HEALTH LIBRARY i Education FOR HEALTH REPORT OF THE ADVISORY COMMITTEE ON HEALTH EDUCATION AND COMMUNICATIONS : rie | / * a wr \ Sf / U 5. D, a 2 s , S, NS SS ~ 7 is-5. DEPARTMENT OF HEALTH, slag acl tee i || S Public Health Service 4 io ?/ S pi J pfey ‘ al '' an ee ''_EDUCATION FOR HEALTH | Report of the Advisory Committee on Health Education and Communications to the Bureau of State Services (Community Health) / U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE (uu » Public Health Service | Washington, D.C. 20201 ''Public Health Service Publication No. 1430 February 1966 U.S. GOVERNMENT PRINTING OFFICE WASHINGTON : 1966 For sale by the Superintendent of Documents, U.S. Government Printing Office Washington, D.C. 20402 Price 20 cents ''CONTENTS Page Letter of transmittal... _-_--__-_-_---_-_---- eee Vv Members of the Committee__________-___-_-_--_--- vl Charge of the Committee_-.------_-_-____________- viii The challenge of education for better health _______- 1 A national program for health education and com- munications..-.------ eee 7 Appendixes A. Committee members and staff_-..__________- 15 B. Chronology of Committee activities. _______- 17 C. Committee resources..-_.---- == 19 iii 391 ''''NovemsBer 15, 1965. Wituram H. Stewart, M.D. Surgeon General, Public Health Service. Dear Dr. Stewart: In an address, “Goals of Health Communica- tion,” delivered at the National Health Forum several years ago, Dr. Leona Baumgartner stated, “If someone invented a drug that would cure half the present cases of cancer, the excitement would be beyond belief. We have such a drug—and I am completely serious: It is communication.” I know that you have long recognized the deep and continuing interest of the Public Health Service in problems related to the dis- semination and application of health knowledge. It is my privilege to forward to you the report of a committee which was created for the purpose of advising the Service on improving and intensifying the education-communications component of our programs to facilli- tate the fuller use of available knowledge. The Committee, composed of leaders in the fields of public health education, adult education, continuing professional education, mass communications, behavioral research, public relations, and public health administration, met as a committee on five occasions and met as panels on many others, interviewed numerous persons in the Bureau of State Services (Community Health)—the organization having the major program interest in health education and communications— and consulted an impressive number of other sources in the course of its study. An important byproduct has been the stimulation, specific suggestions, and the reports and working papers which their review has contributed to education-communications personnel in all our programs. This report embodies recommendations for a national program in health education and communications. While we are not so presump- tuous as to suggest the proposed program as a cure for all Dr. Baum- gartner’s figurative cases of cancer, we do believe that it constitutes a sound and realistic action program—one which would contribute substantially to helping the American people to attain better health. It is a pleasure for me to thank the members of the Committee for their highly constructive efforts and to commend their report to you for your careful and favorable consideration. Sincerely yours, Aaron W. Curistensen, M.D., Chairman. Vv ''Bureau of State Services (Community Health) Committee on Health Education and Communications Dr. Leland C. Hendershot Editor, Journal of the American Dental Association Chicago, Il. Dr. George Beal Professor of Rural Sociology Iowa State University Ames, Iowa Dr. Ralph H. Boatman Chairman, Department of Health Education, School of Public Dr. George James Health Vice President University of North Mount Sinai Medical Carolina Center Chapel Hill, N.C. New York City, N.Y. Dr. Eugene I. Johnson Executive Director Adult Education As- sociation of U.S.A. 1225 19th St NW. Washington, D.C. Dr. Wesley P. Cushman Department of Physical Education Ohio State University Columbus, Ohio Dr. William W. Frye Dean, Medical School Louisiana State University New Orleans, La. Dr. Paul F. Lazarsfeld Department of Sociology Columbia University New York, N.Y. Mr. William Harley President, National Association of Edu- cational Broadcasters Washington, D.C. Dr. Berwyn Mattison Executive Director, American Public Health Association New York, N.Y. '' Dr. George E. Miller Director of Research in Medical Education, College of Medicine University of Illinois Chicago, Il. Dr. Dorothy B. Nyswander Professor Emeritus, School of Public Health University of California Berkeley, Calif. Miss Virginia M. Ohlson Chairman, Department of Public Health Nursing, University of Illinois Chicago, Ill. Miss Sara C. Stice Director, Division of Public Health Educa- tion, Kentucky State Department of Health Frankfort, Ky. Dr. John Tuohy Director of Medical Education St. Agnes Hospital Baltimore, Md. 207-835 O—66—__2 Mr. H. J. Weddle Executive Director TB and Health Associa- tion of California Oakland, Calif. Mr. Harold N. Weiner Executive Director National Public Rela- tions Council for Health and Welfare Services New York, N.Y. Liaison from National Advisory Community Health Committee Dr. Hamilton B. G. Robinson Dean, School of Dentistry, University of Missouri at Kansas City 1108 East 10th Street Kansas City, Mo. Consultant to Committee Dr. Granville W. Larimore First Deputy Commis- sioner, New York State Department of Health Albany, N.Y. vii ''CHARGE TO THE COMMITTEE The Advisory Committee on Health Education and Com- munications will— (a) review research, training, and practices in health edu- cation and communications, and activities in continu- ing education, currently being conducted by Commu- nity Health Divisions; (b) make an objective report of its assessment of programs as observed at the present time; and (c) recommend goals and priorities, expansion or redirec- tion of existing programs, new activities, and changes in organization and staffing which it considers essential to keep abreast of knowledge and technology in the field and to maximize program effectiveness. viii ''The Challenge of Education for Better Health The sweep of science in recent decades has brought within reach the eradication of many diseases, the early detection and cure of many more, the restoration of strength among those who suffer from still other conditions which remain beyond our present powers of preven- tion and cure. It has, in short, brought us to the threshold of a longer and more satisfying lifespan for people everywhere. But for too many, the threshold has not yet been crossed. Too many die prematurely because they have not received the full measure of our scientific potential. Too many others unnecessarily live out their lives in pain or enforced idleness. The lag time is too long, the gap too broad and too deep, between the promise of science and its fulfillment. It is the central thesis of this report that the educational process is the strongest weapon available to the health professions in shortening the interval between discovery and delivery of medical advances. From Research to Application In any scientific field—whether it be rocketry or surgery—the proc- ess of translating research into application begins with the develop- ment of practical techniques and equipment which can be reproduced and routinely employed. This is a professional job, done by highly trained experts. The next step is to train the practitioner—as distinct from the researcher—in the use of the new technique. And the third step is to put the process, whatever it is, into as widespread use as its capabili- ties for meeting a human need may require. It is in these latter two steps that the process of applying medical discoveries differs from the process in other fields. First, most of the practitioners in the health field, unlike their counterparts in the hard sciences, are engaged in private practice—in- dependent of corporate direction and dispersed throughout the com- munity. Thus, their