Glossary of health care terminology

: .0 . 1-t-0/ 13..u 0 . I PUBLIC HEALTH IN EUROPE 4 by James Hogarth •, ... i • ' . . ·.: t, .. . • • • .. . -. , ~ . : . • ·' • .. •' ::::.~·- • . ,.,,. ~.,..,,,.,. REGIONAL OFFICE FOR EUROPE World Health Organization . Copenhagen 1975

No. 4 GLOSSARY OF HEALTH CARE TERMI NOLOGY by Jam es Hogarth Not for Sale Distributed by th e REGIO NAL OFFICE FOR EUROP E Wo rld Health Organi zation COPENHA GE N 197 5 Note Data and excerpts from "Public Health in Europe" may be reproduced provided that the source of the re- printed text is acknowledged . For rights articles in toto, gional Office for applications . of reproduction or translation of the application should be made to the Re - Europe. The Office welcomes such Authors alone are responsible for views expressed in signed articles . ii Reissued under ISBN: 9789289023634 (print) in 2025. Originally published under ISBN-10: 9290201231. ISBN 92 9020 123 1 ISSN 0300-4880 © World Health Organization 1975 Introdu c tion Cons pectus Gl os s ;-try R efe ren ces I nd e x . CO NTENTS Page 1 4 13 395 463 iii FOREWORD The WHO Regional Office for Europe produces a large amount of documehtation and continually has to face the problem of terminology. Governments face the same problem in their contacts with the Organization and when analysing information on health services from international sources, In order to assist in the standardization of public health terminology, the WHO Regional Office for Europe commissioned Mr James Hogarth, formerly Under-Secretary, Scottish Home and Health Department, to prepare a Glossary of such terminology and we are greatly indebted to him for the effort he has devoted to the task and the skill with which he has carried it out. The Glossary is being first issued in the Public Health in Europe series and, exceptionally, in English only, but it will later be published by WHO with versions in French and perhaps other languages. To make the Glossary as comprehensive as possible, the con1ments and criticisms of users are invited. They will be taken into account when the Glossary is published. Leo A. Kaprio, Regional Director Copenhagen, June 1975 iv INTRODUCTION This Glossary, commissioned by the European Regional Office of WHO, seeks to bring together in convenient form definitions of terms com- monly us ed in discussions on health care. The possibility of misunder- standing, of talking at cross purposes, is present in all human communica- tion; and the possibility is all the greater in international discussions when the participants come from different backgrounds of experience and speak different languages. Realizing the difficulti e s of terminology, WHO committees and working groups have increasingly tended in recent years to include in their reports some consideration of the definitions adopted for the terms used in their discussions; and indeed this Glossary is essentially an anthology of terms which have been defined in the numerous reports produced by WHO and EURO bodies since 1948. The Glossary is therefore, deliberately and in principle, confined to terms which have been defined, expressly or by implication, in documents used or issued by WHO, with the addition of a limited number of "outside" definitions - particularly those used by other international organizations - where these us efully supplement the terms defined in WHO documents. None of the definitions - apart from the definition of "health", which a ppe ar s in the Constitution of WHO, and perhaps one or two other terms which have been specifically considered by the World Health Assembly - c arry any mandatory authority. They reflect merely the considered views of a particular author or a group of people (an expert committee, scientific group, seminar, symposium or working group ) brought together by WHO for a particular purpos e . Evidently, however, the definitions formulated by thes e various experts and expert groups must carry considerable weight with others working in the particular fields concerned; and even though further consideration, or the development of the field under review, may suggest a need for modification the existing definitions still provide a use- ful starting point. The Glossary therefore relies heavily on the reports of WHO committe e s published in the Technical Report Series and on the numerous reports produced under the EURO imprint, as well as on studies published as Public Health Papers or WHO Monographs. The compilation of the Glossary has revealed some variation and occasional inconsistency in the definitions which have been used in WHO discussions over the past quarter of a century and more. This is of course entirely understandable in a field which has been developing very rapidly during that p eriod. Inevitably, too, there are many gaps in the Glossary, either because the meaning of certain terms used by a commit- tee or working group gave rise to no difficulty and was taken for granted, or because committees and working groups did not always frame a con- veniently quotable definition - or of course because the compiler, in the mass of documentation at his disposal, failed to track down the definition he needed. I have not seen it as my function to resolve any differences of view between different expert committees and working groups about the meaning of particular terms. In some cases I have set down two or more different definitions so that some future committee or working group may have the opportunity of considering the matter further and perhaps resolving any apparent inconsistency; in others I have ventured on a brief discussion and occasionally suggested a preference. But essentially the Glossary depends on the work of the many expert groups which have formulated the definitions, and it must be for futur e groups of this kind to examine any difficulties of terminology and to fill a ny gaps which the preparation of this Glossary has brought to light. The present Glossary must be regarded as a first edition, imperfect in its present form, which can be improved and com- pleted as the years go on. The Glossary has been prepared in English and on the basis of the English texts of WHO documents. It is therefore inevitably conditioned by English language habits and terminology. Some of the difficulties of terminology noted in the Glossary may not arise in the other official WHO languages; and these other languages may have difficulties peculiar to themselves. The process of translation into other languages may also re- veal particular dangers of misconception as between one language and another. I have occasionally referred to this kind of difficulty in the present Glossary: it may be hoped, however, that some future edition will have more to say on this subject in the light of comparison with the editions in other WHO languages. The Glossary - which consists of some 350 main entries, with re- ferences to many more terms, all of which are listed in the Index - has been arranged in alphabetical order, without any attempt at systematic arrangement. It is tempting to imagine a fully articulated presentation of the subject matter in logical grouping. This may be possible some day; but at the present stage the material is not available to fill out a complete scheme covering the whole of the wide-ranging field of health care. For a working tool which is confessedly incomplete, but can be completed with the help of those who use it, an alphabetical layout seemed the most con- venient arrangement. It has seemed useful, however, to prefix a Conspectus or general survey of the ground covered by the Glossary, arranged in a rough logical sequence. In order to keep this within reasonable bounds it is confined for the most part to the main entries in the Glossary, with a few of the other terms referred to where it seemed helpful to include them. The Con- spectus does not pretend to any great systematic rigour, but it may serve to indicate the general scope of the Glossary and point to some of the gaps in the available stock of definitions. It may thus help to secure one of the objects of the Glossary - to provide a stimulus towards the creation of a fuller terminology of health care, which it may be possible one day to present in more systematic form. 2 The field covered by a glossary of health care terminology is a wide one, as the definition of the term "health c a re" itself suggests. But the Glossary must go even wider than that definition implies, since the dis- cussion of modern health care inevitably leads into a variety of marginal fields: not only into the consideration of clinical matte rs, but also into the specia lized vocabulary of management and planning. The Glossary do e s not concern itself with clinical terminology, and it doe s not seek to com- pete with the various specialized glossaries and terminology lists which a lr eady exist in the various peripheral fields. It do e s, however, includ e a selection of commonly used terms in these fields which have featur e d or are likely to fe a ture in th e discussions of WHO committees and working groups. I a m grateful to a ll those members of the WHO staff in Copenhagen and Geneva who have h e lpe d m e with advice, r efer ence s an d the stimula tion of discussion. I owe a ve ry great de a l to the gene r o sity with which they have put th e ir knowle d ge a nd expe ri e nce - and th e ir tim e - a t my dispos a l. I hope that the y may find something of value in the result. 3 J a m e s Hogarth De c ember 197 4 CONSPECTUS This Cons p ectu s is a rrang ed und e r the followin g h eadings: Health ca r e H ealth s e r vices Resour ce s: finance, m a npower, buildin gs Drugs Man agement, pl a nning , st a tisti c s. T e rms defined in th e Gloss a r y a r e und e rlin e d. Health c are 1. Health ca r e a ims at th e h ealth pr otection of the popul a tion of a g iven a r ea a nd at m a int a ining a nd improving the health st a tu s of that population . It is conce rn e d wit h th e promoti on of health - not onl y physi cal health (including d ental h ealth a nd physi cal fitn e ss) but m ental he a lth. It is a ls o, in con s eque n ce, concerned with si c kn ess or mo r b idity (bot h ac ute and chroni c disease); an d , inevitably , with mortality . It ext e nds from the c radle to the g rave, from m a ternity care to geriatrics a nd the proble ms of old a ge; indeed it begins ea rli e r than the c r ad l e, with fa mily pl a nning a nd with the con sid e r a tion of fertility a nd infert ility. 2. Health ca r e goes wider tha n m e di cal ca r e to e mbr ace nursing ca r e , dental care and many as soc iated fo rms of ca r e not sepa r ate ly defin e d in the Gloss a ry. 3 . Health ca re is ne ces s a rily orientat ed towards p atient ca r e, provid ed for a particula r p atient (who may be an insur ed p e rson or a beneficiary of a social s ec urity s c hem e) or a particula r patient ca r e group. The ca r e may be given to the family as a whol e , a nd muc h h ealth ca r e is directed towards the whol e of a given community. 4. Th e great bulk of h ealth c are (medic al ca r e) is pr imary ca re (primary medical care). Prima ry medical care is the provinc e of primary medic ine. Other forms of care are some time s called s econdary ca r e and t e rtiary care. 5 . Health care may be given to in-patients, out-pati e nts or d a y p a ti e nts; it includes ambulatory care, home ca re or domiciliary care, community care and day care. The term progr e ssive patient car e cove rs a range 4 extending from intensive care (or intensive the rapy), thr o ug h intermediate care and self - care (minimal care) to long - term care. 6. Mental h ealth care (mental hygiene) is concerned with mental disord e r, c overing both mental illness and mental ret a rdation (a t e rm for which ther e a r e a variety of a lternative designations) . Delinquency may be consider ed as fa ll ing within this general field. 7. Forms of m ental h ealth care which a re d e fined in th e Glossary a re soc ial psyc hiatry, psychogeriatrics a nd child guidance . 8. Mat e rnity care is conce rned with the h e alth of th e c hild a s well as the mother; with birth (live birth, stillbirth), but a lso w i th fetal death, a bortion a nd miscarria e; with th e problems of pre maturity and th e ~ - term (or post-term infant; with infant mortality and a lli ed c oncepts like p e rinatal mortality a nd neonatal, ea rly neonatal a nd post-neonatal mortality; and with th e mother's health in the post-pa rtum p er iod . g Rehabilitation and rehabilitative services (covering medical , social and vocational r e habilitation, including vocational counselling and selective place m e nt) a r e a n eces sary p a rt of health ca r e . They are c on- ce rned with th e sequence of impairment (resulting from acc ident, dis e ase or c ongenital causes), disability, h a ndicap a nd invalidity , and with th e c are of disabl ed persons and disabling illness. 10. He a lth ca r e is concerned a lso with food, nutriti on a nd di e t. This e ntails c onsid e r at ion of food standards ge n erally (includ ing~d additives), a nd of food hygi e ne or food sanitation (including food handling) . P arti cul a r health p robl e ms that m a y arise in this f ield are nutritiona l disorders, d e ficiency diseases a nd food poisoning or food-borne diseases. Th e effect of these various factors will determin e the nutrition a l st a tus of a p e rson or popul a tion. The "reference m a n" and "r efe r e n ce woman" provide a basis of comparison for m e asuring food requirements. 11. The unit of health care provided to individual patients can be described a s a cons ultation, a term which m a y cover a v isit by a physician or other health worker to a patient or an attendance by a patient at premises where h e alth care is provid ed . The term medi ca l a dvice is a pplied to a consulta- tion by a physic i a n. Health services 12 . Health care is prov ided by health services (the h e alth infrastructure) organized in a health service system. Health servic e s include not only medica l services but nursing and dental health servic e s as well as a wide range of other service s. One particular servi ce defin ed in the Glossary is a health laboratory service. 5 13. Health care may be provided under a system of social security, a national health service, a (less comprehensive) scheme of social i nsurance or Ue ss commonly nowadays) social assistance. 14. The health profile of any area describes its health status and its health services. 15. Services may be organized on various levels. The organization of services may be based on the principle of centralization or of decentraliz a - tion. A local health area may be served by a local health unit, an inter- mediate area by an intermediate health administration. The intermediate area may be a region, with regionalization of services. The integration of services, on a local, regional or national basis, may be regarded as a desirable objective. 16. In the organization of health services the importance of public re- lations and the need for consumer research must not be forgotten . 17. Traditionally a distinction has been made between public health services (including particularly environmental health services) and personal health services. In recent years the scope of public health has been widely extended, and new concepts like social medicine, community health and community medicine have emerged . The term comprehensive medicine has also been used. 18. A special aspect of public health, is veterinary public health, con- cerned in particular with food hygiene and the zoonoses. Two particular fields defined in the Glossary are public health nursing and public health ophthalmology. 19. Environmental health includes environmental sanitation and sanitary inspection. It is concerned with air pollution and water pollution. One activity which also falls into place here is disinsection. 20. Preventive medicine and the pre ventive services cover a wide field, extended by the concepts of primary, secondary and tertiary prevention. Health education (including dental health education) has an important part to play in this field, as have health surveys (morbidity surveys) and the various forms of early disease detection - a term which covers all forms of e idemiolo ical sur vei llanc e or epidemiological survey (including a "population laboratory " , scr eening and case-finding, as well as ~ campaigns. 21. Epidemiology has much extended its scope in modern medical care. 22. An important and developing service is occupational health. 23. The health services must a lso have links with social work and such special services as the youth advisory service. 6 Resources: finance, manpower, buildings 24 . Among the main resources required for the provision of health care and the main constraints on its provision - are finance, manpower and buildings. One type of resource, drugs, raises particular problems of its own. Finance 25. Health s e rvices are limited by their budget (for both capital expendi- tur e and revenue expenditure), and proper budgetary control is there- fore required, involving careful costing and watching over costs. Some of the management techniques referred to below are techniques of financial control. Cost-efficiency (the economic use of r e sources) is an important objective, and t e chniques of cost-effectiveness analysis an d cost-benefit analysis are employed to achieve it. Health care, like other activities, has to compete for its share of the gross national product. Manpower 26. The largest single r e source deployed in h ealth c a re is manpower, specifically health manpower. Its most effective deployment depends on health manpow e r planning. 27. The distinction b e tween professional, paramedica l and auxiliary personnel is sometimes a difficult one. Th e object must, however, be to ensure that all types of health care personnel work together a s a team. 28. Each member of the team has his or her own job . This involves the concepts of job analysis, job description, job specification and job evaluation. Ergonomics may have an application here. Job performanc e can be assessed by activity studies. 29. Relationships between staff may be line relationships, lateral relations, functional relations or staff relations . 30. Medical care is provided by a physician (doctor, medical practitioner). He may be a specialist or a generalist (general practitioner, family doctor, family physician). The only type of specialist separately defined in the Glossary is a radiologist. Definitions are, however, given for certain fields of medical practice (general practice and the specialist fields of b acte riology, geriatrics and psychogeriatrics, medical physics, paediatrics, pathology, physical medicine, tahysiology and radiation medicine) and associated professional fields audiology, occupational therapy, physio- therapy and speech therapy. 7 31. Primary medical care is provided by a primary physician, who may or may not be a genera l practitioner, and may or may not be the physician of first contact. 32. General prac tice, one of the possible patterns for the prov1s1on of primary medical care, may take the form of group practic e or individual practic e; partnership is one form of group practice. A ssistance may be obtained from an emergency call service. 33. Physicia ns with special fields of activity are public health physicians, district physicians and child health doctors. 34. A type of a uxiliary medical personnel found in some countries is the medical assistant. 35. The r emuneration of physician s may be by fee-for-service or, in an organized system of medical care, by capitation or salary. 36. Nursing car e is provided by nursing p er sonnel , a term which includes nurses (wh e th e r employed in hospital, as public health nurses or in other fields of nursing) and auxiliary nursing p e rsonnel, and may a lso in some contexts include midwives. Working together, they form the nur sing care te a m . The organization within which nursing car e is provide d is a ~ng service, and the nursing personnel are deployed under a nursing p ersonnel system. The range of work of nursing p er sonnel is defined as nursing practice . 37. The personnel engaged in the prov1s1on of dental health services (or in dental practic e) include th e dentist (or stomatologist) and a variety of dental auxiliaries (chairside assi stants, dental hygienists, dental nurses, dental laboratory technici a ns), as well as dental administrators. Working together, they form the dental health team. 38. Other types of health car e personn e l defined in the Glossary are public health officers, sanitary inspectors and sanitary engineer s, health educators and management technologists. 39. Consideration must be given to the training of staff. Under this heading two broad fields are defined: medical education and nursing education, in each of which a number of different sta ges are distinguished. Two items in the medical curriculum which are defined are the basic medical sciences and the behavioural sciences. A special field of training is public he a lth training . Buildings 40. The buildings in which and from which health care may be provided include premises for both in-patient and ambulatory care. 8 41. The main in-patient establishment is the hospital. are the day hospital and the night hospital. V a ri a nts of this 42. A hospital may contain an intensive care unit (intensive therapy unit). 43. The unit of hospital accommodation is the hospital bed. The use of beds is measured by statistics of admissions, bed occupancy and discharges 44. Other forms of residential car e may be provided in a nursing home, geriatric home, half-way house, night hostel or protected residence. 45. Ambulatory care may be provided in an out -patient clinic (department) or in some form of primary care centre (health centre, polyclinic, dispensary), in a day care centre or in day patient facilities. A child guidance centre provides a special form of out-pa tien t c a r e. 46. Premises indirectly concerned with health car e are medical schools and schools of public health. Drugs 47. The definition of a drug raises the difficulty of distinguishing between the general meaning of the term (pharmaceutical pr eparation) and its specific modern use, r eferring to a substance (e.g. a psychotropic drug) capable of being misused and of producing undesirable medical or social effects. 48. The safety of drugs in general is watched over by drug monitoring (of adverse reactions). The efficacy of a drug may be te sted by a double - blind or single - blind trial. 49. Continuing use of a drug may lead to tolerance. 50 . The non-medical us e of drugs raises the problem of drug abuse and the possibility of drug dependence (the term now recommended to cover drug addiction and drug habituation). This creates the need for drug control. Certain drugs may be dependence-producing (addiction-producing, habit-forming). 51. Alcoholism may be consider ed a form of drug dependence. Management1 planning, statistics 52. Since modern health care implies a substanti al organization for its provision, the Glossary inevitably extends into the field of management and administration. 9 53. Management may make use of various management techniques, including budgetary control, cost-benefit analysis, cost-effectiveness analysis, critical path analysis, cybernetics, linear ro rammin , management accounting, network analysis, operational research a term which comprehends many of the techniques here listed), organization and methods, output budgeting, PERT, PPBS, project systems analysis, applications of queueing theory, simulation (including the use of models), systems analysis and work study. Consideration must be given to the scope for automation or mechanization. 54. Management also depends on the existence of a management informa- tion system. 55. Management implies planning, and health servic es must therefore be concerned with plans and planning of various kinds, including national development planning and r egional planning, and, more specifically, with health planning or national h ealth planning. One important field of health planning is health manpower plan"1ing. 56. Planning is conc erned with assessing the need and demand for health services, consid e ring the resources likely to be available, and setting goals, objectives and targets (which are to be distinguished from projec- tions or forecasts), norms a nd standards. 57. A plan may comprise a number of programmes, and programming can be considered as a subdivision of planning. A programme will pro- vide for the appropriate a lloc a tion of resources and r e sponsibilities. It may comprehend differ ent functions, and may be broken down into a series of projects or activities, which m ay in turn consist of a set of tasks. A pilot progr amme or a field trial may be mounted for a particular purpose. 58. Planning is concerned with th e operation of a system, and must therefore pay attention to systems design. Systems a nalysis has already been noted as one of the techniques of management. 59. Planning should be accompanied by evaluation of the services pro- vided. This involves monitoring their operation (in relation to appropri - ate baseline data) and assessing their effectiveness, efficiency, adequacy and a ppropriateness; determining the validity of these results; measuring the coverage and consumption of services; and weighing the inputs against the outputs (effects, outcomes). The concept of satisficing, as distinguished from optimizing, may be found useful here. There ought always to be some feedback from the process of evaluation . 60. Situation analysis is a form of assessment which falls short of evaluation. 61. Medical audit and nursing audit are methods of evaluating profes- sional services. 10 62. Planning d e pends on information, and thus on the existence of a health information syste m. This in turn depends on th e availability of statistics based on appropriate tJarameter s, including vital statistics (vital records) and informationhealth indic e s, indicators) on the incid ence a nd prevalence of disease and disability. 63 . Statistics of dise a s e depend on appropriate notific a tion a nd r egis tr a ti on arrangements . 64. In this connexion the use of such terms as rate or r a tio (birth r a t e , death rate , fertility rate, morbidity r a te, etc .) and average;~' mode or median requires care. And p e rhaps a c a ution about th e use of the t e rm billion may b e a ppropri a te h e r e. 65. Concepts whi ch fall into this genera l field are record linkage; data processing and data bank; sample, sampling and s a mpling unit; universe and population; cohort and cohort analysis; an d such speci a l t e rms a s the De lphi method. 66 . Provision must also b e m a de for research . Apart from clinica l r e- s earch, this includes h ea lth pr a ctic e res ea rch and, in the management field, operationa l r e s earc h a nd systems r e s ea rch. P a rticula r forms of r e s earch a r e action research a nd public health field studi e s. The conc e pt of rese a rch and development is a lso of importa nce. 11 ABORTION The definition of abortion has been the subject of much discussion, and there is still considerable variation from country to country. A use- ful summary is to be found in the Report {1970){1) of a WHO Scientifi c Group on Spontaneous and Induced A bortion: "As used b y the medical profession, the term ' a bortion' denot e s the termination of a pregna n cy before the fetus has attained viability, i.e. become cap a ble of independent extra-uterine life . Vi a bility is usu a lly defined in terms of duration of pregnancy and/or weight of fetus, or o cca - sionally length of fetus . A r ece nt inquir y by WHO r evealed considerable variation in th e definitions us e d in differ e nt countri es . (2) "It h a s traditionally b een assumed tha t v i a bility is a tta ined at 28 weeks of gestation, corres ponding to a fetal w e ight of approximately 10 00 g. This definition is based on th e observation th a t infants below this weight have little chance of survival, while the mortality of infants above 1000 g decline s rapidly . In recent yea rs som e au thorities have pla ced the upper limit of abortion at 2 0 we ek s or at 500 or even 4 00 g, because some infants of this weight have in fact sur v i ved, and the t e rm 'immature ' h as been used to describ e fetuses weighing between 500 {o r 400) and 1 000 g . The etiologi cal and clinical factors associated with intermedia te fetal deaths {20-27 weeks) are in fa ct more similar to those found later in pregnancy than to those found in the early group. "Mo st members of the S c ientifi c Group expr essed a pr e feren ce for 20 weeks as th e upper ges t a tiona l limit in defining abort ion . The tr a di- tional limit of 28 weeks h as be en r e t a ine d in this report, however, because it is used by most of th e countries that have adopted a definition of abortion, because it complements the definition of stillbirth r ecommended by the WHO Expert Committee on Health Statistics ( 3) ... and bec a use it co rr es- ponds to a definition given in the International Classification of Diseases. T he choice of upper gestational limit is relative ly unimportant as regards the incid e nce of abortion, since fet a l de a ths in the p e riod 20-27 weeks are far outnumbered by those o ccurring before 20 weeks . The choice is of greater importa n ce when dealing with statistics rel a ting to perinatal mortality . " The S cientific Group noted that from a clinical point of view it was important to make a distinction be-tween earl1 abortions {less than 12 com-pleted weeks of ges tation) and late abortions over 12 weeks ). There are two major categories of abortion, induced and spontaneous: induced abortions: those terminated by deliberate action undertaken with the intention of terminating pregnancy; 13 ABORTION ( contd) spontaneous abortions: all other abortions, even if an external cause such as trauma or communicable disease is involved . ( 4) Other classifications are: therapeutic abortion: an abortion which is induced for medical reasons; legal abortion: an induced abortion permitted by the laws of the area; illegal abortion: an abortion not permitted by l aw. ( 5) 11 The t e rm 'miscarriage ' is employed by the lay public as equivalent to spontaneous abortion; i ts use in a scientific context is obsolescent and is not r ecommended. 11 ( 6) A semantic distinction should be made between abortion ( the process of expulsion or removal of the product of conception) and abortus ( the product of conception itself after its expulsion or removal). ( 7) Abortion rate : the number of abortions per 1000 live births. ( 5) Total abortion rate: the number of all types of abortion, usually per 1000 women of child-bearing age. ( 5) 14 ACCIDENT "An unpremeditated event resulting in a recognizable injury. 11 (1) "An unexp e cted, unplanned occurrenc e which m a y involve injury. "(2) 15 ACTION RESEARCH "In a situa tion whe r e it is desir e d to e valuate a n e st a blished prog- r a mm e tha t is a lr eady b e ing a pplied throughout a n ar ea , it m a y b e n ec es- s a ry to _i n t r oduce diffe r e nt pro<;:e dur e s -a nd acti v itie s , in on e or more parts of t hat a r ea, d es i g n ed t o ac hieve the s a m e o bj ec tive s a s th e programme to b e e va lua t ed . The s e ex p e rime ntal proj ects o r progr a mme s the n a c t as a c hall e n ge to (o r, in on e s ens e , a ' c ontrol' f o r) the e st a blishe d progra mm e s. This proce dur e is some tim e s t e rmed ' ac tion r e sear c h '. 11 (1) A mor e t ec hni cal definit i on was g ive n in the R e p o rt o f a WHO S c i e n- t i f i c Gr o up m 197 0 (2): 11The m a nipul a tion of s e rvice inputs to t e st the ir r e l a ti ve impac t 1n c ontroll e d exp e rime nts . 11 16 ACTIVITY "A gene ral cat egory of work p e rformed by personnel in the attain - ment of a n objective , e.g . hom e visiting, r efe rral, couns e lling, Each act ivity comprises a group of t a sks, and a g roup of ac tiviti es c onstitutes a method of carrying out a function. "(l) A c tivity is sometime s r ega r ded a s e quivalent to proj ec t (q.v.), sometim e s as a sub-unit of a proj ect . 17 ACTIVITY STUDIES "Studie s c arri e d out usually to analys e th e work of groups and indi - v iduals ov e r a g i ve n p e riod, e.g . one w ee k or one month, during which a ll the a c tiv iti e s during the wo rk p e riod a r e cat eg oriz e d and e x a mine d. The studi e s endeav our to c h ec k the e ffici e n c y of the work b e haviour a nd the value of the work p e rform ed - in t e rms of s e r v i ce . 11 (1) 18 AC UTE (DISEASE, ILLNESS) The difficulty of definition was c omm e nt ed on by a EURO Symposium m 1965 (1): "Up to now no widely acceptable definition (of ac ut e and chronic pati e nts) has b een found. Some authors m a intain that a n ac ut e illn e ss usually consists of a single e pisode of fairly short dur a tion from whi c h th e p a ti e nt returns to normal activity, whereas a ch r oni c illnes s is one of lon g dur a tion in which the patient is p e rman e ntly incap ac itat ed to a mor e o r less marke d degree . There is a lso the view that pr og r e ss in th e t ech - nology of resuscitation a nd h ae mobiology (has) blurred the borderline be- tween ac ute a nd chronic conditions. Thos e who belong to this s c hool of thought prefer to speak of medical a nd nursing d ependency or of rhythm of ca re, an acute illness requiring frequent m edical and nursing ca r e a nd a c hroni c illness episodic m ed i cal a nd nursing ca r e ." The following is a re cent American definition (2): "Dis ea s e h av in g a short a n d r e l at i vely s eve r e course." S ee chronic. 19 ADDICTION-PRODUCI NG DRUG This t e rm was defin e d in the 2nd Report (1950) ( 1) of the WHO Expert Committee on Ad di ct ion-Produc ing Drugs (now the Expert Committee on Drug Dependence) as follows: "An a ddi c tion-produ c ing drug is one which produce s a ddi c tion as de f in e d . " (For th e Committe e ' s d efinition of addi c tion, se e drug a ddiction . ) The term add i c tion-produ c ing drug was suggested in substitution for the ea rlier term addiction-forming drug . In acco rdance wi th the r ecomm e nd a tion in the Expert Committee ' s 13th R e port (1964) that the term d r ug d e p e ndence (q . v.) shoul d repl ace the terms drug addiction and drug habituation (qq. v. ), the te r m addiction - producing drug (al ong with habit-forming drug) should now give p l ace to dep e nden ce -producin g drug (q . v . ) . 20 ADEQUACY "The allocation of ac tivities and resources in m a nner a nd quantity suffi c i ent to permit the ac hi eve m ent of desired objectives. "(l) "Ad e quac y may h ave var ious meanings, but in this r e p o rt it is basically c onside red a s the measure of a programme ' s ac tua l coverage i n r e l a tion to its target popul a tion. "(2 ) 21 ADMINISTRATION This term must be discussed a long with management, sinc e no satis - fa ct ory distin c tion h as been d r awn between th em . They h ave bee n most simply defined a s " a s y stem whe r e by publi c and private e nt e rpris es condu c t th e i r busine ss" , with the c omm e nts th a t "admini str a tion s ee ms to be us ed more wit h refe r e n ce to publi c act i v iti e s w h e r ea s m a n age m e nt r efers ge n- e r a lly to private bu sin e ss" and that "m a nag e m e nt now a ppea rs to be th e mor e d y n a mic wo rd". ( 1) The r ecent t e ndency, howeve r, has been fo r in- c r ea sing attention to be p a id to m a n agement in th e publi c s e r vices a nd in consequ e n ce for increasing use to be made of management t e rminology . The fo ll owing ve r y gene r a l def ini tion of m a n a g eme nt is tak e n from an !LO publi cat i on (2): "Management i s the organisat i on a nd cont rol of human activity dir ected towa rd s spec ifi c ends . " With this m ay be compa r ed a n equally l apid a ry B ritish d e finition (3) : "The guidance of an undertakin g tow a rd s the achi evement of its purpos e ." A WHO Ex p e rt Committee sought in 1 q7 2 (4 ) to distinguish between adm inistration and managem e nt on the follow in g lines : "A dministr at ion is con ce rned with pl a nning, pr og ramming a nd evalua - tion. Man a g ement is a p a rt of administrat i on - a r a tional technique tha t c onnotes the ph a sing of administr a ti ve act i vitie s, enabling administr at ions to de vel op to the fu ll their human, te c hni cal and f in a n c i a l r e sources an d therefore to r e nd e r optimum service a t minimum cost ." Against this may b e c it e d the c omments in a r ece nt Public He a lth P a p e r (5 ): "The s e t e rms (administrat ion a nd man age m e nt ) a r e w id e l y a ppli ed , some tim e s with the int e ntion of making a distinction between them, but often int e r c hangeably. Distinction is som etim e s made, for instance , b e - tween administra tion a s conce rned with m a tt e rs of broad policy and m a n a g e m ent a s dealing with the execution of that poli cy and hence as a m a tter of subordina t e conce rn. Somet im e s the distinction is mad e the other way round ... None of the se distinc tions are helpful to the pres e nt dis c ussion since the y might c onvey the incorrect implic a tion tha t mod e rn t ec hnique s a r e a ppli cabl e to 'ma nage m ent ' a nd not t o ' a dministration' or vice versa. For the purpos e of this p a p e r, the r efo r e, the t e rms have been used without any distinction." 22 ADMINISTRATION (contd ) The functions involved in administration were d efined in 1959 (6 ) as follows: "l. the structur a l function - pl a nnin g , reac hin g d e c isions on poli cy o r <1 c tion . a nd c ontrolling; "2. the human fun c tion - handling people so as to obta in coope rative effo rt, s e l e c ting staff, or ganizing a nd manag ing them , c oordinating th e ir ,, c t iv iti e s, fo s t e ring the right clima te to promote the be st e fforts and e n- sur e p e rsonal and professional dev e lopment." A d e finiti o n suggest e d in 1973 (7) for m a n a g e m en t p a ralleled this, but ga ve more prominenc e to t h e "struc tur a l" than to th e "huma n " function: " C arr y in g out the following a c tivities: (a ) pl a nning and s e tting obj ec tive s; (b) organizing avail a ble resour ce s; (c ) moti v ating and training staff a t all l e v e ls; (d) c ontr o lling th e fulfilment of th e pl a n." T h is d ef inition w a s expa nded in an a n a l y sis of t he m a n a ge m ent p r o - ce ss in t he P ub li c He a lth Pa p e r (8 ) a lr eady r e f e rr ed t o : "Whe ther in the he a lth servic e s or els ewh e r e, the m a n a geme nt pro- c e ss inv olves ac tiviti e s of the follo w ing kinds: ( 1) s c anning the object being managed, and the influences that surround i t , and dia gnosing pres e nt and future probl e ms; (2) formulating the se problems so as t o a ssess t h e ir signifi can c e , a n d to d e fine aims a nd objectives; (3 ) g en e r a ting alt e rn a tive m eans of me e tin g th e obj ec tives, examin- ing th em a nd choosing between th e m; (4 ) obtaining {a lways subject to constraints) the resources {ma t e rial , human a nd finan c i a l) necessary to implement the c hosen means; (5) d efining tasks (of organiz a tion as w e ll as of individuals or groups ) in such a way as to make e ffectiv e use of available skills; (6) d e veloping and e nlarging skills and capabiliti e s; 23 ADMI NISTRA TIO N (c ontd) (7) motivating people t o acce pt th e obje c tiv e s a nd to work to wa r d s th e m by th e c hose n m eans; (8 ) m onitorin g , c ontrol a nd evalua tion so as t o a d a pt th e c h osen m ean s i n acco r dance w ith ex p e ri e n ce. 11 24 ADMISSIO N (TO HOSPITAL) "The acceptance of a person by a hospital as an in-patient. "(l) "An admission must involve a stay in hospital l a sting one night or more, irrespective of whether the patient is admitted for the first time, re a dmitted fo r a condition for which in-patient treatment has a lr eady b een given or transferred from another hospital. "(2) Admission rate: " the annual numb e r of a dmissions for a population of 1000".( 3) 25 ADVERSE REACTION (TO A DRUG) This term was d e fined in the Report of a WHO Meeting on Inter- national Drug Monitoring ( 1972) (1) as follows : "An a dvers e r eac tion to a drug is one that is noxious, is unint e nd ed a nd occurs at doses normally used in m a n ." A simil a r definition was given in the Report (2) of an earlier WHO Me e ting on the sam e subj ec t, which not e d that the definition should not b e applied rigidly but might vary for differ e nt centr e s a nd under diffe r e nt circumstances, provid ed that suc h va ri a tions did not result in ambiguity. 26 AIR POLLUTIO N "In a strict sense, pollution of the atmosphere can b e said to exist w h e neve r a ny subst ance, a side from the ine rt a ir g a s e s a nd moisture , is pr e s e nt in tha t a tmosph e r e w hi c h doe s not s e rv e a us eful fun c tion. Un- pollut e d a ir in this s e ns e, howeve r , is rar e l y found on earth. It is r e ason- a bl e , th e refor e , to c onside r that the t e rm a ir pollution be limited to the situations in whi c h the outdoor a mbi e nt a tmosph e re contains materi a ls in c on c entrations which ar e h a rmful to m a n or t o his e nvironment. The C ommitt e e , in c onside rin g this definiti on a n d its own r e sponsibility , h a s d ec id e d to limit itself to m an-made pollution only a nd to exclude from con- side ration the pollutants of natura l o r ig ins, suc h a s pollen, products of v olcanic a c tiv it y or of the d ecay of ro cks a n d organi c m a tt e r, and dusts from outsid e th e ea rth ' s a tmosph e r e . "(l) 27 A L C OH O LIS M The di ff i c ulti e s of d e finition o f this t e rm w e r e discuss e d in th e I st R e p o rt (1 95 1) ( 1) of th e A lcoholism Subcommittee of th e WHO E xpert C om- m itt ee on Me nt a l Health , w hi c h n ot e d tha t th e t e rm ch roni c a lcoholism w a s us e d in a d iffe r e nt s e ns e in prac ti cally eve r y c ountr y r e pr e s e nt e d on th e Sub c ommitt ee : in its n a rrowe st connot a tion it i m pli e d a st a t e in w hi c h an indi v idua l , a s a r e sult of lon g - ontinu e d drinking, h a d sust a ine d p e rma nent organi c d a m age or s e rious m e nt a l d e t e ri o rati on pre suma bl y d e p e ndent on su c h or gani c c ha n ge s , whil e a t th e oth e r e nd of the s cal e it w a s us e d in som e c ountri es in a mu c h br oad e r s e ns e to m ean c ontinue d e x ce ssive drinkin g r ega r d l e ss of irr eve rsi b l e ph y si cal or psyc hi c dam age . The Sub - committ ee its e lf sugge st e d th e fo llo w in g d ef initi on o f a lcoholism: " An y form of drinking w hi c h in its e xt e nt goe s be yond th e tr a ditional a nd c ust o m a r y ' di e tar y ' use or the ordina r y c omplia n c e with the soc i a l drinking c ustoms o f th e w hol e c ommunit y c on ce rne d, irrespec ti ve o f th e e tiolo g i cal fac tors le ad in g to suc h be ha viour and irr e spec tiv e a lso of the ex t e nt to w hi c h suc h e ti o l og i cal fac t o rs a r e d e p e nd e nt upon h e r e dit y, con- stit uti on o r ac quir ed p hys i o p a t hol og i cal a nd m e t a boli c influe n ce s. 11 In it s 2nd R e port (19 52 )( 2 ) t he Subco mm ittee expr essed th e v i ew, on r ec onsid e r a tion, th a t this d e finiti on w a s mor e appropri a te to the term e x ce ssive drinkin g, a nd s ugge st ed th e followin g definition of a lcoholism: " Alcoholi c s ar e thos e e x ce ssive drink e rs whos e d e p e nden c e upon a lcohol h a s a ttain e d suc h a d eg r ee that it shows a noti ce abl e m e ntal dis - turban ce or a n int e rfe r e n ce w ith th e ir bodily a nd m e nt a l health, the ir int e r- p e rsona l r e l a tions a nd th e ir smooth s oc i a l a nd ec onomic fun c tioning ; or who show th e prodroma l signs of such d e velopments. They therefor e r e quir e tr eatme nt. " With this m a y b e c ompa r e d th e br oad d e finition suggeste d m 1960 b y J e llin e k (3), a former WHO c onsult a nt : A l coholism: " a n y use of a l c oholi c be v e r age s tha t causes a ny damage to the individua l or soc i e ty or b oth" . Since this d efinition might a ppea r m itself too gener a l, Jellinek sug- gest e d a subdi v ision into a lpha , beta , gamma and d e lta alcoholism, with separat e definitions. 