COLORADO   PUBLIC   HEALTH   NEEDS

A I? D   HOW TO  MEiT   THEM

January, 1946

***

Soghia Smith Beaosch Boom


January 1946

PUBLIC HEALTH IN COLORADO

Scope and Sponsorship of Study.

  The health study, of which this is a preliminary and partial report,
is being made, at the request of the Governor, the Health Committee of the
Governor's Post-War Planning Committee, the State Board of Health, and the
Colorado Public Health Association, by the American Public Health Association
through its Pield Staff.*  The study is being made without cost to the State
of Colorado through a grant to the American Public Health Association by the
Commonwealth Fund for the purpose of conducting health studies in a few care-
fully selected states.  This and other state surveys are made under the
sponsorship and supervision of the Sub-Committee on State and Local Health
Administration of the Committee on Administrative Practice of the American
Public Health Association.**

-99-9,

*Field Staff:  Carl E. *Buck, Dr. P.H., Field Director
        Rosooe P. Kandle, M.D., Associate Field Director

**Members of the Committee on State and Local Health Administration

Ira V. Hisoock, Sc.D., Co-chairman - Dean of the School of Public Uealth,
     Yale University, New Haven, Corm.
George B. Darling, Dr. P.H., Co-chairman - Secretary of the National
      Acadew of Sciences, Washington, D.C.
Gregoire F. Amyot, n.D., Provincial He,alth Officer, Victoria, B.C., Canada
Floyd C. Heelman, M.D., Secretary, State Board of Health, Topeka, Kansas
Roland R. Cross, M.D., State Director of Public Health, SpringfieId, Ill,
Martha K , Eliot, M.D., Mzdicul Director, U.S. Children's Bureau, Washington,D.C.
Carl M. Gambill, M.D., Director Division of County Health Work, State Dept.
      of Health, Louisville, Ky.
Vlado A. Getting, M.D., State Commissioner of Public Health, Boston, Mass.
Benjamin G. Horning, M.D., Field Dirtictor, W.K. Kellogg Foundation, Battle
       Creek,, Mich.
Joseph W. Mountin, M.D., Director of States Relations, United States Public
      Health Service, Washington, R.C.
George T. Palmer, Dr. P.H., United States Public Health Service, Washin&ton,D,C.
Carolina R. Randolph, Director of Studies, Division of Public Health, the
      Commonwealth Fund, N.Y.C.
Hugh B. Robins, M.D., Director Calhoun Crsunty Health Department, Battle Creek,
        Mich.
Clarence L. Scamman, M.D., Director Division of Public Health, the Commonwealth
       Fund, N.Y.C.

John W. Shackelford, M.D., Assistant Health Officer, Memphis-Shelby County,
      Memphis., Tenn.

Felix J. IJnderwood, M.D., Executive Officer, State Board of Health, Jackson,
        Miss.
Henry F. Vaughan, Dr. P.H. (Consultant) Dean of the School of Public Health,
      University of Michigan, Ann Arbor, Mich,

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  The statements in this report are those of the field staff and do not
necessarily represent the opinion of the American Public health Association
or its Sub-Committee on State and Local Health Administration.

  The field staff acknowledges with deep appreciation the splendid assist-
ance of Dr. Roy L. Cleere, the Executive Officer, and the members of the State
Division of Public Health and the State Board of Health.

  The consideration and careful study which this report is receiving in the
Health Committee of the Intorim Committee, through its chairman, Mr. Hubert
Henry, is worthy of special mention.

  The interest and support of Mr. Harry Huffman, the Chairman of the Govern-
or's Post-War Planning Committee, and the enthusiastic, sound, and untiring
efforts of Doctor Florence Sabin, the distinguished Chairman of the Health
Committee, and the members of her Committee, constitute the study's most
important and far-reaching asset.

  The field staff is also deeply appreciative of the helpful advice and
counsel given by Dr. Fred T. Foard, Director of District No. 8, of the United
States Public Realth Service and by Dr. L. B. Byington, and Dr. Ii. T, Wagner,
and Mr. C. T. 'irright,  all of the United States Public Ifealth Service.

  This is essentially an administrative study, designed to suggest a
simplification of administration and a more effective approach to the problem
of encouraging and facilitating the development of full-time local health pro-
grams geared to meet local needs.  It makes no effort to evaluate the details
of professional or technical procedures,

Objectives of the Study

  The objectives of the study arc to reduce sickness and death rates in
Colorado and to suggest ways and means by which the people of the state may
enjoy the maximum of goad health, health over and above the mere absence of
disease,

  To attain these objectives it seems pertinent to examine critically, but
constructively,

(a) The present plan of organization and administration of
   the state health service,

(b) The extent and soundness of the development of local
   health services.

(c) The effectiveness of the cooperation or working relationships
  betweenthe public health agencies (which are essentially, but
  not solely educational in character), and the medical, dental,
  nursing and allied professional groups (which groups provide
  the services for which the health agencies have created a
  demand.)

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(d) The extent to which there are effective wuiking relationships
  between health departments (state and local) fnd other govorn-
  mental agencies and between them and the voluntary health
  agencies.

(e) Last, but perhaps most important, the degree to which,the
  people of the state wderstand.the services which they should
  have for thexnselvos and their families in order to enjoy the
  maximum of good health.

Understanding of Essential Health Services

  Upon these several factors depends the health of tho people. In its
final rrnalysis the effectiveness of all the Other factors (u,b,c, and d)
depend upon (e) the understanding of' the people as to what health protection
and health promotion services they need for themselves and their families.

  It is this lack of understanding on the part of the people, (due to the
failure to conduct a well plannod, continuous program of health education or
health information) in Colorado, as in many other states, which is responsible
for tho failure to provido the best in the way of health protection and hoalth
promotion services.

   To use but a few examples.  If you and I don't see the value of visiting
a physician and a dentist regularly we won't do so.  If ~~13 don't see the need
for and vduc of protecting our children against such diseases as diphtheria
and smallpox we will not have them protected.  If we don't understand the
value of adequate medical pre-natal, obstetrical and post-natal care for our
wives we will not seek those services,  If we don't understand that safe,
potable water supplies, adequate, safe sewerage systems, and a clean, safely
pasteurized milk supply, are essential for our health, we, of course, won't
care whether anything is done or isn't done about them.  If we don't reoog-
nize adequate hospital facilities as a necessity we will not be concerned
about their presence or absence.  If we don't think w need physicians and
dentists in our community we won't have them.  If we don't feol that contin-
uous adequate appropriations for medical education nre important we non't
have the best of physici&,.

   If w don't recognize the fact that a strong State Department of Health
(freed from political interference and permitted to progress on a sOund scien-
tifio basis) and ndequatcly staffed full-time local health departmnts (also
freed from political maneuvering) are essential to the stimulation and
developrmnt of these facilities and services, we wn:;'t have them.

  To state the problem somewhat differently this means that the study
should endeavor,

(a) to determine &at types of organization, planning and
  program seem likely to bring about the greatest degree
  of good health for the people of Colorado, and,

(b) to recommend such legislation and planing as seem necessary
  to obtain this objective.

Some, perhaps many of you, may doubt that Colorado has any important

                        3.


health problems which need solution.  The fact that Colorado has the reputation
of having a superior climate unfortunately seems to have resulted in people
having a false sense of security; a feeling that, because of the climate,
people in Colorado are healthy and therefore no special effort is necessary
to attain or maintain good health.

  That this is a totally erroneous conception is Lamply attested to by the
records which will soon be presented.

It is to be hoped that this report will oonvinoe one,

(a) that Colorado has some very important un-met health problems

(b) that meeting these health problems sucessfully would constitute
  a tremendous asset to the state and,

(4  will suggest practical mans (both in terms of legislation and
  administration) of so reducing Colorado's sickness and death
  rates that it will have a htinlth record of which it can be
  justly proud.

Some Facts Concerning Colorado's Health Record

  We have said that the records will prove that it is a fallacy to think
that Colorado is an unusually healthy state. Let us examine the death rates
(rates per 100,000 population) fron certain o`~sses which are either prevent-
able or controllable to determine how Colorado stands in relation to the other
forty-seven states and the District of Columbia.

  The following table gives Colorado's standing, among the forty-eight
states and the District of Columbia in 1936 and 1943, in deaths from certain
causes which are preventable or controllable.

Cause

*Colorado Standing     *Colorado Standing
     1936                 1943

Scarlet Fever
Diphtheria
Diarrhea & Enteritis
Pneumcnin (all formsj
Infant Mortality
Acute Rheumatic Fever
Premature Births
Materndl Deaths
Auto Accidents
Syphilis
Tuberculosis (all forms)
Whooping Cough
Typhoid C% Paratyphoid

Average Standing

6
19
10
4
4
32
17

12
15

9
16

13

3
6
7
7
8
11
14
18
18
20
26
28
31

15

  *Based on death rates per 100,000 population as published by the U,S,
Census Bureau.  Rates for Maternal Deaths, Infant hfortality and Premature
Births are per 1,000 live births. The figure given for standing (such as

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14 or 16) indicates Colorado's position in relation to the other forty-seven
states and the District of Columbia when 1 is the highest or most unfavorable
rate and 49 is the lowest or most favorable rate.  For example, in 1943 in
Diphtheria death rates Colorado stood 6th, meaning that it had the 6th worst re-
cord in the United States; 41 states and the District of Columbia had better
records,

    The year 1943 is used since that is the most recent year for which complete
data for the entire United States is available.

   The foregoing table shows clearly that Colorado has an unenviable record
for these preventable or controllable causes of death. There has been a slight,
but a very slight improvement since 1936.  In 1936 Colorado had the 13th worst
record and in 1943 it had the 15th worst r&cord which means that 33 states and
the District of Columbia all have better records than Colorado.   In 10 of the 13
causes listed Colorado stands on the unfavorable side of the ledger.

    The people of Colorado and particularly Chambers of Commerce and other
groups who are looking to the future of the state's development would not like to
have. these facts broadcast. Yet these figures, even if they are not publicized,
are available to industries and individuals who may wish to locate in Colorado.

    Very recently the medical school had the possibility of obtaining a sub-
stantial grant from one of the large philantropic agencies.  The grant was not
made because the'agcncy said,  "There does not seem to be suff'iciont interest in
public health in Colorado to ,iustiQJ the grant which you request."

    Vould it not be a very valuable asset if Colorado could truthfully say that
it had ant of the best health records in the nation instead of having to rely upon
platitudinous statements about its superior climate?