participation in the educational process which transmits new knowledge and techniques is individually motivated and the transmission process itself must be suited to individual needs. Second, the role of the private citizen is vastly different in the ap- plication of medical knowledge. In most other areas of scientific ad- 1 ''vance, his participation consists largely of paying his taxes and in the case of commercial applications, buying the product. But in health, most actions must begin with the private citizen. He decides to have a medical examination, to have his family immunized, to visit a physi- cian at the first appearance of a warning symptom. He decides wheth- er or not to modify dietary and smoking habits. His vote decides whether or not his community will fluoridate its water supply or build a sewage treatment plant. Thus, the application of medical knowledge is, to a unique degree, the sum of separate individual decisions and actions by professional and nonprofessionals alike. The corollary is perfectly clear. If these decisions and actions are to be sound they must be based on appropriate understanding, atti- tudes, and skills. “Education, therefore, is the fundamental instrument of progress in health. Resources for Education and Communications Many individuals and agencies in the United States are engaged in the educational process directed toward better health. These resources begin, of course, with the educational institutions whose primary reason for being is the preparation of health profes- sionals. These medical, dental, nursing, public health, and other pro- fessional schools are now beginning to broaden their programs from an almost exclusive concern with the education of new professionals to include the continuing education of professionals already in practice. Our resources include also the more generalized educational system which imparts health information to children and youth as part of its all-embracing educational package. There is currently widespread ferment among school health educators who desire to sharpen the aim of their programs so as to have a stronger impact on their target audience. Outside the field of formal education, there are many public and private agencies for which health education, in its broadest sense, is a primary function. These include public health departments in com- munities and States, voluntary health associations, insurance compa- nies and other corporate groups for which health education has become a byproduct goal. In addition there are the purveyors of information to the public as a whole—the newspapers, magazines, television and radio stations which have found that health information, well pre- sented, is a matter of vital interest to their various audiences and which contribute, in substantial measure, to the general climate of acceptance of medical advances. A significant, though sometimes forgotten, resource is the educational potential of health personnel and institutions. Every doctor is an educator—perhaps the most influential single health educator—for his 2 ''patients. Every hospital is a source of education for its staff and par- ticipating professionals. Yet relatively few practitioners and hospi- tals consciously and systematically perform their educational function. There is also the consumer himself. He is not merely the target of the great mass of education and information materials. In addition, if we are to achieve the two-way communication which is the essence of education, he should be an ever more active participant in health activities, a valuable guide in the adaptation of programs and mate- rials to the audiences for which they are intended. Today, however, too little effort is made to provide the consumer with the experiences which will increase his understanding and develop in him the atti- tudes and skills which lead to sound health practice, and, similarly, too little is done to make use of his contribution to the communication process. Finally, there is the vast potential resource of the Federal Govern- ment. Acting primarily through the Public Health Service, the Fed- eral Government has become, in recent years, the world’s strongest supporter of the generation of health knowledge through biomedical research. It has helped to underwrite an enormous expansion in the Nation’s hospitals and other medical facilities. It has assisted States and other agencies in carrying out broad-scale public health programs directed toward the prevention of many diseases and the protection of the human environment. Most recently it has become a major contrib- utor to education for the health professions through various forms of support to professional schools. To date, however, the Federal Government has not yet contributed to improvement of education practices in health programs—either for the public or for professionals—on a scale and in a manner commen- surate with the importance of such practices. One of the most obvious weaknesses in this respect is the failure to make adequate use of research in the behavioral sciences, as it applies to health problems in general and to health education and communica- tions in particular. Although it is generally acknowledged that public reaction to mat- ters of health is not determined by disease alone but is also affected by sociological factors, efforts to employ behavioral research in action programs have been faltering. When such research is undertaken, it too often centers on the evaluation of actions already completed. Pilot studies offering evaluation of alternative courses of action be- fore any is formally decided upon for the program proper are seldom attempted.~ As a result, government health agencies are unnecessarily handicapped by not knowing how best to approach the people they serve. To overcome this weakness, agencies whose missions involve actions that will have long-lasting effects should, whenever feasible, conduct 3 ''pilot programs incorporating adequate behavioral research prior to the activation of large-scale programs, or at the very least, research on action programs should be undertaken simultaneously with the initiation of action and used to guide further development. Health Education and Communications Through the diverse channels and from the various sources just re- viewed, a great quantity of useful information about health is being transmitted to the professions and the public. The general news media alone carry a tremendous volume. Professional journals designed to acquaint practitioners with research discoveries have multiplied in number and size. At professional schools and hospitals, and in sym- posia and conferences across the country, information is being ex- changed and new developments discussed. Public and voluntary agencies generate and disseminate an avalanche of pamphlets and brochures. And in some cases, for some people, the mere provision of informa- tion—repeated often enough and loudly enough—triggers beneficial health action. The announcement that free polio vaccine will be avail- able on Sunday afternoon brings many families to the schoolhouse door. Clearly this is the result of wide public acceptance of two con- cepts: that immunization is a helpful thing and that polio is deadly peril. This acceptance, in turn, is the product of a long conditioning process in which public education, the mass media, and the private practitioner have played important roles. But polio vaccine is a special case, both historically and in the nature of the desired response which is specific, simple, and painless. And even here, acceptance is far short of universal. Many people do not appear at the schoolhouse door—including many of those who need protection most. The record of public response to other self-generated protective actions is rather bleak. Millions of those who take ad- vantage of polio immunization do not routinely have a medical exami- nation, nor do they give up smoking, nor do they protect themselves against accidents. Unfortunately, the protective actions required to combat most of today’s major health problems are lifelong. Many are costly, or painful, or both. The barriers to behavior change are much harder to surmount. A parallel situation obtains among the health professions. There is a substantial group of physicians, dentists, nurses, and others who systematically attend courses avilable to them, conscientiously read the literature, make a strenuous effort to keep pace with their swiftly changing profession. But there are many others who do not, and their daily practice is subject to what has been called “instant obsolescence.” In general, in professional as well as public behavior, the simple, dramatic changes are adopted and the complex changes neglected. 