174 COMMUNITY HEALTH
One school of fully qualified healers, the osteopathic
physicians, were once considered as having a discipline that
was distinctly different from allopathic physicians. Today,
osteopathic physicians graduate from osteopathic medical
schools that have full governmental certification and provide
training of equivalent quality to other U.S. medical schools.
Osteopathic physicians are licensed in all states and osteo-
pathic specialty certifications are acceptable for full practice
privileges and positions on hospital medical staffs.
Modern socialized health care that began in Germany
in 1876 has spread in one form or another to almost all of
the world’s developed nations, notably excepting the United
States of America. Socialized health systems have varied
from care that is nearly totally government controlled to
that which is delivered by independent practitioners whose
patients have freedom to select their caregivers. Payment
systems also differ, with mixtures of public pay from govern-
ment directed services to private pay for personal services to
individuals.
In the U.S., mixtures of private or public insured care
and public entitled care exists. Health care insurance is avail-
able to many workers as part of their employment obtained
through union efforts or purchased by employers. Federal
Medicare is available to persons over 65 years of age and
those who receive Social Service disability payments. Public
entitlements include military personnel, certain categories of
persons in need, such as pregnant mothers, children, prison-
ers, and Medicaid for persons receiving governmental sub-
sistence aid.
Federal grants were given to medical schools during
WW I to speed the training of medical students and produce
the physicians needed by an expanding military establish-
ment. Funding for medical education and research increased
regularly during World War II and continued to escalate
after hostilities ceased. Medical school enrollments grew
and new schools were opened to accommodate the soldiers
who were returning to seek new careers. Premedical courses
were expanded to provide basic instruction to prepare medi-
cal school candidates, and hospital residency programs
expanded rapidly to provide training after medical school in
the burgeoning medical specialties.
Concurrently, efforts were under way to make sure that
patients and entire communities that once suffered tragically
from diseases like acute poliomyelitis and chronic tuber-
culosis would no longer be threatened by these scourges.
Protective oral and injectable vaccines have nearly elimi-
nated polio, and effective antituberculosis drugs have ren-
dered sanitoria for very long-term care no longer necessary.
The severe late effects of sexually transmitted diseases
[STDs], like cardiac complications of syphilis and its severe
central nervous system damage, or late complications of
gonorrhea that resulted in sterility, pelvic abscesses, or puru-
lent arthritis, are now forestalled by early treatment with
antibiotics. Scarlet fever, child-bed fever or puerperal sepsis,
rheumatic fever, and erysipelas, streptococcal infections are
nearly medical rarities. However, drug-resistant forms of all
common bacteria are viewed as major therapeutic dangers,
and new diseases like those of the Ebola and Hanta virusesbegin to challenge infectious disease specialists, leading to a
surging interest in global infectious diseases.
Major advances occurred in basic health care technol-
ogy and pharmaceutical products manufacturing but also in
the engineering skills and sciences that produced computed
tomography, magnetic resonance imaging, molecular biol-
ogy, laparoscopic surgery, and rapid, convenient laboratory
methods. A current view of these fields has been described
by N.P. Alazraki.^6
Medical divisions of all major universities and large pri-
vate hospitals compete vigorously for federal funding for
basic and advanced research in health sciences, and insur-
ance reimbursements and private bequests or donations of
money to enable the expansion of existing facilities and
structures needed for new health technologies and the related
technical staffs.
Much controversy exists over rising costs of medi-
cal care, specialized equipment, laboratory procedures,
and growing numbers of professional personnel. Efforts
to remedy the large U.S. medical care system and reduce
expenditures met much opposition from organized caregiv-
ers and thwarted the efforts of the Clinton administration
to carry out sweeping changes in the way that health care
would be delivered. Perhaps paradoxically, much attention
is now being given to curbing excessive or elaborate care
through better organization, shorter hospital stays, living
wills and durable powers of attorney that help patients to
terminate useless care under predetermined conditions, and
even a medical concept of “futility care” that attempts to
deal with hopeless cases. Despite many condemnations of
modern medical practice that has grown rich, the balance of
curative efforts has been positive. Abel Wolman, the famed
water and sanitation engineer, once summed up the prog-
ress that federal and other monies have supported by saying,
“Money is the root of all ... good!”HEALTH AGENCIESThe health department of any political subdivision is the
governmental unit that enforces the health code and the sani-
tary ordinances and regulations that follow. Its director is
a governmental officer for health sworn to uphold the laws
that relate to health and sanitation and to recommend new
measures to counter any recognized dangers to the public’s
health. No other licensed physician group or hospital or vol-
untary health agency has this key legal authority to main-
tain health in a political jurisdiction. Each health department
is responsible for guarding the health of its entire assigned
geographic and political subdivision, a legal commitment to
abate any health hazard that is as broad as the political units
to which they belong. Contrasted to the border-to-border
obligations of a health officer, the wall-to-wall scope of hos-
pitals is limited to medical events within its buildings or in
contractual obligations of outreach programs. Physicians and
other healthcare providers are more or less limited in their
concerns to person-to-person duties in the care of individual
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