A cOllpar1on of the mapa help one to dec1dewhether
to provide a aulti-8ervice cl1D1c or spec1f1c type of
cliD1c As stated in Part I of thi paprserv1ces
shouldhaYe both treatlieDt and prfMmt10n cOmponents
As he been stated fta ne1lbborhood health care
Qenter muat be a fac111tY plazme4 with an aamesa
ot the neds of the consumer and the c01llll1m1tybull
Part II of this rport haa been an attaapt to indicate
and clarify 8011 ottheae coDlllUDity neds This has
been done through8elect10n of apc1f1c problems
The indic were then visuallyrecorded through the
use of ups and charta ODe dan asseS8 thedsreeof
1DIportance of certain concems to spec~t1c areaa by
comparinl the chart aDd maps Prom this oDeean
41 dec1de which are48 vb1chcUD1c-or indeed if
the need a clinic at all However further factors
should be considered hebullbull include
a The amount of fuDd1 available
b What 18 the percentage ot peopleineoh ceaaua tract tbat would actually us such cl1n1cIl
c Wbat 1 tbeco--1tymiddot 8 IeeliDashyreaardtDI particular cl1D1c8 Would this dcrebullbullbullmiddot the ettctiveness ot thse cl1n1ca
IJ
li
D_OlraphicPopulatLon Challie 1960 to 1970 48
Cen8U8 1 of Pop 1 Cbaqemiddot 1 Change1 ofPopTract Under 19 Yr8 Over 65 Yrs1960-70 1960-70
middot1Q701Q70
1 319 -12 171 -H) 1
2722 215-27 +68 301 366 -22 127 +35 302 371 +19 111 -04
311middot401 144-41 +29 402 321 13~7-39 +24 501 356 124-08 -02 5~O2 351 133-23 +12
405601 82-10 -02 394602 103-01 -06
701 275 149-76 +56 702 361 +01 121 -07
+10middot801 326 140-22 802 321 middot127
(
-29 -03 9~01 342 124 -H) 6-18 902 294 128 -H) 3-24
10middotmiddot -14312 140 -17 1101 182 +25 -23197
2411102 186-59 +29 1201 226 169-17 -41
31middot01202 +11 182 -05 295 -H) 81301 208 -H) 4
1302 331 +08 197 +04
14 323 +15 middot185 -08 middotmiddot15 329 +16 16~5 -13
-28middot 1601 332 131 +12
1602 356 98 +24middot-39 middot3101701 161-33 +21
1702 370 -15 85 +02 +19 1801 264 151middot-50
185middot1802 256 +47-58
IJ ~
D_raphlc Population Change 1960 to 1970middot 49 (Contd)
4io
Census Tract
of pop Uncter 19 Yra
1Q1n
1Cha1l8e 1960-70
of PopOver 65 Yra
lQO Change
1960-70
19 389 +29 141 -24 20 223 -13 206 +18
21 227 +08 194 -36 2201 356 -27 112 +05
2202 290 -18 ll~9 -29 2301 356 -03 154 +24 2302 260 -37 245 +97
2401 410 +6~1 123 -31 2402 163 -80 320 +99 2501 381 +13 140 -01 25()2 237 31 lil +02 26 343 +25 186 +149 2701 370 +29 1S5 -01 2702 249 -44 304 +98 2801 337 +19 187 +09 2802 306 -10 156 +31 2901 304 -38 142 +24 2902 i 307 -32 146 t3~9
30 29~0 -48 16~2 +51
31 355 +30 160 +01 32 370 +48 148 -13 3301 395 +45 130 -20 3302 368 +06 138 -02 3401 386 +16 117 000
3402
400 +32 92 -26 3501 304 -07 115 +35
3502 344 000 140 -13
3601
36~02 357 -04 132 +32
3603 30~1 42 149 -67 3701 342 +28 152 +19
1
IJ
Jianolraphic Population Chan 1960 to 1970 50 (Contd)
Census Tract
of Pop Under 19 Yrs
JJl7J
middotChanae 1960-70
middotofmiddotpop Over 65 Yrs
1c~7n
Change 196070
3702 409 +39 122 -11 3801 308 -11 151 +29 3802 275 -35 180 +46 3803 282 -32 192 +54 3901 376 ~13 100 +17 3902 296 -03 177 +29 4001 438 -11 84 +13 4002 353 -21 115 +20
4101 397 11 9middot0 +11 4102 346 -19 120 +03 42 331 +19 11 bull 3 -16 43 347 -72 105 +31 44 113 +84 183 +154 4S 33~9 +07 110 -06 4601 2501 22 193 +38 4602 332 +59 126 -29 47middot 161middot 000 211 +01 48 103 -26 302 +59 49 138 +1 bull 3 252 +09 50 141 -26 204 -12 51 12 -39 257 +07 52 47 -61 351 +48 53 89 +49 314 -30 54 25 l1li15 327 -17 55 131 -17 115 -121 56 198 +93 227 -47 57 71 102 189 -88 58 240 ~middot41 16~1 +55 59 322 +25 142 +06middot 6001 264 95 132 +50
6002 328 -31middot 89 +07
JJ
Demographic Population Change 1960 to 1970 51 (Contd)
Census 1 ofPop lChange of Pop bull ChangeTract Under 19 Yrbullbull 1960-70 Over 65 Yrs 1960-70
1970 1970
61 355 -58 85 +39
62 328 39 110 +18
63 414 04 73 10
64 382 -22 72 +04
6501 383 02 67 -20
6502 329 -56 96 +09
6601 391 +13 88 -03
6602 319 -59 97 +06
6701 327 71 145 +72
6702 331 ~67 83 +1-0
6801 365 -66 49 +01
6802 388 4bull3 54 +06
69 354 -41 80 +23
70 400 -23 68 -06
71 359 -48 72 +05
72 255 -88 82 +11
73 346 -39 91 +25
74 313middot -63 105 +24
75 329 -42 129 +37
76 336 -52 85 +21
77 370 -10 69 +05
78 309 -10 120 +21
79 325 -56 87 +10
8001 358 -81 57 +12
8002 391 ~81 76 +12
81 315 -76 108 +21
8201 403 -23 64 +08
8202 392 23 65 +08
83 357 -34 120 +31
84 402 -18 73 +16
85 413 -06 76 -09
r
Demographic Population Change 1960 to 1970 52 (Contd)
Census Tract
t of Pop Uncler 19 Yrs
1970
Change 1960-70
1 of Pop OVer 65 Yrs
1970
ex Change 196070
86
87
88
89
90
91 9201
9202
93
94
95
9601
9602
9701
9702
9801
9802
99
100 I
101
102
103
10401
10402
lOS
368
351
379
391
391
413
379
433
372
429
414
432
419
439
~32
377
457 420
378 41middot7
345
360 417
417
412
-04
-02
-35
-26
-28
-11
-64
-20
-S9
-39
-32
-21
-34
-40
-47
-lO~7middot
-27middot +04
+56
+07
-34 01
+04
+04
+10
103
128
97
11il3 99
69
79
42
77
46
34 38
44
40
54
111
51middot
81
133
59
74
140
63
87
76
-08
-06
+04
+08
+17
-05
+3S -02
+1~4
+19
+33
-14
-08
+12
+26
+71
+11
-16 -34
-20
-19 +37
-49
-2S +15
NOte The The
Taken frOi
averageullder averageabove
middotUSCensus ---shy -
19 years == 6S years ==
figures 197
32r 13(14
p a~d 1960
--
Rank
1
2
3
4
5
6
7
8
9
10
11 12 -_
13
14
15
16
17
18
Tract
69 46
60
58
- 68
61
302
2501
67
63
19
62
26
94
3603
3902
64
30 -----~-
Rank
19
20
21 -
22
23-shy
24
25
26
27
28
29
30
31
32
33
34
35
36 -
Ranking of Per Capita Income by Census Tract
Tract
65
2701
- 15
1601
701
66
93
82
2903
3602
30
2502
80
2401
81
- 70
91 shy
4001
High
Rank Tractshy
-32shy37
38 97
120239
7840
41 ~ _2_1__ 42 31
43 2501
44 18
45 98
46 37
47 3803
1702
49
48
1602 92 2702
I
50 89
51 901
52 801
Ra_
53
54
55
56
57
58
59
60
61
62
63
64
6S
66
67
68
TractTract Ra~
74692
170196 70 I
401 71 90
72 1037J
79 70273
3802 74 601
24024102 75
85 76 101
77 9023901
7699 78 100 4101 79
3601 I
380180
458140~ t---- _ - - shy83 82 42
888384
59843501
4777 8~
502
Low
802 86
Rank Tract
87 shy
--88
89
90
91
92
93
94
- 95
96
97
middot98
99
100
101
102
103
104
1201
14
49
72
73
43
87
3502
105
1
52
86
71
1
501
10
3301
104 tf
Rank
105
106
107
108
109
110
III
112
113
114
115
116
117
118
119
120
121
Ranking of Per Capitalucoae by Census Tract
(Contd)
Tract Rank
4001 122--shy602
13
1102 2302
3302
55
3401
48
21
56
50
3402
lL01
2202
2301
53
2201
-shy
Tract Rank Tract Rank T~aet Rank
57 I-----
Imiddote
bull
Tract
- Low -k Note Information taken from 1960 U SCensus
Rank Tract
I ~
Ie
Imiddot
~
----
----
--
--
Rank
1
2
3
4
5
6
1
8
9
10
11
i-
-Tract
391 922 921
972 971
100
132 131 121
962 961
822 821 401
982 981
20 111
47 10 1
412
High
Total Number of Henta1 Health Visits
Ranked by Census Tract High to Low
TractTract RankTractRank Rnk
12 182 22 78 29 87 76 381 73181 ~------- 1913 371 8538230162372 271 2616-121 8272 2
14 80~2 31 94 7923 84801 59 15251362 4232 15 52 _ 32 103 8924 651 17240216 652
_ 91 351 33 341 23117 83 122 25 25 48 1123921418 34 shy61 86 661
19 662 6493 81 26 91 8153 49 50 55 41383 71 27 51 3120 90 672241 35shy 104167162 461
I 411 46211121 28 88342 I
2502 36 69 54 5251 50 272
-Ra
37
38
39
_ 40
_ 41 Ishy
I
42 I
-I 43 44
45
shy
Tract
~ --- shy 95 56
45 292 242
102 62 352 291y
92
101 281
99 72 63 601 60~ 42 2201
77 74 61 57
363 232
70
32 31
11 44 282 2202
Low l
- Tract
46 682 681 I 331 30
r~$ 47 1042 332
48 102_41_
11
~
Visits to Family Planning Clinics Ranked by Census Tract High to Low
Rank Tract Rank Tract Rankmiddot Tract Rank Tract Rank Tract Rank Tract
1
2
3
4
5
6
7
8
9
10
11
12
13middot
14
15
16
17
361
56
401
341
48
59 121
20
55
342
10
31
58
93 21
241 132
331
53
461 462
18
19
20-shy21
22
23
24
25
26
27middot
28
29
30
31
32
33
391
32
middot47 I-i-_-shy _ -
231 111
332
972 1
372 371
52
89
32
92
82
100 31
182
30 242
402
34
35
36
37
38
39
40
41
42
43
44
45
42
1714 i 661 221
78 362 2
90 602 601 352
63 251
105 921
971 351
73 42 292 232
411 51
662
81 45 52
46
47
48
49shy
50
51
52
53
54
55
56
961
801
49 81 72 71
19
9~1
172
68 2 57 162 14 112
91 75 681
381 42
3~3
83 161
57 f
58
59
60
61shy
62 Imiddot
63
Imiddot 64
65
66
64 62 36~3 252
74 652 SO 392 291
651 6bull 2
79 271
r-- ---- shy981 222
672 671
821 272
94 87
281
382
67
68
69
70
71
72
73
74
75
76
77
78
981 26 12~2
IS 61
85 82~2 69
61 43
101 86 84 282
76
131
51 72
1041 962 88 70
99 922 77
103
95 802 181
i
~
Low High
RankRank Tract
5479
4480
81 1042 ~) middot102
71 - - + ~ - ~
Visits to Family Planning Clinics
(Contd)
Tract Rank
I
Tract llaDk l
RankTract Tract Rank Tract
~
I
~
J1 ~
Low
Total Number of public Health Nursing Visits
Ranked by Census TractsHigh to Low
TractTract RankTractRank RankRank TractTractRankTractRank
25249 71 79 17249 8033 6586 99189711 84 2915072 34 661 76 66 811519512
402 5035 51 161 2518220 122 1713423 352 55801 7120 6752 2 149814 41236 83 2662 38 94 6821 53 2924015 362 37 32 42 75 69 281 84 63
546 8822 54 222 85 3925431 70383417 3818223 6439 4386652 718 21 55 103332 8924 232 87 19 271729219619 24156 16211140 382 628825 10523110 112 73411 10141-- ----shy 89 363 4457 8126 16111 221 74 9142 90 46158331 53 671279012 46243 48 59 351 3837528 1083 9313 91 5844 59 -_242 76 1----- shy60 272 72 74104114 60145 42 9287 7729 92 6151 8215 57371 934630 91 307762 12113116 282 619447 41391 9531 78100 63 7378 ~95 681 6945 32 5632 798517 6448 47 52 181
High ~ Low
Rank Tract Rank
96 31 132 70
97 102
98 182 372middot 602 651 662
- -shy
~72 682 802
822 922 962 972 982
1042 ----shy
Low
Total Number of Public Health Nursing Visits
(Contd)
Rank Rank Rank TractTract Tract
I
I lt
I
Tract Rank Tract
[
~~~-
I
~
IJilfimiddot ~
j
Ranking of VD Caea According to Census Tracts 61 By High and LOll Youth Itatio
A media~ of 34 5 was determined Any tract having greater
than 34 5~ of popu1tionunde~ 19 years of age -High~
Any tract having l8S than 345 of population under 19
years == Low
Any tract having rate less than 390 =Low
Any tract having rate more than 390 == HLgl4
YOUTH
LOW HIGH
L
0
12 402 1801 1802 343 2801 2802 29023603
54 6001 600262 66~02 72 74 75 76
78 79 81 t02 65 1202
W
(25)
VD
H
I
G
H
401 701 801802 901 902 10 1101 241 1201 1301 132 14 15 1601 1701 20~ 21 2202 2j02 2402 2502 2702 2901 303501 3502 34023801 3802 383 3902 42 44 45 4601 4602 47 48 49 SO 51~2 53 55 56 57 58 S9 6701 6702 73 95
3~02 7021702 19 25~01 2701 4102 4101 63 64601 ~601 6801 680270 7l 77 8001 80~02 8201 8202 83 84
85 86 87 88~ 90 91 9202 920193 94 9601 9602~ 9701 9102 9801 9802 99 100 101 103 10402 105 6501 10401
(47)
301 501 502 601 1602 2401 2301 2201 31 32 3301 3302 3401 3402~ 3602 3702 3901 400140 02 43 61 69 B(
(53) (23)
~ ~gt
Ranking of VD by Rate Per 100000 By Census Tract
~
Rank Tract Rank Tract Rank Tract Rank Tract llank Tract Rank Tract Rank Tract
1 2202 21 S6 40 902 58 1602 74 75
90-shy 64 107 26 --~-
2 3402 22 45 41 10 59 902 75 78 91 54 108 61
3 2301 23 3502 42 2502 60 602 76 6802 92 402 109 87
4 3302 24 49 43 1102 61 501 17 2 93 94 110 90
5 50 25 52 44 6702 62 14 78 8202 94 97 02 III 76
6 2201 26 20 6701 63 4002 8201 2501
9701 41~02 112 91
7 44 27 48 45 401 64 3802 2902 95 63 113 62
8 3301 28 1701 46 502 65 30 79 83 74 96 9602 114 71
9 55 29 47 47 42 66 3803 80 2801 96Q1 115 85 10
11
12
13
14
15
16
17
18
3401
53
2302
2401
57
21
2402
1101
51
30-shy31
32
33
34
35
36
37
3701 - -~ 1201
3702
89
43
132 131
3602
4001
48
49
50
51
52
53
54
55
58
1601
601
4602 4601
69
701
31
3901
67
68
69
70
71
72
2901
801
39021~ 802
6502 6501 122
702
41~01
81
82
83
84
85
86
87
88
19
1
1702
2802
79
93
100 6801 6602
81
97
98
99
100
101
102
103
104
9201 9202
9802 9801
77
302
79
86
72
84
116
117
118
119
120
121
3603
8002 8001
101
99
95
10401
105 10402 103 102
19
20
59
32
38
39
2702
3501
56
57
301
3801
73 1802 1801
89 6002 6001
105
106
2701
88
High Low
-- -----
Rank OrdermiddotTuberclosis Cases by Rate Per 100000 Ranked by Census Tract High to Low
Tract TractRankTractRank Rank TractRaukTractRankTractRank
801
79 9601501411 52 6835340120511 I 960269 903603532036 $-~~F130221542 4366 311301 70 68~013802 _ I- _ 4001_37213 3921201 6802802 H71523822024 22 54 193302 3802 80 8958 I37139535 70155 9801 I60123 72 6702 98023914011016 6701250124 10 56
81 94 401r 7 154152 73 7057 2625 122 92028
90242 162312301 92~158 86 7172434526509 82 79160159 74 100 87412240227220110 6502836960 75 30 8317244 6501782801285711 61 901 42765645 84 66021459294912 9701 660146 171 302 9702 47
6235023033113 85 822821182 917755 16335013110214 841814832 78 103 938564 324815 86 1057940149272 38036523216 10401 87 2902241 725Q 10402360266340217middot IF88 88 9937233 282 51 218 101 01102 46016234
I)167 2901460219 47
High ~ Low ~
- -
TractRank
9S89
6490
8191 8001 8002
63 61 60middot01 6002 44 2701
92
J
2502 402 --- ----shy
I
Rank
Rank Order Tuberculosis Cases by Rate per 100000
(Coutd)
Tract Rank Tract ~nk
I
Tract Ballk Tract Rank
Imiddot
Tract
Imiddot
1~
t 1I i Pi i l I
o
1 -1shyL I
I J
8 40 icO ~ I -lt 0
-t (1) I
i I
r o E
II
a
I
r--i
shy
I
~
I (
Jgt
(011 fi(
Ggt
I II ~j
()
(f 0
~ ()
I
11
f9
r
II 99
o ~
Ggt r
~ __-J~ I t I ~ I
r--J l I
~ _ __ J
) 1
fTl
1gt
r I
()
r
()
lt en -i en
()
I1l
(J)
(J)
-i
P ()
19
r o ~
r G1 I
I
c
~
o I 89
--- -I-shy
r-r I
1- 0 _~ _ _--J E
G1 I I I
i i
I 1-1-1 ~ _J ~2 ~ II
II
()
1 I I I 1
id i bullbull
~
A n 69
r 1shy
- 0 Gl
l--~ ~ I
~ II
II )
I () isect i
en l i
(J)
-t
0
IA Ol
2
middot$
contemporary policy issue
1 Health is a resource for the social and economiC development of the nation as a mole
2 The healthand social needs of the indishyvidual in modern society are Ulti~atelyinseparable thus the presence of indenti shy
tiable poverty as an adverse influence on health progress and improvement and equally the condition of 111 health will tend to interfere with the individualts ability to function and beproductive~
3 The concept of public health in today s world has begun to expand markedly moving in the direction of convergence withprivate medicine and voluntary efforts these spheresbeing included in the broader term ttcommushynity health
4 Thereex1sts aninescapable interdependence-shycommunity state and national--in the adminishystration and organization of community health services
Obviously the health care system is one 1hich has
many aspects bull Although these aspects--financing manshy
pow~r service delivery~are interrelated we intend in
this report to deal specifically with one facet This is
the decentralization of health care facilities to provide
comprehensive health care services at the local level
The report is presented in two parts The first
part will examine the literature relating to the developshy
ment of the comprehensive neighborhood health care center
as a means for the delivery ofmed1cal care services An
attempt will be made to determine from the health literashy
ture criteria for the evaluation of medical care systems
and further revie of the literature 1111 attempt to
3
determine how these criteria can best be met in a
decentralized medical care delivery system
The second part of the report will examine the health
needs of Multnomah County Oregon with the goal of
providing information about theseneecis for use in health
serv1cemiddotplanning particularly in relation to the
decentralization of health care services
I ltllYd
-
5
~E
Evaluating the Health em Sxatem
~ (8 pp1-2) has 1nc11cateda number of the weakshy
nessea of thepreaent health care system in this nat1on
She c1 tes risDs coats iDadequate pooriy distributed
and 1rietf1ciently utilized manpower andtrapented
service delivery a8 ma3or problema and state that The
systeiD 1swaste1ll otreaourcea andfunctions W1th too
11ttl reprd tor U1ci8Dcy aDd aCoDOIIIY
Shepo1Dts out
hoWever tbattbere are tour points regard1ns reform Upon
which there is widespread agreement Firat she states
IIaccesstoneede4 health emces must not be 1mpeded by
t1DaDcial barriers II BersecODd POint1s that bull bull the
continuoua health sernceare eftryw2ere ava1iable under
cond1t1ons that are physically conveDient comfortable
anclnot destructi to the d1lD1ty or selt-respectof the
recip1ent b1rd it is essential that the health care
syst8lll Iie due reprd to ecODOIIIY 1D the use of scarce
resources providtDg services with eff1ciency Finally
the system must be accoUDtab1e to those who tiDance it
and to those who 11IIe 1t and in particular must be highly
responsiva to the interests of coD8Ulll8rs II
Gre8Dlick (18 p756) also prQPoses a set of princ1shy
ples which can be used to naluate the ed1cal care
system ae states tint that bull bull all those who need
medical care shouldhave equal access to 1t second
(
6
bull bull the sernce prortded ahould be precisely approshy
priate to the pat1entl1eedemiddot ft and tb1rd bull bull the
med1cal care ayatea ahould provide the lOst eff1cient
and econoa1C8l use of scarce IIe41Cal resources
orthepurpoesof tb18 report certa1not these
crtteXaw1l1bestreaae4 lION tbaD others The rema1llder
of PaXt I Will renew the l1teraturerelating to the issuee
ofcomprehenaivene8sof ervice access1b111ty ot serv1ces
aDdett1c1ency oten1ces 111 tbedel1very ofdecentralized
medical car
ratCopcept of C_ Beal1h care Asd1oal tecmolol1 bas advanced a process of
evolution basoccurred inthe aed1cal and health t1elds
As JOhDsoD (21 pp~361-363) etamptsmiddot bull the goal of
healtb carelD our society baa evolve4trom rel1ef of
ajmptolU to ~ otdi toex1steDce in a potent1ally
diseaselessstate C1t1Dl tbelJm1 tat10DS in health care
resources and presenttechnololY he cont1nues to state
that The resulting cbal18D1e facing the Amer1can health
serncesystem is to provide each 1D41Y1dual with the
sreatest possible opporturnty toach1eve an optimum level
of phys1cal Jl8Dtal amd so()1alwall be1Dg
to
reter to the type othe81th care aystemwh1ch attempts to
answer tb1s cba]] and fult111 the three principles of
1
access1b11it Prov1UOI1ot appropriate services and
eff1cient use ot middotre80urc He state that a IYStem ot
comprehensive healthmiddotmiddot care 1DmiddotoXder to apIo middottbe stated
principles fD lleetiDlita 1Oalttst havemiddot certain
attributes
1 middoteare utdbeollW~ItaC1~orpn1zatlOM]ec ~ bull p~~ol1calbarriers IlU8t be removedbull
2 bull Care abould ace he~ecl1merlt8 ot distance residttiiCemiddot tille must be removed
middotcare8ho1ll411eC-r0WIZ the Ufemiddot span it diseases eapec ychronic are to be controlled betoretheybecome disabling or lite threateD1Dg
4 CeresboUd be~teJ1nCludlJ1C p~vention cure ma1ntiDiiCeand rehabI11tation
5 Care aho11l4be~i9_ttIa1t1ephyaiolol1ca1 aD4 pay1Fci1~cTrIS-ticot the pat~ent
6 Care aboul4 middotbe9L~ tJwrefore shouldbebu11t aro~ middotslJOc1al1natltutloDs which relate to the patients Way of lite suCh as middotthe home school and place of work
7 bull Carellbolld be m-ar and therefore shoUld bemiddot provIded ~Wliils where responsishybiUty tor the patient bas beendetem1nedauthority has been delqated and a communishycation syst_ provided
s care slIould 1Ie HIl 1nclud1Dg theintesratlon ottac1~1ts~ ~prsOllDel neceaary tor modern medical care
9 bull care dbe Of hip ~ eresboul Th ahouldbe aD adequate audit 0 care pee~ reviewcoDtlDUDI naluatioDBnd research intomiddot adequacy aDd quality
Ult1ately as 1Dd1cate4by the Nat10Dal CollllDisshy
8
sion on ColDJIIUUity Health Service (26 pp 1~20) the
c1evelopmezat of a ampyt of comprehensive health care is
a cOlDJIIUUityw14ere8pODSibilit1 1nvolviDS the integrashy
tion of all the health care facilitie and programs in
the cOlDJIIUUity or the c0arcm1ty8 healthc~ system
the PamprqlOIIlt goal ~
PrQv11~ of a ~rehive ~e 9tcoaaun1ty health aervicea
2 Ma1DteIlace ot aD a4equateqUaDtity ot al~requ1re4 health care facilities
Iritsrat~oDof ~v1c1ualUD1ta and s1steas ot bealth aerviceinto a coordishy
natedpattem ot continuous care tor theindiVidual
HoWYer aYerby (37 t pp71-72) 1Dd1cate the
med1cal and health care 81atmiddotaa it ball t1nct1oned haa
not facil~tate4 the delivery ot COap~usive middothealth
care IDcl1Y1c1ualhealth care facilitie themaelve havemiddot
notg8D8nally tuDcU0Af4tOach1eve tbi810al pUblic
health departaent 11) prond1q prev_tive services and
$1Ch trea~t activities aa are involved in venereal
disease or tuberculois control have in general avoided
1Dvad1Ds the curativedoma1Dotprivate mediCine Th1s
haa even been cabullbull1DareaawherelI~cal care is not
readily availa)le except throUlh hoepital outpatient departshy
lDent8~ Aa he 81IIet mothealth departaaents have tailed
to proVide an adequate _try point for the patient 1Dtothe
diapoatic and curative a bull t of tile health care aystell
This may be particularly true tor the pOOr patient who may
9
b_dloallYUDaoptdatlcaW4lberefore th past decade
babullbullbull~ bull lIOYeaeftt to evolve DfW torms ot health care
and new types ot health oare institutloDS providing
comprehensive oDlOiDI care rather thaD trapented care
There seems to be little dispute in the health
aboe requ1res both an lDtesratloD ofprev1ously uncoo~
ditultec1 health care ervlcbullbull brlDSins tolether into one
alency what Johnaon (21 p362) reterred to as bullbullbull the
concepts ot cOllPrehms1veIled1C1ne andpos1tlve health
andaporpph1cclecctrailzat1on ot ervlce dellvery
he NatlODal CoimD18810D0D CouD1ty H_81th Services
report Health Care gilitis (26 p37) suggests
proYic11Dl compreheDaive health care services by centrashy
llz1Da a varlet ot publlc and prlvate healthcare
tacllities 1ntohealtb campuses However as Kahn
(22 pp274) states amppeskin ot soclal servlces in genshy
eral bullbull bull if the loal ls to develop a service-delivery
approach that improves access taclltates teedback 80 as
toadapt to user preterence8nd prlorlty and maximizes
case 1nteptatlon aDd accountabl11ty the base of the
total 80clal service system Should be tnthe nelSbborhood
Dec~tral1zatloD not only makes services IIOre accesslble
but allows therv1ce to be tailored to the Deeds of the
10
areaDe Diaz (14 p3) indicates the importance of
being aware of groups in the neighborhood with special
health problems such as elderly people or large families
witb yOlmg children This means that it is important
in planning to be aware of the demographic features of the patient population This will be considered more
thoroughly inPart II of this report
Kahn (22 p275) continues however to indicate
that more than the improvement of service usage is I
involved in decentralization and that decentralization
ot service delivery also represents part of tI a general
search to break down cities to human scale for some
purposes on the assumption that people find it easier toshy
relate to a neighborhood orsection and to its populationbull
bull bull bull Thus the organization of services at the neighshy
borhood level bas the added purpose of contributing to
the search tor neighborhood n He adds that this process
i8 more relevant it there is a measure of local control
over as well as local availability of services
Kahn indicates that decentralization is not a
viable goal in some circumstances These include situashy
tiona in wh1chthe need for a particular service is too
TJI t
-
11
little to justityits proVision in a l()calun1t where
skills or resources are too rare to be provided locally
or where the costs ot decentralization vastly outweigh
the benefits He Visualizestheult1mate emergence ofa
h1erarcb1c81 patternofserv1ce delivery tnwhichcertain
services andresp0D81bilities are middot1ntegrat8d1Dto the
collimun1ty at thelooal level Other more specialized
services relate to larpr un1ts of the colDlllUD1ty such as
eomb1nationa ot neigbborhooc18 Veryspecialized services
are to be delivered at city countystateop regional
level8 fh1slevel would al80 be the seat ot prosram
coord1zaat1on staDdardprotection and evaluation 811
of which call for cons1deZable centraliZation for overall
program adm1 nlatrat1on(22 p275) AlthoughKahnt s
model was not developed specltlCally tor health care services 1t1s quite relevant- and appliCable to health
care service delivery systems
Omiddot Donnell (27 p3) reviewing the 1iterat~e on
service delivery and social action through neighborhood
service centers preseJJbB a list of characteristics
generallydesirable in ~eighbOrhood service delivery
centers Firsthe states that the center should be
accessible It should be in a physically convenient
location and should be open evenings and weekends as
well as providing at least em~rg8ncy telephone coverage
t
~ II
12
24 hours a day
The center should als~ be irDmed1ate in 1ts funcshy
tioning That is the centermust have the capacity to
provide prOmpt efficient service and should be able to bullrespond to problems middotwithout long hours ofwalt1ng and
many rounds of apPointments
The centexsservices should be 6omprehensive liThe
center should offer a full range ofusable oil-the-spot
services or easyaccess to other resources by available
transportation It should gear itself to the needs that
peoplehaV8-especially poor people-and provide for the
slmultaneoushar1d11ng of problems were possible
SerVices should 8180 b 1J1tegrated and coordinated so
thatseMces can more effectively be provided
The operation of the service center should fInally
be responsive to the needs and desir-es of the neighborshy
hood It should provide ways in which reSidents can
shape th~ program and continue to contribute to its course
and development It should be relevant and ready to
respond to changing needs II
The concept of the comprehensive neighborhood health
center developed by OEO (31 p324) has been described by
severalwriters Yarby (37 p73) describes it as an
outpatient racility which has certain def~n1te characshy
teristiCS middot1 Accessible to a poPulat1on concentration
bull 13
2 Open 24 hours a day seven days a week 3 Family-centered c~e by a team of lnteniists pediatricians clinical and publichealthnurses and social workers 4 Availability ot frequently~requ1redspecialist in such fieldsaspsycbiatryobstetrics gynecology surgerY5 Con~1nu1tyof doctor-patient relationshyship 6 Family records with social and medical ~raquomDaries of relevant information about each family member 7 Basic diagnosticlaboramptoryand x-raytacl1itles and drugs and biologicalsavailable atthe center 8 Directline (1)y center-controlledambushy
lance when-necessary) to ateach1nghospltaifor cl1agnostic ~d therapeutic servlcf)srequiring the fa011itlesandpersonnel of thehospltal 9 Patient-cantered and eommUn1ty-oriented -
The range ot services in the comprehens1venelghborshy
hood health center shouldbe as complete as possible
inCluding preventivediagnost10 treatment and rehabi-
litative services and Sbouldbe deslgnedto eliminate
episodioandfragmented services (31 pp324-325) Schorr
and English (33p291) add as additional characteristics
ot the compr8henslveneighborhood health cent~r that it
should ~ve intensive participation by and involvement
of the population to be served both in policy making and
as employees and that it should be fully integrated with
the existing health care system The Office of Economic
Opportunity (28 p63) stresses the potential for easing
health manpowershortage$by trairiing local neighborhood
reSidents as non-professional health aides at the same
time creating new job and careeropportunitles As
14
Gordon (16 p bull 422) indicates Many of the outstanding
problems in medical practice todayrevolve around
effectively motivating the patient and the prospective
patient to be concerned with his health This is
especially true in a deprived environment The community
health center with its technique ot consumer partici
pation maybe a way to create this cooperation effectvely
It is important to note at this point that the
comprehensive neiShborhood health center haaas its
constituency an integratedmiddot community r~ther than a
particular segment It should haveas Blum and Levy
(6 pp~5) indicate a horizontal rather than a vertical
relationship with the commuriitybull The vertical relatlonshy
ship they state is characteristic ot those service
organizations wh1chapproach the community only in terms
of their own fUnction Tbey see only their relationship
with the users of their service and assume that problems
of accountability will be handled by these consumers
However they pOintout this ienot likely as a vertical
approach creates dependency onthe institution Agencies
in a horizontal relationBhllp recognizetha1 they have
both acommunityand a consumer to serve The horizontal
approach places the matter of accoUltability on a broader
basis than just the involvement of the consumer De Diaz
(14 p4) speaks otthe need to ~develop a community
facility which difters from a clinic for low income
1ji ~
15
people in that it should serve an economically integrated
community The reason for this is that a wide variation
of consumers may assure a better quality of care
The advantages of the comprehensive neighborhood t
health center over traditional systems of providing
commuruty health services are numerous Hospital outshy
patient departments a major traditional source of ambushy
latory health c8refor poor patients have been indicted
for neglecting preventive health care ~romoting fragshy
mentedeare and subjecting patients to degrading and
impersonal conditions to mention only a few of the major
defects (31 p324) Another defect has been the
tendency to shunt low income patients back and forth
between different cliniCS often at different locations
arid with differel)t open hours for different treatments
or tests in regard to the same lllness(26 p63)
The comprehensive neighborhood health programs that
have been organized present a great variety of organishy
zationalpatterns one area of difference 1s in the
emphasis placed upon making each faci1ity comprehensive
in the services it provides to the patient population
In the Montefieri Hospital Neighborhood Medical Care
Demonstration program in New York City services have
been made available through a central health center and
two store frontsatellites the center to be the base
bull
Li
l of opratiol18 of ta1lJpIlflicl- ancl the satellite
center the ba of oparat1oDa of public heaJth nurses
an4 nllbborbood amp1 be satellite centers wereto
proVide preVentift tutaltll bullbulln1c1-m1zaticms w811shy
baby care per1od1c ~ectiland tJle central health
center to proViAle care tor illnes If (36 p299)
bis propWI VUDOt ~ttullytunct10DIDI at the t1JDe
it d1cu8ae4 18 tbe Uterature aDd all aernce Were
be1Dl provided 1D_~terBowever itwould ae
tbat the ntua1pro~ as aY1ioae4by its plmmers
would boclJ aoaeot bull 4efeot~ otthe current lud1cal
ccde teaIt pObullbulllne_t coorctJl8td admSDtshy
etration eD4 well 4eftlopecl refelTal procedtlreacould
1I1a~ thecOllDeCticmof t~_t8 withappropr1ate preTellshy
t1 aD4 therapeu1ampcaen1cbullbull aV81lable 111 diffrent
locationa Bowner tile barrieraottiaeaDdUatanc
between center and truaraUon tor the UDSopb1aticated
patieatlook1Dl tor 1her1~pJce too tor ~1CU-
larhalth serfplusmnQewoGl4~to JJa1t tbbll1ty o~
tb18 ~811D to provide iaaiYCOliprelleU1P18hboltleod
health servicebullbull III tactmiddot tappeareto coDtlict with
tbepro own taW cOfdotpro-1~a tam1ly
mecl1cal careprogru 111 wIa10h pre-teAtlYe aDd therapeutic
health erY1cecan be proY-lW to all IIl81Ibers of
tamily in the coure of aaSDll vi8it (36 PP301-3(2)
Dle Delmtr Coloradoprepa11ke the Montet1ori
LI
17
prograJlut111zbullbull abe1rarcJly ot SlDa11 aatellItestations
andlerer IIOreceDtallzedtac11It1es It 41ffers
howeverill tbcolap~81vene80f the services avail shy
able Inthe 4ecentraUzed facIJJtiesIt resembles very
clc)sely the IOdel ~ordecentral1zed social servicedell shy
very developed by 1ahII~ Which was 41sCussed above he
SIlall neImiddotgbborhoodmiddot c8Dt~aw1tb1n walkl distance of
most of the populatiotl havebeendesilDedto take care
of allthenorllalhealth probl of 3000-5000 patJentsshy
check-ups IlzatiOZl8s1Jlpl laboratory testa and
treataentand iaecucatlol18 (d1apeued by phyS1cians) for
IIOst DODCrltIcal 1l11le PatIent 1d1Oneed IIOrespecIal-
Ized care are reterrecttobacJalp facilities BaCkup
support tor themiddot~t1oDa are the tWo l8rsernelshborhood
health C8Dter8~ttr1Dl aCOglete~e of out-patient
serneeaDd three part1clpat1q hoap1iampl bull bullbull which
proVide1Dpat18Dt~t andcoDSUltatlve services
(13 p1028) Intb1a prosrama coaprehens1ve range of
prevent1ve aDd trea1aeDt serric 18 aVailable throughout
the decentraUzed middotta The CoapreheulY8 ReIgbborhood Hea1~ Service Project
otKa1er iC)UDdatlcm HOspitals 111 Portlan4 OreOD 1s
s1ll11arto th DenVer prosraa 1D thata comprehensive range
ot out-patientmiddot services 1D prov14e4 in each of 1ts 10cashy
t1oDa althoUlhmiddotmiddot tbe oentera are larger and l bullbulls DDIerous
than 1nth DenverproPUh (12 p6)
Li i
18
In order that a comprehensive neighborhood health
care center be able to proVide continuity of care it
must have arrangements for hospital services integrated
into th system Yarby (37 p73) as quoted above
states that it 1s characteristic of the neighborhood
health center to be directly connected with a teaching
hospital However De Diaz (14p3) indicates that it
may be advantageous for purposes of service delivery not
to havemiddotthe center affiliated with a teaching hospital
She feels that such anaft11iation may lead to asltuation
in which policies might be determined more by the teaching
needs of a medical school than by the service needs of
the patient
middotThe Nat10nalmiddotCommissionmiddoton Community Health Services
(25 p69) states that such a system of comprehensive
health care integrat1na ~e servicmiddotes of several health
and roedical agencies snould utilize Itas much single or
unified management as possible Neighborhood health
centers have been operated under a variety of auspices
but several writers have pointed out the advantages in
termsof coordinated prOvision of servictts management by
the hospital of the neighborhood health center For
instancethisfac111tates the keeping of unified medical
records of all the care a patient Msrecelved either at
the neighborhood health center or _le hospitalized
(12p6) ~ermore a3 Young (38 p1741) points out
19
direct operationot the u1sbborhood health oenter by
the hoSpital canll8lceaftilable to the center expertise lt bull
in sOlle aapcta 0 Operation that m18ht not be aa readily
available otherwie
Relardlebullbull of wbetberthe hospital and the neighborshy
hoodhealtbcent8r haVe a cOJIIIOaadmjntstration they
IIlU8thaVealTlved at a str1Dsent delineation of IDUtUal
role and reSpoDBlbilltiebullbull All OOIIpoienta ot the care
yst IIlWStQlarify and understand one anothers position
In the syatem and acree on objeCtive ancimethOds
(26 pp16-17p31) SODae areas of iDUtUalconcemare
reterral procedures record keepiDg aDC1 mutual use of
facilit1es statt1Dl i8 anotb8r ~ ot coaaon conc~
Ditt1cultift have u-laeniD the pastiD cOllprehensive bull t bull
healtbc~ prosraumiddot 1d11ch were batil plauned in wb1ch
all of the health canter phy1C~1IDa did DOt bavetatf
privilege at all ot thebackuJlhospltala (29 p21)
SUch a8ituat10n i8 1Dampcceptablelt inpatient care i8 to
continue to be p4by the pat1eatmiddot health center
physician and it cont1Du1ty ot care 18 to be maintained
Hoapital and health center1lUSt laav 301nt responsibility
tor the recruitaentot physicians
VticlentU IPan BJcNrcu Much otwhat haa b8ea sUd has stre88e4 at leastmiddot
iJlplicit17tbaD8ed tor tM etticit middotprovision ot8emcea
20
There appears to be two aspects of efficiency which are
discussed by writers on the su~3ect of the comprehensive
neighborhood health care centef one of these is the
need to organize) services to make the most efficient and
economical use of scarce medical care resources The
other closelyrelat8d in realIty is the need to help
the public use services in the most efficient manner
The comprehensive neighborhood health center concept
1s lhherentlymiddot efficient in that preventive curative and
rehabilitative health ~are programs are coordinated under
one roof with integrated a~stration Furthermore
theempbasLson prevention health education and early
disease detectionis eftic1ent troJll~estandpoint of
the health care system as well as beneficial to the patient
(18 p760) HQwever ~ue tothe scarcity of health care
personnel thecoiDprehensive neighborhood health center
mustbe an arena tor eXperimentation with new staffing
patterns~ The Kaiser program is indicative of the way
in which health care systems must begin to operate in
that appropr1ate ancillary personnel are used Wherever
possible to perform functions that do not need to be
carried out by the physician As Saward (32 p42)
states
1hroughou10ur organ1zat1on~ there are many of the customary experiments be1ngmade-shyJse of speciallr trained nurses for well-baby care under the SUpervision of the pedi9trlcianexperiments with routine prenatal care by
w ~
21
middotSPC1a1l~t~JlUrbullbull per8ema_1 bullJmdlJleu y our fuDotlou are auoh that DOtb1Da 18 dorutbYtbe phY8iCianstbat doe DOt vet to be done by the
phys1c111U1fhe other aldlle4 person- Del-nurse middotreC~0D18t the appo1ntshymeDt center or clerical praormelshyaremiddot there to free h1amiddotto use his spec1al sk111
Awell lmoWn treDd1D the area of eaaiDI health
c8re JII8DPOY8rShortagjs bas middotbe thetrend toward tra1nshy
1DB poverty area rea1deats as DOD~pro~eaionalmiddoth8lth
aide and nepborboocl health workeramiddot (28 p63) This
bas the effectofmiddotmiddot1J)creaa1q II8DPOWrand 8180 can help
bridle the cuJ~ cap betweenprondera and colllUmers
of aen1C8s This attarD at least tlleoretically
createa a situation 1D WIa1ch providers andcoD8Ullers can
be educated to UDderatad OD88DOtber and interactJlore
ettectlvely~ HoWever amiddotpltt8ll has beeD themiddot tel14ency in
801D8 oamp8e8 tomiddot us aidesmiddot ssale8lllcw t~r the center
alJDOatexclwdY811rathertbaD ua1Dltheal to protide the
health care for wh1ch ~ were trained (29 pp3B-39)
1bat ismiddotmiddot vh1~e the a14e Yalue in ~~m1catiDI with
low 1nCOlMt patieata haa beeR recoSD1zed and stressed
their role ashealtb carepersoDDelhil been slighted 1n )
any 1Dstancea
Anotber step 1d11Ob bullbull been taken to provide 8rY1ces
more efficiently eUeot1ftlybas beenmiddot theorgan1zation
of per8ODDeliDto IIllt141sc1pl1Dary teamaaaa means ot
proYid1DgmiddotCOQrd1DatedserY1ce SUch te8lll8 sen_rally
~
hf
~
22
include PhYsiciaQs nursbullbullbullbull soc1al workers and outreach
workers Conceptually th8y fmlct10n to me~ the intershy
relate lled1cal and social needs ot the families sened
Hor there are a number ot barriers to the etfectve
tlmctiOD1nlof lIuchte8ll8 SODieot these are heavy caseshy
loads the inordiDate amount ot tille consumed by multlshy
prOblem tamtliethel1m1ted tra1n1 ngmiddotmiddotand laCk of tnterest
on tile part ot aoae tebers in examinJng aspects of
problems out14e~lr oWn areaaotcolIPetencemiddot and
~ourdcation prc)blell8 between proteasioDala and nonshy
prot81~s (10ppa-10) middotrurtbemOre as De Diaz
(14 middotp6)1nd1cate tbel8 maybe a teDdency tor vertical
dp8rtmental lines of auperv1810nto become paramount
over the team coDamloation syst lead1ngto conflIcts
in determ1niDI the ro1ea ot solie team bers particularly
the DOD-prote81011alaInauch exper1l1enta Witb new
~t1Dlpatterna it 1s bullbullaentialtbat line of authority
roles aDd NsP0D81bll1tlea be made explicit and that there
beJDechaD 8IUI tor relUlar evaluat1onotfunctlorUng
Another way inwb1ch health care sernee delivery can
be made more ett1cl8Dt is to proVide servicea dur1DC the
hours whentbey aremiddot -ostnee4ed As reQo_ded by Yarby
(37p1) serY1ce can bemadelIOre accesslble by making
themava1lable 24 hours a day seven days a week If
rg8l1Cy service are aft11ab1e aroua4-tbe-cloek at ~
nil1iborhood health center the continuity ot tbepat1ent ts
23
careiamaiDtalDedand meatry point into the
cOIIPre~i health care 8 be made available
tothe patient who aoZMllyU8ea ozilymiddot emergency care in
tille of med1cal criais More 8isDificantly ava11ab1-
lity of a tull rase of bullbullrv1c8 tor seVeral hours 11the
eVerlna aI1Cl On ~ prevent the los ot earn1JiSs
involved if th patierat 1IU8tt8cet1me oftfroawork dur1q
the d8y for aed1Cal oare bull his can be an eSpecially
importantc0J1814eration tor lo1aCOlleDUUg1nally qloYEtd
patient aa4caJla18o PIOJIOtet1)e 0Da01Dl use othealth
servicebullbull
exper1eDO ot tbeKa1er prosraa in tb1s~reprdAs
Greenl1clt(19 p10) states wA lllNt 8ip1flcant
proportion ot the abulatory care 8n1cp~Y1dd tor ~
total popUlatiC)U ~ ~ after clWc hours and this
Deed i8 apParenUyaoN prODGUDced tor aJl8d1cally
iDCust population On the other hand the bulk ot all
aabulatory med1cal cu 88l91ce are performed dur1nS
regular cl1D1c hour eVen when services are available 24
hours a dayJ day bull week W
It has ~ the experi8D~eof a ftIDber ot ne1g1lboXshy
hooct hea1tbcentere _t a_jor obstacle to efficient
proViSion ot anicbullbullhas beentbe teD4eDcy of medically
1ncl1pnt patieats to utilize the center oa a walk-in
baais tor epi8od1ccr181or1entect bullbullrv1cea rather than
4)i
h~ ~~f ~~ L
24
to make appoJlltaeata tor ODIo1qprevmt1ve treataent
and rehebl11tat1Ye care ad ampl1O to bave a blah failure
to Show rat_for tbe appo1DtaeDts that they dO make
Atone center 628 of appo1Dtments made were kept
while 3Oottbepati_ta een were ~1n patients
AlthoUP fewer patiets were actually 88811 by the cater
1D middottb1s 1Datance thaathe -bervholuidmadeappointshy
mta the walk-iD patlat required an iDord1nate amount
ot staff t1ae tor aCreeDiaaacl ~trral to pplOprlate
~ttor caregt (9 pgg) Arraquotbr1llpl1catjo~ of the
plOVidedto valk-iD patient by other thaD their
(19 p12)rurtbermore
when patients uti11ze Wlk-1Il er181 centered care
athelr ODlf tona ot ootact with the _d1~ care
ay_ta fUilycentered care the treata_t of tUl11y
bers
a a UD1t 11
dlarupted
hewalk-1Dphenoaaencm appear to barelated to
diUerence between soclal clase in the style of Dlaking
contactJt1th the a11oal C~ay8t As Greenlick f ~
(19 p11)1Dd1oate8 thepheDOaenOn ot INater usage of shy
walk-in ervice by aed10ally middot1Jid11ent patient thaD by
others baa otte been attr1buted to a stoical att1tude
tQward 1llDe8 em the~ ot poor people leacl1D8 to a
~
25
greaterdelay1n tbe k i Dlofa8d1cal care These
patients wppoedlyeelcmiddotcareODlymiddotwIleD tbeirmiddotillDess
becOlles1Dtolerable resultiDSin middotthMr appeariDS withshy
outnot1ce1o rece1ve oareHlwever Greenlicks
r8aearcbbaa cut doubt on the existence ot tb1delay
111 report1Dg middot8J1IPtoJumiddotOfDeW 11laessand seek1ng care
Be bas tcrQDd 1bat s1ll11ar peze_tases of dioally
1nd1sent 8DClJ1on-aed1cally 1Dd1PD~ pat1enta seek care
on the aue daytbat aptou tirstaPPear
1fb11e GrHDllclc 1nd1cat tbat the reasonator the
greatertendeDCY of low 1Do~e pat18Ilta to 1$8 walk-in I
serY1ces are notlcDo1rAmiddotmiddot tbe7 _ be rel~tedto a tendency
ot lower aocio-ecaaaoclaa patieota to preter face-toshy ~
face contacts with II841cal persoDl181posslbly because
such contacts areft coatortiDS an4reasauriDS to
patients who are hJpotbeafzed to bave a dependent attltude
toward IIed1Cal care perS0Jm81 (30 p161)
It a8 itmiddot baa pnerally beenhld the appointment
s1stemts the most efficient Ileana of dellveriDS
comprehenSive oODtllluiDlh-lth care (9~100)1t is
necessary that educaUoraalmiddotbulltfort be taken to proaote the
use ot middotappo1ntaents8DClmiddot tQrec1ucethe fa111re to appe~
ratB4uOatioaalwhlQb baft~utl11zedhave been
IJ
26
1Dten1ews with walk-in patients home Vi8its and group 4i
meetiDp1D8D attemptto1Dierpret1o the patients
the value of rtitgular ppo1ntmentamp andot con~in~
c~1ve care rather than epiI041c care (9 p1OO)
h1s 1safuD~tioD torwhtch nOl~prot81QDal colDlllUD1ty
YOrkersllaY bebe~r8U11ed tban other statf H()wever
euch aD ~ucat1oaal propul __~ ~e related to the senUiDe
capacity otth health oenter to provide comprehensivebull gt
ervice8 to1tpat1_t~odoD aD app01ntment bas18 It
1amp pos8ibleo~rw1 tor educa110Dal ttorts to result
LD a~8JImCl tor ltPP01ntaen~8 at a ratewb1ohi8beyond
the capacity ot thee_tar to t without uareaaoDably
1_ wa1t1Dlprio4a QOBt1nuad use Ot the center on a
wallt-in bU1 _1tbeoosiItpos81ble to et an appoint-
met anc11nCreued pit1entcoJaplampia1a bull Therew111 of
course always be a need and demand tor acute ep1so~c
Care -ci the health centerDlWlt be planned with the capashy
billty ot bullbullbullt1D8 tb1aneed wh1~ cont1Du1nI to stress
aDd educate the patient to utillze oDlOinI comprehensive
faa11y middotc~te~d Cflre (9p 100l
att g4 CODClva1opa
In order to bea4equate any coJlltemporary health care SY8tem muat bullbulletcerta1D interrelated criteria he
IJ
27
minimum criteria areaccessability of services to those
who need them compr8heX1siveness and appropriatness of
services and efficIency 1nthft utilizat~on of SCarce
health care personnel and resources The scareity of
pex-sonnel andtbe need for h1gh quality ongoinghealth
care services
aJIlong the
populationdemanci the most effishy
cientprovision of services
Services must be made accessible to the population
They mustmiddotbe geosraPh1cally accessible to remove the PhysicalmiddotbaTiers betWeen peopleandthem$d1calcare
system They mUst otter their services dur1ngthe
hours when people can make the moat use ofthemA~ it
makes little sense to concentrate services geographically
where they will not be uSed to their fUllest extent it
also is wasteful to provide serv1cesonlydur1righours when
many people are employed his not only presents a hard
ship middotto the consUmer lnrt wastes resources if for instance
the unavailability of preventive services during the hours
when people Can use them causes a need for treatment
services later on
Health carbull sEtrvices must be comprehensive including
prevention treatmcmtand re)abimiddot11tation Ambulatory I
healtbcare facilities wh1cQ are orienteciexclusively
toward either prevept1on or trea1mentare no longer accepshy
table for they are lneft1c1entln their use of resources
and in their prov1s1on of health care to the patient
w ~~
28
If prevent10n1s notmiddot stressed treatment serv1ces that
could have beenavoidedY1l~ be required If prevention
1s the sole focus of the health care facility sick
patients who present themselves must be referred elseshy
where for treatment andsllch referx-als may be taken as
reject1onsor not followed through with until illness
becomes unbearable
The instltutlontbat meets these requirements Is
the comprehensive neighborhood health center It 1s a
local decentralized outpatient facilityprOVld1ng a
fUll range of ambulatoJY health care services It has
a linkage to ahospitalbackUp facilityforlnpatient
treatment and hiihlY apclalized outpatient care
The neighborhood health center must be a fac11ity
planned with an awareness of the needs of the conSUtller
and coDitnUn1ty It must have the r~Ul0urces to provide the
services people need mere they can use them and when
they can use them It must uti11ze the part1cipation of
the community to develop this awareness Not only must
the cen~er beset up to be Amctional for the consumers
but efforts must bemadeaga1n with commun1ty partici shy
pation to help the consumers utilize medical care
services effectively The center muetmake efforts to
educate the community about the valueot regUlar health
care of preventive servicesand of the use of planned
IJ
29
medical appointments ratherthanorisis centered walk-
incare Therealit1es of the existing health care
system have not taught the patient particularly the low
income patienthow to use services effectively
The helthcenterilUst also bea laboratory for
experiments in easing the health caJepersonnel shortage
and c60rd1Datingcare~ A major difficultY iri-exper1shy
menting with neW rolesis freeing staff of old preconshy
ceptions
CoDlprehensiva neighborhood health dare centers have
been developed under a variety ot alisplces including
medicalsociet1es hoSP1talsmiddot(36p299 group pr~ct1ces
(29 p6- 12 117) health departments (13 p1027) and
ne1gbbothoodassoc1ations(14) The literature indicates
somevalues nthe management ot the health center by plusmnts
hospital backup faCility Whatever the auspices many
adm1nistrative fuDctions such as program coordination
standard pr9tectionand evaluation call for considerable
c~tralization of adm1nistration city-wide or coU)tyshy
wide At the same time other aspects hours of servlce
for examPle~ cuI f~radm1nistrative fUnctions made atmiddot
more local levels Each neighborhood center must be
free to adapt its functioning to itscominunity thi-ough
the mechanism otcODlllUl11~ participation inmiddot policy making
Obviouslythe prerogatives and responsibilities of each level must be negotiated and made explic1t
t4~
JJ
BIBLIOGRAPHY 30
1 American Rehabilitation Foundation ~ealth Services Research Center The Health Maintenance Strategy mimeo 1971
2 Anderson Nancy N Comprehensive Health Planning in the States A Study and Critical Analysis Institute for Interdisciplinary Studies American Rehab ilitation Foundation 1958
3 Andrus Len Hughes Comprehensive Health Planning Through Community Demonstration Health Projects mimeo1967
4 Barry Mildred CandCecil G Sheps A New Model for Community Health Planning unpublished paper presented to the American
Public Health Aseociation1967
5 Blum HenrikL Fred Wahl Genelle M Lemon Robert Jorulin and Glen W Kent The Multipurpose Worker and the Neighborhood Multiservice Center InitialImplications and EJeperiences of the Rodeo CommunityService CenterAmerican Journal of Public Health58 (Mar 168) pp 458-468 shy
6 Blum MichaelD and Soloman L Levy A Design for Service Delivery that Reinforces Constructive Tension Between a Health Center and Its (sic) ConSUDlers and Supports Community Power unpUblished paper presented to the American Public Health Asaociatiltn 1968
7 Brielaud Donald Comm~ity Advisory Boards and Maximum Feasible Participation American Journal of Public Health 61 (Feb 1971) pp 292-296 shy
8 Burns Eveline M Health Insurance Not If or When But What Kind Madison Wisco~sin University of WisconsinScllool of Soci~l Work 1971
9 Campbell John Working ~elationships Between Providers and Conshysumers in a Neighborhood Health CenterU American Journal2 Public Health 61 (Jan 1971) pp 97-103
10 Caxr Willene Neighborhood Health Centers Funded by the Office of Economic Opportunity mimeo 1970~
11 Colombo Theodore J Ernest W Sawardand Merwyn R Greenlick The Integration of an OEO Health Program into a Prepaid Comrehensive Group Practice Plan American Journal of Public Health 59 (April 1969) pp 641-650~ -
12 Comprehensive Neighborhood Health Services Projectof Kaiser FoundatioIl Hospital~ Prcgtgram YearE grant renewal proposal mimeo~1971 bull
13 CowenDavidL~ Denvers Neighborhood Health Program Public Health Reports 84 (Dec 1969) pp 1027-1031
IJ
14 De Diaz Sharon Daniel Beyond Rhetoric The NENA Health31 Center After One Year unpublished paper pres~rited to the American Public Health Association 1970
15middot Gerrie NorrrianF and RichardH~ Ferraro Organizing a Program for Dental Care in a Neighborhood Health Center Public Health Reports 8 (Aug 1968) pp 419-428
16 Gordon JeoffreyB~ The Politics of Community Medicine Projects A Conflict Analysis Medical Care 7 (Nov -Dec 1969) pp 419-428 shy
17 Greely David The Neighborhood Health Center Program and Its Implication(3 for Medical Care H~alth Forum of the Welfare Council of Metropolitan Chicago (mimeo) 1967
18 Greenlick Merwyn R Newgtimensions in Health Care American JOurnal of Pharmacentical Education 34 (Dec 1970) pp 754-4
19 GreenlickMerwyn R Donald K Freeborn TheodoreJbull Colombo Jeffrey Abull Pruesin and Erne$t W saw~d Comparing the
Use of Medical Care Services by a Medically Indigent and a General MemberShip Population in a Comprehensive Prepaid Group Practice Prosram II unpublished paper presented to the AmericanPublic Aesociation1970
20 H~tadoArJiloldVMerllYll RGreenlick and TheodoreJ Colombo Determinants of Medical Care Utilization Failure to Keep Appointments unpublished paper presented to the American Public Health Association 1971
21 Johnson Richard E and Merwyn R Greenlick Comprehensive Medical Care A Problem and Cballengeto Pharmacy ff AJilericanJournal of PbarmacenticalEducation 33 (Aug 1969) pp 361-367 -
22 Kahn Alfred J Studiee Social Policy and Planning New York Russell Sage Foundation 1969
23 Kotler Milton Neyhborhood Government Local Foundations 2 Political~New York The BobbsMerrill Company 1969
24 NationalCommisaion on CommunityHealthSfrvic~sActionPlanniriamp for Community SetithServices~ashington p C Public Affairs-Press 19t7
25 National Commission on C~mmunity Health Services Health Adminishysration andOrMPization l the Decade Ali9$-d Washington D C Public Affairs Press 1967
26 NationalCornmiesion onqomm1Jllity Health Servicesbull Health ~ Facilities Washington D C PUblic Affairs Press 1967 bull
~ n
32 27 ODonnell Edward J and Marilyn M Sullivan ServiceDelivery
and Social Action Through the Neighborhood Center A Review of Research tt Welfare ~ Review 7 (Nov~Dec 1969) pp 112
28 Office of Economic Opportunity Second Annual Report Washington D C~ U S Government Printing Office 1966
29 Office of EConomic Opportunity and the Medical Foundation of Be~laire Ohio Eighth Report 2l ~ Committee2a Governshy
ment OperatiOll~ Va8hiiiSton D C Government Printing Office 1969
30 Pope Clyde R Samuel S Yoshioka and Merwyn R Greenlick Determinants of Medical Care Utilization nhe Use of the Telephone for ReportiDg Symptons Journal of Health and SocialBebavior12 (June 1971) pp155-162 shy
31 RenthalA Gerald nComprehensive Health Centers in Large US Cities American Journal of Public Health 61 (Feb 1971) pp 324-336 shy
32 Saward Ernest W The Relevance of Prepaid Group Practice to the Effective Delivery ofHealthServicestt The New Physician 18 (Jan 1969) pp39-44 - shy
33bull Schorr Lisbeth Bamberger and Joseph T English Background Content and Significant IssUes in Neighborhood Health
Center Programs Milbank Memorial ~ Quarterly 46 July 1968) part 1pp 289-296
34 Weiss James E and Merwyn RGreenlick UDeterminants of MedioalCareUtilization The Effects of Social Class and Distance on Contacts With the Medical Care System Medical~ 8 (Nov-Dec 1970 pp 456-462
35 Weiss James E MerwynR Greenlick and Joseph F Jones Determinants of Medical Care Utilization The Impact of Ecological Factorstt unpublished paper presented to the American Public Health Association 1970
36 Wise Harold B Montefiore Hospital Neighborhood Medical Demonstration A Case StudyMilbaDkMemorial Fund Quarterly46 (July 1968) part 1 pp297-308~
37 Yerby Alonzo S ttHealth Departments Hospital and Health Services Medica1~5 (March-April 1967) pp 70-74
38 Young M M~ Chatanooga IS Experience with Reorganization fOr Delivery of Health Services ttAmerican Journ8l of Public Health60 (Sept 1970) pp 1739-1748
f or l
II bull 11 Y d
II
IJ
34
ThepurposeOfPart II of th1aa paper1atod1scuas
elected Speclfic needs ofecltlc areas within Multnomah
County A8P01ll~oUt 1D ~ I of t1a1bullpapermiddot Ita nelgbshy
borhood health oare cater IlU8t be a facl1lty plaDlled with
aD awarenes of the neeels of the oODllUller and collllUDity
Part II of this paper nIl Show 80e of thoe speclflc
needs
he1DforutiOD tor t1li Portlon of the report
obta1nec1 troll tbroupout tbe follow1Dl threepUb11catloDS
1gr~e_tiMshylIPrIxaiidOreson JuDe 1963
2 1~_middot_sectSI8e~ected1teai c-ua 0 S 8 e first count coaputer tape Coluab a_lion AssocshylatloD of QoveraMD-8 Jlme 1971
3 Jtu1tDoab County Oreaon BDY1roDlHtlltal SurveyEarly 1971
The JIultDOIIIlb COUDty OrttIOD BDv1roDllfmtal Surley
Barly 1971 1s bull stat1stical report of the activ1tles of
theentlreMultDOIIIl2 CcNDty Health Dep~t during the
year of 1970 Die speclflc 1nd1cs elected from tb1s
study amprejMental aealtll Publlc Health N~s1D1 vlslts
FaJUly ~ Veaereal])1 ~ ~rcul081
Throush tie use of cUrts and mapa ODe CaD roup these i
speclflc ~oea to ahcnr the healthneedsof speclfic I
census trtcta aD4 then the health needs of iarer neIghshy
borhooda 1m4 o~ Uebullbull
Rf)~UP1Dl of areu was accompllshed in thefolloWinl I
JJ ~
35
he MiltDoIliahCountY oregon BDViromaental SUrvey
early 1971 isamp statistical report ot tbeaotivities ot
the entire MultDolllh COUDty Health ])epartiDent dur1nl the
year ot1970 he specitic 1Dd1C8S selected frOm this
aUy are 1Il8Dtal health public healthDurs8s visits
fUl1ly pia waereal elisease aDd tuberculosia
Tbroq11the Wle otcbart aDd mapa aDecm szoup these
specific indic to show the health Deeds ofapecitic
ccmaua tracts aDdtIum th8health neecla of larsr ~eilh-
bOrhooda and co8I13 tlbullbullbull
RegroupiDI ot areas waa accoap118hed1D the
tollOWiDl lIIIIm1er~ A bullbullcifie 1ndex 8selectcl auch as
venereal di8bullbulle or tuberculo8i~ he total number ot
cs was then deterll1ne4 for each census tract Through
the use of the maber ot cRbullbullbull tor a 11Yen cenaus tract
aDd tbe population ot thattractaltrateot1lla1ampmcper
100OOOpopUlaticm wu cleteXll1ned for each census tract
This was ~e to starl4ard1ze the population ditterence
amongOeD8U8 -tracts 1he rate of incidence toreaob
cenauatract was then llstedby rank position on a chart
In rank poition1DI any cen8Wl tracts haviDg equal
rates ot1l1c1dence are assipe4tbe iaDk posttiona
Beeauseot the abo fact tbAt cbarta w111 vary in length
neveltbAtlea eacb cbart will 1Dclu4eall census tracts
inMullnoaah Couaty Atter the census tracts bave been
listed accord1q to raalcth1s list will bediv1ded into
IJ
36 three levelsotinc14ence he three levels are
1~ The upper 14 of1DcldenCe
2 Thelower 14 ot incidence
middot3 The ILld 12 of incidence
Tlles three srouplqa are then used in compiling a map ~f
Mu1tnOmahCountyfor ach apecltictop1cbull TIle maps are
uaefuJliD tbatthey V1suallycoJib1De 1Dd1v1Clualproblem
census tracts into larger problem nellhbOrhooc1s
The 1960 statistical iDtormatloD was Used in a similar
liIaDDr to tbatexpla1Dedabove 1Dthe4evelopaent of a
chartmiddot and map 1Ihow1DI e cOllpampriSOr1 of per capita lncolle
tor ttaCh ceDsua tJact aDdmiddot combiDed census middotmiddottract areas
he 1910 aDd 1960 statlstlcal iDtOrllatl0D was combined
lna map and chart he purpose of this and chart is
to d8aonatrate the e cl1stributloa1DeachceD8U8 tract
and middot1ndlcatbull tuture ace populatlon treD4a bull
When one be middotbullbullbullbullbullHdth ne8cts ot an area and has
declded to establlsh a cl1D1c to serve that area the
physical location otthat cl1D1c IllU8t be consldered In
order to coapreb8ll81vel develop an area cl1n1c one should
conslder thepre88Dttraftlc middot~ytaa an4tranaportatlon
systems Thecl1D1cahoUld be located close enoUlh to
major arterlals to giva asy access from the total area
be_ ervecl by this cliD1c At the t1ll8they should
be tar eo away froll thesarterlals to all8Y1ate traffic
CODCell18 andpark1D8 conpstlon By traff1c concerns I
IJ
37
lIlan one lUSt consider thertarro1fne8S of streets whether
streets are oD8--C)r two-way iqres8 and egress to parking
amp0111tie eros tratflC) spedof trattJQ children 1n
ll8a traffic i1lht Vislon re8tr1ctionS etc
BwstraDsportat1onshould alao be central in this area
as maay people ~U f1Df1 1tD8Cessary to use this form of
transportatlon
~e tutqredlopHQt of bull treewa systems should be
c0J1S1dered soastolesen thecumce ofmiddot future roada
cutt1DSotltbe cl1D1c llte line
nrrph1c middotDampta
It is 1JDportaDtto kDOw the demosraphic distribution
characteristics of the oUenteltbat i8 to be served by
localized health cl1D1cs
Acl1D1c which erves8J1 area where1D the prepondershy
ance of persona arecrter 65 years of mayf1nd that these
people rely more on pUblic transportation call for more
home- services and haV4t 110ft ChroD1c and debilitating
types of disorders (b1_ blood pressure poor heariDg and
eyesight) tbaD do8 an area ot a YOUDIer population On
the other hand thL area of older residents may have little
need for family plabDlng cllni08
In order to better ~Ybullbull the 4eaoraphic population
of each CeD8U8 tract the 1970 CeD8U8 iatormation was viewed
and two specific catelOri8 considered These two cat
IJ
38
lori8S woUld be the perc_tap ot population under 19
year of ase and the percentase ot each oensuetractover
65 years of age he 1960 1Dtormatlon tor eaCh tract was
then compared witbthe 1970 intormation and a percentage
ofincreaae or4ecreamp8 tormiddot e~chtract1n each category
cOJlputecland achartma4e By the use of this chart one
18 able to View tJleap populat1odiatr1but10n of census
tract and at the _ t1lle accesa middottrencl Por example
let us choose census tract 601 W see 40-4 otthe
population is under 19 years ot and that ODly82 1s
over 65 years ot middotAtthe e tille the percentage of
youth bas ~ed ODly 1_ intbe laSt teD year whilethe
percentale over 65 year ot middotbas stayedmiddotthe same With
this in mJnc1 ODe ~ 1DfItr libat ol1D1o aerviDg this
area WOuld bellQre conq~w1th the problems of a
YOUQier populat1on and that _ would probably be true foJ
some t1aein tbefuture On the other hand CeDSU8 tract 54
has only 2 ollt population UDder 19 yel1s ot age and
this has decreased by 1 over the last ten years middotwhile at
the same time 32-377 ot the populat1on 18 over 65 years of
age A ol1D1C ___ this area should be or1eJ1ted toward
tbespecttic problema otthe ampledbull
PerCapia __ bY gsa neat
WhaD cona1der1qlooat10D1 tor health cl1n1cs one
shoUld take the 1DC01Ieot areas into consideration Areas
IJ
39
of lowiDcome would not 11kel~be 8erved more by localized
cl1D1cs tbaD would are of hilbincome It 18 likely
people haYiq a hip iDeoll8would preter to be aeenby a
chosen ~r1vatephylc1a1l tban at a local cl1D1cwhere
10Dier waits y beraceaaampryand leas personal attention
gl_
The 19701ncOII81atoWampt10n tor MultnomahC~ty was
not available at the tille thi8report W88 made The 1Dto~shy
tiOD Was taken ~adtro tbe1960 census publlcation
his woUld ~8Il thea tbat ral1I8 OD the chart ynot 1raquoe
completely accurate hi writer telthatthe areas most
affected by tb8 1I8eof the older 1Dco1DtOlaat1oDWOuld be
those tracts wh1ch baYebad a rapid 1ncreaae1n populatlon
over the past tfmyHr8 bullbullbull tracts would include tracts
nUmbered 104 9897 96 aDd 95 be perc~ita 1Dcome
referredto1il-tb1a Paper18the lIean 1DCo per person per
census tract
Attar the iDeoeper census tract was listed on a chart
a map was de 1D41catiDg those census tracts belonging to
the lower 14 ot income tor all censue tracts in Multnomah
COlDltytbose beloqins to the upper 14 ot income tor all
census tract 111 MultnolUlhCounty and those belonging to
the mid 12 ot 1I1coaetor all oeuuetracts in Multnomah
C01mty
In yiew1Dg the _p 1t caa be seen that the low income
area seautotollow aloas the at aide ot the Wl1lamette
IJ
40
R1ver the full length of Kultnomah County A second low
income area follows the south edge of the Columbia from
the northwest corner of Multnomah County easterly to 148 St
A third problem area seems to be on the east bank of the
Willamette River with the Union Pacific Railroad being
about the center of this tract The extreme loutheast
corner of Multnomah COUDty appears to be a low income area
but as this area bas bad rapid grouth in the last ten years
this could be erroneous
Mental Health
be first ~ecific indica to be selected from the
Multnomah County envirollllental survey of early 1971 and
to be considered in this paper i8 that of Mental Health
At the present for mental health purposes Multnomah
County is divided into five catchmentareas with a mental
health cl1n1cin each area These clinics are Model
Citles Delaunay ADkeny street Office Hansen Health
Building end Southeast Clinic
All lIlental health cl1n1cslcept statlstlcal information
on all patients visiting their cl1n1cs this included the
address of the patient hese addresses were then listed
upon the approprlate C8D8US tract Each census tract was
then ranked on a chart according to the nUllber of mental
health patients who reslde ln thatCeDSUS tract attending
any of the above listed ental health clinics This chart
IJ
41
wasttum d1v14ed1ato proper quartile bbullbullbull
quartile vereUs to dne10 u appropl1ate Multnoh
County _tal health ItLa middotmiddotmiddotthelipO~a1bl by lOoJcJIUE
at the UDtal health _to uteN1De which ueu have the
lars-t use otCOllDty 1alh~th faci11t1Rot
1Ilclu4ecl 111 tbia woUld tber otpeopleYia1t1Da
pr1vat patch1atriata aDd pr1_t _ntalhealtb cl1D1c8
WheDtbe M1 18Yienclmiddot Itmiddotmiddotmiddotmiddot~middotbe~_ tbat ~rtt
appears to lMt fourmiddotmiddot-al are iii _oil the nuaber ot
lIental healthcl1D1c na1t toM tbjh1sheat 1he
tour areaa woUld be tollows
1ttrea Ore to~Blo Drimiddot ~tb Burrus14e aDd tIMtmiddot Colb1a Riftr H1gbwyaeri1Dla th nortllra boundaryshy
2 bull ProII 82D4 1_~ 10 20th streetwitil the ra1lMd Mu the north ltouadary
3 ~ et et tUgl_b1bull MYel froamiddot the Clackaaa COUDty l1ae aorth to Dln8lon stret
4 beDOlvt1ttfe-t ~efllt4 COatytrca Jle1aware streetmiddot toR1C1a11oDd wlth Colubla Blvd heiDI tbAtnorth bouaclary_
It ODe coapareatbiap to th iDeobullbullmiddotp 1t can be
eamiddotthat lIOat ot the c tracts baY1Dg bllh v1i11tatlcma
middottfl public tal health cJ1rUc8 ~ 111 t13e low ~ aid
1DcOile SroupiDIOJa1y of til 25 tracta llsted as
haviDlbip aental Maltll nlltatlou are ~ the1g60 hip
iDeo arebullbullbull
17 Plpn
42
amily PlellnSDI ]Jlce Metal Health i8 an 1nd1ce of
use Theperson 111 ordertobavebe_ 1Dcluclecl 1n this
atu4ywouldhave tohaft Ue4 ataa11y plaDI cl1D1c
tacilities of soaetype It 41fter troll tile _tal health
study1nthat i t1Jicludestatist1catrollbotb public and
privateclJD1os
The iDformation tor the iak orurcbart 8Dd map of
t8ll111 plenn1 na ob1a1De4 by cOIIblnlDlthe mabel of
1rlcuv1duals bullbull_ attbe tbreellUltrampo-ti Coatyhll11y
PlalJQllIl C11ll10s 111til tbo at the Planned PareDthood
Association CliD1C8 be tbree -JIultDouh Couaty r8ldly
PlamSq Cl1D1c are Solrtbweatth Col_bla 1111- a114
HaDsell Health BWlcl1Dl CllD1cbi middot1Dtormat1oD vas then
bullbullbullesed tomiddot detellWMt l10w people troll eacb c8IUIUS
chart wastben Mele IUs oIIart jn 4iY1ded to show
the censuS tracts lIaYiDlmiddottIle h1t1iest qUart1le of incidence
of use lowest quartile of 1Qc1deao ot use Jlid 12 of
incidence of Wle an4 a map sprepared troll thts 1Dto~
mation
The C8U118 tractsbelOJISnl to the h1lhestquartile of
use appear to be 1lO~ 8catt~ on tbipwas true ot
either the _p ot aental health cl1D1c uaageor ot the map
abow1DI per capita 1I1COM Iaere40 to be three
d18t1nct areas of UIIaP beJ woul4 be
1
IJ
43
t10D of BurD81cl and the W11lallette River 4
2 S~t Portland 8Otth otmiddot the ra11shyrcaadand alona the W11lamette River
lIortbeaat Portl8D4 between MisSiss1pp1 and 24tbStreet the northbouBclary be1DgColwb1aBlvd
Pylzl1c BMltl IrpI Y11ta
Publlc Healtil nur81D1Y1s1t nclud8 an vists to
theholles of client by PubUc Health Nurbullbullbullbull his shows
visits to bull f8Jl1ly fer aDY purpos SUCh aatuberculolJ1s
het1Dl tem1tyaeatalu4 8IiOt10D8l cODd1t1ona etc
he atat18t1C~ 1fele C()4ed accord1Dg tomiddot the 1llli301fOCUS
of the Y18lt tt doe DOt 1D41cate the Dmlber of holies or
f8ll11lev181tecl or 1D41Y14ual Y1a1ted more tban oDcein
the propwl It dobullbull I1ve 80M 1D41cat1on by coaparlshy
OD ot the 8JIoUDt of aedlcal problema 1n eachcen8WI tract
Ap1nmiddot the _p abowa 8 scatter patteraof probl_
areas althoUSh there appear to be a sroup1Dl of hiSh J
l8aIeccmaus tract 1ntlut extreme southeast part of tbe
County other areu uIriaI any nura1Dl contacts are
1 bull he 801lth-oa-al CO1Dty on eaCh 814 of 82nd Av from Clackallaa County north to Dinloa
2 ear bullbullbullt 814e aroUDd Preacottand Misaisippi
Dowatom Bunul14eonboth 1de of the river
44
V_real Pis The iDfomatloil uaec1 to tabulate the Venereal
disease chart includes all the ooab1ned case otmiddotODormea
and syphilIs reported by bothmiddot publIc and prIvate physicIans
dur1nl 1970 There were 3602 caes ot IOnorrhea reported
dur1nl 1970 While ODly 17 cabullbullsot ayphilimiddot were reported
A chart was prepUed aDd att8llPt wasmiddotmiddot de tomiddot
determ1De Wh_therVttDereal 41ease was more p~vaJent in
areas othigb or lowmiddot proportIon ot youth hi waadone
bymiddotdetemlna a 1leaD prceiltacmiddotmiddotmiddottor the population ot
resld~ts UDder19 years ot (34) middotA mean ratemiddot per
100000 popUlatIon al80c1ttem1Ded tor the middotoccurreDCe
ot venereal dieae This was et at 390 oass Areas
hav1nl a population 1n which leiS than 34 were lmder 19
years ot ampIe were called low- yOuth abOve tbl percentaae
hiSh youth The aaa waatrue ot the occurrence oivenershy
eal disea_ per CeD8UStract It the rate waacomputed
as 1I0re than 390 cases per 100000 it was called hiah
venerealdiaeasei it less than thia tisure low venereal
disease It was tound that 1D Multn~ COmlty there sems
to be poSitive OOlatI0n(x21S19gt between low youth
and hipmiddot venereal diseaand hip youth and low venereal
diseasebull
RaDk ordr Iitot all c traot middottbAm made
Th1s was done byt1Ddlna the ratepr 100000 populatIon
of venereal disator all census tracts in the County bull
45
These were thenlisted from h1lhto low (sreatest to
least) in a rank order The l1sting was then divided
into Upperandlower 14 aDd listed on the MUltnomah
Countymiddot up
The areas of b1gh venereal disease se8ll18to
roup thBl~8 middotin a very tllht area ~oq both 1des
of thell18l8~ R1 w1th BurDaldeS~et being
~bout theceDter qf tbi8IZ9uping This area woUld
appear to be m ldeal spot for the denlopment of a
locallzed venereal d1sbullbullbullbull cl1D1c
UbepoundCUlO1s
In this report bull tube1C1llosls caS8S refrred
to include alltbobullbull cabullbulls ontubercUlo8is follow-up
rather middotthan just new C Accord1Ds to the Multnomah
County Health SUrvey of early 1971 this would include
all ca repOrte4 over thelaat three years The
total number of tuberculosi8 cabullbullbull usedin this study
was 666 lh1 included 128 new cabullbullbullbull
A rate per 100000 of tuberculosis for each
census tract wa- then computed and the c~us tracts
listed by rank order be b11h Qartlle mel low
quartl1 were then reoordd on a Multnomah CoUnty map
TWo genral areaa baY1Dg a hip mcldencaot tubercu~
losiare 1D41cated heyare
1 Both middotsld ot theWilla11lette River
Ll -
46
with Burns1de about thecnter
2 he extrea Northebullbullt comer of the County bull
By coap8r1ng the tuberculois an4ven8real
diseae maps ODe can 8ee that the downtown areas ot
hiSh 1nc1denceare alIIo8t 1c1eDt1cal on ach map
This WOuld 1nd1cate that 1t would be of value to
bullbulltab11sh acl1D1c 111 th1aampreatbat would provide
bothtuberCulos1s 8Dd ytmereal 418ase srvicbullbullbull
Thchart aDd 1181gt8 are wsfuln 11v1DI
1Ddicat10DS tor the type aDd placemeototlocal
health cl1n1c8 tbro1qhout tbe MultnomahCounty area
A cOllpar1on of the mapa help one to dec1dewhether
to provide a aulti-8ervice cl1D1c or spec1f1c type of
cliD1c As stated in Part I of thi paprserv1ces
shouldhaYe both treatlieDt and prfMmt10n cOmponents
As he been stated fta ne1lbborhood health care
Qenter muat be a fac111tY plazme4 with an aamesa
ot the neds of the consumer and the c01llll1m1tybull
Part II of this rport haa been an attaapt to indicate
and clarify 8011 ottheae coDlllUDity neds This has
been done through8elect10n of apc1f1c problems
The indic were then visuallyrecorded through the
use of ups and charta ODe dan asseS8 thedsreeof
1DIportance of certain concems to spec~t1c areaa by
comparinl the chart aDd maps Prom this oDeean
41 dec1de which are48 vb1chcUD1c-or indeed if
the need a clinic at all However further factors
should be considered hebullbull include
a The amount of fuDd1 available
b What 18 the percentage ot peopleineoh ceaaua tract tbat would actually us such cl1n1cIl
c Wbat 1 tbeco--1tymiddot 8 IeeliDashyreaardtDI particular cl1D1c8 Would this dcrebullbullbullmiddot the ettctiveness ot thse cl1n1ca
IJ
li
D_OlraphicPopulatLon Challie 1960 to 1970 48
Cen8U8 1 of Pop 1 Cbaqemiddot 1 Change1 ofPopTract Under 19 Yr8 Over 65 Yrs1960-70 1960-70
middot1Q701Q70
1 319 -12 171 -H) 1
2722 215-27 +68 301 366 -22 127 +35 302 371 +19 111 -04
311middot401 144-41 +29 402 321 13~7-39 +24 501 356 124-08 -02 5~O2 351 133-23 +12
405601 82-10 -02 394602 103-01 -06
701 275 149-76 +56 702 361 +01 121 -07
+10middot801 326 140-22 802 321 middot127
(
-29 -03 9~01 342 124 -H) 6-18 902 294 128 -H) 3-24
10middotmiddot -14312 140 -17 1101 182 +25 -23197
2411102 186-59 +29 1201 226 169-17 -41
31middot01202 +11 182 -05 295 -H) 81301 208 -H) 4
1302 331 +08 197 +04
14 323 +15 middot185 -08 middotmiddot15 329 +16 16~5 -13
-28middot 1601 332 131 +12
1602 356 98 +24middot-39 middot3101701 161-33 +21
1702 370 -15 85 +02 +19 1801 264 151middot-50
185middot1802 256 +47-58
IJ ~
D_raphlc Population Change 1960 to 1970middot 49 (Contd)
4io
Census Tract
of pop Uncter 19 Yra
1Q1n
1Cha1l8e 1960-70
of PopOver 65 Yra
lQO Change
1960-70
19 389 +29 141 -24 20 223 -13 206 +18
21 227 +08 194 -36 2201 356 -27 112 +05
2202 290 -18 ll~9 -29 2301 356 -03 154 +24 2302 260 -37 245 +97
2401 410 +6~1 123 -31 2402 163 -80 320 +99 2501 381 +13 140 -01 25()2 237 31 lil +02 26 343 +25 186 +149 2701 370 +29 1S5 -01 2702 249 -44 304 +98 2801 337 +19 187 +09 2802 306 -10 156 +31 2901 304 -38 142 +24 2902 i 307 -32 146 t3~9
30 29~0 -48 16~2 +51
31 355 +30 160 +01 32 370 +48 148 -13 3301 395 +45 130 -20 3302 368 +06 138 -02 3401 386 +16 117 000
3402
400 +32 92 -26 3501 304 -07 115 +35
3502 344 000 140 -13
3601
36~02 357 -04 132 +32
3603 30~1 42 149 -67 3701 342 +28 152 +19
1
IJ
Jianolraphic Population Chan 1960 to 1970 50 (Contd)
Census Tract
of Pop Under 19 Yrs
JJl7J
middotChanae 1960-70
middotofmiddotpop Over 65 Yrs
1c~7n
Change 196070
3702 409 +39 122 -11 3801 308 -11 151 +29 3802 275 -35 180 +46 3803 282 -32 192 +54 3901 376 ~13 100 +17 3902 296 -03 177 +29 4001 438 -11 84 +13 4002 353 -21 115 +20
4101 397 11 9middot0 +11 4102 346 -19 120 +03 42 331 +19 11 bull 3 -16 43 347 -72 105 +31 44 113 +84 183 +154 4S 33~9 +07 110 -06 4601 2501 22 193 +38 4602 332 +59 126 -29 47middot 161middot 000 211 +01 48 103 -26 302 +59 49 138 +1 bull 3 252 +09 50 141 -26 204 -12 51 12 -39 257 +07 52 47 -61 351 +48 53 89 +49 314 -30 54 25 l1li15 327 -17 55 131 -17 115 -121 56 198 +93 227 -47 57 71 102 189 -88 58 240 ~middot41 16~1 +55 59 322 +25 142 +06middot 6001 264 95 132 +50
6002 328 -31middot 89 +07
JJ
Demographic Population Change 1960 to 1970 51 (Contd)
Census 1 ofPop lChange of Pop bull ChangeTract Under 19 Yrbullbull 1960-70 Over 65 Yrs 1960-70
1970 1970
61 355 -58 85 +39
62 328 39 110 +18
63 414 04 73 10
64 382 -22 72 +04
6501 383 02 67 -20
6502 329 -56 96 +09
6601 391 +13 88 -03
6602 319 -59 97 +06
6701 327 71 145 +72
6702 331 ~67 83 +1-0
6801 365 -66 49 +01
6802 388 4bull3 54 +06
69 354 -41 80 +23
70 400 -23 68 -06
71 359 -48 72 +05
72 255 -88 82 +11
73 346 -39 91 +25
74 313middot -63 105 +24
75 329 -42 129 +37
76 336 -52 85 +21
77 370 -10 69 +05
78 309 -10 120 +21
79 325 -56 87 +10
8001 358 -81 57 +12
8002 391 ~81 76 +12
81 315 -76 108 +21
8201 403 -23 64 +08
8202 392 23 65 +08
83 357 -34 120 +31
84 402 -18 73 +16
85 413 -06 76 -09
r
Demographic Population Change 1960 to 1970 52 (Contd)
Census Tract
t of Pop Uncler 19 Yrs
1970
Change 1960-70
1 of Pop OVer 65 Yrs
1970
ex Change 196070
86
87
88
89
90
91 9201
9202
93
94
95
9601
9602
9701
9702
9801
9802
99
100 I
101
102
103
10401
10402
lOS
368
351
379
391
391
413
379
433
372
429
414
432
419
439
~32
377
457 420
378 41middot7
345
360 417
417
412
-04
-02
-35
-26
-28
-11
-64
-20
-S9
-39
-32
-21
-34
-40
-47
-lO~7middot
-27middot +04
+56
+07
-34 01
+04
+04
+10
103
128
97
11il3 99
69
79
42
77
46
34 38
44
40
54
111
51middot
81
133
59
74
140
63
87
76
-08
-06
+04
+08
+17
-05
+3S -02
+1~4
+19
+33
-14
-08
+12
+26
+71
+11
-16 -34
-20
-19 +37
-49
-2S +15
NOte The The
Taken frOi
averageullder averageabove
middotUSCensus ---shy -
19 years == 6S years ==
figures 197
32r 13(14
p a~d 1960
--
Rank
1
2
3
4
5
6
7
8
9
10
11 12 -_
13
14
15
16
17
18
Tract
69 46
60
58
- 68
61
302
2501
67
63
19
62
26
94
3603
3902
64
30 -----~-
Rank
19
20
21 -
22
23-shy
24
25
26
27
28
29
30
31
32
33
34
35
36 -
Ranking of Per Capita Income by Census Tract
Tract
65
2701
- 15
1601
701
66
93
82
2903
3602
30
2502
80
2401
81
- 70
91 shy
4001
High
Rank Tractshy
-32shy37
38 97
120239
7840
41 ~ _2_1__ 42 31
43 2501
44 18
45 98
46 37
47 3803
1702
49
48
1602 92 2702
I
50 89
51 901
52 801
Ra_
53
54
55
56
57
58
59
60
61
62
63
64
6S
66
67
68
TractTract Ra~
74692
170196 70 I
401 71 90
72 1037J
79 70273
3802 74 601
24024102 75
85 76 101
77 9023901
7699 78 100 4101 79
3601 I
380180
458140~ t---- _ - - shy83 82 42
888384
59843501
4777 8~
502
Low
802 86
Rank Tract
87 shy
--88
89
90
91
92
93
94
- 95
96
97
middot98
99
100
101
102
103
104
1201
14
49
72
73
43
87
3502
105
1
52
86
71
1
501
10
3301
104 tf
Rank
105
106
107
108
109
110
III
112
113
114
115
116
117
118
119
120
121
Ranking of Per Capitalucoae by Census Tract
(Contd)
Tract Rank
4001 122--shy602
13
1102 2302
3302
55
3401
48
21
56
50
3402
lL01
2202
2301
53
2201
-shy
Tract Rank Tract Rank T~aet Rank
57 I-----
Imiddote
bull
Tract
- Low -k Note Information taken from 1960 U SCensus
Rank Tract
I ~
Ie
Imiddot
~
----
----
--
--
Rank
1
2
3
4
5
6
1
8
9
10
11
i-
-Tract
391 922 921
972 971
100
132 131 121
962 961
822 821 401
982 981
20 111
47 10 1
412
High
Total Number of Henta1 Health Visits
Ranked by Census Tract High to Low
TractTract RankTractRank Rnk
12 182 22 78 29 87 76 381 73181 ~------- 1913 371 8538230162372 271 2616-121 8272 2
14 80~2 31 94 7923 84801 59 15251362 4232 15 52 _ 32 103 8924 651 17240216 652
_ 91 351 33 341 23117 83 122 25 25 48 1123921418 34 shy61 86 661
19 662 6493 81 26 91 8153 49 50 55 41383 71 27 51 3120 90 672241 35shy 104167162 461
I 411 46211121 28 88342 I
2502 36 69 54 5251 50 272
-Ra
37
38
39
_ 40
_ 41 Ishy
I
42 I
-I 43 44
45
shy
Tract
~ --- shy 95 56
45 292 242
102 62 352 291y
92
101 281
99 72 63 601 60~ 42 2201
77 74 61 57
363 232
70
32 31
11 44 282 2202
Low l
- Tract
46 682 681 I 331 30
r~$ 47 1042 332
48 102_41_
11
~
Visits to Family Planning Clinics Ranked by Census Tract High to Low
Rank Tract Rank Tract Rankmiddot Tract Rank Tract Rank Tract Rank Tract
1
2
3
4
5
6
7
8
9
10
11
12
13middot
14
15
16
17
361
56
401
341
48
59 121
20
55
342
10
31
58
93 21
241 132
331
53
461 462
18
19
20-shy21
22
23
24
25
26
27middot
28
29
30
31
32
33
391
32
middot47 I-i-_-shy _ -
231 111
332
972 1
372 371
52
89
32
92
82
100 31
182
30 242
402
34
35
36
37
38
39
40
41
42
43
44
45
42
1714 i 661 221
78 362 2
90 602 601 352
63 251
105 921
971 351
73 42 292 232
411 51
662
81 45 52
46
47
48
49shy
50
51
52
53
54
55
56
961
801
49 81 72 71
19
9~1
172
68 2 57 162 14 112
91 75 681
381 42
3~3
83 161
57 f
58
59
60
61shy
62 Imiddot
63
Imiddot 64
65
66
64 62 36~3 252
74 652 SO 392 291
651 6bull 2
79 271
r-- ---- shy981 222
672 671
821 272
94 87
281
382
67
68
69
70
71
72
73
74
75
76
77
78
981 26 12~2
IS 61
85 82~2 69
61 43
101 86 84 282
76
131
51 72
1041 962 88 70
99 922 77
103
95 802 181
i
~
Low High
RankRank Tract
5479
4480
81 1042 ~) middot102
71 - - + ~ - ~
Visits to Family Planning Clinics
(Contd)
Tract Rank
I
Tract llaDk l
RankTract Tract Rank Tract
~
I
~
J1 ~
Low
Total Number of public Health Nursing Visits
Ranked by Census TractsHigh to Low
TractTract RankTractRank RankRank TractTractRankTractRank
25249 71 79 17249 8033 6586 99189711 84 2915072 34 661 76 66 811519512
402 5035 51 161 2518220 122 1713423 352 55801 7120 6752 2 149814 41236 83 2662 38 94 6821 53 2924015 362 37 32 42 75 69 281 84 63
546 8822 54 222 85 3925431 70383417 3818223 6439 4386652 718 21 55 103332 8924 232 87 19 271729219619 24156 16211140 382 628825 10523110 112 73411 10141-- ----shy 89 363 4457 8126 16111 221 74 9142 90 46158331 53 671279012 46243 48 59 351 3837528 1083 9313 91 5844 59 -_242 76 1----- shy60 272 72 74104114 60145 42 9287 7729 92 6151 8215 57371 934630 91 307762 12113116 282 619447 41391 9531 78100 63 7378 ~95 681 6945 32 5632 798517 6448 47 52 181
High ~ Low
Rank Tract Rank
96 31 132 70
97 102
98 182 372middot 602 651 662
- -shy
~72 682 802
822 922 962 972 982
1042 ----shy
Low
Total Number of Public Health Nursing Visits
(Contd)
Rank Rank Rank TractTract Tract
I
I lt
I
Tract Rank Tract
[
~~~-
I
~
IJilfimiddot ~
j
Ranking of VD Caea According to Census Tracts 61 By High and LOll Youth Itatio
A media~ of 34 5 was determined Any tract having greater
than 34 5~ of popu1tionunde~ 19 years of age -High~
Any tract having l8S than 345 of population under 19
years == Low
Any tract having rate less than 390 =Low
Any tract having rate more than 390 == HLgl4
YOUTH
LOW HIGH
L
0
12 402 1801 1802 343 2801 2802 29023603
54 6001 600262 66~02 72 74 75 76
78 79 81 t02 65 1202
W
(25)
VD
H
I
G
H
401 701 801802 901 902 10 1101 241 1201 1301 132 14 15 1601 1701 20~ 21 2202 2j02 2402 2502 2702 2901 303501 3502 34023801 3802 383 3902 42 44 45 4601 4602 47 48 49 SO 51~2 53 55 56 57 58 S9 6701 6702 73 95
3~02 7021702 19 25~01 2701 4102 4101 63 64601 ~601 6801 680270 7l 77 8001 80~02 8201 8202 83 84
85 86 87 88~ 90 91 9202 920193 94 9601 9602~ 9701 9102 9801 9802 99 100 101 103 10402 105 6501 10401
(47)
301 501 502 601 1602 2401 2301 2201 31 32 3301 3302 3401 3402~ 3602 3702 3901 400140 02 43 61 69 B(
(53) (23)
~ ~gt
Ranking of VD by Rate Per 100000 By Census Tract
~
Rank Tract Rank Tract Rank Tract Rank Tract llank Tract Rank Tract Rank Tract
1 2202 21 S6 40 902 58 1602 74 75
90-shy 64 107 26 --~-
2 3402 22 45 41 10 59 902 75 78 91 54 108 61
3 2301 23 3502 42 2502 60 602 76 6802 92 402 109 87
4 3302 24 49 43 1102 61 501 17 2 93 94 110 90
5 50 25 52 44 6702 62 14 78 8202 94 97 02 III 76
6 2201 26 20 6701 63 4002 8201 2501
9701 41~02 112 91
7 44 27 48 45 401 64 3802 2902 95 63 113 62
8 3301 28 1701 46 502 65 30 79 83 74 96 9602 114 71
9 55 29 47 47 42 66 3803 80 2801 96Q1 115 85 10
11
12
13
14
15
16
17
18
3401
53
2302
2401
57
21
2402
1101
51
30-shy31
32
33
34
35
36
37
3701 - -~ 1201
3702
89
43
132 131
3602
4001
48
49
50
51
52
53
54
55
58
1601
601
4602 4601
69
701
31
3901
67
68
69
70
71
72
2901
801
39021~ 802
6502 6501 122
702
41~01
81
82
83
84
85
86
87
88
19
1
1702
2802
79
93
100 6801 6602
81
97
98
99
100
101
102
103
104
9201 9202
9802 9801
77
302
79
86
72
84
116
117
118
119
120
121
3603
8002 8001
101
99
95
10401
105 10402 103 102
19
20
59
32
38
39
2702
3501
56
57
301
3801
73 1802 1801
89 6002 6001
105
106
2701
88
High Low
-- -----
Rank OrdermiddotTuberclosis Cases by Rate Per 100000 Ranked by Census Tract High to Low
Tract TractRankTractRank Rank TractRaukTractRankTractRank
801
79 9601501411 52 6835340120511 I 960269 903603532036 $-~~F130221542 4366 311301 70 68~013802 _ I- _ 4001_37213 3921201 6802802 H71523822024 22 54 193302 3802 80 8958 I37139535 70155 9801 I60123 72 6702 98023914011016 6701250124 10 56
81 94 401r 7 154152 73 7057 2625 122 92028
90242 162312301 92~158 86 7172434526509 82 79160159 74 100 87412240227220110 6502836960 75 30 8317244 6501782801285711 61 901 42765645 84 66021459294912 9701 660146 171 302 9702 47
6235023033113 85 822821182 917755 16335013110214 841814832 78 103 938564 324815 86 1057940149272 38036523216 10401 87 2902241 725Q 10402360266340217middot IF88 88 9937233 282 51 218 101 01102 46016234
I)167 2901460219 47
High ~ Low ~
- -
TractRank
9S89
6490
8191 8001 8002
63 61 60middot01 6002 44 2701
92
J
2502 402 --- ----shy
I
Rank
Rank Order Tuberculosis Cases by Rate per 100000
(Coutd)
Tract Rank Tract ~nk
I
Tract Ballk Tract Rank
Imiddot
Tract
Imiddot
1~
t 1I i Pi i l I
o
1 -1shyL I
I J
8 40 icO ~ I -lt 0
-t (1) I
i I
r o E
II
a
I
r--i
shy
I
~
I (
Jgt
(011 fi(
Ggt
I II ~j
()
(f 0
~ ()
I
11
f9
r
II 99
o ~
Ggt r
~ __-J~ I t I ~ I
r--J l I
~ _ __ J
) 1
fTl
1gt
r I
()
r
()
lt en -i en
()
I1l
(J)
(J)
-i
P ()
19
r o ~
r G1 I
I
c
~
o I 89
--- -I-shy
r-r I
1- 0 _~ _ _--J E
G1 I I I
i i
I 1-1-1 ~ _J ~2 ~ II
II
()
1 I I I 1
id i bullbull
~
A n 69
r 1shy
- 0 Gl
l--~ ~ I
~ II
II )
I () isect i
en l i
(J)
-t
0
IA Ol
3
determine how these criteria can best be met in a
decentralized medical care delivery system
The second part of the report will examine the health
needs of Multnomah County Oregon with the goal of
providing information about theseneecis for use in health
serv1cemiddotplanning particularly in relation to the
decentralization of health care services
I ltllYd
-
5
~E
Evaluating the Health em Sxatem
~ (8 pp1-2) has 1nc11cateda number of the weakshy
nessea of thepreaent health care system in this nat1on
She c1 tes risDs coats iDadequate pooriy distributed
and 1rietf1ciently utilized manpower andtrapented
service delivery a8 ma3or problema and state that The
systeiD 1swaste1ll otreaourcea andfunctions W1th too
11ttl reprd tor U1ci8Dcy aDd aCoDOIIIY
Shepo1Dts out
hoWever tbattbere are tour points regard1ns reform Upon
which there is widespread agreement Firat she states
IIaccesstoneede4 health emces must not be 1mpeded by
t1DaDcial barriers II BersecODd POint1s that bull bull the
continuoua health sernceare eftryw2ere ava1iable under
cond1t1ons that are physically conveDient comfortable
anclnot destructi to the d1lD1ty or selt-respectof the
recip1ent b1rd it is essential that the health care
syst8lll Iie due reprd to ecODOIIIY 1D the use of scarce
resources providtDg services with eff1ciency Finally
the system must be accoUDtab1e to those who tiDance it
and to those who 11IIe 1t and in particular must be highly
responsiva to the interests of coD8Ulll8rs II
Gre8Dlick (18 p756) also prQPoses a set of princ1shy
ples which can be used to naluate the ed1cal care
system ae states tint that bull bull all those who need
medical care shouldhave equal access to 1t second
(
6
bull bull the sernce prortded ahould be precisely approshy
priate to the pat1entl1eedemiddot ft and tb1rd bull bull the
med1cal care ayatea ahould provide the lOst eff1cient
and econoa1C8l use of scarce IIe41Cal resources
orthepurpoesof tb18 report certa1not these
crtteXaw1l1bestreaae4 lION tbaD others The rema1llder
of PaXt I Will renew the l1teraturerelating to the issuee
ofcomprehenaivene8sof ervice access1b111ty ot serv1ces
aDdett1c1ency oten1ces 111 tbedel1very ofdecentralized
medical car
ratCopcept of C_ Beal1h care Asd1oal tecmolol1 bas advanced a process of
evolution basoccurred inthe aed1cal and health t1elds
As JOhDsoD (21 pp~361-363) etamptsmiddot bull the goal of
healtb carelD our society baa evolve4trom rel1ef of
ajmptolU to ~ otdi toex1steDce in a potent1ally
diseaselessstate C1t1Dl tbelJm1 tat10DS in health care
resources and presenttechnololY he cont1nues to state
that The resulting cbal18D1e facing the Amer1can health
serncesystem is to provide each 1D41Y1dual with the
sreatest possible opporturnty toach1eve an optimum level
of phys1cal Jl8Dtal amd so()1alwall be1Dg
to
reter to the type othe81th care aystemwh1ch attempts to
answer tb1s cba]] and fult111 the three principles of
1
access1b11it Prov1UOI1ot appropriate services and
eff1cient use ot middotre80urc He state that a IYStem ot
comprehensive healthmiddotmiddot care 1DmiddotoXder to apIo middottbe stated
principles fD lleetiDlita 1Oalttst havemiddot certain
attributes
1 middoteare utdbeollW~ItaC1~orpn1zatlOM]ec ~ bull p~~ol1calbarriers IlU8t be removedbull
2 bull Care abould ace he~ecl1merlt8 ot distance residttiiCemiddot tille must be removed
middotcare8ho1ll411eC-r0WIZ the Ufemiddot span it diseases eapec ychronic are to be controlled betoretheybecome disabling or lite threateD1Dg
4 CeresboUd be~teJ1nCludlJ1C p~vention cure ma1ntiDiiCeand rehabI11tation
5 Care aho11l4be~i9_ttIa1t1ephyaiolol1ca1 aD4 pay1Fci1~cTrIS-ticot the pat~ent
6 Care aboul4 middotbe9L~ tJwrefore shouldbebu11t aro~ middotslJOc1al1natltutloDs which relate to the patients Way of lite suCh as middotthe home school and place of work
7 bull Carellbolld be m-ar and therefore shoUld bemiddot provIded ~Wliils where responsishybiUty tor the patient bas beendetem1nedauthority has been delqated and a communishycation syst_ provided
s care slIould 1Ie HIl 1nclud1Dg theintesratlon ottac1~1ts~ ~prsOllDel neceaary tor modern medical care
9 bull care dbe Of hip ~ eresboul Th ahouldbe aD adequate audit 0 care pee~ reviewcoDtlDUDI naluatioDBnd research intomiddot adequacy aDd quality
Ult1ately as 1Dd1cate4by the Nat10Dal CollllDisshy
8
sion on ColDJIIUUity Health Service (26 pp 1~20) the
c1evelopmezat of a ampyt of comprehensive health care is
a cOlDJIIUUityw14ere8pODSibilit1 1nvolviDS the integrashy
tion of all the health care facilitie and programs in
the cOlDJIIUUity or the c0arcm1ty8 healthc~ system
the PamprqlOIIlt goal ~
PrQv11~ of a ~rehive ~e 9tcoaaun1ty health aervicea
2 Ma1DteIlace ot aD a4equateqUaDtity ot al~requ1re4 health care facilities
Iritsrat~oDof ~v1c1ualUD1ta and s1steas ot bealth aerviceinto a coordishy
natedpattem ot continuous care tor theindiVidual
HoWYer aYerby (37 t pp71-72) 1Dd1cate the
med1cal and health care 81atmiddotaa it ball t1nct1oned haa
not facil~tate4 the delivery ot COap~usive middothealth
care IDcl1Y1c1ualhealth care facilitie themaelve havemiddot
notg8D8nally tuDcU0Af4tOach1eve tbi810al pUblic
health departaent 11) prond1q prev_tive services and
$1Ch trea~t activities aa are involved in venereal
disease or tuberculois control have in general avoided
1Dvad1Ds the curativedoma1Dotprivate mediCine Th1s
haa even been cabullbull1DareaawherelI~cal care is not
readily availa)le except throUlh hoepital outpatient departshy
lDent8~ Aa he 81IIet mothealth departaaents have tailed
to proVide an adequate _try point for the patient 1Dtothe
diapoatic and curative a bull t of tile health care aystell
This may be particularly true tor the pOOr patient who may
9
b_dloallYUDaoptdatlcaW4lberefore th past decade
babullbullbull~ bull lIOYeaeftt to evolve DfW torms ot health care
and new types ot health oare institutloDS providing
comprehensive oDlOiDI care rather thaD trapented care
There seems to be little dispute in the health
aboe requ1res both an lDtesratloD ofprev1ously uncoo~
ditultec1 health care ervlcbullbull brlDSins tolether into one
alency what Johnaon (21 p362) reterred to as bullbullbull the
concepts ot cOllPrehms1veIled1C1ne andpos1tlve health
andaporpph1cclecctrailzat1on ot ervlce dellvery
he NatlODal CoimD18810D0D CouD1ty H_81th Services
report Health Care gilitis (26 p37) suggests
proYic11Dl compreheDaive health care services by centrashy
llz1Da a varlet ot publlc and prlvate healthcare
tacllities 1ntohealtb campuses However as Kahn
(22 pp274) states amppeskin ot soclal servlces in genshy
eral bullbull bull if the loal ls to develop a service-delivery
approach that improves access taclltates teedback 80 as
toadapt to user preterence8nd prlorlty and maximizes
case 1nteptatlon aDd accountabl11ty the base of the
total 80clal service system Should be tnthe nelSbborhood
Dec~tral1zatloD not only makes services IIOre accesslble
but allows therv1ce to be tailored to the Deeds of the
10
areaDe Diaz (14 p3) indicates the importance of
being aware of groups in the neighborhood with special
health problems such as elderly people or large families
witb yOlmg children This means that it is important
in planning to be aware of the demographic features of the patient population This will be considered more
thoroughly inPart II of this report
Kahn (22 p275) continues however to indicate
that more than the improvement of service usage is I
involved in decentralization and that decentralization
ot service delivery also represents part of tI a general
search to break down cities to human scale for some
purposes on the assumption that people find it easier toshy
relate to a neighborhood orsection and to its populationbull
bull bull bull Thus the organization of services at the neighshy
borhood level bas the added purpose of contributing to
the search tor neighborhood n He adds that this process
i8 more relevant it there is a measure of local control
over as well as local availability of services
Kahn indicates that decentralization is not a
viable goal in some circumstances These include situashy
tiona in wh1chthe need for a particular service is too
TJI t
-
11
little to justityits proVision in a l()calun1t where
skills or resources are too rare to be provided locally
or where the costs ot decentralization vastly outweigh
the benefits He Visualizestheult1mate emergence ofa
h1erarcb1c81 patternofserv1ce delivery tnwhichcertain
services andresp0D81bilities are middot1ntegrat8d1Dto the
collimun1ty at thelooal level Other more specialized
services relate to larpr un1ts of the colDlllUD1ty such as
eomb1nationa ot neigbborhooc18 Veryspecialized services
are to be delivered at city countystateop regional
level8 fh1slevel would al80 be the seat ot prosram
coord1zaat1on staDdardprotection and evaluation 811
of which call for cons1deZable centraliZation for overall
program adm1 nlatrat1on(22 p275) AlthoughKahnt s
model was not developed specltlCally tor health care services 1t1s quite relevant- and appliCable to health
care service delivery systems
Omiddot Donnell (27 p3) reviewing the 1iterat~e on
service delivery and social action through neighborhood
service centers preseJJbB a list of characteristics
generallydesirable in ~eighbOrhood service delivery
centers Firsthe states that the center should be
accessible It should be in a physically convenient
location and should be open evenings and weekends as
well as providing at least em~rg8ncy telephone coverage
t
~ II
12
24 hours a day
The center should als~ be irDmed1ate in 1ts funcshy
tioning That is the centermust have the capacity to
provide prOmpt efficient service and should be able to bullrespond to problems middotwithout long hours ofwalt1ng and
many rounds of apPointments
The centexsservices should be 6omprehensive liThe
center should offer a full range ofusable oil-the-spot
services or easyaccess to other resources by available
transportation It should gear itself to the needs that
peoplehaV8-especially poor people-and provide for the
slmultaneoushar1d11ng of problems were possible
SerVices should 8180 b 1J1tegrated and coordinated so
thatseMces can more effectively be provided
The operation of the service center should fInally
be responsive to the needs and desir-es of the neighborshy
hood It should provide ways in which reSidents can
shape th~ program and continue to contribute to its course
and development It should be relevant and ready to
respond to changing needs II
The concept of the comprehensive neighborhood health
center developed by OEO (31 p324) has been described by
severalwriters Yarby (37 p73) describes it as an
outpatient racility which has certain def~n1te characshy
teristiCS middot1 Accessible to a poPulat1on concentration
bull 13
2 Open 24 hours a day seven days a week 3 Family-centered c~e by a team of lnteniists pediatricians clinical and publichealthnurses and social workers 4 Availability ot frequently~requ1redspecialist in such fieldsaspsycbiatryobstetrics gynecology surgerY5 Con~1nu1tyof doctor-patient relationshyship 6 Family records with social and medical ~raquomDaries of relevant information about each family member 7 Basic diagnosticlaboramptoryand x-raytacl1itles and drugs and biologicalsavailable atthe center 8 Directline (1)y center-controlledambushy
lance when-necessary) to ateach1nghospltaifor cl1agnostic ~d therapeutic servlcf)srequiring the fa011itlesandpersonnel of thehospltal 9 Patient-cantered and eommUn1ty-oriented -
The range ot services in the comprehens1venelghborshy
hood health center shouldbe as complete as possible
inCluding preventivediagnost10 treatment and rehabi-
litative services and Sbouldbe deslgnedto eliminate
episodioandfragmented services (31 pp324-325) Schorr
and English (33p291) add as additional characteristics
ot the compr8henslveneighborhood health cent~r that it
should ~ve intensive participation by and involvement
of the population to be served both in policy making and
as employees and that it should be fully integrated with
the existing health care system The Office of Economic
Opportunity (28 p63) stresses the potential for easing
health manpowershortage$by trairiing local neighborhood
reSidents as non-professional health aides at the same
time creating new job and careeropportunitles As
14
Gordon (16 p bull 422) indicates Many of the outstanding
problems in medical practice todayrevolve around
effectively motivating the patient and the prospective
patient to be concerned with his health This is
especially true in a deprived environment The community
health center with its technique ot consumer partici
pation maybe a way to create this cooperation effectvely
It is important to note at this point that the
comprehensive neiShborhood health center haaas its
constituency an integratedmiddot community r~ther than a
particular segment It should haveas Blum and Levy
(6 pp~5) indicate a horizontal rather than a vertical
relationship with the commuriitybull The vertical relatlonshy
ship they state is characteristic ot those service
organizations wh1chapproach the community only in terms
of their own fUnction Tbey see only their relationship
with the users of their service and assume that problems
of accountability will be handled by these consumers
However they pOintout this ienot likely as a vertical
approach creates dependency onthe institution Agencies
in a horizontal relationBhllp recognizetha1 they have
both acommunityand a consumer to serve The horizontal
approach places the matter of accoUltability on a broader
basis than just the involvement of the consumer De Diaz
(14 p4) speaks otthe need to ~develop a community
facility which difters from a clinic for low income
1ji ~
15
people in that it should serve an economically integrated
community The reason for this is that a wide variation
of consumers may assure a better quality of care
The advantages of the comprehensive neighborhood t
health center over traditional systems of providing
commuruty health services are numerous Hospital outshy
patient departments a major traditional source of ambushy
latory health c8refor poor patients have been indicted
for neglecting preventive health care ~romoting fragshy
mentedeare and subjecting patients to degrading and
impersonal conditions to mention only a few of the major
defects (31 p324) Another defect has been the
tendency to shunt low income patients back and forth
between different cliniCS often at different locations
arid with differel)t open hours for different treatments
or tests in regard to the same lllness(26 p63)
The comprehensive neighborhood health programs that
have been organized present a great variety of organishy
zationalpatterns one area of difference 1s in the
emphasis placed upon making each faci1ity comprehensive
in the services it provides to the patient population
In the Montefieri Hospital Neighborhood Medical Care
Demonstration program in New York City services have
been made available through a central health center and
two store frontsatellites the center to be the base
bull
Li
l of opratiol18 of ta1lJpIlflicl- ancl the satellite
center the ba of oparat1oDa of public heaJth nurses
an4 nllbborbood amp1 be satellite centers wereto
proVide preVentift tutaltll bullbulln1c1-m1zaticms w811shy
baby care per1od1c ~ectiland tJle central health
center to proViAle care tor illnes If (36 p299)
bis propWI VUDOt ~ttullytunct10DIDI at the t1JDe
it d1cu8ae4 18 tbe Uterature aDd all aernce Were
be1Dl provided 1D_~terBowever itwould ae
tbat the ntua1pro~ as aY1ioae4by its plmmers
would boclJ aoaeot bull 4efeot~ otthe current lud1cal
ccde teaIt pObullbulllne_t coorctJl8td admSDtshy
etration eD4 well 4eftlopecl refelTal procedtlreacould
1I1a~ thecOllDeCticmof t~_t8 withappropr1ate preTellshy
t1 aD4 therapeu1ampcaen1cbullbull aV81lable 111 diffrent
locationa Bowner tile barrieraottiaeaDdUatanc
between center and truaraUon tor the UDSopb1aticated
patieatlook1Dl tor 1her1~pJce too tor ~1CU-
larhalth serfplusmnQewoGl4~to JJa1t tbbll1ty o~
tb18 ~811D to provide iaaiYCOliprelleU1P18hboltleod
health servicebullbull III tactmiddot tappeareto coDtlict with
tbepro own taW cOfdotpro-1~a tam1ly
mecl1cal careprogru 111 wIa10h pre-teAtlYe aDd therapeutic
health erY1cecan be proY-lW to all IIl81Ibers of
tamily in the coure of aaSDll vi8it (36 PP301-3(2)
Dle Delmtr Coloradoprepa11ke the Montet1ori
LI
17
prograJlut111zbullbull abe1rarcJly ot SlDa11 aatellItestations
andlerer IIOreceDtallzedtac11It1es It 41ffers
howeverill tbcolap~81vene80f the services avail shy
able Inthe 4ecentraUzed facIJJtiesIt resembles very
clc)sely the IOdel ~ordecentral1zed social servicedell shy
very developed by 1ahII~ Which was 41sCussed above he
SIlall neImiddotgbborhoodmiddot c8Dt~aw1tb1n walkl distance of
most of the populatiotl havebeendesilDedto take care
of allthenorllalhealth probl of 3000-5000 patJentsshy
check-ups IlzatiOZl8s1Jlpl laboratory testa and
treataentand iaecucatlol18 (d1apeued by phyS1cians) for
IIOst DODCrltIcal 1l11le PatIent 1d1Oneed IIOrespecIal-
Ized care are reterrecttobacJalp facilities BaCkup
support tor themiddot~t1oDa are the tWo l8rsernelshborhood
health C8Dter8~ttr1Dl aCOglete~e of out-patient
serneeaDd three part1clpat1q hoap1iampl bull bullbull which
proVide1Dpat18Dt~t andcoDSUltatlve services
(13 p1028) Intb1a prosrama coaprehens1ve range of
prevent1ve aDd trea1aeDt serric 18 aVailable throughout
the decentraUzed middotta The CoapreheulY8 ReIgbborhood Hea1~ Service Project
otKa1er iC)UDdatlcm HOspitals 111 Portlan4 OreOD 1s
s1ll11arto th DenVer prosraa 1D thata comprehensive range
ot out-patientmiddot services 1D prov14e4 in each of 1ts 10cashy
t1oDa althoUlhmiddotmiddot tbe oentera are larger and l bullbulls DDIerous
than 1nth DenverproPUh (12 p6)
Li i
18
In order that a comprehensive neighborhood health
care center be able to proVide continuity of care it
must have arrangements for hospital services integrated
into th system Yarby (37 p73) as quoted above
states that it 1s characteristic of the neighborhood
health center to be directly connected with a teaching
hospital However De Diaz (14p3) indicates that it
may be advantageous for purposes of service delivery not
to havemiddotthe center affiliated with a teaching hospital
She feels that such anaft11iation may lead to asltuation
in which policies might be determined more by the teaching
needs of a medical school than by the service needs of
the patient
middotThe Nat10nalmiddotCommissionmiddoton Community Health Services
(25 p69) states that such a system of comprehensive
health care integrat1na ~e servicmiddotes of several health
and roedical agencies snould utilize Itas much single or
unified management as possible Neighborhood health
centers have been operated under a variety of auspices
but several writers have pointed out the advantages in
termsof coordinated prOvision of servictts management by
the hospital of the neighborhood health center For
instancethisfac111tates the keeping of unified medical
records of all the care a patient Msrecelved either at
the neighborhood health center or _le hospitalized
(12p6) ~ermore a3 Young (38 p1741) points out
19
direct operationot the u1sbborhood health oenter by
the hoSpital canll8lceaftilable to the center expertise lt bull
in sOlle aapcta 0 Operation that m18ht not be aa readily
available otherwie
Relardlebullbull of wbetberthe hospital and the neighborshy
hoodhealtbcent8r haVe a cOJIIIOaadmjntstration they
IIlU8thaVealTlved at a str1Dsent delineation of IDUtUal
role and reSpoDBlbilltiebullbull All OOIIpoienta ot the care
yst IIlWStQlarify and understand one anothers position
In the syatem and acree on objeCtive ancimethOds
(26 pp16-17p31) SODae areas of iDUtUalconcemare
reterral procedures record keepiDg aDC1 mutual use of
facilit1es statt1Dl i8 anotb8r ~ ot coaaon conc~
Ditt1cultift have u-laeniD the pastiD cOllprehensive bull t bull
healtbc~ prosraumiddot 1d11ch were batil plauned in wb1ch
all of the health canter phy1C~1IDa did DOt bavetatf
privilege at all ot thebackuJlhospltala (29 p21)
SUch a8ituat10n i8 1Dampcceptablelt inpatient care i8 to
continue to be p4by the pat1eatmiddot health center
physician and it cont1Du1ty ot care 18 to be maintained
Hoapital and health center1lUSt laav 301nt responsibility
tor the recruitaentot physicians
VticlentU IPan BJcNrcu Much otwhat haa b8ea sUd has stre88e4 at leastmiddot
iJlplicit17tbaD8ed tor tM etticit middotprovision ot8emcea
20
There appears to be two aspects of efficiency which are
discussed by writers on the su~3ect of the comprehensive
neighborhood health care centef one of these is the
need to organize) services to make the most efficient and
economical use of scarce medical care resources The
other closelyrelat8d in realIty is the need to help
the public use services in the most efficient manner
The comprehensive neighborhood health center concept
1s lhherentlymiddot efficient in that preventive curative and
rehabilitative health ~are programs are coordinated under
one roof with integrated a~stration Furthermore
theempbasLson prevention health education and early
disease detectionis eftic1ent troJll~estandpoint of
the health care system as well as beneficial to the patient
(18 p760) HQwever ~ue tothe scarcity of health care
personnel thecoiDprehensive neighborhood health center
mustbe an arena tor eXperimentation with new staffing
patterns~ The Kaiser program is indicative of the way
in which health care systems must begin to operate in
that appropr1ate ancillary personnel are used Wherever
possible to perform functions that do not need to be
carried out by the physician As Saward (32 p42)
states
1hroughou10ur organ1zat1on~ there are many of the customary experiments be1ngmade-shyJse of speciallr trained nurses for well-baby care under the SUpervision of the pedi9trlcianexperiments with routine prenatal care by
w ~
21
middotSPC1a1l~t~JlUrbullbull per8ema_1 bullJmdlJleu y our fuDotlou are auoh that DOtb1Da 18 dorutbYtbe phY8iCianstbat doe DOt vet to be done by the
phys1c111U1fhe other aldlle4 person- Del-nurse middotreC~0D18t the appo1ntshymeDt center or clerical praormelshyaremiddot there to free h1amiddotto use his spec1al sk111
Awell lmoWn treDd1D the area of eaaiDI health
c8re JII8DPOY8rShortagjs bas middotbe thetrend toward tra1nshy
1DB poverty area rea1deats as DOD~pro~eaionalmiddoth8lth
aide and nepborboocl health workeramiddot (28 p63) This
bas the effectofmiddotmiddot1J)creaa1q II8DPOWrand 8180 can help
bridle the cuJ~ cap betweenprondera and colllUmers
of aen1C8s This attarD at least tlleoretically
createa a situation 1D WIa1ch providers andcoD8Ullers can
be educated to UDderatad OD88DOtber and interactJlore
ettectlvely~ HoWever amiddotpltt8ll has beeD themiddot tel14ency in
801D8 oamp8e8 tomiddot us aidesmiddot ssale8lllcw t~r the center
alJDOatexclwdY811rathertbaD ua1Dltheal to protide the
health care for wh1ch ~ were trained (29 pp3B-39)
1bat ismiddotmiddot vh1~e the a14e Yalue in ~~m1catiDI with
low 1nCOlMt patieata haa beeR recoSD1zed and stressed
their role ashealtb carepersoDDelhil been slighted 1n )
any 1Dstancea
Anotber step 1d11Ob bullbull been taken to provide 8rY1ces
more efficiently eUeot1ftlybas beenmiddot theorgan1zation
of per8ODDeliDto IIllt141sc1pl1Dary teamaaaa means ot
proYid1DgmiddotCOQrd1DatedserY1ce SUch te8lll8 sen_rally
~
hf
~
22
include PhYsiciaQs nursbullbullbullbull soc1al workers and outreach
workers Conceptually th8y fmlct10n to me~ the intershy
relate lled1cal and social needs ot the families sened
Hor there are a number ot barriers to the etfectve
tlmctiOD1nlof lIuchte8ll8 SODieot these are heavy caseshy
loads the inordiDate amount ot tille consumed by multlshy
prOblem tamtliethel1m1ted tra1n1 ngmiddotmiddotand laCk of tnterest
on tile part ot aoae tebers in examinJng aspects of
problems out14e~lr oWn areaaotcolIPetencemiddot and
~ourdcation prc)blell8 between proteasioDala and nonshy
prot81~s (10ppa-10) middotrurtbemOre as De Diaz
(14 middotp6)1nd1cate tbel8 maybe a teDdency tor vertical
dp8rtmental lines of auperv1810nto become paramount
over the team coDamloation syst lead1ngto conflIcts
in determ1niDI the ro1ea ot solie team bers particularly
the DOD-prote81011alaInauch exper1l1enta Witb new
~t1Dlpatterna it 1s bullbullaentialtbat line of authority
roles aDd NsP0D81bll1tlea be made explicit and that there
beJDechaD 8IUI tor relUlar evaluat1onotfunctlorUng
Another way inwb1ch health care sernee delivery can
be made more ett1cl8Dt is to proVide servicea dur1DC the
hours whentbey aremiddot -ostnee4ed As reQo_ded by Yarby
(37p1) serY1ce can bemadelIOre accesslble by making
themava1lable 24 hours a day seven days a week If
rg8l1Cy service are aft11ab1e aroua4-tbe-cloek at ~
nil1iborhood health center the continuity ot tbepat1ent ts
23
careiamaiDtalDedand meatry point into the
cOIIPre~i health care 8 be made available
tothe patient who aoZMllyU8ea ozilymiddot emergency care in
tille of med1cal criais More 8isDificantly ava11ab1-
lity of a tull rase of bullbullrv1c8 tor seVeral hours 11the
eVerlna aI1Cl On ~ prevent the los ot earn1JiSs
involved if th patierat 1IU8tt8cet1me oftfroawork dur1q
the d8y for aed1Cal oare bull his can be an eSpecially
importantc0J1814eration tor lo1aCOlleDUUg1nally qloYEtd
patient aa4caJla18o PIOJIOtet1)e 0Da01Dl use othealth
servicebullbull
exper1eDO ot tbeKa1er prosraa in tb1s~reprdAs
Greenl1clt(19 p10) states wA lllNt 8ip1flcant
proportion ot the abulatory care 8n1cp~Y1dd tor ~
total popUlatiC)U ~ ~ after clWc hours and this
Deed i8 apParenUyaoN prODGUDced tor aJl8d1cally
iDCust population On the other hand the bulk ot all
aabulatory med1cal cu 88l91ce are performed dur1nS
regular cl1D1c hour eVen when services are available 24
hours a dayJ day bull week W
It has ~ the experi8D~eof a ftIDber ot ne1g1lboXshy
hooct hea1tbcentere _t a_jor obstacle to efficient
proViSion ot anicbullbullhas beentbe teD4eDcy of medically
1ncl1pnt patieats to utilize the center oa a walk-in
baais tor epi8od1ccr181or1entect bullbullrv1cea rather than
4)i
h~ ~~f ~~ L
24
to make appoJlltaeata tor ODIo1qprevmt1ve treataent
and rehebl11tat1Ye care ad ampl1O to bave a blah failure
to Show rat_for tbe appo1DtaeDts that they dO make
Atone center 628 of appo1Dtments made were kept
while 3Oottbepati_ta een were ~1n patients
AlthoUP fewer patiets were actually 88811 by the cater
1D middottb1s 1Datance thaathe -bervholuidmadeappointshy
mta the walk-iD patlat required an iDord1nate amount
ot staff t1ae tor aCreeDiaaacl ~trral to pplOprlate
~ttor caregt (9 pgg) Arraquotbr1llpl1catjo~ of the
plOVidedto valk-iD patient by other thaD their
(19 p12)rurtbermore
when patients uti11ze Wlk-1Il er181 centered care
athelr ODlf tona ot ootact with the _d1~ care
ay_ta fUilycentered care the treata_t of tUl11y
bers
a a UD1t 11
dlarupted
hewalk-1Dphenoaaencm appear to barelated to
diUerence between soclal clase in the style of Dlaking
contactJt1th the a11oal C~ay8t As Greenlick f ~
(19 p11)1Dd1oate8 thepheDOaenOn ot INater usage of shy
walk-in ervice by aed10ally middot1Jid11ent patient thaD by
others baa otte been attr1buted to a stoical att1tude
tQward 1llDe8 em the~ ot poor people leacl1D8 to a
~
25
greaterdelay1n tbe k i Dlofa8d1cal care These
patients wppoedlyeelcmiddotcareODlymiddotwIleD tbeirmiddotillDess
becOlles1Dtolerable resultiDSin middotthMr appeariDS withshy
outnot1ce1o rece1ve oareHlwever Greenlicks
r8aearcbbaa cut doubt on the existence ot tb1delay
111 report1Dg middot8J1IPtoJumiddotOfDeW 11laessand seek1ng care
Be bas tcrQDd 1bat s1ll11ar peze_tases of dioally
1nd1sent 8DClJ1on-aed1cally 1Dd1PD~ pat1enta seek care
on the aue daytbat aptou tirstaPPear
1fb11e GrHDllclc 1nd1cat tbat the reasonator the
greatertendeDCY of low 1Do~e pat18Ilta to 1$8 walk-in I
serY1ces are notlcDo1rAmiddotmiddot tbe7 _ be rel~tedto a tendency
ot lower aocio-ecaaaoclaa patieota to preter face-toshy ~
face contacts with II841cal persoDl181posslbly because
such contacts areft coatortiDS an4reasauriDS to
patients who are hJpotbeafzed to bave a dependent attltude
toward IIed1Cal care perS0Jm81 (30 p161)
It a8 itmiddot baa pnerally beenhld the appointment
s1stemts the most efficient Ileana of dellveriDS
comprehenSive oODtllluiDlh-lth care (9~100)1t is
necessary that educaUoraalmiddotbulltfort be taken to proaote the
use ot middotappo1ntaents8DClmiddot tQrec1ucethe fa111re to appe~
ratB4uOatioaalwhlQb baft~utl11zedhave been
IJ
26
1Dten1ews with walk-in patients home Vi8its and group 4i
meetiDp1D8D attemptto1Dierpret1o the patients
the value of rtitgular ppo1ntmentamp andot con~in~
c~1ve care rather than epiI041c care (9 p1OO)
h1s 1safuD~tioD torwhtch nOl~prot81QDal colDlllUD1ty
YOrkersllaY bebe~r8U11ed tban other statf H()wever
euch aD ~ucat1oaal propul __~ ~e related to the senUiDe
capacity otth health oenter to provide comprehensivebull gt
ervice8 to1tpat1_t~odoD aD app01ntment bas18 It
1amp pos8ibleo~rw1 tor educa110Dal ttorts to result
LD a~8JImCl tor ltPP01ntaen~8 at a ratewb1ohi8beyond
the capacity ot thee_tar to t without uareaaoDably
1_ wa1t1Dlprio4a QOBt1nuad use Ot the center on a
wallt-in bU1 _1tbeoosiItpos81ble to et an appoint-
met anc11nCreued pit1entcoJaplampia1a bull Therew111 of
course always be a need and demand tor acute ep1so~c
Care -ci the health centerDlWlt be planned with the capashy
billty ot bullbullbullt1D8 tb1aneed wh1~ cont1Du1nI to stress
aDd educate the patient to utillze oDlOinI comprehensive
faa11y middotc~te~d Cflre (9p 100l
att g4 CODClva1opa
In order to bea4equate any coJlltemporary health care SY8tem muat bullbulletcerta1D interrelated criteria he
IJ
27
minimum criteria areaccessability of services to those
who need them compr8heX1siveness and appropriatness of
services and efficIency 1nthft utilizat~on of SCarce
health care personnel and resources The scareity of
pex-sonnel andtbe need for h1gh quality ongoinghealth
care services
aJIlong the
populationdemanci the most effishy
cientprovision of services
Services must be made accessible to the population
They mustmiddotbe geosraPh1cally accessible to remove the PhysicalmiddotbaTiers betWeen peopleandthem$d1calcare
system They mUst otter their services dur1ngthe
hours when people can make the moat use ofthemA~ it
makes little sense to concentrate services geographically
where they will not be uSed to their fUllest extent it
also is wasteful to provide serv1cesonlydur1righours when
many people are employed his not only presents a hard
ship middotto the consUmer lnrt wastes resources if for instance
the unavailability of preventive services during the hours
when people Can use them causes a need for treatment
services later on
Health carbull sEtrvices must be comprehensive including
prevention treatmcmtand re)abimiddot11tation Ambulatory I
healtbcare facilities wh1cQ are orienteciexclusively
toward either prevept1on or trea1mentare no longer accepshy
table for they are lneft1c1entln their use of resources
and in their prov1s1on of health care to the patient
w ~~
28
If prevent10n1s notmiddot stressed treatment serv1ces that
could have beenavoidedY1l~ be required If prevention
1s the sole focus of the health care facility sick
patients who present themselves must be referred elseshy
where for treatment andsllch referx-als may be taken as
reject1onsor not followed through with until illness
becomes unbearable
The instltutlontbat meets these requirements Is
the comprehensive neighborhood health center It 1s a
local decentralized outpatient facilityprOVld1ng a
fUll range of ambulatoJY health care services It has
a linkage to ahospitalbackUp facilityforlnpatient
treatment and hiihlY apclalized outpatient care
The neighborhood health center must be a fac11ity
planned with an awareness of the needs of the conSUtller
and coDitnUn1ty It must have the r~Ul0urces to provide the
services people need mere they can use them and when
they can use them It must uti11ze the part1cipation of
the community to develop this awareness Not only must
the cen~er beset up to be Amctional for the consumers
but efforts must bemadeaga1n with commun1ty partici shy
pation to help the consumers utilize medical care
services effectively The center muetmake efforts to
educate the community about the valueot regUlar health
care of preventive servicesand of the use of planned
IJ
29
medical appointments ratherthanorisis centered walk-
incare Therealit1es of the existing health care
system have not taught the patient particularly the low
income patienthow to use services effectively
The helthcenterilUst also bea laboratory for
experiments in easing the health caJepersonnel shortage
and c60rd1Datingcare~ A major difficultY iri-exper1shy
menting with neW rolesis freeing staff of old preconshy
ceptions
CoDlprehensiva neighborhood health dare centers have
been developed under a variety ot alisplces including
medicalsociet1es hoSP1talsmiddot(36p299 group pr~ct1ces
(29 p6- 12 117) health departments (13 p1027) and
ne1gbbothoodassoc1ations(14) The literature indicates
somevalues nthe management ot the health center by plusmnts
hospital backup faCility Whatever the auspices many
adm1nistrative fuDctions such as program coordination
standard pr9tectionand evaluation call for considerable
c~tralization of adm1nistration city-wide or coU)tyshy
wide At the same time other aspects hours of servlce
for examPle~ cuI f~radm1nistrative fUnctions made atmiddot
more local levels Each neighborhood center must be
free to adapt its functioning to itscominunity thi-ough
the mechanism otcODlllUl11~ participation inmiddot policy making
Obviouslythe prerogatives and responsibilities of each level must be negotiated and made explic1t
t4~
JJ
BIBLIOGRAPHY 30
1 American Rehabilitation Foundation ~ealth Services Research Center The Health Maintenance Strategy mimeo 1971
2 Anderson Nancy N Comprehensive Health Planning in the States A Study and Critical Analysis Institute for Interdisciplinary Studies American Rehab ilitation Foundation 1958
3 Andrus Len Hughes Comprehensive Health Planning Through Community Demonstration Health Projects mimeo1967
4 Barry Mildred CandCecil G Sheps A New Model for Community Health Planning unpublished paper presented to the American
Public Health Aseociation1967
5 Blum HenrikL Fred Wahl Genelle M Lemon Robert Jorulin and Glen W Kent The Multipurpose Worker and the Neighborhood Multiservice Center InitialImplications and EJeperiences of the Rodeo CommunityService CenterAmerican Journal of Public Health58 (Mar 168) pp 458-468 shy
6 Blum MichaelD and Soloman L Levy A Design for Service Delivery that Reinforces Constructive Tension Between a Health Center and Its (sic) ConSUDlers and Supports Community Power unpUblished paper presented to the American Public Health Asaociatiltn 1968
7 Brielaud Donald Comm~ity Advisory Boards and Maximum Feasible Participation American Journal of Public Health 61 (Feb 1971) pp 292-296 shy
8 Burns Eveline M Health Insurance Not If or When But What Kind Madison Wisco~sin University of WisconsinScllool of Soci~l Work 1971
9 Campbell John Working ~elationships Between Providers and Conshysumers in a Neighborhood Health CenterU American Journal2 Public Health 61 (Jan 1971) pp 97-103
10 Caxr Willene Neighborhood Health Centers Funded by the Office of Economic Opportunity mimeo 1970~
11 Colombo Theodore J Ernest W Sawardand Merwyn R Greenlick The Integration of an OEO Health Program into a Prepaid Comrehensive Group Practice Plan American Journal of Public Health 59 (April 1969) pp 641-650~ -
12 Comprehensive Neighborhood Health Services Projectof Kaiser FoundatioIl Hospital~ Prcgtgram YearE grant renewal proposal mimeo~1971 bull
13 CowenDavidL~ Denvers Neighborhood Health Program Public Health Reports 84 (Dec 1969) pp 1027-1031
IJ
14 De Diaz Sharon Daniel Beyond Rhetoric The NENA Health31 Center After One Year unpublished paper pres~rited to the American Public Health Association 1970
15middot Gerrie NorrrianF and RichardH~ Ferraro Organizing a Program for Dental Care in a Neighborhood Health Center Public Health Reports 8 (Aug 1968) pp 419-428
16 Gordon JeoffreyB~ The Politics of Community Medicine Projects A Conflict Analysis Medical Care 7 (Nov -Dec 1969) pp 419-428 shy
17 Greely David The Neighborhood Health Center Program and Its Implication(3 for Medical Care H~alth Forum of the Welfare Council of Metropolitan Chicago (mimeo) 1967
18 Greenlick Merwyn R Newgtimensions in Health Care American JOurnal of Pharmacentical Education 34 (Dec 1970) pp 754-4
19 GreenlickMerwyn R Donald K Freeborn TheodoreJbull Colombo Jeffrey Abull Pruesin and Erne$t W saw~d Comparing the
Use of Medical Care Services by a Medically Indigent and a General MemberShip Population in a Comprehensive Prepaid Group Practice Prosram II unpublished paper presented to the AmericanPublic Aesociation1970
20 H~tadoArJiloldVMerllYll RGreenlick and TheodoreJ Colombo Determinants of Medical Care Utilization Failure to Keep Appointments unpublished paper presented to the American Public Health Association 1971
21 Johnson Richard E and Merwyn R Greenlick Comprehensive Medical Care A Problem and Cballengeto Pharmacy ff AJilericanJournal of PbarmacenticalEducation 33 (Aug 1969) pp 361-367 -
22 Kahn Alfred J Studiee Social Policy and Planning New York Russell Sage Foundation 1969
23 Kotler Milton Neyhborhood Government Local Foundations 2 Political~New York The BobbsMerrill Company 1969
24 NationalCommisaion on CommunityHealthSfrvic~sActionPlanniriamp for Community SetithServices~ashington p C Public Affairs-Press 19t7
25 National Commission on C~mmunity Health Services Health Adminishysration andOrMPization l the Decade Ali9$-d Washington D C Public Affairs Press 1967
26 NationalCornmiesion onqomm1Jllity Health Servicesbull Health ~ Facilities Washington D C PUblic Affairs Press 1967 bull
~ n
32 27 ODonnell Edward J and Marilyn M Sullivan ServiceDelivery
and Social Action Through the Neighborhood Center A Review of Research tt Welfare ~ Review 7 (Nov~Dec 1969) pp 112
28 Office of Economic Opportunity Second Annual Report Washington D C~ U S Government Printing Office 1966
29 Office of EConomic Opportunity and the Medical Foundation of Be~laire Ohio Eighth Report 2l ~ Committee2a Governshy
ment OperatiOll~ Va8hiiiSton D C Government Printing Office 1969
30 Pope Clyde R Samuel S Yoshioka and Merwyn R Greenlick Determinants of Medical Care Utilization nhe Use of the Telephone for ReportiDg Symptons Journal of Health and SocialBebavior12 (June 1971) pp155-162 shy
31 RenthalA Gerald nComprehensive Health Centers in Large US Cities American Journal of Public Health 61 (Feb 1971) pp 324-336 shy
32 Saward Ernest W The Relevance of Prepaid Group Practice to the Effective Delivery ofHealthServicestt The New Physician 18 (Jan 1969) pp39-44 - shy
33bull Schorr Lisbeth Bamberger and Joseph T English Background Content and Significant IssUes in Neighborhood Health
Center Programs Milbank Memorial ~ Quarterly 46 July 1968) part 1pp 289-296
34 Weiss James E and Merwyn RGreenlick UDeterminants of MedioalCareUtilization The Effects of Social Class and Distance on Contacts With the Medical Care System Medical~ 8 (Nov-Dec 1970 pp 456-462
35 Weiss James E MerwynR Greenlick and Joseph F Jones Determinants of Medical Care Utilization The Impact of Ecological Factorstt unpublished paper presented to the American Public Health Association 1970
36 Wise Harold B Montefiore Hospital Neighborhood Medical Demonstration A Case StudyMilbaDkMemorial Fund Quarterly46 (July 1968) part 1 pp297-308~
37 Yerby Alonzo S ttHealth Departments Hospital and Health Services Medica1~5 (March-April 1967) pp 70-74
38 Young M M~ Chatanooga IS Experience with Reorganization fOr Delivery of Health Services ttAmerican Journ8l of Public Health60 (Sept 1970) pp 1739-1748
f or l
II bull 11 Y d
II
IJ
34
ThepurposeOfPart II of th1aa paper1atod1scuas
elected Speclfic needs ofecltlc areas within Multnomah
County A8P01ll~oUt 1D ~ I of t1a1bullpapermiddot Ita nelgbshy
borhood health oare cater IlU8t be a facl1lty plaDlled with
aD awarenes of the neeels of the oODllUller and collllUDity
Part II of this paper nIl Show 80e of thoe speclflc
needs
he1DforutiOD tor t1li Portlon of the report
obta1nec1 troll tbroupout tbe follow1Dl threepUb11catloDS
1gr~e_tiMshylIPrIxaiidOreson JuDe 1963
2 1~_middot_sectSI8e~ected1teai c-ua 0 S 8 e first count coaputer tape Coluab a_lion AssocshylatloD of QoveraMD-8 Jlme 1971
3 Jtu1tDoab County Oreaon BDY1roDlHtlltal SurveyEarly 1971
The JIultDOIIIlb COUDty OrttIOD BDv1roDllfmtal Surley
Barly 1971 1s bull stat1stical report of the activ1tles of
theentlreMultDOIIIl2 CcNDty Health Dep~t during the
year of 1970 Die speclflc 1nd1cs elected from tb1s
study amprejMental aealtll Publlc Health N~s1D1 vlslts
FaJUly ~ Veaereal])1 ~ ~rcul081
Throush tie use of cUrts and mapa ODe CaD roup these i
speclflc ~oea to ahcnr the healthneedsof speclfic I
census trtcta aD4 then the health needs of iarer neIghshy
borhooda 1m4 o~ Uebullbull
Rf)~UP1Dl of areu was accompllshed in thefolloWinl I
JJ ~
35
he MiltDoIliahCountY oregon BDViromaental SUrvey
early 1971 isamp statistical report ot tbeaotivities ot
the entire MultDolllh COUDty Health ])epartiDent dur1nl the
year ot1970 he specitic 1Dd1C8S selected frOm this
aUy are 1Il8Dtal health public healthDurs8s visits
fUl1ly pia waereal elisease aDd tuberculosia
Tbroq11the Wle otcbart aDd mapa aDecm szoup these
specific indic to show the health Deeds ofapecitic
ccmaua tracts aDdtIum th8health neecla of larsr ~eilh-
bOrhooda and co8I13 tlbullbullbull
RegroupiDI ot areas waa accoap118hed1D the
tollOWiDl lIIIIm1er~ A bullbullcifie 1ndex 8selectcl auch as
venereal di8bullbulle or tuberculo8i~ he total number ot
cs was then deterll1ne4 for each census tract Through
the use of the maber ot cRbullbullbull tor a 11Yen cenaus tract
aDd tbe population ot thattractaltrateot1lla1ampmcper
100OOOpopUlaticm wu cleteXll1ned for each census tract
This was ~e to starl4ard1ze the population ditterence
amongOeD8U8 -tracts 1he rate of incidence toreaob
cenauatract was then llstedby rank position on a chart
In rank poition1DI any cen8Wl tracts haviDg equal
rates ot1l1c1dence are assipe4tbe iaDk posttiona
Beeauseot the abo fact tbAt cbarta w111 vary in length
neveltbAtlea eacb cbart will 1Dclu4eall census tracts
inMullnoaah Couaty Atter the census tracts bave been
listed accord1q to raalcth1s list will bediv1ded into
IJ
36 three levelsotinc14ence he three levels are
1~ The upper 14 of1DcldenCe
2 Thelower 14 ot incidence
middot3 The ILld 12 of incidence
Tlles three srouplqa are then used in compiling a map ~f
Mu1tnOmahCountyfor ach apecltictop1cbull TIle maps are
uaefuJliD tbatthey V1suallycoJib1De 1Dd1v1Clualproblem
census tracts into larger problem nellhbOrhooc1s
The 1960 statistical iDtormatloD was Used in a similar
liIaDDr to tbatexpla1Dedabove 1Dthe4evelopaent of a
chartmiddot and map 1Ihow1DI e cOllpampriSOr1 of per capita lncolle
tor ttaCh ceDsua tJact aDdmiddot combiDed census middotmiddottract areas
he 1910 aDd 1960 statlstlcal iDtOrllatl0D was combined
lna map and chart he purpose of this and chart is
to d8aonatrate the e cl1stributloa1DeachceD8U8 tract
and middot1ndlcatbull tuture ace populatlon treD4a bull
When one be middotbullbullbullbullbullHdth ne8cts ot an area and has
declded to establlsh a cl1D1c to serve that area the
physical location otthat cl1D1c IllU8t be consldered In
order to coapreb8ll81vel develop an area cl1n1c one should
conslder thepre88Dttraftlc middot~ytaa an4tranaportatlon
systems Thecl1D1cahoUld be located close enoUlh to
major arterlals to giva asy access from the total area
be_ ervecl by this cliD1c At the t1ll8they should
be tar eo away froll thesarterlals to all8Y1ate traffic
CODCell18 andpark1D8 conpstlon By traff1c concerns I
IJ
37
lIlan one lUSt consider thertarro1fne8S of streets whether
streets are oD8--C)r two-way iqres8 and egress to parking
amp0111tie eros tratflC) spedof trattJQ children 1n
ll8a traffic i1lht Vislon re8tr1ctionS etc
BwstraDsportat1onshould alao be central in this area
as maay people ~U f1Df1 1tD8Cessary to use this form of
transportatlon
~e tutqredlopHQt of bull treewa systems should be
c0J1S1dered soastolesen thecumce ofmiddot future roada
cutt1DSotltbe cl1D1c llte line
nrrph1c middotDampta
It is 1JDportaDtto kDOw the demosraphic distribution
characteristics of the oUenteltbat i8 to be served by
localized health cl1D1cs
Acl1D1c which erves8J1 area where1D the prepondershy
ance of persona arecrter 65 years of mayf1nd that these
people rely more on pUblic transportation call for more
home- services and haV4t 110ft ChroD1c and debilitating
types of disorders (b1_ blood pressure poor heariDg and
eyesight) tbaD do8 an area ot a YOUDIer population On
the other hand thL area of older residents may have little
need for family plabDlng cllni08
In order to better ~Ybullbull the 4eaoraphic population
of each CeD8U8 tract the 1970 CeD8U8 iatormation was viewed
and two specific catelOri8 considered These two cat
IJ
38
lori8S woUld be the perc_tap ot population under 19
year of ase and the percentase ot each oensuetractover
65 years of age he 1960 1Dtormatlon tor eaCh tract was
then compared witbthe 1970 intormation and a percentage
ofincreaae or4ecreamp8 tormiddot e~chtract1n each category
cOJlputecland achartma4e By the use of this chart one
18 able to View tJleap populat1odiatr1but10n of census
tract and at the _ t1lle accesa middottrencl Por example
let us choose census tract 601 W see 40-4 otthe
population is under 19 years ot and that ODly82 1s
over 65 years ot middotAtthe e tille the percentage of
youth bas ~ed ODly 1_ intbe laSt teD year whilethe
percentale over 65 year ot middotbas stayedmiddotthe same With
this in mJnc1 ODe ~ 1DfItr libat ol1D1o aerviDg this
area WOuld bellQre conq~w1th the problems of a
YOUQier populat1on and that _ would probably be true foJ
some t1aein tbefuture On the other hand CeDSU8 tract 54
has only 2 ollt population UDder 19 yel1s ot age and
this has decreased by 1 over the last ten years middotwhile at
the same time 32-377 ot the populat1on 18 over 65 years of
age A ol1D1C ___ this area should be or1eJ1ted toward
tbespecttic problema otthe ampledbull
PerCapia __ bY gsa neat
WhaD cona1der1qlooat10D1 tor health cl1n1cs one
shoUld take the 1DC01Ieot areas into consideration Areas
IJ
39
of lowiDcome would not 11kel~be 8erved more by localized
cl1D1cs tbaD would are of hilbincome It 18 likely
people haYiq a hip iDeoll8would preter to be aeenby a
chosen ~r1vatephylc1a1l tban at a local cl1D1cwhere
10Dier waits y beraceaaampryand leas personal attention
gl_
The 19701ncOII81atoWampt10n tor MultnomahC~ty was
not available at the tille thi8report W88 made The 1Dto~shy
tiOD Was taken ~adtro tbe1960 census publlcation
his woUld ~8Il thea tbat ral1I8 OD the chart ynot 1raquoe
completely accurate hi writer telthatthe areas most
affected by tb8 1I8eof the older 1Dco1DtOlaat1oDWOuld be
those tracts wh1ch baYebad a rapid 1ncreaae1n populatlon
over the past tfmyHr8 bullbullbull tracts would include tracts
nUmbered 104 9897 96 aDd 95 be perc~ita 1Dcome
referredto1il-tb1a Paper18the lIean 1DCo per person per
census tract
Attar the iDeoeper census tract was listed on a chart
a map was de 1D41catiDg those census tracts belonging to
the lower 14 ot income tor all censue tracts in Multnomah
COlDltytbose beloqins to the upper 14 ot income tor all
census tract 111 MultnolUlhCounty and those belonging to
the mid 12 ot 1I1coaetor all oeuuetracts in Multnomah
C01mty
In yiew1Dg the _p 1t caa be seen that the low income
area seautotollow aloas the at aide ot the Wl1lamette
IJ
40
R1ver the full length of Kultnomah County A second low
income area follows the south edge of the Columbia from
the northwest corner of Multnomah County easterly to 148 St
A third problem area seems to be on the east bank of the
Willamette River with the Union Pacific Railroad being
about the center of this tract The extreme loutheast
corner of Multnomah COUDty appears to be a low income area
but as this area bas bad rapid grouth in the last ten years
this could be erroneous
Mental Health
be first ~ecific indica to be selected from the
Multnomah County envirollllental survey of early 1971 and
to be considered in this paper i8 that of Mental Health
At the present for mental health purposes Multnomah
County is divided into five catchmentareas with a mental
health cl1n1cin each area These clinics are Model
Citles Delaunay ADkeny street Office Hansen Health
Building end Southeast Clinic
All lIlental health cl1n1cslcept statlstlcal information
on all patients visiting their cl1n1cs this included the
address of the patient hese addresses were then listed
upon the approprlate C8D8US tract Each census tract was
then ranked on a chart according to the nUllber of mental
health patients who reslde ln thatCeDSUS tract attending
any of the above listed ental health clinics This chart
IJ
41
wasttum d1v14ed1ato proper quartile bbullbullbull
quartile vereUs to dne10 u appropl1ate Multnoh
County _tal health ItLa middotmiddotmiddotthelipO~a1bl by lOoJcJIUE
at the UDtal health _to uteN1De which ueu have the
lars-t use otCOllDty 1alh~th faci11t1Rot
1Ilclu4ecl 111 tbia woUld tber otpeopleYia1t1Da
pr1vat patch1atriata aDd pr1_t _ntalhealtb cl1D1c8
WheDtbe M1 18Yienclmiddot Itmiddotmiddotmiddotmiddot~middotbe~_ tbat ~rtt
appears to lMt fourmiddotmiddot-al are iii _oil the nuaber ot
lIental healthcl1D1c na1t toM tbjh1sheat 1he
tour areaa woUld be tollows
1ttrea Ore to~Blo Drimiddot ~tb Burrus14e aDd tIMtmiddot Colb1a Riftr H1gbwyaeri1Dla th nortllra boundaryshy
2 bull ProII 82D4 1_~ 10 20th streetwitil the ra1lMd Mu the north ltouadary
3 ~ et et tUgl_b1bull MYel froamiddot the Clackaaa COUDty l1ae aorth to Dln8lon stret
4 beDOlvt1ttfe-t ~efllt4 COatytrca Jle1aware streetmiddot toR1C1a11oDd wlth Colubla Blvd heiDI tbAtnorth bouaclary_
It ODe coapareatbiap to th iDeobullbullmiddotp 1t can be
eamiddotthat lIOat ot the c tracts baY1Dg bllh v1i11tatlcma
middottfl public tal health cJ1rUc8 ~ 111 t13e low ~ aid
1DcOile SroupiDIOJa1y of til 25 tracta llsted as
haviDlbip aental Maltll nlltatlou are ~ the1g60 hip
iDeo arebullbullbull
17 Plpn
42
amily PlellnSDI ]Jlce Metal Health i8 an 1nd1ce of
use Theperson 111 ordertobavebe_ 1Dcluclecl 1n this
atu4ywouldhave tohaft Ue4 ataa11y plaDI cl1D1c
tacilities of soaetype It 41fter troll tile _tal health
study1nthat i t1Jicludestatist1catrollbotb public and
privateclJD1os
The iDformation tor the iak orurcbart 8Dd map of
t8ll111 plenn1 na ob1a1De4 by cOIIblnlDlthe mabel of
1rlcuv1duals bullbull_ attbe tbreellUltrampo-ti Coatyhll11y
PlalJQllIl C11ll10s 111til tbo at the Planned PareDthood
Association CliD1C8 be tbree -JIultDouh Couaty r8ldly
PlamSq Cl1D1c are Solrtbweatth Col_bla 1111- a114
HaDsell Health BWlcl1Dl CllD1cbi middot1Dtormat1oD vas then
bullbullbullesed tomiddot detellWMt l10w people troll eacb c8IUIUS
chart wastben Mele IUs oIIart jn 4iY1ded to show
the censuS tracts lIaYiDlmiddottIle h1t1iest qUart1le of incidence
of use lowest quartile of 1Qc1deao ot use Jlid 12 of
incidence of Wle an4 a map sprepared troll thts 1Dto~
mation
The C8U118 tractsbelOJISnl to the h1lhestquartile of
use appear to be 1lO~ 8catt~ on tbipwas true ot
either the _p ot aental health cl1D1c uaageor ot the map
abow1DI per capita 1I1COM Iaere40 to be three
d18t1nct areas of UIIaP beJ woul4 be
1
IJ
43
t10D of BurD81cl and the W11lallette River 4
2 S~t Portland 8Otth otmiddot the ra11shyrcaadand alona the W11lamette River
lIortbeaat Portl8D4 between MisSiss1pp1 and 24tbStreet the northbouBclary be1DgColwb1aBlvd
Pylzl1c BMltl IrpI Y11ta
Publlc Healtil nur81D1Y1s1t nclud8 an vists to
theholles of client by PubUc Health Nurbullbullbullbull his shows
visits to bull f8Jl1ly fer aDY purpos SUCh aatuberculolJ1s
het1Dl tem1tyaeatalu4 8IiOt10D8l cODd1t1ona etc
he atat18t1C~ 1fele C()4ed accord1Dg tomiddot the 1llli301fOCUS
of the Y18lt tt doe DOt 1D41cate the Dmlber of holies or
f8ll11lev181tecl or 1D41Y14ual Y1a1ted more tban oDcein
the propwl It dobullbull I1ve 80M 1D41cat1on by coaparlshy
OD ot the 8JIoUDt of aedlcal problema 1n eachcen8WI tract
Ap1nmiddot the _p abowa 8 scatter patteraof probl_
areas althoUSh there appear to be a sroup1Dl of hiSh J
l8aIeccmaus tract 1ntlut extreme southeast part of tbe
County other areu uIriaI any nura1Dl contacts are
1 bull he 801lth-oa-al CO1Dty on eaCh 814 of 82nd Av from Clackallaa County north to Dinloa
2 ear bullbullbullt 814e aroUDd Preacottand Misaisippi
Dowatom Bunul14eonboth 1de of the river
44
V_real Pis The iDfomatloil uaec1 to tabulate the Venereal
disease chart includes all the ooab1ned case otmiddotODormea
and syphilIs reported by bothmiddot publIc and prIvate physicIans
dur1nl 1970 There were 3602 caes ot IOnorrhea reported
dur1nl 1970 While ODly 17 cabullbullsot ayphilimiddot were reported
A chart was prepUed aDd att8llPt wasmiddotmiddot de tomiddot
determ1De Wh_therVttDereal 41ease was more p~vaJent in
areas othigb or lowmiddot proportIon ot youth hi waadone
bymiddotdetemlna a 1leaD prceiltacmiddotmiddotmiddottor the population ot
resld~ts UDder19 years ot (34) middotA mean ratemiddot per
100000 popUlatIon al80c1ttem1Ded tor the middotoccurreDCe
ot venereal dieae This was et at 390 oass Areas
hav1nl a population 1n which leiS than 34 were lmder 19
years ot ampIe were called low- yOuth abOve tbl percentaae
hiSh youth The aaa waatrue ot the occurrence oivenershy
eal disea_ per CeD8UStract It the rate waacomputed
as 1I0re than 390 cases per 100000 it was called hiah
venerealdiaeasei it less than thia tisure low venereal
disease It was tound that 1D Multn~ COmlty there sems
to be poSitive OOlatI0n(x21S19gt between low youth
and hipmiddot venereal diseaand hip youth and low venereal
diseasebull
RaDk ordr Iitot all c traot middottbAm made
Th1s was done byt1Ddlna the ratepr 100000 populatIon
of venereal disator all census tracts in the County bull
45
These were thenlisted from h1lhto low (sreatest to
least) in a rank order The l1sting was then divided
into Upperandlower 14 aDd listed on the MUltnomah
Countymiddot up
The areas of b1gh venereal disease se8ll18to
roup thBl~8 middotin a very tllht area ~oq both 1des
of thell18l8~ R1 w1th BurDaldeS~et being
~bout theceDter qf tbi8IZ9uping This area woUld
appear to be m ldeal spot for the denlopment of a
locallzed venereal d1sbullbullbullbull cl1D1c
UbepoundCUlO1s
In this report bull tube1C1llosls caS8S refrred
to include alltbobullbull cabullbulls ontubercUlo8is follow-up
rather middotthan just new C Accord1Ds to the Multnomah
County Health SUrvey of early 1971 this would include
all ca repOrte4 over thelaat three years The
total number of tuberculosi8 cabullbullbull usedin this study
was 666 lh1 included 128 new cabullbullbullbull
A rate per 100000 of tuberculosis for each
census tract wa- then computed and the c~us tracts
listed by rank order be b11h Qartlle mel low
quartl1 were then reoordd on a Multnomah CoUnty map
TWo genral areaa baY1Dg a hip mcldencaot tubercu~
losiare 1D41cated heyare
1 Both middotsld ot theWilla11lette River
Ll -
46
with Burns1de about thecnter
2 he extrea Northebullbullt comer of the County bull
By coap8r1ng the tuberculois an4ven8real
diseae maps ODe can 8ee that the downtown areas ot
hiSh 1nc1denceare alIIo8t 1c1eDt1cal on ach map
This WOuld 1nd1cate that 1t would be of value to
bullbulltab11sh acl1D1c 111 th1aampreatbat would provide
bothtuberCulos1s 8Dd ytmereal 418ase srvicbullbullbull
Thchart aDd 1181gt8 are wsfuln 11v1DI
1Ddicat10DS tor the type aDd placemeototlocal
health cl1n1c8 tbro1qhout tbe MultnomahCounty area
A cOllpar1on of the mapa help one to dec1dewhether
to provide a aulti-8ervice cl1D1c or spec1f1c type of
cliD1c As stated in Part I of thi paprserv1ces
shouldhaYe both treatlieDt and prfMmt10n cOmponents
As he been stated fta ne1lbborhood health care
Qenter muat be a fac111tY plazme4 with an aamesa
ot the neds of the consumer and the c01llll1m1tybull
Part II of this rport haa been an attaapt to indicate
and clarify 8011 ottheae coDlllUDity neds This has
been done through8elect10n of apc1f1c problems
The indic were then visuallyrecorded through the
use of ups and charta ODe dan asseS8 thedsreeof
1DIportance of certain concems to spec~t1c areaa by
comparinl the chart aDd maps Prom this oDeean
41 dec1de which are48 vb1chcUD1c-or indeed if
the need a clinic at all However further factors
should be considered hebullbull include
a The amount of fuDd1 available
b What 18 the percentage ot peopleineoh ceaaua tract tbat would actually us such cl1n1cIl
c Wbat 1 tbeco--1tymiddot 8 IeeliDashyreaardtDI particular cl1D1c8 Would this dcrebullbullbullmiddot the ettctiveness ot thse cl1n1ca
IJ
li
D_OlraphicPopulatLon Challie 1960 to 1970 48
Cen8U8 1 of Pop 1 Cbaqemiddot 1 Change1 ofPopTract Under 19 Yr8 Over 65 Yrs1960-70 1960-70
middot1Q701Q70
1 319 -12 171 -H) 1
2722 215-27 +68 301 366 -22 127 +35 302 371 +19 111 -04
311middot401 144-41 +29 402 321 13~7-39 +24 501 356 124-08 -02 5~O2 351 133-23 +12
405601 82-10 -02 394602 103-01 -06
701 275 149-76 +56 702 361 +01 121 -07
+10middot801 326 140-22 802 321 middot127
(
-29 -03 9~01 342 124 -H) 6-18 902 294 128 -H) 3-24
10middotmiddot -14312 140 -17 1101 182 +25 -23197
2411102 186-59 +29 1201 226 169-17 -41
31middot01202 +11 182 -05 295 -H) 81301 208 -H) 4
1302 331 +08 197 +04
14 323 +15 middot185 -08 middotmiddot15 329 +16 16~5 -13
-28middot 1601 332 131 +12
1602 356 98 +24middot-39 middot3101701 161-33 +21
1702 370 -15 85 +02 +19 1801 264 151middot-50
185middot1802 256 +47-58
IJ ~
D_raphlc Population Change 1960 to 1970middot 49 (Contd)
4io
Census Tract
of pop Uncter 19 Yra
1Q1n
1Cha1l8e 1960-70
of PopOver 65 Yra
lQO Change
1960-70
19 389 +29 141 -24 20 223 -13 206 +18
21 227 +08 194 -36 2201 356 -27 112 +05
2202 290 -18 ll~9 -29 2301 356 -03 154 +24 2302 260 -37 245 +97
2401 410 +6~1 123 -31 2402 163 -80 320 +99 2501 381 +13 140 -01 25()2 237 31 lil +02 26 343 +25 186 +149 2701 370 +29 1S5 -01 2702 249 -44 304 +98 2801 337 +19 187 +09 2802 306 -10 156 +31 2901 304 -38 142 +24 2902 i 307 -32 146 t3~9
30 29~0 -48 16~2 +51
31 355 +30 160 +01 32 370 +48 148 -13 3301 395 +45 130 -20 3302 368 +06 138 -02 3401 386 +16 117 000
3402
400 +32 92 -26 3501 304 -07 115 +35
3502 344 000 140 -13
3601
36~02 357 -04 132 +32
3603 30~1 42 149 -67 3701 342 +28 152 +19
1
IJ
Jianolraphic Population Chan 1960 to 1970 50 (Contd)
Census Tract
of Pop Under 19 Yrs
JJl7J
middotChanae 1960-70
middotofmiddotpop Over 65 Yrs
1c~7n
Change 196070
3702 409 +39 122 -11 3801 308 -11 151 +29 3802 275 -35 180 +46 3803 282 -32 192 +54 3901 376 ~13 100 +17 3902 296 -03 177 +29 4001 438 -11 84 +13 4002 353 -21 115 +20
4101 397 11 9middot0 +11 4102 346 -19 120 +03 42 331 +19 11 bull 3 -16 43 347 -72 105 +31 44 113 +84 183 +154 4S 33~9 +07 110 -06 4601 2501 22 193 +38 4602 332 +59 126 -29 47middot 161middot 000 211 +01 48 103 -26 302 +59 49 138 +1 bull 3 252 +09 50 141 -26 204 -12 51 12 -39 257 +07 52 47 -61 351 +48 53 89 +49 314 -30 54 25 l1li15 327 -17 55 131 -17 115 -121 56 198 +93 227 -47 57 71 102 189 -88 58 240 ~middot41 16~1 +55 59 322 +25 142 +06middot 6001 264 95 132 +50
6002 328 -31middot 89 +07
JJ
Demographic Population Change 1960 to 1970 51 (Contd)
Census 1 ofPop lChange of Pop bull ChangeTract Under 19 Yrbullbull 1960-70 Over 65 Yrs 1960-70
1970 1970
61 355 -58 85 +39
62 328 39 110 +18
63 414 04 73 10
64 382 -22 72 +04
6501 383 02 67 -20
6502 329 -56 96 +09
6601 391 +13 88 -03
6602 319 -59 97 +06
6701 327 71 145 +72
6702 331 ~67 83 +1-0
6801 365 -66 49 +01
6802 388 4bull3 54 +06
69 354 -41 80 +23
70 400 -23 68 -06
71 359 -48 72 +05
72 255 -88 82 +11
73 346 -39 91 +25
74 313middot -63 105 +24
75 329 -42 129 +37
76 336 -52 85 +21
77 370 -10 69 +05
78 309 -10 120 +21
79 325 -56 87 +10
8001 358 -81 57 +12
8002 391 ~81 76 +12
81 315 -76 108 +21
8201 403 -23 64 +08
8202 392 23 65 +08
83 357 -34 120 +31
84 402 -18 73 +16
85 413 -06 76 -09
r
Demographic Population Change 1960 to 1970 52 (Contd)
Census Tract
t of Pop Uncler 19 Yrs
1970
Change 1960-70
1 of Pop OVer 65 Yrs
1970
ex Change 196070
86
87
88
89
90
91 9201
9202
93
94
95
9601
9602
9701
9702
9801
9802
99
100 I
101
102
103
10401
10402
lOS
368
351
379
391
391
413
379
433
372
429
414
432
419
439
~32
377
457 420
378 41middot7
345
360 417
417
412
-04
-02
-35
-26
-28
-11
-64
-20
-S9
-39
-32
-21
-34
-40
-47
-lO~7middot
-27middot +04
+56
+07
-34 01
+04
+04
+10
103
128
97
11il3 99
69
79
42
77
46
34 38
44
40
54
111
51middot
81
133
59
74
140
63
87
76
-08
-06
+04
+08
+17
-05
+3S -02
+1~4
+19
+33
-14
-08
+12
+26
+71
+11
-16 -34
-20
-19 +37
-49
-2S +15
NOte The The
Taken frOi
averageullder averageabove
middotUSCensus ---shy -
19 years == 6S years ==
figures 197
32r 13(14
p a~d 1960
--
Rank
1
2
3
4
5
6
7
8
9
10
11 12 -_
13
14
15
16
17
18
Tract
69 46
60
58
- 68
61
302
2501
67
63
19
62
26
94
3603
3902
64
30 -----~-
Rank
19
20
21 -
22
23-shy
24
25
26
27
28
29
30
31
32
33
34
35
36 -
Ranking of Per Capita Income by Census Tract
Tract
65
2701
- 15
1601
701
66
93
82
2903
3602
30
2502
80
2401
81
- 70
91 shy
4001
High
Rank Tractshy
-32shy37
38 97
120239
7840
41 ~ _2_1__ 42 31
43 2501
44 18
45 98
46 37
47 3803
1702
49
48
1602 92 2702
I
50 89
51 901
52 801
Ra_
53
54
55
56
57
58
59
60
61
62
63
64
6S
66
67
68
TractTract Ra~
74692
170196 70 I
401 71 90
72 1037J
79 70273
3802 74 601
24024102 75
85 76 101
77 9023901
7699 78 100 4101 79
3601 I
380180
458140~ t---- _ - - shy83 82 42
888384
59843501
4777 8~
502
Low
802 86
Rank Tract
87 shy
--88
89
90
91
92
93
94
- 95
96
97
middot98
99
100
101
102
103
104
1201
14
49
72
73
43
87
3502
105
1
52
86
71
1
501
10
3301
104 tf
Rank
105
106
107
108
109
110
III
112
113
114
115
116
117
118
119
120
121
Ranking of Per Capitalucoae by Census Tract
(Contd)
Tract Rank
4001 122--shy602
13
1102 2302
3302
55
3401
48
21
56
50
3402
lL01
2202
2301
53
2201
-shy
Tract Rank Tract Rank T~aet Rank
57 I-----
Imiddote
bull
Tract
- Low -k Note Information taken from 1960 U SCensus
Rank Tract
I ~
Ie
Imiddot
~
----
----
--
--
Rank
1
2
3
4
5
6
1
8
9
10
11
i-
-Tract
391 922 921
972 971
100
132 131 121
962 961
822 821 401
982 981
20 111
47 10 1
412
High
Total Number of Henta1 Health Visits
Ranked by Census Tract High to Low
TractTract RankTractRank Rnk
12 182 22 78 29 87 76 381 73181 ~------- 1913 371 8538230162372 271 2616-121 8272 2
14 80~2 31 94 7923 84801 59 15251362 4232 15 52 _ 32 103 8924 651 17240216 652
_ 91 351 33 341 23117 83 122 25 25 48 1123921418 34 shy61 86 661
19 662 6493 81 26 91 8153 49 50 55 41383 71 27 51 3120 90 672241 35shy 104167162 461
I 411 46211121 28 88342 I
2502 36 69 54 5251 50 272
-Ra
37
38
39
_ 40
_ 41 Ishy
I
42 I
-I 43 44
45
shy
Tract
~ --- shy 95 56
45 292 242
102 62 352 291y
92
101 281
99 72 63 601 60~ 42 2201
77 74 61 57
363 232
70
32 31
11 44 282 2202
Low l
- Tract
46 682 681 I 331 30
r~$ 47 1042 332
48 102_41_
11
~
Visits to Family Planning Clinics Ranked by Census Tract High to Low
Rank Tract Rank Tract Rankmiddot Tract Rank Tract Rank Tract Rank Tract
1
2
3
4
5
6
7
8
9
10
11
12
13middot
14
15
16
17
361
56
401
341
48
59 121
20
55
342
10
31
58
93 21
241 132
331
53
461 462
18
19
20-shy21
22
23
24
25
26
27middot
28
29
30
31
32
33
391
32
middot47 I-i-_-shy _ -
231 111
332
972 1
372 371
52
89
32
92
82
100 31
182
30 242
402
34
35
36
37
38
39
40
41
42
43
44
45
42
1714 i 661 221
78 362 2
90 602 601 352
63 251
105 921
971 351
73 42 292 232
411 51
662
81 45 52
46
47
48
49shy
50
51
52
53
54
55
56
961
801
49 81 72 71
19
9~1
172
68 2 57 162 14 112
91 75 681
381 42
3~3
83 161
57 f
58
59
60
61shy
62 Imiddot
63
Imiddot 64
65
66
64 62 36~3 252
74 652 SO 392 291
651 6bull 2
79 271
r-- ---- shy981 222
672 671
821 272
94 87
281
382
67
68
69
70
71
72
73
74
75
76
77
78
981 26 12~2
IS 61
85 82~2 69
61 43
101 86 84 282
76
131
51 72
1041 962 88 70
99 922 77
103
95 802 181
i
~
Low High
RankRank Tract
5479
4480
81 1042 ~) middot102
71 - - + ~ - ~
Visits to Family Planning Clinics
(Contd)
Tract Rank
I
Tract llaDk l
RankTract Tract Rank Tract
~
I
~
J1 ~
Low
Total Number of public Health Nursing Visits
Ranked by Census TractsHigh to Low
TractTract RankTractRank RankRank TractTractRankTractRank
25249 71 79 17249 8033 6586 99189711 84 2915072 34 661 76 66 811519512
402 5035 51 161 2518220 122 1713423 352 55801 7120 6752 2 149814 41236 83 2662 38 94 6821 53 2924015 362 37 32 42 75 69 281 84 63
546 8822 54 222 85 3925431 70383417 3818223 6439 4386652 718 21 55 103332 8924 232 87 19 271729219619 24156 16211140 382 628825 10523110 112 73411 10141-- ----shy 89 363 4457 8126 16111 221 74 9142 90 46158331 53 671279012 46243 48 59 351 3837528 1083 9313 91 5844 59 -_242 76 1----- shy60 272 72 74104114 60145 42 9287 7729 92 6151 8215 57371 934630 91 307762 12113116 282 619447 41391 9531 78100 63 7378 ~95 681 6945 32 5632 798517 6448 47 52 181
High ~ Low
Rank Tract Rank
96 31 132 70
97 102
98 182 372middot 602 651 662
- -shy
~72 682 802
822 922 962 972 982
1042 ----shy
Low
Total Number of Public Health Nursing Visits
(Contd)
Rank Rank Rank TractTract Tract
I
I lt
I
Tract Rank Tract
[
~~~-
I
~
IJilfimiddot ~
j
Ranking of VD Caea According to Census Tracts 61 By High and LOll Youth Itatio
A media~ of 34 5 was determined Any tract having greater
than 34 5~ of popu1tionunde~ 19 years of age -High~
Any tract having l8S than 345 of population under 19
years == Low
Any tract having rate less than 390 =Low
Any tract having rate more than 390 == HLgl4
YOUTH
LOW HIGH
L
0
12 402 1801 1802 343 2801 2802 29023603
54 6001 600262 66~02 72 74 75 76
78 79 81 t02 65 1202
W
(25)
VD
H
I
G
H
401 701 801802 901 902 10 1101 241 1201 1301 132 14 15 1601 1701 20~ 21 2202 2j02 2402 2502 2702 2901 303501 3502 34023801 3802 383 3902 42 44 45 4601 4602 47 48 49 SO 51~2 53 55 56 57 58 S9 6701 6702 73 95
3~02 7021702 19 25~01 2701 4102 4101 63 64601 ~601 6801 680270 7l 77 8001 80~02 8201 8202 83 84
85 86 87 88~ 90 91 9202 920193 94 9601 9602~ 9701 9102 9801 9802 99 100 101 103 10402 105 6501 10401
(47)
301 501 502 601 1602 2401 2301 2201 31 32 3301 3302 3401 3402~ 3602 3702 3901 400140 02 43 61 69 B(
(53) (23)
~ ~gt
Ranking of VD by Rate Per 100000 By Census Tract
~
Rank Tract Rank Tract Rank Tract Rank Tract llank Tract Rank Tract Rank Tract
1 2202 21 S6 40 902 58 1602 74 75
90-shy 64 107 26 --~-
2 3402 22 45 41 10 59 902 75 78 91 54 108 61
3 2301 23 3502 42 2502 60 602 76 6802 92 402 109 87
4 3302 24 49 43 1102 61 501 17 2 93 94 110 90
5 50 25 52 44 6702 62 14 78 8202 94 97 02 III 76
6 2201 26 20 6701 63 4002 8201 2501
9701 41~02 112 91
7 44 27 48 45 401 64 3802 2902 95 63 113 62
8 3301 28 1701 46 502 65 30 79 83 74 96 9602 114 71
9 55 29 47 47 42 66 3803 80 2801 96Q1 115 85 10
11
12
13
14
15
16
17
18
3401
53
2302
2401
57
21
2402
1101
51
30-shy31
32
33
34
35
36
37
3701 - -~ 1201
3702
89
43
132 131
3602
4001
48
49
50
51
52
53
54
55
58
1601
601
4602 4601
69
701
31
3901
67
68
69
70
71
72
2901
801
39021~ 802
6502 6501 122
702
41~01
81
82
83
84
85
86
87
88
19
1
1702
2802
79
93
100 6801 6602
81
97
98
99
100
101
102
103
104
9201 9202
9802 9801
77
302
79
86
72
84
116
117
118
119
120
121
3603
8002 8001
101
99
95
10401
105 10402 103 102
19
20
59
32
38
39
2702
3501
56
57
301
3801
73 1802 1801
89 6002 6001
105
106
2701
88
High Low
-- -----
Rank OrdermiddotTuberclosis Cases by Rate Per 100000 Ranked by Census Tract High to Low
Tract TractRankTractRank Rank TractRaukTractRankTractRank
801
79 9601501411 52 6835340120511 I 960269 903603532036 $-~~F130221542 4366 311301 70 68~013802 _ I- _ 4001_37213 3921201 6802802 H71523822024 22 54 193302 3802 80 8958 I37139535 70155 9801 I60123 72 6702 98023914011016 6701250124 10 56
81 94 401r 7 154152 73 7057 2625 122 92028
90242 162312301 92~158 86 7172434526509 82 79160159 74 100 87412240227220110 6502836960 75 30 8317244 6501782801285711 61 901 42765645 84 66021459294912 9701 660146 171 302 9702 47
6235023033113 85 822821182 917755 16335013110214 841814832 78 103 938564 324815 86 1057940149272 38036523216 10401 87 2902241 725Q 10402360266340217middot IF88 88 9937233 282 51 218 101 01102 46016234
I)167 2901460219 47
High ~ Low ~
- -
TractRank
9S89
6490
8191 8001 8002
63 61 60middot01 6002 44 2701
92
J
2502 402 --- ----shy
I
Rank
Rank Order Tuberculosis Cases by Rate per 100000
(Coutd)
Tract Rank Tract ~nk
I
Tract Ballk Tract Rank
Imiddot
Tract
Imiddot
1~
t 1I i Pi i l I
o
1 -1shyL I
I J
8 40 icO ~ I -lt 0
-t (1) I
i I
r o E
II
a
I
r--i
shy
I
~
I (
Jgt
(011 fi(
Ggt
I II ~j
()
(f 0
~ ()
I
11
f9
r
II 99
o ~
Ggt r
~ __-J~ I t I ~ I
r--J l I
~ _ __ J
) 1
fTl
1gt
r I
()
r
()
lt en -i en
()
I1l
(J)
(J)
-i
P ()
19
r o ~
r G1 I
I
c
~
o I 89
--- -I-shy
r-r I
1- 0 _~ _ _--J E
G1 I I I
i i
I 1-1-1 ~ _J ~2 ~ II
II
()
1 I I I 1
id i bullbull
~
A n 69
r 1shy
- 0 Gl
l--~ ~ I
~ II
II )
I () isect i
en l i
(J)
-t
0
IA Ol
I ltllYd
-
5
~E
Evaluating the Health em Sxatem
~ (8 pp1-2) has 1nc11cateda number of the weakshy
nessea of thepreaent health care system in this nat1on
She c1 tes risDs coats iDadequate pooriy distributed
and 1rietf1ciently utilized manpower andtrapented
service delivery a8 ma3or problema and state that The
systeiD 1swaste1ll otreaourcea andfunctions W1th too
11ttl reprd tor U1ci8Dcy aDd aCoDOIIIY
Shepo1Dts out
hoWever tbattbere are tour points regard1ns reform Upon
which there is widespread agreement Firat she states
IIaccesstoneede4 health emces must not be 1mpeded by
t1DaDcial barriers II BersecODd POint1s that bull bull the
continuoua health sernceare eftryw2ere ava1iable under
cond1t1ons that are physically conveDient comfortable
anclnot destructi to the d1lD1ty or selt-respectof the
recip1ent b1rd it is essential that the health care
syst8lll Iie due reprd to ecODOIIIY 1D the use of scarce
resources providtDg services with eff1ciency Finally
the system must be accoUDtab1e to those who tiDance it
and to those who 11IIe 1t and in particular must be highly
responsiva to the interests of coD8Ulll8rs II
Gre8Dlick (18 p756) also prQPoses a set of princ1shy
ples which can be used to naluate the ed1cal care
system ae states tint that bull bull all those who need
medical care shouldhave equal access to 1t second
(
6
bull bull the sernce prortded ahould be precisely approshy
priate to the pat1entl1eedemiddot ft and tb1rd bull bull the
med1cal care ayatea ahould provide the lOst eff1cient
and econoa1C8l use of scarce IIe41Cal resources
orthepurpoesof tb18 report certa1not these
crtteXaw1l1bestreaae4 lION tbaD others The rema1llder
of PaXt I Will renew the l1teraturerelating to the issuee
ofcomprehenaivene8sof ervice access1b111ty ot serv1ces
aDdett1c1ency oten1ces 111 tbedel1very ofdecentralized
medical car
ratCopcept of C_ Beal1h care Asd1oal tecmolol1 bas advanced a process of
evolution basoccurred inthe aed1cal and health t1elds
As JOhDsoD (21 pp~361-363) etamptsmiddot bull the goal of
healtb carelD our society baa evolve4trom rel1ef of
ajmptolU to ~ otdi toex1steDce in a potent1ally
diseaselessstate C1t1Dl tbelJm1 tat10DS in health care
resources and presenttechnololY he cont1nues to state
that The resulting cbal18D1e facing the Amer1can health
serncesystem is to provide each 1D41Y1dual with the
sreatest possible opporturnty toach1eve an optimum level
of phys1cal Jl8Dtal amd so()1alwall be1Dg
to
reter to the type othe81th care aystemwh1ch attempts to
answer tb1s cba]] and fult111 the three principles of
1
access1b11it Prov1UOI1ot appropriate services and
eff1cient use ot middotre80urc He state that a IYStem ot
comprehensive healthmiddotmiddot care 1DmiddotoXder to apIo middottbe stated
principles fD lleetiDlita 1Oalttst havemiddot certain
attributes
1 middoteare utdbeollW~ItaC1~orpn1zatlOM]ec ~ bull p~~ol1calbarriers IlU8t be removedbull
2 bull Care abould ace he~ecl1merlt8 ot distance residttiiCemiddot tille must be removed
middotcare8ho1ll411eC-r0WIZ the Ufemiddot span it diseases eapec ychronic are to be controlled betoretheybecome disabling or lite threateD1Dg
4 CeresboUd be~teJ1nCludlJ1C p~vention cure ma1ntiDiiCeand rehabI11tation
5 Care aho11l4be~i9_ttIa1t1ephyaiolol1ca1 aD4 pay1Fci1~cTrIS-ticot the pat~ent
6 Care aboul4 middotbe9L~ tJwrefore shouldbebu11t aro~ middotslJOc1al1natltutloDs which relate to the patients Way of lite suCh as middotthe home school and place of work
7 bull Carellbolld be m-ar and therefore shoUld bemiddot provIded ~Wliils where responsishybiUty tor the patient bas beendetem1nedauthority has been delqated and a communishycation syst_ provided
s care slIould 1Ie HIl 1nclud1Dg theintesratlon ottac1~1ts~ ~prsOllDel neceaary tor modern medical care
9 bull care dbe Of hip ~ eresboul Th ahouldbe aD adequate audit 0 care pee~ reviewcoDtlDUDI naluatioDBnd research intomiddot adequacy aDd quality
Ult1ately as 1Dd1cate4by the Nat10Dal CollllDisshy
8
sion on ColDJIIUUity Health Service (26 pp 1~20) the
c1evelopmezat of a ampyt of comprehensive health care is
a cOlDJIIUUityw14ere8pODSibilit1 1nvolviDS the integrashy
tion of all the health care facilitie and programs in
the cOlDJIIUUity or the c0arcm1ty8 healthc~ system
the PamprqlOIIlt goal ~
PrQv11~ of a ~rehive ~e 9tcoaaun1ty health aervicea
2 Ma1DteIlace ot aD a4equateqUaDtity ot al~requ1re4 health care facilities
Iritsrat~oDof ~v1c1ualUD1ta and s1steas ot bealth aerviceinto a coordishy
natedpattem ot continuous care tor theindiVidual
HoWYer aYerby (37 t pp71-72) 1Dd1cate the
med1cal and health care 81atmiddotaa it ball t1nct1oned haa
not facil~tate4 the delivery ot COap~usive middothealth
care IDcl1Y1c1ualhealth care facilitie themaelve havemiddot
notg8D8nally tuDcU0Af4tOach1eve tbi810al pUblic
health departaent 11) prond1q prev_tive services and
$1Ch trea~t activities aa are involved in venereal
disease or tuberculois control have in general avoided
1Dvad1Ds the curativedoma1Dotprivate mediCine Th1s
haa even been cabullbull1DareaawherelI~cal care is not
readily availa)le except throUlh hoepital outpatient departshy
lDent8~ Aa he 81IIet mothealth departaaents have tailed
to proVide an adequate _try point for the patient 1Dtothe
diapoatic and curative a bull t of tile health care aystell
This may be particularly true tor the pOOr patient who may
9
b_dloallYUDaoptdatlcaW4lberefore th past decade
babullbullbull~ bull lIOYeaeftt to evolve DfW torms ot health care
and new types ot health oare institutloDS providing
comprehensive oDlOiDI care rather thaD trapented care
There seems to be little dispute in the health
aboe requ1res both an lDtesratloD ofprev1ously uncoo~
ditultec1 health care ervlcbullbull brlDSins tolether into one
alency what Johnaon (21 p362) reterred to as bullbullbull the
concepts ot cOllPrehms1veIled1C1ne andpos1tlve health
andaporpph1cclecctrailzat1on ot ervlce dellvery
he NatlODal CoimD18810D0D CouD1ty H_81th Services
report Health Care gilitis (26 p37) suggests
proYic11Dl compreheDaive health care services by centrashy
llz1Da a varlet ot publlc and prlvate healthcare
tacllities 1ntohealtb campuses However as Kahn
(22 pp274) states amppeskin ot soclal servlces in genshy
eral bullbull bull if the loal ls to develop a service-delivery
approach that improves access taclltates teedback 80 as
toadapt to user preterence8nd prlorlty and maximizes
case 1nteptatlon aDd accountabl11ty the base of the
total 80clal service system Should be tnthe nelSbborhood
Dec~tral1zatloD not only makes services IIOre accesslble
but allows therv1ce to be tailored to the Deeds of the
10
areaDe Diaz (14 p3) indicates the importance of
being aware of groups in the neighborhood with special
health problems such as elderly people or large families
witb yOlmg children This means that it is important
in planning to be aware of the demographic features of the patient population This will be considered more
thoroughly inPart II of this report
Kahn (22 p275) continues however to indicate
that more than the improvement of service usage is I
involved in decentralization and that decentralization
ot service delivery also represents part of tI a general
search to break down cities to human scale for some
purposes on the assumption that people find it easier toshy
relate to a neighborhood orsection and to its populationbull
bull bull bull Thus the organization of services at the neighshy
borhood level bas the added purpose of contributing to
the search tor neighborhood n He adds that this process
i8 more relevant it there is a measure of local control
over as well as local availability of services
Kahn indicates that decentralization is not a
viable goal in some circumstances These include situashy
tiona in wh1chthe need for a particular service is too
TJI t
-
11
little to justityits proVision in a l()calun1t where
skills or resources are too rare to be provided locally
or where the costs ot decentralization vastly outweigh
the benefits He Visualizestheult1mate emergence ofa
h1erarcb1c81 patternofserv1ce delivery tnwhichcertain
services andresp0D81bilities are middot1ntegrat8d1Dto the
collimun1ty at thelooal level Other more specialized
services relate to larpr un1ts of the colDlllUD1ty such as
eomb1nationa ot neigbborhooc18 Veryspecialized services
are to be delivered at city countystateop regional
level8 fh1slevel would al80 be the seat ot prosram
coord1zaat1on staDdardprotection and evaluation 811
of which call for cons1deZable centraliZation for overall
program adm1 nlatrat1on(22 p275) AlthoughKahnt s
model was not developed specltlCally tor health care services 1t1s quite relevant- and appliCable to health
care service delivery systems
Omiddot Donnell (27 p3) reviewing the 1iterat~e on
service delivery and social action through neighborhood
service centers preseJJbB a list of characteristics
generallydesirable in ~eighbOrhood service delivery
centers Firsthe states that the center should be
accessible It should be in a physically convenient
location and should be open evenings and weekends as
well as providing at least em~rg8ncy telephone coverage
t
~ II
12
24 hours a day
The center should als~ be irDmed1ate in 1ts funcshy
tioning That is the centermust have the capacity to
provide prOmpt efficient service and should be able to bullrespond to problems middotwithout long hours ofwalt1ng and
many rounds of apPointments
The centexsservices should be 6omprehensive liThe
center should offer a full range ofusable oil-the-spot
services or easyaccess to other resources by available
transportation It should gear itself to the needs that
peoplehaV8-especially poor people-and provide for the
slmultaneoushar1d11ng of problems were possible
SerVices should 8180 b 1J1tegrated and coordinated so
thatseMces can more effectively be provided
The operation of the service center should fInally
be responsive to the needs and desir-es of the neighborshy
hood It should provide ways in which reSidents can
shape th~ program and continue to contribute to its course
and development It should be relevant and ready to
respond to changing needs II
The concept of the comprehensive neighborhood health
center developed by OEO (31 p324) has been described by
severalwriters Yarby (37 p73) describes it as an
outpatient racility which has certain def~n1te characshy
teristiCS middot1 Accessible to a poPulat1on concentration
bull 13
2 Open 24 hours a day seven days a week 3 Family-centered c~e by a team of lnteniists pediatricians clinical and publichealthnurses and social workers 4 Availability ot frequently~requ1redspecialist in such fieldsaspsycbiatryobstetrics gynecology surgerY5 Con~1nu1tyof doctor-patient relationshyship 6 Family records with social and medical ~raquomDaries of relevant information about each family member 7 Basic diagnosticlaboramptoryand x-raytacl1itles and drugs and biologicalsavailable atthe center 8 Directline (1)y center-controlledambushy
lance when-necessary) to ateach1nghospltaifor cl1agnostic ~d therapeutic servlcf)srequiring the fa011itlesandpersonnel of thehospltal 9 Patient-cantered and eommUn1ty-oriented -
The range ot services in the comprehens1venelghborshy
hood health center shouldbe as complete as possible
inCluding preventivediagnost10 treatment and rehabi-
litative services and Sbouldbe deslgnedto eliminate
episodioandfragmented services (31 pp324-325) Schorr
and English (33p291) add as additional characteristics
ot the compr8henslveneighborhood health cent~r that it
should ~ve intensive participation by and involvement
of the population to be served both in policy making and
as employees and that it should be fully integrated with
the existing health care system The Office of Economic
Opportunity (28 p63) stresses the potential for easing
health manpowershortage$by trairiing local neighborhood
reSidents as non-professional health aides at the same
time creating new job and careeropportunitles As
14
Gordon (16 p bull 422) indicates Many of the outstanding
problems in medical practice todayrevolve around
effectively motivating the patient and the prospective
patient to be concerned with his health This is
especially true in a deprived environment The community
health center with its technique ot consumer partici
pation maybe a way to create this cooperation effectvely
It is important to note at this point that the
comprehensive neiShborhood health center haaas its
constituency an integratedmiddot community r~ther than a
particular segment It should haveas Blum and Levy
(6 pp~5) indicate a horizontal rather than a vertical
relationship with the commuriitybull The vertical relatlonshy
ship they state is characteristic ot those service
organizations wh1chapproach the community only in terms
of their own fUnction Tbey see only their relationship
with the users of their service and assume that problems
of accountability will be handled by these consumers
However they pOintout this ienot likely as a vertical
approach creates dependency onthe institution Agencies
in a horizontal relationBhllp recognizetha1 they have
both acommunityand a consumer to serve The horizontal
approach places the matter of accoUltability on a broader
basis than just the involvement of the consumer De Diaz
(14 p4) speaks otthe need to ~develop a community
facility which difters from a clinic for low income
1ji ~
15
people in that it should serve an economically integrated
community The reason for this is that a wide variation
of consumers may assure a better quality of care
The advantages of the comprehensive neighborhood t
health center over traditional systems of providing
commuruty health services are numerous Hospital outshy
patient departments a major traditional source of ambushy
latory health c8refor poor patients have been indicted
for neglecting preventive health care ~romoting fragshy
mentedeare and subjecting patients to degrading and
impersonal conditions to mention only a few of the major
defects (31 p324) Another defect has been the
tendency to shunt low income patients back and forth
between different cliniCS often at different locations
arid with differel)t open hours for different treatments
or tests in regard to the same lllness(26 p63)
The comprehensive neighborhood health programs that
have been organized present a great variety of organishy
zationalpatterns one area of difference 1s in the
emphasis placed upon making each faci1ity comprehensive
in the services it provides to the patient population
In the Montefieri Hospital Neighborhood Medical Care
Demonstration program in New York City services have
been made available through a central health center and
two store frontsatellites the center to be the base
bull
Li
l of opratiol18 of ta1lJpIlflicl- ancl the satellite
center the ba of oparat1oDa of public heaJth nurses
an4 nllbborbood amp1 be satellite centers wereto
proVide preVentift tutaltll bullbulln1c1-m1zaticms w811shy
baby care per1od1c ~ectiland tJle central health
center to proViAle care tor illnes If (36 p299)
bis propWI VUDOt ~ttullytunct10DIDI at the t1JDe
it d1cu8ae4 18 tbe Uterature aDd all aernce Were
be1Dl provided 1D_~terBowever itwould ae
tbat the ntua1pro~ as aY1ioae4by its plmmers
would boclJ aoaeot bull 4efeot~ otthe current lud1cal
ccde teaIt pObullbulllne_t coorctJl8td admSDtshy
etration eD4 well 4eftlopecl refelTal procedtlreacould
1I1a~ thecOllDeCticmof t~_t8 withappropr1ate preTellshy
t1 aD4 therapeu1ampcaen1cbullbull aV81lable 111 diffrent
locationa Bowner tile barrieraottiaeaDdUatanc
between center and truaraUon tor the UDSopb1aticated
patieatlook1Dl tor 1her1~pJce too tor ~1CU-
larhalth serfplusmnQewoGl4~to JJa1t tbbll1ty o~
tb18 ~811D to provide iaaiYCOliprelleU1P18hboltleod
health servicebullbull III tactmiddot tappeareto coDtlict with
tbepro own taW cOfdotpro-1~a tam1ly
mecl1cal careprogru 111 wIa10h pre-teAtlYe aDd therapeutic
health erY1cecan be proY-lW to all IIl81Ibers of
tamily in the coure of aaSDll vi8it (36 PP301-3(2)
Dle Delmtr Coloradoprepa11ke the Montet1ori
LI
17
prograJlut111zbullbull abe1rarcJly ot SlDa11 aatellItestations
andlerer IIOreceDtallzedtac11It1es It 41ffers
howeverill tbcolap~81vene80f the services avail shy
able Inthe 4ecentraUzed facIJJtiesIt resembles very
clc)sely the IOdel ~ordecentral1zed social servicedell shy
very developed by 1ahII~ Which was 41sCussed above he
SIlall neImiddotgbborhoodmiddot c8Dt~aw1tb1n walkl distance of
most of the populatiotl havebeendesilDedto take care
of allthenorllalhealth probl of 3000-5000 patJentsshy
check-ups IlzatiOZl8s1Jlpl laboratory testa and
treataentand iaecucatlol18 (d1apeued by phyS1cians) for
IIOst DODCrltIcal 1l11le PatIent 1d1Oneed IIOrespecIal-
Ized care are reterrecttobacJalp facilities BaCkup
support tor themiddot~t1oDa are the tWo l8rsernelshborhood
health C8Dter8~ttr1Dl aCOglete~e of out-patient
serneeaDd three part1clpat1q hoap1iampl bull bullbull which
proVide1Dpat18Dt~t andcoDSUltatlve services
(13 p1028) Intb1a prosrama coaprehens1ve range of
prevent1ve aDd trea1aeDt serric 18 aVailable throughout
the decentraUzed middotta The CoapreheulY8 ReIgbborhood Hea1~ Service Project
otKa1er iC)UDdatlcm HOspitals 111 Portlan4 OreOD 1s
s1ll11arto th DenVer prosraa 1D thata comprehensive range
ot out-patientmiddot services 1D prov14e4 in each of 1ts 10cashy
t1oDa althoUlhmiddotmiddot tbe oentera are larger and l bullbulls DDIerous
than 1nth DenverproPUh (12 p6)
Li i
18
In order that a comprehensive neighborhood health
care center be able to proVide continuity of care it
must have arrangements for hospital services integrated
into th system Yarby (37 p73) as quoted above
states that it 1s characteristic of the neighborhood
health center to be directly connected with a teaching
hospital However De Diaz (14p3) indicates that it
may be advantageous for purposes of service delivery not
to havemiddotthe center affiliated with a teaching hospital
She feels that such anaft11iation may lead to asltuation
in which policies might be determined more by the teaching
needs of a medical school than by the service needs of
the patient
middotThe Nat10nalmiddotCommissionmiddoton Community Health Services
(25 p69) states that such a system of comprehensive
health care integrat1na ~e servicmiddotes of several health
and roedical agencies snould utilize Itas much single or
unified management as possible Neighborhood health
centers have been operated under a variety of auspices
but several writers have pointed out the advantages in
termsof coordinated prOvision of servictts management by
the hospital of the neighborhood health center For
instancethisfac111tates the keeping of unified medical
records of all the care a patient Msrecelved either at
the neighborhood health center or _le hospitalized
(12p6) ~ermore a3 Young (38 p1741) points out
19
direct operationot the u1sbborhood health oenter by
the hoSpital canll8lceaftilable to the center expertise lt bull
in sOlle aapcta 0 Operation that m18ht not be aa readily
available otherwie
Relardlebullbull of wbetberthe hospital and the neighborshy
hoodhealtbcent8r haVe a cOJIIIOaadmjntstration they
IIlU8thaVealTlved at a str1Dsent delineation of IDUtUal
role and reSpoDBlbilltiebullbull All OOIIpoienta ot the care
yst IIlWStQlarify and understand one anothers position
In the syatem and acree on objeCtive ancimethOds
(26 pp16-17p31) SODae areas of iDUtUalconcemare
reterral procedures record keepiDg aDC1 mutual use of
facilit1es statt1Dl i8 anotb8r ~ ot coaaon conc~
Ditt1cultift have u-laeniD the pastiD cOllprehensive bull t bull
healtbc~ prosraumiddot 1d11ch were batil plauned in wb1ch
all of the health canter phy1C~1IDa did DOt bavetatf
privilege at all ot thebackuJlhospltala (29 p21)
SUch a8ituat10n i8 1Dampcceptablelt inpatient care i8 to
continue to be p4by the pat1eatmiddot health center
physician and it cont1Du1ty ot care 18 to be maintained
Hoapital and health center1lUSt laav 301nt responsibility
tor the recruitaentot physicians
VticlentU IPan BJcNrcu Much otwhat haa b8ea sUd has stre88e4 at leastmiddot
iJlplicit17tbaD8ed tor tM etticit middotprovision ot8emcea
20
There appears to be two aspects of efficiency which are
discussed by writers on the su~3ect of the comprehensive
neighborhood health care centef one of these is the
need to organize) services to make the most efficient and
economical use of scarce medical care resources The
other closelyrelat8d in realIty is the need to help
the public use services in the most efficient manner
The comprehensive neighborhood health center concept
1s lhherentlymiddot efficient in that preventive curative and
rehabilitative health ~are programs are coordinated under
one roof with integrated a~stration Furthermore
theempbasLson prevention health education and early
disease detectionis eftic1ent troJll~estandpoint of
the health care system as well as beneficial to the patient
(18 p760) HQwever ~ue tothe scarcity of health care
personnel thecoiDprehensive neighborhood health center
mustbe an arena tor eXperimentation with new staffing
patterns~ The Kaiser program is indicative of the way
in which health care systems must begin to operate in
that appropr1ate ancillary personnel are used Wherever
possible to perform functions that do not need to be
carried out by the physician As Saward (32 p42)
states
1hroughou10ur organ1zat1on~ there are many of the customary experiments be1ngmade-shyJse of speciallr trained nurses for well-baby care under the SUpervision of the pedi9trlcianexperiments with routine prenatal care by
w ~
21
middotSPC1a1l~t~JlUrbullbull per8ema_1 bullJmdlJleu y our fuDotlou are auoh that DOtb1Da 18 dorutbYtbe phY8iCianstbat doe DOt vet to be done by the
phys1c111U1fhe other aldlle4 person- Del-nurse middotreC~0D18t the appo1ntshymeDt center or clerical praormelshyaremiddot there to free h1amiddotto use his spec1al sk111
Awell lmoWn treDd1D the area of eaaiDI health
c8re JII8DPOY8rShortagjs bas middotbe thetrend toward tra1nshy
1DB poverty area rea1deats as DOD~pro~eaionalmiddoth8lth
aide and nepborboocl health workeramiddot (28 p63) This
bas the effectofmiddotmiddot1J)creaa1q II8DPOWrand 8180 can help
bridle the cuJ~ cap betweenprondera and colllUmers
of aen1C8s This attarD at least tlleoretically
createa a situation 1D WIa1ch providers andcoD8Ullers can
be educated to UDderatad OD88DOtber and interactJlore
ettectlvely~ HoWever amiddotpltt8ll has beeD themiddot tel14ency in
801D8 oamp8e8 tomiddot us aidesmiddot ssale8lllcw t~r the center
alJDOatexclwdY811rathertbaD ua1Dltheal to protide the
health care for wh1ch ~ were trained (29 pp3B-39)
1bat ismiddotmiddot vh1~e the a14e Yalue in ~~m1catiDI with
low 1nCOlMt patieata haa beeR recoSD1zed and stressed
their role ashealtb carepersoDDelhil been slighted 1n )
any 1Dstancea
Anotber step 1d11Ob bullbull been taken to provide 8rY1ces
more efficiently eUeot1ftlybas beenmiddot theorgan1zation
of per8ODDeliDto IIllt141sc1pl1Dary teamaaaa means ot
proYid1DgmiddotCOQrd1DatedserY1ce SUch te8lll8 sen_rally
~
hf
~
22
include PhYsiciaQs nursbullbullbullbull soc1al workers and outreach
workers Conceptually th8y fmlct10n to me~ the intershy
relate lled1cal and social needs ot the families sened
Hor there are a number ot barriers to the etfectve
tlmctiOD1nlof lIuchte8ll8 SODieot these are heavy caseshy
loads the inordiDate amount ot tille consumed by multlshy
prOblem tamtliethel1m1ted tra1n1 ngmiddotmiddotand laCk of tnterest
on tile part ot aoae tebers in examinJng aspects of
problems out14e~lr oWn areaaotcolIPetencemiddot and
~ourdcation prc)blell8 between proteasioDala and nonshy
prot81~s (10ppa-10) middotrurtbemOre as De Diaz
(14 middotp6)1nd1cate tbel8 maybe a teDdency tor vertical
dp8rtmental lines of auperv1810nto become paramount
over the team coDamloation syst lead1ngto conflIcts
in determ1niDI the ro1ea ot solie team bers particularly
the DOD-prote81011alaInauch exper1l1enta Witb new
~t1Dlpatterna it 1s bullbullaentialtbat line of authority
roles aDd NsP0D81bll1tlea be made explicit and that there
beJDechaD 8IUI tor relUlar evaluat1onotfunctlorUng
Another way inwb1ch health care sernee delivery can
be made more ett1cl8Dt is to proVide servicea dur1DC the
hours whentbey aremiddot -ostnee4ed As reQo_ded by Yarby
(37p1) serY1ce can bemadelIOre accesslble by making
themava1lable 24 hours a day seven days a week If
rg8l1Cy service are aft11ab1e aroua4-tbe-cloek at ~
nil1iborhood health center the continuity ot tbepat1ent ts
23
careiamaiDtalDedand meatry point into the
cOIIPre~i health care 8 be made available
tothe patient who aoZMllyU8ea ozilymiddot emergency care in
tille of med1cal criais More 8isDificantly ava11ab1-
lity of a tull rase of bullbullrv1c8 tor seVeral hours 11the
eVerlna aI1Cl On ~ prevent the los ot earn1JiSs
involved if th patierat 1IU8tt8cet1me oftfroawork dur1q
the d8y for aed1Cal oare bull his can be an eSpecially
importantc0J1814eration tor lo1aCOlleDUUg1nally qloYEtd
patient aa4caJla18o PIOJIOtet1)e 0Da01Dl use othealth
servicebullbull
exper1eDO ot tbeKa1er prosraa in tb1s~reprdAs
Greenl1clt(19 p10) states wA lllNt 8ip1flcant
proportion ot the abulatory care 8n1cp~Y1dd tor ~
total popUlatiC)U ~ ~ after clWc hours and this
Deed i8 apParenUyaoN prODGUDced tor aJl8d1cally
iDCust population On the other hand the bulk ot all
aabulatory med1cal cu 88l91ce are performed dur1nS
regular cl1D1c hour eVen when services are available 24
hours a dayJ day bull week W
It has ~ the experi8D~eof a ftIDber ot ne1g1lboXshy
hooct hea1tbcentere _t a_jor obstacle to efficient
proViSion ot anicbullbullhas beentbe teD4eDcy of medically
1ncl1pnt patieats to utilize the center oa a walk-in
baais tor epi8od1ccr181or1entect bullbullrv1cea rather than
4)i
h~ ~~f ~~ L
24
to make appoJlltaeata tor ODIo1qprevmt1ve treataent
and rehebl11tat1Ye care ad ampl1O to bave a blah failure
to Show rat_for tbe appo1DtaeDts that they dO make
Atone center 628 of appo1Dtments made were kept
while 3Oottbepati_ta een were ~1n patients
AlthoUP fewer patiets were actually 88811 by the cater
1D middottb1s 1Datance thaathe -bervholuidmadeappointshy
mta the walk-iD patlat required an iDord1nate amount
ot staff t1ae tor aCreeDiaaacl ~trral to pplOprlate
~ttor caregt (9 pgg) Arraquotbr1llpl1catjo~ of the
plOVidedto valk-iD patient by other thaD their
(19 p12)rurtbermore
when patients uti11ze Wlk-1Il er181 centered care
athelr ODlf tona ot ootact with the _d1~ care
ay_ta fUilycentered care the treata_t of tUl11y
bers
a a UD1t 11
dlarupted
hewalk-1Dphenoaaencm appear to barelated to
diUerence between soclal clase in the style of Dlaking
contactJt1th the a11oal C~ay8t As Greenlick f ~
(19 p11)1Dd1oate8 thepheDOaenOn ot INater usage of shy
walk-in ervice by aed10ally middot1Jid11ent patient thaD by
others baa otte been attr1buted to a stoical att1tude
tQward 1llDe8 em the~ ot poor people leacl1D8 to a
~
25
greaterdelay1n tbe k i Dlofa8d1cal care These
patients wppoedlyeelcmiddotcareODlymiddotwIleD tbeirmiddotillDess
becOlles1Dtolerable resultiDSin middotthMr appeariDS withshy
outnot1ce1o rece1ve oareHlwever Greenlicks
r8aearcbbaa cut doubt on the existence ot tb1delay
111 report1Dg middot8J1IPtoJumiddotOfDeW 11laessand seek1ng care
Be bas tcrQDd 1bat s1ll11ar peze_tases of dioally
1nd1sent 8DClJ1on-aed1cally 1Dd1PD~ pat1enta seek care
on the aue daytbat aptou tirstaPPear
1fb11e GrHDllclc 1nd1cat tbat the reasonator the
greatertendeDCY of low 1Do~e pat18Ilta to 1$8 walk-in I
serY1ces are notlcDo1rAmiddotmiddot tbe7 _ be rel~tedto a tendency
ot lower aocio-ecaaaoclaa patieota to preter face-toshy ~
face contacts with II841cal persoDl181posslbly because
such contacts areft coatortiDS an4reasauriDS to
patients who are hJpotbeafzed to bave a dependent attltude
toward IIed1Cal care perS0Jm81 (30 p161)
It a8 itmiddot baa pnerally beenhld the appointment
s1stemts the most efficient Ileana of dellveriDS
comprehenSive oODtllluiDlh-lth care (9~100)1t is
necessary that educaUoraalmiddotbulltfort be taken to proaote the
use ot middotappo1ntaents8DClmiddot tQrec1ucethe fa111re to appe~
ratB4uOatioaalwhlQb baft~utl11zedhave been
IJ
26
1Dten1ews with walk-in patients home Vi8its and group 4i
meetiDp1D8D attemptto1Dierpret1o the patients
the value of rtitgular ppo1ntmentamp andot con~in~
c~1ve care rather than epiI041c care (9 p1OO)
h1s 1safuD~tioD torwhtch nOl~prot81QDal colDlllUD1ty
YOrkersllaY bebe~r8U11ed tban other statf H()wever
euch aD ~ucat1oaal propul __~ ~e related to the senUiDe
capacity otth health oenter to provide comprehensivebull gt
ervice8 to1tpat1_t~odoD aD app01ntment bas18 It
1amp pos8ibleo~rw1 tor educa110Dal ttorts to result
LD a~8JImCl tor ltPP01ntaen~8 at a ratewb1ohi8beyond
the capacity ot thee_tar to t without uareaaoDably
1_ wa1t1Dlprio4a QOBt1nuad use Ot the center on a
wallt-in bU1 _1tbeoosiItpos81ble to et an appoint-
met anc11nCreued pit1entcoJaplampia1a bull Therew111 of
course always be a need and demand tor acute ep1so~c
Care -ci the health centerDlWlt be planned with the capashy
billty ot bullbullbullt1D8 tb1aneed wh1~ cont1Du1nI to stress
aDd educate the patient to utillze oDlOinI comprehensive
faa11y middotc~te~d Cflre (9p 100l
att g4 CODClva1opa
In order to bea4equate any coJlltemporary health care SY8tem muat bullbulletcerta1D interrelated criteria he
IJ
27
minimum criteria areaccessability of services to those
who need them compr8heX1siveness and appropriatness of
services and efficIency 1nthft utilizat~on of SCarce
health care personnel and resources The scareity of
pex-sonnel andtbe need for h1gh quality ongoinghealth
care services
aJIlong the
populationdemanci the most effishy
cientprovision of services
Services must be made accessible to the population
They mustmiddotbe geosraPh1cally accessible to remove the PhysicalmiddotbaTiers betWeen peopleandthem$d1calcare
system They mUst otter their services dur1ngthe
hours when people can make the moat use ofthemA~ it
makes little sense to concentrate services geographically
where they will not be uSed to their fUllest extent it
also is wasteful to provide serv1cesonlydur1righours when
many people are employed his not only presents a hard
ship middotto the consUmer lnrt wastes resources if for instance
the unavailability of preventive services during the hours
when people Can use them causes a need for treatment
services later on
Health carbull sEtrvices must be comprehensive including
prevention treatmcmtand re)abimiddot11tation Ambulatory I
healtbcare facilities wh1cQ are orienteciexclusively
toward either prevept1on or trea1mentare no longer accepshy
table for they are lneft1c1entln their use of resources
and in their prov1s1on of health care to the patient
w ~~
28
If prevent10n1s notmiddot stressed treatment serv1ces that
could have beenavoidedY1l~ be required If prevention
1s the sole focus of the health care facility sick
patients who present themselves must be referred elseshy
where for treatment andsllch referx-als may be taken as
reject1onsor not followed through with until illness
becomes unbearable
The instltutlontbat meets these requirements Is
the comprehensive neighborhood health center It 1s a
local decentralized outpatient facilityprOVld1ng a
fUll range of ambulatoJY health care services It has
a linkage to ahospitalbackUp facilityforlnpatient
treatment and hiihlY apclalized outpatient care
The neighborhood health center must be a fac11ity
planned with an awareness of the needs of the conSUtller
and coDitnUn1ty It must have the r~Ul0urces to provide the
services people need mere they can use them and when
they can use them It must uti11ze the part1cipation of
the community to develop this awareness Not only must
the cen~er beset up to be Amctional for the consumers
but efforts must bemadeaga1n with commun1ty partici shy
pation to help the consumers utilize medical care
services effectively The center muetmake efforts to
educate the community about the valueot regUlar health
care of preventive servicesand of the use of planned
IJ
29
medical appointments ratherthanorisis centered walk-
incare Therealit1es of the existing health care
system have not taught the patient particularly the low
income patienthow to use services effectively
The helthcenterilUst also bea laboratory for
experiments in easing the health caJepersonnel shortage
and c60rd1Datingcare~ A major difficultY iri-exper1shy
menting with neW rolesis freeing staff of old preconshy
ceptions
CoDlprehensiva neighborhood health dare centers have
been developed under a variety ot alisplces including
medicalsociet1es hoSP1talsmiddot(36p299 group pr~ct1ces
(29 p6- 12 117) health departments (13 p1027) and
ne1gbbothoodassoc1ations(14) The literature indicates
somevalues nthe management ot the health center by plusmnts
hospital backup faCility Whatever the auspices many
adm1nistrative fuDctions such as program coordination
standard pr9tectionand evaluation call for considerable
c~tralization of adm1nistration city-wide or coU)tyshy
wide At the same time other aspects hours of servlce
for examPle~ cuI f~radm1nistrative fUnctions made atmiddot
more local levels Each neighborhood center must be
free to adapt its functioning to itscominunity thi-ough
the mechanism otcODlllUl11~ participation inmiddot policy making
Obviouslythe prerogatives and responsibilities of each level must be negotiated and made explic1t
t4~
JJ
BIBLIOGRAPHY 30
1 American Rehabilitation Foundation ~ealth Services Research Center The Health Maintenance Strategy mimeo 1971
2 Anderson Nancy N Comprehensive Health Planning in the States A Study and Critical Analysis Institute for Interdisciplinary Studies American Rehab ilitation Foundation 1958
3 Andrus Len Hughes Comprehensive Health Planning Through Community Demonstration Health Projects mimeo1967
4 Barry Mildred CandCecil G Sheps A New Model for Community Health Planning unpublished paper presented to the American
Public Health Aseociation1967
5 Blum HenrikL Fred Wahl Genelle M Lemon Robert Jorulin and Glen W Kent The Multipurpose Worker and the Neighborhood Multiservice Center InitialImplications and EJeperiences of the Rodeo CommunityService CenterAmerican Journal of Public Health58 (Mar 168) pp 458-468 shy
6 Blum MichaelD and Soloman L Levy A Design for Service Delivery that Reinforces Constructive Tension Between a Health Center and Its (sic) ConSUDlers and Supports Community Power unpUblished paper presented to the American Public Health Asaociatiltn 1968
7 Brielaud Donald Comm~ity Advisory Boards and Maximum Feasible Participation American Journal of Public Health 61 (Feb 1971) pp 292-296 shy
8 Burns Eveline M Health Insurance Not If or When But What Kind Madison Wisco~sin University of WisconsinScllool of Soci~l Work 1971
9 Campbell John Working ~elationships Between Providers and Conshysumers in a Neighborhood Health CenterU American Journal2 Public Health 61 (Jan 1971) pp 97-103
10 Caxr Willene Neighborhood Health Centers Funded by the Office of Economic Opportunity mimeo 1970~
11 Colombo Theodore J Ernest W Sawardand Merwyn R Greenlick The Integration of an OEO Health Program into a Prepaid Comrehensive Group Practice Plan American Journal of Public Health 59 (April 1969) pp 641-650~ -
12 Comprehensive Neighborhood Health Services Projectof Kaiser FoundatioIl Hospital~ Prcgtgram YearE grant renewal proposal mimeo~1971 bull
13 CowenDavidL~ Denvers Neighborhood Health Program Public Health Reports 84 (Dec 1969) pp 1027-1031
IJ
14 De Diaz Sharon Daniel Beyond Rhetoric The NENA Health31 Center After One Year unpublished paper pres~rited to the American Public Health Association 1970
15middot Gerrie NorrrianF and RichardH~ Ferraro Organizing a Program for Dental Care in a Neighborhood Health Center Public Health Reports 8 (Aug 1968) pp 419-428
16 Gordon JeoffreyB~ The Politics of Community Medicine Projects A Conflict Analysis Medical Care 7 (Nov -Dec 1969) pp 419-428 shy
17 Greely David The Neighborhood Health Center Program and Its Implication(3 for Medical Care H~alth Forum of the Welfare Council of Metropolitan Chicago (mimeo) 1967
18 Greenlick Merwyn R Newgtimensions in Health Care American JOurnal of Pharmacentical Education 34 (Dec 1970) pp 754-4
19 GreenlickMerwyn R Donald K Freeborn TheodoreJbull Colombo Jeffrey Abull Pruesin and Erne$t W saw~d Comparing the
Use of Medical Care Services by a Medically Indigent and a General MemberShip Population in a Comprehensive Prepaid Group Practice Prosram II unpublished paper presented to the AmericanPublic Aesociation1970
20 H~tadoArJiloldVMerllYll RGreenlick and TheodoreJ Colombo Determinants of Medical Care Utilization Failure to Keep Appointments unpublished paper presented to the American Public Health Association 1971
21 Johnson Richard E and Merwyn R Greenlick Comprehensive Medical Care A Problem and Cballengeto Pharmacy ff AJilericanJournal of PbarmacenticalEducation 33 (Aug 1969) pp 361-367 -
22 Kahn Alfred J Studiee Social Policy and Planning New York Russell Sage Foundation 1969
23 Kotler Milton Neyhborhood Government Local Foundations 2 Political~New York The BobbsMerrill Company 1969
24 NationalCommisaion on CommunityHealthSfrvic~sActionPlanniriamp for Community SetithServices~ashington p C Public Affairs-Press 19t7
25 National Commission on C~mmunity Health Services Health Adminishysration andOrMPization l the Decade Ali9$-d Washington D C Public Affairs Press 1967
26 NationalCornmiesion onqomm1Jllity Health Servicesbull Health ~ Facilities Washington D C PUblic Affairs Press 1967 bull
~ n
32 27 ODonnell Edward J and Marilyn M Sullivan ServiceDelivery
and Social Action Through the Neighborhood Center A Review of Research tt Welfare ~ Review 7 (Nov~Dec 1969) pp 112
28 Office of Economic Opportunity Second Annual Report Washington D C~ U S Government Printing Office 1966
29 Office of EConomic Opportunity and the Medical Foundation of Be~laire Ohio Eighth Report 2l ~ Committee2a Governshy
ment OperatiOll~ Va8hiiiSton D C Government Printing Office 1969
30 Pope Clyde R Samuel S Yoshioka and Merwyn R Greenlick Determinants of Medical Care Utilization nhe Use of the Telephone for ReportiDg Symptons Journal of Health and SocialBebavior12 (June 1971) pp155-162 shy
31 RenthalA Gerald nComprehensive Health Centers in Large US Cities American Journal of Public Health 61 (Feb 1971) pp 324-336 shy
32 Saward Ernest W The Relevance of Prepaid Group Practice to the Effective Delivery ofHealthServicestt The New Physician 18 (Jan 1969) pp39-44 - shy
33bull Schorr Lisbeth Bamberger and Joseph T English Background Content and Significant IssUes in Neighborhood Health
Center Programs Milbank Memorial ~ Quarterly 46 July 1968) part 1pp 289-296
34 Weiss James E and Merwyn RGreenlick UDeterminants of MedioalCareUtilization The Effects of Social Class and Distance on Contacts With the Medical Care System Medical~ 8 (Nov-Dec 1970 pp 456-462
35 Weiss James E MerwynR Greenlick and Joseph F Jones Determinants of Medical Care Utilization The Impact of Ecological Factorstt unpublished paper presented to the American Public Health Association 1970
36 Wise Harold B Montefiore Hospital Neighborhood Medical Demonstration A Case StudyMilbaDkMemorial Fund Quarterly46 (July 1968) part 1 pp297-308~
37 Yerby Alonzo S ttHealth Departments Hospital and Health Services Medica1~5 (March-April 1967) pp 70-74
38 Young M M~ Chatanooga IS Experience with Reorganization fOr Delivery of Health Services ttAmerican Journ8l of Public Health60 (Sept 1970) pp 1739-1748
f or l
II bull 11 Y d
II
IJ
34
ThepurposeOfPart II of th1aa paper1atod1scuas
elected Speclfic needs ofecltlc areas within Multnomah
County A8P01ll~oUt 1D ~ I of t1a1bullpapermiddot Ita nelgbshy
borhood health oare cater IlU8t be a facl1lty plaDlled with
aD awarenes of the neeels of the oODllUller and collllUDity
Part II of this paper nIl Show 80e of thoe speclflc
needs
he1DforutiOD tor t1li Portlon of the report
obta1nec1 troll tbroupout tbe follow1Dl threepUb11catloDS
1gr~e_tiMshylIPrIxaiidOreson JuDe 1963
2 1~_middot_sectSI8e~ected1teai c-ua 0 S 8 e first count coaputer tape Coluab a_lion AssocshylatloD of QoveraMD-8 Jlme 1971
3 Jtu1tDoab County Oreaon BDY1roDlHtlltal SurveyEarly 1971
The JIultDOIIIlb COUDty OrttIOD BDv1roDllfmtal Surley
Barly 1971 1s bull stat1stical report of the activ1tles of
theentlreMultDOIIIl2 CcNDty Health Dep~t during the
year of 1970 Die speclflc 1nd1cs elected from tb1s
study amprejMental aealtll Publlc Health N~s1D1 vlslts
FaJUly ~ Veaereal])1 ~ ~rcul081
Throush tie use of cUrts and mapa ODe CaD roup these i
speclflc ~oea to ahcnr the healthneedsof speclfic I
census trtcta aD4 then the health needs of iarer neIghshy
borhooda 1m4 o~ Uebullbull
Rf)~UP1Dl of areu was accompllshed in thefolloWinl I
JJ ~
35
he MiltDoIliahCountY oregon BDViromaental SUrvey
early 1971 isamp statistical report ot tbeaotivities ot
the entire MultDolllh COUDty Health ])epartiDent dur1nl the
year ot1970 he specitic 1Dd1C8S selected frOm this
aUy are 1Il8Dtal health public healthDurs8s visits
fUl1ly pia waereal elisease aDd tuberculosia
Tbroq11the Wle otcbart aDd mapa aDecm szoup these
specific indic to show the health Deeds ofapecitic
ccmaua tracts aDdtIum th8health neecla of larsr ~eilh-
bOrhooda and co8I13 tlbullbullbull
RegroupiDI ot areas waa accoap118hed1D the
tollOWiDl lIIIIm1er~ A bullbullcifie 1ndex 8selectcl auch as
venereal di8bullbulle or tuberculo8i~ he total number ot
cs was then deterll1ne4 for each census tract Through
the use of the maber ot cRbullbullbull tor a 11Yen cenaus tract
aDd tbe population ot thattractaltrateot1lla1ampmcper
100OOOpopUlaticm wu cleteXll1ned for each census tract
This was ~e to starl4ard1ze the population ditterence
amongOeD8U8 -tracts 1he rate of incidence toreaob
cenauatract was then llstedby rank position on a chart
In rank poition1DI any cen8Wl tracts haviDg equal
rates ot1l1c1dence are assipe4tbe iaDk posttiona
Beeauseot the abo fact tbAt cbarta w111 vary in length
neveltbAtlea eacb cbart will 1Dclu4eall census tracts
inMullnoaah Couaty Atter the census tracts bave been
listed accord1q to raalcth1s list will bediv1ded into
IJ
36 three levelsotinc14ence he three levels are
1~ The upper 14 of1DcldenCe
2 Thelower 14 ot incidence
middot3 The ILld 12 of incidence
Tlles three srouplqa are then used in compiling a map ~f
Mu1tnOmahCountyfor ach apecltictop1cbull TIle maps are
uaefuJliD tbatthey V1suallycoJib1De 1Dd1v1Clualproblem
census tracts into larger problem nellhbOrhooc1s
The 1960 statistical iDtormatloD was Used in a similar
liIaDDr to tbatexpla1Dedabove 1Dthe4evelopaent of a
chartmiddot and map 1Ihow1DI e cOllpampriSOr1 of per capita lncolle
tor ttaCh ceDsua tJact aDdmiddot combiDed census middotmiddottract areas
he 1910 aDd 1960 statlstlcal iDtOrllatl0D was combined
lna map and chart he purpose of this and chart is
to d8aonatrate the e cl1stributloa1DeachceD8U8 tract
and middot1ndlcatbull tuture ace populatlon treD4a bull
When one be middotbullbullbullbullbullHdth ne8cts ot an area and has
declded to establlsh a cl1D1c to serve that area the
physical location otthat cl1D1c IllU8t be consldered In
order to coapreb8ll81vel develop an area cl1n1c one should
conslder thepre88Dttraftlc middot~ytaa an4tranaportatlon
systems Thecl1D1cahoUld be located close enoUlh to
major arterlals to giva asy access from the total area
be_ ervecl by this cliD1c At the t1ll8they should
be tar eo away froll thesarterlals to all8Y1ate traffic
CODCell18 andpark1D8 conpstlon By traff1c concerns I
IJ
37
lIlan one lUSt consider thertarro1fne8S of streets whether
streets are oD8--C)r two-way iqres8 and egress to parking
amp0111tie eros tratflC) spedof trattJQ children 1n
ll8a traffic i1lht Vislon re8tr1ctionS etc
BwstraDsportat1onshould alao be central in this area
as maay people ~U f1Df1 1tD8Cessary to use this form of
transportatlon
~e tutqredlopHQt of bull treewa systems should be
c0J1S1dered soastolesen thecumce ofmiddot future roada
cutt1DSotltbe cl1D1c llte line
nrrph1c middotDampta
It is 1JDportaDtto kDOw the demosraphic distribution
characteristics of the oUenteltbat i8 to be served by
localized health cl1D1cs
Acl1D1c which erves8J1 area where1D the prepondershy
ance of persona arecrter 65 years of mayf1nd that these
people rely more on pUblic transportation call for more
home- services and haV4t 110ft ChroD1c and debilitating
types of disorders (b1_ blood pressure poor heariDg and
eyesight) tbaD do8 an area ot a YOUDIer population On
the other hand thL area of older residents may have little
need for family plabDlng cllni08
In order to better ~Ybullbull the 4eaoraphic population
of each CeD8U8 tract the 1970 CeD8U8 iatormation was viewed
and two specific catelOri8 considered These two cat
IJ
38
lori8S woUld be the perc_tap ot population under 19
year of ase and the percentase ot each oensuetractover
65 years of age he 1960 1Dtormatlon tor eaCh tract was
then compared witbthe 1970 intormation and a percentage
ofincreaae or4ecreamp8 tormiddot e~chtract1n each category
cOJlputecland achartma4e By the use of this chart one
18 able to View tJleap populat1odiatr1but10n of census
tract and at the _ t1lle accesa middottrencl Por example
let us choose census tract 601 W see 40-4 otthe
population is under 19 years ot and that ODly82 1s
over 65 years ot middotAtthe e tille the percentage of
youth bas ~ed ODly 1_ intbe laSt teD year whilethe
percentale over 65 year ot middotbas stayedmiddotthe same With
this in mJnc1 ODe ~ 1DfItr libat ol1D1o aerviDg this
area WOuld bellQre conq~w1th the problems of a
YOUQier populat1on and that _ would probably be true foJ
some t1aein tbefuture On the other hand CeDSU8 tract 54
has only 2 ollt population UDder 19 yel1s ot age and
this has decreased by 1 over the last ten years middotwhile at
the same time 32-377 ot the populat1on 18 over 65 years of
age A ol1D1C ___ this area should be or1eJ1ted toward
tbespecttic problema otthe ampledbull
PerCapia __ bY gsa neat
WhaD cona1der1qlooat10D1 tor health cl1n1cs one
shoUld take the 1DC01Ieot areas into consideration Areas
IJ
39
of lowiDcome would not 11kel~be 8erved more by localized
cl1D1cs tbaD would are of hilbincome It 18 likely
people haYiq a hip iDeoll8would preter to be aeenby a
chosen ~r1vatephylc1a1l tban at a local cl1D1cwhere
10Dier waits y beraceaaampryand leas personal attention
gl_
The 19701ncOII81atoWampt10n tor MultnomahC~ty was
not available at the tille thi8report W88 made The 1Dto~shy
tiOD Was taken ~adtro tbe1960 census publlcation
his woUld ~8Il thea tbat ral1I8 OD the chart ynot 1raquoe
completely accurate hi writer telthatthe areas most
affected by tb8 1I8eof the older 1Dco1DtOlaat1oDWOuld be
those tracts wh1ch baYebad a rapid 1ncreaae1n populatlon
over the past tfmyHr8 bullbullbull tracts would include tracts
nUmbered 104 9897 96 aDd 95 be perc~ita 1Dcome
referredto1il-tb1a Paper18the lIean 1DCo per person per
census tract
Attar the iDeoeper census tract was listed on a chart
a map was de 1D41catiDg those census tracts belonging to
the lower 14 ot income tor all censue tracts in Multnomah
COlDltytbose beloqins to the upper 14 ot income tor all
census tract 111 MultnolUlhCounty and those belonging to
the mid 12 ot 1I1coaetor all oeuuetracts in Multnomah
C01mty
In yiew1Dg the _p 1t caa be seen that the low income
area seautotollow aloas the at aide ot the Wl1lamette
IJ
40
R1ver the full length of Kultnomah County A second low
income area follows the south edge of the Columbia from
the northwest corner of Multnomah County easterly to 148 St
A third problem area seems to be on the east bank of the
Willamette River with the Union Pacific Railroad being
about the center of this tract The extreme loutheast
corner of Multnomah COUDty appears to be a low income area
but as this area bas bad rapid grouth in the last ten years
this could be erroneous
Mental Health
be first ~ecific indica to be selected from the
Multnomah County envirollllental survey of early 1971 and
to be considered in this paper i8 that of Mental Health
At the present for mental health purposes Multnomah
County is divided into five catchmentareas with a mental
health cl1n1cin each area These clinics are Model
Citles Delaunay ADkeny street Office Hansen Health
Building end Southeast Clinic
All lIlental health cl1n1cslcept statlstlcal information
on all patients visiting their cl1n1cs this included the
address of the patient hese addresses were then listed
upon the approprlate C8D8US tract Each census tract was
then ranked on a chart according to the nUllber of mental
health patients who reslde ln thatCeDSUS tract attending
any of the above listed ental health clinics This chart
IJ
41
wasttum d1v14ed1ato proper quartile bbullbullbull
quartile vereUs to dne10 u appropl1ate Multnoh
County _tal health ItLa middotmiddotmiddotthelipO~a1bl by lOoJcJIUE
at the UDtal health _to uteN1De which ueu have the
lars-t use otCOllDty 1alh~th faci11t1Rot
1Ilclu4ecl 111 tbia woUld tber otpeopleYia1t1Da
pr1vat patch1atriata aDd pr1_t _ntalhealtb cl1D1c8
WheDtbe M1 18Yienclmiddot Itmiddotmiddotmiddotmiddot~middotbe~_ tbat ~rtt
appears to lMt fourmiddotmiddot-al are iii _oil the nuaber ot
lIental healthcl1D1c na1t toM tbjh1sheat 1he
tour areaa woUld be tollows
1ttrea Ore to~Blo Drimiddot ~tb Burrus14e aDd tIMtmiddot Colb1a Riftr H1gbwyaeri1Dla th nortllra boundaryshy
2 bull ProII 82D4 1_~ 10 20th streetwitil the ra1lMd Mu the north ltouadary
3 ~ et et tUgl_b1bull MYel froamiddot the Clackaaa COUDty l1ae aorth to Dln8lon stret
4 beDOlvt1ttfe-t ~efllt4 COatytrca Jle1aware streetmiddot toR1C1a11oDd wlth Colubla Blvd heiDI tbAtnorth bouaclary_
It ODe coapareatbiap to th iDeobullbullmiddotp 1t can be
eamiddotthat lIOat ot the c tracts baY1Dg bllh v1i11tatlcma
middottfl public tal health cJ1rUc8 ~ 111 t13e low ~ aid
1DcOile SroupiDIOJa1y of til 25 tracta llsted as
haviDlbip aental Maltll nlltatlou are ~ the1g60 hip
iDeo arebullbullbull
17 Plpn
42
amily PlellnSDI ]Jlce Metal Health i8 an 1nd1ce of
use Theperson 111 ordertobavebe_ 1Dcluclecl 1n this
atu4ywouldhave tohaft Ue4 ataa11y plaDI cl1D1c
tacilities of soaetype It 41fter troll tile _tal health
study1nthat i t1Jicludestatist1catrollbotb public and
privateclJD1os
The iDformation tor the iak orurcbart 8Dd map of
t8ll111 plenn1 na ob1a1De4 by cOIIblnlDlthe mabel of
1rlcuv1duals bullbull_ attbe tbreellUltrampo-ti Coatyhll11y
PlalJQllIl C11ll10s 111til tbo at the Planned PareDthood
Association CliD1C8 be tbree -JIultDouh Couaty r8ldly
PlamSq Cl1D1c are Solrtbweatth Col_bla 1111- a114
HaDsell Health BWlcl1Dl CllD1cbi middot1Dtormat1oD vas then
bullbullbullesed tomiddot detellWMt l10w people troll eacb c8IUIUS
chart wastben Mele IUs oIIart jn 4iY1ded to show
the censuS tracts lIaYiDlmiddottIle h1t1iest qUart1le of incidence
of use lowest quartile of 1Qc1deao ot use Jlid 12 of
incidence of Wle an4 a map sprepared troll thts 1Dto~
mation
The C8U118 tractsbelOJISnl to the h1lhestquartile of
use appear to be 1lO~ 8catt~ on tbipwas true ot
either the _p ot aental health cl1D1c uaageor ot the map
abow1DI per capita 1I1COM Iaere40 to be three
d18t1nct areas of UIIaP beJ woul4 be
1
IJ
43
t10D of BurD81cl and the W11lallette River 4
2 S~t Portland 8Otth otmiddot the ra11shyrcaadand alona the W11lamette River
lIortbeaat Portl8D4 between MisSiss1pp1 and 24tbStreet the northbouBclary be1DgColwb1aBlvd
Pylzl1c BMltl IrpI Y11ta
Publlc Healtil nur81D1Y1s1t nclud8 an vists to
theholles of client by PubUc Health Nurbullbullbullbull his shows
visits to bull f8Jl1ly fer aDY purpos SUCh aatuberculolJ1s
het1Dl tem1tyaeatalu4 8IiOt10D8l cODd1t1ona etc
he atat18t1C~ 1fele C()4ed accord1Dg tomiddot the 1llli301fOCUS
of the Y18lt tt doe DOt 1D41cate the Dmlber of holies or
f8ll11lev181tecl or 1D41Y14ual Y1a1ted more tban oDcein
the propwl It dobullbull I1ve 80M 1D41cat1on by coaparlshy
OD ot the 8JIoUDt of aedlcal problema 1n eachcen8WI tract
Ap1nmiddot the _p abowa 8 scatter patteraof probl_
areas althoUSh there appear to be a sroup1Dl of hiSh J
l8aIeccmaus tract 1ntlut extreme southeast part of tbe
County other areu uIriaI any nura1Dl contacts are
1 bull he 801lth-oa-al CO1Dty on eaCh 814 of 82nd Av from Clackallaa County north to Dinloa
2 ear bullbullbullt 814e aroUDd Preacottand Misaisippi
Dowatom Bunul14eonboth 1de of the river
44
V_real Pis The iDfomatloil uaec1 to tabulate the Venereal
disease chart includes all the ooab1ned case otmiddotODormea
and syphilIs reported by bothmiddot publIc and prIvate physicIans
dur1nl 1970 There were 3602 caes ot IOnorrhea reported
dur1nl 1970 While ODly 17 cabullbullsot ayphilimiddot were reported
A chart was prepUed aDd att8llPt wasmiddotmiddot de tomiddot
determ1De Wh_therVttDereal 41ease was more p~vaJent in
areas othigb or lowmiddot proportIon ot youth hi waadone
bymiddotdetemlna a 1leaD prceiltacmiddotmiddotmiddottor the population ot
resld~ts UDder19 years ot (34) middotA mean ratemiddot per
100000 popUlatIon al80c1ttem1Ded tor the middotoccurreDCe
ot venereal dieae This was et at 390 oass Areas
hav1nl a population 1n which leiS than 34 were lmder 19
years ot ampIe were called low- yOuth abOve tbl percentaae
hiSh youth The aaa waatrue ot the occurrence oivenershy
eal disea_ per CeD8UStract It the rate waacomputed
as 1I0re than 390 cases per 100000 it was called hiah
venerealdiaeasei it less than thia tisure low venereal
disease It was tound that 1D Multn~ COmlty there sems
to be poSitive OOlatI0n(x21S19gt between low youth
and hipmiddot venereal diseaand hip youth and low venereal
diseasebull
RaDk ordr Iitot all c traot middottbAm made
Th1s was done byt1Ddlna the ratepr 100000 populatIon
of venereal disator all census tracts in the County bull
45
These were thenlisted from h1lhto low (sreatest to
least) in a rank order The l1sting was then divided
into Upperandlower 14 aDd listed on the MUltnomah
Countymiddot up
The areas of b1gh venereal disease se8ll18to
roup thBl~8 middotin a very tllht area ~oq both 1des
of thell18l8~ R1 w1th BurDaldeS~et being
~bout theceDter qf tbi8IZ9uping This area woUld
appear to be m ldeal spot for the denlopment of a
locallzed venereal d1sbullbullbullbull cl1D1c
UbepoundCUlO1s
In this report bull tube1C1llosls caS8S refrred
to include alltbobullbull cabullbulls ontubercUlo8is follow-up
rather middotthan just new C Accord1Ds to the Multnomah
County Health SUrvey of early 1971 this would include
all ca repOrte4 over thelaat three years The
total number of tuberculosi8 cabullbullbull usedin this study
was 666 lh1 included 128 new cabullbullbullbull
A rate per 100000 of tuberculosis for each
census tract wa- then computed and the c~us tracts
listed by rank order be b11h Qartlle mel low
quartl1 were then reoordd on a Multnomah CoUnty map
TWo genral areaa baY1Dg a hip mcldencaot tubercu~
losiare 1D41cated heyare
1 Both middotsld ot theWilla11lette River
Ll -
46
with Burns1de about thecnter
2 he extrea Northebullbullt comer of the County bull
By coap8r1ng the tuberculois an4ven8real
diseae maps ODe can 8ee that the downtown areas ot
hiSh 1nc1denceare alIIo8t 1c1eDt1cal on ach map
This WOuld 1nd1cate that 1t would be of value to
bullbulltab11sh acl1D1c 111 th1aampreatbat would provide
bothtuberCulos1s 8Dd ytmereal 418ase srvicbullbullbull
Thchart aDd 1181gt8 are wsfuln 11v1DI
1Ddicat10DS tor the type aDd placemeototlocal
health cl1n1c8 tbro1qhout tbe MultnomahCounty area
A cOllpar1on of the mapa help one to dec1dewhether
to provide a aulti-8ervice cl1D1c or spec1f1c type of
cliD1c As stated in Part I of thi paprserv1ces
shouldhaYe both treatlieDt and prfMmt10n cOmponents
As he been stated fta ne1lbborhood health care
Qenter muat be a fac111tY plazme4 with an aamesa
ot the neds of the consumer and the c01llll1m1tybull
Part II of this rport haa been an attaapt to indicate
and clarify 8011 ottheae coDlllUDity neds This has
been done through8elect10n of apc1f1c problems
The indic were then visuallyrecorded through the
use of ups and charta ODe dan asseS8 thedsreeof
1DIportance of certain concems to spec~t1c areaa by
comparinl the chart aDd maps Prom this oDeean
41 dec1de which are48 vb1chcUD1c-or indeed if
the need a clinic at all However further factors
should be considered hebullbull include
a The amount of fuDd1 available
b What 18 the percentage ot peopleineoh ceaaua tract tbat would actually us such cl1n1cIl
c Wbat 1 tbeco--1tymiddot 8 IeeliDashyreaardtDI particular cl1D1c8 Would this dcrebullbullbullmiddot the ettctiveness ot thse cl1n1ca
IJ
li
D_OlraphicPopulatLon Challie 1960 to 1970 48
Cen8U8 1 of Pop 1 Cbaqemiddot 1 Change1 ofPopTract Under 19 Yr8 Over 65 Yrs1960-70 1960-70
middot1Q701Q70
1 319 -12 171 -H) 1
2722 215-27 +68 301 366 -22 127 +35 302 371 +19 111 -04
311middot401 144-41 +29 402 321 13~7-39 +24 501 356 124-08 -02 5~O2 351 133-23 +12
405601 82-10 -02 394602 103-01 -06
701 275 149-76 +56 702 361 +01 121 -07
+10middot801 326 140-22 802 321 middot127
(
-29 -03 9~01 342 124 -H) 6-18 902 294 128 -H) 3-24
10middotmiddot -14312 140 -17 1101 182 +25 -23197
2411102 186-59 +29 1201 226 169-17 -41
31middot01202 +11 182 -05 295 -H) 81301 208 -H) 4
1302 331 +08 197 +04
14 323 +15 middot185 -08 middotmiddot15 329 +16 16~5 -13
-28middot 1601 332 131 +12
1602 356 98 +24middot-39 middot3101701 161-33 +21
1702 370 -15 85 +02 +19 1801 264 151middot-50
185middot1802 256 +47-58
IJ ~
D_raphlc Population Change 1960 to 1970middot 49 (Contd)
4io
Census Tract
of pop Uncter 19 Yra
1Q1n
1Cha1l8e 1960-70
of PopOver 65 Yra
lQO Change
1960-70
19 389 +29 141 -24 20 223 -13 206 +18
21 227 +08 194 -36 2201 356 -27 112 +05
2202 290 -18 ll~9 -29 2301 356 -03 154 +24 2302 260 -37 245 +97
2401 410 +6~1 123 -31 2402 163 -80 320 +99 2501 381 +13 140 -01 25()2 237 31 lil +02 26 343 +25 186 +149 2701 370 +29 1S5 -01 2702 249 -44 304 +98 2801 337 +19 187 +09 2802 306 -10 156 +31 2901 304 -38 142 +24 2902 i 307 -32 146 t3~9
30 29~0 -48 16~2 +51
31 355 +30 160 +01 32 370 +48 148 -13 3301 395 +45 130 -20 3302 368 +06 138 -02 3401 386 +16 117 000
3402
400 +32 92 -26 3501 304 -07 115 +35
3502 344 000 140 -13
3601
36~02 357 -04 132 +32
3603 30~1 42 149 -67 3701 342 +28 152 +19
1
IJ
Jianolraphic Population Chan 1960 to 1970 50 (Contd)
Census Tract
of Pop Under 19 Yrs
JJl7J
middotChanae 1960-70
middotofmiddotpop Over 65 Yrs
1c~7n
Change 196070
3702 409 +39 122 -11 3801 308 -11 151 +29 3802 275 -35 180 +46 3803 282 -32 192 +54 3901 376 ~13 100 +17 3902 296 -03 177 +29 4001 438 -11 84 +13 4002 353 -21 115 +20
4101 397 11 9middot0 +11 4102 346 -19 120 +03 42 331 +19 11 bull 3 -16 43 347 -72 105 +31 44 113 +84 183 +154 4S 33~9 +07 110 -06 4601 2501 22 193 +38 4602 332 +59 126 -29 47middot 161middot 000 211 +01 48 103 -26 302 +59 49 138 +1 bull 3 252 +09 50 141 -26 204 -12 51 12 -39 257 +07 52 47 -61 351 +48 53 89 +49 314 -30 54 25 l1li15 327 -17 55 131 -17 115 -121 56 198 +93 227 -47 57 71 102 189 -88 58 240 ~middot41 16~1 +55 59 322 +25 142 +06middot 6001 264 95 132 +50
6002 328 -31middot 89 +07
JJ
Demographic Population Change 1960 to 1970 51 (Contd)
Census 1 ofPop lChange of Pop bull ChangeTract Under 19 Yrbullbull 1960-70 Over 65 Yrs 1960-70
1970 1970
61 355 -58 85 +39
62 328 39 110 +18
63 414 04 73 10
64 382 -22 72 +04
6501 383 02 67 -20
6502 329 -56 96 +09
6601 391 +13 88 -03
6602 319 -59 97 +06
6701 327 71 145 +72
6702 331 ~67 83 +1-0
6801 365 -66 49 +01
6802 388 4bull3 54 +06
69 354 -41 80 +23
70 400 -23 68 -06
71 359 -48 72 +05
72 255 -88 82 +11
73 346 -39 91 +25
74 313middot -63 105 +24
75 329 -42 129 +37
76 336 -52 85 +21
77 370 -10 69 +05
78 309 -10 120 +21
79 325 -56 87 +10
8001 358 -81 57 +12
8002 391 ~81 76 +12
81 315 -76 108 +21
8201 403 -23 64 +08
8202 392 23 65 +08
83 357 -34 120 +31
84 402 -18 73 +16
85 413 -06 76 -09
r
Demographic Population Change 1960 to 1970 52 (Contd)
Census Tract
t of Pop Uncler 19 Yrs
1970
Change 1960-70
1 of Pop OVer 65 Yrs
1970
ex Change 196070
86
87
88
89
90
91 9201
9202
93
94
95
9601
9602
9701
9702
9801
9802
99
100 I
101
102
103
10401
10402
lOS
368
351
379
391
391
413
379
433
372
429
414
432
419
439
~32
377
457 420
378 41middot7
345
360 417
417
412
-04
-02
-35
-26
-28
-11
-64
-20
-S9
-39
-32
-21
-34
-40
-47
-lO~7middot
-27middot +04
+56
+07
-34 01
+04
+04
+10
103
128
97
11il3 99
69
79
42
77
46
34 38
44
40
54
111
51middot
81
133
59
74
140
63
87
76
-08
-06
+04
+08
+17
-05
+3S -02
+1~4
+19
+33
-14
-08
+12
+26
+71
+11
-16 -34
-20
-19 +37
-49
-2S +15
NOte The The
Taken frOi
averageullder averageabove
middotUSCensus ---shy -
19 years == 6S years ==
figures 197
32r 13(14
p a~d 1960
--
Rank
1
2
3
4
5
6
7
8
9
10
11 12 -_
13
14
15
16
17
18
Tract
69 46
60
58
- 68
61
302
2501
67
63
19
62
26
94
3603
3902
64
30 -----~-
Rank
19
20
21 -
22
23-shy
24
25
26
27
28
29
30
31
32
33
34
35
36 -
Ranking of Per Capita Income by Census Tract
Tract
65
2701
- 15
1601
701
66
93
82
2903
3602
30
2502
80
2401
81
- 70
91 shy
4001
High
Rank Tractshy
-32shy37
38 97
120239
7840
41 ~ _2_1__ 42 31
43 2501
44 18
45 98
46 37
47 3803
1702
49
48
1602 92 2702
I
50 89
51 901
52 801
Ra_
53
54
55
56
57
58
59
60
61
62
63
64
6S
66
67
68
TractTract Ra~
74692
170196 70 I
401 71 90
72 1037J
79 70273
3802 74 601
24024102 75
85 76 101
77 9023901
7699 78 100 4101 79
3601 I
380180
458140~ t---- _ - - shy83 82 42
888384
59843501
4777 8~
502
Low
802 86
Rank Tract
87 shy
--88
89
90
91
92
93
94
- 95
96
97
middot98
99
100
101
102
103
104
1201
14
49
72
73
43
87
3502
105
1
52
86
71
1
501
10
3301
104 tf
Rank
105
106
107
108
109
110
III
112
113
114
115
116
117
118
119
120
121
Ranking of Per Capitalucoae by Census Tract
(Contd)
Tract Rank
4001 122--shy602
13
1102 2302
3302
55
3401
48
21
56
50
3402
lL01
2202
2301
53
2201
-shy
Tract Rank Tract Rank T~aet Rank
57 I-----
Imiddote
bull
Tract
- Low -k Note Information taken from 1960 U SCensus
Rank Tract
I ~
Ie
Imiddot
~
----
----
--
--
Rank
1
2
3
4
5
6
1
8
9
10
11
i-
-Tract
391 922 921
972 971
100
132 131 121
962 961
822 821 401
982 981
20 111
47 10 1
412
High
Total Number of Henta1 Health Visits
Ranked by Census Tract High to Low
TractTract RankTractRank Rnk
12 182 22 78 29 87 76 381 73181 ~------- 1913 371 8538230162372 271 2616-121 8272 2
14 80~2 31 94 7923 84801 59 15251362 4232 15 52 _ 32 103 8924 651 17240216 652
_ 91 351 33 341 23117 83 122 25 25 48 1123921418 34 shy61 86 661
19 662 6493 81 26 91 8153 49 50 55 41383 71 27 51 3120 90 672241 35shy 104167162 461
I 411 46211121 28 88342 I
2502 36 69 54 5251 50 272
-Ra
37
38
39
_ 40
_ 41 Ishy
I
42 I
-I 43 44
45
shy
Tract
~ --- shy 95 56
45 292 242
102 62 352 291y
92
101 281
99 72 63 601 60~ 42 2201
77 74 61 57
363 232
70
32 31
11 44 282 2202
Low l
- Tract
46 682 681 I 331 30
r~$ 47 1042 332
48 102_41_
11
~
Visits to Family Planning Clinics Ranked by Census Tract High to Low
Rank Tract Rank Tract Rankmiddot Tract Rank Tract Rank Tract Rank Tract
1
2
3
4
5
6
7
8
9
10
11
12
13middot
14
15
16
17
361
56
401
341
48
59 121
20
55
342
10
31
58
93 21
241 132
331
53
461 462
18
19
20-shy21
22
23
24
25
26
27middot
28
29
30
31
32
33
391
32
middot47 I-i-_-shy _ -
231 111
332
972 1
372 371
52
89
32
92
82
100 31
182
30 242
402
34
35
36
37
38
39
40
41
42
43
44
45
42
1714 i 661 221
78 362 2
90 602 601 352
63 251
105 921
971 351
73 42 292 232
411 51
662
81 45 52
46
47
48
49shy
50
51
52
53
54
55
56
961
801
49 81 72 71
19
9~1
172
68 2 57 162 14 112
91 75 681
381 42
3~3
83 161
57 f
58
59
60
61shy
62 Imiddot
63
Imiddot 64
65
66
64 62 36~3 252
74 652 SO 392 291
651 6bull 2
79 271
r-- ---- shy981 222
672 671
821 272
94 87
281
382
67
68
69
70
71
72
73
74
75
76
77
78
981 26 12~2
IS 61
85 82~2 69
61 43
101 86 84 282
76
131
51 72
1041 962 88 70
99 922 77
103
95 802 181
i
~
Low High
RankRank Tract
5479
4480
81 1042 ~) middot102
71 - - + ~ - ~
Visits to Family Planning Clinics
(Contd)
Tract Rank
I
Tract llaDk l
RankTract Tract Rank Tract
~
I
~
J1 ~
Low
Total Number of public Health Nursing Visits
Ranked by Census TractsHigh to Low
TractTract RankTractRank RankRank TractTractRankTractRank
25249 71 79 17249 8033 6586 99189711 84 2915072 34 661 76 66 811519512
402 5035 51 161 2518220 122 1713423 352 55801 7120 6752 2 149814 41236 83 2662 38 94 6821 53 2924015 362 37 32 42 75 69 281 84 63
546 8822 54 222 85 3925431 70383417 3818223 6439 4386652 718 21 55 103332 8924 232 87 19 271729219619 24156 16211140 382 628825 10523110 112 73411 10141-- ----shy 89 363 4457 8126 16111 221 74 9142 90 46158331 53 671279012 46243 48 59 351 3837528 1083 9313 91 5844 59 -_242 76 1----- shy60 272 72 74104114 60145 42 9287 7729 92 6151 8215 57371 934630 91 307762 12113116 282 619447 41391 9531 78100 63 7378 ~95 681 6945 32 5632 798517 6448 47 52 181
High ~ Low
Rank Tract Rank
96 31 132 70
97 102
98 182 372middot 602 651 662
- -shy
~72 682 802
822 922 962 972 982
1042 ----shy
Low
Total Number of Public Health Nursing Visits
(Contd)
Rank Rank Rank TractTract Tract
I
I lt
I
Tract Rank Tract
[
~~~-
I
~
IJilfimiddot ~
j
Ranking of VD Caea According to Census Tracts 61 By High and LOll Youth Itatio
A media~ of 34 5 was determined Any tract having greater
than 34 5~ of popu1tionunde~ 19 years of age -High~
Any tract having l8S than 345 of population under 19
years == Low
Any tract having rate less than 390 =Low
Any tract having rate more than 390 == HLgl4
YOUTH
LOW HIGH
L
0
12 402 1801 1802 343 2801 2802 29023603
54 6001 600262 66~02 72 74 75 76
78 79 81 t02 65 1202
W
(25)
VD
H
I
G
H
401 701 801802 901 902 10 1101 241 1201 1301 132 14 15 1601 1701 20~ 21 2202 2j02 2402 2502 2702 2901 303501 3502 34023801 3802 383 3902 42 44 45 4601 4602 47 48 49 SO 51~2 53 55 56 57 58 S9 6701 6702 73 95
3~02 7021702 19 25~01 2701 4102 4101 63 64601 ~601 6801 680270 7l 77 8001 80~02 8201 8202 83 84
85 86 87 88~ 90 91 9202 920193 94 9601 9602~ 9701 9102 9801 9802 99 100 101 103 10402 105 6501 10401
(47)
301 501 502 601 1602 2401 2301 2201 31 32 3301 3302 3401 3402~ 3602 3702 3901 400140 02 43 61 69 B(
(53) (23)
~ ~gt
Ranking of VD by Rate Per 100000 By Census Tract
~
Rank Tract Rank Tract Rank Tract Rank Tract llank Tract Rank Tract Rank Tract
1 2202 21 S6 40 902 58 1602 74 75
90-shy 64 107 26 --~-
2 3402 22 45 41 10 59 902 75 78 91 54 108 61
3 2301 23 3502 42 2502 60 602 76 6802 92 402 109 87
4 3302 24 49 43 1102 61 501 17 2 93 94 110 90
5 50 25 52 44 6702 62 14 78 8202 94 97 02 III 76
6 2201 26 20 6701 63 4002 8201 2501
9701 41~02 112 91
7 44 27 48 45 401 64 3802 2902 95 63 113 62
8 3301 28 1701 46 502 65 30 79 83 74 96 9602 114 71
9 55 29 47 47 42 66 3803 80 2801 96Q1 115 85 10
11
12
13
14
15
16
17
18
3401
53
2302
2401
57
21
2402
1101
51
30-shy31
32
33
34
35
36
37
3701 - -~ 1201
3702
89
43
132 131
3602
4001
48
49
50
51
52
53
54
55
58
1601
601
4602 4601
69
701
31
3901
67
68
69
70
71
72
2901
801
39021~ 802
6502 6501 122
702
41~01
81
82
83
84
85
86
87
88
19
1
1702
2802
79
93
100 6801 6602
81
97
98
99
100
101
102
103
104
9201 9202
9802 9801
77
302
79
86
72
84
116
117
118
119
120
121
3603
8002 8001
101
99
95
10401
105 10402 103 102
19
20
59
32
38
39
2702
3501
56
57
301
3801
73 1802 1801
89 6002 6001
105
106
2701
88
High Low
-- -----
Rank OrdermiddotTuberclosis Cases by Rate Per 100000 Ranked by Census Tract High to Low
Tract TractRankTractRank Rank TractRaukTractRankTractRank
801
79 9601501411 52 6835340120511 I 960269 903603532036 $-~~F130221542 4366 311301 70 68~013802 _ I- _ 4001_37213 3921201 6802802 H71523822024 22 54 193302 3802 80 8958 I37139535 70155 9801 I60123 72 6702 98023914011016 6701250124 10 56
81 94 401r 7 154152 73 7057 2625 122 92028
90242 162312301 92~158 86 7172434526509 82 79160159 74 100 87412240227220110 6502836960 75 30 8317244 6501782801285711 61 901 42765645 84 66021459294912 9701 660146 171 302 9702 47
6235023033113 85 822821182 917755 16335013110214 841814832 78 103 938564 324815 86 1057940149272 38036523216 10401 87 2902241 725Q 10402360266340217middot IF88 88 9937233 282 51 218 101 01102 46016234
I)167 2901460219 47
High ~ Low ~
- -
TractRank
9S89
6490
8191 8001 8002
63 61 60middot01 6002 44 2701
92
J
2502 402 --- ----shy
I
Rank
Rank Order Tuberculosis Cases by Rate per 100000
(Coutd)
Tract Rank Tract ~nk
I
Tract Ballk Tract Rank
Imiddot
Tract
Imiddot
1~
t 1I i Pi i l I
o
1 -1shyL I
I J
8 40 icO ~ I -lt 0
-t (1) I
i I
r o E
II
a
I
r--i
shy
I
~
I (
Jgt
(011 fi(
Ggt
I II ~j
()
(f 0
~ ()
I
11
f9
r
II 99
o ~
Ggt r
~ __-J~ I t I ~ I
r--J l I
~ _ __ J
) 1
fTl
1gt
r I
()
r
()
lt en -i en
()
I1l
(J)
(J)
-i
P ()
19
r o ~
r G1 I
I
c
~
o I 89
--- -I-shy
r-r I
1- 0 _~ _ _--J E
G1 I I I
i i
I 1-1-1 ~ _J ~2 ~ II
II
()
1 I I I 1
id i bullbull
~
A n 69
r 1shy
- 0 Gl
l--~ ~ I
~ II
II )
I () isect i
en l i
(J)
-t
0
IA Ol
5
~E
Evaluating the Health em Sxatem
~ (8 pp1-2) has 1nc11cateda number of the weakshy
nessea of thepreaent health care system in this nat1on
She c1 tes risDs coats iDadequate pooriy distributed
and 1rietf1ciently utilized manpower andtrapented
service delivery a8 ma3or problema and state that The
systeiD 1swaste1ll otreaourcea andfunctions W1th too
11ttl reprd tor U1ci8Dcy aDd aCoDOIIIY
Shepo1Dts out
hoWever tbattbere are tour points regard1ns reform Upon
which there is widespread agreement Firat she states
IIaccesstoneede4 health emces must not be 1mpeded by
t1DaDcial barriers II BersecODd POint1s that bull bull the
continuoua health sernceare eftryw2ere ava1iable under
cond1t1ons that are physically conveDient comfortable
anclnot destructi to the d1lD1ty or selt-respectof the
recip1ent b1rd it is essential that the health care
syst8lll Iie due reprd to ecODOIIIY 1D the use of scarce
resources providtDg services with eff1ciency Finally
the system must be accoUDtab1e to those who tiDance it
and to those who 11IIe 1t and in particular must be highly
responsiva to the interests of coD8Ulll8rs II
Gre8Dlick (18 p756) also prQPoses a set of princ1shy
ples which can be used to naluate the ed1cal care
system ae states tint that bull bull all those who need
medical care shouldhave equal access to 1t second
(
6
bull bull the sernce prortded ahould be precisely approshy
priate to the pat1entl1eedemiddot ft and tb1rd bull bull the
med1cal care ayatea ahould provide the lOst eff1cient
and econoa1C8l use of scarce IIe41Cal resources
orthepurpoesof tb18 report certa1not these
crtteXaw1l1bestreaae4 lION tbaD others The rema1llder
of PaXt I Will renew the l1teraturerelating to the issuee
ofcomprehenaivene8sof ervice access1b111ty ot serv1ces
aDdett1c1ency oten1ces 111 tbedel1very ofdecentralized
medical car
ratCopcept of C_ Beal1h care Asd1oal tecmolol1 bas advanced a process of
evolution basoccurred inthe aed1cal and health t1elds
As JOhDsoD (21 pp~361-363) etamptsmiddot bull the goal of
healtb carelD our society baa evolve4trom rel1ef of
ajmptolU to ~ otdi toex1steDce in a potent1ally
diseaselessstate C1t1Dl tbelJm1 tat10DS in health care
resources and presenttechnololY he cont1nues to state
that The resulting cbal18D1e facing the Amer1can health
serncesystem is to provide each 1D41Y1dual with the
sreatest possible opporturnty toach1eve an optimum level
of phys1cal Jl8Dtal amd so()1alwall be1Dg
to
reter to the type othe81th care aystemwh1ch attempts to
answer tb1s cba]] and fult111 the three principles of
1
access1b11it Prov1UOI1ot appropriate services and
eff1cient use ot middotre80urc He state that a IYStem ot
comprehensive healthmiddotmiddot care 1DmiddotoXder to apIo middottbe stated
principles fD lleetiDlita 1Oalttst havemiddot certain
attributes
1 middoteare utdbeollW~ItaC1~orpn1zatlOM]ec ~ bull p~~ol1calbarriers IlU8t be removedbull
2 bull Care abould ace he~ecl1merlt8 ot distance residttiiCemiddot tille must be removed
middotcare8ho1ll411eC-r0WIZ the Ufemiddot span it diseases eapec ychronic are to be controlled betoretheybecome disabling or lite threateD1Dg
4 CeresboUd be~teJ1nCludlJ1C p~vention cure ma1ntiDiiCeand rehabI11tation
5 Care aho11l4be~i9_ttIa1t1ephyaiolol1ca1 aD4 pay1Fci1~cTrIS-ticot the pat~ent
6 Care aboul4 middotbe9L~ tJwrefore shouldbebu11t aro~ middotslJOc1al1natltutloDs which relate to the patients Way of lite suCh as middotthe home school and place of work
7 bull Carellbolld be m-ar and therefore shoUld bemiddot provIded ~Wliils where responsishybiUty tor the patient bas beendetem1nedauthority has been delqated and a communishycation syst_ provided
s care slIould 1Ie HIl 1nclud1Dg theintesratlon ottac1~1ts~ ~prsOllDel neceaary tor modern medical care
9 bull care dbe Of hip ~ eresboul Th ahouldbe aD adequate audit 0 care pee~ reviewcoDtlDUDI naluatioDBnd research intomiddot adequacy aDd quality
Ult1ately as 1Dd1cate4by the Nat10Dal CollllDisshy
8
sion on ColDJIIUUity Health Service (26 pp 1~20) the
c1evelopmezat of a ampyt of comprehensive health care is
a cOlDJIIUUityw14ere8pODSibilit1 1nvolviDS the integrashy
tion of all the health care facilitie and programs in
the cOlDJIIUUity or the c0arcm1ty8 healthc~ system
the PamprqlOIIlt goal ~
PrQv11~ of a ~rehive ~e 9tcoaaun1ty health aervicea
2 Ma1DteIlace ot aD a4equateqUaDtity ot al~requ1re4 health care facilities
Iritsrat~oDof ~v1c1ualUD1ta and s1steas ot bealth aerviceinto a coordishy
natedpattem ot continuous care tor theindiVidual
HoWYer aYerby (37 t pp71-72) 1Dd1cate the
med1cal and health care 81atmiddotaa it ball t1nct1oned haa
not facil~tate4 the delivery ot COap~usive middothealth
care IDcl1Y1c1ualhealth care facilitie themaelve havemiddot
notg8D8nally tuDcU0Af4tOach1eve tbi810al pUblic
health departaent 11) prond1q prev_tive services and
$1Ch trea~t activities aa are involved in venereal
disease or tuberculois control have in general avoided
1Dvad1Ds the curativedoma1Dotprivate mediCine Th1s
haa even been cabullbull1DareaawherelI~cal care is not
readily availa)le except throUlh hoepital outpatient departshy
lDent8~ Aa he 81IIet mothealth departaaents have tailed
to proVide an adequate _try point for the patient 1Dtothe
diapoatic and curative a bull t of tile health care aystell
This may be particularly true tor the pOOr patient who may
9
b_dloallYUDaoptdatlcaW4lberefore th past decade
babullbullbull~ bull lIOYeaeftt to evolve DfW torms ot health care
and new types ot health oare institutloDS providing
comprehensive oDlOiDI care rather thaD trapented care
There seems to be little dispute in the health
aboe requ1res both an lDtesratloD ofprev1ously uncoo~
ditultec1 health care ervlcbullbull brlDSins tolether into one
alency what Johnaon (21 p362) reterred to as bullbullbull the
concepts ot cOllPrehms1veIled1C1ne andpos1tlve health
andaporpph1cclecctrailzat1on ot ervlce dellvery
he NatlODal CoimD18810D0D CouD1ty H_81th Services
report Health Care gilitis (26 p37) suggests
proYic11Dl compreheDaive health care services by centrashy
llz1Da a varlet ot publlc and prlvate healthcare
tacllities 1ntohealtb campuses However as Kahn
(22 pp274) states amppeskin ot soclal servlces in genshy
eral bullbull bull if the loal ls to develop a service-delivery
approach that improves access taclltates teedback 80 as
toadapt to user preterence8nd prlorlty and maximizes
case 1nteptatlon aDd accountabl11ty the base of the
total 80clal service system Should be tnthe nelSbborhood
Dec~tral1zatloD not only makes services IIOre accesslble
but allows therv1ce to be tailored to the Deeds of the
10
areaDe Diaz (14 p3) indicates the importance of
being aware of groups in the neighborhood with special
health problems such as elderly people or large families
witb yOlmg children This means that it is important
in planning to be aware of the demographic features of the patient population This will be considered more
thoroughly inPart II of this report
Kahn (22 p275) continues however to indicate
that more than the improvement of service usage is I
involved in decentralization and that decentralization
ot service delivery also represents part of tI a general
search to break down cities to human scale for some
purposes on the assumption that people find it easier toshy
relate to a neighborhood orsection and to its populationbull
bull bull bull Thus the organization of services at the neighshy
borhood level bas the added purpose of contributing to
the search tor neighborhood n He adds that this process
i8 more relevant it there is a measure of local control
over as well as local availability of services
Kahn indicates that decentralization is not a
viable goal in some circumstances These include situashy
tiona in wh1chthe need for a particular service is too
TJI t
-
11
little to justityits proVision in a l()calun1t where
skills or resources are too rare to be provided locally
or where the costs ot decentralization vastly outweigh
the benefits He Visualizestheult1mate emergence ofa
h1erarcb1c81 patternofserv1ce delivery tnwhichcertain
services andresp0D81bilities are middot1ntegrat8d1Dto the
collimun1ty at thelooal level Other more specialized
services relate to larpr un1ts of the colDlllUD1ty such as
eomb1nationa ot neigbborhooc18 Veryspecialized services
are to be delivered at city countystateop regional
level8 fh1slevel would al80 be the seat ot prosram
coord1zaat1on staDdardprotection and evaluation 811
of which call for cons1deZable centraliZation for overall
program adm1 nlatrat1on(22 p275) AlthoughKahnt s
model was not developed specltlCally tor health care services 1t1s quite relevant- and appliCable to health
care service delivery systems
Omiddot Donnell (27 p3) reviewing the 1iterat~e on
service delivery and social action through neighborhood
service centers preseJJbB a list of characteristics
generallydesirable in ~eighbOrhood service delivery
centers Firsthe states that the center should be
accessible It should be in a physically convenient
location and should be open evenings and weekends as
well as providing at least em~rg8ncy telephone coverage
t
~ II
12
24 hours a day
The center should als~ be irDmed1ate in 1ts funcshy
tioning That is the centermust have the capacity to
provide prOmpt efficient service and should be able to bullrespond to problems middotwithout long hours ofwalt1ng and
many rounds of apPointments
The centexsservices should be 6omprehensive liThe
center should offer a full range ofusable oil-the-spot
services or easyaccess to other resources by available
transportation It should gear itself to the needs that
peoplehaV8-especially poor people-and provide for the
slmultaneoushar1d11ng of problems were possible
SerVices should 8180 b 1J1tegrated and coordinated so
thatseMces can more effectively be provided
The operation of the service center should fInally
be responsive to the needs and desir-es of the neighborshy
hood It should provide ways in which reSidents can
shape th~ program and continue to contribute to its course
and development It should be relevant and ready to
respond to changing needs II
The concept of the comprehensive neighborhood health
center developed by OEO (31 p324) has been described by
severalwriters Yarby (37 p73) describes it as an
outpatient racility which has certain def~n1te characshy
teristiCS middot1 Accessible to a poPulat1on concentration
bull 13
2 Open 24 hours a day seven days a week 3 Family-centered c~e by a team of lnteniists pediatricians clinical and publichealthnurses and social workers 4 Availability ot frequently~requ1redspecialist in such fieldsaspsycbiatryobstetrics gynecology surgerY5 Con~1nu1tyof doctor-patient relationshyship 6 Family records with social and medical ~raquomDaries of relevant information about each family member 7 Basic diagnosticlaboramptoryand x-raytacl1itles and drugs and biologicalsavailable atthe center 8 Directline (1)y center-controlledambushy
lance when-necessary) to ateach1nghospltaifor cl1agnostic ~d therapeutic servlcf)srequiring the fa011itlesandpersonnel of thehospltal 9 Patient-cantered and eommUn1ty-oriented -
The range ot services in the comprehens1venelghborshy
hood health center shouldbe as complete as possible
inCluding preventivediagnost10 treatment and rehabi-
litative services and Sbouldbe deslgnedto eliminate
episodioandfragmented services (31 pp324-325) Schorr
and English (33p291) add as additional characteristics
ot the compr8henslveneighborhood health cent~r that it
should ~ve intensive participation by and involvement
of the population to be served both in policy making and
as employees and that it should be fully integrated with
the existing health care system The Office of Economic
Opportunity (28 p63) stresses the potential for easing
health manpowershortage$by trairiing local neighborhood
reSidents as non-professional health aides at the same
time creating new job and careeropportunitles As
14
Gordon (16 p bull 422) indicates Many of the outstanding
problems in medical practice todayrevolve around
effectively motivating the patient and the prospective
patient to be concerned with his health This is
especially true in a deprived environment The community
health center with its technique ot consumer partici
pation maybe a way to create this cooperation effectvely
It is important to note at this point that the
comprehensive neiShborhood health center haaas its
constituency an integratedmiddot community r~ther than a
particular segment It should haveas Blum and Levy
(6 pp~5) indicate a horizontal rather than a vertical
relationship with the commuriitybull The vertical relatlonshy
ship they state is characteristic ot those service
organizations wh1chapproach the community only in terms
of their own fUnction Tbey see only their relationship
with the users of their service and assume that problems
of accountability will be handled by these consumers
However they pOintout this ienot likely as a vertical
approach creates dependency onthe institution Agencies
in a horizontal relationBhllp recognizetha1 they have
both acommunityand a consumer to serve The horizontal
approach places the matter of accoUltability on a broader
basis than just the involvement of the consumer De Diaz
(14 p4) speaks otthe need to ~develop a community
facility which difters from a clinic for low income
1ji ~
15
people in that it should serve an economically integrated
community The reason for this is that a wide variation
of consumers may assure a better quality of care
The advantages of the comprehensive neighborhood t
health center over traditional systems of providing
commuruty health services are numerous Hospital outshy
patient departments a major traditional source of ambushy
latory health c8refor poor patients have been indicted
for neglecting preventive health care ~romoting fragshy
mentedeare and subjecting patients to degrading and
impersonal conditions to mention only a few of the major
defects (31 p324) Another defect has been the
tendency to shunt low income patients back and forth
between different cliniCS often at different locations
arid with differel)t open hours for different treatments
or tests in regard to the same lllness(26 p63)
The comprehensive neighborhood health programs that
have been organized present a great variety of organishy
zationalpatterns one area of difference 1s in the
emphasis placed upon making each faci1ity comprehensive
in the services it provides to the patient population
In the Montefieri Hospital Neighborhood Medical Care
Demonstration program in New York City services have
been made available through a central health center and
two store frontsatellites the center to be the base
bull
Li
l of opratiol18 of ta1lJpIlflicl- ancl the satellite
center the ba of oparat1oDa of public heaJth nurses
an4 nllbborbood amp1 be satellite centers wereto
proVide preVentift tutaltll bullbulln1c1-m1zaticms w811shy
baby care per1od1c ~ectiland tJle central health
center to proViAle care tor illnes If (36 p299)
bis propWI VUDOt ~ttullytunct10DIDI at the t1JDe
it d1cu8ae4 18 tbe Uterature aDd all aernce Were
be1Dl provided 1D_~terBowever itwould ae
tbat the ntua1pro~ as aY1ioae4by its plmmers
would boclJ aoaeot bull 4efeot~ otthe current lud1cal
ccde teaIt pObullbulllne_t coorctJl8td admSDtshy
etration eD4 well 4eftlopecl refelTal procedtlreacould
1I1a~ thecOllDeCticmof t~_t8 withappropr1ate preTellshy
t1 aD4 therapeu1ampcaen1cbullbull aV81lable 111 diffrent
locationa Bowner tile barrieraottiaeaDdUatanc
between center and truaraUon tor the UDSopb1aticated
patieatlook1Dl tor 1her1~pJce too tor ~1CU-
larhalth serfplusmnQewoGl4~to JJa1t tbbll1ty o~
tb18 ~811D to provide iaaiYCOliprelleU1P18hboltleod
health servicebullbull III tactmiddot tappeareto coDtlict with
tbepro own taW cOfdotpro-1~a tam1ly
mecl1cal careprogru 111 wIa10h pre-teAtlYe aDd therapeutic
health erY1cecan be proY-lW to all IIl81Ibers of
tamily in the coure of aaSDll vi8it (36 PP301-3(2)
Dle Delmtr Coloradoprepa11ke the Montet1ori
LI
17
prograJlut111zbullbull abe1rarcJly ot SlDa11 aatellItestations
andlerer IIOreceDtallzedtac11It1es It 41ffers
howeverill tbcolap~81vene80f the services avail shy
able Inthe 4ecentraUzed facIJJtiesIt resembles very
clc)sely the IOdel ~ordecentral1zed social servicedell shy
very developed by 1ahII~ Which was 41sCussed above he
SIlall neImiddotgbborhoodmiddot c8Dt~aw1tb1n walkl distance of
most of the populatiotl havebeendesilDedto take care
of allthenorllalhealth probl of 3000-5000 patJentsshy
check-ups IlzatiOZl8s1Jlpl laboratory testa and
treataentand iaecucatlol18 (d1apeued by phyS1cians) for
IIOst DODCrltIcal 1l11le PatIent 1d1Oneed IIOrespecIal-
Ized care are reterrecttobacJalp facilities BaCkup
support tor themiddot~t1oDa are the tWo l8rsernelshborhood
health C8Dter8~ttr1Dl aCOglete~e of out-patient
serneeaDd three part1clpat1q hoap1iampl bull bullbull which
proVide1Dpat18Dt~t andcoDSUltatlve services
(13 p1028) Intb1a prosrama coaprehens1ve range of
prevent1ve aDd trea1aeDt serric 18 aVailable throughout
the decentraUzed middotta The CoapreheulY8 ReIgbborhood Hea1~ Service Project
otKa1er iC)UDdatlcm HOspitals 111 Portlan4 OreOD 1s
s1ll11arto th DenVer prosraa 1D thata comprehensive range
ot out-patientmiddot services 1D prov14e4 in each of 1ts 10cashy
t1oDa althoUlhmiddotmiddot tbe oentera are larger and l bullbulls DDIerous
than 1nth DenverproPUh (12 p6)
Li i
18
In order that a comprehensive neighborhood health
care center be able to proVide continuity of care it
must have arrangements for hospital services integrated
into th system Yarby (37 p73) as quoted above
states that it 1s characteristic of the neighborhood
health center to be directly connected with a teaching
hospital However De Diaz (14p3) indicates that it
may be advantageous for purposes of service delivery not
to havemiddotthe center affiliated with a teaching hospital
She feels that such anaft11iation may lead to asltuation
in which policies might be determined more by the teaching
needs of a medical school than by the service needs of
the patient
middotThe Nat10nalmiddotCommissionmiddoton Community Health Services
(25 p69) states that such a system of comprehensive
health care integrat1na ~e servicmiddotes of several health
and roedical agencies snould utilize Itas much single or
unified management as possible Neighborhood health
centers have been operated under a variety of auspices
but several writers have pointed out the advantages in
termsof coordinated prOvision of servictts management by
the hospital of the neighborhood health center For
instancethisfac111tates the keeping of unified medical
records of all the care a patient Msrecelved either at
the neighborhood health center or _le hospitalized
(12p6) ~ermore a3 Young (38 p1741) points out
19
direct operationot the u1sbborhood health oenter by
the hoSpital canll8lceaftilable to the center expertise lt bull
in sOlle aapcta 0 Operation that m18ht not be aa readily
available otherwie
Relardlebullbull of wbetberthe hospital and the neighborshy
hoodhealtbcent8r haVe a cOJIIIOaadmjntstration they
IIlU8thaVealTlved at a str1Dsent delineation of IDUtUal
role and reSpoDBlbilltiebullbull All OOIIpoienta ot the care
yst IIlWStQlarify and understand one anothers position
In the syatem and acree on objeCtive ancimethOds
(26 pp16-17p31) SODae areas of iDUtUalconcemare
reterral procedures record keepiDg aDC1 mutual use of
facilit1es statt1Dl i8 anotb8r ~ ot coaaon conc~
Ditt1cultift have u-laeniD the pastiD cOllprehensive bull t bull
healtbc~ prosraumiddot 1d11ch were batil plauned in wb1ch
all of the health canter phy1C~1IDa did DOt bavetatf
privilege at all ot thebackuJlhospltala (29 p21)
SUch a8ituat10n i8 1Dampcceptablelt inpatient care i8 to
continue to be p4by the pat1eatmiddot health center
physician and it cont1Du1ty ot care 18 to be maintained
Hoapital and health center1lUSt laav 301nt responsibility
tor the recruitaentot physicians
VticlentU IPan BJcNrcu Much otwhat haa b8ea sUd has stre88e4 at leastmiddot
iJlplicit17tbaD8ed tor tM etticit middotprovision ot8emcea
20
There appears to be two aspects of efficiency which are
discussed by writers on the su~3ect of the comprehensive
neighborhood health care centef one of these is the
need to organize) services to make the most efficient and
economical use of scarce medical care resources The
other closelyrelat8d in realIty is the need to help
the public use services in the most efficient manner
The comprehensive neighborhood health center concept
1s lhherentlymiddot efficient in that preventive curative and
rehabilitative health ~are programs are coordinated under
one roof with integrated a~stration Furthermore
theempbasLson prevention health education and early
disease detectionis eftic1ent troJll~estandpoint of
the health care system as well as beneficial to the patient
(18 p760) HQwever ~ue tothe scarcity of health care
personnel thecoiDprehensive neighborhood health center
mustbe an arena tor eXperimentation with new staffing
patterns~ The Kaiser program is indicative of the way
in which health care systems must begin to operate in
that appropr1ate ancillary personnel are used Wherever
possible to perform functions that do not need to be
carried out by the physician As Saward (32 p42)
states
1hroughou10ur organ1zat1on~ there are many of the customary experiments be1ngmade-shyJse of speciallr trained nurses for well-baby care under the SUpervision of the pedi9trlcianexperiments with routine prenatal care by
w ~
21
middotSPC1a1l~t~JlUrbullbull per8ema_1 bullJmdlJleu y our fuDotlou are auoh that DOtb1Da 18 dorutbYtbe phY8iCianstbat doe DOt vet to be done by the
phys1c111U1fhe other aldlle4 person- Del-nurse middotreC~0D18t the appo1ntshymeDt center or clerical praormelshyaremiddot there to free h1amiddotto use his spec1al sk111
Awell lmoWn treDd1D the area of eaaiDI health
c8re JII8DPOY8rShortagjs bas middotbe thetrend toward tra1nshy
1DB poverty area rea1deats as DOD~pro~eaionalmiddoth8lth
aide and nepborboocl health workeramiddot (28 p63) This
bas the effectofmiddotmiddot1J)creaa1q II8DPOWrand 8180 can help
bridle the cuJ~ cap betweenprondera and colllUmers
of aen1C8s This attarD at least tlleoretically
createa a situation 1D WIa1ch providers andcoD8Ullers can
be educated to UDderatad OD88DOtber and interactJlore
ettectlvely~ HoWever amiddotpltt8ll has beeD themiddot tel14ency in
801D8 oamp8e8 tomiddot us aidesmiddot ssale8lllcw t~r the center
alJDOatexclwdY811rathertbaD ua1Dltheal to protide the
health care for wh1ch ~ were trained (29 pp3B-39)
1bat ismiddotmiddot vh1~e the a14e Yalue in ~~m1catiDI with
low 1nCOlMt patieata haa beeR recoSD1zed and stressed
their role ashealtb carepersoDDelhil been slighted 1n )
any 1Dstancea
Anotber step 1d11Ob bullbull been taken to provide 8rY1ces
more efficiently eUeot1ftlybas beenmiddot theorgan1zation
of per8ODDeliDto IIllt141sc1pl1Dary teamaaaa means ot
proYid1DgmiddotCOQrd1DatedserY1ce SUch te8lll8 sen_rally
~
hf
~
22
include PhYsiciaQs nursbullbullbullbull soc1al workers and outreach
workers Conceptually th8y fmlct10n to me~ the intershy
relate lled1cal and social needs ot the families sened
Hor there are a number ot barriers to the etfectve
tlmctiOD1nlof lIuchte8ll8 SODieot these are heavy caseshy
loads the inordiDate amount ot tille consumed by multlshy
prOblem tamtliethel1m1ted tra1n1 ngmiddotmiddotand laCk of tnterest
on tile part ot aoae tebers in examinJng aspects of
problems out14e~lr oWn areaaotcolIPetencemiddot and
~ourdcation prc)blell8 between proteasioDala and nonshy
prot81~s (10ppa-10) middotrurtbemOre as De Diaz
(14 middotp6)1nd1cate tbel8 maybe a teDdency tor vertical
dp8rtmental lines of auperv1810nto become paramount
over the team coDamloation syst lead1ngto conflIcts
in determ1niDI the ro1ea ot solie team bers particularly
the DOD-prote81011alaInauch exper1l1enta Witb new
~t1Dlpatterna it 1s bullbullaentialtbat line of authority
roles aDd NsP0D81bll1tlea be made explicit and that there
beJDechaD 8IUI tor relUlar evaluat1onotfunctlorUng
Another way inwb1ch health care sernee delivery can
be made more ett1cl8Dt is to proVide servicea dur1DC the
hours whentbey aremiddot -ostnee4ed As reQo_ded by Yarby
(37p1) serY1ce can bemadelIOre accesslble by making
themava1lable 24 hours a day seven days a week If
rg8l1Cy service are aft11ab1e aroua4-tbe-cloek at ~
nil1iborhood health center the continuity ot tbepat1ent ts
23
careiamaiDtalDedand meatry point into the
cOIIPre~i health care 8 be made available
tothe patient who aoZMllyU8ea ozilymiddot emergency care in
tille of med1cal criais More 8isDificantly ava11ab1-
lity of a tull rase of bullbullrv1c8 tor seVeral hours 11the
eVerlna aI1Cl On ~ prevent the los ot earn1JiSs
involved if th patierat 1IU8tt8cet1me oftfroawork dur1q
the d8y for aed1Cal oare bull his can be an eSpecially
importantc0J1814eration tor lo1aCOlleDUUg1nally qloYEtd
patient aa4caJla18o PIOJIOtet1)e 0Da01Dl use othealth
servicebullbull
exper1eDO ot tbeKa1er prosraa in tb1s~reprdAs
Greenl1clt(19 p10) states wA lllNt 8ip1flcant
proportion ot the abulatory care 8n1cp~Y1dd tor ~
total popUlatiC)U ~ ~ after clWc hours and this
Deed i8 apParenUyaoN prODGUDced tor aJl8d1cally
iDCust population On the other hand the bulk ot all
aabulatory med1cal cu 88l91ce are performed dur1nS
regular cl1D1c hour eVen when services are available 24
hours a dayJ day bull week W
It has ~ the experi8D~eof a ftIDber ot ne1g1lboXshy
hooct hea1tbcentere _t a_jor obstacle to efficient
proViSion ot anicbullbullhas beentbe teD4eDcy of medically
1ncl1pnt patieats to utilize the center oa a walk-in
baais tor epi8od1ccr181or1entect bullbullrv1cea rather than
4)i
h~ ~~f ~~ L
24
to make appoJlltaeata tor ODIo1qprevmt1ve treataent
and rehebl11tat1Ye care ad ampl1O to bave a blah failure
to Show rat_for tbe appo1DtaeDts that they dO make
Atone center 628 of appo1Dtments made were kept
while 3Oottbepati_ta een were ~1n patients
AlthoUP fewer patiets were actually 88811 by the cater
1D middottb1s 1Datance thaathe -bervholuidmadeappointshy
mta the walk-iD patlat required an iDord1nate amount
ot staff t1ae tor aCreeDiaaacl ~trral to pplOprlate
~ttor caregt (9 pgg) Arraquotbr1llpl1catjo~ of the
plOVidedto valk-iD patient by other thaD their
(19 p12)rurtbermore
when patients uti11ze Wlk-1Il er181 centered care
athelr ODlf tona ot ootact with the _d1~ care
ay_ta fUilycentered care the treata_t of tUl11y
bers
a a UD1t 11
dlarupted
hewalk-1Dphenoaaencm appear to barelated to
diUerence between soclal clase in the style of Dlaking
contactJt1th the a11oal C~ay8t As Greenlick f ~
(19 p11)1Dd1oate8 thepheDOaenOn ot INater usage of shy
walk-in ervice by aed10ally middot1Jid11ent patient thaD by
others baa otte been attr1buted to a stoical att1tude
tQward 1llDe8 em the~ ot poor people leacl1D8 to a
~
25
greaterdelay1n tbe k i Dlofa8d1cal care These
patients wppoedlyeelcmiddotcareODlymiddotwIleD tbeirmiddotillDess
becOlles1Dtolerable resultiDSin middotthMr appeariDS withshy
outnot1ce1o rece1ve oareHlwever Greenlicks
r8aearcbbaa cut doubt on the existence ot tb1delay
111 report1Dg middot8J1IPtoJumiddotOfDeW 11laessand seek1ng care
Be bas tcrQDd 1bat s1ll11ar peze_tases of dioally
1nd1sent 8DClJ1on-aed1cally 1Dd1PD~ pat1enta seek care
on the aue daytbat aptou tirstaPPear
1fb11e GrHDllclc 1nd1cat tbat the reasonator the
greatertendeDCY of low 1Do~e pat18Ilta to 1$8 walk-in I
serY1ces are notlcDo1rAmiddotmiddot tbe7 _ be rel~tedto a tendency
ot lower aocio-ecaaaoclaa patieota to preter face-toshy ~
face contacts with II841cal persoDl181posslbly because
such contacts areft coatortiDS an4reasauriDS to
patients who are hJpotbeafzed to bave a dependent attltude
toward IIed1Cal care perS0Jm81 (30 p161)
It a8 itmiddot baa pnerally beenhld the appointment
s1stemts the most efficient Ileana of dellveriDS
comprehenSive oODtllluiDlh-lth care (9~100)1t is
necessary that educaUoraalmiddotbulltfort be taken to proaote the
use ot middotappo1ntaents8DClmiddot tQrec1ucethe fa111re to appe~
ratB4uOatioaalwhlQb baft~utl11zedhave been
IJ
26
1Dten1ews with walk-in patients home Vi8its and group 4i
meetiDp1D8D attemptto1Dierpret1o the patients
the value of rtitgular ppo1ntmentamp andot con~in~
c~1ve care rather than epiI041c care (9 p1OO)
h1s 1safuD~tioD torwhtch nOl~prot81QDal colDlllUD1ty
YOrkersllaY bebe~r8U11ed tban other statf H()wever
euch aD ~ucat1oaal propul __~ ~e related to the senUiDe
capacity otth health oenter to provide comprehensivebull gt
ervice8 to1tpat1_t~odoD aD app01ntment bas18 It
1amp pos8ibleo~rw1 tor educa110Dal ttorts to result
LD a~8JImCl tor ltPP01ntaen~8 at a ratewb1ohi8beyond
the capacity ot thee_tar to t without uareaaoDably
1_ wa1t1Dlprio4a QOBt1nuad use Ot the center on a
wallt-in bU1 _1tbeoosiItpos81ble to et an appoint-
met anc11nCreued pit1entcoJaplampia1a bull Therew111 of
course always be a need and demand tor acute ep1so~c
Care -ci the health centerDlWlt be planned with the capashy
billty ot bullbullbullt1D8 tb1aneed wh1~ cont1Du1nI to stress
aDd educate the patient to utillze oDlOinI comprehensive
faa11y middotc~te~d Cflre (9p 100l
att g4 CODClva1opa
In order to bea4equate any coJlltemporary health care SY8tem muat bullbulletcerta1D interrelated criteria he
IJ
27
minimum criteria areaccessability of services to those
who need them compr8heX1siveness and appropriatness of
services and efficIency 1nthft utilizat~on of SCarce
health care personnel and resources The scareity of
pex-sonnel andtbe need for h1gh quality ongoinghealth
care services
aJIlong the
populationdemanci the most effishy
cientprovision of services
Services must be made accessible to the population
They mustmiddotbe geosraPh1cally accessible to remove the PhysicalmiddotbaTiers betWeen peopleandthem$d1calcare
system They mUst otter their services dur1ngthe
hours when people can make the moat use ofthemA~ it
makes little sense to concentrate services geographically
where they will not be uSed to their fUllest extent it
also is wasteful to provide serv1cesonlydur1righours when
many people are employed his not only presents a hard
ship middotto the consUmer lnrt wastes resources if for instance
the unavailability of preventive services during the hours
when people Can use them causes a need for treatment
services later on
Health carbull sEtrvices must be comprehensive including
prevention treatmcmtand re)abimiddot11tation Ambulatory I
healtbcare facilities wh1cQ are orienteciexclusively
toward either prevept1on or trea1mentare no longer accepshy
table for they are lneft1c1entln their use of resources
and in their prov1s1on of health care to the patient
w ~~
28
If prevent10n1s notmiddot stressed treatment serv1ces that
could have beenavoidedY1l~ be required If prevention
1s the sole focus of the health care facility sick
patients who present themselves must be referred elseshy
where for treatment andsllch referx-als may be taken as
reject1onsor not followed through with until illness
becomes unbearable
The instltutlontbat meets these requirements Is
the comprehensive neighborhood health center It 1s a
local decentralized outpatient facilityprOVld1ng a
fUll range of ambulatoJY health care services It has
a linkage to ahospitalbackUp facilityforlnpatient
treatment and hiihlY apclalized outpatient care
The neighborhood health center must be a fac11ity
planned with an awareness of the needs of the conSUtller
and coDitnUn1ty It must have the r~Ul0urces to provide the
services people need mere they can use them and when
they can use them It must uti11ze the part1cipation of
the community to develop this awareness Not only must
the cen~er beset up to be Amctional for the consumers
but efforts must bemadeaga1n with commun1ty partici shy
pation to help the consumers utilize medical care
services effectively The center muetmake efforts to
educate the community about the valueot regUlar health
care of preventive servicesand of the use of planned
IJ
29
medical appointments ratherthanorisis centered walk-
incare Therealit1es of the existing health care
system have not taught the patient particularly the low
income patienthow to use services effectively
The helthcenterilUst also bea laboratory for
experiments in easing the health caJepersonnel shortage
and c60rd1Datingcare~ A major difficultY iri-exper1shy
menting with neW rolesis freeing staff of old preconshy
ceptions
CoDlprehensiva neighborhood health dare centers have
been developed under a variety ot alisplces including
medicalsociet1es hoSP1talsmiddot(36p299 group pr~ct1ces
(29 p6- 12 117) health departments (13 p1027) and
ne1gbbothoodassoc1ations(14) The literature indicates
somevalues nthe management ot the health center by plusmnts
hospital backup faCility Whatever the auspices many
adm1nistrative fuDctions such as program coordination
standard pr9tectionand evaluation call for considerable
c~tralization of adm1nistration city-wide or coU)tyshy
wide At the same time other aspects hours of servlce
for examPle~ cuI f~radm1nistrative fUnctions made atmiddot
more local levels Each neighborhood center must be
free to adapt its functioning to itscominunity thi-ough
the mechanism otcODlllUl11~ participation inmiddot policy making
Obviouslythe prerogatives and responsibilities of each level must be negotiated and made explic1t
t4~
JJ
BIBLIOGRAPHY 30
1 American Rehabilitation Foundation ~ealth Services Research Center The Health Maintenance Strategy mimeo 1971
2 Anderson Nancy N Comprehensive Health Planning in the States A Study and Critical Analysis Institute for Interdisciplinary Studies American Rehab ilitation Foundation 1958
3 Andrus Len Hughes Comprehensive Health Planning Through Community Demonstration Health Projects mimeo1967
4 Barry Mildred CandCecil G Sheps A New Model for Community Health Planning unpublished paper presented to the American
Public Health Aseociation1967
5 Blum HenrikL Fred Wahl Genelle M Lemon Robert Jorulin and Glen W Kent The Multipurpose Worker and the Neighborhood Multiservice Center InitialImplications and EJeperiences of the Rodeo CommunityService CenterAmerican Journal of Public Health58 (Mar 168) pp 458-468 shy
6 Blum MichaelD and Soloman L Levy A Design for Service Delivery that Reinforces Constructive Tension Between a Health Center and Its (sic) ConSUDlers and Supports Community Power unpUblished paper presented to the American Public Health Asaociatiltn 1968
7 Brielaud Donald Comm~ity Advisory Boards and Maximum Feasible Participation American Journal of Public Health 61 (Feb 1971) pp 292-296 shy
8 Burns Eveline M Health Insurance Not If or When But What Kind Madison Wisco~sin University of WisconsinScllool of Soci~l Work 1971
9 Campbell John Working ~elationships Between Providers and Conshysumers in a Neighborhood Health CenterU American Journal2 Public Health 61 (Jan 1971) pp 97-103
10 Caxr Willene Neighborhood Health Centers Funded by the Office of Economic Opportunity mimeo 1970~
11 Colombo Theodore J Ernest W Sawardand Merwyn R Greenlick The Integration of an OEO Health Program into a Prepaid Comrehensive Group Practice Plan American Journal of Public Health 59 (April 1969) pp 641-650~ -
12 Comprehensive Neighborhood Health Services Projectof Kaiser FoundatioIl Hospital~ Prcgtgram YearE grant renewal proposal mimeo~1971 bull
13 CowenDavidL~ Denvers Neighborhood Health Program Public Health Reports 84 (Dec 1969) pp 1027-1031
IJ
14 De Diaz Sharon Daniel Beyond Rhetoric The NENA Health31 Center After One Year unpublished paper pres~rited to the American Public Health Association 1970
15middot Gerrie NorrrianF and RichardH~ Ferraro Organizing a Program for Dental Care in a Neighborhood Health Center Public Health Reports 8 (Aug 1968) pp 419-428