    The none-too-rosy picture which these figures portray can and should be
changed.  These are preventable or controllable causes of death and all that is
needed to attain a really good health record is to establish and support an ude-
quata State Department of Health, freed from political machinations and maneuvering,,
and to develop adequate local health services through the institution of full-time
city-county, county, or multiple county health departments,

    Thus far, we have been desoribing how Colorado stands in relation to other
states on the basis of death rates,  Let us for a moment examine the records to
see what this means te Colorado's own citizens.  The following table gives the
number of deaths from csrtain preventable or controllable causes in the five year
period from 194G to 1944.

     Deaths of Colorado Citizens from Certain Causes, 1940-1944
Preventable         Numbor of             Controllable       Numbor rf
Causes             Deaths                Causes            Deaths
Typhoid Fever          24 '.          Tuberculosis (all forms) 2069
Diphtheria           106            Pnoumonin (all forms)    4071
Syphilis             490                 Maternal Deaths         278
Rocky 1%. Spotted Fever 18                 Premature i3irths        1773
Diarrhea & Enteritis   916                 Accidents            4642,
Whooping Cough        169                     Total         f833
Mea&es              106
    Total       -TTET                       Grand Total     14,662

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  These figures conclusively refute the theory that Coloradgans do not
suffer from, or die from preventable diseases.  These are Colorado oitizens -
1629 of them, who died from definitely preventable cau= and an additional
12833 who died from controllable causes, making a total of 14662 or an
average of 2932 each year.

    All of the deaths from preventable causes, 1829, could have been pre-
vented and at a very conservative estimate at least half of the deaths from
controllable causes, 6416, making a total of 8245, could have been prevented
had the knowledge which we already have concerning preventive medicine and
health protection been universally applied throughout the state. This means
that at least 8245 Colorado citizens are dead who might be alive today had
we had well organized and adequately supported state and local health de-
partments.  An average of about 1650 unnecessary deaths each year is a big
toll to pay for failing to provfde a&quate h8afth protection and health
promotion services.  &re& tf a human life were worthnslittls as $5000 the
saving of 1650 lives woubl rcpresen9 &n anntad saving of $8,250,000. As
you will note, these estfragtes take no account of the misery, suffering
and,economic losses which result Strom these same preventable or controllable
. causes which do not end in death.  (For more detailed information on deaths
by suggested health districts and by counties sot Appendix A.)

   With such appalling, unnecessary losses, wouldn't reasonable appropria-
tions for, and adequate support of good state and local health departments
be a sound investment if such health departzents can, and we know they can,
produce such savings in terms of life and health?

   The total amount of money spent in Colorado is insufficient to provide
the health protection and health promotion services which the people need
and ought to have.  Public health budgets for 1945-1946 in Colorado total
$751,799.00 or 68.3 cents per capita.*  This amount includes the budget of
the State Division of Public Health and the budgets of the various counties
which are receiving some federal financial, aid through the State Division of
Public FIealth.  It does not include local funds expended for public health
in Denver and Pueblo.  (This information appears not to bo available.)

  The State Division of Public Health has $412,682.41 to spend
($475,060.97 1 es8 on estimated income of $62,378.50 which goes back into
the general Fund.) or 37.5 cents per capita,  Of this amount, .$107,384.00
or 9.8 cents per capita is from state tax funds, 17.8 cents from the U.S.
Public Health Service, 8.3 cents from the U. S. Children's Bureau (making a
total of 26.1 cents of federal funds) and 1.6 cents from other sources.

   Considering county health budgets we find that 52.3 porccnt of these
funds are *from local health sources, 31.5 percent from the U.S. Public
Health Service, and ltj.2 percent from the 1J. S. Children's Bureau.  Got a
cent of state money is available for assisting in the maintenance of local
hcalti departments.

  Considering the source of funds of the total health budgets (State Div.
of Public Health-and county budgets receiving federal financial aid) we find
that only 14.3 percent of the money comes from state fmds, 23.6 percent from
local tax funds, 40.2 percent from the U.S. Public Health Service, 19.5 per-
cent from the U.S.Children's Bureau (making a total of 59.7 from fedora1
sources) and 2.4 percent from other sources.
   *Based on M estimated population of l,lOO,OOO.
                          6.


  There are three significant facts in these figures. First, Colorado is
not spending enough from all sources to secure adequate health services.
Second, the state, through state tax funds, is not assuming anything like its
rightful responsibility for public health, only I? percent of tho budget being
state money.  Third, the actual total of state tax funds being devotod to health
is 9.8 cents - think of it - less than 10 cents per capita.

  How does Colorado's contribution, through state tax funds, to total state
health expenditures compare with that of other states in this region? As
already stated, state tax funds in Colorado represent but 14 percent of total
state health expenditures,  In Wyoming, state tax funds amount to 22 percent cf
all health expenditures in the state, in Idaho 23 percent, in Nontanu 35 percent
and in Utah 43 percent.* The fact that Colorado stands lowest in its percent
contribution to public health, in ccmparison with its neighboring states, is
amazing v&en ono consi,-lers how strongly Coloraclo champions states' rights. 11s
far as wealth is concerned, Colcrado is rmch better able to contribute a sub-
stantial proportion of its total health budget than any of tho other states
with VJlich it is compared; yet its percent contribution is considvrably less
than any of its neighbors.  (For more dctailed information concerning health
expenditures see Appendix B.)

  Before discussing specific rocox:mlendations for the improvement of Colo-
rado's health record it would seem pertinent tc mention sr:.le of the assets c7r
strengths of the present health situation in the state.

Strengths

  The State Division of Public Health is fortunate in having a well trained,
capable health administrator as its executive officer.

  The Division of Labcratories, with its Central Laboratory and three brunch
laboratories, is capably administered and is rendoring valuable service to the
state.

  The Division of Public Health Nursing is well administered and sctund in its
planning.

  The Division of Venereal Disease Ccntrol is in capable hanils and is probably
the most highly developed service in the State Division of Public Health,

  The Division of Tuberculosis Control, mrking in cooperation with the State
Tuberculosis kssccintion, has a well formulated plan which is making ccmmendable
progross.

   Tho State Division of Public Health has two well trained medical social
workers.

  The Division of Public Benlth Dentistry was quite well developed and pro-
gressive in its planning but because of vacancies the Director of Dentistry has
been obliged tc act also as Director of Maternal and Child Health, the E.M.I.C.
program anl Crippled Children, which obviously has interfered with the normal
development of the dentnl program,

*Based on burlgets for the year ending June 30, 1346.
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  Colorado has a strong State Tuberculosis Association rhich, with its
affiliated societies and committees in the various counties of the state,
constitute a very valuable public health asset.

  The Denver Publie Health Council, tith its unusually strong membership,
can and should have a very powerful influence in bringing about a sounder and
more effective health organizational and administrative plan for the state as
a whole, even though it has, thus far, been relatively ineffectual in improving
the official health services in the City of Denver.

  The Governor*s Post-riar Plarnzing Committee, through its Chairman, Mr.
Harry Huffman, has indioated an interest whioh can be very helpful to the
future of public health progress izt Colorado.

  The Bealth Committee, of the Governor's Post-War Planning Committee,
chairmanad by Dr. Florenoe Sabin, the distinguished scientist, is unquestion-
ably the most potent and hopeful asset to effeotive public health effort in
Colorado.

Major Public Health Issues and Recommendations Designed to Meet Them

  The most important weaknesses affecting public health in Colorado and the
recommendations which, if put into effect, will correct them are:

The Place of Health in State Government

  The most important weakness in state public health organization is that
at present public health is a division of the executive branch of government
under the direct control of the governor.  The health of the people in any
state is altogether toa important to place it in State Government in a position
to be so oompletely susceptible to political machinations and maneuvering,
{If one does not believe that public health in Colorado is susceptible to,
and is being politically maneuvered, there is plenty of evidence to prove it,)
Public health must be completely freed from political interference and permitted
to develop and-gress on a sound scientific basis.

It is therefore recommended:

(1) THAT THE DIVISION OF PUBLIC HEALTH BE TAKER OUT OF THE ADMINISTRATIVE

BRABCB OF STATE GOVERIWEBT AND IQ'%DE A DEPARTMENT OF HEALTH COMSISTING OF TWO

BRAKCHES, THE STATti BOARD OF HEALTH AS THE ADVISORY, COIJSULTATIVE, JUDICIARY,

BUT NdT EXEXUTIVE BRANCH, AND THE STATE HEALTH OFFICER AND HIS STAFF AS THE

EXECUTIVE B@WX.  THE DEPARTMENT OF IIEALTH SIIGULD COIJSIST OF SUCH DIVISIONS

AND SECTIONS AS THE STAT,4 BOARD OF HEALTM SHAIL~DECIDE.  DIVISIOWS AND SECTIONS

OF THE DEPARTMEIJT PWY BE ABOLISIiED OR ADDED AT THE DISCRETION OF THE BOARD.


  A bill should be introduced to make possible this fundamentally important
change.  The great majority of our states now have departments of health
constituted essentially as suggested in the foregoing recommendation.  (SW
also recommendation 4 concerning the reorganization of the State Board of
health.)

Selection and Bnployrent of Personnel

  The next most important weakness lies in the present system of selecting
and employing personnel.  No person may be placed on the state payroll until
he or she is accepted by the State Civil Servioe Commission. This plan would
seem to be in accord with good administrative pr:i-:ictice but the Civil Service
Commission is oomposed of three members Politically appzaed by the Gove.rnor
for long overlapping six year terms of office.  The members of the Commissjon
are paid salaries and thus the Commission is an executive body rather than an
advisory, judiciary, regulatory group.  lkmbers of the Commission need have no
special qualifications fcr the positions to which they are appointed. The
Commission (Probably because it is a Paid rather than a non-paid Commission)
does not have an appropriation which will permit tht. employment of an adequate
staff of trainad per;;onnel.  Tht ant? trained person whom it does employ is not
given the authority and backing to do a good job.  he does not attend meetings
of the Commission at vuhich appointmonts are discussed and made.  It would
appear that his recommenaations are accepted when they coincide with what the
Commission wants, or is told, to do,and ignored when they do not.  To date, no
examinations have been hold for professional iTersonne1.  This is understandable
because of the scarcity of professional personnel during the war but it is still
in no position to give adequate, fair examinations for professional personnel.
The Commission is certainly not in a position to give such examinations nor
does it i.ave the trained staff to do so.  Many of the clnssificutions ado;jted
by the Commission arc extrornely faulty, meaningless and confusing.  The salary
scales, or one should say salaries, bucausi, thcro ure no salary scales, for
professional personnel are among the lowest in the entire United States.