28 ALLOCATION "The distribution of resources , tasks , respons ib ilities to and within a programme; a general term comprising suc h specia lized terms a s assignment, a pportionment and allotment. "(l ) 29 AM B ULATORY CARE " Care provid e d to p a ti e nts who a r e not conf ine d to bed. 11 (1) The r e is a tendency for " a mbul a tory c ar e " to b e e qu a t ed with "no n-h o spit a l ca r e "; but this is not stric tl y c orr ec t , sin ce a p a ti e n t be in g t r eat e d a t hom e by a g e nera l prac tition e r is not r ece i v ing a m b u l a t o r y ca r e . The m a in type s of a mbul a tor y c are a r e ca r e a s a n out-pa ti e nt or d a y p a ti e nt (qq. v .) a nd ca r e gi ve n b y a g ene r a l prac titione r a t his prac ti ce pr e mis e s. Th e r e m ay b e a n ee d f o r furth e r c onsid e r a tion a im e d a t a n ag r eed d efini t ion of this t e rm . 30 APPROPRIATENESS A term used in planning and evaluation. "The degree to which one alternative set of activities and resources has the potential for ameliorating health status relative to that inherent in other alternatives. "(l) "Appropriateness takes into consideration choices or decisions made in planning to see if they r eally were the best under the c ir c umstances . To find out if a programm e is appropriate, th e alternative uses of re- sources, employing different treatment or preventive methods, would have to be reviewed to a s ce rtain if more obje ct ives could be a ttained by using a different resour ce mix within the same ce iling of expenditure. For in- stan ce, a programme including only fillings a nd extractions might some- times achieve more in the long run if som e resour ce s were devoted to preventive activities that would de c rease th e need for them. So, again, an effective and efficient programme, adequate in terms of coverage, may be inappropriate in terms of c hoice of methods to combat disease and in th e light of the goals of the system . "{2) 31 AUDIOLOGY "The study, examination, appreciation and treatment of hearing defects, as well as the utilization of auditory substitutional devices and therapeutic treatment."( 1) 32 AUTOMATION A distin c tion is mad e b e tween automation a nd m ec hanization . Mechanization is a proce ss whereby th e n ee d for huma n interve ntion is r e duced to the minimum. Automation impli e s a n inh e r e nt capability of s e lf - c orre c tion by a feedback mechanism, so tha t th e m ac hin e recogniz e s the pre sence of e rrors a nd brings about a n a utom a ti c co rr e ction. (1 ) 33 AUX ILIARY NU RSI NG PERSONNEL P e rsonn e l with training in nursing skills which fa lls short of a full nursing qualification, usually working under the supervision of a qualified nurse . This d efinition follows a numb e r of simila r definitions in WHO publications. beginning with th e 1st Report of the WHO Expert Committee on N ursing ( ltl 50) ( 1). The E xpert C ommitt ee drew a distinction between the fully qu a li fied nurs e (q . v . ) a nd a uxili a ry nursing p e rsonnel, th e latt e r ' <' rm be ing a ppli ed to "those who give, in c omparison, less e xac ting ca r e ' '-h i c h suppl e m e nts tha t g iv e n by nurs es, or those whose duti e s are con - finf'rl t o som e p a r ticul a r phas e of nursing ca r e" . A r evi e w of l egis l a tion on auxiliary nursing personnel in the Int e rnation a l Digest of Health L eg isl a tion ( 1966) (2) noted that: "A ce rtain d eg r ee of confusion exists on the subject of nursing auxili a ri es . This is probably due not only to the variety of terms used to d e signa t e thes e h ealth workers but a lso to diffe ring conceptions of their role and dut i e s". Auxiliary nursing personn e l can b e identified with the second and third of the thre e categories of nursing personnel (q . v . ) distinguished by the WHO Expert C ommitt ee on Nursing in its 5th Report ( 1966). Designa• tions associated with the second category are nursing assistant and nursin auxiliary, with the third category nursing aide; but numerous variants of these terms are found in diff e rent countries. See the discussion in the Interna tional Digest of Health Legislation. 34 AUXILIARY PERSONNEL The d efinition and status of auxiliary p e rsonnel, auxiliary work e rs , et c ., h ave been th e subje c t of much discussion. The most authoritative d efinition, in a n organizational study by t h e WHO Execut ive Board, is a v e ry wid e one: "Acc ording to th e d efinition acce pt e d by a ll Unit ed Nations agencies, a n a uxilia ry worke r is I a p a id w ork e r i n a parti c ul a r field, with less than full qualific a tions in that f i e l d, w h o a ssists and is supervis e d by a profes- sional work e r'. Thus th e r e m a y be a uxiliary p e rs onne l in medicine , nursing, s a nitation, e t c. Furthe rmor e, th e re can be different l evels within th e broad cat egory of a uxiliaries, e.g . in nursing the re a r e a uxil- i a ry nurses, nursing a ides, e t c . "(l ) This d efinition h a s been acce pted, sometim e s w it h minor vari a tions, by a numb e r of W HO Expert Committe es. (2 ) One suc h c ommitte e (3), noting the r e strict ion of the definition to paid work e rs, add ed the c omme nt that "voluntary unpaid collab or at ors m ay act in a simila r ca p ac ity". A nothe r WHO Expe rt C ommittee ( 1968 ) ( 4) a dop ted an even mo r e gener a l d efinition: "The t e rm I auxili a ry' , a s commonly used , has a gene ri c meaning; it r efer s to all h ealth p e rsonn e l below the profes siona l leve l who assist a fully qualified p e rson". The actual designations of auxiliary work e rs v a ry in diff e r e nt coun - tri es and diffe r e nt profe ssiona l fields, oft e n using the t e rm assistant or auxiliary comb ined w ith a n ad j ective or noun r e l ating to the p a rticul a r profe ssional field; the term a ide is also somet im es used, norma lly imply- in g a lower grade of a uxili a ry-. -For a di s cussion of specific terms us e d m different countries , se e a r ecent WHO survey of ex isting l eg islation . (5) The term a ncilla ry, form e rl y equated with, or sometimes distin- guished from, auxili a ry, a ppears now to h ave fall e n out of use. The inhe r e nt difficulty of such terms as a uxiliary is that they are felt to be invidious, a s impl y in g a n inferior status: cf. a lso the fate of paramedical . A WHO C onsultation on the Classification of Auxiliary He a lth P e rsonnel in 197 2 (6) accordingly advised tha t WHO and its Member States should in due course cease to use such terms a s aide, assistant and auxiliary and adopt instead a four level classification (grades A, B, C and D) based on an a ssessment of width of competence, d e pth of technical responsibility, ability to work independently and supervisory ability. (It is not clear how these new designations would avoid the implications of status whi c h attach to the existing terms.) 35 AUXILIARY PERSONNEL (contd) The term allied personnel has been sugg e sted as a neutral designa- tion with no status implications (7), but has not found general favour. For particular types of auxiliary personne l, s ee auxiliary nursing personnel, dental auxiliary, m edi cal a ssistant. 36 AVERAGE "The average or m e an most frequently employed in demography is the a rithmetic average or arithmetic mean which consists of the sum of a number of quantities divided by their number. Where the term average or mean is used without furth e r qualification the arithmetic average is usually meant. The geometric mean or geometric average is sometimes used to estimate the tota l popul a tion in the middle of a period for which the popula- tion at either end is given; it is the square root of the product of the two end populations. A weighted average or weighted mean is obtained when different items are given varying importance by multiplying each item by a particular weight. The median is the value of the e l ement which divides a s et of observations into two halves. The mode is the most common or most frequent valu e of a set of observations :"(ff 37 BACTERIOLOGY The WHO Expert Committee on Health Laboratory Methods (1957) ( 1) distinguished between· medi cal bacteriology a nd sanitary bacteriology: medic al bacteriology deals with sp ec ime ns from hum a n beings and a nimals; sanitary bacteriology deals with spe c im e ns from inanimate mat e rial, including dead animals used for food. 39 BASELINE (DAT A, ETC.) Data, etc . , reflectirrn the state of affairs at the beginning of a prog- ramme or a programme phase, which serve as a point from which subse- quent changes can be measured. (1) 40 BASIC MEDICAL SCIENCES "The 'ba si c m ed i cal s c iences' a r e those d is c ipline s that exist in their own right a s a r eas of s c ientifi c enquiry, but nevertheless form a n e ss e nti a l basis for th e clinic a l educat ion of medical stud e nts a nd for m e di cal res ea r c h. Whi l e they often pr ovid e mate ri a l of a factual n a tur e of value for clinical s tudies , th e ir prim a ry objec tive i s to tr a in stud e nts in a s cient i f i c a pproac h to the evalua tion and testing of e vidence, an d to broac h an d a ppr ehend new p r ob l e ms .. . a s: "F o r purposes of dis c ussion th e basic medical s c iences we r e def ined ( 1) gene r a l hum a n b iol ogy, including genetics and immunology; (2) a n a tomy, in clud in g his t ol ogy, e mbryol ogy and n e uro-anatomy; (3) b iom athe m atics, includ ing statist ics a nd t ec hniques a ppr op ri ate to e pid emiol ogy , and f inite m a th e m a ti cs ; (4) physi ol ogy, i ncluding clinical physi o l ogy; (5) b i o c h e mistr y, including c lini cal biochemi st ry; (6) b iophysics ; (7) p s ych ology a nd soc i ol ogy; (8) ph a rmac ology; (9) p at holog y, including morbid a natomy a nd p a thophysiology; ( 10 ) mi c robiology, including bac t e riology, v irol ogy, para sitology a nd myc ology . " ( l ) 41 BED, HOSPITAL The WHO Expert Committee on Health Statistics adopted the following definition in its 8th Report ( 1963) ( 1 ): "A hospital bed is one maintained for c ontinuous (24 -hour) use by in- patients 11 • By implication this definition includes beds in quiet rooms, observa- tion rooms and other areas utilized as norma l places of residence o f in- patients, and excludes, for example, beds in store-rooms or those intended for special purposes such as re c overy or delivery. A EURO Symposium on the Estimation of Hospital Bed Requirements ( 1965) (2) adopted a slightly more specific definition: "The hospital bed, provid ed with staff, the necessa ry therapeutic and diagnostic equipment and financial resources, is the unit of accommodation for the admission of patients and for continuous (not l es s than 24-hour) use by patients 11 • Qualifying adjectives m ay be used as r equired: e .g. availabl e beds, installed beds, oc c upied beds, staffed beds. Bed/population ratio: "The numb e r of hospital beds for a population of 1000. In calculating this ind ex different types of beds may be taken into consideration, for example the number of available beds, the number of beds to me et requirements , etc. It will in a ll ca s es be necessary to specify the type of bed being used in calcul a ting the index. "(3) Bed occupancy rate: "The quotient of the average number of beds occupied for a given period and the average number of beds available during that period, generally one year, expressed as a percentage. "(4) Average bed occupancy: "The average number of days during which the bed is occupied by a patient in the course of a given period of time, generally a year. "(4) Bed turnover: "The ave r age number of p a tients ca red for p er bed during a given period , usually one year. "(4) Bed turnover interval: "The average period, in days that a bed re- mains empty, i.e. the average time elapsing between the discharge of on e patient and the admission of the next. "(5) Bed complement: "The number of beds permanently retained at the hospital for the treatment of in-patients. "(2) 42 BEHAVIOURAL SCIE NCE S "The group of studies which des c ribes man' s r eac tions to stimuli a nd to c ircumstances . Prominent a mong these are a nthropology, c ultural a nthropology, psychology, etc."( 1) "The behavioural s c i e n ce s include the contributions to medicine and public he a lth of sociology, c ultural anthropology a nd soc i a l psyc hology. "(2) 43 BENEFICIARY "The term 1 :beneficiary' in relation to a specified (social security) benefit indicates the protected person (q. v.) who has re ce ived the benefit during a given period or is in receipt of the benefit at a given point of time."(l) 44 B ILLIO N It should b e noted th a t this term does not mean the same thing on both side s of the Atl a ntic. In norma l English a nd gen e r a l European usage it m e ans a million millions ; in A meri can usage it me a ns a thousand millions, the E uropean t e rm for whi c h - unusua l in English usage - is milliard. The A meri can e quiva l e nt of the European billio_p is a trillion , w hi c h in E urop e would me a n a million million million (10 1~). It is pr e fe r a bl e , th e r efo r e, to avoid the us e of th e t e rm billion in inte rn a tional d oc uments. 45 BIRTH RATE "There are a number of measures which a re used to calcul ate the frequency of births. The simplest is the birth rate, more accurately the crude birth rate, which is the fraction, the numerator of which is the total number of births in a population during a given period and the denominator is the total number of person-years lived by th e population during tha t period . The l a tter expression is generally a pproxim ated by the siz e of the population at the mid - point of the period multipli ed by the length of the period in years. The rate is usually stated p e r 1000 . Like other rat e s in which the population at the mid-point of the p e riod is used a s the denomi - nator of the fraction, this is sometimes called the central birth rate. Where the term 'birth rate I is used without qualification, the live birth rate is generally meant and only live births appear in the denominator (sic : presumably an error for num e r a tor) . The total b irth rate based on live births and late foetal deaths is somet imes calcul ated . Legitimate birth rates and illegitimate birth rates with legitim a te and illegitimate births respectively are computed, and the illegitimac y ratio, the number of illegitimate births per 1000 total births, is frequently used . These rates and ratios are generally based on live births. To compa re the fertility of different popula tions, standardized birth r ates are often used to eliminate the effect on the birth rate of certa in differences in struc ture of the population (most commonly the age a nd sex structure) . "(l) One such standardized birth r a te, the age -specifi c birth-rate, is obtained by relating the number of live births which occurred to mothers or fathers of a specified age-group of the popul a tion of a given geographical area during a given year to the mid-year female or m a l e population of the specified age-group in the area during th e year. (2) 46 BUDGE T " A pl a n in fin a n c i a l t e rms f or th e c arrying out of a prog ramme o f act i v iti e s in a spec ifi e d p e riod."( 1) 47 BUDGETARY CONTROL "A means of controlling the act1v1t1es of a n enterprise by car efully forecasting the leve l of each activity and conv e rting th e estimates into mon e tary terms. The ac tu a l cost of or rev e nu e from eac h activity is c heck e d against the estimates . " ( l) 48 CAPITAL EXPENDITURE "Capital expenditur e o r c osts: that expenditur E' which is requir ed for f in a n c in g p e rmanent or s emi-permanenl goods ; for ex;i mple buildings , m ach inery, equipment, vehicl e s. [n ca s es of doubt, whe r e a good b.s t s for more tha n one y P.a r. th e n it is a capital good . "(l ) 49 CAPITATION A m e thod of m e di c al r e mun e r a tion w ithi n a n o r g a n i ze d system of m e di c al ca re , in whi c h a physic i a n is p a id a fi x e d a m o unt f or each pati e nt for whom h e tak e s responsibility durin g a g i ven p e ri od (e . g . a quart e r or a month) . ( 1) 5 0 CASE-FINDING "That form of s c r eening (q. v . ) of which th e m ain obj ec t is to detect disea!;,e a nd bring pati e nts to tr e atment, in c ontrast to e pidem iological surve ys (q. v . ) . " ( l) 51 • CENTRALIZATION "The act of bringing together operations of the s a me type, or ac t1v1- ties that are similar in function, and combining them to form a central group or unit with del egat ion of a uthority to effect executive ac tion. "(l) Contrast with d ee ent r a liz a tion . 52 C HAIRS IDE A SSIST ANT A d e ntal auxiliary (som etimes called a clinical a ssistant or dental a ssistant ) who is pres e n t in the dentist's sur ge ry whil e h e is r ec eiving p atients a nd whos e fun c tions include r ece i vin g the pati e nt and preparing h im fo r treatm e nt , caring for him after tre at ment, pr e pa r ing instrum ents, e t c ., prepa ri ng a nd mixin g r e st o r a tiv e materi a l s, assistan c e w ith X - ray wo rk a nd documentation. ( 1) 53 CHILD GUIDANCE The scope of c hild guidance was dis c ussed by a EURO Seminar m 1960. (1) The following definition is ba sed on their r e port. Basically chil d guidanc e is a psyc hi a tri c s e rvi c e for c hildren, and this term {or psyc hotherapy) is in use in som e c ountri e s. The word "guidance" implies an educational approac h. 54 CHILD GUIDANCE CENTRE A clinic or other centre from whi c h a c b ild guid a n ce s e rvice (q. v .) operates. A EURO Seminar in 19 60 discuss e d various t e rm s us e d in diffe r e nt E uropean l angu a ges and a greed that a nam e in c or.pora t i ng th e word "guidance" might be th e most generally acce ptabl e . ( 1) 55 CHILD HEALTH DOCTOR "This term is us ed to indi cat e a doc tor who has had some spec ia l training or experience in wo rk with c hildr en but is n o t necessarily attac h ed to a hospital and whose r eg ular wo rk is r athe r the care and surveill a nce of normal and handi capped chi ldr en th a n th e clini ca l tr eatment o f c hildr en w ho are ac ut e ly ill. It would include doctors wo rkin g in c hild we lfa re centres, s chool medical off i ce rs a n d the p aediat ri c i ans who do the routin 0 work of c hildr en ' s polyclini c s . "(l) 56 CHRONIC (DISEASE, ILLNESS) The following definition was suggested, after consideration of various earlier definitions, by a EURO Symposium in 1957 (1): "An impairment of bodily structure and / or fun c tion that necessitates a modification of the patient's normal life, and has p e rsisted or may be expected to persist over an extended period of time." The Symposium observed th a t: "( 1) Chronicity must in large measure depend upon the curability of the disease in the li ght of present medi c al knowledg e . What is a c hroni c disease at one period will not ne c essarily r e main so on ce the means have been discovered for treating it ad e quatel y . "(2) The chroni c ity of a diseas e involves medi c al, administrative, social and e c onomi c fa c tors . "It is not considered either practi cable or desira ble to suggest a definite minimum period. In some c irc umst a n c es, for example, the administration of social security funds , a working definition of chronic disease might be based on dur a tion; for gener a l publi c health purposes the chronicity of a disease is determined more by its c h a ra c ter and that of the patient than by its duration in time." The difficulty of definition was noted by another EURO Symposium in 1965 (2): "Up to now no widely acceptable definition (of a cute and chronic patients) has been found. Some authors maintain that an acute illness usually consists of a simple episode of fairly short duration from which the patient returns to normal activity, whereas a chronic illness is one of long duration in which the patient is permanently incapacitated to a more or less marked degree. There is also the view that progress in the tech- nology of resuscitation and haemobiology (ha s ) blurred the borderline be- tween acute and chronic conditions. Those who belong to this school of thought prefer to speak of medical and nursing dependency, or of rhythm of care, an acute illness requiring frequent medical and nursing care and a chronic illness episodic medical and nursing care." See acute. 57 COHORT "A group of persons who experienc e a ce rtain event 1n a spe c ified period of tim e. "Birth c ohort: a group of peopl e born in the s 2.me p e riod of time. "Marriage cohort: a group of m a les or fema l es married in the sam e period of time . "( 1) 58 COHORT ANALYSIS "A method of anal yzing data in which th e exp e ri e n ce of individua l cohorts is studied throughout a give n p e riod suc h a s th e ir live s, m a rri ages, child- be aring p e riods, etc . "(l) 59 COMMUNITY "A c ommunity has been defined a s ' a group in face -to-face contact - having a basic h a rmony of int erest and a spir ations and bound by common values and objectives'. It an be geographical, socio-economic, profes- siona l , etc. It can be small - a v illage, a factory; it c an be large - up to a r egion. "(l) 60 COMMUNITY CARE "This is an expression with spec i a l c onnotat ions in th e mental h ealth fie l d, wher e it is us e d to m ean th e ca r e and sup e r v ision of psychiatric p a ti e nts outsid e hospit a l, by me a ns of m ed ic a l and s ocial agencie s based m th e community . "{I ) The us e of the term is not , of course, confined to the psychia tri c fie l d . 6 1 COMMUNITY HEALTH A EURO Symposium in 1966 (1) defined community health as includ- ing "all the personal health and environmental services in any human community, irrespective of whether such services were public or private ones' '. The WHO Expert Committee on Postgraduate Education and Training in Public Health ( l 97 3) ( 2) noted, however , that: "This expression is now current in a number of countries. Without further qualification it is ambiguous. In some instances it is used as a synonym for environmental health to refer to health care of the community; on other occasions it refe rs to non-institutional health care, or health care in the community . It is also used to refer to the totality of health care provided for a community, and in this sens e embraces public health as define d above (i.e. in a broad sense to encompass the problems affect- ing the health of a population, the collective status of health of the people, environmental health and h ealth services, and the administration of health care services ). 11 This uncertainty of definition suggests a need for caution in the use of the term community health, and for careful definition if it is used. There may well be advantage in the use of a term - perhaps preferably community health care - to cover the wide field indicated by the definition adopted by the 1966 Symposium and the 1973 Expert Committee. 62 COMMUNITY MEDICINE As a WHO Conference on the Public Health Training of General Practitioners noted in 1956 (1 ), this term means different things in dif- feren t countries. A W HO study of health centres in 1972 (2) observed that " this term stresses the preventive aspec t of medicine and the treat- ment of common ailments, rather than the management of the more severe or exotic disorders seen in hospital wards". Since the specialty of com- munity medicine has rec ently been recogni zed in the United Kingdom in p l ace of the older concepts of public health, preventive medicine and soc ial medicine (qq. v. ), it may be helpful to quote a British definition (3): "Put at its simplest, community m e dicine is conce rn ed with the study of health and disease in populations. The function of the specialist in community medicine is to investigate and assess the nee ds of the popula- tion so that priorities may be e stablished for th e promotion of health, the prevention of disease and th e pro vision of m edical care. The specialty is a l so concerned with coordinating medi c al expertise so that policies which are in accord with medical need can b e presented to (the authorities responsible for the provision of health servi c e s)." By anal ogy the term community dentistry has also been introduced; it is "concerned with the distribution of dental and associated oral disease, its causes and the managem ent of r esources for its prevention and treat- ment ". (4) 63 COMPREHENSIVE MEDICINE A term sometimes used to include the practice of somatic, psychic , social and preventive medicine. ( l) 64 CONGENITAL The re is some difference of view about the scope of this term. A EURO Working Group in l 967 (1) noted that the term congenital had traditionally carried the connotation of a wholly prenatal determination, although this restriction was difficult to justify etymologically. Although the term congenital mi,ilformation had frequently been confined to those structural malformations thought to arise from embryonic maldevelopment, the clinical homogeneity of the larger group of conditions arising both before and during birth made it reasonable, in the Working Group's view, to apply the term to this larger group. In their Report , therefore, they defined congenital disorders as "those diseases that ar e substantially determined before or during birth and which · are in principle recognizable 1n early life". The Working Group noted that the term connatal had been employed in the Netherlands in this wider sense, and commended this term to coun- tries in whose language there was an appropriate and unambiguous equi- valent. A WHO Scientific Group in 1968 (2) sought to extend the accepted definition of congenital malformation in anothe r respect , defining this term as including not only anatomical defects but also molecular and cellular abnormalities present at birth. A WHO docum e nt in 1972 (3), however , held that the term congenital malformation should be confined to structural defects present at birth, the term congenital anomaly b e ing used to include all biochemical, structural and functional disorders pre sent at birth. 65 CONSTRAINTS "Constraints set the limits of flexibility that the planner c hoosing alternatives to be submitted to the decision-maker . constraints usually fall into four categories as follows: has in Major ( 1) behavioural. The system cannot do more for people than they are willing to rec eive. (2) economic . .. (3) socia l , political and administrative .. . (4) professional. .. "(1) 66 CONSULTATION This term has been defined g ene r a lly as : "A meeting of two or more individual s wh o a r e s ee king through the e x c h a nge of information to arrive at a de cision. In the cou rse of this proce ss the adv i ce or opinion of e xperts may be necessa ry . " (l) For practical use a r a ther m ore speci fic d e fini tion than this seems necessary. A distinctio n need s to b e made between (a ) a consultation between doctor s (or othe r h ealth c ar e wo rke r s ) a nd (b) a consultation between doctor (or othe r h ealth worker ) and p a tient; a nd it is p a rti cular l y in r e lation to the latter that an ag r eed d efi n it ion woul d b e helpful. The c ommonest use of the term is in the fi e l d of gen e ral prac ti ce o r primary medicine, where it is s ometime s used t o mean a ny con tact be tween doctor a nd patient , sometimes confined to the s ituation in w hi c h the patient attends at the doc tor's practice premises (" surge ry consultation" o r " attendance") as distinc t from a c onsultation in t h e patient's home o r o t h e r pre mises (" domi c iliary consu l tation" or "visi t") . Vis it has bee n defined for WHO purpose s a s "the medical att e ntion gi " en bv the p h y s i. c i a.n at the p atient ' s bedside" (2 ) ; it may also cover a ttentio n b v o ther h e al th ca r e work e r s. Attendance is also a n important concept i.n r e l at ion to the atte n dance of patients at h ospital out-pa tie nt departments , e tc . (3) 67 CONSUMER RESEARCH "The collection, recording and analysis of information obtained from purchasers and users relating to specified products or services, together with their suggestions for making those products or services more suitable to their requirements." (1) The concept of consur.-1er re search may have an application in the field of health services , \l•ith the patient or user of services put in the place of the "consumer". 68 CONSUMPTION (OF MEDICAL CARE) Consumption of medical care: "the utilization of health services by an individual or a group of individuals. "( l) 69 CONTROL Two m eanings of this term were defined in a paper prepared for the WHO Scientific Group on Evaluation of Environmental Health Programmes ( l 97 2) ( l ): " (a) A group of p e rsons or environment factors from which a programme or a c tivity is withheld to enable comparison with a group receiving the programme or activity . "(b) The process , in the administration of a programme, whe r eby it is determined whether the programme in operation accords with the programme as planne d . " To these may be added a third s e ns e, r e lating to the control of disease: "The term (disease) control is applied in its widest s ense, refe rring to all aspects of health protection (prevention of the disease or of its complications, ear ly diagnosis, appropriate tr e atm e nt , rehabilitation , health education ) and include s al so endeavours to obtain better knowledge of the respective disease . "(2 ) 70 • COST-BE NE FIT ANALYSIS "The syste matic compari son - in monet a ry te r ms - of all th e costs and benefits of proposed a lte rnative schemes with a view to de termining (a) which scheme or combina tion of schemes will con tribut e most to the achievement of predetermined obj ectives at a fixed inves tment, or (b) the magnitude of the b e n efit that can r esult from schemes requiring the minimum investment. The resour ces r equired per unit o f benefit must be determined, accou n t being t aken of the fact that costs c1 n<l benefi t s acc rue with time. "(l) See a ls o cos t-effec tivene ss anal y sis . 71 COST-EFFECTIVENESS ANALYSIS "A procedure used when benefits are difficult to measure or when those that are measurable are not commensurable. It is similar to cost-benefit analysis (q. v.) except that benefit, instead of being expressed in monetary terms, is expressed in terms of results achieved, e.g. number of lives saved or number of days free from disease. 11 (1) The following distinction between cost-effectiveness analysis and cost-benefit analysis was drawn by the European Conference on National Health Planning in l 97 4 (2 ): "Cost-effectivene ss analysis is a powerful method of looking for the least expensive way of reaching a given target. It is concerned with the selection of a strategy, when costs and benefits are known and can be quantified . Cost-benefit analysis, in contrast, is aimed at and helps in the selection of objectives; this implies the making of subjective judge - m ent s as to the value of different health goals." 72 COST-EFFICIENCY "The ability of a h ealth service or a specific ac t ivity within this service to be effective with conservation of r esour ce s. Whereas e.ffective- ness in many instances may be assessed in more or less absolute terms (yes or no), cost-efficiency is always r e l ative to what is generally con - sidered reasonable or to the corresponding figure of othe r program:ne s. " ( 1) 7J COSTING "The techniques and processes of ascertaining the amount of expenditure (actual or notional) incurred on or attributable to particular products, processes or services . 11 (1) Functional costing : see output budgeting . Standard costing: "The preparation and use of standard costs , thei r comparison with actual costs (assessed on the same basis) and the analy- sis of variances to their causes and points of incidence . "(2) Unit costing: "A method whereby costs are broken down to single measures of output; for example a cost can be derived for one kilogram of laundry , for one bed day, for one out-patient consultation. The cost represents the average cost of services given and material used for a given unitary entity. "(3) 74 COSTS "Resources expended in carrying out activiti es; a lso, benefits not realized (as in lost productivity through premature death , disability, debility). "(l) Typ e s of cost (2): Capital co st: se e capital expenditure. Direct co st: "A cost which it is possible to identify directly with a particular activity or product." Fixed cost (period cost): "A cos t which tends to be unaffected by variations in volume of output but to depend mainly on the passing of time, e.g. th e cost of providing the facilities and organisation to produce and market goods. 11 Marginal cost: "The amount at any given volume of output by which aggregate costs are changed if the volume of output is increased or de- c reased by one unit. 11 Opportunity co st: "The maximum amount which could be obtained at any given p oint of time if assets or resources were to be sold, hired or put to the most valuable alternative use which would be practicable. " Replacement cost: "The cost of replacing a machine or other asset at any given point of time , either now or in the futur e (excluding any e lement attributable to improvement)." Standard co st: "A predetermined co st which is calcul ated from manageme nts standards of efficient operation and the relevant necessary expenditure . " Unit cost: the cost of a single unit of output. See costing . Variable cost: "A cost which tends to vary di r ectly with volume of output , e.g. the additional cost s incurred in producing and marketing goods once the organisation has been set up." 75 COVERAGE "Coverage of the population by health services: "Physical or geographical coverage is the ratio between the number of health establishments or institutions per administrative unit and the population and area sizes of the unit. This is a theoretical coverage which corresponds to the institutions' zones of responsibility. "Functional coverage is characterized by the 'catchment areas' of the health institutions, which in turn are defined in terms of the utilization of health institutions by the population (passive coverage) and of the pene- tration into the population by mobile elements of the health institution or the radius along which population is contacted (active coverage). This is a practical coverage which corresponds to the zones of effective activity of the institutions. "Coverage thus defin e d is quantitative . Qualitative coverage depends upon the level of health technology offered to the population which is de - fined in terms of equipment and personal ability. "(I) 76 CRITICAL PATH ANALYSIS A method of preparing the implementation of a project by estimating the time and/or cos t for all the activities to b e carried out in the . project. (l) It may be helpful to supplement this somewhat compressed d efinition by quoting a r ecent British definition: "An operational r e sear c h technique us e d in m anage ment. The idea is to examine a project in detail with the objective of (1) breaking it down into component parts , and (2) examining each part both in isolation and in its relationship to the other parts. By this means it may be seen h ow the project can be completed in the b e st possible way in the shortest possible time. "(2 ) In pra c ti ce this term is now interchangeable with PERT (q. v. ). (3) 77 CYBERNETICS "The study of communications systems in machines human brain; or the means of controlling an activity or a to keep them direc ted towards a particular goal. "(l ) 78 and also in the set of activities DATA BANK "A system for accepting and storing data concerning defined g r oups of persons, events or institutions in such a way th at the information may be aggregated and retrieved according to the users' needs." (l) 79 [ DATA PROCESSING 11 A general term for all operations such as editing, coding and tabulation carried out on data a c cording to precise rules of procedure. Frequently used in a more limited sense to refer to the use of e lectronic computer equipment for such operations." (l) This definition seems preferabl e , for general purposes, to another recent WHO definition which confines the term to procedures involving computers: "A general term for any sequence of ope rations carried out on data, such as sorting, collating, etc., and used to distinguish the wide range of procedures involving computers that cannot properly be called cal culation. "(2) Compare a recent British definition: "The operations performed on data , usually by automatic equipment, 1n order to derive information or to achieve order among files. A data processing system may incorporate clerical functions and ancillary machine operations as well as all arithmetic and lo gical operations per- formed by a computer. " (3) File is defined as "an organized collection of records". (3) 80 DAY CARE Day care has been defined by the United Nations as: "An organized service for the care of c hildr e n a way from their own homes during some part of the day, when circumstance s call for normal care in the home to be supplemented. "(1) 81 DAY CARE CENTRE An institution in which day car e (q. v. )· is g i ven to ,chil drf?n . . In prac ti ce a variety of terms are used: day care centre, c r eche, day nursery , day home, afte r-s chool cent r e, l e isur e -hour home, nursery school, kindergarten. (1) The ILO Encyclopaedia of Occupational Health and Safety defines day nursery and nursery school as fo llows: " Da nurseries (for c hildr e n und er 3 years of age) and nu rs er y school s for c hildren over 3 y ea rs of age ) are publi c or p ri vate e stablish- ments intended for th e ca r e of health y chi l dren be l ow school age. " (2) 82 DAY CARE PROGRAMME "A day care progr amme is one having an organized profes sional staff that provides diagnostic and/or trea tment services for individuals whose ne e ds can be met by a limited number of hours of specialized care during the day, but who do not require in-patient care. This type of ca re r ep r e s e nts an interme diate state between in-patient care and rela- tively inde p e nden t community living. " (l) Cf. day patient. 83 DAY HO SPIT AL "Day hospitals are establishments in which patients can receive attention during the day and return to their home and family for the evening meal and the night. 11 (1) ."The function of the day hospital is limited to deal with patients needing protracted and intensive forms of treatment but who are ambulant and have satisfactory home conditions. "(2) 84 DAY PATIENT A patient who re ceives health care or treatment from a hospital or other health service institution without occupying a regular hospital bed, but attends more frequently or regular l y than an out-patient. Day patient facilities are premises where the patients do not live in but a ttend for treatment at l eas t several days a week if not every day, and participate in group activities with other patients and members of the staff; and premises where the patients do not li ve in but attend mainly for training, occupational or social activi t ies. (1) Compare the definitions of out -p atient and out-patient facilities (qq. v. ). Day patient and out-patient care ar e both forms of ambulatory care (q. v. ). 85 DECENTRALIZATION "Dispersion of the same type of work or activity with full executive powers to the responsible authorities of various areas away from the centre, thereby locating the work close to the source that initiates the activity. "(1) Contrast with centralization. 86 DEFICIENCY DISEASE "Any spe c ifi c pathological state, with characteris t ic clinical signs, that is du e to an i n suffi c i e nt intake of energy or e ssen ti a l nutrients; it is usually of dietary o rigin and can ofte n b e preve nted or cured by bringing the intake up to an adequat e level . " ( l) 87 DELINQUENCY "The expression of an act .harming someone, something or a social group, and which is penalized by the l aw . "(l) 88 DELPHI METHOD "A method whereby weighting or index factors are assigned to parameters that are not readily quantifiable, on the basis of a consensus or majority opinion of a group of unprejudiced experts. "(l) 89 DENTAL In its Report (1965)(1) on the Organization of Dental Public Health Services the WHO Expert Committee on Dental Health used the word dental in the broadest possible meaning, as applying to "all objects, actions and programmes concerned with the oral cavity and its related and supporting structures, and not in the narrow sense refe rring solely to teeth". The Committee noted that in some countries the term stomatological or odontostomatological was used in essentially the same meaning. The Committee gave the term dentist (q. v.) a correspondingly wide meaning. 