4 ''Several conclusions may be drawn from these observations. First, we need to develop knowledge concerning reasons for the failure to take advantage of available health control measures. In this vitally important area the disciplines of health eduction and com- munication can and must draw heavily upon the rapidly developing behavioral sciences. Second, we need to apply such knowledge to our educational pro- grams—to the channels we select, the materials we prepare, the tactics we employ. Educational methods are often used as though they were ends in themselves. Scientific educational programing requires care- ful consideration of the persons to be educated—their present level of understanding, their values, their evaluation of sources and channels, and their motivation to action. Third, we need to coordinate our efforts in health education and communications. The current situation, in which thousands of in- dividuals representing hundreds of organizations are earnestly and diligently pouring out information with insufficient regard to each other’s labors, leads inevitably to duplication and overlap, to gap areas totally uncovered, to competition where there should be collab- oration. Development of health programs categorized only to dis- eases has intensified the fragmentation of health education activities. And as a result, the whole is substantially less than the sum of the parts. The payoff in modifying health behavior has not been in pro- portion to the effort expended. A Federal Role in Health Education and Communications In all these areas, it is the conviction of this Committee that the Fed- eral Government, through the Public Health Service, has a vital con- tribution to make. We are not alone in this conviction. Numerous public and private spokesmen, ranging from congressional committees to top-level medical advisory panels, have urged greater Federal at- tention to problems of health communication. National leadership is urgently needed in research, in training, in technical assistance to other agencies, and in many other areas related to health education and communications. The recommendations which make up the body of this report are principally directed toward the delineation of a feasible and appro- priate Federal role in the total national process of education for better health. They are made at the invitation of the Public Health Service and are primarily addressed to the Community Health component of the Bureau of State Services—the organizational entity whose mis- sion to to foster the availability of the best in modern medical services to those who need them. This mission is clearly compatible with and dependent upon major educational efforts directed toward the health professions and the public. 207-835 O—66——3 ''The recommendations are based upon two sets of factors. The first, which the Committee brought to the task, is the collective knowledge of a group of persons working outside the Federal establishment whose various professions span a broad range of activity related directly or indirectly to health education and communications. The second, which the Committee acquired during its year of inten- sive study, consists of observations of the current Federal program, accumulated through interviews and discussions with personnel of the Public Health Service engaged in activities related to these fields. These, plus the conviction that meeting the challenge of health edu- cation and communication is vital to the health of the Nation, are the things we shared. Some years ago the World Health Organization’s Expert Commit- tee on Health Education of the Public defined health education this way : “The aim of health education is to help people achieve health by their own actions and efforts. Health education begins therefore with the interest of people in improving their condition of living and aims at developing a sense of responsibility for their own health betterment as individuals and as members of families, communities or governments.” To this aim we subscribe, and to its fuller accomplishment we dedi- cate this report. oe ''+. ats A National Program For Health Education and Communications Recommendation 1: That skills and knowledge of health educa- tion, public information, and other communications specialists be incorporated at every appropriate stage of program planning and policy development throughout the Public Health Service. It has been stated as a fundamental thesis of this report that health education and communications are essential instruments for translat- ing all types of research discovery into effective health action. They are, therefore, an inseparable part of every health program intended to achieve improvement in health service. Moreover, the educational component of such programs cannot make its due contribution if it is added as an afterthought after the basic decisions have been made as to program content, procedures, and priorities. These conditions apply to virtually every program of the Bureau of State Services—Community Health and to many other programs of the Public Health Service. Yet, in the Committee’s observations, pro- grams in which educational thinking forms an integral part of overall planning are the rare exception rather than the rule. In some, though by no means all, the public information function is represented in the inner council of the program chief. This, though desirable, is not enough. Educational, informational, and behavioral science program components must be full participants in planning from its earliest stages and in the developments underlying basic policy decisions if the Service is to obtain full return for its program efforts and expenditures. Recommendation 2: That the Public Health Service provide cate- gorical grants to official State and local health agencies for the specific purpose of supporting programs and personnel in the health education of the public. State agencies, which are the traditional and logical focal point for activities related to health education of the public, receive Federal sup- port primarily to carry out categorical programs of disease control. Health education is, or should be, an important part of each such pro- gram. The nature of the Federal financing now is such that a State finds its health education program fragmented because it must employ, 7 ''for example, “one-fourth” of a health educator for one diesase cate- gorical program and “one-third” for another. These budgetary con- ditions results in a diluted and fragmented effort by health education personnel and defeat attempts to plan for the most effective use of the limited health education resource. The Committee urges, therefore, that concrete budgetary recognition be accorded to the importance of health education in the States by developing a program of Federal grants dedicated specifically to health education purposes, thereby as- suring a Federal-State-local partnership in program support. Recommendation 3: That the Public Health Service strengthen its programs of technical assistance and consultation to State health departments and other agencies in health education and com- munications. The provision of technical assistance and consultation to State health agencies and others via the regional office personnel of the Public Health Service has made important contributions to health programs inmany fields. In health education, however, the Committee feels that the effectiveness of technical assistance has been seriously impaired by inadequate staff, by