The Civil service Commission instead of being an agency for the recruit-
ment and employment of properly qualified persons actually is a formidable
barrit;r to the procuremtint of good people.  The Colorado Civil Service System
is a disgrace to the state.  Civic minded persons ho huve an interest in good
government ought to circularize a petition for the: tibolition of the presant
Civil Sorvice system and its complete reorganization,

  Unless public heulth'can be freed from politics by establishing a real
State Department of Publi c Kenlth and by completely reorganizing the State
Civil Service system, there is little hope of improving Colorado"s none-too-
enviable health record.

  The State Division of Public Health has an alarming number of important
vacancie s.  At present (January 1946) there are six principal administrative
positions vacant witi1 another certain to occur in the very near future. These
positions are Director of Xaternal and Child Iicalth, Director of Crippled
Children's Service, Director of Epidorniology, Director of Local Health Ser-
vices, Director of Public Health Engineering, Dir<.:ctor of Industriul Hygiene
and, to be vac::nt very soon, the Director of Labors*torics.  This is by far the
greatest number of import;uzt vacancies which your surveyor has found in any
state,  Granted that there is a scarcity of trained professional personnel

9.


this alarming and unusual number of vacancies is unquestionably due to poor
salaries, the lack of a training program in recent years, and the totally
unnecessary and unwarranted barriers to obtaining appointments of qualifisd
personnel.

It is recommended:

(2) THAT THE SELECTIOP ARD EMPLOYhlENT OF P&WUiU?FlL IN THE STATE DIVISION OF

PUBLIC HEALTH ( RXOXXiDi.lD TO BE $IU STldE DX'i&T;&I.TT OF fw&LTfI ) BE

TRANSFERRED FROM TIM STATE CIVIL SERVICE COX%ISS1011 TO THE STATE BOARD OF

  Since the State Division of Public Health receives End expends funds
fram the United States Public Iionlth Service and the United Stntss Children's
Bureau the merit system established by the State Uoard of Bealth would, of
course, have to meet the approval of those fedora1 agencies.

  If this transfer of the function of selecting and employing personnel
cannot be effected then it is recommended:

(2a) THAT THERE BE A COMPLETE REORGAIiIZATION OF THE STATE CIVIL SERVICE

SYSTa$.  THE: CIVIL SERVICE COA0~ISSIO~~, CONSISTIIJG OF FIVE MEMBERS, SROULD BE

APPOIHTED BY THE GOVERNOk ON A NON-PARTISAN BASIS, FOR FIVE Y&R S'J.AGGmED

TERMS OF OFFICE.  THE C~JKISSIOIJ SHOULD BE AN ADVISORY, JUDICIARY, kEGULATORY,

BUT NOT AX EXECUTIVE BODY.  MEKBERS OF THE CIVIL SERVICE C@Ji!IISSION SHOULD

SERVE WI TROUT COMPE1?SATION EXEPT FOR NECISSSARY E,X'~BSES IWJRRED IN CONNECTION

WITH THEIR INTIES.  THE COMI:ISSIOIJ SUOULD, IUJ'V~VER, BE GIVEN 1&N APPROPRIATION

The Civil Service Systom should be essentially a recruiting agency for
qualified personnel.

The fundamental necessities for its success are:

(a) That the Commission be non-political.

(b) That it establish proper classifications for positions to be
   filled.  For oxample, Public Health physicians grades 1, 2,
  3 and 4; Bacteriologists grades 1,2,3 and 4~ Public Health
  Nurses grades 1,2,3 and 4; Public IIcnlth Dentists grades 1,2,
  3 and 4; Public Health dnginecrs grades 1,2,3 and 4, etc.

(c) That it establish adequate qualifications of training and
  experience for the various broad classifications established
  and write job specifications for individunl positions to be

10.


filled as the only assured method of obtainingAthe"right person for
the particulur ,job.

(d) To institute salary scales which will enable the Department of Bealth
  to recruit and retain adequately trained personnel.  It is impossible
  to do this at present because of the very faulty system of classifisa-
  tions and the totally inadequate salary scales.

(e) That the Civil Service Commission establish a retirement age with
  retirement permitted at a certain age , probably 60, and required at
   say 65.

  The same principles as have just been onumernted should of course be
observed by the State Board of Health if it &vclops its own merit system.

  Legislation should be enacted to provide for this very important change.
If a constitutional amendment is necessary, civic minded prsons throughout
the state should join together in circularizing a petition to place the ques-
tion on the ballot at the next general election.

Local Health DC:partments

  There are at present only four full-time local health departments in
Colorado and three of those tire now without full-time health off'iccrs.   There
is neod for local health department legislation which will encourage and
facilitate the development of City-County, County and Multiple County full-
time health departments in general accordance with the plun as outlined in
Local iicalth Units for the Nation.*

It is thcrcfore recommended:

(3) TI%T A PERMISSIVE LOCAL HEALTH BILL BE ENACTED KHICH i'lILL PERXIT MJD

FACILITATZ THE DLV~OPXtiNT OF CITY-CGUXTY, COUNTY i:rsU MJLTIPLE COUNTY FULL-

TIIIE X&LTH DEPARTWlJTS WITiI A SIIdGLB BOARD OF HEALTLI. AND 11 SIUGLti FISCAL

AGZNT FOR EACH AR% OF JQXLTH JURISDICTIOB.  THE BILL SHOULD FURTHER PROVIDE

TINT kHY CITY CR CITIES OF I.,ZSS THAN 50,000 POPUL6TIOX (AS GIVEIi 18 T1f.E MOST

RECEIJT OFFICIAL U.S. CENSUS BURXAU REPGRT)  IN AKY COBTL?:PLATED COUNTY OR

WJLTIPLE COiJNTY !i&lLTH DEPART?!i;'NT SHOULD ilUTO!'ATICA12LY BbCOKE AN INTEGRAL

PART OF SUCH HZALTR DEPARTF.XIJT.  THE BILL SHOiJLD ALSO PROVIDE T&T A1lY CITY

OF OVER 50,COO POPULATIOIJ E:iiY EL2CT TO CO1.2 I!u' OR STAY OUT OF THG CONTtiflIPL-

ATED COUHTY OR WLTIPL,E W`UNTY HEALTH DZP1~RTEIENT PROVIDED, HOWVER, T&U' IF

*Local Health Units for the Xation, Published by the Common-wealth Fund,
Hew York, N.Y., 1945
                       11.


IT ELECTS TO STAY OUT IT I?KJST ?&iIWTXiI A FULL-TIME HEALTH DWXHTKENT WITH

LISIIED BY TBE STATE BOARD OF HEALTH.

  (See Appendix C for a more detailed discussion of the provisions which
should be included in the bill,.)

  The suggestions concerning the inclusion, or exclusion, of cities of under
or over 50,000 population are based on the premise that it is uneconomical for
places of under 50,000 to have full-time adequately stsffed health departments
and that communities of over that size should be required to provide full-time
health service.

The State Board of Realth

  The StfLte Board of Health should be reorganized.  (This statement has noth-
ing whatsoever to do with personnel but rather with functions and composition.)

  The composition of the State Board of Health is faulty and its functions
are n& adequately or satisfactorily defined.  There are nine members of the
Board (which seems an unnecessarily large numbar)'and tile Secretary of the
Board and tixecutive Officer of the Division of Public Iiealth is a member of
the Board and is elected to that position by his follow members, The quul-
ifications for the Executive Officer of the State Division of Public Bealth
are inadequrlte.  The qualifications are merely that he be a physician licensed
to practice in Colorado and bo experienced in public health work. This latter
phrase is obviously indufinite and relatively meaningloss. Xhile it might
never happ311, with the present plan, it would be possible for the governor or
succeeding governors to appoint .a State Board of Wealth of eight laymen and
one physician.  That physician regardless of the fact that ho might not halve
any real knowledge of public health would have to be elected us State Health
Officer.

It is recommended:

(4) TEAT THE STATE BOARD OF HEALTH BE CCKPOSED OF LITHER FIVE OR SEVEiJ h93IBERS

APPOINTED FOR REASOIJABLY LOXG OVERLAPPING TER!!S OF OFFICE.   IF TIIE; BOARD IS TO

BiZ A FIVE I%Z.!BER BOARD THE TZRXS OF OFFICE SHOULD BX FOR FIVE YEARS; IF OF

SLrVEN I.lE%BCRS, THE TERZS SEIO'ULD BE FOR SEWN YEARS.  THE ORIGINAL APPOINTIMNTS

SEC032 AT T';?O YEARS, ETC.  AT ITS FIRST bl&ETIXG T!IE BOARD SHOULD Di2T,3%INE BY

SHOULD BL: FOR FIVE OR SEVEE YZAR Ti;R!..lS AS THE ChSd IlAY 52. L'il.CNBCRS OF THE

BOARD SHOULD BL' APPOIITTED BY THi: GOVdRNOR OK A Iu'O$Jv'-PARTISM BASIS. Hi3GARDLESS

12.


OF THE SIZE OF TIIE BOARD NO BUSINESS OR PRCFESSIONAL GROUP SHOULD COIJSTITUTE

A !lAJORITY OF S'IJCB BOARD.  L4EMBERS OF THE BOARD OF HtiALTH SHOULD BE AFPOIPJTED

01: THZ BASIS OF THEIR 'INTEREST-Ii1 CIVIC AFFAIRS AIlD IIGT BW'&SE OF ANY POLITI-

CAL AFFILIATIOB.  MEMBERS SIIOULD SERVE WITHOUT R2WJNERATIOiJ EXCEPT FOR EX-

PENSES IUCURRED IIJ CONlJECTIO!L WITIi THEIR DUTIES.

  THE BOARD OF HEALTH SBOULD BE THE ADVISORY, COlJSULTATIVk:, JUDICId?Y, BUT

NOT THE EYdCUTIVE BRAlJCH OF TIIE STirT'r: DEPARTMENT OF LlCALT?l.

  THE STAT2 HlhL~TIf OFFICER AND HIS STtLFF siio:iLD COlJSTITUTE THE l:XECUT IVE

BRdKJH OF THE DdPkRTl~WrJT.

  THE STATE fI&LTEl OFFICtiR OR STilTi; DIH1.?,CTOR OF Il1~ALTJ-J SHOULD B5 Wi'OINTED

BY THE STATE BOARD OF FIEALTii FOR h FIVE YtiAR TEJM OF OFFICE PROVIDklD, HOWEVER,

THAT BE MUST MEET TUti QUALIFICATIOl*'S FOR 3:CH OFFICL: F1EREIIJAF'i'l:R ENUMERATED.

