LETTERS TO THE EDITOR

X from Poisson's distribution at 95% confidence level. Fifteen cases in Pulaski are not significantly different from 7.6 expected among its large population. In public health terms that finding is quite unhelpful but it stresses that the original geographic propinquity and space relationships of the cluster are being concealed rather than illuminated by Dean's derisory suggestions of "technique". Neil D. McGlashan, MA, PhD University of Tasmania "Rotherway" Potterne Wick Devizes, Wiltshire SNIO 5QP

REFERENCE 1. Dean, A. G. Population-based spot maps: An epidemiologic technique. Am. J. Public Health 66:988-989, 1976.

Dr. Dean's Response Everyone has to choose techniques appropriate to his own work and there are limitations to each of the methods for plotting data in relation to population. Dr. McGlashan has recommended alternative techniques elsewhere,* which the reader may wish to compare with the one presented. Andrew G. Dean, MD Pacific Research Section The Research Corp. of the University of Hawaii P.O. Box 1680 Honolulu, HI 96806

More on Population-Based Spot Maps Since publication of the article "Population-Based Spot Maps: An Epidemiologic Technique" (AJPH 66:988, 1976) a previous description of the technique in addition to the one cited has been brought to my attention. M. E. Levison and W. Haddon, Jr. prepared a population-based map of New York State and described the method in "The Area-adjusted Map: An Epidemiologic Device" (Public Health Reports 80:50-59, 1965). *McGlashan, N. D. and Harington, J. S. 1976. Some techniques for mapping mortality. S. Afr. Geogr. J. 58:18-24. AJPH April, 1977, Vol. 67, No. 4

The recent article parallels their work entirely except for the additional suggestion that such a map can be prepared for the "catchment area" of an institution using records of the addresses of the clientele over a period of years. My apologies to Levison and Haddon for overlooking their contribution; I hope both articles together will stimulate more widespread use of this simple technique. Andrew G. Dean, MD Pacific Research Section The Research Corporation of The University of Hawaii P.O. Box 1680 Honolulu, HI 96806

On Health Misinformation on National Television The report on television advertising and drug use in the October issue of the Journal' suggests limiting claims of drug advertisement on television. This does not deal with the basic issue of the overall misinformation about health, drugs, and human biology on national network television. Another kind of solution was suggested in a 1972 paper2 on the health content of U.S. network television. This earlier proposal was to give equal time to health teachers to present real health information and education on equivalent television time. This plan is more meaningful in the light of the earlier report which established that the "health" content was 7.2 per cent of TV's total program time but only 30 per cent of this time offered useful health information while 70 per cent was inaccurate or misleading or both. Equal time for the truth about health is a possibility even in the profit motivated television industry if there is sufficient support beginning with APHA. A recognition or endorsement of this viewpoint by Peterson and his co-authors would increase their scope and impact. Paul Lowinger, MD Director, Residency Training Associate Clinical Professor Community Medicine and Psychiatry University ofCalifornia, San Francisco

REFERENCES 1. Peterson, B. et al. Television advertising and drug use. Am. J. Public Health 66:975-978, 1976. 2. Smith, F., Trivax, G., Zuehlke, D., Lowinger, P., and Nghien, T., Health information during a week of television, N. Eng. J. Med., 286: 516-20, 1972.

Authors' Response Dr. Lowinger makes an excellent point in his letter on the issue of misinformation about health in the program content of national network television. The Scientists' Committee is in favor of the public receiving accurate and adequate information. However, we have not studied this particular problem nor proposed remedy. It is certainly an area worth considering. Barry Peterson, PhD Chairman, Subcommittee on Drugs and Other Toxic Substances New York Scientists' Committee

for Public Information 49 East 53rd St. New York, NY 10022

On Converting Child Health Stations to Pediatric Treatment Centers Somewhat belatedly, I am commenting on a report, appearing in the June issue of the Journal in the section Public Health Briefs-namely the one entitled "Converting Child Health Stations to Pediatric Treatment Centers: Utilization Patterns of Children Using Three Upper Manhattan Facilities Offering Treatment Services." Clearly the study supports the validity of the change from the traditional child health clinics to a program providing care to both sick and well children thereby avoiding obvious fragmentation of service to a population whose medical care patterns are characteristically crisis oriented. The authors are to be congratulated for whatever share they may have had in the original idea and for furnishing the supporting data to show the need for illness care. Although I realize that the focus of the study was on utilization patterns, and not on social needs, I am sorry that no 381

