EDITORIALS
a mass transfer of human resources, including physicians and other health workers; such a transfer in any case would be inappropriate for political, economic, social, and cultural reasons. What can be done is to focus on those resources that will enable the LDCs to educate and train their own cadre of appropriate health workers. This brings us to the other important finding of Zeighami and his co-workers.1 In Iran under the conditions investigated, which one could loosely describe as primary care practice, the population seemed to prefer Iranian auxiliaries to foreign physicians by a considerable margin. Circumstances made this simultaneous comparison of two variables necessary; the comparison does not indicate whether the Iranian auxiliaries were preferred because they were Iranians or because they were auxiliaries. A comparison between Iranian and foreign physicians and between Iranian physicians and Iranian auxiliaries would have helped to answer that
preferred family and self-help to the foreign physician; the inference is that these are other potentially important alternatives which, with educational input, could help ease manpower shortages and reduce health care costs. This important investigation, which should be repeated and expanded, demonstrates that many health care problems are international in scope. It emphasizes for us our need to produce enough manpower to meet our own needs so that we do not deliberately drain off LDC resources. It should also motivate us to re-examine the tasks and capabilities of different levels of health care providers as a promising way to remedy shortages and distribution problems without jeopardizing quality.
DIETER KOCH- WESER, MD, PHD
question. Language plays a very important role in preventing disease and in diagnosing and treating illness; sick people like the comfort of speaking their own language with the care providers; together with cultural, social, and other affinities, these are powerful incentives for people from ethnic minorities to seek health care from physicians of the same ethnic group.4 Regardless of ethnic differences, patients relate better to providers from the same, or at least a similar, cultural and socioeconomic level. Even in a highly specialized field, like psychiatry, a carefully conducted investigation in Columbia indicates that auxiliaries are as effective in diagnosis and treatment and often better accepted by patients than physicians.5 It is possible that the Iranian population investigated 1 would have chosen an Iranian auxiliary over an Iranian physician, and that might be the case in many settings in many countries. This study from Iran presents few data and almost no discussion on the "Indigenous Practitioner", "Family Help", or "Self-Help", all of which respondents were asked to compare with Iranian auxiliaries and foreign physicians. Indigenous practitioners did not fare too well, but females
Address reprint requests to Dr. Dieter Koch-Weser, Associate Dean for International Programs, and Chairman, Department of Preventive and Social Medicine, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115.
REFERENCES 1. Zeighami B, Zeighami E, Mehrabanpour J, Jairdian I, and Ronaghy H: Physician importation-A solution to developing countries' rural health care problems. Am J Public Health 68:739-742,
1978. 2. Task Force on Foreign Medical Graduates. Association of American Medical Colleges: Graduates of foreign medical schools in the United States: A challenge to medical education. Journal of Medical Education 49:813, 1974. 3. Butter I, Wright G and Tasca D: FMG's in Michigan: A case of dependence. Inquiry XV: No. 1, p. 45, 1978. 4. Strasser S: The exile physicians. Journal of Intern. Physicians Vol. 1, No. 6:2, 1977. 5. Climent CE, de Arango MV, Plutchik R and Leon CA: Development of an alternative , efficient, low cost mental health delivery system in Cali, Colombia Part I: The auxiliary nurse. Social Psychiatry 13:29-35, 1978.