the lack of clear-cut relationships between field and headquarters programs of the Service itself, and by similar lack of clarity and consistency in relationships between the Service, the States, and other agencies. State and local health agencies, which bear a heavy share of the responsibility for health education of the public and are frequently short of staff and resources, have a particularly acute need for consul- tation and other forms of assistance. The Federal regional offices are the normal channel for such technical aid. However, these also are currently understaffed. It is therefore essential that additional staff be assigned to the regional offices so that they can provide the consultation and assistance required by State and local agencies. Recommendation 4: That the Public Health Service provide finan- cial assistance to medical, dental, nursing, public health, and other professional schools, hospitals, professional organizations, and other appropriate agencies for the support of programs and per- sonnel in the continuing education of the health professions. Health professional schools, professional societies, hospitals, and other institutions and groups recognize that continuing education is among their vitally important functions. In most cases, however, it is a secondary function: the medical school is concerned first with the education of its regular students, the hospital with providing patient 8 * ~ '' care, etc. Thus continuing education tends to receive the resources that are “left over” after the primary objective is achieved; and none of these institutions has an overabundance of resources. Needed, therefore, is a form of basic, continuing support to be supplemented by the institution or organization itself. The Federal Government, because of its national responsibilities in the health field, is the logical source of this support upon which programs can be built. Recommendation 5: That the Public Health Service support dem- onstration projects for improved use of educational science and technology in health programs for both the professions and the public. The demonstration grant is considered one of the most effective means of developing, testing, and disseminating new methods across the entire health field. Yet its use in the communications area has been minimal at best. The availability of project grants to State or local official agencies, to educational institutions and to voluntary or other nonprofit organizations for work in health education of the public and continuing education of the professions would furnish strong stimulation for urgently needed experimentation research and development in these fields. In particular, to assure realization of the potential value of such demonstrations, methods for concurrent evaluation of results could and should be built into the original pro- gram designs. Recommendation 6: That the Public Health Service give substan- tially greater emphasis and priority in its existing programs of research grants to the support of behavioral science research re- lated to health education and the communication of health knowledge. As has been noted, there is an urgent need to develop basic scientific information related to health education and communications. Far too little is known of the nature of health communication, the reasons underlying acceptance or rejection of specific health messages by spe- cific audiences, the criteria for selection of specific media of communi- cation, and many related subjects fundamental to efficient education, both of the public and of the professions. Universities, health organi- zations, and other research institutions should be stimulated and encouraged to undertake such research. This can only be achieved by devoting a greater proportional share of research grant funds to this field, and by assuring that applications receive highly competent ''review by professionals in the field. In this latter connection, the Committee urges that a special expert advisory committee be estab- lished to review grant applications. Recommendation 7: That the Public Health Service carry out a greatly expanded program of intramural research in the be- havioral science fields related to education and communications. Implementation of Recommendation 6 can be expected to stimulate more vigorous research programs in educational and other scientific institutions. These should be complemented by an intramural research program designed to attack directly those scientific problems related to education and communications which are appropriate and ame- nable to Federal investigation and experimentation. This combination of intramural and extramural research activity has been highly pro- ductive in other scientific fields related to health. To achieve similar success in the behavioral science area, the Public Health Service will need to augment and strengthen its existing staff and resources. It is recommended that the Public Health Service organize a formal system for the recruitment and training of research personnel to carry out the planning, coordination, and integration of grant and intramural research. Recommendation 8: That the Public Health Service create a formal mechanism designed to assure that research findings gen- erated by its behavioral science program are translated syste- matically into operating practice by the programs concerned. The gap between research discovery and application exists within the education and communications fields just as it does in the broader world of medicine itself. The investigator’s concern is the develop- ment of scientifically sound data. These, which are the endpoint for the researcher, can be the point of departure for the educational prac- titioner. But too often, because there is no systematic means of bridging the gap, scientific findings which might have important practical application do not find their way into practice. The Com- mittee urges that this problem be recognized and that machinery be established to facilitate the two-way flow of information between be- havioral research and educational practice. 10 '' Recommendation 9: That the Public Health Service develop, in institutions of higher learning and other continuing education facilities, regional demonstration centers for the purpose of train- ing the teachers of the health professions in the effective use of educational science. The professional faculty members of medical, dental, nursing schools, schools of public health, and other institutions of higher learning self-evidently constitute a primary educational resource, not only for the preparation of new generations of health professionals but also for the continuing education of those in practice. In general, however, this resource has been inadequately developed and used. Advances in educational methodology have not been generally incorporated into continuing education programs, nor into the basic curriculum for pro- fessional students. In the judgment of the Committee, health professional schools should become centers of educational as well as medical excellence. We be- lieve that the Public Health Service can most effectively exercise its proper role of leadership in continuing education by assuring that the best in educational science is made readily available to teachers of the health professions. The establishment of regional demonstration centers, geographically distributed so as to be conveniently accessible to as many institutions as possible, is recommended as a practical method for achieving this goal. Each center would serve first of all as a training facility for faculty members. In addition it would be a source of high quality assistance in developing curricula, preparing educational materials, establishing criteria for evaluation, research in educational mehods, and other aspects of the educational process. Recommendation 10: That the Public Health Service provide leadership in assessing manpower needs and in recruiting and training needed manpower in the various specialized disciplines related to health education and communications, and in assuring that existing health education