16 Gordon JeoffreyB~ The Politics of Community Medicine Projects A Conflict Analysis Medical Care 7 (Nov -Dec 1969) pp 419-428 shy
17 Greely David The Neighborhood Health Center Program and Its Implication(3 for Medical Care H~alth Forum of the Welfare Council of Metropolitan Chicago (mimeo) 1967
18 Greenlick Merwyn R Newgtimensions in Health Care American JOurnal of Pharmacentical Education 34 (Dec 1970) pp 754-4
19 GreenlickMerwyn R Donald K Freeborn TheodoreJbull Colombo Jeffrey Abull Pruesin and Erne$t W saw~d Comparing the
Use of Medical Care Services by a Medically Indigent and a General MemberShip Population in a Comprehensive Prepaid Group Practice Prosram II unpublished paper presented to the AmericanPublic Aesociation1970
20 H~tadoArJiloldVMerllYll RGreenlick and TheodoreJ Colombo Determinants of Medical Care Utilization Failure to Keep Appointments unpublished paper presented to the American Public Health Association 1971
21 Johnson Richard E and Merwyn R Greenlick Comprehensive Medical Care A Problem and Cballengeto Pharmacy ff AJilericanJournal of PbarmacenticalEducation 33 (Aug 1969) pp 361-367 -
22 Kahn Alfred J Studiee Social Policy and Planning New York Russell Sage Foundation 1969
23 Kotler Milton Neyhborhood Government Local Foundations 2 Political~New York The BobbsMerrill Company 1969
24 NationalCommisaion on CommunityHealthSfrvic~sActionPlanniriamp for Community SetithServices~ashington p C Public Affairs-Press 19t7
25 National Commission on C~mmunity Health Services Health Adminishysration andOrMPization l the Decade Ali9$-d Washington D C Public Affairs Press 1967
26 NationalCornmiesion onqomm1Jllity Health Servicesbull Health ~ Facilities Washington D C PUblic Affairs Press 1967 bull
~ n
32 27 ODonnell Edward J and Marilyn M Sullivan ServiceDelivery
and Social Action Through the Neighborhood Center A Review of Research tt Welfare ~ Review 7 (Nov~Dec 1969) pp 112
28 Office of Economic Opportunity Second Annual Report Washington D C~ U S Government Printing Office 1966
29 Office of EConomic Opportunity and the Medical Foundation of Be~laire Ohio Eighth Report 2l ~ Committee2a Governshy
ment OperatiOll~ Va8hiiiSton D C Government Printing Office 1969
30 Pope Clyde R Samuel S Yoshioka and Merwyn R Greenlick Determinants of Medical Care Utilization nhe Use of the Telephone for ReportiDg Symptons Journal of Health and SocialBebavior12 (June 1971) pp155-162 shy
31 RenthalA Gerald nComprehensive Health Centers in Large US Cities American Journal of Public Health 61 (Feb 1971) pp 324-336 shy
32 Saward Ernest W The Relevance of Prepaid Group Practice to the Effective Delivery ofHealthServicestt The New Physician 18 (Jan 1969) pp39-44 - shy
33bull Schorr Lisbeth Bamberger and Joseph T English Background Content and Significant IssUes in Neighborhood Health
Center Programs Milbank Memorial ~ Quarterly 46 July 1968) part 1pp 289-296
34 Weiss James E and Merwyn RGreenlick UDeterminants of MedioalCareUtilization The Effects of Social Class and Distance on Contacts With the Medical Care System Medical~ 8 (Nov-Dec 1970 pp 456-462
35 Weiss James E MerwynR Greenlick and Joseph F Jones Determinants of Medical Care Utilization The Impact of Ecological Factorstt unpublished paper presented to the American Public Health Association 1970
36 Wise Harold B Montefiore Hospital Neighborhood Medical Demonstration A Case StudyMilbaDkMemorial Fund Quarterly46 (July 1968) part 1 pp297-308~
37 Yerby Alonzo S ttHealth Departments Hospital and Health Services Medica1~5 (March-April 1967) pp 70-74
38 Young M M~ Chatanooga IS Experience with Reorganization fOr Delivery of Health Services ttAmerican Journ8l of Public Health60 (Sept 1970) pp 1739-1748
f or l
II bull 11 Y d
II
IJ
34
ThepurposeOfPart II of th1aa paper1atod1scuas
elected Speclfic needs ofecltlc areas within Multnomah
County A8P01ll~oUt 1D ~ I of t1a1bullpapermiddot Ita nelgbshy
borhood health oare cater IlU8t be a facl1lty plaDlled with
aD awarenes of the neeels of the oODllUller and collllUDity
Part II of this paper nIl Show 80e of thoe speclflc
needs
he1DforutiOD tor t1li Portlon of the report
obta1nec1 troll tbroupout tbe follow1Dl threepUb11catloDS
1gr~e_tiMshylIPrIxaiidOreson JuDe 1963
2 1~_middot_sectSI8e~ected1teai c-ua 0 S 8 e first count coaputer tape Coluab a_lion AssocshylatloD of QoveraMD-8 Jlme 1971
3 Jtu1tDoab County Oreaon BDY1roDlHtlltal SurveyEarly 1971
The JIultDOIIIlb COUDty OrttIOD BDv1roDllfmtal Surley
Barly 1971 1s bull stat1stical report of the activ1tles of
theentlreMultDOIIIl2 CcNDty Health Dep~t during the
year of 1970 Die speclflc 1nd1cs elected from tb1s
study amprejMental aealtll Publlc Health N~s1D1 vlslts
FaJUly ~ Veaereal])1 ~ ~rcul081
Throush tie use of cUrts and mapa ODe CaD roup these i
speclflc ~oea to ahcnr the healthneedsof speclfic I
census trtcta aD4 then the health needs of iarer neIghshy
borhooda 1m4 o~ Uebullbull
Rf)~UP1Dl of areu was accompllshed in thefolloWinl I
JJ ~
35
he MiltDoIliahCountY oregon BDViromaental SUrvey
early 1971 isamp statistical report ot tbeaotivities ot
the entire MultDolllh COUDty Health ])epartiDent dur1nl the
year ot1970 he specitic 1Dd1C8S selected frOm this
aUy are 1Il8Dtal health public healthDurs8s visits
fUl1ly pia waereal elisease aDd tuberculosia
Tbroq11the Wle otcbart aDd mapa aDecm szoup these
specific indic to show the health Deeds ofapecitic
ccmaua tracts aDdtIum th8health neecla of larsr ~eilh-
bOrhooda and co8I13 tlbullbullbull
RegroupiDI ot areas waa accoap118hed1D the
tollOWiDl lIIIIm1er~ A bullbullcifie 1ndex 8selectcl auch as
venereal di8bullbulle or tuberculo8i~ he total number ot
cs was then deterll1ne4 for each census tract Through
the use of the maber ot cRbullbullbull tor a 11Yen cenaus tract
aDd tbe population ot thattractaltrateot1lla1ampmcper
100OOOpopUlaticm wu cleteXll1ned for each census tract
This was ~e to starl4ard1ze the population ditterence
amongOeD8U8 -tracts 1he rate of incidence toreaob
cenauatract was then llstedby rank position on a chart
In rank poition1DI any cen8Wl tracts haviDg equal
rates ot1l1c1dence are assipe4tbe iaDk posttiona
Beeauseot the abo fact tbAt cbarta w111 vary in length
neveltbAtlea eacb cbart will 1Dclu4eall census tracts
inMullnoaah Couaty Atter the census tracts bave been
listed accord1q to raalcth1s list will bediv1ded into
IJ
36 three levelsotinc14ence he three levels are
1~ The upper 14 of1DcldenCe
2 Thelower 14 ot incidence
middot3 The ILld 12 of incidence
Tlles three srouplqa are then used in compiling a map ~f
Mu1tnOmahCountyfor ach apecltictop1cbull TIle maps are
uaefuJliD tbatthey V1suallycoJib1De 1Dd1v1Clualproblem
census tracts into larger problem nellhbOrhooc1s
The 1960 statistical iDtormatloD was Used in a similar
liIaDDr to tbatexpla1Dedabove 1Dthe4evelopaent of a
chartmiddot and map 1Ihow1DI e cOllpampriSOr1 of per capita lncolle
tor ttaCh ceDsua tJact aDdmiddot combiDed census middotmiddottract areas
he 1910 aDd 1960 statlstlcal iDtOrllatl0D was combined
lna map and chart he purpose of this and chart is
to d8aonatrate the e cl1stributloa1DeachceD8U8 tract
and middot1ndlcatbull tuture ace populatlon treD4a bull
When one be middotbullbullbullbullbullHdth ne8cts ot an area and has
declded to establlsh a cl1D1c to serve that area the
physical location otthat cl1D1c IllU8t be consldered In
order to coapreb8ll81vel develop an area cl1n1c one should
conslder thepre88Dttraftlc middot~ytaa an4tranaportatlon
systems Thecl1D1cahoUld be located close enoUlh to
major arterlals to giva asy access from the total area
be_ ervecl by this cliD1c At the t1ll8they should
be tar eo away froll thesarterlals to all8Y1ate traffic
CODCell18 andpark1D8 conpstlon By traff1c concerns I
IJ
37
lIlan one lUSt consider thertarro1fne8S of streets whether
streets are oD8--C)r two-way iqres8 and egress to parking
amp0111tie eros tratflC) spedof trattJQ children 1n
ll8a traffic i1lht Vislon re8tr1ctionS etc
BwstraDsportat1onshould alao be central in this area
as maay people ~U f1Df1 1tD8Cessary to use this form of
transportatlon
~e tutqredlopHQt of bull treewa systems should be
c0J1S1dered soastolesen thecumce ofmiddot future roada
cutt1DSotltbe cl1D1c llte line
nrrph1c middotDampta
It is 1JDportaDtto kDOw the demosraphic distribution
characteristics of the oUenteltbat i8 to be served by
localized health cl1D1cs
Acl1D1c which erves8J1 area where1D the prepondershy
ance of persona arecrter 65 years of mayf1nd that these
people rely more on pUblic transportation call for more
home- services and haV4t 110ft ChroD1c and debilitating
types of disorders (b1_ blood pressure poor heariDg and
eyesight) tbaD do8 an area ot a YOUDIer population On
the other hand thL area of older residents may have little
need for family plabDlng cllni08
In order to better ~Ybullbull the 4eaoraphic population
of each CeD8U8 tract the 1970 CeD8U8 iatormation was viewed
and two specific catelOri8 considered These two cat
IJ
38
lori8S woUld be the perc_tap ot population under 19
year of ase and the percentase ot each oensuetractover
65 years of age he 1960 1Dtormatlon tor eaCh tract was
then compared witbthe 1970 intormation and a percentage
ofincreaae or4ecreamp8 tormiddot e~chtract1n each category
cOJlputecland achartma4e By the use of this chart one
18 able to View tJleap populat1odiatr1but10n of census
tract and at the _ t1lle accesa middottrencl Por example
let us choose census tract 601 W see 40-4 otthe
population is under 19 years ot and that ODly82 1s
over 65 years ot middotAtthe e tille the percentage of
youth bas ~ed ODly 1_ intbe laSt teD year whilethe
percentale over 65 year ot middotbas stayedmiddotthe same With
this in mJnc1 ODe ~ 1DfItr libat ol1D1o aerviDg this
area WOuld bellQre conq~w1th the problems of a
YOUQier populat1on and that _ would probably be true foJ
some t1aein tbefuture On the other hand CeDSU8 tract 54
has only 2 ollt population UDder 19 yel1s ot age and
this has decreased by 1 over the last ten years middotwhile at
the same time 32-377 ot the populat1on 18 over 65 years of
age A ol1D1C ___ this area should be or1eJ1ted toward
tbespecttic problema otthe ampledbull
PerCapia __ bY gsa neat
WhaD cona1der1qlooat10D1 tor health cl1n1cs one
shoUld take the 1DC01Ieot areas into consideration Areas
IJ
39
of lowiDcome would not 11kel~be 8erved more by localized
cl1D1cs tbaD would are of hilbincome It 18 likely
people haYiq a hip iDeoll8would preter to be aeenby a
chosen ~r1vatephylc1a1l tban at a local cl1D1cwhere
10Dier waits y beraceaaampryand leas personal attention
gl_
The 19701ncOII81atoWampt10n tor MultnomahC~ty was
not available at the tille thi8report W88 made The 1Dto~shy
tiOD Was taken ~adtro tbe1960 census publlcation
his woUld ~8Il thea tbat ral1I8 OD the chart ynot 1raquoe
completely accurate hi writer telthatthe areas most
affected by tb8 1I8eof the older 1Dco1DtOlaat1oDWOuld be
those tracts wh1ch baYebad a rapid 1ncreaae1n populatlon
over the past tfmyHr8 bullbullbull tracts would include tracts
nUmbered 104 9897 96 aDd 95 be perc~ita 1Dcome
referredto1il-tb1a Paper18the lIean 1DCo per person per
census tract
Attar the iDeoeper census tract was listed on a chart
a map was de 1D41catiDg those census tracts belonging to
the lower 14 ot income tor all censue tracts in Multnomah
COlDltytbose beloqins to the upper 14 ot income tor all
census tract 111 MultnolUlhCounty and those belonging to
the mid 12 ot 1I1coaetor all oeuuetracts in Multnomah
C01mty
In yiew1Dg the _p 1t caa be seen that the low income
area seautotollow aloas the at aide ot the Wl1lamette
IJ
40
R1ver the full length of Kultnomah County A second low
income area follows the south edge of the Columbia from
the northwest corner of Multnomah County easterly to 148 St
A third problem area seems to be on the east bank of the
Willamette River with the Union Pacific Railroad being
about the center of this tract The extreme loutheast
corner of Multnomah COUDty appears to be a low income area
but as this area bas bad rapid grouth in the last ten years
this could be erroneous
Mental Health
be first ~ecific indica to be selected from the
Multnomah County envirollllental survey of early 1971 and
to be considered in this paper i8 that of Mental Health
At the present for mental health purposes Multnomah
County is divided into five catchmentareas with a mental
health cl1n1cin each area These clinics are Model
Citles Delaunay ADkeny street Office Hansen Health
Building end Southeast Clinic
All lIlental health cl1n1cslcept statlstlcal information
on all patients visiting their cl1n1cs this included the
address of the patient hese addresses were then listed
upon the approprlate C8D8US tract Each census tract was
then ranked on a chart according to the nUllber of mental
health patients who reslde ln thatCeDSUS tract attending
any of the above listed ental health clinics This chart
IJ
41
wasttum d1v14ed1ato proper quartile bbullbullbull
quartile vereUs to dne10 u appropl1ate Multnoh
County _tal health ItLa middotmiddotmiddotthelipO~a1bl by lOoJcJIUE
at the UDtal health _to uteN1De which ueu have the
lars-t use otCOllDty 1alh~th faci11t1Rot
1Ilclu4ecl 111 tbia woUld tber otpeopleYia1t1Da
pr1vat patch1atriata aDd pr1_t _ntalhealtb cl1D1c8
WheDtbe M1 18Yienclmiddot Itmiddotmiddotmiddotmiddot~middotbe~_ tbat ~rtt
appears to lMt fourmiddotmiddot-al are iii _oil the nuaber ot
lIental healthcl1D1c na1t toM tbjh1sheat 1he
tour areaa woUld be tollows
1ttrea Ore to~Blo Drimiddot ~tb Burrus14e aDd tIMtmiddot Colb1a Riftr H1gbwyaeri1Dla th nortllra boundaryshy
2 bull ProII 82D4 1_~ 10 20th streetwitil the ra1lMd Mu the north ltouadary
3 ~ et et tUgl_b1bull MYel froamiddot the Clackaaa COUDty l1ae aorth to Dln8lon stret
4 beDOlvt1ttfe-t ~efllt4 COatytrca Jle1aware streetmiddot toR1C1a11oDd wlth Colubla Blvd heiDI tbAtnorth bouaclary_
It ODe coapareatbiap to th iDeobullbullmiddotp 1t can be
eamiddotthat lIOat ot the c tracts baY1Dg bllh v1i11tatlcma
middottfl public tal health cJ1rUc8 ~ 111 t13e low ~ aid
1DcOile SroupiDIOJa1y of til 25 tracta llsted as
haviDlbip aental Maltll nlltatlou are ~ the1g60 hip
iDeo arebullbullbull
17 Plpn
42
amily PlellnSDI ]Jlce Metal Health i8 an 1nd1ce of
use Theperson 111 ordertobavebe_ 1Dcluclecl 1n this
atu4ywouldhave tohaft Ue4 ataa11y plaDI cl1D1c
tacilities of soaetype It 41fter troll tile _tal health
study1nthat i t1Jicludestatist1catrollbotb public and
privateclJD1os
The iDformation tor the iak orurcbart 8Dd map of
t8ll111 plenn1 na ob1a1De4 by cOIIblnlDlthe mabel of
1rlcuv1duals bullbull_ attbe tbreellUltrampo-ti Coatyhll11y
PlalJQllIl C11ll10s 111til tbo at the Planned PareDthood
Association CliD1C8 be tbree -JIultDouh Couaty r8ldly
PlamSq Cl1D1c are Solrtbweatth Col_bla 1111- a114
HaDsell Health BWlcl1Dl CllD1cbi middot1Dtormat1oD vas then
bullbullbullesed tomiddot detellWMt l10w people troll eacb c8IUIUS
chart wastben Mele IUs oIIart jn 4iY1ded to show
the censuS tracts lIaYiDlmiddottIle h1t1iest qUart1le of incidence
of use lowest quartile of 1Qc1deao ot use Jlid 12 of
incidence of Wle an4 a map sprepared troll thts 1Dto~
mation
The C8U118 tractsbelOJISnl to the h1lhestquartile of
use appear to be 1lO~ 8catt~ on tbipwas true ot
either the _p ot aental health cl1D1c uaageor ot the map
abow1DI per capita 1I1COM Iaere40 to be three
d18t1nct areas of UIIaP beJ woul4 be
1
IJ
43
t10D of BurD81cl and the W11lallette River 4
2 S~t Portland 8Otth otmiddot the ra11shyrcaadand alona the W11lamette River
lIortbeaat Portl8D4 between MisSiss1pp1 and 24tbStreet the northbouBclary be1DgColwb1aBlvd
Pylzl1c BMltl IrpI Y11ta
Publlc Healtil nur81D1Y1s1t nclud8 an vists to
theholles of client by PubUc Health Nurbullbullbullbull his shows
visits to bull f8Jl1ly fer aDY purpos SUCh aatuberculolJ1s
het1Dl tem1tyaeatalu4 8IiOt10D8l cODd1t1ona etc
he atat18t1C~ 1fele C()4ed accord1Dg tomiddot the 1llli301fOCUS
of the Y18lt tt doe DOt 1D41cate the Dmlber of holies or
f8ll11lev181tecl or 1D41Y14ual Y1a1ted more tban oDcein
the propwl It dobullbull I1ve 80M 1D41cat1on by coaparlshy
OD ot the 8JIoUDt of aedlcal problema 1n eachcen8WI tract
Ap1nmiddot the _p abowa 8 scatter patteraof probl_
areas althoUSh there appear to be a sroup1Dl of hiSh J
l8aIeccmaus tract 1ntlut extreme southeast part of tbe
County other areu uIriaI any nura1Dl contacts are
1 bull he 801lth-oa-al CO1Dty on eaCh 814 of 82nd Av from Clackallaa County north to Dinloa
2 ear bullbullbullt 814e aroUDd Preacottand Misaisippi
Dowatom Bunul14eonboth 1de of the river
44
V_real Pis The iDfomatloil uaec1 to tabulate the Venereal
disease chart includes all the ooab1ned case otmiddotODormea
and syphilIs reported by bothmiddot publIc and prIvate physicIans
dur1nl 1970 There were 3602 caes ot IOnorrhea reported
dur1nl 1970 While ODly 17 cabullbullsot ayphilimiddot were reported
A chart was prepUed aDd att8llPt wasmiddotmiddot de tomiddot
determ1De Wh_therVttDereal 41ease was more p~vaJent in
areas othigb or lowmiddot proportIon ot youth hi waadone
bymiddotdetemlna a 1leaD prceiltacmiddotmiddotmiddottor the population ot
resld~ts UDder19 years ot (34) middotA mean ratemiddot per
100000 popUlatIon al80c1ttem1Ded tor the middotoccurreDCe
ot venereal dieae This was et at 390 oass Areas
hav1nl a population 1n which leiS than 34 were lmder 19
years ot ampIe were called low- yOuth abOve tbl percentaae
hiSh youth The aaa waatrue ot the occurrence oivenershy
eal disea_ per CeD8UStract It the rate waacomputed
as 1I0re than 390 cases per 100000 it was called hiah
venerealdiaeasei it less than thia tisure low venereal
disease It was tound that 1D Multn~ COmlty there sems
to be poSitive OOlatI0n(x21S19gt between low youth
and hipmiddot venereal diseaand hip youth and low venereal
diseasebull
RaDk ordr Iitot all c traot middottbAm made
Th1s was done byt1Ddlna the ratepr 100000 populatIon
of venereal disator all census tracts in the County bull
45
These were thenlisted from h1lhto low (sreatest to
least) in a rank order The l1sting was then divided
into Upperandlower 14 aDd listed on the MUltnomah
Countymiddot up
The areas of b1gh venereal disease se8ll18to
roup thBl~8 middotin a very tllht area ~oq both 1des
of thell18l8~ R1 w1th BurDaldeS~et being
~bout theceDter qf tbi8IZ9uping This area woUld
appear to be m ldeal spot for the denlopment of a
locallzed venereal d1sbullbullbullbull cl1D1c
UbepoundCUlO1s
In this report bull tube1C1llosls caS8S refrred
to include alltbobullbull cabullbulls ontubercUlo8is follow-up
rather middotthan just new C Accord1Ds to the Multnomah
County Health SUrvey of early 1971 this would include
all ca repOrte4 over thelaat three years The
total number of tuberculosi8 cabullbullbull usedin this study
was 666 lh1 included 128 new cabullbullbullbull
A rate per 100000 of tuberculosis for each
census tract wa- then computed and the c~us tracts
listed by rank order be b11h Qartlle mel low
quartl1 were then reoordd on a Multnomah CoUnty map
TWo genral areaa baY1Dg a hip mcldencaot tubercu~
losiare 1D41cated heyare
1 Both middotsld ot theWilla11lette River
Ll -
46
with Burns1de about thecnter
2 he extrea Northebullbullt comer of the County bull
By coap8r1ng the tuberculois an4ven8real
diseae maps ODe can 8ee that the downtown areas ot
hiSh 1nc1denceare alIIo8t 1c1eDt1cal on ach map
This WOuld 1nd1cate that 1t would be of value to
bullbulltab11sh acl1D1c 111 th1aampreatbat would provide
bothtuberCulos1s 8Dd ytmereal 418ase srvicbullbullbull
Thchart aDd 1181gt8 are wsfuln 11v1DI
1Ddicat10DS tor the type aDd placemeototlocal
health cl1n1c8 tbro1qhout tbe MultnomahCounty area
A cOllpar1on of the mapa help one to dec1dewhether
to provide a aulti-8ervice cl1D1c or spec1f1c type of
cliD1c As stated in Part I of thi paprserv1ces
shouldhaYe both treatlieDt and prfMmt10n cOmponents
As he been stated fta ne1lbborhood health care
Qenter muat be a fac111tY plazme4 with an aamesa
ot the neds of the consumer and the c01llll1m1tybull
Part II of this rport haa been an attaapt to indicate
and clarify 8011 ottheae coDlllUDity neds This has
been done through8elect10n of apc1f1c problems
The indic were then visuallyrecorded through the
use of ups and charta ODe dan asseS8 thedsreeof
1DIportance of certain concems to spec~t1c areaa by
comparinl the chart aDd maps Prom this oDeean
41 dec1de which are48 vb1chcUD1c-or indeed if
the need a clinic at all However further factors
should be considered hebullbull include
a The amount of fuDd1 available
b What 18 the percentage ot peopleineoh ceaaua tract tbat would actually us such cl1n1cIl
c Wbat 1 tbeco--1tymiddot 8 IeeliDashyreaardtDI particular cl1D1c8 Would this dcrebullbullbullmiddot the ettctiveness ot thse cl1n1ca
IJ
li
D_OlraphicPopulatLon Challie 1960 to 1970 48
Cen8U8 1 of Pop 1 Cbaqemiddot 1 Change1 ofPopTract Under 19 Yr8 Over 65 Yrs1960-70 1960-70
middot1Q701Q70
1 319 -12 171 -H) 1
2722 215-27 +68 301 366 -22 127 +35 302 371 +19 111 -04
311middot401 144-41 +29 402 321 13~7-39 +24 501 356 124-08 -02 5~O2 351 133-23 +12
405601 82-10 -02 394602 103-01 -06
701 275 149-76 +56 702 361 +01 121 -07
+10middot801 326 140-22 802 321 middot127
(
-29 -03 9~01 342 124 -H) 6-18 902 294 128 -H) 3-24
10middotmiddot -14312 140 -17 1101 182 +25 -23197
2411102 186-59 +29 1201 226 169-17 -41
31middot01202 +11 182 -05 295 -H) 81301 208 -H) 4
1302 331 +08 197 +04
14 323 +15 middot185 -08 middotmiddot15 329 +16 16~5 -13
-28middot 1601 332 131 +12
1602 356 98 +24middot-39 middot3101701 161-33 +21
1702 370 -15 85 +02 +19 1801 264 151middot-50
185middot1802 256 +47-58
IJ ~
D_raphlc Population Change 1960 to 1970middot 49 (Contd)
4io
Census Tract
of pop Uncter 19 Yra
1Q1n
1Cha1l8e 1960-70
of PopOver 65 Yra
lQO Change
1960-70
19 389 +29 141 -24 20 223 -13 206 +18
21 227 +08 194 -36 2201 356 -27 112 +05
2202 290 -18 ll~9 -29 2301 356 -03 154 +24 2302 260 -37 245 +97
2401 410 +6~1 123 -31 2402 163 -80 320 +99 2501 381 +13 140 -01 25()2 237 31 lil +02 26 343 +25 186 +149 2701 370 +29 1S5 -01 2702 249 -44 304 +98 2801 337 +19 187 +09 2802 306 -10 156 +31 2901 304 -38 142 +24 2902 i 307 -32 146 t3~9
30 29~0 -48 16~2 +51
31 355 +30 160 +01 32 370 +48 148 -13 3301 395 +45 130 -20 3302 368 +06 138 -02 3401 386 +16 117 000
3402
400 +32 92 -26 3501 304 -07 115 +35
3502 344 000 140 -13
3601
36~02 357 -04 132 +32
3603 30~1 42 149 -67 3701 342 +28 152 +19
1
IJ
Jianolraphic Population Chan 1960 to 1970 50 (Contd)
Census Tract
of Pop Under 19 Yrs
JJl7J
middotChanae 1960-70
middotofmiddotpop Over 65 Yrs
1c~7n
Change 196070
3702 409 +39 122 -11 3801 308 -11 151 +29 3802 275 -35 180 +46 3803 282 -32 192 +54 3901 376 ~13 100 +17 3902 296 -03 177 +29 4001 438 -11 84 +13 4002 353 -21 115 +20
4101 397 11 9middot0 +11 4102 346 -19 120 +03 42 331 +19 11 bull 3 -16 43 347 -72 105 +31 44 113 +84 183 +154 4S 33~9 +07 110 -06 4601 2501 22 193 +38 4602 332 +59 126 -29 47middot 161middot 000 211 +01 48 103 -26 302 +59 49 138 +1 bull 3 252 +09 50 141 -26 204 -12 51 12 -39 257 +07 52 47 -61 351 +48 53 89 +49 314 -30 54 25 l1li15 327 -17 55 131 -17 115 -121 56 198 +93 227 -47 57 71 102 189 -88 58 240 ~middot41 16~1 +55 59 322 +25 142 +06middot 6001 264 95 132 +50
6002 328 -31middot 89 +07
JJ
Demographic Population Change 1960 to 1970 51 (Contd)
Census 1 ofPop lChange of Pop bull ChangeTract Under 19 Yrbullbull 1960-70 Over 65 Yrs 1960-70
1970 1970
61 355 -58 85 +39
62 328 39 110 +18
63 414 04 73 10
64 382 -22 72 +04
6501 383 02 67 -20
6502 329 -56 96 +09
6601 391 +13 88 -03
6602 319 -59 97 +06
6701 327 71 145 +72
6702 331 ~67 83 +1-0
6801 365 -66 49 +01
6802 388 4bull3 54 +06
69 354 -41 80 +23
70 400 -23 68 -06
71 359 -48 72 +05
72 255 -88 82 +11
73 346 -39 91 +25
74 313middot -63 105 +24
75 329 -42 129 +37
76 336 -52 85 +21
77 370 -10 69 +05
78 309 -10 120 +21
79 325 -56 87 +10
8001 358 -81 57 +12
8002 391 ~81 76 +12
81 315 -76 108 +21
8201 403 -23 64 +08
8202 392 23 65 +08
83 357 -34 120 +31
84 402 -18 73 +16
85 413 -06 76 -09
r
Demographic Population Change 1960 to 1970 52 (Contd)
Census Tract
t of Pop Uncler 19 Yrs
1970
Change 1960-70
1 of Pop OVer 65 Yrs
1970
ex Change 196070
86
87
88
89
90
91 9201
9202
93
94
95
9601
9602
9701
9702
9801
9802
99
100 I
101
102
103
10401
10402
lOS
368
351
379
391
391
413
379
433
372
429
414
432
419
439
~32
377
457 420
378 41middot7
345
360 417
417
412
-04
-02
-35
-26
-28
-11
-64
-20
-S9
-39
-32
-21
-34
-40
-47
-lO~7middot
-27middot +04
+56
+07
-34 01
+04
+04
+10
103
128
97
11il3 99
69
79
42
77
46
34 38
44
40
54
111
51middot
81
133
59
74
140
63
87
76
-08
-06
+04
+08
+17
-05
+3S -02
+1~4
+19
+33
-14
-08
+12
+26
+71
+11
-16 -34
-20
-19 +37
-49
-2S +15
NOte The The
Taken frOi
averageullder averageabove
middotUSCensus ---shy -
19 years == 6S years ==
figures 197
32r 13(14
p a~d 1960
--
Rank
1
2
3
4
5
6
7
8
9
10
11 12 -_
13
14
15
16
17
18
Tract
69 46
60
58
- 68
61
302
2501
67
63
19
62
26
94
3603
3902
64
30 -----~-
Rank
19
20
21 -
22
23-shy
24
25
26
27
28
29
30
31
32
33
34
35
36 -
Ranking of Per Capita Income by Census Tract
Tract
65
2701
- 15
1601
701
66
93
82
2903
3602
30
2502
80
2401
81
- 70
91 shy
4001
High
Rank Tractshy
-32shy37
38 97
120239
7840
41 ~ _2_1__ 42 31
43 2501
44 18
45 98
46 37
47 3803
1702
49
48
1602 92 2702
I
50 89
51 901
52 801
Ra_
53
54
55
56
57
58
59
60
61
62
63
64
6S
66
67
68
TractTract Ra~
74692
170196 70 I
401 71 90
72 1037J
79 70273
3802 74 601
24024102 75
85 76 101
77 9023901
7699 78 100 4101 79
3601 I
380180
458140~ t---- _ - - shy83 82 42
888384
59843501
4777 8~
502
Low
802 86
Rank Tract
87 shy
--88
89
90
91
92
93
94
- 95
96
97
middot98
99
100
101
102
103
104
1201
14
49
72
73
43
87
3502
105
1
52
86
71
1
501
10
3301
104 tf
Rank
105
106
107
108
109
110
III
112
113
114
115
116
117
118
119
120
121
Ranking of Per Capitalucoae by Census Tract
(Contd)
Tract Rank
4001 122--shy602
13
1102 2302
3302
55
3401
48
21
56
50
3402
lL01
2202
2301
53
2201
-shy
Tract Rank Tract Rank T~aet Rank
57 I-----
Imiddote
bull
Tract
- Low -k Note Information taken from 1960 U SCensus
Rank Tract
I ~
Ie
Imiddot
~
----
----
--
--
Rank
1
2
3
4
5
6
1
8
9
10
11
i-
-Tract
391 922 921
972 971
100
132 131 121
962 961
822 821 401
982 981
20 111
47 10 1
412
High
Total Number of Henta1 Health Visits
Ranked by Census Tract High to Low
TractTract RankTractRank Rnk
12 182 22 78 29 87 76 381 73181 ~------- 1913 371 8538230162372 271 2616-121 8272 2
14 80~2 31 94 7923 84801 59 15251362 4232 15 52 _ 32 103 8924 651 17240216 652
_ 91 351 33 341 23117 83 122 25 25 48 1123921418 34 shy61 86 661
19 662 6493 81 26 91 8153 49 50 55 41383 71 27 51 3120 90 672241 35shy 104167162 461
I 411 46211121 28 88342 I
2502 36 69 54 5251 50 272
-Ra
37
38
39
_ 40
_ 41 Ishy
I
42 I
-I 43 44
45
shy
Tract
~ --- shy 95 56
45 292 242
102 62 352 291y
92
101 281
99 72 63 601 60~ 42 2201
77 74 61 57
363 232
70
32 31
11 44 282 2202
Low l
- Tract
46 682 681 I 331 30
r~$ 47 1042 332
48 102_41_
11
~
Visits to Family Planning Clinics Ranked by Census Tract High to Low
Rank Tract Rank Tract Rankmiddot Tract Rank Tract Rank Tract Rank Tract
1
2
3
4
5
6
7
8
9
10
11
12
13middot
14
15
16
17
361
56
401
341
48
59 121
20
55
342
10
31
58
93 21
241 132
331
53
461 462
18
19
20-shy21
22
23
24
25
26
27middot
28
29
30
31
32
33
391
32
middot47 I-i-_-shy _ -
231 111
332
972 1
372 371
52
89
32
92
82
100 31
182
30 242
402
34
35
36
37
38
39
40
41
42
43
44
45
42
1714 i 661 221
78 362 2
90 602 601 352
63 251
105 921
971 351
73 42 292 232
411 51
662
81 45 52
46
47
48
49shy
50
51
52
53
54
55
56
961
801
49 81 72 71
19
9~1
172
68 2 57 162 14 112
91 75 681
381 42
3~3
83 161
57 f
58
59
60
61shy
62 Imiddot
63
Imiddot 64
65
66
64 62 36~3 252
74 652 SO 392 291
651 6bull 2
79 271
r-- ---- shy981 222
672 671
821 272
94 87
281
382
67
68
69
70
71
72
73
74
75
76
77
78
981 26 12~2
IS 61
85 82~2 69
61 43
101 86 84 282
76
131
51 72
1041 962 88 70
99 922 77
103
95 802 181
i
~
Low High
RankRank Tract
5479
4480
81 1042 ~) middot102
71 - - + ~ - ~
Visits to Family Planning Clinics
(Contd)
Tract Rank
I
Tract llaDk l
RankTract Tract Rank Tract
~
I
~
J1 ~
Low
Total Number of public Health Nursing Visits
Ranked by Census TractsHigh to Low
TractTract RankTractRank RankRank TractTractRankTractRank
25249 71 79 17249 8033 6586 99189711 84 2915072 34 661 76 66 811519512
402 5035 51 161 2518220 122 1713423 352 55801 7120 6752 2 149814 41236 83 2662 38 94 6821 53 2924015 362 37 32 42 75 69 281 84 63
546 8822 54 222 85 3925431 70383417 3818223 6439 4386652 718 21 55 103332 8924 232 87 19 271729219619 24156 16211140 382 628825 10523110 112 73411 10141-- ----shy 89 363 4457 8126 16111 221 74 9142 90 46158331 53 671279012 46243 48 59 351 3837528 1083 9313 91 5844 59 -_242 76 1----- shy60 272 72 74104114 60145 42 9287 7729 92 6151 8215 57371 934630 91 307762 12113116 282 619447 41391 9531 78100 63 7378 ~95 681 6945 32 5632 798517 6448 47 52 181
High ~ Low
Rank Tract Rank
96 31 132 70
97 102
98 182 372middot 602 651 662
- -shy
~72 682 802
822 922 962 972 982
1042 ----shy
Low
Total Number of Public Health Nursing Visits
(Contd)
Rank Rank Rank TractTract Tract
I
I lt
I
Tract Rank Tract
[
~~~-
I
~
IJilfimiddot ~
j
Ranking of VD Caea According to Census Tracts 61 By High and LOll Youth Itatio
A media~ of 34 5 was determined Any tract having greater
than 34 5~ of popu1tionunde~ 19 years of age -High~
Any tract having l8S than 345 of population under 19
years == Low
Any tract having rate less than 390 =Low
Any tract having rate more than 390 == HLgl4
YOUTH
LOW HIGH
L
0
12 402 1801 1802 343 2801 2802 29023603
54 6001 600262 66~02 72 74 75 76
78 79 81 t02 65 1202
W
(25)
VD
H
I
G
H
401 701 801802 901 902 10 1101 241 1201 1301 132 14 15 1601 1701 20~ 21 2202 2j02 2402 2502 2702 2901 303501 3502 34023801 3802 383 3902 42 44 45 4601 4602 47 48 49 SO 51~2 53 55 56 57 58 S9 6701 6702 73 95
3~02 7021702 19 25~01 2701 4102 4101 63 64601 ~601 6801 680270 7l 77 8001 80~02 8201 8202 83 84
85 86 87 88~ 90 91 9202 920193 94 9601 9602~ 9701 9102 9801 9802 99 100 101 103 10402 105 6501 10401
(47)
301 501 502 601 1602 2401 2301 2201 31 32 3301 3302 3401 3402~ 3602 3702 3901 400140 02 43 61 69 B(
(53) (23)
~ ~gt
Ranking of VD by Rate Per 100000 By Census Tract
~
Rank Tract Rank Tract Rank Tract Rank Tract llank Tract Rank Tract Rank Tract
1 2202 21 S6 40 902 58 1602 74 75
90-shy 64 107 26 --~-
2 3402 22 45 41 10 59 902 75 78 91 54 108 61
3 2301 23 3502 42 2502 60 602 76 6802 92 402 109 87
4 3302 24 49 43 1102 61 501 17 2 93 94 110 90
5 50 25 52 44 6702 62 14 78 8202 94 97 02 III 76
6 2201 26 20 6701 63 4002 8201 2501
9701 41~02 112 91
7 44 27 48 45 401 64 3802 2902 95 63 113 62
8 3301 28 1701 46 502 65 30 79 83 74 96 9602 114 71
9 55 29 47 47 42 66 3803 80 2801 96Q1 115 85 10
11
12
13
14
15
16
17
18
3401
53
2302
2401
57
21
2402
1101
51
30-shy31
32
33
34
35
36
37
3701 - -~ 1201
3702
89
43
132 131
3602
4001
48
49
50
51
52
53
54
55
58
1601
601
4602 4601
69
701
31
3901
67
68
69
70
71
72
2901
801
39021~ 802
6502 6501 122
702
41~01
81
82
83
84
85
86
87
88
19
1
1702
2802
79
93
100 6801 6602
81
97
98
99
100
101
102
103
104
9201 9202
9802 9801
77
302
79
86
72
84
116
117
118
119
120
121
3603
8002 8001
101
99
95
10401
105 10402 103 102
19
20
59
32
38
39
2702
3501
56
57
301
3801
73 1802 1801
89 6002 6001
105
106
2701
88
High Low
-- -----
Rank OrdermiddotTuberclosis Cases by Rate Per 100000 Ranked by Census Tract High to Low
Tract TractRankTractRank Rank TractRaukTractRankTractRank
801
79 9601501411 52 6835340120511 I 960269 903603532036 $-~~F130221542 4366 311301 70 68~013802 _ I- _ 4001_37213 3921201 6802802 H71523822024 22 54 193302 3802 80 8958 I37139535 70155 9801 I60123 72 6702 98023914011016 6701250124 10 56
81 94 401r 7 154152 73 7057 2625 122 92028
90242 162312301 92~158 86 7172434526509 82 79160159 74 100 87412240227220110 6502836960 75 30 8317244 6501782801285711 61 901 42765645 84 66021459294912 9701 660146 171 302 9702 47
6235023033113 85 822821182 917755 16335013110214 841814832 78 103 938564 324815 86 1057940149272 38036523216 10401 87 2902241 725Q 10402360266340217middot IF88 88 9937233 282 51 218 101 01102 46016234
I)167 2901460219 47
High ~ Low ~
- -
TractRank
9S89
6490
8191 8001 8002
63 61 60middot01 6002 44 2701
92
J
2502 402 --- ----shy
I
Rank
Rank Order Tuberculosis Cases by Rate per 100000
(Coutd)
Tract Rank Tract ~nk
I
Tract Ballk Tract Rank
Imiddot
Tract
Imiddot
1~
t 1I i Pi i l I
o
1 -1shyL I
I J
8 40 icO ~ I -lt 0
-t (1) I
i I
r o E
II
a
I
r--i
shy
I
~
I (
Jgt
(011 fi(
Ggt
I II ~j
()
(f 0
~ ()
I
11
f9
r
II 99
o ~
Ggt r
~ __-J~ I t I ~ I
r--J l I
~ _ __ J
) 1
fTl
1gt
r I
()
r
()
lt en -i en
()
I1l
(J)
(J)
-i
P ()
19
r o ~
r G1 I
I
c
~
o I 89
--- -I-shy
r-r I
1- 0 _~ _ _--J E
G1 I I I
i i
I 1-1-1 ~ _J ~2 ~ II
II
()
1 I I I 1
id i bullbull
~
A n 69
r 1shy
- 0 Gl
l--~ ~ I
~ II
II )
I () isect i
en l i
(J)
-t
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6
bull bull the sernce prortded ahould be precisely approshy
priate to the pat1entl1eedemiddot ft and tb1rd bull bull the
med1cal care ayatea ahould provide the lOst eff1cient
and econoa1C8l use of scarce IIe41Cal resources
orthepurpoesof tb18 report certa1not these
crtteXaw1l1bestreaae4 lION tbaD others The rema1llder
of PaXt I Will renew the l1teraturerelating to the issuee
ofcomprehenaivene8sof ervice access1b111ty ot serv1ces
aDdett1c1ency oten1ces 111 tbedel1very ofdecentralized
medical car
ratCopcept of C_ Beal1h care Asd1oal tecmolol1 bas advanced a process of
evolution basoccurred inthe aed1cal and health t1elds
As JOhDsoD (21 pp~361-363) etamptsmiddot bull the goal of
healtb carelD our society baa evolve4trom rel1ef of
ajmptolU to ~ otdi toex1steDce in a potent1ally
diseaselessstate C1t1Dl tbelJm1 tat10DS in health care
resources and presenttechnololY he cont1nues to state
that The resulting cbal18D1e facing the Amer1can health
serncesystem is to provide each 1D41Y1dual with the
sreatest possible opporturnty toach1eve an optimum level
of phys1cal Jl8Dtal amd so()1alwall be1Dg
to
reter to the type othe81th care aystemwh1ch attempts to
answer tb1s cba]] and fult111 the three principles of
1
access1b11it Prov1UOI1ot appropriate services and
eff1cient use ot middotre80urc He state that a IYStem ot
comprehensive healthmiddotmiddot care 1DmiddotoXder to apIo middottbe stated
principles fD lleetiDlita 1Oalttst havemiddot certain
attributes
1 middoteare utdbeollW~ItaC1~orpn1zatlOM]ec ~ bull p~~ol1calbarriers IlU8t be removedbull
2 bull Care abould ace he~ecl1merlt8 ot distance residttiiCemiddot tille must be removed
middotcare8ho1ll411eC-r0WIZ the Ufemiddot span it diseases eapec ychronic are to be controlled betoretheybecome disabling or lite threateD1Dg
4 CeresboUd be~teJ1nCludlJ1C p~vention cure ma1ntiDiiCeand rehabI11tation
5 Care aho11l4be~i9_ttIa1t1ephyaiolol1ca1 aD4 pay1Fci1~cTrIS-ticot the pat~ent
6 Care aboul4 middotbe9L~ tJwrefore shouldbebu11t aro~ middotslJOc1al1natltutloDs which relate to the patients Way of lite suCh as middotthe home school and place of work
7 bull Carellbolld be m-ar and therefore shoUld bemiddot provIded ~Wliils where responsishybiUty tor the patient bas beendetem1nedauthority has been delqated and a communishycation syst_ provided
s care slIould 1Ie HIl 1nclud1Dg theintesratlon ottac1~1ts~ ~prsOllDel neceaary tor modern medical care
9 bull care dbe Of hip ~ eresboul Th ahouldbe aD adequate audit 0 care pee~ reviewcoDtlDUDI naluatioDBnd research intomiddot adequacy aDd quality
Ult1ately as 1Dd1cate4by the Nat10Dal CollllDisshy
8
sion on ColDJIIUUity Health Service (26 pp 1~20) the
c1evelopmezat of a ampyt of comprehensive health care is
a cOlDJIIUUityw14ere8pODSibilit1 1nvolviDS the integrashy
tion of all the health care facilitie and programs in
the cOlDJIIUUity or the c0arcm1ty8 healthc~ system
the PamprqlOIIlt goal ~
PrQv11~ of a ~rehive ~e 9tcoaaun1ty health aervicea
2 Ma1DteIlace ot aD a4equateqUaDtity ot al~requ1re4 health care facilities
Iritsrat~oDof ~v1c1ualUD1ta and s1steas ot bealth aerviceinto a coordishy
natedpattem ot continuous care tor theindiVidual
HoWYer aYerby (37 t pp71-72) 1Dd1cate the
med1cal and health care 81atmiddotaa it ball t1nct1oned haa
not facil~tate4 the delivery ot COap~usive middothealth
care IDcl1Y1c1ualhealth care facilitie themaelve havemiddot
notg8D8nally tuDcU0Af4tOach1eve tbi810al pUblic
health departaent 11) prond1q prev_tive services and
$1Ch trea~t activities aa are involved in venereal
disease or tuberculois control have in general avoided
1Dvad1Ds the curativedoma1Dotprivate mediCine Th1s
haa even been cabullbull1DareaawherelI~cal care is not
readily availa)le except throUlh hoepital outpatient departshy
lDent8~ Aa he 81IIet mothealth departaaents have tailed
to proVide an adequate _try point for the patient 1Dtothe
diapoatic and curative a bull t of tile health care aystell
This may be particularly true tor the pOOr patient who may
9
b_dloallYUDaoptdatlcaW4lberefore th past decade
babullbullbull~ bull lIOYeaeftt to evolve DfW torms ot health care
and new types ot health oare institutloDS providing
comprehensive oDlOiDI care rather thaD trapented care
There seems to be little dispute in the health
aboe requ1res both an lDtesratloD ofprev1ously uncoo~
ditultec1 health care ervlcbullbull brlDSins tolether into one
alency what Johnaon (21 p362) reterred to as bullbullbull the
concepts ot cOllPrehms1veIled1C1ne andpos1tlve health
andaporpph1cclecctrailzat1on ot ervlce dellvery
he NatlODal CoimD18810D0D CouD1ty H_81th Services
report Health Care gilitis (26 p37) suggests
proYic11Dl compreheDaive health care services by centrashy
llz1Da a varlet ot publlc and prlvate healthcare
tacllities 1ntohealtb campuses However as Kahn
(22 pp274) states amppeskin ot soclal servlces in genshy
eral bullbull bull if the loal ls to develop a service-delivery
approach that improves access taclltates teedback 80 as
toadapt to user preterence8nd prlorlty and maximizes
case 1nteptatlon aDd accountabl11ty the base of the
total 80clal service system Should be tnthe nelSbborhood
Dec~tral1zatloD not only makes services IIOre accesslble
but allows therv1ce to be tailored to the Deeds of the
10
areaDe Diaz (14 p3) indicates the importance of
being aware of groups in the neighborhood with special
health problems such as elderly people or large families
witb yOlmg children This means that it is important
in planning to be aware of the demographic features of the patient population This will be considered more
thoroughly inPart II of this report
Kahn (22 p275) continues however to indicate
that more than the improvement of service usage is I
involved in decentralization and that decentralization
ot service delivery also represents part of tI a general
search to break down cities to human scale for some
purposes on the assumption that people find it easier toshy
relate to a neighborhood orsection and to its populationbull
bull bull bull Thus the organization of services at the neighshy
borhood level bas the added purpose of contributing to
the search tor neighborhood n He adds that this process
i8 more relevant it there is a measure of local control
over as well as local availability of services
Kahn indicates that decentralization is not a
viable goal in some circumstances These include situashy
tiona in wh1chthe need for a particular service is too
TJI t
-
11
little to justityits proVision in a l()calun1t where
skills or resources are too rare to be provided locally
or where the costs ot decentralization vastly outweigh
the benefits He Visualizestheult1mate emergence ofa
h1erarcb1c81 patternofserv1ce delivery tnwhichcertain
services andresp0D81bilities are middot1ntegrat8d1Dto the
collimun1ty at thelooal level Other more specialized
services relate to larpr un1ts of the colDlllUD1ty such as
eomb1nationa ot neigbborhooc18 Veryspecialized services
are to be delivered at city countystateop regional
level8 fh1slevel would al80 be the seat ot prosram
coord1zaat1on staDdardprotection and evaluation 811
of which call for cons1deZable centraliZation for overall
program adm1 nlatrat1on(22 p275) AlthoughKahnt s
model was not developed specltlCally tor health care services 1t1s quite relevant- and appliCable to health
care service delivery systems
Omiddot Donnell (27 p3) reviewing the 1iterat~e on
service delivery and social action through neighborhood
service centers preseJJbB a list of characteristics
generallydesirable in ~eighbOrhood service delivery
centers Firsthe states that the center should be
accessible It should be in a physically convenient
location and should be open evenings and weekends as
well as providing at least em~rg8ncy telephone coverage
t
~ II
12
24 hours a day
The center should als~ be irDmed1ate in 1ts funcshy
tioning That is the centermust have the capacity to
provide prOmpt efficient service and should be able to bullrespond to problems middotwithout long hours ofwalt1ng and
many rounds of apPointments
The centexsservices should be 6omprehensive liThe
center should offer a full range ofusable oil-the-spot
services or easyaccess to other resources by available
transportation It should gear itself to the needs that
peoplehaV8-especially poor people-and provide for the
slmultaneoushar1d11ng of problems were possible
SerVices should 8180 b 1J1tegrated and coordinated so
thatseMces can more effectively be provided
The operation of the service center should fInally
be responsive to the needs and desir-es of the neighborshy
hood It should provide ways in which reSidents can
shape th~ program and continue to contribute to its course
and development It should be relevant and ready to
respond to changing needs II
The concept of the comprehensive neighborhood health
center developed by OEO (31 p324) has been described by
severalwriters Yarby (37 p73) describes it as an
outpatient racility which has certain def~n1te characshy
teristiCS middot1 Accessible to a poPulat1on concentration
bull 13
2 Open 24 hours a day seven days a week 3 Family-centered c~e by a team of lnteniists pediatricians clinical and publichealthnurses and social workers 4 Availability ot frequently~requ1redspecialist in such fieldsaspsycbiatryobstetrics gynecology surgerY5 Con~1nu1tyof doctor-patient relationshyship 6 Family records with social and medical ~raquomDaries of relevant information about each family member 7 Basic diagnosticlaboramptoryand x-raytacl1itles and drugs and biologicalsavailable atthe center 8 Directline (1)y center-controlledambushy
lance when-necessary) to ateach1nghospltaifor cl1agnostic ~d therapeutic servlcf)srequiring the fa011itlesandpersonnel of thehospltal 9 Patient-cantered and eommUn1ty-oriented -
The range ot services in the comprehens1venelghborshy
hood health center shouldbe as complete as possible
inCluding preventivediagnost10 treatment and rehabi-
litative services and Sbouldbe deslgnedto eliminate
episodioandfragmented services (31 pp324-325) Schorr
and English (33p291) add as additional characteristics
ot the compr8henslveneighborhood health cent~r that it
should ~ve intensive participation by and involvement
of the population to be served both in policy making and
as employees and that it should be fully integrated with
the existing health care system The Office of Economic
Opportunity (28 p63) stresses the potential for easing
health manpowershortage$by trairiing local neighborhood
reSidents as non-professional health aides at the same
time creating new job and careeropportunitles As
14
Gordon (16 p bull 422) indicates Many of the outstanding
problems in medical practice todayrevolve around
effectively motivating the patient and the prospective
patient to be concerned with his health This is
especially true in a deprived environment The community
health center with its technique ot consumer partici
pation maybe a way to create this cooperation effectvely
It is important to note at this point that the
comprehensive neiShborhood health center haaas its
constituency an integratedmiddot community r~ther than a
particular segment It should haveas Blum and Levy
(6 pp~5) indicate a horizontal rather than a vertical
relationship with the commuriitybull The vertical relatlonshy
ship they state is characteristic ot those service
organizations wh1chapproach the community only in terms
of their own fUnction Tbey see only their relationship
with the users of their service and assume that problems
of accountability will be handled by these consumers
However they pOintout this ienot likely as a vertical
approach creates dependency onthe institution Agencies
in a horizontal relationBhllp recognizetha1 they have
both acommunityand a consumer to serve The horizontal
approach places the matter of accoUltability on a broader
basis than just the involvement of the consumer De Diaz
(14 p4) speaks otthe need to ~develop a community
facility which difters from a clinic for low income
1ji ~
15
people in that it should serve an economically integrated
community The reason for this is that a wide variation
of consumers may assure a better quality of care
The advantages of the comprehensive neighborhood t
health center over traditional systems of providing
commuruty health services are numerous Hospital outshy
patient departments a major traditional source of ambushy
latory health c8refor poor patients have been indicted
for neglecting preventive health care ~romoting fragshy
mentedeare and subjecting patients to degrading and
impersonal conditions to mention only a few of the major
defects (31 p324) Another defect has been the
tendency to shunt low income patients back and forth
between different cliniCS often at different locations
arid with differel)t open hours for different treatments
or tests in regard to the same lllness(26 p63)
The comprehensive neighborhood health programs that
have been organized present a great variety of organishy
zationalpatterns one area of difference 1s in the
emphasis placed upon making each faci1ity comprehensive
in the services it provides to the patient population
In the Montefieri Hospital Neighborhood Medical Care
Demonstration program in New York City services have
been made available through a central health center and
two store frontsatellites the center to be the base
bull
Li
l of opratiol18 of ta1lJpIlflicl- ancl the satellite
center the ba of oparat1oDa of public heaJth nurses
an4 nllbborbood amp1 be satellite centers wereto
proVide preVentift tutaltll bullbulln1c1-m1zaticms w811shy
baby care per1od1c ~ectiland tJle central health
center to proViAle care tor illnes If (36 p299)
bis propWI VUDOt ~ttullytunct10DIDI at the t1JDe
it d1cu8ae4 18 tbe Uterature aDd all aernce Were
be1Dl provided 1D_~terBowever itwould ae
tbat the ntua1pro~ as aY1ioae4by its plmmers
would boclJ aoaeot bull 4efeot~ otthe current lud1cal
ccde teaIt pObullbulllne_t coorctJl8td admSDtshy
etration eD4 well 4eftlopecl refelTal procedtlreacould
1I1a~ thecOllDeCticmof t~_t8 withappropr1ate preTellshy
t1 aD4 therapeu1ampcaen1cbullbull aV81lable 111 diffrent
locationa Bowner tile barrieraottiaeaDdUatanc
between center and truaraUon tor the UDSopb1aticated
patieatlook1Dl tor 1her1~pJce too tor ~1CU-
larhalth serfplusmnQewoGl4~to JJa1t tbbll1ty o~
tb18 ~811D to provide iaaiYCOliprelleU1P18hboltleod
health servicebullbull III tactmiddot tappeareto coDtlict with
tbepro own taW cOfdotpro-1~a tam1ly
mecl1cal careprogru 111 wIa10h pre-teAtlYe aDd therapeutic
health erY1cecan be proY-lW to all IIl81Ibers of
tamily in the coure of aaSDll vi8it (36 PP301-3(2)
Dle Delmtr Coloradoprepa11ke the Montet1ori
LI
17
prograJlut111zbullbull abe1rarcJly ot SlDa11 aatellItestations
andlerer IIOreceDtallzedtac11It1es It 41ffers
howeverill tbcolap~81vene80f the services avail shy
able Inthe 4ecentraUzed facIJJtiesIt resembles very
clc)sely the IOdel ~ordecentral1zed social servicedell shy
very developed by 1ahII~ Which was 41sCussed above he
SIlall neImiddotgbborhoodmiddot c8Dt~aw1tb1n walkl distance of
most of the populatiotl havebeendesilDedto take care
of allthenorllalhealth probl of 3000-5000 patJentsshy
check-ups IlzatiOZl8s1Jlpl laboratory testa and
treataentand iaecucatlol18 (d1apeued by phyS1cians) for
IIOst DODCrltIcal 1l11le PatIent 1d1Oneed IIOrespecIal-
Ized care are reterrecttobacJalp facilities BaCkup
support tor themiddot~t1oDa are the tWo l8rsernelshborhood
health C8Dter8~ttr1Dl aCOglete~e of out-patient
serneeaDd three part1clpat1q hoap1iampl bull bullbull which
proVide1Dpat18Dt~t andcoDSUltatlve services
(13 p1028) Intb1a prosrama coaprehens1ve range of
prevent1ve aDd trea1aeDt serric 18 aVailable throughout
the decentraUzed middotta The CoapreheulY8 ReIgbborhood Hea1~ Service Project
otKa1er iC)UDdatlcm HOspitals 111 Portlan4 OreOD 1s
s1ll11arto th DenVer prosraa 1D thata comprehensive range
ot out-patientmiddot services 1D prov14e4 in each of 1ts 10cashy
t1oDa althoUlhmiddotmiddot tbe oentera are larger and l bullbulls DDIerous
than 1nth DenverproPUh (12 p6)
Li i
18
In order that a comprehensive neighborhood health
care center be able to proVide continuity of care it
must have arrangements for hospital services integrated
into th system Yarby (37 p73) as quoted above
states that it 1s characteristic of the neighborhood
health center to be directly connected with a teaching
hospital However De Diaz (14p3) indicates that it
may be advantageous for purposes of service delivery not
to havemiddotthe center affiliated with a teaching hospital
She feels that such anaft11iation may lead to asltuation
in which policies might be determined more by the teaching
needs of a medical school than by the service needs of
the patient
middotThe Nat10nalmiddotCommissionmiddoton Community Health Services
(25 p69) states that such a system of comprehensive
health care integrat1na ~e servicmiddotes of several health
and roedical agencies snould utilize Itas much single or
unified management as possible Neighborhood health
centers have been operated under a variety of auspices
but several writers have pointed out the advantages in
termsof coordinated prOvision of servictts management by
the hospital of the neighborhood health center For
instancethisfac111tates the keeping of unified medical
records of all the care a patient Msrecelved either at
the neighborhood health center or _le hospitalized
(12p6) ~ermore a3 Young (38 p1741) points out
19
direct operationot the u1sbborhood health oenter by
the hoSpital canll8lceaftilable to the center expertise lt bull
in sOlle aapcta 0 Operation that m18ht not be aa readily
available otherwie
Relardlebullbull of wbetberthe hospital and the neighborshy
hoodhealtbcent8r haVe a cOJIIIOaadmjntstration they
IIlU8thaVealTlved at a str1Dsent delineation of IDUtUal
role and reSpoDBlbilltiebullbull All OOIIpoienta ot the care
yst IIlWStQlarify and understand one anothers position
In the syatem and acree on objeCtive ancimethOds
(26 pp16-17p31) SODae areas of iDUtUalconcemare
reterral procedures record keepiDg aDC1 mutual use of
facilit1es statt1Dl i8 anotb8r ~ ot coaaon conc~
Ditt1cultift have u-laeniD the pastiD cOllprehensive bull t bull
healtbc~ prosraumiddot 1d11ch were batil plauned in wb1ch
all of the health canter phy1C~1IDa did DOt bavetatf
privilege at all ot thebackuJlhospltala (29 p21)
SUch a8ituat10n i8 1Dampcceptablelt inpatient care i8 to
continue to be p4by the pat1eatmiddot health center
physician and it cont1Du1ty ot care 18 to be maintained
Hoapital and health center1lUSt laav 301nt responsibility
tor the recruitaentot physicians
VticlentU IPan BJcNrcu Much otwhat haa b8ea sUd has stre88e4 at leastmiddot
iJlplicit17tbaD8ed tor tM etticit middotprovision ot8emcea
20
There appears to be two aspects of efficiency which are
discussed by writers on the su~3ect of the comprehensive
neighborhood health care centef one of these is the
need to organize) services to make the most efficient and
economical use of scarce medical care resources The
other closelyrelat8d in realIty is the need to help
the public use services in the most efficient manner
The comprehensive neighborhood health center concept
1s lhherentlymiddot efficient in that preventive curative and
rehabilitative health ~are programs are coordinated under
one roof with integrated a~stration Furthermore
theempbasLson prevention health education and early
disease detectionis eftic1ent troJll~estandpoint of
the health care system as well as beneficial to the patient
(18 p760) HQwever ~ue tothe scarcity of health care
personnel thecoiDprehensive neighborhood health center
mustbe an arena tor eXperimentation with new staffing
patterns~ The Kaiser program is indicative of the way
in which health care systems must begin to operate in
that appropr1ate ancillary personnel are used Wherever
possible to perform functions that do not need to be
carried out by the physician As Saward (32 p42)
states
1hroughou10ur organ1zat1on~ there are many of the customary experiments be1ngmade-shyJse of speciallr trained nurses for well-baby care under the SUpervision of the pedi9trlcianexperiments with routine prenatal care by
w ~
21
middotSPC1a1l~t~JlUrbullbull per8ema_1 bullJmdlJleu y our fuDotlou are auoh that DOtb1Da 18 dorutbYtbe phY8iCianstbat doe DOt vet to be done by the
phys1c111U1fhe other aldlle4 person- Del-nurse middotreC~0D18t the appo1ntshymeDt center or clerical praormelshyaremiddot there to free h1amiddotto use his spec1al sk111
Awell lmoWn treDd1D the area of eaaiDI health
c8re JII8DPOY8rShortagjs bas middotbe thetrend toward tra1nshy
1DB poverty area rea1deats as DOD~pro~eaionalmiddoth8lth
aide and nepborboocl health workeramiddot (28 p63) This
bas the effectofmiddotmiddot1J)creaa1q II8DPOWrand 8180 can help
bridle the cuJ~ cap betweenprondera and colllUmers
of aen1C8s This attarD at least tlleoretically
createa a situation 1D WIa1ch providers andcoD8Ullers can
be educated to UDderatad OD88DOtber and interactJlore
ettectlvely~ HoWever amiddotpltt8ll has beeD themiddot tel14ency in
801D8 oamp8e8 tomiddot us aidesmiddot ssale8lllcw t~r the center
alJDOatexclwdY811rathertbaD ua1Dltheal to protide the
health care for wh1ch ~ were trained (29 pp3B-39)
1bat ismiddotmiddot vh1~e the a14e Yalue in ~~m1catiDI with
low 1nCOlMt patieata haa beeR recoSD1zed and stressed
their role ashealtb carepersoDDelhil been slighted 1n )
any 1Dstancea
Anotber step 1d11Ob bullbull been taken to provide 8rY1ces
more efficiently eUeot1ftlybas beenmiddot theorgan1zation
of per8ODDeliDto IIllt141sc1pl1Dary teamaaaa means ot
proYid1DgmiddotCOQrd1DatedserY1ce SUch te8lll8 sen_rally
~
hf
~
22
include PhYsiciaQs nursbullbullbullbull soc1al workers and outreach
workers Conceptually th8y fmlct10n to me~ the intershy
relate lled1cal and social needs ot the families sened
Hor there are a number ot barriers to the etfectve
tlmctiOD1nlof lIuchte8ll8 SODieot these are heavy caseshy
loads the inordiDate amount ot tille consumed by multlshy
prOblem tamtliethel1m1ted tra1n1 ngmiddotmiddotand laCk of tnterest
on tile part ot aoae tebers in examinJng aspects of
problems out14e~lr oWn areaaotcolIPetencemiddot and
~ourdcation prc)blell8 between proteasioDala and nonshy
prot81~s (10ppa-10) middotrurtbemOre as De Diaz
(14 middotp6)1nd1cate tbel8 maybe a teDdency tor vertical
dp8rtmental lines of auperv1810nto become paramount
over the team coDamloation syst lead1ngto conflIcts
in determ1niDI the ro1ea ot solie team bers particularly
the DOD-prote81011alaInauch exper1l1enta Witb new
~t1Dlpatterna it 1s bullbullaentialtbat line of authority
roles aDd NsP0D81bll1tlea be made explicit and that there
beJDechaD 8IUI tor relUlar evaluat1onotfunctlorUng
Another way inwb1ch health care sernee delivery can
be made more ett1cl8Dt is to proVide servicea dur1DC the
hours whentbey aremiddot -ostnee4ed As reQo_ded by Yarby
(37p1) serY1ce can bemadelIOre accesslble by making
themava1lable 24 hours a day seven days a week If
rg8l1Cy service are aft11ab1e aroua4-tbe-cloek at ~
nil1iborhood health center the continuity ot tbepat1ent ts
23
careiamaiDtalDedand meatry point into the
cOIIPre~i health care 8 be made available
tothe patient who aoZMllyU8ea ozilymiddot emergency care in
tille of med1cal criais More 8isDificantly ava11ab1-
lity of a tull rase of bullbullrv1c8 tor seVeral hours 11the
eVerlna aI1Cl On ~ prevent the los ot earn1JiSs
involved if th patierat 1IU8tt8cet1me oftfroawork dur1q
the d8y for aed1Cal oare bull his can be an eSpecially
importantc0J1814eration tor lo1aCOlleDUUg1nally qloYEtd
patient aa4caJla18o PIOJIOtet1)e 0Da01Dl use othealth
servicebullbull
exper1eDO ot tbeKa1er prosraa in tb1s~reprdAs
Greenl1clt(19 p10) states wA lllNt 8ip1flcant
proportion ot the abulatory care 8n1cp~Y1dd tor ~
total popUlatiC)U ~ ~ after clWc hours and this
Deed i8 apParenUyaoN prODGUDced tor aJl8d1cally
iDCust population On the other hand the bulk ot all
aabulatory med1cal cu 88l91ce are performed dur1nS
regular cl1D1c hour eVen when services are available 24
hours a dayJ day bull week W
It has ~ the experi8D~eof a ftIDber ot ne1g1lboXshy
hooct hea1tbcentere _t a_jor obstacle to efficient
proViSion ot anicbullbullhas beentbe teD4eDcy of medically
1ncl1pnt patieats to utilize the center oa a walk-in
baais tor epi8od1ccr181or1entect bullbullrv1cea rather than
4)i
h~ ~~f ~~ L
24
to make appoJlltaeata tor ODIo1qprevmt1ve treataent
and rehebl11tat1Ye care ad ampl1O to bave a blah failure
to Show rat_for tbe appo1DtaeDts that they dO make
Atone center 628 of appo1Dtments made were kept
while 3Oottbepati_ta een were ~1n patients
AlthoUP fewer patiets were actually 88811 by the cater
1D middottb1s 1Datance thaathe -bervholuidmadeappointshy
mta the walk-iD patlat required an iDord1nate amount
ot staff t1ae tor aCreeDiaaacl ~trral to pplOprlate
~ttor caregt (9 pgg) Arraquotbr1llpl1catjo~ of the
plOVidedto valk-iD patient by other thaD their
(19 p12)rurtbermore
when patients uti11ze Wlk-1Il er181 centered care
athelr ODlf tona ot ootact with the _d1~ care
ay_ta fUilycentered care the treata_t of tUl11y
bers
a a UD1t 11
dlarupted
hewalk-1Dphenoaaencm appear to barelated to
diUerence between soclal clase in the style of Dlaking
contactJt1th the a11oal C~ay8t As Greenlick f ~
(19 p11)1Dd1oate8 thepheDOaenOn ot INater usage of shy
walk-in ervice by aed10ally middot1Jid11ent patient thaD by
others baa otte been attr1buted to a stoical att1tude
tQward 1llDe8 em the~ ot poor people leacl1D8 to a
~
25
greaterdelay1n tbe k i Dlofa8d1cal care These
patients wppoedlyeelcmiddotcareODlymiddotwIleD tbeirmiddotillDess
becOlles1Dtolerable resultiDSin middotthMr appeariDS withshy
outnot1ce1o rece1ve oareHlwever Greenlicks
r8aearcbbaa cut doubt on the existence ot tb1delay
111 report1Dg middot8J1IPtoJumiddotOfDeW 11laessand seek1ng care
Be bas tcrQDd 1bat s1ll11ar peze_tases of dioally
1nd1sent 8DClJ1on-aed1cally 1Dd1PD~ pat1enta seek care
on the aue daytbat aptou tirstaPPear
1fb11e GrHDllclc 1nd1cat tbat the reasonator the
greatertendeDCY of low 1Do~e pat18Ilta to 1$8 walk-in I
serY1ces are notlcDo1rAmiddotmiddot tbe7 _ be rel~tedto a tendency
ot lower aocio-ecaaaoclaa patieota to preter face-toshy ~
face contacts with II841cal persoDl181posslbly because
such contacts areft coatortiDS an4reasauriDS to
patients who are hJpotbeafzed to bave a dependent attltude
toward IIed1Cal care perS0Jm81 (30 p161)
It a8 itmiddot baa pnerally beenhld the appointment
s1stemts the most efficient Ileana of dellveriDS
comprehenSive oODtllluiDlh-lth care (9~100)1t is
necessary that educaUoraalmiddotbulltfort be taken to proaote the
use ot middotappo1ntaents8DClmiddot tQrec1ucethe fa111re to appe~
ratB4uOatioaalwhlQb baft~utl11zedhave been
IJ
26
1Dten1ews with walk-in patients home Vi8its and group 4i
meetiDp1D8D attemptto1Dierpret1o the patients
the value of rtitgular ppo1ntmentamp andot con~in~
c~1ve care rather than epiI041c care (9 p1OO)
h1s 1safuD~tioD torwhtch nOl~prot81QDal colDlllUD1ty
YOrkersllaY bebe~r8U11ed tban other statf H()wever
euch aD ~ucat1oaal propul __~ ~e related to the senUiDe
capacity otth health oenter to provide comprehensivebull gt
ervice8 to1tpat1_t~odoD aD app01ntment bas18 It
1amp pos8ibleo~rw1 tor educa110Dal ttorts to result
LD a~8JImCl tor ltPP01ntaen~8 at a ratewb1ohi8beyond
the capacity ot thee_tar to t without uareaaoDably
1_ wa1t1Dlprio4a QOBt1nuad use Ot the center on a
wallt-in bU1 _1tbeoosiItpos81ble to et an appoint-
met anc11nCreued pit1entcoJaplampia1a bull Therew111 of
course always be a need and demand tor acute ep1so~c
Care -ci the health centerDlWlt be planned with the capashy
billty ot bullbullbullt1D8 tb1aneed wh1~ cont1Du1nI to stress
aDd educate the patient to utillze oDlOinI comprehensive
faa11y middotc~te~d Cflre (9p 100l
att g4 CODClva1opa
In order to bea4equate any coJlltemporary health care SY8tem muat bullbulletcerta1D interrelated criteria he
IJ
27
minimum criteria areaccessability of services to those
who need them compr8heX1siveness and appropriatness of
services and efficIency 1nthft utilizat~on of SCarce
health care personnel and resources The scareity of
pex-sonnel andtbe need for h1gh quality ongoinghealth
care services
aJIlong the
populationdemanci the most effishy
cientprovision of services
Services must be made accessible to the population
They mustmiddotbe geosraPh1cally accessible to remove the PhysicalmiddotbaTiers betWeen peopleandthem$d1calcare
system They mUst otter their services dur1ngthe
hours when people can make the moat use ofthemA~ it
makes little sense to concentrate services geographically
where they will not be uSed to their fUllest extent it
also is wasteful to provide serv1cesonlydur1righours when
many people are employed his not only presents a hard
ship middotto the consUmer lnrt wastes resources if for instance
the unavailability of preventive services during the hours
when people Can use them causes a need for treatment
services later on
Health carbull sEtrvices must be comprehensive including
prevention treatmcmtand re)abimiddot11tation Ambulatory I
healtbcare facilities wh1cQ are orienteciexclusively
toward either prevept1on or trea1mentare no longer accepshy
table for they are lneft1c1entln their use of resources
and in their prov1s1on of health care to the patient
w ~~
28
If prevent10n1s notmiddot stressed treatment serv1ces that
could have beenavoidedY1l~ be required If prevention
1s the sole focus of the health care facility sick
patients who present themselves must be referred elseshy
where for treatment andsllch referx-als may be taken as
reject1onsor not followed through with until illness
becomes unbearable
The instltutlontbat meets these requirements Is
the comprehensive neighborhood health center It 1s a
local decentralized outpatient facilityprOVld1ng a
fUll range of ambulatoJY health care services It has
a linkage to ahospitalbackUp facilityforlnpatient
treatment and hiihlY apclalized outpatient care
The neighborhood health center must be a fac11ity
planned with an awareness of the needs of the conSUtller
and coDitnUn1ty It must have the r~Ul0urces to provide the
services people need mere they can use them and when
they can use them It must uti11ze the part1cipation of
the community to develop this awareness Not only must
the cen~er beset up to be Amctional for the consumers
but efforts must bemadeaga1n with commun1ty partici shy
pation to help the consumers utilize medical care
services effectively The center muetmake efforts to
educate the community about the valueot regUlar health
care of preventive servicesand of the use of planned
IJ
29
medical appointments ratherthanorisis centered walk-
incare Therealit1es of the existing health care
system have not taught the patient particularly the low
income patienthow to use services effectively
The helthcenterilUst also bea laboratory for
experiments in easing the health caJepersonnel shortage
and c60rd1Datingcare~ A major difficultY iri-exper1shy
menting with neW rolesis freeing staff of old preconshy
ceptions
CoDlprehensiva neighborhood health dare centers have
been developed under a variety ot alisplces including
medicalsociet1es hoSP1talsmiddot(36p299 group pr~ct1ces
(29 p6- 12 117) health departments (13 p1027) and
ne1gbbothoodassoc1ations(14) The literature indicates
somevalues nthe management ot the health center by plusmnts
hospital backup faCility Whatever the auspices many
adm1nistrative fuDctions such as program coordination
standard pr9tectionand evaluation call for considerable
c~tralization of adm1nistration city-wide or coU)tyshy
wide At the same time other aspects hours of servlce
for examPle~ cuI f~radm1nistrative fUnctions made atmiddot
more local levels Each neighborhood center must be
free to adapt its functioning to itscominunity thi-ough
the mechanism otcODlllUl11~ participation inmiddot policy making
Obviouslythe prerogatives and responsibilities of each level must be negotiated and made explic1t
t4~
JJ
BIBLIOGRAPHY 30
1 American Rehabilitation Foundation ~ealth Services Research Center The Health Maintenance Strategy mimeo 1971
2 Anderson Nancy N Comprehensive Health Planning in the States A Study and Critical Analysis Institute for Interdisciplinary Studies American Rehab ilitation Foundation 1958
3 Andrus Len Hughes Comprehensive Health Planning Through Community Demonstration Health Projects mimeo1967
4 Barry Mildred CandCecil G Sheps A New Model for Community Health Planning unpublished paper presented to the American
Public Health Aseociation1967
5 Blum HenrikL Fred Wahl Genelle M Lemon Robert Jorulin and Glen W Kent The Multipurpose Worker and the Neighborhood Multiservice Center InitialImplications and EJeperiences of the Rodeo CommunityService CenterAmerican Journal of Public Health58 (Mar 168) pp 458-468 shy
6 Blum MichaelD and Soloman L Levy A Design for Service Delivery that Reinforces Constructive Tension Between a Health Center and Its (sic) ConSUDlers and Supports Community Power unpUblished paper presented to the American Public Health Asaociatiltn 1968
7 Brielaud Donald Comm~ity Advisory Boards and Maximum Feasible Participation American Journal of Public Health 61 (Feb 1971) pp 292-296 shy
8 Burns Eveline M Health Insurance Not If or When But What Kind Madison Wisco~sin University of WisconsinScllool of Soci~l Work 1971
9 Campbell John Working ~elationships Between Providers and Conshysumers in a Neighborhood Health CenterU American Journal2 Public Health 61 (Jan 1971) pp 97-103
10 Caxr Willene Neighborhood Health Centers Funded by the Office of Economic Opportunity mimeo 1970~
11 Colombo Theodore J Ernest W Sawardand Merwyn R Greenlick The Integration of an OEO Health Program into a Prepaid Comrehensive Group Practice Plan American Journal of Public Health 59 (April 1969) pp 641-650~ -
12 Comprehensive Neighborhood Health Services Projectof Kaiser FoundatioIl Hospital~ Prcgtgram YearE grant renewal proposal mimeo~1971 bull
13 CowenDavidL~ Denvers Neighborhood Health Program Public Health Reports 84 (Dec 1969) pp 1027-1031
IJ
14 De Diaz Sharon Daniel Beyond Rhetoric The NENA Health31 Center After One Year unpublished paper pres~rited to the American Public Health Association 1970
15middot Gerrie NorrrianF and RichardH~ Ferraro Organizing a Program for Dental Care in a Neighborhood Health Center Public Health Reports 8 (Aug 1968) pp 419-428
16 Gordon JeoffreyB~ The Politics of Community Medicine Projects A Conflict Analysis Medical Care 7 (Nov -Dec 1969) pp 419-428 shy
17 Greely David The Neighborhood Health Center Program and Its Implication(3 for Medical Care H~alth Forum of the Welfare Council of Metropolitan Chicago (mimeo) 1967
18 Greenlick Merwyn R Newgtimensions in Health Care American JOurnal of Pharmacentical Education 34 (Dec 1970) pp 754-4
19 GreenlickMerwyn R Donald K Freeborn TheodoreJbull Colombo Jeffrey Abull Pruesin and Erne$t W saw~d Comparing the
Use of Medical Care Services by a Medically Indigent and a General MemberShip Population in a Comprehensive Prepaid Group Practice Prosram II unpublished paper presented to the AmericanPublic Aesociation1970
20 H~tadoArJiloldVMerllYll RGreenlick and TheodoreJ Colombo Determinants of Medical Care Utilization Failure to Keep Appointments unpublished paper presented to the American Public Health Association 1971
21 Johnson Richard E and Merwyn R Greenlick Comprehensive Medical Care A Problem and Cballengeto Pharmacy ff AJilericanJournal of PbarmacenticalEducation 33 (Aug 1969) pp 361-367 -
22 Kahn Alfred J Studiee Social Policy and Planning New York Russell Sage Foundation 1969
23 Kotler Milton Neyhborhood Government Local Foundations 2 Political~New York The BobbsMerrill Company 1969
24 NationalCommisaion on CommunityHealthSfrvic~sActionPlanniriamp for Community SetithServices~ashington p C Public Affairs-Press 19t7
25 National Commission on C~mmunity Health Services Health Adminishysration andOrMPization l the Decade Ali9$-d Washington D C Public Affairs Press 1967
26 NationalCornmiesion onqomm1Jllity Health Servicesbull Health ~ Facilities Washington D C PUblic Affairs Press 1967 bull
~ n
32 27 ODonnell Edward J and Marilyn M Sullivan ServiceDelivery
and Social Action Through the Neighborhood Center A Review of Research tt Welfare ~ Review 7 (Nov~Dec 1969) pp 112
28 Office of Economic Opportunity Second Annual Report Washington D C~ U S Government Printing Office 1966
29 Office of EConomic Opportunity and the Medical Foundation of Be~laire Ohio Eighth Report 2l ~ Committee2a Governshy
ment OperatiOll~ Va8hiiiSton D C Government Printing Office 1969
30 Pope Clyde R Samuel S Yoshioka and Merwyn R Greenlick Determinants of Medical Care Utilization nhe Use of the Telephone for ReportiDg Symptons Journal of Health and SocialBebavior12 (June 1971) pp155-162 shy
31 RenthalA Gerald nComprehensive Health Centers in Large US Cities American Journal of Public Health 61 (Feb 1971) pp 324-336 shy
32 Saward Ernest W The Relevance of Prepaid Group Practice to the Effective Delivery ofHealthServicestt The New Physician 18 (Jan 1969) pp39-44 - shy
33bull Schorr Lisbeth Bamberger and Joseph T English Background Content and Significant IssUes in Neighborhood Health
Center Programs Milbank Memorial ~ Quarterly 46 July 1968) part 1pp 289-296
34 Weiss James E and Merwyn RGreenlick UDeterminants of MedioalCareUtilization The Effects of Social Class and Distance on Contacts With the Medical Care System Medical~ 8 (Nov-Dec 1970 pp 456-462
35 Weiss James E MerwynR Greenlick and Joseph F Jones Determinants of Medical Care Utilization The Impact of Ecological Factorstt unpublished paper presented to the American Public Health Association 1970
36 Wise Harold B Montefiore Hospital Neighborhood Medical Demonstration A Case StudyMilbaDkMemorial Fund Quarterly46 (July 1968) part 1 pp297-308~
37 Yerby Alonzo S ttHealth Departments Hospital and Health Services Medica1~5 (March-April 1967) pp 70-74
38 Young M M~ Chatanooga IS Experience with Reorganization fOr Delivery of Health Services ttAmerican Journ8l of Public Health60 (Sept 1970) pp 1739-1748
f or l
II bull 11 Y d
II
IJ
34
ThepurposeOfPart II of th1aa paper1atod1scuas
elected Speclfic needs ofecltlc areas within Multnomah
County A8P01ll~oUt 1D ~ I of t1a1bullpapermiddot Ita nelgbshy
borhood health oare cater IlU8t be a facl1lty plaDlled with
aD awarenes of the neeels of the oODllUller and collllUDity
Part II of this paper nIl Show 80e of thoe speclflc
needs
he1DforutiOD tor t1li Portlon of the report
obta1nec1 troll tbroupout tbe follow1Dl threepUb11catloDS
1gr~e_tiMshylIPrIxaiidOreson JuDe 1963
2 1~_middot_sectSI8e~ected1teai c-ua 0 S 8 e first count coaputer tape Coluab a_lion AssocshylatloD of QoveraMD-8 Jlme 1971
3 Jtu1tDoab County Oreaon BDY1roDlHtlltal SurveyEarly 1971
The JIultDOIIIlb COUDty OrttIOD BDv1roDllfmtal Surley
Barly 1971 1s bull stat1stical report of the activ1tles of
theentlreMultDOIIIl2 CcNDty Health Dep~t during the
year of 1970 Die speclflc 1nd1cs elected from tb1s
study amprejMental aealtll Publlc Health N~s1D1 vlslts
FaJUly ~ Veaereal])1 ~ ~rcul081
Throush tie use of cUrts and mapa ODe CaD roup these i
speclflc ~oea to ahcnr the healthneedsof speclfic I
census trtcta aD4 then the health needs of iarer neIghshy
borhooda 1m4 o~ Uebullbull
Rf)~UP1Dl of areu was accompllshed in thefolloWinl I
JJ ~
35
he MiltDoIliahCountY oregon BDViromaental SUrvey
early 1971 isamp statistical report ot tbeaotivities ot
the entire MultDolllh COUDty Health ])epartiDent dur1nl the
year ot1970 he specitic 1Dd1C8S selected frOm this
aUy are 1Il8Dtal health public healthDurs8s visits
fUl1ly pia waereal elisease aDd tuberculosia
Tbroq11the Wle otcbart aDd mapa aDecm szoup these
specific indic to show the health Deeds ofapecitic
ccmaua tracts aDdtIum th8health neecla of larsr ~eilh-
bOrhooda and co8I13 tlbullbullbull
RegroupiDI ot areas waa accoap118hed1D the
tollOWiDl lIIIIm1er~ A bullbullcifie 1ndex 8selectcl auch as
venereal di8bullbulle or tuberculo8i~ he total number ot
cs was then deterll1ne4 for each census tract Through
the use of the maber ot cRbullbullbull tor a 11Yen cenaus tract
aDd tbe population ot thattractaltrateot1lla1ampmcper
100OOOpopUlaticm wu cleteXll1ned for each census tract
This was ~e to starl4ard1ze the population ditterence
amongOeD8U8 -tracts 1he rate of incidence toreaob
cenauatract was then llstedby rank position on a chart
In rank poition1DI any cen8Wl tracts haviDg equal
rates ot1l1c1dence are assipe4tbe iaDk posttiona
Beeauseot the abo fact tbAt cbarta w111 vary in length
neveltbAtlea eacb cbart will 1Dclu4eall census tracts
inMullnoaah Couaty Atter the census tracts bave been
listed accord1q to raalcth1s list will bediv1ded into
IJ
36 three levelsotinc14ence he three levels are
1~ The upper 14 of1DcldenCe
2 Thelower 14 ot incidence
middot3 The ILld 12 of incidence
Tlles three srouplqa are then used in compiling a map ~f
Mu1tnOmahCountyfor ach apecltictop1cbull TIle maps are
uaefuJliD tbatthey V1suallycoJib1De 1Dd1v1Clualproblem
census tracts into larger problem nellhbOrhooc1s
The 1960 statistical iDtormatloD was Used in a similar
liIaDDr to tbatexpla1Dedabove 1Dthe4evelopaent of a
chartmiddot and map 1Ihow1DI e cOllpampriSOr1 of per capita lncolle
tor ttaCh ceDsua tJact aDdmiddot combiDed census middotmiddottract areas
he 1910 aDd 1960 statlstlcal iDtOrllatl0D was combined
lna map and chart he purpose of this and chart is
to d8aonatrate the e cl1stributloa1DeachceD8U8 tract
and middot1ndlcatbull tuture ace populatlon treD4a bull
When one be middotbullbullbullbullbullHdth ne8cts ot an area and has
declded to establlsh a cl1D1c to serve that area the
physical location otthat cl1D1c IllU8t be consldered In
order to coapreb8ll81vel develop an area cl1n1c one should
conslder thepre88Dttraftlc middot~ytaa an4tranaportatlon
systems Thecl1D1cahoUld be located close enoUlh to
major arterlals to giva asy access from the total area
be_ ervecl by this cliD1c At the t1ll8they should
be tar eo away froll thesarterlals to all8Y1ate traffic
CODCell18 andpark1D8 conpstlon By traff1c concerns I
IJ
37
lIlan one lUSt consider thertarro1fne8S of streets whether
streets are oD8--C)r two-way iqres8 and egress to parking
amp0111tie eros tratflC) spedof trattJQ children 1n
ll8a traffic i1lht Vislon re8tr1ctionS etc
BwstraDsportat1onshould alao be central in this area
as maay people ~U f1Df1 1tD8Cessary to use this form of
transportatlon
~e tutqredlopHQt of bull treewa systems should be
c0J1S1dered soastolesen thecumce ofmiddot future roada
cutt1DSotltbe cl1D1c llte line
nrrph1c middotDampta
It is 1JDportaDtto kDOw the demosraphic distribution
characteristics of the oUenteltbat i8 to be served by
localized health cl1D1cs
Acl1D1c which erves8J1 area where1D the prepondershy
ance of persona arecrter 65 years of mayf1nd that these
people rely more on pUblic transportation call for more
home- services and haV4t 110ft ChroD1c and debilitating
types of disorders (b1_ blood pressure poor heariDg and
eyesight) tbaD do8 an area ot a YOUDIer population On
the other hand thL area of older residents may have little
need for family plabDlng cllni08
In order to better ~Ybullbull the 4eaoraphic population
of each CeD8U8 tract the 1970 CeD8U8 iatormation was viewed
and two specific catelOri8 considered These two cat
IJ
38
lori8S woUld be the perc_tap ot population under 19
year of ase and the percentase ot each oensuetractover
65 years of age he 1960 1Dtormatlon tor eaCh tract was
then compared witbthe 1970 intormation and a percentage
ofincreaae or4ecreamp8 tormiddot e~chtract1n each category
cOJlputecland achartma4e By the use of this chart one
18 able to View tJleap populat1odiatr1but10n of census
tract and at the _ t1lle accesa middottrencl Por example
let us choose census tract 601 W see 40-4 otthe
population is under 19 years ot and that ODly82 1s
over 65 years ot middotAtthe e tille the percentage of
youth bas ~ed ODly 1_ intbe laSt teD year whilethe
percentale over 65 year ot middotbas stayedmiddotthe same With
this in mJnc1 ODe ~ 1DfItr libat ol1D1o aerviDg this
area WOuld bellQre conq~w1th the problems of a
YOUQier populat1on and that _ would probably be true foJ
some t1aein tbefuture On the other hand CeDSU8 tract 54
has only 2 ollt population UDder 19 yel1s ot age and
this has decreased by 1 over the last ten years middotwhile at
the same time 32-377 ot the populat1on 18 over 65 years of
age A ol1D1C ___ this area should be or1eJ1ted toward
tbespecttic problema otthe ampledbull
PerCapia __ bY gsa neat
WhaD cona1der1qlooat10D1 tor health cl1n1cs one
shoUld take the 1DC01Ieot areas into consideration Areas
IJ
39
of lowiDcome would not 11kel~be 8erved more by localized
cl1D1cs tbaD would are of hilbincome It 18 likely
people haYiq a hip iDeoll8would preter to be aeenby a
chosen ~r1vatephylc1a1l tban at a local cl1D1cwhere
10Dier waits y beraceaaampryand leas personal attention
gl_
The 19701ncOII81atoWampt10n tor MultnomahC~ty was
not available at the tille thi8report W88 made The 1Dto~shy
tiOD Was taken ~adtro tbe1960 census publlcation
his woUld ~8Il thea tbat ral1I8 OD the chart ynot 1raquoe
completely accurate hi writer telthatthe areas most
affected by tb8 1I8eof the older 1Dco1DtOlaat1oDWOuld be
those tracts wh1ch baYebad a rapid 1ncreaae1n populatlon
over the past tfmyHr8 bullbullbull tracts would include tracts
nUmbered 104 9897 96 aDd 95 be perc~ita 1Dcome
referredto1il-tb1a Paper18the lIean 1DCo per person per
census tract
Attar the iDeoeper census tract was listed on a chart
a map was de 1D41catiDg those census tracts belonging to
the lower 14 ot income tor all censue tracts in Multnomah
COlDltytbose beloqins to the upper 14 ot income tor all
census tract 111 MultnolUlhCounty and those belonging to
the mid 12 ot 1I1coaetor all oeuuetracts in Multnomah
C01mty
In yiew1Dg the _p 1t caa be seen that the low income
area seautotollow aloas the at aide ot the Wl1lamette
IJ
40
R1ver the full length of Kultnomah County A second low
income area follows the south edge of the Columbia from
the northwest corner of Multnomah County easterly to 148 St
A third problem area seems to be on the east bank of the
Willamette River with the Union Pacific Railroad being
about the center of this tract The extreme loutheast
corner of Multnomah COUDty appears to be a low income area
but as this area bas bad rapid grouth in the last ten years
this could be erroneous
Mental Health
be first ~ecific indica to be selected from the
Multnomah County envirollllental survey of early 1971 and
to be considered in this paper i8 that of Mental Health
At the present for mental health purposes Multnomah
County is divided into five catchmentareas with a mental
health cl1n1cin each area These clinics are Model
Citles Delaunay ADkeny street Office Hansen Health
Building end Southeast Clinic
All lIlental health cl1n1cslcept statlstlcal information
on all patients visiting their cl1n1cs this included the
address of the patient hese addresses were then listed
upon the approprlate C8D8US tract Each census tract was
then ranked on a chart according to the nUllber of mental
health patients who reslde ln thatCeDSUS tract attending
any of the above listed ental health clinics This chart
IJ
41
wasttum d1v14ed1ato proper quartile bbullbullbull
quartile vereUs to dne10 u appropl1ate Multnoh
County _tal health ItLa middotmiddotmiddotthelipO~a1bl by lOoJcJIUE
at the UDtal health _to uteN1De which ueu have the
lars-t use otCOllDty 1alh~th faci11t1Rot
1Ilclu4ecl 111 tbia woUld tber otpeopleYia1t1Da
pr1vat patch1atriata aDd pr1_t _ntalhealtb cl1D1c8
WheDtbe M1 18Yienclmiddot Itmiddotmiddotmiddotmiddot~middotbe~_ tbat ~rtt
appears to lMt fourmiddotmiddot-al are iii _oil the nuaber ot
lIental healthcl1D1c na1t toM tbjh1sheat 1he
tour areaa woUld be tollows
1ttrea Ore to~Blo Drimiddot ~tb Burrus14e aDd tIMtmiddot Colb1a Riftr H1gbwyaeri1Dla th nortllra boundaryshy
2 bull ProII 82D4 1_~ 10 20th streetwitil the ra1lMd Mu the north ltouadary
3 ~ et et tUgl_b1bull MYel froamiddot the Clackaaa COUDty l1ae aorth to Dln8lon stret
4 beDOlvt1ttfe-t ~efllt4 COatytrca Jle1aware streetmiddot toR1C1a11oDd wlth Colubla Blvd heiDI tbAtnorth bouaclary_
It ODe coapareatbiap to th iDeobullbullmiddotp 1t can be
eamiddotthat lIOat ot the c tracts baY1Dg bllh v1i11tatlcma
middottfl public tal health cJ1rUc8 ~ 111 t13e low ~ aid
1DcOile SroupiDIOJa1y of til 25 tracta llsted as
haviDlbip aental Maltll nlltatlou are ~ the1g60 hip
iDeo arebullbullbull
17 Plpn
42
amily PlellnSDI ]Jlce Metal Health i8 an 1nd1ce of
use Theperson 111 ordertobavebe_ 1Dcluclecl 1n this
atu4ywouldhave tohaft Ue4 ataa11y plaDI cl1D1c
tacilities of soaetype It 41fter troll tile _tal health
study1nthat i t1Jicludestatist1catrollbotb public and
privateclJD1os
The iDformation tor the iak orurcbart 8Dd map of
t8ll111 plenn1 na ob1a1De4 by cOIIblnlDlthe mabel of
1rlcuv1duals bullbull_ attbe tbreellUltrampo-ti Coatyhll11y
PlalJQllIl C11ll10s 111til tbo at the Planned PareDthood
Association CliD1C8 be tbree -JIultDouh Couaty r8ldly
PlamSq Cl1D1c are Solrtbweatth Col_bla 1111- a114
HaDsell Health BWlcl1Dl CllD1cbi middot1Dtormat1oD vas then
bullbullbullesed tomiddot detellWMt l10w people troll eacb c8IUIUS
chart wastben Mele IUs oIIart jn 4iY1ded to show
the censuS tracts lIaYiDlmiddottIle h1t1iest qUart1le of incidence
of use lowest quartile of 1Qc1deao ot use Jlid 12 of
incidence of Wle an4 a map sprepared troll thts 1Dto~
mation
The C8U118 tractsbelOJISnl to the h1lhestquartile of
use appear to be 1lO~ 8catt~ on tbipwas true ot
either the _p ot aental health cl1D1c uaageor ot the map
abow1DI per capita 1I1COM Iaere40 to be three
d18t1nct areas of UIIaP beJ woul4 be
1
IJ
43
t10D of BurD81cl and the W11lallette River 4
2 S~t Portland 8Otth otmiddot the ra11shyrcaadand alona the W11lamette River
lIortbeaat Portl8D4 between MisSiss1pp1 and 24tbStreet the northbouBclary be1DgColwb1aBlvd
Pylzl1c BMltl IrpI Y11ta
Publlc Healtil nur81D1Y1s1t nclud8 an vists to
theholles of client by PubUc Health Nurbullbullbullbull his shows
visits to bull f8Jl1ly fer aDY purpos SUCh aatuberculolJ1s
het1Dl tem1tyaeatalu4 8IiOt10D8l cODd1t1ona etc
he atat18t1C~ 1fele C()4ed accord1Dg tomiddot the 1llli301fOCUS
of the Y18lt tt doe DOt 1D41cate the Dmlber of holies or
f8ll11lev181tecl or 1D41Y14ual Y1a1ted more tban oDcein
the propwl It dobullbull I1ve 80M 1D41cat1on by coaparlshy
OD ot the 8JIoUDt of aedlcal problema 1n eachcen8WI tract
Ap1nmiddot the _p abowa 8 scatter patteraof probl_
areas althoUSh there appear to be a sroup1Dl of hiSh J
l8aIeccmaus tract 1ntlut extreme southeast part of tbe
County other areu uIriaI any nura1Dl contacts are
1 bull he 801lth-oa-al CO1Dty on eaCh 814 of 82nd Av from Clackallaa County north to Dinloa
2 ear bullbullbullt 814e aroUDd Preacottand Misaisippi
Dowatom Bunul14eonboth 1de of the river
44
V_real Pis The iDfomatloil uaec1 to tabulate the Venereal
disease chart includes all the ooab1ned case otmiddotODormea
and syphilIs reported by bothmiddot publIc and prIvate physicIans
dur1nl 1970 There were 3602 caes ot IOnorrhea reported
dur1nl 1970 While ODly 17 cabullbullsot ayphilimiddot were reported
A chart was prepUed aDd att8llPt wasmiddotmiddot de tomiddot
determ1De Wh_therVttDereal 41ease was more p~vaJent in
areas othigb or lowmiddot proportIon ot youth hi waadone
bymiddotdetemlna a 1leaD prceiltacmiddotmiddotmiddottor the population ot
resld~ts UDder19 years ot (34) middotA mean ratemiddot per
100000 popUlatIon al80c1ttem1Ded tor the middotoccurreDCe
ot venereal dieae This was et at 390 oass Areas
hav1nl a population 1n which leiS than 34 were lmder 19
years ot ampIe were called low- yOuth abOve tbl percentaae
hiSh youth The aaa waatrue ot the occurrence oivenershy
eal disea_ per CeD8UStract It the rate waacomputed
as 1I0re than 390 cases per 100000 it was called hiah
venerealdiaeasei it less than thia tisure low venereal
disease It was tound that 1D Multn~ COmlty there sems
to be poSitive OOlatI0n(x21S19gt between low youth
and hipmiddot venereal diseaand hip youth and low venereal
diseasebull
RaDk ordr Iitot all c traot middottbAm made
Th1s was done byt1Ddlna the ratepr 100000 populatIon
of venereal disator all census tracts in the County bull
45
These were thenlisted from h1lhto low (sreatest to
least) in a rank order The l1sting was then divided
into Upperandlower 14 aDd listed on the MUltnomah
Countymiddot up
The areas of b1gh venereal disease se8ll18to
roup thBl~8 middotin a very tllht area ~oq both 1des
of thell18l8~ R1 w1th BurDaldeS~et being
~bout theceDter qf tbi8IZ9uping This area woUld
appear to be m ldeal spot for the denlopment of a
locallzed venereal d1sbullbullbullbull cl1D1c
UbepoundCUlO1s
In this report bull tube1C1llosls caS8S refrred
to include alltbobullbull cabullbulls ontubercUlo8is follow-up
rather middotthan just new C Accord1Ds to the Multnomah
County Health SUrvey of early 1971 this would include
all ca repOrte4 over thelaat three years The
total number of tuberculosi8 cabullbullbull usedin this study
was 666 lh1 included 128 new cabullbullbullbull
A rate per 100000 of tuberculosis for each
census tract wa- then computed and the c~us tracts
listed by rank order be b11h Qartlle mel low
quartl1 were then reoordd on a Multnomah CoUnty map
TWo genral areaa baY1Dg a hip mcldencaot tubercu~
losiare 1D41cated heyare
1 Both middotsld ot theWilla11lette River
Ll -
46
with Burns1de about thecnter
2 he extrea Northebullbullt comer of the County bull
By coap8r1ng the tuberculois an4ven8real
diseae maps ODe can 8ee that the downtown areas ot
hiSh 1nc1denceare alIIo8t 1c1eDt1cal on ach map
This WOuld 1nd1cate that 1t would be of value to
bullbulltab11sh acl1D1c 111 th1aampreatbat would provide
bothtuberCulos1s 8Dd ytmereal 418ase srvicbullbullbull
Thchart aDd 1181gt8 are wsfuln 11v1DI
1Ddicat10DS tor the type aDd placemeototlocal
health cl1n1c8 tbro1qhout tbe MultnomahCounty area
A cOllpar1on of the mapa help one to dec1dewhether
to provide a aulti-8ervice cl1D1c or spec1f1c type of
cliD1c As stated in Part I of thi paprserv1ces
shouldhaYe both treatlieDt and prfMmt10n cOmponents
As he been stated fta ne1lbborhood health care
Qenter muat be a fac111tY plazme4 with an aamesa
ot the neds of the consumer and the c01llll1m1tybull
Part II of this rport haa been an attaapt to indicate
and clarify 8011 ottheae coDlllUDity neds This has
been done through8elect10n of apc1f1c problems
The indic were then visuallyrecorded through the
use of ups and charta ODe dan asseS8 thedsreeof
1DIportance of certain concems to spec~t1c areaa by
comparinl the chart aDd maps Prom this oDeean
41 dec1de which are48 vb1chcUD1c-or indeed if
the need a clinic at all However further factors
should be considered hebullbull include
a The amount of fuDd1 available
b What 18 the percentage ot peopleineoh ceaaua tract tbat would actually us such cl1n1cIl
c Wbat 1 tbeco--1tymiddot 8 IeeliDashyreaardtDI particular cl1D1c8 Would this dcrebullbullbullmiddot the ettctiveness ot thse cl1n1ca
IJ
li
D_OlraphicPopulatLon Challie 1960 to 1970 48
Cen8U8 1 of Pop 1 Cbaqemiddot 1 Change1 ofPopTract Under 19 Yr8 Over 65 Yrs1960-70 1960-70
middot1Q701Q70
1 319 -12 171 -H) 1
2722 215-27 +68 301 366 -22 127 +35 302 371 +19 111 -04
311middot401 144-41 +29 402 321 13~7-39 +24 501 356 124-08 -02 5~O2 351 133-23 +12
405601 82-10 -02 394602 103-01 -06
701 275 149-76 +56 702 361 +01 121 -07
+10middot801 326 140-22 802 321 middot127
(
-29 -03 9~01 342 124 -H) 6-18 902 294 128 -H) 3-24
10middotmiddot -14312 140 -17 1101 182 +25 -23197
2411102 186-59 +29 1201 226 169-17 -41
31middot01202 +11 182 -05 295 -H) 81301 208 -H) 4
1302 331 +08 197 +04
14 323 +15 middot185 -08 middotmiddot15 329 +16 16~5 -13
-28middot 1601 332 131 +12
1602 356 98 +24middot-39 middot3101701 161-33 +21
1702 370 -15 85 +02 +19 1801 264 151middot-50
185middot1802 256 +47-58
IJ ~
D_raphlc Population Change 1960 to 1970middot 49 (Contd)
4io
Census Tract
of pop Uncter 19 Yra
1Q1n
1Cha1l8e 1960-70
of PopOver 65 Yra
lQO Change
1960-70
19 389 +29 141 -24 20 223 -13 206 +18
21 227 +08 194 -36 2201 356 -27 112 +05
2202 290 -18 ll~9 -29 2301 356 -03 154 +24 2302 260 -37 245 +97
2401 410 +6~1 123 -31 2402 163 -80 320 +99 2501 381 +13 140 -01 25()2 237 31 lil +02 26 343 +25 186 +149 2701 370 +29 1S5 -01 2702 249 -44 304 +98 2801 337 +19 187 +09 2802 306 -10 156 +31 2901 304 -38 142 +24 2902 i 307 -32 146 t3~9
30 29~0 -48 16~2 +51
31 355 +30 160 +01 32 370 +48 148 -13 3301 395 +45 130 -20 3302 368 +06 138 -02 3401 386 +16 117 000
3402
400 +32 92 -26 3501 304 -07 115 +35
3502 344 000 140 -13
3601
36~02 357 -04 132 +32
3603 30~1 42 149 -67 3701 342 +28 152 +19
1
IJ
Jianolraphic Population Chan 1960 to 1970 50 (Contd)
Census Tract
of Pop Under 19 Yrs
JJl7J
middotChanae 1960-70
middotofmiddotpop Over 65 Yrs
1c~7n
Change 196070
3702 409 +39 122 -11 3801 308 -11 151 +29 3802 275 -35 180 +46 3803 282 -32 192 +54 3901 376 ~13 100 +17 3902 296 -03 177 +29 4001 438 -11 84 +13 4002 353 -21 115 +20
4101 397 11 9middot0 +11 4102 346 -19 120 +03 42 331 +19 11 bull 3 -16 43 347 -72 105 +31 44 113 +84 183 +154 4S 33~9 +07 110 -06 4601 2501 22 193 +38 4602 332 +59 126 -29 47middot 161middot 000 211 +01 48 103 -26 302 +59 49 138 +1 bull 3 252 +09 50 141 -26 204 -12 51 12 -39 257 +07 52 47 -61 351 +48 53 89 +49 314 -30 54 25 l1li15 327 -17 55 131 -17 115 -121 56 198 +93 227 -47 57 71 102 189 -88 58 240 ~middot41 16~1 +55 59 322 +25 142 +06middot 6001 264 95 132 +50
6002 328 -31middot 89 +07
JJ
Demographic Population Change 1960 to 1970 51 (Contd)
Census 1 ofPop lChange of Pop bull ChangeTract Under 19 Yrbullbull 1960-70 Over 65 Yrs 1960-70
1970 1970
61 355 -58 85 +39
62 328 39 110 +18
63 414 04 73 10
64 382 -22 72 +04
6501 383 02 67 -20
6502 329 -56 96 +09
6601 391 +13 88 -03
6602 319 -59 97 +06
6701 327 71 145 +72
6702 331 ~67 83 +1-0
6801 365 -66 49 +01
6802 388 4bull3 54 +06
69 354 -41 80 +23
70 400 -23 68 -06
71 359 -48 72 +05
72 255 -88 82 +11
73 346 -39 91 +25
74 313middot -63 105 +24
75 329 -42 129 +37
76 336 -52 85 +21
77 370 -10 69 +05
78 309 -10 120 +21
79 325 -56 87 +10
8001 358 -81 57 +12
8002 391 ~81 76 +12
81 315 -76 108 +21
8201 403 -23 64 +08
8202 392 23 65 +08
83 357 -34 120 +31
84 402 -18 73 +16
85 413 -06 76 -09
r
Demographic Population Change 1960 to 1970 52 (Contd)
Census Tract
t of Pop Uncler 19 Yrs
1970
Change 1960-70
1 of Pop OVer 65 Yrs
1970
ex Change 196070
86
87
88
89
90
91 9201
9202
93
94
95
9601
9602
9701
9702
9801
9802
99
100 I
101
102
103
10401
10402
lOS
368
351
379
391
391
413
379
433
372
429
414
432
419
439
~32
377
457 420
378 41middot7
345
360 417
417
412
-04
-02
-35
-26
-28
-11
-64
-20
-S9
-39
-32
-21
-34
-40
-47
-lO~7middot
-27middot +04
+56
+07
-34 01
+04
+04
+10
103
128
97
11il3 99
69
79
42
77
46
34 38
44
40
54
111
51middot
81
133
59
74
140
63
87
76
-08
-06
+04
+08
+17
-05
+3S -02
+1~4
+19
+33
-14
-08
+12
+26
+71
+11
-16 -34
-20
-19 +37
-49
-2S +15
NOte The The
Taken frOi
averageullder averageabove
middotUSCensus ---shy -
19 years == 6S years ==
figures 197
32r 13(14
p a~d 1960
--
Rank
1
2
3
4
5
6
7
8
9
10
11 12 -_
13
14
15
16
17
18
Tract
69 46
60
58
- 68
61
302
2501
67
63
19
62
26
94
3603
3902
64
30 -----~-
Rank
19
20
21 -
22
23-shy
24
25
26
27
28
29
30
31
32
33
34
35
36 -
Ranking of Per Capita Income by Census Tract
Tract
65
2701
- 15
1601
701
66
93
82
2903
3602
30
2502
80
2401
81
- 70
91 shy
4001
High
Rank Tractshy
-32shy37
38 97
120239
7840
41 ~ _2_1__ 42 31
43 2501
44 18
45 98
46 37
47 3803
1702
49
48
1602 92 2702
I
50 89
51 901
52 801
Ra_
53
54
55
56
57
58
59
60
61
62
63
64
6S
66
67
68
TractTract Ra~
74692
170196 70 I
401 71 90
72 1037J
79 70273
3802 74 601
24024102 75
85 76 101
77 9023901
7699 78 100 4101 79
3601 I
380180
458140~ t---- _ - - shy83 82 42
888384
59843501
4777 8~
502
Low
802 86
Rank Tract
87 shy
--88
89
90
91
92
93
94
- 95
96
97
middot98
99
100
101
102
103
104
1201
14
49
72
73
43
87
3502
105
1
52
86
71
1
501
10
3301
104 tf
Rank
105
106
107
108
109
110
III
112
113
114
115
116
117
118
119
120
121
Ranking of Per Capitalucoae by Census Tract
(Contd)
Tract Rank
4001 122--shy602
13
1102 2302
3302
55
3401
48
21
56
50
3402
lL01
2202
2301
53
2201
-shy
Tract Rank Tract Rank T~aet Rank
57 I-----
Imiddote
bull
Tract
- Low -k Note Information taken from 1960 U SCensus
Rank Tract
I ~
Ie
Imiddot
~
----
----
--
--
Rank
1
2
3
4
5
6
1
8
9
10
11
i-
-Tract
391 922 921
972 971
100
132 131 121
962 961
822 821 401
982 981
20 111
47 10 1
412
High
Total Number of Henta1 Health Visits
Ranked by Census Tract High to Low
TractTract RankTractRank Rnk
12 182 22 78 29 87 76 381 73181 ~------- 1913 371 8538230162372 271 2616-121 8272 2
14 80~2 31 94 7923 84801 59 15251362 4232 15 52 _ 32 103 8924 651 17240216 652
_ 91 351 33 341 23117 83 122 25 25 48 1123921418 34 shy61 86 661
19 662 6493 81 26 91 8153 49 50 55 41383 71 27 51 3120 90 672241 35shy 104167162 461
I 411 46211121 28 88342 I
2502 36 69 54 5251 50 272
-Ra
37
38
39
_ 40
_ 41 Ishy
I
42 I
-I 43 44
45
shy
Tract
~ --- shy 95 56
45 292 242
102 62 352 291y
92
101 281
99 72 63 601 60~ 42 2201
77 74 61 57
363 232
70
32 31
11 44 282 2202
Low l
- Tract
46 682 681 I 331 30
r~$ 47 1042 332
48 102_41_
11
~
Visits to Family Planning Clinics Ranked by Census Tract High to Low
Rank Tract Rank Tract Rankmiddot Tract Rank Tract Rank Tract Rank Tract
1
2
3
4
5
6
7
8
9
10
11
12
13middot
14
15
16
17
361
56
401
341
48
59 121
20
55
342
10
31
58
93 21
241 132
331
53
461 462
18
19
20-shy21
22
23
24
25
26
27middot
28
29
30
31
32
33
391
32
middot47 I-i-_-shy _ -
231 111
332
972 1
372 371
52
89
32
92
82
100 31
182
30 242
402
34
35
36
37
38
39
40
41
42
43
44
45
42
1714 i 661 221
78 362 2
90 602 601 352
63 251
105 921
971 351
73 42 292 232
411 51
662
81 45 52
46
47
48
49shy
50
51
52
53
54
55
56
961
801
49 81 72 71
19
9~1
172
68 2 57 162 14 112
91 75 681
381 42
3~3
83 161
57 f
58
59
60
61shy
62 Imiddot
63
Imiddot 64
65
66
64 62 36~3 252
74 652 SO 392 291
651 6bull 2
79 271
r-- ---- shy981 222
672 671
821 272
94 87
281
382
67
68
69
70
71
72
73
74
75
76
77
78
981 26 12~2
IS 61
85 82~2 69
61 43
101 86 84 282
76
131
51 72
1041 962 88 70
99 922 77
103
95 802 181
i
~
Low High
RankRank Tract
5479
4480
81 1042 ~) middot102
71 - - + ~ - ~
Visits to Family Planning Clinics
(Contd)
Tract Rank
I
Tract llaDk l
RankTract Tract Rank Tract
~
I
~
J1 ~
Low
Total Number of public Health Nursing Visits
Ranked by Census TractsHigh to Low
TractTract RankTractRank RankRank TractTractRankTractRank
25249 71 79 17249 8033 6586 99189711 84 2915072 34 661 76 66 811519512
402 5035 51 161 2518220 122 1713423 352 55801 7120 6752 2 149814 41236 83 2662 38 94 6821 53 2924015 362 37 32 42 75 69 281 84 63
546 8822 54 222 85 3925431 70383417 3818223 6439 4386652 718 21 55 103332 8924 232 87 19 271729219619 24156 16211140 382 628825 10523110 112 73411 10141-- ----shy 89 363 4457 8126 16111 221 74 9142 90 46158331 53 671279012 46243 48 59 351 3837528 1083 9313 91 5844 59 -_242 76 1----- shy60 272 72 74104114 60145 42 9287 7729 92 6151 8215 57371 934630 91 307762 12113116 282 619447 41391 9531 78100 63 7378 ~95 681 6945 32 5632 798517 6448 47 52 181
High ~ Low
Rank Tract Rank
96 31 132 70
97 102
98 182 372middot 602 651 662
- -shy
~72 682 802
822 922 962 972 982
1042 ----shy
Low
Total Number of Public Health Nursing Visits
(Contd)
Rank Rank Rank TractTract Tract
I
I lt
I
Tract Rank Tract
[
~~~-
I
~
IJilfimiddot ~
j
Ranking of VD Caea According to Census Tracts 61 By High and LOll Youth Itatio
A media~ of 34 5 was determined Any tract having greater
than 34 5~ of popu1tionunde~ 19 years of age -High~
Any tract having l8S than 345 of population under 19
years == Low
Any tract having rate less than 390 =Low
Any tract having rate more than 390 == HLgl4
YOUTH
LOW HIGH
L
0
12 402 1801 1802 343 2801 2802 29023603
54 6001 600262 66~02 72 74 75 76
78 79 81 t02 65 1202
W
(25)
VD
H
I
G
H
401 701 801802 901 902 10 1101 241 1201 1301 132 14 15 1601 1701 20~ 21 2202 2j02 2402 2502 2702 2901 303501 3502 34023801 3802 383 3902 42 44 45 4601 4602 47 48 49 SO 51~2 53 55 56 57 58 S9 6701 6702 73 95
3~02 7021702 19 25~01 2701 4102 4101 63 64601 ~601 6801 680270 7l 77 8001 80~02 8201 8202 83 84
85 86 87 88~ 90 91 9202 920193 94 9601 9602~ 9701 9102 9801 9802 99 100 101 103 10402 105 6501 10401
(47)
301 501 502 601 1602 2401 2301 2201 31 32 3301 3302 3401 3402~ 3602 3702 3901 400140 02 43 61 69 B(
(53) (23)
~ ~gt
Ranking of VD by Rate Per 100000 By Census Tract
~
Rank Tract Rank Tract Rank Tract Rank Tract llank Tract Rank Tract Rank Tract
1 2202 21 S6 40 902 58 1602 74 75
90-shy 64 107 26 --~-
2 3402 22 45 41 10 59 902 75 78 91 54 108 61
3 2301 23 3502 42 2502 60 602 76 6802 92 402 109 87
4 3302 24 49 43 1102 61 501 17 2 93 94 110 90
5 50 25 52 44 6702 62 14 78 8202 94 97 02 III 76
6 2201 26 20 6701 63 4002 8201 2501
9701 41~02 112 91
7 44 27 48 45 401 64 3802 2902 95 63 113 62
8 3301 28 1701 46 502 65 30 79 83 74 96 9602 114 71
9 55 29 47 47 42 66 3803 80 2801 96Q1 115 85 10
11
12
13
14
15
16
17
18
3401
53
2302
2401
57
21
2402
1101
51
30-shy31
32
33
34
35
36
37
3701 - -~ 1201
3702
89
43
132 131
3602
4001
48
49
50
51
52
53
54
55
58
1601
601
4602 4601
69
701
31
3901
67
68
69
70
71
72
2901
801
39021~ 802
6502 6501 122
702
41~01
81
82
83
84
85
86
87
88
19
1
1702
2802
79
93
100 6801 6602
81
97
98
99
100
101
102
103
104
9201 9202
9802 9801
77
302
79
86
72
84
116
117
118
119
120
121
3603
8002 8001
101
99
95
10401
105 10402 103 102
19
20
59
32
38
39
2702
3501
56
57
301
3801
73 1802 1801
89 6002 6001
105
106
2701
88
High Low
-- -----
Rank OrdermiddotTuberclosis Cases by Rate Per 100000 Ranked by Census Tract High to Low
Tract TractRankTractRank Rank TractRaukTractRankTractRank
801
79 9601501411 52 6835340120511 I 960269 903603532036 $-~~F130221542 4366 311301 70 68~013802 _ I- _ 4001_37213 3921201 6802802 H71523822024 22 54 193302 3802 80 8958 I37139535 70155 9801 I60123 72 6702 98023914011016 6701250124 10 56
81 94 401r 7 154152 73 7057 2625 122 92028
90242 162312301 92~158 86 7172434526509 82 79160159 74 100 87412240227220110 6502836960 75 30 8317244 6501782801285711 61 901 42765645 84 66021459294912 9701 660146 171 302 9702 47
6235023033113 85 822821182 917755 16335013110214 841814832 78 103 938564 324815 86 1057940149272 38036523216 10401 87 2902241 725Q 10402360266340217middot IF88 88 9937233 282 51 218 101 01102 46016234
I)167 2901460219 47
High ~ Low ~
- -
TractRank
9S89
6490
8191 8001 8002
63 61 60middot01 6002 44 2701
92
J
2502 402 --- ----shy
I
Rank
Rank Order Tuberculosis Cases by Rate per 100000
(Coutd)
Tract Rank Tract ~nk
I
Tract Ballk Tract Rank
Imiddot
Tract
Imiddot
1~
t 1I i Pi i l I
o
1 -1shyL I
I J
8 40 icO ~ I -lt 0
-t (1) I
i I
r o E
II
a
I
r--i
shy
I
~
I (
Jgt
(011 fi(
Ggt
I II ~j
()
(f 0
~ ()
I
11
f9
r
II 99
o ~
Ggt r
~ __-J~ I t I ~ I
r--J l I
~ _ __ J
) 1
fTl
1gt
r I
()
r
()
lt en -i en
()
I1l
(J)
(J)
-i
P ()
19
r o ~
r G1 I
I
c
~
o I 89
--- -I-shy
r-r I
1- 0 _~ _ _--J E
G1 I I I
i i
I 1-1-1 ~ _J ~2 ~ II
II
()
1 I I I 1
id i bullbull
~
A n 69
r 1shy
- 0 Gl
l--~ ~ I
~ II
II )
I () isect i
en l i
(J)
-t
0
IA Ol
1
access1b11it Prov1UOI1ot appropriate services and
eff1cient use ot middotre80urc He state that a IYStem ot
comprehensive healthmiddotmiddot care 1DmiddotoXder to apIo middottbe stated
principles fD lleetiDlita 1Oalttst havemiddot certain
attributes
1 middoteare utdbeollW~ItaC1~orpn1zatlOM]ec ~ bull p~~ol1calbarriers IlU8t be removedbull
2 bull Care abould ace he~ecl1merlt8 ot distance residttiiCemiddot tille must be removed
middotcare8ho1ll411eC-r0WIZ the Ufemiddot span it diseases eapec ychronic are to be controlled betoretheybecome disabling or lite threateD1Dg
4 CeresboUd be~teJ1nCludlJ1C p~vention cure ma1ntiDiiCeand rehabI11tation
5 Care aho11l4be~i9_ttIa1t1ephyaiolol1ca1 aD4 pay1Fci1~cTrIS-ticot the pat~ent
6 Care aboul4 middotbe9L~ tJwrefore shouldbebu11t aro~ middotslJOc1al1natltutloDs which relate to the patients Way of lite suCh as middotthe home school and place of work
7 bull Carellbolld be m-ar and therefore shoUld bemiddot provIded ~Wliils where responsishybiUty tor the patient bas beendetem1nedauthority has been delqated and a communishycation syst_ provided
s care slIould 1Ie HIl 1nclud1Dg theintesratlon ottac1~1ts~ ~prsOllDel neceaary tor modern medical care
9 bull care dbe Of hip ~ eresboul Th ahouldbe aD adequate audit 0 care pee~ reviewcoDtlDUDI naluatioDBnd research intomiddot adequacy aDd quality
Ult1ately as 1Dd1cate4by the Nat10Dal CollllDisshy
8
sion on ColDJIIUUity Health Service (26 pp 1~20) the
c1evelopmezat of a ampyt of comprehensive health care is
a cOlDJIIUUityw14ere8pODSibilit1 1nvolviDS the integrashy
tion of all the health care facilitie and programs in
the cOlDJIIUUity or the c0arcm1ty8 healthc~ system
the PamprqlOIIlt goal ~
PrQv11~ of a ~rehive ~e 9tcoaaun1ty health aervicea
2 Ma1DteIlace ot aD a4equateqUaDtity ot al~requ1re4 health care facilities
Iritsrat~oDof ~v1c1ualUD1ta and s1steas ot bealth aerviceinto a coordishy
natedpattem ot continuous care tor theindiVidual
HoWYer aYerby (37 t pp71-72) 1Dd1cate the
med1cal and health care 81atmiddotaa it ball t1nct1oned haa
not facil~tate4 the delivery ot COap~usive middothealth
care IDcl1Y1c1ualhealth care facilitie themaelve havemiddot
notg8D8nally tuDcU0Af4tOach1eve tbi810al pUblic
health departaent 11) prond1q prev_tive services and
$1Ch trea~t activities aa are involved in venereal
disease or tuberculois control have in general avoided
1Dvad1Ds the curativedoma1Dotprivate mediCine Th1s
haa even been cabullbull1DareaawherelI~cal care is not
readily availa)le except throUlh hoepital outpatient departshy
lDent8~ Aa he 81IIet mothealth departaaents have tailed
to proVide an adequate _try point for the patient 1Dtothe
diapoatic and curative a bull t of tile health care aystell
This may be particularly true tor the pOOr patient who may
9
b_dloallYUDaoptdatlcaW4lberefore th past decade
babullbullbull~ bull lIOYeaeftt to evolve DfW torms ot health care
and new types ot health oare institutloDS providing
comprehensive oDlOiDI care rather thaD trapented care
There seems to be little dispute in the health
aboe requ1res both an lDtesratloD ofprev1ously uncoo~
ditultec1 health care ervlcbullbull brlDSins tolether into one
alency what Johnaon (21 p362) reterred to as bullbullbull the
concepts ot cOllPrehms1veIled1C1ne andpos1tlve health
andaporpph1cclecctrailzat1on ot ervlce dellvery
he NatlODal CoimD18810D0D CouD1ty H_81th Services
report Health Care gilitis (26 p37) suggests
proYic11Dl compreheDaive health care services by centrashy
llz1Da a varlet ot publlc and prlvate healthcare
tacllities 1ntohealtb campuses However as Kahn
(22 pp274) states amppeskin ot soclal servlces in genshy
eral bullbull bull if the loal ls to develop a service-delivery
approach that improves access taclltates teedback 80 as
toadapt to user preterence8nd prlorlty and maximizes
case 1nteptatlon aDd accountabl11ty the base of the
total 80clal service system Should be tnthe nelSbborhood
Dec~tral1zatloD not only makes services IIOre accesslble
but allows therv1ce to be tailored to the Deeds of the
10
areaDe Diaz (14 p3) indicates the importance of
being aware of groups in the neighborhood with special
health problems such as elderly people or large families
witb yOlmg children This means that it is important
in planning to be aware of the demographic features of the patient population This will be considered more
thoroughly inPart II of this report
Kahn (22 p275) continues however to indicate
that more than the improvement of service usage is I
involved in decentralization and that decentralization
ot service delivery also represents part of tI a general
search to break down cities to human scale for some
purposes on the assumption that people find it easier toshy
relate to a neighborhood orsection and to its populationbull
bull bull bull Thus the organization of services at the neighshy
borhood level bas the added purpose of contributing to
the search tor neighborhood n He adds that this process
i8 more relevant it there is a measure of local control
over as well as local availability of services
Kahn indicates that decentralization is not a
viable goal in some circumstances These include situashy
tiona in wh1chthe need for a particular service is too
TJI t
-
11
little to justityits proVision in a l()calun1t where
skills or resources are too rare to be provided locally
or where the costs ot decentralization vastly outweigh
the benefits He Visualizestheult1mate emergence ofa
h1erarcb1c81 patternofserv1ce delivery tnwhichcertain
services andresp0D81bilities are middot1ntegrat8d1Dto the
collimun1ty at thelooal level Other more specialized
services relate to larpr un1ts of the colDlllUD1ty such as
eomb1nationa ot neigbborhooc18 Veryspecialized services
are to be delivered at city countystateop regional
level8 fh1slevel would al80 be the seat ot prosram
coord1zaat1on staDdardprotection and evaluation 811
of which call for cons1deZable centraliZation for overall
program adm1 nlatrat1on(22 p275) AlthoughKahnt s
model was not developed specltlCally tor health care services 1t1s quite relevant- and appliCable to health
care service delivery systems
Omiddot Donnell (27 p3) reviewing the 1iterat~e on
service delivery and social action through neighborhood
service centers preseJJbB a list of characteristics
generallydesirable in ~eighbOrhood service delivery
centers Firsthe states that the center should be
accessible It should be in a physically convenient
location and should be open evenings and weekends as
well as providing at least em~rg8ncy telephone coverage
t
~ II
12
24 hours a day
The center should als~ be irDmed1ate in 1ts funcshy
tioning That is the centermust have the capacity to
provide prOmpt efficient service and should be able to bullrespond to problems middotwithout long hours ofwalt1ng and
many rounds of apPointments
The centexsservices should be 6omprehensive liThe
center should offer a full range ofusable oil-the-spot
services or easyaccess to other resources by available
transportation It should gear itself to the needs that
peoplehaV8-especially poor people-and provide for the
slmultaneoushar1d11ng of problems were possible
SerVices should 8180 b 1J1tegrated and coordinated so
thatseMces can more effectively be provided
The operation of the service center should fInally
be responsive to the needs and desir-es of the neighborshy
hood It should provide ways in which reSidents can
shape th~ program and continue to contribute to its course
and development It should be relevant and ready to
respond to changing needs II
The concept of the comprehensive neighborhood health
center developed by OEO (31 p324) has been described by
severalwriters Yarby (37 p73) describes it as an
outpatient racility which has certain def~n1te characshy
teristiCS middot1 Accessible to a poPulat1on concentration
bull 13
2 Open 24 hours a day seven days a week 3 Family-centered c~e by a team of lnteniists pediatricians clinical and publichealthnurses and social workers 4 Availability ot frequently~requ1redspecialist in such fieldsaspsycbiatryobstetrics gynecology surgerY5 Con~1nu1tyof doctor-patient relationshyship 6 Family records with social and medical ~raquomDaries of relevant information about each family member 7 Basic diagnosticlaboramptoryand x-raytacl1itles and drugs and biologicalsavailable atthe center 8 Directline (1)y center-controlledambushy
lance when-necessary) to ateach1nghospltaifor cl1agnostic ~d therapeutic servlcf)srequiring the fa011itlesandpersonnel of thehospltal 9 Patient-cantered and eommUn1ty-oriented -
The range ot services in the comprehens1venelghborshy
hood health center shouldbe as complete as possible
inCluding preventivediagnost10 treatment and rehabi-
litative services and Sbouldbe deslgnedto eliminate
episodioandfragmented services (31 pp324-325) Schorr
and English (33p291) add as additional characteristics
ot the compr8henslveneighborhood health cent~r that it
should ~ve intensive participation by and involvement
of the population to be served both in policy making and
as employees and that it should be fully integrated with
the existing health care system The Office of Economic
Opportunity (28 p63) stresses the potential for easing
health manpowershortage$by trairiing local neighborhood
reSidents as non-professional health aides at the same
time creating new job and careeropportunitles As
14
Gordon (16 p bull 422) indicates Many of the outstanding
problems in medical practice todayrevolve around
effectively motivating the patient and the prospective
patient to be concerned with his health This is
especially true in a deprived environment The community
health center with its technique ot consumer partici
pation maybe a way to create this cooperation effectvely
It is important to note at this point that the
comprehensive neiShborhood health center haaas its
constituency an integratedmiddot community r~ther than a
particular segment It should haveas Blum and Levy
(6 pp~5) indicate a horizontal rather than a vertical
relationship with the commuriitybull The vertical relatlonshy
ship they state is characteristic ot those service
organizations wh1chapproach the community only in terms
of their own fUnction Tbey see only their relationship
with the users of their service and assume that problems
of accountability will be handled by these consumers
However they pOintout this ienot likely as a vertical
approach creates dependency onthe institution Agencies
in a horizontal relationBhllp recognizetha1 they have
both acommunityand a consumer to serve The horizontal
approach places the matter of accoUltability on a broader
basis than just the involvement of the consumer De Diaz
(14 p4) speaks otthe need to ~develop a community
facility which difters from a clinic for low income
1ji ~
15
people in that it should serve an economically integrated
community The reason for this is that a wide variation
of consumers may assure a better quality of care
The advantages of the comprehensive neighborhood t
health center over traditional systems of providing
commuruty health services are numerous Hospital outshy
patient departments a major traditional source of ambushy
latory health c8refor poor patients have been indicted
for neglecting preventive health care ~romoting fragshy
mentedeare and subjecting patients to degrading and
impersonal conditions to mention only a few of the major
defects (31 p324) Another defect has been the
tendency to shunt low income patients back and forth
between different cliniCS often at different locations
arid with differel)t open hours for different treatments
or tests in regard to the same lllness(26 p63)
The comprehensive neighborhood health programs that
have been organized present a great variety of organishy
zationalpatterns one area of difference 1s in the
emphasis placed upon making each faci1ity comprehensive
in the services it provides to the patient population
In the Montefieri Hospital Neighborhood Medical Care
Demonstration program in New York City services have
been made available through a central health center and
two store frontsatellites the center to be the base
bull
Li
l of opratiol18 of ta1lJpIlflicl- ancl the satellite
center the ba of oparat1oDa of public heaJth nurses
an4 nllbborbood amp1 be satellite centers wereto
proVide preVentift tutaltll bullbulln1c1-m1zaticms w811shy
baby care per1od1c ~ectiland tJle central health
center to proViAle care tor illnes If (36 p299)
bis propWI VUDOt ~ttullytunct10DIDI at the t1JDe
it d1cu8ae4 18 tbe Uterature aDd all aernce Were
be1Dl provided 1D_~terBowever itwould ae
tbat the ntua1pro~ as aY1ioae4by its plmmers
would boclJ aoaeot bull 4efeot~ otthe current lud1cal
ccde teaIt pObullbulllne_t coorctJl8td admSDtshy
etration eD4 well 4eftlopecl refelTal procedtlreacould
1I1a~ thecOllDeCticmof t~_t8 withappropr1ate preTellshy
t1 aD4 therapeu1ampcaen1cbullbull aV81lable 111 diffrent
locationa Bowner tile barrieraottiaeaDdUatanc
between center and truaraUon tor the UDSopb1aticated
patieatlook1Dl tor 1her1~pJce too tor ~1CU-
larhalth serfplusmnQewoGl4~to JJa1t tbbll1ty o~
tb18 ~811D to provide iaaiYCOliprelleU1P18hboltleod
health servicebullbull III tactmiddot tappeareto coDtlict with
tbepro own taW cOfdotpro-1~a tam1ly
mecl1cal careprogru 111 wIa10h pre-teAtlYe aDd therapeutic
health erY1cecan be proY-lW to all IIl81Ibers of
tamily in the coure of aaSDll vi8it (36 PP301-3(2)
Dle Delmtr Coloradoprepa11ke the Montet1ori
LI
17
prograJlut111zbullbull abe1rarcJly ot SlDa11 aatellItestations
andlerer IIOreceDtallzedtac11It1es It 41ffers
howeverill tbcolap~81vene80f the services avail shy
able Inthe 4ecentraUzed facIJJtiesIt resembles very
clc)sely the IOdel ~ordecentral1zed social servicedell shy
very developed by 1ahII~ Which was 41sCussed above he
SIlall neImiddotgbborhoodmiddot c8Dt~aw1tb1n walkl distance of
most of the populatiotl havebeendesilDedto take care
of allthenorllalhealth probl of 3000-5000 patJentsshy
check-ups IlzatiOZl8s1Jlpl laboratory testa and
treataentand iaecucatlol18 (d1apeued by phyS1cians) for
IIOst DODCrltIcal 1l11le PatIent 1d1Oneed IIOrespecIal-
Ized care are reterrecttobacJalp facilities BaCkup
support tor themiddot~t1oDa are the tWo l8rsernelshborhood
health C8Dter8~ttr1Dl aCOglete~e of out-patient
serneeaDd three part1clpat1q hoap1iampl bull bullbull which
proVide1Dpat18Dt~t andcoDSUltatlve services
(13 p1028) Intb1a prosrama coaprehens1ve range of
prevent1ve aDd trea1aeDt serric 18 aVailable throughout
the decentraUzed middotta The CoapreheulY8 ReIgbborhood Hea1~ Service Project
otKa1er iC)UDdatlcm HOspitals 111 Portlan4 OreOD 1s
s1ll11arto th DenVer prosraa 1D thata comprehensive range
ot out-patientmiddot services 1D prov14e4 in each of 1ts 10cashy
t1oDa althoUlhmiddotmiddot tbe oentera are larger and l bullbulls DDIerous
than 1nth DenverproPUh (12 p6)
Li i
18
In order that a comprehensive neighborhood health
care center be able to proVide continuity of care it
must have arrangements for hospital services integrated
into th system Yarby (37 p73) as quoted above
states that it 1s characteristic of the neighborhood
health center to be directly connected with a teaching
hospital However De Diaz (14p3) indicates that it
may be advantageous for purposes of service delivery not
to havemiddotthe center affiliated with a teaching hospital
She feels that such anaft11iation may lead to asltuation
in which policies might be determined more by the teaching
needs of a medical school than by the service needs of
the patient
middotThe Nat10nalmiddotCommissionmiddoton Community Health Services
(25 p69) states that such a system of comprehensive
health care integrat1na ~e servicmiddotes of several health
and roedical agencies snould utilize Itas much single or
unified management as possible Neighborhood health
centers have been operated under a variety of auspices
but several writers have pointed out the advantages in
termsof coordinated prOvision of servictts management by
the hospital of the neighborhood health center For
instancethisfac111tates the keeping of unified medical
records of all the care a patient Msrecelved either at
the neighborhood health center or _le hospitalized
(12p6) ~ermore a3 Young (38 p1741) points out
19
direct operationot the u1sbborhood health oenter by
the hoSpital canll8lceaftilable to the center expertise lt bull
in sOlle aapcta 0 Operation that m18ht not be aa readily
available otherwie
Relardlebullbull of wbetberthe hospital and the neighborshy
hoodhealtbcent8r haVe a cOJIIIOaadmjntstration they
IIlU8thaVealTlved at a str1Dsent delineation of IDUtUal
role and reSpoDBlbilltiebullbull All OOIIpoienta ot the care
yst IIlWStQlarify and understand one anothers position
In the syatem and acree on objeCtive ancimethOds
(26 pp16-17p31) SODae areas of iDUtUalconcemare
reterral procedures record keepiDg aDC1 mutual use of
facilit1es statt1Dl i8 anotb8r ~ ot coaaon conc~
Ditt1cultift have u-laeniD the pastiD cOllprehensive bull t bull
healtbc~ prosraumiddot 1d11ch were batil plauned in wb1ch
all of the health canter phy1C~1IDa did DOt bavetatf
privilege at all ot thebackuJlhospltala (29 p21)
SUch a8ituat10n i8 1Dampcceptablelt inpatient care i8 to
continue to be p4by the pat1eatmiddot health center
physician and it cont1Du1ty ot care 18 to be maintained
Hoapital and health center1lUSt laav 301nt responsibility
tor the recruitaentot physicians
VticlentU IPan BJcNrcu Much otwhat haa b8ea sUd has stre88e4 at leastmiddot
iJlplicit17tbaD8ed tor tM etticit middotprovision ot8emcea
20
There appears to be two aspects of efficiency which are
discussed by writers on the su~3ect of the comprehensive
neighborhood health care centef one of these is the
need to organize) services to make the most efficient and
economical use of scarce medical care resources The
other closelyrelat8d in realIty is the need to help
the public use services in the most efficient manner
The comprehensive neighborhood health center concept
1s lhherentlymiddot efficient in that preventive curative and
rehabilitative health ~are programs are coordinated under
one roof with integrated a~stration Furthermore
theempbasLson prevention health education and early
disease detectionis eftic1ent troJll~estandpoint of
the health care system as well as beneficial to the patient
(18 p760) HQwever ~ue tothe scarcity of health care
personnel thecoiDprehensive neighborhood health center
mustbe an arena tor eXperimentation with new staffing
patterns~ The Kaiser program is indicative of the way
in which health care systems must begin to operate in
that appropr1ate ancillary personnel are used Wherever
possible to perform functions that do not need to be
carried out by the physician As Saward (32 p42)
states
1hroughou10ur organ1zat1on~ there are many of the customary experiments be1ngmade-shyJse of speciallr trained nurses for well-baby care under the SUpervision of the pedi9trlcianexperiments with routine prenatal care by
w ~
21
middotSPC1a1l~t~JlUrbullbull per8ema_1 bullJmdlJleu y our fuDotlou are auoh that DOtb1Da 18 dorutbYtbe phY8iCianstbat doe DOt vet to be done by the
phys1c111U1fhe other aldlle4 person- Del-nurse middotreC~0D18t the appo1ntshymeDt center or clerical praormelshyaremiddot there to free h1amiddotto use his spec1al sk111
Awell lmoWn treDd1D the area of eaaiDI health
c8re JII8DPOY8rShortagjs bas middotbe thetrend toward tra1nshy
1DB poverty area rea1deats as DOD~pro~eaionalmiddoth8lth
aide and nepborboocl health workeramiddot (28 p63) This
bas the effectofmiddotmiddot1J)creaa1q II8DPOWrand 8180 can help
bridle the cuJ~ cap betweenprondera and colllUmers
of aen1C8s This attarD at least tlleoretically
createa a situation 1D WIa1ch providers andcoD8Ullers can
be educated to UDderatad OD88DOtber and interactJlore
ettectlvely~ HoWever amiddotpltt8ll has beeD themiddot tel14ency in
801D8 oamp8e8 tomiddot us aidesmiddot ssale8lllcw t~r the center
alJDOatexclwdY811rathertbaD ua1Dltheal to protide the
health care for wh1ch ~ were trained (29 pp3B-39)
1bat ismiddotmiddot vh1~e the a14e Yalue in ~~m1catiDI with
low 1nCOlMt patieata haa beeR recoSD1zed and stressed
their role ashealtb carepersoDDelhil been slighted 1n )
any 1Dstancea
Anotber step 1d11Ob bullbull been taken to provide 8rY1ces
more efficiently eUeot1ftlybas beenmiddot theorgan1zation
of per8ODDeliDto IIllt141sc1pl1Dary teamaaaa means ot
proYid1DgmiddotCOQrd1DatedserY1ce SUch te8lll8 sen_rally
~
hf
~
22
include PhYsiciaQs nursbullbullbullbull soc1al workers and outreach
workers Conceptually th8y fmlct10n to me~ the intershy
relate lled1cal and social needs ot the families sened
Hor there are a number ot barriers to the etfectve
tlmctiOD1nlof lIuchte8ll8 SODieot these are heavy caseshy
loads the inordiDate amount ot tille consumed by multlshy
prOblem tamtliethel1m1ted tra1n1 ngmiddotmiddotand laCk of tnterest
on tile part ot aoae tebers in examinJng aspects of
problems out14e~lr oWn areaaotcolIPetencemiddot and
~ourdcation prc)blell8 between proteasioDala and nonshy
prot81~s (10ppa-10) middotrurtbemOre as De Diaz
(14 middotp6)1nd1cate tbel8 maybe a teDdency tor vertical
dp8rtmental lines of auperv1810nto become paramount
over the team coDamloation syst lead1ngto conflIcts
in determ1niDI the ro1ea ot solie team bers particularly
the DOD-prote81011alaInauch exper1l1enta Witb new
~t1Dlpatterna it 1s bullbullaentialtbat line of authority
roles aDd NsP0D81bll1tlea be made explicit and that there
beJDechaD 8IUI tor relUlar evaluat1onotfunctlorUng
Another way inwb1ch health care sernee delivery can
be made more ett1cl8Dt is to proVide servicea dur1DC the
hours whentbey aremiddot -ostnee4ed As reQo_ded by Yarby
(37p1) serY1ce can bemadelIOre accesslble by making
themava1lable 24 hours a day seven days a week If
rg8l1Cy service are aft11ab1e aroua4-tbe-cloek at ~
nil1iborhood health center the continuity ot tbepat1ent ts
23
careiamaiDtalDedand meatry point into the
cOIIPre~i health care 8 be made available
tothe patient who aoZMllyU8ea ozilymiddot emergency care in
tille of med1cal criais More 8isDificantly ava11ab1-
lity of a tull rase of bullbullrv1c8 tor seVeral hours 11the
eVerlna aI1Cl On ~ prevent the los ot earn1JiSs
involved if th patierat 1IU8tt8cet1me oftfroawork dur1q
the d8y for aed1Cal oare bull his can be an eSpecially
importantc0J1814eration tor lo1aCOlleDUUg1nally qloYEtd
patient aa4caJla18o PIOJIOtet1)e 0Da01Dl use othealth
servicebullbull
exper1eDO ot tbeKa1er prosraa in tb1s~reprdAs
Greenl1clt(19 p10) states wA lllNt 8ip1flcant
proportion ot the abulatory care 8n1cp~Y1dd tor ~
total popUlatiC)U ~ ~ after clWc hours and this
Deed i8 apParenUyaoN prODGUDced tor aJl8d1cally
iDCust population On the other hand the bulk ot all
aabulatory med1cal cu 88l91ce are performed dur1nS
regular cl1D1c hour eVen when services are available 24
hours a dayJ day bull week W
It has ~ the experi8D~eof a ftIDber ot ne1g1lboXshy
hooct hea1tbcentere _t a_jor obstacle to efficient
proViSion ot anicbullbullhas beentbe teD4eDcy of medically
1ncl1pnt patieats to utilize the center oa a walk-in
baais tor epi8od1ccr181or1entect bullbullrv1cea rather than
4)i
h~ ~~f ~~ L
24
to make appoJlltaeata tor ODIo1qprevmt1ve treataent
and rehebl11tat1Ye care ad ampl1O to bave a blah failure
to Show rat_for tbe appo1DtaeDts that they dO make
Atone center 628 of appo1Dtments made were kept
while 3Oottbepati_ta een were ~1n patients
AlthoUP fewer patiets were actually 88811 by the cater
1D middottb1s 1Datance thaathe -bervholuidmadeappointshy
mta the walk-iD patlat required an iDord1nate amount
ot staff t1ae tor aCreeDiaaacl ~trral to pplOprlate
~ttor caregt (9 pgg) Arraquotbr1llpl1catjo~ of the
plOVidedto valk-iD patient by other thaD their
(19 p12)rurtbermore
when patients uti11ze Wlk-1Il er181 centered care
athelr ODlf tona ot ootact with the _d1~ care
ay_ta fUilycentered care the treata_t of tUl11y
bers
a a UD1t 11
dlarupted
hewalk-1Dphenoaaencm appear to barelated to
diUerence between soclal clase in the style of Dlaking
contactJt1th the a11oal C~ay8t As Greenlick f ~
(19 p11)1Dd1oate8 thepheDOaenOn ot INater usage of shy
walk-in ervice by aed10ally middot1Jid11ent patient thaD by
others baa otte been attr1buted to a stoical att1tude
tQward 1llDe8 em the~ ot poor people leacl1D8 to a
~
25
greaterdelay1n tbe k i Dlofa8d1cal care These
patients wppoedlyeelcmiddotcareODlymiddotwIleD tbeirmiddotillDess
becOlles1Dtolerable resultiDSin middotthMr appeariDS withshy
outnot1ce1o rece1ve oareHlwever Greenlicks
r8aearcbbaa cut doubt on the existence ot tb1delay
111 report1Dg middot8J1IPtoJumiddotOfDeW 11laessand seek1ng care
Be bas tcrQDd 1bat s1ll11ar peze_tases of dioally
1nd1sent 8DClJ1on-aed1cally 1Dd1PD~ pat1enta seek care
on the aue daytbat aptou tirstaPPear
1fb11e GrHDllclc 1nd1cat tbat the reasonator the
greatertendeDCY of low 1Do~e pat18Ilta to 1$8 walk-in I
serY1ces are notlcDo1rAmiddotmiddot tbe7 _ be rel~tedto a tendency
ot lower aocio-ecaaaoclaa patieota to preter face-toshy ~
face contacts with II841cal persoDl181posslbly because
such contacts areft coatortiDS an4reasauriDS to
patients who are hJpotbeafzed to bave a dependent attltude
toward IIed1Cal care perS0Jm81 (30 p161)
It a8 itmiddot baa pnerally beenhld the appointment
s1stemts the most efficient Ileana of dellveriDS
comprehenSive oODtllluiDlh-lth care (9~100)1t is
necessary that educaUoraalmiddotbulltfort be taken to proaote the
use ot middotappo1ntaents8DClmiddot tQrec1ucethe fa111re to appe~
ratB4uOatioaalwhlQb baft~utl11zedhave been
IJ
26
1Dten1ews with walk-in patients home Vi8its and group 4i
meetiDp1D8D attemptto1Dierpret1o the patients
the value of rtitgular ppo1ntmentamp andot con~in~
c~1ve care rather than epiI041c care (9 p1OO)
h1s 1safuD~tioD torwhtch nOl~prot81QDal colDlllUD1ty
YOrkersllaY bebe~r8U11ed tban other statf H()wever
euch aD ~ucat1oaal propul __~ ~e related to the senUiDe
capacity otth health oenter to provide comprehensivebull gt
ervice8 to1tpat1_t~odoD aD app01ntment bas18 It
1amp pos8ibleo~rw1 tor educa110Dal ttorts to result
LD a~8JImCl tor ltPP01ntaen~8 at a ratewb1ohi8beyond
the capacity ot thee_tar to t without uareaaoDably
1_ wa1t1Dlprio4a QOBt1nuad use Ot the center on a
wallt-in bU1 _1tbeoosiItpos81ble to et an appoint-
met anc11nCreued pit1entcoJaplampia1a bull Therew111 of
course always be a need and demand tor acute ep1so~c
Care -ci the health centerDlWlt be planned with the capashy
billty ot bullbullbullt1D8 tb1aneed wh1~ cont1Du1nI to stress
aDd educate the patient to utillze oDlOinI comprehensive
faa11y middotc~te~d Cflre (9p 100l
att g4 CODClva1opa
In order to bea4equate any coJlltemporary health care SY8tem muat bullbulletcerta1D interrelated criteria he
IJ
27
minimum criteria areaccessability of services to those
who need them compr8heX1siveness and appropriatness of
services and efficIency 1nthft utilizat~on of SCarce
health care personnel and resources The scareity of
pex-sonnel andtbe need for h1gh quality ongoinghealth
care services
aJIlong the
populationdemanci the most effishy
cientprovision of services
Services must be made accessible to the population
They mustmiddotbe geosraPh1cally accessible to remove the PhysicalmiddotbaTiers betWeen peopleandthem$d1calcare
system They mUst otter their services dur1ngthe
hours when people can make the moat use ofthemA~ it
makes little sense to concentrate services geographically
where they will not be uSed to their fUllest extent it
also is wasteful to provide serv1cesonlydur1righours when
many people are employed his not only presents a hard
ship middotto the consUmer lnrt wastes resources if for instance
the unavailability of preventive services during the hours
when people Can use them causes a need for treatment
services later on
Health carbull sEtrvices must be comprehensive including
prevention treatmcmtand re)abimiddot11tation Ambulatory I
healtbcare facilities wh1cQ are orienteciexclusively
toward either prevept1on or trea1mentare no longer accepshy
table for they are lneft1c1entln their use of resources
and in their prov1s1on of health care to the patient
w ~~
28
If prevent10n1s notmiddot stressed treatment serv1ces that
could have beenavoidedY1l~ be required If prevention
1s the sole focus of the health care facility sick
patients who present themselves must be referred elseshy
where for treatment andsllch referx-als may be taken as
reject1onsor not followed through with until illness
becomes unbearable
The instltutlontbat meets these requirements Is
the comprehensive neighborhood health center It 1s a
local decentralized outpatient facilityprOVld1ng a
fUll range of ambulatoJY health care services It has
a linkage to ahospitalbackUp facilityforlnpatient
treatment and hiihlY apclalized outpatient care
The neighborhood health center must be a fac11ity
planned with an awareness of the needs of the conSUtller
and coDitnUn1ty It must have the r~Ul0urces to provide the
services people need mere they can use them and when
they can use them It must uti11ze the part1cipation of
the community to develop this awareness Not only must
the cen~er beset up to be Amctional for the consumers
but efforts must bemadeaga1n with commun1ty partici shy
pation to help the consumers utilize medical care
services effectively The center muetmake efforts to
educate the community about the valueot regUlar health
care of preventive servicesand of the use of planned
IJ
29
medical appointments ratherthanorisis centered walk-
incare Therealit1es of the existing health care
system have not taught the patient particularly the low
income patienthow to use services effectively
The helthcenterilUst also bea laboratory for
experiments in easing the health caJepersonnel shortage
and c60rd1Datingcare~ A major difficultY iri-exper1shy
menting with neW rolesis freeing staff of old preconshy
ceptions
CoDlprehensiva neighborhood health dare centers have
been developed under a variety ot alisplces including
medicalsociet1es hoSP1talsmiddot(36p299 group pr~ct1ces
(29 p6- 12 117) health departments (13 p1027) and
ne1gbbothoodassoc1ations(14) The literature indicates
somevalues nthe management ot the health center by plusmnts
hospital backup faCility Whatever the auspices many
adm1nistrative fuDctions such as program coordination
standard pr9tectionand evaluation call for considerable
c~tralization of adm1nistration city-wide or coU)tyshy
wide At the same time other aspects hours of servlce
for examPle~ cuI f~radm1nistrative fUnctions made atmiddot
more local levels Each neighborhood center must be
free to adapt its functioning to itscominunity thi-ough
the mechanism otcODlllUl11~ participation inmiddot policy making
Obviouslythe prerogatives and responsibilities of each level must be negotiated and made explic1t
t4~
JJ
BIBLIOGRAPHY 30
1 American Rehabilitation Foundation ~ealth Services Research Center The Health Maintenance Strategy mimeo 1971
2 Anderson Nancy N Comprehensive Health Planning in the States A Study and Critical Analysis Institute for Interdisciplinary Studies American Rehab ilitation Foundation 1958
3 Andrus Len Hughes Comprehensive Health Planning Through Community Demonstration Health Projects mimeo1967
4 Barry Mildred CandCecil G Sheps A New Model for Community Health Planning unpublished paper presented to the American
Public Health Aseociation1967
5 Blum HenrikL Fred Wahl Genelle M Lemon Robert Jorulin and Glen W Kent The Multipurpose Worker and the Neighborhood Multiservice Center InitialImplications and EJeperiences of the Rodeo CommunityService CenterAmerican Journal of Public Health58 (Mar 168) pp 458-468 shy
6 Blum MichaelD and Soloman L Levy A Design for Service Delivery that Reinforces Constructive Tension Between a Health Center and Its (sic) ConSUDlers and Supports Community Power unpUblished paper presented to the American Public Health Asaociatiltn 1968
7 Brielaud Donald Comm~ity Advisory Boards and Maximum Feasible Participation American Journal of Public Health 61 (Feb 1971) pp 292-296 shy
8 Burns Eveline M Health Insurance Not If or When But What Kind Madison Wisco~sin University of WisconsinScllool of Soci~l Work 1971
9 Campbell John Working ~elationships Between Providers and Conshysumers in a Neighborhood Health CenterU American Journal2 Public Health 61 (Jan 1971) pp 97-103
10 Caxr Willene Neighborhood Health Centers Funded by the Office of Economic Opportunity mimeo 1970~
11 Colombo Theodore J Ernest W Sawardand Merwyn R Greenlick The Integration of an OEO Health Program into a Prepaid Comrehensive Group Practice Plan American Journal of Public Health 59 (April 1969) pp 641-650~ -
12 Comprehensive Neighborhood Health Services Projectof Kaiser FoundatioIl Hospital~ Prcgtgram YearE grant renewal proposal mimeo~1971 bull
13 CowenDavidL~ Denvers Neighborhood Health Program Public Health Reports 84 (Dec 1969) pp 1027-1031
IJ
14 De Diaz Sharon Daniel Beyond Rhetoric The NENA Health31 Center After One Year unpublished paper pres~rited to the American Public Health Association 1970
15middot Gerrie NorrrianF and RichardH~ Ferraro Organizing a Program for Dental Care in a Neighborhood Health Center Public Health Reports 8 (Aug 1968) pp 419-428
16 Gordon JeoffreyB~ The Politics of Community Medicine Projects A Conflict Analysis Medical Care 7 (Nov -Dec 1969) pp 419-428 shy
17 Greely David The Neighborhood Health Center Program and Its Implication(3 for Medical Care H~alth Forum of the Welfare Council of Metropolitan Chicago (mimeo) 1967
18 Greenlick Merwyn R Newgtimensions in Health Care American JOurnal of Pharmacentical Education 34 (Dec 1970) pp 754-4
19 GreenlickMerwyn R Donald K Freeborn TheodoreJbull Colombo Jeffrey Abull Pruesin and Erne$t W saw~d Comparing the
Use of Medical Care Services by a Medically Indigent and a General MemberShip Population in a Comprehensive Prepaid Group Practice Prosram II unpublished paper presented to the AmericanPublic Aesociation1970
20 H~tadoArJiloldVMerllYll RGreenlick and TheodoreJ Colombo Determinants of Medical Care Utilization Failure to Keep Appointments unpublished paper presented to the American Public Health Association 1971
21 Johnson Richard E and Merwyn R Greenlick Comprehensive Medical Care A Problem and Cballengeto Pharmacy ff AJilericanJournal of PbarmacenticalEducation 33 (Aug 1969) pp 361-367 -
22 Kahn Alfred J Studiee Social Policy and Planning New York Russell Sage Foundation 1969
23 Kotler Milton Neyhborhood Government Local Foundations 2 Political~New York The BobbsMerrill Company 1969
24 NationalCommisaion on CommunityHealthSfrvic~sActionPlanniriamp for Community SetithServices~ashington p C Public Affairs-Press 19t7
25 National Commission on C~mmunity Health Services Health Adminishysration andOrMPization l the Decade Ali9$-d Washington D C Public Affairs Press 1967
26 NationalCornmiesion onqomm1Jllity Health Servicesbull Health ~ Facilities Washington D C PUblic Affairs Press 1967 bull
~ n
32 27 ODonnell Edward J and Marilyn M Sullivan ServiceDelivery
and Social Action Through the Neighborhood Center A Review of Research tt Welfare ~ Review 7 (Nov~Dec 1969) pp 112
28 Office of Economic Opportunity Second Annual Report Washington D C~ U S Government Printing Office 1966
29 Office of EConomic Opportunity and the Medical Foundation of Be~laire Ohio Eighth Report 2l ~ Committee2a Governshy
ment OperatiOll~ Va8hiiiSton D C Government Printing Office 1969
30 Pope Clyde R Samuel S Yoshioka and Merwyn R Greenlick Determinants of Medical Care Utilization nhe Use of the Telephone for ReportiDg Symptons Journal of Health and SocialBebavior12 (June 1971) pp155-162 shy
31 RenthalA Gerald nComprehensive Health Centers in Large US Cities American Journal of Public Health 61 (Feb 1971) pp 324-336 shy
32 Saward Ernest W The Relevance of Prepaid Group Practice to the Effective Delivery ofHealthServicestt The New Physician 18 (Jan 1969) pp39-44 - shy
33bull Schorr Lisbeth Bamberger and Joseph T English Background Content and Significant IssUes in Neighborhood Health
Center Programs Milbank Memorial ~ Quarterly 46 July 1968) part 1pp 289-296
34 Weiss James E and Merwyn RGreenlick UDeterminants of MedioalCareUtilization The Effects of Social Class and Distance on Contacts With the Medical Care System Medical~ 8 (Nov-Dec 1970 pp 456-462
35 Weiss James E MerwynR Greenlick and Joseph F Jones Determinants of Medical Care Utilization The Impact of Ecological Factorstt unpublished paper presented to the American Public Health Association 1970
36 Wise Harold B Montefiore Hospital Neighborhood Medical Demonstration A Case StudyMilbaDkMemorial Fund Quarterly46 (July 1968) part 1 pp297-308~
37 Yerby Alonzo S ttHealth Departments Hospital and Health Services Medica1~5 (March-April 1967) pp 70-74
38 Young M M~ Chatanooga IS Experience with Reorganization fOr Delivery of Health Services ttAmerican Journ8l of Public Health60 (Sept 1970) pp 1739-1748
f or l
II bull 11 Y d
II
IJ
34
ThepurposeOfPart II of th1aa paper1atod1scuas
elected Speclfic needs ofecltlc areas within Multnomah
County A8P01ll~oUt 1D ~ I of t1a1bullpapermiddot Ita nelgbshy
borhood health oare cater IlU8t be a facl1lty plaDlled with
aD awarenes of the neeels of the oODllUller and collllUDity
Part II of this paper nIl Show 80e of thoe speclflc
needs
he1DforutiOD tor t1li Portlon of the report
obta1nec1 troll tbroupout tbe follow1Dl threepUb11catloDS
1gr~e_tiMshylIPrIxaiidOreson JuDe 1963
2 1~_middot_sectSI8e~ected1teai c-ua 0 S 8 e first count coaputer tape Coluab a_lion AssocshylatloD of QoveraMD-8 Jlme 1971
3 Jtu1tDoab County Oreaon BDY1roDlHtlltal SurveyEarly 1971
The JIultDOIIIlb COUDty OrttIOD BDv1roDllfmtal Surley
Barly 1971 1s bull stat1stical report of the activ1tles of
theentlreMultDOIIIl2 CcNDty Health Dep~t during the
year of 1970 Die speclflc 1nd1cs elected from tb1s
study amprejMental aealtll Publlc Health N~s1D1 vlslts
FaJUly ~ Veaereal])1 ~ ~rcul081
Throush tie use of cUrts and mapa ODe CaD roup these i
speclflc ~oea to ahcnr the healthneedsof speclfic I
census trtcta aD4 then the health needs of iarer neIghshy
borhooda 1m4 o~ Uebullbull
Rf)~UP1Dl of areu was accompllshed in thefolloWinl I
JJ ~
35
he MiltDoIliahCountY oregon BDViromaental SUrvey
early 1971 isamp statistical report ot tbeaotivities ot
the entire MultDolllh COUDty Health ])epartiDent dur1nl the
year ot1970 he specitic 1Dd1C8S selected frOm this
aUy are 1Il8Dtal health public healthDurs8s visits
fUl1ly pia waereal elisease aDd tuberculosia
Tbroq11the Wle otcbart aDd mapa aDecm szoup these
specific indic to show the health Deeds ofapecitic
ccmaua tracts aDdtIum th8health neecla of larsr ~eilh-
bOrhooda and co8I13 tlbullbullbull
RegroupiDI ot areas waa accoap118hed1D the
tollOWiDl lIIIIm1er~ A bullbullcifie 1ndex 8selectcl auch as
venereal di8bullbulle or tuberculo8i~ he total number ot
cs was then deterll1ne4 for each census tract Through
the use of the maber ot cRbullbullbull tor a 11Yen cenaus tract
aDd tbe population ot thattractaltrateot1lla1ampmcper
100OOOpopUlaticm wu cleteXll1ned for each census tract
This was ~e to starl4ard1ze the population ditterence
amongOeD8U8 -tracts 1he rate of incidence toreaob
cenauatract was then llstedby rank position on a chart
In rank poition1DI any cen8Wl tracts haviDg equal
rates ot1l1c1dence are assipe4tbe iaDk posttiona
Beeauseot the abo fact tbAt cbarta w111 vary in length
neveltbAtlea eacb cbart will 1Dclu4eall census tracts
inMullnoaah Couaty Atter the census tracts bave been
listed accord1q to raalcth1s list will bediv1ded into
IJ
36 three levelsotinc14ence he three levels are
1~ The upper 14 of1DcldenCe
2 Thelower 14 ot incidence
middot3 The ILld 12 of incidence
Tlles three srouplqa are then used in compiling a map ~f
Mu1tnOmahCountyfor ach apecltictop1cbull TIle maps are
uaefuJliD tbatthey V1suallycoJib1De 1Dd1v1Clualproblem
census tracts into larger problem nellhbOrhooc1s
The 1960 statistical iDtormatloD was Used in a similar
liIaDDr to tbatexpla1Dedabove 1Dthe4evelopaent of a
chartmiddot and map 1Ihow1DI e cOllpampriSOr1 of per capita lncolle
tor ttaCh ceDsua tJact aDdmiddot combiDed census middotmiddottract areas
he 1910 aDd 1960 statlstlcal iDtOrllatl0D was combined
lna map and chart he purpose of this and chart is
to d8aonatrate the e cl1stributloa1DeachceD8U8 tract
and middot1ndlcatbull tuture ace populatlon treD4a bull
When one be middotbullbullbullbullbullHdth ne8cts ot an area and has
declded to establlsh a cl1D1c to serve that area the
physical location otthat cl1D1c IllU8t be consldered In
order to coapreb8ll81vel develop an area cl1n1c one should
conslder thepre88Dttraftlc middot~ytaa an4tranaportatlon
systems Thecl1D1cahoUld be located close enoUlh to
major arterlals to giva asy access from the total area
be_ ervecl by this cliD1c At the t1ll8they should
be tar eo away froll thesarterlals to all8Y1ate traffic
CODCell18 andpark1D8 conpstlon By traff1c concerns I
IJ
37
lIlan one lUSt consider thertarro1fne8S of streets whether
streets are oD8--C)r two-way iqres8 and egress to parking
amp0111tie eros tratflC) spedof trattJQ children 1n
ll8a traffic i1lht Vislon re8tr1ctionS etc
BwstraDsportat1onshould alao be central in this area
as maay people ~U f1Df1 1tD8Cessary to use this form of
transportatlon
~e tutqredlopHQt of bull treewa systems should be
c0J1S1dered soastolesen thecumce ofmiddot future roada
cutt1DSotltbe cl1D1c llte line
nrrph1c middotDampta
It is 1JDportaDtto kDOw the demosraphic distribution
characteristics of the oUenteltbat i8 to be served by
localized health cl1D1cs
Acl1D1c which erves8J1 area where1D the prepondershy
ance of persona arecrter 65 years of mayf1nd that these
people rely more on pUblic transportation call for more
home- services and haV4t 110ft ChroD1c and debilitating
types of disorders (b1_ blood pressure poor heariDg and
eyesight) tbaD do8 an area ot a YOUDIer population On
the other hand thL area of older residents may have little
need for family plabDlng cllni08
In order to better ~Ybullbull the 4eaoraphic population
of each CeD8U8 tract the 1970 CeD8U8 iatormation was viewed
and two specific catelOri8 considered These two cat
IJ
38
lori8S woUld be the perc_tap ot population under 19
year of ase and the percentase ot each oensuetractover
65 years of age he 1960 1Dtormatlon tor eaCh tract was
then compared witbthe 1970 intormation and a percentage
ofincreaae or4ecreamp8 tormiddot e~chtract1n each category
cOJlputecland achartma4e By the use of this chart one
18 able to View tJleap populat1odiatr1but10n of census
tract and at the _ t1lle accesa middottrencl Por example
let us choose census tract 601 W see 40-4 otthe
population is under 19 years ot and that ODly82 1s
over 65 years ot middotAtthe e tille the percentage of
youth bas ~ed ODly 1_ intbe laSt teD year whilethe
percentale over 65 year ot middotbas stayedmiddotthe same With
this in mJnc1 ODe ~ 1DfItr libat ol1D1o aerviDg this
area WOuld bellQre conq~w1th the problems of a
YOUQier populat1on and that _ would probably be true foJ
some t1aein tbefuture On the other hand CeDSU8 tract 54
has only 2 ollt population UDder 19 yel1s ot age and
this has decreased by 1 over the last ten years middotwhile at
the same time 32-377 ot the populat1on 18 over 65 years of
age A ol1D1C ___ this area should be or1eJ1ted toward
tbespecttic problema otthe ampledbull
PerCapia __ bY gsa neat
WhaD cona1der1qlooat10D1 tor health cl1n1cs one
shoUld take the 1DC01Ieot areas into consideration Areas
IJ
39
of lowiDcome would not 11kel~be 8erved more by localized
cl1D1cs tbaD would are of hilbincome It 18 likely
people haYiq a hip iDeoll8would preter to be aeenby a
chosen ~r1vatephylc1a1l tban at a local cl1D1cwhere
10Dier waits y beraceaaampryand leas personal attention
gl_
The 19701ncOII81atoWampt10n tor MultnomahC~ty was
not available at the tille thi8report W88 made The 1Dto~shy
tiOD Was taken ~adtro tbe1960 census publlcation
his woUld ~8Il thea tbat ral1I8 OD the chart ynot 1raquoe
completely accurate hi writer telthatthe areas most
affected by tb8 1I8eof the older 1Dco1DtOlaat1oDWOuld be
those tracts wh1ch baYebad a rapid 1ncreaae1n populatlon
over the past tfmyHr8 bullbullbull tracts would include tracts
nUmbered 104 9897 96 aDd 95 be perc~ita 1Dcome
referredto1il-tb1a Paper18the lIean 1DCo per person per
census tract
Attar the iDeoeper census tract was listed on a chart
a map was de 1D41catiDg those census tracts belonging to
the lower 14 ot income tor all censue tracts in Multnomah
COlDltytbose beloqins to the upper 14 ot income tor all
census tract 111 MultnolUlhCounty and those belonging to
the mid 12 ot 1I1coaetor all oeuuetracts in Multnomah
C01mty
In yiew1Dg the _p 1t caa be seen that the low income
area seautotollow aloas the at aide ot the Wl1lamette
IJ
40
R1ver the full length of Kultnomah County A second low
income area follows the south edge of the Columbia from
the northwest corner of Multnomah County easterly to 148 St
A third problem area seems to be on the east bank of the
Willamette River with the Union Pacific Railroad being
about the center of this tract The extreme loutheast
corner of Multnomah COUDty appears to be a low income area
but as this area bas bad rapid grouth in the last ten years
this could be erroneous
Mental Health
be first ~ecific indica to be selected from the
Multnomah County envirollllental survey of early 1971 and
to be considered in this paper i8 that of Mental Health
At the present for mental health purposes Multnomah
County is divided into five catchmentareas with a mental
health cl1n1cin each area These clinics are Model
Citles Delaunay ADkeny street Office Hansen Health
Building end Southeast Clinic
All lIlental health cl1n1cslcept statlstlcal information
on all patients visiting their cl1n1cs this included the
address of the patient hese addresses were then listed
upon the approprlate C8D8US tract Each census tract was
then ranked on a chart according to the nUllber of mental
health patients who reslde ln thatCeDSUS tract attending
any of the above listed ental health clinics This chart
IJ
41
wasttum d1v14ed1ato proper quartile bbullbullbull
quartile vereUs to dne10 u appropl1ate Multnoh
County _tal health ItLa middotmiddotmiddotthelipO~a1bl by lOoJcJIUE
at the UDtal health _to uteN1De which ueu have the
lars-t use otCOllDty 1alh~th faci11t1Rot
1Ilclu4ecl 111 tbia woUld tber otpeopleYia1t1Da
pr1vat patch1atriata aDd pr1_t _ntalhealtb cl1D1c8
WheDtbe M1 18Yienclmiddot Itmiddotmiddotmiddotmiddot~middotbe~_ tbat ~rtt
appears to lMt fourmiddotmiddot-al are iii _oil the nuaber ot
lIental healthcl1D1c na1t toM tbjh1sheat 1he
tour areaa woUld be tollows
1ttrea Ore to~Blo Drimiddot ~tb Burrus14e aDd tIMtmiddot Colb1a Riftr H1gbwyaeri1Dla th nortllra boundaryshy
2 bull ProII 82D4 1_~ 10 20th streetwitil the ra1lMd Mu the north ltouadary
3 ~ et et tUgl_b1bull MYel froamiddot the Clackaaa COUDty l1ae aorth to Dln8lon stret
4 beDOlvt1ttfe-t ~efllt4 COatytrca Jle1aware streetmiddot toR1C1a11oDd wlth Colubla Blvd heiDI tbAtnorth bouaclary_
It ODe coapareatbiap to th iDeobullbullmiddotp 1t can be
eamiddotthat lIOat ot the c tracts baY1Dg bllh v1i11tatlcma
middottfl public tal health cJ1rUc8 ~ 111 t13e low ~ aid
1DcOile SroupiDIOJa1y of til 25 tracta llsted as
haviDlbip aental Maltll nlltatlou are ~ the1g60 hip
iDeo arebullbullbull
17 Plpn
42
amily PlellnSDI ]Jlce Metal Health i8 an 1nd1ce of
use Theperson 111 ordertobavebe_ 1Dcluclecl 1n this
atu4ywouldhave tohaft Ue4 ataa11y plaDI cl1D1c
tacilities of soaetype It 41fter troll tile _tal health
study1nthat i t1Jicludestatist1catrollbotb public and
privateclJD1os
The iDformation tor the iak orurcbart 8Dd map of
t8ll111 plenn1 na ob1a1De4 by cOIIblnlDlthe mabel of
1rlcuv1duals bullbull_ attbe tbreellUltrampo-ti Coatyhll11y
PlalJQllIl C11ll10s 111til tbo at the Planned PareDthood
Association CliD1C8 be tbree -JIultDouh Couaty r8ldly
PlamSq Cl1D1c are Solrtbweatth Col_bla 1111- a114
HaDsell Health BWlcl1Dl CllD1cbi middot1Dtormat1oD vas then
bullbullbullesed tomiddot detellWMt l10w people troll eacb c8IUIUS
chart wastben Mele IUs oIIart jn 4iY1ded to show
the censuS tracts lIaYiDlmiddottIle h1t1iest qUart1le of incidence
of use lowest quartile of 1Qc1deao ot use Jlid 12 of
incidence of Wle an4 a map sprepared troll thts 1Dto~
mation
The C8U118 tractsbelOJISnl to the h1lhestquartile of
use appear to be 1lO~ 8catt~ on tbipwas true ot
either the _p ot aental health cl1D1c uaageor ot the map
abow1DI per capita 1I1COM Iaere40 to be three
d18t1nct areas of UIIaP beJ woul4 be
1
IJ
43
t10D of BurD81cl and the W11lallette River 4
2 S~t Portland 8Otth otmiddot the ra11shyrcaadand alona the W11lamette River
lIortbeaat Portl8D4 between MisSiss1pp1 and 24tbStreet the northbouBclary be1DgColwb1aBlvd
Pylzl1c BMltl IrpI Y11ta
Publlc Healtil nur81D1Y1s1t nclud8 an vists to
theholles of client by PubUc Health Nurbullbullbullbull his shows
visits to bull f8Jl1ly fer aDY purpos SUCh aatuberculolJ1s
het1Dl tem1tyaeatalu4 8IiOt10D8l cODd1t1ona etc
he atat18t1C~ 1fele C()4ed accord1Dg tomiddot the 1llli301fOCUS
of the Y18lt tt doe DOt 1D41cate the Dmlber of holies or
f8ll11lev181tecl or 1D41Y14ual Y1a1ted more tban oDcein
the propwl It dobullbull I1ve 80M 1D41cat1on by coaparlshy
OD ot the 8JIoUDt of aedlcal problema 1n eachcen8WI tract
Ap1nmiddot the _p abowa 8 scatter patteraof probl_
areas althoUSh there appear to be a sroup1Dl of hiSh J
l8aIeccmaus tract 1ntlut extreme southeast part of tbe
County other areu uIriaI any nura1Dl contacts are
1 bull he 801lth-oa-al CO1Dty on eaCh 814 of 82nd Av from Clackallaa County north to Dinloa
2 ear bullbullbullt 814e aroUDd Preacottand Misaisippi
Dowatom Bunul14eonboth 1de of the river
44
V_real Pis The iDfomatloil uaec1 to tabulate the Venereal
disease chart includes all the ooab1ned case otmiddotODormea
and syphilIs reported by bothmiddot publIc and prIvate physicIans
dur1nl 1970 There were 3602 caes ot IOnorrhea reported
dur1nl 1970 While ODly 17 cabullbullsot ayphilimiddot were reported
A chart was prepUed aDd att8llPt wasmiddotmiddot de tomiddot
determ1De Wh_therVttDereal 41ease was more p~vaJent in
areas othigb or lowmiddot proportIon ot youth hi waadone
bymiddotdetemlna a 1leaD prceiltacmiddotmiddotmiddottor the population ot
resld~ts UDder19 years ot (34) middotA mean ratemiddot per
100000 popUlatIon al80c1ttem1Ded tor the middotoccurreDCe
ot venereal dieae This was et at 390 oass Areas
hav1nl a population 1n which leiS than 34 were lmder 19
years ot ampIe were called low- yOuth abOve tbl percentaae
hiSh youth The aaa waatrue ot the occurrence oivenershy
eal disea_ per CeD8UStract It the rate waacomputed
as 1I0re than 390 cases per 100000 it was called hiah
venerealdiaeasei it less than thia tisure low venereal
disease It was tound that 1D Multn~ COmlty there sems
to be poSitive OOlatI0n(x21S19gt between low youth
and hipmiddot venereal diseaand hip youth and low venereal
diseasebull
RaDk ordr Iitot all c traot middottbAm made
Th1s was done byt1Ddlna the ratepr 100000 populatIon
of venereal disator all census tracts in the County bull
45
These were thenlisted from h1lhto low (sreatest to
least) in a rank order The l1sting was then divided
into Upperandlower 14 aDd listed on the MUltnomah
Countymiddot up
The areas of b1gh venereal disease se8ll18to
roup thBl~8 middotin a very tllht area ~oq both 1des
of thell18l8~ R1 w1th BurDaldeS~et being
~bout theceDter qf tbi8IZ9uping This area woUld
appear to be m ldeal spot for the denlopment of a
locallzed venereal d1sbullbullbullbull cl1D1c
UbepoundCUlO1s
In this report bull tube1C1llosls caS8S refrred
to include alltbobullbull cabullbulls ontubercUlo8is follow-up
rather middotthan just new C Accord1Ds to the Multnomah
County Health SUrvey of early 1971 this would include
all ca repOrte4 over thelaat three years The
total number of tuberculosi8 cabullbullbull usedin this study
was 666 lh1 included 128 new cabullbullbullbull
A rate per 100000 of tuberculosis for each
census tract wa- then computed and the c~us tracts
listed by rank order be b11h Qartlle mel low
quartl1 were then reoordd on a Multnomah CoUnty map
TWo genral areaa baY1Dg a hip mcldencaot tubercu~
losiare 1D41cated heyare
1 Both middotsld ot theWilla11lette River
Ll -
46
with Burns1de about thecnter
2 he extrea Northebullbullt comer of the County bull
By coap8r1ng the tuberculois an4ven8real
diseae maps ODe can 8ee that the downtown areas ot
hiSh 1nc1denceare alIIo8t 1c1eDt1cal on ach map
This WOuld 1nd1cate that 1t would be of value to
bullbulltab11sh acl1D1c 111 th1aampreatbat would provide
bothtuberCulos1s 8Dd ytmereal 418ase srvicbullbullbull
Thchart aDd 1181gt8 are wsfuln 11v1DI
1Ddicat10DS tor the type aDd placemeototlocal
health cl1n1c8 tbro1qhout tbe MultnomahCounty area
A cOllpar1on of the mapa help one to dec1dewhether
to provide a aulti-8ervice cl1D1c or spec1f1c type of
cliD1c As stated in Part I of thi paprserv1ces
shouldhaYe both treatlieDt and prfMmt10n cOmponents
As he been stated fta ne1lbborhood health care
Qenter muat be a fac111tY plazme4 with an aamesa
ot the neds of the consumer and the c01llll1m1tybull
Part II of this rport haa been an attaapt to indicate
and clarify 8011 ottheae coDlllUDity neds This has
been done through8elect10n of apc1f1c problems
The indic were then visuallyrecorded through the
use of ups and charta ODe dan asseS8 thedsreeof
1DIportance of certain concems to spec~t1c areaa by
comparinl the chart aDd maps Prom this oDeean
41 dec1de which are48 vb1chcUD1c-or indeed if
the need a clinic at all However further factors
should be considered hebullbull include
a The amount of fuDd1 available
b What 18 the percentage ot peopleineoh ceaaua tract tbat would actually us such cl1n1cIl
c Wbat 1 tbeco--1tymiddot 8 IeeliDashyreaardtDI particular cl1D1c8 Would this dcrebullbullbullmiddot the ettctiveness ot thse cl1n1ca
IJ
li
D_OlraphicPopulatLon Challie 1960 to 1970 48
Cen8U8 1 of Pop 1 Cbaqemiddot 1 Change1 ofPopTract Under 19 Yr8 Over 65 Yrs1960-70 1960-70
middot1Q701Q70
1 319 -12 171 -H) 1
2722 215-27 +68 301 366 -22 127 +35 302 371 +19 111 -04
311middot401 144-41 +29 402 321 13~7-39 +24 501 356 124-08 -02 5~O2 351 133-23 +12
405601 82-10 -02 394602 103-01 -06
701 275 149-76 +56 702 361 +01 121 -07
+10middot801 326 140-22 802 321 middot127
(
-29 -03 9~01 342 124 -H) 6-18 902 294 128 -H) 3-24
10middotmiddot -14312 140 -17 1101 182 +25 -23197
2411102 186-59 +29 1201 226 169-17 -41
31middot01202 +11 182 -05 295 -H) 81301 208 -H) 4
1302 331 +08 197 +04
14 323 +15 middot185 -08 middotmiddot15 329 +16 16~5 -13
-28middot 1601 332 131 +12
1602 356 98 +24middot-39 middot3101701 161-33 +21
1702 370 -15 85 +02 +19 1801 264 151middot-50
185middot1802 256 +47-58
IJ ~
D_raphlc Population Change 1960 to 1970middot 49 (Contd)
4io
Census Tract
of pop Uncter 19 Yra
1Q1n
1Cha1l8e 1960-70
of PopOver 65 Yra
lQO Change
1960-70
19 389 +29 141 -24 20 223 -13 206 +18
21 227 +08 194 -36 2201 356 -27 112 +05
2202 290 -18 ll~9 -29 2301 356 -03 154 +24 2302 260 -37 245 +97
2401 410 +6~1 123 -31 2402 163 -80 320 +99 2501 381 +13 140 -01 25()2 237 31 lil +02 26 343 +25 186 +149 2701 370 +29 1S5 -01 2702 249 -44 304 +98 2801 337 +19 187 +09 2802 306 -10 156 +31 2901 304 -38 142 +24 2902 i 307 -32 146 t3~9
30 29~0 -48 16~2 +51
31 355 +30 160 +01 32 370 +48 148 -13 3301 395 +45 130 -20 3302 368 +06 138 -02 3401 386 +16 117 000
3402
400 +32 92 -26 3501 304 -07 115 +35
3502 344 000 140 -13
3601
36~02 357 -04 132 +32
3603 30~1 42 149 -67 3701 342 +28 152 +19
1
IJ
Jianolraphic Population Chan 1960 to 1970 50 (Contd)
Census Tract
of Pop Under 19 Yrs
JJl7J
middotChanae 1960-70
middotofmiddotpop Over 65 Yrs
1c~7n
Change 196070
3702 409 +39 122 -11 3801 308 -11 151 +29 3802 275 -35 180 +46 3803 282 -32 192 +54 3901 376 ~13 100 +17 3902 296 -03 177 +29 4001 438 -11 84 +13 4002 353 -21 115 +20
4101 397 11 9middot0 +11 4102 346 -19 120 +03 42 331 +19 11 bull 3 -16 43 347 -72 105 +31 44 113 +84 183 +154 4S 33~9 +07 110 -06 4601 2501 22 193 +38 4602 332 +59 126 -29 47middot 161middot 000 211 +01 48 103 -26 302 +59 49 138 +1 bull 3 252 +09 50 141 -26 204 -12 51 12 -39 257 +07 52 47 -61 351 +48 53 89 +49 314 -30 54 25 l1li15 327 -17 55 131 -17 115 -121 56 198 +93 227 -47 57 71 102 189 -88 58 240 ~middot41 16~1 +55 59 322 +25 142 +06middot 6001 264 95 132 +50
6002 328 -31middot 89 +07
JJ
Demographic Population Change 1960 to 1970 51 (Contd)
Census 1 ofPop lChange of Pop bull ChangeTract Under 19 Yrbullbull 1960-70 Over 65 Yrs 1960-70
1970 1970
61 355 -58 85 +39
62 328 39 110 +18
63 414 04 73 10
64 382 -22 72 +04
6501 383 02 67 -20
6502 329 -56 96 +09
6601 391 +13 88 -03
6602 319 -59 97 +06
6701 327 71 145 +72
6702 331 ~67 83 +1-0
6801 365 -66 49 +01
6802 388 4bull3 54 +06
69 354 -41 80 +23
70 400 -23 68 -06
71 359 -48 72 +05
72 255 -88 82 +11
73 346 -39 91 +25
74 313middot -63 105 +24
75 329 -42 129 +37
76 336 -52 85 +21
77 370 -10 69 +05
78 309 -10 120 +21
79 325 -56 87 +10
8001 358 -81 57 +12
8002 391 ~81 76 +12
81 315 -76 108 +21
8201 403 -23 64 +08
8202 392 23 65 +08
83 357 -34 120 +31
84 402 -18 73 +16
85 413 -06 76 -09
r
Demographic Population Change 1960 to 1970 52 (Contd)
Census Tract
t of Pop Uncler 19 Yrs
1970
Change 1960-70
1 of Pop OVer 65 Yrs
1970
ex Change 196070
86
87
88
89
90
91 9201
9202
93
94
95
9601
9602
9701
9702
9801
9802
99
100 I
101
102
103
10401
10402
lOS
368
351
379
391
391
413
379
433
372
429
414
432
419
439
~32
377
457 420
378 41middot7
345
360 417
417
412
-04
-02
-35
-26
-28
-11
-64
-20
-S9
-39
-32
-21
-34
-40
-47
-lO~7middot
-27middot +04
+56
+07
-34 01
+04
+04
+10
103
128
97
11il3 99
69
79
42
77
46
34 38
44
40
54
111
51middot
81
133
59
74
140
63
87
76
-08
-06
+04
+08
+17
-05
+3S -02
+1~4
+19
+33
-14
-08
+12
+26
+71
+11
-16 -34
-20
-19 +37
-49
-2S +15
NOte The The
Taken frOi
averageullder averageabove
middotUSCensus ---shy -
19 years == 6S years ==
figures 197
32r 13(14
p a~d 1960
--
Rank
1
2
3
4
5
6
7
8
9
10
11 12 -_
13
14
15
16
17
18
Tract
69 46
60
58
- 68
61
302
2501
67
63
19
62
26
94
3603
3902
64
30 -----~-
Rank
19
20
21 -
22
23-shy
24
25
26
27
28
29
30
31
32
33
34
35
36 -
Ranking of Per Capita Income by Census Tract
Tract
65
2701
- 15
1601
701
66
93
82
2903
3602
30
2502
80
2401
81
- 70
91 shy
4001
High
Rank Tractshy
-32shy37
38 97
120239
7840
41 ~ _2_1__ 42 31
43 2501
44 18
45 98
46 37
47 3803
1702
49
48
1602 92 2702
I
50 89
51 901
52 801
Ra_
53
54
55
56
57
58
59
60
61
62
63
64
6S
66
67
68
TractTract Ra~
74692
170196 70 I
401 71 90
72 1037J
79 70273
3802 74 601
24024102 75
85 76 101
77 9023901
7699 78 100 4101 79
3601 I
380180
458140~ t---- _ - - shy83 82 42
888384
59843501
4777 8~
502
Low
802 86
Rank Tract
87 shy
--88
89
90
91
92
93
94
- 95
96
97
middot98
99
100
101
102
103
104
1201
14
49
72
73
43
87
3502
105
1
52
86
71
1
501
10
3301
104 tf
Rank
105
106
107
108
109
110
III
112
113
114
115
116
117
118
119
120
121
Ranking of Per Capitalucoae by Census Tract
(Contd)
Tract Rank
4001 122--shy602
13
1102 2302
3302
55
3401
48
21
56
50
3402
lL01
2202
2301
53
2201
-shy
Tract Rank Tract Rank T~aet Rank
57 I-----
Imiddote
bull
Tract
- Low -k Note Information taken from 1960 U SCensus
Rank Tract
I ~
Ie
Imiddot
~
----
----
--
--
Rank
1
2
3
4
5
6
1
8
9
10
11
i-
-Tract
391 922 921
972 971
100
132 131 121
962 961
822 821 401
982 981
20 111
47 10 1
412
High
Total Number of Henta1 Health Visits
Ranked by Census Tract High to Low
TractTract RankTractRank Rnk
12 182 22 78 29 87 76 381 73181 ~------- 1913 371 8538230162372 271 2616-121 8272 2
14 80~2 31 94 7923 84801 59 15251362 4232 15 52 _ 32 103 8924 651 17240216 652
_ 91 351 33 341 23117 83 122 25 25 48 1123921418 34 shy61 86 661
19 662 6493 81 26 91 8153 49 50 55 41383 71 27 51 3120 90 672241 35shy 104167162 461
I 411 46211121 28 88342 I
2502 36 69 54 5251 50 272
-Ra
37
38
39
_ 40
_ 41 Ishy
I
42 I
-I 43 44
45
shy
Tract
~ --- shy 95 56
45 292 242
102 62 352 291y
92
101 281
99 72 63 601 60~ 42 2201
77 74 61 57
363 232
70
32 31
11 44 282 2202
Low l
- Tract
46 682 681 I 331 30
r~$ 47 1042 332
48 102_41_
11
~
Visits to Family Planning Clinics Ranked by Census Tract High to Low
Rank Tract Rank Tract Rankmiddot Tract Rank Tract Rank Tract Rank Tract
1
2
3
4
5
6
7
8
9
10
11
12
13middot
14
15
16
17
361
56
401
341
48
59 121
20
55
342
10
31
58
93 21
241 132
331
53
461 462
18
19
20-shy21
22
23
24
25
26
27middot
28
29
30
31
32
33
391
32
middot47 I-i-_-shy _ -
231 111
332
972 1
372 371
52
89
32
92
82
100 31
182
30 242
402
34
35
36
37
38
39
40
41
42
43
44
45
42
1714 i 661 221
78 362 2
90 602 601 352
63 251
105 921
971 351
73 42 292 232
411 51
662
81 45 52
46
47
48
49shy
50
51
52
53
54
55
56
961
801
49 81 72 71
19
9~1
172
68 2 57 162 14 112
91 75 681
381 42
3~3
83 161
57 f
58
59
60
61shy
62 Imiddot
63
Imiddot 64
65
66
64 62 36~3 252
74 652 SO 392 291
651 6bull 2
79 271
r-- ---- shy981 222
672 671
821 272
94 87
281
382
67
68
69
70
71
72
73
74
75
76
77
78
981 26 12~2
IS 61
85 82~2 69
61 43
101 86 84 282
76
131
51 72
1041 962 88 70
99 922 77
103
95 802 181
i
~
Low High
RankRank Tract
5479
4480
81 1042 ~) middot102
71 - - + ~ - ~
Visits to Family Planning Clinics
(Contd)
Tract Rank
I
Tract llaDk l
RankTract Tract Rank Tract
~
I
~
J1 ~
Low
Total Number of public Health Nursing Visits
Ranked by Census TractsHigh to Low
TractTract RankTractRank RankRank TractTractRankTractRank
25249 71 79 17249 8033 6586 99189711 84 2915072 34 661 76 66 811519512
402 5035 51 161 2518220 122 1713423 352 55801 7120 6752 2 149814 41236 83 2662 38 94 6821 53 2924015 362 37 32 42 75 69 281 84 63
546 8822 54 222 85 3925431 70383417 3818223 6439 4386652 718 21 55 103332 8924 232 87 19 271729219619 24156 16211140 382 628825 10523110 112 73411 10141-- ----shy 89 363 4457 8126 16111 221 74 9142 90 46158331 53 671279012 46243 48 59 351 3837528 1083 9313 91 5844 59 -_242 76 1----- shy60 272 72 74104114 60145 42 9287 7729 92 6151 8215 57371 934630 91 307762 12113116 282 619447 41391 9531 78100 63 7378 ~95 681 6945 32 5632 798517 6448 47 52 181
High ~ Low
Rank Tract Rank
96 31 132 70
97 102
98 182 372middot 602 651 662
- -shy
~72 682 802
822 922 962 972 982
1042 ----shy
Low
Total Number of Public Health Nursing Visits
(Contd)
Rank Rank Rank TractTract Tract
I
I lt
I
Tract Rank Tract
[
~~~-
I
~
IJilfimiddot ~
j
Ranking of VD Caea According to Census Tracts 61 By High and LOll Youth Itatio
A media~ of 34 5 was determined Any tract having greater
than 34 5~ of popu1tionunde~ 19 years of age -High~
Any tract having l8S than 345 of population under 19
years == Low
Any tract having rate less than 390 =Low
Any tract having rate more than 390 == HLgl4
YOUTH
LOW HIGH
L
0
12 402 1801 1802 343 2801 2802 29023603
54 6001 600262 66~02 72 74 75 76
78 79 81 t02 65 1202
W
(25)
VD
H
I
G
H
401 701 801802 901 902 10 1101 241 1201 1301 132 14 15 1601 1701 20~ 21 2202 2j02 2402 2502 2702 2901 303501 3502 34023801 3802 383 3902 42 44 45 4601 4602 47 48 49 SO 51~2 53 55 56 57 58 S9 6701 6702 73 95
3~02 7021702 19 25~01 2701 4102 4101 63 64601 ~601 6801 680270 7l 77 8001 80~02 8201 8202 83 84
85 86 87 88~ 90 91 9202 920193 94 9601 9602~ 9701 9102 9801 9802 99 100 101 103 10402 105 6501 10401
(47)
301 501 502 601 1602 2401 2301 2201 31 32 3301 3302 3401 3402~ 3602 3702 3901 400140 02 43 61 69 B(
(53) (23)
~ ~gt
Ranking of VD by Rate Per 100000 By Census Tract
~
Rank Tract Rank Tract Rank Tract Rank Tract llank Tract Rank Tract Rank Tract
1 2202 21 S6 40 902 58 1602 74 75
90-shy 64 107 26 --~-
2 3402 22 45 41 10 59 902 75 78 91 54 108 61
3 2301 23 3502 42 2502 60 602 76 6802 92 402 109 87
4 3302 24 49 43 1102 61 501 17 2 93 94 110 90
5 50 25 52 44 6702 62 14 78 8202 94 97 02 III 76
6 2201 26 20 6701 63 4002 8201 2501
9701 41~02 112 91
7 44 27 48 45 401 64 3802 2902 95 63 113 62
8 3301 28 1701 46 502 65 30 79 83 74 96 9602 114 71
9 55 29 47 47 42 66 3803 80 2801 96Q1 115 85 10
11
12
13
14
15
16
17
18
3401
53
2302
2401
57
21
2402
1101
51
30-shy31
32
33
34
35
36
37
3701 - -~ 1201
3702
89
43
132 131
3602
4001
48
49
50
51
52
53
54
55
58
1601
601
4602 4601
69
701
31
3901
67
68
69
70
71
72
2901
801
39021~ 802
6502 6501 122
702
41~01
81
82
83
84
85
86
87
88
19
1
1702
2802
79
93
100 6801 6602
81
97
98
99
100
101
102
103
104
9201 9202
9802 9801
77
302
79
86
72
84
116
117
118
119
120
121
3603
8002 8001
101
99
95
10401
105 10402 103 102
19
20
59
32
38
39
2702
3501
56
57
301
3801
73 1802 1801
89 6002 6001
105
106
2701
88
High Low
-- -----
Rank OrdermiddotTuberclosis Cases by Rate Per 100000 Ranked by Census Tract High to Low
Tract TractRankTractRank Rank TractRaukTractRankTractRank
801
79 9601501411 52 6835340120511 I 960269 903603532036 $-~~F130221542 4366 311301 70 68~013802 _ I- _ 4001_37213 3921201 6802802 H71523822024 22 54 193302 3802 80 8958 I37139535 70155 9801 I60123 72 6702 98023914011016 6701250124 10 56
81 94 401r 7 154152 73 7057 2625 122 92028
90242 162312301 92~158 86 7172434526509 82 79160159 74 100 87412240227220110 6502836960 75 30 8317244 6501782801285711 61 901 42765645 84 66021459294912 9701 660146 171 302 9702 47
6235023033113 85 822821182 917755 16335013110214 841814832 78 103 938564 324815 86 1057940149272 38036523216 10401 87 2902241 725Q 10402360266340217middot IF88 88 9937233 282 51 218 101 01102 46016234
I)167 2901460219 47
High ~ Low ~
- -
TractRank
9S89
6490
8191 8001 8002
63 61 60middot01 6002 44 2701
92
J
2502 402 --- ----shy
I
Rank
Rank Order Tuberculosis Cases by Rate per 100000
(Coutd)
Tract Rank Tract ~nk
I
Tract Ballk Tract Rank
Imiddot
Tract
Imiddot
1~
t 1I i Pi i l I
o
1 -1shyL I
I J
8 40 icO ~ I -lt 0
-t (1) I
i I
r o E
II
a
I
r--i
shy
I
~
I (
Jgt
(011 fi(
Ggt
I II ~j
()
(f 0
~ ()
I
11
f9
r
II 99
o ~
Ggt r
~ __-J~ I t I ~ I
r--J l I
~ _ __ J
) 1
fTl
1gt
r I
()
r
()
lt en -i en
()
I1l
(J)
(J)
-i
P ()
19
r o ~
r G1 I
I
c
~
o I 89
--- -I-shy
r-r I
1- 0 _~ _ _--J E
G1 I I I
i i
I 1-1-1 ~ _J ~2 ~ II
II
()
1 I I I 1
id i bullbull
~
A n 69
r 1shy
- 0 Gl
l--~ ~ I
~ II
II )
I () isect i
en l i
(J)
-t
0
IA Ol
8
sion on ColDJIIUUity Health Service (26 pp 1~20) the
c1evelopmezat of a ampyt of comprehensive health care is
a cOlDJIIUUityw14ere8pODSibilit1 1nvolviDS the integrashy
tion of all the health care facilitie and programs in
the cOlDJIIUUity or the c0arcm1ty8 healthc~ system
the PamprqlOIIlt goal ~
PrQv11~ of a ~rehive ~e 9tcoaaun1ty health aervicea
2 Ma1DteIlace ot aD a4equateqUaDtity ot al~requ1re4 health care facilities
Iritsrat~oDof ~v1c1ualUD1ta and s1steas ot bealth aerviceinto a coordishy
natedpattem ot continuous care tor theindiVidual
HoWYer aYerby (37 t pp71-72) 1Dd1cate the
med1cal and health care 81atmiddotaa it ball t1nct1oned haa
not facil~tate4 the delivery ot COap~usive middothealth
care IDcl1Y1c1ualhealth care facilitie themaelve havemiddot
notg8D8nally tuDcU0Af4tOach1eve tbi810al pUblic
health departaent 11) prond1q prev_tive services and
$1Ch trea~t activities aa are involved in venereal
disease or tuberculois control have in general avoided
1Dvad1Ds the curativedoma1Dotprivate mediCine Th1s
haa even been cabullbull1DareaawherelI~cal care is not
readily availa)le except throUlh hoepital outpatient departshy
lDent8~ Aa he 81IIet mothealth departaaents have tailed
to proVide an adequate _try point for the patient 1Dtothe
diapoatic and curative a bull t of tile health care aystell
This may be particularly true tor the pOOr patient who may
9
b_dloallYUDaoptdatlcaW4lberefore th past decade
babullbullbull~ bull lIOYeaeftt to evolve DfW torms ot health care
and new types ot health oare institutloDS providing
comprehensive oDlOiDI care rather thaD trapented care
There seems to be little dispute in the health
aboe requ1res both an lDtesratloD ofprev1ously uncoo~
ditultec1 health care ervlcbullbull brlDSins tolether into one
alency what Johnaon (21 p362) reterred to as bullbullbull the
concepts ot cOllPrehms1veIled1C1ne andpos1tlve health
andaporpph1cclecctrailzat1on ot ervlce dellvery
he NatlODal CoimD18810D0D CouD1ty H_81th Services
report Health Care gilitis (26 p37) suggests
proYic11Dl compreheDaive health care services by centrashy
llz1Da a varlet ot publlc and prlvate healthcare
tacllities 1ntohealtb campuses However as Kahn
(22 pp274) states amppeskin ot soclal servlces in genshy
eral bullbull bull if the loal ls to develop a service-delivery
approach that improves access taclltates teedback 80 as
toadapt to user preterence8nd prlorlty and maximizes
case 1nteptatlon aDd accountabl11ty the base of the
total 80clal service system Should be tnthe nelSbborhood
Dec~tral1zatloD not only makes services IIOre accesslble
but allows therv1ce to be tailored to the Deeds of the
10
areaDe Diaz (14 p3) indicates the importance of
being aware of groups in the neighborhood with special
health problems such as elderly people or large families
witb yOlmg children This means that it is important
in planning to be aware of the demographic features of the patient population This will be considered more
thoroughly inPart II of this report
Kahn (22 p275) continues however to indicate
that more than the improvement of service usage is I
involved in decentralization and that decentralization
ot service delivery also represents part of tI a general
search to break down cities to human scale for some
purposes on the assumption that people find it easier toshy
relate to a neighborhood orsection and to its populationbull
bull bull bull Thus the organization of services at the neighshy
borhood level bas the added purpose of contributing to
the search tor neighborhood n He adds that this process
i8 more relevant it there is a measure of local control
over as well as local availability of services
Kahn indicates that decentralization is not a
viable goal in some circumstances These include situashy
tiona in wh1chthe need for a particular service is too
TJI t
-
11
little to justityits proVision in a l()calun1t where
skills or resources are too rare to be provided locally
or where the costs ot decentralization vastly outweigh
the benefits He Visualizestheult1mate emergence ofa
h1erarcb1c81 patternofserv1ce delivery tnwhichcertain
services andresp0D81bilities are middot1ntegrat8d1Dto the
collimun1ty at thelooal level Other more specialized
services relate to larpr un1ts of the colDlllUD1ty such as
eomb1nationa ot neigbborhooc18 Veryspecialized services
are to be delivered at city countystateop regional
level8 fh1slevel would al80 be the seat ot prosram
coord1zaat1on staDdardprotection and evaluation 811
of which call for cons1deZable centraliZation for overall
program adm1 nlatrat1on(22 p275) AlthoughKahnt s
model was not developed specltlCally tor health care services 1t1s quite relevant- and appliCable to health
care service delivery systems
Omiddot Donnell (27 p3) reviewing the 1iterat~e on
service delivery and social action through neighborhood
service centers preseJJbB a list of characteristics
generallydesirable in ~eighbOrhood service delivery
centers Firsthe states that the center should be
accessible It should be in a physically convenient
location and should be open evenings and weekends as
well as providing at least em~rg8ncy telephone coverage
t
~ II
12
24 hours a day
The center should als~ be irDmed1ate in 1ts funcshy
tioning That is the centermust have the capacity to
provide prOmpt efficient service and should be able to bullrespond to problems middotwithout long hours ofwalt1ng and
many rounds of apPointments
The centexsservices should be 6omprehensive liThe
center should offer a full range ofusable oil-the-spot
services or easyaccess to other resources by available
transportation It should gear itself to the needs that
peoplehaV8-especially poor people-and provide for the
slmultaneoushar1d11ng of problems were possible
SerVices should 8180 b 1J1tegrated and coordinated so
thatseMces can more effectively be provided
The operation of the service center should fInally
be responsive to the needs and desir-es of the neighborshy
hood It should provide ways in which reSidents can
shape th~ program and continue to contribute to its course
and development It should be relevant and ready to
respond to changing needs II
The concept of the comprehensive neighborhood health
center developed by OEO (31 p324) has been described by
severalwriters Yarby (37 p73) describes it as an
outpatient racility which has certain def~n1te characshy
teristiCS middot1 Accessible to a poPulat1on concentration
bull 13
2 Open 24 hours a day seven days a week 3 Family-centered c~e by a team of lnteniists pediatricians clinical and publichealthnurses and social workers 4 Availability ot frequently~requ1redspecialist in such fieldsaspsycbiatryobstetrics gynecology surgerY5 Con~1nu1tyof doctor-patient relationshyship 6 Family records with social and medical ~raquomDaries of relevant information about each family member 7 Basic diagnosticlaboramptoryand x-raytacl1itles and drugs and biologicalsavailable atthe center 8 Directline (1)y center-controlledambushy
lance when-necessary) to ateach1nghospltaifor cl1agnostic ~d therapeutic servlcf)srequiring the fa011itlesandpersonnel of thehospltal 9 Patient-cantered and eommUn1ty-oriented -
The range ot services in the comprehens1venelghborshy
hood health center shouldbe as complete as possible
inCluding preventivediagnost10 treatment and rehabi-
litative services and Sbouldbe deslgnedto eliminate
episodioandfragmented services (31 pp324-325) Schorr
and English (33p291) add as additional characteristics
ot the compr8henslveneighborhood health cent~r that it
should ~ve intensive participation by and involvement
of the population to be served both in policy making and
as employees and that it should be fully integrated with
the existing health care system The Office of Economic
Opportunity (28 p63) stresses the potential for easing
health manpowershortage$by trairiing local neighborhood
reSidents as non-professional health aides at the same
time creating new job and careeropportunitles As
14
Gordon (16 p bull 422) indicates Many of the outstanding
problems in medical practice todayrevolve around
effectively motivating the patient and the prospective
patient to be concerned with his health This is
especially true in a deprived environment The community
health center with its technique ot consumer partici
pation maybe a way to create this cooperation effectvely
It is important to note at this point that the
comprehensive neiShborhood health center haaas its
constituency an integratedmiddot community r~ther than a
particular segment It should haveas Blum and Levy
(6 pp~5) indicate a horizontal rather than a vertical
relationship with the commuriitybull The vertical relatlonshy
ship they state is characteristic ot those service
organizations wh1chapproach the community only in terms
of their own fUnction Tbey see only their relationship
with the users of their service and assume that problems
of accountability will be handled by these consumers
However they pOintout this ienot likely as a vertical
approach creates dependency onthe institution Agencies
in a horizontal relationBhllp recognizetha1 they have
both acommunityand a consumer to serve The horizontal
approach places the matter of accoUltability on a broader
basis than just the involvement of the consumer De Diaz
(14 p4) speaks otthe need to ~develop a community
facility which difters from a clinic for low income
1ji ~
15
people in that it should serve an economically integrated
community The reason for this is that a wide variation
of consumers may assure a better quality of care
The advantages of the comprehensive neighborhood t
health center over traditional systems of providing
commuruty health services are numerous Hospital outshy
patient departments a major traditional source of ambushy
latory health c8refor poor patients have been indicted
for neglecting preventive health care ~romoting fragshy
mentedeare and subjecting patients to degrading and
impersonal conditions to mention only a few of the major
defects (31 p324) Another defect has been the
tendency to shunt low income patients back and forth
between different cliniCS often at different locations
arid with differel)t open hours for different treatments
or tests in regard to the same lllness(26 p63)
The comprehensive neighborhood health programs that
have been organized present a great variety of organishy
zationalpatterns one area of difference 1s in the
emphasis placed upon making each faci1ity comprehensive
in the services it provides to the patient population
In the Montefieri Hospital Neighborhood Medical Care
Demonstration program in New York City services have
been made available through a central health center and
two store frontsatellites the center to be the base
bull
Li
l of opratiol18 of ta1lJpIlflicl- ancl the satellite
center the ba of oparat1oDa of public heaJth nurses
an4 nllbborbood amp1 be satellite centers wereto
proVide preVentift tutaltll bullbulln1c1-m1zaticms w811shy
baby care per1od1c ~ectiland tJle central health
center to proViAle care tor illnes If (36 p299)
bis propWI VUDOt ~ttullytunct10DIDI at the t1JDe
it d1cu8ae4 18 tbe Uterature aDd all aernce Were
be1Dl provided 1D_~terBowever itwould ae
tbat the ntua1pro~ as aY1ioae4by its plmmers
would boclJ aoaeot bull 4efeot~ otthe current lud1cal
ccde teaIt pObullbulllne_t coorctJl8td admSDtshy
etration eD4 well 4eftlopecl refelTal procedtlreacould
1I1a~ thecOllDeCticmof t~_t8 withappropr1ate preTellshy
t1 aD4 therapeu1ampcaen1cbullbull aV81lable 111 diffrent
locationa Bowner tile barrieraottiaeaDdUatanc
between center and truaraUon tor the UDSopb1aticated
patieatlook1Dl tor 1her1~pJce too tor ~1CU-
larhalth serfplusmnQewoGl4~to JJa1t tbbll1ty o~
tb18 ~811D to provide iaaiYCOliprelleU1P18hboltleod
health servicebullbull III tactmiddot tappeareto coDtlict with
tbepro own taW cOfdotpro-1~a tam1ly
mecl1cal careprogru 111 wIa10h pre-teAtlYe aDd therapeutic
health erY1cecan be proY-lW to all IIl81Ibers of
tamily in the coure of aaSDll vi8it (36 PP301-3(2)
Dle Delmtr Coloradoprepa11ke the Montet1ori
LI
17
prograJlut111zbullbull abe1rarcJly ot SlDa11 aatellItestations
andlerer IIOreceDtallzedtac11It1es It 41ffers
howeverill tbcolap~81vene80f the services avail shy
able Inthe 4ecentraUzed facIJJtiesIt resembles very
clc)sely the IOdel ~ordecentral1zed social servicedell shy
very developed by 1ahII~ Which was 41sCussed above he
SIlall neImiddotgbborhoodmiddot c8Dt~aw1tb1n walkl distance of
most of the populatiotl havebeendesilDedto take care
of allthenorllalhealth probl of 3000-5000 patJentsshy
check-ups IlzatiOZl8s1Jlpl laboratory testa and
treataentand iaecucatlol18 (d1apeued by phyS1cians) for
IIOst DODCrltIcal 1l11le PatIent 1d1Oneed IIOrespecIal-
Ized care are reterrecttobacJalp facilities BaCkup
support tor themiddot~t1oDa are the tWo l8rsernelshborhood
health C8Dter8~ttr1Dl aCOglete~e of out-patient
serneeaDd three part1clpat1q hoap1iampl bull bullbull which
proVide1Dpat18Dt~t andcoDSUltatlve services
(13 p1028) Intb1a prosrama coaprehens1ve range of
prevent1ve aDd trea1aeDt serric 18 aVailable throughout
the decentraUzed middotta The CoapreheulY8 ReIgbborhood Hea1~ Service Project
otKa1er iC)UDdatlcm HOspitals 111 Portlan4 OreOD 1s
s1ll11arto th DenVer prosraa 1D thata comprehensive range
ot out-patientmiddot services 1D prov14e4 in each of 1ts 10cashy
t1oDa althoUlhmiddotmiddot tbe oentera are larger and l bullbulls DDIerous
than 1nth DenverproPUh (12 p6)
Li i
18
In order that a comprehensive neighborhood health
care center be able to proVide continuity of care it
must have arrangements for hospital services integrated
into th system Yarby (37 p73) as quoted above
states that it 1s characteristic of the neighborhood
health center to be directly connected with a teaching
hospital However De Diaz (14p3) indicates that it
may be advantageous for purposes of service delivery not
to havemiddotthe center affiliated with a teaching hospital
She feels that such anaft11iation may lead to asltuation
in which policies might be determined more by the teaching
needs of a medical school than by the service needs of
the patient
middotThe Nat10nalmiddotCommissionmiddoton Community Health Services
(25 p69) states that such a system of comprehensive
health care integrat1na ~e servicmiddotes of several health
and roedical agencies snould utilize Itas much single or
unified management as possible Neighborhood health
centers have been operated under a variety of auspices
but several writers have pointed out the advantages in
termsof coordinated prOvision of servictts management by
the hospital of the neighborhood health center For
instancethisfac111tates the keeping of unified medical
records of all the care a patient Msrecelved either at
the neighborhood health center or _le hospitalized
(12p6) ~ermore a3 Young (38 p1741) points out
19
direct operationot the u1sbborhood health oenter by
the hoSpital canll8lceaftilable to the center expertise lt bull
in sOlle aapcta 0 Operation that m18ht not be aa readily
available otherwie
Relardlebullbull of wbetberthe hospital and the neighborshy
hoodhealtbcent8r haVe a cOJIIIOaadmjntstration they
IIlU8thaVealTlved at a str1Dsent delineation of IDUtUal
role and reSpoDBlbilltiebullbull All OOIIpoienta ot the care
yst IIlWStQlarify and understand one anothers position
In the syatem and acree on objeCtive ancimethOds
(26 pp16-17p31) SODae areas of iDUtUalconcemare
reterral procedures record keepiDg aDC1 mutual use of
facilit1es statt1Dl i8 anotb8r ~ ot coaaon conc~
Ditt1cultift have u-laeniD the pastiD cOllprehensive bull t bull
healtbc~ prosraumiddot 1d11ch were batil plauned in wb1ch
all of the health canter phy1C~1IDa did DOt bavetatf
privilege at all ot thebackuJlhospltala (29 p21)
SUch a8ituat10n i8 1Dampcceptablelt inpatient care i8 to
continue to be p4by the pat1eatmiddot health center
physician and it cont1Du1ty ot care 18 to be maintained
Hoapital and health center1lUSt laav 301nt responsibility
tor the recruitaentot physicians
VticlentU IPan BJcNrcu Much otwhat haa b8ea sUd has stre88e4 at leastmiddot
iJlplicit17tbaD8ed tor tM etticit middotprovision ot8emcea
20
There appears to be two aspects of efficiency which are
discussed by writers on the su~3ect of the comprehensive
neighborhood health care centef one of these is the
need to organize) services to make the most efficient and
economical use of scarce medical care resources The
other closelyrelat8d in realIty is the need to help
the public use services in the most efficient manner
The comprehensive neighborhood health center concept
1s lhherentlymiddot efficient in that preventive curative and
rehabilitative health ~are programs are coordinated under
one roof with integrated a~stration Furthermore
theempbasLson prevention health education and early
disease detectionis eftic1ent troJll~estandpoint of
the health care system as well as beneficial to the patient
(18 p760) HQwever ~ue tothe scarcity of health care
personnel thecoiDprehensive neighborhood health center
mustbe an arena tor eXperimentation with new staffing
patterns~ The Kaiser program is indicative of the way
in which health care systems must begin to operate in
that appropr1ate ancillary personnel are used Wherever
possible to perform functions that do not need to be
carried out by the physician As Saward (32 p42)
states
1hroughou10ur organ1zat1on~ there are many of the customary experiments be1ngmade-shyJse of speciallr trained nurses for well-baby care under the SUpervision of the pedi9trlcianexperiments with routine prenatal care by
w ~
21
middotSPC1a1l~t~JlUrbullbull per8ema_1 bullJmdlJleu y our fuDotlou are auoh that DOtb1Da 18 dorutbYtbe phY8iCianstbat doe DOt vet to be done by the
phys1c111U1fhe other aldlle4 person- Del-nurse middotreC~0D18t the appo1ntshymeDt center or clerical praormelshyaremiddot there to free h1amiddotto use his spec1al sk111
Awell lmoWn treDd1D the area of eaaiDI health
c8re JII8DPOY8rShortagjs bas middotbe thetrend toward tra1nshy
1DB poverty area rea1deats as DOD~pro~eaionalmiddoth8lth
aide and nepborboocl health workeramiddot (28 p63) This
bas the effectofmiddotmiddot1J)creaa1q II8DPOWrand 8180 can help
bridle the cuJ~ cap betweenprondera and colllUmers
of aen1C8s This attarD at least tlleoretically
createa a situation 1D WIa1ch providers andcoD8Ullers can
be educated to UDderatad OD88DOtber and interactJlore
ettectlvely~ HoWever amiddotpltt8ll has beeD themiddot tel14ency in
801D8 oamp8e8 tomiddot us aidesmiddot ssale8lllcw t~r the center
alJDOatexclwdY811rathertbaD ua1Dltheal to protide the
health care for wh1ch ~ were trained (29 pp3B-39)
1bat ismiddotmiddot vh1~e the a14e Yalue in ~~m1catiDI with
low 1nCOlMt patieata haa beeR recoSD1zed and stressed
their role ashealtb carepersoDDelhil been slighted 1n )
any 1Dstancea
Anotber step 1d11Ob bullbull been taken to provide 8rY1ces
more efficiently eUeot1ftlybas beenmiddot theorgan1zation
of per8ODDeliDto IIllt141sc1pl1Dary teamaaaa means ot
proYid1DgmiddotCOQrd1DatedserY1ce SUch te8lll8 sen_rally
~
hf
~
22
include PhYsiciaQs nursbullbullbullbull soc1al workers and outreach
workers Conceptually th8y fmlct10n to me~ the intershy
relate lled1cal and social needs ot the families sened
Hor there are a number ot barriers to the etfectve
tlmctiOD1nlof lIuchte8ll8 SODieot these are heavy caseshy
loads the inordiDate amount ot tille consumed by multlshy
prOblem tamtliethel1m1ted tra1n1 ngmiddotmiddotand laCk of tnterest
on tile part ot aoae tebers in examinJng aspects of
problems out14e~lr oWn areaaotcolIPetencemiddot and
~ourdcation prc)blell8 between proteasioDala and nonshy
prot81~s (10ppa-10) middotrurtbemOre as De Diaz
(14 middotp6)1nd1cate tbel8 maybe a teDdency tor vertical
dp8rtmental lines of auperv1810nto become paramount
over the team coDamloation syst lead1ngto conflIcts
in determ1niDI the ro1ea ot solie team bers particularly
the DOD-prote81011alaInauch exper1l1enta Witb new
~t1Dlpatterna it 1s bullbullaentialtbat line of authority
roles aDd NsP0D81bll1tlea be made explicit and that there
beJDechaD 8IUI tor relUlar evaluat1onotfunctlorUng
Another way inwb1ch health care sernee delivery can
be made more ett1cl8Dt is to proVide servicea dur1DC the
hours whentbey aremiddot -ostnee4ed As reQo_ded by Yarby
(37p1) serY1ce can bemadelIOre accesslble by making
themava1lable 24 hours a day seven days a week If
rg8l1Cy service are aft11ab1e aroua4-tbe-cloek at ~
nil1iborhood health center the continuity ot tbepat1ent ts
23
careiamaiDtalDedand meatry point into the
cOIIPre~i health care 8 be made available
tothe patient who aoZMllyU8ea ozilymiddot emergency care in
tille of med1cal criais More 8isDificantly ava11ab1-
lity of a tull rase of bullbullrv1c8 tor seVeral hours 11the
eVerlna aI1Cl On ~ prevent the los ot earn1JiSs
involved if th patierat 1IU8tt8cet1me oftfroawork dur1q
the d8y for aed1Cal oare bull his can be an eSpecially
importantc0J1814eration tor lo1aCOlleDUUg1nally qloYEtd
patient aa4caJla18o PIOJIOtet1)e 0Da01Dl use othealth
servicebullbull
exper1eDO ot tbeKa1er prosraa in tb1s~reprdAs
Greenl1clt(19 p10) states wA lllNt 8ip1flcant
proportion ot the abulatory care 8n1cp~Y1dd tor ~
total popUlatiC)U ~ ~ after clWc hours and this
Deed i8 apParenUyaoN prODGUDced tor aJl8d1cally
iDCust population On the other hand the bulk ot all
aabulatory med1cal cu 88l91ce are performed dur1nS
regular cl1D1c hour eVen when services are available 24
hours a dayJ day bull week W
It has ~ the experi8D~eof a ftIDber ot ne1g1lboXshy
hooct hea1tbcentere _t a_jor obstacle to efficient
proViSion ot anicbullbullhas beentbe teD4eDcy of medically
1ncl1pnt patieats to utilize the center oa a walk-in
baais tor epi8od1ccr181or1entect bullbullrv1cea rather than
4)i
h~ ~~f ~~ L
24
to make appoJlltaeata tor ODIo1qprevmt1ve treataent
and rehebl11tat1Ye care ad ampl1O to bave a blah failure
to Show rat_for tbe appo1DtaeDts that they dO make
Atone center 628 of appo1Dtments made were kept
while 3Oottbepati_ta een were ~1n patients
AlthoUP fewer patiets were actually 88811 by the cater
1D middottb1s 1Datance thaathe -bervholuidmadeappointshy
mta the walk-iD patlat required an iDord1nate amount
ot staff t1ae tor aCreeDiaaacl ~trral to pplOprlate
~ttor caregt (9 pgg) Arraquotbr1llpl1catjo~ of the
plOVidedto valk-iD patient by other thaD their
(19 p12)rurtbermore
when patients uti11ze Wlk-1Il er181 centered care
athelr ODlf tona ot ootact with the _d1~ care
ay_ta fUilycentered care the treata_t of tUl11y
bers
a a UD1t 11
dlarupted
hewalk-1Dphenoaaencm appear to barelated to
diUerence between soclal clase in the style of Dlaking
contactJt1th the a11oal C~ay8t As Greenlick f ~
(19 p11)1Dd1oate8 thepheDOaenOn ot INater usage of shy
walk-in ervice by aed10ally middot1Jid11ent patient thaD by
others baa otte been attr1buted to a stoical att1tude
tQward 1llDe8 em the~ ot poor people leacl1D8 to a
~
25
greaterdelay1n tbe k i Dlofa8d1cal care These
patients wppoedlyeelcmiddotcareODlymiddotwIleD tbeirmiddotillDess
becOlles1Dtolerable resultiDSin middotthMr appeariDS withshy
outnot1ce1o rece1ve oareHlwever Greenlicks
r8aearcbbaa cut doubt on the existence ot tb1delay
111 report1Dg middot8J1IPtoJumiddotOfDeW 11laessand seek1ng care
Be bas tcrQDd 1bat s1ll11ar peze_tases of dioally
1nd1sent 8DClJ1on-aed1cally 1Dd1PD~ pat1enta seek care
on the aue daytbat aptou tirstaPPear
1fb11e GrHDllclc 1nd1cat tbat the reasonator the
greatertendeDCY of low 1Do~e pat18Ilta to 1$8 walk-in I
serY1ces are notlcDo1rAmiddotmiddot tbe7 _ be rel~tedto a tendency
ot lower aocio-ecaaaoclaa patieota to preter face-toshy ~
face contacts with II841cal persoDl181posslbly because
such contacts areft coatortiDS an4reasauriDS to
patients who are hJpotbeafzed to bave a dependent attltude
toward IIed1Cal care perS0Jm81 (30 p161)
It a8 itmiddot baa pnerally beenhld the appointment
s1stemts the most efficient Ileana of dellveriDS
comprehenSive oODtllluiDlh-lth care (9~100)1t is
necessary that educaUoraalmiddotbulltfort be taken to proaote the
use ot middotappo1ntaents8DClmiddot tQrec1ucethe fa111re to appe~
ratB4uOatioaalwhlQb baft~utl11zedhave been
IJ
26
1Dten1ews with walk-in patients home Vi8its and group 4i
meetiDp1D8D attemptto1Dierpret1o the patients
the value of rtitgular ppo1ntmentamp andot con~in~
c~1ve care rather than epiI041c care (9 p1OO)
h1s 1safuD~tioD torwhtch nOl~prot81QDal colDlllUD1ty
YOrkersllaY bebe~r8U11ed tban other statf H()wever
euch aD ~ucat1oaal propul __~ ~e related to the senUiDe
capacity otth health oenter to provide comprehensivebull gt
ervice8 to1tpat1_t~odoD aD app01ntment bas18 It
1amp pos8ibleo~rw1 tor educa110Dal ttorts to result
LD a~8JImCl tor ltPP01ntaen~8 at a ratewb1ohi8beyond
the capacity ot thee_tar to t without uareaaoDably
1_ wa1t1Dlprio4a QOBt1nuad use Ot the center on a
wallt-in bU1 _1tbeoosiItpos81ble to et an appoint-
met anc11nCreued pit1entcoJaplampia1a bull Therew111 of
course always be a need and demand tor acute ep1so~c
Care -ci the health centerDlWlt be planned with the capashy
billty ot bullbullbullt1D8 tb1aneed wh1~ cont1Du1nI to stress
aDd educate the patient to utillze oDlOinI comprehensive
faa11y middotc~te~d Cflre (9p 100l
att g4 CODClva1opa
In order to bea4equate any coJlltemporary health care SY8tem muat bullbulletcerta1D interrelated criteria he
IJ
27
minimum criteria areaccessability of services to those
who need them compr8heX1siveness and appropriatness of
services and efficIency 1nthft utilizat~on of SCarce
health care personnel and resources The scareity of
pex-sonnel andtbe need for h1gh quality ongoinghealth
care services
aJIlong the
populationdemanci the most effishy
cientprovision of services
Services must be made accessible to the population
They mustmiddotbe geosraPh1cally accessible to remove the PhysicalmiddotbaTiers betWeen peopleandthem$d1calcare
system They mUst otter their services dur1ngthe
hours when people can make the moat use ofthemA~ it
makes little sense to concentrate services geographically
where they will not be uSed to their fUllest extent it
also is wasteful to provide serv1cesonlydur1righours when
many people are employed his not only presents a hard
ship middotto the consUmer lnrt wastes resources if for instance
the unavailability of preventive services during the hours
when people Can use them causes a need for treatment
services later on
Health carbull sEtrvices must be comprehensive including
prevention treatmcmtand re)abimiddot11tation Ambulatory I
healtbcare facilities wh1cQ are orienteciexclusively
toward either prevept1on or trea1mentare no longer accepshy
table for they are lneft1c1entln their use of resources
and in their prov1s1on of health care to the patient
w ~~
28
If prevent10n1s notmiddot stressed treatment serv1ces that
could have beenavoidedY1l~ be required If prevention
1s the sole focus of the health care facility sick
patients who present themselves must be referred elseshy
where for treatment andsllch referx-als may be taken as
reject1onsor not followed through with until illness
becomes unbearable
The instltutlontbat meets these requirements Is
the comprehensive neighborhood health center It 1s a
local decentralized outpatient facilityprOVld1ng a
fUll range of ambulatoJY health care services It has
a linkage to ahospitalbackUp facilityforlnpatient
treatment and hiihlY apclalized outpatient care
The neighborhood health center must be a fac11ity
planned with an awareness of the needs of the conSUtller
and coDitnUn1ty It must have the r~Ul0urces to provide the
services people need mere they can use them and when
they can use them It must uti11ze the part1cipation of
the community to develop this awareness Not only must
the cen~er beset up to be Amctional for the consumers
but efforts must bemadeaga1n with commun1ty partici shy
pation to help the consumers utilize medical care
services effectively The center muetmake efforts to
educate the community about the valueot regUlar health
care of preventive servicesand of the use of planned
IJ
29
medical appointments ratherthanorisis centered walk-
incare Therealit1es of the existing health care
system have not taught the patient particularly the low
income patienthow to use services effectively
The helthcenterilUst also bea laboratory for
experiments in easing the health caJepersonnel shortage
and c60rd1Datingcare~ A major difficultY iri-exper1shy
menting with neW rolesis freeing staff of old preconshy
ceptions
CoDlprehensiva neighborhood health dare centers have
been developed under a variety ot alisplces including
medicalsociet1es hoSP1talsmiddot(36p299 group pr~ct1ces
(29 p6- 12 117) health departments (13 p1027) and
ne1gbbothoodassoc1ations(14) The literature indicates
somevalues nthe management ot the health center by plusmnts
hospital backup faCility Whatever the auspices many
adm1nistrative fuDctions such as program coordination
standard pr9tectionand evaluation call for considerable
c~tralization of adm1nistration city-wide or coU)tyshy
wide At the same time other aspects hours of servlce
for examPle~ cuI f~radm1nistrative fUnctions made atmiddot
more local levels Each neighborhood center must be
free to adapt its functioning to itscominunity thi-ough
the mechanism otcODlllUl11~ participation inmiddot policy making
Obviouslythe prerogatives and responsibilities of each level must be negotiated and made explic1t
t4~
JJ
BIBLIOGRAPHY 30
1 American Rehabilitation Foundation ~ealth Services Research Center The Health Maintenance Strategy mimeo 1971
2 Anderson Nancy N Comprehensive Health Planning in the States A Study and Critical Analysis Institute for Interdisciplinary Studies American Rehab ilitation Foundation 1958
3 Andrus Len Hughes Comprehensive Health Planning Through Community Demonstration Health Projects mimeo1967
4 Barry Mildred CandCecil G Sheps A New Model for Community Health Planning unpublished paper presented to the American
Public Health Aseociation1967
5 Blum HenrikL Fred Wahl Genelle M Lemon Robert Jorulin and Glen W Kent The Multipurpose Worker and the Neighborhood Multiservice Center InitialImplications and EJeperiences of the Rodeo CommunityService CenterAmerican Journal of Public Health58 (Mar 168) pp 458-468 shy
6 Blum MichaelD and Soloman L Levy A Design for Service Delivery that Reinforces Constructive Tension Between a Health Center and Its (sic) ConSUDlers and Supports Community Power unpUblished paper presented to the American Public Health Asaociatiltn 1968
7 Brielaud Donald Comm~ity Advisory Boards and Maximum Feasible Participation American Journal of Public Health 61 (Feb 1971) pp 292-296 shy
8 Burns Eveline M Health Insurance Not If or When But What Kind Madison Wisco~sin University of WisconsinScllool of Soci~l Work 1971
9 Campbell John Working ~elationships Between Providers and Conshysumers in a Neighborhood Health CenterU American Journal2 Public Health 61 (Jan 1971) pp 97-103
10 Caxr Willene Neighborhood Health Centers Funded by the Office of Economic Opportunity mimeo 1970~
11 Colombo Theodore J Ernest W Sawardand Merwyn R Greenlick The Integration of an OEO Health Program into a Prepaid Comrehensive Group Practice Plan American Journal of Public Health 59 (April 1969) pp 641-650~ -
12 Comprehensive Neighborhood Health Services Projectof Kaiser FoundatioIl Hospital~ Prcgtgram YearE grant renewal proposal mimeo~1971 bull
13 CowenDavidL~ Denvers Neighborhood Health Program Public Health Reports 84 (Dec 1969) pp 1027-1031
IJ
14 De Diaz Sharon Daniel Beyond Rhetoric The NENA Health31 Center After One Year unpublished paper pres~rited to the American Public Health Association 1970
15middot Gerrie NorrrianF and RichardH~ Ferraro Organizing a Program for Dental Care in a Neighborhood Health Center Public Health Reports 8 (Aug 1968) pp 419-428
16 Gordon JeoffreyB~ The Politics of Community Medicine Projects A Conflict Analysis Medical Care 7 (Nov -Dec 1969) pp 419-428 shy
17 Greely David The Neighborhood Health Center Program and Its Implication(3 for Medical Care H~alth Forum of the Welfare Council of Metropolitan Chicago (mimeo) 1967
18 Greenlick Merwyn R Newgtimensions in Health Care American JOurnal of Pharmacentical Education 34 (Dec 1970) pp 754-4
19 GreenlickMerwyn R Donald K Freeborn TheodoreJbull Colombo Jeffrey Abull Pruesin and Erne$t W saw~d Comparing the
Use of Medical Care Services by a Medically Indigent and a General MemberShip Population in a Comprehensive Prepaid Group Practice Prosram II unpublished paper presented to the AmericanPublic Aesociation1970
20 H~tadoArJiloldVMerllYll RGreenlick and TheodoreJ Colombo Determinants of Medical Care Utilization Failure to Keep Appointments unpublished paper presented to the American Public Health Association 1971
21 Johnson Richard E and Merwyn R Greenlick Comprehensive Medical Care A Problem and Cballengeto Pharmacy ff AJilericanJournal of PbarmacenticalEducation 33 (Aug 1969) pp 361-367 -
22 Kahn Alfred J Studiee Social Policy and Planning New York Russell Sage Foundation 1969
23 Kotler Milton Neyhborhood Government Local Foundations 2 Political~New York The BobbsMerrill Company 1969
24 NationalCommisaion on CommunityHealthSfrvic~sActionPlanniriamp for Community SetithServices~ashington p C Public Affairs-Press 19t7
25 National Commission on C~mmunity Health Services Health Adminishysration andOrMPization l the Decade Ali9$-d Washington D C Public Affairs Press 1967
26 NationalCornmiesion onqomm1Jllity Health Servicesbull Health ~ Facilities Washington D C PUblic Affairs Press 1967 bull
~ n
32 27 ODonnell Edward J and Marilyn M Sullivan ServiceDelivery
and Social Action Through the Neighborhood Center A Review of Research tt Welfare ~ Review 7 (Nov~Dec 1969) pp 112
28 Office of Economic Opportunity Second Annual Report Washington D C~ U S Government Printing Office 1966
29 Office of EConomic Opportunity and the Medical Foundation of Be~laire Ohio Eighth Report 2l ~ Committee2a Governshy
ment OperatiOll~ Va8hiiiSton D C Government Printing Office 1969
30 Pope Clyde R Samuel S Yoshioka and Merwyn R Greenlick Determinants of Medical Care Utilization nhe Use of the Telephone for ReportiDg Symptons Journal of Health and SocialBebavior12 (June 1971) pp155-162 shy
31 RenthalA Gerald nComprehensive Health Centers in Large US Cities American Journal of Public Health 61 (Feb 1971) pp 324-336 shy
32 Saward Ernest W The Relevance of Prepaid Group Practice to the Effective Delivery ofHealthServicestt The New Physician 18 (Jan 1969) pp39-44 - shy
33bull Schorr Lisbeth Bamberger and Joseph T English Background Content and Significant IssUes in Neighborhood Health
Center Programs Milbank Memorial ~ Quarterly 46 July 1968) part 1pp 289-296
34 Weiss James E and Merwyn RGreenlick UDeterminants of MedioalCareUtilization The Effects of Social Class and Distance on Contacts With the Medical Care System Medical~ 8 (Nov-Dec 1970 pp 456-462
35 Weiss James E MerwynR Greenlick and Joseph F Jones Determinants of Medical Care Utilization The Impact of Ecological Factorstt unpublished paper presented to the American Public Health Association 1970
36 Wise Harold B Montefiore Hospital Neighborhood Medical Demonstration A Case StudyMilbaDkMemorial Fund Quarterly46 (July 1968) part 1 pp297-308~
37 Yerby Alonzo S ttHealth Departments Hospital and Health Services Medica1~5 (March-April 1967) pp 70-74
38 Young M M~ Chatanooga IS Experience with Reorganization fOr Delivery of Health Services ttAmerican Journ8l of Public Health60 (Sept 1970) pp 1739-1748
f or l
II bull 11 Y d
II
IJ
34
ThepurposeOfPart II of th1aa paper1atod1scuas
elected Speclfic needs ofecltlc areas within Multnomah
County A8P01ll~oUt 1D ~ I of t1a1bullpapermiddot Ita nelgbshy
borhood health oare cater IlU8t be a facl1lty plaDlled with
aD awarenes of the neeels of the oODllUller and collllUDity
Part II of this paper nIl Show 80e of thoe speclflc
needs
he1DforutiOD tor t1li Portlon of the report
obta1nec1 troll tbroupout tbe follow1Dl threepUb11catloDS
1gr~e_tiMshylIPrIxaiidOreson JuDe 1963
2 1~_middot_sectSI8e~ected1teai c-ua 0 S 8 e first count coaputer tape Coluab a_lion AssocshylatloD of QoveraMD-8 Jlme 1971
3 Jtu1tDoab County Oreaon BDY1roDlHtlltal SurveyEarly 1971
The JIultDOIIIlb COUDty OrttIOD BDv1roDllfmtal Surley
Barly 1971 1s bull stat1stical report of the activ1tles of
theentlreMultDOIIIl2 CcNDty Health Dep~t during the
year of 1970 Die speclflc 1nd1cs elected from tb1s
study amprejMental aealtll Publlc Health N~s1D1 vlslts
FaJUly ~ Veaereal])1 ~ ~rcul081
Throush tie use of cUrts and mapa ODe CaD roup these i
speclflc ~oea to ahcnr the healthneedsof speclfic I
census trtcta aD4 then the health needs of iarer neIghshy
borhooda 1m4 o~ Uebullbull
Rf)~UP1Dl of areu was accompllshed in thefolloWinl I
JJ ~
35
he MiltDoIliahCountY oregon BDViromaental SUrvey
early 1971 isamp statistical report ot tbeaotivities ot
the entire MultDolllh COUDty Health ])epartiDent dur1nl the
year ot1970 he specitic 1Dd1C8S selected frOm this
aUy are 1Il8Dtal health public healthDurs8s visits
fUl1ly pia waereal elisease aDd tuberculosia
Tbroq11the Wle otcbart aDd mapa aDecm szoup these
specific indic to show the health Deeds ofapecitic
ccmaua tracts aDdtIum th8health neecla of larsr ~eilh-
bOrhooda and co8I13 tlbullbullbull
RegroupiDI ot areas waa accoap118hed1D the
tollOWiDl lIIIIm1er~ A bullbullcifie 1ndex 8selectcl auch as
venereal di8bullbulle or tuberculo8i~ he total number ot
cs was then deterll1ne4 for each census tract Through
the use of the maber ot cRbullbullbull tor a 11Yen cenaus tract
aDd tbe population ot thattractaltrateot1lla1ampmcper
100OOOpopUlaticm wu cleteXll1ned for each census tract
This was ~e to starl4ard1ze the population ditterence
amongOeD8U8 -tracts 1he rate of incidence toreaob
cenauatract was then llstedby rank position on a chart
In rank poition1DI any cen8Wl tracts haviDg equal
rates ot1l1c1dence are assipe4tbe iaDk posttiona
Beeauseot the abo fact tbAt cbarta w111 vary in length
neveltbAtlea eacb cbart will 1Dclu4eall census tracts
inMullnoaah Couaty Atter the census tracts bave been
listed accord1q to raalcth1s list will bediv1ded into
IJ
36 three levelsotinc14ence he three levels are
1~ The upper 14 of1DcldenCe
2 Thelower 14 ot incidence
middot3 The ILld 12 of incidence
Tlles three srouplqa are then used in compiling a map ~f
Mu1tnOmahCountyfor ach apecltictop1cbull TIle maps are
uaefuJliD tbatthey V1suallycoJib1De 1Dd1v1Clualproblem
census tracts into larger problem nellhbOrhooc1s
The 1960 statistical iDtormatloD was Used in a similar
liIaDDr to tbatexpla1Dedabove 1Dthe4evelopaent of a
chartmiddot and map 1Ihow1DI e cOllpampriSOr1 of per capita lncolle
tor ttaCh ceDsua tJact aDdmiddot combiDed census middotmiddottract areas
he 1910 aDd 1960 statlstlcal iDtOrllatl0D was combined
lna map and chart he purpose of this and chart is
to d8aonatrate the e cl1stributloa1DeachceD8U8 tract
and middot1ndlcatbull tuture ace populatlon treD4a bull
When one be middotbullbullbullbullbullHdth ne8cts ot an area and has
declded to establlsh a cl1D1c to serve that area the
physical location otthat cl1D1c IllU8t be consldered In
order to coapreb8ll81vel develop an area cl1n1c one should
conslder thepre88Dttraftlc middot~ytaa an4tranaportatlon
systems Thecl1D1cahoUld be located close enoUlh to
major arterlals to giva asy access from the total area
be_ ervecl by this cliD1c At the t1ll8they should
be tar eo away froll thesarterlals to all8Y1ate traffic
CODCell18 andpark1D8 conpstlon By traff1c concerns I
IJ
37
lIlan one lUSt consider thertarro1fne8S of streets whether
streets are oD8--C)r two-way iqres8 and egress to parking
amp0111tie eros tratflC) spedof trattJQ children 1n
ll8a traffic i1lht Vislon re8tr1ctionS etc
BwstraDsportat1onshould alao be central in this area
as maay people ~U f1Df1 1tD8Cessary to use this form of
transportatlon
~e tutqredlopHQt of bull treewa systems should be
c0J1S1dered soastolesen thecumce ofmiddot future roada
cutt1DSotltbe cl1D1c llte line
nrrph1c middotDampta
It is 1JDportaDtto kDOw the demosraphic distribution
characteristics of the oUenteltbat i8 to be served by
localized health cl1D1cs
Acl1D1c which erves8J1 area where1D the prepondershy
ance of persona arecrter 65 years of mayf1nd that these
people rely more on pUblic transportation call for more
home- services and haV4t 110ft ChroD1c and debilitating
types of disorders (b1_ blood pressure poor heariDg and
eyesight) tbaD do8 an area ot a YOUDIer population On
the other hand thL area of older residents may have little
need for family plabDlng cllni08
In order to better ~Ybullbull the 4eaoraphic population
of each CeD8U8 tract the 1970 CeD8U8 iatormation was viewed
and two specific catelOri8 considered These two cat
IJ
38
lori8S woUld be the perc_tap ot population under 19
year of ase and the percentase ot each oensuetractover
65 years of age he 1960 1Dtormatlon tor eaCh tract was
then compared witbthe 1970 intormation and a percentage
ofincreaae or4ecreamp8 tormiddot e~chtract1n each category
cOJlputecland achartma4e By the use of this chart one
18 able to View tJleap populat1odiatr1but10n of census
tract and at the _ t1lle accesa middottrencl Por example
let us choose census tract 601 W see 40-4 otthe
population is under 19 years ot and that ODly82 1s
over 65 years ot middotAtthe e tille the percentage of
youth bas ~ed ODly 1_ intbe laSt teD year whilethe
percentale over 65 year ot middotbas stayedmiddotthe same With
this in mJnc1 ODe ~ 1DfItr libat ol1D1o aerviDg this
area WOuld bellQre conq~w1th the problems of a
YOUQier populat1on and that _ would probably be true foJ
some t1aein tbefuture On the other hand CeDSU8 tract 54
has only 2 ollt population UDder 19 yel1s ot age and
this has decreased by 1 over the last ten years middotwhile at
the same time 32-377 ot the populat1on 18 over 65 years of
age A ol1D1C ___ this area should be or1eJ1ted toward
tbespecttic problema otthe ampledbull
PerCapia __ bY gsa neat
WhaD cona1der1qlooat10D1 tor health cl1n1cs one
shoUld take the 1DC01Ieot areas into consideration Areas
IJ
39
of lowiDcome would not 11kel~be 8erved more by localized
cl1D1cs tbaD would are of hilbincome It 18 likely
people haYiq a hip iDeoll8would preter to be aeenby a
chosen ~r1vatephylc1a1l tban at a local cl1D1cwhere
10Dier waits y beraceaaampryand leas personal attention
gl_
The 19701ncOII81atoWampt10n tor MultnomahC~ty was
not available at the tille thi8report W88 made The 1Dto~shy
tiOD Was taken ~adtro tbe1960 census publlcation
his woUld ~8Il thea tbat ral1I8 OD the chart ynot 1raquoe
completely accurate hi writer telthatthe areas most
affected by tb8 1I8eof the older 1Dco1DtOlaat1oDWOuld be
those tracts wh1ch baYebad a rapid 1ncreaae1n populatlon
over the past tfmyHr8 bullbullbull tracts would include tracts
nUmbered 104 9897 96 aDd 95 be perc~ita 1Dcome
referredto1il-tb1a Paper18the lIean 1DCo per person per
census tract
Attar the iDeoeper census tract was listed on a chart
a map was de 1D41catiDg those census tracts belonging to
the lower 14 ot income tor all censue tracts in Multnomah
COlDltytbose beloqins to the upper 14 ot income tor all
census tract 111 MultnolUlhCounty and those belonging to
the mid 12 ot 1I1coaetor all oeuuetracts in Multnomah
C01mty
In yiew1Dg the _p 1t caa be seen that the low income
area seautotollow aloas the at aide ot the Wl1lamette
IJ
40
R1ver the full length of Kultnomah County A second low
income area follows the south edge of the Columbia from
the northwest corner of Multnomah County easterly to 148 St
A third problem area seems to be on the east bank of the
Willamette River with the Union Pacific Railroad being
about the center of this tract The extreme loutheast
corner of Multnomah COUDty appears to be a low income area
but as this area bas bad rapid grouth in the last ten years
this could be erroneous
Mental Health
be first ~ecific indica to be selected from the
Multnomah County envirollllental survey of early 1971 and
to be considered in this paper i8 that of Mental Health
At the present for mental health purposes Multnomah
County is divided into five catchmentareas with a mental
health cl1n1cin each area These clinics are Model
Citles Delaunay ADkeny street Office Hansen Health
Building end Southeast Clinic
All lIlental health cl1n1cslcept statlstlcal information
on all patients visiting their cl1n1cs this included the
address of the patient hese addresses were then listed
upon the approprlate C8D8US tract Each census tract was
then ranked on a chart according to the nUllber of mental
health patients who reslde ln thatCeDSUS tract attending
any of the above listed ental health clinics This chart
IJ
41
wasttum d1v14ed1ato proper quartile bbullbullbull
quartile vereUs to dne10 u appropl1ate Multnoh
County _tal health ItLa middotmiddotmiddotthelipO~a1bl by lOoJcJIUE
at the UDtal health _to uteN1De which ueu have the
lars-t use otCOllDty 1alh~th faci11t1Rot
1Ilclu4ecl 111 tbia woUld tber otpeopleYia1t1Da
pr1vat patch1atriata aDd pr1_t _ntalhealtb cl1D1c8
WheDtbe M1 18Yienclmiddot Itmiddotmiddotmiddotmiddot~middotbe~_ tbat ~rtt
appears to lMt fourmiddotmiddot-al are iii _oil the nuaber ot
lIental healthcl1D1c na1t toM tbjh1sheat 1he
tour areaa woUld be tollows
1ttrea Ore to~Blo Drimiddot ~tb Burrus14e aDd tIMtmiddot Colb1a Riftr H1gbwyaeri1Dla th nortllra boundaryshy
2 bull ProII 82D4 1_~ 10 20th streetwitil the ra1lMd Mu the north ltouadary
3 ~ et et tUgl_b1bull MYel froamiddot the Clackaaa COUDty l1ae aorth to Dln8lon stret
4 beDOlvt1ttfe-t ~efllt4 COatytrca Jle1aware streetmiddot toR1C1a11oDd wlth Colubla Blvd heiDI tbAtnorth bouaclary_
It ODe coapareatbiap to th iDeobullbullmiddotp 1t can be
eamiddotthat lIOat ot the c tracts baY1Dg bllh v1i11tatlcma
middottfl public tal health cJ1rUc8 ~ 111 t13e low ~ aid
1DcOile SroupiDIOJa1y of til 25 tracta llsted as
haviDlbip aental Maltll nlltatlou are ~ the1g60 hip
iDeo arebullbullbull
17 Plpn
42
amily PlellnSDI ]Jlce Metal Health i8 an 1nd1ce of
use Theperson 111 ordertobavebe_ 1Dcluclecl 1n this
atu4ywouldhave tohaft Ue4 ataa11y plaDI cl1D1c
tacilities of soaetype It 41fter troll tile _tal health
study1nthat i t1Jicludestatist1catrollbotb public and
privateclJD1os
The iDformation tor the iak orurcbart 8Dd map of
t8ll111 plenn1 na ob1a1De4 by cOIIblnlDlthe mabel of
1rlcuv1duals bullbull_ attbe tbreellUltrampo-ti Coatyhll11y
PlalJQllIl C11ll10s 111til tbo at the Planned PareDthood
Association CliD1C8 be tbree -JIultDouh Couaty r8ldly
PlamSq Cl1D1c are Solrtbweatth Col_bla 1111- a114
HaDsell Health BWlcl1Dl CllD1cbi middot1Dtormat1oD vas then
bullbullbullesed tomiddot detellWMt l10w people troll eacb c8IUIUS
chart wastben Mele IUs oIIart jn 4iY1ded to show
the censuS tracts lIaYiDlmiddottIle h1t1iest qUart1le of incidence
of use lowest quartile of 1Qc1deao ot use Jlid 12 of
incidence of Wle an4 a map sprepared troll thts 1Dto~
mation
The C8U118 tractsbelOJISnl to the h1lhestquartile of
use appear to be 1lO~ 8catt~ on tbipwas true ot
either the _p ot aental health cl1D1c uaageor ot the map
abow1DI per capita 1I1COM Iaere40 to be three
d18t1nct areas of UIIaP beJ woul4 be
1
IJ
43
t10D of BurD81cl and the W11lallette River 4
2 S~t Portland 8Otth otmiddot the ra11shyrcaadand alona the W11lamette River
lIortbeaat Portl8D4 between MisSiss1pp1 and 24tbStreet the northbouBclary be1DgColwb1aBlvd
Pylzl1c BMltl IrpI Y11ta
Publlc Healtil nur81D1Y1s1t nclud8 an vists to
theholles of client by PubUc Health Nurbullbullbullbull his shows
visits to bull f8Jl1ly fer aDY purpos SUCh aatuberculolJ1s
het1Dl tem1tyaeatalu4 8IiOt10D8l cODd1t1ona etc
he atat18t1C~ 1fele C()4ed accord1Dg tomiddot the 1llli301fOCUS
of the Y18lt tt doe DOt 1D41cate the Dmlber of holies or
f8ll11lev181tecl or 1D41Y14ual Y1a1ted more tban oDcein
the propwl It dobullbull I1ve 80M 1D41cat1on by coaparlshy
OD ot the 8JIoUDt of aedlcal problema 1n eachcen8WI tract
Ap1nmiddot the _p abowa 8 scatter patteraof probl_
areas althoUSh there appear to be a sroup1Dl of hiSh J
l8aIeccmaus tract 1ntlut extreme southeast part of tbe
County other areu uIriaI any nura1Dl contacts are
1 bull he 801lth-oa-al CO1Dty on eaCh 814 of 82nd Av from Clackallaa County north to Dinloa
2 ear bullbullbullt 814e aroUDd Preacottand Misaisippi
Dowatom Bunul14eonboth 1de of the river
44
V_real Pis The iDfomatloil uaec1 to tabulate the Venereal
disease chart includes all the ooab1ned case otmiddotODormea
and syphilIs reported by bothmiddot publIc and prIvate physicIans
dur1nl 1970 There were 3602 caes ot IOnorrhea reported
dur1nl 1970 While ODly 17 cabullbullsot ayphilimiddot were reported
A chart was prepUed aDd att8llPt wasmiddotmiddot de tomiddot
determ1De Wh_therVttDereal 41ease was more p~vaJent in
areas othigb or lowmiddot proportIon ot youth hi waadone
bymiddotdetemlna a 1leaD prceiltacmiddotmiddotmiddottor the population ot
resld~ts UDder19 years ot (34) middotA mean ratemiddot per
100000 popUlatIon al80c1ttem1Ded tor the middotoccurreDCe
ot venereal dieae This was et at 390 oass Areas
hav1nl a population 1n which leiS than 34 were lmder 19
years ot ampIe were called low- yOuth abOve tbl percentaae
hiSh youth The aaa waatrue ot the occurrence oivenershy
eal disea_ per CeD8UStract It the rate waacomputed
as 1I0re than 390 cases per 100000 it was called hiah
venerealdiaeasei it less than thia tisure low venereal
disease It was tound that 1D Multn~ COmlty there sems
to be poSitive OOlatI0n(x21S19gt between low youth
and hipmiddot venereal diseaand hip youth and low venereal
diseasebull
RaDk ordr Iitot all c traot middottbAm made
Th1s was done byt1Ddlna the ratepr 100000 populatIon
of venereal disator all census tracts in the County bull
45
These were thenlisted from h1lhto low (sreatest to
least) in a rank order The l1sting was then divided
into Upperandlower 14 aDd listed on the MUltnomah
Countymiddot up
The areas of b1gh venereal disease se8ll18to
roup thBl~8 middotin a very tllht area ~oq both 1des
of thell18l8~ R1 w1th BurDaldeS~et being
~bout theceDter qf tbi8IZ9uping This area woUld
appear to be m ldeal spot for the denlopment of a
locallzed venereal d1sbullbullbullbull cl1D1c
UbepoundCUlO1s
In this report bull tube1C1llosls caS8S refrred
to include alltbobullbull cabullbulls ontubercUlo8is follow-up
rather middotthan just new C Accord1Ds to the Multnomah
County Health SUrvey of early 1971 this would include
all ca repOrte4 over thelaat three years The
total number of tuberculosi8 cabullbullbull usedin this study
was 666 lh1 included 128 new cabullbullbullbull
A rate per 100000 of tuberculosis for each
census tract wa- then computed and the c~us tracts
listed by rank order be b11h Qartlle mel low
quartl1 were then reoordd on a Multnomah CoUnty map
TWo genral areaa baY1Dg a hip mcldencaot tubercu~
losiare 1D41cated heyare
1 Both middotsld ot theWilla11lette River
Ll -
46
with Burns1de about thecnter
2 he extrea Northebullbullt comer of the County bull
By coap8r1ng the tuberculois an4ven8real
diseae maps ODe can 8ee that the downtown areas ot
hiSh 1nc1denceare alIIo8t 1c1eDt1cal on ach map
This WOuld 1nd1cate that 1t would be of value to
bullbulltab11sh acl1D1c 111 th1aampreatbat would provide
bothtuberCulos1s 8Dd ytmereal 418ase srvicbullbullbull
Thchart aDd 1181gt8 are wsfuln 11v1DI
1Ddicat10DS tor the type aDd placemeototlocal
health cl1n1c8 tbro1qhout tbe MultnomahCounty area
A cOllpar1on of the mapa help one to dec1dewhether
to provide a aulti-8ervice cl1D1c or spec1f1c type of
cliD1c As stated in Part I of thi paprserv1ces
shouldhaYe both treatlieDt and prfMmt10n cOmponents
As he been stated fta ne1lbborhood health care
Qenter muat be a fac111tY plazme4 with an aamesa
ot the neds of the consumer and the c01llll1m1tybull
Part II of this rport haa been an attaapt to indicate
and clarify 8011 ottheae coDlllUDity neds This has
been done through8elect10n of apc1f1c problems
The indic were then visuallyrecorded through the
use of ups and charta ODe dan asseS8 thedsreeof
1DIportance of certain concems to spec~t1c areaa by
comparinl the chart aDd maps Prom this oDeean
41 dec1de which are48 vb1chcUD1c-or indeed if
the need a clinic at all However further factors
should be considered hebullbull include
a The amount of fuDd1 available
b What 18 the percentage ot peopleineoh ceaaua tract tbat would actually us such cl1n1cIl
c Wbat 1 tbeco--1tymiddot 8 IeeliDashyreaardtDI particular cl1D1c8 Would this dcrebullbullbullmiddot the ettctiveness ot thse cl1n1ca
IJ
li
D_OlraphicPopulatLon Challie 1960 to 1970 48
Cen8U8 1 of Pop 1 Cbaqemiddot 1 Change1 ofPopTract Under 19 Yr8 Over 65 Yrs1960-70 1960-70
middot1Q701Q70
1 319 -12 171 -H) 1
2722 215-27 +68 301 366 -22 127 +35 302 371 +19 111 -04
311middot401 144-41 +29 402 321 13~7-39 +24 501 356 124-08 -02 5~O2 351 133-23 +12
405601 82-10 -02 394602 103-01 -06
701 275 149-76 +56 702 361 +01 121 -07
+10middot801 326 140-22 802 321 middot127
(
-29 -03 9~01 342 124 -H) 6-18 902 294 128 -H) 3-24
10middotmiddot -14312 140 -17 1101 182 +25 -23197
2411102 186-59 +29 1201 226 169-17 -41
31middot01202 +11 182 -05 295 -H) 81301 208 -H) 4
1302 331 +08 197 +04
14 323 +15 middot185 -08 middotmiddot15 329 +16 16~5 -13
-28middot 1601 332 131 +12
1602 356 98 +24middot-39 middot3101701 161-33 +21
1702 370 -15 85 +02 +19 1801 264 151middot-50
185middot1802 256 +47-58
IJ ~
D_raphlc Population Change 1960 to 1970middot 49 (Contd)
4io
Census Tract
of pop Uncter 19 Yra
1Q1n
1Cha1l8e 1960-70
of PopOver 65 Yra
lQO Change
1960-70
19 389 +29 141 -24 20 223 -13 206 +18
21 227 +08 194 -36 2201 356 -27 112 +05
2202 290 -18 ll~9 -29 2301 356 -03 154 +24 2302 260 -37 245 +97
2401 410 +6~1 123 -31 2402 163 -80 320 +99 2501 381 +13 140 -01 25()2 237 31 lil +02 26 343 +25 186 +149 2701 370 +29 1S5 -01 2702 249 -44 304 +98 2801 337 +19 187 +09 2802 306 -10 156 +31 2901 304 -38 142 +24 2902 i 307 -32 146 t3~9
30 29~0 -48 16~2 +51
31 355 +30 160 +01 32 370 +48 148 -13 3301 395 +45 130 -20 3302 368 +06 138 -02 3401 386 +16 117 000
3402
400 +32 92 -26 3501 304 -07 115 +35
3502 344 000 140 -13
3601
36~02 357 -04 132 +32
3603 30~1 42 149 -67 3701 342 +28 152 +19
1
IJ
Jianolraphic Population Chan 1960 to 1970 50 (Contd)
Census Tract
of Pop Under 19 Yrs
JJl7J
middotChanae 1960-70
middotofmiddotpop Over 65 Yrs
1c~7n
Change 196070
3702 409 +39 122 -11 3801 308 -11 151 +29 3802 275 -35 180 +46 3803 282 -32 192 +54 3901 376 ~13 100 +17 3902 296 -03 177 +29 4001 438 -11 84 +13 4002 353 -21 115 +20
4101 397 11 9middot0 +11 4102 346 -19 120 +03 42 331 +19 11 bull 3 -16 43 347 -72 105 +31 44 113 +84 183 +154 4S 33~9 +07 110 -06 4601 2501 22 193 +38 4602 332 +59 126 -29 47middot 161middot 000 211 +01 48 103 -26 302 +59 49 138 +1 bull 3 252 +09 50 141 -26 204 -12 51 12 -39 257 +07 52 47 -61 351 +48 53 89 +49 314 -30 54 25 l1li15 327 -17 55 131 -17 115 -121 56 198 +93 227 -47 57 71 102 189 -88 58 240 ~middot41 16~1 +55 59 322 +25 142 +06middot 6001 264 95 132 +50
6002 328 -31middot 89 +07
JJ
Demographic Population Change 1960 to 1970 51 (Contd)
Census 1 ofPop lChange of Pop bull ChangeTract Under 19 Yrbullbull 1960-70 Over 65 Yrs 1960-70
1970 1970
61 355 -58 85 +39
62 328 39 110 +18
63 414 04 73 10
64 382 -22 72 +04
6501 383 02 67 -20
6502 329 -56 96 +09
6601 391 +13 88 -03
6602 319 -59 97 +06
6701 327 71 145 +72
6702 331 ~67 83 +1-0
6801 365 -66 49 +01
6802 388 4bull3 54 +06
69 354 -41 80 +23
70 400 -23 68 -06
71 359 -48 72 +05
72 255 -88 82 +11
73 346 -39 91 +25
74 313middot -63 105 +24
75 329 -42 129 +37
76 336 -52 85 +21
77 370 -10 69 +05
78 309 -10 120 +21
79 325 -56 87 +10
8001 358 -81 57 +12
8002 391 ~81 76 +12
81 315 -76 108 +21
8201 403 -23 64 +08
8202 392 23 65 +08
83 357 -34 120 +31
84 402 -18 73 +16
85 413 -06 76 -09
r
Demographic Population Change 1960 to 1970 52 (Contd)
Census Tract
t of Pop Uncler 19 Yrs
1970
Change 1960-70
1 of Pop OVer 65 Yrs
1970
ex Change 196070
86
87
88
89
90
91 9201
9202
93
94
95
9601
9602
9701
9702
9801
9802
99
100 I
101
102
103
10401
10402
lOS
368
351
379
391
391
413
379
433
372
429
414
432
419
439
~32
377
457 420
378 41middot7
345
360 417
417
412
-04
-02
-35
-26
-28
-11
-64
-20
-S9
-39
-32
-21
-34
-40
-47
-lO~7middot
-27middot +04
+56
+07
-34 01
+04
+04
+10
103
128
97
11il3 99
69
79
42
77
46
34 38
44
40
54
111
51middot
81
133
59
74
140
63
87
76
-08
-06
+04
+08
+17
-05
+3S -02
+1~4
+19
+33
-14
-08
+12
+26
+71
+11
-16 -34
-20
-19 +37
-49
-2S +15
NOte The The
Taken frOi
averageullder averageabove
middotUSCensus ---shy -
19 years == 6S years ==
figures 197
32r 13(14
p a~d 1960
--
Rank
1
2
3
4
5
6
7
8
9
10
11 12 -_
13
14
15
16
17
18
Tract
69 46
60
58
- 68
61
302
2501
67
63
19
62
26
94
3603
3902
64
30 -----~-
Rank
19
20
21 -
22
23-shy
24
25
26
27
28
29
30
31
32
33
34
35
36 -
Ranking of Per Capita Income by Census Tract
Tract
65
2701
- 15
1601
701
66
93
82
2903
3602
30
2502
80
2401
81
- 70
91 shy
4001
High
Rank Tractshy
-32shy37
38 97
120239
7840
41 ~ _2_1__ 42 31
43 2501
44 18
45 98
46 37
47 3803
1702
49
48
1602 92 2702
I
50 89
51 901
52 801
Ra_
53
54
55
56
57
58
59
60
61
62
63
64
6S
66
67
68
TractTract Ra~
74692
170196 70 I
401 71 90
72 1037J
79 70273
3802 74 601
24024102 75
85 76 101
77 9023901
7699 78 100 4101 79
3601 I
380180
458140~ t---- _ - - shy83 82 42
888384
59843501
4777 8~
502
Low
802 86
Rank Tract
87 shy
--88
89
90
91
92
93
94
- 95
96
97
middot98
99
100
101
102
103
104
1201
14
49
72
73
43
87
3502
105
1
52
86
71
1
501
10
3301
104 tf
Rank
105
106
107
108
109
110
III
112
113
114
115
116
117
118
119
120
121
Ranking of Per Capitalucoae by Census Tract
(Contd)
Tract Rank
4001 122--shy602
13
1102 2302
3302
55
3401
48
21
56
50
3402
lL01
2202
2301
53
2201
-shy
Tract Rank Tract Rank T~aet Rank
57 I-----
Imiddote
bull
Tract
- Low -k Note Information taken from 1960 U SCensus
Rank Tract
I ~
Ie
Imiddot
~
----
----
--
--
Rank
1
2
3
4
5
6
1
8
9
10
11
i-
-Tract
391 922 921
972 971
100
132 131 121
962 961
822 821 401
982 981
20 111
47 10 1
412
High
Total Number of Henta1 Health Visits
Ranked by Census Tract High to Low
TractTract RankTractRank Rnk
12 182 22 78 29 87 76 381 73181 ~------- 1913 371 8538230162372 271 2616-121 8272 2
14 80~2 31 94 7923 84801 59 15251362 4232 15 52 _ 32 103 8924 651 17240216 652
_ 91 351 33 341 23117 83 122 25 25 48 1123921418 34 shy61 86 661
19 662 6493 81 26 91 8153 49 50 55 41383 71 27 51 3120 90 672241 35shy 104167162 461
I 411 46211121 28 88342 I
2502 36 69 54 5251 50 272
-Ra
37
38
39
_ 40
_ 41 Ishy
I
42 I
-I 43 44
45
shy
Tract
~ --- shy 95 56
45 292 242
102 62 352 291y
92
101 281
99 72 63 601 60~ 42 2201
77 74 61 57
363 232
70
32 31
11 44 282 2202
Low l
- Tract
46 682 681 I 331 30
r~$ 47 1042 332
48 102_41_
11
~
Visits to Family Planning Clinics Ranked by Census Tract High to Low
Rank Tract Rank Tract Rankmiddot Tract Rank Tract Rank Tract Rank Tract
1
2
3
4
5
6
7
8
9
10
11
12
13middot
14
15
16
17
361
56
401
341
48
59 121
20
55
342
10
31
58
93 21
241 132
331
53
461 462
18
19
20-shy21
22
23
24
25
26
27middot
28
29
30
31
32
33
391
32
middot47 I-i-_-shy _ -
231 111
332
972 1
372 371
52
89
32
92
82
100 31
182
30 242
402
34
35
36
37
38
39
40
41
42
43
44
45
42
1714 i 661 221
78 362 2
90 602 601 352
63 251
105 921
971 351
73 42 292 232
411 51
662
81 45 52
46
47
48
49shy
50
51
52
53
54
55
56
961
801
49 81 72 71
19
9~1
172
68 2 57 162 14 112
91 75 681
381 42
3~3
83 161
57 f
58
59
60
61shy
62 Imiddot
63
Imiddot 64
65
66
64 62 36~3 252
74 652 SO 392 291
651 6bull 2
79 271
r-- ---- shy981 222
672 671
821 272
94 87
281
382
67
68
69
70
71
72
73
74
75
76
77
78
981 26 12~2
IS 61
85 82~2 69
61 43
101 86 84 282
76
131
51 72
1041 962 88 70
99 922 77
103
95 802 181
i
~
Low High
RankRank Tract
5479
4480
81 1042 ~) middot102
71 - - + ~ - ~
Visits to Family Planning Clinics
(Contd)
Tract Rank
I
Tract llaDk l
RankTract Tract Rank Tract
~
I
~
J1 ~
Low
Total Number of public Health Nursing Visits
Ranked by Census TractsHigh to Low
TractTract RankTractRank RankRank TractTractRankTractRank
25249 71 79 17249 8033 6586 99189711 84 2915072 34 661 76 66 811519512
402 5035 51 161 2518220 122 1713423 352 55801 7120 6752 2 149814 41236 83 2662 38 94 6821 53 2924015 362 37 32 42 75 69 281 84 63
546 8822 54 222 85 3925431 70383417 3818223 6439 4386652 718 21 55 103332 8924 232 87 19 271729219619 24156 16211140 382 628825 10523110 112 73411 10141-- ----shy 89 363 4457 8126 16111 221 74 9142 90 46158331 53 671279012 46243 48 59 351 3837528 1083 9313 91 5844 59 -_242 76 1----- shy60 272 72 74104114 60145 42 9287 7729 92 6151 8215 57371 934630 91 307762 12113116 282 619447 41391 9531 78100 63 7378 ~95 681 6945 32 5632 798517 6448 47 52 181
High ~ Low
Rank Tract Rank
96 31 132 70
97 102
98 182 372middot 602 651 662
- -shy
~72 682 802
822 922 962 972 982
1042 ----shy
Low
Total Number of Public Health Nursing Visits
(Contd)
Rank Rank Rank TractTract Tract
I
I lt
I
Tract Rank Tract
[
~~~-
I
~
IJilfimiddot ~
j
Ranking of VD Caea According to Census Tracts 61 By High and LOll Youth Itatio
A media~ of 34 5 was determined Any tract having greater
than 34 5~ of popu1tionunde~ 19 years of age -High~
Any tract having l8S than 345 of population under 19
years == Low
Any tract having rate less than 390 =Low
Any tract having rate more than 390 == HLgl4
YOUTH
LOW HIGH
L
0
12 402 1801 1802 343 2801 2802 29023603
54 6001 600262 66~02 72 74 75 76
78 79 81 t02 65 1202
W
(25)
VD
H
I
G
H
401 701 801802 901 902 10 1101 241 1201 1301 132 14 15 1601 1701 20~ 21 2202 2j02 2402 2502 2702 2901 303501 3502 34023801 3802 383 3902 42 44 45 4601 4602 47 48 49 SO 51~2 53 55 56 57 58 S9 6701 6702 73 95
3~02 7021702 19 25~01 2701 4102 4101 63 64601 ~601 6801 680270 7l 77 8001 80~02 8201 8202 83 84
85 86 87 88~ 90 91 9202 920193 94 9601 9602~ 9701 9102 9801 9802 99 100 101 103 10402 105 6501 10401
(47)
301 501 502 601 1602 2401 2301 2201 31 32 3301 3302 3401 3402~ 3602 3702 3901 400140 02 43 61 69 B(
(53) (23)
~ ~gt
Ranking of VD by Rate Per 100000 By Census Tract
~
Rank Tract Rank Tract Rank Tract Rank Tract llank Tract Rank Tract Rank Tract
1 2202 21 S6 40 902 58 1602 74 75
90-shy 64 107 26 --~-
2 3402 22 45 41 10 59 902 75 78 91 54 108 61
3 2301 23 3502 42 2502 60 602 76 6802 92 402 109 87
4 3302 24 49 43 1102 61 501 17 2 93 94 110 90
5 50 25 52 44 6702 62 14 78 8202 94 97 02 III 76
6 2201 26 20 6701 63 4002 8201 2501
9701 41~02 112 91
7 44 27 48 45 401 64 3802 2902 95 63 113 62
8 3301 28 1701 46 502 65 30 79 83 74 96 9602 114 71
9 55 29 47 47 42 66 3803 80 2801 96Q1 115 85 10
11
12
13
14
15
16
17
18
3401
53
2302
2401
57
21
2402
1101
51
30-shy31
32
33
34
35
36
37
3701 - -~ 1201
3702
89
43
132 131
3602
4001
48
49
50
51
52
53
54
55
58
1601
601
4602 4601
69
701
31
3901
67
68
69
70
71
72
2901
801
39021~ 802
6502 6501 122
702
41~01
81
82
83
84
85
86
87
88
19
1
1702
2802
79
93
100 6801 6602
81
97
98
99
100
101
102
103
104
9201 9202
9802 9801
77
302
79
86
72
84
116
117
118
119
120
121
3603
8002 8001
101
99
95
10401
105 10402 103 102
19
20
59
32
38
39
2702
3501
56
57
301
3801
73 1802 1801
89 6002 6001
105
106
2701
88
High Low
-- -----
Rank OrdermiddotTuberclosis Cases by Rate Per 100000 Ranked by Census Tract High to Low
Tract TractRankTractRank Rank TractRaukTractRankTractRank
801
79 9601501411 52 6835340120511 I 960269 903603532036 $-~~F130221542 4366 311301 70 68~013802 _ I- _ 4001_37213 3921201 6802802 H71523822024 22 54 193302 3802 80 8958 I37139535 70155 9801 I60123 72 6702 98023914011016 6701250124 10 56
81 94 401r 7 154152 73 7057 2625 122 92028
90242 162312301 92~158 86 7172434526509 82 79160159 74 100 87412240227220110 6502836960 75 30 8317244 6501782801285711 61 901 42765645 84 66021459294912 9701 660146 171 302 9702 47
6235023033113 85 822821182 917755 16335013110214 841814832 78 103 938564 324815 86 1057940149272 38036523216 10401 87 2902241 725Q 10402360266340217middot IF88 88 9937233 282 51 218 101 01102 46016234
I)167 2901460219 47
High ~ Low ~
- -
TractRank
9S89
6490
8191 8001 8002
63 61 60middot01 6002 44 2701
92
J
2502 402 --- ----shy
I
Rank
Rank Order Tuberculosis Cases by Rate per 100000
(Coutd)
Tract Rank Tract ~nk
I
Tract Ballk Tract Rank
Imiddot
Tract
Imiddot
1~
t 1I i Pi i l I
o
1 -1shyL I
I J
8 40 icO ~ I -lt 0
-t (1) I
i I
r o E
II
a
I
r--i
shy
I
~
I (
Jgt
(011 fi(
Ggt
I II ~j
()
(f 0
~ ()
I
11
f9
r
II 99
o ~
Ggt r
~ __-J~ I t I ~ I
r--J l I
~ _ __ J
) 1
fTl
1gt
r I
()
r
()
lt en -i en
()
I1l
(J)
(J)
-i
P ()
19
r o ~
r G1 I
I
c
~
o I 89
--- -I-shy
r-r I
1- 0 _~ _ _--J E
G1 I I I
i i
I 1-1-1 ~ _J ~2 ~ II
II
()
1 I I I 1
id i bullbull
~
A n 69
r 1shy
- 0 Gl
l--~ ~ I
~ II
II )
I () isect i
en l i
(J)
-t
0
IA Ol
9
b_dloallYUDaoptdatlcaW4lberefore th past decade
babullbullbull~ bull lIOYeaeftt to evolve DfW torms ot health care
and new types ot health oare institutloDS providing
comprehensive oDlOiDI care rather thaD trapented care
There seems to be little dispute in the health
aboe requ1res both an lDtesratloD ofprev1ously uncoo~
ditultec1 health care ervlcbullbull brlDSins tolether into one
alency what Johnaon (21 p362) reterred to as bullbullbull the
concepts ot cOllPrehms1veIled1C1ne andpos1tlve health
andaporpph1cclecctrailzat1on ot ervlce dellvery
he NatlODal CoimD18810D0D CouD1ty H_81th Services
report Health Care gilitis (26 p37) suggests
proYic11Dl compreheDaive health care services by centrashy
llz1Da a varlet ot publlc and prlvate healthcare
tacllities 1ntohealtb campuses However as Kahn
(22 pp274) states amppeskin ot soclal servlces in genshy
eral bullbull bull if the loal ls to develop a service-delivery
approach that improves access taclltates teedback 80 as
toadapt to user preterence8nd prlorlty and maximizes
case 1nteptatlon aDd accountabl11ty the base of the
total 80clal service system Should be tnthe nelSbborhood
Dec~tral1zatloD not only makes services IIOre accesslble
but allows therv1ce to be tailored to the Deeds of the
10
areaDe Diaz (14 p3) indicates the importance of
being aware of groups in the neighborhood with special
health problems such as elderly people or large families
witb yOlmg children This means that it is important
in planning to be aware of the demographic features of the patient population This will be considered more
thoroughly inPart II of this report
Kahn (22 p275) continues however to indicate
that more than the improvement of service usage is I
involved in decentralization and that decentralization
ot service delivery also represents part of tI a general
search to break down cities to human scale for some
purposes on the assumption that people find it easier toshy
relate to a neighborhood orsection and to its populationbull
bull bull bull Thus the organization of services at the neighshy
borhood level bas the added purpose of contributing to
the search tor neighborhood n He adds that this process
i8 more relevant it there is a measure of local control
over as well as local availability of services
Kahn indicates that decentralization is not a
viable goal in some circumstances These include situashy
tiona in wh1chthe need for a particular service is too
TJI t
-
11
little to justityits proVision in a l()calun1t where
skills or resources are too rare to be provided locally
or where the costs ot decentralization vastly outweigh
the benefits He Visualizestheult1mate emergence ofa
h1erarcb1c81 patternofserv1ce delivery tnwhichcertain
services andresp0D81bilities are middot1ntegrat8d1Dto the
collimun1ty at thelooal level Other more specialized
services relate to larpr un1ts of the colDlllUD1ty such as
eomb1nationa ot neigbborhooc18 Veryspecialized services
are to be delivered at city countystateop regional
level8 fh1slevel would al80 be the seat ot prosram
coord1zaat1on staDdardprotection and evaluation 811
of which call for cons1deZable centraliZation for overall
program adm1 nlatrat1on(22 p275) AlthoughKahnt s
model was not developed specltlCally tor health care services 1t1s quite relevant- and appliCable to health
care service delivery systems
Omiddot Donnell (27 p3) reviewing the 1iterat~e on
service delivery and social action through neighborhood
service centers preseJJbB a list of characteristics
generallydesirable in ~eighbOrhood service delivery
centers Firsthe states that the center should be
accessible It should be in a physically convenient
location and should be open evenings and weekends as
well as providing at least em~rg8ncy telephone coverage
t
~ II
12
24 hours a day
The center should als~ be irDmed1ate in 1ts funcshy
tioning That is the centermust have the capacity to
provide prOmpt efficient service and should be able to bullrespond to problems middotwithout long hours ofwalt1ng and
many rounds of apPointments
The centexsservices should be 6omprehensive liThe
center should offer a full range ofusable oil-the-spot
services or easyaccess to other resources by available
transportation It should gear itself to the needs that
peoplehaV8-especially poor people-and provide for the
slmultaneoushar1d11ng of problems were possible
SerVices should 8180 b 1J1tegrated and coordinated so
thatseMces can more effectively be provided
The operation of the service center should fInally
be responsive to the needs and desir-es of the neighborshy
hood It should provide ways in which reSidents can
shape th~ program and continue to contribute to its course
and development It should be relevant and ready to
respond to changing needs II
The concept of the comprehensive neighborhood health
center developed by OEO (31 p324) has been described by
severalwriters Yarby (37 p73) describes it as an
outpatient racility which has certain def~n1te characshy
teristiCS middot1 Accessible to a poPulat1on concentration
bull 13
2 Open 24 hours a day seven days a week 3 Family-centered c~e by a team of lnteniists pediatricians clinical and publichealthnurses and social workers 4 Availability ot frequently~requ1redspecialist in such fieldsaspsycbiatryobstetrics gynecology surgerY5 Con~1nu1tyof doctor-patient relationshyship 6 Family records with social and medical ~raquomDaries of relevant information about each family member 7 Basic diagnosticlaboramptoryand x-raytacl1itles and drugs and biologicalsavailable atthe center 8 Directline (1)y center-controlledambushy
lance when-necessary) to ateach1nghospltaifor cl1agnostic ~d therapeutic servlcf)srequiring the fa011itlesandpersonnel of thehospltal 9 Patient-cantered and eommUn1ty-oriented -
The range ot services in the comprehens1venelghborshy
hood health center shouldbe as complete as possible
inCluding preventivediagnost10 treatment and rehabi-
litative services and Sbouldbe deslgnedto eliminate
episodioandfragmented services (31 pp324-325) Schorr
and English (33p291) add as additional characteristics
ot the compr8henslveneighborhood health cent~r that it
should ~ve intensive participation by and involvement
of the population to be served both in policy making and
as employees and that it should be fully integrated with
the existing health care system The Office of Economic
Opportunity (28 p63) stresses the potential for easing
health manpowershortage$by trairiing local neighborhood
reSidents as non-professional health aides at the same
time creating new job and careeropportunitles As
14
Gordon (16 p bull 422) indicates Many of the outstanding
problems in medical practice todayrevolve around
effectively motivating the patient and the prospective
patient to be concerned with his health This is
especially true in a deprived environment The community
health center with its technique ot consumer partici
pation maybe a way to create this cooperation effectvely
It is important to note at this point that the
comprehensive neiShborhood health center haaas its
constituency an integratedmiddot community r~ther than a
particular segment It should haveas Blum and Levy
(6 pp~5) indicate a horizontal rather than a vertical
relationship with the commuriitybull The vertical relatlonshy
ship they state is characteristic ot those service
organizations wh1chapproach the community only in terms
of their own fUnction Tbey see only their relationship
with the users of their service and assume that problems
of accountability will be handled by these consumers
However they pOintout this ienot likely as a vertical
approach creates dependency onthe institution Agencies
in a horizontal relationBhllp recognizetha1 they have
both acommunityand a consumer to serve The horizontal
approach places the matter of accoUltability on a broader
basis than just the involvement of the consumer De Diaz
(14 p4) speaks otthe need to ~develop a community
facility which difters from a clinic for low income
1ji ~
15
people in that it should serve an economically integrated
community The reason for this is that a wide variation
of consumers may assure a better quality of care
The advantages of the comprehensive neighborhood t
health center over traditional systems of providing
commuruty health services are numerous Hospital outshy
patient departments a major traditional source of ambushy
latory health c8refor poor patients have been indicted
for neglecting preventive health care ~romoting fragshy
mentedeare and subjecting patients to degrading and
impersonal conditions to mention only a few of the major
defects (31 p324) Another defect has been the
tendency to shunt low income patients back and forth
between different cliniCS often at different locations
arid with differel)t open hours for different treatments
or tests in regard to the same lllness(26 p63)
The comprehensive neighborhood health programs that
have been organized present a great variety of organishy
zationalpatterns one area of difference 1s in the
emphasis placed upon making each faci1ity comprehensive
in the services it provides to the patient population
In the Montefieri Hospital Neighborhood Medical Care
Demonstration program in New York City services have
been made available through a central health center and
two store frontsatellites the center to be the base
bull
Li
l of opratiol18 of ta1lJpIlflicl- ancl the satellite
center the ba of oparat1oDa of public heaJth nurses
an4 nllbborbood amp1 be satellite centers wereto
proVide preVentift tutaltll bullbulln1c1-m1zaticms w811shy
baby care per1od1c ~ectiland tJle central health
center to proViAle care tor illnes If (36 p299)
bis propWI VUDOt ~ttullytunct10DIDI at the t1JDe
it d1cu8ae4 18 tbe Uterature aDd all aernce Were
be1Dl provided 1D_~terBowever itwould ae
tbat the ntua1pro~ as aY1ioae4by its plmmers
would boclJ aoaeot bull 4efeot~ otthe current lud1cal
ccde teaIt pObullbulllne_t coorctJl8td admSDtshy
etration eD4 well 4eftlopecl refelTal procedtlreacould
1I1a~ thecOllDeCticmof t~_t8 withappropr1ate preTellshy
t1 aD4 therapeu1ampcaen1cbullbull aV81lable 111 diffrent
locationa Bowner tile barrieraottiaeaDdUatanc
between center and truaraUon tor the UDSopb1aticated
patieatlook1Dl tor 1her1~pJce too tor ~1CU-
larhalth serfplusmnQewoGl4~to JJa1t tbbll1ty o~
tb18 ~811D to provide iaaiYCOliprelleU1P18hboltleod
health servicebullbull III tactmiddot tappeareto coDtlict with
tbepro own taW cOfdotpro-1~a tam1ly
mecl1cal careprogru 111 wIa10h pre-teAtlYe aDd therapeutic
health erY1cecan be proY-lW to all IIl81Ibers of
tamily in the coure of aaSDll vi8it (36 PP301-3(2)
Dle Delmtr Coloradoprepa11ke the Montet1ori
LI
17
prograJlut111zbullbull abe1rarcJly ot SlDa11 aatellItestations
andlerer IIOreceDtallzedtac11It1es It 41ffers
howeverill tbcolap~81vene80f the services avail shy
able Inthe 4ecentraUzed facIJJtiesIt resembles very
clc)sely the IOdel ~ordecentral1zed social servicedell shy
very developed by 1ahII~ Which was 41sCussed above he
SIlall neImiddotgbborhoodmiddot c8Dt~aw1tb1n walkl distance of
most of the populatiotl havebeendesilDedto take care
of allthenorllalhealth probl of 3000-5000 patJentsshy
check-ups IlzatiOZl8s1Jlpl laboratory testa and
treataentand iaecucatlol18 (d1apeued by phyS1cians) for
IIOst DODCrltIcal 1l11le PatIent 1d1Oneed IIOrespecIal-
Ized care are reterrecttobacJalp facilities BaCkup
support tor themiddot~t1oDa are the tWo l8rsernelshborhood
health C8Dter8~ttr1Dl aCOglete~e of out-patient
serneeaDd three part1clpat1q hoap1iampl bull bullbull which
proVide1Dpat18Dt~t andcoDSUltatlve services
(13 p1028) Intb1a prosrama coaprehens1ve range of
prevent1ve aDd trea1aeDt serric 18 aVailable throughout
the decentraUzed middotta The CoapreheulY8 ReIgbborhood Hea1~ Service Project
otKa1er iC)UDdatlcm HOspitals 111 Portlan4 OreOD 1s
s1ll11arto th DenVer prosraa 1D thata comprehensive range
ot out-patientmiddot services 1D prov14e4 in each of 1ts 10cashy
t1oDa althoUlhmiddotmiddot tbe oentera are larger and l bullbulls DDIerous
than 1nth DenverproPUh (12 p6)
Li i
18
In order that a comprehensive neighborhood health
care center be able to proVide continuity of care it
must have arrangements for hospital services integrated
into th system Yarby (37 p73) as quoted above
states that it 1s characteristic of the neighborhood
health center to be directly connected with a teaching
hospital However De Diaz (14p3) indicates that it
may be advantageous for purposes of service delivery not
to havemiddotthe center affiliated with a teaching hospital
She feels that such anaft11iation may lead to asltuation
in which policies might be determined more by the teaching
needs of a medical school than by the service needs of
the patient
middotThe Nat10nalmiddotCommissionmiddoton Community Health Services
(25 p69) states that such a system of comprehensive
health care integrat1na ~e servicmiddotes of several health
and roedical agencies snould utilize Itas much single or
unified management as possible Neighborhood health
centers have been operated under a variety of auspices
but several writers have pointed out the advantages in
termsof coordinated prOvision of servictts management by
the hospital of the neighborhood health center For
instancethisfac111tates the keeping of unified medical
records of all the care a patient Msrecelved either at
the neighborhood health center or _le hospitalized
(12p6) ~ermore a3 Young (38 p1741) points out
19
direct operationot the u1sbborhood health oenter by
the hoSpital canll8lceaftilable to the center expertise lt bull
in sOlle aapcta 0 Operation that m18ht not be aa readily
available otherwie
Relardlebullbull of wbetberthe hospital and the neighborshy
hoodhealtbcent8r haVe a cOJIIIOaadmjntstration they
IIlU8thaVealTlved at a str1Dsent delineation of IDUtUal
role and reSpoDBlbilltiebullbull All OOIIpoienta ot the care
yst IIlWStQlarify and understand one anothers position
In the syatem and acree on objeCtive ancimethOds
(26 pp16-17p31) SODae areas of iDUtUalconcemare
reterral procedures record keepiDg aDC1 mutual use of
facilit1es statt1Dl i8 anotb8r ~ ot coaaon conc~
Ditt1cultift have u-laeniD the pastiD cOllprehensive bull t bull
healtbc~ prosraumiddot 1d11ch were batil plauned in wb1ch
all of the health canter phy1C~1IDa did DOt bavetatf
privilege at all ot thebackuJlhospltala (29 p21)
SUch a8ituat10n i8 1Dampcceptablelt inpatient care i8 to
continue to be p4by the pat1eatmiddot health center
physician and it cont1Du1ty ot care 18 to be maintained
Hoapital and health center1lUSt laav 301nt responsibility
tor the recruitaentot physicians
VticlentU IPan BJcNrcu Much otwhat haa b8ea sUd has stre88e4 at leastmiddot
iJlplicit17tbaD8ed tor tM etticit middotprovision ot8emcea
20
There appears to be two aspects of efficiency which are
discussed by writers on the su~3ect of the comprehensive
neighborhood health care centef one of these is the
need to organize) services to make the most efficient and
economical use of scarce medical care resources The
other closelyrelat8d in realIty is the need to help
the public use services in the most efficient manner
The comprehensive neighborhood health center concept
1s lhherentlymiddot efficient in that preventive curative and
rehabilitative health ~are programs are coordinated under
one roof with integrated a~stration Furthermore
theempbasLson prevention health education and early
disease detectionis eftic1ent troJll~estandpoint of
the health care system as well as beneficial to the patient
(18 p760) HQwever ~ue tothe scarcity of health care
personnel thecoiDprehensive neighborhood health center
mustbe an arena tor eXperimentation with new staffing
patterns~ The Kaiser program is indicative of the way
in which health care systems must begin to operate in
that appropr1ate ancillary personnel are used Wherever
possible to perform functions that do not need to be
carried out by the physician As Saward (32 p42)
states
1hroughou10ur organ1zat1on~ there are many of the customary experiments be1ngmade-shyJse of speciallr trained nurses for well-baby care under the SUpervision of the pedi9trlcianexperiments with routine prenatal care by
w ~
21
middotSPC1a1l~t~JlUrbullbull per8ema_1 bullJmdlJleu y our fuDotlou are auoh that DOtb1Da 18 dorutbYtbe phY8iCianstbat doe DOt vet to be done by the
phys1c111U1fhe other aldlle4 person- Del-nurse middotreC~0D18t the appo1ntshymeDt center or clerical praormelshyaremiddot there to free h1amiddotto use his spec1al sk111
Awell lmoWn treDd1D the area of eaaiDI health
c8re JII8DPOY8rShortagjs bas middotbe thetrend toward tra1nshy
1DB poverty area rea1deats as DOD~pro~eaionalmiddoth8lth
aide and nepborboocl health workeramiddot (28 p63) This
bas the effectofmiddotmiddot1J)creaa1q II8DPOWrand 8180 can help
bridle the cuJ~ cap betweenprondera and colllUmers
of aen1C8s This attarD at least tlleoretically
createa a situation 1D WIa1ch providers andcoD8Ullers can
be educated to UDderatad OD88DOtber and interactJlore
ettectlvely~ HoWever amiddotpltt8ll has beeD themiddot tel14ency in
801D8 oamp8e8 tomiddot us aidesmiddot ssale8lllcw t~r the center
alJDOatexclwdY811rathertbaD ua1Dltheal to protide the
health care for wh1ch ~ were trained (29 pp3B-39)
1bat ismiddotmiddot vh1~e the a14e Yalue in ~~m1catiDI with
low 1nCOlMt patieata haa beeR recoSD1zed and stressed
their role ashealtb carepersoDDelhil been slighted 1n )
any 1Dstancea
Anotber step 1d11Ob bullbull been taken to provide 8rY1ces
more efficiently eUeot1ftlybas beenmiddot theorgan1zation
of per8ODDeliDto IIllt141sc1pl1Dary teamaaaa means ot
proYid1DgmiddotCOQrd1DatedserY1ce SUch te8lll8 sen_rally
~
hf
~
22
include PhYsiciaQs nursbullbullbullbull soc1al workers and outreach
workers Conceptually th8y fmlct10n to me~ the intershy
relate lled1cal and social needs ot the families sened
Hor there are a number ot barriers to the etfectve
tlmctiOD1nlof lIuchte8ll8 SODieot these are heavy caseshy
loads the inordiDate amount ot tille consumed by multlshy
prOblem tamtliethel1m1ted tra1n1 ngmiddotmiddotand laCk of tnterest
on tile part ot aoae tebers in examinJng aspects of
problems out14e~lr oWn areaaotcolIPetencemiddot and
~ourdcation prc)blell8 between proteasioDala and nonshy
prot81~s (10ppa-10) middotrurtbemOre as De Diaz
(14 middotp6)1nd1cate tbel8 maybe a teDdency tor vertical
dp8rtmental lines of auperv1810nto become paramount
over the team coDamloation syst lead1ngto conflIcts
in determ1niDI the ro1ea ot solie team bers particularly
the DOD-prote81011alaInauch exper1l1enta Witb new
~t1Dlpatterna it 1s bullbullaentialtbat line of authority
roles aDd NsP0D81bll1tlea be made explicit and that there
beJDechaD 8IUI tor relUlar evaluat1onotfunctlorUng
Another way inwb1ch health care sernee delivery can
be made more ett1cl8Dt is to proVide servicea dur1DC the
hours whentbey aremiddot -ostnee4ed As reQo_ded by Yarby
(37p1) serY1ce can bemadelIOre accesslble by making
themava1lable 24 hours a day seven days a week If
rg8l1Cy service are aft11ab1e aroua4-tbe-cloek at ~
nil1iborhood health center the continuity ot tbepat1ent ts
23
careiamaiDtalDedand meatry point into the
cOIIPre~i health care 8 be made available
tothe patient who aoZMllyU8ea ozilymiddot emergency care in
tille of med1cal criais More 8isDificantly ava11ab1-
lity of a tull rase of bullbullrv1c8 tor seVeral hours 11the
eVerlna aI1Cl On ~ prevent the los ot earn1JiSs
involved if th patierat 1IU8tt8cet1me oftfroawork dur1q
the d8y for aed1Cal oare bull his can be an eSpecially
importantc0J1814eration tor lo1aCOlleDUUg1nally qloYEtd
patient aa4caJla18o PIOJIOtet1)e 0Da01Dl use othealth
servicebullbull
exper1eDO ot tbeKa1er prosraa in tb1s~reprdAs
Greenl1clt(19 p10) states wA lllNt 8ip1flcant
proportion ot the abulatory care 8n1cp~Y1dd tor ~
total popUlatiC)U ~ ~ after clWc hours and this
Deed i8 apParenUyaoN prODGUDced tor aJl8d1cally
iDCust population On the other hand the bulk ot all
aabulatory med1cal cu 88l91ce are performed dur1nS
regular cl1D1c hour eVen when services are available 24
hours a dayJ day bull week W
It has ~ the experi8D~eof a ftIDber ot ne1g1lboXshy
hooct hea1tbcentere _t a_jor obstacle to efficient
proViSion ot anicbullbullhas beentbe teD4eDcy of medically
1ncl1pnt patieats to utilize the center oa a walk-in
baais tor epi8od1ccr181or1entect bullbullrv1cea rather than
4)i
h~ ~~f ~~ L
24
to make appoJlltaeata tor ODIo1qprevmt1ve treataent
and rehebl11tat1Ye care ad ampl1O to bave a blah failure
to Show rat_for tbe appo1DtaeDts that they dO make
Atone center 628 of appo1Dtments made were kept
while 3Oottbepati_ta een were ~1n patients
AlthoUP fewer patiets were actually 88811 by the cater
1D middottb1s 1Datance thaathe -bervholuidmadeappointshy
mta the walk-iD patlat required an iDord1nate amount
ot staff t1ae tor aCreeDiaaacl ~trral to pplOprlate
~ttor caregt (9 pgg) Arraquotbr1llpl1catjo~ of the
plOVidedto valk-iD patient by other thaD their
(19 p12)rurtbermore
when patients uti11ze Wlk-1Il er181 centered care
athelr ODlf tona ot ootact with the _d1~ care
ay_ta fUilycentered care the treata_t of tUl11y
bers
a a UD1t 11
dlarupted
hewalk-1Dphenoaaencm appear to barelated to
diUerence between soclal clase in the style of Dlaking
contactJt1th the a11oal C~ay8t As Greenlick f ~
(19 p11)1Dd1oate8 thepheDOaenOn ot INater usage of shy
walk-in ervice by aed10ally middot1Jid11ent patient thaD by
others baa otte been attr1buted to a stoical att1tude
tQward 1llDe8 em the~ ot poor people leacl1D8 to a
~
25
greaterdelay1n tbe k i Dlofa8d1cal care These
patients wppoedlyeelcmiddotcareODlymiddotwIleD tbeirmiddotillDess
becOlles1Dtolerable resultiDSin middotthMr appeariDS withshy
outnot1ce1o rece1ve oareHlwever Greenlicks
r8aearcbbaa cut doubt on the existence ot tb1delay
111 report1Dg middot8J1IPtoJumiddotOfDeW 11laessand seek1ng care
Be bas tcrQDd 1bat s1ll11ar peze_tases of dioally
1nd1sent 8DClJ1on-aed1cally 1Dd1PD~ pat1enta seek care
on the aue daytbat aptou tirstaPPear
1fb11e GrHDllclc 1nd1cat tbat the reasonator the
greatertendeDCY of low 1Do~e pat18Ilta to 1$8 walk-in I
serY1ces are notlcDo1rAmiddotmiddot tbe7 _ be rel~tedto a tendency
ot lower aocio-ecaaaoclaa patieota to preter face-toshy ~
face contacts with II841cal persoDl181posslbly because
such contacts areft coatortiDS an4reasauriDS to
patients who are hJpotbeafzed to bave a dependent attltude
toward IIed1Cal care perS0Jm81 (30 p161)
It a8 itmiddot baa pnerally beenhld the appointment
s1stemts the most efficient Ileana of dellveriDS
comprehenSive oODtllluiDlh-lth care (9~100)1t is
necessary that educaUoraalmiddotbulltfort be taken to proaote the
use ot middotappo1ntaents8DClmiddot tQrec1ucethe fa111re to appe~
ratB4uOatioaalwhlQb baft~utl11zedhave been
IJ
26
1Dten1ews with walk-in patients home Vi8its and group 4i
meetiDp1D8D attemptto1Dierpret1o the patients
the value of rtitgular ppo1ntmentamp andot con~in~
c~1ve care rather than epiI041c care (9 p1OO)
h1s 1safuD~tioD torwhtch nOl~prot81QDal colDlllUD1ty
YOrkersllaY bebe~r8U11ed tban other statf H()wever
euch aD ~ucat1oaal propul __~ ~e related to the senUiDe
capacity otth health oenter to provide comprehensivebull gt
ervice8 to1tpat1_t~odoD aD app01ntment bas18 It
1amp pos8ibleo~rw1 tor educa110Dal ttorts to result
LD a~8JImCl tor ltPP01ntaen~8 at a ratewb1ohi8beyond
the capacity ot thee_tar to t without uareaaoDably
1_ wa1t1Dlprio4a QOBt1nuad use Ot the center on a
wallt-in bU1 _1tbeoosiItpos81ble to et an appoint-
met anc11nCreued pit1entcoJaplampia1a bull Therew111 of
course always be a need and demand tor acute ep1so~c
Care -ci the health centerDlWlt be planned with the capashy
billty ot bullbullbullt1D8 tb1aneed wh1~ cont1Du1nI to stress
aDd educate the patient to utillze oDlOinI comprehensive
faa11y middotc~te~d Cflre (9p 100l
att g4 CODClva1opa
In order to bea4equate any coJlltemporary health care SY8tem muat bullbulletcerta1D interrelated criteria he
IJ
27
minimum criteria areaccessability of services to those
who need them compr8heX1siveness and appropriatness of
services and efficIency 1nthft utilizat~on of SCarce
health care personnel and resources The scareity of
pex-sonnel andtbe need for h1gh quality ongoinghealth
care services
aJIlong the
populationdemanci the most effishy
cientprovision of services
Services must be made accessible to the population
They mustmiddotbe geosraPh1cally accessible to remove the PhysicalmiddotbaTiers betWeen peopleandthem$d1calcare
system They mUst otter their services dur1ngthe
hours when people can make the moat use ofthemA~ it
makes little sense to concentrate services geographically
where they will not be uSed to their fUllest extent it
also is wasteful to provide serv1cesonlydur1righours when
many people are employed his not only presents a hard
ship middotto the consUmer lnrt wastes resources if for instance
the unavailability of preventive services during the hours
when people Can use them causes a need for treatment
services later on
Health carbull sEtrvices must be comprehensive including
prevention treatmcmtand re)abimiddot11tation Ambulatory I
healtbcare facilities wh1cQ are orienteciexclusively
toward either prevept1on or trea1mentare no longer accepshy
table for they are lneft1c1entln their use of resources
and in their prov1s1on of health care to the patient
w ~~
28
If prevent10n1s notmiddot stressed treatment serv1ces that
could have beenavoidedY1l~ be required If prevention
1s the sole focus of the health care facility sick
patients who present themselves must be referred elseshy
where for treatment andsllch referx-als may be taken as
reject1onsor not followed through with until illness
becomes unbearable
The instltutlontbat meets these requirements Is
the comprehensive neighborhood health center It 1s a
local decentralized outpatient facilityprOVld1ng a
fUll range of ambulatoJY health care services It has
a linkage to ahospitalbackUp facilityforlnpatient
treatment and hiihlY apclalized outpatient care
The neighborhood health center must be a fac11ity
planned with an awareness of the needs of the conSUtller
and coDitnUn1ty It must have the r~Ul0urces to provide the