Achievement, Awards, and APHA While much may be said for the philosophic inner satisfaction that comes from knowing that one has done well in a particular endeavor, public recognition of high achievement is both heart-warming and stimulating, not only to the one recognized but to colleagues and friends. Recognized achievement assumes an even greater significance when it involves services to the public's interest and, in particular, to the people's health. Allen Pond's scholarly and comprehensive review of how, over the years, the American Public Health Association has recognized excellence, achievement, and public service covers an illuminating panorama.I From an essay 734
competition in the early days, directed at a single specified goal, the awards have moved on to a pattern of assessing and rewarding achievement, both generally and specifically, over the broad spectrum of public health. As the narrative unfolds, one can appreciate certain constant values-leadership, innovation and, above all, an example to be emulated-that appear over and over again in the assessments and citations, even though the immediate public health goals have continually changed and evolved. Indeed, those public health goals have become better known and better understood with each year's announcement of the awards. For those being honored, it is a humbling experienceAJPH August, 1978, Vol. 68, No. 8
EDITORIALS
recorded so often in acceptance speeches-to have been singled out for accolades. Equally frequent are the tributes paid to one's collaborators and colleagues, pointing out that they are just as worthy as the honoree. Many others, in turn, derive vicarious satisfaction from an award presented to an admired colleague, especially when they know that they have made a contribution-be it large or small-to the achievement being recognized. The very real inner doubts about preeminence that an awardee often suffers also highlight the inherent difficulties of the selection task. An equitable and effective selection process demands many things, including at the very least: a clear definition of the criteria for the award; a jury that is representative, knowledgeable, and consummately impartial; and a truly comprehensive list of candidates, supported by documentation adequate for unbiased comparative evalu-
ation. Anyone who has ever been a member of an awards committee can testify to the frustration of not being able to recognize all who are worthy. Indeed, it is a measure of the progress of public health that, unlike the era of the Lomb prizes, a competition where there is no candidate worthy of recognition is essentially unheard of today. What hurts most is the need to make a single choice from the final shortened list-that is, to choose among health workers whose qualifications are often so close that the selection of one leaves a gnawing fear that another is being treated unfairly. This thought brings to mind a quotation from Poor Richard's Almanack which says, "There have been as great souls unknown to fame as any of the most famous." For this reason, in fact, some people insist that, since many who never receive an award are at least as worthy as those who do, any awards program leads inevitably to injustices; they therefore question the whole idea of making choices where the final decision is so often subjective. Most, however, believe that merit should be recognized and rewarded and that the disadvantages are outweighed by the broad stimulus and value of public citation of outstanding performance. Even more, public recognition brings substantial benefit by raising general consciousness, among public health workers as well as the total population, of the significance of public health as a field of action. All of these considerations underscore the dilemma faced by a multifaceted association like APHA as it looks back on its history of varied awards, and their tenuous future.
Generous philanthropists have taken remarkably selfless attitudes in providing the wherewithal for such a program, while allowing considerable autonomy and independence to the American Public Health Association in the selection and presentation. Four major supporters-Lomb, Lasker, Bronfman, and Rosenhaus-and many more specific grantors deserve our everlasting thanks for their notable examples. The finite resources for these awards in the past
AJPH August 1978, Vol. 68, No. 8
have always, as expected, come to their circumscribed limits, necessitating that the prizes be phased out. The most recent of our benefactors, the Rosenhaus Peace Foundation, wisely set the stage for the future, however, by insisting back in 1973 that these new awards be designated not by the name of the Foundation but as the "APHA Awards for Excellence," thus establishing a precedent for the Association's perpetual recognition of achievement and enterprise through awards which dramatize to the public the magnitude of benefit derived from individuals who dared to invent, to challenge tradition, and to synthesize and achieve. Like its predecessors, the APHA Awards for Excellence now face the possibility of "phase out" in the near future, as the current funding approaches termination. To assure continuity in its recognition and encouragement of accomplishment in public health, and to arrive at a degree of independence, the American Public Health Association clearly needs an awards endowment of its own. This in no way precludes acceptance of special gifts or continued responsibility to select awardees for prizes financed from gifts for special purposes-such as the Browning and Sedgwick Medals which will continue to be granted, the former from a trust fund and the latter by APHA itself from current funds. An endowment means that the APHA Awards for Excellence, supported up to now by outside munificence, may be maintained for the future. An awards endowment fund goal of $500,000, to be achieved through contributions over the next 18 months, has been set by the Association. Well-designed plans for seeking support from corporations, philanthropic groups, and other generous contributors have been set forth by the officers of APHA. But no persuasion of such potential givers can be stronger than manifest support by the membership itself. In the largest sense, a soundly based awards program is one of the most effective tools APHA has to carry out its fundamental goal of helping to achieve a higher level of public health. It is up to each APHA member to accept the individual responsibility implicit in this goal, and demonstrate that responsibility with tangible backing. Only in this way can the APHA awards program fulfill its real purpose, public recognition with all its implications for the public as well as the profession, and an expression of gratitude for achievement by public health colleagues-now and into the future.
MYRON E. WEGMAN, MD, MPH Dr. Wegman is Dean Emeritus, School of Public Health, University of Michigan, Ann Arbor.
REFERENCE 1. Pond MA: A synoptic view of the history of APHA awards (18851977). Am J Public Health 68:789-804, 1978.