communications manpower is effec- tively used. Many special skills are required in the development of health educa- tion and communications programs. These include behavioral scien- tists, professional health educators, writers and editors, specialists in educational media, and many others. Skilled personnel in all these areas are in short supply to serve the needs of governmental agencies at all levels, educational institutions, voluntary agencies, and other organizations which contribute to health education and communica- tions, The Committee believes that these categories of personnel should receive support for professional preparation and continuing 11 ''education comparable with such support now being accorded to other health disciplines. Subprofessional and postdoctorate training should also be supported. In addition, it is important that the Public Health Service conduct and support studies and other activities designed to define areas of need and to improve recruitment, preparation, and utilization of these personnel. Recommendation 11: That the Public Health Service assume the leadership in the coordination of all health education programs that now are located in various Federal agencies. Health education and communications, to be effective on a national scale, must be a well-designed and coordinated effort which incorpo- rates the skills and resources of agencies and organizations at every level of our national life. When this combining of strengths has been achieved, as it was in the early polio campaigns, our progress has been dramatic. The recent establishment of an Interagency Committee on Smoking and Health is another promising example. When joint plan- ning is lacking—and, unfortunately, this is the most common pat- tern—efforts tend to be fragmented and their impact seriously weakened. It seems clear to the Committee that the Public Health Service can provide incentive and guidance toward the achievement. of more effec- tive national programs of health education. It needs to mesh its own activities with those of other Federal agencies, such as the Department of Agriculture and the Office of Economic Opportunity, which have valuable existing resources for the development of educational material and offer direct avenues for effective dissemination. The Service should also initiate joint planning efforts with nongovernmental orga- nizations in an effort to make full use of all existing resources. Recommendation 12: That the Public Health Service carry out a more vigorous and diversified program for enlisting the interest of science writers and others engaged in communicating information through the mass media and for assuring that the information dis- seminated in this way is presented accurately and in proper context. Although health information disseminated through the mass media may rarely result directly in modification of health behavior without reinforcement through other channels, there is no doubt that the mass media constitute a tremendous communications resource for creating a favorable climate and spreading important knowledge. 12 ''The Committee believes that the Public Health Service can take the lead in making full use of this resource by a variety of means, includ- ing frequent press conferences, writers’ seminars, and the like designed to provide background for understanding of health advances rather than simply to publicize spot news; production or sponsorship of films with a carefully developed educational message, of high enough quality to compete for prime viewing time; and in many other ways. Recommendation 13: That the Bureau of State Services (Com- munity Health) take the leadership in establishing a central serv- ice for health education and communications to help translate health knowledge into action through effective, efficient education- communications activities. The service would provide a source of high-level technical compe- tence to individual programs; foster coordination of education-com- munications effort within the Bureau and the Public Health Service; conduct education, communications, and behavioral science activities which are beyond the scope of individual divisions; administer finan- cial and technical assistance programs in continuing education and health education of the public; and strengthen education-communica- tions activities of other organizations. The Committee urges that the central service be placed at such an organizational level and with sufficient status to serve as a fundamental - resource for all Community Health divisions and programs and that its services be readily available to programs throughout the Public Health Service. The proposed service would be staffed by skilled professionals from specialties related to the educational process in the health field. These would include specialists in behavioral science research, continuing education of the health professions, health education of the public, design and production of educational materials, and others. The proposed service would not supplant or exercise supervisory control over the education and communications activities of the vari- ous divisions and programs. Indeed, the Committee is convinced that the education and information functions are integral to the individual programs. It is essential that topflight information and education personnel should be employed by these programs and should be imme- diately and directly involved in their program’s planning and conduct. Thus, one important function of the proposed central service within the Public Health Service would be to encourage full and effective participation of the education and communications staffs at each level of organization in actual program planning, operation, and evaluation. A second would be to foster full coordination of effort in the health edu- 13 ''cation-communications field across organizational lines. Both of these responsibilities could best be fulfilled by a central service staff capable of providing expert consultation and direct assistance, readily avail- able as a resource upon which education-communications personnel could call for top-quality professional support. In the Committee’s judgment, the demand for this service would grow rapidly as its prac- tical value was demonstrated to operating program personnel. In addition to its intramural responsibilities the proposed service would provide equally important support to other official health agencies and professional and voluntary organizations with whom the Public Health Service collaborates in health education-communica- tions activities. It would work closely with regional offices in respond- ing to requests from State agencies for guidance and services. It would serve as a central contact point for universities, professional groups, and others working in the areas of public education and continuing professional education about health. It would be a basic resource for stimulating and furthering behavioral science research in fields related to health education and communication. It would provide leadership in the development and effective use of health education-communica- tions manpower both within the Public Health Service and throughout the country. It would pull together the three indispensable elements of effective health education—behavioral research, production of ma- terials, and educational practice. In summary, all of the Committee’s recommendations are directed toward Federal leadership in health education of the public and con- tinuing education of the health professions. Each recommendation. taken separately, would contribute a significant stimulus to more effec- tive education for health. All of them, taken together, would con- stitute the core of a comprehensive national program. Most important of all, this national program, by improving educa- tional practices used in health, would make a major contribution to improve the Nation’s health itself. For in the health field, effective education and communications are never an end in themselves. They are a means—in our judgment, the most fundamental means—to a much higher end: longer and more satisfying life for the American people. The success of health education and communications can be truly measured only in relation to this goal. The Public Health Service should therefore give immediate atten- tion to the enactment of those legislative and budgetary programs necessary to implement the recommendations of this Committee. 