  IF IT IS IMFOSSIBLE TO PUT IIJTO EFFECT TH2.S R~COI~li:~~I~DXTIOEJ THE STliTE

IiE&TII OFF'ICi3 9R i>IHdCTCR OF HEALT! i SBOULD BE APPOIlJTED BY THE GOV~WJOR, ON

THE H~COhlMCl~DATIOl~ OF TJ-l.li STAT2 BOAHD.OF I-ICALTiI, FOR A FIVE YL;& TERM OF OFFICE +

HE SHOULD BE ELIGIBLE FOR I~~APPOIIJ'TliK~lJT AT TII8 DISCRETION OF THE APPOINTIVZ

AGENCY (THE STATE BOARD OF HEALTH OR THE GOVkMOR ON THi3 RECOLJl~;ENDBTION OF TEE

BOARD OF HEALTH.)

THE PRINCIPAL FUNCTIONS OF TBj: STATE BOARD OF HEALTH SHOULD INCLUDE:

(a) TI1.!3 APPOIl?TL"liQJT OF THE STATE H&LTH OFFICZI:.
(b) 013 TM R~CO3f3JDATIO~J OF TEiE STATE lii2~.TH OFFICZR, TO PASS SUCH

RULES AND ~iE;GUihTIUMS hS IT DEEMS :JECESSAKY AND ADVISABLE FOR THE

PRO'i'~~CTIOIJ AND PROMOTION,OF TI-11: PUBLIC Hi:ALTH.  SUCH RuI,dS AND


HEGULhT IOIJS SHOULD HAW THlI dFFECT OF LAW id LONG h8 THEY AiiE NOT

   III CONFLICT 'dITH l3XISTIMG LEGISLATION.

(c) TRE RESPOIJSIBILITY FOR SEEING TO IT THAT THE STATE HEALTH OFFICER

  EIJFOCCES STATE HEALTJl LAWS, AND RULES AlJD REG'JIATIOIiS OF THE STATE

13.


BOARD OF HEALTH.

(d)   TO HOLD HEARINGS FOR EMPLOYEES, COMPANIES, CORPORATIONS, OR INDIVID-

UALS WITH ALLEGED GRIEVANCES AGAINST THE STATE DEPARTn!EZJT OF HEALTH

WHICH ALLEGED GRIEVANCES CANUOT BE SATISFACTORILY DISPOSED OF BY THE

STATE HEALTH OFFICER.  DECISIONS OF THE BOARD SHOULD BE CONSIDERED

FINAL.

  Legislation should be enacted Foviding for such a Board of Health as has
been recommended in the foregoing paragraphs.

Qualifications and Functions
of the State Health Officer

  As previously indicated the provisions concerning the qualifications of
the state health officer are weak and relatively meaningless.  It should be
borne in mind that public health is a definite profession with specific
qualifications.  A doctor of tncdicine is not qualified to be a health officer
unless ho or she has had training and experience in public ht>alth. A nurse is
not a public health nurse unless she has had special training and experience
in public health.  An engineer is not a public health engineer simply because
he is a graduate engineer.  It is important that we recognize these facts if
we are to keep public health out of politics and obtain properly qualified
personnel to carry on our health services.

It is recommended:

(5)  THAT TO BE ELIGIBLE FOR APPOIIJTBIEIJT AS SThTE HEALTH OFFICER OR

DIRECTOR OF HEALT!i A PERSON SiiOULD BE A GRADUATE OF A GRADE A 1iEDICkL SilIiCOL

AND BE ELIGIBLE FOR LICENSE TO PRACTICE IN COLORADO.  HE, OR SHE, SHOULD HAVE

HAD AT LEAST ONE YEAR OF POST-GRADJJATE CURRICULAR WORK IN A?J ACCREDITED SCHOOL

OF PUBLIC WALTH AKJ AT LEilST THREE YEARS SUCCESSFUL EXPERIENCE IN A FULL-TIME

ADElINISTRATIVE POSITIOIJ III AN APPROVED J-ZZBLTR DEPARTMENT OR OTHER HEALTH

AGENCY.  IN LIEU OF THE YEAR OF POST-GRADUATE WORK IN AIJ ACCREDITED SCHOOL OF

PUBLIC HEALTH ONE SHOULD BAVE ITAD A TOTAL OF r\T LEAST FIVE YEARS SUCCESSFUL

EXPERIENCE IN A FULL-TIME ADMINfSTRATIVE POSITIOIJ IJJ AU MTROVED IH.JQLLTH DE-

PARTMENT OR OTHER REALTIJ AGENCY.  (THE QUESTIONS OF SUCCESSFUL EXPERIENCE AND

APPROVED BEALTH DEPARTEEIJT OR OTHER HZALTII AGEJJCY SHOULD BE DECIDED BY THE

STATE BOARD OF HiZALTH.)


QT~ALIFIC~ITIOK~ ESTABLISIIED BY TIj.E i%WIT Oil CIVIL SE;cVICE SYSTE?;.

TiX STATE liZAL,TfI OFFICEii: SliOilLD BE itESPO;jSIBLIG, r?I'fI-Zli i'iZI:SOIJALLY OIL BY

STATE BOt'GD OF HEALTTI.

(This recommendation should be included in state legislation.)

The Milk Supply

At present the legal responsibility for milk and other dairy products is
with the Department of Agriculture.  The control of the public health aspects
of milk and milk products is r: basically important public hcnlth function which
should be vested in the health department.

It is therefore recorznended:

(6) TI?.AT TIZ PUBLIC :IEALTII ASPCY'CTS OF T!IE COIITliOL AI\TD SUPEiiVISXOI'J OF MILK

  (This recommendation could be
"gentlemen's agreement"      effected either by legislation or by a
           between the Departments of Agriculture and IIeulth.)

The success,%1 and affective control and supervision of the milk supply
will depend 1 rrrgo.1~
health departments.  on the establishment of full-time adequately staffed local

State Tuberculosis Sanatorium

  There is an insufficient number of beds for the cart of the tuberculous
and a number of the institutions for tuburculous arc not equipped to provide
anything more than custodial care.

  A recent study by the United. States Public Zonlth Service recommends the
establishment of a State Tuberculosis Santitorium of from 300 to 400 beds, to
be erected on the grounds of the University of Colorado i.ledicul School. In
this recommendation rz must heartily concur.  This would seem to be a paramount
need if Colorado's pressing tuberculosis problem is to be met satisfactorily.

15,


It is rucommendedt

(7) THAT A STATE T-UBkXCULOSIS SANATORIUM OF FROM 300 TO 400 BEDS B%

EiitiCTi2D 01,: THE GROUNDS OF THE UIIIVEi~SITY OF COLOM)O ~IIXDICAL SCHOOL f&D, TO

ASSURE TIiX FIJLFILLME~JT OF ITS MOST iJSCFUL IlOL% II? RELATIOR TO THi2 2NTIiiE

TUBi2itL:ULOSIS COIITROL P~iOGiW, IT IS FITKTREi.: R1:COkUiEI?DED TIiAT:

(4





(b)







(4

THE STATE TUBERCULOSIS SAiJATOHIL$I BE CLOSELY ALLIED TO TILE UMIV8RSITY

OF COLOitADO MEDICti8 SCXOOL, IN Oi:D&Z THAT IT MY BE USED AS AN

IbIPOltiTANT TEACNIU'G C2HTER.

TI5.2 STATE TUBERCULOSIS SAKATORIU'bl BE ESSENTIALLY FOi[ TIiE CAkE OF THOSE

TUBERCULOUS PATIEYJTS WXO :IEXD SPECIAL TUBERCULOSIS SlXGZRY 02/AND

ADDITIOKAL !\.;EDICAJ., CM Sm;GICAL S2WICGS NOT AVAILABLE AT OTHEiI TUBER-

CULOSIS INSTITLJTIO1~S.

THE STAT3 DEPhilTYZJJT OF iiE:ALTli Iihvi: A T~@tii&CtJI,OSIS CCQ!@TltOLLEil WI0

SI!OULD, IIJ GEidi?&L,  B2 X!XPOijSIBL$ FOR THE 2:BTIi(E STATA PltOGIW,! OF

TUB%iiCULOSIS COKTROL AND l.lO;iti STXCIFIMLLY 96 iiESPOI;SIBLE FOR:


I.  ALL OUT PATISKTS SGEiVICXS XSTAilLISHED BY TiiE STliTii: DdPAi~TI.dXT


   OF IIZALTII.

II. THE -4DKISSION TO i'diD DISCiHAi:G% F2Old THE PROPOSED STi';TZ TUBER-

  CULOSIS SAHATOHIUN d:ID ALL OTfiEI: IBSTIT'UTIONS, CI&iiIG FOR THIi:

  TUBl%CULOUS, WHICH A2.E SUBSIDIZED BY TIlE STATE.

I]Ci.Tm ESTABLISH~~J~~T OF (SUBJECT fro Tm mmovia 0~ TRE STATE HEALTH

  OFFICEI: AND TIfE STATE BOf&D OF ll%LTH) kIINI?2Uib! I:l.JLES ND i?XGmA-

  TIONS, FOR ALL INSTITUTIONS ilECEIVI!JG STATE SUBSIDY FGi: TlIE CARE

  OF THE TUBERCULOUS AliD TlIE E~JFORCELIEJJT OF SUCII RUL,ES Af*'D REGULA-

  TIONS.  1JO Il%.TITUTIOil CMIIJG FOI: THE TlJBE2CULOUS SHOULD RECEIVE

  ANY STATE 02 FEDiW~L~ SlJBSIDY BLESS OR -UNTIL IT I&S BEEN AP~M!~ED
                                                                           _---

BY THE TUBEitCULOSIS CO&T~;LLLER.

(This recommendation will require legislation.)
                 16.


Water and Sewerage

  Colorado has many-unsafe or potontially dangerous water supplies and there
are very, very few adequate scwags disposal plants.

  Legislation with respect to public water supplies and sewerage systems is
not adequate to assure full protection for these public health essentials.

It is recommended:

(8) THAT STATE LEGISLATICIJ XTB hESPECT TO WATE11 AND SE&'ERAGE BE SC

STilXJGTHENED AS TO IIJSUiti TO TIIE PEOPLE OF COLOXADO:

(a) SAFE, POTABLE WATER SUPPLIES

(b)  hD3&iATE, SAFE SEWEitiGE SYSTti;T:S. (See Appendix D)

Public Health Training

  Colorado should be training public health personnel in accredited schools
of public health.  Funds are available for this purpose but the present state
administration has refused to permit training outside of the state and at
present there is no school of public heulth in the state.  Because of the
governor's attitude it has been difficult if not impossible for nurses in the
state service to obtain public health nursing and training even in the state.

  This failure to train personnel in the past several years is now a serirus
drawback because there is absolutely no backlog of trained persons.

