A national public health service.

The development of the British public health services is briefly reviewed and it is suggested that two types of epidemiologist (Community Physician) are necessary in each locality: one concerned with medical administration and health care planning-the medical administrator, and the other with the prevention of disease-the clinical epidemiologist. A new nation public health service is proposed to revive disease prevention with four main features: (1) A district Clinical Epidemiologist who is a member of the district department of community medicine with responsibility for prevention but with no district administrative duties. (2) A District Epidemiology Unit comprising other appropriate staff. (3) National specialist epidemiology units within the NHS with service roles to support and coordinate the District Clinical Epidemiologists. (4) A national authority within the NHS with responsibility for prevention and for administering the national specialist units.     

Mental health. Commissioned for service

GPs often lack the data to make well-informed judgements about commissioning mental health services. A multi-agency group, including a multifund, health authority and social services, has developed service agreements which are proving useful to practices. The system provides primary care commissioners with clinical information linked to expenditure for all patients with a mental illness.     

Empirical designation of health service areas.

A method for identifying viable health service areas for a state is described. A computer program was developed that evaluates combinations of contiguous counties using a set of 56 variables strategic to the construction of health planning areas and the spatial context of health care delivery, in keeping with the structural requirements of the National Health Planning and Resources Development Act of 1974. The objective of the evaluation is to minimize differences among planning regions and between planning regions and the state.     

Single mothers: their health and health service use.

STUDY OBJECTIVE: The aim of the study was to investigate differences in reported health and health service use in single mothers. DESIGN: The study was a survey of data derived from the General Household Surveys conducted by the Office of Population Censuses and Surveys (OPCS). SETTING: The OPCS data are derived from samples of households throughout Great Britain. PARTICIPANTS: OPCS data for 1983 and 1984 were used, comprising approximately 60,000 individuals, of whom 793 were single mothers. MEASUREMENTS AND MAIN RESULTS: Five different health outcomes were examined, two on perceived morbidity and three on the use of health services. The chief determinants of health and health services use among single mothers were housing tenure, employment status and the age of the youngest child. Single mother status did not consistently contribute to self reported morbidity and uptake of care when adjusted for other social variables, but there was a difference between categories of single mother, with those who were separated/divorced and those who were widowed reporting more acute illness than those who were married. CONCLUSION: The findings suggest that single mothers do not form a homogeneous group and that, if special consideration is to be given to them when planning and allocating health service resources, this needs to be taken into account in the context of other socioeconomic factors.     

Occupational stress in health service employees.

Levels of occupational stress were examined in 383 employees of various occupations in one health district, as a preliminary to devising a strategy to reduce the negative effects of stress in the workplace. In comparison with white collar and professional workers in industry, health workers reported significantly greater pressure at work, higher ratings of physical and mental ill health, lower job satisfaction, less internal control over their working environment but used more coping strategies. Approximately one in eight of the subjects has stress symptoms of equal magnitude to patients attending clinical psychology outpatient clinics. It was also found that job satisfaction and psychosomatic ill health were related to sickness absence amongst health employees. The implications of these findings and the consequent challenges facing health service managers are discussed.