90 DENT AL ADMINISTRATOR In its R e port (1 965 )(1) on the Organization of D ental Public Health Se rvices the WHO Expert Committee on D ental Health us e d this term to denote "the chief dentist with administrative responsibility in the general health administration". The Committee noted that his functions would depe nd on the pattern of organization of th e dental public health services of the country and might b e e ither advisory, administrative or executive, or varying combinations of the three. The actual title used wi ll of co urs e var y from country to country. As a general t e rm, however, d en tal administrator suffers from the defect that it do e s not necessarily imply that the administr a tor is himself a dentist. A possible alt e rnat i ve might b e chief a dmin istr ative dental offi ce r. 91 DENT AL AUXILIARY The term d ental auxiliary or dental auxiliary personnel (alternatively, auxiliary dental personnel) was defined by the WHO Expert Committee on Auxiliary Dental Personnel in 1959 (1) as covering a ll auxiliarie s, including those sometimes r efe rr ed to as "ancillary p e rsonnel ", who work under the dir ec tion and supervision of a li censed o r qualified dentist and are auxiliary to him. As examples of dental auxiliaries th e Report quoted the dental hygi e nist, the school dental nurse, the d e ntal l abo rat o ry technician and the dental or chairside assistant . It should be noted that the term dental auxiliar is applied rn the United Kingdom t o the (1 ew Zealand type school denta l nurs e. A distinction has b ee n made (2) b e twee n opera ting dental auxiliaries, who are qualified to perform a limited and d efin ed range of intra-oral procedures under the supervision of a dentist (direct or indirect depending on th e statutory provisions of the country concerned ), and non-operating dental auxiliaries, who are not. D e nt a l hygienists and dental nurses are ope r a ting auxil iaries in this sense ; cha irside assistants and denta l l abora - tory t echnicians are non-op e rating auxili a ries. 92 DENT AL HEAL TH In its Report (196 5) (l) on the Organization of Dental Public Health Services the WHO Expert Committee on Dental Health noted that on the basis of the WHO definition of health the concept of dental health b ecam e an inseparable part of general health and only gained meaning when con- sidered in this context. The Committee therefore defined dental health as: "A state of complete normality and functional efficiency of the teeth and supporting structur e s and also of the surrounding parts of the oral cavity and of the va riou s structures rel a ted to mastica tion and the maxillo - facial complex." A WHO Expert Committee on Dental Health Education observed in its Report (1970)(2) that on this definition the scope of dental health was wider than the term implied, and suggested that it might be more correct to use the term oral h ealth. In its Report the Committee used the two terms for the most part interchangeably. 93 DENTAL HEALTH EDUCATION The following d ef inition is based on the Report (1970) (1) of the W HO Expert Committee on D e ntal H ealth Education: Health educa tion directed towards obtaining and maintaining optimum dental and oral h ealth status for a ll individuals throughout life. A more concrete formulation can be found in th e definition of e ducative activities (in d e ntal h ealth services) g iven in th e Report (1 965 )( 2) of a WHO Expert Committee on the Organization of Dental Public Health Servic e s: "Educative activities are those that are concerned with informing individuals and communities how dental health contributes t o general health, how it should be attained and pr e served , and how dental and oral diseases may b e preven ted , and with encouraging individuals and communi- ties to transform knowl edge into action . 11 94 DENTAL HEALTH SERVICES "Dental health services may now b e defin e d as those services whi c h are designed to promote, maintain or restor e dental health. They may include e ducative , pr even ti ve or treatment a c tivities in varying pro- portions ... "Public dental health services a r e thos e d e ntal health services of an e ducative , preventive or cura tive nature organized by gove rnment (ce ntral, r eg ional or local) with its exclusive r esou r ces o r with participation from other individuals or agenc ies, or throu g h organized community efforts . " (l) The e xpression d en tal publi c h ealth s e r v i ce s is also used, with the same meaning as publi c denta l h ealth s e rvi ces . A E URO study in 197 4 (2) noted that : "The t e rm 'denta l public h ealth service' may , in E urope, have three different meanings. In th e southe rn Mediterr a n e an area it is a system serving broad indigent l aye rs of the p opul ation and d e l ive r ing e m e rg enc y dental care, mostly thr ough general hospi t a l s. In th e ea stern European c ountrie s, and in a certain sense also i n the United Kingdom , i t is equi- val ent to national dental h ealth s e r v ices, covering th e w hol e population, including c hildr en, whe r eas in th e oth e r Eu r opean c ountries it usually means a special syste m of dental service fin ance d fr om public funds and dealing with children. Only in a few countries (c . g. No rway and Sweden) are a small number of a dults a lso tr ea t ed by this syst e m , und e r c ertain conditions ." 95 DENT AL HEAL TH TEAM "A qualified dental surgeon working with one or more trained auxiliaries. 11 (1) 96 DENT AL HYGIENIST A type of dental auxiliary, defined in the Report (1958)(1) of a EURO Study Group on Dental Health Services for Children as: "A person trained to carry out strictly limited treatment (the removal of calculus, topical application of solutions) under the personal supervision of a dentist, and to give instruction to parents and children in oral hygiene methods." The Report (1961)(2) of the WHO Expert Committee on Auxiliary Dental Personnel, while agreeing that dental hygienists should work under the close supervision and direction of a dental practitioner, accepted that for certain public health aspects of the work they might have some inde - pendence of action provided that this was carried out as part of the public health team work. The Committee specified the functions of the dental hygienist as including the cleaning of teeth; the removal of calculus; individual and group instruction in oral hygiene; the cleaning of mouths, on the orders of the dentist, before treatment was begun; the topical application of fluorides or other prophylactic solutions; the screening or primary examination of groups such as schoolchildren or factory employees for dental defects, in order that they might then be referred to qualified dentists for treatment; and, in the case of schoolchildren, liaison with local public h ealth nursing services to ensure effective follow-up of recom- mendations or treatment. 97 DENT AL LABORATORY TECHNICIAN A type of dental auxiliary, working to the prescriptions and under the supervision of a fully qualified dentist, whose main function is the fabrication of appliances. He has no contact with patients . (1) 98 DENT AL NURSE A type of dental auxiliary, defined in the Report (1953) (1) of a EURO Study Group on Dental Health Se rvices for Children as: . "A p e rson trained to carry out operative treatment for children under the supervision of a dentist." The functions of the dental nurse or school dental nurse, a type of auxiliary pioneered in New Zealand, were discussed in th e Report (1959) (2) of the WHO Expert Committee on Auxiliary Dental Personnel. The Committee defined the functions of the school dental nurse in general t e rms as including (a) the maintenance of a specific group of children in sound dental h ealth and free from dental defects by examining and treating them at regular intervals, and (b) teaching the principles of oral hygiene and gaining the interest and co -operation of the children and their parents in this matter. The tr e atment given would extend to prophylaxis, filling both permanent and deciduous teeth, extracting teeth under local anaes- thesia , and recognizing malocclusion and l esion s which were beyond the dental nurse's scope and referring them to a dentist. In the United Kingdom the t erm dental auxi liary is used in this specific sense. 99 DENT AL PRACTICE This term was defined in the Report (1959) (1) of the WHO Expert Committee on Auxiliary Dental Personnel as: "The rendering of s e rvices aiming to prevent , a lleviate or cure a dental disease, and to repair or correct a dental anomaly or defect." The Committee deliberately drew this definition in broad terms as more adequate for discussion at the international leve l , but recognized that in certain countries it would be appropriate to ins e rt a limiting reference to the r endering of services "by fully qualifi ed practitioners". Within this broad definition the Committee noted that three levels of serv- ice could be distinguished: (a) by professional personnel (qualified practitioners and dental specialists); (b) by subsidiary or sub-professional personnel (auxiliary personnel); (c) by non-professional personnel (unqualified practitioners, indigenous practitioners). In some count ries th e third of these cate gories may not be present. 1 00 DENTIST In its Report (1965) (1) on the Organization of Dental Public Health Services the WHO Expert Committee on Dental Health used the term dentist in the broadest possible meaning to describe "the professional person who is authorized by education and by law to tr e at diseases of the oral cavity and related structures", and not merely a person who treats only teeth. The Expert Committee noted that in some countries this professional person was known as a stomatolo ist (a t e rm which e lsewhere implie s a m edi cally qualifie d specialist , with essentially the same meaning. The Committee gave the term dental (q . v. ) a correspondingly wide m eaning. There are perhaps disadvantages in giving the t e rm dentist an unduly wide connotation and in making no distinction betwe e n dentist and stomatologist. There may th e r efo re be a case for further consideration of these definitions. See also stomatologist. Alternative terms are dental practitioner (which in British usage tends to imply the practitioner of general dentistry rather than the specialist) and dental surgeon (traditional and now perhaps old-fashioned) . 1 0 1 DEPENDENCE -PRODUCING DRUG The following definition was adopted by a WHO Study Group on Youth and Drugs (1973)(1) and accepted by the WHO Expert Committee on Drug Dependence in its 19th Report (197 3) ( 2) : "A drug having the capacity to interact with a living organism to produce a state of psychic or physical dependence or both." In the light of the recommendation of the Expe rt Committee in its 13th Report that the term drug dependence should replace the terms drug addiction and drug habituation, the term dependence -producing drug must be taken to subsume the older terms addiction-producing drug and habit- forming drug. See the articles on these terms. 102 DIET 11 l. The total solid and liquid foods consumed by an individual or by a population group, either on an average basis or during a specified period. 11 2. A special schedule for eating and drinking, usually pre scribed by a physician or a die tician and intended to meet specific nutritional requirements or the needs of a group of patients with a given disease (e.g. diabetes mellitus) . It includes or excludes certain foods or types of food and gene rally regulates the times of ingestion. 11 (1) 103 DIRECT (PATTERN OF PROVIDING MEDICAL CARE) "When health personnel are employed by an organized body , whether a social security agency or a public health authority, this has been defined as the 'direct pattern' of providing medical care. When the responsibl e agency contracts with private practitioners or autonomous local entities (such as hospitals) to render services to certain persons for stipulated payments , or simply reimburses the patient for his medical expenses, this has been defined as the 'indirect pattern'. "(1) 104 DISABILITY This term (and disablement) must be considered along with impairment , handicap and incapacity. The va rious t e rms have not always be en clearly distinguished from one another. In general E nglish usage disability and handicap are often us e d interchangeably, and there is a t e ndency to equate both t e rms with the more severe and obvious conditions , leaving impairment as a more general term; incapacity is an alternative to disability. Disablement is often regarded as interchangeable with disability, although there is a theoretical distinction between the two (disability being a condition, and disablement the state of a person with that condition). The 2nd R e port (1969) (1) of the WHO Expe rt Committee on M edical Rehabilitation distinguished betwe en disability and impairment as follows: Disability: "The reduction of functional ability to l ead a fruitful daily life. It is the result not only of mental and/ or physic al impairment but also of the individual's adjustment to this." Impairment: "A permanent or transitory pathological condition r es ulting in a diminution of functions. " With these definitions may b e compa r ed three recent British definitions (2 ): Disablement: "the l oss or r eduction of functional ability". Impairment: "lacking part or a ll of a limb , or having a defective limb , organism or mechanism of the body" . Handicap: "the disadvantage or r est ri c tion of activity caused by disability". A logical sequence (3) might b e as follows: (i) impa irment , the basic pathological condition (i.e. lacking part or all of a limb , or having a defective limb, organism or mechanism of the body) . An impairment may be so minor a s not to interfere materially with functional ability, or it may be possible to correct or restor e function. If an impairment is major, and not capable of correction, it will produce - (ii) disability , the loss or reduction of functional ability. The effect of this will depend on the individual's personal circumstances and requirements: it may well amount to - 105 DISABILITY (contd) (iii) handicap, the disadvantage or restriction of activity caused by disability. If this is s eve re it may l ead to - (iv) invalidity (q. v.), the state of being unabl e to ca rry out accustomed work. Se e also th e definitions of disabled p e rs on and disabling illness. For disability rate, see morbidity rate. 106 DISABLED PERSON "An individual whose prospects of securing and retaining suitable employment are substantially reduced as a result of physical or mental impairment. " ( 1) Compa re a recent WHO d e finition of handicapped person: "A person whose physical and/or mental well-being is temporarily or permanently injured, whe ther congenitally or through age, illness or accident, with the result that his self-dependence , schooling or employment is impeded. "(2) 107 DISABLING ILLNESS "An illness causing any degree of interference with the ability of the patient to continue his ordinary acti vi ties . " ( l ) An alternative term , with the same definition, is incapacitating illness. 108 DISCHARGE (FROM HOSPITAL) "A discharge is the departure from hospital of any patient who has previously gone through the admission procedure and f or whom a bed is not being retained. The t e rm includes deaths, but no t patients who have been allowed home temporarily, say on weekend leave , and for whom a hospital bed is specifically reserved. "(1) The following definition, originally from an English report (2), is used by OMC/EURO: "Discharge: the conclusion of a period of inpatient care in the hospital concerned, whether the patient returned to his home, was trans- ferred to another hospital or institution or di e d . " 109 DISINSECTION In its 11th Report (1 961 ) (1) the WHO Expert Committee on Insecticides adopted the form disinsection in preference to disinsectization to describe the operation in which m ea sures are taken to kill the insects present in aircraft or ships. 110 DISPENSARY The WHO Expert Committee on the Organization of Medical Care noted in 1959 (1) that tr ad itionally the dispensary had been, and in some countries still was, an out-patient clinic offering the services of a general practitioner for ambulatory consultation, with the assistance of a pharma- cist or "dispenser" to provide elementary and standard medicines accord- ing to the physician's prescription. The term is now more gene rally applied to a spe cializ ed out -patient institution ("prophylactic dispensary " ), which may be attached to a hospital or may be separate, dealing with specific disease groups (tuberculosis, venereal diseases, etc.) or age or social categories. The emphasis in these institutions is on prevention and ea rly diagnosis through systematic screening and surveillance of the patient groups concerned, often in mass campaigns, but they are also equipped for treatment. (2) Dispensaries of this type are particularly characteristic of the health services of th e So viet Union. Classified in effect by Roemer (3) as one form of health centre (q. v. ). 111 DISTRICT PHYSICIAN "A primary physician who takes continuing responsibility for the general medical care of all persons living in a defined geographical area. He undertakes treatment of all forms of illness and injury insofar as these are not dealt with directly by specialists; in addition he is frequently responsible for personal preventive services in the area. "(1) The term is usually applied to a physician employed by a central or local government authority, as in the S -:andinavian countries. 112 DOUBLE-BLIND TRIAL "The expri:ssion ' double-blind ' (sometimes 'double blindfold') is used to de scribe a trial in which the nature of the treatment being received by a subject at any time is unknown to both subject and observer ... "The term 'singl e -blind' refers to a tria l in whi ch one usually the subject rather than the observer or investigator, of the tr eatment he is receiving at any spe cific time." (1) 113 participant, is unaware DRUG The difficulty of this term is the confusion that may arise between its general sense of a pharmaceutical preparation and its special and more limited sense of a substance used for non-medical purposes and capable of producing drug dependence or other undesirable effects. Recent brief WHO definitions of drug in its more general sense are : "Any substance administered to man for the prophylaxis, diagnosis or therapy of disease or for the modification of physiological function. "( l) "Any substance or product that is us ed o r intende d to be used to modify or explore phy siolo~ical systems or pathological states for the benefit of the recipient. "(2) The definition used in the International Pharmacopeia and adopted at a number of WHO meetings, which is more directly orientated towards the sense of drug as a pharmac eutical preparation, is as follows : "Any substance or mixture of substances thaL is manufactured, sold , offered for sale or represented for use in (1) the treatment, mitigation , prevention or diagnosis of disease, an abnormal physical state or the symptoms thereof in man or animal; or (2) the restoration, correction or modification of organic functions in man or animal. "(3) The use of the term pharmaceutical preparation in this sense as a preferable alternative to drug was recomme nded by a WHO Conference m 1962, in order to avoid confusion with addiction-producing drugs. (4) The narrower term pharmaceutical specialty is also used, with the meaning of "a simple or compound drug ready for use and placed on the market under a special name or in a characteris tic form". (5) It is convenient to distinguish the following types o f drug (pharma- ceutical preparation) (6 ): prescription drug: a pharmaceutical spe c iality which can be obtained by the public on prescription only ; over-the-counter drug: a pharmaceutical spe c iality which can be obtained by the public without prescription; proprietary drug: a drug marketed under a trademark; non-proprietary drug: a drug marketed otherwise than under a trademark (i .e . under its scientific name). 114 DRUG (contd) In the discussion of drug dependence an d its associate d problems the term drug tends to acquire a specialized con n o t a tion , reflected in the definition adopted by the WHO Exper t Committee on Drug Dependence, w ith its deliberate omission of any re fe rence t o the benefit of the patient: "Any substa nce that, w hen taken i n t o the living organism, m a y modify one or more of its functions." (7) A re ce nt study of the terminol og y and c riteria of drug dependence (8 ) accep ted this as a s a tisfactory gene ri c defini tion, but co mmented that in this field the focus was more narrowly on " a ll those ps y choac tive sub - stances which internatio na lly o r by a parti c ula r society a r e, o n a wide variety of objective criteria and the subjective asses sme nt of the relative importance of the se c riteri a , deemed to be problematical.. Su c h a drug may or may not ha ve dependence - inducing properties". 11 5 DRUG ABUSE The WHO Expert Committee on Drug Dependence defined drug abuse m its 14th Report (1965)(1) as follows: "The consumption of a drug apart from medical need or in unneces- sary quantities." A more formal definition was given rn the Committee's 16th Report ( l 96 9) (2 ): "Persistent or sporadic excessive drug use inconsistent with or unrelated to acceptable medical pra c tice." In their study of the terminology and criteria of drug dependence (3) Edwards and Hawks accepted this second definition as entirely valid, but suggested that it might not be the most useful one for operational purposes later on. In their view the insufficiency of the definition, based on the use of "acceptable medical practice" as a criterion, related "both to the likelihood that society will consider the use of certain substances as problematical for purposes quite other than medical , and also to the like- lihood of there being recreational use of a particular substance quite un- related to acceptable medical practice and yet approved by that society". They suggested, therefore, that it might prove more appropriate to define for each substance or combination of substances problem syndromes, i.e. "profiles of adverse - consequence experience related to particular patterns of use , patterns of symptoms, experience and milieu involvement". 116 DRUG ADDICTION The WHO Expert Committee on Addiction -Producing Drugs (now the Expert Committee on Drug Dependence) drafted a definition of drug addiction in their 2nd Report (1950) (1), clarified it in their 3rd Report {1952) (2) and revised it in their 7th Report (1957) (3). The definition in their 7th Report was as follows: "D rug addiction is a state of periodic or chronic intoxication pro- duced by the repeated consumption of a drug (natural or synthetic ). Its characteris t ics include (1) an overpowering desire or need (compulsion) to continue taking the drug and to obtain it by any means; (2) a tehdency to increase the dose; (3) a psychic (psychologi cal ) and generally a physical dependence on the effects of the drug; (4) detrimental effect on the indi - vidual and on society. " In their 7th Report the Expert Committee we re tinguish between drug addiction and drug habituation. term (q. v. ) they provided a new definition. concerned to dis- For the latter In their 13th Report (1964) (4) , however , the Committee noted that although their definition of drug addiction had gained some acceptance there was still confusion between addiction and habituation, and misuse of the former term; moreover the list of drugs abused was increasing in number and diversity. Accordingly various attempts had been made to find a term which could be applied to drug abuse generally . The Commit- tee ob served that the component in common appeared to be dependence, and they therefore recommended that the terms drug addiction and drug habituation should both be replaced by the single term drug dependence (q. V. ). Drug addiction can perhaps be roughly equated with physical dependence. (5) 117 DRUG CONTROL "A national law or international agreement governing and restricting production , movement and use of a drug to m e dical and scientific needs in the interest of public health and for the preve ntion of drug abuse. "(1) 118 DRUG DEPENDENCE The WHO Expert Committee on Addi c tion-Producing Drugs (now the Expert Committee on Drug Dependence) recommended in its 13th Report (1964) (1) that the term drug dependence should take the place of the terms drug addiction and drug habituation (qq. v. ) which the Committee had pre - viously defined. They noted that although their definition of drug addic - tion had gained some acceptance there was still confusion between addic- tion and habituation, and misuse of the former term; moreover the list of drugs abused was increasing in number and diversity. Accordingly va rious attempts had been made to find a term which could be applied to drug abuse generally. The Committee observed that the component in common appeared to be dep endence, either psychic or physical or both. They therefore recommended that , in place of drug addiction and drug habituation , the single term drug dependence should be used, with a modi- fying phrase linking it to a particular drug type in order to differentiate one class of drugs from another. The Expert Committee defined drug dependence as 11 a state arising from repeated administration of a drug on a periodic o r continuous basis . Its characteristics will vary with the agent involved, and this must be made clear by designating the particular type of drug dependence in each specific case - for example, drug dependence of morphine type, of canna- bis type, of barbiturate type, of amphetamine type, etc. 11 The Committee emphasized that drug dependence was a general term selected for its applicability to all types of drug abuse, and carried no connotation of the degree of risk to public health or the need for a particu- lar type of drug control. The Committee's recommendation was endorsed by the WHO Scien- tific Group on the Evaluation of Dependence -Producing Drugs (1964) (2) . In its 16th Report (1969) (3) the Expert Committee amplified the definition of drug dependen ce as follows: 11 A state, psychic and sometimes also physical, resulting from the interaction between a living organism and a drug, characterized by be- havioural and other responses that always include a compulsion to take the drug on a continuous or periodic basis in order to experience its psychic effects, and sometimes to avoid the discomfort of its absence. Tolerance may or may not be pre sent. A per son may be dependent on more than one drug. 11 The Committee noted, and in its 19th Report (1973) (4) specifically accepted, the following definitions of s chic de endence and Thf:sical dependence, taken from an article in the WHO Bulletin 1965) 5 : 119 DRUG DEPENDENCE (contd) Psychic dependence: "a condition in which a drug produces a feeling of satisfaction and a psychic drive that require periodic or continuous administration of the drug to produce pleasure or to avoid discomfort". (The term psychological dependence is also used.) Physical dependence: "an adaptive state that manifests itself b y intense physical disturbance s when the administration of the drug is sus - pended... These disturbances, i.e. the withdrawal or abstinence syn- dromes, are made up of specific arrays of symptoms and signs of ps ychic and physical nature that are characte ristic for each drug type". Psychic dependence can perhaps be roughly equated with drug habituation, and physical dependence with drug addiction. (6) 12 0 DRUG HABITUATION The WHO Expert Committee on Addiction-Producing Drugs (now the Expert Committee on Drug Dependence) approved the following definition of drug habituation in their 7th Report (1957) (l ): "Drug habituation (habit) is a condition resulting from the repeated consumption of a drug. Its characteristics include (l ) a desire (but not a compulsion) to continue taking the drug for the sense of improved well- being which it engenders; (2) little or no tendency to increase the dose; (3) some degree of psychic dependence on the effect of the drug, but absence of physical dependence and hence of an abstinence syndrome ; (4) detri- mental effects, if any, primarily on the individual." In this report the Committee were conc e rned to distinguish between drug habituation and drug addiction (q. v. ), providing parallel definitions of the two terms. In their 13th Report (1964) (2), however, the Committee noted that although their definition of drug addiction had gained some acceptance there was still confusion betwe en addiction and habituation, and misuse of the former term; moreover the list of drugs abused was increasing in number and diversity. Accordingly various attempts had been made to find a term which could be applied to drug abuse genera lly. The Committee ob- served that the component in common appear ed to be d ependence, and they therefore recommended that the terms drug habituation and drug addiction should both be replaced by the single term drug dependence (q. v. ). Drug habituation can perhaps be roughly equated with psychic d ependence . (3) 121 DRUG MONITORING Drug monitoring was defined by a WHO Committee in 1969 (1) as: "The systematic reporting, recording and evaluation of adverse reactions to drugs generally available with or without prescription." A distinction was made between spontaneous monitoring, in which information is obtained through voluntary reporting by practising doctors and hospitals to designated centres, and intensive monitoring, in which information is obtained by epidemiological techniques aimed at systematic coverage of separate hospitals, representative samples of the physician population, etc. An alternative definition was proposed in the Report (1972) (2) of a WHO Meeting on International Drug Monitoring: "Any procedure that aims at providing systematic inferences on likely chains of causation linking drugs and adverse reactions within a population." This report distinguished between three systems of reporting: individual reporting (replacing the term spontaneous monitoring), in which reports are sent to a national reference centre either by individual practising doctors and dentists on their own initiative or by groups of practising doctors organized in some manner so as to facilitate their reporting; comprehensive monitoring, in which a special group of physicians, such as may be found in reference centres, is organized to survey drug use and identify adverse effects; and population monitoring, which differs from comprehensive monitoring in the patient population studied and the methods of data collection; it is characterized by automatic recording of drug use and patient syndromes or events and by a search for associations between the two. 122 EARLY DISEASE DETECTION A term which refers to all forms of early detection of disease or defect whether by screening, physical examination or other means. (1) 123 ECONOMIC "A term applicable to any process or action which has to do with the creation of goods or services designed to satisfy human wants. More specifically, the term is used to characterize the production of goods and services by the most effective means and in accordance with existing technical knowledge. 11 (1) 124 EFFECT "A genera l t e rm covering the imp acts, outcomes and results, but distin guishin g t h e s e from the direct outputs of activiti e s p e r s e . 11 (1) 125 EFFECTIVENESS/EFFICACY /EFFICIENCY Much effort has been devoted by WHO committees, working groups, etc., to defining these three terms and distinguishing between them. Of the three terms, efficacy is the most limited in sense. It was defined as follows in the 14th Report (1971) (1) of the WHO Expert Commit- tee on Health Statistics: "Efficacy: the benefit or utility to the individual of the s ervices, treatment regimen, drug, preventive or control measure advocated or applied." The m eanings of effectiveness and efficiency, and the difference be- tween them, can be illustr a ted by comparing three recent pairs of defini- tions. 14th Report (1971) (1) of WHO Expert Committee on Health Statistics: "Effectiveness: the effect of the activity and the end-results, out- comes or benefits for the population achieved in relation to the stated objectives." "Efficiency: the effects or end-results achieved in relation to the effort expended in terms of money, resources and time." Resolutions of WHO Executive Board, 1973 (2) : "Effectiveness: the ratio between the achievement of the programme activity and the desired level which, during the planning process, th e planners had proposed would r e sult from the programme activity." "Efficiency: the ratio between the result that might be achieved through the exp enditure of a specified amount of resources and the result that might be achieved through a minimum of expenditure." Terminology List pr e pared by WHO Secretariat for European Con- ference on National Health Planning , 197 4 (3 ): "Effectiveness: the degree to which a plan, a programme or a project has achieved its purpose within the limits set for reaching its objective . " "Efficiency: the skill with which resources have been used to achieve a given end." Since these are ordinary English words and not technical terms it is perhaps unnecessary to elaborate their definitions unduly, and for most purposes the last and simplest of these pairs of definitions may be found 126 EFFECTIVENESS/EFFICACY /EFFICIENCY (contd) adequate. The essential difference between the two terms is that effective- ness is related to the results achieved (or pla nne d to be achieved) and efficiency to the cost, in terms of resources, of achi eving those results. The latter term a pproaches the meaning of the technic a l term cost- effectiveness (q. v. ). A s noted in a study (1971) (1) i n the Public Health Papers seri e s, there is no necessary r e lationship between the effectiveness and the efficiency of an activity or programme. Refe r ences a re gi ven to some other WHO defini tion s of these terms . (5) See also cost-efficiency, cost-effectiveness analysis. 127 EMERGENCY CALL SERVICE "Emergency call service (deputizing ser vice) : A s ervice which provides temporary medical cover, by arrangement with a primary physi- cian, while he is off duty or during his absence from his practice." (1) 128 ENVIRONMENT AL HEAL TH " (a) The state of the 'physical, mental and social well-being' of an individual or group in rela tion to the factors of their environment. "(b) A field of organized effort aimed at understanding, explaining and intervening to improve the relationship described in (a). 11 (1) The term is most commonly used in th e second of these two senses. A more specific definition of this sense was given by a WHO Expert Com- mittee in 1972 (2): "Environmental health is concerned with the control of all physical, chemical and biological processes, influence s and factors that exercise or may exercise, by direct or indirect m ean s, a significant effect on the physical and mental health and social well-being of man and his society." The various fields of activity covered by the term environmental health were specified by the WHO Exp ert Committe e on National Environ- mental Health Progr ammes in 1970. (3) The te rm environmental sanitation was defined, in a narrower sens e, by the WHO Expert Committee on Environmental Sanitation in 1950 (4): "The control of all those factors in man 's physical environment which exercise or may exercise a deleterious effect on his physical de- velopment, health and survival." The Committee 's 2nd Report (1952) (5) used a slightly modified ver- sion of this definition: "The control of all those factors in man ' s physical environment which exercise or may exercise a deleterious effect on his physical, mental or socia l well - being." The fields of activity covered by this term were specified by the Committee. (6) There might be advantage rn reconsidering the relationship between these two terms. 129 EPIDEMIOLOGICAL SURVEILLANCE This term is often used as a synonym for scre en ing (q. v. ), but should be distin guishe d from it. Screening is usua lly thought of as a short- term operation on a population at risk, while surve illanc e conveys the idea of a long-term proc es s in which s c r eening examination s a r e repeated at int erval s. (1) The term survei llance can be a ppli ed either to a person or to a dis- ease. When appli ed to a p e rs on, it means "close observation to detect the early signs of infection without restricting his freedom of movement. It impli e s maintaining a responsible alertness, making s y stematic obser- vation s and taking a ppropriate acti o n where indicated . " (2) When applied to a disease, surveillance means "the continued watchfulness over the distribution and trends of incid ence through the systematic collection, consolidation a nd evaluation of morbidity and mortality reports and othe r r e l evant data. Intrinsic in the concept is the regular dissemination of the basic data and interpr etations to all who have contributed and to a ll others who nee d to know. The conce p t , however, doe s not encompa ss dir e ct r es ponsibility for control activiti e s. 11 (2) In this latter sens e the following definition was proposed at a EURO Seminar in 1969 (3): "The epidemiological study of a dis ease as a dynamic process in- volving the ecology of the infectious agent, the host, the reservoirs, the vectors and the environment, as well a s th e complex mechanisms con- cerned in the spread of infection and the extent to which this spread occurs." The Seminar noted also that a lthough methods of epidemiological sur- veillance must vary from one infection to anothe r certain basic functions were characteristic for all surveillance activities, namely systematic collection of data, consolidation and analysis of the collected data, and dissemination of information by means of narrative epidemiological reports. 13 0 EPIDEMIOLOGI CAL SURVEY " A survey, which may use screening (q. v.) tests, but whose princi- p a l a i m is no t to bring patients to treatment but to elucidate the prevalence, incidence and natural history of a disease under study - though case- finding is a natural by-product of such surveys. 11 (1) Also known as a p opulation survey. 131 EPIDEMIOLOG Y In the guide to th e teaching of e pidemiology (197 4) (1) prepar e d by the Int e rn ational E pid emio l ogi c a l Association wi th th e collaboration of WHO e pidemiol ogy is defined as : "The study of the factor s determining the frequ en cy and distribution of diseases in human popula tions . " This d efinition wa s adopted in the Report (1 ·97 3) (2) of a E URO Wo rki ng Group on the A ppli cation of E pidemiology to the Planning and Evalu ation of Hea lth Ser vic e s, whic h noted that epidemiology now took w ithin i t s s cope a ll illnes s and diseas e , whethe r acute or chronic, physical or mental , communicabl e or non -communica ble. A s li gh tly fuller definition was a d opt ed in the R e port (1967) (3) of a EURO Symposium on the T eaching of E pidemi ology in Medicine and Public Health : "The s tudy of th e distribution of d is ease and disa b ility in human populations and of t h e factors whi ch influence th a t dis t ribution." The Symposium noted that epidemiologi cal studies had, in general, three purpos e s: to guid e the development of hea lth s ervice s by defining the siz e and distribution of the diseas e probl e ms facing a community; to revea l eti ological factors which may permit the modification or control of thos e diseases; and to provide a m ethod of measuring the effectivene ss of s ervice s introduced to control diseas e and im'pro ve the health of the community. The Symposium r e cognized, however, t h at this broad definition of e pid emiology was not u nive rsally a cc e pted in E urope today. For some a uthors the word cove r ed quite specifically the study of the spread and control of communicable disease; a recent Soviet textbook, for instance, define d epidemiology as "the science of the objective l a ws underlyin g the origin, spread and decline of infe ctious dise a se in hum a n population g roups a nd of th e prophylaxi s and eradication of those diseases". But for the purposes of the Symposium th e broader definition was accepted by all p a rticipants ; indeed the majority considered that the attempt to dis - tinguish between the use of epidemiological methods in communicable and non-communicable diseas e was artifici a l, since so many diseases were due to a combination of e tiological factors. Th e WHO E xpert Committee on Mental He alth note d in its 8th Report (196 0) (4) that the use of the term epidemiolo gy in relation to the study of mental disorders had now become widely acce pted. 1 32 EPIDEMIOLOGY (contd) Some textbooks distinguish b e tween three types of e pidemiological study (5): descriptive e pidemiology , concerned with obser ving the distribution of a disea:=-e or diseases in popula tions ; ana ly tica l e pidemiology , concerned with investi ga ting, by means of retrospective and prospe ctive investigations, hy pot h e s e s form ulat ed to explain the,s e ob s ervations; and experimental e pidemiology, concerned with experime nts which attempt to measure the e ffect of controlled trial s of the manipulation of suspected harmful influences or of pr e venti ve measures in populations. A distinction must also be m a de between e pidemiology as a discipline (a s discussed in this article) and th e e pid emiology of a disease (i. e . its e pidemiological characteristics). (6) 133 ERGONOMICS "Study of the relation of man to the environment in which he works and the application of anatomical, physiological and psychological knowledge to the problems involved" (1 ); or, more briefly, "the technology of work design". (2) With these formal definitions may be compared a more concrete formulation cited in a WHO working document (3): "The multidisciplinary science which deals with the problem of how to adapt a job to man's anatomical, physiological and psychological capa- cities with the aim of enhancing human well-being and efficiency. 11 134 EVALUATION Many definitions of this term have been proposed in WHO litera- ture. (1) The following definition adopted by the WHO Executive Board rn 197 3 (2) may serve as a summary: "Evaluation of health services: the systematic and scientific pro- cess of determining the extent to which an action or sets of actions were successful in the achievement of predetermined objectives. It involves measurement of adequacy, effectiveness and efficiency of health services. It renders possible the reallocation of priorities and resources on the basis of changing health needs." Evaluation is to be distinguished from assessment and appraisal: "Assessment and appraisal are used as more general terms than evaluation, connoting the drawing of conclusions from the examination of a situation or its elements. Evaluation, then, is a particular type of assessment. 