It is strongly recommended:

(9) THAT CIILOBADO IXXEDIATELY BE-ESTABLISII ITS Pi1OGiMI i)F TMINIIJG PUBLIC

IIEALTI! PEI&.XJFEL, BOTII KITBIN THE STATE AND $B&:ti iJ.WESSAliY OUTSIDE TIiE STATE,

AS THE CIJLY LOGICAL MEAIr'S OF ASSlJkIIJG hilEQUf~T1:Ly QUALIFIED PEilSCI@?EL FIX PUBLIC

HEALTB SEWICE I11 TIIE STATE.

  The present exceptionally large number of vacancies in the state health
service is ample testimony as to the need for such a training program.  (This
recommendation requires no legislation, merely a change of attitude on the part
of the state administration.

Ifealth Education

  At present there is no Division of Health Education or any trained health
educator in the State Division of Public Health.  As previously stated, the
future of public health progress in Colorado will dcpond largely upon the
extent to which there is widespread understanding of the health protection
and health promotion services which they should have for themselves and their
families,  There should therefore be a Division of Bealth Education, with

17.


adequately trained- personnel paid decent solaries, carrying on a continuous
year-around program of health education or health information. Doctor Sabin's
Health Committee CM and should constitute the backbone of the finest kind of
health education program.

It is recommended as one of the very fundamental essentials of good publio
health service:

(10)  TBAT A DIVISION OF WALTH EDUCATION WITH A WELL QUALIFIED Al?D WELL

PAID DIRECTCX3 BE ESTABLISHED AT THE EARLIEST POSSIBLE OPPORTUNITY,

(This recommendation does not need legislative action; merely a change in
tho attitude of state administration.)

Medical Education

In its final analysis the health of the people of any state or area will
depend upon four major factors:

(a) Full-time adequately staffed and decently paid state and local health
  departments.

(b) A sufficient number of well trained physicians.
(c) Adequate, modern hospital facilities.

(d) A general understanding of the noed for and value of these facilities.

All four of these factors need further development. Colorado has a well
organized and administered medical school v&ich, however, has not always had
sufficient appropriations to do the job of which it is capable.  The State
Tuberculosis Sanatorium (alreudy recommended) should prove an aid to medical
education.

  It is greatly to be hoped that effective working relationships between the
University of Colorado Medical School and the Denver General Hospital can be
brought about.  Some plan might be worked out by which the City of Denver would
own (as it now does), and operate the hospital from the standpoint of house-
keeping, general administration, and the control of admissions and discharges,
and would finance the resident and interne service and the University of Color-
ado Medical School would furnish the medical and surgical service including the
visiting medical staff and the appointment of residents and internes.  (Th is is
very similar to the plan now in operation at the San Francisco Hospital.)

  At present there is no school of public health between California and
Michigan.  There has been considerable discussion concerning the possibility
of establishing such a school in Colorado.  It is to be hoped that a dchool of
public health in the University of Colorado can and will be established and it
seems probable that the Committee on Professional Education of the American
Public Health Association will so recommend.  The successful operation of such
a school of public health will depend in no small measure on the stabilization
nf a sound, progressive state department of health and the establishment of a
well organized, adequately staffed, and ade*ately financed Field Training

10


Center either in 'or near Denver or in a community not too far distant from
Denver and Boulder.

It is recommended;

(11) THAT A SCIiOOL OF PUBLIC HEALTH BE ESTABLISBED IN THE UNIV?JRSITY OF

COLORADO.

It is also strongly recommended:

(12) THAT THE PEOPLE OF COLORADO GIVE ACTIVE SUPPORT TO THE PROCUREWNT

AND MAINTEIWCE OF ADEQUATE APPROPRIATIONS FOR THE COLORADO MEDICAL SCHOOL

AND ITS HOSPITALS AS THE ONLY ASSURED KEANS OF OBTAINING THE BEST TYPE OF

PHYSICIAZJS FOR THE&SELVES ARD THEIR FXKILIES.

  (This recommendation needs widespread public support to obtain necessary
legislative action.)

  Although the State Division of Health has worked closely with the State
Nutrition Council there is no trained nutritionist in its (the Division of
Health) personnel.  Nutrition is altogether too important as a basic health
need to be so neglected in a state health service program.

It is recommended:

(13) THAT A JL'LL TRAIZED NIJTRITIONIST, PAID A DECENT SALARY, BE ADDED TO

THE STAFF 0F THE STATE DIVISION 0~ PUBLIC HEALTH (REC~~EIJDED TO BE TRE STATE

DEPARTZENT OF HEALTH.)

  As previously pointed out state appropriations for public health are very
meagre and inadequate; less than 3.10 per capita and only 147: of the total
health budget.

It is therefore recommended:

(14) THAT MORE ADEQUATE STATE TAX FUNDS BE APPROPRIATED FOR PUBLIC HF&TE

TO; (a) INCREASE THE SALARIES OF PROFESSIONAL PUBLIC ,BEALTH PERSOIJNEL IN

THE STATE DIVISION OF PUBLIC HEALTH (RECOMIWDED ~0 BE THE STATE DEPARTBIEBT OF

HEALTH) WICH PERSONNEL 'KILL GIVE CONSULTATION ADVISORY SERVICE TO LOCAL

HEALTH DEPARTMEWS AND (b) TO ASSIST LOCAL AREAS 111 DEVELOPIHG FULL-T7R:E

ADEQUATE LOCAL BEALTH,SERVICES,

19.


  Hospital facilities, in certain areas of the state are inadequate or non-
existant.  A survey now being made by the State Division of Public Health, with
personnel loaned by the United States Public Health Service, under the sponsor-
ship of the Health Committee of the Governor's Post-War Planning Committee, will
make recommendations for a state-wide hospital program.

  These are, of course, not the only needs which should be met but they do,
we,believe, constitute the more important basic needs which can only be met
satisfactorily by a comprehensive and enlightened understanding on the part of
the people throughout the state.

  Vhile it is realiced that this group is naturally essentially concerned
with its own health problemsi we ass&e that it also has an interest in the
basic health needs of the state as a whole.

  As a matter of fact thu kind and quality of health services which you will
have in your own comnunities will depend largely upon the effective solution of
these basic state-wide health needs.  Xhether or not these recommendations are
actually put into effect will depend largely on the active and enthusiastic
support and backing of this group and the numerous agencies and organizations
which it represents.  Obviously many of these recommendations will require
legislative action.  If you decide to actively support these recommendations,
as we hope you will, and the bills for their achievment have been satisfactorily
formulated and if you are interested in the future health of Colorado, do not
permit your legislators to be "pressured" into accepting amendments which will
make the bills worse than useless.  Doctor S&bin and her Health Committee, of
which you are affiliated members, are relying very heavily on you people to
bring about a health record for Colorado of which you can be justly proud,

2i;.


APPENDIX A

   FIVE YEAR DEATHS AND
DEATH RATES FROM CERTAIN CAUSES
IN SUGGESTED HEALTH UNIT AREAS
  and deaths by counties

Tablet, 1,2, and 3

*SUGGESTED IN LOCAL HEALTH UNITS FOR THE NATION PUBLISHED BY THE COMMONWEALTH FUND, NEiY YORK CITY, 1945.


(1)
  UNITS

Unit 1

    2
   3
    4
    5
   6
    7

    a
   9
   IO

   II
   12
   13
   I4
   15

21,670     IO
26,81 I     I2
64,626 39
27,075    33
44,641    168
31,318 I5
67,567 30
91,557    34
331,000    123
91,933    26
71,850    56
42,273    145
56,737    I14
59,904 31
59,989 61
1,089,351    907

8

4
19
I4
17
6
If
29
I66
20
23
25
23
0
13
388

3    0     1
3    2

10     I  1
2     I     2

4     I      I

4   3'    I

0     0      I
5     I      I
23    5     2
7     0     0
5     5     0
14     4     I

8     I      0

4     I      I
I2     0      0

104    24    I8

3
3
8
6

21
9
2
5
IO

8
z
7
5
4
106

* THIS TABLE DOES NOT AGREE WITH COUNTY TABLE SINCE DEATHS IN
  INSTITUTIONS COULD NOT BE ALLOCATED TO PROPER UNIT

POPULdT ION

TABLE 1

DEATHS FROM CEkTAlN CAUSES IN THE FIVE YEAR PERIOD  1940 - 1944 *

PREVENTABLE CAUSES                                       CONTROLLABLE CAUSES

m
w
ii
Y

3    28         I02    143     6t       I4        8        4     332
B   33        I86     146      122      27      I9       7     507
IO   93       369    293     lB3     64      61     23     993
15   73        253    t.26     133      50       20       II     593
15  227       569    162     287     35      13       22     1088
I    41        I46     158     130     56      32       12     534
5   49        260     249      204     96      67      13     889
IO   86       356    315     257      224       74       24    t250
24  353       134a    1287    1133     803     342      51    4964
3   64        347    3%     261      209      73     23    1269
13   119         412     291      247      108      62       I4    I I34
25   220        534    238     307      100      37      25     f241
t6  169        398    307     125      90      53      25     998
14   64          288    229     133      45       70      I5     700
7   97       368    241     177      79       41       9     915
169  ti'i6      5936    4541    3760     2000      972     278   17,487

(I) THESE UNITS ARE THE HEALTH UNIT AREAS SUGBESTED IN LOCAL
  HEALTH UNITS FOR THE NATION, THE COMMONXALTH FUND, NEW
  YORK CITY, 1945


    fl)
    UN IT
Unit I
      2
    3
      4
  2
     7
      8
    9
     IO
     II
     12
    13
     14
    15
RATE FOR STATE

POPULAT 1 ON
  21,670
  26,811
64,626
  27,075
44,641
  31,818
  67,567
  91,557
331,000
  91,833
  71,850
  42,273
  56,737
  59,904
59, $89
I ,089,351

TABLE 2

DEATH RATES FROM CERTAIN CAUSES IN THE FIVE YEAR PER100 1940 - 1944

PREVENTABLE CAUSES                               CONTROLLABLE CAUSES

9.2    7.4   2.8    0                 44.8     132.0     56.3      12.9     7.4     I.8
9.0    3.0   2.2    1.5             66.0     108.9       91.0      20.1    14.2    2.5
12.1    5.9   3.1    9.3               52.5      90.7      56.6      19.8    IS.9    3.3
24.4   IO.3   1.5    0.7              73.8     93.1       98.2     36.9    14.8    3.2
75.3   7.6    I .a    0.4               112.6      72.1      128.6      15.7     5.8     4.4
9.4    5.0   2.5    I.9               49.5     99.3      81.7     35.2    20.1     4.2
a.9    3.3    0      0                 40.7      73.7      60.b      28.4    19.8     2.0
?.4   6.3    1.1    0.2            36.4     68.8     56.1      4a.v    to.2     2.5
7.4    10.0   I.9   0.03             39.9      77.8      68.4      48*5    20.7     1.5
5.7    4.4   1.5     0                 42.0      77.5      56.8      45.5    15.9     2.8
18.4   6.4    1.4    I.1              53.8      81.0      60.0     30.1    17.3     I.8
60.6    11.8   6.6    1.9               112.4     112.6      144.8      47.3    17.5    5.3
40.2.   8.1   2.8    0.4               55.7     108.2       54. I      31.7    IS.7    3b5
IO.3    2.7   1.3    0.3              44.3     76.5       43.4      15.0    23.4    2.3
20.3    4.3   4.0    0                55.0     so.3      59.0     26.3    13.7    l-3
16.8    9.0   I.9    0.4               52.0      85.2       74.7     38.0    18.2     2.4

(2)

(I) THESE UNITS ARE THE HEALTH UNIT AREAS SUGGESTED IN LOCAL HEALJH UNITS FOR THE NATION, THE COMIONWEALTH FUND, NEW YORK CITY 1945.