services people need mere they can use them and when
they can use them It must uti11ze the part1cipation of
the community to develop this awareness Not only must
the cen~er beset up to be Amctional for the consumers
but efforts must bemadeaga1n with commun1ty partici shy
pation to help the consumers utilize medical care
services effectively The center muetmake efforts to
educate the community about the valueot regUlar health
care of preventive servicesand of the use of planned
IJ
29
medical appointments ratherthanorisis centered walk-
incare Therealit1es of the existing health care
system have not taught the patient particularly the low
income patienthow to use services effectively
The helthcenterilUst also bea laboratory for
experiments in easing the health caJepersonnel shortage
and c60rd1Datingcare~ A major difficultY iri-exper1shy
menting with neW rolesis freeing staff of old preconshy
ceptions
CoDlprehensiva neighborhood health dare centers have
been developed under a variety ot alisplces including
medicalsociet1es hoSP1talsmiddot(36p299 group pr~ct1ces
(29 p6- 12 117) health departments (13 p1027) and
ne1gbbothoodassoc1ations(14) The literature indicates
somevalues nthe management ot the health center by plusmnts
hospital backup faCility Whatever the auspices many
adm1nistrative fuDctions such as program coordination
standard pr9tectionand evaluation call for considerable
c~tralization of adm1nistration city-wide or coU)tyshy
wide At the same time other aspects hours of servlce
for examPle~ cuI f~radm1nistrative fUnctions made atmiddot
more local levels Each neighborhood center must be
free to adapt its functioning to itscominunity thi-ough
the mechanism otcODlllUl11~ participation inmiddot policy making
Obviouslythe prerogatives and responsibilities of each level must be negotiated and made explic1t
t4~
JJ
BIBLIOGRAPHY 30
1 American Rehabilitation Foundation ~ealth Services Research Center The Health Maintenance Strategy mimeo 1971
2 Anderson Nancy N Comprehensive Health Planning in the States A Study and Critical Analysis Institute for Interdisciplinary Studies American Rehab ilitation Foundation 1958
3 Andrus Len Hughes Comprehensive Health Planning Through Community Demonstration Health Projects mimeo1967
4 Barry Mildred CandCecil G Sheps A New Model for Community Health Planning unpublished paper presented to the American
Public Health Aseociation1967
5 Blum HenrikL Fred Wahl Genelle M Lemon Robert Jorulin and Glen W Kent The Multipurpose Worker and the Neighborhood Multiservice Center InitialImplications and EJeperiences of the Rodeo CommunityService CenterAmerican Journal of Public Health58 (Mar 168) pp 458-468 shy
6 Blum MichaelD and Soloman L Levy A Design for Service Delivery that Reinforces Constructive Tension Between a Health Center and Its (sic) ConSUDlers and Supports Community Power unpUblished paper presented to the American Public Health Asaociatiltn 1968
7 Brielaud Donald Comm~ity Advisory Boards and Maximum Feasible Participation American Journal of Public Health 61 (Feb 1971) pp 292-296 shy
8 Burns Eveline M Health Insurance Not If or When But What Kind Madison Wisco~sin University of WisconsinScllool of Soci~l Work 1971
9 Campbell John Working ~elationships Between Providers and Conshysumers in a Neighborhood Health CenterU American Journal2 Public Health 61 (Jan 1971) pp 97-103
10 Caxr Willene Neighborhood Health Centers Funded by the Office of Economic Opportunity mimeo 1970~
11 Colombo Theodore J Ernest W Sawardand Merwyn R Greenlick The Integration of an OEO Health Program into a Prepaid Comrehensive Group Practice Plan American Journal of Public Health 59 (April 1969) pp 641-650~ -
12 Comprehensive Neighborhood Health Services Projectof Kaiser FoundatioIl Hospital~ Prcgtgram YearE grant renewal proposal mimeo~1971 bull
13 CowenDavidL~ Denvers Neighborhood Health Program Public Health Reports 84 (Dec 1969) pp 1027-1031
IJ
14 De Diaz Sharon Daniel Beyond Rhetoric The NENA Health31 Center After One Year unpublished paper pres~rited to the American Public Health Association 1970
15middot Gerrie NorrrianF and RichardH~ Ferraro Organizing a Program for Dental Care in a Neighborhood Health Center Public Health Reports 8 (Aug 1968) pp 419-428
16 Gordon JeoffreyB~ The Politics of Community Medicine Projects A Conflict Analysis Medical Care 7 (Nov -Dec 1969) pp 419-428 shy
17 Greely David The Neighborhood Health Center Program and Its Implication(3 for Medical Care H~alth Forum of the Welfare Council of Metropolitan Chicago (mimeo) 1967
18 Greenlick Merwyn R Newgtimensions in Health Care American JOurnal of Pharmacentical Education 34 (Dec 1970) pp 754-4
19 GreenlickMerwyn R Donald K Freeborn TheodoreJbull Colombo Jeffrey Abull Pruesin and Erne$t W saw~d Comparing the
Use of Medical Care Services by a Medically Indigent and a General MemberShip Population in a Comprehensive Prepaid Group Practice Prosram II unpublished paper presented to the AmericanPublic Aesociation1970
20 H~tadoArJiloldVMerllYll RGreenlick and TheodoreJ Colombo Determinants of Medical Care Utilization Failure to Keep Appointments unpublished paper presented to the American Public Health Association 1971
21 Johnson Richard E and Merwyn R Greenlick Comprehensive Medical Care A Problem and Cballengeto Pharmacy ff AJilericanJournal of PbarmacenticalEducation 33 (Aug 1969) pp 361-367 -
22 Kahn Alfred J Studiee Social Policy and Planning New York Russell Sage Foundation 1969
23 Kotler Milton Neyhborhood Government Local Foundations 2 Political~New York The BobbsMerrill Company 1969
24 NationalCommisaion on CommunityHealthSfrvic~sActionPlanniriamp for Community SetithServices~ashington p C Public Affairs-Press 19t7
25 National Commission on C~mmunity Health Services Health Adminishysration andOrMPization l the Decade Ali9$-d Washington D C Public Affairs Press 1967
26 NationalCornmiesion onqomm1Jllity Health Servicesbull Health ~ Facilities Washington D C PUblic Affairs Press 1967 bull
~ n
32 27 ODonnell Edward J and Marilyn M Sullivan ServiceDelivery
and Social Action Through the Neighborhood Center A Review of Research tt Welfare ~ Review 7 (Nov~Dec 1969) pp 112
28 Office of Economic Opportunity Second Annual Report Washington D C~ U S Government Printing Office 1966
29 Office of EConomic Opportunity and the Medical Foundation of Be~laire Ohio Eighth Report 2l ~ Committee2a Governshy
ment OperatiOll~ Va8hiiiSton D C Government Printing Office 1969
30 Pope Clyde R Samuel S Yoshioka and Merwyn R Greenlick Determinants of Medical Care Utilization nhe Use of the Telephone for ReportiDg Symptons Journal of Health and SocialBebavior12 (June 1971) pp155-162 shy
31 RenthalA Gerald nComprehensive Health Centers in Large US Cities American Journal of Public Health 61 (Feb 1971) pp 324-336 shy
32 Saward Ernest W The Relevance of Prepaid Group Practice to the Effective Delivery ofHealthServicestt The New Physician 18 (Jan 1969) pp39-44 - shy
33bull Schorr Lisbeth Bamberger and Joseph T English Background Content and Significant IssUes in Neighborhood Health
Center Programs Milbank Memorial ~ Quarterly 46 July 1968) part 1pp 289-296
34 Weiss James E and Merwyn RGreenlick UDeterminants of MedioalCareUtilization The Effects of Social Class and Distance on Contacts With the Medical Care System Medical~ 8 (Nov-Dec 1970 pp 456-462
35 Weiss James E MerwynR Greenlick and Joseph F Jones Determinants of Medical Care Utilization The Impact of Ecological Factorstt unpublished paper presented to the American Public Health Association 1970
36 Wise Harold B Montefiore Hospital Neighborhood Medical Demonstration A Case StudyMilbaDkMemorial Fund Quarterly46 (July 1968) part 1 pp297-308~
37 Yerby Alonzo S ttHealth Departments Hospital and Health Services Medica1~5 (March-April 1967) pp 70-74
38 Young M M~ Chatanooga IS Experience with Reorganization fOr Delivery of Health Services ttAmerican Journ8l of Public Health60 (Sept 1970) pp 1739-1748
f or l
II bull 11 Y d
II
IJ
34
ThepurposeOfPart II of th1aa paper1atod1scuas
elected Speclfic needs ofecltlc areas within Multnomah
County A8P01ll~oUt 1D ~ I of t1a1bullpapermiddot Ita nelgbshy
borhood health oare cater IlU8t be a facl1lty plaDlled with
aD awarenes of the neeels of the oODllUller and collllUDity
Part II of this paper nIl Show 80e of thoe speclflc
needs
he1DforutiOD tor t1li Portlon of the report
obta1nec1 troll tbroupout tbe follow1Dl threepUb11catloDS
1gr~e_tiMshylIPrIxaiidOreson JuDe 1963
2 1~_middot_sectSI8e~ected1teai c-ua 0 S 8 e first count coaputer tape Coluab a_lion AssocshylatloD of QoveraMD-8 Jlme 1971
3 Jtu1tDoab County Oreaon BDY1roDlHtlltal SurveyEarly 1971
The JIultDOIIIlb COUDty OrttIOD BDv1roDllfmtal Surley
Barly 1971 1s bull stat1stical report of the activ1tles of
theentlreMultDOIIIl2 CcNDty Health Dep~t during the
year of 1970 Die speclflc 1nd1cs elected from tb1s
study amprejMental aealtll Publlc Health N~s1D1 vlslts
FaJUly ~ Veaereal])1 ~ ~rcul081
Throush tie use of cUrts and mapa ODe CaD roup these i
speclflc ~oea to ahcnr the healthneedsof speclfic I
census trtcta aD4 then the health needs of iarer neIghshy
borhooda 1m4 o~ Uebullbull
Rf)~UP1Dl of areu was accompllshed in thefolloWinl I
JJ ~
35
he MiltDoIliahCountY oregon BDViromaental SUrvey
early 1971 isamp statistical report ot tbeaotivities ot
the entire MultDolllh COUDty Health ])epartiDent dur1nl the
year ot1970 he specitic 1Dd1C8S selected frOm this
aUy are 1Il8Dtal health public healthDurs8s visits
fUl1ly pia waereal elisease aDd tuberculosia
Tbroq11the Wle otcbart aDd mapa aDecm szoup these
specific indic to show the health Deeds ofapecitic
ccmaua tracts aDdtIum th8health neecla of larsr ~eilh-
bOrhooda and co8I13 tlbullbullbull
RegroupiDI ot areas waa accoap118hed1D the
tollOWiDl lIIIIm1er~ A bullbullcifie 1ndex 8selectcl auch as
venereal di8bullbulle or tuberculo8i~ he total number ot
cs was then deterll1ne4 for each census tract Through
the use of the maber ot cRbullbullbull tor a 11Yen cenaus tract
aDd tbe population ot thattractaltrateot1lla1ampmcper
100OOOpopUlaticm wu cleteXll1ned for each census tract
This was ~e to starl4ard1ze the population ditterence
amongOeD8U8 -tracts 1he rate of incidence toreaob
cenauatract was then llstedby rank position on a chart
In rank poition1DI any cen8Wl tracts haviDg equal
rates ot1l1c1dence are assipe4tbe iaDk posttiona
Beeauseot the abo fact tbAt cbarta w111 vary in length
neveltbAtlea eacb cbart will 1Dclu4eall census tracts
inMullnoaah Couaty Atter the census tracts bave been
listed accord1q to raalcth1s list will bediv1ded into
IJ
36 three levelsotinc14ence he three levels are
1~ The upper 14 of1DcldenCe
2 Thelower 14 ot incidence
middot3 The ILld 12 of incidence
Tlles three srouplqa are then used in compiling a map ~f
Mu1tnOmahCountyfor ach apecltictop1cbull TIle maps are
uaefuJliD tbatthey V1suallycoJib1De 1Dd1v1Clualproblem
census tracts into larger problem nellhbOrhooc1s
The 1960 statistical iDtormatloD was Used in a similar
liIaDDr to tbatexpla1Dedabove 1Dthe4evelopaent of a
chartmiddot and map 1Ihow1DI e cOllpampriSOr1 of per capita lncolle
tor ttaCh ceDsua tJact aDdmiddot combiDed census middotmiddottract areas
he 1910 aDd 1960 statlstlcal iDtOrllatl0D was combined
lna map and chart he purpose of this and chart is
to d8aonatrate the e cl1stributloa1DeachceD8U8 tract
and middot1ndlcatbull tuture ace populatlon treD4a bull
When one be middotbullbullbullbullbullHdth ne8cts ot an area and has
declded to establlsh a cl1D1c to serve that area the
physical location otthat cl1D1c IllU8t be consldered In
order to coapreb8ll81vel develop an area cl1n1c one should
conslder thepre88Dttraftlc middot~ytaa an4tranaportatlon
systems Thecl1D1cahoUld be located close enoUlh to
major arterlals to giva asy access from the total area
be_ ervecl by this cliD1c At the t1ll8they should
be tar eo away froll thesarterlals to all8Y1ate traffic
CODCell18 andpark1D8 conpstlon By traff1c concerns I
IJ
37
lIlan one lUSt consider thertarro1fne8S of streets whether
streets are oD8--C)r two-way iqres8 and egress to parking
amp0111tie eros tratflC) spedof trattJQ children 1n
ll8a traffic i1lht Vislon re8tr1ctionS etc
BwstraDsportat1onshould alao be central in this area
as maay people ~U f1Df1 1tD8Cessary to use this form of
transportatlon
~e tutqredlopHQt of bull treewa systems should be
c0J1S1dered soastolesen thecumce ofmiddot future roada
cutt1DSotltbe cl1D1c llte line
nrrph1c middotDampta
It is 1JDportaDtto kDOw the demosraphic distribution
characteristics of the oUenteltbat i8 to be served by
localized health cl1D1cs
Acl1D1c which erves8J1 area where1D the prepondershy
ance of persona arecrter 65 years of mayf1nd that these
people rely more on pUblic transportation call for more
home- services and haV4t 110ft ChroD1c and debilitating
types of disorders (b1_ blood pressure poor heariDg and
eyesight) tbaD do8 an area ot a YOUDIer population On
the other hand thL area of older residents may have little
need for family plabDlng cllni08
In order to better ~Ybullbull the 4eaoraphic population
of each CeD8U8 tract the 1970 CeD8U8 iatormation was viewed
and two specific catelOri8 considered These two cat
IJ
38
lori8S woUld be the perc_tap ot population under 19
year of ase and the percentase ot each oensuetractover
65 years of age he 1960 1Dtormatlon tor eaCh tract was
then compared witbthe 1970 intormation and a percentage
ofincreaae or4ecreamp8 tormiddot e~chtract1n each category
cOJlputecland achartma4e By the use of this chart one
18 able to View tJleap populat1odiatr1but10n of census
tract and at the _ t1lle accesa middottrencl Por example
let us choose census tract 601 W see 40-4 otthe
population is under 19 years ot and that ODly82 1s
over 65 years ot middotAtthe e tille the percentage of
youth bas ~ed ODly 1_ intbe laSt teD year whilethe
percentale over 65 year ot middotbas stayedmiddotthe same With
this in mJnc1 ODe ~ 1DfItr libat ol1D1o aerviDg this
area WOuld bellQre conq~w1th the problems of a
YOUQier populat1on and that _ would probably be true foJ
some t1aein tbefuture On the other hand CeDSU8 tract 54
has only 2 ollt population UDder 19 yel1s ot age and
this has decreased by 1 over the last ten years middotwhile at
the same time 32-377 ot the populat1on 18 over 65 years of
age A ol1D1C ___ this area should be or1eJ1ted toward
tbespecttic problema otthe ampledbull
PerCapia __ bY gsa neat
WhaD cona1der1qlooat10D1 tor health cl1n1cs one
shoUld take the 1DC01Ieot areas into consideration Areas
IJ
39
of lowiDcome would not 11kel~be 8erved more by localized
cl1D1cs tbaD would are of hilbincome It 18 likely
people haYiq a hip iDeoll8would preter to be aeenby a
chosen ~r1vatephylc1a1l tban at a local cl1D1cwhere
10Dier waits y beraceaaampryand leas personal attention
gl_
The 19701ncOII81atoWampt10n tor MultnomahC~ty was
not available at the tille thi8report W88 made The 1Dto~shy
tiOD Was taken ~adtro tbe1960 census publlcation
his woUld ~8Il thea tbat ral1I8 OD the chart ynot 1raquoe
completely accurate hi writer telthatthe areas most
affected by tb8 1I8eof the older 1Dco1DtOlaat1oDWOuld be
those tracts wh1ch baYebad a rapid 1ncreaae1n populatlon
over the past tfmyHr8 bullbullbull tracts would include tracts
nUmbered 104 9897 96 aDd 95 be perc~ita 1Dcome
referredto1il-tb1a Paper18the lIean 1DCo per person per
census tract
Attar the iDeoeper census tract was listed on a chart
a map was de 1D41catiDg those census tracts belonging to
the lower 14 ot income tor all censue tracts in Multnomah
COlDltytbose beloqins to the upper 14 ot income tor all
census tract 111 MultnolUlhCounty and those belonging to
the mid 12 ot 1I1coaetor all oeuuetracts in Multnomah
C01mty
In yiew1Dg the _p 1t caa be seen that the low income
area seautotollow aloas the at aide ot the Wl1lamette
IJ
40
R1ver the full length of Kultnomah County A second low
income area follows the south edge of the Columbia from
the northwest corner of Multnomah County easterly to 148 St
A third problem area seems to be on the east bank of the
Willamette River with the Union Pacific Railroad being
about the center of this tract The extreme loutheast
corner of Multnomah COUDty appears to be a low income area
but as this area bas bad rapid grouth in the last ten years
this could be erroneous
Mental Health
be first ~ecific indica to be selected from the
Multnomah County envirollllental survey of early 1971 and
to be considered in this paper i8 that of Mental Health
At the present for mental health purposes Multnomah
County is divided into five catchmentareas with a mental
health cl1n1cin each area These clinics are Model
Citles Delaunay ADkeny street Office Hansen Health
Building end Southeast Clinic
All lIlental health cl1n1cslcept statlstlcal information
on all patients visiting their cl1n1cs this included the
address of the patient hese addresses were then listed
upon the approprlate C8D8US tract Each census tract was
then ranked on a chart according to the nUllber of mental
health patients who reslde ln thatCeDSUS tract attending
any of the above listed ental health clinics This chart
IJ
41
wasttum d1v14ed1ato proper quartile bbullbullbull
quartile vereUs to dne10 u appropl1ate Multnoh
County _tal health ItLa middotmiddotmiddotthelipO~a1bl by lOoJcJIUE
at the UDtal health _to uteN1De which ueu have the
lars-t use otCOllDty 1alh~th faci11t1Rot
1Ilclu4ecl 111 tbia woUld tber otpeopleYia1t1Da
pr1vat patch1atriata aDd pr1_t _ntalhealtb cl1D1c8
WheDtbe M1 18Yienclmiddot Itmiddotmiddotmiddotmiddot~middotbe~_ tbat ~rtt
appears to lMt fourmiddotmiddot-al are iii _oil the nuaber ot
lIental healthcl1D1c na1t toM tbjh1sheat 1he
tour areaa woUld be tollows
1ttrea Ore to~Blo Drimiddot ~tb Burrus14e aDd tIMtmiddot Colb1a Riftr H1gbwyaeri1Dla th nortllra boundaryshy
2 bull ProII 82D4 1_~ 10 20th streetwitil the ra1lMd Mu the north ltouadary
3 ~ et et tUgl_b1bull MYel froamiddot the Clackaaa COUDty l1ae aorth to Dln8lon stret
4 beDOlvt1ttfe-t ~efllt4 COatytrca Jle1aware streetmiddot toR1C1a11oDd wlth Colubla Blvd heiDI tbAtnorth bouaclary_
It ODe coapareatbiap to th iDeobullbullmiddotp 1t can be
eamiddotthat lIOat ot the c tracts baY1Dg bllh v1i11tatlcma
middottfl public tal health cJ1rUc8 ~ 111 t13e low ~ aid
1DcOile SroupiDIOJa1y of til 25 tracta llsted as
haviDlbip aental Maltll nlltatlou are ~ the1g60 hip
iDeo arebullbullbull
17 Plpn
42
amily PlellnSDI ]Jlce Metal Health i8 an 1nd1ce of
use Theperson 111 ordertobavebe_ 1Dcluclecl 1n this
atu4ywouldhave tohaft Ue4 ataa11y plaDI cl1D1c
tacilities of soaetype It 41fter troll tile _tal health
study1nthat i t1Jicludestatist1catrollbotb public and
privateclJD1os
The iDformation tor the iak orurcbart 8Dd map of
t8ll111 plenn1 na ob1a1De4 by cOIIblnlDlthe mabel of
1rlcuv1duals bullbull_ attbe tbreellUltrampo-ti Coatyhll11y
PlalJQllIl C11ll10s 111til tbo at the Planned PareDthood
Association CliD1C8 be tbree -JIultDouh Couaty r8ldly
PlamSq Cl1D1c are Solrtbweatth Col_bla 1111- a114
HaDsell Health BWlcl1Dl CllD1cbi middot1Dtormat1oD vas then
bullbullbullesed tomiddot detellWMt l10w people troll eacb c8IUIUS
chart wastben Mele IUs oIIart jn 4iY1ded to show
the censuS tracts lIaYiDlmiddottIle h1t1iest qUart1le of incidence
of use lowest quartile of 1Qc1deao ot use Jlid 12 of
incidence of Wle an4 a map sprepared troll thts 1Dto~
mation
The C8U118 tractsbelOJISnl to the h1lhestquartile of
use appear to be 1lO~ 8catt~ on tbipwas true ot
either the _p ot aental health cl1D1c uaageor ot the map
abow1DI per capita 1I1COM Iaere40 to be three
d18t1nct areas of UIIaP beJ woul4 be
1
IJ
43
t10D of BurD81cl and the W11lallette River 4
2 S~t Portland 8Otth otmiddot the ra11shyrcaadand alona the W11lamette River
lIortbeaat Portl8D4 between MisSiss1pp1 and 24tbStreet the northbouBclary be1DgColwb1aBlvd
Pylzl1c BMltl IrpI Y11ta
Publlc Healtil nur81D1Y1s1t nclud8 an vists to
theholles of client by PubUc Health Nurbullbullbullbull his shows
visits to bull f8Jl1ly fer aDY purpos SUCh aatuberculolJ1s
het1Dl tem1tyaeatalu4 8IiOt10D8l cODd1t1ona etc
he atat18t1C~ 1fele C()4ed accord1Dg tomiddot the 1llli301fOCUS
of the Y18lt tt doe DOt 1D41cate the Dmlber of holies or
f8ll11lev181tecl or 1D41Y14ual Y1a1ted more tban oDcein
the propwl It dobullbull I1ve 80M 1D41cat1on by coaparlshy
OD ot the 8JIoUDt of aedlcal problema 1n eachcen8WI tract
Ap1nmiddot the _p abowa 8 scatter patteraof probl_
areas althoUSh there appear to be a sroup1Dl of hiSh J
l8aIeccmaus tract 1ntlut extreme southeast part of tbe
County other areu uIriaI any nura1Dl contacts are
1 bull he 801lth-oa-al CO1Dty on eaCh 814 of 82nd Av from Clackallaa County north to Dinloa
2 ear bullbullbullt 814e aroUDd Preacottand Misaisippi
Dowatom Bunul14eonboth 1de of the river
44
V_real Pis The iDfomatloil uaec1 to tabulate the Venereal
disease chart includes all the ooab1ned case otmiddotODormea
and syphilIs reported by bothmiddot publIc and prIvate physicIans
dur1nl 1970 There were 3602 caes ot IOnorrhea reported
dur1nl 1970 While ODly 17 cabullbullsot ayphilimiddot were reported
A chart was prepUed aDd att8llPt wasmiddotmiddot de tomiddot
determ1De Wh_therVttDereal 41ease was more p~vaJent in
areas othigb or lowmiddot proportIon ot youth hi waadone
bymiddotdetemlna a 1leaD prceiltacmiddotmiddotmiddottor the population ot
resld~ts UDder19 years ot (34) middotA mean ratemiddot per
100000 popUlatIon al80c1ttem1Ded tor the middotoccurreDCe
ot venereal dieae This was et at 390 oass Areas
hav1nl a population 1n which leiS than 34 were lmder 19
years ot ampIe were called low- yOuth abOve tbl percentaae
hiSh youth The aaa waatrue ot the occurrence oivenershy
eal disea_ per CeD8UStract It the rate waacomputed
as 1I0re than 390 cases per 100000 it was called hiah
venerealdiaeasei it less than thia tisure low venereal
disease It was tound that 1D Multn~ COmlty there sems
to be poSitive OOlatI0n(x21S19gt between low youth
and hipmiddot venereal diseaand hip youth and low venereal
diseasebull
RaDk ordr Iitot all c traot middottbAm made
Th1s was done byt1Ddlna the ratepr 100000 populatIon
of venereal disator all census tracts in the County bull
45
These were thenlisted from h1lhto low (sreatest to
least) in a rank order The l1sting was then divided
into Upperandlower 14 aDd listed on the MUltnomah
Countymiddot up
The areas of b1gh venereal disease se8ll18to
roup thBl~8 middotin a very tllht area ~oq both 1des
of thell18l8~ R1 w1th BurDaldeS~et being
~bout theceDter qf tbi8IZ9uping This area woUld
appear to be m ldeal spot for the denlopment of a
locallzed venereal d1sbullbullbullbull cl1D1c
UbepoundCUlO1s
In this report bull tube1C1llosls caS8S refrred
to include alltbobullbull cabullbulls ontubercUlo8is follow-up
rather middotthan just new C Accord1Ds to the Multnomah
County Health SUrvey of early 1971 this would include
all ca repOrte4 over thelaat three years The
total number of tuberculosi8 cabullbullbull usedin this study
was 666 lh1 included 128 new cabullbullbullbull
A rate per 100000 of tuberculosis for each
census tract wa- then computed and the c~us tracts
listed by rank order be b11h Qartlle mel low
quartl1 were then reoordd on a Multnomah CoUnty map
TWo genral areaa baY1Dg a hip mcldencaot tubercu~
losiare 1D41cated heyare
1 Both middotsld ot theWilla11lette River
Ll -
46
with Burns1de about thecnter
2 he extrea Northebullbullt comer of the County bull
By coap8r1ng the tuberculois an4ven8real
diseae maps ODe can 8ee that the downtown areas ot
hiSh 1nc1denceare alIIo8t 1c1eDt1cal on ach map
This WOuld 1nd1cate that 1t would be of value to
bullbulltab11sh acl1D1c 111 th1aampreatbat would provide
bothtuberCulos1s 8Dd ytmereal 418ase srvicbullbullbull
Thchart aDd 1181gt8 are wsfuln 11v1DI
1Ddicat10DS tor the type aDd placemeototlocal
health cl1n1c8 tbro1qhout tbe MultnomahCounty area
A cOllpar1on of the mapa help one to dec1dewhether
to provide a aulti-8ervice cl1D1c or spec1f1c type of
cliD1c As stated in Part I of thi paprserv1ces
shouldhaYe both treatlieDt and prfMmt10n cOmponents
As he been stated fta ne1lbborhood health care
Qenter muat be a fac111tY plazme4 with an aamesa
ot the neds of the consumer and the c01llll1m1tybull
Part II of this rport haa been an attaapt to indicate
and clarify 8011 ottheae coDlllUDity neds This has
been done through8elect10n of apc1f1c problems
The indic were then visuallyrecorded through the
use of ups and charta ODe dan asseS8 thedsreeof
1DIportance of certain concems to spec~t1c areaa by
comparinl the chart aDd maps Prom this oDeean
41 dec1de which are48 vb1chcUD1c-or indeed if
the need a clinic at all However further factors
should be considered hebullbull include
a The amount of fuDd1 available
b What 18 the percentage ot peopleineoh ceaaua tract tbat would actually us such cl1n1cIl
c Wbat 1 tbeco--1tymiddot 8 IeeliDashyreaardtDI particular cl1D1c8 Would this dcrebullbullbullmiddot the ettctiveness ot thse cl1n1ca
IJ
li
D_OlraphicPopulatLon Challie 1960 to 1970 48
Cen8U8 1 of Pop 1 Cbaqemiddot 1 Change1 ofPopTract Under 19 Yr8 Over 65 Yrs1960-70 1960-70
middot1Q701Q70
1 319 -12 171 -H) 1
2722 215-27 +68 301 366 -22 127 +35 302 371 +19 111 -04
311middot401 144-41 +29 402 321 13~7-39 +24 501 356 124-08 -02 5~O2 351 133-23 +12
405601 82-10 -02 394602 103-01 -06
701 275 149-76 +56 702 361 +01 121 -07
+10middot801 326 140-22 802 321 middot127
(
-29 -03 9~01 342 124 -H) 6-18 902 294 128 -H) 3-24
10middotmiddot -14312 140 -17 1101 182 +25 -23197
2411102 186-59 +29 1201 226 169-17 -41
31middot01202 +11 182 -05 295 -H) 81301 208 -H) 4
1302 331 +08 197 +04
14 323 +15 middot185 -08 middotmiddot15 329 +16 16~5 -13
-28middot 1601 332 131 +12
1602 356 98 +24middot-39 middot3101701 161-33 +21
1702 370 -15 85 +02 +19 1801 264 151middot-50
185middot1802 256 +47-58
IJ ~
D_raphlc Population Change 1960 to 1970middot 49 (Contd)
4io
Census Tract
of pop Uncter 19 Yra
1Q1n
1Cha1l8e 1960-70
of PopOver 65 Yra
lQO Change
1960-70
19 389 +29 141 -24 20 223 -13 206 +18
21 227 +08 194 -36 2201 356 -27 112 +05
2202 290 -18 ll~9 -29 2301 356 -03 154 +24 2302 260 -37 245 +97
2401 410 +6~1 123 -31 2402 163 -80 320 +99 2501 381 +13 140 -01 25()2 237 31 lil +02 26 343 +25 186 +149 2701 370 +29 1S5 -01 2702 249 -44 304 +98 2801 337 +19 187 +09 2802 306 -10 156 +31 2901 304 -38 142 +24 2902 i 307 -32 146 t3~9
30 29~0 -48 16~2 +51
31 355 +30 160 +01 32 370 +48 148 -13 3301 395 +45 130 -20 3302 368 +06 138 -02 3401 386 +16 117 000
3402
400 +32 92 -26 3501 304 -07 115 +35
3502 344 000 140 -13
3601
36~02 357 -04 132 +32
3603 30~1 42 149 -67 3701 342 +28 152 +19
1
IJ
Jianolraphic Population Chan 1960 to 1970 50 (Contd)
Census Tract
of Pop Under 19 Yrs
JJl7J
middotChanae 1960-70
middotofmiddotpop Over 65 Yrs
1c~7n
Change 196070
3702 409 +39 122 -11 3801 308 -11 151 +29 3802 275 -35 180 +46 3803 282 -32 192 +54 3901 376 ~13 100 +17 3902 296 -03 177 +29 4001 438 -11 84 +13 4002 353 -21 115 +20
4101 397 11 9middot0 +11 4102 346 -19 120 +03 42 331 +19 11 bull 3 -16 43 347 -72 105 +31 44 113 +84 183 +154 4S 33~9 +07 110 -06 4601 2501 22 193 +38 4602 332 +59 126 -29 47middot 161middot 000 211 +01 48 103 -26 302 +59 49 138 +1 bull 3 252 +09 50 141 -26 204 -12 51 12 -39 257 +07 52 47 -61 351 +48 53 89 +49 314 -30 54 25 l1li15 327 -17 55 131 -17 115 -121 56 198 +93 227 -47 57 71 102 189 -88 58 240 ~middot41 16~1 +55 59 322 +25 142 +06middot 6001 264 95 132 +50
6002 328 -31middot 89 +07
JJ
Demographic Population Change 1960 to 1970 51 (Contd)
Census 1 ofPop lChange of Pop bull ChangeTract Under 19 Yrbullbull 1960-70 Over 65 Yrs 1960-70
1970 1970
61 355 -58 85 +39
62 328 39 110 +18
63 414 04 73 10
64 382 -22 72 +04
6501 383 02 67 -20
6502 329 -56 96 +09
6601 391 +13 88 -03
6602 319 -59 97 +06
6701 327 71 145 +72
6702 331 ~67 83 +1-0
6801 365 -66 49 +01
6802 388 4bull3 54 +06
69 354 -41 80 +23
70 400 -23 68 -06
71 359 -48 72 +05
72 255 -88 82 +11
73 346 -39 91 +25
74 313middot -63 105 +24
75 329 -42 129 +37
76 336 -52 85 +21
77 370 -10 69 +05
78 309 -10 120 +21
79 325 -56 87 +10
8001 358 -81 57 +12
8002 391 ~81 76 +12
81 315 -76 108 +21
8201 403 -23 64 +08
8202 392 23 65 +08
83 357 -34 120 +31
84 402 -18 73 +16
85 413 -06 76 -09
r
Demographic Population Change 1960 to 1970 52 (Contd)
Census Tract
t of Pop Uncler 19 Yrs
1970
Change 1960-70
1 of Pop OVer 65 Yrs
1970
ex Change 196070
86
87
88
89
90
91 9201
9202
93
94
95
9601
9602
9701
9702
9801
9802
99
100 I
101
102
103
10401
10402
lOS
368
351
379
391
391
413
379
433
372
429
414
432
419
439
~32
377
457 420
378 41middot7
345
360 417
417
412
-04
-02
-35
-26
-28
-11
-64
-20
-S9
-39
-32
-21
-34
-40
-47
-lO~7middot
-27middot +04
+56
+07
-34 01
+04
+04
+10
103
128
97
11il3 99
69
79
42
77
46
34 38
44
40
54
111
51middot
81
133
59
74
140
63
87
76
-08
-06
+04
+08
+17
-05
+3S -02
+1~4
+19
+33
-14
-08
+12
+26
+71
+11
-16 -34
-20
-19 +37
-49
-2S +15
NOte The The
Taken frOi
averageullder averageabove
middotUSCensus ---shy -
19 years == 6S years ==
figures 197
32r 13(14
p a~d 1960
--
Rank
1
2
3
4
5
6
7
8
9
10
11 12 -_
13
14
15
16
17
18
Tract
69 46
60
58
- 68
61
302
2501
67
63
19
62
26
94
3603
3902
64
30 -----~-
Rank
19
20
21 -
22
23-shy
24
25
26
27
28
29
30
31
32
33
34
35
36 -
Ranking of Per Capita Income by Census Tract
Tract
65
2701
- 15
1601
701
66
93
82
2903
3602
30
2502
80
2401
81
- 70
91 shy
4001
High
Rank Tractshy
-32shy37
38 97
120239
7840
41 ~ _2_1__ 42 31
43 2501
44 18
45 98
46 37
47 3803
1702
49
48
1602 92 2702
I
50 89
51 901
52 801
Ra_
53
54
55
56
57
58
59
60
61
62
63
64
6S
66
67
68
TractTract Ra~
74692
170196 70 I
401 71 90
72 1037J
79 70273
3802 74 601
24024102 75
85 76 101
77 9023901
7699 78 100 4101 79
3601 I
380180
458140~ t---- _ - - shy83 82 42
888384
59843501
4777 8~
502
Low
802 86
Rank Tract
87 shy
--88
89
90
91
92
93
94
- 95
96
97
middot98
99
100
101
102
103
104
1201
14
49
72
73
43
87
3502
105
1
52
86
71
1
501
10
3301
104 tf
Rank
105
106
107
108
109
110
III
112
113
114
115
116
117
118
119
120
121
Ranking of Per Capitalucoae by Census Tract
(Contd)
Tract Rank
4001 122--shy602
13
1102 2302
3302
55
3401
48
21
56
50
3402
lL01
2202
2301
53
2201
-shy
Tract Rank Tract Rank T~aet Rank
57 I-----
Imiddote
bull
Tract
- Low -k Note Information taken from 1960 U SCensus
Rank Tract
I ~
Ie
Imiddot
~
----
----
--
--
Rank
1
2
3
4
5
6
1
8
9
10
11
i-
-Tract
391 922 921
972 971
100
132 131 121
962 961
822 821 401
982 981
20 111
47 10 1
412
High
Total Number of Henta1 Health Visits
Ranked by Census Tract High to Low
TractTract RankTractRank Rnk
12 182 22 78 29 87 76 381 73181 ~------- 1913 371 8538230162372 271 2616-121 8272 2
14 80~2 31 94 7923 84801 59 15251362 4232 15 52 _ 32 103 8924 651 17240216 652
_ 91 351 33 341 23117 83 122 25 25 48 1123921418 34 shy61 86 661
19 662 6493 81 26 91 8153 49 50 55 41383 71 27 51 3120 90 672241 35shy 104167162 461
I 411 46211121 28 88342 I
2502 36 69 54 5251 50 272
-Ra
37
38
39
_ 40
_ 41 Ishy
I
42 I
-I 43 44
45
shy
Tract
~ --- shy 95 56
45 292 242
102 62 352 291y
92
101 281
99 72 63 601 60~ 42 2201
77 74 61 57
363 232
70
32 31
11 44 282 2202
Low l
- Tract
46 682 681 I 331 30
r~$ 47 1042 332
48 102_41_
11
~
Visits to Family Planning Clinics Ranked by Census Tract High to Low
Rank Tract Rank Tract Rankmiddot Tract Rank Tract Rank Tract Rank Tract
1
2
3
4
5
6
7
8
9
10
11
12
13middot
14
15
16
17
361
56
401
341
48
59 121
20
55
342
10
31
58
93 21
241 132
331
53
461 462
18
19
20-shy21
22
23
24
25
26
27middot
28
29
30
31
32
33
391
32
middot47 I-i-_-shy _ -
231 111
332
972 1
372 371
52
89
32
92
82
100 31
182
30 242
402
34
35
36
37
38
39
40
41
42
43
44
45
42
1714 i 661 221
78 362 2
90 602 601 352
63 251
105 921
971 351
73 42 292 232
411 51
662
81 45 52
46
47
48
49shy
50
51
52
53
54
55
56
961
801
49 81 72 71
19
9~1
172
68 2 57 162 14 112
91 75 681
381 42
3~3
83 161
57 f
58
59
60
61shy
62 Imiddot
63
Imiddot 64
65
66
64 62 36~3 252
74 652 SO 392 291
651 6bull 2
79 271
r-- ---- shy981 222
672 671
821 272
94 87
281
382
67
68
69
70
71
72
73
74
75
76
77
78
981 26 12~2
IS 61
85 82~2 69
61 43
101 86 84 282
76
131
51 72
1041 962 88 70
99 922 77
103
95 802 181
i
~
Low High
RankRank Tract
5479
4480
81 1042 ~) middot102
71 - - + ~ - ~
Visits to Family Planning Clinics
(Contd)
Tract Rank
I
Tract llaDk l
RankTract Tract Rank Tract
~
I
~
J1 ~
Low
Total Number of public Health Nursing Visits
Ranked by Census TractsHigh to Low
TractTract RankTractRank RankRank TractTractRankTractRank
25249 71 79 17249 8033 6586 99189711 84 2915072 34 661 76 66 811519512
402 5035 51 161 2518220 122 1713423 352 55801 7120 6752 2 149814 41236 83 2662 38 94 6821 53 2924015 362 37 32 42 75 69 281 84 63
546 8822 54 222 85 3925431 70383417 3818223 6439 4386652 718 21 55 103332 8924 232 87 19 271729219619 24156 16211140 382 628825 10523110 112 73411 10141-- ----shy 89 363 4457 8126 16111 221 74 9142 90 46158331 53 671279012 46243 48 59 351 3837528 1083 9313 91 5844 59 -_242 76 1----- shy60 272 72 74104114 60145 42 9287 7729 92 6151 8215 57371 934630 91 307762 12113116 282 619447 41391 9531 78100 63 7378 ~95 681 6945 32 5632 798517 6448 47 52 181
High ~ Low
Rank Tract Rank
96 31 132 70
97 102
98 182 372middot 602 651 662
- -shy
~72 682 802
822 922 962 972 982
1042 ----shy
Low
Total Number of Public Health Nursing Visits
(Contd)
Rank Rank Rank TractTract Tract
I
I lt
I
Tract Rank Tract
[
~~~-
I
~
IJilfimiddot ~
j
Ranking of VD Caea According to Census Tracts 61 By High and LOll Youth Itatio
A media~ of 34 5 was determined Any tract having greater
than 34 5~ of popu1tionunde~ 19 years of age -High~
Any tract having l8S than 345 of population under 19
years == Low
Any tract having rate less than 390 =Low
Any tract having rate more than 390 == HLgl4
YOUTH
LOW HIGH
L
0
12 402 1801 1802 343 2801 2802 29023603
54 6001 600262 66~02 72 74 75 76
78 79 81 t02 65 1202
W
(25)
VD
H
I
G
H
401 701 801802 901 902 10 1101 241 1201 1301 132 14 15 1601 1701 20~ 21 2202 2j02 2402 2502 2702 2901 303501 3502 34023801 3802 383 3902 42 44 45 4601 4602 47 48 49 SO 51~2 53 55 56 57 58 S9 6701 6702 73 95
3~02 7021702 19 25~01 2701 4102 4101 63 64601 ~601 6801 680270 7l 77 8001 80~02 8201 8202 83 84
85 86 87 88~ 90 91 9202 920193 94 9601 9602~ 9701 9102 9801 9802 99 100 101 103 10402 105 6501 10401
(47)
301 501 502 601 1602 2401 2301 2201 31 32 3301 3302 3401 3402~ 3602 3702 3901 400140 02 43 61 69 B(
(53) (23)
~ ~gt
Ranking of VD by Rate Per 100000 By Census Tract
~
Rank Tract Rank Tract Rank Tract Rank Tract llank Tract Rank Tract Rank Tract
1 2202 21 S6 40 902 58 1602 74 75
90-shy 64 107 26 --~-
2 3402 22 45 41 10 59 902 75 78 91 54 108 61
3 2301 23 3502 42 2502 60 602 76 6802 92 402 109 87
4 3302 24 49 43 1102 61 501 17 2 93 94 110 90
5 50 25 52 44 6702 62 14 78 8202 94 97 02 III 76
6 2201 26 20 6701 63 4002 8201 2501
9701 41~02 112 91
7 44 27 48 45 401 64 3802 2902 95 63 113 62
8 3301 28 1701 46 502 65 30 79 83 74 96 9602 114 71
9 55 29 47 47 42 66 3803 80 2801 96Q1 115 85 10
11
12
13
14
15
16
17
18
3401
53
2302
2401
57
21
2402
1101
51
30-shy31
32
33
34
35
36
37
3701 - -~ 1201
3702
89
43
132 131
3602
4001
48
49
50
51
52
53
54
55
58
1601
601
4602 4601
69
701
31
3901
67
68
69
70
71
72
2901
801
39021~ 802
6502 6501 122
702
41~01
81
82
83
84
85
86
87
88
19
1
1702
2802
79
93
100 6801 6602
81
97
98
99
100
101
102
103
104
9201 9202
9802 9801
77
302
79
86
72
84
116
117
118
119
120
121
3603
8002 8001
101
99
95
10401
105 10402 103 102
19
20
59
32
38
39
2702
3501
56
57
301
3801
73 1802 1801
89 6002 6001
105
106
2701
88
High Low
-- -----
Rank OrdermiddotTuberclosis Cases by Rate Per 100000 Ranked by Census Tract High to Low
Tract TractRankTractRank Rank TractRaukTractRankTractRank
801
79 9601501411 52 6835340120511 I 960269 903603532036 $-~~F130221542 4366 311301 70 68~013802 _ I- _ 4001_37213 3921201 6802802 H71523822024 22 54 193302 3802 80 8958 I37139535 70155 9801 I60123 72 6702 98023914011016 6701250124 10 56
81 94 401r 7 154152 73 7057 2625 122 92028
90242 162312301 92~158 86 7172434526509 82 79160159 74 100 87412240227220110 6502836960 75 30 8317244 6501782801285711 61 901 42765645 84 66021459294912 9701 660146 171 302 9702 47
6235023033113 85 822821182 917755 16335013110214 841814832 78 103 938564 324815 86 1057940149272 38036523216 10401 87 2902241 725Q 10402360266340217middot IF88 88 9937233 282 51 218 101 01102 46016234
I)167 2901460219 47
High ~ Low ~
- -
TractRank
9S89
6490
8191 8001 8002
63 61 60middot01 6002 44 2701
92
J
2502 402 --- ----shy
I
Rank
Rank Order Tuberculosis Cases by Rate per 100000
(Coutd)
Tract Rank Tract ~nk
I
Tract Ballk Tract Rank
Imiddot
Tract
Imiddot
1~
t 1I i Pi i l I
o
1 -1shyL I
I J
8 40 icO ~ I -lt 0
-t (1) I
i I
r o E
II
a
I
r--i
shy
I
~
I (
Jgt
(011 fi(
Ggt
I II ~j
()
(f 0
~ ()
I
11
f9
r
II 99
o ~
Ggt r
~ __-J~ I t I ~ I
r--J l I
~ _ __ J
) 1
fTl
1gt
r I
()
r
()
lt en -i en
()
I1l
(J)
(J)
-i
P ()
19
r o ~
r G1 I
I
c
~
o I 89
--- -I-shy
r-r I
1- 0 _~ _ _--J E
G1 I I I
i i
I 1-1-1 ~ _J ~2 ~ II
II
()
1 I I I 1
id i bullbull
~
A n 69
r 1shy
- 0 Gl
l--~ ~ I
~ II
II )
I () isect i
en l i
(J)
-t
0
IA Ol
10
areaDe Diaz (14 p3) indicates the importance of
being aware of groups in the neighborhood with special
health problems such as elderly people or large families
witb yOlmg children This means that it is important
in planning to be aware of the demographic features of the patient population This will be considered more
thoroughly inPart II of this report
Kahn (22 p275) continues however to indicate
that more than the improvement of service usage is I
involved in decentralization and that decentralization
ot service delivery also represents part of tI a general
search to break down cities to human scale for some
purposes on the assumption that people find it easier toshy
relate to a neighborhood orsection and to its populationbull
bull bull bull Thus the organization of services at the neighshy
borhood level bas the added purpose of contributing to
the search tor neighborhood n He adds that this process
i8 more relevant it there is a measure of local control
over as well as local availability of services
Kahn indicates that decentralization is not a
viable goal in some circumstances These include situashy
tiona in wh1chthe need for a particular service is too
TJI t
-
11
little to justityits proVision in a l()calun1t where
skills or resources are too rare to be provided locally
or where the costs ot decentralization vastly outweigh
the benefits He Visualizestheult1mate emergence ofa
h1erarcb1c81 patternofserv1ce delivery tnwhichcertain
services andresp0D81bilities are middot1ntegrat8d1Dto the
collimun1ty at thelooal level Other more specialized
services relate to larpr un1ts of the colDlllUD1ty such as
eomb1nationa ot neigbborhooc18 Veryspecialized services
are to be delivered at city countystateop regional
level8 fh1slevel would al80 be the seat ot prosram
coord1zaat1on staDdardprotection and evaluation 811
of which call for cons1deZable centraliZation for overall
program adm1 nlatrat1on(22 p275) AlthoughKahnt s
model was not developed specltlCally tor health care services 1t1s quite relevant- and appliCable to health
care service delivery systems
Omiddot Donnell (27 p3) reviewing the 1iterat~e on
service delivery and social action through neighborhood
service centers preseJJbB a list of characteristics
generallydesirable in ~eighbOrhood service delivery
centers Firsthe states that the center should be
accessible It should be in a physically convenient
location and should be open evenings and weekends as
well as providing at least em~rg8ncy telephone coverage
t
~ II
12
24 hours a day
The center should als~ be irDmed1ate in 1ts funcshy
tioning That is the centermust have the capacity to
provide prOmpt efficient service and should be able to bullrespond to problems middotwithout long hours ofwalt1ng and
many rounds of apPointments
The centexsservices should be 6omprehensive liThe
center should offer a full range ofusable oil-the-spot
services or easyaccess to other resources by available
transportation It should gear itself to the needs that
peoplehaV8-especially poor people-and provide for the
slmultaneoushar1d11ng of problems were possible
SerVices should 8180 b 1J1tegrated and coordinated so
thatseMces can more effectively be provided
The operation of the service center should fInally
be responsive to the needs and desir-es of the neighborshy
hood It should provide ways in which reSidents can
shape th~ program and continue to contribute to its course
and development It should be relevant and ready to
respond to changing needs II
The concept of the comprehensive neighborhood health
center developed by OEO (31 p324) has been described by
severalwriters Yarby (37 p73) describes it as an
outpatient racility which has certain def~n1te characshy
teristiCS middot1 Accessible to a poPulat1on concentration
bull 13
2 Open 24 hours a day seven days a week 3 Family-centered c~e by a team of lnteniists pediatricians clinical and publichealthnurses and social workers 4 Availability ot frequently~requ1redspecialist in such fieldsaspsycbiatryobstetrics gynecology surgerY5 Con~1nu1tyof doctor-patient relationshyship 6 Family records with social and medical ~raquomDaries of relevant information about each family member 7 Basic diagnosticlaboramptoryand x-raytacl1itles and drugs and biologicalsavailable atthe center 8 Directline (1)y center-controlledambushy
lance when-necessary) to ateach1nghospltaifor cl1agnostic ~d therapeutic servlcf)srequiring the fa011itlesandpersonnel of thehospltal 9 Patient-cantered and eommUn1ty-oriented -
The range ot services in the comprehens1venelghborshy
hood health center shouldbe as complete as possible
inCluding preventivediagnost10 treatment and rehabi-
litative services and Sbouldbe deslgnedto eliminate
episodioandfragmented services (31 pp324-325) Schorr
and English (33p291) add as additional characteristics
ot the compr8henslveneighborhood health cent~r that it
should ~ve intensive participation by and involvement
of the population to be served both in policy making and
as employees and that it should be fully integrated with
the existing health care system The Office of Economic
Opportunity (28 p63) stresses the potential for easing
health manpowershortage$by trairiing local neighborhood
reSidents as non-professional health aides at the same
time creating new job and careeropportunitles As
14
Gordon (16 p bull 422) indicates Many of the outstanding
problems in medical practice todayrevolve around
effectively motivating the patient and the prospective
patient to be concerned with his health This is
especially true in a deprived environment The community
health center with its technique ot consumer partici
pation maybe a way to create this cooperation effectvely
It is important to note at this point that the
comprehensive neiShborhood health center haaas its
constituency an integratedmiddot community r~ther than a
particular segment It should haveas Blum and Levy
(6 pp~5) indicate a horizontal rather than a vertical
relationship with the commuriitybull The vertical relatlonshy
ship they state is characteristic ot those service
organizations wh1chapproach the community only in terms
of their own fUnction Tbey see only their relationship
with the users of their service and assume that problems
of accountability will be handled by these consumers
However they pOintout this ienot likely as a vertical
approach creates dependency onthe institution Agencies
in a horizontal relationBhllp recognizetha1 they have
both acommunityand a consumer to serve The horizontal
approach places the matter of accoUltability on a broader
basis than just the involvement of the consumer De Diaz
(14 p4) speaks otthe need to ~develop a community
facility which difters from a clinic for low income
1ji ~
15
people in that it should serve an economically integrated
community The reason for this is that a wide variation
of consumers may assure a better quality of care
The advantages of the comprehensive neighborhood t
health center over traditional systems of providing
commuruty health services are numerous Hospital outshy
patient departments a major traditional source of ambushy
latory health c8refor poor patients have been indicted
for neglecting preventive health care ~romoting fragshy
mentedeare and subjecting patients to degrading and
impersonal conditions to mention only a few of the major
defects (31 p324) Another defect has been the
tendency to shunt low income patients back and forth
between different cliniCS often at different locations
arid with differel)t open hours for different treatments
or tests in regard to the same lllness(26 p63)
The comprehensive neighborhood health programs that
have been organized present a great variety of organishy
zationalpatterns one area of difference 1s in the
emphasis placed upon making each faci1ity comprehensive
in the services it provides to the patient population
In the Montefieri Hospital Neighborhood Medical Care
Demonstration program in New York City services have
been made available through a central health center and
two store frontsatellites the center to be the base
bull
Li
l of opratiol18 of ta1lJpIlflicl- ancl the satellite
center the ba of oparat1oDa of public heaJth nurses
an4 nllbborbood amp1 be satellite centers wereto
proVide preVentift tutaltll bullbulln1c1-m1zaticms w811shy
baby care per1od1c ~ectiland tJle central health
center to proViAle care tor illnes If (36 p299)
bis propWI VUDOt ~ttullytunct10DIDI at the t1JDe
it d1cu8ae4 18 tbe Uterature aDd all aernce Were
be1Dl provided 1D_~terBowever itwould ae
tbat the ntua1pro~ as aY1ioae4by its plmmers
would boclJ aoaeot bull 4efeot~ otthe current lud1cal
ccde teaIt pObullbulllne_t coorctJl8td admSDtshy
etration eD4 well 4eftlopecl refelTal procedtlreacould
1I1a~ thecOllDeCticmof t~_t8 withappropr1ate preTellshy
t1 aD4 therapeu1ampcaen1cbullbull aV81lable 111 diffrent
locationa Bowner tile barrieraottiaeaDdUatanc
between center and truaraUon tor the UDSopb1aticated
patieatlook1Dl tor 1her1~pJce too tor ~1CU-
larhalth serfplusmnQewoGl4~to JJa1t tbbll1ty o~
tb18 ~811D to provide iaaiYCOliprelleU1P18hboltleod
health servicebullbull III tactmiddot tappeareto coDtlict with
tbepro own taW cOfdotpro-1~a tam1ly
mecl1cal careprogru 111 wIa10h pre-teAtlYe aDd therapeutic
health erY1cecan be proY-lW to all IIl81Ibers of
tamily in the coure of aaSDll vi8it (36 PP301-3(2)
Dle Delmtr Coloradoprepa11ke the Montet1ori
LI
17
prograJlut111zbullbull abe1rarcJly ot SlDa11 aatellItestations
andlerer IIOreceDtallzedtac11It1es It 41ffers
howeverill tbcolap~81vene80f the services avail shy
able Inthe 4ecentraUzed facIJJtiesIt resembles very
clc)sely the IOdel ~ordecentral1zed social servicedell shy
very developed by 1ahII~ Which was 41sCussed above he
SIlall neImiddotgbborhoodmiddot c8Dt~aw1tb1n walkl distance of
most of the populatiotl havebeendesilDedto take care
of allthenorllalhealth probl of 3000-5000 patJentsshy
check-ups IlzatiOZl8s1Jlpl laboratory testa and
treataentand iaecucatlol18 (d1apeued by phyS1cians) for
IIOst DODCrltIcal 1l11le PatIent 1d1Oneed IIOrespecIal-
Ized care are reterrecttobacJalp facilities BaCkup
support tor themiddot~t1oDa are the tWo l8rsernelshborhood
health C8Dter8~ttr1Dl aCOglete~e of out-patient
serneeaDd three part1clpat1q hoap1iampl bull bullbull which
proVide1Dpat18Dt~t andcoDSUltatlve services
(13 p1028) Intb1a prosrama coaprehens1ve range of
prevent1ve aDd trea1aeDt serric 18 aVailable throughout
the decentraUzed middotta The CoapreheulY8 ReIgbborhood Hea1~ Service Project
otKa1er iC)UDdatlcm HOspitals 111 Portlan4 OreOD 1s
s1ll11arto th DenVer prosraa 1D thata comprehensive range
ot out-patientmiddot services 1D prov14e4 in each of 1ts 10cashy
t1oDa althoUlhmiddotmiddot tbe oentera are larger and l bullbulls DDIerous
than 1nth DenverproPUh (12 p6)
Li i
18
In order that a comprehensive neighborhood health
care center be able to proVide continuity of care it
must have arrangements for hospital services integrated
into th system Yarby (37 p73) as quoted above
states that it 1s characteristic of the neighborhood
health center to be directly connected with a teaching
hospital However De Diaz (14p3) indicates that it
may be advantageous for purposes of service delivery not
to havemiddotthe center affiliated with a teaching hospital
She feels that such anaft11iation may lead to asltuation
in which policies might be determined more by the teaching
needs of a medical school than by the service needs of
the patient
middotThe Nat10nalmiddotCommissionmiddoton Community Health Services
(25 p69) states that such a system of comprehensive
health care integrat1na ~e servicmiddotes of several health
and roedical agencies snould utilize Itas much single or
unified management as possible Neighborhood health
centers have been operated under a variety of auspices
but several writers have pointed out the advantages in
termsof coordinated prOvision of servictts management by
the hospital of the neighborhood health center For
instancethisfac111tates the keeping of unified medical
records of all the care a patient Msrecelved either at
the neighborhood health center or _le hospitalized
(12p6) ~ermore a3 Young (38 p1741) points out
19
direct operationot the u1sbborhood health oenter by
the hoSpital canll8lceaftilable to the center expertise lt bull
in sOlle aapcta 0 Operation that m18ht not be aa readily
available otherwie
Relardlebullbull of wbetberthe hospital and the neighborshy
hoodhealtbcent8r haVe a cOJIIIOaadmjntstration they
IIlU8thaVealTlved at a str1Dsent delineation of IDUtUal
role and reSpoDBlbilltiebullbull All OOIIpoienta ot the care
yst IIlWStQlarify and understand one anothers position
In the syatem and acree on objeCtive ancimethOds
(26 pp16-17p31) SODae areas of iDUtUalconcemare
reterral procedures record keepiDg aDC1 mutual use of
facilit1es statt1Dl i8 anotb8r ~ ot coaaon conc~
Ditt1cultift have u-laeniD the pastiD cOllprehensive bull t bull
healtbc~ prosraumiddot 1d11ch were batil plauned in wb1ch
all of the health canter phy1C~1IDa did DOt bavetatf
privilege at all ot thebackuJlhospltala (29 p21)
SUch a8ituat10n i8 1Dampcceptablelt inpatient care i8 to
continue to be p4by the pat1eatmiddot health center
physician and it cont1Du1ty ot care 18 to be maintained
Hoapital and health center1lUSt laav 301nt responsibility
tor the recruitaentot physicians
VticlentU IPan BJcNrcu Much otwhat haa b8ea sUd has stre88e4 at leastmiddot
iJlplicit17tbaD8ed tor tM etticit middotprovision ot8emcea
20
There appears to be two aspects of efficiency which are
discussed by writers on the su~3ect of the comprehensive
neighborhood health care centef one of these is the
need to organize) services to make the most efficient and
economical use of scarce medical care resources The
other closelyrelat8d in realIty is the need to help
the public use services in the most efficient manner
The comprehensive neighborhood health center concept
1s lhherentlymiddot efficient in that preventive curative and
rehabilitative health ~are programs are coordinated under
one roof with integrated a~stration Furthermore
theempbasLson prevention health education and early
disease detectionis eftic1ent troJll~estandpoint of
the health care system as well as beneficial to the patient
(18 p760) HQwever ~ue tothe scarcity of health care
personnel thecoiDprehensive neighborhood health center
mustbe an arena tor eXperimentation with new staffing
patterns~ The Kaiser program is indicative of the way
in which health care systems must begin to operate in
that appropr1ate ancillary personnel are used Wherever
possible to perform functions that do not need to be
carried out by the physician As Saward (32 p42)
states
1hroughou10ur organ1zat1on~ there are many of the customary experiments be1ngmade-shyJse of speciallr trained nurses for well-baby care under the SUpervision of the pedi9trlcianexperiments with routine prenatal care by
w ~
21
middotSPC1a1l~t~JlUrbullbull per8ema_1 bullJmdlJleu y our fuDotlou are auoh that DOtb1Da 18 dorutbYtbe phY8iCianstbat doe DOt vet to be done by the
phys1c111U1fhe other aldlle4 person- Del-nurse middotreC~0D18t the appo1ntshymeDt center or clerical praormelshyaremiddot there to free h1amiddotto use his spec1al sk111
Awell lmoWn treDd1D the area of eaaiDI health
c8re JII8DPOY8rShortagjs bas middotbe thetrend toward tra1nshy
1DB poverty area rea1deats as DOD~pro~eaionalmiddoth8lth
aide and nepborboocl health workeramiddot (28 p63) This
bas the effectofmiddotmiddot1J)creaa1q II8DPOWrand 8180 can help
bridle the cuJ~ cap betweenprondera and colllUmers
of aen1C8s This attarD at least tlleoretically
createa a situation 1D WIa1ch providers andcoD8Ullers can
be educated to UDderatad OD88DOtber and interactJlore
ettectlvely~ HoWever amiddotpltt8ll has beeD themiddot tel14ency in
801D8 oamp8e8 tomiddot us aidesmiddot ssale8lllcw t~r the center
alJDOatexclwdY811rathertbaD ua1Dltheal to protide the
health care for wh1ch ~ were trained (29 pp3B-39)
1bat ismiddotmiddot vh1~e the a14e Yalue in ~~m1catiDI with
low 1nCOlMt patieata haa beeR recoSD1zed and stressed
their role ashealtb carepersoDDelhil been slighted 1n )
any 1Dstancea
Anotber step 1d11Ob bullbull been taken to provide 8rY1ces
more efficiently eUeot1ftlybas beenmiddot theorgan1zation
of per8ODDeliDto IIllt141sc1pl1Dary teamaaaa means ot
proYid1DgmiddotCOQrd1DatedserY1ce SUch te8lll8 sen_rally
~
hf
~
22
include PhYsiciaQs nursbullbullbullbull soc1al workers and outreach
workers Conceptually th8y fmlct10n to me~ the intershy
relate lled1cal and social needs ot the families sened
Hor there are a number ot barriers to the etfectve
tlmctiOD1nlof lIuchte8ll8 SODieot these are heavy caseshy
loads the inordiDate amount ot tille consumed by multlshy
prOblem tamtliethel1m1ted tra1n1 ngmiddotmiddotand laCk of tnterest
on tile part ot aoae tebers in examinJng aspects of
problems out14e~lr oWn areaaotcolIPetencemiddot and
~ourdcation prc)blell8 between proteasioDala and nonshy
prot81~s (10ppa-10) middotrurtbemOre as De Diaz
(14 middotp6)1nd1cate tbel8 maybe a teDdency tor vertical
dp8rtmental lines of auperv1810nto become paramount
over the team coDamloation syst lead1ngto conflIcts
in determ1niDI the ro1ea ot solie team bers particularly
the DOD-prote81011alaInauch exper1l1enta Witb new
~t1Dlpatterna it 1s bullbullaentialtbat line of authority
roles aDd NsP0D81bll1tlea be made explicit and that there
beJDechaD 8IUI tor relUlar evaluat1onotfunctlorUng
Another way inwb1ch health care sernee delivery can
be made more ett1cl8Dt is to proVide servicea dur1DC the
hours whentbey aremiddot -ostnee4ed As reQo_ded by Yarby
(37p1) serY1ce can bemadelIOre accesslble by making
themava1lable 24 hours a day seven days a week If
rg8l1Cy service are aft11ab1e aroua4-tbe-cloek at ~
nil1iborhood health center the continuity ot tbepat1ent ts
23
careiamaiDtalDedand meatry point into the
cOIIPre~i health care 8 be made available
tothe patient who aoZMllyU8ea ozilymiddot emergency care in
tille of med1cal criais More 8isDificantly ava11ab1-
lity of a tull rase of bullbullrv1c8 tor seVeral hours 11the
eVerlna aI1Cl On ~ prevent the los ot earn1JiSs
involved if th patierat 1IU8tt8cet1me oftfroawork dur1q
the d8y for aed1Cal oare bull his can be an eSpecially
importantc0J1814eration tor lo1aCOlleDUUg1nally qloYEtd
patient aa4caJla18o PIOJIOtet1)e 0Da01Dl use othealth
servicebullbull
exper1eDO ot tbeKa1er prosraa in tb1s~reprdAs
Greenl1clt(19 p10) states wA lllNt 8ip1flcant
proportion ot the abulatory care 8n1cp~Y1dd tor ~
total popUlatiC)U ~ ~ after clWc hours and this
Deed i8 apParenUyaoN prODGUDced tor aJl8d1cally
iDCust population On the other hand the bulk ot all
aabulatory med1cal cu 88l91ce are performed dur1nS
regular cl1D1c hour eVen when services are available 24
hours a dayJ day bull week W
It has ~ the experi8D~eof a ftIDber ot ne1g1lboXshy
hooct hea1tbcentere _t a_jor obstacle to efficient
proViSion ot anicbullbullhas beentbe teD4eDcy of medically
1ncl1pnt patieats to utilize the center oa a walk-in
baais tor epi8od1ccr181or1entect bullbullrv1cea rather than
4)i
h~ ~~f ~~ L
24
to make appoJlltaeata tor ODIo1qprevmt1ve treataent
and rehebl11tat1Ye care ad ampl1O to bave a blah failure
to Show rat_for tbe appo1DtaeDts that they dO make
Atone center 628 of appo1Dtments made were kept
while 3Oottbepati_ta een were ~1n patients
AlthoUP fewer patiets were actually 88811 by the cater
1D middottb1s 1Datance thaathe -bervholuidmadeappointshy
mta the walk-iD patlat required an iDord1nate amount
ot staff t1ae tor aCreeDiaaacl ~trral to pplOprlate
~ttor caregt (9 pgg) Arraquotbr1llpl1catjo~ of the
plOVidedto valk-iD patient by other thaD their
(19 p12)rurtbermore
when patients uti11ze Wlk-1Il er181 centered care
athelr ODlf tona ot ootact with the _d1~ care
ay_ta fUilycentered care the treata_t of tUl11y
bers
a a UD1t 11
dlarupted
hewalk-1Dphenoaaencm appear to barelated to
diUerence between soclal clase in the style of Dlaking
contactJt1th the a11oal C~ay8t As Greenlick f ~
(19 p11)1Dd1oate8 thepheDOaenOn ot INater usage of shy
walk-in ervice by aed10ally middot1Jid11ent patient thaD by
others baa otte been attr1buted to a stoical att1tude
tQward 1llDe8 em the~ ot poor people leacl1D8 to a
~
25
greaterdelay1n tbe k i Dlofa8d1cal care These
patients wppoedlyeelcmiddotcareODlymiddotwIleD tbeirmiddotillDess
becOlles1Dtolerable resultiDSin middotthMr appeariDS withshy
outnot1ce1o rece1ve oareHlwever Greenlicks
r8aearcbbaa cut doubt on the existence ot tb1delay
111 report1Dg middot8J1IPtoJumiddotOfDeW 11laessand seek1ng care
Be bas tcrQDd 1bat s1ll11ar peze_tases of dioally
1nd1sent 8DClJ1on-aed1cally 1Dd1PD~ pat1enta seek care
on the aue daytbat aptou tirstaPPear
1fb11e GrHDllclc 1nd1cat tbat the reasonator the
greatertendeDCY of low 1Do~e pat18Ilta to 1$8 walk-in I
serY1ces are notlcDo1rAmiddotmiddot tbe7 _ be rel~tedto a tendency
ot lower aocio-ecaaaoclaa patieota to preter face-toshy ~
face contacts with II841cal persoDl181posslbly because
such contacts areft coatortiDS an4reasauriDS to
patients who are hJpotbeafzed to bave a dependent attltude
toward IIed1Cal care perS0Jm81 (30 p161)
It a8 itmiddot baa pnerally beenhld the appointment
s1stemts the most efficient Ileana of dellveriDS
comprehenSive oODtllluiDlh-lth care (9~100)1t is
necessary that educaUoraalmiddotbulltfort be taken to proaote the
use ot middotappo1ntaents8DClmiddot tQrec1ucethe fa111re to appe~
ratB4uOatioaalwhlQb baft~utl11zedhave been
IJ
26
1Dten1ews with walk-in patients home Vi8its and group 4i
meetiDp1D8D attemptto1Dierpret1o the patients
the value of rtitgular ppo1ntmentamp andot con~in~
c~1ve care rather than epiI041c care (9 p1OO)
h1s 1safuD~tioD torwhtch nOl~prot81QDal colDlllUD1ty
YOrkersllaY bebe~r8U11ed tban other statf H()wever
euch aD ~ucat1oaal propul __~ ~e related to the senUiDe
capacity otth health oenter to provide comprehensivebull gt
ervice8 to1tpat1_t~odoD aD app01ntment bas18 It
1amp pos8ibleo~rw1 tor educa110Dal ttorts to result
LD a~8JImCl tor ltPP01ntaen~8 at a ratewb1ohi8beyond
the capacity ot thee_tar to t without uareaaoDably
1_ wa1t1Dlprio4a QOBt1nuad use Ot the center on a
wallt-in bU1 _1tbeoosiItpos81ble to et an appoint-
met anc11nCreued pit1entcoJaplampia1a bull Therew111 of
course always be a need and demand tor acute ep1so~c
Care -ci the health centerDlWlt be planned with the capashy
billty ot bullbullbullt1D8 tb1aneed wh1~ cont1Du1nI to stress
aDd educate the patient to utillze oDlOinI comprehensive
faa11y middotc~te~d Cflre (9p 100l
att g4 CODClva1opa
In order to bea4equate any coJlltemporary health care SY8tem muat bullbulletcerta1D interrelated criteria he
IJ
27
minimum criteria areaccessability of services to those
who need them compr8heX1siveness and appropriatness of
services and efficIency 1nthft utilizat~on of SCarce
health care personnel and resources The scareity of
pex-sonnel andtbe need for h1gh quality ongoinghealth
care services
aJIlong the
populationdemanci the most effishy
cientprovision of services
Services must be made accessible to the population
They mustmiddotbe geosraPh1cally accessible to remove the PhysicalmiddotbaTiers betWeen peopleandthem$d1calcare
system They mUst otter their services dur1ngthe
hours when people can make the moat use ofthemA~ it
makes little sense to concentrate services geographically
where they will not be uSed to their fUllest extent it
also is wasteful to provide serv1cesonlydur1righours when
many people are employed his not only presents a hard
ship middotto the consUmer lnrt wastes resources if for instance
the unavailability of preventive services during the hours
when people Can use them causes a need for treatment
services later on
Health carbull sEtrvices must be comprehensive including
prevention treatmcmtand re)abimiddot11tation Ambulatory I
healtbcare facilities wh1cQ are orienteciexclusively
toward either prevept1on or trea1mentare no longer accepshy
table for they are lneft1c1entln their use of resources
and in their prov1s1on of health care to the patient
w ~~
28
If prevent10n1s notmiddot stressed treatment serv1ces that
could have beenavoidedY1l~ be required If prevention
1s the sole focus of the health care facility sick
patients who present themselves must be referred elseshy
where for treatment andsllch referx-als may be taken as
reject1onsor not followed through with until illness
becomes unbearable
The instltutlontbat meets these requirements Is
the comprehensive neighborhood health center It 1s a
local decentralized outpatient facilityprOVld1ng a
fUll range of ambulatoJY health care services It has
a linkage to ahospitalbackUp facilityforlnpatient
treatment and hiihlY apclalized outpatient care
The neighborhood health center must be a fac11ity
planned with an awareness of the needs of the conSUtller
and coDitnUn1ty It must have the r~Ul0urces to provide the
services people need mere they can use them and when
they can use them It must uti11ze the part1cipation of
the community to develop this awareness Not only must
the cen~er beset up to be Amctional for the consumers
but efforts must bemadeaga1n with commun1ty partici shy
pation to help the consumers utilize medical care
services effectively The center muetmake efforts to
educate the community about the valueot regUlar health
care of preventive servicesand of the use of planned
IJ
29
medical appointments ratherthanorisis centered walk-
incare Therealit1es of the existing health care
system have not taught the patient particularly the low
income patienthow to use services effectively
The helthcenterilUst also bea laboratory for
experiments in easing the health caJepersonnel shortage
and c60rd1Datingcare~ A major difficultY iri-exper1shy
menting with neW rolesis freeing staff of old preconshy
ceptions
CoDlprehensiva neighborhood health dare centers have
been developed under a variety ot alisplces including
medicalsociet1es hoSP1talsmiddot(36p299 group pr~ct1ces
(29 p6- 12 117) health departments (13 p1027) and
ne1gbbothoodassoc1ations(14) The literature indicates
somevalues nthe management ot the health center by plusmnts
hospital backup faCility Whatever the auspices many
adm1nistrative fuDctions such as program coordination
standard pr9tectionand evaluation call for considerable
c~tralization of adm1nistration city-wide or coU)tyshy
wide At the same time other aspects hours of servlce
for examPle~ cuI f~radm1nistrative fUnctions made atmiddot
more local levels Each neighborhood center must be
free to adapt its functioning to itscominunity thi-ough
the mechanism otcODlllUl11~ participation inmiddot policy making
Obviouslythe prerogatives and responsibilities of each level must be negotiated and made explic1t
t4~
JJ
BIBLIOGRAPHY 30
1 American Rehabilitation Foundation ~ealth Services Research Center The Health Maintenance Strategy mimeo 1971
2 Anderson Nancy N Comprehensive Health Planning in the States A Study and Critical Analysis Institute for Interdisciplinary Studies American Rehab ilitation Foundation 1958
3 Andrus Len Hughes Comprehensive Health Planning Through Community Demonstration Health Projects mimeo1967
4 Barry Mildred CandCecil G Sheps A New Model for Community Health Planning unpublished paper presented to the American
Public Health Aseociation1967
5 Blum HenrikL Fred Wahl Genelle M Lemon Robert Jorulin and Glen W Kent The Multipurpose Worker and the Neighborhood Multiservice Center InitialImplications and EJeperiences of the Rodeo CommunityService CenterAmerican Journal of Public Health58 (Mar 168) pp 458-468 shy
6 Blum MichaelD and Soloman L Levy A Design for Service Delivery that Reinforces Constructive Tension Between a Health Center and Its (sic) ConSUDlers and Supports Community Power unpUblished paper presented to the American Public Health Asaociatiltn 1968
7 Brielaud Donald Comm~ity Advisory Boards and Maximum Feasible Participation American Journal of Public Health 61 (Feb 1971) pp 292-296 shy
8 Burns Eveline M Health Insurance Not If or When But What Kind Madison Wisco~sin University of WisconsinScllool of Soci~l Work 1971
9 Campbell John Working ~elationships Between Providers and Conshysumers in a Neighborhood Health CenterU American Journal2 Public Health 61 (Jan 1971) pp 97-103
10 Caxr Willene Neighborhood Health Centers Funded by the Office of Economic Opportunity mimeo 1970~
11 Colombo Theodore J Ernest W Sawardand Merwyn R Greenlick The Integration of an OEO Health Program into a Prepaid Comrehensive Group Practice Plan American Journal of Public Health 59 (April 1969) pp 641-650~ -
12 Comprehensive Neighborhood Health Services Projectof Kaiser FoundatioIl Hospital~ Prcgtgram YearE grant renewal proposal mimeo~1971 bull
13 CowenDavidL~ Denvers Neighborhood Health Program Public Health Reports 84 (Dec 1969) pp 1027-1031
IJ
14 De Diaz Sharon Daniel Beyond Rhetoric The NENA Health31 Center After One Year unpublished paper pres~rited to the American Public Health Association 1970
15middot Gerrie NorrrianF and RichardH~ Ferraro Organizing a Program for Dental Care in a Neighborhood Health Center Public Health Reports 8 (Aug 1968) pp 419-428
16 Gordon JeoffreyB~ The Politics of Community Medicine Projects A Conflict Analysis Medical Care 7 (Nov -Dec 1969) pp 419-428 shy
17 Greely David The Neighborhood Health Center Program and Its Implication(3 for Medical Care H~alth Forum of the Welfare Council of Metropolitan Chicago (mimeo) 1967
18 Greenlick Merwyn R Newgtimensions in Health Care American JOurnal of Pharmacentical Education 34 (Dec 1970) pp 754-4
19 GreenlickMerwyn R Donald K Freeborn TheodoreJbull Colombo Jeffrey Abull Pruesin and Erne$t W saw~d Comparing the
Use of Medical Care Services by a Medically Indigent and a General MemberShip Population in a Comprehensive Prepaid Group Practice Prosram II unpublished paper presented to the AmericanPublic Aesociation1970
20 H~tadoArJiloldVMerllYll RGreenlick and TheodoreJ Colombo Determinants of Medical Care Utilization Failure to Keep Appointments unpublished paper presented to the American Public Health Association 1971
21 Johnson Richard E and Merwyn R Greenlick Comprehensive Medical Care A Problem and Cballengeto Pharmacy ff AJilericanJournal of PbarmacenticalEducation 33 (Aug 1969) pp 361-367 -
22 Kahn Alfred J Studiee Social Policy and Planning New York Russell Sage Foundation 1969
23 Kotler Milton Neyhborhood Government Local Foundations 2 Political~New York The BobbsMerrill Company 1969
24 NationalCommisaion on CommunityHealthSfrvic~sActionPlanniriamp for Community SetithServices~ashington p C Public Affairs-Press 19t7
25 National Commission on C~mmunity Health Services Health Adminishysration andOrMPization l the Decade Ali9$-d Washington D C Public Affairs Press 1967
26 NationalCornmiesion onqomm1Jllity Health Servicesbull Health ~ Facilities Washington D C PUblic Affairs Press 1967 bull
~ n
32 27 ODonnell Edward J and Marilyn M Sullivan ServiceDelivery
and Social Action Through the Neighborhood Center A Review of Research tt Welfare ~ Review 7 (Nov~Dec 1969) pp 112
28 Office of Economic Opportunity Second Annual Report Washington D C~ U S Government Printing Office 1966
29 Office of EConomic Opportunity and the Medical Foundation of Be~laire Ohio Eighth Report 2l ~ Committee2a Governshy
ment OperatiOll~ Va8hiiiSton D C Government Printing Office 1969
30 Pope Clyde R Samuel S Yoshioka and Merwyn R Greenlick Determinants of Medical Care Utilization nhe Use of the Telephone for ReportiDg Symptons Journal of Health and SocialBebavior12 (June 1971) pp155-162 shy
31 RenthalA Gerald nComprehensive Health Centers in Large US Cities American Journal of Public Health 61 (Feb 1971) pp 324-336 shy
32 Saward Ernest W The Relevance of Prepaid Group Practice to the Effective Delivery ofHealthServicestt The New Physician 18 (Jan 1969) pp39-44 - shy
33bull Schorr Lisbeth Bamberger and Joseph T English Background Content and Significant IssUes in Neighborhood Health
Center Programs Milbank Memorial ~ Quarterly 46 July 1968) part 1pp 289-296
34 Weiss James E and Merwyn RGreenlick UDeterminants of MedioalCareUtilization The Effects of Social Class and Distance on Contacts With the Medical Care System Medical~ 8 (Nov-Dec 1970 pp 456-462
35 Weiss James E MerwynR Greenlick and Joseph F Jones Determinants of Medical Care Utilization The Impact of Ecological Factorstt unpublished paper presented to the American Public Health Association 1970
36 Wise Harold B Montefiore Hospital Neighborhood Medical Demonstration A Case StudyMilbaDkMemorial Fund Quarterly46 (July 1968) part 1 pp297-308~
37 Yerby Alonzo S ttHealth Departments Hospital and Health Services Medica1~5 (March-April 1967) pp 70-74
38 Young M M~ Chatanooga IS Experience with Reorganization fOr Delivery of Health Services ttAmerican Journ8l of Public Health60 (Sept 1970) pp 1739-1748
f or l
II bull 11 Y d
II
IJ
34
ThepurposeOfPart II of th1aa paper1atod1scuas
elected Speclfic needs ofecltlc areas within Multnomah
County A8P01ll~oUt 1D ~ I of t1a1bullpapermiddot Ita nelgbshy
borhood health oare cater IlU8t be a facl1lty plaDlled with
aD awarenes of the neeels of the oODllUller and collllUDity
Part II of this paper nIl Show 80e of thoe speclflc
needs
he1DforutiOD tor t1li Portlon of the report
obta1nec1 troll tbroupout tbe follow1Dl threepUb11catloDS
1gr~e_tiMshylIPrIxaiidOreson JuDe 1963
2 1~_middot_sectSI8e~ected1teai c-ua 0 S 8 e first count coaputer tape Coluab a_lion AssocshylatloD of QoveraMD-8 Jlme 1971
3 Jtu1tDoab County Oreaon BDY1roDlHtlltal SurveyEarly 1971
The JIultDOIIIlb COUDty OrttIOD BDv1roDllfmtal Surley
Barly 1971 1s bull stat1stical report of the activ1tles of
theentlreMultDOIIIl2 CcNDty Health Dep~t during the
year of 1970 Die speclflc 1nd1cs elected from tb1s
study amprejMental aealtll Publlc Health N~s1D1 vlslts
FaJUly ~ Veaereal])1 ~ ~rcul081
Throush tie use of cUrts and mapa ODe CaD roup these i
speclflc ~oea to ahcnr the healthneedsof speclfic I
census trtcta aD4 then the health needs of iarer neIghshy
borhooda 1m4 o~ Uebullbull
Rf)~UP1Dl of areu was accompllshed in thefolloWinl I
JJ ~
35
he MiltDoIliahCountY oregon BDViromaental SUrvey
early 1971 isamp statistical report ot tbeaotivities ot
the entire MultDolllh COUDty Health ])epartiDent dur1nl the
year ot1970 he specitic 1Dd1C8S selected frOm this
aUy are 1Il8Dtal health public healthDurs8s visits
fUl1ly pia waereal elisease aDd tuberculosia
Tbroq11the Wle otcbart aDd mapa aDecm szoup these
specific indic to show the health Deeds ofapecitic
ccmaua tracts aDdtIum th8health neecla of larsr ~eilh-
bOrhooda and co8I13 tlbullbullbull
RegroupiDI ot areas waa accoap118hed1D the
tollOWiDl lIIIIm1er~ A bullbullcifie 1ndex 8selectcl auch as
venereal di8bullbulle or tuberculo8i~ he total number ot
cs was then deterll1ne4 for each census tract Through
the use of the maber ot cRbullbullbull tor a 11Yen cenaus tract
aDd tbe population ot thattractaltrateot1lla1ampmcper
100OOOpopUlaticm wu cleteXll1ned for each census tract
This was ~e to starl4ard1ze the population ditterence
amongOeD8U8 -tracts 1he rate of incidence toreaob
cenauatract was then llstedby rank position on a chart
In rank poition1DI any cen8Wl tracts haviDg equal
rates ot1l1c1dence are assipe4tbe iaDk posttiona
Beeauseot the abo fact tbAt cbarta w111 vary in length
neveltbAtlea eacb cbart will 1Dclu4eall census tracts
inMullnoaah Couaty Atter the census tracts bave been
listed accord1q to raalcth1s list will bediv1ded into
IJ
36 three levelsotinc14ence he three levels are
1~ The upper 14 of1DcldenCe
2 Thelower 14 ot incidence
middot3 The ILld 12 of incidence
Tlles three srouplqa are then used in compiling a map ~f
Mu1tnOmahCountyfor ach apecltictop1cbull TIle maps are
uaefuJliD tbatthey V1suallycoJib1De 1Dd1v1Clualproblem
census tracts into larger problem nellhbOrhooc1s
The 1960 statistical iDtormatloD was Used in a similar
liIaDDr to tbatexpla1Dedabove 1Dthe4evelopaent of a
chartmiddot and map 1Ihow1DI e cOllpampriSOr1 of per capita lncolle
tor ttaCh ceDsua tJact aDdmiddot combiDed census middotmiddottract areas
he 1910 aDd 1960 statlstlcal iDtOrllatl0D was combined
lna map and chart he purpose of this and chart is
to d8aonatrate the e cl1stributloa1DeachceD8U8 tract
and middot1ndlcatbull tuture ace populatlon treD4a bull
When one be middotbullbullbullbullbullHdth ne8cts ot an area and has
declded to establlsh a cl1D1c to serve that area the
physical location otthat cl1D1c IllU8t be consldered In
order to coapreb8ll81vel develop an area cl1n1c one should
conslder thepre88Dttraftlc middot~ytaa an4tranaportatlon
systems Thecl1D1cahoUld be located close enoUlh to
major arterlals to giva asy access from the total area
be_ ervecl by this cliD1c At the t1ll8they should
be tar eo away froll thesarterlals to all8Y1ate traffic
CODCell18 andpark1D8 conpstlon By traff1c concerns I
IJ
37
lIlan one lUSt consider thertarro1fne8S of streets whether
streets are oD8--C)r two-way iqres8 and egress to parking
amp0111tie eros tratflC) spedof trattJQ children 1n
ll8a traffic i1lht Vislon re8tr1ctionS etc
BwstraDsportat1onshould alao be central in this area
as maay people ~U f1Df1 1tD8Cessary to use this form of
transportatlon
~e tutqredlopHQt of bull treewa systems should be
c0J1S1dered soastolesen thecumce ofmiddot future roada
cutt1DSotltbe cl1D1c llte line
nrrph1c middotDampta
It is 1JDportaDtto kDOw the demosraphic distribution
characteristics of the oUenteltbat i8 to be served by
localized health cl1D1cs
Acl1D1c which erves8J1 area where1D the prepondershy
ance of persona arecrter 65 years of mayf1nd that these
people rely more on pUblic transportation call for more
home- services and haV4t 110ft ChroD1c and debilitating
types of disorders (b1_ blood pressure poor heariDg and
eyesight) tbaD do8 an area ot a YOUDIer population On
the other hand thL area of older residents may have little
need for family plabDlng cllni08
In order to better ~Ybullbull the 4eaoraphic population
of each CeD8U8 tract the 1970 CeD8U8 iatormation was viewed
and two specific catelOri8 considered These two cat
IJ
38
lori8S woUld be the perc_tap ot population under 19
year of ase and the percentase ot each oensuetractover
65 years of age he 1960 1Dtormatlon tor eaCh tract was
then compared witbthe 1970 intormation and a percentage
ofincreaae or4ecreamp8 tormiddot e~chtract1n each category
cOJlputecland achartma4e By the use of this chart one
18 able to View tJleap populat1odiatr1but10n of census
tract and at the _ t1lle accesa middottrencl Por example
let us choose census tract 601 W see 40-4 otthe
population is under 19 years ot and that ODly82 1s
over 65 years ot middotAtthe e tille the percentage of
youth bas ~ed ODly 1_ intbe laSt teD year whilethe
percentale over 65 year ot middotbas stayedmiddotthe same With
this in mJnc1 ODe ~ 1DfItr libat ol1D1o aerviDg this
area WOuld bellQre conq~w1th the problems of a
YOUQier populat1on and that _ would probably be true foJ
some t1aein tbefuture On the other hand CeDSU8 tract 54
has only 2 ollt population UDder 19 yel1s ot age and
this has decreased by 1 over the last ten years middotwhile at
the same time 32-377 ot the populat1on 18 over 65 years of
age A ol1D1C ___ this area should be or1eJ1ted toward
tbespecttic problema otthe ampledbull
PerCapia __ bY gsa neat
WhaD cona1der1qlooat10D1 tor health cl1n1cs one
shoUld take the 1DC01Ieot areas into consideration Areas
IJ
39
of lowiDcome would not 11kel~be 8erved more by localized
cl1D1cs tbaD would are of hilbincome It 18 likely
people haYiq a hip iDeoll8would preter to be aeenby a
chosen ~r1vatephylc1a1l tban at a local cl1D1cwhere
10Dier waits y beraceaaampryand leas personal attention
gl_
The 19701ncOII81atoWampt10n tor MultnomahC~ty was
not available at the tille thi8report W88 made The 1Dto~shy
tiOD Was taken ~adtro tbe1960 census publlcation
his woUld ~8Il thea tbat ral1I8 OD the chart ynot 1raquoe
completely accurate hi writer telthatthe areas most
affected by tb8 1I8eof the older 1Dco1DtOlaat1oDWOuld be
those tracts wh1ch baYebad a rapid 1ncreaae1n populatlon
over the past tfmyHr8 bullbullbull tracts would include tracts
nUmbered 104 9897 96 aDd 95 be perc~ita 1Dcome
referredto1il-tb1a Paper18the lIean 1DCo per person per
census tract
Attar the iDeoeper census tract was listed on a chart
a map was de 1D41catiDg those census tracts belonging to
the lower 14 ot income tor all censue tracts in Multnomah
COlDltytbose beloqins to the upper 14 ot income tor all
census tract 111 MultnolUlhCounty and those belonging to
the mid 12 ot 1I1coaetor all oeuuetracts in Multnomah
C01mty
In yiew1Dg the _p 1t caa be seen that the low income
area seautotollow aloas the at aide ot the Wl1lamette
IJ
40
R1ver the full length of Kultnomah County A second low
income area follows the south edge of the Columbia from
the northwest corner of Multnomah County easterly to 148 St
A third problem area seems to be on the east bank of the
Willamette River with the Union Pacific Railroad being
about the center of this tract The extreme loutheast
corner of Multnomah COUDty appears to be a low income area
but as this area bas bad rapid grouth in the last ten years
this could be erroneous
Mental Health
be first ~ecific indica to be selected from the
Multnomah County envirollllental survey of early 1971 and
to be considered in this paper i8 that of Mental Health
At the present for mental health purposes Multnomah
County is divided into five catchmentareas with a mental
health cl1n1cin each area These clinics are Model
Citles Delaunay ADkeny street Office Hansen Health
Building end Southeast Clinic
All lIlental health cl1n1cslcept statlstlcal information
on all patients visiting their cl1n1cs this included the
address of the patient hese addresses were then listed
upon the approprlate C8D8US tract Each census tract was
then ranked on a chart according to the nUllber of mental
health patients who reslde ln thatCeDSUS tract attending
any of the above listed ental health clinics This chart
IJ
41
wasttum d1v14ed1ato proper quartile bbullbullbull
quartile vereUs to dne10 u appropl1ate Multnoh
County _tal health ItLa middotmiddotmiddotthelipO~a1bl by lOoJcJIUE
at the UDtal health _to uteN1De which ueu have the
lars-t use otCOllDty 1alh~th faci11t1Rot
1Ilclu4ecl 111 tbia woUld tber otpeopleYia1t1Da
pr1vat patch1atriata aDd pr1_t _ntalhealtb cl1D1c8
WheDtbe M1 18Yienclmiddot Itmiddotmiddotmiddotmiddot~middotbe~_ tbat ~rtt
appears to lMt fourmiddotmiddot-al are iii _oil the nuaber ot
lIental healthcl1D1c na1t toM tbjh1sheat 1he
tour areaa woUld be tollows
1ttrea Ore to~Blo Drimiddot ~tb Burrus14e aDd tIMtmiddot Colb1a Riftr H1gbwyaeri1Dla th nortllra boundaryshy
2 bull ProII 82D4 1_~ 10 20th streetwitil the ra1lMd Mu the north ltouadary
3 ~ et et tUgl_b1bull MYel froamiddot the Clackaaa COUDty l1ae aorth to Dln8lon stret
4 beDOlvt1ttfe-t ~efllt4 COatytrca Jle1aware streetmiddot toR1C1a11oDd wlth Colubla Blvd heiDI tbAtnorth bouaclary_
It ODe coapareatbiap to th iDeobullbullmiddotp 1t can be
eamiddotthat lIOat ot the c tracts baY1Dg bllh v1i11tatlcma
middottfl public tal health cJ1rUc8 ~ 111 t13e low ~ aid
1DcOile SroupiDIOJa1y of til 25 tracta llsted as
haviDlbip aental Maltll nlltatlou are ~ the1g60 hip
iDeo arebullbullbull
17 Plpn
42
amily PlellnSDI ]Jlce Metal Health i8 an 1nd1ce of
use Theperson 111 ordertobavebe_ 1Dcluclecl 1n this
atu4ywouldhave tohaft Ue4 ataa11y plaDI cl1D1c
tacilities of soaetype It 41fter troll tile _tal health
study1nthat i t1Jicludestatist1catrollbotb public and
privateclJD1os
The iDformation tor the iak orurcbart 8Dd map of
t8ll111 plenn1 na ob1a1De4 by cOIIblnlDlthe mabel of
1rlcuv1duals bullbull_ attbe tbreellUltrampo-ti Coatyhll11y
PlalJQllIl C11ll10s 111til tbo at the Planned PareDthood
Association CliD1C8 be tbree -JIultDouh Couaty r8ldly
PlamSq Cl1D1c are Solrtbweatth Col_bla 1111- a114
HaDsell Health BWlcl1Dl CllD1cbi middot1Dtormat1oD vas then
bullbullbullesed tomiddot detellWMt l10w people troll eacb c8IUIUS
chart wastben Mele IUs oIIart jn 4iY1ded to show
the censuS tracts lIaYiDlmiddottIle h1t1iest qUart1le of incidence
of use lowest quartile of 1Qc1deao ot use Jlid 12 of
incidence of Wle an4 a map sprepared troll thts 1Dto~
mation
The C8U118 tractsbelOJISnl to the h1lhestquartile of
use appear to be 1lO~ 8catt~ on tbipwas true ot
either the _p ot aental health cl1D1c uaageor ot the map
abow1DI per capita 1I1COM Iaere40 to be three
d18t1nct areas of UIIaP beJ woul4 be
1
IJ
43
t10D of BurD81cl and the W11lallette River 4
2 S~t Portland 8Otth otmiddot the ra11shyrcaadand alona the W11lamette River
lIortbeaat Portl8D4 between MisSiss1pp1 and 24tbStreet the northbouBclary be1DgColwb1aBlvd
Pylzl1c BMltl IrpI Y11ta
Publlc Healtil nur81D1Y1s1t nclud8 an vists to
theholles of client by PubUc Health Nurbullbullbullbull his shows
visits to bull f8Jl1ly fer aDY purpos SUCh aatuberculolJ1s
het1Dl tem1tyaeatalu4 8IiOt10D8l cODd1t1ona etc
he atat18t1C~ 1fele C()4ed accord1Dg tomiddot the 1llli301fOCUS
of the Y18lt tt doe DOt 1D41cate the Dmlber of holies or
f8ll11lev181tecl or 1D41Y14ual Y1a1ted more tban oDcein
the propwl It dobullbull I1ve 80M 1D41cat1on by coaparlshy
OD ot the 8JIoUDt of aedlcal problema 1n eachcen8WI tract
Ap1nmiddot the _p abowa 8 scatter patteraof probl_
areas althoUSh there appear to be a sroup1Dl of hiSh J
l8aIeccmaus tract 1ntlut extreme southeast part of tbe
County other areu uIriaI any nura1Dl contacts are
1 bull he 801lth-oa-al CO1Dty on eaCh 814 of 82nd Av from Clackallaa County north to Dinloa
2 ear bullbullbullt 814e aroUDd Preacottand Misaisippi
Dowatom Bunul14eonboth 1de of the river
44
V_real Pis The iDfomatloil uaec1 to tabulate the Venereal
disease chart includes all the ooab1ned case otmiddotODormea
and syphilIs reported by bothmiddot publIc and prIvate physicIans
dur1nl 1970 There were 3602 caes ot IOnorrhea reported
dur1nl 1970 While ODly 17 cabullbullsot ayphilimiddot were reported
A chart was prepUed aDd att8llPt wasmiddotmiddot de tomiddot
determ1De Wh_therVttDereal 41ease was more p~vaJent in
areas othigb or lowmiddot proportIon ot youth hi waadone
bymiddotdetemlna a 1leaD prceiltacmiddotmiddotmiddottor the population ot
resld~ts UDder19 years ot (34) middotA mean ratemiddot per
100000 popUlatIon al80c1ttem1Ded tor the middotoccurreDCe
ot venereal dieae This was et at 390 oass Areas
hav1nl a population 1n which leiS than 34 were lmder 19
years ot ampIe were called low- yOuth abOve tbl percentaae
hiSh youth The aaa waatrue ot the occurrence oivenershy
eal disea_ per CeD8UStract It the rate waacomputed
as 1I0re than 390 cases per 100000 it was called hiah
venerealdiaeasei it less than thia tisure low venereal
disease It was tound that 1D Multn~ COmlty there sems
to be poSitive OOlatI0n(x21S19gt between low youth
and hipmiddot venereal diseaand hip youth and low venereal
diseasebull
RaDk ordr Iitot all c traot middottbAm made
Th1s was done byt1Ddlna the ratepr 100000 populatIon
of venereal disator all census tracts in the County bull
45
These were thenlisted from h1lhto low (sreatest to
least) in a rank order The l1sting was then divided
into Upperandlower 14 aDd listed on the MUltnomah
Countymiddot up
The areas of b1gh venereal disease se8ll18to
roup thBl~8 middotin a very tllht area ~oq both 1des
of thell18l8~ R1 w1th BurDaldeS~et being
~bout theceDter qf tbi8IZ9uping This area woUld
appear to be m ldeal spot for the denlopment of a
locallzed venereal d1sbullbullbullbull cl1D1c
UbepoundCUlO1s
In this report bull tube1C1llosls caS8S refrred
to include alltbobullbull cabullbulls ontubercUlo8is follow-up
rather middotthan just new C Accord1Ds to the Multnomah
County Health SUrvey of early 1971 this would include
all ca repOrte4 over thelaat three years The
total number of tuberculosi8 cabullbullbull usedin this study
was 666 lh1 included 128 new cabullbullbullbull
A rate per 100000 of tuberculosis for each
census tract wa- then computed and the c~us tracts
listed by rank order be b11h Qartlle mel low
quartl1 were then reoordd on a Multnomah CoUnty map
TWo genral areaa baY1Dg a hip mcldencaot tubercu~
losiare 1D41cated heyare
1 Both middotsld ot theWilla11lette River
Ll -
46
with Burns1de about thecnter
2 he extrea Northebullbullt comer of the County bull
By coap8r1ng the tuberculois an4ven8real
diseae maps ODe can 8ee that the downtown areas ot
hiSh 1nc1denceare alIIo8t 1c1eDt1cal on ach map
This WOuld 1nd1cate that 1t would be of value to
bullbulltab11sh acl1D1c 111 th1aampreatbat would provide
bothtuberCulos1s 8Dd ytmereal 418ase srvicbullbullbull
Thchart aDd 1181gt8 are wsfuln 11v1DI
1Ddicat10DS tor the type aDd placemeototlocal
health cl1n1c8 tbro1qhout tbe MultnomahCounty area
A cOllpar1on of the mapa help one to dec1dewhether
to provide a aulti-8ervice cl1D1c or spec1f1c type of
cliD1c As stated in Part I of thi paprserv1ces
shouldhaYe both treatlieDt and prfMmt10n cOmponents
As he been stated fta ne1lbborhood health care
Qenter muat be a fac111tY plazme4 with an aamesa
ot the neds of the consumer and the c01llll1m1tybull
Part II of this rport haa been an attaapt to indicate
and clarify 8011 ottheae coDlllUDity neds This has
been done through8elect10n of apc1f1c problems
The indic were then visuallyrecorded through the
use of ups and charta ODe dan asseS8 thedsreeof
1DIportance of certain concems to spec~t1c areaa by
comparinl the chart aDd maps Prom this oDeean
41 dec1de which are48 vb1chcUD1c-or indeed if
the need a clinic at all However further factors
should be considered hebullbull include
a The amount of fuDd1 available
b What 18 the percentage ot peopleineoh ceaaua tract tbat would actually us such cl1n1cIl
c Wbat 1 tbeco--1tymiddot 8 IeeliDashyreaardtDI particular cl1D1c8 Would this dcrebullbullbullmiddot the ettctiveness ot thse cl1n1ca
IJ
li
D_OlraphicPopulatLon Challie 1960 to 1970 48
Cen8U8 1 of Pop 1 Cbaqemiddot 1 Change1 ofPopTract Under 19 Yr8 Over 65 Yrs1960-70 1960-70
middot1Q701Q70
1 319 -12 171 -H) 1
2722 215-27 +68 301 366 -22 127 +35 302 371 +19 111 -04
311middot401 144-41 +29 402 321 13~7-39 +24 501 356 124-08 -02 5~O2 351 133-23 +12
405601 82-10 -02 394602 103-01 -06
701 275 149-76 +56 702 361 +01 121 -07
+10middot801 326 140-22 802 321 middot127
(
-29 -03 9~01 342 124 -H) 6-18 902 294 128 -H) 3-24
10middotmiddot -14312 140 -17 1101 182 +25 -23197
2411102 186-59 +29 1201 226 169-17 -41
31middot01202 +11 182 -05 295 -H) 81301 208 -H) 4
1302 331 +08 197 +04
14 323 +15 middot185 -08 middotmiddot15 329 +16 16~5 -13
-28middot 1601 332 131 +12
1602 356 98 +24middot-39 middot3101701 161-33 +21
1702 370 -15 85 +02 +19 1801 264 151middot-50
185middot1802 256 +47-58
IJ ~
D_raphlc Population Change 1960 to 1970middot 49 (Contd)
4io
Census Tract
of pop Uncter 19 Yra
1Q1n
1Cha1l8e 1960-70
of PopOver 65 Yra
lQO Change
1960-70
19 389 +29 141 -24 20 223 -13 206 +18
21 227 +08 194 -36 2201 356 -27 112 +05
2202 290 -18 ll~9 -29 2301 356 -03 154 +24 2302 260 -37 245 +97
2401 410 +6~1 123 -31 2402 163 -80 320 +99 2501 381 +13 140 -01 25()2 237 31 lil +02 26 343 +25 186 +149 2701 370 +29 1S5 -01 2702 249 -44 304 +98 2801 337 +19 187 +09 2802 306 -10 156 +31 2901 304 -38 142 +24 2902 i 307 -32 146 t3~9
30 29~0 -48 16~2 +51
31 355 +30 160 +01 32 370 +48 148 -13 3301 395 +45 130 -20 3302 368 +06 138 -02 3401 386 +16 117 000
3402
400 +32 92 -26 3501 304 -07 115 +35
3502 344 000 140 -13
3601
36~02 357 -04 132 +32
3603 30~1 42 149 -67 3701 342 +28 152 +19
1
IJ
Jianolraphic Population Chan 1960 to 1970 50 (Contd)
Census Tract
of Pop Under 19 Yrs
JJl7J
middotChanae 1960-70
middotofmiddotpop Over 65 Yrs
1c~7n
Change 196070
3702 409 +39 122 -11 3801 308 -11 151 +29 3802 275 -35 180 +46 3803 282 -32 192 +54 3901 376 ~13 100 +17 3902 296 -03 177 +29 4001 438 -11 84 +13 4002 353 -21 115 +20
4101 397 11 9middot0 +11 4102 346 -19 120 +03 42 331 +19 11 bull 3 -16 43 347 -72 105 +31 44 113 +84 183 +154 4S 33~9 +07 110 -06 4601 2501 22 193 +38 4602 332 +59 126 -29 47middot 161middot 000 211 +01 48 103 -26 302 +59 49 138 +1 bull 3 252 +09 50 141 -26 204 -12 51 12 -39 257 +07 52 47 -61 351 +48 53 89 +49 314 -30 54 25 l1li15 327 -17 55 131 -17 115 -121 56 198 +93 227 -47 57 71 102 189 -88 58 240 ~middot41 16~1 +55 59 322 +25 142 +06middot 6001 264 95 132 +50
6002 328 -31middot 89 +07
JJ
Demographic Population Change 1960 to 1970 51 (Contd)
Census 1 ofPop lChange of Pop bull ChangeTract Under 19 Yrbullbull 1960-70 Over 65 Yrs 1960-70
1970 1970
61 355 -58 85 +39
62 328 39 110 +18
63 414 04 73 10
64 382 -22 72 +04
6501 383 02 67 -20
6502 329 -56 96 +09
6601 391 +13 88 -03
6602 319 -59 97 +06
6701 327 71 145 +72
6702 331 ~67 83 +1-0
6801 365 -66 49 +01
6802 388 4bull3 54 +06
69 354 -41 80 +23
70 400 -23 68 -06
71 359 -48 72 +05
72 255 -88 82 +11
73 346 -39 91 +25
74 313middot -63 105 +24
75 329 -42 129 +37
76 336 -52 85 +21
77 370 -10 69 +05
78 309 -10 120 +21
79 325 -56 87 +10
8001 358 -81 57 +12
8002 391 ~81 76 +12
81 315 -76 108 +21
8201 403 -23 64 +08
8202 392 23 65 +08
83 357 -34 120 +31
84 402 -18 73 +16
85 413 -06 76 -09
r
Demographic Population Change 1960 to 1970 52 (Contd)
Census Tract
t of Pop Uncler 19 Yrs
1970
Change 1960-70
1 of Pop OVer 65 Yrs
1970
ex Change 196070
86
87
88
89
90
91 9201
9202
93
94
95
9601
9602
9701
9702
9801
9802
99
100 I
101
102
103
10401
10402
lOS
368
351
379
391
391
413
379
433
372
429
414
432
419
439
~32
377
457 420
378 41middot7
345
360 417
417
412
-04
-02
-35
-26
-28
-11
-64
-20
-S9
-39
-32
-21
-34
-40
-47
-lO~7middot
-27middot +04
+56
+07
-34 01
+04
+04
+10
103
128
97
11il3 99
69
79
42
77
46
34 38
44
40
54
111
51middot
81
133
59
74
140
63
87
76
-08
-06
+04
+08
+17
-05
+3S -02
+1~4
+19
+33
-14
-08
+12
+26
+71
+11
-16 -34
-20
-19 +37
-49
-2S +15
NOte The The
Taken frOi
averageullder averageabove
middotUSCensus ---shy -
19 years == 6S years ==
figures 197
32r 13(14
p a~d 1960
--
Rank
1
2
3
4
5
6
7
8
9
10
11 12 -_
13
14
15
16
17
18
Tract
69 46
60
58
- 68
61
302
2501
67
63
19
62
26
94
3603
3902
64
30 -----~-
Rank
19
20
21 -
22
23-shy
24
25
26
27
28
29
30
31
32
33
34
35
36 -
Ranking of Per Capita Income by Census Tract
Tract
65
2701
- 15
1601
701
66
93
82
2903
3602
30
2502
80
2401
81
- 70
91 shy
4001
High
Rank Tractshy
-32shy37
38 97
120239
7840
41 ~ _2_1__ 42 31
43 2501
44 18
45 98
46 37
47 3803
1702
49
48
1602 92 2702
I
50 89
51 901
52 801
Ra_
53
54
55
56
57
58
59
60
61
62
63
64
6S
66
67
68
TractTract Ra~
74692
170196 70 I
401 71 90
72 1037J
79 70273
3802 74 601
24024102 75
85 76 101
77 9023901
7699 78 100 4101 79
3601 I
380180
458140~ t---- _ - - shy83 82 42
888384
59843501
4777 8~
502
Low
802 86
Rank Tract
87 shy
--88
89
90
91
92
93
94
- 95
96
97
middot98
99
100
101
102
103
104
1201
14
49
72
73
43
87
3502
105
1
52
86
71
1
501
10
3301
104 tf
Rank
105
106
107
108
109
110
III
112
113
114
115
116
117
118
119
120
121
Ranking of Per Capitalucoae by Census Tract
(Contd)
Tract Rank
4001 122--shy602
13
1102 2302
3302
55
3401
48
21
56
50
3402
lL01
2202
2301
53
2201
-shy
Tract Rank Tract Rank T~aet Rank
57 I-----
Imiddote
bull
Tract
- Low -k Note Information taken from 1960 U SCensus
Rank Tract
I ~
Ie
Imiddot
~
----
----
--
--
Rank
1
2
3
4
5
6
1
8
9
10
11
i-
-Tract
391 922 921
972 971
100
132 131 121
962 961
822 821 401
982 981
20 111
47 10 1
412
High
Total Number of Henta1 Health Visits
Ranked by Census Tract High to Low
TractTract RankTractRank Rnk
12 182 22 78 29 87 76 381 73181 ~------- 1913 371 8538230162372 271 2616-121 8272 2
14 80~2 31 94 7923 84801 59 15251362 4232 15 52 _ 32 103 8924 651 17240216 652
_ 91 351 33 341 23117 83 122 25 25 48 1123921418 34 shy61 86 661
19 662 6493 81 26 91 8153 49 50 55 41383 71 27 51 3120 90 672241 35shy 104167162 461
I 411 46211121 28 88342 I
2502 36 69 54 5251 50 272
-Ra
37
38
39
_ 40
_ 41 Ishy
I
42 I
-I 43 44
45
shy
Tract
~ --- shy 95 56
45 292 242
102 62 352 291y
92
101 281
99 72 63 601 60~ 42 2201
77 74 61 57
363 232
70
32 31
11 44 282 2202
Low l
- Tract
46 682 681 I 331 30
r~$ 47 1042 332
48 102_41_
11
~
Visits to Family Planning Clinics Ranked by Census Tract High to Low
Rank Tract Rank Tract Rankmiddot Tract Rank Tract Rank Tract Rank Tract
1
2
3
4
5
6
7
8
9
10
11
12
13middot
14
15
16
17
361
56
401
341
48
59 121
20
55
342
10
31
58
93 21
241 132
331
53
461 462
18
19
20-shy21
22
23
24
25
26
27middot
28
29
30
31
32
33
391
32
middot47 I-i-_-shy _ -
231 111
332
972 1
372 371
52
89
32
92
82
100 31
182
30 242
402
34
35
36
37
38
39
40
41
42
43
44
45
42
1714 i 661 221
78 362 2
90 602 601 352
63 251
105 921
971 351
73 42 292 232
411 51
662
81 45 52
46
47
48
49shy
50
51
52
53
54
55
56
961
801
49 81 72 71
19
9~1
172
68 2 57 162 14 112
91 75 681
381 42
3~3
83 161
57 f
58
59
60
61shy
62 Imiddot
63
Imiddot 64
65
66
64 62 36~3 252
74 652 SO 392 291
651 6bull 2
79 271
r-- ---- shy981 222
672 671
821 272
94 87
281
382
67
68
69
70
71
72
73
74
75
76
77
78
981 26 12~2
IS 61
85 82~2 69
61 43
101 86 84 282
76
131
51 72
1041 962 88 70
99 922 77
103
95 802 181
i
~
Low High
RankRank Tract
5479
4480
81 1042 ~) middot102
71 - - + ~ - ~
Visits to Family Planning Clinics
(Contd)
Tract Rank
I
Tract llaDk l
RankTract Tract Rank Tract
~
I
~
J1 ~
Low
Total Number of public Health Nursing Visits
Ranked by Census TractsHigh to Low
TractTract RankTractRank RankRank TractTractRankTractRank
25249 71 79 17249 8033 6586 99189711 84 2915072 34 661 76 66 811519512
402 5035 51 161 2518220 122 1713423 352 55801 7120 6752 2 149814 41236 83 2662 38 94 6821 53 2924015 362 37 32 42 75 69 281 84 63
546 8822 54 222 85 3925431 70383417 3818223 6439 4386652 718 21 55 103332 8924 232 87 19 271729219619 24156 16211140 382 628825 10523110 112 73411 10141-- ----shy 89 363 4457 8126 16111 221 74 9142 90 46158331 53 671279012 46243 48 59 351 3837528 1083 9313 91 5844 59 -_242 76 1----- shy60 272 72 74104114 60145 42 9287 7729 92 6151 8215 57371 934630 91 307762 12113116 282 619447 41391 9531 78100 63 7378 ~95 681 6945 32 5632 798517 6448 47 52 181
High ~ Low
Rank Tract Rank
96 31 132 70
97 102
98 182 372middot 602 651 662
- -shy
~72 682 802
822 922 962 972 982
1042 ----shy
Low
Total Number of Public Health Nursing Visits
(Contd)
Rank Rank Rank TractTract Tract
I
I lt
I
Tract Rank Tract
[
~~~-
I
~
IJilfimiddot ~
j
Ranking of VD Caea According to Census Tracts 61 By High and LOll Youth Itatio
A media~ of 34 5 was determined Any tract having greater
than 34 5~ of popu1tionunde~ 19 years of age -High~
Any tract having l8S than 345 of population under 19
years == Low
Any tract having rate less than 390 =Low
Any tract having rate more than 390 == HLgl4
YOUTH
LOW HIGH
L
0
12 402 1801 1802 343 2801 2802 29023603
54 6001 600262 66~02 72 74 75 76
78 79 81 t02 65 1202
W
(25)
VD
H
I
G
H
401 701 801802 901 902 10 1101 241 1201 1301 132 14 15 1601 1701 20~ 21 2202 2j02 2402 2502 2702 2901 303501 3502 34023801 3802 383 3902 42 44 45 4601 4602 47 48 49 SO 51~2 53 55 56 57 58 S9 6701 6702 73 95
3~02 7021702 19 25~01 2701 4102 4101 63 64601 ~601 6801 680270 7l 77 8001 80~02 8201 8202 83 84
85 86 87 88~ 90 91 9202 920193 94 9601 9602~ 9701 9102 9801 9802 99 100 101 103 10402 105 6501 10401
(47)
301 501 502 601 1602 2401 2301 2201 31 32 3301 3302 3401 3402~ 3602 3702 3901 400140 02 43 61 69 B(
(53) (23)
~ ~gt
Ranking of VD by Rate Per 100000 By Census Tract
~
Rank Tract Rank Tract Rank Tract Rank Tract llank Tract Rank Tract Rank Tract
1 2202 21 S6 40 902 58 1602 74 75
90-shy 64 107 26 --~-
2 3402 22 45 41 10 59 902 75 78 91 54 108 61
3 2301 23 3502 42 2502 60 602 76 6802 92 402 109 87
4 3302 24 49 43 1102 61 501 17 2 93 94 110 90
5 50 25 52 44 6702 62 14 78 8202 94 97 02 III 76
6 2201 26 20 6701 63 4002 8201 2501
9701 41~02 112 91
7 44 27 48 45 401 64 3802 2902 95 63 113 62
8 3301 28 1701 46 502 65 30 79 83 74 96 9602 114 71
9 55 29 47 47 42 66 3803 80 2801 96Q1 115 85 10
11
12
13
14
15
16
17
18
3401
53
2302
2401
57
21
2402
1101
51
30-shy31
32
33
34
35
36
37
3701 - -~ 1201
3702
89
43
132 131
3602
4001
48
49
50
51
52
53
54
55
58
1601
601
4602 4601
69
701
31
3901
67
68
69
70
71
72
2901
801
39021~ 802
6502 6501 122
702
41~01
81
82
83
84
85
86
87
88
19
1
1702
2802
79
93
100 6801 6602
81
97
98
99
100
101
102
103
104
9201 9202
9802 9801
77
302
79
86
72
84
116
117
118
119
120
121
3603
8002 8001
101
99
95
10401
105 10402 103 102
19
20
59
32
38
39
2702
3501
56
57
301
3801
73 1802 1801
89 6002 6001
105
106
2701
88
High Low
-- -----
Rank OrdermiddotTuberclosis Cases by Rate Per 100000 Ranked by Census Tract High to Low
Tract TractRankTractRank Rank TractRaukTractRankTractRank
801
79 9601501411 52 6835340120511 I 960269 903603532036 $-~~F130221542 4366 311301 70 68~013802 _ I- _ 4001_37213 3921201 6802802 H71523822024 22 54 193302 3802 80 8958 I37139535 70155 9801 I60123 72 6702 98023914011016 6701250124 10 56
81 94 401r 7 154152 73 7057 2625 122 92028
90242 162312301 92~158 86 7172434526509 82 79160159 74 100 87412240227220110 6502836960 75 30 8317244 6501782801285711 61 901 42765645 84 66021459294912 9701 660146 171 302 9702 47
6235023033113 85 822821182 917755 16335013110214 841814832 78 103 938564 324815 86 1057940149272 38036523216 10401 87 2902241 725Q 10402360266340217middot IF88 88 9937233 282 51 218 101 01102 46016234
I)167 2901460219 47
High ~ Low ~
- -
TractRank
9S89
6490
8191 8001 8002
63 61 60middot01 6002 44 2701
92
J
2502 402 --- ----shy
I
Rank
Rank Order Tuberculosis Cases by Rate per 100000
(Coutd)
Tract Rank Tract ~nk
I
Tract Ballk Tract Rank
Imiddot
Tract
Imiddot
1~
t 1I i Pi i l I
o
1 -1shyL I
I J
8 40 icO ~ I -lt 0
-t (1) I
i I
r o E
II
a
I
r--i
shy
I
~
I (
Jgt
(011 fi(
Ggt
I II ~j
()
(f 0
~ ()
I
11
f9
r
II 99
o ~
Ggt r
~ __-J~ I t I ~ I
r--J l I
~ _ __ J
) 1
fTl
1gt
r I
()
r
()
lt en -i en
()
I1l
(J)
(J)
-i
P ()
19
r o ~
r G1 I
I
c
~
o I 89
--- -I-shy
r-r I
1- 0 _~ _ _--J E
G1 I I I
i i
I 1-1-1 ~ _J ~2 ~ II
II
()
1 I I I 1
id i bullbull
~
A n 69
r 1shy
- 0 Gl
l--~ ~ I
~ II
II )
I () isect i
en l i
(J)
-t
0
IA Ol
11
little to justityits proVision in a l()calun1t where
skills or resources are too rare to be provided locally
or where the costs ot decentralization vastly outweigh
the benefits He Visualizestheult1mate emergence ofa
h1erarcb1c81 patternofserv1ce delivery tnwhichcertain
services andresp0D81bilities are middot1ntegrat8d1Dto the
collimun1ty at thelooal level Other more specialized
services relate to larpr un1ts of the colDlllUD1ty such as
eomb1nationa ot neigbborhooc18 Veryspecialized services
are to be delivered at city countystateop regional
level8 fh1slevel would al80 be the seat ot prosram
coord1zaat1on staDdardprotection and evaluation 811
of which call for cons1deZable centraliZation for overall
program adm1 nlatrat1on(22 p275) AlthoughKahnt s
model was not developed specltlCally tor health care services 1t1s quite relevant- and appliCable to health
care service delivery systems
Omiddot Donnell (27 p3) reviewing the 1iterat~e on
service delivery and social action through neighborhood
service centers preseJJbB a list of characteristics
generallydesirable in ~eighbOrhood service delivery
centers Firsthe states that the center should be
accessible It should be in a physically convenient
location and should be open evenings and weekends as
well as providing at least em~rg8ncy telephone coverage
t
~ II
12
24 hours a day
The center should als~ be irDmed1ate in 1ts funcshy
tioning That is the centermust have the capacity to
provide prOmpt efficient service and should be able to bullrespond to problems middotwithout long hours ofwalt1ng and
many rounds of apPointments
The centexsservices should be 6omprehensive liThe
center should offer a full range ofusable oil-the-spot
services or easyaccess to other resources by available
transportation It should gear itself to the needs that
peoplehaV8-especially poor people-and provide for the
slmultaneoushar1d11ng of problems were possible
SerVices should 8180 b 1J1tegrated and coordinated so
thatseMces can more effectively be provided
The operation of the service center should fInally
be responsive to the needs and desir-es of the neighborshy
hood It should provide ways in which reSidents can
shape th~ program and continue to contribute to its course
and development It should be relevant and ready to
respond to changing needs II
The concept of the comprehensive neighborhood health
center developed by OEO (31 p324) has been described by
severalwriters Yarby (37 p73) describes it as an
outpatient racility which has certain def~n1te characshy
teristiCS middot1 Accessible to a poPulat1on concentration
bull 13
2 Open 24 hours a day seven days a week 3 Family-centered c~e by a team of lnteniists pediatricians clinical and publichealthnurses and social workers 4 Availability ot frequently~requ1redspecialist in such fieldsaspsycbiatryobstetrics gynecology surgerY5 Con~1nu1tyof doctor-patient relationshyship 6 Family records with social and medical ~raquomDaries of relevant information about each family member 7 Basic diagnosticlaboramptoryand x-raytacl1itles and drugs and biologicalsavailable atthe center 8 Directline (1)y center-controlledambushy
lance when-necessary) to ateach1nghospltaifor cl1agnostic ~d therapeutic servlcf)srequiring the fa011itlesandpersonnel of thehospltal 9 Patient-cantered and eommUn1ty-oriented -
The range ot services in the comprehens1venelghborshy
hood health center shouldbe as complete as possible
inCluding preventivediagnost10 treatment and rehabi-
litative services and Sbouldbe deslgnedto eliminate
episodioandfragmented services (31 pp324-325) Schorr
and English (33p291) add as additional characteristics
ot the compr8henslveneighborhood health cent~r that it
should ~ve intensive participation by and involvement
of the population to be served both in policy making and
as employees and that it should be fully integrated with
the existing health care system The Office of Economic
Opportunity (28 p63) stresses the potential for easing
health manpowershortage$by trairiing local neighborhood
reSidents as non-professional health aides at the same
time creating new job and careeropportunitles As
14
Gordon (16 p bull 422) indicates Many of the outstanding
problems in medical practice todayrevolve around
effectively motivating the patient and the prospective
patient to be concerned with his health This is
especially true in a deprived environment The community
health center with its technique ot consumer partici
pation maybe a way to create this cooperation effectvely
It is important to note at this point that the
comprehensive neiShborhood health center haaas its
constituency an integratedmiddot community r~ther than a
particular segment It should haveas Blum and Levy
(6 pp~5) indicate a horizontal rather than a vertical
relationship with the commuriitybull The vertical relatlonshy
ship they state is characteristic ot those service
organizations wh1chapproach the community only in terms
of their own fUnction Tbey see only their relationship
with the users of their service and assume that problems
of accountability will be handled by these consumers
However they pOintout this ienot likely as a vertical
approach creates dependency onthe institution Agencies
in a horizontal relationBhllp recognizetha1 they have
both acommunityand a consumer to serve The horizontal
approach places the matter of accoUltability on a broader
basis than just the involvement of the consumer De Diaz
(14 p4) speaks otthe need to ~develop a community
facility which difters from a clinic for low income
1ji ~
15
people in that it should serve an economically integrated
community The reason for this is that a wide variation
of consumers may assure a better quality of care
The advantages of the comprehensive neighborhood t
health center over traditional systems of providing
commuruty health services are numerous Hospital outshy
patient departments a major traditional source of ambushy
latory health c8refor poor patients have been indicted
for neglecting preventive health care ~romoting fragshy
mentedeare and subjecting patients to degrading and
impersonal conditions to mention only a few of the major
defects (31 p324) Another defect has been the
tendency to shunt low income patients back and forth
between different cliniCS often at different locations
arid with differel)t open hours for different treatments
or tests in regard to the same lllness(26 p63)
The comprehensive neighborhood health programs that
have been organized present a great variety of organishy
zationalpatterns one area of difference 1s in the
emphasis placed upon making each faci1ity comprehensive
in the services it provides to the patient population
In the Montefieri Hospital Neighborhood Medical Care
Demonstration program in New York City services have
been made available through a central health center and
two store frontsatellites the center to be the base
bull
Li
l of opratiol18 of ta1lJpIlflicl- ancl the satellite
center the ba of oparat1oDa of public heaJth nurses
an4 nllbborbood amp1 be satellite centers wereto
proVide preVentift tutaltll bullbulln1c1-m1zaticms w811shy
baby care per1od1c ~ectiland tJle central health
center to proViAle care tor illnes If (36 p299)
bis propWI VUDOt ~ttullytunct10DIDI at the t1JDe
it d1cu8ae4 18 tbe Uterature aDd all aernce Were
be1Dl provided 1D_~terBowever itwould ae
tbat the ntua1pro~ as aY1ioae4by its plmmers
would boclJ aoaeot bull 4efeot~ otthe current lud1cal
ccde teaIt pObullbulllne_t coorctJl8td admSDtshy
etration eD4 well 4eftlopecl refelTal procedtlreacould
1I1a~ thecOllDeCticmof t~_t8 withappropr1ate preTellshy
t1 aD4 therapeu1ampcaen1cbullbull aV81lable 111 diffrent
locationa Bowner tile barrieraottiaeaDdUatanc
between center and truaraUon tor the UDSopb1aticated
patieatlook1Dl tor 1her1~pJce too tor ~1CU-
larhalth serfplusmnQewoGl4~to JJa1t tbbll1ty o~
tb18 ~811D to provide iaaiYCOliprelleU1P18hboltleod
health servicebullbull III tactmiddot tappeareto coDtlict with
tbepro own taW cOfdotpro-1~a tam1ly
mecl1cal careprogru 111 wIa10h pre-teAtlYe aDd therapeutic
health erY1cecan be proY-lW to all IIl81Ibers of
tamily in the coure of aaSDll vi8it (36 PP301-3(2)
Dle Delmtr Coloradoprepa11ke the Montet1ori
LI
17
prograJlut111zbullbull abe1rarcJly ot SlDa11 aatellItestations
andlerer IIOreceDtallzedtac11It1es It 41ffers
howeverill tbcolap~81vene80f the services avail shy
able Inthe 4ecentraUzed facIJJtiesIt resembles very
clc)sely the IOdel ~ordecentral1zed social servicedell shy
very developed by 1ahII~ Which was 41sCussed above he
SIlall neImiddotgbborhoodmiddot c8Dt~aw1tb1n walkl distance of
most of the populatiotl havebeendesilDedto take care
of allthenorllalhealth probl of 3000-5000 patJentsshy
check-ups IlzatiOZl8s1Jlpl laboratory testa and
treataentand iaecucatlol18 (d1apeued by phyS1cians) for
IIOst DODCrltIcal 1l11le PatIent 1d1Oneed IIOrespecIal-
Ized care are reterrecttobacJalp facilities BaCkup
support tor themiddot~t1oDa are the tWo l8rsernelshborhood
health C8Dter8~ttr1Dl aCOglete~e of out-patient
serneeaDd three part1clpat1q hoap1iampl bull bullbull which
proVide1Dpat18Dt~t andcoDSUltatlve services
(13 p1028) Intb1a prosrama coaprehens1ve range of
prevent1ve aDd trea1aeDt serric 18 aVailable throughout
the decentraUzed middotta The CoapreheulY8 ReIgbborhood Hea1~ Service Project
otKa1er iC)UDdatlcm HOspitals 111 Portlan4 OreOD 1s
s1ll11arto th DenVer prosraa 1D thata comprehensive range
ot out-patientmiddot services 1D prov14e4 in each of 1ts 10cashy
t1oDa althoUlhmiddotmiddot tbe oentera are larger and l bullbulls DDIerous
than 1nth DenverproPUh (12 p6)
Li i
18
In order that a comprehensive neighborhood health
care center be able to proVide continuity of care it
must have arrangements for hospital services integrated
into th system Yarby (37 p73) as quoted above
states that it 1s characteristic of the neighborhood
health center to be directly connected with a teaching
hospital However De Diaz (14p3) indicates that it
may be advantageous for purposes of service delivery not
to havemiddotthe center affiliated with a teaching hospital
She feels that such anaft11iation may lead to asltuation
in which policies might be determined more by the teaching
needs of a medical school than by the service needs of
the patient
middotThe Nat10nalmiddotCommissionmiddoton Community Health Services
(25 p69) states that such a system of comprehensive
health care integrat1na ~e servicmiddotes of several health
and roedical agencies snould utilize Itas much single or
unified management as possible Neighborhood health
centers have been operated under a variety of auspices
but several writers have pointed out the advantages in
termsof coordinated prOvision of servictts management by
the hospital of the neighborhood health center For
instancethisfac111tates the keeping of unified medical
records of all the care a patient Msrecelved either at
the neighborhood health center or _le hospitalized
(12p6) ~ermore a3 Young (38 p1741) points out
19
direct operationot the u1sbborhood health oenter by
the hoSpital canll8lceaftilable to the center expertise lt bull
in sOlle aapcta 0 Operation that m18ht not be aa readily
available otherwie
Relardlebullbull of wbetberthe hospital and the neighborshy
hoodhealtbcent8r haVe a cOJIIIOaadmjntstration they
IIlU8thaVealTlved at a str1Dsent delineation of IDUtUal
role and reSpoDBlbilltiebullbull All OOIIpoienta ot the care
yst IIlWStQlarify and understand one anothers position
In the syatem and acree on objeCtive ancimethOds
(26 pp16-17p31) SODae areas of iDUtUalconcemare
reterral procedures record keepiDg aDC1 mutual use of
facilit1es statt1Dl i8 anotb8r ~ ot coaaon conc~
Ditt1cultift have u-laeniD the pastiD cOllprehensive bull t bull
healtbc~ prosraumiddot 1d11ch were batil plauned in wb1ch
all of the health canter phy1C~1IDa did DOt bavetatf
privilege at all ot thebackuJlhospltala (29 p21)
SUch a8ituat10n i8 1Dampcceptablelt inpatient care i8 to
continue to be p4by the pat1eatmiddot health center
physician and it cont1Du1ty ot care 18 to be maintained
Hoapital and health center1lUSt laav 301nt responsibility
tor the recruitaentot physicians
VticlentU IPan BJcNrcu Much otwhat haa b8ea sUd has stre88e4 at leastmiddot
iJlplicit17tbaD8ed tor tM etticit middotprovision ot8emcea
20
There appears to be two aspects of efficiency which are
discussed by writers on the su~3ect of the comprehensive
neighborhood health care centef one of these is the
need to organize) services to make the most efficient and
economical use of scarce medical care resources The
other closelyrelat8d in realIty is the need to help
the public use services in the most efficient manner
The comprehensive neighborhood health center concept
1s lhherentlymiddot efficient in that preventive curative and
rehabilitative health ~are programs are coordinated under
one roof with integrated a~stration Furthermore
theempbasLson prevention health education and early
disease detectionis eftic1ent troJll~estandpoint of
the health care system as well as beneficial to the patient
(18 p760) HQwever ~ue tothe scarcity of health care
personnel thecoiDprehensive neighborhood health center
mustbe an arena tor eXperimentation with new staffing
patterns~ The Kaiser program is indicative of the way
in which health care systems must begin to operate in
that appropr1ate ancillary personnel are used Wherever
possible to perform functions that do not need to be
carried out by the physician As Saward (32 p42)
states
1hroughou10ur organ1zat1on~ there are many of the customary experiments be1ngmade-shyJse of speciallr trained nurses for well-baby care under the SUpervision of the pedi9trlcianexperiments with routine prenatal care by
w ~
21
middotSPC1a1l~t~JlUrbullbull per8ema_1 bullJmdlJleu y our fuDotlou are auoh that DOtb1Da 18 dorutbYtbe phY8iCianstbat doe DOt vet to be done by the
phys1c111U1fhe other aldlle4 person- Del-nurse middotreC~0D18t the appo1ntshymeDt center or clerical praormelshyaremiddot there to free h1amiddotto use his spec1al sk111
Awell lmoWn treDd1D the area of eaaiDI health
c8re JII8DPOY8rShortagjs bas middotbe thetrend toward tra1nshy
1DB poverty area rea1deats as DOD~pro~eaionalmiddoth8lth
aide and nepborboocl health workeramiddot (28 p63) This
bas the effectofmiddotmiddot1J)creaa1q II8DPOWrand 8180 can help
bridle the cuJ~ cap betweenprondera and colllUmers
of aen1C8s This attarD at least tlleoretically
createa a situation 1D WIa1ch providers andcoD8Ullers can
be educated to UDderatad OD88DOtber and interactJlore
ettectlvely~ HoWever amiddotpltt8ll has beeD themiddot tel14ency in
801D8 oamp8e8 tomiddot us aidesmiddot ssale8lllcw t~r the center
alJDOatexclwdY811rathertbaD ua1Dltheal to protide the
health care for wh1ch ~ were trained (29 pp3B-39)
1bat ismiddotmiddot vh1~e the a14e Yalue in ~~m1catiDI with
low 1nCOlMt patieata haa beeR recoSD1zed and stressed
their role ashealtb carepersoDDelhil been slighted 1n )
any 1Dstancea
Anotber step 1d11Ob bullbull been taken to provide 8rY1ces
more efficiently eUeot1ftlybas beenmiddot theorgan1zation
of per8ODDeliDto IIllt141sc1pl1Dary teamaaaa means ot
proYid1DgmiddotCOQrd1DatedserY1ce SUch te8lll8 sen_rally
~
hf
~
22
include PhYsiciaQs nursbullbullbullbull soc1al workers and outreach
workers Conceptually th8y fmlct10n to me~ the intershy
relate lled1cal and social needs ot the families sened
Hor there are a number ot barriers to the etfectve
tlmctiOD1nlof lIuchte8ll8 SODieot these are heavy caseshy
loads the inordiDate amount ot tille consumed by multlshy
prOblem tamtliethel1m1ted tra1n1 ngmiddotmiddotand laCk of tnterest
on tile part ot aoae tebers in examinJng aspects of
problems out14e~lr oWn areaaotcolIPetencemiddot and
~ourdcation prc)blell8 between proteasioDala and nonshy
prot81~s (10ppa-10) middotrurtbemOre as De Diaz
(14 middotp6)1nd1cate tbel8 maybe a teDdency tor vertical
dp8rtmental lines of auperv1810nto become paramount
over the team coDamloation syst lead1ngto conflIcts
in determ1niDI the ro1ea ot solie team bers particularly
the DOD-prote81011alaInauch exper1l1enta Witb new
~t1Dlpatterna it 1s bullbullaentialtbat line of authority
roles aDd NsP0D81bll1tlea be made explicit and that there
beJDechaD 8IUI tor relUlar evaluat1onotfunctlorUng
Another way inwb1ch health care sernee delivery can
be made more ett1cl8Dt is to proVide servicea dur1DC the
hours whentbey aremiddot -ostnee4ed As reQo_ded by Yarby
(37p1) serY1ce can bemadelIOre accesslble by making
themava1lable 24 hours a day seven days a week If
rg8l1Cy service are aft11ab1e aroua4-tbe-cloek at ~
nil1iborhood health center the continuity ot tbepat1ent ts
23
careiamaiDtalDedand meatry point into the
cOIIPre~i health care 8 be made available
tothe patient who aoZMllyU8ea ozilymiddot emergency care in
tille of med1cal criais More 8isDificantly ava11ab1-
lity of a tull rase of bullbullrv1c8 tor seVeral hours 11the
eVerlna aI1Cl On ~ prevent the los ot earn1JiSs
involved if th patierat 1IU8tt8cet1me oftfroawork dur1q
the d8y for aed1Cal oare bull his can be an eSpecially
importantc0J1814eration tor lo1aCOlleDUUg1nally qloYEtd
patient aa4caJla18o PIOJIOtet1)e 0Da01Dl use othealth
servicebullbull
exper1eDO ot tbeKa1er prosraa in tb1s~reprdAs
Greenl1clt(19 p10) states wA lllNt 8ip1flcant
proportion ot the abulatory care 8n1cp~Y1dd tor ~
total popUlatiC)U ~ ~ after clWc hours and this
Deed i8 apParenUyaoN prODGUDced tor aJl8d1cally
iDCust population On the other hand the bulk ot all
aabulatory med1cal cu 88l91ce are performed dur1nS
regular cl1D1c hour eVen when services are available 24
hours a dayJ day bull week W
It has ~ the experi8D~eof a ftIDber ot ne1g1lboXshy
hooct hea1tbcentere _t a_jor obstacle to efficient
proViSion ot anicbullbullhas beentbe teD4eDcy of medically
1ncl1pnt patieats to utilize the center oa a walk-in
baais tor epi8od1ccr181or1entect bullbullrv1cea rather than
4)i
h~ ~~f ~~ L
24
to make appoJlltaeata tor ODIo1qprevmt1ve treataent
and rehebl11tat1Ye care ad ampl1O to bave a blah failure
to Show rat_for tbe appo1DtaeDts that they dO make
Atone center 628 of appo1Dtments made were kept
while 3Oottbepati_ta een were ~1n patients
AlthoUP fewer patiets were actually 88811 by the cater
1D middottb1s 1Datance thaathe -bervholuidmadeappointshy
mta the walk-iD patlat required an iDord1nate amount
ot staff t1ae tor aCreeDiaaacl ~trral to pplOprlate
~ttor caregt (9 pgg) Arraquotbr1llpl1catjo~ of the
plOVidedto valk-iD patient by other thaD their
(19 p12)rurtbermore
when patients uti11ze Wlk-1Il er181 centered care
athelr ODlf tona ot ootact with the _d1~ care
ay_ta fUilycentered care the treata_t of tUl11y
bers
a a UD1t 11
dlarupted
hewalk-1Dphenoaaencm appear to barelated to
diUerence between soclal clase in the style of Dlaking
contactJt1th the a11oal C~ay8t As Greenlick f ~
(19 p11)1Dd1oate8 thepheDOaenOn ot INater usage of shy
walk-in ervice by aed10ally middot1Jid11ent patient thaD by
others baa otte been attr1buted to a stoical att1tude
tQward 1llDe8 em the~ ot poor people leacl1D8 to a
~
25
greaterdelay1n tbe k i Dlofa8d1cal care These
patients wppoedlyeelcmiddotcareODlymiddotwIleD tbeirmiddotillDess
becOlles1Dtolerable resultiDSin middotthMr appeariDS withshy
outnot1ce1o rece1ve oareHlwever Greenlicks
r8aearcbbaa cut doubt on the existence ot tb1delay
111 report1Dg middot8J1IPtoJumiddotOfDeW 11laessand seek1ng care
Be bas tcrQDd 1bat s1ll11ar peze_tases of dioally
1nd1sent 8DClJ1on-aed1cally 1Dd1PD~ pat1enta seek care
on the aue daytbat aptou tirstaPPear
1fb11e GrHDllclc 1nd1cat tbat the reasonator the
greatertendeDCY of low 1Do~e pat18Ilta to 1$8 walk-in I
serY1ces are notlcDo1rAmiddotmiddot tbe7 _ be rel~tedto a tendency
ot lower aocio-ecaaaoclaa patieota to preter face-toshy ~
face contacts with II841cal persoDl181posslbly because
such contacts areft coatortiDS an4reasauriDS to
patients who are hJpotbeafzed to bave a dependent attltude
toward IIed1Cal care perS0Jm81 (30 p161)
It a8 itmiddot baa pnerally beenhld the appointment
s1stemts the most efficient Ileana of dellveriDS
comprehenSive oODtllluiDlh-lth care (9~100)1t is
necessary that educaUoraalmiddotbulltfort be taken to proaote the
use ot middotappo1ntaents8DClmiddot tQrec1ucethe fa111re to appe~
ratB4uOatioaalwhlQb baft~utl11zedhave been
IJ
26
1Dten1ews with walk-in patients home Vi8its and group 4i
meetiDp1D8D attemptto1Dierpret1o the patients
the value of rtitgular ppo1ntmentamp andot con~in~
c~1ve care rather than epiI041c care (9 p1OO)
h1s 1safuD~tioD torwhtch nOl~prot81QDal colDlllUD1ty
YOrkersllaY bebe~r8U11ed tban other statf H()wever
euch aD ~ucat1oaal propul __~ ~e related to the senUiDe
capacity otth health oenter to provide comprehensivebull gt
ervice8 to1tpat1_t~odoD aD app01ntment bas18 It
1amp pos8ibleo~rw1 tor educa110Dal ttorts to result
LD a~8JImCl tor ltPP01ntaen~8 at a ratewb1ohi8beyond
the capacity ot thee_tar to t without uareaaoDably
1_ wa1t1Dlprio4a QOBt1nuad use Ot the center on a
wallt-in bU1 _1tbeoosiItpos81ble to et an appoint-
met anc11nCreued pit1entcoJaplampia1a bull Therew111 of
course always be a need and demand tor acute ep1so~c
Care -ci the health centerDlWlt be planned with the capashy
billty ot bullbullbullt1D8 tb1aneed wh1~ cont1Du1nI to stress
aDd educate the patient to utillze oDlOinI comprehensive
faa11y middotc~te~d Cflre (9p 100l
att g4 CODClva1opa
In order to bea4equate any coJlltemporary health care SY8tem muat bullbulletcerta1D interrelated criteria he
IJ
27
minimum criteria areaccessability of services to those
who need them compr8heX1siveness and appropriatness of
services and efficIency 1nthft utilizat~on of SCarce
health care personnel and resources The scareity of
pex-sonnel andtbe need for h1gh quality ongoinghealth
care services
aJIlong the
populationdemanci the most effishy
cientprovision of services
Services must be made accessible to the population
They mustmiddotbe geosraPh1cally accessible to remove the PhysicalmiddotbaTiers betWeen peopleandthem$d1calcare
system They mUst otter their services dur1ngthe
hours when people can make the moat use ofthemA~ it
makes little sense to concentrate services geographically
where they will not be uSed to their fUllest extent it
also is wasteful to provide serv1cesonlydur1righours when
many people are employed his not only presents a hard
ship middotto the consUmer lnrt wastes resources if for instance
the unavailability of preventive services during the hours
when people Can use them causes a need for treatment
services later on
Health carbull sEtrvices must be comprehensive including
prevention treatmcmtand re)abimiddot11tation Ambulatory I
healtbcare facilities wh1cQ are orienteciexclusively
toward either prevept1on or trea1mentare no longer accepshy
table for they are lneft1c1entln their use of resources
and in their prov1s1on of health care to the patient
w ~~
28
If prevent10n1s notmiddot stressed treatment serv1ces that
could have beenavoidedY1l~ be required If prevention
1s the sole focus of the health care facility sick
patients who present themselves must be referred elseshy
where for treatment andsllch referx-als may be taken as
reject1onsor not followed through with until illness
becomes unbearable
The instltutlontbat meets these requirements Is
the comprehensive neighborhood health center It 1s a
local decentralized outpatient facilityprOVld1ng a
fUll range of ambulatoJY health care services It has
a linkage to ahospitalbackUp facilityforlnpatient
treatment and hiihlY apclalized outpatient care
The neighborhood health center must be a fac11ity
planned with an awareness of the needs of the conSUtller
and coDitnUn1ty It must have the r~Ul0urces to provide the
services people need mere they can use them and when
they can use them It must uti11ze the part1cipation of
the community to develop this awareness Not only must
the cen~er beset up to be Amctional for the consumers
but efforts must bemadeaga1n with commun1ty partici shy
pation to help the consumers utilize medical care
services effectively The center muetmake efforts to
educate the community about the valueot regUlar health
care of preventive servicesand of the use of planned
IJ
29
medical appointments ratherthanorisis centered walk-
incare Therealit1es of the existing health care
system have not taught the patient particularly the low
income patienthow to use services effectively
The helthcenterilUst also bea laboratory for
experiments in easing the health caJepersonnel shortage
and c60rd1Datingcare~ A major difficultY iri-exper1shy
menting with neW rolesis freeing staff of old preconshy
ceptions
CoDlprehensiva neighborhood health dare centers have
been developed under a variety ot alisplces including
medicalsociet1es hoSP1talsmiddot(36p299 group pr~ct1ces
(29 p6- 12 117) health departments (13 p1027) and
ne1gbbothoodassoc1ations(14) The literature indicates
somevalues nthe management ot the health center by plusmnts
hospital backup faCility Whatever the auspices many
adm1nistrative fuDctions such as program coordination
standard pr9tectionand evaluation call for considerable
c~tralization of adm1nistration city-wide or coU)tyshy
wide At the same time other aspects hours of servlce
for examPle~ cuI f~radm1nistrative fUnctions made atmiddot
more local levels Each neighborhood center must be
free to adapt its functioning to itscominunity thi-ough
the mechanism otcODlllUl11~ participation inmiddot policy making
Obviouslythe prerogatives and responsibilities of each level must be negotiated and made explic1t
t4~
JJ
BIBLIOGRAPHY 30
1 American Rehabilitation Foundation ~ealth Services Research Center The Health Maintenance Strategy mimeo 1971
2 Anderson Nancy N Comprehensive Health Planning in the States A Study and Critical Analysis Institute for Interdisciplinary Studies American Rehab ilitation Foundation 1958
3 Andrus Len Hughes Comprehensive Health Planning Through Community Demonstration Health Projects mimeo1967
4 Barry Mildred CandCecil G Sheps A New Model for Community Health Planning unpublished paper presented to the American
Public Health Aseociation1967
5 Blum HenrikL Fred Wahl Genelle M Lemon Robert Jorulin and Glen W Kent The Multipurpose Worker and the Neighborhood Multiservice Center InitialImplications and EJeperiences of the Rodeo CommunityService CenterAmerican Journal of Public Health58 (Mar 168) pp 458-468 shy
6 Blum MichaelD and Soloman L Levy A Design for Service Delivery that Reinforces Constructive Tension Between a Health Center and Its (sic) ConSUDlers and Supports Community Power unpUblished paper presented to the American Public Health Asaociatiltn 1968
7 Brielaud Donald Comm~ity Advisory Boards and Maximum Feasible Participation American Journal of Public Health 61 (Feb 1971) pp 292-296 shy
8 Burns Eveline M Health Insurance Not If or When But What Kind Madison Wisco~sin University of WisconsinScllool of Soci~l Work 1971
9 Campbell John Working ~elationships Between Providers and Conshysumers in a Neighborhood Health CenterU American Journal2 Public Health 61 (Jan 1971) pp 97-103
10 Caxr Willene Neighborhood Health Centers Funded by the Office of Economic Opportunity mimeo 1970~
11 Colombo Theodore J Ernest W Sawardand Merwyn R Greenlick The Integration of an OEO Health Program into a Prepaid Comrehensive Group Practice Plan American Journal of Public Health 59 (April 1969) pp 641-650~ -
12 Comprehensive Neighborhood Health Services Projectof Kaiser FoundatioIl Hospital~ Prcgtgram YearE grant renewal proposal mimeo~1971 bull
13 CowenDavidL~ Denvers Neighborhood Health Program Public Health Reports 84 (Dec 1969) pp 1027-1031
IJ
14 De Diaz Sharon Daniel Beyond Rhetoric The NENA Health31 Center After One Year unpublished paper pres~rited to the American Public Health Association 1970
15middot Gerrie NorrrianF and RichardH~ Ferraro Organizing a Program for Dental Care in a Neighborhood Health Center Public Health Reports 8 (Aug 1968) pp 419-428
16 Gordon JeoffreyB~ The Politics of Community Medicine Projects A Conflict Analysis Medical Care 7 (Nov -Dec 1969) pp 419-428 shy
17 Greely David The Neighborhood Health Center Program and Its Implication(3 for Medical Care H~alth Forum of the Welfare Council of Metropolitan Chicago (mimeo) 1967
18 Greenlick Merwyn R Newgtimensions in Health Care American JOurnal of Pharmacentical Education 34 (Dec 1970) pp 754-4
19 GreenlickMerwyn R Donald K Freeborn TheodoreJbull Colombo Jeffrey Abull Pruesin and Erne$t W saw~d Comparing the
Use of Medical Care Services by a Medically Indigent and a General MemberShip Population in a Comprehensive Prepaid Group Practice Prosram II unpublished paper presented to the AmericanPublic Aesociation1970
20 H~tadoArJiloldVMerllYll RGreenlick and TheodoreJ Colombo Determinants of Medical Care Utilization Failure to Keep Appointments unpublished paper presented to the American Public Health Association 1971
21 Johnson Richard E and Merwyn R Greenlick Comprehensive Medical Care A Problem and Cballengeto Pharmacy ff AJilericanJournal of PbarmacenticalEducation 33 (Aug 1969) pp 361-367 -
22 Kahn Alfred J Studiee Social Policy and Planning New York Russell Sage Foundation 1969
23 Kotler Milton Neyhborhood Government Local Foundations 2 Political~New York The BobbsMerrill Company 1969
24 NationalCommisaion on CommunityHealthSfrvic~sActionPlanniriamp for Community SetithServices~ashington p C Public Affairs-Press 19t7
25 National Commission on C~mmunity Health Services Health Adminishysration andOrMPization l the Decade Ali9$-d Washington D C Public Affairs Press 1967
26 NationalCornmiesion onqomm1Jllity Health Servicesbull Health ~ Facilities Washington D C PUblic Affairs Press 1967 bull
~ n
32 27 ODonnell Edward J and Marilyn M Sullivan ServiceDelivery
and Social Action Through the Neighborhood Center A Review of Research tt Welfare ~ Review 7 (Nov~Dec 1969) pp 112
28 Office of Economic Opportunity Second Annual Report Washington D C~ U S Government Printing Office 1966
29 Office of EConomic Opportunity and the Medical Foundation of Be~laire Ohio Eighth Report 2l ~ Committee2a Governshy
ment OperatiOll~ Va8hiiiSton D C Government Printing Office 1969
30 Pope Clyde R Samuel S Yoshioka and Merwyn R Greenlick Determinants of Medical Care Utilization nhe Use of the Telephone for ReportiDg Symptons Journal of Health and SocialBebavior12 (June 1971) pp155-162 shy
31 RenthalA Gerald nComprehensive Health Centers in Large US Cities American Journal of Public Health 61 (Feb 1971) pp 324-336 shy
32 Saward Ernest W The Relevance of Prepaid Group Practice to the Effective Delivery ofHealthServicestt The New Physician 18 (Jan 1969) pp39-44 - shy
33bull Schorr Lisbeth Bamberger and Joseph T English Background Content and Significant IssUes in Neighborhood Health
Center Programs Milbank Memorial ~ Quarterly 46 July 1968) part 1pp 289-296
34 Weiss James E and Merwyn RGreenlick UDeterminants of MedioalCareUtilization The Effects of Social Class and Distance on Contacts With the Medical Care System Medical~ 8 (Nov-Dec 1970 pp 456-462
35 Weiss James E MerwynR Greenlick and Joseph F Jones Determinants of Medical Care Utilization The Impact of Ecological Factorstt unpublished paper presented to the American Public Health Association 1970
36 Wise Harold B Montefiore Hospital Neighborhood Medical Demonstration A Case StudyMilbaDkMemorial Fund Quarterly46 (July 1968) part 1 pp297-308~
37 Yerby Alonzo S ttHealth Departments Hospital and Health Services Medica1~5 (March-April 1967) pp 70-74
38 Young M M~ Chatanooga IS Experience with Reorganization fOr Delivery of Health Services ttAmerican Journ8l of Public Health60 (Sept 1970) pp 1739-1748
f or l
II bull 11 Y d
II
IJ
34
ThepurposeOfPart II of th1aa paper1atod1scuas
elected Speclfic needs ofecltlc areas within Multnomah
County A8P01ll~oUt 1D ~ I of t1a1bullpapermiddot Ita nelgbshy
borhood health oare cater IlU8t be a facl1lty plaDlled with
aD awarenes of the neeels of the oODllUller and collllUDity
Part II of this paper nIl Show 80e of thoe speclflc
needs
he1DforutiOD tor t1li Portlon of the report
obta1nec1 troll tbroupout tbe follow1Dl threepUb11catloDS
1gr~e_tiMshylIPrIxaiidOreson JuDe 1963
2 1~_middot_sectSI8e~ected1teai c-ua 0 S 8 e first count coaputer tape Coluab a_lion AssocshylatloD of QoveraMD-8 Jlme 1971
3 Jtu1tDoab County Oreaon BDY1roDlHtlltal SurveyEarly 1971
The JIultDOIIIlb COUDty OrttIOD BDv1roDllfmtal Surley
Barly 1971 1s bull stat1stical report of the activ1tles of
theentlreMultDOIIIl2 CcNDty Health Dep~t during the
year of 1970 Die speclflc 1nd1cs elected from tb1s
study amprejMental aealtll Publlc Health N~s1D1 vlslts
FaJUly ~ Veaereal])1 ~ ~rcul081
Throush tie use of cUrts and mapa ODe CaD roup these i
speclflc ~oea to ahcnr the healthneedsof speclfic I
census trtcta aD4 then the health needs of iarer neIghshy
borhooda 1m4 o~ Uebullbull
Rf)~UP1Dl of areu was accompllshed in thefolloWinl I
JJ ~
35
he MiltDoIliahCountY oregon BDViromaental SUrvey
early 1971 isamp statistical report ot tbeaotivities ot
the entire MultDolllh COUDty Health ])epartiDent dur1nl the
year ot1970 he specitic 1Dd1C8S selected frOm this
aUy are 1Il8Dtal health public healthDurs8s visits
fUl1ly pia waereal elisease aDd tuberculosia
Tbroq11the Wle otcbart aDd mapa aDecm szoup these
specific indic to show the health Deeds ofapecitic
ccmaua tracts aDdtIum th8health neecla of larsr ~eilh-
bOrhooda and co8I13 tlbullbullbull
RegroupiDI ot areas waa accoap118hed1D the
tollOWiDl lIIIIm1er~ A bullbullcifie 1ndex 8selectcl auch as
venereal di8bullbulle or tuberculo8i~ he total number ot
cs was then deterll1ne4 for each census tract Through
the use of the maber ot cRbullbullbull tor a 11Yen cenaus tract
aDd tbe population ot thattractaltrateot1lla1ampmcper
100OOOpopUlaticm wu cleteXll1ned for each census tract
This was ~e to starl4ard1ze the population ditterence
amongOeD8U8 -tracts 1he rate of incidence toreaob
cenauatract was then llstedby rank position on a chart
In rank poition1DI any cen8Wl tracts haviDg equal
rates ot1l1c1dence are assipe4tbe iaDk posttiona
Beeauseot the abo fact tbAt cbarta w111 vary in length
neveltbAtlea eacb cbart will 1Dclu4eall census tracts
inMullnoaah Couaty Atter the census tracts bave been
listed accord1q to raalcth1s list will bediv1ded into
IJ
36 three levelsotinc14ence he three levels are
1~ The upper 14 of1DcldenCe
2 Thelower 14 ot incidence
middot3 The ILld 12 of incidence
Tlles three srouplqa are then used in compiling a map ~f
Mu1tnOmahCountyfor ach apecltictop1cbull TIle maps are
uaefuJliD tbatthey V1suallycoJib1De 1Dd1v1Clualproblem
census tracts into larger problem nellhbOrhooc1s
The 1960 statistical iDtormatloD was Used in a similar
liIaDDr to tbatexpla1Dedabove 1Dthe4evelopaent of a
chartmiddot and map 1Ihow1DI e cOllpampriSOr1 of per capita lncolle
tor ttaCh ceDsua tJact aDdmiddot combiDed census middotmiddottract areas
he 1910 aDd 1960 statlstlcal iDtOrllatl0D was combined
lna map and chart he purpose of this and chart is
to d8aonatrate the e cl1stributloa1DeachceD8U8 tract
and middot1ndlcatbull tuture ace populatlon treD4a bull
When one be middotbullbullbullbullbullHdth ne8cts ot an area and has
declded to establlsh a cl1D1c to serve that area the
physical location otthat cl1D1c IllU8t be consldered In
order to coapreb8ll81vel develop an area cl1n1c one should
conslder thepre88Dttraftlc middot~ytaa an4tranaportatlon
systems Thecl1D1cahoUld be located close enoUlh to
major arterlals to giva asy access from the total area
be_ ervecl by this cliD1c At the t1ll8they should
be tar eo away froll thesarterlals to all8Y1ate traffic
CODCell18 andpark1D8 conpstlon By traff1c concerns I
IJ
37
lIlan one lUSt consider thertarro1fne8S of streets whether
streets are oD8--C)r two-way iqres8 and egress to parking
amp0111tie eros tratflC) spedof trattJQ children 1n
ll8a traffic i1lht Vislon re8tr1ctionS etc
BwstraDsportat1onshould alao be central in this area
as maay people ~U f1Df1 1tD8Cessary to use this form of
transportatlon
~e tutqredlopHQt of bull treewa systems should be
c0J1S1dered soastolesen thecumce ofmiddot future roada
cutt1DSotltbe cl1D1c llte line
nrrph1c middotDampta
It is 1JDportaDtto kDOw the demosraphic distribution
characteristics of the oUenteltbat i8 to be served by
localized health cl1D1cs
Acl1D1c which erves8J1 area where1D the prepondershy
ance of persona arecrter 65 years of mayf1nd that these
people rely more on pUblic transportation call for more
home- services and haV4t 110ft ChroD1c and debilitating
types of disorders (b1_ blood pressure poor heariDg and
eyesight) tbaD do8 an area ot a YOUDIer population On
the other hand thL area of older residents may have little
need for family plabDlng cllni08
In order to better ~Ybullbull the 4eaoraphic population
of each CeD8U8 tract the 1970 CeD8U8 iatormation was viewed
and two specific catelOri8 considered These two cat
IJ
38
lori8S woUld be the perc_tap ot population under 19
year of ase and the percentase ot each oensuetractover
65 years of age he 1960 1Dtormatlon tor eaCh tract was
then compared witbthe 1970 intormation and a percentage
ofincreaae or4ecreamp8 tormiddot e~chtract1n each category
cOJlputecland achartma4e By the use of this chart one
18 able to View tJleap populat1odiatr1but10n of census
tract and at the _ t1lle accesa middottrencl Por example
let us choose census tract 601 W see 40-4 otthe
population is under 19 years ot and that ODly82 1s
over 65 years ot middotAtthe e tille the percentage of
youth bas ~ed ODly 1_ intbe laSt teD year whilethe
percentale over 65 year ot middotbas stayedmiddotthe same With
this in mJnc1 ODe ~ 1DfItr libat ol1D1o aerviDg this
area WOuld bellQre conq~w1th the problems of a
YOUQier populat1on and that _ would probably be true foJ
some t1aein tbefuture On the other hand CeDSU8 tract 54
has only 2 ollt population UDder 19 yel1s ot age and
this has decreased by 1 over the last ten years middotwhile at
the same time 32-377 ot the populat1on 18 over 65 years of
age A ol1D1C ___ this area should be or1eJ1ted toward
tbespecttic problema otthe ampledbull
PerCapia __ bY gsa neat
WhaD cona1der1qlooat10D1 tor health cl1n1cs one
shoUld take the 1DC01Ieot areas into consideration Areas
IJ
39
of lowiDcome would not 11kel~be 8erved more by localized
cl1D1cs tbaD would are of hilbincome It 18 likely
people haYiq a hip iDeoll8would preter to be aeenby a
chosen ~r1vatephylc1a1l tban at a local cl1D1cwhere
10Dier waits y beraceaaampryand leas personal attention
gl_
The 19701ncOII81atoWampt10n tor MultnomahC~ty was
not available at the tille thi8report W88 made The 1Dto~shy
tiOD Was taken ~adtro tbe1960 census publlcation
his woUld ~8Il thea tbat ral1I8 OD the chart ynot 1raquoe
completely accurate hi writer telthatthe areas most
affected by tb8 1I8eof the older 1Dco1DtOlaat1oDWOuld be
those tracts wh1ch baYebad a rapid 1ncreaae1n populatlon
over the past tfmyHr8 bullbullbull tracts would include tracts
nUmbered 104 9897 96 aDd 95 be perc~ita 1Dcome
referredto1il-tb1a Paper18the lIean 1DCo per person per
census tract
Attar the iDeoeper census tract was listed on a chart
a map was de 1D41catiDg those census tracts belonging to
the lower 14 ot income tor all censue tracts in Multnomah
COlDltytbose beloqins to the upper 14 ot income tor all
census tract 111 MultnolUlhCounty and those belonging to
the mid 12 ot 1I1coaetor all oeuuetracts in Multnomah
C01mty
In yiew1Dg the _p 1t caa be seen that the low income
area seautotollow aloas the at aide ot the Wl1lamette
IJ
40
R1ver the full length of Kultnomah County A second low
income area follows the south edge of the Columbia from
the northwest corner of Multnomah County easterly to 148 St
A third problem area seems to be on the east bank of the
Willamette River with the Union Pacific Railroad being
about the center of this tract The extreme loutheast
corner of Multnomah COUDty appears to be a low income area
but as this area bas bad rapid grouth in the last ten years
this could be erroneous
Mental Health
be first ~ecific indica to be selected from the
Multnomah County envirollllental survey of early 1971 and
to be considered in this paper i8 that of Mental Health
At the present for mental health purposes Multnomah
County is divided into five catchmentareas with a mental
health cl1n1cin each area These clinics are Model
Citles Delaunay ADkeny street Office Hansen Health
Building end Southeast Clinic
All lIlental health cl1n1cslcept statlstlcal information
on all patients visiting their cl1n1cs this included the
address of the patient hese addresses were then listed
upon the approprlate C8D8US tract Each census tract was
then ranked on a chart according to the nUllber of mental
health patients who reslde ln thatCeDSUS tract attending
any of the above listed ental health clinics This chart
IJ
41
wasttum d1v14ed1ato proper quartile bbullbullbull
quartile vereUs to dne10 u appropl1ate Multnoh
County _tal health ItLa middotmiddotmiddotthelipO~a1bl by lOoJcJIUE
at the UDtal health _to uteN1De which ueu have the
lars-t use otCOllDty 1alh~th faci11t1Rot
1Ilclu4ecl 111 tbia woUld tber otpeopleYia1t1Da
pr1vat patch1atriata aDd pr1_t _ntalhealtb cl1D1c8
WheDtbe M1 18Yienclmiddot Itmiddotmiddotmiddotmiddot~middotbe~_ tbat ~rtt
appears to lMt fourmiddotmiddot-al are iii _oil the nuaber ot
lIental healthcl1D1c na1t toM tbjh1sheat 1he
tour areaa woUld be tollows
1ttrea Ore to~Blo Drimiddot ~tb Burrus14e aDd tIMtmiddot Colb1a Riftr H1gbwyaeri1Dla th nortllra boundaryshy
2 bull ProII 82D4 1_~ 10 20th streetwitil the ra1lMd Mu the north ltouadary
3 ~ et et tUgl_b1bull MYel froamiddot the Clackaaa COUDty l1ae aorth to Dln8lon stret
4 beDOlvt1ttfe-t ~efllt4 COatytrca Jle1aware streetmiddot toR1C1a11oDd wlth Colubla Blvd heiDI tbAtnorth bouaclary_
It ODe coapareatbiap to th iDeobullbullmiddotp 1t can be
eamiddotthat lIOat ot the c tracts baY1Dg bllh v1i11tatlcma
middottfl public tal health cJ1rUc8 ~ 111 t13e low ~ aid
1DcOile SroupiDIOJa1y of til 25 tracta llsted as
haviDlbip aental Maltll nlltatlou are ~ the1g60 hip
iDeo arebullbullbull
17 Plpn
42
amily PlellnSDI ]Jlce Metal Health i8 an 1nd1ce of
use Theperson 111 ordertobavebe_ 1Dcluclecl 1n this
atu4ywouldhave tohaft Ue4 ataa11y plaDI cl1D1c
tacilities of soaetype It 41fter troll tile _tal health
study1nthat i t1Jicludestatist1catrollbotb public and
privateclJD1os
The iDformation tor the iak orurcbart 8Dd map of
t8ll111 plenn1 na ob1a1De4 by cOIIblnlDlthe mabel of
1rlcuv1duals bullbull_ attbe tbreellUltrampo-ti Coatyhll11y
PlalJQllIl C11ll10s 111til tbo at the Planned PareDthood
Association CliD1C8 be tbree -JIultDouh Couaty r8ldly
PlamSq Cl1D1c are Solrtbweatth Col_bla 1111- a114
HaDsell Health BWlcl1Dl CllD1cbi middot1Dtormat1oD vas then
bullbullbullesed tomiddot detellWMt l10w people troll eacb c8IUIUS
chart wastben Mele IUs oIIart jn 4iY1ded to show
the censuS tracts lIaYiDlmiddottIle h1t1iest qUart1le of incidence
of use lowest quartile of 1Qc1deao ot use Jlid 12 of
incidence of Wle an4 a map sprepared troll thts 1Dto~
mation
The C8U118 tractsbelOJISnl to the h1lhestquartile of
use appear to be 1lO~ 8catt~ on tbipwas true ot
either the _p ot aental health cl1D1c uaageor ot the map
abow1DI per capita 1I1COM Iaere40 to be three
d18t1nct areas of UIIaP beJ woul4 be
1
IJ
43
t10D of BurD81cl and the W11lallette River 4
2 S~t Portland 8Otth otmiddot the ra11shyrcaadand alona the W11lamette River
lIortbeaat Portl8D4 between MisSiss1pp1 and 24tbStreet the northbouBclary be1DgColwb1aBlvd
Pylzl1c BMltl IrpI Y11ta
Publlc Healtil nur81D1Y1s1t nclud8 an vists to
theholles of client by PubUc Health Nurbullbullbullbull his shows
visits to bull f8Jl1ly fer aDY purpos SUCh aatuberculolJ1s
het1Dl tem1tyaeatalu4 8IiOt10D8l cODd1t1ona etc
he atat18t1C~ 1fele C()4ed accord1Dg tomiddot the 1llli301fOCUS
of the Y18lt tt doe DOt 1D41cate the Dmlber of holies or
f8ll11lev181tecl or 1D41Y14ual Y1a1ted more tban oDcein
the propwl It dobullbull I1ve 80M 1D41cat1on by coaparlshy
OD ot the 8JIoUDt of aedlcal problema 1n eachcen8WI tract
Ap1nmiddot the _p abowa 8 scatter patteraof probl_
areas althoUSh there appear to be a sroup1Dl of hiSh J
l8aIeccmaus tract 1ntlut extreme southeast part of tbe
County other areu uIriaI any nura1Dl contacts are
1 bull he 801lth-oa-al CO1Dty on eaCh 814 of 82nd Av from Clackallaa County north to Dinloa
2 ear bullbullbullt 814e aroUDd Preacottand Misaisippi
Dowatom Bunul14eonboth 1de of the river
44
V_real Pis The iDfomatloil uaec1 to tabulate the Venereal
disease chart includes all the ooab1ned case otmiddotODormea
and syphilIs reported by bothmiddot publIc and prIvate physicIans
dur1nl 1970 There were 3602 caes ot IOnorrhea reported
dur1nl 1970 While ODly 17 cabullbullsot ayphilimiddot were reported
A chart was prepUed aDd att8llPt wasmiddotmiddot de tomiddot
determ1De Wh_therVttDereal 41ease was more p~vaJent in
areas othigb or lowmiddot proportIon ot youth hi waadone
bymiddotdetemlna a 1leaD prceiltacmiddotmiddotmiddottor the population ot
resld~ts UDder19 years ot (34) middotA mean ratemiddot per
100000 popUlatIon al80c1ttem1Ded tor the middotoccurreDCe
ot venereal dieae This was et at 390 oass Areas
hav1nl a population 1n which leiS than 34 were lmder 19
years ot ampIe were called low- yOuth abOve tbl percentaae
hiSh youth The aaa waatrue ot the occurrence oivenershy
eal disea_ per CeD8UStract It the rate waacomputed
as 1I0re than 390 cases per 100000 it was called hiah
venerealdiaeasei it less than thia tisure low venereal
disease It was tound that 1D Multn~ COmlty there sems
to be poSitive OOlatI0n(x21S19gt between low youth
and hipmiddot venereal diseaand hip youth and low venereal
diseasebull
RaDk ordr Iitot all c traot middottbAm made
Th1s was done byt1Ddlna the ratepr 100000 populatIon
of venereal disator all census tracts in the County bull
45
These were thenlisted from h1lhto low (sreatest to
least) in a rank order The l1sting was then divided
into Upperandlower 14 aDd listed on the MUltnomah
Countymiddot up
The areas of b1gh venereal disease se8ll18to
roup thBl~8 middotin a very tllht area ~oq both 1des
of thell18l8~ R1 w1th BurDaldeS~et being
~bout theceDter qf tbi8IZ9uping This area woUld
appear to be m ldeal spot for the denlopment of a
locallzed venereal d1sbullbullbullbull cl1D1c
UbepoundCUlO1s
In this report bull tube1C1llosls caS8S refrred
to include alltbobullbull cabullbulls ontubercUlo8is follow-up
rather middotthan just new C Accord1Ds to the Multnomah
County Health SUrvey of early 1971 this would include
all ca repOrte4 over thelaat three years The
total number of tuberculosi8 cabullbullbull usedin this study
was 666 lh1 included 128 new cabullbullbullbull
A rate per 100000 of tuberculosis for each
census tract wa- then computed and the c~us tracts
listed by rank order be b11h Qartlle mel low
quartl1 were then reoordd on a Multnomah CoUnty map
TWo genral areaa baY1Dg a hip mcldencaot tubercu~
losiare 1D41cated heyare
1 Both middotsld ot theWilla11lette River
Ll -
46
with Burns1de about thecnter
2 he extrea Northebullbullt comer of the County bull
By coap8r1ng the tuberculois an4ven8real
diseae maps ODe can 8ee that the downtown areas ot
hiSh 1nc1denceare alIIo8t 1c1eDt1cal on ach map
This WOuld 1nd1cate that 1t would be of value to
bullbulltab11sh acl1D1c 111 th1aampreatbat would provide
bothtuberCulos1s 8Dd ytmereal 418ase srvicbullbullbull
Thchart aDd 1181gt8 are wsfuln 11v1DI
1Ddicat10DS tor the type aDd placemeototlocal
health cl1n1c8 tbro1qhout tbe MultnomahCounty area
A cOllpar1on of the mapa help one to dec1dewhether
to provide a aulti-8ervice cl1D1c or spec1f1c type of
cliD1c As stated in Part I of thi paprserv1ces
shouldhaYe both treatlieDt and prfMmt10n cOmponents
As he been stated fta ne1lbborhood health care
Qenter muat be a fac111tY plazme4 with an aamesa
ot the neds of the consumer and the c01llll1m1tybull
Part II of this rport haa been an attaapt to indicate
and clarify 8011 ottheae coDlllUDity neds This has
been done through8elect10n of apc1f1c problems
The indic were then visuallyrecorded through the
use of ups and charta ODe dan asseS8 thedsreeof
1DIportance of certain concems to spec~t1c areaa by
comparinl the chart aDd maps Prom this oDeean
41 dec1de which are48 vb1chcUD1c-or indeed if
the need a clinic at all However further factors
should be considered hebullbull include
a The amount of fuDd1 available
b What 18 the percentage ot peopleineoh ceaaua tract tbat would actually us such cl1n1cIl
c Wbat 1 tbeco--1tymiddot 8 IeeliDashyreaardtDI particular cl1D1c8 Would this dcrebullbullbullmiddot the ettctiveness ot thse cl1n1ca
IJ
li
D_OlraphicPopulatLon Challie 1960 to 1970 48
Cen8U8 1 of Pop 1 Cbaqemiddot 1 Change1 ofPopTract Under 19 Yr8 Over 65 Yrs1960-70 1960-70
middot1Q701Q70
1 319 -12 171 -H) 1
2722 215-27 +68 301 366 -22 127 +35 302 371 +19 111 -04
311middot401 144-41 +29 402 321 13~7-39 +24 501 356 124-08 -02 5~O2 351 133-23 +12
405601 82-10 -02 394602 103-01 -06
701 275 149-76 +56 702 361 +01 121 -07
+10middot801 326 140-22 802 321 middot127
(
-29 -03 9~01 342 124 -H) 6-18 902 294 128 -H) 3-24
10middotmiddot -14312 140 -17 1101 182 +25 -23197
2411102 186-59 +29 1201 226 169-17 -41
31middot01202 +11 182 -05 295 -H) 81301 208 -H) 4
1302 331 +08 197 +04
14 323 +15 middot185 -08 middotmiddot15 329 +16 16~5 -13
-28middot 1601 332 131 +12
1602 356 98 +24middot-39 middot3101701 161-33 +21
1702 370 -15 85 +02 +19 1801 264 151middot-50
185middot1802 256 +47-58
IJ ~
D_raphlc Population Change 1960 to 1970middot 49 (Contd)
4io
Census Tract
of pop Uncter 19 Yra
1Q1n
1Cha1l8e 1960-70
of PopOver 65 Yra
lQO Change
1960-70
19 389 +29 141 -24 20 223 -13 206 +18
21 227 +08 194 -36 2201 356 -27 112 +05
2202 290 -18 ll~9 -29 2301 356 -03 154 +24 2302 260 -37 245 +97
2401 410 +6~1 123 -31 2402 163 -80 320 +99 2501 381 +13 140 -01 25()2 237 31 lil +02 26 343 +25 186 +149 2701 370 +29 1S5 -01 2702 249 -44 304 +98 2801 337 +19 187 +09 2802 306 -10 156 +31 2901 304 -38 142 +24 2902 i 307 -32 146 t3~9
30 29~0 -48 16~2 +51
31 355 +30 160 +01 32 370 +48 148 -13 3301 395 +45 130 -20 3302 368 +06 138 -02 3401 386 +16 117 000
3402
400 +32 92 -26 3501 304 -07 115 +35
3502 344 000 140 -13
3601
36~02 357 -04 132 +32
3603 30~1 42 149 -67 3701 342 +28 152 +19
1
IJ
Jianolraphic Population Chan 1960 to 1970 50 (Contd)
Census Tract
of Pop Under 19 Yrs
JJl7J
middotChanae 1960-70
middotofmiddotpop Over 65 Yrs
1c~7n
Change 196070
3702 409 +39 122 -11 3801 308 -11 151 +29 3802 275 -35 180 +46 3803 282 -32 192 +54 3901 376 ~13 100 +17 3902 296 -03 177 +29 4001 438 -11 84 +13 4002 353 -21 115 +20
4101 397 11 9middot0 +11 4102 346 -19 120 +03 42 331 +19 11 bull 3 -16 43 347 -72 105 +31 44 113 +84 183 +154 4S 33~9 +07 110 -06 4601 2501 22 193 +38 4602 332 +59 126 -29 47middot 161middot 000 211 +01 48 103 -26 302 +59 49 138 +1 bull 3 252 +09 50 141 -26 204 -12 51 12 -39 257 +07 52 47 -61 351 +48 53 89 +49 314 -30 54 25 l1li15 327 -17 55 131 -17 115 -121 56 198 +93 227 -47 57 71 102 189 -88 58 240 ~middot41 16~1 +55 59 322 +25 142 +06middot 6001 264 95 132 +50
6002 328 -31middot 89 +07
JJ
Demographic Population Change 1960 to 1970 51 (Contd)
Census 1 ofPop lChange of Pop bull ChangeTract Under 19 Yrbullbull 1960-70 Over 65 Yrs 1960-70
1970 1970
61 355 -58 85 +39
62 328 39 110 +18
63 414 04 73 10
64 382 -22 72 +04
6501 383 02 67 -20
6502 329 -56 96 +09
6601 391 +13 88 -03
6602 319 -59 97 +06
6701 327 71 145 +72
6702 331 ~67 83 +1-0
6801 365 -66 49 +01
6802 388 4bull3 54 +06
69 354 -41 80 +23
70 400 -23 68 -06
71 359 -48 72 +05
72 255 -88 82 +11
73 346 -39 91 +25
74 313middot -63 105 +24
75 329 -42 129 +37
76 336 -52 85 +21
77 370 -10 69 +05
78 309 -10 120 +21
79 325 -56 87 +10
8001 358 -81 57 +12
8002 391 ~81 76 +12
81 315 -76 108 +21
8201 403 -23 64 +08
8202 392 23 65 +08
83 357 -34 120 +31
84 402 -18 73 +16
85 413 -06 76 -09
r
Demographic Population Change 1960 to 1970 52 (Contd)
Census Tract
t of Pop Uncler 19 Yrs
1970
Change 1960-70
1 of Pop OVer 65 Yrs
1970
ex Change 196070
86
87
88
89
90
91 9201
9202
93
94
95
9601
9602
9701
9702
9801
9802
99
100 I
101
102
103
10401
10402
lOS
368
351
379
391
391
413
379
433
372
429
414
432
419
439
~32
377
457 420
378 41middot7
345
360 417
417
412
-04
-02
-35
-26
-28
-11
-64
-20
-S9
-39
-32
-21
-34
-40
-47
-lO~7middot
-27middot +04
+56
+07
-34 01
+04
+04
+10
103
128
97
11il3 99
69
79
42
77
46
34 38
44
40
54
111
51middot
81
133
59
74
140
63
87
76
-08
-06
+04
+08
+17
-05
+3S -02
+1~4
+19
+33
-14
-08
+12
+26
+71
+11
-16 -34
-20
-19 +37
-49
-2S +15
NOte The The
Taken frOi
averageullder averageabove
middotUSCensus ---shy -
19 years == 6S years ==
figures 197
32r 13(14
p a~d 1960
--
Rank
1
2
3
4
5
6
7
8
9
10
11 12 -_
13
14
15
16
17
18
Tract
69 46
60
58
- 68
61
302
2501
67
63
19
62
26
94
3603
3902
64
30 -----~-
Rank
19
20
21 -
22
23-shy
24
25
26
27
28
29
30
31
32
33
34
35
36 -
Ranking of Per Capita Income by Census Tract
Tract
65
2701
- 15
1601
701
66
93
82
2903
3602
30
2502
80
2401
81
- 70
91 shy
4001
High
Rank Tractshy
-32shy37
38 97
120239
7840
41 ~ _2_1__ 42 31
43 2501
44 18
45 98
46 37
47 3803
1702
49
48
1602 92 2702
I
50 89
51 901
52 801
Ra_
53
54
55
56
57
58
59
60
61
62
63
64
6S
66
67
68
TractTract Ra~
74692
170196 70 I
401 71 90
72 1037J
79 70273
3802 74 601
24024102 75
85 76 101
77 9023901
7699 78 100 4101 79
3601 I
380180
458140~ t---- _ - - shy83 82 42
888384
59843501
4777 8~
502
Low
802 86
Rank Tract
87 shy
--88
89
90
91
92
93
94
- 95
96
97
middot98
99
100
101
102
103
104
1201
14
49
72
73
43
87
3502
105
1
52
86
71
1
501
10
3301
104 tf
Rank
105
106
107
108
109
110
III
112
113
114
115
116
117
118
119
120
121
Ranking of Per Capitalucoae by Census Tract
(Contd)
Tract Rank
4001 122--shy602
13
1102 2302
3302
55
3401
48
21
56
50
3402
lL01
2202
2301
53
2201
-shy
Tract Rank Tract Rank T~aet Rank
57 I-----
Imiddote
bull
Tract
- Low -k Note Information taken from 1960 U SCensus
Rank Tract
I ~
Ie
Imiddot
~
----
----
--
--
Rank
1
2
3
4
5
6
1
8
9
10
11
i-
-Tract
391 922 921
972 971
100
132 131 121
962 961
822 821 401
982 981
20 111
47 10 1
412
High
Total Number of Henta1 Health Visits
Ranked by Census Tract High to Low
TractTract RankTractRank Rnk
12 182 22 78 29 87 76 381 73181 ~------- 1913 371 8538230162372 271 2616-121 8272 2
14 80~2 31 94 7923 84801 59 15251362 4232 15 52 _ 32 103 8924 651 17240216 652
_ 91 351 33 341 23117 83 122 25 25 48 1123921418 34 shy61 86 661
19 662 6493 81 26 91 8153 49 50 55 41383 71 27 51 3120 90 672241 35shy 104167162 461
I 411 46211121 28 88342 I
2502 36 69 54 5251 50 272
-Ra
37
38
39
_ 40
_ 41 Ishy
I
42 I
-I 43 44
45
shy
Tract
~ --- shy 95 56
45 292 242
102 62 352 291y
92
101 281
99 72 63 601 60~ 42 2201
77 74 61 57
363 232
70
32 31
11 44 282 2202
Low l
- Tract
46 682 681 I 331 30
r~$ 47 1042 332
48 102_41_
11
~
Visits to Family Planning Clinics Ranked by Census Tract High to Low
Rank Tract Rank Tract Rankmiddot Tract Rank Tract Rank Tract Rank Tract
1
2
3
4
5
6
7
8
9
10
11
12
13middot
14
15
16
17
361
56
401
341
48
59 121
20
55
342
10
31
58
93 21
241 132
331
53
461 462
18
19
20-shy21
22
23
24
25
26
27middot
28
29
30
31
32
33
391
32
middot47 I-i-_-shy _ -
231 111
332
972 1
372 371
52
89
32
92
82
100 31
182
30 242
402
34
35
36
37
38
39
40
41
42
43
44
45
42
1714 i 661 221
78 362 2
90 602 601 352
63 251
105 921
971 351
73 42 292 232
411 51
662
81 45 52
46
47
48
49shy
50
51
52
53
54
55
56
961
801
49 81 72 71
19
9~1
172
68 2 57 162 14 112
91 75 681
381 42
3~3
83 161
57 f
58
59
60
61shy
62 Imiddot
63
Imiddot 64
65
66
64 62 36~3 252
74 652 SO 392 291
651 6bull 2
79 271
r-- ---- shy981 222
672 671
821 272
94 87
281
382
67
68
69
70
71
72
73
74
75
76
77
78
981 26 12~2
IS 61
85 82~2 69
61 43
101 86 84 282
76
131
51 72
1041 962 88 70
99 922 77
103
95 802 181
i
~
Low High
RankRank Tract
5479
4480
81 1042 ~) middot102
71 - - + ~ - ~
Visits to Family Planning Clinics
(Contd)
Tract Rank
I
Tract llaDk l
RankTract Tract Rank Tract
~
I
~
J1 ~
Low
Total Number of public Health Nursing Visits
Ranked by Census TractsHigh to Low
TractTract RankTractRank RankRank TractTractRankTractRank
25249 71 79 17249 8033 6586 99189711 84 2915072 34 661 76 66 811519512
402 5035 51 161 2518220 122 1713423 352 55801 7120 6752 2 149814 41236 83 2662 38 94 6821 53 2924015 362 37 32 42 75 69 281 84 63
546 8822 54 222 85 3925431 70383417 3818223 6439 4386652 718 21 55 103332 8924 232 87 19 271729219619 24156 16211140 382 628825 10523110 112 73411 10141-- ----shy 89 363 4457 8126 16111 221 74 9142 90 46158331 53 671279012 46243 48 59 351 3837528 1083 9313 91 5844 59 -_242 76 1----- shy60 272 72 74104114 60145 42 9287 7729 92 6151 8215 57371 934630 91 307762 12113116 282 619447 41391 9531 78100 63 7378 ~95 681 6945 32 5632 798517 6448 47 52 181
High ~ Low
Rank Tract Rank
96 31 132 70
97 102
98 182 372middot 602 651 662
- -shy
~72 682 802
822 922 962 972 982
1042 ----shy
Low
Total Number of Public Health Nursing Visits
(Contd)
Rank Rank Rank TractTract Tract
I
I lt
I
Tract Rank Tract
[
~~~-
I
~
IJilfimiddot ~
j
Ranking of VD Caea According to Census Tracts 61 By High and LOll Youth Itatio
A media~ of 34 5 was determined Any tract having greater
than 34 5~ of popu1tionunde~ 19 years of age -High~
Any tract having l8S than 345 of population under 19
years == Low
Any tract having rate less than 390 =Low
Any tract having rate more than 390 == HLgl4
YOUTH
LOW HIGH
L
0
12 402 1801 1802 343 2801 2802 29023603
54 6001 600262 66~02 72 74 75 76
78 79 81 t02 65 1202
W
(25)
VD
H
I
G
H
401 701 801802 901 902 10 1101 241 1201 1301 132 14 15 1601 1701 20~ 21 2202 2j02 2402 2502 2702 2901 303501 3502 34023801 3802 383 3902 42 44 45 4601 4602 47 48 49 SO 51~2 53 55 56 57 58 S9 6701 6702 73 95
3~02 7021702 19 25~01 2701 4102 4101 63 64601 ~601 6801 680270 7l 77 8001 80~02 8201 8202 83 84
85 86 87 88~ 90 91 9202 920193 94 9601 9602~ 9701 9102 9801 9802 99 100 101 103 10402 105 6501 10401
(47)
301 501 502 601 1602 2401 2301 2201 31 32 3301 3302 3401 3402~ 3602 3702 3901 400140 02 43 61 69 B(
(53) (23)
~ ~gt
Ranking of VD by Rate Per 100000 By Census Tract
~
Rank Tract Rank Tract Rank Tract Rank Tract llank Tract Rank Tract Rank Tract
1 2202 21 S6 40 902 58 1602 74 75
90-shy 64 107 26 --~-
2 3402 22 45 41 10 59 902 75 78 91 54 108 61
3 2301 23 3502 42 2502 60 602 76 6802 92 402 109 87
4 3302 24 49 43 1102 61 501 17 2 93 94 110 90
5 50 25 52 44 6702 62 14 78 8202 94 97 02 III 76
6 2201 26 20 6701 63 4002 8201 2501
9701 41~02 112 91
7 44 27 48 45 401 64 3802 2902 95 63 113 62
8 3301 28 1701 46 502 65 30 79 83 74 96 9602 114 71
9 55 29 47 47 42 66 3803 80 2801 96Q1 115 85 10
11
12
13
14
15
16
17
18
3401
53
2302
2401
57
21
2402
1101
51
30-shy31
32
33
34
35
36
37
3701 - -~ 1201
3702
89
43
132 131
3602
4001
48
49
50
51
52
53
54
55
58
1601
601
4602 4601
69
701
31
3901
67
68
69
70
71
72
2901
801
39021~ 802
6502 6501 122
702
41~01
81
82
83
84
85
86
87
88
19
1
1702
2802
79
93
100 6801 6602
81
97
98
99
100
101
102
103
104
9201 9202
9802 9801
77
302
79
86
72
84
116
117
118
119
120
121
3603
8002 8001
101
99
95
10401
105 10402 103 102
19
20
59
32
38
39
2702
3501
56
57
301
3801
73 1802 1801
89 6002 6001
105
106
2701
88
High Low
-- -----
Rank OrdermiddotTuberclosis Cases by Rate Per 100000 Ranked by Census Tract High to Low
Tract TractRankTractRank Rank TractRaukTractRankTractRank
801
79 9601501411 52 6835340120511 I 960269 903603532036 $-~~F130221542 4366 311301 70 68~013802 _ I- _ 4001_37213 3921201 6802802 H71523822024 22 54 193302 3802 80 8958 I37139535 70155 9801 I60123 72 6702 98023914011016 6701250124 10 56
81 94 401r 7 154152 73 7057 2625 122 92028
90242 162312301 92~158 86 7172434526509 82 79160159 74 100 87412240227220110 6502836960 75 30 8317244 6501782801285711 61 901 42765645 84 66021459294912 9701 660146 171 302 9702 47
6235023033113 85 822821182 917755 16335013110214 841814832 78 103 938564 324815 86 1057940149272 38036523216 10401 87 2902241 725Q 10402360266340217middot IF88 88 9937233 282 51 218 101 01102 46016234
I)167 2901460219 47
High ~ Low ~
- -
TractRank
9S89
6490
8191 8001 8002
63 61 60middot01 6002 44 2701
92
J
2502 402 --- ----shy
I
Rank
Rank Order Tuberculosis Cases by Rate per 100000
(Coutd)
Tract Rank Tract ~nk
I
Tract Ballk Tract Rank
Imiddot
Tract
Imiddot
1~
t 1I i Pi i l I
o
1 -1shyL I
I J
8 40 icO ~ I -lt 0
-t (1) I
i I
r o E
II
a
I
r--i
shy
I
~
I (
Jgt
(011 fi(
Ggt
I II ~j
()
(f 0
~ ()
I
11
f9
r
II 99
o ~
Ggt r
~ __-J~ I t I ~ I
r--J l I
~ _ __ J
) 1
fTl
1gt
r I
()
r
()
lt en -i en
()
I1l
(J)
(J)
-i
P ()
19
r o ~
r G1 I
I
c
~
o I 89
--- -I-shy
r-r I
1- 0 _~ _ _--J E
G1 I I I
i i
I 1-1-1 ~ _J ~2 ~ II
II
()
1 I I I 1
id i bullbull
~
A n 69
r 1shy
- 0 Gl
l--~ ~ I
~ II
II )
I () isect i
en l i
(J)
-t
0
IA Ol
t
~ II
12
24 hours a day
The center should als~ be irDmed1ate in 1ts funcshy
tioning That is the centermust have the capacity to
provide prOmpt efficient service and should be able to bullrespond to problems middotwithout long hours ofwalt1ng and
many rounds of apPointments
The centexsservices should be 6omprehensive liThe
center should offer a full range ofusable oil-the-spot
services or easyaccess to other resources by available
transportation It should gear itself to the needs that
peoplehaV8-especially poor people-and provide for the
slmultaneoushar1d11ng of problems were possible
SerVices should 8180 b 1J1tegrated and coordinated so
thatseMces can more effectively be provided
The operation of the service center should fInally
be responsive to the needs and desir-es of the neighborshy
hood It should provide ways in which reSidents can
shape th~ program and continue to contribute to its course
and development It should be relevant and ready to
respond to changing needs II
The concept of the comprehensive neighborhood health
center developed by OEO (31 p324) has been described by
severalwriters Yarby (37 p73) describes it as an
outpatient racility which has certain def~n1te characshy
teristiCS middot1 Accessible to a poPulat1on concentration
bull 13
2 Open 24 hours a day seven days a week 3 Family-centered c~e by a team of lnteniists pediatricians clinical and publichealthnurses and social workers 4 Availability ot frequently~requ1redspecialist in such fieldsaspsycbiatryobstetrics gynecology surgerY5 Con~1nu1tyof doctor-patient relationshyship 6 Family records with social and medical ~raquomDaries of relevant information about each family member 7 Basic diagnosticlaboramptoryand x-raytacl1itles and drugs and biologicalsavailable atthe center 8 Directline (1)y center-controlledambushy
lance when-necessary) to ateach1nghospltaifor cl1agnostic ~d therapeutic servlcf)srequiring the fa011itlesandpersonnel of thehospltal 9 Patient-cantered and eommUn1ty-oriented -
The range ot services in the comprehens1venelghborshy
hood health center shouldbe as complete as possible
inCluding preventivediagnost10 treatment and rehabi-
litative services and Sbouldbe deslgnedto eliminate
episodioandfragmented services (31 pp324-325) Schorr
and English (33p291) add as additional characteristics
ot the compr8henslveneighborhood health cent~r that it
should ~ve intensive participation by and involvement
of the population to be served both in policy making and
as employees and that it should be fully integrated with
the existing health care system The Office of Economic
Opportunity (28 p63) stresses the potential for easing
health manpowershortage$by trairiing local neighborhood
reSidents as non-professional health aides at the same
time creating new job and careeropportunitles As
14
Gordon (16 p bull 422) indicates Many of the outstanding
problems in medical practice todayrevolve around
effectively motivating the patient and the prospective
patient to be concerned with his health This is
especially true in a deprived environment The community
health center with its technique ot consumer partici
pation maybe a way to create this cooperation effectvely
It is important to note at this point that the
comprehensive neiShborhood health center haaas its
constituency an integratedmiddot community r~ther than a
particular segment It should haveas Blum and Levy
(6 pp~5) indicate a horizontal rather than a vertical
relationship with the commuriitybull The vertical relatlonshy
ship they state is characteristic ot those service
organizations wh1chapproach the community only in terms
of their own fUnction Tbey see only their relationship
with the users of their service and assume that problems
of accountability will be handled by these consumers
However they pOintout this ienot likely as a vertical
approach creates dependency onthe institution Agencies
in a horizontal relationBhllp recognizetha1 they have
both acommunityand a consumer to serve The horizontal
approach places the matter of accoUltability on a broader
basis than just the involvement of the consumer De Diaz
(14 p4) speaks otthe need to ~develop a community
facility which difters from a clinic for low income
1ji ~
15
people in that it should serve an economically integrated
community The reason for this is that a wide variation
of consumers may assure a better quality of care
The advantages of the comprehensive neighborhood t
health center over traditional systems of providing
commuruty health services are numerous Hospital outshy
patient departments a major traditional source of ambushy
latory health c8refor poor patients have been indicted
for neglecting preventive health care ~romoting fragshy
mentedeare and subjecting patients to degrading and
impersonal conditions to mention only a few of the major
defects (31 p324) Another defect has been the
tendency to shunt low income patients back and forth
between different cliniCS often at different locations
arid with differel)t open hours for different treatments
or tests in regard to the same lllness(26 p63)
The comprehensive neighborhood health programs that
have been organized present a great variety of organishy
zationalpatterns one area of difference 1s in the
emphasis placed upon making each faci1ity comprehensive
in the services it provides to the patient population
In the Montefieri Hospital Neighborhood Medical Care
Demonstration program in New York City services have
been made available through a central health center and
two store frontsatellites the center to be the base
bull
Li
l of opratiol18 of ta1lJpIlflicl- ancl the satellite
center the ba of oparat1oDa of public heaJth nurses
an4 nllbborbood amp1 be satellite centers wereto
proVide preVentift tutaltll bullbulln1c1-m1zaticms w811shy
baby care per1od1c ~ectiland tJle central health
center to proViAle care tor illnes If (36 p299)
bis propWI VUDOt ~ttullytunct10DIDI at the t1JDe
it d1cu8ae4 18 tbe Uterature aDd all aernce Were
be1Dl provided 1D_~terBowever itwould ae
tbat the ntua1pro~ as aY1ioae4by its plmmers
would boclJ aoaeot bull 4efeot~ otthe current lud1cal
ccde teaIt pObullbulllne_t coorctJl8td admSDtshy
etration eD4 well 4eftlopecl refelTal procedtlreacould
1I1a~ thecOllDeCticmof t~_t8 withappropr1ate preTellshy
t1 aD4 therapeu1ampcaen1cbullbull aV81lable 111 diffrent
locationa Bowner tile barrieraottiaeaDdUatanc
between center and truaraUon tor the UDSopb1aticated
patieatlook1Dl tor 1her1~pJce too tor ~1CU-
larhalth serfplusmnQewoGl4~to JJa1t tbbll1ty o~
tb18 ~811D to provide iaaiYCOliprelleU1P18hboltleod
health servicebullbull III tactmiddot tappeareto coDtlict with
tbepro own taW cOfdotpro-1~a tam1ly
mecl1cal careprogru 111 wIa10h pre-teAtlYe aDd therapeutic
health erY1cecan be proY-lW to all IIl81Ibers of
tamily in the coure of aaSDll vi8it (36 PP301-3(2)
Dle Delmtr Coloradoprepa11ke the Montet1ori
LI
17
prograJlut111zbullbull abe1rarcJly ot SlDa11 aatellItestations
andlerer IIOreceDtallzedtac11It1es It 41ffers
howeverill tbcolap~81vene80f the services avail shy
able Inthe 4ecentraUzed facIJJtiesIt resembles very
clc)sely the IOdel ~ordecentral1zed social servicedell shy
very developed by 1ahII~ Which was 41sCussed above he
SIlall neImiddotgbborhoodmiddot c8Dt~aw1tb1n walkl distance of
most of the populatiotl havebeendesilDedto take care
of allthenorllalhealth probl of 3000-5000 patJentsshy
check-ups IlzatiOZl8s1Jlpl laboratory testa and
treataentand iaecucatlol18 (d1apeued by phyS1cians) for
IIOst DODCrltIcal 1l11le PatIent 1d1Oneed IIOrespecIal-
Ized care are reterrecttobacJalp facilities BaCkup
support tor themiddot~t1oDa are the tWo l8rsernelshborhood
health C8Dter8~ttr1Dl aCOglete~e of out-patient
serneeaDd three part1clpat1q hoap1iampl bull bullbull which
proVide1Dpat18Dt~t andcoDSUltatlve services
(13 p1028) Intb1a prosrama coaprehens1ve range of
prevent1ve aDd trea1aeDt serric 18 aVailable throughout
the decentraUzed middotta The CoapreheulY8 ReIgbborhood Hea1~ Service Project
otKa1er iC)UDdatlcm HOspitals 111 Portlan4 OreOD 1s
s1ll11arto th DenVer prosraa 1D thata comprehensive range
ot out-patientmiddot services 1D prov14e4 in each of 1ts 10cashy
t1oDa althoUlhmiddotmiddot tbe oentera are larger and l bullbulls DDIerous
than 1nth DenverproPUh (12 p6)
Li i
18
In order that a comprehensive neighborhood health
care center be able to proVide continuity of care it
must have arrangements for hospital services integrated
into th system Yarby (37 p73) as quoted above
states that it 1s characteristic of the neighborhood
health center to be directly connected with a teaching
hospital However De Diaz (14p3) indicates that it
may be advantageous for purposes of service delivery not
to havemiddotthe center affiliated with a teaching hospital
She feels that such anaft11iation may lead to asltuation
in which policies might be determined more by the teaching
needs of a medical school than by the service needs of
the patient
middotThe Nat10nalmiddotCommissionmiddoton Community Health Services
(25 p69) states that such a system of comprehensive
health care integrat1na ~e servicmiddotes of several health
and roedical agencies snould utilize Itas much single or
unified management as possible Neighborhood health
centers have been operated under a variety of auspices
but several writers have pointed out the advantages in
termsof coordinated prOvision of servictts management by
the hospital of the neighborhood health center For
instancethisfac111tates the keeping of unified medical
records of all the care a patient Msrecelved either at
the neighborhood health center or _le hospitalized
(12p6) ~ermore a3 Young (38 p1741) points out
19
direct operationot the u1sbborhood health oenter by
the hoSpital canll8lceaftilable to the center expertise lt bull
in sOlle aapcta 0 Operation that m18ht not be aa readily
available otherwie
Relardlebullbull of wbetberthe hospital and the neighborshy
hoodhealtbcent8r haVe a cOJIIIOaadmjntstration they
IIlU8thaVealTlved at a str1Dsent delineation of IDUtUal
role and reSpoDBlbilltiebullbull All OOIIpoienta ot the care
yst IIlWStQlarify and understand one anothers position
In the syatem and acree on objeCtive ancimethOds
(26 pp16-17p31) SODae areas of iDUtUalconcemare
reterral procedures record keepiDg aDC1 mutual use of
facilit1es statt1Dl i8 anotb8r ~ ot coaaon conc~
Ditt1cultift have u-laeniD the pastiD cOllprehensive bull t bull
healtbc~ prosraumiddot 1d11ch were batil plauned in wb1ch
all of the health canter phy1C~1IDa did DOt bavetatf
privilege at all ot thebackuJlhospltala (29 p21)
SUch a8ituat10n i8 1Dampcceptablelt inpatient care i8 to
continue to be p4by the pat1eatmiddot health center
physician and it cont1Du1ty ot care 18 to be maintained
Hoapital and health center1lUSt laav 301nt responsibility
tor the recruitaentot physicians
VticlentU IPan BJcNrcu Much otwhat haa b8ea sUd has stre88e4 at leastmiddot
iJlplicit17tbaD8ed tor tM etticit middotprovision ot8emcea
20
There appears to be two aspects of efficiency which are
discussed by writers on the su~3ect of the comprehensive
neighborhood health care centef one of these is the
need to organize) services to make the most efficient and
economical use of scarce medical care resources The
other closelyrelat8d in realIty is the need to help
the public use services in the most efficient manner
The comprehensive neighborhood health center concept
1s lhherentlymiddot efficient in that preventive curative and
rehabilitative health ~are programs are coordinated under
one roof with integrated a~stration Furthermore
theempbasLson prevention health education and early
disease detectionis eftic1ent troJll~estandpoint of
the health care system as well as beneficial to the patient
(18 p760) HQwever ~ue tothe scarcity of health care
personnel thecoiDprehensive neighborhood health center
mustbe an arena tor eXperimentation with new staffing
patterns~ The Kaiser program is indicative of the way
in which health care systems must begin to operate in
that appropr1ate ancillary personnel are used Wherever
possible to perform functions that do not need to be
carried out by the physician As Saward (32 p42)
states
1hroughou10ur organ1zat1on~ there are many of the customary experiments be1ngmade-shyJse of speciallr trained nurses for well-baby care under the SUpervision of the pedi9trlcianexperiments with routine prenatal care by
w ~
21
middotSPC1a1l~t~JlUrbullbull per8ema_1 bullJmdlJleu y our fuDotlou are auoh that DOtb1Da 18 dorutbYtbe phY8iCianstbat doe DOt vet to be done by the
phys1c111U1fhe other aldlle4 person- Del-nurse middotreC~0D18t the appo1ntshymeDt center or clerical praormelshyaremiddot there to free h1amiddotto use his spec1al sk111
Awell lmoWn treDd1D the area of eaaiDI health
c8re JII8DPOY8rShortagjs bas middotbe thetrend toward tra1nshy
1DB poverty area rea1deats as DOD~pro~eaionalmiddoth8lth
aide and nepborboocl health workeramiddot (28 p63) This
bas the effectofmiddotmiddot1J)creaa1q II8DPOWrand 8180 can help
bridle the cuJ~ cap betweenprondera and colllUmers
of aen1C8s This attarD at least tlleoretically
createa a situation 1D WIa1ch providers andcoD8Ullers can
be educated to UDderatad OD88DOtber and interactJlore
ettectlvely~ HoWever amiddotpltt8ll has beeD themiddot tel14ency in
801D8 oamp8e8 tomiddot us aidesmiddot ssale8lllcw t~r the center
alJDOatexclwdY811rathertbaD ua1Dltheal to protide the
health care for wh1ch ~ were trained (29 pp3B-39)
1bat ismiddotmiddot vh1~e the a14e Yalue in ~~m1catiDI with
low 1nCOlMt patieata haa beeR recoSD1zed and stressed
their role ashealtb carepersoDDelhil been slighted 1n )
any 1Dstancea
Anotber step 1d11Ob bullbull been taken to provide 8rY1ces
more efficiently eUeot1ftlybas beenmiddot theorgan1zation
of per8ODDeliDto IIllt141sc1pl1Dary teamaaaa means ot
proYid1DgmiddotCOQrd1DatedserY1ce SUch te8lll8 sen_rally
~
hf
~
22
include PhYsiciaQs nursbullbullbullbull soc1al workers and outreach
workers Conceptually th8y fmlct10n to me~ the intershy
relate lled1cal and social needs ot the families sened
Hor there are a number ot barriers to the etfectve
tlmctiOD1nlof lIuchte8ll8 SODieot these are heavy caseshy
loads the inordiDate amount ot tille consumed by multlshy
prOblem tamtliethel1m1ted tra1n1 ngmiddotmiddotand laCk of tnterest
on tile part ot aoae tebers in examinJng aspects of
problems out14e~lr oWn areaaotcolIPetencemiddot and
~ourdcation prc)blell8 between proteasioDala and nonshy
prot81~s (10ppa-10) middotrurtbemOre as De Diaz
(14 middotp6)1nd1cate tbel8 maybe a teDdency tor vertical
dp8rtmental lines of auperv1810nto become paramount
over the team coDamloation syst lead1ngto conflIcts
in determ1niDI the ro1ea ot solie team bers particularly
the DOD-prote81011alaInauch exper1l1enta Witb new
~t1Dlpatterna it 1s bullbullaentialtbat line of authority
roles aDd NsP0D81bll1tlea be made explicit and that there
beJDechaD 8IUI tor relUlar evaluat1onotfunctlorUng
Another way inwb1ch health care sernee delivery can
be made more ett1cl8Dt is to proVide servicea dur1DC the
hours whentbey aremiddot -ostnee4ed As reQo_ded by Yarby
(37p1) serY1ce can bemadelIOre accesslble by making
themava1lable 24 hours a day seven days a week If
rg8l1Cy service are aft11ab1e aroua4-tbe-cloek at ~
nil1iborhood health center the continuity ot tbepat1ent ts
23
careiamaiDtalDedand meatry point into the
cOIIPre~i health care 8 be made available
tothe patient who aoZMllyU8ea ozilymiddot emergency care in
tille of med1cal criais More 8isDificantly ava11ab1-
lity of a tull rase of bullbullrv1c8 tor seVeral hours 11the
eVerlna aI1Cl On ~ prevent the los ot earn1JiSs
involved if th patierat 1IU8tt8cet1me oftfroawork dur1q
the d8y for aed1Cal oare bull his can be an eSpecially
importantc0J1814eration tor lo1aCOlleDUUg1nally qloYEtd
patient aa4caJla18o PIOJIOtet1)e 0Da01Dl use othealth
servicebullbull
exper1eDO ot tbeKa1er prosraa in tb1s~reprdAs
Greenl1clt(19 p10) states wA lllNt 8ip1flcant
proportion ot the abulatory care 8n1cp~Y1dd tor ~
total popUlatiC)U ~ ~ after clWc hours and this
Deed i8 apParenUyaoN prODGUDced tor aJl8d1cally
iDCust population On the other hand the bulk ot all
aabulatory med1cal cu 88l91ce are performed dur1nS
regular cl1D1c hour eVen when services are available 24
hours a dayJ day bull week W
It has ~ the experi8D~eof a ftIDber ot ne1g1lboXshy
hooct hea1tbcentere _t a_jor obstacle to efficient
proViSion ot anicbullbullhas beentbe teD4eDcy of medically
1ncl1pnt patieats to utilize the center oa a walk-in
baais tor epi8od1ccr181or1entect bullbullrv1cea rather than
4)i
h~ ~~f ~~ L
24
to make appoJlltaeata tor ODIo1qprevmt1ve treataent
and rehebl11tat1Ye care ad ampl1O to bave a blah failure
to Show rat_for tbe appo1DtaeDts that they dO make
Atone center 628 of appo1Dtments made were kept
while 3Oottbepati_ta een were ~1n patients
AlthoUP fewer patiets were actually 88811 by the cater
1D middottb1s 1Datance thaathe -bervholuidmadeappointshy
mta the walk-iD patlat required an iDord1nate amount
ot staff t1ae tor aCreeDiaaacl ~trral to pplOprlate
~ttor caregt (9 pgg) Arraquotbr1llpl1catjo~ of the
plOVidedto valk-iD patient by other thaD their
(19 p12)rurtbermore
when patients uti11ze Wlk-1Il er181 centered care
athelr ODlf tona ot ootact with the _d1~ care
ay_ta fUilycentered care the treata_t of tUl11y
bers
a a UD1t 11
dlarupted
hewalk-1Dphenoaaencm appear to barelated to
diUerence between soclal clase in the style of Dlaking
contactJt1th the a11oal C~ay8t As Greenlick f ~
(19 p11)1Dd1oate8 thepheDOaenOn ot INater usage of shy
walk-in ervice by aed10ally middot1Jid11ent patient thaD by
others baa otte been attr1buted to a stoical att1tude
tQward 1llDe8 em the~ ot poor people leacl1D8 to a
~
25
greaterdelay1n tbe k i Dlofa8d1cal care These
patients wppoedlyeelcmiddotcareODlymiddotwIleD tbeirmiddotillDess
becOlles1Dtolerable resultiDSin middotthMr appeariDS withshy
outnot1ce1o rece1ve oareHlwever Greenlicks
r8aearcbbaa cut doubt on the existence ot tb1delay
111 report1Dg middot8J1IPtoJumiddotOfDeW 11laessand seek1ng care
Be bas tcrQDd 1bat s1ll11ar peze_tases of dioally
1nd1sent 8DClJ1on-aed1cally 1Dd1PD~ pat1enta seek care
on the aue daytbat aptou tirstaPPear
1fb11e GrHDllclc 1nd1cat tbat the reasonator the
greatertendeDCY of low 1Do~e pat18Ilta to 1$8 walk-in I
serY1ces are notlcDo1rAmiddotmiddot tbe7 _ be rel~tedto a tendency
ot lower aocio-ecaaaoclaa patieota to preter face-toshy ~
face contacts with II841cal persoDl181posslbly because
such contacts areft coatortiDS an4reasauriDS to
patients who are hJpotbeafzed to bave a dependent attltude
toward IIed1Cal care perS0Jm81 (30 p161)
It a8 itmiddot baa pnerally beenhld the appointment
s1stemts the most efficient Ileana of dellveriDS
comprehenSive oODtllluiDlh-lth care (9~100)1t is
necessary that educaUoraalmiddotbulltfort be taken to proaote the
use ot middotappo1ntaents8DClmiddot tQrec1ucethe fa111re to appe~
ratB4uOatioaalwhlQb baft~utl11zedhave been
IJ
26
1Dten1ews with walk-in patients home Vi8its and group 4i
meetiDp1D8D attemptto1Dierpret1o the patients
the value of rtitgular ppo1ntmentamp andot con~in~
c~1ve care rather than epiI041c care (9 p1OO)
h1s 1safuD~tioD torwhtch nOl~prot81QDal colDlllUD1ty
YOrkersllaY bebe~r8U11ed tban other statf H()wever
euch aD ~ucat1oaal propul __~ ~e related to the senUiDe
capacity otth health oenter to provide comprehensivebull gt
ervice8 to1tpat1_t~odoD aD app01ntment bas18 It
1amp pos8ibleo~rw1 tor educa110Dal ttorts to result
LD a~8JImCl tor ltPP01ntaen~8 at a ratewb1ohi8beyond
the capacity ot thee_tar to t without uareaaoDably
1_ wa1t1Dlprio4a QOBt1nuad use Ot the center on a
wallt-in bU1 _1tbeoosiItpos81ble to et an appoint-
met anc11nCreued pit1entcoJaplampia1a bull Therew111 of
course always be a need and demand tor acute ep1so~c
Care -ci the health centerDlWlt be planned with the capashy
billty ot bullbullbullt1D8 tb1aneed wh1~ cont1Du1nI to stress
aDd educate the patient to utillze oDlOinI comprehensive
faa11y middotc~te~d Cflre (9p 100l
att g4 CODClva1opa
In order to bea4equate any coJlltemporary health care SY8tem muat bullbulletcerta1D interrelated criteria he
IJ
27
minimum criteria areaccessability of services to those
who need them compr8heX1siveness and appropriatness of
services and efficIency 1nthft utilizat~on of SCarce
health care personnel and resources The scareity of
pex-sonnel andtbe need for h1gh quality ongoinghealth
care services
aJIlong the
populationdemanci the most effishy
cientprovision of services
Services must be made accessible to the population
They mustmiddotbe geosraPh1cally accessible to remove the PhysicalmiddotbaTiers betWeen peopleandthem$d1calcare
system They mUst otter their services dur1ngthe
hours when people can make the moat use ofthemA~ it
makes little sense to concentrate services geographically
where they will not be uSed to their fUllest extent it
also is wasteful to provide serv1cesonlydur1righours when
many people are employed his not only presents a hard
ship middotto the consUmer lnrt wastes resources if for instance
the unavailability of preventive services during the hours
when people Can use them causes a need for treatment
services later on
Health carbull sEtrvices must be comprehensive including
prevention treatmcmtand re)abimiddot11tation Ambulatory I
healtbcare facilities wh1cQ are orienteciexclusively
toward either prevept1on or trea1mentare no longer accepshy
table for they are lneft1c1entln their use of resources
and in their prov1s1on of health care to the patient
w ~~
28
If prevent10n1s notmiddot stressed treatment serv1ces that
could have beenavoidedY1l~ be required If prevention
1s the sole focus of the health care facility sick
patients who present themselves must be referred elseshy
where for treatment andsllch referx-als may be taken as
reject1onsor not followed through with until illness
becomes unbearable
The instltutlontbat meets these requirements Is
the comprehensive neighborhood health center It 1s a
local decentralized outpatient facilityprOVld1ng a
fUll range of ambulatoJY health care services It has
a linkage to ahospitalbackUp facilityforlnpatient
treatment and hiihlY apclalized outpatient care
The neighborhood health center must be a fac11ity
planned with an awareness of the needs of the conSUtller
and coDitnUn1ty It must have the r~Ul0urces to provide the
services people need mere they can use them and when
they can use them It must uti11ze the part1cipation of
the community to develop this awareness Not only must
the cen~er beset up to be Amctional for the consumers
but efforts must bemadeaga1n with commun1ty partici shy
pation to help the consumers utilize medical care
services effectively The center muetmake efforts to
educate the community about the valueot regUlar health
care of preventive servicesand of the use of planned
IJ
29
medical appointments ratherthanorisis centered walk-
incare Therealit1es of the existing health care
system have not taught the patient particularly the low
income patienthow to use services effectively
The helthcenterilUst also bea laboratory for
experiments in easing the health caJepersonnel shortage
and c60rd1Datingcare~ A major difficultY iri-exper1shy
menting with neW rolesis freeing staff of old preconshy
ceptions
CoDlprehensiva neighborhood health dare centers have
been developed under a variety ot alisplces including
medicalsociet1es hoSP1talsmiddot(36p299 group pr~ct1ces
(29 p6- 12 117) health departments (13 p1027) and
ne1gbbothoodassoc1ations(14) The literature indicates
somevalues nthe management ot the health center by plusmnts
hospital backup faCility Whatever the auspices many
adm1nistrative fuDctions such as program coordination
standard pr9tectionand evaluation call for considerable
c~tralization of adm1nistration city-wide or coU)tyshy
wide At the same time other aspects hours of servlce
for examPle~ cuI f~radm1nistrative fUnctions made atmiddot
more local levels Each neighborhood center must be
free to adapt its functioning to itscominunity thi-ough
the mechanism otcODlllUl11~ participation inmiddot policy making
Obviouslythe prerogatives and responsibilities of each level must be negotiated and made explic1t
t4~
JJ
BIBLIOGRAPHY 30
1 American Rehabilitation Foundation ~ealth Services Research Center The Health Maintenance Strategy mimeo 1971
2 Anderson Nancy N Comprehensive Health Planning in the States A Study and Critical Analysis Institute for Interdisciplinary Studies American Rehab ilitation Foundation 1958
3 Andrus Len Hughes Comprehensive Health Planning Through Community Demonstration Health Projects mimeo1967
4 Barry Mildred CandCecil G Sheps A New Model for Community Health Planning unpublished paper presented to the American
Public Health Aseociation1967
5 Blum HenrikL Fred Wahl Genelle M Lemon Robert Jorulin and Glen W Kent The Multipurpose Worker and the Neighborhood Multiservice Center InitialImplications and EJeperiences of the Rodeo CommunityService CenterAmerican Journal of Public Health58 (Mar 168) pp 458-468 shy
6 Blum MichaelD and Soloman L Levy A Design for Service Delivery that Reinforces Constructive Tension Between a Health Center and Its (sic) ConSUDlers and Supports Community Power unpUblished paper presented to the American Public Health Asaociatiltn 1968
7 Brielaud Donald Comm~ity Advisory Boards and Maximum Feasible Participation American Journal of Public Health 61 (Feb 1971) pp 292-296 shy
8 Burns Eveline M Health Insurance Not If or When But What Kind Madison Wisco~sin University of WisconsinScllool of Soci~l Work 1971
9 Campbell John Working ~elationships Between Providers and Conshysumers in a Neighborhood Health CenterU American Journal2 Public Health 61 (Jan 1971) pp 97-103
10 Caxr Willene Neighborhood Health Centers Funded by the Office of Economic Opportunity mimeo 1970~
11 Colombo Theodore J Ernest W Sawardand Merwyn R Greenlick The Integration of an OEO Health Program into a Prepaid Comrehensive Group Practice Plan American Journal of Public Health 59 (April 1969) pp 641-650~ -
12 Comprehensive Neighborhood Health Services Projectof Kaiser FoundatioIl Hospital~ Prcgtgram YearE grant renewal proposal mimeo~1971 bull
13 CowenDavidL~ Denvers Neighborhood Health Program Public Health Reports 84 (Dec 1969) pp 1027-1031
IJ
14 De Diaz Sharon Daniel Beyond Rhetoric The NENA Health31 Center After One Year unpublished paper pres~rited to the American Public Health Association 1970
15middot Gerrie NorrrianF and RichardH~ Ferraro Organizing a Program for Dental Care in a Neighborhood Health Center Public Health Reports 8 (Aug 1968) pp 419-428
16 Gordon JeoffreyB~ The Politics of Community Medicine Projects A Conflict Analysis Medical Care 7 (Nov -Dec 1969) pp 419-428 shy
17 Greely David The Neighborhood Health Center Program and Its Implication(3 for Medical Care H~alth Forum of the Welfare Council of Metropolitan Chicago (mimeo) 1967
18 Greenlick Merwyn R Newgtimensions in Health Care American JOurnal of Pharmacentical Education 34 (Dec 1970) pp 754-4
19 GreenlickMerwyn R Donald K Freeborn TheodoreJbull Colombo Jeffrey Abull Pruesin and Erne$t W saw~d Comparing the
Use of Medical Care Services by a Medically Indigent and a General MemberShip Population in a Comprehensive Prepaid Group Practice Prosram II unpublished paper presented to the AmericanPublic Aesociation1970
20 H~tadoArJiloldVMerllYll RGreenlick and TheodoreJ Colombo Determinants of Medical Care Utilization Failure to Keep Appointments unpublished paper presented to the American Public Health Association 1971
21 Johnson Richard E and Merwyn R Greenlick Comprehensive Medical Care A Problem and Cballengeto Pharmacy ff AJilericanJournal of PbarmacenticalEducation 33 (Aug 1969) pp 361-367 -
22 Kahn Alfred J Studiee Social Policy and Planning New York Russell Sage Foundation 1969
23 Kotler Milton Neyhborhood Government Local Foundations 2 Political~New York The BobbsMerrill Company 1969
24 NationalCommisaion on CommunityHealthSfrvic~sActionPlanniriamp for Community SetithServices~ashington p C Public Affairs-Press 19t7
25 National Commission on C~mmunity Health Services Health Adminishysration andOrMPization l the Decade Ali9$-d Washington D C Public Affairs Press 1967
26 NationalCornmiesion onqomm1Jllity Health Servicesbull Health ~ Facilities Washington D C PUblic Affairs Press 1967 bull
~ n
32 27 ODonnell Edward J and Marilyn M Sullivan ServiceDelivery
and Social Action Through the Neighborhood Center A Review of Research tt Welfare ~ Review 7 (Nov~Dec 1969) pp 112
28 Office of Economic Opportunity Second Annual Report Washington D C~ U S Government Printing Office 1966
29 Office of EConomic Opportunity and the Medical Foundation of Be~laire Ohio Eighth Report 2l ~ Committee2a Governshy
ment OperatiOll~ Va8hiiiSton D C Government Printing Office 1969
30 Pope Clyde R Samuel S Yoshioka and Merwyn R Greenlick Determinants of Medical Care Utilization nhe Use of the Telephone for ReportiDg Symptons Journal of Health and SocialBebavior12 (June 1971) pp155-162 shy
31 RenthalA Gerald nComprehensive Health Centers in Large US Cities American Journal of Public Health 61 (Feb 1971) pp 324-336 shy
32 Saward Ernest W The Relevance of Prepaid Group Practice to the Effective Delivery ofHealthServicestt The New Physician 18 (Jan 1969) pp39-44 - shy
33bull Schorr Lisbeth Bamberger and Joseph T English Background Content and Significant IssUes in Neighborhood Health
Center Programs Milbank Memorial ~ Quarterly 46 July 1968) part 1pp 289-296
34 Weiss James E and Merwyn RGreenlick UDeterminants of MedioalCareUtilization The Effects of Social Class and Distance on Contacts With the Medical Care System Medical~ 8 (Nov-Dec 1970 pp 456-462
35 Weiss James E MerwynR Greenlick and Joseph F Jones Determinants of Medical Care Utilization The Impact of Ecological Factorstt unpublished paper presented to the American Public Health Association 1970
36 Wise Harold B Montefiore Hospital Neighborhood Medical Demonstration A Case StudyMilbaDkMemorial Fund Quarterly46 (July 1968) part 1 pp297-308~
37 Yerby Alonzo S ttHealth Departments Hospital and Health Services Medica1~5 (March-April 1967) pp 70-74
38 Young M M~ Chatanooga IS Experience with Reorganization fOr Delivery of Health Services ttAmerican Journ8l of Public Health60 (Sept 1970) pp 1739-1748
f or l
II bull 11 Y d
II
IJ
34
ThepurposeOfPart II of th1aa paper1atod1scuas
elected Speclfic needs ofecltlc areas within Multnomah
County A8P01ll~oUt 1D ~ I of t1a1bullpapermiddot Ita nelgbshy
borhood health oare cater IlU8t be a facl1lty plaDlled with
aD awarenes of the neeels of the oODllUller and collllUDity
Part II of this paper nIl Show 80e of thoe speclflc
needs
he1DforutiOD tor t1li Portlon of the report
obta1nec1 troll tbroupout tbe follow1Dl threepUb11catloDS
1gr~e_tiMshylIPrIxaiidOreson JuDe 1963
2 1~_middot_sectSI8e~ected1teai c-ua 0 S 8 e first count coaputer tape Coluab a_lion AssocshylatloD of QoveraMD-8 Jlme 1971
3 Jtu1tDoab County Oreaon BDY1roDlHtlltal SurveyEarly 1971
The JIultDOIIIlb COUDty OrttIOD BDv1roDllfmtal Surley
Barly 1971 1s bull stat1stical report of the activ1tles of
theentlreMultDOIIIl2 CcNDty Health Dep~t during the
year of 1970 Die speclflc 1nd1cs elected from tb1s
study amprejMental aealtll Publlc Health N~s1D1 vlslts
FaJUly ~ Veaereal])1 ~ ~rcul081
Throush tie use of cUrts and mapa ODe CaD roup these i
speclflc ~oea to ahcnr the healthneedsof speclfic I
census trtcta aD4 then the health needs of iarer neIghshy
borhooda 1m4 o~ Uebullbull
Rf)~UP1Dl of areu was accompllshed in thefolloWinl I
JJ ~
35
he MiltDoIliahCountY oregon BDViromaental SUrvey
early 1971 isamp statistical report ot tbeaotivities ot
the entire MultDolllh COUDty Health ])epartiDent dur1nl the
year ot1970 he specitic 1Dd1C8S selected frOm this
aUy are 1Il8Dtal health public healthDurs8s visits
fUl1ly pia waereal elisease aDd tuberculosia
Tbroq11the Wle otcbart aDd mapa aDecm szoup these
specific indic to show the health Deeds ofapecitic
ccmaua tracts aDdtIum th8health neecla of larsr ~eilh-
bOrhooda and co8I13 tlbullbullbull
RegroupiDI ot areas waa accoap118hed1D the
tollOWiDl lIIIIm1er~ A bullbullcifie 1ndex 8selectcl auch as
venereal di8bullbulle or tuberculo8i~ he total number ot
cs was then deterll1ne4 for each census tract Through
the use of the maber ot cRbullbullbull tor a 11Yen cenaus tract
aDd tbe population ot thattractaltrateot1lla1ampmcper
100OOOpopUlaticm wu cleteXll1ned for each census tract
This was ~e to starl4ard1ze the population ditterence
amongOeD8U8 -tracts 1he rate of incidence toreaob
cenauatract was then llstedby rank position on a chart
In rank poition1DI any cen8Wl tracts haviDg equal
rates ot1l1c1dence are assipe4tbe iaDk posttiona
Beeauseot the abo fact tbAt cbarta w111 vary in length
neveltbAtlea eacb cbart will 1Dclu4eall census tracts
inMullnoaah Couaty Atter the census tracts bave been
listed accord1q to raalcth1s list will bediv1ded into
IJ
36 three levelsotinc14ence he three levels are
1~ The upper 14 of1DcldenCe
2 Thelower 14 ot incidence
middot3 The ILld 12 of incidence
Tlles three srouplqa are then used in compiling a map ~f
Mu1tnOmahCountyfor ach apecltictop1cbull TIle maps are
uaefuJliD tbatthey V1suallycoJib1De 1Dd1v1Clualproblem
census tracts into larger problem nellhbOrhooc1s
The 1960 statistical iDtormatloD was Used in a similar
liIaDDr to tbatexpla1Dedabove 1Dthe4evelopaent of a
chartmiddot and map 1Ihow1DI e cOllpampriSOr1 of per capita lncolle
tor ttaCh ceDsua tJact aDdmiddot combiDed census middotmiddottract areas
he 1910 aDd 1960 statlstlcal iDtOrllatl0D was combined
lna map and chart he purpose of this and chart is
to d8aonatrate the e cl1stributloa1DeachceD8U8 tract
and middot1ndlcatbull tuture ace populatlon treD4a bull
When one be middotbullbullbullbullbullHdth ne8cts ot an area and has
declded to establlsh a cl1D1c to serve that area the
physical location otthat cl1D1c IllU8t be consldered In
order to coapreb8ll81vel develop an area cl1n1c one should
conslder thepre88Dttraftlc middot~ytaa an4tranaportatlon
systems Thecl1D1cahoUld be located close enoUlh to
major arterlals to giva asy access from the total area
be_ ervecl by this cliD1c At the t1ll8they should
be tar eo away froll thesarterlals to all8Y1ate traffic
CODCell18 andpark1D8 conpstlon By traff1c concerns I
IJ
37
lIlan one lUSt consider thertarro1fne8S of streets whether
streets are oD8--C)r two-way iqres8 and egress to parking
amp0111tie eros tratflC) spedof trattJQ children 1n
ll8a traffic i1lht Vislon re8tr1ctionS etc
BwstraDsportat1onshould alao be central in this area
as maay people ~U f1Df1 1tD8Cessary to use this form of
transportatlon
~e tutqredlopHQt of bull treewa systems should be
c0J1S1dered soastolesen thecumce ofmiddot future roada
cutt1DSotltbe cl1D1c llte line
nrrph1c middotDampta
It is 1JDportaDtto kDOw the demosraphic distribution
characteristics of the oUenteltbat i8 to be served by
localized health cl1D1cs
Acl1D1c which erves8J1 area where1D the prepondershy
ance of persona arecrter 65 years of mayf1nd that these
people rely more on pUblic transportation call for more
home- services and haV4t 110ft ChroD1c and debilitating
types of disorders (b1_ blood pressure poor heariDg and
eyesight) tbaD do8 an area ot a YOUDIer population On
the other hand thL area of older residents may have little
need for family plabDlng cllni08
In order to better ~Ybullbull the 4eaoraphic population
of each CeD8U8 tract the 1970 CeD8U8 iatormation was viewed
and two specific catelOri8 considered These two cat
IJ
38
lori8S woUld be the perc_tap ot population under 19
year of ase and the percentase ot each oensuetractover
65 years of age he 1960 1Dtormatlon tor eaCh tract was
then compared witbthe 1970 intormation and a percentage
ofincreaae or4ecreamp8 tormiddot e~chtract1n each category
cOJlputecland achartma4e By the use of this chart one
18 able to View tJleap populat1odiatr1but10n of census
tract and at the _ t1lle accesa middottrencl Por example
let us choose census tract 601 W see 40-4 otthe
population is under 19 years ot and that ODly82 1s
over 65 years ot middotAtthe e tille the percentage of
youth bas ~ed ODly 1_ intbe laSt teD year whilethe
percentale over 65 year ot middotbas stayedmiddotthe same With
this in mJnc1 ODe ~ 1DfItr libat ol1D1o aerviDg this
area WOuld bellQre conq~w1th the problems of a
YOUQier populat1on and that _ would probably be true foJ
some t1aein tbefuture On the other hand CeDSU8 tract 54
has only 2 ollt population UDder 19 yel1s ot age and
this has decreased by 1 over the last ten years middotwhile at
the same time 32-377 ot the populat1on 18 over 65 years of
age A ol1D1C ___ this area should be or1eJ1ted toward
tbespecttic problema otthe ampledbull
PerCapia __ bY gsa neat
WhaD cona1der1qlooat10D1 tor health cl1n1cs one
shoUld take the 1DC01Ieot areas into consideration Areas
IJ
39
of lowiDcome would not 11kel~be 8erved more by localized
cl1D1cs tbaD would are of hilbincome It 18 likely
people haYiq a hip iDeoll8would preter to be aeenby a
chosen ~r1vatephylc1a1l tban at a local cl1D1cwhere
10Dier waits y beraceaaampryand leas personal attention
gl_
The 19701ncOII81atoWampt10n tor MultnomahC~ty was
not available at the tille thi8report W88 made The 1Dto~shy
tiOD Was taken ~adtro tbe1960 census publlcation
his woUld ~8Il thea tbat ral1I8 OD the chart ynot 1raquoe
completely accurate hi writer telthatthe areas most
affected by tb8 1I8eof the older 1Dco1DtOlaat1oDWOuld be
those tracts wh1ch baYebad a rapid 1ncreaae1n populatlon
over the past tfmyHr8 bullbullbull tracts would include tracts
nUmbered 104 9897 96 aDd 95 be perc~ita 1Dcome
referredto1il-tb1a Paper18the lIean 1DCo per person per
census tract
Attar the iDeoeper census tract was listed on a chart
a map was de 1D41catiDg those census tracts belonging to
the lower 14 ot income tor all censue tracts in Multnomah
COlDltytbose beloqins to the upper 14 ot income tor all
census tract 111 MultnolUlhCounty and those belonging to
the mid 12 ot 1I1coaetor all oeuuetracts in Multnomah
C01mty
In yiew1Dg the _p 1t caa be seen that the low income
area seautotollow aloas the at aide ot the Wl1lamette
IJ
40
R1ver the full length of Kultnomah County A second low
income area follows the south edge of the Columbia from
the northwest corner of Multnomah County easterly to 148 St
A third problem area seems to be on the east bank of the
Willamette River with the Union Pacific Railroad being
about the center of this tract The extreme loutheast
corner of Multnomah COUDty appears to be a low income area
but as this area bas bad rapid grouth in the last ten years
this could be erroneous
Mental Health
be first ~ecific indica to be selected from the
Multnomah County envirollllental survey of early 1971 and
to be considered in this paper i8 that of Mental Health
At the present for mental health purposes Multnomah
County is divided into five catchmentareas with a mental
health cl1n1cin each area These clinics are Model
Citles Delaunay ADkeny street Office Hansen Health
Building end Southeast Clinic
All lIlental health cl1n1cslcept statlstlcal information
on all patients visiting their cl1n1cs this included the
address of the patient hese addresses were then listed
upon the approprlate C8D8US tract Each census tract was
then ranked on a chart according to the nUllber of mental
health patients who reslde ln thatCeDSUS tract attending
any of the above listed ental health clinics This chart
IJ
41
wasttum d1v14ed1ato proper quartile bbullbullbull
quartile vereUs to dne10 u appropl1ate Multnoh
County _tal health ItLa middotmiddotmiddotthelipO~a1bl by lOoJcJIUE
at the UDtal health _to uteN1De which ueu have the
lars-t use otCOllDty 1alh~th faci11t1Rot
1Ilclu4ecl 111 tbia woUld tber otpeopleYia1t1Da
pr1vat patch1atriata aDd pr1_t _ntalhealtb cl1D1c8
WheDtbe M1 18Yienclmiddot Itmiddotmiddotmiddotmiddot~middotbe~_ tbat ~rtt
appears to lMt fourmiddotmiddot-al are iii _oil the nuaber ot
lIental healthcl1D1c na1t toM tbjh1sheat 1he
tour areaa woUld be tollows
1ttrea Ore to~Blo Drimiddot ~tb Burrus14e aDd tIMtmiddot Colb1a Riftr H1gbwyaeri1Dla th nortllra boundaryshy
2 bull ProII 82D4 1_~ 10 20th streetwitil the ra1lMd Mu the north ltouadary
3 ~ et et tUgl_b1bull MYel froamiddot the Clackaaa COUDty l1ae aorth to Dln8lon stret
4 beDOlvt1ttfe-t ~efllt4 COatytrca Jle1aware streetmiddot toR1C1a11oDd wlth Colubla Blvd heiDI tbAtnorth bouaclary_
It ODe coapareatbiap to th iDeobullbullmiddotp 1t can be
eamiddotthat lIOat ot the c tracts baY1Dg bllh v1i11tatlcma
middottfl public tal health cJ1rUc8 ~ 111 t13e low ~ aid
1DcOile SroupiDIOJa1y of til 25 tracta llsted as
haviDlbip aental Maltll nlltatlou are ~ the1g60 hip
iDeo arebullbullbull
17 Plpn
42
amily PlellnSDI ]Jlce Metal Health i8 an 1nd1ce of
use Theperson 111 ordertobavebe_ 1Dcluclecl 1n this
atu4ywouldhave tohaft Ue4 ataa11y plaDI cl1D1c
tacilities of soaetype It 41fter troll tile _tal health
study1nthat i t1Jicludestatist1catrollbotb public and
privateclJD1os
The iDformation tor the iak orurcbart 8Dd map of
t8ll111 plenn1 na ob1a1De4 by cOIIblnlDlthe mabel of
1rlcuv1duals bullbull_ attbe tbreellUltrampo-ti Coatyhll11y
PlalJQllIl C11ll10s 111til tbo at the Planned PareDthood
Association CliD1C8 be tbree -JIultDouh Couaty r8ldly
PlamSq Cl1D1c are Solrtbweatth Col_bla 1111- a114
HaDsell Health BWlcl1Dl CllD1cbi middot1Dtormat1oD vas then
bullbullbullesed tomiddot detellWMt l10w people troll eacb c8IUIUS
chart wastben Mele IUs oIIart jn 4iY1ded to show
the censuS tracts lIaYiDlmiddottIle h1t1iest qUart1le of incidence
of use lowest quartile of 1Qc1deao ot use Jlid 12 of
incidence of Wle an4 a map sprepared troll thts 1Dto~
mation
The C8U118 tractsbelOJISnl to the h1lhestquartile of
use appear to be 1lO~ 8catt~ on tbipwas true ot
either the _p ot aental health cl1D1c uaageor ot the map
abow1DI per capita 1I1COM Iaere40 to be three
d18t1nct areas of UIIaP beJ woul4 be
1
IJ
43
t10D of BurD81cl and the W11lallette River 4
2 S~t Portland 8Otth otmiddot the ra11shyrcaadand alona the W11lamette River
lIortbeaat Portl8D4 between MisSiss1pp1 and 24tbStreet the northbouBclary be1DgColwb1aBlvd
Pylzl1c BMltl IrpI Y11ta
Publlc Healtil nur81D1Y1s1t nclud8 an vists to
theholles of client by PubUc Health Nurbullbullbullbull his shows
visits to bull f8Jl1ly fer aDY purpos SUCh aatuberculolJ1s
het1Dl tem1tyaeatalu4 8IiOt10D8l cODd1t1ona etc
he atat18t1C~ 1fele C()4ed accord1Dg tomiddot the 1llli301fOCUS
of the Y18lt tt doe DOt 1D41cate the Dmlber of holies or
f8ll11lev181tecl or 1D41Y14ual Y1a1ted more tban oDcein
the propwl It dobullbull I1ve 80M 1D41cat1on by coaparlshy
OD ot the 8JIoUDt of aedlcal problema 1n eachcen8WI tract
Ap1nmiddot the _p abowa 8 scatter patteraof probl_
areas althoUSh there appear to be a sroup1Dl of hiSh J
l8aIeccmaus tract 1ntlut extreme southeast part of tbe
County other areu uIriaI any nura1Dl contacts are
1 bull he 801lth-oa-al CO1Dty on eaCh 814 of 82nd Av from Clackallaa County north to Dinloa
2 ear bullbullbullt 814e aroUDd Preacottand Misaisippi
Dowatom Bunul14eonboth 1de of the river
44
V_real Pis The iDfomatloil uaec1 to tabulate the Venereal
disease chart includes all the ooab1ned case otmiddotODormea
and syphilIs reported by bothmiddot publIc and prIvate physicIans
dur1nl 1970 There were 3602 caes ot IOnorrhea reported
dur1nl 1970 While ODly 17 cabullbullsot ayphilimiddot were reported
A chart was prepUed aDd att8llPt wasmiddotmiddot de tomiddot
determ1De Wh_therVttDereal 41ease was more p~vaJent in
areas othigb or lowmiddot proportIon ot youth hi waadone
bymiddotdetemlna a 1leaD prceiltacmiddotmiddotmiddottor the population ot
resld~ts UDder19 years ot (34) middotA mean ratemiddot per
100000 popUlatIon al80c1ttem1Ded tor the middotoccurreDCe
ot venereal dieae This was et at 390 oass Areas
hav1nl a population 1n which leiS than 34 were lmder 19
years ot ampIe were called low- yOuth abOve tbl percentaae
hiSh youth The aaa waatrue ot the occurrence oivenershy
eal disea_ per CeD8UStract It the rate waacomputed
as 1I0re than 390 cases per 100000 it was called hiah
venerealdiaeasei it less than thia tisure low venereal
disease It was tound that 1D Multn~ COmlty there sems
to be poSitive OOlatI0n(x21S19gt between low youth
and hipmiddot venereal diseaand hip youth and low venereal
diseasebull
RaDk ordr Iitot all c traot middottbAm made
Th1s was done byt1Ddlna the ratepr 100000 populatIon
of venereal disator all census tracts in the County bull
45
These were thenlisted from h1lhto low (sreatest to
least) in a rank order The l1sting was then divided
into Upperandlower 14 aDd listed on the MUltnomah
Countymiddot up
The areas of b1gh venereal disease se8ll18to
roup thBl~8 middotin a very tllht area ~oq both 1des
of thell18l8~ R1 w1th BurDaldeS~et being
~bout theceDter qf tbi8IZ9uping This area woUld
appear to be m ldeal spot for the denlopment of a
locallzed venereal d1sbullbullbullbull cl1D1c
UbepoundCUlO1s
In this report bull tube1C1llosls caS8S refrred
to include alltbobullbull cabullbulls ontubercUlo8is follow-up
rather middotthan just new C Accord1Ds to the Multnomah
County Health SUrvey of early 1971 this would include
all ca repOrte4 over thelaat three years The
total number of tuberculosi8 cabullbullbull usedin this study
was 666 lh1 included 128 new cabullbullbullbull
A rate per 100000 of tuberculosis for each
census tract wa- then computed and the c~us tracts
listed by rank order be b11h Qartlle mel low
quartl1 were then reoordd on a Multnomah CoUnty map
TWo genral areaa baY1Dg a hip mcldencaot tubercu~
losiare 1D41cated heyare
1 Both middotsld ot theWilla11lette River
Ll -
46
with Burns1de about thecnter
2 he extrea Northebullbullt comer of the County bull
By coap8r1ng the tuberculois an4ven8real
diseae maps ODe can 8ee that the downtown areas ot
hiSh 1nc1denceare alIIo8t 1c1eDt1cal on ach map
This WOuld 1nd1cate that 1t would be of value to
bullbulltab11sh acl1D1c 111 th1aampreatbat would provide
bothtuberCulos1s 8Dd ytmereal 418ase srvicbullbullbull
Thchart aDd 1181gt8 are wsfuln 11v1DI
1Ddicat10DS tor the type aDd placemeototlocal
health cl1n1c8 tbro1qhout tbe MultnomahCounty area
A cOllpar1on of the mapa help one to dec1dewhether
to provide a aulti-8ervice cl1D1c or spec1f1c type of
cliD1c As stated in Part I of thi paprserv1ces
shouldhaYe both treatlieDt and prfMmt10n cOmponents
As he been stated fta ne1lbborhood health care
Qenter muat be a fac111tY plazme4 with an aamesa
ot the neds of the consumer and the c01llll1m1tybull
Part II of this rport haa been an attaapt to indicate
and clarify 8011 ottheae coDlllUDity neds This has
been done through8elect10n of apc1f1c problems
The indic were then visuallyrecorded through the
use of ups and charta ODe dan asseS8 thedsreeof
1DIportance of certain concems to spec~t1c areaa by
comparinl the chart aDd maps Prom this oDeean
41 dec1de which are48 vb1chcUD1c-or indeed if
the need a clinic at all However further factors
should be considered hebullbull include
a The amount of fuDd1 available
b What 18 the percentage ot peopleineoh ceaaua tract tbat would actually us such cl1n1cIl
c Wbat 1 tbeco--1tymiddot 8 IeeliDashyreaardtDI particular cl1D1c8 Would this dcrebullbullbullmiddot the ettctiveness ot thse cl1n1ca
IJ
li
D_OlraphicPopulatLon Challie 1960 to 1970 48
Cen8U8 1 of Pop 1 Cbaqemiddot 1 Change1 ofPopTract Under 19 Yr8 Over 65 Yrs1960-70 1960-70
middot1Q701Q70
1 319 -12 171 -H) 1
2722 215-27 +68 301 366 -22 127 +35 302 371 +19 111 -04
311middot401 144-41 +29 402 321 13~7-39 +24 501 356 124-08 -02 5~O2 351 133-23 +12
405601 82-10 -02 394602 103-01 -06
701 275 149-76 +56 702 361 +01 121 -07
+10middot801 326 140-22 802 321 middot127
(
-29 -03 9~01 342 124 -H) 6-18 902 294 128 -H) 3-24
10middotmiddot -14312 140 -17 1101 182 +25 -23197
2411102 186-59 +29 1201 226 169-17 -41
31middot01202 +11 182 -05 295 -H) 81301 208 -H) 4
1302 331 +08 197 +04
14 323 +15 middot185 -08 middotmiddot15 329 +16 16~5 -13
-28middot 1601 332 131 +12
1602 356 98 +24middot-39 middot3101701 161-33 +21
1702 370 -15 85 +02 +19 1801 264 151middot-50
185middot1802 256 +47-58
IJ ~
D_raphlc Population Change 1960 to 1970middot 49 (Contd)
4io
Census Tract
of pop Uncter 19 Yra
1Q1n
1Cha1l8e 1960-70
of PopOver 65 Yra
lQO Change
1960-70
19 389 +29 141 -24 20 223 -13 206 +18
21 227 +08 194 -36 2201 356 -27 112 +05
2202 290 -18 ll~9 -29 2301 356 -03 154 +24 2302 260 -37 245 +97
2401 410 +6~1 123 -31 2402 163 -80 320 +99 2501 381 +13 140 -01 25()2 237 31 lil +02 26 343 +25 186 +149 2701 370 +29 1S5 -01 2702 249 -44 304 +98 2801 337 +19 187 +09 2802 306 -10 156 +31 2901 304 -38 142 +24 2902 i 307 -32 146 t3~9
30 29~0 -48 16~2 +51
31 355 +30 160 +01 32 370 +48 148 -13 3301 395 +45 130 -20 3302 368 +06 138 -02 3401 386 +16 117 000
3402
400 +32 92 -26 3501 304 -07 115 +35
3502 344 000 140 -13
3601
36~02 357 -04 132 +32
3603 30~1 42 149 -67 3701 342 +28 152 +19
1
IJ
Jianolraphic Population Chan 1960 to 1970 50 (Contd)
Census Tract
of Pop Under 19 Yrs
JJl7J
middotChanae 1960-70
middotofmiddotpop Over 65 Yrs
1c~7n
Change 196070
3702 409 +39 122 -11 3801 308 -11 151 +29 3802 275 -35 180 +46 3803 282 -32 192 +54 3901 376 ~13 100 +17 3902 296 -03 177 +29 4001 438 -11 84 +13 4002 353 -21 115 +20
4101 397 11 9middot0 +11 4102 346 -19 120 +03 42 331 +19 11 bull 3 -16 43 347 -72 105 +31 44 113 +84 183 +154 4S 33~9 +07 110 -06 4601 2501 22 193 +38 4602 332 +59 126 -29 47middot 161middot 000 211 +01 48 103 -26 302 +59 49 138 +1 bull 3 252 +09 50 141 -26 204 -12 51 12 -39 257 +07 52 47 -61 351 +48 53 89 +49 314 -30 54 25 l1li15 327 -17 55 131 -17 115 -121 56 198 +93 227 -47 57 71 102 189 -88 58 240 ~middot41 16~1 +55 59 322 +25 142 +06middot 6001 264 95 132 +50
6002 328 -31middot 89 +07
JJ
Demographic Population Change 1960 to 1970 51 (Contd)
Census 1 ofPop lChange of Pop bull ChangeTract Under 19 Yrbullbull 1960-70 Over 65 Yrs 1960-70
1970 1970
61 355 -58 85 +39
62 328 39 110 +18
63 414 04 73 10
64 382 -22 72 +04
6501 383 02 67 -20
6502 329 -56 96 +09
6601 391 +13 88 -03
6602 319 -59 97 +06
6701 327 71 145 +72
6702 331 ~67 83 +1-0
6801 365 -66 49 +01
6802 388 4bull3 54 +06
69 354 -41 80 +23
70 400 -23 68 -06
71 359 -48 72 +05
72 255 -88 82 +11
73 346 -39 91 +25
74 313middot -63 105 +24
75 329 -42 129 +37
76 336 -52 85 +21
77 370 -10 69 +05
78 309 -10 120 +21
79 325 -56 87 +10
8001 358 -81 57 +12
8002 391 ~81 76 +12
81 315 -76 108 +21
8201 403 -23 64 +08
8202 392 23 65 +08
83 357 -34 120 +31
84 402 -18 73 +16
85 413 -06 76 -09
r
Demographic Population Change 1960 to 1970 52 (Contd)
Census Tract
t of Pop Uncler 19 Yrs
1970
Change 1960-70
1 of Pop OVer 65 Yrs
1970
ex Change 196070
86
87
88
89
90
91 9201
9202
93
94
95
9601
9602
9701
9702
9801
9802
99
100 I
101
102
103
10401
10402
lOS
368
351
379
391
391
413
379
433
372
429
414
432
419
439
~32
377
457 420
378 41middot7
345
360 417
417
412
-04
-02
-35
-26
-28
-11
-64
-20
-S9
-39
-32
-21
-34
-40
-47
-lO~7middot
-27middot +04
+56
+07
-34 01
+04
+04
+10
103
128
97
11il3 99
69
79
42
77
46
34 38
44
40
54
111
51middot
81
133
59
74
140
63
87
76
-08
-06
+04
+08
+17
-05
+3S -02
+1~4
+19
+33
-14
-08
+12
+26
+71
+11
-16 -34
-20
-19 +37
-49
-2S +15
NOte The The
Taken frOi
averageullder averageabove
middotUSCensus ---shy -
19 years == 6S years ==
figures 197
32r 13(14
p a~d 1960
--
Rank
1
2
3
4
5
6
7
8
9
10
11 12 -_
13
14
15
16
17
18
Tract
69 46
60
58
- 68
61
302
2501
67
63
19
62
26
94
3603
3902
64
30 -----~-
Rank
19
20
21 -
22
23-shy
24
25
26
27
28
29
30
31
32
33
34
35
36 -
Ranking of Per Capita Income by Census Tract
Tract
65
2701
- 15
1601
701
66
93
82
2903
3602
30
2502
80
2401
81
- 70
91 shy
4001
High
Rank Tractshy
-32shy37
38 97
120239
7840
41 ~ _2_1__ 42 31
43 2501
44 18
45 98
46 37
47 3803
1702
49
48
1602 92 2702
I
50 89
51 901
52 801
Ra_
53
54
55
56
57
58
59
60
61
62
63
64
6S
66
67
68
TractTract Ra~
74692
170196 70 I
401 71 90
72 1037J
79 70273
3802 74 601
24024102 75
85 76 101
77 9023901
7699 78 100 4101 79
3601 I
380180
458140~ t---- _ - - shy83 82 42
888384
59843501
4777 8~
502
Low
802 86
Rank Tract
87 shy
--88
89
90
91
92
93
94
- 95
96
97
middot98
99
100
101
102
103
104
1201
14
49
72
73
43
87
3502
105
1
52
86
71
1
501
10
3301
104 tf
Rank
105
106
107
108
109
110
III
112
113
114
115
116
117
118
119
120
121
Ranking of Per Capitalucoae by Census Tract
(Contd)
Tract Rank
4001 122--shy602
13
1102 2302
3302
55
3401
48
21
56
50
3402
lL01
2202
2301
53
2201
-shy
Tract Rank Tract Rank T~aet Rank
57 I-----
Imiddote
bull
Tract
- Low -k Note Information taken from 1960 U SCensus
Rank Tract
I ~
Ie
Imiddot
~
----
----
--
--
Rank
1
2
3
4
5
6
1
8
9
10
11
i-
-Tract
391 922 921
972 971
100
132 131 121
962 961
822 821 401
982 981
20 111
47 10 1
412
High
Total Number of Henta1 Health Visits
Ranked by Census Tract High to Low
TractTract RankTractRank Rnk
12 182 22 78 29 87 76 381 73181 ~------- 1913 371 8538230162372 271 2616-121 8272 2
14 80~2 31 94 7923 84801 59 15251362 4232 15 52 _ 32 103 8924 651 17240216 652
_ 91 351 33 341 23117 83 122 25 25 48 1123921418 34 shy61 86 661
19 662 6493 81 26 91 8153 49 50 55 41383 71 27 51 3120 90 672241 35shy 104167162 461
I 411 46211121 28 88342 I
2502 36 69 54 5251 50 272
-Ra
37
38
39
_ 40
_ 41 Ishy
I
42 I
-I 43 44
45
shy
Tract
~ --- shy 95 56
45 292 242
102 62 352 291y
92
101 281
99 72 63 601 60~ 42 2201
77 74 61 57
363 232
70
32 31
11 44 282 2202
Low l
- Tract
46 682 681 I 331 30
r~$ 47 1042 332
48 102_41_
11
~
Visits to Family Planning Clinics Ranked by Census Tract High to Low
Rank Tract Rank Tract Rankmiddot Tract Rank Tract Rank Tract Rank Tract
1
2
3
4
5
6
7
8
9
10
11
12
13middot
14
15
16
17
361
56
401
341
48
59 121
20
55
342
10
31
58
93 21
241 132
331
53
461 462
18
19
20-shy21
22
23
24
25
26
27middot
28
29
30
31
32
33
391
32
middot47 I-i-_-shy _ -
231 111
332
972 1
372 371
52
89
32
92
82
100 31
182
30 242
402
34
35
36
37
38
39
40
41
42
43
44
45
42
1714 i 661 221
78 362 2
90 602 601 352
63 251
105 921
971 351
73 42 292 232
411 51
662
81 45 52
46
47
48
49shy
50
51
52
53
54
55
56
961
801
49 81 72 71
19
9~1
172
68 2 57 162 14 112
91 75 681
381 42
3~3
83 161
57 f
58
59
60
61shy
62 Imiddot
63
Imiddot 64
65
66
64 62 36~3 252
74 652 SO 392 291
651 6bull 2
79 271
r-- ---- shy981 222
672 671
821 272
94 87
281
382
67
68
69
70
71
72
73
74
75
76
77
78
981 26 12~2
IS 61
85 82~2 69
61 43
101 86 84 282
76
131
51 72
1041 962 88 70
99 922 77
103
95 802 181
i
~
Low High
RankRank Tract
5479
4480
81 1042 ~) middot102
71 - - + ~ - ~
Visits to Family Planning Clinics
(Contd)
Tract Rank
I
Tract llaDk l
RankTract Tract Rank Tract
~
I
~
J1 ~
Low
Total Number of public Health Nursing Visits
Ranked by Census TractsHigh to Low
TractTract RankTractRank RankRank TractTractRankTractRank
25249 71 79 17249 8033 6586 99189711 84 2915072 34 661 76 66 811519512
402 5035 51 161 2518220 122 1713423 352 55801 7120 6752 2 149814 41236 83 2662 38 94 6821 53 2924015 362 37 32 42 75 69 281 84 63
546 8822 54 222 85 3925431 70383417 3818223 6439 4386652 718 21 55 103332 8924 232 87 19 271729219619 24156 16211140 382 628825 10523110 112 73411 10141-- ----shy 89 363 4457 8126 16111 221 74 9142 90 46158331 53 671279012 46243 48 59 351 3837528 1083 9313 91 5844 59 -_242 76 1----- shy60 272 72 74104114 60145 42 9287 7729 92 6151 8215 57371 934630 91 307762 12113116 282 619447 41391 9531 78100 63 7378 ~95 681 6945 32 5632 798517 6448 47 52 181
High ~ Low
Rank Tract Rank
96 31 132 70
97 102
98 182 372middot 602 651 662
- -shy
~72 682 802
822 922 962 972 982
1042 ----shy
Low
Total Number of Public Health Nursing Visits
(Contd)
Rank Rank Rank TractTract Tract
I
I lt
I
Tract Rank Tract
[
~~~-
I
~
IJilfimiddot ~
j
Ranking of VD Caea According to Census Tracts 61 By High and LOll Youth Itatio
A media~ of 34 5 was determined Any tract having greater
than 34 5~ of popu1tionunde~ 19 years of age -High~
Any tract having l8S than 345 of population under 19
years == Low
Any tract having rate less than 390 =Low
Any tract having rate more than 390 == HLgl4
YOUTH
LOW HIGH
L
0
12 402 1801 1802 343 2801 2802 29023603
54 6001 600262 66~02 72 74 75 76
78 79 81 t02 65 1202
W
(25)
VD
H
I
G
H
401 701 801802 901 902 10 1101 241 1201 1301 132 14 15 1601 1701 20~ 21 2202 2j02 2402 2502 2702 2901 303501 3502 34023801 3802 383 3902 42 44 45 4601 4602 47 48 49 SO 51~2 53 55 56 57 58 S9 6701 6702 73 95
3~02 7021702 19 25~01 2701 4102 4101 63 64601 ~601 6801 680270 7l 77 8001 80~02 8201 8202 83 84
85 86 87 88~ 90 91 9202 920193 94 9601 9602~ 9701 9102 9801 9802 99 100 101 103 10402 105 6501 10401
(47)
301 501 502 601 1602 2401 2301 2201 31 32 3301 3302 3401 3402~ 3602 3702 3901 400140 02 43 61 69 B(
(53) (23)
~ ~gt
Ranking of VD by Rate Per 100000 By Census Tract
~
Rank Tract Rank Tract Rank Tract Rank Tract llank Tract Rank Tract Rank Tract
1 2202 21 S6 40 902 58 1602 74 75
90-shy 64 107 26 --~-
2 3402 22 45 41 10 59 902 75 78 91 54 108 61
3 2301 23 3502 42 2502 60 602 76 6802 92 402 109 87
4 3302 24 49 43 1102 61 501 17 2 93 94 110 90
5 50 25 52 44 6702 62 14 78 8202 94 97 02 III 76
6 2201 26 20 6701 63 4002 8201 2501
9701 41~02 112 91
7 44 27 48 45 401 64 3802 2902 95 63 113 62
8 3301 28 1701 46 502 65 30 79 83 74 96 9602 114 71
9 55 29 47 47 42 66 3803 80 2801 96Q1 115 85 10
11
12
13
14
15
16
17
18
3401
53
2302
2401
57
21
2402
1101
51
30-shy31
32
33
34
35
36
37
3701 - -~ 1201
3702
89
43
132 131
3602
4001
48
49
50
51
52
53
54
55
58
1601
601
4602 4601
69
701
31
3901
67
68
69
70
71
72
2901
801
39021~ 802
6502 6501 122
702
41~01
81
82
83
84
85
86
87
88
19
1
1702
2802
79
93
100 6801 6602
81
97
98
99
100
101
102
103
104
9201 9202
9802 9801
77
302
79
86
72
84
116
117
118
119
120
121
3603
8002 8001
101
99
95
10401
105 10402 103 102
19
20
59
32
38
39
2702
3501
56
57
301
3801
73 1802 1801
89 6002 6001
105
106
2701
88
High Low
-- -----
Rank OrdermiddotTuberclosis Cases by Rate Per 100000 Ranked by Census Tract High to Low
Tract TractRankTractRank Rank TractRaukTractRankTractRank
801
79 9601501411 52 6835340120511 I 960269 903603532036 $-~~F130221542 4366 311301 70 68~013802 _ I- _ 4001_37213 3921201 6802802 H71523822024 22 54 193302 3802 80 8958 I37139535 70155 9801 I60123 72 6702 98023914011016 6701250124 10 56
81 94 401r 7 154152 73 7057 2625 122 92028
90242 162312301 92~158 86 7172434526509 82 79160159 74 100 87412240227220110 6502836960 75 30 8317244 6501782801285711 61 901 42765645 84 66021459294912 9701 660146 171 302 9702 47
6235023033113 85 822821182 917755 16335013110214 841814832 78 103 938564 324815 86 1057940149272 38036523216 10401 87 2902241 725Q 10402360266340217middot IF88 88 9937233 282 51 218 101 01102 46016234
I)167 2901460219 47
High ~ Low ~
- -
TractRank
9S89
6490
8191 8001 8002
63 61 60middot01 6002 44 2701
92
J
2502 402 --- ----shy
I
Rank
Rank Order Tuberculosis Cases by Rate per 100000
(Coutd)
Tract Rank Tract ~nk
I
Tract Ballk Tract Rank
Imiddot
Tract
Imiddot
1~
t 1I i Pi i l I
o
1 -1shyL I
I J
8 40 icO ~ I -lt 0
-t (1) I
i I
r o E
II
a
I
r--i
shy
I
~
I (
Jgt
(011 fi(
Ggt
I II ~j
()
(f 0
~ ()
I
11
f9
r
II 99
o ~
Ggt r
~ __-J~ I t I ~ I
r--J l I
~ _ __ J
) 1
fTl
1gt
r I
()
r
()
lt en -i en
()
I1l
(J)
(J)
-i
P ()
19
r o ~
r G1 I
I
c
~
o I 89
--- -I-shy
r-r I
1- 0 _~ _ _--J E
G1 I I I
i i
I 1-1-1 ~ _J ~2 ~ II
II
()
1 I I I 1
id i bullbull
~
A n 69
r 1shy
- 0 Gl
l--~ ~ I
~ II
II )
I () isect i
en l i
(J)
-t
0
IA Ol
bull 13
2 Open 24 hours a day seven days a week 3 Family-centered c~e by a team of lnteniists pediatricians clinical and publichealthnurses and social workers 4 Availability ot frequently~requ1redspecialist in such fieldsaspsycbiatryobstetrics gynecology surgerY5 Con~1nu1tyof doctor-patient relationshyship 6 Family records with social and medical ~raquomDaries of relevant information about each family member 7 Basic diagnosticlaboramptoryand x-raytacl1itles and drugs and biologicalsavailable atthe center 8 Directline (1)y center-controlledambushy
lance when-necessary) to ateach1nghospltaifor cl1agnostic ~d therapeutic servlcf)srequiring the fa011itlesandpersonnel of thehospltal 9 Patient-cantered and eommUn1ty-oriented -
The range ot services in the comprehens1venelghborshy
hood health center shouldbe as complete as possible
inCluding preventivediagnost10 treatment and rehabi-
litative services and Sbouldbe deslgnedto eliminate
episodioandfragmented services (31 pp324-325) Schorr
and English (33p291) add as additional characteristics
ot the compr8henslveneighborhood health cent~r that it
should ~ve intensive participation by and involvement
of the population to be served both in policy making and
as employees and that it should be fully integrated with
the existing health care system The Office of Economic
Opportunity (28 p63) stresses the potential for easing
health manpowershortage$by trairiing local neighborhood
reSidents as non-professional health aides at the same
time creating new job and careeropportunitles As
14
Gordon (16 p bull 422) indicates Many of the outstanding
problems in medical practice todayrevolve around
effectively motivating the patient and the prospective
patient to be concerned with his health This is
especially true in a deprived environment The community
health center with its technique ot consumer partici
pation maybe a way to create this cooperation effectvely
It is important to note at this point that the
comprehensive neiShborhood health center haaas its
constituency an integratedmiddot community r~ther than a
particular segment It should haveas Blum and Levy
(6 pp~5) indicate a horizontal rather than a vertical
relationship with the commuriitybull The vertical relatlonshy
ship they state is characteristic ot those service
organizations wh1chapproach the community only in terms
of their own fUnction Tbey see only their relationship
with the users of their service and assume that problems
of accountability will be handled by these consumers
However they pOintout this ienot likely as a vertical
approach creates dependency onthe institution Agencies
in a horizontal relationBhllp recognizetha1 they have
both acommunityand a consumer to serve The horizontal
approach places the matter of accoUltability on a broader
basis than just the involvement of the consumer De Diaz
(14 p4) speaks otthe need to ~develop a community
facility which difters from a clinic for low income
1ji ~
15
people in that it should serve an economically integrated
community The reason for this is that a wide variation
of consumers may assure a better quality of care
The advantages of the comprehensive neighborhood t
health center over traditional systems of providing
commuruty health services are numerous Hospital outshy
patient departments a major traditional source of ambushy
latory health c8refor poor patients have been indicted
for neglecting preventive health care ~romoting fragshy
mentedeare and subjecting patients to degrading and
impersonal conditions to mention only a few of the major
defects (31 p324) Another defect has been the
tendency to shunt low income patients back and forth
between different cliniCS often at different locations
arid with differel)t open hours for different treatments
or tests in regard to the same lllness(26 p63)
The comprehensive neighborhood health programs that
have been organized present a great variety of organishy
zationalpatterns one area of difference 1s in the
emphasis placed upon making each faci1ity comprehensive
in the services it provides to the patient population
In the Montefieri Hospital Neighborhood Medical Care
Demonstration program in New York City services have
been made available through a central health center and
two store frontsatellites the center to be the base
bull
Li
l of opratiol18 of ta1lJpIlflicl- ancl the satellite
center the ba of oparat1oDa of public heaJth nurses
an4 nllbborbood amp1 be satellite centers wereto
proVide preVentift tutaltll bullbulln1c1-m1zaticms w811shy
baby care per1od1c ~ectiland tJle central health
center to proViAle care tor illnes If (36 p299)
bis propWI VUDOt ~ttullytunct10DIDI at the t1JDe
it d1cu8ae4 18 tbe Uterature aDd all aernce Were
be1Dl provided 1D_~terBowever itwould ae
tbat the ntua1pro~ as aY1ioae4by its plmmers
would boclJ aoaeot bull 4efeot~ otthe current lud1cal
ccde teaIt pObullbulllne_t coorctJl8td admSDtshy
etration eD4 well 4eftlopecl refelTal procedtlreacould
1I1a~ thecOllDeCticmof t~_t8 withappropr1ate preTellshy
t1 aD4 therapeu1ampcaen1cbullbull aV81lable 111 diffrent
locationa Bowner tile barrieraottiaeaDdUatanc
between center and truaraUon tor the UDSopb1aticated
patieatlook1Dl tor 1her1~pJce too tor ~1CU-
larhalth serfplusmnQewoGl4~to JJa1t tbbll1ty o~
tb18 ~811D to provide iaaiYCOliprelleU1P18hboltleod
health servicebullbull III tactmiddot tappeareto coDtlict with
tbepro own taW cOfdotpro-1~a tam1ly
mecl1cal careprogru 111 wIa10h pre-teAtlYe aDd therapeutic
health erY1cecan be proY-lW to all IIl81Ibers of
tamily in the coure of aaSDll vi8it (36 PP301-3(2)
Dle Delmtr Coloradoprepa11ke the Montet1ori
LI
17
prograJlut111zbullbull abe1rarcJly ot SlDa11 aatellItestations
andlerer IIOreceDtallzedtac11It1es It 41ffers
howeverill tbcolap~81vene80f the services avail shy
able Inthe 4ecentraUzed facIJJtiesIt resembles very
clc)sely the IOdel ~ordecentral1zed social servicedell shy
very developed by 1ahII~ Which was 41sCussed above he
SIlall neImiddotgbborhoodmiddot c8Dt~aw1tb1n walkl distance of
most of the populatiotl havebeendesilDedto take care
of allthenorllalhealth probl of 3000-5000 patJentsshy
check-ups IlzatiOZl8s1Jlpl laboratory testa and
treataentand iaecucatlol18 (d1apeued by phyS1cians) for
IIOst DODCrltIcal 1l11le PatIent 1d1Oneed IIOrespecIal-
Ized care are reterrecttobacJalp facilities BaCkup
support tor themiddot~t1oDa are the tWo l8rsernelshborhood
health C8Dter8~ttr1Dl aCOglete~e of out-patient
serneeaDd three part1clpat1q hoap1iampl bull bullbull which
proVide1Dpat18Dt~t andcoDSUltatlve services
(13 p1028) Intb1a prosrama coaprehens1ve range of
prevent1ve aDd trea1aeDt serric 18 aVailable throughout
the decentraUzed middotta The CoapreheulY8 ReIgbborhood Hea1~ Service Project
otKa1er iC)UDdatlcm HOspitals 111 Portlan4 OreOD 1s
s1ll11arto th DenVer prosraa 1D thata comprehensive range
ot out-patientmiddot services 1D prov14e4 in each of 1ts 10cashy
t1oDa althoUlhmiddotmiddot tbe oentera are larger and l bullbulls DDIerous
than 1nth DenverproPUh (12 p6)
Li i
18
In order that a comprehensive neighborhood health
care center be able to proVide continuity of care it
must have arrangements for hospital services integrated
into th system Yarby (37 p73) as quoted above
states that it 1s characteristic of the neighborhood
health center to be directly connected with a teaching
hospital However De Diaz (14p3) indicates that it
may be advantageous for purposes of service delivery not
to havemiddotthe center affiliated with a teaching hospital
She feels that such anaft11iation may lead to asltuation
in which policies might be determined more by the teaching
needs of a medical school than by the service needs of
the patient
middotThe Nat10nalmiddotCommissionmiddoton Community Health Services
(25 p69) states that such a system of comprehensive
health care integrat1na ~e servicmiddotes of several health
and roedical agencies snould utilize Itas much single or
unified management as possible Neighborhood health
centers have been operated under a variety of auspices
but several writers have pointed out the advantages in
termsof coordinated prOvision of servictts management by
the hospital of the neighborhood health center For
instancethisfac111tates the keeping of unified medical
records of all the care a patient Msrecelved either at
the neighborhood health center or _le hospitalized
(12p6) ~ermore a3 Young (38 p1741) points out
19
direct operationot the u1sbborhood health oenter by
the hoSpital canll8lceaftilable to the center expertise lt bull
in sOlle aapcta 0 Operation that m18ht not be aa readily
available otherwie
Relardlebullbull of wbetberthe hospital and the neighborshy
hoodhealtbcent8r haVe a cOJIIIOaadmjntstration they
IIlU8thaVealTlved at a str1Dsent delineation of IDUtUal
role and reSpoDBlbilltiebullbull All OOIIpoienta ot the care
yst IIlWStQlarify and understand one anothers position
In the syatem and acree on objeCtive ancimethOds
(26 pp16-17p31) SODae areas of iDUtUalconcemare
reterral procedures record keepiDg aDC1 mutual use of
facilit1es statt1Dl i8 anotb8r ~ ot coaaon conc~
Ditt1cultift have u-laeniD the pastiD cOllprehensive bull t bull
healtbc~ prosraumiddot 1d11ch were batil plauned in wb1ch
all of the health canter phy1C~1IDa did DOt bavetatf
privilege at all ot thebackuJlhospltala (29 p21)
SUch a8ituat10n i8 1Dampcceptablelt inpatient care i8 to
continue to be p4by the pat1eatmiddot health center
physician and it cont1Du1ty ot care 18 to be maintained
Hoapital and health center1lUSt laav 301nt responsibility
tor the recruitaentot physicians
VticlentU IPan BJcNrcu Much otwhat haa b8ea sUd has stre88e4 at leastmiddot
iJlplicit17tbaD8ed tor tM etticit middotprovision ot8emcea
20
There appears to be two aspects of efficiency which are
discussed by writers on the su~3ect of the comprehensive
neighborhood health care centef one of these is the
need to organize) services to make the most efficient and
economical use of scarce medical care resources The
other closelyrelat8d in realIty is the need to help
the public use services in the most efficient manner
The comprehensive neighborhood health center concept
1s lhherentlymiddot efficient in that preventive curative and
rehabilitative health ~are programs are coordinated under
one roof with integrated a~stration Furthermore
theempbasLson prevention health education and early
disease detectionis eftic1ent troJll~estandpoint of
the health care system as well as beneficial to the patient
(18 p760) HQwever ~ue tothe scarcity of health care
personnel thecoiDprehensive neighborhood health center
mustbe an arena tor eXperimentation with new staffing
patterns~ The Kaiser program is indicative of the way
in which health care systems must begin to operate in
that appropr1ate ancillary personnel are used Wherever
possible to perform functions that do not need to be
carried out by the physician As Saward (32 p42)
states
1hroughou10ur organ1zat1on~ there are many of the customary experiments be1ngmade-shyJse of speciallr trained nurses for well-baby care under the SUpervision of the pedi9trlcianexperiments with routine prenatal care by
w ~
21
middotSPC1a1l~t~JlUrbullbull per8ema_1 bullJmdlJleu y our fuDotlou are auoh that DOtb1Da 18 dorutbYtbe phY8iCianstbat doe DOt vet to be done by the
phys1c111U1fhe other aldlle4 person- Del-nurse middotreC~0D18t the appo1ntshymeDt center or clerical praormelshyaremiddot there to free h1amiddotto use his spec1al sk111
Awell lmoWn treDd1D the area of eaaiDI health
c8re JII8DPOY8rShortagjs bas middotbe thetrend toward tra1nshy
1DB poverty area rea1deats as DOD~pro~eaionalmiddoth8lth
aide and nepborboocl health workeramiddot (28 p63) This
bas the effectofmiddotmiddot1J)creaa1q II8DPOWrand 8180 can help
bridle the cuJ~ cap betweenprondera and colllUmers
of aen1C8s This attarD at least tlleoretically
createa a situation 1D WIa1ch providers andcoD8Ullers can
be educated to UDderatad OD88DOtber and interactJlore
ettectlvely~ HoWever amiddotpltt8ll has beeD themiddot tel14ency in
801D8 oamp8e8 tomiddot us aidesmiddot ssale8lllcw t~r the center
alJDOatexclwdY811rathertbaD ua1Dltheal to protide the
health care for wh1ch ~ were trained (29 pp3B-39)
1bat ismiddotmiddot vh1~e the a14e Yalue in ~~m1catiDI with
low 1nCOlMt patieata haa beeR recoSD1zed and stressed
their role ashealtb carepersoDDelhil been slighted 1n )
any 1Dstancea
Anotber step 1d11Ob bullbull been taken to provide 8rY1ces
more efficiently eUeot1ftlybas beenmiddot theorgan1zation
of per8ODDeliDto IIllt141sc1pl1Dary teamaaaa means ot
proYid1DgmiddotCOQrd1DatedserY1ce SUch te8lll8 sen_rally
~
hf
~
22
include PhYsiciaQs nursbullbullbullbull soc1al workers and outreach
workers Conceptually th8y fmlct10n to me~ the intershy
relate lled1cal and social needs ot the families sened
Hor there are a number ot barriers to the etfectve
tlmctiOD1nlof lIuchte8ll8 SODieot these are heavy caseshy
loads the inordiDate amount ot tille consumed by multlshy
prOblem tamtliethel1m1ted tra1n1 ngmiddotmiddotand laCk of tnterest
on tile part ot aoae tebers in examinJng aspects of
problems out14e~lr oWn areaaotcolIPetencemiddot and
~ourdcation prc)blell8 between proteasioDala and nonshy
prot81~s (10ppa-10) middotrurtbemOre as De Diaz
(14 middotp6)1nd1cate tbel8 maybe a teDdency tor vertical
dp8rtmental lines of auperv1810nto become paramount
over the team coDamloation syst lead1ngto conflIcts
in determ1niDI the ro1ea ot solie team bers particularly
the DOD-prote81011alaInauch exper1l1enta Witb new
~t1Dlpatterna it 1s bullbullaentialtbat line of authority
roles aDd NsP0D81bll1tlea be made explicit and that there
beJDechaD 8IUI tor relUlar evaluat1onotfunctlorUng
Another way inwb1ch health care sernee delivery can
be made more ett1cl8Dt is to proVide servicea dur1DC the
hours whentbey aremiddot -ostnee4ed As reQo_ded by Yarby
(37p1) serY1ce can bemadelIOre accesslble by making
themava1lable 24 hours a day seven days a week If
rg8l1Cy service are aft11ab1e aroua4-tbe-cloek at ~
nil1iborhood health center the continuity ot tbepat1ent ts
23
careiamaiDtalDedand meatry point into the
cOIIPre~i health care 8 be made available
tothe patient who aoZMllyU8ea ozilymiddot emergency care in
tille of med1cal criais More 8isDificantly ava11ab1-
lity of a tull rase of bullbullrv1c8 tor seVeral hours 11the
eVerlna aI1Cl On ~ prevent the los ot earn1JiSs
involved if th patierat 1IU8tt8cet1me oftfroawork dur1q
the d8y for aed1Cal oare bull his can be an eSpecially
importantc0J1814eration tor lo1aCOlleDUUg1nally qloYEtd
patient aa4caJla18o PIOJIOtet1)e 0Da01Dl use othealth
servicebullbull
exper1eDO ot tbeKa1er prosraa in tb1s~reprdAs
Greenl1clt(19 p10) states wA lllNt 8ip1flcant
proportion ot the abulatory care 8n1cp~Y1dd tor ~
total popUlatiC)U ~ ~ after clWc hours and this
Deed i8 apParenUyaoN prODGUDced tor aJl8d1cally
iDCust population On the other hand the bulk ot all
aabulatory med1cal cu 88l91ce are performed dur1nS
regular cl1D1c hour eVen when services are available 24
hours a dayJ day bull week W
It has ~ the experi8D~eof a ftIDber ot ne1g1lboXshy
hooct hea1tbcentere _t a_jor obstacle to efficient
proViSion ot anicbullbullhas beentbe teD4eDcy of medically
1ncl1pnt patieats to utilize the center oa a walk-in
baais tor epi8od1ccr181or1entect bullbullrv1cea rather than
4)i
h~ ~~f ~~ L
24
to make appoJlltaeata tor ODIo1qprevmt1ve treataent
and rehebl11tat1Ye care ad ampl1O to bave a blah failure
to Show rat_for tbe appo1DtaeDts that they dO make
Atone center 628 of appo1Dtments made were kept
while 3Oottbepati_ta een were ~1n patients
AlthoUP fewer patiets were actually 88811 by the cater
1D middottb1s 1Datance thaathe -bervholuidmadeappointshy
mta the walk-iD patlat required an iDord1nate amount
ot staff t1ae tor aCreeDiaaacl ~trral to pplOprlate
~ttor caregt (9 pgg) Arraquotbr1llpl1catjo~ of the
plOVidedto valk-iD patient by other thaD their
(19 p12)rurtbermore
when patients uti11ze Wlk-1Il er181 centered care
athelr ODlf tona ot ootact with the _d1~ care
ay_ta fUilycentered care the treata_t of tUl11y
bers
a a UD1t 11
dlarupted
hewalk-1Dphenoaaencm appear to barelated to
diUerence between soclal clase in the style of Dlaking
contactJt1th the a11oal C~ay8t As Greenlick f ~
(19 p11)1Dd1oate8 thepheDOaenOn ot INater usage of shy
walk-in ervice by aed10ally middot1Jid11ent patient thaD by
others baa otte been attr1buted to a stoical att1tude
tQward 1llDe8 em the~ ot poor people leacl1D8 to a
~
25
greaterdelay1n tbe k i Dlofa8d1cal care These
patients wppoedlyeelcmiddotcareODlymiddotwIleD tbeirmiddotillDess
becOlles1Dtolerable resultiDSin middotthMr appeariDS withshy
outnot1ce1o rece1ve oareHlwever Greenlicks
r8aearcbbaa cut doubt on the existence ot tb1delay
111 report1Dg middot8J1IPtoJumiddotOfDeW 11laessand seek1ng care
Be bas tcrQDd 1bat s1ll11ar peze_tases of dioally
1nd1sent 8DClJ1on-aed1cally 1Dd1PD~ pat1enta seek care
on the aue daytbat aptou tirstaPPear
1fb11e GrHDllclc 1nd1cat tbat the reasonator the
greatertendeDCY of low 1Do~e pat18Ilta to 1$8 walk-in I
serY1ces are notlcDo1rAmiddotmiddot tbe7 _ be rel~tedto a tendency
ot lower aocio-ecaaaoclaa patieota to preter face-toshy ~
face contacts with II841cal persoDl181posslbly because
such contacts areft coatortiDS an4reasauriDS to
patients who are hJpotbeafzed to bave a dependent attltude
toward IIed1Cal care perS0Jm81 (30 p161)
It a8 itmiddot baa pnerally beenhld the appointment
s1stemts the most efficient Ileana of dellveriDS
comprehenSive oODtllluiDlh-lth care (9~100)1t is
necessary that educaUoraalmiddotbulltfort be taken to proaote the
use ot middotappo1ntaents8DClmiddot tQrec1ucethe fa111re to appe~
ratB4uOatioaalwhlQb baft~utl11zedhave been
IJ
26
1Dten1ews with walk-in patients home Vi8its and group 4i
meetiDp1D8D attemptto1Dierpret1o the patients
the value of rtitgular ppo1ntmentamp andot con~in~
c~1ve care rather than epiI041c care (9 p1OO)
h1s 1safuD~tioD torwhtch nOl~prot81QDal colDlllUD1ty
YOrkersllaY bebe~r8U11ed tban other statf H()wever
euch aD ~ucat1oaal propul __~ ~e related to the senUiDe
capacity otth health oenter to provide comprehensivebull gt
ervice8 to1tpat1_t~odoD aD app01ntment bas18 It
1amp pos8ibleo~rw1 tor educa110Dal ttorts to result
LD a~8JImCl tor ltPP01ntaen~8 at a ratewb1ohi8beyond
the capacity ot thee_tar to t without uareaaoDably
1_ wa1t1Dlprio4a QOBt1nuad use Ot the center on a
wallt-in bU1 _1tbeoosiItpos81ble to et an appoint-
met anc11nCreued pit1entcoJaplampia1a bull Therew111 of
course always be a need and demand tor acute ep1so~c
Care -ci the health centerDlWlt be planned with the capashy
billty ot bullbullbullt1D8 tb1aneed wh1~ cont1Du1nI to stress
aDd educate the patient to utillze oDlOinI comprehensive
faa11y middotc~te~d Cflre (9p 100l
att g4 CODClva1opa
In order to bea4equate any coJlltemporary health care SY8tem muat bullbulletcerta1D interrelated criteria he
IJ
27
minimum criteria areaccessability of services to those
who need them compr8heX1siveness and appropriatness of
services and efficIency 1nthft utilizat~on of SCarce
health care personnel and resources The scareity of
pex-sonnel andtbe need for h1gh quality ongoinghealth
care services
aJIlong the
populationdemanci the most effishy
cientprovision of services
Services must be made accessible to the population
They mustmiddotbe geosraPh1cally accessible to remove the PhysicalmiddotbaTiers betWeen peopleandthem$d1calcare
system They mUst otter their services dur1ngthe
hours when people can make the moat use ofthemA~ it
makes little sense to concentrate services geographically
where they will not be uSed to their fUllest extent it
also is wasteful to provide serv1cesonlydur1righours when
many people are employed his not only presents a hard
ship middotto the consUmer lnrt wastes resources if for instance
the unavailability of preventive services during the hours
when people Can use them causes a need for treatment
services later on
Health carbull sEtrvices must be comprehensive including
prevention treatmcmtand re)abimiddot11tation Ambulatory I
healtbcare facilities wh1cQ are orienteciexclusively
toward either prevept1on or trea1mentare no longer accepshy
table for they are lneft1c1entln their use of resources
and in their prov1s1on of health care to the patient
w ~~
28
If prevent10n1s notmiddot stressed treatment serv1ces that
could have beenavoidedY1l~ be required If prevention
1s the sole focus of the health care facility sick
patients who present themselves must be referred elseshy
where for treatment andsllch referx-als may be taken as
reject1onsor not followed through with until illness
becomes unbearable
The instltutlontbat meets these requirements Is
the comprehensive neighborhood health center It 1s a
local decentralized outpatient facilityprOVld1ng a
fUll range of ambulatoJY health care services It has
a linkage to ahospitalbackUp facilityforlnpatient
treatment and hiihlY apclalized outpatient care
The neighborhood health center must be a fac11ity
planned with an awareness of the needs of the conSUtller
and coDitnUn1ty It must have the r~Ul0urces to provide the
services people need mere they can use them and when
they can use them It must uti11ze the part1cipation of
the community to develop this awareness Not only must
the cen~er beset up to be Amctional for the consumers
but efforts must bemadeaga1n with commun1ty partici shy
pation to help the consumers utilize medical care
services effectively The center muetmake efforts to
educate the community about the valueot regUlar health
care of preventive servicesand of the use of planned
IJ
29
medical appointments ratherthanorisis centered walk-
incare Therealit1es of the existing health care
system have not taught the patient particularly the low
income patienthow to use services effectively
The helthcenterilUst also bea laboratory for
experiments in easing the health caJepersonnel shortage
and c60rd1Datingcare~ A major difficultY iri-exper1shy
menting with neW rolesis freeing staff of old preconshy
ceptions
CoDlprehensiva neighborhood health dare centers have
been developed under a variety ot alisplces including
medicalsociet1es hoSP1talsmiddot(36p299 group pr~ct1ces
(29 p6- 12 117) health departments (13 p1027) and
ne1gbbothoodassoc1ations(14) The literature indicates
somevalues nthe management ot the health center by plusmnts
hospital backup faCility Whatever the auspices many
adm1nistrative fuDctions such as program coordination
standard pr9tectionand evaluation call for considerable
c~tralization of adm1nistration city-wide or coU)tyshy
wide At the same time other aspects hours of servlce
for examPle~ cuI f~radm1nistrative fUnctions made atmiddot
more local levels Each neighborhood center must be
free to adapt its functioning to itscominunity thi-ough
the mechanism otcODlllUl11~ participation inmiddot policy making
Obviouslythe prerogatives and responsibilities of each level must be negotiated and made explic1t
t4~
JJ
BIBLIOGRAPHY 30
1 American Rehabilitation Foundation ~ealth Services Research Center The Health Maintenance Strategy mimeo 1971
2 Anderson Nancy N Comprehensive Health Planning in the States A Study and Critical Analysis Institute for Interdisciplinary Studies American Rehab ilitation Foundation 1958
3 Andrus Len Hughes Comprehensive Health Planning Through Community Demonstration Health Projects mimeo1967
4 Barry Mildred CandCecil G Sheps A New Model for Community Health Planning unpublished paper presented to the American
Public Health Aseociation1967
5 Blum HenrikL Fred Wahl Genelle M Lemon Robert Jorulin and Glen W Kent The Multipurpose Worker and the Neighborhood Multiservice Center InitialImplications and EJeperiences of the Rodeo CommunityService CenterAmerican Journal of Public Health58 (Mar 168) pp 458-468 shy
6 Blum MichaelD and Soloman L Levy A Design for Service Delivery that Reinforces Constructive Tension Between a Health Center and Its (sic) ConSUDlers and Supports Community Power unpUblished paper presented to the American Public Health Asaociatiltn 1968
7 Brielaud Donald Comm~ity Advisory Boards and Maximum Feasible Participation American Journal of Public Health 61 (Feb 1971) pp 292-296 shy
8 Burns Eveline M Health Insurance Not If or When But What Kind Madison Wisco~sin University of WisconsinScllool of Soci~l Work 1971
9 Campbell John Working ~elationships Between Providers and Conshysumers in a Neighborhood Health CenterU American Journal2 Public Health 61 (Jan 1971) pp 97-103
10 Caxr Willene Neighborhood Health Centers Funded by the Office of Economic Opportunity mimeo 1970~
11 Colombo Theodore J Ernest W Sawardand Merwyn R Greenlick The Integration of an OEO Health Program into a Prepaid Comrehensive Group Practice Plan American Journal of Public Health 59 (April 1969) pp 641-650~ -
12 Comprehensive Neighborhood Health Services Projectof Kaiser FoundatioIl Hospital~ Prcgtgram YearE grant renewal proposal mimeo~1971 bull
13 CowenDavidL~ Denvers Neighborhood Health Program Public Health Reports 84 (Dec 1969) pp 1027-1031
IJ
14 De Diaz Sharon Daniel Beyond Rhetoric The NENA Health31 Center After One Year unpublished paper pres~rited to the American Public Health Association 1970
15middot Gerrie NorrrianF and RichardH~ Ferraro Organizing a Program for Dental Care in a Neighborhood Health Center Public Health Reports 8 (Aug 1968) pp 419-428
16 Gordon JeoffreyB~ The Politics of Community Medicine Projects A Conflict Analysis Medical Care 7 (Nov -Dec 1969) pp 419-428 shy
17 Greely David The Neighborhood Health Center Program and Its Implication(3 for Medical Care H~alth Forum of the Welfare Council of Metropolitan Chicago (mimeo) 1967
18 Greenlick Merwyn R Newgtimensions in Health Care American JOurnal of Pharmacentical Education 34 (Dec 1970) pp 754-4
19 GreenlickMerwyn R Donald K Freeborn TheodoreJbull Colombo Jeffrey Abull Pruesin and Erne$t W saw~d Comparing the
Use of Medical Care Services by a Medically Indigent and a General MemberShip Population in a Comprehensive Prepaid Group Practice Prosram II unpublished paper presented to the AmericanPublic Aesociation1970
20 H~tadoArJiloldVMerllYll RGreenlick and TheodoreJ Colombo Determinants of Medical Care Utilization Failure to Keep Appointments unpublished paper presented to the American Public Health Association 1971
21 Johnson Richard E and Merwyn R Greenlick Comprehensive Medical Care A Problem and Cballengeto Pharmacy ff AJilericanJournal of PbarmacenticalEducation 33 (Aug 1969) pp 361-367 -
22 Kahn Alfred J Studiee Social Policy and Planning New York Russell Sage Foundation 1969
23 Kotler Milton Neyhborhood Government Local Foundations 2 Political~New York The BobbsMerrill Company 1969
24 NationalCommisaion on CommunityHealthSfrvic~sActionPlanniriamp for Community SetithServices~ashington p C Public Affairs-Press 19t7
25 National Commission on C~mmunity Health Services Health Adminishysration andOrMPization l the Decade Ali9$-d Washington D C Public Affairs Press 1967
26 NationalCornmiesion onqomm1Jllity Health Servicesbull Health ~ Facilities Washington D C PUblic Affairs Press 1967 bull
~ n
32 27 ODonnell Edward J and Marilyn M Sullivan ServiceDelivery
and Social Action Through the Neighborhood Center A Review of Research tt Welfare ~ Review 7 (Nov~Dec 1969) pp 112
28 Office of Economic Opportunity Second Annual Report Washington D C~ U S Government Printing Office 1966
29 Office of EConomic Opportunity and the Medical Foundation of Be~laire Ohio Eighth Report 2l ~ Committee2a Governshy
ment OperatiOll~ Va8hiiiSton D C Government Printing Office 1969
30 Pope Clyde R Samuel S Yoshioka and Merwyn R Greenlick Determinants of Medical Care Utilization nhe Use of the Telephone for ReportiDg Symptons Journal of Health and SocialBebavior12 (June 1971) pp155-162 shy
31 RenthalA Gerald nComprehensive Health Centers in Large US Cities American Journal of Public Health 61 (Feb 1971) pp 324-336 shy
32 Saward Ernest W The Relevance of Prepaid Group Practice to the Effective Delivery ofHealthServicestt The New Physician 18 (Jan 1969) pp39-44 - shy
33bull Schorr Lisbeth Bamberger and Joseph T English Background Content and Significant IssUes in Neighborhood Health
Center Programs Milbank Memorial ~ Quarterly 46 July 1968) part 1pp 289-296
34 Weiss James E and Merwyn RGreenlick UDeterminants of MedioalCareUtilization The Effects of Social Class and Distance on Contacts With the Medical Care System Medical~ 8 (Nov-Dec 1970 pp 456-462
35 Weiss James E MerwynR Greenlick and Joseph F Jones Determinants of Medical Care Utilization The Impact of Ecological Factorstt unpublished paper presented to the American Public Health Association 1970
36 Wise Harold B Montefiore Hospital Neighborhood Medical Demonstration A Case StudyMilbaDkMemorial Fund Quarterly46 (July 1968) part 1 pp297-308~
37 Yerby Alonzo S ttHealth Departments Hospital and Health Services Medica1~5 (March-April 1967) pp 70-74
38 Young M M~ Chatanooga IS Experience with Reorganization fOr Delivery of Health Services ttAmerican Journ8l of Public Health60 (Sept 1970) pp 1739-1748
f or l
II bull 11 Y d
II
IJ
34
ThepurposeOfPart II of th1aa paper1atod1scuas
elected Speclfic needs ofecltlc areas within Multnomah
County A8P01ll~oUt 1D ~ I of t1a1bullpapermiddot Ita nelgbshy
borhood health oare cater IlU8t be a facl1lty plaDlled with
aD awarenes of the neeels of the oODllUller and collllUDity
Part II of this paper nIl Show 80e of thoe speclflc
needs
he1DforutiOD tor t1li Portlon of the report
obta1nec1 troll tbroupout tbe follow1Dl threepUb11catloDS
1gr~e_tiMshylIPrIxaiidOreson JuDe 1963
2 1~_middot_sectSI8e~ected1teai c-ua 0 S 8 e first count coaputer tape Coluab a_lion AssocshylatloD of QoveraMD-8 Jlme 1971
3 Jtu1tDoab County Oreaon BDY1roDlHtlltal SurveyEarly 1971
The JIultDOIIIlb COUDty OrttIOD BDv1roDllfmtal Surley
Barly 1971 1s bull stat1stical report of the activ1tles of
theentlreMultDOIIIl2 CcNDty Health Dep~t during the
year of 1970 Die speclflc 1nd1cs elected from tb1s
study amprejMental aealtll Publlc Health N~s1D1 vlslts
FaJUly ~ Veaereal])1 ~ ~rcul081
Throush tie use of cUrts and mapa ODe CaD roup these i
speclflc ~oea to ahcnr the healthneedsof speclfic I
census trtcta aD4 then the health needs of iarer neIghshy
borhooda 1m4 o~ Uebullbull
Rf)~UP1Dl of areu was accompllshed in thefolloWinl I
JJ ~
35
he MiltDoIliahCountY oregon BDViromaental SUrvey
early 1971 isamp statistical report ot tbeaotivities ot
the entire MultDolllh COUDty Health ])epartiDent dur1nl the
year ot1970 he specitic 1Dd1C8S selected frOm this
aUy are 1Il8Dtal health public healthDurs8s visits
fUl1ly pia waereal elisease aDd tuberculosia
Tbroq11the Wle otcbart aDd mapa aDecm szoup these
specific indic to show the health Deeds ofapecitic
ccmaua tracts aDdtIum th8health neecla of larsr ~eilh-
bOrhooda and co8I13 tlbullbullbull
RegroupiDI ot areas waa accoap118hed1D the
tollOWiDl lIIIIm1er~ A bullbullcifie 1ndex 8selectcl auch as
venereal di8bullbulle or tuberculo8i~ he total number ot
cs was then deterll1ne4 for each census tract Through
the use of the maber ot cRbullbullbull tor a 11Yen cenaus tract
aDd tbe population ot thattractaltrateot1lla1ampmcper
100OOOpopUlaticm wu cleteXll1ned for each census tract
This was ~e to starl4ard1ze the population ditterence
amongOeD8U8 -tracts 1he rate of incidence toreaob
cenauatract was then llstedby rank position on a chart
In rank poition1DI any cen8Wl tracts haviDg equal
rates ot1l1c1dence are assipe4tbe iaDk posttiona
Beeauseot the abo fact tbAt cbarta w111 vary in length
neveltbAtlea eacb cbart will 1Dclu4eall census tracts
inMullnoaah Couaty Atter the census tracts bave been
listed accord1q to raalcth1s list will bediv1ded into
IJ
36 three levelsotinc14ence he three levels are
1~ The upper 14 of1DcldenCe
2 Thelower 14 ot incidence
middot3 The ILld 12 of incidence
Tlles three srouplqa are then used in compiling a map ~f
Mu1tnOmahCountyfor ach apecltictop1cbull TIle maps are
uaefuJliD tbatthey V1suallycoJib1De 1Dd1v1Clualproblem
census tracts into larger problem nellhbOrhooc1s
The 1960 statistical iDtormatloD was Used in a similar
liIaDDr to tbatexpla1Dedabove 1Dthe4evelopaent of a
chartmiddot and map 1Ihow1DI e cOllpampriSOr1 of per capita lncolle
tor ttaCh ceDsua tJact aDdmiddot combiDed census middotmiddottract areas
he 1910 aDd 1960 statlstlcal iDtOrllatl0D was combined
lna map and chart he purpose of this and chart is
to d8aonatrate the e cl1stributloa1DeachceD8U8 tract
and middot1ndlcatbull tuture ace populatlon treD4a bull
When one be middotbullbullbullbullbullHdth ne8cts ot an area and has
declded to establlsh a cl1D1c to serve that area the
physical location otthat cl1D1c IllU8t be consldered In
order to coapreb8ll81vel develop an area cl1n1c one should
conslder thepre88Dttraftlc middot~ytaa an4tranaportatlon
systems Thecl1D1cahoUld be located close enoUlh to
major arterlals to giva asy access from the total area
be_ ervecl by this cliD1c At the t1ll8they should
be tar eo away froll thesarterlals to all8Y1ate traffic
CODCell18 andpark1D8 conpstlon By traff1c concerns I
IJ
37
lIlan one lUSt consider thertarro1fne8S of streets whether
streets are oD8--C)r two-way iqres8 and egress to parking
amp0111tie eros tratflC) spedof trattJQ children 1n
ll8a traffic i1lht Vislon re8tr1ctionS etc
BwstraDsportat1onshould alao be central in this area
as maay people ~U f1Df1 1tD8Cessary to use this form of
transportatlon
~e tutqredlopHQt of bull treewa systems should be
c0J1S1dered soastolesen thecumce ofmiddot future roada
cutt1DSotltbe cl1D1c llte line
nrrph1c middotDampta
It is 1JDportaDtto kDOw the demosraphic distribution
characteristics of the oUenteltbat i8 to be served by
localized health cl1D1cs
Acl1D1c which erves8J1 area where1D the prepondershy
ance of persona arecrter 65 years of mayf1nd that these
people rely more on pUblic transportation call for more
home- services and haV4t 110ft ChroD1c and debilitating
types of disorders (b1_ blood pressure poor heariDg and
eyesight) tbaD do8 an area ot a YOUDIer population On
the other hand thL area of older residents may have little
need for family plabDlng cllni08
In order to better ~Ybullbull the 4eaoraphic population
of each CeD8U8 tract the 1970 CeD8U8 iatormation was viewed
and two specific catelOri8 considered These two cat
IJ
38
lori8S woUld be the perc_tap ot population under 19
year of ase and the percentase ot each oensuetractover
65 years of age he 1960 1Dtormatlon tor eaCh tract was
then compared witbthe 1970 intormation and a percentage
ofincreaae or4ecreamp8 tormiddot e~chtract1n each category
cOJlputecland achartma4e By the use of this chart one
18 able to View tJleap populat1odiatr1but10n of census
tract and at the _ t1lle accesa middottrencl Por example
let us choose census tract 601 W see 40-4 otthe
population is under 19 years ot and that ODly82 1s
over 65 years ot middotAtthe e tille the percentage of
youth bas ~ed ODly 1_ intbe laSt teD year whilethe
percentale over 65 year ot middotbas stayedmiddotthe same With
this in mJnc1 ODe ~ 1DfItr libat ol1D1o aerviDg this
area WOuld bellQre conq~w1th the problems of a
YOUQier populat1on and that _ would probably be true foJ
some t1aein tbefuture On the other hand CeDSU8 tract 54
has only 2 ollt population UDder 19 yel1s ot age and
this has decreased by 1 over the last ten years middotwhile at
the same time 32-377 ot the populat1on 18 over 65 years of
age A ol1D1C ___ this area should be or1eJ1ted toward
tbespecttic problema otthe ampledbull
PerCapia __ bY gsa neat
WhaD cona1der1qlooat10D1 tor health cl1n1cs one
shoUld take the 1DC01Ieot areas into consideration Areas
IJ
39
of lowiDcome would not 11kel~be 8erved more by localized
cl1D1cs tbaD would are of hilbincome It 18 likely
people haYiq a hip iDeoll8would preter to be aeenby a
chosen ~r1vatephylc1a1l tban at a local cl1D1cwhere
10Dier waits y beraceaaampryand leas personal attention
gl_
The 19701ncOII81atoWampt10n tor MultnomahC~ty was
not available at the tille thi8report W88 made The 1Dto~shy
tiOD Was taken ~adtro tbe1960 census publlcation
his woUld ~8Il thea tbat ral1I8 OD the chart ynot 1raquoe
completely accurate hi writer telthatthe areas most
affected by tb8 1I8eof the older 1Dco1DtOlaat1oDWOuld be
those tracts wh1ch baYebad a rapid 1ncreaae1n populatlon
over the past tfmyHr8 bullbullbull tracts would include tracts
nUmbered 104 9897 96 aDd 95 be perc~ita 1Dcome
referredto1il-tb1a Paper18the lIean 1DCo per person per
census tract
Attar the iDeoeper census tract was listed on a chart
a map was de 1D41catiDg those census tracts belonging to
the lower 14 ot income tor all censue tracts in Multnomah
COlDltytbose beloqins to the upper 14 ot income tor all
census tract 111 MultnolUlhCounty and those belonging to
the mid 12 ot 1I1coaetor all oeuuetracts in Multnomah
C01mty
In yiew1Dg the _p 1t caa be seen that the low income
area seautotollow aloas the at aide ot the Wl1lamette
IJ
40
R1ver the full length of Kultnomah County A second low
income area follows the south edge of the Columbia from
the northwest corner of Multnomah County easterly to 148 St
A third problem area seems to be on the east bank of the
Willamette River with the Union Pacific Railroad being
about the center of this tract The extreme loutheast
corner of Multnomah COUDty appears to be a low income area
but as this area bas bad rapid grouth in the last ten years
this could be erroneous
Mental Health
be first ~ecific indica to be selected from the
Multnomah County envirollllental survey of early 1971 and
to be considered in this paper i8 that of Mental Health