735
a mass transfer of human resources, including physicians and other health workers; such a transfer in any case would be inappropriate for political, economic, social, and cultural reasons. What can be done is to focus on those resources that will enable the LDCs to educate and train their own cadre of appropriate health workers. This brings us to the other important finding of Zeighami and his co-workers.1 In Iran under the conditions investigated, which one could loosely describe as primary care practice, the population seemed to prefer Iranian auxiliaries to foreign physicians by a considerable margin. Circumstances made this simultaneous comparison of two variables necessary; the comparison does not indicate whether the Iranian auxiliaries were preferred because they were Iranians or because they were auxiliaries. A comparison between Iranian and foreign physicians and between Iranian physicians and Iranian auxiliaries would have helped to answer that
preferred family and self-help to the foreign physician; the inference is that these are other potentially important alternatives which, with educational input, could help ease manpower shortages and reduce health care costs. This important investigation, which should be repeated and expanded, demonstrates that many health care problems are international in scope. It emphasizes for us our need to produce enough manpower to meet our own needs so that we do not deliberately drain off LDC resources. It should also motivate us to re-examine the tasks and capabilities of different levels of health care providers as a promising way to remedy shortages and distribution problems without jeopardizing quality.
DIETER KOCH- WESER, MD, PHD
question. Language plays a very important role in preventing disease and in diagnosing and treating illness; sick people like the comfort of speaking their own language with the care providers; together with cultural, social, and other affinities, these are powerful incentives for people from ethnic minorities to seek health care from physicians of the same ethnic group.4 Regardless of ethnic differences, patients relate better to providers from the same, or at least a similar, cultural and socioeconomic level. Even in a highly specialized field, like psychiatry, a carefully conducted investigation in Columbia indicates that auxiliaries are as effective in diagnosis and treatment and often better accepted by patients than physicians.5 It is possible that the Iranian population investigated 1 would have chosen an Iranian auxiliary over an Iranian physician, and that might be the case in many settings in many countries. This study from Iran presents few data and almost no discussion on the "Indigenous Practitioner", "Family Help", or "Self-Help", all of which respondents were asked to compare with Iranian auxiliaries and foreign physicians. Indigenous practitioners did not fare too well, but females
Address reprint requests to Dr. Dieter Koch-Weser, Associate Dean for International Programs, and Chairman, Department of Preventive and Social Medicine, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115.
REFERENCES 1. Zeighami B, Zeighami E, Mehrabanpour J, Jairdian I, and Ronaghy H: Physician importation-A solution to developing countries' rural health care problems. Am J Public Health 68:739-742,
1978. 2. Task Force on Foreign Medical Graduates. Association of American Medical Colleges: Graduates of foreign medical schools in the United States: A challenge to medical education. Journal of Medical Education 49:813, 1974. 3. Butter I, Wright G and Tasca D: FMG's in Michigan: A case of dependence. Inquiry XV: No. 1, p. 45, 1978. 4. Strasser S: The exile physicians. Journal of Intern. Physicians Vol. 1, No. 6:2, 1977. 5. Climent CE, de Arango MV, Plutchik R and Leon CA: Development of an alternative , efficient, low cost mental health delivery system in Cali, Colombia Part I: The auxiliary nurse. Social Psychiatry 13:29-35, 1978.