14 ''APPENDIX A Members and Staff of the Committee Chairman Dr. Aaron W. Christensen, Deputy Chief, Bureau of State Services. Members Dr. George H. Beal, Professor of Rural Sociology, Iowa State Uni- versity, Ames. Dr. Ralph H. Boatman, Chairman, Department of Health Education, School of Public Health, University of North Carolina, Chapel Hill. Dr. Wesley P. Cushman, Professor of Health Education, Department of Physical Education, Ohio State University, Columbus. Dr. William W. Frye, Chancellor, Medical Center, Louisiana State University, New Orleans. *Dr. John C. Glidewell, Director, Research and Development, St. Louis County Health Department, Clayton, Mo. Mr. William G. Harley, President, National Association of Educa- tional Broadcasters, Washington, D.C. Dr. Leland C. Hendershot, Editor, Journal of the American Dental Association, Chicago. / Dr. George James, Vice-President, Mount Sinai Medical Center, New York City. Dr. Eugene I. Johnson, Executive Director, Adult Education Asso- ciation of America, Washington, D.C. Dr. Paul F. Lazarsfeld, Quetelet Professor of Social Science, Colum- bia University, New York City. Dr. Berwyn F. Mattison, Executive Director, American Public Health Association, New York City. Dr. George E. Miller, Director of Research in Medical Education, University of Illinois, Chicago. Dr. Dorothy Nyswander, Professor Emeritus, School of Public Health, University of California, Berkeley. Miss Virginia M. Ohlson, Associate Professor of Public Health Nursing, College of Nursing, University of Illinois, Chicago. Miss Sara ©. Stice, Director, Division of Public Health Education, Kentucky State Department of Health, Frankfort. Dr. John H. Tuohy, Director of Medical Education, St. Agnes Hos- pital, Baltimore. Mr. H. J. Weddle, Executive Director, Tuberculosis and Health Association of California, Oakland. Mr. Harold N. Weiner, Executive Director, National Public Relations Council of Health and Welfare Services, New York City. Liaison from the National Advisory Community Health Committee Dr. Raymond L. White, Director, Division of Environmental Medi- cine, American Medical Association, Chicago (until December 1964). Dr. Hamilton B. G. Robinson, Dean, School of Dentistry, University of Missouri at Kansas City (from December 1964). *Resigned Nov. 4, 1964. 15 ''Consultant to the Committee and Steering Group Dr. Granville W. Larimore, First Deputy Commissioner, New York State Health Department, Albany. Steering Group Dr. Paul Q. Peterson, Associate Chief for Community Health, Bureau of State Services, Chairman. Dr. Daniel Horn, Director, National Clearinghouse for Smoking and Health, Cancer Control Branch, Division of Chronic Diseases. Mr. Edward F. McClellan, Deputy Chief, Public Health Service Audiovisual Facility. Mr. Horace G. Ogden, Associate Chief, Information Services, Office of the Surgeon General. Mr. Daniel Sullivan, Acting Chief, Health Communications Branch, Division of Community Health Services. Panel Recorders Communications and Behavioral Research—Miss Ruth F. Richards, Health Educator, Division of Hospital and Medical Facilities. Continuing Education of the Health Professions—Miss Cecilia C. Conrath, Health Education Consultant, Health Communications Branch, Division of Community Health Services. Manpower and Training in Health Education and Communications— Mr. Daniel Sullivan, Acting Chief, Health Communications Branch, Division of Community Health Services. Public Education and Commuuiieations Practices—Miss Mary N. Gailbreath, Associate Chief for Health Communications, Office of Information, Bureau of State Services (Community Health). Division Representatives Accident Prevention—Mr. Alphonse F. Schaplowsky. Chronic Diseases—Mr. John 'T. Walden. Communicable Disease Center—Mr. George M. Stenhouse. Community Health Services—Dr. John W. Cashman.* Dental Health—Miss Emma Carr Bivins. . Hospital and Medical Facilities—Miss Helen Hollingsworth (until August 1964), Miss Ruth F. Richards (from August 1964). Nursing—Mrs. Mary R. Lester. Executive Secretary Mr. John D. Huss (until October 1965). Mr. George Kreiner (from October 1965). Staff Services Mrs. Dorothy Edwards Mrs. Maurita C. Jenkins Mrs. Mabel Fleming Mrs. Joan D. Mannix Mrs. Marion D. Fleming Mrs. Jannie J. Smith Miss Marjorie Hayes Mrs. Marguerite Waxler Miss Betty D. Herndon Miss Judi Wills Mrs. Eleanor Howell *Appointed Chief of the newly created Division of Medical Care Adminis- tration, Aug. 11, 1965. 16 ''APPENDIX B Chronology of Committee Activities (Meetings were held in Washington, D.C., unless otherwise noted) 1964 May 19 BSS-CH Advisory Committee on Health Educa- tion and Communications formally established b the Deputy Chief, Bureau of State Services, with the approval of the Surgeon General. June-September Staff work in preparation for the Committee’s in- Oct. 19-20 Dee. 2 Dec. 7-8 1965 Jan. 8 Jan. 13 Jan. 14-15 Jan. 22 Feb. 8-9 Feb. 18 Feb. 19 Mar. 5 Mar. 29-30 Apr. 26-27 May 6-7 May 24-95 June 2 June 15-16 vestigation, including the processing of appoint- ments to the Committee planning meetings of both the steering group and the Division represen- tatives, and the development of working papers on Bureau activities in the areas of concern to the Committee. First meeting of the Committee. Meeting of the Steering Group, Atlanta, to plan second meeting. Panel on Continuing Education of the Health Pro- fessions, Chicago. Panel on Communications and Behavioral Research. Panel on Manpower and Training in Health Edu- cation and Communications, Atlanta. Second meeting of the Committee, Communicable Disease Center, Atlanta. Panel on Continuing Education of the Health Professions. Panel on Public Education and Communications Practices. Panel on Manpower and Training in Health Edu- cation and Communications. Panel Chairmen’s meeting, New York City. Panel on Communications and Behavioral Research. Panel on Manpower and Training in Health Edu- cation and Communications. Third meeting of the Committee. Panel Chairmen’s meeting, New Orleans. Panel on Manpower and Training in Health Edu- cation and Communications. Panel on Communications and Behavioral Research, Chicago. Panel on Public Education and Communications Practices. 17 ''1965 June 17-18 Fourth meeting of the Committee, Center of Adult Education, ‘University of Maryland, College Park. June-September Staff work on report. Sept. 20-21 Nov. 15 18 Fifth meeting of the Committee. Final meeting of the Committee. ''APPENDIX C Committee Resources Bureau of State Services (Community Health) Personnel Consulted by Committee Dr. Faye G. Abdellah, Chief, Research Grants Branch, Division of Nursing. Mr. Stephen J. Ackerman, Associate (Bureau) Chief for Planning and Analysis. Mr. John KE. Baker, Chief, Fluoridation Services Section, Disease Control Branch, Division of Dental Health. Dr. Gilbert R. Barnhart, Chief, Office of Research Grants. Miss Emma Carr Bivins, Health Educator, Division of Dental Health. Miss Ida Brugnetti, Health Education Consultant, Health Education Unit, Heart Disease Control Branch, Division of Chronic Diseases. Mr. Franklin B. Caffee, Deputy Chief, Research Grants Branch, Di- vision of Community Health Services. Dr. John W. Cashman, Chief, Division of Medical Care Adminis- tration Dr. Wilfred David, Deputy Chief, Division of Chronic Diseases. Mr. Roy L. Davis, School Health Consultant, School Health Section, Public Health Administration Branch, Division of Community Health Services. Dr. Viron L. Diefenbach, Deputy Chief, Division of Dental Health. Dr. Harold F. Eisele, Special Assistant in Planning and Analysis, Office of Planning and Analysis. Dr. Marion Ferguson, Deputy Chief, Division of Nursing. Dr. Gotthelf O. iedlor, Chief, Research Grants Branch, Division of Hospital and Medical Facilities. Dr. F. R. Freckleton, Chief, Immunization Activities, Communicable Disease Center. Dr. Frank E. Freeman, Associate Chief for Research Development and Utilization, Office of Research Grants. Dr. James L. Goddard, Chief,“Communicable Disease Center. Dr. Harald M. Graning, Chief, Division of Hospital and Medical Facilities. Dr. Robert G. Hayden, Research Psychologist, Division of Nursing. Dr. Fred Heinzelmann, Research Psychologist, Heart Disease Control Branch, Division of Chronic Diseases. Dr. Godfrey M. Hochbaum, Chief, Behavioral Science Section, Re- search Grants Branch, Division of Community Health Services. Dr. Daniel Horn, Chief, Special Projects Section, Cancer Control Branch, Division of Chronic Diseases. Mrs. Alice M. Johnson, Health Education Consultant, Region VII (Dallas). Dr. Paul V. Joliet, Chief, Division of Accident Prevention. 