At the present for mental health purposes Multnomah
County is divided into five catchmentareas with a mental
health cl1n1cin each area These clinics are Model
Citles Delaunay ADkeny street Office Hansen Health
Building end Southeast Clinic
All lIlental health cl1n1cslcept statlstlcal information
on all patients visiting their cl1n1cs this included the
address of the patient hese addresses were then listed
upon the approprlate C8D8US tract Each census tract was
then ranked on a chart according to the nUllber of mental
health patients who reslde ln thatCeDSUS tract attending
any of the above listed ental health clinics This chart
IJ
41
wasttum d1v14ed1ato proper quartile bbullbullbull
quartile vereUs to dne10 u appropl1ate Multnoh
County _tal health ItLa middotmiddotmiddotthelipO~a1bl by lOoJcJIUE
at the UDtal health _to uteN1De which ueu have the
lars-t use otCOllDty 1alh~th faci11t1Rot
1Ilclu4ecl 111 tbia woUld tber otpeopleYia1t1Da
pr1vat patch1atriata aDd pr1_t _ntalhealtb cl1D1c8
WheDtbe M1 18Yienclmiddot Itmiddotmiddotmiddotmiddot~middotbe~_ tbat ~rtt
appears to lMt fourmiddotmiddot-al are iii _oil the nuaber ot
lIental healthcl1D1c na1t toM tbjh1sheat 1he
tour areaa woUld be tollows
1ttrea Ore to~Blo Drimiddot ~tb Burrus14e aDd tIMtmiddot Colb1a Riftr H1gbwyaeri1Dla th nortllra boundaryshy
2 bull ProII 82D4 1_~ 10 20th streetwitil the ra1lMd Mu the north ltouadary
3 ~ et et tUgl_b1bull MYel froamiddot the Clackaaa COUDty l1ae aorth to Dln8lon stret
4 beDOlvt1ttfe-t ~efllt4 COatytrca Jle1aware streetmiddot toR1C1a11oDd wlth Colubla Blvd heiDI tbAtnorth bouaclary_
It ODe coapareatbiap to th iDeobullbullmiddotp 1t can be
eamiddotthat lIOat ot the c tracts baY1Dg bllh v1i11tatlcma
middottfl public tal health cJ1rUc8 ~ 111 t13e low ~ aid
1DcOile SroupiDIOJa1y of til 25 tracta llsted as
haviDlbip aental Maltll nlltatlou are ~ the1g60 hip
iDeo arebullbullbull
17 Plpn
42
amily PlellnSDI ]Jlce Metal Health i8 an 1nd1ce of
use Theperson 111 ordertobavebe_ 1Dcluclecl 1n this
atu4ywouldhave tohaft Ue4 ataa11y plaDI cl1D1c
tacilities of soaetype It 41fter troll tile _tal health
study1nthat i t1Jicludestatist1catrollbotb public and
privateclJD1os
The iDformation tor the iak orurcbart 8Dd map of
t8ll111 plenn1 na ob1a1De4 by cOIIblnlDlthe mabel of
1rlcuv1duals bullbull_ attbe tbreellUltrampo-ti Coatyhll11y
PlalJQllIl C11ll10s 111til tbo at the Planned PareDthood
Association CliD1C8 be tbree -JIultDouh Couaty r8ldly
PlamSq Cl1D1c are Solrtbweatth Col_bla 1111- a114
HaDsell Health BWlcl1Dl CllD1cbi middot1Dtormat1oD vas then
bullbullbullesed tomiddot detellWMt l10w people troll eacb c8IUIUS
chart wastben Mele IUs oIIart jn 4iY1ded to show
the censuS tracts lIaYiDlmiddottIle h1t1iest qUart1le of incidence
of use lowest quartile of 1Qc1deao ot use Jlid 12 of
incidence of Wle an4 a map sprepared troll thts 1Dto~
mation
The C8U118 tractsbelOJISnl to the h1lhestquartile of
use appear to be 1lO~ 8catt~ on tbipwas true ot
either the _p ot aental health cl1D1c uaageor ot the map
abow1DI per capita 1I1COM Iaere40 to be three
d18t1nct areas of UIIaP beJ woul4 be
1
IJ
43
t10D of BurD81cl and the W11lallette River 4
2 S~t Portland 8Otth otmiddot the ra11shyrcaadand alona the W11lamette River
lIortbeaat Portl8D4 between MisSiss1pp1 and 24tbStreet the northbouBclary be1DgColwb1aBlvd
Pylzl1c BMltl IrpI Y11ta
Publlc Healtil nur81D1Y1s1t nclud8 an vists to
theholles of client by PubUc Health Nurbullbullbullbull his shows
visits to bull f8Jl1ly fer aDY purpos SUCh aatuberculolJ1s
het1Dl tem1tyaeatalu4 8IiOt10D8l cODd1t1ona etc
he atat18t1C~ 1fele C()4ed accord1Dg tomiddot the 1llli301fOCUS
of the Y18lt tt doe DOt 1D41cate the Dmlber of holies or
f8ll11lev181tecl or 1D41Y14ual Y1a1ted more tban oDcein
the propwl It dobullbull I1ve 80M 1D41cat1on by coaparlshy
OD ot the 8JIoUDt of aedlcal problema 1n eachcen8WI tract
Ap1nmiddot the _p abowa 8 scatter patteraof probl_
areas althoUSh there appear to be a sroup1Dl of hiSh J
l8aIeccmaus tract 1ntlut extreme southeast part of tbe
County other areu uIriaI any nura1Dl contacts are
1 bull he 801lth-oa-al CO1Dty on eaCh 814 of 82nd Av from Clackallaa County north to Dinloa
2 ear bullbullbullt 814e aroUDd Preacottand Misaisippi
Dowatom Bunul14eonboth 1de of the river
44
V_real Pis The iDfomatloil uaec1 to tabulate the Venereal
disease chart includes all the ooab1ned case otmiddotODormea
and syphilIs reported by bothmiddot publIc and prIvate physicIans
dur1nl 1970 There were 3602 caes ot IOnorrhea reported
dur1nl 1970 While ODly 17 cabullbullsot ayphilimiddot were reported
A chart was prepUed aDd att8llPt wasmiddotmiddot de tomiddot
determ1De Wh_therVttDereal 41ease was more p~vaJent in
areas othigb or lowmiddot proportIon ot youth hi waadone
bymiddotdetemlna a 1leaD prceiltacmiddotmiddotmiddottor the population ot
resld~ts UDder19 years ot (34) middotA mean ratemiddot per
100000 popUlatIon al80c1ttem1Ded tor the middotoccurreDCe
ot venereal dieae This was et at 390 oass Areas
hav1nl a population 1n which leiS than 34 were lmder 19
years ot ampIe were called low- yOuth abOve tbl percentaae
hiSh youth The aaa waatrue ot the occurrence oivenershy
eal disea_ per CeD8UStract It the rate waacomputed
as 1I0re than 390 cases per 100000 it was called hiah
venerealdiaeasei it less than thia tisure low venereal
disease It was tound that 1D Multn~ COmlty there sems
to be poSitive OOlatI0n(x21S19gt between low youth
and hipmiddot venereal diseaand hip youth and low venereal
diseasebull
RaDk ordr Iitot all c traot middottbAm made
Th1s was done byt1Ddlna the ratepr 100000 populatIon
of venereal disator all census tracts in the County bull
45
These were thenlisted from h1lhto low (sreatest to
least) in a rank order The l1sting was then divided
into Upperandlower 14 aDd listed on the MUltnomah
Countymiddot up
The areas of b1gh venereal disease se8ll18to
roup thBl~8 middotin a very tllht area ~oq both 1des
of thell18l8~ R1 w1th BurDaldeS~et being
~bout theceDter qf tbi8IZ9uping This area woUld
appear to be m ldeal spot for the denlopment of a
locallzed venereal d1sbullbullbullbull cl1D1c
UbepoundCUlO1s
In this report bull tube1C1llosls caS8S refrred
to include alltbobullbull cabullbulls ontubercUlo8is follow-up
rather middotthan just new C Accord1Ds to the Multnomah
County Health SUrvey of early 1971 this would include
all ca repOrte4 over thelaat three years The
total number of tuberculosi8 cabullbullbull usedin this study
was 666 lh1 included 128 new cabullbullbullbull
A rate per 100000 of tuberculosis for each
census tract wa- then computed and the c~us tracts
listed by rank order be b11h Qartlle mel low
quartl1 were then reoordd on a Multnomah CoUnty map
TWo genral areaa baY1Dg a hip mcldencaot tubercu~
losiare 1D41cated heyare
1 Both middotsld ot theWilla11lette River
Ll -
46
with Burns1de about thecnter
2 he extrea Northebullbullt comer of the County bull
By coap8r1ng the tuberculois an4ven8real
diseae maps ODe can 8ee that the downtown areas ot
hiSh 1nc1denceare alIIo8t 1c1eDt1cal on ach map
This WOuld 1nd1cate that 1t would be of value to
bullbulltab11sh acl1D1c 111 th1aampreatbat would provide
bothtuberCulos1s 8Dd ytmereal 418ase srvicbullbullbull
Thchart aDd 1181gt8 are wsfuln 11v1DI
1Ddicat10DS tor the type aDd placemeototlocal
health cl1n1c8 tbro1qhout tbe MultnomahCounty area
A cOllpar1on of the mapa help one to dec1dewhether
to provide a aulti-8ervice cl1D1c or spec1f1c type of
cliD1c As stated in Part I of thi paprserv1ces
shouldhaYe both treatlieDt and prfMmt10n cOmponents
As he been stated fta ne1lbborhood health care
Qenter muat be a fac111tY plazme4 with an aamesa
ot the neds of the consumer and the c01llll1m1tybull
Part II of this rport haa been an attaapt to indicate
and clarify 8011 ottheae coDlllUDity neds This has
been done through8elect10n of apc1f1c problems
The indic were then visuallyrecorded through the
use of ups and charta ODe dan asseS8 thedsreeof
1DIportance of certain concems to spec~t1c areaa by
comparinl the chart aDd maps Prom this oDeean
41 dec1de which are48 vb1chcUD1c-or indeed if
the need a clinic at all However further factors
should be considered hebullbull include
a The amount of fuDd1 available
b What 18 the percentage ot peopleineoh ceaaua tract tbat would actually us such cl1n1cIl
c Wbat 1 tbeco--1tymiddot 8 IeeliDashyreaardtDI particular cl1D1c8 Would this dcrebullbullbullmiddot the ettctiveness ot thse cl1n1ca
IJ
li
D_OlraphicPopulatLon Challie 1960 to 1970 48
Cen8U8 1 of Pop 1 Cbaqemiddot 1 Change1 ofPopTract Under 19 Yr8 Over 65 Yrs1960-70 1960-70
middot1Q701Q70
1 319 -12 171 -H) 1
2722 215-27 +68 301 366 -22 127 +35 302 371 +19 111 -04
311middot401 144-41 +29 402 321 13~7-39 +24 501 356 124-08 -02 5~O2 351 133-23 +12
405601 82-10 -02 394602 103-01 -06
701 275 149-76 +56 702 361 +01 121 -07
+10middot801 326 140-22 802 321 middot127
(
-29 -03 9~01 342 124 -H) 6-18 902 294 128 -H) 3-24
10middotmiddot -14312 140 -17 1101 182 +25 -23197
2411102 186-59 +29 1201 226 169-17 -41
31middot01202 +11 182 -05 295 -H) 81301 208 -H) 4
1302 331 +08 197 +04
14 323 +15 middot185 -08 middotmiddot15 329 +16 16~5 -13
-28middot 1601 332 131 +12
1602 356 98 +24middot-39 middot3101701 161-33 +21
1702 370 -15 85 +02 +19 1801 264 151middot-50
185middot1802 256 +47-58
IJ ~
D_raphlc Population Change 1960 to 1970middot 49 (Contd)
4io
Census Tract
of pop Uncter 19 Yra
1Q1n
1Cha1l8e 1960-70
of PopOver 65 Yra
lQO Change
1960-70
19 389 +29 141 -24 20 223 -13 206 +18
21 227 +08 194 -36 2201 356 -27 112 +05
2202 290 -18 ll~9 -29 2301 356 -03 154 +24 2302 260 -37 245 +97
2401 410 +6~1 123 -31 2402 163 -80 320 +99 2501 381 +13 140 -01 25()2 237 31 lil +02 26 343 +25 186 +149 2701 370 +29 1S5 -01 2702 249 -44 304 +98 2801 337 +19 187 +09 2802 306 -10 156 +31 2901 304 -38 142 +24 2902 i 307 -32 146 t3~9
30 29~0 -48 16~2 +51
31 355 +30 160 +01 32 370 +48 148 -13 3301 395 +45 130 -20 3302 368 +06 138 -02 3401 386 +16 117 000
3402
400 +32 92 -26 3501 304 -07 115 +35
3502 344 000 140 -13
3601
36~02 357 -04 132 +32
3603 30~1 42 149 -67 3701 342 +28 152 +19
1
IJ
Jianolraphic Population Chan 1960 to 1970 50 (Contd)
Census Tract
of Pop Under 19 Yrs
JJl7J
middotChanae 1960-70
middotofmiddotpop Over 65 Yrs
1c~7n
Change 196070
3702 409 +39 122 -11 3801 308 -11 151 +29 3802 275 -35 180 +46 3803 282 -32 192 +54 3901 376 ~13 100 +17 3902 296 -03 177 +29 4001 438 -11 84 +13 4002 353 -21 115 +20
4101 397 11 9middot0 +11 4102 346 -19 120 +03 42 331 +19 11 bull 3 -16 43 347 -72 105 +31 44 113 +84 183 +154 4S 33~9 +07 110 -06 4601 2501 22 193 +38 4602 332 +59 126 -29 47middot 161middot 000 211 +01 48 103 -26 302 +59 49 138 +1 bull 3 252 +09 50 141 -26 204 -12 51 12 -39 257 +07 52 47 -61 351 +48 53 89 +49 314 -30 54 25 l1li15 327 -17 55 131 -17 115 -121 56 198 +93 227 -47 57 71 102 189 -88 58 240 ~middot41 16~1 +55 59 322 +25 142 +06middot 6001 264 95 132 +50
6002 328 -31middot 89 +07
JJ
Demographic Population Change 1960 to 1970 51 (Contd)
Census 1 ofPop lChange of Pop bull ChangeTract Under 19 Yrbullbull 1960-70 Over 65 Yrs 1960-70
1970 1970
61 355 -58 85 +39
62 328 39 110 +18
63 414 04 73 10
64 382 -22 72 +04
6501 383 02 67 -20
6502 329 -56 96 +09
6601 391 +13 88 -03
6602 319 -59 97 +06
6701 327 71 145 +72
6702 331 ~67 83 +1-0
6801 365 -66 49 +01
6802 388 4bull3 54 +06
69 354 -41 80 +23
70 400 -23 68 -06
71 359 -48 72 +05
72 255 -88 82 +11
73 346 -39 91 +25
74 313middot -63 105 +24
75 329 -42 129 +37
76 336 -52 85 +21
77 370 -10 69 +05
78 309 -10 120 +21
79 325 -56 87 +10
8001 358 -81 57 +12
8002 391 ~81 76 +12
81 315 -76 108 +21
8201 403 -23 64 +08
8202 392 23 65 +08
83 357 -34 120 +31
84 402 -18 73 +16
85 413 -06 76 -09
r
Demographic Population Change 1960 to 1970 52 (Contd)
Census Tract
t of Pop Uncler 19 Yrs
1970
Change 1960-70
1 of Pop OVer 65 Yrs
1970
ex Change 196070
86
87
88
89
90
91 9201
9202
93
94
95
9601
9602
9701
9702
9801
9802
99
100 I
101
102
103
10401
10402
lOS
368
351
379
391
391
413
379
433
372
429
414
432
419
439
~32
377
457 420
378 41middot7
345
360 417
417
412
-04
-02
-35
-26
-28
-11
-64
-20
-S9
-39
-32
-21
-34
-40
-47
-lO~7middot
-27middot +04
+56
+07
-34 01
+04
+04
+10
103
128
97
11il3 99
69
79
42
77
46
34 38
44
40
54
111
51middot
81
133
59
74
140
63
87
76
-08
-06
+04
+08
+17
-05
+3S -02
+1~4
+19
+33
-14
-08
+12
+26
+71
+11
-16 -34
-20
-19 +37
-49
-2S +15
NOte The The
Taken frOi
averageullder averageabove
middotUSCensus ---shy -
19 years == 6S years ==
figures 197
32r 13(14
p a~d 1960
--
Rank
1
2
3
4
5
6
7
8
9
10
11 12 -_
13
14
15
16
17
18
Tract
69 46
60
58
- 68
61
302
2501
67
63
19
62
26
94
3603
3902
64
30 -----~-
Rank
19
20
21 -
22
23-shy
24
25
26
27
28
29
30
31
32
33
34
35
36 -
Ranking of Per Capita Income by Census Tract
Tract
65
2701
- 15
1601
701
66
93
82
2903
3602
30
2502
80
2401
81
- 70
91 shy
4001
High
Rank Tractshy
-32shy37
38 97
120239
7840
41 ~ _2_1__ 42 31
43 2501
44 18
45 98
46 37
47 3803
1702
49
48
1602 92 2702
I
50 89
51 901
52 801
Ra_
53
54
55
56
57
58
59
60
61
62
63
64
6S
66
67
68
TractTract Ra~
74692
170196 70 I
401 71 90
72 1037J
79 70273
3802 74 601
24024102 75
85 76 101
77 9023901
7699 78 100 4101 79
3601 I
380180
458140~ t---- _ - - shy83 82 42
888384
59843501
4777 8~
502
Low
802 86
Rank Tract
87 shy
--88
89
90
91
92
93
94
- 95
96
97
middot98
99
100
101
102
103
104
1201
14
49
72
73
43
87
3502
105
1
52
86
71
1
501
10
3301
104 tf
Rank
105
106
107
108
109
110
III
112
113
114
115
116
117
118
119
120
121
Ranking of Per Capitalucoae by Census Tract
(Contd)
Tract Rank
4001 122--shy602
13
1102 2302
3302
55
3401
48
21
56
50
3402
lL01
2202
2301
53
2201
-shy
Tract Rank Tract Rank T~aet Rank
57 I-----
Imiddote
bull
Tract
- Low -k Note Information taken from 1960 U SCensus
Rank Tract
I ~
Ie
Imiddot
~
----
----
--
--
Rank
1
2
3
4
5
6
1
8
9
10
11
i-
-Tract
391 922 921
972 971
100
132 131 121
962 961
822 821 401
982 981
20 111
47 10 1
412
High
Total Number of Henta1 Health Visits
Ranked by Census Tract High to Low
TractTract RankTractRank Rnk
12 182 22 78 29 87 76 381 73181 ~------- 1913 371 8538230162372 271 2616-121 8272 2
14 80~2 31 94 7923 84801 59 15251362 4232 15 52 _ 32 103 8924 651 17240216 652
_ 91 351 33 341 23117 83 122 25 25 48 1123921418 34 shy61 86 661
19 662 6493 81 26 91 8153 49 50 55 41383 71 27 51 3120 90 672241 35shy 104167162 461
I 411 46211121 28 88342 I
2502 36 69 54 5251 50 272
-Ra
37
38
39
_ 40
_ 41 Ishy
I
42 I
-I 43 44
45
shy
Tract
~ --- shy 95 56
45 292 242
102 62 352 291y
92
101 281
99 72 63 601 60~ 42 2201
77 74 61 57
363 232
70
32 31
11 44 282 2202
Low l
- Tract
46 682 681 I 331 30
r~$ 47 1042 332
48 102_41_
11
~
Visits to Family Planning Clinics Ranked by Census Tract High to Low
Rank Tract Rank Tract Rankmiddot Tract Rank Tract Rank Tract Rank Tract
1
2
3
4
5
6
7
8
9
10
11
12
13middot
14
15
16
17
361
56
401
341
48
59 121
20
55
342
10
31
58
93 21
241 132
331
53
461 462
18
19
20-shy21
22
23
24
25
26
27middot
28
29
30
31
32
33
391
32
middot47 I-i-_-shy _ -
231 111
332
972 1
372 371
52
89
32
92
82
100 31
182
30 242
402
34
35
36
37
38
39
40
41
42
43
44
45
42
1714 i 661 221
78 362 2
90 602 601 352
63 251
105 921
971 351
73 42 292 232
411 51
662
81 45 52
46
47
48
49shy
50
51
52
53
54
55
56
961
801
49 81 72 71
19
9~1
172
68 2 57 162 14 112
91 75 681
381 42
3~3
83 161
57 f
58
59
60
61shy
62 Imiddot
63
Imiddot 64
65
66
64 62 36~3 252
74 652 SO 392 291
651 6bull 2
79 271
r-- ---- shy981 222
672 671
821 272
94 87
281
382
67
68
69
70
71
72
73
74
75
76
77
78
981 26 12~2
IS 61
85 82~2 69
61 43
101 86 84 282
76
131
51 72
1041 962 88 70
99 922 77
103
95 802 181
i
~
Low High
RankRank Tract
5479
4480
81 1042 ~) middot102
71 - - + ~ - ~
Visits to Family Planning Clinics
(Contd)
Tract Rank
I
Tract llaDk l
RankTract Tract Rank Tract
~
I
~
J1 ~
Low
Total Number of public Health Nursing Visits
Ranked by Census TractsHigh to Low
TractTract RankTractRank RankRank TractTractRankTractRank
25249 71 79 17249 8033 6586 99189711 84 2915072 34 661 76 66 811519512
402 5035 51 161 2518220 122 1713423 352 55801 7120 6752 2 149814 41236 83 2662 38 94 6821 53 2924015 362 37 32 42 75 69 281 84 63
546 8822 54 222 85 3925431 70383417 3818223 6439 4386652 718 21 55 103332 8924 232 87 19 271729219619 24156 16211140 382 628825 10523110 112 73411 10141-- ----shy 89 363 4457 8126 16111 221 74 9142 90 46158331 53 671279012 46243 48 59 351 3837528 1083 9313 91 5844 59 -_242 76 1----- shy60 272 72 74104114 60145 42 9287 7729 92 6151 8215 57371 934630 91 307762 12113116 282 619447 41391 9531 78100 63 7378 ~95 681 6945 32 5632 798517 6448 47 52 181
High ~ Low
Rank Tract Rank
96 31 132 70
97 102
98 182 372middot 602 651 662
- -shy
~72 682 802
822 922 962 972 982
1042 ----shy
Low
Total Number of Public Health Nursing Visits
(Contd)
Rank Rank Rank TractTract Tract
I
I lt
I
Tract Rank Tract
[
~~~-
I
~
IJilfimiddot ~
j
Ranking of VD Caea According to Census Tracts 61 By High and LOll Youth Itatio
A media~ of 34 5 was determined Any tract having greater
than 34 5~ of popu1tionunde~ 19 years of age -High~
Any tract having l8S than 345 of population under 19
years == Low
Any tract having rate less than 390 =Low
Any tract having rate more than 390 == HLgl4
YOUTH
LOW HIGH
L
0
12 402 1801 1802 343 2801 2802 29023603
54 6001 600262 66~02 72 74 75 76
78 79 81 t02 65 1202
W
(25)
VD
H
I
G
H
401 701 801802 901 902 10 1101 241 1201 1301 132 14 15 1601 1701 20~ 21 2202 2j02 2402 2502 2702 2901 303501 3502 34023801 3802 383 3902 42 44 45 4601 4602 47 48 49 SO 51~2 53 55 56 57 58 S9 6701 6702 73 95
3~02 7021702 19 25~01 2701 4102 4101 63 64601 ~601 6801 680270 7l 77 8001 80~02 8201 8202 83 84
85 86 87 88~ 90 91 9202 920193 94 9601 9602~ 9701 9102 9801 9802 99 100 101 103 10402 105 6501 10401
(47)
301 501 502 601 1602 2401 2301 2201 31 32 3301 3302 3401 3402~ 3602 3702 3901 400140 02 43 61 69 B(
(53) (23)
~ ~gt
Ranking of VD by Rate Per 100000 By Census Tract
~
Rank Tract Rank Tract Rank Tract Rank Tract llank Tract Rank Tract Rank Tract
1 2202 21 S6 40 902 58 1602 74 75
90-shy 64 107 26 --~-
2 3402 22 45 41 10 59 902 75 78 91 54 108 61
3 2301 23 3502 42 2502 60 602 76 6802 92 402 109 87
4 3302 24 49 43 1102 61 501 17 2 93 94 110 90
5 50 25 52 44 6702 62 14 78 8202 94 97 02 III 76
6 2201 26 20 6701 63 4002 8201 2501
9701 41~02 112 91
7 44 27 48 45 401 64 3802 2902 95 63 113 62
8 3301 28 1701 46 502 65 30 79 83 74 96 9602 114 71
9 55 29 47 47 42 66 3803 80 2801 96Q1 115 85 10
11
12
13
14
15
16
17
18
3401
53
2302
2401
57
21
2402
1101
51
30-shy31
32
33
34
35
36
37
3701 - -~ 1201
3702
89
43
132 131
3602
4001
48
49
50
51
52
53
54
55
58
1601
601
4602 4601
69
701
31
3901
67
68
69
70
71
72
2901
801
39021~ 802
6502 6501 122
702
41~01
81
82
83
84
85
86
87
88
19
1
1702
2802
79
93
100 6801 6602
81
97
98
99
100
101
102
103
104
9201 9202
9802 9801
77
302
79
86
72
84
116
117
118
119
120
121
3603
8002 8001
101
99
95
10401
105 10402 103 102
19
20
59
32
38
39
2702
3501
56
57
301
3801
73 1802 1801
89 6002 6001
105
106
2701
88
High Low
-- -----
Rank OrdermiddotTuberclosis Cases by Rate Per 100000 Ranked by Census Tract High to Low
Tract TractRankTractRank Rank TractRaukTractRankTractRank
801
79 9601501411 52 6835340120511 I 960269 903603532036 $-~~F130221542 4366 311301 70 68~013802 _ I- _ 4001_37213 3921201 6802802 H71523822024 22 54 193302 3802 80 8958 I37139535 70155 9801 I60123 72 6702 98023914011016 6701250124 10 56
81 94 401r 7 154152 73 7057 2625 122 92028
90242 162312301 92~158 86 7172434526509 82 79160159 74 100 87412240227220110 6502836960 75 30 8317244 6501782801285711 61 901 42765645 84 66021459294912 9701 660146 171 302 9702 47
6235023033113 85 822821182 917755 16335013110214 841814832 78 103 938564 324815 86 1057940149272 38036523216 10401 87 2902241 725Q 10402360266340217middot IF88 88 9937233 282 51 218 101 01102 46016234
I)167 2901460219 47
High ~ Low ~
- -
TractRank
9S89
6490
8191 8001 8002
63 61 60middot01 6002 44 2701
92
J
2502 402 --- ----shy
I
Rank
Rank Order Tuberculosis Cases by Rate per 100000
(Coutd)
Tract Rank Tract ~nk
I
Tract Ballk Tract Rank
Imiddot
Tract
Imiddot
1~
t 1I i Pi i l I
o
1 -1shyL I
I J
8 40 icO ~ I -lt 0
-t (1) I
i I
r o E
II
a
I
r--i
shy
I
~
I (
Jgt
(011 fi(
Ggt
I II ~j
()
(f 0
~ ()
I
11
f9
r
II 99
o ~
Ggt r
~ __-J~ I t I ~ I
r--J l I
~ _ __ J
) 1
fTl
1gt
r I
()
r
()
lt en -i en
()
I1l
(J)
(J)
-i
P ()
19
r o ~
r G1 I
I
c
~
o I 89
--- -I-shy
r-r I
1- 0 _~ _ _--J E
G1 I I I
i i
I 1-1-1 ~ _J ~2 ~ II
II
()
1 I I I 1
id i bullbull
~
A n 69
r 1shy
- 0 Gl
l--~ ~ I
~ II
II )
I () isect i
en l i
(J)
-t
0
IA Ol
14
Gordon (16 p bull 422) indicates Many of the outstanding
problems in medical practice todayrevolve around
effectively motivating the patient and the prospective
patient to be concerned with his health This is
especially true in a deprived environment The community
health center with its technique ot consumer partici
pation maybe a way to create this cooperation effectvely
It is important to note at this point that the
comprehensive neiShborhood health center haaas its
constituency an integratedmiddot community r~ther than a
particular segment It should haveas Blum and Levy
(6 pp~5) indicate a horizontal rather than a vertical
relationship with the commuriitybull The vertical relatlonshy
ship they state is characteristic ot those service
organizations wh1chapproach the community only in terms
of their own fUnction Tbey see only their relationship
with the users of their service and assume that problems
of accountability will be handled by these consumers
However they pOintout this ienot likely as a vertical
approach creates dependency onthe institution Agencies
in a horizontal relationBhllp recognizetha1 they have
both acommunityand a consumer to serve The horizontal
approach places the matter of accoUltability on a broader
basis than just the involvement of the consumer De Diaz
(14 p4) speaks otthe need to ~develop a community
facility which difters from a clinic for low income
1ji ~
15
people in that it should serve an economically integrated
community The reason for this is that a wide variation
of consumers may assure a better quality of care
The advantages of the comprehensive neighborhood t
health center over traditional systems of providing
commuruty health services are numerous Hospital outshy
patient departments a major traditional source of ambushy
latory health c8refor poor patients have been indicted
for neglecting preventive health care ~romoting fragshy
mentedeare and subjecting patients to degrading and
impersonal conditions to mention only a few of the major
defects (31 p324) Another defect has been the
tendency to shunt low income patients back and forth
between different cliniCS often at different locations
arid with differel)t open hours for different treatments
or tests in regard to the same lllness(26 p63)
The comprehensive neighborhood health programs that
have been organized present a great variety of organishy
zationalpatterns one area of difference 1s in the
emphasis placed upon making each faci1ity comprehensive
in the services it provides to the patient population
In the Montefieri Hospital Neighborhood Medical Care
Demonstration program in New York City services have
been made available through a central health center and
two store frontsatellites the center to be the base
bull
Li
l of opratiol18 of ta1lJpIlflicl- ancl the satellite
center the ba of oparat1oDa of public heaJth nurses
an4 nllbborbood amp1 be satellite centers wereto
proVide preVentift tutaltll bullbulln1c1-m1zaticms w811shy
baby care per1od1c ~ectiland tJle central health
center to proViAle care tor illnes If (36 p299)
bis propWI VUDOt ~ttullytunct10DIDI at the t1JDe
it d1cu8ae4 18 tbe Uterature aDd all aernce Were
be1Dl provided 1D_~terBowever itwould ae
tbat the ntua1pro~ as aY1ioae4by its plmmers
would boclJ aoaeot bull 4efeot~ otthe current lud1cal
ccde teaIt pObullbulllne_t coorctJl8td admSDtshy
etration eD4 well 4eftlopecl refelTal procedtlreacould
1I1a~ thecOllDeCticmof t~_t8 withappropr1ate preTellshy
t1 aD4 therapeu1ampcaen1cbullbull aV81lable 111 diffrent
locationa Bowner tile barrieraottiaeaDdUatanc
between center and truaraUon tor the UDSopb1aticated
patieatlook1Dl tor 1her1~pJce too tor ~1CU-
larhalth serfplusmnQewoGl4~to JJa1t tbbll1ty o~
tb18 ~811D to provide iaaiYCOliprelleU1P18hboltleod
health servicebullbull III tactmiddot tappeareto coDtlict with
tbepro own taW cOfdotpro-1~a tam1ly
mecl1cal careprogru 111 wIa10h pre-teAtlYe aDd therapeutic
health erY1cecan be proY-lW to all IIl81Ibers of
tamily in the coure of aaSDll vi8it (36 PP301-3(2)
Dle Delmtr Coloradoprepa11ke the Montet1ori
LI
17
prograJlut111zbullbull abe1rarcJly ot SlDa11 aatellItestations
andlerer IIOreceDtallzedtac11It1es It 41ffers
howeverill tbcolap~81vene80f the services avail shy
able Inthe 4ecentraUzed facIJJtiesIt resembles very
clc)sely the IOdel ~ordecentral1zed social servicedell shy
very developed by 1ahII~ Which was 41sCussed above he
SIlall neImiddotgbborhoodmiddot c8Dt~aw1tb1n walkl distance of
most of the populatiotl havebeendesilDedto take care
of allthenorllalhealth probl of 3000-5000 patJentsshy
check-ups IlzatiOZl8s1Jlpl laboratory testa and
treataentand iaecucatlol18 (d1apeued by phyS1cians) for
IIOst DODCrltIcal 1l11le PatIent 1d1Oneed IIOrespecIal-
Ized care are reterrecttobacJalp facilities BaCkup
support tor themiddot~t1oDa are the tWo l8rsernelshborhood
health C8Dter8~ttr1Dl aCOglete~e of out-patient
serneeaDd three part1clpat1q hoap1iampl bull bullbull which
proVide1Dpat18Dt~t andcoDSUltatlve services
(13 p1028) Intb1a prosrama coaprehens1ve range of
prevent1ve aDd trea1aeDt serric 18 aVailable throughout
the decentraUzed middotta The CoapreheulY8 ReIgbborhood Hea1~ Service Project
otKa1er iC)UDdatlcm HOspitals 111 Portlan4 OreOD 1s
s1ll11arto th DenVer prosraa 1D thata comprehensive range
ot out-patientmiddot services 1D prov14e4 in each of 1ts 10cashy
t1oDa althoUlhmiddotmiddot tbe oentera are larger and l bullbulls DDIerous
than 1nth DenverproPUh (12 p6)
Li i
18
In order that a comprehensive neighborhood health
care center be able to proVide continuity of care it
must have arrangements for hospital services integrated
into th system Yarby (37 p73) as quoted above
states that it 1s characteristic of the neighborhood
health center to be directly connected with a teaching
hospital However De Diaz (14p3) indicates that it
may be advantageous for purposes of service delivery not
to havemiddotthe center affiliated with a teaching hospital
She feels that such anaft11iation may lead to asltuation
in which policies might be determined more by the teaching
needs of a medical school than by the service needs of
the patient
middotThe Nat10nalmiddotCommissionmiddoton Community Health Services
(25 p69) states that such a system of comprehensive
health care integrat1na ~e servicmiddotes of several health
and roedical agencies snould utilize Itas much single or
unified management as possible Neighborhood health
centers have been operated under a variety of auspices
but several writers have pointed out the advantages in
termsof coordinated prOvision of servictts management by
the hospital of the neighborhood health center For
instancethisfac111tates the keeping of unified medical
records of all the care a patient Msrecelved either at
the neighborhood health center or _le hospitalized
(12p6) ~ermore a3 Young (38 p1741) points out
19
direct operationot the u1sbborhood health oenter by
the hoSpital canll8lceaftilable to the center expertise lt bull
in sOlle aapcta 0 Operation that m18ht not be aa readily
available otherwie
Relardlebullbull of wbetberthe hospital and the neighborshy
hoodhealtbcent8r haVe a cOJIIIOaadmjntstration they
IIlU8thaVealTlved at a str1Dsent delineation of IDUtUal
role and reSpoDBlbilltiebullbull All OOIIpoienta ot the care
yst IIlWStQlarify and understand one anothers position
In the syatem and acree on objeCtive ancimethOds
(26 pp16-17p31) SODae areas of iDUtUalconcemare
reterral procedures record keepiDg aDC1 mutual use of
facilit1es statt1Dl i8 anotb8r ~ ot coaaon conc~
Ditt1cultift have u-laeniD the pastiD cOllprehensive bull t bull
healtbc~ prosraumiddot 1d11ch were batil plauned in wb1ch
all of the health canter phy1C~1IDa did DOt bavetatf
privilege at all ot thebackuJlhospltala (29 p21)
SUch a8ituat10n i8 1Dampcceptablelt inpatient care i8 to
continue to be p4by the pat1eatmiddot health center
physician and it cont1Du1ty ot care 18 to be maintained
Hoapital and health center1lUSt laav 301nt responsibility
tor the recruitaentot physicians
VticlentU IPan BJcNrcu Much otwhat haa b8ea sUd has stre88e4 at leastmiddot
iJlplicit17tbaD8ed tor tM etticit middotprovision ot8emcea
20
There appears to be two aspects of efficiency which are
discussed by writers on the su~3ect of the comprehensive
neighborhood health care centef one of these is the
need to organize) services to make the most efficient and
economical use of scarce medical care resources The
other closelyrelat8d in realIty is the need to help
the public use services in the most efficient manner
The comprehensive neighborhood health center concept
1s lhherentlymiddot efficient in that preventive curative and
rehabilitative health ~are programs are coordinated under
one roof with integrated a~stration Furthermore
theempbasLson prevention health education and early
disease detectionis eftic1ent troJll~estandpoint of
the health care system as well as beneficial to the patient
(18 p760) HQwever ~ue tothe scarcity of health care
personnel thecoiDprehensive neighborhood health center
mustbe an arena tor eXperimentation with new staffing
patterns~ The Kaiser program is indicative of the way
in which health care systems must begin to operate in
that appropr1ate ancillary personnel are used Wherever
possible to perform functions that do not need to be
carried out by the physician As Saward (32 p42)
states
1hroughou10ur organ1zat1on~ there are many of the customary experiments be1ngmade-shyJse of speciallr trained nurses for well-baby care under the SUpervision of the pedi9trlcianexperiments with routine prenatal care by
w ~
21
middotSPC1a1l~t~JlUrbullbull per8ema_1 bullJmdlJleu y our fuDotlou are auoh that DOtb1Da 18 dorutbYtbe phY8iCianstbat doe DOt vet to be done by the
phys1c111U1fhe other aldlle4 person- Del-nurse middotreC~0D18t the appo1ntshymeDt center or clerical praormelshyaremiddot there to free h1amiddotto use his spec1al sk111
Awell lmoWn treDd1D the area of eaaiDI health
c8re JII8DPOY8rShortagjs bas middotbe thetrend toward tra1nshy
1DB poverty area rea1deats as DOD~pro~eaionalmiddoth8lth
aide and nepborboocl health workeramiddot (28 p63) This
bas the effectofmiddotmiddot1J)creaa1q II8DPOWrand 8180 can help
bridle the cuJ~ cap betweenprondera and colllUmers
of aen1C8s This attarD at least tlleoretically
createa a situation 1D WIa1ch providers andcoD8Ullers can
be educated to UDderatad OD88DOtber and interactJlore
ettectlvely~ HoWever amiddotpltt8ll has beeD themiddot tel14ency in
801D8 oamp8e8 tomiddot us aidesmiddot ssale8lllcw t~r the center
alJDOatexclwdY811rathertbaD ua1Dltheal to protide the
health care for wh1ch ~ were trained (29 pp3B-39)
1bat ismiddotmiddot vh1~e the a14e Yalue in ~~m1catiDI with
low 1nCOlMt patieata haa beeR recoSD1zed and stressed
their role ashealtb carepersoDDelhil been slighted 1n )
any 1Dstancea
Anotber step 1d11Ob bullbull been taken to provide 8rY1ces
more efficiently eUeot1ftlybas beenmiddot theorgan1zation
of per8ODDeliDto IIllt141sc1pl1Dary teamaaaa means ot
proYid1DgmiddotCOQrd1DatedserY1ce SUch te8lll8 sen_rally
~
hf
~
22
include PhYsiciaQs nursbullbullbullbull soc1al workers and outreach
workers Conceptually th8y fmlct10n to me~ the intershy
relate lled1cal and social needs ot the families sened
Hor there are a number ot barriers to the etfectve
tlmctiOD1nlof lIuchte8ll8 SODieot these are heavy caseshy
loads the inordiDate amount ot tille consumed by multlshy
prOblem tamtliethel1m1ted tra1n1 ngmiddotmiddotand laCk of tnterest
on tile part ot aoae tebers in examinJng aspects of
problems out14e~lr oWn areaaotcolIPetencemiddot and
~ourdcation prc)blell8 between proteasioDala and nonshy
prot81~s (10ppa-10) middotrurtbemOre as De Diaz
(14 middotp6)1nd1cate tbel8 maybe a teDdency tor vertical
dp8rtmental lines of auperv1810nto become paramount
over the team coDamloation syst lead1ngto conflIcts
in determ1niDI the ro1ea ot solie team bers particularly
the DOD-prote81011alaInauch exper1l1enta Witb new
~t1Dlpatterna it 1s bullbullaentialtbat line of authority
roles aDd NsP0D81bll1tlea be made explicit and that there
beJDechaD 8IUI tor relUlar evaluat1onotfunctlorUng
Another way inwb1ch health care sernee delivery can
be made more ett1cl8Dt is to proVide servicea dur1DC the
hours whentbey aremiddot -ostnee4ed As reQo_ded by Yarby
(37p1) serY1ce can bemadelIOre accesslble by making
themava1lable 24 hours a day seven days a week If
rg8l1Cy service are aft11ab1e aroua4-tbe-cloek at ~
nil1iborhood health center the continuity ot tbepat1ent ts
23
careiamaiDtalDedand meatry point into the
cOIIPre~i health care 8 be made available
tothe patient who aoZMllyU8ea ozilymiddot emergency care in
tille of med1cal criais More 8isDificantly ava11ab1-
lity of a tull rase of bullbullrv1c8 tor seVeral hours 11the
eVerlna aI1Cl On ~ prevent the los ot earn1JiSs
involved if th patierat 1IU8tt8cet1me oftfroawork dur1q
the d8y for aed1Cal oare bull his can be an eSpecially
importantc0J1814eration tor lo1aCOlleDUUg1nally qloYEtd
patient aa4caJla18o PIOJIOtet1)e 0Da01Dl use othealth
servicebullbull
exper1eDO ot tbeKa1er prosraa in tb1s~reprdAs
Greenl1clt(19 p10) states wA lllNt 8ip1flcant
proportion ot the abulatory care 8n1cp~Y1dd tor ~
total popUlatiC)U ~ ~ after clWc hours and this
Deed i8 apParenUyaoN prODGUDced tor aJl8d1cally
iDCust population On the other hand the bulk ot all
aabulatory med1cal cu 88l91ce are performed dur1nS
regular cl1D1c hour eVen when services are available 24
hours a dayJ day bull week W
It has ~ the experi8D~eof a ftIDber ot ne1g1lboXshy
hooct hea1tbcentere _t a_jor obstacle to efficient
proViSion ot anicbullbullhas beentbe teD4eDcy of medically
1ncl1pnt patieats to utilize the center oa a walk-in
baais tor epi8od1ccr181or1entect bullbullrv1cea rather than
4)i
h~ ~~f ~~ L
24
to make appoJlltaeata tor ODIo1qprevmt1ve treataent
and rehebl11tat1Ye care ad ampl1O to bave a blah failure
to Show rat_for tbe appo1DtaeDts that they dO make
Atone center 628 of appo1Dtments made were kept
while 3Oottbepati_ta een were ~1n patients
AlthoUP fewer patiets were actually 88811 by the cater
1D middottb1s 1Datance thaathe -bervholuidmadeappointshy
mta the walk-iD patlat required an iDord1nate amount
ot staff t1ae tor aCreeDiaaacl ~trral to pplOprlate
~ttor caregt (9 pgg) Arraquotbr1llpl1catjo~ of the
plOVidedto valk-iD patient by other thaD their
(19 p12)rurtbermore
when patients uti11ze Wlk-1Il er181 centered care
athelr ODlf tona ot ootact with the _d1~ care
ay_ta fUilycentered care the treata_t of tUl11y
bers
a a UD1t 11
dlarupted
hewalk-1Dphenoaaencm appear to barelated to
diUerence between soclal clase in the style of Dlaking
contactJt1th the a11oal C~ay8t As Greenlick f ~
(19 p11)1Dd1oate8 thepheDOaenOn ot INater usage of shy
walk-in ervice by aed10ally middot1Jid11ent patient thaD by
others baa otte been attr1buted to a stoical att1tude
tQward 1llDe8 em the~ ot poor people leacl1D8 to a
~
25
greaterdelay1n tbe k i Dlofa8d1cal care These
patients wppoedlyeelcmiddotcareODlymiddotwIleD tbeirmiddotillDess
becOlles1Dtolerable resultiDSin middotthMr appeariDS withshy
outnot1ce1o rece1ve oareHlwever Greenlicks
r8aearcbbaa cut doubt on the existence ot tb1delay
111 report1Dg middot8J1IPtoJumiddotOfDeW 11laessand seek1ng care
Be bas tcrQDd 1bat s1ll11ar peze_tases of dioally
1nd1sent 8DClJ1on-aed1cally 1Dd1PD~ pat1enta seek care
on the aue daytbat aptou tirstaPPear
1fb11e GrHDllclc 1nd1cat tbat the reasonator the
greatertendeDCY of low 1Do~e pat18Ilta to 1$8 walk-in I
serY1ces are notlcDo1rAmiddotmiddot tbe7 _ be rel~tedto a tendency
ot lower aocio-ecaaaoclaa patieota to preter face-toshy ~
face contacts with II841cal persoDl181posslbly because
such contacts areft coatortiDS an4reasauriDS to
patients who are hJpotbeafzed to bave a dependent attltude
toward IIed1Cal care perS0Jm81 (30 p161)
It a8 itmiddot baa pnerally beenhld the appointment
s1stemts the most efficient Ileana of dellveriDS
comprehenSive oODtllluiDlh-lth care (9~100)1t is
necessary that educaUoraalmiddotbulltfort be taken to proaote the
use ot middotappo1ntaents8DClmiddot tQrec1ucethe fa111re to appe~
ratB4uOatioaalwhlQb baft~utl11zedhave been
IJ
26
1Dten1ews with walk-in patients home Vi8its and group 4i
meetiDp1D8D attemptto1Dierpret1o the patients
the value of rtitgular ppo1ntmentamp andot con~in~
c~1ve care rather than epiI041c care (9 p1OO)
h1s 1safuD~tioD torwhtch nOl~prot81QDal colDlllUD1ty
YOrkersllaY bebe~r8U11ed tban other statf H()wever
euch aD ~ucat1oaal propul __~ ~e related to the senUiDe
capacity otth health oenter to provide comprehensivebull gt
ervice8 to1tpat1_t~odoD aD app01ntment bas18 It
1amp pos8ibleo~rw1 tor educa110Dal ttorts to result
LD a~8JImCl tor ltPP01ntaen~8 at a ratewb1ohi8beyond
the capacity ot thee_tar to t without uareaaoDably
1_ wa1t1Dlprio4a QOBt1nuad use Ot the center on a
wallt-in bU1 _1tbeoosiItpos81ble to et an appoint-
met anc11nCreued pit1entcoJaplampia1a bull Therew111 of
course always be a need and demand tor acute ep1so~c
Care -ci the health centerDlWlt be planned with the capashy
billty ot bullbullbullt1D8 tb1aneed wh1~ cont1Du1nI to stress
aDd educate the patient to utillze oDlOinI comprehensive
faa11y middotc~te~d Cflre (9p 100l
att g4 CODClva1opa
In order to bea4equate any coJlltemporary health care SY8tem muat bullbulletcerta1D interrelated criteria he
IJ
27
minimum criteria areaccessability of services to those
who need them compr8heX1siveness and appropriatness of
services and efficIency 1nthft utilizat~on of SCarce
health care personnel and resources The scareity of
pex-sonnel andtbe need for h1gh quality ongoinghealth
care services
aJIlong the
populationdemanci the most effishy
cientprovision of services
Services must be made accessible to the population
They mustmiddotbe geosraPh1cally accessible to remove the PhysicalmiddotbaTiers betWeen peopleandthem$d1calcare
system They mUst otter their services dur1ngthe
hours when people can make the moat use ofthemA~ it
makes little sense to concentrate services geographically
where they will not be uSed to their fUllest extent it
also is wasteful to provide serv1cesonlydur1righours when
many people are employed his not only presents a hard
ship middotto the consUmer lnrt wastes resources if for instance
the unavailability of preventive services during the hours
when people Can use them causes a need for treatment
services later on
Health carbull sEtrvices must be comprehensive including
prevention treatmcmtand re)abimiddot11tation Ambulatory I
healtbcare facilities wh1cQ are orienteciexclusively
toward either prevept1on or trea1mentare no longer accepshy
table for they are lneft1c1entln their use of resources
and in their prov1s1on of health care to the patient
w ~~
28
If prevent10n1s notmiddot stressed treatment serv1ces that
could have beenavoidedY1l~ be required If prevention
1s the sole focus of the health care facility sick
patients who present themselves must be referred elseshy
where for treatment andsllch referx-als may be taken as
reject1onsor not followed through with until illness
becomes unbearable
The instltutlontbat meets these requirements Is
the comprehensive neighborhood health center It 1s a
local decentralized outpatient facilityprOVld1ng a
fUll range of ambulatoJY health care services It has
a linkage to ahospitalbackUp facilityforlnpatient
treatment and hiihlY apclalized outpatient care
The neighborhood health center must be a fac11ity
planned with an awareness of the needs of the conSUtller
and coDitnUn1ty It must have the r~Ul0urces to provide the
services people need mere they can use them and when
they can use them It must uti11ze the part1cipation of
the community to develop this awareness Not only must
the cen~er beset up to be Amctional for the consumers
but efforts must bemadeaga1n with commun1ty partici shy
pation to help the consumers utilize medical care
services effectively The center muetmake efforts to
educate the community about the valueot regUlar health
care of preventive servicesand of the use of planned
IJ
29
medical appointments ratherthanorisis centered walk-
incare Therealit1es of the existing health care
system have not taught the patient particularly the low
income patienthow to use services effectively
The helthcenterilUst also bea laboratory for
experiments in easing the health caJepersonnel shortage
and c60rd1Datingcare~ A major difficultY iri-exper1shy
menting with neW rolesis freeing staff of old preconshy
ceptions
CoDlprehensiva neighborhood health dare centers have
been developed under a variety ot alisplces including
medicalsociet1es hoSP1talsmiddot(36p299 group pr~ct1ces
(29 p6- 12 117) health departments (13 p1027) and
ne1gbbothoodassoc1ations(14) The literature indicates
somevalues nthe management ot the health center by plusmnts
hospital backup faCility Whatever the auspices many
adm1nistrative fuDctions such as program coordination
standard pr9tectionand evaluation call for considerable
c~tralization of adm1nistration city-wide or coU)tyshy
wide At the same time other aspects hours of servlce
for examPle~ cuI f~radm1nistrative fUnctions made atmiddot
more local levels Each neighborhood center must be
free to adapt its functioning to itscominunity thi-ough
the mechanism otcODlllUl11~ participation inmiddot policy making
Obviouslythe prerogatives and responsibilities of each level must be negotiated and made explic1t
t4~
JJ
BIBLIOGRAPHY 30
1 American Rehabilitation Foundation ~ealth Services Research Center The Health Maintenance Strategy mimeo 1971
2 Anderson Nancy N Comprehensive Health Planning in the States A Study and Critical Analysis Institute for Interdisciplinary Studies American Rehab ilitation Foundation 1958
3 Andrus Len Hughes Comprehensive Health Planning Through Community Demonstration Health Projects mimeo1967
4 Barry Mildred CandCecil G Sheps A New Model for Community Health Planning unpublished paper presented to the American
Public Health Aseociation1967
5 Blum HenrikL Fred Wahl Genelle M Lemon Robert Jorulin and Glen W Kent The Multipurpose Worker and the Neighborhood Multiservice Center InitialImplications and EJeperiences of the Rodeo CommunityService CenterAmerican Journal of Public Health58 (Mar 168) pp 458-468 shy
6 Blum MichaelD and Soloman L Levy A Design for Service Delivery that Reinforces Constructive Tension Between a Health Center and Its (sic) ConSUDlers and Supports Community Power unpUblished paper presented to the American Public Health Asaociatiltn 1968
7 Brielaud Donald Comm~ity Advisory Boards and Maximum Feasible Participation American Journal of Public Health 61 (Feb 1971) pp 292-296 shy
8 Burns Eveline M Health Insurance Not If or When But What Kind Madison Wisco~sin University of WisconsinScllool of Soci~l Work 1971
9 Campbell John Working ~elationships Between Providers and Conshysumers in a Neighborhood Health CenterU American Journal2 Public Health 61 (Jan 1971) pp 97-103
10 Caxr Willene Neighborhood Health Centers Funded by the Office of Economic Opportunity mimeo 1970~
11 Colombo Theodore J Ernest W Sawardand Merwyn R Greenlick The Integration of an OEO Health Program into a Prepaid Comrehensive Group Practice Plan American Journal of Public Health 59 (April 1969) pp 641-650~ -
12 Comprehensive Neighborhood Health Services Projectof Kaiser FoundatioIl Hospital~ Prcgtgram YearE grant renewal proposal mimeo~1971 bull
13 CowenDavidL~ Denvers Neighborhood Health Program Public Health Reports 84 (Dec 1969) pp 1027-1031
IJ
14 De Diaz Sharon Daniel Beyond Rhetoric The NENA Health31 Center After One Year unpublished paper pres~rited to the American Public Health Association 1970
15middot Gerrie NorrrianF and RichardH~ Ferraro Organizing a Program for Dental Care in a Neighborhood Health Center Public Health Reports 8 (Aug 1968) pp 419-428
16 Gordon JeoffreyB~ The Politics of Community Medicine Projects A Conflict Analysis Medical Care 7 (Nov -Dec 1969) pp 419-428 shy
17 Greely David The Neighborhood Health Center Program and Its Implication(3 for Medical Care H~alth Forum of the Welfare Council of Metropolitan Chicago (mimeo) 1967
18 Greenlick Merwyn R Newgtimensions in Health Care American JOurnal of Pharmacentical Education 34 (Dec 1970) pp 754-4
19 GreenlickMerwyn R Donald K Freeborn TheodoreJbull Colombo Jeffrey Abull Pruesin and Erne$t W saw~d Comparing the
Use of Medical Care Services by a Medically Indigent and a General MemberShip Population in a Comprehensive Prepaid Group Practice Prosram II unpublished paper presented to the AmericanPublic Aesociation1970
20 H~tadoArJiloldVMerllYll RGreenlick and TheodoreJ Colombo Determinants of Medical Care Utilization Failure to Keep Appointments unpublished paper presented to the American Public Health Association 1971
21 Johnson Richard E and Merwyn R Greenlick Comprehensive Medical Care A Problem and Cballengeto Pharmacy ff AJilericanJournal of PbarmacenticalEducation 33 (Aug 1969) pp 361-367 -
22 Kahn Alfred J Studiee Social Policy and Planning New York Russell Sage Foundation 1969
23 Kotler Milton Neyhborhood Government Local Foundations 2 Political~New York The BobbsMerrill Company 1969
24 NationalCommisaion on CommunityHealthSfrvic~sActionPlanniriamp for Community SetithServices~ashington p C Public Affairs-Press 19t7
25 National Commission on C~mmunity Health Services Health Adminishysration andOrMPization l the Decade Ali9$-d Washington D C Public Affairs Press 1967
26 NationalCornmiesion onqomm1Jllity Health Servicesbull Health ~ Facilities Washington D C PUblic Affairs Press 1967 bull
~ n
32 27 ODonnell Edward J and Marilyn M Sullivan ServiceDelivery
and Social Action Through the Neighborhood Center A Review of Research tt Welfare ~ Review 7 (Nov~Dec 1969) pp 112
28 Office of Economic Opportunity Second Annual Report Washington D C~ U S Government Printing Office 1966
29 Office of EConomic Opportunity and the Medical Foundation of Be~laire Ohio Eighth Report 2l ~ Committee2a Governshy
ment OperatiOll~ Va8hiiiSton D C Government Printing Office 1969
30 Pope Clyde R Samuel S Yoshioka and Merwyn R Greenlick Determinants of Medical Care Utilization nhe Use of the Telephone for ReportiDg Symptons Journal of Health and SocialBebavior12 (June 1971) pp155-162 shy
31 RenthalA Gerald nComprehensive Health Centers in Large US Cities American Journal of Public Health 61 (Feb 1971) pp 324-336 shy
32 Saward Ernest W The Relevance of Prepaid Group Practice to the Effective Delivery ofHealthServicestt The New Physician 18 (Jan 1969) pp39-44 - shy
33bull Schorr Lisbeth Bamberger and Joseph T English Background Content and Significant IssUes in Neighborhood Health
Center Programs Milbank Memorial ~ Quarterly 46 July 1968) part 1pp 289-296
34 Weiss James E and Merwyn RGreenlick UDeterminants of MedioalCareUtilization The Effects of Social Class and Distance on Contacts With the Medical Care System Medical~ 8 (Nov-Dec 1970 pp 456-462
35 Weiss James E MerwynR Greenlick and Joseph F Jones Determinants of Medical Care Utilization The Impact of Ecological Factorstt unpublished paper presented to the American Public Health Association 1970
36 Wise Harold B Montefiore Hospital Neighborhood Medical Demonstration A Case StudyMilbaDkMemorial Fund Quarterly46 (July 1968) part 1 pp297-308~
37 Yerby Alonzo S ttHealth Departments Hospital and Health Services Medica1~5 (March-April 1967) pp 70-74
38 Young M M~ Chatanooga IS Experience with Reorganization fOr Delivery of Health Services ttAmerican Journ8l of Public Health60 (Sept 1970) pp 1739-1748
f or l
II bull 11 Y d
II
IJ
34
ThepurposeOfPart II of th1aa paper1atod1scuas
elected Speclfic needs ofecltlc areas within Multnomah
County A8P01ll~oUt 1D ~ I of t1a1bullpapermiddot Ita nelgbshy
borhood health oare cater IlU8t be a facl1lty plaDlled with
aD awarenes of the neeels of the oODllUller and collllUDity
Part II of this paper nIl Show 80e of thoe speclflc
needs
he1DforutiOD tor t1li Portlon of the report
obta1nec1 troll tbroupout tbe follow1Dl threepUb11catloDS
1gr~e_tiMshylIPrIxaiidOreson JuDe 1963
2 1~_middot_sectSI8e~ected1teai c-ua 0 S 8 e first count coaputer tape Coluab a_lion AssocshylatloD of QoveraMD-8 Jlme 1971
3 Jtu1tDoab County Oreaon BDY1roDlHtlltal SurveyEarly 1971
The JIultDOIIIlb COUDty OrttIOD BDv1roDllfmtal Surley
Barly 1971 1s bull stat1stical report of the activ1tles of
theentlreMultDOIIIl2 CcNDty Health Dep~t during the
year of 1970 Die speclflc 1nd1cs elected from tb1s
study amprejMental aealtll Publlc Health N~s1D1 vlslts
FaJUly ~ Veaereal])1 ~ ~rcul081
Throush tie use of cUrts and mapa ODe CaD roup these i
speclflc ~oea to ahcnr the healthneedsof speclfic I
census trtcta aD4 then the health needs of iarer neIghshy
borhooda 1m4 o~ Uebullbull
Rf)~UP1Dl of areu was accompllshed in thefolloWinl I
JJ ~
35
he MiltDoIliahCountY oregon BDViromaental SUrvey
early 1971 isamp statistical report ot tbeaotivities ot
the entire MultDolllh COUDty Health ])epartiDent dur1nl the
year ot1970 he specitic 1Dd1C8S selected frOm this
aUy are 1Il8Dtal health public healthDurs8s visits
fUl1ly pia waereal elisease aDd tuberculosia
Tbroq11the Wle otcbart aDd mapa aDecm szoup these
specific indic to show the health Deeds ofapecitic
ccmaua tracts aDdtIum th8health neecla of larsr ~eilh-
bOrhooda and co8I13 tlbullbullbull
RegroupiDI ot areas waa accoap118hed1D the
tollOWiDl lIIIIm1er~ A bullbullcifie 1ndex 8selectcl auch as
venereal di8bullbulle or tuberculo8i~ he total number ot
cs was then deterll1ne4 for each census tract Through
the use of the maber ot cRbullbullbull tor a 11Yen cenaus tract
aDd tbe population ot thattractaltrateot1lla1ampmcper
100OOOpopUlaticm wu cleteXll1ned for each census tract
This was ~e to starl4ard1ze the population ditterence
amongOeD8U8 -tracts 1he rate of incidence toreaob
cenauatract was then llstedby rank position on a chart
In rank poition1DI any cen8Wl tracts haviDg equal
rates ot1l1c1dence are assipe4tbe iaDk posttiona
Beeauseot the abo fact tbAt cbarta w111 vary in length
neveltbAtlea eacb cbart will 1Dclu4eall census tracts
inMullnoaah Couaty Atter the census tracts bave been
listed accord1q to raalcth1s list will bediv1ded into
IJ
36 three levelsotinc14ence he three levels are
1~ The upper 14 of1DcldenCe
2 Thelower 14 ot incidence
middot3 The ILld 12 of incidence
Tlles three srouplqa are then used in compiling a map ~f
Mu1tnOmahCountyfor ach apecltictop1cbull TIle maps are
uaefuJliD tbatthey V1suallycoJib1De 1Dd1v1Clualproblem
census tracts into larger problem nellhbOrhooc1s
The 1960 statistical iDtormatloD was Used in a similar
liIaDDr to tbatexpla1Dedabove 1Dthe4evelopaent of a
chartmiddot and map 1Ihow1DI e cOllpampriSOr1 of per capita lncolle
tor ttaCh ceDsua tJact aDdmiddot combiDed census middotmiddottract areas
he 1910 aDd 1960 statlstlcal iDtOrllatl0D was combined
lna map and chart he purpose of this and chart is
to d8aonatrate the e cl1stributloa1DeachceD8U8 tract
and middot1ndlcatbull tuture ace populatlon treD4a bull
When one be middotbullbullbullbullbullHdth ne8cts ot an area and has
declded to establlsh a cl1D1c to serve that area the
physical location otthat cl1D1c IllU8t be consldered In
order to coapreb8ll81vel develop an area cl1n1c one should
conslder thepre88Dttraftlc middot~ytaa an4tranaportatlon
systems Thecl1D1cahoUld be located close enoUlh to
major arterlals to giva asy access from the total area
be_ ervecl by this cliD1c At the t1ll8they should
be tar eo away froll thesarterlals to all8Y1ate traffic
CODCell18 andpark1D8 conpstlon By traff1c concerns I
IJ
37
lIlan one lUSt consider thertarro1fne8S of streets whether
streets are oD8--C)r two-way iqres8 and egress to parking
amp0111tie eros tratflC) spedof trattJQ children 1n
ll8a traffic i1lht Vislon re8tr1ctionS etc
BwstraDsportat1onshould alao be central in this area
as maay people ~U f1Df1 1tD8Cessary to use this form of
transportatlon
~e tutqredlopHQt of bull treewa systems should be
c0J1S1dered soastolesen thecumce ofmiddot future roada
cutt1DSotltbe cl1D1c llte line
nrrph1c middotDampta
It is 1JDportaDtto kDOw the demosraphic distribution
characteristics of the oUenteltbat i8 to be served by
localized health cl1D1cs
Acl1D1c which erves8J1 area where1D the prepondershy
ance of persona arecrter 65 years of mayf1nd that these
people rely more on pUblic transportation call for more
home- services and haV4t 110ft ChroD1c and debilitating
types of disorders (b1_ blood pressure poor heariDg and
eyesight) tbaD do8 an area ot a YOUDIer population On
the other hand thL area of older residents may have little
need for family plabDlng cllni08
In order to better ~Ybullbull the 4eaoraphic population
of each CeD8U8 tract the 1970 CeD8U8 iatormation was viewed
and two specific catelOri8 considered These two cat
IJ
38
lori8S woUld be the perc_tap ot population under 19
year of ase and the percentase ot each oensuetractover
65 years of age he 1960 1Dtormatlon tor eaCh tract was
then compared witbthe 1970 intormation and a percentage
ofincreaae or4ecreamp8 tormiddot e~chtract1n each category
cOJlputecland achartma4e By the use of this chart one
18 able to View tJleap populat1odiatr1but10n of census
tract and at the _ t1lle accesa middottrencl Por example
let us choose census tract 601 W see 40-4 otthe
population is under 19 years ot and that ODly82 1s
over 65 years ot middotAtthe e tille the percentage of
youth bas ~ed ODly 1_ intbe laSt teD year whilethe
percentale over 65 year ot middotbas stayedmiddotthe same With
this in mJnc1 ODe ~ 1DfItr libat ol1D1o aerviDg this
area WOuld bellQre conq~w1th the problems of a
YOUQier populat1on and that _ would probably be true foJ
some t1aein tbefuture On the other hand CeDSU8 tract 54
has only 2 ollt population UDder 19 yel1s ot age and
this has decreased by 1 over the last ten years middotwhile at
the same time 32-377 ot the populat1on 18 over 65 years of
age A ol1D1C ___ this area should be or1eJ1ted toward
tbespecttic problema otthe ampledbull
PerCapia __ bY gsa neat
WhaD cona1der1qlooat10D1 tor health cl1n1cs one
shoUld take the 1DC01Ieot areas into consideration Areas
IJ
39
of lowiDcome would not 11kel~be 8erved more by localized
cl1D1cs tbaD would are of hilbincome It 18 likely
people haYiq a hip iDeoll8would preter to be aeenby a
chosen ~r1vatephylc1a1l tban at a local cl1D1cwhere
10Dier waits y beraceaaampryand leas personal attention
gl_
The 19701ncOII81atoWampt10n tor MultnomahC~ty was
not available at the tille thi8report W88 made The 1Dto~shy
tiOD Was taken ~adtro tbe1960 census publlcation
his woUld ~8Il thea tbat ral1I8 OD the chart ynot 1raquoe
completely accurate hi writer telthatthe areas most
affected by tb8 1I8eof the older 1Dco1DtOlaat1oDWOuld be
those tracts wh1ch baYebad a rapid 1ncreaae1n populatlon
over the past tfmyHr8 bullbullbull tracts would include tracts
nUmbered 104 9897 96 aDd 95 be perc~ita 1Dcome
referredto1il-tb1a Paper18the lIean 1DCo per person per
census tract
Attar the iDeoeper census tract was listed on a chart
a map was de 1D41catiDg those census tracts belonging to
the lower 14 ot income tor all censue tracts in Multnomah
COlDltytbose beloqins to the upper 14 ot income tor all
census tract 111 MultnolUlhCounty and those belonging to
the mid 12 ot 1I1coaetor all oeuuetracts in Multnomah
C01mty
In yiew1Dg the _p 1t caa be seen that the low income
area seautotollow aloas the at aide ot the Wl1lamette
IJ
40
R1ver the full length of Kultnomah County A second low
income area follows the south edge of the Columbia from
the northwest corner of Multnomah County easterly to 148 St
A third problem area seems to be on the east bank of the
Willamette River with the Union Pacific Railroad being
about the center of this tract The extreme loutheast
corner of Multnomah COUDty appears to be a low income area
but as this area bas bad rapid grouth in the last ten years
this could be erroneous
Mental Health
be first ~ecific indica to be selected from the
Multnomah County envirollllental survey of early 1971 and
to be considered in this paper i8 that of Mental Health
At the present for mental health purposes Multnomah
County is divided into five catchmentareas with a mental
health cl1n1cin each area These clinics are Model
Citles Delaunay ADkeny street Office Hansen Health
Building end Southeast Clinic
All lIlental health cl1n1cslcept statlstlcal information
on all patients visiting their cl1n1cs this included the
address of the patient hese addresses were then listed
upon the approprlate C8D8US tract Each census tract was
then ranked on a chart according to the nUllber of mental
health patients who reslde ln thatCeDSUS tract attending
any of the above listed ental health clinics This chart
IJ
41
wasttum d1v14ed1ato proper quartile bbullbullbull
quartile vereUs to dne10 u appropl1ate Multnoh
County _tal health ItLa middotmiddotmiddotthelipO~a1bl by lOoJcJIUE
at the UDtal health _to uteN1De which ueu have the
lars-t use otCOllDty 1alh~th faci11t1Rot
1Ilclu4ecl 111 tbia woUld tber otpeopleYia1t1Da
pr1vat patch1atriata aDd pr1_t _ntalhealtb cl1D1c8
WheDtbe M1 18Yienclmiddot Itmiddotmiddotmiddotmiddot~middotbe~_ tbat ~rtt
appears to lMt fourmiddotmiddot-al are iii _oil the nuaber ot
lIental healthcl1D1c na1t toM tbjh1sheat 1he
tour areaa woUld be tollows
1ttrea Ore to~Blo Drimiddot ~tb Burrus14e aDd tIMtmiddot Colb1a Riftr H1gbwyaeri1Dla th nortllra boundaryshy
2 bull ProII 82D4 1_~ 10 20th streetwitil the ra1lMd Mu the north ltouadary
3 ~ et et tUgl_b1bull MYel froamiddot the Clackaaa COUDty l1ae aorth to Dln8lon stret
4 beDOlvt1ttfe-t ~efllt4 COatytrca Jle1aware streetmiddot toR1C1a11oDd wlth Colubla Blvd heiDI tbAtnorth bouaclary_
It ODe coapareatbiap to th iDeobullbullmiddotp 1t can be
eamiddotthat lIOat ot the c tracts baY1Dg bllh v1i11tatlcma
middottfl public tal health cJ1rUc8 ~ 111 t13e low ~ aid
1DcOile SroupiDIOJa1y of til 25 tracta llsted as
haviDlbip aental Maltll nlltatlou are ~ the1g60 hip
iDeo arebullbullbull
17 Plpn
42
amily PlellnSDI ]Jlce Metal Health i8 an 1nd1ce of
use Theperson 111 ordertobavebe_ 1Dcluclecl 1n this
atu4ywouldhave tohaft Ue4 ataa11y plaDI cl1D1c
tacilities of soaetype It 41fter troll tile _tal health
study1nthat i t1Jicludestatist1catrollbotb public and
privateclJD1os
The iDformation tor the iak orurcbart 8Dd map of
t8ll111 plenn1 na ob1a1De4 by cOIIblnlDlthe mabel of
1rlcuv1duals bullbull_ attbe tbreellUltrampo-ti Coatyhll11y
PlalJQllIl C11ll10s 111til tbo at the Planned PareDthood
Association CliD1C8 be tbree -JIultDouh Couaty r8ldly
PlamSq Cl1D1c are Solrtbweatth Col_bla 1111- a114
HaDsell Health BWlcl1Dl CllD1cbi middot1Dtormat1oD vas then
bullbullbullesed tomiddot detellWMt l10w people troll eacb c8IUIUS
chart wastben Mele IUs oIIart jn 4iY1ded to show
the censuS tracts lIaYiDlmiddottIle h1t1iest qUart1le of incidence
of use lowest quartile of 1Qc1deao ot use Jlid 12 of
incidence of Wle an4 a map sprepared troll thts 1Dto~
mation
The C8U118 tractsbelOJISnl to the h1lhestquartile of
use appear to be 1lO~ 8catt~ on tbipwas true ot
either the _p ot aental health cl1D1c uaageor ot the map
abow1DI per capita 1I1COM Iaere40 to be three
d18t1nct areas of UIIaP beJ woul4 be
1
IJ
43
t10D of BurD81cl and the W11lallette River 4
2 S~t Portland 8Otth otmiddot the ra11shyrcaadand alona the W11lamette River
lIortbeaat Portl8D4 between MisSiss1pp1 and 24tbStreet the northbouBclary be1DgColwb1aBlvd
Pylzl1c BMltl IrpI Y11ta
Publlc Healtil nur81D1Y1s1t nclud8 an vists to
theholles of client by PubUc Health Nurbullbullbullbull his shows
visits to bull f8Jl1ly fer aDY purpos SUCh aatuberculolJ1s
het1Dl tem1tyaeatalu4 8IiOt10D8l cODd1t1ona etc
he atat18t1C~ 1fele C()4ed accord1Dg tomiddot the 1llli301fOCUS
of the Y18lt tt doe DOt 1D41cate the Dmlber of holies or
f8ll11lev181tecl or 1D41Y14ual Y1a1ted more tban oDcein
the propwl It dobullbull I1ve 80M 1D41cat1on by coaparlshy
OD ot the 8JIoUDt of aedlcal problema 1n eachcen8WI tract
Ap1nmiddot the _p abowa 8 scatter patteraof probl_
areas althoUSh there appear to be a sroup1Dl of hiSh J
l8aIeccmaus tract 1ntlut extreme southeast part of tbe
County other areu uIriaI any nura1Dl contacts are
1 bull he 801lth-oa-al CO1Dty on eaCh 814 of 82nd Av from Clackallaa County north to Dinloa
2 ear bullbullbullt 814e aroUDd Preacottand Misaisippi
Dowatom Bunul14eonboth 1de of the river
44
V_real Pis The iDfomatloil uaec1 to tabulate the Venereal
disease chart includes all the ooab1ned case otmiddotODormea
and syphilIs reported by bothmiddot publIc and prIvate physicIans
dur1nl 1970 There were 3602 caes ot IOnorrhea reported
dur1nl 1970 While ODly 17 cabullbullsot ayphilimiddot were reported
A chart was prepUed aDd att8llPt wasmiddotmiddot de tomiddot
determ1De Wh_therVttDereal 41ease was more p~vaJent in
areas othigb or lowmiddot proportIon ot youth hi waadone
bymiddotdetemlna a 1leaD prceiltacmiddotmiddotmiddottor the population ot
resld~ts UDder19 years ot (34) middotA mean ratemiddot per
100000 popUlatIon al80c1ttem1Ded tor the middotoccurreDCe
ot venereal dieae This was et at 390 oass Areas
hav1nl a population 1n which leiS than 34 were lmder 19
years ot ampIe were called low- yOuth abOve tbl percentaae
hiSh youth The aaa waatrue ot the occurrence oivenershy
eal disea_ per CeD8UStract It the rate waacomputed
as 1I0re than 390 cases per 100000 it was called hiah
venerealdiaeasei it less than thia tisure low venereal
disease It was tound that 1D Multn~ COmlty there sems
to be poSitive OOlatI0n(x21S19gt between low youth
and hipmiddot venereal diseaand hip youth and low venereal
diseasebull
RaDk ordr Iitot all c traot middottbAm made
Th1s was done byt1Ddlna the ratepr 100000 populatIon
of venereal disator all census tracts in the County bull
45
These were thenlisted from h1lhto low (sreatest to
least) in a rank order The l1sting was then divided
into Upperandlower 14 aDd listed on the MUltnomah
Countymiddot up
The areas of b1gh venereal disease se8ll18to
roup thBl~8 middotin a very tllht area ~oq both 1des
of thell18l8~ R1 w1th BurDaldeS~et being
~bout theceDter qf tbi8IZ9uping This area woUld
appear to be m ldeal spot for the denlopment of a
locallzed venereal d1sbullbullbullbull cl1D1c
UbepoundCUlO1s
In this report bull tube1C1llosls caS8S refrred
to include alltbobullbull cabullbulls ontubercUlo8is follow-up
rather middotthan just new C Accord1Ds to the Multnomah
County Health SUrvey of early 1971 this would include
all ca repOrte4 over thelaat three years The
total number of tuberculosi8 cabullbullbull usedin this study
was 666 lh1 included 128 new cabullbullbullbull
A rate per 100000 of tuberculosis for each
census tract wa- then computed and the c~us tracts
listed by rank order be b11h Qartlle mel low
quartl1 were then reoordd on a Multnomah CoUnty map
TWo genral areaa baY1Dg a hip mcldencaot tubercu~
losiare 1D41cated heyare
1 Both middotsld ot theWilla11lette River
Ll -
46
with Burns1de about thecnter
2 he extrea Northebullbullt comer of the County bull
By coap8r1ng the tuberculois an4ven8real
diseae maps ODe can 8ee that the downtown areas ot
hiSh 1nc1denceare alIIo8t 1c1eDt1cal on ach map
This WOuld 1nd1cate that 1t would be of value to
bullbulltab11sh acl1D1c 111 th1aampreatbat would provide
bothtuberCulos1s 8Dd ytmereal 418ase srvicbullbullbull
Thchart aDd 1181gt8 are wsfuln 11v1DI
1Ddicat10DS tor the type aDd placemeototlocal
health cl1n1c8 tbro1qhout tbe MultnomahCounty area
A cOllpar1on of the mapa help one to dec1dewhether
to provide a aulti-8ervice cl1D1c or spec1f1c type of
cliD1c As stated in Part I of thi paprserv1ces
shouldhaYe both treatlieDt and prfMmt10n cOmponents
As he been stated fta ne1lbborhood health care
Qenter muat be a fac111tY plazme4 with an aamesa
ot the neds of the consumer and the c01llll1m1tybull
Part II of this rport haa been an attaapt to indicate
and clarify 8011 ottheae coDlllUDity neds This has
been done through8elect10n of apc1f1c problems
The indic were then visuallyrecorded through the
use of ups and charta ODe dan asseS8 thedsreeof
1DIportance of certain concems to spec~t1c areaa by
comparinl the chart aDd maps Prom this oDeean
41 dec1de which are48 vb1chcUD1c-or indeed if
the need a clinic at all However further factors
should be considered hebullbull include
a The amount of fuDd1 available
b What 18 the percentage ot peopleineoh ceaaua tract tbat would actually us such cl1n1cIl
c Wbat 1 tbeco--1tymiddot 8 IeeliDashyreaardtDI particular cl1D1c8 Would this dcrebullbullbullmiddot the ettctiveness ot thse cl1n1ca
IJ
li
D_OlraphicPopulatLon Challie 1960 to 1970 48
Cen8U8 1 of Pop 1 Cbaqemiddot 1 Change1 ofPopTract Under 19 Yr8 Over 65 Yrs1960-70 1960-70
middot1Q701Q70
1 319 -12 171 -H) 1
2722 215-27 +68 301 366 -22 127 +35 302 371 +19 111 -04
311middot401 144-41 +29 402 321 13~7-39 +24 501 356 124-08 -02 5~O2 351 133-23 +12
405601 82-10 -02 394602 103-01 -06
701 275 149-76 +56 702 361 +01 121 -07
+10middot801 326 140-22 802 321 middot127
(
-29 -03 9~01 342 124 -H) 6-18 902 294 128 -H) 3-24
10middotmiddot -14312 140 -17 1101 182 +25 -23197
2411102 186-59 +29 1201 226 169-17 -41
31middot01202 +11 182 -05 295 -H) 81301 208 -H) 4
1302 331 +08 197 +04
14 323 +15 middot185 -08 middotmiddot15 329 +16 16~5 -13
-28middot 1601 332 131 +12
1602 356 98 +24middot-39 middot3101701 161-33 +21
1702 370 -15 85 +02 +19 1801 264 151middot-50
185middot1802 256 +47-58
IJ ~
D_raphlc Population Change 1960 to 1970middot 49 (Contd)
4io
Census Tract
of pop Uncter 19 Yra
1Q1n
1Cha1l8e 1960-70
of PopOver 65 Yra
lQO Change
1960-70
19 389 +29 141 -24 20 223 -13 206 +18
21 227 +08 194 -36 2201 356 -27 112 +05
2202 290 -18 ll~9 -29 2301 356 -03 154 +24 2302 260 -37 245 +97
2401 410 +6~1 123 -31 2402 163 -80 320 +99 2501 381 +13 140 -01 25()2 237 31 lil +02 26 343 +25 186 +149 2701 370 +29 1S5 -01 2702 249 -44 304 +98 2801 337 +19 187 +09 2802 306 -10 156 +31 2901 304 -38 142 +24 2902 i 307 -32 146 t3~9
30 29~0 -48 16~2 +51
31 355 +30 160 +01 32 370 +48 148 -13 3301 395 +45 130 -20 3302 368 +06 138 -02 3401 386 +16 117 000
3402
400 +32 92 -26 3501 304 -07 115 +35
3502 344 000 140 -13
3601
36~02 357 -04 132 +32
3603 30~1 42 149 -67 3701 342 +28 152 +19
1
IJ
Jianolraphic Population Chan 1960 to 1970 50 (Contd)
Census Tract
of Pop Under 19 Yrs
JJl7J
middotChanae 1960-70
middotofmiddotpop Over 65 Yrs
1c~7n
Change 196070
3702 409 +39 122 -11 3801 308 -11 151 +29 3802 275 -35 180 +46 3803 282 -32 192 +54 3901 376 ~13 100 +17 3902 296 -03 177 +29 4001 438 -11 84 +13 4002 353 -21 115 +20
4101 397 11 9middot0 +11 4102 346 -19 120 +03 42 331 +19 11 bull 3 -16 43 347 -72 105 +31 44 113 +84 183 +154 4S 33~9 +07 110 -06 4601 2501 22 193 +38 4602 332 +59 126 -29 47middot 161middot 000 211 +01 48 103 -26 302 +59 49 138 +1 bull 3 252 +09 50 141 -26 204 -12 51 12 -39 257 +07 52 47 -61 351 +48 53 89 +49 314 -30 54 25 l1li15 327 -17 55 131 -17 115 -121 56 198 +93 227 -47 57 71 102 189 -88 58 240 ~middot41 16~1 +55 59 322 +25 142 +06middot 6001 264 95 132 +50
6002 328 -31middot 89 +07
JJ
Demographic Population Change 1960 to 1970 51 (Contd)
Census 1 ofPop lChange of Pop bull ChangeTract Under 19 Yrbullbull 1960-70 Over 65 Yrs 1960-70
1970 1970
61 355 -58 85 +39
62 328 39 110 +18
63 414 04 73 10
64 382 -22 72 +04
6501 383 02 67 -20
6502 329 -56 96 +09
6601 391 +13 88 -03
6602 319 -59 97 +06
6701 327 71 145 +72
6702 331 ~67 83 +1-0
6801 365 -66 49 +01
6802 388 4bull3 54 +06
69 354 -41 80 +23
70 400 -23 68 -06
71 359 -48 72 +05
72 255 -88 82 +11
73 346 -39 91 +25
74 313middot -63 105 +24
75 329 -42 129 +37
76 336 -52 85 +21
77 370 -10 69 +05
78 309 -10 120 +21
79 325 -56 87 +10
8001 358 -81 57 +12
8002 391 ~81 76 +12
81 315 -76 108 +21
8201 403 -23 64 +08
8202 392 23 65 +08
83 357 -34 120 +31
84 402 -18 73 +16
85 413 -06 76 -09
r
Demographic Population Change 1960 to 1970 52 (Contd)
Census Tract
t of Pop Uncler 19 Yrs
1970
Change 1960-70
1 of Pop OVer 65 Yrs
1970
ex Change 196070
86
87
88
89
90
91 9201
9202
93
94
95
9601
9602
9701
9702
9801
9802
99
100 I
101
102
103
10401
10402
lOS
368
351
379
391
391
413
379
433
372
429
414
432
419
439
~32
377
457 420
378 41middot7
345
360 417
417
412
-04
-02
-35
-26
-28
-11
-64
-20
-S9
-39
-32
-21
-34
-40
-47
-lO~7middot
-27middot +04
+56
+07
-34 01
+04
+04
+10
103
128
97
11il3 99
69
79
42
77
46
34 38
44
40
54
111
51middot
81
133
59
74
140
63
87
76
-08
-06
+04
+08
+17
-05
+3S -02
+1~4
+19
+33
-14
-08
+12
+26
+71
+11
-16 -34
-20
-19 +37
-49
-2S +15
NOte The The
Taken frOi
averageullder averageabove
middotUSCensus ---shy -
19 years == 6S years ==
figures 197
32r 13(14
p a~d 1960
--
Rank
1
2
3
4
5
6
7
8
9
10
11 12 -_
13
14
15
16
17
18
Tract
69 46
60
58
- 68
61
302
2501
67
63
19
62
26
94
3603
3902
64
30 -----~-
Rank
19
20
21 -
22
23-shy
24
25
26
27
28
29
30
31
32
33
34
35
36 -
Ranking of Per Capita Income by Census Tract
Tract
65
2701
- 15
1601
701
66
93
82
2903
3602
30
2502
80
2401
81
- 70
91 shy
4001
High
Rank Tractshy
-32shy37
38 97
120239
7840
41 ~ _2_1__ 42 31
43 2501
44 18
45 98
46 37
47 3803
1702
49
48
1602 92 2702
I
50 89
51 901
52 801
Ra_
53
54
55
56
57
58
59
60
61
62
63
64
6S
66
67
68
TractTract Ra~
74692
170196 70 I
401 71 90
72 1037J
79 70273
3802 74 601
24024102 75
85 76 101
77 9023901
7699 78 100 4101 79
3601 I
380180
458140~ t---- _ - - shy83 82 42
888384
59843501
4777 8~
502
Low
802 86
Rank Tract
87 shy
--88
89
90
91
92
93
94
- 95
96
97
middot98
99
100
101
102
103
104
1201
14
49
72
73
43
87
3502
105
1
52
86
71
1
501
10
3301
104 tf
Rank
105
106
107
108
109
110
III
112
113
114
115
116
117
118
119
120
121
Ranking of Per Capitalucoae by Census Tract
(Contd)
Tract Rank
4001 122--shy602
13
1102 2302
3302
55
3401
48
21
56
50
3402
lL01
2202
2301
53
2201
-shy
Tract Rank Tract Rank T~aet Rank
57 I-----
Imiddote
bull
Tract
- Low -k Note Information taken from 1960 U SCensus
Rank Tract
I ~
Ie
Imiddot
~
----
----
--
--
Rank
1
2
3
4
5
6
1
8
9
10
11
i-
-Tract
391 922 921
972 971
100
132 131 121
962 961
822 821 401
982 981
20 111
47 10 1
412
High
Total Number of Henta1 Health Visits
Ranked by Census Tract High to Low
TractTract RankTractRank Rnk
12 182 22 78 29 87 76 381 73181 ~------- 1913 371 8538230162372 271 2616-121 8272 2
14 80~2 31 94 7923 84801 59 15251362 4232 15 52 _ 32 103 8924 651 17240216 652
_ 91 351 33 341 23117 83 122 25 25 48 1123921418 34 shy61 86 661
19 662 6493 81 26 91 8153 49 50 55 41383 71 27 51 3120 90 672241 35shy 104167162 461
I 411 46211121 28 88342 I
2502 36 69 54 5251 50 272
-Ra
37
38
39
_ 40
_ 41 Ishy
I
42 I
-I 43 44
45
shy
Tract
~ --- shy 95 56
45 292 242
102 62 352 291y
92
101 281
99 72 63 601 60~ 42 2201
77 74 61 57
363 232
70
32 31
11 44 282 2202
Low l
- Tract
46 682 681 I 331 30
r~$ 47 1042 332
48 102_41_
11
~
Visits to Family Planning Clinics Ranked by Census Tract High to Low
Rank Tract Rank Tract Rankmiddot Tract Rank Tract Rank Tract Rank Tract
1
2
3
4
5
6
7
8
9
10
11
12
13middot
14
15
16
17
361
56
401
341
48
59 121
20
55
342
10
31
58
93 21
241 132
331
53
461 462
18
19
20-shy21
22
23
24
25
26
27middot
28
29
30
31
32
33
391
32
middot47 I-i-_-shy _ -
231 111
332
972 1
372 371
52
89
32
92
82
100 31
182
30 242
402
34
35
36
37
38
39
40
41
42
43
44
45
42
1714 i 661 221
78 362 2
90 602 601 352
63 251
105 921
971 351
73 42 292 232
411 51
662
81 45 52
46
47
48
49shy
50
51
52
53
54
55
56
961
801
49 81 72 71
19
9~1
172
68 2 57 162 14 112
91 75 681
381 42
3~3
83 161
57 f
58
59
60
61shy
62 Imiddot
63
Imiddot 64
65
66
64 62 36~3 252
74 652 SO 392 291
651 6bull 2
79 271
r-- ---- shy981 222
672 671
821 272
94 87
281
382
67
68
69
70
71
72
73
74
75
76
77
78
981 26 12~2
IS 61
85 82~2 69
61 43
101 86 84 282
76
131
51 72
1041 962 88 70
99 922 77
103
95 802 181
i
~
Low High
RankRank Tract
5479
4480
81 1042 ~) middot102
71 - - + ~ - ~
Visits to Family Planning Clinics
(Contd)
Tract Rank
I
Tract llaDk l
RankTract Tract Rank Tract
~
I
~
J1 ~
Low
Total Number of public Health Nursing Visits
Ranked by Census TractsHigh to Low
TractTract RankTractRank RankRank TractTractRankTractRank
25249 71 79 17249 8033 6586 99189711 84 2915072 34 661 76 66 811519512
402 5035 51 161 2518220 122 1713423 352 55801 7120 6752 2 149814 41236 83 2662 38 94 6821 53 2924015 362 37 32 42 75 69 281 84 63
546 8822 54 222 85 3925431 70383417 3818223 6439 4386652 718 21 55 103332 8924 232 87 19 271729219619 24156 16211140 382 628825 10523110 112 73411 10141-- ----shy 89 363 4457 8126 16111 221 74 9142 90 46158331 53 671279012 46243 48 59 351 3837528 1083 9313 91 5844 59 -_242 76 1----- shy60 272 72 74104114 60145 42 9287 7729 92 6151 8215 57371 934630 91 307762 12113116 282 619447 41391 9531 78100 63 7378 ~95 681 6945 32 5632 798517 6448 47 52 181
High ~ Low
Rank Tract Rank
96 31 132 70
97 102
98 182 372middot 602 651 662
- -shy
~72 682 802
822 922 962 972 982
1042 ----shy
Low
Total Number of Public Health Nursing Visits
(Contd)
Rank Rank Rank TractTract Tract
I
I lt
I
Tract Rank Tract
[
~~~-
I
~
IJilfimiddot ~
j
Ranking of VD Caea According to Census Tracts 61 By High and LOll Youth Itatio
A media~ of 34 5 was determined Any tract having greater
than 34 5~ of popu1tionunde~ 19 years of age -High~
Any tract having l8S than 345 of population under 19
years == Low
Any tract having rate less than 390 =Low
Any tract having rate more than 390 == HLgl4
YOUTH
LOW HIGH
L
0
12 402 1801 1802 343 2801 2802 29023603
54 6001 600262 66~02 72 74 75 76
78 79 81 t02 65 1202
W
(25)
VD
H
I
G
H
401 701 801802 901 902 10 1101 241 1201 1301 132 14 15 1601 1701 20~ 21 2202 2j02 2402 2502 2702 2901 303501 3502 34023801 3802 383 3902 42 44 45 4601 4602 47 48 49 SO 51~2 53 55 56 57 58 S9 6701 6702 73 95
3~02 7021702 19 25~01 2701 4102 4101 63 64601 ~601 6801 680270 7l 77 8001 80~02 8201 8202 83 84
85 86 87 88~ 90 91 9202 920193 94 9601 9602~ 9701 9102 9801 9802 99 100 101 103 10402 105 6501 10401
(47)
301 501 502 601 1602 2401 2301 2201 31 32 3301 3302 3401 3402~ 3602 3702 3901 400140 02 43 61 69 B(
(53) (23)
~ ~gt
Ranking of VD by Rate Per 100000 By Census Tract
~
Rank Tract Rank Tract Rank Tract Rank Tract llank Tract Rank Tract Rank Tract
1 2202 21 S6 40 902 58 1602 74 75
90-shy 64 107 26 --~-
2 3402 22 45 41 10 59 902 75 78 91 54 108 61
3 2301 23 3502 42 2502 60 602 76 6802 92 402 109 87
4 3302 24 49 43 1102 61 501 17 2 93 94 110 90
5 50 25 52 44 6702 62 14 78 8202 94 97 02 III 76
6 2201 26 20 6701 63 4002 8201 2501
9701 41~02 112 91
7 44 27 48 45 401 64 3802 2902 95 63 113 62
8 3301 28 1701 46 502 65 30 79 83 74 96 9602 114 71
9 55 29 47 47 42 66 3803 80 2801 96Q1 115 85 10
11
12
13
14
15
16
17
18
3401
53
2302
2401
57
21
2402
1101
51
30-shy31
32
33
34
35
36
37
3701 - -~ 1201
3702
89
43
132 131
3602
4001
48
49
50
51
52
53
54
55
58
1601
601
4602 4601
69
701
31
3901
67
68
69
70
71
72
2901
801
39021~ 802
6502 6501 122
702
41~01
81
82
83
84
85
86
87
88
19
1
1702
2802
79
93
100 6801 6602
81
97
98
99
100
101
102
103
104
9201 9202
9802 9801
77
302
79
86
72
84
116
117
118
119
120
121
3603
8002 8001
101
99
95
10401
105 10402 103 102
19
20
59
32
38
39
2702
3501
56
57
301
3801
73 1802 1801
89 6002 6001
105
106
2701
88
High Low
-- -----
Rank OrdermiddotTuberclosis Cases by Rate Per 100000 Ranked by Census Tract High to Low
Tract TractRankTractRank Rank TractRaukTractRankTractRank
801
79 9601501411 52 6835340120511 I 960269 903603532036 $-~~F130221542 4366 311301 70 68~013802 _ I- _ 4001_37213 3921201 6802802 H71523822024 22 54 193302 3802 80 8958 I37139535 70155 9801 I60123 72 6702 98023914011016 6701250124 10 56
81 94 401r 7 154152 73 7057 2625 122 92028
90242 162312301 92~158 86 7172434526509 82 79160159 74 100 87412240227220110 6502836960 75 30 8317244 6501782801285711 61 901 42765645 84 66021459294912 9701 660146 171 302 9702 47
6235023033113 85 822821182 917755 16335013110214 841814832 78 103 938564 324815 86 1057940149272 38036523216 10401 87 2902241 725Q 10402360266340217middot IF88 88 9937233 282 51 218 101 01102 46016234
I)167 2901460219 47
High ~ Low ~
- -
TractRank
9S89
6490
8191 8001 8002
63 61 60middot01 6002 44 2701
92
J
2502 402 --- ----shy
I
Rank
Rank Order Tuberculosis Cases by Rate per 100000
(Coutd)
Tract Rank Tract ~nk
I
Tract Ballk Tract Rank
Imiddot
Tract
Imiddot
1~
t 1I i Pi i l I
o
1 -1shyL I
I J
8 40 icO ~ I -lt 0
-t (1) I
i I
r o E
II
a
I
r--i
shy
I
~
I (
Jgt
(011 fi(
Ggt
I II ~j
()
(f 0
~ ()
I
11
f9
r
II 99
o ~
Ggt r
~ __-J~ I t I ~ I
r--J l I
~ _ __ J
) 1
fTl
1gt
r I
()
r
()
lt en -i en
()
I1l
(J)
(J)
-i
P ()
19
r o ~
r G1 I
I
c
~
o I 89
--- -I-shy
r-r I
1- 0 _~ _ _--J E
G1 I I I
i i
I 1-1-1 ~ _J ~2 ~ II
II
()
1 I I I 1
id i bullbull
~
A n 69
r 1shy
- 0 Gl
l--~ ~ I
~ II
II )
I () isect i
en l i
(J)
-t
0
IA Ol
15
people in that it should serve an economically integrated
community The reason for this is that a wide variation
of consumers may assure a better quality of care
The advantages of the comprehensive neighborhood t
health center over traditional systems of providing
commuruty health services are numerous Hospital outshy
patient departments a major traditional source of ambushy
latory health c8refor poor patients have been indicted
for neglecting preventive health care ~romoting fragshy
mentedeare and subjecting patients to degrading and
impersonal conditions to mention only a few of the major
defects (31 p324) Another defect has been the
tendency to shunt low income patients back and forth
between different cliniCS often at different locations
arid with differel)t open hours for different treatments
or tests in regard to the same lllness(26 p63)
The comprehensive neighborhood health programs that
have been organized present a great variety of organishy
zationalpatterns one area of difference 1s in the
emphasis placed upon making each faci1ity comprehensive
in the services it provides to the patient population
In the Montefieri Hospital Neighborhood Medical Care
Demonstration program in New York City services have
been made available through a central health center and
two store frontsatellites the center to be the base
bull
Li
l of opratiol18 of ta1lJpIlflicl- ancl the satellite
center the ba of oparat1oDa of public heaJth nurses
an4 nllbborbood amp1 be satellite centers wereto
proVide preVentift tutaltll bullbulln1c1-m1zaticms w811shy
baby care per1od1c ~ectiland tJle central health
center to proViAle care tor illnes If (36 p299)
bis propWI VUDOt ~ttullytunct10DIDI at the t1JDe
it d1cu8ae4 18 tbe Uterature aDd all aernce Were
be1Dl provided 1D_~terBowever itwould ae
tbat the ntua1pro~ as aY1ioae4by its plmmers
would boclJ aoaeot bull 4efeot~ otthe current lud1cal
ccde teaIt pObullbulllne_t coorctJl8td admSDtshy
etration eD4 well 4eftlopecl refelTal procedtlreacould
1I1a~ thecOllDeCticmof t~_t8 withappropr1ate preTellshy
t1 aD4 therapeu1ampcaen1cbullbull aV81lable 111 diffrent
locationa Bowner tile barrieraottiaeaDdUatanc
between center and truaraUon tor the UDSopb1aticated
patieatlook1Dl tor 1her1~pJce too tor ~1CU-
larhalth serfplusmnQewoGl4~to JJa1t tbbll1ty o~
tb18 ~811D to provide iaaiYCOliprelleU1P18hboltleod
health servicebullbull III tactmiddot tappeareto coDtlict with
tbepro own taW cOfdotpro-1~a tam1ly
mecl1cal careprogru 111 wIa10h pre-teAtlYe aDd therapeutic
health erY1cecan be proY-lW to all IIl81Ibers of
tamily in the coure of aaSDll vi8it (36 PP301-3(2)
Dle Delmtr Coloradoprepa11ke the Montet1ori
LI
17
prograJlut111zbullbull abe1rarcJly ot SlDa11 aatellItestations
andlerer IIOreceDtallzedtac11It1es It 41ffers
howeverill tbcolap~81vene80f the services avail shy
able Inthe 4ecentraUzed facIJJtiesIt resembles very
clc)sely the IOdel ~ordecentral1zed social servicedell shy
very developed by 1ahII~ Which was 41sCussed above he
SIlall neImiddotgbborhoodmiddot c8Dt~aw1tb1n walkl distance of
most of the populatiotl havebeendesilDedto take care
of allthenorllalhealth probl of 3000-5000 patJentsshy
check-ups IlzatiOZl8s1Jlpl laboratory testa and
treataentand iaecucatlol18 (d1apeued by phyS1cians) for
IIOst DODCrltIcal 1l11le PatIent 1d1Oneed IIOrespecIal-
Ized care are reterrecttobacJalp facilities BaCkup
support tor themiddot~t1oDa are the tWo l8rsernelshborhood
health C8Dter8~ttr1Dl aCOglete~e of out-patient
serneeaDd three part1clpat1q hoap1iampl bull bullbull which
proVide1Dpat18Dt~t andcoDSUltatlve services
(13 p1028) Intb1a prosrama coaprehens1ve range of
prevent1ve aDd trea1aeDt serric 18 aVailable throughout
the decentraUzed middotta The CoapreheulY8 ReIgbborhood Hea1~ Service Project
otKa1er iC)UDdatlcm HOspitals 111 Portlan4 OreOD 1s
s1ll11arto th DenVer prosraa 1D thata comprehensive range
ot out-patientmiddot services 1D prov14e4 in each of 1ts 10cashy
t1oDa althoUlhmiddotmiddot tbe oentera are larger and l bullbulls DDIerous
than 1nth DenverproPUh (12 p6)
Li i
18
In order that a comprehensive neighborhood health
care center be able to proVide continuity of care it
must have arrangements for hospital services integrated
into th system Yarby (37 p73) as quoted above
states that it 1s characteristic of the neighborhood
health center to be directly connected with a teaching
hospital However De Diaz (14p3) indicates that it
may be advantageous for purposes of service delivery not
to havemiddotthe center affiliated with a teaching hospital
She feels that such anaft11iation may lead to asltuation
in which policies might be determined more by the teaching
needs of a medical school than by the service needs of
the patient
middotThe Nat10nalmiddotCommissionmiddoton Community Health Services
(25 p69) states that such a system of comprehensive
health care integrat1na ~e servicmiddotes of several health
and roedical agencies snould utilize Itas much single or
unified management as possible Neighborhood health
centers have been operated under a variety of auspices
but several writers have pointed out the advantages in
termsof coordinated prOvision of servictts management by
the hospital of the neighborhood health center For
instancethisfac111tates the keeping of unified medical
records of all the care a patient Msrecelved either at
the neighborhood health center or _le hospitalized
(12p6) ~ermore a3 Young (38 p1741) points out
19
direct operationot the u1sbborhood health oenter by
the hoSpital canll8lceaftilable to the center expertise lt bull
in sOlle aapcta 0 Operation that m18ht not be aa readily
available otherwie
Relardlebullbull of wbetberthe hospital and the neighborshy
hoodhealtbcent8r haVe a cOJIIIOaadmjntstration they
IIlU8thaVealTlved at a str1Dsent delineation of IDUtUal
role and reSpoDBlbilltiebullbull All OOIIpoienta ot the care
yst IIlWStQlarify and understand one anothers position
In the syatem and acree on objeCtive ancimethOds
(26 pp16-17p31) SODae areas of iDUtUalconcemare
reterral procedures record keepiDg aDC1 mutual use of
facilit1es statt1Dl i8 anotb8r ~ ot coaaon conc~
Ditt1cultift have u-laeniD the pastiD cOllprehensive bull t bull
healtbc~ prosraumiddot 1d11ch were batil plauned in wb1ch
all of the health canter phy1C~1IDa did DOt bavetatf
privilege at all ot thebackuJlhospltala (29 p21)
SUch a8ituat10n i8 1Dampcceptablelt inpatient care i8 to
continue to be p4by the pat1eatmiddot health center
physician and it cont1Du1ty ot care 18 to be maintained
Hoapital and health center1lUSt laav 301nt responsibility
tor the recruitaentot physicians
VticlentU IPan BJcNrcu Much otwhat haa b8ea sUd has stre88e4 at leastmiddot
iJlplicit17tbaD8ed tor tM etticit middotprovision ot8emcea
20
There appears to be two aspects of efficiency which are
discussed by writers on the su~3ect of the comprehensive
neighborhood health care centef one of these is the
need to organize) services to make the most efficient and
economical use of scarce medical care resources The
other closelyrelat8d in realIty is the need to help
the public use services in the most efficient manner
The comprehensive neighborhood health center concept
1s lhherentlymiddot efficient in that preventive curative and
rehabilitative health ~are programs are coordinated under
one roof with integrated a~stration Furthermore
theempbasLson prevention health education and early
disease detectionis eftic1ent troJll~estandpoint of
the health care system as well as beneficial to the patient
(18 p760) HQwever ~ue tothe scarcity of health care
personnel thecoiDprehensive neighborhood health center
mustbe an arena tor eXperimentation with new staffing
patterns~ The Kaiser program is indicative of the way
in which health care systems must begin to operate in
that appropr1ate ancillary personnel are used Wherever
possible to perform functions that do not need to be
carried out by the physician As Saward (32 p42)
states
1hroughou10ur organ1zat1on~ there are many of the customary experiments be1ngmade-shyJse of speciallr trained nurses for well-baby care under the SUpervision of the pedi9trlcianexperiments with routine prenatal care by
w ~
21
middotSPC1a1l~t~JlUrbullbull per8ema_1 bullJmdlJleu y our fuDotlou are auoh that DOtb1Da 18 dorutbYtbe phY8iCianstbat doe DOt vet to be done by the
phys1c111U1fhe other aldlle4 person- Del-nurse middotreC~0D18t the appo1ntshymeDt center or clerical praormelshyaremiddot there to free h1amiddotto use his spec1al sk111
Awell lmoWn treDd1D the area of eaaiDI health
c8re JII8DPOY8rShortagjs bas middotbe thetrend toward tra1nshy
1DB poverty area rea1deats as DOD~pro~eaionalmiddoth8lth
aide and nepborboocl health workeramiddot (28 p63) This
bas the effectofmiddotmiddot1J)creaa1q II8DPOWrand 8180 can help
bridle the cuJ~ cap betweenprondera and colllUmers
of aen1C8s This attarD at least tlleoretically
createa a situation 1D WIa1ch providers andcoD8Ullers can
be educated to UDderatad OD88DOtber and interactJlore
ettectlvely~ HoWever amiddotpltt8ll has beeD themiddot tel14ency in
801D8 oamp8e8 tomiddot us aidesmiddot ssale8lllcw t~r the center
alJDOatexclwdY811rathertbaD ua1Dltheal to protide the
health care for wh1ch ~ were trained (29 pp3B-39)
1bat ismiddotmiddot vh1~e the a14e Yalue in ~~m1catiDI with
low 1nCOlMt patieata haa beeR recoSD1zed and stressed
their role ashealtb carepersoDDelhil been slighted 1n )
any 1Dstancea
Anotber step 1d11Ob bullbull been taken to provide 8rY1ces
more efficiently eUeot1ftlybas beenmiddot theorgan1zation
of per8ODDeliDto IIllt141sc1pl1Dary teamaaaa means ot
proYid1DgmiddotCOQrd1DatedserY1ce SUch te8lll8 sen_rally
~
hf
~
22
include PhYsiciaQs nursbullbullbullbull soc1al workers and outreach
workers Conceptually th8y fmlct10n to me~ the intershy
relate lled1cal and social needs ot the families sened
Hor there are a number ot barriers to the etfectve
tlmctiOD1nlof lIuchte8ll8 SODieot these are heavy caseshy
loads the inordiDate amount ot tille consumed by multlshy
prOblem tamtliethel1m1ted tra1n1 ngmiddotmiddotand laCk of tnterest
on tile part ot aoae tebers in examinJng aspects of
problems out14e~lr oWn areaaotcolIPetencemiddot and
~ourdcation prc)blell8 between proteasioDala and nonshy
prot81~s (10ppa-10) middotrurtbemOre as De Diaz
(14 middotp6)1nd1cate tbel8 maybe a teDdency tor vertical
dp8rtmental lines of auperv1810nto become paramount
over the team coDamloation syst lead1ngto conflIcts
in determ1niDI the ro1ea ot solie team bers particularly
the DOD-prote81011alaInauch exper1l1enta Witb new
~t1Dlpatterna it 1s bullbullaentialtbat line of authority
roles aDd NsP0D81bll1tlea be made explicit and that there
beJDechaD 8IUI tor relUlar evaluat1onotfunctlorUng
Another way inwb1ch health care sernee delivery can
be made more ett1cl8Dt is to proVide servicea dur1DC the
hours whentbey aremiddot -ostnee4ed As reQo_ded by Yarby
(37p1) serY1ce can bemadelIOre accesslble by making
themava1lable 24 hours a day seven days a week If
rg8l1Cy service are aft11ab1e aroua4-tbe-cloek at ~
nil1iborhood health center the continuity ot tbepat1ent ts
23
careiamaiDtalDedand meatry point into the
cOIIPre~i health care 8 be made available
tothe patient who aoZMllyU8ea ozilymiddot emergency care in
tille of med1cal criais More 8isDificantly ava11ab1-
lity of a tull rase of bullbullrv1c8 tor seVeral hours 11the
eVerlna aI1Cl On ~ prevent the los ot earn1JiSs
involved if th patierat 1IU8tt8cet1me oftfroawork dur1q
the d8y for aed1Cal oare bull his can be an eSpecially
importantc0J1814eration tor lo1aCOlleDUUg1nally qloYEtd
patient aa4caJla18o PIOJIOtet1)e 0Da01Dl use othealth
servicebullbull
exper1eDO ot tbeKa1er prosraa in tb1s~reprdAs
Greenl1clt(19 p10) states wA lllNt 8ip1flcant
proportion ot the abulatory care 8n1cp~Y1dd tor ~
total popUlatiC)U ~ ~ after clWc hours and this
Deed i8 apParenUyaoN prODGUDced tor aJl8d1cally
iDCust population On the other hand the bulk ot all
aabulatory med1cal cu 88l91ce are performed dur1nS
regular cl1D1c hour eVen when services are available 24
hours a dayJ day bull week W
It has ~ the experi8D~eof a ftIDber ot ne1g1lboXshy
hooct hea1tbcentere _t a_jor obstacle to efficient
proViSion ot anicbullbullhas beentbe teD4eDcy of medically
1ncl1pnt patieats to utilize the center oa a walk-in
baais tor epi8od1ccr181or1entect bullbullrv1cea rather than
4)i
h~ ~~f ~~ L
24
to make appoJlltaeata tor ODIo1qprevmt1ve treataent
and rehebl11tat1Ye care ad ampl1O to bave a blah failure
to Show rat_for tbe appo1DtaeDts that they dO make
Atone center 628 of appo1Dtments made were kept
while 3Oottbepati_ta een were ~1n patients
AlthoUP fewer patiets were actually 88811 by the cater
1D middottb1s 1Datance thaathe -bervholuidmadeappointshy
mta the walk-iD patlat required an iDord1nate amount
ot staff t1ae tor aCreeDiaaacl ~trral to pplOprlate
~ttor caregt (9 pgg) Arraquotbr1llpl1catjo~ of the
plOVidedto valk-iD patient by other thaD their
(19 p12)rurtbermore
when patients uti11ze Wlk-1Il er181 centered care
athelr ODlf tona ot ootact with the _d1~ care
ay_ta fUilycentered care the treata_t of tUl11y
bers
a a UD1t 11
dlarupted
hewalk-1Dphenoaaencm appear to barelated to
diUerence between soclal clase in the style of Dlaking
contactJt1th the a11oal C~ay8t As Greenlick f ~
(19 p11)1Dd1oate8 thepheDOaenOn ot INater usage of shy
walk-in ervice by aed10ally middot1Jid11ent patient thaD by
others baa otte been attr1buted to a stoical att1tude
tQward 1llDe8 em the~ ot poor people leacl1D8 to a
~
25
greaterdelay1n tbe k i Dlofa8d1cal care These
patients wppoedlyeelcmiddotcareODlymiddotwIleD tbeirmiddotillDess
becOlles1Dtolerable resultiDSin middotthMr appeariDS withshy
outnot1ce1o rece1ve oareHlwever Greenlicks
r8aearcbbaa cut doubt on the existence ot tb1delay
111 report1Dg middot8J1IPtoJumiddotOfDeW 11laessand seek1ng care
Be bas tcrQDd 1bat s1ll11ar peze_tases of dioally
1nd1sent 8DClJ1on-aed1cally 1Dd1PD~ pat1enta seek care
on the aue daytbat aptou tirstaPPear
1fb11e GrHDllclc 1nd1cat tbat the reasonator the
greatertendeDCY of low 1Do~e pat18Ilta to 1$8 walk-in I
serY1ces are notlcDo1rAmiddotmiddot tbe7 _ be rel~tedto a tendency
ot lower aocio-ecaaaoclaa patieota to preter face-toshy ~
face contacts with II841cal persoDl181posslbly because
such contacts areft coatortiDS an4reasauriDS to
patients who are hJpotbeafzed to bave a dependent attltude
toward IIed1Cal care perS0Jm81 (30 p161)
It a8 itmiddot baa pnerally beenhld the appointment
s1stemts the most efficient Ileana of dellveriDS
comprehenSive oODtllluiDlh-lth care (9~100)1t is
necessary that educaUoraalmiddotbulltfort be taken to proaote the
use ot middotappo1ntaents8DClmiddot tQrec1ucethe fa111re to appe~
ratB4uOatioaalwhlQb baft~utl11zedhave been
IJ
26
1Dten1ews with walk-in patients home Vi8its and group 4i
meetiDp1D8D attemptto1Dierpret1o the patients
the value of rtitgular ppo1ntmentamp andot con~in~
c~1ve care rather than epiI041c care (9 p1OO)
h1s 1safuD~tioD torwhtch nOl~prot81QDal colDlllUD1ty
YOrkersllaY bebe~r8U11ed tban other statf H()wever
euch aD ~ucat1oaal propul __~ ~e related to the senUiDe
capacity otth health oenter to provide comprehensivebull gt
ervice8 to1tpat1_t~odoD aD app01ntment bas18 It
1amp pos8ibleo~rw1 tor educa110Dal ttorts to result
LD a~8JImCl tor ltPP01ntaen~8 at a ratewb1ohi8beyond
the capacity ot thee_tar to t without uareaaoDably
1_ wa1t1Dlprio4a QOBt1nuad use Ot the center on a
wallt-in bU1 _1tbeoosiItpos81ble to et an appoint-
met anc11nCreued pit1entcoJaplampia1a bull Therew111 of
course always be a need and demand tor acute ep1so~c
Care -ci the health centerDlWlt be planned with the capashy
billty ot bullbullbullt1D8 tb1aneed wh1~ cont1Du1nI to stress
aDd educate the patient to utillze oDlOinI comprehensive
faa11y middotc~te~d Cflre (9p 100l
att g4 CODClva1opa
In order to bea4equate any coJlltemporary health care SY8tem muat bullbulletcerta1D interrelated criteria he
IJ
27
minimum criteria areaccessability of services to those
who need them compr8heX1siveness and appropriatness of
services and efficIency 1nthft utilizat~on of SCarce
health care personnel and resources The scareity of
pex-sonnel andtbe need for h1gh quality ongoinghealth
care services
aJIlong the
populationdemanci the most effishy
cientprovision of services
Services must be made accessible to the population
They mustmiddotbe geosraPh1cally accessible to remove the PhysicalmiddotbaTiers betWeen peopleandthem$d1calcare
system They mUst otter their services dur1ngthe
hours when people can make the moat use ofthemA~ it
makes little sense to concentrate services geographically
where they will not be uSed to their fUllest extent it
also is wasteful to provide serv1cesonlydur1righours when
many people are employed his not only presents a hard
ship middotto the consUmer lnrt wastes resources if for instance
the unavailability of preventive services during the hours
when people Can use them causes a need for treatment
services later on
Health carbull sEtrvices must be comprehensive including
prevention treatmcmtand re)abimiddot11tation Ambulatory I
healtbcare facilities wh1cQ are orienteciexclusively
toward either prevept1on or trea1mentare no longer accepshy
table for they are lneft1c1entln their use of resources
and in their prov1s1on of health care to the patient
w ~~
28
If prevent10n1s notmiddot stressed treatment serv1ces that
could have beenavoidedY1l~ be required If prevention
1s the sole focus of the health care facility sick
patients who present themselves must be referred elseshy
where for treatment andsllch referx-als may be taken as
reject1onsor not followed through with until illness
becomes unbearable
The instltutlontbat meets these requirements Is
the comprehensive neighborhood health center It 1s a
local decentralized outpatient facilityprOVld1ng a
fUll range of ambulatoJY health care services It has
a linkage to ahospitalbackUp facilityforlnpatient
treatment and hiihlY apclalized outpatient care
The neighborhood health center must be a fac11ity
planned with an awareness of the needs of the conSUtller
and coDitnUn1ty It must have the r~Ul0urces to provide the
services people need mere they can use them and when
they can use them It must uti11ze the part1cipation of
the community to develop this awareness Not only must
the cen~er beset up to be Amctional for the consumers
but efforts must bemadeaga1n with commun1ty partici shy
pation to help the consumers utilize medical care
services effectively The center muetmake efforts to
educate the community about the valueot regUlar health
care of preventive servicesand of the use of planned
IJ
29
medical appointments ratherthanorisis centered walk-
incare Therealit1es of the existing health care
system have not taught the patient particularly the low
income patienthow to use services effectively
The helthcenterilUst also bea laboratory for
experiments in easing the health caJepersonnel shortage
and c60rd1Datingcare~ A major difficultY iri-exper1shy
menting with neW rolesis freeing staff of old preconshy
ceptions
CoDlprehensiva neighborhood health dare centers have
been developed under a variety ot alisplces including
medicalsociet1es hoSP1talsmiddot(36p299 group pr~ct1ces
(29 p6- 12 117) health departments (13 p1027) and
ne1gbbothoodassoc1ations(14) The literature indicates
somevalues nthe management ot the health center by plusmnts
hospital backup faCility Whatever the auspices many
adm1nistrative fuDctions such as program coordination
standard pr9tectionand evaluation call for considerable
c~tralization of adm1nistration city-wide or coU)tyshy
wide At the same time other aspects hours of servlce
for examPle~ cuI f~radm1nistrative fUnctions made atmiddot
more local levels Each neighborhood center must be
free to adapt its functioning to itscominunity thi-ough
the mechanism otcODlllUl11~ participation inmiddot policy making
Obviouslythe prerogatives and responsibilities of each level must be negotiated and made explic1t
t4~
JJ
BIBLIOGRAPHY 30
1 American Rehabilitation Foundation ~ealth Services Research Center The Health Maintenance Strategy mimeo 1971
2 Anderson Nancy N Comprehensive Health Planning in the States A Study and Critical Analysis Institute for Interdisciplinary Studies American Rehab ilitation Foundation 1958
3 Andrus Len Hughes Comprehensive Health Planning Through Community Demonstration Health Projects mimeo1967
4 Barry Mildred CandCecil G Sheps A New Model for Community Health Planning unpublished paper presented to the American
Public Health Aseociation1967
5 Blum HenrikL Fred Wahl Genelle M Lemon Robert Jorulin and Glen W Kent The Multipurpose Worker and the Neighborhood Multiservice Center InitialImplications and EJeperiences of the Rodeo CommunityService CenterAmerican Journal of Public Health58 (Mar 168) pp 458-468 shy
6 Blum MichaelD and Soloman L Levy A Design for Service Delivery that Reinforces Constructive Tension Between a Health Center and Its (sic) ConSUDlers and Supports Community Power unpUblished paper presented to the American Public Health Asaociatiltn 1968
7 Brielaud Donald Comm~ity Advisory Boards and Maximum Feasible Participation American Journal of Public Health 61 (Feb 1971) pp 292-296 shy
8 Burns Eveline M Health Insurance Not If or When But What Kind Madison Wisco~sin University of WisconsinScllool of Soci~l Work 1971
9 Campbell John Working ~elationships Between Providers and Conshysumers in a Neighborhood Health CenterU American Journal2 Public Health 61 (Jan 1971) pp 97-103
10 Caxr Willene Neighborhood Health Centers Funded by the Office of Economic Opportunity mimeo 1970~
11 Colombo Theodore J Ernest W Sawardand Merwyn R Greenlick The Integration of an OEO Health Program into a Prepaid Comrehensive Group Practice Plan American Journal of Public Health 59 (April 1969) pp 641-650~ -
12 Comprehensive Neighborhood Health Services Projectof Kaiser FoundatioIl Hospital~ Prcgtgram YearE grant renewal proposal mimeo~1971 bull
13 CowenDavidL~ Denvers Neighborhood Health Program Public Health Reports 84 (Dec 1969) pp 1027-1031
IJ
14 De Diaz Sharon Daniel Beyond Rhetoric The NENA Health31 Center After One Year unpublished paper pres~rited to the American Public Health Association 1970
15middot Gerrie NorrrianF and RichardH~ Ferraro Organizing a Program for Dental Care in a Neighborhood Health Center Public Health Reports 8 (Aug 1968) pp 419-428
16 Gordon JeoffreyB~ The Politics of Community Medicine Projects A Conflict Analysis Medical Care 7 (Nov -Dec 1969) pp 419-428 shy
17 Greely David The Neighborhood Health Center Program and Its Implication(3 for Medical Care H~alth Forum of the Welfare Council of Metropolitan Chicago (mimeo) 1967
18 Greenlick Merwyn R Newgtimensions in Health Care American JOurnal of Pharmacentical Education 34 (Dec 1970) pp 754-4
19 GreenlickMerwyn R Donald K Freeborn TheodoreJbull Colombo Jeffrey Abull Pruesin and Erne$t W saw~d Comparing the
Use of Medical Care Services by a Medically Indigent and a General MemberShip Population in a Comprehensive Prepaid Group Practice Prosram II unpublished paper presented to the AmericanPublic Aesociation1970
20 H~tadoArJiloldVMerllYll RGreenlick and TheodoreJ Colombo Determinants of Medical Care Utilization Failure to Keep Appointments unpublished paper presented to the American Public Health Association 1971
21 Johnson Richard E and Merwyn R Greenlick Comprehensive Medical Care A Problem and Cballengeto Pharmacy ff AJilericanJournal of PbarmacenticalEducation 33 (Aug 1969) pp 361-367 -
22 Kahn Alfred J Studiee Social Policy and Planning New York Russell Sage Foundation 1969
23 Kotler Milton Neyhborhood Government Local Foundations 2 Political~New York The BobbsMerrill Company 1969
24 NationalCommisaion on CommunityHealthSfrvic~sActionPlanniriamp for Community SetithServices~ashington p C Public Affairs-Press 19t7
25 National Commission on C~mmunity Health Services Health Adminishysration andOrMPization l the Decade Ali9$-d Washington D C Public Affairs Press 1967
26 NationalCornmiesion onqomm1Jllity Health Servicesbull Health ~ Facilities Washington D C PUblic Affairs Press 1967 bull
~ n
32 27 ODonnell Edward J and Marilyn M Sullivan ServiceDelivery
and Social Action Through the Neighborhood Center A Review of Research tt Welfare ~ Review 7 (Nov~Dec 1969) pp 112
28 Office of Economic Opportunity Second Annual Report Washington D C~ U S Government Printing Office 1966
29 Office of EConomic Opportunity and the Medical Foundation of Be~laire Ohio Eighth Report 2l ~ Committee2a Governshy
ment OperatiOll~ Va8hiiiSton D C Government Printing Office 1969
30 Pope Clyde R Samuel S Yoshioka and Merwyn R Greenlick Determinants of Medical Care Utilization nhe Use of the Telephone for ReportiDg Symptons Journal of Health and SocialBebavior12 (June 1971) pp155-162 shy
31 RenthalA Gerald nComprehensive Health Centers in Large US Cities American Journal of Public Health 61 (Feb 1971) pp 324-336 shy
32 Saward Ernest W The Relevance of Prepaid Group Practice to the Effective Delivery ofHealthServicestt The New Physician 18 (Jan 1969) pp39-44 - shy
33bull Schorr Lisbeth Bamberger and Joseph T English Background Content and Significant IssUes in Neighborhood Health
Center Programs Milbank Memorial ~ Quarterly 46 July 1968) part 1pp 289-296
34 Weiss James E and Merwyn RGreenlick UDeterminants of MedioalCareUtilization The Effects of Social Class and Distance on Contacts With the Medical Care System Medical~ 8 (Nov-Dec 1970 pp 456-462
35 Weiss James E MerwynR Greenlick and Joseph F Jones Determinants of Medical Care Utilization The Impact of Ecological Factorstt unpublished paper presented to the American Public Health Association 1970
36 Wise Harold B Montefiore Hospital Neighborhood Medical Demonstration A Case StudyMilbaDkMemorial Fund Quarterly46 (July 1968) part 1 pp297-308~
37 Yerby Alonzo S ttHealth Departments Hospital and Health Services Medica1~5 (March-April 1967) pp 70-74
38 Young M M~ Chatanooga IS Experience with Reorganization fOr Delivery of Health Services ttAmerican Journ8l of Public Health60 (Sept 1970) pp 1739-1748
f or l
II bull 11 Y d
II
IJ
34
ThepurposeOfPart II of th1aa paper1atod1scuas
elected Speclfic needs ofecltlc areas within Multnomah
County A8P01ll~oUt 1D ~ I of t1a1bullpapermiddot Ita nelgbshy
borhood health oare cater IlU8t be a facl1lty plaDlled with
aD awarenes of the neeels of the oODllUller and collllUDity
Part II of this paper nIl Show 80e of thoe speclflc
needs
he1DforutiOD tor t1li Portlon of the report
obta1nec1 troll tbroupout tbe follow1Dl threepUb11catloDS
1gr~e_tiMshylIPrIxaiidOreson JuDe 1963
2 1~_middot_sectSI8e~ected1teai c-ua 0 S 8 e first count coaputer tape Coluab a_lion AssocshylatloD of QoveraMD-8 Jlme 1971
3 Jtu1tDoab County Oreaon BDY1roDlHtlltal SurveyEarly 1971
The JIultDOIIIlb COUDty OrttIOD BDv1roDllfmtal Surley
Barly 1971 1s bull stat1stical report of the activ1tles of
theentlreMultDOIIIl2 CcNDty Health Dep~t during the
year of 1970 Die speclflc 1nd1cs elected from tb1s
study amprejMental aealtll Publlc Health N~s1D1 vlslts
FaJUly ~ Veaereal])1 ~ ~rcul081
Throush tie use of cUrts and mapa ODe CaD roup these i
speclflc ~oea to ahcnr the healthneedsof speclfic I
census trtcta aD4 then the health needs of iarer neIghshy
borhooda 1m4 o~ Uebullbull
Rf)~UP1Dl of areu was accompllshed in thefolloWinl I
JJ ~
35
he MiltDoIliahCountY oregon BDViromaental SUrvey
early 1971 isamp statistical report ot tbeaotivities ot
the entire MultDolllh COUDty Health ])epartiDent dur1nl the
year ot1970 he specitic 1Dd1C8S selected frOm this
aUy are 1Il8Dtal health public healthDurs8s visits
fUl1ly pia waereal elisease aDd tuberculosia
Tbroq11the Wle otcbart aDd mapa aDecm szoup these
specific indic to show the health Deeds ofapecitic
ccmaua tracts aDdtIum th8health neecla of larsr ~eilh-
bOrhooda and co8I13 tlbullbullbull
RegroupiDI ot areas waa accoap118hed1D the
tollOWiDl lIIIIm1er~ A bullbullcifie 1ndex 8selectcl auch as
venereal di8bullbulle or tuberculo8i~ he total number ot
cs was then deterll1ne4 for each census tract Through
the use of the maber ot cRbullbullbull tor a 11Yen cenaus tract
aDd tbe population ot thattractaltrateot1lla1ampmcper
100OOOpopUlaticm wu cleteXll1ned for each census tract
This was ~e to starl4ard1ze the population ditterence
amongOeD8U8 -tracts 1he rate of incidence toreaob
cenauatract was then llstedby rank position on a chart
In rank poition1DI any cen8Wl tracts haviDg equal
rates ot1l1c1dence are assipe4tbe iaDk posttiona
Beeauseot the abo fact tbAt cbarta w111 vary in length
neveltbAtlea eacb cbart will 1Dclu4eall census tracts
inMullnoaah Couaty Atter the census tracts bave been
listed accord1q to raalcth1s list will bediv1ded into
IJ
36 three levelsotinc14ence he three levels are
1~ The upper 14 of1DcldenCe
2 Thelower 14 ot incidence
middot3 The ILld 12 of incidence
Tlles three srouplqa are then used in compiling a map ~f
Mu1tnOmahCountyfor ach apecltictop1cbull TIle maps are
uaefuJliD tbatthey V1suallycoJib1De 1Dd1v1Clualproblem
census tracts into larger problem nellhbOrhooc1s
The 1960 statistical iDtormatloD was Used in a similar
liIaDDr to tbatexpla1Dedabove 1Dthe4evelopaent of a
chartmiddot and map 1Ihow1DI e cOllpampriSOr1 of per capita lncolle
tor ttaCh ceDsua tJact aDdmiddot combiDed census middotmiddottract areas
he 1910 aDd 1960 statlstlcal iDtOrllatl0D was combined
lna map and chart he purpose of this and chart is
to d8aonatrate the e cl1stributloa1DeachceD8U8 tract
and middot1ndlcatbull tuture ace populatlon treD4a bull
When one be middotbullbullbullbullbullHdth ne8cts ot an area and has
declded to establlsh a cl1D1c to serve that area the
physical location otthat cl1D1c IllU8t be consldered In
order to coapreb8ll81vel develop an area cl1n1c one should
conslder thepre88Dttraftlc middot~ytaa an4tranaportatlon
systems Thecl1D1cahoUld be located close enoUlh to
major arterlals to giva asy access from the total area
be_ ervecl by this cliD1c At the t1ll8they should
be tar eo away froll thesarterlals to all8Y1ate traffic
CODCell18 andpark1D8 conpstlon By traff1c concerns I
IJ
37
lIlan one lUSt consider thertarro1fne8S of streets whether
streets are oD8--C)r two-way iqres8 and egress to parking
amp0111tie eros tratflC) spedof trattJQ children 1n
ll8a traffic i1lht Vislon re8tr1ctionS etc
BwstraDsportat1onshould alao be central in this area
as maay people ~U f1Df1 1tD8Cessary to use this form of
transportatlon
~e tutqredlopHQt of bull treewa systems should be
c0J1S1dered soastolesen thecumce ofmiddot future roada
cutt1DSotltbe cl1D1c llte line
nrrph1c middotDampta
It is 1JDportaDtto kDOw the demosraphic distribution
characteristics of the oUenteltbat i8 to be served by
localized health cl1D1cs
Acl1D1c which erves8J1 area where1D the prepondershy
ance of persona arecrter 65 years of mayf1nd that these
people rely more on pUblic transportation call for more
home- services and haV4t 110ft ChroD1c and debilitating
types of disorders (b1_ blood pressure poor heariDg and
eyesight) tbaD do8 an area ot a YOUDIer population On
the other hand thL area of older residents may have little
need for family plabDlng cllni08
In order to better ~Ybullbull the 4eaoraphic population
of each CeD8U8 tract the 1970 CeD8U8 iatormation was viewed
and two specific catelOri8 considered These two cat
IJ
38
lori8S woUld be the perc_tap ot population under 19
year of ase and the percentase ot each oensuetractover
65 years of age he 1960 1Dtormatlon tor eaCh tract was
then compared witbthe 1970 intormation and a percentage
ofincreaae or4ecreamp8 tormiddot e~chtract1n each category
cOJlputecland achartma4e By the use of this chart one
18 able to View tJleap populat1odiatr1but10n of census
tract and at the _ t1lle accesa middottrencl Por example
let us choose census tract 601 W see 40-4 otthe
population is under 19 years ot and that ODly82 1s
over 65 years ot middotAtthe e tille the percentage of
youth bas ~ed ODly 1_ intbe laSt teD year whilethe
percentale over 65 year ot middotbas stayedmiddotthe same With
this in mJnc1 ODe ~ 1DfItr libat ol1D1o aerviDg this
area WOuld bellQre conq~w1th the problems of a
YOUQier populat1on and that _ would probably be true foJ
some t1aein tbefuture On the other hand CeDSU8 tract 54
has only 2 ollt population UDder 19 yel1s ot age and
this has decreased by 1 over the last ten years middotwhile at
the same time 32-377 ot the populat1on 18 over 65 years of
age A ol1D1C ___ this area should be or1eJ1ted toward
tbespecttic problema otthe ampledbull
PerCapia __ bY gsa neat
WhaD cona1der1qlooat10D1 tor health cl1n1cs one
shoUld take the 1DC01Ieot areas into consideration Areas
IJ
39
of lowiDcome would not 11kel~be 8erved more by localized
cl1D1cs tbaD would are of hilbincome It 18 likely
people haYiq a hip iDeoll8would preter to be aeenby a
chosen ~r1vatephylc1a1l tban at a local cl1D1cwhere
10Dier waits y beraceaaampryand leas personal attention
gl_
The 19701ncOII81atoWampt10n tor MultnomahC~ty was
not available at the tille thi8report W88 made The 1Dto~shy
tiOD Was taken ~adtro tbe1960 census publlcation
his woUld ~8Il thea tbat ral1I8 OD the chart ynot 1raquoe
completely accurate hi writer telthatthe areas most
affected by tb8 1I8eof the older 1Dco1DtOlaat1oDWOuld be
those tracts wh1ch baYebad a rapid 1ncreaae1n populatlon
over the past tfmyHr8 bullbullbull tracts would include tracts
nUmbered 104 9897 96 aDd 95 be perc~ita 1Dcome
referredto1il-tb1a Paper18the lIean 1DCo per person per
census tract
Attar the iDeoeper census tract was listed on a chart
a map was de 1D41catiDg those census tracts belonging to
the lower 14 ot income tor all censue tracts in Multnomah
COlDltytbose beloqins to the upper 14 ot income tor all
census tract 111 MultnolUlhCounty and those belonging to
the mid 12 ot 1I1coaetor all oeuuetracts in Multnomah
C01mty
In yiew1Dg the _p 1t caa be seen that the low income
area seautotollow aloas the at aide ot the Wl1lamette
IJ
40
R1ver the full length of Kultnomah County A second low
income area follows the south edge of the Columbia from
the northwest corner of Multnomah County easterly to 148 St
A third problem area seems to be on the east bank of the
Willamette River with the Union Pacific Railroad being
about the center of this tract The extreme loutheast
corner of Multnomah COUDty appears to be a low income area
but as this area bas bad rapid grouth in the last ten years
this could be erroneous
Mental Health
be first ~ecific indica to be selected from the
Multnomah County envirollllental survey of early 1971 and
to be considered in this paper i8 that of Mental Health
At the present for mental health purposes Multnomah
County is divided into five catchmentareas with a mental
health cl1n1cin each area These clinics are Model
Citles Delaunay ADkeny street Office Hansen Health
Building end Southeast Clinic
All lIlental health cl1n1cslcept statlstlcal information
on all patients visiting their cl1n1cs this included the
address of the patient hese addresses were then listed
upon the approprlate C8D8US tract Each census tract was
then ranked on a chart according to the nUllber of mental
health patients who reslde ln thatCeDSUS tract attending
any of the above listed ental health clinics This chart
IJ
41
wasttum d1v14ed1ato proper quartile bbullbullbull
quartile vereUs to dne10 u appropl1ate Multnoh
County _tal health ItLa middotmiddotmiddotthelipO~a1bl by lOoJcJIUE
at the UDtal health _to uteN1De which ueu have the
lars-t use otCOllDty 1alh~th faci11t1Rot
1Ilclu4ecl 111 tbia woUld tber otpeopleYia1t1Da
pr1vat patch1atriata aDd pr1_t _ntalhealtb cl1D1c8
WheDtbe M1 18Yienclmiddot Itmiddotmiddotmiddotmiddot~middotbe~_ tbat ~rtt
appears to lMt fourmiddotmiddot-al are iii _oil the nuaber ot
lIental healthcl1D1c na1t toM tbjh1sheat 1he
tour areaa woUld be tollows
1ttrea Ore to~Blo Drimiddot ~tb Burrus14e aDd tIMtmiddot Colb1a Riftr H1gbwyaeri1Dla th nortllra boundaryshy
2 bull ProII 82D4 1_~ 10 20th streetwitil the ra1lMd Mu the north ltouadary
3 ~ et et tUgl_b1bull MYel froamiddot the Clackaaa COUDty l1ae aorth to Dln8lon stret
4 beDOlvt1ttfe-t ~efllt4 COatytrca Jle1aware streetmiddot toR1C1a11oDd wlth Colubla Blvd heiDI tbAtnorth bouaclary_
It ODe coapareatbiap to th iDeobullbullmiddotp 1t can be
eamiddotthat lIOat ot the c tracts baY1Dg bllh v1i11tatlcma
middottfl public tal health cJ1rUc8 ~ 111 t13e low ~ aid
1DcOile SroupiDIOJa1y of til 25 tracta llsted as
haviDlbip aental Maltll nlltatlou are ~ the1g60 hip
iDeo arebullbullbull
17 Plpn
42
amily PlellnSDI ]Jlce Metal Health i8 an 1nd1ce of
use Theperson 111 ordertobavebe_ 1Dcluclecl 1n this
atu4ywouldhave tohaft Ue4 ataa11y plaDI cl1D1c
tacilities of soaetype It 41fter troll tile _tal health
study1nthat i t1Jicludestatist1catrollbotb public and
privateclJD1os
The iDformation tor the iak orurcbart 8Dd map of
t8ll111 plenn1 na ob1a1De4 by cOIIblnlDlthe mabel of
1rlcuv1duals bullbull_ attbe tbreellUltrampo-ti Coatyhll11y
PlalJQllIl C11ll10s 111til tbo at the Planned PareDthood
Association CliD1C8 be tbree -JIultDouh Couaty r8ldly
PlamSq Cl1D1c are Solrtbweatth Col_bla 1111- a114
HaDsell Health BWlcl1Dl CllD1cbi middot1Dtormat1oD vas then
bullbullbullesed tomiddot detellWMt l10w people troll eacb c8IUIUS
chart wastben Mele IUs oIIart jn 4iY1ded to show
the censuS tracts lIaYiDlmiddottIle h1t1iest qUart1le of incidence
of use lowest quartile of 1Qc1deao ot use Jlid 12 of
incidence of Wle an4 a map sprepared troll thts 1Dto~
mation
The C8U118 tractsbelOJISnl to the h1lhestquartile of
use appear to be 1lO~ 8catt~ on tbipwas true ot
either the _p ot aental health cl1D1c uaageor ot the map
abow1DI per capita 1I1COM Iaere40 to be three
d18t1nct areas of UIIaP beJ woul4 be
1
IJ
43
t10D of BurD81cl and the W11lallette River 4
2 S~t Portland 8Otth otmiddot the ra11shyrcaadand alona the W11lamette River
lIortbeaat Portl8D4 between MisSiss1pp1 and 24tbStreet the northbouBclary be1DgColwb1aBlvd
Pylzl1c BMltl IrpI Y11ta
Publlc Healtil nur81D1Y1s1t nclud8 an vists to
theholles of client by PubUc Health Nurbullbullbullbull his shows
visits to bull f8Jl1ly fer aDY purpos SUCh aatuberculolJ1s
het1Dl tem1tyaeatalu4 8IiOt10D8l cODd1t1ona etc
he atat18t1C~ 1fele C()4ed accord1Dg tomiddot the 1llli301fOCUS
of the Y18lt tt doe DOt 1D41cate the Dmlber of holies or
f8ll11lev181tecl or 1D41Y14ual Y1a1ted more tban oDcein
the propwl It dobullbull I1ve 80M 1D41cat1on by coaparlshy
OD ot the 8JIoUDt of aedlcal problema 1n eachcen8WI tract
Ap1nmiddot the _p abowa 8 scatter patteraof probl_
areas althoUSh there appear to be a sroup1Dl of hiSh J
l8aIeccmaus tract 1ntlut extreme southeast part of tbe
County other areu uIriaI any nura1Dl contacts are
1 bull he 801lth-oa-al CO1Dty on eaCh 814 of 82nd Av from Clackallaa County north to Dinloa
2 ear bullbullbullt 814e aroUDd Preacottand Misaisippi
Dowatom Bunul14eonboth 1de of the river
44
V_real Pis The iDfomatloil uaec1 to tabulate the Venereal
disease chart includes all the ooab1ned case otmiddotODormea
and syphilIs reported by bothmiddot publIc and prIvate physicIans
dur1nl 1970 There were 3602 caes ot IOnorrhea reported
dur1nl 1970 While ODly 17 cabullbullsot ayphilimiddot were reported
A chart was prepUed aDd att8llPt wasmiddotmiddot de tomiddot
determ1De Wh_therVttDereal 41ease was more p~vaJent in
areas othigb or lowmiddot proportIon ot youth hi waadone
bymiddotdetemlna a 1leaD prceiltacmiddotmiddotmiddottor the population ot
resld~ts UDder19 years ot (34) middotA mean ratemiddot per
100000 popUlatIon al80c1ttem1Ded tor the middotoccurreDCe
ot venereal dieae This was et at 390 oass Areas
hav1nl a population 1n which leiS than 34 were lmder 19
years ot ampIe were called low- yOuth abOve tbl percentaae
hiSh youth The aaa waatrue ot the occurrence oivenershy
eal disea_ per CeD8UStract It the rate waacomputed
as 1I0re than 390 cases per 100000 it was called hiah
venerealdiaeasei it less than thia tisure low venereal
disease It was tound that 1D Multn~ COmlty there sems
to be poSitive OOlatI0n(x21S19gt between low youth
and hipmiddot venereal diseaand hip youth and low venereal
diseasebull
RaDk ordr Iitot all c traot middottbAm made
Th1s was done byt1Ddlna the ratepr 100000 populatIon
of venereal disator all census tracts in the County bull
45
These were thenlisted from h1lhto low (sreatest to
least) in a rank order The l1sting was then divided
into Upperandlower 14 aDd listed on the MUltnomah
Countymiddot up
The areas of b1gh venereal disease se8ll18to
roup thBl~8 middotin a very tllht area ~oq both 1des
of thell18l8~ R1 w1th BurDaldeS~et being
~bout theceDter qf tbi8IZ9uping This area woUld
appear to be m ldeal spot for the denlopment of a
locallzed venereal d1sbullbullbullbull cl1D1c
UbepoundCUlO1s
In this report bull tube1C1llosls caS8S refrred
to include alltbobullbull cabullbulls ontubercUlo8is follow-up
rather middotthan just new C Accord1Ds to the Multnomah
County Health SUrvey of early 1971 this would include
all ca repOrte4 over thelaat three years The
total number of tuberculosi8 cabullbullbull usedin this study
was 666 lh1 included 128 new cabullbullbullbull
A rate per 100000 of tuberculosis for each
census tract wa- then computed and the c~us tracts
listed by rank order be b11h Qartlle mel low
quartl1 were then reoordd on a Multnomah CoUnty map
TWo genral areaa baY1Dg a hip mcldencaot tubercu~
losiare 1D41cated heyare
1 Both middotsld ot theWilla11lette River
Ll -
46
with Burns1de about thecnter
2 he extrea Northebullbullt comer of the County bull
By coap8r1ng the tuberculois an4ven8real
diseae maps ODe can 8ee that the downtown areas ot
hiSh 1nc1denceare alIIo8t 1c1eDt1cal on ach map
This WOuld 1nd1cate that 1t would be of value to
bullbulltab11sh acl1D1c 111 th1aampreatbat would provide
bothtuberCulos1s 8Dd ytmereal 418ase srvicbullbullbull
Thchart aDd 1181gt8 are wsfuln 11v1DI
1Ddicat10DS tor the type aDd placemeototlocal
health cl1n1c8 tbro1qhout tbe MultnomahCounty area
A cOllpar1on of the mapa help one to dec1dewhether
to provide a aulti-8ervice cl1D1c or spec1f1c type of
cliD1c As stated in Part I of thi paprserv1ces
shouldhaYe both treatlieDt and prfMmt10n cOmponents
As he been stated fta ne1lbborhood health care
Qenter muat be a fac111tY plazme4 with an aamesa
ot the neds of the consumer and the c01llll1m1tybull
Part II of this rport haa been an attaapt to indicate
and clarify 8011 ottheae coDlllUDity neds This has
been done through8elect10n of apc1f1c problems
The indic were then visuallyrecorded through the
use of ups and charta ODe dan asseS8 thedsreeof
1DIportance of certain concems to spec~t1c areaa by
comparinl the chart aDd maps Prom this oDeean
41 dec1de which are48 vb1chcUD1c-or indeed if
the need a clinic at all However further factors
should be considered hebullbull include
a The amount of fuDd1 available
b What 18 the percentage ot peopleineoh ceaaua tract tbat would actually us such cl1n1cIl
c Wbat 1 tbeco--1tymiddot 8 IeeliDashyreaardtDI particular cl1D1c8 Would this dcrebullbullbullmiddot the ettctiveness ot thse cl1n1ca
IJ
li
D_OlraphicPopulatLon Challie 1960 to 1970 48
Cen8U8 1 of Pop 1 Cbaqemiddot 1 Change1 ofPopTract Under 19 Yr8 Over 65 Yrs1960-70 1960-70
middot1Q701Q70
1 319 -12 171 -H) 1
2722 215-27 +68 301 366 -22 127 +35 302 371 +19 111 -04
311middot401 144-41 +29 402 321 13~7-39 +24 501 356 124-08 -02 5~O2 351 133-23 +12
405601 82-10 -02 394602 103-01 -06
701 275 149-76 +56 702 361 +01 121 -07
+10middot801 326 140-22 802 321 middot127
(
-29 -03 9~01 342 124 -H) 6-18 902 294 128 -H) 3-24
10middotmiddot -14312 140 -17 1101 182 +25 -23197
2411102 186-59 +29 1201 226 169-17 -41
31middot01202 +11 182 -05 295 -H) 81301 208 -H) 4
1302 331 +08 197 +04
14 323 +15 middot185 -08 middotmiddot15 329 +16 16~5 -13
-28middot 1601 332 131 +12
1602 356 98 +24middot-39 middot3101701 161-33 +21
1702 370 -15 85 +02 +19 1801 264 151middot-50
185middot1802 256 +47-58
IJ ~
D_raphlc Population Change 1960 to 1970middot 49 (Contd)
4io
Census Tract
of pop Uncter 19 Yra
1Q1n
1Cha1l8e 1960-70
of PopOver 65 Yra
lQO Change
1960-70
19 389 +29 141 -24 20 223 -13 206 +18
21 227 +08 194 -36 2201 356 -27 112 +05
2202 290 -18 ll~9 -29 2301 356 -03 154 +24 2302 260 -37 245 +97
2401 410 +6~1 123 -31 2402 163 -80 320 +99 2501 381 +13 140 -01 25()2 237 31 lil +02 26 343 +25 186 +149 2701 370 +29 1S5 -01 2702 249 -44 304 +98 2801 337 +19 187 +09 2802 306 -10 156 +31 2901 304 -38 142 +24 2902 i 307 -32 146 t3~9
30 29~0 -48 16~2 +51
31 355 +30 160 +01 32 370 +48 148 -13 3301 395 +45 130 -20 3302 368 +06 138 -02 3401 386 +16 117 000
3402
400 +32 92 -26 3501 304 -07 115 +35
3502 344 000 140 -13
3601
36~02 357 -04 132 +32
3603 30~1 42 149 -67 3701 342 +28 152 +19
1
IJ
Jianolraphic Population Chan 1960 to 1970 50 (Contd)
Census Tract
of Pop Under 19 Yrs
JJl7J
middotChanae 1960-70
middotofmiddotpop Over 65 Yrs
1c~7n
Change 196070
3702 409 +39 122 -11 3801 308 -11 151 +29 3802 275 -35 180 +46 3803 282 -32 192 +54 3901 376 ~13 100 +17 3902 296 -03 177 +29 4001 438 -11 84 +13 4002 353 -21 115 +20
4101 397 11 9middot0 +11 4102 346 -19 120 +03 42 331 +19 11 bull 3 -16 43 347 -72 105 +31 44 113 +84 183 +154 4S 33~9 +07 110 -06 4601 2501 22 193 +38 4602 332 +59 126 -29 47middot 161middot 000 211 +01 48 103 -26 302 +59 49 138 +1 bull 3 252 +09 50 141 -26 204 -12 51 12 -39 257 +07 52 47 -61 351 +48 53 89 +49 314 -30 54 25 l1li15 327 -17 55 131 -17 115 -121 56 198 +93 227 -47 57 71 102 189 -88 58 240 ~middot41 16~1 +55 59 322 +25 142 +06middot 6001 264 95 132 +50
6002 328 -31middot 89 +07
JJ
Demographic Population Change 1960 to 1970 51 (Contd)
Census 1 ofPop lChange of Pop bull ChangeTract Under 19 Yrbullbull 1960-70 Over 65 Yrs 1960-70
1970 1970
61 355 -58 85 +39
62 328 39 110 +18
63 414 04 73 10
64 382 -22 72 +04
6501 383 02 67 -20
6502 329 -56 96 +09
6601 391 +13 88 -03
6602 319 -59 97 +06
6701 327 71 145 +72
6702 331 ~67 83 +1-0
6801 365 -66 49 +01
6802 388 4bull3 54 +06
69 354 -41 80 +23
70 400 -23 68 -06
71 359 -48 72 +05
72 255 -88 82 +11
73 346 -39 91 +25
74 313middot -63 105 +24
75 329 -42 129 +37
76 336 -52 85 +21
77 370 -10 69 +05
78 309 -10 120 +21
79 325 -56 87 +10
8001 358 -81 57 +12
8002 391 ~81 76 +12
81 315 -76 108 +21
8201 403 -23 64 +08
8202 392 23 65 +08
83 357 -34 120 +31
84 402 -18 73 +16
85 413 -06 76 -09
r
Demographic Population Change 1960 to 1970 52 (Contd)
Census Tract
t of Pop Uncler 19 Yrs
1970
Change 1960-70
1 of Pop OVer 65 Yrs
1970
ex Change 196070
86
87
88
89
90
91 9201
9202
93
94
95
9601
9602
9701
9702
9801
9802
99
100 I
101
102
103
10401
10402
lOS
368
351
379
391
391
413
379
433
372
429
414
432
419
439
~32
377
457 420
378 41middot7
345
360 417
417
412
-04
-02
-35
-26
-28
-11
-64
-20
-S9
-39
-32
-21
-34
-40
-47
-lO~7middot
-27middot +04
+56
+07
-34 01
+04
+04
+10
103
128
97
11il3 99
69
79
42
77
46
34 38
44
40
54
111
51middot
81
133
59
74
140
63
87
76
-08
-06
+04
+08
+17
-05
+3S -02
+1~4
+19
+33
-14
-08
+12
+26
+71
+11
-16 -34
-20
-19 +37
-49
-2S +15
NOte The The
Taken frOi
averageullder averageabove
middotUSCensus ---shy -
19 years == 6S years ==
figures 197
32r 13(14
p a~d 1960
--
Rank
1
2
3
4
5
6
7
8
9
10
11 12 -_
13
14
15
16
17
18
Tract
69 46
60
58
- 68
61
302
2501
67
63
19
62
26
94
3603
3902
64
30 -----~-
Rank
19
20
21 -
22
23-shy
24
25
26
27
28
29
30
31
32
33
34
35
36 -
Ranking of Per Capita Income by Census Tract
Tract
65
2701
- 15
1601
701
66
93
82
2903
3602
30
2502
80
2401
81
- 70
91 shy
4001
High
Rank Tractshy
-32shy37
38 97
120239
7840
41 ~ _2_1__ 42 31
43 2501
44 18
45 98
46 37
47 3803
1702
49
48
1602 92 2702
I
50 89
51 901
52 801
Ra_
53
54
55
56
57
58
59
60
61
62
63
64
6S
66
67
68
TractTract Ra~
74692
170196 70 I
401 71 90
72 1037J
79 70273
3802 74 601
24024102 75
85 76 101
77 9023901
7699 78 100 4101 79
3601 I
380180
458140~ t---- _ - - shy83 82 42
888384
59843501
4777 8~
502
Low
802 86
Rank Tract
87 shy
--88
89
90
91
92
93
94
- 95
96
97
middot98
99
100
101
102
103
104
1201
14
49
72
73
43
87
3502
105
1
52
86
71
1
501
10
3301
104 tf
Rank
105
106
107
108
109
110
III
112
113
114
115
116
117
118
119
120
121
Ranking of Per Capitalucoae by Census Tract
(Contd)
Tract Rank
4001 122--shy602
13
1102 2302
3302
55
3401
48
21
56
50
3402
lL01
2202
2301
53
2201
-shy
Tract Rank Tract Rank T~aet Rank
57 I-----
Imiddote
bull
Tract
- Low -k Note Information taken from 1960 U SCensus
Rank Tract
I ~
Ie
Imiddot
~
----
----
--
--
Rank
1
2
3
4
5
6
1
8
9
10
11
i-
-Tract
391 922 921
972 971
100
132 131 121
962 961
822 821 401
982 981
20 111
47 10 1
412
High
Total Number of Henta1 Health Visits
Ranked by Census Tract High to Low
TractTract RankTractRank Rnk
12 182 22 78 29 87 76 381 73181 ~------- 1913 371 8538230162372 271 2616-121 8272 2
14 80~2 31 94 7923 84801 59 15251362 4232 15 52 _ 32 103 8924 651 17240216 652
_ 91 351 33 341 23117 83 122 25 25 48 1123921418 34 shy61 86 661
19 662 6493 81 26 91 8153 49 50 55 41383 71 27 51 3120 90 672241 35shy 104167162 461
I 411 46211121 28 88342 I
2502 36 69 54 5251 50 272
-Ra
37
38
39
_ 40
_ 41 Ishy
I
42 I
-I 43 44
45
shy
Tract
~ --- shy 95 56
45 292 242
102 62 352 291y
92
101 281
99 72 63 601 60~ 42 2201
77 74 61 57
363 232
70
32 31
11 44 282 2202
Low l
- Tract
46 682 681 I 331 30
r~$ 47 1042 332
48 102_41_
11
~
Visits to Family Planning Clinics Ranked by Census Tract High to Low
Rank Tract Rank Tract Rankmiddot Tract Rank Tract Rank Tract Rank Tract
1
2
3
4
5
6
7
8
9
10
11
12
13middot
14
15
16
17
361
56
401
341
48
59 121
20
55
342
10
31
58
93 21
241 132
331
53
461 462
18
19
20-shy21
22
23
24
25
26
27middot
28
29
30
31
32
33
391
32
middot47 I-i-_-shy _ -
231 111
332
972 1
372 371
52
89
32
92
82
100 31
182
30 242
402
34
35
36
37
38
39
40
41
42
43
44
45
42
1714 i 661 221
78 362 2
90 602 601 352
63 251
105 921
971 351
73 42 292 232
411 51
662
81 45 52
46
47
48
49shy
50
51
52
53
54
55
56
961
801
49 81 72 71
19
9~1
172
68 2 57 162 14 112
91 75 681
381 42
3~3
83 161
57 f
58
59
60
61shy
62 Imiddot
63
Imiddot 64
65
66
64 62 36~3 252
74 652 SO 392 291
651 6bull 2
79 271
r-- ---- shy981 222
672 671
821 272
94 87
281
382
67
68
69
70
71
72
73
74
75
76
77
78
981 26 12~2
IS 61
85 82~2 69
61 43
101 86 84 282
76
131
51 72
1041 962 88 70
99 922 77
103
95 802 181
i
~
Low High
RankRank Tract
5479
4480
81 1042 ~) middot102
71 - - + ~ - ~
Visits to Family Planning Clinics
(Contd)
Tract Rank
I
Tract llaDk l
RankTract Tract Rank Tract
~
I
~
J1 ~
Low
Total Number of public Health Nursing Visits
Ranked by Census TractsHigh to Low
TractTract RankTractRank RankRank TractTractRankTractRank
25249 71 79 17249 8033 6586 99189711 84 2915072 34 661 76 66 811519512
402 5035 51 161 2518220 122 1713423 352 55801 7120 6752 2 149814 41236 83 2662 38 94 6821 53 2924015 362 37 32 42 75 69 281 84 63
546 8822 54 222 85 3925431 70383417 3818223 6439 4386652 718 21 55 103332 8924 232 87 19 271729219619 24156 16211140 382 628825 10523110 112 73411 10141-- ----shy 89 363 4457 8126 16111 221 74 9142 90 46158331 53 671279012 46243 48 59 351 3837528 1083 9313 91 5844 59 -_242 76 1----- shy60 272 72 74104114 60145 42 9287 7729 92 6151 8215 57371 934630 91 307762 12113116 282 619447 41391 9531 78100 63 7378 ~95 681 6945 32 5632 798517 6448 47 52 181
High ~ Low
Rank Tract Rank
96 31 132 70
97 102
98 182 372middot 602 651 662
- -shy
~72 682 802
822 922 962 972 982
1042 ----shy
Low
Total Number of Public Health Nursing Visits
(Contd)
Rank Rank Rank TractTract Tract
I
I lt
I
Tract Rank Tract
[
~~~-
I
~
IJilfimiddot ~
j
Ranking of VD Caea According to Census Tracts 61 By High and LOll Youth Itatio
A media~ of 34 5 was determined Any tract having greater
than 34 5~ of popu1tionunde~ 19 years of age -High~
Any tract having l8S than 345 of population under 19
years == Low
Any tract having rate less than 390 =Low
Any tract having rate more than 390 == HLgl4
YOUTH
LOW HIGH
L
0
12 402 1801 1802 343 2801 2802 29023603
54 6001 600262 66~02 72 74 75 76
78 79 81 t02 65 1202
W
(25)
VD
H
I
G
H
401 701 801802 901 902 10 1101 241 1201 1301 132 14 15 1601 1701 20~ 21 2202 2j02 2402 2502 2702 2901 303501 3502 34023801 3802 383 3902 42 44 45 4601 4602 47 48 49 SO 51~2 53 55 56 57 58 S9 6701 6702 73 95
3~02 7021702 19 25~01 2701 4102 4101 63 64601 ~601 6801 680270 7l 77 8001 80~02 8201 8202 83 84
85 86 87 88~ 90 91 9202 920193 94 9601 9602~ 9701 9102 9801 9802 99 100 101 103 10402 105 6501 10401
(47)
301 501 502 601 1602 2401 2301 2201 31 32 3301 3302 3401 3402~ 3602 3702 3901 400140 02 43 61 69 B(
(53) (23)
~ ~gt
Ranking of VD by Rate Per 100000 By Census Tract
~
Rank Tract Rank Tract Rank Tract Rank Tract llank Tract Rank Tract Rank Tract
1 2202 21 S6 40 902 58 1602 74 75
90-shy 64 107 26 --~-
2 3402 22 45 41 10 59 902 75 78 91 54 108 61
3 2301 23 3502 42 2502 60 602 76 6802 92 402 109 87
4 3302 24 49 43 1102 61 501 17 2 93 94 110 90
5 50 25 52 44 6702 62 14 78 8202 94 97 02 III 76
6 2201 26 20 6701 63 4002 8201 2501
9701 41~02 112 91
7 44 27 48 45 401 64 3802 2902 95 63 113 62
8 3301 28 1701 46 502 65 30 79 83 74 96 9602 114 71
9 55 29 47 47 42 66 3803 80 2801 96Q1 115 85 10
11
12
13
14
15
16
17
18
3401
53
2302
2401
57
21
2402
1101
51
30-shy31
32
33
34
35
36
37
3701 - -~ 1201
3702
89
43
132 131
3602
4001
48
49
50
51
52
53
54
55
58
1601
601
4602 4601
69
701
31
3901
67
68
69
70
71
72
2901
801
39021~ 802
6502 6501 122
702
41~01
81
82
83
84
85
86
87
88
19
1
1702
2802
79
93
100 6801 6602
81
97
98
99
100
101
102
103
104
9201 9202
9802 9801
77
302
79
86
72
84
116
117
118
119
120
121
3603
8002 8001
101
99
95
10401
105 10402 103 102
19
20
59
32
38
39
2702
3501
56
57
301
3801
73 1802 1801
89 6002 6001
105
106
2701
88
High Low
-- -----
Rank OrdermiddotTuberclosis Cases by Rate Per 100000 Ranked by Census Tract High to Low
Tract TractRankTractRank Rank TractRaukTractRankTractRank
801
79 9601501411 52 6835340120511 I 960269 903603532036 $-~~F130221542 4366 311301 70 68~013802 _ I- _ 4001_37213 3921201 6802802 H71523822024 22 54 193302 3802 80 8958 I37139535 70155 9801 I60123 72 6702 98023914011016 6701250124 10 56
81 94 401r 7 154152 73 7057 2625 122 92028
90242 162312301 92~158 86 7172434526509 82 79160159 74 100 87412240227220110 6502836960 75 30 8317244 6501782801285711 61 901 42765645 84 66021459294912 9701 660146 171 302 9702 47
6235023033113 85 822821182 917755 16335013110214 841814832 78 103 938564 324815 86 1057940149272 38036523216 10401 87 2902241 725Q 10402360266340217middot IF88 88 9937233 282 51 218 101 01102 46016234
I)167 2901460219 47
High ~ Low ~
- -
TractRank
9S89
6490
8191 8001 8002
63 61 60middot01 6002 44 2701
92
J
2502 402 --- ----shy
I
Rank
Rank Order Tuberculosis Cases by Rate per 100000
(Coutd)
Tract Rank Tract ~nk
I
Tract Ballk Tract Rank
Imiddot
Tract
Imiddot
1~
t 1I i Pi i l I
o
1 -1shyL I
I J
8 40 icO ~ I -lt 0
-t (1) I
i I
r o E
II
a
I
r--i
shy
I
~
I (
Jgt
(011 fi(
Ggt
I II ~j
()
(f 0
~ ()
I
11
f9
r
II 99
o ~
Ggt r
~ __-J~ I t I ~ I
r--J l I
~ _ __ J
) 1
fTl
1gt
r I
()
r
()
lt en -i en
()
I1l
(J)
(J)
-i
P ()
19
r o ~
r G1 I
I
c
~
o I 89
--- -I-shy
r-r I
1- 0 _~ _ _--J E
G1 I I I
i i
I 1-1-1 ~ _J ~2 ~ II
II
()
1 I I I 1
id i bullbull
~
A n 69
r 1shy
- 0 Gl
l--~ ~ I
~ II
II )
I () isect i
en l i
(J)
-t
0
IA Ol
Li
l of opratiol18 of ta1lJpIlflicl- ancl the satellite
center the ba of oparat1oDa of public heaJth nurses
an4 nllbborbood amp1 be satellite centers wereto
proVide preVentift tutaltll bullbulln1c1-m1zaticms w811shy
baby care per1od1c ~ectiland tJle central health
center to proViAle care tor illnes If (36 p299)
bis propWI VUDOt ~ttullytunct10DIDI at the t1JDe
it d1cu8ae4 18 tbe Uterature aDd all aernce Were
be1Dl provided 1D_~terBowever itwould ae
tbat the ntua1pro~ as aY1ioae4by its plmmers
would boclJ aoaeot bull 4efeot~ otthe current lud1cal
ccde teaIt pObullbulllne_t coorctJl8td admSDtshy
etration eD4 well 4eftlopecl refelTal procedtlreacould
1I1a~ thecOllDeCticmof t~_t8 withappropr1ate preTellshy
t1 aD4 therapeu1ampcaen1cbullbull aV81lable 111 diffrent
locationa Bowner tile barrieraottiaeaDdUatanc
between center and truaraUon tor the UDSopb1aticated
patieatlook1Dl tor 1her1~pJce too tor ~1CU-
larhalth serfplusmnQewoGl4~to JJa1t tbbll1ty o~
tb18 ~811D to provide iaaiYCOliprelleU1P18hboltleod
health servicebullbull III tactmiddot tappeareto coDtlict with
tbepro own taW cOfdotpro-1~a tam1ly
mecl1cal careprogru 111 wIa10h pre-teAtlYe aDd therapeutic
health erY1cecan be proY-lW to all IIl81Ibers of
tamily in the coure of aaSDll vi8it (36 PP301-3(2)
Dle Delmtr Coloradoprepa11ke the Montet1ori
LI
17
prograJlut111zbullbull abe1rarcJly ot SlDa11 aatellItestations
andlerer IIOreceDtallzedtac11It1es It 41ffers
howeverill tbcolap~81vene80f the services avail shy
able Inthe 4ecentraUzed facIJJtiesIt resembles very
clc)sely the IOdel ~ordecentral1zed social servicedell shy
very developed by 1ahII~ Which was 41sCussed above he
SIlall neImiddotgbborhoodmiddot c8Dt~aw1tb1n walkl distance of
most of the populatiotl havebeendesilDedto take care
of allthenorllalhealth probl of 3000-5000 patJentsshy
check-ups IlzatiOZl8s1Jlpl laboratory testa and
treataentand iaecucatlol18 (d1apeued by phyS1cians) for
IIOst DODCrltIcal 1l11le PatIent 1d1Oneed IIOrespecIal-
Ized care are reterrecttobacJalp facilities BaCkup
support tor themiddot~t1oDa are the tWo l8rsernelshborhood
health C8Dter8~ttr1Dl aCOglete~e of out-patient
serneeaDd three part1clpat1q hoap1iampl bull bullbull which
proVide1Dpat18Dt~t andcoDSUltatlve services
(13 p1028) Intb1a prosrama coaprehens1ve range of
prevent1ve aDd trea1aeDt serric 18 aVailable throughout
the decentraUzed middotta The CoapreheulY8 ReIgbborhood Hea1~ Service Project
otKa1er iC)UDdatlcm HOspitals 111 Portlan4 OreOD 1s
s1ll11arto th DenVer prosraa 1D thata comprehensive range
ot out-patientmiddot services 1D prov14e4 in each of 1ts 10cashy
t1oDa althoUlhmiddotmiddot tbe oentera are larger and l bullbulls DDIerous
than 1nth DenverproPUh (12 p6)
Li i
18
In order that a comprehensive neighborhood health
care center be able to proVide continuity of care it
must have arrangements for hospital services integrated
into th system Yarby (37 p73) as quoted above
states that it 1s characteristic of the neighborhood
health center to be directly connected with a teaching
hospital However De Diaz (14p3) indicates that it
may be advantageous for purposes of service delivery not
to havemiddotthe center affiliated with a teaching hospital
She feels that such anaft11iation may lead to asltuation
in which policies might be determined more by the teaching
needs of a medical school than by the service needs of
the patient
middotThe Nat10nalmiddotCommissionmiddoton Community Health Services
(25 p69) states that such a system of comprehensive
health care integrat1na ~e servicmiddotes of several health
and roedical agencies snould utilize Itas much single or
unified management as possible Neighborhood health
centers have been operated under a variety of auspices
but several writers have pointed out the advantages in
termsof coordinated prOvision of servictts management by
the hospital of the neighborhood health center For
instancethisfac111tates the keeping of unified medical
records of all the care a patient Msrecelved either at
the neighborhood health center or _le hospitalized
(12p6) ~ermore a3 Young (38 p1741) points out
19
direct operationot the u1sbborhood health oenter by
the hoSpital canll8lceaftilable to the center expertise lt bull
in sOlle aapcta 0 Operation that m18ht not be aa readily
available otherwie
Relardlebullbull of wbetberthe hospital and the neighborshy
hoodhealtbcent8r haVe a cOJIIIOaadmjntstration they
IIlU8thaVealTlved at a str1Dsent delineation of IDUtUal
role and reSpoDBlbilltiebullbull All OOIIpoienta ot the care
yst IIlWStQlarify and understand one anothers position
In the syatem and acree on objeCtive ancimethOds
(26 pp16-17p31) SODae areas of iDUtUalconcemare
reterral procedures record keepiDg aDC1 mutual use of
facilit1es statt1Dl i8 anotb8r ~ ot coaaon conc~
Ditt1cultift have u-laeniD the pastiD cOllprehensive bull t bull
healtbc~ prosraumiddot 1d11ch were batil plauned in wb1ch
all of the health canter phy1C~1IDa did DOt bavetatf
privilege at all ot thebackuJlhospltala (29 p21)
SUch a8ituat10n i8 1Dampcceptablelt inpatient care i8 to
continue to be p4by the pat1eatmiddot health center
physician and it cont1Du1ty ot care 18 to be maintained
Hoapital and health center1lUSt laav 301nt responsibility
tor the recruitaentot physicians
VticlentU IPan BJcNrcu Much otwhat haa b8ea sUd has stre88e4 at leastmiddot
iJlplicit17tbaD8ed tor tM etticit middotprovision ot8emcea
20
There appears to be two aspects of efficiency which are
discussed by writers on the su~3ect of the comprehensive
neighborhood health care centef one of these is the
need to organize) services to make the most efficient and
economical use of scarce medical care resources The
other closelyrelat8d in realIty is the need to help
the public use services in the most efficient manner
The comprehensive neighborhood health center concept
1s lhherentlymiddot efficient in that preventive curative and
rehabilitative health ~are programs are coordinated under
one roof with integrated a~stration Furthermore
theempbasLson prevention health education and early
disease detectionis eftic1ent troJll~estandpoint of
the health care system as well as beneficial to the patient
(18 p760) HQwever ~ue tothe scarcity of health care
personnel thecoiDprehensive neighborhood health center
mustbe an arena tor eXperimentation with new staffing
patterns~ The Kaiser program is indicative of the way
in which health care systems must begin to operate in
that appropr1ate ancillary personnel are used Wherever
possible to perform functions that do not need to be
carried out by the physician As Saward (32 p42)
states
1hroughou10ur organ1zat1on~ there are many of the customary experiments be1ngmade-shyJse of speciallr trained nurses for well-baby care under the SUpervision of the pedi9trlcianexperiments with routine prenatal care by
w ~
21
middotSPC1a1l~t~JlUrbullbull per8ema_1 bullJmdlJleu y our fuDotlou are auoh that DOtb1Da 18 dorutbYtbe phY8iCianstbat doe DOt vet to be done by the
phys1c111U1fhe other aldlle4 person- Del-nurse middotreC~0D18t the appo1ntshymeDt center or clerical praormelshyaremiddot there to free h1amiddotto use his spec1al sk111
Awell lmoWn treDd1D the area of eaaiDI health
c8re JII8DPOY8rShortagjs bas middotbe thetrend toward tra1nshy
1DB poverty area rea1deats as DOD~pro~eaionalmiddoth8lth
aide and nepborboocl health workeramiddot (28 p63) This
bas the effectofmiddotmiddot1J)creaa1q II8DPOWrand 8180 can help
bridle the cuJ~ cap betweenprondera and colllUmers
of aen1C8s This attarD at least tlleoretically
createa a situation 1D WIa1ch providers andcoD8Ullers can
be educated to UDderatad OD88DOtber and interactJlore
ettectlvely~ HoWever amiddotpltt8ll has beeD themiddot tel14ency in
801D8 oamp8e8 tomiddot us aidesmiddot ssale8lllcw t~r the center
alJDOatexclwdY811rathertbaD ua1Dltheal to protide the
health care for wh1ch ~ were trained (29 pp3B-39)
1bat ismiddotmiddot vh1~e the a14e Yalue in ~~m1catiDI with
low 1nCOlMt patieata haa beeR recoSD1zed and stressed
their role ashealtb carepersoDDelhil been slighted 1n )
any 1Dstancea
Anotber step 1d11Ob bullbull been taken to provide 8rY1ces
more efficiently eUeot1ftlybas beenmiddot theorgan1zation
of per8ODDeliDto IIllt141sc1pl1Dary teamaaaa means ot
proYid1DgmiddotCOQrd1DatedserY1ce SUch te8lll8 sen_rally
~
hf
~
22
include PhYsiciaQs nursbullbullbullbull soc1al workers and outreach
workers Conceptually th8y fmlct10n to me~ the intershy
relate lled1cal and social needs ot the families sened
Hor there are a number ot barriers to the etfectve
tlmctiOD1nlof lIuchte8ll8 SODieot these are heavy caseshy
loads the inordiDate amount ot tille consumed by multlshy
prOblem tamtliethel1m1ted tra1n1 ngmiddotmiddotand laCk of tnterest
on tile part ot aoae tebers in examinJng aspects of
problems out14e~lr oWn areaaotcolIPetencemiddot and
~ourdcation prc)blell8 between proteasioDala and nonshy
prot81~s (10ppa-10) middotrurtbemOre as De Diaz
(14 middotp6)1nd1cate tbel8 maybe a teDdency tor vertical
dp8rtmental lines of auperv1810nto become paramount
over the team coDamloation syst lead1ngto conflIcts
in determ1niDI the ro1ea ot solie team bers particularly
the DOD-prote81011alaInauch exper1l1enta Witb new
~t1Dlpatterna it 1s bullbullaentialtbat line of authority
roles aDd NsP0D81bll1tlea be made explicit and that there
beJDechaD 8IUI tor relUlar evaluat1onotfunctlorUng
Another way inwb1ch health care sernee delivery can
be made more ett1cl8Dt is to proVide servicea dur1DC the
hours whentbey aremiddot -ostnee4ed As reQo_ded by Yarby
(37p1) serY1ce can bemadelIOre accesslble by making
themava1lable 24 hours a day seven days a week If
rg8l1Cy service are aft11ab1e aroua4-tbe-cloek at ~
nil1iborhood health center the continuity ot tbepat1ent ts
23
careiamaiDtalDedand meatry point into the
cOIIPre~i health care 8 be made available
tothe patient who aoZMllyU8ea ozilymiddot emergency care in
tille of med1cal criais More 8isDificantly ava11ab1-
lity of a tull rase of bullbullrv1c8 tor seVeral hours 11the
eVerlna aI1Cl On ~ prevent the los ot earn1JiSs
involved if th patierat 1IU8tt8cet1me oftfroawork dur1q
the d8y for aed1Cal oare bull his can be an eSpecially
importantc0J1814eration tor lo1aCOlleDUUg1nally qloYEtd
patient aa4caJla18o PIOJIOtet1)e 0Da01Dl use othealth
servicebullbull
exper1eDO ot tbeKa1er prosraa in tb1s~reprdAs
Greenl1clt(19 p10) states wA lllNt 8ip1flcant
proportion ot the abulatory care 8n1cp~Y1dd tor ~
total popUlatiC)U ~ ~ after clWc hours and this
Deed i8 apParenUyaoN prODGUDced tor aJl8d1cally
iDCust population On the other hand the bulk ot all
aabulatory med1cal cu 88l91ce are performed dur1nS
regular cl1D1c hour eVen when services are available 24
hours a dayJ day bull week W
It has ~ the experi8D~eof a ftIDber ot ne1g1lboXshy
hooct hea1tbcentere _t a_jor obstacle to efficient
proViSion ot anicbullbullhas beentbe teD4eDcy of medically
1ncl1pnt patieats to utilize the center oa a walk-in
baais tor epi8od1ccr181or1entect bullbullrv1cea rather than
4)i
h~ ~~f ~~ L
24
to make appoJlltaeata tor ODIo1qprevmt1ve treataent
and rehebl11tat1Ye care ad ampl1O to bave a blah failure
to Show rat_for tbe appo1DtaeDts that they dO make
Atone center 628 of appo1Dtments made were kept
while 3Oottbepati_ta een were ~1n patients
AlthoUP fewer patiets were actually 88811 by the cater
1D middottb1s 1Datance thaathe -bervholuidmadeappointshy
mta the walk-iD patlat required an iDord1nate amount
ot staff t1ae tor aCreeDiaaacl ~trral to pplOprlate
~ttor caregt (9 pgg) Arraquotbr1llpl1catjo~ of the
plOVidedto valk-iD patient by other thaD their
(19 p12)rurtbermore
when patients uti11ze Wlk-1Il er181 centered care
athelr ODlf tona ot ootact with the _d1~ care
ay_ta fUilycentered care the treata_t of tUl11y
bers
a a UD1t 11
dlarupted
hewalk-1Dphenoaaencm appear to barelated to
diUerence between soclal clase in the style of Dlaking
contactJt1th the a11oal C~ay8t As Greenlick f ~
(19 p11)1Dd1oate8 thepheDOaenOn ot INater usage of shy
walk-in ervice by aed10ally middot1Jid11ent patient thaD by
others baa otte been attr1buted to a stoical att1tude
tQward 1llDe8 em the~ ot poor people leacl1D8 to a
~
25
greaterdelay1n tbe k i Dlofa8d1cal care These
patients wppoedlyeelcmiddotcareODlymiddotwIleD tbeirmiddotillDess
becOlles1Dtolerable resultiDSin middotthMr appeariDS withshy
outnot1ce1o rece1ve oareHlwever Greenlicks
r8aearcbbaa cut doubt on the existence ot tb1delay
111 report1Dg middot8J1IPtoJumiddotOfDeW 11laessand seek1ng care
Be bas tcrQDd 1bat s1ll11ar peze_tases of dioally
1nd1sent 8DClJ1on-aed1cally 1Dd1PD~ pat1enta seek care
on the aue daytbat aptou tirstaPPear
1fb11e GrHDllclc 1nd1cat tbat the reasonator the
greatertendeDCY of low 1Do~e pat18Ilta to 1$8 walk-in I
serY1ces are notlcDo1rAmiddotmiddot tbe7 _ be rel~tedto a tendency
ot lower aocio-ecaaaoclaa patieota to preter face-toshy ~
face contacts with II841cal persoDl181posslbly because
such contacts areft coatortiDS an4reasauriDS to
patients who are hJpotbeafzed to bave a dependent attltude
toward IIed1Cal care perS0Jm81 (30 p161)
It a8 itmiddot baa pnerally beenhld the appointment
s1stemts the most efficient Ileana of dellveriDS
comprehenSive oODtllluiDlh-lth care (9~100)1t is
necessary that educaUoraalmiddotbulltfort be taken to proaote the
use ot middotappo1ntaents8DClmiddot tQrec1ucethe fa111re to appe~
ratB4uOatioaalwhlQb baft~utl11zedhave been
IJ
26
1Dten1ews with walk-in patients home Vi8its and group 4i
meetiDp1D8D attemptto1Dierpret1o the patients
the value of rtitgular ppo1ntmentamp andot con~in~
c~1ve care rather than epiI041c care (9 p1OO)
h1s 1safuD~tioD torwhtch nOl~prot81QDal colDlllUD1ty
YOrkersllaY bebe~r8U11ed tban other statf H()wever
euch aD ~ucat1oaal propul __~ ~e related to the senUiDe
capacity otth health oenter to provide comprehensivebull gt
ervice8 to1tpat1_t~odoD aD app01ntment bas18 It
1amp pos8ibleo~rw1 tor educa110Dal ttorts to result
LD a~8JImCl tor ltPP01ntaen~8 at a ratewb1ohi8beyond
the capacity ot thee_tar to t without uareaaoDably
1_ wa1t1Dlprio4a QOBt1nuad use Ot the center on a
wallt-in bU1 _1tbeoosiItpos81ble to et an appoint-
met anc11nCreued pit1entcoJaplampia1a bull Therew111 of
course always be a need and demand tor acute ep1so~c
Care -ci the health centerDlWlt be planned with the capashy
billty ot bullbullbullt1D8 tb1aneed wh1~ cont1Du1nI to stress
aDd educate the patient to utillze oDlOinI comprehensive
faa11y middotc~te~d Cflre (9p 100l
att g4 CODClva1opa
In order to bea4equate any coJlltemporary health care SY8tem muat bullbulletcerta1D interrelated criteria he
IJ
27
minimum criteria areaccessability of services to those
who need them compr8heX1siveness and appropriatness of
services and efficIency 1nthft utilizat~on of SCarce
health care personnel and resources The scareity of
pex-sonnel andtbe need for h1gh quality ongoinghealth
care services
aJIlong the
populationdemanci the most effishy
cientprovision of services
Services must be made accessible to the population
They mustmiddotbe geosraPh1cally accessible to remove the PhysicalmiddotbaTiers betWeen peopleandthem$d1calcare
system They mUst otter their services dur1ngthe
hours when people can make the moat use ofthemA~ it
makes little sense to concentrate services geographically
where they will not be uSed to their fUllest extent it
also is wasteful to provide serv1cesonlydur1righours when
many people are employed his not only presents a hard
ship middotto the consUmer lnrt wastes resources if for instance
the unavailability of preventive services during the hours
when people Can use them causes a need for treatment
services later on
Health carbull sEtrvices must be comprehensive including
prevention treatmcmtand re)abimiddot11tation Ambulatory I
healtbcare facilities wh1cQ are orienteciexclusively
toward either prevept1on or trea1mentare no longer accepshy
table for they are lneft1c1entln their use of resources
and in their prov1s1on of health care to the patient
w ~~
28
If prevent10n1s notmiddot stressed treatment serv1ces that
could have beenavoidedY1l~ be required If prevention
1s the sole focus of the health care facility sick
patients who present themselves must be referred elseshy
where for treatment andsllch referx-als may be taken as
reject1onsor not followed through with until illness
becomes unbearable
The instltutlontbat meets these requirements Is
the comprehensive neighborhood health center It 1s a
local decentralized outpatient facilityprOVld1ng a
fUll range of ambulatoJY health care services It has
a linkage to ahospitalbackUp facilityforlnpatient
treatment and hiihlY apclalized outpatient care
The neighborhood health center must be a fac11ity
planned with an awareness of the needs of the conSUtller
and coDitnUn1ty It must have the r~Ul0urces to provide the
services people need mere they can use them and when
they can use them It must uti11ze the part1cipation of
the community to develop this awareness Not only must
the cen~er beset up to be Amctional for the consumers
but efforts must bemadeaga1n with commun1ty partici shy
pation to help the consumers utilize medical care
services effectively The center muetmake efforts to
educate the community about the valueot regUlar health
care of preventive servicesand of the use of planned
IJ
29
medical appointments ratherthanorisis centered walk-
incare Therealit1es of the existing health care
system have not taught the patient particularly the low
income patienthow to use services effectively
The helthcenterilUst also bea laboratory for
experiments in easing the health caJepersonnel shortage
and c60rd1Datingcare~ A major difficultY iri-exper1shy
menting with neW rolesis freeing staff of old preconshy
ceptions
CoDlprehensiva neighborhood health dare centers have
been developed under a variety ot alisplces including
medicalsociet1es hoSP1talsmiddot(36p299 group pr~ct1ces
(29 p6- 12 117) health departments (13 p1027) and
ne1gbbothoodassoc1ations(14) The literature indicates
somevalues nthe management ot the health center by plusmnts
hospital backup faCility Whatever the auspices many
adm1nistrative fuDctions such as program coordination
standard pr9tectionand evaluation call for considerable
c~tralization of adm1nistration city-wide or coU)tyshy
wide At the same time other aspects hours of servlce
for examPle~ cuI f~radm1nistrative fUnctions made atmiddot
more local levels Each neighborhood center must be
free to adapt its functioning to itscominunity thi-ough
the mechanism otcODlllUl11~ participation inmiddot policy making
Obviouslythe prerogatives and responsibilities of each level must be negotiated and made explic1t
t4~
JJ
BIBLIOGRAPHY 30
1 American Rehabilitation Foundation ~ealth Services Research Center The Health Maintenance Strategy mimeo 1971
2 Anderson Nancy N Comprehensive Health Planning in the States A Study and Critical Analysis Institute for Interdisciplinary Studies American Rehab ilitation Foundation 1958
3 Andrus Len Hughes Comprehensive Health Planning Through Community Demonstration Health Projects mimeo1967
4 Barry Mildred CandCecil G Sheps A New Model for Community Health Planning unpublished paper presented to the American
Public Health Aseociation1967
5 Blum HenrikL Fred Wahl Genelle M Lemon Robert Jorulin and Glen W Kent The Multipurpose Worker and the Neighborhood Multiservice Center InitialImplications and EJeperiences of the Rodeo CommunityService CenterAmerican Journal of Public Health58 (Mar 168) pp 458-468 shy
6 Blum MichaelD and Soloman L Levy A Design for Service Delivery that Reinforces Constructive Tension Between a Health Center and Its (sic) ConSUDlers and Supports Community Power unpUblished paper presented to the American Public Health Asaociatiltn 1968
7 Brielaud Donald Comm~ity Advisory Boards and Maximum Feasible Participation American Journal of Public Health 61 (Feb 1971) pp 292-296 shy
8 Burns Eveline M Health Insurance Not If or When But What Kind Madison Wisco~sin University of WisconsinScllool of Soci~l Work 1971
9 Campbell John Working ~elationships Between Providers and Conshysumers in a Neighborhood Health CenterU American Journal2 Public Health 61 (Jan 1971) pp 97-103
10 Caxr Willene Neighborhood Health Centers Funded by the Office of Economic Opportunity mimeo 1970~
11 Colombo Theodore J Ernest W Sawardand Merwyn R Greenlick The Integration of an OEO Health Program into a Prepaid Comrehensive Group Practice Plan American Journal of Public Health 59 (April 1969) pp 641-650~ -
12 Comprehensive Neighborhood Health Services Projectof Kaiser FoundatioIl Hospital~ Prcgtgram YearE grant renewal proposal mimeo~1971 bull
13 CowenDavidL~ Denvers Neighborhood Health Program Public Health Reports 84 (Dec 1969) pp 1027-1031
IJ
14 De Diaz Sharon Daniel Beyond Rhetoric The NENA Health31 Center After One Year unpublished paper pres~rited to the American Public Health Association 1970
15middot Gerrie NorrrianF and RichardH~ Ferraro Organizing a Program for Dental Care in a Neighborhood Health Center Public Health Reports 8 (Aug 1968) pp 419-428
16 Gordon JeoffreyB~ The Politics of Community Medicine Projects A Conflict Analysis Medical Care 7 (Nov -Dec 1969) pp 419-428 shy
17 Greely David The Neighborhood Health Center Program and Its Implication(3 for Medical Care H~alth Forum of the Welfare Council of Metropolitan Chicago (mimeo) 1967
18 Greenlick Merwyn R Newgtimensions in Health Care American JOurnal of Pharmacentical Education 34 (Dec 1970) pp 754-4
19 GreenlickMerwyn R Donald K Freeborn TheodoreJbull Colombo Jeffrey Abull Pruesin and Erne$t W saw~d Comparing the
Use of Medical Care Services by a Medically Indigent and a General MemberShip Population in a Comprehensive Prepaid Group Practice Prosram II unpublished paper presented to the AmericanPublic Aesociation1970
20 H~tadoArJiloldVMerllYll RGreenlick and TheodoreJ Colombo Determinants of Medical Care Utilization Failure to Keep Appointments unpublished paper presented to the American Public Health Association 1971
21 Johnson Richard E and Merwyn R Greenlick Comprehensive Medical Care A Problem and Cballengeto Pharmacy ff AJilericanJournal of PbarmacenticalEducation 33 (Aug 1969) pp 361-367 -
22 Kahn Alfred J Studiee Social Policy and Planning New York Russell Sage Foundation 1969
23 Kotler Milton Neyhborhood Government Local Foundations 2 Political~New York The BobbsMerrill Company 1969
24 NationalCommisaion on CommunityHealthSfrvic~sActionPlanniriamp for Community SetithServices~ashington p C Public Affairs-Press 19t7
25 National Commission on C~mmunity Health Services Health Adminishysration andOrMPization l the Decade Ali9$-d Washington D C Public Affairs Press 1967
26 NationalCornmiesion onqomm1Jllity Health Servicesbull Health ~ Facilities Washington D C PUblic Affairs Press 1967 bull
~ n
32 27 ODonnell Edward J and Marilyn M Sullivan ServiceDelivery
and Social Action Through the Neighborhood Center A Review of Research tt Welfare ~ Review 7 (Nov~Dec 1969) pp 112
28 Office of Economic Opportunity Second Annual Report Washington D C~ U S Government Printing Office 1966
29 Office of EConomic Opportunity and the Medical Foundation of Be~laire Ohio Eighth Report 2l ~ Committee2a Governshy
ment OperatiOll~ Va8hiiiSton D C Government Printing Office 1969
30 Pope Clyde R Samuel S Yoshioka and Merwyn R Greenlick Determinants of Medical Care Utilization nhe Use of the Telephone for ReportiDg Symptons Journal of Health and SocialBebavior12 (June 1971) pp155-162 shy
31 RenthalA Gerald nComprehensive Health Centers in Large US Cities American Journal of Public Health 61 (Feb 1971) pp 324-336 shy
32 Saward Ernest W The Relevance of Prepaid Group Practice to the Effective Delivery ofHealthServicestt The New Physician 18 (Jan 1969) pp39-44 - shy
33bull Schorr Lisbeth Bamberger and Joseph T English Background Content and Significant IssUes in Neighborhood Health
Center Programs Milbank Memorial ~ Quarterly 46 July 1968) part 1pp 289-296
34 Weiss James E and Merwyn RGreenlick UDeterminants of MedioalCareUtilization The Effects of Social Class and Distance on Contacts With the Medical Care System Medical~ 8 (Nov-Dec 1970 pp 456-462
35 Weiss James E MerwynR Greenlick and Joseph F Jones Determinants of Medical Care Utilization The Impact of Ecological Factorstt unpublished paper presented to the American Public Health Association 1970
36 Wise Harold B Montefiore Hospital Neighborhood Medical Demonstration A Case StudyMilbaDkMemorial Fund Quarterly46 (July 1968) part 1 pp297-308~
37 Yerby Alonzo S ttHealth Departments Hospital and Health Services Medica1~5 (March-April 1967) pp 70-74
38 Young M M~ Chatanooga IS Experience with Reorganization fOr Delivery of Health Services ttAmerican Journ8l of Public Health60 (Sept 1970) pp 1739-1748
f or l
II bull 11 Y d
II
IJ
34
ThepurposeOfPart II of th1aa paper1atod1scuas
elected Speclfic needs ofecltlc areas within Multnomah
County A8P01ll~oUt 1D ~ I of t1a1bullpapermiddot Ita nelgbshy
borhood health oare cater IlU8t be a facl1lty plaDlled with
aD awarenes of the neeels of the oODllUller and collllUDity
Part II of this paper nIl Show 80e of thoe speclflc
needs
he1DforutiOD tor t1li Portlon of the report
obta1nec1 troll tbroupout tbe follow1Dl threepUb11catloDS
1gr~e_tiMshylIPrIxaiidOreson JuDe 1963
2 1~_middot_sectSI8e~ected1teai c-ua 0 S 8 e first count coaputer tape Coluab a_lion AssocshylatloD of QoveraMD-8 Jlme 1971
3 Jtu1tDoab County Oreaon BDY1roDlHtlltal SurveyEarly 1971
The JIultDOIIIlb COUDty OrttIOD BDv1roDllfmtal Surley
Barly 1971 1s bull stat1stical report of the activ1tles of
theentlreMultDOIIIl2 CcNDty Health Dep~t during the
year of 1970 Die speclflc 1nd1cs elected from tb1s
study amprejMental aealtll Publlc Health N~s1D1 vlslts
FaJUly ~ Veaereal])1 ~ ~rcul081
Throush tie use of cUrts and mapa ODe CaD roup these i
speclflc ~oea to ahcnr the healthneedsof speclfic I
census trtcta aD4 then the health needs of iarer neIghshy
borhooda 1m4 o~ Uebullbull
Rf)~UP1Dl of areu was accompllshed in thefolloWinl I
JJ ~
35
he MiltDoIliahCountY oregon BDViromaental SUrvey
early 1971 isamp statistical report ot tbeaotivities ot
the entire MultDolllh COUDty Health ])epartiDent dur1nl the
year ot1970 he specitic 1Dd1C8S selected frOm this
aUy are 1Il8Dtal health public healthDurs8s visits
fUl1ly pia waereal elisease aDd tuberculosia
Tbroq11the Wle otcbart aDd mapa aDecm szoup these
specific indic to show the health Deeds ofapecitic
ccmaua tracts aDdtIum th8health neecla of larsr ~eilh-
bOrhooda and co8I13 tlbullbullbull
RegroupiDI ot areas waa accoap118hed1D the
tollOWiDl lIIIIm1er~ A bullbullcifie 1ndex 8selectcl auch as
venereal di8bullbulle or tuberculo8i~ he total number ot
cs was then deterll1ne4 for each census tract Through
the use of the maber ot cRbullbullbull tor a 11Yen cenaus tract
aDd tbe population ot thattractaltrateot1lla1ampmcper
100OOOpopUlaticm wu cleteXll1ned for each census tract
This was ~e to starl4ard1ze the population ditterence
amongOeD8U8 -tracts 1he rate of incidence toreaob
cenauatract was then llstedby rank position on a chart
In rank poition1DI any cen8Wl tracts haviDg equal
rates ot1l1c1dence are assipe4tbe iaDk posttiona
Beeauseot the abo fact tbAt cbarta w111 vary in length
neveltbAtlea eacb cbart will 1Dclu4eall census tracts
inMullnoaah Couaty Atter the census tracts bave been
listed accord1q to raalcth1s list will bediv1ded into
IJ
36 three levelsotinc14ence he three levels are
1~ The upper 14 of1DcldenCe
2 Thelower 14 ot incidence
middot3 The ILld 12 of incidence
Tlles three srouplqa are then used in compiling a map ~f
Mu1tnOmahCountyfor ach apecltictop1cbull TIle maps are
uaefuJliD tbatthey V1suallycoJib1De 1Dd1v1Clualproblem
census tracts into larger problem nellhbOrhooc1s
The 1960 statistical iDtormatloD was Used in a similar
liIaDDr to tbatexpla1Dedabove 1Dthe4evelopaent of a
chartmiddot and map 1Ihow1DI e cOllpampriSOr1 of per capita lncolle
tor ttaCh ceDsua tJact aDdmiddot combiDed census middotmiddottract areas
he 1910 aDd 1960 statlstlcal iDtOrllatl0D was combined
lna map and chart he purpose of this and chart is
to d8aonatrate the e cl1stributloa1DeachceD8U8 tract
and middot1ndlcatbull tuture ace populatlon treD4a bull
When one be middotbullbullbullbullbullHdth ne8cts ot an area and has
declded to establlsh a cl1D1c to serve that area the
physical location otthat cl1D1c IllU8t be consldered In
order to coapreb8ll81vel develop an area cl1n1c one should
conslder thepre88Dttraftlc middot~ytaa an4tranaportatlon
systems Thecl1D1cahoUld be located close enoUlh to
major arterlals to giva asy access from the total area
be_ ervecl by this cliD1c At the t1ll8they should
be tar eo away froll thesarterlals to all8Y1ate traffic
CODCell18 andpark1D8 conpstlon By traff1c concerns I
IJ
37
lIlan one lUSt consider thertarro1fne8S of streets whether
streets are oD8--C)r two-way iqres8 and egress to parking
amp0111tie eros tratflC) spedof trattJQ children 1n
ll8a traffic i1lht Vislon re8tr1ctionS etc
BwstraDsportat1onshould alao be central in this area
as maay people ~U f1Df1 1tD8Cessary to use this form of
transportatlon
~e tutqredlopHQt of bull treewa systems should be
c0J1S1dered soastolesen thecumce ofmiddot future roada
cutt1DSotltbe cl1D1c llte line
nrrph1c middotDampta
It is 1JDportaDtto kDOw the demosraphic distribution
characteristics of the oUenteltbat i8 to be served by
localized health cl1D1cs
Acl1D1c which erves8J1 area where1D the prepondershy
ance of persona arecrter 65 years of mayf1nd that these
people rely more on pUblic transportation call for more
home- services and haV4t 110ft ChroD1c and debilitating
types of disorders (b1_ blood pressure poor heariDg and
eyesight) tbaD do8 an area ot a YOUDIer population On
the other hand thL area of older residents may have little
need for family plabDlng cllni08
In order to better ~Ybullbull the 4eaoraphic population
of each CeD8U8 tract the 1970 CeD8U8 iatormation was viewed
and two specific catelOri8 considered These two cat
IJ
38
lori8S woUld be the perc_tap ot population under 19
year of ase and the percentase ot each oensuetractover
65 years of age he 1960 1Dtormatlon tor eaCh tract was
then compared witbthe 1970 intormation and a percentage
ofincreaae or4ecreamp8 tormiddot e~chtract1n each category
cOJlputecland achartma4e By the use of this chart one
18 able to View tJleap populat1odiatr1but10n of census
tract and at the _ t1lle accesa middottrencl Por example
let us choose census tract 601 W see 40-4 otthe
population is under 19 years ot and that ODly82 1s
over 65 years ot middotAtthe e tille the percentage of
youth bas ~ed ODly 1_ intbe laSt teD year whilethe
percentale over 65 year ot middotbas stayedmiddotthe same With
this in mJnc1 ODe ~ 1DfItr libat ol1D1o aerviDg this
area WOuld bellQre conq~w1th the problems of a
YOUQier populat1on and that _ would probably be true foJ
some t1aein tbefuture On the other hand CeDSU8 tract 54
has only 2 ollt population UDder 19 yel1s ot age and
this has decreased by 1 over the last ten years middotwhile at
the same time 32-377 ot the populat1on 18 over 65 years of
age A ol1D1C ___ this area should be or1eJ1ted toward
tbespecttic problema otthe ampledbull
PerCapia __ bY gsa neat
WhaD cona1der1qlooat10D1 tor health cl1n1cs one
shoUld take the 1DC01Ieot areas into consideration Areas
IJ
39
of lowiDcome would not 11kel~be 8erved more by localized
cl1D1cs tbaD would are of hilbincome It 18 likely
people haYiq a hip iDeoll8would preter to be aeenby a
chosen ~r1vatephylc1a1l tban at a local cl1D1cwhere
10Dier waits y beraceaaampryand leas personal attention
gl_
The 19701ncOII81atoWampt10n tor MultnomahC~ty was
not available at the tille thi8report W88 made The 1Dto~shy
tiOD Was taken ~adtro tbe1960 census publlcation
his woUld ~8Il thea tbat ral1I8 OD the chart ynot 1raquoe
completely accurate hi writer telthatthe areas most
affected by tb8 1I8eof the older 1Dco1DtOlaat1oDWOuld be
those tracts wh1ch baYebad a rapid 1ncreaae1n populatlon
over the past tfmyHr8 bullbullbull tracts would include tracts
nUmbered 104 9897 96 aDd 95 be perc~ita 1Dcome
referredto1il-tb1a Paper18the lIean 1DCo per person per
census tract
Attar the iDeoeper census tract was listed on a chart
a map was de 1D41catiDg those census tracts belonging to
the lower 14 ot income tor all censue tracts in Multnomah
COlDltytbose beloqins to the upper 14 ot income tor all
census tract 111 MultnolUlhCounty and those belonging to
the mid 12 ot 1I1coaetor all oeuuetracts in Multnomah
C01mty
In yiew1Dg the _p 1t caa be seen that the low income
area seautotollow aloas the at aide ot the Wl1lamette
IJ
40
R1ver the full length of Kultnomah County A second low
income area follows the south edge of the Columbia from
the northwest corner of Multnomah County easterly to 148 St
A third problem area seems to be on the east bank of the
Willamette River with the Union Pacific Railroad being
about the center of this tract The extreme loutheast
corner of Multnomah COUDty appears to be a low income area
but as this area bas bad rapid grouth in the last ten years
this could be erroneous
Mental Health
be first ~ecific indica to be selected from the
Multnomah County envirollllental survey of early 1971 and
to be considered in this paper i8 that of Mental Health
At the present for mental health purposes Multnomah
County is divided into five catchmentareas with a mental
health cl1n1cin each area These clinics are Model
Citles Delaunay ADkeny street Office Hansen Health
Building end Southeast Clinic
All lIlental health cl1n1cslcept statlstlcal information
on all patients visiting their cl1n1cs this included the
address of the patient hese addresses were then listed
upon the approprlate C8D8US tract Each census tract was
then ranked on a chart according to the nUllber of mental
health patients who reslde ln thatCeDSUS tract attending
any of the above listed ental health clinics This chart
IJ
41
wasttum d1v14ed1ato proper quartile bbullbullbull
quartile vereUs to dne10 u appropl1ate Multnoh
County _tal health ItLa middotmiddotmiddotthelipO~a1bl by lOoJcJIUE
at the UDtal health _to uteN1De which ueu have the
lars-t use otCOllDty 1alh~th faci11t1Rot
1Ilclu4ecl 111 tbia woUld tber otpeopleYia1t1Da
pr1vat patch1atriata aDd pr1_t _ntalhealtb cl1D1c8
WheDtbe M1 18Yienclmiddot Itmiddotmiddotmiddotmiddot~middotbe~_ tbat ~rtt
appears to lMt fourmiddotmiddot-al are iii _oil the nuaber ot
lIental healthcl1D1c na1t toM tbjh1sheat 1he
tour areaa woUld be tollows
1ttrea Ore to~Blo Drimiddot ~tb Burrus14e aDd tIMtmiddot Colb1a Riftr H1gbwyaeri1Dla th nortllra boundaryshy
2 bull ProII 82D4 1_~ 10 20th streetwitil the ra1lMd Mu the north ltouadary
3 ~ et et tUgl_b1bull MYel froamiddot the Clackaaa COUDty l1ae aorth to Dln8lon stret
4 beDOlvt1ttfe-t ~efllt4 COatytrca Jle1aware streetmiddot toR1C1a11oDd wlth Colubla Blvd heiDI tbAtnorth bouaclary_
It ODe coapareatbiap to th iDeobullbullmiddotp 1t can be
eamiddotthat lIOat ot the c tracts baY1Dg bllh v1i11tatlcma
middottfl public tal health cJ1rUc8 ~ 111 t13e low ~ aid
1DcOile SroupiDIOJa1y of til 25 tracta llsted as
haviDlbip aental Maltll nlltatlou are ~ the1g60 hip
iDeo arebullbullbull
17 Plpn
42
amily PlellnSDI ]Jlce Metal Health i8 an 1nd1ce of
use Theperson 111 ordertobavebe_ 1Dcluclecl 1n this
atu4ywouldhave tohaft Ue4 ataa11y plaDI cl1D1c
tacilities of soaetype It 41fter troll tile _tal health
study1nthat i t1Jicludestatist1catrollbotb public and
privateclJD1os
The iDformation tor the iak orurcbart 8Dd map of
t8ll111 plenn1 na ob1a1De4 by cOIIblnlDlthe mabel of
1rlcuv1duals bullbull_ attbe tbreellUltrampo-ti Coatyhll11y
PlalJQllIl C11ll10s 111til tbo at the Planned PareDthood
Association CliD1C8 be tbree -JIultDouh Couaty r8ldly
PlamSq Cl1D1c are Solrtbweatth Col_bla 1111- a114
HaDsell Health BWlcl1Dl CllD1cbi middot1Dtormat1oD vas then
bullbullbullesed tomiddot detellWMt l10w people troll eacb c8IUIUS
chart wastben Mele IUs oIIart jn 4iY1ded to show
the censuS tracts lIaYiDlmiddottIle h1t1iest qUart1le of incidence
of use lowest quartile of 1Qc1deao ot use Jlid 12 of
incidence of Wle an4 a map sprepared troll thts 1Dto~
mation
The C8U118 tractsbelOJISnl to the h1lhestquartile of
use appear to be 1lO~ 8catt~ on tbipwas true ot
either the _p ot aental health cl1D1c uaageor ot the map
abow1DI per capita 1I1COM Iaere40 to be three
d18t1nct areas of UIIaP beJ woul4 be
1
IJ
43
t10D of BurD81cl and the W11lallette River 4
2 S~t Portland 8Otth otmiddot the ra11shyrcaadand alona the W11lamette River
lIortbeaat Portl8D4 between MisSiss1pp1 and 24tbStreet the northbouBclary be1DgColwb1aBlvd
Pylzl1c BMltl IrpI Y11ta
Publlc Healtil nur81D1Y1s1t nclud8 an vists to
theholles of client by PubUc Health Nurbullbullbullbull his shows
visits to bull f8Jl1ly fer aDY purpos SUCh aatuberculolJ1s
het1Dl tem1tyaeatalu4 8IiOt10D8l cODd1t1ona etc
he atat18t1C~ 1fele C()4ed accord1Dg tomiddot the 1llli301fOCUS
of the Y18lt tt doe DOt 1D41cate the Dmlber of holies or
f8ll11lev181tecl or 1D41Y14ual Y1a1ted more tban oDcein
the propwl It dobullbull I1ve 80M 1D41cat1on by coaparlshy
OD ot the 8JIoUDt of aedlcal problema 1n eachcen8WI tract
Ap1nmiddot the _p abowa 8 scatter patteraof probl_
areas althoUSh there appear to be a sroup1Dl of hiSh J
l8aIeccmaus tract 1ntlut extreme southeast part of tbe
County other areu uIriaI any nura1Dl contacts are
1 bull he 801lth-oa-al CO1Dty on eaCh 814 of 82nd Av from Clackallaa County north to Dinloa
2 ear bullbullbullt 814e aroUDd Preacottand Misaisippi
Dowatom Bunul14eonboth 1de of the river
44
V_real Pis The iDfomatloil uaec1 to tabulate the Venereal
disease chart includes all the ooab1ned case otmiddotODormea
and syphilIs reported by bothmiddot publIc and prIvate physicIans
dur1nl 1970 There were 3602 caes ot IOnorrhea reported
dur1nl 1970 While ODly 17 cabullbullsot ayphilimiddot were reported
A chart was prepUed aDd att8llPt wasmiddotmiddot de tomiddot
determ1De Wh_therVttDereal 41ease was more p~vaJent in
areas othigb or lowmiddot proportIon ot youth hi waadone
bymiddotdetemlna a 1leaD prceiltacmiddotmiddotmiddottor the population ot
resld~ts UDder19 years ot (34) middotA mean ratemiddot per
100000 popUlatIon al80c1ttem1Ded tor the middotoccurreDCe
ot venereal dieae This was et at 390 oass Areas
hav1nl a population 1n which leiS than 34 were lmder 19
years ot ampIe were called low- yOuth abOve tbl percentaae
hiSh youth The aaa waatrue ot the occurrence oivenershy
eal disea_ per CeD8UStract It the rate waacomputed
as 1I0re than 390 cases per 100000 it was called hiah
venerealdiaeasei it less than thia tisure low venereal
disease It was tound that 1D Multn~ COmlty there sems
to be poSitive OOlatI0n(x21S19gt between low youth
and hipmiddot venereal diseaand hip youth and low venereal
diseasebull
RaDk ordr Iitot all c traot middottbAm made
Th1s was done byt1Ddlna the ratepr 100000 populatIon
of venereal disator all census tracts in the County bull
45
These were thenlisted from h1lhto low (sreatest to
least) in a rank order The l1sting was then divided
into Upperandlower 14 aDd listed on the MUltnomah
Countymiddot up
The areas of b1gh venereal disease se8ll18to
roup thBl~8 middotin a very tllht area ~oq both 1des
of thell18l8~ R1 w1th BurDaldeS~et being
~bout theceDter qf tbi8IZ9uping This area woUld
appear to be m ldeal spot for the denlopment of a
locallzed venereal d1sbullbullbullbull cl1D1c
UbepoundCUlO1s
In this report bull tube1C1llosls caS8S refrred
to include alltbobullbull cabullbulls ontubercUlo8is follow-up
rather middotthan just new C Accord1Ds to the Multnomah
County Health SUrvey of early 1971 this would include
all ca repOrte4 over thelaat three years The
total number of tuberculosi8 cabullbullbull usedin this study
was 666 lh1 included 128 new cabullbullbullbull
A rate per 100000 of tuberculosis for each
census tract wa- then computed and the c~us tracts
listed by rank order be b11h Qartlle mel low
quartl1 were then reoordd on a Multnomah CoUnty map
TWo genral areaa baY1Dg a hip mcldencaot tubercu~
losiare 1D41cated heyare
1 Both middotsld ot theWilla11lette River
Ll -
46
with Burns1de about thecnter
2 he extrea Northebullbullt comer of the County bull
By coap8r1ng the tuberculois an4ven8real
diseae maps ODe can 8ee that the downtown areas ot
hiSh 1nc1denceare alIIo8t 1c1eDt1cal on ach map
This WOuld 1nd1cate that 1t would be of value to
bullbulltab11sh acl1D1c 111 th1aampreatbat would provide
bothtuberCulos1s 8Dd ytmereal 418ase srvicbullbullbull
Thchart aDd 1181gt8 are wsfuln 11v1DI
1Ddicat10DS tor the type aDd placemeototlocal
health cl1n1c8 tbro1qhout tbe MultnomahCounty area
A cOllpar1on of the mapa help one to dec1dewhether
to provide a aulti-8ervice cl1D1c or spec1f1c type of
cliD1c As stated in Part I of thi paprserv1ces
shouldhaYe both treatlieDt and prfMmt10n cOmponents
As he been stated fta ne1lbborhood health care
Qenter muat be a fac111tY plazme4 with an aamesa
ot the neds of the consumer and the c01llll1m1tybull
Part II of this rport haa been an attaapt to indicate
and clarify 8011 ottheae coDlllUDity neds This has
been done through8elect10n of apc1f1c problems
The indic were then visuallyrecorded through the
use of ups and charta ODe dan asseS8 thedsreeof
1DIportance of certain concems to spec~t1c areaa by
comparinl the chart aDd maps Prom this oDeean
41 dec1de which are48 vb1chcUD1c-or indeed if
the need a clinic at all However further factors
should be considered hebullbull include
a The amount of fuDd1 available
b What 18 the percentage ot peopleineoh ceaaua tract tbat would actually us such cl1n1cIl
c Wbat 1 tbeco--1tymiddot 8 IeeliDashyreaardtDI particular cl1D1c8 Would this dcrebullbullbullmiddot the ettctiveness ot thse cl1n1ca
IJ
li
D_OlraphicPopulatLon Challie 1960 to 1970 48
Cen8U8 1 of Pop 1 Cbaqemiddot 1 Change1 ofPopTract Under 19 Yr8 Over 65 Yrs1960-70 1960-70
middot1Q701Q70
1 319 -12 171 -H) 1
2722 215-27 +68 301 366 -22 127 +35 302 371 +19 111 -04
311middot401 144-41 +29 402 321 13~7-39 +24 501 356 124-08 -02 5~O2 351 133-23 +12
405601 82-10 -02 394602 103-01 -06
701 275 149-76 +56 702 361 +01 121 -07
+10middot801 326 140-22 802 321 middot127
(
-29 -03 9~01 342 124 -H) 6-18 902 294 128 -H) 3-24
10middotmiddot -14312 140 -17 1101 182 +25 -23197
2411102 186-59 +29 1201 226 169-17 -41
31middot01202 +11 182 -05 295 -H) 81301 208 -H) 4
1302 331 +08 197 +04
14 323 +15 middot185 -08 middotmiddot15 329 +16 16~5 -13
-28middot 1601 332 131 +12
1602 356 98 +24middot-39 middot3101701 161-33 +21
1702 370 -15 85 +02 +19 1801 264 151middot-50
185middot1802 256 +47-58
IJ ~
D_raphlc Population Change 1960 to 1970middot 49 (Contd)
4io
Census Tract
of pop Uncter 19 Yra
1Q1n
1Cha1l8e 1960-70
of PopOver 65 Yra
lQO Change
1960-70
19 389 +29 141 -24 20 223 -13 206 +18
21 227 +08 194 -36 2201 356 -27 112 +05
2202 290 -18 ll~9 -29 2301 356 -03 154 +24 2302 260 -37 245 +97
2401 410 +6~1 123 -31 2402 163 -80 320 +99 2501 381 +13 140 -01 25()2 237 31 lil +02 26 343 +25 186 +149 2701 370 +29 1S5 -01 2702 249 -44 304 +98 2801 337 +19 187 +09 2802 306 -10 156 +31 2901 304 -38 142 +24 2902 i 307 -32 146 t3~9
30 29~0 -48 16~2 +51
31 355 +30 160 +01 32 370 +48 148 -13 3301 395 +45 130 -20 3302 368 +06 138 -02 3401 386 +16 117 000
3402
400 +32 92 -26 3501 304 -07 115 +35
3502 344 000 140 -13
3601
36~02 357 -04 132 +32
3603 30~1 42 149 -67 3701 342 +28 152 +19
1
IJ
Jianolraphic Population Chan 1960 to 1970 50 (Contd)
Census Tract
of Pop Under 19 Yrs
JJl7J
middotChanae 1960-70
middotofmiddotpop Over 65 Yrs
1c~7n
Change 196070
3702 409 +39 122 -11 3801 308 -11 151 +29 3802 275 -35 180 +46 3803 282 -32 192 +54 3901 376 ~13 100 +17 3902 296 -03 177 +29 4001 438 -11 84 +13 4002 353 -21 115 +20
4101 397 11 9middot0 +11 4102 346 -19 120 +03 42 331 +19 11 bull 3 -16 43 347 -72 105 +31 44 113 +84 183 +154 4S 33~9 +07 110 -06 4601 2501 22 193 +38 4602 332 +59 126 -29 47middot 161middot 000 211 +01 48 103 -26 302 +59 49 138 +1 bull 3 252 +09 50 141 -26 204 -12 51 12 -39 257 +07 52 47 -61 351 +48 53 89 +49 314 -30 54 25 l1li15 327 -17 55 131 -17 115 -121 56 198 +93 227 -47 57 71 102 189 -88 58 240 ~middot41 16~1 +55 59 322 +25 142 +06middot 6001 264 95 132 +50
6002 328 -31middot 89 +07
JJ
Demographic Population Change 1960 to 1970 51 (Contd)
Census 1 ofPop lChange of Pop bull ChangeTract Under 19 Yrbullbull 1960-70 Over 65 Yrs 1960-70
1970 1970
61 355 -58 85 +39
62 328 39 110 +18
63 414 04 73 10
64 382 -22 72 +04
6501 383 02 67 -20
6502 329 -56 96 +09
6601 391 +13 88 -03
6602 319 -59 97 +06
6701 327 71 145 +72
6702 331 ~67 83 +1-0
6801 365 -66 49 +01
6802 388 4bull3 54 +06
69 354 -41 80 +23
70 400 -23 68 -06
71 359 -48 72 +05
72 255 -88 82 +11
73 346 -39 91 +25
74 313middot -63 105 +24
75 329 -42 129 +37
76 336 -52 85 +21
77 370 -10 69 +05
78 309 -10 120 +21
79 325 -56 87 +10
8001 358 -81 57 +12
8002 391 ~81 76 +12
81 315 -76 108 +21
8201 403 -23 64 +08
8202 392 23 65 +08
83 357 -34 120 +31
84 402 -18 73 +16
85 413 -06 76 -09
r
Demographic Population Change 1960 to 1970 52 (Contd)
Census Tract
t of Pop Uncler 19 Yrs
1970
Change 1960-70
1 of Pop OVer 65 Yrs
1970
ex Change 196070
86
87
88
89
90
91 9201
9202
93
94
95
9601
9602
9701
9702
9801
9802
99
100 I
101
102
103
10401
10402
lOS
368
351
379
391
391
413
379
433
372
429
414
432
419
439
~32
377
457 420
378 41middot7
345
360 417
417
412
-04
-02
-35
-26
-28
-11
-64
-20
-S9
-39
-32
-21
-34
-40
-47
-lO~7middot
-27middot +04
+56
+07
-34 01
+04
+04
+10
103
128
97
11il3 99
69
79
42
77
46
34 38
44
40
54
111
51middot
81
133
59
74
140
63
87
76
-08
-06
+04
+08
+17
-05
+3S -02
+1~4
+19
+33
-14
-08
+12
+26
+71
+11
-16 -34
-20
-19 +37
-49
-2S +15
NOte The The
Taken frOi
averageullder averageabove
middotUSCensus ---shy -
19 years == 6S years ==
figures 197
32r 13(14
p a~d 1960
--
Rank
1
2
3
4
5
6
7
8
9
10
11 12 -_
13
14
15
16
17
18
Tract
69 46
60
58
- 68
61
302
2501
67
63
19
62
26
94
3603
3902
64
30 -----~-
Rank
19
20
21 -
22
23-shy
24
25
26
27
28
29
30
31
32
33
34
35
36 -
Ranking of Per Capita Income by Census Tract
Tract
65
2701
- 15
1601
701
66
93
82
2903
3602
30
2502
80
2401
81
- 70
91 shy
4001
High
Rank Tractshy
-32shy37
38 97
120239
7840
41 ~ _2_1__ 42 31
43 2501
44 18
45 98
46 37
47 3803
1702
49
48
1602 92 2702
I
50 89
51 901
52 801
Ra_
53
54
55
56
57
58
59
60
61
62
63
64
6S
66
67
68
TractTract Ra~
74692
170196 70 I
401 71 90
72 1037J
79 70273
3802 74 601
24024102 75
85 76 101
77 9023901
7699 78 100 4101 79
3601 I
380180
458140~ t---- _ - - shy83 82 42
888384
59843501
4777 8~
502
Low
802 86
Rank Tract
87 shy
--88
89
90
91
92
93
94
- 95
96
97
middot98
99
100
101
102
103
104
1201
14
49
72
73
43
87
3502
105
1
52
86
71
1
501
10
3301
104 tf
Rank
105
106
107
108
109
110
III
112
113
114
115
116
117
118
119
120
121
Ranking of Per Capitalucoae by Census Tract
(Contd)
Tract Rank
4001 122--shy602
13
1102 2302
3302
55
3401
48
21
56
50
3402
lL01
2202
2301
53
2201
-shy
Tract Rank Tract Rank T~aet Rank
57 I-----
Imiddote
bull
Tract
- Low -k Note Information taken from 1960 U SCensus
Rank Tract
I ~
Ie
Imiddot
~
----
----
--
--
Rank
1
2
3
4
5
6
1
8
9
10
11
i-
-Tract
391 922 921
972 971
100
132 131 121
962 961
822 821 401
982 981
20 111
47 10 1
412
High
Total Number of Henta1 Health Visits
Ranked by Census Tract High to Low
TractTract RankTractRank Rnk
12 182 22 78 29 87 76 381 73181 ~------- 1913 371 8538230162372 271 2616-121 8272 2
14 80~2 31 94 7923 84801 59 15251362 4232 15 52 _ 32 103 8924 651 17240216 652
_ 91 351 33 341 23117 83 122 25 25 48 1123921418 34 shy61 86 661
19 662 6493 81 26 91 8153 49 50 55 41383 71 27 51 3120 90 672241 35shy 104167162 461
I 411 46211121 28 88342 I
2502 36 69 54 5251 50 272
-Ra
37
38
39
_ 40
_ 41 Ishy
I
42 I
-I 43 44
45
shy
Tract
~ --- shy 95 56
45 292 242
102 62 352 291y
92
101 281
99 72 63 601 60~ 42 2201
77 74 61 57
363 232
70
32 31
11 44 282 2202
Low l
- Tract
46 682 681 I 331 30
r~$ 47 1042 332
48 102_41_
11
~
Visits to Family Planning Clinics Ranked by Census Tract High to Low
Rank Tract Rank Tract Rankmiddot Tract Rank Tract Rank Tract Rank Tract
1
2
3
4
5
6
7
8
9
10
11
12
13middot
14
15
16
17
361
56
401
341
48
59 121
20
55
342
10
31
58
93 21
241 132
331
53
461 462
18
19
20-shy21
22
23
24
25
26
27middot
28
29
30
31
32
33
391
32
middot47 I-i-_-shy _ -
231 111
332
972 1
372 371
52
89
32
92
82
100 31
182
30 242
402
34
35
36
37
38
39
40
41
42
43
44
45
42
1714 i 661 221
78 362 2
90 602 601 352
63 251
105 921
971 351
73 42 292 232
411 51
662
81 45 52
46
47
48
49shy
50
51
52
53
54
55
56
961
801
49 81 72 71
19
9~1
172
68 2 57 162 14 112
91 75 681
381 42
3~3
83 161
57 f
58
59
60
61shy
62 Imiddot
63
Imiddot 64
65
66
64 62 36~3 252
74 652 SO 392 291
651 6bull 2
79 271
r-- ---- shy981 222
672 671
821 272
94 87
281
382
67
68
69
70
71
72
73
74
75
76
77
78
981 26 12~2
IS 61
85 82~2 69
61 43
101 86 84 282
76
131
51 72
1041 962 88 70
99 922 77
103
95 802 181
i
~
Low High
RankRank Tract
5479
4480
81 1042 ~) middot102
71 - - + ~ - ~
Visits to Family Planning Clinics
(Contd)
Tract Rank
I
Tract llaDk l
RankTract Tract Rank Tract
~
I
~
J1 ~
Low
Total Number of public Health Nursing Visits
Ranked by Census TractsHigh to Low
TractTract RankTractRank RankRank TractTractRankTractRank
25249 71 79 17249 8033 6586 99189711 84 2915072 34 661 76 66 811519512
402 5035 51 161 2518220 122 1713423 352 55801 7120 6752 2 149814 41236 83 2662 38 94 6821 53 2924015 362 37 32 42 75 69 281 84 63
546 8822 54 222 85 3925431 70383417 3818223 6439 4386652 718 21 55 103332 8924 232 87 19 271729219619 24156 16211140 382 628825 10523110 112 73411 10141-- ----shy 89 363 4457 8126 16111 221 74 9142 90 46158331 53 671279012 46243 48 59 351 3837528 1083 9313 91 5844 59 -_242 76 1----- shy60 272 72 74104114 60145 42 9287 7729 92 6151 8215 57371 934630 91 307762 12113116 282 619447 41391 9531 78100 63 7378 ~95 681 6945 32 5632 798517 6448 47 52 181
High ~ Low
Rank Tract Rank
96 31 132 70
97 102
98 182 372middot 602 651 662
- -shy
~72 682 802
822 922 962 972 982
1042 ----shy
Low
Total Number of Public Health Nursing Visits
(Contd)
Rank Rank Rank TractTract Tract
I
I lt
I
Tract Rank Tract
[
~~~-
I
~
IJilfimiddot ~
j
Ranking of VD Caea According to Census Tracts 61 By High and LOll Youth Itatio
A media~ of 34 5 was determined Any tract having greater
than 34 5~ of popu1tionunde~ 19 years of age -High~
Any tract having l8S than 345 of population under 19
years == Low
Any tract having rate less than 390 =Low
Any tract having rate more than 390 == HLgl4
YOUTH
LOW HIGH
L
0
12 402 1801 1802 343 2801 2802 29023603
54 6001 600262 66~02 72 74 75 76
78 79 81 t02 65 1202
W
(25)
VD
H
I
G
H
401 701 801802 901 902 10 1101 241 1201 1301 132 14 15 1601 1701 20~ 21 2202 2j02 2402 2502 2702 2901 303501 3502 34023801 3802 383 3902 42 44 45 4601 4602 47 48 49 SO 51~2 53 55 56 57 58 S9 6701 6702 73 95
3~02 7021702 19 25~01 2701 4102 4101 63 64601 ~601 6801 680270 7l 77 8001 80~02 8201 8202 83 84
85 86 87 88~ 90 91 9202 920193 94 9601 9602~ 9701 9102 9801 9802 99 100 101 103 10402 105 6501 10401
(47)
301 501 502 601 1602 2401 2301 2201 31 32 3301 3302 3401 3402~ 3602 3702 3901 400140 02 43 61 69 B(
(53) (23)
~ ~gt
Ranking of VD by Rate Per 100000 By Census Tract
~
Rank Tract Rank Tract Rank Tract Rank Tract llank Tract Rank Tract Rank Tract
1 2202 21 S6 40 902 58 1602 74 75
90-shy 64 107 26 --~-
2 3402 22 45 41 10 59 902 75 78 91 54 108 61
3 2301 23 3502 42 2502 60 602 76 6802 92 402 109 87
4 3302 24 49 43 1102 61 501 17 2 93 94 110 90
5 50 25 52 44 6702 62 14 78 8202 94 97 02 III 76
6 2201 26 20 6701 63 4002 8201 2501
9701 41~02 112 91
7 44 27 48 45 401 64 3802 2902 95 63 113 62
8 3301 28 1701 46 502 65 30 79 83 74 96 9602 114 71
9 55 29 47 47 42 66 3803 80 2801 96Q1 115 85 10
11
12
13
14
15
16
17
18
3401
53
2302
2401
57
21
2402
1101
51
30-shy31
32
33
34
35
36
37
3701 - -~ 1201
3702
89
43
132 131
3602
4001
48
49
50
51
52
53
54
55
58
1601
601
4602 4601
69
701
31
3901
67
68
69
70
71
72
2901
801
39021~ 802
6502 6501 122
702
41~01
81
82
83
84
85
86
87
88
19
1
1702
2802
79
93
100 6801 6602
81
97
98
99
100
101
102
103
104
9201 9202
9802 9801
77
302
79
86
72
84
116
117
118
119
120
121
3603
8002 8001
101
99
95
10401
105 10402 103 102
19
20
59
32
38
39
2702
3501
56
57
301
3801
73 1802 1801
89 6002 6001
105
106
2701
88
High Low
-- -----
Rank OrdermiddotTuberclosis Cases by Rate Per 100000 Ranked by Census Tract High to Low
Tract TractRankTractRank Rank TractRaukTractRankTractRank
801
79 9601501411 52 6835340120511 I 960269 903603532036 $-~~F130221542 4366 311301 70 68~013802 _ I- _ 4001_37213 3921201 6802802 H71523822024 22 54 193302 3802 80 8958 I37139535 70155 9801 I60123 72 6702 98023914011016 6701250124 10 56
81 94 401r 7 154152 73 7057 2625 122 92028
90242 162312301 92~158 86 7172434526509 82 79160159 74 100 87412240227220110 6502836960 75 30 8317244 6501782801285711 61 901 42765645 84 66021459294912 9701 660146 171 302 9702 47
6235023033113 85 822821182 917755 16335013110214 841814832 78 103 938564 324815 86 1057940149272 38036523216 10401 87 2902241 725Q 10402360266340217middot IF88 88 9937233 282 51 218 101 01102 46016234
I)167 2901460219 47
High ~ Low ~
- -
TractRank
9S89
6490
8191 8001 8002
63 61 60middot01 6002 44 2701
92
J
2502 402 --- ----shy
I
Rank
Rank Order Tuberculosis Cases by Rate per 100000
(Coutd)
Tract Rank Tract ~nk
I
Tract Ballk Tract Rank
Imiddot
Tract
Imiddot
1~
t 1I i Pi i l I
o
1 -1shyL I
I J
8 40 icO ~ I -lt 0
-t (1) I
i I
r o E
II
a
I
r--i
shy
I
~
I (
Jgt
(011 fi(
Ggt
I II ~j
()
(f 0
~ ()
I
11
f9
r
II 99
o ~
Ggt r
~ __-J~ I t I ~ I
r--J l I
~ _ __ J
) 1
fTl
1gt
r I
()
r
()
lt en -i en
()
I1l
(J)
(J)
-i
P ()
19
r o ~
r G1 I
I
c
~
o I 89
--- -I-shy
r-r I
1- 0 _~ _ _--J E
G1 I I I
i i
I 1-1-1 ~ _J ~2 ~ II
II
()
1 I I I 1
id i bullbull
~
A n 69
r 1shy
- 0 Gl
l--~ ~ I
~ II
II )
I () isect i
en l i
(J)
-t
0
IA Ol
LI
17
prograJlut111zbullbull abe1rarcJly ot SlDa11 aatellItestations
andlerer IIOreceDtallzedtac11It1es It 41ffers
howeverill tbcolap~81vene80f the services avail shy
able Inthe 4ecentraUzed facIJJtiesIt resembles very
clc)sely the IOdel ~ordecentral1zed social servicedell shy
very developed by 1ahII~ Which was 41sCussed above he
SIlall neImiddotgbborhoodmiddot c8Dt~aw1tb1n walkl distance of
most of the populatiotl havebeendesilDedto take care
of allthenorllalhealth probl of 3000-5000 patJentsshy
check-ups IlzatiOZl8s1Jlpl laboratory testa and
treataentand iaecucatlol18 (d1apeued by phyS1cians) for
IIOst DODCrltIcal 1l11le PatIent 1d1Oneed IIOrespecIal-
Ized care are reterrecttobacJalp facilities BaCkup
support tor themiddot~t1oDa are the tWo l8rsernelshborhood
health C8Dter8~ttr1Dl aCOglete~e of out-patient
serneeaDd three part1clpat1q hoap1iampl bull bullbull which
proVide1Dpat18Dt~t andcoDSUltatlve services
(13 p1028) Intb1a prosrama coaprehens1ve range of
prevent1ve aDd trea1aeDt serric 18 aVailable throughout
the decentraUzed middotta The CoapreheulY8 ReIgbborhood Hea1~ Service Project
otKa1er iC)UDdatlcm HOspitals 111 Portlan4 OreOD 1s
s1ll11arto th DenVer prosraa 1D thata comprehensive range
ot out-patientmiddot services 1D prov14e4 in each of 1ts 10cashy
t1oDa althoUlhmiddotmiddot tbe oentera are larger and l bullbulls DDIerous
than 1nth DenverproPUh (12 p6)
Li i
18
In order that a comprehensive neighborhood health
care center be able to proVide continuity of care it
must have arrangements for hospital services integrated
into th system Yarby (37 p73) as quoted above
states that it 1s characteristic of the neighborhood
health center to be directly connected with a teaching
hospital However De Diaz (14p3) indicates that it
may be advantageous for purposes of service delivery not
to havemiddotthe center affiliated with a teaching hospital
She feels that such anaft11iation may lead to asltuation
in which policies might be determined more by the teaching
needs of a medical school than by the service needs of
the patient
middotThe Nat10nalmiddotCommissionmiddoton Community Health Services
(25 p69) states that such a system of comprehensive
health care integrat1na ~e servicmiddotes of several health
and roedical agencies snould utilize Itas much single or
unified management as possible Neighborhood health
centers have been operated under a variety of auspices
but several writers have pointed out the advantages in
termsof coordinated prOvision of servictts management by
the hospital of the neighborhood health center For
instancethisfac111tates the keeping of unified medical
records of all the care a patient Msrecelved either at
the neighborhood health center or _le hospitalized
(12p6) ~ermore a3 Young (38 p1741) points out
19
direct operationot the u1sbborhood health oenter by
the hoSpital canll8lceaftilable to the center expertise lt bull
in sOlle aapcta 0 Operation that m18ht not be aa readily
available otherwie
Relardlebullbull of wbetberthe hospital and the neighborshy
hoodhealtbcent8r haVe a cOJIIIOaadmjntstration they
IIlU8thaVealTlved at a str1Dsent delineation of IDUtUal
role and reSpoDBlbilltiebullbull All OOIIpoienta ot the care
yst IIlWStQlarify and understand one anothers position
In the syatem and acree on objeCtive ancimethOds
(26 pp16-17p31) SODae areas of iDUtUalconcemare
reterral procedures record keepiDg aDC1 mutual use of
facilit1es statt1Dl i8 anotb8r ~ ot coaaon conc~
Ditt1cultift have u-laeniD the pastiD cOllprehensive bull t bull
healtbc~ prosraumiddot 1d11ch were batil plauned in wb1ch
all of the health canter phy1C~1IDa did DOt bavetatf
privilege at all ot thebackuJlhospltala (29 p21)
SUch a8ituat10n i8 1Dampcceptablelt inpatient care i8 to
continue to be p4by the pat1eatmiddot health center
physician and it cont1Du1ty ot care 18 to be maintained
Hoapital and health center1lUSt laav 301nt responsibility
tor the recruitaentot physicians
VticlentU IPan BJcNrcu Much otwhat haa b8ea sUd has stre88e4 at leastmiddot
iJlplicit17tbaD8ed tor tM etticit middotprovision ot8emcea
20
There appears to be two aspects of efficiency which are
discussed by writers on the su~3ect of the comprehensive
neighborhood health care centef one of these is the
need to organize) services to make the most efficient and
economical use of scarce medical care resources The
other closelyrelat8d in realIty is the need to help
the public use services in the most efficient manner
The comprehensive neighborhood health center concept
1s lhherentlymiddot efficient in that preventive curative and
rehabilitative health ~are programs are coordinated under
one roof with integrated a~stration Furthermore
theempbasLson prevention health education and early
disease detectionis eftic1ent troJll~estandpoint of
the health care system as well as beneficial to the patient
(18 p760) HQwever ~ue tothe scarcity of health care
personnel thecoiDprehensive neighborhood health center
mustbe an arena tor eXperimentation with new staffing
patterns~ The Kaiser program is indicative of the way
in which health care systems must begin to operate in
that appropr1ate ancillary personnel are used Wherever
possible to perform functions that do not need to be
carried out by the physician As Saward (32 p42)
states
1hroughou10ur organ1zat1on~ there are many of the customary experiments be1ngmade-shyJse of speciallr trained nurses for well-baby care under the SUpervision of the pedi9trlcianexperiments with routine prenatal care by
w ~
21
middotSPC1a1l~t~JlUrbullbull per8ema_1 bullJmdlJleu y our fuDotlou are auoh that DOtb1Da 18 dorutbYtbe phY8iCianstbat doe DOt vet to be done by the
phys1c111U1fhe other aldlle4 person- Del-nurse middotreC~0D18t the appo1ntshymeDt center or clerical praormelshyaremiddot there to free h1amiddotto use his spec1al sk111
Awell lmoWn treDd1D the area of eaaiDI health
c8re JII8DPOY8rShortagjs bas middotbe thetrend toward tra1nshy
1DB poverty area rea1deats as DOD~pro~eaionalmiddoth8lth
aide and nepborboocl health workeramiddot (28 p63) This
bas the effectofmiddotmiddot1J)creaa1q II8DPOWrand 8180 can help
bridle the cuJ~ cap betweenprondera and colllUmers
of aen1C8s This attarD at least tlleoretically
createa a situation 1D WIa1ch providers andcoD8Ullers can
be educated to UDderatad OD88DOtber and interactJlore
ettectlvely~ HoWever amiddotpltt8ll has beeD themiddot tel14ency in
801D8 oamp8e8 tomiddot us aidesmiddot ssale8lllcw t~r the center
alJDOatexclwdY811rathertbaD ua1Dltheal to protide the
health care for wh1ch ~ were trained (29 pp3B-39)
1bat ismiddotmiddot vh1~e the a14e Yalue in ~~m1catiDI with
low 1nCOlMt patieata haa beeR recoSD1zed and stressed
their role ashealtb carepersoDDelhil been slighted 1n )
any 1Dstancea
Anotber step 1d11Ob bullbull been taken to provide 8rY1ces
more efficiently eUeot1ftlybas beenmiddot theorgan1zation
of per8ODDeliDto IIllt141sc1pl1Dary teamaaaa means ot
proYid1DgmiddotCOQrd1DatedserY1ce SUch te8lll8 sen_rally
~
hf
~
22
include PhYsiciaQs nursbullbullbullbull soc1al workers and outreach
workers Conceptually th8y fmlct10n to me~ the intershy
relate lled1cal and social needs ot the families sened
Hor there are a number ot barriers to the etfectve
tlmctiOD1nlof lIuchte8ll8 SODieot these are heavy caseshy
loads the inordiDate amount ot tille consumed by multlshy
prOblem tamtliethel1m1ted tra1n1 ngmiddotmiddotand laCk of tnterest
on tile part ot aoae tebers in examinJng aspects of
problems out14e~lr oWn areaaotcolIPetencemiddot and
~ourdcation prc)blell8 between proteasioDala and nonshy
prot81~s (10ppa-10) middotrurtbemOre as De Diaz
(14 middotp6)1nd1cate tbel8 maybe a teDdency tor vertical
dp8rtmental lines of auperv1810nto become paramount
over the team coDamloation syst lead1ngto conflIcts
in determ1niDI the ro1ea ot solie team bers particularly
the DOD-prote81011alaInauch exper1l1enta Witb new
~t1Dlpatterna it 1s bullbullaentialtbat line of authority
roles aDd NsP0D81bll1tlea be made explicit and that there
beJDechaD 8IUI tor relUlar evaluat1onotfunctlorUng
Another way inwb1ch health care sernee delivery can
be made more ett1cl8Dt is to proVide servicea dur1DC the
hours whentbey aremiddot -ostnee4ed As reQo_ded by Yarby
(37p1) serY1ce can bemadelIOre accesslble by making
themava1lable 24 hours a day seven days a week If
rg8l1Cy service are aft11ab1e aroua4-tbe-cloek at ~
nil1iborhood health center the continuity ot tbepat1ent ts
23
careiamaiDtalDedand meatry point into the
cOIIPre~i health care 8 be made available
tothe patient who aoZMllyU8ea ozilymiddot emergency care in
tille of med1cal criais More 8isDificantly ava11ab1-
lity of a tull rase of bullbullrv1c8 tor seVeral hours 11the
eVerlna aI1Cl On ~ prevent the los ot earn1JiSs
involved if th patierat 1IU8tt8cet1me oftfroawork dur1q
the d8y for aed1Cal oare bull his can be an eSpecially
importantc0J1814eration tor lo1aCOlleDUUg1nally qloYEtd
patient aa4caJla18o PIOJIOtet1)e 0Da01Dl use othealth
servicebullbull
exper1eDO ot tbeKa1er prosraa in tb1s~reprdAs
Greenl1clt(19 p10) states wA lllNt 8ip1flcant
proportion ot the abulatory care 8n1cp~Y1dd tor ~
total popUlatiC)U ~ ~ after clWc hours and this
Deed i8 apParenUyaoN prODGUDced tor aJl8d1cally
iDCust population On the other hand the bulk ot all
aabulatory med1cal cu 88l91ce are performed dur1nS
regular cl1D1c hour eVen when services are available 24
hours a dayJ day bull week W
It has ~ the experi8D~eof a ftIDber ot ne1g1lboXshy
hooct hea1tbcentere _t a_jor obstacle to efficient
proViSion ot anicbullbullhas beentbe teD4eDcy of medically
1ncl1pnt patieats to utilize the center oa a walk-in
baais tor epi8od1ccr181or1entect bullbullrv1cea rather than
4)i
h~ ~~f ~~ L
24
to make appoJlltaeata tor ODIo1qprevmt1ve treataent
and rehebl11tat1Ye care ad ampl1O to bave a blah failure
to Show rat_for tbe appo1DtaeDts that they dO make
Atone center 628 of appo1Dtments made were kept
while 3Oottbepati_ta een were ~1n patients
AlthoUP fewer patiets were actually 88811 by the cater
1D middottb1s 1Datance thaathe -bervholuidmadeappointshy
mta the walk-iD patlat required an iDord1nate amount
ot staff t1ae tor aCreeDiaaacl ~trral to pplOprlate
~ttor caregt (9 pgg) Arraquotbr1llpl1catjo~ of the
plOVidedto valk-iD patient by other thaD their
(19 p12)rurtbermore
when patients uti11ze Wlk-1Il er181 centered care
athelr ODlf tona ot ootact with the _d1~ care
ay_ta fUilycentered care the treata_t of tUl11y
bers
a a UD1t 11
dlarupted
hewalk-1Dphenoaaencm appear to barelated to
diUerence between soclal clase in the style of Dlaking
contactJt1th the a11oal C~ay8t As Greenlick f ~
(19 p11)1Dd1oate8 thepheDOaenOn ot INater usage of shy
walk-in ervice by aed10ally middot1Jid11ent patient thaD by
others baa otte been attr1buted to a stoical att1tude
tQward 1llDe8 em the~ ot poor people leacl1D8 to a
~
25
greaterdelay1n tbe k i Dlofa8d1cal care These
patients wppoedlyeelcmiddotcareODlymiddotwIleD tbeirmiddotillDess
becOlles1Dtolerable resultiDSin middotthMr appeariDS withshy
outnot1ce1o rece1ve oareHlwever Greenlicks
r8aearcbbaa cut doubt on the existence ot tb1delay
111 report1Dg middot8J1IPtoJumiddotOfDeW 11laessand seek1ng care
Be bas tcrQDd 1bat s1ll11ar peze_tases of dioally
1nd1sent 8DClJ1on-aed1cally 1Dd1PD~ pat1enta seek care
on the aue daytbat aptou tirstaPPear
1fb11e GrHDllclc 1nd1cat tbat the reasonator the
greatertendeDCY of low 1Do~e pat18Ilta to 1$8 walk-in I
serY1ces are notlcDo1rAmiddotmiddot tbe7 _ be rel~tedto a tendency
ot lower aocio-ecaaaoclaa patieota to preter face-toshy ~
face contacts with II841cal persoDl181posslbly because
such contacts areft coatortiDS an4reasauriDS to
patients who are hJpotbeafzed to bave a dependent attltude
toward IIed1Cal care perS0Jm81 (30 p161)
It a8 itmiddot baa pnerally beenhld the appointment
s1stemts the most efficient Ileana of dellveriDS
comprehenSive oODtllluiDlh-lth care (9~100)1t is
necessary that educaUoraalmiddotbulltfort be taken to proaote the
use ot middotappo1ntaents8DClmiddot tQrec1ucethe fa111re to appe~
ratB4uOatioaalwhlQb baft~utl11zedhave been
IJ
26
1Dten1ews with walk-in patients home Vi8its and group 4i
meetiDp1D8D attemptto1Dierpret1o the patients
the value of rtitgular ppo1ntmentamp andot con~in~
c~1ve care rather than epiI041c care (9 p1OO)
h1s 1safuD~tioD torwhtch nOl~prot81QDal colDlllUD1ty
YOrkersllaY bebe~r8U11ed tban other statf H()wever
euch aD ~ucat1oaal propul __~ ~e related to the senUiDe
capacity otth health oenter to provide comprehensivebull gt
ervice8 to1tpat1_t~odoD aD app01ntment bas18 It
1amp pos8ibleo~rw1 tor educa110Dal ttorts to result
LD a~8JImCl tor ltPP01ntaen~8 at a ratewb1ohi8beyond
the capacity ot thee_tar to t without uareaaoDably
1_ wa1t1Dlprio4a QOBt1nuad use Ot the center on a
wallt-in bU1 _1tbeoosiItpos81ble to et an appoint-
met anc11nCreued pit1entcoJaplampia1a bull Therew111 of
course always be a need and demand tor acute ep1so~c
Care -ci the health centerDlWlt be planned with the capashy
billty ot bullbullbullt1D8 tb1aneed wh1~ cont1Du1nI to stress
aDd educate the patient to utillze oDlOinI comprehensive
faa11y middotc~te~d Cflre (9p 100l
att g4 CODClva1opa
In order to bea4equate any coJlltemporary health care SY8tem muat bullbulletcerta1D interrelated criteria he
IJ
27
minimum criteria areaccessability of services to those
who need them compr8heX1siveness and appropriatness of
services and efficIency 1nthft utilizat~on of SCarce
health care personnel and resources The scareity of
pex-sonnel andtbe need for h1gh quality ongoinghealth
care services
aJIlong the
populationdemanci the most effishy
cientprovision of services
Services must be made accessible to the population
They mustmiddotbe geosraPh1cally accessible to remove the PhysicalmiddotbaTiers betWeen peopleandthem$d1calcare
system They mUst otter their services dur1ngthe
hours when people can make the moat use ofthemA~ it
makes little sense to concentrate services geographically
where they will not be uSed to their fUllest extent it
also is wasteful to provide serv1cesonlydur1righours when
many people are employed his not only presents a hard
ship middotto the consUmer lnrt wastes resources if for instance
the unavailability of preventive services during the hours
when people Can use them causes a need for treatment
services later on
Health carbull sEtrvices must be comprehensive including
prevention treatmcmtand re)abimiddot11tation Ambulatory I
healtbcare facilities wh1cQ are orienteciexclusively
toward either prevept1on or trea1mentare no longer accepshy
table for they are lneft1c1entln their use of resources
and in their prov1s1on of health care to the patient
w ~~
28
If prevent10n1s notmiddot stressed treatment serv1ces that
could have beenavoidedY1l~ be required If prevention
1s the sole focus of the health care facility sick
patients who present themselves must be referred elseshy
where for treatment andsllch referx-als may be taken as
reject1onsor not followed through with until illness
becomes unbearable
The instltutlontbat meets these requirements Is
the comprehensive neighborhood health center It 1s a
local decentralized outpatient facilityprOVld1ng a
fUll range of ambulatoJY health care services It has
a linkage to ahospitalbackUp facilityforlnpatient
treatment and hiihlY apclalized outpatient care
The neighborhood health center must be a fac11ity
planned with an awareness of the needs of the conSUtller
and coDitnUn1ty It must have the r~Ul0urces to provide the
services people need mere they can use them and when
they can use them It must uti11ze the part1cipation of
the community to develop this awareness Not only must
the cen~er beset up to be Amctional for the consumers
but efforts must bemadeaga1n with commun1ty partici shy
pation to help the consumers utilize medical care
services effectively The center muetmake efforts to
educate the community about the valueot regUlar health
care of preventive servicesand of the use of planned
IJ
29
medical appointments ratherthanorisis centered walk-
incare Therealit1es of the existing health care
system have not taught the patient particularly the low
income patienthow to use services effectively
The helthcenterilUst also bea laboratory for
experiments in easing the health caJepersonnel shortage
and c60rd1Datingcare~ A major difficultY iri-exper1shy
menting with neW rolesis freeing staff of old preconshy
ceptions
CoDlprehensiva neighborhood health dare centers have
been developed under a variety ot alisplces including
medicalsociet1es hoSP1talsmiddot(36p299 group pr~ct1ces
(29 p6- 12 117) health departments (13 p1027) and
ne1gbbothoodassoc1ations(14) The literature indicates
somevalues nthe management ot the health center by plusmnts
hospital backup faCility Whatever the auspices many
adm1nistrative fuDctions such as program coordination
standard pr9tectionand evaluation call for considerable
c~tralization of adm1nistration city-wide or coU)tyshy
wide At the same time other aspects hours of servlce
for examPle~ cuI f~radm1nistrative fUnctions made atmiddot
more local levels Each neighborhood center must be
free to adapt its functioning to itscominunity thi-ough
the mechanism otcODlllUl11~ participation inmiddot policy making
Obviouslythe prerogatives and responsibilities of each level must be negotiated and made explic1t
t4~
JJ
BIBLIOGRAPHY 30
1 American Rehabilitation Foundation ~ealth Services Research Center The Health Maintenance Strategy mimeo 1971
2 Anderson Nancy N Comprehensive Health Planning in the States A Study and Critical Analysis Institute for Interdisciplinary Studies American Rehab ilitation Foundation 1958
3 Andrus Len Hughes Comprehensive Health Planning Through Community Demonstration Health Projects mimeo1967
4 Barry Mildred CandCecil G Sheps A New Model for Community Health Planning unpublished paper presented to the American
Public Health Aseociation1967
5 Blum HenrikL Fred Wahl Genelle M Lemon Robert Jorulin and Glen W Kent The Multipurpose Worker and the Neighborhood Multiservice Center InitialImplications and EJeperiences of the Rodeo CommunityService CenterAmerican Journal of Public Health58 (Mar 168) pp 458-468 shy
6 Blum MichaelD and Soloman L Levy A Design for Service Delivery that Reinforces Constructive Tension Between a Health Center and Its (sic) ConSUDlers and Supports Community Power unpUblished paper presented to the American Public Health Asaociatiltn 1968
7 Brielaud Donald Comm~ity Advisory Boards and Maximum Feasible Participation American Journal of Public Health 61 (Feb 1971) pp 292-296 shy
8 Burns Eveline M Health Insurance Not If or When But What Kind Madison Wisco~sin University of WisconsinScllool of Soci~l Work 1971
9 Campbell John Working ~elationships Between Providers and Conshysumers in a Neighborhood Health CenterU American Journal2 Public Health 61 (Jan 1971) pp 97-103
10 Caxr Willene Neighborhood Health Centers Funded by the Office of Economic Opportunity mimeo 1970~
11 Colombo Theodore J Ernest W Sawardand Merwyn R Greenlick The Integration of an OEO Health Program into a Prepaid Comrehensive Group Practice Plan American Journal of Public Health 59 (April 1969) pp 641-650~ -
12 Comprehensive Neighborhood Health Services Projectof Kaiser FoundatioIl Hospital~ Prcgtgram YearE grant renewal proposal mimeo~1971 bull
13 CowenDavidL~ Denvers Neighborhood Health Program Public Health Reports 84 (Dec 1969) pp 1027-1031
IJ
14 De Diaz Sharon Daniel Beyond Rhetoric The NENA Health31 Center After One Year unpublished paper pres~rited to the American Public Health Association 1970
15middot Gerrie NorrrianF and RichardH~ Ferraro Organizing a Program for Dental Care in a Neighborhood Health Center Public Health Reports 8 (Aug 1968) pp 419-428
16 Gordon JeoffreyB~ The Politics of Community Medicine Projects A Conflict Analysis Medical Care 7 (Nov -Dec 1969) pp 419-428 shy
17 Greely David The Neighborhood Health Center Program and Its Implication(3 for Medical Care H~alth Forum of the Welfare Council of Metropolitan Chicago (mimeo) 1967
18 Greenlick Merwyn R Newgtimensions in Health Care American JOurnal of Pharmacentical Education 34 (Dec 1970) pp 754-4
19 GreenlickMerwyn R Donald K Freeborn TheodoreJbull Colombo Jeffrey Abull Pruesin and Erne$t W saw~d Comparing the
Use of Medical Care Services by a Medically Indigent and a General MemberShip Population in a Comprehensive Prepaid Group Practice Prosram II unpublished paper presented to the AmericanPublic Aesociation1970
20 H~tadoArJiloldVMerllYll RGreenlick and TheodoreJ Colombo Determinants of Medical Care Utilization Failure to Keep Appointments unpublished paper presented to the American Public Health Association 1971
21 Johnson Richard E and Merwyn R Greenlick Comprehensive Medical Care A Problem and Cballengeto Pharmacy ff AJilericanJournal of PbarmacenticalEducation 33 (Aug 1969) pp 361-367 -
22 Kahn Alfred J Studiee Social Policy and Planning New York Russell Sage Foundation 1969
23 Kotler Milton Neyhborhood Government Local Foundations 2 Political~New York The BobbsMerrill Company 1969
24 NationalCommisaion on CommunityHealthSfrvic~sActionPlanniriamp for Community SetithServices~ashington p C Public Affairs-Press 19t7
25 National Commission on C~mmunity Health Services Health Adminishysration andOrMPization l the Decade Ali9$-d Washington D C Public Affairs Press 1967
26 NationalCornmiesion onqomm1Jllity Health Servicesbull Health ~ Facilities Washington D C PUblic Affairs Press 1967 bull
~ n
32 27 ODonnell Edward J and Marilyn M Sullivan ServiceDelivery
and Social Action Through the Neighborhood Center A Review of Research tt Welfare ~ Review 7 (Nov~Dec 1969) pp 112
28 Office of Economic Opportunity Second Annual Report Washington D C~ U S Government Printing Office 1966
29 Office of EConomic Opportunity and the Medical Foundation of Be~laire Ohio Eighth Report 2l ~ Committee2a Governshy
ment OperatiOll~ Va8hiiiSton D C Government Printing Office 1969
30 Pope Clyde R Samuel S Yoshioka and Merwyn R Greenlick Determinants of Medical Care Utilization nhe Use of the Telephone for ReportiDg Symptons Journal of Health and SocialBebavior12 (June 1971) pp155-162 shy
31 RenthalA Gerald nComprehensive Health Centers in Large US Cities American Journal of Public Health 61 (Feb 1971) pp 324-336 shy
32 Saward Ernest W The Relevance of Prepaid Group Practice to the Effective Delivery ofHealthServicestt The New Physician 18 (Jan 1969) pp39-44 - shy
33bull Schorr Lisbeth Bamberger and Joseph T English Background Content and Significant IssUes in Neighborhood Health
Center Programs Milbank Memorial ~ Quarterly 46 July 1968) part 1pp 289-296
34 Weiss James E and Merwyn RGreenlick UDeterminants of MedioalCareUtilization The Effects of Social Class and Distance on Contacts With the Medical Care System Medical~ 8 (Nov-Dec 1970 pp 456-462
35 Weiss James E MerwynR Greenlick and Joseph F Jones Determinants of Medical Care Utilization The Impact of Ecological Factorstt unpublished paper presented to the American Public Health Association 1970
36 Wise Harold B Montefiore Hospital Neighborhood Medical Demonstration A Case StudyMilbaDkMemorial Fund Quarterly46 (July 1968) part 1 pp297-308~
37 Yerby Alonzo S ttHealth Departments Hospital and Health Services Medica1~5 (March-April 1967) pp 70-74
38 Young M M~ Chatanooga IS Experience with Reorganization fOr Delivery of Health Services ttAmerican Journ8l of Public Health60 (Sept 1970) pp 1739-1748
f or l
II bull 11 Y d
II
IJ
34
ThepurposeOfPart II of th1aa paper1atod1scuas
elected Speclfic needs ofecltlc areas within Multnomah
County A8P01ll~oUt 1D ~ I of t1a1bullpapermiddot Ita nelgbshy
borhood health oare cater IlU8t be a facl1lty plaDlled with
aD awarenes of the neeels of the oODllUller and collllUDity
Part II of this paper nIl Show 80e of thoe speclflc
needs
he1DforutiOD tor t1li Portlon of the report
obta1nec1 troll tbroupout tbe follow1Dl threepUb11catloDS
1gr~e_tiMshylIPrIxaiidOreson JuDe 1963
2 1~_middot_sectSI8e~ected1teai c-ua 0 S 8 e first count coaputer tape Coluab a_lion AssocshylatloD of QoveraMD-8 Jlme 1971
3 Jtu1tDoab County Oreaon BDY1roDlHtlltal SurveyEarly 1971
The JIultDOIIIlb COUDty OrttIOD BDv1roDllfmtal Surley
Barly 1971 1s bull stat1stical report of the activ1tles of
theentlreMultDOIIIl2 CcNDty Health Dep~t during the
year of 1970 Die speclflc 1nd1cs elected from tb1s
study amprejMental aealtll Publlc Health N~s1D1 vlslts
FaJUly ~ Veaereal])1 ~ ~rcul081
Throush tie use of cUrts and mapa ODe CaD roup these i
speclflc ~oea to ahcnr the healthneedsof speclfic I
census trtcta aD4 then the health needs of iarer neIghshy
borhooda 1m4 o~ Uebullbull
Rf)~UP1Dl of areu was accompllshed in thefolloWinl I
JJ ~
35
he MiltDoIliahCountY oregon BDViromaental SUrvey
early 1971 isamp statistical report ot tbeaotivities ot
the entire MultDolllh COUDty Health ])epartiDent dur1nl the
year ot1970 he specitic 1Dd1C8S selected frOm this
aUy are 1Il8Dtal health public healthDurs8s visits
fUl1ly pia waereal elisease aDd tuberculosia
Tbroq11the Wle otcbart aDd mapa aDecm szoup these
specific indic to show the health Deeds ofapecitic
ccmaua tracts aDdtIum th8health neecla of larsr ~eilh-
bOrhooda and co8I13 tlbullbullbull
RegroupiDI ot areas waa accoap118hed1D the
tollOWiDl lIIIIm1er~ A bullbullcifie 1ndex 8selectcl auch as
venereal di8bullbulle or tuberculo8i~ he total number ot
cs was then deterll1ne4 for each census tract Through
the use of the maber ot cRbullbullbull tor a 11Yen cenaus tract
aDd tbe population ot thattractaltrateot1lla1ampmcper
100OOOpopUlaticm wu cleteXll1ned for each census tract
This was ~e to starl4ard1ze the population ditterence
amongOeD8U8 -tracts 1he rate of incidence toreaob
cenauatract was then llstedby rank position on a chart
In rank poition1DI any cen8Wl tracts haviDg equal
rates ot1l1c1dence are assipe4tbe iaDk posttiona
Beeauseot the abo fact tbAt cbarta w111 vary in length
neveltbAtlea eacb cbart will 1Dclu4eall census tracts
inMullnoaah Couaty Atter the census tracts bave been
listed accord1q to raalcth1s list will bediv1ded into
IJ
36 three levelsotinc14ence he three levels are
1~ The upper 14 of1DcldenCe
2 Thelower 14 ot incidence
middot3 The ILld 12 of incidence
Tlles three srouplqa are then used in compiling a map ~f
Mu1tnOmahCountyfor ach apecltictop1cbull TIle maps are
uaefuJliD tbatthey V1suallycoJib1De 1Dd1v1Clualproblem
census tracts into larger problem nellhbOrhooc1s
The 1960 statistical iDtormatloD was Used in a similar
liIaDDr to tbatexpla1Dedabove 1Dthe4evelopaent of a
chartmiddot and map 1Ihow1DI e cOllpampriSOr1 of per capita lncolle
tor ttaCh ceDsua tJact aDdmiddot combiDed census middotmiddottract areas
he 1910 aDd 1960 statlstlcal iDtOrllatl0D was combined
lna map and chart he purpose of this and chart is
to d8aonatrate the e cl1stributloa1DeachceD8U8 tract
and middot1ndlcatbull tuture ace populatlon treD4a bull
When one be middotbullbullbullbullbullHdth ne8cts ot an area and has
declded to establlsh a cl1D1c to serve that area the
physical location otthat cl1D1c IllU8t be consldered In
order to coapreb8ll81vel develop an area cl1n1c one should
conslder thepre88Dttraftlc middot~ytaa an4tranaportatlon
systems Thecl1D1cahoUld be located close enoUlh to
major arterlals to giva asy access from the total area
be_ ervecl by this cliD1c At the t1ll8they should
be tar eo away froll thesarterlals to all8Y1ate traffic
CODCell18 andpark1D8 conpstlon By traff1c concerns I
IJ
37
lIlan one lUSt consider thertarro1fne8S of streets whether
streets are oD8--C)r two-way iqres8 and egress to parking
amp0111tie eros tratflC) spedof trattJQ children 1n
ll8a traffic i1lht Vislon re8tr1ctionS etc
BwstraDsportat1onshould alao be central in this area
as maay people ~U f1Df1 1tD8Cessary to use this form of
transportatlon
~e tutqredlopHQt of bull treewa systems should be
c0J1S1dered soastolesen thecumce ofmiddot future roada
cutt1DSotltbe cl1D1c llte line
nrrph1c middotDampta
It is 1JDportaDtto kDOw the demosraphic distribution
characteristics of the oUenteltbat i8 to be served by
localized health cl1D1cs
Acl1D1c which erves8J1 area where1D the prepondershy
ance of persona arecrter 65 years of mayf1nd that these
people rely more on pUblic transportation call for more
home- services and haV4t 110ft ChroD1c and debilitating
types of disorders (b1_ blood pressure poor heariDg and
eyesight) tbaD do8 an area ot a YOUDIer population On
the other hand thL area of older residents may have little
need for family plabDlng cllni08
In order to better ~Ybullbull the 4eaoraphic population
of each CeD8U8 tract the 1970 CeD8U8 iatormation was viewed
and two specific catelOri8 considered These two cat
IJ
38
lori8S woUld be the perc_tap ot population under 19
year of ase and the percentase ot each oensuetractover
65 years of age he 1960 1Dtormatlon tor eaCh tract was
then compared witbthe 1970 intormation and a percentage
ofincreaae or4ecreamp8 tormiddot e~chtract1n each category
cOJlputecland achartma4e By the use of this chart one
18 able to View tJleap populat1odiatr1but10n of census
tract and at the _ t1lle accesa middottrencl Por example
let us choose census tract 601 W see 40-4 otthe
population is under 19 years ot and that ODly82 1s
over 65 years ot middotAtthe e tille the percentage of
youth bas ~ed ODly 1_ intbe laSt teD year whilethe
percentale over 65 year ot middotbas stayedmiddotthe same With
this in mJnc1 ODe ~ 1DfItr libat ol1D1o aerviDg this
area WOuld bellQre conq~w1th the problems of a
YOUQier populat1on and that _ would probably be true foJ
some t1aein tbefuture On the other hand CeDSU8 tract 54
has only 2 ollt population UDder 19 yel1s ot age and
this has decreased by 1 over the last ten years middotwhile at
the same time 32-377 ot the populat1on 18 over 65 years of
age A ol1D1C ___ this area should be or1eJ1ted toward
tbespecttic problema otthe ampledbull
PerCapia __ bY gsa neat
WhaD cona1der1qlooat10D1 tor health cl1n1cs one
shoUld take the 1DC01Ieot areas into consideration Areas
IJ
39
of lowiDcome would not 11kel~be 8erved more by localized
cl1D1cs tbaD would are of hilbincome It 18 likely
people haYiq a hip iDeoll8would preter to be aeenby a
chosen ~r1vatephylc1a1l tban at a local cl1D1cwhere
10Dier waits y beraceaaampryand leas personal attention
gl_
The 19701ncOII81atoWampt10n tor MultnomahC~ty was
not available at the tille thi8report W88 made The 1Dto~shy
tiOD Was taken ~adtro tbe1960 census publlcation
his woUld ~8Il thea tbat ral1I8 OD the chart ynot 1raquoe
completely accurate hi writer telthatthe areas most
affected by tb8 1I8eof the older 1Dco1DtOlaat1oDWOuld be
those tracts wh1ch baYebad a rapid 1ncreaae1n populatlon
over the past tfmyHr8 bullbullbull tracts would include tracts
nUmbered 104 9897 96 aDd 95 be perc~ita 1Dcome
referredto1il-tb1a Paper18the lIean 1DCo per person per
census tract
Attar the iDeoeper census tract was listed on a chart
a map was de 1D41catiDg those census tracts belonging to
the lower 14 ot income tor all censue tracts in Multnomah
COlDltytbose beloqins to the upper 14 ot income tor all
census tract 111 MultnolUlhCounty and those belonging to
the mid 12 ot 1I1coaetor all oeuuetracts in Multnomah
C01mty
In yiew1Dg the _p 1t caa be seen that the low income
area seautotollow aloas the at aide ot the Wl1lamette
IJ
40
R1ver the full length of Kultnomah County A second low
income area follows the south edge of the Columbia from
the northwest corner of Multnomah County easterly to 148 St
A third problem area seems to be on the east bank of the
Willamette River with the Union Pacific Railroad being
about the center of this tract The extreme loutheast
corner of Multnomah COUDty appears to be a low income area
but as this area bas bad rapid grouth in the last ten years
this could be erroneous
Mental Health
be first ~ecific indica to be selected from the
Multnomah County envirollllental survey of early 1971 and
to be considered in this paper i8 that of Mental Health
At the present for mental health purposes Multnomah
County is divided into five catchmentareas with a mental
health cl1n1cin each area These clinics are Model
Citles Delaunay ADkeny street Office Hansen Health
Building end Southeast Clinic
All lIlental health cl1n1cslcept statlstlcal information
on all patients visiting their cl1n1cs this included the
address of the patient hese addresses were then listed
upon the approprlate C8D8US tract Each census tract was
then ranked on a chart according to the nUllber of mental
health patients who reslde ln thatCeDSUS tract attending
any of the above listed ental health clinics This chart
IJ
41
wasttum d1v14ed1ato proper quartile bbullbullbull
quartile vereUs to dne10 u appropl1ate Multnoh
County _tal health ItLa middotmiddotmiddotthelipO~a1bl by lOoJcJIUE
at the UDtal health _to uteN1De which ueu have the
lars-t use otCOllDty 1alh~th faci11t1Rot
1Ilclu4ecl 111 tbia woUld tber otpeopleYia1t1Da
pr1vat patch1atriata aDd pr1_t _ntalhealtb cl1D1c8
WheDtbe M1 18Yienclmiddot Itmiddotmiddotmiddotmiddot~middotbe~_ tbat ~rtt
appears to lMt fourmiddotmiddot-al are iii _oil the nuaber ot
lIental healthcl1D1c na1t toM tbjh1sheat 1he
tour areaa woUld be tollows
1ttrea Ore to~Blo Drimiddot ~tb Burrus14e aDd tIMtmiddot Colb1a Riftr H1gbwyaeri1Dla th nortllra boundaryshy
2 bull ProII 82D4 1_~ 10 20th streetwitil the ra1lMd Mu the north ltouadary
3 ~ et et tUgl_b1bull MYel froamiddot the Clackaaa COUDty l1ae aorth to Dln8lon stret
4 beDOlvt1ttfe-t ~efllt4 COatytrca Jle1aware streetmiddot toR1C1a11oDd wlth Colubla Blvd heiDI tbAtnorth bouaclary_
It ODe coapareatbiap to th iDeobullbullmiddotp 1t can be
eamiddotthat lIOat ot the c tracts baY1Dg bllh v1i11tatlcma
middottfl public tal health cJ1rUc8 ~ 111 t13e low ~ aid
1DcOile SroupiDIOJa1y of til 25 tracta llsted as
haviDlbip aental Maltll nlltatlou are ~ the1g60 hip
iDeo arebullbullbull
17 Plpn
42
amily PlellnSDI ]Jlce Metal Health i8 an 1nd1ce of
use Theperson 111 ordertobavebe_ 1Dcluclecl 1n this
atu4ywouldhave tohaft Ue4 ataa11y plaDI cl1D1c
tacilities of soaetype It 41fter troll tile _tal health
study1nthat i t1Jicludestatist1catrollbotb public and
privateclJD1os
The iDformation tor the iak orurcbart 8Dd map of
t8ll111 plenn1 na ob1a1De4 by cOIIblnlDlthe mabel of
1rlcuv1duals bullbull_ attbe tbreellUltrampo-ti Coatyhll11y
PlalJQllIl C11ll10s 111til tbo at the Planned PareDthood
Association CliD1C8 be tbree -JIultDouh Couaty r8ldly
PlamSq Cl1D1c are Solrtbweatth Col_bla 1111- a114
HaDsell Health BWlcl1Dl CllD1cbi middot1Dtormat1oD vas then
bullbullbullesed tomiddot detellWMt l10w people troll eacb c8IUIUS
chart wastben Mele IUs oIIart jn 4iY1ded to show
the censuS tracts lIaYiDlmiddottIle h1t1iest qUart1le of incidence
of use lowest quartile of 1Qc1deao ot use Jlid 12 of
incidence of Wle an4 a map sprepared troll thts 1Dto~
mation
The C8U118 tractsbelOJISnl to the h1lhestquartile of
use appear to be 1lO~ 8catt~ on tbipwas true ot
either the _p ot aental health cl1D1c uaageor ot the map
abow1DI per capita 1I1COM Iaere40 to be three
d18t1nct areas of UIIaP beJ woul4 be
1
IJ
43
t10D of BurD81cl and the W11lallette River 4
2 S~t Portland 8Otth otmiddot the ra11shyrcaadand alona the W11lamette River
lIortbeaat Portl8D4 between MisSiss1pp1 and 24tbStreet the northbouBclary be1DgColwb1aBlvd
Pylzl1c BMltl IrpI Y11ta
Publlc Healtil nur81D1Y1s1t nclud8 an vists to
theholles of client by PubUc Health Nurbullbullbullbull his shows
visits to bull f8Jl1ly fer aDY purpos SUCh aatuberculolJ1s
het1Dl tem1tyaeatalu4 8IiOt10D8l cODd1t1ona etc
he atat18t1C~ 1fele C()4ed accord1Dg tomiddot the 1llli301fOCUS
of the Y18lt tt doe DOt 1D41cate the Dmlber of holies or
f8ll11lev181tecl or 1D41Y14ual Y1a1ted more tban oDcein
the propwl It dobullbull I1ve 80M 1D41cat1on by coaparlshy
OD ot the 8JIoUDt of aedlcal problema 1n eachcen8WI tract
Ap1nmiddot the _p abowa 8 scatter patteraof probl_
areas althoUSh there appear to be a sroup1Dl of hiSh J
l8aIeccmaus tract 1ntlut extreme southeast part of tbe
County other areu uIriaI any nura1Dl contacts are
1 bull he 801lth-oa-al CO1Dty on eaCh 814 of 82nd Av from Clackallaa County north to Dinloa
2 ear bullbullbullt 814e aroUDd Preacottand Misaisippi
Dowatom Bunul14eonboth 1de of the river
44
V_real Pis The iDfomatloil uaec1 to tabulate the Venereal
disease chart includes all the ooab1ned case otmiddotODormea
and syphilIs reported by bothmiddot publIc and prIvate physicIans
dur1nl 1970 There were 3602 caes ot IOnorrhea reported
dur1nl 1970 While ODly 17 cabullbullsot ayphilimiddot were reported
A chart was prepUed aDd att8llPt wasmiddotmiddot de tomiddot
determ1De Wh_therVttDereal 41ease was more p~vaJent in
areas othigb or lowmiddot proportIon ot youth hi waadone
bymiddotdetemlna a 1leaD prceiltacmiddotmiddotmiddottor the population ot
resld~ts UDder19 years ot (34) middotA mean ratemiddot per
100000 popUlatIon al80c1ttem1Ded tor the middotoccurreDCe
ot venereal dieae This was et at 390 oass Areas
hav1nl a population 1n which leiS than 34 were lmder 19
years ot ampIe were called low- yOuth abOve tbl percentaae
hiSh youth The aaa waatrue ot the occurrence oivenershy
eal disea_ per CeD8UStract It the rate waacomputed
as 1I0re than 390 cases per 100000 it was called hiah
venerealdiaeasei it less than thia tisure low venereal
disease It was tound that 1D Multn~ COmlty there sems
to be poSitive OOlatI0n(x21S19gt between low youth
and hipmiddot venereal diseaand hip youth and low venereal
diseasebull
RaDk ordr Iitot all c traot middottbAm made
Th1s was done byt1Ddlna the ratepr 100000 populatIon
of venereal disator all census tracts in the County bull
45
These were thenlisted from h1lhto low (sreatest to
least) in a rank order The l1sting was then divided
into Upperandlower 14 aDd listed on the MUltnomah
Countymiddot up
The areas of b1gh venereal disease se8ll18to
roup thBl~8 middotin a very tllht area ~oq both 1des
of thell18l8~ R1 w1th BurDaldeS~et being
~bout theceDter qf tbi8IZ9uping This area woUld
appear to be m ldeal spot for the denlopment of a
locallzed venereal d1sbullbullbullbull cl1D1c
UbepoundCUlO1s
In this report bull tube1C1llosls caS8S refrred
to include alltbobullbull cabullbulls ontubercUlo8is follow-up
rather middotthan just new C Accord1Ds to the Multnomah
County Health SUrvey of early 1971 this would include
all ca repOrte4 over thelaat three years The
total number of tuberculosi8 cabullbullbull usedin this study
was 666 lh1 included 128 new cabullbullbullbull
A rate per 100000 of tuberculosis for each
census tract wa- then computed and the c~us tracts
listed by rank order be b11h Qartlle mel low
quartl1 were then reoordd on a Multnomah CoUnty map
TWo genral areaa baY1Dg a hip mcldencaot tubercu~
losiare 1D41cated heyare
1 Both middotsld ot theWilla11lette River
Ll -
46
with Burns1de about thecnter
2 he extrea Northebullbullt comer of the County bull
By coap8r1ng the tuberculois an4ven8real
diseae maps ODe can 8ee that the downtown areas ot
hiSh 1nc1denceare alIIo8t 1c1eDt1cal on ach map
This WOuld 1nd1cate that 1t would be of value to
bullbulltab11sh acl1D1c 111 th1aampreatbat would provide
bothtuberCulos1s 8Dd ytmereal 418ase srvicbullbullbull
Thchart aDd 1181gt8 are wsfuln 11v1DI
1Ddicat10DS tor the type aDd placemeototlocal
health cl1n1c8 tbro1qhout tbe MultnomahCounty area
A cOllpar1on of the mapa help one to dec1dewhether
to provide a aulti-8ervice cl1D1c or spec1f1c type of
cliD1c As stated in Part I of thi paprserv1ces
shouldhaYe both treatlieDt and prfMmt10n cOmponents
As he been stated fta ne1lbborhood health care
Qenter muat be a fac111tY plazme4 with an aamesa
ot the neds of the consumer and the c01llll1m1tybull
Part II of this rport haa been an attaapt to indicate
and clarify 8011 ottheae coDlllUDity neds This has
been done through8elect10n of apc1f1c problems
The indic were then visuallyrecorded through the
use of ups and charta ODe dan asseS8 thedsreeof
1DIportance of certain concems to spec~t1c areaa by
comparinl the chart aDd maps Prom this oDeean
41 dec1de which are48 vb1chcUD1c-or indeed if
the need a clinic at all However further factors
should be considered hebullbull include
a The amount of fuDd1 available
b What 18 the percentage ot peopleineoh ceaaua tract tbat would actually us such cl1n1cIl
c Wbat 1 tbeco--1tymiddot 8 IeeliDashyreaardtDI particular cl1D1c8 Would this dcrebullbullbullmiddot the ettctiveness ot thse cl1n1ca
IJ
li
D_OlraphicPopulatLon Challie 1960 to 1970 48
Cen8U8 1 of Pop 1 Cbaqemiddot 1 Change1 ofPopTract Under 19 Yr8 Over 65 Yrs1960-70 1960-70
middot1Q701Q70
1 319 -12 171 -H) 1
2722 215-27 +68 301 366 -22 127 +35 302 371 +19 111 -04
311middot401 144-41 +29 402 321 13~7-39 +24 501 356 124-08 -02 5~O2 351 133-23 +12
405601 82-10 -02 394602 103-01 -06
701 275 149-76 +56 702 361 +01 121 -07
+10middot801 326 140-22 802 321 middot127
(
-29 -03 9~01 342 124 -H) 6-18 902 294 128 -H) 3-24
10middotmiddot -14312 140 -17 1101 182 +25 -23197
2411102 186-59 +29 1201 226 169-17 -41
31middot01202 +11 182 -05 295 -H) 81301 208 -H) 4
1302 331 +08 197 +04
14 323 +15 middot185 -08 middotmiddot15 329 +16 16~5 -13
-28middot 1601 332 131 +12
1602 356 98 +24middot-39 middot3101701 161-33 +21
1702 370 -15 85 +02 +19 1801 264 151middot-50
185middot1802 256 +47-58
IJ ~
D_raphlc Population Change 1960 to 1970middot 49 (Contd)
4io
Census Tract
of pop Uncter 19 Yra
1Q1n
1Cha1l8e 1960-70
of PopOver 65 Yra
lQO Change
1960-70
19 389 +29 141 -24 20 223 -13 206 +18
21 227 +08 194 -36 2201 356 -27 112 +05
2202 290 -18 ll~9 -29 2301 356 -03 154 +24 2302 260 -37 245 +97
2401 410 +6~1 123 -31 2402 163 -80 320 +99 2501 381 +13 140 -01 25()2 237 31 lil +02 26 343 +25 186 +149 2701 370 +29 1S5 -01 2702 249 -44 304 +98 2801 337 +19 187 +09 2802 306 -10 156 +31 2901 304 -38 142 +24 2902 i 307 -32 146 t3~9
30 29~0 -48 16~2 +51
31 355 +30 160 +01 32 370 +48 148 -13 3301 395 +45 130 -20 3302 368 +06 138 -02 3401 386 +16 117 000
3402
400 +32 92 -26 3501 304 -07 115 +35
3502 344 000 140 -13
3601
36~02 357 -04 132 +32
3603 30~1 42 149 -67 3701 342 +28 152 +19
1
IJ
Jianolraphic Population Chan 1960 to 1970 50 (Contd)
Census Tract
of Pop Under 19 Yrs
JJl7J
middotChanae 1960-70
middotofmiddotpop Over 65 Yrs
1c~7n
Change 196070
3702 409 +39 122 -11 3801 308 -11 151 +29 3802 275 -35 180 +46 3803 282 -32 192 +54 3901 376 ~13 100 +17 3902 296 -03 177 +29 4001 438 -11 84 +13 4002 353 -21 115 +20
4101 397 11 9middot0 +11 4102 346 -19 120 +03 42 331 +19 11 bull 3 -16 43 347 -72 105 +31 44 113 +84 183 +154 4S 33~9 +07 110 -06 4601 2501 22 193 +38 4602 332 +59 126 -29 47middot 161middot 000 211 +01 48 103 -26 302 +59 49 138 +1 bull 3 252 +09 50 141 -26 204 -12 51 12 -39 257 +07 52 47 -61 351 +48 53 89 +49 314 -30 54 25 l1li15 327 -17 55 131 -17 115 -121 56 198 +93 227 -47 57 71 102 189 -88 58 240 ~middot41 16~1 +55 59 322 +25 142 +06middot 6001 264 95 132 +50
6002 328 -31middot 89 +07
JJ
Demographic Population Change 1960 to 1970 51 (Contd)
Census 1 ofPop lChange of Pop bull ChangeTract Under 19 Yrbullbull 1960-70 Over 65 Yrs 1960-70
1970 1970
61 355 -58 85 +39
62 328 39 110 +18
63 414 04 73 10
64 382 -22 72 +04
6501 383 02 67 -20
6502 329 -56 96 +09
6601 391 +13 88 -03
6602 319 -59 97 +06
6701 327 71 145 +72
6702 331 ~67 83 +1-0
6801 365 -66 49 +01
6802 388 4bull3 54 +06
69 354 -41 80 +23
70 400 -23 68 -06
71 359 -48 72 +05
72 255 -88 82 +11
73 346 -39 91 +25
74 313middot -63 105 +24
75 329 -42 129 +37
76 336 -52 85 +21
77 370 -10 69 +05
78 309 -10 120 +21
79 325 -56 87 +10
8001 358 -81 57 +12
8002 391 ~81 76 +12
81 315 -76 108 +21
8201 403 -23 64 +08
8202 392 23 65 +08
83 357 -34 120 +31
84 402 -18 73 +16
85 413 -06 76 -09
r
Demographic Population Change 1960 to 1970 52 (Contd)
Census Tract
t of Pop Uncler 19 Yrs
1970
Change 1960-70
1 of Pop OVer 65 Yrs
1970
ex Change 196070
86
87
88
89
90
91 9201
9202
93
94
95
9601
9602
9701
9702
9801
9802
99
100 I
101
102
103
10401
10402
lOS
368
351
379
391
391
413
379
433
372
429
414
432
419
439
~32
377
457 420
378 41middot7
345
360 417
417
412
-04
-02
-35
-26
-28
-11
-64
-20
-S9
-39
-32
-21
-34
-40
-47
-lO~7middot
-27middot +04
+56
+07
-34 01
+04
+04
+10
103
128
97
11il3 99
69
79
42
77
46
34 38
44
40
54
111
51middot
81
133
59
74
140
63
87
76
-08
-06
+04
+08
+17
-05
+3S -02
+1~4
+19
+33
-14
-08
+12
+26
+71
+11
-16 -34
-20
-19 +37
-49
-2S +15
NOte The The
Taken frOi
averageullder averageabove
middotUSCensus ---shy -
19 years == 6S years ==
figures 197
32r 13(14
p a~d 1960
--
Rank
1
2
3
4
5
6
7
8
9
10
11 12 -_
13
14
15
16
17
18
Tract
69 46
60
58
- 68
61
302
2501
67
63
19
62
26
94
3603
3902
64
30 -----~-
Rank
19
20
21 -
22
23-shy
24
25
26
27
28
29
30
31
32
33
34
35
36 -
Ranking of Per Capita Income by Census Tract
Tract
65
2701
- 15
1601
701
66
93
82
2903
3602
30
2502
80
2401
81
- 70
91 shy
4001
High
Rank Tractshy
-32shy37
38 97
120239
7840
41 ~ _2_1__ 42 31
43 2501
44 18
45 98
46 37
47 3803
1702
49
48
1602 92 2702
I
50 89
51 901
52 801
Ra_
53
54
55
56
57
58
59
60
61
62
63
64
6S
66
67
68
TractTract Ra~
74692
170196 70 I
401 71 90
72 1037J
79 70273
3802 74 601
24024102 75
85 76 101
77 9023901
7699 78 100 4101 79
3601 I
380180
458140~ t---- _ - - shy83 82 42
888384
59843501
4777 8~
502
Low
802 86
Rank Tract
87 shy
--88
89
90
91
92
93
94
- 95
96
97
middot98
99
100
101
102
103
104
1201
14
49
72
73
43
87
3502
105
1
52
86
71
1
501
10
3301
104 tf
Rank
105
106
107
108
109
110
III
112
113
114
115
116
117
118
119
120
121
Ranking of Per Capitalucoae by Census Tract
(Contd)
Tract Rank
4001 122--shy602
13
1102 2302
3302
55
3401
48
21
56
50
3402
lL01
2202
2301
53
2201
-shy
Tract Rank Tract Rank T~aet Rank
57 I-----
Imiddote
bull
Tract
- Low -k Note Information taken from 1960 U SCensus
Rank Tract
I ~
Ie
Imiddot
~
----
----
--
--
Rank
1
2
3
4
5
6
1
8
9
10
11
i-
-Tract
391 922 921
972 971
100
132 131 121
962 961
822 821 401
982 981
20 111
47 10 1
412
High
Total Number of Henta1 Health Visits
Ranked by Census Tract High to Low
TractTract RankTractRank Rnk
12 182 22 78 29 87 76 381 73181 ~------- 1913 371 8538230162372 271 2616-121 8272 2
14 80~2 31 94 7923 84801 59 15251362 4232 15 52 _ 32 103 8924 651 17240216 652
_ 91 351 33 341 23117 83 122 25 25 48 1123921418 34 shy61 86 661
19 662 6493 81 26 91 8153 49 50 55 41383 71 27 51 3120 90 672241 35shy 104167162 461
I 411 46211121 28 88342 I
2502 36 69 54 5251 50 272
-Ra
37
38
39
_ 40
_ 41 Ishy
I
42 I
-I 43 44
45
shy
Tract
~ --- shy 95 56
45 292 242
102 62 352 291y
92
101 281
99 72 63 601 60~ 42 2201
77 74 61 57
363 232
70
32 31
11 44 282 2202
Low l
- Tract
46 682 681 I 331 30
r~$ 47 1042 332
48 102_41_
11
~
Visits to Family Planning Clinics Ranked by Census Tract High to Low
Rank Tract Rank Tract Rankmiddot Tract Rank Tract Rank Tract Rank Tract
1
2
3
4
5
6
7
8
9
10
11
12
13middot
14
15
16
17
361
56
401
341
48
59 121
20
55
342
10
31
58
93 21
241 132
331
53
461 462
18
19
20-shy21
22
23
24
25
26
27middot
28
29
30
31
32
33
391
32
middot47 I-i-_-shy _ -
231 111
332
972 1
372 371
52
89
32
92
82
100 31
182
30 242
402
34
35
36
37
38
39
40
41
42
43
44
45
42
1714 i 661 221
78 362 2
90 602 601 352
63 251
105 921
971 351
73 42 292 232
411 51
662
81 45 52
46
47
48
49shy
50
51
52
53
54
55
56
961
801
49 81 72 71
19
9~1
172
68 2 57 162 14 112
91 75 681
381 42
3~3
83 161
57 f
58
59
60
61shy
62 Imiddot
63
Imiddot 64
65
66
64 62 36~3 252
74 652 SO 392 291
651 6bull 2
79 271
r-- ---- shy981 222
672 671
821 272
94 87
281
382
67
68
69
70
71
72
73
74
75
76
77
78
981 26 12~2
IS 61
85 82~2 69
61 43
101 86 84 282
76
131
51 72
1041 962 88 70
99 922 77
103
95 802 181
i
~
Low High
RankRank Tract
5479
4480
81 1042 ~) middot102
71 - - + ~ - ~
Visits to Family Planning Clinics
(Contd)
Tract Rank
I
Tract llaDk l
RankTract Tract Rank Tract
~
I
~
J1 ~
Low
Total Number of public Health Nursing Visits
Ranked by Census TractsHigh to Low
TractTract RankTractRank RankRank TractTractRankTractRank
25249 71 79 17249 8033 6586 99189711 84 2915072 34 661 76 66 811519512
402 5035 51 161 2518220 122 1713423 352 55801 7120 6752 2 149814 41236 83 2662 38 94 6821 53 2924015 362 37 32 42 75 69 281 84 63
546 8822 54 222 85 3925431 70383417 3818223 6439 4386652 718 21 55 103332 8924 232 87 19 271729219619 24156 16211140 382 628825 10523110 112 73411 10141-- ----shy 89 363 4457 8126 16111 221 74 9142 90 46158331 53 671279012 46243 48 59 351 3837528 1083 9313 91 5844 59 -_242 76 1----- shy60 272 72 74104114 60145 42 9287 7729 92 6151 8215 57371 934630 91 307762 12113116 282 619447 41391 9531 78100 63 7378 ~95 681 6945 32 5632 798517 6448 47 52 181
High ~ Low
Rank Tract Rank
96 31 132 70
97 102
98 182 372middot 602 651 662
- -shy
~72 682 802
822 922 962 972 982
1042 ----shy
Low
Total Number of Public Health Nursing Visits
(Contd)
Rank Rank Rank TractTract Tract
I
I lt
I
Tract Rank Tract
[
~~~-
I
~
IJilfimiddot ~
j
Ranking of VD Caea According to Census Tracts 61 By High and LOll Youth Itatio
A media~ of 34 5 was determined Any tract having greater
than 34 5~ of popu1tionunde~ 19 years of age -High~
Any tract having l8S than 345 of population under 19
years == Low
Any tract having rate less than 390 =Low
Any tract having rate more than 390 == HLgl4
YOUTH
LOW HIGH
L
0
12 402 1801 1802 343 2801 2802 29023603
54 6001 600262 66~02 72 74 75 76
78 79 81 t02 65 1202
W
(25)
VD
H
I
G
H
401 701 801802 901 902 10 1101 241 1201 1301 132 14 15 1601 1701 20~ 21 2202 2j02 2402 2502 2702 2901 303501 3502 34023801 3802 383 3902 42 44 45 4601 4602 47 48 49 SO 51~2 53 55 56 57 58 S9 6701 6702 73 95
3~02 7021702 19 25~01 2701 4102 4101 63 64601 ~601 6801 680270 7l 77 8001 80~02 8201 8202 83 84
85 86 87 88~ 90 91 9202 920193 94 9601 9602~ 9701 9102 9801 9802 99 100 101 103 10402 105 6501 10401
(47)
301 501 502 601 1602 2401 2301 2201 31 32 3301 3302 3401 3402~ 3602 3702 3901 400140 02 43 61 69 B(
(53) (23)
~ ~gt
Ranking of VD by Rate Per 100000 By Census Tract
~
Rank Tract Rank Tract Rank Tract Rank Tract llank Tract Rank Tract Rank Tract
1 2202 21 S6 40 902 58 1602 74 75
90-shy 64 107 26 --~-
2 3402 22 45 41 10 59 902 75 78 91 54 108 61
3 2301 23 3502 42 2502 60 602 76 6802 92 402 109 87
4 3302 24 49 43 1102 61 501 17 2 93 94 110 90
5 50 25 52 44 6702 62 14 78 8202 94 97 02 III 76
6 2201 26 20 6701 63 4002 8201 2501
9701 41~02 112 91
7 44 27 48 45 401 64 3802 2902 95 63 113 62
8 3301 28 1701 46 502 65 30 79 83 74 96 9602 114 71
9 55 29 47 47 42 66 3803 80 2801 96Q1 115 85 10
11
12
13
14
15
16
17
18
3401
53
2302
2401
57
21
2402
1101
51
30-shy31
32
33
34
35
36
37
3701 - -~ 1201
3702
89
43
132 131
3602
4001
48
49
50
51
52
53
54
55
58
1601
601
4602 4601
69
701
31
3901
67
68
69
70
71
72
2901
801
39021~ 802
6502 6501 122
702
41~01
81
82
83
84
85
86
87
88
19
1
1702
2802
79
93
100 6801 6602
81
97
98
99
100
101
102
103
104
9201 9202
9802 9801
77
302
79
86
72
84
116
117
118
119
120
121
3603
8002 8001
101
99
95
10401
105 10402 103 102
19
20
59
32
38
39
2702
3501
56
57
301
3801
73 1802 1801
89 6002 6001
105
106
2701
88
High Low
-- -----
Rank OrdermiddotTuberclosis Cases by Rate Per 100000 Ranked by Census Tract High to Low
Tract TractRankTractRank Rank TractRaukTractRankTractRank
801
79 9601501411 52 6835340120511 I 960269 903603532036 $-~~F130221542 4366 311301 70 68~013802 _ I- _ 4001_37213 3921201 6802802 H71523822024 22 54 193302 3802 80 8958 I37139535 70155 9801 I60123 72 6702 98023914011016 6701250124 10 56
81 94 401r 7 154152 73 7057 2625 122 92028
90242 162312301 92~158 86 7172434526509 82 79160159 74 100 87412240227220110 6502836960 75 30 8317244 6501782801285711 61 901 42765645 84 66021459294912 9701 660146 171 302 9702 47
6235023033113 85 822821182 917755 16335013110214 841814832 78 103 938564 324815 86 1057940149272 38036523216 10401 87 2902241 725Q 10402360266340217middot IF88 88 9937233 282 51 218 101 01102 46016234
I)167 2901460219 47
High ~ Low ~
- -
TractRank
9S89
6490
8191 8001 8002
63 61 60middot01 6002 44 2701
92
J
2502 402 --- ----shy
I
Rank
Rank Order Tuberculosis Cases by Rate per 100000
(Coutd)
Tract Rank Tract ~nk
I
Tract Ballk Tract Rank
Imiddot
Tract
Imiddot
1~
t 1I i Pi i l I
o
1 -1shyL I
I J
8 40 icO ~ I -lt 0
-t (1) I
i I
r o E
II
a
I
r--i
shy
I
~
I (
Jgt
(011 fi(
Ggt
I II ~j
()
(f 0
~ ()
I
11
f9
r
II 99
o ~
Ggt r
~ __-J~ I t I ~ I
r--J l I
~ _ __ J
) 1
fTl
1gt
r I
()
r
()
lt en -i en
()
I1l
(J)
(J)
-i
P ()
19
r o ~
r G1 I
I
c
~
o I 89
--- -I-shy
r-r I
1- 0 _~ _ _--J E
G1 I I I
i i
I 1-1-1 ~ _J ~2 ~ II
II
()
1 I I I 1
id i bullbull
~
A n 69
r 1shy
- 0 Gl
l--~ ~ I
~ II
II )
I () isect i
en l i
(J)
-t
0
IA Ol
Li i
18
In order that a comprehensive neighborhood health
care center be able to proVide continuity of care it
must have arrangements for hospital services integrated
into th system Yarby (37 p73) as quoted above
states that it 1s characteristic of the neighborhood
health center to be directly connected with a teaching
hospital However De Diaz (14p3) indicates that it
may be advantageous for purposes of service delivery not
to havemiddotthe center affiliated with a teaching hospital
She feels that such anaft11iation may lead to asltuation
in which policies might be determined more by the teaching
needs of a medical school than by the service needs of
the patient
middotThe Nat10nalmiddotCommissionmiddoton Community Health Services
(25 p69) states that such a system of comprehensive
health care integrat1na ~e servicmiddotes of several health
and roedical agencies snould utilize Itas much single or
unified management as possible Neighborhood health
centers have been operated under a variety of auspices
but several writers have pointed out the advantages in
termsof coordinated prOvision of servictts management by
the hospital of the neighborhood health center For
instancethisfac111tates the keeping of unified medical
records of all the care a patient Msrecelved either at
the neighborhood health center or _le hospitalized
(12p6) ~ermore a3 Young (38 p1741) points out
19
direct operationot the u1sbborhood health oenter by
the hoSpital canll8lceaftilable to the center expertise lt bull
in sOlle aapcta 0 Operation that m18ht not be aa readily
available otherwie
Relardlebullbull of wbetberthe hospital and the neighborshy
hoodhealtbcent8r haVe a cOJIIIOaadmjntstration they
IIlU8thaVealTlved at a str1Dsent delineation of IDUtUal
role and reSpoDBlbilltiebullbull All OOIIpoienta ot the care
yst IIlWStQlarify and understand one anothers position
In the syatem and acree on objeCtive ancimethOds
(26 pp16-17p31) SODae areas of iDUtUalconcemare
reterral procedures record keepiDg aDC1 mutual use of
facilit1es statt1Dl i8 anotb8r ~ ot coaaon conc~
Ditt1cultift have u-laeniD the pastiD cOllprehensive bull t bull
healtbc~ prosraumiddot 1d11ch were batil plauned in wb1ch
all of the health canter phy1C~1IDa did DOt bavetatf
privilege at all ot thebackuJlhospltala (29 p21)
SUch a8ituat10n i8 1Dampcceptablelt inpatient care i8 to
continue to be p4by the pat1eatmiddot health center
physician and it cont1Du1ty ot care 18 to be maintained
Hoapital and health center1lUSt laav 301nt responsibility
tor the recruitaentot physicians
VticlentU IPan BJcNrcu Much otwhat haa b8ea sUd has stre88e4 at leastmiddot
iJlplicit17tbaD8ed tor tM etticit middotprovision ot8emcea
20
There appears to be two aspects of efficiency which are
discussed by writers on the su~3ect of the comprehensive
neighborhood health care centef one of these is the
need to organize) services to make the most efficient and
economical use of scarce medical care resources The
other closelyrelat8d in realIty is the need to help
the public use services in the most efficient manner
The comprehensive neighborhood health center concept
1s lhherentlymiddot efficient in that preventive curative and
rehabilitative health ~are programs are coordinated under
one roof with integrated a~stration Furthermore
theempbasLson prevention health education and early
disease detectionis eftic1ent troJll~estandpoint of
the health care system as well as beneficial to the patient
(18 p760) HQwever ~ue tothe scarcity of health care
personnel thecoiDprehensive neighborhood health center
mustbe an arena tor eXperimentation with new staffing
patterns~ The Kaiser program is indicative of the way
in which health care systems must begin to operate in
that appropr1ate ancillary personnel are used Wherever
possible to perform functions that do not need to be
carried out by the physician As Saward (32 p42)
states
1hroughou10ur organ1zat1on~ there are many of the customary experiments be1ngmade-shyJse of speciallr trained nurses for well-baby care under the SUpervision of the pedi9trlcianexperiments with routine prenatal care by
w ~
21
middotSPC1a1l~t~JlUrbullbull per8ema_1 bullJmdlJleu y our fuDotlou are auoh that DOtb1Da 18 dorutbYtbe phY8iCianstbat doe DOt vet to be done by the
phys1c111U1fhe other aldlle4 person- Del-nurse middotreC~0D18t the appo1ntshymeDt center or clerical praormelshyaremiddot there to free h1amiddotto use his spec1al sk111
Awell lmoWn treDd1D the area of eaaiDI health
c8re JII8DPOY8rShortagjs bas middotbe thetrend toward tra1nshy
1DB poverty area rea1deats as DOD~pro~eaionalmiddoth8lth
aide and nepborboocl health workeramiddot (28 p63) This
bas the effectofmiddotmiddot1J)creaa1q II8DPOWrand 8180 can help
bridle the cuJ~ cap betweenprondera and colllUmers
of aen1C8s This attarD at least tlleoretically
createa a situation 1D WIa1ch providers andcoD8Ullers can
be educated to UDderatad OD88DOtber and interactJlore
ettectlvely~ HoWever amiddotpltt8ll has beeD themiddot tel14ency in
801D8 oamp8e8 tomiddot us aidesmiddot ssale8lllcw t~r the center
alJDOatexclwdY811rathertbaD ua1Dltheal to protide the
health care for wh1ch ~ were trained (29 pp3B-39)
1bat ismiddotmiddot vh1~e the a14e Yalue in ~~m1catiDI with
low 1nCOlMt patieata haa beeR recoSD1zed and stressed
their role ashealtb carepersoDDelhil been slighted 1n )
any 1Dstancea
Anotber step 1d11Ob bullbull been taken to provide 8rY1ces
more efficiently eUeot1ftlybas beenmiddot theorgan1zation
of per8ODDeliDto IIllt141sc1pl1Dary teamaaaa means ot
proYid1DgmiddotCOQrd1DatedserY1ce SUch te8lll8 sen_rally
~
hf
~
22
include PhYsiciaQs nursbullbullbullbull soc1al workers and outreach
workers Conceptually th8y fmlct10n to me~ the intershy
relate lled1cal and social needs ot the families sened
Hor there are a number ot barriers to the etfectve
tlmctiOD1nlof lIuchte8ll8 SODieot these are heavy caseshy
loads the inordiDate amount ot tille consumed by multlshy
prOblem tamtliethel1m1ted tra1n1 ngmiddotmiddotand laCk of tnterest
on tile part ot aoae tebers in examinJng aspects of
problems out14e~lr oWn areaaotcolIPetencemiddot and
~ourdcation prc)blell8 between proteasioDala and nonshy
prot81~s (10ppa-10) middotrurtbemOre as De Diaz
(14 middotp6)1nd1cate tbel8 maybe a teDdency tor vertical
dp8rtmental lines of auperv1810nto become paramount
over the team coDamloation syst lead1ngto conflIcts
in determ1niDI the ro1ea ot solie team bers particularly
the DOD-prote81011alaInauch exper1l1enta Witb new
~t1Dlpatterna it 1s bullbullaentialtbat line of authority
roles aDd NsP0D81bll1tlea be made explicit and that there
beJDechaD 8IUI tor relUlar evaluat1onotfunctlorUng
Another way inwb1ch health care sernee delivery can
be made more ett1cl8Dt is to proVide servicea dur1DC the
hours whentbey aremiddot -ostnee4ed As reQo_ded by Yarby
(37p1) serY1ce can bemadelIOre accesslble by making
themava1lable 24 hours a day seven days a week If
rg8l1Cy service are aft11ab1e aroua4-tbe-cloek at ~
nil1iborhood health center the continuity ot tbepat1ent ts
23
careiamaiDtalDedand meatry point into the
cOIIPre~i health care 8 be made available
tothe patient who aoZMllyU8ea ozilymiddot emergency care in
tille of med1cal criais More 8isDificantly ava11ab1-
lity of a tull rase of bullbullrv1c8 tor seVeral hours 11the
eVerlna aI1Cl On ~ prevent the los ot earn1JiSs
involved if th patierat 1IU8tt8cet1me oftfroawork dur1q
the d8y for aed1Cal oare bull his can be an eSpecially
importantc0J1814eration tor lo1aCOlleDUUg1nally qloYEtd
patient aa4caJla18o PIOJIOtet1)e 0Da01Dl use othealth
servicebullbull
exper1eDO ot tbeKa1er prosraa in tb1s~reprdAs
Greenl1clt(19 p10) states wA lllNt 8ip1flcant
proportion ot the abulatory care 8n1cp~Y1dd tor ~
total popUlatiC)U ~ ~ after clWc hours and this
Deed i8 apParenUyaoN prODGUDced tor aJl8d1cally
iDCust population On the other hand the bulk ot all
aabulatory med1cal cu 88l91ce are performed dur1nS
regular cl1D1c hour eVen when services are available 24
hours a dayJ day bull week W
It has ~ the experi8D~eof a ftIDber ot ne1g1lboXshy
hooct hea1tbcentere _t a_jor obstacle to efficient
proViSion ot anicbullbullhas beentbe teD4eDcy of medically
1ncl1pnt patieats to utilize the center oa a walk-in
baais tor epi8od1ccr181or1entect bullbullrv1cea rather than
4)i
h~ ~~f ~~ L
24
to make appoJlltaeata tor ODIo1qprevmt1ve treataent
and rehebl11tat1Ye care ad ampl1O to bave a blah failure
to Show rat_for tbe appo1DtaeDts that they dO make
Atone center 628 of appo1Dtments made were kept
while 3Oottbepati_ta een were ~1n patients
AlthoUP fewer patiets were actually 88811 by the cater
1D middottb1s 1Datance thaathe -bervholuidmadeappointshy
mta the walk-iD patlat required an iDord1nate amount
ot staff t1ae tor aCreeDiaaacl ~trral to pplOprlate
~ttor caregt (9 pgg) Arraquotbr1llpl1catjo~ of the
plOVidedto valk-iD patient by other thaD their
(19 p12)rurtbermore
when patients uti11ze Wlk-1Il er181 centered care
athelr ODlf tona ot ootact with the _d1~ care
ay_ta fUilycentered care the treata_t of tUl11y
bers
a a UD1t 11
dlarupted
hewalk-1Dphenoaaencm appear to barelated to
diUerence between soclal clase in the style of Dlaking
contactJt1th the a11oal C~ay8t As Greenlick f ~
(19 p11)1Dd1oate8 thepheDOaenOn ot INater usage of shy
walk-in ervice by aed10ally middot1Jid11ent patient thaD by
others baa otte been attr1buted to a stoical att1tude
tQward 1llDe8 em the~ ot poor people leacl1D8 to a
~
25
greaterdelay1n tbe k i Dlofa8d1cal care These
patients wppoedlyeelcmiddotcareODlymiddotwIleD tbeirmiddotillDess
becOlles1Dtolerable resultiDSin middotthMr appeariDS withshy
outnot1ce1o rece1ve oareHlwever Greenlicks
r8aearcbbaa cut doubt on the existence ot tb1delay
111 report1Dg middot8J1IPtoJumiddotOfDeW 11laessand seek1ng care
Be bas tcrQDd 1bat s1ll11ar peze_tases of dioally
1nd1sent 8DClJ1on-aed1cally 1Dd1PD~ pat1enta seek care
on the aue daytbat aptou tirstaPPear
1fb11e GrHDllclc 1nd1cat tbat the reasonator the
greatertendeDCY of low 1Do~e pat18Ilta to 1$8 walk-in I
serY1ces are notlcDo1rAmiddotmiddot tbe7 _ be rel~tedto a tendency
ot lower aocio-ecaaaoclaa patieota to preter face-toshy ~
face contacts with II841cal persoDl181posslbly because
such contacts areft coatortiDS an4reasauriDS to
patients who are hJpotbeafzed to bave a dependent attltude
toward IIed1Cal care perS0Jm81 (30 p161)
It a8 itmiddot baa pnerally beenhld the appointment
s1stemts the most efficient Ileana of dellveriDS
comprehenSive oODtllluiDlh-lth care (9~100)1t is
necessary that educaUoraalmiddotbulltfort be taken to proaote the
use ot middotappo1ntaents8DClmiddot tQrec1ucethe fa111re to appe~
ratB4uOatioaalwhlQb baft~utl11zedhave been
IJ
26
1Dten1ews with walk-in patients home Vi8its and group 4i
meetiDp1D8D attemptto1Dierpret1o the patients
the value of rtitgular ppo1ntmentamp andot con~in~
c~1ve care rather than epiI041c care (9 p1OO)
h1s 1safuD~tioD torwhtch nOl~prot81QDal colDlllUD1ty
YOrkersllaY bebe~r8U11ed tban other statf H()wever
euch aD ~ucat1oaal propul __~ ~e related to the senUiDe
capacity otth health oenter to provide comprehensivebull gt
ervice8 to1tpat1_t~odoD aD app01ntment bas18 It
1amp pos8ibleo~rw1 tor educa110Dal ttorts to result
LD a~8JImCl tor ltPP01ntaen~8 at a ratewb1ohi8beyond
the capacity ot thee_tar to t without uareaaoDably
1_ wa1t1Dlprio4a QOBt1nuad use Ot the center on a
wallt-in bU1 _1tbeoosiItpos81ble to et an appoint-
met anc11nCreued pit1entcoJaplampia1a bull Therew111 of
course always be a need and demand tor acute ep1so~c
Care -ci the health centerDlWlt be planned with the capashy
billty ot bullbullbullt1D8 tb1aneed wh1~ cont1Du1nI to stress
aDd educate the patient to utillze oDlOinI comprehensive
faa11y middotc~te~d Cflre (9p 100l
att g4 CODClva1opa
In order to bea4equate any coJlltemporary health care SY8tem muat bullbulletcerta1D interrelated criteria he
IJ
27
minimum criteria areaccessability of services to those
who need them compr8heX1siveness and appropriatness of
services and efficIency 1nthft utilizat~on of SCarce
health care personnel and resources The scareity of
pex-sonnel andtbe need for h1gh quality ongoinghealth
care services
aJIlong the
populationdemanci the most effishy
cientprovision of services
Services must be made accessible to the population
They mustmiddotbe geosraPh1cally accessible to remove the PhysicalmiddotbaTiers betWeen peopleandthem$d1calcare
system They mUst otter their services dur1ngthe
hours when people can make the moat use ofthemA~ it
makes little sense to concentrate services geographically
where they will not be uSed to their fUllest extent it
also is wasteful to provide serv1cesonlydur1righours when
many people are employed his not only presents a hard
ship middotto the consUmer lnrt wastes resources if for instance
the unavailability of preventive services during the hours
when people Can use them causes a need for treatment
services later on
Health carbull sEtrvices must be comprehensive including
prevention treatmcmtand re)abimiddot11tation Ambulatory I
healtbcare facilities wh1cQ are orienteciexclusively
toward either prevept1on or trea1mentare no longer accepshy
table for they are lneft1c1entln their use of resources
and in their prov1s1on of health care to the patient
w ~~
28
If prevent10n1s notmiddot stressed treatment serv1ces that
could have beenavoidedY1l~ be required If prevention
1s the sole focus of the health care facility sick
patients who present themselves must be referred elseshy
where for treatment andsllch referx-als may be taken as
reject1onsor not followed through with until illness
becomes unbearable
The instltutlontbat meets these requirements Is
the comprehensive neighborhood health center It 1s a
local decentralized outpatient facilityprOVld1ng a
fUll range of ambulatoJY health care services It has
a linkage to ahospitalbackUp facilityforlnpatient
treatment and hiihlY apclalized outpatient care
The neighborhood health center must be a fac11ity
planned with an awareness of the needs of the conSUtller
and coDitnUn1ty It must have the r~Ul0urces to provide the
services people need mere they can use them and when
they can use them It must uti11ze the part1cipation of
the community to develop this awareness Not only must
the cen~er beset up to be Amctional for the consumers
but efforts must bemadeaga1n with commun1ty partici shy
pation to help the consumers utilize medical care
services effectively The center muetmake efforts to
educate the community about the valueot regUlar health
care of preventive servicesand of the use of planned
IJ
29
medical appointments ratherthanorisis centered walk-
incare Therealit1es of the existing health care
system have not taught the patient particularly the low
income patienthow to use services effectively
The helthcenterilUst also bea laboratory for
experiments in easing the health caJepersonnel shortage
and c60rd1Datingcare~ A major difficultY iri-exper1shy
menting with neW rolesis freeing staff of old preconshy
ceptions
CoDlprehensiva neighborhood health dare centers have
been developed under a variety ot alisplces including
medicalsociet1es hoSP1talsmiddot(36p299 group pr~ct1ces
(29 p6- 12 117) health departments (13 p1027) and
ne1gbbothoodassoc1ations(14) The literature indicates
somevalues nthe management ot the health center by plusmnts
hospital backup faCility Whatever the auspices many
adm1nistrative fuDctions such as program coordination
standard pr9tectionand evaluation call for considerable
c~tralization of adm1nistration city-wide or coU)tyshy
wide At the same time other aspects hours of servlce
for examPle~ cuI f~radm1nistrative fUnctions made atmiddot
more local levels Each neighborhood center must be
free to adapt its functioning to itscominunity thi-ough
the mechanism otcODlllUl11~ participation inmiddot policy making
Obviouslythe prerogatives and responsibilities of each level must be negotiated and made explic1t
t4~
JJ
BIBLIOGRAPHY 30
1 American Rehabilitation Foundation ~ealth Services Research Center The Health Maintenance Strategy mimeo 1971
2 Anderson Nancy N Comprehensive Health Planning in the States A Study and Critical Analysis Institute for Interdisciplinary Studies American Rehab ilitation Foundation 1958
3 Andrus Len Hughes Comprehensive Health Planning Through Community Demonstration Health Projects mimeo1967
4 Barry Mildred CandCecil G Sheps A New Model for Community Health Planning unpublished paper presented to the American
Public Health Aseociation1967
5 Blum HenrikL Fred Wahl Genelle M Lemon Robert Jorulin and Glen W Kent The Multipurpose Worker and the Neighborhood Multiservice Center InitialImplications and EJeperiences of the Rodeo CommunityService CenterAmerican Journal of Public Health58 (Mar 168) pp 458-468 shy
6 Blum MichaelD and Soloman L Levy A Design for Service Delivery that Reinforces Constructive Tension Between a Health Center and Its (sic) ConSUDlers and Supports Community Power unpUblished paper presented to the American Public Health Asaociatiltn 1968
7 Brielaud Donald Comm~ity Advisory Boards and Maximum Feasible Participation American Journal of Public Health 61 (Feb 1971) pp 292-296 shy
8 Burns Eveline M Health Insurance Not If or When But What Kind Madison Wisco~sin University of WisconsinScllool of Soci~l Work 1971
9 Campbell John Working ~elationships Between Providers and Conshysumers in a Neighborhood Health CenterU American Journal2 Public Health 61 (Jan 1971) pp 97-103
10 Caxr Willene Neighborhood Health Centers Funded by the Office of Economic Opportunity mimeo 1970~
11 Colombo Theodore J Ernest W Sawardand Merwyn R Greenlick The Integration of an OEO Health Program into a Prepaid Comrehensive Group Practice Plan American Journal of Public Health 59 (April 1969) pp 641-650~ -
12 Comprehensive Neighborhood Health Services Projectof Kaiser FoundatioIl Hospital~ Prcgtgram YearE grant renewal proposal mimeo~1971 bull
13 CowenDavidL~ Denvers Neighborhood Health Program Public Health Reports 84 (Dec 1969) pp 1027-1031
IJ