(2) THESE RATES ARE BASED ON 1000 LIVE BIRTHS.  ALL OTHERS ARE @ASED ON WO,OOO POPULATION


COLORADO
koktcl
ALAMOSA

ARAPAHOE
ARCHULETA

BACA

BENT
BOULDER
CHAFFEE

CHEYENNE
CLEAR CREEK
CONEJOS
COSTILLA

CROWLEY
CUSTER
DELTA
DENVER
DOLORES
DOUGLAS
EAGLE
ELBERT
EL PASO
FREMONT
GARFIELD

GILPIN
GRAND
GUNNISON
HINSDALE
HUERFANO
JACKSON
JEFFERSON
KtOOA
KIT CARSON
LAKE
LA PLATA
LARIMER
LAS ANIMAS
LINCOLN
LOGAN
MESA

MINERAL

MOFFAT
MONTEZUMA
MONTROSE
MORGAN
OTERO
OURAY
PARK
PHILLIPS
PtTKlN
PROWERS

PUEBLO
RtO QLANGO
RIO GRANDE

ROUT1
SAGUACHE
SAN JUAN
SAN MIGUEL
SEDGWICK
SUMMIT

TELLER
WASHINGTON
WELD
YUMA

I
00

I

1672
20
52
II9
22

  2

12

4

I
7

4

8       8

204     750

I
5
56
i

5
I
'59
I5
I

I
I9

9
57

I

13     32

4

2

21

I
7

2
211

25
22
13
2
I29

2
32
5

4

2
3
5

7
31

7
I
3
40
a
5
3

2      I?
20     94
3      I8

2     16
6      I5

CASES OF CERTAIN COMMUNICABLE DISEASE% IN I945

204
7
5
lb

6

35








3

I

I     I

I      i

      4

2

3
2

I              4
I9     34 9 5
              I

?

2

3

6

12

3
I

2

2,915
34
  70
166
23
  3
95
  20
  15
   2

   I
   2
   7
  6

21
1075

I
7.
6
135
20

B
I

15
77

2

82

32
24
36
7
I62
3
36
219

lb
6
15
46
60
6

I2
31
I
21
130
21

24

21

6

5
79
I


DEATHS FROM CERTAIN C&USES IN THE FIVE YEAR PERlOD

COLORADO
ADAMS
ALAMOSA
ARAPAHOE
ARCHULETA
BACA

BENT
BOULDER
CHAFFEE
CHEYENNE
CLEAR CREEK
CONEJOS
COST ILLA
CROWLEY
CUSTER
DELTA
DENVER
OOLORES
DOUGLAS
EAGLE

ELBERT
EL PASO
FREMONT
CARF I ELD
GILPIN

ORAND
GUNNISON
HINSOALE
HUERFANO
JACKSON
JEFFERSON

KIO'YA
KIT CAdSON
LAKE
LA PLATA
LARIb"&R
LAS ANlhMS

L INCOLN
LOGAN
MESA
:d I NERAL
MOFFAT
MONTEZUMA
MONTROSE
MORGAN
OTERD
OURAY
PARK
RiICL~PS
PITKIN

PRO!YERS
PUEBLO
RIO BLANC0
R10 GRANIE
ROUTT
SAGIJACHE
SAN JUAN
SAN hItWEb
SEOGWlCK
SUMMIT

TELLER

WASHINGTON
WELD

YUMA

INSTS.

PDPULAT ION
t,O89,351
21,301
  9,302
  33,950
  3,458
  6,405
  9,562
35,991
  6,681
  2,739
  2,560
  10,890
  6,586
  4,846
  1,go7
  14,770
331,000
  1,932
  3,187
  4,742
  4,642
64,354
17,665
  9,476
  1,046
  3,774
  5,586
    279
  13,142
  1,622
  32,800
  2,580
  6,920
  7,28 J
  12,495
31,576
  29, I31
  5,534
16,660
29,800
    024
  3,705
  7,954
15,068
16,084
21,761
  1,621
  2,304
  4,528
  1,455
  11,583
  71,850
  2,721
I 1,659
  0,848
  5,380
  1,236
  3,367
  3,666
  1,553
  4,457
  7,373
59,989
10,593

169 916 ago
3 I6 IO
3 35 6
3 7 7
6 4
   6 5
2   20 b

4  16 5
   6 2
         I
    I4
3 47 2
I   13 f
3 8 1

3   I4 5
24 123 lb6
1 I

    I
3 7 1
    I

2   20 I4
1 9 6
3 4 1

I        2

6 51 6
        I
3   IO 8
2        2

I4 I
2 I2
5 22 I2

I   I4 6
I6 94 19
        2

8 4 I
5   13 9
    I

    2 I
3 6 1
2   II .5
3 19 6
4 69 9

8   Ii 2
13 66 23
13
3 58 5
15 4
5   14 3
        I
    I
   3 1

       2
12
7 61 I3
2 3
   7 102

106

I

I

I


3
23

I

2

4

I









1



4





2



13
4







I

I

6"









I
5
I

4

I




7









12

24  18 1829
I     34
      48
      19
I      I4

       II
     29
   c  26
a      IO

  I    7
     59
   I   17
    13
   II

I   2   30
5   2  353
       2

      2

      I2
     3
      44
I      25
I I II

3

       I
3     to

      2
     25
  d
     9

   I   42
    23
P   I  147
     6
     14
  2  32

   1   5
   I   I4

  2   22

   1   35
I     91

I       I

     24

4     119
      7
I     76
      II
    26

a

4

      2
     3
     97
I       8

5936  4642
129   71
113   39
104   II6
34    IO
32    28
s9   31
t,bo   152
41   31
10     a
13   33
139   29
25    22
33   I5
  5     4
94   68
1348  1287
I1    7
6    22
50   37
13    7
245   220
79  '83
46    42
6    6
19    I4
21   39

162    81
6    10

104   89
13    20
30   34
72   38
III    51
I20   97
372   157
19   I6

81   54
167   135
4     4
31    21
87   46

a:   61
97   71
I92   I68
6    IO

II   13
24   25
2  f
69   45
412   291
8    8
191   46
38   90
97    22

IO    I2
t8    19
21    18
5    9
24   49
26    I8
368   241
39   43

4071
62
42
99
13
  8
I2
I21
30
13
15
a2

28
I2
  7
37
1133

6
23
13
177
68
32
5
7
24

69
3
76
7
II
54
72
83
238
18
39
77

13     4       2
35    14 8 2
52   I7 I3 5
33   13 17 3
59    51 20 II

4    9 5 1
a    3 1 1
17     I   12 2
3    3 1 1
27   15 13 3
247   lo8 62 I4

8     II
78    4 4 5
30    8 6 I
56    5 I 4
6    6        i
13    2 II

IO    4 0
2    2
23    7 2 4
lb    3 9
177   79 41 9
18     6   If 5

2069 994 278 17,990

55 17 5
4 4 2
73 30 9
2        1
2 4 2
12 3 8
61 37.6
5 7 4
I2 I
3 3 2
I4 3 7
8 I4
7 8 I
I I
8 ? 0
803 342 51
2        I
3 5 1
5 4 2
2 3 4
I89 49 It
44 21 7
9 5 t
4 II

     I I
6 3 1


23 12 12
I
89 23 7
3 5
4    4
5 8 2
26 12 6
35 30 7
77 25 13
3 8 2
I6 I3 5
28 35 8

339
204
422
60
76
125
517
II8
35
69
274
  68
76
  I8
222
4964
  28
43
I21
  42
891
302
135
23
  42
94
  2
359
  20
388
  48
83
I 79
278
372
882
66
208
450
  9
7J
192
232
234
501
35
37
  81
17
I72
II34
26
328
173
185
35
54
61

  18
I09
72
915
1.24

109      130  303   63 22       518


HEALTH OISTRICT *

UNIT I

GRAND

JACKSON
MOFFAT

RIO BLANC0

ROUTT

2
UNIT

ALAMOSA
CONEJOS
COSTILLA
MtNERAt
RIO GRANOE
SAGUACHE

UNIT 9

OEUYER

UNIT 12

BACA

BENT

CRO'#LEY
KIOWA

OTERO

PROWEAS

UNIT 2

EAGLE
GARFIELD
LAKE
PARK

PITKIN
SUUMIT

UNlT 6

CHAFFEE
CUSTER

FAEMONT
GUNNISON
HINSOALE

UNIT IO

CHEYENNE

OOUGLAS
ELBERT

EL PASO
KIT CARSON
LINCOLN
TELLER

UNIT 14

LOGAN
MORGAN
PHfLLlPS
SEDGWICK
WASHINGTON

YUMA

UNIT 2

DELTA
MESA
MONTROSE
OURAY
SAN MIGUEL

UNIT 7

BOULDER
LARIMER

UNIT II

PUEBLO

I5
UNIT

WELD

UNIT 4

ARCHULETA
DOLORES
LA PLATA
MONTEZUMA
SAN JUAN

UNtT B

ADAMS
ARAPAHOE
CLEAR CREEK
GILPIN
JEFFERSON

UNIT 12

HUERFANO
LAS ANIMAS

'AS SUGGESTED IN "LOCAL HEALTH UNITS FOR THE NATION," PUBLISHED BY THE COMMONWEkLTH FUND, NEW YORK, 1945


APPENDIX B

HEALTH EXPENDITURES

TABLES

. I, 2, 3, and C


TASLE I

COLORADO ?UeLlC HEALTH EUOGET - YEAR ENDING JUNE 3C, I946
            SHOWING SOURCE OF FUNDS

STATE DIVISIOI: OF
PUBL IC HEALTH

AOMlNlSTRAT!ON
EPIDEMIOLOGY
VENERRL DISEASE
T UBERCULOS IS CONTROL
CANCER CONTROL
DENTAL HEALTH
MAT. 6 CH ILO HEALTH
CR I PPLED CH ILDREN
P. H. NURSIYG
LABORATORIES
SAN. ENG INEERING
T;SUt,~.T tNG UN IT
FOOD AND DRUGS

PLUMBING
VITAL STATISTICS
IND. HYO IENE
TRAINING
BEDDING INSPECTtON
HOSPITAL INSPECT ION

STATE

16,361.21

6,ooo.oo

I ,626.oo
5,?94.20
5,189.60
45,ooo.oo
I ,456.OD
16,865.60
5,599.20
2,e97.00
26,034.oo
7,771 .oo
20,492.OO

3,619.oo
5rO47.20

IN SERVICE F IELD-OR IEEIT
TOT. STATE DIV. OF PUBLIC
HEALTH        169,762.21

POPULATION - I, 100,000

GEh.ERAL

HEALTH

U.S. P.H. SERVICE


V.O.      T.B.