LETTERS TO THE EDITOR

mention was made of psychosocial factors as an influence in utilization patterns. The description of these children (predominantly from minority groups and in two of the sites approximately one-half enrolled in Medicaid) suggest that they come from a low socioeconomic urban population. In an article published in this journal in June 1965, "Social Work in a Child Health Clinic-Report of a Demonstration" by Cowin, Rice and Schmidt, it was documented that the current threats to child growth and development in low socioeconomic urban populations are in psychosocial terms and that efforts to promote better utilization and followthrough are futile unless these needs are understood and attempts made to deal with them. The statement contained in this brief that "Children older than six years rarely used two of the Pediatric Centers reflecting a previous age limitation employed by these facilities when they were preventive care oriented child-health stations" suggests the need for outreach efforts with parents to inform them of this added dimension and some mutual assessment of the child and family's health and social functioning as one way of promoting more effective utilization. Even so simple a need as a baby sitter for small children at home can affect service utilization. I hope that the authors will continue their conversion efforts and I write this letter only to promote the notion that in their future planning consideration be given to some social work consultation to the primary care givers. Ruth Cowin Assistant Clinical Professor School of Social Work Boston University 264 Bay State Rd. Boston, MA 02215

On Self-Help Groups and Government Agencies While I thoroughly agree with the article by Gartner and Riessman, "Self-Help Models and Consumer Intensive Health Practice" in the August issue of American Journal of Public Health, I would like to add a few com382

ments regarding self-help groups as they affect governmental agencies. Perhaps I should begin my response with entitling it "Self-Help Groups-The New Professionals?" It is not unreasonable to believe that there are health professionals who may feel at times threatened by self-help groups. Self-help groups are a kind of paradox which first seem to take the form of loose-knit groups of individuals with a common need, then with time, become more highly organized, and finally become professional. Examples of this can be found in the older selfhelp organizations, such as Alcoholics Anonymous, the National Association for Retarded Citizens, etc. Self-help groups have their problems in trying to effect change in a particular agency or bureau of an agency. Often they seek remedy by directly confronting the agency director with their dissatisfactions or other grievances. While it is true that much information can come only from the heads of agencies, it is likewise true that the further an executive is from the scene of action, the more distorted his view of the situation becomes. This is in the nature of things and is one of the problems that all organizations suffer from, often being described as breakdowns in communications. For self-help groups to increase their effectiveness, they need to become more astute in understanding the processes of government which proceed from legislative action to agency implementation. It is when a law gets to the implementing agency that it is most important to know directly from those who are at the operational line what problems they perceive. It is here that self-help groups can develop mutually satisfying relationships with professionals which will benefit all concerned. The information obtained from "first-line staff' can reveal to self-help groups a more precise understanding of the difficulties that either prevent or slow a service from being provided as rapidly as desired. Self-help groups can then offer tangible and constructive action with agency directors, which in turn acts as a useful tool by which agency directors can become more responsible and effective in carrying out their agency's operations.

Such action on the part of self-help groups will tend to make them more effective in achieving change. Change by passing a law, while admittedly an achievement, is not necessarily the end of the process; it is in fact only the beginning. At the same time, as self-help groups talk to first-line professionals in agencies, they can begin a process of understanding and appreciating, if not actually increasing, their respect for the everyday professional practitioner and the bureaucracy for which he works. It is easy to condemn an agency's efforts and at the same time paint the professionals within that agency with the same tarred brush. As self-help groups utilize professionals in agencies constructively, they will achieve their goals with less negative side effects and they will open an exchange of ideas between equally concerned and dedicated people. Self-help groups in particular need to act on the fact that no action takes place without organization. Organization is found in every facet of our culture. Individual behavior, to achieve certain ends, is no longer feasible or possible as it was 50 or 100 years ago. Self-help groups as they grow and mature will find themselves utilizing professionals to an increasing extent and the paradox now is one where these people are now "their professionals". This is an easily observable phenomenon in many of the established self-help groups, such as Easter Seal, NARC, Cerebral Palsy, etc. It is a natural by-product that occurs with time. Perhaps the final message on this matter of self-help groups being critical of professional services in the public sector should be the words of the immortal Pogo: "We have met the enemy and they is us." Irwin Probstein, ACSW Social Worker 1425 East Skyline Drive Madison, WI53705

On Care in Free Clinics The work of Grover and Greenberg' shows the importance of adequate documentation if "quality of AJPH April, 1977, Vol. 67, No. 4

On converting child health stations to pediatric treatment centers.

LETTERS TO THE EDITOR X from Poisson's distribution at 95% confidence level. Fifteen cases in Pulaski are not significantly different from 7.6 expect...
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