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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

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

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

)

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

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

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

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

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

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

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

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

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

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

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

~

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~

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~

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~

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

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

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

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

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

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

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

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

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

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)

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)

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)

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)

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)

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)

--

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)

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)

----

----

--

--

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)

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)

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)

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)

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)

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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  • • An Approach to the Decentralization of Health Care Services in Multnomah County Oregon
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      • • Recommended Citation
        • • tmp1395265409pdf33QlK

-- -----

Rank OrdermiddotTuberclosis Cases by Rate Per 100000 Ranked by Census Tract High to Low

Tract TractRankTractRank Rank TractRaukTractRankTractRank

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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

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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

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      • Let us know how access to this document benefits you
      • • Recommended Citation
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      • • Recommended Citation
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      • Let us know how access to this document benefits you
      • • Recommended Citation
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      • • Recommended Citation
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• • 1972
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    • • Stephen L R Cook
      • Let us know how access to this document benefits you
      • • Recommended Citation
        • • tmp1395265409pdf33QlK

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• • 1972
  • • An Approach to the Decentralization of Health Care Services in Multnomah County Oregon
    • • Stephen L R Cook
      • Let us know how access to this document benefits you
      • • Recommended Citation
        • • tmp1395265409pdf33QlK

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• PDXScholar
• • 1972
  • • An Approach to the Decentralization of Health Care Services in Multnomah County Oregon
    • • Stephen L R Cook
      • Let us know how access to this document benefits you
      • • Recommended Citation
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• • 1972
  • • An Approach to the Decentralization of Health Care Services in Multnomah County Oregon
    • • Stephen L R Cook
      • Let us know how access to this document benefits you
      • • Recommended Citation
        • • tmp1395265409pdf33QlK