14 De Diaz Sharon Daniel Beyond Rhetoric The NENA Health31 Center After One Year unpublished paper pres~rited to the American Public Health Association 1970
15middot Gerrie NorrrianF and RichardH~ Ferraro Organizing a Program for Dental Care in a Neighborhood Health Center Public Health Reports 8 (Aug 1968) pp 419-428
16 Gordon JeoffreyB~ The Politics of Community Medicine Projects A Conflict Analysis Medical Care 7 (Nov -Dec 1969) pp 419-428 shy
17 Greely David The Neighborhood Health Center Program and Its Implication(3 for Medical Care H~alth Forum of the Welfare Council of Metropolitan Chicago (mimeo) 1967
18 Greenlick Merwyn R Newgtimensions in Health Care American JOurnal of Pharmacentical Education 34 (Dec 1970) pp 754-4
19 GreenlickMerwyn R Donald K Freeborn TheodoreJbull Colombo Jeffrey Abull Pruesin and Erne$t W saw~d Comparing the
Use of Medical Care Services by a Medically Indigent and a General MemberShip Population in a Comprehensive Prepaid Group Practice Prosram II unpublished paper presented to the AmericanPublic Aesociation1970
20 H~tadoArJiloldVMerllYll RGreenlick and TheodoreJ Colombo Determinants of Medical Care Utilization Failure to Keep Appointments unpublished paper presented to the American Public Health Association 1971
21 Johnson Richard E and Merwyn R Greenlick Comprehensive Medical Care A Problem and Cballengeto Pharmacy ff AJilericanJournal of PbarmacenticalEducation 33 (Aug 1969) pp 361-367 -
22 Kahn Alfred J Studiee Social Policy and Planning New York Russell Sage Foundation 1969
23 Kotler Milton Neyhborhood Government Local Foundations 2 Political~New York The BobbsMerrill Company 1969
24 NationalCommisaion on CommunityHealthSfrvic~sActionPlanniriamp for Community SetithServices~ashington p C Public Affairs-Press 19t7
25 National Commission on C~mmunity Health Services Health Adminishysration andOrMPization l the Decade Ali9$-d Washington D C Public Affairs Press 1967
26 NationalCornmiesion onqomm1Jllity Health Servicesbull Health ~ Facilities Washington D C PUblic Affairs Press 1967 bull
~ n
32 27 ODonnell Edward J and Marilyn M Sullivan ServiceDelivery
and Social Action Through the Neighborhood Center A Review of Research tt Welfare ~ Review 7 (Nov~Dec 1969) pp 112
28 Office of Economic Opportunity Second Annual Report Washington D C~ U S Government Printing Office 1966
29 Office of EConomic Opportunity and the Medical Foundation of Be~laire Ohio Eighth Report 2l ~ Committee2a Governshy
ment OperatiOll~ Va8hiiiSton D C Government Printing Office 1969
30 Pope Clyde R Samuel S Yoshioka and Merwyn R Greenlick Determinants of Medical Care Utilization nhe Use of the Telephone for ReportiDg Symptons Journal of Health and SocialBebavior12 (June 1971) pp155-162 shy
31 RenthalA Gerald nComprehensive Health Centers in Large US Cities American Journal of Public Health 61 (Feb 1971) pp 324-336 shy
32 Saward Ernest W The Relevance of Prepaid Group Practice to the Effective Delivery ofHealthServicestt The New Physician 18 (Jan 1969) pp39-44 - shy
33bull Schorr Lisbeth Bamberger and Joseph T English Background Content and Significant IssUes in Neighborhood Health
Center Programs Milbank Memorial ~ Quarterly 46 July 1968) part 1pp 289-296
34 Weiss James E and Merwyn RGreenlick UDeterminants of MedioalCareUtilization The Effects of Social Class and Distance on Contacts With the Medical Care System Medical~ 8 (Nov-Dec 1970 pp 456-462
35 Weiss James E MerwynR Greenlick and Joseph F Jones Determinants of Medical Care Utilization The Impact of Ecological Factorstt unpublished paper presented to the American Public Health Association 1970
36 Wise Harold B Montefiore Hospital Neighborhood Medical Demonstration A Case StudyMilbaDkMemorial Fund Quarterly46 (July 1968) part 1 pp297-308~
37 Yerby Alonzo S ttHealth Departments Hospital and Health Services Medica1~5 (March-April 1967) pp 70-74
38 Young M M~ Chatanooga IS Experience with Reorganization fOr Delivery of Health Services ttAmerican Journ8l of Public Health60 (Sept 1970) pp 1739-1748
f or l
II bull 11 Y d
II
IJ
34
ThepurposeOfPart II of th1aa paper1atod1scuas
elected Speclfic needs ofecltlc areas within Multnomah
County A8P01ll~oUt 1D ~ I of t1a1bullpapermiddot Ita nelgbshy
borhood health oare cater IlU8t be a facl1lty plaDlled with
aD awarenes of the neeels of the oODllUller and collllUDity
Part II of this paper nIl Show 80e of thoe speclflc
needs
he1DforutiOD tor t1li Portlon of the report
obta1nec1 troll tbroupout tbe follow1Dl threepUb11catloDS
1gr~e_tiMshylIPrIxaiidOreson JuDe 1963
2 1~_middot_sectSI8e~ected1teai c-ua 0 S 8 e first count coaputer tape Coluab a_lion AssocshylatloD of QoveraMD-8 Jlme 1971
3 Jtu1tDoab County Oreaon BDY1roDlHtlltal SurveyEarly 1971
The JIultDOIIIlb COUDty OrttIOD BDv1roDllfmtal Surley
Barly 1971 1s bull stat1stical report of the activ1tles of
theentlreMultDOIIIl2 CcNDty Health Dep~t during the
year of 1970 Die speclflc 1nd1cs elected from tb1s
study amprejMental aealtll Publlc Health N~s1D1 vlslts
FaJUly ~ Veaereal])1 ~ ~rcul081
Throush tie use of cUrts and mapa ODe CaD roup these i
speclflc ~oea to ahcnr the healthneedsof speclfic I
census trtcta aD4 then the health needs of iarer neIghshy
borhooda 1m4 o~ Uebullbull
Rf)~UP1Dl of areu was accompllshed in thefolloWinl I
JJ ~
35
he MiltDoIliahCountY oregon BDViromaental SUrvey
early 1971 isamp statistical report ot tbeaotivities ot
the entire MultDolllh COUDty Health ])epartiDent dur1nl the
year ot1970 he specitic 1Dd1C8S selected frOm this
aUy are 1Il8Dtal health public healthDurs8s visits
fUl1ly pia waereal elisease aDd tuberculosia
Tbroq11the Wle otcbart aDd mapa aDecm szoup these
specific indic to show the health Deeds ofapecitic
ccmaua tracts aDdtIum th8health neecla of larsr ~eilh-
bOrhooda and co8I13 tlbullbullbull
RegroupiDI ot areas waa accoap118hed1D the
tollOWiDl lIIIIm1er~ A bullbullcifie 1ndex 8selectcl auch as
venereal di8bullbulle or tuberculo8i~ he total number ot
cs was then deterll1ne4 for each census tract Through
the use of the maber ot cRbullbullbull tor a 11Yen cenaus tract
aDd tbe population ot thattractaltrateot1lla1ampmcper
100OOOpopUlaticm wu cleteXll1ned for each census tract
This was ~e to starl4ard1ze the population ditterence
amongOeD8U8 -tracts 1he rate of incidence toreaob
cenauatract was then llstedby rank position on a chart
In rank poition1DI any cen8Wl tracts haviDg equal
rates ot1l1c1dence are assipe4tbe iaDk posttiona
Beeauseot the abo fact tbAt cbarta w111 vary in length
neveltbAtlea eacb cbart will 1Dclu4eall census tracts
inMullnoaah Couaty Atter the census tracts bave been
listed accord1q to raalcth1s list will bediv1ded into
IJ
36 three levelsotinc14ence he three levels are
1~ The upper 14 of1DcldenCe
2 Thelower 14 ot incidence
middot3 The ILld 12 of incidence
Tlles three srouplqa are then used in compiling a map ~f
Mu1tnOmahCountyfor ach apecltictop1cbull TIle maps are
uaefuJliD tbatthey V1suallycoJib1De 1Dd1v1Clualproblem
census tracts into larger problem nellhbOrhooc1s
The 1960 statistical iDtormatloD was Used in a similar
liIaDDr to tbatexpla1Dedabove 1Dthe4evelopaent of a
chartmiddot and map 1Ihow1DI e cOllpampriSOr1 of per capita lncolle
tor ttaCh ceDsua tJact aDdmiddot combiDed census middotmiddottract areas
he 1910 aDd 1960 statlstlcal iDtOrllatl0D was combined
lna map and chart he purpose of this and chart is
to d8aonatrate the e cl1stributloa1DeachceD8U8 tract
and middot1ndlcatbull tuture ace populatlon treD4a bull
When one be middotbullbullbullbullbullHdth ne8cts ot an area and has
declded to establlsh a cl1D1c to serve that area the
physical location otthat cl1D1c IllU8t be consldered In
order to coapreb8ll81vel develop an area cl1n1c one should
conslder thepre88Dttraftlc middot~ytaa an4tranaportatlon
systems Thecl1D1cahoUld be located close enoUlh to
major arterlals to giva asy access from the total area
be_ ervecl by this cliD1c At the t1ll8they should
be tar eo away froll thesarterlals to all8Y1ate traffic
CODCell18 andpark1D8 conpstlon By traff1c concerns I
IJ
37
lIlan one lUSt consider thertarro1fne8S of streets whether
streets are oD8--C)r two-way iqres8 and egress to parking
amp0111tie eros tratflC) spedof trattJQ children 1n
ll8a traffic i1lht Vislon re8tr1ctionS etc
BwstraDsportat1onshould alao be central in this area
as maay people ~U f1Df1 1tD8Cessary to use this form of
transportatlon
~e tutqredlopHQt of bull treewa systems should be
c0J1S1dered soastolesen thecumce ofmiddot future roada
cutt1DSotltbe cl1D1c llte line
nrrph1c middotDampta
It is 1JDportaDtto kDOw the demosraphic distribution
characteristics of the oUenteltbat i8 to be served by
localized health cl1D1cs
Acl1D1c which erves8J1 area where1D the prepondershy
ance of persona arecrter 65 years of mayf1nd that these
people rely more on pUblic transportation call for more
home- services and haV4t 110ft ChroD1c and debilitating
types of disorders (b1_ blood pressure poor heariDg and
eyesight) tbaD do8 an area ot a YOUDIer population On
the other hand thL area of older residents may have little
need for family plabDlng cllni08
In order to better ~Ybullbull the 4eaoraphic population
of each CeD8U8 tract the 1970 CeD8U8 iatormation was viewed
and two specific catelOri8 considered These two cat
IJ
38
lori8S woUld be the perc_tap ot population under 19
year of ase and the percentase ot each oensuetractover
65 years of age he 1960 1Dtormatlon tor eaCh tract was
then compared witbthe 1970 intormation and a percentage
ofincreaae or4ecreamp8 tormiddot e~chtract1n each category
cOJlputecland achartma4e By the use of this chart one
18 able to View tJleap populat1odiatr1but10n of census
tract and at the _ t1lle accesa middottrencl Por example
let us choose census tract 601 W see 40-4 otthe
population is under 19 years ot and that ODly82 1s
over 65 years ot middotAtthe e tille the percentage of
youth bas ~ed ODly 1_ intbe laSt teD year whilethe
percentale over 65 year ot middotbas stayedmiddotthe same With
this in mJnc1 ODe ~ 1DfItr libat ol1D1o aerviDg this
area WOuld bellQre conq~w1th the problems of a
YOUQier populat1on and that _ would probably be true foJ
some t1aein tbefuture On the other hand CeDSU8 tract 54
has only 2 ollt population UDder 19 yel1s ot age and
this has decreased by 1 over the last ten years middotwhile at
the same time 32-377 ot the populat1on 18 over 65 years of
age A ol1D1C ___ this area should be or1eJ1ted toward
tbespecttic problema otthe ampledbull
PerCapia __ bY gsa neat
WhaD cona1der1qlooat10D1 tor health cl1n1cs one
shoUld take the 1DC01Ieot areas into consideration Areas
IJ
39
of lowiDcome would not 11kel~be 8erved more by localized
cl1D1cs tbaD would are of hilbincome It 18 likely
people haYiq a hip iDeoll8would preter to be aeenby a
chosen ~r1vatephylc1a1l tban at a local cl1D1cwhere
10Dier waits y beraceaaampryand leas personal attention
gl_
The 19701ncOII81atoWampt10n tor MultnomahC~ty was
not available at the tille thi8report W88 made The 1Dto~shy
tiOD Was taken ~adtro tbe1960 census publlcation
his woUld ~8Il thea tbat ral1I8 OD the chart ynot 1raquoe
completely accurate hi writer telthatthe areas most
affected by tb8 1I8eof the older 1Dco1DtOlaat1oDWOuld be
those tracts wh1ch baYebad a rapid 1ncreaae1n populatlon
over the past tfmyHr8 bullbullbull tracts would include tracts
nUmbered 104 9897 96 aDd 95 be perc~ita 1Dcome
referredto1il-tb1a Paper18the lIean 1DCo per person per
census tract
Attar the iDeoeper census tract was listed on a chart
a map was de 1D41catiDg those census tracts belonging to
the lower 14 ot income tor all censue tracts in Multnomah
COlDltytbose beloqins to the upper 14 ot income tor all
census tract 111 MultnolUlhCounty and those belonging to
the mid 12 ot 1I1coaetor all oeuuetracts in Multnomah
C01mty
In yiew1Dg the _p 1t caa be seen that the low income
area seautotollow aloas the at aide ot the Wl1lamette
IJ
40
R1ver the full length of Kultnomah County A second low
income area follows the south edge of the Columbia from
the northwest corner of Multnomah County easterly to 148 St
A third problem area seems to be on the east bank of the
Willamette River with the Union Pacific Railroad being
about the center of this tract The extreme loutheast
corner of Multnomah COUDty appears to be a low income area
but as this area bas bad rapid grouth in the last ten years
this could be erroneous
Mental Health
be first ~ecific indica to be selected from the
Multnomah County envirollllental survey of early 1971 and
to be considered in this paper i8 that of Mental Health
At the present for mental health purposes Multnomah
County is divided into five catchmentareas with a mental
health cl1n1cin each area These clinics are Model
Citles Delaunay ADkeny street Office Hansen Health
Building end Southeast Clinic
All lIlental health cl1n1cslcept statlstlcal information
on all patients visiting their cl1n1cs this included the
address of the patient hese addresses were then listed
upon the approprlate C8D8US tract Each census tract was
then ranked on a chart according to the nUllber of mental
health patients who reslde ln thatCeDSUS tract attending
any of the above listed ental health clinics This chart
IJ
41
wasttum d1v14ed1ato proper quartile bbullbullbull
quartile vereUs to dne10 u appropl1ate Multnoh
County _tal health ItLa middotmiddotmiddotthelipO~a1bl by lOoJcJIUE
at the UDtal health _to uteN1De which ueu have the
lars-t use otCOllDty 1alh~th faci11t1Rot
1Ilclu4ecl 111 tbia woUld tber otpeopleYia1t1Da
pr1vat patch1atriata aDd pr1_t _ntalhealtb cl1D1c8
WheDtbe M1 18Yienclmiddot Itmiddotmiddotmiddotmiddot~middotbe~_ tbat ~rtt
appears to lMt fourmiddotmiddot-al are iii _oil the nuaber ot
lIental healthcl1D1c na1t toM tbjh1sheat 1he
tour areaa woUld be tollows
1ttrea Ore to~Blo Drimiddot ~tb Burrus14e aDd tIMtmiddot Colb1a Riftr H1gbwyaeri1Dla th nortllra boundaryshy
2 bull ProII 82D4 1_~ 10 20th streetwitil the ra1lMd Mu the north ltouadary
3 ~ et et tUgl_b1bull MYel froamiddot the Clackaaa COUDty l1ae aorth to Dln8lon stret
4 beDOlvt1ttfe-t ~efllt4 COatytrca Jle1aware streetmiddot toR1C1a11oDd wlth Colubla Blvd heiDI tbAtnorth bouaclary_
It ODe coapareatbiap to th iDeobullbullmiddotp 1t can be
eamiddotthat lIOat ot the c tracts baY1Dg bllh v1i11tatlcma
middottfl public tal health cJ1rUc8 ~ 111 t13e low ~ aid
1DcOile SroupiDIOJa1y of til 25 tracta llsted as
haviDlbip aental Maltll nlltatlou are ~ the1g60 hip
iDeo arebullbullbull
17 Plpn
42
amily PlellnSDI ]Jlce Metal Health i8 an 1nd1ce of
use Theperson 111 ordertobavebe_ 1Dcluclecl 1n this
atu4ywouldhave tohaft Ue4 ataa11y plaDI cl1D1c
tacilities of soaetype It 41fter troll tile _tal health
study1nthat i t1Jicludestatist1catrollbotb public and
privateclJD1os
The iDformation tor the iak orurcbart 8Dd map of
t8ll111 plenn1 na ob1a1De4 by cOIIblnlDlthe mabel of
1rlcuv1duals bullbull_ attbe tbreellUltrampo-ti Coatyhll11y
PlalJQllIl C11ll10s 111til tbo at the Planned PareDthood
Association CliD1C8 be tbree -JIultDouh Couaty r8ldly
PlamSq Cl1D1c are Solrtbweatth Col_bla 1111- a114
HaDsell Health BWlcl1Dl CllD1cbi middot1Dtormat1oD vas then
bullbullbullesed tomiddot detellWMt l10w people troll eacb c8IUIUS
chart wastben Mele IUs oIIart jn 4iY1ded to show
the censuS tracts lIaYiDlmiddottIle h1t1iest qUart1le of incidence
of use lowest quartile of 1Qc1deao ot use Jlid 12 of
incidence of Wle an4 a map sprepared troll thts 1Dto~
mation
The C8U118 tractsbelOJISnl to the h1lhestquartile of
use appear to be 1lO~ 8catt~ on tbipwas true ot
either the _p ot aental health cl1D1c uaageor ot the map
abow1DI per capita 1I1COM Iaere40 to be three
d18t1nct areas of UIIaP beJ woul4 be
1
IJ
43
t10D of BurD81cl and the W11lallette River 4
2 S~t Portland 8Otth otmiddot the ra11shyrcaadand alona the W11lamette River
lIortbeaat Portl8D4 between MisSiss1pp1 and 24tbStreet the northbouBclary be1DgColwb1aBlvd
Pylzl1c BMltl IrpI Y11ta
Publlc Healtil nur81D1Y1s1t nclud8 an vists to
theholles of client by PubUc Health Nurbullbullbullbull his shows
visits to bull f8Jl1ly fer aDY purpos SUCh aatuberculolJ1s
het1Dl tem1tyaeatalu4 8IiOt10D8l cODd1t1ona etc
he atat18t1C~ 1fele C()4ed accord1Dg tomiddot the 1llli301fOCUS
of the Y18lt tt doe DOt 1D41cate the Dmlber of holies or
f8ll11lev181tecl or 1D41Y14ual Y1a1ted more tban oDcein
the propwl It dobullbull I1ve 80M 1D41cat1on by coaparlshy
OD ot the 8JIoUDt of aedlcal problema 1n eachcen8WI tract
Ap1nmiddot the _p abowa 8 scatter patteraof probl_
areas althoUSh there appear to be a sroup1Dl of hiSh J
l8aIeccmaus tract 1ntlut extreme southeast part of tbe
County other areu uIriaI any nura1Dl contacts are
1 bull he 801lth-oa-al CO1Dty on eaCh 814 of 82nd Av from Clackallaa County north to Dinloa
2 ear bullbullbullt 814e aroUDd Preacottand Misaisippi
Dowatom Bunul14eonboth 1de of the river
44
V_real Pis The iDfomatloil uaec1 to tabulate the Venereal
disease chart includes all the ooab1ned case otmiddotODormea
and syphilIs reported by bothmiddot publIc and prIvate physicIans
dur1nl 1970 There were 3602 caes ot IOnorrhea reported
dur1nl 1970 While ODly 17 cabullbullsot ayphilimiddot were reported
A chart was prepUed aDd att8llPt wasmiddotmiddot de tomiddot
determ1De Wh_therVttDereal 41ease was more p~vaJent in
areas othigb or lowmiddot proportIon ot youth hi waadone
bymiddotdetemlna a 1leaD prceiltacmiddotmiddotmiddottor the population ot
resld~ts UDder19 years ot (34) middotA mean ratemiddot per
100000 popUlatIon al80c1ttem1Ded tor the middotoccurreDCe
ot venereal dieae This was et at 390 oass Areas
hav1nl a population 1n which leiS than 34 were lmder 19
years ot ampIe were called low- yOuth abOve tbl percentaae
hiSh youth The aaa waatrue ot the occurrence oivenershy
eal disea_ per CeD8UStract It the rate waacomputed
as 1I0re than 390 cases per 100000 it was called hiah
venerealdiaeasei it less than thia tisure low venereal
disease It was tound that 1D Multn~ COmlty there sems
to be poSitive OOlatI0n(x21S19gt between low youth
and hipmiddot venereal diseaand hip youth and low venereal
diseasebull
RaDk ordr Iitot all c traot middottbAm made
Th1s was done byt1Ddlna the ratepr 100000 populatIon
of venereal disator all census tracts in the County bull
45
These were thenlisted from h1lhto low (sreatest to
least) in a rank order The l1sting was then divided
into Upperandlower 14 aDd listed on the MUltnomah
Countymiddot up
The areas of b1gh venereal disease se8ll18to
roup thBl~8 middotin a very tllht area ~oq both 1des
of thell18l8~ R1 w1th BurDaldeS~et being
~bout theceDter qf tbi8IZ9uping This area woUld
appear to be m ldeal spot for the denlopment of a
locallzed venereal d1sbullbullbullbull cl1D1c
UbepoundCUlO1s
In this report bull tube1C1llosls caS8S refrred
to include alltbobullbull cabullbulls ontubercUlo8is follow-up
rather middotthan just new C Accord1Ds to the Multnomah
County Health SUrvey of early 1971 this would include
all ca repOrte4 over thelaat three years The
total number of tuberculosi8 cabullbullbull usedin this study
was 666 lh1 included 128 new cabullbullbullbull
A rate per 100000 of tuberculosis for each
census tract wa- then computed and the c~us tracts
listed by rank order be b11h Qartlle mel low
quartl1 were then reoordd on a Multnomah CoUnty map
TWo genral areaa baY1Dg a hip mcldencaot tubercu~
losiare 1D41cated heyare
1 Both middotsld ot theWilla11lette River
Ll -
46
with Burns1de about thecnter
2 he extrea Northebullbullt comer of the County bull
By coap8r1ng the tuberculois an4ven8real
diseae maps ODe can 8ee that the downtown areas ot
hiSh 1nc1denceare alIIo8t 1c1eDt1cal on ach map
This WOuld 1nd1cate that 1t would be of value to
bullbulltab11sh acl1D1c 111 th1aampreatbat would provide
bothtuberCulos1s 8Dd ytmereal 418ase srvicbullbullbull
Thchart aDd 1181gt8 are wsfuln 11v1DI
1Ddicat10DS tor the type aDd placemeototlocal
health cl1n1c8 tbro1qhout tbe MultnomahCounty area
A cOllpar1on of the mapa help one to dec1dewhether
to provide a aulti-8ervice cl1D1c or spec1f1c type of
cliD1c As stated in Part I of thi paprserv1ces
shouldhaYe both treatlieDt and prfMmt10n cOmponents
As he been stated fta ne1lbborhood health care
Qenter muat be a fac111tY plazme4 with an aamesa
ot the neds of the consumer and the c01llll1m1tybull
Part II of this rport haa been an attaapt to indicate
and clarify 8011 ottheae coDlllUDity neds This has
been done through8elect10n of apc1f1c problems
The indic were then visuallyrecorded through the
use of ups and charta ODe dan asseS8 thedsreeof
1DIportance of certain concems to spec~t1c areaa by
comparinl the chart aDd maps Prom this oDeean
41 dec1de which are48 vb1chcUD1c-or indeed if
the need a clinic at all However further factors
should be considered hebullbull include
a The amount of fuDd1 available
b What 18 the percentage ot peopleineoh ceaaua tract tbat would actually us such cl1n1cIl
c Wbat 1 tbeco--1tymiddot 8 IeeliDashyreaardtDI particular cl1D1c8 Would this dcrebullbullbullmiddot the ettctiveness ot thse cl1n1ca
IJ
li
D_OlraphicPopulatLon Challie 1960 to 1970 48
Cen8U8 1 of Pop 1 Cbaqemiddot 1 Change1 ofPopTract Under 19 Yr8 Over 65 Yrs1960-70 1960-70
middot1Q701Q70
1 319 -12 171 -H) 1
2722 215-27 +68 301 366 -22 127 +35 302 371 +19 111 -04
311middot401 144-41 +29 402 321 13~7-39 +24 501 356 124-08 -02 5~O2 351 133-23 +12
405601 82-10 -02 394602 103-01 -06
701 275 149-76 +56 702 361 +01 121 -07
+10middot801 326 140-22 802 321 middot127
(
-29 -03 9~01 342 124 -H) 6-18 902 294 128 -H) 3-24
10middotmiddot -14312 140 -17 1101 182 +25 -23197
2411102 186-59 +29 1201 226 169-17 -41
31middot01202 +11 182 -05 295 -H) 81301 208 -H) 4
1302 331 +08 197 +04
14 323 +15 middot185 -08 middotmiddot15 329 +16 16~5 -13
-28middot 1601 332 131 +12
1602 356 98 +24middot-39 middot3101701 161-33 +21
1702 370 -15 85 +02 +19 1801 264 151middot-50
185middot1802 256 +47-58
IJ ~
D_raphlc Population Change 1960 to 1970middot 49 (Contd)
4io
Census Tract
of pop Uncter 19 Yra
1Q1n
1Cha1l8e 1960-70
of PopOver 65 Yra
lQO Change
1960-70
19 389 +29 141 -24 20 223 -13 206 +18
21 227 +08 194 -36 2201 356 -27 112 +05
2202 290 -18 ll~9 -29 2301 356 -03 154 +24 2302 260 -37 245 +97
2401 410 +6~1 123 -31 2402 163 -80 320 +99 2501 381 +13 140 -01 25()2 237 31 lil +02 26 343 +25 186 +149 2701 370 +29 1S5 -01 2702 249 -44 304 +98 2801 337 +19 187 +09 2802 306 -10 156 +31 2901 304 -38 142 +24 2902 i 307 -32 146 t3~9
30 29~0 -48 16~2 +51
31 355 +30 160 +01 32 370 +48 148 -13 3301 395 +45 130 -20 3302 368 +06 138 -02 3401 386 +16 117 000
3402
400 +32 92 -26 3501 304 -07 115 +35
3502 344 000 140 -13
3601
36~02 357 -04 132 +32
3603 30~1 42 149 -67 3701 342 +28 152 +19
1
IJ
Jianolraphic Population Chan 1960 to 1970 50 (Contd)
Census Tract
of Pop Under 19 Yrs
JJl7J
middotChanae 1960-70
middotofmiddotpop Over 65 Yrs
1c~7n
Change 196070
3702 409 +39 122 -11 3801 308 -11 151 +29 3802 275 -35 180 +46 3803 282 -32 192 +54 3901 376 ~13 100 +17 3902 296 -03 177 +29 4001 438 -11 84 +13 4002 353 -21 115 +20
4101 397 11 9middot0 +11 4102 346 -19 120 +03 42 331 +19 11 bull 3 -16 43 347 -72 105 +31 44 113 +84 183 +154 4S 33~9 +07 110 -06 4601 2501 22 193 +38 4602 332 +59 126 -29 47middot 161middot 000 211 +01 48 103 -26 302 +59 49 138 +1 bull 3 252 +09 50 141 -26 204 -12 51 12 -39 257 +07 52 47 -61 351 +48 53 89 +49 314 -30 54 25 l1li15 327 -17 55 131 -17 115 -121 56 198 +93 227 -47 57 71 102 189 -88 58 240 ~middot41 16~1 +55 59 322 +25 142 +06middot 6001 264 95 132 +50
6002 328 -31middot 89 +07
JJ
Demographic Population Change 1960 to 1970 51 (Contd)
Census 1 ofPop lChange of Pop bull ChangeTract Under 19 Yrbullbull 1960-70 Over 65 Yrs 1960-70
1970 1970
61 355 -58 85 +39
62 328 39 110 +18
63 414 04 73 10
64 382 -22 72 +04
6501 383 02 67 -20
6502 329 -56 96 +09
6601 391 +13 88 -03
6602 319 -59 97 +06
6701 327 71 145 +72
6702 331 ~67 83 +1-0
6801 365 -66 49 +01
6802 388 4bull3 54 +06
69 354 -41 80 +23
70 400 -23 68 -06
71 359 -48 72 +05
72 255 -88 82 +11
73 346 -39 91 +25
74 313middot -63 105 +24
75 329 -42 129 +37
76 336 -52 85 +21
77 370 -10 69 +05
78 309 -10 120 +21
79 325 -56 87 +10
8001 358 -81 57 +12
8002 391 ~81 76 +12
81 315 -76 108 +21
8201 403 -23 64 +08
8202 392 23 65 +08
83 357 -34 120 +31
84 402 -18 73 +16
85 413 -06 76 -09
r
Demographic Population Change 1960 to 1970 52 (Contd)
Census Tract
t of Pop Uncler 19 Yrs
1970
Change 1960-70
1 of Pop OVer 65 Yrs
1970
ex Change 196070
86
87
88
89
90
91 9201
9202
93
94
95
9601
9602
9701
9702
9801
9802
99
100 I
101
102
103
10401
10402
lOS
368
351
379
391
391
413
379
433
372
429
414
432
419
439
~32
377
457 420
378 41middot7
345
360 417
417
412
-04
-02
-35
-26
-28
-11
-64
-20
-S9
-39
-32
-21
-34
-40
-47
-lO~7middot
-27middot +04
+56
+07
-34 01
+04
+04
+10
103
128
97
11il3 99
69
79
42
77
46
34 38
44
40
54
111
51middot
81
133
59
74
140
63
87
76
-08
-06
+04
+08
+17
-05
+3S -02
+1~4
+19
+33
-14
-08
+12
+26
+71
+11
-16 -34
-20
-19 +37
-49
-2S +15
NOte The The
Taken frOi
averageullder averageabove
middotUSCensus ---shy -
19 years == 6S years ==
figures 197
32r 13(14
p a~d 1960
--
Rank
1
2
3
4
5
6
7
8
9
10
11 12 -_
13
14
15
16
17
18
Tract
69 46
60
58
- 68
61
302
2501
67
63
19
62
26
94
3603
3902
64
30 -----~-
Rank
19
20
21 -
22
23-shy
24
25
26
27
28
29
30
31
32
33
34
35
36 -
Ranking of Per Capita Income by Census Tract
Tract
65
2701
- 15
1601
701
66
93
82
2903
3602
30
2502
80
2401
81
- 70
91 shy
4001
High
Rank Tractshy
-32shy37
38 97
120239
7840
41 ~ _2_1__ 42 31
43 2501
44 18
45 98
46 37
47 3803
1702
49
48
1602 92 2702
I
50 89
51 901
52 801
Ra_
53
54
55
56
57
58
59
60
61
62
63
64
6S
66
67
68
TractTract Ra~
74692
170196 70 I
401 71 90
72 1037J
79 70273
3802 74 601
24024102 75
85 76 101
77 9023901
7699 78 100 4101 79
3601 I
380180
458140~ t---- _ - - shy83 82 42
888384
59843501
4777 8~
502
Low
802 86
Rank Tract
87 shy
--88
89
90
91
92
93
94
- 95
96
97
middot98
99
100
101
102
103
104
1201
14
49
72
73
43
87
3502
105
1
52
86
71
1
501
10
3301
104 tf
Rank
105
106
107
108
109
110
III
112
113
114
115
116
117
118
119
120
121
Ranking of Per Capitalucoae by Census Tract
(Contd)
Tract Rank
4001 122--shy602
13
1102 2302
3302
55
3401
48
21
56
50
3402
lL01
2202
2301
53
2201
-shy
Tract Rank Tract Rank T~aet Rank
57 I-----
Imiddote
bull
Tract
- Low -k Note Information taken from 1960 U SCensus
Rank Tract
I ~
Ie
Imiddot
~
----
----
--
--
Rank
1
2
3
4
5
6
1
8
9
10
11
i-
-Tract
391 922 921
972 971
100
132 131 121
962 961
822 821 401
982 981
20 111
47 10 1
412
High
Total Number of Henta1 Health Visits
Ranked by Census Tract High to Low
TractTract RankTractRank Rnk
12 182 22 78 29 87 76 381 73181 ~------- 1913 371 8538230162372 271 2616-121 8272 2
14 80~2 31 94 7923 84801 59 15251362 4232 15 52 _ 32 103 8924 651 17240216 652
_ 91 351 33 341 23117 83 122 25 25 48 1123921418 34 shy61 86 661
19 662 6493 81 26 91 8153 49 50 55 41383 71 27 51 3120 90 672241 35shy 104167162 461
I 411 46211121 28 88342 I
2502 36 69 54 5251 50 272
-Ra
37
38
39
_ 40
_ 41 Ishy
I
42 I
-I 43 44
45
shy
Tract
~ --- shy 95 56
45 292 242
102 62 352 291y
92
101 281
99 72 63 601 60~ 42 2201
77 74 61 57
363 232
70
32 31
11 44 282 2202
Low l
- Tract
46 682 681 I 331 30
r~$ 47 1042 332
48 102_41_
11
~
Visits to Family Planning Clinics Ranked by Census Tract High to Low
Rank Tract Rank Tract Rankmiddot Tract Rank Tract Rank Tract Rank Tract
1
2
3
4
5
6
7
8
9
10
11
12
13middot
14
15
16
17
361
56
401
341
48
59 121
20
55
342
10
31
58
93 21
241 132
331
53
461 462
18
19
20-shy21
22
23
24
25
26
27middot
28
29
30
31
32
33
391
32
middot47 I-i-_-shy _ -
231 111
332
972 1
372 371
52
89
32
92
82
100 31
182
30 242
402
34
35
36
37
38
39
40
41
42
43
44
45
42
1714 i 661 221
78 362 2
90 602 601 352
63 251
105 921
971 351
73 42 292 232
411 51
662
81 45 52
46
47
48
49shy
50
51
52
53
54
55
56
961
801
49 81 72 71
19
9~1
172
68 2 57 162 14 112
91 75 681
381 42
3~3
83 161
57 f
58
59
60
61shy
62 Imiddot
63
Imiddot 64
65
66
64 62 36~3 252
74 652 SO 392 291
651 6bull 2
79 271
r-- ---- shy981 222
672 671
821 272
94 87
281
382
67
68
69
70
71
72
73
74
75
76
77
78
981 26 12~2
IS 61
85 82~2 69
61 43
101 86 84 282
76
131
51 72
1041 962 88 70
99 922 77
103
95 802 181
i
~
Low High
RankRank Tract
5479
4480
81 1042 ~) middot102
71 - - + ~ - ~
Visits to Family Planning Clinics
(Contd)
Tract Rank
I
Tract llaDk l
RankTract Tract Rank Tract
~
I
~
J1 ~
Low
Total Number of public Health Nursing Visits
Ranked by Census TractsHigh to Low
TractTract RankTractRank RankRank TractTractRankTractRank
25249 71 79 17249 8033 6586 99189711 84 2915072 34 661 76 66 811519512
402 5035 51 161 2518220 122 1713423 352 55801 7120 6752 2 149814 41236 83 2662 38 94 6821 53 2924015 362 37 32 42 75 69 281 84 63
546 8822 54 222 85 3925431 70383417 3818223 6439 4386652 718 21 55 103332 8924 232 87 19 271729219619 24156 16211140 382 628825 10523110 112 73411 10141-- ----shy 89 363 4457 8126 16111 221 74 9142 90 46158331 53 671279012 46243 48 59 351 3837528 1083 9313 91 5844 59 -_242 76 1----- shy60 272 72 74104114 60145 42 9287 7729 92 6151 8215 57371 934630 91 307762 12113116 282 619447 41391 9531 78100 63 7378 ~95 681 6945 32 5632 798517 6448 47 52 181
High ~ Low
Rank Tract Rank
96 31 132 70
97 102
98 182 372middot 602 651 662
- -shy
~72 682 802
822 922 962 972 982
1042 ----shy
Low
Total Number of Public Health Nursing Visits
(Contd)
Rank Rank Rank TractTract Tract
I
I lt
I
Tract Rank Tract
[
~~~-
I
~
IJilfimiddot ~
j
Ranking of VD Caea According to Census Tracts 61 By High and LOll Youth Itatio
A media~ of 34 5 was determined Any tract having greater
than 34 5~ of popu1tionunde~ 19 years of age -High~
Any tract having l8S than 345 of population under 19
years == Low
Any tract having rate less than 390 =Low
Any tract having rate more than 390 == HLgl4
YOUTH
LOW HIGH
L
0
12 402 1801 1802 343 2801 2802 29023603
54 6001 600262 66~02 72 74 75 76
78 79 81 t02 65 1202
W
(25)
VD
H
I
G
H
401 701 801802 901 902 10 1101 241 1201 1301 132 14 15 1601 1701 20~ 21 2202 2j02 2402 2502 2702 2901 303501 3502 34023801 3802 383 3902 42 44 45 4601 4602 47 48 49 SO 51~2 53 55 56 57 58 S9 6701 6702 73 95
3~02 7021702 19 25~01 2701 4102 4101 63 64601 ~601 6801 680270 7l 77 8001 80~02 8201 8202 83 84
85 86 87 88~ 90 91 9202 920193 94 9601 9602~ 9701 9102 9801 9802 99 100 101 103 10402 105 6501 10401
(47)
301 501 502 601 1602 2401 2301 2201 31 32 3301 3302 3401 3402~ 3602 3702 3901 400140 02 43 61 69 B(
(53) (23)
~ ~gt
Ranking of VD by Rate Per 100000 By Census Tract
~
Rank Tract Rank Tract Rank Tract Rank Tract llank Tract Rank Tract Rank Tract
1 2202 21 S6 40 902 58 1602 74 75
90-shy 64 107 26 --~-
2 3402 22 45 41 10 59 902 75 78 91 54 108 61
3 2301 23 3502 42 2502 60 602 76 6802 92 402 109 87
4 3302 24 49 43 1102 61 501 17 2 93 94 110 90
5 50 25 52 44 6702 62 14 78 8202 94 97 02 III 76
6 2201 26 20 6701 63 4002 8201 2501
9701 41~02 112 91
7 44 27 48 45 401 64 3802 2902 95 63 113 62
8 3301 28 1701 46 502 65 30 79 83 74 96 9602 114 71
9 55 29 47 47 42 66 3803 80 2801 96Q1 115 85 10
11
12
13
14
15
16
17
18
3401
53
2302
2401
57
21
2402
1101
51
30-shy31
32
33
34
35
36
37
3701 - -~ 1201
3702
89
43
132 131
3602
4001
48
49
50
51
52
53
54
55
58
1601
601
4602 4601
69
701
31
3901
67
68
69
70
71
72
2901
801
39021~ 802
6502 6501 122
702
41~01
81
82
83
84
85
86
87
88
19
1
1702
2802
79
93
100 6801 6602
81
97
98
99
100
101
102
103
104
9201 9202
9802 9801
77
302
79
86
72
84
116
117
118
119
120
121
3603
8002 8001
101
99
95
10401
105 10402 103 102
19
20
59
32
38
39
2702
3501
56
57
301
3801
73 1802 1801
89 6002 6001
105
106
2701
88
High Low
-- -----
Rank OrdermiddotTuberclosis Cases by Rate Per 100000 Ranked by Census Tract High to Low
Tract TractRankTractRank Rank TractRaukTractRankTractRank
801
79 9601501411 52 6835340120511 I 960269 903603532036 $-~~F130221542 4366 311301 70 68~013802 _ I- _ 4001_37213 3921201 6802802 H71523822024 22 54 193302 3802 80 8958 I37139535 70155 9801 I60123 72 6702 98023914011016 6701250124 10 56
81 94 401r 7 154152 73 7057 2625 122 92028
90242 162312301 92~158 86 7172434526509 82 79160159 74 100 87412240227220110 6502836960 75 30 8317244 6501782801285711 61 901 42765645 84 66021459294912 9701 660146 171 302 9702 47
6235023033113 85 822821182 917755 16335013110214 841814832 78 103 938564 324815 86 1057940149272 38036523216 10401 87 2902241 725Q 10402360266340217middot IF88 88 9937233 282 51 218 101 01102 46016234
I)167 2901460219 47
High ~ Low ~
- -
TractRank
9S89
6490
8191 8001 8002
63 61 60middot01 6002 44 2701
92
J
2502 402 --- ----shy
I
Rank
Rank Order Tuberculosis Cases by Rate per 100000
(Coutd)
Tract Rank Tract ~nk
I
Tract Ballk Tract Rank
Imiddot
Tract
Imiddot
1~
t 1I i Pi i l I
o
1 -1shyL I
I J
8 40 icO ~ I -lt 0
-t (1) I
i I
r o E
II
a
I
r--i
shy
I
~
I (
Jgt
(011 fi(
Ggt
I II ~j
()
(f 0
~ ()
I
11
f9
r
II 99
o ~
Ggt r
~ __-J~ I t I ~ I
r--J l I
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19
direct operationot the u1sbborhood health oenter by
the hoSpital canll8lceaftilable to the center expertise lt bull
in sOlle aapcta 0 Operation that m18ht not be aa readily
available otherwie
Relardlebullbull of wbetberthe hospital and the neighborshy
hoodhealtbcent8r haVe a cOJIIIOaadmjntstration they
IIlU8thaVealTlved at a str1Dsent delineation of IDUtUal
role and reSpoDBlbilltiebullbull All OOIIpoienta ot the care
yst IIlWStQlarify and understand one anothers position
In the syatem and acree on objeCtive ancimethOds
(26 pp16-17p31) SODae areas of iDUtUalconcemare
reterral procedures record keepiDg aDC1 mutual use of
facilit1es statt1Dl i8 anotb8r ~ ot coaaon conc~
Ditt1cultift have u-laeniD the pastiD cOllprehensive bull t bull
healtbc~ prosraumiddot 1d11ch were batil plauned in wb1ch
all of the health canter phy1C~1IDa did DOt bavetatf
privilege at all ot thebackuJlhospltala (29 p21)
SUch a8ituat10n i8 1Dampcceptablelt inpatient care i8 to
continue to be p4by the pat1eatmiddot health center
physician and it cont1Du1ty ot care 18 to be maintained
Hoapital and health center1lUSt laav 301nt responsibility
tor the recruitaentot physicians
VticlentU IPan BJcNrcu Much otwhat haa b8ea sUd has stre88e4 at leastmiddot
iJlplicit17tbaD8ed tor tM etticit middotprovision ot8emcea
20
There appears to be two aspects of efficiency which are
discussed by writers on the su~3ect of the comprehensive
neighborhood health care centef one of these is the
need to organize) services to make the most efficient and
economical use of scarce medical care resources The
other closelyrelat8d in realIty is the need to help
the public use services in the most efficient manner
The comprehensive neighborhood health center concept
1s lhherentlymiddot efficient in that preventive curative and
rehabilitative health ~are programs are coordinated under
one roof with integrated a~stration Furthermore
theempbasLson prevention health education and early
disease detectionis eftic1ent troJll~estandpoint of
the health care system as well as beneficial to the patient
(18 p760) HQwever ~ue tothe scarcity of health care
personnel thecoiDprehensive neighborhood health center
mustbe an arena tor eXperimentation with new staffing
patterns~ The Kaiser program is indicative of the way
in which health care systems must begin to operate in
that appropr1ate ancillary personnel are used Wherever
possible to perform functions that do not need to be
carried out by the physician As Saward (32 p42)
states
1hroughou10ur organ1zat1on~ there are many of the customary experiments be1ngmade-shyJse of speciallr trained nurses for well-baby care under the SUpervision of the pedi9trlcianexperiments with routine prenatal care by
w ~
21
middotSPC1a1l~t~JlUrbullbull per8ema_1 bullJmdlJleu y our fuDotlou are auoh that DOtb1Da 18 dorutbYtbe phY8iCianstbat doe DOt vet to be done by the
phys1c111U1fhe other aldlle4 person- Del-nurse middotreC~0D18t the appo1ntshymeDt center or clerical praormelshyaremiddot there to free h1amiddotto use his spec1al sk111
Awell lmoWn treDd1D the area of eaaiDI health
c8re JII8DPOY8rShortagjs bas middotbe thetrend toward tra1nshy
1DB poverty area rea1deats as DOD~pro~eaionalmiddoth8lth
aide and nepborboocl health workeramiddot (28 p63) This
bas the effectofmiddotmiddot1J)creaa1q II8DPOWrand 8180 can help
bridle the cuJ~ cap betweenprondera and colllUmers
of aen1C8s This attarD at least tlleoretically
createa a situation 1D WIa1ch providers andcoD8Ullers can
be educated to UDderatad OD88DOtber and interactJlore
ettectlvely~ HoWever amiddotpltt8ll has beeD themiddot tel14ency in
801D8 oamp8e8 tomiddot us aidesmiddot ssale8lllcw t~r the center
alJDOatexclwdY811rathertbaD ua1Dltheal to protide the
health care for wh1ch ~ were trained (29 pp3B-39)
1bat ismiddotmiddot vh1~e the a14e Yalue in ~~m1catiDI with
low 1nCOlMt patieata haa beeR recoSD1zed and stressed
their role ashealtb carepersoDDelhil been slighted 1n )
any 1Dstancea
Anotber step 1d11Ob bullbull been taken to provide 8rY1ces
more efficiently eUeot1ftlybas beenmiddot theorgan1zation
of per8ODDeliDto IIllt141sc1pl1Dary teamaaaa means ot
proYid1DgmiddotCOQrd1DatedserY1ce SUch te8lll8 sen_rally
~
hf
~
22
include PhYsiciaQs nursbullbullbullbull soc1al workers and outreach
workers Conceptually th8y fmlct10n to me~ the intershy
relate lled1cal and social needs ot the families sened
Hor there are a number ot barriers to the etfectve
tlmctiOD1nlof lIuchte8ll8 SODieot these are heavy caseshy
loads the inordiDate amount ot tille consumed by multlshy
prOblem tamtliethel1m1ted tra1n1 ngmiddotmiddotand laCk of tnterest
on tile part ot aoae tebers in examinJng aspects of
problems out14e~lr oWn areaaotcolIPetencemiddot and
~ourdcation prc)blell8 between proteasioDala and nonshy
prot81~s (10ppa-10) middotrurtbemOre as De Diaz
(14 middotp6)1nd1cate tbel8 maybe a teDdency tor vertical
dp8rtmental lines of auperv1810nto become paramount
over the team coDamloation syst lead1ngto conflIcts
in determ1niDI the ro1ea ot solie team bers particularly
the DOD-prote81011alaInauch exper1l1enta Witb new
~t1Dlpatterna it 1s bullbullaentialtbat line of authority
roles aDd NsP0D81bll1tlea be made explicit and that there
beJDechaD 8IUI tor relUlar evaluat1onotfunctlorUng
Another way inwb1ch health care sernee delivery can
be made more ett1cl8Dt is to proVide servicea dur1DC the
hours whentbey aremiddot -ostnee4ed As reQo_ded by Yarby
(37p1) serY1ce can bemadelIOre accesslble by making
themava1lable 24 hours a day seven days a week If
rg8l1Cy service are aft11ab1e aroua4-tbe-cloek at ~
nil1iborhood health center the continuity ot tbepat1ent ts
23
careiamaiDtalDedand meatry point into the
cOIIPre~i health care 8 be made available
tothe patient who aoZMllyU8ea ozilymiddot emergency care in
tille of med1cal criais More 8isDificantly ava11ab1-
lity of a tull rase of bullbullrv1c8 tor seVeral hours 11the
eVerlna aI1Cl On ~ prevent the los ot earn1JiSs
involved if th patierat 1IU8tt8cet1me oftfroawork dur1q
the d8y for aed1Cal oare bull his can be an eSpecially
importantc0J1814eration tor lo1aCOlleDUUg1nally qloYEtd
patient aa4caJla18o PIOJIOtet1)e 0Da01Dl use othealth
servicebullbull
exper1eDO ot tbeKa1er prosraa in tb1s~reprdAs
Greenl1clt(19 p10) states wA lllNt 8ip1flcant
proportion ot the abulatory care 8n1cp~Y1dd tor ~
total popUlatiC)U ~ ~ after clWc hours and this
Deed i8 apParenUyaoN prODGUDced tor aJl8d1cally
iDCust population On the other hand the bulk ot all
aabulatory med1cal cu 88l91ce are performed dur1nS
regular cl1D1c hour eVen when services are available 24
hours a dayJ day bull week W
It has ~ the experi8D~eof a ftIDber ot ne1g1lboXshy
hooct hea1tbcentere _t a_jor obstacle to efficient
proViSion ot anicbullbullhas beentbe teD4eDcy of medically
1ncl1pnt patieats to utilize the center oa a walk-in
baais tor epi8od1ccr181or1entect bullbullrv1cea rather than
4)i
h~ ~~f ~~ L
24
to make appoJlltaeata tor ODIo1qprevmt1ve treataent
and rehebl11tat1Ye care ad ampl1O to bave a blah failure
to Show rat_for tbe appo1DtaeDts that they dO make
Atone center 628 of appo1Dtments made were kept
while 3Oottbepati_ta een were ~1n patients
AlthoUP fewer patiets were actually 88811 by the cater
1D middottb1s 1Datance thaathe -bervholuidmadeappointshy
mta the walk-iD patlat required an iDord1nate amount
ot staff t1ae tor aCreeDiaaacl ~trral to pplOprlate
~ttor caregt (9 pgg) Arraquotbr1llpl1catjo~ of the
plOVidedto valk-iD patient by other thaD their
(19 p12)rurtbermore
when patients uti11ze Wlk-1Il er181 centered care
athelr ODlf tona ot ootact with the _d1~ care
ay_ta fUilycentered care the treata_t of tUl11y
bers
a a UD1t 11
dlarupted
hewalk-1Dphenoaaencm appear to barelated to
diUerence between soclal clase in the style of Dlaking
contactJt1th the a11oal C~ay8t As Greenlick f ~
(19 p11)1Dd1oate8 thepheDOaenOn ot INater usage of shy
walk-in ervice by aed10ally middot1Jid11ent patient thaD by
others baa otte been attr1buted to a stoical att1tude
tQward 1llDe8 em the~ ot poor people leacl1D8 to a
~
25
greaterdelay1n tbe k i Dlofa8d1cal care These
patients wppoedlyeelcmiddotcareODlymiddotwIleD tbeirmiddotillDess
becOlles1Dtolerable resultiDSin middotthMr appeariDS withshy
outnot1ce1o rece1ve oareHlwever Greenlicks
r8aearcbbaa cut doubt on the existence ot tb1delay
111 report1Dg middot8J1IPtoJumiddotOfDeW 11laessand seek1ng care
Be bas tcrQDd 1bat s1ll11ar peze_tases of dioally
1nd1sent 8DClJ1on-aed1cally 1Dd1PD~ pat1enta seek care
on the aue daytbat aptou tirstaPPear
1fb11e GrHDllclc 1nd1cat tbat the reasonator the
greatertendeDCY of low 1Do~e pat18Ilta to 1$8 walk-in I
serY1ces are notlcDo1rAmiddotmiddot tbe7 _ be rel~tedto a tendency
ot lower aocio-ecaaaoclaa patieota to preter face-toshy ~
face contacts with II841cal persoDl181posslbly because
such contacts areft coatortiDS an4reasauriDS to
patients who are hJpotbeafzed to bave a dependent attltude
toward IIed1Cal care perS0Jm81 (30 p161)
It a8 itmiddot baa pnerally beenhld the appointment
s1stemts the most efficient Ileana of dellveriDS
comprehenSive oODtllluiDlh-lth care (9~100)1t is
necessary that educaUoraalmiddotbulltfort be taken to proaote the
use ot middotappo1ntaents8DClmiddot tQrec1ucethe fa111re to appe~
ratB4uOatioaalwhlQb baft~utl11zedhave been
IJ
26
1Dten1ews with walk-in patients home Vi8its and group 4i
meetiDp1D8D attemptto1Dierpret1o the patients
the value of rtitgular ppo1ntmentamp andot con~in~
c~1ve care rather than epiI041c care (9 p1OO)
h1s 1safuD~tioD torwhtch nOl~prot81QDal colDlllUD1ty
YOrkersllaY bebe~r8U11ed tban other statf H()wever
euch aD ~ucat1oaal propul __~ ~e related to the senUiDe
capacity otth health oenter to provide comprehensivebull gt
ervice8 to1tpat1_t~odoD aD app01ntment bas18 It
1amp pos8ibleo~rw1 tor educa110Dal ttorts to result
LD a~8JImCl tor ltPP01ntaen~8 at a ratewb1ohi8beyond
the capacity ot thee_tar to t without uareaaoDably
1_ wa1t1Dlprio4a QOBt1nuad use Ot the center on a
wallt-in bU1 _1tbeoosiItpos81ble to et an appoint-
met anc11nCreued pit1entcoJaplampia1a bull Therew111 of
course always be a need and demand tor acute ep1so~c
Care -ci the health centerDlWlt be planned with the capashy
billty ot bullbullbullt1D8 tb1aneed wh1~ cont1Du1nI to stress
aDd educate the patient to utillze oDlOinI comprehensive
faa11y middotc~te~d Cflre (9p 100l
att g4 CODClva1opa
In order to bea4equate any coJlltemporary health care SY8tem muat bullbulletcerta1D interrelated criteria he
IJ
27
minimum criteria areaccessability of services to those
who need them compr8heX1siveness and appropriatness of
services and efficIency 1nthft utilizat~on of SCarce
health care personnel and resources The scareity of
pex-sonnel andtbe need for h1gh quality ongoinghealth
care services
aJIlong the
populationdemanci the most effishy
cientprovision of services
Services must be made accessible to the population
They mustmiddotbe geosraPh1cally accessible to remove the PhysicalmiddotbaTiers betWeen peopleandthem$d1calcare
system They mUst otter their services dur1ngthe
hours when people can make the moat use ofthemA~ it
makes little sense to concentrate services geographically
where they will not be uSed to their fUllest extent it
also is wasteful to provide serv1cesonlydur1righours when
many people are employed his not only presents a hard
ship middotto the consUmer lnrt wastes resources if for instance
the unavailability of preventive services during the hours
when people Can use them causes a need for treatment
services later on
Health carbull sEtrvices must be comprehensive including
prevention treatmcmtand re)abimiddot11tation Ambulatory I
healtbcare facilities wh1cQ are orienteciexclusively
toward either prevept1on or trea1mentare no longer accepshy
table for they are lneft1c1entln their use of resources
and in their prov1s1on of health care to the patient
w ~~
28
If prevent10n1s notmiddot stressed treatment serv1ces that
could have beenavoidedY1l~ be required If prevention
1s the sole focus of the health care facility sick
patients who present themselves must be referred elseshy
where for treatment andsllch referx-als may be taken as
reject1onsor not followed through with until illness
becomes unbearable
The instltutlontbat meets these requirements Is
the comprehensive neighborhood health center It 1s a
local decentralized outpatient facilityprOVld1ng a
fUll range of ambulatoJY health care services It has
a linkage to ahospitalbackUp facilityforlnpatient
treatment and hiihlY apclalized outpatient care
The neighborhood health center must be a fac11ity
planned with an awareness of the needs of the conSUtller
and coDitnUn1ty It must have the r~Ul0urces to provide the
services people need mere they can use them and when
they can use them It must uti11ze the part1cipation of
the community to develop this awareness Not only must
the cen~er beset up to be Amctional for the consumers
but efforts must bemadeaga1n with commun1ty partici shy
pation to help the consumers utilize medical care
services effectively The center muetmake efforts to
educate the community about the valueot regUlar health
care of preventive servicesand of the use of planned
IJ
29
medical appointments ratherthanorisis centered walk-
incare Therealit1es of the existing health care
system have not taught the patient particularly the low
income patienthow to use services effectively
The helthcenterilUst also bea laboratory for
experiments in easing the health caJepersonnel shortage
and c60rd1Datingcare~ A major difficultY iri-exper1shy
menting with neW rolesis freeing staff of old preconshy
ceptions
CoDlprehensiva neighborhood health dare centers have
been developed under a variety ot alisplces including
medicalsociet1es hoSP1talsmiddot(36p299 group pr~ct1ces
(29 p6- 12 117) health departments (13 p1027) and
ne1gbbothoodassoc1ations(14) The literature indicates
somevalues nthe management ot the health center by plusmnts
hospital backup faCility Whatever the auspices many
adm1nistrative fuDctions such as program coordination
standard pr9tectionand evaluation call for considerable
c~tralization of adm1nistration city-wide or coU)tyshy
wide At the same time other aspects hours of servlce
for examPle~ cuI f~radm1nistrative fUnctions made atmiddot
more local levels Each neighborhood center must be
free to adapt its functioning to itscominunity thi-ough
the mechanism otcODlllUl11~ participation inmiddot policy making
Obviouslythe prerogatives and responsibilities of each level must be negotiated and made explic1t
t4~
JJ
BIBLIOGRAPHY 30
1 American Rehabilitation Foundation ~ealth Services Research Center The Health Maintenance Strategy mimeo 1971
2 Anderson Nancy N Comprehensive Health Planning in the States A Study and Critical Analysis Institute for Interdisciplinary Studies American Rehab ilitation Foundation 1958
3 Andrus Len Hughes Comprehensive Health Planning Through Community Demonstration Health Projects mimeo1967
4 Barry Mildred CandCecil G Sheps A New Model for Community Health Planning unpublished paper presented to the American
Public Health Aseociation1967
5 Blum HenrikL Fred Wahl Genelle M Lemon Robert Jorulin and Glen W Kent The Multipurpose Worker and the Neighborhood Multiservice Center InitialImplications and EJeperiences of the Rodeo CommunityService CenterAmerican Journal of Public Health58 (Mar 168) pp 458-468 shy
6 Blum MichaelD and Soloman L Levy A Design for Service Delivery that Reinforces Constructive Tension Between a Health Center and Its (sic) ConSUDlers and Supports Community Power unpUblished paper presented to the American Public Health Asaociatiltn 1968
7 Brielaud Donald Comm~ity Advisory Boards and Maximum Feasible Participation American Journal of Public Health 61 (Feb 1971) pp 292-296 shy
8 Burns Eveline M Health Insurance Not If or When But What Kind Madison Wisco~sin University of WisconsinScllool of Soci~l Work 1971
9 Campbell John Working ~elationships Between Providers and Conshysumers in a Neighborhood Health CenterU American Journal2 Public Health 61 (Jan 1971) pp 97-103
10 Caxr Willene Neighborhood Health Centers Funded by the Office of Economic Opportunity mimeo 1970~
11 Colombo Theodore J Ernest W Sawardand Merwyn R Greenlick The Integration of an OEO Health Program into a Prepaid Comrehensive Group Practice Plan American Journal of Public Health 59 (April 1969) pp 641-650~ -
12 Comprehensive Neighborhood Health Services Projectof Kaiser FoundatioIl Hospital~ Prcgtgram YearE grant renewal proposal mimeo~1971 bull
13 CowenDavidL~ Denvers Neighborhood Health Program Public Health Reports 84 (Dec 1969) pp 1027-1031
IJ
14 De Diaz Sharon Daniel Beyond Rhetoric The NENA Health31 Center After One Year unpublished paper pres~rited to the American Public Health Association 1970
15middot Gerrie NorrrianF and RichardH~ Ferraro Organizing a Program for Dental Care in a Neighborhood Health Center Public Health Reports 8 (Aug 1968) pp 419-428
16 Gordon JeoffreyB~ The Politics of Community Medicine Projects A Conflict Analysis Medical Care 7 (Nov -Dec 1969) pp 419-428 shy
17 Greely David The Neighborhood Health Center Program and Its Implication(3 for Medical Care H~alth Forum of the Welfare Council of Metropolitan Chicago (mimeo) 1967
18 Greenlick Merwyn R Newgtimensions in Health Care American JOurnal of Pharmacentical Education 34 (Dec 1970) pp 754-4
19 GreenlickMerwyn R Donald K Freeborn TheodoreJbull Colombo Jeffrey Abull Pruesin and Erne$t W saw~d Comparing the
Use of Medical Care Services by a Medically Indigent and a General MemberShip Population in a Comprehensive Prepaid Group Practice Prosram II unpublished paper presented to the AmericanPublic Aesociation1970
20 H~tadoArJiloldVMerllYll RGreenlick and TheodoreJ Colombo Determinants of Medical Care Utilization Failure to Keep Appointments unpublished paper presented to the American Public Health Association 1971
21 Johnson Richard E and Merwyn R Greenlick Comprehensive Medical Care A Problem and Cballengeto Pharmacy ff AJilericanJournal of PbarmacenticalEducation 33 (Aug 1969) pp 361-367 -
22 Kahn Alfred J Studiee Social Policy and Planning New York Russell Sage Foundation 1969
23 Kotler Milton Neyhborhood Government Local Foundations 2 Political~New York The BobbsMerrill Company 1969
24 NationalCommisaion on CommunityHealthSfrvic~sActionPlanniriamp for Community SetithServices~ashington p C Public Affairs-Press 19t7
25 National Commission on C~mmunity Health Services Health Adminishysration andOrMPization l the Decade Ali9$-d Washington D C Public Affairs Press 1967
26 NationalCornmiesion onqomm1Jllity Health Servicesbull Health ~ Facilities Washington D C PUblic Affairs Press 1967 bull
~ n
32 27 ODonnell Edward J and Marilyn M Sullivan ServiceDelivery
and Social Action Through the Neighborhood Center A Review of Research tt Welfare ~ Review 7 (Nov~Dec 1969) pp 112
28 Office of Economic Opportunity Second Annual Report Washington D C~ U S Government Printing Office 1966
29 Office of EConomic Opportunity and the Medical Foundation of Be~laire Ohio Eighth Report 2l ~ Committee2a Governshy
ment OperatiOll~ Va8hiiiSton D C Government Printing Office 1969
30 Pope Clyde R Samuel S Yoshioka and Merwyn R Greenlick Determinants of Medical Care Utilization nhe Use of the Telephone for ReportiDg Symptons Journal of Health and SocialBebavior12 (June 1971) pp155-162 shy
31 RenthalA Gerald nComprehensive Health Centers in Large US Cities American Journal of Public Health 61 (Feb 1971) pp 324-336 shy
32 Saward Ernest W The Relevance of Prepaid Group Practice to the Effective Delivery ofHealthServicestt The New Physician 18 (Jan 1969) pp39-44 - shy
33bull Schorr Lisbeth Bamberger and Joseph T English Background Content and Significant IssUes in Neighborhood Health
Center Programs Milbank Memorial ~ Quarterly 46 July 1968) part 1pp 289-296
34 Weiss James E and Merwyn RGreenlick UDeterminants of MedioalCareUtilization The Effects of Social Class and Distance on Contacts With the Medical Care System Medical~ 8 (Nov-Dec 1970 pp 456-462
35 Weiss James E MerwynR Greenlick and Joseph F Jones Determinants of Medical Care Utilization The Impact of Ecological Factorstt unpublished paper presented to the American Public Health Association 1970
36 Wise Harold B Montefiore Hospital Neighborhood Medical Demonstration A Case StudyMilbaDkMemorial Fund Quarterly46 (July 1968) part 1 pp297-308~
37 Yerby Alonzo S ttHealth Departments Hospital and Health Services Medica1~5 (March-April 1967) pp 70-74
38 Young M M~ Chatanooga IS Experience with Reorganization fOr Delivery of Health Services ttAmerican Journ8l of Public Health60 (Sept 1970) pp 1739-1748
f or l
II bull 11 Y d
II
IJ
34
ThepurposeOfPart II of th1aa paper1atod1scuas
elected Speclfic needs ofecltlc areas within Multnomah
County A8P01ll~oUt 1D ~ I of t1a1bullpapermiddot Ita nelgbshy
borhood health oare cater IlU8t be a facl1lty plaDlled with
aD awarenes of the neeels of the oODllUller and collllUDity
Part II of this paper nIl Show 80e of thoe speclflc
needs
he1DforutiOD tor t1li Portlon of the report
obta1nec1 troll tbroupout tbe follow1Dl threepUb11catloDS
1gr~e_tiMshylIPrIxaiidOreson JuDe 1963
2 1~_middot_sectSI8e~ected1teai c-ua 0 S 8 e first count coaputer tape Coluab a_lion AssocshylatloD of QoveraMD-8 Jlme 1971
3 Jtu1tDoab County Oreaon BDY1roDlHtlltal SurveyEarly 1971
The JIultDOIIIlb COUDty OrttIOD BDv1roDllfmtal Surley
Barly 1971 1s bull stat1stical report of the activ1tles of
theentlreMultDOIIIl2 CcNDty Health Dep~t during the
year of 1970 Die speclflc 1nd1cs elected from tb1s
study amprejMental aealtll Publlc Health N~s1D1 vlslts
FaJUly ~ Veaereal])1 ~ ~rcul081
Throush tie use of cUrts and mapa ODe CaD roup these i
speclflc ~oea to ahcnr the healthneedsof speclfic I
census trtcta aD4 then the health needs of iarer neIghshy
borhooda 1m4 o~ Uebullbull
Rf)~UP1Dl of areu was accompllshed in thefolloWinl I
JJ ~
35
he MiltDoIliahCountY oregon BDViromaental SUrvey
early 1971 isamp statistical report ot tbeaotivities ot
the entire MultDolllh COUDty Health ])epartiDent dur1nl the
year ot1970 he specitic 1Dd1C8S selected frOm this
aUy are 1Il8Dtal health public healthDurs8s visits
fUl1ly pia waereal elisease aDd tuberculosia
Tbroq11the Wle otcbart aDd mapa aDecm szoup these
specific indic to show the health Deeds ofapecitic
ccmaua tracts aDdtIum th8health neecla of larsr ~eilh-
bOrhooda and co8I13 tlbullbullbull
RegroupiDI ot areas waa accoap118hed1D the
tollOWiDl lIIIIm1er~ A bullbullcifie 1ndex 8selectcl auch as
venereal di8bullbulle or tuberculo8i~ he total number ot
cs was then deterll1ne4 for each census tract Through
the use of the maber ot cRbullbullbull tor a 11Yen cenaus tract
aDd tbe population ot thattractaltrateot1lla1ampmcper
100OOOpopUlaticm wu cleteXll1ned for each census tract
This was ~e to starl4ard1ze the population ditterence
amongOeD8U8 -tracts 1he rate of incidence toreaob
cenauatract was then llstedby rank position on a chart
In rank poition1DI any cen8Wl tracts haviDg equal
rates ot1l1c1dence are assipe4tbe iaDk posttiona
Beeauseot the abo fact tbAt cbarta w111 vary in length
neveltbAtlea eacb cbart will 1Dclu4eall census tracts
inMullnoaah Couaty Atter the census tracts bave been
listed accord1q to raalcth1s list will bediv1ded into
IJ
36 three levelsotinc14ence he three levels are
1~ The upper 14 of1DcldenCe
2 Thelower 14 ot incidence
middot3 The ILld 12 of incidence
Tlles three srouplqa are then used in compiling a map ~f
Mu1tnOmahCountyfor ach apecltictop1cbull TIle maps are
uaefuJliD tbatthey V1suallycoJib1De 1Dd1v1Clualproblem
census tracts into larger problem nellhbOrhooc1s
The 1960 statistical iDtormatloD was Used in a similar
liIaDDr to tbatexpla1Dedabove 1Dthe4evelopaent of a
chartmiddot and map 1Ihow1DI e cOllpampriSOr1 of per capita lncolle
tor ttaCh ceDsua tJact aDdmiddot combiDed census middotmiddottract areas
he 1910 aDd 1960 statlstlcal iDtOrllatl0D was combined
lna map and chart he purpose of this and chart is
to d8aonatrate the e cl1stributloa1DeachceD8U8 tract
and middot1ndlcatbull tuture ace populatlon treD4a bull
When one be middotbullbullbullbullbullHdth ne8cts ot an area and has
declded to establlsh a cl1D1c to serve that area the
physical location otthat cl1D1c IllU8t be consldered In
order to coapreb8ll81vel develop an area cl1n1c one should
conslder thepre88Dttraftlc middot~ytaa an4tranaportatlon
systems Thecl1D1cahoUld be located close enoUlh to
major arterlals to giva asy access from the total area
be_ ervecl by this cliD1c At the t1ll8they should
be tar eo away froll thesarterlals to all8Y1ate traffic
CODCell18 andpark1D8 conpstlon By traff1c concerns I
IJ
37
lIlan one lUSt consider thertarro1fne8S of streets whether
streets are oD8--C)r two-way iqres8 and egress to parking
amp0111tie eros tratflC) spedof trattJQ children 1n
ll8a traffic i1lht Vislon re8tr1ctionS etc
BwstraDsportat1onshould alao be central in this area
as maay people ~U f1Df1 1tD8Cessary to use this form of
transportatlon
~e tutqredlopHQt of bull treewa systems should be
c0J1S1dered soastolesen thecumce ofmiddot future roada
cutt1DSotltbe cl1D1c llte line
nrrph1c middotDampta
It is 1JDportaDtto kDOw the demosraphic distribution
characteristics of the oUenteltbat i8 to be served by
localized health cl1D1cs
Acl1D1c which erves8J1 area where1D the prepondershy
ance of persona arecrter 65 years of mayf1nd that these
people rely more on pUblic transportation call for more
home- services and haV4t 110ft ChroD1c and debilitating
types of disorders (b1_ blood pressure poor heariDg and
eyesight) tbaD do8 an area ot a YOUDIer population On
the other hand thL area of older residents may have little
need for family plabDlng cllni08
In order to better ~Ybullbull the 4eaoraphic population
of each CeD8U8 tract the 1970 CeD8U8 iatormation was viewed
and two specific catelOri8 considered These two cat
IJ
38
lori8S woUld be the perc_tap ot population under 19
year of ase and the percentase ot each oensuetractover
65 years of age he 1960 1Dtormatlon tor eaCh tract was
then compared witbthe 1970 intormation and a percentage
ofincreaae or4ecreamp8 tormiddot e~chtract1n each category
cOJlputecland achartma4e By the use of this chart one
18 able to View tJleap populat1odiatr1but10n of census
tract and at the _ t1lle accesa middottrencl Por example
let us choose census tract 601 W see 40-4 otthe
population is under 19 years ot and that ODly82 1s
over 65 years ot middotAtthe e tille the percentage of
youth bas ~ed ODly 1_ intbe laSt teD year whilethe
percentale over 65 year ot middotbas stayedmiddotthe same With
this in mJnc1 ODe ~ 1DfItr libat ol1D1o aerviDg this
area WOuld bellQre conq~w1th the problems of a
YOUQier populat1on and that _ would probably be true foJ
some t1aein tbefuture On the other hand CeDSU8 tract 54
has only 2 ollt population UDder 19 yel1s ot age and
this has decreased by 1 over the last ten years middotwhile at
the same time 32-377 ot the populat1on 18 over 65 years of
age A ol1D1C ___ this area should be or1eJ1ted toward
tbespecttic problema otthe ampledbull
PerCapia __ bY gsa neat
WhaD cona1der1qlooat10D1 tor health cl1n1cs one
shoUld take the 1DC01Ieot areas into consideration Areas
IJ
39
of lowiDcome would not 11kel~be 8erved more by localized
cl1D1cs tbaD would are of hilbincome It 18 likely
people haYiq a hip iDeoll8would preter to be aeenby a
chosen ~r1vatephylc1a1l tban at a local cl1D1cwhere
10Dier waits y beraceaaampryand leas personal attention
gl_
The 19701ncOII81atoWampt10n tor MultnomahC~ty was
not available at the tille thi8report W88 made The 1Dto~shy
tiOD Was taken ~adtro tbe1960 census publlcation
his woUld ~8Il thea tbat ral1I8 OD the chart ynot 1raquoe
completely accurate hi writer telthatthe areas most
affected by tb8 1I8eof the older 1Dco1DtOlaat1oDWOuld be
those tracts wh1ch baYebad a rapid 1ncreaae1n populatlon
over the past tfmyHr8 bullbullbull tracts would include tracts
nUmbered 104 9897 96 aDd 95 be perc~ita 1Dcome
referredto1il-tb1a Paper18the lIean 1DCo per person per
census tract
Attar the iDeoeper census tract was listed on a chart
a map was de 1D41catiDg those census tracts belonging to
the lower 14 ot income tor all censue tracts in Multnomah
COlDltytbose beloqins to the upper 14 ot income tor all
census tract 111 MultnolUlhCounty and those belonging to
the mid 12 ot 1I1coaetor all oeuuetracts in Multnomah
C01mty
In yiew1Dg the _p 1t caa be seen that the low income
area seautotollow aloas the at aide ot the Wl1lamette
IJ
40
R1ver the full length of Kultnomah County A second low
income area follows the south edge of the Columbia from
the northwest corner of Multnomah County easterly to 148 St
A third problem area seems to be on the east bank of the
Willamette River with the Union Pacific Railroad being
about the center of this tract The extreme loutheast
corner of Multnomah COUDty appears to be a low income area
but as this area bas bad rapid grouth in the last ten years
this could be erroneous
Mental Health
be first ~ecific indica to be selected from the
Multnomah County envirollllental survey of early 1971 and
to be considered in this paper i8 that of Mental Health
At the present for mental health purposes Multnomah
County is divided into five catchmentareas with a mental
health cl1n1cin each area These clinics are Model
Citles Delaunay ADkeny street Office Hansen Health
Building end Southeast Clinic
All lIlental health cl1n1cslcept statlstlcal information
on all patients visiting their cl1n1cs this included the
address of the patient hese addresses were then listed
upon the approprlate C8D8US tract Each census tract was
then ranked on a chart according to the nUllber of mental
health patients who reslde ln thatCeDSUS tract attending
any of the above listed ental health clinics This chart
IJ
41
wasttum d1v14ed1ato proper quartile bbullbullbull
quartile vereUs to dne10 u appropl1ate Multnoh
County _tal health ItLa middotmiddotmiddotthelipO~a1bl by lOoJcJIUE
at the UDtal health _to uteN1De which ueu have the
lars-t use otCOllDty 1alh~th faci11t1Rot
1Ilclu4ecl 111 tbia woUld tber otpeopleYia1t1Da
pr1vat patch1atriata aDd pr1_t _ntalhealtb cl1D1c8
WheDtbe M1 18Yienclmiddot Itmiddotmiddotmiddotmiddot~middotbe~_ tbat ~rtt
appears to lMt fourmiddotmiddot-al are iii _oil the nuaber ot
lIental healthcl1D1c na1t toM tbjh1sheat 1he
tour areaa woUld be tollows
1ttrea Ore to~Blo Drimiddot ~tb Burrus14e aDd tIMtmiddot Colb1a Riftr H1gbwyaeri1Dla th nortllra boundaryshy
2 bull ProII 82D4 1_~ 10 20th streetwitil the ra1lMd Mu the north ltouadary
3 ~ et et tUgl_b1bull MYel froamiddot the Clackaaa COUDty l1ae aorth to Dln8lon stret
4 beDOlvt1ttfe-t ~efllt4 COatytrca Jle1aware streetmiddot toR1C1a11oDd wlth Colubla Blvd heiDI tbAtnorth bouaclary_
It ODe coapareatbiap to th iDeobullbullmiddotp 1t can be
eamiddotthat lIOat ot the c tracts baY1Dg bllh v1i11tatlcma
middottfl public tal health cJ1rUc8 ~ 111 t13e low ~ aid
1DcOile SroupiDIOJa1y of til 25 tracta llsted as
haviDlbip aental Maltll nlltatlou are ~ the1g60 hip
iDeo arebullbullbull
17 Plpn
42
amily PlellnSDI ]Jlce Metal Health i8 an 1nd1ce of
use Theperson 111 ordertobavebe_ 1Dcluclecl 1n this
atu4ywouldhave tohaft Ue4 ataa11y plaDI cl1D1c
tacilities of soaetype It 41fter troll tile _tal health
study1nthat i t1Jicludestatist1catrollbotb public and
privateclJD1os
The iDformation tor the iak orurcbart 8Dd map of
t8ll111 plenn1 na ob1a1De4 by cOIIblnlDlthe mabel of
1rlcuv1duals bullbull_ attbe tbreellUltrampo-ti Coatyhll11y
PlalJQllIl C11ll10s 111til tbo at the Planned PareDthood
Association CliD1C8 be tbree -JIultDouh Couaty r8ldly
PlamSq Cl1D1c are Solrtbweatth Col_bla 1111- a114
HaDsell Health BWlcl1Dl CllD1cbi middot1Dtormat1oD vas then
bullbullbullesed tomiddot detellWMt l10w people troll eacb c8IUIUS
chart wastben Mele IUs oIIart jn 4iY1ded to show
the censuS tracts lIaYiDlmiddottIle h1t1iest qUart1le of incidence
of use lowest quartile of 1Qc1deao ot use Jlid 12 of
incidence of Wle an4 a map sprepared troll thts 1Dto~
mation
The C8U118 tractsbelOJISnl to the h1lhestquartile of
use appear to be 1lO~ 8catt~ on tbipwas true ot
either the _p ot aental health cl1D1c uaageor ot the map
abow1DI per capita 1I1COM Iaere40 to be three
d18t1nct areas of UIIaP beJ woul4 be
1
IJ
43
t10D of BurD81cl and the W11lallette River 4
2 S~t Portland 8Otth otmiddot the ra11shyrcaadand alona the W11lamette River
lIortbeaat Portl8D4 between MisSiss1pp1 and 24tbStreet the northbouBclary be1DgColwb1aBlvd
Pylzl1c BMltl IrpI Y11ta
Publlc Healtil nur81D1Y1s1t nclud8 an vists to
theholles of client by PubUc Health Nurbullbullbullbull his shows
visits to bull f8Jl1ly fer aDY purpos SUCh aatuberculolJ1s
het1Dl tem1tyaeatalu4 8IiOt10D8l cODd1t1ona etc
he atat18t1C~ 1fele C()4ed accord1Dg tomiddot the 1llli301fOCUS
of the Y18lt tt doe DOt 1D41cate the Dmlber of holies or
f8ll11lev181tecl or 1D41Y14ual Y1a1ted more tban oDcein
the propwl It dobullbull I1ve 80M 1D41cat1on by coaparlshy
OD ot the 8JIoUDt of aedlcal problema 1n eachcen8WI tract
Ap1nmiddot the _p abowa 8 scatter patteraof probl_
areas althoUSh there appear to be a sroup1Dl of hiSh J
l8aIeccmaus tract 1ntlut extreme southeast part of tbe
County other areu uIriaI any nura1Dl contacts are
1 bull he 801lth-oa-al CO1Dty on eaCh 814 of 82nd Av from Clackallaa County north to Dinloa
2 ear bullbullbullt 814e aroUDd Preacottand Misaisippi
Dowatom Bunul14eonboth 1de of the river
44
V_real Pis The iDfomatloil uaec1 to tabulate the Venereal
disease chart includes all the ooab1ned case otmiddotODormea
and syphilIs reported by bothmiddot publIc and prIvate physicIans
dur1nl 1970 There were 3602 caes ot IOnorrhea reported
dur1nl 1970 While ODly 17 cabullbullsot ayphilimiddot were reported
A chart was prepUed aDd att8llPt wasmiddotmiddot de tomiddot
determ1De Wh_therVttDereal 41ease was more p~vaJent in
areas othigb or lowmiddot proportIon ot youth hi waadone
bymiddotdetemlna a 1leaD prceiltacmiddotmiddotmiddottor the population ot
resld~ts UDder19 years ot (34) middotA mean ratemiddot per
100000 popUlatIon al80c1ttem1Ded tor the middotoccurreDCe
ot venereal dieae This was et at 390 oass Areas
hav1nl a population 1n which leiS than 34 were lmder 19
years ot ampIe were called low- yOuth abOve tbl percentaae
hiSh youth The aaa waatrue ot the occurrence oivenershy
eal disea_ per CeD8UStract It the rate waacomputed
as 1I0re than 390 cases per 100000 it was called hiah
venerealdiaeasei it less than thia tisure low venereal
disease It was tound that 1D Multn~ COmlty there sems
to be poSitive OOlatI0n(x21S19gt between low youth
and hipmiddot venereal diseaand hip youth and low venereal
diseasebull
RaDk ordr Iitot all c traot middottbAm made
Th1s was done byt1Ddlna the ratepr 100000 populatIon
of venereal disator all census tracts in the County bull
45
These were thenlisted from h1lhto low (sreatest to
least) in a rank order The l1sting was then divided
into Upperandlower 14 aDd listed on the MUltnomah
Countymiddot up
The areas of b1gh venereal disease se8ll18to
roup thBl~8 middotin a very tllht area ~oq both 1des
of thell18l8~ R1 w1th BurDaldeS~et being
~bout theceDter qf tbi8IZ9uping This area woUld
appear to be m ldeal spot for the denlopment of a
locallzed venereal d1sbullbullbullbull cl1D1c
UbepoundCUlO1s
In this report bull tube1C1llosls caS8S refrred
to include alltbobullbull cabullbulls ontubercUlo8is follow-up
rather middotthan just new C Accord1Ds to the Multnomah
County Health SUrvey of early 1971 this would include
all ca repOrte4 over thelaat three years The
total number of tuberculosi8 cabullbullbull usedin this study
was 666 lh1 included 128 new cabullbullbullbull
A rate per 100000 of tuberculosis for each
census tract wa- then computed and the c~us tracts
listed by rank order be b11h Qartlle mel low
quartl1 were then reoordd on a Multnomah CoUnty map
TWo genral areaa baY1Dg a hip mcldencaot tubercu~
losiare 1D41cated heyare
1 Both middotsld ot theWilla11lette River
Ll -
46
with Burns1de about thecnter
2 he extrea Northebullbullt comer of the County bull
By coap8r1ng the tuberculois an4ven8real
diseae maps ODe can 8ee that the downtown areas ot
hiSh 1nc1denceare alIIo8t 1c1eDt1cal on ach map
This WOuld 1nd1cate that 1t would be of value to
bullbulltab11sh acl1D1c 111 th1aampreatbat would provide
bothtuberCulos1s 8Dd ytmereal 418ase srvicbullbullbull
Thchart aDd 1181gt8 are wsfuln 11v1DI
1Ddicat10DS tor the type aDd placemeototlocal
health cl1n1c8 tbro1qhout tbe MultnomahCounty area
A cOllpar1on of the mapa help one to dec1dewhether
to provide a aulti-8ervice cl1D1c or spec1f1c type of
cliD1c As stated in Part I of thi paprserv1ces
shouldhaYe both treatlieDt and prfMmt10n cOmponents
As he been stated fta ne1lbborhood health care
Qenter muat be a fac111tY plazme4 with an aamesa
ot the neds of the consumer and the c01llll1m1tybull
Part II of this rport haa been an attaapt to indicate
and clarify 8011 ottheae coDlllUDity neds This has
been done through8elect10n of apc1f1c problems
The indic were then visuallyrecorded through the
use of ups and charta ODe dan asseS8 thedsreeof
1DIportance of certain concems to spec~t1c areaa by
comparinl the chart aDd maps Prom this oDeean
41 dec1de which are48 vb1chcUD1c-or indeed if
the need a clinic at all However further factors
should be considered hebullbull include
a The amount of fuDd1 available
b What 18 the percentage ot peopleineoh ceaaua tract tbat would actually us such cl1n1cIl
c Wbat 1 tbeco--1tymiddot 8 IeeliDashyreaardtDI particular cl1D1c8 Would this dcrebullbullbullmiddot the ettctiveness ot thse cl1n1ca
IJ
li
D_OlraphicPopulatLon Challie 1960 to 1970 48
Cen8U8 1 of Pop 1 Cbaqemiddot 1 Change1 ofPopTract Under 19 Yr8 Over 65 Yrs1960-70 1960-70
middot1Q701Q70
1 319 -12 171 -H) 1
2722 215-27 +68 301 366 -22 127 +35 302 371 +19 111 -04
311middot401 144-41 +29 402 321 13~7-39 +24 501 356 124-08 -02 5~O2 351 133-23 +12
405601 82-10 -02 394602 103-01 -06
701 275 149-76 +56 702 361 +01 121 -07
+10middot801 326 140-22 802 321 middot127
(
-29 -03 9~01 342 124 -H) 6-18 902 294 128 -H) 3-24
10middotmiddot -14312 140 -17 1101 182 +25 -23197
2411102 186-59 +29 1201 226 169-17 -41
31middot01202 +11 182 -05 295 -H) 81301 208 -H) 4
1302 331 +08 197 +04
14 323 +15 middot185 -08 middotmiddot15 329 +16 16~5 -13
-28middot 1601 332 131 +12
1602 356 98 +24middot-39 middot3101701 161-33 +21
1702 370 -15 85 +02 +19 1801 264 151middot-50
185middot1802 256 +47-58
IJ ~
D_raphlc Population Change 1960 to 1970middot 49 (Contd)
4io
Census Tract
of pop Uncter 19 Yra
1Q1n
1Cha1l8e 1960-70
of PopOver 65 Yra
lQO Change
1960-70
19 389 +29 141 -24 20 223 -13 206 +18
21 227 +08 194 -36 2201 356 -27 112 +05
2202 290 -18 ll~9 -29 2301 356 -03 154 +24 2302 260 -37 245 +97
2401 410 +6~1 123 -31 2402 163 -80 320 +99 2501 381 +13 140 -01 25()2 237 31 lil +02 26 343 +25 186 +149 2701 370 +29 1S5 -01 2702 249 -44 304 +98 2801 337 +19 187 +09 2802 306 -10 156 +31 2901 304 -38 142 +24 2902 i 307 -32 146 t3~9
30 29~0 -48 16~2 +51
31 355 +30 160 +01 32 370 +48 148 -13 3301 395 +45 130 -20 3302 368 +06 138 -02 3401 386 +16 117 000
3402
400 +32 92 -26 3501 304 -07 115 +35
3502 344 000 140 -13
3601
36~02 357 -04 132 +32
3603 30~1 42 149 -67 3701 342 +28 152 +19
1
IJ
Jianolraphic Population Chan 1960 to 1970 50 (Contd)
Census Tract
of Pop Under 19 Yrs
JJl7J
middotChanae 1960-70
middotofmiddotpop Over 65 Yrs
1c~7n
Change 196070
3702 409 +39 122 -11 3801 308 -11 151 +29 3802 275 -35 180 +46 3803 282 -32 192 +54 3901 376 ~13 100 +17 3902 296 -03 177 +29 4001 438 -11 84 +13 4002 353 -21 115 +20
4101 397 11 9middot0 +11 4102 346 -19 120 +03 42 331 +19 11 bull 3 -16 43 347 -72 105 +31 44 113 +84 183 +154 4S 33~9 +07 110 -06 4601 2501 22 193 +38 4602 332 +59 126 -29 47middot 161middot 000 211 +01 48 103 -26 302 +59 49 138 +1 bull 3 252 +09 50 141 -26 204 -12 51 12 -39 257 +07 52 47 -61 351 +48 53 89 +49 314 -30 54 25 l1li15 327 -17 55 131 -17 115 -121 56 198 +93 227 -47 57 71 102 189 -88 58 240 ~middot41 16~1 +55 59 322 +25 142 +06middot 6001 264 95 132 +50
6002 328 -31middot 89 +07
JJ
Demographic Population Change 1960 to 1970 51 (Contd)
Census 1 ofPop lChange of Pop bull ChangeTract Under 19 Yrbullbull 1960-70 Over 65 Yrs 1960-70
1970 1970
61 355 -58 85 +39
62 328 39 110 +18
63 414 04 73 10
64 382 -22 72 +04
6501 383 02 67 -20
6502 329 -56 96 +09
6601 391 +13 88 -03
6602 319 -59 97 +06
6701 327 71 145 +72
6702 331 ~67 83 +1-0
6801 365 -66 49 +01
6802 388 4bull3 54 +06
69 354 -41 80 +23
70 400 -23 68 -06
71 359 -48 72 +05
72 255 -88 82 +11
73 346 -39 91 +25
74 313middot -63 105 +24
75 329 -42 129 +37
76 336 -52 85 +21
77 370 -10 69 +05
78 309 -10 120 +21
79 325 -56 87 +10
8001 358 -81 57 +12
8002 391 ~81 76 +12
81 315 -76 108 +21
8201 403 -23 64 +08
8202 392 23 65 +08
83 357 -34 120 +31
84 402 -18 73 +16
85 413 -06 76 -09
r
Demographic Population Change 1960 to 1970 52 (Contd)
Census Tract
t of Pop Uncler 19 Yrs
1970
Change 1960-70
1 of Pop OVer 65 Yrs
1970
ex Change 196070
86
87
88
89
90
91 9201
9202
93
94
95
9601
9602
9701
9702
9801
9802
99
100 I
101
102
103
10401
10402
lOS
368
351
379
391
391
413
379
433
372
429
414
432
419
439
~32
377
457 420
378 41middot7
345
360 417
417
412
-04
-02
-35
-26
-28
-11
-64
-20
-S9
-39
-32
-21
-34
-40
-47
-lO~7middot
-27middot +04
+56
+07
-34 01
+04
+04
+10
103
128
97
11il3 99
69
79
42
77
46
34 38
44
40
54
111
51middot
81
133
59
74
140
63
87
76
-08
-06
+04
+08
+17
-05
+3S -02
+1~4
+19
+33
-14
-08
+12
+26
+71
+11
-16 -34
-20
-19 +37
-49
-2S +15
NOte The The
Taken frOi
averageullder averageabove
middotUSCensus ---shy -
19 years == 6S years ==
figures 197
32r 13(14
p a~d 1960
--
Rank
1
2
3
4
5
6
7
8
9
10
11 12 -_
13
14
15
16
17
18
Tract
69 46
60
58
- 68
61
302
2501
67
63
19
62
26
94
3603
3902
64
30 -----~-
Rank
19
20
21 -
22
23-shy
24
25
26
27
28
29
30
31
32
33
34
35
36 -
Ranking of Per Capita Income by Census Tract
Tract
65
2701
- 15
1601
701
66
93
82
2903
3602
30
2502
80
2401
81
- 70
91 shy
4001
High
Rank Tractshy
-32shy37
38 97
120239
7840
41 ~ _2_1__ 42 31
43 2501
44 18
45 98
46 37
47 3803
1702
49
48
1602 92 2702
I
50 89
51 901
52 801
Ra_
53
54
55
56
57
58
59
60
61
62
63
64
6S
66
67
68
TractTract Ra~
74692
170196 70 I
401 71 90
72 1037J
79 70273
3802 74 601
24024102 75
85 76 101
77 9023901
7699 78 100 4101 79
3601 I
380180
458140~ t---- _ - - shy83 82 42
888384
59843501
4777 8~
502
Low
802 86
Rank Tract
87 shy
--88
89
90
91
92
93
94
- 95
96
97
middot98
99
100
101
102
103
104
1201
14
49
72
73
43
87
3502
105
1
52
86
71
1
501
10
3301
104 tf
Rank
105
106
107
108
109
110
III
112
113
114
115
116
117
118
119
120
121
Ranking of Per Capitalucoae by Census Tract
(Contd)
Tract Rank
4001 122--shy602
13
1102 2302
3302
55
3401
48
21
56
50
3402
lL01
2202
2301
53
2201
-shy
Tract Rank Tract Rank T~aet Rank
57 I-----
Imiddote
bull
Tract
- Low -k Note Information taken from 1960 U SCensus
Rank Tract
I ~
Ie
Imiddot
~
----
----
--
--
Rank
1
2
3
4
5
6
1
8
9
10
11
i-
-Tract
391 922 921
972 971
100
132 131 121
962 961
822 821 401
982 981
20 111
47 10 1
412
High
Total Number of Henta1 Health Visits
Ranked by Census Tract High to Low
TractTract RankTractRank Rnk
12 182 22 78 29 87 76 381 73181 ~------- 1913 371 8538230162372 271 2616-121 8272 2
14 80~2 31 94 7923 84801 59 15251362 4232 15 52 _ 32 103 8924 651 17240216 652
_ 91 351 33 341 23117 83 122 25 25 48 1123921418 34 shy61 86 661
19 662 6493 81 26 91 8153 49 50 55 41383 71 27 51 3120 90 672241 35shy 104167162 461
I 411 46211121 28 88342 I
2502 36 69 54 5251 50 272
-Ra
37
38
39
_ 40
_ 41 Ishy
I
42 I
-I 43 44
45
shy
Tract
~ --- shy 95 56
45 292 242
102 62 352 291y
92
101 281
99 72 63 601 60~ 42 2201
77 74 61 57
363 232
70
32 31
11 44 282 2202
Low l
- Tract
46 682 681 I 331 30
r~$ 47 1042 332
48 102_41_
11
~
Visits to Family Planning Clinics Ranked by Census Tract High to Low
Rank Tract Rank Tract Rankmiddot Tract Rank Tract Rank Tract Rank Tract
1
2
3
4
5
6
7
8
9
10
11
12
13middot
14
15
16
17
361
56
401
341
48
59 121
20
55
342
10
31
58
93 21
241 132
331
53
461 462
18
19
20-shy21
22
23
24
25
26
27middot
28
29
30
31
32
33
391
32
middot47 I-i-_-shy _ -
231 111
332
972 1
372 371
52
89
32
92
82
100 31
182
30 242
402
34
35
36
37
38
39
40
41
42
43
44
45
42
1714 i 661 221
78 362 2
90 602 601 352
63 251
105 921
971 351
73 42 292 232
411 51
662
81 45 52
46
47
48
49shy
50
51
52
53
54
55
56
961
801
49 81 72 71
19
9~1
172
68 2 57 162 14 112
91 75 681
381 42
3~3
83 161
57 f
58
59
60
61shy
62 Imiddot
63
Imiddot 64
65
66
64 62 36~3 252
74 652 SO 392 291
651 6bull 2
79 271
r-- ---- shy981 222
672 671
821 272
94 87
281
382
67
68
69
70
71
72
73
74
75
76
77
78
981 26 12~2
IS 61
85 82~2 69
61 43
101 86 84 282
76
131
51 72
1041 962 88 70
99 922 77
103
95 802 181
i
~
Low High
RankRank Tract
5479
4480
81 1042 ~) middot102
71 - - + ~ - ~
Visits to Family Planning Clinics
(Contd)
Tract Rank
I
Tract llaDk l
RankTract Tract Rank Tract
~
I
~
J1 ~
Low
Total Number of public Health Nursing Visits
Ranked by Census TractsHigh to Low
TractTract RankTractRank RankRank TractTractRankTractRank
25249 71 79 17249 8033 6586 99189711 84 2915072 34 661 76 66 811519512
402 5035 51 161 2518220 122 1713423 352 55801 7120 6752 2 149814 41236 83 2662 38 94 6821 53 2924015 362 37 32 42 75 69 281 84 63
546 8822 54 222 85 3925431 70383417 3818223 6439 4386652 718 21 55 103332 8924 232 87 19 271729219619 24156 16211140 382 628825 10523110 112 73411 10141-- ----shy 89 363 4457 8126 16111 221 74 9142 90 46158331 53 671279012 46243 48 59 351 3837528 1083 9313 91 5844 59 -_242 76 1----- shy60 272 72 74104114 60145 42 9287 7729 92 6151 8215 57371 934630 91 307762 12113116 282 619447 41391 9531 78100 63 7378 ~95 681 6945 32 5632 798517 6448 47 52 181
High ~ Low
Rank Tract Rank
96 31 132 70
97 102
98 182 372middot 602 651 662
- -shy
~72 682 802
822 922 962 972 982
1042 ----shy
Low
Total Number of Public Health Nursing Visits
(Contd)
Rank Rank Rank TractTract Tract
I
I lt
I
Tract Rank Tract
[
~~~-
I
~
IJilfimiddot ~
j
Ranking of VD Caea According to Census Tracts 61 By High and LOll Youth Itatio
A media~ of 34 5 was determined Any tract having greater
than 34 5~ of popu1tionunde~ 19 years of age -High~
Any tract having l8S than 345 of population under 19
years == Low
Any tract having rate less than 390 =Low
Any tract having rate more than 390 == HLgl4
YOUTH
LOW HIGH
L
0
12 402 1801 1802 343 2801 2802 29023603
54 6001 600262 66~02 72 74 75 76
78 79 81 t02 65 1202
W
(25)
VD
H
I
G
H
401 701 801802 901 902 10 1101 241 1201 1301 132 14 15 1601 1701 20~ 21 2202 2j02 2402 2502 2702 2901 303501 3502 34023801 3802 383 3902 42 44 45 4601 4602 47 48 49 SO 51~2 53 55 56 57 58 S9 6701 6702 73 95
3~02 7021702 19 25~01 2701 4102 4101 63 64601 ~601 6801 680270 7l 77 8001 80~02 8201 8202 83 84
85 86 87 88~ 90 91 9202 920193 94 9601 9602~ 9701 9102 9801 9802 99 100 101 103 10402 105 6501 10401
(47)
301 501 502 601 1602 2401 2301 2201 31 32 3301 3302 3401 3402~ 3602 3702 3901 400140 02 43 61 69 B(
(53) (23)
~ ~gt
Ranking of VD by Rate Per 100000 By Census Tract
~
Rank Tract Rank Tract Rank Tract Rank Tract llank Tract Rank Tract Rank Tract
1 2202 21 S6 40 902 58 1602 74 75
90-shy 64 107 26 --~-
2 3402 22 45 41 10 59 902 75 78 91 54 108 61
3 2301 23 3502 42 2502 60 602 76 6802 92 402 109 87
4 3302 24 49 43 1102 61 501 17 2 93 94 110 90
5 50 25 52 44 6702 62 14 78 8202 94 97 02 III 76
6 2201 26 20 6701 63 4002 8201 2501
9701 41~02 112 91
7 44 27 48 45 401 64 3802 2902 95 63 113 62
8 3301 28 1701 46 502 65 30 79 83 74 96 9602 114 71
9 55 29 47 47 42 66 3803 80 2801 96Q1 115 85 10
11
12
13
14
15
16
17
18
3401
53
2302
2401
57
21
2402
1101
51
30-shy31
32
33
34
35
36
37
3701 - -~ 1201
3702
89
43
132 131
3602
4001
48
49
50
51
52
53
54
55
58
1601
601
4602 4601
69
701
31
3901
67
68
69
70
71
72
2901
801
39021~ 802
6502 6501 122
702
41~01
81
82
83
84
85
86
87
88
19
1
1702
2802
79
93
100 6801 6602
81
97
98
99
100
101
102
103
104
9201 9202
9802 9801
77
302
79
86
72
84
116
117
118
119
120
121
3603
8002 8001
101
99
95
10401
105 10402 103 102
19
20
59
32
38
39
2702
3501
56
57
301
3801
73 1802 1801
89 6002 6001
105
106
2701
88
High Low
-- -----
Rank OrdermiddotTuberclosis Cases by Rate Per 100000 Ranked by Census Tract High to Low
Tract TractRankTractRank Rank TractRaukTractRankTractRank
801
79 9601501411 52 6835340120511 I 960269 903603532036 $-~~F130221542 4366 311301 70 68~013802 _ I- _ 4001_37213 3921201 6802802 H71523822024 22 54 193302 3802 80 8958 I37139535 70155 9801 I60123 72 6702 98023914011016 6701250124 10 56
81 94 401r 7 154152 73 7057 2625 122 92028
90242 162312301 92~158 86 7172434526509 82 79160159 74 100 87412240227220110 6502836960 75 30 8317244 6501782801285711 61 901 42765645 84 66021459294912 9701 660146 171 302 9702 47
6235023033113 85 822821182 917755 16335013110214 841814832 78 103 938564 324815 86 1057940149272 38036523216 10401 87 2902241 725Q 10402360266340217middot IF88 88 9937233 282 51 218 101 01102 46016234
I)167 2901460219 47
High ~ Low ~
- -
TractRank
9S89
6490
8191 8001 8002
63 61 60middot01 6002 44 2701
92
J
2502 402 --- ----shy
I
Rank
Rank Order Tuberculosis Cases by Rate per 100000
(Coutd)
Tract Rank Tract ~nk
I
Tract Ballk Tract Rank
Imiddot
Tract
Imiddot
1~
t 1I i Pi i l I
o
1 -1shyL I
I J
8 40 icO ~ I -lt 0
-t (1) I
i I
r o E
II
a
I
r--i
shy
I
~
I (
Jgt
(011 fi(
Ggt
I II ~j
()
(f 0
~ ()
I
11
f9
r
II 99
o ~
Ggt r
~ __-J~ I t I ~ I
r--J l I
~ _ __ J
) 1
fTl
1gt
r I
()
r
()
lt en -i en
()
I1l
(J)
(J)
-i
P ()
19
r o ~
r G1 I
I
c
~
o I 89
--- -I-shy
r-r I
1- 0 _~ _ _--J E
G1 I I I
i i
I 1-1-1 ~ _J ~2 ~ II
II
()
1 I I I 1
id i bullbull
~
A n 69
r 1shy
- 0 Gl
l--~ ~ I
~ II
II )
I () isect i
en l i
(J)
-t
0
IA Ol
20
There appears to be two aspects of efficiency which are
discussed by writers on the su~3ect of the comprehensive
neighborhood health care centef one of these is the
need to organize) services to make the most efficient and
economical use of scarce medical care resources The
other closelyrelat8d in realIty is the need to help
the public use services in the most efficient manner
The comprehensive neighborhood health center concept
1s lhherentlymiddot efficient in that preventive curative and
rehabilitative health ~are programs are coordinated under
one roof with integrated a~stration Furthermore
theempbasLson prevention health education and early
disease detectionis eftic1ent troJll~estandpoint of
the health care system as well as beneficial to the patient
(18 p760) HQwever ~ue tothe scarcity of health care
personnel thecoiDprehensive neighborhood health center
mustbe an arena tor eXperimentation with new staffing
patterns~ The Kaiser program is indicative of the way
in which health care systems must begin to operate in
that appropr1ate ancillary personnel are used Wherever
possible to perform functions that do not need to be
carried out by the physician As Saward (32 p42)
states
1hroughou10ur organ1zat1on~ there are many of the customary experiments be1ngmade-shyJse of speciallr trained nurses for well-baby care under the SUpervision of the pedi9trlcianexperiments with routine prenatal care by
w ~
21
middotSPC1a1l~t~JlUrbullbull per8ema_1 bullJmdlJleu y our fuDotlou are auoh that DOtb1Da 18 dorutbYtbe phY8iCianstbat doe DOt vet to be done by the
phys1c111U1fhe other aldlle4 person- Del-nurse middotreC~0D18t the appo1ntshymeDt center or clerical praormelshyaremiddot there to free h1amiddotto use his spec1al sk111
Awell lmoWn treDd1D the area of eaaiDI health
c8re JII8DPOY8rShortagjs bas middotbe thetrend toward tra1nshy
1DB poverty area rea1deats as DOD~pro~eaionalmiddoth8lth
aide and nepborboocl health workeramiddot (28 p63) This
bas the effectofmiddotmiddot1J)creaa1q II8DPOWrand 8180 can help
bridle the cuJ~ cap betweenprondera and colllUmers
of aen1C8s This attarD at least tlleoretically
createa a situation 1D WIa1ch providers andcoD8Ullers can
be educated to UDderatad OD88DOtber and interactJlore
ettectlvely~ HoWever amiddotpltt8ll has beeD themiddot tel14ency in
801D8 oamp8e8 tomiddot us aidesmiddot ssale8lllcw t~r the center
alJDOatexclwdY811rathertbaD ua1Dltheal to protide the
health care for wh1ch ~ were trained (29 pp3B-39)
1bat ismiddotmiddot vh1~e the a14e Yalue in ~~m1catiDI with
low 1nCOlMt patieata haa beeR recoSD1zed and stressed
their role ashealtb carepersoDDelhil been slighted 1n )
any 1Dstancea
Anotber step 1d11Ob bullbull been taken to provide 8rY1ces
more efficiently eUeot1ftlybas beenmiddot theorgan1zation
of per8ODDeliDto IIllt141sc1pl1Dary teamaaaa means ot
proYid1DgmiddotCOQrd1DatedserY1ce SUch te8lll8 sen_rally
~
hf
~
22
include PhYsiciaQs nursbullbullbullbull soc1al workers and outreach
workers Conceptually th8y fmlct10n to me~ the intershy
relate lled1cal and social needs ot the families sened
Hor there are a number ot barriers to the etfectve
tlmctiOD1nlof lIuchte8ll8 SODieot these are heavy caseshy
loads the inordiDate amount ot tille consumed by multlshy
prOblem tamtliethel1m1ted tra1n1 ngmiddotmiddotand laCk of tnterest
on tile part ot aoae tebers in examinJng aspects of
problems out14e~lr oWn areaaotcolIPetencemiddot and
~ourdcation prc)blell8 between proteasioDala and nonshy
prot81~s (10ppa-10) middotrurtbemOre as De Diaz
(14 middotp6)1nd1cate tbel8 maybe a teDdency tor vertical
dp8rtmental lines of auperv1810nto become paramount
over the team coDamloation syst lead1ngto conflIcts
in determ1niDI the ro1ea ot solie team bers particularly
the DOD-prote81011alaInauch exper1l1enta Witb new
~t1Dlpatterna it 1s bullbullaentialtbat line of authority
roles aDd NsP0D81bll1tlea be made explicit and that there
beJDechaD 8IUI tor relUlar evaluat1onotfunctlorUng
Another way inwb1ch health care sernee delivery can
be made more ett1cl8Dt is to proVide servicea dur1DC the
hours whentbey aremiddot -ostnee4ed As reQo_ded by Yarby
(37p1) serY1ce can bemadelIOre accesslble by making
themava1lable 24 hours a day seven days a week If
rg8l1Cy service are aft11ab1e aroua4-tbe-cloek at ~
nil1iborhood health center the continuity ot tbepat1ent ts
23
careiamaiDtalDedand meatry point into the
cOIIPre~i health care 8 be made available
tothe patient who aoZMllyU8ea ozilymiddot emergency care in
tille of med1cal criais More 8isDificantly ava11ab1-
lity of a tull rase of bullbullrv1c8 tor seVeral hours 11the
eVerlna aI1Cl On ~ prevent the los ot earn1JiSs
involved if th patierat 1IU8tt8cet1me oftfroawork dur1q
the d8y for aed1Cal oare bull his can be an eSpecially
importantc0J1814eration tor lo1aCOlleDUUg1nally qloYEtd
patient aa4caJla18o PIOJIOtet1)e 0Da01Dl use othealth
servicebullbull
exper1eDO ot tbeKa1er prosraa in tb1s~reprdAs
Greenl1clt(19 p10) states wA lllNt 8ip1flcant
proportion ot the abulatory care 8n1cp~Y1dd tor ~
total popUlatiC)U ~ ~ after clWc hours and this
Deed i8 apParenUyaoN prODGUDced tor aJl8d1cally
iDCust population On the other hand the bulk ot all
aabulatory med1cal cu 88l91ce are performed dur1nS
regular cl1D1c hour eVen when services are available 24
hours a dayJ day bull week W
It has ~ the experi8D~eof a ftIDber ot ne1g1lboXshy
hooct hea1tbcentere _t a_jor obstacle to efficient
proViSion ot anicbullbullhas beentbe teD4eDcy of medically
1ncl1pnt patieats to utilize the center oa a walk-in
baais tor epi8od1ccr181or1entect bullbullrv1cea rather than
4)i
h~ ~~f ~~ L
24
to make appoJlltaeata tor ODIo1qprevmt1ve treataent
and rehebl11tat1Ye care ad ampl1O to bave a blah failure
to Show rat_for tbe appo1DtaeDts that they dO make
Atone center 628 of appo1Dtments made were kept
while 3Oottbepati_ta een were ~1n patients
AlthoUP fewer patiets were actually 88811 by the cater
1D middottb1s 1Datance thaathe -bervholuidmadeappointshy
mta the walk-iD patlat required an iDord1nate amount
ot staff t1ae tor aCreeDiaaacl ~trral to pplOprlate
~ttor caregt (9 pgg) Arraquotbr1llpl1catjo~ of the
plOVidedto valk-iD patient by other thaD their
(19 p12)rurtbermore
when patients uti11ze Wlk-1Il er181 centered care
athelr ODlf tona ot ootact with the _d1~ care
ay_ta fUilycentered care the treata_t of tUl11y
bers
a a UD1t 11
dlarupted
hewalk-1Dphenoaaencm appear to barelated to
diUerence between soclal clase in the style of Dlaking
contactJt1th the a11oal C~ay8t As Greenlick f ~
(19 p11)1Dd1oate8 thepheDOaenOn ot INater usage of shy
walk-in ervice by aed10ally middot1Jid11ent patient thaD by
others baa otte been attr1buted to a stoical att1tude
tQward 1llDe8 em the~ ot poor people leacl1D8 to a
~
25
greaterdelay1n tbe k i Dlofa8d1cal care These
patients wppoedlyeelcmiddotcareODlymiddotwIleD tbeirmiddotillDess
becOlles1Dtolerable resultiDSin middotthMr appeariDS withshy
outnot1ce1o rece1ve oareHlwever Greenlicks
r8aearcbbaa cut doubt on the existence ot tb1delay
111 report1Dg middot8J1IPtoJumiddotOfDeW 11laessand seek1ng care
Be bas tcrQDd 1bat s1ll11ar peze_tases of dioally
1nd1sent 8DClJ1on-aed1cally 1Dd1PD~ pat1enta seek care
on the aue daytbat aptou tirstaPPear
1fb11e GrHDllclc 1nd1cat tbat the reasonator the
greatertendeDCY of low 1Do~e pat18Ilta to 1$8 walk-in I
serY1ces are notlcDo1rAmiddotmiddot tbe7 _ be rel~tedto a tendency
ot lower aocio-ecaaaoclaa patieota to preter face-toshy ~
face contacts with II841cal persoDl181posslbly because
such contacts areft coatortiDS an4reasauriDS to
patients who are hJpotbeafzed to bave a dependent attltude
toward IIed1Cal care perS0Jm81 (30 p161)
It a8 itmiddot baa pnerally beenhld the appointment
s1stemts the most efficient Ileana of dellveriDS
comprehenSive oODtllluiDlh-lth care (9~100)1t is
necessary that educaUoraalmiddotbulltfort be taken to proaote the
use ot middotappo1ntaents8DClmiddot tQrec1ucethe fa111re to appe~
ratB4uOatioaalwhlQb baft~utl11zedhave been
IJ
26
1Dten1ews with walk-in patients home Vi8its and group 4i
meetiDp1D8D attemptto1Dierpret1o the patients
the value of rtitgular ppo1ntmentamp andot con~in~
c~1ve care rather than epiI041c care (9 p1OO)
h1s 1safuD~tioD torwhtch nOl~prot81QDal colDlllUD1ty
YOrkersllaY bebe~r8U11ed tban other statf H()wever
euch aD ~ucat1oaal propul __~ ~e related to the senUiDe
capacity otth health oenter to provide comprehensivebull gt
ervice8 to1tpat1_t~odoD aD app01ntment bas18 It
1amp pos8ibleo~rw1 tor educa110Dal ttorts to result
LD a~8JImCl tor ltPP01ntaen~8 at a ratewb1ohi8beyond
the capacity ot thee_tar to t without uareaaoDably
1_ wa1t1Dlprio4a QOBt1nuad use Ot the center on a
wallt-in bU1 _1tbeoosiItpos81ble to et an appoint-
met anc11nCreued pit1entcoJaplampia1a bull Therew111 of
course always be a need and demand tor acute ep1so~c
Care -ci the health centerDlWlt be planned with the capashy
billty ot bullbullbullt1D8 tb1aneed wh1~ cont1Du1nI to stress
aDd educate the patient to utillze oDlOinI comprehensive
faa11y middotc~te~d Cflre (9p 100l
att g4 CODClva1opa
In order to bea4equate any coJlltemporary health care SY8tem muat bullbulletcerta1D interrelated criteria he
IJ
27
minimum criteria areaccessability of services to those
who need them compr8heX1siveness and appropriatness of
services and efficIency 1nthft utilizat~on of SCarce
health care personnel and resources The scareity of
pex-sonnel andtbe need for h1gh quality ongoinghealth
care services
aJIlong the
populationdemanci the most effishy
cientprovision of services
Services must be made accessible to the population
They mustmiddotbe geosraPh1cally accessible to remove the PhysicalmiddotbaTiers betWeen peopleandthem$d1calcare
system They mUst otter their services dur1ngthe
hours when people can make the moat use ofthemA~ it
makes little sense to concentrate services geographically
where they will not be uSed to their fUllest extent it
also is wasteful to provide serv1cesonlydur1righours when
many people are employed his not only presents a hard
ship middotto the consUmer lnrt wastes resources if for instance
the unavailability of preventive services during the hours
when people Can use them causes a need for treatment
services later on
Health carbull sEtrvices must be comprehensive including
prevention treatmcmtand re)abimiddot11tation Ambulatory I
healtbcare facilities wh1cQ are orienteciexclusively
toward either prevept1on or trea1mentare no longer accepshy
table for they are lneft1c1entln their use of resources
and in their prov1s1on of health care to the patient
w ~~
28
If prevent10n1s notmiddot stressed treatment serv1ces that
could have beenavoidedY1l~ be required If prevention
1s the sole focus of the health care facility sick
patients who present themselves must be referred elseshy
where for treatment andsllch referx-als may be taken as
reject1onsor not followed through with until illness
becomes unbearable
The instltutlontbat meets these requirements Is
the comprehensive neighborhood health center It 1s a
local decentralized outpatient facilityprOVld1ng a
fUll range of ambulatoJY health care services It has
a linkage to ahospitalbackUp facilityforlnpatient
treatment and hiihlY apclalized outpatient care
The neighborhood health center must be a fac11ity
planned with an awareness of the needs of the conSUtller
and coDitnUn1ty It must have the r~Ul0urces to provide the
services people need mere they can use them and when
they can use them It must uti11ze the part1cipation of
the community to develop this awareness Not only must
the cen~er beset up to be Amctional for the consumers
but efforts must bemadeaga1n with commun1ty partici shy
pation to help the consumers utilize medical care
services effectively The center muetmake efforts to
educate the community about the valueot regUlar health
care of preventive servicesand of the use of planned
IJ
29
medical appointments ratherthanorisis centered walk-
incare Therealit1es of the existing health care
system have not taught the patient particularly the low
income patienthow to use services effectively
The helthcenterilUst also bea laboratory for
experiments in easing the health caJepersonnel shortage
and c60rd1Datingcare~ A major difficultY iri-exper1shy
menting with neW rolesis freeing staff of old preconshy
ceptions
CoDlprehensiva neighborhood health dare centers have
been developed under a variety ot alisplces including
medicalsociet1es hoSP1talsmiddot(36p299 group pr~ct1ces
(29 p6- 12 117) health departments (13 p1027) and
ne1gbbothoodassoc1ations(14) The literature indicates
somevalues nthe management ot the health center by plusmnts
hospital backup faCility Whatever the auspices many
adm1nistrative fuDctions such as program coordination
standard pr9tectionand evaluation call for considerable
c~tralization of adm1nistration city-wide or coU)tyshy
wide At the same time other aspects hours of servlce
for examPle~ cuI f~radm1nistrative fUnctions made atmiddot
more local levels Each neighborhood center must be
free to adapt its functioning to itscominunity thi-ough
the mechanism otcODlllUl11~ participation inmiddot policy making
Obviouslythe prerogatives and responsibilities of each level must be negotiated and made explic1t
t4~
JJ
BIBLIOGRAPHY 30
1 American Rehabilitation Foundation ~ealth Services Research Center The Health Maintenance Strategy mimeo 1971
2 Anderson Nancy N Comprehensive Health Planning in the States A Study and Critical Analysis Institute for Interdisciplinary Studies American Rehab ilitation Foundation 1958
3 Andrus Len Hughes Comprehensive Health Planning Through Community Demonstration Health Projects mimeo1967
4 Barry Mildred CandCecil G Sheps A New Model for Community Health Planning unpublished paper presented to the American
Public Health Aseociation1967
5 Blum HenrikL Fred Wahl Genelle M Lemon Robert Jorulin and Glen W Kent The Multipurpose Worker and the Neighborhood Multiservice Center InitialImplications and EJeperiences of the Rodeo CommunityService CenterAmerican Journal of Public Health58 (Mar 168) pp 458-468 shy
6 Blum MichaelD and Soloman L Levy A Design for Service Delivery that Reinforces Constructive Tension Between a Health Center and Its (sic) ConSUDlers and Supports Community Power unpUblished paper presented to the American Public Health Asaociatiltn 1968
7 Brielaud Donald Comm~ity Advisory Boards and Maximum Feasible Participation American Journal of Public Health 61 (Feb 1971) pp 292-296 shy
8 Burns Eveline M Health Insurance Not If or When But What Kind Madison Wisco~sin University of WisconsinScllool of Soci~l Work 1971
9 Campbell John Working ~elationships Between Providers and Conshysumers in a Neighborhood Health CenterU American Journal2 Public Health 61 (Jan 1971) pp 97-103
10 Caxr Willene Neighborhood Health Centers Funded by the Office of Economic Opportunity mimeo 1970~
11 Colombo Theodore J Ernest W Sawardand Merwyn R Greenlick The Integration of an OEO Health Program into a Prepaid Comrehensive Group Practice Plan American Journal of Public Health 59 (April 1969) pp 641-650~ -
12 Comprehensive Neighborhood Health Services Projectof Kaiser FoundatioIl Hospital~ Prcgtgram YearE grant renewal proposal mimeo~1971 bull
13 CowenDavidL~ Denvers Neighborhood Health Program Public Health Reports 84 (Dec 1969) pp 1027-1031
IJ
14 De Diaz Sharon Daniel Beyond Rhetoric The NENA Health31 Center After One Year unpublished paper pres~rited to the American Public Health Association 1970
15middot Gerrie NorrrianF and RichardH~ Ferraro Organizing a Program for Dental Care in a Neighborhood Health Center Public Health Reports 8 (Aug 1968) pp 419-428
16 Gordon JeoffreyB~ The Politics of Community Medicine Projects A Conflict Analysis Medical Care 7 (Nov -Dec 1969) pp 419-428 shy
17 Greely David The Neighborhood Health Center Program and Its Implication(3 for Medical Care H~alth Forum of the Welfare Council of Metropolitan Chicago (mimeo) 1967
18 Greenlick Merwyn R Newgtimensions in Health Care American JOurnal of Pharmacentical Education 34 (Dec 1970) pp 754-4
19 GreenlickMerwyn R Donald K Freeborn TheodoreJbull Colombo Jeffrey Abull Pruesin and Erne$t W saw~d Comparing the
Use of Medical Care Services by a Medically Indigent and a General MemberShip Population in a Comprehensive Prepaid Group Practice Prosram II unpublished paper presented to the AmericanPublic Aesociation1970
20 H~tadoArJiloldVMerllYll RGreenlick and TheodoreJ Colombo Determinants of Medical Care Utilization Failure to Keep Appointments unpublished paper presented to the American Public Health Association 1971
21 Johnson Richard E and Merwyn R Greenlick Comprehensive Medical Care A Problem and Cballengeto Pharmacy ff AJilericanJournal of PbarmacenticalEducation 33 (Aug 1969) pp 361-367 -
22 Kahn Alfred J Studiee Social Policy and Planning New York Russell Sage Foundation 1969
23 Kotler Milton Neyhborhood Government Local Foundations 2 Political~New York The BobbsMerrill Company 1969
24 NationalCommisaion on CommunityHealthSfrvic~sActionPlanniriamp for Community SetithServices~ashington p C Public Affairs-Press 19t7
25 National Commission on C~mmunity Health Services Health Adminishysration andOrMPization l the Decade Ali9$-d Washington D C Public Affairs Press 1967
26 NationalCornmiesion onqomm1Jllity Health Servicesbull Health ~ Facilities Washington D C PUblic Affairs Press 1967 bull
~ n
32 27 ODonnell Edward J and Marilyn M Sullivan ServiceDelivery
and Social Action Through the Neighborhood Center A Review of Research tt Welfare ~ Review 7 (Nov~Dec 1969) pp 112
28 Office of Economic Opportunity Second Annual Report Washington D C~ U S Government Printing Office 1966
29 Office of EConomic Opportunity and the Medical Foundation of Be~laire Ohio Eighth Report 2l ~ Committee2a Governshy
ment OperatiOll~ Va8hiiiSton D C Government Printing Office 1969
30 Pope Clyde R Samuel S Yoshioka and Merwyn R Greenlick Determinants of Medical Care Utilization nhe Use of the Telephone for ReportiDg Symptons Journal of Health and SocialBebavior12 (June 1971) pp155-162 shy
31 RenthalA Gerald nComprehensive Health Centers in Large US Cities American Journal of Public Health 61 (Feb 1971) pp 324-336 shy
32 Saward Ernest W The Relevance of Prepaid Group Practice to the Effective Delivery ofHealthServicestt The New Physician 18 (Jan 1969) pp39-44 - shy
33bull Schorr Lisbeth Bamberger and Joseph T English Background Content and Significant IssUes in Neighborhood Health
Center Programs Milbank Memorial ~ Quarterly 46 July 1968) part 1pp 289-296
34 Weiss James E and Merwyn RGreenlick UDeterminants of MedioalCareUtilization The Effects of Social Class and Distance on Contacts With the Medical Care System Medical~ 8 (Nov-Dec 1970 pp 456-462
35 Weiss James E MerwynR Greenlick and Joseph F Jones Determinants of Medical Care Utilization The Impact of Ecological Factorstt unpublished paper presented to the American Public Health Association 1970
36 Wise Harold B Montefiore Hospital Neighborhood Medical Demonstration A Case StudyMilbaDkMemorial Fund Quarterly46 (July 1968) part 1 pp297-308~
37 Yerby Alonzo S ttHealth Departments Hospital and Health Services Medica1~5 (March-April 1967) pp 70-74
38 Young M M~ Chatanooga IS Experience with Reorganization fOr Delivery of Health Services ttAmerican Journ8l of Public Health60 (Sept 1970) pp 1739-1748
f or l
II bull 11 Y d
II
IJ
34
ThepurposeOfPart II of th1aa paper1atod1scuas
elected Speclfic needs ofecltlc areas within Multnomah
County A8P01ll~oUt 1D ~ I of t1a1bullpapermiddot Ita nelgbshy
borhood health oare cater IlU8t be a facl1lty plaDlled with
aD awarenes of the neeels of the oODllUller and collllUDity
Part II of this paper nIl Show 80e of thoe speclflc
needs
he1DforutiOD tor t1li Portlon of the report
obta1nec1 troll tbroupout tbe follow1Dl threepUb11catloDS
1gr~e_tiMshylIPrIxaiidOreson JuDe 1963
2 1~_middot_sectSI8e~ected1teai c-ua 0 S 8 e first count coaputer tape Coluab a_lion AssocshylatloD of QoveraMD-8 Jlme 1971
3 Jtu1tDoab County Oreaon BDY1roDlHtlltal SurveyEarly 1971
The JIultDOIIIlb COUDty OrttIOD BDv1roDllfmtal Surley
Barly 1971 1s bull stat1stical report of the activ1tles of
theentlreMultDOIIIl2 CcNDty Health Dep~t during the
year of 1970 Die speclflc 1nd1cs elected from tb1s
study amprejMental aealtll Publlc Health N~s1D1 vlslts
FaJUly ~ Veaereal])1 ~ ~rcul081
Throush tie use of cUrts and mapa ODe CaD roup these i
speclflc ~oea to ahcnr the healthneedsof speclfic I
census trtcta aD4 then the health needs of iarer neIghshy
borhooda 1m4 o~ Uebullbull
Rf)~UP1Dl of areu was accompllshed in thefolloWinl I
JJ ~
35
he MiltDoIliahCountY oregon BDViromaental SUrvey
early 1971 isamp statistical report ot tbeaotivities ot
the entire MultDolllh COUDty Health ])epartiDent dur1nl the
year ot1970 he specitic 1Dd1C8S selected frOm this
aUy are 1Il8Dtal health public healthDurs8s visits
fUl1ly pia waereal elisease aDd tuberculosia
Tbroq11the Wle otcbart aDd mapa aDecm szoup these
specific indic to show the health Deeds ofapecitic
ccmaua tracts aDdtIum th8health neecla of larsr ~eilh-
bOrhooda and co8I13 tlbullbullbull
RegroupiDI ot areas waa accoap118hed1D the
tollOWiDl lIIIIm1er~ A bullbullcifie 1ndex 8selectcl auch as
venereal di8bullbulle or tuberculo8i~ he total number ot
cs was then deterll1ne4 for each census tract Through
the use of the maber ot cRbullbullbull tor a 11Yen cenaus tract
aDd tbe population ot thattractaltrateot1lla1ampmcper
100OOOpopUlaticm wu cleteXll1ned for each census tract
This was ~e to starl4ard1ze the population ditterence
amongOeD8U8 -tracts 1he rate of incidence toreaob
cenauatract was then llstedby rank position on a chart
In rank poition1DI any cen8Wl tracts haviDg equal
rates ot1l1c1dence are assipe4tbe iaDk posttiona
Beeauseot the abo fact tbAt cbarta w111 vary in length
neveltbAtlea eacb cbart will 1Dclu4eall census tracts
inMullnoaah Couaty Atter the census tracts bave been
listed accord1q to raalcth1s list will bediv1ded into
IJ
36 three levelsotinc14ence he three levels are
1~ The upper 14 of1DcldenCe
2 Thelower 14 ot incidence
middot3 The ILld 12 of incidence
Tlles three srouplqa are then used in compiling a map ~f
Mu1tnOmahCountyfor ach apecltictop1cbull TIle maps are
uaefuJliD tbatthey V1suallycoJib1De 1Dd1v1Clualproblem
census tracts into larger problem nellhbOrhooc1s
The 1960 statistical iDtormatloD was Used in a similar
liIaDDr to tbatexpla1Dedabove 1Dthe4evelopaent of a
chartmiddot and map 1Ihow1DI e cOllpampriSOr1 of per capita lncolle
tor ttaCh ceDsua tJact aDdmiddot combiDed census middotmiddottract areas
he 1910 aDd 1960 statlstlcal iDtOrllatl0D was combined
lna map and chart he purpose of this and chart is
to d8aonatrate the e cl1stributloa1DeachceD8U8 tract
and middot1ndlcatbull tuture ace populatlon treD4a bull
When one be middotbullbullbullbullbullHdth ne8cts ot an area and has
declded to establlsh a cl1D1c to serve that area the
physical location otthat cl1D1c IllU8t be consldered In
order to coapreb8ll81vel develop an area cl1n1c one should
conslder thepre88Dttraftlc middot~ytaa an4tranaportatlon
systems Thecl1D1cahoUld be located close enoUlh to
major arterlals to giva asy access from the total area
be_ ervecl by this cliD1c At the t1ll8they should
be tar eo away froll thesarterlals to all8Y1ate traffic
CODCell18 andpark1D8 conpstlon By traff1c concerns I
IJ
37
lIlan one lUSt consider thertarro1fne8S of streets whether
streets are oD8--C)r two-way iqres8 and egress to parking
amp0111tie eros tratflC) spedof trattJQ children 1n
ll8a traffic i1lht Vislon re8tr1ctionS etc
BwstraDsportat1onshould alao be central in this area
as maay people ~U f1Df1 1tD8Cessary to use this form of
transportatlon
~e tutqredlopHQt of bull treewa systems should be
c0J1S1dered soastolesen thecumce ofmiddot future roada
cutt1DSotltbe cl1D1c llte line
nrrph1c middotDampta
It is 1JDportaDtto kDOw the demosraphic distribution
characteristics of the oUenteltbat i8 to be served by
localized health cl1D1cs
Acl1D1c which erves8J1 area where1D the prepondershy
ance of persona arecrter 65 years of mayf1nd that these
people rely more on pUblic transportation call for more
home- services and haV4t 110ft ChroD1c and debilitating
types of disorders (b1_ blood pressure poor heariDg and
eyesight) tbaD do8 an area ot a YOUDIer population On
the other hand thL area of older residents may have little
need for family plabDlng cllni08
In order to better ~Ybullbull the 4eaoraphic population
of each CeD8U8 tract the 1970 CeD8U8 iatormation was viewed
and two specific catelOri8 considered These two cat
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38
lori8S woUld be the perc_tap ot population under 19
year of ase and the percentase ot each oensuetractover
65 years of age he 1960 1Dtormatlon tor eaCh tract was
then compared witbthe 1970 intormation and a percentage
ofincreaae or4ecreamp8 tormiddot e~chtract1n each category
cOJlputecland achartma4e By the use of this chart one
18 able to View tJleap populat1odiatr1but10n of census
tract and at the _ t1lle accesa middottrencl Por example
let us choose census tract 601 W see 40-4 otthe
population is under 19 years ot and that ODly82 1s
over 65 years ot middotAtthe e tille the percentage of
youth bas ~ed ODly 1_ intbe laSt teD year whilethe
percentale over 65 year ot middotbas stayedmiddotthe same With
this in mJnc1 ODe ~ 1DfItr libat ol1D1o aerviDg this
area WOuld bellQre conq~w1th the problems of a
YOUQier populat1on and that _ would probably be true foJ
some t1aein tbefuture On the other hand CeDSU8 tract 54
has only 2 ollt population UDder 19 yel1s ot age and
this has decreased by 1 over the last ten years middotwhile at
the same time 32-377 ot the populat1on 18 over 65 years of
age A ol1D1C ___ this area should be or1eJ1ted toward
tbespecttic problema otthe ampledbull
PerCapia __ bY gsa neat
WhaD cona1der1qlooat10D1 tor health cl1n1cs one
shoUld take the 1DC01Ieot areas into consideration Areas
IJ
39
of lowiDcome would not 11kel~be 8erved more by localized
cl1D1cs tbaD would are of hilbincome It 18 likely
people haYiq a hip iDeoll8would preter to be aeenby a
chosen ~r1vatephylc1a1l tban at a local cl1D1cwhere
10Dier waits y beraceaaampryand leas personal attention
gl_
The 19701ncOII81atoWampt10n tor MultnomahC~ty was
not available at the tille thi8report W88 made The 1Dto~shy
tiOD Was taken ~adtro tbe1960 census publlcation
his woUld ~8Il thea tbat ral1I8 OD the chart ynot 1raquoe
completely accurate hi writer telthatthe areas most
affected by tb8 1I8eof the older 1Dco1DtOlaat1oDWOuld be
those tracts wh1ch baYebad a rapid 1ncreaae1n populatlon
over the past tfmyHr8 bullbullbull tracts would include tracts
nUmbered 104 9897 96 aDd 95 be perc~ita 1Dcome
referredto1il-tb1a Paper18the lIean 1DCo per person per
census tract
Attar the iDeoeper census tract was listed on a chart
a map was de 1D41catiDg those census tracts belonging to
the lower 14 ot income tor all censue tracts in Multnomah
COlDltytbose beloqins to the upper 14 ot income tor all
census tract 111 MultnolUlhCounty and those belonging to
the mid 12 ot 1I1coaetor all oeuuetracts in Multnomah
C01mty
In yiew1Dg the _p 1t caa be seen that the low income
area seautotollow aloas the at aide ot the Wl1lamette
IJ
40
R1ver the full length of Kultnomah County A second low
income area follows the south edge of the Columbia from
the northwest corner of Multnomah County easterly to 148 St
A third problem area seems to be on the east bank of the
Willamette River with the Union Pacific Railroad being
about the center of this tract The extreme loutheast
corner of Multnomah COUDty appears to be a low income area
but as this area bas bad rapid grouth in the last ten years
this could be erroneous
Mental Health
be first ~ecific indica to be selected from the
Multnomah County envirollllental survey of early 1971 and
to be considered in this paper i8 that of Mental Health
At the present for mental health purposes Multnomah
County is divided into five catchmentareas with a mental
health cl1n1cin each area These clinics are Model
Citles Delaunay ADkeny street Office Hansen Health
Building end Southeast Clinic
All lIlental health cl1n1cslcept statlstlcal information
on all patients visiting their cl1n1cs this included the
address of the patient hese addresses were then listed
upon the approprlate C8D8US tract Each census tract was
then ranked on a chart according to the nUllber of mental
health patients who reslde ln thatCeDSUS tract attending
any of the above listed ental health clinics This chart
IJ
41
wasttum d1v14ed1ato proper quartile bbullbullbull
quartile vereUs to dne10 u appropl1ate Multnoh
County _tal health ItLa middotmiddotmiddotthelipO~a1bl by lOoJcJIUE
at the UDtal health _to uteN1De which ueu have the
lars-t use otCOllDty 1alh~th faci11t1Rot
1Ilclu4ecl 111 tbia woUld tber otpeopleYia1t1Da
pr1vat patch1atriata aDd pr1_t _ntalhealtb cl1D1c8
WheDtbe M1 18Yienclmiddot Itmiddotmiddotmiddotmiddot~middotbe~_ tbat ~rtt
appears to lMt fourmiddotmiddot-al are iii _oil the nuaber ot
lIental healthcl1D1c na1t toM tbjh1sheat 1he
tour areaa woUld be tollows
1ttrea Ore to~Blo Drimiddot ~tb Burrus14e aDd tIMtmiddot Colb1a Riftr H1gbwyaeri1Dla th nortllra boundaryshy
2 bull ProII 82D4 1_~ 10 20th streetwitil the ra1lMd Mu the north ltouadary
3 ~ et et tUgl_b1bull MYel froamiddot the Clackaaa COUDty l1ae aorth to Dln8lon stret
4 beDOlvt1ttfe-t ~efllt4 COatytrca Jle1aware streetmiddot toR1C1a11oDd wlth Colubla Blvd heiDI tbAtnorth bouaclary_
It ODe coapareatbiap to th iDeobullbullmiddotp 1t can be
eamiddotthat lIOat ot the c tracts baY1Dg bllh v1i11tatlcma
middottfl public tal health cJ1rUc8 ~ 111 t13e low ~ aid
1DcOile SroupiDIOJa1y of til 25 tracta llsted as
haviDlbip aental Maltll nlltatlou are ~ the1g60 hip
iDeo arebullbullbull
17 Plpn
42
amily PlellnSDI ]Jlce Metal Health i8 an 1nd1ce of
use Theperson 111 ordertobavebe_ 1Dcluclecl 1n this
atu4ywouldhave tohaft Ue4 ataa11y plaDI cl1D1c
tacilities of soaetype It 41fter troll tile _tal health
study1nthat i t1Jicludestatist1catrollbotb public and
privateclJD1os
The iDformation tor the iak orurcbart 8Dd map of
t8ll111 plenn1 na ob1a1De4 by cOIIblnlDlthe mabel of
1rlcuv1duals bullbull_ attbe tbreellUltrampo-ti Coatyhll11y
PlalJQllIl C11ll10s 111til tbo at the Planned PareDthood
Association CliD1C8 be tbree -JIultDouh Couaty r8ldly
PlamSq Cl1D1c are Solrtbweatth Col_bla 1111- a114
HaDsell Health BWlcl1Dl CllD1cbi middot1Dtormat1oD vas then
bullbullbullesed tomiddot detellWMt l10w people troll eacb c8IUIUS
chart wastben Mele IUs oIIart jn 4iY1ded to show
the censuS tracts lIaYiDlmiddottIle h1t1iest qUart1le of incidence
of use lowest quartile of 1Qc1deao ot use Jlid 12 of
incidence of Wle an4 a map sprepared troll thts 1Dto~
mation
The C8U118 tractsbelOJISnl to the h1lhestquartile of
use appear to be 1lO~ 8catt~ on tbipwas true ot
either the _p ot aental health cl1D1c uaageor ot the map
abow1DI per capita 1I1COM Iaere40 to be three
d18t1nct areas of UIIaP beJ woul4 be
1
IJ
43
t10D of BurD81cl and the W11lallette River 4
2 S~t Portland 8Otth otmiddot the ra11shyrcaadand alona the W11lamette River
lIortbeaat Portl8D4 between MisSiss1pp1 and 24tbStreet the northbouBclary be1DgColwb1aBlvd
Pylzl1c BMltl IrpI Y11ta
Publlc Healtil nur81D1Y1s1t nclud8 an vists to
theholles of client by PubUc Health Nurbullbullbullbull his shows
visits to bull f8Jl1ly fer aDY purpos SUCh aatuberculolJ1s
het1Dl tem1tyaeatalu4 8IiOt10D8l cODd1t1ona etc
he atat18t1C~ 1fele C()4ed accord1Dg tomiddot the 1llli301fOCUS
of the Y18lt tt doe DOt 1D41cate the Dmlber of holies or
f8ll11lev181tecl or 1D41Y14ual Y1a1ted more tban oDcein
the propwl It dobullbull I1ve 80M 1D41cat1on by coaparlshy
OD ot the 8JIoUDt of aedlcal problema 1n eachcen8WI tract
Ap1nmiddot the _p abowa 8 scatter patteraof probl_
areas althoUSh there appear to be a sroup1Dl of hiSh J
l8aIeccmaus tract 1ntlut extreme southeast part of tbe
County other areu uIriaI any nura1Dl contacts are
1 bull he 801lth-oa-al CO1Dty on eaCh 814 of 82nd Av from Clackallaa County north to Dinloa
2 ear bullbullbullt 814e aroUDd Preacottand Misaisippi
Dowatom Bunul14eonboth 1de of the river
44
V_real Pis The iDfomatloil uaec1 to tabulate the Venereal
disease chart includes all the ooab1ned case otmiddotODormea
and syphilIs reported by bothmiddot publIc and prIvate physicIans
dur1nl 1970 There were 3602 caes ot IOnorrhea reported
dur1nl 1970 While ODly 17 cabullbullsot ayphilimiddot were reported
A chart was prepUed aDd att8llPt wasmiddotmiddot de tomiddot
determ1De Wh_therVttDereal 41ease was more p~vaJent in
areas othigb or lowmiddot proportIon ot youth hi waadone
bymiddotdetemlna a 1leaD prceiltacmiddotmiddotmiddottor the population ot
resld~ts UDder19 years ot (34) middotA mean ratemiddot per
100000 popUlatIon al80c1ttem1Ded tor the middotoccurreDCe
ot venereal dieae This was et at 390 oass Areas
hav1nl a population 1n which leiS than 34 were lmder 19
years ot ampIe were called low- yOuth abOve tbl percentaae
hiSh youth The aaa waatrue ot the occurrence oivenershy
eal disea_ per CeD8UStract It the rate waacomputed
as 1I0re than 390 cases per 100000 it was called hiah
venerealdiaeasei it less than thia tisure low venereal
disease It was tound that 1D Multn~ COmlty there sems
to be poSitive OOlatI0n(x21S19gt between low youth
and hipmiddot venereal diseaand hip youth and low venereal
diseasebull
RaDk ordr Iitot all c traot middottbAm made
Th1s was done byt1Ddlna the ratepr 100000 populatIon
of venereal disator all census tracts in the County bull
45
These were thenlisted from h1lhto low (sreatest to
least) in a rank order The l1sting was then divided
into Upperandlower 14 aDd listed on the MUltnomah
Countymiddot up
The areas of b1gh venereal disease se8ll18to
roup thBl~8 middotin a very tllht area ~oq both 1des
of thell18l8~ R1 w1th BurDaldeS~et being
~bout theceDter qf tbi8IZ9uping This area woUld
appear to be m ldeal spot for the denlopment of a
locallzed venereal d1sbullbullbullbull cl1D1c
UbepoundCUlO1s
In this report bull tube1C1llosls caS8S refrred
to include alltbobullbull cabullbulls ontubercUlo8is follow-up
rather middotthan just new C Accord1Ds to the Multnomah
County Health SUrvey of early 1971 this would include
all ca repOrte4 over thelaat three years The
total number of tuberculosi8 cabullbullbull usedin this study
was 666 lh1 included 128 new cabullbullbullbull
A rate per 100000 of tuberculosis for each
census tract wa- then computed and the c~us tracts
listed by rank order be b11h Qartlle mel low
quartl1 were then reoordd on a Multnomah CoUnty map
TWo genral areaa baY1Dg a hip mcldencaot tubercu~
losiare 1D41cated heyare
1 Both middotsld ot theWilla11lette River
Ll -
46
with Burns1de about thecnter
2 he extrea Northebullbullt comer of the County bull
By coap8r1ng the tuberculois an4ven8real
diseae maps ODe can 8ee that the downtown areas ot
hiSh 1nc1denceare alIIo8t 1c1eDt1cal on ach map
This WOuld 1nd1cate that 1t would be of value to
bullbulltab11sh acl1D1c 111 th1aampreatbat would provide
bothtuberCulos1s 8Dd ytmereal 418ase srvicbullbullbull
Thchart aDd 1181gt8 are wsfuln 11v1DI
1Ddicat10DS tor the type aDd placemeototlocal
health cl1n1c8 tbro1qhout tbe MultnomahCounty area
A cOllpar1on of the mapa help one to dec1dewhether
to provide a aulti-8ervice cl1D1c or spec1f1c type of
cliD1c As stated in Part I of thi paprserv1ces
shouldhaYe both treatlieDt and prfMmt10n cOmponents
As he been stated fta ne1lbborhood health care
Qenter muat be a fac111tY plazme4 with an aamesa
ot the neds of the consumer and the c01llll1m1tybull
Part II of this rport haa been an attaapt to indicate
and clarify 8011 ottheae coDlllUDity neds This has
been done through8elect10n of apc1f1c problems
The indic were then visuallyrecorded through the
use of ups and charta ODe dan asseS8 thedsreeof
1DIportance of certain concems to spec~t1c areaa by
comparinl the chart aDd maps Prom this oDeean
41 dec1de which are48 vb1chcUD1c-or indeed if
the need a clinic at all However further factors
should be considered hebullbull include
a The amount of fuDd1 available
b What 18 the percentage ot peopleineoh ceaaua tract tbat would actually us such cl1n1cIl
c Wbat 1 tbeco--1tymiddot 8 IeeliDashyreaardtDI particular cl1D1c8 Would this dcrebullbullbullmiddot the ettctiveness ot thse cl1n1ca
IJ
li
D_OlraphicPopulatLon Challie 1960 to 1970 48
Cen8U8 1 of Pop 1 Cbaqemiddot 1 Change1 ofPopTract Under 19 Yr8 Over 65 Yrs1960-70 1960-70
middot1Q701Q70
1 319 -12 171 -H) 1
2722 215-27 +68 301 366 -22 127 +35 302 371 +19 111 -04
311middot401 144-41 +29 402 321 13~7-39 +24 501 356 124-08 -02 5~O2 351 133-23 +12
405601 82-10 -02 394602 103-01 -06
701 275 149-76 +56 702 361 +01 121 -07
+10middot801 326 140-22 802 321 middot127
(
-29 -03 9~01 342 124 -H) 6-18 902 294 128 -H) 3-24
10middotmiddot -14312 140 -17 1101 182 +25 -23197
2411102 186-59 +29 1201 226 169-17 -41
31middot01202 +11 182 -05 295 -H) 81301 208 -H) 4
1302 331 +08 197 +04
14 323 +15 middot185 -08 middotmiddot15 329 +16 16~5 -13
-28middot 1601 332 131 +12
1602 356 98 +24middot-39 middot3101701 161-33 +21
1702 370 -15 85 +02 +19 1801 264 151middot-50
185middot1802 256 +47-58
IJ ~
D_raphlc Population Change 1960 to 1970middot 49 (Contd)
4io
Census Tract
of pop Uncter 19 Yra
1Q1n
1Cha1l8e 1960-70
of PopOver 65 Yra
lQO Change
1960-70
19 389 +29 141 -24 20 223 -13 206 +18
21 227 +08 194 -36 2201 356 -27 112 +05
2202 290 -18 ll~9 -29 2301 356 -03 154 +24 2302 260 -37 245 +97
2401 410 +6~1 123 -31 2402 163 -80 320 +99 2501 381 +13 140 -01 25()2 237 31 lil +02 26 343 +25 186 +149 2701 370 +29 1S5 -01 2702 249 -44 304 +98 2801 337 +19 187 +09 2802 306 -10 156 +31 2901 304 -38 142 +24 2902 i 307 -32 146 t3~9
30 29~0 -48 16~2 +51
31 355 +30 160 +01 32 370 +48 148 -13 3301 395 +45 130 -20 3302 368 +06 138 -02 3401 386 +16 117 000
3402
400 +32 92 -26 3501 304 -07 115 +35
3502 344 000 140 -13
3601
36~02 357 -04 132 +32
3603 30~1 42 149 -67 3701 342 +28 152 +19
1
IJ
Jianolraphic Population Chan 1960 to 1970 50 (Contd)
Census Tract
of Pop Under 19 Yrs
JJl7J
middotChanae 1960-70
middotofmiddotpop Over 65 Yrs
1c~7n
Change 196070
3702 409 +39 122 -11 3801 308 -11 151 +29 3802 275 -35 180 +46 3803 282 -32 192 +54 3901 376 ~13 100 +17 3902 296 -03 177 +29 4001 438 -11 84 +13 4002 353 -21 115 +20
4101 397 11 9middot0 +11 4102 346 -19 120 +03 42 331 +19 11 bull 3 -16 43 347 -72 105 +31 44 113 +84 183 +154 4S 33~9 +07 110 -06 4601 2501 22 193 +38 4602 332 +59 126 -29 47middot 161middot 000 211 +01 48 103 -26 302 +59 49 138 +1 bull 3 252 +09 50 141 -26 204 -12 51 12 -39 257 +07 52 47 -61 351 +48 53 89 +49 314 -30 54 25 l1li15 327 -17 55 131 -17 115 -121 56 198 +93 227 -47 57 71 102 189 -88 58 240 ~middot41 16~1 +55 59 322 +25 142 +06middot 6001 264 95 132 +50
6002 328 -31middot 89 +07
JJ
Demographic Population Change 1960 to 1970 51 (Contd)
Census 1 ofPop lChange of Pop bull ChangeTract Under 19 Yrbullbull 1960-70 Over 65 Yrs 1960-70
1970 1970
61 355 -58 85 +39
62 328 39 110 +18
63 414 04 73 10
64 382 -22 72 +04
6501 383 02 67 -20
6502 329 -56 96 +09
6601 391 +13 88 -03
6602 319 -59 97 +06
6701 327 71 145 +72
6702 331 ~67 83 +1-0
6801 365 -66 49 +01
6802 388 4bull3 54 +06
69 354 -41 80 +23
70 400 -23 68 -06
71 359 -48 72 +05
72 255 -88 82 +11
73 346 -39 91 +25
74 313middot -63 105 +24
75 329 -42 129 +37
76 336 -52 85 +21
77 370 -10 69 +05
78 309 -10 120 +21
79 325 -56 87 +10
8001 358 -81 57 +12
8002 391 ~81 76 +12
81 315 -76 108 +21
8201 403 -23 64 +08
8202 392 23 65 +08
83 357 -34 120 +31
84 402 -18 73 +16
85 413 -06 76 -09
r
Demographic Population Change 1960 to 1970 52 (Contd)
Census Tract
t of Pop Uncler 19 Yrs
1970
Change 1960-70
1 of Pop OVer 65 Yrs
1970
ex Change 196070
86
87
88
89
90
91 9201
9202
93
94
95
9601
9602
9701
9702
9801
9802
99
100 I
101
102
103
10401
10402
lOS
368
351
379
391
391
413
379
433
372
429
414
432
419
439
~32
377
457 420
378 41middot7
345
360 417
417
412
-04
-02
-35
-26
-28
-11
-64
-20
-S9
-39
-32
-21
-34
-40
-47
-lO~7middot
-27middot +04
+56
+07
-34 01
+04
+04
+10
103
128
97
11il3 99
69
79
42
77
46
34 38
44
40
54
111
51middot
81
133
59
74
140
63
87
76
-08
-06
+04
+08
+17
-05
+3S -02
+1~4
+19
+33
-14
-08
+12
+26
+71
+11
-16 -34
-20
-19 +37
-49
-2S +15
NOte The The
Taken frOi
averageullder averageabove
middotUSCensus ---shy -
19 years == 6S years ==
figures 197
32r 13(14
p a~d 1960
--
Rank
1
2
3
4
5
6
7
8
9
10
11 12 -_
13
14
15
16
17
18
Tract
69 46
60
58
- 68
61
302
2501
67
63
19
62
26
94
3603
3902
64
30 -----~-
Rank
19
20
21 -
22
23-shy
24
25
26
27
28
29
30
31
32
33
34
35
36 -
Ranking of Per Capita Income by Census Tract
Tract
65
2701
- 15
1601
701
66
93
82
2903
3602
30
2502
80
2401
81
- 70
91 shy
4001
High
Rank Tractshy
-32shy37
38 97
120239
7840
41 ~ _2_1__ 42 31
43 2501
44 18
45 98
46 37
47 3803
1702
49
48
1602 92 2702
I
50 89
51 901
52 801
Ra_
53
54
55
56
57
58
59
60
61
62
63
64
6S
66
67
68
TractTract Ra~
74692
170196 70 I
401 71 90
72 1037J
79 70273
3802 74 601
24024102 75
85 76 101
77 9023901
7699 78 100 4101 79
3601 I
380180
458140~ t---- _ - - shy83 82 42
888384
59843501
4777 8~
502
Low
802 86
Rank Tract
87 shy
--88
89
90
91
92
93
94
- 95
96
97
middot98
99
100
101
102
103
104
1201
14
49
72
73
43
87
3502
105
1
52
86
71
1
501
10
3301
104 tf
Rank
105
106
107
108
109
110
III
112
113
114
115
116
117
118
119
120
121
Ranking of Per Capitalucoae by Census Tract
(Contd)
Tract Rank
4001 122--shy602
13
1102 2302
3302
55
3401
48
21
56
50
3402
lL01
2202
2301
53
2201
-shy
Tract Rank Tract Rank T~aet Rank
57 I-----
Imiddote
bull
Tract
- Low -k Note Information taken from 1960 U SCensus
Rank Tract
I ~
Ie
Imiddot
~
----
----
--
--
Rank
1
2
3
4
5
6
1
8
9
10
11
i-
-Tract
391 922 921
972 971
100
132 131 121
962 961
822 821 401
982 981
20 111
47 10 1
412
High
Total Number of Henta1 Health Visits
Ranked by Census Tract High to Low
TractTract RankTractRank Rnk
12 182 22 78 29 87 76 381 73181 ~------- 1913 371 8538230162372 271 2616-121 8272 2
14 80~2 31 94 7923 84801 59 15251362 4232 15 52 _ 32 103 8924 651 17240216 652
_ 91 351 33 341 23117 83 122 25 25 48 1123921418 34 shy61 86 661
19 662 6493 81 26 91 8153 49 50 55 41383 71 27 51 3120 90 672241 35shy 104167162 461
I 411 46211121 28 88342 I
2502 36 69 54 5251 50 272
-Ra
37
38
39
_ 40
_ 41 Ishy
I
42 I
-I 43 44
45
shy
Tract
~ --- shy 95 56
45 292 242
102 62 352 291y
92
101 281
99 72 63 601 60~ 42 2201
77 74 61 57
363 232
70
32 31
11 44 282 2202
Low l
- Tract
46 682 681 I 331 30
r~$ 47 1042 332
48 102_41_
11
~
Visits to Family Planning Clinics Ranked by Census Tract High to Low
Rank Tract Rank Tract Rankmiddot Tract Rank Tract Rank Tract Rank Tract
1
2
3
4
5
6
7
8
9
10
11
12
13middot
14
15
16
17
361
56
401
341
48
59 121
20
55
342
10
31
58
93 21
241 132
331
53
461 462
18
19
20-shy21
22
23
24
25
26
27middot
28
29
30
31
32
33
391
32
middot47 I-i-_-shy _ -
231 111
332
972 1
372 371
52
89
32
92
82
100 31
182
30 242
402
34
35
36
37
38
39
40
41
42
43
44
45
42
1714 i 661 221
78 362 2
90 602 601 352
63 251
105 921
971 351
73 42 292 232
411 51
662
81 45 52
46
47
48
49shy
50
51
52
53
54
55
56
961
801
49 81 72 71
19
9~1
172
68 2 57 162 14 112
91 75 681
381 42
3~3
83 161
57 f
58
59
60
61shy
62 Imiddot
63
Imiddot 64
65
66
64 62 36~3 252
74 652 SO 392 291
651 6bull 2
79 271
r-- ---- shy981 222
672 671
821 272
94 87
281
382
67
68
69
70
71
72
73
74
75
76
77
78
981 26 12~2
IS 61
85 82~2 69
61 43
101 86 84 282
76
131
51 72
1041 962 88 70
99 922 77
103
95 802 181
i
~
Low High
RankRank Tract
5479
4480
81 1042 ~) middot102
71 - - + ~ - ~
Visits to Family Planning Clinics
(Contd)
Tract Rank
I
Tract llaDk l
RankTract Tract Rank Tract
~
I
~
J1 ~
Low
Total Number of public Health Nursing Visits
Ranked by Census TractsHigh to Low
TractTract RankTractRank RankRank TractTractRankTractRank
25249 71 79 17249 8033 6586 99189711 84 2915072 34 661 76 66 811519512
402 5035 51 161 2518220 122 1713423 352 55801 7120 6752 2 149814 41236 83 2662 38 94 6821 53 2924015 362 37 32 42 75 69 281 84 63
546 8822 54 222 85 3925431 70383417 3818223 6439 4386652 718 21 55 103332 8924 232 87 19 271729219619 24156 16211140 382 628825 10523110 112 73411 10141-- ----shy 89 363 4457 8126 16111 221 74 9142 90 46158331 53 671279012 46243 48 59 351 3837528 1083 9313 91 5844 59 -_242 76 1----- shy60 272 72 74104114 60145 42 9287 7729 92 6151 8215 57371 934630 91 307762 12113116 282 619447 41391 9531 78100 63 7378 ~95 681 6945 32 5632 798517 6448 47 52 181
High ~ Low
Rank Tract Rank
96 31 132 70
97 102
98 182 372middot 602 651 662
- -shy
~72 682 802
822 922 962 972 982
1042 ----shy
Low
Total Number of Public Health Nursing Visits
(Contd)
Rank Rank Rank TractTract Tract
I
I lt
I
Tract Rank Tract
[
~~~-
I
~
IJilfimiddot ~
j
Ranking of VD Caea According to Census Tracts 61 By High and LOll Youth Itatio
A media~ of 34 5 was determined Any tract having greater
than 34 5~ of popu1tionunde~ 19 years of age -High~
Any tract having l8S than 345 of population under 19
years == Low
Any tract having rate less than 390 =Low
Any tract having rate more than 390 == HLgl4
YOUTH
LOW HIGH
L
0
12 402 1801 1802 343 2801 2802 29023603
54 6001 600262 66~02 72 74 75 76
78 79 81 t02 65 1202
W
(25)
VD
H
I
G
H
401 701 801802 901 902 10 1101 241 1201 1301 132 14 15 1601 1701 20~ 21 2202 2j02 2402 2502 2702 2901 303501 3502 34023801 3802 383 3902 42 44 45 4601 4602 47 48 49 SO 51~2 53 55 56 57 58 S9 6701 6702 73 95
3~02 7021702 19 25~01 2701 4102 4101 63 64601 ~601 6801 680270 7l 77 8001 80~02 8201 8202 83 84
85 86 87 88~ 90 91 9202 920193 94 9601 9602~ 9701 9102 9801 9802 99 100 101 103 10402 105 6501 10401
(47)
301 501 502 601 1602 2401 2301 2201 31 32 3301 3302 3401 3402~ 3602 3702 3901 400140 02 43 61 69 B(
(53) (23)
~ ~gt
Ranking of VD by Rate Per 100000 By Census Tract
~
Rank Tract Rank Tract Rank Tract Rank Tract llank Tract Rank Tract Rank Tract
1 2202 21 S6 40 902 58 1602 74 75
90-shy 64 107 26 --~-
2 3402 22 45 41 10 59 902 75 78 91 54 108 61
3 2301 23 3502 42 2502 60 602 76 6802 92 402 109 87
4 3302 24 49 43 1102 61 501 17 2 93 94 110 90
5 50 25 52 44 6702 62 14 78 8202 94 97 02 III 76
6 2201 26 20 6701 63 4002 8201 2501
9701 41~02 112 91
7 44 27 48 45 401 64 3802 2902 95 63 113 62
8 3301 28 1701 46 502 65 30 79 83 74 96 9602 114 71
9 55 29 47 47 42 66 3803 80 2801 96Q1 115 85 10
11
12
13
14
15
16
17
18
3401
53
2302
2401
57
21
2402
1101
51
30-shy31
32
33
34
35
36
37
3701 - -~ 1201
3702
89
43
132 131
3602
4001
48
49
50
51
52
53
54
55
58
1601
601
4602 4601
69
701
31
3901
67
68
69
70
71
72
2901
801
39021~ 802
6502 6501 122
702
41~01
81
82
83
84
85
86
87
88
19
1
1702
2802
79
93
100 6801 6602
81
97
98
99
100
101
102
103
104
9201 9202
9802 9801
77
302
79
86
72
84
116
117
118
119
120
121
3603
8002 8001
101
99
95
10401
105 10402 103 102
19
20
59
32
38
39
2702
3501
56
57
301
3801
73 1802 1801
89 6002 6001
105
106
2701
88
High Low
-- -----
Rank OrdermiddotTuberclosis Cases by Rate Per 100000 Ranked by Census Tract High to Low
Tract TractRankTractRank Rank TractRaukTractRankTractRank
801
79 9601501411 52 6835340120511 I 960269 903603532036 $-~~F130221542 4366 311301 70 68~013802 _ I- _ 4001_37213 3921201 6802802 H71523822024 22 54 193302 3802 80 8958 I37139535 70155 9801 I60123 72 6702 98023914011016 6701250124 10 56
81 94 401r 7 154152 73 7057 2625 122 92028
90242 162312301 92~158 86 7172434526509 82 79160159 74 100 87412240227220110 6502836960 75 30 8317244 6501782801285711 61 901 42765645 84 66021459294912 9701 660146 171 302 9702 47
6235023033113 85 822821182 917755 16335013110214 841814832 78 103 938564 324815 86 1057940149272 38036523216 10401 87 2902241 725Q 10402360266340217middot IF88 88 9937233 282 51 218 101 01102 46016234
I)167 2901460219 47
High ~ Low ~
- -
TractRank
9S89
6490
8191 8001 8002
63 61 60middot01 6002 44 2701
92
J
2502 402 --- ----shy
I
Rank
Rank Order Tuberculosis Cases by Rate per 100000
(Coutd)
Tract Rank Tract ~nk
I
Tract Ballk Tract Rank
Imiddot
Tract
Imiddot
1~
t 1I i Pi i l I
o
1 -1shyL I
I J
8 40 icO ~ I -lt 0
-t (1) I
i I
r o E
II
a
I
r--i
shy
I
~
I (
Jgt
(011 fi(
Ggt
I II ~j
()
(f 0
~ ()
I
11
f9
r
II 99
o ~
Ggt r
~ __-J~ I t I ~ I
r--J l I
~ _ __ J
) 1
fTl
1gt
r I
()
r
()
lt en -i en
()
I1l
(J)
(J)
-i
P ()
19
r o ~
r G1 I
I
c
~
o I 89
--- -I-shy
r-r I
1- 0 _~ _ _--J E
G1 I I I
i i
I 1-1-1 ~ _J ~2 ~ II
II
()
1 I I I 1
id i bullbull
~
A n 69
r 1shy
- 0 Gl
l--~ ~ I
~ II
II )
I () isect i
en l i
(J)
-t
0
IA Ol
w ~
21
middotSPC1a1l~t~JlUrbullbull per8ema_1 bullJmdlJleu y our fuDotlou are auoh that DOtb1Da 18 dorutbYtbe phY8iCianstbat doe DOt vet to be done by the
phys1c111U1fhe other aldlle4 person- Del-nurse middotreC~0D18t the appo1ntshymeDt center or clerical praormelshyaremiddot there to free h1amiddotto use his spec1al sk111
Awell lmoWn treDd1D the area of eaaiDI health
c8re JII8DPOY8rShortagjs bas middotbe thetrend toward tra1nshy
1DB poverty area rea1deats as DOD~pro~eaionalmiddoth8lth
aide and nepborboocl health workeramiddot (28 p63) This
bas the effectofmiddotmiddot1J)creaa1q II8DPOWrand 8180 can help
bridle the cuJ~ cap betweenprondera and colllUmers
of aen1C8s This attarD at least tlleoretically
createa a situation 1D WIa1ch providers andcoD8Ullers can
be educated to UDderatad OD88DOtber and interactJlore
ettectlvely~ HoWever amiddotpltt8ll has beeD themiddot tel14ency in
801D8 oamp8e8 tomiddot us aidesmiddot ssale8lllcw t~r the center
alJDOatexclwdY811rathertbaD ua1Dltheal to protide the
health care for wh1ch ~ were trained (29 pp3B-39)
1bat ismiddotmiddot vh1~e the a14e Yalue in ~~m1catiDI with
low 1nCOlMt patieata haa beeR recoSD1zed and stressed
their role ashealtb carepersoDDelhil been slighted 1n )
any 1Dstancea
Anotber step 1d11Ob bullbull been taken to provide 8rY1ces
more efficiently eUeot1ftlybas beenmiddot theorgan1zation
of per8ODDeliDto IIllt141sc1pl1Dary teamaaaa means ot
proYid1DgmiddotCOQrd1DatedserY1ce SUch te8lll8 sen_rally
~
hf
~
22
include PhYsiciaQs nursbullbullbullbull soc1al workers and outreach
workers Conceptually th8y fmlct10n to me~ the intershy
relate lled1cal and social needs ot the families sened
Hor there are a number ot barriers to the etfectve
tlmctiOD1nlof lIuchte8ll8 SODieot these are heavy caseshy
loads the inordiDate amount ot tille consumed by multlshy
prOblem tamtliethel1m1ted tra1n1 ngmiddotmiddotand laCk of tnterest
on tile part ot aoae tebers in examinJng aspects of
problems out14e~lr oWn areaaotcolIPetencemiddot and
~ourdcation prc)blell8 between proteasioDala and nonshy
prot81~s (10ppa-10) middotrurtbemOre as De Diaz
(14 middotp6)1nd1cate tbel8 maybe a teDdency tor vertical
dp8rtmental lines of auperv1810nto become paramount
over the team coDamloation syst lead1ngto conflIcts
in determ1niDI the ro1ea ot solie team bers particularly
the DOD-prote81011alaInauch exper1l1enta Witb new
~t1Dlpatterna it 1s bullbullaentialtbat line of authority
roles aDd NsP0D81bll1tlea be made explicit and that there
beJDechaD 8IUI tor relUlar evaluat1onotfunctlorUng
Another way inwb1ch health care sernee delivery can
be made more ett1cl8Dt is to proVide servicea dur1DC the
hours whentbey aremiddot -ostnee4ed As reQo_ded by Yarby
(37p1) serY1ce can bemadelIOre accesslble by making
themava1lable 24 hours a day seven days a week If
rg8l1Cy service are aft11ab1e aroua4-tbe-cloek at ~
nil1iborhood health center the continuity ot tbepat1ent ts
23
careiamaiDtalDedand meatry point into the
cOIIPre~i health care 8 be made available
tothe patient who aoZMllyU8ea ozilymiddot emergency care in
tille of med1cal criais More 8isDificantly ava11ab1-
lity of a tull rase of bullbullrv1c8 tor seVeral hours 11the
eVerlna aI1Cl On ~ prevent the los ot earn1JiSs
involved if th patierat 1IU8tt8cet1me oftfroawork dur1q
the d8y for aed1Cal oare bull his can be an eSpecially
importantc0J1814eration tor lo1aCOlleDUUg1nally qloYEtd
patient aa4caJla18o PIOJIOtet1)e 0Da01Dl use othealth
servicebullbull
exper1eDO ot tbeKa1er prosraa in tb1s~reprdAs
Greenl1clt(19 p10) states wA lllNt 8ip1flcant
proportion ot the abulatory care 8n1cp~Y1dd tor ~
total popUlatiC)U ~ ~ after clWc hours and this
Deed i8 apParenUyaoN prODGUDced tor aJl8d1cally
iDCust population On the other hand the bulk ot all
aabulatory med1cal cu 88l91ce are performed dur1nS
regular cl1D1c hour eVen when services are available 24
hours a dayJ day bull week W
It has ~ the experi8D~eof a ftIDber ot ne1g1lboXshy
hooct hea1tbcentere _t a_jor obstacle to efficient
proViSion ot anicbullbullhas beentbe teD4eDcy of medically
1ncl1pnt patieats to utilize the center oa a walk-in
baais tor epi8od1ccr181or1entect bullbullrv1cea rather than
4)i
h~ ~~f ~~ L
24
to make appoJlltaeata tor ODIo1qprevmt1ve treataent
and rehebl11tat1Ye care ad ampl1O to bave a blah failure
to Show rat_for tbe appo1DtaeDts that they dO make
Atone center 628 of appo1Dtments made were kept
while 3Oottbepati_ta een were ~1n patients
AlthoUP fewer patiets were actually 88811 by the cater
1D middottb1s 1Datance thaathe -bervholuidmadeappointshy
mta the walk-iD patlat required an iDord1nate amount
ot staff t1ae tor aCreeDiaaacl ~trral to pplOprlate
~ttor caregt (9 pgg) Arraquotbr1llpl1catjo~ of the
plOVidedto valk-iD patient by other thaD their
(19 p12)rurtbermore
when patients uti11ze Wlk-1Il er181 centered care
athelr ODlf tona ot ootact with the _d1~ care
ay_ta fUilycentered care the treata_t of tUl11y
bers
a a UD1t 11
dlarupted
hewalk-1Dphenoaaencm appear to barelated to
diUerence between soclal clase in the style of Dlaking
contactJt1th the a11oal C~ay8t As Greenlick f ~
(19 p11)1Dd1oate8 thepheDOaenOn ot INater usage of shy
walk-in ervice by aed10ally middot1Jid11ent patient thaD by
others baa otte been attr1buted to a stoical att1tude
tQward 1llDe8 em the~ ot poor people leacl1D8 to a
~
25
greaterdelay1n tbe k i Dlofa8d1cal care These
patients wppoedlyeelcmiddotcareODlymiddotwIleD tbeirmiddotillDess
becOlles1Dtolerable resultiDSin middotthMr appeariDS withshy
outnot1ce1o rece1ve oareHlwever Greenlicks
r8aearcbbaa cut doubt on the existence ot tb1delay
111 report1Dg middot8J1IPtoJumiddotOfDeW 11laessand seek1ng care
Be bas tcrQDd 1bat s1ll11ar peze_tases of dioally
1nd1sent 8DClJ1on-aed1cally 1Dd1PD~ pat1enta seek care
on the aue daytbat aptou tirstaPPear
1fb11e GrHDllclc 1nd1cat tbat the reasonator the
greatertendeDCY of low 1Do~e pat18Ilta to 1$8 walk-in I
serY1ces are notlcDo1rAmiddotmiddot tbe7 _ be rel~tedto a tendency
ot lower aocio-ecaaaoclaa patieota to preter face-toshy ~
face contacts with II841cal persoDl181posslbly because
such contacts areft coatortiDS an4reasauriDS to
patients who are hJpotbeafzed to bave a dependent attltude
toward IIed1Cal care perS0Jm81 (30 p161)
It a8 itmiddot baa pnerally beenhld the appointment
s1stemts the most efficient Ileana of dellveriDS
comprehenSive oODtllluiDlh-lth care (9~100)1t is
necessary that educaUoraalmiddotbulltfort be taken to proaote the
use ot middotappo1ntaents8DClmiddot tQrec1ucethe fa111re to appe~
ratB4uOatioaalwhlQb baft~utl11zedhave been
IJ
26
1Dten1ews with walk-in patients home Vi8its and group 4i
meetiDp1D8D attemptto1Dierpret1o the patients
the value of rtitgular ppo1ntmentamp andot con~in~
c~1ve care rather than epiI041c care (9 p1OO)
h1s 1safuD~tioD torwhtch nOl~prot81QDal colDlllUD1ty
YOrkersllaY bebe~r8U11ed tban other statf H()wever
euch aD ~ucat1oaal propul __~ ~e related to the senUiDe
capacity otth health oenter to provide comprehensivebull gt
ervice8 to1tpat1_t~odoD aD app01ntment bas18 It
1amp pos8ibleo~rw1 tor educa110Dal ttorts to result
LD a~8JImCl tor ltPP01ntaen~8 at a ratewb1ohi8beyond
the capacity ot thee_tar to t without uareaaoDably
1_ wa1t1Dlprio4a QOBt1nuad use Ot the center on a
wallt-in bU1 _1tbeoosiItpos81ble to et an appoint-
met anc11nCreued pit1entcoJaplampia1a bull Therew111 of
course always be a need and demand tor acute ep1so~c
Care -ci the health centerDlWlt be planned with the capashy
billty ot bullbullbullt1D8 tb1aneed wh1~ cont1Du1nI to stress
aDd educate the patient to utillze oDlOinI comprehensive
faa11y middotc~te~d Cflre (9p 100l
att g4 CODClva1opa
In order to bea4equate any coJlltemporary health care SY8tem muat bullbulletcerta1D interrelated criteria he
IJ
27
minimum criteria areaccessability of services to those
who need them compr8heX1siveness and appropriatness of
services and efficIency 1nthft utilizat~on of SCarce
health care personnel and resources The scareity of
pex-sonnel andtbe need for h1gh quality ongoinghealth
care services
aJIlong the
populationdemanci the most effishy
cientprovision of services
Services must be made accessible to the population
They mustmiddotbe geosraPh1cally accessible to remove the PhysicalmiddotbaTiers betWeen peopleandthem$d1calcare
system They mUst otter their services dur1ngthe
hours when people can make the moat use ofthemA~ it
makes little sense to concentrate services geographically
where they will not be uSed to their fUllest extent it
also is wasteful to provide serv1cesonlydur1righours when
many people are employed his not only presents a hard
ship middotto the consUmer lnrt wastes resources if for instance
the unavailability of preventive services during the hours
when people Can use them causes a need for treatment
services later on
Health carbull sEtrvices must be comprehensive including
prevention treatmcmtand re)abimiddot11tation Ambulatory I
healtbcare facilities wh1cQ are orienteciexclusively
toward either prevept1on or trea1mentare no longer accepshy
table for they are lneft1c1entln their use of resources
and in their prov1s1on of health care to the patient
w ~~
28
If prevent10n1s notmiddot stressed treatment serv1ces that
could have beenavoidedY1l~ be required If prevention
1s the sole focus of the health care facility sick
patients who present themselves must be referred elseshy
where for treatment andsllch referx-als may be taken as
reject1onsor not followed through with until illness
becomes unbearable
The instltutlontbat meets these requirements Is
the comprehensive neighborhood health center It 1s a
local decentralized outpatient facilityprOVld1ng a
fUll range of ambulatoJY health care services It has
a linkage to ahospitalbackUp facilityforlnpatient
treatment and hiihlY apclalized outpatient care
The neighborhood health center must be a fac11ity
planned with an awareness of the needs of the conSUtller
and coDitnUn1ty It must have the r~Ul0urces to provide the
services people need mere they can use them and when
they can use them It must uti11ze the part1cipation of
the community to develop this awareness Not only must
the cen~er beset up to be Amctional for the consumers
but efforts must bemadeaga1n with commun1ty partici shy
pation to help the consumers utilize medical care
services effectively The center muetmake efforts to
educate the community about the valueot regUlar health
care of preventive servicesand of the use of planned
IJ
29
medical appointments ratherthanorisis centered walk-
incare Therealit1es of the existing health care
system have not taught the patient particularly the low
income patienthow to use services effectively
The helthcenterilUst also bea laboratory for
experiments in easing the health caJepersonnel shortage
and c60rd1Datingcare~ A major difficultY iri-exper1shy
menting with neW rolesis freeing staff of old preconshy
ceptions
CoDlprehensiva neighborhood health dare centers have
been developed under a variety ot alisplces including
medicalsociet1es hoSP1talsmiddot(36p299 group pr~ct1ces
(29 p6- 12 117) health departments (13 p1027) and
ne1gbbothoodassoc1ations(14) The literature indicates
somevalues nthe management ot the health center by plusmnts
hospital backup faCility Whatever the auspices many
adm1nistrative fuDctions such as program coordination
standard pr9tectionand evaluation call for considerable
c~tralization of adm1nistration city-wide or coU)tyshy
wide At the same time other aspects hours of servlce
for examPle~ cuI f~radm1nistrative fUnctions made atmiddot
more local levels Each neighborhood center must be
free to adapt its functioning to itscominunity thi-ough
the mechanism otcODlllUl11~ participation inmiddot policy making
Obviouslythe prerogatives and responsibilities of each level must be negotiated and made explic1t
t4~
JJ
BIBLIOGRAPHY 30
1 American Rehabilitation Foundation ~ealth Services Research Center The Health Maintenance Strategy mimeo 1971
2 Anderson Nancy N Comprehensive Health Planning in the States A Study and Critical Analysis Institute for Interdisciplinary Studies American Rehab ilitation Foundation 1958
3 Andrus Len Hughes Comprehensive Health Planning Through Community Demonstration Health Projects mimeo1967
4 Barry Mildred CandCecil G Sheps A New Model for Community Health Planning unpublished paper presented to the American
Public Health Aseociation1967
5 Blum HenrikL Fred Wahl Genelle M Lemon Robert Jorulin and Glen W Kent The Multipurpose Worker and the Neighborhood Multiservice Center InitialImplications and EJeperiences of the Rodeo CommunityService CenterAmerican Journal of Public Health58 (Mar 168) pp 458-468 shy
6 Blum MichaelD and Soloman L Levy A Design for Service Delivery that Reinforces Constructive Tension Between a Health Center and Its (sic) ConSUDlers and Supports Community Power unpUblished paper presented to the American Public Health Asaociatiltn 1968
7 Brielaud Donald Comm~ity Advisory Boards and Maximum Feasible Participation American Journal of Public Health 61 (Feb 1971) pp 292-296 shy
8 Burns Eveline M Health Insurance Not If or When But What Kind Madison Wisco~sin University of WisconsinScllool of Soci~l Work 1971
9 Campbell John Working ~elationships Between Providers and Conshysumers in a Neighborhood Health CenterU American Journal2 Public Health 61 (Jan 1971) pp 97-103
10 Caxr Willene Neighborhood Health Centers Funded by the Office of Economic Opportunity mimeo 1970~
11 Colombo Theodore J Ernest W Sawardand Merwyn R Greenlick The Integration of an OEO Health Program into a Prepaid Comrehensive Group Practice Plan American Journal of Public Health 59 (April 1969) pp 641-650~ -
12 Comprehensive Neighborhood Health Services Projectof Kaiser FoundatioIl Hospital~ Prcgtgram YearE grant renewal proposal mimeo~1971 bull
13 CowenDavidL~ Denvers Neighborhood Health Program Public Health Reports 84 (Dec 1969) pp 1027-1031
IJ
14 De Diaz Sharon Daniel Beyond Rhetoric The NENA Health31 Center After One Year unpublished paper pres~rited to the American Public Health Association 1970
15middot Gerrie NorrrianF and RichardH~ Ferraro Organizing a Program for Dental Care in a Neighborhood Health Center Public Health Reports 8 (Aug 1968) pp 419-428
16 Gordon JeoffreyB~ The Politics of Community Medicine Projects A Conflict Analysis Medical Care 7 (Nov -Dec 1969) pp 419-428 shy
17 Greely David The Neighborhood Health Center Program and Its Implication(3 for Medical Care H~alth Forum of the Welfare Council of Metropolitan Chicago (mimeo) 1967
18 Greenlick Merwyn R Newgtimensions in Health Care American JOurnal of Pharmacentical Education 34 (Dec 1970) pp 754-4
19 GreenlickMerwyn R Donald K Freeborn TheodoreJbull Colombo Jeffrey Abull Pruesin and Erne$t W saw~d Comparing the
Use of Medical Care Services by a Medically Indigent and a General MemberShip Population in a Comprehensive Prepaid Group Practice Prosram II unpublished paper presented to the AmericanPublic Aesociation1970
20 H~tadoArJiloldVMerllYll RGreenlick and TheodoreJ Colombo Determinants of Medical Care Utilization Failure to Keep Appointments unpublished paper presented to the American Public Health Association 1971
21 Johnson Richard E and Merwyn R Greenlick Comprehensive Medical Care A Problem and Cballengeto Pharmacy ff AJilericanJournal of PbarmacenticalEducation 33 (Aug 1969) pp 361-367 -
22 Kahn Alfred J Studiee Social Policy and Planning New York Russell Sage Foundation 1969
23 Kotler Milton Neyhborhood Government Local Foundations 2 Political~New York The BobbsMerrill Company 1969
24 NationalCommisaion on CommunityHealthSfrvic~sActionPlanniriamp for Community SetithServices~ashington p C Public Affairs-Press 19t7
25 National Commission on C~mmunity Health Services Health Adminishysration andOrMPization l the Decade Ali9$-d Washington D C Public Affairs Press 1967
26 NationalCornmiesion onqomm1Jllity Health Servicesbull Health ~ Facilities Washington D C PUblic Affairs Press 1967 bull
~ n
32 27 ODonnell Edward J and Marilyn M Sullivan ServiceDelivery
and Social Action Through the Neighborhood Center A Review of Research tt Welfare ~ Review 7 (Nov~Dec 1969) pp 112
28 Office of Economic Opportunity Second Annual Report Washington D C~ U S Government Printing Office 1966
29 Office of EConomic Opportunity and the Medical Foundation of Be~laire Ohio Eighth Report 2l ~ Committee2a Governshy
ment OperatiOll~ Va8hiiiSton D C Government Printing Office 1969
30 Pope Clyde R Samuel S Yoshioka and Merwyn R Greenlick Determinants of Medical Care Utilization nhe Use of the Telephone for ReportiDg Symptons Journal of Health and SocialBebavior12 (June 1971) pp155-162 shy
31 RenthalA Gerald nComprehensive Health Centers in Large US Cities American Journal of Public Health 61 (Feb 1971) pp 324-336 shy
32 Saward Ernest W The Relevance of Prepaid Group Practice to the Effective Delivery ofHealthServicestt The New Physician 18 (Jan 1969) pp39-44 - shy
33bull Schorr Lisbeth Bamberger and Joseph T English Background Content and Significant IssUes in Neighborhood Health
Center Programs Milbank Memorial ~ Quarterly 46 July 1968) part 1pp 289-296
34 Weiss James E and Merwyn RGreenlick UDeterminants of MedioalCareUtilization The Effects of Social Class and Distance on Contacts With the Medical Care System Medical~ 8 (Nov-Dec 1970 pp 456-462
35 Weiss James E MerwynR Greenlick and Joseph F Jones Determinants of Medical Care Utilization The Impact of Ecological Factorstt unpublished paper presented to the American Public Health Association 1970
36 Wise Harold B Montefiore Hospital Neighborhood Medical Demonstration A Case StudyMilbaDkMemorial Fund Quarterly46 (July 1968) part 1 pp297-308~
37 Yerby Alonzo S ttHealth Departments Hospital and Health Services Medica1~5 (March-April 1967) pp 70-74
38 Young M M~ Chatanooga IS Experience with Reorganization fOr Delivery of Health Services ttAmerican Journ8l of Public Health60 (Sept 1970) pp 1739-1748
f or l
II bull 11 Y d
II
IJ
34
ThepurposeOfPart II of th1aa paper1atod1scuas
elected Speclfic needs ofecltlc areas within Multnomah
County A8P01ll~oUt 1D ~ I of t1a1bullpapermiddot Ita nelgbshy
borhood health oare cater IlU8t be a facl1lty plaDlled with
aD awarenes of the neeels of the oODllUller and collllUDity
Part II of this paper nIl Show 80e of thoe speclflc
needs
he1DforutiOD tor t1li Portlon of the report
obta1nec1 troll tbroupout tbe follow1Dl threepUb11catloDS
1gr~e_tiMshylIPrIxaiidOreson JuDe 1963
2 1~_middot_sectSI8e~ected1teai c-ua 0 S 8 e first count coaputer tape Coluab a_lion AssocshylatloD of QoveraMD-8 Jlme 1971
3 Jtu1tDoab County Oreaon BDY1roDlHtlltal SurveyEarly 1971
The JIultDOIIIlb COUDty OrttIOD BDv1roDllfmtal Surley
Barly 1971 1s bull stat1stical report of the activ1tles of
theentlreMultDOIIIl2 CcNDty Health Dep~t during the
year of 1970 Die speclflc 1nd1cs elected from tb1s
study amprejMental aealtll Publlc Health N~s1D1 vlslts
FaJUly ~ Veaereal])1 ~ ~rcul081
Throush tie use of cUrts and mapa ODe CaD roup these i
speclflc ~oea to ahcnr the healthneedsof speclfic I
census trtcta aD4 then the health needs of iarer neIghshy
borhooda 1m4 o~ Uebullbull
Rf)~UP1Dl of areu was accompllshed in thefolloWinl I
JJ ~
35
he MiltDoIliahCountY oregon BDViromaental SUrvey
early 1971 isamp statistical report ot tbeaotivities ot
the entire MultDolllh COUDty Health ])epartiDent dur1nl the
year ot1970 he specitic 1Dd1C8S selected frOm this
aUy are 1Il8Dtal health public healthDurs8s visits
fUl1ly pia waereal elisease aDd tuberculosia
Tbroq11the Wle otcbart aDd mapa aDecm szoup these
specific indic to show the health Deeds ofapecitic
ccmaua tracts aDdtIum th8health neecla of larsr ~eilh-
bOrhooda and co8I13 tlbullbullbull
RegroupiDI ot areas waa accoap118hed1D the
tollOWiDl lIIIIm1er~ A bullbullcifie 1ndex 8selectcl auch as
venereal di8bullbulle or tuberculo8i~ he total number ot
cs was then deterll1ne4 for each census tract Through
the use of the maber ot cRbullbullbull tor a 11Yen cenaus tract
aDd tbe population ot thattractaltrateot1lla1ampmcper
100OOOpopUlaticm wu cleteXll1ned for each census tract
This was ~e to starl4ard1ze the population ditterence
amongOeD8U8 -tracts 1he rate of incidence toreaob
cenauatract was then llstedby rank position on a chart
In rank poition1DI any cen8Wl tracts haviDg equal
rates ot1l1c1dence are assipe4tbe iaDk posttiona
Beeauseot the abo fact tbAt cbarta w111 vary in length
neveltbAtlea eacb cbart will 1Dclu4eall census tracts
inMullnoaah Couaty Atter the census tracts bave been
listed accord1q to raalcth1s list will bediv1ded into
IJ
36 three levelsotinc14ence he three levels are
1~ The upper 14 of1DcldenCe
2 Thelower 14 ot incidence
middot3 The ILld 12 of incidence
Tlles three srouplqa are then used in compiling a map ~f
Mu1tnOmahCountyfor ach apecltictop1cbull TIle maps are
uaefuJliD tbatthey V1suallycoJib1De 1Dd1v1Clualproblem
census tracts into larger problem nellhbOrhooc1s
The 1960 statistical iDtormatloD was Used in a similar
liIaDDr to tbatexpla1Dedabove 1Dthe4evelopaent of a
chartmiddot and map 1Ihow1DI e cOllpampriSOr1 of per capita lncolle
tor ttaCh ceDsua tJact aDdmiddot combiDed census middotmiddottract areas
he 1910 aDd 1960 statlstlcal iDtOrllatl0D was combined
lna map and chart he purpose of this and chart is
to d8aonatrate the e cl1stributloa1DeachceD8U8 tract
and middot1ndlcatbull tuture ace populatlon treD4a bull
When one be middotbullbullbullbullbullHdth ne8cts ot an area and has
declded to establlsh a cl1D1c to serve that area the
physical location otthat cl1D1c IllU8t be consldered In
order to coapreb8ll81vel develop an area cl1n1c one should
conslder thepre88Dttraftlc middot~ytaa an4tranaportatlon
systems Thecl1D1cahoUld be located close enoUlh to
major arterlals to giva asy access from the total area
be_ ervecl by this cliD1c At the t1ll8they should
be tar eo away froll thesarterlals to all8Y1ate traffic
CODCell18 andpark1D8 conpstlon By traff1c concerns I
IJ
37
lIlan one lUSt consider thertarro1fne8S of streets whether
streets are oD8--C)r two-way iqres8 and egress to parking
amp0111tie eros tratflC) spedof trattJQ children 1n
ll8a traffic i1lht Vislon re8tr1ctionS etc
BwstraDsportat1onshould alao be central in this area
as maay people ~U f1Df1 1tD8Cessary to use this form of
transportatlon
~e tutqredlopHQt of bull treewa systems should be
c0J1S1dered soastolesen thecumce ofmiddot future roada
cutt1DSotltbe cl1D1c llte line
nrrph1c middotDampta
It is 1JDportaDtto kDOw the demosraphic distribution
characteristics of the oUenteltbat i8 to be served by
localized health cl1D1cs
Acl1D1c which erves8J1 area where1D the prepondershy
ance of persona arecrter 65 years of mayf1nd that these
people rely more on pUblic transportation call for more
home- services and haV4t 110ft ChroD1c and debilitating
types of disorders (b1_ blood pressure poor heariDg and
eyesight) tbaD do8 an area ot a YOUDIer population On
the other hand thL area of older residents may have little
need for family plabDlng cllni08
In order to better ~Ybullbull the 4eaoraphic population
of each CeD8U8 tract the 1970 CeD8U8 iatormation was viewed
and two specific catelOri8 considered These two cat
IJ
38
lori8S woUld be the perc_tap ot population under 19
year of ase and the percentase ot each oensuetractover
65 years of age he 1960 1Dtormatlon tor eaCh tract was
then compared witbthe 1970 intormation and a percentage
ofincreaae or4ecreamp8 tormiddot e~chtract1n each category
cOJlputecland achartma4e By the use of this chart one
18 able to View tJleap populat1odiatr1but10n of census
tract and at the _ t1lle accesa middottrencl Por example
let us choose census tract 601 W see 40-4 otthe
population is under 19 years ot and that ODly82 1s
over 65 years ot middotAtthe e tille the percentage of
youth bas ~ed ODly 1_ intbe laSt teD year whilethe
percentale over 65 year ot middotbas stayedmiddotthe same With
this in mJnc1 ODe ~ 1DfItr libat ol1D1o aerviDg this
area WOuld bellQre conq~w1th the problems of a
YOUQier populat1on and that _ would probably be true foJ
some t1aein tbefuture On the other hand CeDSU8 tract 54
has only 2 ollt population UDder 19 yel1s ot age and
this has decreased by 1 over the last ten years middotwhile at
the same time 32-377 ot the populat1on 18 over 65 years of
age A ol1D1C ___ this area should be or1eJ1ted toward
tbespecttic problema otthe ampledbull
PerCapia __ bY gsa neat
WhaD cona1der1qlooat10D1 tor health cl1n1cs one
shoUld take the 1DC01Ieot areas into consideration Areas
IJ
39
of lowiDcome would not 11kel~be 8erved more by localized
cl1D1cs tbaD would are of hilbincome It 18 likely
people haYiq a hip iDeoll8would preter to be aeenby a
chosen ~r1vatephylc1a1l tban at a local cl1D1cwhere
10Dier waits y beraceaaampryand leas personal attention
gl_
The 19701ncOII81atoWampt10n tor MultnomahC~ty was
not available at the tille thi8report W88 made The 1Dto~shy
tiOD Was taken ~adtro tbe1960 census publlcation
his woUld ~8Il thea tbat ral1I8 OD the chart ynot 1raquoe
completely accurate hi writer telthatthe areas most
affected by tb8 1I8eof the older 1Dco1DtOlaat1oDWOuld be
those tracts wh1ch baYebad a rapid 1ncreaae1n populatlon
over the past tfmyHr8 bullbullbull tracts would include tracts
nUmbered 104 9897 96 aDd 95 be perc~ita 1Dcome
referredto1il-tb1a Paper18the lIean 1DCo per person per
census tract
Attar the iDeoeper census tract was listed on a chart
a map was de 1D41catiDg those census tracts belonging to
the lower 14 ot income tor all censue tracts in Multnomah
COlDltytbose beloqins to the upper 14 ot income tor all
census tract 111 MultnolUlhCounty and those belonging to
the mid 12 ot 1I1coaetor all oeuuetracts in Multnomah
C01mty
In yiew1Dg the _p 1t caa be seen that the low income
area seautotollow aloas the at aide ot the Wl1lamette
IJ
40
R1ver the full length of Kultnomah County A second low
income area follows the south edge of the Columbia from
the northwest corner of Multnomah County easterly to 148 St
A third problem area seems to be on the east bank of the
Willamette River with the Union Pacific Railroad being
about the center of this tract The extreme loutheast
corner of Multnomah COUDty appears to be a low income area
but as this area bas bad rapid grouth in the last ten years
this could be erroneous
Mental Health
be first ~ecific indica to be selected from the
Multnomah County envirollllental survey of early 1971 and
to be considered in this paper i8 that of Mental Health
At the present for mental health purposes Multnomah
County is divided into five catchmentareas with a mental
health cl1n1cin each area These clinics are Model
Citles Delaunay ADkeny street Office Hansen Health
Building end Southeast Clinic
All lIlental health cl1n1cslcept statlstlcal information
on all patients visiting their cl1n1cs this included the
address of the patient hese addresses were then listed
upon the approprlate C8D8US tract Each census tract was
then ranked on a chart according to the nUllber of mental
health patients who reslde ln thatCeDSUS tract attending
any of the above listed ental health clinics This chart
IJ
41
wasttum d1v14ed1ato proper quartile bbullbullbull
quartile vereUs to dne10 u appropl1ate Multnoh
County _tal health ItLa middotmiddotmiddotthelipO~a1bl by lOoJcJIUE
at the UDtal health _to uteN1De which ueu have the
lars-t use otCOllDty 1alh~th faci11t1Rot
1Ilclu4ecl 111 tbia woUld tber otpeopleYia1t1Da
pr1vat patch1atriata aDd pr1_t _ntalhealtb cl1D1c8
WheDtbe M1 18Yienclmiddot Itmiddotmiddotmiddotmiddot~middotbe~_ tbat ~rtt
appears to lMt fourmiddotmiddot-al are iii _oil the nuaber ot
lIental healthcl1D1c na1t toM tbjh1sheat 1he
tour areaa woUld be tollows
1ttrea Ore to~Blo Drimiddot ~tb Burrus14e aDd tIMtmiddot Colb1a Riftr H1gbwyaeri1Dla th nortllra boundaryshy
2 bull ProII 82D4 1_~ 10 20th streetwitil the ra1lMd Mu the north ltouadary
3 ~ et et tUgl_b1bull MYel froamiddot the Clackaaa COUDty l1ae aorth to Dln8lon stret
4 beDOlvt1ttfe-t ~efllt4 COatytrca Jle1aware streetmiddot toR1C1a11oDd wlth Colubla Blvd heiDI tbAtnorth bouaclary_
It ODe coapareatbiap to th iDeobullbullmiddotp 1t can be
eamiddotthat lIOat ot the c tracts baY1Dg bllh v1i11tatlcma
middottfl public tal health cJ1rUc8 ~ 111 t13e low ~ aid
1DcOile SroupiDIOJa1y of til 25 tracta llsted as
haviDlbip aental Maltll nlltatlou are ~ the1g60 hip
iDeo arebullbullbull
17 Plpn
42
amily PlellnSDI ]Jlce Metal Health i8 an 1nd1ce of
use Theperson 111 ordertobavebe_ 1Dcluclecl 1n this
atu4ywouldhave tohaft Ue4 ataa11y plaDI cl1D1c
tacilities of soaetype It 41fter troll tile _tal health
study1nthat i t1Jicludestatist1catrollbotb public and
privateclJD1os
The iDformation tor the iak orurcbart 8Dd map of
t8ll111 plenn1 na ob1a1De4 by cOIIblnlDlthe mabel of
1rlcuv1duals bullbull_ attbe tbreellUltrampo-ti Coatyhll11y
PlalJQllIl C11ll10s 111til tbo at the Planned PareDthood
Association CliD1C8 be tbree -JIultDouh Couaty r8ldly
PlamSq Cl1D1c are Solrtbweatth Col_bla 1111- a114
HaDsell Health BWlcl1Dl CllD1cbi middot1Dtormat1oD vas then
bullbullbullesed tomiddot detellWMt l10w people troll eacb c8IUIUS
chart wastben Mele IUs oIIart jn 4iY1ded to show
the censuS tracts lIaYiDlmiddottIle h1t1iest qUart1le of incidence
of use lowest quartile of 1Qc1deao ot use Jlid 12 of
incidence of Wle an4 a map sprepared troll thts 1Dto~
mation
The C8U118 tractsbelOJISnl to the h1lhestquartile of
use appear to be 1lO~ 8catt~ on tbipwas true ot
either the _p ot aental health cl1D1c uaageor ot the map
abow1DI per capita 1I1COM Iaere40 to be three
d18t1nct areas of UIIaP beJ woul4 be
1
IJ
43
t10D of BurD81cl and the W11lallette River 4
2 S~t Portland 8Otth otmiddot the ra11shyrcaadand alona the W11lamette River
lIortbeaat Portl8D4 between MisSiss1pp1 and 24tbStreet the northbouBclary be1DgColwb1aBlvd
Pylzl1c BMltl IrpI Y11ta
Publlc Healtil nur81D1Y1s1t nclud8 an vists to
theholles of client by PubUc Health Nurbullbullbullbull his shows
visits to bull f8Jl1ly fer aDY purpos SUCh aatuberculolJ1s
het1Dl tem1tyaeatalu4 8IiOt10D8l cODd1t1ona etc
he atat18t1C~ 1fele C()4ed accord1Dg tomiddot the 1llli301fOCUS
of the Y18lt tt doe DOt 1D41cate the Dmlber of holies or
f8ll11lev181tecl or 1D41Y14ual Y1a1ted more tban oDcein
the propwl It dobullbull I1ve 80M 1D41cat1on by coaparlshy
OD ot the 8JIoUDt of aedlcal problema 1n eachcen8WI tract
Ap1nmiddot the _p abowa 8 scatter patteraof probl_
areas althoUSh there appear to be a sroup1Dl of hiSh J
l8aIeccmaus tract 1ntlut extreme southeast part of tbe
County other areu uIriaI any nura1Dl contacts are
1 bull he 801lth-oa-al CO1Dty on eaCh 814 of 82nd Av from Clackallaa County north to Dinloa
2 ear bullbullbullt 814e aroUDd Preacottand Misaisippi
Dowatom Bunul14eonboth 1de of the river
44
V_real Pis The iDfomatloil uaec1 to tabulate the Venereal
disease chart includes all the ooab1ned case otmiddotODormea
and syphilIs reported by bothmiddot publIc and prIvate physicIans
dur1nl 1970 There were 3602 caes ot IOnorrhea reported
dur1nl 1970 While ODly 17 cabullbullsot ayphilimiddot were reported
A chart was prepUed aDd att8llPt wasmiddotmiddot de tomiddot
determ1De Wh_therVttDereal 41ease was more p~vaJent in
areas othigb or lowmiddot proportIon ot youth hi waadone
bymiddotdetemlna a 1leaD prceiltacmiddotmiddotmiddottor the population ot
resld~ts UDder19 years ot (34) middotA mean ratemiddot per
100000 popUlatIon al80c1ttem1Ded tor the middotoccurreDCe
ot venereal dieae This was et at 390 oass Areas
hav1nl a population 1n which leiS than 34 were lmder 19
years ot ampIe were called low- yOuth abOve tbl percentaae
hiSh youth The aaa waatrue ot the occurrence oivenershy
eal disea_ per CeD8UStract It the rate waacomputed
as 1I0re than 390 cases per 100000 it was called hiah
venerealdiaeasei it less than thia tisure low venereal
disease It was tound that 1D Multn~ COmlty there sems
to be poSitive OOlatI0n(x21S19gt between low youth
and hipmiddot venereal diseaand hip youth and low venereal
diseasebull
RaDk ordr Iitot all c traot middottbAm made
Th1s was done byt1Ddlna the ratepr 100000 populatIon
of venereal disator all census tracts in the County bull
45
These were thenlisted from h1lhto low (sreatest to
least) in a rank order The l1sting was then divided
into Upperandlower 14 aDd listed on the MUltnomah
Countymiddot up
The areas of b1gh venereal disease se8ll18to
roup thBl~8 middotin a very tllht area ~oq both 1des
of thell18l8~ R1 w1th BurDaldeS~et being
~bout theceDter qf tbi8IZ9uping This area woUld
appear to be m ldeal spot for the denlopment of a
locallzed venereal d1sbullbullbullbull cl1D1c
UbepoundCUlO1s
In this report bull tube1C1llosls caS8S refrred
to include alltbobullbull cabullbulls ontubercUlo8is follow-up
rather middotthan just new C Accord1Ds to the Multnomah
County Health SUrvey of early 1971 this would include
all ca repOrte4 over thelaat three years The
total number of tuberculosi8 cabullbullbull usedin this study
was 666 lh1 included 128 new cabullbullbullbull
A rate per 100000 of tuberculosis for each
census tract wa- then computed and the c~us tracts
listed by rank order be b11h Qartlle mel low
quartl1 were then reoordd on a Multnomah CoUnty map
TWo genral areaa baY1Dg a hip mcldencaot tubercu~
losiare 1D41cated heyare
1 Both middotsld ot theWilla11lette River
Ll -
46
with Burns1de about thecnter
2 he extrea Northebullbullt comer of the County bull
By coap8r1ng the tuberculois an4ven8real
diseae maps ODe can 8ee that the downtown areas ot
hiSh 1nc1denceare alIIo8t 1c1eDt1cal on ach map
This WOuld 1nd1cate that 1t would be of value to
bullbulltab11sh acl1D1c 111 th1aampreatbat would provide
bothtuberCulos1s 8Dd ytmereal 418ase srvicbullbullbull
Thchart aDd 1181gt8 are wsfuln 11v1DI
1Ddicat10DS tor the type aDd placemeototlocal
health cl1n1c8 tbro1qhout tbe MultnomahCounty area
A cOllpar1on of the mapa help one to dec1dewhether
to provide a aulti-8ervice cl1D1c or spec1f1c type of
cliD1c As stated in Part I of thi paprserv1ces
shouldhaYe both treatlieDt and prfMmt10n cOmponents
As he been stated fta ne1lbborhood health care
Qenter muat be a fac111tY plazme4 with an aamesa
ot the neds of the consumer and the c01llll1m1tybull
Part II of this rport haa been an attaapt to indicate
and clarify 8011 ottheae coDlllUDity neds This has
been done through8elect10n of apc1f1c problems
The indic were then visuallyrecorded through the
use of ups and charta ODe dan asseS8 thedsreeof
1DIportance of certain concems to spec~t1c areaa by
comparinl the chart aDd maps Prom this oDeean
41 dec1de which are48 vb1chcUD1c-or indeed if
the need a clinic at all However further factors
should be considered hebullbull include
a The amount of fuDd1 available
b What 18 the percentage ot peopleineoh ceaaua tract tbat would actually us such cl1n1cIl
c Wbat 1 tbeco--1tymiddot 8 IeeliDashyreaardtDI particular cl1D1c8 Would this dcrebullbullbullmiddot the ettctiveness ot thse cl1n1ca
IJ
li
D_OlraphicPopulatLon Challie 1960 to 1970 48
Cen8U8 1 of Pop 1 Cbaqemiddot 1 Change1 ofPopTract Under 19 Yr8 Over 65 Yrs1960-70 1960-70
middot1Q701Q70
1 319 -12 171 -H) 1
2722 215-27 +68 301 366 -22 127 +35 302 371 +19 111 -04
311middot401 144-41 +29 402 321 13~7-39 +24 501 356 124-08 -02 5~O2 351 133-23 +12
405601 82-10 -02 394602 103-01 -06
701 275 149-76 +56 702 361 +01 121 -07
+10middot801 326 140-22 802 321 middot127
(
-29 -03 9~01 342 124 -H) 6-18 902 294 128 -H) 3-24
10middotmiddot -14312 140 -17 1101 182 +25 -23197
2411102 186-59 +29 1201 226 169-17 -41
31middot01202 +11 182 -05 295 -H) 81301 208 -H) 4
1302 331 +08 197 +04
14 323 +15 middot185 -08 middotmiddot15 329 +16 16~5 -13
-28middot 1601 332 131 +12
1602 356 98 +24middot-39 middot3101701 161-33 +21
1702 370 -15 85 +02 +19 1801 264 151middot-50
185middot1802 256 +47-58
IJ ~
D_raphlc Population Change 1960 to 1970middot 49 (Contd)
4io
Census Tract
of pop Uncter 19 Yra
1Q1n
1Cha1l8e 1960-70
of PopOver 65 Yra
lQO Change
1960-70
19 389 +29 141 -24 20 223 -13 206 +18
21 227 +08 194 -36 2201 356 -27 112 +05
2202 290 -18 ll~9 -29 2301 356 -03 154 +24 2302 260 -37 245 +97
2401 410 +6~1 123 -31 2402 163 -80 320 +99 2501 381 +13 140 -01 25()2 237 31 lil +02 26 343 +25 186 +149 2701 370 +29 1S5 -01 2702 249 -44 304 +98 2801 337 +19 187 +09 2802 306 -10 156 +31 2901 304 -38 142 +24 2902 i 307 -32 146 t3~9
30 29~0 -48 16~2 +51
31 355 +30 160 +01 32 370 +48 148 -13 3301 395 +45 130 -20 3302 368 +06 138 -02 3401 386 +16 117 000
3402
400 +32 92 -26 3501 304 -07 115 +35
3502 344 000 140 -13
3601
36~02 357 -04 132 +32
3603 30~1 42 149 -67 3701 342 +28 152 +19
1
IJ
Jianolraphic Population Chan 1960 to 1970 50 (Contd)
Census Tract
of Pop Under 19 Yrs
JJl7J
middotChanae 1960-70
middotofmiddotpop Over 65 Yrs
1c~7n
Change 196070
3702 409 +39 122 -11 3801 308 -11 151 +29 3802 275 -35 180 +46 3803 282 -32 192 +54 3901 376 ~13 100 +17 3902 296 -03 177 +29 4001 438 -11 84 +13 4002 353 -21 115 +20
4101 397 11 9middot0 +11 4102 346 -19 120 +03 42 331 +19 11 bull 3 -16 43 347 -72 105 +31 44 113 +84 183 +154 4S 33~9 +07 110 -06 4601 2501 22 193 +38 4602 332 +59 126 -29 47middot 161middot 000 211 +01 48 103 -26 302 +59 49 138 +1 bull 3 252 +09 50 141 -26 204 -12 51 12 -39 257 +07 52 47 -61 351 +48 53 89 +49 314 -30 54 25 l1li15 327 -17 55 131 -17 115 -121 56 198 +93 227 -47 57 71 102 189 -88 58 240 ~middot41 16~1 +55 59 322 +25 142 +06middot 6001 264 95 132 +50
6002 328 -31middot 89 +07
JJ
Demographic Population Change 1960 to 1970 51 (Contd)
Census 1 ofPop lChange of Pop bull ChangeTract Under 19 Yrbullbull 1960-70 Over 65 Yrs 1960-70
1970 1970
61 355 -58 85 +39
62 328 39 110 +18
63 414 04 73 10
64 382 -22 72 +04
6501 383 02 67 -20
6502 329 -56 96 +09
6601 391 +13 88 -03
6602 319 -59 97 +06
6701 327 71 145 +72
6702 331 ~67 83 +1-0
6801 365 -66 49 +01
6802 388 4bull3 54 +06
69 354 -41 80 +23
70 400 -23 68 -06
71 359 -48 72 +05
72 255 -88 82 +11
73 346 -39 91 +25
74 313middot -63 105 +24
75 329 -42 129 +37
76 336 -52 85 +21
77 370 -10 69 +05
78 309 -10 120 +21
79 325 -56 87 +10
8001 358 -81 57 +12
8002 391 ~81 76 +12
81 315 -76 108 +21
8201 403 -23 64 +08
8202 392 23 65 +08
83 357 -34 120 +31
84 402 -18 73 +16
85 413 -06 76 -09
r
Demographic Population Change 1960 to 1970 52 (Contd)
Census Tract
t of Pop Uncler 19 Yrs
1970
Change 1960-70
1 of Pop OVer 65 Yrs
1970
ex Change 196070
86
87
88
89
90
91 9201
9202
93
94
95
9601
9602
9701
9702
9801
9802
99
100 I
101
102
103
10401
10402
lOS
368
351
379
391
391
413
379
433
372
429
414
432
419
439
~32
377
457 420
378 41middot7
345
360 417
417
412
-04
-02
-35
-26
-28
-11
-64
-20
-S9
-39
-32
-21
-34
-40
-47
-lO~7middot
-27middot +04
+56
+07
-34 01
+04
+04
+10
103
128
97
11il3 99
69
79
42
77
46
34 38
44
40
54
111
51middot
81
133
59
74
140
63
87
76
-08
-06
+04
+08
+17
-05
+3S -02
+1~4
+19
+33
-14
-08
+12
+26
+71
+11
-16 -34
-20
-19 +37
-49
-2S +15
NOte The The
Taken frOi
averageullder averageabove
middotUSCensus ---shy -
19 years == 6S years ==
figures 197
32r 13(14
p a~d 1960
--
Rank
1
2
3
4
5
6
7
8
9
10
11 12 -_
13
14
15
16
17
18
Tract
69 46
60
58
- 68
61
302
2501
67
63
19
62
26
94
3603
3902
64
30 -----~-
Rank
19
20
21 -
22
23-shy
24
25
26
27
28
29
30
31
32
33
34
35
36 -
Ranking of Per Capita Income by Census Tract
Tract
65
2701
- 15
1601
701
66
93
82
2903
3602
30
2502
80
2401
81
- 70
91 shy
4001
High
Rank Tractshy
-32shy37
38 97
120239
7840
41 ~ _2_1__ 42 31
43 2501
44 18
45 98
46 37
47 3803
1702
49
48
1602 92 2702
I
50 89
51 901
52 801
Ra_
53
54
55
56
57
58
59
60
61
62
63
64
6S
66
67
68
TractTract Ra~
74692
170196 70 I
401 71 90
72 1037J
79 70273
3802 74 601
24024102 75
85 76 101
77 9023901
7699 78 100 4101 79
3601 I
380180
458140~ t---- _ - - shy83 82 42
888384
59843501
4777 8~
502
Low
802 86
Rank Tract
87 shy
--88
89
90
91
92
93
94
- 95
96
97
middot98
99
100
101
102
103
104
1201
14
49
72
73
43
87
3502
105
1
52
86
71
1
501
10
3301
104 tf
Rank
105
106
107
108
109
110
III
112
113
114
115
116
117
118
119
120
121
Ranking of Per Capitalucoae by Census Tract
(Contd)
Tract Rank
4001 122--shy602
13
1102 2302
3302
55
3401
48
21
56
50
3402
lL01
2202
2301
53
2201
-shy
Tract Rank Tract Rank T~aet Rank
57 I-----
Imiddote
bull
Tract
- Low -k Note Information taken from 1960 U SCensus
Rank Tract
I ~
Ie
Imiddot
~
----
----
--
--
Rank
1
2
3
4
5
6
1
8
9
10
11
i-
-Tract
391 922 921
972 971
100
132 131 121
962 961
822 821 401
982 981
20 111
47 10 1
412
High
Total Number of Henta1 Health Visits
Ranked by Census Tract High to Low
TractTract RankTractRank Rnk
12 182 22 78 29 87 76 381 73181 ~------- 1913 371 8538230162372 271 2616-121 8272 2
14 80~2 31 94 7923 84801 59 15251362 4232 15 52 _ 32 103 8924 651 17240216 652
_ 91 351 33 341 23117 83 122 25 25 48 1123921418 34 shy61 86 661
19 662 6493 81 26 91 8153 49 50 55 41383 71 27 51 3120 90 672241 35shy 104167162 461
I 411 46211121 28 88342 I
2502 36 69 54 5251 50 272
-Ra
37
38
39
_ 40
_ 41 Ishy
I
42 I
-I 43 44
45
shy
Tract
~ --- shy 95 56
45 292 242
102 62 352 291y
92
101 281
99 72 63 601 60~ 42 2201
77 74 61 57
363 232
70
32 31
11 44 282 2202
Low l
- Tract
46 682 681 I 331 30
r~$ 47 1042 332
48 102_41_
11
~
Visits to Family Planning Clinics Ranked by Census Tract High to Low
Rank Tract Rank Tract Rankmiddot Tract Rank Tract Rank Tract Rank Tract
1
2
3
4
5
6
7
8
9
10
11
12
13middot
14
15
16
17
361
56
401
341
48
59 121
20
55
342
10
31
58
93 21
241 132
331
53
461 462
18
19
20-shy21
22
23
24
25
26
27middot
28
29
30
31
32
33
391
32
middot47 I-i-_-shy _ -
231 111
332
972 1
372 371
52
89
32
92
82
100 31
182
30 242
402
34
35
36
37
38
39
40
41
42
43
44
45
42
1714 i 661 221
78 362 2
90 602 601 352
63 251
105 921
971 351
73 42 292 232
411 51
662
81 45 52
46
47
48
49shy
50
51
52
53
54
55
56
961
801
49 81 72 71
19
9~1
172
68 2 57 162 14 112
91 75 681
381 42
3~3
83 161
57 f
58
59
60
61shy
62 Imiddot
63
Imiddot 64
65
66
64 62 36~3 252
74 652 SO 392 291
651 6bull 2
79 271
r-- ---- shy981 222
672 671
821 272
94 87
281
382
67
68
69
70
71
72
73
74
75
76
77
78
981 26 12~2
IS 61
85 82~2 69
61 43
101 86 84 282
76
131
51 72
1041 962 88 70
99 922 77
103
95 802 181
i
~
Low High
RankRank Tract
5479
4480
81 1042 ~) middot102
71 - - + ~ - ~
Visits to Family Planning Clinics
(Contd)
Tract Rank
I
Tract llaDk l
RankTract Tract Rank Tract
~
I
~
J1 ~
Low
Total Number of public Health Nursing Visits
Ranked by Census TractsHigh to Low
TractTract RankTractRank RankRank TractTractRankTractRank
25249 71 79 17249 8033 6586 99189711 84 2915072 34 661 76 66 811519512
402 5035 51 161 2518220 122 1713423 352 55801 7120 6752 2 149814 41236 83 2662 38 94 6821 53 2924015 362 37 32 42 75 69 281 84 63
546 8822 54 222 85 3925431 70383417 3818223 6439 4386652 718 21 55 103332 8924 232 87 19 271729219619 24156 16211140 382 628825 10523110 112 73411 10141-- ----shy 89 363 4457 8126 16111 221 74 9142 90 46158331 53 671279012 46243 48 59 351 3837528 1083 9313 91 5844 59 -_242 76 1----- shy60 272 72 74104114 60145 42 9287 7729 92 6151 8215 57371 934630 91 307762 12113116 282 619447 41391 9531 78100 63 7378 ~95 681 6945 32 5632 798517 6448 47 52 181
High ~ Low
Rank Tract Rank
96 31 132 70
97 102
98 182 372middot 602 651 662
- -shy
~72 682 802
822 922 962 972 982
1042 ----shy
Low
Total Number of Public Health Nursing Visits
(Contd)
Rank Rank Rank TractTract Tract
I
I lt
I
Tract Rank Tract
[
~~~-
I
~
IJilfimiddot ~
j
Ranking of VD Caea According to Census Tracts 61 By High and LOll Youth Itatio
A media~ of 34 5 was determined Any tract having greater
than 34 5~ of popu1tionunde~ 19 years of age -High~
Any tract having l8S than 345 of population under 19
years == Low
Any tract having rate less than 390 =Low
Any tract having rate more than 390 == HLgl4
YOUTH
LOW HIGH
L
0
12 402 1801 1802 343 2801 2802 29023603
54 6001 600262 66~02 72 74 75 76
78 79 81 t02 65 1202
W
(25)
VD
H
I
G
H
401 701 801802 901 902 10 1101 241 1201 1301 132 14 15 1601 1701 20~ 21 2202 2j02 2402 2502 2702 2901 303501 3502 34023801 3802 383 3902 42 44 45 4601 4602 47 48 49 SO 51~2 53 55 56 57 58 S9 6701 6702 73 95
3~02 7021702 19 25~01 2701 4102 4101 63 64601 ~601 6801 680270 7l 77 8001 80~02 8201 8202 83 84
85 86 87 88~ 90 91 9202 920193 94 9601 9602~ 9701 9102 9801 9802 99 100 101 103 10402 105 6501 10401
(47)
301 501 502 601 1602 2401 2301 2201 31 32 3301 3302 3401 3402~ 3602 3702 3901 400140 02 43 61 69 B(
(53) (23)
~ ~gt
Ranking of VD by Rate Per 100000 By Census Tract
~
Rank Tract Rank Tract Rank Tract Rank Tract llank Tract Rank Tract Rank Tract
1 2202 21 S6 40 902 58 1602 74 75
90-shy 64 107 26 --~-
2 3402 22 45 41 10 59 902 75 78 91 54 108 61
3 2301 23 3502 42 2502 60 602 76 6802 92 402 109 87
4 3302 24 49 43 1102 61 501 17 2 93 94 110 90
5 50 25 52 44 6702 62 14 78 8202 94 97 02 III 76
6 2201 26 20 6701 63 4002 8201 2501
9701 41~02 112 91
7 44 27 48 45 401 64 3802 2902 95 63 113 62
8 3301 28 1701 46 502 65 30 79 83 74 96 9602 114 71
9 55 29 47 47 42 66 3803 80 2801 96Q1 115 85 10
11
12
13
14
15
16
17
18
3401
53
2302
2401
57
21
2402
1101
51
30-shy31
32
33
34
35
36
37
3701 - -~ 1201
3702
89
43
132 131
3602
4001
48
49
50
51
52
53
54
55
58
1601
601
4602 4601
69
701
31
3901
67
68
69
70
71
72
2901
801
39021~ 802
6502 6501 122
702
41~01
81
82
83
84
85
86
87
88
19
1
1702
2802
79
93
100 6801 6602
81
97
98
99
100
101
102
103
104
9201 9202
9802 9801
77
302
79
86
72
84
116
117
118
119
120
121
3603
8002 8001
101
99
95
10401
105 10402 103 102
19
20
59
32
38
39
2702
3501
56
57
301
3801
73 1802 1801
89 6002 6001
105
106
2701
88
High Low
-- -----
Rank OrdermiddotTuberclosis Cases by Rate Per 100000 Ranked by Census Tract High to Low
Tract TractRankTractRank Rank TractRaukTractRankTractRank
801
79 9601501411 52 6835340120511 I 960269 903603532036 $-~~F130221542 4366 311301 70 68~013802 _ I- _ 4001_37213 3921201 6802802 H71523822024 22 54 193302 3802 80 8958 I37139535 70155 9801 I60123 72 6702 98023914011016 6701250124 10 56
81 94 401r 7 154152 73 7057 2625 122 92028
90242 162312301 92~158 86 7172434526509 82 79160159 74 100 87412240227220110 6502836960 75 30 8317244 6501782801285711 61 901 42765645 84 66021459294912 9701 660146 171 302 9702 47
6235023033113 85 822821182 917755 16335013110214 841814832 78 103 938564 324815 86 1057940149272 38036523216 10401 87 2902241 725Q 10402360266340217middot IF88 88 9937233 282 51 218 101 01102 46016234
I)167 2901460219 47
High ~ Low ~
- -
TractRank
9S89
6490
8191 8001 8002
63 61 60middot01 6002 44 2701
92
J
2502 402 --- ----shy
I
Rank
Rank Order Tuberculosis Cases by Rate per 100000
(Coutd)
Tract Rank Tract ~nk
I
Tract Ballk Tract Rank
Imiddot
Tract
Imiddot
1~
t 1I i Pi i l I
o
1 -1shyL I
I J
8 40 icO ~ I -lt 0
-t (1) I
i I
r o E
II
a
I
r--i
shy
I
~
I (
Jgt
(011 fi(
Ggt
I II ~j
()
(f 0
~ ()
I
11
f9
r
II 99
o ~
Ggt r
~ __-J~ I t I ~ I
r--J l I
~ _ __ J
) 1
fTl
1gt
r I
()
r
()
lt en -i en
()
I1l
(J)
(J)
-i
P ()
19
r o ~
r G1 I
I
c
~
o I 89
--- -I-shy
r-r I
1- 0 _~ _ _--J E
G1 I I I
i i
I 1-1-1 ~ _J ~2 ~ II
II
()
1 I I I 1
id i bullbull
~
A n 69
r 1shy
- 0 Gl
l--~ ~ I
~ II
II )
I () isect i
en l i
(J)
-t
0
IA Ol
hf
~
22
include PhYsiciaQs nursbullbullbullbull soc1al workers and outreach
workers Conceptually th8y fmlct10n to me~ the intershy
relate lled1cal and social needs ot the families sened
Hor there are a number ot barriers to the etfectve
tlmctiOD1nlof lIuchte8ll8 SODieot these are heavy caseshy
loads the inordiDate amount ot tille consumed by multlshy
prOblem tamtliethel1m1ted tra1n1 ngmiddotmiddotand laCk of tnterest
on tile part ot aoae tebers in examinJng aspects of
problems out14e~lr oWn areaaotcolIPetencemiddot and
~ourdcation prc)blell8 between proteasioDala and nonshy
prot81~s (10ppa-10) middotrurtbemOre as De Diaz
(14 middotp6)1nd1cate tbel8 maybe a teDdency tor vertical
dp8rtmental lines of auperv1810nto become paramount
over the team coDamloation syst lead1ngto conflIcts
in determ1niDI the ro1ea ot solie team bers particularly
the DOD-prote81011alaInauch exper1l1enta Witb new
~t1Dlpatterna it 1s bullbullaentialtbat line of authority
roles aDd NsP0D81bll1tlea be made explicit and that there
beJDechaD 8IUI tor relUlar evaluat1onotfunctlorUng
Another way inwb1ch health care sernee delivery can
be made more ett1cl8Dt is to proVide servicea dur1DC the
hours whentbey aremiddot -ostnee4ed As reQo_ded by Yarby
(37p1) serY1ce can bemadelIOre accesslble by making
themava1lable 24 hours a day seven days a week If
rg8l1Cy service are aft11ab1e aroua4-tbe-cloek at ~
nil1iborhood health center the continuity ot tbepat1ent ts
23
careiamaiDtalDedand meatry point into the
cOIIPre~i health care 8 be made available
tothe patient who aoZMllyU8ea ozilymiddot emergency care in
tille of med1cal criais More 8isDificantly ava11ab1-
lity of a tull rase of bullbullrv1c8 tor seVeral hours 11the
eVerlna aI1Cl On ~ prevent the los ot earn1JiSs
involved if th patierat 1IU8tt8cet1me oftfroawork dur1q
the d8y for aed1Cal oare bull his can be an eSpecially
importantc0J1814eration tor lo1aCOlleDUUg1nally qloYEtd
patient aa4caJla18o PIOJIOtet1)e 0Da01Dl use othealth
servicebullbull
exper1eDO ot tbeKa1er prosraa in tb1s~reprdAs
Greenl1clt(19 p10) states wA lllNt 8ip1flcant
proportion ot the abulatory care 8n1cp~Y1dd tor ~
total popUlatiC)U ~ ~ after clWc hours and this
Deed i8 apParenUyaoN prODGUDced tor aJl8d1cally
iDCust population On the other hand the bulk ot all
aabulatory med1cal cu 88l91ce are performed dur1nS
regular cl1D1c hour eVen when services are available 24
hours a dayJ day bull week W
It has ~ the experi8D~eof a ftIDber ot ne1g1lboXshy
hooct hea1tbcentere _t a_jor obstacle to efficient
proViSion ot anicbullbullhas beentbe teD4eDcy of medically
1ncl1pnt patieats to utilize the center oa a walk-in
baais tor epi8od1ccr181or1entect bullbullrv1cea rather than
4)i
h~ ~~f ~~ L
24
to make appoJlltaeata tor ODIo1qprevmt1ve treataent
and rehebl11tat1Ye care ad ampl1O to bave a blah failure
to Show rat_for tbe appo1DtaeDts that they dO make
Atone center 628 of appo1Dtments made were kept
while 3Oottbepati_ta een were ~1n patients
AlthoUP fewer patiets were actually 88811 by the cater
1D middottb1s 1Datance thaathe -bervholuidmadeappointshy
mta the walk-iD patlat required an iDord1nate amount
ot staff t1ae tor aCreeDiaaacl ~trral to pplOprlate
~ttor caregt (9 pgg) Arraquotbr1llpl1catjo~ of the
plOVidedto valk-iD patient by other thaD their
(19 p12)rurtbermore
when patients uti11ze Wlk-1Il er181 centered care
athelr ODlf tona ot ootact with the _d1~ care
ay_ta fUilycentered care the treata_t of tUl11y
bers
a a UD1t 11
dlarupted
hewalk-1Dphenoaaencm appear to barelated to
diUerence between soclal clase in the style of Dlaking
contactJt1th the a11oal C~ay8t As Greenlick f ~
(19 p11)1Dd1oate8 thepheDOaenOn ot INater usage of shy
walk-in ervice by aed10ally middot1Jid11ent patient thaD by
others baa otte been attr1buted to a stoical att1tude
tQward 1llDe8 em the~ ot poor people leacl1D8 to a
~
25
greaterdelay1n tbe k i Dlofa8d1cal care These
patients wppoedlyeelcmiddotcareODlymiddotwIleD tbeirmiddotillDess
becOlles1Dtolerable resultiDSin middotthMr appeariDS withshy
outnot1ce1o rece1ve oareHlwever Greenlicks
r8aearcbbaa cut doubt on the existence ot tb1delay
111 report1Dg middot8J1IPtoJumiddotOfDeW 11laessand seek1ng care
Be bas tcrQDd 1bat s1ll11ar peze_tases of dioally
1nd1sent 8DClJ1on-aed1cally 1Dd1PD~ pat1enta seek care
on the aue daytbat aptou tirstaPPear
1fb11e GrHDllclc 1nd1cat tbat the reasonator the
greatertendeDCY of low 1Do~e pat18Ilta to 1$8 walk-in I
serY1ces are notlcDo1rAmiddotmiddot tbe7 _ be rel~tedto a tendency
ot lower aocio-ecaaaoclaa patieota to preter face-toshy ~
face contacts with II841cal persoDl181posslbly because
such contacts areft coatortiDS an4reasauriDS to
patients who are hJpotbeafzed to bave a dependent attltude
toward IIed1Cal care perS0Jm81 (30 p161)
It a8 itmiddot baa pnerally beenhld the appointment
s1stemts the most efficient Ileana of dellveriDS
comprehenSive oODtllluiDlh-lth care (9~100)1t is
necessary that educaUoraalmiddotbulltfort be taken to proaote the
use ot middotappo1ntaents8DClmiddot tQrec1ucethe fa111re to appe~
ratB4uOatioaalwhlQb baft~utl11zedhave been
IJ
26
1Dten1ews with walk-in patients home Vi8its and group 4i
meetiDp1D8D attemptto1Dierpret1o the patients
the value of rtitgular ppo1ntmentamp andot con~in~
c~1ve care rather than epiI041c care (9 p1OO)
h1s 1safuD~tioD torwhtch nOl~prot81QDal colDlllUD1ty
YOrkersllaY bebe~r8U11ed tban other statf H()wever
euch aD ~ucat1oaal propul __~ ~e related to the senUiDe
capacity otth health oenter to provide comprehensivebull gt
ervice8 to1tpat1_t~odoD aD app01ntment bas18 It
1amp pos8ibleo~rw1 tor educa110Dal ttorts to result
LD a~8JImCl tor ltPP01ntaen~8 at a ratewb1ohi8beyond
the capacity ot thee_tar to t without uareaaoDably
1_ wa1t1Dlprio4a QOBt1nuad use Ot the center on a
wallt-in bU1 _1tbeoosiItpos81ble to et an appoint-
met anc11nCreued pit1entcoJaplampia1a bull Therew111 of
course always be a need and demand tor acute ep1so~c
Care -ci the health centerDlWlt be planned with the capashy
billty ot bullbullbullt1D8 tb1aneed wh1~ cont1Du1nI to stress
aDd educate the patient to utillze oDlOinI comprehensive
faa11y middotc~te~d Cflre (9p 100l
att g4 CODClva1opa
In order to bea4equate any coJlltemporary health care SY8tem muat bullbulletcerta1D interrelated criteria he
IJ
27
minimum criteria areaccessability of services to those
who need them compr8heX1siveness and appropriatness of
services and efficIency 1nthft utilizat~on of SCarce
health care personnel and resources The scareity of
pex-sonnel andtbe need for h1gh quality ongoinghealth
care services
aJIlong the
populationdemanci the most effishy
cientprovision of services
Services must be made accessible to the population
They mustmiddotbe geosraPh1cally accessible to remove the PhysicalmiddotbaTiers betWeen peopleandthem$d1calcare
system They mUst otter their services dur1ngthe
hours when people can make the moat use ofthemA~ it
makes little sense to concentrate services geographically
where they will not be uSed to their fUllest extent it
also is wasteful to provide serv1cesonlydur1righours when
many people are employed his not only presents a hard
ship middotto the consUmer lnrt wastes resources if for instance
the unavailability of preventive services during the hours
when people Can use them causes a need for treatment
services later on
Health carbull sEtrvices must be comprehensive including
prevention treatmcmtand re)abimiddot11tation Ambulatory I
healtbcare facilities wh1cQ are orienteciexclusively
toward either prevept1on or trea1mentare no longer accepshy
table for they are lneft1c1entln their use of resources
and in their prov1s1on of health care to the patient
w ~~
28
If prevent10n1s notmiddot stressed treatment serv1ces that
could have beenavoidedY1l~ be required If prevention
1s the sole focus of the health care facility sick
patients who present themselves must be referred elseshy
where for treatment andsllch referx-als may be taken as
reject1onsor not followed through with until illness
becomes unbearable
The instltutlontbat meets these requirements Is
the comprehensive neighborhood health center It 1s a
local decentralized outpatient facilityprOVld1ng a
fUll range of ambulatoJY health care services It has
a linkage to ahospitalbackUp facilityforlnpatient
treatment and hiihlY apclalized outpatient care
The neighborhood health center must be a fac11ity
planned with an awareness of the needs of the conSUtller
and coDitnUn1ty It must have the r~Ul0urces to provide the
services people need mere they can use them and when
they can use them It must uti11ze the part1cipation of
the community to develop this awareness Not only must
the cen~er beset up to be Amctional for the consumers
but efforts must bemadeaga1n with commun1ty partici shy
pation to help the consumers utilize medical care
services effectively The center muetmake efforts to
educate the community about the valueot regUlar health
care of preventive servicesand of the use of planned
IJ
29
medical appointments ratherthanorisis centered walk-
incare Therealit1es of the existing health care
system have not taught the patient particularly the low
income patienthow to use services effectively
The helthcenterilUst also bea laboratory for
experiments in easing the health caJepersonnel shortage
and c60rd1Datingcare~ A major difficultY iri-exper1shy
menting with neW rolesis freeing staff of old preconshy
ceptions
CoDlprehensiva neighborhood health dare centers have
been developed under a variety ot alisplces including
medicalsociet1es hoSP1talsmiddot(36p299 group pr~ct1ces
(29 p6- 12 117) health departments (13 p1027) and
ne1gbbothoodassoc1ations(14) The literature indicates
somevalues nthe management ot the health center by plusmnts
hospital backup faCility Whatever the auspices many
adm1nistrative fuDctions such as program coordination
standard pr9tectionand evaluation call for considerable
c~tralization of adm1nistration city-wide or coU)tyshy
wide At the same time other aspects hours of servlce
for examPle~ cuI f~radm1nistrative fUnctions made atmiddot
more local levels Each neighborhood center must be
free to adapt its functioning to itscominunity thi-ough
the mechanism otcODlllUl11~ participation inmiddot policy making
Obviouslythe prerogatives and responsibilities of each level must be negotiated and made explic1t
t4~
JJ
BIBLIOGRAPHY 30
1 American Rehabilitation Foundation ~ealth Services Research Center The Health Maintenance Strategy mimeo 1971
2 Anderson Nancy N Comprehensive Health Planning in the States A Study and Critical Analysis Institute for Interdisciplinary Studies American Rehab ilitation Foundation 1958
3 Andrus Len Hughes Comprehensive Health Planning Through Community Demonstration Health Projects mimeo1967
4 Barry Mildred CandCecil G Sheps A New Model for Community Health Planning unpublished paper presented to the American
Public Health Aseociation1967
5 Blum HenrikL Fred Wahl Genelle M Lemon Robert Jorulin and Glen W Kent The Multipurpose Worker and the Neighborhood Multiservice Center InitialImplications and EJeperiences of the Rodeo CommunityService CenterAmerican Journal of Public Health58 (Mar 168) pp 458-468 shy
6 Blum MichaelD and Soloman L Levy A Design for Service Delivery that Reinforces Constructive Tension Between a Health Center and Its (sic) ConSUDlers and Supports Community Power unpUblished paper presented to the American Public Health Asaociatiltn 1968
7 Brielaud Donald Comm~ity Advisory Boards and Maximum Feasible Participation American Journal of Public Health 61 (Feb 1971) pp 292-296 shy
8 Burns Eveline M Health Insurance Not If or When But What Kind Madison Wisco~sin University of WisconsinScllool of Soci~l Work 1971
9 Campbell John Working ~elationships Between Providers and Conshysumers in a Neighborhood Health CenterU American Journal2 Public Health 61 (Jan 1971) pp 97-103
10 Caxr Willene Neighborhood Health Centers Funded by the Office of Economic Opportunity mimeo 1970~
11 Colombo Theodore J Ernest W Sawardand Merwyn R Greenlick The Integration of an OEO Health Program into a Prepaid Comrehensive Group Practice Plan American Journal of Public Health 59 (April 1969) pp 641-650~ -
12 Comprehensive Neighborhood Health Services Projectof Kaiser FoundatioIl Hospital~ Prcgtgram YearE grant renewal proposal mimeo~1971 bull
13 CowenDavidL~ Denvers Neighborhood Health Program Public Health Reports 84 (Dec 1969) pp 1027-1031
IJ
14 De Diaz Sharon Daniel Beyond Rhetoric The NENA Health31 Center After One Year unpublished paper pres~rited to the American Public Health Association 1970
15middot Gerrie NorrrianF and RichardH~ Ferraro Organizing a Program for Dental Care in a Neighborhood Health Center Public Health Reports 8 (Aug 1968) pp 419-428
16 Gordon JeoffreyB~ The Politics of Community Medicine Projects A Conflict Analysis Medical Care 7 (Nov -Dec 1969) pp 419-428 shy
17 Greely David The Neighborhood Health Center Program and Its Implication(3 for Medical Care H~alth Forum of the Welfare Council of Metropolitan Chicago (mimeo) 1967
18 Greenlick Merwyn R Newgtimensions in Health Care American JOurnal of Pharmacentical Education 34 (Dec 1970) pp 754-4
19 GreenlickMerwyn R Donald K Freeborn TheodoreJbull Colombo Jeffrey Abull Pruesin and Erne$t W saw~d Comparing the
Use of Medical Care Services by a Medically Indigent and a General MemberShip Population in a Comprehensive Prepaid Group Practice Prosram II unpublished paper presented to the AmericanPublic Aesociation1970
20 H~tadoArJiloldVMerllYll RGreenlick and TheodoreJ Colombo Determinants of Medical Care Utilization Failure to Keep Appointments unpublished paper presented to the American Public Health Association 1971
21 Johnson Richard E and Merwyn R Greenlick Comprehensive Medical Care A Problem and Cballengeto Pharmacy ff AJilericanJournal of PbarmacenticalEducation 33 (Aug 1969) pp 361-367 -
22 Kahn Alfred J Studiee Social Policy and Planning New York Russell Sage Foundation 1969
23 Kotler Milton Neyhborhood Government Local Foundations 2 Political~New York The BobbsMerrill Company 1969
24 NationalCommisaion on CommunityHealthSfrvic~sActionPlanniriamp for Community SetithServices~ashington p C Public Affairs-Press 19t7
25 National Commission on C~mmunity Health Services Health Adminishysration andOrMPization l the Decade Ali9$-d Washington D C Public Affairs Press 1967
26 NationalCornmiesion onqomm1Jllity Health Servicesbull Health ~ Facilities Washington D C PUblic Affairs Press 1967 bull
~ n
32 27 ODonnell Edward J and Marilyn M Sullivan ServiceDelivery
and Social Action Through the Neighborhood Center A Review of Research tt Welfare ~ Review 7 (Nov~Dec 1969) pp 112
28 Office of Economic Opportunity Second Annual Report Washington D C~ U S Government Printing Office 1966
29 Office of EConomic Opportunity and the Medical Foundation of Be~laire Ohio Eighth Report 2l ~ Committee2a Governshy
ment OperatiOll~ Va8hiiiSton D C Government Printing Office 1969
30 Pope Clyde R Samuel S Yoshioka and Merwyn R Greenlick Determinants of Medical Care Utilization nhe Use of the Telephone for ReportiDg Symptons Journal of Health and SocialBebavior12 (June 1971) pp155-162 shy
31 RenthalA Gerald nComprehensive Health Centers in Large US Cities American Journal of Public Health 61 (Feb 1971) pp 324-336 shy
32 Saward Ernest W The Relevance of Prepaid Group Practice to the Effective Delivery ofHealthServicestt The New Physician 18 (Jan 1969) pp39-44 - shy
33bull Schorr Lisbeth Bamberger and Joseph T English Background Content and Significant IssUes in Neighborhood Health
Center Programs Milbank Memorial ~ Quarterly 46 July 1968) part 1pp 289-296
34 Weiss James E and Merwyn RGreenlick UDeterminants of MedioalCareUtilization The Effects of Social Class and Distance on Contacts With the Medical Care System Medical~ 8 (Nov-Dec 1970 pp 456-462
35 Weiss James E MerwynR Greenlick and Joseph F Jones Determinants of Medical Care Utilization The Impact of Ecological Factorstt unpublished paper presented to the American Public Health Association 1970
36 Wise Harold B Montefiore Hospital Neighborhood Medical Demonstration A Case StudyMilbaDkMemorial Fund Quarterly46 (July 1968) part 1 pp297-308~
37 Yerby Alonzo S ttHealth Departments Hospital and Health Services Medica1~5 (March-April 1967) pp 70-74
38 Young M M~ Chatanooga IS Experience with Reorganization fOr Delivery of Health Services ttAmerican Journ8l of Public Health60 (Sept 1970) pp 1739-1748
f or l
II bull 11 Y d
II
IJ
34
ThepurposeOfPart II of th1aa paper1atod1scuas
elected Speclfic needs ofecltlc areas within Multnomah
County A8P01ll~oUt 1D ~ I of t1a1bullpapermiddot Ita nelgbshy
borhood health oare cater IlU8t be a facl1lty plaDlled with
aD awarenes of the neeels of the oODllUller and collllUDity
Part II of this paper nIl Show 80e of thoe speclflc
needs
he1DforutiOD tor t1li Portlon of the report
obta1nec1 troll tbroupout tbe follow1Dl threepUb11catloDS
1gr~e_tiMshylIPrIxaiidOreson JuDe 1963
2 1~_middot_sectSI8e~ected1teai c-ua 0 S 8 e first count coaputer tape Coluab a_lion AssocshylatloD of QoveraMD-8 Jlme 1971
3 Jtu1tDoab County Oreaon BDY1roDlHtlltal SurveyEarly 1971
The JIultDOIIIlb COUDty OrttIOD BDv1roDllfmtal Surley
Barly 1971 1s bull stat1stical report of the activ1tles of
theentlreMultDOIIIl2 CcNDty Health Dep~t during the
year of 1970 Die speclflc 1nd1cs elected from tb1s
study amprejMental aealtll Publlc Health N~s1D1 vlslts
FaJUly ~ Veaereal])1 ~ ~rcul081
Throush tie use of cUrts and mapa ODe CaD roup these i
speclflc ~oea to ahcnr the healthneedsof speclfic I
census trtcta aD4 then the health needs of iarer neIghshy
borhooda 1m4 o~ Uebullbull
Rf)~UP1Dl of areu was accompllshed in thefolloWinl I
JJ ~
35
he MiltDoIliahCountY oregon BDViromaental SUrvey
early 1971 isamp statistical report ot tbeaotivities ot
the entire MultDolllh COUDty Health ])epartiDent dur1nl the
year ot1970 he specitic 1Dd1C8S selected frOm this
aUy are 1Il8Dtal health public healthDurs8s visits
fUl1ly pia waereal elisease aDd tuberculosia
Tbroq11the Wle otcbart aDd mapa aDecm szoup these
specific indic to show the health Deeds ofapecitic
ccmaua tracts aDdtIum th8health neecla of larsr ~eilh-
bOrhooda and co8I13 tlbullbullbull
RegroupiDI ot areas waa accoap118hed1D the
tollOWiDl lIIIIm1er~ A bullbullcifie 1ndex 8selectcl auch as
venereal di8bullbulle or tuberculo8i~ he total number ot
cs was then deterll1ne4 for each census tract Through
the use of the maber ot cRbullbullbull tor a 11Yen cenaus tract
aDd tbe population ot thattractaltrateot1lla1ampmcper
100OOOpopUlaticm wu cleteXll1ned for each census tract
This was ~e to starl4ard1ze the population ditterence
amongOeD8U8 -tracts 1he rate of incidence toreaob
cenauatract was then llstedby rank position on a chart
In rank poition1DI any cen8Wl tracts haviDg equal
rates ot1l1c1dence are assipe4tbe iaDk posttiona
Beeauseot the abo fact tbAt cbarta w111 vary in length
neveltbAtlea eacb cbart will 1Dclu4eall census tracts
inMullnoaah Couaty Atter the census tracts bave been
listed accord1q to raalcth1s list will bediv1ded into
IJ
36 three levelsotinc14ence he three levels are
1~ The upper 14 of1DcldenCe
2 Thelower 14 ot incidence
middot3 The ILld 12 of incidence
Tlles three srouplqa are then used in compiling a map ~f
Mu1tnOmahCountyfor ach apecltictop1cbull TIle maps are
uaefuJliD tbatthey V1suallycoJib1De 1Dd1v1Clualproblem
census tracts into larger problem nellhbOrhooc1s
The 1960 statistical iDtormatloD was Used in a similar
liIaDDr to tbatexpla1Dedabove 1Dthe4evelopaent of a
chartmiddot and map 1Ihow1DI e cOllpampriSOr1 of per capita lncolle
tor ttaCh ceDsua tJact aDdmiddot combiDed census middotmiddottract areas
he 1910 aDd 1960 statlstlcal iDtOrllatl0D was combined
lna map and chart he purpose of this and chart is
to d8aonatrate the e cl1stributloa1DeachceD8U8 tract
and middot1ndlcatbull tuture ace populatlon treD4a bull
When one be middotbullbullbullbullbullHdth ne8cts ot an area and has
declded to establlsh a cl1D1c to serve that area the
physical location otthat cl1D1c IllU8t be consldered In
order to coapreb8ll81vel develop an area cl1n1c one should
conslder thepre88Dttraftlc middot~ytaa an4tranaportatlon
systems Thecl1D1cahoUld be located close enoUlh to
major arterlals to giva asy access from the total area
be_ ervecl by this cliD1c At the t1ll8they should
be tar eo away froll thesarterlals to all8Y1ate traffic
CODCell18 andpark1D8 conpstlon By traff1c concerns I
IJ
37
lIlan one lUSt consider thertarro1fne8S of streets whether
streets are oD8--C)r two-way iqres8 and egress to parking
amp0111tie eros tratflC) spedof trattJQ children 1n
ll8a traffic i1lht Vislon re8tr1ctionS etc
BwstraDsportat1onshould alao be central in this area
as maay people ~U f1Df1 1tD8Cessary to use this form of
transportatlon
~e tutqredlopHQt of bull treewa systems should be
c0J1S1dered soastolesen thecumce ofmiddot future roada
cutt1DSotltbe cl1D1c llte line
nrrph1c middotDampta
It is 1JDportaDtto kDOw the demosraphic distribution
characteristics of the oUenteltbat i8 to be served by
localized health cl1D1cs
Acl1D1c which erves8J1 area where1D the prepondershy
ance of persona arecrter 65 years of mayf1nd that these
people rely more on pUblic transportation call for more
home- services and haV4t 110ft ChroD1c and debilitating
types of disorders (b1_ blood pressure poor heariDg and
eyesight) tbaD do8 an area ot a YOUDIer population On
the other hand thL area of older residents may have little
need for family plabDlng cllni08
In order to better ~Ybullbull the 4eaoraphic population
of each CeD8U8 tract the 1970 CeD8U8 iatormation was viewed
and two specific catelOri8 considered These two cat
IJ
38
lori8S woUld be the perc_tap ot population under 19
year of ase and the percentase ot each oensuetractover
65 years of age he 1960 1Dtormatlon tor eaCh tract was
then compared witbthe 1970 intormation and a percentage
ofincreaae or4ecreamp8 tormiddot e~chtract1n each category
cOJlputecland achartma4e By the use of this chart one
18 able to View tJleap populat1odiatr1but10n of census
tract and at the _ t1lle accesa middottrencl Por example
let us choose census tract 601 W see 40-4 otthe
population is under 19 years ot and that ODly82 1s
over 65 years ot middotAtthe e tille the percentage of
youth bas ~ed ODly 1_ intbe laSt teD year whilethe
percentale over 65 year ot middotbas stayedmiddotthe same With
this in mJnc1 ODe ~ 1DfItr libat ol1D1o aerviDg this
area WOuld bellQre conq~w1th the problems of a
YOUQier populat1on and that _ would probably be true foJ
some t1aein tbefuture On the other hand CeDSU8 tract 54
has only 2 ollt population UDder 19 yel1s ot age and
this has decreased by 1 over the last ten years middotwhile at
the same time 32-377 ot the populat1on 18 over 65 years of
age A ol1D1C ___ this area should be or1eJ1ted toward
tbespecttic problema otthe ampledbull
PerCapia __ bY gsa neat
WhaD cona1der1qlooat10D1 tor health cl1n1cs one
shoUld take the 1DC01Ieot areas into consideration Areas
IJ
39
of lowiDcome would not 11kel~be 8erved more by localized
cl1D1cs tbaD would are of hilbincome It 18 likely
people haYiq a hip iDeoll8would preter to be aeenby a
chosen ~r1vatephylc1a1l tban at a local cl1D1cwhere
10Dier waits y beraceaaampryand leas personal attention
gl_
The 19701ncOII81atoWampt10n tor MultnomahC~ty was
not available at the tille thi8report W88 made The 1Dto~shy
tiOD Was taken ~adtro tbe1960 census publlcation
his woUld ~8Il thea tbat ral1I8 OD the chart ynot 1raquoe
completely accurate hi writer telthatthe areas most
affected by tb8 1I8eof the older 1Dco1DtOlaat1oDWOuld be
those tracts wh1ch baYebad a rapid 1ncreaae1n populatlon
over the past tfmyHr8 bullbullbull tracts would include tracts
nUmbered 104 9897 96 aDd 95 be perc~ita 1Dcome
referredto1il-tb1a Paper18the lIean 1DCo per person per
census tract
Attar the iDeoeper census tract was listed on a chart
a map was de 1D41catiDg those census tracts belonging to
the lower 14 ot income tor all censue tracts in Multnomah
COlDltytbose beloqins to the upper 14 ot income tor all
census tract 111 MultnolUlhCounty and those belonging to
the mid 12 ot 1I1coaetor all oeuuetracts in Multnomah
C01mty
In yiew1Dg the _p 1t caa be seen that the low income
area seautotollow aloas the at aide ot the Wl1lamette
IJ
40
R1ver the full length of Kultnomah County A second low
income area follows the south edge of the Columbia from
the northwest corner of Multnomah County easterly to 148 St
A third problem area seems to be on the east bank of the
Willamette River with the Union Pacific Railroad being
about the center of this tract The extreme loutheast
corner of Multnomah COUDty appears to be a low income area
but as this area bas bad rapid grouth in the last ten years
this could be erroneous
Mental Health
be first ~ecific indica to be selected from the
Multnomah County envirollllental survey of early 1971 and
to be considered in this paper i8 that of Mental Health
At the present for mental health purposes Multnomah
County is divided into five catchmentareas with a mental
health cl1n1cin each area These clinics are Model
Citles Delaunay ADkeny street Office Hansen Health
Building end Southeast Clinic
All lIlental health cl1n1cslcept statlstlcal information
on all patients visiting their cl1n1cs this included the
address of the patient hese addresses were then listed
upon the approprlate C8D8US tract Each census tract was
then ranked on a chart according to the nUllber of mental
health patients who reslde ln thatCeDSUS tract attending
any of the above listed ental health clinics This chart
IJ
41
wasttum d1v14ed1ato proper quartile bbullbullbull
quartile vereUs to dne10 u appropl1ate Multnoh
County _tal health ItLa middotmiddotmiddotthelipO~a1bl by lOoJcJIUE
at the UDtal health _to uteN1De which ueu have the
lars-t use otCOllDty 1alh~th faci11t1Rot
1Ilclu4ecl 111 tbia woUld tber otpeopleYia1t1Da
pr1vat patch1atriata aDd pr1_t _ntalhealtb cl1D1c8
WheDtbe M1 18Yienclmiddot Itmiddotmiddotmiddotmiddot~middotbe~_ tbat ~rtt
appears to lMt fourmiddotmiddot-al are iii _oil the nuaber ot
lIental healthcl1D1c na1t toM tbjh1sheat 1he
tour areaa woUld be tollows
1ttrea Ore to~Blo Drimiddot ~tb Burrus14e aDd tIMtmiddot Colb1a Riftr H1gbwyaeri1Dla th nortllra boundaryshy
2 bull ProII 82D4 1_~ 10 20th streetwitil the ra1lMd Mu the north ltouadary
3 ~ et et tUgl_b1bull MYel froamiddot the Clackaaa COUDty l1ae aorth to Dln8lon stret
4 beDOlvt1ttfe-t ~efllt4 COatytrca Jle1aware streetmiddot toR1C1a11oDd wlth Colubla Blvd heiDI tbAtnorth bouaclary_
It ODe coapareatbiap to th iDeobullbullmiddotp 1t can be
eamiddotthat lIOat ot the c tracts baY1Dg bllh v1i11tatlcma
middottfl public tal health cJ1rUc8 ~ 111 t13e low ~ aid
1DcOile SroupiDIOJa1y of til 25 tracta llsted as
haviDlbip aental Maltll nlltatlou are ~ the1g60 hip
iDeo arebullbullbull
17 Plpn
42
amily PlellnSDI ]Jlce Metal Health i8 an 1nd1ce of
use Theperson 111 ordertobavebe_ 1Dcluclecl 1n this
atu4ywouldhave tohaft Ue4 ataa11y plaDI cl1D1c
tacilities of soaetype It 41fter troll tile _tal health
study1nthat i t1Jicludestatist1catrollbotb public and
privateclJD1os
The iDformation tor the iak orurcbart 8Dd map of
t8ll111 plenn1 na ob1a1De4 by cOIIblnlDlthe mabel of
1rlcuv1duals bullbull_ attbe tbreellUltrampo-ti Coatyhll11y
PlalJQllIl C11ll10s 111til tbo at the Planned PareDthood
Association CliD1C8 be tbree -JIultDouh Couaty r8ldly
PlamSq Cl1D1c are Solrtbweatth Col_bla 1111- a114
HaDsell Health BWlcl1Dl CllD1cbi middot1Dtormat1oD vas then
bullbullbullesed tomiddot detellWMt l10w people troll eacb c8IUIUS
chart wastben Mele IUs oIIart jn 4iY1ded to show
the censuS tracts lIaYiDlmiddottIle h1t1iest qUart1le of incidence
of use lowest quartile of 1Qc1deao ot use Jlid 12 of
incidence of Wle an4 a map sprepared troll thts 1Dto~
mation
The C8U118 tractsbelOJISnl to the h1lhestquartile of
use appear to be 1lO~ 8catt~ on tbipwas true ot
either the _p ot aental health cl1D1c uaageor ot the map
abow1DI per capita 1I1COM Iaere40 to be three
d18t1nct areas of UIIaP beJ woul4 be
1
IJ
43
t10D of BurD81cl and the W11lallette River 4
2 S~t Portland 8Otth otmiddot the ra11shyrcaadand alona the W11lamette River
lIortbeaat Portl8D4 between MisSiss1pp1 and 24tbStreet the northbouBclary be1DgColwb1aBlvd
Pylzl1c BMltl IrpI Y11ta
Publlc Healtil nur81D1Y1s1t nclud8 an vists to
theholles of client by PubUc Health Nurbullbullbullbull his shows
visits to bull f8Jl1ly fer aDY purpos SUCh aatuberculolJ1s
het1Dl tem1tyaeatalu4 8IiOt10D8l cODd1t1ona etc
he atat18t1C~ 1fele C()4ed accord1Dg tomiddot the 1llli301fOCUS
of the Y18lt tt doe DOt 1D41cate the Dmlber of holies or
f8ll11lev181tecl or 1D41Y14ual Y1a1ted more tban oDcein
the propwl It dobullbull I1ve 80M 1D41cat1on by coaparlshy
OD ot the 8JIoUDt of aedlcal problema 1n eachcen8WI tract
Ap1nmiddot the _p abowa 8 scatter patteraof probl_
areas althoUSh there appear to be a sroup1Dl of hiSh J
l8aIeccmaus tract 1ntlut extreme southeast part of tbe
County other areu uIriaI any nura1Dl contacts are
1 bull he 801lth-oa-al CO1Dty on eaCh 814 of 82nd Av from Clackallaa County north to Dinloa
2 ear bullbullbullt 814e aroUDd Preacottand Misaisippi
Dowatom Bunul14eonboth 1de of the river
44
V_real Pis The iDfomatloil uaec1 to tabulate the Venereal
disease chart includes all the ooab1ned case otmiddotODormea
and syphilIs reported by bothmiddot publIc and prIvate physicIans
dur1nl 1970 There were 3602 caes ot IOnorrhea reported
dur1nl 1970 While ODly 17 cabullbullsot ayphilimiddot were reported
A chart was prepUed aDd att8llPt wasmiddotmiddot de tomiddot
determ1De Wh_therVttDereal 41ease was more p~vaJent in
areas othigb or lowmiddot proportIon ot youth hi waadone
bymiddotdetemlna a 1leaD prceiltacmiddotmiddotmiddottor the population ot
resld~ts UDder19 years ot (34) middotA mean ratemiddot per
100000 popUlatIon al80c1ttem1Ded tor the middotoccurreDCe
ot venereal dieae This was et at 390 oass Areas
hav1nl a population 1n which leiS than 34 were lmder 19
years ot ampIe were called low- yOuth abOve tbl percentaae
hiSh youth The aaa waatrue ot the occurrence oivenershy
eal disea_ per CeD8UStract It the rate waacomputed
as 1I0re than 390 cases per 100000 it was called hiah
venerealdiaeasei it less than thia tisure low venereal
disease It was tound that 1D Multn~ COmlty there sems
to be poSitive OOlatI0n(x21S19gt between low youth
and hipmiddot venereal diseaand hip youth and low venereal
diseasebull
RaDk ordr Iitot all c traot middottbAm made
Th1s was done byt1Ddlna the ratepr 100000 populatIon
of venereal disator all census tracts in the County bull
45
These were thenlisted from h1lhto low (sreatest to
least) in a rank order The l1sting was then divided
into Upperandlower 14 aDd listed on the MUltnomah
Countymiddot up
The areas of b1gh venereal disease se8ll18to
roup thBl~8 middotin a very tllht area ~oq both 1des
of thell18l8~ R1 w1th BurDaldeS~et being
~bout theceDter qf tbi8IZ9uping This area woUld
appear to be m ldeal spot for the denlopment of a
locallzed venereal d1sbullbullbullbull cl1D1c
UbepoundCUlO1s
In this report bull tube1C1llosls caS8S refrred
to include alltbobullbull cabullbulls ontubercUlo8is follow-up
rather middotthan just new C Accord1Ds to the Multnomah
County Health SUrvey of early 1971 this would include
all ca repOrte4 over thelaat three years The
total number of tuberculosi8 cabullbullbull usedin this study
was 666 lh1 included 128 new cabullbullbullbull
A rate per 100000 of tuberculosis for each
census tract wa- then computed and the c~us tracts
listed by rank order be b11h Qartlle mel low
quartl1 were then reoordd on a Multnomah CoUnty map
TWo genral areaa baY1Dg a hip mcldencaot tubercu~
losiare 1D41cated heyare
1 Both middotsld ot theWilla11lette River
Ll -
46
with Burns1de about thecnter
2 he extrea Northebullbullt comer of the County bull
By coap8r1ng the tuberculois an4ven8real
diseae maps ODe can 8ee that the downtown areas ot
hiSh 1nc1denceare alIIo8t 1c1eDt1cal on ach map
This WOuld 1nd1cate that 1t would be of value to
bullbulltab11sh acl1D1c 111 th1aampreatbat would provide
bothtuberCulos1s 8Dd ytmereal 418ase srvicbullbullbull
Thchart aDd 1181gt8 are wsfuln 11v1DI
1Ddicat10DS tor the type aDd placemeototlocal
health cl1n1c8 tbro1qhout tbe MultnomahCounty area
A cOllpar1on of the mapa help one to dec1dewhether
to provide a aulti-8ervice cl1D1c or spec1f1c type of
cliD1c As stated in Part I of thi paprserv1ces
shouldhaYe both treatlieDt and prfMmt10n cOmponents
As he been stated fta ne1lbborhood health care
Qenter muat be a fac111tY plazme4 with an aamesa
ot the neds of the consumer and the c01llll1m1tybull
Part II of this rport haa been an attaapt to indicate
and clarify 8011 ottheae coDlllUDity neds This has
been done through8elect10n of apc1f1c problems
The indic were then visuallyrecorded through the
use of ups and charta ODe dan asseS8 thedsreeof
1DIportance of certain concems to spec~t1c areaa by
comparinl the chart aDd maps Prom this oDeean
41 dec1de which are48 vb1chcUD1c-or indeed if
the need a clinic at all However further factors
should be considered hebullbull include
a The amount of fuDd1 available
b What 18 the percentage ot peopleineoh ceaaua tract tbat would actually us such cl1n1cIl
c Wbat 1 tbeco--1tymiddot 8 IeeliDashyreaardtDI particular cl1D1c8 Would this dcrebullbullbullmiddot the ettctiveness ot thse cl1n1ca
IJ
li
D_OlraphicPopulatLon Challie 1960 to 1970 48
Cen8U8 1 of Pop 1 Cbaqemiddot 1 Change1 ofPopTract Under 19 Yr8 Over 65 Yrs1960-70 1960-70
middot1Q701Q70
1 319 -12 171 -H) 1
2722 215-27 +68 301 366 -22 127 +35 302 371 +19 111 -04
311middot401 144-41 +29 402 321 13~7-39 +24 501 356 124-08 -02 5~O2 351 133-23 +12
405601 82-10 -02 394602 103-01 -06
701 275 149-76 +56 702 361 +01 121 -07
+10middot801 326 140-22 802 321 middot127
(
-29 -03 9~01 342 124 -H) 6-18 902 294 128 -H) 3-24
10middotmiddot -14312 140 -17 1101 182 +25 -23197
2411102 186-59 +29 1201 226 169-17 -41
31middot01202 +11 182 -05 295 -H) 81301 208 -H) 4
1302 331 +08 197 +04
14 323 +15 middot185 -08 middotmiddot15 329 +16 16~5 -13
-28middot 1601 332 131 +12
1602 356 98 +24middot-39 middot3101701 161-33 +21
1702 370 -15 85 +02 +19 1801 264 151middot-50
185middot1802 256 +47-58
IJ ~
D_raphlc Population Change 1960 to 1970middot 49 (Contd)
4io
Census Tract
of pop Uncter 19 Yra
1Q1n
1Cha1l8e 1960-70
of PopOver 65 Yra
lQO Change
1960-70
19 389 +29 141 -24 20 223 -13 206 +18
21 227 +08 194 -36 2201 356 -27 112 +05
2202 290 -18 ll~9 -29 2301 356 -03 154 +24 2302 260 -37 245 +97
2401 410 +6~1 123 -31 2402 163 -80 320 +99 2501 381 +13 140 -01 25()2 237 31 lil +02 26 343 +25 186 +149 2701 370 +29 1S5 -01 2702 249 -44 304 +98 2801 337 +19 187 +09 2802 306 -10 156 +31 2901 304 -38 142 +24 2902 i 307 -32 146 t3~9
30 29~0 -48 16~2 +51
31 355 +30 160 +01 32 370 +48 148 -13 3301 395 +45 130 -20 3302 368 +06 138 -02 3401 386 +16 117 000
3402
400 +32 92 -26 3501 304 -07 115 +35
3502 344 000 140 -13
3601
36~02 357 -04 132 +32
3603 30~1 42 149 -67 3701 342 +28 152 +19
1
IJ
Jianolraphic Population Chan 1960 to 1970 50 (Contd)
Census Tract
of Pop Under 19 Yrs
JJl7J
middotChanae 1960-70
middotofmiddotpop Over 65 Yrs
1c~7n
Change 196070
3702 409 +39 122 -11 3801 308 -11 151 +29 3802 275 -35 180 +46 3803 282 -32 192 +54 3901 376 ~13 100 +17 3902 296 -03 177 +29 4001 438 -11 84 +13 4002 353 -21 115 +20
4101 397 11 9middot0 +11 4102 346 -19 120 +03 42 331 +19 11 bull 3 -16 43 347 -72 105 +31 44 113 +84 183 +154 4S 33~9 +07 110 -06 4601 2501 22 193 +38 4602 332 +59 126 -29 47middot 161middot 000 211 +01 48 103 -26 302 +59 49 138 +1 bull 3 252 +09 50 141 -26 204 -12 51 12 -39 257 +07 52 47 -61 351 +48 53 89 +49 314 -30 54 25 l1li15 327 -17 55 131 -17 115 -121 56 198 +93 227 -47 57 71 102 189 -88 58 240 ~middot41 16~1 +55 59 322 +25 142 +06middot 6001 264 95 132 +50
6002 328 -31middot 89 +07
JJ
Demographic Population Change 1960 to 1970 51 (Contd)
Census 1 ofPop lChange of Pop bull ChangeTract Under 19 Yrbullbull 1960-70 Over 65 Yrs 1960-70
1970 1970
61 355 -58 85 +39
62 328 39 110 +18
63 414 04 73 10
64 382 -22 72 +04
6501 383 02 67 -20
6502 329 -56 96 +09
6601 391 +13 88 -03
6602 319 -59 97 +06
6701 327 71 145 +72
6702 331 ~67 83 +1-0
6801 365 -66 49 +01
6802 388 4bull3 54 +06
69 354 -41 80 +23
70 400 -23 68 -06
71 359 -48 72 +05
72 255 -88 82 +11
73 346 -39 91 +25
74 313middot -63 105 +24
75 329 -42 129 +37
76 336 -52 85 +21
77 370 -10 69 +05
78 309 -10 120 +21
79 325 -56 87 +10
8001 358 -81 57 +12
8002 391 ~81 76 +12
81 315 -76 108 +21
8201 403 -23 64 +08
8202 392 23 65 +08
83 357 -34 120 +31
84 402 -18 73 +16
85 413 -06 76 -09
r
Demographic Population Change 1960 to 1970 52 (Contd)
Census Tract
t of Pop Uncler 19 Yrs
1970
Change 1960-70
1 of Pop OVer 65 Yrs
1970
ex Change 196070
86
87
88
89
90
91 9201
9202
93
94
95
9601
9602
9701
9702
9801
9802
99
100 I
101
102
103
10401
10402
lOS
368
351
379
391
391
413
379
433
372
429
414
432
419
439
~32
377
457 420
378 41middot7
345
360 417
417
412
-04
-02
-35
-26
-28
-11
-64
-20
-S9
-39
-32
-21
-34
-40
-47
-lO~7middot
-27middot +04
+56
+07
-34 01
+04
+04
+10
103
128
97
11il3 99
69
79
42
77
46
34 38
44
40
54
111
51middot
81
133
59
74
140
63
87
76
-08
-06
+04
+08
+17
-05
+3S -02
+1~4
+19
+33
-14
-08
+12
+26
+71
+11
-16 -34
-20
-19 +37
-49
-2S +15
NOte The The
Taken frOi
averageullder averageabove
middotUSCensus ---shy -
19 years == 6S years ==
figures 197
32r 13(14
p a~d 1960
--
Rank
1
2
3
4
5
6
7
8
9
10
11 12 -_
13
14
15
16
17
18
Tract
69 46
60
58
- 68
61
302
2501
67
63
19
62
26
94
3603
3902
64
30 -----~-
Rank
19
20
21 -
22
23-shy
24
25
26
27
28
29
30
31
32
33
34
35
36 -
Ranking of Per Capita Income by Census Tract
Tract
65
2701
- 15
1601
701
66
93
82
2903
3602
30
2502
80
2401
81
- 70
91 shy
4001
High
Rank Tractshy
-32shy37
38 97
120239
7840
41 ~ _2_1__ 42 31
43 2501
44 18
45 98
46 37
47 3803
1702
49
48
1602 92 2702
I
50 89
51 901
52 801
Ra_
53
54
55
56
57
58
59
60
61
62
63
64
6S
66
67
68
TractTract Ra~
74692
170196 70 I
401 71 90
72 1037J
79 70273
3802 74 601
24024102 75
85 76 101
77 9023901
7699 78 100 4101 79
3601 I
380180
458140~ t---- _ - - shy83 82 42
888384
59843501
4777 8~
502
Low
802 86
Rank Tract
87 shy
--88
89
90
91
92
93
94
- 95
96
97
middot98
99
100
101
102
103
104
1201
14
49
72
73
43
87
3502
105
1
52
86
71
1
501
10
3301
104 tf
Rank
105
106
107
108
109
110
III
112
113
114
115
116
117
118
119
120
121
Ranking of Per Capitalucoae by Census Tract
(Contd)
Tract Rank
4001 122--shy602
13
1102 2302
3302
55
3401
48
21
56
50
3402
lL01
2202
2301
53
2201
-shy
Tract Rank Tract Rank T~aet Rank
57 I-----
Imiddote
bull
Tract
- Low -k Note Information taken from 1960 U SCensus
Rank Tract
I ~
Ie
Imiddot
~
----
----
--
--
Rank
1
2
3
4
5
6
1
8
9
10
11
i-
-Tract
391 922 921
972 971
100
132 131 121
962 961
822 821 401
982 981
20 111
47 10 1
412
High
Total Number of Henta1 Health Visits
Ranked by Census Tract High to Low
TractTract RankTractRank Rnk
12 182 22 78 29 87 76 381 73181 ~------- 1913 371 8538230162372 271 2616-121 8272 2
14 80~2 31 94 7923 84801 59 15251362 4232 15 52 _ 32 103 8924 651 17240216 652
_ 91 351 33 341 23117 83 122 25 25 48 1123921418 34 shy61 86 661
19 662 6493 81 26 91 8153 49 50 55 41383 71 27 51 3120 90 672241 35shy 104167162 461
I 411 46211121 28 88342 I
2502 36 69 54 5251 50 272
-Ra
37
38
39
_ 40
_ 41 Ishy
I
42 I
-I 43 44
45
shy
Tract
~ --- shy 95 56
45 292 242
102 62 352 291y
92
101 281
99 72 63 601 60~ 42 2201
77 74 61 57
363 232
70
32 31
11 44 282 2202
Low l
- Tract
46 682 681 I 331 30
r~$ 47 1042 332
48 102_41_
11
~
Visits to Family Planning Clinics Ranked by Census Tract High to Low
Rank Tract Rank Tract Rankmiddot Tract Rank Tract Rank Tract Rank Tract
1
2
3
4
5
6
7
8
9
10
11
12
13middot
14
15
16
17
361
56
401
341
48
59 121
20
55
342
10
31
58
93 21
241 132
331
53
461 462
18
19
20-shy21
22
23
24
25
26
27middot
28
29
30
31
32
33
391
32
middot47 I-i-_-shy _ -
231 111
332
972 1
372 371
52
89
32
92
82
100 31
182
30 242
402
34
35
36
37
38
39
40
41
42
43
44
45
42
1714 i 661 221
78 362 2
90 602 601 352
63 251
105 921
971 351
73 42 292 232
411 51
662
81 45 52
46
47
48
49shy
50
51
52
53
54
55
56
961
801
49 81 72 71
19
9~1
172
68 2 57 162 14 112
91 75 681
381 42
3~3
83 161
57 f
58
59
60
61shy
62 Imiddot
63
Imiddot 64
65
66
64 62 36~3 252
74 652 SO 392 291
651 6bull 2
79 271
r-- ---- shy981 222
672 671
821 272
94 87
281
382
67
68
69
70
71
72
73
74
75
76
77
78
981 26 12~2
IS 61
85 82~2 69
61 43
101 86 84 282
76
131
51 72
1041 962 88 70
99 922 77
103
95 802 181
i
~
Low High
RankRank Tract
5479
4480
81 1042 ~) middot102
71 - - + ~ - ~
Visits to Family Planning Clinics
(Contd)
Tract Rank
I
Tract llaDk l
RankTract Tract Rank Tract
~
I
~
J1 ~
Low
Total Number of public Health Nursing Visits
Ranked by Census TractsHigh to Low
TractTract RankTractRank RankRank TractTractRankTractRank
25249 71 79 17249 8033 6586 99189711 84 2915072 34 661 76 66 811519512
402 5035 51 161 2518220 122 1713423 352 55801 7120 6752 2 149814 41236 83 2662 38 94 6821 53 2924015 362 37 32 42 75 69 281 84 63
546 8822 54 222 85 3925431 70383417 3818223 6439 4386652 718 21 55 103332 8924 232 87 19 271729219619 24156 16211140 382 628825 10523110 112 73411 10141-- ----shy 89 363 4457 8126 16111 221 74 9142 90 46158331 53 671279012 46243 48 59 351 3837528 1083 9313 91 5844 59 -_242 76 1----- shy60 272 72 74104114 60145 42 9287 7729 92 6151 8215 57371 934630 91 307762 12113116 282 619447 41391 9531 78100 63 7378 ~95 681 6945 32 5632 798517 6448 47 52 181
High ~ Low
Rank Tract Rank
96 31 132 70
97 102
98 182 372middot 602 651 662
- -shy
~72 682 802
822 922 962 972 982
1042 ----shy
Low
Total Number of Public Health Nursing Visits
(Contd)
Rank Rank Rank TractTract Tract
I
I lt
I
Tract Rank Tract
[
~~~-
I
~
IJilfimiddot ~
j
Ranking of VD Caea According to Census Tracts 61 By High and LOll Youth Itatio
A media~ of 34 5 was determined Any tract having greater
than 34 5~ of popu1tionunde~ 19 years of age -High~
Any tract having l8S than 345 of population under 19
years == Low
Any tract having rate less than 390 =Low
Any tract having rate more than 390 == HLgl4
YOUTH
LOW HIGH
L
0
12 402 1801 1802 343 2801 2802 29023603
54 6001 600262 66~02 72 74 75 76
78 79 81 t02 65 1202
W
(25)
VD
H
I
G
H
401 701 801802 901 902 10 1101 241 1201 1301 132 14 15 1601 1701 20~ 21 2202 2j02 2402 2502 2702 2901 303501 3502 34023801 3802 383 3902 42 44 45 4601 4602 47 48 49 SO 51~2 53 55 56 57 58 S9 6701 6702 73 95
3~02 7021702 19 25~01 2701 4102 4101 63 64601 ~601 6801 680270 7l 77 8001 80~02 8201 8202 83 84
85 86 87 88~ 90 91 9202 920193 94 9601 9602~ 9701 9102 9801 9802 99 100 101 103 10402 105 6501 10401
(47)
301 501 502 601 1602 2401 2301 2201 31 32 3301 3302 3401 3402~ 3602 3702 3901 400140 02 43 61 69 B(
(53) (23)
~ ~gt
Ranking of VD by Rate Per 100000 By Census Tract
~
Rank Tract Rank Tract Rank Tract Rank Tract llank Tract Rank Tract Rank Tract
1 2202 21 S6 40 902 58 1602 74 75
90-shy 64 107 26 --~-
2 3402 22 45 41 10 59 902 75 78 91 54 108 61
3 2301 23 3502 42 2502 60 602 76 6802 92 402 109 87
4 3302 24 49 43 1102 61 501 17 2 93 94 110 90
5 50 25 52 44 6702 62 14 78 8202 94 97 02 III 76
6 2201 26 20 6701 63 4002 8201 2501
9701 41~02 112 91
7 44 27 48 45 401 64 3802 2902 95 63 113 62
8 3301 28 1701 46 502 65 30 79 83 74 96 9602 114 71
9 55 29 47 47 42 66 3803 80 2801 96Q1 115 85 10
11
12
13
14
15
16
17
18
3401
53
2302
2401
57
21
2402
1101
51
30-shy31
32
33
34
35
36
37
3701 - -~ 1201
3702
89
43
132 131
3602
4001
48
49
50
51
52
53
54
55
58
1601
601
4602 4601
69
701
31
3901
67
68
69
70
71
72
2901
801
39021~ 802
6502 6501 122
702
41~01
81
82
83
84
85
86
87
88
19
1
1702
2802
79
93
100 6801 6602
81
97
98
99
100
101
102
103
104
9201 9202
9802 9801
77
302
79
86
72
84
116
117
118
119
120
121
3603
8002 8001
101
99
95
10401
105 10402 103 102
19
20
59
32
38
39
2702
3501
56
57
301
3801
73 1802 1801
89 6002 6001
105
106
2701
88
High Low
-- -----
Rank OrdermiddotTuberclosis Cases by Rate Per 100000 Ranked by Census Tract High to Low
Tract TractRankTractRank Rank TractRaukTractRankTractRank
801
79 9601501411 52 6835340120511 I 960269 903603532036 $-~~F130221542 4366 311301 70 68~013802 _ I- _ 4001_37213 3921201 6802802 H71523822024 22 54 193302 3802 80 8958 I37139535 70155 9801 I60123 72 6702 98023914011016 6701250124 10 56
81 94 401r 7 154152 73 7057 2625 122 92028
90242 162312301 92~158 86 7172434526509 82 79160159 74 100 87412240227220110 6502836960 75 30 8317244 6501782801285711 61 901 42765645 84 66021459294912 9701 660146 171 302 9702 47
6235023033113 85 822821182 917755 16335013110214 841814832 78 103 938564 324815 86 1057940149272 38036523216 10401 87 2902241 725Q 10402360266340217middot IF88 88 9937233 282 51 218 101 01102 46016234
I)167 2901460219 47
High ~ Low ~
- -
TractRank
9S89
6490
8191 8001 8002
63 61 60middot01 6002 44 2701
92
J
2502 402 --- ----shy
I
Rank
Rank Order Tuberculosis Cases by Rate per 100000
(Coutd)
Tract Rank Tract ~nk
I
Tract Ballk Tract Rank
Imiddot
Tract
Imiddot
1~
t 1I i Pi i l I
o
1 -1shyL I
I J
8 40 icO ~ I -lt 0
-t (1) I
i I
r o E
II
a
I
r--i
shy
I
~
I (
Jgt
(011 fi(
Ggt
I II ~j
()
(f 0
~ ()
I
11
f9
r
II 99
o ~
Ggt r
~ __-J~ I t I ~ I
r--J l I
~ _ __ J
) 1
fTl
1gt
r I
()
r
()
lt en -i en
()
I1l
(J)
(J)
-i
P ()
19
r o ~
r G1 I
I
c
~
o I 89
--- -I-shy
r-r I
1- 0 _~ _ _--J E
G1 I I I
i i
I 1-1-1 ~ _J ~2 ~ II
II
()
1 I I I 1
id i bullbull
~
A n 69
r 1shy
- 0 Gl
l--~ ~ I
~ II
II )
I () isect i
en l i
(J)
-t
0
IA Ol
23
careiamaiDtalDedand meatry point into the
cOIIPre~i health care 8 be made available
tothe patient who aoZMllyU8ea ozilymiddot emergency care in
tille of med1cal criais More 8isDificantly ava11ab1-
lity of a tull rase of bullbullrv1c8 tor seVeral hours 11the
eVerlna aI1Cl On ~ prevent the los ot earn1JiSs
involved if th patierat 1IU8tt8cet1me oftfroawork dur1q
the d8y for aed1Cal oare bull his can be an eSpecially
importantc0J1814eration tor lo1aCOlleDUUg1nally qloYEtd
patient aa4caJla18o PIOJIOtet1)e 0Da01Dl use othealth
servicebullbull
exper1eDO ot tbeKa1er prosraa in tb1s~reprdAs
Greenl1clt(19 p10) states wA lllNt 8ip1flcant
proportion ot the abulatory care 8n1cp~Y1dd tor ~
total popUlatiC)U ~ ~ after clWc hours and this
Deed i8 apParenUyaoN prODGUDced tor aJl8d1cally
iDCust population On the other hand the bulk ot all
aabulatory med1cal cu 88l91ce are performed dur1nS
regular cl1D1c hour eVen when services are available 24
hours a dayJ day bull week W
It has ~ the experi8D~eof a ftIDber ot ne1g1lboXshy
hooct hea1tbcentere _t a_jor obstacle to efficient
proViSion ot anicbullbullhas beentbe teD4eDcy of medically
1ncl1pnt patieats to utilize the center oa a walk-in
baais tor epi8od1ccr181or1entect bullbullrv1cea rather than
4)i
h~ ~~f ~~ L
24
to make appoJlltaeata tor ODIo1qprevmt1ve treataent
and rehebl11tat1Ye care ad ampl1O to bave a blah failure
to Show rat_for tbe appo1DtaeDts that they dO make
Atone center 628 of appo1Dtments made were kept
while 3Oottbepati_ta een were ~1n patients
AlthoUP fewer patiets were actually 88811 by the cater
1D middottb1s 1Datance thaathe -bervholuidmadeappointshy
mta the walk-iD patlat required an iDord1nate amount
ot staff t1ae tor aCreeDiaaacl ~trral to pplOprlate
~ttor caregt (9 pgg) Arraquotbr1llpl1catjo~ of the
plOVidedto valk-iD patient by other thaD their
(19 p12)rurtbermore
when patients uti11ze Wlk-1Il er181 centered care
athelr ODlf tona ot ootact with the _d1~ care
ay_ta fUilycentered care the treata_t of tUl11y
bers
a a UD1t 11
dlarupted
hewalk-1Dphenoaaencm appear to barelated to
diUerence between soclal clase in the style of Dlaking
contactJt1th the a11oal C~ay8t As Greenlick f ~
(19 p11)1Dd1oate8 thepheDOaenOn ot INater usage of shy
walk-in ervice by aed10ally middot1Jid11ent patient thaD by
others baa otte been attr1buted to a stoical att1tude
tQward 1llDe8 em the~ ot poor people leacl1D8 to a
~
25
greaterdelay1n tbe k i Dlofa8d1cal care These
patients wppoedlyeelcmiddotcareODlymiddotwIleD tbeirmiddotillDess
becOlles1Dtolerable resultiDSin middotthMr appeariDS withshy
outnot1ce1o rece1ve oareHlwever Greenlicks
r8aearcbbaa cut doubt on the existence ot tb1delay
111 report1Dg middot8J1IPtoJumiddotOfDeW 11laessand seek1ng care
Be bas tcrQDd 1bat s1ll11ar peze_tases of dioally
1nd1sent 8DClJ1on-aed1cally 1Dd1PD~ pat1enta seek care
on the aue daytbat aptou tirstaPPear
1fb11e GrHDllclc 1nd1cat tbat the reasonator the
greatertendeDCY of low 1Do~e pat18Ilta to 1$8 walk-in I
serY1ces are notlcDo1rAmiddotmiddot tbe7 _ be rel~tedto a tendency
ot lower aocio-ecaaaoclaa patieota to preter face-toshy ~
face contacts with II841cal persoDl181posslbly because
such contacts areft coatortiDS an4reasauriDS to
patients who are hJpotbeafzed to bave a dependent attltude
toward IIed1Cal care perS0Jm81 (30 p161)
It a8 itmiddot baa pnerally beenhld the appointment
s1stemts the most efficient Ileana of dellveriDS
comprehenSive oODtllluiDlh-lth care (9~100)1t is
necessary that educaUoraalmiddotbulltfort be taken to proaote the
use ot middotappo1ntaents8DClmiddot tQrec1ucethe fa111re to appe~
ratB4uOatioaalwhlQb baft~utl11zedhave been
IJ
26
1Dten1ews with walk-in patients home Vi8its and group 4i
meetiDp1D8D attemptto1Dierpret1o the patients
the value of rtitgular ppo1ntmentamp andot con~in~
c~1ve care rather than epiI041c care (9 p1OO)
h1s 1safuD~tioD torwhtch nOl~prot81QDal colDlllUD1ty
YOrkersllaY bebe~r8U11ed tban other statf H()wever
euch aD ~ucat1oaal propul __~ ~e related to the senUiDe
capacity otth health oenter to provide comprehensivebull gt
ervice8 to1tpat1_t~odoD aD app01ntment bas18 It
1amp pos8ibleo~rw1 tor educa110Dal ttorts to result
LD a~8JImCl tor ltPP01ntaen~8 at a ratewb1ohi8beyond
the capacity ot thee_tar to t without uareaaoDably
1_ wa1t1Dlprio4a QOBt1nuad use Ot the center on a
wallt-in bU1 _1tbeoosiItpos81ble to et an appoint-
met anc11nCreued pit1entcoJaplampia1a bull Therew111 of
course always be a need and demand tor acute ep1so~c
Care -ci the health centerDlWlt be planned with the capashy
billty ot bullbullbullt1D8 tb1aneed wh1~ cont1Du1nI to stress
aDd educate the patient to utillze oDlOinI comprehensive
faa11y middotc~te~d Cflre (9p 100l
att g4 CODClva1opa
In order to bea4equate any coJlltemporary health care SY8tem muat bullbulletcerta1D interrelated criteria he
IJ
27
minimum criteria areaccessability of services to those
who need them compr8heX1siveness and appropriatness of
services and efficIency 1nthft utilizat~on of SCarce
health care personnel and resources The scareity of
pex-sonnel andtbe need for h1gh quality ongoinghealth
care services
aJIlong the
populationdemanci the most effishy
cientprovision of services
Services must be made accessible to the population
They mustmiddotbe geosraPh1cally accessible to remove the PhysicalmiddotbaTiers betWeen peopleandthem$d1calcare
system They mUst otter their services dur1ngthe
hours when people can make the moat use ofthemA~ it
makes little sense to concentrate services geographically
where they will not be uSed to their fUllest extent it
also is wasteful to provide serv1cesonlydur1righours when
many people are employed his not only presents a hard
ship middotto the consUmer lnrt wastes resources if for instance
the unavailability of preventive services during the hours
when people Can use them causes a need for treatment
services later on
Health carbull sEtrvices must be comprehensive including
prevention treatmcmtand re)abimiddot11tation Ambulatory I
healtbcare facilities wh1cQ are orienteciexclusively
toward either prevept1on or trea1mentare no longer accepshy
table for they are lneft1c1entln their use of resources
and in their prov1s1on of health care to the patient
w ~~
28
If prevent10n1s notmiddot stressed treatment serv1ces that
could have beenavoidedY1l~ be required If prevention
1s the sole focus of the health care facility sick
patients who present themselves must be referred elseshy
where for treatment andsllch referx-als may be taken as
reject1onsor not followed through with until illness
becomes unbearable
The instltutlontbat meets these requirements Is
the comprehensive neighborhood health center It 1s a
local decentralized outpatient facilityprOVld1ng a
fUll range of ambulatoJY health care services It has
a linkage to ahospitalbackUp facilityforlnpatient
treatment and hiihlY apclalized outpatient care
The neighborhood health center must be a fac11ity
planned with an awareness of the needs of the conSUtller
and coDitnUn1ty It must have the r~Ul0urces to provide the
services people need mere they can use them and when
they can use them It must uti11ze the part1cipation of
the community to develop this awareness Not only must
the cen~er beset up to be Amctional for the consumers
but efforts must bemadeaga1n with commun1ty partici shy
pation to help the consumers utilize medical care
services effectively The center muetmake efforts to
educate the community about the valueot regUlar health
care of preventive servicesand of the use of planned
IJ
29
medical appointments ratherthanorisis centered walk-
incare Therealit1es of the existing health care
system have not taught the patient particularly the low
income patienthow to use services effectively
The helthcenterilUst also bea laboratory for
experiments in easing the health caJepersonnel shortage
and c60rd1Datingcare~ A major difficultY iri-exper1shy
menting with neW rolesis freeing staff of old preconshy
ceptions
CoDlprehensiva neighborhood health dare centers have
been developed under a variety ot alisplces including
medicalsociet1es hoSP1talsmiddot(36p299 group pr~ct1ces
(29 p6- 12 117) health departments (13 p1027) and
ne1gbbothoodassoc1ations(14) The literature indicates
somevalues nthe management ot the health center by plusmnts
hospital backup faCility Whatever the auspices many
adm1nistrative fuDctions such as program coordination
standard pr9tectionand evaluation call for considerable
c~tralization of adm1nistration city-wide or coU)tyshy
wide At the same time other aspects hours of servlce
for examPle~ cuI f~radm1nistrative fUnctions made atmiddot
more local levels Each neighborhood center must be
free to adapt its functioning to itscominunity thi-ough
the mechanism otcODlllUl11~ participation inmiddot policy making
Obviouslythe prerogatives and responsibilities of each level must be negotiated and made explic1t
t4~
JJ
BIBLIOGRAPHY 30
1 American Rehabilitation Foundation ~ealth Services Research Center The Health Maintenance Strategy mimeo 1971
2 Anderson Nancy N Comprehensive Health Planning in the States A Study and Critical Analysis Institute for Interdisciplinary Studies American Rehab ilitation Foundation 1958
3 Andrus Len Hughes Comprehensive Health Planning Through Community Demonstration Health Projects mimeo1967
4 Barry Mildred CandCecil G Sheps A New Model for Community Health Planning unpublished paper presented to the American
Public Health Aseociation1967
5 Blum HenrikL Fred Wahl Genelle M Lemon Robert Jorulin and Glen W Kent The Multipurpose Worker and the Neighborhood Multiservice Center InitialImplications and EJeperiences of the Rodeo CommunityService CenterAmerican Journal of Public Health58 (Mar 168) pp 458-468 shy
6 Blum MichaelD and Soloman L Levy A Design for Service Delivery that Reinforces Constructive Tension Between a Health Center and Its (sic) ConSUDlers and Supports Community Power unpUblished paper presented to the American Public Health Asaociatiltn 1968
7 Brielaud Donald Comm~ity Advisory Boards and Maximum Feasible Participation American Journal of Public Health 61 (Feb 1971) pp 292-296 shy
8 Burns Eveline M Health Insurance Not If or When But What Kind Madison Wisco~sin University of WisconsinScllool of Soci~l Work 1971
9 Campbell John Working ~elationships Between Providers and Conshysumers in a Neighborhood Health CenterU American Journal2 Public Health 61 (Jan 1971) pp 97-103
10 Caxr Willene Neighborhood Health Centers Funded by the Office of Economic Opportunity mimeo 1970~
11 Colombo Theodore J Ernest W Sawardand Merwyn R Greenlick The Integration of an OEO Health Program into a Prepaid Comrehensive Group Practice Plan American Journal of Public Health 59 (April 1969) pp 641-650~ -
12 Comprehensive Neighborhood Health Services Projectof Kaiser FoundatioIl Hospital~ Prcgtgram YearE grant renewal proposal mimeo~1971 bull
13 CowenDavidL~ Denvers Neighborhood Health Program Public Health Reports 84 (Dec 1969) pp 1027-1031
IJ
14 De Diaz Sharon Daniel Beyond Rhetoric The NENA Health31 Center After One Year unpublished paper pres~rited to the American Public Health Association 1970
15middot Gerrie NorrrianF and RichardH~ Ferraro Organizing a Program for Dental Care in a Neighborhood Health Center Public Health Reports 8 (Aug 1968) pp 419-428
16 Gordon JeoffreyB~ The Politics of Community Medicine Projects A Conflict Analysis Medical Care 7 (Nov -Dec 1969) pp 419-428 shy
17 Greely David The Neighborhood Health Center Program and Its Implication(3 for Medical Care H~alth Forum of the Welfare Council of Metropolitan Chicago (mimeo) 1967
18 Greenlick Merwyn R Newgtimensions in Health Care American JOurnal of Pharmacentical Education 34 (Dec 1970) pp 754-4
19 GreenlickMerwyn R Donald K Freeborn TheodoreJbull Colombo Jeffrey Abull Pruesin and Erne$t W saw~d Comparing the
Use of Medical Care Services by a Medically Indigent and a General MemberShip Population in a Comprehensive Prepaid Group Practice Prosram II unpublished paper presented to the AmericanPublic Aesociation1970
20 H~tadoArJiloldVMerllYll RGreenlick and TheodoreJ Colombo Determinants of Medical Care Utilization Failure to Keep Appointments unpublished paper presented to the American Public Health Association 1971
21 Johnson Richard E and Merwyn R Greenlick Comprehensive Medical Care A Problem and Cballengeto Pharmacy ff AJilericanJournal of PbarmacenticalEducation 33 (Aug 1969) pp 361-367 -
22 Kahn Alfred J Studiee Social Policy and Planning New York Russell Sage Foundation 1969
23 Kotler Milton Neyhborhood Government Local Foundations 2 Political~New York The BobbsMerrill Company 1969
24 NationalCommisaion on CommunityHealthSfrvic~sActionPlanniriamp for Community SetithServices~ashington p C Public Affairs-Press 19t7
25 National Commission on C~mmunity Health Services Health Adminishysration andOrMPization l the Decade Ali9$-d Washington D C Public Affairs Press 1967
26 NationalCornmiesion onqomm1Jllity Health Servicesbull Health ~ Facilities Washington D C PUblic Affairs Press 1967 bull
~ n
32 27 ODonnell Edward J and Marilyn M Sullivan ServiceDelivery
and Social Action Through the Neighborhood Center A Review of Research tt Welfare ~ Review 7 (Nov~Dec 1969) pp 112
28 Office of Economic Opportunity Second Annual Report Washington D C~ U S Government Printing Office 1966
29 Office of EConomic Opportunity and the Medical Foundation of Be~laire Ohio Eighth Report 2l ~ Committee2a Governshy
ment OperatiOll~ Va8hiiiSton D C Government Printing Office 1969
30 Pope Clyde R Samuel S Yoshioka and Merwyn R Greenlick Determinants of Medical Care Utilization nhe Use of the Telephone for ReportiDg Symptons Journal of Health and SocialBebavior12 (June 1971) pp155-162 shy
31 RenthalA Gerald nComprehensive Health Centers in Large US Cities American Journal of Public Health 61 (Feb 1971) pp 324-336 shy
32 Saward Ernest W The Relevance of Prepaid Group Practice to the Effective Delivery ofHealthServicestt The New Physician 18 (Jan 1969) pp39-44 - shy
33bull Schorr Lisbeth Bamberger and Joseph T English Background Content and Significant IssUes in Neighborhood Health
Center Programs Milbank Memorial ~ Quarterly 46 July 1968) part 1pp 289-296
34 Weiss James E and Merwyn RGreenlick UDeterminants of MedioalCareUtilization The Effects of Social Class and Distance on Contacts With the Medical Care System Medical~ 8 (Nov-Dec 1970 pp 456-462
35 Weiss James E MerwynR Greenlick and Joseph F Jones Determinants of Medical Care Utilization The Impact of Ecological Factorstt unpublished paper presented to the American Public Health Association 1970
36 Wise Harold B Montefiore Hospital Neighborhood Medical Demonstration A Case StudyMilbaDkMemorial Fund Quarterly46 (July 1968) part 1 pp297-308~
37 Yerby Alonzo S ttHealth Departments Hospital and Health Services Medica1~5 (March-April 1967) pp 70-74
38 Young M M~ Chatanooga IS Experience with Reorganization fOr Delivery of Health Services ttAmerican Journ8l of Public Health60 (Sept 1970) pp 1739-1748
f or l
II bull 11 Y d
II
IJ
34
ThepurposeOfPart II of th1aa paper1atod1scuas
elected Speclfic needs ofecltlc areas within Multnomah
County A8P01ll~oUt 1D ~ I of t1a1bullpapermiddot Ita nelgbshy
borhood health oare cater IlU8t be a facl1lty plaDlled with
aD awarenes of the neeels of the oODllUller and collllUDity
Part II of this paper nIl Show 80e of thoe speclflc
needs
he1DforutiOD tor t1li Portlon of the report
obta1nec1 troll tbroupout tbe follow1Dl threepUb11catloDS
1gr~e_tiMshylIPrIxaiidOreson JuDe 1963
2 1~_middot_sectSI8e~ected1teai c-ua 0 S 8 e first count coaputer tape Coluab a_lion AssocshylatloD of QoveraMD-8 Jlme 1971
3 Jtu1tDoab County Oreaon BDY1roDlHtlltal SurveyEarly 1971
The JIultDOIIIlb COUDty OrttIOD BDv1roDllfmtal Surley
Barly 1971 1s bull stat1stical report of the activ1tles of
theentlreMultDOIIIl2 CcNDty Health Dep~t during the
year of 1970 Die speclflc 1nd1cs elected from tb1s
study amprejMental aealtll Publlc Health N~s1D1 vlslts
FaJUly ~ Veaereal])1 ~ ~rcul081
Throush tie use of cUrts and mapa ODe CaD roup these i
speclflc ~oea to ahcnr the healthneedsof speclfic I
census trtcta aD4 then the health needs of iarer neIghshy
borhooda 1m4 o~ Uebullbull
Rf)~UP1Dl of areu was accompllshed in thefolloWinl I
JJ ~
35
he MiltDoIliahCountY oregon BDViromaental SUrvey
early 1971 isamp statistical report ot tbeaotivities ot
the entire MultDolllh COUDty Health ])epartiDent dur1nl the
year ot1970 he specitic 1Dd1C8S selected frOm this
aUy are 1Il8Dtal health public healthDurs8s visits
fUl1ly pia waereal elisease aDd tuberculosia
Tbroq11the Wle otcbart aDd mapa aDecm szoup these
specific indic to show the health Deeds ofapecitic
ccmaua tracts aDdtIum th8health neecla of larsr ~eilh-
bOrhooda and co8I13 tlbullbullbull
RegroupiDI ot areas waa accoap118hed1D the
tollOWiDl lIIIIm1er~ A bullbullcifie 1ndex 8selectcl auch as
venereal di8bullbulle or tuberculo8i~ he total number ot
cs was then deterll1ne4 for each census tract Through
the use of the maber ot cRbullbullbull tor a 11Yen cenaus tract
aDd tbe population ot thattractaltrateot1lla1ampmcper
100OOOpopUlaticm wu cleteXll1ned for each census tract
This was ~e to starl4ard1ze the population ditterence
amongOeD8U8 -tracts 1he rate of incidence toreaob
cenauatract was then llstedby rank position on a chart
In rank poition1DI any cen8Wl tracts haviDg equal
rates ot1l1c1dence are assipe4tbe iaDk posttiona
Beeauseot the abo fact tbAt cbarta w111 vary in length
neveltbAtlea eacb cbart will 1Dclu4eall census tracts
inMullnoaah Couaty Atter the census tracts bave been
listed accord1q to raalcth1s list will bediv1ded into
IJ
36 three levelsotinc14ence he three levels are
1~ The upper 14 of1DcldenCe
2 Thelower 14 ot incidence
middot3 The ILld 12 of incidence
Tlles three srouplqa are then used in compiling a map ~f
Mu1tnOmahCountyfor ach apecltictop1cbull TIle maps are
uaefuJliD tbatthey V1suallycoJib1De 1Dd1v1Clualproblem
census tracts into larger problem nellhbOrhooc1s
The 1960 statistical iDtormatloD was Used in a similar
liIaDDr to tbatexpla1Dedabove 1Dthe4evelopaent of a
chartmiddot and map 1Ihow1DI e cOllpampriSOr1 of per capita lncolle
tor ttaCh ceDsua tJact aDdmiddot combiDed census middotmiddottract areas
he 1910 aDd 1960 statlstlcal iDtOrllatl0D was combined
lna map and chart he purpose of this and chart is
to d8aonatrate the e cl1stributloa1DeachceD8U8 tract
and middot1ndlcatbull tuture ace populatlon treD4a bull
When one be middotbullbullbullbullbullHdth ne8cts ot an area and has
declded to establlsh a cl1D1c to serve that area the
physical location otthat cl1D1c IllU8t be consldered In
order to coapreb8ll81vel develop an area cl1n1c one should
conslder thepre88Dttraftlc middot~ytaa an4tranaportatlon
systems Thecl1D1cahoUld be located close enoUlh to
major arterlals to giva asy access from the total area
be_ ervecl by this cliD1c At the t1ll8they should
be tar eo away froll thesarterlals to all8Y1ate traffic
CODCell18 andpark1D8 conpstlon By traff1c concerns I
IJ
37
lIlan one lUSt consider thertarro1fne8S of streets whether
streets are oD8--C)r two-way iqres8 and egress to parking
amp0111tie eros tratflC) spedof trattJQ children 1n
ll8a traffic i1lht Vislon re8tr1ctionS etc
BwstraDsportat1onshould alao be central in this area
as maay people ~U f1Df1 1tD8Cessary to use this form of
transportatlon
~e tutqredlopHQt of bull treewa systems should be
c0J1S1dered soastolesen thecumce ofmiddot future roada
cutt1DSotltbe cl1D1c llte line
nrrph1c middotDampta
It is 1JDportaDtto kDOw the demosraphic distribution
characteristics of the oUenteltbat i8 to be served by
localized health cl1D1cs
Acl1D1c which erves8J1 area where1D the prepondershy
ance of persona arecrter 65 years of mayf1nd that these
people rely more on pUblic transportation call for more
home- services and haV4t 110ft ChroD1c and debilitating
types of disorders (b1_ blood pressure poor heariDg and
eyesight) tbaD do8 an area ot a YOUDIer population On
the other hand thL area of older residents may have little
need for family plabDlng cllni08
In order to better ~Ybullbull the 4eaoraphic population
of each CeD8U8 tract the 1970 CeD8U8 iatormation was viewed
and two specific catelOri8 considered These two cat
IJ
38
lori8S woUld be the perc_tap ot population under 19
year of ase and the percentase ot each oensuetractover
65 years of age he 1960 1Dtormatlon tor eaCh tract was
then compared witbthe 1970 intormation and a percentage
ofincreaae or4ecreamp8 tormiddot e~chtract1n each category
cOJlputecland achartma4e By the use of this chart one
18 able to View tJleap populat1odiatr1but10n of census
tract and at the _ t1lle accesa middottrencl Por example
let us choose census tract 601 W see 40-4 otthe
population is under 19 years ot and that ODly82 1s
over 65 years ot middotAtthe e tille the percentage of
youth bas ~ed ODly 1_ intbe laSt teD year whilethe
percentale over 65 year ot middotbas stayedmiddotthe same With
this in mJnc1 ODe ~ 1DfItr libat ol1D1o aerviDg this
area WOuld bellQre conq~w1th the problems of a
YOUQier populat1on and that _ would probably be true foJ
some t1aein tbefuture On the other hand CeDSU8 tract 54
has only 2 ollt population UDder 19 yel1s ot age and
this has decreased by 1 over the last ten years middotwhile at
the same time 32-377 ot the populat1on 18 over 65 years of
age A ol1D1C ___ this area should be or1eJ1ted toward
tbespecttic problema otthe ampledbull
PerCapia __ bY gsa neat
WhaD cona1der1qlooat10D1 tor health cl1n1cs one
shoUld take the 1DC01Ieot areas into consideration Areas
IJ
39
of lowiDcome would not 11kel~be 8erved more by localized
cl1D1cs tbaD would are of hilbincome It 18 likely
people haYiq a hip iDeoll8would preter to be aeenby a
chosen ~r1vatephylc1a1l tban at a local cl1D1cwhere
10Dier waits y beraceaaampryand leas personal attention
gl_
The 19701ncOII81atoWampt10n tor MultnomahC~ty was
not available at the tille thi8report W88 made The 1Dto~shy
tiOD Was taken ~adtro tbe1960 census publlcation
his woUld ~8Il thea tbat ral1I8 OD the chart ynot 1raquoe
completely accurate hi writer telthatthe areas most
affected by tb8 1I8eof the older 1Dco1DtOlaat1oDWOuld be
those tracts wh1ch baYebad a rapid 1ncreaae1n populatlon
over the past tfmyHr8 bullbullbull tracts would include tracts
nUmbered 104 9897 96 aDd 95 be perc~ita 1Dcome
referredto1il-tb1a Paper18the lIean 1DCo per person per
census tract
Attar the iDeoeper census tract was listed on a chart
a map was de 1D41catiDg those census tracts belonging to
the lower 14 ot income tor all censue tracts in Multnomah
COlDltytbose beloqins to the upper 14 ot income tor all
census tract 111 MultnolUlhCounty and those belonging to
the mid 12 ot 1I1coaetor all oeuuetracts in Multnomah
C01mty
In yiew1Dg the _p 1t caa be seen that the low income
area seautotollow aloas the at aide ot the Wl1lamette
IJ
40
R1ver the full length of Kultnomah County A second low
income area follows the south edge of the Columbia from
the northwest corner of Multnomah County easterly to 148 St
A third problem area seems to be on the east bank of the
Willamette River with the Union Pacific Railroad being
about the center of this tract The extreme loutheast
corner of Multnomah COUDty appears to be a low income area
but as this area bas bad rapid grouth in the last ten years
this could be erroneous
Mental Health
be first ~ecific indica to be selected from the
Multnomah County envirollllental survey of early 1971 and
to be considered in this paper i8 that of Mental Health
At the present for mental health purposes Multnomah
County is divided into five catchmentareas with a mental
health cl1n1cin each area These clinics are Model
Citles Delaunay ADkeny street Office Hansen Health
Building end Southeast Clinic
All lIlental health cl1n1cslcept statlstlcal information
on all patients visiting their cl1n1cs this included the
address of the patient hese addresses were then listed
upon the approprlate C8D8US tract Each census tract was
then ranked on a chart according to the nUllber of mental
health patients who reslde ln thatCeDSUS tract attending
any of the above listed ental health clinics This chart
IJ
41
wasttum d1v14ed1ato proper quartile bbullbullbull
quartile vereUs to dne10 u appropl1ate Multnoh
County _tal health ItLa middotmiddotmiddotthelipO~a1bl by lOoJcJIUE
at the UDtal health _to uteN1De which ueu have the
lars-t use otCOllDty 1alh~th faci11t1Rot
1Ilclu4ecl 111 tbia woUld tber otpeopleYia1t1Da
pr1vat patch1atriata aDd pr1_t _ntalhealtb cl1D1c8
WheDtbe M1 18Yienclmiddot Itmiddotmiddotmiddotmiddot~middotbe~_ tbat ~rtt
appears to lMt fourmiddotmiddot-al are iii _oil the nuaber ot
lIental healthcl1D1c na1t toM tbjh1sheat 1he
tour areaa woUld be tollows
1ttrea Ore to~Blo Drimiddot ~tb Burrus14e aDd tIMtmiddot Colb1a Riftr H1gbwyaeri1Dla th nortllra boundaryshy
2 bull ProII 82D4 1_~ 10 20th streetwitil the ra1lMd Mu the north ltouadary
3 ~ et et tUgl_b1bull MYel froamiddot the Clackaaa COUDty l1ae aorth to Dln8lon stret
4 beDOlvt1ttfe-t ~efllt4 COatytrca Jle1aware streetmiddot toR1C1a11oDd wlth Colubla Blvd heiDI tbAtnorth bouaclary_
It ODe coapareatbiap to th iDeobullbullmiddotp 1t can be
eamiddotthat lIOat ot the c tracts baY1Dg bllh v1i11tatlcma
middottfl public tal health cJ1rUc8 ~ 111 t13e low ~ aid
1DcOile SroupiDIOJa1y of til 25 tracta llsted as
haviDlbip aental Maltll nlltatlou are ~ the1g60 hip
iDeo arebullbullbull
17 Plpn
42
amily PlellnSDI ]Jlce Metal Health i8 an 1nd1ce of
use Theperson 111 ordertobavebe_ 1Dcluclecl 1n this
atu4ywouldhave tohaft Ue4 ataa11y plaDI cl1D1c
tacilities of soaetype It 41fter troll tile _tal health
study1nthat i t1Jicludestatist1catrollbotb public and
privateclJD1os
The iDformation tor the iak orurcbart 8Dd map of
t8ll111 plenn1 na ob1a1De4 by cOIIblnlDlthe mabel of
1rlcuv1duals bullbull_ attbe tbreellUltrampo-ti Coatyhll11y
PlalJQllIl C11ll10s 111til tbo at the Planned PareDthood
Association CliD1C8 be tbree -JIultDouh Couaty r8ldly
PlamSq Cl1D1c are Solrtbweatth Col_bla 1111- a114
HaDsell Health BWlcl1Dl CllD1cbi middot1Dtormat1oD vas then
bullbullbullesed tomiddot detellWMt l10w people troll eacb c8IUIUS
chart wastben Mele IUs oIIart jn 4iY1ded to show
the censuS tracts lIaYiDlmiddottIle h1t1iest qUart1le of incidence
of use lowest quartile of 1Qc1deao ot use Jlid 12 of
incidence of Wle an4 a map sprepared troll thts 1Dto~
mation
The C8U118 tractsbelOJISnl to the h1lhestquartile of
use appear to be 1lO~ 8catt~ on tbipwas true ot
either the _p ot aental health cl1D1c uaageor ot the map
abow1DI per capita 1I1COM Iaere40 to be three
d18t1nct areas of UIIaP beJ woul4 be
1
IJ
43
t10D of BurD81cl and the W11lallette River 4
2 S~t Portland 8Otth otmiddot the ra11shyrcaadand alona the W11lamette River
lIortbeaat Portl8D4 between MisSiss1pp1 and 24tbStreet the northbouBclary be1DgColwb1aBlvd
Pylzl1c BMltl IrpI Y11ta
Publlc Healtil nur81D1Y1s1t nclud8 an vists to
theholles of client by PubUc Health Nurbullbullbullbull his shows
visits to bull f8Jl1ly fer aDY purpos SUCh aatuberculolJ1s
het1Dl tem1tyaeatalu4 8IiOt10D8l cODd1t1ona etc
he atat18t1C~ 1fele C()4ed accord1Dg tomiddot the 1llli301fOCUS
of the Y18lt tt doe DOt 1D41cate the Dmlber of holies or
f8ll11lev181tecl or 1D41Y14ual Y1a1ted more tban oDcein
the propwl It dobullbull I1ve 80M 1D41cat1on by coaparlshy
OD ot the 8JIoUDt of aedlcal problema 1n eachcen8WI tract
Ap1nmiddot the _p abowa 8 scatter patteraof probl_
areas althoUSh there appear to be a sroup1Dl of hiSh J
l8aIeccmaus tract 1ntlut extreme southeast part of tbe
County other areu uIriaI any nura1Dl contacts are
1 bull he 801lth-oa-al CO1Dty on eaCh 814 of 82nd Av from Clackallaa County north to Dinloa
2 ear bullbullbullt 814e aroUDd Preacottand Misaisippi
Dowatom Bunul14eonboth 1de of the river
44
V_real Pis The iDfomatloil uaec1 to tabulate the Venereal
disease chart includes all the ooab1ned case otmiddotODormea
and syphilIs reported by bothmiddot publIc and prIvate physicIans
dur1nl 1970 There were 3602 caes ot IOnorrhea reported
dur1nl 1970 While ODly 17 cabullbullsot ayphilimiddot were reported
A chart was prepUed aDd att8llPt wasmiddotmiddot de tomiddot
determ1De Wh_therVttDereal 41ease was more p~vaJent in
areas othigb or lowmiddot proportIon ot youth hi waadone
bymiddotdetemlna a 1leaD prceiltacmiddotmiddotmiddottor the population ot
resld~ts UDder19 years ot (34) middotA mean ratemiddot per
100000 popUlatIon al80c1ttem1Ded tor the middotoccurreDCe
ot venereal dieae This was et at 390 oass Areas
hav1nl a population 1n which leiS than 34 were lmder 19
years ot ampIe were called low- yOuth abOve tbl percentaae
hiSh youth The aaa waatrue ot the occurrence oivenershy
eal disea_ per CeD8UStract It the rate waacomputed
as 1I0re than 390 cases per 100000 it was called hiah
venerealdiaeasei it less than thia tisure low venereal
disease It was tound that 1D Multn~ COmlty there sems
to be poSitive OOlatI0n(x21S19gt between low youth
and hipmiddot venereal diseaand hip youth and low venereal
diseasebull
RaDk ordr Iitot all c traot middottbAm made
Th1s was done byt1Ddlna the ratepr 100000 populatIon
of venereal disator all census tracts in the County bull
45
These were thenlisted from h1lhto low (sreatest to
least) in a rank order The l1sting was then divided
into Upperandlower 14 aDd listed on the MUltnomah
Countymiddot up
The areas of b1gh venereal disease se8ll18to
roup thBl~8 middotin a very tllht area ~oq both 1des
of thell18l8~ R1 w1th BurDaldeS~et being
~bout theceDter qf tbi8IZ9uping This area woUld
appear to be m ldeal spot for the denlopment of a
locallzed venereal d1sbullbullbullbull cl1D1c
UbepoundCUlO1s
In this report bull tube1C1llosls caS8S refrred
to include alltbobullbull cabullbulls ontubercUlo8is follow-up
rather middotthan just new C Accord1Ds to the Multnomah
County Health SUrvey of early 1971 this would include
all ca repOrte4 over thelaat three years The
total number of tuberculosi8 cabullbullbull usedin this study
was 666 lh1 included 128 new cabullbullbullbull
A rate per 100000 of tuberculosis for each
census tract wa- then computed and the c~us tracts
listed by rank order be b11h Qartlle mel low
quartl1 were then reoordd on a Multnomah CoUnty map
TWo genral areaa baY1Dg a hip mcldencaot tubercu~
losiare 1D41cated heyare
1 Both middotsld ot theWilla11lette River
Ll -
46
with Burns1de about thecnter
2 he extrea Northebullbullt comer of the County bull
By coap8r1ng the tuberculois an4ven8real
diseae maps ODe can 8ee that the downtown areas ot
hiSh 1nc1denceare alIIo8t 1c1eDt1cal on ach map
This WOuld 1nd1cate that 1t would be of value to
bullbulltab11sh acl1D1c 111 th1aampreatbat would provide
bothtuberCulos1s 8Dd ytmereal 418ase srvicbullbullbull
Thchart aDd 1181gt8 are wsfuln 11v1DI
1Ddicat10DS tor the type aDd placemeototlocal
health cl1n1c8 tbro1qhout tbe MultnomahCounty area
A cOllpar1on of the mapa help one to dec1dewhether
to provide a aulti-8ervice cl1D1c or spec1f1c type of
cliD1c As stated in Part I of thi paprserv1ces
shouldhaYe both treatlieDt and prfMmt10n cOmponents
As he been stated fta ne1lbborhood health care
Qenter muat be a fac111tY plazme4 with an aamesa
ot the neds of the consumer and the c01llll1m1tybull
Part II of this rport haa been an attaapt to indicate
and clarify 8011 ottheae coDlllUDity neds This has
been done through8elect10n of apc1f1c problems
The indic were then visuallyrecorded through the
use of ups and charta ODe dan asseS8 thedsreeof
1DIportance of certain concems to spec~t1c areaa by
comparinl the chart aDd maps Prom this oDeean
41 dec1de which are48 vb1chcUD1c-or indeed if
the need a clinic at all However further factors
should be considered hebullbull include
a The amount of fuDd1 available
b What 18 the percentage ot peopleineoh ceaaua tract tbat would actually us such cl1n1cIl
c Wbat 1 tbeco--1tymiddot 8 IeeliDashyreaardtDI particular cl1D1c8 Would this dcrebullbullbullmiddot the ettctiveness ot thse cl1n1ca
IJ
li
D_OlraphicPopulatLon Challie 1960 to 1970 48
Cen8U8 1 of Pop 1 Cbaqemiddot 1 Change1 ofPopTract Under 19 Yr8 Over 65 Yrs1960-70 1960-70
middot1Q701Q70
1 319 -12 171 -H) 1
2722 215-27 +68 301 366 -22 127 +35 302 371 +19 111 -04
311middot401 144-41 +29 402 321 13~7-39 +24 501 356 124-08 -02 5~O2 351 133-23 +12
405601 82-10 -02 394602 103-01 -06
701 275 149-76 +56 702 361 +01 121 -07
+10middot801 326 140-22 802 321 middot127
(
-29 -03 9~01 342 124 -H) 6-18 902 294 128 -H) 3-24
10middotmiddot -14312 140 -17 1101 182 +25 -23197
2411102 186-59 +29 1201 226 169-17 -41
31middot01202 +11 182 -05 295 -H) 81301 208 -H) 4
1302 331 +08 197 +04
14 323 +15 middot185 -08 middotmiddot15 329 +16 16~5 -13
-28middot 1601 332 131 +12
1602 356 98 +24middot-39 middot3101701 161-33 +21
1702 370 -15 85 +02 +19 1801 264 151middot-50
185middot1802 256 +47-58
IJ ~
D_raphlc Population Change 1960 to 1970middot 49 (Contd)
4io
Census Tract
of pop Uncter 19 Yra
1Q1n
1Cha1l8e 1960-70
of PopOver 65 Yra
lQO Change
1960-70
19 389 +29 141 -24 20 223 -13 206 +18
21 227 +08 194 -36 2201 356 -27 112 +05
2202 290 -18 ll~9 -29 2301 356 -03 154 +24 2302 260 -37 245 +97