23,930.oo   I ,ooo.oo   I ,472.OO
4,908.40
       41,599.20
              47,134.oo
2,783.oo

7,Cl3.00   2,508.OC
t7,940.20   9,207.60   I ,693.OO
5r599.20   9,092.oo
1,200.00  8,278.oo   2,OOC.~O

9,996.03
                 lVO.OO

3,ooo.oo

3,oco.oo

cgL;k&J;;V. o   8,44:.20

?      34,260.76
      76,102.80
      26,18:.00
      45,906.40
      I 4,691.20
      16,823.40
      26,044m
        7,771 .oo
       22,008.20
       9,996.OG
        3,o:o.oo
       3,619.oo
        51047.20
       6,ooo.oo

10.3
I.C
10.0
9.9
4.3
I .8
7.2
ID.0
5.5
9 .:
?.I
3-5
5.5
I .6
4.6
2.1

0 .7
0.6

I.1
I.3

4.5
0.4
4.3
4.3
I.9
0.0"
3.1
6.9
2.4
4.2
1.3
1.5
2.4
0.7
2.0
2.9
0.2
0.3
C.5
0.6

80,262.60 62,552.eo 52,639.oo   39,641.36  42,553.OO   9,6oc.o0   18,@00.00  175,060.97    lOO.0   43.2

U.S. CHILDREN'S BUREAU

:ii . C . H .       C.C.

2,490.OO   3,509.20

2,650.CO
l7,770.96
       31,102.80
7,466.00   7,341 .co

i,S4E.S0    600.00

1,516.30

P,?CO.Oc)

E.3. I .C.

300 .oc

9,300.co

OTHER       TOTAL

09~062.41
4,908.45
47,559.20

FJ ELI) iRMY  47,igc.co
16,000.~0

PERCENT

?ER CAP.

TOTAL


TABLE 2

CQLORADO PUBLIC HEALTH BUDGET - YEAR ENDING JUNE 30, 1946

COUNTIES

ADAMS
ARAPAHOE
EENT
BOULDER
CLEAR CREEK
CROWLEY
V.O. CITY L CO. - DENVER
DOUGLAS
EAGLE
Et PASO - CITY I CO.
FREMONT
GARF IELO
GUNN I SON
JEFFERSON
LRKE

LA PLATA
LAR IMER
LAS A#IMkS CO. H. UNIT
LOGAN
MORGAN
OTERO CO. H. UNIT .

PUEBLO

ROUTT
WELD CO. H. UNIT

YUMA

   TOTAL
   PERCENT OF TOTAL

LOCAL    PERCENT

3,69 I .oo    42.9
7,429.oo   60.9
1,347.00     40.8
7,332.oo   73.6
l,28t.50    50.0
a61 .oo    25.6
30,327.20    57.8
975.00     41.0
I, 466 .oo    50.0
43,32 I .OO    60.t
1,361 .oo    50.0
1,316.oo    SO,.0
I ,610.oo    61.6
6,204.20    59.2
2,574.28   65.2
1,367.00    50.G
8,606.OO    70.7
12,322.~     44.1
1,361.oci    5c.:
1,316.0!!    50.2
8,758.X    32.7

1,5?7.:-L:
29,436.90
1,616&3
177,466.so

52.3

GENERAL
HEALTH

4,769.oo
I ,247.OO

1,771.oo

I ,46< .oo
13,250.OO

4,339.2o
924.20

2,95cj.o0

I2,95y.O0

rs,a75.5o

62,55:.90

U.S. PUBLIC HEALTH SERVtCE               U.S. CH. BUR.

V.D.

708 .oo

  708.00
22,167.oo

4,328.40

450.00

7ca.co
2,470 .JC

I ,D4O.L"
6,63$.~

39o.s;

39,&7.43

           TOTAL

  T.B.    U.S.P.H.S.


I ,932.oo    I ,932.oo
      4,769.oo
        I r955.00

2,479.oo
22,167.oo

I ,466.OE
17,578.40

4,339.2G
I ,37:.20

          708 o oo
2,5 32.00    7,960.30

l3,999.00
6,633.o~

19,265.50

,4,464.~;   106,622.30

(I) M.C.H. WEANS MATERNAL AND CHILD HEALTH

PERCENT  iLC.H.( I)  PERCENT    TOTAL

22.4   2,983.OO
39.1
59.2
    2,632.oo
     1,281.50
74.2
42.2
     I ,405.oo
5o.c
24.4  I l,t52.00
    1,361.oo
    1,316.00
     I ,004.GO
40.8
34.8
    I ,367.oo
5.8   2,859.OC
28.5   7,658.40
    1,361 .oo
    I ,316.o~:
52.2   .!,03e.x
IG0.O
     I ,5c7:x
32.7  lO,l71.4i;
    1,6th.oC'
    55,028.33
31.5

34.7

26.4
5o.c

59.0

15.5
50.0
50 .o
3a.4

50.6
23.5
2714
5c.o
50 .o
IS.1

52.2
17.3
55.0

8,606.OO
12,19E.00
3,302.OO
9,964.oo
2,563.OO
3,340.oo
52,494.20
2,360.oo
2,932.oo
72,051.40
2,722.OO
2,632,oO
2,514.oo
1~,623.40
3,938.40
2,734.30
12,173.OC
27,94;.4o
2,722.::
2,632.x
26,795.co
6,63s.c3
3,Ol4.?d
58,873.8C
3,232.S
338.116.6~

16.2             1 2 : . ;

PERCENT
OF TOTAL

2.5
3*6
0.9
2.9
0.8
I .o
15.5
0.7
0.9
21.2

0.8

00.8
0.7
3.1
1.2
0.8
3.6
8.2
3.8
0.R
7.9
2 .z

-1 .
* 9
17.4
I .c


TABLE 3

COLORADO PUBLIC HEALTH BUDGET - YEAR ENDING JUNE 30, 1946
            SHOWtNG SOURCE OF FUNDS

STATE OIV. OF PUBLIC H.

  PERCENT
  PER CAF IT A+
FUNDS USED LESS INCOME(I)
  PERCENT
  PER CAP ITA+
COUMY HEALTH BUDGETS
  PERCENT
  PER CAPITA*
GRAND TOTAL (2)
  PERCENT
  PER CAPITA*

+ BASED 01 POPULATION OF

STATE

169,762.21
   35.6
   15.5
107r383.71
   26.0
    9.8

107,383.71
   IO.3
    9.8

I,l00,303

         GENERAL

LOCAL      HEALTH

     80,262.60

177,466.os   6215w.93
   52.3
   16.1
177,466.~   142.813.50
  23.6
   r6.1

(I) INCOME REVERTS TO THE STATE GENERAL FUND

(2) GRAND TOTAL LESS INCOME (BASED ON 1945 INCOME]

U.S.  P.H. SERVICE                                 U.S.  CHILDREN'S BUREAU

V.D.        T.B.        TOTAL         L.C.H.

C.C.

E.hl. I.C.

62,552.~~   52,689.K    195,504.40
                       41.2
                       17.8
                1?5,534.40
                       47.4
                        17.8
39,607.a    4,464.m   Io6,622,30
                   31.5
                      9.7
102,160.20    57,153.x   3c2,126.70
                       40.2
                      27.5

39,64l.36     42,553.W  9,600.~50   91,794.36   t8,c'!x.O0  475d60.97 $ 62,378.50
                          19.3       3.9      lO0.O  PERCENT PERCAP ITA
                            8.3       I o 6      43.2
                    91,794.36   13,0:3.;5  412,682.41    54.9    37.5
                           22.3       4.3       100.0
                           8.3       1.6      37.5
55.C28.30                   55,C28.30         339,116.60         3C.8
                           16.2               103.0
                              5.0              3: .a
94,669.66     42,553.N  9,603.0@  146,822.66   18,OC3.30 $ 751,7S9.11    45.1
                              19.5       2.4      IOO.@   lOO.0
                          13.3      1.6     68.3        68.3

TOTAL

(3) INCOME OF OtVlSlON OF PUSLIC HEALTH 1945
     RESTAURANTS         27,610.03
     PLUM3 ING             7,725.50
    BEdD 1 NG  IIISPECT I ON      10,575.w
     HOSPITAL IriSPECTlON       26.20
     VITAL STATISTICS       16,442.~
        TOTAL         $ 62,37a.50

             (3)
OTHER      TOTAL       rNcohE


TABLE 4

COLORADO COUNTY HEALTH BUDGETS FOR THE YEAR ENDING JUNE jO,f946

SHOWING SOURCE OF FUNDS

COUNT 1ES

POPULAT 1 ON

ADAMS            21,301
ARAPAH OE           33r850
BENT            9,562
BOULDER            35,991
CLEAR CREEK        2,560
CROWLEY          4,ab
DOUGLAS           3,187
EAGLE             4,742
*ELPASO -CITY-COUNTY    64,354
FREMONT          17,665
GARF fELD          9,476
GlJNNlSON          5,556
JEf FERSON          32,800
LAKE              7,281
LA PLATA          12,495
LAR IMER          31,576
o LASANtMAS CO. H.UNIT    29,131
LOGAN 1          l6,660
MORGAN           16,084
+OTERG GO. H.UNIT     21,761
ROUTT             8,848
*WELD CO. H. UNIT      59,989
YUHA             JO,593
   TOTAL        460,338

LOCAL

3,691 .oo
7,429.OG
1,347roo
7,931.00
1,281.M
  86 1 .OQ
  975.00
I ,466,oo
43,321.00
1&1.00~
I ,yLoo
I ,6io,30
6,284.20
2,574.20
I ,367.oo
8,606.OO
12,322.oo
1,361.oo
1,316.oo
8,758&O
1,557.oo
29,436.90
1,616.co
147,138.80

FEDERAL

4,9l5*00
4,769.00
I ,955.oo
2,632.eo
1,281.50
2,479.00
I ,405.oo
I, 466.00
28,730.40
l,$l.OO
1,316.oo
1,004.oo
41339.20
1,374.23
1,367.oo
3r567.00
15,618.40
l,36l.W
1,316.oo
18,037.QO
1,507.GO
.29,4$.90
1,616,oo
132d353.60

* FULL-TIME HEALTH DEPARTMENTS; ALL OTHERS ARE PART-TIME.