11 (3) As noted by Schaefer (4), the terms evaluational research and evaluative research have given some difficulty. The following definitions were proposed by Dr M. D. Warren for a EURO Symposium in 1967 (5): Evaluational research: "research work into methods of evaluation. The main concern here is with methodology and not with the evaluation of any particular services or programme." Evaluative research: "research work carried out as part of the process of evaluation. It is additional to the routine collection of data, but after the completion of an evaluative research project some aspects of the work done may be incorporated as part of the routine surveillance of the programme and thereafter cease to be evaluative research in the true sense of the word." 135 FAMILY "One person or a group of people living tog e th e r and related to one another by blood, marriage or adoption . "(l) A distinction is to b e drawn betwee n family and household. The family is defined primarily by r e lationships whi c h pertain to or arise from reproductive processes and which are r egulated by l aw and by cus t om ; the household is a socio - eco nomic unit consis ting of individuals who live tog e ther. (2) Nuclear family: "the head of the hous e hold, his spouse and th e ir unmarried c hildr en. " ( 3) Joint family or composite family: "usually more than two gene ra- tions of a biological family where it is not the custom for c hildr en to leave the parental hom e upon marriage. "(3 ) 137 FAMILY PLANNING This term has superseded the olde r t e rm birth control, which was felt to b e too negative and r e strictive as a descrip tio n of the wide fi e ld now cove r e d by family planning; it can still b e used in a more limited s ense (see below). Family pl a nning has been defined simpl y in terms of "avoiding unwanted pregnan c i e s". (1) Th e following is a mor e formal definition (2): "Family planning r efe rs to the us e of a r a nge of methods of f e rtility regulation to help individuals or couples t o a ttain certain objectives: avoid unwant ed births; b ring about wante d births; produce a c hange in the number of childr en born ; r egulate the intervals b e tween pregnanc ies; and control th e tim e a t which births o ccu r in r e lation to the age of parents. In ma y include an array of ac tiviti es ranging from birth planning and the m anage m ent of infertility to s ex education, marital counselling and even genetic couns e lling." Birth control is used to include con tra ce ption as well as intentional abortion, steriliz a tion and complet e a bstinence from coi tus. (3) Contraception, strictly speaking , refe rs t o measures excluding sterili zation (and, in some discussions, p e rmanent and periodi c absti- nence) whi c h are taken in order to preve nt s exua l int e r c ours e from resulting in conception. (4) 138 FEEDBACK "The flow of information from a later phase of a pro c ess to a n earlier phase. "(l) An alternative formulation is found in a r e cent English definition: "The use of information produced at one stage in a s e ries of ope ra- tions as input at another stage. " (2) 139 FEE -FOR-SERVICE The fee-for -service or item-of-service method of remuneration is a system under which a physician receives a fee for each consultation, visit or specific item of service rendered to a patient to whom he has agreed to give medical care. The fees are usually set out in a fee schedule or nomenclature. This method of payment is contrasted with payment by salary or by capitation (q. v. ). 140 FERTILITY "The capacity of a man , a woman or a couple t o part1c1pate in repro - duction (i. e . the produc tion of a live child) is c alled fec undity. The lack of that capacity is called infecundi ty , sterility or physiological infertility. F e rtility on the other hand means a ctual reproductive performance - whether applied to an individual or group. It should be noted that in many Latin languages the ety mological equivalents of fer~ilit y and fecundity are used in a sense diametrically opposite to that in English. Thus the French fecondite or the Span ish fecundidad are properly translated by fertility, and fertilite or fertilid a d by fec undity. It should also be noted that although the conventions outline d above are gene rally followed by demographers the terms fertility and fecundity a re used much more loose l y in m e dical literature , where they are sometime s tre a t ed as being a lmost synonymous." ( l) For a discussion of the diffi c ulties of terminolog y in this field, see the Report of a WHO Scientific Group on the Biological Components of Human Reproduct ion (1969). (2) 141 FERTILITY RATE Age-specific fertility rate: the number of births that occur in a year to l 000 women of a particular age (either in single years, or mo st commonly in five year age -groups). (1) Completed fertility rate: births to women who have reached meno- pause. (1) General fertility rate: the number of births which occur in a year per 1000 women of child -bearing age (usually 15-55 or 14-49). (1) Total fertility rate: an estimate of the number of children a hypo- thetical cohort of l 000 women would bear if they all went through their reproductive years exposed to the age - specific rates in effect at a particu- lar time. It is computed simply by summing the age -spe c ifi c ferti lity rates for all ages and multiplying by the interval into which the ages are grouped . (1) 142 FETAL DEATH (According to the Oxford English Dictionary, the spelling of fetal is "etymologically preferable" to foetal.) On the recommendation of the WHO Expert Committee on Statistics the 3rd World Health Assembly in 1950 (1) adopted the following definition of this term: "Death prior to the complete expulsion or extraction from its mother of a product of conception, irrespective of th e duration of preg- nancy." The Expert Committee also recommended (2) that fetal deaths should be divided into three major categories: early fetal deaths , at less than 20 completed weeks of gestation; intermediate fetal deaths, at 20 but l ess than 28 weeks; and late fetal deaths, at 28 weeks or more: this category to be rega rded as synonymous with the older concept of stillbirth (q. v. ). A later WHO Expert Committee (1970) (3) considered this subdivision to be impracticable, owing to the difficulty of determining gestational age and to lack of accurate dating of the last menstrual period, and recom- mended a classification based on birth weight: early fetal deaths: up to and including 500 g (approximately car - responding to a gestational age of 20 weeks); intermediate fetal deaths: over 500 g, up to and including 1000 g (approximately corresponding to a gestational age of 28 weeks); and late fetal deaths: over 1000 g. The concept of fetal deaths supersedes older uses of abortion, miscarriage and stillbirth (qq. v.) and can be taken as equivalent to all three terms collectively. (4) The 3rd World Health Assembly agreed in 1950 (5) that the terms abortion and stillbirth should be used only if essen- tial for internal use within a nation, in which case stillbirth should be considered synonymous with late fetal death. Fetal death rate or fetal mortality rate: usually calculated as the ratio of the number of fetal deaths registered during a year to the com- bined number of live births and fetal deaths registered during the year. (6) 143 FIELD TRIAL "An experiment under natural conditions that aims at testing the effectiveness of a method or substance. "(l) 144 FOOD In its 4th Report (1956) (1) the WHO Expert Committee on Environ- mental Hygiene defined food as including all substances, whether in a natural state or in a manufactured or prepared form, which are part of the human diet. In considering the subject of food as a factor in environ- mental sanitation, however, the Committee excluded from its considera- tion water, drugs and therapeutic sub stances. It recognized the vital importance of water as an element in human diet as well as in food handling and food hygiene, but observed that the purity and wholesomeness of water was a wide subject in itself which called for consideration by specialists in that field. In the WHO/FAO Food and Nutrition Terminology (2) a more formal definition of food is given: 11 1. (Physiological sense) Nutritive material taken into an organism and which fulfils needs for maintenance, growth, work and tissue repair. 11 2 . (Behavioural sense) Biological material recognized by an individual or group as being fit to fulfil the physiological functions des - cribed above and usually consumed to these ends, or sometimes for social and other reasons." To this definition two footnotes are added: (a) In popular usage food is often used to designate nourishment taken in solid form, as opposed to beverages. This is not a distinction endorsed by the international organizations, which recognize as food any nutritive material consumed by people, whatever its state. (b) For legal purposes various countries have adopted very wide definitions of the term food in order to bring a variety of what would normally be considered non-food substances (e.g. toothpaste, chewing gum) under the control of the same r egulatory agencies as food. 145 FOOD ADDITIVE "A substance added intentionally to food, generally in small quanti- ties, to prevent spoilage, to stabilize or improve its keeping qualities, texture, flavour or appearance or to aid in processing. By contrast, an 'ingredient' usually is a quantitatively larger component and often an original constituent of a food or food product." (1) 146 FOOD -BORNE DISEASE "Food-borne diseases can be defined as those diseases which, with pre sent knowledge and methods, can be traced (a) to a specific food, substance in the food, or dish which has been contaminated by noxious organisms or substances, or (b) to a particular food -producing or food- dispensing establishment where a contamination has occurred . "Food-borne infections and intoxications include diseases which in some instances may be transmitted by food and those which are usually conveyed by food." (1) 147 FOOD HANDLING "The sum of processes and treatments to which food is subjected from its production to its final consumption." (1) This is a briefer version of a definition adopted in the 4th Report ( l 956) (2) of the WHO Expert Committe e on Environme ntal H y giene: "Every activity, process or treatment to which food is subje c ted from its growth, production or manufactur e until its final consumption , and which may have an influence on its safet y, wholesomeness or sound- n e ss for human consumption." 148 FOOD HYGIENE "The measures whereby the wholesomeness , soundness and safety for human consumption are secured or increas e d, covering all facets of food production, harvesting, processing , distribution , preparation and service and of possible causes of toxicity (phy sical , c h e mi cal or micro- biological). "(1) This definition was suggested as an alternative to the definition given in the 4th Report (1956)(2) of the WHO Expert Committee on Environ- mental Hygiene: "All measures necessary for ensuring th e safety, wholesomeness and soundness of food at all stag e s from its growth, production or manu- facture until its final consumption. 11 The term food sanitation , strictl y d efined as forming part of the wider field of food hygiene, is sometimes used as a s y nony m of food hygiene . Se e food sanitation. 149 FOOD POISONING "Harmful effects following ingestion of food resulting from (i) contamination with pathogenic bacteria, (ii) toxic products of fungi and bacte ria, (iii) allergic reaction to certain proteins or other components of food, or (iv) chemical contaminants." (1) This definition must be taken as superseding earlier definitions adopted by the Joint FAO / WHO Expert Committee on Meat Hygiene (1955) , the WHO Expert Committee on Environmental Hygiene (1956) and the European Technical Conference on Food-Borne Infections and Intoxica- tions (1959) , as well as this last Confere n ce 's preference for the term food-borne intoxication. (2) Se e food-borne disease. 150 FOOD STANDARDS "A body of rules or legislation defining certain criteria - suc h as composition, appearance, freshness, source, sanitation, maximum bacterial count, purity and maximum concentration of additive s - which food must fulfil to be suitable for distribution or sale . " (1) 151 FUNCTION "A broad area of responsibility composed of many activities aimed at achieving a predetermined objective. Functions are not constrained by time or resources."(1) 152 GENERAL PRACTICE General practice, as opposed to specialist practice, is a form of medical practice in which the practitioner takes continuing responsibility for the general medical care of patients in the community, n o t limited to particular disease entities or particular age -groups. See general practitioner. In some countries the field of general practice almost coincides with primary medical care (q. v. ); in others there is a considerable degree of overlap between the two concepts; in others again general practice as defined above does not exist. General practice may be individual practice, in which the practi- tioner works indpendently of other practitioners, though he may have nurses and various auxiliary workers assisting him; or group practic e (q. v. ), in which two or more practitioners work together. A group practice may or may not involve partnership (q.v.) between the doctors concerned. 153 GENERAL PRACTITIONER A traditional term which has been the subject of much consideration in recent years, reflecting changing views on the role of the general prac- titioner himself. The following definition was adopted by the WHO Expert Committee on General Practice (l 964) (1 ): "A general practitioner is a doctor who works in general practice . He does not usually limit his professional work to certain disease entities or to certain age-groups. Patients have direct access to him , and he assumes responsibility for providing or arranging for the provision of continuing and comprehensive medical care, both preve ntive and curative. " More recently a EURO Working Group on Psychia try and Primary Medical Care ( 197 3 )( 2) adopted a similar definition, while recognizing that it was both complex and imprecise: "General practitioner: A primary physician who takes con tinuing responsibility for the general medical care of patients in the community, including the prevention and treatment of any illness or injury affecting the mind or any part of the body. Distin c tive features of his work are that part of it is carried out in the patient's home, and that he frequently gives care to the whole family." This last feature is reflec ted in the traditional designation of family doctor or family physician which is often regarded as synonymous with "general practitioner". The 1973 Working Group noted (3) that th e use of the term general practitioner (and general practice) had come under criticism, largely on the ground that the general practitioner should not be contrasted with the specialist but should be recognized as a specialist in his own field, and that the use of the terms primary physician and primary medical care (qq. v.) had been proposed in their place. The Working Group observed, however, that in many countries the primary physician was not necessarily a generalist (nor a family doctor), and therefore felt it necessary to retain the term general practitioner to refer to those primary physicians who were in fact generalists within the terms of their definition. A WHO Expert Committee in 1974 (4) made a similar distinction between family physician and general practitioner: "The family physician offers to all the members of a family he is serving a direct and continuing access to his services. Family physicians are usually general practitioners but may also be internists. The general 154 GENERAL PRACTITIONER (contd) practitioner is a physician who does not . limit his practice to -certain disease entities and who offers his patients direct and c ontinuing access to his services." 155 GERIATRIC HOME "An institution providing facilities and services for coordinated social, medical and rehabilitative care of aged individuals who may re - quire not only custo::lial and personal services but who may also require skilled nursing care and related medical services or diagnosis and inten- sive treatment." ( l) This definition appears unduly wide, since it encompasses services more appropriate to a hospital than a home . 156 GERIATRICS "Gerontolofiy may be defined as the scie ntific approach to all aspe cts of aginghealth , sociological , economic, behavioural , environ- mental and others). It is most o f ten a multidisciplina r y fie l d. "Geriatrics may be defined as a branch of gerontolo gy and medicine that is concerned with the health of the e lderly in all its aspects: preven- tive , clinical , remedial , rehabilitative, and continuous surveillance . "( l) 157 GROSS NATIONAL PRODUCT "The total sum in a country of three major components consumption expenditure on goods and services; ~overnment on goods and services; investment expenditure . "(!) 158 - personal expenditure GROUP PRACTICE "A medical practice c onducted by two or more physicians from common premises, linked together in a variety of ways but providing various degrees of mutual support. They may be generalists and/or specialists." (1) As noted by the WHO Expert Committee on General Practice rn l 964 (2) , there are many types of group practice: "Two or more general practitioners may retain their own separate premises and work from these , the main reason for the formation of the group being to enable one partner to replace anothe r when the latter is off duty. Or several practitioners may work from common premises and pool their resources. In some group practices there may be one or more specialists working with the general practitioners; in others all the mem- bers of the group may be specialists. Group practices may be large enough to have a complete range of diagnostic and therapeutic facilities and even their own hospitals or nursing homes." Group practice will often take the form of a partner ship (q. v, ) of general practitioners, but does not necessarily involve the special com- mitments and financial relationships of partnership. Any partnership, however, implies some form of group practice. 159 HABIT -FORMING DRUG II). its 2nd Report ( 1950 ) ( l) the WHO Expert Committee on Addiction- Producing Drugs (now the Expert Committee on Drug Addiction) defined a habit-forming drug as "one which is or may be taken repeatedly without the production of all the characteristics outlined in the definition of addic- tion and which is not generally considered to be detrimental to the indi- vidual and to s,Jciety." (For the definition of addiction see drug addiction.) The Committee was of the opinion that the use of the expression "habit-forming", when the meaning was clearly "addiction-producing" , should be discontinued . It reiterated this view in its 3rd Report (1952) (2), declaring that "a distinction can and must be made between drug addiction and habituation (habit) , and between addiction - producing and habit-forming drugs, that the terms are not interchangeable, and that only the expressions drug addiction and addiction-producing drugs should be used in documentation with respect to substa nces brought under, or to be brought under, int e rna tiona l cont rol." In its 7th Report (1957) (3) the Expert Committee noted that this definition was ambiguous, since it implied that any one or more of the characteristics of an addiction-producing drug might not be apparent; moreover it was doubtful whether it was correct to say that a habit- forming drug was not generally considered to be d e terimental to the individual. The Committee therefore suggested the following new defini- tion: "A habit-forming drug is one which produces habituation (habit) but not addiction when used continuously at about the usual therapeutic dose leve l. Some habit-forming drugs when used excessively, in terms of dosage and/or frequency of administration, may produce a true physical dependence (addiction) , superimposed upon a psychic dependence." In accordance with the re commendation in the Ex:pe rt Committee ' s 13th Report (1964) that the term drug dependence (q . v. ) should replace the terms drug addiction and drug habituation, the term habit - forming drug (along with addiction-producing drug ) should now give place to dependence - producing drug (q. v. ). 161 HALF-WAY HOUSE "Accommodation provided for handicapped patients to allow them to make a gradual and smooth transition from hospital to home."( 1) The term may be used in a wider sense to cover any form of accom- modation intermediate between hospital and the patient's own home. 162 HEALTH "A state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. "(l) 163 HEALTH CARE "Health care implies not only the care of the acutely and chronically ill but also rehabilitation, case-finding, health maintenance, prevention of disease and disability, and health education. "(l) A similar definition has been given to comprehensive health care: "The promotion of health, the prevention of illness at all levels, early diagnosis and treatment of disease, and rehabilitation of the patients. It implies health education at all these stages. "(2) See also community health (care). 164 HEALTH CENTRE A t erm which means different things in different countrie s, and may th e r efore require to be defined in th e context of th e particular discussion. A su r vey by Roemer in the Publi c Health Papers series (197 2 )(1) defines the term widel y to cover " primary care centres", roughly in th e sens e of health centre as usu a lly understood in Weste rn Europe; special - iz ed se r vice s directed to th e treatment of particular diseases, on the lines of the dispens a ry ( q . v .) of the Sovie t Union a nd th e Eastern European countries ; and the Soviet a nd Easte rn European poly c linic (q. v. ). Th e following definition (1966)(2) , though it conta ins the ess e n c e of th e m a tter, is perhaps also too gene r a l to be of much se rvi ce : "A health c entre may be d e fined as a n institution providing he a lth servi ce s to a defined community . Ideally, it should include ( a ) health ca r e, both preventive a nd promotive, for individu a ls, fam ilies, other spe c ial groups a nd for t h e comm u nity as a who l e ; ( b ) medic a l care of the sick , both at th e health c entr e itself and at home; and ( c ) r eha bilitation servi c es in asso c iation with community welfa r e a gen c i e s . " An a lt e r native, and p e rhap s mo r e helpfu l , definition by a EURO Working G roup on Ps ychi a try and Prim a r y M e di c al C a r e (1 97 3)( 3 ) is th e following: "Health cent r e : a centre pro viding both medical ca re and preventi ve p e rsonal health services, usually staffed by a multidis c iplinary team. Specialists ma y be a vai l a ble on a part-tim e or full-tim e basis, but the emphasis is on prim a r y medical ca r e , continuity of care and treatment in the community . " As this definition - a slightly expanded ve rsion of one adopted by an earlier EU RO confe r ence ( 197 0 ) ( 4) - implies, the he a lth centr e is basic - ally a n institution pro viding am:)ulatory c are, though in some cou ntries it may have a small number of beds. It m a y o r m a y not be directly att ached to a hospital, but will often have an asso c i ation with a hospital and with hospita l staff. It will norm a lly pro vide faci lities for as so ciation between he a lth and social welfare services. It has been suggested ( 5 ) that the term health centre should be con- fined to public institutions, exclud ing facilities provid ed privately by groups of doctors. It may sometimes b e difficult to define the boundary b e twe en health ce ntr e on the one hand and out-patient department and polyclini c (qq. v. ) on th e other. The distinguishing featu r e of an out-patient d e partment is that it is norm a lly more closely and exclusively associated with a hospital, 16 5 HEALTH CENTRE (contd) usually with a particular department or departments of the hospital. The polyclini c of the Soviet Union and the Eastern European countries is distinguished by having a largely specialized medical staff and b y its emphasis on the differ entiation of disease categories and specialist care from an ear l y stage of illness. The Report (197 3)( 6 ) of a EURO Working Party on Trends in the Developm e nt of Primary Ca re noted the ambiguity of the term health centr e and suggested the use of primary care ce ntre (q. v. ) as a possible neutral term. 166 HEALTH EDUCATION "The term ' health education' has a numbe r of meanings, of whi ch two a re of special significance in the context of this r e port. In its broadest interpretation he a lth education conce rns all those experiences of an indi v idua l, group o r community th a t influence b e liefs, attitudes and behaviour with respect to health, as well as the processes and efforts of producing c hange when this is ne ce ssary for optimal health. This all- inclusive co n cept of health education re cogniz es that many experiences, both positive a nd negati ve, have an impac t on what an indiv idual, group or community thinks, feels and does abou t h ealth; and it does not restrict h ealth e du cation to thos e situations in which h ealth a c tivities are planned or formal. In the mor e limited meaning health education usually me ans the planne d or formal efforts to stimulate and pro v id e experience at times, in ways and through situa tions l eading to th e development of the health knowl e d ge, a ttitudes and b ehaviour that a r e most conducive to the attain- ment of individual, group or community health. "(l) "The focus of he a lth educatio n is on people a nd on action. In gene r a l , its a i ms a re to p e rsuad e p eo pl e to ado pt and sustain healthful life practi ces, to us e judi c iously and wisely the health s e rvi ces available to them, a nd to take their own de cis ions, bqth individually and collectively, to improve their h ealth status and environment. "(2 ) 167 HEALTH EDUCATOR The use of this term may give ris e to diffi c ulty, since it can be a pplied either to a person who has ado pted he a lth education (q. v. ) as a professional ca reer or to a professional p e rson (nurs e, do c tor, e t c .) whose professional activities include health education as p a rt of his or h e r rel a tionship with patients or the publi c. Th e pr efe rr ed WHO term in th e former s ense is specialist in health education. 168 HEALTH INFORMATION SYSTEM The following definition was adopted by the 3rd European Conference on Health Statistics (1971)(1) and the European Conference on National Health Planning ( 197 4) ( 2): "A mechanism for the collection, analysis and distribution of health statistical information required to enable health planners to assess pri- orities, and to assist them in deciding how to meet particular priority needs and finally to enable health administrators to measure their achieve- ments. 11 A variant of this definition was used by a EURO Conference on Health Information Systems in 1973 (3): 11 A mechanism for the collection, processing, analysis and trans- mission of information required for organizing and operating health serv- ices, and also for research and training. 11 The 1971 Conference on Health Statistics agreed that the basic con- stituents of a modern health information system were indicators of the state of health of the population; measurements of the utilization of health services; statistics on the resources available; socio-demographic data on the population; environmental data, both on the natural environ- ment and on pollution of various kinds; and means of obtaining informa- tion on the outcome of treatment or preventive measures, including in- formation on residual disability. Cf. management information system. 169 HE~LTH INFRASTRUCTURE "The ' health infrastructure' is defined as that organized network of peripheral units cap able of providing certain basic health services within the availab l e local resources to cater for the most urgent health needs of the population."(l) It may be questioned whether this restriction of the term to peri- pheral units is a ppropriate to general use: "infrastructure" is normally applied to the complete basic structure of a service. 17 0 HEALTH INSURANCE A system of social insurance (q. v.) devoted solely to hea.lth-related benefits. It may, however, be private (voluntary ) as well as public ( compulsory for the whole population or for certain categories). The older term sickness insurance, with its implied exclusion of preventive care, is now seldom used . ( 1) 171 HE A LTH L ABORATORY SER.Vl CE "The health laboratory service groups all the laboratories used in both pr e v e ntive and curative medicine: public health laboratories, hospital l a bora tori e s and other laboratories whi ch in som,~ way deal with the h ealth of th e p e ople of a country , wh e ther consid e red individually or colle c tive - l y . "(l) 17 2 HEALTH MA.NPOWER "The concept of health manpower generally includes: the number of individuals ava ilable for, o r undergoing training in, the diffe rent health occupations ; the demographic characteristi c s of these individuals; their social cha r acteristics in terms of education, expe rie nce and values; and the changes required, both in numbers and qualification of personnel, to pro v id e the health services needed and demanded by a population. As generally und e rstood , therefore, health m a npower includes: (1) those al re ady working in the fi e ld o f h e alth servic e s ; ( 2 ) potential h e a lth wo r kers, i . e. thos e who ha v e the a bility to engage in a p a rti cul a r health occupation but are not a t present doing so; and (3) prospective manpower, i.e. thos e who are a t present undergoing education and training th at will p ermit them to join the health servi c es . " ( I) 17 3 HEALTH MANPOWER PL ANNING "Health manpower planning is the process of estimating the quantity and t y pe of knowledge, skills and abilities ·ne e ded to introduce predeter- mined alterations in the functioning of a health system so as to ma.ke it mo re probable that the d e sirable changes in the health of a population will be ach ieved. Su c h planning involve s specifying who is going to do what, and also where, when, how a nd for what patients or popula tion group, so th a t th e knowledge a nd skills necessary for adequate p e rform a nce can b e established and made available ac cording to a predete rmine d schedule. This must be a continuing , not a sporadic pro cess . " In general, health m a npower pl a nning implies the generation and utiliz ation of skills, and invol ve s: (1) the anal y sis and proje c tion of h ealth needs and th e population's d emands for servi ce s; (2) th e m easurem e nt of pres e nt availab ility of he a lth manpower and an a n a l ysis of its p a ttern of utiliz a tion a nd e ffe c tive ness; ( 3 ) the es tim ;i. tion of future manpowe r requirem e nts a nd of education and training needs in the light of overa ll h ealth plans; (4) the detection of imbalances betwee n the estimated requir e ments and the expected supply ; and (5) the formulation of poli cy to alleviate thes e imbalances, including measures to achieve optimum utilization of the a vailable man- power. " (l) 17 4 HEALTH PLANNING For definitions of planning in general and different types of planning, see planning. Health planning, or national health planning, has been defined as "the orderly pro cess of defining community health problems, identifying unm et needs and surveying the resources to meet them, establishing priority goals that are realistic and feasible, and projecting administrative action to accomplish the purpose of the proposed programme . "(1) The Report of a WHO Expert Committee in 1970 (2) noted that: 11 When fully developed, national he a lth planning is concerned not only with the adequacy, efficacy and efficiency of health services but also with those factors of ecology and of social and individual behaviour th a t affect the health of the individual and the community." The Terminology List prepa red for the European Conference on National Health Planning in 1974 (3) distinguished between two t ypes of health planning: "Planning for health, or national health planning: this has been taken to mean planning for the optimal use of all the scarce national re- sources available for improvement of health (or health status) over a given period, whether those resources lie within the so-called health sector or outside it. "Planning for health services, or planning for the delivery of health care: this implies planning for the mo st effective me a ns of providing health services or delivering health care over a given period with the pre- dicted limited health resources likely to be available." The Conference noted that the form which health planning took in different countries - in line with the former (wider) definition or the latter (narrower) one - would depend on the administrative structure and characteristics of each country. ( 4) See also health manpower planning. 17 5 HEALTH PRACTICE "Health practice (public health practice) includes the provision of traditional public health services, namely disease control, environmental control and other general preventive services, and the planning, adminis- tration and management of all forms of personal health care, namely personal preventive services, health surveillance and screening, diagnosi s and treatment, and restorative services, both in hospitals and in the com- munity. "( 1) 176 HEALTH PRACTICE RESEARCH "Health practice research can be defined as the use of the scientific method in investigating problems of planning, organization and adminis- tration (including management and evaluation) of health services. Its broad purpose is to study and analyse systems for the delivery of health care and other health services, with a v i ew to ascertaining what the optimal organization might be, to indi cate where and how improvements may be made, and to support health service planning. "(l) "Health pra cti ce resear ch is conce rned with o r ganizational problems - with the planning, management, logisti cs and deliver y of health ca r e serv- ices. The problems of c linical -patholo gical medicine and biomedical science therefore lie outside its pro vince. The a ppli cation of the r esults of rese a r c h in biom ed ical science to individual patient ca r e, etio logi cal studies , pathology, questions of biometrics and h~m ;:m physiology, and laborator y procedure also belong elsewhere, though they a ll contribute to the body of knowledge and methods that health pr act i ce research takes into account and uses. Although health pr actice research overlaps to some extent with epidemiology and often ma'<es us e of the epidemio logic a l mP.thod, epidemiology as such is outsid e its scope. "(2) 177 HE A LTH PROFILE "All the elements that indicate the health profile of a population a s well as the various means used for the delivery and evaluation of health ca r e . " (1) 178 HEALTH PROTECTIO N "The provision of conditions for norm a l m,~ntal and phy sical function- ing of the human being indi v idually and in the g roup. (It includes ) the promotion of health, the pr eve ntion of sickness a nd cu rati ve and r estorative medicine in all its a spects . " ( 1) 179 HEALTH SER VICES "Health services a r e difficult to define but can be described as a perm::i.nent country-wide system of established institutions , the multi- purpose objective of which is to cope with th e various he a lth needs and dem a nds of the population, and thereb y provide health ca r e to individuals and the community, including a broad spectrum of pr eve ntive a nd curative act ivities, and utilizing, to a large extent, mcilti-purpose health workers . " (l) A similar definition has been given for g ene ral health servi ces . ( 2) Basic h ealth ser v i ces have been defined as : "A '1.etwork of coordinated periphe ral, int e rmediate and central health units, staffed by compe t e nt profess ional a nd a uxiliary personnel, and capable of performing effectively a s e lected group of functions essen- tial to the health of the p eo ple living in the area . It is administe red by central, interm ed iate and lo cal organs, as appropriate to the general administrative p at t e rn of th e countr y . "(3 ) Se e also p ersonal he a lth se r vices . 180 HEALTH SERVICE SYSTEM "A health service system includes all formal and informal activities centred on the provision of health services for a given population and the utilization of su ch services by the population."( 1) 181 HEALTH STATUS The state of health of a person or a population, assessed by reference to general mbrbidity, morbidity from particular diseases, impairments, anthropomorphic measurements and mortality. ( 1) 182 HEALTH SURVEY " A programme for studying a populatio n or a p articular segment of the population, in order to assess its health problems o r to detect condi- tions to which preventive ·m e asures may be a pplied."( 1) "The term 'health survey' has a much wide r connotation than 'morbidity survey', the latter being, in fact, only one element in the full range of possible components of a health surve y . A ge neral health sur- ve y is capable of providing information on one or all of the following broad subjects: (1) Health status of the population: this includes such subje c ts as general morbidity, morbidity from one disease or group(s) of diseases, impai rments, anthropomorphic measurements and mortality . (2) Conditions influencing or influenced b y health: among the conditions to be co nsidered are socio-economic conditions, nutrition, environmental factors, living habits and genetic factors. ( 3 ) Health services and medi ca l care: subjects included are the need for health services, the availability and uti lization of health ser v i ces, the evaluation of health programmes and the measurement of expenditures in connexion with the prevention and / or treatment of illness . "Morbidity surveys usually compris e onl y the first two sub-items mentioned under { 1) above, although information may be obtained upon some of the other items so as to provide a b a kground to the morbidity information. "(2) 183 HOME CARE "The provision of health and/or supportive services in the home to individuals who are ill or disabled, but who do not require institutional care. "(l) Alternative term: domiciliary care . See also progressive patient care. 184 HOSPITAL The 1st Report of the WHO Expert Committee on the Organization of Medical Care (1957)(1) gave the following d efinition: "The hospital is an integral part of a so cial and m e di c al organiz a tion, the function of which is to pro vide for the populat ion complete h ealth care, both cu rative and preventive, and whose out - p a tient s e r v i ces reach out to the family in its home environment ; the hospit a l is a l so a centr e for the training of health workers a nd for bio-so c ial r esearch." In terms of size the Committee distinguished thr ee t yp e s of hospita l: "(l) the regional hospital, which is loc a t e d in th e c hief town of a region, and may be working in collaboration with a m e dical s chool; it gives a hig,h 5tandard of s ervice in general me dicine, surgery and obstetric~ covering all the needs of the local inhabitants; it is a lso full y equipped with highly specialized departm e nts, such as those of neuro- surgery , plasti c surgery , radiotherap y, e t c . , capable of h a ndling a ll the patients of the entire r egion needing such s e r vice s. "(2) the intermediate hospital, which is responsible for a smaller district. In addition to departments of general medi c ine, paediatri c s, surgery and obste trics, it has a number of d e p a rtments d ealing with more common specialities, for example otorhinolaryngo log y and ophthalmology . An X-ray department under a well qu a lifi e d specialist is indispensable. "(3) the lo cal hospital, which pro v id es gene r a l medic ine, surgery and obstetrics for the d ay -to-day needs o f a sm a ll loca lized group. " ( 2 ) (The passage in square brackets is missing the the English text, and has been restored from the French edition.) The WHO Expert Committee on Health Sta tistics ob s e rved in its 8 th Report (1963)(3) that th e 1957 Committee's d e finition of hospital was not suitable to statistical purpos es, and propos e d the follo wing as a working definition: "A hospital is a residential establishm e nt which provides short-term and long-term medical ca r e cons isting of observational, diagnostic, thera- peutic and rehabilitative servic es for persons suffering or suspected to be suffering from a disease or injury, and for parturients. It may or m ay not also provide services for ambulatory patie nts on an out-patient basis." The Committee noted that such a definition would exclude c ertain types of institution (old people's homes, hom e s for th e blind and deaf, etc.) where regular medi c al treatment w a s not availabl e , though occasional medical care might be provided when needed. 18 5 HOS PIT AL ( contd) The Committee also defined general hospital and specialized hospital as follows: "A general hospital is a hospital which provides a range of differen- tiated services for patients of various age-groups and with varying disease conditions. " "A specialized hospital is a hospital admitting primarily patients suffering from a specific disease or affection of one system, or reserved for the diagnosis and treatment of conditions affecting a specific age- group or of a long-term nature." A later WHO Expert Committee in 1968 ( 4) proposed a simple and broad definition designed to cover the varied types of hospitals found in both developing and highly industrialized countries : "An institution that provides in-patient accommodation for medical and nursing care." The Committee noted that this definition could be elaborated as required to cover additional functions. 186 INCIDENCE "The number of instances of illness commencing, or of persons falling ill, during a given period in a specified population. " (l) In referring to incidence it should be made clear whether the data represent the number of instances of the disease recorded or the number of persons ill. The distinction between incidence and prevalence (q. v.) is that whereas incidence refers onl y to new cases prevalence refers to all cases, irrespective o f whether the y are new or old . Incidence is usually expressed as an incidence rate, the denominator being the average number of persons in the spe c ified population during the defined period or the estimated number of persons at the mid-point of that period. 187 I INDEX "In its most general sense, the term index (pl. indexes or indices) or the term indicator is employed for any number measuring a given quantity; but in a more restricted sense an index is a ratio showing the v alue of a given quantity relatively to a base, which is conventionally taken as l 00 . "( 1) "Indices are generally defined as 'relative numbers expressing the value of a certain quantity as compared with another ' . "(2) It has been suggested ( 3 ) that in relation to health trends the term indicator is to be preferred to index, which sugge sts a degree of pre cision not yet attained in health data. 188 INF ANT MORT ALI TY Infant mortality: "The mortality of live-born children who have not yet reached their first birthday. "(1) Infant death: the death of a child under one year of age. Infant mortality rate: the ratio of infant deaths registered in a given year to the total number of live births registered in the s ame yea r (l); usually expressed as a rate per 1000 live births. Neonatal mortality: "The mortality of live-born children who die before reaching a certain age, taken as four weeks or a month. "(l) Neonatal death: a death occurring within this period. Neonatal mortality rate: the ratio of neonatal deaths in a given y ear to the total number of live births in the same year; usually expressed as a rate per 1000. Early neonatal mortality: the mortality of live-born c hildren who die in the first week of life. The WHO Expert Committee on the Preven- tion of Perinatal Mortality and Morbidity (1970) (2) re commended that this conventional definition should be expressed more precisely to refer to the first 168 hours of life. Early neonatal death: a death occurring within this period. Early neonatal mortality rate: the ratio of early neonatal deaths in a given year to the total number of live births in the same year; usually expressed as a rate per 1000. Post-neonatal mortality: the mortality of live-born children who die after the neonatal period but before reaching the age of one year.