Achievement, Awards, and APHA While much may be said for the philosophic inner satisfaction that comes from knowing that one has done well in a particular endeavor, public recognition of high achievement is both heart-warming and stimulating, not only to the one recognized but to colleagues and friends. Recognized achievement assumes an even greater significance when it involves services to the public's interest and, in particular, to the people's health. Allen Pond's scholarly and comprehensive review of how, over the years, the American Public Health Association has recognized excellence, achievement, and public service covers an illuminating panorama.I From an essay 734
competition in the early days, directed at a single specified goal, the awards have moved on to a pattern of assessing and rewarding achievement, both generally and specifically, over the broad spectrum of public health. As the narrative unfolds, one can appreciate certain constant values-leadership, innovation and, above all, an example to be emulated-that appear over and over again in the assessments and citations, even though the immediate public health goals have continually changed and evolved. Indeed, those public health goals have become better known and better understood with each year's announcement of the awards. For those being honored, it is a humbling experienceAJPH August, 1978, Vol. 68, No. 8
EDITORIALS
recorded so often in acceptance speeches-to have been singled out for accolades. Equally frequent are the tributes paid to one's collaborators and colleagues, pointing out that they are just as worthy as the honoree. Many others, in turn, derive vicarious satisfaction from an award presented to an admired colleague, especially when they know that they have made a contribution-be it large or small-to the achievement being recognized. The very real inner doubts about preeminence that an awardee often suffers also highlight the inherent difficulties of the selection task. An equitable and effective selection process demands many things, including at the very least: a clear definition of the criteria for the award; a jury that is representative, knowledgeable, and consummately impartial; and a truly comprehensive list of candidates, supported by documentation adequate for unbiased comparative evalu-
ation. Anyone who has ever been a member of an awards committee can testify to the frustration of not being able to recognize all who are worthy. Indeed, it is a measure of the progress of public health that, unlike the era of the Lomb prizes, a competition where there is no candidate worthy of recognition is essentially unheard of today. What hurts most is the need to make a single choice from the final shortened list-that is, to choose among health workers whose qualifications are often so close that the selection of one leaves a gnawing fear that another is being treated unfairly. This thought brings to mind a quotation from Poor Richard's Almanack which says, "There have been as great souls unknown to fame as any of the most famous." For this reason, in fact, some people insist that, since many who never receive an award are at least as worthy as those who do, any awards program leads inevitably to injustices; they therefore question the whole idea of making choices where the final decision is so often subjective. Most, however, believe that merit should be recognized and rewarded and that the disadvantages are outweighed by the broad stimulus and value of public citation of outstanding performance. Even more, public recognition brings substantial benefit by raising general consciousness, among public health workers as well as the total population, of the significance of public health as a field of action. All of these considerations underscore the dilemma faced by a multifaceted association like APHA as it looks back on its history of varied awards, and their tenuous future.
Generous philanthropists have taken remarkably selfless attitudes in providing the wherewithal for such a program, while allowing considerable autonomy and independence to the American Public Health Association in the selection and presentation. Four major supporters-Lomb, Lasker, Bronfman, and Rosenhaus-and many more specific grantors deserve our everlasting thanks for their notable examples. The finite resources for these awards in the past
AJPH August 1978, Vol. 68, No. 8
have always, as expected, come to their circumscribed limits, necessitating that the prizes be phased out. The most recent of our benefactors, the Rosenhaus Peace Foundation, wisely set the stage for the future, however, by insisting back in 1973 that these new awards be designated not by the name of the Foundation but as the "APHA Awards for Excellence," thus establishing a precedent for the Association's perpetual recognition of achievement and enterprise through awards which dramatize to the public the magnitude of benefit derived from individuals who dared to invent, to challenge tradition, and to synthesize and achieve. Like its predecessors, the APHA Awards for Excellence now face the possibility of "phase out" in the near future, as the current funding approaches termination. To assure continuity in its recognition and encouragement of accomplishment in public health, and to arrive at a degree of independence, the American Public Health Association clearly needs an awards endowment of its own. This in no way precludes acceptance of special gifts or continued responsibility to select awardees for prizes financed from gifts for special purposes-such as the Browning and Sedgwick Medals which will continue to be granted, the former from a trust fund and the latter by APHA itself from current funds. An endowment means that the APHA Awards for Excellence, supported up to now by outside munificence, may be maintained for the future. An awards endowment fund goal of $500,000, to be achieved through contributions over the next 18 months, has been set by the Association. Well-designed plans for seeking support from corporations, philanthropic groups, and other generous contributors have been set forth by the officers of APHA. But no persuasion of such potential givers can be stronger than manifest support by the membership itself. In the largest sense, a soundly based awards program is one of the most effective tools APHA has to carry out its fundamental goal of helping to achieve a higher level of public health. It is up to each APHA member to accept the individual responsibility implicit in this goal, and demonstrate that responsibility with tangible backing. Only in this way can the APHA awards program fulfill its real purpose, public recognition with all its implications for the public as well as the profession, and an expression of gratitude for achievement by public health colleagues-now and into the future.
MYRON E. WEGMAN, MD, MPH Dr. Wegman is Dean Emeritus, School of Public Health, University of Michigan, Ann Arbor.
REFERENCE 1. Pond MA: A synoptic view of the history of APHA awards (18851977). Am J Public Health 68:789-804, 1978.
735