19 ''Dr. Annie Laurie Keyes, Chief, Health Education Unit, Heart Dis- ease Control Branch, Division of Chronic Diseases. Mrs. Mary Lester, Chief, Community Nursing Branch, Division of Nursing. Dr. Eugene Levine, Chief, Manpower Analysis and Resources Branch, Division of Nursing. Dr. James Lieberman, Chief, Medical Audiovisual Branch, Com- municable Disease Center. Dr. Donald S. Martin, Chief, Training Branch, Communicable Disease Center. Mr. Edward F. McClellan, Deputy Chief, Medical Audiovisual Branch, Communicable Disease Center. Mrs. Marion A. Morrison, Research Analyst, Office of Research Grants. Miss Elsa Nelson, Health Education Consultant, Health Communica- tions Branch, Division of Community Health Services. Mr. Horace G. Ogden, Associate Chief, Information Services, Office of the Surgeon General. Mr. John R. Olsen, Chief, Training Methods Unit, Training Methods Perloga Section, Training Branch, Communicable Disease mter. Mr. Robert M. O’Shea, Chief, Behavioral Studies Section, Disease Control Branch, Division of Dental Health. Mr. Jesse I. Ostroff, Chief, Intelligence Unit, Community Fluorida- tion Section, Disease Control Branch, Division of Dental Health. Dr. Paul Q. Peterson, Associate (Bureau) Chief for Community Health. Dr. William J. Putnam, Chief, Disease Control Branch, Division of Dental Health. Miss Evelyn Rahm, Health Education Consultant, Region I (Boston). Mr. Robert L. Reynolds, Chief, Instructive Communications Unit, Training Methods Development Center, Training Branch, Com- municable Disease Center. Miss Ruth F. Richards, Health Educator, Division of Hospital and Medical Facilities. Dr. Arthur EF. Rikli, Chief, Intramural Research, Division of Hos- pital and Medical Facilities. Mr. Thomas E. Roberson, Health Education Consultant, Migrant Health Branch, Division of Community Health Services. Miss Anne Rolfe, Chief, Educational Services Section, Cancer Control Branch, Division of Chronic Diseases. Miss Jessie M. Scott, Chief, Division of Nursing. Mr. Stanley Siegel, Assistant Chief, Manpower Analysis and Re- sources Branch, Division of Nursing. Mrs. Mary Lou Skinner, Health Education Consultant, Region IV (Atlanta). — George M. Stenhouse, Information Officer, Communicable Disease enter. Mr. Daniel Sullivan, Acting Chief, Health Communications Branch, Division of Community Health Services. Dr. Ruth Sumner, Health Education Consultant, Health Communi- cations Branch, Division of Community Health Services. Mr. Robert M. Thorner, Chief, Research Grants, Division of Chronic Diseases. Miss Ellwynne M. Vreeland, Nurse Consultant, Division of Nursing. 20 ''Persons Outside Bureau Consulted by Committee Miss Susan B. Crawford, Director, Archives Library Department, American Medical Association, Chicago. Mr. Ralph Creer, Medical Motion Pictures, American Medical Asso- ciation, Chicago. Dr. Mordecai H. Gordon, Deputy Chief, Research Grants Review Branch, Division of Research Grants, National Institutes of Health, U.S. Public Health Service. Dr. Fred V. Hein, Director, Department of Community Health Edu- cation, American Medical Association, Chicago. Dr. Henry F. Howe, Council on Occupational Health, American Med- ical Association, Chicago. Dr. H. H. Hussey, Director, Division of Scientific Activities, American Medical Association, Chicago. Dr. Charles Kadushin, Bureau of Applied Social Research, Columbia University, New York City. Dr. F. Ellis Kelsey, Special Assistant to the Surgeon General for Scientific Information, U.S. Public Health Service. Dr. Patricia L. Kendall, Bureau of Applied Social Research, Colum- bia University, New York City. Dr. Granville W. Larimore, First Deputy Commissioner, New York State Health Department, Albany. ae Lucile Petry Leone, Chief Nurse Officer, U.S. Public Health ervice. Dr. Arthur J. Lesser, Associate Director, Division of Health Services, Children’s Bureau, Welfare Administration, U.S. Department of Health, Education, and Welfare. Dr. A. Helen Martikainen, Chief, Health Education of the Public, World Health Organization, Geneva. Mr. Ray Maurice, Bureau of Applied Social Research, Columbia Uni- versity, New York City. Mr. Rolf Meyersohn, Bureau of Applied Social Research, Columbia University, New York City. Dr. George G. Reader, Professor of Medicine, Cornell University, Ithaca, New York. Dr. John F. Sherman, Associate Director for Extramural Programs, National Institutes of Health, U.S. Public Health Service. Dr. Patrick B. Storey, Director, Department of Postgraduate Pro- rams, American Medical Association, Chicago. Miss Mary E. Switzer, Commissioner, Vocational Rehabilitation Ad- ministration, U.S. Department of Health, Education, and Welfare. Dr. John H. Talbott, Editor, Journal of the American Medical As- sociation and Specialty Journals, American Medical Association, Chicago. Dr. A. N. Taylor, Director, Council on Medical Education, American Medical Association, Chicago. Dr. Jean K. Weston, Director, Council on Drugs, American Medical Association, Chicago. Dr. Raymond L. White, Director, Division of Environmental and Medical Services, American Medical Association, Chicago. Dr. Marjorie P. Wilson, Associate Director for Extramural Programs, National Library of Medicine, U.S. Public Health Service. Dr. Walter Wolman, Department of Mental Health, American Medi- cal Association, Chicago. 21 ''Mail Survey The Panel on Continuing Education of the Health Professions requested information from 43 sponsors of continuing education pro- grams. The following is a list of those who replied: American Cancer Society. American College of Surgeons. American College of Chest Physicians. American Dental Association. American Heart Association. American Public Health Association, Western Division. California Department of Health. Florida State Department of Health. Institute of Agricultural Medicine, State University of Iowa. Johnson & Johnson. Eli Lilly & Co. Medical College of South Carolina. Merck Sharp & Dohme. National League of Nursing. National Society for Crippled Children and Adults. National Tuberculosis Association. New York State Department of Health. Parke, Davis & Co. Chas. Pfizer & Co. Ross Laboratories. Smith Kline & French. Boston University, School of Nursing. Columbia University, Teachers College, School of Nursing. University of Arizona, School of Nursing. University of California, School of Medicine. University of California, School of Public Health. Indiana University, School of Dentistry. University of Kansas, School of Medicine. University of Michigan, School of Dentistry. University of Minnesota, School of Dentistry. University of Minnesota, School of Medicine. University of North Carolina, School of Nursing. University of North Carolina, School of Public Health. Ohio State University, School of Dentistry. University of Southern California, School of Dentistry. University of Texas, School of Nursing. Washington State Department of Health. Western Interstate Commission for Higher Education. 