(l) Post-neonatal death: a death occurring within this period. Post-neonatal mortality rate: the ratio of post-neonatal deaths in a given year to the total number of live births in the same year; usually expressed as a rate per 1000. Perinatal mortality: mortality during the prenatal period (which is variously defined but in general terms is understood to cover the latter period of fetal development), the birth process and some portion of the neonatal period. (3) According to the International Classification of Diseases it extends from the 28th week of gestation to the 7th day of life.(4) 189 INFANT MORTALITY ( contd} Perinatal death: a death occurring within the perinatal period. In normal usage the term would cover late fetal deaths (stillbirths} and early neonatal deaths. Perinatal mortality rate: the ratio of perinatal deaths in a given year to the total number of live births in the same year; usually expressed as a rate per 1000. The WHO Expert Committee on the Prevention of Perinatal Mortality and Morbidity (1970}(5) recommended a more precise formulation: "Late fetal and early neonatal deaths weighing over 1000 g at birth expressed as a ratio per 1000 live births weighing over 1000 g at birth." 190 IN-PATIENT "A person admitted to hospital who oc c upies an adult or child ho spit al bed £or observation, care, diagnosis or tr e atment. 11 ( 1) In-patient facilities are (a) hospital facilities; and (b) other facili- ties where residential accommodation for patients is provided, including nursing homes, sanatoria, hostels, half-way houses, night hospitals, etc.(2) Compare out-patient, day patient. 191 INPUT "The sum total of resources and energies purposefully engaged in order to intervene in the spontaneous operation of a system."( 1) "The basic resources required in terms of manpower , mone y , materials and time. "(2) 192 INSURED PERSO N Under a s c heme of socia l insurance (q. v . }, an insured p erson is a person entered in the r ecords or registers of the scheme as covered by the pro v isions of the s cheme . The term covered p erson is a lso used, 1n the sens e of a p erson subject to a social insurance scheme but not necessarily entitl ed to benefit ( whi ch may depend on ce rtain qu a lify i ng conditions, a means test, etc .). A protected p e rson is a p er son who has a right to benefit if a given c ontingency should materialize. A contributor is a p erson who p ays cont rib utions to an insurance scheme, or on whose behalf contributions are paid. (1) 19 3 INTEGRATION According to a definition proposed b y the WHO Executive Board in 1 97 3 ( 1): "Integration means putting different parts together to form a whole; to unify, or complete b y addition of parts, to combine parts into a whole. In the field of health it applies to a c tivities, programmes, plans, services. There may be administrative , technical integration, or both." The Report of a WHO Study Group in 196 5 (2) noted the importance of integrating mental attitudes as well as structures: " Integration: a series of operations concerned in e ssence with the bringing together of otherwise independent administrative structures, functions and mental attitudes in such a way as to combine these into a whole." A n inte1rated h ealth s e r vice was d efined b y a WHO Expert Commit-tee in 1954 (3 as: "The service ne ce ssary for th e health protection of a given area and provided either under a single administration or under several agencies, with proper provision for the coordination of their services." 194 INTENSIVE CARE One of the stages of progressive patient care (q. v . ). A EURO Seminar on Nurs ing in Intensive Ca r e ( 1969 ) ( 1) c riti c ized the commonly used term intensive care, prefer ring the a lternative expres- sion intensive therapy, which it defined as: "The c are and .treatm ent of patient s who a re de emed r ecove rabl e but who need continued supervi sion and need or are likely to need the prompt use of spe cialized techniques b y skilled p e r sonnel. 11 The Seminar accepted the term intensive nursing ca re: see nursing care. 19 5 INTENSIVE CARE UNIT A EURO Seminar on Nursing in Intensive Care (1969)(1) preferred the term intensive therapy unit to the commonly used intensive care unit. It defined intensive therapy unit as: 11 A special unit providing ( l) a facility available to all medical staff, with more space, staff and equipment for the care of the patient than can be provided in the ordinary wards; (2) a servi c e which provides continuous observation of the vital functions and can support these functions more promptly and efficiently than would be the case elsewhere in the hospital. 11 196 INTERMEDIATE AREA "A politically endorsed entity, state, region, province or district that is capable, in terms of its resources (actual or potential), of managing a comprehensive health programme within its geographical boundaries, and to which adequate executive authority can be granted for this purpose."( 1) (For most health care purposes the concept of region, q. v., may be a more useful one.) 197 INTERME DIA TE H EA LTH A DM I NIST RATIO N "A body that a d m inist e rs a nd supe r v is e s th e serv ic e s of a numb e r o f lo cal health ar e as (q. v . ) . Within this d e finition s eve r a l organizationa l a nd fun c tional ty p e s of int e r me dia t e h ealth s e r v i ce may b e found . The r e may b e more th a n one int e r me di a t e h ealth se r v i ce b e twee n th e lo cal and ce ntr a l h ealth a uthori t i e s. T he r eg io nal h ealth a d m i n i s tr a tio n is o ne example o f an i n t e r me diate health s e r v i ce. " (l ) 198 INVALIDITY The following is a general definition: "The state of being unable to carry out accustomed work. "(l} The term is likely to have precise statutory significance in national legislation. The WHO Expert Committee on Medical Rehabilitation agreed on the following neutral definition in its 2nd Report (1969) (2): "A measure of the diminution of the individual's capacities." See also the article on disability . 199 JOB "For the purposes of job analysis, the definition (of a job) is 'the group of duties, r e sponsibilities and a ctivities assigned to an individua l' Thus a job refe rs to an occupation, e.g. that of nurse or shorthand- typist; it does not refer to a portion of the work assigned to an individual, such a s changing a dressing or typing a letter ." (l) 201 J JOB ANALYSIS This term must be considered along with job description, job spe- cification and job evaluation. Job analysis: " The sci entific study a nd statement of all the facts a bout a job which reveal its content and all the modifying factors which surround it." (1) Job description: "(a) the description of a job as a result of job analysis; (b) a 'word picture' of the duties, responsibilities and organiza- tional relationships that constitute a given job or position." (2) Job specification: "Gives a summary of the job description, together with the qualifications, personnel requirements, skills and physical de- mands of a job. Job specifications are used for selection and placement procedures. 11 (3) Job evaluation: "A system of job measurement which stems from the theory that there are a number of factors common to all jobs. These factors vary in degree from job to job, but if the job description has been properly compiled the extent to which each factor is present can be readily ascertained. These differences in job factors, when measured, show the relative importance of each in proper job performance. 11 (4) 202 LINEAR PROGRAMMING One of the techniques of operational research (q. v. ). "A form of mathematical programming whereby limited resources are allocated among a set of activities so as to optimize some (given) measure of effectiveness. 11 (1) "The use of linear (one-dimensional) equations to predict the effect of changing certain factors (variables). 11 (2) 203 L LINE RELATIONSHIPS Four main types of relationship between members of the staff of an organization have been distinguished: "Line relationships exist between a superior and the subordinates immediately and directly responsible to him. "Lateral relations are those between positions in various parts of an undertaking where no direct authority is involved. "Functional relations are those which arise when duties are divided on a functional basis, i.e. when an individual exercises authority on one particular subject by reason of special skill or knowledge. They can and should exist side by side with line relations. "Staff relations are those between individuals, one or both of whom is acting as the representative of a superior, expressing that superior 1s authority and engaging his personal responsibilities. 11 (1) 204 LIVE BIRTH "Live birth is the complete expulsion or extraction from its mother of a product of conception, irrespective of the duration of the pregnancy, which, after such separation, breathes or shows any other evidence of life, such as beating of the heart, pulsation of the umbilical cord or definite movement of voluntary muscles, whether or not the umbilical cord has been cut or the placenta is attached; each product of such a birth is considered live born. 11 (1) The WHO Expert Committee on the Prevention of Perinatal Mortality and Morbidity (1970) (2) noted that this definition required the inclusion as live births of very early and patently non-viable fetuses and that according- ly it was not strictly applied. The Committee suggested, therefore, that WHO should introduce a viability criterion into the definition so that very immature fetuses surviving for very short periods were excluded, even though they showed one or more of the transitory signs of life. 205 LOCAL HEALTH AREA "An area where health services are located and administered to serve a local urban or rural community." (1) 206 LOCAL HEALTH UNIT "An organizati on providin g or making acces sible, under the direct supervision of at l ea st one physician, the basic health services for a community . " (1) 2 07 LONG-TERM CARE "Long-term care is taken to refer to the treatment and re- education of individuals with lasting disabilities in an attempt to restore them as far as possible to their former state of health, independence and ability to participate in community life . To achieve optimal results it requires early diagnosis of illnesses liable to cause lasting disability and continuing care at home, in hospital or in a purpose-built residential s e tting in an a ttempt to r e duce or limit dependency and relieve distress. 11 (1) See also progressive p at i ent care. 208 MANAGEME N T ACCOUN TI NG "The ap pli cation of a ccounting knowle dge to the purpos e of producing and of interpretin g ac countin g and statistic a l information designe d to assist m anagement in its functions of pr omotin g maximum effi ci en cy and in formulatin g and coordin at in g future plans and subsequen tly in measuring their execution." (l) 209 M MANAGEMENT BY EXCEPTION "A method of management whereby only exceptions from a given course of action are reported for action to be taken, rather than routine reporting and analysis of all activities carried out whether change is required or not." (1) 210 MANAGEMENT BY OBJECTIVES "Management carried out with the aim of achieving clearly stated ob jectives, usually in the least possible time and at the lowest cost. 11 (1) 11 A management technique which involves the setting of targets and objectives, and a regular review of progress towards the attainment of these targets. The emphasis on identification of targets facilitates the assembly of a rational plan; monitoring progress against these targets then results in a continual review, and in intervention as soon as necessary. 11 (2) 211 MANAGEMENT INFORMATION SYSTEM "A system designed to produce information to be presented to management to a ssist in decision-making and to enable it to ascertain the progr e ss made by the organization in the achievement of its major objectives. 11 (1) Cf. health information system. 212 MANAGEMENT TECHNIQUES "Management techniques are systematic procedures of investigation, planning or control which can be applied to all management problems of a given type wherever they may occur. 11 (1) The ILO publication from which this definition is taken notes that management techniques are not so hard and fast as many techniques in science or technology and usually have to be adapted to the requirements of the existing situation. Management techniques include a wide range of methods, many of which are defined in this Glossary. See, for example, budgetary control, cost-benefit analysis, cost-effectiveness analysis, critical path analysis, management accounting, network analysis, operational research, organi- zation and methods, output budgeting, PERT, PPBS, systems analysis, work study. 213 M AN .AGEMENT TECHNOLOGIST A term which includes systems analysts, operational research scientists, work study engineers, computer specialists, etc.(l) 214 MANPOWER "There is no generally accepted definition of the notion of human resources. The term has been used interchangeably with manpower, but it may also be defined in broader terms. Huma n resources comprise the skills, knowledge and capabilities actually or potentially available for the economic and socia l development of a community. Both men and women are included, whether they are active members of the labour force or ec onomica lly inactive. Manpower, is usually restricted to persons who have received, or are receiving, education and training for specific occupations. 11 (1) See also h ealth manpower. 215 MASS CAMPAIGN "A scheme for the control or eradication of a particular communic- able disease on a community-wide basis, carried out by machinery operat- ing with that precise objective. 11 (1) This definition can, of course, be generalized to apply to any health care activity, e.g. in the field of health education. 216 MATERNITY CARE "The object of maternity care is to ensure that every expectant and nursing mother maintains good health, learns the art of child care, has a normal delivery and bears healthy children . Maternity care in the narrower sense consists in the care of the pregnant woman, her safe delivery, her postnatal care and examination, the care of her newly born infant and the maintenance of lactation. In the wider sense it begins much earlier in measures aimed to promote the health and well-being of the young people who are potential p a rents, and to help them to develop the right approach to family life and to the place of the family in the community. It should also include guidance in parent-craft and in problems associa ted with infertility and family planning. 11 (1) 217 MEDICAL ADVICE "A medical act, which can include diagnosis, prognosis and treat- ment, 'requested by a patient from a physician, and taking place either in his consulting rooms or a public or private medical establishment . 11 (1) It does not seem necessary to exclude - as this definition apparently does - the possibility that the medical advice might be given in the patient's home. Cf. consultation. 218 MEDICAL ASSIST ANT A type of auxiliary personnel, defined by a WHO Expert Committee (1968)(1)as: "A health worker who has r eceived an appropriate training and who, in the field of promotion, protection and restoration of health (including diagnosis and treatment of disease), has certain clearly defined duties and responsibilities. He is employed within an organized health service under the supervision and guidance of qualified physicians, to whom he must refer a ll difficult cases." The designation of the medical assistant varies from country to country: feldsher (in the Soviet Union), rural medical practitioner, etc. For a discussion of national designations, see a rec ent WHO survey of existing legisla tion. (2) 219 MEDICAL AUDIT "THis implies evaluation of the quality and quantity of work done by physicians, by 'peer judgement': that is, by a group of physicians similarly qualified but usually with greater experience . " (1) 220 MEDICAL CARE A term which has been variously defined. It has sometimes (1) been restricted to the diagnosis and treatment of injury or disease, ex- cluding preventive care, a wider term such as health protection (q. v.) being used to include prevention a s well as dia gno sis and treatment. It may appear more natural, however, to adopt a wider definition, e.g. as proposed by a WHO Expert Committee in 1959 (2): "Medical care is a programme of services that should make avai l- ab le to the individua l, and thereby to the community, all facilities of medical and a llied sciences necessary to promote and maintain health of mind and body. This progr amme should take into account the physical, socia l a nd family environment, w ith a view to the pre vention of diseas e , th e r e storation of h ealth and the a llevi at ion of disability ." A similarly wide definition is given in the ILO Encyclopaedia of Occupa tional Health and Safety (3 ): "By 'medical care' is meant a programme of technical services which is provided to the individual with a view to promoting, maintaining and restoring his physical and mental health. 221 MEDICAL EDUCATION The process of education and training which qualifies an individual to practise medicine. A number of different sta ge s can be distinguished: Undergraduate e ducation: "The period which b eg ins when the student enters medical school and ends with the final examination for his basic medical qualification, or with the granting of his licence to practise." (1) (The licence to practise may be provisional an d subject to conditions as to supervision until a period of graduate training has been successfully completed). The period of undergraduate education comprises a pr e-clinical a nd a clinic a l p e riod . Graduate training: "The phase of widening clinical experience and acquisition through practice of basic clinical skills and judgment: normally used to cover the period of hospital internship." (1) This stage normally leads to a full licence to practis e . The periods of undergradua te education and graduate training to- gether make up the doctor's basic medical education. (2) Postgraduate training (or professional training): "This term is used to cover the more or less continuous period of postbasic training which, when it occurs, normally follows directly after graduate training and is designed to l ead to competence in a chosen branch of medical practice. It is roughly synonymous with vocational training: that is, all training designed to fit the doctor to perform his intended future role. 11 (1) Continuing medical education : "This term is used for all dis- continuous or part-time education designed to strengthen and refresh the knowledge and awareness of the practising physician, and to keer him in touch with new developments in medical theory and practice, 11 (1 This period is also known as postgraduate medical education. It would seem desirable to reach agreement about the meaning of the term postgraduate training/ education. 222 MEDIC AL PHYSICS "The term 'medical physics' is not a lways interpreted consistently. For the purposes of this Report, 'medical physics' may be described as including all applications of physics to m e dicine, being concerned with th e use of physical principles and techniques in any aspect of the prevention, diagnosis and treatment of huma n disease, and in medical research for the promotion of human health." (1) 223 MEDICAL SCHOOL "The expression 'medical school' includes all higher education (or uni ve rsity level) institutions offering a pr e scribed cours e of medicine . The following are examples o f the names that such institutions may bear an d which vary from one country to another or even within countries : medical college; college of sur ge ons; medical institute; institute of medicine and pharmacy; institute of medicine and surg ery; faculty of medicine; faculte mixte d e medecine et de pharmaci e; faculdad d e ciencias m e dicas; faculdad de medicina y c ir c ugfa; academy of medicine ; university centre for health scienc e s; medical univer sity." (1) 224 MENTAL DIS OR DER A general term which comprehends mental illness and mental re- tardation (qq. v. ). 22 5 MENT A. L HE A LTH The concept of menta l health was discussed by the WHO Expert Committee on Mental Health in 1951 (1 ) : "Menta l health as the committee understands it is influenced by both biologica l a nd socia l factors. It is not a st a tic condition but subject to variations a nd fluctuations of degree; the committee ' s conception im- plies the capacity in a n individua l to form harmonious relations with othe rs, a nd to participate in, or contribute constructively to, changes in his socia l and physical environment. It implies a lso his ability to achieve a harmonious and balanced satisfaction of his own potentially conflicting instinctive drives - harmonious in that it reaches an integrated synthesis r ather tha n the denial of satisfaction to c e rtain instinctive tendencies as a m ean s of avoiding the thwartin g of others. It implies in addition an individual whose personality has developed in a way which enables his poten ti a lly conflicting instinctive drives to find harmonious expression in the full realization of his potentialities." 226 MENTAL HYGIENE The WHO Expert Committee on Mental Health noted in 1951 (1) that the term mental hygiene was frequently us e d as a euphemism for early psychi a tric treatment, but decided to use it in their report in its strict and literal sense, definin g it as "the activities and techniques which pro- mote and maintain mental health . " 227 MENTAL ILLNESS Mental illness, or }sychiatric illness, was defined by a EURO Working P a rty in 1973 (1 as: "All fo rms of illness in which psychological, emotional or be- havioural disturbance s a r e the dominating feat ur e s . This broad definition is us ed to cover minor disorde rs (neuros e s, e tc .) as well as major dis- orders (psychoses, etc.). This is in lin e with the definitions of different categories of mentally ill p atients in a EUR O Ques tionnaire on Mental Health Resources (1969 ) (2), which imply a d efini tion of mental illness a s including functional and organic psychosis, psycho-n eurosis and personality disorders and, in the case of chi ldr en and adolescents, e motional disturbance and behavioural problems . Simila r terminology is us e d in a study of statis tics of pati ents admitted to psychiatric s e rvic e s in the World Health Stati stics R e port (1 973) (3). With these d efinitions may be compared a recent dictionary defini- tion (4) : "Mental illness: Any p e rsistent disabling disturbance of mental and / or emo tion a l equilibrium, usu a lly m a nifested through persistent maladjustment and mor e or less irrationa l, even biz a rre behaviour and speech, whet h e r psychic or orga nic in origin. The term is rel a tive in force, there bein g a wide r a ng e of seve rity, from m e re 'ne rvousness' a nd the mild tran sient personality disorder , through the psycho-neuroses, to the thoroughly debilitating psychos e s. " The 197 3 Working P arty referr ed to a bove distinguishe d two types of psychia tric morbidity (1 ): "Con spicuous psychi at ric morbidity: Al 1 forms of psychiatric illness in which the pa tient presents with frank psychological disturbance, or in which such disturbance is clearly manifest at consultation. "Hidden psychia tric morbidity: All forms of psychiatric illness in which the p a tient presents with related or co-existing somatic symptoms, but with an underlying psychological disturb a nce which c a n be elicited on examination. " 228 MENTAL RETARDATION This term, as used in the Internationa l Classification of Diseases, is on that ac count to be pr eferred in EURO usage to the various synonyms or near-synonyms which are or h a ve be en current in English (either British or American) us age : mental subnormality, menta l deficiency, mental handicap, mental disability, etc. Mental retardation is commonly regarded as implying an intelligence quotient, on the Stanford-Binet scale, of below 7 0 . The International Classification of Diseases (1) and the WHO Glossary of Mental Disorders and Guide to the Classification (197 4) (2) distinguish the following categories: 310 Borderline mental retardation (IQ 68 - 85) : including backwardness, border line intelligence, borderline mental deficiency or subnormality a nd temporary retardation of intellectual development. 311 Mild mental retardation (IQ 52 - 67 ): including feeble- mindedness, high-grade defect, morons and mild mental deficiency or subnormality. 312 Moderate mental retardation (IQ 36-51 ): including imbeciles within this IQ ran ge and moderate mental deficiency or sub- normality. 313 Severe mental ret a rd a tion (IQ 20-35): including imbeciles within this IQ range and severe mental deficiency or sub- normality. 314 Profound mental retardation (IQ under 20): including idiocy and profound mental deficiency or subnormality. (The narrative of the Glossary, which is followed here, differs very slightly from that of the ICD.) The terminology of mental deficiency/subnormality / retardation was discussed by the WHO/UN/ILO/UNESCO Joint Committee on the Mentally Subnormal Child (1954) (3 ), which noted that the term mental deficiency wa s often applied to persons suffering from incomplete emotional develop- ment ("moral de fect") but not incomplete intellectual development, and that mental retardation, in American usage equivalent to mental deficiency, had in British usa ge a developmental implication. The Committee decided, therefore, that the most appropriate general term was mental subnormal- !,!y, defined as "an incomplete or insufficient general development of the mental capacities", which they saw as including both mental defect, a condition in which the mental capacities are diminished as a result of 229 MENTAL RETARDATION (contd) pathological causes, and mental retardation, covering persons whose educational and social performance, as a result of environmental causes, is markedly lower than would be expected from what is known of their intellectual abilities. There is a useful discussion of English and French terminology in this field in the Notes on Terminology prepared for -a EURO Seminar on the Mental Health of the Subnormal Child (1959). (4) Among the terms considered are mental subnormality, mental deficiency, mental handicap, mental retardation and oligophrenia. In recent years the term mental retardation, originally an American usage, has come to be more widely accepted, its international currency being confirmed by its use in the ICD. Similar terminology was used in the EURO Questionnaire on Mental Health Resources (1969) (5), although mental subnormality was given preference in a study of statistics of patients admitted to psychiatric services in the World Health Statistics Report (1973). (6) 230 MIDWIFE A E URO Conference on Midwifery Ed uc a tion a nd Services m 1 964 (1) adopt e d th e following definition of a midwife : 11 A p e rson specially in structe d and qualified to provide care for women durin g pregnancy , delivery and the postnatal p e riod, and for the newly-born infant. This car e include s pr eve ntive measur e s, the det e ction of abnormal conditions i n the mother and chi l d , the procur e ment of medi- c a l a ssista nce a nd the e x e cution of emerg e ncy mea sures in th e absence of medical help. 11 An expanded definition on similar lines wa s a dopted by a WHO E xp e rt Committee on the Midwife in Maternity Ca r e in 1 966 (2 ) : 11 A midwife is a pers on who is qualified to pr ac tise midwifery. She is trained to give the n e c e ss a ry ca re a nd a dvi ce to women during pr egnancy, l a bour and the postnatal period, to conduct normal deliveries on h er own res pon sibi lity and to c a r e for the newly born i nfant . A t a ll times she must be a ble to recogn i ze the wa rnin g si gn s of a bnorma l or potentially abnormal conditions w hich ne c e ssita te referral to a doctor, and to carry out eme r ge ncy measur e s in th e a bsence of medical help . She m ay pr ac tis e in hospita ls, he a lth units or domiciliary services. In any one of thes e situa tions she has an importan t task in health e duc ation within the family and the community. In som e countries h e r work extend s into the fields of gynaecology, family planning a nd child care. 11 This definition was considered in 1972 by a Joint Study Group on the Trai nin g and Pr actice of Midwives a nd Maternity Nurs e s s et up by the Inte rnat ional Federation of Gynaecology and Obstetrics. The Study Group felt that it was outdated and needed revision to cover a broader fi e ld , and drew up the following definition, which was approved by the Council of the Internationa l Confederation of Midwives in November 1 972 : 11 A midwife is a person who, having been regularly a dmitted to a midwifery educational pro gr amme duly r ec ognized in the country in which it is located, has successfully comple te d the prescribed course of studies in midwifer y and has acquired the r e quisite qualifications to be registered and / or legally licensed to practise midwife ry. 11 It should be noted that in general WHO usag e the terms nurse and nursing are regarded as, where appropriate, including midwife and midwifery. This practic e has been criticized by the International Con- federation of Midwives as obscuring the special position of midwifery, which in many European countries is r e cognized as a separate profes- sion. (3) 231 MISCARRIAGE "The accidental loss of a fetus before a full term pregnancy result- ing in the death of the fetus," (1) The WHO Scientific Group on Spontaneous and Induced Abortion noted in 197 0 (1) that the term miscarriar,e was employed by the lay public as equivalent to spontaneous abortionq . v. ), but observed that its use in a scientific context was obsolescent and not recommended. 232 MODEL "This u s u a lly refers to a representation of an actua l situation in m1mature . In p l anning jargon it may mean : (a) a representation of a country situation through an 'average region ' which bears characteristics close to those of the whole country; (b) a replica in miniature showing the physical characteristics of a building structu re, for example, as u sed in planning; (c) a mathematical representation of major characters of an e conomic, health or other situation which can be manipulated to examine cons e quences of various actions." (1) Various types of model are classified by Grundy and Reinke in their study of health practice research in the Public Health Papers series, which notes that a model may be figurative or non-figurative; deterministic or stochastic; static or dynamic; descriptive, predictive or pre- scriptive. (2) Mathematical model: "A representation of a system or process 1n mathematical form, equations being used to simulate the behaviour of the system or process represented . " (3) Simulation model : "A simplified mathematical representation of a system throu gh which a number of alternative choices can be run whereby the outcome of the various choices can be demonstrated . " (4) 233 MONITORING "Monitoring has two distinct functions: first, the making of routine measurements on health and environmental indices and the recording and transmission of these data and, second, the collation and interpretation of such data with a view to detecting changes in the health status of popula- tions and their environment. 11 (l) It may be worth while adding a comment based on United Kingdom experience: "A monitoring relationship is not managerial. The per son who monitors has the authority to require to be kept informed about the activi- ties of the persons monitored and has authority to persuade them to change but, in the final analysis, he cannot order them to do anything and, if not satisfied, must refer the matter to higher authority. Monitoring does not call for any particular managerial relationship in the ranks of the persons concerned. 11 (2) 234 MORBIDITY This term is used as equival e nt to such terms as sickness , illne ss, et c . It is also applied to the incidence or prevalence of sickness in a give n population . In the former sense, morbidity has be en defined as "any d e p a rtur e , subj ecti ve or objective, from a state of physiological well-being." (1 ) In this s en s e sickness, illness and morbid condition are similarly de- fin e d (2), a nd r ega rded a s synonymous . The WHO Exp e rt Committee on Health Statistics noted in its 6th Repor t (1959) (2) th a t morbid ity could be measured in terms of three units: (1 ) p e r sons w ho we r e ill; (2) t he illn es s e s (periods or spells of i llness) that th e s e persons e xpe ri enced; and (3) the dur a tion (da ys, weeks, etc .) of th e s e illn e ss e s. Psychi a t ri c morbidity: s ee mental illness 235 MORBIDITY RATE / RATIO "Three aspects of morbidity are commonly measured by morbidity rates or morbidity ratios: frequency, duration and severity. Two indices of the frequency of ill-health are the incidence rate, the number of new cases of disease related to the average population at a particular period of time, and the prevalence rate, which is the number of cases of ill-health existing at a given moment of time expressed per unit of the average population. The average duration per case or the disability rate, which is the average number of days of disability per person, may ~e as a measure of the duration of illness. The case fatality rate, which is the proportion of fatal cases among the reported cases of the specific disease, may be used as an index of severity. It is usually com- puted only for acute diseases of relatively short duration." (1) 236 I\ !OR T A LITY Th E' ratio of the total number of d ea ths in a year in a given popula- tion, from a p a rticular cause, group of causes or a ll causes , to the total populat io n . (1 ) Cr ud e mortality rat e : The numb er of deaths per 1000 total popula- tion during a given year. (z) Age-s p ecific mortality rate : the number of deaths which occur in a year to l noo persons of a particular age or age-group . (2) 237 NATIONAL DEVELOPMENT PLANNING "National development planning is continuous, systematic, coordin- ated planning for the investment of the resources of a country (men, money and materials) in programmes of action aimed at achieving the most rapid economic and social development possible. It involves the combination of sectoral plans for health, education, agriculture, industry, public safety, transportation, etc." (1) See also planning, health planning. 239 NATIONAL HEALTH SERVICE "When a system of personal health servi ces has been extended as a right to cover an entire national population, or nearly so, it may be de- fined as a 'national health service'. Such universal health protection may be conceived as an ultimate extension of social security for health purposes, or likewise as an extension of puhlic health services to include a statutory right to benefits for all persons. By implication, a national he a lth service means that there are adequate resources (manpower, fac ilities, drugs, etc.) in the nation to meet the health needs of the popu- lation. Sometimes the phrase is used loosely to imply an intention or a goal of universal personal health servi ce , when the available resour ce s are far below the le ve l of needs."( 1) 240 NEED/DEMAND The r e lationship betwe e n need and demand has been the subject of much discussion in WHO documents . (1) A re cent statement is contained rn the Offi c ial Reco rds of WIIO, 1973 (2): "Health needs may be defined as scientifically (biologi cally, epidemio- logically, etc .) determined deficiencies in health that call for preventive, cu rative and eventually ( = where appropriate?) control or eradication 1r1easures . "Health demands are usuall y m easured in terms of the actual utiliza- tion of health services. Consideration must be given to the fact that a ll felt needs b y a pop u l ation (most usuall y in curative medicine) cannot be trans lated into express ed need or demand for va rious reasons (absence of acce ssible health servi ce s, lack of information, l ack o f confidence, low income, etc. )." A rnore r e fined c l assification was proposed by th e WHO Expert Committe e on Health Sta tisti cs in 1971 ( 3): " ( a ) Per ce i ved n eed : the nee d for h e alth services th e individual and which he is prepared to acknowledge. co nditions it may ex ceed th e professionally defined need. exp e ri enced by Under certain "(b) Professionally defined ne e d : the need for health services recognized by a health professional from the point of view of the benefit obtainable from advice , preventive measures, management or specific therapy . Under certain conditions it may exceed the p e rceived need. "( c) Scientifically confi rmed need: the need confirmed by objective measu res of biological, anth ropometri c or psychological factors, expert opinion or the passage of time. It is generally cons id e red to correspond to those conditions that can be classified in accordance with the Interna- tional Classification of Diseases. " (d) Potential demand: the demand for health services correspond- ing to whichever is the greater of the perceived and professionally defined needs for each parti cular condition or for all the conditions affecting a given population. "(e) Expressed demand : the demand actually made on the he a lth services available to a populatio n . It may be g reater than the actual utilization because of th e existence of waiting lists, limited resources or differences between patients' per c eptions of their needs and professionals' definition of those needs." 241 NETWORK ANA LYSIS "A technique whereby objectives are identified, the activities and tasks involved in attaining the objectives are determined, and the inter- relationships between tasks, activities and objectives are presented g raphically in the form of a network and used as a basis for determining the sequence of activities and tasks and the allocation of resour ce s. "{l) Critical path analysis and PERT {qq. v.) are forms of network analysis. 242 NIGHT HOS PIT AL "A night hospital is an institution having an organized medical staff and providing facilities and services for individuals whose needs can be met by specialized inpatient care at night. This type of care represents an intermediate stage between inpatient care and relatively independent community living. "(l) 243 NIGHT HOSTEL "Night hostels are hostels for workers who are able to work but who have difficulties in adapting themselves to their family envirorunent or to their lodgings. Most of these hostels are for workers who suffer from slight mental and neurotic disorders. They stay there for some weeks, receiving attention after working hours from rehabilitation personnel and psychologists."( 1) "The 'night hostel' is in a sense the counterpart of the day hospital. It is intended for patients able to work during the day but whose home con- ditions contribute to their illness, for example certain patients with mental disturbances or suffering from diseases which militate against their chance of successful treatment, as in some cases of pulmonary tuberculosis. " (2) 244 NON-MEDICAL USE OF DRUGS The following definition was adopted by th e WHO Working Group on Youth and Drugs (1973 )(1) : "The use of depend ence -produ c ing drugs of the t ype s noted abo ve (2), other than when medicall y i nd i cat e d." 245 NORM This term must be considered along with the related terms standard, criterion, guide and guideline. A convenient summary of their definitions and relationship was contained in a background statement prepared for the WriO Scientific Group on the Evaluation of Environmental Health Prog- rammes (1): "Norms, standards and criteria all refer to those elements in an evaluation that express what is desired, with which information about a programme or problem is compared, to reach a conclusion as to whether {the) programme or problem conforms or not with the desiderata. The three terms are distinguished from each other ... as follows: Norm is the most general term, encompassing such expressions of desiderata as goals, objectives , policies, standards and their component criteria. Standard is an explicit statement of conditions to be fulfilled either in an operating process {personal cleanliness of food handlers) or as a characteristic of an end-state {water fit for drinking ) . Criteria are measurable components {or tests) of a standard that permit determinations to be made of whether or in what respects a standard has been met {e.g. a water quality standard has as its component criteria such measurements as pH, dissolved oxygen, chlorine and ammonia content, etc . ). By implication, baseline measurements serve as criteria for determining what changes have taken place. {These definitions are compatible with those officially in use for the WHO Di vision of Environmental Health, in which WHO has the function of pro - viding information on criteria on environmental health factors, which may be used by Member States to formulate standards for their national or sub- national jurisdictions. WHO also uses the term guide to denote its own expression of levels and exposure times associated with specific effects; these are roughly equivalent to a suggested standard or draft standard without the legal force of standards promulgated in the countries... WHO also uses the term guideline to denote a collection of statements or a ' code of good practice ' relative to a major programme area, such as water supply, housing, etc . )." An appendix to the Resolutions of the WHO Executive Board, 197 3 (2) , distinguishes between norms and standards as follows : "Norms express the I scientifically' determined requirements in a given sector of health, for instance the percentage of admissions to 246 NORM ( contd) hospitals out of the number of applications for medical ca re, the avera~ e l ength of stay of patients in the beds a nd the subsequent number of bed / day s r e quired per yea r. "Standards express the mate rial, labour and finan c i al resourc es r equi red if the norms are to be satisfied; for instance, it can be dedu c ed from the above example relating to norms that~ beds for medi cal car e p e r 1 000 population a r e required in the gi v en conditions. " The following distinc tion was m a de b y a EURO S ymposium rn 1966 ( 3): "Based on the report o f the techni cal dis c ussions a t the Eighte enth World Health A ssembly , a norm was defined a s a quantitative index d es- c ribing any aspect of publi c he a lth, arrived a t by resear c h. 