2401 410 +6~1 123 -31 2402 163 -80 320 +99 2501 381 +13 140 -01 25()2 237 31 lil +02 26 343 +25 186 +149 2701 370 +29 1S5 -01 2702 249 -44 304 +98 2801 337 +19 187 +09 2802 306 -10 156 +31 2901 304 -38 142 +24 2902 i 307 -32 146 t3~9
30 29~0 -48 16~2 +51
31 355 +30 160 +01 32 370 +48 148 -13 3301 395 +45 130 -20 3302 368 +06 138 -02 3401 386 +16 117 000
3402
400 +32 92 -26 3501 304 -07 115 +35
3502 344 000 140 -13
3601
36~02 357 -04 132 +32
3603 30~1 42 149 -67 3701 342 +28 152 +19
1
IJ
Jianolraphic Population Chan 1960 to 1970 50 (Contd)
Census Tract
of Pop Under 19 Yrs
JJl7J
middotChanae 1960-70
middotofmiddotpop Over 65 Yrs
1c~7n
Change 196070
3702 409 +39 122 -11 3801 308 -11 151 +29 3802 275 -35 180 +46 3803 282 -32 192 +54 3901 376 ~13 100 +17 3902 296 -03 177 +29 4001 438 -11 84 +13 4002 353 -21 115 +20
4101 397 11 9middot0 +11 4102 346 -19 120 +03 42 331 +19 11 bull 3 -16 43 347 -72 105 +31 44 113 +84 183 +154 4S 33~9 +07 110 -06 4601 2501 22 193 +38 4602 332 +59 126 -29 47middot 161middot 000 211 +01 48 103 -26 302 +59 49 138 +1 bull 3 252 +09 50 141 -26 204 -12 51 12 -39 257 +07 52 47 -61 351 +48 53 89 +49 314 -30 54 25 l1li15 327 -17 55 131 -17 115 -121 56 198 +93 227 -47 57 71 102 189 -88 58 240 ~middot41 16~1 +55 59 322 +25 142 +06middot 6001 264 95 132 +50
6002 328 -31middot 89 +07
JJ
Demographic Population Change 1960 to 1970 51 (Contd)
Census 1 ofPop lChange of Pop bull ChangeTract Under 19 Yrbullbull 1960-70 Over 65 Yrs 1960-70
1970 1970
61 355 -58 85 +39
62 328 39 110 +18
63 414 04 73 10
64 382 -22 72 +04
6501 383 02 67 -20
6502 329 -56 96 +09
6601 391 +13 88 -03
6602 319 -59 97 +06
6701 327 71 145 +72
6702 331 ~67 83 +1-0
6801 365 -66 49 +01
6802 388 4bull3 54 +06
69 354 -41 80 +23
70 400 -23 68 -06
71 359 -48 72 +05
72 255 -88 82 +11
73 346 -39 91 +25
74 313middot -63 105 +24
75 329 -42 129 +37
76 336 -52 85 +21
77 370 -10 69 +05
78 309 -10 120 +21
79 325 -56 87 +10
8001 358 -81 57 +12
8002 391 ~81 76 +12
81 315 -76 108 +21
8201 403 -23 64 +08
8202 392 23 65 +08
83 357 -34 120 +31
84 402 -18 73 +16
85 413 -06 76 -09
r
Demographic Population Change 1960 to 1970 52 (Contd)
Census Tract
t of Pop Uncler 19 Yrs
1970
Change 1960-70
1 of Pop OVer 65 Yrs
1970
ex Change 196070
86
87
88
89
90
91 9201
9202
93
94
95
9601
9602
9701
9702
9801
9802
99
100 I
101
102
103
10401
10402
lOS
368
351
379
391
391
413
379
433
372
429
414
432
419
439
~32
377
457 420
378 41middot7
345
360 417
417
412
-04
-02
-35
-26
-28
-11
-64
-20
-S9
-39
-32
-21
-34
-40
-47
-lO~7middot
-27middot +04
+56
+07
-34 01
+04
+04
+10
103
128
97
11il3 99
69
79
42
77
46
34 38
44
40
54
111
51middot
81
133
59
74
140
63
87
76
-08
-06
+04
+08
+17
-05
+3S -02
+1~4
+19
+33
-14
-08
+12
+26
+71
+11
-16 -34
-20
-19 +37
-49
-2S +15
NOte The The
Taken frOi
averageullder averageabove
middotUSCensus ---shy -
19 years == 6S years ==
figures 197
32r 13(14
p a~d 1960
--
Rank
1
2
3
4
5
6
7
8
9
10
11 12 -_
13
14
15
16
17
18
Tract
69 46
60
58
- 68
61
302
2501
67
63
19
62
26
94
3603
3902
64
30 -----~-
Rank
19
20
21 -
22
23-shy
24
25
26
27
28
29
30
31
32
33
34
35
36 -
Ranking of Per Capita Income by Census Tract
Tract
65
2701
- 15
1601
701
66
93
82
2903
3602
30
2502
80
2401
81
- 70
91 shy
4001
High
Rank Tractshy
-32shy37
38 97
120239
7840
41 ~ _2_1__ 42 31
43 2501
44 18
45 98
46 37
47 3803
1702
49
48
1602 92 2702
I
50 89
51 901
52 801
Ra_
53
54
55
56
57
58
59
60
61
62
63
64
6S
66
67
68
TractTract Ra~
74692
170196 70 I
401 71 90
72 1037J
79 70273
3802 74 601
24024102 75
85 76 101
77 9023901
7699 78 100 4101 79
3601 I
380180
458140~ t---- _ - - shy83 82 42
888384
59843501
4777 8~
502
Low
802 86
Rank Tract
87 shy
--88
89
90
91
92
93
94
- 95
96
97
middot98
99
100
101
102
103
104
1201
14
49
72
73
43
87
3502
105
1
52
86
71
1
501
10
3301
104 tf
Rank
105
106
107
108
109
110
III
112
113
114
115
116
117
118
119
120
121
Ranking of Per Capitalucoae by Census Tract
(Contd)
Tract Rank
4001 122--shy602
13
1102 2302
3302
55
3401
48
21
56
50
3402
lL01
2202
2301
53
2201
-shy
Tract Rank Tract Rank T~aet Rank
57 I-----
Imiddote
bull
Tract
- Low -k Note Information taken from 1960 U SCensus
Rank Tract
I ~
Ie
Imiddot
~
----
----
--
--
Rank
1
2
3
4
5
6
1
8
9
10
11
i-
-Tract
391 922 921
972 971
100
132 131 121
962 961
822 821 401
982 981
20 111
47 10 1
412
High
Total Number of Henta1 Health Visits
Ranked by Census Tract High to Low
TractTract RankTractRank Rnk
12 182 22 78 29 87 76 381 73181 ~------- 1913 371 8538230162372 271 2616-121 8272 2
14 80~2 31 94 7923 84801 59 15251362 4232 15 52 _ 32 103 8924 651 17240216 652
_ 91 351 33 341 23117 83 122 25 25 48 1123921418 34 shy61 86 661
19 662 6493 81 26 91 8153 49 50 55 41383 71 27 51 3120 90 672241 35shy 104167162 461
I 411 46211121 28 88342 I
2502 36 69 54 5251 50 272
-Ra
37
38
39
_ 40
_ 41 Ishy
I
42 I
-I 43 44
45
shy
Tract
~ --- shy 95 56
45 292 242
102 62 352 291y
92
101 281
99 72 63 601 60~ 42 2201
77 74 61 57
363 232
70
32 31
11 44 282 2202
Low l
- Tract
46 682 681 I 331 30
r~$ 47 1042 332
48 102_41_
11
~
Visits to Family Planning Clinics Ranked by Census Tract High to Low
Rank Tract Rank Tract Rankmiddot Tract Rank Tract Rank Tract Rank Tract
1
2
3
4
5
6
7
8
9
10
11
12
13middot
14
15
16
17
361
56
401
341
48
59 121
20
55
342
10
31
58
93 21
241 132
331
53
461 462
18
19
20-shy21
22
23
24
25
26
27middot
28
29
30
31
32
33
391
32
middot47 I-i-_-shy _ -
231 111
332
972 1
372 371
52
89
32
92
82
100 31
182
30 242
402
34
35
36
37
38
39
40
41
42
43
44
45
42
1714 i 661 221
78 362 2
90 602 601 352
63 251
105 921
971 351
73 42 292 232
411 51
662
81 45 52
46
47
48
49shy
50
51
52
53
54
55
56
961
801
49 81 72 71
19
9~1
172
68 2 57 162 14 112
91 75 681
381 42
3~3
83 161
57 f
58
59
60
61shy
62 Imiddot
63
Imiddot 64
65
66
64 62 36~3 252
74 652 SO 392 291
651 6bull 2
79 271
r-- ---- shy981 222
672 671
821 272
94 87
281
382
67
68
69
70
71
72
73
74
75
76
77
78
981 26 12~2
IS 61
85 82~2 69
61 43
101 86 84 282
76
131
51 72
1041 962 88 70
99 922 77
103
95 802 181
i
~
Low High
RankRank Tract
5479
4480
81 1042 ~) middot102
71 - - + ~ - ~
Visits to Family Planning Clinics
(Contd)
Tract Rank
I
Tract llaDk l
RankTract Tract Rank Tract
~
I
~
J1 ~
Low
Total Number of public Health Nursing Visits
Ranked by Census TractsHigh to Low
TractTract RankTractRank RankRank TractTractRankTractRank
25249 71 79 17249 8033 6586 99189711 84 2915072 34 661 76 66 811519512
402 5035 51 161 2518220 122 1713423 352 55801 7120 6752 2 149814 41236 83 2662 38 94 6821 53 2924015 362 37 32 42 75 69 281 84 63
546 8822 54 222 85 3925431 70383417 3818223 6439 4386652 718 21 55 103332 8924 232 87 19 271729219619 24156 16211140 382 628825 10523110 112 73411 10141-- ----shy 89 363 4457 8126 16111 221 74 9142 90 46158331 53 671279012 46243 48 59 351 3837528 1083 9313 91 5844 59 -_242 76 1----- shy60 272 72 74104114 60145 42 9287 7729 92 6151 8215 57371 934630 91 307762 12113116 282 619447 41391 9531 78100 63 7378 ~95 681 6945 32 5632 798517 6448 47 52 181
High ~ Low
Rank Tract Rank
96 31 132 70
97 102
98 182 372middot 602 651 662
- -shy
~72 682 802
822 922 962 972 982
1042 ----shy
Low
Total Number of Public Health Nursing Visits
(Contd)
Rank Rank Rank TractTract Tract
I
I lt
I
Tract Rank Tract
[
~~~-
I
~
IJilfimiddot ~
j
Ranking of VD Caea According to Census Tracts 61 By High and LOll Youth Itatio
A media~ of 34 5 was determined Any tract having greater
than 34 5~ of popu1tionunde~ 19 years of age -High~
Any tract having l8S than 345 of population under 19
years == Low
Any tract having rate less than 390 =Low
Any tract having rate more than 390 == HLgl4
YOUTH
LOW HIGH
L
0
12 402 1801 1802 343 2801 2802 29023603
54 6001 600262 66~02 72 74 75 76
78 79 81 t02 65 1202
W
(25)
VD
H
I
G
H
401 701 801802 901 902 10 1101 241 1201 1301 132 14 15 1601 1701 20~ 21 2202 2j02 2402 2502 2702 2901 303501 3502 34023801 3802 383 3902 42 44 45 4601 4602 47 48 49 SO 51~2 53 55 56 57 58 S9 6701 6702 73 95
3~02 7021702 19 25~01 2701 4102 4101 63 64601 ~601 6801 680270 7l 77 8001 80~02 8201 8202 83 84
85 86 87 88~ 90 91 9202 920193 94 9601 9602~ 9701 9102 9801 9802 99 100 101 103 10402 105 6501 10401
(47)
301 501 502 601 1602 2401 2301 2201 31 32 3301 3302 3401 3402~ 3602 3702 3901 400140 02 43 61 69 B(
(53) (23)
~ ~gt
Ranking of VD by Rate Per 100000 By Census Tract
~
Rank Tract Rank Tract Rank Tract Rank Tract llank Tract Rank Tract Rank Tract
1 2202 21 S6 40 902 58 1602 74 75
90-shy 64 107 26 --~-
2 3402 22 45 41 10 59 902 75 78 91 54 108 61
3 2301 23 3502 42 2502 60 602 76 6802 92 402 109 87
4 3302 24 49 43 1102 61 501 17 2 93 94 110 90
5 50 25 52 44 6702 62 14 78 8202 94 97 02 III 76
6 2201 26 20 6701 63 4002 8201 2501
9701 41~02 112 91
7 44 27 48 45 401 64 3802 2902 95 63 113 62
8 3301 28 1701 46 502 65 30 79 83 74 96 9602 114 71
9 55 29 47 47 42 66 3803 80 2801 96Q1 115 85 10
11
12
13
14
15
16
17
18
3401
53
2302
2401
57
21
2402
1101
51
30-shy31
32
33
34
35
36
37
3701 - -~ 1201
3702
89
43
132 131
3602
4001
48
49
50
51
52
53
54
55
58
1601
601
4602 4601
69
701
31
3901
67
68
69
70
71
72
2901
801
39021~ 802
6502 6501 122
702
41~01
81
82
83
84
85
86
87
88
19
1
1702
2802
79
93
100 6801 6602
81
97
98
99
100
101
102
103
104
9201 9202
9802 9801
77
302
79
86
72
84
116
117
118
119
120
121
3603
8002 8001
101
99
95
10401
105 10402 103 102
19
20
59
32
38
39
2702
3501
56
57
301
3801
73 1802 1801
89 6002 6001
105
106
2701
88
High Low
-- -----
Rank OrdermiddotTuberclosis Cases by Rate Per 100000 Ranked by Census Tract High to Low
Tract TractRankTractRank Rank TractRaukTractRankTractRank
801
79 9601501411 52 6835340120511 I 960269 903603532036 $-~~F130221542 4366 311301 70 68~013802 _ I- _ 4001_37213 3921201 6802802 H71523822024 22 54 193302 3802 80 8958 I37139535 70155 9801 I60123 72 6702 98023914011016 6701250124 10 56
81 94 401r 7 154152 73 7057 2625 122 92028
90242 162312301 92~158 86 7172434526509 82 79160159 74 100 87412240227220110 6502836960 75 30 8317244 6501782801285711 61 901 42765645 84 66021459294912 9701 660146 171 302 9702 47
6235023033113 85 822821182 917755 16335013110214 841814832 78 103 938564 324815 86 1057940149272 38036523216 10401 87 2902241 725Q 10402360266340217middot IF88 88 9937233 282 51 218 101 01102 46016234
I)167 2901460219 47
High ~ Low ~
- -
TractRank
9S89
6490
8191 8001 8002
63 61 60middot01 6002 44 2701
92
J
2502 402 --- ----shy
I
Rank
Rank Order Tuberculosis Cases by Rate per 100000
(Coutd)
Tract Rank Tract ~nk
I
Tract Ballk Tract Rank
Imiddot
Tract
Imiddot
1~
t 1I i Pi i l I
o
1 -1shyL I
I J
8 40 icO ~ I -lt 0
-t (1) I
i I
r o E
II
a
I
r--i
shy
I
~
I (
Jgt
(011 fi(
Ggt
I II ~j
()
(f 0
~ ()
I
11
f9
r
II 99
o ~
Ggt r
~ __-J~ I t I ~ I
r--J l I
~ _ __ J
) 1
fTl
1gt
r I
()
r
()
lt en -i en
()
I1l
(J)
(J)
-i
P ()
19
r o ~
r G1 I
I
c
~
o I 89
--- -I-shy
r-r I
1- 0 _~ _ _--J E
G1 I I I
i i
I 1-1-1 ~ _J ~2 ~ II
II
()
1 I I I 1
id i bullbull
~
A n 69
r 1shy
- 0 Gl
l--~ ~ I
~ II
II )
I () isect i
en l i
(J)
-t
0
IA Ol
4)i
h~ ~~f ~~ L
24
to make appoJlltaeata tor ODIo1qprevmt1ve treataent
and rehebl11tat1Ye care ad ampl1O to bave a blah failure
to Show rat_for tbe appo1DtaeDts that they dO make
Atone center 628 of appo1Dtments made were kept
while 3Oottbepati_ta een were ~1n patients
AlthoUP fewer patiets were actually 88811 by the cater
1D middottb1s 1Datance thaathe -bervholuidmadeappointshy
mta the walk-iD patlat required an iDord1nate amount
ot staff t1ae tor aCreeDiaaacl ~trral to pplOprlate
~ttor caregt (9 pgg) Arraquotbr1llpl1catjo~ of the
plOVidedto valk-iD patient by other thaD their
(19 p12)rurtbermore
when patients uti11ze Wlk-1Il er181 centered care
athelr ODlf tona ot ootact with the _d1~ care
ay_ta fUilycentered care the treata_t of tUl11y
bers
a a UD1t 11
dlarupted
hewalk-1Dphenoaaencm appear to barelated to
diUerence between soclal clase in the style of Dlaking
contactJt1th the a11oal C~ay8t As Greenlick f ~
(19 p11)1Dd1oate8 thepheDOaenOn ot INater usage of shy
walk-in ervice by aed10ally middot1Jid11ent patient thaD by
others baa otte been attr1buted to a stoical att1tude
tQward 1llDe8 em the~ ot poor people leacl1D8 to a
~
25
greaterdelay1n tbe k i Dlofa8d1cal care These
patients wppoedlyeelcmiddotcareODlymiddotwIleD tbeirmiddotillDess
becOlles1Dtolerable resultiDSin middotthMr appeariDS withshy
outnot1ce1o rece1ve oareHlwever Greenlicks
r8aearcbbaa cut doubt on the existence ot tb1delay
111 report1Dg middot8J1IPtoJumiddotOfDeW 11laessand seek1ng care
Be bas tcrQDd 1bat s1ll11ar peze_tases of dioally
1nd1sent 8DClJ1on-aed1cally 1Dd1PD~ pat1enta seek care
on the aue daytbat aptou tirstaPPear
1fb11e GrHDllclc 1nd1cat tbat the reasonator the
greatertendeDCY of low 1Do~e pat18Ilta to 1$8 walk-in I
serY1ces are notlcDo1rAmiddotmiddot tbe7 _ be rel~tedto a tendency
ot lower aocio-ecaaaoclaa patieota to preter face-toshy ~
face contacts with II841cal persoDl181posslbly because
such contacts areft coatortiDS an4reasauriDS to
patients who are hJpotbeafzed to bave a dependent attltude
toward IIed1Cal care perS0Jm81 (30 p161)
It a8 itmiddot baa pnerally beenhld the appointment
s1stemts the most efficient Ileana of dellveriDS
comprehenSive oODtllluiDlh-lth care (9~100)1t is
necessary that educaUoraalmiddotbulltfort be taken to proaote the
use ot middotappo1ntaents8DClmiddot tQrec1ucethe fa111re to appe~
ratB4uOatioaalwhlQb baft~utl11zedhave been
IJ
26
1Dten1ews with walk-in patients home Vi8its and group 4i
meetiDp1D8D attemptto1Dierpret1o the patients
the value of rtitgular ppo1ntmentamp andot con~in~
c~1ve care rather than epiI041c care (9 p1OO)
h1s 1safuD~tioD torwhtch nOl~prot81QDal colDlllUD1ty
YOrkersllaY bebe~r8U11ed tban other statf H()wever
euch aD ~ucat1oaal propul __~ ~e related to the senUiDe
capacity otth health oenter to provide comprehensivebull gt
ervice8 to1tpat1_t~odoD aD app01ntment bas18 It
1amp pos8ibleo~rw1 tor educa110Dal ttorts to result
LD a~8JImCl tor ltPP01ntaen~8 at a ratewb1ohi8beyond
the capacity ot thee_tar to t without uareaaoDably
1_ wa1t1Dlprio4a QOBt1nuad use Ot the center on a
wallt-in bU1 _1tbeoosiItpos81ble to et an appoint-
met anc11nCreued pit1entcoJaplampia1a bull Therew111 of
course always be a need and demand tor acute ep1so~c
Care -ci the health centerDlWlt be planned with the capashy
billty ot bullbullbullt1D8 tb1aneed wh1~ cont1Du1nI to stress
aDd educate the patient to utillze oDlOinI comprehensive
faa11y middotc~te~d Cflre (9p 100l
att g4 CODClva1opa
In order to bea4equate any coJlltemporary health care SY8tem muat bullbulletcerta1D interrelated criteria he
IJ
27
minimum criteria areaccessability of services to those
who need them compr8heX1siveness and appropriatness of
services and efficIency 1nthft utilizat~on of SCarce
health care personnel and resources The scareity of
pex-sonnel andtbe need for h1gh quality ongoinghealth
care services
aJIlong the
populationdemanci the most effishy
cientprovision of services
Services must be made accessible to the population
They mustmiddotbe geosraPh1cally accessible to remove the PhysicalmiddotbaTiers betWeen peopleandthem$d1calcare
system They mUst otter their services dur1ngthe
hours when people can make the moat use ofthemA~ it
makes little sense to concentrate services geographically
where they will not be uSed to their fUllest extent it
also is wasteful to provide serv1cesonlydur1righours when
many people are employed his not only presents a hard
ship middotto the consUmer lnrt wastes resources if for instance
the unavailability of preventive services during the hours
when people Can use them causes a need for treatment
services later on
Health carbull sEtrvices must be comprehensive including
prevention treatmcmtand re)abimiddot11tation Ambulatory I
healtbcare facilities wh1cQ are orienteciexclusively
toward either prevept1on or trea1mentare no longer accepshy
table for they are lneft1c1entln their use of resources
and in their prov1s1on of health care to the patient
w ~~
28
If prevent10n1s notmiddot stressed treatment serv1ces that
could have beenavoidedY1l~ be required If prevention
1s the sole focus of the health care facility sick
patients who present themselves must be referred elseshy
where for treatment andsllch referx-als may be taken as
reject1onsor not followed through with until illness
becomes unbearable
The instltutlontbat meets these requirements Is
the comprehensive neighborhood health center It 1s a
local decentralized outpatient facilityprOVld1ng a
fUll range of ambulatoJY health care services It has
a linkage to ahospitalbackUp facilityforlnpatient
treatment and hiihlY apclalized outpatient care
The neighborhood health center must be a fac11ity
planned with an awareness of the needs of the conSUtller
and coDitnUn1ty It must have the r~Ul0urces to provide the
services people need mere they can use them and when
they can use them It must uti11ze the part1cipation of
the community to develop this awareness Not only must
the cen~er beset up to be Amctional for the consumers
but efforts must bemadeaga1n with commun1ty partici shy
pation to help the consumers utilize medical care
services effectively The center muetmake efforts to
educate the community about the valueot regUlar health
care of preventive servicesand of the use of planned
IJ
29
medical appointments ratherthanorisis centered walk-
incare Therealit1es of the existing health care
system have not taught the patient particularly the low
income patienthow to use services effectively
The helthcenterilUst also bea laboratory for
experiments in easing the health caJepersonnel shortage
and c60rd1Datingcare~ A major difficultY iri-exper1shy
menting with neW rolesis freeing staff of old preconshy
ceptions
CoDlprehensiva neighborhood health dare centers have
been developed under a variety ot alisplces including
medicalsociet1es hoSP1talsmiddot(36p299 group pr~ct1ces
(29 p6- 12 117) health departments (13 p1027) and
ne1gbbothoodassoc1ations(14) The literature indicates
somevalues nthe management ot the health center by plusmnts
hospital backup faCility Whatever the auspices many
adm1nistrative fuDctions such as program coordination
standard pr9tectionand evaluation call for considerable
c~tralization of adm1nistration city-wide or coU)tyshy
wide At the same time other aspects hours of servlce
for examPle~ cuI f~radm1nistrative fUnctions made atmiddot
more local levels Each neighborhood center must be
free to adapt its functioning to itscominunity thi-ough
the mechanism otcODlllUl11~ participation inmiddot policy making
Obviouslythe prerogatives and responsibilities of each level must be negotiated and made explic1t
t4~
JJ
BIBLIOGRAPHY 30
1 American Rehabilitation Foundation ~ealth Services Research Center The Health Maintenance Strategy mimeo 1971
2 Anderson Nancy N Comprehensive Health Planning in the States A Study and Critical Analysis Institute for Interdisciplinary Studies American Rehab ilitation Foundation 1958
3 Andrus Len Hughes Comprehensive Health Planning Through Community Demonstration Health Projects mimeo1967
4 Barry Mildred CandCecil G Sheps A New Model for Community Health Planning unpublished paper presented to the American
Public Health Aseociation1967
5 Blum HenrikL Fred Wahl Genelle M Lemon Robert Jorulin and Glen W Kent The Multipurpose Worker and the Neighborhood Multiservice Center InitialImplications and EJeperiences of the Rodeo CommunityService CenterAmerican Journal of Public Health58 (Mar 168) pp 458-468 shy
6 Blum MichaelD and Soloman L Levy A Design for Service Delivery that Reinforces Constructive Tension Between a Health Center and Its (sic) ConSUDlers and Supports Community Power unpUblished paper presented to the American Public Health Asaociatiltn 1968
7 Brielaud Donald Comm~ity Advisory Boards and Maximum Feasible Participation American Journal of Public Health 61 (Feb 1971) pp 292-296 shy
8 Burns Eveline M Health Insurance Not If or When But What Kind Madison Wisco~sin University of WisconsinScllool of Soci~l Work 1971
9 Campbell John Working ~elationships Between Providers and Conshysumers in a Neighborhood Health CenterU American Journal2 Public Health 61 (Jan 1971) pp 97-103
10 Caxr Willene Neighborhood Health Centers Funded by the Office of Economic Opportunity mimeo 1970~
11 Colombo Theodore J Ernest W Sawardand Merwyn R Greenlick The Integration of an OEO Health Program into a Prepaid Comrehensive Group Practice Plan American Journal of Public Health 59 (April 1969) pp 641-650~ -
12 Comprehensive Neighborhood Health Services Projectof Kaiser FoundatioIl Hospital~ Prcgtgram YearE grant renewal proposal mimeo~1971 bull
13 CowenDavidL~ Denvers Neighborhood Health Program Public Health Reports 84 (Dec 1969) pp 1027-1031
IJ
14 De Diaz Sharon Daniel Beyond Rhetoric The NENA Health31 Center After One Year unpublished paper pres~rited to the American Public Health Association 1970
15middot Gerrie NorrrianF and RichardH~ Ferraro Organizing a Program for Dental Care in a Neighborhood Health Center Public Health Reports 8 (Aug 1968) pp 419-428
16 Gordon JeoffreyB~ The Politics of Community Medicine Projects A Conflict Analysis Medical Care 7 (Nov -Dec 1969) pp 419-428 shy
17 Greely David The Neighborhood Health Center Program and Its Implication(3 for Medical Care H~alth Forum of the Welfare Council of Metropolitan Chicago (mimeo) 1967
18 Greenlick Merwyn R Newgtimensions in Health Care American JOurnal of Pharmacentical Education 34 (Dec 1970) pp 754-4
19 GreenlickMerwyn R Donald K Freeborn TheodoreJbull Colombo Jeffrey Abull Pruesin and Erne$t W saw~d Comparing the
Use of Medical Care Services by a Medically Indigent and a General MemberShip Population in a Comprehensive Prepaid Group Practice Prosram II unpublished paper presented to the AmericanPublic Aesociation1970
20 H~tadoArJiloldVMerllYll RGreenlick and TheodoreJ Colombo Determinants of Medical Care Utilization Failure to Keep Appointments unpublished paper presented to the American Public Health Association 1971
21 Johnson Richard E and Merwyn R Greenlick Comprehensive Medical Care A Problem and Cballengeto Pharmacy ff AJilericanJournal of PbarmacenticalEducation 33 (Aug 1969) pp 361-367 -
22 Kahn Alfred J Studiee Social Policy and Planning New York Russell Sage Foundation 1969
23 Kotler Milton Neyhborhood Government Local Foundations 2 Political~New York The BobbsMerrill Company 1969
24 NationalCommisaion on CommunityHealthSfrvic~sActionPlanniriamp for Community SetithServices~ashington p C Public Affairs-Press 19t7
25 National Commission on C~mmunity Health Services Health Adminishysration andOrMPization l the Decade Ali9$-d Washington D C Public Affairs Press 1967
26 NationalCornmiesion onqomm1Jllity Health Servicesbull Health ~ Facilities Washington D C PUblic Affairs Press 1967 bull
~ n
32 27 ODonnell Edward J and Marilyn M Sullivan ServiceDelivery
and Social Action Through the Neighborhood Center A Review of Research tt Welfare ~ Review 7 (Nov~Dec 1969) pp 112
28 Office of Economic Opportunity Second Annual Report Washington D C~ U S Government Printing Office 1966
29 Office of EConomic Opportunity and the Medical Foundation of Be~laire Ohio Eighth Report 2l ~ Committee2a Governshy
ment OperatiOll~ Va8hiiiSton D C Government Printing Office 1969
30 Pope Clyde R Samuel S Yoshioka and Merwyn R Greenlick Determinants of Medical Care Utilization nhe Use of the Telephone for ReportiDg Symptons Journal of Health and SocialBebavior12 (June 1971) pp155-162 shy
31 RenthalA Gerald nComprehensive Health Centers in Large US Cities American Journal of Public Health 61 (Feb 1971) pp 324-336 shy
32 Saward Ernest W The Relevance of Prepaid Group Practice to the Effective Delivery ofHealthServicestt The New Physician 18 (Jan 1969) pp39-44 - shy
33bull Schorr Lisbeth Bamberger and Joseph T English Background Content and Significant IssUes in Neighborhood Health
Center Programs Milbank Memorial ~ Quarterly 46 July 1968) part 1pp 289-296
34 Weiss James E and Merwyn RGreenlick UDeterminants of MedioalCareUtilization The Effects of Social Class and Distance on Contacts With the Medical Care System Medical~ 8 (Nov-Dec 1970 pp 456-462
35 Weiss James E MerwynR Greenlick and Joseph F Jones Determinants of Medical Care Utilization The Impact of Ecological Factorstt unpublished paper presented to the American Public Health Association 1970
36 Wise Harold B Montefiore Hospital Neighborhood Medical Demonstration A Case StudyMilbaDkMemorial Fund Quarterly46 (July 1968) part 1 pp297-308~
37 Yerby Alonzo S ttHealth Departments Hospital and Health Services Medica1~5 (March-April 1967) pp 70-74
38 Young M M~ Chatanooga IS Experience with Reorganization fOr Delivery of Health Services ttAmerican Journ8l of Public Health60 (Sept 1970) pp 1739-1748
f or l
II bull 11 Y d
II
IJ
34
ThepurposeOfPart II of th1aa paper1atod1scuas
elected Speclfic needs ofecltlc areas within Multnomah
County A8P01ll~oUt 1D ~ I of t1a1bullpapermiddot Ita nelgbshy
borhood health oare cater IlU8t be a facl1lty plaDlled with
aD awarenes of the neeels of the oODllUller and collllUDity
Part II of this paper nIl Show 80e of thoe speclflc
needs
he1DforutiOD tor t1li Portlon of the report
obta1nec1 troll tbroupout tbe follow1Dl threepUb11catloDS
1gr~e_tiMshylIPrIxaiidOreson JuDe 1963
2 1~_middot_sectSI8e~ected1teai c-ua 0 S 8 e first count coaputer tape Coluab a_lion AssocshylatloD of QoveraMD-8 Jlme 1971
3 Jtu1tDoab County Oreaon BDY1roDlHtlltal SurveyEarly 1971
The JIultDOIIIlb COUDty OrttIOD BDv1roDllfmtal Surley
Barly 1971 1s bull stat1stical report of the activ1tles of
theentlreMultDOIIIl2 CcNDty Health Dep~t during the
year of 1970 Die speclflc 1nd1cs elected from tb1s
study amprejMental aealtll Publlc Health N~s1D1 vlslts
FaJUly ~ Veaereal])1 ~ ~rcul081
Throush tie use of cUrts and mapa ODe CaD roup these i
speclflc ~oea to ahcnr the healthneedsof speclfic I
census trtcta aD4 then the health needs of iarer neIghshy
borhooda 1m4 o~ Uebullbull
Rf)~UP1Dl of areu was accompllshed in thefolloWinl I
JJ ~
35
he MiltDoIliahCountY oregon BDViromaental SUrvey
early 1971 isamp statistical report ot tbeaotivities ot
the entire MultDolllh COUDty Health ])epartiDent dur1nl the
year ot1970 he specitic 1Dd1C8S selected frOm this
aUy are 1Il8Dtal health public healthDurs8s visits
fUl1ly pia waereal elisease aDd tuberculosia
Tbroq11the Wle otcbart aDd mapa aDecm szoup these
specific indic to show the health Deeds ofapecitic
ccmaua tracts aDdtIum th8health neecla of larsr ~eilh-
bOrhooda and co8I13 tlbullbullbull
RegroupiDI ot areas waa accoap118hed1D the
tollOWiDl lIIIIm1er~ A bullbullcifie 1ndex 8selectcl auch as
venereal di8bullbulle or tuberculo8i~ he total number ot
cs was then deterll1ne4 for each census tract Through
the use of the maber ot cRbullbullbull tor a 11Yen cenaus tract
aDd tbe population ot thattractaltrateot1lla1ampmcper
100OOOpopUlaticm wu cleteXll1ned for each census tract
This was ~e to starl4ard1ze the population ditterence
amongOeD8U8 -tracts 1he rate of incidence toreaob
cenauatract was then llstedby rank position on a chart
In rank poition1DI any cen8Wl tracts haviDg equal
rates ot1l1c1dence are assipe4tbe iaDk posttiona
Beeauseot the abo fact tbAt cbarta w111 vary in length
neveltbAtlea eacb cbart will 1Dclu4eall census tracts
inMullnoaah Couaty Atter the census tracts bave been
listed accord1q to raalcth1s list will bediv1ded into
IJ
36 three levelsotinc14ence he three levels are
1~ The upper 14 of1DcldenCe
2 Thelower 14 ot incidence
middot3 The ILld 12 of incidence
Tlles three srouplqa are then used in compiling a map ~f
Mu1tnOmahCountyfor ach apecltictop1cbull TIle maps are
uaefuJliD tbatthey V1suallycoJib1De 1Dd1v1Clualproblem
census tracts into larger problem nellhbOrhooc1s
The 1960 statistical iDtormatloD was Used in a similar
liIaDDr to tbatexpla1Dedabove 1Dthe4evelopaent of a
chartmiddot and map 1Ihow1DI e cOllpampriSOr1 of per capita lncolle
tor ttaCh ceDsua tJact aDdmiddot combiDed census middotmiddottract areas
he 1910 aDd 1960 statlstlcal iDtOrllatl0D was combined
lna map and chart he purpose of this and chart is
to d8aonatrate the e cl1stributloa1DeachceD8U8 tract
and middot1ndlcatbull tuture ace populatlon treD4a bull
When one be middotbullbullbullbullbullHdth ne8cts ot an area and has
declded to establlsh a cl1D1c to serve that area the
physical location otthat cl1D1c IllU8t be consldered In
order to coapreb8ll81vel develop an area cl1n1c one should
conslder thepre88Dttraftlc middot~ytaa an4tranaportatlon
systems Thecl1D1cahoUld be located close enoUlh to
major arterlals to giva asy access from the total area
be_ ervecl by this cliD1c At the t1ll8they should
be tar eo away froll thesarterlals to all8Y1ate traffic
CODCell18 andpark1D8 conpstlon By traff1c concerns I
IJ
37
lIlan one lUSt consider thertarro1fne8S of streets whether
streets are oD8--C)r two-way iqres8 and egress to parking
amp0111tie eros tratflC) spedof trattJQ children 1n
ll8a traffic i1lht Vislon re8tr1ctionS etc
BwstraDsportat1onshould alao be central in this area
as maay people ~U f1Df1 1tD8Cessary to use this form of
transportatlon
~e tutqredlopHQt of bull treewa systems should be
c0J1S1dered soastolesen thecumce ofmiddot future roada
cutt1DSotltbe cl1D1c llte line
nrrph1c middotDampta
It is 1JDportaDtto kDOw the demosraphic distribution
characteristics of the oUenteltbat i8 to be served by
localized health cl1D1cs
Acl1D1c which erves8J1 area where1D the prepondershy
ance of persona arecrter 65 years of mayf1nd that these
people rely more on pUblic transportation call for more
home- services and haV4t 110ft ChroD1c and debilitating
types of disorders (b1_ blood pressure poor heariDg and
eyesight) tbaD do8 an area ot a YOUDIer population On
the other hand thL area of older residents may have little
need for family plabDlng cllni08
In order to better ~Ybullbull the 4eaoraphic population
of each CeD8U8 tract the 1970 CeD8U8 iatormation was viewed
and two specific catelOri8 considered These two cat
IJ
38
lori8S woUld be the perc_tap ot population under 19
year of ase and the percentase ot each oensuetractover
65 years of age he 1960 1Dtormatlon tor eaCh tract was
then compared witbthe 1970 intormation and a percentage
ofincreaae or4ecreamp8 tormiddot e~chtract1n each category
cOJlputecland achartma4e By the use of this chart one
18 able to View tJleap populat1odiatr1but10n of census
tract and at the _ t1lle accesa middottrencl Por example
let us choose census tract 601 W see 40-4 otthe
population is under 19 years ot and that ODly82 1s
over 65 years ot middotAtthe e tille the percentage of
youth bas ~ed ODly 1_ intbe laSt teD year whilethe
percentale over 65 year ot middotbas stayedmiddotthe same With
this in mJnc1 ODe ~ 1DfItr libat ol1D1o aerviDg this
area WOuld bellQre conq~w1th the problems of a
YOUQier populat1on and that _ would probably be true foJ
some t1aein tbefuture On the other hand CeDSU8 tract 54
has only 2 ollt population UDder 19 yel1s ot age and
this has decreased by 1 over the last ten years middotwhile at
the same time 32-377 ot the populat1on 18 over 65 years of
age A ol1D1C ___ this area should be or1eJ1ted toward
tbespecttic problema otthe ampledbull
PerCapia __ bY gsa neat
WhaD cona1der1qlooat10D1 tor health cl1n1cs one
shoUld take the 1DC01Ieot areas into consideration Areas
IJ
39
of lowiDcome would not 11kel~be 8erved more by localized
cl1D1cs tbaD would are of hilbincome It 18 likely
people haYiq a hip iDeoll8would preter to be aeenby a
chosen ~r1vatephylc1a1l tban at a local cl1D1cwhere
10Dier waits y beraceaaampryand leas personal attention
gl_
The 19701ncOII81atoWampt10n tor MultnomahC~ty was
not available at the tille thi8report W88 made The 1Dto~shy
tiOD Was taken ~adtro tbe1960 census publlcation
his woUld ~8Il thea tbat ral1I8 OD the chart ynot 1raquoe
completely accurate hi writer telthatthe areas most
affected by tb8 1I8eof the older 1Dco1DtOlaat1oDWOuld be
those tracts wh1ch baYebad a rapid 1ncreaae1n populatlon
over the past tfmyHr8 bullbullbull tracts would include tracts
nUmbered 104 9897 96 aDd 95 be perc~ita 1Dcome
referredto1il-tb1a Paper18the lIean 1DCo per person per
census tract
Attar the iDeoeper census tract was listed on a chart
a map was de 1D41catiDg those census tracts belonging to
the lower 14 ot income tor all censue tracts in Multnomah
COlDltytbose beloqins to the upper 14 ot income tor all
census tract 111 MultnolUlhCounty and those belonging to
the mid 12 ot 1I1coaetor all oeuuetracts in Multnomah
C01mty
In yiew1Dg the _p 1t caa be seen that the low income
area seautotollow aloas the at aide ot the Wl1lamette
IJ
40
R1ver the full length of Kultnomah County A second low
income area follows the south edge of the Columbia from
the northwest corner of Multnomah County easterly to 148 St
A third problem area seems to be on the east bank of the
Willamette River with the Union Pacific Railroad being
about the center of this tract The extreme loutheast
corner of Multnomah COUDty appears to be a low income area
but as this area bas bad rapid grouth in the last ten years
this could be erroneous
Mental Health
be first ~ecific indica to be selected from the
Multnomah County envirollllental survey of early 1971 and
to be considered in this paper i8 that of Mental Health
At the present for mental health purposes Multnomah
County is divided into five catchmentareas with a mental
health cl1n1cin each area These clinics are Model
Citles Delaunay ADkeny street Office Hansen Health
Building end Southeast Clinic
All lIlental health cl1n1cslcept statlstlcal information
on all patients visiting their cl1n1cs this included the
address of the patient hese addresses were then listed
upon the approprlate C8D8US tract Each census tract was
then ranked on a chart according to the nUllber of mental
health patients who reslde ln thatCeDSUS tract attending
any of the above listed ental health clinics This chart
IJ
41
wasttum d1v14ed1ato proper quartile bbullbullbull
quartile vereUs to dne10 u appropl1ate Multnoh
County _tal health ItLa middotmiddotmiddotthelipO~a1bl by lOoJcJIUE
at the UDtal health _to uteN1De which ueu have the
lars-t use otCOllDty 1alh~th faci11t1Rot
1Ilclu4ecl 111 tbia woUld tber otpeopleYia1t1Da
pr1vat patch1atriata aDd pr1_t _ntalhealtb cl1D1c8
WheDtbe M1 18Yienclmiddot Itmiddotmiddotmiddotmiddot~middotbe~_ tbat ~rtt
appears to lMt fourmiddotmiddot-al are iii _oil the nuaber ot
lIental healthcl1D1c na1t toM tbjh1sheat 1he
tour areaa woUld be tollows
1ttrea Ore to~Blo Drimiddot ~tb Burrus14e aDd tIMtmiddot Colb1a Riftr H1gbwyaeri1Dla th nortllra boundaryshy
2 bull ProII 82D4 1_~ 10 20th streetwitil the ra1lMd Mu the north ltouadary
3 ~ et et tUgl_b1bull MYel froamiddot the Clackaaa COUDty l1ae aorth to Dln8lon stret
4 beDOlvt1ttfe-t ~efllt4 COatytrca Jle1aware streetmiddot toR1C1a11oDd wlth Colubla Blvd heiDI tbAtnorth bouaclary_
It ODe coapareatbiap to th iDeobullbullmiddotp 1t can be
eamiddotthat lIOat ot the c tracts baY1Dg bllh v1i11tatlcma
middottfl public tal health cJ1rUc8 ~ 111 t13e low ~ aid
1DcOile SroupiDIOJa1y of til 25 tracta llsted as
haviDlbip aental Maltll nlltatlou are ~ the1g60 hip
iDeo arebullbullbull
17 Plpn
42
amily PlellnSDI ]Jlce Metal Health i8 an 1nd1ce of
use Theperson 111 ordertobavebe_ 1Dcluclecl 1n this
atu4ywouldhave tohaft Ue4 ataa11y plaDI cl1D1c
tacilities of soaetype It 41fter troll tile _tal health
study1nthat i t1Jicludestatist1catrollbotb public and
privateclJD1os
The iDformation tor the iak orurcbart 8Dd map of
t8ll111 plenn1 na ob1a1De4 by cOIIblnlDlthe mabel of
1rlcuv1duals bullbull_ attbe tbreellUltrampo-ti Coatyhll11y
PlalJQllIl C11ll10s 111til tbo at the Planned PareDthood
Association CliD1C8 be tbree -JIultDouh Couaty r8ldly
PlamSq Cl1D1c are Solrtbweatth Col_bla 1111- a114
HaDsell Health BWlcl1Dl CllD1cbi middot1Dtormat1oD vas then
bullbullbullesed tomiddot detellWMt l10w people troll eacb c8IUIUS
chart wastben Mele IUs oIIart jn 4iY1ded to show
the censuS tracts lIaYiDlmiddottIle h1t1iest qUart1le of incidence
of use lowest quartile of 1Qc1deao ot use Jlid 12 of
incidence of Wle an4 a map sprepared troll thts 1Dto~
mation
The C8U118 tractsbelOJISnl to the h1lhestquartile of
use appear to be 1lO~ 8catt~ on tbipwas true ot
either the _p ot aental health cl1D1c uaageor ot the map
abow1DI per capita 1I1COM Iaere40 to be three
d18t1nct areas of UIIaP beJ woul4 be
1
IJ
43
t10D of BurD81cl and the W11lallette River 4
2 S~t Portland 8Otth otmiddot the ra11shyrcaadand alona the W11lamette River
lIortbeaat Portl8D4 between MisSiss1pp1 and 24tbStreet the northbouBclary be1DgColwb1aBlvd
Pylzl1c BMltl IrpI Y11ta
Publlc Healtil nur81D1Y1s1t nclud8 an vists to
theholles of client by PubUc Health Nurbullbullbullbull his shows
visits to bull f8Jl1ly fer aDY purpos SUCh aatuberculolJ1s
het1Dl tem1tyaeatalu4 8IiOt10D8l cODd1t1ona etc
he atat18t1C~ 1fele C()4ed accord1Dg tomiddot the 1llli301fOCUS
of the Y18lt tt doe DOt 1D41cate the Dmlber of holies or
f8ll11lev181tecl or 1D41Y14ual Y1a1ted more tban oDcein
the propwl It dobullbull I1ve 80M 1D41cat1on by coaparlshy
OD ot the 8JIoUDt of aedlcal problema 1n eachcen8WI tract
Ap1nmiddot the _p abowa 8 scatter patteraof probl_
areas althoUSh there appear to be a sroup1Dl of hiSh J
l8aIeccmaus tract 1ntlut extreme southeast part of tbe
County other areu uIriaI any nura1Dl contacts are
1 bull he 801lth-oa-al CO1Dty on eaCh 814 of 82nd Av from Clackallaa County north to Dinloa
2 ear bullbullbullt 814e aroUDd Preacottand Misaisippi
Dowatom Bunul14eonboth 1de of the river
44
V_real Pis The iDfomatloil uaec1 to tabulate the Venereal
disease chart includes all the ooab1ned case otmiddotODormea
and syphilIs reported by bothmiddot publIc and prIvate physicIans
dur1nl 1970 There were 3602 caes ot IOnorrhea reported
dur1nl 1970 While ODly 17 cabullbullsot ayphilimiddot were reported
A chart was prepUed aDd att8llPt wasmiddotmiddot de tomiddot
determ1De Wh_therVttDereal 41ease was more p~vaJent in
areas othigb or lowmiddot proportIon ot youth hi waadone
bymiddotdetemlna a 1leaD prceiltacmiddotmiddotmiddottor the population ot
resld~ts UDder19 years ot (34) middotA mean ratemiddot per
100000 popUlatIon al80c1ttem1Ded tor the middotoccurreDCe
ot venereal dieae This was et at 390 oass Areas
hav1nl a population 1n which leiS than 34 were lmder 19
years ot ampIe were called low- yOuth abOve tbl percentaae
hiSh youth The aaa waatrue ot the occurrence oivenershy
eal disea_ per CeD8UStract It the rate waacomputed
as 1I0re than 390 cases per 100000 it was called hiah
venerealdiaeasei it less than thia tisure low venereal
disease It was tound that 1D Multn~ COmlty there sems
to be poSitive OOlatI0n(x21S19gt between low youth
and hipmiddot venereal diseaand hip youth and low venereal
diseasebull
RaDk ordr Iitot all c traot middottbAm made
Th1s was done byt1Ddlna the ratepr 100000 populatIon
of venereal disator all census tracts in the County bull
45
These were thenlisted from h1lhto low (sreatest to
least) in a rank order The l1sting was then divided
into Upperandlower 14 aDd listed on the MUltnomah
Countymiddot up
The areas of b1gh venereal disease se8ll18to
roup thBl~8 middotin a very tllht area ~oq both 1des
of thell18l8~ R1 w1th BurDaldeS~et being
~bout theceDter qf tbi8IZ9uping This area woUld
appear to be m ldeal spot for the denlopment of a
locallzed venereal d1sbullbullbullbull cl1D1c
UbepoundCUlO1s
In this report bull tube1C1llosls caS8S refrred
to include alltbobullbull cabullbulls ontubercUlo8is follow-up
rather middotthan just new C Accord1Ds to the Multnomah
County Health SUrvey of early 1971 this would include
all ca repOrte4 over thelaat three years The
total number of tuberculosi8 cabullbullbull usedin this study
was 666 lh1 included 128 new cabullbullbullbull
A rate per 100000 of tuberculosis for each
census tract wa- then computed and the c~us tracts
listed by rank order be b11h Qartlle mel low
quartl1 were then reoordd on a Multnomah CoUnty map
TWo genral areaa baY1Dg a hip mcldencaot tubercu~
losiare 1D41cated heyare
1 Both middotsld ot theWilla11lette River
Ll -
46
with Burns1de about thecnter
2 he extrea Northebullbullt comer of the County bull
By coap8r1ng the tuberculois an4ven8real
diseae maps ODe can 8ee that the downtown areas ot
hiSh 1nc1denceare alIIo8t 1c1eDt1cal on ach map
This WOuld 1nd1cate that 1t would be of value to
bullbulltab11sh acl1D1c 111 th1aampreatbat would provide
bothtuberCulos1s 8Dd ytmereal 418ase srvicbullbullbull
Thchart aDd 1181gt8 are wsfuln 11v1DI
1Ddicat10DS tor the type aDd placemeototlocal
health cl1n1c8 tbro1qhout tbe MultnomahCounty area
A cOllpar1on of the mapa help one to dec1dewhether
to provide a aulti-8ervice cl1D1c or spec1f1c type of
cliD1c As stated in Part I of thi paprserv1ces
shouldhaYe both treatlieDt and prfMmt10n cOmponents
As he been stated fta ne1lbborhood health care
Qenter muat be a fac111tY plazme4 with an aamesa
ot the neds of the consumer and the c01llll1m1tybull
Part II of this rport haa been an attaapt to indicate
and clarify 8011 ottheae coDlllUDity neds This has
been done through8elect10n of apc1f1c problems
The indic were then visuallyrecorded through the
use of ups and charta ODe dan asseS8 thedsreeof
1DIportance of certain concems to spec~t1c areaa by
comparinl the chart aDd maps Prom this oDeean
41 dec1de which are48 vb1chcUD1c-or indeed if
the need a clinic at all However further factors
should be considered hebullbull include
a The amount of fuDd1 available
b What 18 the percentage ot peopleineoh ceaaua tract tbat would actually us such cl1n1cIl
c Wbat 1 tbeco--1tymiddot 8 IeeliDashyreaardtDI particular cl1D1c8 Would this dcrebullbullbullmiddot the ettctiveness ot thse cl1n1ca
IJ
li
D_OlraphicPopulatLon Challie 1960 to 1970 48
Cen8U8 1 of Pop 1 Cbaqemiddot 1 Change1 ofPopTract Under 19 Yr8 Over 65 Yrs1960-70 1960-70
middot1Q701Q70
1 319 -12 171 -H) 1
2722 215-27 +68 301 366 -22 127 +35 302 371 +19 111 -04
311middot401 144-41 +29 402 321 13~7-39 +24 501 356 124-08 -02 5~O2 351 133-23 +12
405601 82-10 -02 394602 103-01 -06
701 275 149-76 +56 702 361 +01 121 -07
+10middot801 326 140-22 802 321 middot127
(
-29 -03 9~01 342 124 -H) 6-18 902 294 128 -H) 3-24
10middotmiddot -14312 140 -17 1101 182 +25 -23197
2411102 186-59 +29 1201 226 169-17 -41
31middot01202 +11 182 -05 295 -H) 81301 208 -H) 4
1302 331 +08 197 +04
14 323 +15 middot185 -08 middotmiddot15 329 +16 16~5 -13
-28middot 1601 332 131 +12
1602 356 98 +24middot-39 middot3101701 161-33 +21
1702 370 -15 85 +02 +19 1801 264 151middot-50
185middot1802 256 +47-58
IJ ~
D_raphlc Population Change 1960 to 1970middot 49 (Contd)
4io
Census Tract
of pop Uncter 19 Yra
1Q1n
1Cha1l8e 1960-70
of PopOver 65 Yra
lQO Change
1960-70
19 389 +29 141 -24 20 223 -13 206 +18
21 227 +08 194 -36 2201 356 -27 112 +05
2202 290 -18 ll~9 -29 2301 356 -03 154 +24 2302 260 -37 245 +97
2401 410 +6~1 123 -31 2402 163 -80 320 +99 2501 381 +13 140 -01 25()2 237 31 lil +02 26 343 +25 186 +149 2701 370 +29 1S5 -01 2702 249 -44 304 +98 2801 337 +19 187 +09 2802 306 -10 156 +31 2901 304 -38 142 +24 2902 i 307 -32 146 t3~9
30 29~0 -48 16~2 +51
31 355 +30 160 +01 32 370 +48 148 -13 3301 395 +45 130 -20 3302 368 +06 138 -02 3401 386 +16 117 000
3402
400 +32 92 -26 3501 304 -07 115 +35
3502 344 000 140 -13
3601
36~02 357 -04 132 +32
3603 30~1 42 149 -67 3701 342 +28 152 +19
1
IJ
Jianolraphic Population Chan 1960 to 1970 50 (Contd)
Census Tract
of Pop Under 19 Yrs
JJl7J
middotChanae 1960-70
middotofmiddotpop Over 65 Yrs
1c~7n
Change 196070
3702 409 +39 122 -11 3801 308 -11 151 +29 3802 275 -35 180 +46 3803 282 -32 192 +54 3901 376 ~13 100 +17 3902 296 -03 177 +29 4001 438 -11 84 +13 4002 353 -21 115 +20
4101 397 11 9middot0 +11 4102 346 -19 120 +03 42 331 +19 11 bull 3 -16 43 347 -72 105 +31 44 113 +84 183 +154 4S 33~9 +07 110 -06 4601 2501 22 193 +38 4602 332 +59 126 -29 47middot 161middot 000 211 +01 48 103 -26 302 +59 49 138 +1 bull 3 252 +09 50 141 -26 204 -12 51 12 -39 257 +07 52 47 -61 351 +48 53 89 +49 314 -30 54 25 l1li15 327 -17 55 131 -17 115 -121 56 198 +93 227 -47 57 71 102 189 -88 58 240 ~middot41 16~1 +55 59 322 +25 142 +06middot 6001 264 95 132 +50
6002 328 -31middot 89 +07
JJ
Demographic Population Change 1960 to 1970 51 (Contd)
Census 1 ofPop lChange of Pop bull ChangeTract Under 19 Yrbullbull 1960-70 Over 65 Yrs 1960-70
1970 1970
61 355 -58 85 +39
62 328 39 110 +18
63 414 04 73 10
64 382 -22 72 +04
6501 383 02 67 -20
6502 329 -56 96 +09
6601 391 +13 88 -03
6602 319 -59 97 +06
6701 327 71 145 +72
6702 331 ~67 83 +1-0
6801 365 -66 49 +01
6802 388 4bull3 54 +06
69 354 -41 80 +23
70 400 -23 68 -06
71 359 -48 72 +05
72 255 -88 82 +11
73 346 -39 91 +25
74 313middot -63 105 +24
75 329 -42 129 +37
76 336 -52 85 +21
77 370 -10 69 +05
78 309 -10 120 +21
79 325 -56 87 +10
8001 358 -81 57 +12
8002 391 ~81 76 +12
81 315 -76 108 +21
8201 403 -23 64 +08
8202 392 23 65 +08
83 357 -34 120 +31
84 402 -18 73 +16
85 413 -06 76 -09
r
Demographic Population Change 1960 to 1970 52 (Contd)
Census Tract
t of Pop Uncler 19 Yrs
1970
Change 1960-70
1 of Pop OVer 65 Yrs
1970
ex Change 196070
86
87
88
89
90
91 9201
9202
93
94
95
9601
9602
9701
9702
9801
9802
99
100 I
101
102
103
10401
10402
lOS
368
351
379
391
391
413
379
433
372
429
414
432
419
439
~32
377
457 420
378 41middot7
345
360 417
417
412
-04
-02
-35
-26
-28
-11
-64
-20
-S9
-39
-32
-21
-34
-40
-47
-lO~7middot
-27middot +04
+56
+07
-34 01
+04
+04
+10
103
128
97
11il3 99
69
79
42
77
46
34 38
44
40
54
111
51middot
81
133
59
74
140
63
87
76
-08
-06
+04
+08
+17
-05
+3S -02
+1~4
+19
+33
-14
-08
+12
+26
+71
+11
-16 -34
-20
-19 +37
-49
-2S +15
NOte The The
Taken frOi
averageullder averageabove
middotUSCensus ---shy -
19 years == 6S years ==
figures 197
32r 13(14
p a~d 1960
--
Rank
1
2
3
4
5
6
7
8
9
10
11 12 -_
13
14
15
16
17
18
Tract
69 46
60
58
- 68
61
302
2501
67
63
19
62
26
94
3603
3902
64
30 -----~-
Rank
19
20
21 -
22
23-shy
24
25
26
27
28
29
30
31
32
33
34
35
36 -
Ranking of Per Capita Income by Census Tract
Tract
65
2701
- 15
1601
701
66
93
82
2903
3602
30
2502
80
2401
81
- 70
91 shy
4001
High
Rank Tractshy
-32shy37
38 97
120239
7840
41 ~ _2_1__ 42 31
43 2501
44 18
45 98
46 37
47 3803
1702
49
48
1602 92 2702
I
50 89
51 901
52 801
Ra_
53
54
55
56
57
58
59
60
61
62
63
64
6S
66
67
68
TractTract Ra~
74692
170196 70 I
401 71 90
72 1037J
79 70273
3802 74 601
24024102 75
85 76 101
77 9023901
7699 78 100 4101 79
3601 I
380180
458140~ t---- _ - - shy83 82 42
888384
59843501
4777 8~
502
Low
802 86
Rank Tract
87 shy
--88
89
90
91
92
93
94
- 95
96
97
middot98
99
100
101
102
103
104
1201
14
49
72
73
43
87
3502
105
1
52
86
71
1
501
10
3301
104 tf
Rank
105
106
107
108
109
110
III
112
113
114
115
116
117
118
119
120
121
Ranking of Per Capitalucoae by Census Tract
(Contd)
Tract Rank
4001 122--shy602
13
1102 2302
3302
55
3401
48
21
56
50
3402
lL01
2202
2301
53
2201
-shy
Tract Rank Tract Rank T~aet Rank
57 I-----
Imiddote
bull
Tract
- Low -k Note Information taken from 1960 U SCensus
Rank Tract
I ~
Ie
Imiddot
~
----
----
--
--
Rank
1
2
3
4
5
6
1
8
9
10
11
i-
-Tract
391 922 921
972 971
100
132 131 121
962 961
822 821 401
982 981
20 111
47 10 1
412
High
Total Number of Henta1 Health Visits
Ranked by Census Tract High to Low
TractTract RankTractRank Rnk
12 182 22 78 29 87 76 381 73181 ~------- 1913 371 8538230162372 271 2616-121 8272 2
14 80~2 31 94 7923 84801 59 15251362 4232 15 52 _ 32 103 8924 651 17240216 652
_ 91 351 33 341 23117 83 122 25 25 48 1123921418 34 shy61 86 661
19 662 6493 81 26 91 8153 49 50 55 41383 71 27 51 3120 90 672241 35shy 104167162 461
I 411 46211121 28 88342 I
2502 36 69 54 5251 50 272
-Ra
37
38
39
_ 40
_ 41 Ishy
I
42 I
-I 43 44
45
shy
Tract
~ --- shy 95 56
45 292 242
102 62 352 291y
92
101 281
99 72 63 601 60~ 42 2201
77 74 61 57
363 232
70
32 31
11 44 282 2202
Low l
- Tract
46 682 681 I 331 30
r~$ 47 1042 332
48 102_41_
11
~
Visits to Family Planning Clinics Ranked by Census Tract High to Low
Rank Tract Rank Tract Rankmiddot Tract Rank Tract Rank Tract Rank Tract
1
2
3
4
5
6
7
8
9
10
11
12
13middot
14
15
16
17
361
56
401
341
48
59 121
20
55
342
10
31
58
93 21
241 132
331
53
461 462
18
19
20-shy21
22
23
24
25
26
27middot
28
29
30
31
32
33
391
32
middot47 I-i-_-shy _ -
231 111
332
972 1
372 371
52
89
32
92
82
100 31
182
30 242
402
34
35
36
37
38
39
40
41
42
43
44
45
42
1714 i 661 221
78 362 2
90 602 601 352
63 251
105 921
971 351
73 42 292 232
411 51
662
81 45 52
46
47
48
49shy
50
51
52
53
54
55
56
961
801
49 81 72 71
19
9~1
172
68 2 57 162 14 112
91 75 681
381 42
3~3
83 161
57 f
58
59
60
61shy
62 Imiddot
63
Imiddot 64
65
66
64 62 36~3 252
74 652 SO 392 291
651 6bull 2
79 271
r-- ---- shy981 222
672 671
821 272
94 87
281
382
67
68
69
70
71
72
73
74
75
76
77
78
981 26 12~2
IS 61
85 82~2 69
61 43
101 86 84 282
76
131
51 72
1041 962 88 70
99 922 77
103
95 802 181
i
~
Low High
RankRank Tract
5479
4480
81 1042 ~) middot102
71 - - + ~ - ~
Visits to Family Planning Clinics
(Contd)
Tract Rank
I
Tract llaDk l
RankTract Tract Rank Tract
~
I
~
J1 ~
Low
Total Number of public Health Nursing Visits
Ranked by Census TractsHigh to Low
TractTract RankTractRank RankRank TractTractRankTractRank
25249 71 79 17249 8033 6586 99189711 84 2915072 34 661 76 66 811519512
402 5035 51 161 2518220 122 1713423 352 55801 7120 6752 2 149814 41236 83 2662 38 94 6821 53 2924015 362 37 32 42 75 69 281 84 63
546 8822 54 222 85 3925431 70383417 3818223 6439 4386652 718 21 55 103332 8924 232 87 19 271729219619 24156 16211140 382 628825 10523110 112 73411 10141-- ----shy 89 363 4457 8126 16111 221 74 9142 90 46158331 53 671279012 46243 48 59 351 3837528 1083 9313 91 5844 59 -_242 76 1----- shy60 272 72 74104114 60145 42 9287 7729 92 6151 8215 57371 934630 91 307762 12113116 282 619447 41391 9531 78100 63 7378 ~95 681 6945 32 5632 798517 6448 47 52 181
High ~ Low
Rank Tract Rank
96 31 132 70
97 102
98 182 372middot 602 651 662
- -shy
~72 682 802
822 922 962 972 982
1042 ----shy
Low
Total Number of Public Health Nursing Visits
(Contd)
Rank Rank Rank TractTract Tract
I
I lt
I
Tract Rank Tract
[
~~~-
I
~
IJilfimiddot ~
j
Ranking of VD Caea According to Census Tracts 61 By High and LOll Youth Itatio
A media~ of 34 5 was determined Any tract having greater
than 34 5~ of popu1tionunde~ 19 years of age -High~
Any tract having l8S than 345 of population under 19
years == Low
Any tract having rate less than 390 =Low
Any tract having rate more than 390 == HLgl4
YOUTH
LOW HIGH
L
0
12 402 1801 1802 343 2801 2802 29023603
54 6001 600262 66~02 72 74 75 76
78 79 81 t02 65 1202
W
(25)
VD
H
I
G
H
401 701 801802 901 902 10 1101 241 1201 1301 132 14 15 1601 1701 20~ 21 2202 2j02 2402 2502 2702 2901 303501 3502 34023801 3802 383 3902 42 44 45 4601 4602 47 48 49 SO 51~2 53 55 56 57 58 S9 6701 6702 73 95
3~02 7021702 19 25~01 2701 4102 4101 63 64601 ~601 6801 680270 7l 77 8001 80~02 8201 8202 83 84
85 86 87 88~ 90 91 9202 920193 94 9601 9602~ 9701 9102 9801 9802 99 100 101 103 10402 105 6501 10401
(47)
301 501 502 601 1602 2401 2301 2201 31 32 3301 3302 3401 3402~ 3602 3702 3901 400140 02 43 61 69 B(
(53) (23)
~ ~gt
Ranking of VD by Rate Per 100000 By Census Tract
~
Rank Tract Rank Tract Rank Tract Rank Tract llank Tract Rank Tract Rank Tract
1 2202 21 S6 40 902 58 1602 74 75
90-shy 64 107 26 --~-
2 3402 22 45 41 10 59 902 75 78 91 54 108 61
3 2301 23 3502 42 2502 60 602 76 6802 92 402 109 87
4 3302 24 49 43 1102 61 501 17 2 93 94 110 90
5 50 25 52 44 6702 62 14 78 8202 94 97 02 III 76
6 2201 26 20 6701 63 4002 8201 2501
9701 41~02 112 91
7 44 27 48 45 401 64 3802 2902 95 63 113 62
8 3301 28 1701 46 502 65 30 79 83 74 96 9602 114 71
9 55 29 47 47 42 66 3803 80 2801 96Q1 115 85 10
11
12
13
14
15
16
17
18
3401
53
2302
2401
57
21
2402
1101
51
30-shy31
32
33
34
35
36
37
3701 - -~ 1201
3702
89
43
132 131
3602
4001
48
49
50
51
52
53
54
55
58
1601
601
4602 4601
69
701
31
3901
67
68
69
70
71
72
2901
801
39021~ 802
6502 6501 122
702
41~01
81
82
83
84
85
86
87
88
19
1
1702
2802
79
93
100 6801 6602
81
97
98
99
100
101
102
103
104
9201 9202
9802 9801
77
302
79
86
72
84
116
117
118
119
120
121
3603
8002 8001
101
99
95
10401
105 10402 103 102
19
20
59
32
38
39
2702
3501
56
57
301
3801
73 1802 1801
89 6002 6001
105
106
2701
88
High Low
-- -----
Rank OrdermiddotTuberclosis Cases by Rate Per 100000 Ranked by Census Tract High to Low
Tract TractRankTractRank Rank TractRaukTractRankTractRank
801
79 9601501411 52 6835340120511 I 960269 903603532036 $-~~F130221542 4366 311301 70 68~013802 _ I- _ 4001_37213 3921201 6802802 H71523822024 22 54 193302 3802 80 8958 I37139535 70155 9801 I60123 72 6702 98023914011016 6701250124 10 56
81 94 401r 7 154152 73 7057 2625 122 92028
90242 162312301 92~158 86 7172434526509 82 79160159 74 100 87412240227220110 6502836960 75 30 8317244 6501782801285711 61 901 42765645 84 66021459294912 9701 660146 171 302 9702 47
6235023033113 85 822821182 917755 16335013110214 841814832 78 103 938564 324815 86 1057940149272 38036523216 10401 87 2902241 725Q 10402360266340217middot IF88 88 9937233 282 51 218 101 01102 46016234
I)167 2901460219 47
High ~ Low ~
- -
TractRank
9S89
6490
8191 8001 8002
63 61 60middot01 6002 44 2701
92
J
2502 402 --- ----shy
I
Rank
Rank Order Tuberculosis Cases by Rate per 100000
(Coutd)
Tract Rank Tract ~nk
I
Tract Ballk Tract Rank
Imiddot
Tract
Imiddot
1~
t 1I i Pi i l I
o
1 -1shyL I
I J
8 40 icO ~ I -lt 0
-t (1) I
i I
r o E
II
a
I
r--i
shy
I
~
I (
Jgt
(011 fi(
Ggt
I II ~j
()
(f 0
~ ()
I
11
f9
r
II 99
o ~
Ggt r
~ __-J~ I t I ~ I
r--J l I
~ _ __ J
) 1
fTl
1gt
r I
()
r
()
lt en -i en
()
I1l
(J)
(J)
-i
P ()
19
r o ~
r G1 I
I
c
~
o I 89
--- -I-shy
r-r I
1- 0 _~ _ _--J E
G1 I I I
i i
I 1-1-1 ~ _J ~2 ~ II
II
()
1 I I I 1
id i bullbull
~
A n 69
r 1shy
- 0 Gl
l--~ ~ I
~ II
II )
I () isect i
en l i
(J)
-t
0
IA Ol
~
25
greaterdelay1n tbe k i Dlofa8d1cal care These
patients wppoedlyeelcmiddotcareODlymiddotwIleD tbeirmiddotillDess
becOlles1Dtolerable resultiDSin middotthMr appeariDS withshy
outnot1ce1o rece1ve oareHlwever Greenlicks
r8aearcbbaa cut doubt on the existence ot tb1delay
111 report1Dg middot8J1IPtoJumiddotOfDeW 11laessand seek1ng care
Be bas tcrQDd 1bat s1ll11ar peze_tases of dioally
1nd1sent 8DClJ1on-aed1cally 1Dd1PD~ pat1enta seek care
on the aue daytbat aptou tirstaPPear
1fb11e GrHDllclc 1nd1cat tbat the reasonator the
greatertendeDCY of low 1Do~e pat18Ilta to 1$8 walk-in I
serY1ces are notlcDo1rAmiddotmiddot tbe7 _ be rel~tedto a tendency
ot lower aocio-ecaaaoclaa patieota to preter face-toshy ~
face contacts with II841cal persoDl181posslbly because
such contacts areft coatortiDS an4reasauriDS to
patients who are hJpotbeafzed to bave a dependent attltude
toward IIed1Cal care perS0Jm81 (30 p161)
It a8 itmiddot baa pnerally beenhld the appointment
s1stemts the most efficient Ileana of dellveriDS
comprehenSive oODtllluiDlh-lth care (9~100)1t is
necessary that educaUoraalmiddotbulltfort be taken to proaote the
use ot middotappo1ntaents8DClmiddot tQrec1ucethe fa111re to appe~
ratB4uOatioaalwhlQb baft~utl11zedhave been
IJ
26
1Dten1ews with walk-in patients home Vi8its and group 4i
meetiDp1D8D attemptto1Dierpret1o the patients
the value of rtitgular ppo1ntmentamp andot con~in~
c~1ve care rather than epiI041c care (9 p1OO)
h1s 1safuD~tioD torwhtch nOl~prot81QDal colDlllUD1ty
YOrkersllaY bebe~r8U11ed tban other statf H()wever
euch aD ~ucat1oaal propul __~ ~e related to the senUiDe
capacity otth health oenter to provide comprehensivebull gt
ervice8 to1tpat1_t~odoD aD app01ntment bas18 It
1amp pos8ibleo~rw1 tor educa110Dal ttorts to result
LD a~8JImCl tor ltPP01ntaen~8 at a ratewb1ohi8beyond
the capacity ot thee_tar to t without uareaaoDably
1_ wa1t1Dlprio4a QOBt1nuad use Ot the center on a
wallt-in bU1 _1tbeoosiItpos81ble to et an appoint-
met anc11nCreued pit1entcoJaplampia1a bull Therew111 of
course always be a need and demand tor acute ep1so~c
Care -ci the health centerDlWlt be planned with the capashy
billty ot bullbullbullt1D8 tb1aneed wh1~ cont1Du1nI to stress
aDd educate the patient to utillze oDlOinI comprehensive
faa11y middotc~te~d Cflre (9p 100l
att g4 CODClva1opa
In order to bea4equate any coJlltemporary health care SY8tem muat bullbulletcerta1D interrelated criteria he
IJ
27
minimum criteria areaccessability of services to those
who need them compr8heX1siveness and appropriatness of
services and efficIency 1nthft utilizat~on of SCarce
health care personnel and resources The scareity of
pex-sonnel andtbe need for h1gh quality ongoinghealth
care services
aJIlong the
populationdemanci the most effishy
cientprovision of services
Services must be made accessible to the population
They mustmiddotbe geosraPh1cally accessible to remove the PhysicalmiddotbaTiers betWeen peopleandthem$d1calcare
system They mUst otter their services dur1ngthe
hours when people can make the moat use ofthemA~ it
makes little sense to concentrate services geographically
where they will not be uSed to their fUllest extent it
also is wasteful to provide serv1cesonlydur1righours when
many people are employed his not only presents a hard
ship middotto the consUmer lnrt wastes resources if for instance
the unavailability of preventive services during the hours
when people Can use them causes a need for treatment
services later on
Health carbull sEtrvices must be comprehensive including
prevention treatmcmtand re)abimiddot11tation Ambulatory I
healtbcare facilities wh1cQ are orienteciexclusively
toward either prevept1on or trea1mentare no longer accepshy
table for they are lneft1c1entln their use of resources
and in their prov1s1on of health care to the patient
w ~~
28
If prevent10n1s notmiddot stressed treatment serv1ces that
could have beenavoidedY1l~ be required If prevention
1s the sole focus of the health care facility sick
patients who present themselves must be referred elseshy
where for treatment andsllch referx-als may be taken as
reject1onsor not followed through with until illness
becomes unbearable
The instltutlontbat meets these requirements Is
the comprehensive neighborhood health center It 1s a
local decentralized outpatient facilityprOVld1ng a
fUll range of ambulatoJY health care services It has
a linkage to ahospitalbackUp facilityforlnpatient
treatment and hiihlY apclalized outpatient care
The neighborhood health center must be a fac11ity
planned with an awareness of the needs of the conSUtller
and coDitnUn1ty It must have the r~Ul0urces to provide the
services people need mere they can use them and when
they can use them It must uti11ze the part1cipation of
the community to develop this awareness Not only must
the cen~er beset up to be Amctional for the consumers
but efforts must bemadeaga1n with commun1ty partici shy
pation to help the consumers utilize medical care
services effectively The center muetmake efforts to
educate the community about the valueot regUlar health
care of preventive servicesand of the use of planned
IJ
29
medical appointments ratherthanorisis centered walk-
incare Therealit1es of the existing health care
system have not taught the patient particularly the low
income patienthow to use services effectively
The helthcenterilUst also bea laboratory for
experiments in easing the health caJepersonnel shortage
and c60rd1Datingcare~ A major difficultY iri-exper1shy
menting with neW rolesis freeing staff of old preconshy
ceptions
CoDlprehensiva neighborhood health dare centers have
been developed under a variety ot alisplces including
medicalsociet1es hoSP1talsmiddot(36p299 group pr~ct1ces
(29 p6- 12 117) health departments (13 p1027) and
ne1gbbothoodassoc1ations(14) The literature indicates
somevalues nthe management ot the health center by plusmnts
hospital backup faCility Whatever the auspices many
adm1nistrative fuDctions such as program coordination
standard pr9tectionand evaluation call for considerable
c~tralization of adm1nistration city-wide or coU)tyshy
wide At the same time other aspects hours of servlce
for examPle~ cuI f~radm1nistrative fUnctions made atmiddot
more local levels Each neighborhood center must be
free to adapt its functioning to itscominunity thi-ough
the mechanism otcODlllUl11~ participation inmiddot policy making
Obviouslythe prerogatives and responsibilities of each level must be negotiated and made explic1t
t4~
JJ
BIBLIOGRAPHY 30
1 American Rehabilitation Foundation ~ealth Services Research Center The Health Maintenance Strategy mimeo 1971
2 Anderson Nancy N Comprehensive Health Planning in the States A Study and Critical Analysis Institute for Interdisciplinary Studies American Rehab ilitation Foundation 1958
3 Andrus Len Hughes Comprehensive Health Planning Through Community Demonstration Health Projects mimeo1967
4 Barry Mildred CandCecil G Sheps A New Model for Community Health Planning unpublished paper presented to the American
Public Health Aseociation1967
5 Blum HenrikL Fred Wahl Genelle M Lemon Robert Jorulin and Glen W Kent The Multipurpose Worker and the Neighborhood Multiservice Center InitialImplications and EJeperiences of the Rodeo CommunityService CenterAmerican Journal of Public Health58 (Mar 168) pp 458-468 shy
6 Blum MichaelD and Soloman L Levy A Design for Service Delivery that Reinforces Constructive Tension Between a Health Center and Its (sic) ConSUDlers and Supports Community Power unpUblished paper presented to the American Public Health Asaociatiltn 1968
7 Brielaud Donald Comm~ity Advisory Boards and Maximum Feasible Participation American Journal of Public Health 61 (Feb 1971) pp 292-296 shy
8 Burns Eveline M Health Insurance Not If or When But What Kind Madison Wisco~sin University of WisconsinScllool of Soci~l Work 1971
9 Campbell John Working ~elationships Between Providers and Conshysumers in a Neighborhood Health CenterU American Journal2 Public Health 61 (Jan 1971) pp 97-103
10 Caxr Willene Neighborhood Health Centers Funded by the Office of Economic Opportunity mimeo 1970~
11 Colombo Theodore J Ernest W Sawardand Merwyn R Greenlick The Integration of an OEO Health Program into a Prepaid Comrehensive Group Practice Plan American Journal of Public Health 59 (April 1969) pp 641-650~ -
12 Comprehensive Neighborhood Health Services Projectof Kaiser FoundatioIl Hospital~ Prcgtgram YearE grant renewal proposal mimeo~1971 bull
13 CowenDavidL~ Denvers Neighborhood Health Program Public Health Reports 84 (Dec 1969) pp 1027-1031
IJ
14 De Diaz Sharon Daniel Beyond Rhetoric The NENA Health31 Center After One Year unpublished paper pres~rited to the American Public Health Association 1970
15middot Gerrie NorrrianF and RichardH~ Ferraro Organizing a Program for Dental Care in a Neighborhood Health Center Public Health Reports 8 (Aug 1968) pp 419-428
16 Gordon JeoffreyB~ The Politics of Community Medicine Projects A Conflict Analysis Medical Care 7 (Nov -Dec 1969) pp 419-428 shy
17 Greely David The Neighborhood Health Center Program and Its Implication(3 for Medical Care H~alth Forum of the Welfare Council of Metropolitan Chicago (mimeo) 1967
18 Greenlick Merwyn R Newgtimensions in Health Care American JOurnal of Pharmacentical Education 34 (Dec 1970) pp 754-4
19 GreenlickMerwyn R Donald K Freeborn TheodoreJbull Colombo Jeffrey Abull Pruesin and Erne$t W saw~d Comparing the
Use of Medical Care Services by a Medically Indigent and a General MemberShip Population in a Comprehensive Prepaid Group Practice Prosram II unpublished paper presented to the AmericanPublic Aesociation1970
20 H~tadoArJiloldVMerllYll RGreenlick and TheodoreJ Colombo Determinants of Medical Care Utilization Failure to Keep Appointments unpublished paper presented to the American Public Health Association 1971
21 Johnson Richard E and Merwyn R Greenlick Comprehensive Medical Care A Problem and Cballengeto Pharmacy ff AJilericanJournal of PbarmacenticalEducation 33 (Aug 1969) pp 361-367 -
22 Kahn Alfred J Studiee Social Policy and Planning New York Russell Sage Foundation 1969
23 Kotler Milton Neyhborhood Government Local Foundations 2 Political~New York The BobbsMerrill Company 1969
24 NationalCommisaion on CommunityHealthSfrvic~sActionPlanniriamp for Community SetithServices~ashington p C Public Affairs-Press 19t7
25 National Commission on C~mmunity Health Services Health Adminishysration andOrMPization l the Decade Ali9$-d Washington D C Public Affairs Press 1967
26 NationalCornmiesion onqomm1Jllity Health Servicesbull Health ~ Facilities Washington D C PUblic Affairs Press 1967 bull
~ n
32 27 ODonnell Edward J and Marilyn M Sullivan ServiceDelivery
and Social Action Through the Neighborhood Center A Review of Research tt Welfare ~ Review 7 (Nov~Dec 1969) pp 112
28 Office of Economic Opportunity Second Annual Report Washington D C~ U S Government Printing Office 1966
29 Office of EConomic Opportunity and the Medical Foundation of Be~laire Ohio Eighth Report 2l ~ Committee2a Governshy
ment OperatiOll~ Va8hiiiSton D C Government Printing Office 1969
30 Pope Clyde R Samuel S Yoshioka and Merwyn R Greenlick Determinants of Medical Care Utilization nhe Use of the Telephone for ReportiDg Symptons Journal of Health and SocialBebavior12 (June 1971) pp155-162 shy
31 RenthalA Gerald nComprehensive Health Centers in Large US Cities American Journal of Public Health 61 (Feb 1971) pp 324-336 shy
32 Saward Ernest W The Relevance of Prepaid Group Practice to the Effective Delivery ofHealthServicestt The New Physician 18 (Jan 1969) pp39-44 - shy
33bull Schorr Lisbeth Bamberger and Joseph T English Background Content and Significant IssUes in Neighborhood Health
Center Programs Milbank Memorial ~ Quarterly 46 July 1968) part 1pp 289-296
34 Weiss James E and Merwyn RGreenlick UDeterminants of MedioalCareUtilization The Effects of Social Class and Distance on Contacts With the Medical Care System Medical~ 8 (Nov-Dec 1970 pp 456-462
35 Weiss James E MerwynR Greenlick and Joseph F Jones Determinants of Medical Care Utilization The Impact of Ecological Factorstt unpublished paper presented to the American Public Health Association 1970
36 Wise Harold B Montefiore Hospital Neighborhood Medical Demonstration A Case StudyMilbaDkMemorial Fund Quarterly46 (July 1968) part 1 pp297-308~
37 Yerby Alonzo S ttHealth Departments Hospital and Health Services Medica1~5 (March-April 1967) pp 70-74
38 Young M M~ Chatanooga IS Experience with Reorganization fOr Delivery of Health Services ttAmerican Journ8l of Public Health60 (Sept 1970) pp 1739-1748
f or l
II bull 11 Y d
II
IJ
34
ThepurposeOfPart II of th1aa paper1atod1scuas
elected Speclfic needs ofecltlc areas within Multnomah
County A8P01ll~oUt 1D ~ I of t1a1bullpapermiddot Ita nelgbshy
borhood health oare cater IlU8t be a facl1lty plaDlled with
aD awarenes of the neeels of the oODllUller and collllUDity
Part II of this paper nIl Show 80e of thoe speclflc
needs
he1DforutiOD tor t1li Portlon of the report
obta1nec1 troll tbroupout tbe follow1Dl threepUb11catloDS
1gr~e_tiMshylIPrIxaiidOreson JuDe 1963
2 1~_middot_sectSI8e~ected1teai c-ua 0 S 8 e first count coaputer tape Coluab a_lion AssocshylatloD of QoveraMD-8 Jlme 1971
3 Jtu1tDoab County Oreaon BDY1roDlHtlltal SurveyEarly 1971
The JIultDOIIIlb COUDty OrttIOD BDv1roDllfmtal Surley
Barly 1971 1s bull stat1stical report of the activ1tles of
theentlreMultDOIIIl2 CcNDty Health Dep~t during the
year of 1970 Die speclflc 1nd1cs elected from tb1s
study amprejMental aealtll Publlc Health N~s1D1 vlslts
FaJUly ~ Veaereal])1 ~ ~rcul081
Throush tie use of cUrts and mapa ODe CaD roup these i
speclflc ~oea to ahcnr the healthneedsof speclfic I
census trtcta aD4 then the health needs of iarer neIghshy
borhooda 1m4 o~ Uebullbull
Rf)~UP1Dl of areu was accompllshed in thefolloWinl I
JJ ~
35
he MiltDoIliahCountY oregon BDViromaental SUrvey
early 1971 isamp statistical report ot tbeaotivities ot
the entire MultDolllh COUDty Health ])epartiDent dur1nl the
year ot1970 he specitic 1Dd1C8S selected frOm this
aUy are 1Il8Dtal health public healthDurs8s visits
fUl1ly pia waereal elisease aDd tuberculosia
Tbroq11the Wle otcbart aDd mapa aDecm szoup these
specific indic to show the health Deeds ofapecitic
ccmaua tracts aDdtIum th8health neecla of larsr ~eilh-
bOrhooda and co8I13 tlbullbullbull
RegroupiDI ot areas waa accoap118hed1D the
tollOWiDl lIIIIm1er~ A bullbullcifie 1ndex 8selectcl auch as
venereal di8bullbulle or tuberculo8i~ he total number ot
cs was then deterll1ne4 for each census tract Through
the use of the maber ot cRbullbullbull tor a 11Yen cenaus tract
aDd tbe population ot thattractaltrateot1lla1ampmcper
100OOOpopUlaticm wu cleteXll1ned for each census tract
This was ~e to starl4ard1ze the population ditterence
amongOeD8U8 -tracts 1he rate of incidence toreaob
cenauatract was then llstedby rank position on a chart
In rank poition1DI any cen8Wl tracts haviDg equal
rates ot1l1c1dence are assipe4tbe iaDk posttiona
Beeauseot the abo fact tbAt cbarta w111 vary in length
neveltbAtlea eacb cbart will 1Dclu4eall census tracts
inMullnoaah Couaty Atter the census tracts bave been
listed accord1q to raalcth1s list will bediv1ded into
IJ
36 three levelsotinc14ence he three levels are
1~ The upper 14 of1DcldenCe
2 Thelower 14 ot incidence
middot3 The ILld 12 of incidence
Tlles three srouplqa are then used in compiling a map ~f
Mu1tnOmahCountyfor ach apecltictop1cbull TIle maps are
uaefuJliD tbatthey V1suallycoJib1De 1Dd1v1Clualproblem
census tracts into larger problem nellhbOrhooc1s
The 1960 statistical iDtormatloD was Used in a similar
liIaDDr to tbatexpla1Dedabove 1Dthe4evelopaent of a
chartmiddot and map 1Ihow1DI e cOllpampriSOr1 of per capita lncolle
tor ttaCh ceDsua tJact aDdmiddot combiDed census middotmiddottract areas
he 1910 aDd 1960 statlstlcal iDtOrllatl0D was combined
lna map and chart he purpose of this and chart is
to d8aonatrate the e cl1stributloa1DeachceD8U8 tract
and middot1ndlcatbull tuture ace populatlon treD4a bull
When one be middotbullbullbullbullbullHdth ne8cts ot an area and has
declded to establlsh a cl1D1c to serve that area the
physical location otthat cl1D1c IllU8t be consldered In
order to coapreb8ll81vel develop an area cl1n1c one should
conslder thepre88Dttraftlc middot~ytaa an4tranaportatlon
systems Thecl1D1cahoUld be located close enoUlh to
major arterlals to giva asy access from the total area
be_ ervecl by this cliD1c At the t1ll8they should
be tar eo away froll thesarterlals to all8Y1ate traffic
CODCell18 andpark1D8 conpstlon By traff1c concerns I
IJ
37
lIlan one lUSt consider thertarro1fne8S of streets whether
streets are oD8--C)r two-way iqres8 and egress to parking
amp0111tie eros tratflC) spedof trattJQ children 1n
ll8a traffic i1lht Vislon re8tr1ctionS etc
BwstraDsportat1onshould alao be central in this area
as maay people ~U f1Df1 1tD8Cessary to use this form of
transportatlon
~e tutqredlopHQt of bull treewa systems should be
c0J1S1dered soastolesen thecumce ofmiddot future roada
cutt1DSotltbe cl1D1c llte line
nrrph1c middotDampta
It is 1JDportaDtto kDOw the demosraphic distribution
characteristics of the oUenteltbat i8 to be served by
localized health cl1D1cs
Acl1D1c which erves8J1 area where1D the prepondershy
ance of persona arecrter 65 years of mayf1nd that these
people rely more on pUblic transportation call for more
home- services and haV4t 110ft ChroD1c and debilitating
types of disorders (b1_ blood pressure poor heariDg and
eyesight) tbaD do8 an area ot a YOUDIer population On
the other hand thL area of older residents may have little
need for family plabDlng cllni08
In order to better ~Ybullbull the 4eaoraphic population
of each CeD8U8 tract the 1970 CeD8U8 iatormation was viewed
and two specific catelOri8 considered These two cat
IJ
38
lori8S woUld be the perc_tap ot population under 19
year of ase and the percentase ot each oensuetractover
65 years of age he 1960 1Dtormatlon tor eaCh tract was
then compared witbthe 1970 intormation and a percentage
ofincreaae or4ecreamp8 tormiddot e~chtract1n each category
cOJlputecland achartma4e By the use of this chart one
18 able to View tJleap populat1odiatr1but10n of census
tract and at the _ t1lle accesa middottrencl Por example
let us choose census tract 601 W see 40-4 otthe
population is under 19 years ot and that ODly82 1s
over 65 years ot middotAtthe e tille the percentage of
youth bas ~ed ODly 1_ intbe laSt teD year whilethe
percentale over 65 year ot middotbas stayedmiddotthe same With
this in mJnc1 ODe ~ 1DfItr libat ol1D1o aerviDg this
area WOuld bellQre conq~w1th the problems of a
YOUQier populat1on and that _ would probably be true foJ
some t1aein tbefuture On the other hand CeDSU8 tract 54
has only 2 ollt population UDder 19 yel1s ot age and
this has decreased by 1 over the last ten years middotwhile at
the same time 32-377 ot the populat1on 18 over 65 years of
age A ol1D1C ___ this area should be or1eJ1ted toward
tbespecttic problema otthe ampledbull
PerCapia __ bY gsa neat
WhaD cona1der1qlooat10D1 tor health cl1n1cs one
shoUld take the 1DC01Ieot areas into consideration Areas
IJ
39
of lowiDcome would not 11kel~be 8erved more by localized
cl1D1cs tbaD would are of hilbincome It 18 likely
people haYiq a hip iDeoll8would preter to be aeenby a
chosen ~r1vatephylc1a1l tban at a local cl1D1cwhere
10Dier waits y beraceaaampryand leas personal attention
gl_
The 19701ncOII81atoWampt10n tor MultnomahC~ty was
not available at the tille thi8report W88 made The 1Dto~shy
tiOD Was taken ~adtro tbe1960 census publlcation
his woUld ~8Il thea tbat ral1I8 OD the chart ynot 1raquoe
completely accurate hi writer telthatthe areas most
affected by tb8 1I8eof the older 1Dco1DtOlaat1oDWOuld be
those tracts wh1ch baYebad a rapid 1ncreaae1n populatlon
over the past tfmyHr8 bullbullbull tracts would include tracts
nUmbered 104 9897 96 aDd 95 be perc~ita 1Dcome
referredto1il-tb1a Paper18the lIean 1DCo per person per
census tract
Attar the iDeoeper census tract was listed on a chart
a map was de 1D41catiDg those census tracts belonging to
the lower 14 ot income tor all censue tracts in Multnomah
COlDltytbose beloqins to the upper 14 ot income tor all
census tract 111 MultnolUlhCounty and those belonging to
the mid 12 ot 1I1coaetor all oeuuetracts in Multnomah
C01mty
In yiew1Dg the _p 1t caa be seen that the low income
area seautotollow aloas the at aide ot the Wl1lamette
IJ
40
R1ver the full length of Kultnomah County A second low
income area follows the south edge of the Columbia from
the northwest corner of Multnomah County easterly to 148 St
A third problem area seems to be on the east bank of the
Willamette River with the Union Pacific Railroad being
about the center of this tract The extreme loutheast
corner of Multnomah COUDty appears to be a low income area
but as this area bas bad rapid grouth in the last ten years
this could be erroneous
Mental Health
be first ~ecific indica to be selected from the
Multnomah County envirollllental survey of early 1971 and
to be considered in this paper i8 that of Mental Health
At the present for mental health purposes Multnomah
County is divided into five catchmentareas with a mental
health cl1n1cin each area These clinics are Model
Citles Delaunay ADkeny street Office Hansen Health
Building end Southeast Clinic
All lIlental health cl1n1cslcept statlstlcal information
on all patients visiting their cl1n1cs this included the
address of the patient hese addresses were then listed
upon the approprlate C8D8US tract Each census tract was
then ranked on a chart according to the nUllber of mental
health patients who reslde ln thatCeDSUS tract attending
any of the above listed ental health clinics This chart
IJ
41
wasttum d1v14ed1ato proper quartile bbullbullbull
quartile vereUs to dne10 u appropl1ate Multnoh
County _tal health ItLa middotmiddotmiddotthelipO~a1bl by lOoJcJIUE
at the UDtal health _to uteN1De which ueu have the
lars-t use otCOllDty 1alh~th faci11t1Rot
1Ilclu4ecl 111 tbia woUld tber otpeopleYia1t1Da
pr1vat patch1atriata aDd pr1_t _ntalhealtb cl1D1c8
WheDtbe M1 18Yienclmiddot Itmiddotmiddotmiddotmiddot~middotbe~_ tbat ~rtt
appears to lMt fourmiddotmiddot-al are iii _oil the nuaber ot
lIental healthcl1D1c na1t toM tbjh1sheat 1he
tour areaa woUld be tollows
1ttrea Ore to~Blo Drimiddot ~tb Burrus14e aDd tIMtmiddot Colb1a Riftr H1gbwyaeri1Dla th nortllra boundaryshy
2 bull ProII 82D4 1_~ 10 20th streetwitil the ra1lMd Mu the north ltouadary
3 ~ et et tUgl_b1bull MYel froamiddot the Clackaaa COUDty l1ae aorth to Dln8lon stret
4 beDOlvt1ttfe-t ~efllt4 COatytrca Jle1aware streetmiddot toR1C1a11oDd wlth Colubla Blvd heiDI tbAtnorth bouaclary_
It ODe coapareatbiap to th iDeobullbullmiddotp 1t can be
eamiddotthat lIOat ot the c tracts baY1Dg bllh v1i11tatlcma
middottfl public tal health cJ1rUc8 ~ 111 t13e low ~ aid
1DcOile SroupiDIOJa1y of til 25 tracta llsted as
haviDlbip aental Maltll nlltatlou are ~ the1g60 hip
iDeo arebullbullbull
17 Plpn
42
amily PlellnSDI ]Jlce Metal Health i8 an 1nd1ce of
use Theperson 111 ordertobavebe_ 1Dcluclecl 1n this
atu4ywouldhave tohaft Ue4 ataa11y plaDI cl1D1c
tacilities of soaetype It 41fter troll tile _tal health
study1nthat i t1Jicludestatist1catrollbotb public and
privateclJD1os
The iDformation tor the iak orurcbart 8Dd map of
t8ll111 plenn1 na ob1a1De4 by cOIIblnlDlthe mabel of
1rlcuv1duals bullbull_ attbe tbreellUltrampo-ti Coatyhll11y
PlalJQllIl C11ll10s 111til tbo at the Planned PareDthood
Association CliD1C8 be tbree -JIultDouh Couaty r8ldly
PlamSq Cl1D1c are Solrtbweatth Col_bla 1111- a114
HaDsell Health BWlcl1Dl CllD1cbi middot1Dtormat1oD vas then
bullbullbullesed tomiddot detellWMt l10w people troll eacb c8IUIUS
chart wastben Mele IUs oIIart jn 4iY1ded to show
the censuS tracts lIaYiDlmiddottIle h1t1iest qUart1le of incidence
of use lowest quartile of 1Qc1deao ot use Jlid 12 of
incidence of Wle an4 a map sprepared troll thts 1Dto~
mation
The C8U118 tractsbelOJISnl to the h1lhestquartile of
use appear to be 1lO~ 8catt~ on tbipwas true ot
either the _p ot aental health cl1D1c uaageor ot the map
abow1DI per capita 1I1COM Iaere40 to be three
d18t1nct areas of UIIaP beJ woul4 be
1
IJ
43
t10D of BurD81cl and the W11lallette River 4
2 S~t Portland 8Otth otmiddot the ra11shyrcaadand alona the W11lamette River
lIortbeaat Portl8D4 between MisSiss1pp1 and 24tbStreet the northbouBclary be1DgColwb1aBlvd
Pylzl1c BMltl IrpI Y11ta
Publlc Healtil nur81D1Y1s1t nclud8 an vists to
theholles of client by PubUc Health Nurbullbullbullbull his shows
visits to bull f8Jl1ly fer aDY purpos SUCh aatuberculolJ1s
het1Dl tem1tyaeatalu4 8IiOt10D8l cODd1t1ona etc
he atat18t1C~ 1fele C()4ed accord1Dg tomiddot the 1llli301fOCUS
of the Y18lt tt doe DOt 1D41cate the Dmlber of holies or
f8ll11lev181tecl or 1D41Y14ual Y1a1ted more tban oDcein
the propwl It dobullbull I1ve 80M 1D41cat1on by coaparlshy
OD ot the 8JIoUDt of aedlcal problema 1n eachcen8WI tract
Ap1nmiddot the _p abowa 8 scatter patteraof probl_
areas althoUSh there appear to be a sroup1Dl of hiSh J
l8aIeccmaus tract 1ntlut extreme southeast part of tbe
County other areu uIriaI any nura1Dl contacts are
1 bull he 801lth-oa-al CO1Dty on eaCh 814 of 82nd Av from Clackallaa County north to Dinloa
2 ear bullbullbullt 814e aroUDd Preacottand Misaisippi
Dowatom Bunul14eonboth 1de of the river
44
V_real Pis The iDfomatloil uaec1 to tabulate the Venereal
disease chart includes all the ooab1ned case otmiddotODormea
and syphilIs reported by bothmiddot publIc and prIvate physicIans
dur1nl 1970 There were 3602 caes ot IOnorrhea reported
dur1nl 1970 While ODly 17 cabullbullsot ayphilimiddot were reported
A chart was prepUed aDd att8llPt wasmiddotmiddot de tomiddot
determ1De Wh_therVttDereal 41ease was more p~vaJent in
areas othigb or lowmiddot proportIon ot youth hi waadone
bymiddotdetemlna a 1leaD prceiltacmiddotmiddotmiddottor the population ot
resld~ts UDder19 years ot (34) middotA mean ratemiddot per
100000 popUlatIon al80c1ttem1Ded tor the middotoccurreDCe
ot venereal dieae This was et at 390 oass Areas
hav1nl a population 1n which leiS than 34 were lmder 19
years ot ampIe were called low- yOuth abOve tbl percentaae
hiSh youth The aaa waatrue ot the occurrence oivenershy
eal disea_ per CeD8UStract It the rate waacomputed
as 1I0re than 390 cases per 100000 it was called hiah
venerealdiaeasei it less than thia tisure low venereal
disease It was tound that 1D Multn~ COmlty there sems
to be poSitive OOlatI0n(x21S19gt between low youth
and hipmiddot venereal diseaand hip youth and low venereal
diseasebull
RaDk ordr Iitot all c traot middottbAm made
Th1s was done byt1Ddlna the ratepr 100000 populatIon
of venereal disator all census tracts in the County bull
45
These were thenlisted from h1lhto low (sreatest to
least) in a rank order The l1sting was then divided
into Upperandlower 14 aDd listed on the MUltnomah
Countymiddot up
The areas of b1gh venereal disease se8ll18to
roup thBl~8 middotin a very tllht area ~oq both 1des
of thell18l8~ R1 w1th BurDaldeS~et being
~bout theceDter qf tbi8IZ9uping This area woUld
appear to be m ldeal spot for the denlopment of a
locallzed venereal d1sbullbullbullbull cl1D1c
UbepoundCUlO1s
In this report bull tube1C1llosls caS8S refrred
to include alltbobullbull cabullbulls ontubercUlo8is follow-up
rather middotthan just new C Accord1Ds to the Multnomah
County Health SUrvey of early 1971 this would include
all ca repOrte4 over thelaat three years The
total number of tuberculosi8 cabullbullbull usedin this study
was 666 lh1 included 128 new cabullbullbullbull
A rate per 100000 of tuberculosis for each
census tract wa- then computed and the c~us tracts
listed by rank order be b11h Qartlle mel low
quartl1 were then reoordd on a Multnomah CoUnty map
TWo genral areaa baY1Dg a hip mcldencaot tubercu~
losiare 1D41cated heyare
1 Both middotsld ot theWilla11lette River
Ll -
46
with Burns1de about thecnter
2 he extrea Northebullbullt comer of the County bull
By coap8r1ng the tuberculois an4ven8real
diseae maps ODe can 8ee that the downtown areas ot
hiSh 1nc1denceare alIIo8t 1c1eDt1cal on ach map
This WOuld 1nd1cate that 1t would be of value to
bullbulltab11sh acl1D1c 111 th1aampreatbat would provide
bothtuberCulos1s 8Dd ytmereal 418ase srvicbullbullbull
Thchart aDd 1181gt8 are wsfuln 11v1DI
1Ddicat10DS tor the type aDd placemeototlocal
health cl1n1c8 tbro1qhout tbe MultnomahCounty area
A cOllpar1on of the mapa help one to dec1dewhether
to provide a aulti-8ervice cl1D1c or spec1f1c type of
cliD1c As stated in Part I of thi paprserv1ces
shouldhaYe both treatlieDt and prfMmt10n cOmponents
As he been stated fta ne1lbborhood health care
Qenter muat be a fac111tY plazme4 with an aamesa
ot the neds of the consumer and the c01llll1m1tybull
Part II of this rport haa been an attaapt to indicate
and clarify 8011 ottheae coDlllUDity neds This has
been done through8elect10n of apc1f1c problems
The indic were then visuallyrecorded through the
use of ups and charta ODe dan asseS8 thedsreeof
1DIportance of certain concems to spec~t1c areaa by
comparinl the chart aDd maps Prom this oDeean
41 dec1de which are48 vb1chcUD1c-or indeed if
the need a clinic at all However further factors
should be considered hebullbull include
a The amount of fuDd1 available
b What 18 the percentage ot peopleineoh ceaaua tract tbat would actually us such cl1n1cIl
c Wbat 1 tbeco--1tymiddot 8 IeeliDashyreaardtDI particular cl1D1c8 Would this dcrebullbullbullmiddot the ettctiveness ot thse cl1n1ca
IJ
li
D_OlraphicPopulatLon Challie 1960 to 1970 48
Cen8U8 1 of Pop 1 Cbaqemiddot 1 Change1 ofPopTract Under 19 Yr8 Over 65 Yrs1960-70 1960-70
middot1Q701Q70
1 319 -12 171 -H) 1
2722 215-27 +68 301 366 -22 127 +35 302 371 +19 111 -04
311middot401 144-41 +29 402 321 13~7-39 +24 501 356 124-08 -02 5~O2 351 133-23 +12
405601 82-10 -02 394602 103-01 -06
701 275 149-76 +56 702 361 +01 121 -07
+10middot801 326 140-22 802 321 middot127
(
-29 -03 9~01 342 124 -H) 6-18 902 294 128 -H) 3-24
10middotmiddot -14312 140 -17 1101 182 +25 -23197
2411102 186-59 +29 1201 226 169-17 -41
31middot01202 +11 182 -05 295 -H) 81301 208 -H) 4
1302 331 +08 197 +04
14 323 +15 middot185 -08 middotmiddot15 329 +16 16~5 -13
-28middot 1601 332 131 +12
1602 356 98 +24middot-39 middot3101701 161-33 +21
1702 370 -15 85 +02 +19 1801 264 151middot-50
185middot1802 256 +47-58
IJ ~
D_raphlc Population Change 1960 to 1970middot 49 (Contd)
4io
Census Tract
of pop Uncter 19 Yra
1Q1n
1Cha1l8e 1960-70
of PopOver 65 Yra
lQO Change
1960-70
19 389 +29 141 -24 20 223 -13 206 +18
21 227 +08 194 -36 2201 356 -27 112 +05
2202 290 -18 ll~9 -29 2301 356 -03 154 +24 2302 260 -37 245 +97
2401 410 +6~1 123 -31 2402 163 -80 320 +99 2501 381 +13 140 -01 25()2 237 31 lil +02 26 343 +25 186 +149 2701 370 +29 1S5 -01 2702 249 -44 304 +98 2801 337 +19 187 +09 2802 306 -10 156 +31 2901 304 -38 142 +24 2902 i 307 -32 146 t3~9
30 29~0 -48 16~2 +51
31 355 +30 160 +01 32 370 +48 148 -13 3301 395 +45 130 -20 3302 368 +06 138 -02 3401 386 +16 117 000
3402
400 +32 92 -26 3501 304 -07 115 +35
3502 344 000 140 -13
3601
36~02 357 -04 132 +32
3603 30~1 42 149 -67 3701 342 +28 152 +19
1
IJ
Jianolraphic Population Chan 1960 to 1970 50 (Contd)
Census Tract
of Pop Under 19 Yrs
JJl7J
middotChanae 1960-70
middotofmiddotpop Over 65 Yrs
1c~7n
Change 196070
3702 409 +39 122 -11 3801 308 -11 151 +29 3802 275 -35 180 +46 3803 282 -32 192 +54 3901 376 ~13 100 +17 3902 296 -03 177 +29 4001 438 -11 84 +13 4002 353 -21 115 +20
4101 397 11 9middot0 +11 4102 346 -19 120 +03 42 331 +19 11 bull 3 -16 43 347 -72 105 +31 44 113 +84 183 +154 4S 33~9 +07 110 -06 4601 2501 22 193 +38 4602 332 +59 126 -29 47middot 161middot 000 211 +01 48 103 -26 302 +59 49 138 +1 bull 3 252 +09 50 141 -26 204 -12 51 12 -39 257 +07 52 47 -61 351 +48 53 89 +49 314 -30 54 25 l1li15 327 -17 55 131 -17 115 -121 56 198 +93 227 -47 57 71 102 189 -88 58 240 ~middot41 16~1 +55 59 322 +25 142 +06middot 6001 264 95 132 +50
6002 328 -31middot 89 +07
JJ
Demographic Population Change 1960 to 1970 51 (Contd)
Census 1 ofPop lChange of Pop bull ChangeTract Under 19 Yrbullbull 1960-70 Over 65 Yrs 1960-70
1970 1970
61 355 -58 85 +39
62 328 39 110 +18
63 414 04 73 10
64 382 -22 72 +04
6501 383 02 67 -20
6502 329 -56 96 +09
6601 391 +13 88 -03
6602 319 -59 97 +06
6701 327 71 145 +72
6702 331 ~67 83 +1-0
6801 365 -66 49 +01
6802 388 4bull3 54 +06
69 354 -41 80 +23
70 400 -23 68 -06
71 359 -48 72 +05
72 255 -88 82 +11
73 346 -39 91 +25
74 313middot -63 105 +24
75 329 -42 129 +37
76 336 -52 85 +21
77 370 -10 69 +05
78 309 -10 120 +21
79 325 -56 87 +10
8001 358 -81 57 +12
8002 391 ~81 76 +12
81 315 -76 108 +21
8201 403 -23 64 +08
8202 392 23 65 +08
83 357 -34 120 +31
84 402 -18 73 +16
85 413 -06 76 -09
r
Demographic Population Change 1960 to 1970 52 (Contd)
Census Tract
t of Pop Uncler 19 Yrs
1970
Change 1960-70
1 of Pop OVer 65 Yrs
1970
ex Change 196070
86
87
88
89
90
91 9201
9202
93
94
95
9601
9602
9701
9702
9801
9802
99
100 I
101
102
103
10401
10402
lOS
368
351
379
391
391
413
379
433
372
429
414
432
419
439
~32
377
457 420
378 41middot7
345
360 417
417
412
-04
-02
-35
-26
-28
-11
-64
-20
-S9
-39
-32
-21
-34
-40
-47
-lO~7middot
-27middot +04
+56
+07
-34 01
+04
+04
+10
103
128
97
11il3 99
69
79
42
77
46
34 38
44
40
54
111
51middot
81
133
59
74
140
63
87
76
-08
-06
+04
+08
+17
-05
+3S -02
+1~4
+19
+33
-14
-08
+12
+26
+71
+11
-16 -34
-20
-19 +37
-49
-2S +15
NOte The The
Taken frOi
averageullder averageabove
middotUSCensus ---shy -
19 years == 6S years ==
figures 197
32r 13(14
p a~d 1960
--
Rank
1
2
3
4
5
6
7
8
9
10
11 12 -_
13
14
15
16
17
18
Tract
69 46
60
58
- 68
61
302
2501
67
63
19
62
26
94
3603
3902
64
30 -----~-
Rank
19
20
21 -
22
23-shy
24
25
26
27
28
29
30
31
32
33
34
35
36 -
Ranking of Per Capita Income by Census Tract
Tract
65
2701
- 15
1601
701
66
93
82
2903
3602
30
2502
80
2401
81
- 70
91 shy
4001
High
Rank Tractshy
-32shy37
38 97
120239
7840
41 ~ _2_1__ 42 31
43 2501
44 18
45 98
46 37
47 3803
1702
49
48
1602 92 2702
I
50 89
51 901
52 801
Ra_
53
54
55
56
57
58
59
60
61
62
63
64
6S
66
67
68
TractTract Ra~
74692
170196 70 I
401 71 90
72 1037J
79 70273
3802 74 601
24024102 75
85 76 101
77 9023901
7699 78 100 4101 79
3601 I
380180
458140~ t---- _ - - shy83 82 42
888384
59843501
4777 8~
502
Low
802 86
Rank Tract
87 shy
--88
89
90
91
92
93
94
- 95
96
97
middot98
99
100
101
102
103
104
1201
14
49
72
73
43
87
3502
105
1
52
86
71
1
501
10
3301
104 tf
Rank
105
106
107
108
109
110
III
112
113
114
115
116
117
118
119
120
121
Ranking of Per Capitalucoae by Census Tract
(Contd)
Tract Rank
4001 122--shy602
13
1102 2302
3302
55
3401
48
21
56
50
3402
lL01
2202
2301
53
2201
-shy
Tract Rank Tract Rank T~aet Rank
57 I-----
Imiddote
bull
Tract
- Low -k Note Information taken from 1960 U SCensus
Rank Tract
I ~
Ie
Imiddot
~
----
----
--
--
Rank
1
2
3
4
5
6
1
8
9
10
11
i-
-Tract
391 922 921
972 971
100
132 131 121
962 961
822 821 401
982 981
20 111
47 10 1
412
High
Total Number of Henta1 Health Visits
Ranked by Census Tract High to Low
TractTract RankTractRank Rnk
12 182 22 78 29 87 76 381 73181 ~------- 1913 371 8538230162372 271 2616-121 8272 2
14 80~2 31 94 7923 84801 59 15251362 4232 15 52 _ 32 103 8924 651 17240216 652
_ 91 351 33 341 23117 83 122 25 25 48 1123921418 34 shy61 86 661
19 662 6493 81 26 91 8153 49 50 55 41383 71 27 51 3120 90 672241 35shy 104167162 461
I 411 46211121 28 88342 I
2502 36 69 54 5251 50 272
-Ra
37
38
39
_ 40
_ 41 Ishy
I
42 I
-I 43 44
45
shy
Tract
~ --- shy 95 56
45 292 242
102 62 352 291y
92
101 281
99 72 63 601 60~ 42 2201
77 74 61 57
363 232
70
32 31
11 44 282 2202
Low l
- Tract
46 682 681 I 331 30
r~$ 47 1042 332
48 102_41_
11
~
Visits to Family Planning Clinics Ranked by Census Tract High to Low
Rank Tract Rank Tract Rankmiddot Tract Rank Tract Rank Tract Rank Tract
1
2
3
4
5
6
7
8
9
10
11
12
13middot
14
15
16
17
361
56
401
341
48
59 121
20
55
342
10
31
58
93 21
241 132
331
53
461 462
18
19
20-shy21
22
23
24
25
26
27middot
28
29
30
31
32
33
391
32
middot47 I-i-_-shy _ -
231 111
332
972 1
372 371
52
89
32
92
82
100 31
182
30 242
402
34
35
36
37
38
39
40
41
42
43
44
45
42
1714 i 661 221
78 362 2
90 602 601 352
63 251
105 921
971 351
73 42 292 232
411 51
662
81 45 52
46
47
48
49shy
50
51
52
53
54
55
56
961
801
49 81 72 71
19
9~1
172
68 2 57 162 14 112
91 75 681
381 42
3~3
83 161
57 f
58
59
60
61shy
62 Imiddot
63
Imiddot 64
65
66
64 62 36~3 252
74 652 SO 392 291
651 6bull 2
79 271
r-- ---- shy981 222
672 671
821 272
94 87
281
382
67
68
69
70
71
72
73
74
75
76
77
78
981 26 12~2
IS 61
85 82~2 69
61 43
101 86 84 282
76
131
51 72
1041 962 88 70
99 922 77
103
95 802 181
i
~
Low High
RankRank Tract
5479
4480
81 1042 ~) middot102
71 - - + ~ - ~
Visits to Family Planning Clinics
(Contd)
Tract Rank
I
Tract llaDk l
RankTract Tract Rank Tract
~
I
~
J1 ~
Low
Total Number of public Health Nursing Visits
Ranked by Census TractsHigh to Low
TractTract RankTractRank RankRank TractTractRankTractRank
25249 71 79 17249 8033 6586 99189711 84 2915072 34 661 76 66 811519512
402 5035 51 161 2518220 122 1713423 352 55801 7120 6752 2 149814 41236 83 2662 38 94 6821 53 2924015 362 37 32 42 75 69 281 84 63
546 8822 54 222 85 3925431 70383417 3818223 6439 4386652 718 21 55 103332 8924 232 87 19 271729219619 24156 16211140 382 628825 10523110 112 73411 10141-- ----shy 89 363 4457 8126 16111 221 74 9142 90 46158331 53 671279012 46243 48 59 351 3837528 1083 9313 91 5844 59 -_242 76 1----- shy60 272 72 74104114 60145 42 9287 7729 92 6151 8215 57371 934630 91 307762 12113116 282 619447 41391 9531 78100 63 7378 ~95 681 6945 32 5632 798517 6448 47 52 181
High ~ Low
Rank Tract Rank
96 31 132 70
97 102
98 182 372middot 602 651 662
- -shy
~72 682 802
822 922 962 972 982
1042 ----shy
Low
Total Number of Public Health Nursing Visits
(Contd)
Rank Rank Rank TractTract Tract
I
I lt
I
Tract Rank Tract
[
~~~-
I
~
IJilfimiddot ~
j
Ranking of VD Caea According to Census Tracts 61 By High and LOll Youth Itatio
A media~ of 34 5 was determined Any tract having greater
than 34 5~ of popu1tionunde~ 19 years of age -High~
Any tract having l8S than 345 of population under 19
years == Low
Any tract having rate less than 390 =Low
Any tract having rate more than 390 == HLgl4
YOUTH
LOW HIGH
L
0
12 402 1801 1802 343 2801 2802 29023603
54 6001 600262 66~02 72 74 75 76
78 79 81 t02 65 1202
W
(25)
VD
H
I
G
H
401 701 801802 901 902 10 1101 241 1201 1301 132 14 15 1601 1701 20~ 21 2202 2j02 2402 2502 2702 2901 303501 3502 34023801 3802 383 3902 42 44 45 4601 4602 47 48 49 SO 51~2 53 55 56 57 58 S9 6701 6702 73 95
3~02 7021702 19 25~01 2701 4102 4101 63 64601 ~601 6801 680270 7l 77 8001 80~02 8201 8202 83 84
85 86 87 88~ 90 91 9202 920193 94 9601 9602~ 9701 9102 9801 9802 99 100 101 103 10402 105 6501 10401
(47)
301 501 502 601 1602 2401 2301 2201 31 32 3301 3302 3401 3402~ 3602 3702 3901 400140 02 43 61 69 B(
(53) (23)
~ ~gt
Ranking of VD by Rate Per 100000 By Census Tract
~
Rank Tract Rank Tract Rank Tract Rank Tract llank Tract Rank Tract Rank Tract
1 2202 21 S6 40 902 58 1602 74 75
90-shy 64 107 26 --~-
2 3402 22 45 41 10 59 902 75 78 91 54 108 61
3 2301 23 3502 42 2502 60 602 76 6802 92 402 109 87
4 3302 24 49 43 1102 61 501 17 2 93 94 110 90
5 50 25 52 44 6702 62 14 78 8202 94 97 02 III 76
6 2201 26 20 6701 63 4002 8201 2501
9701 41~02 112 91
7 44 27 48 45 401 64 3802 2902 95 63 113 62
8 3301 28 1701 46 502 65 30 79 83 74 96 9602 114 71
9 55 29 47 47 42 66 3803 80 2801 96Q1 115 85 10
11
12
13
14
15
16
17
18
3401
53
2302
2401
57
21
2402
1101
51
30-shy31
32
33
34
35
36
37
3701 - -~ 1201
3702
89
43
132 131
3602
4001
48
49
50
51
52
53
54
55
58
1601
601
4602 4601
69
701
31
3901
67
68
69
70
71
72
2901
801
39021~ 802
6502 6501 122
702
41~01
81
82
83
84
85
86
87
88
19
1
1702
2802
79
93
100 6801 6602
81
97
98
99
100
101
102
103
104
9201 9202
9802 9801
77
302
79
86
72
84
116
117
118
119
120
121
3603
8002 8001
101
99
95
10401
105 10402 103 102
19
20
59
32
38
39
2702
3501
56
57
301
3801
73 1802 1801
89 6002 6001
105
106
2701
88
High Low
-- -----
Rank OrdermiddotTuberclosis Cases by Rate Per 100000 Ranked by Census Tract High to Low
Tract TractRankTractRank Rank TractRaukTractRankTractRank
801
79 9601501411 52 6835340120511 I 960269 903603532036 $-~~F130221542 4366 311301 70 68~013802 _ I- _ 4001_37213 3921201 6802802 H71523822024 22 54 193302 3802 80 8958 I37139535 70155 9801 I60123 72 6702 98023914011016 6701250124 10 56
81 94 401r 7 154152 73 7057 2625 122 92028
90242 162312301 92~158 86 7172434526509 82 79160159 74 100 87412240227220110 6502836960 75 30 8317244 6501782801285711 61 901 42765645 84 66021459294912 9701 660146 171 302 9702 47
6235023033113 85 822821182 917755 16335013110214 841814832 78 103 938564 324815 86 1057940149272 38036523216 10401 87 2902241 725Q 10402360266340217middot IF88 88 9937233 282 51 218 101 01102 46016234
I)167 2901460219 47
High ~ Low ~
- -
TractRank
9S89
6490
8191 8001 8002
63 61 60middot01 6002 44 2701
92
J
2502 402 --- ----shy
I
Rank
Rank Order Tuberculosis Cases by Rate per 100000
(Coutd)
Tract Rank Tract ~nk
I
Tract Ballk Tract Rank
Imiddot
Tract
Imiddot
1~
t 1I i Pi i l I
o
1 -1shyL I
I J
8 40 icO ~ I -lt 0
-t (1) I
i I
r o E
II
a
I
r--i
shy
I
~
I (
Jgt
(011 fi(
Ggt
I II ~j
()
(f 0
~ ()
I
11
f9
r
II 99
o ~
Ggt r
~ __-J~ I t I ~ I
r--J l I
~ _ __ J
) 1
fTl
1gt
r I
()
r
()
lt en -i en
()
I1l
(J)
(J)
-i
P ()
19
r o ~
r G1 I
I
c
~
o I 89
--- -I-shy
r-r I
1- 0 _~ _ _--J E
G1 I I I
i i
I 1-1-1 ~ _J ~2 ~ II
II
()
1 I I I 1
id i bullbull
~
A n 69
r 1shy
- 0 Gl
l--~ ~ I
~ II
II )
I () isect i
en l i
(J)
-t
0
IA Ol
IJ
26
1Dten1ews with walk-in patients home Vi8its and group 4i
meetiDp1D8D attemptto1Dierpret1o the patients
the value of rtitgular ppo1ntmentamp andot con~in~
c~1ve care rather than epiI041c care (9 p1OO)
h1s 1safuD~tioD torwhtch nOl~prot81QDal colDlllUD1ty
YOrkersllaY bebe~r8U11ed tban other statf H()wever
euch aD ~ucat1oaal propul __~ ~e related to the senUiDe
capacity otth health oenter to provide comprehensivebull gt
ervice8 to1tpat1_t~odoD aD app01ntment bas18 It
1amp pos8ibleo~rw1 tor educa110Dal ttorts to result
LD a~8JImCl tor ltPP01ntaen~8 at a ratewb1ohi8beyond
the capacity ot thee_tar to t without uareaaoDably
1_ wa1t1Dlprio4a QOBt1nuad use Ot the center on a
wallt-in bU1 _1tbeoosiItpos81ble to et an appoint-
met anc11nCreued pit1entcoJaplampia1a bull Therew111 of
course always be a need and demand tor acute ep1so~c
Care -ci the health centerDlWlt be planned with the capashy
billty ot bullbullbullt1D8 tb1aneed wh1~ cont1Du1nI to stress
aDd educate the patient to utillze oDlOinI comprehensive
faa11y middotc~te~d Cflre (9p 100l
att g4 CODClva1opa
In order to bea4equate any coJlltemporary health care SY8tem muat bullbulletcerta1D interrelated criteria he
IJ
27
minimum criteria areaccessability of services to those
who need them compr8heX1siveness and appropriatness of
services and efficIency 1nthft utilizat~on of SCarce
health care personnel and resources The scareity of
pex-sonnel andtbe need for h1gh quality ongoinghealth
care services
aJIlong the
populationdemanci the most effishy
cientprovision of services
Services must be made accessible to the population
They mustmiddotbe geosraPh1cally accessible to remove the PhysicalmiddotbaTiers betWeen peopleandthem$d1calcare
system They mUst otter their services dur1ngthe
hours when people can make the moat use ofthemA~ it
makes little sense to concentrate services geographically
where they will not be uSed to their fUllest extent it
also is wasteful to provide serv1cesonlydur1righours when
many people are employed his not only presents a hard
ship middotto the consUmer lnrt wastes resources if for instance
the unavailability of preventive services during the hours
when people Can use them causes a need for treatment
services later on
Health carbull sEtrvices must be comprehensive including
prevention treatmcmtand re)abimiddot11tation Ambulatory I
healtbcare facilities wh1cQ are orienteciexclusively
toward either prevept1on or trea1mentare no longer accepshy
table for they are lneft1c1entln their use of resources
and in their prov1s1on of health care to the patient
w ~~
28
If prevent10n1s notmiddot stressed treatment serv1ces that
could have beenavoidedY1l~ be required If prevention
1s the sole focus of the health care facility sick
patients who present themselves must be referred elseshy
where for treatment andsllch referx-als may be taken as
reject1onsor not followed through with until illness
becomes unbearable
The instltutlontbat meets these requirements Is
the comprehensive neighborhood health center It 1s a
local decentralized outpatient facilityprOVld1ng a
fUll range of ambulatoJY health care services It has
a linkage to ahospitalbackUp facilityforlnpatient
treatment and hiihlY apclalized outpatient care
The neighborhood health center must be a fac11ity
planned with an awareness of the needs of the conSUtller
and coDitnUn1ty It must have the r~Ul0urces to provide the
services people need mere they can use them and when
they can use them It must uti11ze the part1cipation of
the community to develop this awareness Not only must
the cen~er beset up to be Amctional for the consumers
but efforts must bemadeaga1n with commun1ty partici shy
pation to help the consumers utilize medical care
services effectively The center muetmake efforts to
educate the community about the valueot regUlar health
care of preventive servicesand of the use of planned
IJ
29
medical appointments ratherthanorisis centered walk-
incare Therealit1es of the existing health care
system have not taught the patient particularly the low
income patienthow to use services effectively
The helthcenterilUst also bea laboratory for
experiments in easing the health caJepersonnel shortage
and c60rd1Datingcare~ A major difficultY iri-exper1shy
menting with neW rolesis freeing staff of old preconshy
ceptions
CoDlprehensiva neighborhood health dare centers have
been developed under a variety ot alisplces including
medicalsociet1es hoSP1talsmiddot(36p299 group pr~ct1ces
(29 p6- 12 117) health departments (13 p1027) and
ne1gbbothoodassoc1ations(14) The literature indicates
somevalues nthe management ot the health center by plusmnts
hospital backup faCility Whatever the auspices many
adm1nistrative fuDctions such as program coordination
standard pr9tectionand evaluation call for considerable
c~tralization of adm1nistration city-wide or coU)tyshy
wide At the same time other aspects hours of servlce
for examPle~ cuI f~radm1nistrative fUnctions made atmiddot
more local levels Each neighborhood center must be
free to adapt its functioning to itscominunity thi-ough
the mechanism otcODlllUl11~ participation inmiddot policy making
Obviouslythe prerogatives and responsibilities of each level must be negotiated and made explic1t
t4~
JJ
BIBLIOGRAPHY 30
1 American Rehabilitation Foundation ~ealth Services Research Center The Health Maintenance Strategy mimeo 1971
2 Anderson Nancy N Comprehensive Health Planning in the States A Study and Critical Analysis Institute for Interdisciplinary Studies American Rehab ilitation Foundation 1958
3 Andrus Len Hughes Comprehensive Health Planning Through Community Demonstration Health Projects mimeo1967
4 Barry Mildred CandCecil G Sheps A New Model for Community Health Planning unpublished paper presented to the American
Public Health Aseociation1967
5 Blum HenrikL Fred Wahl Genelle M Lemon Robert Jorulin and Glen W Kent The Multipurpose Worker and the Neighborhood Multiservice Center InitialImplications and EJeperiences of the Rodeo CommunityService CenterAmerican Journal of Public Health58 (Mar 168) pp 458-468 shy
6 Blum MichaelD and Soloman L Levy A Design for Service Delivery that Reinforces Constructive Tension Between a Health Center and Its (sic) ConSUDlers and Supports Community Power unpUblished paper presented to the American Public Health Asaociatiltn 1968
7 Brielaud Donald Comm~ity Advisory Boards and Maximum Feasible Participation American Journal of Public Health 61 (Feb 1971) pp 292-296 shy
8 Burns Eveline M Health Insurance Not If or When But What Kind Madison Wisco~sin University of WisconsinScllool of Soci~l Work 1971
9 Campbell John Working ~elationships Between Providers and Conshysumers in a Neighborhood Health CenterU American Journal2 Public Health 61 (Jan 1971) pp 97-103
10 Caxr Willene Neighborhood Health Centers Funded by the Office of Economic Opportunity mimeo 1970~
11 Colombo Theodore J Ernest W Sawardand Merwyn R Greenlick The Integration of an OEO Health Program into a Prepaid Comrehensive Group Practice Plan American Journal of Public Health 59 (April 1969) pp 641-650~ -
12 Comprehensive Neighborhood Health Services Projectof Kaiser FoundatioIl Hospital~ Prcgtgram YearE grant renewal proposal mimeo~1971 bull
13 CowenDavidL~ Denvers Neighborhood Health Program Public Health Reports 84 (Dec 1969) pp 1027-1031
IJ
14 De Diaz Sharon Daniel Beyond Rhetoric The NENA Health31 Center After One Year unpublished paper pres~rited to the American Public Health Association 1970
15middot Gerrie NorrrianF and RichardH~ Ferraro Organizing a Program for Dental Care in a Neighborhood Health Center Public Health Reports 8 (Aug 1968) pp 419-428
16 Gordon JeoffreyB~ The Politics of Community Medicine Projects A Conflict Analysis Medical Care 7 (Nov -Dec 1969) pp 419-428 shy
17 Greely David The Neighborhood Health Center Program and Its Implication(3 for Medical Care H~alth Forum of the Welfare Council of Metropolitan Chicago (mimeo) 1967
18 Greenlick Merwyn R Newgtimensions in Health Care American JOurnal of Pharmacentical Education 34 (Dec 1970) pp 754-4
19 GreenlickMerwyn R Donald K Freeborn TheodoreJbull Colombo Jeffrey Abull Pruesin and Erne$t W saw~d Comparing the
Use of Medical Care Services by a Medically Indigent and a General MemberShip Population in a Comprehensive Prepaid Group Practice Prosram II unpublished paper presented to the AmericanPublic Aesociation1970
20 H~tadoArJiloldVMerllYll RGreenlick and TheodoreJ Colombo Determinants of Medical Care Utilization Failure to Keep Appointments unpublished paper presented to the American Public Health Association 1971
21 Johnson Richard E and Merwyn R Greenlick Comprehensive Medical Care A Problem and Cballengeto Pharmacy ff AJilericanJournal of PbarmacenticalEducation 33 (Aug 1969) pp 361-367 -
22 Kahn Alfred J Studiee Social Policy and Planning New York Russell Sage Foundation 1969
23 Kotler Milton Neyhborhood Government Local Foundations 2 Political~New York The BobbsMerrill Company 1969
24 NationalCommisaion on CommunityHealthSfrvic~sActionPlanniriamp for Community SetithServices~ashington p C Public Affairs-Press 19t7
25 National Commission on C~mmunity Health Services Health Adminishysration andOrMPization l the Decade Ali9$-d Washington D C Public Affairs Press 1967
26 NationalCornmiesion onqomm1Jllity Health Servicesbull Health ~ Facilities Washington D C PUblic Affairs Press 1967 bull
~ n
32 27 ODonnell Edward J and Marilyn M Sullivan ServiceDelivery
and Social Action Through the Neighborhood Center A Review of Research tt Welfare ~ Review 7 (Nov~Dec 1969) pp 112
28 Office of Economic Opportunity Second Annual Report Washington D C~ U S Government Printing Office 1966
29 Office of EConomic Opportunity and the Medical Foundation of Be~laire Ohio Eighth Report 2l ~ Committee2a Governshy
ment OperatiOll~ Va8hiiiSton D C Government Printing Office 1969
30 Pope Clyde R Samuel S Yoshioka and Merwyn R Greenlick Determinants of Medical Care Utilization nhe Use of the Telephone for ReportiDg Symptons Journal of Health and SocialBebavior12 (June 1971) pp155-162 shy
31 RenthalA Gerald nComprehensive Health Centers in Large US Cities American Journal of Public Health 61 (Feb 1971) pp 324-336 shy
32 Saward Ernest W The Relevance of Prepaid Group Practice to the Effective Delivery ofHealthServicestt The New Physician 18 (Jan 1969) pp39-44 - shy
33bull Schorr Lisbeth Bamberger and Joseph T English Background Content and Significant IssUes in Neighborhood Health
Center Programs Milbank Memorial ~ Quarterly 46 July 1968) part 1pp 289-296
34 Weiss James E and Merwyn RGreenlick UDeterminants of MedioalCareUtilization The Effects of Social Class and Distance on Contacts With the Medical Care System Medical~ 8 (Nov-Dec 1970 pp 456-462
35 Weiss James E MerwynR Greenlick and Joseph F Jones Determinants of Medical Care Utilization The Impact of Ecological Factorstt unpublished paper presented to the American Public Health Association 1970
36 Wise Harold B Montefiore Hospital Neighborhood Medical Demonstration A Case StudyMilbaDkMemorial Fund Quarterly46 (July 1968) part 1 pp297-308~
37 Yerby Alonzo S ttHealth Departments Hospital and Health Services Medica1~5 (March-April 1967) pp 70-74
38 Young M M~ Chatanooga IS Experience with Reorganization fOr Delivery of Health Services ttAmerican Journ8l of Public Health60 (Sept 1970) pp 1739-1748
f or l
II bull 11 Y d
II
IJ
34
ThepurposeOfPart II of th1aa paper1atod1scuas
elected Speclfic needs ofecltlc areas within Multnomah
County A8P01ll~oUt 1D ~ I of t1a1bullpapermiddot Ita nelgbshy
borhood health oare cater IlU8t be a facl1lty plaDlled with
aD awarenes of the neeels of the oODllUller and collllUDity
Part II of this paper nIl Show 80e of thoe speclflc
needs
he1DforutiOD tor t1li Portlon of the report
obta1nec1 troll tbroupout tbe follow1Dl threepUb11catloDS
1gr~e_tiMshylIPrIxaiidOreson JuDe 1963
2 1~_middot_sectSI8e~ected1teai c-ua 0 S 8 e first count coaputer tape Coluab a_lion AssocshylatloD of QoveraMD-8 Jlme 1971
3 Jtu1tDoab County Oreaon BDY1roDlHtlltal SurveyEarly 1971
The JIultDOIIIlb COUDty OrttIOD BDv1roDllfmtal Surley
Barly 1971 1s bull stat1stical report of the activ1tles of
theentlreMultDOIIIl2 CcNDty Health Dep~t during the
year of 1970 Die speclflc 1nd1cs elected from tb1s
study amprejMental aealtll Publlc Health N~s1D1 vlslts
FaJUly ~ Veaereal])1 ~ ~rcul081
Throush tie use of cUrts and mapa ODe CaD roup these i
speclflc ~oea to ahcnr the healthneedsof speclfic I
census trtcta aD4 then the health needs of iarer neIghshy
borhooda 1m4 o~ Uebullbull
Rf)~UP1Dl of areu was accompllshed in thefolloWinl I
JJ ~
35
he MiltDoIliahCountY oregon BDViromaental SUrvey
early 1971 isamp statistical report ot tbeaotivities ot
the entire MultDolllh COUDty Health ])epartiDent dur1nl the
year ot1970 he specitic 1Dd1C8S selected frOm this
aUy are 1Il8Dtal health public healthDurs8s visits
fUl1ly pia waereal elisease aDd tuberculosia
Tbroq11the Wle otcbart aDd mapa aDecm szoup these
specific indic to show the health Deeds ofapecitic
ccmaua tracts aDdtIum th8health neecla of larsr ~eilh-
bOrhooda and co8I13 tlbullbullbull
RegroupiDI ot areas waa accoap118hed1D the
tollOWiDl lIIIIm1er~ A bullbullcifie 1ndex 8selectcl auch as
venereal di8bullbulle or tuberculo8i~ he total number ot
cs was then deterll1ne4 for each census tract Through
the use of the maber ot cRbullbullbull tor a 11Yen cenaus tract
aDd tbe population ot thattractaltrateot1lla1ampmcper
100OOOpopUlaticm wu cleteXll1ned for each census tract
This was ~e to starl4ard1ze the population ditterence
amongOeD8U8 -tracts 1he rate of incidence toreaob
cenauatract was then llstedby rank position on a chart
In rank poition1DI any cen8Wl tracts haviDg equal
rates ot1l1c1dence are assipe4tbe iaDk posttiona
Beeauseot the abo fact tbAt cbarta w111 vary in length
neveltbAtlea eacb cbart will 1Dclu4eall census tracts
inMullnoaah Couaty Atter the census tracts bave been
listed accord1q to raalcth1s list will bediv1ded into
IJ
36 three levelsotinc14ence he three levels are
1~ The upper 14 of1DcldenCe
2 Thelower 14 ot incidence
middot3 The ILld 12 of incidence
Tlles three srouplqa are then used in compiling a map ~f
Mu1tnOmahCountyfor ach apecltictop1cbull TIle maps are
uaefuJliD tbatthey V1suallycoJib1De 1Dd1v1Clualproblem
census tracts into larger problem nellhbOrhooc1s
The 1960 statistical iDtormatloD was Used in a similar
liIaDDr to tbatexpla1Dedabove 1Dthe4evelopaent of a
chartmiddot and map 1Ihow1DI e cOllpampriSOr1 of per capita lncolle
tor ttaCh ceDsua tJact aDdmiddot combiDed census middotmiddottract areas
he 1910 aDd 1960 statlstlcal iDtOrllatl0D was combined
lna map and chart he purpose of this and chart is
to d8aonatrate the e cl1stributloa1DeachceD8U8 tract
and middot1ndlcatbull tuture ace populatlon treD4a bull
When one be middotbullbullbullbullbullHdth ne8cts ot an area and has
declded to establlsh a cl1D1c to serve that area the
physical location otthat cl1D1c IllU8t be consldered In
order to coapreb8ll81vel develop an area cl1n1c one should
conslder thepre88Dttraftlc middot~ytaa an4tranaportatlon
systems Thecl1D1cahoUld be located close enoUlh to
major arterlals to giva asy access from the total area
be_ ervecl by this cliD1c At the t1ll8they should
be tar eo away froll thesarterlals to all8Y1ate traffic
CODCell18 andpark1D8 conpstlon By traff1c concerns I
IJ
37
lIlan one lUSt consider thertarro1fne8S of streets whether
streets are oD8--C)r two-way iqres8 and egress to parking
amp0111tie eros tratflC) spedof trattJQ children 1n
ll8a traffic i1lht Vislon re8tr1ctionS etc
BwstraDsportat1onshould alao be central in this area
as maay people ~U f1Df1 1tD8Cessary to use this form of
transportatlon
~e tutqredlopHQt of bull treewa systems should be
c0J1S1dered soastolesen thecumce ofmiddot future roada
cutt1DSotltbe cl1D1c llte line
nrrph1c middotDampta
It is 1JDportaDtto kDOw the demosraphic distribution
characteristics of the oUenteltbat i8 to be served by
localized health cl1D1cs
Acl1D1c which erves8J1 area where1D the prepondershy
ance of persona arecrter 65 years of mayf1nd that these
people rely more on pUblic transportation call for more
home- services and haV4t 110ft ChroD1c and debilitating
types of disorders (b1_ blood pressure poor heariDg and
eyesight) tbaD do8 an area ot a YOUDIer population On
the other hand thL area of older residents may have little
need for family plabDlng cllni08
In order to better ~Ybullbull the 4eaoraphic population
of each CeD8U8 tract the 1970 CeD8U8 iatormation was viewed
and two specific catelOri8 considered These two cat
IJ
38
lori8S woUld be the perc_tap ot population under 19
year of ase and the percentase ot each oensuetractover
65 years of age he 1960 1Dtormatlon tor eaCh tract was
then compared witbthe 1970 intormation and a percentage
ofincreaae or4ecreamp8 tormiddot e~chtract1n each category
cOJlputecland achartma4e By the use of this chart one
18 able to View tJleap populat1odiatr1but10n of census
tract and at the _ t1lle accesa middottrencl Por example
let us choose census tract 601 W see 40-4 otthe
population is under 19 years ot and that ODly82 1s
over 65 years ot middotAtthe e tille the percentage of
youth bas ~ed ODly 1_ intbe laSt teD year whilethe
percentale over 65 year ot middotbas stayedmiddotthe same With
this in mJnc1 ODe ~ 1DfItr libat ol1D1o aerviDg this
area WOuld bellQre conq~w1th the problems of a
YOUQier populat1on and that _ would probably be true foJ
some t1aein tbefuture On the other hand CeDSU8 tract 54
has only 2 ollt population UDder 19 yel1s ot age and
this has decreased by 1 over the last ten years middotwhile at
the same time 32-377 ot the populat1on 18 over 65 years of
age A ol1D1C ___ this area should be or1eJ1ted toward
tbespecttic problema otthe ampledbull
PerCapia __ bY gsa neat
WhaD cona1der1qlooat10D1 tor health cl1n1cs one
shoUld take the 1DC01Ieot areas into consideration Areas
IJ
39
of lowiDcome would not 11kel~be 8erved more by localized
cl1D1cs tbaD would are of hilbincome It 18 likely
people haYiq a hip iDeoll8would preter to be aeenby a
chosen ~r1vatephylc1a1l tban at a local cl1D1cwhere
10Dier waits y beraceaaampryand leas personal attention
gl_
The 19701ncOII81atoWampt10n tor MultnomahC~ty was
not available at the tille thi8report W88 made The 1Dto~shy
tiOD Was taken ~adtro tbe1960 census publlcation
his woUld ~8Il thea tbat ral1I8 OD the chart ynot 1raquoe
completely accurate hi writer telthatthe areas most
affected by tb8 1I8eof the older 1Dco1DtOlaat1oDWOuld be
those tracts wh1ch baYebad a rapid 1ncreaae1n populatlon
over the past tfmyHr8 bullbullbull tracts would include tracts
nUmbered 104 9897 96 aDd 95 be perc~ita 1Dcome
referredto1il-tb1a Paper18the lIean 1DCo per person per
census tract
Attar the iDeoeper census tract was listed on a chart
a map was de 1D41catiDg those census tracts belonging to
the lower 14 ot income tor all censue tracts in Multnomah
COlDltytbose beloqins to the upper 14 ot income tor all
census tract 111 MultnolUlhCounty and those belonging to
the mid 12 ot 1I1coaetor all oeuuetracts in Multnomah
C01mty
In yiew1Dg the _p 1t caa be seen that the low income
area seautotollow aloas the at aide ot the Wl1lamette
IJ
40
R1ver the full length of Kultnomah County A second low
income area follows the south edge of the Columbia from
the northwest corner of Multnomah County easterly to 148 St
A third problem area seems to be on the east bank of the
Willamette River with the Union Pacific Railroad being
about the center of this tract The extreme loutheast
corner of Multnomah COUDty appears to be a low income area
but as this area bas bad rapid grouth in the last ten years
this could be erroneous
Mental Health
be first ~ecific indica to be selected from the
Multnomah County envirollllental survey of early 1971 and
to be considered in this paper i8 that of Mental Health
At the present for mental health purposes Multnomah
County is divided into five catchmentareas with a mental
health cl1n1cin each area These clinics are Model
Citles Delaunay ADkeny street Office Hansen Health
Building end Southeast Clinic
All lIlental health cl1n1cslcept statlstlcal information
on all patients visiting their cl1n1cs this included the
address of the patient hese addresses were then listed
upon the approprlate C8D8US tract Each census tract was
then ranked on a chart according to the nUllber of mental
health patients who reslde ln thatCeDSUS tract attending
any of the above listed ental health clinics This chart
IJ
41
wasttum d1v14ed1ato proper quartile bbullbullbull
quartile vereUs to dne10 u appropl1ate Multnoh
County _tal health ItLa middotmiddotmiddotthelipO~a1bl by lOoJcJIUE
at the UDtal health _to uteN1De which ueu have the
lars-t use otCOllDty 1alh~th faci11t1Rot
1Ilclu4ecl 111 tbia woUld tber otpeopleYia1t1Da
pr1vat patch1atriata aDd pr1_t _ntalhealtb cl1D1c8
WheDtbe M1 18Yienclmiddot Itmiddotmiddotmiddotmiddot~middotbe~_ tbat ~rtt
appears to lMt fourmiddotmiddot-al are iii _oil the nuaber ot
lIental healthcl1D1c na1t toM tbjh1sheat 1he
tour areaa woUld be tollows
1ttrea Ore to~Blo Drimiddot ~tb Burrus14e aDd tIMtmiddot Colb1a Riftr H1gbwyaeri1Dla th nortllra boundaryshy
2 bull ProII 82D4 1_~ 10 20th streetwitil the ra1lMd Mu the north ltouadary
3 ~ et et tUgl_b1bull MYel froamiddot the Clackaaa COUDty l1ae aorth to Dln8lon stret
4 beDOlvt1ttfe-t ~efllt4 COatytrca Jle1aware streetmiddot toR1C1a11oDd wlth Colubla Blvd heiDI tbAtnorth bouaclary_
It ODe coapareatbiap to th iDeobullbullmiddotp 1t can be
eamiddotthat lIOat ot the c tracts baY1Dg bllh v1i11tatlcma
middottfl public tal health cJ1rUc8 ~ 111 t13e low ~ aid
1DcOile SroupiDIOJa1y of til 25 tracta llsted as
haviDlbip aental Maltll nlltatlou are ~ the1g60 hip
iDeo arebullbullbull
17 Plpn
42
amily PlellnSDI ]Jlce Metal Health i8 an 1nd1ce of
use Theperson 111 ordertobavebe_ 1Dcluclecl 1n this
atu4ywouldhave tohaft Ue4 ataa11y plaDI cl1D1c
tacilities of soaetype It 41fter troll tile _tal health
study1nthat i t1Jicludestatist1catrollbotb public and
privateclJD1os
The iDformation tor the iak orurcbart 8Dd map of
t8ll111 plenn1 na ob1a1De4 by cOIIblnlDlthe mabel of
1rlcuv1duals bullbull_ attbe tbreellUltrampo-ti Coatyhll11y
PlalJQllIl C11ll10s 111til tbo at the Planned PareDthood
Association CliD1C8 be tbree -JIultDouh Couaty r8ldly
PlamSq Cl1D1c are Solrtbweatth Col_bla 1111- a114
HaDsell Health BWlcl1Dl CllD1cbi middot1Dtormat1oD vas then
bullbullbullesed tomiddot detellWMt l10w people troll eacb c8IUIUS
chart wastben Mele IUs oIIart jn 4iY1ded to show
the censuS tracts lIaYiDlmiddottIle h1t1iest qUart1le of incidence
of use lowest quartile of 1Qc1deao ot use Jlid 12 of
incidence of Wle an4 a map sprepared troll thts 1Dto~
mation
The C8U118 tractsbelOJISnl to the h1lhestquartile of
use appear to be 1lO~ 8catt~ on tbipwas true ot
either the _p ot aental health cl1D1c uaageor ot the map
abow1DI per capita 1I1COM Iaere40 to be three
d18t1nct areas of UIIaP beJ woul4 be
1
IJ
43
t10D of BurD81cl and the W11lallette River 4
2 S~t Portland 8Otth otmiddot the ra11shyrcaadand alona the W11lamette River
lIortbeaat Portl8D4 between MisSiss1pp1 and 24tbStreet the northbouBclary be1DgColwb1aBlvd
Pylzl1c BMltl IrpI Y11ta
Publlc Healtil nur81D1Y1s1t nclud8 an vists to
theholles of client by PubUc Health Nurbullbullbullbull his shows
visits to bull f8Jl1ly fer aDY purpos SUCh aatuberculolJ1s
het1Dl tem1tyaeatalu4 8IiOt10D8l cODd1t1ona etc
he atat18t1C~ 1fele C()4ed accord1Dg tomiddot the 1llli301fOCUS
of the Y18lt tt doe DOt 1D41cate the Dmlber of holies or
f8ll11lev181tecl or 1D41Y14ual Y1a1ted more tban oDcein
the propwl It dobullbull I1ve 80M 1D41cat1on by coaparlshy
OD ot the 8JIoUDt of aedlcal problema 1n eachcen8WI tract
Ap1nmiddot the _p abowa 8 scatter patteraof probl_
areas althoUSh there appear to be a sroup1Dl of hiSh J
l8aIeccmaus tract 1ntlut extreme southeast part of tbe
County other areu uIriaI any nura1Dl contacts are
1 bull he 801lth-oa-al CO1Dty on eaCh 814 of 82nd Av from Clackallaa County north to Dinloa
2 ear bullbullbullt 814e aroUDd Preacottand Misaisippi
Dowatom Bunul14eonboth 1de of the river
44
V_real Pis The iDfomatloil uaec1 to tabulate the Venereal
disease chart includes all the ooab1ned case otmiddotODormea
and syphilIs reported by bothmiddot publIc and prIvate physicIans
dur1nl 1970 There were 3602 caes ot IOnorrhea reported
dur1nl 1970 While ODly 17 cabullbullsot ayphilimiddot were reported
A chart was prepUed aDd att8llPt wasmiddotmiddot de tomiddot
determ1De Wh_therVttDereal 41ease was more p~vaJent in
areas othigb or lowmiddot proportIon ot youth hi waadone
bymiddotdetemlna a 1leaD prceiltacmiddotmiddotmiddottor the population ot
resld~ts UDder19 years ot (34) middotA mean ratemiddot per
100000 popUlatIon al80c1ttem1Ded tor the middotoccurreDCe
ot venereal dieae This was et at 390 oass Areas
hav1nl a population 1n which leiS than 34 were lmder 19
years ot ampIe were called low- yOuth abOve tbl percentaae
hiSh youth The aaa waatrue ot the occurrence oivenershy
eal disea_ per CeD8UStract It the rate waacomputed
as 1I0re than 390 cases per 100000 it was called hiah
venerealdiaeasei it less than thia tisure low venereal
disease It was tound that 1D Multn~ COmlty there sems
to be poSitive OOlatI0n(x21S19gt between low youth
and hipmiddot venereal diseaand hip youth and low venereal
diseasebull
RaDk ordr Iitot all c traot middottbAm made
Th1s was done byt1Ddlna the ratepr 100000 populatIon
of venereal disator all census tracts in the County bull
45
These were thenlisted from h1lhto low (sreatest to
least) in a rank order The l1sting was then divided
into Upperandlower 14 aDd listed on the MUltnomah
Countymiddot up
The areas of b1gh venereal disease se8ll18to
roup thBl~8 middotin a very tllht area ~oq both 1des
of thell18l8~ R1 w1th BurDaldeS~et being
~bout theceDter qf tbi8IZ9uping This area woUld
appear to be m ldeal spot for the denlopment of a
locallzed venereal d1sbullbullbullbull cl1D1c
UbepoundCUlO1s
In this report bull tube1C1llosls caS8S refrred
to include alltbobullbull cabullbulls ontubercUlo8is follow-up
rather middotthan just new C Accord1Ds to the Multnomah
County Health SUrvey of early 1971 this would include
all ca repOrte4 over thelaat three years The
total number of tuberculosi8 cabullbullbull usedin this study
was 666 lh1 included 128 new cabullbullbullbull
A rate per 100000 of tuberculosis for each
census tract wa- then computed and the c~us tracts
listed by rank order be b11h Qartlle mel low
quartl1 were then reoordd on a Multnomah CoUnty map
TWo genral areaa baY1Dg a hip mcldencaot tubercu~
losiare 1D41cated heyare
1 Both middotsld ot theWilla11lette River
Ll -
46
with Burns1de about thecnter
2 he extrea Northebullbullt comer of the County bull
By coap8r1ng the tuberculois an4ven8real
diseae maps ODe can 8ee that the downtown areas ot
hiSh 1nc1denceare alIIo8t 1c1eDt1cal on ach map
This WOuld 1nd1cate that 1t would be of value to
bullbulltab11sh acl1D1c 111 th1aampreatbat would provide
bothtuberCulos1s 8Dd ytmereal 418ase srvicbullbullbull
Thchart aDd 1181gt8 are wsfuln 11v1DI
1Ddicat10DS tor the type aDd placemeototlocal
health cl1n1c8 tbro1qhout tbe MultnomahCounty area
A cOllpar1on of the mapa help one to dec1dewhether
to provide a aulti-8ervice cl1D1c or spec1f1c type of
cliD1c As stated in Part I of thi paprserv1ces
shouldhaYe both treatlieDt and prfMmt10n cOmponents
As he been stated fta ne1lbborhood health care
Qenter muat be a fac111tY plazme4 with an aamesa
ot the neds of the consumer and the c01llll1m1tybull
Part II of this rport haa been an attaapt to indicate
and clarify 8011 ottheae coDlllUDity neds This has
been done through8elect10n of apc1f1c problems
The indic were then visuallyrecorded through the
use of ups and charta ODe dan asseS8 thedsreeof
1DIportance of certain concems to spec~t1c areaa by
comparinl the chart aDd maps Prom this oDeean
41 dec1de which are48 vb1chcUD1c-or indeed if
the need a clinic at all However further factors
should be considered hebullbull include
a The amount of fuDd1 available
b What 18 the percentage ot peopleineoh ceaaua tract tbat would actually us such cl1n1cIl
c Wbat 1 tbeco--1tymiddot 8 IeeliDashyreaardtDI particular cl1D1c8 Would this dcrebullbullbullmiddot the ettctiveness ot thse cl1n1ca
IJ
li
D_OlraphicPopulatLon Challie 1960 to 1970 48
Cen8U8 1 of Pop 1 Cbaqemiddot 1 Change1 ofPopTract Under 19 Yr8 Over 65 Yrs1960-70 1960-70
middot1Q701Q70
1 319 -12 171 -H) 1
2722 215-27 +68 301 366 -22 127 +35 302 371 +19 111 -04
311middot401 144-41 +29 402 321 13~7-39 +24 501 356 124-08 -02 5~O2 351 133-23 +12
405601 82-10 -02 394602 103-01 -06
701 275 149-76 +56 702 361 +01 121 -07
+10middot801 326 140-22 802 321 middot127
(
-29 -03 9~01 342 124 -H) 6-18 902 294 128 -H) 3-24
10middotmiddot -14312 140 -17 1101 182 +25 -23197
2411102 186-59 +29 1201 226 169-17 -41
31middot01202 +11 182 -05 295 -H) 81301 208 -H) 4
1302 331 +08 197 +04
14 323 +15 middot185 -08 middotmiddot15 329 +16 16~5 -13
-28middot 1601 332 131 +12
1602 356 98 +24middot-39 middot3101701 161-33 +21
1702 370 -15 85 +02 +19 1801 264 151middot-50
185middot1802 256 +47-58
IJ ~
D_raphlc Population Change 1960 to 1970middot 49 (Contd)
4io
Census Tract
of pop Uncter 19 Yra
1Q1n
1Cha1l8e 1960-70
of PopOver 65 Yra
lQO Change
1960-70
19 389 +29 141 -24 20 223 -13 206 +18
21 227 +08 194 -36 2201 356 -27 112 +05
2202 290 -18 ll~9 -29 2301 356 -03 154 +24 2302 260 -37 245 +97
2401 410 +6~1 123 -31 2402 163 -80 320 +99 2501 381 +13 140 -01 25()2 237 31 lil +02 26 343 +25 186 +149 2701 370 +29 1S5 -01 2702 249 -44 304 +98 2801 337 +19 187 +09 2802 306 -10 156 +31 2901 304 -38 142 +24 2902 i 307 -32 146 t3~9
30 29~0 -48 16~2 +51
31 355 +30 160 +01 32 370 +48 148 -13 3301 395 +45 130 -20 3302 368 +06 138 -02 3401 386 +16 117 000
3402
400 +32 92 -26 3501 304 -07 115 +35
3502 344 000 140 -13
3601
36~02 357 -04 132 +32
3603 30~1 42 149 -67 3701 342 +28 152 +19
1
IJ
Jianolraphic Population Chan 1960 to 1970 50 (Contd)
Census Tract
of Pop Under 19 Yrs
JJl7J
middotChanae 1960-70
middotofmiddotpop Over 65 Yrs
1c~7n
Change 196070
3702 409 +39 122 -11 3801 308 -11 151 +29 3802 275 -35 180 +46 3803 282 -32 192 +54 3901 376 ~13 100 +17 3902 296 -03 177 +29 4001 438 -11 84 +13 4002 353 -21 115 +20
4101 397 11 9middot0 +11 4102 346 -19 120 +03 42 331 +19 11 bull 3 -16 43 347 -72 105 +31 44 113 +84 183 +154 4S 33~9 +07 110 -06 4601 2501 22 193 +38 4602 332 +59 126 -29 47middot 161middot 000 211 +01 48 103 -26 302 +59 49 138 +1 bull 3 252 +09 50 141 -26 204 -12 51 12 -39 257 +07 52 47 -61 351 +48 53 89 +49 314 -30 54 25 l1li15 327 -17 55 131 -17 115 -121 56 198 +93 227 -47 57 71 102 189 -88 58 240 ~middot41 16~1 +55 59 322 +25 142 +06middot 6001 264 95 132 +50
6002 328 -31middot 89 +07
JJ
Demographic Population Change 1960 to 1970 51 (Contd)
Census 1 ofPop lChange of Pop bull ChangeTract Under 19 Yrbullbull 1960-70 Over 65 Yrs 1960-70
1970 1970
61 355 -58 85 +39
62 328 39 110 +18
63 414 04 73 10
64 382 -22 72 +04
6501 383 02 67 -20
6502 329 -56 96 +09
6601 391 +13 88 -03
6602 319 -59 97 +06
6701 327 71 145 +72
6702 331 ~67 83 +1-0
6801 365 -66 49 +01
6802 388 4bull3 54 +06
69 354 -41 80 +23
70 400 -23 68 -06
71 359 -48 72 +05
72 255 -88 82 +11
73 346 -39 91 +25
74 313middot -63 105 +24
75 329 -42 129 +37
76 336 -52 85 +21
77 370 -10 69 +05
78 309 -10 120 +21
79 325 -56 87 +10
8001 358 -81 57 +12
8002 391 ~81 76 +12
81 315 -76 108 +21
8201 403 -23 64 +08
8202 392 23 65 +08
83 357 -34 120 +31
84 402 -18 73 +16
85 413 -06 76 -09
r
Demographic Population Change 1960 to 1970 52 (Contd)
Census Tract
t of Pop Uncler 19 Yrs
1970
Change 1960-70
1 of Pop OVer 65 Yrs
1970
ex Change 196070
86
87
88
89
90
91 9201
9202
93
94
95
9601
9602
9701
9702
9801
9802
99
100 I
101
102
103
10401
10402
lOS
368
351
379
391
391
413
379
433
372
429
414
432
419
439
~32
377
457 420
378 41middot7
345
360 417
417
412
-04
-02
-35
-26
-28
-11
-64
-20
-S9
-39
-32
-21
-34
-40
-47
-lO~7middot
-27middot +04
+56
+07
-34 01
+04
+04
+10
103
128
97
11il3 99
69
79
42
77
46
34 38
44
40
54
111
51middot
81
133
59
74
140
63
87
76
-08
-06
+04
+08
+17
-05
+3S -02
+1~4
+19
+33
-14
-08
+12
+26
+71
+11
-16 -34
-20
-19 +37
-49
-2S +15
NOte The The
Taken frOi
averageullder averageabove
middotUSCensus ---shy -
19 years == 6S years ==
figures 197
32r 13(14
p a~d 1960
--
Rank
1
2
3
4
5
6
7
8
9
10
11 12 -_
13
14
15
16
17
18
Tract
69 46
60
58
- 68
61
302
2501
67
63
19
62
26
94
3603
3902
64
30 -----~-
Rank
19
20
21 -
22
23-shy
24
25
26
27
28
29
30
31
32
33
34
35
36 -
Ranking of Per Capita Income by Census Tract
Tract
65
2701
- 15
1601
701
66
93
82
2903
3602
30
2502
80
2401
81
- 70
91 shy
4001
High
Rank Tractshy
-32shy37
38 97
120239
7840
41 ~ _2_1__ 42 31
43 2501
44 18
45 98
46 37
47 3803
1702
49
48
1602 92 2702
I
50 89
51 901
52 801
Ra_
53
54
55
56
57
58
59
60
61
62
63
64
6S
66
67
68
TractTract Ra~
74692
170196 70 I
401 71 90
72 1037J
79 70273
3802 74 601
24024102 75
85 76 101
77 9023901
7699 78 100 4101 79
3601 I
380180
458140~ t---- _ - - shy83 82 42
888384
59843501
4777 8~
502
Low
802 86
Rank Tract
87 shy
--88
89
90
91
92
93
94
- 95
96
97
middot98
99
100
101
102
103
104
1201
14
49
72
73
43
87
3502
105
1
52
86
71
1
501
10
3301
104 tf
Rank
105
106
107
108
109
110
III
112
113
114
115
116
117
118
119
120
121
Ranking of Per Capitalucoae by Census Tract
(Contd)
Tract Rank
4001 122--shy602
13
1102 2302
3302
55
3401
48
21
56
50
3402
lL01
2202
2301
53
2201
-shy
Tract Rank Tract Rank T~aet Rank
57 I-----
Imiddote
bull
Tract
- Low -k Note Information taken from 1960 U SCensus
Rank Tract
I ~
Ie
Imiddot
~
----
----
--
--
Rank
1
2
3
4
5
6
1
8
9
10
11
i-
-Tract
391 922 921
972 971
100
132 131 121
962 961
822 821 401
982 981
20 111
47 10 1
412
High
Total Number of Henta1 Health Visits
Ranked by Census Tract High to Low
TractTract RankTractRank Rnk
12 182 22 78 29 87 76 381 73181 ~------- 1913 371 8538230162372 271 2616-121 8272 2
14 80~2 31 94 7923 84801 59 15251362 4232 15 52 _ 32 103 8924 651 17240216 652
_ 91 351 33 341 23117 83 122 25 25 48 1123921418 34 shy61 86 661
19 662 6493 81 26 91 8153 49 50 55 41383 71 27 51 3120 90 672241 35shy 104167162 461
I 411 46211121 28 88342 I
2502 36 69 54 5251 50 272
-Ra
37
38
39
_ 40
_ 41 Ishy
I
42 I
-I 43 44
45
shy
Tract
~ --- shy 95 56
45 292 242
102 62 352 291y
92
101 281
99 72 63 601 60~ 42 2201
77 74 61 57
363 232
70
32 31
11 44 282 2202
Low l
- Tract
46 682 681 I 331 30
r~$ 47 1042 332
48 102_41_
11
~
Visits to Family Planning Clinics Ranked by Census Tract High to Low
Rank Tract Rank Tract Rankmiddot Tract Rank Tract Rank Tract Rank Tract
1
2
3
4
5
6
7
8
9
10
11
12
13middot
14
15
16
17
361
56
401
341
48
59 121
20
55
342
10
31
58
93 21
241 132
331
53
461 462
18
19
20-shy21
22
23
24
25
26
27middot
28
29
30
31
32
33
391
32
middot47 I-i-_-shy _ -
231 111
332
972 1
372 371
52
89
32
92
82
100 31
182
30 242
402
34
35
36
37
38
39
40
41
42
43
44
45
42
1714 i 661 221
78 362 2
90 602 601 352
63 251
105 921
971 351
73 42 292 232
411 51
662
81 45 52
46
47
48
49shy
50
51
52
53
54
55
56
961
801
49 81 72 71
19
9~1
172
68 2 57 162 14 112
91 75 681
381 42
3~3
83 161
57 f
58
59
60
61shy
62 Imiddot
63
Imiddot 64
65
66
64 62 36~3 252
74 652 SO 392 291
651 6bull 2
79 271
r-- ---- shy981 222
672 671
821 272
94 87
281
382
67
68
69
70
71
72
73
74
75
76
77
78
981 26 12~2
IS 61
85 82~2 69
61 43
101 86 84 282
76
131
51 72
1041 962 88 70
99 922 77
103
95 802 181
i
~
Low High
RankRank Tract
5479
4480
81 1042 ~) middot102
71 - - + ~ - ~
Visits to Family Planning Clinics
(Contd)
Tract Rank
I
Tract llaDk l
RankTract Tract Rank Tract
~
I
~
J1 ~
Low
Total Number of public Health Nursing Visits
Ranked by Census TractsHigh to Low
TractTract RankTractRank RankRank TractTractRankTractRank
25249 71 79 17249 8033 6586 99189711 84 2915072 34 661 76 66 811519512
402 5035 51 161 2518220 122 1713423 352 55801 7120 6752 2 149814 41236 83 2662 38 94 6821 53 2924015 362 37 32 42 75 69 281 84 63
546 8822 54 222 85 3925431 70383417 3818223 6439 4386652 718 21 55 103332 8924 232 87 19 271729219619 24156 16211140 382 628825 10523110 112 73411 10141-- ----shy 89 363 4457 8126 16111 221 74 9142 90 46158331 53 671279012 46243 48 59 351 3837528 1083 9313 91 5844 59 -_242 76 1----- shy60 272 72 74104114 60145 42 9287 7729 92 6151 8215 57371 934630 91 307762 12113116 282 619447 41391 9531 78100 63 7378 ~95 681 6945 32 5632 798517 6448 47 52 181
High ~ Low
Rank Tract Rank
96 31 132 70
97 102
98 182 372middot 602 651 662
- -shy
~72 682 802
822 922 962 972 982
1042 ----shy
Low
Total Number of Public Health Nursing Visits
(Contd)
Rank Rank Rank TractTract Tract
I
I lt
I
Tract Rank Tract
[
~~~-
I
~
IJilfimiddot ~
j
Ranking of VD Caea According to Census Tracts 61 By High and LOll Youth Itatio
A media~ of 34 5 was determined Any tract having greater
than 34 5~ of popu1tionunde~ 19 years of age -High~
Any tract having l8S than 345 of population under 19
years == Low
Any tract having rate less than 390 =Low
Any tract having rate more than 390 == HLgl4
YOUTH
LOW HIGH
L
0
12 402 1801 1802 343 2801 2802 29023603
54 6001 600262 66~02 72 74 75 76
78 79 81 t02 65 1202
W
(25)
VD
H
I
G
H
401 701 801802 901 902 10 1101 241 1201 1301 132 14 15 1601 1701 20~ 21 2202 2j02 2402 2502 2702 2901 303501 3502 34023801 3802 383 3902 42 44 45 4601 4602 47 48 49 SO 51~2 53 55 56 57 58 S9 6701 6702 73 95
3~02 7021702 19 25~01 2701 4102 4101 63 64601 ~601 6801 680270 7l 77 8001 80~02 8201 8202 83 84
85 86 87 88~ 90 91 9202 920193 94 9601 9602~ 9701 9102 9801 9802 99 100 101 103 10402 105 6501 10401
(47)
301 501 502 601 1602 2401 2301 2201 31 32 3301 3302 3401 3402~ 3602 3702 3901 400140 02 43 61 69 B(
(53) (23)
~ ~gt
Ranking of VD by Rate Per 100000 By Census Tract
~
Rank Tract Rank Tract Rank Tract Rank Tract llank Tract Rank Tract Rank Tract
1 2202 21 S6 40 902 58 1602 74 75
90-shy 64 107 26 --~-
2 3402 22 45 41 10 59 902 75 78 91 54 108 61
3 2301 23 3502 42 2502 60 602 76 6802 92 402 109 87
4 3302 24 49 43 1102 61 501 17 2 93 94 110 90
5 50 25 52 44 6702 62 14 78 8202 94 97 02 III 76
6 2201 26 20 6701 63 4002 8201 2501
9701 41~02 112 91
7 44 27 48 45 401 64 3802 2902 95 63 113 62
8 3301 28 1701 46 502 65 30 79 83 74 96 9602 114 71
9 55 29 47 47 42 66 3803 80 2801 96Q1 115 85 10
11
12
13
14
15
16
17
18
3401
53
2302
2401
57
21
2402
1101
51
30-shy31
32
33
34
35
36
37
3701 - -~ 1201
3702
89
43
132 131
3602
4001
48
49
50
51
52
53
54
55
58
1601
601
4602 4601
69
701
31
3901
67
68
69
70
71
72
2901
801
39021~ 802
6502 6501 122
702
41~01
81
82
83
84
85
86
87
88
19
1
1702
2802
79
93
100 6801 6602
81
97
98
99
100
101
102
103
104
9201 9202
9802 9801
77
302
79
86
72
84
116
117
118
119
120
121
3603
8002 8001
101
99
95
10401
105 10402 103 102
19
20
59
32
38
39
2702
3501
56
57
301
3801
73 1802 1801
89 6002 6001
105
106
2701
88
High Low
-- -----
Rank OrdermiddotTuberclosis Cases by Rate Per 100000 Ranked by Census Tract High to Low
Tract TractRankTractRank Rank TractRaukTractRankTractRank
801
79 9601501411 52 6835340120511 I 960269 903603532036 $-~~F130221542 4366 311301 70 68~013802 _ I- _ 4001_37213 3921201 6802802 H71523822024 22 54 193302 3802 80 8958 I37139535 70155 9801 I60123 72 6702 98023914011016 6701250124 10 56
81 94 401r 7 154152 73 7057 2625 122 92028
90242 162312301 92~158 86 7172434526509 82 79160159 74 100 87412240227220110 6502836960 75 30 8317244 6501782801285711 61 901 42765645 84 66021459294912 9701 660146 171 302 9702 47
6235023033113 85 822821182 917755 16335013110214 841814832 78 103 938564 324815 86 1057940149272 38036523216 10401 87 2902241 725Q 10402360266340217middot IF88 88 9937233 282 51 218 101 01102 46016234
I)167 2901460219 47
High ~ Low ~
- -
TractRank
9S89
6490
8191 8001 8002
63 61 60middot01 6002 44 2701
92
J
2502 402 --- ----shy
I
Rank
Rank Order Tuberculosis Cases by Rate per 100000
(Coutd)
Tract Rank Tract ~nk
I
Tract Ballk Tract Rank
Imiddot
Tract
Imiddot
1~
t 1I i Pi i l I
o
1 -1shyL I
I J
8 40 icO ~ I -lt 0
-t (1) I
i I
r o E
II
a
I
r--i
shy
I
~
I (
Jgt
(011 fi(
Ggt
I II ~j
()
(f 0
~ ()
I
11
f9
r
II 99
o ~
Ggt r
~ __-J~ I t I ~ I
r--J l I
~ _ __ J
) 1
fTl
1gt
r I
()
r
()
lt en -i en
()
I1l
(J)
(J)
-i
P ()
19
r o ~
r G1 I
I
c
~
o I 89
--- -I-shy
r-r I
1- 0 _~ _ _--J E
G1 I I I
i i
I 1-1-1 ~ _J ~2 ~ II
II
()
1 I I I 1
id i bullbull
~
A n 69
r 1shy
- 0 Gl
l--~ ~ I
~ II
II )
I () isect i
en l i
(J)
-t
0
IA Ol
IJ
27
minimum criteria areaccessability of services to those
who need them compr8heX1siveness and appropriatness of
services and efficIency 1nthft utilizat~on of SCarce
health care personnel and resources The scareity of
pex-sonnel andtbe need for h1gh quality ongoinghealth
care services
aJIlong the
populationdemanci the most effishy
cientprovision of services
Services must be made accessible to the population
They mustmiddotbe geosraPh1cally accessible to remove the PhysicalmiddotbaTiers betWeen peopleandthem$d1calcare
system They mUst otter their services dur1ngthe
hours when people can make the moat use ofthemA~ it
makes little sense to concentrate services geographically
where they will not be uSed to their fUllest extent it
also is wasteful to provide serv1cesonlydur1righours when
many people are employed his not only presents a hard
ship middotto the consUmer lnrt wastes resources if for instance
the unavailability of preventive services during the hours
when people Can use them causes a need for treatment
services later on
Health carbull sEtrvices must be comprehensive including
prevention treatmcmtand re)abimiddot11tation Ambulatory I
healtbcare facilities wh1cQ are orienteciexclusively
toward either prevept1on or trea1mentare no longer accepshy
table for they are lneft1c1entln their use of resources
and in their prov1s1on of health care to the patient
w ~~
28
If prevent10n1s notmiddot stressed treatment serv1ces that
could have beenavoidedY1l~ be required If prevention
1s the sole focus of the health care facility sick
patients who present themselves must be referred elseshy
where for treatment andsllch referx-als may be taken as
reject1onsor not followed through with until illness
becomes unbearable
The instltutlontbat meets these requirements Is
the comprehensive neighborhood health center It 1s a
local decentralized outpatient facilityprOVld1ng a
fUll range of ambulatoJY health care services It has
a linkage to ahospitalbackUp facilityforlnpatient
treatment and hiihlY apclalized outpatient care
The neighborhood health center must be a fac11ity
planned with an awareness of the needs of the conSUtller
and coDitnUn1ty It must have the r~Ul0urces to provide the
services people need mere they can use them and when
they can use them It must uti11ze the part1cipation of
the community to develop this awareness Not only must
the cen~er beset up to be Amctional for the consumers
but efforts must bemadeaga1n with commun1ty partici shy
pation to help the consumers utilize medical care
services effectively The center muetmake efforts to
educate the community about the valueot regUlar health
care of preventive servicesand of the use of planned
IJ
29
medical appointments ratherthanorisis centered walk-
incare Therealit1es of the existing health care
system have not taught the patient particularly the low
income patienthow to use services effectively
The helthcenterilUst also bea laboratory for
experiments in easing the health caJepersonnel shortage
and c60rd1Datingcare~ A major difficultY iri-exper1shy
menting with neW rolesis freeing staff of old preconshy
ceptions
CoDlprehensiva neighborhood health dare centers have
been developed under a variety ot alisplces including
medicalsociet1es hoSP1talsmiddot(36p299 group pr~ct1ces
(29 p6- 12 117) health departments (13 p1027) and
ne1gbbothoodassoc1ations(14) The literature indicates
somevalues nthe management ot the health center by plusmnts
hospital backup faCility Whatever the auspices many
adm1nistrative fuDctions such as program coordination
standard pr9tectionand evaluation call for considerable
c~tralization of adm1nistration city-wide or coU)tyshy
wide At the same time other aspects hours of servlce
for examPle~ cuI f~radm1nistrative fUnctions made atmiddot
more local levels Each neighborhood center must be
free to adapt its functioning to itscominunity thi-ough
the mechanism otcODlllUl11~ participation inmiddot policy making
Obviouslythe prerogatives and responsibilities of each level must be negotiated and made explic1t
t4~
JJ
BIBLIOGRAPHY 30
1 American Rehabilitation Foundation ~ealth Services Research Center The Health Maintenance Strategy mimeo 1971
2 Anderson Nancy N Comprehensive Health Planning in the States A Study and Critical Analysis Institute for Interdisciplinary Studies American Rehab ilitation Foundation 1958
3 Andrus Len Hughes Comprehensive Health Planning Through Community Demonstration Health Projects mimeo1967
4 Barry Mildred CandCecil G Sheps A New Model for Community Health Planning unpublished paper presented to the American
Public Health Aseociation1967
5 Blum HenrikL Fred Wahl Genelle M Lemon Robert Jorulin and Glen W Kent The Multipurpose Worker and the Neighborhood Multiservice Center InitialImplications and EJeperiences of the Rodeo CommunityService CenterAmerican Journal of Public Health58 (Mar 168) pp 458-468 shy
6 Blum MichaelD and Soloman L Levy A Design for Service Delivery that Reinforces Constructive Tension Between a Health Center and Its (sic) ConSUDlers and Supports Community Power unpUblished paper presented to the American Public Health Asaociatiltn 1968
7 Brielaud Donald Comm~ity Advisory Boards and Maximum Feasible Participation American Journal of Public Health 61 (Feb 1971) pp 292-296 shy
8 Burns Eveline M Health Insurance Not If or When But What Kind Madison Wisco~sin University of WisconsinScllool of Soci~l Work 1971
9 Campbell John Working ~elationships Between Providers and Conshysumers in a Neighborhood Health CenterU American Journal2 Public Health 61 (Jan 1971) pp 97-103
10 Caxr Willene Neighborhood Health Centers Funded by the Office of Economic Opportunity mimeo 1970~
11 Colombo Theodore J Ernest W Sawardand Merwyn R Greenlick The Integration of an OEO Health Program into a Prepaid Comrehensive Group Practice Plan American Journal of Public Health 59 (April 1969) pp 641-650~ -
12 Comprehensive Neighborhood Health Services Projectof Kaiser FoundatioIl Hospital~ Prcgtgram YearE grant renewal proposal mimeo~1971 bull
13 CowenDavidL~ Denvers Neighborhood Health Program Public Health Reports 84 (Dec 1969) pp 1027-1031
IJ
14 De Diaz Sharon Daniel Beyond Rhetoric The NENA Health31 Center After One Year unpublished paper pres~rited to the American Public Health Association 1970
15middot Gerrie NorrrianF and RichardH~ Ferraro Organizing a Program for Dental Care in a Neighborhood Health Center Public Health Reports 8 (Aug 1968) pp 419-428
16 Gordon JeoffreyB~ The Politics of Community Medicine Projects A Conflict Analysis Medical Care 7 (Nov -Dec 1969) pp 419-428 shy
17 Greely David The Neighborhood Health Center Program and Its Implication(3 for Medical Care H~alth Forum of the Welfare Council of Metropolitan Chicago (mimeo) 1967
18 Greenlick Merwyn R Newgtimensions in Health Care American JOurnal of Pharmacentical Education 34 (Dec 1970) pp 754-4
19 GreenlickMerwyn R Donald K Freeborn TheodoreJbull Colombo Jeffrey Abull Pruesin and Erne$t W saw~d Comparing the
Use of Medical Care Services by a Medically Indigent and a General MemberShip Population in a Comprehensive Prepaid Group Practice Prosram II unpublished paper presented to the AmericanPublic Aesociation1970
20 H~tadoArJiloldVMerllYll RGreenlick and TheodoreJ Colombo Determinants of Medical Care Utilization Failure to Keep Appointments unpublished paper presented to the American Public Health Association 1971
21 Johnson Richard E and Merwyn R Greenlick Comprehensive Medical Care A Problem and Cballengeto Pharmacy ff AJilericanJournal of PbarmacenticalEducation 33 (Aug 1969) pp 361-367 -
22 Kahn Alfred J Studiee Social Policy and Planning New York Russell Sage Foundation 1969
23 Kotler Milton Neyhborhood Government Local Foundations 2 Political~New York The BobbsMerrill Company 1969
24 NationalCommisaion on CommunityHealthSfrvic~sActionPlanniriamp for Community SetithServices~ashington p C Public Affairs-Press 19t7
25 National Commission on C~mmunity Health Services Health Adminishysration andOrMPization l the Decade Ali9$-d Washington D C Public Affairs Press 1967
26 NationalCornmiesion onqomm1Jllity Health Servicesbull Health ~ Facilities Washington D C PUblic Affairs Press 1967 bull
~ n
32 27 ODonnell Edward J and Marilyn M Sullivan ServiceDelivery
and Social Action Through the Neighborhood Center A Review of Research tt Welfare ~ Review 7 (Nov~Dec 1969) pp 112
28 Office of Economic Opportunity Second Annual Report Washington D C~ U S Government Printing Office 1966
29 Office of EConomic Opportunity and the Medical Foundation of Be~laire Ohio Eighth Report 2l ~ Committee2a Governshy
ment OperatiOll~ Va8hiiiSton D C Government Printing Office 1969
30 Pope Clyde R Samuel S Yoshioka and Merwyn R Greenlick Determinants of Medical Care Utilization nhe Use of the Telephone for ReportiDg Symptons Journal of Health and SocialBebavior12 (June 1971) pp155-162 shy
31 RenthalA Gerald nComprehensive Health Centers in Large US Cities American Journal of Public Health 61 (Feb 1971) pp 324-336 shy
32 Saward Ernest W The Relevance of Prepaid Group Practice to the Effective Delivery ofHealthServicestt The New Physician 18 (Jan 1969) pp39-44 - shy
33bull Schorr Lisbeth Bamberger and Joseph T English Background Content and Significant IssUes in Neighborhood Health
Center Programs Milbank Memorial ~ Quarterly 46 July 1968) part 1pp 289-296
34 Weiss James E and Merwyn RGreenlick UDeterminants of MedioalCareUtilization The Effects of Social Class and Distance on Contacts With the Medical Care System Medical~ 8 (Nov-Dec 1970 pp 456-462
35 Weiss James E MerwynR Greenlick and Joseph F Jones Determinants of Medical Care Utilization The Impact of Ecological Factorstt unpublished paper presented to the American Public Health Association 1970
36 Wise Harold B Montefiore Hospital Neighborhood Medical Demonstration A Case StudyMilbaDkMemorial Fund Quarterly46 (July 1968) part 1 pp297-308~
37 Yerby Alonzo S ttHealth Departments Hospital and Health Services Medica1~5 (March-April 1967) pp 70-74
38 Young M M~ Chatanooga IS Experience with Reorganization fOr Delivery of Health Services ttAmerican Journ8l of Public Health60 (Sept 1970) pp 1739-1748
f or l
II bull 11 Y d
II
IJ
34
ThepurposeOfPart II of th1aa paper1atod1scuas
elected Speclfic needs ofecltlc areas within Multnomah
County A8P01ll~oUt 1D ~ I of t1a1bullpapermiddot Ita nelgbshy
borhood health oare cater IlU8t be a facl1lty plaDlled with
aD awarenes of the neeels of the oODllUller and collllUDity
Part II of this paper nIl Show 80e of thoe speclflc
needs
he1DforutiOD tor t1li Portlon of the report
obta1nec1 troll tbroupout tbe follow1Dl threepUb11catloDS
1gr~e_tiMshylIPrIxaiidOreson JuDe 1963
2 1~_middot_sectSI8e~ected1teai c-ua 0 S 8 e first count coaputer tape Coluab a_lion AssocshylatloD of QoveraMD-8 Jlme 1971
3 Jtu1tDoab County Oreaon BDY1roDlHtlltal SurveyEarly 1971
The JIultDOIIIlb COUDty OrttIOD BDv1roDllfmtal Surley
Barly 1971 1s bull stat1stical report of the activ1tles of
theentlreMultDOIIIl2 CcNDty Health Dep~t during the
year of 1970 Die speclflc 1nd1cs elected from tb1s
study amprejMental aealtll Publlc Health N~s1D1 vlslts
FaJUly ~ Veaereal])1 ~ ~rcul081
Throush tie use of cUrts and mapa ODe CaD roup these i
speclflc ~oea to ahcnr the healthneedsof speclfic I
census trtcta aD4 then the health needs of iarer neIghshy
borhooda 1m4 o~ Uebullbull
Rf)~UP1Dl of areu was accompllshed in thefolloWinl I
JJ ~
35
he MiltDoIliahCountY oregon BDViromaental SUrvey
early 1971 isamp statistical report ot tbeaotivities ot
the entire MultDolllh COUDty Health ])epartiDent dur1nl the
year ot1970 he specitic 1Dd1C8S selected frOm this
aUy are 1Il8Dtal health public healthDurs8s visits
fUl1ly pia waereal elisease aDd tuberculosia
Tbroq11the Wle otcbart aDd mapa aDecm szoup these
specific indic to show the health Deeds ofapecitic
ccmaua tracts aDdtIum th8health neecla of larsr ~eilh-
bOrhooda and co8I13 tlbullbullbull
RegroupiDI ot areas waa accoap118hed1D the
tollOWiDl lIIIIm1er~ A bullbullcifie 1ndex 8selectcl auch as
venereal di8bullbulle or tuberculo8i~ he total number ot
cs was then deterll1ne4 for each census tract Through
the use of the maber ot cRbullbullbull tor a 11Yen cenaus tract
aDd tbe population ot thattractaltrateot1lla1ampmcper
100OOOpopUlaticm wu cleteXll1ned for each census tract
This was ~e to starl4ard1ze the population ditterence
amongOeD8U8 -tracts 1he rate of incidence toreaob
cenauatract was then llstedby rank position on a chart
In rank poition1DI any cen8Wl tracts haviDg equal
rates ot1l1c1dence are assipe4tbe iaDk posttiona
Beeauseot the abo fact tbAt cbarta w111 vary in length
neveltbAtlea eacb cbart will 1Dclu4eall census tracts
inMullnoaah Couaty Atter the census tracts bave been
listed accord1q to raalcth1s list will bediv1ded into
IJ
36 three levelsotinc14ence he three levels are
1~ The upper 14 of1DcldenCe
2 Thelower 14 ot incidence
middot3 The ILld 12 of incidence
Tlles three srouplqa are then used in compiling a map ~f
Mu1tnOmahCountyfor ach apecltictop1cbull TIle maps are
uaefuJliD tbatthey V1suallycoJib1De 1Dd1v1Clualproblem
census tracts into larger problem nellhbOrhooc1s
The 1960 statistical iDtormatloD was Used in a similar
liIaDDr to tbatexpla1Dedabove 1Dthe4evelopaent of a
chartmiddot and map 1Ihow1DI e cOllpampriSOr1 of per capita lncolle
tor ttaCh ceDsua tJact aDdmiddot combiDed census middotmiddottract areas
he 1910 aDd 1960 statlstlcal iDtOrllatl0D was combined
lna map and chart he purpose of this and chart is
to d8aonatrate the e cl1stributloa1DeachceD8U8 tract
and middot1ndlcatbull tuture ace populatlon treD4a bull
When one be middotbullbullbullbullbullHdth ne8cts ot an area and has
declded to establlsh a cl1D1c to serve that area the
physical location otthat cl1D1c IllU8t be consldered In
order to coapreb8ll81vel develop an area cl1n1c one should
conslder thepre88Dttraftlc middot~ytaa an4tranaportatlon
systems Thecl1D1cahoUld be located close enoUlh to
major arterlals to giva asy access from the total area
be_ ervecl by this cliD1c At the t1ll8they should
be tar eo away froll thesarterlals to all8Y1ate traffic
CODCell18 andpark1D8 conpstlon By traff1c concerns I
IJ
37
lIlan one lUSt consider thertarro1fne8S of streets whether
streets are oD8--C)r two-way iqres8 and egress to parking
amp0111tie eros tratflC) spedof trattJQ children 1n
ll8a traffic i1lht Vislon re8tr1ctionS etc
BwstraDsportat1onshould alao be central in this area
as maay people ~U f1Df1 1tD8Cessary to use this form of
transportatlon
~e tutqredlopHQt of bull treewa systems should be
c0J1S1dered soastolesen thecumce ofmiddot future roada
cutt1DSotltbe cl1D1c llte line
nrrph1c middotDampta
It is 1JDportaDtto kDOw the demosraphic distribution
characteristics of the oUenteltbat i8 to be served by
localized health cl1D1cs
Acl1D1c which erves8J1 area where1D the prepondershy
ance of persona arecrter 65 years of mayf1nd that these
people rely more on pUblic transportation call for more
home- services and haV4t 110ft ChroD1c and debilitating
types of disorders (b1_ blood pressure poor heariDg and
eyesight) tbaD do8 an area ot a YOUDIer population On
the other hand thL area of older residents may have little
need for family plabDlng cllni08
In order to better ~Ybullbull the 4eaoraphic population
of each CeD8U8 tract the 1970 CeD8U8 iatormation was viewed
and two specific catelOri8 considered These two cat
IJ
38
lori8S woUld be the perc_tap ot population under 19
year of ase and the percentase ot each oensuetractover
65 years of age he 1960 1Dtormatlon tor eaCh tract was
then compared witbthe 1970 intormation and a percentage
ofincreaae or4ecreamp8 tormiddot e~chtract1n each category
cOJlputecland achartma4e By the use of this chart one
18 able to View tJleap populat1odiatr1but10n of census
tract and at the _ t1lle accesa middottrencl Por example
let us choose census tract 601 W see 40-4 otthe
population is under 19 years ot and that ODly82 1s
over 65 years ot middotAtthe e tille the percentage of
youth bas ~ed ODly 1_ intbe laSt teD year whilethe
percentale over 65 year ot middotbas stayedmiddotthe same With
this in mJnc1 ODe ~ 1DfItr libat ol1D1o aerviDg this
area WOuld bellQre conq~w1th the problems of a
YOUQier populat1on and that _ would probably be true foJ
some t1aein tbefuture On the other hand CeDSU8 tract 54
has only 2 ollt population UDder 19 yel1s ot age and
this has decreased by 1 over the last ten years middotwhile at
the same time 32-377 ot the populat1on 18 over 65 years of
age A ol1D1C ___ this area should be or1eJ1ted toward
tbespecttic problema otthe ampledbull
PerCapia __ bY gsa neat
WhaD cona1der1qlooat10D1 tor health cl1n1cs one
shoUld take the 1DC01Ieot areas into consideration Areas
IJ
39
of lowiDcome would not 11kel~be 8erved more by localized
cl1D1cs tbaD would are of hilbincome It 18 likely
people haYiq a hip iDeoll8would preter to be aeenby a
chosen ~r1vatephylc1a1l tban at a local cl1D1cwhere
10Dier waits y beraceaaampryand leas personal attention
gl_
The 19701ncOII81atoWampt10n tor MultnomahC~ty was
not available at the tille thi8report W88 made The 1Dto~shy
tiOD Was taken ~adtro tbe1960 census publlcation
his woUld ~8Il thea tbat ral1I8 OD the chart ynot 1raquoe
completely accurate hi writer telthatthe areas most
affected by tb8 1I8eof the older 1Dco1DtOlaat1oDWOuld be
those tracts wh1ch baYebad a rapid 1ncreaae1n populatlon
over the past tfmyHr8 bullbullbull tracts would include tracts
nUmbered 104 9897 96 aDd 95 be perc~ita 1Dcome
referredto1il-tb1a Paper18the lIean 1DCo per person per
census tract
Attar the iDeoeper census tract was listed on a chart
a map was de 1D41catiDg those census tracts belonging to
the lower 14 ot income tor all censue tracts in Multnomah
COlDltytbose beloqins to the upper 14 ot income tor all
census tract 111 MultnolUlhCounty and those belonging to
the mid 12 ot 1I1coaetor all oeuuetracts in Multnomah
C01mty
In yiew1Dg the _p 1t caa be seen that the low income
area seautotollow aloas the at aide ot the Wl1lamette
IJ
40
R1ver the full length of Kultnomah County A second low
income area follows the south edge of the Columbia from
the northwest corner of Multnomah County easterly to 148 St
A third problem area seems to be on the east bank of the
Willamette River with the Union Pacific Railroad being
about the center of this tract The extreme loutheast
corner of Multnomah COUDty appears to be a low income area
but as this area bas bad rapid grouth in the last ten years
this could be erroneous
Mental Health
be first ~ecific indica to be selected from the
Multnomah County envirollllental survey of early 1971 and
to be considered in this paper i8 that of Mental Health
At the present for mental health purposes Multnomah
County is divided into five catchmentareas with a mental
health cl1n1cin each area These clinics are Model
Citles Delaunay ADkeny street Office Hansen Health
Building end Southeast Clinic
All lIlental health cl1n1cslcept statlstlcal information
on all patients visiting their cl1n1cs this included the
address of the patient hese addresses were then listed
upon the approprlate C8D8US tract Each census tract was
then ranked on a chart according to the nUllber of mental
health patients who reslde ln thatCeDSUS tract attending
any of the above listed ental health clinics This chart
IJ
41
wasttum d1v14ed1ato proper quartile bbullbullbull
quartile vereUs to dne10 u appropl1ate Multnoh
County _tal health ItLa middotmiddotmiddotthelipO~a1bl by lOoJcJIUE
at the UDtal health _to uteN1De which ueu have the
lars-t use otCOllDty 1alh~th faci11t1Rot
1Ilclu4ecl 111 tbia woUld tber otpeopleYia1t1Da
pr1vat patch1atriata aDd pr1_t _ntalhealtb cl1D1c8
WheDtbe M1 18Yienclmiddot Itmiddotmiddotmiddotmiddot~middotbe~_ tbat ~rtt
appears to lMt fourmiddotmiddot-al are iii _oil the nuaber ot
lIental healthcl1D1c na1t toM tbjh1sheat 1he
tour areaa woUld be tollows
1ttrea Ore to~Blo Drimiddot ~tb Burrus14e aDd tIMtmiddot Colb1a Riftr H1gbwyaeri1Dla th nortllra boundaryshy
2 bull ProII 82D4 1_~ 10 20th streetwitil the ra1lMd Mu the north ltouadary
3 ~ et et tUgl_b1bull MYel froamiddot the Clackaaa COUDty l1ae aorth to Dln8lon stret
4 beDOlvt1ttfe-t ~efllt4 COatytrca Jle1aware streetmiddot toR1C1a11oDd wlth Colubla Blvd heiDI tbAtnorth bouaclary_
It ODe coapareatbiap to th iDeobullbullmiddotp 1t can be
eamiddotthat lIOat ot the c tracts baY1Dg bllh v1i11tatlcma
middottfl public tal health cJ1rUc8 ~ 111 t13e low ~ aid
1DcOile SroupiDIOJa1y of til 25 tracta llsted as
haviDlbip aental Maltll nlltatlou are ~ the1g60 hip
iDeo arebullbullbull
17 Plpn
42
amily PlellnSDI ]Jlce Metal Health i8 an 1nd1ce of
use Theperson 111 ordertobavebe_ 1Dcluclecl 1n this
atu4ywouldhave tohaft Ue4 ataa11y plaDI cl1D1c
tacilities of soaetype It 41fter troll tile _tal health
study1nthat i t1Jicludestatist1catrollbotb public and
privateclJD1os
The iDformation tor the iak orurcbart 8Dd map of
t8ll111 plenn1 na ob1a1De4 by cOIIblnlDlthe mabel of
1rlcuv1duals bullbull_ attbe tbreellUltrampo-ti Coatyhll11y
PlalJQllIl C11ll10s 111til tbo at the Planned PareDthood
Association CliD1C8 be tbree -JIultDouh Couaty r8ldly
PlamSq Cl1D1c are Solrtbweatth Col_bla 1111- a114
HaDsell Health BWlcl1Dl CllD1cbi middot1Dtormat1oD vas then
bullbullbullesed tomiddot detellWMt l10w people troll eacb c8IUIUS
chart wastben Mele IUs oIIart jn 4iY1ded to show
the censuS tracts lIaYiDlmiddottIle h1t1iest qUart1le of incidence
of use lowest quartile of 1Qc1deao ot use Jlid 12 of
incidence of Wle an4 a map sprepared troll thts 1Dto~
mation
The C8U118 tractsbelOJISnl to the h1lhestquartile of
use appear to be 1lO~ 8catt~ on tbipwas true ot
either the _p ot aental health cl1D1c uaageor ot the map
abow1DI per capita 1I1COM Iaere40 to be three
d18t1nct areas of UIIaP beJ woul4 be
1
IJ
43
t10D of BurD81cl and the W11lallette River 4
2 S~t Portland 8Otth otmiddot the ra11shyrcaadand alona the W11lamette River
lIortbeaat Portl8D4 between MisSiss1pp1 and 24tbStreet the northbouBclary be1DgColwb1aBlvd
Pylzl1c BMltl IrpI Y11ta
Publlc Healtil nur81D1Y1s1t nclud8 an vists to
theholles of client by PubUc Health Nurbullbullbullbull his shows
visits to bull f8Jl1ly fer aDY purpos SUCh aatuberculolJ1s
het1Dl tem1tyaeatalu4 8IiOt10D8l cODd1t1ona etc
he atat18t1C~ 1fele C()4ed accord1Dg tomiddot the 1llli301fOCUS
of the Y18lt tt doe DOt 1D41cate the Dmlber of holies or
f8ll11lev181tecl or 1D41Y14ual Y1a1ted more tban oDcein
the propwl It dobullbull I1ve 80M 1D41cat1on by coaparlshy
OD ot the 8JIoUDt of aedlcal problema 1n eachcen8WI tract
Ap1nmiddot the _p abowa 8 scatter patteraof probl_
areas althoUSh there appear to be a sroup1Dl of hiSh J
l8aIeccmaus tract 1ntlut extreme southeast part of tbe
County other areu uIriaI any nura1Dl contacts are
1 bull he 801lth-oa-al CO1Dty on eaCh 814 of 82nd Av from Clackallaa County north to Dinloa
2 ear bullbullbullt 814e aroUDd Preacottand Misaisippi
Dowatom Bunul14eonboth 1de of the river
44
V_real Pis The iDfomatloil uaec1 to tabulate the Venereal
disease chart includes all the ooab1ned case otmiddotODormea
and syphilIs reported by bothmiddot publIc and prIvate physicIans
dur1nl 1970 There were 3602 caes ot IOnorrhea reported
dur1nl 1970 While ODly 17 cabullbullsot ayphilimiddot were reported
A chart was prepUed aDd att8llPt wasmiddotmiddot de tomiddot
determ1De Wh_therVttDereal 41ease was more p~vaJent in
areas othigb or lowmiddot proportIon ot youth hi waadone
bymiddotdetemlna a 1leaD prceiltacmiddotmiddotmiddottor the population ot
resld~ts UDder19 years ot (34) middotA mean ratemiddot per
100000 popUlatIon al80c1ttem1Ded tor the middotoccurreDCe
ot venereal dieae This was et at 390 oass Areas
hav1nl a population 1n which leiS than 34 were lmder 19
years ot ampIe were called low- yOuth abOve tbl percentaae
hiSh youth The aaa waatrue ot the occurrence oivenershy
eal disea_ per CeD8UStract It the rate waacomputed
as 1I0re than 390 cases per 100000 it was called hiah
venerealdiaeasei it less than thia tisure low venereal
disease It was tound that 1D Multn~ COmlty there sems
to be poSitive OOlatI0n(x21S19gt between low youth
and hipmiddot venereal diseaand hip youth and low venereal
diseasebull
RaDk ordr Iitot all c traot middottbAm made
Th1s was done byt1Ddlna the ratepr 100000 populatIon
of venereal disator all census tracts in the County bull
45
These were thenlisted from h1lhto low (sreatest to
least) in a rank order The l1sting was then divided
into Upperandlower 14 aDd listed on the MUltnomah
Countymiddot up
The areas of b1gh venereal disease se8ll18to
roup thBl~8 middotin a very tllht area ~oq both 1des
of thell18l8~ R1 w1th BurDaldeS~et being
~bout theceDter qf tbi8IZ9uping This area woUld
appear to be m ldeal spot for the denlopment of a
locallzed venereal d1sbullbullbullbull cl1D1c
UbepoundCUlO1s
In this report bull tube1C1llosls caS8S refrred
to include alltbobullbull cabullbulls ontubercUlo8is follow-up
rather middotthan just new C Accord1Ds to the Multnomah
County Health SUrvey of early 1971 this would include
all ca repOrte4 over thelaat three years The
total number of tuberculosi8 cabullbullbull usedin this study
was 666 lh1 included 128 new cabullbullbullbull
A rate per 100000 of tuberculosis for each
census tract wa- then computed and the c~us tracts
listed by rank order be b11h Qartlle mel low
quartl1 were then reoordd on a Multnomah CoUnty map
TWo genral areaa baY1Dg a hip mcldencaot tubercu~
losiare 1D41cated heyare
1 Both middotsld ot theWilla11lette River
Ll -
46
with Burns1de about thecnter
2 he extrea Northebullbullt comer of the County bull
By coap8r1ng the tuberculois an4ven8real
diseae maps ODe can 8ee that the downtown areas ot
hiSh 1nc1denceare alIIo8t 1c1eDt1cal on ach map
This WOuld 1nd1cate that 1t would be of value to
bullbulltab11sh acl1D1c 111 th1aampreatbat would provide
bothtuberCulos1s 8Dd ytmereal 418ase srvicbullbullbull
Thchart aDd 1181gt8 are wsfuln 11v1DI
1Ddicat10DS tor the type aDd placemeototlocal
health cl1n1c8 tbro1qhout tbe MultnomahCounty area
A cOllpar1on of the mapa help one to dec1dewhether
to provide a aulti-8ervice cl1D1c or spec1f1c type of
cliD1c As stated in Part I of thi paprserv1ces
shouldhaYe both treatlieDt and prfMmt10n cOmponents
As he been stated fta ne1lbborhood health care
Qenter muat be a fac111tY plazme4 with an aamesa
ot the neds of the consumer and the c01llll1m1tybull
Part II of this rport haa been an attaapt to indicate
and clarify 8011 ottheae coDlllUDity neds This has
been done through8elect10n of apc1f1c problems
The indic were then visuallyrecorded through the
use of ups and charta ODe dan asseS8 thedsreeof
1DIportance of certain concems to spec~t1c areaa by
comparinl the chart aDd maps Prom this oDeean
41 dec1de which are48 vb1chcUD1c-or indeed if
the need a clinic at all However further factors
should be considered hebullbull include
a The amount of fuDd1 available
b What 18 the percentage ot peopleineoh ceaaua tract tbat would actually us such cl1n1cIl
c Wbat 1 tbeco--1tymiddot 8 IeeliDashyreaardtDI particular cl1D1c8 Would this dcrebullbullbullmiddot the ettctiveness ot thse cl1n1ca
IJ
li
D_OlraphicPopulatLon Challie 1960 to 1970 48
Cen8U8 1 of Pop 1 Cbaqemiddot 1 Change1 ofPopTract Under 19 Yr8 Over 65 Yrs1960-70 1960-70
middot1Q701Q70
1 319 -12 171 -H) 1
2722 215-27 +68 301 366 -22 127 +35 302 371 +19 111 -04
311middot401 144-41 +29 402 321 13~7-39 +24 501 356 124-08 -02 5~O2 351 133-23 +12
405601 82-10 -02 394602 103-01 -06
701 275 149-76 +56 702 361 +01 121 -07
+10middot801 326 140-22 802 321 middot127
(
-29 -03 9~01 342 124 -H) 6-18 902 294 128 -H) 3-24
10middotmiddot -14312 140 -17 1101 182 +25 -23197
2411102 186-59 +29 1201 226 169-17 -41
31middot01202 +11 182 -05 295 -H) 81301 208 -H) 4
1302 331 +08 197 +04
14 323 +15 middot185 -08 middotmiddot15 329 +16 16~5 -13
-28middot 1601 332 131 +12
1602 356 98 +24middot-39 middot3101701 161-33 +21
1702 370 -15 85 +02 +19 1801 264 151middot-50
185middot1802 256 +47-58
IJ ~
D_raphlc Population Change 1960 to 1970middot 49 (Contd)
4io
Census Tract
of pop Uncter 19 Yra
1Q1n
1Cha1l8e 1960-70
of PopOver 65 Yra
lQO Change
1960-70
19 389 +29 141 -24 20 223 -13 206 +18
21 227 +08 194 -36 2201 356 -27 112 +05
2202 290 -18 ll~9 -29 2301 356 -03 154 +24 2302 260 -37 245 +97
2401 410 +6~1 123 -31 2402 163 -80 320 +99 2501 381 +13 140 -01 25()2 237 31 lil +02 26 343 +25 186 +149 2701 370 +29 1S5 -01 2702 249 -44 304 +98 2801 337 +19 187 +09 2802 306 -10 156 +31 2901 304 -38 142 +24 2902 i 307 -32 146 t3~9
30 29~0 -48 16~2 +51
31 355 +30 160 +01 32 370 +48 148 -13 3301 395 +45 130 -20 3302 368 +06 138 -02 3401 386 +16 117 000
3402
400 +32 92 -26 3501 304 -07 115 +35
3502 344 000 140 -13
3601
36~02 357 -04 132 +32
3603 30~1 42 149 -67 3701 342 +28 152 +19
1
IJ
Jianolraphic Population Chan 1960 to 1970 50 (Contd)
Census Tract
of Pop Under 19 Yrs
JJl7J
middotChanae 1960-70
middotofmiddotpop Over 65 Yrs
1c~7n
Change 196070
3702 409 +39 122 -11 3801 308 -11 151 +29 3802 275 -35 180 +46 3803 282 -32 192 +54 3901 376 ~13 100 +17 3902 296 -03 177 +29 4001 438 -11 84 +13 4002 353 -21 115 +20
4101 397 11 9middot0 +11 4102 346 -19 120 +03 42 331 +19 11 bull 3 -16 43 347 -72 105 +31 44 113 +84 183 +154 4S 33~9 +07 110 -06 4601 2501 22 193 +38 4602 332 +59 126 -29 47middot 161middot 000 211 +01 48 103 -26 302 +59 49 138 +1 bull 3 252 +09 50 141 -26 204 -12 51 12 -39 257 +07 52 47 -61 351 +48 53 89 +49 314 -30 54 25 l1li15 327 -17 55 131 -17 115 -121 56 198 +93 227 -47 57 71 102 189 -88 58 240 ~middot41 16~1 +55 59 322 +25 142 +06middot 6001 264 95 132 +50
6002 328 -31middot 89 +07
JJ
Demographic Population Change 1960 to 1970 51 (Contd)
Census 1 ofPop lChange of Pop bull ChangeTract Under 19 Yrbullbull 1960-70 Over 65 Yrs 1960-70
1970 1970
61 355 -58 85 +39
62 328 39 110 +18
63 414 04 73 10
64 382 -22 72 +04
6501 383 02 67 -20
6502 329 -56 96 +09
6601 391 +13 88 -03
6602 319 -59 97 +06
6701 327 71 145 +72
6702 331 ~67 83 +1-0
6801 365 -66 49 +01
6802 388 4bull3 54 +06
69 354 -41 80 +23
70 400 -23 68 -06
71 359 -48 72 +05
72 255 -88 82 +11
73 346 -39 91 +25
74 313middot -63 105 +24
75 329 -42 129 +37
76 336 -52 85 +21
77 370 -10 69 +05
78 309 -10 120 +21
79 325 -56 87 +10
8001 358 -81 57 +12
8002 391 ~81 76 +12
81 315 -76 108 +21
8201 403 -23 64 +08
8202 392 23 65 +08
83 357 -34 120 +31
84 402 -18 73 +16
85 413 -06 76 -09
r
Demographic Population Change 1960 to 1970 52 (Contd)
Census Tract
t of Pop Uncler 19 Yrs
1970
Change 1960-70
1 of Pop OVer 65 Yrs
1970
ex Change 196070
86
87
88
89
90
91 9201
9202
93
94
95
9601
9602
9701
9702
9801
9802
99
100 I
101
102
103
10401
10402
lOS
368
351
379
391
391
413
379
433
372
429
414
432
419
439
~32
377
457 420
378 41middot7
345
360 417
417
412
-04
-02
-35
-26
-28
-11
-64
-20
-S9
-39
-32
-21
-34
-40
-47
-lO~7middot
-27middot +04
+56
+07
-34 01
+04
+04
+10
103
128
97
11il3 99
69
79
42
77
46
34 38
44
40
54
111
51middot
81
133
59
74
140
63
87
76
-08
-06
+04
+08
+17
-05
+3S -02
+1~4
+19
+33
-14
-08
+12
+26
+71
+11
-16 -34
-20
-19 +37
-49
-2S +15
NOte The The
Taken frOi
averageullder averageabove
middotUSCensus ---shy -
19 years == 6S years ==
figures 197
32r 13(14
p a~d 1960
--
Rank
1
2
3
4
5
6
7
8
9
10
11 12 -_
13
14
15
16
17
18
Tract
69 46
60
58
- 68
61
302
2501
67
63
19
62
26
94
3603
3902
64
30 -----~-
Rank
19
20
21 -
22
23-shy
24
25
26
27
28
29
30
31
32
33
34
35
36 -
Ranking of Per Capita Income by Census Tract
Tract
65
2701
- 15
1601
701
66
93
82
2903
3602
30
2502
80
2401
81
- 70
91 shy
4001
High
Rank Tractshy
-32shy37
38 97
120239
7840
41 ~ _2_1__ 42 31
43 2501
44 18
45 98
46 37
47 3803
1702
49
48
1602 92 2702
I
50 89
51 901
52 801
Ra_
53
54
55
56
57
58
59
60
61
62
63
64
6S
66
67
68
TractTract Ra~
74692
170196 70 I
401 71 90
72 1037J
79 70273
3802 74 601
24024102 75
85 76 101
77 9023901
7699 78 100 4101 79
3601 I
380180
458140~ t---- _ - - shy83 82 42
888384
59843501
4777 8~
502
Low
802 86
Rank Tract
87 shy
--88
89
90
91
92
93
94
- 95
96
97
middot98
99
100
101
102
103
104
1201
14
49
72
73
43
87
3502
105
1
52
86
71
1
501
10
3301
104 tf
Rank
105
106
107
108
109
110
III
112
113
114
115
116
117
118
119
120
121
Ranking of Per Capitalucoae by Census Tract
(Contd)
Tract Rank
4001 122--shy602
13
1102 2302
3302
55
3401
48
21
56
50
3402
lL01
2202
2301
53
2201
-shy
Tract Rank Tract Rank T~aet Rank
57 I-----
Imiddote
bull
Tract
- Low -k Note Information taken from 1960 U SCensus
Rank Tract
I ~
Ie
Imiddot
~
----
----
--
--
Rank
1
2
3
4
5
6
1
8
9
10
11
i-
-Tract
391 922 921
972 971
100
132 131 121
962 961
822 821 401
982 981
20 111
47 10 1
412
High
Total Number of Henta1 Health Visits
Ranked by Census Tract High to Low
TractTract RankTractRank Rnk
12 182 22 78 29 87 76 381 73181 ~------- 1913 371 8538230162372 271 2616-121 8272 2
14 80~2 31 94 7923 84801 59 15251362 4232 15 52 _ 32 103 8924 651 17240216 652
_ 91 351 33 341 23117 83 122 25 25 48 1123921418 34 shy61 86 661
19 662 6493 81 26 91 8153 49 50 55 41383 71 27 51 3120 90 672241 35shy 104167162 461
I 411 46211121 28 88342 I
2502 36 69 54 5251 50 272
-Ra
37
38
39
_ 40
_ 41 Ishy
I
42 I
-I 43 44
45
shy
Tract
~ --- shy 95 56
45 292 242
102 62 352 291y
92
101 281
99 72 63 601 60~ 42 2201
77 74 61 57
363 232
70
32 31
11 44 282 2202
Low l
- Tract
46 682 681 I 331 30
r~$ 47 1042 332
48 102_41_
11
~
Visits to Family Planning Clinics Ranked by Census Tract High to Low
Rank Tract Rank Tract Rankmiddot Tract Rank Tract Rank Tract Rank Tract
1
2
3
4
5
6
7
8
9
10
11
12
13middot
14
15
16
17
361
56
401
341
48
59 121
20
55
342
10
31
58
93 21
241 132
331
53
461 462
18
19
20-shy21
22
23
24
25
26
27middot
28
29
30
31
32
33
391
32
middot47 I-i-_-shy _ -
231 111
332
972 1
372 371
52
89
32
92
82
100 31
182
30 242
402
34
35
36
37
38
39
40
41
42
43
44
45
42
1714 i 661 221
78 362 2
90 602 601 352
63 251
105 921
971 351
73 42 292 232
411 51
662
81 45 52
46
47
48
49shy
50
51
52
53
54
55
56
961
801
49 81 72 71
19
9~1
172
68 2 57 162 14 112
91 75 681
381 42
3~3
83 161
57 f
58
59
60
61shy
62 Imiddot
63
Imiddot 64
65
66
64 62 36~3 252
74 652 SO 392 291
651 6bull 2
79 271
r-- ---- shy981 222
672 671
821 272
94 87
281
382
67
68
69
70
71
72
73
74
75
76
77
78
981 26 12~2
IS 61
85 82~2 69
61 43
101 86 84 282
76
131
51 72
1041 962 88 70
99 922 77
103
95 802 181
i
~
Low High
RankRank Tract
5479
4480
81 1042 ~) middot102
71 - - + ~ - ~
Visits to Family Planning Clinics
(Contd)
Tract Rank
I
Tract llaDk l
RankTract Tract Rank Tract
~
I
~
J1 ~
Low
Total Number of public Health Nursing Visits
Ranked by Census TractsHigh to Low
TractTract RankTractRank RankRank TractTractRankTractRank
25249 71 79 17249 8033 6586 99189711 84 2915072 34 661 76 66 811519512
402 5035 51 161 2518220 122 1713423 352 55801 7120 6752 2 149814 41236 83 2662 38 94 6821 53 2924015 362 37 32 42 75 69 281 84 63
546 8822 54 222 85 3925431 70383417 3818223 6439 4386652 718 21 55 103332 8924 232 87 19 271729219619 24156 16211140 382 628825 10523110 112 73411 10141-- ----shy 89 363 4457 8126 16111 221 74 9142 90 46158331 53 671279012 46243 48 59 351 3837528 1083 9313 91 5844 59 -_242 76 1----- shy60 272 72 74104114 60145 42 9287 7729 92 6151 8215 57371 934630 91 307762 12113116 282 619447 41391 9531 78100 63 7378 ~95 681 6945 32 5632 798517 6448 47 52 181
High ~ Low
Rank Tract Rank
96 31 132 70
97 102
98 182 372middot 602 651 662
- -shy
~72 682 802
822 922 962 972 982
1042 ----shy
Low
Total Number of Public Health Nursing Visits
(Contd)
Rank Rank Rank TractTract Tract
I
I lt
I
Tract Rank Tract
[
~~~-
I
~
IJilfimiddot ~
j
Ranking of VD Caea According to Census Tracts 61 By High and LOll Youth Itatio
A media~ of 34 5 was determined Any tract having greater
than 34 5~ of popu1tionunde~ 19 years of age -High~
Any tract having l8S than 345 of population under 19
years == Low
Any tract having rate less than 390 =Low
Any tract having rate more than 390 == HLgl4
YOUTH
LOW HIGH
L
0
12 402 1801 1802 343 2801 2802 29023603
54 6001 600262 66~02 72 74 75 76
78 79 81 t02 65 1202
W
(25)
VD
H
I
G
H
401 701 801802 901 902 10 1101 241 1201 1301 132 14 15 1601 1701 20~ 21 2202 2j02 2402 2502 2702 2901 303501 3502 34023801 3802 383 3902 42 44 45 4601 4602 47 48 49 SO 51~2 53 55 56 57 58 S9 6701 6702 73 95
3~02 7021702 19 25~01 2701 4102 4101 63 64601 ~601 6801 680270 7l 77 8001 80~02 8201 8202 83 84
85 86 87 88~ 90 91 9202 920193 94 9601 9602~ 9701 9102 9801 9802 99 100 101 103 10402 105 6501 10401
(47)
301 501 502 601 1602 2401 2301 2201 31 32 3301 3302 3401 3402~ 3602 3702 3901 400140 02 43 61 69 B(
(53) (23)
~ ~gt
Ranking of VD by Rate Per 100000 By Census Tract
~
Rank Tract Rank Tract Rank Tract Rank Tract llank Tract Rank Tract Rank Tract
1 2202 21 S6 40 902 58 1602 74 75
90-shy 64 107 26 --~-
2 3402 22 45 41 10 59 902 75 78 91 54 108 61
3 2301 23 3502 42 2502 60 602 76 6802 92 402 109 87
4 3302 24 49 43 1102 61 501 17 2 93 94 110 90
5 50 25 52 44 6702 62 14 78 8202 94 97 02 III 76
6 2201 26 20 6701 63 4002 8201 2501
9701 41~02 112 91
7 44 27 48 45 401 64 3802 2902 95 63 113 62
8 3301 28 1701 46 502 65 30 79 83 74 96 9602 114 71
9 55 29 47 47 42 66 3803 80 2801 96Q1 115 85 10
11
12
13
14
15
16
17
18
3401
53
2302
2401
57
21
2402
1101
51
30-shy31
32
33
34
35
36
37
3701 - -~ 1201
3702
89
43
132 131
3602
4001
48
49
50
51
52
53
54
55
58
1601
601
4602 4601
69
701
31
3901
67
68
69
70
71
72
2901
801
39021~ 802
6502 6501 122
702
41~01
81
82
83
84
85
86
87
88
19
1
1702
2802
79
93
100 6801 6602
81
97
98
99
100
101
102
103
104
9201 9202
9802 9801
77
302
79
86
72
84
116
117
118
119
120
121
3603
8002 8001
101
99
95
10401
105 10402 103 102
19
20
59
32
38
39
2702
3501
56
57
301
3801
73 1802 1801
89 6002 6001
105
106
2701
88
High Low
-- -----
Rank OrdermiddotTuberclosis Cases by Rate Per 100000 Ranked by Census Tract High to Low
Tract TractRankTractRank Rank TractRaukTractRankTractRank
801
79 9601501411 52 6835340120511 I 960269 903603532036 $-~~F130221542 4366 311301 70 68~013802 _ I- _ 4001_37213 3921201 6802802 H71523822024 22 54 193302 3802 80 8958 I37139535 70155 9801 I60123 72 6702 98023914011016 6701250124 10 56
81 94 401r 7 154152 73 7057 2625 122 92028
90242 162312301 92~158 86 7172434526509 82 79160159 74 100 87412240227220110 6502836960 75 30 8317244 6501782801285711 61 901 42765645 84 66021459294912 9701 660146 171 302 9702 47
6235023033113 85 822821182 917755 16335013110214 841814832 78 103 938564 324815 86 1057940149272 38036523216 10401 87 2902241 725Q 10402360266340217middot IF88 88 9937233 282 51 218 101 01102 46016234
I)167 2901460219 47
High ~ Low ~
- -
TractRank
9S89
6490
8191 8001 8002
63 61 60middot01 6002 44 2701
92
J
2502 402 --- ----shy
I
Rank
Rank Order Tuberculosis Cases by Rate per 100000
(Coutd)
Tract Rank Tract ~nk
I
Tract Ballk Tract Rank
Imiddot
Tract
Imiddot
1~
t 1I i Pi i l I
o
1 -1shyL I
I J
8 40 icO ~ I -lt 0
-t (1) I
i I
r o E
II
a
I
r--i
shy
I
~
I (
Jgt
(011 fi(
Ggt
I II ~j
()
(f 0
~ ()
I
11
f9
r
II 99
o ~
Ggt r
~ __-J~ I t I ~ I
r--J l I
~ _ __ J
) 1
fTl
1gt
r I
()
r
()
lt en -i en
()
I1l
(J)
(J)
-i
P ()
19
r o ~
r G1 I
I
c
~
o I 89
--- -I-shy
r-r I
1- 0 _~ _ _--J E
G1 I I I
i i
I 1-1-1 ~ _J ~2 ~ II
II
()
1 I I I 1
id i bullbull
~
A n 69
r 1shy
- 0 Gl
l--~ ~ I
~ II
II )
I () isect i
en l i
(J)
-t
0
IA Ol
w ~~
28
If prevent10n1s notmiddot stressed treatment serv1ces that
could have beenavoidedY1l~ be required If prevention
1s the sole focus of the health care facility sick
patients who present themselves must be referred elseshy
where for treatment andsllch referx-als may be taken as
reject1onsor not followed through with until illness
becomes unbearable
The instltutlontbat meets these requirements Is
the comprehensive neighborhood health center It 1s a
local decentralized outpatient facilityprOVld1ng a
fUll range of ambulatoJY health care services It has
a linkage to ahospitalbackUp facilityforlnpatient
treatment and hiihlY apclalized outpatient care
The neighborhood health center must be a fac11ity
planned with an awareness of the needs of the conSUtller
and coDitnUn1ty It must have the r~Ul0urces to provide the
services people need mere they can use them and when
they can use them It must uti11ze the part1cipation of
the community to develop this awareness Not only must
the cen~er beset up to be Amctional for the consumers
but efforts must bemadeaga1n with commun1ty partici shy
pation to help the consumers utilize medical care
services effectively The center muetmake efforts to
educate the community about the valueot regUlar health
care of preventive servicesand of the use of planned
IJ
29
medical appointments ratherthanorisis centered walk-
incare Therealit1es of the existing health care
system have not taught the patient particularly the low
income patienthow to use services effectively
The helthcenterilUst also bea laboratory for
experiments in easing the health caJepersonnel shortage
and c60rd1Datingcare~ A major difficultY iri-exper1shy
menting with neW rolesis freeing staff of old preconshy
ceptions
CoDlprehensiva neighborhood health dare centers have
been developed under a variety ot alisplces including
medicalsociet1es hoSP1talsmiddot(36p299 group pr~ct1ces
(29 p6- 12 117) health departments (13 p1027) and
ne1gbbothoodassoc1ations(14) The literature indicates
somevalues nthe management ot the health center by plusmnts
hospital backup faCility Whatever the auspices many
adm1nistrative fuDctions such as program coordination
standard pr9tectionand evaluation call for considerable
c~tralization of adm1nistration city-wide or coU)tyshy
wide At the same time other aspects hours of servlce
for examPle~ cuI f~radm1nistrative fUnctions made atmiddot
more local levels Each neighborhood center must be
free to adapt its functioning to itscominunity thi-ough
the mechanism otcODlllUl11~ participation inmiddot policy making
Obviouslythe prerogatives and responsibilities of each level must be negotiated and made explic1t
t4~
JJ
BIBLIOGRAPHY 30
1 American Rehabilitation Foundation ~ealth Services Research Center The Health Maintenance Strategy mimeo 1971
2 Anderson Nancy N Comprehensive Health Planning in the States A Study and Critical Analysis Institute for Interdisciplinary Studies American Rehab ilitation Foundation 1958
3 Andrus Len Hughes Comprehensive Health Planning Through Community Demonstration Health Projects mimeo1967
4 Barry Mildred CandCecil G Sheps A New Model for Community Health Planning unpublished paper presented to the American
Public Health Aseociation1967
5 Blum HenrikL Fred Wahl Genelle M Lemon Robert Jorulin and Glen W Kent The Multipurpose Worker and the Neighborhood Multiservice Center InitialImplications and EJeperiences of the Rodeo CommunityService CenterAmerican Journal of Public Health58 (Mar 168) pp 458-468 shy
6 Blum MichaelD and Soloman L Levy A Design for Service Delivery that Reinforces Constructive Tension Between a Health Center and Its (sic) ConSUDlers and Supports Community Power unpUblished paper presented to the American Public Health Asaociatiltn 1968
7 Brielaud Donald Comm~ity Advisory Boards and Maximum Feasible Participation American Journal of Public Health 61 (Feb 1971) pp 292-296 shy
8 Burns Eveline M Health Insurance Not If or When But What Kind Madison Wisco~sin University of WisconsinScllool of Soci~l Work 1971
9 Campbell John Working ~elationships Between Providers and Conshysumers in a Neighborhood Health CenterU American Journal2 Public Health 61 (Jan 1971) pp 97-103
10 Caxr Willene Neighborhood Health Centers Funded by the Office of Economic Opportunity mimeo 1970~
11 Colombo Theodore J Ernest W Sawardand Merwyn R Greenlick The Integration of an OEO Health Program into a Prepaid Comrehensive Group Practice Plan American Journal of Public Health 59 (April 1969) pp 641-650~ -
12 Comprehensive Neighborhood Health Services Projectof Kaiser FoundatioIl Hospital~ Prcgtgram YearE grant renewal proposal mimeo~1971 bull
13 CowenDavidL~ Denvers Neighborhood Health Program Public Health Reports 84 (Dec 1969) pp 1027-1031
IJ
14 De Diaz Sharon Daniel Beyond Rhetoric The NENA Health31 Center After One Year unpublished paper pres~rited to the American Public Health Association 1970
15middot Gerrie NorrrianF and RichardH~ Ferraro Organizing a Program for Dental Care in a Neighborhood Health Center Public Health Reports 8 (Aug 1968) pp 419-428
16 Gordon JeoffreyB~ The Politics of Community Medicine Projects A Conflict Analysis Medical Care 7 (Nov -Dec 1969) pp 419-428 shy
17 Greely David The Neighborhood Health Center Program and Its Implication(3 for Medical Care H~alth Forum of the Welfare Council of Metropolitan Chicago (mimeo) 1967
18 Greenlick Merwyn R Newgtimensions in Health Care American JOurnal of Pharmacentical Education 34 (Dec 1970) pp 754-4
19 GreenlickMerwyn R Donald K Freeborn TheodoreJbull Colombo Jeffrey Abull Pruesin and Erne$t W saw~d Comparing the
Use of Medical Care Services by a Medically Indigent and a General MemberShip Population in a Comprehensive Prepaid Group Practice Prosram II unpublished paper presented to the AmericanPublic Aesociation1970
20 H~tadoArJiloldVMerllYll RGreenlick and TheodoreJ Colombo Determinants of Medical Care Utilization Failure to Keep Appointments unpublished paper presented to the American Public Health Association 1971
21 Johnson Richard E and Merwyn R Greenlick Comprehensive Medical Care A Problem and Cballengeto Pharmacy ff AJilericanJournal of PbarmacenticalEducation 33 (Aug 1969) pp 361-367 -
22 Kahn Alfred J Studiee Social Policy and Planning New York Russell Sage Foundation 1969
23 Kotler Milton Neyhborhood Government Local Foundations 2 Political~New York The BobbsMerrill Company 1969
24 NationalCommisaion on CommunityHealthSfrvic~sActionPlanniriamp for Community SetithServices~ashington p C Public Affairs-Press 19t7
25 National Commission on C~mmunity Health Services Health Adminishysration andOrMPization l the Decade Ali9$-d Washington D C Public Affairs Press 1967
26 NationalCornmiesion onqomm1Jllity Health Servicesbull Health ~ Facilities Washington D C PUblic Affairs Press 1967 bull
~ n
32 27 ODonnell Edward J and Marilyn M Sullivan ServiceDelivery
and Social Action Through the Neighborhood Center A Review of Research tt Welfare ~ Review 7 (Nov~Dec 1969) pp 112
28 Office of Economic Opportunity Second Annual Report Washington D C~ U S Government Printing Office 1966
29 Office of EConomic Opportunity and the Medical Foundation of Be~laire Ohio Eighth Report 2l ~ Committee2a Governshy
ment OperatiOll~ Va8hiiiSton D C Government Printing Office 1969
30 Pope Clyde R Samuel S Yoshioka and Merwyn R Greenlick Determinants of Medical Care Utilization nhe Use of the Telephone for ReportiDg Symptons Journal of Health and SocialBebavior12 (June 1971) pp155-162 shy
31 RenthalA Gerald nComprehensive Health Centers in Large US Cities American Journal of Public Health 61 (Feb 1971) pp 324-336 shy
32 Saward Ernest W The Relevance of Prepaid Group Practice to the Effective Delivery ofHealthServicestt The New Physician 18 (Jan 1969) pp39-44 - shy
33bull Schorr Lisbeth Bamberger and Joseph T English Background Content and Significant IssUes in Neighborhood Health
Center Programs Milbank Memorial ~ Quarterly 46 July 1968) part 1pp 289-296
34 Weiss James E and Merwyn RGreenlick UDeterminants of MedioalCareUtilization The Effects of Social Class and Distance on Contacts With the Medical Care System Medical~ 8 (Nov-Dec 1970 pp 456-462
35 Weiss James E MerwynR Greenlick and Joseph F Jones Determinants of Medical Care Utilization The Impact of Ecological Factorstt unpublished paper presented to the American Public Health Association 1970
36 Wise Harold B Montefiore Hospital Neighborhood Medical Demonstration A Case StudyMilbaDkMemorial Fund Quarterly46 (July 1968) part 1 pp297-308~
37 Yerby Alonzo S ttHealth Departments Hospital and Health Services Medica1~5 (March-April 1967) pp 70-74
38 Young M M~ Chatanooga IS Experience with Reorganization fOr Delivery of Health Services ttAmerican Journ8l of Public Health60 (Sept 1970) pp 1739-1748
f or l
II bull 11 Y d
II
IJ
34
ThepurposeOfPart II of th1aa paper1atod1scuas
elected Speclfic needs ofecltlc areas within Multnomah
County A8P01ll~oUt 1D ~ I of t1a1bullpapermiddot Ita nelgbshy
borhood health oare cater IlU8t be a facl1lty plaDlled with
aD awarenes of the neeels of the oODllUller and collllUDity
Part II of this paper nIl Show 80e of thoe speclflc
needs
he1DforutiOD tor t1li Portlon of the report
obta1nec1 troll tbroupout tbe follow1Dl threepUb11catloDS
1gr~e_tiMshylIPrIxaiidOreson JuDe 1963
2 1~_middot_sectSI8e~ected1teai c-ua 0 S 8 e first count coaputer tape Coluab a_lion AssocshylatloD of QoveraMD-8 Jlme 1971
3 Jtu1tDoab County Oreaon BDY1roDlHtlltal SurveyEarly 1971
The JIultDOIIIlb COUDty OrttIOD BDv1roDllfmtal Surley
Barly 1971 1s bull stat1stical report of the activ1tles of
theentlreMultDOIIIl2 CcNDty Health Dep~t during the
year of 1970 Die speclflc 1nd1cs elected from tb1s
study amprejMental aealtll Publlc Health N~s1D1 vlslts
FaJUly ~ Veaereal])1 ~ ~rcul081
Throush tie use of cUrts and mapa ODe CaD roup these i
speclflc ~oea to ahcnr the healthneedsof speclfic I
census trtcta aD4 then the health needs of iarer neIghshy
borhooda 1m4 o~ Uebullbull
Rf)~UP1Dl of areu was accompllshed in thefolloWinl I
JJ ~
35
he MiltDoIliahCountY oregon BDViromaental SUrvey
early 1971 isamp statistical report ot tbeaotivities ot
the entire MultDolllh COUDty Health ])epartiDent dur1nl the
year ot1970 he specitic 1Dd1C8S selected frOm this
aUy are 1Il8Dtal health public healthDurs8s visits
fUl1ly pia waereal elisease aDd tuberculosia
Tbroq11the Wle otcbart aDd mapa aDecm szoup these
specific indic to show the health Deeds ofapecitic
ccmaua tracts aDdtIum th8health neecla of larsr ~eilh-
bOrhooda and co8I13 tlbullbullbull
RegroupiDI ot areas waa accoap118hed1D the
tollOWiDl lIIIIm1er~ A bullbullcifie 1ndex 8selectcl auch as
venereal di8bullbulle or tuberculo8i~ he total number ot
cs was then deterll1ne4 for each census tract Through
the use of the maber ot cRbullbullbull tor a 11Yen cenaus tract
aDd tbe population ot thattractaltrateot1lla1ampmcper
100OOOpopUlaticm wu cleteXll1ned for each census tract
This was ~e to starl4ard1ze the population ditterence
amongOeD8U8 -tracts 1he rate of incidence toreaob
cenauatract was then llstedby rank position on a chart
In rank poition1DI any cen8Wl tracts haviDg equal
rates ot1l1c1dence are assipe4tbe iaDk posttiona
Beeauseot the abo fact tbAt cbarta w111 vary in length
neveltbAtlea eacb cbart will 1Dclu4eall census tracts
inMullnoaah Couaty Atter the census tracts bave been
listed accord1q to raalcth1s list will bediv1ded into
IJ
36 three levelsotinc14ence he three levels are
1~ The upper 14 of1DcldenCe
2 Thelower 14 ot incidence
middot3 The ILld 12 of incidence
Tlles three srouplqa are then used in compiling a map ~f
Mu1tnOmahCountyfor ach apecltictop1cbull TIle maps are
uaefuJliD tbatthey V1suallycoJib1De 1Dd1v1Clualproblem
census tracts into larger problem nellhbOrhooc1s
The 1960 statistical iDtormatloD was Used in a similar
liIaDDr to tbatexpla1Dedabove 1Dthe4evelopaent of a
chartmiddot and map 1Ihow1DI e cOllpampriSOr1 of per capita lncolle
tor ttaCh ceDsua tJact aDdmiddot combiDed census middotmiddottract areas
he 1910 aDd 1960 statlstlcal iDtOrllatl0D was combined
lna map and chart he purpose of this and chart is
to d8aonatrate the e cl1stributloa1DeachceD8U8 tract
and middot1ndlcatbull tuture ace populatlon treD4a bull
When one be middotbullbullbullbullbullHdth ne8cts ot an area and has
declded to establlsh a cl1D1c to serve that area the
physical location otthat cl1D1c IllU8t be consldered In
order to coapreb8ll81vel develop an area cl1n1c one should
conslder thepre88Dttraftlc middot~ytaa an4tranaportatlon
systems Thecl1D1cahoUld be located close enoUlh to
major arterlals to giva asy access from the total area
be_ ervecl by this cliD1c At the t1ll8they should
be tar eo away froll thesarterlals to all8Y1ate traffic
CODCell18 andpark1D8 conpstlon By traff1c concerns I
IJ
37
lIlan one lUSt consider thertarro1fne8S of streets whether
streets are oD8--C)r two-way iqres8 and egress to parking
amp0111tie eros tratflC) spedof trattJQ children 1n
ll8a traffic i1lht Vislon re8tr1ctionS etc
BwstraDsportat1onshould alao be central in this area
as maay people ~U f1Df1 1tD8Cessary to use this form of
transportatlon
~e tutqredlopHQt of bull treewa systems should be
c0J1S1dered soastolesen thecumce ofmiddot future roada
cutt1DSotltbe cl1D1c llte line
nrrph1c middotDampta
It is 1JDportaDtto kDOw the demosraphic distribution
characteristics of the oUenteltbat i8 to be served by
localized health cl1D1cs
Acl1D1c which erves8J1 area where1D the prepondershy
ance of persona arecrter 65 years of mayf1nd that these
people rely more on pUblic transportation call for more
home- services and haV4t 110ft ChroD1c and debilitating
types of disorders (b1_ blood pressure poor heariDg and
eyesight) tbaD do8 an area ot a YOUDIer population On
the other hand thL area of older residents may have little
need for family plabDlng cllni08
In order to better ~Ybullbull the 4eaoraphic population
of each CeD8U8 tract the 1970 CeD8U8 iatormation was viewed
and two specific catelOri8 considered These two cat
IJ
38
lori8S woUld be the perc_tap ot population under 19
year of ase and the percentase ot each oensuetractover
65 years of age he 1960 1Dtormatlon tor eaCh tract was
then compared witbthe 1970 intormation and a percentage
ofincreaae or4ecreamp8 tormiddot e~chtract1n each category
cOJlputecland achartma4e By the use of this chart one
18 able to View tJleap populat1odiatr1but10n of census
tract and at the _ t1lle accesa middottrencl Por example
let us choose census tract 601 W see 40-4 otthe
population is under 19 years ot and that ODly82 1s
over 65 years ot middotAtthe e tille the percentage of
youth bas ~ed ODly 1_ intbe laSt teD year whilethe
percentale over 65 year ot middotbas stayedmiddotthe same With
this in mJnc1 ODe ~ 1DfItr libat ol1D1o aerviDg this
area WOuld bellQre conq~w1th the problems of a
YOUQier populat1on and that _ would probably be true foJ
some t1aein tbefuture On the other hand CeDSU8 tract 54
has only 2 ollt population UDder 19 yel1s ot age and
this has decreased by 1 over the last ten years middotwhile at
the same time 32-377 ot the populat1on 18 over 65 years of
age A ol1D1C ___ this area should be or1eJ1ted toward
tbespecttic problema otthe ampledbull
PerCapia __ bY gsa neat
WhaD cona1der1qlooat10D1 tor health cl1n1cs one
shoUld take the 1DC01Ieot areas into consideration Areas
IJ
39
of lowiDcome would not 11kel~be 8erved more by localized
cl1D1cs tbaD would are of hilbincome It 18 likely
people haYiq a hip iDeoll8would preter to be aeenby a
chosen ~r1vatephylc1a1l tban at a local cl1D1cwhere
10Dier waits y beraceaaampryand leas personal attention
gl_
The 19701ncOII81atoWampt10n tor MultnomahC~ty was
not available at the tille thi8report W88 made The 1Dto~shy
tiOD Was taken ~adtro tbe1960 census publlcation
his woUld ~8Il thea tbat ral1I8 OD the chart ynot 1raquoe
completely accurate hi writer telthatthe areas most
affected by tb8 1I8eof the older 1Dco1DtOlaat1oDWOuld be
those tracts wh1ch baYebad a rapid 1ncreaae1n populatlon
over the past tfmyHr8 bullbullbull tracts would include tracts
nUmbered 104 9897 96 aDd 95 be perc~ita 1Dcome
referredto1il-tb1a Paper18the lIean 1DCo per person per
census tract
Attar the iDeoeper census tract was listed on a chart
a map was de 1D41catiDg those census tracts belonging to
the lower 14 ot income tor all censue tracts in Multnomah
COlDltytbose beloqins to the upper 14 ot income tor all
census tract 111 MultnolUlhCounty and those belonging to
the mid 12 ot 1I1coaetor all oeuuetracts in Multnomah
C01mty
In yiew1Dg the _p 1t caa be seen that the low income
area seautotollow aloas the at aide ot the Wl1lamette
IJ
40
R1ver the full length of Kultnomah County A second low
income area follows the south edge of the Columbia from
the northwest corner of Multnomah County easterly to 148 St
A third problem area seems to be on the east bank of the
Willamette River with the Union Pacific Railroad being
about the center of this tract The extreme loutheast
corner of Multnomah COUDty appears to be a low income area
but as this area bas bad rapid grouth in the last ten years
this could be erroneous
Mental Health
be first ~ecific indica to be selected from the
Multnomah County envirollllental survey of early 1971 and
to be considered in this paper i8 that of Mental Health
At the present for mental health purposes Multnomah
County is divided into five catchmentareas with a mental
health cl1n1cin each area These clinics are Model
Citles Delaunay ADkeny street Office Hansen Health
Building end Southeast Clinic
All lIlental health cl1n1cslcept statlstlcal information
on all patients visiting their cl1n1cs this included the
address of the patient hese addresses were then listed
upon the approprlate C8D8US tract Each census tract was
then ranked on a chart according to the nUllber of mental
health patients who reslde ln thatCeDSUS tract attending
any of the above listed ental health clinics This chart
IJ
41
wasttum d1v14ed1ato proper quartile bbullbullbull
quartile vereUs to dne10 u appropl1ate Multnoh
County _tal health ItLa middotmiddotmiddotthelipO~a1bl by lOoJcJIUE
at the UDtal health _to uteN1De which ueu have the
lars-t use otCOllDty 1alh~th faci11t1Rot
1Ilclu4ecl 111 tbia woUld tber otpeopleYia1t1Da
pr1vat patch1atriata aDd pr1_t _ntalhealtb cl1D1c8
WheDtbe M1 18Yienclmiddot Itmiddotmiddotmiddotmiddot~middotbe~_ tbat ~rtt
appears to lMt fourmiddotmiddot-al are iii _oil the nuaber ot
lIental healthcl1D1c na1t toM tbjh1sheat 1he
tour areaa woUld be tollows
1ttrea Ore to~Blo Drimiddot ~tb Burrus14e aDd tIMtmiddot Colb1a Riftr H1gbwyaeri1Dla th nortllra boundaryshy
2 bull ProII 82D4 1_~ 10 20th streetwitil the ra1lMd Mu the north ltouadary
3 ~ et et tUgl_b1bull MYel froamiddot the Clackaaa COUDty l1ae aorth to Dln8lon stret
4 beDOlvt1ttfe-t ~efllt4 COatytrca Jle1aware streetmiddot toR1C1a11oDd wlth Colubla Blvd heiDI tbAtnorth bouaclary_
It ODe coapareatbiap to th iDeobullbullmiddotp 1t can be
eamiddotthat lIOat ot the c tracts baY1Dg bllh v1i11tatlcma
middottfl public tal health cJ1rUc8 ~ 111 t13e low ~ aid
1DcOile SroupiDIOJa1y of til 25 tracta llsted as
haviDlbip aental Maltll nlltatlou are ~ the1g60 hip
iDeo arebullbullbull
17 Plpn
42
amily PlellnSDI ]Jlce Metal Health i8 an 1nd1ce of
use Theperson 111 ordertobavebe_ 1Dcluclecl 1n this
atu4ywouldhave tohaft Ue4 ataa11y plaDI cl1D1c
tacilities of soaetype It 41fter troll tile _tal health
study1nthat i t1Jicludestatist1catrollbotb public and
privateclJD1os
The iDformation tor the iak orurcbart 8Dd map of
t8ll111 plenn1 na ob1a1De4 by cOIIblnlDlthe mabel of
1rlcuv1duals bullbull_ attbe tbreellUltrampo-ti Coatyhll11y
PlalJQllIl C11ll10s 111til tbo at the Planned PareDthood
Association CliD1C8 be tbree -JIultDouh Couaty r8ldly
PlamSq Cl1D1c are Solrtbweatth Col_bla 1111- a114
HaDsell Health BWlcl1Dl CllD1cbi middot1Dtormat1oD vas then
bullbullbullesed tomiddot detellWMt l10w people troll eacb c8IUIUS
chart wastben Mele IUs oIIart jn 4iY1ded to show
the censuS tracts lIaYiDlmiddottIle h1t1iest qUart1le of incidence
of use lowest quartile of 1Qc1deao ot use Jlid 12 of
incidence of Wle an4 a map sprepared troll thts 1Dto~
mation
The C8U118 tractsbelOJISnl to the h1lhestquartile of
use appear to be 1lO~ 8catt~ on tbipwas true ot
either the _p ot aental health cl1D1c uaageor ot the map
abow1DI per capita 1I1COM Iaere40 to be three
d18t1nct areas of UIIaP beJ woul4 be
1
IJ
43
t10D of BurD81cl and the W11lallette River 4
2 S~t Portland 8Otth otmiddot the ra11shyrcaadand alona the W11lamette River
lIortbeaat Portl8D4 between MisSiss1pp1 and 24tbStreet the northbouBclary be1DgColwb1aBlvd
Pylzl1c BMltl IrpI Y11ta
Publlc Healtil nur81D1Y1s1t nclud8 an vists to
theholles of client by PubUc Health Nurbullbullbullbull his shows
visits to bull f8Jl1ly fer aDY purpos SUCh aatuberculolJ1s
het1Dl tem1tyaeatalu4 8IiOt10D8l cODd1t1ona etc
he atat18t1C~ 1fele C()4ed accord1Dg tomiddot the 1llli301fOCUS
of the Y18lt tt doe DOt 1D41cate the Dmlber of holies or
f8ll11lev181tecl or 1D41Y14ual Y1a1ted more tban oDcein
the propwl It dobullbull I1ve 80M 1D41cat1on by coaparlshy
OD ot the 8JIoUDt of aedlcal problema 1n eachcen8WI tract
Ap1nmiddot the _p abowa 8 scatter patteraof probl_
areas althoUSh there appear to be a sroup1Dl of hiSh J
l8aIeccmaus tract 1ntlut extreme southeast part of tbe
County other areu uIriaI any nura1Dl contacts are
1 bull he 801lth-oa-al CO1Dty on eaCh 814 of 82nd Av from Clackallaa County north to Dinloa
2 ear bullbullbullt 814e aroUDd Preacottand Misaisippi
Dowatom Bunul14eonboth 1de of the river
44
V_real Pis The iDfomatloil uaec1 to tabulate the Venereal
disease chart includes all the ooab1ned case otmiddotODormea
and syphilIs reported by bothmiddot publIc and prIvate physicIans
dur1nl 1970 There were 3602 caes ot IOnorrhea reported
dur1nl 1970 While ODly 17 cabullbullsot ayphilimiddot were reported
A chart was prepUed aDd att8llPt wasmiddotmiddot de tomiddot
determ1De Wh_therVttDereal 41ease was more p~vaJent in
areas othigb or lowmiddot proportIon ot youth hi waadone
bymiddotdetemlna a 1leaD prceiltacmiddotmiddotmiddottor the population ot
resld~ts UDder19 years ot (34) middotA mean ratemiddot per
100000 popUlatIon al80c1ttem1Ded tor the middotoccurreDCe
ot venereal dieae This was et at 390 oass Areas
hav1nl a population 1n which leiS than 34 were lmder 19
years ot ampIe were called low- yOuth abOve tbl percentaae
hiSh youth The aaa waatrue ot the occurrence oivenershy
eal disea_ per CeD8UStract It the rate waacomputed
as 1I0re than 390 cases per 100000 it was called hiah
venerealdiaeasei it less than thia tisure low venereal
disease It was tound that 1D Multn~ COmlty there sems
to be poSitive OOlatI0n(x21S19gt between low youth
and hipmiddot venereal diseaand hip youth and low venereal
diseasebull
RaDk ordr Iitot all c traot middottbAm made
Th1s was done byt1Ddlna the ratepr 100000 populatIon
of venereal disator all census tracts in the County bull
45
These were thenlisted from h1lhto low (sreatest to
least) in a rank order The l1sting was then divided
into Upperandlower 14 aDd listed on the MUltnomah
Countymiddot up
The areas of b1gh venereal disease se8ll18to
roup thBl~8 middotin a very tllht area ~oq both 1des
of thell18l8~ R1 w1th BurDaldeS~et being
~bout theceDter qf tbi8IZ9uping This area woUld
appear to be m ldeal spot for the denlopment of a
locallzed venereal d1sbullbullbullbull cl1D1c
UbepoundCUlO1s
In this report bull tube1C1llosls caS8S refrred
to include alltbobullbull cabullbulls ontubercUlo8is follow-up
rather middotthan just new C Accord1Ds to the Multnomah
County Health SUrvey of early 1971 this would include
all ca repOrte4 over thelaat three years The
total number of tuberculosi8 cabullbullbull usedin this study
was 666 lh1 included 128 new cabullbullbullbull
A rate per 100000 of tuberculosis for each
census tract wa- then computed and the c~us tracts
listed by rank order be b11h Qartlle mel low
quartl1 were then reoordd on a Multnomah CoUnty map
TWo genral areaa baY1Dg a hip mcldencaot tubercu~
losiare 1D41cated heyare
1 Both middotsld ot theWilla11lette River
Ll -
46
with Burns1de about thecnter
2 he extrea Northebullbullt comer of the County bull
By coap8r1ng the tuberculois an4ven8real
diseae maps ODe can 8ee that the downtown areas ot
hiSh 1nc1denceare alIIo8t 1c1eDt1cal on ach map
This WOuld 1nd1cate that 1t would be of value to
bullbulltab11sh acl1D1c 111 th1aampreatbat would provide
bothtuberCulos1s 8Dd ytmereal 418ase srvicbullbullbull
Thchart aDd 1181gt8 are wsfuln 11v1DI
1Ddicat10DS tor the type aDd placemeototlocal
health cl1n1c8 tbro1qhout tbe MultnomahCounty area
A cOllpar1on of the mapa help one to dec1dewhether
to provide a aulti-8ervice cl1D1c or spec1f1c type of
cliD1c As stated in Part I of thi paprserv1ces
shouldhaYe both treatlieDt and prfMmt10n cOmponents
As he been stated fta ne1lbborhood health care
Qenter muat be a fac111tY plazme4 with an aamesa
ot the neds of the consumer and the c01llll1m1tybull
Part II of this rport haa been an attaapt to indicate
and clarify 8011 ottheae coDlllUDity neds This has
been done through8elect10n of apc1f1c problems
The indic were then visuallyrecorded through the
use of ups and charta ODe dan asseS8 thedsreeof
1DIportance of certain concems to spec~t1c areaa by
comparinl the chart aDd maps Prom this oDeean
41 dec1de which are48 vb1chcUD1c-or indeed if
the need a clinic at all However further factors
should be considered hebullbull include
a The amount of fuDd1 available
b What 18 the percentage ot peopleineoh ceaaua tract tbat would actually us such cl1n1cIl
c Wbat 1 tbeco--1tymiddot 8 IeeliDashyreaardtDI particular cl1D1c8 Would this dcrebullbullbullmiddot the ettctiveness ot thse cl1n1ca
IJ
li
D_OlraphicPopulatLon Challie 1960 to 1970 48
Cen8U8 1 of Pop 1 Cbaqemiddot 1 Change1 ofPopTract Under 19 Yr8 Over 65 Yrs1960-70 1960-70
middot1Q701Q70
1 319 -12 171 -H) 1
2722 215-27 +68 301 366 -22 127 +35 302 371 +19 111 -04
311middot401 144-41 +29 402 321 13~7-39 +24 501 356 124-08 -02 5~O2 351 133-23 +12
405601 82-10 -02 394602 103-01 -06
701 275 149-76 +56 702 361 +01 121 -07
+10middot801 326 140-22 802 321 middot127
(
-29 -03 9~01 342 124 -H) 6-18 902 294 128 -H) 3-24
10middotmiddot -14312 140 -17 1101 182 +25 -23197
2411102 186-59 +29 1201 226 169-17 -41
31middot01202 +11 182 -05 295 -H) 81301 208 -H) 4
1302 331 +08 197 +04
14 323 +15 middot185 -08 middotmiddot15 329 +16 16~5 -13
-28middot 1601 332 131 +12
1602 356 98 +24middot-39 middot3101701 161-33 +21
1702 370 -15 85 +02 +19 1801 264 151middot-50
185middot1802 256 +47-58
IJ ~
D_raphlc Population Change 1960 to 1970middot 49 (Contd)
4io
Census Tract
of pop Uncter 19 Yra
1Q1n
1Cha1l8e 1960-70
of PopOver 65 Yra
lQO Change
1960-70
19 389 +29 141 -24 20 223 -13 206 +18
21 227 +08 194 -36 2201 356 -27 112 +05
2202 290 -18 ll~9 -29 2301 356 -03 154 +24 2302 260 -37 245 +97
2401 410 +6~1 123 -31 2402 163 -80 320 +99 2501 381 +13 140 -01 25()2 237 31 lil +02 26 343 +25 186 +149 2701 370 +29 1S5 -01 2702 249 -44 304 +98 2801 337 +19 187 +09 2802 306 -10 156 +31 2901 304 -38 142 +24 2902 i 307 -32 146 t3~9
30 29~0 -48 16~2 +51
31 355 +30 160 +01 32 370 +48 148 -13 3301 395 +45 130 -20 3302 368 +06 138 -02 3401 386 +16 117 000
3402
400 +32 92 -26 3501 304 -07 115 +35
3502 344 000 140 -13
3601
36~02 357 -04 132 +32
3603 30~1 42 149 -67 3701 342 +28 152 +19
1
IJ
Jianolraphic Population Chan 1960 to 1970 50 (Contd)
Census Tract
of Pop Under 19 Yrs
JJl7J
middotChanae 1960-70
middotofmiddotpop Over 65 Yrs
1c~7n
Change 196070
3702 409 +39 122 -11 3801 308 -11 151 +29 3802 275 -35 180 +46 3803 282 -32 192 +54 3901 376 ~13 100 +17 3902 296 -03 177 +29 4001 438 -11 84 +13 4002 353 -21 115 +20
4101 397 11 9middot0 +11 4102 346 -19 120 +03 42 331 +19 11 bull 3 -16 43 347 -72 105 +31 44 113 +84 183 +154 4S 33~9 +07 110 -06 4601 2501 22 193 +38 4602 332 +59 126 -29 47middot 161middot 000 211 +01 48 103 -26 302 +59 49 138 +1 bull 3 252 +09 50 141 -26 204 -12 51 12 -39 257 +07 52 47 -61 351 +48 53 89 +49 314 -30 54 25 l1li15 327 -17 55 131 -17 115 -121 56 198 +93 227 -47 57 71 102 189 -88 58 240 ~middot41 16~1 +55 59 322 +25 142 +06middot 6001 264 95 132 +50
6002 328 -31middot 89 +07
JJ
Demographic Population Change 1960 to 1970 51 (Contd)
Census 1 ofPop lChange of Pop bull ChangeTract Under 19 Yrbullbull 1960-70 Over 65 Yrs 1960-70
1970 1970
61 355 -58 85 +39
62 328 39 110 +18
63 414 04 73 10
64 382 -22 72 +04
6501 383 02 67 -20
6502 329 -56 96 +09
6601 391 +13 88 -03
6602 319 -59 97 +06
6701 327 71 145 +72
6702 331 ~67 83 +1-0
6801 365 -66 49 +01
6802 388 4bull3 54 +06
69 354 -41 80 +23
70 400 -23 68 -06
71 359 -48 72 +05
72 255 -88 82 +11
73 346 -39 91 +25
74 313middot -63 105 +24
75 329 -42 129 +37
76 336 -52 85 +21
77 370 -10 69 +05
78 309 -10 120 +21
79 325 -56 87 +10
8001 358 -81 57 +12
8002 391 ~81 76 +12
81 315 -76 108 +21
8201 403 -23 64 +08
8202 392 23 65 +08
83 357 -34 120 +31
84 402 -18 73 +16
85 413 -06 76 -09
r
Demographic Population Change 1960 to 1970 52 (Contd)
Census Tract
t of Pop Uncler 19 Yrs
1970
Change 1960-70
1 of Pop OVer 65 Yrs
1970
ex Change 196070
86
87
88
89
90
91 9201
9202
93
94
95
9601
9602
9701
9702
9801
9802
99
100 I
101
102
103
10401
10402
lOS
368
351
379
391
391
413
379
433
372
429
414
432
419
439
~32
377
457 420
378 41middot7
345
360 417
417
412
-04
-02
-35
-26
-28
-11
-64
-20
-S9
-39
-32
-21
-34
-40
-47
-lO~7middot
-27middot +04
+56
+07
-34 01
+04
+04
+10
103
128
97
11il3 99
69
79
42
77
46
34 38
44
40
54
111
51middot
81
133
59
74
140
63
87
76
-08
-06
+04
+08
+17
-05
+3S -02
+1~4
+19
+33
-14
-08
+12
+26
+71
+11
-16 -34
-20
-19 +37
-49
-2S +15
NOte The The
Taken frOi
averageullder averageabove
middotUSCensus ---shy -
19 years == 6S years ==
figures 197
32r 13(14
p a~d 1960
--
Rank
1
2
3
4
5
6
7
8
9
10
11 12 -_
13
14
15
16
17
18
Tract
69 46
60
58
- 68
61
302
2501
67
63
19
62
26
94
3603
3902
64
30 -----~-
Rank
19
20
21 -
22
23-shy
24
25
26
27
28
29
30
31
32
33
34
35
36 -
Ranking of Per Capita Income by Census Tract
Tract
65
2701
- 15
1601
701
66
93
82
2903
3602
30
2502
80
2401
81
- 70
91 shy
4001
High
Rank Tractshy
-32shy37
38 97
120239
7840
41 ~ _2_1__ 42 31
43 2501
44 18
45 98
46 37
47 3803
1702
49
48
1602 92 2702
I
50 89
51 901
52 801
Ra_
53
54
55
56
57
58
59
60
61
62
63
64
6S
66
67
68
TractTract Ra~
74692
170196 70 I
401 71 90
72 1037J
79 70273
3802 74 601
24024102 75
85 76 101
77 9023901
7699 78 100 4101 79
3601 I
380180
458140~ t---- _ - - shy83 82 42
888384
59843501
4777 8~
502
Low
802 86
Rank Tract
87 shy
--88
89
90
91
92
93
94
- 95
96
97
middot98
99
100
101
102
103
104
1201
14
49
72
73
43
87
3502
105
1
52
86
71
1
501
10
3301
104 tf
Rank
105
106
107
108
109
110
III
112
113
114
115
116
117
118
119
120
121
Ranking of Per Capitalucoae by Census Tract
(Contd)
Tract Rank
4001 122--shy602
13
1102 2302
3302
55
3401
48
21
56
50
3402
lL01
2202
2301
53
2201
-shy
Tract Rank Tract Rank T~aet Rank
57 I-----
Imiddote
bull
Tract
- Low -k Note Information taken from 1960 U SCensus
Rank Tract
I ~
Ie
Imiddot
~
----
----
--
--
Rank
1
2
3
4
5
6
1
8
9
10
11
i-
-Tract
391 922 921
972 971
100
132 131 121
962 961
822 821 401
982 981
20 111
47 10 1
412
High
Total Number of Henta1 Health Visits
Ranked by Census Tract High to Low
TractTract RankTractRank Rnk
12 182 22 78 29 87 76 381 73181 ~------- 1913 371 8538230162372 271 2616-121 8272 2
14 80~2 31 94 7923 84801 59 15251362 4232 15 52 _ 32 103 8924 651 17240216 652
_ 91 351 33 341 23117 83 122 25 25 48 1123921418 34 shy61 86 661
19 662 6493 81 26 91 8153 49 50 55 41383 71 27 51 3120 90 672241 35shy 104167162 461
I 411 46211121 28 88342 I
2502 36 69 54 5251 50 272
-Ra
37
38
39
_ 40
_ 41 Ishy
I
42 I
-I 43 44
45
shy
Tract
~ --- shy 95 56
45 292 242
102 62 352 291y
92
101 281
99 72 63 601 60~ 42 2201
77 74 61 57
363 232
70
32 31
11 44 282 2202
Low l
- Tract
46 682 681 I 331 30
r~$ 47 1042 332
48 102_41_
11
~
Visits to Family Planning Clinics Ranked by Census Tract High to Low
Rank Tract Rank Tract Rankmiddot Tract Rank Tract Rank Tract Rank Tract
1
2
3
4
5
6
7
8
9
10
11
12
13middot
14
15
16
17
361
56
401
341
48
59 121
20
55
342
10
31
58
93 21
241 132
331
53
461 462
18
19
20-shy21
22
23
24
25
26
27middot
28
29
30
31
32
33
391
32
middot47 I-i-_-shy _ -
231 111
332
972 1
372 371
52
89
32
92
82
100 31
182
30 242
402
34
35
36
37
38
39
40
41
42
43
44
45
42
1714 i 661 221
78 362 2
90 602 601 352
63 251
105 921
971 351
73 42 292 232
411 51
662
81 45 52
46
47
48
49shy
50
51
52
53
54
55
56
961
801
49 81 72 71
19
9~1
172
68 2 57 162 14 112
91 75 681
381 42
3~3
83 161
57 f
58
59
60
61shy
62 Imiddot
63
Imiddot 64
65
66
64 62 36~3 252
74 652 SO 392 291
651 6bull 2
79 271
r-- ---- shy981 222
672 671
821 272
94 87
281
382
67
68
69
70
71
72
73
74
75
76
77
78
981 26 12~2
IS 61
85 82~2 69
61 43
101 86 84 282
76
131
51 72
1041 962 88 70
99 922 77
103
95 802 181
i
~
Low High
RankRank Tract
5479
4480
81 1042 ~) middot102
71 - - + ~ - ~
Visits to Family Planning Clinics
(Contd)
Tract Rank
I
Tract llaDk l
RankTract Tract Rank Tract
~
I
~
J1 ~
Low
Total Number of public Health Nursing Visits
Ranked by Census TractsHigh to Low
TractTract RankTractRank RankRank TractTractRankTractRank
25249 71 79 17249 8033 6586 99189711 84 2915072 34 661 76 66 811519512
402 5035 51 161 2518220 122 1713423 352 55801 7120 6752 2 149814 41236 83 2662 38 94 6821 53 2924015 362 37 32 42 75 69 281 84 63
546 8822 54 222 85 3925431 70383417 3818223 6439 4386652 718 21 55 103332 8924 232 87 19 271729219619 24156 16211140 382 628825 10523110 112 73411 10141-- ----shy 89 363 4457 8126 16111 221 74 9142 90 46158331 53 671279012 46243 48 59 351 3837528 1083 9313 91 5844 59 -_242 76 1----- shy60 272 72 74104114 60145 42 9287 7729 92 6151 8215 57371 934630 91 307762 12113116 282 619447 41391 9531 78100 63 7378 ~95 681 6945 32 5632 798517 6448 47 52 181
High ~ Low
Rank Tract Rank
96 31 132 70
97 102
98 182 372middot 602 651 662
- -shy
~72 682 802
822 922 962 972 982
1042 ----shy
Low
Total Number of Public Health Nursing Visits
(Contd)
Rank Rank Rank TractTract Tract
I
I lt
I
Tract Rank Tract
[
~~~-
I
~
IJilfimiddot ~
j
Ranking of VD Caea According to Census Tracts 61 By High and LOll Youth Itatio
A media~ of 34 5 was determined Any tract having greater
than 34 5~ of popu1tionunde~ 19 years of age -High~
Any tract having l8S than 345 of population under 19
years == Low
Any tract having rate less than 390 =Low
Any tract having rate more than 390 == HLgl4
YOUTH
LOW HIGH
L
0
12 402 1801 1802 343 2801 2802 29023603
54 6001 600262 66~02 72 74 75 76
78 79 81 t02 65 1202
W
(25)
VD
H
I
G
H
401 701 801802 901 902 10 1101 241 1201 1301 132 14 15 1601 1701 20~ 21 2202 2j02 2402 2502 2702 2901 303501 3502 34023801 3802 383 3902 42 44 45 4601 4602 47 48 49 SO 51~2 53 55 56 57 58 S9 6701 6702 73 95
3~02 7021702 19 25~01 2701 4102 4101 63 64601 ~601 6801 680270 7l 77 8001 80~02 8201 8202 83 84
85 86 87 88~ 90 91 9202 920193 94 9601 9602~ 9701 9102 9801 9802 99 100 101 103 10402 105 6501 10401
(47)
301 501 502 601 1602 2401 2301 2201 31 32 3301 3302 3401 3402~ 3602 3702 3901 400140 02 43 61 69 B(
(53) (23)
~ ~gt
Ranking of VD by Rate Per 100000 By Census Tract
~
Rank Tract Rank Tract Rank Tract Rank Tract llank Tract Rank Tract Rank Tract
1 2202 21 S6 40 902 58 1602 74 75
90-shy 64 107 26 --~-
2 3402 22 45 41 10 59 902 75 78 91 54 108 61
3 2301 23 3502 42 2502 60 602 76 6802 92 402 109 87
4 3302 24 49 43 1102 61 501 17 2 93 94 110 90
5 50 25 52 44 6702 62 14 78 8202 94 97 02 III 76
6 2201 26 20 6701 63 4002 8201 2501
9701 41~02 112 91
7 44 27 48 45 401 64 3802 2902 95 63 113 62
8 3301 28 1701 46 502 65 30 79 83 74 96 9602 114 71
9 55 29 47 47 42 66 3803 80 2801 96Q1 115 85 10
11
12
13
14
15
16
17
18
3401
53
2302
2401
57
21
2402
1101
51
30-shy31
32
33
34
35
36
37
3701 - -~ 1201
3702
89
43
132 131
3602
4001
48
49
50
51
52
53
54
55
58
1601
601
4602 4601
69
701
31
3901
67
68
69
70
71
72
2901
801
39021~ 802
6502 6501 122
702
41~01
81
82
83
84
85
86
87
88
19
1
1702
2802
79
93
100 6801 6602
81
97
98
99
100
101
102
103
104
9201 9202
9802 9801
77
302
79
86
72
84
116
117
118
119
120
121
3603
8002 8001
101
99
95
10401
105 10402 103 102
19
20
59
32
38
39
2702
3501
56
57
301
3801
73 1802 1801
89 6002 6001
105
106
2701
88
High Low
-- -----
Rank OrdermiddotTuberclosis Cases by Rate Per 100000 Ranked by Census Tract High to Low
Tract TractRankTractRank Rank TractRaukTractRankTractRank
801
79 9601501411 52 6835340120511 I 960269 903603532036 $-~~F130221542 4366 311301 70 68~013802 _ I- _ 4001_37213 3921201 6802802 H71523822024 22 54 193302 3802 80 8958 I37139535 70155 9801 I60123 72 6702 98023914011016 6701250124 10 56
81 94 401r 7 154152 73 7057 2625 122 92028
90242 162312301 92~158 86 7172434526509 82 79160159 74 100 87412240227220110 6502836960 75 30 8317244 6501782801285711 61 901 42765645 84 66021459294912 9701 660146 171 302 9702 47
6235023033113 85 822821182 917755 16335013110214 841814832 78 103 938564 324815 86 1057940149272 38036523216 10401 87 2902241 725Q 10402360266340217middot IF88 88 9937233 282 51 218 101 01102 46016234
I)167 2901460219 47
High ~ Low ~
- -
TractRank
9S89
6490
8191 8001 8002
63 61 60middot01 6002 44 2701
92
J
2502 402 --- ----shy
I
Rank
Rank Order Tuberculosis Cases by Rate per 100000
(Coutd)
Tract Rank Tract ~nk
I
Tract Ballk Tract Rank
Imiddot
Tract
Imiddot
1~
t 1I i Pi i l I
o
1 -1shyL I
I J
8 40 icO ~ I -lt 0
-t (1) I
i I
r o E
II
a
I
r--i
shy
I
~
I (
Jgt
(011 fi(
Ggt
I II ~j
()
(f 0
~ ()
I
11
f9
r
II 99
o ~
Ggt r
~ __-J~ I t I ~ I
r--J l I
~ _ __ J
) 1
fTl
1gt
r I
()
r
()
lt en -i en
()
I1l
(J)
(J)
-i
P ()
19
r o ~
r G1 I
I
c
~
o I 89
--- -I-shy
r-r I
1- 0 _~ _ _--J E
G1 I I I
i i
I 1-1-1 ~ _J ~2 ~ II
II
()
1 I I I 1
id i bullbull
~
A n 69
r 1shy
- 0 Gl
l--~ ~ I
~ II
II )
I () isect i
en l i
(J)
-t
0
IA Ol
IJ
29
medical appointments ratherthanorisis centered walk-
incare Therealit1es of the existing health care
system have not taught the patient particularly the low
income patienthow to use services effectively
The helthcenterilUst also bea laboratory for
experiments in easing the health caJepersonnel shortage
and c60rd1Datingcare~ A major difficultY iri-exper1shy
menting with neW rolesis freeing staff of old preconshy
ceptions
CoDlprehensiva neighborhood health dare centers have
been developed under a variety ot alisplces including
medicalsociet1es hoSP1talsmiddot(36p299 group pr~ct1ces
(29 p6- 12 117) health departments (13 p1027) and
ne1gbbothoodassoc1ations(14) The literature indicates
somevalues nthe management ot the health center by plusmnts
hospital backup faCility Whatever the auspices many
adm1nistrative fuDctions such as program coordination
standard pr9tectionand evaluation call for considerable
c~tralization of adm1nistration city-wide or coU)tyshy
wide At the same time other aspects hours of servlce
for examPle~ cuI f~radm1nistrative fUnctions made atmiddot
more local levels Each neighborhood center must be
free to adapt its functioning to itscominunity thi-ough
the mechanism otcODlllUl11~ participation inmiddot policy making
Obviouslythe prerogatives and responsibilities of each level must be negotiated and made explic1t
t4~
JJ
BIBLIOGRAPHY 30
1 American Rehabilitation Foundation ~ealth Services Research Center The Health Maintenance Strategy mimeo 1971
2 Anderson Nancy N Comprehensive Health Planning in the States A Study and Critical Analysis Institute for Interdisciplinary Studies American Rehab ilitation Foundation 1958
3 Andrus Len Hughes Comprehensive Health Planning Through Community Demonstration Health Projects mimeo1967
4 Barry Mildred CandCecil G Sheps A New Model for Community Health Planning unpublished paper presented to the American
Public Health Aseociation1967
5 Blum HenrikL Fred Wahl Genelle M Lemon Robert Jorulin and Glen W Kent The Multipurpose Worker and the Neighborhood Multiservice Center InitialImplications and EJeperiences of the Rodeo CommunityService CenterAmerican Journal of Public Health58 (Mar 168) pp 458-468 shy
6 Blum MichaelD and Soloman L Levy A Design for Service Delivery that Reinforces Constructive Tension Between a Health Center and Its (sic) ConSUDlers and Supports Community Power unpUblished paper presented to the American Public Health Asaociatiltn 1968
7 Brielaud Donald Comm~ity Advisory Boards and Maximum Feasible Participation American Journal of Public Health 61 (Feb 1971) pp 292-296 shy
8 Burns Eveline M Health Insurance Not If or When But What Kind Madison Wisco~sin University of WisconsinScllool of Soci~l Work 1971
9 Campbell John Working ~elationships Between Providers and Conshysumers in a Neighborhood Health CenterU American Journal2 Public Health 61 (Jan 1971) pp 97-103
10 Caxr Willene Neighborhood Health Centers Funded by the Office of Economic Opportunity mimeo 1970~
11 Colombo Theodore J Ernest W Sawardand Merwyn R Greenlick The Integration of an OEO Health Program into a Prepaid Comrehensive Group Practice Plan American Journal of Public Health 59 (April 1969) pp 641-650~ -
12 Comprehensive Neighborhood Health Services Projectof Kaiser FoundatioIl Hospital~ Prcgtgram YearE grant renewal proposal mimeo~1971 bull
13 CowenDavidL~ Denvers Neighborhood Health Program Public Health Reports 84 (Dec 1969) pp 1027-1031
IJ
14 De Diaz Sharon Daniel Beyond Rhetoric The NENA Health31 Center After One Year unpublished paper pres~rited to the American Public Health Association 1970
15middot Gerrie NorrrianF and RichardH~ Ferraro Organizing a Program for Dental Care in a Neighborhood Health Center Public Health Reports 8 (Aug 1968) pp 419-428
16 Gordon JeoffreyB~ The Politics of Community Medicine Projects A Conflict Analysis Medical Care 7 (Nov -Dec 1969) pp 419-428 shy
17 Greely David The Neighborhood Health Center Program and Its Implication(3 for Medical Care H~alth Forum of the Welfare Council of Metropolitan Chicago (mimeo) 1967
18 Greenlick Merwyn R Newgtimensions in Health Care American JOurnal of Pharmacentical Education 34 (Dec 1970) pp 754-4
19 GreenlickMerwyn R Donald K Freeborn TheodoreJbull Colombo Jeffrey Abull Pruesin and Erne$t W saw~d Comparing the
Use of Medical Care Services by a Medically Indigent and a General MemberShip Population in a Comprehensive Prepaid Group Practice Prosram II unpublished paper presented to the AmericanPublic Aesociation1970
20 H~tadoArJiloldVMerllYll RGreenlick and TheodoreJ Colombo Determinants of Medical Care Utilization Failure to Keep Appointments unpublished paper presented to the American Public Health Association 1971
21 Johnson Richard E and Merwyn R Greenlick Comprehensive Medical Care A Problem and Cballengeto Pharmacy ff AJilericanJournal of PbarmacenticalEducation 33 (Aug 1969) pp 361-367 -
22 Kahn Alfred J Studiee Social Policy and Planning New York Russell Sage Foundation 1969
23 Kotler Milton Neyhborhood Government Local Foundations 2 Political~New York The BobbsMerrill Company 1969
24 NationalCommisaion on CommunityHealthSfrvic~sActionPlanniriamp for Community SetithServices~ashington p C Public Affairs-Press 19t7
25 National Commission on C~mmunity Health Services Health Adminishysration andOrMPization l the Decade Ali9$-d Washington D C Public Affairs Press 1967
26 NationalCornmiesion onqomm1Jllity Health Servicesbull Health ~ Facilities Washington D C PUblic Affairs Press 1967 bull
~ n
32 27 ODonnell Edward J and Marilyn M Sullivan ServiceDelivery
and Social Action Through the Neighborhood Center A Review of Research tt Welfare ~ Review 7 (Nov~Dec 1969) pp 112
28 Office of Economic Opportunity Second Annual Report Washington D C~ U S Government Printing Office 1966
29 Office of EConomic Opportunity and the Medical Foundation of Be~laire Ohio Eighth Report 2l ~ Committee2a Governshy
ment OperatiOll~ Va8hiiiSton D C Government Printing Office 1969
30 Pope Clyde R Samuel S Yoshioka and Merwyn R Greenlick Determinants of Medical Care Utilization nhe Use of the Telephone for ReportiDg Symptons Journal of Health and SocialBebavior12 (June 1971) pp155-162 shy
31 RenthalA Gerald nComprehensive Health Centers in Large US Cities American Journal of Public Health 61 (Feb 1971) pp 324-336 shy
32 Saward Ernest W The Relevance of Prepaid Group Practice to the Effective Delivery ofHealthServicestt The New Physician 18 (Jan 1969) pp39-44 - shy
33bull Schorr Lisbeth Bamberger and Joseph T English Background Content and Significant IssUes in Neighborhood Health
Center Programs Milbank Memorial ~ Quarterly 46 July 1968) part 1pp 289-296
34 Weiss James E and Merwyn RGreenlick UDeterminants of MedioalCareUtilization The Effects of Social Class and Distance on Contacts With the Medical Care System Medical~ 8 (Nov-Dec 1970 pp 456-462
35 Weiss James E MerwynR Greenlick and Joseph F Jones Determinants of Medical Care Utilization The Impact of Ecological Factorstt unpublished paper presented to the American Public Health Association 1970
36 Wise Harold B Montefiore Hospital Neighborhood Medical Demonstration A Case StudyMilbaDkMemorial Fund Quarterly46 (July 1968) part 1 pp297-308~
37 Yerby Alonzo S ttHealth Departments Hospital and Health Services Medica1~5 (March-April 1967) pp 70-74
38 Young M M~ Chatanooga IS Experience with Reorganization fOr Delivery of Health Services ttAmerican Journ8l of Public Health60 (Sept 1970) pp 1739-1748
f or l
II bull 11 Y d
II
IJ
34
ThepurposeOfPart II of th1aa paper1atod1scuas
elected Speclfic needs ofecltlc areas within Multnomah
County A8P01ll~oUt 1D ~ I of t1a1bullpapermiddot Ita nelgbshy
borhood health oare cater IlU8t be a facl1lty plaDlled with
aD awarenes of the neeels of the oODllUller and collllUDity
Part II of this paper nIl Show 80e of thoe speclflc
needs
he1DforutiOD tor t1li Portlon of the report
obta1nec1 troll tbroupout tbe follow1Dl threepUb11catloDS
1gr~e_tiMshylIPrIxaiidOreson JuDe 1963
2 1~_middot_sectSI8e~ected1teai c-ua 0 S 8 e first count coaputer tape Coluab a_lion AssocshylatloD of QoveraMD-8 Jlme 1971
3 Jtu1tDoab County Oreaon BDY1roDlHtlltal SurveyEarly 1971
The JIultDOIIIlb COUDty OrttIOD BDv1roDllfmtal Surley
Barly 1971 1s bull stat1stical report of the activ1tles of
theentlreMultDOIIIl2 CcNDty Health Dep~t during the
year of 1970 Die speclflc 1nd1cs elected from tb1s
study amprejMental aealtll Publlc Health N~s1D1 vlslts
FaJUly ~ Veaereal])1 ~ ~rcul081
Throush tie use of cUrts and mapa ODe CaD roup these i
speclflc ~oea to ahcnr the healthneedsof speclfic I
census trtcta aD4 then the health needs of iarer neIghshy
borhooda 1m4 o~ Uebullbull
Rf)~UP1Dl of areu was accompllshed in thefolloWinl I
JJ ~
35
he MiltDoIliahCountY oregon BDViromaental SUrvey
early 1971 isamp statistical report ot tbeaotivities ot
the entire MultDolllh COUDty Health ])epartiDent dur1nl the
year ot1970 he specitic 1Dd1C8S selected frOm this
aUy are 1Il8Dtal health public healthDurs8s visits
fUl1ly pia waereal elisease aDd tuberculosia
Tbroq11the Wle otcbart aDd mapa aDecm szoup these
specific indic to show the health Deeds ofapecitic
ccmaua tracts aDdtIum th8health neecla of larsr ~eilh-
bOrhooda and co8I13 tlbullbullbull
RegroupiDI ot areas waa accoap118hed1D the
tollOWiDl lIIIIm1er~ A bullbullcifie 1ndex 8selectcl auch as
venereal di8bullbulle or tuberculo8i~ he total number ot
cs was then deterll1ne4 for each census tract Through
the use of the maber ot cRbullbullbull tor a 11Yen cenaus tract
aDd tbe population ot thattractaltrateot1lla1ampmcper
100OOOpopUlaticm wu cleteXll1ned for each census tract
This was ~e to starl4ard1ze the population ditterence
amongOeD8U8 -tracts 1he rate of incidence toreaob
cenauatract was then llstedby rank position on a chart
In rank poition1DI any cen8Wl tracts haviDg equal
rates ot1l1c1dence are assipe4tbe iaDk posttiona
Beeauseot the abo fact tbAt cbarta w111 vary in length
neveltbAtlea eacb cbart will 1Dclu4eall census tracts
inMullnoaah Couaty Atter the census tracts bave been
listed accord1q to raalcth1s list will bediv1ded into
IJ
36 three levelsotinc14ence he three levels are
1~ The upper 14 of1DcldenCe
2 Thelower 14 ot incidence
middot3 The ILld 12 of incidence
Tlles three srouplqa are then used in compiling a map ~f
Mu1tnOmahCountyfor ach apecltictop1cbull TIle maps are
uaefuJliD tbatthey V1suallycoJib1De 1Dd1v1Clualproblem
census tracts into larger problem nellhbOrhooc1s
The 1960 statistical iDtormatloD was Used in a similar
liIaDDr to tbatexpla1Dedabove 1Dthe4evelopaent of a
chartmiddot and map 1Ihow1DI e cOllpampriSOr1 of per capita lncolle
tor ttaCh ceDsua tJact aDdmiddot combiDed census middotmiddottract areas
he 1910 aDd 1960 statlstlcal iDtOrllatl0D was combined
lna map and chart he purpose of this and chart is
to d8aonatrate the e cl1stributloa1DeachceD8U8 tract
and middot1ndlcatbull tuture ace populatlon treD4a bull
When one be middotbullbullbullbullbullHdth ne8cts ot an area and has
declded to establlsh a cl1D1c to serve that area the
physical location otthat cl1D1c IllU8t be consldered In
order to coapreb8ll81vel develop an area cl1n1c one should
conslder thepre88Dttraftlc middot~ytaa an4tranaportatlon
systems Thecl1D1cahoUld be located close enoUlh to
major arterlals to giva asy access from the total area
be_ ervecl by this cliD1c At the t1ll8they should
be tar eo away froll thesarterlals to all8Y1ate traffic
CODCell18 andpark1D8 conpstlon By traff1c concerns I
IJ
37
lIlan one lUSt consider thertarro1fne8S of streets whether
streets are oD8--C)r two-way iqres8 and egress to parking
amp0111tie eros tratflC) spedof trattJQ children 1n
ll8a traffic i1lht Vislon re8tr1ctionS etc
BwstraDsportat1onshould alao be central in this area
as maay people ~U f1Df1 1tD8Cessary to use this form of
transportatlon
~e tutqredlopHQt of bull treewa systems should be
c0J1S1dered soastolesen thecumce ofmiddot future roada
cutt1DSotltbe cl1D1c llte line
nrrph1c middotDampta
It is 1JDportaDtto kDOw the demosraphic distribution
characteristics of the oUenteltbat i8 to be served by
localized health cl1D1cs
Acl1D1c which erves8J1 area where1D the prepondershy
ance of persona arecrter 65 years of mayf1nd that these
people rely more on pUblic transportation call for more
home- services and haV4t 110ft ChroD1c and debilitating
types of disorders (b1_ blood pressure poor heariDg and
eyesight) tbaD do8 an area ot a YOUDIer population On
the other hand thL area of older residents may have little
need for family plabDlng cllni08
In order to better ~Ybullbull the 4eaoraphic population
of each CeD8U8 tract the 1970 CeD8U8 iatormation was viewed
and two specific catelOri8 considered These two cat
IJ
38
lori8S woUld be the perc_tap ot population under 19
year of ase and the percentase ot each oensuetractover
65 years of age he 1960 1Dtormatlon tor eaCh tract was
then compared witbthe 1970 intormation and a percentage
ofincreaae or4ecreamp8 tormiddot e~chtract1n each category
cOJlputecland achartma4e By the use of this chart one
18 able to View tJleap populat1odiatr1but10n of census
tract and at the _ t1lle accesa middottrencl Por example
let us choose census tract 601 W see 40-4 otthe
population is under 19 years ot and that ODly82 1s
over 65 years ot middotAtthe e tille the percentage of
youth bas ~ed ODly 1_ intbe laSt teD year whilethe
percentale over 65 year ot middotbas stayedmiddotthe same With
this in mJnc1 ODe ~ 1DfItr libat ol1D1o aerviDg this
area WOuld bellQre conq~w1th the problems of a
YOUQier populat1on and that _ would probably be true foJ
some t1aein tbefuture On the other hand CeDSU8 tract 54
has only 2 ollt population UDder 19 yel1s ot age and
this has decreased by 1 over the last ten years middotwhile at
the same time 32-377 ot the populat1on 18 over 65 years of
age A ol1D1C ___ this area should be or1eJ1ted toward
tbespecttic problema otthe ampledbull
PerCapia __ bY gsa neat
WhaD cona1der1qlooat10D1 tor health cl1n1cs one
shoUld take the 1DC01Ieot areas into consideration Areas
IJ
39
of lowiDcome would not 11kel~be 8erved more by localized
cl1D1cs tbaD would are of hilbincome It 18 likely
people haYiq a hip iDeoll8would preter to be aeenby a
chosen ~r1vatephylc1a1l tban at a local cl1D1cwhere
10Dier waits y beraceaaampryand leas personal attention
gl_
The 19701ncOII81atoWampt10n tor MultnomahC~ty was
not available at the tille thi8report W88 made The 1Dto~shy
tiOD Was taken ~adtro tbe1960 census publlcation
his woUld ~8Il thea tbat ral1I8 OD the chart ynot 1raquoe
completely accurate hi writer telthatthe areas most
affected by tb8 1I8eof the older 1Dco1DtOlaat1oDWOuld be
those tracts wh1ch baYebad a rapid 1ncreaae1n populatlon
over the past tfmyHr8 bullbullbull tracts would include tracts
nUmbered 104 9897 96 aDd 95 be perc~ita 1Dcome
referredto1il-tb1a Paper18the lIean 1DCo per person per
census tract
Attar the iDeoeper census tract was listed on a chart
a map was de 1D41catiDg those census tracts belonging to
the lower 14 ot income tor all censue tracts in Multnomah
COlDltytbose beloqins to the upper 14 ot income tor all
census tract 111 MultnolUlhCounty and those belonging to
the mid 12 ot 1I1coaetor all oeuuetracts in Multnomah
C01mty
In yiew1Dg the _p 1t caa be seen that the low income
area seautotollow aloas the at aide ot the Wl1lamette
IJ
40
R1ver the full length of Kultnomah County A second low
income area follows the south edge of the Columbia from
the northwest corner of Multnomah County easterly to 148 St
A third problem area seems to be on the east bank of the
Willamette River with the Union Pacific Railroad being
about the center of this tract The extreme loutheast
corner of Multnomah COUDty appears to be a low income area
but as this area bas bad rapid grouth in the last ten years
this could be erroneous
Mental Health
be first ~ecific indica to be selected from the
Multnomah County envirollllental survey of early 1971 and
to be considered in this paper i8 that of Mental Health
At the present for mental health purposes Multnomah
County is divided into five catchmentareas with a mental
health cl1n1cin each area These clinics are Model
Citles Delaunay ADkeny street Office Hansen Health
Building end Southeast Clinic
All lIlental health cl1n1cslcept statlstlcal information
on all patients visiting their cl1n1cs this included the
address of the patient hese addresses were then listed
upon the approprlate C8D8US tract Each census tract was
then ranked on a chart according to the nUllber of mental
health patients who reslde ln thatCeDSUS tract attending
any of the above listed ental health clinics This chart
IJ
41
wasttum d1v14ed1ato proper quartile bbullbullbull
quartile vereUs to dne10 u appropl1ate Multnoh
County _tal health ItLa middotmiddotmiddotthelipO~a1bl by lOoJcJIUE
at the UDtal health _to uteN1De which ueu have the
lars-t use otCOllDty 1alh~th faci11t1Rot
1Ilclu4ecl 111 tbia woUld tber otpeopleYia1t1Da
pr1vat patch1atriata aDd pr1_t _ntalhealtb cl1D1c8
WheDtbe M1 18Yienclmiddot Itmiddotmiddotmiddotmiddot~middotbe~_ tbat ~rtt
appears to lMt fourmiddotmiddot-al are iii _oil the nuaber ot
lIental healthcl1D1c na1t toM tbjh1sheat 1he
tour areaa woUld be tollows
1ttrea Ore to~Blo Drimiddot ~tb Burrus14e aDd tIMtmiddot Colb1a Riftr H1gbwyaeri1Dla th nortllra boundaryshy
2 bull ProII 82D4 1_~ 10 20th streetwitil the ra1lMd Mu the north ltouadary
3 ~ et et tUgl_b1bull MYel froamiddot the Clackaaa COUDty l1ae aorth to Dln8lon stret
4 beDOlvt1ttfe-t ~efllt4 COatytrca Jle1aware streetmiddot toR1C1a11oDd wlth Colubla Blvd heiDI tbAtnorth bouaclary_
It ODe coapareatbiap to th iDeobullbullmiddotp 1t can be
eamiddotthat lIOat ot the c tracts baY1Dg bllh v1i11tatlcma
middottfl public tal health cJ1rUc8 ~ 111 t13e low ~ aid
1DcOile SroupiDIOJa1y of til 25 tracta llsted as
haviDlbip aental Maltll nlltatlou are ~ the1g60 hip
iDeo arebullbullbull
17 Plpn
42
amily PlellnSDI ]Jlce Metal Health i8 an 1nd1ce of
use Theperson 111 ordertobavebe_ 1Dcluclecl 1n this
atu4ywouldhave tohaft Ue4 ataa11y plaDI cl1D1c
tacilities of soaetype It 41fter troll tile _tal health
study1nthat i t1Jicludestatist1catrollbotb public and
privateclJD1os
The iDformation tor the iak orurcbart 8Dd map of
t8ll111 plenn1 na ob1a1De4 by cOIIblnlDlthe mabel of
1rlcuv1duals bullbull_ attbe tbreellUltrampo-ti Coatyhll11y
PlalJQllIl C11ll10s 111til tbo at the Planned PareDthood
Association CliD1C8 be tbree -JIultDouh Couaty r8ldly
PlamSq Cl1D1c are Solrtbweatth Col_bla 1111- a114
HaDsell Health BWlcl1Dl CllD1cbi middot1Dtormat1oD vas then
bullbullbullesed tomiddot detellWMt l10w people troll eacb c8IUIUS
chart wastben Mele IUs oIIart jn 4iY1ded to show
the censuS tracts lIaYiDlmiddottIle h1t1iest qUart1le of incidence
of use lowest quartile of 1Qc1deao ot use Jlid 12 of
incidence of Wle an4 a map sprepared troll thts 1Dto~
mation
The C8U118 tractsbelOJISnl to the h1lhestquartile of
use appear to be 1lO~ 8catt~ on tbipwas true ot
either the _p ot aental health cl1D1c uaageor ot the map
abow1DI per capita 1I1COM Iaere40 to be three
d18t1nct areas of UIIaP beJ woul4 be
1
IJ
43
t10D of BurD81cl and the W11lallette River 4
2 S~t Portland 8Otth otmiddot the ra11shyrcaadand alona the W11lamette River
lIortbeaat Portl8D4 between MisSiss1pp1 and 24tbStreet the northbouBclary be1DgColwb1aBlvd
Pylzl1c BMltl IrpI Y11ta
Publlc Healtil nur81D1Y1s1t nclud8 an vists to
theholles of client by PubUc Health Nurbullbullbullbull his shows
visits to bull f8Jl1ly fer aDY purpos SUCh aatuberculolJ1s
het1Dl tem1tyaeatalu4 8IiOt10D8l cODd1t1ona etc
he atat18t1C~ 1fele C()4ed accord1Dg tomiddot the 1llli301fOCUS
of the Y18lt tt doe DOt 1D41cate the Dmlber of holies or
f8ll11lev181tecl or 1D41Y14ual Y1a1ted more tban oDcein
the propwl It dobullbull I1ve 80M 1D41cat1on by coaparlshy
OD ot the 8JIoUDt of aedlcal problema 1n eachcen8WI tract
Ap1nmiddot the _p abowa 8 scatter patteraof probl_
areas althoUSh there appear to be a sroup1Dl of hiSh J
l8aIeccmaus tract 1ntlut extreme southeast part of tbe
County other areu uIriaI any nura1Dl contacts are
1 bull he 801lth-oa-al CO1Dty on eaCh 814 of 82nd Av from Clackallaa County north to Dinloa
2 ear bullbullbullt 814e aroUDd Preacottand Misaisippi
Dowatom Bunul14eonboth 1de of the river
44
V_real Pis The iDfomatloil uaec1 to tabulate the Venereal
disease chart includes all the ooab1ned case otmiddotODormea
and syphilIs reported by bothmiddot publIc and prIvate physicIans
dur1nl 1970 There were 3602 caes ot IOnorrhea reported
dur1nl 1970 While ODly 17 cabullbullsot ayphilimiddot were reported
A chart was prepUed aDd att8llPt wasmiddotmiddot de tomiddot
determ1De Wh_therVttDereal 41ease was more p~vaJent in
areas othigb or lowmiddot proportIon ot youth hi waadone
bymiddotdetemlna a 1leaD prceiltacmiddotmiddotmiddottor the population ot
resld~ts UDder19 years ot (34) middotA mean ratemiddot per
100000 popUlatIon al80c1ttem1Ded tor the middotoccurreDCe
ot venereal dieae This was et at 390 oass Areas
hav1nl a population 1n which leiS than 34 were lmder 19
years ot ampIe were called low- yOuth abOve tbl percentaae
hiSh youth The aaa waatrue ot the occurrence oivenershy
eal disea_ per CeD8UStract It the rate waacomputed
as 1I0re than 390 cases per 100000 it was called hiah
venerealdiaeasei it less than thia tisure low venereal
disease It was tound that 1D Multn~ COmlty there sems
to be poSitive OOlatI0n(x21S19gt between low youth
and hipmiddot venereal diseaand hip youth and low venereal
diseasebull
RaDk ordr Iitot all c traot middottbAm made
Th1s was done byt1Ddlna the ratepr 100000 populatIon
of venereal disator all census tracts in the County bull
45
These were thenlisted from h1lhto low (sreatest to
least) in a rank order The l1sting was then divided
into Upperandlower 14 aDd listed on the MUltnomah
Countymiddot up
The areas of b1gh venereal disease se8ll18to
roup thBl~8 middotin a very tllht area ~oq both 1des
of thell18l8~ R1 w1th BurDaldeS~et being
~bout theceDter qf tbi8IZ9uping This area woUld
appear to be m ldeal spot for the denlopment of a
locallzed venereal d1sbullbullbullbull cl1D1c
UbepoundCUlO1s
In this report bull tube1C1llosls caS8S refrred
to include alltbobullbull cabullbulls ontubercUlo8is follow-up
rather middotthan just new C Accord1Ds to the Multnomah
County Health SUrvey of early 1971 this would include
all ca repOrte4 over thelaat three years The
total number of tuberculosi8 cabullbullbull usedin this study
was 666 lh1 included 128 new cabullbullbullbull
A rate per 100000 of tuberculosis for each
census tract wa- then computed and the c~us tracts
listed by rank order be b11h Qartlle mel low
quartl1 were then reoordd on a Multnomah CoUnty map
TWo genral areaa baY1Dg a hip mcldencaot tubercu~
losiare 1D41cated heyare
1 Both middotsld ot theWilla11lette River
Ll -
46
with Burns1de about thecnter
2 he extrea Northebullbullt comer of the County bull
By coap8r1ng the tuberculois an4ven8real
diseae maps ODe can 8ee that the downtown areas ot
hiSh 1nc1denceare alIIo8t 1c1eDt1cal on ach map
This WOuld 1nd1cate that 1t would be of value to
bullbulltab11sh acl1D1c 111 th1aampreatbat would provide
bothtuberCulos1s 8Dd ytmereal 418ase srvicbullbullbull
Thchart aDd 1181gt8 are wsfuln 11v1DI
1Ddicat10DS tor the type aDd placemeototlocal
health cl1n1c8 tbro1qhout tbe MultnomahCounty area
A cOllpar1on of the mapa help one to dec1dewhether
to provide a aulti-8ervice cl1D1c or spec1f1c type of
cliD1c As stated in Part I of thi paprserv1ces
shouldhaYe both treatlieDt and prfMmt10n cOmponents
As he been stated fta ne1lbborhood health care
Qenter muat be a fac111tY plazme4 with an aamesa
ot the neds of the consumer and the c01llll1m1tybull
Part II of this rport haa been an attaapt to indicate
and clarify 8011 ottheae coDlllUDity neds This has
been done through8elect10n of apc1f1c problems
The indic were then visuallyrecorded through the
use of ups and charta ODe dan asseS8 thedsreeof
1DIportance of certain concems to spec~t1c areaa by
comparinl the chart aDd maps Prom this oDeean
41 dec1de which are48 vb1chcUD1c-or indeed if
the need a clinic at all However further factors
should be considered hebullbull include
a The amount of fuDd1 available
b What 18 the percentage ot peopleineoh ceaaua tract tbat would actually us such cl1n1cIl
c Wbat 1 tbeco--1tymiddot 8 IeeliDashyreaardtDI particular cl1D1c8 Would this dcrebullbullbullmiddot the ettctiveness ot thse cl1n1ca
IJ
li
D_OlraphicPopulatLon Challie 1960 to 1970 48
Cen8U8 1 of Pop 1 Cbaqemiddot 1 Change1 ofPopTract Under 19 Yr8 Over 65 Yrs1960-70 1960-70
middot1Q701Q70
1 319 -12 171 -H) 1
2722 215-27 +68 301 366 -22 127 +35 302 371 +19 111 -04
311middot401 144-41 +29 402 321 13~7-39 +24 501 356 124-08 -02 5~O2 351 133-23 +12
405601 82-10 -02 394602 103-01 -06
701 275 149-76 +56 702 361 +01 121 -07
+10middot801 326 140-22 802 321 middot127
(
-29 -03 9~01 342 124 -H) 6-18 902 294 128 -H) 3-24
10middotmiddot -14312 140 -17 1101 182 +25 -23197
2411102 186-59 +29 1201 226 169-17 -41
31middot01202 +11 182 -05 295 -H) 81301 208 -H) 4
1302 331 +08 197 +04
14 323 +15 middot185 -08 middotmiddot15 329 +16 16~5 -13
-28middot 1601 332 131 +12
1602 356 98 +24middot-39 middot3101701 161-33 +21
1702 370 -15 85 +02 +19 1801 264 151middot-50
185middot1802 256 +47-58
IJ ~
D_raphlc Population Change 1960 to 1970middot 49 (Contd)
4io
Census Tract
of pop Uncter 19 Yra
1Q1n
1Cha1l8e 1960-70
of PopOver 65 Yra
lQO Change
1960-70
19 389 +29 141 -24 20 223 -13 206 +18
21 227 +08 194 -36 2201 356 -27 112 +05
2202 290 -18 ll~9 -29 2301 356 -03 154 +24 2302 260 -37 245 +97
2401 410 +6~1 123 -31 2402 163 -80 320 +99 2501 381 +13 140 -01 25()2 237 31 lil +02 26 343 +25 186 +149 2701 370 +29 1S5 -01 2702 249 -44 304 +98 2801 337 +19 187 +09 2802 306 -10 156 +31 2901 304 -38 142 +24 2902 i 307 -32 146 t3~9
30 29~0 -48 16~2 +51
31 355 +30 160 +01 32 370 +48 148 -13 3301 395 +45 130 -20 3302 368 +06 138 -02 3401 386 +16 117 000
3402
400 +32 92 -26 3501 304 -07 115 +35
3502 344 000 140 -13
3601
36~02 357 -04 132 +32
3603 30~1 42 149 -67 3701 342 +28 152 +19
1
IJ
Jianolraphic Population Chan 1960 to 1970 50 (Contd)
Census Tract
of Pop Under 19 Yrs
JJl7J
middotChanae 1960-70
middotofmiddotpop Over 65 Yrs
1c~7n
Change 196070
3702 409 +39 122 -11 3801 308 -11 151 +29 3802 275 -35 180 +46 3803 282 -32 192 +54 3901 376 ~13 100 +17 3902 296 -03 177 +29 4001 438 -11 84 +13 4002 353 -21 115 +20
4101 397 11 9middot0 +11 4102 346 -19 120 +03 42 331 +19 11 bull 3 -16 43 347 -72 105 +31 44 113 +84 183 +154 4S 33~9 +07 110 -06 4601 2501 22 193 +38 4602 332 +59 126 -29 47middot 161middot 000 211 +01 48 103 -26 302 +59 49 138 +1 bull 3 252 +09 50 141 -26 204 -12 51 12 -39 257 +07 52 47 -61 351 +48 53 89 +49 314 -30 54 25 l1li15 327 -17 55 131 -17 115 -121 56 198 +93 227 -47 57 71 102 189 -88 58 240 ~middot41 16~1 +55 59 322 +25 142 +06middot 6001 264 95 132 +50
6002 328 -31middot 89 +07
JJ
Demographic Population Change 1960 to 1970 51 (Contd)
Census 1 ofPop lChange of Pop bull ChangeTract Under 19 Yrbullbull 1960-70 Over 65 Yrs 1960-70
1970 1970
61 355 -58 85 +39
62 328 39 110 +18
63 414 04 73 10
64 382 -22 72 +04
6501 383 02 67 -20
6502 329 -56 96 +09
6601 391 +13 88 -03
6602 319 -59 97 +06
6701 327 71 145 +72
6702 331 ~67 83 +1-0
6801 365 -66 49 +01
6802 388 4bull3 54 +06
69 354 -41 80 +23
70 400 -23 68 -06
71 359 -48 72 +05
72 255 -88 82 +11
73 346 -39 91 +25
74 313middot -63 105 +24
75 329 -42 129 +37
76 336 -52 85 +21
77 370 -10 69 +05
78 309 -10 120 +21
79 325 -56 87 +10
8001 358 -81 57 +12
8002 391 ~81 76 +12
81 315 -76 108 +21
8201 403 -23 64 +08
8202 392 23 65 +08
83 357 -34 120 +31
84 402 -18 73 +16
85 413 -06 76 -09
r
Demographic Population Change 1960 to 1970 52 (Contd)
Census Tract
t of Pop Uncler 19 Yrs
1970
Change 1960-70
1 of Pop OVer 65 Yrs
1970
ex Change 196070
86
87
88
89
90
91 9201
9202
93
94
95
9601
9602
9701
9702
9801
9802
99
100 I
101
102
103
10401
10402
lOS
368
351
379
391
391
413
379
433
372
429
414
432
419
439
~32
377
457 420
378 41middot7
345
360 417
417
412
-04
-02
-35
-26
-28
-11
-64
-20
-S9
-39
-32
-21
-34
-40
-47
-lO~7middot
-27middot +04
+56
+07
-34 01
+04
+04
+10
103
128
97
11il3 99
69
79
42
77
46
34 38
44
40
54
111
51middot
81
133
59
74
140
63
87
76
-08
-06
+04
+08
+17
-05
+3S -02
+1~4
+19
+33
-14
-08
+12
+26
+71
+11
-16 -34
-20
-19 +37
-49
-2S +15
NOte The The
Taken frOi
averageullder averageabove
middotUSCensus ---shy -
19 years == 6S years ==
figures 197
32r 13(14
p a~d 1960
--
Rank
1
2
3
4
5
6
7
8
9
10
11 12 -_
13
14
15
16
17
18
Tract
69 46
60
58
- 68
61
302
2501
67
63
19
62
26
94
3603
3902
64
30 -----~-
Rank
19
20
21 -
22
23-shy
24
25
26
27
28
29
30
31
32
33
34
35
36 -
Ranking of Per Capita Income by Census Tract
Tract
65
2701
- 15
1601
701
66
93
82
2903
3602
30
2502
80
2401
81
- 70
91 shy
4001
High
Rank Tractshy
-32shy37
38 97
120239
7840
41 ~ _2_1__ 42 31
43 2501
44 18
45 98
46 37
47 3803
1702
49
48
1602 92 2702
I
50 89
51 901
52 801
Ra_
53
54
55
56
57
58
59
60
61
62
63
64
6S
66
67
68
TractTract Ra~
74692
170196 70 I
401 71 90
72 1037J
79 70273
3802 74 601
24024102 75
85 76 101
77 9023901
7699 78 100 4101 79
3601 I
380180
458140~ t---- _ - - shy83 82 42
888384
59843501
4777 8~
502
Low
802 86
Rank Tract
87 shy
--88
89
90
91
92
93
94
- 95
96
97
middot98
99
100
101
102
103
104
1201
14
49
72
73
43
87
3502
105
1
52
86
71
1
501
10
3301
104 tf
Rank
105
106
107
108
109
110
III
112
113
114
115
116
117
118
119
120
121
Ranking of Per Capitalucoae by Census Tract
(Contd)
Tract Rank
4001 122--shy602
13
1102 2302
3302
55
3401
48
21
56
50
3402
lL01
2202
2301
53
2201
-shy
Tract Rank Tract Rank T~aet Rank
57 I-----
Imiddote
bull
Tract
- Low -k Note Information taken from 1960 U SCensus
Rank Tract
I ~
Ie
Imiddot
~
----
----
--
--
Rank
1
2
3
4
5
6
1
8
9
10
11
i-
-Tract
391 922 921
972 971
100
132 131 121
962 961
822 821 401
982 981
20 111
47 10 1
412
High
Total Number of Henta1 Health Visits
Ranked by Census Tract High to Low
TractTract RankTractRank Rnk
12 182 22 78 29 87 76 381 73181 ~------- 1913 371 8538230162372 271 2616-121 8272 2
14 80~2 31 94 7923 84801 59 15251362 4232 15 52 _ 32 103 8924 651 17240216 652
_ 91 351 33 341 23117 83 122 25 25 48 1123921418 34 shy61 86 661
19 662 6493 81 26 91 8153 49 50 55 41383 71 27 51 3120 90 672241 35shy 104167162 461
I 411 46211121 28 88342 I
2502 36 69 54 5251 50 272
-Ra
37
38
39
_ 40
_ 41 Ishy
I
42 I
-I 43 44
45
shy
Tract
~ --- shy 95 56
45 292 242
102 62 352 291y
92
101 281
99 72 63 601 60~ 42 2201
77 74 61 57
363 232
70
32 31
11 44 282 2202
Low l
- Tract
46 682 681 I 331 30
r~$ 47 1042 332
48 102_41_
11
~
Visits to Family Planning Clinics Ranked by Census Tract High to Low
Rank Tract Rank Tract Rankmiddot Tract Rank Tract Rank Tract Rank Tract
1
2
3
4
5
6
7
8
9
10
11
12
13middot
14
15
16
17
361
56
401
341
48
59 121
20
55
342
10
31
58
93 21
241 132
331
53
461 462
18
19
20-shy21
22
23
24
25
26
27middot
28
29
30
31
32
33
391
32
middot47 I-i-_-shy _ -
231 111
332
972 1
372 371
52
89
32
92
82
100 31
182
30 242
402
34
35
36
37
38
39
40
41
42
43
44
45
42
1714 i 661 221
78 362 2
90 602 601 352
63 251
105 921
971 351
73 42 292 232
411 51
662
81 45 52
46
47
48
49shy
50
51
52
53
54
55
56
961
801
49 81 72 71
19
9~1
172
68 2 57 162 14 112
91 75 681
381 42
3~3
83 161
57 f
58
59
60
61shy
62 Imiddot
63
Imiddot 64
65
66
64 62 36~3 252
74 652 SO 392 291
651 6bull 2
79 271
r-- ---- shy981 222
672 671
821 272
94 87
281
382
67
68
69
70
71
72
73
74
75
76
77
78
981 26 12~2
IS 61
85 82~2 69
61 43
101 86 84 282
76
131
51 72
1041 962 88 70
99 922 77
103
95 802 181
i
~
Low High
RankRank Tract
5479
4480
81 1042 ~) middot102
71 - - + ~ - ~
Visits to Family Planning Clinics
(Contd)
Tract Rank
I
Tract llaDk l
RankTract Tract Rank Tract
~
I
~
J1 ~
Low
Total Number of public Health Nursing Visits
Ranked by Census TractsHigh to Low
TractTract RankTractRank RankRank TractTractRankTractRank
25249 71 79 17249 8033 6586 99189711 84 2915072 34 661 76 66 811519512
402 5035 51 161 2518220 122 1713423 352 55801 7120 6752 2 149814 41236 83 2662 38 94 6821 53 2924015 362 37 32 42 75 69 281 84 63
546 8822 54 222 85 3925431 70383417 3818223 6439 4386652 718 21 55 103332 8924 232 87 19 271729219619 24156 16211140 382 628825 10523110 112 73411 10141-- ----shy 89 363 4457 8126 16111 221 74 9142 90 46158331 53 671279012 46243 48 59 351 3837528 1083 9313 91 5844 59 -_242 76 1----- shy60 272 72 74104114 60145 42 9287 7729 92 6151 8215 57371 934630 91 307762 12113116 282 619447 41391 9531 78100 63 7378 ~95 681 6945 32 5632 798517 6448 47 52 181
High ~ Low
Rank Tract Rank
96 31 132 70
97 102
98 182 372middot 602 651 662
- -shy
~72 682 802
822 922 962 972 982
1042 ----shy
Low
Total Number of Public Health Nursing Visits
(Contd)
Rank Rank Rank TractTract Tract
I
I lt
I
Tract Rank Tract
[
~~~-
I
~
IJilfimiddot ~
j
Ranking of VD Caea According to Census Tracts 61 By High and LOll Youth Itatio
A media~ of 34 5 was determined Any tract having greater
than 34 5~ of popu1tionunde~ 19 years of age -High~
Any tract having l8S than 345 of population under 19
years == Low
Any tract having rate less than 390 =Low
Any tract having rate more than 390 == HLgl4
YOUTH
LOW HIGH
L
0
12 402 1801 1802 343 2801 2802 29023603
54 6001 600262 66~02 72 74 75 76
78 79 81 t02 65 1202
W
(25)
VD
H
I
G
H
401 701 801802 901 902 10 1101 241 1201 1301 132 14 15 1601 1701 20~ 21 2202 2j02 2402 2502 2702 2901 303501 3502 34023801 3802 383 3902 42 44 45 4601 4602 47 48 49 SO 51~2 53 55 56 57 58 S9 6701 6702 73 95
3~02 7021702 19 25~01 2701 4102 4101 63 64601 ~601 6801 680270 7l 77 8001 80~02 8201 8202 83 84
85 86 87 88~ 90 91 9202 920193 94 9601 9602~ 9701 9102 9801 9802 99 100 101 103 10402 105 6501 10401
(47)
301 501 502 601 1602 2401 2301 2201 31 32 3301 3302 3401 3402~ 3602 3702 3901 400140 02 43 61 69 B(
(53) (23)
~ ~gt
Ranking of VD by Rate Per 100000 By Census Tract
~
Rank Tract Rank Tract Rank Tract Rank Tract llank Tract Rank Tract Rank Tract
1 2202 21 S6 40 902 58 1602 74 75
90-shy 64 107 26 --~-
2 3402 22 45 41 10 59 902 75 78 91 54 108 61
3 2301 23 3502 42 2502 60 602 76 6802 92 402 109 87
4 3302 24 49 43 1102 61 501 17 2 93 94 110 90
5 50 25 52 44 6702 62 14 78 8202 94 97 02 III 76
6 2201 26 20 6701 63 4002 8201 2501
9701 41~02 112 91
7 44 27 48 45 401 64 3802 2902 95 63 113 62
8 3301 28 1701 46 502 65 30 79 83 74 96 9602 114 71
9 55 29 47 47 42 66 3803 80 2801 96Q1 115 85 10
11
12
13
14
15
16
17
18
3401
53
2302
2401
57
21
2402
1101
51
30-shy31
32
33
34
35
36
37
3701 - -~ 1201
3702
89
43
132 131
3602
4001
48
49
50
51
52
53
54
55
58
1601
601
4602 4601
69
701
31
3901
67
68
69
70
71
72
2901
801
39021~ 802
6502 6501 122
702
41~01
81
82
83
84
85
86
87
88
19
1
1702
2802
79
93
100 6801 6602
81
97
98
99
100
101
102
103
104
9201 9202
9802 9801
77
302
79
86
72
84
116
117
118
119
120
121
3603
8002 8001
101
99
95
10401
105 10402 103 102
19
20
59
32
38
39
2702
3501
56
57
301
3801
73 1802 1801
89 6002 6001
105
106
2701
88
High Low
-- -----
Rank OrdermiddotTuberclosis Cases by Rate Per 100000 Ranked by Census Tract High to Low
Tract TractRankTractRank Rank TractRaukTractRankTractRank
801
79 9601501411 52 6835340120511 I 960269 903603532036 $-~~F130221542 4366 311301 70 68~013802 _ I- _ 4001_37213 3921201 6802802 H71523822024 22 54 193302 3802 80 8958 I37139535 70155 9801 I60123 72 6702 98023914011016 6701250124 10 56
81 94 401r 7 154152 73 7057 2625 122 92028
90242 162312301 92~158 86 7172434526509 82 79160159 74 100 87412240227220110 6502836960 75 30 8317244 6501782801285711 61 901 42765645 84 66021459294912 9701 660146 171 302 9702 47
6235023033113 85 822821182 917755 16335013110214 841814832 78 103 938564 324815 86 1057940149272 38036523216 10401 87 2902241 725Q 10402360266340217middot IF88 88 9937233 282 51 218 101 01102 46016234
I)167 2901460219 47
High ~ Low ~
- -
TractRank
9S89
6490
8191 8001 8002
63 61 60middot01 6002 44 2701
92
J
2502 402 --- ----shy
I
Rank
Rank Order Tuberculosis Cases by Rate per 100000
(Coutd)
Tract Rank Tract ~nk
I
Tract Ballk Tract Rank
Imiddot
Tract
Imiddot
1~
t 1I i Pi i l I
o
1 -1shyL I
I J
8 40 icO ~ I -lt 0
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i I
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Jgt
(011 fi(
Ggt
I II ~j
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(f 0
~ ()
I
11
f9
r
II 99
o ~
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r--J l I
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) 1
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r I
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r
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lt en -i en
()
I1l
(J)
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19
r o ~
r G1 I
I
c
~
o I 89
--- -I-shy
r-r I
1- 0 _~ _ _--J E
G1 I I I
i i
I 1-1-1 ~ _J ~2 ~ II
II
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1 I I I 1
id i bullbull
~
A n 69
r 1shy
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JJ
BIBLIOGRAPHY 30
1 American Rehabilitation Foundation ~ealth Services Research Center The Health Maintenance Strategy mimeo 1971
2 Anderson Nancy N Comprehensive Health Planning in the States A Study and Critical Analysis Institute for Interdisciplinary Studies American Rehab ilitation Foundation 1958
3 Andrus Len Hughes Comprehensive Health Planning Through Community Demonstration Health Projects mimeo1967
4 Barry Mildred CandCecil G Sheps A New Model for Community Health Planning unpublished paper presented to the American
Public Health Aseociation1967
5 Blum HenrikL Fred Wahl Genelle M Lemon Robert Jorulin and Glen W Kent The Multipurpose Worker and the Neighborhood Multiservice Center InitialImplications and EJeperiences of the Rodeo CommunityService CenterAmerican Journal of Public Health58 (Mar 168) pp 458-468 shy
6 Blum MichaelD and Soloman L Levy A Design for Service Delivery that Reinforces Constructive Tension Between a Health Center and Its (sic) ConSUDlers and Supports Community Power unpUblished paper presented to the American Public Health Asaociatiltn 1968
7 Brielaud Donald Comm~ity Advisory Boards and Maximum Feasible Participation American Journal of Public Health 61 (Feb 1971) pp 292-296 shy
8 Burns Eveline M Health Insurance Not If or When But What Kind Madison Wisco~sin University of WisconsinScllool of Soci~l Work 1971
9 Campbell John Working ~elationships Between Providers and Conshysumers in a Neighborhood Health CenterU American Journal2 Public Health 61 (Jan 1971) pp 97-103
10 Caxr Willene Neighborhood Health Centers Funded by the Office of Economic Opportunity mimeo 1970~
11 Colombo Theodore J Ernest W Sawardand Merwyn R Greenlick The Integration of an OEO Health Program into a Prepaid Comrehensive Group Practice Plan American Journal of Public Health 59 (April 1969) pp 641-650~ -
12 Comprehensive Neighborhood Health Services Projectof Kaiser FoundatioIl Hospital~ Prcgtgram YearE grant renewal proposal mimeo~1971 bull
13 CowenDavidL~ Denvers Neighborhood Health Program Public Health Reports 84 (Dec 1969) pp 1027-1031
IJ
14 De Diaz Sharon Daniel Beyond Rhetoric The NENA Health31 Center After One Year unpublished paper pres~rited to the American Public Health Association 1970
15middot Gerrie NorrrianF and RichardH~ Ferraro Organizing a Program for Dental Care in a Neighborhood Health Center Public Health Reports 8 (Aug 1968) pp 419-428
16 Gordon JeoffreyB~ The Politics of Community Medicine Projects A Conflict Analysis Medical Care 7 (Nov -Dec 1969) pp 419-428 shy
17 Greely David The Neighborhood Health Center Program and Its Implication(3 for Medical Care H~alth Forum of the Welfare Council of Metropolitan Chicago (mimeo) 1967
18 Greenlick Merwyn R Newgtimensions in Health Care American JOurnal of Pharmacentical Education 34 (Dec 1970) pp 754-4
19 GreenlickMerwyn R Donald K Freeborn TheodoreJbull Colombo Jeffrey Abull Pruesin and Erne$t W saw~d Comparing the
Use of Medical Care Services by a Medically Indigent and a General MemberShip Population in a Comprehensive Prepaid Group Practice Prosram II unpublished paper presented to the AmericanPublic Aesociation1970
20 H~tadoArJiloldVMerllYll RGreenlick and TheodoreJ Colombo Determinants of Medical Care Utilization Failure to Keep Appointments unpublished paper presented to the American Public Health Association 1971
21 Johnson Richard E and Merwyn R Greenlick Comprehensive Medical Care A Problem and Cballengeto Pharmacy ff AJilericanJournal of PbarmacenticalEducation 33 (Aug 1969) pp 361-367 -
22 Kahn Alfred J Studiee Social Policy and Planning New York Russell Sage Foundation 1969
23 Kotler Milton Neyhborhood Government Local Foundations 2 Political~New York The BobbsMerrill Company 1969
24 NationalCommisaion on CommunityHealthSfrvic~sActionPlanniriamp for Community SetithServices~ashington p C Public Affairs-Press 19t7
25 National Commission on C~mmunity Health Services Health Adminishysration andOrMPization l the Decade Ali9$-d Washington D C Public Affairs Press 1967
26 NationalCornmiesion onqomm1Jllity Health Servicesbull Health ~ Facilities Washington D C PUblic Affairs Press 1967 bull
~ n
32 27 ODonnell Edward J and Marilyn M Sullivan ServiceDelivery
and Social Action Through the Neighborhood Center A Review of Research tt Welfare ~ Review 7 (Nov~Dec 1969) pp 112
28 Office of Economic Opportunity Second Annual Report Washington D C~ U S Government Printing Office 1966
29 Office of EConomic Opportunity and the Medical Foundation of Be~laire Ohio Eighth Report 2l ~ Committee2a Governshy
ment OperatiOll~ Va8hiiiSton D C Government Printing Office 1969
30 Pope Clyde R Samuel S Yoshioka and Merwyn R Greenlick Determinants of Medical Care Utilization nhe Use of the Telephone for ReportiDg Symptons Journal of Health and SocialBebavior12 (June 1971) pp155-162 shy
31 RenthalA Gerald nComprehensive Health Centers in Large US Cities American Journal of Public Health 61 (Feb 1971) pp 324-336 shy
32 Saward Ernest W The Relevance of Prepaid Group Practice to the Effective Delivery ofHealthServicestt The New Physician 18 (Jan 1969) pp39-44 - shy
33bull Schorr Lisbeth Bamberger and Joseph T English Background Content and Significant IssUes in Neighborhood Health
Center Programs Milbank Memorial ~ Quarterly 46 July 1968) part 1pp 289-296
34 Weiss James E and Merwyn RGreenlick UDeterminants of MedioalCareUtilization The Effects of Social Class and Distance on Contacts With the Medical Care System Medical~ 8 (Nov-Dec 1970 pp 456-462
35 Weiss James E MerwynR Greenlick and Joseph F Jones Determinants of Medical Care Utilization The Impact of Ecological Factorstt unpublished paper presented to the American Public Health Association 1970
36 Wise Harold B Montefiore Hospital Neighborhood Medical Demonstration A Case StudyMilbaDkMemorial Fund Quarterly46 (July 1968) part 1 pp297-308~
37 Yerby Alonzo S ttHealth Departments Hospital and Health Services Medica1~5 (March-April 1967) pp 70-74
38 Young M M~ Chatanooga IS Experience with Reorganization fOr Delivery of Health Services ttAmerican Journ8l of Public Health60 (Sept 1970) pp 1739-1748
f or l
II bull 11 Y d
II
IJ
34
ThepurposeOfPart II of th1aa paper1atod1scuas
elected Speclfic needs ofecltlc areas within Multnomah
County A8P01ll~oUt 1D ~ I of t1a1bullpapermiddot Ita nelgbshy
borhood health oare cater IlU8t be a facl1lty plaDlled with
aD awarenes of the neeels of the oODllUller and collllUDity
Part II of this paper nIl Show 80e of thoe speclflc
needs
he1DforutiOD tor t1li Portlon of the report
obta1nec1 troll tbroupout tbe follow1Dl threepUb11catloDS
1gr~e_tiMshylIPrIxaiidOreson JuDe 1963
2 1~_middot_sectSI8e~ected1teai c-ua 0 S 8 e first count coaputer tape Coluab a_lion AssocshylatloD of QoveraMD-8 Jlme 1971
3 Jtu1tDoab County Oreaon BDY1roDlHtlltal SurveyEarly 1971
The JIultDOIIIlb COUDty OrttIOD BDv1roDllfmtal Surley
Barly 1971 1s bull stat1stical report of the activ1tles of
theentlreMultDOIIIl2 CcNDty Health Dep~t during the
year of 1970 Die speclflc 1nd1cs elected from tb1s