TOTAL

PERCENT

PER CAPITA
IN CENTS

8,606.OO    42.9     17.3
12,198.00   60.9     21.9
3r332.00    40.8      14.1
9,964.oo   73.6     20.4
2,563.m    50.0     50.0
3,340,OO    25.8     17.7
2,380.50    41.0    30.6
2,932.oo    50.0     30.9
72,051.40   60. I    67.3
2,722.OO    50.0      7.7
2,632.oo    50.0     13.9
2,614.oo   61.6     28.8
10,623.40    59.2     19.2
3,948.40   65.2     35.4
2,734.OO    50.0     IO.9
12,173.00    70.7     27.3
27.940.40    44. I     42.3
2,722.OO    5w      8.2
2,632.oo    50.0      8.2
26,795&o    32.7     40.2
3,014,OO    50.9     17.0
58,873&O    50.0     49.1
3,232.00   So.0     15.3
279,992.45    52.6     32.0

LOCAL

FEDERAL
    PER CAP tTA

PEROENT

IN CENTS

PERCENT

TOTAL
  PER CAPlTA
   IN CENTS

57.1     23.1      100.0       40.4
39.1      14.1      100.0     36.0
59.2     20.4     100.0      34.5
26.4     7.3      100.0      27.7
50.0     50.0     too.0      100.0
74.2     51.2     100.0     68.9
59.0    44.1     100.0      74.7
50.0     30.9      100.0      61.8
39.9     44.6     to5.0      Ill.9
50.0      7.7      100.0       t5.4
50.0     13.9     100.0      27.8
38.4     18.0      100.0     466.8
40.8    13.2 .   too.0      32.4
35.3     18.9     100.0       54.2
50.0    10.9   100.0      21.8
29.3    II.3   lO0.0     38.6
55.9    53.6     100.0      95.9
50.0     8.2     100.0      16.4
50.0      8.2      100.0      k6.4
67.3     82.9      ICC.?     123.1
50.0     17.0      100.9      34.0
50.0 '   49.1      100.2       98.2
50.6     15.2     IC0.D      30.5
47.4     28.8     100.0     60.8

DENVER AND PUEBLO COUNTIES HAVE SEEN OMITTED BECAUSE OF LACK OF INFORMAT ION AS TO THEIR CO:rPLOE BUDGET8


PROVISIONS ljJH1C.H SHOULD BE INCLUDED
   IN A LOti EULTH BILL


     (Appendix C)


  A bill to permit the establishment of full-time county, city-county, or
combination of county health departments should ?Fovide:

(1)

(2)

(3)

(4)

(5)

(6)

0)

That the County Commissioners of any county may vote to establish
a full-time county health department.

That two, three or four but not over four counties may combine for
public health purposes to establish a full-time health department
by the favorable vote of the several Boards of County Commissioners.
More than four counties may combine for Dublic health purposes only
with the psrmission of the State Health Officer.

That the city-county, county or counties involved in the establish-
ment of a full-time health department may, through their duly
constituted appropriating bodies, appropriate such funds as may be
necessary for the operation and maintenance of such full-time
health department.

That where available tax funds are insufficient for the maintenance
end operation of the health department the County Commissioners of
the county or the several counties included in the proposed health
department may by a majority vote levy a tax of not to exceed one
mill per each dollar of assessed valuation for maintaining and
orerating such department.

That in such county, or multiple county, health departments,
cities of under 50,000 population (as shown in the last U. S.
Census) shall become integral parts, for purposes of public health
administration, of such health departments.
That cities of over 50,000 population (as shown in the last U. S.
Census) may elect to come into the county or multiple county health
department or to maintain their own health departments. If a city
of over 50,000 Do@ation decides to maintain its own health
department,  it must have a full-time qualified health officer (a
health officer meeting the qualifications for full-time health
officers as established by the State Board of Xealth).

  (This and tho preceding provision PJC based on the premise
that it is not economical for a city of less than 50,000 population
to maintain its own independent health department rnd that, if it
is large enough to support its own depcrtment, it should be required
to employ properly qualified personnel to conduct it.)

That nothing in this bill shall be construed as in any way intcr-
fering with the appointment., prerogatives, or financial support
of local boards of health, health officers or other locrtl ho?Jth
personnel except that the full-time county or multiple county
health officer shall be the senior health officer of the area and
shall have general supervision.over other health officers of the
area except full-time qualified health officers of cities of over
50,000 pomlation.

(Appendix C - I)


(8 ) T&hat, similarly, nothing in tho bill should be construed as
  preventing other local health jurisdictions in full-time county
  or multiple county health department areas from abolishing such
  local health jurisdiction functions if they so desire.

(9) That the properly constituted authorities, in a county or counties
  establishing full-time health departments, be authorized to
  negotiate with the State Dopzrtmcr,t of Public Hc?Jth for such
  financir.1 assistance for the operation ,and maintenance of the
  full-time county or multiple county health department as the St;.te
  Department of Public Health may be able to provide through sto-te
  ' -a.- f 0a0rd. f~ikt.

(10) That the properly constituted authorities in a county or counties
  establishing full-time health departments be authorized to accent
  private funds, d0mti0ns, progcrty and materials for the use of
   such health departments.

(11) That there be a Board of Eealth as the advisory, judiciary, policy
  forming, `but not executive body, for each such county, multiple
  county or city-county health department established in accordance
  with the provisions of this act.

(12) That the Board of Health of a single county Health Degartmcnt be
  appointed by the Chairman of the Soard of County Commissioners and
  consist of five members, appointed for five year staggered terms
  of office, two of whom should be physicians and three from other
   walks of life.

(13) That the Board of Health of a combined City-County Iiealth Depnt-
  mcnt consist of five members, three of whom should be appointed
  by the Chairmr?n of the Board of County Commissioners, one of whom
  should be a physician, and two should bo appointed by the Mayor
  of the City, one of whom should be a physician.  If the population
  of the city is larger than the population of the remainder of the
  county, then the city should appoint three nembors and the county
    two.  At the time of origin21 a?pointncnt the five members thus
  appointed should determine by lot which members shall serve
  respectively for one, two, three, four md five years. All sub-
   sequent amointments should be for five year terms.
(14) That where two or more counties establish a Health De$artment the
  Chairman of the Board of County Commissioners of each participating
  county should qqoiht ono member of the Board of Health except that
  where only two counties are participating two members should be
  appointed from ccch county ,and the county having the larger po_pula-
  tion should appoint the fifth member.  Two members of the Board of
  Health, whether it be a Board for two, tkrce or more counties,
  should be phys icizna.  At the timo of original appointments of
  Boards established in accord?.nce with the provisions of this clause
  the ner;;bcrs thus appointed should determine by lot the length of
  term to be served by each member. A11 subsequent appointments
  should be for f ivo year terms,

(Appendix C - II)


(15)

Any Board of Health, established in accordance with the provisions
of any of the preceding clauses, should appoint a single fiscal
agent for the health Department.

(16)

That any Board of Health, established in accordance with the provis-
ions of any of the preceding clauses should have the right to make
such rules and regulations as it deems necessary for the protection
and promotion of health provided, however, that such rules and
regulations must not be in conflict with state legislation or with
rules and regulations of the State Board of Iiealth.  Rules and
regulations adopted by local boards of health may be more stringent
but not less stringent than state legislation or rules and regulations
of the State Board of Health.

07)

The Board of Health of any such county, multiple county, or cit:r-
county health department should appoint the health officer provided,
however, that he or she must meet the qualifications for such health
officers as are established by the State Roard of Health.

08)

The appointment of tho health officer should be for five years and
he or she may be rcuppointod at the discretion of th<j Hoard. The
health officer may bc removod at any time for cause but should have
the right to a hearing by the Board of Health.

(19)

That the health officer of a full-time city-county, county or mul-
tiple county health department should be rcsponsiblo for the
appointment of all other personnel in his or her department, provided,
however, that such personnel must meet the qualifications of training
and exporienci:  a s prescribed by the State Board of health.

(20)

That the health officer of any city-county, county, or combination
county health department shall observe such rules and regulations as
may from time to time be promulgnt6d by the State Department of Public
Health and shall m&o such reports as may bo required by such
Department.

Any city-county, county or multiple county health department tistab-
lished in accordance with the: provisions of this act may bc abolished
by a majority vote of the people of the area provided, howtiver, that
such vote shall be taken only if 10% or mori: of the electors have
petitioned for such vote.  MO popular vote -on the question of
abolishing a full-time health department should be taken until such
health department has been in existonce for at least two years.

It is

     fully appreciated that the legislation proposed in the preceding
seotions places no compulsion upon any unit of government.  It simply makes it
possible for the properly constituted county authorities to act if the people
want them to act.  This philosophy is based on the premise that sound public
health progress is seldom achieved by compulsion or compulsory legislation but
rather by a sound program of health education or health information.

(hppondix C - III)


Appendix D

Water Supplies and Sewerage Systems

(il brief summaryj


Appendix D

Colorado has about 178 communities of 200 or more population.

The following table gives a brief summary of the water supplies and

sewerage systems in these 178 communities:*

      Water Supplies

Adequate Supplies

Number

Percent

Supplies needing minor corrections

29         16.3
63         35.3

Total supplies in fairly good shape

92

51.6

Supplies needing treatment                     64         36.0
Supplies needing other major corrections          14          7.9
Communities with no water systems                8         4.5

Total Communities needing real improvement

                     Grand total

86

178

48.4

100.0

Seworage Systems

With adequate systems and adequate treatment      16         9.2
Only minor corrections needed                     9         5,l
Sewerage systems impractical                     3         1.7

Total in fairly good shape                     28         16.0

Communities with no systems                     79        45.2
Systems with no treatment                      41        23.4
Systems with inadequate treatment               21         12.0
Communities with inadequate systems               6         3.4

Total Communities needing real improvement

                     Grand total

147


175


3


178

84.0


100.0

Towns for which no information was obtained

Total

  *Data obtained from a report compiled January 25, 1946 by H. Id. Giges,
                  _ .
kss't. Engineer (R) U.S.P.H.S. Dist, $8, from information obtained by the
U.S.P.H.S. through a state-wide sanitary facilities survey conducted September
to Iiwsmber, 1945.