'In contr a- distinction standards ... are fixed arbitrarily .' " Normative is som etime s used inst ead of standard. (4) It mu st be recognized, however, that th ere is consider a bl e variation in the usage of these va rious terms from co untry to count r y. It has been noted (5) that in effe c t usag e in the Soviet Union substitutes norm for standard and standard for c riterion as define d above. 247 NURSE The following definition was agreed on by the International Council of Nurses in 1965 and "noted with favour" by the WHO Expert Committee on Nursing in its 5th Report (196 6 )(1): "The nurse is a person who has completed a programme of basic nursing education and is qualified and authorized in her country to supply the mo st responsible service of a nursing nature for the promotion of health, the prevention of illness and the care of the sick. 11 A revised definition was accepted by the International Council of Nurses in 197 3 (2): "A~ is a person who has completed a programme of basic nursing education and is qualified and authorized in her / his country to pro- vide responsible and competent service for the promotion of health, the prevention of illness, the care of the sick and rehabilitation. 11 This revised definition is open to the criticism that it does not differentiate between the first two of the three generally recognized cate- gories of nursing personnel (q. v. ). At a meeting between representatives of the WHO Regional Office for Europe and nursing/midwifery associations in 1974 ( 3) it was noted that if the term~ is used collectively to identify more than one category of nursing personnel it is impossible to speak of the members of any individual category with meaning. The problem was seen to be a semantic one associated with the international use of the English language: in most other European languages there was no confu- sion, since different terms were used for each category. For the pur- poses of their discussion, therefore, the 197 4 meeting adopted the following definition (paraphrased from the description in the 5th Report of the Expert Committee on Nursing ( 4) of the highest of the three categories of nursing personnel): "The nurse is the worker who provides the most skilled nursing care in the hospital or community and makes decisions - in consultation with the other members of the health team or independently - based on scientific, clinical and management principles. She is the leader of the nursing care team. 11 In general WHO usage the term ~ is regarded as, where appro- priate, including midwife. This practice has been criticized by the International Confederation of Midwives as obscuring the special position of midwifery, which in many European countries is recognized as a separate profession. ( 5) See also publi c health nurse, dental nurse. 248 NURSING "Nursing, in its broadest sense, may be defined as the provision of nursing care to individuals, families or communities in connexion with the restoration or preservation of health, and comprising the nursing compo- nent of the organized health care and preventive services . Such care may be provided by personnel ranging from the nursing aide to the professional nurse and nurse-midwife. It is recognized that the significance of the term I nursing care' varies from country to country, depending on the health system, and that it will change as new health knowledge is acquired, and as changes occur in the functions performed by and availability of other categories of health personnel, in the social, phys i cal and economic situation, and in the characteristics of the population and its health prob - lems . The concept of nursing in each country will thus be both specific to that country and flexible."( 1) In general WHO usage the term nursing is r eg ard e d as, where appro- priate, including midwifery. This pr actice has been criticized by the International Confederation of Midwives as obs c uring the spe cial position of midwifery, which in many European countries is recognized as a separate profession. (2) See also nursing care, public health nursing. 249 NURSING AUDIT "A detailed review and evaluation of selected clinical records by qualified nursing personnel for evaluating quality of nursing care. "{l) Cf. medical audit. 250 NURSING CARE "In a broad sense nursing care is derived from what has been called the unique function of the nurse ... 1 to assist the individual, sick or well, in the performance of those activities contributing to health or its re- covery {or to peaceful death) that he would perform unaided if he had the necessary strength, will or knowledge... In addition, she helps the patient c arry out the therapeutic plan as initiated by the physician. She also, as a member of a medical team, helps other members, as they in turn help her to plan and carry out the total progr a mme whether it be for the im- provement of health, or the recovery from illness or support in death'. "(l) Intensive nursing care: "Care of patients who make complex demands on nursing care as regards knowledge, skill and time. A detailed and enlightened care of the whole patient, the appropriate rest and movement, feeding, ca re of the skin and hygiene of excreta. "(2) Nursing care team: see nursing personnel. See also nursing. 251 NURSING EDUCATION The whole pattern of training and vocational development for nurses, extending from the basic training which qualifies a person for recognition as a nurse to the most specialized and advanced forms of post-basic and postgraduate education. The following levels of nursing education have been distinguished: Basic nursing education: "A planned educational programme which pro vides a broad and sound foundation for the effective practice of profes- sional nursing and a basis for post-basic e ducation. "(l ) The definition of a nurse {q. v .) adopted by the International Council of Nur ses implies that basic nursing education leads to the nurse ' s basic qualifi cation as a nurse. Post-basic nursin education : "A programme for nurses previously prepared in basic nursing that a takes place in a university or other institute of higher education, (b) is continued from year to year {i.e. is not a refresher cou rse or seminar), { c ) is recognized by an appropriate authority, {d) has specified admission requirements and {e) has a full- timP- teaching staff or faculty . "(2) Postgraduate nursing education: "A programme in nursing that re- quires the possession of a university degree as a condition of admission and that offers an advanced degree upon completion of the course. "(3 ) Advanced nursin education : "The highest level of nursing education available or planned for within the nursing education system of the coun- try being considered; e.g . in a country where nursing education does not follow the university pattern the term would apply to educational prog- rammes which are re cognized by the country as offering the highest qualification available in nursing. "{4) 252 NURSING HOME "A nursing home is an institution providing facilities and services primarily for inpatient care of individuals who require skilled nursing c are and related medical services but who do not require hospital care, with these servi ces being prescribed b y and performed under the general dire c tion of persons legally authorized to perform medicine or surgery . " (l} In English usage a nursing home is normally a privately rather than a publicly run institution. 253 NURSING PERSONNEL Defined in the 3rd Report (1954)(1) of the WHO Expert Committee on Nursing as : "All nurses and auxiliary nursing workers who are employed in the nursing service." Midwives and auxiliar y midwives may also be included. (2) This practi c e has been c riticized by the International Confederation of Midwives as obscuring the special position of midwifery , which in many European countries is recognized as a separate profession. (3) The 5th Report (1966)(4) of the Expert Committee on Nursing dis- tinguished three categories of nursing personnel: (a) full y qualified nurses; (b) nursing personnel able to provide generalized patient care of a simpler nature requiring both techni c al and inter-personal skills; and ( c ) nursing personnel able to perform specified tasks related to patient care that require considerably less use of judgement." A position paper considered at a meeting between representatives of WHO' s Regional Offi c e for Europe and nursing / midwifery associations in 197 4 (5) showed category {b) as including nursing assistants, nursing auxiliaires, etc ., and category ( c ) as including nursing aides, etc . The importance of the distin ction betwe en (b) and ( c ) will vary from country to country: in developed countries the essential distinction is likely to be between fully qualified nurses and the general category of auxiliary nursing personnel (q. v . ). The 197 4 meeting was not convinced that three categories of nursing personnel were always the optimum num- ber, but agreed that at least two categories were required for an effective and efficient nursing service. (6) The meeting also recognized that nursing care was often best delivered by a group of nursing personnel o f different categories, forming the nurs- ing care team, under the leadership of a fully qualified nurse. (7 ) -- 254 NURSING PERSONNEL SYSTEM "An organized plan for the employment and assignment of nursing personnel. It implies that the elements of nursing work in each country can be classified in terms of the complexity or le ve l of decision requir e d a nd fac ilitates the estimation of numbers and types of personne l needed. Unde r the leadership of the best prepared nurse, appropriate functions can be delegated to less highly trained and less expensive p ersonnel; fragmentation of service and proliferation of le vels of personnel can be prevented. 11 (1) 255 NURSING PRACTICE "The entire range of work of the nurse wherever she is employed, e . g . in a hospital or other institution, in domi ciliary care or in other community health services. "(l) 256 NURSING SER VICE "The nursing service is that part of the total health organization which aims to satisfy the nursing needs of the community. The major objective of the nursing servic e is to provide: ( 1) the nursing care required for the prevention of disease and the promotion of health; (2) the nursing care of the patient required (a) in the interest of his phy sical and mental comfort, and (b) by reason of the disease from which he is suffering."( 1) A briefer definition is: "The many aspects of administration and organization within which nursing is practised. "(2) The term may also be used to mean an organized structure for the employment and deplo yment of nursing personnel. 257 NUTRITION "l. The pro cesses whereby living organisms utilize food for main- tenance of life, growth, the normal functioning of organs and tis sues, and th e production of energy . "2. The science and study of the reactions of the body to intake of food, to variations in the diet and to other factors of pathological or s y stemic significance . ''Note " ' Human nutrition' is the scientific discipline that deals with nutri- tion in man; in particular it is concerned with nutritional requirements , food compos ition, food consumption, food habits, the nutritive value of foods and diets, the relationship between diet and health and with research in these fields. The exp r ession ' science of human nutrition' is sometimes used in approximate l y the same sense . " The word' nutrition ' which applies to a d y n a mi c process is some- times used to mean' diet' or 'food' , which are static terms. In the con- text of projects to produ ce mo r e food of high nutritive value it is better to say that these will improve the 'diet ' rather than the ' nutrition' of the community concerned, although, of course, improvement in diet will be accompanied by improvem ent in nutritional status."( 1) The term is also applied to "the sector of public health concerned with relationships between diet, health and disease, and with the improve- ment of health through pr evention and treatment of nutritional diseases."( 1) 258 NUTRITIONA L DISORDER "Any abnormal state of the body due to th e consumption of a diet not conforming with physiologi c al requirements, or to failure in the utiliz a tion of food a ft e r ingestion. "(l) 259 NU T R ITIO NAL ST A TUS " The condition of the body r esulting from t h e intake , a bsorption and utili zation of food and from fa c tors of patho lo g i cal s i g nifi cance . "( 1) 2 60 OBJECTIVE The meaning of this term must b e considered along with the related concepts of goal and target. Some have despaired of achieving agreement on the definition of the three terms and their relationship to one another: "Objective, ~and target are all defined as a desired end-state sought by a programme or sub-programme. (Since there are widespread differences in the ways in which various administrative systems relate these terms to ea ch other - as to which are more general and more specific - this rather gross generalization seems unavoidable. ) " (1) The attempt has, however, been made to distinguish the three terms. There appears to be a fair measure of agreement that ~is the most general of the three, target the most specific and objective intermediate between the two. Compare two recent s ets of definitions used in WHO documents: Goal "A specified sta te towards which actions and resources are directed. Unlike objectives and targets, goals are not constrained by time or existing resources, nor are they necessarily attainable, but are rather an ultimate desired state towards which actions and resources are directed." (2) Objective "A measurable and attainable state that is expected to exist at a predetermined place and time, as a result of the application of certain :erocedures and resources (instruments). It should include a description of the state desired, the extent to which it is desired, when it is expected to be attained, where it is expected to exist, and to whom it refers." (2) Target "The desired end-result of certain activities, as distinguished from 261 "Broad definitions of policy, e.g . services will be provided to maintain and improve the health of pre-school age children. 11 (3) Objectives "More precisely defined policies than goals, giving broad manage - ment decisions, e.g. the services to be provided for the health of pre - school age children will include health centres accessible to the whole population and will provide immunization programmes against diphtheria, pertussis and tetanus for pre-school children." (3) Targets "Specific indicators for programme achievement on the basis of earlier OBJECTIVE { contd) an objective, which specifies the effect of an activity on a problem. Targets are thus concerned with the factors involved in a problem, whereas objectives are concerned directly with the problem itself. Targets represent the measurable and attainable aims directed towards objectives which, in turn, are directed towards the ultimate goal. " (2) assessment of the capabilities of the service to carry out the prog- rammes, e.g. health centres will be provided at the rate of one per two thousand population over a period of 3 years; immunization against diphtheria, pertussis and tetanus will have reached 100 % of the pre - school age population with- in 5 years and will be incorporated into the health centre prog- ramme. 11 (3) A similar distinction between goal and target (with no reference to the intermediate term objective) was made in the R e port on a EURO Symposium in 1967 (4): Goal: "The intended outcome of a programme; (it) does not necessarily have to be quantifiable or measurable in operational terms. 11 Target: "A defined end result of specific public health activity to be achieved in a finite period of time. Targets are stated as definite aims or outcomes, which should be quantitatively measurable - they may be long-range, intermediate or short-range." For the distinction between target, projection and forecast, see projection. 262 OCCUPATIONA L HE A LTH The 1st World Health Assembly in 1948 recommended (1) that this term should be used in place of the older term industrial health, which implied an unduly narrow field of activity. Occupational health, in the wide definition now accepted, is "con- cerned with the physical, mental and social well-being of man in relation to his work and working environment and his adjustment to work and the adjustment of work to man. 11 (2) Its scope was defined as follows by the Joint ILO/WHO Committee on Occupational Health in 1950 (3): "'Occupational health' should aim at the promotion and maintenance of the highest degree of physical, mental and social well-being of workers in all occupations; the prevention among workers of departures from health caused by their working conditions ; the protection of workers in their employment from risks resulting from factors adverse to health; the placing and maintenance of the worker in an occupational environment adapted to his physiological and psychological equipment; and, to sum- marize, the adaptation of work to man and of each man to his job." An ILO /WHO conference in 197 2 (4) noted that this definition still stood, but observed that: "Occupational health is a wide field, and during the last decade the relative importance of its component parts has changed. This changing concept has been linked with scientific progress in relation to occupational health and safety, and also with changes in the evaluation of work and the work environment on the part of individuals. In the past the emphasis has been on safety; now it is rather on health and job satisfaction. 11 Occupational health is distinguished from public health (q. v.) by being concerned with "man in relation to his work and working environment, both physically and mentally, whereas public health is concerned with man in relation to his environment in society, outside the workplace. 11 (5) A number of specialties are sometimes distinguished within occupa- tional health: e.g. occupational physiology, occupational psychology, occupational pathology or occupational medicine, occupational hygiene, occupational psychiatry. (5) 263 OCCUPATIONAL THERAPY "Medically directed treatment of the physically and/ or mentally disabled by means of constructive activities designed and adapted by a professionally qualified occupational therapist to promote the restoration of useful function." (1) 264 OLD AGE "For the purposes of the present report ... old age or senescence is taken to mean that period of life when impairment of mental and physical functions becomes increasingly manifest by comparison with previous periods of life. For statistical purposes it is necessary to come to an agreement about an arbitrary threshold, and the Group has selected the age limit of 65 years as marking the beginning of old age. This corresponds fairly well with the generally agreed age of retirement and completion of professional activity in most countries." (1) 26 5 OPERATIONAL RESEARCH This term (operational research in British usage, operations research in America ) has been variously defined. A paper prepared for a EURO Symposium on Methods of Evaluating Public Health Programmes (1967)(1) quoted an American definition: "Operational res ea r ch has been defined as 'the application of scien- tific methods, techniques and tools to problems involving the operation of a system so as to provide those in control of the system with optimum solutions to the problems ' . Operational research uses mathematical models based on a set of equations which reflect different aspects of the working of the s y stem to predict the consequences of alternative poli cies or a llo cation of resour ces and to produ ce the 'optimum' solution as de- fined in terms of the objectives to be achieved." A variant of the definition quoted in this passage was adopted by the WHO Executive Board in 197 3 (2): "The appli cation of scientific methods, by interdisciplinary teams, to problems involving the control of any as p ect of an organized system so as to provide solutions." Two further definitions were considered by a EURO Seminar on Health Operational Research in 1969 ( 3): "Operational research is the a pplication of any or all the disciplines of science to the problems of decision-making in organizations or systems." "Operational research is the a ppli cation of rational tools of analysis to decision-making." A recent study in the Public Health Papers series (4) uses the follow- ing definition: "By operations research is meant any formalized quantitative analysis whose purpose is to improve efficiency in a situation where 'efficiency ' is clearly defined." This study notes that the techniques of operational research include network analysis (PERT, critical path analysis), linear programminr, computer simulation procedures and applications of queueing theoryqq. v. ), as well as statistical analysis, projection and extrapolation methods, budgetary and accountancy methods, including in particular cost- effectiveness analysis (q. v. ), work study (q. v.) and, perhaps more con- troversially, appli cations of decision-tree theory and gaming exercises. 266 OPERATIONAL RESEARCH ( contd} The same study distinguishes between operational r esearch and systems analysis (q. v.} as follows: "Operations research may be contrasted with systems analysis. The latter is usually concerned with problems in which the difficulty lies in deciding what ought to be done, not simply how to do it most efficiently . Both systems analysis and operations research have to deal with practical problems of choice or d ecision, but with a difference. Systems research is conce rned mainly with the strategy of choice , operations research with the tactics. Onl y rarely are the problems fully understood in either case, but they a re more completely specified in operations research than in systems analysis. The models used in operations rese arch, though often tentative as compared with those of pur e science, are more circumscribed and better defined than those used in systems anal ysis. When objectives are unambiguous, criteria pre cise l y d efined and data adequate, the models of operations resear ch are quantitative and incorporate quantified r elation- ships. Typically, they are mathematical in form and employ optimization techniques that a re rarely feasible in systems analysis." Operational research has also to be distinguished from work study (q. v . }, with which it has sometimes been equated. A recent British publication ( 5) notes that: "OR is concerned with systems. In this way it differs from Work Study , which is in general co n cerned with routines, particularly manual and clerical routines. Work Study, as its name implies, aims at minimiza- tion of physical effort. Operational Research is used for optimization of planning effort. " 267 ORGANIZATION A useful distinction has been drawn ( 1} between the organization, structure and functioning of a health system: "Organization. The pattern of responsibilities and accountability as defined by the terms of reference and powers of the various health agencies and of divisions and departments within these agencies. The term is sometimes used exclusively to refer to relatively permanent hierarchical forms of organization, but other patterns are becoming common, such as organizations consisting of transient project teams or so called 'matrix ' forms of organization. "Structure. This term refers to the pattern of facilities and opera- tional units forming a health system. This may be described both in physical terms and in terms of the services that the operational units pro- vide. The facilities forming the structure of a health service need not and in many cases do not a ll belong to the same agency . For example, voluntary so c ial services may be an important element of the total structure. "Functioning. This term r efe rs to the detailed working of the opera- tional units forming a health care system and of the working relationships that exist between the units, e.g. for the referral of patients from one to another ." 268 ORGANIZATION AND METHODS "A method of evaluation, often known as O and M, of the organization, management, methods of control and general procedures of an undertaking, the aim of which is to determine how the undertaking can be made to func- tion more efficiently and effectively. "(l) "A management term (0 & M) used to denote certain disciplines in management which study organization of work and methods of work with a view to increasing production, reducing costs and so on. "(2} With these two WHO definitions may be compared the following British definition, which underlines the fa c t that O & M studies are nor- mally carried out by individuals or teams independent of the undertaking or activity being studied: "' Organisation and Methods', or '0 and M', is a term generally used to describe the activities of groups of people in government or other publi c bodies or in private firms, who are asked to advise administrators or managers on questions of organisation and methods so as to increase the efficiency of the work for which the manager is responsible, either b y providing a better service, or a cheaper one, or both. "(3) 269 OUTCOME "In a restricted sense, all the possible results that may stem from specific treatment for a given condition. May also refer to all identified consequences of the handling of a general medical care problem. "(l) "Outcome is the actual result of a certain activity and represents one of the major parameters in the assessment of effectiveness. "(2) 27 0 OUT-PATIENT "A person who makes use of the diagnostic or therapeutic service of a hospital out-patient department but who does not occupy a regular hospital bed. "(l) Out-patient facilities are premises for the care of patients who do not live in but attend for' consultation, treatment and/or follow-up, rarely more than once a week and often less, and whose contact is mainly with individual members of the staff and seldom if at all with other patients. Such premises may be part of a hospital or health centre or may be separ- ate clinics, dispensaries, etc. (2) Out-patient and out-patient facilities are day patient and day patient facilities (qq. v. ). care are both forms of ambulatory care (q. v .) See also out-patient clinic/department. 271 to be distinguished from Out-patient and day patient OUT-PATIENT CLINIC/DEPARTMENT "The institution or agency which cares for the ambulatory patient who comes for diagnosis, treatment and follow-up care. It is usually associated with a hospital or inpatient establishment, and patients are referred between the two institutions."( 1) For the distinction between this term on the one hand and health centre and polyclini c on the other, see health centre . 272 OUTPUT "The sum total of results of purposeful intervention in the spontaneous operation of a system. "(l) "The amount of benefit or the effect produced as a result of the use of certain resources. "(2) 27 3 OUTPUT BUDGETING "A system for analysing programmed expenditure by reference to particular objectives instead of under input headings su c h as staff, buildings, equipment, etc . " ( 1) A lternative terms a re functional cost ing, programme budgeting, p erfo rmance budgeting. 274 PAEDIATRICS A WHO Study Group in 1957 (1) defined paediatrics as "general medicine applied to children". A later EURO Conference (1965)(2) adopted a wider definition which reflected the development of the discipline in recent years: "For the purposes of the Conference' paediatrics' was accepted as covering the whole of the field of medical care of children. This could be divided into three distinct types of activity: (1) diagnosis and treatment of sick children in hospital; (2) diagnosis and treatment of sick children in the home or con- sulting room; (3) preventive and social care of well children." 27 5 PARAMEDICAL (PROFESSIONS) An organizational study by the WHO Executive Board in 1963 (1) defined the paramedical professions as "all the professions allied to medicine which together make up the team of health personnel, i.e. nursing and midwifery, sanitation, dentistry, veterinary health, pharmacy, physiotherapy, statistics, microbiology, etc." A EURO Working Group in 1966 (2), discussing the term paramedical workers, noted that: "This is a convenient general term to apply to a wide variety of health workers who are associated with aspects of medical work. They have special skills and have undergone special training. As a rule, though not invariably, they work under the general direction of a physician or surgeon . " In 197 2, however, the Director-General of WHO noted in his Progress Report (3) that the use of this term had led to misunderstanding and that the word itself had sometimes been interpreted as suggesting the inequality or inferiority of the professions concerned in relation to medicine. The Director-General therefore announced that the term paramedical would no longer be used by WHO to refer to the various health professions allied to medicine. Possible alternative terms are allied health professions, health care professions, etc . There is, however, a need for agreed definitions of such terms. 276 PARAMETER "A dictionary definition of a parameter is a 'characteristic or constant factor' or ' a variable which determines the specific form of a function'. The term is often largely (= loosely?) used to mean boundary or limit. "(l) In view of this variation in meaning - reflected in the wide range of other dictionary definitions in other fields - there appears to be a need for closer definition of the term as used in the field of health care. 277 PARITY In demography, parity means "the classification of women by the number of live-born children (e.g. a woman of parity 4 has had four live- born children). "(l) In medical usage, it means "the classification of women by the total number of births they have had, including both live births and stillbirths; or the total number of times a woman has been pregnant minus the number of abortions and / or miscarriages occurring up to 28 weeks. "(l) 278 PARTNERSHIP A form of association between two or more medical practitioners, two or more dental practitioners, etc., based on a sharing of professional responsibilities, expenses and remuneration. 279 PATHOLOGY International differences in the meaning of this term have been dis- cussed by a number of WHO committees. The following is taken from the Report of an Expert Group on Medical Education (1962)(1): "The Group recognized the wide differences in the use of the term 1 p athology ' . In some countries it is taken to mean exclusively morbid anatomy and morbid histology and is based essentially on autopsies. At the other extreme the term is used to cover the whole range of diseas e processes, excluding only the diagnostic and therapeutic work of the clini- cian . In the present context the term is applied in a broad sense to cover morbid anatomy and histology, clinical pathology (i.e. cytological examina- tion of body fluids, excreta, etc .} and chemical pathology (the study of dis- ease by chemical examination of tissues or their produ ct s). A sub-division of pathology termed 'pathological physiology ' is recognized in some coun- tries; this is concerned with the application of physiological methods to the diagnosis of disease. In other countries this subject may be the pro- vince of the internist or the physiologist. In this sense it will be seen that pathology merges insensibly into microbiology in that the injurious effects of microorganisms cannot be studied without the consideration of pathologi- cal reactions. It is, however, usually administratively convenient to regard microbiology as a separate subject, although in its presentation to the student the distinction should be minimized. "The term 'pathology ' may also designate, on the one hand, a basic science in its own right, growing naturally from anatomy and physiology; on the other, an applied science providing the fabric of clinical pra c tice." 280 PATIENT According to a EURO Symposium in 1965 (1): "In the widest sense, the term 'patient' includes any sick person, whether receiving medical attention or not." But in fact this definition is not wide enough, since a patient need not actually be sick. In this respect an earlier definition by a WHO Expert Committee in 1953 (2) appears preferable: "A person, whether ill or not, who has a relationship with a physi- cian acting in his professional capacity . " Even this, however, is still not sufficiently wide, since the patient' s relationship may be with some other health professional, not always neces- sarily with a physician. There seems to be a need for further considera- tion of the definition of this term. See also in-patient, out-patient, day patient. 281 PATIENT CARE "The health care services provided to a patient... The term may include care given to healthy people, i.e. preventive as well as curative and rehabilitative measures."( 1) Patient care group: "A group of people or patients having a set of problems that are similar in nature and in the general management required. " (2) The term client group is sometimes used in the same general sense as patient care group. 282 PERSONAL HEALTH SERVICES "These are technical services rendered to individuals, as distin- guished from other health services which are directed towards control of the environment, mass education or other activities in society. It is important to realize, however, that personal health services may be preventive, curative or rehabilitative in their purpose. "{l} "This term is used to bring out the basis of the distinction between the environmental and sanitation services discussed above and other health services. The essence of the distinction is that personal services are provided to individual persons who can be identified. Included in personal services are not only treatment and immunization services but health examination and screening carried out for health purposes and health education of the public. "(2) 283 PERT "The Programme Evaluation and Review Technique (PERT) is used to determine whether a plan is logi cal, whether all necessary activities and tasks have been considered and whether the programme is proceeding as planned. It is a form of network analysis (q. v.) used for the control of time and cost in complex projects. PERT requires a detailed analysis of a programme, the listing of all activities a nd tasks that must be per- formed in order to achieve a predetermined overall objective, and their pres entation in the form of a network showing the sequential relationships between them . 11 ( 1) In practice this term is now interchangeable with c ritical path analysis (q. v . ) . ( 2 ) 284 PHYSICAL FITNESS " The ability to perform muscular work satisfactorily under specified conditions. "(l) 285 PHYSICAL MEDICINE " The term I physi c al medicine ' co ve rs kinesitherapy , heliotherapy, b a lneotherapy , the application of various physical agents, e t c . " (l) 286 PHYSICIAN The practitioner of the art and science of medicine in all its branches. {l) This is the term in regular WHO use: in British usage the term doctor is more normal, physician being commonly used in the sense of a practitioner of medi c ine as opposed to surgery . The term practitioner, strictly used, implies a phy sician actively engaged in the exercise of his profession: "a person who is a qualified physi cian and engaged in the practice of his profession as a general prac- titioner, specialist, research worker, etc. "(2) The designation medica l practitioner tends to be used in formal or official contexts, in the sense of "registered medical practitioner", i . e. one who is authorized to perform certain actions in virtue of that capacity. The following definition of physician was recommended to the 25th World Health Assembly b y the WHO Executive Board and noted b y the Assembly in May 1972 (3): "A physician is a person who, having been r eg ul a rly admitted to a medical school, duly recognized in the country in which it is located, has successfully completed the prescribed course of studies in medicine and has acquired the requisite qualifications to be legally licensed to practise medicine ( comprising prevention, diagnosis, treatment and rehabilitation), using independent judgement, to promote community and individual health." Family physician: see general practitioner. Physician of first contact: "The physician first seen by the patient during any episode of ill-health or injury"{4) - usually, but not necessarily, the primary physician, family doctor or general practitioner {qq. v . ). Primary physi cian: see that term. 287 PHYSIOLOGY "Although in its widest sense I physiology' embraces all aspects of the function of living organisms, in the particular context of medical edu- cation it is taken to mean mammalian function, particularly that of man. Physiology should embrace biophysics and biochemistry, which, while re cognizably distinct subdivisions, are closely associated in the sense that it is impossible to conceive of general physiology without reference to biophysical and biochemical concepts."( 1) 288 PHYSIOTHERAPY "The art and science of physical treatment by means of therapeutic exercise , heat, cold, light, water, massage and electricity. Among the aims of treatment are the relief of pain, the increase of circulation, the prevention and correction of disability and the maximum return of strength, mobility and coordination. Phy siotherapy also includes the performance of electrical and manual tests to determine the amount of impairment of nerve supply and the strength of muscles; tests to determine functional abilities; measurement of range of joint movement, and measurement of vital capacity as diagnostic aids for the physician and for recording progress . " ( 1) 289 PILOT PROGRAMME "Pilot programme means a programme of predetermined duration and on a restricted scale, which should serve as a model for extended or general action, if it proves to be feasible, effective and sufficiently effi c ient. "(1) 290 PLAN This term has been defined as having two aspects. It is {a) a model of an intended future situation; and {b) a programme of action and pre- determined coordination of legislative, fiscal and administrative measures designed to achieve the intended situation. { 1) See a lso planning, programme plan. 291 PLANNING This article is concerned with the general co ncept of planning. The term health planning is discuss ed separately. There are many definitions of planning. The T ermino log y List pre- pared for the European Conference on National Health Planning {1974) {l) listed a selection: "{a) Planning is a r ational application of human knowledg e to the process of reach ing decisions which are to serve a s the basis for human action... The central core of meaning remains the establishment of rela- tionships between means and ends with the objective of achieving the l a tter by the most efficient use of the former. {Ensenanza de la Planificacion en l a Am {> rica Latina) . "{b) Planning is the selection of the best available alternatives to achieve specific goals {Waterston, A .). "( c ) Planning is the exercise of intelligence to deal with facts and situations as they are and finally to solve problems {Nehru, J. ). " {d) Planning is a pro ces s by which pro vision is made for resources required in future on the basis of available knowledge and through special- ized methods and techniques { WHO EURO do cument). "{e) Planning is an activity or series of activities aimed at the achievement of some future goal or goals {Adapted from Manning, R. L., WHO, Geneva). "The trend at present appears to be towards {d) and {e)." Still other definitions were considered during the deliberations of the Conference. (2) A distinction is made between long-term, medium-term and short- term planning; there is, however, no firm agreement about the demarca- tion between the three. Long-term planning {sometimes called perspective lannin ) usually covers a period of 15 to 20 years; medium-term planning strate ic lannin ) periods ranging from 5 to 10 yea rs; short-term planning tactical planning) a period of 1 to 3 yea rs. (3) It has, however, been suggested { 4) that "the distinction between short-range and long-range planning lies not so much in the number of years covered as in the nature of the constraints that operate, thus : 292 PLANNING ( contd) - 'short-term' - concerned with meeting needs as defined by present trends, using resour ces whose availability is already determined {typically: 1 progr amming ' ; partial reallocation of resources; repairing current deficiencies); - 'medium-term' - in which there is some scope to modify demands, r ecognize new needs and obtain new resources {typically : choice between competing objectives); - 'long-term' - in which the concern is to sele c t a desired future, i n broad terms, and to design a way of reaching it (typi cally : reform of social institutions)." A distinction is also made (5) between macro planning {concerned with major national questions of economic growth, investment, priorities and allocation of natural resources) and micro planning (proj ect planning). Other terms: normative planning: planning based on norms and standards which have some form of legal backing. (6 ) indicative planning: planning not based on mandatory requirements but realized with the help of guidance and incentives.(7) deductive planning: "Broad poli cies and objectives a re established at the highest level of the organization and detailed proposals for imple- mentation flow downwards to those who provide services. 11 (8) inductive planning: "Local experiences, services and practices are identified and efforts are made to coordinate and consolidate them so that greater benefits can be made more widely available. 11 (8) impressionistic planning: "Decis ions and choices are made on the basis of experience, pressures, minimal information and rough estimates of needs and possibilities. The process is more intuitive and political in character than rational or scientific, and can scarcely be regarded as planning in the strict sense of the term. "(8) idealistic planning: "The aims of the plan are stated only in the form of unattainable ideals. Action is encouraged by exhortation, but precise objectives or methods of achieving them are not specified. "(8) See also national development planning, programme planning, regional planning. 293 POLYCLINIC An institution providing ambulatory care, characteristic particularly of health services in the Soviet Union and the Eastern European countri es. It was defined by a EURO Working Group in 197 3 (1) as follows : "Polyclinic: a centre providing both medical care and p e rsonal pre- ventive s ervi ces, staffed by a multidisciplinary team. Th e medical staff is comprised lar ge ly of specialists, and the emphasis is on differentiation of disease categories and specialist care from an early stage of illness ." For the distinction between polyclinic and health centre, which m ay sometimes be difficult to draw, s ee health c entre . (R oemer (2) class ifi e s a polyclinic as one form of health centre, but in general usag e it is con- venient to make a distinction between the two terms.) 