study amprejMental aealtll Publlc Health N~s1D1 vlslts
FaJUly ~ Veaereal])1 ~ ~rcul081
Throush tie use of cUrts and mapa ODe CaD roup these i
speclflc ~oea to ahcnr the healthneedsof speclfic I
census trtcta aD4 then the health needs of iarer neIghshy
borhooda 1m4 o~ Uebullbull
Rf)~UP1Dl of areu was accompllshed in thefolloWinl I
JJ ~
35
he MiltDoIliahCountY oregon BDViromaental SUrvey
early 1971 isamp statistical report ot tbeaotivities ot
the entire MultDolllh COUDty Health ])epartiDent dur1nl the
year ot1970 he specitic 1Dd1C8S selected frOm this
aUy are 1Il8Dtal health public healthDurs8s visits
fUl1ly pia waereal elisease aDd tuberculosia
Tbroq11the Wle otcbart aDd mapa aDecm szoup these
specific indic to show the health Deeds ofapecitic
ccmaua tracts aDdtIum th8health neecla of larsr ~eilh-
bOrhooda and co8I13 tlbullbullbull
RegroupiDI ot areas waa accoap118hed1D the
tollOWiDl lIIIIm1er~ A bullbullcifie 1ndex 8selectcl auch as
venereal di8bullbulle or tuberculo8i~ he total number ot
cs was then deterll1ne4 for each census tract Through
the use of the maber ot cRbullbullbull tor a 11Yen cenaus tract
aDd tbe population ot thattractaltrateot1lla1ampmcper
100OOOpopUlaticm wu cleteXll1ned for each census tract
This was ~e to starl4ard1ze the population ditterence
amongOeD8U8 -tracts 1he rate of incidence toreaob
cenauatract was then llstedby rank position on a chart
In rank poition1DI any cen8Wl tracts haviDg equal
rates ot1l1c1dence are assipe4tbe iaDk posttiona
Beeauseot the abo fact tbAt cbarta w111 vary in length
neveltbAtlea eacb cbart will 1Dclu4eall census tracts
inMullnoaah Couaty Atter the census tracts bave been
listed accord1q to raalcth1s list will bediv1ded into
IJ
36 three levelsotinc14ence he three levels are
1~ The upper 14 of1DcldenCe
2 Thelower 14 ot incidence
middot3 The ILld 12 of incidence
Tlles three srouplqa are then used in compiling a map ~f
Mu1tnOmahCountyfor ach apecltictop1cbull TIle maps are
uaefuJliD tbatthey V1suallycoJib1De 1Dd1v1Clualproblem
census tracts into larger problem nellhbOrhooc1s
The 1960 statistical iDtormatloD was Used in a similar
liIaDDr to tbatexpla1Dedabove 1Dthe4evelopaent of a
chartmiddot and map 1Ihow1DI e cOllpampriSOr1 of per capita lncolle
tor ttaCh ceDsua tJact aDdmiddot combiDed census middotmiddottract areas
he 1910 aDd 1960 statlstlcal iDtOrllatl0D was combined
lna map and chart he purpose of this and chart is
to d8aonatrate the e cl1stributloa1DeachceD8U8 tract
and middot1ndlcatbull tuture ace populatlon treD4a bull
When one be middotbullbullbullbullbullHdth ne8cts ot an area and has
declded to establlsh a cl1D1c to serve that area the
physical location otthat cl1D1c IllU8t be consldered In
order to coapreb8ll81vel develop an area cl1n1c one should
conslder thepre88Dttraftlc middot~ytaa an4tranaportatlon
systems Thecl1D1cahoUld be located close enoUlh to
major arterlals to giva asy access from the total area
be_ ervecl by this cliD1c At the t1ll8they should
be tar eo away froll thesarterlals to all8Y1ate traffic
CODCell18 andpark1D8 conpstlon By traff1c concerns I
IJ
37
lIlan one lUSt consider thertarro1fne8S of streets whether
streets are oD8--C)r two-way iqres8 and egress to parking
amp0111tie eros tratflC) spedof trattJQ children 1n
ll8a traffic i1lht Vislon re8tr1ctionS etc
BwstraDsportat1onshould alao be central in this area
as maay people ~U f1Df1 1tD8Cessary to use this form of
transportatlon
~e tutqredlopHQt of bull treewa systems should be
c0J1S1dered soastolesen thecumce ofmiddot future roada
cutt1DSotltbe cl1D1c llte line
nrrph1c middotDampta
It is 1JDportaDtto kDOw the demosraphic distribution
characteristics of the oUenteltbat i8 to be served by
localized health cl1D1cs
Acl1D1c which erves8J1 area where1D the prepondershy
ance of persona arecrter 65 years of mayf1nd that these
people rely more on pUblic transportation call for more
home- services and haV4t 110ft ChroD1c and debilitating
types of disorders (b1_ blood pressure poor heariDg and
eyesight) tbaD do8 an area ot a YOUDIer population On
the other hand thL area of older residents may have little
need for family plabDlng cllni08
In order to better ~Ybullbull the 4eaoraphic population
of each CeD8U8 tract the 1970 CeD8U8 iatormation was viewed
and two specific catelOri8 considered These two cat
IJ
38
lori8S woUld be the perc_tap ot population under 19
year of ase and the percentase ot each oensuetractover
65 years of age he 1960 1Dtormatlon tor eaCh tract was
then compared witbthe 1970 intormation and a percentage
ofincreaae or4ecreamp8 tormiddot e~chtract1n each category
cOJlputecland achartma4e By the use of this chart one
18 able to View tJleap populat1odiatr1but10n of census
tract and at the _ t1lle accesa middottrencl Por example
let us choose census tract 601 W see 40-4 otthe
population is under 19 years ot and that ODly82 1s
over 65 years ot middotAtthe e tille the percentage of
youth bas ~ed ODly 1_ intbe laSt teD year whilethe
percentale over 65 year ot middotbas stayedmiddotthe same With
this in mJnc1 ODe ~ 1DfItr libat ol1D1o aerviDg this
area WOuld bellQre conq~w1th the problems of a
YOUQier populat1on and that _ would probably be true foJ
some t1aein tbefuture On the other hand CeDSU8 tract 54
has only 2 ollt population UDder 19 yel1s ot age and
this has decreased by 1 over the last ten years middotwhile at
the same time 32-377 ot the populat1on 18 over 65 years of
age A ol1D1C ___ this area should be or1eJ1ted toward
tbespecttic problema otthe ampledbull
PerCapia __ bY gsa neat
WhaD cona1der1qlooat10D1 tor health cl1n1cs one
shoUld take the 1DC01Ieot areas into consideration Areas
IJ
39
of lowiDcome would not 11kel~be 8erved more by localized
cl1D1cs tbaD would are of hilbincome It 18 likely
people haYiq a hip iDeoll8would preter to be aeenby a
chosen ~r1vatephylc1a1l tban at a local cl1D1cwhere
10Dier waits y beraceaaampryand leas personal attention
gl_
The 19701ncOII81atoWampt10n tor MultnomahC~ty was
not available at the tille thi8report W88 made The 1Dto~shy
tiOD Was taken ~adtro tbe1960 census publlcation
his woUld ~8Il thea tbat ral1I8 OD the chart ynot 1raquoe
completely accurate hi writer telthatthe areas most
affected by tb8 1I8eof the older 1Dco1DtOlaat1oDWOuld be
those tracts wh1ch baYebad a rapid 1ncreaae1n populatlon
over the past tfmyHr8 bullbullbull tracts would include tracts
nUmbered 104 9897 96 aDd 95 be perc~ita 1Dcome
referredto1il-tb1a Paper18the lIean 1DCo per person per
census tract
Attar the iDeoeper census tract was listed on a chart
a map was de 1D41catiDg those census tracts belonging to
the lower 14 ot income tor all censue tracts in Multnomah
COlDltytbose beloqins to the upper 14 ot income tor all
census tract 111 MultnolUlhCounty and those belonging to
the mid 12 ot 1I1coaetor all oeuuetracts in Multnomah
C01mty
In yiew1Dg the _p 1t caa be seen that the low income
area seautotollow aloas the at aide ot the Wl1lamette
IJ
40
R1ver the full length of Kultnomah County A second low
income area follows the south edge of the Columbia from
the northwest corner of Multnomah County easterly to 148 St
A third problem area seems to be on the east bank of the
Willamette River with the Union Pacific Railroad being
about the center of this tract The extreme loutheast
corner of Multnomah COUDty appears to be a low income area
but as this area bas bad rapid grouth in the last ten years
this could be erroneous
Mental Health
be first ~ecific indica to be selected from the
Multnomah County envirollllental survey of early 1971 and
to be considered in this paper i8 that of Mental Health
At the present for mental health purposes Multnomah
County is divided into five catchmentareas with a mental
health cl1n1cin each area These clinics are Model
Citles Delaunay ADkeny street Office Hansen Health
Building end Southeast Clinic
All lIlental health cl1n1cslcept statlstlcal information
on all patients visiting their cl1n1cs this included the
address of the patient hese addresses were then listed
upon the approprlate C8D8US tract Each census tract was
then ranked on a chart according to the nUllber of mental
health patients who reslde ln thatCeDSUS tract attending
any of the above listed ental health clinics This chart
IJ
41
wasttum d1v14ed1ato proper quartile bbullbullbull
quartile vereUs to dne10 u appropl1ate Multnoh
County _tal health ItLa middotmiddotmiddotthelipO~a1bl by lOoJcJIUE
at the UDtal health _to uteN1De which ueu have the
lars-t use otCOllDty 1alh~th faci11t1Rot
1Ilclu4ecl 111 tbia woUld tber otpeopleYia1t1Da
pr1vat patch1atriata aDd pr1_t _ntalhealtb cl1D1c8
WheDtbe M1 18Yienclmiddot Itmiddotmiddotmiddotmiddot~middotbe~_ tbat ~rtt
appears to lMt fourmiddotmiddot-al are iii _oil the nuaber ot
lIental healthcl1D1c na1t toM tbjh1sheat 1he
tour areaa woUld be tollows
1ttrea Ore to~Blo Drimiddot ~tb Burrus14e aDd tIMtmiddot Colb1a Riftr H1gbwyaeri1Dla th nortllra boundaryshy
2 bull ProII 82D4 1_~ 10 20th streetwitil the ra1lMd Mu the north ltouadary
3 ~ et et tUgl_b1bull MYel froamiddot the Clackaaa COUDty l1ae aorth to Dln8lon stret
4 beDOlvt1ttfe-t ~efllt4 COatytrca Jle1aware streetmiddot toR1C1a11oDd wlth Colubla Blvd heiDI tbAtnorth bouaclary_
It ODe coapareatbiap to th iDeobullbullmiddotp 1t can be
eamiddotthat lIOat ot the c tracts baY1Dg bllh v1i11tatlcma
middottfl public tal health cJ1rUc8 ~ 111 t13e low ~ aid
1DcOile SroupiDIOJa1y of til 25 tracta llsted as
haviDlbip aental Maltll nlltatlou are ~ the1g60 hip
iDeo arebullbullbull
17 Plpn
42
amily PlellnSDI ]Jlce Metal Health i8 an 1nd1ce of
use Theperson 111 ordertobavebe_ 1Dcluclecl 1n this
atu4ywouldhave tohaft Ue4 ataa11y plaDI cl1D1c
tacilities of soaetype It 41fter troll tile _tal health
study1nthat i t1Jicludestatist1catrollbotb public and
privateclJD1os
The iDformation tor the iak orurcbart 8Dd map of
t8ll111 plenn1 na ob1a1De4 by cOIIblnlDlthe mabel of
1rlcuv1duals bullbull_ attbe tbreellUltrampo-ti Coatyhll11y
PlalJQllIl C11ll10s 111til tbo at the Planned PareDthood
Association CliD1C8 be tbree -JIultDouh Couaty r8ldly
PlamSq Cl1D1c are Solrtbweatth Col_bla 1111- a114
HaDsell Health BWlcl1Dl CllD1cbi middot1Dtormat1oD vas then
bullbullbullesed tomiddot detellWMt l10w people troll eacb c8IUIUS
chart wastben Mele IUs oIIart jn 4iY1ded to show
the censuS tracts lIaYiDlmiddottIle h1t1iest qUart1le of incidence
of use lowest quartile of 1Qc1deao ot use Jlid 12 of
incidence of Wle an4 a map sprepared troll thts 1Dto~
mation
The C8U118 tractsbelOJISnl to the h1lhestquartile of
use appear to be 1lO~ 8catt~ on tbipwas true ot
either the _p ot aental health cl1D1c uaageor ot the map
abow1DI per capita 1I1COM Iaere40 to be three
d18t1nct areas of UIIaP beJ woul4 be
1
IJ
43
t10D of BurD81cl and the W11lallette River 4
2 S~t Portland 8Otth otmiddot the ra11shyrcaadand alona the W11lamette River
lIortbeaat Portl8D4 between MisSiss1pp1 and 24tbStreet the northbouBclary be1DgColwb1aBlvd
Pylzl1c BMltl IrpI Y11ta
Publlc Healtil nur81D1Y1s1t nclud8 an vists to
theholles of client by PubUc Health Nurbullbullbullbull his shows
visits to bull f8Jl1ly fer aDY purpos SUCh aatuberculolJ1s
het1Dl tem1tyaeatalu4 8IiOt10D8l cODd1t1ona etc
he atat18t1C~ 1fele C()4ed accord1Dg tomiddot the 1llli301fOCUS
of the Y18lt tt doe DOt 1D41cate the Dmlber of holies or
f8ll11lev181tecl or 1D41Y14ual Y1a1ted more tban oDcein
the propwl It dobullbull I1ve 80M 1D41cat1on by coaparlshy
OD ot the 8JIoUDt of aedlcal problema 1n eachcen8WI tract
Ap1nmiddot the _p abowa 8 scatter patteraof probl_
areas althoUSh there appear to be a sroup1Dl of hiSh J
l8aIeccmaus tract 1ntlut extreme southeast part of tbe
County other areu uIriaI any nura1Dl contacts are
1 bull he 801lth-oa-al CO1Dty on eaCh 814 of 82nd Av from Clackallaa County north to Dinloa
2 ear bullbullbullt 814e aroUDd Preacottand Misaisippi
Dowatom Bunul14eonboth 1de of the river
44
V_real Pis The iDfomatloil uaec1 to tabulate the Venereal
disease chart includes all the ooab1ned case otmiddotODormea
and syphilIs reported by bothmiddot publIc and prIvate physicIans
dur1nl 1970 There were 3602 caes ot IOnorrhea reported
dur1nl 1970 While ODly 17 cabullbullsot ayphilimiddot were reported
A chart was prepUed aDd att8llPt wasmiddotmiddot de tomiddot
determ1De Wh_therVttDereal 41ease was more p~vaJent in
areas othigb or lowmiddot proportIon ot youth hi waadone
bymiddotdetemlna a 1leaD prceiltacmiddotmiddotmiddottor the population ot
resld~ts UDder19 years ot (34) middotA mean ratemiddot per
100000 popUlatIon al80c1ttem1Ded tor the middotoccurreDCe
ot venereal dieae This was et at 390 oass Areas
hav1nl a population 1n which leiS than 34 were lmder 19
years ot ampIe were called low- yOuth abOve tbl percentaae
hiSh youth The aaa waatrue ot the occurrence oivenershy
eal disea_ per CeD8UStract It the rate waacomputed
as 1I0re than 390 cases per 100000 it was called hiah
venerealdiaeasei it less than thia tisure low venereal
disease It was tound that 1D Multn~ COmlty there sems
to be poSitive OOlatI0n(x21S19gt between low youth
and hipmiddot venereal diseaand hip youth and low venereal
diseasebull
RaDk ordr Iitot all c traot middottbAm made
Th1s was done byt1Ddlna the ratepr 100000 populatIon
of venereal disator all census tracts in the County bull
45
These were thenlisted from h1lhto low (sreatest to
least) in a rank order The l1sting was then divided
into Upperandlower 14 aDd listed on the MUltnomah
Countymiddot up
The areas of b1gh venereal disease se8ll18to
roup thBl~8 middotin a very tllht area ~oq both 1des
of thell18l8~ R1 w1th BurDaldeS~et being
~bout theceDter qf tbi8IZ9uping This area woUld
appear to be m ldeal spot for the denlopment of a
locallzed venereal d1sbullbullbullbull cl1D1c
UbepoundCUlO1s
In this report bull tube1C1llosls caS8S refrred
to include alltbobullbull cabullbulls ontubercUlo8is follow-up
rather middotthan just new C Accord1Ds to the Multnomah
County Health SUrvey of early 1971 this would include
all ca repOrte4 over thelaat three years The
total number of tuberculosi8 cabullbullbull usedin this study
was 666 lh1 included 128 new cabullbullbullbull
A rate per 100000 of tuberculosis for each
census tract wa- then computed and the c~us tracts
listed by rank order be b11h Qartlle mel low
quartl1 were then reoordd on a Multnomah CoUnty map
TWo genral areaa baY1Dg a hip mcldencaot tubercu~
losiare 1D41cated heyare
1 Both middotsld ot theWilla11lette River
Ll -
46
with Burns1de about thecnter
2 he extrea Northebullbullt comer of the County bull
By coap8r1ng the tuberculois an4ven8real
diseae maps ODe can 8ee that the downtown areas ot
hiSh 1nc1denceare alIIo8t 1c1eDt1cal on ach map
This WOuld 1nd1cate that 1t would be of value to
bullbulltab11sh acl1D1c 111 th1aampreatbat would provide
bothtuberCulos1s 8Dd ytmereal 418ase srvicbullbullbull
Thchart aDd 1181gt8 are wsfuln 11v1DI
1Ddicat10DS tor the type aDd placemeototlocal
health cl1n1c8 tbro1qhout tbe MultnomahCounty area
A cOllpar1on of the mapa help one to dec1dewhether
to provide a aulti-8ervice cl1D1c or spec1f1c type of
cliD1c As stated in Part I of thi paprserv1ces
shouldhaYe both treatlieDt and prfMmt10n cOmponents
As he been stated fta ne1lbborhood health care
Qenter muat be a fac111tY plazme4 with an aamesa
ot the neds of the consumer and the c01llll1m1tybull
Part II of this rport haa been an attaapt to indicate
and clarify 8011 ottheae coDlllUDity neds This has
been done through8elect10n of apc1f1c problems
The indic were then visuallyrecorded through the
use of ups and charta ODe dan asseS8 thedsreeof
1DIportance of certain concems to spec~t1c areaa by
comparinl the chart aDd maps Prom this oDeean
41 dec1de which are48 vb1chcUD1c-or indeed if
the need a clinic at all However further factors
should be considered hebullbull include
a The amount of fuDd1 available
b What 18 the percentage ot peopleineoh ceaaua tract tbat would actually us such cl1n1cIl
c Wbat 1 tbeco--1tymiddot 8 IeeliDashyreaardtDI particular cl1D1c8 Would this dcrebullbullbullmiddot the ettctiveness ot thse cl1n1ca
IJ
li
D_OlraphicPopulatLon Challie 1960 to 1970 48
Cen8U8 1 of Pop 1 Cbaqemiddot 1 Change1 ofPopTract Under 19 Yr8 Over 65 Yrs1960-70 1960-70
middot1Q701Q70
1 319 -12 171 -H) 1
2722 215-27 +68 301 366 -22 127 +35 302 371 +19 111 -04
311middot401 144-41 +29 402 321 13~7-39 +24 501 356 124-08 -02 5~O2 351 133-23 +12
405601 82-10 -02 394602 103-01 -06
701 275 149-76 +56 702 361 +01 121 -07
+10middot801 326 140-22 802 321 middot127
(
-29 -03 9~01 342 124 -H) 6-18 902 294 128 -H) 3-24
10middotmiddot -14312 140 -17 1101 182 +25 -23197
2411102 186-59 +29 1201 226 169-17 -41
31middot01202 +11 182 -05 295 -H) 81301 208 -H) 4
1302 331 +08 197 +04
14 323 +15 middot185 -08 middotmiddot15 329 +16 16~5 -13
-28middot 1601 332 131 +12
1602 356 98 +24middot-39 middot3101701 161-33 +21
1702 370 -15 85 +02 +19 1801 264 151middot-50
185middot1802 256 +47-58
IJ ~
D_raphlc Population Change 1960 to 1970middot 49 (Contd)
4io
Census Tract
of pop Uncter 19 Yra
1Q1n
1Cha1l8e 1960-70
of PopOver 65 Yra
lQO Change
1960-70
19 389 +29 141 -24 20 223 -13 206 +18
21 227 +08 194 -36 2201 356 -27 112 +05
2202 290 -18 ll~9 -29 2301 356 -03 154 +24 2302 260 -37 245 +97
2401 410 +6~1 123 -31 2402 163 -80 320 +99 2501 381 +13 140 -01 25()2 237 31 lil +02 26 343 +25 186 +149 2701 370 +29 1S5 -01 2702 249 -44 304 +98 2801 337 +19 187 +09 2802 306 -10 156 +31 2901 304 -38 142 +24 2902 i 307 -32 146 t3~9
30 29~0 -48 16~2 +51
31 355 +30 160 +01 32 370 +48 148 -13 3301 395 +45 130 -20 3302 368 +06 138 -02 3401 386 +16 117 000
3402
400 +32 92 -26 3501 304 -07 115 +35
3502 344 000 140 -13
3601
36~02 357 -04 132 +32
3603 30~1 42 149 -67 3701 342 +28 152 +19
1
IJ
Jianolraphic Population Chan 1960 to 1970 50 (Contd)
Census Tract
of Pop Under 19 Yrs
JJl7J
middotChanae 1960-70
middotofmiddotpop Over 65 Yrs
1c~7n
Change 196070
3702 409 +39 122 -11 3801 308 -11 151 +29 3802 275 -35 180 +46 3803 282 -32 192 +54 3901 376 ~13 100 +17 3902 296 -03 177 +29 4001 438 -11 84 +13 4002 353 -21 115 +20
4101 397 11 9middot0 +11 4102 346 -19 120 +03 42 331 +19 11 bull 3 -16 43 347 -72 105 +31 44 113 +84 183 +154 4S 33~9 +07 110 -06 4601 2501 22 193 +38 4602 332 +59 126 -29 47middot 161middot 000 211 +01 48 103 -26 302 +59 49 138 +1 bull 3 252 +09 50 141 -26 204 -12 51 12 -39 257 +07 52 47 -61 351 +48 53 89 +49 314 -30 54 25 l1li15 327 -17 55 131 -17 115 -121 56 198 +93 227 -47 57 71 102 189 -88 58 240 ~middot41 16~1 +55 59 322 +25 142 +06middot 6001 264 95 132 +50
6002 328 -31middot 89 +07
JJ
Demographic Population Change 1960 to 1970 51 (Contd)
Census 1 ofPop lChange of Pop bull ChangeTract Under 19 Yrbullbull 1960-70 Over 65 Yrs 1960-70
1970 1970
61 355 -58 85 +39
62 328 39 110 +18
63 414 04 73 10
64 382 -22 72 +04
6501 383 02 67 -20
6502 329 -56 96 +09
6601 391 +13 88 -03
6602 319 -59 97 +06
6701 327 71 145 +72
6702 331 ~67 83 +1-0
6801 365 -66 49 +01
6802 388 4bull3 54 +06
69 354 -41 80 +23
70 400 -23 68 -06
71 359 -48 72 +05
72 255 -88 82 +11
73 346 -39 91 +25
74 313middot -63 105 +24
75 329 -42 129 +37
76 336 -52 85 +21
77 370 -10 69 +05
78 309 -10 120 +21
79 325 -56 87 +10
8001 358 -81 57 +12
8002 391 ~81 76 +12
81 315 -76 108 +21
8201 403 -23 64 +08
8202 392 23 65 +08
83 357 -34 120 +31
84 402 -18 73 +16
85 413 -06 76 -09
r
Demographic Population Change 1960 to 1970 52 (Contd)
Census Tract
t of Pop Uncler 19 Yrs
1970
Change 1960-70
1 of Pop OVer 65 Yrs
1970
ex Change 196070
86
87
88
89
90
91 9201
9202
93
94
95
9601
9602
9701
9702
9801
9802
99
100 I
101
102
103
10401
10402
lOS
368
351
379
391
391
413
379
433
372
429
414
432
419
439
~32
377
457 420
378 41middot7
345
360 417
417
412
-04
-02
-35
-26
-28
-11
-64
-20
-S9
-39
-32
-21
-34
-40
-47
-lO~7middot
-27middot +04
+56
+07
-34 01
+04
+04
+10
103
128
97
11il3 99
69
79
42
77
46
34 38
44
40
54
111
51middot
81
133
59
74
140
63
87
76
-08
-06
+04
+08
+17
-05
+3S -02
+1~4
+19
+33
-14
-08
+12
+26
+71
+11
-16 -34
-20
-19 +37
-49
-2S +15
NOte The The
Taken frOi
averageullder averageabove
middotUSCensus ---shy -
19 years == 6S years ==
figures 197
32r 13(14
p a~d 1960
--
Rank
1
2
3
4
5
6
7
8
9
10
11 12 -_
13
14
15
16
17
18
Tract
69 46
60
58
- 68
61
302
2501
67
63
19
62
26
94
3603
3902
64
30 -----~-
Rank
19
20
21 -
22
23-shy
24
25
26
27
28
29
30
31
32
33
34
35
36 -
Ranking of Per Capita Income by Census Tract
Tract
65
2701
- 15
1601
701
66
93
82
2903
3602
30
2502
80
2401
81
- 70
91 shy
4001
High
Rank Tractshy
-32shy37
38 97
120239
7840
41 ~ _2_1__ 42 31
43 2501
44 18
45 98
46 37
47 3803
1702
49
48
1602 92 2702
I
50 89
51 901
52 801
Ra_
53
54
55
56
57
58
59
60
61
62
63
64
6S
66
67
68
TractTract Ra~
74692
170196 70 I
401 71 90
72 1037J
79 70273
3802 74 601
24024102 75
85 76 101
77 9023901
7699 78 100 4101 79
3601 I
380180
458140~ t---- _ - - shy83 82 42
888384
59843501
4777 8~
502
Low
802 86
Rank Tract
87 shy
--88
89
90
91
92
93
94
- 95
96
97
middot98
99
100
101
102
103
104
1201
14
49
72
73
43
87
3502
105
1
52
86
71
1
501
10
3301
104 tf
Rank
105
106
107
108
109
110
III
112
113
114
115
116
117
118
119
120
121
Ranking of Per Capitalucoae by Census Tract
(Contd)
Tract Rank
4001 122--shy602
13
1102 2302
3302
55
3401
48
21
56
50
3402
lL01
2202
2301
53
2201
-shy
Tract Rank Tract Rank T~aet Rank
57 I-----
Imiddote
bull
Tract
- Low -k Note Information taken from 1960 U SCensus
Rank Tract
I ~
Ie
Imiddot
~
----
----
--
--
Rank
1
2
3
4
5
6
1
8
9
10
11
i-
-Tract
391 922 921
972 971
100
132 131 121
962 961
822 821 401
982 981
20 111
47 10 1
412
High
Total Number of Henta1 Health Visits
Ranked by Census Tract High to Low
TractTract RankTractRank Rnk
12 182 22 78 29 87 76 381 73181 ~------- 1913 371 8538230162372 271 2616-121 8272 2
14 80~2 31 94 7923 84801 59 15251362 4232 15 52 _ 32 103 8924 651 17240216 652
_ 91 351 33 341 23117 83 122 25 25 48 1123921418 34 shy61 86 661
19 662 6493 81 26 91 8153 49 50 55 41383 71 27 51 3120 90 672241 35shy 104167162 461
I 411 46211121 28 88342 I
2502 36 69 54 5251 50 272
-Ra
37
38
39
_ 40
_ 41 Ishy
I
42 I
-I 43 44
45
shy
Tract
~ --- shy 95 56
45 292 242
102 62 352 291y
92
101 281
99 72 63 601 60~ 42 2201
77 74 61 57
363 232
70
32 31
11 44 282 2202
Low l
- Tract
46 682 681 I 331 30
r~$ 47 1042 332
48 102_41_
11
~
Visits to Family Planning Clinics Ranked by Census Tract High to Low
Rank Tract Rank Tract Rankmiddot Tract Rank Tract Rank Tract Rank Tract
1
2
3
4
5
6
7
8
9
10
11
12
13middot
14
15
16
17
361
56
401
341
48
59 121
20
55
342
10
31
58
93 21
241 132
331
53
461 462
18
19
20-shy21
22
23
24
25
26
27middot
28
29
30
31
32
33
391
32
middot47 I-i-_-shy _ -
231 111
332
972 1
372 371
52
89
32
92
82
100 31
182
30 242
402
34
35
36
37
38
39
40
41
42
43
44
45
42
1714 i 661 221
78 362 2
90 602 601 352
63 251
105 921
971 351
73 42 292 232
411 51
662
81 45 52
46
47
48
49shy
50
51
52
53
54
55
56
961
801
49 81 72 71
19
9~1
172
68 2 57 162 14 112
91 75 681
381 42
3~3
83 161
57 f
58
59
60
61shy
62 Imiddot
63
Imiddot 64
65
66
64 62 36~3 252
74 652 SO 392 291
651 6bull 2
79 271
r-- ---- shy981 222
672 671
821 272
94 87
281
382
67
68
69
70
71
72
73
74
75
76
77
78
981 26 12~2
IS 61
85 82~2 69
61 43
101 86 84 282
76
131
51 72
1041 962 88 70
99 922 77
103
95 802 181
i
~
Low High
RankRank Tract
5479
4480
81 1042 ~) middot102
71 - - + ~ - ~
Visits to Family Planning Clinics
(Contd)
Tract Rank
I
Tract llaDk l
RankTract Tract Rank Tract
~
I
~
J1 ~
Low
Total Number of public Health Nursing Visits
Ranked by Census TractsHigh to Low
TractTract RankTractRank RankRank TractTractRankTractRank
25249 71 79 17249 8033 6586 99189711 84 2915072 34 661 76 66 811519512
402 5035 51 161 2518220 122 1713423 352 55801 7120 6752 2 149814 41236 83 2662 38 94 6821 53 2924015 362 37 32 42 75 69 281 84 63
546 8822 54 222 85 3925431 70383417 3818223 6439 4386652 718 21 55 103332 8924 232 87 19 271729219619 24156 16211140 382 628825 10523110 112 73411 10141-- ----shy 89 363 4457 8126 16111 221 74 9142 90 46158331 53 671279012 46243 48 59 351 3837528 1083 9313 91 5844 59 -_242 76 1----- shy60 272 72 74104114 60145 42 9287 7729 92 6151 8215 57371 934630 91 307762 12113116 282 619447 41391 9531 78100 63 7378 ~95 681 6945 32 5632 798517 6448 47 52 181
High ~ Low
Rank Tract Rank
96 31 132 70
97 102
98 182 372middot 602 651 662
- -shy
~72 682 802
822 922 962 972 982
1042 ----shy
Low
Total Number of Public Health Nursing Visits
(Contd)
Rank Rank Rank TractTract Tract
I
I lt
I
Tract Rank Tract
[
~~~-
I
~
IJilfimiddot ~
j
Ranking of VD Caea According to Census Tracts 61 By High and LOll Youth Itatio
A media~ of 34 5 was determined Any tract having greater
than 34 5~ of popu1tionunde~ 19 years of age -High~
Any tract having l8S than 345 of population under 19
years == Low
Any tract having rate less than 390 =Low
Any tract having rate more than 390 == HLgl4
YOUTH
LOW HIGH
L
0
12 402 1801 1802 343 2801 2802 29023603
54 6001 600262 66~02 72 74 75 76
78 79 81 t02 65 1202
W
(25)
VD
H
I
G
H
401 701 801802 901 902 10 1101 241 1201 1301 132 14 15 1601 1701 20~ 21 2202 2j02 2402 2502 2702 2901 303501 3502 34023801 3802 383 3902 42 44 45 4601 4602 47 48 49 SO 51~2 53 55 56 57 58 S9 6701 6702 73 95
3~02 7021702 19 25~01 2701 4102 4101 63 64601 ~601 6801 680270 7l 77 8001 80~02 8201 8202 83 84
85 86 87 88~ 90 91 9202 920193 94 9601 9602~ 9701 9102 9801 9802 99 100 101 103 10402 105 6501 10401
(47)
301 501 502 601 1602 2401 2301 2201 31 32 3301 3302 3401 3402~ 3602 3702 3901 400140 02 43 61 69 B(
(53) (23)
~ ~gt
Ranking of VD by Rate Per 100000 By Census Tract
~
Rank Tract Rank Tract Rank Tract Rank Tract llank Tract Rank Tract Rank Tract
1 2202 21 S6 40 902 58 1602 74 75
90-shy 64 107 26 --~-
2 3402 22 45 41 10 59 902 75 78 91 54 108 61
3 2301 23 3502 42 2502 60 602 76 6802 92 402 109 87
4 3302 24 49 43 1102 61 501 17 2 93 94 110 90
5 50 25 52 44 6702 62 14 78 8202 94 97 02 III 76
6 2201 26 20 6701 63 4002 8201 2501
9701 41~02 112 91
7 44 27 48 45 401 64 3802 2902 95 63 113 62
8 3301 28 1701 46 502 65 30 79 83 74 96 9602 114 71
9 55 29 47 47 42 66 3803 80 2801 96Q1 115 85 10
11
12
13
14
15
16
17
18
3401
53
2302
2401
57
21
2402
1101
51
30-shy31
32
33
34
35
36
37
3701 - -~ 1201
3702
89
43
132 131
3602
4001
48
49
50
51
52
53
54
55
58
1601
601
4602 4601
69
701
31
3901
67
68
69
70
71
72
2901
801
39021~ 802
6502 6501 122
702
41~01
81
82
83
84
85
86
87
88
19
1
1702
2802
79
93
100 6801 6602
81
97
98
99
100
101
102
103
104
9201 9202
9802 9801
77
302
79
86
72
84
116
117
118
119
120
121
3603
8002 8001
101
99
95
10401
105 10402 103 102
19
20
59
32
38
39
2702
3501
56
57
301
3801
73 1802 1801
89 6002 6001
105
106
2701
88
High Low
-- -----
Rank OrdermiddotTuberclosis Cases by Rate Per 100000 Ranked by Census Tract High to Low
Tract TractRankTractRank Rank TractRaukTractRankTractRank
801
79 9601501411 52 6835340120511 I 960269 903603532036 $-~~F130221542 4366 311301 70 68~013802 _ I- _ 4001_37213 3921201 6802802 H71523822024 22 54 193302 3802 80 8958 I37139535 70155 9801 I60123 72 6702 98023914011016 6701250124 10 56
81 94 401r 7 154152 73 7057 2625 122 92028
90242 162312301 92~158 86 7172434526509 82 79160159 74 100 87412240227220110 6502836960 75 30 8317244 6501782801285711 61 901 42765645 84 66021459294912 9701 660146 171 302 9702 47
6235023033113 85 822821182 917755 16335013110214 841814832 78 103 938564 324815 86 1057940149272 38036523216 10401 87 2902241 725Q 10402360266340217middot IF88 88 9937233 282 51 218 101 01102 46016234
I)167 2901460219 47
High ~ Low ~
- -
TractRank
9S89
6490
8191 8001 8002
63 61 60middot01 6002 44 2701
92
J
2502 402 --- ----shy
I
Rank
Rank Order Tuberculosis Cases by Rate per 100000
(Coutd)
Tract Rank Tract ~nk
I
Tract Ballk Tract Rank
Imiddot
Tract
Imiddot
1~
t 1I i Pi i l I
o
1 -1shyL I
I J
8 40 icO ~ I -lt 0
-t (1) I
i I
r o E
II
a
I
r--i
shy
I
~
I (
Jgt
(011 fi(
Ggt
I II ~j
()
(f 0
~ ()
I
11
f9
r
II 99
o ~
Ggt r
~ __-J~ I t I ~ I
r--J l I
~ _ __ J
) 1
fTl
1gt
r I
()
r
()
lt en -i en
()
I1l
(J)
(J)
-i
P ()
19
r o ~
r G1 I
I
c
~
o I 89
--- -I-shy
r-r I
1- 0 _~ _ _--J E
G1 I I I
i i
I 1-1-1 ~ _J ~2 ~ II
II
()
1 I I I 1
id i bullbull
~
A n 69
r 1shy
- 0 Gl
l--~ ~ I
~ II
II )
I () isect i
en l i
(J)
-t
0
IA Ol
IJ
14 De Diaz Sharon Daniel Beyond Rhetoric The NENA Health31 Center After One Year unpublished paper pres~rited to the American Public Health Association 1970
15middot Gerrie NorrrianF and RichardH~ Ferraro Organizing a Program for Dental Care in a Neighborhood Health Center Public Health Reports 8 (Aug 1968) pp 419-428
16 Gordon JeoffreyB~ The Politics of Community Medicine Projects A Conflict Analysis Medical Care 7 (Nov -Dec 1969) pp 419-428 shy
17 Greely David The Neighborhood Health Center Program and Its Implication(3 for Medical Care H~alth Forum of the Welfare Council of Metropolitan Chicago (mimeo) 1967
18 Greenlick Merwyn R Newgtimensions in Health Care American JOurnal of Pharmacentical Education 34 (Dec 1970) pp 754-4
19 GreenlickMerwyn R Donald K Freeborn TheodoreJbull Colombo Jeffrey Abull Pruesin and Erne$t W saw~d Comparing the
Use of Medical Care Services by a Medically Indigent and a General MemberShip Population in a Comprehensive Prepaid Group Practice Prosram II unpublished paper presented to the AmericanPublic Aesociation1970
20 H~tadoArJiloldVMerllYll RGreenlick and TheodoreJ Colombo Determinants of Medical Care Utilization Failure to Keep Appointments unpublished paper presented to the American Public Health Association 1971
21 Johnson Richard E and Merwyn R Greenlick Comprehensive Medical Care A Problem and Cballengeto Pharmacy ff AJilericanJournal of PbarmacenticalEducation 33 (Aug 1969) pp 361-367 -
22 Kahn Alfred J Studiee Social Policy and Planning New York Russell Sage Foundation 1969
23 Kotler Milton Neyhborhood Government Local Foundations 2 Political~New York The BobbsMerrill Company 1969
24 NationalCommisaion on CommunityHealthSfrvic~sActionPlanniriamp for Community SetithServices~ashington p C Public Affairs-Press 19t7
25 National Commission on C~mmunity Health Services Health Adminishysration andOrMPization l the Decade Ali9$-d Washington D C Public Affairs Press 1967
26 NationalCornmiesion onqomm1Jllity Health Servicesbull Health ~ Facilities Washington D C PUblic Affairs Press 1967 bull
~ n
32 27 ODonnell Edward J and Marilyn M Sullivan ServiceDelivery
and Social Action Through the Neighborhood Center A Review of Research tt Welfare ~ Review 7 (Nov~Dec 1969) pp 112
28 Office of Economic Opportunity Second Annual Report Washington D C~ U S Government Printing Office 1966
29 Office of EConomic Opportunity and the Medical Foundation of Be~laire Ohio Eighth Report 2l ~ Committee2a Governshy
ment OperatiOll~ Va8hiiiSton D C Government Printing Office 1969
30 Pope Clyde R Samuel S Yoshioka and Merwyn R Greenlick Determinants of Medical Care Utilization nhe Use of the Telephone for ReportiDg Symptons Journal of Health and SocialBebavior12 (June 1971) pp155-162 shy
31 RenthalA Gerald nComprehensive Health Centers in Large US Cities American Journal of Public Health 61 (Feb 1971) pp 324-336 shy
32 Saward Ernest W The Relevance of Prepaid Group Practice to the Effective Delivery ofHealthServicestt The New Physician 18 (Jan 1969) pp39-44 - shy
33bull Schorr Lisbeth Bamberger and Joseph T English Background Content and Significant IssUes in Neighborhood Health
Center Programs Milbank Memorial ~ Quarterly 46 July 1968) part 1pp 289-296
34 Weiss James E and Merwyn RGreenlick UDeterminants of MedioalCareUtilization The Effects of Social Class and Distance on Contacts With the Medical Care System Medical~ 8 (Nov-Dec 1970 pp 456-462
35 Weiss James E MerwynR Greenlick and Joseph F Jones Determinants of Medical Care Utilization The Impact of Ecological Factorstt unpublished paper presented to the American Public Health Association 1970
36 Wise Harold B Montefiore Hospital Neighborhood Medical Demonstration A Case StudyMilbaDkMemorial Fund Quarterly46 (July 1968) part 1 pp297-308~
37 Yerby Alonzo S ttHealth Departments Hospital and Health Services Medica1~5 (March-April 1967) pp 70-74
38 Young M M~ Chatanooga IS Experience with Reorganization fOr Delivery of Health Services ttAmerican Journ8l of Public Health60 (Sept 1970) pp 1739-1748
f or l
II bull 11 Y d
II
IJ
34
ThepurposeOfPart II of th1aa paper1atod1scuas
elected Speclfic needs ofecltlc areas within Multnomah
County A8P01ll~oUt 1D ~ I of t1a1bullpapermiddot Ita nelgbshy
borhood health oare cater IlU8t be a facl1lty plaDlled with
aD awarenes of the neeels of the oODllUller and collllUDity
Part II of this paper nIl Show 80e of thoe speclflc
needs
he1DforutiOD tor t1li Portlon of the report
obta1nec1 troll tbroupout tbe follow1Dl threepUb11catloDS
1gr~e_tiMshylIPrIxaiidOreson JuDe 1963
2 1~_middot_sectSI8e~ected1teai c-ua 0 S 8 e first count coaputer tape Coluab a_lion AssocshylatloD of QoveraMD-8 Jlme 1971
3 Jtu1tDoab County Oreaon BDY1roDlHtlltal SurveyEarly 1971
The JIultDOIIIlb COUDty OrttIOD BDv1roDllfmtal Surley
Barly 1971 1s bull stat1stical report of the activ1tles of
theentlreMultDOIIIl2 CcNDty Health Dep~t during the
year of 1970 Die speclflc 1nd1cs elected from tb1s
study amprejMental aealtll Publlc Health N~s1D1 vlslts
FaJUly ~ Veaereal])1 ~ ~rcul081
Throush tie use of cUrts and mapa ODe CaD roup these i
speclflc ~oea to ahcnr the healthneedsof speclfic I
census trtcta aD4 then the health needs of iarer neIghshy
borhooda 1m4 o~ Uebullbull
Rf)~UP1Dl of areu was accompllshed in thefolloWinl I
JJ ~
35
he MiltDoIliahCountY oregon BDViromaental SUrvey
early 1971 isamp statistical report ot tbeaotivities ot
the entire MultDolllh COUDty Health ])epartiDent dur1nl the
year ot1970 he specitic 1Dd1C8S selected frOm this
aUy are 1Il8Dtal health public healthDurs8s visits
fUl1ly pia waereal elisease aDd tuberculosia
Tbroq11the Wle otcbart aDd mapa aDecm szoup these
specific indic to show the health Deeds ofapecitic
ccmaua tracts aDdtIum th8health neecla of larsr ~eilh-
bOrhooda and co8I13 tlbullbullbull
RegroupiDI ot areas waa accoap118hed1D the
tollOWiDl lIIIIm1er~ A bullbullcifie 1ndex 8selectcl auch as
venereal di8bullbulle or tuberculo8i~ he total number ot
cs was then deterll1ne4 for each census tract Through
the use of the maber ot cRbullbullbull tor a 11Yen cenaus tract
aDd tbe population ot thattractaltrateot1lla1ampmcper
100OOOpopUlaticm wu cleteXll1ned for each census tract
This was ~e to starl4ard1ze the population ditterence
amongOeD8U8 -tracts 1he rate of incidence toreaob
cenauatract was then llstedby rank position on a chart
In rank poition1DI any cen8Wl tracts haviDg equal
rates ot1l1c1dence are assipe4tbe iaDk posttiona
Beeauseot the abo fact tbAt cbarta w111 vary in length
neveltbAtlea eacb cbart will 1Dclu4eall census tracts
inMullnoaah Couaty Atter the census tracts bave been
listed accord1q to raalcth1s list will bediv1ded into
IJ
36 three levelsotinc14ence he three levels are
1~ The upper 14 of1DcldenCe
2 Thelower 14 ot incidence
middot3 The ILld 12 of incidence
Tlles three srouplqa are then used in compiling a map ~f
Mu1tnOmahCountyfor ach apecltictop1cbull TIle maps are
uaefuJliD tbatthey V1suallycoJib1De 1Dd1v1Clualproblem
census tracts into larger problem nellhbOrhooc1s
The 1960 statistical iDtormatloD was Used in a similar
liIaDDr to tbatexpla1Dedabove 1Dthe4evelopaent of a
chartmiddot and map 1Ihow1DI e cOllpampriSOr1 of per capita lncolle
tor ttaCh ceDsua tJact aDdmiddot combiDed census middotmiddottract areas
he 1910 aDd 1960 statlstlcal iDtOrllatl0D was combined
lna map and chart he purpose of this and chart is
to d8aonatrate the e cl1stributloa1DeachceD8U8 tract
and middot1ndlcatbull tuture ace populatlon treD4a bull
When one be middotbullbullbullbullbullHdth ne8cts ot an area and has
declded to establlsh a cl1D1c to serve that area the
physical location otthat cl1D1c IllU8t be consldered In
order to coapreb8ll81vel develop an area cl1n1c one should
conslder thepre88Dttraftlc middot~ytaa an4tranaportatlon
systems Thecl1D1cahoUld be located close enoUlh to
major arterlals to giva asy access from the total area
be_ ervecl by this cliD1c At the t1ll8they should
be tar eo away froll thesarterlals to all8Y1ate traffic
CODCell18 andpark1D8 conpstlon By traff1c concerns I
IJ
37
lIlan one lUSt consider thertarro1fne8S of streets whether
streets are oD8--C)r two-way iqres8 and egress to parking
amp0111tie eros tratflC) spedof trattJQ children 1n
ll8a traffic i1lht Vislon re8tr1ctionS etc
BwstraDsportat1onshould alao be central in this area
as maay people ~U f1Df1 1tD8Cessary to use this form of
transportatlon
~e tutqredlopHQt of bull treewa systems should be
c0J1S1dered soastolesen thecumce ofmiddot future roada
cutt1DSotltbe cl1D1c llte line
nrrph1c middotDampta
It is 1JDportaDtto kDOw the demosraphic distribution
characteristics of the oUenteltbat i8 to be served by
localized health cl1D1cs
Acl1D1c which erves8J1 area where1D the prepondershy
ance of persona arecrter 65 years of mayf1nd that these
people rely more on pUblic transportation call for more
home- services and haV4t 110ft ChroD1c and debilitating
types of disorders (b1_ blood pressure poor heariDg and
eyesight) tbaD do8 an area ot a YOUDIer population On
the other hand thL area of older residents may have little
need for family plabDlng cllni08
In order to better ~Ybullbull the 4eaoraphic population
of each CeD8U8 tract the 1970 CeD8U8 iatormation was viewed
and two specific catelOri8 considered These two cat
IJ
38
lori8S woUld be the perc_tap ot population under 19
year of ase and the percentase ot each oensuetractover
65 years of age he 1960 1Dtormatlon tor eaCh tract was
then compared witbthe 1970 intormation and a percentage
ofincreaae or4ecreamp8 tormiddot e~chtract1n each category
cOJlputecland achartma4e By the use of this chart one
18 able to View tJleap populat1odiatr1but10n of census
tract and at the _ t1lle accesa middottrencl Por example
let us choose census tract 601 W see 40-4 otthe
population is under 19 years ot and that ODly82 1s
over 65 years ot middotAtthe e tille the percentage of
youth bas ~ed ODly 1_ intbe laSt teD year whilethe
percentale over 65 year ot middotbas stayedmiddotthe same With
this in mJnc1 ODe ~ 1DfItr libat ol1D1o aerviDg this
area WOuld bellQre conq~w1th the problems of a
YOUQier populat1on and that _ would probably be true foJ
some t1aein tbefuture On the other hand CeDSU8 tract 54
has only 2 ollt population UDder 19 yel1s ot age and
this has decreased by 1 over the last ten years middotwhile at
the same time 32-377 ot the populat1on 18 over 65 years of
age A ol1D1C ___ this area should be or1eJ1ted toward
tbespecttic problema otthe ampledbull
PerCapia __ bY gsa neat
WhaD cona1der1qlooat10D1 tor health cl1n1cs one
shoUld take the 1DC01Ieot areas into consideration Areas
IJ
39
of lowiDcome would not 11kel~be 8erved more by localized
cl1D1cs tbaD would are of hilbincome It 18 likely
people haYiq a hip iDeoll8would preter to be aeenby a
chosen ~r1vatephylc1a1l tban at a local cl1D1cwhere
10Dier waits y beraceaaampryand leas personal attention
gl_
The 19701ncOII81atoWampt10n tor MultnomahC~ty was
not available at the tille thi8report W88 made The 1Dto~shy
tiOD Was taken ~adtro tbe1960 census publlcation
his woUld ~8Il thea tbat ral1I8 OD the chart ynot 1raquoe
completely accurate hi writer telthatthe areas most
affected by tb8 1I8eof the older 1Dco1DtOlaat1oDWOuld be
those tracts wh1ch baYebad a rapid 1ncreaae1n populatlon
over the past tfmyHr8 bullbullbull tracts would include tracts
nUmbered 104 9897 96 aDd 95 be perc~ita 1Dcome
referredto1il-tb1a Paper18the lIean 1DCo per person per
census tract
Attar the iDeoeper census tract was listed on a chart
a map was de 1D41catiDg those census tracts belonging to
the lower 14 ot income tor all censue tracts in Multnomah
COlDltytbose beloqins to the upper 14 ot income tor all
census tract 111 MultnolUlhCounty and those belonging to
the mid 12 ot 1I1coaetor all oeuuetracts in Multnomah
C01mty
In yiew1Dg the _p 1t caa be seen that the low income
area seautotollow aloas the at aide ot the Wl1lamette
IJ
40
R1ver the full length of Kultnomah County A second low
income area follows the south edge of the Columbia from
the northwest corner of Multnomah County easterly to 148 St
A third problem area seems to be on the east bank of the
Willamette River with the Union Pacific Railroad being
about the center of this tract The extreme loutheast
corner of Multnomah COUDty appears to be a low income area
but as this area bas bad rapid grouth in the last ten years
this could be erroneous
Mental Health
be first ~ecific indica to be selected from the
Multnomah County envirollllental survey of early 1971 and
to be considered in this paper i8 that of Mental Health
At the present for mental health purposes Multnomah
County is divided into five catchmentareas with a mental
health cl1n1cin each area These clinics are Model
Citles Delaunay ADkeny street Office Hansen Health
Building end Southeast Clinic
All lIlental health cl1n1cslcept statlstlcal information
on all patients visiting their cl1n1cs this included the
address of the patient hese addresses were then listed
upon the approprlate C8D8US tract Each census tract was
then ranked on a chart according to the nUllber of mental
health patients who reslde ln thatCeDSUS tract attending
any of the above listed ental health clinics This chart
IJ
41
wasttum d1v14ed1ato proper quartile bbullbullbull
quartile vereUs to dne10 u appropl1ate Multnoh
County _tal health ItLa middotmiddotmiddotthelipO~a1bl by lOoJcJIUE
at the UDtal health _to uteN1De which ueu have the
lars-t use otCOllDty 1alh~th faci11t1Rot
1Ilclu4ecl 111 tbia woUld tber otpeopleYia1t1Da
pr1vat patch1atriata aDd pr1_t _ntalhealtb cl1D1c8
WheDtbe M1 18Yienclmiddot Itmiddotmiddotmiddotmiddot~middotbe~_ tbat ~rtt
appears to lMt fourmiddotmiddot-al are iii _oil the nuaber ot
lIental healthcl1D1c na1t toM tbjh1sheat 1he
tour areaa woUld be tollows
1ttrea Ore to~Blo Drimiddot ~tb Burrus14e aDd tIMtmiddot Colb1a Riftr H1gbwyaeri1Dla th nortllra boundaryshy
2 bull ProII 82D4 1_~ 10 20th streetwitil the ra1lMd Mu the north ltouadary
3 ~ et et tUgl_b1bull MYel froamiddot the Clackaaa COUDty l1ae aorth to Dln8lon stret
4 beDOlvt1ttfe-t ~efllt4 COatytrca Jle1aware streetmiddot toR1C1a11oDd wlth Colubla Blvd heiDI tbAtnorth bouaclary_
It ODe coapareatbiap to th iDeobullbullmiddotp 1t can be
eamiddotthat lIOat ot the c tracts baY1Dg bllh v1i11tatlcma
middottfl public tal health cJ1rUc8 ~ 111 t13e low ~ aid
1DcOile SroupiDIOJa1y of til 25 tracta llsted as
haviDlbip aental Maltll nlltatlou are ~ the1g60 hip
iDeo arebullbullbull
17 Plpn
42
amily PlellnSDI ]Jlce Metal Health i8 an 1nd1ce of
use Theperson 111 ordertobavebe_ 1Dcluclecl 1n this
atu4ywouldhave tohaft Ue4 ataa11y plaDI cl1D1c
tacilities of soaetype It 41fter troll tile _tal health
study1nthat i t1Jicludestatist1catrollbotb public and
privateclJD1os
The iDformation tor the iak orurcbart 8Dd map of
t8ll111 plenn1 na ob1a1De4 by cOIIblnlDlthe mabel of
1rlcuv1duals bullbull_ attbe tbreellUltrampo-ti Coatyhll11y
PlalJQllIl C11ll10s 111til tbo at the Planned PareDthood
Association CliD1C8 be tbree -JIultDouh Couaty r8ldly
PlamSq Cl1D1c are Solrtbweatth Col_bla 1111- a114
HaDsell Health BWlcl1Dl CllD1cbi middot1Dtormat1oD vas then
bullbullbullesed tomiddot detellWMt l10w people troll eacb c8IUIUS
chart wastben Mele IUs oIIart jn 4iY1ded to show
the censuS tracts lIaYiDlmiddottIle h1t1iest qUart1le of incidence
of use lowest quartile of 1Qc1deao ot use Jlid 12 of
incidence of Wle an4 a map sprepared troll thts 1Dto~
mation
The C8U118 tractsbelOJISnl to the h1lhestquartile of
use appear to be 1lO~ 8catt~ on tbipwas true ot
either the _p ot aental health cl1D1c uaageor ot the map
abow1DI per capita 1I1COM Iaere40 to be three
d18t1nct areas of UIIaP beJ woul4 be
1
IJ
43
t10D of BurD81cl and the W11lallette River 4
2 S~t Portland 8Otth otmiddot the ra11shyrcaadand alona the W11lamette River
lIortbeaat Portl8D4 between MisSiss1pp1 and 24tbStreet the northbouBclary be1DgColwb1aBlvd
Pylzl1c BMltl IrpI Y11ta
Publlc Healtil nur81D1Y1s1t nclud8 an vists to
theholles of client by PubUc Health Nurbullbullbullbull his shows
visits to bull f8Jl1ly fer aDY purpos SUCh aatuberculolJ1s
het1Dl tem1tyaeatalu4 8IiOt10D8l cODd1t1ona etc
he atat18t1C~ 1fele C()4ed accord1Dg tomiddot the 1llli301fOCUS
of the Y18lt tt doe DOt 1D41cate the Dmlber of holies or
f8ll11lev181tecl or 1D41Y14ual Y1a1ted more tban oDcein
the propwl It dobullbull I1ve 80M 1D41cat1on by coaparlshy
OD ot the 8JIoUDt of aedlcal problema 1n eachcen8WI tract
Ap1nmiddot the _p abowa 8 scatter patteraof probl_
areas althoUSh there appear to be a sroup1Dl of hiSh J
l8aIeccmaus tract 1ntlut extreme southeast part of tbe
County other areu uIriaI any nura1Dl contacts are
1 bull he 801lth-oa-al CO1Dty on eaCh 814 of 82nd Av from Clackallaa County north to Dinloa
2 ear bullbullbullt 814e aroUDd Preacottand Misaisippi
Dowatom Bunul14eonboth 1de of the river
44
V_real Pis The iDfomatloil uaec1 to tabulate the Venereal
disease chart includes all the ooab1ned case otmiddotODormea
and syphilIs reported by bothmiddot publIc and prIvate physicIans
dur1nl 1970 There were 3602 caes ot IOnorrhea reported
dur1nl 1970 While ODly 17 cabullbullsot ayphilimiddot were reported
A chart was prepUed aDd att8llPt wasmiddotmiddot de tomiddot
determ1De Wh_therVttDereal 41ease was more p~vaJent in
areas othigb or lowmiddot proportIon ot youth hi waadone
bymiddotdetemlna a 1leaD prceiltacmiddotmiddotmiddottor the population ot
resld~ts UDder19 years ot (34) middotA mean ratemiddot per
100000 popUlatIon al80c1ttem1Ded tor the middotoccurreDCe
ot venereal dieae This was et at 390 oass Areas
hav1nl a population 1n which leiS than 34 were lmder 19
years ot ampIe were called low- yOuth abOve tbl percentaae
hiSh youth The aaa waatrue ot the occurrence oivenershy
eal disea_ per CeD8UStract It the rate waacomputed
as 1I0re than 390 cases per 100000 it was called hiah
venerealdiaeasei it less than thia tisure low venereal
disease It was tound that 1D Multn~ COmlty there sems
to be poSitive OOlatI0n(x21S19gt between low youth
and hipmiddot venereal diseaand hip youth and low venereal
diseasebull
RaDk ordr Iitot all c traot middottbAm made
Th1s was done byt1Ddlna the ratepr 100000 populatIon
of venereal disator all census tracts in the County bull
45
These were thenlisted from h1lhto low (sreatest to
least) in a rank order The l1sting was then divided
into Upperandlower 14 aDd listed on the MUltnomah
Countymiddot up
The areas of b1gh venereal disease se8ll18to
roup thBl~8 middotin a very tllht area ~oq both 1des
of thell18l8~ R1 w1th BurDaldeS~et being
~bout theceDter qf tbi8IZ9uping This area woUld
appear to be m ldeal spot for the denlopment of a
locallzed venereal d1sbullbullbullbull cl1D1c
UbepoundCUlO1s
In this report bull tube1C1llosls caS8S refrred
to include alltbobullbull cabullbulls ontubercUlo8is follow-up
rather middotthan just new C Accord1Ds to the Multnomah
County Health SUrvey of early 1971 this would include
all ca repOrte4 over thelaat three years The
total number of tuberculosi8 cabullbullbull usedin this study
was 666 lh1 included 128 new cabullbullbullbull
A rate per 100000 of tuberculosis for each
census tract wa- then computed and the c~us tracts
listed by rank order be b11h Qartlle mel low
quartl1 were then reoordd on a Multnomah CoUnty map
TWo genral areaa baY1Dg a hip mcldencaot tubercu~
losiare 1D41cated heyare
1 Both middotsld ot theWilla11lette River
Ll -
46
with Burns1de about thecnter
2 he extrea Northebullbullt comer of the County bull
By coap8r1ng the tuberculois an4ven8real
diseae maps ODe can 8ee that the downtown areas ot
hiSh 1nc1denceare alIIo8t 1c1eDt1cal on ach map
This WOuld 1nd1cate that 1t would be of value to
bullbulltab11sh acl1D1c 111 th1aampreatbat would provide
bothtuberCulos1s 8Dd ytmereal 418ase srvicbullbullbull
Thchart aDd 1181gt8 are wsfuln 11v1DI
1Ddicat10DS tor the type aDd placemeototlocal
health cl1n1c8 tbro1qhout tbe MultnomahCounty area
A cOllpar1on of the mapa help one to dec1dewhether
to provide a aulti-8ervice cl1D1c or spec1f1c type of
cliD1c As stated in Part I of thi paprserv1ces
shouldhaYe both treatlieDt and prfMmt10n cOmponents
As he been stated fta ne1lbborhood health care
Qenter muat be a fac111tY plazme4 with an aamesa
ot the neds of the consumer and the c01llll1m1tybull
Part II of this rport haa been an attaapt to indicate
and clarify 8011 ottheae coDlllUDity neds This has
been done through8elect10n of apc1f1c problems
The indic were then visuallyrecorded through the
use of ups and charta ODe dan asseS8 thedsreeof
1DIportance of certain concems to spec~t1c areaa by
comparinl the chart aDd maps Prom this oDeean
41 dec1de which are48 vb1chcUD1c-or indeed if
the need a clinic at all However further factors
should be considered hebullbull include
a The amount of fuDd1 available
b What 18 the percentage ot peopleineoh ceaaua tract tbat would actually us such cl1n1cIl
c Wbat 1 tbeco--1tymiddot 8 IeeliDashyreaardtDI particular cl1D1c8 Would this dcrebullbullbullmiddot the ettctiveness ot thse cl1n1ca
IJ
li
D_OlraphicPopulatLon Challie 1960 to 1970 48
Cen8U8 1 of Pop 1 Cbaqemiddot 1 Change1 ofPopTract Under 19 Yr8 Over 65 Yrs1960-70 1960-70
middot1Q701Q70
1 319 -12 171 -H) 1
2722 215-27 +68 301 366 -22 127 +35 302 371 +19 111 -04
311middot401 144-41 +29 402 321 13~7-39 +24 501 356 124-08 -02 5~O2 351 133-23 +12
405601 82-10 -02 394602 103-01 -06
701 275 149-76 +56 702 361 +01 121 -07
+10middot801 326 140-22 802 321 middot127
(
-29 -03 9~01 342 124 -H) 6-18 902 294 128 -H) 3-24
10middotmiddot -14312 140 -17 1101 182 +25 -23197
2411102 186-59 +29 1201 226 169-17 -41
31middot01202 +11 182 -05 295 -H) 81301 208 -H) 4
1302 331 +08 197 +04
14 323 +15 middot185 -08 middotmiddot15 329 +16 16~5 -13
-28middot 1601 332 131 +12
1602 356 98 +24middot-39 middot3101701 161-33 +21
1702 370 -15 85 +02 +19 1801 264 151middot-50
185middot1802 256 +47-58
IJ ~
D_raphlc Population Change 1960 to 1970middot 49 (Contd)
4io
Census Tract
of pop Uncter 19 Yra
1Q1n
1Cha1l8e 1960-70
of PopOver 65 Yra
lQO Change
1960-70
19 389 +29 141 -24 20 223 -13 206 +18
21 227 +08 194 -36 2201 356 -27 112 +05
2202 290 -18 ll~9 -29 2301 356 -03 154 +24 2302 260 -37 245 +97
2401 410 +6~1 123 -31 2402 163 -80 320 +99 2501 381 +13 140 -01 25()2 237 31 lil +02 26 343 +25 186 +149 2701 370 +29 1S5 -01 2702 249 -44 304 +98 2801 337 +19 187 +09 2802 306 -10 156 +31 2901 304 -38 142 +24 2902 i 307 -32 146 t3~9
30 29~0 -48 16~2 +51
31 355 +30 160 +01 32 370 +48 148 -13 3301 395 +45 130 -20 3302 368 +06 138 -02 3401 386 +16 117 000
3402
400 +32 92 -26 3501 304 -07 115 +35
3502 344 000 140 -13
3601
36~02 357 -04 132 +32
3603 30~1 42 149 -67 3701 342 +28 152 +19
1
IJ
Jianolraphic Population Chan 1960 to 1970 50 (Contd)
Census Tract
of Pop Under 19 Yrs
JJl7J
middotChanae 1960-70
middotofmiddotpop Over 65 Yrs
1c~7n
Change 196070
3702 409 +39 122 -11 3801 308 -11 151 +29 3802 275 -35 180 +46 3803 282 -32 192 +54 3901 376 ~13 100 +17 3902 296 -03 177 +29 4001 438 -11 84 +13 4002 353 -21 115 +20
4101 397 11 9middot0 +11 4102 346 -19 120 +03 42 331 +19 11 bull 3 -16 43 347 -72 105 +31 44 113 +84 183 +154 4S 33~9 +07 110 -06 4601 2501 22 193 +38 4602 332 +59 126 -29 47middot 161middot 000 211 +01 48 103 -26 302 +59 49 138 +1 bull 3 252 +09 50 141 -26 204 -12 51 12 -39 257 +07 52 47 -61 351 +48 53 89 +49 314 -30 54 25 l1li15 327 -17 55 131 -17 115 -121 56 198 +93 227 -47 57 71 102 189 -88 58 240 ~middot41 16~1 +55 59 322 +25 142 +06middot 6001 264 95 132 +50
6002 328 -31middot 89 +07
JJ
Demographic Population Change 1960 to 1970 51 (Contd)
Census 1 ofPop lChange of Pop bull ChangeTract Under 19 Yrbullbull 1960-70 Over 65 Yrs 1960-70
1970 1970
61 355 -58 85 +39
62 328 39 110 +18
63 414 04 73 10
64 382 -22 72 +04
6501 383 02 67 -20
6502 329 -56 96 +09
6601 391 +13 88 -03
6602 319 -59 97 +06
6701 327 71 145 +72
6702 331 ~67 83 +1-0
6801 365 -66 49 +01
6802 388 4bull3 54 +06
69 354 -41 80 +23
70 400 -23 68 -06
71 359 -48 72 +05
72 255 -88 82 +11
73 346 -39 91 +25
74 313middot -63 105 +24
75 329 -42 129 +37
76 336 -52 85 +21
77 370 -10 69 +05
78 309 -10 120 +21
79 325 -56 87 +10
8001 358 -81 57 +12
8002 391 ~81 76 +12
81 315 -76 108 +21
8201 403 -23 64 +08
8202 392 23 65 +08
83 357 -34 120 +31
84 402 -18 73 +16
85 413 -06 76 -09
r
Demographic Population Change 1960 to 1970 52 (Contd)
Census Tract
t of Pop Uncler 19 Yrs
1970
Change 1960-70
1 of Pop OVer 65 Yrs
1970
ex Change 196070
86
87
88
89
90
91 9201
9202
93
94
95
9601
9602
9701
9702
9801
9802
99
100 I
101
102
103
10401
10402
lOS
368
351
379
391
391
413
379
433
372
429
414
432
419
439
~32
377
457 420
378 41middot7
345
360 417
417
412
-04
-02
-35
-26
-28
-11
-64
-20
-S9
-39
-32
-21
-34
-40
-47
-lO~7middot
-27middot +04
+56
+07
-34 01
+04
+04
+10
103
128
97
11il3 99
69
79
42
77
46
34 38
44
40
54
111
51middot
81
133
59
74
140
63
87
76
-08
-06
+04
+08
+17
-05
+3S -02
+1~4
+19
+33
-14
-08
+12
+26
+71
+11
-16 -34
-20
-19 +37
-49
-2S +15
NOte The The
Taken frOi
averageullder averageabove
middotUSCensus ---shy -
19 years == 6S years ==
figures 197
32r 13(14
p a~d 1960
--
Rank
1
2
3
4
5
6
7
8
9
10
11 12 -_
13
14
15
16
17
18
Tract
69 46
60
58
- 68
61
302
2501
67
63
19
62
26
94
3603
3902
64
30 -----~-
Rank
19
20
21 -
22
23-shy
24
25
26
27
28
29
30
31
32
33
34
35
36 -
Ranking of Per Capita Income by Census Tract
Tract
65
2701
- 15
1601
701
66
93
82
2903
3602
30
2502
80
2401
81
- 70
91 shy
4001
High
Rank Tractshy
-32shy37
38 97
120239
7840
41 ~ _2_1__ 42 31
43 2501
44 18
45 98
46 37
47 3803
1702
49
48
1602 92 2702
I
50 89
51 901
52 801
Ra_
53
54
55
56
57
58
59
60
61
62
63
64
6S
66
67
68
TractTract Ra~
74692
170196 70 I
401 71 90
72 1037J
79 70273
3802 74 601
24024102 75
85 76 101
77 9023901
7699 78 100 4101 79
3601 I
380180
458140~ t---- _ - - shy83 82 42
888384
59843501
4777 8~
502
Low
802 86
Rank Tract
87 shy
--88
89
90
91
92
93
94
- 95
96
97
middot98
99
100
101
102
103
104
1201
14
49
72
73
43
87
3502
105
1
52
86
71
1
501
10
3301
104 tf
Rank
105
106
107
108
109
110
III
112
113
114
115
116
117
118
119
120
121
Ranking of Per Capitalucoae by Census Tract
(Contd)
Tract Rank
4001 122--shy602
13
1102 2302
3302
55
3401
48
21
56
50
3402
lL01
2202
2301
53
2201
-shy
Tract Rank Tract Rank T~aet Rank
57 I-----
Imiddote
bull
Tract
- Low -k Note Information taken from 1960 U SCensus
Rank Tract
I ~
Ie
Imiddot
~
----
----
--
--
Rank
1
2
3
4
5
6
1
8
9
10
11
i-
-Tract
391 922 921
972 971
100
132 131 121
962 961
822 821 401
982 981
20 111
47 10 1
412
High
Total Number of Henta1 Health Visits
Ranked by Census Tract High to Low
TractTract RankTractRank Rnk
12 182 22 78 29 87 76 381 73181 ~------- 1913 371 8538230162372 271 2616-121 8272 2
14 80~2 31 94 7923 84801 59 15251362 4232 15 52 _ 32 103 8924 651 17240216 652
_ 91 351 33 341 23117 83 122 25 25 48 1123921418 34 shy61 86 661
19 662 6493 81 26 91 8153 49 50 55 41383 71 27 51 3120 90 672241 35shy 104167162 461
I 411 46211121 28 88342 I
2502 36 69 54 5251 50 272
-Ra
37
38
39
_ 40
_ 41 Ishy
I
42 I
-I 43 44
45
shy
Tract
~ --- shy 95 56
45 292 242
102 62 352 291y
92
101 281
99 72 63 601 60~ 42 2201
77 74 61 57
363 232
70
32 31
11 44 282 2202
Low l
- Tract
46 682 681 I 331 30
r~$ 47 1042 332
48 102_41_
11
~
Visits to Family Planning Clinics Ranked by Census Tract High to Low
Rank Tract Rank Tract Rankmiddot Tract Rank Tract Rank Tract Rank Tract
1
2
3
4
5
6
7
8
9
10
11
12
13middot
14
15
16
17
361
56
401
341
48
59 121
20
55
342
10
31
58
93 21
241 132
331
53
461 462
18
19
20-shy21
22
23
24
25
26
27middot
28
29
30
31
32
33
391
32
middot47 I-i-_-shy _ -
231 111
332
972 1
372 371
52
89
32
92
82
100 31
182
30 242
402
34
35
36
37
38
39
40
41
42
43
44
45
42
1714 i 661 221
78 362 2
90 602 601 352
63 251
105 921
971 351
73 42 292 232
411 51
662
81 45 52
46
47
48
49shy
50
51
52
53
54
55
56
961
801
49 81 72 71
19
9~1
172
68 2 57 162 14 112
91 75 681
381 42
3~3
83 161
57 f
58
59
60
61shy
62 Imiddot
63
Imiddot 64
65
66
64 62 36~3 252
74 652 SO 392 291
651 6bull 2
79 271
r-- ---- shy981 222
672 671
821 272
94 87
281
382
67
68
69
70
71
72
73
74
75
76
77
78
981 26 12~2
IS 61
85 82~2 69
61 43
101 86 84 282
76
131
51 72
1041 962 88 70
99 922 77
103
95 802 181
i
~
Low High
RankRank Tract
5479
4480
81 1042 ~) middot102
71 - - + ~ - ~
Visits to Family Planning Clinics
(Contd)
Tract Rank
I
Tract llaDk l
RankTract Tract Rank Tract
~
I
~
J1 ~
Low
Total Number of public Health Nursing Visits
Ranked by Census TractsHigh to Low
TractTract RankTractRank RankRank TractTractRankTractRank
25249 71 79 17249 8033 6586 99189711 84 2915072 34 661 76 66 811519512
402 5035 51 161 2518220 122 1713423 352 55801 7120 6752 2 149814 41236 83 2662 38 94 6821 53 2924015 362 37 32 42 75 69 281 84 63
546 8822 54 222 85 3925431 70383417 3818223 6439 4386652 718 21 55 103332 8924 232 87 19 271729219619 24156 16211140 382 628825 10523110 112 73411 10141-- ----shy 89 363 4457 8126 16111 221 74 9142 90 46158331 53 671279012 46243 48 59 351 3837528 1083 9313 91 5844 59 -_242 76 1----- shy60 272 72 74104114 60145 42 9287 7729 92 6151 8215 57371 934630 91 307762 12113116 282 619447 41391 9531 78100 63 7378 ~95 681 6945 32 5632 798517 6448 47 52 181
High ~ Low
Rank Tract Rank
96 31 132 70
97 102
98 182 372middot 602 651 662
- -shy
~72 682 802
822 922 962 972 982
1042 ----shy
Low
Total Number of Public Health Nursing Visits
(Contd)
Rank Rank Rank TractTract Tract
I
I lt
I
Tract Rank Tract
[
~~~-
I
~
IJilfimiddot ~
j
Ranking of VD Caea According to Census Tracts 61 By High and LOll Youth Itatio
A media~ of 34 5 was determined Any tract having greater
than 34 5~ of popu1tionunde~ 19 years of age -High~
Any tract having l8S than 345 of population under 19
years == Low
Any tract having rate less than 390 =Low
Any tract having rate more than 390 == HLgl4
YOUTH
LOW HIGH
L
0
12 402 1801 1802 343 2801 2802 29023603
54 6001 600262 66~02 72 74 75 76
78 79 81 t02 65 1202
W
(25)
VD
H
I
G
H
401 701 801802 901 902 10 1101 241 1201 1301 132 14 15 1601 1701 20~ 21 2202 2j02 2402 2502 2702 2901 303501 3502 34023801 3802 383 3902 42 44 45 4601 4602 47 48 49 SO 51~2 53 55 56 57 58 S9 6701 6702 73 95
3~02 7021702 19 25~01 2701 4102 4101 63 64601 ~601 6801 680270 7l 77 8001 80~02 8201 8202 83 84
85 86 87 88~ 90 91 9202 920193 94 9601 9602~ 9701 9102 9801 9802 99 100 101 103 10402 105 6501 10401
(47)
301 501 502 601 1602 2401 2301 2201 31 32 3301 3302 3401 3402~ 3602 3702 3901 400140 02 43 61 69 B(
(53) (23)
~ ~gt
Ranking of VD by Rate Per 100000 By Census Tract
~
Rank Tract Rank Tract Rank Tract Rank Tract llank Tract Rank Tract Rank Tract
1 2202 21 S6 40 902 58 1602 74 75
90-shy 64 107 26 --~-
2 3402 22 45 41 10 59 902 75 78 91 54 108 61
3 2301 23 3502 42 2502 60 602 76 6802 92 402 109 87
4 3302 24 49 43 1102 61 501 17 2 93 94 110 90
5 50 25 52 44 6702 62 14 78 8202 94 97 02 III 76
6 2201 26 20 6701 63 4002 8201 2501
9701 41~02 112 91
7 44 27 48 45 401 64 3802 2902 95 63 113 62
8 3301 28 1701 46 502 65 30 79 83 74 96 9602 114 71
9 55 29 47 47 42 66 3803 80 2801 96Q1 115 85 10
11
12
13
14
15
16
17
18
3401
53
2302
2401
57
21
2402
1101
51
30-shy31
32
33
34
35
36
37
3701 - -~ 1201
3702
89
43
132 131
3602
4001
48
49
50
51
52
53
54
55
58
1601
601
4602 4601
69
701
31
3901
67
68
69
70
71
72
2901
801
39021~ 802
6502 6501 122
702
41~01
81
82
83
84
85
86
87
88
19
1
1702
2802
79
93
100 6801 6602
81
97
98
99
100
101
102
103
104
9201 9202
9802 9801
77
302
79
86
72
84
116
117
118
119
120
121
3603
8002 8001
101
99
95
10401
105 10402 103 102
19
20
59
32
38
39
2702
3501
56
57
301
3801
73 1802 1801
89 6002 6001
105
106
2701
88
High Low
-- -----
Rank OrdermiddotTuberclosis Cases by Rate Per 100000 Ranked by Census Tract High to Low
Tract TractRankTractRank Rank TractRaukTractRankTractRank
801
79 9601501411 52 6835340120511 I 960269 903603532036 $-~~F130221542 4366 311301 70 68~013802 _ I- _ 4001_37213 3921201 6802802 H71523822024 22 54 193302 3802 80 8958 I37139535 70155 9801 I60123 72 6702 98023914011016 6701250124 10 56
81 94 401r 7 154152 73 7057 2625 122 92028
90242 162312301 92~158 86 7172434526509 82 79160159 74 100 87412240227220110 6502836960 75 30 8317244 6501782801285711 61 901 42765645 84 66021459294912 9701 660146 171 302 9702 47
6235023033113 85 822821182 917755 16335013110214 841814832 78 103 938564 324815 86 1057940149272 38036523216 10401 87 2902241 725Q 10402360266340217middot IF88 88 9937233 282 51 218 101 01102 46016234
I)167 2901460219 47
High ~ Low ~
- -
TractRank
9S89
6490
8191 8001 8002
63 61 60middot01 6002 44 2701
92
J
2502 402 --- ----shy
I
Rank
Rank Order Tuberculosis Cases by Rate per 100000
(Coutd)
Tract Rank Tract ~nk
I
Tract Ballk Tract Rank
Imiddot
Tract
Imiddot
1~
t 1I i Pi i l I
o
1 -1shyL I
I J
8 40 icO ~ I -lt 0
-t (1) I
i I
r o E
II
a
I
r--i
shy
I
~
I (
Jgt
(011 fi(
Ggt
I II ~j
()
(f 0
~ ()
I
11
f9
r
II 99
o ~
Ggt r
~ __-J~ I t I ~ I
r--J l I
~ _ __ J
) 1
fTl
1gt
r I
()
r
()
lt en -i en
()
I1l
(J)
(J)
-i
P ()
19
r o ~
r G1 I
I
c
~
o I 89
--- -I-shy
r-r I
1- 0 _~ _ _--J E
G1 I I I
i i
I 1-1-1 ~ _J ~2 ~ II
II
()
1 I I I 1
id i bullbull
~
A n 69
r 1shy
- 0 Gl
l--~ ~ I
~ II
II )
I () isect i
en l i
(J)
-t
0
IA Ol
32 27 ODonnell Edward J and Marilyn M Sullivan ServiceDelivery
and Social Action Through the Neighborhood Center A Review of Research tt Welfare ~ Review 7 (Nov~Dec 1969) pp 112
28 Office of Economic Opportunity Second Annual Report Washington D C~ U S Government Printing Office 1966
29 Office of EConomic Opportunity and the Medical Foundation of Be~laire Ohio Eighth Report 2l ~ Committee2a Governshy
ment OperatiOll~ Va8hiiiSton D C Government Printing Office 1969
30 Pope Clyde R Samuel S Yoshioka and Merwyn R Greenlick Determinants of Medical Care Utilization nhe Use of the Telephone for ReportiDg Symptons Journal of Health and SocialBebavior12 (June 1971) pp155-162 shy
31 RenthalA Gerald nComprehensive Health Centers in Large US Cities American Journal of Public Health 61 (Feb 1971) pp 324-336 shy
32 Saward Ernest W The Relevance of Prepaid Group Practice to the Effective Delivery ofHealthServicestt The New Physician 18 (Jan 1969) pp39-44 - shy
33bull Schorr Lisbeth Bamberger and Joseph T English Background Content and Significant IssUes in Neighborhood Health
Center Programs Milbank Memorial ~ Quarterly 46 July 1968) part 1pp 289-296
34 Weiss James E and Merwyn RGreenlick UDeterminants of MedioalCareUtilization The Effects of Social Class and Distance on Contacts With the Medical Care System Medical~ 8 (Nov-Dec 1970 pp 456-462
35 Weiss James E MerwynR Greenlick and Joseph F Jones Determinants of Medical Care Utilization The Impact of Ecological Factorstt unpublished paper presented to the American Public Health Association 1970
36 Wise Harold B Montefiore Hospital Neighborhood Medical Demonstration A Case StudyMilbaDkMemorial Fund Quarterly46 (July 1968) part 1 pp297-308~
37 Yerby Alonzo S ttHealth Departments Hospital and Health Services Medica1~5 (March-April 1967) pp 70-74
38 Young M M~ Chatanooga IS Experience with Reorganization fOr Delivery of Health Services ttAmerican Journ8l of Public Health60 (Sept 1970) pp 1739-1748
f or l
II bull 11 Y d
II
IJ
34
ThepurposeOfPart II of th1aa paper1atod1scuas
elected Speclfic needs ofecltlc areas within Multnomah
County A8P01ll~oUt 1D ~ I of t1a1bullpapermiddot Ita nelgbshy
borhood health oare cater IlU8t be a facl1lty plaDlled with
aD awarenes of the neeels of the oODllUller and collllUDity
Part II of this paper nIl Show 80e of thoe speclflc
needs
he1DforutiOD tor t1li Portlon of the report
obta1nec1 troll tbroupout tbe follow1Dl threepUb11catloDS
1gr~e_tiMshylIPrIxaiidOreson JuDe 1963
2 1~_middot_sectSI8e~ected1teai c-ua 0 S 8 e first count coaputer tape Coluab a_lion AssocshylatloD of QoveraMD-8 Jlme 1971
3 Jtu1tDoab County Oreaon BDY1roDlHtlltal SurveyEarly 1971
The JIultDOIIIlb COUDty OrttIOD BDv1roDllfmtal Surley
Barly 1971 1s bull stat1stical report of the activ1tles of
theentlreMultDOIIIl2 CcNDty Health Dep~t during the
year of 1970 Die speclflc 1nd1cs elected from tb1s
study amprejMental aealtll Publlc Health N~s1D1 vlslts
FaJUly ~ Veaereal])1 ~ ~rcul081
Throush tie use of cUrts and mapa ODe CaD roup these i
speclflc ~oea to ahcnr the healthneedsof speclfic I
census trtcta aD4 then the health needs of iarer neIghshy
borhooda 1m4 o~ Uebullbull
Rf)~UP1Dl of areu was accompllshed in thefolloWinl I
JJ ~
35
he MiltDoIliahCountY oregon BDViromaental SUrvey
early 1971 isamp statistical report ot tbeaotivities ot
the entire MultDolllh COUDty Health ])epartiDent dur1nl the
year ot1970 he specitic 1Dd1C8S selected frOm this
aUy are 1Il8Dtal health public healthDurs8s visits
fUl1ly pia waereal elisease aDd tuberculosia
Tbroq11the Wle otcbart aDd mapa aDecm szoup these
specific indic to show the health Deeds ofapecitic
ccmaua tracts aDdtIum th8health neecla of larsr ~eilh-
bOrhooda and co8I13 tlbullbullbull
RegroupiDI ot areas waa accoap118hed1D the
tollOWiDl lIIIIm1er~ A bullbullcifie 1ndex 8selectcl auch as
venereal di8bullbulle or tuberculo8i~ he total number ot
cs was then deterll1ne4 for each census tract Through
the use of the maber ot cRbullbullbull tor a 11Yen cenaus tract
aDd tbe population ot thattractaltrateot1lla1ampmcper
100OOOpopUlaticm wu cleteXll1ned for each census tract
This was ~e to starl4ard1ze the population ditterence
amongOeD8U8 -tracts 1he rate of incidence toreaob
cenauatract was then llstedby rank position on a chart
In rank poition1DI any cen8Wl tracts haviDg equal
rates ot1l1c1dence are assipe4tbe iaDk posttiona
Beeauseot the abo fact tbAt cbarta w111 vary in length
neveltbAtlea eacb cbart will 1Dclu4eall census tracts
inMullnoaah Couaty Atter the census tracts bave been
listed accord1q to raalcth1s list will bediv1ded into
IJ
36 three levelsotinc14ence he three levels are
1~ The upper 14 of1DcldenCe
2 Thelower 14 ot incidence
middot3 The ILld 12 of incidence
Tlles three srouplqa are then used in compiling a map ~f
Mu1tnOmahCountyfor ach apecltictop1cbull TIle maps are
uaefuJliD tbatthey V1suallycoJib1De 1Dd1v1Clualproblem
census tracts into larger problem nellhbOrhooc1s
The 1960 statistical iDtormatloD was Used in a similar
liIaDDr to tbatexpla1Dedabove 1Dthe4evelopaent of a
chartmiddot and map 1Ihow1DI e cOllpampriSOr1 of per capita lncolle
tor ttaCh ceDsua tJact aDdmiddot combiDed census middotmiddottract areas
he 1910 aDd 1960 statlstlcal iDtOrllatl0D was combined
lna map and chart he purpose of this and chart is
to d8aonatrate the e cl1stributloa1DeachceD8U8 tract
and middot1ndlcatbull tuture ace populatlon treD4a bull
When one be middotbullbullbullbullbullHdth ne8cts ot an area and has
declded to establlsh a cl1D1c to serve that area the
physical location otthat cl1D1c IllU8t be consldered In
order to coapreb8ll81vel develop an area cl1n1c one should
conslder thepre88Dttraftlc middot~ytaa an4tranaportatlon
systems Thecl1D1cahoUld be located close enoUlh to
major arterlals to giva asy access from the total area
be_ ervecl by this cliD1c At the t1ll8they should
be tar eo away froll thesarterlals to all8Y1ate traffic
CODCell18 andpark1D8 conpstlon By traff1c concerns I
IJ
37
lIlan one lUSt consider thertarro1fne8S of streets whether
streets are oD8--C)r two-way iqres8 and egress to parking
amp0111tie eros tratflC) spedof trattJQ children 1n
ll8a traffic i1lht Vislon re8tr1ctionS etc
BwstraDsportat1onshould alao be central in this area
as maay people ~U f1Df1 1tD8Cessary to use this form of
transportatlon
~e tutqredlopHQt of bull treewa systems should be
c0J1S1dered soastolesen thecumce ofmiddot future roada
cutt1DSotltbe cl1D1c llte line
nrrph1c middotDampta
It is 1JDportaDtto kDOw the demosraphic distribution
characteristics of the oUenteltbat i8 to be served by
localized health cl1D1cs
Acl1D1c which erves8J1 area where1D the prepondershy
ance of persona arecrter 65 years of mayf1nd that these
people rely more on pUblic transportation call for more
home- services and haV4t 110ft ChroD1c and debilitating
types of disorders (b1_ blood pressure poor heariDg and
eyesight) tbaD do8 an area ot a YOUDIer population On
the other hand thL area of older residents may have little
need for family plabDlng cllni08
In order to better ~Ybullbull the 4eaoraphic population
of each CeD8U8 tract the 1970 CeD8U8 iatormation was viewed
and two specific catelOri8 considered These two cat
IJ
38
lori8S woUld be the perc_tap ot population under 19
year of ase and the percentase ot each oensuetractover
65 years of age he 1960 1Dtormatlon tor eaCh tract was
then compared witbthe 1970 intormation and a percentage
ofincreaae or4ecreamp8 tormiddot e~chtract1n each category
cOJlputecland achartma4e By the use of this chart one
18 able to View tJleap populat1odiatr1but10n of census
tract and at the _ t1lle accesa middottrencl Por example
let us choose census tract 601 W see 40-4 otthe
population is under 19 years ot and that ODly82 1s
over 65 years ot middotAtthe e tille the percentage of
youth bas ~ed ODly 1_ intbe laSt teD year whilethe
percentale over 65 year ot middotbas stayedmiddotthe same With
this in mJnc1 ODe ~ 1DfItr libat ol1D1o aerviDg this
area WOuld bellQre conq~w1th the problems of a
YOUQier populat1on and that _ would probably be true foJ
some t1aein tbefuture On the other hand CeDSU8 tract 54
has only 2 ollt population UDder 19 yel1s ot age and
this has decreased by 1 over the last ten years middotwhile at
the same time 32-377 ot the populat1on 18 over 65 years of
age A ol1D1C ___ this area should be or1eJ1ted toward
tbespecttic problema otthe ampledbull
PerCapia __ bY gsa neat
WhaD cona1der1qlooat10D1 tor health cl1n1cs one
shoUld take the 1DC01Ieot areas into consideration Areas
IJ
39
of lowiDcome would not 11kel~be 8erved more by localized
cl1D1cs tbaD would are of hilbincome It 18 likely
people haYiq a hip iDeoll8would preter to be aeenby a
chosen ~r1vatephylc1a1l tban at a local cl1D1cwhere
10Dier waits y beraceaaampryand leas personal attention
gl_
The 19701ncOII81atoWampt10n tor MultnomahC~ty was
not available at the tille thi8report W88 made The 1Dto~shy
tiOD Was taken ~adtro tbe1960 census publlcation
his woUld ~8Il thea tbat ral1I8 OD the chart ynot 1raquoe
completely accurate hi writer telthatthe areas most
affected by tb8 1I8eof the older 1Dco1DtOlaat1oDWOuld be
those tracts wh1ch baYebad a rapid 1ncreaae1n populatlon
over the past tfmyHr8 bullbullbull tracts would include tracts
nUmbered 104 9897 96 aDd 95 be perc~ita 1Dcome
referredto1il-tb1a Paper18the lIean 1DCo per person per
census tract
Attar the iDeoeper census tract was listed on a chart
a map was de 1D41catiDg those census tracts belonging to
the lower 14 ot income tor all censue tracts in Multnomah
COlDltytbose beloqins to the upper 14 ot income tor all
census tract 111 MultnolUlhCounty and those belonging to
the mid 12 ot 1I1coaetor all oeuuetracts in Multnomah
C01mty
In yiew1Dg the _p 1t caa be seen that the low income
area seautotollow aloas the at aide ot the Wl1lamette
IJ
40
R1ver the full length of Kultnomah County A second low
income area follows the south edge of the Columbia from
the northwest corner of Multnomah County easterly to 148 St
A third problem area seems to be on the east bank of the
Willamette River with the Union Pacific Railroad being
about the center of this tract The extreme loutheast
corner of Multnomah COUDty appears to be a low income area
but as this area bas bad rapid grouth in the last ten years
this could be erroneous
Mental Health
be first ~ecific indica to be selected from the
Multnomah County envirollllental survey of early 1971 and
to be considered in this paper i8 that of Mental Health
At the present for mental health purposes Multnomah
County is divided into five catchmentareas with a mental
health cl1n1cin each area These clinics are Model
Citles Delaunay ADkeny street Office Hansen Health
Building end Southeast Clinic
All lIlental health cl1n1cslcept statlstlcal information
on all patients visiting their cl1n1cs this included the
address of the patient hese addresses were then listed
upon the approprlate C8D8US tract Each census tract was
then ranked on a chart according to the nUllber of mental
health patients who reslde ln thatCeDSUS tract attending
any of the above listed ental health clinics This chart
IJ
41
wasttum d1v14ed1ato proper quartile bbullbullbull
quartile vereUs to dne10 u appropl1ate Multnoh
County _tal health ItLa middotmiddotmiddotthelipO~a1bl by lOoJcJIUE
at the UDtal health _to uteN1De which ueu have the
lars-t use otCOllDty 1alh~th faci11t1Rot
1Ilclu4ecl 111 tbia woUld tber otpeopleYia1t1Da
pr1vat patch1atriata aDd pr1_t _ntalhealtb cl1D1c8
WheDtbe M1 18Yienclmiddot Itmiddotmiddotmiddotmiddot~middotbe~_ tbat ~rtt
appears to lMt fourmiddotmiddot-al are iii _oil the nuaber ot
lIental healthcl1D1c na1t toM tbjh1sheat 1he
tour areaa woUld be tollows
1ttrea Ore to~Blo Drimiddot ~tb Burrus14e aDd tIMtmiddot Colb1a Riftr H1gbwyaeri1Dla th nortllra boundaryshy
2 bull ProII 82D4 1_~ 10 20th streetwitil the ra1lMd Mu the north ltouadary
3 ~ et et tUgl_b1bull MYel froamiddot the Clackaaa COUDty l1ae aorth to Dln8lon stret
4 beDOlvt1ttfe-t ~efllt4 COatytrca Jle1aware streetmiddot toR1C1a11oDd wlth Colubla Blvd heiDI tbAtnorth bouaclary_
It ODe coapareatbiap to th iDeobullbullmiddotp 1t can be
eamiddotthat lIOat ot the c tracts baY1Dg bllh v1i11tatlcma
middottfl public tal health cJ1rUc8 ~ 111 t13e low ~ aid
1DcOile SroupiDIOJa1y of til 25 tracta llsted as
haviDlbip aental Maltll nlltatlou are ~ the1g60 hip
iDeo arebullbullbull
17 Plpn
42
amily PlellnSDI ]Jlce Metal Health i8 an 1nd1ce of
use Theperson 111 ordertobavebe_ 1Dcluclecl 1n this
atu4ywouldhave tohaft Ue4 ataa11y plaDI cl1D1c
tacilities of soaetype It 41fter troll tile _tal health
study1nthat i t1Jicludestatist1catrollbotb public and
privateclJD1os
The iDformation tor the iak orurcbart 8Dd map of
t8ll111 plenn1 na ob1a1De4 by cOIIblnlDlthe mabel of
1rlcuv1duals bullbull_ attbe tbreellUltrampo-ti Coatyhll11y
PlalJQllIl C11ll10s 111til tbo at the Planned PareDthood
Association CliD1C8 be tbree -JIultDouh Couaty r8ldly
PlamSq Cl1D1c are Solrtbweatth Col_bla 1111- a114
HaDsell Health BWlcl1Dl CllD1cbi middot1Dtormat1oD vas then
bullbullbullesed tomiddot detellWMt l10w people troll eacb c8IUIUS
chart wastben Mele IUs oIIart jn 4iY1ded to show
the censuS tracts lIaYiDlmiddottIle h1t1iest qUart1le of incidence
of use lowest quartile of 1Qc1deao ot use Jlid 12 of
incidence of Wle an4 a map sprepared troll thts 1Dto~
mation
The C8U118 tractsbelOJISnl to the h1lhestquartile of
use appear to be 1lO~ 8catt~ on tbipwas true ot
either the _p ot aental health cl1D1c uaageor ot the map
abow1DI per capita 1I1COM Iaere40 to be three
d18t1nct areas of UIIaP beJ woul4 be
1
IJ
43
t10D of BurD81cl and the W11lallette River 4
2 S~t Portland 8Otth otmiddot the ra11shyrcaadand alona the W11lamette River
lIortbeaat Portl8D4 between MisSiss1pp1 and 24tbStreet the northbouBclary be1DgColwb1aBlvd
Pylzl1c BMltl IrpI Y11ta
Publlc Healtil nur81D1Y1s1t nclud8 an vists to
theholles of client by PubUc Health Nurbullbullbullbull his shows
visits to bull f8Jl1ly fer aDY purpos SUCh aatuberculolJ1s
het1Dl tem1tyaeatalu4 8IiOt10D8l cODd1t1ona etc
he atat18t1C~ 1fele C()4ed accord1Dg tomiddot the 1llli301fOCUS
of the Y18lt tt doe DOt 1D41cate the Dmlber of holies or
f8ll11lev181tecl or 1D41Y14ual Y1a1ted more tban oDcein
the propwl It dobullbull I1ve 80M 1D41cat1on by coaparlshy
OD ot the 8JIoUDt of aedlcal problema 1n eachcen8WI tract
Ap1nmiddot the _p abowa 8 scatter patteraof probl_
areas althoUSh there appear to be a sroup1Dl of hiSh J
l8aIeccmaus tract 1ntlut extreme southeast part of tbe
County other areu uIriaI any nura1Dl contacts are
1 bull he 801lth-oa-al CO1Dty on eaCh 814 of 82nd Av from Clackallaa County north to Dinloa
2 ear bullbullbullt 814e aroUDd Preacottand Misaisippi
Dowatom Bunul14eonboth 1de of the river
44
V_real Pis The iDfomatloil uaec1 to tabulate the Venereal
disease chart includes all the ooab1ned case otmiddotODormea
and syphilIs reported by bothmiddot publIc and prIvate physicIans
dur1nl 1970 There were 3602 caes ot IOnorrhea reported
dur1nl 1970 While ODly 17 cabullbullsot ayphilimiddot were reported
A chart was prepUed aDd att8llPt wasmiddotmiddot de tomiddot
determ1De Wh_therVttDereal 41ease was more p~vaJent in
areas othigb or lowmiddot proportIon ot youth hi waadone
bymiddotdetemlna a 1leaD prceiltacmiddotmiddotmiddottor the population ot
resld~ts UDder19 years ot (34) middotA mean ratemiddot per
100000 popUlatIon al80c1ttem1Ded tor the middotoccurreDCe
ot venereal dieae This was et at 390 oass Areas
hav1nl a population 1n which leiS than 34 were lmder 19
years ot ampIe were called low- yOuth abOve tbl percentaae
hiSh youth The aaa waatrue ot the occurrence oivenershy
eal disea_ per CeD8UStract It the rate waacomputed
as 1I0re than 390 cases per 100000 it was called hiah
venerealdiaeasei it less than thia tisure low venereal
disease It was tound that 1D Multn~ COmlty there sems
to be poSitive OOlatI0n(x21S19gt between low youth
and hipmiddot venereal diseaand hip youth and low venereal
diseasebull
RaDk ordr Iitot all c traot middottbAm made
Th1s was done byt1Ddlna the ratepr 100000 populatIon
of venereal disator all census tracts in the County bull
45
These were thenlisted from h1lhto low (sreatest to
least) in a rank order The l1sting was then divided
into Upperandlower 14 aDd listed on the MUltnomah
Countymiddot up
The areas of b1gh venereal disease se8ll18to
roup thBl~8 middotin a very tllht area ~oq both 1des
of thell18l8~ R1 w1th BurDaldeS~et being
~bout theceDter qf tbi8IZ9uping This area woUld
appear to be m ldeal spot for the denlopment of a
locallzed venereal d1sbullbullbullbull cl1D1c
UbepoundCUlO1s
In this report bull tube1C1llosls caS8S refrred
to include alltbobullbull cabullbulls ontubercUlo8is follow-up
rather middotthan just new C Accord1Ds to the Multnomah
County Health SUrvey of early 1971 this would include
all ca repOrte4 over thelaat three years The
total number of tuberculosi8 cabullbullbull usedin this study
was 666 lh1 included 128 new cabullbullbullbull
A rate per 100000 of tuberculosis for each
census tract wa- then computed and the c~us tracts
listed by rank order be b11h Qartlle mel low
quartl1 were then reoordd on a Multnomah CoUnty map
TWo genral areaa baY1Dg a hip mcldencaot tubercu~
losiare 1D41cated heyare
1 Both middotsld ot theWilla11lette River
Ll -
46
with Burns1de about thecnter
2 he extrea Northebullbullt comer of the County bull
By coap8r1ng the tuberculois an4ven8real
diseae maps ODe can 8ee that the downtown areas ot
hiSh 1nc1denceare alIIo8t 1c1eDt1cal on ach map
This WOuld 1nd1cate that 1t would be of value to
bullbulltab11sh acl1D1c 111 th1aampreatbat would provide
bothtuberCulos1s 8Dd ytmereal 418ase srvicbullbullbull
Thchart aDd 1181gt8 are wsfuln 11v1DI
1Ddicat10DS tor the type aDd placemeototlocal
health cl1n1c8 tbro1qhout tbe MultnomahCounty area
A cOllpar1on of the mapa help one to dec1dewhether
to provide a aulti-8ervice cl1D1c or spec1f1c type of
cliD1c As stated in Part I of thi paprserv1ces
shouldhaYe both treatlieDt and prfMmt10n cOmponents
As he been stated fta ne1lbborhood health care
Qenter muat be a fac111tY plazme4 with an aamesa
ot the neds of the consumer and the c01llll1m1tybull
Part II of this rport haa been an attaapt to indicate
and clarify 8011 ottheae coDlllUDity neds This has
been done through8elect10n of apc1f1c problems
The indic were then visuallyrecorded through the
use of ups and charta ODe dan asseS8 thedsreeof
1DIportance of certain concems to spec~t1c areaa by
comparinl the chart aDd maps Prom this oDeean
41 dec1de which are48 vb1chcUD1c-or indeed if
the need a clinic at all However further factors
should be considered hebullbull include
a The amount of fuDd1 available
b What 18 the percentage ot peopleineoh ceaaua tract tbat would actually us such cl1n1cIl
c Wbat 1 tbeco--1tymiddot 8 IeeliDashyreaardtDI particular cl1D1c8 Would this dcrebullbullbullmiddot the ettctiveness ot thse cl1n1ca
IJ
li
D_OlraphicPopulatLon Challie 1960 to 1970 48
Cen8U8 1 of Pop 1 Cbaqemiddot 1 Change1 ofPopTract Under 19 Yr8 Over 65 Yrs1960-70 1960-70
middot1Q701Q70
1 319 -12 171 -H) 1
2722 215-27 +68 301 366 -22 127 +35 302 371 +19 111 -04
311middot401 144-41 +29 402 321 13~7-39 +24 501 356 124-08 -02 5~O2 351 133-23 +12
405601 82-10 -02 394602 103-01 -06
701 275 149-76 +56 702 361 +01 121 -07
+10middot801 326 140-22 802 321 middot127
(
-29 -03 9~01 342 124 -H) 6-18 902 294 128 -H) 3-24
10middotmiddot -14312 140 -17 1101 182 +25 -23197
2411102 186-59 +29 1201 226 169-17 -41
31middot01202 +11 182 -05 295 -H) 81301 208 -H) 4
1302 331 +08 197 +04
14 323 +15 middot185 -08 middotmiddot15 329 +16 16~5 -13
-28middot 1601 332 131 +12
1602 356 98 +24middot-39 middot3101701 161-33 +21
1702 370 -15 85 +02 +19 1801 264 151middot-50
185middot1802 256 +47-58
IJ ~
D_raphlc Population Change 1960 to 1970middot 49 (Contd)
4io
Census Tract
of pop Uncter 19 Yra
1Q1n
1Cha1l8e 1960-70
of PopOver 65 Yra
lQO Change
1960-70
19 389 +29 141 -24 20 223 -13 206 +18
21 227 +08 194 -36 2201 356 -27 112 +05
2202 290 -18 ll~9 -29 2301 356 -03 154 +24 2302 260 -37 245 +97
2401 410 +6~1 123 -31 2402 163 -80 320 +99 2501 381 +13 140 -01 25()2 237 31 lil +02 26 343 +25 186 +149 2701 370 +29 1S5 -01 2702 249 -44 304 +98 2801 337 +19 187 +09 2802 306 -10 156 +31 2901 304 -38 142 +24 2902 i 307 -32 146 t3~9
30 29~0 -48 16~2 +51
31 355 +30 160 +01 32 370 +48 148 -13 3301 395 +45 130 -20 3302 368 +06 138 -02 3401 386 +16 117 000
3402
400 +32 92 -26 3501 304 -07 115 +35
3502 344 000 140 -13
3601
36~02 357 -04 132 +32
3603 30~1 42 149 -67 3701 342 +28 152 +19
1
IJ
Jianolraphic Population Chan 1960 to 1970 50 (Contd)
Census Tract
of Pop Under 19 Yrs
JJl7J
middotChanae 1960-70
middotofmiddotpop Over 65 Yrs
1c~7n
Change 196070
3702 409 +39 122 -11 3801 308 -11 151 +29 3802 275 -35 180 +46 3803 282 -32 192 +54 3901 376 ~13 100 +17 3902 296 -03 177 +29 4001 438 -11 84 +13 4002 353 -21 115 +20
4101 397 11 9middot0 +11 4102 346 -19 120 +03 42 331 +19 11 bull 3 -16 43 347 -72 105 +31 44 113 +84 183 +154 4S 33~9 +07 110 -06 4601 2501 22 193 +38 4602 332 +59 126 -29 47middot 161middot 000 211 +01 48 103 -26 302 +59 49 138 +1 bull 3 252 +09 50 141 -26 204 -12 51 12 -39 257 +07 52 47 -61 351 +48 53 89 +49 314 -30 54 25 l1li15 327 -17 55 131 -17 115 -121 56 198 +93 227 -47 57 71 102 189 -88 58 240 ~middot41 16~1 +55 59 322 +25 142 +06middot 6001 264 95 132 +50
6002 328 -31middot 89 +07
JJ
Demographic Population Change 1960 to 1970 51 (Contd)
Census 1 ofPop lChange of Pop bull ChangeTract Under 19 Yrbullbull 1960-70 Over 65 Yrs 1960-70
1970 1970
61 355 -58 85 +39
62 328 39 110 +18
63 414 04 73 10
64 382 -22 72 +04
6501 383 02 67 -20
6502 329 -56 96 +09
6601 391 +13 88 -03
6602 319 -59 97 +06
6701 327 71 145 +72
6702 331 ~67 83 +1-0
6801 365 -66 49 +01
6802 388 4bull3 54 +06
69 354 -41 80 +23
70 400 -23 68 -06
71 359 -48 72 +05
72 255 -88 82 +11
73 346 -39 91 +25
74 313middot -63 105 +24
75 329 -42 129 +37
76 336 -52 85 +21
77 370 -10 69 +05
78 309 -10 120 +21
79 325 -56 87 +10
8001 358 -81 57 +12
8002 391 ~81 76 +12
81 315 -76 108 +21
8201 403 -23 64 +08
8202 392 23 65 +08
83 357 -34 120 +31
84 402 -18 73 +16
85 413 -06 76 -09
r
Demographic Population Change 1960 to 1970 52 (Contd)
Census Tract
t of Pop Uncler 19 Yrs
1970
Change 1960-70
1 of Pop OVer 65 Yrs
1970
ex Change 196070
86
87
88
89
90
91 9201
9202
93
94
95
9601
9602
9701
9702
9801
9802
99
100 I
101
102
103
10401
10402
lOS
368
351
379
391
391
413
379
433
372
429
414
432
419
439
~32
377
457 420
378 41middot7
345
360 417
417
412
-04
-02
-35
-26
-28
-11
-64
-20
-S9
-39
-32
-21
-34
-40
-47
-lO~7middot
-27middot +04
+56
+07
-34 01
+04
+04
+10
103
128
97
11il3 99
69
79
42
77
46
34 38
44
40
54
111
51middot
81
133
59
74
140
63
87
76
-08
-06
+04
+08
+17
-05
+3S -02
+1~4
+19
+33
-14
-08
+12
+26
+71
+11
-16 -34
-20
-19 +37
-49
-2S +15
NOte The The
Taken frOi
averageullder averageabove
middotUSCensus ---shy -
19 years == 6S years ==
figures 197
32r 13(14
p a~d 1960
--
Rank
1
2
3
4
5
6
7
8
9
10
11 12 -_
13
14
15
16
17
18
Tract
69 46
60
58
- 68
61
302
2501
67
63
19
62
26
94
3603
3902
64
30 -----~-
Rank
19
20
21 -
22
23-shy
24
25
26
27
28
29
30
31
32
33
34
35
36 -
Ranking of Per Capita Income by Census Tract
Tract
65
2701
- 15
1601
701
66
93
82
2903
3602
30
2502
80
2401
81
- 70
91 shy
4001
High
Rank Tractshy
-32shy37
38 97
120239
7840
41 ~ _2_1__ 42 31
43 2501
44 18
45 98
46 37
47 3803
1702
49
48
1602 92 2702
I
50 89
51 901
52 801
Ra_
53
54
55
56
57
58
59
60
61
62
63
64
6S
66
67
68
TractTract Ra~
74692
170196 70 I
401 71 90
72 1037J
79 70273
3802 74 601
24024102 75
85 76 101
77 9023901
7699 78 100 4101 79
3601 I
380180
458140~ t---- _ - - shy83 82 42
888384
59843501
4777 8~
502
Low
802 86
Rank Tract
87 shy
--88
89
90
91
92
93
94
- 95
96
97
middot98
99
100
101
102
103
104
1201
14
49
72
73
43
87
3502
105
1
52
86
71
1
501
10
3301
104 tf
Rank
105
106
107
108
109
110
III
112
113
114
115
116
117
118
119
120
121
Ranking of Per Capitalucoae by Census Tract
(Contd)
Tract Rank
4001 122--shy602
13
1102 2302
3302
55
3401
48
21
56
50
3402
lL01
2202
2301
53
2201
-shy
Tract Rank Tract Rank T~aet Rank
57 I-----
Imiddote
bull
Tract
- Low -k Note Information taken from 1960 U SCensus
Rank Tract
I ~
Ie
Imiddot
~
----
----
--
--
Rank
1
2
3
4
5
6
1
8
9
10
11
i-
-Tract
391 922 921
972 971
100
132 131 121
962 961
822 821 401
982 981
20 111
47 10 1
412
High
Total Number of Henta1 Health Visits
Ranked by Census Tract High to Low
TractTract RankTractRank Rnk
12 182 22 78 29 87 76 381 73181 ~------- 1913 371 8538230162372 271 2616-121 8272 2
14 80~2 31 94 7923 84801 59 15251362 4232 15 52 _ 32 103 8924 651 17240216 652
_ 91 351 33 341 23117 83 122 25 25 48 1123921418 34 shy61 86 661
19 662 6493 81 26 91 8153 49 50 55 41383 71 27 51 3120 90 672241 35shy 104167162 461
I 411 46211121 28 88342 I
2502 36 69 54 5251 50 272
-Ra
37
38
39
_ 40
_ 41 Ishy
I
42 I
-I 43 44
45
shy
Tract
~ --- shy 95 56
45 292 242
102 62 352 291y
92
101 281
99 72 63 601 60~ 42 2201
77 74 61 57
363 232
70
32 31
11 44 282 2202
Low l
- Tract
46 682 681 I 331 30
r~$ 47 1042 332
48 102_41_
11
~
Visits to Family Planning Clinics Ranked by Census Tract High to Low
Rank Tract Rank Tract Rankmiddot Tract Rank Tract Rank Tract Rank Tract
1
2
3
4
5
6
7
8
9
10
11
12
13middot
14
15
16
17
361
56
401
341
48
59 121
20
55
342
10
31
58
93 21
241 132
331
53
461 462
18
19
20-shy21
22
23
24
25
26
27middot
28
29
30
31
32
33
391
32
middot47 I-i-_-shy _ -
231 111
332
972 1
372 371
52
89
32
92
82
100 31
182
30 242
402
34
35
36
37
38
39
40
41
42
43
44
45
42
1714 i 661 221
78 362 2
90 602 601 352
63 251
105 921
971 351
73 42 292 232
411 51
662
81 45 52
46
47
48
49shy
50
51
52
53
54
55
56
961
801
49 81 72 71
19
9~1
172
68 2 57 162 14 112
91 75 681
381 42
3~3
83 161
57 f
58
59
60
61shy
62 Imiddot
63
Imiddot 64
65
66
64 62 36~3 252
74 652 SO 392 291
651 6bull 2
79 271
r-- ---- shy981 222
672 671
821 272
94 87
281
382
67
68
69
70
71
72
73
74
75
76
77
78
981 26 12~2
IS 61
85 82~2 69
61 43
101 86 84 282
76
131
51 72
1041 962 88 70
99 922 77
103
95 802 181
i
~
Low High
RankRank Tract
5479
4480
81 1042 ~) middot102
71 - - + ~ - ~
Visits to Family Planning Clinics
(Contd)
Tract Rank
I
Tract llaDk l
RankTract Tract Rank Tract
~
I
~
J1 ~
Low
Total Number of public Health Nursing Visits
Ranked by Census TractsHigh to Low
TractTract RankTractRank RankRank TractTractRankTractRank
25249 71 79 17249 8033 6586 99189711 84 2915072 34 661 76 66 811519512
402 5035 51 161 2518220 122 1713423 352 55801 7120 6752 2 149814 41236 83 2662 38 94 6821 53 2924015 362 37 32 42 75 69 281 84 63
546 8822 54 222 85 3925431 70383417 3818223 6439 4386652 718 21 55 103332 8924 232 87 19 271729219619 24156 16211140 382 628825 10523110 112 73411 10141-- ----shy 89 363 4457 8126 16111 221 74 9142 90 46158331 53 671279012 46243 48 59 351 3837528 1083 9313 91 5844 59 -_242 76 1----- shy60 272 72 74104114 60145 42 9287 7729 92 6151 8215 57371 934630 91 307762 12113116 282 619447 41391 9531 78100 63 7378 ~95 681 6945 32 5632 798517 6448 47 52 181
High ~ Low
Rank Tract Rank
96 31 132 70
97 102
98 182 372middot 602 651 662
- -shy
~72 682 802
822 922 962 972 982
1042 ----shy
Low
Total Number of Public Health Nursing Visits
(Contd)
Rank Rank Rank TractTract Tract
I
I lt
I
Tract Rank Tract
[
~~~-
I
~
IJilfimiddot ~
j
Ranking of VD Caea According to Census Tracts 61 By High and LOll Youth Itatio
A media~ of 34 5 was determined Any tract having greater
than 34 5~ of popu1tionunde~ 19 years of age -High~
Any tract having l8S than 345 of population under 19
years == Low
Any tract having rate less than 390 =Low
Any tract having rate more than 390 == HLgl4
YOUTH
LOW HIGH
L
0
12 402 1801 1802 343 2801 2802 29023603
54 6001 600262 66~02 72 74 75 76
78 79 81 t02 65 1202
W
(25)
VD
H
I
G
H
401 701 801802 901 902 10 1101 241 1201 1301 132 14 15 1601 1701 20~ 21 2202 2j02 2402 2502 2702 2901 303501 3502 34023801 3802 383 3902 42 44 45 4601 4602 47 48 49 SO 51~2 53 55 56 57 58 S9 6701 6702 73 95
3~02 7021702 19 25~01 2701 4102 4101 63 64601 ~601 6801 680270 7l 77 8001 80~02 8201 8202 83 84
85 86 87 88~ 90 91 9202 920193 94 9601 9602~ 9701 9102 9801 9802 99 100 101 103 10402 105 6501 10401
(47)
301 501 502 601 1602 2401 2301 2201 31 32 3301 3302 3401 3402~ 3602 3702 3901 400140 02 43 61 69 B(
(53) (23)
~ ~gt
Ranking of VD by Rate Per 100000 By Census Tract
~
Rank Tract Rank Tract Rank Tract Rank Tract llank Tract Rank Tract Rank Tract
1 2202 21 S6 40 902 58 1602 74 75
90-shy 64 107 26 --~-
2 3402 22 45 41 10 59 902 75 78 91 54 108 61
3 2301 23 3502 42 2502 60 602 76 6802 92 402 109 87
4 3302 24 49 43 1102 61 501 17 2 93 94 110 90
5 50 25 52 44 6702 62 14 78 8202 94 97 02 III 76
6 2201 26 20 6701 63 4002 8201 2501
9701 41~02 112 91
7 44 27 48 45 401 64 3802 2902 95 63 113 62
8 3301 28 1701 46 502 65 30 79 83 74 96 9602 114 71
9 55 29 47 47 42 66 3803 80 2801 96Q1 115 85 10
11
12
13
14
15
16
17
18
3401
53
2302
2401
57
21
2402
1101
51
30-shy31
32
33
34
35
36
37
3701 - -~ 1201
3702
89
43
132 131
3602
4001
48
49
50
51
52
53
54
55
58
1601
601
4602 4601
69
701
31
3901
67
68
69
70
71
72
2901
801
39021~ 802
6502 6501 122
702
41~01
81
82
83
84
85
86
87
88
19
1
1702
2802
79
93
100 6801 6602
81
97
98
99
100
101
102
103
104
9201 9202
9802 9801
77
302
79
86
72
84
116
117
118
119
120
121
3603
8002 8001
101
99
95
10401
105 10402 103 102
19
20
59
32
38
39
2702
3501
56
57
301
3801
73 1802 1801
89 6002 6001
105
106
2701
88
High Low
-- -----
Rank OrdermiddotTuberclosis Cases by Rate Per 100000 Ranked by Census Tract High to Low
Tract TractRankTractRank Rank TractRaukTractRankTractRank
801
79 9601501411 52 6835340120511 I 960269 903603532036 $-~~F130221542 4366 311301 70 68~013802 _ I- _ 4001_37213 3921201 6802802 H71523822024 22 54 193302 3802 80 8958 I37139535 70155 9801 I60123 72 6702 98023914011016 6701250124 10 56
81 94 401r 7 154152 73 7057 2625 122 92028
90242 162312301 92~158 86 7172434526509 82 79160159 74 100 87412240227220110 6502836960 75 30 8317244 6501782801285711 61 901 42765645 84 66021459294912 9701 660146 171 302 9702 47
6235023033113 85 822821182 917755 16335013110214 841814832 78 103 938564 324815 86 1057940149272 38036523216 10401 87 2902241 725Q 10402360266340217middot IF88 88 9937233 282 51 218 101 01102 46016234
I)167 2901460219 47
High ~ Low ~
- -
TractRank
9S89
6490
8191 8001 8002
63 61 60middot01 6002 44 2701
92
J
2502 402 --- ----shy
I
Rank
Rank Order Tuberculosis Cases by Rate per 100000
(Coutd)
Tract Rank Tract ~nk
I
Tract Ballk Tract Rank
Imiddot
Tract
Imiddot
1~
t 1I i Pi i l I
o
1 -1shyL I
I J
8 40 icO ~ I -lt 0
-t (1) I
i I
r o E
II
a
I
r--i
shy
I
~
I (
Jgt
(011 fi(
Ggt
I II ~j
()
(f 0
~ ()
I
11
f9
r
II 99
o ~
Ggt r
~ __-J~ I t I ~ I
r--J l I
~ _ __ J
) 1
fTl
1gt
r I
()
r
()
lt en -i en
()
I1l
(J)
(J)
-i
P ()
19
r o ~
r G1 I
I
c
~
o I 89
--- -I-shy
r-r I
1- 0 _~ _ _--J E
G1 I I I
i i
I 1-1-1 ~ _J ~2 ~ II
II
()
1 I I I 1
id i bullbull
~
A n 69
r 1shy
- 0 Gl
l--~ ~ I
~ II
II )
I () isect i
en l i
(J)
-t
0
IA Ol
f or l
II bull 11 Y d
II
IJ
34
ThepurposeOfPart II of th1aa paper1atod1scuas
elected Speclfic needs ofecltlc areas within Multnomah
County A8P01ll~oUt 1D ~ I of t1a1bullpapermiddot Ita nelgbshy
borhood health oare cater IlU8t be a facl1lty plaDlled with
aD awarenes of the neeels of the oODllUller and collllUDity
Part II of this paper nIl Show 80e of thoe speclflc
needs
he1DforutiOD tor t1li Portlon of the report
obta1nec1 troll tbroupout tbe follow1Dl threepUb11catloDS
1gr~e_tiMshylIPrIxaiidOreson JuDe 1963
2 1~_middot_sectSI8e~ected1teai c-ua 0 S 8 e first count coaputer tape Coluab a_lion AssocshylatloD of QoveraMD-8 Jlme 1971
3 Jtu1tDoab County Oreaon BDY1roDlHtlltal SurveyEarly 1971
The JIultDOIIIlb COUDty OrttIOD BDv1roDllfmtal Surley
Barly 1971 1s bull stat1stical report of the activ1tles of
theentlreMultDOIIIl2 CcNDty Health Dep~t during the
year of 1970 Die speclflc 1nd1cs elected from tb1s
study amprejMental aealtll Publlc Health N~s1D1 vlslts
FaJUly ~ Veaereal])1 ~ ~rcul081
Throush tie use of cUrts and mapa ODe CaD roup these i
speclflc ~oea to ahcnr the healthneedsof speclfic I
census trtcta aD4 then the health needs of iarer neIghshy
borhooda 1m4 o~ Uebullbull
Rf)~UP1Dl of areu was accompllshed in thefolloWinl I
JJ ~
35
he MiltDoIliahCountY oregon BDViromaental SUrvey
early 1971 isamp statistical report ot tbeaotivities ot
the entire MultDolllh COUDty Health ])epartiDent dur1nl the
year ot1970 he specitic 1Dd1C8S selected frOm this
aUy are 1Il8Dtal health public healthDurs8s visits
fUl1ly pia waereal elisease aDd tuberculosia
Tbroq11the Wle otcbart aDd mapa aDecm szoup these
specific indic to show the health Deeds ofapecitic
ccmaua tracts aDdtIum th8health neecla of larsr ~eilh-
bOrhooda and co8I13 tlbullbullbull
RegroupiDI ot areas waa accoap118hed1D the
tollOWiDl lIIIIm1er~ A bullbullcifie 1ndex 8selectcl auch as
venereal di8bullbulle or tuberculo8i~ he total number ot
cs was then deterll1ne4 for each census tract Through
the use of the maber ot cRbullbullbull tor a 11Yen cenaus tract
aDd tbe population ot thattractaltrateot1lla1ampmcper
100OOOpopUlaticm wu cleteXll1ned for each census tract
This was ~e to starl4ard1ze the population ditterence
amongOeD8U8 -tracts 1he rate of incidence toreaob
cenauatract was then llstedby rank position on a chart
In rank poition1DI any cen8Wl tracts haviDg equal
rates ot1l1c1dence are assipe4tbe iaDk posttiona
Beeauseot the abo fact tbAt cbarta w111 vary in length
neveltbAtlea eacb cbart will 1Dclu4eall census tracts
inMullnoaah Couaty Atter the census tracts bave been
listed accord1q to raalcth1s list will bediv1ded into
IJ
36 three levelsotinc14ence he three levels are
1~ The upper 14 of1DcldenCe
2 Thelower 14 ot incidence
middot3 The ILld 12 of incidence
Tlles three srouplqa are then used in compiling a map ~f
Mu1tnOmahCountyfor ach apecltictop1cbull TIle maps are
uaefuJliD tbatthey V1suallycoJib1De 1Dd1v1Clualproblem
census tracts into larger problem nellhbOrhooc1s
The 1960 statistical iDtormatloD was Used in a similar
liIaDDr to tbatexpla1Dedabove 1Dthe4evelopaent of a
chartmiddot and map 1Ihow1DI e cOllpampriSOr1 of per capita lncolle
tor ttaCh ceDsua tJact aDdmiddot combiDed census middotmiddottract areas
he 1910 aDd 1960 statlstlcal iDtOrllatl0D was combined
lna map and chart he purpose of this and chart is
to d8aonatrate the e cl1stributloa1DeachceD8U8 tract
and middot1ndlcatbull tuture ace populatlon treD4a bull
When one be middotbullbullbullbullbullHdth ne8cts ot an area and has
declded to establlsh a cl1D1c to serve that area the
physical location otthat cl1D1c IllU8t be consldered In
order to coapreb8ll81vel develop an area cl1n1c one should
conslder thepre88Dttraftlc middot~ytaa an4tranaportatlon
systems Thecl1D1cahoUld be located close enoUlh to
major arterlals to giva asy access from the total area
be_ ervecl by this cliD1c At the t1ll8they should
be tar eo away froll thesarterlals to all8Y1ate traffic
CODCell18 andpark1D8 conpstlon By traff1c concerns I
IJ
37
lIlan one lUSt consider thertarro1fne8S of streets whether
streets are oD8--C)r two-way iqres8 and egress to parking
amp0111tie eros tratflC) spedof trattJQ children 1n
ll8a traffic i1lht Vislon re8tr1ctionS etc
BwstraDsportat1onshould alao be central in this area
as maay people ~U f1Df1 1tD8Cessary to use this form of
transportatlon
~e tutqredlopHQt of bull treewa systems should be
c0J1S1dered soastolesen thecumce ofmiddot future roada
cutt1DSotltbe cl1D1c llte line
nrrph1c middotDampta
It is 1JDportaDtto kDOw the demosraphic distribution
characteristics of the oUenteltbat i8 to be served by
localized health cl1D1cs
Acl1D1c which erves8J1 area where1D the prepondershy
ance of persona arecrter 65 years of mayf1nd that these
people rely more on pUblic transportation call for more
home- services and haV4t 110ft ChroD1c and debilitating
types of disorders (b1_ blood pressure poor heariDg and
eyesight) tbaD do8 an area ot a YOUDIer population On
the other hand thL area of older residents may have little
need for family plabDlng cllni08
In order to better ~Ybullbull the 4eaoraphic population
of each CeD8U8 tract the 1970 CeD8U8 iatormation was viewed
and two specific catelOri8 considered These two cat
IJ
38
lori8S woUld be the perc_tap ot population under 19
year of ase and the percentase ot each oensuetractover
65 years of age he 1960 1Dtormatlon tor eaCh tract was
then compared witbthe 1970 intormation and a percentage
ofincreaae or4ecreamp8 tormiddot e~chtract1n each category
cOJlputecland achartma4e By the use of this chart one
18 able to View tJleap populat1odiatr1but10n of census
tract and at the _ t1lle accesa middottrencl Por example
let us choose census tract 601 W see 40-4 otthe
population is under 19 years ot and that ODly82 1s
over 65 years ot middotAtthe e tille the percentage of
youth bas ~ed ODly 1_ intbe laSt teD year whilethe
percentale over 65 year ot middotbas stayedmiddotthe same With
this in mJnc1 ODe ~ 1DfItr libat ol1D1o aerviDg this
area WOuld bellQre conq~w1th the problems of a
YOUQier populat1on and that _ would probably be true foJ
some t1aein tbefuture On the other hand CeDSU8 tract 54
has only 2 ollt population UDder 19 yel1s ot age and
this has decreased by 1 over the last ten years middotwhile at
the same time 32-377 ot the populat1on 18 over 65 years of
age A ol1D1C ___ this area should be or1eJ1ted toward
tbespecttic problema otthe ampledbull
PerCapia __ bY gsa neat
WhaD cona1der1qlooat10D1 tor health cl1n1cs one
shoUld take the 1DC01Ieot areas into consideration Areas
IJ
39
of lowiDcome would not 11kel~be 8erved more by localized
cl1D1cs tbaD would are of hilbincome It 18 likely
people haYiq a hip iDeoll8would preter to be aeenby a
chosen ~r1vatephylc1a1l tban at a local cl1D1cwhere
10Dier waits y beraceaaampryand leas personal attention
gl_
The 19701ncOII81atoWampt10n tor MultnomahC~ty was
not available at the tille thi8report W88 made The 1Dto~shy
tiOD Was taken ~adtro tbe1960 census publlcation
his woUld ~8Il thea tbat ral1I8 OD the chart ynot 1raquoe
completely accurate hi writer telthatthe areas most
affected by tb8 1I8eof the older 1Dco1DtOlaat1oDWOuld be
those tracts wh1ch baYebad a rapid 1ncreaae1n populatlon
over the past tfmyHr8 bullbullbull tracts would include tracts
nUmbered 104 9897 96 aDd 95 be perc~ita 1Dcome
referredto1il-tb1a Paper18the lIean 1DCo per person per
census tract
Attar the iDeoeper census tract was listed on a chart
a map was de 1D41catiDg those census tracts belonging to
the lower 14 ot income tor all censue tracts in Multnomah
COlDltytbose beloqins to the upper 14 ot income tor all
census tract 111 MultnolUlhCounty and those belonging to
the mid 12 ot 1I1coaetor all oeuuetracts in Multnomah
C01mty
In yiew1Dg the _p 1t caa be seen that the low income
area seautotollow aloas the at aide ot the Wl1lamette
IJ
40
R1ver the full length of Kultnomah County A second low
income area follows the south edge of the Columbia from
the northwest corner of Multnomah County easterly to 148 St
A third problem area seems to be on the east bank of the
Willamette River with the Union Pacific Railroad being
about the center of this tract The extreme loutheast
corner of Multnomah COUDty appears to be a low income area
but as this area bas bad rapid grouth in the last ten years
this could be erroneous
Mental Health
be first ~ecific indica to be selected from the
Multnomah County envirollllental survey of early 1971 and
to be considered in this paper i8 that of Mental Health
At the present for mental health purposes Multnomah
County is divided into five catchmentareas with a mental
health cl1n1cin each area These clinics are Model
Citles Delaunay ADkeny street Office Hansen Health
Building end Southeast Clinic
All lIlental health cl1n1cslcept statlstlcal information
on all patients visiting their cl1n1cs this included the
address of the patient hese addresses were then listed
upon the approprlate C8D8US tract Each census tract was
then ranked on a chart according to the nUllber of mental
health patients who reslde ln thatCeDSUS tract attending
any of the above listed ental health clinics This chart
IJ
41
wasttum d1v14ed1ato proper quartile bbullbullbull
quartile vereUs to dne10 u appropl1ate Multnoh
County _tal health ItLa middotmiddotmiddotthelipO~a1bl by lOoJcJIUE
at the UDtal health _to uteN1De which ueu have the
lars-t use otCOllDty 1alh~th faci11t1Rot
1Ilclu4ecl 111 tbia woUld tber otpeopleYia1t1Da
pr1vat patch1atriata aDd pr1_t _ntalhealtb cl1D1c8
WheDtbe M1 18Yienclmiddot Itmiddotmiddotmiddotmiddot~middotbe~_ tbat ~rtt
appears to lMt fourmiddotmiddot-al are iii _oil the nuaber ot
lIental healthcl1D1c na1t toM tbjh1sheat 1he
tour areaa woUld be tollows
1ttrea Ore to~Blo Drimiddot ~tb Burrus14e aDd tIMtmiddot Colb1a Riftr H1gbwyaeri1Dla th nortllra boundaryshy
2 bull ProII 82D4 1_~ 10 20th streetwitil the ra1lMd Mu the north ltouadary
3 ~ et et tUgl_b1bull MYel froamiddot the Clackaaa COUDty l1ae aorth to Dln8lon stret
4 beDOlvt1ttfe-t ~efllt4 COatytrca Jle1aware streetmiddot toR1C1a11oDd wlth Colubla Blvd heiDI tbAtnorth bouaclary_
It ODe coapareatbiap to th iDeobullbullmiddotp 1t can be
eamiddotthat lIOat ot the c tracts baY1Dg bllh v1i11tatlcma
middottfl public tal health cJ1rUc8 ~ 111 t13e low ~ aid
1DcOile SroupiDIOJa1y of til 25 tracta llsted as
haviDlbip aental Maltll nlltatlou are ~ the1g60 hip
iDeo arebullbullbull
17 Plpn
42
amily PlellnSDI ]Jlce Metal Health i8 an 1nd1ce of
use Theperson 111 ordertobavebe_ 1Dcluclecl 1n this
atu4ywouldhave tohaft Ue4 ataa11y plaDI cl1D1c
tacilities of soaetype It 41fter troll tile _tal health
study1nthat i t1Jicludestatist1catrollbotb public and
privateclJD1os
The iDformation tor the iak orurcbart 8Dd map of
t8ll111 plenn1 na ob1a1De4 by cOIIblnlDlthe mabel of
1rlcuv1duals bullbull_ attbe tbreellUltrampo-ti Coatyhll11y
PlalJQllIl C11ll10s 111til tbo at the Planned PareDthood
Association CliD1C8 be tbree -JIultDouh Couaty r8ldly
PlamSq Cl1D1c are Solrtbweatth Col_bla 1111- a114
HaDsell Health BWlcl1Dl CllD1cbi middot1Dtormat1oD vas then
bullbullbullesed tomiddot detellWMt l10w people troll eacb c8IUIUS
chart wastben Mele IUs oIIart jn 4iY1ded to show
the censuS tracts lIaYiDlmiddottIle h1t1iest qUart1le of incidence
of use lowest quartile of 1Qc1deao ot use Jlid 12 of
incidence of Wle an4 a map sprepared troll thts 1Dto~
mation
The C8U118 tractsbelOJISnl to the h1lhestquartile of
use appear to be 1lO~ 8catt~ on tbipwas true ot
either the _p ot aental health cl1D1c uaageor ot the map
abow1DI per capita 1I1COM Iaere40 to be three
d18t1nct areas of UIIaP beJ woul4 be
1
IJ
43
t10D of BurD81cl and the W11lallette River 4
2 S~t Portland 8Otth otmiddot the ra11shyrcaadand alona the W11lamette River
lIortbeaat Portl8D4 between MisSiss1pp1 and 24tbStreet the northbouBclary be1DgColwb1aBlvd
Pylzl1c BMltl IrpI Y11ta
Publlc Healtil nur81D1Y1s1t nclud8 an vists to
theholles of client by PubUc Health Nurbullbullbullbull his shows
visits to bull f8Jl1ly fer aDY purpos SUCh aatuberculolJ1s
het1Dl tem1tyaeatalu4 8IiOt10D8l cODd1t1ona etc
he atat18t1C~ 1fele C()4ed accord1Dg tomiddot the 1llli301fOCUS
of the Y18lt tt doe DOt 1D41cate the Dmlber of holies or
f8ll11lev181tecl or 1D41Y14ual Y1a1ted more tban oDcein
the propwl It dobullbull I1ve 80M 1D41cat1on by coaparlshy
OD ot the 8JIoUDt of aedlcal problema 1n eachcen8WI tract
Ap1nmiddot the _p abowa 8 scatter patteraof probl_
areas althoUSh there appear to be a sroup1Dl of hiSh J
l8aIeccmaus tract 1ntlut extreme southeast part of tbe
County other areu uIriaI any nura1Dl contacts are
1 bull he 801lth-oa-al CO1Dty on eaCh 814 of 82nd Av from Clackallaa County north to Dinloa
2 ear bullbullbullt 814e aroUDd Preacottand Misaisippi
Dowatom Bunul14eonboth 1de of the river
44
V_real Pis The iDfomatloil uaec1 to tabulate the Venereal
disease chart includes all the ooab1ned case otmiddotODormea
and syphilIs reported by bothmiddot publIc and prIvate physicIans
dur1nl 1970 There were 3602 caes ot IOnorrhea reported
dur1nl 1970 While ODly 17 cabullbullsot ayphilimiddot were reported
A chart was prepUed aDd att8llPt wasmiddotmiddot de tomiddot
determ1De Wh_therVttDereal 41ease was more p~vaJent in
areas othigb or lowmiddot proportIon ot youth hi waadone
bymiddotdetemlna a 1leaD prceiltacmiddotmiddotmiddottor the population ot
resld~ts UDder19 years ot (34) middotA mean ratemiddot per
100000 popUlatIon al80c1ttem1Ded tor the middotoccurreDCe
ot venereal dieae This was et at 390 oass Areas
hav1nl a population 1n which leiS than 34 were lmder 19
years ot ampIe were called low- yOuth abOve tbl percentaae
hiSh youth The aaa waatrue ot the occurrence oivenershy
eal disea_ per CeD8UStract It the rate waacomputed
as 1I0re than 390 cases per 100000 it was called hiah
venerealdiaeasei it less than thia tisure low venereal
disease It was tound that 1D Multn~ COmlty there sems
to be poSitive OOlatI0n(x21S19gt between low youth
and hipmiddot venereal diseaand hip youth and low venereal
diseasebull
RaDk ordr Iitot all c traot middottbAm made
Th1s was done byt1Ddlna the ratepr 100000 populatIon
of venereal disator all census tracts in the County bull
45
These were thenlisted from h1lhto low (sreatest to
least) in a rank order The l1sting was then divided
into Upperandlower 14 aDd listed on the MUltnomah
Countymiddot up
The areas of b1gh venereal disease se8ll18to
roup thBl~8 middotin a very tllht area ~oq both 1des
of thell18l8~ R1 w1th BurDaldeS~et being
~bout theceDter qf tbi8IZ9uping This area woUld
appear to be m ldeal spot for the denlopment of a
locallzed venereal d1sbullbullbullbull cl1D1c
UbepoundCUlO1s
In this report bull tube1C1llosls caS8S refrred
to include alltbobullbull cabullbulls ontubercUlo8is follow-up
rather middotthan just new C Accord1Ds to the Multnomah
County Health SUrvey of early 1971 this would include
all ca repOrte4 over thelaat three years The
total number of tuberculosi8 cabullbullbull usedin this study
was 666 lh1 included 128 new cabullbullbullbull
A rate per 100000 of tuberculosis for each
census tract wa- then computed and the c~us tracts
listed by rank order be b11h Qartlle mel low
quartl1 were then reoordd on a Multnomah CoUnty map
TWo genral areaa baY1Dg a hip mcldencaot tubercu~
losiare 1D41cated heyare
1 Both middotsld ot theWilla11lette River
Ll -
46
with Burns1de about thecnter
2 he extrea Northebullbullt comer of the County bull
By coap8r1ng the tuberculois an4ven8real
diseae maps ODe can 8ee that the downtown areas ot
hiSh 1nc1denceare alIIo8t 1c1eDt1cal on ach map
This WOuld 1nd1cate that 1t would be of value to
bullbulltab11sh acl1D1c 111 th1aampreatbat would provide
bothtuberCulos1s 8Dd ytmereal 418ase srvicbullbullbull
Thchart aDd 1181gt8 are wsfuln 11v1DI
1Ddicat10DS tor the type aDd placemeototlocal
health cl1n1c8 tbro1qhout tbe MultnomahCounty area
A cOllpar1on of the mapa help one to dec1dewhether
to provide a aulti-8ervice cl1D1c or spec1f1c type of
cliD1c As stated in Part I of thi paprserv1ces
shouldhaYe both treatlieDt and prfMmt10n cOmponents
As he been stated fta ne1lbborhood health care
Qenter muat be a fac111tY plazme4 with an aamesa
ot the neds of the consumer and the c01llll1m1tybull
Part II of this rport haa been an attaapt to indicate
and clarify 8011 ottheae coDlllUDity neds This has
been done through8elect10n of apc1f1c problems
The indic were then visuallyrecorded through the
use of ups and charta ODe dan asseS8 thedsreeof
1DIportance of certain concems to spec~t1c areaa by
comparinl the chart aDd maps Prom this oDeean
41 dec1de which are48 vb1chcUD1c-or indeed if
the need a clinic at all However further factors
should be considered hebullbull include
a The amount of fuDd1 available
b What 18 the percentage ot peopleineoh ceaaua tract tbat would actually us such cl1n1cIl
c Wbat 1 tbeco--1tymiddot 8 IeeliDashyreaardtDI particular cl1D1c8 Would this dcrebullbullbullmiddot the ettctiveness ot thse cl1n1ca
IJ
li
D_OlraphicPopulatLon Challie 1960 to 1970 48
Cen8U8 1 of Pop 1 Cbaqemiddot 1 Change1 ofPopTract Under 19 Yr8 Over 65 Yrs1960-70 1960-70
middot1Q701Q70
1 319 -12 171 -H) 1
2722 215-27 +68 301 366 -22 127 +35 302 371 +19 111 -04
311middot401 144-41 +29 402 321 13~7-39 +24 501 356 124-08 -02 5~O2 351 133-23 +12
405601 82-10 -02 394602 103-01 -06
701 275 149-76 +56 702 361 +01 121 -07
+10middot801 326 140-22 802 321 middot127
(
-29 -03 9~01 342 124 -H) 6-18 902 294 128 -H) 3-24
10middotmiddot -14312 140 -17 1101 182 +25 -23197
2411102 186-59 +29 1201 226 169-17 -41
31middot01202 +11 182 -05 295 -H) 81301 208 -H) 4
1302 331 +08 197 +04
14 323 +15 middot185 -08 middotmiddot15 329 +16 16~5 -13
-28middot 1601 332 131 +12
1602 356 98 +24middot-39 middot3101701 161-33 +21
1702 370 -15 85 +02 +19 1801 264 151middot-50
185middot1802 256 +47-58
IJ ~
D_raphlc Population Change 1960 to 1970middot 49 (Contd)
4io
Census Tract
of pop Uncter 19 Yra
1Q1n
1Cha1l8e 1960-70
of PopOver 65 Yra
lQO Change
1960-70
19 389 +29 141 -24 20 223 -13 206 +18
21 227 +08 194 -36 2201 356 -27 112 +05
2202 290 -18 ll~9 -29 2301 356 -03 154 +24 2302 260 -37 245 +97
2401 410 +6~1 123 -31 2402 163 -80 320 +99 2501 381 +13 140 -01 25()2 237 31 lil +02 26 343 +25 186 +149 2701 370 +29 1S5 -01 2702 249 -44 304 +98 2801 337 +19 187 +09 2802 306 -10 156 +31 2901 304 -38 142 +24 2902 i 307 -32 146 t3~9
30 29~0 -48 16~2 +51
31 355 +30 160 +01 32 370 +48 148 -13 3301 395 +45 130 -20 3302 368 +06 138 -02 3401 386 +16 117 000
3402
400 +32 92 -26 3501 304 -07 115 +35
3502 344 000 140 -13
3601
36~02 357 -04 132 +32
3603 30~1 42 149 -67 3701 342 +28 152 +19
1
IJ
Jianolraphic Population Chan 1960 to 1970 50 (Contd)
Census Tract
of Pop Under 19 Yrs
JJl7J
middotChanae 1960-70
middotofmiddotpop Over 65 Yrs
1c~7n
Change 196070
3702 409 +39 122 -11 3801 308 -11 151 +29 3802 275 -35 180 +46 3803 282 -32 192 +54 3901 376 ~13 100 +17 3902 296 -03 177 +29 4001 438 -11 84 +13 4002 353 -21 115 +20
4101 397 11 9middot0 +11 4102 346 -19 120 +03 42 331 +19 11 bull 3 -16 43 347 -72 105 +31 44 113 +84 183 +154 4S 33~9 +07 110 -06 4601 2501 22 193 +38 4602 332 +59 126 -29 47middot 161middot 000 211 +01 48 103 -26 302 +59 49 138 +1 bull 3 252 +09 50 141 -26 204 -12 51 12 -39 257 +07 52 47 -61 351 +48 53 89 +49 314 -30 54 25 l1li15 327 -17 55 131 -17 115 -121 56 198 +93 227 -47 57 71 102 189 -88 58 240 ~middot41 16~1 +55 59 322 +25 142 +06middot 6001 264 95 132 +50
6002 328 -31middot 89 +07
JJ
Demographic Population Change 1960 to 1970 51 (Contd)
Census 1 ofPop lChange of Pop bull ChangeTract Under 19 Yrbullbull 1960-70 Over 65 Yrs 1960-70
1970 1970
61 355 -58 85 +39
62 328 39 110 +18
63 414 04 73 10
64 382 -22 72 +04
6501 383 02 67 -20
6502 329 -56 96 +09
6601 391 +13 88 -03
6602 319 -59 97 +06
6701 327 71 145 +72
6702 331 ~67 83 +1-0
6801 365 -66 49 +01
6802 388 4bull3 54 +06
69 354 -41 80 +23
70 400 -23 68 -06
71 359 -48 72 +05
72 255 -88 82 +11
73 346 -39 91 +25
74 313middot -63 105 +24
75 329 -42 129 +37
76 336 -52 85 +21
77 370 -10 69 +05
78 309 -10 120 +21
79 325 -56 87 +10
8001 358 -81 57 +12
8002 391 ~81 76 +12
81 315 -76 108 +21
8201 403 -23 64 +08
8202 392 23 65 +08
83 357 -34 120 +31
84 402 -18 73 +16
85 413 -06 76 -09
r
Demographic Population Change 1960 to 1970 52 (Contd)
Census Tract
t of Pop Uncler 19 Yrs
1970
Change 1960-70
1 of Pop OVer 65 Yrs
1970
ex Change 196070
86
87
88
89
90
91 9201
9202
93
94
95
9601
9602
9701
9702
9801
9802
99
100 I
101
102
103
10401
10402
lOS
368
351
379
391
391
413
379
433
372
429
414
432
419
439
~32
377
457 420
378 41middot7
345
360 417
417
412
-04
-02
-35
-26
-28
-11
-64
-20
-S9
-39
-32
-21
-34
-40
-47
-lO~7middot
-27middot +04
+56
+07
-34 01
+04
+04
+10
103
128
97
11il3 99
69
79
42
77
46
34 38
44
40
54
111
51middot
81
133
59
74
140
63
87
76
-08
-06
+04
+08
+17
-05
+3S -02
+1~4
+19
+33
-14
-08
+12
+26
+71
+11
-16 -34
-20
-19 +37
-49
-2S +15
NOte The The
Taken frOi
averageullder averageabove
middotUSCensus ---shy -
19 years == 6S years ==
figures 197
32r 13(14
p a~d 1960
--
Rank
1
2
3
4
5
6
7
8
9
10
11 12 -_
13
14
15
16
17
18
Tract
69 46
60
58
- 68
61
302
2501
67
63
19
62
26
94
3603
3902
64
30 -----~-
Rank
19
20
21 -
22
23-shy
24
25
26
27
28
29
30
31
32
33
34
35
36 -
Ranking of Per Capita Income by Census Tract
Tract
65
2701
- 15
1601
701
66
93
82
2903
3602
30
2502
80
2401
81
- 70
91 shy
4001
High
Rank Tractshy
-32shy37
38 97
120239
7840
41 ~ _2_1__ 42 31
43 2501
44 18
45 98
46 37
47 3803
1702
49
48
1602 92 2702
I
50 89
51 901
52 801
Ra_
53
54
55
56
57
58
59
60
61
62
63
64
6S
66
67
68
TractTract Ra~
74692
170196 70 I
401 71 90
72 1037J
79 70273
3802 74 601
24024102 75
85 76 101
77 9023901
7699 78 100 4101 79
3601 I
380180
458140~ t---- _ - - shy83 82 42
888384
59843501
4777 8~
502
Low
802 86
Rank Tract
87 shy
--88
89
90
91
92
93
94
- 95
96
97
middot98
99
100
101
102
103
104
1201
14
49
72
73
43
87
3502
105
1
52
86
71
1
501
10
3301
104 tf
Rank
105
106
107
108
109
110
III
112
113
114
115
116
117
118
119
120
121
Ranking of Per Capitalucoae by Census Tract
(Contd)
Tract Rank
4001 122--shy602
13
1102 2302
3302
55
3401
48
21
56
50
3402
lL01
2202
2301
53
2201
-shy
Tract Rank Tract Rank T~aet Rank
57 I-----
Imiddote
bull
Tract
- Low -k Note Information taken from 1960 U SCensus
Rank Tract
I ~
Ie
Imiddot
~
----
----
--
--
Rank
1
2
3
4
5
6
1
8
9
10
11
i-
-Tract
391 922 921
972 971
100
132 131 121
962 961
822 821 401
982 981
20 111
47 10 1
412
High
Total Number of Henta1 Health Visits
Ranked by Census Tract High to Low
TractTract RankTractRank Rnk
12 182 22 78 29 87 76 381 73181 ~------- 1913 371 8538230162372 271 2616-121 8272 2
14 80~2 31 94 7923 84801 59 15251362 4232 15 52 _ 32 103 8924 651 17240216 652
_ 91 351 33 341 23117 83 122 25 25 48 1123921418 34 shy61 86 661
19 662 6493 81 26 91 8153 49 50 55 41383 71 27 51 3120 90 672241 35shy 104167162 461
I 411 46211121 28 88342 I
2502 36 69 54 5251 50 272
-Ra
37
38
39
_ 40
_ 41 Ishy
I
42 I
-I 43 44
45
shy
Tract
~ --- shy 95 56
45 292 242
102 62 352 291y
92
101 281
99 72 63 601 60~ 42 2201
77 74 61 57
363 232
70
32 31
11 44 282 2202
Low l
- Tract
46 682 681 I 331 30
r~$ 47 1042 332
48 102_41_
11
~
Visits to Family Planning Clinics Ranked by Census Tract High to Low
Rank Tract Rank Tract Rankmiddot Tract Rank Tract Rank Tract Rank Tract
1
2
3
4
5
6
7
8
9
10
11
12
13middot
14
15
16
17
361
56
401
341
48
59 121
20
55
342
10
31
58
93 21
241 132
331
53
461 462
18
19
20-shy21
22
23
24
25
26
27middot
28
29
30
31
32
33
391
32
middot47 I-i-_-shy _ -
231 111
332
972 1
372 371
52
89
32
92
82
100 31
182
30 242
402
34
35
36
37
38
39
40
41
42
43
44
45
42
1714 i 661 221
78 362 2
90 602 601 352
63 251
105 921
971 351
73 42 292 232
411 51
662
81 45 52
46
47
48
49shy
50
51
52
53
54
55
56
961
801
49 81 72 71
19
9~1
172
68 2 57 162 14 112
91 75 681
381 42
3~3
83 161
57 f
58
59
60
61shy
62 Imiddot
63
Imiddot 64
65
66
64 62 36~3 252
74 652 SO 392 291
651 6bull 2
79 271
r-- ---- shy981 222
672 671
821 272
94 87
281
382
67
68
69
70
71
72
73
74
75
76
77
78
981 26 12~2
IS 61
85 82~2 69
61 43
101 86 84 282
76
131
51 72
1041 962 88 70
99 922 77
103
95 802 181
i
~
Low High
RankRank Tract
5479
4480
81 1042 ~) middot102
71 - - + ~ - ~
Visits to Family Planning Clinics
(Contd)
Tract Rank
I
Tract llaDk l
RankTract Tract Rank Tract
~
I
~
J1 ~
Low
Total Number of public Health Nursing Visits
Ranked by Census TractsHigh to Low
TractTract RankTractRank RankRank TractTractRankTractRank
25249 71 79 17249 8033 6586 99189711 84 2915072 34 661 76 66 811519512
402 5035 51 161 2518220 122 1713423 352 55801 7120 6752 2 149814 41236 83 2662 38 94 6821 53 2924015 362 37 32 42 75 69 281 84 63
546 8822 54 222 85 3925431 70383417 3818223 6439 4386652 718 21 55 103332 8924 232 87 19 271729219619 24156 16211140 382 628825 10523110 112 73411 10141-- ----shy 89 363 4457 8126 16111 221 74 9142 90 46158331 53 671279012 46243 48 59 351 3837528 1083 9313 91 5844 59 -_242 76 1----- shy60 272 72 74104114 60145 42 9287 7729 92 6151 8215 57371 934630 91 307762 12113116 282 619447 41391 9531 78100 63 7378 ~95 681 6945 32 5632 798517 6448 47 52 181
High ~ Low
Rank Tract Rank
96 31 132 70
97 102
98 182 372middot 602 651 662
- -shy
~72 682 802
822 922 962 972 982
1042 ----shy
Low
Total Number of Public Health Nursing Visits
(Contd)
Rank Rank Rank TractTract Tract
I
I lt
I
Tract Rank Tract
[
~~~-
I
~
IJilfimiddot ~
j
Ranking of VD Caea According to Census Tracts 61 By High and LOll Youth Itatio
A media~ of 34 5 was determined Any tract having greater
than 34 5~ of popu1tionunde~ 19 years of age -High~
Any tract having l8S than 345 of population under 19
years == Low
Any tract having rate less than 390 =Low
Any tract having rate more than 390 == HLgl4
YOUTH
LOW HIGH
L
0
12 402 1801 1802 343 2801 2802 29023603
54 6001 600262 66~02 72 74 75 76
78 79 81 t02 65 1202
W
(25)
VD
H
I
G
H
401 701 801802 901 902 10 1101 241 1201 1301 132 14 15 1601 1701 20~ 21 2202 2j02 2402 2502 2702 2901 303501 3502 34023801 3802 383 3902 42 44 45 4601 4602 47 48 49 SO 51~2 53 55 56 57 58 S9 6701 6702 73 95
3~02 7021702 19 25~01 2701 4102 4101 63 64601 ~601 6801 680270 7l 77 8001 80~02 8201 8202 83 84
85 86 87 88~ 90 91 9202 920193 94 9601 9602~ 9701 9102 9801 9802 99 100 101 103 10402 105 6501 10401
(47)
301 501 502 601 1602 2401 2301 2201 31 32 3301 3302 3401 3402~ 3602 3702 3901 400140 02 43 61 69 B(
(53) (23)
~ ~gt
Ranking of VD by Rate Per 100000 By Census Tract
~
Rank Tract Rank Tract Rank Tract Rank Tract llank Tract Rank Tract Rank Tract
1 2202 21 S6 40 902 58 1602 74 75
90-shy 64 107 26 --~-
2 3402 22 45 41 10 59 902 75 78 91 54 108 61
3 2301 23 3502 42 2502 60 602 76 6802 92 402 109 87
4 3302 24 49 43 1102 61 501 17 2 93 94 110 90
5 50 25 52 44 6702 62 14 78 8202 94 97 02 III 76
6 2201 26 20 6701 63 4002 8201 2501
9701 41~02 112 91
7 44 27 48 45 401 64 3802 2902 95 63 113 62
8 3301 28 1701 46 502 65 30 79 83 74 96 9602 114 71
9 55 29 47 47 42 66 3803 80 2801 96Q1 115 85 10
11
12
13
14
15
16
17
18
3401
53
2302
2401
57
21
2402
1101
51
30-shy31
32
33
34
35
36
37
3701 - -~ 1201
3702
89
43
132 131
3602
4001
48
49
50
51
52
53
54
55
58
1601
601
4602 4601
69
701
31
3901
67
68
69
70
71
72
2901
801
39021~ 802
6502 6501 122
702
41~01
81
82
83
84
85
86
87
88
19
1
1702
2802
79
93
100 6801 6602
81
97
98
99
100
101
102
103
104
9201 9202
9802 9801
77
302
79
86
72
84
116
117
118
119
120
121
3603
8002 8001
101
99
95
10401
105 10402 103 102
19
20
59
32
38
39
2702
3501
56
57
301
3801
73 1802 1801
89 6002 6001
105
106
2701
88
High Low
-- -----
Rank OrdermiddotTuberclosis Cases by Rate Per 100000 Ranked by Census Tract High to Low
Tract TractRankTractRank Rank TractRaukTractRankTractRank
801
79 9601501411 52 6835340120511 I 960269 903603532036 $-~~F130221542 4366 311301 70 68~013802 _ I- _ 4001_37213 3921201 6802802 H71523822024 22 54 193302 3802 80 8958 I37139535 70155 9801 I60123 72 6702 98023914011016 6701250124 10 56
81 94 401r 7 154152 73 7057 2625 122 92028
90242 162312301 92~158 86 7172434526509 82 79160159 74 100 87412240227220110 6502836960 75 30 8317244 6501782801285711 61 901 42765645 84 66021459294912 9701 660146 171 302 9702 47
6235023033113 85 822821182 917755 16335013110214 841814832 78 103 938564 324815 86 1057940149272 38036523216 10401 87 2902241 725Q 10402360266340217middot IF88 88 9937233 282 51 218 101 01102 46016234
I)167 2901460219 47
High ~ Low ~
- -
TractRank
9S89
6490
8191 8001 8002
63 61 60middot01 6002 44 2701
92
J
2502 402 --- ----shy
I
Rank
Rank Order Tuberculosis Cases by Rate per 100000
(Coutd)
Tract Rank Tract ~nk
I
Tract Ballk Tract Rank
Imiddot
Tract
Imiddot
1~
t 1I i Pi i l I
o
1 -1shyL I
I J
8 40 icO ~ I -lt 0
-t (1) I
i I
r o E
II
a
I
r--i
shy
I
~
I (
Jgt
(011 fi(
Ggt
I II ~j
()
(f 0
~ ()
I
11
f9
r
II 99
o ~
Ggt r
~ __-J~ I t I ~ I
r--J l I
~ _ __ J
) 1
fTl
1gt
r I
()
r
()
lt en -i en
()
I1l
(J)
(J)
-i
P ()
19
r o ~
r G1 I
I
c
~
o I 89
--- -I-shy
r-r I
1- 0 _~ _ _--J E
G1 I I I
i i
I 1-1-1 ~ _J ~2 ~ II
II
()
1 I I I 1
id i bullbull
~
A n 69
r 1shy
- 0 Gl
l--~ ~ I
~ II
II )
I () isect i
en l i
(J)
-t
0
IA Ol
IJ
34
ThepurposeOfPart II of th1aa paper1atod1scuas
elected Speclfic needs ofecltlc areas within Multnomah
County A8P01ll~oUt 1D ~ I of t1a1bullpapermiddot Ita nelgbshy
borhood health oare cater IlU8t be a facl1lty plaDlled with
aD awarenes of the neeels of the oODllUller and collllUDity
Part II of this paper nIl Show 80e of thoe speclflc
needs
he1DforutiOD tor t1li Portlon of the report
obta1nec1 troll tbroupout tbe follow1Dl threepUb11catloDS
1gr~e_tiMshylIPrIxaiidOreson JuDe 1963
2 1~_middot_sectSI8e~ected1teai c-ua 0 S 8 e first count coaputer tape Coluab a_lion AssocshylatloD of QoveraMD-8 Jlme 1971
3 Jtu1tDoab County Oreaon BDY1roDlHtlltal SurveyEarly 1971
The JIultDOIIIlb COUDty OrttIOD BDv1roDllfmtal Surley
Barly 1971 1s bull stat1stical report of the activ1tles of
theentlreMultDOIIIl2 CcNDty Health Dep~t during the
year of 1970 Die speclflc 1nd1cs elected from tb1s
study amprejMental aealtll Publlc Health N~s1D1 vlslts
FaJUly ~ Veaereal])1 ~ ~rcul081
Throush tie use of cUrts and mapa ODe CaD roup these i
speclflc ~oea to ahcnr the healthneedsof speclfic I
census trtcta aD4 then the health needs of iarer neIghshy
borhooda 1m4 o~ Uebullbull
Rf)~UP1Dl of areu was accompllshed in thefolloWinl I
JJ ~
35
he MiltDoIliahCountY oregon BDViromaental SUrvey
early 1971 isamp statistical report ot tbeaotivities ot
the entire MultDolllh COUDty Health ])epartiDent dur1nl the
year ot1970 he specitic 1Dd1C8S selected frOm this
aUy are 1Il8Dtal health public healthDurs8s visits
fUl1ly pia waereal elisease aDd tuberculosia
Tbroq11the Wle otcbart aDd mapa aDecm szoup these
specific indic to show the health Deeds ofapecitic
ccmaua tracts aDdtIum th8health neecla of larsr ~eilh-
bOrhooda and co8I13 tlbullbullbull
RegroupiDI ot areas waa accoap118hed1D the
tollOWiDl lIIIIm1er~ A bullbullcifie 1ndex 8selectcl auch as
venereal di8bullbulle or tuberculo8i~ he total number ot
cs was then deterll1ne4 for each census tract Through
the use of the maber ot cRbullbullbull tor a 11Yen cenaus tract
aDd tbe population ot thattractaltrateot1lla1ampmcper
100OOOpopUlaticm wu cleteXll1ned for each census tract
This was ~e to starl4ard1ze the population ditterence
amongOeD8U8 -tracts 1he rate of incidence toreaob
cenauatract was then llstedby rank position on a chart
In rank poition1DI any cen8Wl tracts haviDg equal
rates ot1l1c1dence are assipe4tbe iaDk posttiona
Beeauseot the abo fact tbAt cbarta w111 vary in length
neveltbAtlea eacb cbart will 1Dclu4eall census tracts
inMullnoaah Couaty Atter the census tracts bave been
listed accord1q to raalcth1s list will bediv1ded into
IJ
36 three levelsotinc14ence he three levels are
1~ The upper 14 of1DcldenCe
2 Thelower 14 ot incidence
middot3 The ILld 12 of incidence
Tlles three srouplqa are then used in compiling a map ~f
Mu1tnOmahCountyfor ach apecltictop1cbull TIle maps are
uaefuJliD tbatthey V1suallycoJib1De 1Dd1v1Clualproblem
census tracts into larger problem nellhbOrhooc1s
The 1960 statistical iDtormatloD was Used in a similar
liIaDDr to tbatexpla1Dedabove 1Dthe4evelopaent of a
chartmiddot and map 1Ihow1DI e cOllpampriSOr1 of per capita lncolle
tor ttaCh ceDsua tJact aDdmiddot combiDed census middotmiddottract areas
he 1910 aDd 1960 statlstlcal iDtOrllatl0D was combined
lna map and chart he purpose of this and chart is
to d8aonatrate the e cl1stributloa1DeachceD8U8 tract
and middot1ndlcatbull tuture ace populatlon treD4a bull
When one be middotbullbullbullbullbullHdth ne8cts ot an area and has
declded to establlsh a cl1D1c to serve that area the
physical location otthat cl1D1c IllU8t be consldered In
order to coapreb8ll81vel develop an area cl1n1c one should
conslder thepre88Dttraftlc middot~ytaa an4tranaportatlon
systems Thecl1D1cahoUld be located close enoUlh to
major arterlals to giva asy access from the total area
be_ ervecl by this cliD1c At the t1ll8they should
be tar eo away froll thesarterlals to all8Y1ate traffic
CODCell18 andpark1D8 conpstlon By traff1c concerns I
IJ
37
lIlan one lUSt consider thertarro1fne8S of streets whether
streets are oD8--C)r two-way iqres8 and egress to parking
amp0111tie eros tratflC) spedof trattJQ children 1n
ll8a traffic i1lht Vislon re8tr1ctionS etc
BwstraDsportat1onshould alao be central in this area
as maay people ~U f1Df1 1tD8Cessary to use this form of
transportatlon
~e tutqredlopHQt of bull treewa systems should be
c0J1S1dered soastolesen thecumce ofmiddot future roada
cutt1DSotltbe cl1D1c llte line
nrrph1c middotDampta
It is 1JDportaDtto kDOw the demosraphic distribution
characteristics of the oUenteltbat i8 to be served by
localized health cl1D1cs
Acl1D1c which erves8J1 area where1D the prepondershy
ance of persona arecrter 65 years of mayf1nd that these
people rely more on pUblic transportation call for more
home- services and haV4t 110ft ChroD1c and debilitating
types of disorders (b1_ blood pressure poor heariDg and
eyesight) tbaD do8 an area ot a YOUDIer population On
the other hand thL area of older residents may have little
need for family plabDlng cllni08
In order to better ~Ybullbull the 4eaoraphic population
of each CeD8U8 tract the 1970 CeD8U8 iatormation was viewed
and two specific catelOri8 considered These two cat
IJ
38
lori8S woUld be the perc_tap ot population under 19
year of ase and the percentase ot each oensuetractover
65 years of age he 1960 1Dtormatlon tor eaCh tract was
then compared witbthe 1970 intormation and a percentage
ofincreaae or4ecreamp8 tormiddot e~chtract1n each category
cOJlputecland achartma4e By the use of this chart one
18 able to View tJleap populat1odiatr1but10n of census
tract and at the _ t1lle accesa middottrencl Por example
let us choose census tract 601 W see 40-4 otthe
population is under 19 years ot and that ODly82 1s
over 65 years ot middotAtthe e tille the percentage of
youth bas ~ed ODly 1_ intbe laSt teD year whilethe
percentale over 65 year ot middotbas stayedmiddotthe same With
this in mJnc1 ODe ~ 1DfItr libat ol1D1o aerviDg this
area WOuld bellQre conq~w1th the problems of a
YOUQier populat1on and that _ would probably be true foJ
some t1aein tbefuture On the other hand CeDSU8 tract 54
has only 2 ollt population UDder 19 yel1s ot age and
this has decreased by 1 over the last ten years middotwhile at
the same time 32-377 ot the populat1on 18 over 65 years of
age A ol1D1C ___ this area should be or1eJ1ted toward
tbespecttic problema otthe ampledbull
PerCapia __ bY gsa neat
WhaD cona1der1qlooat10D1 tor health cl1n1cs one
shoUld take the 1DC01Ieot areas into consideration Areas
IJ
39
of lowiDcome would not 11kel~be 8erved more by localized
cl1D1cs tbaD would are of hilbincome It 18 likely
people haYiq a hip iDeoll8would preter to be aeenby a
chosen ~r1vatephylc1a1l tban at a local cl1D1cwhere
10Dier waits y beraceaaampryand leas personal attention
gl_
The 19701ncOII81atoWampt10n tor MultnomahC~ty was
not available at the tille thi8report W88 made The 1Dto~shy
tiOD Was taken ~adtro tbe1960 census publlcation
his woUld ~8Il thea tbat ral1I8 OD the chart ynot 1raquoe
completely accurate hi writer telthatthe areas most
affected by tb8 1I8eof the older 1Dco1DtOlaat1oDWOuld be
those tracts wh1ch baYebad a rapid 1ncreaae1n populatlon
over the past tfmyHr8 bullbullbull tracts would include tracts
nUmbered 104 9897 96 aDd 95 be perc~ita 1Dcome
referredto1il-tb1a Paper18the lIean 1DCo per person per
census tract
Attar the iDeoeper census tract was listed on a chart
a map was de 1D41catiDg those census tracts belonging to
the lower 14 ot income tor all censue tracts in Multnomah
COlDltytbose beloqins to the upper 14 ot income tor all
census tract 111 MultnolUlhCounty and those belonging to
the mid 12 ot 1I1coaetor all oeuuetracts in Multnomah
C01mty
In yiew1Dg the _p 1t caa be seen that the low income
area seautotollow aloas the at aide ot the Wl1lamette
IJ
40
R1ver the full length of Kultnomah County A second low
income area follows the south edge of the Columbia from
the northwest corner of Multnomah County easterly to 148 St
A third problem area seems to be on the east bank of the
Willamette River with the Union Pacific Railroad being
about the center of this tract The extreme loutheast
corner of Multnomah COUDty appears to be a low income area
but as this area bas bad rapid grouth in the last ten years
this could be erroneous
Mental Health
be first ~ecific indica to be selected from the
Multnomah County envirollllental survey of early 1971 and
to be considered in this paper i8 that of Mental Health
At the present for mental health purposes Multnomah
County is divided into five catchmentareas with a mental
health cl1n1cin each area These clinics are Model
Citles Delaunay ADkeny street Office Hansen Health
Building end Southeast Clinic
All lIlental health cl1n1cslcept statlstlcal information
on all patients visiting their cl1n1cs this included the
address of the patient hese addresses were then listed
upon the approprlate C8D8US tract Each census tract was
then ranked on a chart according to the nUllber of mental
health patients who reslde ln thatCeDSUS tract attending
any of the above listed ental health clinics This chart
IJ
41
wasttum d1v14ed1ato proper quartile bbullbullbull
quartile vereUs to dne10 u appropl1ate Multnoh
County _tal health ItLa middotmiddotmiddotthelipO~a1bl by lOoJcJIUE
at the UDtal health _to uteN1De which ueu have the
lars-t use otCOllDty 1alh~th faci11t1Rot
1Ilclu4ecl 111 tbia woUld tber otpeopleYia1t1Da
pr1vat patch1atriata aDd pr1_t _ntalhealtb cl1D1c8
WheDtbe M1 18Yienclmiddot Itmiddotmiddotmiddotmiddot~middotbe~_ tbat ~rtt
appears to lMt fourmiddotmiddot-al are iii _oil the nuaber ot
lIental healthcl1D1c na1t toM tbjh1sheat 1he
tour areaa woUld be tollows
1ttrea Ore to~Blo Drimiddot ~tb Burrus14e aDd tIMtmiddot Colb1a Riftr H1gbwyaeri1Dla th nortllra boundaryshy
2 bull ProII 82D4 1_~ 10 20th streetwitil the ra1lMd Mu the north ltouadary
3 ~ et et tUgl_b1bull MYel froamiddot the Clackaaa COUDty l1ae aorth to Dln8lon stret
4 beDOlvt1ttfe-t ~efllt4 COatytrca Jle1aware streetmiddot toR1C1a11oDd wlth Colubla Blvd heiDI tbAtnorth bouaclary_
It ODe coapareatbiap to th iDeobullbullmiddotp 1t can be
eamiddotthat lIOat ot the c tracts baY1Dg bllh v1i11tatlcma
middottfl public tal health cJ1rUc8 ~ 111 t13e low ~ aid
1DcOile SroupiDIOJa1y of til 25 tracta llsted as
haviDlbip aental Maltll nlltatlou are ~ the1g60 hip
iDeo arebullbullbull
17 Plpn
42
amily PlellnSDI ]Jlce Metal Health i8 an 1nd1ce of
use Theperson 111 ordertobavebe_ 1Dcluclecl 1n this
atu4ywouldhave tohaft Ue4 ataa11y plaDI cl1D1c
tacilities of soaetype It 41fter troll tile _tal health
study1nthat i t1Jicludestatist1catrollbotb public and
privateclJD1os
The iDformation tor the iak orurcbart 8Dd map of
t8ll111 plenn1 na ob1a1De4 by cOIIblnlDlthe mabel of
1rlcuv1duals bullbull_ attbe tbreellUltrampo-ti Coatyhll11y
PlalJQllIl C11ll10s 111til tbo at the Planned PareDthood
Association CliD1C8 be tbree -JIultDouh Couaty r8ldly
PlamSq Cl1D1c are Solrtbweatth Col_bla 1111- a114
HaDsell Health BWlcl1Dl CllD1cbi middot1Dtormat1oD vas then
bullbullbullesed tomiddot detellWMt l10w people troll eacb c8IUIUS
chart wastben Mele IUs oIIart jn 4iY1ded to show
the censuS tracts lIaYiDlmiddottIle h1t1iest qUart1le of incidence
of use lowest quartile of 1Qc1deao ot use Jlid 12 of
incidence of Wle an4 a map sprepared troll thts 1Dto~
mation
The C8U118 tractsbelOJISnl to the h1lhestquartile of
use appear to be 1lO~ 8catt~ on tbipwas true ot
either the _p ot aental health cl1D1c uaageor ot the map
abow1DI per capita 1I1COM Iaere40 to be three
d18t1nct areas of UIIaP beJ woul4 be
1
IJ
43
t10D of BurD81cl and the W11lallette River 4
2 S~t Portland 8Otth otmiddot the ra11shyrcaadand alona the W11lamette River
lIortbeaat Portl8D4 between MisSiss1pp1 and 24tbStreet the northbouBclary be1DgColwb1aBlvd
Pylzl1c BMltl IrpI Y11ta
Publlc Healtil nur81D1Y1s1t nclud8 an vists to
theholles of client by PubUc Health Nurbullbullbullbull his shows
visits to bull f8Jl1ly fer aDY purpos SUCh aatuberculolJ1s
het1Dl tem1tyaeatalu4 8IiOt10D8l cODd1t1ona etc
he atat18t1C~ 1fele C()4ed accord1Dg tomiddot the 1llli301fOCUS
of the Y18lt tt doe DOt 1D41cate the Dmlber of holies or
f8ll11lev181tecl or 1D41Y14ual Y1a1ted more tban oDcein
the propwl It dobullbull I1ve 80M 1D41cat1on by coaparlshy
OD ot the 8JIoUDt of aedlcal problema 1n eachcen8WI tract
Ap1nmiddot the _p abowa 8 scatter patteraof probl_
areas althoUSh there appear to be a sroup1Dl of hiSh J
l8aIeccmaus tract 1ntlut extreme southeast part of tbe
County other areu uIriaI any nura1Dl contacts are
1 bull he 801lth-oa-al CO1Dty on eaCh 814 of 82nd Av from Clackallaa County north to Dinloa
2 ear bullbullbullt 814e aroUDd Preacottand Misaisippi
Dowatom Bunul14eonboth 1de of the river
44
V_real Pis The iDfomatloil uaec1 to tabulate the Venereal
disease chart includes all the ooab1ned case otmiddotODormea
and syphilIs reported by bothmiddot publIc and prIvate physicIans
dur1nl 1970 There were 3602 caes ot IOnorrhea reported
dur1nl 1970 While ODly 17 cabullbullsot ayphilimiddot were reported
A chart was prepUed aDd att8llPt wasmiddotmiddot de tomiddot
determ1De Wh_therVttDereal 41ease was more p~vaJent in
areas othigb or lowmiddot proportIon ot youth hi waadone
bymiddotdetemlna a 1leaD prceiltacmiddotmiddotmiddottor the population ot
resld~ts UDder19 years ot (34) middotA mean ratemiddot per
100000 popUlatIon al80c1ttem1Ded tor the middotoccurreDCe
ot venereal dieae This was et at 390 oass Areas
hav1nl a population 1n which leiS than 34 were lmder 19
years ot ampIe were called low- yOuth abOve tbl percentaae
hiSh youth The aaa waatrue ot the occurrence oivenershy
eal disea_ per CeD8UStract It the rate waacomputed
as 1I0re than 390 cases per 100000 it was called hiah
venerealdiaeasei it less than thia tisure low venereal
disease It was tound that 1D Multn~ COmlty there sems
to be poSitive OOlatI0n(x21S19gt between low youth
and hipmiddot venereal diseaand hip youth and low venereal
diseasebull
RaDk ordr Iitot all c traot middottbAm made
Th1s was done byt1Ddlna the ratepr 100000 populatIon
of venereal disator all census tracts in the County bull
45
These were thenlisted from h1lhto low (sreatest to
least) in a rank order The l1sting was then divided
into Upperandlower 14 aDd listed on the MUltnomah
Countymiddot up
The areas of b1gh venereal disease se8ll18to
roup thBl~8 middotin a very tllht area ~oq both 1des
of thell18l8~ R1 w1th BurDaldeS~et being
~bout theceDter qf tbi8IZ9uping This area woUld
appear to be m ldeal spot for the denlopment of a
locallzed venereal d1sbullbullbullbull cl1D1c
UbepoundCUlO1s
In this report bull tube1C1llosls caS8S refrred
to include alltbobullbull cabullbulls ontubercUlo8is follow-up
rather middotthan just new C Accord1Ds to the Multnomah
County Health SUrvey of early 1971 this would include
all ca repOrte4 over thelaat three years The
total number of tuberculosi8 cabullbullbull usedin this study
was 666 lh1 included 128 new cabullbullbullbull
A rate per 100000 of tuberculosis for each
census tract wa- then computed and the c~us tracts
listed by rank order be b11h Qartlle mel low
quartl1 were then reoordd on a Multnomah CoUnty map
TWo genral areaa baY1Dg a hip mcldencaot tubercu~
losiare 1D41cated heyare
1 Both middotsld ot theWilla11lette River
Ll -
46
with Burns1de about thecnter
2 he extrea Northebullbullt comer of the County bull
By coap8r1ng the tuberculois an4ven8real
diseae maps ODe can 8ee that the downtown areas ot
hiSh 1nc1denceare alIIo8t 1c1eDt1cal on ach map
This WOuld 1nd1cate that 1t would be of value to
bullbulltab11sh acl1D1c 111 th1aampreatbat would provide
bothtuberCulos1s 8Dd ytmereal 418ase srvicbullbullbull
Thchart aDd 1181gt8 are wsfuln 11v1DI
1Ddicat10DS tor the type aDd placemeototlocal
health cl1n1c8 tbro1qhout tbe MultnomahCounty area
A cOllpar1on of the mapa help one to dec1dewhether
to provide a aulti-8ervice cl1D1c or spec1f1c type of
cliD1c As stated in Part I of thi paprserv1ces
shouldhaYe both treatlieDt and prfMmt10n cOmponents
As he been stated fta ne1lbborhood health care
Qenter muat be a fac111tY plazme4 with an aamesa
ot the neds of the consumer and the c01llll1m1tybull
Part II of this rport haa been an attaapt to indicate
and clarify 8011 ottheae coDlllUDity neds This has
been done through8elect10n of apc1f1c problems
The indic were then visuallyrecorded through the
use of ups and charta ODe dan asseS8 thedsreeof
1DIportance of certain concems to spec~t1c areaa by
comparinl the chart aDd maps Prom this oDeean
41 dec1de which are48 vb1chcUD1c-or indeed if
the need a clinic at all However further factors
should be considered hebullbull include
a The amount of fuDd1 available
b What 18 the percentage ot peopleineoh ceaaua tract tbat would actually us such cl1n1cIl
c Wbat 1 tbeco--1tymiddot 8 IeeliDashyreaardtDI particular cl1D1c8 Would this dcrebullbullbullmiddot the ettctiveness ot thse cl1n1ca
IJ
li
D_OlraphicPopulatLon Challie 1960 to 1970 48
Cen8U8 1 of Pop 1 Cbaqemiddot 1 Change1 ofPopTract Under 19 Yr8 Over 65 Yrs1960-70 1960-70
middot1Q701Q70
1 319 -12 171 -H) 1
2722 215-27 +68 301 366 -22 127 +35 302 371 +19 111 -04
311middot401 144-41 +29 402 321 13~7-39 +24 501 356 124-08 -02 5~O2 351 133-23 +12
405601 82-10 -02 394602 103-01 -06
701 275 149-76 +56 702 361 +01 121 -07
+10middot801 326 140-22 802 321 middot127
(
-29 -03 9~01 342 124 -H) 6-18 902 294 128 -H) 3-24
10middotmiddot -14312 140 -17 1101 182 +25 -23197
2411102 186-59 +29 1201 226 169-17 -41
31middot01202 +11 182 -05 295 -H) 81301 208 -H) 4
1302 331 +08 197 +04
14 323 +15 middot185 -08 middotmiddot15 329 +16 16~5 -13
-28middot 1601 332 131 +12
1602 356 98 +24middot-39 middot3101701 161-33 +21
1702 370 -15 85 +02 +19 1801 264 151middot-50
185middot1802 256 +47-58
IJ ~
D_raphlc Population Change 1960 to 1970middot 49 (Contd)
4io
Census Tract
of pop Uncter 19 Yra
1Q1n
1Cha1l8e 1960-70
of PopOver 65 Yra
lQO Change
1960-70
19 389 +29 141 -24 20 223 -13 206 +18
21 227 +08 194 -36 2201 356 -27 112 +05
2202 290 -18 ll~9 -29 2301 356 -03 154 +24 2302 260 -37 245 +97
2401 410 +6~1 123 -31 2402 163 -80 320 +99 2501 381 +13 140 -01 25()2 237 31 lil +02 26 343 +25 186 +149 2701 370 +29 1S5 -01 2702 249 -44 304 +98 2801 337 +19 187 +09 2802 306 -10 156 +31 2901 304 -38 142 +24 2902 i 307 -32 146 t3~9
30 29~0 -48 16~2 +51
31 355 +30 160 +01 32 370 +48 148 -13 3301 395 +45 130 -20 3302 368 +06 138 -02 3401 386 +16 117 000
3402
400 +32 92 -26 3501 304 -07 115 +35
3502 344 000 140 -13
3601
36~02 357 -04 132 +32
3603 30~1 42 149 -67 3701 342 +28 152 +19
1
IJ
Jianolraphic Population Chan 1960 to 1970 50 (Contd)
Census Tract
of Pop Under 19 Yrs
JJl7J
middotChanae 1960-70
middotofmiddotpop Over 65 Yrs
1c~7n
Change 196070
3702 409 +39 122 -11 3801 308 -11 151 +29 3802 275 -35 180 +46 3803 282 -32 192 +54 3901 376 ~13 100 +17 3902 296 -03 177 +29 4001 438 -11 84 +13 4002 353 -21 115 +20
4101 397 11 9middot0 +11 4102 346 -19 120 +03 42 331 +19 11 bull 3 -16 43 347 -72 105 +31 44 113 +84 183 +154 4S 33~9 +07 110 -06 4601 2501 22 193 +38 4602 332 +59 126 -29 47middot 161middot 000 211 +01 48 103 -26 302 +59 49 138 +1 bull 3 252 +09 50 141 -26 204 -12 51 12 -39 257 +07 52 47 -61 351 +48 53 89 +49 314 -30 54 25 l1li15 327 -17 55 131 -17 115 -121 56 198 +93 227 -47 57 71 102 189 -88 58 240 ~middot41 16~1 +55 59 322 +25 142 +06middot 6001 264 95 132 +50
6002 328 -31middot 89 +07
JJ
Demographic Population Change 1960 to 1970 51 (Contd)
Census 1 ofPop lChange of Pop bull ChangeTract Under 19 Yrbullbull 1960-70 Over 65 Yrs 1960-70
1970 1970
61 355 -58 85 +39
62 328 39 110 +18
63 414 04 73 10
64 382 -22 72 +04
6501 383 02 67 -20
6502 329 -56 96 +09
6601 391 +13 88 -03
6602 319 -59 97 +06
6701 327 71 145 +72
6702 331 ~67 83 +1-0
6801 365 -66 49 +01
6802 388 4bull3 54 +06
69 354 -41 80 +23
70 400 -23 68 -06
71 359 -48 72 +05
72 255 -88 82 +11
73 346 -39 91 +25
74 313middot -63 105 +24
75 329 -42 129 +37
76 336 -52 85 +21
77 370 -10 69 +05
78 309 -10 120 +21
79 325 -56 87 +10
8001 358 -81 57 +12
8002 391 ~81 76 +12
81 315 -76 108 +21
8201 403 -23 64 +08
8202 392 23 65 +08
83 357 -34 120 +31
84 402 -18 73 +16
85 413 -06 76 -09
r
Demographic Population Change 1960 to 1970 52 (Contd)
Census Tract
t of Pop Uncler 19 Yrs
1970
Change 1960-70
1 of Pop OVer 65 Yrs
1970
ex Change 196070
86
87
88
89
90
91 9201
9202
93
94
95
9601
9602
9701
9702
9801
9802
99
100 I
101
102
103
10401
10402
lOS
368
351
379
391
391
413
379
433
372
429
414
432
419
439
~32
377
457 420
378 41middot7
345
360 417
417
412
-04
-02
-35
-26
-28
-11
-64
-20
-S9
-39
-32
-21
-34
-40
-47
-lO~7middot
-27middot +04
+56
+07
-34 01
+04
+04
+10
103
128
97
11il3 99
69
79
42
77
46
34 38
44
40
54
111
51middot
81
133
59
74
140
63
87
76
-08
-06
+04
+08
+17
-05
+3S -02
+1~4
+19
+33
-14
-08
+12
+26
+71
+11
-16 -34
-20
-19 +37
-49
-2S +15
NOte The The
Taken frOi
averageullder averageabove
middotUSCensus ---shy -
19 years == 6S years ==
figures 197
32r 13(14
p a~d 1960
--
Rank
1
2
3
4
5
6
7
8
9
10
11 12 -_
13
14
15
16
17
18
Tract
69 46
60
58
- 68
61
302
2501
67
63
19
62
26
94
3603
3902
64
30 -----~-
Rank
19
20
21 -
22
23-shy
24
25
26
27
28
29
30
31
32
33
34
35
36 -
Ranking of Per Capita Income by Census Tract
Tract
65
2701
- 15
1601
701
66
93
82
2903
3602
30
2502
80
2401
81
- 70
91 shy
4001
High
Rank Tractshy
-32shy37
38 97
120239
7840
41 ~ _2_1__ 42 31
43 2501
44 18
45 98
46 37
47 3803
1702
49
48
1602 92 2702
I
50 89
51 901
52 801
Ra_
53
54
55
56
57
58
59
60
61
62
63
64
6S
66
67
68
TractTract Ra~
74692
170196 70 I
401 71 90
72 1037J
79 70273
3802 74 601
24024102 75
85 76 101
77 9023901
7699 78 100 4101 79
3601 I
380180
458140~ t---- _ - - shy83 82 42
888384
59843501
4777 8~
502
Low
802 86
Rank Tract
87 shy
--88
89
90
91
92
93
94
- 95
96
97
middot98
99
100
101
102
103
104
1201
14
49
72
73
43
87
3502
105
1
52
86
71
1
501
10
3301
104 tf
Rank
105
106
107
108
109
110
III
112
113
114
115
116
117
118
119
120
121
Ranking of Per Capitalucoae by Census Tract
(Contd)
Tract Rank
4001 122--shy602
13
1102 2302
3302
55
3401
48
21
56
50
3402
lL01
2202
2301
53
2201
-shy
Tract Rank Tract Rank T~aet Rank
57 I-----
Imiddote
bull
Tract
- Low -k Note Information taken from 1960 U SCensus
Rank Tract
I ~
Ie
Imiddot
~
----
----
--
--
Rank
1
2
3
4
5
6
1
8
9
10
11
i-
-Tract
391 922 921
972 971
100
132 131 121
962 961
822 821 401
982 981
20 111
47 10 1
412
High
Total Number of Henta1 Health Visits
Ranked by Census Tract High to Low
TractTract RankTractRank Rnk
12 182 22 78 29 87 76 381 73181 ~------- 1913 371 8538230162372 271 2616-121 8272 2
14 80~2 31 94 7923 84801 59 15251362 4232 15 52 _ 32 103 8924 651 17240216 652
_ 91 351 33 341 23117 83 122 25 25 48 1123921418 34 shy61 86 661
19 662 6493 81 26 91 8153 49 50 55 41383 71 27 51 3120 90 672241 35shy 104167162 461
I 411 46211121 28 88342 I
2502 36 69 54 5251 50 272
-Ra
37
38
39
_ 40
_ 41 Ishy
I
42 I
-I 43 44
45
shy
Tract
~ --- shy 95 56
45 292 242
102 62 352 291y
92
101 281
99 72 63 601 60~ 42 2201
77 74 61 57
363 232
70
32 31
11 44 282 2202
Low l
- Tract
46 682 681 I 331 30
r~$ 47 1042 332
48 102_41_
11
~
Visits to Family Planning Clinics Ranked by Census Tract High to Low
Rank Tract Rank Tract Rankmiddot Tract Rank Tract Rank Tract Rank Tract
1
2
3
4
5
6
7
8
9
10
11
12
13middot
14
15
16
17
361
56
401
341
48
59 121
20
55
342
10
31
58
93 21
241 132
331
53
461 462
18
19
20-shy21
22
23
24
25
26
27middot
28
29
30
31
32
33
391
32
middot47 I-i-_-shy _ -
231 111
332
972 1
372 371
52
89
32
92
82
100 31
182
30 242
402
34
35
36
37
38
39
40
41
42
43
44
45
42
1714 i 661 221
78 362 2
90 602 601 352
63 251
105 921
971 351
73 42 292 232
411 51
662
81 45 52
46
47
48
49shy
50
51
52
53
54
55
56
961
801
49 81 72 71
19
9~1
172
68 2 57 162 14 112
91 75 681
381 42
3~3
83 161
57 f
58
59
60
61shy
62 Imiddot
63
Imiddot 64
65
66
64 62 36~3 252
74 652 SO 392 291
651 6bull 2
79 271
r-- ---- shy981 222
672 671
821 272
94 87
281
382
67
68
69
70
71
72
73
74
75
76
77
78
981 26 12~2
IS 61
85 82~2 69
61 43
101 86 84 282
76
131
51 72
1041 962 88 70
99 922 77
103
95 802 181
i
~
Low High
RankRank Tract
5479
4480
81 1042 ~) middot102
71 - - + ~ - ~
Visits to Family Planning Clinics
(Contd)
Tract Rank
I
Tract llaDk l
RankTract Tract Rank Tract
~
I
~
J1 ~
Low
Total Number of public Health Nursing Visits
Ranked by Census TractsHigh to Low
TractTract RankTractRank RankRank TractTractRankTractRank
25249 71 79 17249 8033 6586 99189711 84 2915072 34 661 76 66 811519512
402 5035 51 161 2518220 122 1713423 352 55801 7120 6752 2 149814 41236 83 2662 38 94 6821 53 2924015 362 37 32 42 75 69 281 84 63
546 8822 54 222 85 3925431 70383417 3818223 6439 4386652 718 21 55 103332 8924 232 87 19 271729219619 24156 16211140 382 628825 10523110 112 73411 10141-- ----shy 89 363 4457 8126 16111 221 74 9142 90 46158331 53 671279012 46243 48 59 351 3837528 1083 9313 91 5844 59 -_242 76 1----- shy60 272 72 74104114 60145 42 9287 7729 92 6151 8215 57371 934630 91 307762 12113116 282 619447 41391 9531 78100 63 7378 ~95 681 6945 32 5632 798517 6448 47 52 181
High ~ Low
Rank Tract Rank
96 31 132 70
97 102
98 182 372middot 602 651 662
- -shy
~72 682 802
822 922 962 972 982
1042 ----shy
Low
Total Number of Public Health Nursing Visits
(Contd)
Rank Rank Rank TractTract Tract
I
I lt
I
Tract Rank Tract
[
~~~-
I
~
IJilfimiddot ~
j
Ranking of VD Caea According to Census Tracts 61 By High and LOll Youth Itatio
A media~ of 34 5 was determined Any tract having greater
than 34 5~ of popu1tionunde~ 19 years of age -High~
Any tract having l8S than 345 of population under 19
years == Low
Any tract having rate less than 390 =Low
Any tract having rate more than 390 == HLgl4
YOUTH
LOW HIGH
L
0
12 402 1801 1802 343 2801 2802 29023603
54 6001 600262 66~02 72 74 75 76
78 79 81 t02 65 1202
W
(25)
VD
H
I
G
H
401 701 801802 901 902 10 1101 241 1201 1301 132 14 15 1601 1701 20~ 21 2202 2j02 2402 2502 2702 2901 303501 3502 34023801 3802 383 3902 42 44 45 4601 4602 47 48 49 SO 51~2 53 55 56 57 58 S9 6701 6702 73 95
3~02 7021702 19 25~01 2701 4102 4101 63 64601 ~601 6801 680270 7l 77 8001 80~02 8201 8202 83 84
85 86 87 88~ 90 91 9202 920193 94 9601 9602~ 9701 9102 9801 9802 99 100 101 103 10402 105 6501 10401
(47)
301 501 502 601 1602 2401 2301 2201 31 32 3301 3302 3401 3402~ 3602 3702 3901 400140 02 43 61 69 B(
(53) (23)
~ ~gt
Ranking of VD by Rate Per 100000 By Census Tract
~
Rank Tract Rank Tract Rank Tract Rank Tract llank Tract Rank Tract Rank Tract
1 2202 21 S6 40 902 58 1602 74 75
90-shy 64 107 26 --~-
2 3402 22 45 41 10 59 902 75 78 91 54 108 61
3 2301 23 3502 42 2502 60 602 76 6802 92 402 109 87
4 3302 24 49 43 1102 61 501 17 2 93 94 110 90
5 50 25 52 44 6702 62 14 78 8202 94 97 02 III 76
6 2201 26 20 6701 63 4002 8201 2501
9701 41~02 112 91
7 44 27 48 45 401 64 3802 2902 95 63 113 62
8 3301 28 1701 46 502 65 30 79 83 74 96 9602 114 71
9 55 29 47 47 42 66 3803 80 2801 96Q1 115 85 10
11
12
13
14
15
16
17
18
3401
53
2302
2401
57
21
2402
1101
51
30-shy31
32
33
34
35
36
37
3701 - -~ 1201
3702
89
43
132 131
3602
4001
48
49
50
51
52
53
54
55
58
1601
601
4602 4601
69
701
31
3901
67
68
69
70
71
72
2901
801
39021~ 802
6502 6501 122
702
41~01
81
82
83
84
85
86
87
88
19
1
1702
2802
79
93
100 6801 6602
81
97
98
99
100
101
102
103
104
9201 9202
9802 9801
77
302
79
86
72
84
116
117
118
119
120
121
3603
8002 8001
101
99
95
10401
105 10402 103 102
19
20
59
32
38
39
2702
3501
56
57
301
3801
73 1802 1801
89 6002 6001
105
106
2701
88
High Low
-- -----
Rank OrdermiddotTuberclosis Cases by Rate Per 100000 Ranked by Census Tract High to Low
Tract TractRankTractRank Rank TractRaukTractRankTractRank
801
79 9601501411 52 6835340120511 I 960269 903603532036 $-~~F130221542 4366 311301 70 68~013802 _ I- _ 4001_37213 3921201 6802802 H71523822024 22 54 193302 3802 80 8958 I37139535 70155 9801 I60123 72 6702 98023914011016 6701250124 10 56
81 94 401r 7 154152 73 7057 2625 122 92028
90242 162312301 92~158 86 7172434526509 82 79160159 74 100 87412240227220110 6502836960 75 30 8317244 6501782801285711 61 901 42765645 84 66021459294912 9701 660146 171 302 9702 47
6235023033113 85 822821182 917755 16335013110214 841814832 78 103 938564 324815 86 1057940149272 38036523216 10401 87 2902241 725Q 10402360266340217middot IF88 88 9937233 282 51 218 101 01102 46016234
I)167 2901460219 47
High ~ Low ~
- -
TractRank
9S89
6490
8191 8001 8002
63 61 60middot01 6002 44 2701
92
J
2502 402 --- ----shy
I
Rank
Rank Order Tuberculosis Cases by Rate per 100000
(Coutd)
Tract Rank Tract ~nk
I
Tract Ballk Tract Rank
Imiddot
Tract
Imiddot
1~
t 1I i Pi i l I
o
1 -1shyL I
I J
8 40 icO ~ I -lt 0
-t (1) I
i I
r o E
II
a
I
r--i
shy
I
~
I (
Jgt
(011 fi(
Ggt
I II ~j
()
(f 0
~ ()
I
11
f9
r
II 99
o ~
Ggt r
~ __-J~ I t I ~ I
r--J l I
~ _ __ J
) 1
fTl
1gt
r I
()
r
()
lt en -i en
()
I1l
(J)
(J)
-i
P ()
19
r o ~
r G1 I
I
c
~
o I 89
--- -I-shy
r-r I
1- 0 _~ _ _--J E
G1 I I I
i i
I 1-1-1 ~ _J ~2 ~ II
II
()
1 I I I 1
id i bullbull
~
A n 69
r 1shy
- 0 Gl
l--~ ~ I
~ II
II )
I () isect i
en l i
(J)
-t
0
IA Ol
JJ ~
35
he MiltDoIliahCountY oregon BDViromaental SUrvey
early 1971 isamp statistical report ot tbeaotivities ot
the entire MultDolllh COUDty Health ])epartiDent dur1nl the
year ot1970 he specitic 1Dd1C8S selected frOm this
aUy are 1Il8Dtal health public healthDurs8s visits
fUl1ly pia waereal elisease aDd tuberculosia
Tbroq11the Wle otcbart aDd mapa aDecm szoup these
specific indic to show the health Deeds ofapecitic
ccmaua tracts aDdtIum th8health neecla of larsr ~eilh-
bOrhooda and co8I13 tlbullbullbull
RegroupiDI ot areas waa accoap118hed1D the
tollOWiDl lIIIIm1er~ A bullbullcifie 1ndex 8selectcl auch as
venereal di8bullbulle or tuberculo8i~ he total number ot
cs was then deterll1ne4 for each census tract Through
the use of the maber ot cRbullbullbull tor a 11Yen cenaus tract
aDd tbe population ot thattractaltrateot1lla1ampmcper
100OOOpopUlaticm wu cleteXll1ned for each census tract
This was ~e to starl4ard1ze the population ditterence
amongOeD8U8 -tracts 1he rate of incidence toreaob
cenauatract was then llstedby rank position on a chart
In rank poition1DI any cen8Wl tracts haviDg equal
rates ot1l1c1dence are assipe4tbe iaDk posttiona
Beeauseot the abo fact tbAt cbarta w111 vary in length
neveltbAtlea eacb cbart will 1Dclu4eall census tracts
inMullnoaah Couaty Atter the census tracts bave been
listed accord1q to raalcth1s list will bediv1ded into
IJ
36 three levelsotinc14ence he three levels are
1~ The upper 14 of1DcldenCe
2 Thelower 14 ot incidence
middot3 The ILld 12 of incidence
Tlles three srouplqa are then used in compiling a map ~f
Mu1tnOmahCountyfor ach apecltictop1cbull TIle maps are
uaefuJliD tbatthey V1suallycoJib1De 1Dd1v1Clualproblem
census tracts into larger problem nellhbOrhooc1s
The 1960 statistical iDtormatloD was Used in a similar
liIaDDr to tbatexpla1Dedabove 1Dthe4evelopaent of a
chartmiddot and map 1Ihow1DI e cOllpampriSOr1 of per capita lncolle
tor ttaCh ceDsua tJact aDdmiddot combiDed census middotmiddottract areas
he 1910 aDd 1960 statlstlcal iDtOrllatl0D was combined
lna map and chart he purpose of this and chart is
to d8aonatrate the e cl1stributloa1DeachceD8U8 tract
and middot1ndlcatbull tuture ace populatlon treD4a bull
When one be middotbullbullbullbullbullHdth ne8cts ot an area and has
declded to establlsh a cl1D1c to serve that area the
physical location otthat cl1D1c IllU8t be consldered In
order to coapreb8ll81vel develop an area cl1n1c one should
conslder thepre88Dttraftlc middot~ytaa an4tranaportatlon
systems Thecl1D1cahoUld be located close enoUlh to
major arterlals to giva asy access from the total area
be_ ervecl by this cliD1c At the t1ll8they should
be tar eo away froll thesarterlals to all8Y1ate traffic
CODCell18 andpark1D8 conpstlon By traff1c concerns I
IJ
37
lIlan one lUSt consider thertarro1fne8S of streets whether
streets are oD8--C)r two-way iqres8 and egress to parking
amp0111tie eros tratflC) spedof trattJQ children 1n
ll8a traffic i1lht Vislon re8tr1ctionS etc
BwstraDsportat1onshould alao be central in this area
as maay people ~U f1Df1 1tD8Cessary to use this form of
transportatlon
~e tutqredlopHQt of bull treewa systems should be
c0J1S1dered soastolesen thecumce ofmiddot future roada
cutt1DSotltbe cl1D1c llte line
nrrph1c middotDampta
It is 1JDportaDtto kDOw the demosraphic distribution
characteristics of the oUenteltbat i8 to be served by
localized health cl1D1cs
Acl1D1c which erves8J1 area where1D the prepondershy
ance of persona arecrter 65 years of mayf1nd that these
people rely more on pUblic transportation call for more
home- services and haV4t 110ft ChroD1c and debilitating
types of disorders (b1_ blood pressure poor heariDg and
eyesight) tbaD do8 an area ot a YOUDIer population On
the other hand thL area of older residents may have little
need for family plabDlng cllni08
In order to better ~Ybullbull the 4eaoraphic population
of each CeD8U8 tract the 1970 CeD8U8 iatormation was viewed
and two specific catelOri8 considered These two cat
IJ
38
lori8S woUld be the perc_tap ot population under 19
year of ase and the percentase ot each oensuetractover
65 years of age he 1960 1Dtormatlon tor eaCh tract was
then compared witbthe 1970 intormation and a percentage
ofincreaae or4ecreamp8 tormiddot e~chtract1n each category
cOJlputecland achartma4e By the use of this chart one
18 able to View tJleap populat1odiatr1but10n of census
tract and at the _ t1lle accesa middottrencl Por example
let us choose census tract 601 W see 40-4 otthe
population is under 19 years ot and that ODly82 1s
over 65 years ot middotAtthe e tille the percentage of
youth bas ~ed ODly 1_ intbe laSt teD year whilethe
percentale over 65 year ot middotbas stayedmiddotthe same With
this in mJnc1 ODe ~ 1DfItr libat ol1D1o aerviDg this
area WOuld bellQre conq~w1th the problems of a
YOUQier populat1on and that _ would probably be true foJ
some t1aein tbefuture On the other hand CeDSU8 tract 54
has only 2 ollt population UDder 19 yel1s ot age and
this has decreased by 1 over the last ten years middotwhile at
the same time 32-377 ot the populat1on 18 over 65 years of
age A ol1D1C ___ this area should be or1eJ1ted toward
tbespecttic problema otthe ampledbull
PerCapia __ bY gsa neat
WhaD cona1der1qlooat10D1 tor health cl1n1cs one
shoUld take the 1DC01Ieot areas into consideration Areas
IJ
39
of lowiDcome would not 11kel~be 8erved more by localized
cl1D1cs tbaD would are of hilbincome It 18 likely
people haYiq a hip iDeoll8would preter to be aeenby a
chosen ~r1vatephylc1a1l tban at a local cl1D1cwhere
10Dier waits y beraceaaampryand leas personal attention
gl_
The 19701ncOII81atoWampt10n tor MultnomahC~ty was
not available at the tille thi8report W88 made The 1Dto~shy
tiOD Was taken ~adtro tbe1960 census publlcation
his woUld ~8Il thea tbat ral1I8 OD the chart ynot 1raquoe
completely accurate hi writer telthatthe areas most
affected by tb8 1I8eof the older 1Dco1DtOlaat1oDWOuld be
those tracts wh1ch baYebad a rapid 1ncreaae1n populatlon
over the past tfmyHr8 bullbullbull tracts would include tracts
nUmbered 104 9897 96 aDd 95 be perc~ita 1Dcome
referredto1il-tb1a Paper18the lIean 1DCo per person per
census tract
Attar the iDeoeper census tract was listed on a chart
a map was de 1D41catiDg those census tracts belonging to
the lower 14 ot income tor all censue tracts in Multnomah
COlDltytbose beloqins to the upper 14 ot income tor all
census tract 111 MultnolUlhCounty and those belonging to
the mid 12 ot 1I1coaetor all oeuuetracts in Multnomah
C01mty
In yiew1Dg the _p 1t caa be seen that the low income
area seautotollow aloas the at aide ot the Wl1lamette
IJ
40
R1ver the full length of Kultnomah County A second low
income area follows the south edge of the Columbia from
the northwest corner of Multnomah County easterly to 148 St
A third problem area seems to be on the east bank of the
Willamette River with the Union Pacific Railroad being
about the center of this tract The extreme loutheast
corner of Multnomah COUDty appears to be a low income area
but as this area bas bad rapid grouth in the last ten years
this could be erroneous
Mental Health
be first ~ecific indica to be selected from the
Multnomah County envirollllental survey of early 1971 and
to be considered in this paper i8 that of Mental Health
At the present for mental health purposes Multnomah
County is divided into five catchmentareas with a mental
health cl1n1cin each area These clinics are Model
Citles Delaunay ADkeny street Office Hansen Health
Building end Southeast Clinic
All lIlental health cl1n1cslcept statlstlcal information
on all patients visiting their cl1n1cs this included the
address of the patient hese addresses were then listed
upon the approprlate C8D8US tract Each census tract was
then ranked on a chart according to the nUllber of mental
health patients who reslde ln thatCeDSUS tract attending
any of the above listed ental health clinics This chart
IJ
41
wasttum d1v14ed1ato proper quartile bbullbullbull
quartile vereUs to dne10 u appropl1ate Multnoh
County _tal health ItLa middotmiddotmiddotthelipO~a1bl by lOoJcJIUE
at the UDtal health _to uteN1De which ueu have the
lars-t use otCOllDty 1alh~th faci11t1Rot
1Ilclu4ecl 111 tbia woUld tber otpeopleYia1t1Da
pr1vat patch1atriata aDd pr1_t _ntalhealtb cl1D1c8
WheDtbe M1 18Yienclmiddot Itmiddotmiddotmiddotmiddot~middotbe~_ tbat ~rtt
appears to lMt fourmiddotmiddot-al are iii _oil the nuaber ot
lIental healthcl1D1c na1t toM tbjh1sheat 1he
tour areaa woUld be tollows
1ttrea Ore to~Blo Drimiddot ~tb Burrus14e aDd tIMtmiddot Colb1a Riftr H1gbwyaeri1Dla th nortllra boundaryshy
2 bull ProII 82D4 1_~ 10 20th streetwitil the ra1lMd Mu the north ltouadary
3 ~ et et tUgl_b1bull MYel froamiddot the Clackaaa COUDty l1ae aorth to Dln8lon stret
4 beDOlvt1ttfe-t ~efllt4 COatytrca Jle1aware streetmiddot toR1C1a11oDd wlth Colubla Blvd heiDI tbAtnorth bouaclary_
It ODe coapareatbiap to th iDeobullbullmiddotp 1t can be
eamiddotthat lIOat ot the c tracts baY1Dg bllh v1i11tatlcma
middottfl public tal health cJ1rUc8 ~ 111 t13e low ~ aid
1DcOile SroupiDIOJa1y of til 25 tracta llsted as
haviDlbip aental Maltll nlltatlou are ~ the1g60 hip
iDeo arebullbullbull
17 Plpn
42
amily PlellnSDI ]Jlce Metal Health i8 an 1nd1ce of
use Theperson 111 ordertobavebe_ 1Dcluclecl 1n this
atu4ywouldhave tohaft Ue4 ataa11y plaDI cl1D1c
tacilities of soaetype It 41fter troll tile _tal health
study1nthat i t1Jicludestatist1catrollbotb public and
privateclJD1os
The iDformation tor the iak orurcbart 8Dd map of
t8ll111 plenn1 na ob1a1De4 by cOIIblnlDlthe mabel of
1rlcuv1duals bullbull_ attbe tbreellUltrampo-ti Coatyhll11y
PlalJQllIl C11ll10s 111til tbo at the Planned PareDthood
Association CliD1C8 be tbree -JIultDouh Couaty r8ldly
PlamSq Cl1D1c are Solrtbweatth Col_bla 1111- a114
HaDsell Health BWlcl1Dl CllD1cbi middot1Dtormat1oD vas then
bullbullbullesed tomiddot detellWMt l10w people troll eacb c8IUIUS
chart wastben Mele IUs oIIart jn 4iY1ded to show
the censuS tracts lIaYiDlmiddottIle h1t1iest qUart1le of incidence
of use lowest quartile of 1Qc1deao ot use Jlid 12 of
incidence of Wle an4 a map sprepared troll thts 1Dto~
mation
The C8U118 tractsbelOJISnl to the h1lhestquartile of
use appear to be 1lO~ 8catt~ on tbipwas true ot
either the _p ot aental health cl1D1c uaageor ot the map
abow1DI per capita 1I1COM Iaere40 to be three
d18t1nct areas of UIIaP beJ woul4 be
1
IJ
43
t10D of BurD81cl and the W11lallette River 4
2 S~t Portland 8Otth otmiddot the ra11shyrcaadand alona the W11lamette River
lIortbeaat Portl8D4 between MisSiss1pp1 and 24tbStreet the northbouBclary be1DgColwb1aBlvd
Pylzl1c BMltl IrpI Y11ta
Publlc Healtil nur81D1Y1s1t nclud8 an vists to
theholles of client by PubUc Health Nurbullbullbullbull his shows
visits to bull f8Jl1ly fer aDY purpos SUCh aatuberculolJ1s
het1Dl tem1tyaeatalu4 8IiOt10D8l cODd1t1ona etc
he atat18t1C~ 1fele C()4ed accord1Dg tomiddot the 1llli301fOCUS
of the Y18lt tt doe DOt 1D41cate the Dmlber of holies or
f8ll11lev181tecl or 1D41Y14ual Y1a1ted more tban oDcein
the propwl It dobullbull I1ve 80M 1D41cat1on by coaparlshy
OD ot the 8JIoUDt of aedlcal problema 1n eachcen8WI tract
Ap1nmiddot the _p abowa 8 scatter patteraof probl_
areas althoUSh there appear to be a sroup1Dl of hiSh J
l8aIeccmaus tract 1ntlut extreme southeast part of tbe
County other areu uIriaI any nura1Dl contacts are
1 bull he 801lth-oa-al CO1Dty on eaCh 814 of 82nd Av from Clackallaa County north to Dinloa
2 ear bullbullbullt 814e aroUDd Preacottand Misaisippi
Dowatom Bunul14eonboth 1de of the river
44
V_real Pis The iDfomatloil uaec1 to tabulate the Venereal
disease chart includes all the ooab1ned case otmiddotODormea
and syphilIs reported by bothmiddot publIc and prIvate physicIans
dur1nl 1970 There were 3602 caes ot IOnorrhea reported
dur1nl 1970 While ODly 17 cabullbullsot ayphilimiddot were reported
A chart was prepUed aDd att8llPt wasmiddotmiddot de tomiddot
determ1De Wh_therVttDereal 41ease was more p~vaJent in
areas othigb or lowmiddot proportIon ot youth hi waadone
bymiddotdetemlna a 1leaD prceiltacmiddotmiddotmiddottor the population ot
resld~ts UDder19 years ot (34) middotA mean ratemiddot per
100000 popUlatIon al80c1ttem1Ded tor the middotoccurreDCe
ot venereal dieae This was et at 390 oass Areas
hav1nl a population 1n which leiS than 34 were lmder 19
years ot ampIe were called low- yOuth abOve tbl percentaae
hiSh youth The aaa waatrue ot the occurrence oivenershy
eal disea_ per CeD8UStract It the rate waacomputed
as 1I0re than 390 cases per 100000 it was called hiah
venerealdiaeasei it less than thia tisure low venereal
disease It was tound that 1D Multn~ COmlty there sems
to be poSitive OOlatI0n(x21S19gt between low youth
and hipmiddot venereal diseaand hip youth and low venereal
diseasebull
RaDk ordr Iitot all c traot middottbAm made
Th1s was done byt1Ddlna the ratepr 100000 populatIon
of venereal disator all census tracts in the County bull
45
These were thenlisted from h1lhto low (sreatest to
least) in a rank order The l1sting was then divided
into Upperandlower 14 aDd listed on the MUltnomah
Countymiddot up
The areas of b1gh venereal disease se8ll18to
roup thBl~8 middotin a very tllht area ~oq both 1des
of thell18l8~ R1 w1th BurDaldeS~et being
~bout theceDter qf tbi8IZ9uping This area woUld
appear to be m ldeal spot for the denlopment of a
locallzed venereal d1sbullbullbullbull cl1D1c
UbepoundCUlO1s
In this report bull tube1C1llosls caS8S refrred
to include alltbobullbull cabullbulls ontubercUlo8is follow-up
rather middotthan just new C Accord1Ds to the Multnomah
County Health SUrvey of early 1971 this would include
all ca repOrte4 over thelaat three years The
total number of tuberculosi8 cabullbullbull usedin this study
was 666 lh1 included 128 new cabullbullbullbull
A rate per 100000 of tuberculosis for each
census tract wa- then computed and the c~us tracts
listed by rank order be b11h Qartlle mel low
quartl1 were then reoordd on a Multnomah CoUnty map
TWo genral areaa baY1Dg a hip mcldencaot tubercu~
losiare 1D41cated heyare
1 Both middotsld ot theWilla11lette River
Ll -
46
with Burns1de about thecnter
2 he extrea Northebullbullt comer of the County bull
By coap8r1ng the tuberculois an4ven8real
diseae maps ODe can 8ee that the downtown areas ot
hiSh 1nc1denceare alIIo8t 1c1eDt1cal on ach map
This WOuld 1nd1cate that 1t would be of value to
bullbulltab11sh acl1D1c 111 th1aampreatbat would provide
bothtuberCulos1s 8Dd ytmereal 418ase srvicbullbullbull
Thchart aDd 1181gt8 are wsfuln 11v1DI
1Ddicat10DS tor the type aDd placemeototlocal
health cl1n1c8 tbro1qhout tbe MultnomahCounty area
A cOllpar1on of the mapa help one to dec1dewhether
to provide a aulti-8ervice cl1D1c or spec1f1c type of
cliD1c As stated in Part I of thi paprserv1ces
shouldhaYe both treatlieDt and prfMmt10n cOmponents
As he been stated fta ne1lbborhood health care
Qenter muat be a fac111tY plazme4 with an aamesa
ot the neds of the consumer and the c01llll1m1tybull
Part II of this rport haa been an attaapt to indicate
and clarify 8011 ottheae coDlllUDity neds This has
been done through8elect10n of apc1f1c problems
The indic were then visuallyrecorded through the
use of ups and charta ODe dan asseS8 thedsreeof
1DIportance of certain concems to spec~t1c areaa by
comparinl the chart aDd maps Prom this oDeean
41 dec1de which are48 vb1chcUD1c-or indeed if
the need a clinic at all However further factors
should be considered hebullbull include
a The amount of fuDd1 available
b What 18 the percentage ot peopleineoh ceaaua tract tbat would actually us such cl1n1cIl
c Wbat 1 tbeco--1tymiddot 8 IeeliDashyreaardtDI particular cl1D1c8 Would this dcrebullbullbullmiddot the ettctiveness ot thse cl1n1ca
IJ
li
D_OlraphicPopulatLon Challie 1960 to 1970 48
Cen8U8 1 of Pop 1 Cbaqemiddot 1 Change1 ofPopTract Under 19 Yr8 Over 65 Yrs1960-70 1960-70
middot1Q701Q70
1 319 -12 171 -H) 1
2722 215-27 +68 301 366 -22 127 +35 302 371 +19 111 -04
311middot401 144-41 +29 402 321 13~7-39 +24 501 356 124-08 -02 5~O2 351 133-23 +12
405601 82-10 -02 394602 103-01 -06
701 275 149-76 +56 702 361 +01 121 -07
+10middot801 326 140-22 802 321 middot127
(
-29 -03 9~01 342 124 -H) 6-18 902 294 128 -H) 3-24
10middotmiddot -14312 140 -17 1101 182 +25 -23197
2411102 186-59 +29 1201 226 169-17 -41
31middot01202 +11 182 -05 295 -H) 81301 208 -H) 4
1302 331 +08 197 +04
14 323 +15 middot185 -08 middotmiddot15 329 +16 16~5 -13
-28middot 1601 332 131 +12
1602 356 98 +24middot-39 middot3101701 161-33 +21
1702 370 -15 85 +02 +19 1801 264 151middot-50
185middot1802 256 +47-58
IJ ~
D_raphlc Population Change 1960 to 1970middot 49 (Contd)
4io
Census Tract
of pop Uncter 19 Yra
1Q1n
1Cha1l8e 1960-70
of PopOver 65 Yra
lQO Change
1960-70
19 389 +29 141 -24 20 223 -13 206 +18
21 227 +08 194 -36 2201 356 -27 112 +05
2202 290 -18 ll~9 -29 2301 356 -03 154 +24 2302 260 -37 245 +97
2401 410 +6~1 123 -31 2402 163 -80 320 +99 2501 381 +13 140 -01 25()2 237 31 lil +02 26 343 +25 186 +149 2701 370 +29 1S5 -01 2702 249 -44 304 +98 2801 337 +19 187 +09 2802 306 -10 156 +31 2901 304 -38 142 +24 2902 i 307 -32 146 t3~9
30 29~0 -48 16~2 +51
31 355 +30 160 +01 32 370 +48 148 -13 3301 395 +45 130 -20 3302 368 +06 138 -02 3401 386 +16 117 000
3402
400 +32 92 -26 3501 304 -07 115 +35
3502 344 000 140 -13
3601
36~02 357 -04 132 +32
3603 30~1 42 149 -67 3701 342 +28 152 +19
1
IJ
Jianolraphic Population Chan 1960 to 1970 50 (Contd)
Census Tract
of Pop Under 19 Yrs
JJl7J
middotChanae 1960-70
middotofmiddotpop Over 65 Yrs
1c~7n
Change 196070
3702 409 +39 122 -11 3801 308 -11 151 +29 3802 275 -35 180 +46 3803 282 -32 192 +54 3901 376 ~13 100 +17 3902 296 -03 177 +29 4001 438 -11 84 +13 4002 353 -21 115 +20
4101 397 11 9middot0 +11 4102 346 -19 120 +03 42 331 +19 11 bull 3 -16 43 347 -72 105 +31 44 113 +84 183 +154 4S 33~9 +07 110 -06 4601 2501 22 193 +38 4602 332 +59 126 -29 47middot 161middot 000 211 +01 48 103 -26 302 +59 49 138 +1 bull 3 252 +09 50 141 -26 204 -12 51 12 -39 257 +07 52 47 -61 351 +48 53 89 +49 314 -30 54 25 l1li15 327 -17 55 131 -17 115 -121 56 198 +93 227 -47 57 71 102 189 -88 58 240 ~middot41 16~1 +55 59 322 +25 142 +06middot 6001 264 95 132 +50
6002 328 -31middot 89 +07
JJ
Demographic Population Change 1960 to 1970 51 (Contd)
Census 1 ofPop lChange of Pop bull ChangeTract Under 19 Yrbullbull 1960-70 Over 65 Yrs 1960-70
1970 1970
61 355 -58 85 +39
62 328 39 110 +18
63 414 04 73 10
64 382 -22 72 +04
6501 383 02 67 -20
6502 329 -56 96 +09
6601 391 +13 88 -03
6602 319 -59 97 +06
6701 327 71 145 +72
6702 331 ~67 83 +1-0
6801 365 -66 49 +01
6802 388 4bull3 54 +06
69 354 -41 80 +23
70 400 -23 68 -06
71 359 -48 72 +05
72 255 -88 82 +11
73 346 -39 91 +25
74 313middot -63 105 +24
75 329 -42 129 +37
76 336 -52 85 +21
77 370 -10 69 +05
78 309 -10 120 +21
79 325 -56 87 +10
8001 358 -81 57 +12
8002 391 ~81 76 +12
81 315 -76 108 +21
8201 403 -23 64 +08
8202 392 23 65 +08
83 357 -34 120 +31
84 402 -18 73 +16
85 413 -06 76 -09
r
Demographic Population Change 1960 to 1970 52 (Contd)
Census Tract
t of Pop Uncler 19 Yrs
1970
Change 1960-70
1 of Pop OVer 65 Yrs
1970
ex Change 196070
86
87
88
89
90
91 9201
9202
93
94
95
9601
9602
9701
9702
9801
9802
99
100 I
101
102
103
10401
10402
lOS
368
351
379
391
391
413
379
433
372
429
414
432
419
439
~32
377
457 420
378 41middot7
345
360 417
417
412
-04
-02
-35
-26
-28
-11
-64
-20
-S9
-39
-32
-21
-34
-40
-47
-lO~7middot
-27middot +04
+56
+07
-34 01
+04
+04
+10
103
128
97
11il3 99
69
79
42
77
46
34 38
44
40
54
111
51middot
81
133
59
74
140
63
87
76
-08
-06
+04
+08
+17
-05
+3S -02
+1~4
+19
+33
-14
-08
+12
+26
+71
+11
-16 -34
-20
-19 +37
-49
-2S +15
NOte The The
Taken frOi
averageullder averageabove
middotUSCensus ---shy -
19 years == 6S years ==
figures 197
32r 13(14
p a~d 1960
--
Rank
1
2
3
4
5
6
7
8
9
10
11 12 -_
13
14
15
16
17
18
Tract
69 46
60
58
- 68
61
302
2501
67
63
19
62
26
94
3603
3902
64
30 -----~-
Rank
19
20
21 -
22
23-shy
24
25
26
27
28
29
30
31
32
33
34
35
36 -
Ranking of Per Capita Income by Census Tract
Tract
65
2701
- 15
1601
701
66
93
82
2903
3602
30
2502
80
2401
81
- 70
91 shy
4001
High
Rank Tractshy
-32shy37
38 97
120239
7840
41 ~ _2_1__ 42 31
43 2501
44 18
45 98
46 37
47 3803
1702
49
48
1602 92 2702
I
50 89
51 901
52 801
Ra_
53
54
55
56
57
58
59
60
61
62
63
64
6S
66
67
68
TractTract Ra~
74692
170196 70 I
401 71 90
72 1037J
79 70273
3802 74 601
24024102 75
85 76 101
77 9023901
7699 78 100 4101 79
3601 I
380180
458140~ t---- _ - - shy83 82 42
888384
59843501
4777 8~
502
Low
802 86
Rank Tract
87 shy
--88
89
90
91
92
93
94
- 95
96
97
middot98
99
100
101
102
103
104
1201
14
49
72
73
43
87
3502
105
1
52
86
71
1
501
10
3301
104 tf
Rank
105
106
107
108
109
110
III
112
113
114
115
116
117
118
119
120
121
Ranking of Per Capitalucoae by Census Tract
(Contd)
Tract Rank
4001 122--shy602
13
1102 2302
3302
55
3401
48
21
56
50
3402
lL01
2202
2301
53
2201
-shy
Tract Rank Tract Rank T~aet Rank
57 I-----
Imiddote
bull
Tract
- Low -k Note Information taken from 1960 U SCensus
Rank Tract
I ~
Ie
Imiddot
~
----
----
--
--
Rank
1
2
3
4
5
6
1
8
9
10
11
i-
-Tract
391 922 921
972 971
100
132 131 121
962 961
822 821 401
982 981
20 111
47 10 1
412
High
Total Number of Henta1 Health Visits
Ranked by Census Tract High to Low
TractTract RankTractRank Rnk
12 182 22 78 29 87 76 381 73181 ~------- 1913 371 8538230162372 271 2616-121 8272 2
14 80~2 31 94 7923 84801 59 15251362 4232 15 52 _ 32 103 8924 651 17240216 652
_ 91 351 33 341 23117 83 122 25 25 48 1123921418 34 shy61 86 661
19 662 6493 81 26 91 8153 49 50 55 41383 71 27 51 3120 90 672241 35shy 104167162 461
I 411 46211121 28 88342 I
2502 36 69 54 5251 50 272
-Ra
37
38
39
_ 40
_ 41 Ishy
I
42 I
-I 43 44
45
shy
Tract
~ --- shy 95 56
45 292 242
102 62 352 291y
92
101 281
99 72 63 601 60~ 42 2201
77 74 61 57
363 232
70
32 31
11 44 282 2202
Low l
- Tract
46 682 681 I 331 30
r~$ 47 1042 332
48 102_41_
11
~
Visits to Family Planning Clinics Ranked by Census Tract High to Low
Rank Tract Rank Tract Rankmiddot Tract Rank Tract Rank Tract Rank Tract
1
2
3
4
5
6
7
8
9
10
11
12
13middot
14
15
16
17
361
56
401
341
48
59 121
20
55
342
10
31
58
93 21
241 132
331
53
461 462
18
19
20-shy21
22
23
24
25
26
27middot
28
29
30
31
32
33
391
32
middot47 I-i-_-shy _ -
231 111
332
972 1
372 371
52
89
32
92
82
100 31
182
30 242
402
34
35
36
37
38
39
40
41
42
43
44
45
42
1714 i 661 221
78 362 2
90 602 601 352
63 251
105 921
971 351
73 42 292 232
411 51
662
81 45 52
46
47
48
49shy
50
51
52
53
54
55
56
961
801
49 81 72 71
19
9~1
172
68 2 57 162 14 112
91 75 681
381 42
3~3
83 161
57 f
58
59
60
61shy
62 Imiddot
63
Imiddot 64
65
66
64 62 36~3 252
74 652 SO 392 291
651 6bull 2
79 271
r-- ---- shy981 222
672 671
821 272
94 87
281
382
67
68
69
70
71
72
73
74
75
76
77
78
981 26 12~2
IS 61
85 82~2 69
61 43
101 86 84 282
76
131
51 72
1041 962 88 70
99 922 77
103
95 802 181
i
~
Low High
RankRank Tract
5479
4480
81 1042 ~) middot102
71 - - + ~ - ~
Visits to Family Planning Clinics
(Contd)
Tract Rank
I
Tract llaDk l
RankTract Tract Rank Tract
~
I
~
J1 ~
Low
Total Number of public Health Nursing Visits
Ranked by Census TractsHigh to Low
TractTract RankTractRank RankRank TractTractRankTractRank
25249 71 79 17249 8033 6586 99189711 84 2915072 34 661 76 66 811519512
402 5035 51 161 2518220 122 1713423 352 55801 7120 6752 2 149814 41236 83 2662 38 94 6821 53 2924015 362 37 32 42 75 69 281 84 63
546 8822 54 222 85 3925431 70383417 3818223 6439 4386652 718 21 55 103332 8924 232 87 19 271729219619 24156 16211140 382 628825 10523110 112 73411 10141-- ----shy 89 363 4457 8126 16111 221 74 9142 90 46158331 53 671279012 46243 48 59 351 3837528 1083 9313 91 5844 59 -_242 76 1----- shy60 272 72 74104114 60145 42 9287 7729 92 6151 8215 57371 934630 91 307762 12113116 282 619447 41391 9531 78100 63 7378 ~95 681 6945 32 5632 798517 6448 47 52 181
High ~ Low
Rank Tract Rank
96 31 132 70
97 102
98 182 372middot 602 651 662
- -shy
~72 682 802
822 922 962 972 982
1042 ----shy
Low
Total Number of Public Health Nursing Visits
(Contd)
Rank Rank Rank TractTract Tract
I
I lt
I
Tract Rank Tract
[
~~~-
I
~
IJilfimiddot ~
j
Ranking of VD Caea According to Census Tracts 61 By High and LOll Youth Itatio
A media~ of 34 5 was determined Any tract having greater
than 34 5~ of popu1tionunde~ 19 years of age -High~
Any tract having l8S than 345 of population under 19
years == Low
Any tract having rate less than 390 =Low
Any tract having rate more than 390 == HLgl4
YOUTH
LOW HIGH
L
0
12 402 1801 1802 343 2801 2802 29023603
54 6001 600262 66~02 72 74 75 76
78 79 81 t02 65 1202
W
(25)
VD
H
I
G
H
401 701 801802 901 902 10 1101 241 1201 1301 132 14 15 1601 1701 20~ 21 2202 2j02 2402 2502 2702 2901 303501 3502 34023801 3802 383 3902 42 44 45 4601 4602 47 48 49 SO 51~2 53 55 56 57 58 S9 6701 6702 73 95
3~02 7021702 19 25~01 2701 4102 4101 63 64601 ~601 6801 680270 7l 77 8001 80~02 8201 8202 83 84
85 86 87 88~ 90 91 9202 920193 94 9601 9602~ 9701 9102 9801 9802 99 100 101 103 10402 105 6501 10401
(47)
301 501 502 601 1602 2401 2301 2201 31 32 3301 3302 3401 3402~ 3602 3702 3901 400140 02 43 61 69 B(
(53) (23)
~ ~gt
Ranking of VD by Rate Per 100000 By Census Tract
~
Rank Tract Rank Tract Rank Tract Rank Tract llank Tract Rank Tract Rank Tract
1 2202 21 S6 40 902 58 1602 74 75
90-shy 64 107 26 --~-
2 3402 22 45 41 10 59 902 75 78 91 54 108 61
3 2301 23 3502 42 2502 60 602 76 6802 92 402 109 87
4 3302 24 49 43 1102 61 501 17 2 93 94 110 90
5 50 25 52 44 6702 62 14 78 8202 94 97 02 III 76
6 2201 26 20 6701 63 4002 8201 2501
9701 41~02 112 91
7 44 27 48 45 401 64 3802 2902 95 63 113 62
8 3301 28 1701 46 502 65 30 79 83 74 96 9602 114 71
9 55 29 47 47 42 66 3803 80 2801 96Q1 115 85 10
11
12
13
14
15
16
17
18
3401
53
2302
2401
57
21
2402
1101
51
30-shy31
32
33
34
35
36
37
3701 - -~ 1201
3702
89
43
132 131
3602
4001
48
49
50
51
52
53
54
55
58
1601
601
4602 4601
69
701
31
3901
67
68
69
70
71
72
2901
801
39021~ 802
6502 6501 122
702
41~01
81
82
83
84
85
86
87
88
19
1
1702
2802
79
93
100 6801 6602
81
97
98
99
100
101
102
103
104
9201 9202
9802 9801
77
302
79
86
72
84
116
117
118
119
120
121
3603
8002 8001
101
99
95
10401
105 10402 103 102
19
20
59
32
38
39
2702
3501
56
57
301
3801
73 1802 1801
89 6002 6001
105
106
2701
88
High Low
-- -----
Rank OrdermiddotTuberclosis Cases by Rate Per 100000 Ranked by Census Tract High to Low
Tract TractRankTractRank Rank TractRaukTractRankTractRank
801
79 9601501411 52 6835340120511 I 960269 903603532036 $-~~F130221542 4366 311301 70 68~013802 _ I- _ 4001_37213 3921201 6802802 H71523822024 22 54 193302 3802 80 8958 I37139535 70155 9801 I60123 72 6702 98023914011016 6701250124 10 56
81 94 401r 7 154152 73 7057 2625 122 92028
90242 162312301 92~158 86 7172434526509 82 79160159 74 100 87412240227220110 6502836960 75 30 8317244 6501782801285711 61 901 42765645 84 66021459294912 9701 660146 171 302 9702 47
6235023033113 85 822821182 917755 16335013110214 841814832 78 103 938564 324815 86 1057940149272 38036523216 10401 87 2902241 725Q 10402360266340217middot IF88 88 9937233 282 51 218 101 01102 46016234
I)167 2901460219 47
High ~ Low ~
- -
TractRank
9S89
6490
8191 8001 8002
63 61 60middot01 6002 44 2701
92
J
2502 402 --- ----shy
I
Rank
Rank Order Tuberculosis Cases by Rate per 100000
(Coutd)
Tract Rank Tract ~nk
I
Tract Ballk Tract Rank
Imiddot
Tract
Imiddot
1~
t 1I i Pi i l I
o
1 -1shyL I
I J
8 40 icO ~ I -lt 0
-t (1) I
i I
r o E
II
a
I
r--i
shy
I
~
I (
Jgt
(011 fi(
Ggt
I II ~j
()
(f 0
~ ()
I
11
f9
r
II 99
o ~
Ggt r
~ __-J~ I t I ~ I
r--J l I
~ _ __ J
) 1
fTl
1gt
r I
()
r
()
lt en -i en
()
I1l
(J)
(J)
-i
P ()
19
r o ~
r G1 I
I
c
~
o I 89
--- -I-shy
r-r I
1- 0 _~ _ _--J E
G1 I I I
i i
I 1-1-1 ~ _J ~2 ~ II
II
()
1 I I I 1
id i bullbull
~
A n 69
r 1shy
- 0 Gl
l--~ ~ I
~ II
II )
I () isect i
en l i
(J)
-t
0
IA Ol
IJ
36 three levelsotinc14ence he three levels are
1~ The upper 14 of1DcldenCe
2 Thelower 14 ot incidence
middot3 The ILld 12 of incidence
Tlles three srouplqa are then used in compiling a map ~f
Mu1tnOmahCountyfor ach apecltictop1cbull TIle maps are
uaefuJliD tbatthey V1suallycoJib1De 1Dd1v1Clualproblem
census tracts into larger problem nellhbOrhooc1s
The 1960 statistical iDtormatloD was Used in a similar
liIaDDr to tbatexpla1Dedabove 1Dthe4evelopaent of a
chartmiddot and map 1Ihow1DI e cOllpampriSOr1 of per capita lncolle
tor ttaCh ceDsua tJact aDdmiddot combiDed census middotmiddottract areas
he 1910 aDd 1960 statlstlcal iDtOrllatl0D was combined
lna map and chart he purpose of this and chart is
to d8aonatrate the e cl1stributloa1DeachceD8U8 tract
and middot1ndlcatbull tuture ace populatlon treD4a bull
When one be middotbullbullbullbullbullHdth ne8cts ot an area and has
declded to establlsh a cl1D1c to serve that area the
physical location otthat cl1D1c IllU8t be consldered In
order to coapreb8ll81vel develop an area cl1n1c one should
conslder thepre88Dttraftlc middot~ytaa an4tranaportatlon
systems Thecl1D1cahoUld be located close enoUlh to
major arterlals to giva asy access from the total area
be_ ervecl by this cliD1c At the t1ll8they should
be tar eo away froll thesarterlals to all8Y1ate traffic
CODCell18 andpark1D8 conpstlon By traff1c concerns I
IJ
37
lIlan one lUSt consider thertarro1fne8S of streets whether
streets are oD8--C)r two-way iqres8 and egress to parking
amp0111tie eros tratflC) spedof trattJQ children 1n
ll8a traffic i1lht Vislon re8tr1ctionS etc
BwstraDsportat1onshould alao be central in this area
as maay people ~U f1Df1 1tD8Cessary to use this form of
transportatlon
~e tutqredlopHQt of bull treewa systems should be
c0J1S1dered soastolesen thecumce ofmiddot future roada
cutt1DSotltbe cl1D1c llte line
nrrph1c middotDampta
It is 1JDportaDtto kDOw the demosraphic distribution
characteristics of the oUenteltbat i8 to be served by
localized health cl1D1cs
Acl1D1c which erves8J1 area where1D the prepondershy
ance of persona arecrter 65 years of mayf1nd that these
people rely more on pUblic transportation call for more
home- services and haV4t 110ft ChroD1c and debilitating
types of disorders (b1_ blood pressure poor heariDg and
eyesight) tbaD do8 an area ot a YOUDIer population On
the other hand thL area of older residents may have little
need for family plabDlng cllni08
In order to better ~Ybullbull the 4eaoraphic population
of each CeD8U8 tract the 1970 CeD8U8 iatormation was viewed
and two specific catelOri8 considered These two cat
IJ
38
lori8S woUld be the perc_tap ot population under 19
year of ase and the percentase ot each oensuetractover
65 years of age he 1960 1Dtormatlon tor eaCh tract was
then compared witbthe 1970 intormation and a percentage
ofincreaae or4ecreamp8 tormiddot e~chtract1n each category
cOJlputecland achartma4e By the use of this chart one
18 able to View tJleap populat1odiatr1but10n of census
tract and at the _ t1lle accesa middottrencl Por example
let us choose census tract 601 W see 40-4 otthe
population is under 19 years ot and that ODly82 1s
over 65 years ot middotAtthe e tille the percentage of
youth bas ~ed ODly 1_ intbe laSt teD year whilethe
percentale over 65 year ot middotbas stayedmiddotthe same With
this in mJnc1 ODe ~ 1DfItr libat ol1D1o aerviDg this
area WOuld bellQre conq~w1th the problems of a
YOUQier populat1on and that _ would probably be true foJ
some t1aein tbefuture On the other hand CeDSU8 tract 54
has only 2 ollt population UDder 19 yel1s ot age and
this has decreased by 1 over the last ten years middotwhile at
the same time 32-377 ot the populat1on 18 over 65 years of
age A ol1D1C ___ this area should be or1eJ1ted toward
tbespecttic problema otthe ampledbull
PerCapia __ bY gsa neat
WhaD cona1der1qlooat10D1 tor health cl1n1cs one
shoUld take the 1DC01Ieot areas into consideration Areas
IJ
39
of lowiDcome would not 11kel~be 8erved more by localized
cl1D1cs tbaD would are of hilbincome It 18 likely
people haYiq a hip iDeoll8would preter to be aeenby a
chosen ~r1vatephylc1a1l tban at a local cl1D1cwhere
10Dier waits y beraceaaampryand leas personal attention
gl_
The 19701ncOII81atoWampt10n tor MultnomahC~ty was
not available at the tille thi8report W88 made The 1Dto~shy
tiOD Was taken ~adtro tbe1960 census publlcation
his woUld ~8Il thea tbat ral1I8 OD the chart ynot 1raquoe
completely accurate hi writer telthatthe areas most
affected by tb8 1I8eof the older 1Dco1DtOlaat1oDWOuld be
those tracts wh1ch baYebad a rapid 1ncreaae1n populatlon
over the past tfmyHr8 bullbullbull tracts would include tracts
nUmbered 104 9897 96 aDd 95 be perc~ita 1Dcome
referredto1il-tb1a Paper18the lIean 1DCo per person per
census tract
Attar the iDeoeper census tract was listed on a chart
a map was de 1D41catiDg those census tracts belonging to
the lower 14 ot income tor all censue tracts in Multnomah
COlDltytbose beloqins to the upper 14 ot income tor all
census tract 111 MultnolUlhCounty and those belonging to
the mid 12 ot 1I1coaetor all oeuuetracts in Multnomah
C01mty
In yiew1Dg the _p 1t caa be seen that the low income
area seautotollow aloas the at aide ot the Wl1lamette
IJ
40
R1ver the full length of Kultnomah County A second low
income area follows the south edge of the Columbia from
the northwest corner of Multnomah County easterly to 148 St
A third problem area seems to be on the east bank of the
Willamette River with the Union Pacific Railroad being
about the center of this tract The extreme loutheast
corner of Multnomah COUDty appears to be a low income area
but as this area bas bad rapid grouth in the last ten years
this could be erroneous
Mental Health
be first ~ecific indica to be selected from the
Multnomah County envirollllental survey of early 1971 and
to be considered in this paper i8 that of Mental Health
At the present for mental health purposes Multnomah
County is divided into five catchmentareas with a mental
health cl1n1cin each area These clinics are Model
Citles Delaunay ADkeny street Office Hansen Health
Building end Southeast Clinic
All lIlental health cl1n1cslcept statlstlcal information
on all patients visiting their cl1n1cs this included the
address of the patient hese addresses were then listed
upon the approprlate C8D8US tract Each census tract was
then ranked on a chart according to the nUllber of mental
health patients who reslde ln thatCeDSUS tract attending
any of the above listed ental health clinics This chart
IJ
41
wasttum d1v14ed1ato proper quartile bbullbullbull
quartile vereUs to dne10 u appropl1ate Multnoh
County _tal health ItLa middotmiddotmiddotthelipO~a1bl by lOoJcJIUE
at the UDtal health _to uteN1De which ueu have the
lars-t use otCOllDty 1alh~th faci11t1Rot
1Ilclu4ecl 111 tbia woUld tber otpeopleYia1t1Da
pr1vat patch1atriata aDd pr1_t _ntalhealtb cl1D1c8
WheDtbe M1 18Yienclmiddot Itmiddotmiddotmiddotmiddot~middotbe~_ tbat ~rtt
appears to lMt fourmiddotmiddot-al are iii _oil the nuaber ot
lIental healthcl1D1c na1t toM tbjh1sheat 1he
tour areaa woUld be tollows
1ttrea Ore to~Blo Drimiddot ~tb Burrus14e aDd tIMtmiddot Colb1a Riftr H1gbwyaeri1Dla th nortllra boundaryshy
2 bull ProII 82D4 1_~ 10 20th streetwitil the ra1lMd Mu the north ltouadary
3 ~ et et tUgl_b1bull MYel froamiddot the Clackaaa COUDty l1ae aorth to Dln8lon stret
4 beDOlvt1ttfe-t ~efllt4 COatytrca Jle1aware streetmiddot toR1C1a11oDd wlth Colubla Blvd heiDI tbAtnorth bouaclary_
It ODe coapareatbiap to th iDeobullbullmiddotp 1t can be
eamiddotthat lIOat ot the c tracts baY1Dg bllh v1i11tatlcma
middottfl public tal health cJ1rUc8 ~ 111 t13e low ~ aid
1DcOile SroupiDIOJa1y of til 25 tracta llsted as
haviDlbip aental Maltll nlltatlou are ~ the1g60 hip
iDeo arebullbullbull
17 Plpn
42
amily PlellnSDI ]Jlce Metal Health i8 an 1nd1ce of
use Theperson 111 ordertobavebe_ 1Dcluclecl 1n this
atu4ywouldhave tohaft Ue4 ataa11y plaDI cl1D1c
tacilities of soaetype It 41fter troll tile _tal health
study1nthat i t1Jicludestatist1catrollbotb public and
privateclJD1os
The iDformation tor the iak orurcbart 8Dd map of
t8ll111 plenn1 na ob1a1De4 by cOIIblnlDlthe mabel of
1rlcuv1duals bullbull_ attbe tbreellUltrampo-ti Coatyhll11y
PlalJQllIl C11ll10s 111til tbo at the Planned PareDthood
Association CliD1C8 be tbree -JIultDouh Couaty r8ldly
PlamSq Cl1D1c are Solrtbweatth Col_bla 1111- a114
HaDsell Health BWlcl1Dl CllD1cbi middot1Dtormat1oD vas then
bullbullbullesed tomiddot detellWMt l10w people troll eacb c8IUIUS
chart wastben Mele IUs oIIart jn 4iY1ded to show
the censuS tracts lIaYiDlmiddottIle h1t1iest qUart1le of incidence
of use lowest quartile of 1Qc1deao ot use Jlid 12 of
incidence of Wle an4 a map sprepared troll thts 1Dto~
mation
The C8U118 tractsbelOJISnl to the h1lhestquartile of
use appear to be 1lO~ 8catt~ on tbipwas true ot
either the _p ot aental health cl1D1c uaageor ot the map
abow1DI per capita 1I1COM Iaere40 to be three
d18t1nct areas of UIIaP beJ woul4 be
1
IJ
43
t10D of BurD81cl and the W11lallette River 4
2 S~t Portland 8Otth otmiddot the ra11shyrcaadand alona the W11lamette River
lIortbeaat Portl8D4 between MisSiss1pp1 and 24tbStreet the northbouBclary be1DgColwb1aBlvd
Pylzl1c BMltl IrpI Y11ta
Publlc Healtil nur81D1Y1s1t nclud8 an vists to
theholles of client by PubUc Health Nurbullbullbullbull his shows
visits to bull f8Jl1ly fer aDY purpos SUCh aatuberculolJ1s
het1Dl tem1tyaeatalu4 8IiOt10D8l cODd1t1ona etc
he atat18t1C~ 1fele C()4ed accord1Dg tomiddot the 1llli301fOCUS
of the Y18lt tt doe DOt 1D41cate the Dmlber of holies or
f8ll11lev181tecl or 1D41Y14ual Y1a1ted more tban oDcein
the propwl It dobullbull I1ve 80M 1D41cat1on by coaparlshy
OD ot the 8JIoUDt of aedlcal problema 1n eachcen8WI tract
Ap1nmiddot the _p abowa 8 scatter patteraof probl_
areas althoUSh there appear to be a sroup1Dl of hiSh J
l8aIeccmaus tract 1ntlut extreme southeast part of tbe
County other areu uIriaI any nura1Dl contacts are
1 bull he 801lth-oa-al CO1Dty on eaCh 814 of 82nd Av from Clackallaa County north to Dinloa
2 ear bullbullbullt 814e aroUDd Preacottand Misaisippi
Dowatom Bunul14eonboth 1de of the river
44
V_real Pis The iDfomatloil uaec1 to tabulate the Venereal
disease chart includes all the ooab1ned case otmiddotODormea
and syphilIs reported by bothmiddot publIc and prIvate physicIans
dur1nl 1970 There were 3602 caes ot IOnorrhea reported
dur1nl 1970 While ODly 17 cabullbullsot ayphilimiddot were reported
A chart was prepUed aDd att8llPt wasmiddotmiddot de tomiddot
determ1De Wh_therVttDereal 41ease was more p~vaJent in
areas othigb or lowmiddot proportIon ot youth hi waadone
bymiddotdetemlna a 1leaD prceiltacmiddotmiddotmiddottor the population ot
resld~ts UDder19 years ot (34) middotA mean ratemiddot per
100000 popUlatIon al80c1ttem1Ded tor the middotoccurreDCe
ot venereal dieae This was et at 390 oass Areas
hav1nl a population 1n which leiS than 34 were lmder 19
years ot ampIe were called low- yOuth abOve tbl percentaae
hiSh youth The aaa waatrue ot the occurrence oivenershy
eal disea_ per CeD8UStract It the rate waacomputed
as 1I0re than 390 cases per 100000 it was called hiah
venerealdiaeasei it less than thia tisure low venereal
disease It was tound that 1D Multn~ COmlty there sems
to be poSitive OOlatI0n(x21S19gt between low youth
and hipmiddot venereal diseaand hip youth and low venereal
diseasebull
RaDk ordr Iitot all c traot middottbAm made
Th1s was done byt1Ddlna the ratepr 100000 populatIon
of venereal disator all census tracts in the County bull
45
These were thenlisted from h1lhto low (sreatest to
least) in a rank order The l1sting was then divided
into Upperandlower 14 aDd listed on the MUltnomah
Countymiddot up
The areas of b1gh venereal disease se8ll18to
roup thBl~8 middotin a very tllht area ~oq both 1des
of thell18l8~ R1 w1th BurDaldeS~et being
~bout theceDter qf tbi8IZ9uping This area woUld
appear to be m ldeal spot for the denlopment of a
locallzed venereal d1sbullbullbullbull cl1D1c
UbepoundCUlO1s
In this report bull tube1C1llosls caS8S refrred
to include alltbobullbull cabullbulls ontubercUlo8is follow-up
rather middotthan just new C Accord1Ds to the Multnomah
County Health SUrvey of early 1971 this would include
all ca repOrte4 over thelaat three years The
total number of tuberculosi8 cabullbullbull usedin this study
was 666 lh1 included 128 new cabullbullbullbull
A rate per 100000 of tuberculosis for each
census tract wa- then computed and the c~us tracts
listed by rank order be b11h Qartlle mel low
quartl1 were then reoordd on a Multnomah CoUnty map
TWo genral areaa baY1Dg a hip mcldencaot tubercu~
losiare 1D41cated heyare
1 Both middotsld ot theWilla11lette River
Ll -
46
with Burns1de about thecnter
2 he extrea Northebullbullt comer of the County bull
By coap8r1ng the tuberculois an4ven8real
diseae maps ODe can 8ee that the downtown areas ot
hiSh 1nc1denceare alIIo8t 1c1eDt1cal on ach map
This WOuld 1nd1cate that 1t would be of value to
bullbulltab11sh acl1D1c 111 th1aampreatbat would provide
bothtuberCulos1s 8Dd ytmereal 418ase srvicbullbullbull
Thchart aDd 1181gt8 are wsfuln 11v1DI
1Ddicat10DS tor the type aDd placemeototlocal
health cl1n1c8 tbro1qhout tbe MultnomahCounty area
A cOllpar1on of the mapa help one to dec1dewhether
to provide a aulti-8ervice cl1D1c or spec1f1c type of
cliD1c As stated in Part I of thi paprserv1ces
shouldhaYe both treatlieDt and prfMmt10n cOmponents
As he been stated fta ne1lbborhood health care
Qenter muat be a fac111tY plazme4 with an aamesa
ot the neds of the consumer and the c01llll1m1tybull
Part II of this rport haa been an attaapt to indicate
and clarify 8011 ottheae coDlllUDity neds This has
been done through8elect10n of apc1f1c problems
The indic were then visuallyrecorded through the
use of ups and charta ODe dan asseS8 thedsreeof
1DIportance of certain concems to spec~t1c areaa by
comparinl the chart aDd maps Prom this oDeean
41 dec1de which are48 vb1chcUD1c-or indeed if
the need a clinic at all However further factors
should be considered hebullbull include
a The amount of fuDd1 available
b What 18 the percentage ot peopleineoh ceaaua tract tbat would actually us such cl1n1cIl
c Wbat 1 tbeco--1tymiddot 8 IeeliDashyreaardtDI particular cl1D1c8 Would this dcrebullbullbullmiddot the ettctiveness ot thse cl1n1ca
IJ
li
D_OlraphicPopulatLon Challie 1960 to 1970 48
Cen8U8 1 of Pop 1 Cbaqemiddot 1 Change1 ofPopTract Under 19 Yr8 Over 65 Yrs1960-70 1960-70
middot1Q701Q70
1 319 -12 171 -H) 1
2722 215-27 +68 301 366 -22 127 +35 302 371 +19 111 -04
311middot401 144-41 +29 402 321 13~7-39 +24 501 356 124-08 -02 5~O2 351 133-23 +12
405601 82-10 -02 394602 103-01 -06
701 275 149-76 +56 702 361 +01 121 -07
+10middot801 326 140-22 802 321 middot127
(
-29 -03 9~01 342 124 -H) 6-18 902 294 128 -H) 3-24
10middotmiddot -14312 140 -17 1101 182 +25 -23197
2411102 186-59 +29 1201 226 169-17 -41
31middot01202 +11 182 -05 295 -H) 81301 208 -H) 4
1302 331 +08 197 +04
14 323 +15 middot185 -08 middotmiddot15 329 +16 16~5 -13
-28middot 1601 332 131 +12
1602 356 98 +24middot-39 middot3101701 161-33 +21
1702 370 -15 85 +02 +19 1801 264 151middot-50
185middot1802 256 +47-58
IJ ~
D_raphlc Population Change 1960 to 1970middot 49 (Contd)
4io
Census Tract
of pop Uncter 19 Yra
1Q1n
1Cha1l8e 1960-70
of PopOver 65 Yra
lQO Change
1960-70
19 389 +29 141 -24 20 223 -13 206 +18
21 227 +08 194 -36 2201 356 -27 112 +05
2202 290 -18 ll~9 -29 2301 356 -03 154 +24 2302 260 -37 245 +97
2401 410 +6~1 123 -31 2402 163 -80 320 +99 2501 381 +13 140 -01 25()2 237 31 lil +02 26 343 +25 186 +149 2701 370 +29 1S5 -01 2702 249 -44 304 +98 2801 337 +19 187 +09 2802 306 -10 156 +31 2901 304 -38 142 +24 2902 i 307 -32 146 t3~9
30 29~0 -48 16~2 +51
31 355 +30 160 +01 32 370 +48 148 -13 3301 395 +45 130 -20 3302 368 +06 138 -02 3401 386 +16 117 000
3402
400 +32 92 -26 3501 304 -07 115 +35
3502 344 000 140 -13
3601
36~02 357 -04 132 +32
3603 30~1 42 149 -67 3701 342 +28 152 +19
1
IJ
Jianolraphic Population Chan 1960 to 1970 50 (Contd)
Census Tract
of Pop Under 19 Yrs
JJl7J
middotChanae 1960-70
middotofmiddotpop Over 65 Yrs
1c~7n
Change 196070
3702 409 +39 122 -11 3801 308 -11 151 +29 3802 275 -35 180 +46 3803 282 -32 192 +54 3901 376 ~13 100 +17 3902 296 -03 177 +29 4001 438 -11 84 +13 4002 353 -21 115 +20
4101 397 11 9middot0 +11 4102 346 -19 120 +03 42 331 +19 11 bull 3 -16 43 347 -72 105 +31 44 113 +84 183 +154 4S 33~9 +07 110 -06 4601 2501 22 193 +38 4602 332 +59 126 -29 47middot 161middot 000 211 +01 48 103 -26 302 +59 49 138 +1 bull 3 252 +09 50 141 -26 204 -12 51 12 -39 257 +07 52 47 -61 351 +48 53 89 +49 314 -30 54 25 l1li15 327 -17 55 131 -17 115 -121 56 198 +93 227 -47 57 71 102 189 -88 58 240 ~middot41 16~1 +55 59 322 +25 142 +06middot 6001 264 95 132 +50
6002 328 -31middot 89 +07
JJ
Demographic Population Change 1960 to 1970 51 (Contd)
Census 1 ofPop lChange of Pop bull ChangeTract Under 19 Yrbullbull 1960-70 Over 65 Yrs 1960-70
1970 1970
61 355 -58 85 +39
62 328 39 110 +18
63 414 04 73 10
64 382 -22 72 +04
6501 383 02 67 -20
6502 329 -56 96 +09
6601 391 +13 88 -03
6602 319 -59 97 +06
6701 327 71 145 +72
6702 331 ~67 83 +1-0
6801 365 -66 49 +01
6802 388 4bull3 54 +06
69 354 -41 80 +23
70 400 -23 68 -06
71 359 -48 72 +05
72 255 -88 82 +11
73 346 -39 91 +25
74 313middot -63 105 +24
75 329 -42 129 +37
76 336 -52 85 +21
77 370 -10 69 +05
78 309 -10 120 +21
79 325 -56 87 +10
8001 358 -81 57 +12
8002 391 ~81 76 +12
81 315 -76 108 +21
8201 403 -23 64 +08
8202 392 23 65 +08
83 357 -34 120 +31
84 402 -18 73 +16
85 413 -06 76 -09
r
Demographic Population Change 1960 to 1970 52 (Contd)
Census Tract
t of Pop Uncler 19 Yrs
1970
Change 1960-70
1 of Pop OVer 65 Yrs
1970
ex Change 196070
86
87
88
89
90
91 9201
9202
93
94
95
9601
9602
9701
9702
9801
9802
99
100 I
101
102
103
10401
10402
lOS
368
351
379
391
391
413
379
433
372
429
414
432
419
439
~32
377
457 420
378 41middot7
345
360 417
417
412
-04
-02
-35
-26
-28
-11
-64
-20
-S9
-39
-32
-21
-34
-40
-47
-lO~7middot
-27middot +04
+56
+07
-34 01
+04
+04
+10
103
128
97
11il3 99
69
79
42
77
46
34 38
44
40
54
111
51middot
81
133
59
74
140
63
87
76
-08
-06
+04
+08
+17
-05
+3S -02
+1~4
+19
+33
-14
-08
+12
+26
+71
+11
-16 -34
-20
-19 +37
-49
-2S +15
NOte The The
Taken frOi
averageullder averageabove
middotUSCensus ---shy -
19 years == 6S years ==
figures 197
32r 13(14
p a~d 1960
--
Rank
1
2
3
4
5
6
7
8
9
10
11 12 -_
13
14
15
16
17
18
Tract
69 46
60
58
- 68
61
302
2501
67
63
19
62
26
94
3603
3902
64
30 -----~-
Rank
19
20
21 -
22
23-shy
24
25
26
27
28
29
30
31
32
33
34
35
36 -
Ranking of Per Capita Income by Census Tract
Tract
65
2701
- 15
1601
701
66
93
82
2903
3602
30
2502
80
2401
81
- 70
91 shy
4001
High
Rank Tractshy
-32shy37
38 97
120239
7840
41 ~ _2_1__ 42 31
43 2501
44 18
45 98
46 37
47 3803
1702
49
48
1602 92 2702
I
50 89
51 901
52 801
Ra_
53
54
55
56
57
58
59
60
61
62
63
64
6S
66
67
68
TractTract Ra~
74692
170196 70 I
401 71 90
72 1037J
79 70273
3802 74 601
24024102 75
85 76 101
77 9023901
7699 78 100 4101 79
3601 I
380180
458140~ t---- _ - - shy83 82 42
888384
59843501
4777 8~
502
Low
802 86
Rank Tract
87 shy
--88
89
90
91
92
93
94
- 95
96
97
middot98
99
100
101
102
103
104
1201
14
49
72
73
43
87
3502
105
1
52
86
71
1
501
10
3301
104 tf
Rank
105
106
107
108
109
110
III
112
113
114
115
116
117
118
119
120
121
Ranking of Per Capitalucoae by Census Tract
(Contd)
Tract Rank
4001 122--shy602
13
1102 2302
3302
55
3401
48
21
56
50
3402
lL01
2202
2301
53
2201
-shy
Tract Rank Tract Rank T~aet Rank
57 I-----
Imiddote
bull
Tract
- Low -k Note Information taken from 1960 U SCensus
Rank Tract
I ~
Ie
Imiddot
~
----
----
--
--
Rank
1
2
3
4
5
6
1
8
9
10
11
i-
-Tract
391 922 921
972 971
100
132 131 121
962 961
822 821 401
982 981
20 111
47 10 1
412
High
Total Number of Henta1 Health Visits
Ranked by Census Tract High to Low
TractTract RankTractRank Rnk
12 182 22 78 29 87 76 381 73181 ~------- 1913 371 8538230162372 271 2616-121 8272 2
14 80~2 31 94 7923 84801 59 15251362 4232 15 52 _ 32 103 8924 651 17240216 652
_ 91 351 33 341 23117 83 122 25 25 48 1123921418 34 shy61 86 661
19 662 6493 81 26 91 8153 49 50 55 41383 71 27 51 3120 90 672241 35shy 104167162 461
I 411 46211121 28 88342 I
2502 36 69 54 5251 50 272
-Ra
37
38
39
_ 40
_ 41 Ishy
I
42 I
-I 43 44
45
shy
Tract
~ --- shy 95 56
45 292 242
102 62 352 291y
92
101 281
99 72 63 601 60~ 42 2201
77 74 61 57
363 232
70
32 31
11 44 282 2202
Low l
- Tract
46 682 681 I 331 30
r~$ 47 1042 332
48 102_41_
11
~
Visits to Family Planning Clinics Ranked by Census Tract High to Low
Rank Tract Rank Tract Rankmiddot Tract Rank Tract Rank Tract Rank Tract
1
2
3
4
5
6
7
8
9
10
11
12
13middot
14
15
16
17
361
56
401
341
48
59 121
20
55
342
10
31
58
93 21
241 132
331
53
461 462
18
19
20-shy21
22
23
24
25
26
27middot
28
29
30
31
32
33
391
32
middot47 I-i-_-shy _ -
231 111
332
972 1
372 371
52
89
32
92
82
100 31
182
30 242
402
34
35
36
37
38
39
40
41
42
43
44
45
42
1714 i 661 221
78 362 2
90 602 601 352
63 251
105 921
971 351
73 42 292 232
411 51
662
81 45 52
46
47
48
49shy
50
51
52
53
54
55
56
961
801
49 81 72 71
19
9~1
172
68 2 57 162 14 112
91 75 681
381 42
3~3
83 161
57 f
58
59
60
61shy
62 Imiddot
63
Imiddot 64
65
66
64 62 36~3 252
74 652 SO 392 291
651 6bull 2
79 271
r-- ---- shy981 222
672 671
821 272
94 87
281
382
67
68
69
70
71
72
73
74
75
76
77
78
981 26 12~2
IS 61
85 82~2 69
61 43
101 86 84 282
76
131
51 72
1041 962 88 70
99 922 77
103
95 802 181
i
~
Low High
RankRank Tract
5479
4480
81 1042 ~) middot102
71 - - + ~ - ~
Visits to Family Planning Clinics
(Contd)
Tract Rank
I
Tract llaDk l
RankTract Tract Rank Tract
~
I
~
J1 ~
Low
Total Number of public Health Nursing Visits
Ranked by Census TractsHigh to Low
TractTract RankTractRank RankRank TractTractRankTractRank
25249 71 79 17249 8033 6586 99189711 84 2915072 34 661 76 66 811519512
402 5035 51 161 2518220 122 1713423 352 55801 7120 6752 2 149814 41236 83 2662 38 94 6821 53 2924015 362 37 32 42 75 69 281 84 63
546 8822 54 222 85 3925431 70383417 3818223 6439 4386652 718 21 55 103332 8924 232 87 19 271729219619 24156 16211140 382 628825 10523110 112 73411 10141-- ----shy 89 363 4457 8126 16111 221 74 9142 90 46158331 53 671279012 46243 48 59 351 3837528 1083 9313 91 5844 59 -_242 76 1----- shy60 272 72 74104114 60145 42 9287 7729 92 6151 8215 57371 934630 91 307762 12113116 282 619447 41391 9531 78100 63 7378 ~95 681 6945 32 5632 798517 6448 47 52 181
High ~ Low
Rank Tract Rank
96 31 132 70
97 102
98 182 372middot 602 651 662
- -shy
~72 682 802
822 922 962 972 982
1042 ----shy
Low
Total Number of Public Health Nursing Visits
(Contd)
Rank Rank Rank TractTract Tract
I
I lt
I
Tract Rank Tract
[
~~~-
I
~
IJilfimiddot ~
j
Ranking of VD Caea According to Census Tracts 61 By High and LOll Youth Itatio
A media~ of 34 5 was determined Any tract having greater
than 34 5~ of popu1tionunde~ 19 years of age -High~
Any tract having l8S than 345 of population under 19
years == Low
Any tract having rate less than 390 =Low
Any tract having rate more than 390 == HLgl4
YOUTH
LOW HIGH
L
0
12 402 1801 1802 343 2801 2802 29023603
54 6001 600262 66~02 72 74 75 76
78 79 81 t02 65 1202
W
(25)
VD
H
I
G
H
401 701 801802 901 902 10 1101 241 1201 1301 132 14 15 1601 1701 20~ 21 2202 2j02 2402 2502 2702 2901 303501 3502 34023801 3802 383 3902 42 44 45 4601 4602 47 48 49 SO 51~2 53 55 56 57 58 S9 6701 6702 73 95
3~02 7021702 19 25~01 2701 4102 4101 63 64601 ~601 6801 680270 7l 77 8001 80~02 8201 8202 83 84
85 86 87 88~ 90 91 9202 920193 94 9601 9602~ 9701 9102 9801 9802 99 100 101 103 10402 105 6501 10401
(47)
301 501 502 601 1602 2401 2301 2201 31 32 3301 3302 3401 3402~ 3602 3702 3901 400140 02 43 61 69 B(
(53) (23)
~ ~gt
Ranking of VD by Rate Per 100000 By Census Tract
~
Rank Tract Rank Tract Rank Tract Rank Tract llank Tract Rank Tract Rank Tract
1 2202 21 S6 40 902 58 1602 74 75
90-shy 64 107 26 --~-
2 3402 22 45 41 10 59 902 75 78 91 54 108 61
3 2301 23 3502 42 2502 60 602 76 6802 92 402 109 87
4 3302 24 49 43 1102 61 501 17 2 93 94 110 90
5 50 25 52 44 6702 62 14 78 8202 94 97 02 III 76
6 2201 26 20 6701 63 4002 8201 2501
9701 41~02 112 91
7 44 27 48 45 401 64 3802 2902 95 63 113 62
8 3301 28 1701 46 502 65 30 79 83 74 96 9602 114 71
9 55 29 47 47 42 66 3803 80 2801 96Q1 115 85 10
11
12
13
14
15
16
17
18
3401
53
2302
2401
57
21
2402
1101
51
30-shy31
32
33
34
35
36
37
3701 - -~ 1201
3702
89
43
132 131
3602
4001
48
49
50
51
52
53
54
55
58
1601
601
4602 4601
69
701
31
3901
67
68
69
70
71
72
2901
801
39021~ 802
6502 6501 122
702
41~01
81
82
83
84
85
86
87
88
19
1
1702
2802
79
93
100 6801 6602
81
97
98
99
100
101
102
103
104
9201 9202
9802 9801
77
302
79
86
72
84
116
117
118
119
120
121
3603
8002 8001
101
99
95
10401
105 10402 103 102
19
20
59
32
38
39
2702
3501
56
57
301
3801
73 1802 1801
89 6002 6001
105
106
2701
88
High Low
-- -----
Rank OrdermiddotTuberclosis Cases by Rate Per 100000 Ranked by Census Tract High to Low
Tract TractRankTractRank Rank TractRaukTractRankTractRank
801
79 9601501411 52 6835340120511 I 960269 903603532036 $-~~F130221542 4366 311301 70 68~013802 _ I- _ 4001_37213 3921201 6802802 H71523822024 22 54 193302 3802 80 8958 I37139535 70155 9801 I60123 72 6702 98023914011016 6701250124 10 56
81 94 401r 7 154152 73 7057 2625 122 92028
90242 162312301 92~158 86 7172434526509 82 79160159 74 100 87412240227220110 6502836960 75 30 8317244 6501782801285711 61 901 42765645 84 66021459294912 9701 660146 171 302 9702 47
6235023033113 85 822821182 917755 16335013110214 841814832 78 103 938564 324815 86 1057940149272 38036523216 10401 87 2902241 725Q 10402360266340217middot IF88 88 9937233 282 51 218 101 01102 46016234
I)167 2901460219 47
High ~ Low ~
- -
TractRank
9S89
6490
8191 8001 8002
63 61 60middot01 6002 44 2701
92
J
2502 402 --- ----shy
I
Rank
Rank Order Tuberculosis Cases by Rate per 100000
(Coutd)
Tract Rank Tract ~nk
I
Tract Ballk Tract Rank
Imiddot
Tract
Imiddot
1~
t 1I i Pi i l I
o
1 -1shyL I
I J
8 40 icO ~ I -lt 0
-t (1) I
i I
r o E
II
a
I
r--i
shy
I
~
I (
Jgt
(011 fi(
Ggt
I II ~j
()
(f 0
~ ()
I
11
f9
r
II 99
o ~
Ggt r
~ __-J~ I t I ~ I
r--J l I
~ _ __ J
) 1
fTl
1gt
r I
()
r
()
lt en -i en
()
I1l
(J)
(J)
-i
P ()
19
r o ~
r G1 I
I
c
~
o I 89
--- -I-shy
r-r I
1- 0 _~ _ _--J E
G1 I I I
i i
I 1-1-1 ~ _J ~2 ~ II
II
()
1 I I I 1
id i bullbull
~
A n 69
r 1shy
- 0 Gl
l--~ ~ I
~ II
II )
I () isect i
en l i
(J)
-t
0
IA Ol
IJ
37
lIlan one lUSt consider thertarro1fne8S of streets whether
streets are oD8--C)r two-way iqres8 and egress to parking
amp0111tie eros tratflC) spedof trattJQ children 1n
ll8a traffic i1lht Vislon re8tr1ctionS etc
BwstraDsportat1onshould alao be central in this area
as maay people ~U f1Df1 1tD8Cessary to use this form of
transportatlon
~e tutqredlopHQt of bull treewa systems should be
c0J1S1dered soastolesen thecumce ofmiddot future roada
cutt1DSotltbe cl1D1c llte line
nrrph1c middotDampta
It is 1JDportaDtto kDOw the demosraphic distribution
characteristics of the oUenteltbat i8 to be served by
localized health cl1D1cs
Acl1D1c which erves8J1 area where1D the prepondershy
ance of persona arecrter 65 years of mayf1nd that these
people rely more on pUblic transportation call for more
home- services and haV4t 110ft ChroD1c and debilitating
types of disorders (b1_ blood pressure poor heariDg and
eyesight) tbaD do8 an area ot a YOUDIer population On
the other hand thL area of older residents may have little
need for family plabDlng cllni08
In order to better ~Ybullbull the 4eaoraphic population
of each CeD8U8 tract the 1970 CeD8U8 iatormation was viewed
and two specific catelOri8 considered These two cat
IJ
38
lori8S woUld be the perc_tap ot population under 19
year of ase and the percentase ot each oensuetractover
65 years of age he 1960 1Dtormatlon tor eaCh tract was
then compared witbthe 1970 intormation and a percentage
ofincreaae or4ecreamp8 tormiddot e~chtract1n each category
cOJlputecland achartma4e By the use of this chart one
18 able to View tJleap populat1odiatr1but10n of census
tract and at the _ t1lle accesa middottrencl Por example
let us choose census tract 601 W see 40-4 otthe
population is under 19 years ot and that ODly82 1s
over 65 years ot middotAtthe e tille the percentage of
youth bas ~ed ODly 1_ intbe laSt teD year whilethe
percentale over 65 year ot middotbas stayedmiddotthe same With
this in mJnc1 ODe ~ 1DfItr libat ol1D1o aerviDg this
area WOuld bellQre conq~w1th the problems of a
YOUQier populat1on and that _ would probably be true foJ
some t1aein tbefuture On the other hand CeDSU8 tract 54
has only 2 ollt population UDder 19 yel1s ot age and
this has decreased by 1 over the last ten years middotwhile at
the same time 32-377 ot the populat1on 18 over 65 years of
age A ol1D1C ___ this area should be or1eJ1ted toward
tbespecttic problema otthe ampledbull
PerCapia __ bY gsa neat
WhaD cona1der1qlooat10D1 tor health cl1n1cs one
shoUld take the 1DC01Ieot areas into consideration Areas
IJ
39
of lowiDcome would not 11kel~be 8erved more by localized
cl1D1cs tbaD would are of hilbincome It 18 likely
people haYiq a hip iDeoll8would preter to be aeenby a
chosen ~r1vatephylc1a1l tban at a local cl1D1cwhere
10Dier waits y beraceaaampryand leas personal attention
gl_
The 19701ncOII81atoWampt10n tor MultnomahC~ty was
not available at the tille thi8report W88 made The 1Dto~shy
tiOD Was taken ~adtro tbe1960 census publlcation
his woUld ~8Il thea tbat ral1I8 OD the chart ynot 1raquoe
completely accurate hi writer telthatthe areas most
affected by tb8 1I8eof the older 1Dco1DtOlaat1oDWOuld be
those tracts wh1ch baYebad a rapid 1ncreaae1n populatlon
over the past tfmyHr8 bullbullbull tracts would include tracts
nUmbered 104 9897 96 aDd 95 be perc~ita 1Dcome
referredto1il-tb1a Paper18the lIean 1DCo per person per
census tract
Attar the iDeoeper census tract was listed on a chart
a map was de 1D41catiDg those census tracts belonging to
the lower 14 ot income tor all censue tracts in Multnomah
COlDltytbose beloqins to the upper 14 ot income tor all
census tract 111 MultnolUlhCounty and those belonging to
the mid 12 ot 1I1coaetor all oeuuetracts in Multnomah
C01mty
In yiew1Dg the _p 1t caa be seen that the low income
area seautotollow aloas the at aide ot the Wl1lamette
IJ
40
R1ver the full length of Kultnomah County A second low
income area follows the south edge of the Columbia from
the northwest corner of Multnomah County easterly to 148 St
A third problem area seems to be on the east bank of the
Willamette River with the Union Pacific Railroad being
about the center of this tract The extreme loutheast
corner of Multnomah COUDty appears to be a low income area
but as this area bas bad rapid grouth in the last ten years
this could be erroneous
Mental Health
be first ~ecific indica to be selected from the
Multnomah County envirollllental survey of early 1971 and
to be considered in this paper i8 that of Mental Health
At the present for mental health purposes Multnomah
County is divided into five catchmentareas with a mental
health cl1n1cin each area These clinics are Model
Citles Delaunay ADkeny street Office Hansen Health
Building end Southeast Clinic
All lIlental health cl1n1cslcept statlstlcal information
on all patients visiting their cl1n1cs this included the
address of the patient hese addresses were then listed
upon the approprlate C8D8US tract Each census tract was
then ranked on a chart according to the nUllber of mental
health patients who reslde ln thatCeDSUS tract attending
any of the above listed ental health clinics This chart
IJ
41
wasttum d1v14ed1ato proper quartile bbullbullbull
quartile vereUs to dne10 u appropl1ate Multnoh
County _tal health ItLa middotmiddotmiddotthelipO~a1bl by lOoJcJIUE
at the UDtal health _to uteN1De which ueu have the
lars-t use otCOllDty 1alh~th faci11t1Rot
1Ilclu4ecl 111 tbia woUld tber otpeopleYia1t1Da
pr1vat patch1atriata aDd pr1_t _ntalhealtb cl1D1c8
WheDtbe M1 18Yienclmiddot Itmiddotmiddotmiddotmiddot~middotbe~_ tbat ~rtt
appears to lMt fourmiddotmiddot-al are iii _oil the nuaber ot
lIental healthcl1D1c na1t toM tbjh1sheat 1he
tour areaa woUld be tollows
1ttrea Ore to~Blo Drimiddot ~tb Burrus14e aDd tIMtmiddot Colb1a Riftr H1gbwyaeri1Dla th nortllra boundaryshy
2 bull ProII 82D4 1_~ 10 20th streetwitil the ra1lMd Mu the north ltouadary
3 ~ et et tUgl_b1bull MYel froamiddot the Clackaaa COUDty l1ae aorth to Dln8lon stret
4 beDOlvt1ttfe-t ~efllt4 COatytrca Jle1aware streetmiddot toR1C1a11oDd wlth Colubla Blvd heiDI tbAtnorth bouaclary_
It ODe coapareatbiap to th iDeobullbullmiddotp 1t can be
eamiddotthat lIOat ot the c tracts baY1Dg bllh v1i11tatlcma
middottfl public tal health cJ1rUc8 ~ 111 t13e low ~ aid
1DcOile SroupiDIOJa1y of til 25 tracta llsted as
haviDlbip aental Maltll nlltatlou are ~ the1g60 hip
iDeo arebullbullbull
17 Plpn
42
amily PlellnSDI ]Jlce Metal Health i8 an 1nd1ce of
use Theperson 111 ordertobavebe_ 1Dcluclecl 1n this
atu4ywouldhave tohaft Ue4 ataa11y plaDI cl1D1c
tacilities of soaetype It 41fter troll tile _tal health
study1nthat i t1Jicludestatist1catrollbotb public and
privateclJD1os
The iDformation tor the iak orurcbart 8Dd map of
t8ll111 plenn1 na ob1a1De4 by cOIIblnlDlthe mabel of
1rlcuv1duals bullbull_ attbe tbreellUltrampo-ti Coatyhll11y
PlalJQllIl C11ll10s 111til tbo at the Planned PareDthood
Association CliD1C8 be tbree -JIultDouh Couaty r8ldly
PlamSq Cl1D1c are Solrtbweatth Col_bla 1111- a114
HaDsell Health BWlcl1Dl CllD1cbi middot1Dtormat1oD vas then
bullbullbullesed tomiddot detellWMt l10w people troll eacb c8IUIUS
chart wastben Mele IUs oIIart jn 4iY1ded to show
the censuS tracts lIaYiDlmiddottIle h1t1iest qUart1le of incidence
of use lowest quartile of 1Qc1deao ot use Jlid 12 of
incidence of Wle an4 a map sprepared troll thts 1Dto~
mation
The C8U118 tractsbelOJISnl to the h1lhestquartile of
use appear to be 1lO~ 8catt~ on tbipwas true ot
either the _p ot aental health cl1D1c uaageor ot the map
abow1DI per capita 1I1COM Iaere40 to be three
d18t1nct areas of UIIaP beJ woul4 be
1
IJ
43
t10D of BurD81cl and the W11lallette River 4
2 S~t Portland 8Otth otmiddot the ra11shyrcaadand alona the W11lamette River
lIortbeaat Portl8D4 between MisSiss1pp1 and 24tbStreet the northbouBclary be1DgColwb1aBlvd
Pylzl1c BMltl IrpI Y11ta
Publlc Healtil nur81D1Y1s1t nclud8 an vists to
theholles of client by PubUc Health Nurbullbullbullbull his shows
visits to bull f8Jl1ly fer aDY purpos SUCh aatuberculolJ1s
het1Dl tem1tyaeatalu4 8IiOt10D8l cODd1t1ona etc
he atat18t1C~ 1fele C()4ed accord1Dg tomiddot the 1llli301fOCUS
of the Y18lt tt doe DOt 1D41cate the Dmlber of holies or
f8ll11lev181tecl or 1D41Y14ual Y1a1ted more tban oDcein
the propwl It dobullbull I1ve 80M 1D41cat1on by coaparlshy
OD ot the 8JIoUDt of aedlcal problema 1n eachcen8WI tract
Ap1nmiddot the _p abowa 8 scatter patteraof probl_
areas althoUSh there appear to be a sroup1Dl of hiSh J
l8aIeccmaus tract 1ntlut extreme southeast part of tbe
County other areu uIriaI any nura1Dl contacts are
1 bull he 801lth-oa-al CO1Dty on eaCh 814 of 82nd Av from Clackallaa County north to Dinloa
2 ear bullbullbullt 814e aroUDd Preacottand Misaisippi
Dowatom Bunul14eonboth 1de of the river
44
V_real Pis The iDfomatloil uaec1 to tabulate the Venereal
disease chart includes all the ooab1ned case otmiddotODormea
and syphilIs reported by bothmiddot publIc and prIvate physicIans
dur1nl 1970 There were 3602 caes ot IOnorrhea reported
dur1nl 1970 While ODly 17 cabullbullsot ayphilimiddot were reported
A chart was prepUed aDd att8llPt wasmiddotmiddot de tomiddot
determ1De Wh_therVttDereal 41ease was more p~vaJent in
areas othigb or lowmiddot proportIon ot youth hi waadone
bymiddotdetemlna a 1leaD prceiltacmiddotmiddotmiddottor the population ot
resld~ts UDder19 years ot (34) middotA mean ratemiddot per
100000 popUlatIon al80c1ttem1Ded tor the middotoccurreDCe
ot venereal dieae This was et at 390 oass Areas
hav1nl a population 1n which leiS than 34 were lmder 19
years ot ampIe were called low- yOuth abOve tbl percentaae
hiSh youth The aaa waatrue ot the occurrence oivenershy
eal disea_ per CeD8UStract It the rate waacomputed
as 1I0re than 390 cases per 100000 it was called hiah
venerealdiaeasei it less than thia tisure low venereal
disease It was tound that 1D Multn~ COmlty there sems
to be poSitive OOlatI0n(x21S19gt between low youth
and hipmiddot venereal diseaand hip youth and low venereal
diseasebull
RaDk ordr Iitot all c traot middottbAm made
Th1s was done byt1Ddlna the ratepr 100000 populatIon
of venereal disator all census tracts in the County bull
45
These were thenlisted from h1lhto low (sreatest to
least) in a rank order The l1sting was then divided
into Upperandlower 14 aDd listed on the MUltnomah
Countymiddot up
The areas of b1gh venereal disease se8ll18to
roup thBl~8 middotin a very tllht area ~oq both 1des
of thell18l8~ R1 w1th BurDaldeS~et being
~bout theceDter qf tbi8IZ9uping This area woUld
appear to be m ldeal spot for the denlopment of a
locallzed venereal d1sbullbullbullbull cl1D1c
UbepoundCUlO1s
In this report bull tube1C1llosls caS8S refrred
to include alltbobullbull cabullbulls ontubercUlo8is follow-up
rather middotthan just new C Accord1Ds to the Multnomah
County Health SUrvey of early 1971 this would include
all ca repOrte4 over thelaat three years The
total number of tuberculosi8 cabullbullbull usedin this study
was 666 lh1 included 128 new cabullbullbullbull
A rate per 100000 of tuberculosis for each
census tract wa- then computed and the c~us tracts
listed by rank order be b11h Qartlle mel low
quartl1 were then reoordd on a Multnomah CoUnty map
TWo genral areaa baY1Dg a hip mcldencaot tubercu~
losiare 1D41cated heyare
1 Both middotsld ot theWilla11lette River
Ll -
46
with Burns1de about thecnter
2 he extrea Northebullbullt comer of the County bull
By coap8r1ng the tuberculois an4ven8real
diseae maps ODe can 8ee that the downtown areas ot
hiSh 1nc1denceare alIIo8t 1c1eDt1cal on ach map
This WOuld 1nd1cate that 1t would be of value to
bullbulltab11sh acl1D1c 111 th1aampreatbat would provide
bothtuberCulos1s 8Dd ytmereal 418ase srvicbullbullbull
Thchart aDd 1181gt8 are wsfuln 11v1DI
1Ddicat10DS tor the type aDd placemeototlocal
health cl1n1c8 tbro1qhout tbe MultnomahCounty area
A cOllpar1on of the mapa help one to dec1dewhether
to provide a aulti-8ervice cl1D1c or spec1f1c type of
cliD1c As stated in Part I of thi paprserv1ces
shouldhaYe both treatlieDt and prfMmt10n cOmponents
As he been stated fta ne1lbborhood health care
Qenter muat be a fac111tY plazme4 with an aamesa
ot the neds of the consumer and the c01llll1m1tybull
Part II of this rport haa been an attaapt to indicate
and clarify 8011 ottheae coDlllUDity neds This has
been done through8elect10n of apc1f1c problems
The indic were then visuallyrecorded through the
use of ups and charta ODe dan asseS8 thedsreeof
1DIportance of certain concems to spec~t1c areaa by
comparinl the chart aDd maps Prom this oDeean
41 dec1de which are48 vb1chcUD1c-or indeed if
the need a clinic at all However further factors
should be considered hebullbull include
a The amount of fuDd1 available
b What 18 the percentage ot peopleineoh ceaaua tract tbat would actually us such cl1n1cIl
c Wbat 1 tbeco--1tymiddot 8 IeeliDashyreaardtDI particular cl1D1c8 Would this dcrebullbullbullmiddot the ettctiveness ot thse cl1n1ca
IJ
li
D_OlraphicPopulatLon Challie 1960 to 1970 48
Cen8U8 1 of Pop 1 Cbaqemiddot 1 Change1 ofPopTract Under 19 Yr8 Over 65 Yrs1960-70 1960-70
middot1Q701Q70
1 319 -12 171 -H) 1
2722 215-27 +68 301 366 -22 127 +35 302 371 +19 111 -04
311middot401 144-41 +29 402 321 13~7-39 +24 501 356 124-08 -02 5~O2 351 133-23 +12
405601 82-10 -02 394602 103-01 -06
701 275 149-76 +56 702 361 +01 121 -07
+10middot801 326 140-22 802 321 middot127
(
-29 -03 9~01 342 124 -H) 6-18 902 294 128 -H) 3-24
10middotmiddot -14312 140 -17 1101 182 +25 -23197
2411102 186-59 +29 1201 226 169-17 -41
31middot01202 +11 182 -05 295 -H) 81301 208 -H) 4
1302 331 +08 197 +04
14 323 +15 middot185 -08 middotmiddot15 329 +16 16~5 -13
-28middot 1601 332 131 +12
1602 356 98 +24middot-39 middot3101701 161-33 +21
1702 370 -15 85 +02 +19 1801 264 151middot-50
185middot1802 256 +47-58
IJ ~
D_raphlc Population Change 1960 to 1970middot 49 (Contd)
4io
Census Tract
of pop Uncter 19 Yra
1Q1n
1Cha1l8e 1960-70
of PopOver 65 Yra
lQO Change
1960-70
19 389 +29 141 -24 20 223 -13 206 +18
21 227 +08 194 -36 2201 356 -27 112 +05
2202 290 -18 ll~9 -29 2301 356 -03 154 +24 2302 260 -37 245 +97
2401 410 +6~1 123 -31 2402 163 -80 320 +99 2501 381 +13 140 -01 25()2 237 31 lil +02 26 343 +25 186 +149 2701 370 +29 1S5 -01 2702 249 -44 304 +98 2801 337 +19 187 +09 2802 306 -10 156 +31 2901 304 -38 142 +24 2902 i 307 -32 146 t3~9
30 29~0 -48 16~2 +51
31 355 +30 160 +01 32 370 +48 148 -13 3301 395 +45 130 -20 3302 368 +06 138 -02 3401 386 +16 117 000
3402
400 +32 92 -26 3501 304 -07 115 +35
3502 344 000 140 -13
3601
36~02 357 -04 132 +32
3603 30~1 42 149 -67 3701 342 +28 152 +19
1
IJ
Jianolraphic Population Chan 1960 to 1970 50 (Contd)
Census Tract
of Pop Under 19 Yrs
JJl7J
middotChanae 1960-70
middotofmiddotpop Over 65 Yrs
1c~7n
Change 196070
3702 409 +39 122 -11 3801 308 -11 151 +29 3802 275 -35 180 +46 3803 282 -32 192 +54 3901 376 ~13 100 +17 3902 296 -03 177 +29 4001 438 -11 84 +13 4002 353 -21 115 +20
4101 397 11 9middot0 +11 4102 346 -19 120 +03 42 331 +19 11 bull 3 -16 43 347 -72 105 +31 44 113 +84 183 +154 4S 33~9 +07 110 -06 4601 2501 22 193 +38 4602 332 +59 126 -29 47middot 161middot 000 211 +01 48 103 -26 302 +59 49 138 +1 bull 3 252 +09 50 141 -26 204 -12 51 12 -39 257 +07 52 47 -61 351 +48 53 89 +49 314 -30 54 25 l1li15 327 -17 55 131 -17 115 -121 56 198 +93 227 -47 57 71 102 189 -88 58 240 ~middot41 16~1 +55 59 322 +25 142 +06middot 6001 264 95 132 +50
6002 328 -31middot 89 +07
JJ
Demographic Population Change 1960 to 1970 51 (Contd)
Census 1 ofPop lChange of Pop bull ChangeTract Under 19 Yrbullbull 1960-70 Over 65 Yrs 1960-70
1970 1970
61 355 -58 85 +39
62 328 39 110 +18
63 414 04 73 10
64 382 -22 72 +04
6501 383 02 67 -20
6502 329 -56 96 +09
6601 391 +13 88 -03
6602 319 -59 97 +06
6701 327 71 145 +72
6702 331 ~67 83 +1-0
6801 365 -66 49 +01
6802 388 4bull3 54 +06
69 354 -41 80 +23
70 400 -23 68 -06
71 359 -48 72 +05
72 255 -88 82 +11
73 346 -39 91 +25
74 313middot -63 105 +24
75 329 -42 129 +37
76 336 -52 85 +21
77 370 -10 69 +05
78 309 -10 120 +21
79 325 -56 87 +10
8001 358 -81 57 +12
8002 391 ~81 76 +12
81 315 -76 108 +21
8201 403 -23 64 +08
8202 392 23 65 +08
83 357 -34 120 +31
84 402 -18 73 +16
85 413 -06 76 -09
r
Demographic Population Change 1960 to 1970 52 (Contd)
Census Tract
t of Pop Uncler 19 Yrs
1970
Change 1960-70
1 of Pop OVer 65 Yrs
1970
ex Change 196070
86
87
88
89
90
91 9201
9202
93
94
95
9601
9602
9701
9702
9801
9802
99
100 I
101
102
103
10401
10402
lOS
368
351
379
391
391
413
379
433
372
429
414
432
419
439
~32
377
457 420
378 41middot7
345
360 417
417
412
-04
-02
-35
-26
-28
-11
-64
-20
-S9
-39
-32
-21
-34
-40
-47
-lO~7middot
-27middot +04
+56
+07
-34 01
+04
+04
+10
103
128
97
11il3 99
69
79
42
77
46
34 38
44
40
54
111
51middot
81
133
59
74
140
63
87
76
-08
-06
+04
+08
+17
-05
+3S -02
+1~4
+19
+33
-14
-08
+12
+26
+71
+11
-16 -34
-20
-19 +37
-49
-2S +15
NOte The The
Taken frOi
averageullder averageabove
middotUSCensus ---shy -
19 years == 6S years ==
figures 197
32r 13(14
p a~d 1960
--
Rank
1
2
3
4
5
6
7
8
9
10
11 12 -_
13
14
15
16
17
18
Tract
69 46
60
58
- 68
61
302
2501
67
63
19
62
26
94
3603
3902
64
30 -----~-
Rank
19
20
21 -
22
23-shy
24
25
26
27
28
29
30
31
32
33
34
35
36 -
Ranking of Per Capita Income by Census Tract
Tract
65
2701
- 15
1601
701
66
93
82
2903
3602
30
2502
80
2401
81
- 70
91 shy
4001
High
Rank Tractshy
-32shy37
38 97
120239
7840
41 ~ _2_1__ 42 31
43 2501
44 18
45 98
46 37
47 3803
1702
49
48
1602 92 2702
I
50 89
51 901
52 801
Ra_
53
54
55
56
57
58
59
60
61
62
63
64
6S
66
67
68
TractTract Ra~
74692
170196 70 I
401 71 90
72 1037J
79 70273
3802 74 601
24024102 75
85 76 101
77 9023901
7699 78 100 4101 79
3601 I
380180
458140~ t---- _ - - shy83 82 42
888384
59843501
4777 8~
502
Low
802 86
Rank Tract
87 shy
--88
89
90
91
92
93
94
- 95
96
97
middot98
99
100
101
102
103
104
1201
14
49
72
73
43
87
3502
105
1
52
86
71
1
501
10
3301
104 tf
Rank
105
106
107
108
109
110
III
112
113
114
115
116
117
118
119
120
121
Ranking of Per Capitalucoae by Census Tract
(Contd)
Tract Rank
4001 122--shy602
13
1102 2302
3302
55
3401
48
21
56
50
3402
lL01
2202
2301
53
2201
-shy
Tract Rank Tract Rank T~aet Rank
57 I-----
Imiddote
bull
Tract
- Low -k Note Information taken from 1960 U SCensus
Rank Tract
I ~
Ie
Imiddot
~
----
----
--
--
Rank
1
2
3
4
5
6
1
8
9
10
11
i-
-Tract
391 922 921
972 971
100
132 131 121
962 961
822 821 401
982 981
20 111
47 10 1
412
High
Total Number of Henta1 Health Visits
Ranked by Census Tract High to Low
TractTract RankTractRank Rnk
12 182 22 78 29 87 76 381 73181 ~------- 1913 371 8538230162372 271 2616-121 8272 2
14 80~2 31 94 7923 84801 59 15251362 4232 15 52 _ 32 103 8924 651 17240216 652
_ 91 351 33 341 23117 83 122 25 25 48 1123921418 34 shy61 86 661
19 662 6493 81 26 91 8153 49 50 55 41383 71 27 51 3120 90 672241 35shy 104167162 461
I 411 46211121 28 88342 I
2502 36 69 54 5251 50 272
-Ra
37
38
39
_ 40
_ 41 Ishy
I
42 I
-I 43 44
45
shy
Tract
~ --- shy 95 56
45 292 242
102 62 352 291y
92
101 281
99 72 63 601 60~ 42 2201
77 74 61 57
363 232
70
32 31
11 44 282 2202
Low l
- Tract
46 682 681 I 331 30
r~$ 47 1042 332
48 102_41_
11
~
Visits to Family Planning Clinics Ranked by Census Tract High to Low
Rank Tract Rank Tract Rankmiddot Tract Rank Tract Rank Tract Rank Tract
1
2
3
4
5
6
7
8
9
10
11
12
13middot
14
15
16
17
361
56
401
341
48
59 121
20
55
342
10
31
58
93 21
241 132
331
53
461 462
18
19
20-shy21
22
23
24
25
26
27middot
28
29
30
31
32
33
391
32
middot47 I-i-_-shy _ -
231 111
332
972 1
372 371
52
89
32
92
82
100 31
182
30 242
402
34
35
36
37
38
39
40
41
42
43
44
45
42
1714 i 661 221
78 362 2
90 602 601 352
63 251
105 921
971 351
73 42 292 232
411 51
662
81 45 52
46
47
48
49shy
50
51
52
53
54
55
56
961
801
49 81 72 71
19
9~1
172
68 2 57 162 14 112
91 75 681
381 42
3~3
83 161
57 f
58
59
60
61shy
62 Imiddot
63
Imiddot 64
65
66
64 62 36~3 252
74 652 SO 392 291
651 6bull 2
79 271
r-- ---- shy981 222
672 671
821 272
94 87
281
382
67
68
69
70
71
72
73
74
75
76
77
78
981 26 12~2
IS 61
85 82~2 69
61 43
101 86 84 282
76
131
51 72
1041 962 88 70
99 922 77
103
95 802 181
i
~
Low High
RankRank Tract
5479
4480
81 1042 ~) middot102
71 - - + ~ - ~
Visits to Family Planning Clinics
(Contd)
Tract Rank
I
Tract llaDk l
RankTract Tract Rank Tract
~
I
~
J1 ~
Low
Total Number of public Health Nursing Visits
Ranked by Census TractsHigh to Low
TractTract RankTractRank RankRank TractTractRankTractRank
25249 71 79 17249 8033 6586 99189711 84 2915072 34 661 76 66 811519512
402 5035 51 161 2518220 122 1713423 352 55801 7120 6752 2 149814 41236 83 2662 38 94 6821 53 2924015 362 37 32 42 75 69 281 84 63
546 8822 54 222 85 3925431 70383417 3818223 6439 4386652 718 21 55 103332 8924 232 87 19 271729219619 24156 16211140 382 628825 10523110 112 73411 10141-- ----shy 89 363 4457 8126 16111 221 74 9142 90 46158331 53 671279012 46243 48 59 351 3837528 1083 9313 91 5844 59 -_242 76 1----- shy60 272 72 74104114 60145 42 9287 7729 92 6151 8215 57371 934630 91 307762 12113116 282 619447 41391 9531 78100 63 7378 ~95 681 6945 32 5632 798517 6448 47 52 181
High ~ Low
Rank Tract Rank
96 31 132 70
97 102
98 182 372middot 602 651 662
- -shy
~72 682 802
822 922 962 972 982
1042 ----shy
Low
Total Number of Public Health Nursing Visits
(Contd)
Rank Rank Rank TractTract Tract
I
I lt
I
Tract Rank Tract
[
~~~-
I
~
IJilfimiddot ~
j
Ranking of VD Caea According to Census Tracts 61 By High and LOll Youth Itatio
A media~ of 34 5 was determined Any tract having greater
than 34 5~ of popu1tionunde~ 19 years of age -High~
Any tract having l8S than 345 of population under 19
years == Low
Any tract having rate less than 390 =Low
Any tract having rate more than 390 == HLgl4
YOUTH
LOW HIGH
L
0
12 402 1801 1802 343 2801 2802 29023603
54 6001 600262 66~02 72 74 75 76
78 79 81 t02 65 1202
W
(25)
VD
H
I
G
H
401 701 801802 901 902 10 1101 241 1201 1301 132 14 15 1601 1701 20~ 21 2202 2j02 2402 2502 2702 2901 303501 3502 34023801 3802 383 3902 42 44 45 4601 4602 47 48 49 SO 51~2 53 55 56 57 58 S9 6701 6702 73 95
3~02 7021702 19 25~01 2701 4102 4101 63 64601 ~601 6801 680270 7l 77 8001 80~02 8201 8202 83 84
85 86 87 88~ 90 91 9202 920193 94 9601 9602~ 9701 9102 9801 9802 99 100 101 103 10402 105 6501 10401
(47)
301 501 502 601 1602 2401 2301 2201 31 32 3301 3302 3401 3402~ 3602 3702 3901 400140 02 43 61 69 B(
(53) (23)
~ ~gt
Ranking of VD by Rate Per 100000 By Census Tract
~
Rank Tract Rank Tract Rank Tract Rank Tract llank Tract Rank Tract Rank Tract
1 2202 21 S6 40 902 58 1602 74 75
90-shy 64 107 26 --~-
2 3402 22 45 41 10 59 902 75 78 91 54 108 61
3 2301 23 3502 42 2502 60 602 76 6802 92 402 109 87
4 3302 24 49 43 1102 61 501 17 2 93 94 110 90
5 50 25 52 44 6702 62 14 78 8202 94 97 02 III 76
6 2201 26 20 6701 63 4002 8201 2501
9701 41~02 112 91
7 44 27 48 45 401 64 3802 2902 95 63 113 62
8 3301 28 1701 46 502 65 30 79 83 74 96 9602 114 71
9 55 29 47 47 42 66 3803 80 2801 96Q1 115 85 10
11
12
13
14
15
16
17
18
3401
53
2302
2401
57
21
2402
1101
51
30-shy31
32
33
34
35
36
37
3701 - -~ 1201
3702
89
43
132 131
3602
4001
48
49
50
51
52
53
54
55
58
1601
601
4602 4601
69
701
31
3901
67
68
69
70
71
72
2901
801
39021~ 802
6502 6501 122
702
41~01
81
82
83
84
85
86
87
88
19
1
1702
2802
79
93
100 6801 6602
81
97
98
99
100
101
102
103
104
9201 9202
9802 9801
77
302
79
86
72
84
116
117
118
119
120
121
3603
8002 8001
101
99
95
10401
105 10402 103 102
19
20
59
32
38
39
2702
3501
56
57
301
3801
73 1802 1801
89 6002 6001
105
106
2701
88
High Low
-- -----
Rank OrdermiddotTuberclosis Cases by Rate Per 100000 Ranked by Census Tract High to Low
Tract TractRankTractRank Rank TractRaukTractRankTractRank
801
79 9601501411 52 6835340120511 I 960269 903603532036 $-~~F130221542 4366 311301 70 68~013802 _ I- _ 4001_37213 3921201 6802802 H71523822024 22 54 193302 3802 80 8958 I37139535 70155 9801 I60123 72 6702 98023914011016 6701250124 10 56
81 94 401r 7 154152 73 7057 2625 122 92028
90242 162312301 92~158 86 7172434526509 82 79160159 74 100 87412240227220110 6502836960 75 30 8317244 6501782801285711 61 901 42765645 84 66021459294912 9701 660146 171 302 9702 47
6235023033113 85 822821182 917755 16335013110214 841814832 78 103 938564 324815 86 1057940149272 38036523216 10401 87 2902241 725Q 10402360266340217middot IF88 88 9937233 282 51 218 101 01102 46016234
I)167 2901460219 47
High ~ Low ~
- -
TractRank
9S89
6490
8191 8001 8002
63 61 60middot01 6002 44 2701
92
J
2502 402 --- ----shy
I
Rank
Rank Order Tuberculosis Cases by Rate per 100000
(Coutd)
Tract Rank Tract ~nk
I
Tract Ballk Tract Rank
Imiddot
Tract
Imiddot
1~
t 1I i Pi i l I
o
1 -1shyL I
I J
8 40 icO ~ I -lt 0
-t (1) I
i I
r o E
II
a
I
r--i
shy
I
~
I (
Jgt
(011 fi(
Ggt
I II ~j
()
(f 0
~ ()
I
11
f9
r
II 99
o ~
Ggt r
~ __-J~ I t I ~ I
r--J l I
~ _ __ J
) 1
fTl
1gt
r I
()
r
()
lt en -i en
()
I1l
(J)
(J)
-i
P ()
19
r o ~
r G1 I
I
c
~
o I 89
--- -I-shy
r-r I
1- 0 _~ _ _--J E
G1 I I I
i i
I 1-1-1 ~ _J ~2 ~ II
II
()
1 I I I 1
id i bullbull
~
A n 69
r 1shy
- 0 Gl
l--~ ~ I
~ II
II )
I () isect i
en l i
(J)
-t
0
IA Ol
IJ
38
lori8S woUld be the perc_tap ot population under 19
year of ase and the percentase ot each oensuetractover
65 years of age he 1960 1Dtormatlon tor eaCh tract was
then compared witbthe 1970 intormation and a percentage
ofincreaae or4ecreamp8 tormiddot e~chtract1n each category
cOJlputecland achartma4e By the use of this chart one
18 able to View tJleap populat1odiatr1but10n of census
tract and at the _ t1lle accesa middottrencl Por example
let us choose census tract 601 W see 40-4 otthe
population is under 19 years ot and that ODly82 1s
over 65 years ot middotAtthe e tille the percentage of
youth bas ~ed ODly 1_ intbe laSt teD year whilethe
percentale over 65 year ot middotbas stayedmiddotthe same With
this in mJnc1 ODe ~ 1DfItr libat ol1D1o aerviDg this
area WOuld bellQre conq~w1th the problems of a
YOUQier populat1on and that _ would probably be true foJ
some t1aein tbefuture On the other hand CeDSU8 tract 54
has only 2 ollt population UDder 19 yel1s ot age and
this has decreased by 1 over the last ten years middotwhile at
the same time 32-377 ot the populat1on 18 over 65 years of
age A ol1D1C ___ this area should be or1eJ1ted toward
tbespecttic problema otthe ampledbull
PerCapia __ bY gsa neat
WhaD cona1der1qlooat10D1 tor health cl1n1cs one
shoUld take the 1DC01Ieot areas into consideration Areas
IJ
39
of lowiDcome would not 11kel~be 8erved more by localized
cl1D1cs tbaD would are of hilbincome It 18 likely
people haYiq a hip iDeoll8would preter to be aeenby a
chosen ~r1vatephylc1a1l tban at a local cl1D1cwhere
10Dier waits y beraceaaampryand leas personal attention
gl_
The 19701ncOII81atoWampt10n tor MultnomahC~ty was
not available at the tille thi8report W88 made The 1Dto~shy
tiOD Was taken ~adtro tbe1960 census publlcation
his woUld ~8Il thea tbat ral1I8 OD the chart ynot 1raquoe
completely accurate hi writer telthatthe areas most
affected by tb8 1I8eof the older 1Dco1DtOlaat1oDWOuld be
those tracts wh1ch baYebad a rapid 1ncreaae1n populatlon
over the past tfmyHr8 bullbullbull tracts would include tracts
nUmbered 104 9897 96 aDd 95 be perc~ita 1Dcome
referredto1il-tb1a Paper18the lIean 1DCo per person per
census tract
Attar the iDeoeper census tract was listed on a chart
a map was de 1D41catiDg those census tracts belonging to
the lower 14 ot income tor all censue tracts in Multnomah
COlDltytbose beloqins to the upper 14 ot income tor all
census tract 111 MultnolUlhCounty and those belonging to
the mid 12 ot 1I1coaetor all oeuuetracts in Multnomah
C01mty
In yiew1Dg the _p 1t caa be seen that the low income
area seautotollow aloas the at aide ot the Wl1lamette
IJ
40
R1ver the full length of Kultnomah County A second low
income area follows the south edge of the Columbia from
the northwest corner of Multnomah County easterly to 148 St
A third problem area seems to be on the east bank of the
Willamette River with the Union Pacific Railroad being
about the center of this tract The extreme loutheast
corner of Multnomah COUDty appears to be a low income area
but as this area bas bad rapid grouth in the last ten years
this could be erroneous
Mental Health
be first ~ecific indica to be selected from the
Multnomah County envirollllental survey of early 1971 and
to be considered in this paper i8 that of Mental Health
At the present for mental health purposes Multnomah
County is divided into five catchmentareas with a mental
health cl1n1cin each area These clinics are Model
Citles Delaunay ADkeny street Office Hansen Health
Building end Southeast Clinic
All lIlental health cl1n1cslcept statlstlcal information
on all patients visiting their cl1n1cs this included the
address of the patient hese addresses were then listed
upon the approprlate C8D8US tract Each census tract was
then ranked on a chart according to the nUllber of mental
health patients who reslde ln thatCeDSUS tract attending
any of the above listed ental health clinics This chart
IJ
41
wasttum d1v14ed1ato proper quartile bbullbullbull
quartile vereUs to dne10 u appropl1ate Multnoh
County _tal health ItLa middotmiddotmiddotthelipO~a1bl by lOoJcJIUE
at the UDtal health _to uteN1De which ueu have the
lars-t use otCOllDty 1alh~th faci11t1Rot
1Ilclu4ecl 111 tbia woUld tber otpeopleYia1t1Da
pr1vat patch1atriata aDd pr1_t _ntalhealtb cl1D1c8
WheDtbe M1 18Yienclmiddot Itmiddotmiddotmiddotmiddot~middotbe~_ tbat ~rtt
appears to lMt fourmiddotmiddot-al are iii _oil the nuaber ot
lIental healthcl1D1c na1t toM tbjh1sheat 1he
tour areaa woUld be tollows
1ttrea Ore to~Blo Drimiddot ~tb Burrus14e aDd tIMtmiddot Colb1a Riftr H1gbwyaeri1Dla th nortllra boundaryshy
2 bull ProII 82D4 1_~ 10 20th streetwitil the ra1lMd Mu the north ltouadary
3 ~ et et tUgl_b1bull MYel froamiddot the Clackaaa COUDty l1ae aorth to Dln8lon stret
4 beDOlvt1ttfe-t ~efllt4 COatytrca Jle1aware streetmiddot toR1C1a11oDd wlth Colubla Blvd heiDI tbAtnorth bouaclary_
It ODe coapareatbiap to th iDeobullbullmiddotp 1t can be
eamiddotthat lIOat ot the c tracts baY1Dg bllh v1i11tatlcma
middottfl public tal health cJ1rUc8 ~ 111 t13e low ~ aid
1DcOile SroupiDIOJa1y of til 25 tracta llsted as
haviDlbip aental Maltll nlltatlou are ~ the1g60 hip
iDeo arebullbullbull
17 Plpn
42
amily PlellnSDI ]Jlce Metal Health i8 an 1nd1ce of
use Theperson 111 ordertobavebe_ 1Dcluclecl 1n this
atu4ywouldhave tohaft Ue4 ataa11y plaDI cl1D1c
tacilities of soaetype It 41fter troll tile _tal health
study1nthat i t1Jicludestatist1catrollbotb public and
privateclJD1os
The iDformation tor the iak orurcbart 8Dd map of
t8ll111 plenn1 na ob1a1De4 by cOIIblnlDlthe mabel of
1rlcuv1duals bullbull_ attbe tbreellUltrampo-ti Coatyhll11y
PlalJQllIl C11ll10s 111til tbo at the Planned PareDthood
Association CliD1C8 be tbree -JIultDouh Couaty r8ldly
PlamSq Cl1D1c are Solrtbweatth Col_bla 1111- a114
HaDsell Health BWlcl1Dl CllD1cbi middot1Dtormat1oD vas then
bullbullbullesed tomiddot detellWMt l10w people troll eacb c8IUIUS
chart wastben Mele IUs oIIart jn 4iY1ded to show
the censuS tracts lIaYiDlmiddottIle h1t1iest qUart1le of incidence
of use lowest quartile of 1Qc1deao ot use Jlid 12 of
incidence of Wle an4 a map sprepared troll thts 1Dto~
mation
The C8U118 tractsbelOJISnl to the h1lhestquartile of
use appear to be 1lO~ 8catt~ on tbipwas true ot
either the _p ot aental health cl1D1c uaageor ot the map
abow1DI per capita 1I1COM Iaere40 to be three
d18t1nct areas of UIIaP beJ woul4 be
1
IJ
43
t10D of BurD81cl and the W11lallette River 4
2 S~t Portland 8Otth otmiddot the ra11shyrcaadand alona the W11lamette River
lIortbeaat Portl8D4 between MisSiss1pp1 and 24tbStreet the northbouBclary be1DgColwb1aBlvd
Pylzl1c BMltl IrpI Y11ta
Publlc Healtil nur81D1Y1s1t nclud8 an vists to
theholles of client by PubUc Health Nurbullbullbullbull his shows
visits to bull f8Jl1ly fer aDY purpos SUCh aatuberculolJ1s
het1Dl tem1tyaeatalu4 8IiOt10D8l cODd1t1ona etc
he atat18t1C~ 1fele C()4ed accord1Dg tomiddot the 1llli301fOCUS
of the Y18lt tt doe DOt 1D41cate the Dmlber of holies or
f8ll11lev181tecl or 1D41Y14ual Y1a1ted more tban oDcein
the propwl It dobullbull I1ve 80M 1D41cat1on by coaparlshy
OD ot the 8JIoUDt of aedlcal problema 1n eachcen8WI tract
Ap1nmiddot the _p abowa 8 scatter patteraof probl_
areas althoUSh there appear to be a sroup1Dl of hiSh J
l8aIeccmaus tract 1ntlut extreme southeast part of tbe
County other areu uIriaI any nura1Dl contacts are
1 bull he 801lth-oa-al CO1Dty on eaCh 814 of 82nd Av from Clackallaa County north to Dinloa
2 ear bullbullbullt 814e aroUDd Preacottand Misaisippi
Dowatom Bunul14eonboth 1de of the river
44
V_real Pis The iDfomatloil uaec1 to tabulate the Venereal
disease chart includes all the ooab1ned case otmiddotODormea
and syphilIs reported by bothmiddot publIc and prIvate physicIans
dur1nl 1970 There were 3602 caes ot IOnorrhea reported
dur1nl 1970 While ODly 17 cabullbullsot ayphilimiddot were reported
A chart was prepUed aDd att8llPt wasmiddotmiddot de tomiddot
determ1De Wh_therVttDereal 41ease was more p~vaJent in
areas othigb or lowmiddot proportIon ot youth hi waadone
bymiddotdetemlna a 1leaD prceiltacmiddotmiddotmiddottor the population ot
resld~ts UDder19 years ot (34) middotA mean ratemiddot per
100000 popUlatIon al80c1ttem1Ded tor the middotoccurreDCe
ot venereal dieae This was et at 390 oass Areas
hav1nl a population 1n which leiS than 34 were lmder 19
years ot ampIe were called low- yOuth abOve tbl percentaae
hiSh youth The aaa waatrue ot the occurrence oivenershy
eal disea_ per CeD8UStract It the rate waacomputed
as 1I0re than 390 cases per 100000 it was called hiah
venerealdiaeasei it less than thia tisure low venereal
disease It was tound that 1D Multn~ COmlty there sems
to be poSitive OOlatI0n(x21S19gt between low youth
and hipmiddot venereal diseaand hip youth and low venereal
diseasebull
RaDk ordr Iitot all c traot middottbAm made
Th1s was done byt1Ddlna the ratepr 100000 populatIon
of venereal disator all census tracts in the County bull
45
These were thenlisted from h1lhto low (sreatest to
least) in a rank order The l1sting was then divided
into Upperandlower 14 aDd listed on the MUltnomah
Countymiddot up
The areas of b1gh venereal disease se8ll18to
roup thBl~8 middotin a very tllht area ~oq both 1des
of thell18l8~ R1 w1th BurDaldeS~et being
~bout theceDter qf tbi8IZ9uping This area woUld
appear to be m ldeal spot for the denlopment of a
locallzed venereal d1sbullbullbullbull cl1D1c
UbepoundCUlO1s
In this report bull tube1C1llosls caS8S refrred
to include alltbobullbull cabullbulls ontubercUlo8is follow-up
rather middotthan just new C Accord1Ds to the Multnomah
County Health SUrvey of early 1971 this would include
all ca repOrte4 over thelaat three years The
total number of tuberculosi8 cabullbullbull usedin this study
was 666 lh1 included 128 new cabullbullbullbull
A rate per 100000 of tuberculosis for each
census tract wa- then computed and the c~us tracts
listed by rank order be b11h Qartlle mel low
quartl1 were then reoordd on a Multnomah CoUnty map
TWo genral areaa baY1Dg a hip mcldencaot tubercu~
losiare 1D41cated heyare
1 Both middotsld ot theWilla11lette River
Ll -
46
with Burns1de about thecnter
2 he extrea Northebullbullt comer of the County bull
By coap8r1ng the tuberculois an4ven8real
diseae maps ODe can 8ee that the downtown areas ot
hiSh 1nc1denceare alIIo8t 1c1eDt1cal on ach map
This WOuld 1nd1cate that 1t would be of value to
bullbulltab11sh acl1D1c 111 th1aampreatbat would provide
bothtuberCulos1s 8Dd ytmereal 418ase srvicbullbullbull
Thchart aDd 1181gt8 are wsfuln 11v1DI
1Ddicat10DS tor the type aDd placemeototlocal
health cl1n1c8 tbro1qhout tbe MultnomahCounty area
A cOllpar1on of the mapa help one to dec1dewhether
to provide a aulti-8ervice cl1D1c or spec1f1c type of
cliD1c As stated in Part I of thi paprserv1ces
shouldhaYe both treatlieDt and prfMmt10n cOmponents
As he been stated fta ne1lbborhood health care
Qenter muat be a fac111tY plazme4 with an aamesa
ot the neds of the consumer and the c01llll1m1tybull
Part II of this rport haa been an attaapt to indicate
and clarify 8011 ottheae coDlllUDity neds This has
been done through8elect10n of apc1f1c problems
The indic were then visuallyrecorded through the
use of ups and charta ODe dan asseS8 thedsreeof
1DIportance of certain concems to spec~t1c areaa by
comparinl the chart aDd maps Prom this oDeean
41 dec1de which are48 vb1chcUD1c-or indeed if
the need a clinic at all However further factors
should be considered hebullbull include
a The amount of fuDd1 available
b What 18 the percentage ot peopleineoh ceaaua tract tbat would actually us such cl1n1cIl
c Wbat 1 tbeco--1tymiddot 8 IeeliDashyreaardtDI particular cl1D1c8 Would this dcrebullbullbullmiddot the ettctiveness ot thse cl1n1ca
IJ
li
D_OlraphicPopulatLon Challie 1960 to 1970 48
Cen8U8 1 of Pop 1 Cbaqemiddot 1 Change1 ofPopTract Under 19 Yr8 Over 65 Yrs1960-70 1960-70
middot1Q701Q70
1 319 -12 171 -H) 1
2722 215-27 +68 301 366 -22 127 +35 302 371 +19 111 -04
311middot401 144-41 +29 402 321 13~7-39 +24 501 356 124-08 -02 5~O2 351 133-23 +12
405601 82-10 -02 394602 103-01 -06
701 275 149-76 +56 702 361 +01 121 -07
+10middot801 326 140-22 802 321 middot127
(
-29 -03 9~01 342 124 -H) 6-18 902 294 128 -H) 3-24
10middotmiddot -14312 140 -17 1101 182 +25 -23197
2411102 186-59 +29 1201 226 169-17 -41
31middot01202 +11 182 -05 295 -H) 81301 208 -H) 4
1302 331 +08 197 +04
14 323 +15 middot185 -08 middotmiddot15 329 +16 16~5 -13
-28middot 1601 332 131 +12
1602 356 98 +24middot-39 middot3101701 161-33 +21
1702 370 -15 85 +02 +19 1801 264 151middot-50
185middot1802 256 +47-58
IJ ~
D_raphlc Population Change 1960 to 1970middot 49 (Contd)
4io
Census Tract
of pop Uncter 19 Yra
1Q1n
1Cha1l8e 1960-70
of PopOver 65 Yra
lQO Change
1960-70
19 389 +29 141 -24 20 223 -13 206 +18
21 227 +08 194 -36 2201 356 -27 112 +05
2202 290 -18 ll~9 -29 2301 356 -03 154 +24 2302 260 -37 245 +97
2401 410 +6~1 123 -31 2402 163 -80 320 +99 2501 381 +13 140 -01 25()2 237 31 lil +02 26 343 +25 186 +149 2701 370 +29 1S5 -01 2702 249 -44 304 +98 2801 337 +19 187 +09 2802 306 -10 156 +31 2901 304 -38 142 +24 2902 i 307 -32 146 t3~9
30 29~0 -48 16~2 +51
31 355 +30 160 +01 32 370 +48 148 -13 3301 395 +45 130 -20 3302 368 +06 138 -02 3401 386 +16 117 000
3402
400 +32 92 -26 3501 304 -07 115 +35
3502 344 000 140 -13
3601
36~02 357 -04 132 +32
3603 30~1 42 149 -67 3701 342 +28 152 +19
1
IJ
Jianolraphic Population Chan 1960 to 1970 50 (Contd)
Census Tract
of Pop Under 19 Yrs
JJl7J
middotChanae 1960-70
middotofmiddotpop Over 65 Yrs
1c~7n
Change 196070
3702 409 +39 122 -11 3801 308 -11 151 +29 3802 275 -35 180 +46 3803 282 -32 192 +54 3901 376 ~13 100 +17 3902 296 -03 177 +29 4001 438 -11 84 +13 4002 353 -21 115 +20
4101 397 11 9middot0 +11 4102 346 -19 120 +03 42 331 +19 11 bull 3 -16 43 347 -72 105 +31 44 113 +84 183 +154 4S 33~9 +07 110 -06 4601 2501 22 193 +38 4602 332 +59 126 -29 47middot 161middot 000 211 +01 48 103 -26 302 +59 49 138 +1 bull 3 252 +09 50 141 -26 204 -12 51 12 -39 257 +07 52 47 -61 351 +48 53 89 +49 314 -30 54 25 l1li15 327 -17 55 131 -17 115 -121 56 198 +93 227 -47 57 71 102 189 -88 58 240 ~middot41 16~1 +55 59 322 +25 142 +06middot 6001 264 95 132 +50
6002 328 -31middot 89 +07
JJ
Demographic Population Change 1960 to 1970 51 (Contd)
Census 1 ofPop lChange of Pop bull ChangeTract Under 19 Yrbullbull 1960-70 Over 65 Yrs 1960-70
1970 1970
61 355 -58 85 +39
62 328 39 110 +18
63 414 04 73 10
64 382 -22 72 +04
6501 383 02 67 -20
6502 329 -56 96 +09
6601 391 +13 88 -03
6602 319 -59 97 +06
6701 327 71 145 +72
6702 331 ~67 83 +1-0
6801 365 -66 49 +01
6802 388 4bull3 54 +06
69 354 -41 80 +23
70 400 -23 68 -06
71 359 -48 72 +05
72 255 -88 82 +11
73 346 -39 91 +25
74 313middot -63 105 +24
75 329 -42 129 +37
76 336 -52 85 +21
77 370 -10 69 +05
78 309 -10 120 +21
79 325 -56 87 +10
8001 358 -81 57 +12
8002 391 ~81 76 +12
81 315 -76 108 +21
8201 403 -23 64 +08
8202 392 23 65 +08
83 357 -34 120 +31
84 402 -18 73 +16
85 413 -06 76 -09
r
Demographic Population Change 1960 to 1970 52 (Contd)
Census Tract
t of Pop Uncler 19 Yrs
1970
Change 1960-70
1 of Pop OVer 65 Yrs
1970
ex Change 196070
86
87
88
89
90
91 9201
9202
93
94
95
9601
9602
9701
9702
9801
9802
99
100 I
101
102
103
10401
10402
lOS
368
351
379
391
391
413
379
433
372
429
414
432
419
439
~32
377
457 420
378 41middot7
345
360 417
417
412
-04
-02
-35
-26
-28
-11
-64
-20
-S9
-39
-32
-21
-34
-40
-47
-lO~7middot
-27middot +04
+56
+07
-34 01
+04
+04
+10
103
128
97
11il3 99
69
79
42
77
46
34 38
44
40
54
111
51middot
81
133
59
74
140
63
87
76
-08
-06
+04
+08
+17
-05
+3S -02
+1~4
+19
+33
-14
-08
+12
+26
+71
+11
-16 -34
-20
-19 +37
-49
-2S +15
NOte The The
Taken frOi
averageullder averageabove
middotUSCensus ---shy -
19 years == 6S years ==
figures 197
32r 13(14
p a~d 1960
--
Rank
1
2
3
4
5
6
7
8
9
10
11 12 -_
13
14
15
16
17
18
Tract
69 46
60
58
- 68
61
302
2501
67
63
19
62
26
94
3603
3902
64
30 -----~-
Rank
19
20
21 -
22
23-shy
24
25
26
27
28
29
30
31
32
33
34
35
36 -
Ranking of Per Capita Income by Census Tract
Tract
65
2701
- 15
1601
701
66
93
82
2903
3602
30
2502
80
2401
81
- 70
91 shy
4001
High
Rank Tractshy
-32shy37
38 97
120239
7840
41 ~ _2_1__ 42 31
43 2501
44 18
45 98
46 37
47 3803
1702
49
48
1602 92 2702
I
50 89
51 901
52 801
Ra_
53
54
55
56
57
58
59
60
61
62
63
64
6S
66
67
68
TractTract Ra~
74692
170196 70 I
401 71 90
72 1037J
79 70273
3802 74 601
24024102 75
85 76 101
77 9023901
7699 78 100 4101 79
3601 I
380180
458140~ t---- _ - - shy83 82 42
888384
59843501
4777 8~
502
Low
802 86
Rank Tract
87 shy
--88
89
90
91
92
93
94
- 95
96
97
middot98
99
100
101
102
103
104
1201
14
49
72
73
43
87
3502
105
1
52
86
71
1
501
10
3301
104 tf
Rank
105
106
107
108
109
110
III
112
113
114
115
116
117
118
119
120
121
Ranking of Per Capitalucoae by Census Tract
(Contd)
Tract Rank
4001 122--shy602
13
1102 2302
3302
55
3401
48
21
56
50
3402
lL01
2202
2301
53
2201
-shy
Tract Rank Tract Rank T~aet Rank
57 I-----
Imiddote
bull
Tract
- Low -k Note Information taken from 1960 U SCensus
Rank Tract
I ~
Ie
Imiddot
~
----
----
--
--
Rank
1
2
3
4
5
6
1
8
9
10
11
i-
-Tract
391 922 921
972 971
100
132 131 121
962 961
822 821 401
982 981
20 111
47 10 1
412
High
Total Number of Henta1 Health Visits
Ranked by Census Tract High to Low
TractTract RankTractRank Rnk
12 182 22 78 29 87 76 381 73181 ~------- 1913 371 8538230162372 271 2616-121 8272 2
14 80~2 31 94 7923 84801 59 15251362 4232 15 52 _ 32 103 8924 651 17240216 652
_ 91 351 33 341 23117 83 122 25 25 48 1123921418 34 shy61 86 661
19 662 6493 81 26 91 8153 49 50 55 41383 71 27 51 3120 90 672241 35shy 104167162 461
I 411 46211121 28 88342 I
2502 36 69 54 5251 50 272
-Ra
37
38
39
_ 40
_ 41 Ishy
I
42 I
-I 43 44
45
shy
Tract
~ --- shy 95 56
45 292 242
102 62 352 291y
92
101 281
99 72 63 601 60~ 42 2201
77 74 61 57
363 232
70
32 31
11 44 282 2202
Low l
- Tract
46 682 681 I 331 30
r~$ 47 1042 332
48 102_41_
11
~
Visits to Family Planning Clinics Ranked by Census Tract High to Low
Rank Tract Rank Tract Rankmiddot Tract Rank Tract Rank Tract Rank Tract
1
2
3
4
5
6
7
8
9
10
11
12
13middot
14
15
16
17
361
56
401
341
48
59 121
20
55
342
10
31
58
93 21
241 132
331
53
461 462
18
19
20-shy21
22
23
24
25
26
27middot
28
29
30
31
32
33
391
32
middot47 I-i-_-shy _ -
231 111
332
972 1
372 371
52
89
32
92
82
100 31
182
30 242
402
34
35
36
37
38
39
40
41
42
43
44
45
42
1714 i 661 221
78 362 2
90 602 601 352
63 251
105 921
971 351
73 42 292 232
411 51
662
81 45 52
46
47
48
49shy
50
51
52
53
54
55
56
961
801
49 81 72 71
19
9~1
172
68 2 57 162 14 112
91 75 681
381 42
3~3
83 161
57 f
58
59
60
61shy
62 Imiddot
63
Imiddot 64
65
66
64 62 36~3 252
74 652 SO 392 291
651 6bull 2
79 271
r-- ---- shy981 222
672 671
821 272
94 87
281
382
67
68
69
70
71
72
73
74
75
76
77
78
981 26 12~2
IS 61
85 82~2 69
61 43
101 86 84 282
76
131
51 72
1041 962 88 70
99 922 77
103
95 802 181
i
~
Low High
RankRank Tract
5479
4480
81 1042 ~) middot102
71 - - + ~ - ~
Visits to Family Planning Clinics
(Contd)
Tract Rank
I
Tract llaDk l
RankTract Tract Rank Tract
~
I
~
J1 ~
Low
Total Number of public Health Nursing Visits
Ranked by Census TractsHigh to Low
TractTract RankTractRank RankRank TractTractRankTractRank
25249 71 79 17249 8033 6586 99189711 84 2915072 34 661 76 66 811519512
402 5035 51 161 2518220 122 1713423 352 55801 7120 6752 2 149814 41236 83 2662 38 94 6821 53 2924015 362 37 32 42 75 69 281 84 63
546 8822 54 222 85 3925431 70383417 3818223 6439 4386652 718 21 55 103332 8924 232 87 19 271729219619 24156 16211140 382 628825 10523110 112 73411 10141-- ----shy 89 363 4457 8126 16111 221 74 9142 90 46158331 53 671279012 46243 48 59 351 3837528 1083 9313 91 5844 59 -_242 76 1----- shy60 272 72 74104114 60145 42 9287 7729 92 6151 8215 57371 934630 91 307762 12113116 282 619447 41391 9531 78100 63 7378 ~95 681 6945 32 5632 798517 6448 47 52 181
High ~ Low
Rank Tract Rank
96 31 132 70
97 102
98 182 372middot 602 651 662
- -shy
~72 682 802
822 922 962 972 982
1042 ----shy
Low
Total Number of Public Health Nursing Visits
(Contd)
Rank Rank Rank TractTract Tract
I
I lt
I
Tract Rank Tract
[
~~~-
I
~
IJilfimiddot ~
j
Ranking of VD Caea According to Census Tracts 61 By High and LOll Youth Itatio
A media~ of 34 5 was determined Any tract having greater
than 34 5~ of popu1tionunde~ 19 years of age -High~
Any tract having l8S than 345 of population under 19
years == Low
Any tract having rate less than 390 =Low
Any tract having rate more than 390 == HLgl4
YOUTH
LOW HIGH
L
0
12 402 1801 1802 343 2801 2802 29023603
54 6001 600262 66~02 72 74 75 76
78 79 81 t02 65 1202
W
(25)
VD
H
I
G
H
401 701 801802 901 902 10 1101 241 1201 1301 132 14 15 1601 1701 20~ 21 2202 2j02 2402 2502 2702 2901 303501 3502 34023801 3802 383 3902 42 44 45 4601 4602 47 48 49 SO 51~2 53 55 56 57 58 S9 6701 6702 73 95
3~02 7021702 19 25~01 2701 4102 4101 63 64601 ~601 6801 680270 7l 77 8001 80~02 8201 8202 83 84
85 86 87 88~ 90 91 9202 920193 94 9601 9602~ 9701 9102 9801 9802 99 100 101 103 10402 105 6501 10401
(47)
301 501 502 601 1602 2401 2301 2201 31 32 3301 3302 3401 3402~ 3602 3702 3901 400140 02 43 61 69 B(
(53) (23)
~ ~gt
Ranking of VD by Rate Per 100000 By Census Tract
~
Rank Tract Rank Tract Rank Tract Rank Tract llank Tract Rank Tract Rank Tract
1 2202 21 S6 40 902 58 1602 74 75
90-shy 64 107 26 --~-
2 3402 22 45 41 10 59 902 75 78 91 54 108 61
3 2301 23 3502 42 2502 60 602 76 6802 92 402 109 87
4 3302 24 49 43 1102 61 501 17 2 93 94 110 90
5 50 25 52 44 6702 62 14 78 8202 94 97 02 III 76
6 2201 26 20 6701 63 4002 8201 2501
9701 41~02 112 91
7 44 27 48 45 401 64 3802 2902 95 63 113 62
8 3301 28 1701 46 502 65 30 79 83 74 96 9602 114 71
9 55 29 47 47 42 66 3803 80 2801 96Q1 115 85 10
11
12
13
14
15
16
17
18
3401
53
2302
2401
57
21
2402
1101
51
30-shy31
32
33
34
35
36
37
3701 - -~ 1201
3702
89
43
132 131
3602
4001
48
49
50
51
52
53
54
55
58
1601
601
4602 4601
69
701
31
3901
67
68
69
70
71
72
2901
801
39021~ 802
6502 6501 122
702
41~01
81
82
83
84
85
86
87
88
19
1
1702
2802
79
93
100 6801 6602
81
97
98
99
100
101
102
103
104
9201 9202
9802 9801
77
302
79
86
72
84
116
117
118
119
120
121
3603
8002 8001
101
99
95
10401
105 10402 103 102
19
20
59
32
38
39
2702
3501
56
57
301
3801
73 1802 1801
89 6002 6001
105
106
2701
88
High Low
-- -----
Rank OrdermiddotTuberclosis Cases by Rate Per 100000 Ranked by Census Tract High to Low
Tract TractRankTractRank Rank TractRaukTractRankTractRank
801
79 9601501411 52 6835340120511 I 960269 903603532036 $-~~F130221542 4366 311301 70 68~013802 _ I- _ 4001_37213 3921201 6802802 H71523822024 22 54 193302 3802 80 8958 I37139535 70155 9801 I60123 72 6702 98023914011016 6701250124 10 56
81 94 401r 7 154152 73 7057 2625 122 92028
90242 162312301 92~158 86 7172434526509 82 79160159 74 100 87412240227220110 6502836960 75 30 8317244 6501782801285711 61 901 42765645 84 66021459294912 9701 660146 171 302 9702 47
6235023033113 85 822821182 917755 16335013110214 841814832 78 103 938564 324815 86 1057940149272 38036523216 10401 87 2902241 725Q 10402360266340217middot IF88 88 9937233 282 51 218 101 01102 46016234
I)167 2901460219 47
High ~ Low ~
- -
TractRank
9S89
6490
8191 8001 8002
63 61 60middot01 6002 44 2701
92
J
2502 402 --- ----shy
I
Rank
Rank Order Tuberculosis Cases by Rate per 100000
(Coutd)
Tract Rank Tract ~nk
I
Tract Ballk Tract Rank
Imiddot
Tract
Imiddot
1~
t 1I i Pi i l I
o
1 -1shyL I
I J
8 40 icO ~ I -lt 0
-t (1) I
i I
r o E
II
a
I
r--i
shy
I
~
I (
Jgt
(011 fi(
Ggt
I II ~j
()
(f 0
~ ()
I
11
f9
r
II 99
o ~
Ggt r
~ __-J~ I t I ~ I
r--J l I
~ _ __ J
) 1
fTl
1gt
r I
()
r
()
lt en -i en
()
I1l
(J)
(J)
-i
P ()
19
r o ~
r G1 I
I
c
~
o I 89
--- -I-shy
r-r I
1- 0 _~ _ _--J E
G1 I I I
i i
I 1-1-1 ~ _J ~2 ~ II
II
()
1 I I I 1
id i bullbull
~
A n 69
r 1shy
- 0 Gl
l--~ ~ I
~ II
II )
I () isect i
en l i
(J)
-t
0
IA Ol
IJ
39
of lowiDcome would not 11kel~be 8erved more by localized
cl1D1cs tbaD would are of hilbincome It 18 likely
people haYiq a hip iDeoll8would preter to be aeenby a
chosen ~r1vatephylc1a1l tban at a local cl1D1cwhere
10Dier waits y beraceaaampryand leas personal attention
gl_
The 19701ncOII81atoWampt10n tor MultnomahC~ty was
not available at the tille thi8report W88 made The 1Dto~shy
tiOD Was taken ~adtro tbe1960 census publlcation
his woUld ~8Il thea tbat ral1I8 OD the chart ynot 1raquoe
completely accurate hi writer telthatthe areas most
affected by tb8 1I8eof the older 1Dco1DtOlaat1oDWOuld be
those tracts wh1ch baYebad a rapid 1ncreaae1n populatlon
over the past tfmyHr8 bullbullbull tracts would include tracts
nUmbered 104 9897 96 aDd 95 be perc~ita 1Dcome
referredto1il-tb1a Paper18the lIean 1DCo per person per
census tract
Attar the iDeoeper census tract was listed on a chart
a map was de 1D41catiDg those census tracts belonging to
the lower 14 ot income tor all censue tracts in Multnomah
COlDltytbose beloqins to the upper 14 ot income tor all
census tract 111 MultnolUlhCounty and those belonging to
the mid 12 ot 1I1coaetor all oeuuetracts in Multnomah
C01mty
In yiew1Dg the _p 1t caa be seen that the low income
area seautotollow aloas the at aide ot the Wl1lamette
IJ
40
R1ver the full length of Kultnomah County A second low
income area follows the south edge of the Columbia from
the northwest corner of Multnomah County easterly to 148 St
A third problem area seems to be on the east bank of the
Willamette River with the Union Pacific Railroad being
about the center of this tract The extreme loutheast
corner of Multnomah COUDty appears to be a low income area
but as this area bas bad rapid grouth in the last ten years
this could be erroneous
Mental Health
be first ~ecific indica to be selected from the
Multnomah County envirollllental survey of early 1971 and
to be considered in this paper i8 that of Mental Health
At the present for mental health purposes Multnomah
County is divided into five catchmentareas with a mental
health cl1n1cin each area These clinics are Model
Citles Delaunay ADkeny street Office Hansen Health
Building end Southeast Clinic
All lIlental health cl1n1cslcept statlstlcal information
on all patients visiting their cl1n1cs this included the
address of the patient hese addresses were then listed
upon the approprlate C8D8US tract Each census tract was
then ranked on a chart according to the nUllber of mental
health patients who reslde ln thatCeDSUS tract attending
any of the above listed ental health clinics This chart
IJ
41
wasttum d1v14ed1ato proper quartile bbullbullbull
quartile vereUs to dne10 u appropl1ate Multnoh
County _tal health ItLa middotmiddotmiddotthelipO~a1bl by lOoJcJIUE
at the UDtal health _to uteN1De which ueu have the
lars-t use otCOllDty 1alh~th faci11t1Rot
1Ilclu4ecl 111 tbia woUld tber otpeopleYia1t1Da
pr1vat patch1atriata aDd pr1_t _ntalhealtb cl1D1c8
WheDtbe M1 18Yienclmiddot Itmiddotmiddotmiddotmiddot~middotbe~_ tbat ~rtt
appears to lMt fourmiddotmiddot-al are iii _oil the nuaber ot
lIental healthcl1D1c na1t toM tbjh1sheat 1he
tour areaa woUld be tollows
1ttrea Ore to~Blo Drimiddot ~tb Burrus14e aDd tIMtmiddot Colb1a Riftr H1gbwyaeri1Dla th nortllra boundaryshy
2 bull ProII 82D4 1_~ 10 20th streetwitil the ra1lMd Mu the north ltouadary
3 ~ et et tUgl_b1bull MYel froamiddot the Clackaaa COUDty l1ae aorth to Dln8lon stret
4 beDOlvt1ttfe-t ~efllt4 COatytrca Jle1aware streetmiddot toR1C1a11oDd wlth Colubla Blvd heiDI tbAtnorth bouaclary_