22 ''Bibliography Copies of selected background papers prepared by the Committee in the course of its deliberations are available upon request from the Information Office, Bureau of State Services (Community Health), U.S. Public Health Service, Washington, D.C., 20201. Central Research Institute for Health Education, Ministry of Public Health, U.S.S.R., Health Education in the USSR, Moscow, 1959. (Xerox copy.) Coggeshall, Lowell T., Planning for Medical Progress Through Edu- cation, A Report Submitted to the Executive Council of the Asso- ciation of American Medical Colleges, Evanston, IIl., 1965. Dominion of Canada, Department of National Health and Welfare, Health Service Directorate, Subcommittee on Health Education, Report of the Divisional Health Education Activities and Pro- cedures, Ottawa, 1963. Dryer, Bernard V., “Lifetime Learning for Physicians: Principles, Practices, Proposals,” The Journal of Medical Education, XXXVI (June 1962), Part 2. Erickson, Harold M., “Can Public Health Fragmentation be Con- tained or Coordinated ?,” California’s Health, XXII (Dec. 15, 1964), 89-92. Evans, Lester J., Zhe Crisis in Medical Education, Ann Arbor, 1964. Hanlon, John J., Principles of Public Health Administration, St. Louis, 1964. Heinzelmann, Fred, “Factors Influencing Prophylaxis Behavior with Respect to Rheumatic Fever: An Exploratory Study,” reprinted from The Journal of Health and Human Behavior, 111 (summer 1962), 73-81. Hochbaum, Godfrey M., “What They Believe and How They Behave,” reproduced with permission from the /nternational Journal of Health Education. International Conference on Health and Health Education, Vol. 6: Professional Preparation in Health Education, Vol. 7: Health Edu- cation in Action—papers and discussions from the Conference, Phil- adelphia, June 30—July 7, 1962, published in Geneva [n.d.]. Joint Committee of the Central and Scottish Health Services Councils, Health Education {The Cohen Report], London, 1964. Kadushin, Charles, “Social Class and the Experience of Il] Health.” ae of Applied Social Research, Columbia University, Reprint 0. 387. 23 ''Kendall, Patricia L., “Impact of Training Programs on the Young Physician’s Attitudes and Experiences,” Journal of the American Medical Association, CLXXVI (June 24, 1961), 992-997. , “Medical Sociology in the United States,” Bureau of Applied Social Research, Columbia University, Reprint No. 375. Mattison, Berwyn F. and T. Lefoy Richman, Community Health Services: The Case of the Missing Mileposts, Public Affairs Pam phlet No. 180-S, New York, 1962. McLaughlin, Curtis P. and Roy Penchansky, “Diffusion of Innovation in Medicine: A Problem of Continuing Education,” reprinted from Journal of Medical Education, XL (May 1965). Menzel, Herbert and others, “Continuation Medical Education by Open-Circuit Television: A Preliminary Report.” Bureau of Ap- plied Social Research, Columbia University, Reprint No. 389. Miller, George E. and others, Teaching and Learning in Medical Schools, Cambridge, Mass., 1961. New York State Committee on Medical Education, Education for the Health Professions, 1963. New York State Department of Health, “State and Territorial Health Department Lay Education Activities in Cardiovascular Diseases,” pispared for the Subcommittee on Education of the General Public, econd National Conference on Cardiovascular Diseases, Wash- ington, D.C., U.S. Government Printing Office, 1964. The President’s Commission on Heart Disease, Cancer and Stroke, A National Program to Conquer Heart Disease, Cancer and Stroke, 2 vols., 1964. Proceedings of a symposium on “Science Information Handling,” U.S. Department of Health, Education, and Welfare, June 3-7, 1963. (Processed. ) Ramakrishna, Venkataram, “Building National Health Education Services [in India],” Society of Public Health Educators, Health Education Monograph No. 18, 1964, pp. 3-82. Rosenstock, Irwin M., “Public Acceptance of Influenza Vaccination Programs,” reprinted from The American Review of Respiratory Diseases, UX XXIII (February 1961), 171-174. Society of Public Health Educators, Research Related to Health Edu- cation Practice, Health Education Monographs, Supplement No. 1, 1963. South Carolina Educational Television Center, Zhe South Carolina ETV Story: A Report on the Nation’s First Statewide Closed Cir- cuit Educational Television Network [n.d.]. aay Research Center, Zhe Public Impact of Science in the Mass Media: A Report on a Nation-wide Survey for the National Asso- ciation of Science Writers, Ann Arbor, 1958. 24 ''U.S. Department of Health, Education, and Welfare, “Training for Service and Leadership in Health Professions,” reprinted from Health, Education, and Welfare Indicators, August, 1964. “University Sponsored Courses,” reprinted from 7'he Journal of the American Dental Association, UX1X (1964), 661-680. “Workshop on Continuing Education,” reprinted from Journal of Dental Education, XXVIII (1964), 297-359. Public Health Service Materials U.S. Public Health Service, Zhe Costly Time Lag Between Discovery and Use of Medical Knowledge, PHS Publication No. 818, Wash- ington, D.C., U.S. Government Printing Office, 1961. » The Film and Medical Communication: Final Report of an Ad Hoc Study Group on International Fachange of Medical Motion Pictures [n.d.]. , Final Report of the Study Group on Mission and Organiza- tion of the Public Health Service [The Hundley Report], 1960. (Out. of print.) , Health Manpower Source Book, PHS Publication No. 263, Section 18: Manpower in the 1960's, Washington, D.C., U.S. Gov- ernment Printing Office, 1964. , The MEDLARS Story at the National Library of Medicine, 1963. (Unnumbered.) , Proceedings of Meeting of Bureau of State Services-Commu- nity Health Committee on Health Education and Communications. Washington, D.C., October 19-20, 1964. (Processed. ) , Proceedings of Meeting of Bureau of State Services-Commu- nity Health Committee on Health Education and Communications, Atlanta, Ga., January 13-14, 1965. (Processed.) , Research in Community Health, PHS Publication No. 1225, Washington, D.C., U.S. Government Printing Office, 1964. , Report of the Panel on Communications and Behavioral Research, Bureau of State Services-Community Health Committee on Health Education and Communications, 1965. (Processed.) , Scientific and Technical Information Activities of the National Institutes of Health, Fiscal Year 1963. (Processed.) , Toward Quality in Nursing: Needs and Goals, Report of the Surgeon General’s Consultant Group on Nursing, PHS Publication No. 992, Washington, D.C., U.S. Government Printing Office, 1963. Response to Representative Fogarty’s request at the February 9, 1965, appropriations hearings for additional information on oppor- tunities, plans, and programs for improved medical communica- tions. (Processed.) 25 ''“The Role of the Public Health Service in Continuing Education for the Health Professions,” a report to the Senate Committee on Appropriations. (Mimeographed.) Terry, Luther L., “The Complex World of Modern Public Health,” Third Annual Bronfman Lecture before the American Public Health Association, Kansas City, Mo., Nov. 14, 1963. World Health Organization Materials Wid Hith Org. Techn. Rep. Ser., 1954, 89, Expert Committee on Health Education of the Public, First Report. Wid Hith Org. Techn. Rep. Ser., 1958, 156, Hapert Committee on Training of Health Personnel in Health Education of the Public. Wld Hith Org. Techn. Rep. Ser., 1960, 193, Teacher Preparation for Health Education. Wld Hith Org. Techn. Rep. Ser., 1964, 278, PAHO/WHO Inter- Regional Conference on the Postgraduate Preparation of Health Workers for Health Education. Wild Hlth Org., Pub Hlth Paper No. 19, Health Education in the USS, Report Prepared by the Participants in a Study Tour Organized by the World Health Organization, 1963. “Suggested Outline for Use by Countries in Discussing ‘Health Edu- cation of the Public’ as Preparation for the Technical Discussions at the Twelfth World Health Assembly in 1959.” (Mimeographed.) Background Document Based on Summary Reports Received from Countries for Reference and Use at the Technical Discussions “Health Education of the Public,” Twelfth World Health Assem- bly, May 1959. (Mimeographed.) Joint WHO/UNESCO European Symposium on the Preparation of Teachers for Health Education, 1961. Working Group on the Training of Doctors in Health Education, 1963. A Compilation of extracts on health education from WHO publica- tions. (Processed.) 26 ''~My €029383913 '' ''''Public Health Service Publication No. 1430 ''