294 POPULATION 1 . All the inhabitants of a given country or area considered together; the number of inhabitants of a given country or area. 2. (in sampling) "The whole collection of units from which a sample may be drawn... This term will not necessarily mean a popula tion of persons: for example, the units may be institutions, records or events. The sample is intended to give results that are representative of the whole populati on." (1) 295 POPULATION LABORATORY In epidemiology this term is used in different senses: "(l) An area (often a focus of disease) in which an effort is made to understand the total ecology - human, animal and plant. 11 (2) A geographically defined population within which observations derived from the correla tion of special surveys, record linkages and over lapping clinical observations are made that would not be possible from any one source alone ... 11 (3) More loosely, any population or area that is repeatedly the subject of epidemiological study. 11 (l) 296 POST-PARTUM PERIOD This term has never been accurately defined. "Textbooks of obstetrics usually employ this term in connexion with events occurring immediately or a very short time after delivery such as, for instance, post-partum haemorrhage, care, exercise. From a medico-legal point of view the post-partum period may extend to three months or longer because complications related to the puerperal state may cause maternal death within that interval from delivery. In the context of post-partum family planning programmes the term seems to have been used as a synonym for puerperium, a period that goes from the birth of the placenta until the generative organs have returned to the pregravid condition - a matter of six to eight weeks. " (1) 297 PPBS An abbreviation for ro ramme- erformance -bud or planning-programming-budgeting system 2 . "A method of applying budgetary allocations to the conduct of operations or activities in order to ensure the optimal performance of the activity. Allocations are made to specific programmes rather than under classical budgetary heads. Thus, instead (say) of allocating a specific sum for all hospitals in a territory, allocation is made in terms of hospital departments, special beds and the like, in terms of the likely programme of the departments over a given period." (1) "The use of PPBS does not necessitate any changes in either the existing organization or the methods of administering it. It calls for the grouping of activities into programmes related to each objective, i.e. for grouping by end-product rather than by administrative organization or by function, in order to determine not only what is produced but how it is pro- duced or what resources are consumed in the process." (2) 298 PREMATURITY The following definition was approved by the 1st World Health Assembly in 1948 (1 ): "An immature infant is a liveborn infant with a birth-weight of 5-1/2 pounds (2500 grams) or less, or specified as immature. In some countries, however, this criterion will not be applicable. If weight is not specified, a liveborn infant with a period of gestation of less than 37 weeks or specified as tpremature t may be considered as the equivalent of an immature infant for purposes of this classification. 11 This definition was adopted in the Final R e port of the WHO Expert Group on Prematurity (1950) (2), which noted that the terms "immature" and "premature" were here used interchangeably and expressed its preference for "premature". The WHO Expert Committee on Maternal and Child Health (1961) (3) recommended that the term prematurity should be replaced by low birth weight, on the ground that some infants weighing less than 2500 g were not prematurely born (i.e. after less than 37 weeks of gestation). The WHO Expert Committee on Nutrition in Pregnancy and Lactation (1965) (4) agreed that "low birth weight" was preferable to "prematurity", but ob- served that it was probably still not sufficiently definitive, since the level of birth weight regarded as low might vary in different communities. An alternative expression for premature is pre-term (q. v. ). 299 PRE-TERM The following definitions were agreed by the WHO Expert Committee on Prevention of Perinatal Mortality and Morbidity (1970) (1) and endorsed by an informal working party of obstetricians and paediatricians from 13 EuroI?ean countries at the 2nd European Congress of Perinatal Medicine (1972) (2): pre-term: before 37 weeks (259 days) of gestational age, calculated from the first day of the last menstrual period; term: from 37 weeks to before 42 weeks (294 days); post-term: from 42 weeks. 300 PREVALENCE "The number of instances of illness or of persons ill, or of any other event such as accidents, in a specified population, without any distinction between new and old cases. The preva lence may be recorded at a stated moment (point prevalence) or during a given period of time (period pr e - valence). . . When the term 'prevalence' is used alone, without any further qualification, it must be taken to have the meaning of 'point prevalence'. 11 (1) In practice the terms "point prevalence" and "period prevalence" are seldom used, reference being made to prevalence on a given date or dur ing a given period . In referring to prevalence it should be made clear whether the data represent the numbers of instances of the disease recorded or the numbers of persons ill. The distinction between prevalence and incidence (q. v.) is that pre- valence refers to all cases, irrespective o f whether the y are new or old, whereas incidence refers only to new cases. Point prevalence and period prevalence are usually expressed as rates. In a point prevalence rate the denominator is the number of per- sons in the specified populat ion at the given time. In a period prevalenc e rate the denominator is the average number of persons in the specified population during the defin e d period or the estimated number of persons at the mid-point of that period. 301 PREVENTIVE MEDICINE A term which has considerably extended its scope in recent years . It is sometimes used to d eno t e the application of preventive principle s by a doctor in d ealin g with individual patients, but h a s increasingly tend e d to b e applied to the or ganiz ed health activiti es of the community. A ssociated with the concept of public health (q. v. ), it has been defined as meaning "not only the organized activities of the community to prevent occurrence as well as pro gression of disease and disability, mental and physical, but a lso the time ly application of a ll means to promote the health of individuals, and of th e community as a whol e , including prophylaxis, h ealth education and similar work done by a good doctor in looking after individuals and famili es ." (1) In line with this extension of the scope of preventive medicine, it is now customary to speak of the primary, s e conda ry and tertiary stages of pr evention, a lthough there is no firm agreement on the definition of these stages. The following d efinitions are taken from the Report (1973) (z) of a EURO Wo rking Group on Psychiatr y and Prima ry Medical Car e : primary pr evention: "All measures designe d to reduce the incidenc e of disease in a population, by r e ducing the risk of onset." This corr e - sponds roughly to the traditional conc e pt of pr even tion. secondary prevention: "All measur e s designed to reduce the pre- valence of disease in a population, by shortening its course and duration. 11 This takes in some aspects of treatment. tertiary pr evention: "All measures designed to reduce the prevalence of chronic disability in a population, by minimizing the functional impair- ment consequent to disease." This extends the concept of prevention into the field of rehabilitation (q. v . ). S li ghtly different boundaries were drawn in the Report (197 3) ( 3) of a EURO Working Group on the Role of the Psychologist in Mental Health Services : "Primary: prevention ... seeks to improve the quality of life, to reform social institutions and to help the community tolerate greater di versity of adjustment. "Secondary prevention is concerned with active case finding, with helping individuals and families to r e duce the impact of stress and with an ticipating the problems of vulnerable sub- groups in the community. "Tertiary prevention ... seeks to reduce relapses and recidivism and tries to prevent chronicity and hospita lism." 302 PREVENTIVE MEDICINE ( contd ) References are given (4) to other recent definitions. A distinction has been made (5) between revention (when the cause of an illness is known) and non-specific pr evention when it is not). See also preventive services. 303 PREVENTIVE SER VICES "All organized efforts to create a health-promoting and health- prote cting environment and for the p r evention and early detection of dis- ease , deformity or disability . " (1) P e rsonal preventive services : "The sum total of preventive s e rvic es which can be rendered on an individual or small-group basis, such as materna l and child h ea lth care, immunization, health education and so on ." (2) 304 PRIMARY CARE The following definition was adopted by the WHO Executive Board in l 97 3 (l ) : "Primary care services a re general health practice services which are offered to the population at the point of entry into the health service system... Primary services are concerned with individual patients' care as well as with community health. They are responsible for curative as well as preventive activities involving individuals and the community. Environmental services are implied at this level... Problems of water supply and environmental pollution, involving sanitary engineering, are usually dealt with in another framework. 11 Primary health care was defined by a EURO Working Group on Trends rn the Development of Primary Care (1973) (2) as: "The advice and primary care given to a person or group of persons for preventive or therapeutic purposes by one or more members of the health or related professions, acting alone or as a team." An alternative definition was given in an article in the WHO Chronicle in1973(3): "Primary health care ... consists of basic curative care - simple diagnosis and treatment, referral of complex cases to a higher level - preventive care and essential educational measures. 11 Primary medical care was recognized by the EURO Working Group referred to above as a narrower concept than primary health care. A definition of this term was given in the Glossary prepared by Professor M. R. Alder son for a EURO Conference on Health Information Systems in 197 3 (4): "The medical care offered after a patient first presents with symptoms or signs of disease. 11 A similar definition was adopted by a WHO Expert Committee in 1974 (5): "Primary medical care: front-line medical care; as a rule not limited to patients with specific diseases within specific age-groups (this is the field of practice where the patient usually makes his first contact with the physician, and has direct access to him)." An alternative, perhaps less satisfactory, definition was used by a EURO Working Group on Psychiatry and Primary Medical Care (1973) (5): 305 PRIMARY CAR E {contd) "The or ganizational setting in which (the primary physician's) knowle dge and skills are applied ." On th e model of "primary care" the concepts of secondary care and t e rti a ry care (qq. v.) have b ee n developed. 306 PRIMARY CARE CENTRE Suggested by a· EURO Working Group on Trends in the Development of Primary Care (1973) (1) as a neutral alternative term for health centre (q. v . ), in the sense of an institution providing facilities for the provision of ambulatory care by a multidisciplinary team. The term primary care centre was also used by Roemer (2) in this sense, as one form of health centre (in his wide definition of that term). The term was also used (without definition) m the Re solutions of the WHO Executive Board, 1973 (3). 307 PRIMARY MEDICINE "The special body of knowledge and skills requisite for the primary physician who undertakes continuing care in the community. 11 (1) 308 PRIMARY PHYSICIAN t1A physician who is often the physician of first contact and who pro- vides continuing and comprehensive care in health or disease for the patient, frequently for his family and, to a greater or lesser degree, his community. t1 (1 ) t1A physician, working mainly in the community, who undertakes the treatment of any medical condition within his competence. He may be a generalist or a specialist, but in the latter event deals with patients who seek his help direct, as well as with any referred by colleagues. t1 (2) As these definitions indicate, the functions of the primary physician overlap - to a degree which varies from one country to another according to the pattern of practice - with those of the general practitioner (q. v. ). 309 PROFESSIONAL "A professional worker is a health worker trained to the generally accepted level for that discipline in a particular country." (1) A WHO Consultation in 1972 (z) noted that there was considerable diss a tisfaction with the use of the term "professional" to describe a category of health personnel, since in some countries several kinds of personnel of widely varying levels of training had been considered as professional. The Consultation advised, therefore, that WHO and its M e mb e r States should in due course cease to use the term "professional" (and other terms such as "aide", "assistant" and "auxiliary") and adopt instead a classification into four grades based on an assessment of width of competence, depth of technical responsibility, ability to work inde- pendently and supervisory ability. It may be doubted, however, whethe r this fourfold classification would avoid the implications of relative status which are inherent in the pres e nt terminology, or would be able to assert itself against the trend towards wider extension of the term "professional" . 310 PROGRAMME "An integrated series of activities, each focused on one or more aspects of a central problem." (l) "The work to be carried out by an organization in order to satisfy a need. A progr amme comprises a number of activities (q. v.) that, with the necessary resources (g. v. ) , result in action directed towards one or more predetermined objectives (g. v. ). " (2) Programme plan: "A time-specific, community-specific statement of the assumptions, norms, goals, a ctivities, instruments and resources of a programme projected into the future." (3) Programme planning: "A process which includes fact-finding or ass e ssment of specific health needs of the group to be served, review of existing or potential resources, the establishment of priorities and the development of activities appropriate to the priority needs." (1) See also programming, planning. 311 PROGRAMMING 11 The detailed allocation of the activities, tasks and resources necessary for implementing a course of action aimed at one or more specifi e d objective s." (1) "The process of dete rmining th e precise objectives, manpowe r, methods, physical faciliti e s (including buildings, e quipment and supplies), time, an d the ir interrela tionships, requir e d for the implementation of a programme ." (2) "Th e act of formulating an activity or a s e ries of activities over time, usin g an estimated quantity of r e sourc e s, in order to achieve a specified t a rget." (3) See also linear programming. 312 L PROGRESSIVE PATIENT CARE "Progressive patient care is a system under which patients are grouped together in units depending on their need for care as determined by their degree of illness rather than by consideration of medical speci- alty . " (7 ) The EURO Report (1 966) from which this definition is taken accepted the view that progressive patient care was more pati ent - than doctor- oriented, but questione d the claim that it was more aligned to degrees of nursing care than to l eve ls of medical care - as suggested, for example, in the Report of a European Conference on Nurs ing Administration in 1959 (z), and still maintained in a EURO Seminar on Nursing in Intensive Care in 1969 (3) . The 1966 Report distinguished the conventional stage s of progressive patient care a s: intensive care: the type of care needed for those who are critically ill. (4) (S ee the article on intensive care.) intermediate care: the range of care intermediate between intensive care and self-car e. The report noted that this was an unsatisfactory de- finition and might need to be differentiated into further components. (5) self-care : a type of care in which bedsid e nursing is minimal. The report noted that this term, in relation to c a re in hospita l wards, was a misnomer, and preferred the term minimal care. (6) The report also noted that some authors had added further stages of progressive p atient care, including long-term care, home care and out- p atient care. It suggeste d that the logic of making such additions would vary from one country to another, and that in any event thes e stages, with the possible exception of home care, were not all to be regarded properly as items in a single progression. (7) 313 PROJECT The following definition of project - a ter m equate d with activity - was adopte d by a EURO Symposium in 1967 (1 ): " The performance of a function by a n or ganiza tional unit toward th e achievement of a stated obje ctive." A distinction has also sometime s been made between project and activity, the form e r term being defin ed a s: "An organiz e d, interrelated set of activities designed to accomplish a specified objective over a pre scribed period of time with a specific amount of r e sourc e s." (2) Proj ec t h a s a lso be en d efined a s "a sub-unit or discrete phas e of a programme." (3) See a lso programme and activity. 314 PROJECTION A n estimate of a future situation b a s e d on given trends and as sump- tions. A s th e WHO Expert C ommitte e on Na tional Health Planning in De - veloping C ountries noted in 1967 (l ), the terms projection, forecast a nd targe t are often us e d indiscriminately and ought to be distinguished from one another. The Committee quoted from an a rticl e by F. Harbison (2): "Proj ec tions ... a r e differ en t from forecasts. They e xpress the lo gic a l c ons e quenc e s of assumed courses of action. They a re helpful in determining what ne e ds to be done if certain objectives are to be attained, or perhaps what will happen anyway if c e rt a in objectives are in fa c t achieved . Targets, on th e other hand, a r e operational direction indicators based upon projections and r ea sonabl e judgement s." For target, se e a lso the a rticle on objectives. 315 PROJECT SYSTEMS ANALYSIS Project systems analysis (PSA) is a form of systems analysis (q. v. ), a technique of health planning based on a careful definition and detailed analysis of a particular problem or programme, the setting out of precisely quantified objectives and the development of a schedule of activities de- signed to realize those objectives, both the analysis and the objectives being related to specific disease conditions. 316 PROTECTED RESIDENCE "A residence provided for frail, aged people with handicaps who can b e aided with minimal care and assistance." (1) 317 PSYCHOGERIATRICS "It is not easy to define the precise field of psychogeriatrics. One difficulty is that nearly all mental disorders in the adult may be combined with effects of aging. As a working definition, psychogeriatrics is here understood to be a branch of psychiatry concerned with all the mental dis- orders of old age, but particularly with those that first emerge as signifi- cant after the age of 6 5 years. Psychogeriatric s is concerned with the various forms of mental disorders of old age, their epidemiology, origin, prevention, development and treatment. 11 (1) 318 PSYCHOSOMATIC "The term ~psychosomatic I is used in two main ways: it may be applied to all illnesses in so far as every type of illness has psychologic a l concomitants, or it may be used more narrowly to denote certain illnesses that show a physical dysfunction or lesion in which psychological and other factors play an etiological role - e . g. asthma, vasomotor rhinitis, peptic ulcer, colonic disorders, arterial hypertension, chronic urticaria, coronary disease and hyperthyroidism . "It would be more convenient a nd satisfactory to use th e term 'psychosomatic sequence' for a process in which psychological events ar e followed by organic changes, and the term 'soma topsychic seque nce' for the effects of disease or physical changes on a person 1s mental or emo- tional state." (1) 319 PSY C HOTROPIC DRUG "A drug that acts on psychic function, b e h a viour or experience . " (1) " A ny drug whose effe cts a re prima rily on the psychologic a l or e motion a l state of the pati e nt. " (2) 320 PUBLIC HEALTH A WHO Conference in 1956 (1) noted the variation of meaning of this term in different countries: "Wherever part of the health service is public and part is private, the meaning of the term 'public health' is, as a rule, limited to organized community efforts in the field of health and disease; individual therapeutic care is more or less excluded. In other countries, where all health services are public, the meaning of the term 'public health' becomes virtually all-embracing." The meaning of the term has been considered by many WHO com- mittees and conferences (2), usually on the basis of a definition by Winslow (3) which is in line with the narrower of these two concepts: "Public health is th e science and art of preventing disease, prolong- ing life and promoting menta l and physical health and efficiency through organized community efforts for the sanitation of the environment, the control of communicable infections, the education of the individual in per- sonal hygiene, the organization of medical and nursing services for the early diagnosis and preventive treatment of disease, and the development of social machinery to ensure to every individual a standard of living adequate for the maintenance of health, so organizing these benefits as to enable every citizen to realize his birthright of health and longevity. 11 As Winslow himself pointed out in a WHO Monograph (1951) (4), however, this definition is itself a wide one. After quoting the definition he comments: "No sound distinction, therefore, can be drawn between 'sanitation', 'pr e ventive medicine', 'curative medicine', 'health promotion' and 'improvement of standards of living'. All are parts of a comprehensive public health programme in the modern sense." A EURO Symposium in 1966 (5) suggested that the definition should be expanded to include the organization of medical care services. This extension in the scope of the term was noted by a WHO Expert Committee in 197 3 (6), which observed that "the expression public health is now used in a broad sense to encompass the problems affecting the health of a population, the collective status of health of the people, en- vironmental health and health services, and the administration of health care services." 321 PUBLIC HEALTH (contd) Taken in this wide sense, the term approximates to the concept of community medicine (q. v.) which has been developed in recent years. It is also closely allied to preventive medicine and social medicine (qq. v. ). See also community health, veterinary public health. 322 PUBLIC HEA LTH FIELD STUDIES "Research projects conducted in the community, usually outside the hospital, and directed towards objectives of public health importance," (I) 323 PUBLIC HEALTH NURSE "The nurse most directly concerned with giving health education and care to individuals and families in the community. 11 (1) 324 PUBLIC HEALTH NURSING "Organized community nursing service, usually outside the hospital, providing comprehensive family-centred care or individual- or disease- centred care, with major emphasis on the promotion of health, the pre- vention of disease and rehabilitation." (1) 325 PUBLIC HEALTH OFFICER "A person to whom society or a group delegates responsibility for filling the health needs of the whole of the population in the promotion of health, the prevention of disease, the treatment of the ill or the mainten- ance of remaining function in persons whose health has been irreparably damaged. More concisely he could be defined as a practitioner of social and preventive medicine. 11 (1) Other alternative terms are now availa ble: e.g. specialist in community medicine (q. v. ). The designation public health officer is perhaps best avoided in re- ferring to a medically qualified officer, since in English usage it is applied to a sanitary inspector (q. v .) 326 PUBLIC HEALTH OPHTHALMOLOGY "A discipline that encompasses the comprehensive community approach to the promotion of eye health and particularly to the prevention of disability due to visual impairment and blindness. 11 (1) 327 PUBLIC HEALTH PHYSICIAN A public health physician was defined by a EURO Symposium in 1966 (1) as "one with formal training in public health, working full- or part-time in the public health service. He should be a senior or junior expert in health administration or in one of the technical specialties associated with public health services. 11 328 PUBLIC HEALTH, SCHOOL OF "An institution with adequate resources which, in addition to re- search in public health and service to the community, provides a full- time course lasting not less than one academic year, or its equivalent, covering the subjects essential to the understanding of the various prob- lems of public health and the concepts, or ganiz ation and techniques required for dealing with them, and which is open to members of the medi- cal and allied professions seeking qualifications in public health." (1) This definition, adopted by a WHO Expert Committee in 1961, was accepted by a later Expert Committee in 197 3 (2), which observed, how- ever, that: 11 A school of public health should be viewed as a functional entity whose main purpose is to provide general and specialist public health training for members of health and other professions who require it. Among the courses offered there should be a basic course leading to a postgraduate-level qualification in public health. Schools of public health may also have research responsibilities a nd provide direct and advisory services to the community. 11 329 PUBLIC HEALTH TRAINING A WHO Expert Committee on Postgraduate Education and Training in Public Health noted in 197 3 (1) that: "As public health practice in some countries includes personal health care services and their administration, whereas in others it relates almost exclusively to sanitary and other environmental health activities, it is necessary to state that in the present context public health training is taken broadly to mean the postgraduate training required by health planners, administrators and personnel engaged in public health services who need such competence . 11 330 PUBLIC RELATIONS "The art of commanding the attention, and maintaining the interest of the whole or appropriate parts of the public on a parti cular matter." (1) 331 QUEUEING THEORY "A process which examines the problem of congestion and delay in flow through service systems, when arrival intervals and service times are randomly variable. 11 (1) A technique used in operational research (q. v. ). 333 RADIATION MEDICINE "The practice of the application of X-rays or other forms of ionizing radiation in the field of medicine, either in the investigation of disease or of body functions or in the treatment of disease." (1) The IAEA/WHO Expert Committee on the Medical Uses of Ionizing Radiation and Radioisotopes (197 2) (2) distinguished three principal branches of radiation medicine: diagnostic radiology, which "has for its objective the provision of information of diagnostic value, making use of two properties of ionizing radiations - penetration through matter and image formation"; radiotherapy, "the tre a tment of disease by ionizing radiation , making use of biological effects, parti cula rly the selective destruction of tissue"; and nuclear medicine, "the a pplication of unsealed radioactive materials for diagnostic and therapeutic purposes, making us e of the emi ssion of ionizing radiation from such materials and of their distribution within the body . " 335 R ADIOLOGIST "A radiologist is a physician qualified to practise in any one or more of these disciplines (i.e. the disciplines of radiation medicine, q. v. ). In m a ny countries there is a tendency for radiologists to practise in only one branch of radiation medicine; they are then re fe rred to as (i) diagnostic radiologist (in some countries 'roentgenologist' or radio- di a gnostici a n ' ); (ii) radiotherapist; or (iii) nuclear medicine speci a list. In other countries radiologists may practise in more than one or even in all three disciplines, and a re then referr e d to as (iv) gener a l radiologists." (1) 336 RATE / RATIO "A ratio is a quotient which indicates the relation in size of one number to another. A proportion is a ratio which indicates the relation in magnitude of a part to the whole. A percentage is a proportion in a hundred. A rate was initially a special type of ratio used to indicate the relative frequ ency of the occurrence of a particular event within a popula- tion or sub-population . The term has, however, acquired a steadily wider meaning and is often used as a synonym for ratio. It is nowadays used in many different senses, but the concept of ratio i s common to them a ll. .. "Rates are generally given per thousand, and where the term 'rate' is used without qualification this is unde rstood . Some rates, howe ve r, are given per ten thousand, per hundred thousand or per million... On othe r occasions rates may be given per head or per person." (z) Attempts are sometimes made to establish a distinction, for par- ticula r purposes, between rate an d ratio . As a WHO Scientific Group noted in 1970 (z), howeve r, distinctions of this kind are not unive rsally accepted and could produce misunderstandin g and confusion: the wise course, therefore, is to follow the practice adopte d by the Group and specify the relevant denominator whenever necessary. 337 RECORD LINKAGE "The bringing together of records relating to one individual (or to one family), the records originating in different times or places under circumstances where identification data are often incomplete . " (1) "Record linkage, as a term applied to the organization of files of records deriving from a variety of sources and agencies, involves the maintenance of a central file consisting of dossiers relating to individua ls, and the systematic addition to each i ndividual ' s dossier of each newly arising record relating to him . " (z) "The term 'medical record linkage' implies the assembly and maintenance, for each individual in a population, of a file of the more important records relating to his health. . . The techniques of (record) retrieval and the related techniques of organization, maintenance and up- dating of the necessary personal files together with the techniques of their application to medical and health care and research comprise the subject of 'medical record linkage ' ." (3) 338 REFERENCE MAN/WOMAN "Hypothetical persons of defined age, body size and physical activity, used for the purpose of calculating the energy needs of populations by means of appropriate corrections based on observed body weights, patterns of activity and age structure. "(a) Reference man. He is between 20 and 39 years of age and weighs 65 kg . He is healthy, that is free from disease and physically fit for active work. On each working day he is employed for 8 hours in an occupation that usually involves moderate activity. When not at work he spends 8 hours in bed, 4-6 hours sitting or moving around in only very light activity, and 2 hours in walking, in active recreation or in household duties. "(b) Reference woman, She is between 20 and 39 years of age, similarly healthy, and weighs 55 kg. She may be engaged for 8 hours in general household work, in light industry or in other moderately active work. Apart from 8 hours in bed, she spends 4-6 hours sitting or moving around in only very light activity and 2 hours in walking, in active recreation or in household duties . 11 (1) 339 REGION A term used in the context of health planning or, more generally, in socio-economic planning. The following definition was adopted by a EURO Conference on the Health Aspects of Planning for Regional Socio-Economic Development in 1 967 (1 ): "A geographical area of a country which is the object of planning for socio-economic development. It is usually coterminous with one or more administrative units and often characterized by special topographic, demographic, cultural, social or economic properties which make separate planning necessary or desirable . " A wider definition was given in the Terminology List prepared for the European Conference on National Health Planning in 1974 (2 ): "The word region is used to represent a number of different entities, but may be taken to mean, amongst other things: (a) an area with particular geographical and economic characteristics, all of which taken together con- stitute a viable entity for planning; (b) a n area requiring special attention because of industrial or agricultural or urban decay or backwardness; (c) an area which by virtue of its local resources is capable of serving itself and a hinterland as an independent - or semi-independent - develop- ment area for which planning is required." As a participant in the Conference noted (3 ), however - "We must bear in mind that the concept of a 'region' for medical services varies widely in European countries, both in terms of the size of the population covered and of the principles on which medical care is organized." 340 REGIONAL PLANNING "A multidimensional, interdisciplinary synthesis of the economic, social and spatial aspects of development. 11 (1) In the context of health services the term might be more simply defined as the planning of health services on a regional basis. See region, health planning . 341 REGIONALIZA TION "The organizational and educational process of rationalized planning of all health services for a geographic a nd political region having a suf- ficiently large population to justify the provision of all significant c ategor ies of health services. 11 (1) "The organization and coordination of a ll th e health resources and services within a defined area for the purpose of maintaining the highest possible l eve l of medical care and adapting a compr e hensive health prog- ramme to the characteristics an d needs of the a r ea." (2) 342 REGISTRATION (OF DISEASE) "The term 'registration' implies something more than 'notification'. A register requires that a permanent record be established, that the cases be followed up, and that basic statistical tabulations be prepared both on frequency and on survival. In addition, the patients on a register should frequently be the subject of special studies." (1) 343 REHABILITATION "As applied to disability, this is the combined and coordinated use of medical, social, educational and vocational measures for training or re-training the individual to the highest possible level of functional ability. 11 (1 ) "The process of restoration of activities and social functioning, following illness or injury, as nearly as possible to the pre-morbid level. 11 (2) Medical rehabilitation: "The process of medical care aiming at developing the functional and psychological abilities of the individual, and if necessary his compensatory mechanisms, so as to enable him to attain self-dependence and lead an active life. 11 (1 / Social rehabilitation: "That part of the rehabilitation process aimed at the integration or reintegration of a disabled person into society by helping him to adjust to the demands of family, community and occupation, while reducing any economic and social burdens that may impede the total rehabilitation process." (1) Vocational rehabilitation: "The provision of those vocational services, e.g. vocational guidance, vocational training and selective placement, designed to enable a disabled person to secure and retain suitable employ- ment. 11 (3) See also rehabilitative services. 344 REHABILITATIVE SERVICES "Those activities and procedures designed to assist a physically or mentally disabled individual to achieve or maintain the highest attainable level of function through an evaluation a nd treatment programme providing, under physician direction, one or a combination of medical, paramedical, psychological, social and vocational services determined by the needs of the patient. " (1 ) 345 RESEARCH Research has been defined as "conscious action to acquire deeper knowledge or new facts about scientific or technical subjects . " (1) Different forms of research can be distinguished: basic research, which consists of "studies in the natural and physical sciences not directed immediately to patient care" (2); clinical re search, whose "important distinguishing characteristic is that attention is focused on the individual" (3); epidemiological research, which "is concerned with the study of a population in terms of time, place and characteristics of individuals" (3); administrative research, in which three types of study can be identified (4) - systems analysis, operational research a nd action research. From the temporal aspect there ar e thr ee main classes of research project (5): retrospective research ("reaching back in time, using records or memory, in an effort to recreate as accurately as possible a sequence of events or to obtain an understanding of distribution"); point-prevalence surveys, which are concerned with the present (see prevalence); and prospective research, designed to collect data in the future. The term self-evaluation research has been applied (6) to "any form of critical examination of the way in which (a health worker's) own work or that of his institution is carried out and the extent t o which it is having the results that are expected of it." See also action research, evaluational and evaluative research, health practice research, operational research, systems research. 346 RESEARCH AND DEVELOPMENT "Work primarily related t? basic and applied research, design and development of prototypes and processes... This includes all work of which the primary objective is to make further improvements in the product or process." (1) 347 RESOURCES "The manpower, money, materials, skills, knowledge, techniques a nd time needed or available for the performance or support of action dir ec t e d towards specified objectives." (l) "Identifiable manpower, expertise, buildings, equipment and dis- posable items for providing a p a rticular service or range of services. 11 (2) "The sum total of manpower, money and m a terials available for production . 11 (3) Human resources: see manpower. 348 S A.. FETY (OF A DRUG) "The extent to which a drug may be used efficaciously with minimum risk to the p a tient. 11 (l) 349 s SAMPLE "A sub-set of a population; in rigorous analytical methods, a sub- set that meets statistical criteria for representativeness of the popula- tion. " (1 ) 350 SAMPLING "The process of selecting a number of cases from all the cases in a particular group or universe." (1) In probability sampling or random sampling the individual units are selected by a method based on probability theory; i.e. by a method in- volving knowledge of the likelihood of any unit 1s being selected. In purposive sampling the individual units are selected according to some criterion other than that of strict probability. (2) 351 S A MPLING UNIT "One of the units into which an aggregate is divided for the purpos e of sampling, each unit being reg a rded as individual and indivisible when the selection is made. Such units m a y be define d on some natural basi s, such a s a household or a person, or on some arbitrary basis, such as a r eas defined by coordina tes on a map." (1) 352 SANITARY ENGINEER "The term 'sanitary engineer' means different things to different people. It may mean an engineer specializing in the design, construction, operation and management of sanitary facilities such as water and sewage treatment works or wastes collection and disposal. In other situations it may refer to an engineer with specialized training in other environmental health areas such as air and water pollution, vector control or housing. Basically, however, the term refers to an engineer 'who is trained in techniques that permit him to advise upon, administer, supervise or other- wise conduct professional and scientific work where the use of engineering knowledge and skills are essential for identification and control of environ- mental factors that may produce a detrimental effect on the physical, mental or social well-being of man. 111 (1) 353 SA NIT ARY INSPECTION Defined by a EURO Symposium on Sanitary Inspection Services in 1964 (1) as part of environmental sanitation (q. v. ), specifically concerned with inspection, reporting, prevention and adjustment of faults in existing environmental conditions, and advising on and ensuring compliance with the law, and with a secondary interest in activities in the nature of self- help, education and stimulation of local interest in favour of a general improvement of environmental conditions. 354 SANITARY INSPECTOR A professional officer concerned with environmental sanitation (q. v.) and responsible for sanitary inspection (q. v. ). (1) The designation of this officer varies widely from country to country: sanitary inspector, health inspector, public health officer, environmental health officer, etc. He may be assisted by auxiliary personnel (sanitary assistant, sanitary aide, etc.). The term sanitarian is sometimes used to cover all types of sanitary inspection personnel. (2) 355 SA TISFICING "P-. term introduced by H. A. Simon in 'Theorie s of D ecision Making in Economics an d Beha viour a l Science', American Econ. R e view, 1959, June. The t e rm implies that d e cision-makin g is not entir e ly a rational process because such facto rs a s m a ximizin g or optimizing are, in re a l life, not a lways possible . On the oth e r hand, where an individual or a n organization gains mor e s a tisfaction from a decision than had pr eviously been achi eved, without complete rational maximizing, this the n is the con- cept of satisficing." (1) A conciser formulation was offe red by Sir John Brother ston at th e conference (19 6 4) (z) for which this d e finition was prepared : "To sa ti sfice is to do 'well enough', but not necessarily 'as well as possible'." 356 SCREENING "The presumptive identification of unrecognized disease or defect by the application of tests, examinations or other procedures which can be applied rapidly. Screening tests sort out apparently well persons who probably have a disease from those who probably do not. A screening test is not intended to be diagnostic. Persons with positive or susp1c1ous findings must be referred to their physicians for diagnosis and necessary treatment. 