It ODe coapareatbiap to th iDeobullbullmiddotp 1t can be
eamiddotthat lIOat ot the c tracts baY1Dg bllh v1i11tatlcma
middottfl public tal health cJ1rUc8 ~ 111 t13e low ~ aid
1DcOile SroupiDIOJa1y of til 25 tracta llsted as
haviDlbip aental Maltll nlltatlou are ~ the1g60 hip
iDeo arebullbullbull
17 Plpn
42
amily PlellnSDI ]Jlce Metal Health i8 an 1nd1ce of
use Theperson 111 ordertobavebe_ 1Dcluclecl 1n this
atu4ywouldhave tohaft Ue4 ataa11y plaDI cl1D1c
tacilities of soaetype It 41fter troll tile _tal health
study1nthat i t1Jicludestatist1catrollbotb public and
privateclJD1os
The iDformation tor the iak orurcbart 8Dd map of
t8ll111 plenn1 na ob1a1De4 by cOIIblnlDlthe mabel of
1rlcuv1duals bullbull_ attbe tbreellUltrampo-ti Coatyhll11y
PlalJQllIl C11ll10s 111til tbo at the Planned PareDthood
Association CliD1C8 be tbree -JIultDouh Couaty r8ldly
PlamSq Cl1D1c are Solrtbweatth Col_bla 1111- a114
HaDsell Health BWlcl1Dl CllD1cbi middot1Dtormat1oD vas then
bullbullbullesed tomiddot detellWMt l10w people troll eacb c8IUIUS
chart wastben Mele IUs oIIart jn 4iY1ded to show
the censuS tracts lIaYiDlmiddottIle h1t1iest qUart1le of incidence
of use lowest quartile of 1Qc1deao ot use Jlid 12 of
incidence of Wle an4 a map sprepared troll thts 1Dto~
mation
The C8U118 tractsbelOJISnl to the h1lhestquartile of
use appear to be 1lO~ 8catt~ on tbipwas true ot
either the _p ot aental health cl1D1c uaageor ot the map
abow1DI per capita 1I1COM Iaere40 to be three
d18t1nct areas of UIIaP beJ woul4 be
1
IJ
43
t10D of BurD81cl and the W11lallette River 4
2 S~t Portland 8Otth otmiddot the ra11shyrcaadand alona the W11lamette River
lIortbeaat Portl8D4 between MisSiss1pp1 and 24tbStreet the northbouBclary be1DgColwb1aBlvd
Pylzl1c BMltl IrpI Y11ta
Publlc Healtil nur81D1Y1s1t nclud8 an vists to
theholles of client by PubUc Health Nurbullbullbullbull his shows
visits to bull f8Jl1ly fer aDY purpos SUCh aatuberculolJ1s
het1Dl tem1tyaeatalu4 8IiOt10D8l cODd1t1ona etc
he atat18t1C~ 1fele C()4ed accord1Dg tomiddot the 1llli301fOCUS
of the Y18lt tt doe DOt 1D41cate the Dmlber of holies or
f8ll11lev181tecl or 1D41Y14ual Y1a1ted more tban oDcein
the propwl It dobullbull I1ve 80M 1D41cat1on by coaparlshy
OD ot the 8JIoUDt of aedlcal problema 1n eachcen8WI tract
Ap1nmiddot the _p abowa 8 scatter patteraof probl_
areas althoUSh there appear to be a sroup1Dl of hiSh J
l8aIeccmaus tract 1ntlut extreme southeast part of tbe
County other areu uIriaI any nura1Dl contacts are
1 bull he 801lth-oa-al CO1Dty on eaCh 814 of 82nd Av from Clackallaa County north to Dinloa
2 ear bullbullbullt 814e aroUDd Preacottand Misaisippi
Dowatom Bunul14eonboth 1de of the river
44
V_real Pis The iDfomatloil uaec1 to tabulate the Venereal
disease chart includes all the ooab1ned case otmiddotODormea
and syphilIs reported by bothmiddot publIc and prIvate physicIans
dur1nl 1970 There were 3602 caes ot IOnorrhea reported
dur1nl 1970 While ODly 17 cabullbullsot ayphilimiddot were reported
A chart was prepUed aDd att8llPt wasmiddotmiddot de tomiddot
determ1De Wh_therVttDereal 41ease was more p~vaJent in
areas othigb or lowmiddot proportIon ot youth hi waadone
bymiddotdetemlna a 1leaD prceiltacmiddotmiddotmiddottor the population ot
resld~ts UDder19 years ot (34) middotA mean ratemiddot per
100000 popUlatIon al80c1ttem1Ded tor the middotoccurreDCe
ot venereal dieae This was et at 390 oass Areas
hav1nl a population 1n which leiS than 34 were lmder 19
years ot ampIe were called low- yOuth abOve tbl percentaae
hiSh youth The aaa waatrue ot the occurrence oivenershy
eal disea_ per CeD8UStract It the rate waacomputed
as 1I0re than 390 cases per 100000 it was called hiah
venerealdiaeasei it less than thia tisure low venereal
disease It was tound that 1D Multn~ COmlty there sems
to be poSitive OOlatI0n(x21S19gt between low youth
and hipmiddot venereal diseaand hip youth and low venereal
diseasebull
RaDk ordr Iitot all c traot middottbAm made
Th1s was done byt1Ddlna the ratepr 100000 populatIon
of venereal disator all census tracts in the County bull
45
These were thenlisted from h1lhto low (sreatest to
least) in a rank order The l1sting was then divided
into Upperandlower 14 aDd listed on the MUltnomah
Countymiddot up
The areas of b1gh venereal disease se8ll18to
roup thBl~8 middotin a very tllht area ~oq both 1des
of thell18l8~ R1 w1th BurDaldeS~et being
~bout theceDter qf tbi8IZ9uping This area woUld
appear to be m ldeal spot for the denlopment of a
locallzed venereal d1sbullbullbullbull cl1D1c
UbepoundCUlO1s
In this report bull tube1C1llosls caS8S refrred
to include alltbobullbull cabullbulls ontubercUlo8is follow-up
rather middotthan just new C Accord1Ds to the Multnomah
County Health SUrvey of early 1971 this would include
all ca repOrte4 over thelaat three years The
total number of tuberculosi8 cabullbullbull usedin this study
was 666 lh1 included 128 new cabullbullbullbull
A rate per 100000 of tuberculosis for each
census tract wa- then computed and the c~us tracts
listed by rank order be b11h Qartlle mel low
quartl1 were then reoordd on a Multnomah CoUnty map
TWo genral areaa baY1Dg a hip mcldencaot tubercu~
losiare 1D41cated heyare
1 Both middotsld ot theWilla11lette River
Ll -
46
with Burns1de about thecnter
2 he extrea Northebullbullt comer of the County bull
By coap8r1ng the tuberculois an4ven8real
diseae maps ODe can 8ee that the downtown areas ot
hiSh 1nc1denceare alIIo8t 1c1eDt1cal on ach map
This WOuld 1nd1cate that 1t would be of value to
bullbulltab11sh acl1D1c 111 th1aampreatbat would provide
bothtuberCulos1s 8Dd ytmereal 418ase srvicbullbullbull
Thchart aDd 1181gt8 are wsfuln 11v1DI
1Ddicat10DS tor the type aDd placemeototlocal
health cl1n1c8 tbro1qhout tbe MultnomahCounty area
A cOllpar1on of the mapa help one to dec1dewhether
to provide a aulti-8ervice cl1D1c or spec1f1c type of
cliD1c As stated in Part I of thi paprserv1ces
shouldhaYe both treatlieDt and prfMmt10n cOmponents
As he been stated fta ne1lbborhood health care
Qenter muat be a fac111tY plazme4 with an aamesa
ot the neds of the consumer and the c01llll1m1tybull
Part II of this rport haa been an attaapt to indicate
and clarify 8011 ottheae coDlllUDity neds This has
been done through8elect10n of apc1f1c problems
The indic were then visuallyrecorded through the
use of ups and charta ODe dan asseS8 thedsreeof
1DIportance of certain concems to spec~t1c areaa by
comparinl the chart aDd maps Prom this oDeean
41 dec1de which are48 vb1chcUD1c-or indeed if
the need a clinic at all However further factors
should be considered hebullbull include
a The amount of fuDd1 available
b What 18 the percentage ot peopleineoh ceaaua tract tbat would actually us such cl1n1cIl
c Wbat 1 tbeco--1tymiddot 8 IeeliDashyreaardtDI particular cl1D1c8 Would this dcrebullbullbullmiddot the ettctiveness ot thse cl1n1ca
IJ
li
D_OlraphicPopulatLon Challie 1960 to 1970 48
Cen8U8 1 of Pop 1 Cbaqemiddot 1 Change1 ofPopTract Under 19 Yr8 Over 65 Yrs1960-70 1960-70
middot1Q701Q70
1 319 -12 171 -H) 1
2722 215-27 +68 301 366 -22 127 +35 302 371 +19 111 -04
311middot401 144-41 +29 402 321 13~7-39 +24 501 356 124-08 -02 5~O2 351 133-23 +12
405601 82-10 -02 394602 103-01 -06
701 275 149-76 +56 702 361 +01 121 -07
+10middot801 326 140-22 802 321 middot127
(
-29 -03 9~01 342 124 -H) 6-18 902 294 128 -H) 3-24
10middotmiddot -14312 140 -17 1101 182 +25 -23197
2411102 186-59 +29 1201 226 169-17 -41
31middot01202 +11 182 -05 295 -H) 81301 208 -H) 4
1302 331 +08 197 +04
14 323 +15 middot185 -08 middotmiddot15 329 +16 16~5 -13
-28middot 1601 332 131 +12
1602 356 98 +24middot-39 middot3101701 161-33 +21
1702 370 -15 85 +02 +19 1801 264 151middot-50
185middot1802 256 +47-58
IJ ~
D_raphlc Population Change 1960 to 1970middot 49 (Contd)
4io
Census Tract
of pop Uncter 19 Yra
1Q1n
1Cha1l8e 1960-70
of PopOver 65 Yra
lQO Change
1960-70
19 389 +29 141 -24 20 223 -13 206 +18
21 227 +08 194 -36 2201 356 -27 112 +05
2202 290 -18 ll~9 -29 2301 356 -03 154 +24 2302 260 -37 245 +97
2401 410 +6~1 123 -31 2402 163 -80 320 +99 2501 381 +13 140 -01 25()2 237 31 lil +02 26 343 +25 186 +149 2701 370 +29 1S5 -01 2702 249 -44 304 +98 2801 337 +19 187 +09 2802 306 -10 156 +31 2901 304 -38 142 +24 2902 i 307 -32 146 t3~9
30 29~0 -48 16~2 +51
31 355 +30 160 +01 32 370 +48 148 -13 3301 395 +45 130 -20 3302 368 +06 138 -02 3401 386 +16 117 000
3402
400 +32 92 -26 3501 304 -07 115 +35
3502 344 000 140 -13
3601
36~02 357 -04 132 +32
3603 30~1 42 149 -67 3701 342 +28 152 +19
1
IJ
Jianolraphic Population Chan 1960 to 1970 50 (Contd)
Census Tract
of Pop Under 19 Yrs
JJl7J
middotChanae 1960-70
middotofmiddotpop Over 65 Yrs
1c~7n
Change 196070
3702 409 +39 122 -11 3801 308 -11 151 +29 3802 275 -35 180 +46 3803 282 -32 192 +54 3901 376 ~13 100 +17 3902 296 -03 177 +29 4001 438 -11 84 +13 4002 353 -21 115 +20
4101 397 11 9middot0 +11 4102 346 -19 120 +03 42 331 +19 11 bull 3 -16 43 347 -72 105 +31 44 113 +84 183 +154 4S 33~9 +07 110 -06 4601 2501 22 193 +38 4602 332 +59 126 -29 47middot 161middot 000 211 +01 48 103 -26 302 +59 49 138 +1 bull 3 252 +09 50 141 -26 204 -12 51 12 -39 257 +07 52 47 -61 351 +48 53 89 +49 314 -30 54 25 l1li15 327 -17 55 131 -17 115 -121 56 198 +93 227 -47 57 71 102 189 -88 58 240 ~middot41 16~1 +55 59 322 +25 142 +06middot 6001 264 95 132 +50
6002 328 -31middot 89 +07
JJ
Demographic Population Change 1960 to 1970 51 (Contd)
Census 1 ofPop lChange of Pop bull ChangeTract Under 19 Yrbullbull 1960-70 Over 65 Yrs 1960-70
1970 1970
61 355 -58 85 +39
62 328 39 110 +18
63 414 04 73 10
64 382 -22 72 +04
6501 383 02 67 -20
6502 329 -56 96 +09
6601 391 +13 88 -03
6602 319 -59 97 +06
6701 327 71 145 +72
6702 331 ~67 83 +1-0
6801 365 -66 49 +01
6802 388 4bull3 54 +06
69 354 -41 80 +23
70 400 -23 68 -06
71 359 -48 72 +05
72 255 -88 82 +11
73 346 -39 91 +25
74 313middot -63 105 +24
75 329 -42 129 +37
76 336 -52 85 +21
77 370 -10 69 +05
78 309 -10 120 +21
79 325 -56 87 +10
8001 358 -81 57 +12
8002 391 ~81 76 +12
81 315 -76 108 +21
8201 403 -23 64 +08
8202 392 23 65 +08
83 357 -34 120 +31
84 402 -18 73 +16
85 413 -06 76 -09
r
Demographic Population Change 1960 to 1970 52 (Contd)
Census Tract
t of Pop Uncler 19 Yrs
1970
Change 1960-70
1 of Pop OVer 65 Yrs
1970
ex Change 196070
86
87
88
89
90
91 9201
9202
93
94
95
9601
9602
9701
9702
9801
9802
99
100 I
101
102
103
10401
10402
lOS
368
351
379
391
391
413
379
433
372
429
414
432
419
439
~32
377
457 420
378 41middot7
345
360 417
417
412
-04
-02
-35
-26
-28
-11
-64
-20
-S9
-39
-32
-21
-34
-40
-47
-lO~7middot
-27middot +04
+56
+07
-34 01
+04
+04
+10
103
128
97
11il3 99
69
79
42
77
46
34 38
44
40
54
111
51middot
81
133
59
74
140
63
87
76
-08
-06
+04
+08
+17
-05
+3S -02
+1~4
+19
+33
-14
-08
+12
+26
+71
+11
-16 -34
-20
-19 +37
-49
-2S +15
NOte The The
Taken frOi
averageullder averageabove
middotUSCensus ---shy -
19 years == 6S years ==
figures 197
32r 13(14
p a~d 1960
--
Rank
1
2
3
4
5
6
7
8
9
10
11 12 -_
13
14
15
16
17
18
Tract
69 46
60
58
- 68
61
302
2501
67
63
19
62
26
94
3603
3902
64
30 -----~-
Rank
19
20
21 -
22
23-shy
24
25
26
27
28
29
30
31
32
33
34
35
36 -
Ranking of Per Capita Income by Census Tract
Tract
65
2701
- 15
1601
701
66
93
82
2903
3602
30
2502
80
2401
81
- 70
91 shy
4001
High
Rank Tractshy
-32shy37
38 97
120239
7840
41 ~ _2_1__ 42 31
43 2501
44 18
45 98
46 37
47 3803
1702
49
48
1602 92 2702
I
50 89
51 901
52 801
Ra_
53
54
55
56
57
58
59
60
61
62
63
64
6S
66
67
68
TractTract Ra~
74692
170196 70 I
401 71 90
72 1037J
79 70273
3802 74 601
24024102 75
85 76 101
77 9023901
7699 78 100 4101 79
3601 I
380180
458140~ t---- _ - - shy83 82 42
888384
59843501
4777 8~
502
Low
802 86
Rank Tract
87 shy
--88
89
90
91
92
93
94
- 95
96
97
middot98
99
100
101
102
103
104
1201
14
49
72
73
43
87
3502
105
1
52
86
71
1
501
10
3301
104 tf
Rank
105
106
107
108
109
110
III
112
113
114
115
116
117
118
119
120
121
Ranking of Per Capitalucoae by Census Tract
(Contd)
Tract Rank
4001 122--shy602
13
1102 2302
3302
55
3401
48
21
56
50
3402
lL01
2202
2301
53
2201
-shy
Tract Rank Tract Rank T~aet Rank
57 I-----
Imiddote
bull
Tract
- Low -k Note Information taken from 1960 U SCensus
Rank Tract
I ~
Ie
Imiddot
~
----
----
--
--
Rank
1
2
3
4
5
6
1
8
9
10
11
i-
-Tract
391 922 921
972 971
100
132 131 121
962 961
822 821 401
982 981
20 111
47 10 1
412
High
Total Number of Henta1 Health Visits
Ranked by Census Tract High to Low
TractTract RankTractRank Rnk
12 182 22 78 29 87 76 381 73181 ~------- 1913 371 8538230162372 271 2616-121 8272 2
14 80~2 31 94 7923 84801 59 15251362 4232 15 52 _ 32 103 8924 651 17240216 652
_ 91 351 33 341 23117 83 122 25 25 48 1123921418 34 shy61 86 661
19 662 6493 81 26 91 8153 49 50 55 41383 71 27 51 3120 90 672241 35shy 104167162 461
I 411 46211121 28 88342 I
2502 36 69 54 5251 50 272
-Ra
37
38
39
_ 40
_ 41 Ishy
I
42 I
-I 43 44
45
shy
Tract
~ --- shy 95 56
45 292 242
102 62 352 291y
92
101 281
99 72 63 601 60~ 42 2201
77 74 61 57
363 232
70
32 31
11 44 282 2202
Low l
- Tract
46 682 681 I 331 30
r~$ 47 1042 332
48 102_41_
11
~
Visits to Family Planning Clinics Ranked by Census Tract High to Low
Rank Tract Rank Tract Rankmiddot Tract Rank Tract Rank Tract Rank Tract
1
2
3
4
5
6
7
8
9
10
11
12
13middot
14
15
16
17
361
56
401
341
48
59 121
20
55
342
10
31
58
93 21
241 132
331
53
461 462
18
19
20-shy21
22
23
24
25
26
27middot
28
29
30
31
32
33
391
32
middot47 I-i-_-shy _ -
231 111
332
972 1
372 371
52
89
32
92
82
100 31
182
30 242
402
34
35
36
37
38
39
40
41
42
43
44
45
42
1714 i 661 221
78 362 2
90 602 601 352
63 251
105 921
971 351
73 42 292 232
411 51
662
81 45 52
46
47
48
49shy
50
51
52
53
54
55
56
961
801
49 81 72 71
19
9~1
172
68 2 57 162 14 112
91 75 681
381 42
3~3
83 161
57 f
58
59
60
61shy
62 Imiddot
63
Imiddot 64
65
66
64 62 36~3 252
74 652 SO 392 291
651 6bull 2
79 271
r-- ---- shy981 222
672 671
821 272
94 87
281
382
67
68
69
70
71
72
73
74
75
76
77
78
981 26 12~2
IS 61
85 82~2 69
61 43
101 86 84 282
76
131
51 72
1041 962 88 70
99 922 77
103
95 802 181
i
~
Low High
RankRank Tract
5479
4480
81 1042 ~) middot102
71 - - + ~ - ~
Visits to Family Planning Clinics
(Contd)
Tract Rank
I
Tract llaDk l
RankTract Tract Rank Tract
~
I
~
J1 ~
Low
Total Number of public Health Nursing Visits
Ranked by Census TractsHigh to Low
TractTract RankTractRank RankRank TractTractRankTractRank
25249 71 79 17249 8033 6586 99189711 84 2915072 34 661 76 66 811519512
402 5035 51 161 2518220 122 1713423 352 55801 7120 6752 2 149814 41236 83 2662 38 94 6821 53 2924015 362 37 32 42 75 69 281 84 63
546 8822 54 222 85 3925431 70383417 3818223 6439 4386652 718 21 55 103332 8924 232 87 19 271729219619 24156 16211140 382 628825 10523110 112 73411 10141-- ----shy 89 363 4457 8126 16111 221 74 9142 90 46158331 53 671279012 46243 48 59 351 3837528 1083 9313 91 5844 59 -_242 76 1----- shy60 272 72 74104114 60145 42 9287 7729 92 6151 8215 57371 934630 91 307762 12113116 282 619447 41391 9531 78100 63 7378 ~95 681 6945 32 5632 798517 6448 47 52 181
High ~ Low
Rank Tract Rank
96 31 132 70
97 102
98 182 372middot 602 651 662
- -shy
~72 682 802
822 922 962 972 982
1042 ----shy
Low
Total Number of Public Health Nursing Visits
(Contd)
Rank Rank Rank TractTract Tract
I
I lt
I
Tract Rank Tract
[
~~~-
I
~
IJilfimiddot ~
j
Ranking of VD Caea According to Census Tracts 61 By High and LOll Youth Itatio
A media~ of 34 5 was determined Any tract having greater
than 34 5~ of popu1tionunde~ 19 years of age -High~
Any tract having l8S than 345 of population under 19
years == Low
Any tract having rate less than 390 =Low
Any tract having rate more than 390 == HLgl4
YOUTH
LOW HIGH
L
0
12 402 1801 1802 343 2801 2802 29023603
54 6001 600262 66~02 72 74 75 76
78 79 81 t02 65 1202
W
(25)
VD
H
I
G
H
401 701 801802 901 902 10 1101 241 1201 1301 132 14 15 1601 1701 20~ 21 2202 2j02 2402 2502 2702 2901 303501 3502 34023801 3802 383 3902 42 44 45 4601 4602 47 48 49 SO 51~2 53 55 56 57 58 S9 6701 6702 73 95
3~02 7021702 19 25~01 2701 4102 4101 63 64601 ~601 6801 680270 7l 77 8001 80~02 8201 8202 83 84
85 86 87 88~ 90 91 9202 920193 94 9601 9602~ 9701 9102 9801 9802 99 100 101 103 10402 105 6501 10401
(47)
301 501 502 601 1602 2401 2301 2201 31 32 3301 3302 3401 3402~ 3602 3702 3901 400140 02 43 61 69 B(
(53) (23)
~ ~gt
Ranking of VD by Rate Per 100000 By Census Tract
~
Rank Tract Rank Tract Rank Tract Rank Tract llank Tract Rank Tract Rank Tract
1 2202 21 S6 40 902 58 1602 74 75
90-shy 64 107 26 --~-
2 3402 22 45 41 10 59 902 75 78 91 54 108 61
3 2301 23 3502 42 2502 60 602 76 6802 92 402 109 87
4 3302 24 49 43 1102 61 501 17 2 93 94 110 90
5 50 25 52 44 6702 62 14 78 8202 94 97 02 III 76
6 2201 26 20 6701 63 4002 8201 2501
9701 41~02 112 91
7 44 27 48 45 401 64 3802 2902 95 63 113 62
8 3301 28 1701 46 502 65 30 79 83 74 96 9602 114 71
9 55 29 47 47 42 66 3803 80 2801 96Q1 115 85 10
11
12
13
14
15
16
17
18
3401
53
2302
2401
57
21
2402
1101
51
30-shy31
32
33
34
35
36
37
3701 - -~ 1201
3702
89
43
132 131
3602
4001
48
49
50
51
52
53
54
55
58
1601
601
4602 4601
69
701
31
3901
67
68
69
70
71
72
2901
801
39021~ 802
6502 6501 122
702
41~01
81
82
83
84
85
86
87
88
19
1
1702
2802
79
93
100 6801 6602
81
97
98
99
100
101
102
103
104
9201 9202
9802 9801
77
302
79
86
72
84
116
117
118
119
120
121
3603
8002 8001
101
99
95
10401
105 10402 103 102
19
20
59
32
38
39
2702
3501
56
57
301
3801
73 1802 1801
89 6002 6001
105
106
2701
88
High Low
-- -----
Rank OrdermiddotTuberclosis Cases by Rate Per 100000 Ranked by Census Tract High to Low
Tract TractRankTractRank Rank TractRaukTractRankTractRank
801
79 9601501411 52 6835340120511 I 960269 903603532036 $-~~F130221542 4366 311301 70 68~013802 _ I- _ 4001_37213 3921201 6802802 H71523822024 22 54 193302 3802 80 8958 I37139535 70155 9801 I60123 72 6702 98023914011016 6701250124 10 56
81 94 401r 7 154152 73 7057 2625 122 92028
90242 162312301 92~158 86 7172434526509 82 79160159 74 100 87412240227220110 6502836960 75 30 8317244 6501782801285711 61 901 42765645 84 66021459294912 9701 660146 171 302 9702 47
6235023033113 85 822821182 917755 16335013110214 841814832 78 103 938564 324815 86 1057940149272 38036523216 10401 87 2902241 725Q 10402360266340217middot IF88 88 9937233 282 51 218 101 01102 46016234
I)167 2901460219 47
High ~ Low ~
- -
TractRank
9S89
6490
8191 8001 8002
63 61 60middot01 6002 44 2701
92
J
2502 402 --- ----shy
I
Rank
Rank Order Tuberculosis Cases by Rate per 100000
(Coutd)
Tract Rank Tract ~nk
I
Tract Ballk Tract Rank
Imiddot
Tract
Imiddot
1~
t 1I i Pi i l I
o
1 -1shyL I
I J
8 40 icO ~ I -lt 0
-t (1) I
i I
r o E
II
a
I
r--i
shy
I
~
I (
Jgt
(011 fi(
Ggt
I II ~j
()
(f 0
~ ()
I
11
f9
r
II 99
o ~
Ggt r
~ __-J~ I t I ~ I
r--J l I
~ _ __ J
) 1
fTl
1gt
r I
()
r
()
lt en -i en
()
I1l
(J)
(J)
-i
P ()
19
r o ~
r G1 I
I
c
~
o I 89
--- -I-shy
r-r I
1- 0 _~ _ _--J E
G1 I I I
i i
I 1-1-1 ~ _J ~2 ~ II
II
()
1 I I I 1
id i bullbull
~
A n 69
r 1shy
- 0 Gl
l--~ ~ I
~ II
II )
I () isect i
en l i
(J)
-t
0
IA Ol
IJ
40
R1ver the full length of Kultnomah County A second low
income area follows the south edge of the Columbia from
the northwest corner of Multnomah County easterly to 148 St
A third problem area seems to be on the east bank of the
Willamette River with the Union Pacific Railroad being
about the center of this tract The extreme loutheast
corner of Multnomah COUDty appears to be a low income area
but as this area bas bad rapid grouth in the last ten years
this could be erroneous
Mental Health
be first ~ecific indica to be selected from the
Multnomah County envirollllental survey of early 1971 and
to be considered in this paper i8 that of Mental Health
At the present for mental health purposes Multnomah
County is divided into five catchmentareas with a mental
health cl1n1cin each area These clinics are Model
Citles Delaunay ADkeny street Office Hansen Health
Building end Southeast Clinic
All lIlental health cl1n1cslcept statlstlcal information
on all patients visiting their cl1n1cs this included the
address of the patient hese addresses were then listed
upon the approprlate C8D8US tract Each census tract was
then ranked on a chart according to the nUllber of mental
health patients who reslde ln thatCeDSUS tract attending
any of the above listed ental health clinics This chart
IJ
41
wasttum d1v14ed1ato proper quartile bbullbullbull
quartile vereUs to dne10 u appropl1ate Multnoh
County _tal health ItLa middotmiddotmiddotthelipO~a1bl by lOoJcJIUE
at the UDtal health _to uteN1De which ueu have the
lars-t use otCOllDty 1alh~th faci11t1Rot
1Ilclu4ecl 111 tbia woUld tber otpeopleYia1t1Da
pr1vat patch1atriata aDd pr1_t _ntalhealtb cl1D1c8
WheDtbe M1 18Yienclmiddot Itmiddotmiddotmiddotmiddot~middotbe~_ tbat ~rtt
appears to lMt fourmiddotmiddot-al are iii _oil the nuaber ot
lIental healthcl1D1c na1t toM tbjh1sheat 1he
tour areaa woUld be tollows
1ttrea Ore to~Blo Drimiddot ~tb Burrus14e aDd tIMtmiddot Colb1a Riftr H1gbwyaeri1Dla th nortllra boundaryshy
2 bull ProII 82D4 1_~ 10 20th streetwitil the ra1lMd Mu the north ltouadary
3 ~ et et tUgl_b1bull MYel froamiddot the Clackaaa COUDty l1ae aorth to Dln8lon stret
4 beDOlvt1ttfe-t ~efllt4 COatytrca Jle1aware streetmiddot toR1C1a11oDd wlth Colubla Blvd heiDI tbAtnorth bouaclary_
It ODe coapareatbiap to th iDeobullbullmiddotp 1t can be
eamiddotthat lIOat ot the c tracts baY1Dg bllh v1i11tatlcma
middottfl public tal health cJ1rUc8 ~ 111 t13e low ~ aid
1DcOile SroupiDIOJa1y of til 25 tracta llsted as
haviDlbip aental Maltll nlltatlou are ~ the1g60 hip
iDeo arebullbullbull
17 Plpn
42
amily PlellnSDI ]Jlce Metal Health i8 an 1nd1ce of
use Theperson 111 ordertobavebe_ 1Dcluclecl 1n this
atu4ywouldhave tohaft Ue4 ataa11y plaDI cl1D1c
tacilities of soaetype It 41fter troll tile _tal health
study1nthat i t1Jicludestatist1catrollbotb public and
privateclJD1os
The iDformation tor the iak orurcbart 8Dd map of
t8ll111 plenn1 na ob1a1De4 by cOIIblnlDlthe mabel of
1rlcuv1duals bullbull_ attbe tbreellUltrampo-ti Coatyhll11y
PlalJQllIl C11ll10s 111til tbo at the Planned PareDthood
Association CliD1C8 be tbree -JIultDouh Couaty r8ldly
PlamSq Cl1D1c are Solrtbweatth Col_bla 1111- a114
HaDsell Health BWlcl1Dl CllD1cbi middot1Dtormat1oD vas then
bullbullbullesed tomiddot detellWMt l10w people troll eacb c8IUIUS
chart wastben Mele IUs oIIart jn 4iY1ded to show
the censuS tracts lIaYiDlmiddottIle h1t1iest qUart1le of incidence
of use lowest quartile of 1Qc1deao ot use Jlid 12 of
incidence of Wle an4 a map sprepared troll thts 1Dto~
mation
The C8U118 tractsbelOJISnl to the h1lhestquartile of
use appear to be 1lO~ 8catt~ on tbipwas true ot
either the _p ot aental health cl1D1c uaageor ot the map
abow1DI per capita 1I1COM Iaere40 to be three
d18t1nct areas of UIIaP beJ woul4 be
1
IJ
43
t10D of BurD81cl and the W11lallette River 4
2 S~t Portland 8Otth otmiddot the ra11shyrcaadand alona the W11lamette River
lIortbeaat Portl8D4 between MisSiss1pp1 and 24tbStreet the northbouBclary be1DgColwb1aBlvd
Pylzl1c BMltl IrpI Y11ta
Publlc Healtil nur81D1Y1s1t nclud8 an vists to
theholles of client by PubUc Health Nurbullbullbullbull his shows
visits to bull f8Jl1ly fer aDY purpos SUCh aatuberculolJ1s
het1Dl tem1tyaeatalu4 8IiOt10D8l cODd1t1ona etc
he atat18t1C~ 1fele C()4ed accord1Dg tomiddot the 1llli301fOCUS
of the Y18lt tt doe DOt 1D41cate the Dmlber of holies or
f8ll11lev181tecl or 1D41Y14ual Y1a1ted more tban oDcein
the propwl It dobullbull I1ve 80M 1D41cat1on by coaparlshy
OD ot the 8JIoUDt of aedlcal problema 1n eachcen8WI tract
Ap1nmiddot the _p abowa 8 scatter patteraof probl_
areas althoUSh there appear to be a sroup1Dl of hiSh J
l8aIeccmaus tract 1ntlut extreme southeast part of tbe
County other areu uIriaI any nura1Dl contacts are
1 bull he 801lth-oa-al CO1Dty on eaCh 814 of 82nd Av from Clackallaa County north to Dinloa
2 ear bullbullbullt 814e aroUDd Preacottand Misaisippi
Dowatom Bunul14eonboth 1de of the river
44
V_real Pis The iDfomatloil uaec1 to tabulate the Venereal
disease chart includes all the ooab1ned case otmiddotODormea
and syphilIs reported by bothmiddot publIc and prIvate physicIans
dur1nl 1970 There were 3602 caes ot IOnorrhea reported
dur1nl 1970 While ODly 17 cabullbullsot ayphilimiddot were reported
A chart was prepUed aDd att8llPt wasmiddotmiddot de tomiddot
determ1De Wh_therVttDereal 41ease was more p~vaJent in
areas othigb or lowmiddot proportIon ot youth hi waadone
bymiddotdetemlna a 1leaD prceiltacmiddotmiddotmiddottor the population ot
resld~ts UDder19 years ot (34) middotA mean ratemiddot per
100000 popUlatIon al80c1ttem1Ded tor the middotoccurreDCe
ot venereal dieae This was et at 390 oass Areas
hav1nl a population 1n which leiS than 34 were lmder 19
years ot ampIe were called low- yOuth abOve tbl percentaae
hiSh youth The aaa waatrue ot the occurrence oivenershy
eal disea_ per CeD8UStract It the rate waacomputed
as 1I0re than 390 cases per 100000 it was called hiah
venerealdiaeasei it less than thia tisure low venereal
disease It was tound that 1D Multn~ COmlty there sems
to be poSitive OOlatI0n(x21S19gt between low youth
and hipmiddot venereal diseaand hip youth and low venereal
diseasebull
RaDk ordr Iitot all c traot middottbAm made
Th1s was done byt1Ddlna the ratepr 100000 populatIon
of venereal disator all census tracts in the County bull
45
These were thenlisted from h1lhto low (sreatest to
least) in a rank order The l1sting was then divided
into Upperandlower 14 aDd listed on the MUltnomah
Countymiddot up
The areas of b1gh venereal disease se8ll18to
roup thBl~8 middotin a very tllht area ~oq both 1des
of thell18l8~ R1 w1th BurDaldeS~et being
~bout theceDter qf tbi8IZ9uping This area woUld
appear to be m ldeal spot for the denlopment of a
locallzed venereal d1sbullbullbullbull cl1D1c
UbepoundCUlO1s
In this report bull tube1C1llosls caS8S refrred
to include alltbobullbull cabullbulls ontubercUlo8is follow-up
rather middotthan just new C Accord1Ds to the Multnomah
County Health SUrvey of early 1971 this would include
all ca repOrte4 over thelaat three years The
total number of tuberculosi8 cabullbullbull usedin this study
was 666 lh1 included 128 new cabullbullbullbull
A rate per 100000 of tuberculosis for each
census tract wa- then computed and the c~us tracts
listed by rank order be b11h Qartlle mel low
quartl1 were then reoordd on a Multnomah CoUnty map
TWo genral areaa baY1Dg a hip mcldencaot tubercu~
losiare 1D41cated heyare
1 Both middotsld ot theWilla11lette River
Ll -
46
with Burns1de about thecnter
2 he extrea Northebullbullt comer of the County bull
By coap8r1ng the tuberculois an4ven8real
diseae maps ODe can 8ee that the downtown areas ot
hiSh 1nc1denceare alIIo8t 1c1eDt1cal on ach map
This WOuld 1nd1cate that 1t would be of value to
bullbulltab11sh acl1D1c 111 th1aampreatbat would provide
bothtuberCulos1s 8Dd ytmereal 418ase srvicbullbullbull
Thchart aDd 1181gt8 are wsfuln 11v1DI
1Ddicat10DS tor the type aDd placemeototlocal
health cl1n1c8 tbro1qhout tbe MultnomahCounty area
A cOllpar1on of the mapa help one to dec1dewhether
to provide a aulti-8ervice cl1D1c or spec1f1c type of
cliD1c As stated in Part I of thi paprserv1ces
shouldhaYe both treatlieDt and prfMmt10n cOmponents
As he been stated fta ne1lbborhood health care
Qenter muat be a fac111tY plazme4 with an aamesa
ot the neds of the consumer and the c01llll1m1tybull
Part II of this rport haa been an attaapt to indicate
and clarify 8011 ottheae coDlllUDity neds This has
been done through8elect10n of apc1f1c problems
The indic were then visuallyrecorded through the
use of ups and charta ODe dan asseS8 thedsreeof
1DIportance of certain concems to spec~t1c areaa by
comparinl the chart aDd maps Prom this oDeean
41 dec1de which are48 vb1chcUD1c-or indeed if
the need a clinic at all However further factors
should be considered hebullbull include
a The amount of fuDd1 available
b What 18 the percentage ot peopleineoh ceaaua tract tbat would actually us such cl1n1cIl
c Wbat 1 tbeco--1tymiddot 8 IeeliDashyreaardtDI particular cl1D1c8 Would this dcrebullbullbullmiddot the ettctiveness ot thse cl1n1ca
IJ
li
D_OlraphicPopulatLon Challie 1960 to 1970 48
Cen8U8 1 of Pop 1 Cbaqemiddot 1 Change1 ofPopTract Under 19 Yr8 Over 65 Yrs1960-70 1960-70
middot1Q701Q70
1 319 -12 171 -H) 1
2722 215-27 +68 301 366 -22 127 +35 302 371 +19 111 -04
311middot401 144-41 +29 402 321 13~7-39 +24 501 356 124-08 -02 5~O2 351 133-23 +12
405601 82-10 -02 394602 103-01 -06
701 275 149-76 +56 702 361 +01 121 -07
+10middot801 326 140-22 802 321 middot127
(
-29 -03 9~01 342 124 -H) 6-18 902 294 128 -H) 3-24
10middotmiddot -14312 140 -17 1101 182 +25 -23197
2411102 186-59 +29 1201 226 169-17 -41
31middot01202 +11 182 -05 295 -H) 81301 208 -H) 4
1302 331 +08 197 +04
14 323 +15 middot185 -08 middotmiddot15 329 +16 16~5 -13
-28middot 1601 332 131 +12
1602 356 98 +24middot-39 middot3101701 161-33 +21
1702 370 -15 85 +02 +19 1801 264 151middot-50
185middot1802 256 +47-58
IJ ~
D_raphlc Population Change 1960 to 1970middot 49 (Contd)
4io
Census Tract
of pop Uncter 19 Yra
1Q1n
1Cha1l8e 1960-70
of PopOver 65 Yra
lQO Change
1960-70
19 389 +29 141 -24 20 223 -13 206 +18
21 227 +08 194 -36 2201 356 -27 112 +05
2202 290 -18 ll~9 -29 2301 356 -03 154 +24 2302 260 -37 245 +97
2401 410 +6~1 123 -31 2402 163 -80 320 +99 2501 381 +13 140 -01 25()2 237 31 lil +02 26 343 +25 186 +149 2701 370 +29 1S5 -01 2702 249 -44 304 +98 2801 337 +19 187 +09 2802 306 -10 156 +31 2901 304 -38 142 +24 2902 i 307 -32 146 t3~9
30 29~0 -48 16~2 +51
31 355 +30 160 +01 32 370 +48 148 -13 3301 395 +45 130 -20 3302 368 +06 138 -02 3401 386 +16 117 000
3402
400 +32 92 -26 3501 304 -07 115 +35
3502 344 000 140 -13
3601
36~02 357 -04 132 +32
3603 30~1 42 149 -67 3701 342 +28 152 +19
1
IJ
Jianolraphic Population Chan 1960 to 1970 50 (Contd)
Census Tract
of Pop Under 19 Yrs
JJl7J
middotChanae 1960-70
middotofmiddotpop Over 65 Yrs
1c~7n
Change 196070
3702 409 +39 122 -11 3801 308 -11 151 +29 3802 275 -35 180 +46 3803 282 -32 192 +54 3901 376 ~13 100 +17 3902 296 -03 177 +29 4001 438 -11 84 +13 4002 353 -21 115 +20
4101 397 11 9middot0 +11 4102 346 -19 120 +03 42 331 +19 11 bull 3 -16 43 347 -72 105 +31 44 113 +84 183 +154 4S 33~9 +07 110 -06 4601 2501 22 193 +38 4602 332 +59 126 -29 47middot 161middot 000 211 +01 48 103 -26 302 +59 49 138 +1 bull 3 252 +09 50 141 -26 204 -12 51 12 -39 257 +07 52 47 -61 351 +48 53 89 +49 314 -30 54 25 l1li15 327 -17 55 131 -17 115 -121 56 198 +93 227 -47 57 71 102 189 -88 58 240 ~middot41 16~1 +55 59 322 +25 142 +06middot 6001 264 95 132 +50
6002 328 -31middot 89 +07
JJ
Demographic Population Change 1960 to 1970 51 (Contd)
Census 1 ofPop lChange of Pop bull ChangeTract Under 19 Yrbullbull 1960-70 Over 65 Yrs 1960-70
1970 1970
61 355 -58 85 +39
62 328 39 110 +18
63 414 04 73 10
64 382 -22 72 +04
6501 383 02 67 -20
6502 329 -56 96 +09
6601 391 +13 88 -03
6602 319 -59 97 +06
6701 327 71 145 +72
6702 331 ~67 83 +1-0
6801 365 -66 49 +01
6802 388 4bull3 54 +06
69 354 -41 80 +23
70 400 -23 68 -06
71 359 -48 72 +05
72 255 -88 82 +11
73 346 -39 91 +25
74 313middot -63 105 +24
75 329 -42 129 +37
76 336 -52 85 +21
77 370 -10 69 +05
78 309 -10 120 +21
79 325 -56 87 +10
8001 358 -81 57 +12
8002 391 ~81 76 +12
81 315 -76 108 +21
8201 403 -23 64 +08
8202 392 23 65 +08
83 357 -34 120 +31
84 402 -18 73 +16
85 413 -06 76 -09
r
Demographic Population Change 1960 to 1970 52 (Contd)
Census Tract
t of Pop Uncler 19 Yrs
1970
Change 1960-70
1 of Pop OVer 65 Yrs
1970
ex Change 196070
86
87
88
89
90
91 9201
9202
93
94
95
9601
9602
9701
9702
9801
9802
99
100 I
101
102
103
10401
10402
lOS
368
351
379
391
391
413
379
433
372
429
414
432
419
439
~32
377
457 420
378 41middot7
345
360 417
417
412
-04
-02
-35
-26
-28
-11
-64
-20
-S9
-39
-32
-21
-34
-40
-47
-lO~7middot
-27middot +04
+56
+07
-34 01
+04
+04
+10
103
128
97
11il3 99
69
79
42
77
46
34 38
44
40
54
111
51middot
81
133
59
74
140
63
87
76
-08
-06
+04
+08
+17
-05
+3S -02
+1~4
+19
+33
-14
-08
+12
+26
+71
+11
-16 -34
-20
-19 +37
-49
-2S +15
NOte The The
Taken frOi
averageullder averageabove
middotUSCensus ---shy -
19 years == 6S years ==
figures 197
32r 13(14
p a~d 1960
--
Rank
1
2
3
4
5
6
7
8
9
10
11 12 -_
13
14
15
16
17
18
Tract
69 46
60
58
- 68
61
302
2501
67
63
19
62
26
94
3603
3902
64
30 -----~-
Rank
19
20
21 -
22
23-shy
24
25
26
27
28
29
30
31
32
33
34
35
36 -
Ranking of Per Capita Income by Census Tract
Tract
65
2701
- 15
1601
701
66
93
82
2903
3602
30
2502
80
2401
81
- 70
91 shy
4001
High
Rank Tractshy
-32shy37
38 97
120239
7840
41 ~ _2_1__ 42 31
43 2501
44 18
45 98
46 37
47 3803
1702
49
48
1602 92 2702
I
50 89
51 901
52 801
Ra_
53
54
55
56
57
58
59
60
61
62
63
64
6S
66
67
68
TractTract Ra~
74692
170196 70 I
401 71 90
72 1037J
79 70273
3802 74 601
24024102 75
85 76 101
77 9023901
7699 78 100 4101 79
3601 I
380180
458140~ t---- _ - - shy83 82 42
888384
59843501
4777 8~
502
Low
802 86
Rank Tract
87 shy
--88
89
90
91
92
93
94
- 95
96
97
middot98
99
100
101
102
103
104
1201
14
49
72
73
43
87
3502
105
1
52
86
71
1
501
10
3301
104 tf
Rank
105
106
107
108
109
110
III
112
113
114
115
116
117
118
119
120
121
Ranking of Per Capitalucoae by Census Tract
(Contd)
Tract Rank
4001 122--shy602
13
1102 2302
3302
55
3401
48
21
56
50
3402
lL01
2202
2301
53
2201
-shy
Tract Rank Tract Rank T~aet Rank
57 I-----
Imiddote
bull
Tract
- Low -k Note Information taken from 1960 U SCensus
Rank Tract
I ~
Ie
Imiddot
~
----
----
--
--
Rank
1
2
3
4
5
6
1
8
9
10
11
i-
-Tract
391 922 921
972 971
100
132 131 121
962 961
822 821 401
982 981
20 111
47 10 1
412
High
Total Number of Henta1 Health Visits
Ranked by Census Tract High to Low
TractTract RankTractRank Rnk
12 182 22 78 29 87 76 381 73181 ~------- 1913 371 8538230162372 271 2616-121 8272 2
14 80~2 31 94 7923 84801 59 15251362 4232 15 52 _ 32 103 8924 651 17240216 652
_ 91 351 33 341 23117 83 122 25 25 48 1123921418 34 shy61 86 661
19 662 6493 81 26 91 8153 49 50 55 41383 71 27 51 3120 90 672241 35shy 104167162 461
I 411 46211121 28 88342 I
2502 36 69 54 5251 50 272
-Ra
37
38
39
_ 40
_ 41 Ishy
I
42 I
-I 43 44
45
shy
Tract
~ --- shy 95 56
45 292 242
102 62 352 291y
92
101 281
99 72 63 601 60~ 42 2201
77 74 61 57
363 232
70
32 31
11 44 282 2202
Low l
- Tract
46 682 681 I 331 30
r~$ 47 1042 332
48 102_41_
11
~
Visits to Family Planning Clinics Ranked by Census Tract High to Low
Rank Tract Rank Tract Rankmiddot Tract Rank Tract Rank Tract Rank Tract
1
2
3
4
5
6
7
8
9
10
11
12
13middot
14
15
16
17
361
56
401
341
48
59 121
20
55
342
10
31
58
93 21
241 132
331
53
461 462
18
19
20-shy21
22
23
24
25
26
27middot
28
29
30
31
32
33
391
32
middot47 I-i-_-shy _ -
231 111
332
972 1
372 371
52
89
32
92
82
100 31
182
30 242
402
34
35
36
37
38
39
40
41
42
43
44
45
42
1714 i 661 221
78 362 2
90 602 601 352
63 251
105 921
971 351
73 42 292 232
411 51
662
81 45 52
46
47
48
49shy
50
51
52
53
54
55
56
961
801
49 81 72 71
19
9~1
172
68 2 57 162 14 112
91 75 681
381 42
3~3
83 161
57 f
58
59
60
61shy
62 Imiddot
63
Imiddot 64
65
66
64 62 36~3 252
74 652 SO 392 291
651 6bull 2
79 271
r-- ---- shy981 222
672 671
821 272
94 87
281
382
67
68
69
70
71
72
73
74
75
76
77
78
981 26 12~2
IS 61
85 82~2 69
61 43
101 86 84 282
76
131
51 72
1041 962 88 70
99 922 77
103
95 802 181
i
~
Low High
RankRank Tract
5479
4480
81 1042 ~) middot102
71 - - + ~ - ~
Visits to Family Planning Clinics
(Contd)
Tract Rank
I
Tract llaDk l
RankTract Tract Rank Tract
~
I
~
J1 ~
Low
Total Number of public Health Nursing Visits
Ranked by Census TractsHigh to Low
TractTract RankTractRank RankRank TractTractRankTractRank
25249 71 79 17249 8033 6586 99189711 84 2915072 34 661 76 66 811519512
402 5035 51 161 2518220 122 1713423 352 55801 7120 6752 2 149814 41236 83 2662 38 94 6821 53 2924015 362 37 32 42 75 69 281 84 63
546 8822 54 222 85 3925431 70383417 3818223 6439 4386652 718 21 55 103332 8924 232 87 19 271729219619 24156 16211140 382 628825 10523110 112 73411 10141-- ----shy 89 363 4457 8126 16111 221 74 9142 90 46158331 53 671279012 46243 48 59 351 3837528 1083 9313 91 5844 59 -_242 76 1----- shy60 272 72 74104114 60145 42 9287 7729 92 6151 8215 57371 934630 91 307762 12113116 282 619447 41391 9531 78100 63 7378 ~95 681 6945 32 5632 798517 6448 47 52 181
High ~ Low
Rank Tract Rank
96 31 132 70
97 102
98 182 372middot 602 651 662
- -shy
~72 682 802
822 922 962 972 982
1042 ----shy
Low
Total Number of Public Health Nursing Visits
(Contd)
Rank Rank Rank TractTract Tract
I
I lt
I
Tract Rank Tract
[
~~~-
I
~
IJilfimiddot ~
j
Ranking of VD Caea According to Census Tracts 61 By High and LOll Youth Itatio
A media~ of 34 5 was determined Any tract having greater
than 34 5~ of popu1tionunde~ 19 years of age -High~
Any tract having l8S than 345 of population under 19
years == Low
Any tract having rate less than 390 =Low
Any tract having rate more than 390 == HLgl4
YOUTH
LOW HIGH
L
0
12 402 1801 1802 343 2801 2802 29023603
54 6001 600262 66~02 72 74 75 76
78 79 81 t02 65 1202
W
(25)
VD
H
I
G
H
401 701 801802 901 902 10 1101 241 1201 1301 132 14 15 1601 1701 20~ 21 2202 2j02 2402 2502 2702 2901 303501 3502 34023801 3802 383 3902 42 44 45 4601 4602 47 48 49 SO 51~2 53 55 56 57 58 S9 6701 6702 73 95
3~02 7021702 19 25~01 2701 4102 4101 63 64601 ~601 6801 680270 7l 77 8001 80~02 8201 8202 83 84
85 86 87 88~ 90 91 9202 920193 94 9601 9602~ 9701 9102 9801 9802 99 100 101 103 10402 105 6501 10401
(47)
301 501 502 601 1602 2401 2301 2201 31 32 3301 3302 3401 3402~ 3602 3702 3901 400140 02 43 61 69 B(
(53) (23)
~ ~gt
Ranking of VD by Rate Per 100000 By Census Tract
~
Rank Tract Rank Tract Rank Tract Rank Tract llank Tract Rank Tract Rank Tract
1 2202 21 S6 40 902 58 1602 74 75
90-shy 64 107 26 --~-
2 3402 22 45 41 10 59 902 75 78 91 54 108 61
3 2301 23 3502 42 2502 60 602 76 6802 92 402 109 87
4 3302 24 49 43 1102 61 501 17 2 93 94 110 90
5 50 25 52 44 6702 62 14 78 8202 94 97 02 III 76
6 2201 26 20 6701 63 4002 8201 2501
9701 41~02 112 91
7 44 27 48 45 401 64 3802 2902 95 63 113 62
8 3301 28 1701 46 502 65 30 79 83 74 96 9602 114 71
9 55 29 47 47 42 66 3803 80 2801 96Q1 115 85 10
11
12
13
14
15
16
17
18
3401
53
2302
2401
57
21
2402
1101
51
30-shy31
32
33
34
35
36
37
3701 - -~ 1201
3702
89
43
132 131
3602
4001
48
49
50
51
52
53
54
55
58
1601
601
4602 4601
69
701
31
3901
67
68
69
70
71
72
2901
801
39021~ 802
6502 6501 122
702
41~01
81
82
83
84
85
86
87
88
19
1
1702
2802
79
93
100 6801 6602
81
97
98
99
100
101
102
103
104
9201 9202
9802 9801
77
302
79
86
72
84
116
117
118
119
120
121
3603
8002 8001
101
99
95
10401
105 10402 103 102
19
20
59
32
38
39
2702
3501
56
57
301
3801
73 1802 1801
89 6002 6001
105
106
2701
88
High Low
-- -----
Rank OrdermiddotTuberclosis Cases by Rate Per 100000 Ranked by Census Tract High to Low
Tract TractRankTractRank Rank TractRaukTractRankTractRank
801
79 9601501411 52 6835340120511 I 960269 903603532036 $-~~F130221542 4366 311301 70 68~013802 _ I- _ 4001_37213 3921201 6802802 H71523822024 22 54 193302 3802 80 8958 I37139535 70155 9801 I60123 72 6702 98023914011016 6701250124 10 56
81 94 401r 7 154152 73 7057 2625 122 92028
90242 162312301 92~158 86 7172434526509 82 79160159 74 100 87412240227220110 6502836960 75 30 8317244 6501782801285711 61 901 42765645 84 66021459294912 9701 660146 171 302 9702 47
6235023033113 85 822821182 917755 16335013110214 841814832 78 103 938564 324815 86 1057940149272 38036523216 10401 87 2902241 725Q 10402360266340217middot IF88 88 9937233 282 51 218 101 01102 46016234
I)167 2901460219 47
High ~ Low ~
- -
TractRank
9S89
6490
8191 8001 8002
63 61 60middot01 6002 44 2701
92
J
2502 402 --- ----shy
I
Rank
Rank Order Tuberculosis Cases by Rate per 100000
(Coutd)
Tract Rank Tract ~nk
I
Tract Ballk Tract Rank
Imiddot
Tract
Imiddot
1~
t 1I i Pi i l I
o
1 -1shyL I
I J
8 40 icO ~ I -lt 0
-t (1) I
i I
r o E
II
a
I
r--i
shy
I
~
I (
Jgt
(011 fi(
Ggt
I II ~j
()
(f 0
~ ()
I
11
f9
r
II 99
o ~
Ggt r
~ __-J~ I t I ~ I
r--J l I
~ _ __ J
) 1
fTl
1gt
r I
()
r
()
lt en -i en
()
I1l
(J)
(J)
-i
P ()
19
r o ~
r G1 I
I
c
~
o I 89
--- -I-shy
r-r I
1- 0 _~ _ _--J E
G1 I I I
i i
I 1-1-1 ~ _J ~2 ~ II
II
()
1 I I I 1
id i bullbull
~
A n 69
r 1shy
- 0 Gl
l--~ ~ I
~ II
II )
I () isect i
en l i
(J)
-t
0
IA Ol
IJ
41
wasttum d1v14ed1ato proper quartile bbullbullbull
quartile vereUs to dne10 u appropl1ate Multnoh
County _tal health ItLa middotmiddotmiddotthelipO~a1bl by lOoJcJIUE
at the UDtal health _to uteN1De which ueu have the
lars-t use otCOllDty 1alh~th faci11t1Rot
1Ilclu4ecl 111 tbia woUld tber otpeopleYia1t1Da
pr1vat patch1atriata aDd pr1_t _ntalhealtb cl1D1c8
WheDtbe M1 18Yienclmiddot Itmiddotmiddotmiddotmiddot~middotbe~_ tbat ~rtt
appears to lMt fourmiddotmiddot-al are iii _oil the nuaber ot
lIental healthcl1D1c na1t toM tbjh1sheat 1he
tour areaa woUld be tollows
1ttrea Ore to~Blo Drimiddot ~tb Burrus14e aDd tIMtmiddot Colb1a Riftr H1gbwyaeri1Dla th nortllra boundaryshy
2 bull ProII 82D4 1_~ 10 20th streetwitil the ra1lMd Mu the north ltouadary
3 ~ et et tUgl_b1bull MYel froamiddot the Clackaaa COUDty l1ae aorth to Dln8lon stret
4 beDOlvt1ttfe-t ~efllt4 COatytrca Jle1aware streetmiddot toR1C1a11oDd wlth Colubla Blvd heiDI tbAtnorth bouaclary_
It ODe coapareatbiap to th iDeobullbullmiddotp 1t can be
eamiddotthat lIOat ot the c tracts baY1Dg bllh v1i11tatlcma
middottfl public tal health cJ1rUc8 ~ 111 t13e low ~ aid
1DcOile SroupiDIOJa1y of til 25 tracta llsted as
haviDlbip aental Maltll nlltatlou are ~ the1g60 hip
iDeo arebullbullbull
17 Plpn
42
amily PlellnSDI ]Jlce Metal Health i8 an 1nd1ce of
use Theperson 111 ordertobavebe_ 1Dcluclecl 1n this
atu4ywouldhave tohaft Ue4 ataa11y plaDI cl1D1c
tacilities of soaetype It 41fter troll tile _tal health
study1nthat i t1Jicludestatist1catrollbotb public and
privateclJD1os
The iDformation tor the iak orurcbart 8Dd map of
t8ll111 plenn1 na ob1a1De4 by cOIIblnlDlthe mabel of
1rlcuv1duals bullbull_ attbe tbreellUltrampo-ti Coatyhll11y
PlalJQllIl C11ll10s 111til tbo at the Planned PareDthood
Association CliD1C8 be tbree -JIultDouh Couaty r8ldly
PlamSq Cl1D1c are Solrtbweatth Col_bla 1111- a114
HaDsell Health BWlcl1Dl CllD1cbi middot1Dtormat1oD vas then
bullbullbullesed tomiddot detellWMt l10w people troll eacb c8IUIUS
chart wastben Mele IUs oIIart jn 4iY1ded to show
the censuS tracts lIaYiDlmiddottIle h1t1iest qUart1le of incidence
of use lowest quartile of 1Qc1deao ot use Jlid 12 of
incidence of Wle an4 a map sprepared troll thts 1Dto~
mation
The C8U118 tractsbelOJISnl to the h1lhestquartile of
use appear to be 1lO~ 8catt~ on tbipwas true ot
either the _p ot aental health cl1D1c uaageor ot the map
abow1DI per capita 1I1COM Iaere40 to be three
d18t1nct areas of UIIaP beJ woul4 be
1
IJ
43
t10D of BurD81cl and the W11lallette River 4
2 S~t Portland 8Otth otmiddot the ra11shyrcaadand alona the W11lamette River
lIortbeaat Portl8D4 between MisSiss1pp1 and 24tbStreet the northbouBclary be1DgColwb1aBlvd
Pylzl1c BMltl IrpI Y11ta
Publlc Healtil nur81D1Y1s1t nclud8 an vists to
theholles of client by PubUc Health Nurbullbullbullbull his shows
visits to bull f8Jl1ly fer aDY purpos SUCh aatuberculolJ1s
het1Dl tem1tyaeatalu4 8IiOt10D8l cODd1t1ona etc
he atat18t1C~ 1fele C()4ed accord1Dg tomiddot the 1llli301fOCUS
of the Y18lt tt doe DOt 1D41cate the Dmlber of holies or
f8ll11lev181tecl or 1D41Y14ual Y1a1ted more tban oDcein
the propwl It dobullbull I1ve 80M 1D41cat1on by coaparlshy
OD ot the 8JIoUDt of aedlcal problema 1n eachcen8WI tract
Ap1nmiddot the _p abowa 8 scatter patteraof probl_
areas althoUSh there appear to be a sroup1Dl of hiSh J
l8aIeccmaus tract 1ntlut extreme southeast part of tbe
County other areu uIriaI any nura1Dl contacts are
1 bull he 801lth-oa-al CO1Dty on eaCh 814 of 82nd Av from Clackallaa County north to Dinloa
2 ear bullbullbullt 814e aroUDd Preacottand Misaisippi
Dowatom Bunul14eonboth 1de of the river
44
V_real Pis The iDfomatloil uaec1 to tabulate the Venereal
disease chart includes all the ooab1ned case otmiddotODormea
and syphilIs reported by bothmiddot publIc and prIvate physicIans
dur1nl 1970 There were 3602 caes ot IOnorrhea reported
dur1nl 1970 While ODly 17 cabullbullsot ayphilimiddot were reported
A chart was prepUed aDd att8llPt wasmiddotmiddot de tomiddot
determ1De Wh_therVttDereal 41ease was more p~vaJent in
areas othigb or lowmiddot proportIon ot youth hi waadone
bymiddotdetemlna a 1leaD prceiltacmiddotmiddotmiddottor the population ot
resld~ts UDder19 years ot (34) middotA mean ratemiddot per
100000 popUlatIon al80c1ttem1Ded tor the middotoccurreDCe
ot venereal dieae This was et at 390 oass Areas
hav1nl a population 1n which leiS than 34 were lmder 19
years ot ampIe were called low- yOuth abOve tbl percentaae
hiSh youth The aaa waatrue ot the occurrence oivenershy
eal disea_ per CeD8UStract It the rate waacomputed
as 1I0re than 390 cases per 100000 it was called hiah
venerealdiaeasei it less than thia tisure low venereal
disease It was tound that 1D Multn~ COmlty there sems
to be poSitive OOlatI0n(x21S19gt between low youth
and hipmiddot venereal diseaand hip youth and low venereal
diseasebull
RaDk ordr Iitot all c traot middottbAm made
Th1s was done byt1Ddlna the ratepr 100000 populatIon
of venereal disator all census tracts in the County bull
45
These were thenlisted from h1lhto low (sreatest to
least) in a rank order The l1sting was then divided
into Upperandlower 14 aDd listed on the MUltnomah
Countymiddot up
The areas of b1gh venereal disease se8ll18to
roup thBl~8 middotin a very tllht area ~oq both 1des
of thell18l8~ R1 w1th BurDaldeS~et being
~bout theceDter qf tbi8IZ9uping This area woUld
appear to be m ldeal spot for the denlopment of a
locallzed venereal d1sbullbullbullbull cl1D1c
UbepoundCUlO1s
In this report bull tube1C1llosls caS8S refrred
to include alltbobullbull cabullbulls ontubercUlo8is follow-up
rather middotthan just new C Accord1Ds to the Multnomah
County Health SUrvey of early 1971 this would include
all ca repOrte4 over thelaat three years The
total number of tuberculosi8 cabullbullbull usedin this study
was 666 lh1 included 128 new cabullbullbullbull
A rate per 100000 of tuberculosis for each
census tract wa- then computed and the c~us tracts
listed by rank order be b11h Qartlle mel low
quartl1 were then reoordd on a Multnomah CoUnty map
TWo genral areaa baY1Dg a hip mcldencaot tubercu~
losiare 1D41cated heyare
1 Both middotsld ot theWilla11lette River
Ll -
46
with Burns1de about thecnter
2 he extrea Northebullbullt comer of the County bull
By coap8r1ng the tuberculois an4ven8real
diseae maps ODe can 8ee that the downtown areas ot
hiSh 1nc1denceare alIIo8t 1c1eDt1cal on ach map
This WOuld 1nd1cate that 1t would be of value to
bullbulltab11sh acl1D1c 111 th1aampreatbat would provide
bothtuberCulos1s 8Dd ytmereal 418ase srvicbullbullbull
Thchart aDd 1181gt8 are wsfuln 11v1DI
1Ddicat10DS tor the type aDd placemeototlocal
health cl1n1c8 tbro1qhout tbe MultnomahCounty area
A cOllpar1on of the mapa help one to dec1dewhether
to provide a aulti-8ervice cl1D1c or spec1f1c type of
cliD1c As stated in Part I of thi paprserv1ces
shouldhaYe both treatlieDt and prfMmt10n cOmponents
As he been stated fta ne1lbborhood health care
Qenter muat be a fac111tY plazme4 with an aamesa
ot the neds of the consumer and the c01llll1m1tybull
Part II of this rport haa been an attaapt to indicate
and clarify 8011 ottheae coDlllUDity neds This has
been done through8elect10n of apc1f1c problems
The indic were then visuallyrecorded through the
use of ups and charta ODe dan asseS8 thedsreeof
1DIportance of certain concems to spec~t1c areaa by
comparinl the chart aDd maps Prom this oDeean
41 dec1de which are48 vb1chcUD1c-or indeed if
the need a clinic at all However further factors
should be considered hebullbull include
a The amount of fuDd1 available
b What 18 the percentage ot peopleineoh ceaaua tract tbat would actually us such cl1n1cIl
c Wbat 1 tbeco--1tymiddot 8 IeeliDashyreaardtDI particular cl1D1c8 Would this dcrebullbullbullmiddot the ettctiveness ot thse cl1n1ca
IJ
li
D_OlraphicPopulatLon Challie 1960 to 1970 48
Cen8U8 1 of Pop 1 Cbaqemiddot 1 Change1 ofPopTract Under 19 Yr8 Over 65 Yrs1960-70 1960-70
middot1Q701Q70
1 319 -12 171 -H) 1
2722 215-27 +68 301 366 -22 127 +35 302 371 +19 111 -04
311middot401 144-41 +29 402 321 13~7-39 +24 501 356 124-08 -02 5~O2 351 133-23 +12
405601 82-10 -02 394602 103-01 -06
701 275 149-76 +56 702 361 +01 121 -07
+10middot801 326 140-22 802 321 middot127
(
-29 -03 9~01 342 124 -H) 6-18 902 294 128 -H) 3-24
10middotmiddot -14312 140 -17 1101 182 +25 -23197
2411102 186-59 +29 1201 226 169-17 -41
31middot01202 +11 182 -05 295 -H) 81301 208 -H) 4
1302 331 +08 197 +04
14 323 +15 middot185 -08 middotmiddot15 329 +16 16~5 -13
-28middot 1601 332 131 +12
1602 356 98 +24middot-39 middot3101701 161-33 +21
1702 370 -15 85 +02 +19 1801 264 151middot-50
185middot1802 256 +47-58
IJ ~
D_raphlc Population Change 1960 to 1970middot 49 (Contd)
4io
Census Tract
of pop Uncter 19 Yra
1Q1n
1Cha1l8e 1960-70
of PopOver 65 Yra
lQO Change
1960-70
19 389 +29 141 -24 20 223 -13 206 +18
21 227 +08 194 -36 2201 356 -27 112 +05
2202 290 -18 ll~9 -29 2301 356 -03 154 +24 2302 260 -37 245 +97
2401 410 +6~1 123 -31 2402 163 -80 320 +99 2501 381 +13 140 -01 25()2 237 31 lil +02 26 343 +25 186 +149 2701 370 +29 1S5 -01 2702 249 -44 304 +98 2801 337 +19 187 +09 2802 306 -10 156 +31 2901 304 -38 142 +24 2902 i 307 -32 146 t3~9
30 29~0 -48 16~2 +51
31 355 +30 160 +01 32 370 +48 148 -13 3301 395 +45 130 -20 3302 368 +06 138 -02 3401 386 +16 117 000
3402
400 +32 92 -26 3501 304 -07 115 +35
3502 344 000 140 -13
3601
36~02 357 -04 132 +32
3603 30~1 42 149 -67 3701 342 +28 152 +19
1
IJ
Jianolraphic Population Chan 1960 to 1970 50 (Contd)
Census Tract
of Pop Under 19 Yrs
JJl7J
middotChanae 1960-70
middotofmiddotpop Over 65 Yrs
1c~7n
Change 196070
3702 409 +39 122 -11 3801 308 -11 151 +29 3802 275 -35 180 +46 3803 282 -32 192 +54 3901 376 ~13 100 +17 3902 296 -03 177 +29 4001 438 -11 84 +13 4002 353 -21 115 +20
4101 397 11 9middot0 +11 4102 346 -19 120 +03 42 331 +19 11 bull 3 -16 43 347 -72 105 +31 44 113 +84 183 +154 4S 33~9 +07 110 -06 4601 2501 22 193 +38 4602 332 +59 126 -29 47middot 161middot 000 211 +01 48 103 -26 302 +59 49 138 +1 bull 3 252 +09 50 141 -26 204 -12 51 12 -39 257 +07 52 47 -61 351 +48 53 89 +49 314 -30 54 25 l1li15 327 -17 55 131 -17 115 -121 56 198 +93 227 -47 57 71 102 189 -88 58 240 ~middot41 16~1 +55 59 322 +25 142 +06middot 6001 264 95 132 +50
6002 328 -31middot 89 +07
JJ
Demographic Population Change 1960 to 1970 51 (Contd)
Census 1 ofPop lChange of Pop bull ChangeTract Under 19 Yrbullbull 1960-70 Over 65 Yrs 1960-70
1970 1970
61 355 -58 85 +39
62 328 39 110 +18
63 414 04 73 10
64 382 -22 72 +04
6501 383 02 67 -20
6502 329 -56 96 +09
6601 391 +13 88 -03
6602 319 -59 97 +06
6701 327 71 145 +72
6702 331 ~67 83 +1-0
6801 365 -66 49 +01
6802 388 4bull3 54 +06
69 354 -41 80 +23
70 400 -23 68 -06
71 359 -48 72 +05
72 255 -88 82 +11
73 346 -39 91 +25
74 313middot -63 105 +24
75 329 -42 129 +37
76 336 -52 85 +21
77 370 -10 69 +05
78 309 -10 120 +21
79 325 -56 87 +10
8001 358 -81 57 +12
8002 391 ~81 76 +12
81 315 -76 108 +21
8201 403 -23 64 +08
8202 392 23 65 +08
83 357 -34 120 +31
84 402 -18 73 +16
85 413 -06 76 -09
r
Demographic Population Change 1960 to 1970 52 (Contd)
Census Tract
t of Pop Uncler 19 Yrs
1970
Change 1960-70
1 of Pop OVer 65 Yrs
1970
ex Change 196070
86
87
88
89
90
91 9201
9202
93
94
95
9601
9602
9701
9702
9801
9802
99
100 I
101
102
103
10401
10402
lOS
368
351
379
391
391
413
379
433
372
429
414
432
419
439
~32
377
457 420
378 41middot7
345
360 417
417
412
-04
-02
-35
-26
-28
-11
-64
-20
-S9
-39
-32
-21
-34
-40
-47
-lO~7middot
-27middot +04
+56
+07
-34 01
+04
+04
+10
103
128
97
11il3 99
69
79
42
77
46
34 38
44
40
54
111
51middot
81
133
59
74
140
63
87
76
-08
-06
+04
+08
+17
-05
+3S -02
+1~4
+19
+33
-14
-08
+12
+26
+71
+11
-16 -34
-20
-19 +37
-49
-2S +15
NOte The The
Taken frOi
averageullder averageabove
middotUSCensus ---shy -
19 years == 6S years ==
figures 197
32r 13(14
p a~d 1960
--
Rank
1
2
3
4
5
6
7
8
9
10
11 12 -_
13
14
15
16
17
18
Tract
69 46
60
58
- 68
61
302
2501
67
63
19
62
26
94
3603
3902
64
30 -----~-
Rank
19
20
21 -
22
23-shy
24
25
26
27
28
29
30
31
32
33
34
35
36 -
Ranking of Per Capita Income by Census Tract
Tract
65
2701
- 15
1601
701
66
93
82
2903
3602
30
2502
80
2401
81
- 70
91 shy
4001
High
Rank Tractshy
-32shy37
38 97
120239
7840
41 ~ _2_1__ 42 31
43 2501
44 18
45 98
46 37
47 3803
1702
49
48
1602 92 2702
I
50 89
51 901
52 801
Ra_
53
54
55
56
57
58
59
60
61
62
63
64
6S
66
67
68
TractTract Ra~
74692
170196 70 I
401 71 90
72 1037J
79 70273
3802 74 601
24024102 75
85 76 101
77 9023901
7699 78 100 4101 79
3601 I
380180
458140~ t---- _ - - shy83 82 42
888384
59843501
4777 8~
502
Low
802 86
Rank Tract
87 shy
--88
89
90
91
92
93
94
- 95
96
97
middot98
99
100
101
102
103
104
1201
14
49
72
73
43
87
3502
105
1
52
86
71
1
501
10
3301
104 tf
Rank
105
106
107
108
109
110
III
112
113
114
115
116
117
118
119
120
121
Ranking of Per Capitalucoae by Census Tract
(Contd)
Tract Rank
4001 122--shy602
13
1102 2302
3302
55
3401
48
21
56
50
3402
lL01
2202
2301
53
2201
-shy
Tract Rank Tract Rank T~aet Rank
57 I-----
Imiddote
bull
Tract
- Low -k Note Information taken from 1960 U SCensus
Rank Tract
I ~
Ie
Imiddot
~
----
----
--
--
Rank
1
2
3
4
5
6
1
8
9
10
11
i-
-Tract
391 922 921
972 971
100
132 131 121
962 961
822 821 401
982 981
20 111
47 10 1
412
High
Total Number of Henta1 Health Visits
Ranked by Census Tract High to Low
TractTract RankTractRank Rnk
12 182 22 78 29 87 76 381 73181 ~------- 1913 371 8538230162372 271 2616-121 8272 2
14 80~2 31 94 7923 84801 59 15251362 4232 15 52 _ 32 103 8924 651 17240216 652
_ 91 351 33 341 23117 83 122 25 25 48 1123921418 34 shy61 86 661
19 662 6493 81 26 91 8153 49 50 55 41383 71 27 51 3120 90 672241 35shy 104167162 461
I 411 46211121 28 88342 I
2502 36 69 54 5251 50 272
-Ra
37
38
39
_ 40
_ 41 Ishy
I
42 I
-I 43 44
45
shy
Tract
~ --- shy 95 56
45 292 242
102 62 352 291y
92
101 281
99 72 63 601 60~ 42 2201
77 74 61 57
363 232
70
32 31
11 44 282 2202
Low l
- Tract
46 682 681 I 331 30
r~$ 47 1042 332
48 102_41_
11
~
Visits to Family Planning Clinics Ranked by Census Tract High to Low
Rank Tract Rank Tract Rankmiddot Tract Rank Tract Rank Tract Rank Tract
1
2
3
4
5
6
7
8
9
10
11
12
13middot
14
15
16
17
361
56
401
341
48
59 121
20
55
342
10
31
58
93 21
241 132
331
53
461 462
18
19
20-shy21
22
23
24
25
26
27middot
28
29
30
31
32
33
391
32
middot47 I-i-_-shy _ -
231 111
332
972 1
372 371
52
89
32
92
82
100 31
182
30 242
402
34
35
36
37
38
39
40
41
42
43
44
45
42
1714 i 661 221
78 362 2
90 602 601 352
63 251
105 921
971 351
73 42 292 232
411 51
662
81 45 52
46
47
48
49shy
50
51
52
53
54
55
56
961
801
49 81 72 71
19
9~1
172
68 2 57 162 14 112
91 75 681
381 42
3~3
83 161
57 f
58
59
60
61shy
62 Imiddot
63
Imiddot 64
65
66
64 62 36~3 252
74 652 SO 392 291
651 6bull 2
79 271
r-- ---- shy981 222
672 671
821 272
94 87
281
382
67
68
69
70
71
72
73
74
75
76
77
78
981 26 12~2
IS 61
85 82~2 69
61 43
101 86 84 282
76
131
51 72
1041 962 88 70
99 922 77
103
95 802 181
i
~
Low High
RankRank Tract
5479
4480
81 1042 ~) middot102
71 - - + ~ - ~
Visits to Family Planning Clinics
(Contd)
Tract Rank
I
Tract llaDk l
RankTract Tract Rank Tract
~
I
~
J1 ~
Low
Total Number of public Health Nursing Visits
Ranked by Census TractsHigh to Low
TractTract RankTractRank RankRank TractTractRankTractRank
25249 71 79 17249 8033 6586 99189711 84 2915072 34 661 76 66 811519512
402 5035 51 161 2518220 122 1713423 352 55801 7120 6752 2 149814 41236 83 2662 38 94 6821 53 2924015 362 37 32 42 75 69 281 84 63
546 8822 54 222 85 3925431 70383417 3818223 6439 4386652 718 21 55 103332 8924 232 87 19 271729219619 24156 16211140 382 628825 10523110 112 73411 10141-- ----shy 89 363 4457 8126 16111 221 74 9142 90 46158331 53 671279012 46243 48 59 351 3837528 1083 9313 91 5844 59 -_242 76 1----- shy60 272 72 74104114 60145 42 9287 7729 92 6151 8215 57371 934630 91 307762 12113116 282 619447 41391 9531 78100 63 7378 ~95 681 6945 32 5632 798517 6448 47 52 181
High ~ Low
Rank Tract Rank
96 31 132 70
97 102
98 182 372middot 602 651 662
- -shy
~72 682 802
822 922 962 972 982
1042 ----shy
Low
Total Number of Public Health Nursing Visits
(Contd)
Rank Rank Rank TractTract Tract
I
I lt
I
Tract Rank Tract
[
~~~-
I
~
IJilfimiddot ~
j
Ranking of VD Caea According to Census Tracts 61 By High and LOll Youth Itatio
A media~ of 34 5 was determined Any tract having greater
than 34 5~ of popu1tionunde~ 19 years of age -High~
Any tract having l8S than 345 of population under 19
years == Low
Any tract having rate less than 390 =Low
Any tract having rate more than 390 == HLgl4
YOUTH
LOW HIGH
L
0
12 402 1801 1802 343 2801 2802 29023603
54 6001 600262 66~02 72 74 75 76
78 79 81 t02 65 1202
W
(25)
VD
H
I
G
H
401 701 801802 901 902 10 1101 241 1201 1301 132 14 15 1601 1701 20~ 21 2202 2j02 2402 2502 2702 2901 303501 3502 34023801 3802 383 3902 42 44 45 4601 4602 47 48 49 SO 51~2 53 55 56 57 58 S9 6701 6702 73 95
3~02 7021702 19 25~01 2701 4102 4101 63 64601 ~601 6801 680270 7l 77 8001 80~02 8201 8202 83 84
85 86 87 88~ 90 91 9202 920193 94 9601 9602~ 9701 9102 9801 9802 99 100 101 103 10402 105 6501 10401
(47)
301 501 502 601 1602 2401 2301 2201 31 32 3301 3302 3401 3402~ 3602 3702 3901 400140 02 43 61 69 B(
(53) (23)
~ ~gt
Ranking of VD by Rate Per 100000 By Census Tract
~
Rank Tract Rank Tract Rank Tract Rank Tract llank Tract Rank Tract Rank Tract
1 2202 21 S6 40 902 58 1602 74 75
90-shy 64 107 26 --~-
2 3402 22 45 41 10 59 902 75 78 91 54 108 61
3 2301 23 3502 42 2502 60 602 76 6802 92 402 109 87
4 3302 24 49 43 1102 61 501 17 2 93 94 110 90
5 50 25 52 44 6702 62 14 78 8202 94 97 02 III 76
6 2201 26 20 6701 63 4002 8201 2501
9701 41~02 112 91
7 44 27 48 45 401 64 3802 2902 95 63 113 62
8 3301 28 1701 46 502 65 30 79 83 74 96 9602 114 71
9 55 29 47 47 42 66 3803 80 2801 96Q1 115 85 10
11
12
13
14
15
16
17
18
3401
53
2302
2401
57
21
2402
1101
51
30-shy31
32
33
34
35
36
37
3701 - -~ 1201
3702
89
43
132 131
3602
4001
48
49
50
51
52
53
54
55
58
1601
601
4602 4601
69
701
31
3901
67
68
69
70
71
72
2901
801
39021~ 802
6502 6501 122
702
41~01
81
82
83
84
85
86
87
88
19
1
1702
2802
79
93
100 6801 6602
81
97
98
99
100
101
102
103
104
9201 9202
9802 9801
77
302
79
86
72
84
116
117
118
119
120
121
3603
8002 8001
101
99
95
10401
105 10402 103 102
19
20
59
32
38
39
2702
3501
56
57
301
3801
73 1802 1801
89 6002 6001
105
106
2701
88
High Low
-- -----
Rank OrdermiddotTuberclosis Cases by Rate Per 100000 Ranked by Census Tract High to Low
Tract TractRankTractRank Rank TractRaukTractRankTractRank
801
79 9601501411 52 6835340120511 I 960269 903603532036 $-~~F130221542 4366 311301 70 68~013802 _ I- _ 4001_37213 3921201 6802802 H71523822024 22 54 193302 3802 80 8958 I37139535 70155 9801 I60123 72 6702 98023914011016 6701250124 10 56
81 94 401r 7 154152 73 7057 2625 122 92028
90242 162312301 92~158 86 7172434526509 82 79160159 74 100 87412240227220110 6502836960 75 30 8317244 6501782801285711 61 901 42765645 84 66021459294912 9701 660146 171 302 9702 47
6235023033113 85 822821182 917755 16335013110214 841814832 78 103 938564 324815 86 1057940149272 38036523216 10401 87 2902241 725Q 10402360266340217middot IF88 88 9937233 282 51 218 101 01102 46016234
I)167 2901460219 47
High ~ Low ~
- -
TractRank
9S89
6490
8191 8001 8002
63 61 60middot01 6002 44 2701
92
J
2502 402 --- ----shy
I
Rank
Rank Order Tuberculosis Cases by Rate per 100000
(Coutd)
Tract Rank Tract ~nk
I
Tract Ballk Tract Rank
Imiddot
Tract
Imiddot
1~
t 1I i Pi i l I
o
1 -1shyL I
I J
8 40 icO ~ I -lt 0
-t (1) I
i I
r o E
II
a
I
r--i
shy
I
~
I (
Jgt
(011 fi(
Ggt
I II ~j
()
(f 0
~ ()
I
11
f9
r
II 99
o ~
Ggt r
~ __-J~ I t I ~ I
r--J l I
~ _ __ J
) 1
fTl
1gt
r I
()
r
()
lt en -i en
()
I1l
(J)
(J)
-i
P ()
19
r o ~
r G1 I
I
c
~
o I 89
--- -I-shy
r-r I
1- 0 _~ _ _--J E
G1 I I I
i i
I 1-1-1 ~ _J ~2 ~ II
II
()
1 I I I 1
id i bullbull
~
A n 69
r 1shy
- 0 Gl
l--~ ~ I
~ II
II )
I () isect i
en l i
(J)
-t
0
IA Ol
42
amily PlellnSDI ]Jlce Metal Health i8 an 1nd1ce of
use Theperson 111 ordertobavebe_ 1Dcluclecl 1n this
atu4ywouldhave tohaft Ue4 ataa11y plaDI cl1D1c
tacilities of soaetype It 41fter troll tile _tal health
study1nthat i t1Jicludestatist1catrollbotb public and
privateclJD1os
The iDformation tor the iak orurcbart 8Dd map of
t8ll111 plenn1 na ob1a1De4 by cOIIblnlDlthe mabel of
1rlcuv1duals bullbull_ attbe tbreellUltrampo-ti Coatyhll11y
PlalJQllIl C11ll10s 111til tbo at the Planned PareDthood
Association CliD1C8 be tbree -JIultDouh Couaty r8ldly
PlamSq Cl1D1c are Solrtbweatth Col_bla 1111- a114
HaDsell Health BWlcl1Dl CllD1cbi middot1Dtormat1oD vas then
bullbullbullesed tomiddot detellWMt l10w people troll eacb c8IUIUS
chart wastben Mele IUs oIIart jn 4iY1ded to show
the censuS tracts lIaYiDlmiddottIle h1t1iest qUart1le of incidence
of use lowest quartile of 1Qc1deao ot use Jlid 12 of
incidence of Wle an4 a map sprepared troll thts 1Dto~
mation
The C8U118 tractsbelOJISnl to the h1lhestquartile of
use appear to be 1lO~ 8catt~ on tbipwas true ot
either the _p ot aental health cl1D1c uaageor ot the map
abow1DI per capita 1I1COM Iaere40 to be three
d18t1nct areas of UIIaP beJ woul4 be
1
IJ
43
t10D of BurD81cl and the W11lallette River 4
2 S~t Portland 8Otth otmiddot the ra11shyrcaadand alona the W11lamette River
lIortbeaat Portl8D4 between MisSiss1pp1 and 24tbStreet the northbouBclary be1DgColwb1aBlvd
Pylzl1c BMltl IrpI Y11ta
Publlc Healtil nur81D1Y1s1t nclud8 an vists to
theholles of client by PubUc Health Nurbullbullbullbull his shows
visits to bull f8Jl1ly fer aDY purpos SUCh aatuberculolJ1s
het1Dl tem1tyaeatalu4 8IiOt10D8l cODd1t1ona etc
he atat18t1C~ 1fele C()4ed accord1Dg tomiddot the 1llli301fOCUS
of the Y18lt tt doe DOt 1D41cate the Dmlber of holies or
f8ll11lev181tecl or 1D41Y14ual Y1a1ted more tban oDcein
the propwl It dobullbull I1ve 80M 1D41cat1on by coaparlshy
OD ot the 8JIoUDt of aedlcal problema 1n eachcen8WI tract
Ap1nmiddot the _p abowa 8 scatter patteraof probl_
areas althoUSh there appear to be a sroup1Dl of hiSh J
l8aIeccmaus tract 1ntlut extreme southeast part of tbe
County other areu uIriaI any nura1Dl contacts are
1 bull he 801lth-oa-al CO1Dty on eaCh 814 of 82nd Av from Clackallaa County north to Dinloa
2 ear bullbullbullt 814e aroUDd Preacottand Misaisippi
Dowatom Bunul14eonboth 1de of the river
44
V_real Pis The iDfomatloil uaec1 to tabulate the Venereal
disease chart includes all the ooab1ned case otmiddotODormea
and syphilIs reported by bothmiddot publIc and prIvate physicIans
dur1nl 1970 There were 3602 caes ot IOnorrhea reported
dur1nl 1970 While ODly 17 cabullbullsot ayphilimiddot were reported
A chart was prepUed aDd att8llPt wasmiddotmiddot de tomiddot
determ1De Wh_therVttDereal 41ease was more p~vaJent in
areas othigb or lowmiddot proportIon ot youth hi waadone
bymiddotdetemlna a 1leaD prceiltacmiddotmiddotmiddottor the population ot
resld~ts UDder19 years ot (34) middotA mean ratemiddot per
100000 popUlatIon al80c1ttem1Ded tor the middotoccurreDCe
ot venereal dieae This was et at 390 oass Areas
hav1nl a population 1n which leiS than 34 were lmder 19
years ot ampIe were called low- yOuth abOve tbl percentaae
hiSh youth The aaa waatrue ot the occurrence oivenershy
eal disea_ per CeD8UStract It the rate waacomputed
as 1I0re than 390 cases per 100000 it was called hiah
venerealdiaeasei it less than thia tisure low venereal
disease It was tound that 1D Multn~ COmlty there sems
to be poSitive OOlatI0n(x21S19gt between low youth
and hipmiddot venereal diseaand hip youth and low venereal
diseasebull
RaDk ordr Iitot all c traot middottbAm made
Th1s was done byt1Ddlna the ratepr 100000 populatIon
of venereal disator all census tracts in the County bull
45
These were thenlisted from h1lhto low (sreatest to
least) in a rank order The l1sting was then divided
into Upperandlower 14 aDd listed on the MUltnomah
Countymiddot up
The areas of b1gh venereal disease se8ll18to
roup thBl~8 middotin a very tllht area ~oq both 1des
of thell18l8~ R1 w1th BurDaldeS~et being
~bout theceDter qf tbi8IZ9uping This area woUld
appear to be m ldeal spot for the denlopment of a
locallzed venereal d1sbullbullbullbull cl1D1c
UbepoundCUlO1s
In this report bull tube1C1llosls caS8S refrred
to include alltbobullbull cabullbulls ontubercUlo8is follow-up
rather middotthan just new C Accord1Ds to the Multnomah
County Health SUrvey of early 1971 this would include
all ca repOrte4 over thelaat three years The
total number of tuberculosi8 cabullbullbull usedin this study
was 666 lh1 included 128 new cabullbullbullbull
A rate per 100000 of tuberculosis for each
census tract wa- then computed and the c~us tracts
listed by rank order be b11h Qartlle mel low
quartl1 were then reoordd on a Multnomah CoUnty map
TWo genral areaa baY1Dg a hip mcldencaot tubercu~
losiare 1D41cated heyare
1 Both middotsld ot theWilla11lette River
Ll -
46
with Burns1de about thecnter
2 he extrea Northebullbullt comer of the County bull
By coap8r1ng the tuberculois an4ven8real
diseae maps ODe can 8ee that the downtown areas ot
hiSh 1nc1denceare alIIo8t 1c1eDt1cal on ach map
This WOuld 1nd1cate that 1t would be of value to
bullbulltab11sh acl1D1c 111 th1aampreatbat would provide
bothtuberCulos1s 8Dd ytmereal 418ase srvicbullbullbull
Thchart aDd 1181gt8 are wsfuln 11v1DI
1Ddicat10DS tor the type aDd placemeototlocal
health cl1n1c8 tbro1qhout tbe MultnomahCounty area
A cOllpar1on of the mapa help one to dec1dewhether
to provide a aulti-8ervice cl1D1c or spec1f1c type of
cliD1c As stated in Part I of thi paprserv1ces
shouldhaYe both treatlieDt and prfMmt10n cOmponents
As he been stated fta ne1lbborhood health care
Qenter muat be a fac111tY plazme4 with an aamesa
ot the neds of the consumer and the c01llll1m1tybull
Part II of this rport haa been an attaapt to indicate
and clarify 8011 ottheae coDlllUDity neds This has
been done through8elect10n of apc1f1c problems
The indic were then visuallyrecorded through the
use of ups and charta ODe dan asseS8 thedsreeof
1DIportance of certain concems to spec~t1c areaa by
comparinl the chart aDd maps Prom this oDeean
41 dec1de which are48 vb1chcUD1c-or indeed if
the need a clinic at all However further factors
should be considered hebullbull include
a The amount of fuDd1 available
b What 18 the percentage ot peopleineoh ceaaua tract tbat would actually us such cl1n1cIl
c Wbat 1 tbeco--1tymiddot 8 IeeliDashyreaardtDI particular cl1D1c8 Would this dcrebullbullbullmiddot the ettctiveness ot thse cl1n1ca
IJ
li
D_OlraphicPopulatLon Challie 1960 to 1970 48
Cen8U8 1 of Pop 1 Cbaqemiddot 1 Change1 ofPopTract Under 19 Yr8 Over 65 Yrs1960-70 1960-70
middot1Q701Q70
1 319 -12 171 -H) 1
2722 215-27 +68 301 366 -22 127 +35 302 371 +19 111 -04
311middot401 144-41 +29 402 321 13~7-39 +24 501 356 124-08 -02 5~O2 351 133-23 +12
405601 82-10 -02 394602 103-01 -06
701 275 149-76 +56 702 361 +01 121 -07
+10middot801 326 140-22 802 321 middot127
(
-29 -03 9~01 342 124 -H) 6-18 902 294 128 -H) 3-24
10middotmiddot -14312 140 -17 1101 182 +25 -23197
2411102 186-59 +29 1201 226 169-17 -41
31middot01202 +11 182 -05 295 -H) 81301 208 -H) 4
1302 331 +08 197 +04
14 323 +15 middot185 -08 middotmiddot15 329 +16 16~5 -13
-28middot 1601 332 131 +12
1602 356 98 +24middot-39 middot3101701 161-33 +21
1702 370 -15 85 +02 +19 1801 264 151middot-50
185middot1802 256 +47-58
IJ ~
D_raphlc Population Change 1960 to 1970middot 49 (Contd)
4io
Census Tract
of pop Uncter 19 Yra
1Q1n
1Cha1l8e 1960-70
of PopOver 65 Yra
lQO Change
1960-70
19 389 +29 141 -24 20 223 -13 206 +18
21 227 +08 194 -36 2201 356 -27 112 +05
2202 290 -18 ll~9 -29 2301 356 -03 154 +24 2302 260 -37 245 +97
2401 410 +6~1 123 -31 2402 163 -80 320 +99 2501 381 +13 140 -01 25()2 237 31 lil +02 26 343 +25 186 +149 2701 370 +29 1S5 -01 2702 249 -44 304 +98 2801 337 +19 187 +09 2802 306 -10 156 +31 2901 304 -38 142 +24 2902 i 307 -32 146 t3~9
30 29~0 -48 16~2 +51
31 355 +30 160 +01 32 370 +48 148 -13 3301 395 +45 130 -20 3302 368 +06 138 -02 3401 386 +16 117 000
3402
400 +32 92 -26 3501 304 -07 115 +35
3502 344 000 140 -13
3601
36~02 357 -04 132 +32
3603 30~1 42 149 -67 3701 342 +28 152 +19
1
IJ
Jianolraphic Population Chan 1960 to 1970 50 (Contd)
Census Tract
of Pop Under 19 Yrs
JJl7J
middotChanae 1960-70
middotofmiddotpop Over 65 Yrs
1c~7n
Change 196070
3702 409 +39 122 -11 3801 308 -11 151 +29 3802 275 -35 180 +46 3803 282 -32 192 +54 3901 376 ~13 100 +17 3902 296 -03 177 +29 4001 438 -11 84 +13 4002 353 -21 115 +20
4101 397 11 9middot0 +11 4102 346 -19 120 +03 42 331 +19 11 bull 3 -16 43 347 -72 105 +31 44 113 +84 183 +154 4S 33~9 +07 110 -06 4601 2501 22 193 +38 4602 332 +59 126 -29 47middot 161middot 000 211 +01 48 103 -26 302 +59 49 138 +1 bull 3 252 +09 50 141 -26 204 -12 51 12 -39 257 +07 52 47 -61 351 +48 53 89 +49 314 -30 54 25 l1li15 327 -17 55 131 -17 115 -121 56 198 +93 227 -47 57 71 102 189 -88 58 240 ~middot41 16~1 +55 59 322 +25 142 +06middot 6001 264 95 132 +50
6002 328 -31middot 89 +07
JJ
Demographic Population Change 1960 to 1970 51 (Contd)
Census 1 ofPop lChange of Pop bull ChangeTract Under 19 Yrbullbull 1960-70 Over 65 Yrs 1960-70
1970 1970
61 355 -58 85 +39
62 328 39 110 +18
63 414 04 73 10
64 382 -22 72 +04
6501 383 02 67 -20
6502 329 -56 96 +09
6601 391 +13 88 -03
6602 319 -59 97 +06
6701 327 71 145 +72
6702 331 ~67 83 +1-0
6801 365 -66 49 +01
6802 388 4bull3 54 +06
69 354 -41 80 +23
70 400 -23 68 -06
71 359 -48 72 +05
72 255 -88 82 +11
73 346 -39 91 +25
74 313middot -63 105 +24
75 329 -42 129 +37
76 336 -52 85 +21
77 370 -10 69 +05
78 309 -10 120 +21
79 325 -56 87 +10
8001 358 -81 57 +12
8002 391 ~81 76 +12
81 315 -76 108 +21
8201 403 -23 64 +08
8202 392 23 65 +08
83 357 -34 120 +31
84 402 -18 73 +16
85 413 -06 76 -09
r
Demographic Population Change 1960 to 1970 52 (Contd)
Census Tract
t of Pop Uncler 19 Yrs
1970
Change 1960-70
1 of Pop OVer 65 Yrs
1970
ex Change 196070
86
87
88
89
90
91 9201
9202
93
94
95
9601
9602
9701
9702
9801
9802
99
100 I
101
102
103
10401
10402
lOS
368
351
379
391
391
413
379
433
372
429
414
432
419
439
~32
377
457 420
378 41middot7
345
360 417
417
412
-04
-02
-35
-26
-28
-11
-64
-20
-S9
-39
-32
-21
-34
-40
-47
-lO~7middot
-27middot +04
+56
+07
-34 01
+04
+04
+10
103
128
97
11il3 99
69
79
42
77
46
34 38
44
40
54
111
51middot
81
133
59
74
140
63
87
76
-08
-06
+04
+08
+17
-05
+3S -02
+1~4
+19
+33
-14
-08
+12
+26
+71
+11
-16 -34
-20
-19 +37
-49
-2S +15
NOte The The
Taken frOi
averageullder averageabove
middotUSCensus ---shy -
19 years == 6S years ==
figures 197
32r 13(14
p a~d 1960
--
Rank
1
2
3
4
5
6
7
8
9
10
11 12 -_
13
14
15
16
17
18
Tract
69 46
60
58
- 68
61
302
2501
67
63
19
62
26
94
3603
3902
64
30 -----~-
Rank
19
20
21 -
22
23-shy
24
25
26
27
28
29
30
31
32
33
34
35
36 -
Ranking of Per Capita Income by Census Tract
Tract
65
2701
- 15
1601
701
66
93
82
2903
3602
30
2502
80
2401
81
- 70
91 shy
4001
High
Rank Tractshy
-32shy37
38 97
120239
7840
41 ~ _2_1__ 42 31
43 2501
44 18
45 98
46 37
47 3803
1702
49
48
1602 92 2702
I
50 89
51 901
52 801
Ra_
53
54
55
56
57
58
59
60
61
62
63
64
6S
66
67
68
TractTract Ra~
74692
170196 70 I
401 71 90
72 1037J
79 70273
3802 74 601
24024102 75
85 76 101
77 9023901
7699 78 100 4101 79
3601 I
380180
458140~ t---- _ - - shy83 82 42
888384
59843501
4777 8~
502
Low
802 86
Rank Tract
87 shy
--88
89
90
91
92
93
94
- 95
96
97
middot98
99
100
101
102
103
104
1201
14
49
72
73
43
87
3502
105
1
52
86
71
1
501
10
3301
104 tf
Rank
105
106
107
108
109
110
III
112
113
114
115
116
117
118
119
120
121
Ranking of Per Capitalucoae by Census Tract
(Contd)
Tract Rank
4001 122--shy602
13
1102 2302
3302
55
3401
48
21
56
50
3402
lL01
2202
2301
53
2201
-shy
Tract Rank Tract Rank T~aet Rank
57 I-----
Imiddote
bull
Tract
- Low -k Note Information taken from 1960 U SCensus
Rank Tract
I ~
Ie
Imiddot
~
----
----
--
--
Rank
1
2
3
4
5
6
1
8
9
10
11
i-
-Tract
391 922 921
972 971
100
132 131 121
962 961
822 821 401
982 981
20 111
47 10 1
412
High
Total Number of Henta1 Health Visits
Ranked by Census Tract High to Low
TractTract RankTractRank Rnk
12 182 22 78 29 87 76 381 73181 ~------- 1913 371 8538230162372 271 2616-121 8272 2
14 80~2 31 94 7923 84801 59 15251362 4232 15 52 _ 32 103 8924 651 17240216 652
_ 91 351 33 341 23117 83 122 25 25 48 1123921418 34 shy61 86 661
19 662 6493 81 26 91 8153 49 50 55 41383 71 27 51 3120 90 672241 35shy 104167162 461
I 411 46211121 28 88342 I
2502 36 69 54 5251 50 272
-Ra
37
38
39
_ 40
_ 41 Ishy
I
42 I
-I 43 44
45
shy
Tract
~ --- shy 95 56
45 292 242
102 62 352 291y
92
101 281
99 72 63 601 60~ 42 2201
77 74 61 57
363 232
70
32 31
11 44 282 2202
Low l
- Tract
46 682 681 I 331 30
r~$ 47 1042 332
48 102_41_
11
~
Visits to Family Planning Clinics Ranked by Census Tract High to Low
Rank Tract Rank Tract Rankmiddot Tract Rank Tract Rank Tract Rank Tract
1
2
3
4
5
6
7
8
9
10
11
12
13middot
14
15
16
17
361
56
401
341
48
59 121
20
55
342
10
31
58
93 21
241 132
331
53
461 462
18
19
20-shy21
22
23
24
25
26
27middot
28
29
30
31
32
33
391
32
middot47 I-i-_-shy _ -
231 111
332
972 1
372 371
52
89
32
92
82
100 31
182
30 242
402
34
35
36
37
38
39
40
41
42
43
44
45
42
1714 i 661 221
78 362 2
90 602 601 352
63 251
105 921
971 351
73 42 292 232
411 51
662
81 45 52
46
47
48
49shy
50
51
52
53
54
55
56
961
801
49 81 72 71
19
9~1
172
68 2 57 162 14 112
91 75 681
381 42
3~3
83 161
57 f
58
59
60
61shy
62 Imiddot
63
Imiddot 64
65
66
64 62 36~3 252
74 652 SO 392 291
651 6bull 2
79 271
r-- ---- shy981 222
672 671
821 272
94 87
281
382
67
68
69
70
71
72
73
74
75
76
77
78
981 26 12~2
IS 61
85 82~2 69
61 43
101 86 84 282
76
131
51 72
1041 962 88 70
99 922 77
103
95 802 181
i
~
Low High
RankRank Tract
5479
4480
81 1042 ~) middot102
71 - - + ~ - ~
Visits to Family Planning Clinics
(Contd)
Tract Rank
I
Tract llaDk l
RankTract Tract Rank Tract
~
I
~
J1 ~
Low
Total Number of public Health Nursing Visits
Ranked by Census TractsHigh to Low
TractTract RankTractRank RankRank TractTractRankTractRank
25249 71 79 17249 8033 6586 99189711 84 2915072 34 661 76 66 811519512
402 5035 51 161 2518220 122 1713423 352 55801 7120 6752 2 149814 41236 83 2662 38 94 6821 53 2924015 362 37 32 42 75 69 281 84 63
546 8822 54 222 85 3925431 70383417 3818223 6439 4386652 718 21 55 103332 8924 232 87 19 271729219619 24156 16211140 382 628825 10523110 112 73411 10141-- ----shy 89 363 4457 8126 16111 221 74 9142 90 46158331 53 671279012 46243 48 59 351 3837528 1083 9313 91 5844 59 -_242 76 1----- shy60 272 72 74104114 60145 42 9287 7729 92 6151 8215 57371 934630 91 307762 12113116 282 619447 41391 9531 78100 63 7378 ~95 681 6945 32 5632 798517 6448 47 52 181
High ~ Low
Rank Tract Rank
96 31 132 70
97 102
98 182 372middot 602 651 662
- -shy
~72 682 802
822 922 962 972 982
1042 ----shy
Low
Total Number of Public Health Nursing Visits
(Contd)
Rank Rank Rank TractTract Tract
I
I lt
I
Tract Rank Tract
[
~~~-
I
~
IJilfimiddot ~
j
Ranking of VD Caea According to Census Tracts 61 By High and LOll Youth Itatio
A media~ of 34 5 was determined Any tract having greater
than 34 5~ of popu1tionunde~ 19 years of age -High~
Any tract having l8S than 345 of population under 19
years == Low
Any tract having rate less than 390 =Low
Any tract having rate more than 390 == HLgl4
YOUTH
LOW HIGH
L
0
12 402 1801 1802 343 2801 2802 29023603
54 6001 600262 66~02 72 74 75 76
78 79 81 t02 65 1202
W
(25)
VD
H
I
G
H
401 701 801802 901 902 10 1101 241 1201 1301 132 14 15 1601 1701 20~ 21 2202 2j02 2402 2502 2702 2901 303501 3502 34023801 3802 383 3902 42 44 45 4601 4602 47 48 49 SO 51~2 53 55 56 57 58 S9 6701 6702 73 95
3~02 7021702 19 25~01 2701 4102 4101 63 64601 ~601 6801 680270 7l 77 8001 80~02 8201 8202 83 84
85 86 87 88~ 90 91 9202 920193 94 9601 9602~ 9701 9102 9801 9802 99 100 101 103 10402 105 6501 10401
(47)
301 501 502 601 1602 2401 2301 2201 31 32 3301 3302 3401 3402~ 3602 3702 3901 400140 02 43 61 69 B(
(53) (23)
~ ~gt
Ranking of VD by Rate Per 100000 By Census Tract
~
Rank Tract Rank Tract Rank Tract Rank Tract llank Tract Rank Tract Rank Tract
1 2202 21 S6 40 902 58 1602 74 75
90-shy 64 107 26 --~-
2 3402 22 45 41 10 59 902 75 78 91 54 108 61
3 2301 23 3502 42 2502 60 602 76 6802 92 402 109 87
4 3302 24 49 43 1102 61 501 17 2 93 94 110 90
5 50 25 52 44 6702 62 14 78 8202 94 97 02 III 76
6 2201 26 20 6701 63 4002 8201 2501
9701 41~02 112 91
7 44 27 48 45 401 64 3802 2902 95 63 113 62
8 3301 28 1701 46 502 65 30 79 83 74 96 9602 114 71
9 55 29 47 47 42 66 3803 80 2801 96Q1 115 85 10
11
12
13
14
15
16
17
18
3401
53
2302
2401
57
21
2402
1101
51
30-shy31
32
33
34
35
36
37
3701 - -~ 1201
3702
89
43
132 131
3602
4001
48
49
50
51
52
53
54
55
58
1601
601
4602 4601
69
701
31
3901
67
68
69
70
71
72
2901
801
39021~ 802
6502 6501 122
702
41~01
81
82
83
84
85
86
87
88
19
1
1702
2802
79
93
100 6801 6602
81
97
98
99
100
101
102
103
104
9201 9202
9802 9801
77
302
79
86
72
84
116
117
118
119
120
121
3603
8002 8001
101
99
95
10401
105 10402 103 102
19
20
59
32
38
39
2702
3501
56
57
301
3801
73 1802 1801
89 6002 6001
105
106
2701
88
High Low
-- -----
Rank OrdermiddotTuberclosis Cases by Rate Per 100000 Ranked by Census Tract High to Low
Tract TractRankTractRank Rank TractRaukTractRankTractRank
801
79 9601501411 52 6835340120511 I 960269 903603532036 $-~~F130221542 4366 311301 70 68~013802 _ I- _ 4001_37213 3921201 6802802 H71523822024 22 54 193302 3802 80 8958 I37139535 70155 9801 I60123 72 6702 98023914011016 6701250124 10 56
81 94 401r 7 154152 73 7057 2625 122 92028
90242 162312301 92~158 86 7172434526509 82 79160159 74 100 87412240227220110 6502836960 75 30 8317244 6501782801285711 61 901 42765645 84 66021459294912 9701 660146 171 302 9702 47
6235023033113 85 822821182 917755 16335013110214 841814832 78 103 938564 324815 86 1057940149272 38036523216 10401 87 2902241 725Q 10402360266340217middot IF88 88 9937233 282 51 218 101 01102 46016234
I)167 2901460219 47
High ~ Low ~
- -
TractRank
9S89
6490
8191 8001 8002
63 61 60middot01 6002 44 2701
92
J
2502 402 --- ----shy
I
Rank
Rank Order Tuberculosis Cases by Rate per 100000
(Coutd)
Tract Rank Tract ~nk
I
Tract Ballk Tract Rank
Imiddot
Tract
Imiddot
1~
t 1I i Pi i l I
o
1 -1shyL I
I J
8 40 icO ~ I -lt 0
-t (1) I
i I
r o E
II
a
I
r--i
shy
I
~
I (
Jgt
(011 fi(
Ggt
I II ~j
()
(f 0
~ ()
I
11
f9
r
II 99
o ~
Ggt r
~ __-J~ I t I ~ I
r--J l I
~ _ __ J
) 1
fTl
1gt
r I
()
r
()
lt en -i en
()
I1l
(J)
(J)
-i
P ()
19
r o ~
r G1 I
I
c
~
o I 89
--- -I-shy
r-r I
1- 0 _~ _ _--J E
G1 I I I
i i
I 1-1-1 ~ _J ~2 ~ II
II
()
1 I I I 1
id i bullbull
~
A n 69
r 1shy
- 0 Gl
l--~ ~ I
~ II
II )
I () isect i
en l i
(J)
-t
0
IA Ol
IJ
43
t10D of BurD81cl and the W11lallette River 4
2 S~t Portland 8Otth otmiddot the ra11shyrcaadand alona the W11lamette River
lIortbeaat Portl8D4 between MisSiss1pp1 and 24tbStreet the northbouBclary be1DgColwb1aBlvd
Pylzl1c BMltl IrpI Y11ta
Publlc Healtil nur81D1Y1s1t nclud8 an vists to
theholles of client by PubUc Health Nurbullbullbullbull his shows
visits to bull f8Jl1ly fer aDY purpos SUCh aatuberculolJ1s
het1Dl tem1tyaeatalu4 8IiOt10D8l cODd1t1ona etc
he atat18t1C~ 1fele C()4ed accord1Dg tomiddot the 1llli301fOCUS
of the Y18lt tt doe DOt 1D41cate the Dmlber of holies or
f8ll11lev181tecl or 1D41Y14ual Y1a1ted more tban oDcein
the propwl It dobullbull I1ve 80M 1D41cat1on by coaparlshy
OD ot the 8JIoUDt of aedlcal problema 1n eachcen8WI tract
Ap1nmiddot the _p abowa 8 scatter patteraof probl_
areas althoUSh there appear to be a sroup1Dl of hiSh J
l8aIeccmaus tract 1ntlut extreme southeast part of tbe
County other areu uIriaI any nura1Dl contacts are
1 bull he 801lth-oa-al CO1Dty on eaCh 814 of 82nd Av from Clackallaa County north to Dinloa
2 ear bullbullbullt 814e aroUDd Preacottand Misaisippi
Dowatom Bunul14eonboth 1de of the river
44
V_real Pis The iDfomatloil uaec1 to tabulate the Venereal
disease chart includes all the ooab1ned case otmiddotODormea
and syphilIs reported by bothmiddot publIc and prIvate physicIans
dur1nl 1970 There were 3602 caes ot IOnorrhea reported
dur1nl 1970 While ODly 17 cabullbullsot ayphilimiddot were reported
A chart was prepUed aDd att8llPt wasmiddotmiddot de tomiddot
determ1De Wh_therVttDereal 41ease was more p~vaJent in
areas othigb or lowmiddot proportIon ot youth hi waadone
bymiddotdetemlna a 1leaD prceiltacmiddotmiddotmiddottor the population ot
resld~ts UDder19 years ot (34) middotA mean ratemiddot per
100000 popUlatIon al80c1ttem1Ded tor the middotoccurreDCe
ot venereal dieae This was et at 390 oass Areas
hav1nl a population 1n which leiS than 34 were lmder 19
years ot ampIe were called low- yOuth abOve tbl percentaae
hiSh youth The aaa waatrue ot the occurrence oivenershy
eal disea_ per CeD8UStract It the rate waacomputed
as 1I0re than 390 cases per 100000 it was called hiah
venerealdiaeasei it less than thia tisure low venereal
disease It was tound that 1D Multn~ COmlty there sems
to be poSitive OOlatI0n(x21S19gt between low youth
and hipmiddot venereal diseaand hip youth and low venereal
diseasebull
RaDk ordr Iitot all c traot middottbAm made
Th1s was done byt1Ddlna the ratepr 100000 populatIon
of venereal disator all census tracts in the County bull
45
These were thenlisted from h1lhto low (sreatest to
least) in a rank order The l1sting was then divided
into Upperandlower 14 aDd listed on the MUltnomah
Countymiddot up
The areas of b1gh venereal disease se8ll18to
roup thBl~8 middotin a very tllht area ~oq both 1des
of thell18l8~ R1 w1th BurDaldeS~et being
~bout theceDter qf tbi8IZ9uping This area woUld
appear to be m ldeal spot for the denlopment of a
locallzed venereal d1sbullbullbullbull cl1D1c
UbepoundCUlO1s
In this report bull tube1C1llosls caS8S refrred
to include alltbobullbull cabullbulls ontubercUlo8is follow-up
rather middotthan just new C Accord1Ds to the Multnomah
County Health SUrvey of early 1971 this would include
all ca repOrte4 over thelaat three years The
total number of tuberculosi8 cabullbullbull usedin this study
was 666 lh1 included 128 new cabullbullbullbull
A rate per 100000 of tuberculosis for each
census tract wa- then computed and the c~us tracts
listed by rank order be b11h Qartlle mel low
quartl1 were then reoordd on a Multnomah CoUnty map
TWo genral areaa baY1Dg a hip mcldencaot tubercu~
losiare 1D41cated heyare
1 Both middotsld ot theWilla11lette River
Ll -
46
with Burns1de about thecnter
2 he extrea Northebullbullt comer of the County bull
By coap8r1ng the tuberculois an4ven8real
diseae maps ODe can 8ee that the downtown areas ot
hiSh 1nc1denceare alIIo8t 1c1eDt1cal on ach map
This WOuld 1nd1cate that 1t would be of value to
bullbulltab11sh acl1D1c 111 th1aampreatbat would provide
bothtuberCulos1s 8Dd ytmereal 418ase srvicbullbullbull
Thchart aDd 1181gt8 are wsfuln 11v1DI
1Ddicat10DS tor the type aDd placemeototlocal
health cl1n1c8 tbro1qhout tbe MultnomahCounty area
A cOllpar1on of the mapa help one to dec1dewhether
to provide a aulti-8ervice cl1D1c or spec1f1c type of
cliD1c As stated in Part I of thi paprserv1ces
shouldhaYe both treatlieDt and prfMmt10n cOmponents
As he been stated fta ne1lbborhood health care
Qenter muat be a fac111tY plazme4 with an aamesa
ot the neds of the consumer and the c01llll1m1tybull
Part II of this rport haa been an attaapt to indicate
and clarify 8011 ottheae coDlllUDity neds This has
been done through8elect10n of apc1f1c problems
The indic were then visuallyrecorded through the
use of ups and charta ODe dan asseS8 thedsreeof
1DIportance of certain concems to spec~t1c areaa by
comparinl the chart aDd maps Prom this oDeean
41 dec1de which are48 vb1chcUD1c-or indeed if
the need a clinic at all However further factors
should be considered hebullbull include
a The amount of fuDd1 available
b What 18 the percentage ot peopleineoh ceaaua tract tbat would actually us such cl1n1cIl
c Wbat 1 tbeco--1tymiddot 8 IeeliDashyreaardtDI particular cl1D1c8 Would this dcrebullbullbullmiddot the ettctiveness ot thse cl1n1ca
IJ
li
D_OlraphicPopulatLon Challie 1960 to 1970 48
Cen8U8 1 of Pop 1 Cbaqemiddot 1 Change1 ofPopTract Under 19 Yr8 Over 65 Yrs1960-70 1960-70
middot1Q701Q70
1 319 -12 171 -H) 1
2722 215-27 +68 301 366 -22 127 +35 302 371 +19 111 -04
311middot401 144-41 +29 402 321 13~7-39 +24 501 356 124-08 -02 5~O2 351 133-23 +12
405601 82-10 -02 394602 103-01 -06
701 275 149-76 +56 702 361 +01 121 -07
+10middot801 326 140-22 802 321 middot127
(
-29 -03 9~01 342 124 -H) 6-18 902 294 128 -H) 3-24
10middotmiddot -14312 140 -17 1101 182 +25 -23197
2411102 186-59 +29 1201 226 169-17 -41
31middot01202 +11 182 -05 295 -H) 81301 208 -H) 4
1302 331 +08 197 +04
14 323 +15 middot185 -08 middotmiddot15 329 +16 16~5 -13
-28middot 1601 332 131 +12
1602 356 98 +24middot-39 middot3101701 161-33 +21
1702 370 -15 85 +02 +19 1801 264 151middot-50
185middot1802 256 +47-58
IJ ~
D_raphlc Population Change 1960 to 1970middot 49 (Contd)
4io
Census Tract
of pop Uncter 19 Yra
1Q1n
1Cha1l8e 1960-70
of PopOver 65 Yra
lQO Change
1960-70
19 389 +29 141 -24 20 223 -13 206 +18
21 227 +08 194 -36 2201 356 -27 112 +05
2202 290 -18 ll~9 -29 2301 356 -03 154 +24 2302 260 -37 245 +97
2401 410 +6~1 123 -31 2402 163 -80 320 +99 2501 381 +13 140 -01 25()2 237 31 lil +02 26 343 +25 186 +149 2701 370 +29 1S5 -01 2702 249 -44 304 +98 2801 337 +19 187 +09 2802 306 -10 156 +31 2901 304 -38 142 +24 2902 i 307 -32 146 t3~9
30 29~0 -48 16~2 +51
31 355 +30 160 +01 32 370 +48 148 -13 3301 395 +45 130 -20 3302 368 +06 138 -02 3401 386 +16 117 000
3402
400 +32 92 -26 3501 304 -07 115 +35
3502 344 000 140 -13
3601
36~02 357 -04 132 +32
3603 30~1 42 149 -67 3701 342 +28 152 +19
1
IJ
Jianolraphic Population Chan 1960 to 1970 50 (Contd)
Census Tract
of Pop Under 19 Yrs
JJl7J
middotChanae 1960-70
middotofmiddotpop Over 65 Yrs
1c~7n
Change 196070
3702 409 +39 122 -11 3801 308 -11 151 +29 3802 275 -35 180 +46 3803 282 -32 192 +54 3901 376 ~13 100 +17 3902 296 -03 177 +29 4001 438 -11 84 +13 4002 353 -21 115 +20
4101 397 11 9middot0 +11 4102 346 -19 120 +03 42 331 +19 11 bull 3 -16 43 347 -72 105 +31 44 113 +84 183 +154 4S 33~9 +07 110 -06 4601 2501 22 193 +38 4602 332 +59 126 -29 47middot 161middot 000 211 +01 48 103 -26 302 +59 49 138 +1 bull 3 252 +09 50 141 -26 204 -12 51 12 -39 257 +07 52 47 -61 351 +48 53 89 +49 314 -30 54 25 l1li15 327 -17 55 131 -17 115 -121 56 198 +93 227 -47 57 71 102 189 -88 58 240 ~middot41 16~1 +55 59 322 +25 142 +06middot 6001 264 95 132 +50
6002 328 -31middot 89 +07
JJ
Demographic Population Change 1960 to 1970 51 (Contd)
Census 1 ofPop lChange of Pop bull ChangeTract Under 19 Yrbullbull 1960-70 Over 65 Yrs 1960-70
1970 1970
61 355 -58 85 +39
62 328 39 110 +18
63 414 04 73 10
64 382 -22 72 +04
6501 383 02 67 -20
6502 329 -56 96 +09
6601 391 +13 88 -03
6602 319 -59 97 +06
6701 327 71 145 +72
6702 331 ~67 83 +1-0
6801 365 -66 49 +01
6802 388 4bull3 54 +06
69 354 -41 80 +23
70 400 -23 68 -06
71 359 -48 72 +05
72 255 -88 82 +11
73 346 -39 91 +25
74 313middot -63 105 +24
75 329 -42 129 +37
76 336 -52 85 +21
77 370 -10 69 +05
78 309 -10 120 +21
79 325 -56 87 +10
8001 358 -81 57 +12
8002 391 ~81 76 +12
81 315 -76 108 +21
8201 403 -23 64 +08
8202 392 23 65 +08
83 357 -34 120 +31
84 402 -18 73 +16
85 413 -06 76 -09
r
Demographic Population Change 1960 to 1970 52 (Contd)
Census Tract
t of Pop Uncler 19 Yrs
1970
Change 1960-70
1 of Pop OVer 65 Yrs
1970
ex Change 196070
86
87
88
89
90
91 9201
9202
93
94
95
9601
9602
9701
9702
9801
9802
99
100 I
101
102
103
10401
10402
lOS
368
351
379
391
391
413
379
433
372
429
414
432
419
439
~32
377
457 420
378 41middot7
345
360 417
417
412
-04
-02
-35
-26
-28
-11
-64
-20
-S9
-39
-32
-21
-34
-40
-47
-lO~7middot
-27middot +04
+56
+07
-34 01
+04
+04
+10
103
128
97
11il3 99
69
79
42
77
46
34 38
44
40
54
111
51middot
81
133
59
74
140
63
87
76
-08
-06
+04
+08
+17
-05
+3S -02
+1~4
+19
+33
-14
-08
+12
+26
+71
+11
-16 -34
-20
-19 +37
-49
-2S +15
NOte The The
Taken frOi
averageullder averageabove
middotUSCensus ---shy -
19 years == 6S years ==
figures 197
32r 13(14
p a~d 1960
--
Rank
1
2
3
4
5
6
7
8
9
10
11 12 -_
13
14
15
16
17
18
Tract
69 46
60
58
- 68
61
302
2501
67
63
19
62
26
94
3603
3902
64
30 -----~-
Rank
19
20
21 -
22
23-shy
24
25
26
27
28
29
30
31
32
33
34
35
36 -
Ranking of Per Capita Income by Census Tract
Tract
65
2701
- 15
1601
701
66
93
82
2903
3602
30
2502
80
2401
81
- 70
91 shy
4001
High
Rank Tractshy
-32shy37
38 97
120239
7840
41 ~ _2_1__ 42 31
43 2501
44 18
45 98
46 37
47 3803
1702
49
48
1602 92 2702
I
50 89
51 901
52 801
Ra_
53
54
55
56
57
58
59
60
61
62
63
64
6S
66
67
68
TractTract Ra~
74692
170196 70 I
401 71 90
72 1037J
79 70273
3802 74 601
24024102 75
85 76 101
77 9023901
7699 78 100 4101 79
3601 I
380180
458140~ t---- _ - - shy83 82 42
888384
59843501
4777 8~
502
Low
802 86
Rank Tract
87 shy
--88
89
90
91
92
93
94
- 95
96
97
middot98
99
100
101
102
103
104
1201
14
49
72
73
43
87
3502
105
1
52
86
71
1
501
10
3301
104 tf
Rank
105
106
107
108
109
110
III
112
113
114
115
116
117
118
119
120
121
Ranking of Per Capitalucoae by Census Tract
(Contd)
Tract Rank
4001 122--shy602
13
1102 2302
3302
55
3401
48
21
56
50
3402
lL01
2202
2301
53
2201
-shy
Tract Rank Tract Rank T~aet Rank
57 I-----
Imiddote
bull
Tract
- Low -k Note Information taken from 1960 U SCensus
Rank Tract
I ~
Ie
Imiddot
~
----
----
--
--
Rank
1
2
3
4
5
6
1
8
9
10
11
i-
-Tract
391 922 921
972 971
100
132 131 121
962 961
822 821 401
982 981
20 111
47 10 1
412
High
Total Number of Henta1 Health Visits
Ranked by Census Tract High to Low
TractTract RankTractRank Rnk
12 182 22 78 29 87 76 381 73181 ~------- 1913 371 8538230162372 271 2616-121 8272 2
14 80~2 31 94 7923 84801 59 15251362 4232 15 52 _ 32 103 8924 651 17240216 652
_ 91 351 33 341 23117 83 122 25 25 48 1123921418 34 shy61 86 661
19 662 6493 81 26 91 8153 49 50 55 41383 71 27 51 3120 90 672241 35shy 104167162 461
I 411 46211121 28 88342 I
2502 36 69 54 5251 50 272
-Ra
37
38
39
_ 40
_ 41 Ishy
I
42 I
-I 43 44
45
shy
Tract
~ --- shy 95 56
45 292 242
102 62 352 291y
92
101 281
99 72 63 601 60~ 42 2201
77 74 61 57
363 232
70
32 31
11 44 282 2202
Low l
- Tract
46 682 681 I 331 30
r~$ 47 1042 332
48 102_41_
11
~
Visits to Family Planning Clinics Ranked by Census Tract High to Low
Rank Tract Rank Tract Rankmiddot Tract Rank Tract Rank Tract Rank Tract
1
2
3
4
5
6
7
8
9
10
11
12
13middot
14
15
16
17
361
56
401
341
48
59 121
20
55
342
10
31
58
93 21
241 132
331
53
461 462
18
19
20-shy21
22
23
24
25
26
27middot
28
29
30
31
32
33
391
32
middot47 I-i-_-shy _ -
231 111
332
972 1
372 371
52
89
32
92
82
100 31
182
30 242
402
34
35
36
37
38
39
40
41
42
43
44
45
42
1714 i 661 221
78 362 2
90 602 601 352
63 251
105 921
971 351
73 42 292 232
411 51
662
81 45 52
46
47
48
49shy
50
51
52
53
54
55
56
961
801
49 81 72 71
19
9~1
172
68 2 57 162 14 112
91 75 681
381 42
3~3
83 161
57 f
58
59
60
61shy
62 Imiddot
63
Imiddot 64
65
66
64 62 36~3 252
74 652 SO 392 291
651 6bull 2
79 271
r-- ---- shy981 222
672 671
821 272
94 87
281
382
67
68
69
70
71
72
73
74
75
76
77
78
981 26 12~2
IS 61
85 82~2 69
61 43
101 86 84 282
76
131
51 72
1041 962 88 70
99 922 77
103
95 802 181
i
~
Low High
RankRank Tract
5479
4480
81 1042 ~) middot102
71 - - + ~ - ~
Visits to Family Planning Clinics
(Contd)
Tract Rank
I
Tract llaDk l
RankTract Tract Rank Tract
~
I
~
J1 ~
Low
Total Number of public Health Nursing Visits
Ranked by Census TractsHigh to Low
TractTract RankTractRank RankRank TractTractRankTractRank
25249 71 79 17249 8033 6586 99189711 84 2915072 34 661 76 66 811519512
402 5035 51 161 2518220 122 1713423 352 55801 7120 6752 2 149814 41236 83 2662 38 94 6821 53 2924015 362 37 32 42 75 69 281 84 63
546 8822 54 222 85 3925431 70383417 3818223 6439 4386652 718 21 55 103332 8924 232 87 19 271729219619 24156 16211140 382 628825 10523110 112 73411 10141-- ----shy 89 363 4457 8126 16111 221 74 9142 90 46158331 53 671279012 46243 48 59 351 3837528 1083 9313 91 5844 59 -_242 76 1----- shy60 272 72 74104114 60145 42 9287 7729 92 6151 8215 57371 934630 91 307762 12113116 282 619447 41391 9531 78100 63 7378 ~95 681 6945 32 5632 798517 6448 47 52 181
High ~ Low
Rank Tract Rank
96 31 132 70
97 102
98 182 372middot 602 651 662
- -shy
~72 682 802
822 922 962 972 982
1042 ----shy
Low
Total Number of Public Health Nursing Visits
(Contd)
Rank Rank Rank TractTract Tract
I
I lt
I
Tract Rank Tract
[
~~~-
I
~
IJilfimiddot ~
j
Ranking of VD Caea According to Census Tracts 61 By High and LOll Youth Itatio
A media~ of 34 5 was determined Any tract having greater
than 34 5~ of popu1tionunde~ 19 years of age -High~
Any tract having l8S than 345 of population under 19
years == Low
Any tract having rate less than 390 =Low
Any tract having rate more than 390 == HLgl4
YOUTH
LOW HIGH
L
0
12 402 1801 1802 343 2801 2802 29023603
54 6001 600262 66~02 72 74 75 76
78 79 81 t02 65 1202
W
(25)
VD
H
I
G
H
401 701 801802 901 902 10 1101 241 1201 1301 132 14 15 1601 1701 20~ 21 2202 2j02 2402 2502 2702 2901 303501 3502 34023801 3802 383 3902 42 44 45 4601 4602 47 48 49 SO 51~2 53 55 56 57 58 S9 6701 6702 73 95
3~02 7021702 19 25~01 2701 4102 4101 63 64601 ~601 6801 680270 7l 77 8001 80~02 8201 8202 83 84
85 86 87 88~ 90 91 9202 920193 94 9601 9602~ 9701 9102 9801 9802 99 100 101 103 10402 105 6501 10401
(47)
301 501 502 601 1602 2401 2301 2201 31 32 3301 3302 3401 3402~ 3602 3702 3901 400140 02 43 61 69 B(
(53) (23)
~ ~gt
Ranking of VD by Rate Per 100000 By Census Tract
~
Rank Tract Rank Tract Rank Tract Rank Tract llank Tract Rank Tract Rank Tract
1 2202 21 S6 40 902 58 1602 74 75
90-shy 64 107 26 --~-
2 3402 22 45 41 10 59 902 75 78 91 54 108 61
3 2301 23 3502 42 2502 60 602 76 6802 92 402 109 87
4 3302 24 49 43 1102 61 501 17 2 93 94 110 90
5 50 25 52 44 6702 62 14 78 8202 94 97 02 III 76
6 2201 26 20 6701 63 4002 8201 2501
9701 41~02 112 91
7 44 27 48 45 401 64 3802 2902 95 63 113 62
8 3301 28 1701 46 502 65 30 79 83 74 96 9602 114 71
9 55 29 47 47 42 66 3803 80 2801 96Q1 115 85 10
11
12
13
14
15
16
17
18
3401
53
2302
2401
57
21
2402
1101
51
30-shy31
32
33
34
35
36
37
3701 - -~ 1201
3702
89
43
132 131
3602
4001
48
49
50
51
52
53
54
55
58
1601
601
4602 4601
69
701
31
3901
67
68
69
70
71
72
2901
801
39021~ 802
6502 6501 122
702
41~01
81
82
83
84
85
86
87
88
19
1
1702
2802
79
93
100 6801 6602
81
97
98
99
100
101
102
103
104
9201 9202
9802 9801
77
302
79
86
72
84
116
117
118
119
120
121
3603
8002 8001
101
99
95
10401
105 10402 103 102
19
20
59
32
38
39
2702
3501
56
57
301
3801
73 1802 1801
89 6002 6001
105
106
2701
88
High Low
-- -----
Rank OrdermiddotTuberclosis Cases by Rate Per 100000 Ranked by Census Tract High to Low
Tract TractRankTractRank Rank TractRaukTractRankTractRank
801
79 9601501411 52 6835340120511 I 960269 903603532036 $-~~F130221542 4366 311301 70 68~013802 _ I- _ 4001_37213 3921201 6802802 H71523822024 22 54 193302 3802 80 8958 I37139535 70155 9801 I60123 72 6702 98023914011016 6701250124 10 56
81 94 401r 7 154152 73 7057 2625 122 92028
90242 162312301 92~158 86 7172434526509 82 79160159 74 100 87412240227220110 6502836960 75 30 8317244 6501782801285711 61 901 42765645 84 66021459294912 9701 660146 171 302 9702 47
6235023033113 85 822821182 917755 16335013110214 841814832 78 103 938564 324815 86 1057940149272 38036523216 10401 87 2902241 725Q 10402360266340217middot IF88 88 9937233 282 51 218 101 01102 46016234
I)167 2901460219 47
High ~ Low ~
- -
TractRank
9S89
6490
8191 8001 8002
63 61 60middot01 6002 44 2701
92
J
2502 402 --- ----shy
I
Rank
Rank Order Tuberculosis Cases by Rate per 100000
(Coutd)
Tract Rank Tract ~nk
I
Tract Ballk Tract Rank
Imiddot
Tract
Imiddot
1~
t 1I i Pi i l I
o
1 -1shyL I
I J
8 40 icO ~ I -lt 0
-t (1) I
i I
r o E
II
a
I
r--i
shy
I
~
I (
Jgt
(011 fi(
Ggt
I II ~j
()
(f 0
~ ()
I
11
f9
r
II 99
o ~
Ggt r
~ __-J~ I t I ~ I
r--J l I
~ _ __ J
) 1
fTl
1gt
r I
()
r
()
lt en -i en
()
I1l
(J)
(J)
-i
P ()
19
r o ~
r G1 I
I
c
~
o I 89
--- -I-shy
r-r I
1- 0 _~ _ _--J E
G1 I I I
i i
I 1-1-1 ~ _J ~2 ~ II
II
()
1 I I I 1
id i bullbull
~
A n 69
r 1shy
- 0 Gl
l--~ ~ I
~ II
II )
I () isect i
en l i
(J)
-t
0
IA Ol
44
V_real Pis The iDfomatloil uaec1 to tabulate the Venereal
disease chart includes all the ooab1ned case otmiddotODormea
and syphilIs reported by bothmiddot publIc and prIvate physicIans
dur1nl 1970 There were 3602 caes ot IOnorrhea reported
dur1nl 1970 While ODly 17 cabullbullsot ayphilimiddot were reported
A chart was prepUed aDd att8llPt wasmiddotmiddot de tomiddot
determ1De Wh_therVttDereal 41ease was more p~vaJent in
areas othigb or lowmiddot proportIon ot youth hi waadone
bymiddotdetemlna a 1leaD prceiltacmiddotmiddotmiddottor the population ot
resld~ts UDder19 years ot (34) middotA mean ratemiddot per
100000 popUlatIon al80c1ttem1Ded tor the middotoccurreDCe
ot venereal dieae This was et at 390 oass Areas
hav1nl a population 1n which leiS than 34 were lmder 19
years ot ampIe were called low- yOuth abOve tbl percentaae
hiSh youth The aaa waatrue ot the occurrence oivenershy
eal disea_ per CeD8UStract It the rate waacomputed
as 1I0re than 390 cases per 100000 it was called hiah
venerealdiaeasei it less than thia tisure low venereal
disease It was tound that 1D Multn~ COmlty there sems
to be poSitive OOlatI0n(x21S19gt between low youth
and hipmiddot venereal diseaand hip youth and low venereal
diseasebull
RaDk ordr Iitot all c traot middottbAm made
Th1s was done byt1Ddlna the ratepr 100000 populatIon
of venereal disator all census tracts in the County bull
45
These were thenlisted from h1lhto low (sreatest to
least) in a rank order The l1sting was then divided
into Upperandlower 14 aDd listed on the MUltnomah
Countymiddot up
The areas of b1gh venereal disease se8ll18to
roup thBl~8 middotin a very tllht area ~oq both 1des
of thell18l8~ R1 w1th BurDaldeS~et being
~bout theceDter qf tbi8IZ9uping This area woUld
appear to be m ldeal spot for the denlopment of a
locallzed venereal d1sbullbullbullbull cl1D1c
UbepoundCUlO1s
In this report bull tube1C1llosls caS8S refrred
to include alltbobullbull cabullbulls ontubercUlo8is follow-up
rather middotthan just new C Accord1Ds to the Multnomah
County Health SUrvey of early 1971 this would include
all ca repOrte4 over thelaat three years The
total number of tuberculosi8 cabullbullbull usedin this study
was 666 lh1 included 128 new cabullbullbullbull
A rate per 100000 of tuberculosis for each
census tract wa- then computed and the c~us tracts
listed by rank order be b11h Qartlle mel low
quartl1 were then reoordd on a Multnomah CoUnty map
TWo genral areaa baY1Dg a hip mcldencaot tubercu~
losiare 1D41cated heyare
1 Both middotsld ot theWilla11lette River
Ll -
46
with Burns1de about thecnter
2 he extrea Northebullbullt comer of the County bull
By coap8r1ng the tuberculois an4ven8real
diseae maps ODe can 8ee that the downtown areas ot
hiSh 1nc1denceare alIIo8t 1c1eDt1cal on ach map
This WOuld 1nd1cate that 1t would be of value to
bullbulltab11sh acl1D1c 111 th1aampreatbat would provide
bothtuberCulos1s 8Dd ytmereal 418ase srvicbullbullbull
Thchart aDd 1181gt8 are wsfuln 11v1DI
1Ddicat10DS tor the type aDd placemeototlocal
health cl1n1c8 tbro1qhout tbe MultnomahCounty area
A cOllpar1on of the mapa help one to dec1dewhether
to provide a aulti-8ervice cl1D1c or spec1f1c type of
cliD1c As stated in Part I of thi paprserv1ces
shouldhaYe both treatlieDt and prfMmt10n cOmponents
As he been stated fta ne1lbborhood health care
Qenter muat be a fac111tY plazme4 with an aamesa
ot the neds of the consumer and the c01llll1m1tybull
Part II of this rport haa been an attaapt to indicate
and clarify 8011 ottheae coDlllUDity neds This has
been done through8elect10n of apc1f1c problems
The indic were then visuallyrecorded through the
use of ups and charta ODe dan asseS8 thedsreeof
1DIportance of certain concems to spec~t1c areaa by
comparinl the chart aDd maps Prom this oDeean
41 dec1de which are48 vb1chcUD1c-or indeed if
the need a clinic at all However further factors
should be considered hebullbull include
a The amount of fuDd1 available
b What 18 the percentage ot peopleineoh ceaaua tract tbat would actually us such cl1n1cIl
c Wbat 1 tbeco--1tymiddot 8 IeeliDashyreaardtDI particular cl1D1c8 Would this dcrebullbullbullmiddot the ettctiveness ot thse cl1n1ca
IJ
li
D_OlraphicPopulatLon Challie 1960 to 1970 48
Cen8U8 1 of Pop 1 Cbaqemiddot 1 Change1 ofPopTract Under 19 Yr8 Over 65 Yrs1960-70 1960-70
middot1Q701Q70
1 319 -12 171 -H) 1
2722 215-27 +68 301 366 -22 127 +35 302 371 +19 111 -04
311middot401 144-41 +29 402 321 13~7-39 +24 501 356 124-08 -02 5~O2 351 133-23 +12
405601 82-10 -02 394602 103-01 -06
701 275 149-76 +56 702 361 +01 121 -07
+10middot801 326 140-22 802 321 middot127
(
-29 -03 9~01 342 124 -H) 6-18 902 294 128 -H) 3-24
10middotmiddot -14312 140 -17 1101 182 +25 -23197
2411102 186-59 +29 1201 226 169-17 -41
31middot01202 +11 182 -05 295 -H) 81301 208 -H) 4
1302 331 +08 197 +04
14 323 +15 middot185 -08 middotmiddot15 329 +16 16~5 -13
-28middot 1601 332 131 +12
1602 356 98 +24middot-39 middot3101701 161-33 +21
1702 370 -15 85 +02 +19 1801 264 151middot-50
185middot1802 256 +47-58
IJ ~
D_raphlc Population Change 1960 to 1970middot 49 (Contd)
4io
Census Tract
of pop Uncter 19 Yra
1Q1n
1Cha1l8e 1960-70
of PopOver 65 Yra
lQO Change
1960-70
19 389 +29 141 -24 20 223 -13 206 +18
21 227 +08 194 -36 2201 356 -27 112 +05
2202 290 -18 ll~9 -29 2301 356 -03 154 +24 2302 260 -37 245 +97
2401 410 +6~1 123 -31 2402 163 -80 320 +99 2501 381 +13 140 -01 25()2 237 31 lil +02 26 343 +25 186 +149 2701 370 +29 1S5 -01 2702 249 -44 304 +98 2801 337 +19 187 +09 2802 306 -10 156 +31 2901 304 -38 142 +24 2902 i 307 -32 146 t3~9
30 29~0 -48 16~2 +51
31 355 +30 160 +01 32 370 +48 148 -13 3301 395 +45 130 -20 3302 368 +06 138 -02 3401 386 +16 117 000
3402
400 +32 92 -26 3501 304 -07 115 +35
3502 344 000 140 -13
3601
36~02 357 -04 132 +32
3603 30~1 42 149 -67 3701 342 +28 152 +19
1
IJ
Jianolraphic Population Chan 1960 to 1970 50 (Contd)
Census Tract
of Pop Under 19 Yrs
JJl7J
middotChanae 1960-70
middotofmiddotpop Over 65 Yrs
1c~7n
Change 196070
3702 409 +39 122 -11 3801 308 -11 151 +29 3802 275 -35 180 +46 3803 282 -32 192 +54 3901 376 ~13 100 +17 3902 296 -03 177 +29 4001 438 -11 84 +13 4002 353 -21 115 +20
4101 397 11 9middot0 +11 4102 346 -19 120 +03 42 331 +19 11 bull 3 -16 43 347 -72 105 +31 44 113 +84 183 +154 4S 33~9 +07 110 -06 4601 2501 22 193 +38 4602 332 +59 126 -29 47middot 161middot 000 211 +01 48 103 -26 302 +59 49 138 +1 bull 3 252 +09 50 141 -26 204 -12 51 12 -39 257 +07 52 47 -61 351 +48 53 89 +49 314 -30 54 25 l1li15 327 -17 55 131 -17 115 -121 56 198 +93 227 -47 57 71 102 189 -88 58 240 ~middot41 16~1 +55 59 322 +25 142 +06middot 6001 264 95 132 +50
6002 328 -31middot 89 +07
JJ
Demographic Population Change 1960 to 1970 51 (Contd)
Census 1 ofPop lChange of Pop bull ChangeTract Under 19 Yrbullbull 1960-70 Over 65 Yrs 1960-70
1970 1970
61 355 -58 85 +39
62 328 39 110 +18
63 414 04 73 10
64 382 -22 72 +04
6501 383 02 67 -20
6502 329 -56 96 +09
6601 391 +13 88 -03
6602 319 -59 97 +06
6701 327 71 145 +72
6702 331 ~67 83 +1-0
6801 365 -66 49 +01
6802 388 4bull3 54 +06
69 354 -41 80 +23
70 400 -23 68 -06
71 359 -48 72 +05
72 255 -88 82 +11
73 346 -39 91 +25
74 313middot -63 105 +24
75 329 -42 129 +37
76 336 -52 85 +21
77 370 -10 69 +05
78 309 -10 120 +21
79 325 -56 87 +10
8001 358 -81 57 +12
8002 391 ~81 76 +12
81 315 -76 108 +21
8201 403 -23 64 +08
8202 392 23 65 +08
83 357 -34 120 +31
84 402 -18 73 +16
85 413 -06 76 -09
r
Demographic Population Change 1960 to 1970 52 (Contd)
Census Tract
t of Pop Uncler 19 Yrs
1970
Change 1960-70
1 of Pop OVer 65 Yrs
1970
ex Change 196070
86
87
88
89
90
91 9201
9202
93
94
95
9601
9602
9701
9702
9801
9802
99
100 I
101
102
103
10401
10402
lOS
368
351
379
391
391
413
379
433
372
429
414
432
419
439
~32
377
457 420
378 41middot7
345
360 417
417
412
-04
-02
-35
-26
-28
-11
-64
-20
-S9
-39
-32
-21
-34
-40
-47
-lO~7middot
-27middot +04
+56
+07
-34 01
+04
+04
+10
103
128
97
11il3 99
69
79
42
77
46
34 38
44
40
54
111
51middot
81
133
59
74
140
63
87
76
-08
-06
+04
+08
+17
-05
+3S -02
+1~4
+19
+33
-14
-08
+12
+26
+71
+11
-16 -34
-20
-19 +37
-49
-2S +15
NOte The The
Taken frOi
averageullder averageabove
middotUSCensus ---shy -
19 years == 6S years ==
figures 197
32r 13(14
p a~d 1960
--
Rank
1
2
3
4
5
6
7
8
9
10
11 12 -_
13
14
15
16
17
18
Tract
69 46
60
58
- 68
61
302
2501
67
63
19
62
26
94
3603
3902
64
30 -----~-
Rank
19
20
21 -
22
23-shy
24
25
26
27
28
29
30
31
32
33
34
35
36 -
Ranking of Per Capita Income by Census Tract
Tract
65
2701
- 15
1601
701
66
93
82
2903
3602
30
2502
80
2401
81
- 70
91 shy
4001
High
Rank Tractshy
-32shy37
38 97
120239
7840
41 ~ _2_1__ 42 31
43 2501
44 18
45 98
46 37
47 3803
1702
49
48
1602 92 2702
I
50 89
51 901
52 801
Ra_
53
54
55
56
57
58
59
60
61
62
63
64
6S
66
67
68
TractTract Ra~
74692
170196 70 I
401 71 90
72 1037J
79 70273
3802 74 601
24024102 75
85 76 101
77 9023901
7699 78 100 4101 79
3601 I
380180
458140~ t---- _ - - shy83 82 42
888384
59843501
4777 8~
502
Low
802 86
Rank Tract
87 shy
--88
89
90
91
92
93
94
- 95
96
97
middot98
99
100
101
102
103
104
1201
14
49
72
73
43
87
3502
105
1
52
86
71
1
501
10
3301
104 tf
Rank
105
106
107
108
109
110
III
112
113
114
115
116
117
118
119
120
121
Ranking of Per Capitalucoae by Census Tract
(Contd)
Tract Rank
4001 122--shy602
13
1102 2302
3302
55
3401
48
21
56
50
3402
lL01
2202
2301
53
2201
-shy
Tract Rank Tract Rank T~aet Rank
57 I-----
Imiddote
bull
Tract
- Low -k Note Information taken from 1960 U SCensus
Rank Tract
I ~
Ie
Imiddot
~
----
----
--
--
Rank
1
2
3
4
5
6
1
8
9
10
11
i-
-Tract
391 922 921
972 971
100
132 131 121
962 961
822 821 401
982 981
20 111
47 10 1
412
High
Total Number of Henta1 Health Visits
Ranked by Census Tract High to Low
TractTract RankTractRank Rnk
12 182 22 78 29 87 76 381 73181 ~------- 1913 371 8538230162372 271 2616-121 8272 2
14 80~2 31 94 7923 84801 59 15251362 4232 15 52 _ 32 103 8924 651 17240216 652
_ 91 351 33 341 23117 83 122 25 25 48 1123921418 34 shy61 86 661
19 662 6493 81 26 91 8153 49 50 55 41383 71 27 51 3120 90 672241 35shy 104167162 461
I 411 46211121 28 88342 I
2502 36 69 54 5251 50 272
-Ra
37
38
39
_ 40
_ 41 Ishy
I
42 I
-I 43 44
45
shy
Tract
~ --- shy 95 56
45 292 242
102 62 352 291y
92
101 281
99 72 63 601 60~ 42 2201
77 74 61 57
363 232
70
32 31
11 44 282 2202
Low l
- Tract
46 682 681 I 331 30
r~$ 47 1042 332
48 102_41_
11
~
Visits to Family Planning Clinics Ranked by Census Tract High to Low
Rank Tract Rank Tract Rankmiddot Tract Rank Tract Rank Tract Rank Tract
1
2
3
4
5
6
7
8
9
10
11
12
13middot
14
15
16
17
361
56
401
341
48
59 121
20
55
342
10
31
58
93 21
241 132
331
53
461 462
18
19
20-shy21
22
23
24
25
26
27middot
28
29
30
31
32
33
391
32
middot47 I-i-_-shy _ -
231 111
332
972 1
372 371
52
89
32
92
82
100 31
182
30 242
402
34
35
36
37
38
39
40
41
42
43
44
45
42
1714 i 661 221
78 362 2
90 602 601 352
63 251
105 921
971 351
73 42 292 232
411 51
662
81 45 52
46
47
48
49shy
50
51
52
53
54
55
56
961
801
49 81 72 71
19
9~1
172
68 2 57 162 14 112
91 75 681
381 42
3~3
83 161
57 f
58
59
60
61shy
62 Imiddot
63
Imiddot 64
65
66
64 62 36~3 252
74 652 SO 392 291
651 6bull 2
79 271
r-- ---- shy981 222
672 671
821 272
94 87
281
382
67
68
69
70
71
72
73
74
75
76
77
78
981 26 12~2
IS 61
85 82~2 69
61 43
101 86 84 282
76
131
51 72
1041 962 88 70
99 922 77
103
95 802 181
i
~
Low High
RankRank Tract
5479
4480
81 1042 ~) middot102
71 - - + ~ - ~
Visits to Family Planning Clinics
(Contd)
Tract Rank
I
Tract llaDk l
RankTract Tract Rank Tract
~
I
~
J1 ~
Low
Total Number of public Health Nursing Visits
Ranked by Census TractsHigh to Low
TractTract RankTractRank RankRank TractTractRankTractRank
25249 71 79 17249 8033 6586 99189711 84 2915072 34 661 76 66 811519512
402 5035 51 161 2518220 122 1713423 352 55801 7120 6752 2 149814 41236 83 2662 38 94 6821 53 2924015 362 37 32 42 75 69 281 84 63
546 8822 54 222 85 3925431 70383417 3818223 6439 4386652 718 21 55 103332 8924 232 87 19 271729219619 24156 16211140 382 628825 10523110 112 73411 10141-- ----shy 89 363 4457 8126 16111 221 74 9142 90 46158331 53 671279012 46243 48 59 351 3837528 1083 9313 91 5844 59 -_242 76 1----- shy60 272 72 74104114 60145 42 9287 7729 92 6151 8215 57371 934630 91 307762 12113116 282 619447 41391 9531 78100 63 7378 ~95 681 6945 32 5632 798517 6448 47 52 181
High ~ Low
Rank Tract Rank
96 31 132 70
97 102
98 182 372middot 602 651 662
- -shy
~72 682 802
822 922 962 972 982
1042 ----shy
Low
Total Number of Public Health Nursing Visits
(Contd)
Rank Rank Rank TractTract Tract
I
I lt
I
Tract Rank Tract
[
~~~-
I
~
IJilfimiddot ~
j
Ranking of VD Caea According to Census Tracts 61 By High and LOll Youth Itatio
A media~ of 34 5 was determined Any tract having greater
than 34 5~ of popu1tionunde~ 19 years of age -High~
Any tract having l8S than 345 of population under 19
years == Low
Any tract having rate less than 390 =Low
Any tract having rate more than 390 == HLgl4
YOUTH
LOW HIGH
L
0
12 402 1801 1802 343 2801 2802 29023603
54 6001 600262 66~02 72 74 75 76
78 79 81 t02 65 1202
W
(25)
VD
H
I
G
H
401 701 801802 901 902 10 1101 241 1201 1301 132 14 15 1601 1701 20~ 21 2202 2j02 2402 2502 2702 2901 303501 3502 34023801 3802 383 3902 42 44 45 4601 4602 47 48 49 SO 51~2 53 55 56 57 58 S9 6701 6702 73 95
3~02 7021702 19 25~01 2701 4102 4101 63 64601 ~601 6801 680270 7l 77 8001 80~02 8201 8202 83 84
85 86 87 88~ 90 91 9202 920193 94 9601 9602~ 9701 9102 9801 9802 99 100 101 103 10402 105 6501 10401
(47)
301 501 502 601 1602 2401 2301 2201 31 32 3301 3302 3401 3402~ 3602 3702 3901 400140 02 43 61 69 B(
(53) (23)
~ ~gt
Ranking of VD by Rate Per 100000 By Census Tract
~
Rank Tract Rank Tract Rank Tract Rank Tract llank Tract Rank Tract Rank Tract
1 2202 21 S6 40 902 58 1602 74 75
90-shy 64 107 26 --~-
2 3402 22 45 41 10 59 902 75 78 91 54 108 61
3 2301 23 3502 42 2502 60 602 76 6802 92 402 109 87
4 3302 24 49 43 1102 61 501 17 2 93 94 110 90
5 50 25 52 44 6702 62 14 78 8202 94 97 02 III 76
6 2201 26 20 6701 63 4002 8201 2501
9701 41~02 112 91
7 44 27 48 45 401 64 3802 2902 95 63 113 62
8 3301 28 1701 46 502 65 30 79 83 74 96 9602 114 71
9 55 29 47 47 42 66 3803 80 2801 96Q1 115 85 10
11
12
13
14
15
16
17
18
3401
53
2302
2401
57
21
2402
1101
51
30-shy31
32
33
34
35
36
37
3701 - -~ 1201
3702
89
43
132 131
3602
4001
48
49
50
51
52
53
54
55
58
1601
601
4602 4601
69
701
31
3901
67
68
69
70
71
72
2901
801
39021~ 802
6502 6501 122
702
41~01
81
82
83
84
85
86
87
88
19
1
1702
2802
79
93
100 6801 6602
81
97
98
99
100
101
102
103
104
9201 9202
9802 9801
77
302
79
86
72
84
116
117
118
119
120
121
3603
8002 8001
101
99
95
10401
105 10402 103 102
19
20
59
32
38
39
2702
3501
56
57
301
3801
73 1802 1801
89 6002 6001
105
106
2701
88
High Low
-- -----
Rank OrdermiddotTuberclosis Cases by Rate Per 100000 Ranked by Census Tract High to Low
Tract TractRankTractRank Rank TractRaukTractRankTractRank
801
79 9601501411 52 6835340120511 I 960269 903603532036 $-~~F130221542 4366 311301 70 68~013802 _ I- _ 4001_37213 3921201 6802802 H71523822024 22 54 193302 3802 80 8958 I37139535 70155 9801 I60123 72 6702 98023914011016 6701250124 10 56
81 94 401r 7 154152 73 7057 2625 122 92028
90242 162312301 92~158 86 7172434526509 82 79160159 74 100 87412240227220110 6502836960 75 30 8317244 6501782801285711 61 901 42765645 84 66021459294912 9701 660146 171 302 9702 47
6235023033113 85 822821182 917755 16335013110214 841814832 78 103 938564 324815 86 1057940149272 38036523216 10401 87 2902241 725Q 10402360266340217middot IF88 88 9937233 282 51 218 101 01102 46016234
I)167 2901460219 47
High ~ Low ~
- -
TractRank
9S89
6490
8191 8001 8002
63 61 60middot01 6002 44 2701
92
J
2502 402 --- ----shy
I
Rank
Rank Order Tuberculosis Cases by Rate per 100000
(Coutd)
Tract Rank Tract ~nk
I
Tract Ballk Tract Rank
Imiddot
Tract
Imiddot
1~
t 1I i Pi i l I
o
1 -1shyL I
I J
8 40 icO ~ I -lt 0
-t (1) I
i I
r o E
II
a
I
r--i
shy
I
~
I (
Jgt
(011 fi(
Ggt
I II ~j
()
(f 0
~ ()
I
11
f9
r
II 99
o ~
Ggt r
~ __-J~ I t I ~ I
r--J l I
~ _ __ J
) 1
fTl
1gt
r I
()
r
()
lt en -i en
()
I1l
(J)
(J)
-i
P ()
19
r o ~
r G1 I
I
c
~
o I 89
--- -I-shy
r-r I
1- 0 _~ _ _--J E
G1 I I I
i i
I 1-1-1 ~ _J ~2 ~ II
II
()
1 I I I 1
id i bullbull
~
A n 69
r 1shy
- 0 Gl
l--~ ~ I
~ II
II )
I () isect i
en l i
(J)
-t
0
IA Ol
45
These were thenlisted from h1lhto low (sreatest to
least) in a rank order The l1sting was then divided
into Upperandlower 14 aDd listed on the MUltnomah
Countymiddot up
The areas of b1gh venereal disease se8ll18to
roup thBl~8 middotin a very tllht area ~oq both 1des
of thell18l8~ R1 w1th BurDaldeS~et being
~bout theceDter qf tbi8IZ9uping This area woUld
appear to be m ldeal spot for the denlopment of a
locallzed venereal d1sbullbullbullbull cl1D1c
UbepoundCUlO1s
In this report bull tube1C1llosls caS8S refrred
to include alltbobullbull cabullbulls ontubercUlo8is follow-up
rather middotthan just new C Accord1Ds to the Multnomah
County Health SUrvey of early 1971 this would include
all ca repOrte4 over thelaat three years The
total number of tuberculosi8 cabullbullbull usedin this study
was 666 lh1 included 128 new cabullbullbullbull
A rate per 100000 of tuberculosis for each
census tract wa- then computed and the c~us tracts
listed by rank order be b11h Qartlle mel low
quartl1 were then reoordd on a Multnomah CoUnty map
TWo genral areaa baY1Dg a hip mcldencaot tubercu~
losiare 1D41cated heyare
1 Both middotsld ot theWilla11lette River
Ll -
46
with Burns1de about thecnter
2 he extrea Northebullbullt comer of the County bull
By coap8r1ng the tuberculois an4ven8real
diseae maps ODe can 8ee that the downtown areas ot
hiSh 1nc1denceare alIIo8t 1c1eDt1cal on ach map
This WOuld 1nd1cate that 1t would be of value to
bullbulltab11sh acl1D1c 111 th1aampreatbat would provide
bothtuberCulos1s 8Dd ytmereal 418ase srvicbullbullbull
Thchart aDd 1181gt8 are wsfuln 11v1DI
1Ddicat10DS tor the type aDd placemeototlocal
health cl1n1c8 tbro1qhout tbe MultnomahCounty area
A cOllpar1on of the mapa help one to dec1dewhether
to provide a aulti-8ervice cl1D1c or spec1f1c type of
cliD1c As stated in Part I of thi paprserv1ces
shouldhaYe both treatlieDt and prfMmt10n cOmponents
As he been stated fta ne1lbborhood health care
Qenter muat be a fac111tY plazme4 with an aamesa
ot the neds of the consumer and the c01llll1m1tybull
Part II of this rport haa been an attaapt to indicate
and clarify 8011 ottheae coDlllUDity neds This has
been done through8elect10n of apc1f1c problems
The indic were then visuallyrecorded through the
use of ups and charta ODe dan asseS8 thedsreeof
1DIportance of certain concems to spec~t1c areaa by
comparinl the chart aDd maps Prom this oDeean
41 dec1de which are48 vb1chcUD1c-or indeed if
the need a clinic at all However further factors
should be considered hebullbull include
a The amount of fuDd1 available
b What 18 the percentage ot peopleineoh ceaaua tract tbat would actually us such cl1n1cIl
c Wbat 1 tbeco--1tymiddot 8 IeeliDashyreaardtDI particular cl1D1c8 Would this dcrebullbullbullmiddot the ettctiveness ot thse cl1n1ca
IJ
li
D_OlraphicPopulatLon Challie 1960 to 1970 48
Cen8U8 1 of Pop 1 Cbaqemiddot 1 Change1 ofPopTract Under 19 Yr8 Over 65 Yrs1960-70 1960-70
middot1Q701Q70
1 319 -12 171 -H) 1
2722 215-27 +68 301 366 -22 127 +35 302 371 +19 111 -04
311middot401 144-41 +29 402 321 13~7-39 +24 501 356 124-08 -02 5~O2 351 133-23 +12
405601 82-10 -02 394602 103-01 -06
701 275 149-76 +56 702 361 +01 121 -07
+10middot801 326 140-22 802 321 middot127
(
-29 -03 9~01 342 124 -H) 6-18 902 294 128 -H) 3-24
10middotmiddot -14312 140 -17 1101 182 +25 -23197
2411102 186-59 +29 1201 226 169-17 -41
31middot01202 +11 182 -05 295 -H) 81301 208 -H) 4
1302 331 +08 197 +04
14 323 +15 middot185 -08 middotmiddot15 329 +16 16~5 -13
-28middot 1601 332 131 +12
1602 356 98 +24middot-39 middot3101701 161-33 +21
1702 370 -15 85 +02 +19 1801 264 151middot-50
185middot1802 256 +47-58
IJ ~
D_raphlc Population Change 1960 to 1970middot 49 (Contd)
4io
Census Tract
of pop Uncter 19 Yra
1Q1n
1Cha1l8e 1960-70
of PopOver 65 Yra
lQO Change
1960-70
19 389 +29 141 -24 20 223 -13 206 +18
21 227 +08 194 -36 2201 356 -27 112 +05
2202 290 -18 ll~9 -29 2301 356 -03 154 +24 2302 260 -37 245 +97
2401 410 +6~1 123 -31 2402 163 -80 320 +99 2501 381 +13 140 -01 25()2 237 31 lil +02 26 343 +25 186 +149 2701 370 +29 1S5 -01 2702 249 -44 304 +98 2801 337 +19 187 +09 2802 306 -10 156 +31 2901 304 -38 142 +24 2902 i 307 -32 146 t3~9
30 29~0 -48 16~2 +51
31 355 +30 160 +01 32 370 +48 148 -13 3301 395 +45 130 -20 3302 368 +06 138 -02 3401 386 +16 117 000
3402
400 +32 92 -26 3501 304 -07 115 +35
3502 344 000 140 -13
3601
36~02 357 -04 132 +32
3603 30~1 42 149 -67 3701 342 +28 152 +19
1
IJ
Jianolraphic Population Chan 1960 to 1970 50 (Contd)
Census Tract
of Pop Under 19 Yrs
JJl7J
middotChanae 1960-70
middotofmiddotpop Over 65 Yrs
1c~7n
Change 196070
3702 409 +39 122 -11 3801 308 -11 151 +29 3802 275 -35 180 +46 3803 282 -32 192 +54 3901 376 ~13 100 +17 3902 296 -03 177 +29 4001 438 -11 84 +13 4002 353 -21 115 +20
4101 397 11 9middot0 +11 4102 346 -19 120 +03 42 331 +19 11 bull 3 -16 43 347 -72 105 +31 44 113 +84 183 +154 4S 33~9 +07 110 -06 4601 2501 22 193 +38 4602 332 +59 126 -29 47middot 161middot 000 211 +01 48 103 -26 302 +59 49 138 +1 bull 3 252 +09 50 141 -26 204 -12 51 12 -39 257 +07 52 47 -61 351 +48 53 89 +49 314 -30 54 25 l1li15 327 -17 55 131 -17 115 -121 56 198 +93 227 -47 57 71 102 189 -88 58 240 ~middot41 16~1 +55 59 322 +25 142 +06middot 6001 264 95 132 +50
6002 328 -31middot 89 +07
JJ
Demographic Population Change 1960 to 1970 51 (Contd)
Census 1 ofPop lChange of Pop bull ChangeTract Under 19 Yrbullbull 1960-70 Over 65 Yrs 1960-70
1970 1970
61 355 -58 85 +39
62 328 39 110 +18
63 414 04 73 10
64 382 -22 72 +04
6501 383 02 67 -20
6502 329 -56 96 +09
6601 391 +13 88 -03
6602 319 -59 97 +06
6701 327 71 145 +72
6702 331 ~67 83 +1-0
6801 365 -66 49 +01
6802 388 4bull3 54 +06
69 354 -41 80 +23
70 400 -23 68 -06
71 359 -48 72 +05
72 255 -88 82 +11
73 346 -39 91 +25
74 313middot -63 105 +24
75 329 -42 129 +37
76 336 -52 85 +21
77 370 -10 69 +05
78 309 -10 120 +21
79 325 -56 87 +10
8001 358 -81 57 +12
8002 391 ~81 76 +12
81 315 -76 108 +21
8201 403 -23 64 +08
8202 392 23 65 +08
83 357 -34 120 +31
84 402 -18 73 +16
85 413 -06 76 -09
r
Demographic Population Change 1960 to 1970 52 (Contd)
Census Tract
t of Pop Uncler 19 Yrs
1970
Change 1960-70
1 of Pop OVer 65 Yrs
1970
ex Change 196070
86
87
88
89
90
91 9201
9202
93
94
95
9601
9602
9701
9702
9801
9802
99
100 I
101
102
103
10401
10402
lOS
368
351
379
391
391
413
379
433
372
429
414
432
419
439
~32
377
457 420
378 41middot7
345
360 417
417
412
-04
-02
-35
-26
-28
-11
-64
-20
-S9
-39
-32
-21
-34
-40
-47
-lO~7middot
-27middot +04
+56
+07
-34 01
+04
+04
+10
103
128
97
11il3 99
69
79
42
77
46
34 38
44
40
54
111
51middot
81
133
59
74
140
63
87
76
-08
-06
+04
+08
+17
-05
+3S -02
+1~4
+19
+33
-14
-08
+12
+26
+71
+11
-16 -34
-20
-19 +37
-49
-2S +15
NOte The The
Taken frOi
averageullder averageabove
middotUSCensus ---shy -
19 years == 6S years ==
figures 197
32r 13(14
p a~d 1960
--
Rank
1
2
3
4
5
6
7
8
9
10
11 12 -_
13
14
15
16
17
18
Tract
69 46
60
58
- 68
61
302
2501
67
63
19
62
26
94
3603
3902
64
30 -----~-
Rank
19
20
21 -
22
23-shy
24
25
26
27
28
29
30
31
32
33
34
35
36 -
Ranking of Per Capita Income by Census Tract
Tract
65
2701
- 15
1601
701
66
93
82
2903
3602
30
2502
80
2401
81
- 70
91 shy
4001
High
Rank Tractshy
-32shy37
38 97
120239
7840
41 ~ _2_1__ 42 31
43 2501
44 18
45 98
46 37
47 3803
1702
49
48
1602 92 2702
I
50 89
51 901
52 801
Ra_
53
54
55
56
57
58
59
60
61
62
63
64
6S
66
67
68
TractTract Ra~
74692
170196 70 I
401 71 90
72 1037J
79 70273
3802 74 601
24024102 75
85 76 101
77 9023901
7699 78 100 4101 79
3601 I
380180
458140~ t---- _ - - shy83 82 42
888384
59843501
4777 8~
502
Low
802 86
Rank Tract
87 shy
--88
89
90
91
92
93
94
- 95
96
97
middot98
99
100
101
102
103
104
1201
14
49
72
73
43
87
3502
105
1
52
86
71
1
501
10
3301
104 tf
Rank
105
106
107
108
109
110
III
112
113
114
115
116
117
118
119
120
121
Ranking of Per Capitalucoae by Census Tract
(Contd)
Tract Rank
4001 122--shy602
13
1102 2302
3302
55
3401
48
21
56
50
3402
lL01
2202
2301
53
2201
-shy
Tract Rank Tract Rank T~aet Rank
57 I-----
Imiddote
bull
Tract
- Low -k Note Information taken from 1960 U SCensus
Rank Tract
I ~
Ie
Imiddot
~
----
----
--
--
Rank
1
2
3
4
5
6
1
8
9
10
11
i-
-Tract
391 922 921
972 971
100
132 131 121
962 961
822 821 401
982 981
20 111
47 10 1
412
High
Total Number of Henta1 Health Visits
Ranked by Census Tract High to Low
TractTract RankTractRank Rnk
12 182 22 78 29 87 76 381 73181 ~------- 1913 371 8538230162372 271 2616-121 8272 2
14 80~2 31 94 7923 84801 59 15251362 4232 15 52 _ 32 103 8924 651 17240216 652
_ 91 351 33 341 23117 83 122 25 25 48 1123921418 34 shy61 86 661
19 662 6493 81 26 91 8153 49 50 55 41383 71 27 51 3120 90 672241 35shy 104167162 461
I 411 46211121 28 88342 I
2502 36 69 54 5251 50 272
-Ra
37
38
39
_ 40
_ 41 Ishy
I
42 I
-I 43 44
45
shy
Tract
~ --- shy 95 56
45 292 242
102 62 352 291y
92
101 281
99 72 63 601 60~ 42 2201
77 74 61 57
363 232
70
32 31
11 44 282 2202
Low l
- Tract
46 682 681 I 331 30
r~$ 47 1042 332
48 102_41_
11
~
Visits to Family Planning Clinics Ranked by Census Tract High to Low
Rank Tract Rank Tract Rankmiddot Tract Rank Tract Rank Tract Rank Tract
1
2
3
4
5
6
7
8
9
10
11
12
13middot
14
15
16
17
361
56
401
341
48
59 121
20
55
342
10
31
58
93 21
241 132
331
53
461 462
18
19
20-shy21
22
23
24
25
26
27middot
28
29
30
31
32
33
391
32
middot47 I-i-_-shy _ -
231 111
332
972 1
372 371
52
89
32
92
82
100 31
182
30 242
402
34
35
36
37
38
39
40
41
42
43
44
45
42
1714 i 661 221
78 362 2
90 602 601 352
63 251
105 921
971 351
73 42 292 232
411 51
662
81 45 52
46
47
48
49shy
50
51
52
53
54
55
56
961
801
49 81 72 71
19
9~1
172
68 2 57 162 14 112
91 75 681
381 42
3~3
83 161
57 f
58
59
60
61shy
62 Imiddot
63
Imiddot 64
65
66
64 62 36~3 252
74 652 SO 392 291
651 6bull 2
79 271
r-- ---- shy981 222
672 671
821 272
94 87
281
382
67
68
69
70
71
72
73
74
75
76
77
78
981 26 12~2
IS 61
85 82~2 69
61 43
101 86 84 282
76
131
51 72
1041 962 88 70
99 922 77
103
95 802 181
i
~
Low High
RankRank Tract
5479
4480
81 1042 ~) middot102
71 - - + ~ - ~
Visits to Family Planning Clinics
(Contd)
Tract Rank
I
Tract llaDk l
RankTract Tract Rank Tract
~
I
~
J1 ~
Low
Total Number of public Health Nursing Visits
Ranked by Census TractsHigh to Low
TractTract RankTractRank RankRank TractTractRankTractRank
25249 71 79 17249 8033 6586 99189711 84 2915072 34 661 76 66 811519512
402 5035 51 161 2518220 122 1713423 352 55801 7120 6752 2 149814 41236 83 2662 38 94 6821 53 2924015 362 37 32 42 75 69 281 84 63
546 8822 54 222 85 3925431 70383417 3818223 6439 4386652 718 21 55 103332 8924 232 87 19 271729219619 24156 16211140 382 628825 10523110 112 73411 10141-- ----shy 89 363 4457 8126 16111 221 74 9142 90 46158331 53 671279012 46243 48 59 351 3837528 1083 9313 91 5844 59 -_242 76 1----- shy60 272 72 74104114 60145 42 9287 7729 92 6151 8215 57371 934630 91 307762 12113116 282 619447 41391 9531 78100 63 7378 ~95 681 6945 32 5632 798517 6448 47 52 181
High ~ Low
Rank Tract Rank
96 31 132 70
97 102
98 182 372middot 602 651 662
- -shy
~72 682 802
822 922 962 972 982
1042 ----shy
Low
Total Number of Public Health Nursing Visits
(Contd)
Rank Rank Rank TractTract Tract
I
I lt
I
Tract Rank Tract
[
~~~-
I
~
IJilfimiddot ~
j
Ranking of VD Caea According to Census Tracts 61 By High and LOll Youth Itatio
A media~ of 34 5 was determined Any tract having greater
than 34 5~ of popu1tionunde~ 19 years of age -High~
Any tract having l8S than 345 of population under 19
years == Low
Any tract having rate less than 390 =Low
Any tract having rate more than 390 == HLgl4
YOUTH
LOW HIGH
L
0
12 402 1801 1802 343 2801 2802 29023603
54 6001 600262 66~02 72 74 75 76
78 79 81 t02 65 1202
W
(25)
VD
H
I
G
H
401 701 801802 901 902 10 1101 241 1201 1301 132 14 15 1601 1701 20~ 21 2202 2j02 2402 2502 2702 2901 303501 3502 34023801 3802 383 3902 42 44 45 4601 4602 47 48 49 SO 51~2 53 55 56 57 58 S9 6701 6702 73 95
3~02 7021702 19 25~01 2701 4102 4101 63 64601 ~601 6801 680270 7l 77 8001 80~02 8201 8202 83 84
85 86 87 88~ 90 91 9202 920193 94 9601 9602~ 9701 9102 9801 9802 99 100 101 103 10402 105 6501 10401
(47)
301 501 502 601 1602 2401 2301 2201 31 32 3301 3302 3401 3402~ 3602 3702 3901 400140 02 43 61 69 B(
(53) (23)
~ ~gt
Ranking of VD by Rate Per 100000 By Census Tract
~
Rank Tract Rank Tract Rank Tract Rank Tract llank Tract Rank Tract Rank Tract
1 2202 21 S6 40 902 58 1602 74 75
90-shy 64 107 26 --~-
2 3402 22 45 41 10 59 902 75 78 91 54 108 61
3 2301 23 3502 42 2502 60 602 76 6802 92 402 109 87
4 3302 24 49 43 1102 61 501 17 2 93 94 110 90
5 50 25 52 44 6702 62 14 78 8202 94 97 02 III 76
6 2201 26 20 6701 63 4002 8201 2501
9701 41~02 112 91
7 44 27 48 45 401 64 3802 2902 95 63 113 62
8 3301 28 1701 46 502 65 30 79 83 74 96 9602 114 71
9 55 29 47 47 42 66 3803 80 2801 96Q1 115 85 10
11
12
13
14
15
16
17
18
3401
53
2302
2401
57
21
2402
1101
51
30-shy31
32
33
34
35
36
37
3701 - -~ 1201
3702
89
43
132 131
3602
4001
48
49
50
51
52
53
54
55
58
1601
601
4602 4601
69
701
31
3901
67
68
69
70
71
72
2901
801
39021~ 802
6502 6501 122
702
41~01
81
82
83
84
85
86
87
88
19
1
1702
2802
79
93
100 6801 6602
81
97
98
99
100
101
102
103
104
9201 9202
9802 9801
77
302
79
86
72
84
116
117
118
119
120
121
3603
8002 8001
101
99
95
10401
105 10402 103 102
19
20
59
32
38
39
2702
3501
56
57
301
3801
73 1802 1801
89 6002 6001
105
106
2701
88
High Low
-- -----
Rank OrdermiddotTuberclosis Cases by Rate Per 100000 Ranked by Census Tract High to Low
Tract TractRankTractRank Rank TractRaukTractRankTractRank
801
79 9601501411 52 6835340120511 I 960269 903603532036 $-~~F130221542 4366 311301 70 68~013802 _ I- _ 4001_37213 3921201 6802802 H71523822024 22 54 193302 3802 80 8958 I37139535 70155 9801 I60123 72 6702 98023914011016 6701250124 10 56
81 94 401r 7 154152 73 7057 2625 122 92028
90242 162312301 92~158 86 7172434526509 82 79160159 74 100 87412240227220110 6502836960 75 30 8317244 6501782801285711 61 901 42765645 84 66021459294912 9701 660146 171 302 9702 47
6235023033113 85 822821182 917755 16335013110214 841814832 78 103 938564 324815 86 1057940149272 38036523216 10401 87 2902241 725Q 10402360266340217middot IF88 88 9937233 282 51 218 101 01102 46016234
I)167 2901460219 47
High ~ Low ~
- -
TractRank
9S89
6490
8191 8001 8002
63 61 60middot01 6002 44 2701
92
J
2502 402 --- ----shy
I
Rank
Rank Order Tuberculosis Cases by Rate per 100000
(Coutd)
Tract Rank Tract ~nk
I
Tract Ballk Tract Rank
Imiddot
Tract
Imiddot
1~
t 1I i Pi i l I
o
1 -1shyL I
I J
8 40 icO ~ I -lt 0
-t (1) I
i I
r o E
II
a
I
r--i
shy
I
~
I (
Jgt
(011 fi(
Ggt
I II ~j
()
(f 0
~ ()
I
11
f9
r
II 99
o ~
Ggt r
~ __-J~ I t I ~ I
r--J l I
~ _ __ J
) 1
fTl
1gt
r I
()
r
()
lt en -i en
()
I1l
(J)
(J)
-i
P ()
19
r o ~
r G1 I
I
c
~
o I 89
--- -I-shy
r-r I
1- 0 _~ _ _--J E
G1 I I I
i i
I 1-1-1 ~ _J ~2 ~ II
II
()
1 I I I 1
id i bullbull
~
A n 69
r 1shy
- 0 Gl
l--~ ~ I
~ II
II )
I () isect i
en l i
(J)
-t
0
IA Ol
Ll -
46
with Burns1de about thecnter
2 he extrea Northebullbullt comer of the County bull
By coap8r1ng the tuberculois an4ven8real
diseae maps ODe can 8ee that the downtown areas ot
hiSh 1nc1denceare alIIo8t 1c1eDt1cal on ach map
This WOuld 1nd1cate that 1t would be of value to
bullbulltab11sh acl1D1c 111 th1aampreatbat would provide
bothtuberCulos1s 8Dd ytmereal 418ase srvicbullbullbull
Thchart aDd 1181gt8 are wsfuln 11v1DI
1Ddicat10DS tor the type aDd placemeototlocal
health cl1n1c8 tbro1qhout tbe MultnomahCounty area
A cOllpar1on of the mapa help one to dec1dewhether
to provide a aulti-8ervice cl1D1c or spec1f1c type of
cliD1c As stated in Part I of thi paprserv1ces
shouldhaYe both treatlieDt and prfMmt10n cOmponents
As he been stated fta ne1lbborhood health care
Qenter muat be a fac111tY plazme4 with an aamesa
ot the neds of the consumer and the c01llll1m1tybull
Part II of this rport haa been an attaapt to indicate
and clarify 8011 ottheae coDlllUDity neds This has
been done through8elect10n of apc1f1c problems
The indic were then visuallyrecorded through the
use of ups and charta ODe dan asseS8 thedsreeof
1DIportance of certain concems to spec~t1c areaa by
comparinl the chart aDd maps Prom this oDeean
41 dec1de which are48 vb1chcUD1c-or indeed if
the need a clinic at all However further factors
should be considered hebullbull include
a The amount of fuDd1 available
b What 18 the percentage ot peopleineoh ceaaua tract tbat would actually us such cl1n1cIl
c Wbat 1 tbeco--1tymiddot 8 IeeliDashyreaardtDI particular cl1D1c8 Would this dcrebullbullbullmiddot the ettctiveness ot thse cl1n1ca
IJ
li
D_OlraphicPopulatLon Challie 1960 to 1970 48
Cen8U8 1 of Pop 1 Cbaqemiddot 1 Change1 ofPopTract Under 19 Yr8 Over 65 Yrs1960-70 1960-70
middot1Q701Q70
1 319 -12 171 -H) 1
2722 215-27 +68 301 366 -22 127 +35 302 371 +19 111 -04
311middot401 144-41 +29 402 321 13~7-39 +24 501 356 124-08 -02 5~O2 351 133-23 +12
405601 82-10 -02 394602 103-01 -06
701 275 149-76 +56 702 361 +01 121 -07
+10middot801 326 140-22 802 321 middot127
(
-29 -03 9~01 342 124 -H) 6-18 902 294 128 -H) 3-24
10middotmiddot -14312 140 -17 1101 182 +25 -23197
2411102 186-59 +29 1201 226 169-17 -41
31middot01202 +11 182 -05 295 -H) 81301 208 -H) 4
1302 331 +08 197 +04
14 323 +15 middot185 -08 middotmiddot15 329 +16 16~5 -13
-28middot 1601 332 131 +12
1602 356 98 +24middot-39 middot3101701 161-33 +21
1702 370 -15 85 +02 +19 1801 264 151middot-50
185middot1802 256 +47-58
IJ ~
D_raphlc Population Change 1960 to 1970middot 49 (Contd)
4io
Census Tract
of pop Uncter 19 Yra
1Q1n
1Cha1l8e 1960-70
of PopOver 65 Yra
lQO Change
1960-70
19 389 +29 141 -24 20 223 -13 206 +18
21 227 +08 194 -36 2201 356 -27 112 +05
2202 290 -18 ll~9 -29 2301 356 -03 154 +24 2302 260 -37 245 +97
2401 410 +6~1 123 -31 2402 163 -80 320 +99 2501 381 +13 140 -01 25()2 237 31 lil +02 26 343 +25 186 +149 2701 370 +29 1S5 -01 2702 249 -44 304 +98 2801 337 +19 187 +09 2802 306 -10 156 +31 2901 304 -38 142 +24 2902 i 307 -32 146 t3~9
30 29~0 -48 16~2 +51
31 355 +30 160 +01 32 370 +48 148 -13 3301 395 +45 130 -20 3302 368 +06 138 -02 3401 386 +16 117 000
3402
400 +32 92 -26 3501 304 -07 115 +35
3502 344 000 140 -13
3601
36~02 357 -04 132 +32
3603 30~1 42 149 -67 3701 342 +28 152 +19
1
IJ
Jianolraphic Population Chan 1960 to 1970 50 (Contd)
Census Tract
of Pop Under 19 Yrs
JJl7J
middotChanae 1960-70
middotofmiddotpop Over 65 Yrs
1c~7n
Change 196070
3702 409 +39 122 -11 3801 308 -11 151 +29 3802 275 -35 180 +46 3803 282 -32 192 +54 3901 376 ~13 100 +17 3902 296 -03 177 +29 4001 438 -11 84 +13 4002 353 -21 115 +20
4101 397 11 9middot0 +11 4102 346 -19 120 +03 42 331 +19 11 bull 3 -16 43 347 -72 105 +31 44 113 +84 183 +154 4S 33~9 +07 110 -06 4601 2501 22 193 +38 4602 332 +59 126 -29 47middot 161middot 000 211 +01 48 103 -26 302 +59 49 138 +1 bull 3 252 +09 50 141 -26 204 -12 51 12 -39 257 +07 52 47 -61 351 +48 53 89 +49 314 -30 54 25 l1li15 327 -17 55 131 -17 115 -121 56 198 +93 227 -47 57 71 102 189 -88 58 240 ~middot41 16~1 +55 59 322 +25 142 +06middot 6001 264 95 132 +50
6002 328 -31middot 89 +07
JJ
Demographic Population Change 1960 to 1970 51 (Contd)
Census 1 ofPop lChange of Pop bull ChangeTract Under 19 Yrbullbull 1960-70 Over 65 Yrs 1960-70
1970 1970
61 355 -58 85 +39
62 328 39 110 +18
63 414 04 73 10
64 382 -22 72 +04
6501 383 02 67 -20
6502 329 -56 96 +09
6601 391 +13 88 -03
6602 319 -59 97 +06
6701 327 71 145 +72
6702 331 ~67 83 +1-0
6801 365 -66 49 +01
6802 388 4bull3 54 +06
69 354 -41 80 +23
70 400 -23 68 -06
71 359 -48 72 +05
72 255 -88 82 +11
73 346 -39 91 +25
74 313middot -63 105 +24
75 329 -42 129 +37
76 336 -52 85 +21
77 370 -10 69 +05
78 309 -10 120 +21
79 325 -56 87 +10
8001 358 -81 57 +12
8002 391 ~81 76 +12
81 315 -76 108 +21
8201 403 -23 64 +08
8202 392 23 65 +08
83 357 -34 120 +31
84 402 -18 73 +16
85 413 -06 76 -09
r
Demographic Population Change 1960 to 1970 52 (Contd)
Census Tract
t of Pop Uncler 19 Yrs
1970
Change 1960-70
1 of Pop OVer 65 Yrs
1970
ex Change 196070
86
87
88
89
90
91 9201
9202
93
94
95
9601
9602
9701
9702
9801
9802
99
100 I
101
102
103
10401
10402
lOS
368
351
379
391
391
413
379
433
372
429
414
432
419
439
~32
377
457 420
378 41middot7
345
360 417
417
412
-04
-02
-35
-26
-28
-11
-64
-20
-S9
-39
-32
-21
-34
-40
-47
-lO~7middot
-27middot +04
+56
+07
-34 01
+04
+04
+10
103
128
97
11il3 99
69
79
42
77
46
34 38
44
40
54
111
51middot
81
133
59
74
140
63
87
76
-08
-06
+04
+08
+17
-05
+3S -02
+1~4
+19
+33
-14
-08
+12
+26
+71
+11
-16 -34
-20
-19 +37
-49
-2S +15
NOte The The
Taken frOi
averageullder averageabove
middotUSCensus ---shy -
19 years == 6S years ==
figures 197
32r 13(14
p a~d 1960
--
Rank
1
2
3
4
5
6
7
8
9
10
11 12 -_
13
14
15
16
17
18
Tract
69 46
60
58
- 68
61
302
2501
67
63
19
62
26
94
3603
3902
64
30 -----~-
Rank
19
20
21 -
22
23-shy
24
25
26
27
28
29
30
31
32
33
34
35
36 -
Ranking of Per Capita Income by Census Tract
Tract
65
2701
- 15
1601
701
66
93
82
2903
3602
30
2502
80
2401
81
- 70
91 shy
4001
High
Rank Tractshy
-32shy37
38 97
120239
7840
41 ~ _2_1__ 42 31
43 2501
44 18
45 98
46 37
47 3803
1702
49
48
1602 92 2702
I
50 89
51 901
52 801
Ra_
53
54
55
56
57
58
59
60
61
62
63
64
6S
66
67
68
TractTract Ra~
74692
170196 70 I
401 71 90
72 1037J
79 70273
3802 74 601
24024102 75
85 76 101
77 9023901
7699 78 100 4101 79
3601 I
380180
458140~ t---- _ - - shy83 82 42
888384
59843501
4777 8~
502
Low
802 86
Rank Tract
87 shy
--88
89
90
91
92
93
94
- 95
96
97
middot98
99
100
101
102
103
104
1201
14
49
72
73
43
87
3502
105
1
52
86
71
1
501
10
3301
104 tf
Rank
105
106
107
108
109
110
III
112
113
114
115
116
117
118
119
120
121
Ranking of Per Capitalucoae by Census Tract
(Contd)
Tract Rank
4001 122--shy602
13
1102 2302
3302
55
3401
48
21
56
50
3402
lL01
2202
2301
53
2201
-shy
Tract Rank Tract Rank T~aet Rank
57 I-----
Imiddote
bull
Tract
- Low -k Note Information taken from 1960 U SCensus
Rank Tract
I ~
Ie
Imiddot
~
----
----
--
--
Rank
1
2
3
4
5
6
1
8
9
10
11
i-
-Tract
391 922 921
972 971
100
132 131 121
962 961
822 821 401
982 981
20 111
47 10 1
412
High
Total Number of Henta1 Health Visits
Ranked by Census Tract High to Low
TractTract RankTractRank Rnk
12 182 22 78 29 87 76 381 73181 ~------- 1913 371 8538230162372 271 2616-121 8272 2
14 80~2 31 94 7923 84801 59 15251362 4232 15 52 _ 32 103 8924 651 17240216 652
_ 91 351 33 341 23117 83 122 25 25 48 1123921418 34 shy61 86 661
19 662 6493 81 26 91 8153 49 50 55 41383 71 27 51 3120 90 672241 35shy 104167162 461
I 411 46211121 28 88342 I
2502 36 69 54 5251 50 272
-Ra
37
38
39
_ 40
_ 41 Ishy
I
42 I
-I 43 44
45
shy
Tract
~ --- shy 95 56
45 292 242
102 62 352 291y
92
101 281
99 72 63 601 60~ 42 2201
77 74 61 57
363 232
70
32 31
11 44 282 2202
Low l
- Tract
46 682 681 I 331 30
r~$ 47 1042 332
48 102_41_
11
~
Visits to Family Planning Clinics Ranked by Census Tract High to Low
Rank Tract Rank Tract Rankmiddot Tract Rank Tract Rank Tract Rank Tract
1
2
3
4
5
6
7
8
9
10
11
12
13middot
14
15
16
17
361
56
401
341
48
59 121
20
55
342
10
31
58
93 21
241 132
331
53
461 462
18
19
20-shy21
22
23
24
25
26
27middot
28
29
30
31
32
33
391
32
middot47 I-i-_-shy _ -
231 111
332
972 1
372 371
52
89
32
92
82
100 31
182
30 242
402
34
35
36
37
38
39
40
41
42
43
44
45
42
1714 i 661 221
78 362 2
90 602 601 352
63 251
105 921
971 351
73 42 292 232
411 51
662
81 45 52
46
47
48
49shy
50
51
52
53
54
55
56
961
801
49 81 72 71
19
9~1
172
68 2 57 162 14 112
91 75 681
381 42
3~3
83 161
57 f
58
59
60
61shy
62 Imiddot
63
Imiddot 64
65
66
64 62 36~3 252
74 652 SO 392 291
651 6bull 2
79 271
r-- ---- shy981 222
672 671
821 272
94 87
281
382
67
68
69
70
71
72
73
74
75
76
77
78
981 26 12~2
IS 61
85 82~2 69
61 43
101 86 84 282
76
131
51 72
1041 962 88 70
99 922 77
103
95 802 181
i
~
Low High
RankRank Tract
5479
4480
81 1042 ~) middot102
71 - - + ~ - ~
Visits to Family Planning Clinics
(Contd)
Tract Rank
I
Tract llaDk l
RankTract Tract Rank Tract
~
I
~
J1 ~
Low
Total Number of public Health Nursing Visits
Ranked by Census TractsHigh to Low
TractTract RankTractRank RankRank TractTractRankTractRank
25249 71 79 17249 8033 6586 99189711 84 2915072 34 661 76 66 811519512
402 5035 51 161 2518220 122 1713423 352 55801 7120 6752 2 149814 41236 83 2662 38 94 6821 53 2924015 362 37 32 42 75 69 281 84 63
546 8822 54 222 85 3925431 70383417 3818223 6439 4386652 718 21 55 103332 8924 232 87 19 271729219619 24156 16211140 382 628825 10523110 112 73411 10141-- ----shy 89 363 4457 8126 16111 221 74 9142 90 46158331 53 671279012 46243 48 59 351 3837528 1083 9313 91 5844 59 -_242 76 1----- shy60 272 72 74104114 60145 42 9287 7729 92 6151 8215 57371 934630 91 307762 12113116 282 619447 41391 9531 78100 63 7378 ~95 681 6945 32 5632 798517 6448 47 52 181
High ~ Low
Rank Tract Rank
96 31 132 70
97 102
98 182 372middot 602 651 662
- -shy
~72 682 802
822 922 962 972 982
1042 ----shy
Low
Total Number of Public Health Nursing Visits
(Contd)
Rank Rank Rank TractTract Tract
I
I lt
I
Tract Rank Tract
[
~~~-
I
~
IJilfimiddot ~
j
Ranking of VD Caea According to Census Tracts 61 By High and LOll Youth Itatio
A media~ of 34 5 was determined Any tract having greater
than 34 5~ of popu1tionunde~ 19 years of age -High~
Any tract having l8S than 345 of population under 19
years == Low
Any tract having rate less than 390 =Low
Any tract having rate more than 390 == HLgl4
YOUTH
LOW HIGH
L
0
12 402 1801 1802 343 2801 2802 29023603
54 6001 600262 66~02 72 74 75 76
78 79 81 t02 65 1202
W
(25)
VD
H
I
G
H
401 701 801802 901 902 10 1101 241 1201 1301 132 14 15 1601 1701 20~ 21 2202 2j02 2402 2502 2702 2901 303501 3502 34023801 3802 383 3902 42 44 45 4601 4602 47 48 49 SO 51~2 53 55 56 57 58 S9 6701 6702 73 95
3~02 7021702 19 25~01 2701 4102 4101 63 64601 ~601 6801 680270 7l 77 8001 80~02 8201 8202 83 84
85 86 87 88~ 90 91 9202 920193 94 9601 9602~ 9701 9102 9801 9802 99 100 101 103 10402 105 6501 10401
(47)
301 501 502 601 1602 2401 2301 2201 31 32 3301 3302 3401 3402~ 3602 3702 3901 400140 02 43 61 69 B(
(53) (23)
~ ~gt
Ranking of VD by Rate Per 100000 By Census Tract
~
Rank Tract Rank Tract Rank Tract Rank Tract llank Tract Rank Tract Rank Tract
1 2202 21 S6 40 902 58 1602 74 75
90-shy 64 107 26 --~-
2 3402 22 45 41 10 59 902 75 78 91 54 108 61
3 2301 23 3502 42 2502 60 602 76 6802 92 402 109 87
4 3302 24 49 43 1102 61 501 17 2 93 94 110 90
5 50 25 52 44 6702 62 14 78 8202 94 97 02 III 76
6 2201 26 20 6701 63 4002 8201 2501
9701 41~02 112 91
7 44 27 48 45 401 64 3802 2902 95 63 113 62
8 3301 28 1701 46 502 65 30 79 83 74 96 9602 114 71
9 55 29 47 47 42 66 3803 80 2801 96Q1 115 85 10
11
12
13
14
15
16
17
18
3401
53
2302
2401
57
21
2402
1101
51
30-shy31
32
33
34
35
36
37
3701 - -~ 1201
3702
89
43
132 131
3602
4001
48
49
50
51
52
53
54
55
58
1601
601
4602 4601
69
701
31
3901
67
68
69
70
71
72
2901
801
39021~ 802
6502 6501 122
702
41~01
81
82
83
84
85
86
87
88
19
1
1702
2802
79
93
100 6801 6602
81
97
98
99
100
101
102
103
104
9201 9202
9802 9801
77
302
79
86
72
84
116
117
118
119
120
121
3603
8002 8001
101
99
95
10401
105 10402 103 102
19
20
59
32
38
39
2702
3501
56
57
301
3801
73 1802 1801
89 6002 6001
105
106
2701
88
High Low
-- -----
Rank OrdermiddotTuberclosis Cases by Rate Per 100000 Ranked by Census Tract High to Low
Tract TractRankTractRank Rank TractRaukTractRankTractRank
801
79 9601501411 52 6835340120511 I 960269 903603532036 $-~~F130221542 4366 311301 70 68~013802 _ I- _ 4001_37213 3921201 6802802 H71523822024 22 54 193302 3802 80 8958 I37139535 70155 9801 I60123 72 6702 98023914011016 6701250124 10 56
81 94 401r 7 154152 73 7057 2625 122 92028
90242 162312301 92~158 86 7172434526509 82 79160159 74 100 87412240227220110 6502836960 75 30 8317244 6501782801285711 61 901 42765645 84 66021459294912 9701 660146 171 302 9702 47
6235023033113 85 822821182 917755 16335013110214 841814832 78 103 938564 324815 86 1057940149272 38036523216 10401 87 2902241 725Q 10402360266340217middot IF88 88 9937233 282 51 218 101 01102 46016234
I)167 2901460219 47
High ~ Low ~
- -
TractRank
9S89
6490
8191 8001 8002
63 61 60middot01 6002 44 2701
92
J
2502 402 --- ----shy
I
Rank
Rank Order Tuberculosis Cases by Rate per 100000
(Coutd)
Tract Rank Tract ~nk
I
Tract Ballk Tract Rank
Imiddot
Tract
Imiddot
1~
t 1I i Pi i l I
o
1 -1shyL I
I J
8 40 icO ~ I -lt 0
-t (1) I
i I
r o E
II
a
I
r--i
shy
I
~
I (
Jgt
(011 fi(
Ggt
I II ~j
()
(f 0
~ ()
I
11
f9
r
II 99
o ~
Ggt r
~ __-J~ I t I ~ I
r--J l I
~ _ __ J
) 1
fTl
1gt
r I
()
r
()
lt en -i en
()
I1l
(J)
(J)
-i
P ()
19
r o ~
r G1 I
I
c
~
o I 89
--- -I-shy
r-r I
1- 0 _~ _ _--J E
G1 I I I
i i
I 1-1-1 ~ _J ~2 ~ II
II
()
1 I I I 1
id i bullbull
~
A n 69
r 1shy
- 0 Gl
l--~ ~ I
~ II
II )
I () isect i
en l i
(J)
-t
0
IA Ol
41 dec1de which are48 vb1chcUD1c-or indeed if
the need a clinic at all However further factors
should be considered hebullbull include
a The amount of fuDd1 available
b What 18 the percentage ot peopleineoh ceaaua tract tbat would actually us such cl1n1cIl
c Wbat 1 tbeco--1tymiddot 8 IeeliDashyreaardtDI particular cl1D1c8 Would this dcrebullbullbullmiddot the ettctiveness ot thse cl1n1ca
IJ
li
D_OlraphicPopulatLon Challie 1960 to 1970 48
Cen8U8 1 of Pop 1 Cbaqemiddot 1 Change1 ofPopTract Under 19 Yr8 Over 65 Yrs1960-70 1960-70
middot1Q701Q70
1 319 -12 171 -H) 1
2722 215-27 +68 301 366 -22 127 +35 302 371 +19 111 -04
311middot401 144-41 +29 402 321 13~7-39 +24 501 356 124-08 -02 5~O2 351 133-23 +12
405601 82-10 -02 394602 103-01 -06
701 275 149-76 +56 702 361 +01 121 -07
+10middot801 326 140-22 802 321 middot127
(
-29 -03 9~01 342 124 -H) 6-18 902 294 128 -H) 3-24
10middotmiddot -14312 140 -17 1101 182 +25 -23197
2411102 186-59 +29 1201 226 169-17 -41
31middot01202 +11 182 -05 295 -H) 81301 208 -H) 4
1302 331 +08 197 +04
14 323 +15 middot185 -08 middotmiddot15 329 +16 16~5 -13
-28middot 1601 332 131 +12
1602 356 98 +24middot-39 middot3101701 161-33 +21
1702 370 -15 85 +02 +19 1801 264 151middot-50
185middot1802 256 +47-58
IJ ~
D_raphlc Population Change 1960 to 1970middot 49 (Contd)
4io
Census Tract
of pop Uncter 19 Yra
1Q1n
1Cha1l8e 1960-70
of PopOver 65 Yra
lQO Change
1960-70
19 389 +29 141 -24 20 223 -13 206 +18
21 227 +08 194 -36 2201 356 -27 112 +05
2202 290 -18 ll~9 -29 2301 356 -03 154 +24 2302 260 -37 245 +97
2401 410 +6~1 123 -31 2402 163 -80 320 +99 2501 381 +13 140 -01 25()2 237 31 lil +02 26 343 +25 186 +149 2701 370 +29 1S5 -01 2702 249 -44 304 +98 2801 337 +19 187 +09 2802 306 -10 156 +31 2901 304 -38 142 +24 2902 i 307 -32 146 t3~9
30 29~0 -48 16~2 +51
31 355 +30 160 +01 32 370 +48 148 -13 3301 395 +45 130 -20 3302 368 +06 138 -02 3401 386 +16 117 000
3402
400 +32 92 -26 3501 304 -07 115 +35
3502 344 000 140 -13
3601
36~02 357 -04 132 +32
3603 30~1 42 149 -67 3701 342 +28 152 +19
1
IJ
Jianolraphic Population Chan 1960 to 1970 50 (Contd)
Census Tract
of Pop Under 19 Yrs
JJl7J
middotChanae 1960-70
middotofmiddotpop Over 65 Yrs
1c~7n
Change 196070
3702 409 +39 122 -11 3801 308 -11 151 +29 3802 275 -35 180 +46 3803 282 -32 192 +54 3901 376 ~13 100 +17 3902 296 -03 177 +29 4001 438 -11 84 +13 4002 353 -21 115 +20
4101 397 11 9middot0 +11 4102 346 -19 120 +03 42 331 +19 11 bull 3 -16 43 347 -72 105 +31 44 113 +84 183 +154 4S 33~9 +07 110 -06 4601 2501 22 193 +38 4602 332 +59 126 -29 47middot 161middot 000 211 +01 48 103 -26 302 +59 49 138 +1 bull 3 252 +09 50 141 -26 204 -12 51 12 -39 257 +07 52 47 -61 351 +48 53 89 +49 314 -30 54 25 l1li15 327 -17 55 131 -17 115 -121 56 198 +93 227 -47 57 71 102 189 -88 58 240 ~middot41 16~1 +55 59 322 +25 142 +06middot 6001 264 95 132 +50
6002 328 -31middot 89 +07
JJ
Demographic Population Change 1960 to 1970 51 (Contd)
Census 1 ofPop lChange of Pop bull ChangeTract Under 19 Yrbullbull 1960-70 Over 65 Yrs 1960-70
1970 1970
61 355 -58 85 +39
62 328 39 110 +18
63 414 04 73 10
64 382 -22 72 +04
6501 383 02 67 -20
6502 329 -56 96 +09
6601 391 +13 88 -03
6602 319 -59 97 +06
6701 327 71 145 +72
6702 331 ~67 83 +1-0
6801 365 -66 49 +01
6802 388 4bull3 54 +06
69 354 -41 80 +23
70 400 -23 68 -06
71 359 -48 72 +05
72 255 -88 82 +11
73 346 -39 91 +25
74 313middot -63 105 +24
75 329 -42 129 +37
76 336 -52 85 +21
77 370 -10 69 +05
78 309 -10 120 +21
79 325 -56 87 +10
8001 358 -81 57 +12
8002 391 ~81 76 +12
81 315 -76 108 +21
8201 403 -23 64 +08
8202 392 23 65 +08
83 357 -34 120 +31
84 402 -18 73 +16
85 413 -06 76 -09
r
Demographic Population Change 1960 to 1970 52 (Contd)
Census Tract
t of Pop Uncler 19 Yrs
1970
Change 1960-70
1 of Pop OVer 65 Yrs
1970
ex Change 196070
86
87
88
89
90
91 9201
9202
93
94
95
9601
9602
9701
9702
9801
9802
99
100 I
101
102
103
10401
10402
lOS
368
351
379
391
391
413
379
433
372
429
414
432
419
439
~32
377
457 420
378 41middot7
345
360 417
417
412
-04
-02
-35
-26
-28
-11
-64
-20
-S9
-39
-32
-21
-34
-40
-47
-lO~7middot
-27middot +04
+56
+07
-34 01
+04
+04
+10
103
128
97
11il3 99
69
79
42
77
46
34 38
44
40
54
111
51middot
81
133
59
74
140
63
87
76
-08
-06
+04
+08
+17
-05
+3S -02
+1~4
+19
+33
-14
-08
+12
+26
+71
+11
-16 -34
-20
-19 +37
-49
-2S +15
NOte The The
Taken frOi
averageullder averageabove
middotUSCensus ---shy -
19 years == 6S years ==
figures 197
32r 13(14
p a~d 1960
--
Rank
1
2
3
4
5
6
7
8
9
10
11 12 -_
13
14
15
16
17
18
Tract
69 46
60
58
- 68
61
302
2501
67
63
19
62
26
94
3603
3902
64
30 -----~-
Rank
19
20
21 -
22
23-shy
24
25
26
27
28
29
30
31
32
33
34
35
36 -
Ranking of Per Capita Income by Census Tract
Tract
65
2701
- 15
1601
701
66
93
82
2903
3602
30
2502
80
2401
81
- 70
91 shy
4001
High
Rank Tractshy
-32shy37
38 97
120239
7840
41 ~ _2_1__ 42 31
43 2501
44 18
45 98
46 37
47 3803
1702
49
48
1602 92 2702
I
50 89
51 901
52 801
Ra_
53
54
55
56
57
58
59
60
61
62
63
64
6S
66
67
68
TractTract Ra~
74692
170196 70 I
401 71 90
72 1037J
79 70273
3802 74 601
24024102 75
85 76 101
77 9023901
7699 78 100 4101 79
3601 I
380180
458140~ t---- _ - - shy83 82 42
888384
59843501
4777 8~
502
Low
802 86
Rank Tract
87 shy
--88
89
90
91
92
93
94
- 95
96
97
middot98
99
100
101
102
103
104
1201
14
49
72
73
43
87
3502
105
1
52
86
71
1
501
10
3301
104 tf
Rank
105
106
107
108
109
110
III
112
113
114
115
116
117
118
119
120
121
Ranking of Per Capitalucoae by Census Tract
(Contd)
Tract Rank
4001 122--shy602
13
1102 2302
3302
55
3401
48
21
56
50
3402
lL01
2202
2301
53
2201
-shy
Tract Rank Tract Rank T~aet Rank
57 I-----
Imiddote
bull
Tract
- Low -k Note Information taken from 1960 U SCensus
Rank Tract
I ~
Ie
Imiddot
~
----
----
--
--
Rank
1
2
3
4
5
6
1
8
9
10
11
i-
-Tract
391 922 921
972 971
100
132 131 121
962 961
822 821 401
982 981
20 111
47 10 1
412
High
Total Number of Henta1 Health Visits
Ranked by Census Tract High to Low
TractTract RankTractRank Rnk
12 182 22 78 29 87 76 381 73181 ~------- 1913 371 8538230162372 271 2616-121 8272 2
14 80~2 31 94 7923 84801 59 15251362 4232 15 52 _ 32 103 8924 651 17240216 652
_ 91 351 33 341 23117 83 122 25 25 48 1123921418 34 shy61 86 661
19 662 6493 81 26 91 8153 49 50 55 41383 71 27 51 3120 90 672241 35shy 104167162 461
I 411 46211121 28 88342 I
2502 36 69 54 5251 50 272
-Ra
37
38
39
_ 40
_ 41 Ishy
I
42 I
-I 43 44
45
shy
Tract
~ --- shy 95 56
45 292 242
102 62 352 291y
92
101 281
99 72 63 601 60~ 42 2201
77 74 61 57
363 232
70
32 31
11 44 282 2202
Low l
- Tract
46 682 681 I 331 30
r~$ 47 1042 332
48 102_41_
11
~
Visits to Family Planning Clinics Ranked by Census Tract High to Low
Rank Tract Rank Tract Rankmiddot Tract Rank Tract Rank Tract Rank Tract
1
2
3
4
5
6
7
8
9
10
11
12
13middot
14
15
16
17
361
56
401
341
48
59 121
20
55
342
10
31
58
93 21
241 132
331
53
461 462
18
19
20-shy21
22
23
24
25
26
27middot
28
29
30
31
32
33
391
32
middot47 I-i-_-shy _ -
231 111
332
972 1
372 371
52
89
32
92
82
100 31
182
30 242
402
34
35
36
37
38
39
40
41
42
43
44
45
42
1714 i 661 221
78 362 2
90 602 601 352
63 251
105 921
971 351
73 42 292 232
411 51
662
81 45 52
46
47
48
49shy
50
51
52
53
54
55
56
961
801
49 81 72 71
19
9~1
172
68 2 57 162 14 112
91 75 681
381 42
3~3
83 161
57 f
58
59
60
61shy
62 Imiddot
63
Imiddot 64
65
66
64 62 36~3 252
74 652 SO 392 291
651 6bull 2
79 271
r-- ---- shy981 222
672 671
821 272
94 87
281
382
67
68
69
70
71
72
73
74
75
76
77
78
981 26 12~2
IS 61
85 82~2 69
61 43
101 86 84 282
76
131
51 72
1041 962 88 70
99 922 77
103
95 802 181
i
~
Low High
RankRank Tract
5479
4480
81 1042 ~) middot102
71 - - + ~ - ~
Visits to Family Planning Clinics
(Contd)
Tract Rank
I
Tract llaDk l
RankTract Tract Rank Tract
~
I
~
J1 ~
Low
Total Number of public Health Nursing Visits
Ranked by Census TractsHigh to Low
TractTract RankTractRank RankRank TractTractRankTractRank
25249 71 79 17249 8033 6586 99189711 84 2915072 34 661 76 66 811519512
402 5035 51 161 2518220 122 1713423 352 55801 7120 6752 2 149814 41236 83 2662 38 94 6821 53 2924015 362 37 32 42 75 69 281 84 63
546 8822 54 222 85 3925431 70383417 3818223 6439 4386652 718 21 55 103332 8924 232 87 19 271729219619 24156 16211140 382 628825 10523110 112 73411 10141-- ----shy 89 363 4457 8126 16111 221 74 9142 90 46158331 53 671279012 46243 48 59 351 3837528 1083 9313 91 5844 59 -_242 76 1----- shy60 272 72 74104114 60145 42 9287 7729 92 6151 8215 57371 934630 91 307762 12113116 282 619447 41391 9531 78100 63 7378 ~95 681 6945 32 5632 798517 6448 47 52 181
High ~ Low
Rank Tract Rank
96 31 132 70
97 102
98 182 372middot 602 651 662
- -shy
~72 682 802
822 922 962 972 982
1042 ----shy
Low
Total Number of Public Health Nursing Visits
(Contd)
Rank Rank Rank TractTract Tract
I
I lt
I
Tract Rank Tract
[
~~~-
I
~
IJilfimiddot ~
j
Ranking of VD Caea According to Census Tracts 61 By High and LOll Youth Itatio
A media~ of 34 5 was determined Any tract having greater
than 34 5~ of popu1tionunde~ 19 years of age -High~
Any tract having l8S than 345 of population under 19
years == Low
Any tract having rate less than 390 =Low
Any tract having rate more than 390 == HLgl4
YOUTH
LOW HIGH
L
0
12 402 1801 1802 343 2801 2802 29023603
54 6001 600262 66~02 72 74 75 76
78 79 81 t02 65 1202
W
(25)
VD
H
I
G
H
401 701 801802 901 902 10 1101 241 1201 1301 132 14 15 1601 1701 20~ 21 2202 2j02 2402 2502 2702 2901 303501 3502 34023801 3802 383 3902 42 44 45 4601 4602 47 48 49 SO 51~2 53 55 56 57 58 S9 6701 6702 73 95
3~02 7021702 19 25~01 2701 4102 4101 63 64601 ~601 6801 680270 7l 77 8001 80~02 8201 8202 83 84
85 86 87 88~ 90 91 9202 920193 94 9601 9602~ 9701 9102 9801 9802 99 100 101 103 10402 105 6501 10401
(47)
301 501 502 601 1602 2401 2301 2201 31 32 3301 3302 3401 3402~ 3602 3702 3901 400140 02 43 61 69 B(
(53) (23)
~ ~gt
Ranking of VD by Rate Per 100000 By Census Tract
~
Rank Tract Rank Tract Rank Tract Rank Tract llank Tract Rank Tract Rank Tract
1 2202 21 S6 40 902 58 1602 74 75
90-shy 64 107 26 --~-
2 3402 22 45 41 10 59 902 75 78 91 54 108 61
3 2301 23 3502 42 2502 60 602 76 6802 92 402 109 87
4 3302 24 49 43 1102 61 501 17 2 93 94 110 90
5 50 25 52 44 6702 62 14 78 8202 94 97 02 III 76
6 2201 26 20 6701 63 4002 8201 2501
9701 41~02 112 91
7 44 27 48 45 401 64 3802 2902 95 63 113 62
8 3301 28 1701 46 502 65 30 79 83 74 96 9602 114 71
9 55 29 47 47 42 66 3803 80 2801 96Q1 115 85 10
11
12
13
14
15
16
17
18
3401
53
2302
2401
57
21
2402
1101
51
30-shy31
32
33
34
35
36
37
3701 - -~ 1201
3702
89
43
132 131
3602
4001
48
49
50
51
52
53
54
55
58
1601
601
4602 4601
69
701
31
3901
67
68
69
70
71
72
2901
801
39021~ 802
6502 6501 122
702
41~01
81
82
83
84
85
86
87
88
19
1
1702
2802
79
93
100 6801 6602
81
97
98
99
100
101
102
103
104
9201 9202
9802 9801
77
302
79
86
72
84
116
117
118
119
120
121
3603
8002 8001
101
99
95
10401
105 10402 103 102
19
20
59
32
38
39
2702
3501
56
57
301
3801
73 1802 1801
89 6002 6001
105
106
2701
88
High Low
-- -----
Rank OrdermiddotTuberclosis Cases by Rate Per 100000 Ranked by Census Tract High to Low
Tract TractRankTractRank Rank TractRaukTractRankTractRank
801
79 9601501411 52 6835340120511 I 960269 903603532036 $-~~F130221542 4366 311301 70 68~013802 _ I- _ 4001_37213 3921201 6802802 H71523822024 22 54 193302 3802 80 8958 I37139535 70155 9801 I60123 72 6702 98023914011016 6701250124 10 56
81 94 401r 7 154152 73 7057 2625 122 92028
90242 162312301 92~158 86 7172434526509 82 79160159 74 100 87412240227220110 6502836960 75 30 8317244 6501782801285711 61 901 42765645 84 66021459294912 9701 660146 171 302 9702 47
6235023033113 85 822821182 917755 16335013110214 841814832 78 103 938564 324815 86 1057940149272 38036523216 10401 87 2902241 725Q 10402360266340217middot IF88 88 9937233 282 51 218 101 01102 46016234
I)167 2901460219 47
High ~ Low ~
- -
TractRank
9S89
6490
8191 8001 8002
63 61 60middot01 6002 44 2701
92
J
2502 402 --- ----shy
I
Rank
Rank Order Tuberculosis Cases by Rate per 100000
(Coutd)
Tract Rank Tract ~nk
I
Tract Ballk Tract Rank
Imiddot
Tract
Imiddot
1~
t 1I i Pi i l I
o
1 -1shyL I
I J
8 40 icO ~ I -lt 0
-t (1) I
i I
r o E
II
a
I
r--i
shy
I
~
I (
Jgt
(011 fi(
Ggt
I II ~j
()
(f 0
~ ()
I
11
f9
r
II 99
o ~
Ggt r
~ __-J~ I t I ~ I
r--J l I
~ _ __ J
) 1
fTl
1gt
r I
()
r
()
lt en -i en
()
I1l
(J)
(J)
-i
P ()
19
r o ~
r G1 I
I
c
~
o I 89
--- -I-shy
r-r I
1- 0 _~ _ _--J E
G1 I I I
i i
I 1-1-1 ~ _J ~2 ~ II
II
()
1 I I I 1
id i bullbull
~
A n 69
r 1shy
- 0 Gl
l--~ ~ I
~ II
II )
I () isect i
en l i
(J)
-t
0
IA Ol
IJ
li
D_OlraphicPopulatLon Challie 1960 to 1970 48
Cen8U8 1 of Pop 1 Cbaqemiddot 1 Change1 ofPopTract Under 19 Yr8 Over 65 Yrs1960-70 1960-70
middot1Q701Q70
1 319 -12 171 -H) 1
2722 215-27 +68 301 366 -22 127 +35 302 371 +19 111 -04
311middot401 144-41 +29 402 321 13~7-39 +24 501 356 124-08 -02 5~O2 351 133-23 +12
405601 82-10 -02 394602 103-01 -06
701 275 149-76 +56 702 361 +01 121 -07
+10middot801 326 140-22 802 321 middot127
(
-29 -03 9~01 342 124 -H) 6-18 902 294 128 -H) 3-24
10middotmiddot -14312 140 -17 1101 182 +25 -23197
2411102 186-59 +29 1201 226 169-17 -41
31middot01202 +11 182 -05 295 -H) 81301 208 -H) 4
1302 331 +08 197 +04
14 323 +15 middot185 -08 middotmiddot15 329 +16 16~5 -13
-28middot 1601 332 131 +12
1602 356 98 +24middot-39 middot3101701 161-33 +21
1702 370 -15 85 +02 +19 1801 264 151middot-50
185middot1802 256 +47-58
IJ ~
D_raphlc Population Change 1960 to 1970middot 49 (Contd)
4io
Census Tract
of pop Uncter 19 Yra
1Q1n
1Cha1l8e 1960-70
of PopOver 65 Yra
lQO Change
1960-70
19 389 +29 141 -24 20 223 -13 206 +18
21 227 +08 194 -36 2201 356 -27 112 +05
2202 290 -18 ll~9 -29 2301 356 -03 154 +24 2302 260 -37 245 +97
2401 410 +6~1 123 -31 2402 163 -80 320 +99 2501 381 +13 140 -01 25()2 237 31 lil +02 26 343 +25 186 +149 2701 370 +29 1S5 -01 2702 249 -44 304 +98 2801 337 +19 187 +09 2802 306 -10 156 +31 2901 304 -38 142 +24 2902 i 307 -32 146 t3~9
30 29~0 -48 16~2 +51
31 355 +30 160 +01 32 370 +48 148 -13 3301 395 +45 130 -20 3302 368 +06 138 -02 3401 386 +16 117 000
3402
400 +32 92 -26 3501 304 -07 115 +35
3502 344 000 140 -13
3601
36~02 357 -04 132 +32
3603 30~1 42 149 -67 3701 342 +28 152 +19
1
IJ
Jianolraphic Population Chan 1960 to 1970 50 (Contd)
Census Tract
of Pop Under 19 Yrs
JJl7J
middotChanae 1960-70
middotofmiddotpop Over 65 Yrs
1c~7n
Change 196070
3702 409 +39 122 -11 3801 308 -11 151 +29 3802 275 -35 180 +46 3803 282 -32 192 +54 3901 376 ~13 100 +17 3902 296 -03 177 +29 4001 438 -11 84 +13 4002 353 -21 115 +20
4101 397 11 9middot0 +11 4102 346 -19 120 +03 42 331 +19 11 bull 3 -16 43 347 -72 105 +31 44 113 +84 183 +154 4S 33~9 +07 110 -06 4601 2501 22 193 +38 4602 332 +59 126 -29 47middot 161middot 000 211 +01 48 103 -26 302 +59 49 138 +1 bull 3 252 +09 50 141 -26 204 -12 51 12 -39 257 +07 52 47 -61 351 +48 53 89 +49 314 -30 54 25 l1li15 327 -17 55 131 -17 115 -121 56 198 +93 227 -47 57 71 102 189 -88 58 240 ~middot41 16~1 +55 59 322 +25 142 +06middot 6001 264 95 132 +50
6002 328 -31middot 89 +07
JJ
Demographic Population Change 1960 to 1970 51 (Contd)
Census 1 ofPop lChange of Pop bull ChangeTract Under 19 Yrbullbull 1960-70 Over 65 Yrs 1960-70
1970 1970
61 355 -58 85 +39
62 328 39 110 +18
63 414 04 73 10
64 382 -22 72 +04
6501 383 02 67 -20
6502 329 -56 96 +09
6601 391 +13 88 -03
6602 319 -59 97 +06
6701 327 71 145 +72
6702 331 ~67 83 +1-0
6801 365 -66 49 +01
6802 388 4bull3 54 +06
69 354 -41 80 +23
70 400 -23 68 -06
71 359 -48 72 +05
72 255 -88 82 +11
73 346 -39 91 +25
74 313middot -63 105 +24
75 329 -42 129 +37
76 336 -52 85 +21
77 370 -10 69 +05
78 309 -10 120 +21
79 325 -56 87 +10
8001 358 -81 57 +12
8002 391 ~81 76 +12
81 315 -76 108 +21
8201 403 -23 64 +08
8202 392 23 65 +08
83 357 -34 120 +31
84 402 -18 73 +16
85 413 -06 76 -09
r
Demographic Population Change 1960 to 1970 52 (Contd)
Census Tract
t of Pop Uncler 19 Yrs
1970
Change 1960-70
1 of Pop OVer 65 Yrs
1970
ex Change 196070
86
87
88
89
90
91 9201
9202
93
94
95
9601
9602
9701
9702
9801
9802
99
100 I
101
102
103
10401
10402
lOS
368
351
379
391
391
413
379
433
372
429
414
432
419
439
~32
377
457 420
378 41middot7
345
360 417
417
412
-04
-02
-35
-26
-28
-11
-64
-20
-S9
-39
-32
-21
-34
-40
-47
-lO~7middot
-27middot +04
+56
+07
-34 01
+04
+04
+10
103
128
97
11il3 99
69
79
42
77
46
34 38
44
40
54
111
51middot
81
133
59
74
140
63
87
76
-08
-06
+04
+08
+17
-05
+3S -02
+1~4
+19
+33
-14
-08
+12
+26
+71
+11
-16 -34
-20
-19 +37
-49
-2S +15
NOte The The
Taken frOi
averageullder averageabove
middotUSCensus ---shy -
19 years == 6S years ==
figures 197
32r 13(14
p a~d 1960
--
Rank
1
2
3
4
5
6
7
8
9
10
11 12 -_
13
14
15
16
17
18
Tract
69 46
60
58
- 68
61
302
2501
67
63
19
62
26
94
3603
3902
64
30 -----~-
Rank
19
20
21 -
22
23-shy
24
25
26
27
28
29
30
31
32
33
34
35
36 -
Ranking of Per Capita Income by Census Tract
Tract
65
2701
- 15
1601
701
66
93
82
2903
3602
30
2502
80
2401
81
- 70
91 shy
4001
High
Rank Tractshy
-32shy37
38 97
120239
7840
41 ~ _2_1__ 42 31
43 2501
44 18
45 98
46 37
47 3803
1702
49
48
1602 92 2702
I
50 89
51 901
52 801
Ra_
53
54
55
56
57
58
59
60
61
62
63
64
6S
66
67
68
TractTract Ra~
74692
170196 70 I
401 71 90
72 1037J
79 70273
3802 74 601
24024102 75
85 76 101
77 9023901
7699 78 100 4101 79
3601 I
380180
458140~ t---- _ - - shy83 82 42
888384
59843501
4777 8~
502
Low
802 86
Rank Tract
87 shy
--88
89
90
91
92
93
94
- 95
96
97
middot98
99
100
101
102
103
104
1201
14
49
72
73
43
87
3502
105
1
52
86
71
1
501
10
3301
104 tf
Rank
105
106
107
108
109
110
III
112
113
114
115
116
117
118
119
120
121
Ranking of Per Capitalucoae by Census Tract
(Contd)
Tract Rank
4001 122--shy602
13
1102 2302
3302
55
3401
48
21
56
50
3402
lL01
2202
2301
53
2201
-shy
Tract Rank Tract Rank T~aet Rank
57 I-----
Imiddote
bull
Tract
- Low -k Note Information taken from 1960 U SCensus
Rank Tract
I ~
Ie
Imiddot
~
----
----
--
--
Rank
1
2
3
4
5
6
1
8
9
10
11
i-
-Tract
391 922 921
972 971
100
132 131 121
962 961
822 821 401
982 981
20 111
47 10 1
412
High
Total Number of Henta1 Health Visits
Ranked by Census Tract High to Low
TractTract RankTractRank Rnk
12 182 22 78 29 87 76 381 73181 ~------- 1913 371 8538230162372 271 2616-121 8272 2
14 80~2 31 94 7923 84801 59 15251362 4232 15 52 _ 32 103 8924 651 17240216 652
_ 91 351 33 341 23117 83 122 25 25 48 1123921418 34 shy61 86 661
19 662 6493 81 26 91 8153 49 50 55 41383 71 27 51 3120 90 672241 35shy 104167162 461
I 411 46211121 28 88342 I
2502 36 69 54 5251 50 272
-Ra
37
38
39
_ 40
_ 41 Ishy
I
42 I
-I 43 44
45
shy
Tract
~ --- shy 95 56
45 292 242
102 62 352 291y
92
101 281
99 72 63 601 60~ 42 2201
77 74 61 57
363 232
70
32 31
11 44 282 2202
Low l
- Tract
46 682 681 I 331 30
r~$ 47 1042 332
48 102_41_
11
~
Visits to Family Planning Clinics Ranked by Census Tract High to Low
Rank Tract Rank Tract Rankmiddot Tract Rank Tract Rank Tract Rank Tract
1
2
3
4
5
6
7
8
9
10
11
12
13middot
14
15
16
17
361
56
401
341
48
59 121
20
55
342
10
31
58
93 21
241 132
331
53
461 462
18
19
20-shy21
22
23
24
25
26
27middot
28
29
30
31
32
33
391
32
middot47 I-i-_-shy _ -
231 111
332
972 1
372 371
52
89
32
92
82
100 31
182
30 242
402
34
35
36
37
38
39
40
41
42
43
44
45
42
1714 i 661 221
78 362 2
90 602 601 352
63 251
105 921
971 351
73 42 292 232
411 51
662
81 45 52
46
47
48
49shy
50
51
52
53
54
55
56
961
801
49 81 72 71
19
9~1
172
68 2 57 162 14 112
91 75 681
381 42
3~3
83 161
57 f
58
59
60
61shy
62 Imiddot
63
Imiddot 64
65
66
64 62 36~3 252
74 652 SO 392 291
651 6bull 2
79 271
r-- ---- shy981 222
672 671
821 272
94 87
281
382
67
68
69
70
71
72
73
74
75
76
77
78
981 26 12~2
IS 61
85 82~2 69
61 43
101 86 84 282
76
131
51 72
1041 962 88 70
99 922 77
103
95 802 181
i
~
Low High
RankRank Tract
5479
4480
81 1042 ~) middot102
71 - - + ~ - ~
Visits to Family Planning Clinics
(Contd)
Tract Rank
I
Tract llaDk l
RankTract Tract Rank Tract
~
I
~
J1 ~
Low
Total Number of public Health Nursing Visits
Ranked by Census TractsHigh to Low
TractTract RankTractRank RankRank TractTractRankTractRank
25249 71 79 17249 8033 6586 99189711 84 2915072 34 661 76 66 811519512
402 5035 51 161 2518220 122 1713423 352 55801 7120 6752 2 149814 41236 83 2662 38 94 6821 53 2924015 362 37 32 42 75 69 281 84 63
546 8822 54 222 85 3925431 70383417 3818223 6439 4386652 718 21 55 103332 8924 232 87 19 271729219619 24156 16211140 382 628825 10523110 112 73411 10141-- ----shy 89 363 4457 8126 16111 221 74 9142 90 46158331 53 671279012 46243 48 59 351 3837528 1083 9313 91 5844 59 -_242 76 1----- shy60 272 72 74104114 60145 42 9287 7729 92 6151 8215 57371 934630 91 307762 12113116 282 619447 41391 9531 78100 63 7378 ~95 681 6945 32 5632 798517 6448 47 52 181
High ~ Low
Rank Tract Rank
96 31 132 70
97 102
98 182 372middot 602 651 662
- -shy
~72 682 802
822 922 962 972 982
1042 ----shy
Low
Total Number of Public Health Nursing Visits
(Contd)
Rank Rank Rank TractTract Tract
I
I lt
I
Tract Rank Tract
[
~~~-
I
~
IJilfimiddot ~
j
Ranking of VD Caea According to Census Tracts 61 By High and LOll Youth Itatio
A media~ of 34 5 was determined Any tract having greater
than 34 5~ of popu1tionunde~ 19 years of age -High~
Any tract having l8S than 345 of population under 19
years == Low
Any tract having rate less than 390 =Low
Any tract having rate more than 390 == HLgl4
YOUTH
LOW HIGH
L
0
12 402 1801 1802 343 2801 2802 29023603
54 6001 600262 66~02 72 74 75 76
78 79 81 t02 65 1202
W
(25)
VD
H
I
G
H
401 701 801802 901 902 10 1101 241 1201 1301 132 14 15 1601 1701 20~ 21 2202 2j02 2402 2502 2702 2901 303501 3502 34023801 3802 383 3902 42 44 45 4601 4602 47 48 49 SO 51~2 53 55 56 57 58 S9 6701 6702 73 95
3~02 7021702 19 25~01 2701 4102 4101 63 64601 ~601 6801 680270 7l 77 8001 80~02 8201 8202 83 84
85 86 87 88~ 90 91 9202 920193 94 9601 9602~ 9701 9102 9801 9802 99 100 101 103 10402 105 6501 10401
(47)
301 501 502 601 1602 2401 2301 2201 31 32 3301 3302 3401 3402~ 3602 3702 3901 400140 02 43 61 69 B(
(53) (23)
~ ~gt
Ranking of VD by Rate Per 100000 By Census Tract
~
Rank Tract Rank Tract Rank Tract Rank Tract llank Tract Rank Tract Rank Tract
1 2202 21 S6 40 902 58 1602 74 75
90-shy 64 107 26 --~-
2 3402 22 45 41 10 59 902 75 78 91 54 108 61
3 2301 23 3502 42 2502 60 602 76 6802 92 402 109 87
4 3302 24 49 43 1102 61 501 17 2 93 94 110 90
5 50 25 52 44 6702 62 14 78 8202 94 97 02 III 76
6 2201 26 20 6701 63 4002 8201 2501
9701 41~02 112 91
7 44 27 48 45 401 64 3802 2902 95 63 113 62
8 3301 28 1701 46 502 65 30 79 83 74 96 9602 114 71
9 55 29 47 47 42 66 3803 80 2801 96Q1 115 85 10
11
12
13
14
15
16
17
18
3401
53
2302
2401
57
21
2402
1101
51
30-shy31
32
33
34
35
36
37
3701 - -~ 1201
3702
89
43
132 131
3602
4001
48
49
50
51
52
53
54
55
58
1601
601
4602 4601
69
701
31
3901
67
68
69
70
71
72
2901
801
39021~ 802
6502 6501 122
702
41~01
81
82
83
84
85
86
87
88
19
1
1702
2802
79
93
100 6801 6602
81
97
98
99
100
101
102
103
104
9201 9202
9802 9801
77
302
79
86
72
84
116
117
118
119
120
121
3603
8002 8001
101
99
95
10401
105 10402 103 102
19
20
59
32
38
39
2702
3501
56
57
301
3801
73 1802 1801
89 6002 6001
105
106
2701
88
High Low
-- -----
Rank OrdermiddotTuberclosis Cases by Rate Per 100000 Ranked by Census Tract High to Low
Tract TractRankTractRank Rank TractRaukTractRankTractRank
801
79 9601501411 52 6835340120511 I 960269 903603532036 $-~~F130221542 4366 311301 70 68~013802 _ I- _ 4001_37213 3921201 6802802 H71523822024 22 54 193302 3802 80 8958 I37139535 70155 9801 I60123 72 6702 98023914011016 6701250124 10 56
81 94 401r 7 154152 73 7057 2625 122 92028
90242 162312301 92~158 86 7172434526509 82 79160159 74 100 87412240227220110 6502836960 75 30 8317244 6501782801285711 61 901 42765645 84 66021459294912 9701 660146 171 302 9702 47
6235023033113 85 822821182 917755 16335013110214 841814832 78 103 938564 324815 86 1057940149272 38036523216 10401 87 2902241 725Q 10402360266340217middot IF88 88 9937233 282 51 218 101 01102 46016234
I)167 2901460219 47
High ~ Low ~
- -
TractRank
9S89
6490
8191 8001 8002
63 61 60middot01 6002 44 2701
92
J
2502 402 --- ----shy
I
Rank
Rank Order Tuberculosis Cases by Rate per 100000
(Coutd)
Tract Rank Tract ~nk
I
Tract Ballk Tract Rank
Imiddot
Tract
Imiddot
1~
t 1I i Pi i l I
o
1 -1shyL I
I J
8 40 icO ~ I -lt 0
-t (1) I
i I
r o E
II
a
I
r--i
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I
~
I (
Jgt
(011 fi(
Ggt
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()
(f 0
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I
11
f9
r
II 99
o ~
Ggt r
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) 1
fTl
1gt
r I
()
r
()
lt en -i en
()
I1l
(J)
(J)
-i
P ()
19
r o ~
r G1 I
I
c
~
o I 89
--- -I-shy
r-r I
1- 0 _~ _ _--J E
G1 I I I
i i
I 1-1-1 ~ _J ~2 ~ II
II
()
1 I I I 1
id i bullbull
~
A n 69
r 1shy
- 0 Gl
l--~ ~ I
~ II
II )
I () isect i
en l i
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IA Ol
IJ ~
D_raphlc Population Change 1960 to 1970middot 49 (Contd)
4io
Census Tract
of pop Uncter 19 Yra
1Q1n
1Cha1l8e 1960-70
of PopOver 65 Yra
lQO Change
1960-70
19 389 +29 141 -24 20 223 -13 206 +18
21 227 +08 194 -36 2201 356 -27 112 +05
2202 290 -18 ll~9 -29 2301 356 -03 154 +24 2302 260 -37 245 +97
2401 410 +6~1 123 -31 2402 163 -80 320 +99 2501 381 +13 140 -01 25()2 237 31 lil +02 26 343 +25 186 +149 2701 370 +29 1S5 -01 2702 249 -44 304 +98 2801 337 +19 187 +09 2802 306 -10 156 +31 2901 304 -38 142 +24 2902 i 307 -32 146 t3~9
30 29~0 -48 16~2 +51
31 355 +30 160 +01 32 370 +48 148 -13 3301 395 +45 130 -20 3302 368 +06 138 -02 3401 386 +16 117 000
3402
400 +32 92 -26 3501 304 -07 115 +35
3502 344 000 140 -13
3601
36~02 357 -04 132 +32
3603 30~1 42 149 -67 3701 342 +28 152 +19
1
IJ
Jianolraphic Population Chan 1960 to 1970 50 (Contd)
Census Tract
of Pop Under 19 Yrs
JJl7J
middotChanae 1960-70
middotofmiddotpop Over 65 Yrs
1c~7n
Change 196070
3702 409 +39 122 -11 3801 308 -11 151 +29 3802 275 -35 180 +46 3803 282 -32 192 +54 3901 376 ~13 100 +17 3902 296 -03 177 +29 4001 438 -11 84 +13 4002 353 -21 115 +20
4101 397 11 9middot0 +11 4102 346 -19 120 +03 42 331 +19 11 bull 3 -16 43 347 -72 105 +31 44 113 +84 183 +154 4S 33~9 +07 110 -06 4601 2501 22 193 +38 4602 332 +59 126 -29 47middot 161middot 000 211 +01 48 103 -26 302 +59 49 138 +1 bull 3 252 +09 50 141 -26 204 -12 51 12 -39 257 +07 52 47 -61 351 +48 53 89 +49 314 -30 54 25 l1li15 327 -17 55 131 -17 115 -121 56 198 +93 227 -47 57 71 102 189 -88 58 240 ~middot41 16~1 +55 59 322 +25 142 +06middot 6001 264 95 132 +50
6002 328 -31middot 89 +07
JJ
Demographic Population Change 1960 to 1970 51 (Contd)
Census 1 ofPop lChange of Pop bull ChangeTract Under 19 Yrbullbull 1960-70 Over 65 Yrs 1960-70
1970 1970
61 355 -58 85 +39
62 328 39 110 +18
63 414 04 73 10
64 382 -22 72 +04
6501 383 02 67 -20
6502 329 -56 96 +09
6601 391 +13 88 -03
6602 319 -59 97 +06
6701 327 71 145 +72
6702 331 ~67 83 +1-0
6801 365 -66 49 +01
6802 388 4bull3 54 +06
69 354 -41 80 +23
70 400 -23 68 -06
71 359 -48 72 +05
72 255 -88 82 +11
73 346 -39 91 +25
74 313middot -63 105 +24
75 329 -42 129 +37
76 336 -52 85 +21
77 370 -10 69 +05
78 309 -10 120 +21
79 325 -56 87 +10
8001 358 -81 57 +12
8002 391 ~81 76 +12
81 315 -76 108 +21
8201 403 -23 64 +08
8202 392 23 65 +08
83 357 -34 120 +31
84 402 -18 73 +16
85 413 -06 76 -09
r
Demographic Population Change 1960 to 1970 52 (Contd)
Census Tract
t of Pop Uncler 19 Yrs
1970
Change 1960-70
1 of Pop OVer 65 Yrs
1970
ex Change 196070
86
87
88
89
90
91 9201
9202
93
94
95
9601
9602
9701
9702
9801
9802
99
100 I
101
102
103
10401
10402
lOS
368
351
379
391
391
413
379
433
372
429
414
432
419
439
~32
377
457 420
378 41middot7
345
360 417
417
412
-04
-02
-35
-26
-28
-11
-64
-20
-S9
-39
-32
-21
-34
-40
-47
-lO~7middot
-27middot +04
+56
+07
-34 01
+04
+04
+10
103
128
97
11il3 99
69
79
42
77
46
34 38
44
40
54
111
51middot
81
133
59
74
140
63
87
76
-08
-06
+04
+08
+17
-05
+3S -02
+1~4
+19
+33
-14
-08
+12
+26
+71
+11
-16 -34
-20
-19 +37
-49
-2S +15
NOte The The
Taken frOi
averageullder averageabove
middotUSCensus ---shy -
19 years == 6S years ==
figures 197
32r 13(14
p a~d 1960
--
Rank
1
2
3
4
5
6
7
8
9
10
11 12 -_
13
14
15
16
17
18
Tract
69 46
60
58
- 68
61
302
2501
67
63
19
62
26
94
3603
3902
64
30 -----~-
Rank
19
20
21 -
22
23-shy
24
25
26
27
28
29
30
31
32
33
34
35
36 -
Ranking of Per Capita Income by Census Tract
Tract
65
2701
- 15
1601
701
66
93
82
2903
3602
30
2502
80
2401
81
- 70
91 shy
4001
High
Rank Tractshy
-32shy37
38 97
120239
7840
41 ~ _2_1__ 42 31
43 2501
44 18
45 98
46 37
47 3803
1702
49
48
1602 92 2702
I
50 89
51 901
52 801
Ra_
53
54
55
56
57
58
59
60
61
62
63
64
6S
66
67
68
TractTract Ra~
74692
170196 70 I
401 71 90
72 1037J
79 70273
3802 74 601
24024102 75
85 76 101
77 9023901
7699 78 100 4101 79
3601 I
380180
458140~ t---- _ - - shy83 82 42
888384
59843501
4777 8~
502
Low
802 86
Rank Tract
87 shy
--88
89
90
91
92
93
94
- 95
96
97
middot98
99
100
101
102
103
104
1201
14
49
72
73
43
87
3502
105
1
52
86
71
1
501
10
3301
104 tf
Rank
105
106
107
108
109
110
III
112
113
114
115
116
117
118
119
120
121
Ranking of Per Capitalucoae by Census Tract
(Contd)
Tract Rank
4001 122--shy602
13
1102 2302
3302
55
3401
48
21
56
50
3402
lL01
2202
2301
53
2201
-shy
Tract Rank Tract Rank T~aet Rank
57 I-----
Imiddote
bull
Tract
- Low -k Note Information taken from 1960 U SCensus
Rank Tract
I ~
Ie
Imiddot
~
----
----
--
--
Rank
1
2
3
4
5
6
1
8
9
10
11
i-
-Tract
391 922 921
972 971
100
132 131 121
962 961
822 821 401
982 981
20 111
47 10 1
412
High
Total Number of Henta1 Health Visits
Ranked by Census Tract High to Low
TractTract RankTractRank Rnk
12 182 22 78 29 87 76 381 73181 ~------- 1913 371 8538230162372 271 2616-121 8272 2
14 80~2 31 94 7923 84801 59 15251362 4232 15 52 _ 32 103 8924 651 17240216 652
_ 91 351 33 341 23117 83 122 25 25 48 1123921418 34 shy61 86 661
19 662 6493 81 26 91 8153 49 50 55 41383 71 27 51 3120 90 672241 35shy 104167162 461
I 411 46211121 28 88342 I
2502 36 69 54 5251 50 272
-Ra
37
38
39
_ 40
_ 41 Ishy
I
42 I
-I 43 44
45
shy
Tract
~ --- shy 95 56
45 292 242
102 62 352 291y
92
101 281
99 72 63 601 60~ 42 2201
77 74 61 57
363 232
70
32 31
11 44 282 2202
Low l
- Tract
46 682 681 I 331 30
r~$ 47 1042 332
48 102_41_
11
~
Visits to Family Planning Clinics Ranked by Census Tract High to Low
Rank Tract Rank Tract Rankmiddot Tract Rank Tract Rank Tract Rank Tract
1
2
3
4
5
6
7
8
9
10
11
12
13middot
14
15
16
17
361
56
401
341
48
59 121
20
55
342
10
31
58
93 21
241 132
331
53
461 462
18
19
20-shy21
22
23
24
25
26
27middot
28
29
30
31
32
33
391
32
middot47 I-i-_-shy _ -
231 111
332
972 1
372 371
52
89
32
92
82
100 31
182
30 242
402
34
35
36
37
38
39
40
41
42
43
44
45
42
1714 i 661 221
78 362 2
90 602 601 352
63 251
105 921
971 351
73 42 292 232
411 51
662
81 45 52
46
47
48
49shy
50
51
52
53
54
55
56
961
801
49 81 72 71
19
9~1
172
68 2 57 162 14 112
91 75 681
381 42
3~3
83 161
57 f
58
59
60
61shy
62 Imiddot
63
Imiddot 64
65
66
64 62 36~3 252
74 652 SO 392 291
651 6bull 2
79 271
r-- ---- shy981 222
672 671
821 272
94 87
281
382
67
68
69
70
71
72
73
74
75
76
77
78
981 26 12~2
IS 61
85 82~2 69
61 43
101 86 84 282
76
131
51 72
1041 962 88 70
99 922 77
103
95 802 181
i
~
Low High
RankRank Tract
5479
4480
81 1042 ~) middot102
71 - - + ~ - ~
Visits to Family Planning Clinics
(Contd)
Tract Rank
I
Tract llaDk l
RankTract Tract Rank Tract
~
I
~
J1 ~
Low
Total Number of public Health Nursing Visits
Ranked by Census TractsHigh to Low
TractTract RankTractRank RankRank TractTractRankTractRank
25249 71 79 17249 8033 6586 99189711 84 2915072 34 661 76 66 811519512
402 5035 51 161 2518220 122 1713423 352 55801 7120 6752 2 149814 41236 83 2662 38 94 6821 53 2924015 362 37 32 42 75 69 281 84 63
546 8822 54 222 85 3925431 70383417 3818223 6439 4386652 718 21 55 103332 8924 232 87 19 271729219619 24156 16211140 382 628825 10523110 112 73411 10141-- ----shy 89 363 4457 8126 16111 221 74 9142 90 46158331 53 671279012 46243 48 59 351 3837528 1083 9313 91 5844 59 -_242 76 1----- shy60 272 72 74104114 60145 42 9287 7729 92 6151 8215 57371 934630 91 307762 12113116 282 619447 41391 9531 78100 63 7378 ~95 681 6945 32 5632 798517 6448 47 52 181
High ~ Low
Rank Tract Rank
96 31 132 70
97 102
98 182 372middot 602 651 662
- -shy
~72 682 802
822 922 962 972 982
1042 ----shy
Low
Total Number of Public Health Nursing Visits
(Contd)
Rank Rank Rank TractTract Tract
I
I lt
I
Tract Rank Tract
[
~~~-
I
~
IJilfimiddot ~
j
Ranking of VD Caea According to Census Tracts 61 By High and LOll Youth Itatio
A media~ of 34 5 was determined Any tract having greater
than 34 5~ of popu1tionunde~ 19 years of age -High~
Any tract having l8S than 345 of population under 19
years == Low
Any tract having rate less than 390 =Low
Any tract having rate more than 390 == HLgl4
YOUTH
LOW HIGH
L
0
12 402 1801 1802 343 2801 2802 29023603
54 6001 600262 66~02 72 74 75 76
78 79 81 t02 65 1202
W
(25)
VD
H
I
G
H
401 701 801802 901 902 10 1101 241 1201 1301 132 14 15 1601 1701 20~ 21 2202 2j02 2402 2502 2702 2901 303501 3502 34023801 3802 383 3902 42 44 45 4601 4602 47 48 49 SO 51~2 53 55 56 57 58 S9 6701 6702 73 95
3~02 7021702 19 25~01 2701 4102 4101 63 64601 ~601 6801 680270 7l 77 8001 80~02 8201 8202 83 84
85 86 87 88~ 90 91 9202 920193 94 9601 9602~ 9701 9102 9801 9802 99 100 101 103 10402 105 6501 10401
(47)
301 501 502 601 1602 2401 2301 2201 31 32 3301 3302 3401 3402~ 3602 3702 3901 400140 02 43 61 69 B(
(53) (23)
~ ~gt
Ranking of VD by Rate Per 100000 By Census Tract
~
Rank Tract Rank Tract Rank Tract Rank Tract llank Tract Rank Tract Rank Tract
1 2202 21 S6 40 902 58 1602 74 75
90-shy 64 107 26 --~-
2 3402 22 45 41 10 59 902 75 78 91 54 108 61
3 2301 23 3502 42 2502 60 602 76 6802 92 402 109 87
4 3302 24 49 43 1102 61 501 17 2 93 94 110 90
5 50 25 52 44 6702 62 14 78 8202 94 97 02 III 76
6 2201 26 20 6701 63 4002 8201 2501
9701 41~02 112 91
7 44 27 48 45 401 64 3802 2902 95 63 113 62
8 3301 28 1701 46 502 65 30 79 83 74 96 9602 114 71
9 55 29 47 47 42 66 3803 80 2801 96Q1 115 85 10
11
12
13
14
15
16
17
18
3401
53
2302
2401
57
21
2402
1101
51
30-shy31
32
33
34
35
36
37
3701 - -~ 1201
3702
89
43
132 131
3602
4001
48
49
50
51
52
53
54
55
58
1601
601
4602 4601
69
701
31
3901
67
68
69
70
71
72
2901
801
39021~ 802
6502 6501 122
702
41~01
81
82
83
84
85
86
87
88
19
1
1702
2802
79
93
100 6801 6602
81
97
98
99
100
101
102
103
104
9201 9202
9802 9801
77
302
79
86
72
84
116
117
118
119
120
121
3603
8002 8001
101
99
95
10401
105 10402 103 102
19
20
59
32
38
39
2702
3501
56
57
301
3801
73 1802 1801
89 6002 6001
105
106
2701
88
High Low
-- -----
Rank OrdermiddotTuberclosis Cases by Rate Per 100000 Ranked by Census Tract High to Low
Tract TractRankTractRank Rank TractRaukTractRankTractRank
801
79 9601501411 52 6835340120511 I 960269 903603532036 $-~~F130221542 4366 311301 70 68~013802 _ I- _ 4001_37213 3921201 6802802 H71523822024 22 54 193302 3802 80 8958 I37139535 70155 9801 I60123 72 6702 98023914011016 6701250124 10 56
81 94 401r 7 154152 73 7057 2625 122 92028
90242 162312301 92~158 86 7172434526509 82 79160159 74 100 87412240227220110 6502836960 75 30 8317244 6501782801285711 61 901 42765645 84 66021459294912 9701 660146 171 302 9702 47
6235023033113 85 822821182 917755 16335013110214 841814832 78 103 938564 324815 86 1057940149272 38036523216 10401 87 2902241 725Q 10402360266340217middot IF88 88 9937233 282 51 218 101 01102 46016234
I)167 2901460219 47
High ~ Low ~
- -
TractRank
9S89
6490
8191 8001 8002
63 61 60middot01 6002 44 2701
92
J
2502 402 --- ----shy
I
Rank
Rank Order Tuberculosis Cases by Rate per 100000
(Coutd)
Tract Rank Tract ~nk
I
Tract Ballk Tract Rank
Imiddot
Tract
Imiddot
1~
t 1I i Pi i l I
o
1 -1shyL I
I J
8 40 icO ~ I -lt 0
-t (1) I
i I
r o E
II
a
I
r--i
shy
I
~
I (
Jgt
(011 fi(
Ggt
I II ~j
()
(f 0
~ ()
I
11
f9
r
II 99
o ~
Ggt r
~ __-J~ I t I ~ I
r--J l I
~ _ __ J
) 1
fTl
1gt
r I
()
r
()
lt en -i en
()
I1l
(J)
(J)
-i
P ()
19
r o ~
r G1 I
I
c
~
o I 89
--- -I-shy
r-r I
1- 0 _~ _ _--J E
G1 I I I
i i
I 1-1-1 ~ _J ~2 ~ II
II
()
1 I I I 1
id i bullbull
~
A n 69
r 1shy
- 0 Gl
l--~ ~ I
~ II
II )
I () isect i
en l i
(J)
-t
0
IA Ol
IJ
Jianolraphic Population Chan 1960 to 1970 50 (Contd)
Census Tract
of Pop Under 19 Yrs
JJl7J
middotChanae 1960-70
middotofmiddotpop Over 65 Yrs
1c~7n
Change 196070
3702 409 +39 122 -11 3801 308 -11 151 +29 3802 275 -35 180 +46 3803 282 -32 192 +54 3901 376 ~13 100 +17 3902 296 -03 177 +29 4001 438 -11 84 +13 4002 353 -21 115 +20
4101 397 11 9middot0 +11 4102 346 -19 120 +03 42 331 +19 11 bull 3 -16 43 347 -72 105 +31 44 113 +84 183 +154 4S 33~9 +07 110 -06 4601 2501 22 193 +38 4602 332 +59 126 -29 47middot 161middot 000 211 +01 48 103 -26 302 +59 49 138 +1 bull 3 252 +09 50 141 -26 204 -12 51 12 -39 257 +07 52 47 -61 351 +48 53 89 +49 314 -30 54 25 l1li15 327 -17 55 131 -17 115 -121 56 198 +93 227 -47 57 71 102 189 -88 58 240 ~middot41 16~1 +55 59 322 +25 142 +06middot 6001 264 95 132 +50
6002 328 -31middot 89 +07
JJ
Demographic Population Change 1960 to 1970 51 (Contd)
Census 1 ofPop lChange of Pop bull ChangeTract Under 19 Yrbullbull 1960-70 Over 65 Yrs 1960-70
1970 1970
61 355 -58 85 +39
62 328 39 110 +18
63 414 04 73 10
64 382 -22 72 +04
6501 383 02 67 -20
6502 329 -56 96 +09
6601 391 +13 88 -03
6602 319 -59 97 +06
6701 327 71 145 +72
6702 331 ~67 83 +1-0
6801 365 -66 49 +01
6802 388 4bull3 54 +06
69 354 -41 80 +23
70 400 -23 68 -06
71 359 -48 72 +05
72 255 -88 82 +11
73 346 -39 91 +25
74 313middot -63 105 +24
75 329 -42 129 +37
76 336 -52 85 +21
77 370 -10 69 +05
78 309 -10 120 +21
79 325 -56 87 +10
8001 358 -81 57 +12
8002 391 ~81 76 +12
81 315 -76 108 +21
8201 403 -23 64 +08
8202 392 23 65 +08
83 357 -34 120 +31
84 402 -18 73 +16
85 413 -06 76 -09
r
Demographic Population Change 1960 to 1970 52 (Contd)
Census Tract
t of Pop Uncler 19 Yrs
1970
Change 1960-70
1 of Pop OVer 65 Yrs
1970
ex Change 196070
86
87
88
89
90
91 9201
9202
93
94
95
9601
9602
9701
9702
9801
9802
99
100 I
101
102
103
10401
10402
lOS
368
351
379
391
391
413
379
433
372
429
414
432
419
439
~32
377
457 420
378 41middot7
345
360 417
417
412
-04
-02
-35
-26
-28
-11
-64
-20
-S9
-39
-32
-21
-34
-40
-47
-lO~7middot
-27middot +04
+56
+07
-34 01
+04
+04
+10
103
128
97
11il3 99
69
79
42
77
46
34 38
44
40
54
111
51middot
81
133
59
74
140
63
87
76
-08
-06
+04
+08
+17
-05
+3S -02
+1~4
+19
+33
-14
-08
+12
+26
+71
+11
-16 -34
-20
-19 +37
-49
-2S +15
NOte The The
Taken frOi
averageullder averageabove
middotUSCensus ---shy -
19 years == 6S years ==
figures 197
32r 13(14
p a~d 1960
--
Rank
1
2
3
4
5
6
7
8
9
10
11 12 -_
13
14
15
16
17
18
Tract
69 46
60
58
- 68
61
302
2501
67
63
19
62
26
94
3603
3902
64
30 -----~-
Rank
19
20
21 -
22
23-shy
24
25
26
27
28
29
30
31
32
33
34
35
36 -
Ranking of Per Capita Income by Census Tract
Tract
65
2701
- 15
1601
701
66
93
82
2903
3602
30
2502
80
2401
81
- 70
91 shy
4001
High
Rank Tractshy
-32shy37
38 97
120239
7840
41 ~ _2_1__ 42 31
43 2501
44 18
45 98
46 37
47 3803
1702
49
48
1602 92 2702
I
50 89
51 901
52 801
Ra_
53
54
55
56
57
58
59
60
61
62
63
64
6S
66
67
68
TractTract Ra~
74692
170196 70 I
401 71 90
72 1037J
79 70273
3802 74 601
24024102 75
85 76 101
77 9023901
7699 78 100 4101 79
3601 I
380180
458140~ t---- _ - - shy83 82 42
888384
59843501
4777 8~
502
Low
802 86
Rank Tract
87 shy
--88
89
90
91
92
93
94
- 95
96
97
middot98
99
100
101
102
103
104
1201
14
49
72
73
43
87
3502
105
1
52
86
71
1
501
10
3301
104 tf
Rank
105
106
107
108
109
110
III
112
113
114
115
116
117
118
119
120
121
Ranking of Per Capitalucoae by Census Tract
(Contd)
Tract Rank
4001 122--shy602
13
1102 2302
3302
55
3401
48
21
56
50
3402
lL01
2202
2301
53
2201
-shy
Tract Rank Tract Rank T~aet Rank
57 I-----
Imiddote
bull
Tract
- Low -k Note Information taken from 1960 U SCensus
Rank Tract
I ~
Ie
Imiddot
~
----
----
--
--
Rank
1
2
3
4
5
6
1
8
9
10
11
i-
-Tract
391 922 921
972 971
100
132 131 121
962 961
822 821 401
982 981
20 111
47 10 1
412
High
Total Number of Henta1 Health Visits
Ranked by Census Tract High to Low
TractTract RankTractRank Rnk
12 182 22 78 29 87 76 381 73181 ~------- 1913 371 8538230162372 271 2616-121 8272 2
14 80~2 31 94 7923 84801 59 15251362 4232 15 52 _ 32 103 8924 651 17240216 652
_ 91 351 33 341 23117 83 122 25 25 48 1123921418 34 shy61 86 661
19 662 6493 81 26 91 8153 49 50 55 41383 71 27 51 3120 90 672241 35shy 104167162 461
I 411 46211121 28 88342 I
2502 36 69 54 5251 50 272
-Ra
37
38
39
_ 40
_ 41 Ishy
I
42 I
-I 43 44
45
shy
Tract
~ --- shy 95 56
45 292 242
102 62 352 291y
92
101 281
99 72 63 601 60~ 42 2201
77 74 61 57
363 232
70
32 31
11 44 282 2202
Low l
- Tract
46 682 681 I 331 30
r~$ 47 1042 332
48 102_41_
11
~
Visits to Family Planning Clinics Ranked by Census Tract High to Low
Rank Tract Rank Tract Rankmiddot Tract Rank Tract Rank Tract Rank Tract
1
2
3
4
5
6
7
8
9
10
11
12
13middot
14
15
16
17
361
56
401
341
48
59 121
20
55
342
10
31
58
93 21
241 132
331
53
461 462
18
19
20-shy21
22
23
24
25
26
27middot
28
29
30
31
32
33
391
32
middot47 I-i-_-shy _ -
231 111
332
972 1
372 371
52
89
32
92
82
100 31
182
30 242
402
34
35
36
37
38
39
40
41
42
43
44
45
42
1714 i 661 221
78 362 2
90 602 601 352
63 251
105 921
971 351
73 42 292 232
411 51
662
81 45 52
46
47
48
49shy
50
51
52
53
54
55
56
961
801
49 81 72 71
19
9~1
172
68 2 57 162 14 112
91 75 681
381 42
3~3
83 161
57 f
58
59
60
61shy
62 Imiddot
63
Imiddot 64
65
66
64 62 36~3 252
74 652 SO 392 291
651 6bull 2
79 271
r-- ---- shy981 222
672 671
821 272
94 87
281
382
67
68
69
70
71
72
73
74
75
76
77
78
981 26 12~2
IS 61
85 82~2 69
61 43
101 86 84 282
76
131
51 72
1041 962 88 70
99 922 77
103
95 802 181
i
~
Low High
RankRank Tract
5479
4480
81 1042 ~) middot102
71 - - + ~ - ~
Visits to Family Planning Clinics
(Contd)
Tract Rank
I
Tract llaDk l
RankTract Tract Rank Tract
~
I
~
J1 ~
Low
Total Number of public Health Nursing Visits
Ranked by Census TractsHigh to Low
TractTract RankTractRank RankRank TractTractRankTractRank
25249 71 79 17249 8033 6586 99189711 84 2915072 34 661 76 66 811519512
402 5035 51 161 2518220 122 1713423 352 55801 7120 6752 2 149814 41236 83 2662 38 94 6821 53 2924015 362 37 32 42 75 69 281 84 63
546 8822 54 222 85 3925431 70383417 3818223 6439 4386652 718 21 55 103332 8924 232 87 19 271729219619 24156 16211140 382 628825 10523110 112 73411 10141-- ----shy 89 363 4457 8126 16111 221 74 9142 90 46158331 53 671279012 46243 48 59 351 3837528 1083 9313 91 5844 59 -_242 76 1----- shy60 272 72 74104114 60145 42 9287 7729 92 6151 8215 57371 934630 91 307762 12113116 282 619447 41391 9531 78100 63 7378 ~95 681 6945 32 5632 798517 6448 47 52 181
High ~ Low
Rank Tract Rank
96 31 132 70
97 102
98 182 372middot 602 651 662
- -shy
~72 682 802
822 922 962 972 982
1042 ----shy
Low
Total Number of Public Health Nursing Visits
(Contd)
Rank Rank Rank TractTract Tract
I
I lt
I
Tract Rank Tract
[
~~~-
I
~
IJilfimiddot ~
j
Ranking of VD Caea According to Census Tracts 61 By High and LOll Youth Itatio
A media~ of 34 5 was determined Any tract having greater
than 34 5~ of popu1tionunde~ 19 years of age -High~
Any tract having l8S than 345 of population under 19
years == Low
Any tract having rate less than 390 =Low
Any tract having rate more than 390 == HLgl4
YOUTH
LOW HIGH
L
0
12 402 1801 1802 343 2801 2802 29023603
54 6001 600262 66~02 72 74 75 76
78 79 81 t02 65 1202
W
(25)
VD
H
I
G
H
401 701 801802 901 902 10 1101 241 1201 1301 132 14 15 1601 1701 20~ 21 2202 2j02 2402 2502 2702 2901 303501 3502 34023801 3802 383 3902 42 44 45 4601 4602 47 48 49 SO 51~2 53 55 56 57 58 S9 6701 6702 73 95
3~02 7021702 19 25~01 2701 4102 4101 63 64601 ~601 6801 680270 7l 77 8001 80~02 8201 8202 83 84
85 86 87 88~ 90 91 9202 920193 94 9601 9602~ 9701 9102 9801 9802 99 100 101 103 10402 105 6501 10401
(47)
301 501 502 601 1602 2401 2301 2201 31 32 3301 3302 3401 3402~ 3602 3702 3901 400140 02 43 61 69 B(
(53) (23)
~ ~gt
Ranking of VD by Rate Per 100000 By Census Tract
~
Rank Tract Rank Tract Rank Tract Rank Tract llank Tract Rank Tract Rank Tract
1 2202 21 S6 40 902 58 1602 74 75
90-shy 64 107 26 --~-
2 3402 22 45 41 10 59 902 75 78 91 54 108 61
3 2301 23 3502 42 2502 60 602 76 6802 92 402 109 87
4 3302 24 49 43 1102 61 501 17 2 93 94 110 90
5 50 25 52 44 6702 62 14 78 8202 94 97 02 III 76
6 2201 26 20 6701 63 4002 8201 2501
9701 41~02 112 91
7 44 27 48 45 401 64 3802 2902 95 63 113 62
8 3301 28 1701 46 502 65 30 79 83 74 96 9602 114 71
9 55 29 47 47 42 66 3803 80 2801 96Q1 115 85 10
11
12
13
14
15
16
17
18
3401
53
2302
2401
57
21
2402
1101
51
30-shy31
32
33
34
35
36
37
3701 - -~ 1201
3702
89
43
132 131
3602
4001
48
49
50
51
52
53
54
55
58
1601
601
4602 4601
69
701
31
3901
67
68
69
70
71
72
2901
801
39021~ 802
6502 6501 122
702
41~01
81
82
83
84
85
86
87
88
19
1
1702
2802
79
93
100 6801 6602
81
97
98
99
100
101
102
103
104
9201 9202
9802 9801
77
302
79
86
72
84
116
117
118
119
120
121
3603
8002 8001
101
99
95
10401
105 10402 103 102
19
20
59
32
38
39
2702
3501
56
57
301
3801
73 1802 1801
89 6002 6001
105
106
2701
88
High Low
-- -----
Rank OrdermiddotTuberclosis Cases by Rate Per 100000 Ranked by Census Tract High to Low
Tract TractRankTractRank Rank TractRaukTractRankTractRank
801
79 9601501411 52 6835340120511 I 960269 903603532036 $-~~F130221542 4366 311301 70 68~013802 _ I- _ 4001_37213 3921201 6802802 H71523822024 22 54 193302 3802 80 8958 I37139535 70155 9801 I60123 72 6702 98023914011016 6701250124 10 56
81 94 401r 7 154152 73 7057 2625 122 92028
90242 162312301 92~158 86 7172434526509 82 79160159 74 100 87412240227220110 6502836960 75 30 8317244 6501782801285711 61 901 42765645 84 66021459294912 9701 660146 171 302 9702 47
6235023033113 85 822821182 917755 16335013110214 841814832 78 103 938564 324815 86 1057940149272 38036523216 10401 87 2902241 725Q 10402360266340217middot IF88 88 9937233 282 51 218 101 01102 46016234
I)167 2901460219 47
High ~ Low ~
- -
TractRank
9S89
6490
8191 8001 8002
63 61 60middot01 6002 44 2701
92
J
2502 402 --- ----shy
I
Rank
Rank Order Tuberculosis Cases by Rate per 100000
(Coutd)
Tract Rank Tract ~nk
I
Tract Ballk Tract Rank
Imiddot
Tract
Imiddot
1~
t 1I i Pi i l I
o
1 -1shyL I
I J
8 40 icO ~ I -lt 0
-t (1) I
i I
r o E
II
a
I
r--i
shy
I
~
I (
Jgt
(011 fi(
Ggt
I II ~j
()
(f 0
~ ()
I
11
f9
r
II 99
o ~
Ggt r
~ __-J~ I t I ~ I
r--J l I
~ _ __ J
) 1
fTl
1gt
r I
()
r
()
lt en -i en
()
I1l
(J)
(J)
-i
P ()
19
r o ~
r G1 I
I
c
~
o I 89
--- -I-shy
r-r I
1- 0 _~ _ _--J E
G1 I I I
i i
I 1-1-1 ~ _J ~2 ~ II
II
()
1 I I I 1
id i bullbull
~
A n 69
r 1shy
- 0 Gl
l--~ ~ I
~ II
II )
I () isect i
en l i
(J)
-t
0
IA Ol
JJ
Demographic Population Change 1960 to 1970 51 (Contd)
Census 1 ofPop lChange of Pop bull ChangeTract Under 19 Yrbullbull 1960-70 Over 65 Yrs 1960-70
1970 1970
61 355 -58 85 +39
62 328 39 110 +18
63 414 04 73 10
64 382 -22 72 +04
6501 383 02 67 -20
6502 329 -56 96 +09
6601 391 +13 88 -03
6602 319 -59 97 +06
6701 327 71 145 +72
6702 331 ~67 83 +1-0
6801 365 -66 49 +01
6802 388 4bull3 54 +06
69 354 -41 80 +23
70 400 -23 68 -06
71 359 -48 72 +05
72 255 -88 82 +11
73 346 -39 91 +25
74 313middot -63 105 +24
75 329 -42 129 +37
76 336 -52 85 +21
77 370 -10 69 +05
78 309 -10 120 +21
79 325 -56 87 +10
8001 358 -81 57 +12
8002 391 ~81 76 +12
81 315 -76 108 +21
8201 403 -23 64 +08
8202 392 23 65 +08
83 357 -34 120 +31
84 402 -18 73 +16
85 413 -06 76 -09
r
Demographic Population Change 1960 to 1970 52 (Contd)
Census Tract
t of Pop Uncler 19 Yrs
1970
Change 1960-70
1 of Pop OVer 65 Yrs
1970
ex Change 196070
86
87
88
89
90
91 9201
9202
93
94
95
9601
9602
9701
9702
9801
9802
99
100 I
101
102
103
10401
10402
lOS
368
351
379
391
391
413
379
433
372
429
414
432
419
439
~32
377
457 420
378 41middot7
345
360 417
417
412
-04
-02
-35
-26
-28
-11
-64
-20
-S9
-39
-32
-21
-34
-40
-47
-lO~7middot
-27middot +04
+56
+07
-34 01
+04
+04
+10
103
128
97
11il3 99
69
79
42
77
46
34 38
44
40
54
111
51middot
81
133
59
74
140
63
87
76
-08
-06
+04
+08
+17
-05
+3S -02
+1~4
+19
+33
-14
-08
+12
+26
+71
+11
-16 -34
-20
-19 +37
-49
-2S +15
NOte The The
Taken frOi
averageullder averageabove
middotUSCensus ---shy -
19 years == 6S years ==
figures 197
32r 13(14
p a~d 1960
--
Rank
1
2
3
4
5
6
7
8
9
10
11 12 -_
13
14
15
16
17
18
Tract
69 46
60
58
- 68
61
302
2501
67
63
19
62
26
94
3603
3902
64
30 -----~-
Rank
19
20
21 -
22
23-shy
24
25
26
27
28
29
30
31
32
33
34
35
36 -
Ranking of Per Capita Income by Census Tract
Tract
65
2701
- 15
1601
701
66
93
82
2903
3602
30
2502
80
2401
81
- 70
91 shy
4001
High
Rank Tractshy
-32shy37
38 97
120239
7840
41 ~ _2_1__ 42 31
43 2501
44 18
45 98
46 37
47 3803
1702
49
48
1602 92 2702
I
50 89
51 901
52 801
Ra_
53
54
55
56
57
58
59
60
61
62
63
64
6S
66
67
68
TractTract Ra~
74692
170196 70 I
401 71 90
72 1037J
79 70273
3802 74 601
24024102 75
85 76 101
77 9023901
7699 78 100 4101 79
3601 I
380180
458140~ t---- _ - - shy83 82 42
888384
59843501
4777 8~
502
Low
802 86
Rank Tract
87 shy
--88
89
90
91
92
93
94
- 95
96
97
middot98
99
100
101
102
103
104
1201
14
49
72
73
43
87
3502
105
1
52
86
71
1
501
10
3301
104 tf
Rank
105
106
107
108
109
110
III
112
113
114
115
116
117
118
119
120
121
Ranking of Per Capitalucoae by Census Tract
(Contd)
Tract Rank
4001 122--shy602
13
1102 2302
3302
55
3401
48
21
56
50
3402
lL01
2202
2301
53
2201
-shy
Tract Rank Tract Rank T~aet Rank
57 I-----
Imiddote
bull
Tract
- Low -k Note Information taken from 1960 U SCensus
Rank Tract
I ~
Ie
Imiddot
~
----
----
--
--
Rank
1
2
3
4
5
6
1
8
9
10
11
i-
-Tract
391 922 921
972 971
100
132 131 121
962 961
822 821 401
982 981
20 111
47 10 1
412
High
Total Number of Henta1 Health Visits
Ranked by Census Tract High to Low
TractTract RankTractRank Rnk
12 182 22 78 29 87 76 381 73181 ~------- 1913 371 8538230162372 271 2616-121 8272 2
14 80~2 31 94 7923 84801 59 15251362 4232 15 52 _ 32 103 8924 651 17240216 652
_ 91 351 33 341 23117 83 122 25 25 48 1123921418 34 shy61 86 661
19 662 6493 81 26 91 8153 49 50 55 41383 71 27 51 3120 90 672241 35shy 104167162 461
I 411 46211121 28 88342 I
2502 36 69 54 5251 50 272
-Ra
37
38
39
_ 40
_ 41 Ishy
I
42 I
-I 43 44
45
shy
Tract
~ --- shy 95 56
45 292 242
102 62 352 291y
92
101 281
99 72 63 601 60~ 42 2201
77 74 61 57
363 232
70
32 31
11 44 282 2202
Low l
- Tract
46 682 681 I 331 30
r~$ 47 1042 332
48 102_41_
11
~
Visits to Family Planning Clinics Ranked by Census Tract High to Low
Rank Tract Rank Tract Rankmiddot Tract Rank Tract Rank Tract Rank Tract
1
2
3
4
5
6
7
8
9
10
11
12
13middot
14
15
16
17
361
56
401
341
48
59 121
20
55
342
10
31
58
93 21
241 132
331
53
461 462
18
19
20-shy21
22
23
24
25
26
27middot
28
29
30
31
32
33
391
32
middot47 I-i-_-shy _ -
231 111
332
972 1
372 371
52
89
32
92
82
100 31
182
30 242
402
34
35
36
37
38
39
40
41
42
43
44
45
42
1714 i 661 221
78 362 2
90 602 601 352
63 251
105 921
971 351
73 42 292 232
411 51
662
81 45 52
46
47
48
49shy
50
51
52
53
54
55
56
961
801
49 81 72 71
19
9~1
172
68 2 57 162 14 112
91 75 681
381 42
3~3
83 161
57 f
58
59
60
61shy
62 Imiddot
63
Imiddot 64
65
66
64 62 36~3 252
74 652 SO 392 291
651 6bull 2
79 271
r-- ---- shy981 222
672 671
821 272
94 87
281
382
67
68
69
70
71
72
73
74
75
76
77
78
981 26 12~2
IS 61
85 82~2 69
61 43
101 86 84 282
76
131
51 72
1041 962 88 70
99 922 77
103
95 802 181
i
~
Low High
RankRank Tract
5479
4480
81 1042 ~) middot102
71 - - + ~ - ~
Visits to Family Planning Clinics
(Contd)
Tract Rank
I
Tract llaDk l
RankTract Tract Rank Tract
~
I
~
J1 ~
Low
Total Number of public Health Nursing Visits
Ranked by Census TractsHigh to Low
TractTract RankTractRank RankRank TractTractRankTractRank
25249 71 79 17249 8033 6586 99189711 84 2915072 34 661 76 66 811519512
402 5035 51 161 2518220 122 1713423 352 55801 7120 6752 2 149814 41236 83 2662 38 94 6821 53 2924015 362 37 32 42 75 69 281 84 63
546 8822 54 222 85 3925431 70383417 3818223 6439 4386652 718 21 55 103332 8924 232 87 19 271729219619 24156 16211140 382 628825 10523110 112 73411 10141-- ----shy 89 363 4457 8126 16111 221 74 9142 90 46158331 53 671279012 46243 48 59 351 3837528 1083 9313 91 5844 59 -_242 76 1----- shy60 272 72 74104114 60145 42 9287 7729 92 6151 8215 57371 934630 91 307762 12113116 282 619447 41391 9531 78100 63 7378 ~95 681 6945 32 5632 798517 6448 47 52 181
High ~ Low
Rank Tract Rank
96 31 132 70
97 102
98 182 372middot 602 651 662
- -shy
~72 682 802
822 922 962 972 982
1042 ----shy
Low
Total Number of Public Health Nursing Visits
(Contd)
Rank Rank Rank TractTract Tract
I
I lt
I
Tract Rank Tract
[
~~~-
I
~
IJilfimiddot ~
j
Ranking of VD Caea According to Census Tracts 61 By High and LOll Youth Itatio
A media~ of 34 5 was determined Any tract having greater
than 34 5~ of popu1tionunde~ 19 years of age -High~
Any tract having l8S than 345 of population under 19
years == Low
Any tract having rate less than 390 =Low
Any tract having rate more than 390 == HLgl4
YOUTH
LOW HIGH
L
0
12 402 1801 1802 343 2801 2802 29023603
54 6001 600262 66~02 72 74 75 76
78 79 81 t02 65 1202
W
(25)
VD
H
I
G
H
401 701 801802 901 902 10 1101 241 1201 1301 132 14 15 1601 1701 20~ 21 2202 2j02 2402 2502 2702 2901 303501 3502 34023801 3802 383 3902 42 44 45 4601 4602 47 48 49 SO 51~2 53 55 56 57 58 S9 6701 6702 73 95
3~02 7021702 19 25~01 2701 4102 4101 63 64601 ~601 6801 680270 7l 77 8001 80~02 8201 8202 83 84
85 86 87 88~ 90 91 9202 920193 94 9601 9602~ 9701 9102 9801 9802 99 100 101 103 10402 105 6501 10401
(47)
301 501 502 601 1602 2401 2301 2201 31 32 3301 3302 3401 3402~ 3602 3702 3901 400140 02 43 61 69 B(
(53) (23)
~ ~gt
Ranking of VD by Rate Per 100000 By Census Tract
~
Rank Tract Rank Tract Rank Tract Rank Tract llank Tract Rank Tract Rank Tract
1 2202 21 S6 40 902 58 1602 74 75
90-shy 64 107 26 --~-
2 3402 22 45 41 10 59 902 75 78 91 54 108 61
3 2301 23 3502 42 2502 60 602 76 6802 92 402 109 87
4 3302 24 49 43 1102 61 501 17 2 93 94 110 90
5 50 25 52 44 6702 62 14 78 8202 94 97 02 III 76
6 2201 26 20 6701 63 4002 8201 2501
9701 41~02 112 91
7 44 27 48 45 401 64 3802 2902 95 63 113 62
8 3301 28 1701 46 502 65 30 79 83 74 96 9602 114 71
9 55 29 47 47 42 66 3803 80 2801 96Q1 115 85 10
11
12
13
14
15
16
17
18
3401
53
2302
2401
57
21
2402
1101
51
30-shy31
32
33
34
35
36
37
3701 - -~ 1201
3702
89
43
132 131
3602
4001
48
49
50
51
52
53
54
55
58
1601
601
4602 4601
69
701
31
3901
67
68
69
70
71
72
2901
801
39021~ 802
6502 6501 122
702
41~01
81
82
83
84
85
86
87
88
19
1
1702
2802
79
93
100 6801 6602
81
97
98
99
100
101
102
103
104
9201 9202
9802 9801
77
302
79
86
72
84
116
117
118
119
120
121
3603
8002 8001
101
99
95
10401
105 10402 103 102
19
20
59
32
38
39
2702
3501
56
57
301
3801
73 1802 1801
89 6002 6001
105
106
2701
88
High Low
-- -----
Rank OrdermiddotTuberclosis Cases by Rate Per 100000 Ranked by Census Tract High to Low
Tract TractRankTractRank Rank TractRaukTractRankTractRank
801
79 9601501411 52 6835340120511 I 960269 903603532036 $-~~F130221542 4366 311301 70 68~013802 _ I- _ 4001_37213 3921201 6802802 H71523822024 22 54 193302 3802 80 8958 I37139535 70155 9801 I60123 72 6702 98023914011016 6701250124 10 56
81 94 401r 7 154152 73 7057 2625 122 92028
90242 162312301 92~158 86 7172434526509 82 79160159 74 100 87412240227220110 6502836960 75 30 8317244 6501782801285711 61 901 42765645 84 66021459294912 9701 660146 171 302 9702 47
6235023033113 85 822821182 917755 16335013110214 841814832 78 103 938564 324815 86 1057940149272 38036523216 10401 87 2902241 725Q 10402360266340217middot IF88 88 9937233 282 51 218 101 01102 46016234
I)167 2901460219 47
High ~ Low ~
- -
TractRank
9S89
6490
8191 8001 8002
63 61 60middot01 6002 44 2701
92
J
2502 402 --- ----shy
I
Rank
Rank Order Tuberculosis Cases by Rate per 100000
(Coutd)
Tract Rank Tract ~nk
I
Tract Ballk Tract Rank
Imiddot
Tract
Imiddot
1~
t 1I i Pi i l I
o
1 -1shyL I
I J
8 40 icO ~ I -lt 0
-t (1) I
i I
r o E
II
a
I
r--i
shy
I
~
I (
Jgt
(011 fi(
Ggt
I II ~j
()
(f 0
~ ()
I
11
f9
r
II 99
o ~
Ggt r
~ __-J~ I t I ~ I
r--J l I
~ _ __ J
) 1
fTl
1gt
r I
()
r
()
lt en -i en
()
I1l
(J)
(J)
-i
P ()
19
r o ~
r G1 I
I
c
~
o I 89
--- -I-shy
r-r I
1- 0 _~ _ _--J E
G1 I I I
i i
I 1-1-1 ~ _J ~2 ~ II
II
()
1 I I I 1
id i bullbull
~
A n 69
r 1shy
- 0 Gl
l--~ ~ I
~ II
II )
I () isect i
en l i
(J)
-t
0
IA Ol
r
Demographic Population Change 1960 to 1970 52 (Contd)
Census Tract
t of Pop Uncler 19 Yrs
1970
Change 1960-70
1 of Pop OVer 65 Yrs
1970
ex Change 196070
86
87
88
89
90
91 9201
9202
93
94
95
9601
9602
9701
9702
9801
9802
99
100 I
101
102
103
10401
10402
lOS
368
351
379
391
391
413
379
433
372
429
414
432
419
439
~32
377
457 420
378 41middot7
345
360 417
417
412
-04
-02
-35
-26
-28
-11
-64
-20
-S9
-39
-32
-21
-34
-40
-47
-lO~7middot
-27middot +04
+56
+07
-34 01
+04
+04
+10
103
128
97
11il3 99
69
79
42
77
46
34 38
44
40
54
111
51middot
81
133
59
74
140
63
87
76
-08
-06
+04
+08
+17
-05
+3S -02
+1~4
+19
+33
-14
-08
+12
+26
+71
+11
-16 -34
-20
-19 +37
-49
-2S +15
NOte The The
Taken frOi
averageullder averageabove
middotUSCensus ---shy -
19 years == 6S years ==
figures 197
32r 13(14
p a~d 1960
--
Rank
1
2
3
4
5
6
7
8
9
10
11 12 -_
13
14
15
16
17
18
Tract
69 46
60
58
- 68
61
302
2501
67
63
19
62
26
94
3603
3902
64
30 -----~-
Rank
19
20
21 -
22
23-shy
24
25
26
27
28
29
30
31
32
33
34
35
36 -
Ranking of Per Capita Income by Census Tract
Tract
65
2701
- 15
1601
701
66
93
82
2903
3602
30
2502
80
2401
81
- 70
91 shy
4001
High
Rank Tractshy
-32shy37
38 97
120239
7840
41 ~ _2_1__ 42 31
43 2501
44 18
45 98
46 37
47 3803
1702
49
48
1602 92 2702
I
50 89
51 901
52 801
Ra_
53
54
55
56
57
58
59
60
61
62
63
64
6S
66
67
68
TractTract Ra~
74692
170196 70 I
401 71 90
72 1037J
79 70273
3802 74 601
24024102 75
85 76 101
77 9023901
7699 78 100 4101 79
3601 I
380180
458140~ t---- _ - - shy83 82 42
888384
59843501
4777 8~
502
Low
802 86
Rank Tract
87 shy
--88
89
90
91
92
93
94
- 95
96
97
middot98
99
100
101
102
103
104
1201
14
49
72
73
43
87
3502
105
1
52
86
71
1
501
10
3301
104 tf
Rank
105
106
107
108
109
110
III
112
113
114
115
116
117
118
119
120
121
Ranking of Per Capitalucoae by Census Tract
(Contd)
Tract Rank
4001 122--shy602
13
1102 2302
3302
55
3401
48
21
56
50
3402
lL01
2202
2301
53
2201
-shy
Tract Rank Tract Rank T~aet Rank
57 I-----
Imiddote
bull
Tract
- Low -k Note Information taken from 1960 U SCensus
Rank Tract
I ~
Ie
Imiddot
~
----
----
--
--
Rank
1
2
3
4
5
6
1
8
9
10
11
i-
-Tract
391 922 921
972 971
100
132 131 121
962 961
822 821 401
982 981
20 111
47 10 1
412
High
Total Number of Henta1 Health Visits
Ranked by Census Tract High to Low
TractTract RankTractRank Rnk
12 182 22 78 29 87 76 381 73181 ~------- 1913 371 8538230162372 271 2616-121 8272 2
14 80~2 31 94 7923 84801 59 15251362 4232 15 52 _ 32 103 8924 651 17240216 652
_ 91 351 33 341 23117 83 122 25 25 48 1123921418 34 shy61 86 661
19 662 6493 81 26 91 8153 49 50 55 41383 71 27 51 3120 90 672241 35shy 104167162 461
I 411 46211121 28 88342 I
2502 36 69 54 5251 50 272
-Ra
37
38
39
_ 40
_ 41 Ishy
I
42 I
-I 43 44
45
shy
Tract
~ --- shy 95 56
45 292 242
102 62 352 291y
92
101 281
99 72 63 601 60~ 42 2201
77 74 61 57
363 232
70
32 31
11 44 282 2202
Low l
- Tract
46 682 681 I 331 30
r~$ 47 1042 332
48 102_41_
11
~
Visits to Family Planning Clinics Ranked by Census Tract High to Low
Rank Tract Rank Tract Rankmiddot Tract Rank Tract Rank Tract Rank Tract
1
2
3
4
5
6
7
8
9
10
11
12
13middot
14
15
16
17
361
56
401
341
48
59 121
20
55
342
10
31
58
93 21
241 132
331
53
461 462
18
19
20-shy21
22
23
24
25
26
27middot
28
29
30
31
32
33
391
32
middot47 I-i-_-shy _ -
231 111
332
972 1
372 371
52
89
32
92
82
100 31
182
30 242
402
34
35
36
37
38
39
40
41
42
43
44
45
42
1714 i 661 221
78 362 2
90 602 601 352
63 251
105 921
971 351
73 42 292 232
411 51
662
81 45 52
46
47
48
49shy
50
51
52
53
54
55
56
961
801
49 81 72 71
19
9~1
172
68 2 57 162 14 112
91 75 681
381 42
3~3
83 161
57 f
58
59
60
61shy
62 Imiddot
63
Imiddot 64
65
66
64 62 36~3 252
74 652 SO 392 291
651 6bull 2
79 271
r-- ---- shy981 222
672 671
821 272
94 87
281
382
67
68
69
70
71
72
73
74
75
76
77
78
981 26 12~2
IS 61
85 82~2 69
61 43
101 86 84 282
76
131
51 72
1041 962 88 70
99 922 77
103
95 802 181
i
~
Low High
RankRank Tract
5479
4480
81 1042 ~) middot102
71 - - + ~ - ~
Visits to Family Planning Clinics
(Contd)
Tract Rank
I
Tract llaDk l
RankTract Tract Rank Tract
~
I
~
J1 ~
Low
Total Number of public Health Nursing Visits
Ranked by Census TractsHigh to Low
TractTract RankTractRank RankRank TractTractRankTractRank
25249 71 79 17249 8033 6586 99189711 84 2915072 34 661 76 66 811519512
402 5035 51 161 2518220 122 1713423 352 55801 7120 6752 2 149814 41236 83 2662 38 94 6821 53 2924015 362 37 32 42 75 69 281 84 63
546 8822 54 222 85 3925431 70383417 3818223 6439 4386652 718 21 55 103332 8924 232 87 19 271729219619 24156 16211140 382 628825 10523110 112 73411 10141-- ----shy 89 363 4457 8126 16111 221 74 9142 90 46158331 53 671279012 46243 48 59 351 3837528 1083 9313 91 5844 59 -_242 76 1----- shy60 272 72 74104114 60145 42 9287 7729 92 6151 8215 57371 934630 91 307762 12113116 282 619447 41391 9531 78100 63 7378 ~95 681 6945 32 5632 798517 6448 47 52 181
High ~ Low
Rank Tract Rank
96 31 132 70
97 102
98 182 372middot 602 651 662
- -shy
~72 682 802
822 922 962 972 982
1042 ----shy
Low
Total Number of Public Health Nursing Visits
(Contd)
Rank Rank Rank TractTract Tract
I
I lt
I
Tract Rank Tract
[
~~~-
I
~
IJilfimiddot ~
j
Ranking of VD Caea According to Census Tracts 61 By High and LOll Youth Itatio
A media~ of 34 5 was determined Any tract having greater
than 34 5~ of popu1tionunde~ 19 years of age -High~
Any tract having l8S than 345 of population under 19
years == Low
Any tract having rate less than 390 =Low
Any tract having rate more than 390 == HLgl4
YOUTH
LOW HIGH
L
0
12 402 1801 1802 343 2801 2802 29023603
54 6001 600262 66~02 72 74 75 76
78 79 81 t02 65 1202
W
(25)
VD
H
I
G
H
401 701 801802 901 902 10 1101 241 1201 1301 132 14 15 1601 1701 20~ 21 2202 2j02 2402 2502 2702 2901 303501 3502 34023801 3802 383 3902 42 44 45 4601 4602 47 48 49 SO 51~2 53 55 56 57 58 S9 6701 6702 73 95
3~02 7021702 19 25~01 2701 4102 4101 63 64601 ~601 6801 680270 7l 77 8001 80~02 8201 8202 83 84
85 86 87 88~ 90 91 9202 920193 94 9601 9602~ 9701 9102 9801 9802 99 100 101 103 10402 105 6501 10401
(47)
301 501 502 601 1602 2401 2301 2201 31 32 3301 3302 3401 3402~ 3602 3702 3901 400140 02 43 61 69 B(
(53) (23)
~ ~gt
Ranking of VD by Rate Per 100000 By Census Tract
~
Rank Tract Rank Tract Rank Tract Rank Tract llank Tract Rank Tract Rank Tract
1 2202 21 S6 40 902 58 1602 74 75
90-shy 64 107 26 --~-
2 3402 22 45 41 10 59 902 75 78 91 54 108 61
3 2301 23 3502 42 2502 60 602 76 6802 92 402 109 87
4 3302 24 49 43 1102 61 501 17 2 93 94 110 90
5 50 25 52 44 6702 62 14 78 8202 94 97 02 III 76
6 2201 26 20 6701 63 4002 8201 2501
9701 41~02 112 91
7 44 27 48 45 401 64 3802 2902 95 63 113 62
8 3301 28 1701 46 502 65 30 79 83 74 96 9602 114 71
9 55 29 47 47 42 66 3803 80 2801 96Q1 115 85 10
11
12
13
14
15
16
17
18
3401
53
2302
2401
57
21
2402
1101
51
30-shy31
32
33
34
35
36
37
3701 - -~ 1201
3702
89
43
132 131
3602
4001
48
49
50
51
52
53
54
55
58
1601
601
4602 4601
69
701
31
3901
67
68
69
70
71
72
2901
801
39021~ 802
6502 6501 122
702
41~01
81
82
83
84
85
86
87
88
19
1
1702
2802
79
93
100 6801 6602
81
97
98
99
100
101
102
103
104
9201 9202
9802 9801
77
302
79
86
72
84
116
117
118
119
120
121
3603
8002 8001
101
99
95
10401
105 10402 103 102
19
20
59
32
38
39
2702
3501
56
57
301
3801
73 1802 1801
89 6002 6001
105
106
2701
88
High Low
-- -----
Rank OrdermiddotTuberclosis Cases by Rate Per 100000 Ranked by Census Tract High to Low
Tract TractRankTractRank Rank TractRaukTractRankTractRank
801
79 9601501411 52 6835340120511 I 960269 903603532036 $-~~F130221542 4366 311301 70 68~013802 _ I- _ 4001_37213 3921201 6802802 H71523822024 22 54 193302 3802 80 8958 I37139535 70155 9801 I60123 72 6702 98023914011016 6701250124 10 56
81 94 401r 7 154152 73 7057 2625 122 92028
90242 162312301 92~158 86 7172434526509 82 79160159 74 100 87412240227220110 6502836960 75 30 8317244 6501782801285711 61 901 42765645 84 66021459294912 9701 660146 171 302 9702 47
6235023033113 85 822821182 917755 16335013110214 841814832 78 103 938564 324815 86 1057940149272 38036523216 10401 87 2902241 725Q 10402360266340217middot IF88 88 9937233 282 51 218 101 01102 46016234
I)167 2901460219 47
High ~ Low ~
- -
TractRank
9S89
6490
8191 8001 8002
63 61 60middot01 6002 44 2701
92
J
2502 402 --- ----shy
I
Rank
Rank Order Tuberculosis Cases by Rate per 100000
(Coutd)
Tract Rank Tract ~nk
I
Tract Ballk Tract Rank
Imiddot
Tract
Imiddot
1~
t 1I i Pi i l I
o
1 -1shyL I
I J
8 40 icO ~ I -lt 0
-t (1) I
i I
r o E
II
a
I
r--i
shy
I
~
I (
Jgt
(011 fi(
Ggt
I II ~j
()
(f 0
~ ()
I
11
f9
r
II 99
o ~
Ggt r
~ __-J~ I t I ~ I
r--J l I
~ _ __ J
) 1
fTl
1gt
r I
()
r
()
lt en -i en
()
I1l
(J)
(J)
-i
P ()
19
r o ~
r G1 I
I
c
~
o I 89
--- -I-shy
r-r I
1- 0 _~ _ _--J E
G1 I I I
i i
I 1-1-1 ~ _J ~2 ~ II
II
()
1 I I I 1
id i bullbull
~
A n 69
r 1shy
- 0 Gl
l--~ ~ I
~ II
II )
I () isect i
en l i
(J)
-t
0
IA Ol
--
Rank
1
2
3
4
5
6
7
8
9
10
11 12 -_
13
14
15
16
17
18
Tract
69 46
60
58
- 68
61
302
2501
67
63
19
62
26
94
3603
3902
64
30 -----~-
Rank
19
20
21 -
22
23-shy
24
25
26
27
28
29
30
31
32
33
34
35
36 -
Ranking of Per Capita Income by Census Tract
Tract
65
2701
- 15
1601
701
66
93
82
2903
3602
30
2502
80
2401
81
- 70
91 shy
4001
High
Rank Tractshy
-32shy37
38 97
120239
7840
41 ~ _2_1__ 42 31
43 2501
44 18
45 98
46 37
47 3803
1702
49
48
1602 92 2702
I
50 89
51 901
52 801
Ra_
53
54
55
56
57
58
59
60
61
62
63
64
6S
66
67
68
TractTract Ra~
74692
170196 70 I
401 71 90
72 1037J
79 70273
3802 74 601
24024102 75
85 76 101
77 9023901
7699 78 100 4101 79
3601 I
380180
458140~ t---- _ - - shy83 82 42
888384
59843501
4777 8~
502
Low
802 86
Rank Tract
87 shy
--88
89
90
91
92
93
94
- 95
96
97
middot98
99
100
101
102
103
104
1201
14
49
72
73
43
87
3502
105
1
52
86
71
1
501
10
3301
104 tf
Rank
105
106
107
108
109
110
III
112
113
114
115
116
117
118
119
120
121
Ranking of Per Capitalucoae by Census Tract
(Contd)
Tract Rank
4001 122--shy602
13
1102 2302
3302
55
3401
48
21
56
50
3402
lL01
2202
2301
53
2201
-shy
Tract Rank Tract Rank T~aet Rank
57 I-----
Imiddote
bull
Tract
- Low -k Note Information taken from 1960 U SCensus
Rank Tract
I ~
Ie
Imiddot
~
----
----
--
--
Rank
1
2
3
4
5
6
1
8
9
10
11
i-
-Tract
391 922 921
972 971
100
132 131 121
962 961
822 821 401
982 981
20 111
47 10 1
412
High
Total Number of Henta1 Health Visits
Ranked by Census Tract High to Low
TractTract RankTractRank Rnk
12 182 22 78 29 87 76 381 73181 ~------- 1913 371 8538230162372 271 2616-121 8272 2
14 80~2 31 94 7923 84801 59 15251362 4232 15 52 _ 32 103 8924 651 17240216 652
_ 91 351 33 341 23117 83 122 25 25 48 1123921418 34 shy61 86 661
19 662 6493 81 26 91 8153 49 50 55 41383 71 27 51 3120 90 672241 35shy 104167162 461
I 411 46211121 28 88342 I
2502 36 69 54 5251 50 272
-Ra
37
38
39
_ 40
_ 41 Ishy
I
42 I
-I 43 44
45
shy
Tract
~ --- shy 95 56
45 292 242
102 62 352 291y
92
101 281
99 72 63 601 60~ 42 2201
77 74 61 57
363 232
70
32 31
11 44 282 2202
Low l
- Tract
46 682 681 I 331 30
r~$ 47 1042 332
48 102_41_
11
~
Visits to Family Planning Clinics Ranked by Census Tract High to Low
Rank Tract Rank Tract Rankmiddot Tract Rank Tract Rank Tract Rank Tract
1
2
3
4
5
6
7
8
9
10
11
12
13middot
14
15
16
17
361
56
401
341
48
59 121
20
55
342
10
31
58
93 21
241 132
331
53
461 462
18
19
20-shy21
22
23
24
25
26
27middot
28
29
30
31
32
33
391
32
middot47 I-i-_-shy _ -
231 111
332
972 1
372 371
52
89
32
92
82
100 31
182
30 242
402
34
35
36
37
38
39
40
41
42
43
44
45
42
1714 i 661 221
78 362 2
90 602 601 352
63 251
105 921
971 351
73 42 292 232
411 51
662
81 45 52
46
47
48
49shy
50
51
52
53
54
55
56
961
801
49 81 72 71
19
9~1
172
68 2 57 162 14 112
91 75 681
381 42
3~3
83 161
57 f
58
59
60
61shy
62 Imiddot
63
Imiddot 64
65
66
64 62 36~3 252
74 652 SO 392 291
651 6bull 2
79 271
r-- ---- shy981 222
672 671
821 272
94 87
281
382
67
68
69
70
71
72
73
74
75
76
77
78
981 26 12~2
IS 61
85 82~2 69
61 43
101 86 84 282
76
131
51 72
1041 962 88 70
99 922 77
103
95 802 181
i
~
Low High
RankRank Tract
5479
4480
81 1042 ~) middot102
71 - - + ~ - ~
Visits to Family Planning Clinics
(Contd)
Tract Rank
I
Tract llaDk l
RankTract Tract Rank Tract
~
I
~
J1 ~
Low
Total Number of public Health Nursing Visits
Ranked by Census TractsHigh to Low
TractTract RankTractRank RankRank TractTractRankTractRank
25249 71 79 17249 8033 6586 99189711 84 2915072 34 661 76 66 811519512
402 5035 51 161 2518220 122 1713423 352 55801 7120 6752 2 149814 41236 83 2662 38 94 6821 53 2924015 362 37 32 42 75 69 281 84 63
546 8822 54 222 85 3925431 70383417 3818223 6439 4386652 718 21 55 103332 8924 232 87 19 271729219619 24156 16211140 382 628825 10523110 112 73411 10141-- ----shy 89 363 4457 8126 16111 221 74 9142 90 46158331 53 671279012 46243 48 59 351 3837528 1083 9313 91 5844 59 -_242 76 1----- shy60 272 72 74104114 60145 42 9287 7729 92 6151 8215 57371 934630 91 307762 12113116 282 619447 41391 9531 78100 63 7378 ~95 681 6945 32 5632 798517 6448 47 52 181
High ~ Low
Rank Tract Rank
96 31 132 70
97 102
98 182 372middot 602 651 662
- -shy
~72 682 802
822 922 962 972 982
1042 ----shy
Low
Total Number of Public Health Nursing Visits
(Contd)
Rank Rank Rank TractTract Tract
I
I lt
I
Tract Rank Tract
[
~~~-
I
~
IJilfimiddot ~
j
Ranking of VD Caea According to Census Tracts 61 By High and LOll Youth Itatio
A media~ of 34 5 was determined Any tract having greater
than 34 5~ of popu1tionunde~ 19 years of age -High~
Any tract having l8S than 345 of population under 19
years == Low
Any tract having rate less than 390 =Low
Any tract having rate more than 390 == HLgl4
YOUTH
LOW HIGH
L
0
12 402 1801 1802 343 2801 2802 29023603
54 6001 600262 66~02 72 74 75 76
78 79 81 t02 65 1202
W
(25)
VD
H
I
G
H
401 701 801802 901 902 10 1101 241 1201 1301 132 14 15 1601 1701 20~ 21 2202 2j02 2402 2502 2702 2901 303501 3502 34023801 3802 383 3902 42 44 45 4601 4602 47 48 49 SO 51~2 53 55 56 57 58 S9 6701 6702 73 95
3~02 7021702 19 25~01 2701 4102 4101 63 64601 ~601 6801 680270 7l 77 8001 80~02 8201 8202 83 84
85 86 87 88~ 90 91 9202 920193 94 9601 9602~ 9701 9102 9801 9802 99 100 101 103 10402 105 6501 10401
(47)
301 501 502 601 1602 2401 2301 2201 31 32 3301 3302 3401 3402~ 3602 3702 3901 400140 02 43 61 69 B(
(53) (23)
~ ~gt
Ranking of VD by Rate Per 100000 By Census Tract
~
Rank Tract Rank Tract Rank Tract Rank Tract llank Tract Rank Tract Rank Tract
1 2202 21 S6 40 902 58 1602 74 75
90-shy 64 107 26 --~-
2 3402 22 45 41 10 59 902 75 78 91 54 108 61
3 2301 23 3502 42 2502 60 602 76 6802 92 402 109 87
4 3302 24 49 43 1102 61 501 17 2 93 94 110 90
5 50 25 52 44 6702 62 14 78 8202 94 97 02 III 76
6 2201 26 20 6701 63 4002 8201 2501
9701 41~02 112 91
7 44 27 48 45 401 64 3802 2902 95 63 113 62
8 3301 28 1701 46 502 65 30 79 83 74 96 9602 114 71
9 55 29 47 47 42 66 3803 80 2801 96Q1 115 85 10
11
12
13
14
15
16
17
18
3401
53
2302
2401
57
21
2402
1101
51
30-shy31
32
33
34
35
36
37
3701 - -~ 1201
3702
89
43
132 131
3602
4001
48
49
50
51
52
53
54
55
58
1601
601
4602 4601
69
701
31
3901
67
68
69
70
71
72
2901
801
39021~ 802
6502 6501 122
702
41~01
81
82
83
84
85
86
87
88
19
1
1702
2802
79
93
100 6801 6602
81
97
98
99
100
101
102
103
104
9201 9202
9802 9801
77
302
79
86
72
84
116
117
118
119
120
121
3603
8002 8001
101
99
95
10401
105 10402 103 102
19
20
59
32
38
39
2702
3501
56
57
301
3801
73 1802 1801
89 6002 6001
105
106
2701
88
High Low
-- -----
Rank OrdermiddotTuberclosis Cases by Rate Per 100000 Ranked by Census Tract High to Low
Tract TractRankTractRank Rank TractRaukTractRankTractRank
801
79 9601501411 52 6835340120511 I 960269 903603532036 $-~~F130221542 4366 311301 70 68~013802 _ I- _ 4001_37213 3921201 6802802 H71523822024 22 54 193302 3802 80 8958 I37139535 70155 9801 I60123 72 6702 98023914011016 6701250124 10 56
81 94 401r 7 154152 73 7057 2625 122 92028
90242 162312301 92~158 86 7172434526509 82 79160159 74 100 87412240227220110 6502836960 75 30 8317244 6501782801285711 61 901 42765645 84 66021459294912 9701 660146 171 302 9702 47
6235023033113 85 822821182 917755 16335013110214 841814832 78 103 938564 324815 86 1057940149272 38036523216 10401 87 2902241 725Q 10402360266340217middot IF88 88 9937233 282 51 218 101 01102 46016234
I)167 2901460219 47
High ~ Low ~
- -
TractRank
9S89
6490
8191 8001 8002
63 61 60middot01 6002 44 2701
92
J
2502 402 --- ----shy
I
Rank
Rank Order Tuberculosis Cases by Rate per 100000
(Coutd)
Tract Rank Tract ~nk
I
Tract Ballk Tract Rank
Imiddot
Tract
Imiddot
1~
t 1I i Pi i l I
o
1 -1shyL I
I J
8 40 icO ~ I -lt 0
-t (1) I
i I
r o E
II
a
I
r--i
shy
I
~
I (
Jgt
(011 fi(
Ggt
I II ~j
()
(f 0
~ ()
I
11
f9
r
II 99
o ~
Ggt r
~ __-J~ I t I ~ I
r--J l I
~ _ __ J
) 1
fTl
1gt
r I
()
r
()
lt en -i en
()
I1l
(J)
(J)
-i
P ()
19
r o ~
r G1 I
I
c
~
o I 89
--- -I-shy
r-r I
1- 0 _~ _ _--J E
G1 I I I
i i
I 1-1-1 ~ _J ~2 ~ II
II
()
1 I I I 1
id i bullbull
~
A n 69
r 1shy
- 0 Gl
l--~ ~ I
~ II
II )
I () isect i
en l i
(J)
-t
0
IA Ol
Rank
105
106
107
108
109
110
III
112
113
114
115
116
117
118
119
120
121
Ranking of Per Capitalucoae by Census Tract
(Contd)
Tract Rank
4001 122--shy602
13
1102 2302
3302
55
3401
48
21
56
50
3402
lL01
2202
2301
53
2201
-shy
Tract Rank Tract Rank T~aet Rank
57 I-----
Imiddote
bull
Tract
- Low -k Note Information taken from 1960 U SCensus
Rank Tract
I ~
Ie
Imiddot
~
----
----
--
--
Rank
1
2
3
4
5
6
1
8
9
10
11
i-
-Tract
391 922 921
972 971
100
132 131 121
962 961
822 821 401
982 981
20 111
47 10 1
412
High
Total Number of Henta1 Health Visits
Ranked by Census Tract High to Low
TractTract RankTractRank Rnk
12 182 22 78 29 87 76 381 73181 ~------- 1913 371 8538230162372 271 2616-121 8272 2
14 80~2 31 94 7923 84801 59 15251362 4232 15 52 _ 32 103 8924 651 17240216 652
_ 91 351 33 341 23117 83 122 25 25 48 1123921418 34 shy61 86 661
19 662 6493 81 26 91 8153 49 50 55 41383 71 27 51 3120 90 672241 35shy 104167162 461
I 411 46211121 28 88342 I
2502 36 69 54 5251 50 272
-Ra
37
38
39
_ 40
_ 41 Ishy
I
42 I
-I 43 44
45
shy
Tract
~ --- shy 95 56
45 292 242
102 62 352 291y
92
101 281
99 72 63 601 60~ 42 2201
77 74 61 57
363 232
70
32 31
11 44 282 2202
Low l
- Tract
46 682 681 I 331 30
r~$ 47 1042 332
48 102_41_
11
~
Visits to Family Planning Clinics Ranked by Census Tract High to Low
Rank Tract Rank Tract Rankmiddot Tract Rank Tract Rank Tract Rank Tract
1
2
3
4
5
6
7
8
9
10
11
12
13middot
14
15
16
17
361
56
401
341
48
59 121
20
55
342
10
31
58
93 21
241 132
331
53
461 462
18
19
20-shy21
22
23
24
25
26
27middot
28
29
30
31
32
33
391
32
middot47 I-i-_-shy _ -
231 111
332
972 1
372 371
52
89
32
92
82
100 31
182
30 242
402
34
35
36
37
38
39
40
41
42
43
44
45
42
1714 i 661 221
78 362 2
90 602 601 352
63 251
105 921
971 351
73 42 292 232
411 51
662
81 45 52
46
47
48
49shy
50
51
52
53
54
55
56
961
801
49 81 72 71
19
9~1
172
68 2 57 162 14 112
91 75 681
381 42
3~3
83 161
57 f
58
59
60
61shy
62 Imiddot
63
Imiddot 64
65
66
64 62 36~3 252
74 652 SO 392 291
651 6bull 2
79 271
r-- ---- shy981 222
672 671
821 272
94 87
281
382
67
68
69
70
71
72
73
74
75
76
77
78
981 26 12~2
IS 61
85 82~2 69
61 43
101 86 84 282
76
131
51 72
1041 962 88 70
99 922 77
103
95 802 181
i
~
Low High
RankRank Tract
5479
4480
81 1042 ~) middot102
71 - - + ~ - ~
Visits to Family Planning Clinics
(Contd)
Tract Rank
I
Tract llaDk l
RankTract Tract Rank Tract
~
I
~
J1 ~
Low
Total Number of public Health Nursing Visits
Ranked by Census TractsHigh to Low
TractTract RankTractRank RankRank TractTractRankTractRank
25249 71 79 17249 8033 6586 99189711 84 2915072 34 661 76 66 811519512
402 5035 51 161 2518220 122 1713423 352 55801 7120 6752 2 149814 41236 83 2662 38 94 6821 53 2924015 362 37 32 42 75 69 281 84 63
546 8822 54 222 85 3925431 70383417 3818223 6439 4386652 718 21 55 103332 8924 232 87 19 271729219619 24156 16211140 382 628825 10523110 112 73411 10141-- ----shy 89 363 4457 8126 16111 221 74 9142 90 46158331 53 671279012 46243 48 59 351 3837528 1083 9313 91 5844 59 -_242 76 1----- shy60 272 72 74104114 60145 42 9287 7729 92 6151 8215 57371 934630 91 307762 12113116 282 619447 41391 9531 78100 63 7378 ~95 681 6945 32 5632 798517 6448 47 52 181
High ~ Low
Rank Tract Rank
96 31 132 70
97 102
98 182 372middot 602 651 662
- -shy
~72 682 802
822 922 962 972 982
1042 ----shy
Low
Total Number of Public Health Nursing Visits
(Contd)
Rank Rank Rank TractTract Tract
I
I lt
I
Tract Rank Tract
[
~~~-
I
~
IJilfimiddot ~
j
Ranking of VD Caea According to Census Tracts 61 By High and LOll Youth Itatio
A media~ of 34 5 was determined Any tract having greater
than 34 5~ of popu1tionunde~ 19 years of age -High~
Any tract having l8S than 345 of population under 19
years == Low
Any tract having rate less than 390 =Low
Any tract having rate more than 390 == HLgl4
YOUTH
LOW HIGH
L
0
12 402 1801 1802 343 2801 2802 29023603
54 6001 600262 66~02 72 74 75 76
78 79 81 t02 65 1202
W
(25)
VD
H
I
G
H
401 701 801802 901 902 10 1101 241 1201 1301 132 14 15 1601 1701 20~ 21 2202 2j02 2402 2502 2702 2901 303501 3502 34023801 3802 383 3902 42 44 45 4601 4602 47 48 49 SO 51~2 53 55 56 57 58 S9 6701 6702 73 95
3~02 7021702 19 25~01 2701 4102 4101 63 64601 ~601 6801 680270 7l 77 8001 80~02 8201 8202 83 84
85 86 87 88~ 90 91 9202 920193 94 9601 9602~ 9701 9102 9801 9802 99 100 101 103 10402 105 6501 10401
(47)
301 501 502 601 1602 2401 2301 2201 31 32 3301 3302 3401 3402~ 3602 3702 3901 400140 02 43 61 69 B(
(53) (23)
~ ~gt
Ranking of VD by Rate Per 100000 By Census Tract
~
Rank Tract Rank Tract Rank Tract Rank Tract llank Tract Rank Tract Rank Tract
1 2202 21 S6 40 902 58 1602 74 75
90-shy 64 107 26 --~-
2 3402 22 45 41 10 59 902 75 78 91 54 108 61
3 2301 23 3502 42 2502 60 602 76 6802 92 402 109 87
4 3302 24 49 43 1102 61 501 17 2 93 94 110 90
5 50 25 52 44 6702 62 14 78 8202 94 97 02 III 76
6 2201 26 20 6701 63 4002 8201 2501
9701 41~02 112 91
7 44 27 48 45 401 64 3802 2902 95 63 113 62
8 3301 28 1701 46 502 65 30 79 83 74 96 9602 114 71
9 55 29 47 47 42 66 3803 80 2801 96Q1 115 85 10
11
12
13
14
15
16
17
18
3401
53
2302
2401
57
21
2402
1101
51
30-shy31
32
33
34
35
36
37
3701 - -~ 1201
3702
89
43
132 131
3602
4001
48
49
50
51
52
53
54
55
58
1601
601
4602 4601
69
701
31
3901
67
68
69
70
71
72
2901
801
39021~ 802
6502 6501 122
702
41~01
81
82
83
84
85
86
87
88
19
1
1702
2802
79
93
100 6801 6602
81
97
98
99
100
101
102
103
104
9201 9202
9802 9801
77
302
79
86
72
84
116
117
118
119
120
121
3603
8002 8001
101
99
95
10401
105 10402 103 102
19
20
59
32
38
39
2702
3501
56
57
301
3801
73 1802 1801
89 6002 6001
105
106
2701
88
High Low
-- -----
Rank OrdermiddotTuberclosis Cases by Rate Per 100000 Ranked by Census Tract High to Low
Tract TractRankTractRank Rank TractRaukTractRankTractRank
801
79 9601501411 52 6835340120511 I 960269 903603532036 $-~~F130221542 4366 311301 70 68~013802 _ I- _ 4001_37213 3921201 6802802 H71523822024 22 54 193302 3802 80 8958 I37139535 70155 9801 I60123 72 6702 98023914011016 6701250124 10 56
81 94 401r 7 154152 73 7057 2625 122 92028
90242 162312301 92~158 86 7172434526509 82 79160159 74 100 87412240227220110 6502836960 75 30 8317244 6501782801285711 61 901 42765645 84 66021459294912 9701 660146 171 302 9702 47
6235023033113 85 822821182 917755 16335013110214 841814832 78 103 938564 324815 86 1057940149272 38036523216 10401 87 2902241 725Q 10402360266340217middot IF88 88 9937233 282 51 218 101 01102 46016234
I)167 2901460219 47
High ~ Low ~
- -
TractRank
9S89
6490
8191 8001 8002
63 61 60middot01 6002 44 2701
92
J
2502 402 --- ----shy
I
Rank
Rank Order Tuberculosis Cases by Rate per 100000
(Coutd)
Tract Rank Tract ~nk
I
Tract Ballk Tract Rank
Imiddot
Tract
Imiddot
1~
t 1I i Pi i l I
o
1 -1shyL I
I J
8 40 icO ~ I -lt 0
-t (1) I
i I
r o E
II
a
I
r--i
shy
I
~
I (
Jgt
(011 fi(
Ggt
I II ~j
()
(f 0
~ ()
I
11
f9
r
II 99
o ~
Ggt r
~ __-J~ I t I ~ I
r--J l I
~ _ __ J
) 1
fTl
1gt
r I
()
r
()
lt en -i en
()
I1l
(J)
(J)
-i
P ()
19
r o ~
r G1 I
I
c
~
o I 89
--- -I-shy
r-r I
1- 0 _~ _ _--J E
G1 I I I
i i
I 1-1-1 ~ _J ~2 ~ II
II
()
1 I I I 1
id i bullbull
~
A n 69
r 1shy
- 0 Gl
l--~ ~ I
~ II
II )
I () isect i
en l i
(J)
-t
0
IA Ol
----
----
--
--
Rank
1
2
3
4
5
6
1
8
9
10
11
i-
-Tract
391 922 921
972 971
100
132 131 121
962 961
822 821 401
982 981
20 111
47 10 1
412
High
Total Number of Henta1 Health Visits
Ranked by Census Tract High to Low
TractTract RankTractRank Rnk
12 182 22 78 29 87 76 381 73181 ~------- 1913 371 8538230162372 271 2616-121 8272 2
14 80~2 31 94 7923 84801 59 15251362 4232 15 52 _ 32 103 8924 651 17240216 652
_ 91 351 33 341 23117 83 122 25 25 48 1123921418 34 shy61 86 661
19 662 6493 81 26 91 8153 49 50 55 41383 71 27 51 3120 90 672241 35shy 104167162 461
I 411 46211121 28 88342 I
2502 36 69 54 5251 50 272
-Ra
37
38
39
_ 40
_ 41 Ishy
I
42 I
-I 43 44
45
shy
Tract
~ --- shy 95 56
45 292 242
102 62 352 291y
92
101 281
99 72 63 601 60~ 42 2201
77 74 61 57
363 232
70
32 31
11 44 282 2202
Low l
- Tract
46 682 681 I 331 30
r~$ 47 1042 332
48 102_41_
11
~
Visits to Family Planning Clinics Ranked by Census Tract High to Low
Rank Tract Rank Tract Rankmiddot Tract Rank Tract Rank Tract Rank Tract
1
2
3
4
5
6
7
8
9
10
11
12
13middot
14
15
16
17
361
56
401
341
48
59 121
20
55
342
10
31
58
93 21
241 132
331
53
461 462
18
19
20-shy21
22
23
24
25
26
27middot
28
29
30
31
32
33
391
32
middot47 I-i-_-shy _ -
231 111
332
972 1
372 371
52
89
32
92
82
100 31
182
30 242
402
34
35
36
37
38
39
40
41
42
43
44
45
42
1714 i 661 221
78 362 2
90 602 601 352
63 251
105 921
971 351
73 42 292 232
411 51
662
81 45 52
46
47
48
49shy
50
51
52
53
54
55
56
961
801
49 81 72 71
19
9~1
172
68 2 57 162 14 112
91 75 681
381 42
3~3
83 161
57 f
58
59
60
61shy
62 Imiddot
63
Imiddot 64
65
66
64 62 36~3 252
74 652 SO 392 291
651 6bull 2
79 271
r-- ---- shy981 222
672 671
821 272
94 87
281
382
67
68
69
70
71
72
73
74
75
76
77
78
981 26 12~2
IS 61
85 82~2 69
61 43
101 86 84 282
76
131
51 72
1041 962 88 70
99 922 77
103
95 802 181
i
~
Low High
RankRank Tract
5479
4480
81 1042 ~) middot102
71 - - + ~ - ~
Visits to Family Planning Clinics
(Contd)
Tract Rank
I
Tract llaDk l
RankTract Tract Rank Tract
~
I
~
J1 ~
Low
Total Number of public Health Nursing Visits
Ranked by Census TractsHigh to Low
TractTract RankTractRank RankRank TractTractRankTractRank
25249 71 79 17249 8033 6586 99189711 84 2915072 34 661 76 66 811519512
402 5035 51 161 2518220 122 1713423 352 55801 7120 6752 2 149814 41236 83 2662 38 94 6821 53 2924015 362 37 32 42 75 69 281 84 63
546 8822 54 222 85 3925431 70383417 3818223 6439 4386652 718 21 55 103332 8924 232 87 19 271729219619 24156 16211140 382 628825 10523110 112 73411 10141-- ----shy 89 363 4457 8126 16111 221 74 9142 90 46158331 53 671279012 46243 48 59 351 3837528 1083 9313 91 5844 59 -_242 76 1----- shy60 272 72 74104114 60145 42 9287 7729 92 6151 8215 57371 934630 91 307762 12113116 282 619447 41391 9531 78100 63 7378 ~95 681 6945 32 5632 798517 6448 47 52 181
High ~ Low
Rank Tract Rank
96 31 132 70
97 102
98 182 372middot 602 651 662
- -shy
~72 682 802
822 922 962 972 982
1042 ----shy
Low
Total Number of Public Health Nursing Visits
(Contd)
Rank Rank Rank TractTract Tract
I
I lt
I
Tract Rank Tract
[
~~~-
I
~
IJilfimiddot ~
j
Ranking of VD Caea According to Census Tracts 61 By High and LOll Youth Itatio
A media~ of 34 5 was determined Any tract having greater
than 34 5~ of popu1tionunde~ 19 years of age -High~
Any tract having l8S than 345 of population under 19
years == Low
Any tract having rate less than 390 =Low
Any tract having rate more than 390 == HLgl4
YOUTH
LOW HIGH
L
0
12 402 1801 1802 343 2801 2802 29023603
54 6001 600262 66~02 72 74 75 76
78 79 81 t02 65 1202
W
(25)
VD
H
I
G
H
401 701 801802 901 902 10 1101 241 1201 1301 132 14 15 1601 1701 20~ 21 2202 2j02 2402 2502 2702 2901 303501 3502 34023801 3802 383 3902 42 44 45 4601 4602 47 48 49 SO 51~2 53 55 56 57 58 S9 6701 6702 73 95
3~02 7021702 19 25~01 2701 4102 4101 63 64601 ~601 6801 680270 7l 77 8001 80~02 8201 8202 83 84
85 86 87 88~ 90 91 9202 920193 94 9601 9602~ 9701 9102 9801 9802 99 100 101 103 10402 105 6501 10401
(47)
301 501 502 601 1602 2401 2301 2201 31 32 3301 3302 3401 3402~ 3602 3702 3901 400140 02 43 61 69 B(
(53) (23)
~ ~gt
Ranking of VD by Rate Per 100000 By Census Tract
~
Rank Tract Rank Tract Rank Tract Rank Tract llank Tract Rank Tract Rank Tract
1 2202 21 S6 40 902 58 1602 74 75
90-shy 64 107 26 --~-
2 3402 22 45 41 10 59 902 75 78 91 54 108 61
3 2301 23 3502 42 2502 60 602 76 6802 92 402 109 87
4 3302 24 49 43 1102 61 501 17 2 93 94 110 90
5 50 25 52 44 6702 62 14 78 8202 94 97 02 III 76
6 2201 26 20 6701 63 4002 8201 2501
9701 41~02 112 91
7 44 27 48 45 401 64 3802 2902 95 63 113 62
8 3301 28 1701 46 502 65 30 79 83 74 96 9602 114 71
9 55 29 47 47 42 66 3803 80 2801 96Q1 115 85 10
11
12
13
14
15
16
17
18
3401
53
2302
2401
57
21
2402
1101
51
30-shy31
32
33
34
35
36
37
3701 - -~ 1201
3702
89
43
132 131
3602
4001
48
49
50
51
52
53
54
55
58
1601
601
4602 4601
69
701
31
3901
67
68
69
70
71
72
2901
801
39021~ 802
6502 6501 122
702
41~01
81
82
83
84
85
86
87
88
19
1
1702
2802
79
93
100 6801 6602
81
97
98
99
100
101
102
103
104
9201 9202
9802 9801
77
302
79
86
72
84
116
117
118
119
120
121
3603
8002 8001
101
99
95
10401
105 10402 103 102
19
20
59
32
38
39
2702
3501
56
57
301
3801
73 1802 1801
89 6002 6001
105
106
2701
88
High Low
-- -----
Rank OrdermiddotTuberclosis Cases by Rate Per 100000 Ranked by Census Tract High to Low
Tract TractRankTractRank Rank TractRaukTractRankTractRank
801
79 9601501411 52 6835340120511 I 960269 903603532036 $-~~F130221542 4366 311301 70 68~013802 _ I- _ 4001_37213 3921201 6802802 H71523822024 22 54 193302 3802 80 8958 I37139535 70155 9801 I60123 72 6702 98023914011016 6701250124 10 56
81 94 401r 7 154152 73 7057 2625 122 92028
90242 162312301 92~158 86 7172434526509 82 79160159 74 100 87412240227220110 6502836960 75 30 8317244 6501782801285711 61 901 42765645 84 66021459294912 9701 660146 171 302 9702 47
6235023033113 85 822821182 917755 16335013110214 841814832 78 103 938564 324815 86 1057940149272 38036523216 10401 87 2902241 725Q 10402360266340217middot IF88 88 9937233 282 51 218 101 01102 46016234
I)167 2901460219 47
High ~ Low ~
- -
TractRank
9S89
6490
8191 8001 8002
63 61 60middot01 6002 44 2701
92
J
2502 402 --- ----shy
I
Rank
Rank Order Tuberculosis Cases by Rate per 100000
(Coutd)
Tract Rank Tract ~nk
I
Tract Ballk Tract Rank
Imiddot
Tract
Imiddot
1~
t 1I i Pi i l I
o
1 -1shyL I
I J
8 40 icO ~ I -lt 0
-t (1) I
i I
r o E
II
a
I
r--i
shy
I
~
I (
Jgt
(011 fi(
Ggt
I II ~j
()
(f 0
~ ()
I
11
f9
r
II 99
o ~
Ggt r
~ __-J~ I t I ~ I
r--J l I
~ _ __ J
) 1
fTl
1gt
r I
()
r
()
lt en -i en
()
I1l
(J)
(J)
-i
P ()
19
r o ~
r G1 I
I
c
~
o I 89
--- -I-shy
r-r I
1- 0 _~ _ _--J E
G1 I I I
i i
I 1-1-1 ~ _J ~2 ~ II
II
()
1 I I I 1
id i bullbull
~
A n 69
r 1shy
- 0 Gl
l--~ ~ I
~ II
II )
I () isect i
en l i
(J)
-t
0
IA Ol
Visits to Family Planning Clinics Ranked by Census Tract High to Low
Rank Tract Rank Tract Rankmiddot Tract Rank Tract Rank Tract Rank Tract
1
2
3
4
5
6
7
8
9
10
11
12
13middot
14
15
16
17
361
56
401
341
48
59 121
20
55
342
10
31
58
93 21
241 132
331
53
461 462
18
19
20-shy21
22
23
24
25
26
27middot
28
29
30
31
32
33
391
32
middot47 I-i-_-shy _ -
231 111
332
972 1
372 371
52
89
32
92
82
100 31
182
30 242
402
34
35
36
37
38
39
40
41
42
43
44
45
42
1714 i 661 221
78 362 2
90 602 601 352
63 251
105 921
971 351
73 42 292 232
411 51
662
81 45 52
46
47
48
49shy
50
51
52
53
54
55
56
961
801
49 81 72 71
19
9~1
172
68 2 57 162 14 112
91 75 681
381 42
3~3
83 161
57 f
58
59
60
61shy
62 Imiddot
63
Imiddot 64
65
66
64 62 36~3 252
74 652 SO 392 291
651 6bull 2
79 271
r-- ---- shy981 222
672 671
821 272
94 87
281
382
67
68
69
70
71
72
73
74
75
76
77
78
981 26 12~2
IS 61
85 82~2 69
61 43
101 86 84 282
76
131
51 72
1041 962 88 70
99 922 77
103
95 802 181
i
~
Low High
RankRank Tract
5479
4480
81 1042 ~) middot102
71 - - + ~ - ~
Visits to Family Planning Clinics
(Contd)
Tract Rank
I
Tract llaDk l
RankTract Tract Rank Tract
~
I
~
J1 ~
Low
Total Number of public Health Nursing Visits
Ranked by Census TractsHigh to Low
TractTract RankTractRank RankRank TractTractRankTractRank
25249 71 79 17249 8033 6586 99189711 84 2915072 34 661 76 66 811519512
402 5035 51 161 2518220 122 1713423 352 55801 7120 6752 2 149814 41236 83 2662 38 94 6821 53 2924015 362 37 32 42 75 69 281 84 63
546 8822 54 222 85 3925431 70383417 3818223 6439 4386652 718 21 55 103332 8924 232 87 19 271729219619 24156 16211140 382 628825 10523110 112 73411 10141-- ----shy 89 363 4457 8126 16111 221 74 9142 90 46158331 53 671279012 46243 48 59 351 3837528 1083 9313 91 5844 59 -_242 76 1----- shy60 272 72 74104114 60145 42 9287 7729 92 6151 8215 57371 934630 91 307762 12113116 282 619447 41391 9531 78100 63 7378 ~95 681 6945 32 5632 798517 6448 47 52 181
High ~ Low
Rank Tract Rank
96 31 132 70
97 102
98 182 372middot 602 651 662
- -shy
~72 682 802
822 922 962 972 982
1042 ----shy
Low
Total Number of Public Health Nursing Visits
(Contd)
Rank Rank Rank TractTract Tract
I
I lt
I
Tract Rank Tract
[
~~~-
I
~
IJilfimiddot ~
j
Ranking of VD Caea According to Census Tracts 61 By High and LOll Youth Itatio
A media~ of 34 5 was determined Any tract having greater
than 34 5~ of popu1tionunde~ 19 years of age -High~
Any tract having l8S than 345 of population under 19
years == Low
Any tract having rate less than 390 =Low
Any tract having rate more than 390 == HLgl4
YOUTH
LOW HIGH
L
0
12 402 1801 1802 343 2801 2802 29023603
54 6001 600262 66~02 72 74 75 76
78 79 81 t02 65 1202
W
(25)
VD
H
I
G
H
401 701 801802 901 902 10 1101 241 1201 1301 132 14 15 1601 1701 20~ 21 2202 2j02 2402 2502 2702 2901 303501 3502 34023801 3802 383 3902 42 44 45 4601 4602 47 48 49 SO 51~2 53 55 56 57 58 S9 6701 6702 73 95
3~02 7021702 19 25~01 2701 4102 4101 63 64601 ~601 6801 680270 7l 77 8001 80~02 8201 8202 83 84
85 86 87 88~ 90 91 9202 920193 94 9601 9602~ 9701 9102 9801 9802 99 100 101 103 10402 105 6501 10401
(47)
301 501 502 601 1602 2401 2301 2201 31 32 3301 3302 3401 3402~ 3602 3702 3901 400140 02 43 61 69 B(
(53) (23)
~ ~gt
Ranking of VD by Rate Per 100000 By Census Tract
~
Rank Tract Rank Tract Rank Tract Rank Tract llank Tract Rank Tract Rank Tract
1 2202 21 S6 40 902 58 1602 74 75
90-shy 64 107 26 --~-
2 3402 22 45 41 10 59 902 75 78 91 54 108 61
3 2301 23 3502 42 2502 60 602 76 6802 92 402 109 87
4 3302 24 49 43 1102 61 501 17 2 93 94 110 90
5 50 25 52 44 6702 62 14 78 8202 94 97 02 III 76
6 2201 26 20 6701 63 4002 8201 2501
9701 41~02 112 91
7 44 27 48 45 401 64 3802 2902 95 63 113 62
8 3301 28 1701 46 502 65 30 79 83 74 96 9602 114 71
9 55 29 47 47 42 66 3803 80 2801 96Q1 115 85 10
11
12
13
14
15
16
17
18
3401
53
2302
2401
57
21
2402
1101
51
30-shy31
32
33
34
35
36
37
3701 - -~ 1201
3702
89
43
132 131
3602
4001
48
49
50
51
52
53
54
55
58
1601
601
4602 4601
69
701
31
3901
67
68
69
70
71
72
2901
801
39021~ 802
6502 6501 122
702
41~01
81
82
83
84
85
86
87
88
19
1
1702
2802
79
93
100 6801 6602
81
97
98
99
100
101
102
103
104
9201 9202
9802 9801
77
302
79
86
72
84
116
117
118
119
120
121
3603
8002 8001
101
99
95
10401
105 10402 103 102
19
20
59
32
38
39
2702
3501
56
57
301
3801
73 1802 1801
89 6002 6001
105
106
2701
88
High Low
-- -----
Rank OrdermiddotTuberclosis Cases by Rate Per 100000 Ranked by Census Tract High to Low
Tract TractRankTractRank Rank TractRaukTractRankTractRank
801
79 9601501411 52 6835340120511 I 960269 903603532036 $-~~F130221542 4366 311301 70 68~013802 _ I- _ 4001_37213 3921201 6802802 H71523822024 22 54 193302 3802 80 8958 I37139535 70155 9801 I60123 72 6702 98023914011016 6701250124 10 56
81 94 401r 7 154152 73 7057 2625 122 92028
90242 162312301 92~158 86 7172434526509 82 79160159 74 100 87412240227220110 6502836960 75 30 8317244 6501782801285711 61 901 42765645 84 66021459294912 9701 660146 171 302 9702 47
6235023033113 85 822821182 917755 16335013110214 841814832 78 103 938564 324815 86 1057940149272 38036523216 10401 87 2902241 725Q 10402360266340217middot IF88 88 9937233 282 51 218 101 01102 46016234
I)167 2901460219 47
High ~ Low ~
- -
TractRank
9S89
6490
8191 8001 8002
63 61 60middot01 6002 44 2701
92
J
2502 402 --- ----shy
I
Rank
Rank Order Tuberculosis Cases by Rate per 100000
(Coutd)
Tract Rank Tract ~nk
I
Tract Ballk Tract Rank
Imiddot
Tract
Imiddot
1~
t 1I i Pi i l I
o
1 -1shyL I
I J
8 40 icO ~ I -lt 0
-t (1) I
i I
r o E
II
a
I
r--i
shy
I
~
I (
Jgt
(011 fi(
Ggt
I II ~j
()
(f 0
~ ()
I
11
f9
r
II 99
o ~
Ggt r
~ __-J~ I t I ~ I
r--J l I
~ _ __ J
) 1
fTl
1gt
r I
()
r
()
lt en -i en
()
I1l
(J)
(J)
-i
P ()
19
r o ~
r G1 I
I
c
~
o I 89
--- -I-shy
r-r I
1- 0 _~ _ _--J E
G1 I I I
i i
I 1-1-1 ~ _J ~2 ~ II
II
()
1 I I I 1
id i bullbull
~
A n 69
r 1shy
- 0 Gl
l--~ ~ I
~ II
II )
I () isect i
en l i
(J)
-t
0
IA Ol
RankRank Tract
5479
4480
81 1042 ~) middot102
71 - - + ~ - ~
Visits to Family Planning Clinics
(Contd)
Tract Rank
I
Tract llaDk l
RankTract Tract Rank Tract
~
I
~
J1 ~
Low
Total Number of public Health Nursing Visits
Ranked by Census TractsHigh to Low
TractTract RankTractRank RankRank TractTractRankTractRank
25249 71 79 17249 8033 6586 99189711 84 2915072 34 661 76 66 811519512
402 5035 51 161 2518220 122 1713423 352 55801 7120 6752 2 149814 41236 83 2662 38 94 6821 53 2924015 362 37 32 42 75 69 281 84 63
546 8822 54 222 85 3925431 70383417 3818223 6439 4386652 718 21 55 103332 8924 232 87 19 271729219619 24156 16211140 382 628825 10523110 112 73411 10141-- ----shy 89 363 4457 8126 16111 221 74 9142 90 46158331 53 671279012 46243 48 59 351 3837528 1083 9313 91 5844 59 -_242 76 1----- shy60 272 72 74104114 60145 42 9287 7729 92 6151 8215 57371 934630 91 307762 12113116 282 619447 41391 9531 78100 63 7378 ~95 681 6945 32 5632 798517 6448 47 52 181
High ~ Low
Rank Tract Rank
96 31 132 70
97 102
98 182 372middot 602 651 662
- -shy
~72 682 802
822 922 962 972 982
1042 ----shy
Low
Total Number of Public Health Nursing Visits
(Contd)
Rank Rank Rank TractTract Tract
I
I lt
I
Tract Rank Tract
[
~~~-
I
~
IJilfimiddot ~
j
Ranking of VD Caea According to Census Tracts 61 By High and LOll Youth Itatio
A media~ of 34 5 was determined Any tract having greater
than 34 5~ of popu1tionunde~ 19 years of age -High~
Any tract having l8S than 345 of population under 19
years == Low
Any tract having rate less than 390 =Low
Any tract having rate more than 390 == HLgl4
YOUTH
LOW HIGH
L
0
12 402 1801 1802 343 2801 2802 29023603
54 6001 600262 66~02 72 74 75 76
78 79 81 t02 65 1202
W
(25)
VD
H
I
G
H
401 701 801802 901 902 10 1101 241 1201 1301 132 14 15 1601 1701 20~ 21 2202 2j02 2402 2502 2702 2901 303501 3502 34023801 3802 383 3902 42 44 45 4601 4602 47 48 49 SO 51~2 53 55 56 57 58 S9 6701 6702 73 95
3~02 7021702 19 25~01 2701 4102 4101 63 64601 ~601 6801 680270 7l 77 8001 80~02 8201 8202 83 84
85 86 87 88~ 90 91 9202 920193 94 9601 9602~ 9701 9102 9801 9802 99 100 101 103 10402 105 6501 10401
(47)
301 501 502 601 1602 2401 2301 2201 31 32 3301 3302 3401 3402~ 3602 3702 3901 400140 02 43 61 69 B(
(53) (23)
~ ~gt
Ranking of VD by Rate Per 100000 By Census Tract
~
Rank Tract Rank Tract Rank Tract Rank Tract llank Tract Rank Tract Rank Tract
1 2202 21 S6 40 902 58 1602 74 75
90-shy 64 107 26 --~-
2 3402 22 45 41 10 59 902 75 78 91 54 108 61
3 2301 23 3502 42 2502 60 602 76 6802 92 402 109 87
4 3302 24 49 43 1102 61 501 17 2 93 94 110 90
5 50 25 52 44 6702 62 14 78 8202 94 97 02 III 76
6 2201 26 20 6701 63 4002 8201 2501
9701 41~02 112 91
7 44 27 48 45 401 64 3802 2902 95 63 113 62
8 3301 28 1701 46 502 65 30 79 83 74 96 9602 114 71
9 55 29 47 47 42 66 3803 80 2801 96Q1 115 85 10
11
12
13
14
15
16
17
18
3401
53
2302
2401
57
21
2402
1101
51
30-shy31
32
33
34
35
36
37
3701 - -~ 1201
3702
89
43
132 131
3602
4001
48
49
50
51
52
53
54
55
58
1601
601
4602 4601
69
701
31
3901
67
68
69
70
71
72
2901
801
39021~ 802
6502 6501 122
702
41~01
81
82
83
84
85
86
87
88
19
1
1702
2802
79
93
100 6801 6602
81
97
98
99
100
101
102
103
104
9201 9202
9802 9801
77
302
79
86
72
84
116
117
118
119
120
121
3603
8002 8001
101
99
95
10401
105 10402 103 102
19
20
59
32
38
39
2702
3501
56
57
301
3801
73 1802 1801
89 6002 6001
105
106
2701
88
High Low
-- -----
Rank OrdermiddotTuberclosis Cases by Rate Per 100000 Ranked by Census Tract High to Low
Tract TractRankTractRank Rank TractRaukTractRankTractRank
801
79 9601501411 52 6835340120511 I 960269 903603532036 $-~~F130221542 4366 311301 70 68~013802 _ I- _ 4001_37213 3921201 6802802 H71523822024 22 54 193302 3802 80 8958 I37139535 70155 9801 I60123 72 6702 98023914011016 6701250124 10 56
81 94 401r 7 154152 73 7057 2625 122 92028
90242 162312301 92~158 86 7172434526509 82 79160159 74 100 87412240227220110 6502836960 75 30 8317244 6501782801285711 61 901 42765645 84 66021459294912 9701 660146 171 302 9702 47
6235023033113 85 822821182 917755 16335013110214 841814832 78 103 938564 324815 86 1057940149272 38036523216 10401 87 2902241 725Q 10402360266340217middot IF88 88 9937233 282 51 218 101 01102 46016234
I)167 2901460219 47
High ~ Low ~
- -
TractRank
9S89
6490
8191 8001 8002
63 61 60middot01 6002 44 2701
92
J
2502 402 --- ----shy
I
Rank
Rank Order Tuberculosis Cases by Rate per 100000
(Coutd)
Tract Rank Tract ~nk
I
Tract Ballk Tract Rank
Imiddot
Tract
Imiddot
1~
t 1I i Pi i l I
o
1 -1shyL I
I J
8 40 icO ~ I -lt 0
-t (1) I
i I
r o E
II
a
I
r--i
shy
I
~
I (
Jgt
(011 fi(
Ggt
I II ~j
()
(f 0
~ ()
I
11
f9
r
II 99
o ~
Ggt r
~ __-J~ I t I ~ I
r--J l I
~ _ __ J
) 1
fTl
1gt
r I
()
r
()
lt en -i en
()
I1l
(J)
(J)
-i
P ()
19
r o ~
r G1 I
I
c
~
o I 89
--- -I-shy
r-r I
1- 0 _~ _ _--J E
G1 I I I
i i
I 1-1-1 ~ _J ~2 ~ II
II
()
1 I I I 1
id i bullbull
~
A n 69
r 1shy
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l--~ ~ I
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I () isect i
en l i
(J)
-t
0
IA Ol
Total Number of public Health Nursing Visits
Ranked by Census TractsHigh to Low
TractTract RankTractRank RankRank TractTractRankTractRank
25249 71 79 17249 8033 6586 99189711 84 2915072 34 661 76 66 811519512
402 5035 51 161 2518220 122 1713423 352 55801 7120 6752 2 149814 41236 83 2662 38 94 6821 53 2924015 362 37 32 42 75 69 281 84 63
546 8822 54 222 85 3925431 70383417 3818223 6439 4386652 718 21 55 103332 8924 232 87 19 271729219619 24156 16211140 382 628825 10523110 112 73411 10141-- ----shy 89 363 4457 8126 16111 221 74 9142 90 46158331 53 671279012 46243 48 59 351 3837528 1083 9313 91 5844 59 -_242 76 1----- shy60 272 72 74104114 60145 42 9287 7729 92 6151 8215 57371 934630 91 307762 12113116 282 619447 41391 9531 78100 63 7378 ~95 681 6945 32 5632 798517 6448 47 52 181
High ~ Low
Rank Tract Rank
96 31 132 70
97 102
98 182 372middot 602 651 662
- -shy
~72 682 802
822 922 962 972 982
1042 ----shy
Low
Total Number of Public Health Nursing Visits
(Contd)
Rank Rank Rank TractTract Tract
I
I lt
I
Tract Rank Tract
[
~~~-
I
~
IJilfimiddot ~
j
Ranking of VD Caea According to Census Tracts 61 By High and LOll Youth Itatio
A media~ of 34 5 was determined Any tract having greater
than 34 5~ of popu1tionunde~ 19 years of age -High~
Any tract having l8S than 345 of population under 19
years == Low
Any tract having rate less than 390 =Low
Any tract having rate more than 390 == HLgl4
YOUTH
LOW HIGH
L
0
12 402 1801 1802 343 2801 2802 29023603
54 6001 600262 66~02 72 74 75 76
78 79 81 t02 65 1202
W
(25)
VD
H
I
G
H
401 701 801802 901 902 10 1101 241 1201 1301 132 14 15 1601 1701 20~ 21 2202 2j02 2402 2502 2702 2901 303501 3502 34023801 3802 383 3902 42 44 45 4601 4602 47 48 49 SO 51~2 53 55 56 57 58 S9 6701 6702 73 95
3~02 7021702 19 25~01 2701 4102 4101 63 64601 ~601 6801 680270 7l 77 8001 80~02 8201 8202 83 84
85 86 87 88~ 90 91 9202 920193 94 9601 9602~ 9701 9102 9801 9802 99 100 101 103 10402 105 6501 10401
(47)
301 501 502 601 1602 2401 2301 2201 31 32 3301 3302 3401 3402~ 3602 3702 3901 400140 02 43 61 69 B(
(53) (23)
~ ~gt
Ranking of VD by Rate Per 100000 By Census Tract
~
Rank Tract Rank Tract Rank Tract Rank Tract llank Tract Rank Tract Rank Tract
1 2202 21 S6 40 902 58 1602 74 75
90-shy 64 107 26 --~-
2 3402 22 45 41 10 59 902 75 78 91 54 108 61
3 2301 23 3502 42 2502 60 602 76 6802 92 402 109 87
4 3302 24 49 43 1102 61 501 17 2 93 94 110 90
5 50 25 52 44 6702 62 14 78 8202 94 97 02 III 76
6 2201 26 20 6701 63 4002 8201 2501
9701 41~02 112 91
7 44 27 48 45 401 64 3802 2902 95 63 113 62
8 3301 28 1701 46 502 65 30 79 83 74 96 9602 114 71
9 55 29 47 47 42 66 3803 80 2801 96Q1 115 85 10
11
12
13
14
15
16
17
18
3401
53
2302
2401
57
21
2402
1101
51
30-shy31
32
33
34
35
36
37
3701 - -~ 1201
3702
89
43
132 131
3602
4001
48
49
50
51
52
53
54
55
58
1601
601
4602 4601
69
701
31
3901
67
68
69
70
71
72
2901
801
39021~ 802
6502 6501 122
702
41~01
81
82
83
84
85
86
87
88
19
1
1702
2802
79
93
100 6801 6602
81
97
98
99
100
101
102
103
104
9201 9202
9802 9801
77
302
79
86
72
84
116
117
118
119
120
121
3603
8002 8001
101
99
95
10401
105 10402 103 102
19
20
59
32
38
39
2702
3501
56
57
301
3801
73 1802 1801
89 6002 6001
105
106
2701
88
High Low
-- -----
Rank OrdermiddotTuberclosis Cases by Rate Per 100000 Ranked by Census Tract High to Low
Tract TractRankTractRank Rank TractRaukTractRankTractRank
801
79 9601501411 52 6835340120511 I 960269 903603532036 $-~~F130221542 4366 311301 70 68~013802 _ I- _ 4001_37213 3921201 6802802 H71523822024 22 54 193302 3802 80 8958 I37139535 70155 9801 I60123 72 6702 98023914011016 6701250124 10 56
81 94 401r 7 154152 73 7057 2625 122 92028
90242 162312301 92~158 86 7172434526509 82 79160159 74 100 87412240227220110 6502836960 75 30 8317244 6501782801285711 61 901 42765645 84 66021459294912 9701 660146 171 302 9702 47
6235023033113 85 822821182 917755 16335013110214 841814832 78 103 938564 324815 86 1057940149272 38036523216 10401 87 2902241 725Q 10402360266340217middot IF88 88 9937233 282 51 218 101 01102 46016234
I)167 2901460219 47
High ~ Low ~
- -
TractRank
9S89
6490
8191 8001 8002
63 61 60middot01 6002 44 2701
92
J
2502 402 --- ----shy
I
Rank
Rank Order Tuberculosis Cases by Rate per 100000
(Coutd)
Tract Rank Tract ~nk
I
Tract Ballk Tract Rank
Imiddot
Tract
Imiddot
1~
t 1I i Pi i l I
o
1 -1shyL I
I J
8 40 icO ~ I -lt 0
-t (1) I
i I
r o E
II
a
I
r--i
shy
I
~
I (
Jgt
(011 fi(
Ggt
I II ~j
()
(f 0
~ ()
I
11
f9
r
II 99
o ~
Ggt r
~ __-J~ I t I ~ I
r--J l I
~ _ __ J
) 1
fTl
1gt
r I
()
r
()
lt en -i en
()
I1l
(J)
(J)
-i
P ()
19
r o ~
r G1 I
I
c
~
o I 89
--- -I-shy
r-r I
1- 0 _~ _ _--J E
G1 I I I
i i
I 1-1-1 ~ _J ~2 ~ II
II
()
1 I I I 1
id i bullbull
~
A n 69
r 1shy
- 0 Gl
l--~ ~ I
~ II
II )
I () isect i
en l i
(J)
-t
0
IA Ol
Rank Tract Rank
96 31 132 70
97 102
98 182 372middot 602 651 662
- -shy
~72 682 802
822 922 962 972 982
1042 ----shy
Low
Total Number of Public Health Nursing Visits
(Contd)
Rank Rank Rank TractTract Tract
I
I lt
I
Tract Rank Tract
[
~~~-
I
~
IJilfimiddot ~
j
Ranking of VD Caea According to Census Tracts 61 By High and LOll Youth Itatio
A media~ of 34 5 was determined Any tract having greater
than 34 5~ of popu1tionunde~ 19 years of age -High~
Any tract having l8S than 345 of population under 19
years == Low
Any tract having rate less than 390 =Low
Any tract having rate more than 390 == HLgl4
YOUTH
LOW HIGH
L
0
12 402 1801 1802 343 2801 2802 29023603
54 6001 600262 66~02 72 74 75 76
78 79 81 t02 65 1202
W
(25)
VD
H
I
G
H
401 701 801802 901 902 10 1101 241 1201 1301 132 14 15 1601 1701 20~ 21 2202 2j02 2402 2502 2702 2901 303501 3502 34023801 3802 383 3902 42 44 45 4601 4602 47 48 49 SO 51~2 53 55 56 57 58 S9 6701 6702 73 95
3~02 7021702 19 25~01 2701 4102 4101 63 64601 ~601 6801 680270 7l 77 8001 80~02 8201 8202 83 84
85 86 87 88~ 90 91 9202 920193 94 9601 9602~ 9701 9102 9801 9802 99 100 101 103 10402 105 6501 10401
(47)
301 501 502 601 1602 2401 2301 2201 31 32 3301 3302 3401 3402~ 3602 3702 3901 400140 02 43 61 69 B(
(53) (23)
~ ~gt
Ranking of VD by Rate Per 100000 By Census Tract
~
Rank Tract Rank Tract Rank Tract Rank Tract llank Tract Rank Tract Rank Tract
1 2202 21 S6 40 902 58 1602 74 75
90-shy 64 107 26 --~-
2 3402 22 45 41 10 59 902 75 78 91 54 108 61
3 2301 23 3502 42 2502 60 602 76 6802 92 402 109 87
4 3302 24 49 43 1102 61 501 17 2 93 94 110 90
5 50 25 52 44 6702 62 14 78 8202 94 97 02 III 76
6 2201 26 20 6701 63 4002 8201 2501
9701 41~02 112 91
7 44 27 48 45 401 64 3802 2902 95 63 113 62
8 3301 28 1701 46 502 65 30 79 83 74 96 9602 114 71
9 55 29 47 47 42 66 3803 80 2801 96Q1 115 85 10
11
12
13
14
15
16
17
18
3401
53
2302
2401
57
21
2402
1101
51
30-shy31
32
33
34
35
36
37
3701 - -~ 1201
3702
89
43
132 131
3602
4001
48
49
50
51
52
53
54
55
58
1601
601
4602 4601
69
701
31
3901
67
68
69
70
71
72
2901
801
39021~ 802
6502 6501 122
702
41~01
81
82
83
84
85
86
87
88
19
1
1702
2802
79
93
100 6801 6602
81
97
98
99
100
101
102
103
104
9201 9202
9802 9801
77
302
79
86
72
84
116
117
118
119
120
121
3603
8002 8001
101
99
95
10401
105 10402 103 102
19
20
59
32
38
39
2702
3501
56
57
301
3801
73 1802 1801
89 6002 6001
105
106
2701
88
High Low
-- -----
Rank OrdermiddotTuberclosis Cases by Rate Per 100000 Ranked by Census Tract High to Low
Tract TractRankTractRank Rank TractRaukTractRankTractRank
801
79 9601501411 52 6835340120511 I 960269 903603532036 $-~~F130221542 4366 311301 70 68~013802 _ I- _ 4001_37213 3921201 6802802 H71523822024 22 54 193302 3802 80 8958 I37139535 70155 9801 I60123 72 6702 98023914011016 6701250124 10 56
81 94 401r 7 154152 73 7057 2625 122 92028
90242 162312301 92~158 86 7172434526509 82 79160159 74 100 87412240227220110 6502836960 75 30 8317244 6501782801285711 61 901 42765645 84 66021459294912 9701 660146 171 302 9702 47
6235023033113 85 822821182 917755 16335013110214 841814832 78 103 938564 324815 86 1057940149272 38036523216 10401 87 2902241 725Q 10402360266340217middot IF88 88 9937233 282 51 218 101 01102 46016234
I)167 2901460219 47
High ~ Low ~
- -
TractRank
9S89
6490
8191 8001 8002
63 61 60middot01 6002 44 2701
92
J
2502 402 --- ----shy
I
Rank
Rank Order Tuberculosis Cases by Rate per 100000
(Coutd)
Tract Rank Tract ~nk
I
Tract Ballk Tract Rank
Imiddot
Tract
Imiddot
1~
t 1I i Pi i l I
o
1 -1shyL I
I J
8 40 icO ~ I -lt 0
-t (1) I
i I
r o E
II
a
I
r--i
shy
I
~
I (
Jgt
(011 fi(
Ggt
I II ~j
()
(f 0
~ ()
I
11
f9
r
II 99
o ~
Ggt r
~ __-J~ I t I ~ I
r--J l I
~ _ __ J
) 1
fTl
1gt
r I
()
r
()
lt en -i en
()
I1l
(J)
(J)
-i
P ()
19
r o ~
r G1 I
I
c
~
o I 89
--- -I-shy
r-r I
1- 0 _~ _ _--J E
G1 I I I
i i
I 1-1-1 ~ _J ~2 ~ II
II
()
1 I I I 1
id i bullbull
~
A n 69
r 1shy
- 0 Gl
l--~ ~ I
~ II
II )
I () isect i
en l i
(J)
-t
0
IA Ol
IJilfimiddot ~
j
Ranking of VD Caea According to Census Tracts 61 By High and LOll Youth Itatio
A media~ of 34 5 was determined Any tract having greater
than 34 5~ of popu1tionunde~ 19 years of age -High~
Any tract having l8S than 345 of population under 19
years == Low
Any tract having rate less than 390 =Low
Any tract having rate more than 390 == HLgl4
YOUTH
LOW HIGH
L
0
12 402 1801 1802 343 2801 2802 29023603
54 6001 600262 66~02 72 74 75 76
78 79 81 t02 65 1202
W
(25)
VD
H
I
G
H
401 701 801802 901 902 10 1101 241 1201 1301 132 14 15 1601 1701 20~ 21 2202 2j02 2402 2502 2702 2901 303501 3502 34023801 3802 383 3902 42 44 45 4601 4602 47 48 49 SO 51~2 53 55 56 57 58 S9 6701 6702 73 95
3~02 7021702 19 25~01 2701 4102 4101 63 64601 ~601 6801 680270 7l 77 8001 80~02 8201 8202 83 84
85 86 87 88~ 90 91 9202 920193 94 9601 9602~ 9701 9102 9801 9802 99 100 101 103 10402 105 6501 10401
(47)
301 501 502 601 1602 2401 2301 2201 31 32 3301 3302 3401 3402~ 3602 3702 3901 400140 02 43 61 69 B(
(53) (23)
~ ~gt
Ranking of VD by Rate Per 100000 By Census Tract
~
Rank Tract Rank Tract Rank Tract Rank Tract llank Tract Rank Tract Rank Tract
1 2202 21 S6 40 902 58 1602 74 75
90-shy 64 107 26 --~-
2 3402 22 45 41 10 59 902 75 78 91 54 108 61
3 2301 23 3502 42 2502 60 602 76 6802 92 402 109 87
4 3302 24 49 43 1102 61 501 17 2 93 94 110 90
5 50 25 52 44 6702 62 14 78 8202 94 97 02 III 76
6 2201 26 20 6701 63 4002 8201 2501
9701 41~02 112 91
7 44 27 48 45 401 64 3802 2902 95 63 113 62
8 3301 28 1701 46 502 65 30 79 83 74 96 9602 114 71
9 55 29 47 47 42 66 3803 80 2801 96Q1 115 85 10
11
12
13
14
15
16
17
18
3401
53
2302
2401
57
21
2402
1101
51
30-shy31
32
33
34
35
36
37
3701 - -~ 1201
3702
89
43
132 131
3602
4001
48
49
50
51
52
53
54
55
58
1601
601
4602 4601
69
701
31
3901
67
68
69
70
71
72
2901
801
39021~ 802
6502 6501 122
702
41~01
81
82
83
84
85
86
87
88
19
1
1702
2802
79
93
100 6801 6602
81
97
98
99
100
101
102
103
104
9201 9202
9802 9801
77
302
79
86
72
84
116
117
118
119
120
121
3603
8002 8001
101
99
95
10401
105 10402 103 102
19
20
59
32
38
39
2702
3501
56
57
301
3801
73 1802 1801
89 6002 6001
105
106
2701
88
High Low
-- -----
Rank OrdermiddotTuberclosis Cases by Rate Per 100000 Ranked by Census Tract High to Low
Tract TractRankTractRank Rank TractRaukTractRankTractRank
801
79 9601501411 52 6835340120511 I 960269 903603532036 $-~~F130221542 4366 311301 70 68~013802 _ I- _ 4001_37213 3921201 6802802 H71523822024 22 54 193302 3802 80 8958 I37139535 70155 9801 I60123 72 6702 98023914011016 6701250124 10 56
81 94 401r 7 154152 73 7057 2625 122 92028
90242 162312301 92~158 86 7172434526509 82 79160159 74 100 87412240227220110 6502836960 75 30 8317244 6501782801285711 61 901 42765645 84 66021459294912 9701 660146 171 302 9702 47
6235023033113 85 822821182 917755 16335013110214 841814832 78 103 938564 324815 86 1057940149272 38036523216 10401 87 2902241 725Q 10402360266340217middot IF88 88 9937233 282 51 218 101 01102 46016234
I)167 2901460219 47
High ~ Low ~
- -
TractRank
9S89
6490
8191 8001 8002
63 61 60middot01 6002 44 2701
92
J
2502 402 --- ----shy
I
Rank
Rank Order Tuberculosis Cases by Rate per 100000
(Coutd)
Tract Rank Tract ~nk
I
Tract Ballk Tract Rank
Imiddot
Tract
Imiddot
1~
t 1I i Pi i l I
o
1 -1shyL I
I J
8 40 icO ~ I -lt 0
-t (1) I
i I
r o E
II
a
I
r--i
shy
I
~
I (
Jgt
(011 fi(
Ggt
I II ~j
()
(f 0
~ ()
I
11
f9
r
II 99
o ~
Ggt r
~ __-J~ I t I ~ I
r--J l I
~ _ __ J
) 1
fTl
1gt
r I
()
r
()
lt en -i en
()
I1l
(J)
(J)
-i
P ()
19
r o ~
r G1 I
I
c
~
o I 89
--- -I-shy
r-r I
1- 0 _~ _ _--J E
G1 I I I
i i
I 1-1-1 ~ _J ~2 ~ II
II
()
1 I I I 1
id i bullbull
~
A n 69
r 1shy
- 0 Gl
l--~ ~ I
~ II
II )
I () isect i
en l i
(J)
-t
0
IA Ol
~ ~gt
Ranking of VD by Rate Per 100000 By Census Tract
~
Rank Tract Rank Tract Rank Tract Rank Tract llank Tract Rank Tract Rank Tract
1 2202 21 S6 40 902 58 1602 74 75
90-shy 64 107 26 --~-
2 3402 22 45 41 10 59 902 75 78 91 54 108 61
3 2301 23 3502 42 2502 60 602 76 6802 92 402 109 87
4 3302 24 49 43 1102 61 501 17 2 93 94 110 90
5 50 25 52 44 6702 62 14 78 8202 94 97 02 III 76
6 2201 26 20 6701 63 4002 8201 2501
9701 41~02 112 91
7 44 27 48 45 401 64 3802 2902 95 63 113 62
8 3301 28 1701 46 502 65 30 79 83 74 96 9602 114 71
9 55 29 47 47 42 66 3803 80 2801 96Q1 115 85 10
11
12
13
14
15
16
17
18
3401
53
2302
2401
57
21
2402
1101
51
30-shy31
32
33
34
35
36
37
3701 - -~ 1201
3702
89
43
132 131
3602
4001
48
49
50
51
52
53
54
55
58
1601
601
4602 4601
69
701
31
3901
67
68
69
70
71
72
2901
801
39021~ 802
6502 6501 122
702
41~01
81
82
83
84
85
86
87
88
19
1
1702
2802
79
93
100 6801 6602
81
97
98
99
100
101
102
103
104
9201 9202
9802 9801
77
302
79
86
72
84
116
117
118
119
120
121
3603
8002 8001
101
99
95
10401
105 10402 103 102
19
20
59
32
38
39
2702
3501
56
57
301
3801
73 1802 1801
89 6002 6001
105
106
2701
88
High Low
-- -----
Rank OrdermiddotTuberclosis Cases by Rate Per 100000 Ranked by Census Tract High to Low
Tract TractRankTractRank Rank TractRaukTractRankTractRank
801
79 9601501411 52 6835340120511 I 960269 903603532036 $-~~F130221542 4366 311301 70 68~013802 _ I- _ 4001_37213 3921201 6802802 H71523822024 22 54 193302 3802 80 8958 I37139535 70155 9801 I60123 72 6702 98023914011016 6701250124 10 56
81 94 401r 7 154152 73 7057 2625 122 92028
90242 162312301 92~158 86 7172434526509 82 79160159 74 100 87412240227220110 6502836960 75 30 8317244 6501782801285711 61 901 42765645 84 66021459294912 9701 660146 171 302 9702 47
6235023033113 85 822821182 917755 16335013110214 841814832 78 103 938564 324815 86 1057940149272 38036523216 10401 87 2902241 725Q 10402360266340217middot IF88 88 9937233 282 51 218 101 01102 46016234
I)167 2901460219 47
High ~ Low ~
- -
TractRank
9S89
6490
8191 8001 8002
63 61 60middot01 6002 44 2701
92
J
2502 402 --- ----shy
I
Rank
Rank Order Tuberculosis Cases by Rate per 100000
(Coutd)
Tract Rank Tract ~nk
I
Tract Ballk Tract Rank
Imiddot
Tract
Imiddot
1~
t 1I i Pi i l I
o
1 -1shyL I
I J
8 40 icO ~ I -lt 0
-t (1) I
i I
r o E
II
a
I
r--i
shy
I
~
I (
Jgt
(011 fi(
Ggt
I II ~j
()
(f 0
~ ()
I
11
f9
r
II 99
o ~
Ggt r
~ __-J~ I t I ~ I
r--J l I
~ _ __ J
) 1
fTl
1gt
r I
()
r
()
lt en -i en
()
I1l
(J)
(J)
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P ()
19
r o ~
r G1 I
I
c
~
o I 89
--- -I-shy
r-r I
1- 0 _~ _ _--J E
G1 I I I
i i
I 1-1-1 ~ _J ~2 ~ II
II
()
1 I I I 1
id i bullbull
~
A n 69
r 1shy
- 0 Gl
l--~ ~ I
~ II
II )
I () isect i
en l i
(J)
-t
0
IA Ol
-- -----
Rank OrdermiddotTuberclosis Cases by Rate Per 100000 Ranked by Census Tract High to Low
Tract TractRankTractRank Rank TractRaukTractRankTractRank
801
79 9601501411 52 6835340120511 I 960269 903603532036 $-~~F130221542 4366 311301 70 68~013802 _ I- _ 4001_37213 3921201 6802802 H71523822024 22 54 193302 3802 80 8958 I37139535 70155 9801 I60123 72 6702 98023914011016 6701250124 10 56
81 94 401r 7 154152 73 7057 2625 122 92028
90242 162312301 92~158 86 7172434526509 82 79160159 74 100 87412240227220110 6502836960 75 30 8317244 6501782801285711 61 901 42765645 84 66021459294912 9701 660146 171 302 9702 47
6235023033113 85 822821182 917755 16335013110214 841814832 78 103 938564 324815 86 1057940149272 38036523216 10401 87 2902241 725Q 10402360266340217middot IF88 88 9937233 282 51 218 101 01102 46016234
I)167 2901460219 47
High ~ Low ~
- -
TractRank
9S89
6490
8191 8001 8002
63 61 60middot01 6002 44 2701
92
J
2502 402 --- ----shy
I
Rank
Rank Order Tuberculosis Cases by Rate per 100000
(Coutd)
Tract Rank Tract ~nk
I
Tract Ballk Tract Rank
Imiddot
Tract
Imiddot
1~
t 1I i Pi i l I
o
1 -1shyL I
I J
8 40 icO ~ I -lt 0
-t (1) I
i I
r o E
II
a
I
r--i
shy
I
~
I (
Jgt
(011 fi(
Ggt
I II ~j
()
(f 0
~ ()
I
11
f9
r
II 99
o ~
Ggt r
~ __-J~ I t I ~ I
r--J l I
~ _ __ J
) 1
fTl
1gt
r I
()
r
()
lt en -i en
()
I1l
(J)
(J)
-i
P ()
19
r o ~
r G1 I
I
c
~
o I 89
--- -I-shy
r-r I
1- 0 _~ _ _--J E
G1 I I I
i i
I 1-1-1 ~ _J ~2 ~ II
II
()
1 I I I 1
id i bullbull
~
A n 69
r 1shy
- 0 Gl
l--~ ~ I
~ II
II )
I () isect i
en l i
(J)
-t
0
IA Ol
- -
TractRank
9S89
6490
8191 8001 8002
63 61 60middot01 6002 44 2701
92
J
2502 402 --- ----shy
I
Rank
Rank Order Tuberculosis Cases by Rate per 100000
(Coutd)
Tract Rank Tract ~nk
I
Tract Ballk Tract Rank
Imiddot
Tract
Imiddot
1~
t 1I i Pi i l I
o
1 -1shyL I
I J
8 40 icO ~ I -lt 0
-t (1) I
i I
r o E
II
a
I
r--i
shy
I
~
I (
Jgt
(011 fi(
Ggt
I II ~j
()
(f 0
~ ()
I
11
f9
r
II 99
o ~
Ggt r
~ __-J~ I t I ~ I
r--J l I
~ _ __ J
) 1
fTl
1gt
r I
()
r
()
lt en -i en
()
I1l
(J)
(J)
-i
P ()
19
r o ~
r G1 I
I
c
~
o I 89
--- -I-shy
r-r I
1- 0 _~ _ _--J E
G1 I I I
i i
I 1-1-1 ~ _J ~2 ~ II
II
()
1 I I I 1
id i bullbull
~
A n 69
r 1shy
- 0 Gl
l--~ ~ I
~ II
II )
I () isect i
en l i
(J)
-t
0
IA Ol
t 1I i Pi i l I
o
1 -1shyL I
I J
8 40 icO ~ I -lt 0
-t (1) I
i I
r o E
II
a
I
r--i
shy
I
~
I (
Jgt
(011 fi(
Ggt
I II ~j
()
(f 0
~ ()
I
11
f9
r
II 99
o ~
Ggt r
~ __-J~ I t I ~ I
r--J l I
~ _ __ J
) 1
fTl
1gt
r I
()
r
()
lt en -i en
()
I1l
(J)
(J)
-i
P ()
19
r o ~
r G1 I
I
c
~
o I 89
--- -I-shy
r-r I
1- 0 _~ _ _--J E
G1 I I I
i i
I 1-1-1 ~ _J ~2 ~ II
II
()
1 I I I 1
id i bullbull
~
A n 69
r 1shy
- 0 Gl
l--~ ~ I
~ II
II )
I () isect i
en l i
(J)
-t
0
IA Ol
r
II 99
o ~
Ggt r
~ __-J~ I t I ~ I
r--J l I
~ _ __ J
) 1
fTl
1gt
r I
()
r
()
lt en -i en
()
I1l
(J)
(J)
-i
P ()
19
r o ~
r G1 I
I
c
~
o I 89
--- -I-shy
r-r I
1- 0 _~ _ _--J E
G1 I I I
i i
I 1-1-1 ~ _J ~2 ~ II
II
()
1 I I I 1
id i bullbull
~
A n 69
r 1shy
- 0 Gl
l--~ ~ I
~ II
II )
I () isect i
en l i
(J)
-t
0
IA Ol
19
r o ~
r G1 I
I
c
~
o I 89
--- -I-shy
r-r I
1- 0 _~ _ _--J E
G1 I I I
i i
I 1-1-1 ~ _J ~2 ~ II
II
()
1 I I I 1
id i bullbull
~
A n 69
r 1shy
- 0 Gl
l--~ ~ I
~ II
II )
I () isect i
en l i
(J)
-t
0
IA Ol
r o ~
r G1 I
I
c
~
o I 89
--- -I-shy
r-r I
1- 0 _~ _ _--J E
G1 I I I
i i
I 1-1-1 ~ _J ~2 ~ II
II
()
1 I I I 1
id i bullbull
~
A n 69
r 1shy
- 0 Gl
l--~ ~ I
~ II
II )
I () isect i
en l i
(J)
-t
0
IA Ol
--- -I-shy
r-r I
1- 0 _~ _ _--J E
G1 I I I
i i
I 1-1-1 ~ _J ~2 ~ II
II
()
1 I I I 1
id i bullbull
~
A n 69
r 1shy
- 0 Gl
l--~ ~ I
~ II
II )
I () isect i
en l i
(J)
-t
0
IA Ol
r 1shy
- 0 Gl
l--~ ~ I
~ II
II )
I () isect i
en l i
(J)
-t
0
IA Ol