11 (1 ) Mass screening: "The large-scale screening of whole population groups. 11 The term is used to refer to screening where no selection of population groups is made. (2) Selective screening: "The screening of selected high-risk groups in the population. " (2) Multiple (or multiphasic) screening: "The application of two or more screening tests in combination to l a rge groups of people." Not to be con- fused with multi-step screening, in which the same individual is screened for the same disease by two or more persons at different professional levels. (3) Related terms (q. v. ): case-finding, early disease detection, epidemiological surveillance, epidemiological (or population) survey, health survey. 357 SECONDARY CARE This term, along with tertiary care, has been developed on the ana logy of the much commoner term primary care (q. v. ). Secondary care and tertiary care (strictly, secondary medical care a nd tertiary medical care) were defined as follows by the WHO Executive Board in l 97 3 (l ): "Secondary care comprises the care provided through specialized services on referral from primary care services ... " Tertiary care includes highly specialized services and eventually (= whe re required?) the super-specialties such as plastic surgery, neuro- surgery and heart surgery." These definitions were developed a little farther in the Report of a WHO E xpert Committee in 197 4 (2 ): "Secondary medical care : care r e quiring attention of a special n a tur e , usually more sophisticated and complicated tha n could be handle d by th e general practitioner. "Tertiary medical care: care requiring highly specialized attention, and which can usually only be provided in centres specially de signed for the purpose and by physicians trained in the area of specialization." 3 58 SELECTIVE PLACEMENT "The process aiming at placing disabled people in employment suited to their age, experience, qualifications and physical and mental capacitie s . .. This is the final stage of reh a bilitation." (1) 359 SIMULA TION "The use of models in situations wh e re experimentation is impos- sible or impracticable, in order to d e termine the e ffect of changes in the va ri a ble s or obj e ctives . The effe cts obs e rve d provid e pl a nners with a b a sis for d e cision s with r e spe ct to th e r ea l situa tion." (l) Simulation model: "A simplified mathemati cal r e pr e sentation of a syste m through which a number of alterna tive choices c a n b e run whe reby the outcom e of the v a rious choices can b e demonstrated." (z) S ee a lso model. 360 SITUATION ANALYSIS "A descriptive assessment of a situa tion through the ordering, analysis and interpretation of information, without necessarily c a rrying out the explicit compa risons of e valuation (q. v. ). " (1) 361 SOCIAL ASSISTANCE A form of social security (q. v.) in which benefits are payable, as of legal right, from public funds in prescribed cases of need deemed not to be due to the applicant's own fault, and not covered by social insurance (q. v. ) or some other form of social security. In most industrialized countries social insurance has largely been superseded by the development of social insurance. (l) 362 SO CIAL INSURANCE "The oldest mechanism, and still the most common one, by which moneys are raised for socia l security purposes is by way of 'social insurance'. This constitutes a mandatory contribution from per sons - usua lly workers a nd employers, but also sometimes from the self- e mployed - to be used for certain specified purposes. By payment of this contribution or tax the employed or self-employed persons earn a ri ght to the designated benefit, such as p er sona l health services. The funds so raised may also be supple mented by moneys from general govern- m e ntal revenues or by mon e ys collected by way of ea rmarked taxes." (1) 363 SOCIAL MEDICINE This term ove rlaps with publi c health (q. v. ), and in re ce nt years has tended in som e countries to be displa ced by the newer term community medicine (q. v. ). A WHO Monograph published in 1957 (1) gave the following definition: "As a comprehensive term, 'so cial medicine' is used to embrace: (1) resear ch into social factors which affe c t health or the in c idence of disease, by means of surveys , case studies and statistical investi - gations ; ( 2) the r e c ipro c al r e l at ions existing between medicine and so cie t y ( medical so c iology) , including the collective responsibility of medi c ine to society for advising on so c ial problems as the y may affe c t health; ( 3) social ps ycholo gy and social psychiatr y ; (4) the agencies of so c i a l therape uti c s - i. e . so c i a l insura n ce and social aspects of publi c he a lth, medical ca r e and welfa r e servi ce s. " Mo r e re centl y th e term has be e n defined in a EURO Report ( 197 0) (2) as follows : "Social medicine deals with such concepts as the demand for services (awa r ene ss of disease, motivation to seek medical care), satisfaction of this d emand, public participa tion in dis ease control pro g r ammes and the applicability and acceptability of services . " 364 SOCIAL PSYCHIATRY "The term 'social psychiatry' h a s come into us e relatively recently and has acquired different sha des of meaning according to author and environment. As employed her e , social psychiatry refe rs to the preventive and c urative measur e s which are dir e cted towards the fitting of the indi- vidu a l for a satisfactory and useful life in terms of his own social environ- ment. In order to achieve this goal, the social psychiatrist attempts to provide for the mentally ill, and for those in dang e r of becoming so, opportuniti e s for making contacts with society which are favourable to the maintenance or re-establishment of social adequacy." (J) 36 5 SOCIAL SECURITY "This is a difficult term to define because its meaning has changed over the years as certain social programmes have developed throughout the world, In its broadest sense it connotes a goal of complete social protection against a variety of risks, such as incapacity for work resulting from a morbid condition a nd involving suspension of earnings, unemploy- ment, old age, disability or de a th of the breadwinner, employment injury, responsibility for family maintenance, any morbid condition whatever its c a use, including the consequences of pre gn a ncy a nd confinement, etc. Short of this ultimate goal, social security means the establishment of certa in benefits a s a right of those persons who a r e protected under legal statute, "Since the social s e curity concept implies a sta tutory right to benefits, an ultimate r espon sibility of government is always implied also. The day-to-da y administration of social security schemes, however, may be and often is dele gated to a utonomous bodies." (1) The following is an official ILO definition (2): "Social security is the result a chieved by a comprehensive and succes sful s erie s of public measures for protecting the public (or a large sector of it) from the economic distress that , in the a bsenc e of such measures, would be caused by the stoppa ge of e arnings in sickness, un- employment , invalidity or old age and afte r death; for making available to that same public medic a l car e as neede d; and for subsidising families brin gin g up youn g children." Soci a l s e curity thus comprehends a variety of different structures - in particular soci a l insurance, social as sistanc e , a national health service (qq. v. ). 366 SOCIAL WORK "Organized social service dealing with the broad range of people's s ocial problems through c a se-work and other specializ e d techniques." (1) " M e dical social work: organized s oc ial s e rvice inside or outside ho s p ita l, with emphasis on social proble ms rel a ted to h ea lth." (1) 367 SPECIALIST "A doctor who has received special training in one branch of medicine and who limits his practice, wholly or partially , to particular disease categories or to certain age-groups. His work is concerned wholly or partially with patients referred to him by professional colleagues. 11 (1) Specialist practice is the practice of a specialist, as opposed to general practice (q . v. ) 368 SPEECH THERAPY "The study, e xami nation , appr ec i ation and treatm e nt of defects of th e voice, of speech and of spoken and written l a nguage, as well as the utiliz a tion of corresponding substitutional devices and therapeutic tr eat- m0nt." (l) 369 STATISTICS "The science of collecting, classi fying , analysing and using num e rical facts." (1) The term is also appli ed to the numer ic al facts themselves. A EURO Symposium which considered the teaching of statistics to medical students (1 962) (2) noted that: "There was often much confusion and misunderstanding because of the different interpretations of the term. Sometimes it was taken to mean 'vital and health statistics', sometimes 'statistical theory or methodology' (in the broade st s ense) . Sometimes the term was taken to mean the a pplication of statistical methods to epidemi olo gical, clinical or laboratory research, sometimes it was given a more comprehensive connotation em- bracing several or all of these possible meanings." The Symposium concluded, therefore, that for teaching purposes medical statistics should b e subdivid e d into thr ee main parts - statistical principles and methods, the a pplication of statistical m e thods to medical and biological problems, and vital and health statistics. Demographic statistics: "Material that describes a range of characteristics of a given population. It is usually restricted to informa- tion on the age a nd sex distribution of the population, the birth, marriage and death rates, and possibly the occupation of the wage-earners. In a more extended form , demographic data can a lso cover such a spects as the distribution of the population accor din g to the housing situation, attitudes to health care and indicators of environmental problems. 11 (3) According to a United Nations Statistical P aper (4) demographic statistics comprise vital statistics together with popula tion and migration statistics. Health statis tics : "For historical reasons the term 'health statistics' has as its scope and objectives a different meaning in different countries. In some countries health statistics forms a part of demographic statistics, in others it is restricted to a 'book-keeping account ' of health service activities; in others, however, it may be interpreted in a much wider sense and comprise, inter alia, health service statistics, etc. 11 (5) It seems desirable to arrive at an agreed WHO int er pretation of this term. 37 0 STATISTICS (contd) Health service statistics: statistics relating to the operation of health services or a health service system (qq. v. ). Vital statistics: see vital records . 371 STILLBIRTH A traditional term which has been variously defined: "The delivery of a foetus after about the sixth month of pregnancy that died before or during delivery." (1) "The proc ess of birth when there is no evidence of life at or aft e r birth. 11 (2) The 3rd World Health A ss e mbly in 1950 (3) adopted the recomm e nda- tion in th e 2nd Re port of the WHO Expert Committee on Health Statistics (4) that this t e rm should be used only if essen tial for internal use within a nation, in which case it should be considered synonymous with late f e tal death (q. v. ). Stillbirth rate : "The number of still -bor n infants per 1 000 total births (stillbirths plus li ve births) . 11 (5) 37 2 STOMA TOLOGIST This t erm was defined in the Report (195 8) (1) of a EURO Study Group on Dental Health Services for Children as : " A person who , in addition to a m e dical qualification , possess es either a dental degree or certific a te. 11 In its Report (1965) (2) on the Organization of Dental Public Health Services the WHO Expert Committee on Dental Health noted that in some countries the term was used in e sse nt i a lly th e s ame meaning a s den tist (q. v . ), a term which th e Committee d e fin e d in broad t erms . There may, however , be a dvanta ge in distinguishi ng between a dentist a s a practitioner of ge neral dentistry a nd a stomatol.ogist a s a specialist with a m e dical as well a s a de nta l qua lific ation . There is perha ps a need for further consider a tion of th e s e definitions . 37 3 SYSTEM 11 A set of inter-related elements brought together to achieve a pur- pose in the environment in which the system exists." (1) 11 A group of elements (persons, organizations , equipment, concepts, etc.) which are rel a ted in such a way that they influence each other and the behaviour of the elements as a whole. 11 (z) "Any recognizable delimited aggregate of dynamic elements that are in some way interconnected and interdependent and that continue to operate together according to certain laws and in such a way as to produce some characteristic total effect. A system, in other words, is something that is concerned with some kind of activity and preserves a kind of integration and unity; and a particular system can be recognized as distinct from other systems to which, however, it may be dynamically related. Systems may be complex; they may be made up of interdependent sub-systems, each of which, though less autonomous than the entire aggregate, is nevertheless fairly distinguishable in operation. 11 (3) 37 4 SYST E MS ANALYSIS The following definition of this term was used by the WHO Executi ve B oa rd in 197 3 (1 ): " T h e examina tion of var i ous e l e m ents of a system with a view t o a s ce rtainin g whe ther th e propos e d solution to a problem or problems will fit i nt o t h e syste m and, in turn, e ff e ct an overall improvement in th e s y stem . 11 A E UR O C onference on H e alth Information Systems m 197 3 (2 ) us e d t h e fo llowing d e finition: "T h e analysis of an a c t i v ity in orde r to det e rmine precis e ly w hat is requir e d of th e syste m, how this c a n b e s t be a ccomplishe d and in what way s th e computer can b e useful. 11 A r ecen t study in th e Pub li c Hea lth P a pe rs s e ri e s (3 ) gi ve s th e fo llowin g de fi n i t i on : 11 'Syste ms a nalysis' r e fe rs to a n y forma l a nalysi s whos e purpos e is 't o sugge st a course of a ction by syste m a tically e x a min ing the objectives, costs, e ffe ctive ness and risks of alternative policies or strate gies - and de si gnin g a dditiona l on e s if thos e e x a mine d a r e f ound w a n tin g . It is a n a pproa ch to or way of looking a t comple x problems of choice under un- certainty; it is not yet a method.' The broad purposes of the systems a pproa ch a re the following: (1) to form a li z e complex proble ms by providin g value-free (objective ) d a t a a nd increa sin g the va lue -fre e element in decision- m a king ; (2) to indicate the probable consequenc e s of alternative courses of a ction; (3) t o inform de b a tes on va lues, objecti ves and the alloca tion of resourc e s whose purpos e is to find ways of improving performance, reducing costs or economi zing in the use of manpower or resources; (4) to compare results achieved with objedives specified; (5) generally, to assist the decision-ma king process in planning and management, i.e. in making adjustments to t h e components, structure, apparatus for information and communications, and decision-ma king proce dures of a n e xisting organization, in order to improve its perform ance. 11 37 5 SYSTEMS ANALYSIS ( contd ) The same study notes that "in some texts ' systems research ' is used to mean ' systems analysis ' plus ' systems planning and design' . For the sake of convenience, ' systems analysis ' is used here in the more comprehensive sense." For the distinction between systems analysis and operational research, see the latter term. 376 SYSTE MS DESIGN " The d e t e rmination of the nature and content of the input, files, procedure s and output of a system." (1) (The words underlined are used in senses defined in the Glossary). 377 SYSTEMS RESEARCH This term is sometimes used as equivalent to systems analysis (q. v. ), sometimes as a wider term which includes systems ana lysis and systems pla nning and research. (1) 378 T ASK One of the units of work into which an activity (q. v. ) can be sub- divided. (1 ) 37 9 1 TEAM The concept of th e t eam . (dictionary de finition : a "set of p e rsons w orking together" (1 )) has been the subj e ct of discussion in r e cent years in the fie ld of health c a r e , particula rly in r elation to th e provision of primary c a re. The term wa s d efined by a EURO Workin g Group in 1973 (2) as fo llo w s: "A non-hierarchical a ssociat ion of peopl e w ith diffe rent professional b a ckg rounds but with a common objective, whi ch in any given s e tting is to provide p atients an d families with the most comprehensive health care practic abl e . " The Wo rkin g Group noted the distinction between th e interdisciplina ry team, which is composed of a variety of he a lth worke rs, and the intra - disciplinary team, made up of members of the s ame health discipline, ea ch with a p articul a r spe cia lization or degree of competence. Nu rsing care t eam : s ee nursing pers onnel. See also dental health t eam . Team pr a ctic e wa s defined by a EURO Confe r ence i n 1 970 (3) as: " N orma lly a medical practice further supporte d by a multidisciplin- ary team of paramedica l professiona l worke rs such a s nurs e s, midwives, social workers, etc . " (The term team practic e might perhaps be more appropriately applied to the method of practice rather than the gr oup of professional workers engaged in it.) T eamwork was defined by a WHO E xpe rt Committe e in 1954 (4) a s: "A method of workin g towards a common g oa l which enables s eve ral persons to make the b e st us e of their qualities by combinin g the ir skills and experience." 380 TOLER ANCE "An adaptive state char acter ize d b y d i mini shed re spons es to the same quanti ty of a drug. 11 (1 ) 38 1 TRAINING Definitions of the different types of training (1 ): Training: a planned formal or informal learning process in which a person is prepared for carrying out certain functions. Basic training: a planned training programme, including theory and supervised practice, which is given before the person begins work in the profession or service concerned. Postbasic training: a planned training programme given after basic training and before the person begins work in the profession or service concerned. In-service training: a planned formal training programme, given after the person has completed basic training and during his period of e mploymen t. On-the-job training: planned informal learning during the period of employment. Cf. the articles on medical education and nursing education. 382 UNIVERSE " The total o r aggre ga te of all possible items of the class under consideration; the entire group of items from whi ch a sample is taken, e . g . the total population of a country . 11 (1) 383 u VALIDITY "The extent to w hich a m e th od pr ovi<les a t rue a s ses s ment of that which it purports to mPas ur e . " (7) "An expression of w hether a respon sf' o r m ea sur e a ctually represents what it purports to ; e ss enti a lly a measur Pment of ' t ruth' within the terms of reference. 11 (2) 385 VETERINARY PUBLIC HEALTH This relatively new term has been defined by WHO committees as follows: "All the community efforts influencing and influenced by the veterin- ary medical arts and sciences applied to the prevention of disease, pro- tection of life and promotion of the well-being and efficiency of man. 11 (1) "Veterinary public health is the field of activity which protects and advances human well-being by utilizing the combined knowledge and re- sources of all those concerned with human and animal health and their inter -relationships. "Veterinary public health is therefore concerned with such activities as the control and eradication of zoonoses; the development and super- vision of food hygiene practices; laboratory and research activities in such fields as diagnosis, production of biological products, zootechnics, microbiology, epidemiology and all aspects of comparative pathology and medicine (oncology, therapeutics, surgery, nutrition, etc.); and the education and training of professional and ancillary workers in veterinary aspe cts of public health." (2) 386 VITAL RECORDS "Vital records may be defined as those dealing with births, deaths, stillbirths, foetal deaths, marriages, adoptions, legitimations, recogni- tions, annulments, divorces and sepa.rations; in short all the events which have to do with an individual's entrance into or departure from life, to- gether with changes in civil status. 11 (1) The events listed in this definition are known as vital events. (2) "Vital statistics are those statistics which, for a designated popula- tion group, provide a description of the number and characteristics of the vital events which are taking place therein." (3) See also statistics. 387 VOCATIONAL COUNSELLING Part of the process of rehabilitation (q. v. ). "The process of assisting an individual to choose an occupation, taking into account his characteristics and their relation to employment opportunities. It is based on free and voluntary choice; the primary objective is to give the individual full opportunity for personal development and satisfaction from work( having due regard for the most effective use of manpower resources. 11 1) Alternative term: vocational guidance. 38 8 W AT E R POLLU'"'ION 11 Pollution of wate r ma.y be described as a condition arising from any a ctivi ty of man that renders water less euitable for any purpose for which it was suitable in its natural condition. It may result from the d i charge of d rnestic s ewage or of waste water from a wide range of industrial a cti viti e s, including the processing of food and othe r agric11ltur- al roducts , manufactu rin g amd mining." (1) 389 WORK STUDY "A method (or methods) whereby the operations of an individual or group are studied systematically in order to find whether efficiency can be improved or production increased." (1) This is in line with the definition given in the ILO "Introduction to Work Study" (2): "Work study is a term used to embrace the techniques of method study and work measurement which are employed to measure the best possible use of human and material resources in carrying out a specified activity." Method study and work measurement a re defined as follows: "Method study is the systematic recording, analysis and critical examination of existing and proposed ways of doing work and th e develop- ment and application of easier and more effective methods." (3) "Work m ea surement is the application of techniques designed to establish the work content of a specified task by determining the time required for carrying it out at a defined standard of performance by a qualified worker." (4) Definitions on similar lines have been used in recent WHO and EURO documents. (5) In British usage the term work study has replaced the older term time and motion study. In American usage the term motion and time study is usual, and motion study is used with the same meaning as method study. (6) For the distinction between work study and operational research, see the latter term. 390 YOUTH ADVISORY SER VICE "A service of a permanent or semi-permanent nature focused on adolescents and young people to provide advice and assistance. In some way, such services commonly make use of professional personnel (per- haps only on a consultant basis), and are aimed at finding solutions within the community either through traditional service structures, through alternatives to classic al institutions or through specialized settings. They are characterized by their informal organizational basis and by attempts to facilitate access and availability, and may offer a variety of services (e.g. advice, counselling, referral, education). Contacts may be anonymous and informal. " (1 ) 391 y ZOONOSES "Tho se disea ses and infe ctions which are natur a lly transmitt e d between vertebrate animals and man . " (1) 393 z REFERENCES The following abbreviated references are used: Demographic Dictionary: Multilingual Demographic Dictionary, prepared by the Demographic Dictionary Committee of the International Union for the Scientific Study of Population, United Nations, 1958. Family Planning Glossary: Glossary of Family Planning Terms, prepared by the International Institute for the Study of Human Reproduction, Columbia University, New York, for a WHO Workshop in Family Planning Programme Statistics for Health Statisticians, 197 2. Food and Nutrition Terminology: Food and Nutrition Terminology, prepared by the World Health Organization and the Food and Agriculture Organization with the collaboration of the Inter- national Union of Nutritional Sciences, revised edition, 1973, NUTR/73. 2 Planning Terminology: Terminology List prepared by WHO Secre- tariat for European Conference on National Health Planning, Bucharest, 197 4, EURO 4107/11. PHP: WHO Public Health Papers series, Geneva TRS: WHO Technical Report Series, Geneva 395 Abortion 1. Report of WHO Scientific Group on Spontaneous and Induced A bortion , TRS 461, 1970, pp. 6-7 2. World Health Statistics Report, 1969, Vol. 22, No. 1, pp. 38 - 4 2 3. Report of WHO Expert Committee on Health Statistic s:, TRS 25, 1950, p. 12 4. Op. cit. at 1, p. 8 5. Family Planning Glossary, p. 2 6. Op. cit. at 1, p. 9 7 . WHO Bulletin, 34, 1966, p. 768; op. cit. at 1, p. 9 A ccident 1. Report of WHO Advisory Group on Accidents in Childhood, TRS 11 8, 1957, pp. 4-5 2. Encyclopaedia of Occupational Health and Safety, ILO, Ge n e va , 1972, Vol. 1, p. 10 A ction research 1. Paper by Dr M. D. Warren, prepared for Symposium on M ethods of Evaluating Public Health Programmes, Kiel, 1967, E UR O 0375, p. 39 2 . Report of WHO Scientific Group on Health Aspects of Family Planning, TRS 442, 1970, p. 39 A ctivity 1 . Planning and Programming for Nursing Services, PHP 44 , 1971 , p. 103 A ctivity studies 1. Planning Terminology, p. 2 396 Acute (disease, illness) 1. Estimation of Hospital Bed Requirements: R e port on a Symposium, Copenhagen, 1965, EURO 295, pp. 4-5 2. National Library of Medicine (USA), MeSH Scope Notes, 1972-1973. Addiction-producing drug 1. 2nd Report of WHO Expert Committee on Addiction-Producing Drugs, TRS 21, 1950, p . 7 Adequacy 1. "Classification and Working Definition of Health Services Functions and Terminology", Appendix to Resolutions of WHO Executive Board, 51st Session, 1973, Official Records of WHO, No. 206, p. 114 2. Planning and Evaluating Dental Health Services: Report on a Working Group, Oslo, 1971, EURO 5 505, p. 6 Administration 1. Planning Terminology, p. 2 2 . Introduction to Work Study, ILO, Geneva, 1960, p. 25 3. The Practice of Organisation and Methods, H. M . Treasury, London, 196.5, p. 7 4. Report of WHO Expert Committee on Organization of Local and Intermediate Health Administrations, TRS 499, 197 2, p. 17 5. Modern Management Methods and the Organization of Health Services, PHP 55, 1974, p. 14 6 . Report of European Conference on Nursing Administration, Bad Homburg, 1959, EURO 133, p. xiii 7 . Glossary prepared by Professor M. R. Alderson for Conference on Health Information Systems, Copenhagen, 1973, EURO 4914, p. 38 B. Op. cit. at 5, p. 15 397 Admission (to hospital) 1. Dr M.A. Heasman, Draft Manual of Hospital Morbidity Statistics. Definition used by OMC / EURO 2. Estimation of Hospital Bed Requirements: Report on a Symposium, Copenhagen, 1965, EURO 295, p. 4 3. Op. cit. at 2, p. 32 Adverse reaction 1. Report of WHO Meeting on International Drug Monitoring: the Role of National Centres, TRS 498, 1972, p. 9 2. Report of WHO Meeting on International Drug Monitoring: the Role of the Hospital, TRS 425, 1969, p. 6 Air pollution 1. 5th Report (on Air Pollution) of WHO Expert Committee on Environ- mental Sanitation, TRS 157, 1958, pp. 3-4 Alcoholism 1. 1st Report of Alcoholism Subcommittee of WHO Expert Committee on Mental Health, TRS 42, 1951, p. 5 2. 2nd Report of Alcoholism Subcommittee of WHO Expert Committee on Mental Health, TRS 48, 1 952, p. 16 3. Unpublished WHO document, DRD/ SEM 7 2. 14, pp . 1 -3 Allocation 1. Professor M. Schaefer, "Concepts and Issues of Programme Evalua- tion in Environmental Health": paper prepared for WHO Scientific Group on Evaluation of Environmental Health Programmes, 1972, DIS/WP/72. 2, p. 47 Ambulatory care 1. National Library of Medicine (USA), Me SH Scope Notes, 1972-1973 398 Appropriateness 1. "Classification and Working Definition of Health Services Functions and Terminology", Appendix to Resolutions of WHO Executive Board, 51 st Session, 197 3, Official Records of WHO, No. 206, p. 114 2. Planning and Evaluating Dental Health Services: Report on a Work- ing Group, Oslo, 1971, EURO 5505, p. 6 Audiology 1. 2nd Report of WHO Expert Committee on Medical Rehabilitation, TRS 419, 1969, p. 8. The wording is taken from the Speech Therapists and Audiologists Act, 1964, of the Province of Quebec. Automation 1. Based on definitions in 5th Report (on Planning and Organization of a Health Laboratory Service) of WHO Expert Committee on Health Laboratory Services, TRS 491, 1972, p. 27 Auxiliary nursing personnel 1. 1st Report of WHO Expert Committee on Nursing, TRS 24, 1950, p. 5; Report of European Conference on Nursing Administration, Bad Homburg, 1959, EURO 133, p. xv; 9th Report of WHO Expert Committee on Professional and Technical Education of Medical and Auxiliary Personnel, TRS 212, 1961, p. 4. Similar definition of nursing auxiliary in Planning and Programming for Nursing Services, PHP 44, 1971, p. 105 2. International Digest of Health Legislation, WHO, Geneva, 17, 1966, p. 197 ff . Introduction reproduced, with minor modifications, in WHO Chronicle, 20, 1966, pp. 344-348; passage quoted, p. 344 Auxiliary p ersonnel 1. Official Records of WHO, No . 127, 1963, p. 184 2. 3rd Report of WHO Expert Committee on Professional and Technical Educati on of Medical and Auxiliary Personnel, TRS 109, 1956, p.4; 9th Report of the same committee, TRS 212, 1961, p. 4; Report of WHO Expert Committee on the Midwife in Maternity Care, TRS 331, 1966, p. 14; 5th Report of WHO Expert Committee on Maternal and Child Health, TRS 428, 1969, p. 29; Report of WHO Study Group on Implications of Individual and Small Group Learning Systems in Medical Education, TRS 489, 1972, p. 6 399 Auxiliary personnel (contd) 3. 5th Report of WHO Expert Committee on Maternal and Child Health, cit. at 2 4. 17th Report (on Training of Medical Assistants and Similar Personnel) of WHO Expert Committee on Professional and Technical Education of Medical and Auxiliary Personnel, TRS _385, 1968, p. 7 5. Medical, Dental and Pharmaceutical Auxiliarie s: a Survey of Exist- ing Legislation, WHO, Geneva, 1968; condensed version of intro- ductory s ection in WHO Chronicle, 22, 1 968, pp. 500- 506 6 . Report of Con sultation on Classification of Auxiliary Health Personnel, Geneva, 197 2, WHO / EDUC/7 2. 154, pp. 5-6 7. E .g. 10th Report of WHO Expert Committee on Mental Health, TRS 223, 1961, p. 25 Average 1. Demographic Dictionary, pp. 8 -9 Bacteriology 1. 1st Report (on the Public Health Laboratory Service) of WHO Expert Committee on Health Laboratory Methods, TRS 128, 1957, p. 5 Baseline (data, etc. ) 1. Based on Professor M. Schaefer, "Concepts and Issues of Programme Evaluation in Environmental Health": paper presented to WHO Scientific Group on Evaluation of Environmental Health Programmes, 1972, DIS/WP/72.2, p. 47 Basic medical sciences 1. The Undergraduate Teaching of the Basic Medical Sciences: Report on a Technical Meeting, Copenhagen, 1967, EURO 0385, pp. 2-3 Bed, hospital 1. 5th Report of WHO Expert Committee on Health Statistics, TRS 261, 1963, p. 12 400 Bed, hospital ( contd) 2. Estimates of Hospital Bed Requirements: Report on a Symposium, Copenhagen, 197 3, EURO 295, p. 3 3. Op. cit. at 2, p. 34 4. Op. cit. at 2, p . 33 5. R. Llewelyn-Davies and H. M. C. Macaulay, Hospital Planning and Administration, WHO Monograph No. 54, 1966, p. 29 Behavioural sciences 1. 2nd Report of WHO Expert Committee on Professional and Technical Education of Medical and Auxiliary Personnel, TRS 69, 1953, p. 25 2. Report of WHO Interregional Conference of Directors of Schools of Public Health, TRS 351, 1967, p. 10 Beneficiary 1, Paper prepared by Secretariat for Joint ECE/WHO Meeting on Health Statistics, Geneva, 1971, EURO 4913/2. Also in paper on "Vital and Health Statistics within the Context of Social Security" prepared by ILO, Geneva, for 2nd International Conference of National Com- mittees on Vital and Health Statistics, Copenhagen, 197 3, DHSS/C/7 3. 32, p. 6 Birth rate 1. Demographic Dictionary, p. 39 2. UN Handbook of Vital Statistics Methods, Geneva, 1955 Budget 1. UN Consultative Committee on Administrative Questions, Glossary of Financial and Budgetary Terms, 1970, p. 6 Budgetary control 1. Introduction to Work Study, ILO, Geneva, 1960, p. 333 401 Capital expenditure 1. Planning Terminology, p. 3 Capitation 1. See M. I. Roemer, The Organisation of Medical Care under Social Security, ILO, Geneva, 1969, p. 28 Case-finding 1. J.M. G. Wilson and G. Jungner, Principles and Practice of Screening for Disease, FHP 34, 1968, p. 12; Report of WHO Expert Committee on Early Detection of Cancer, TRS 422, 1969, p. 7 Centralization 1. R eport of WHO Expert Committee on Organization of Local and Intermediate Health Administrations, TRS 499, 1972, p. 6 Chairside assistant 1. Based on Report of WHO Expert Committee on Auxiliary Dental Personnel, TRS 163, 1959, pp. 8-9 Child guidance 1. Seminar on Child Guidance: Summary of Discussions, Brussels, 1960, EURO 103. 2/WP8, pp. 4-6 Child guidance centre 1. Seminar on Child Guidance: Summary of Discussions, Brussels, 1960, EURO 103. 2/WP8, pp. 4-6 Child health doctor 1. The Early Detection and Treatment of Handicapping Defects in Young Children: Report on a Working Group, Copenhagen, 1966, EURO 0332, pp. 7 -8 402 Chronic (disease, illness) 1. The Public Health Aspects of Chronic Disease: Report on a Symposium, Amsterdam, 1956, EURO 111.1, p. 9 2. Estimation of Hospital Bed Requirements: Report on a Symposium, Copenhagen, 1965, EURO 295, pp. 4-5 Cohort 1. Family Planning Glossary, p. 5 Cohort analysis 1. Family Planning Glossary, p. 5 Community 1. "Classification and Working Definition of Health S e rvices Functions and Terminology", Appendix to Resolutions of WHO Executive Board, 51stSession, 1973, Official Records of WHO, No. 206, p . 114 . The quotation is from a working paper prepared for the ACC Working Group on Rural and Community Development, 1968 Community care 1. Psychiatry and Primary Medical Care: Report on a Working Group, Lysebu, 1973, EURO 5427 I, p. 35 Community health 1. The Education of the Public Health Physician in Relation to his Work in the Community: Report on a Symposium, Lisbon, 1966, EURO 337, p . 7 2. Report of WHO Expert Committee on Postgraduate Education and Training in Public Health, TRS 533, 1973, pp . 6- 7 Community medicine I. Report of WHO Conference on Public Health Training of General Practitioners, TRS 149, 1957, p. 6 2. M. I. Roemer, Evaluation of Community Health Centres, PHP 48, I 972, p. 17 403 Community medicine (contd) 3. Doctors in an Integrated Health Service, Report of a Joint Working Party appointed by the Secretary of State for Scotland, 1971. See also Report of Royal Commission on Medical Education, London, 1968, pp. 66-67 4. Report (unpublished) of Working Party of Scottish C ouncil for Post- graduate Medical Education on Basic Education and Training for Community Dentistry, 197 4 Comprehensive medicine 1. 2nd Report of WHO Expert Committee on Professional. and Technical Education of Medical and Auxiliary Personnel, TRS 69, 1953, p. 5 Congenital 1. Methods of Surveillance of Congenital Disorders: Report on a Working Group, Copenhagen, 1967, EURO 0215(4), p. 3 2. Report of WHO Scientific Group on Paediatric Research, TRS 400, 1968, p. 9. Definition adopted by WHO Expert Committee on Pre- vention of Perinatal Mortality and Morbidity; TRS 457, 1970, p. 25 3. Unpublished WHO paper, DSI/72. 7, p. 2 Constraints 1. Planning and Evaluating Dental Services: Report on a Working Group, Oslo, 1971, EURO 5505, p . 7 Consultation 1. 3rd Report of WHO Expert Committee on Nursing, TRS 91, 1954, p. 27 2. Unpublished WHO paper, HS/NAT. COM/31 3. Paper prepared by EURO Secretariat for Joint ECE/WHO Meeting on Health Statistics, Geneva, 1971, EURO 4913/3, p. 34 Consumer research 1. Introduction to Work Study, ILO, Geneva, 1960, p. 333 404 Consumption (of medical care) 1. The Efficiency of Medical Care: Report on a Symposium, Copenhagen, 1966, EURO 294. 2, p. 4 Control 1. Professor M . Schaefer, "Concepts and Issues of Programme Evaluation in Environmental Health": paper prepared for WHO Scientific Group on Evaluation of Environmental Health Programmes, 1972, DIS /WP/72.2, p. 47 2. Unpublished WHO paper, CVD/WP/ 71. 3 Cost-benefit analysis 1 . "Clarification and Working Definition of Health Services Functions and Terminology", Appendix to Resolutions of WHO Executive Board, 51 st Session, 1973, Official Records of WHO, No. 206, p. 115 Cost-effectiveness analysis 1. "Clarification and Working Definition of Health Services Functions and Terminology", Appendix to Resolutions of WHO Executive Board, 51st Session, 1973, Official Records of WHO, No. 206, p . 115 2. Report of European Conference on National Health Planning, Bucharest, 1974, EURO 4107, p. 21 Cost-efficiency 1. Evaluation of MCH Services in Certain Countries of the European Region: Report of a Working Group, Copenhagen, 1973, EURO 51 0 3 ( 2 ) , p . 4 C osting 1. Glossary of Management Techniques, H. M. Stationery Office, London, 1967, p. 4 2. Op. cit. at 1, p. 5 3. Planning Terminology, p. 16 405 Costs 1. Professor M. Schaefer, "Concepts and Issues of Programme Evaluation in Environmental Health": paper prepared for WHO Scientific Group on Evaluation of Environmental Health Programmes, 1972, DIS/WP/72. 2, p. 47 2. All except capital cost and unit cost from Glossary of Management Techniques, H. M. Stationery Office, London, 1967, pp. 5-6 Coverage l. "Clarification and Working Definition of Health Services Functions and Terminology", Appendix to Resolutions of WHO Executive Board, 51stSession, 1973, Official Records of WHO, No. 206, p. 115 Critical path analysis 1. Planning Terminology, p. 11 2. M. Greener, Penguin Dictionary of C ommerce, Harmondsworth, 1973, p. 117 3. A. Chandor, J. Graham and R. Williamson, A Dictionary of Computers, Penguin Books, Harmondsworth, 197 2, p. 95 Cybernetics 1. Glossary of Management Techniques, H . M . Stationery Office, London, 1967, p. 6 Data bank 1. Health Information Systems: Report on a Conference, Copenhagen, 1973, EURO4914, p . 34 Data processing 1. United Nations Statistical Papers, Series M, No. 19, Rev. 1, p. 198 2. Glossary prepared by Professor Alderson for Conference on Health Information Systems, Copenhagen, 1973, EURO 4914, p. 34 3. A. Chandor, J. Graham and R. Williamson, A Dictionary of Com- puters, Penguin Books, Harmondsworth, 1972, pp. 105, 160 406 Day car e 1. Report of Joint UN/ WHO Expert Committee on the Care of Well Children in Day Care Centres and Institutions, TRS 256, 1963, p. 9 Day care centre 1 . Report of Joint UN / WHO Expert Committee on the Care of Well Children in Day Care Centres and Institutions, TRS 256, 1963, p. 9 2. E ncyclopaedia of Occupational Health and Safety, ILO, Geneva, 1972, Vol. 1, p. 366 Day care programme 1. Unpublished WHO paper, 1962, WHO / HS / 133 Day hospital 1. 2nd Report of WHO Expert Committee on Organization of Medical Care, TRS 176, 1959, p. 24 2. 1st Report of WHO Expert Committee on Organization of Medical Care, TRS 122, 1957, p. 22 Day patient 1. Adapted from definition in EURO Questionnaire on Mental Health Resources, EURO0192, 1969 De centralization 1. Report of WHO Expert Committee on Organization of Local and Intermediate Health Administrations, TRS 499, 197 2, p. 6 Deficiency disease 1. Report of WHO Group of Experts on Nutritional Anaemia, TRS 503, 1972, p. 27; Food and Nutrition Terminology, p. 19 Delinquency 1 . Definition suggested by Professor J. Selosse at a EURO Symposium on Major Issues in Juvenile Delinquency, Bratislava, 197 3: Report, EURO 5430 III, p. 3 407 Delphi method 1. Report of European Conference on National Health Planning, Bucharest, 1974, EURO 4107, p. 21 Dental 1. Report (on Organization of Dental Public Health Services) of WHO Expert Committee on Dental Health, TRS 298, 1 965, p. 5 Dental administration 1. Report (on Organization of Dental Public Health Services) of WHO Expert Committee on Dental Health, TRS 298, 1965, p. 6 Dental auxiliary 1. Report of WHO Expert Committee on Auxiliary Dental Personnel, TRS 163, 1959, pp. 4-5. Quoted in Survey of Child Dental Health in Europe: Report on a Study, 197 4, EURO 5501, p. 13 2. Sharon E. Myers, "Operating Dental Auxiliaries", WHO Chronicle, 26, 1972, pp. 511-515 Dental health 1. Report (on Organization of Dental Public Health Services) of WHO Expert Committee on Dental Health, TRS 298, 1965, pp. 4-5 2. Report of WHO Expert Committee on Dental Health Education, TRS 449, 197 0, p. 6 Dental health education 1. Report of WHO Expert Committee on Dental Health Education, TRS 449, 1970, pp. 13-14 2. Report (on Organization of Dental Public Health Services) of WHO Expert Committee on Dental Health, TRS 298, 1965, p. 5 Dental health services I. Report (on Organization of Dental Public Health Services) of WHO Expert Committee on Dental Health, TRS 2 98, I 965, p. 5 408 Dental health services (c ontd) 2. Survey of Child Dental Health in Europe: Report on a Study, 1974, EURO 5501, p. 24 Dental health team 1. Report of WHO Expert C ommittee on Auxiliary Dental Personnel, TRS1 6 3, 1959, p. 5 Dental hygienist 1. Report of Study Group on Dental Health Services for Children, Brussels, 1958, EURO 151 . 1, p. 22 2. Report of WHO Expert Committee on Auxiliary Dental Personnel, TRS 163, 1959, p. 13 Dental laboratory technician 1. D e finition b a sed on R e port of WHO Expert Committee on Auxiliary Dental Personnel, TRS 1 6 3, 1959, pp. 10-11 Dental nurse 1. Report of Study Group on Dental Health Services for Children, Brussels, 1958 , EURO 151. 1, p. 22 2. Report of WHO Expert Committee on Auxiliary Dental Personnel, TRS 163, 1959, pp. 15-16 Dental practice 1. Report of WHO Expert Committee on Auxiliary Dental Personnel, TRS 163, 1959, p. 17 Dentist 1. Report (on Organization of Dental Public Health Services) of WHO Expert Committee on Dental Health, TRS 298, 1968, p. 5 409 Dependence -producing drug 1. Report of WHO Study Group on Youth and Drugs, TRS 516, 1973, pp. 8-9 2. 19th Report of WHO Expert Committee on Drug Dependence, TRS 526, 197 3, pp. 16-17. Also in the Committee's 20th Report, TRS 551, 1 97 4, pp. 14-15 Diet 1. Food and Nutrition Terminology, p. 9 Direct (pattern of providing medical care) 1. Report of Joint !LO/ WHO Expert Committee on Personal Health Care and Social Security, TRS 48 0, 1 971, p. 26. See also M. I. Roemer, The Organisation of Medical Care under Social Security, ILO, Geneva, 1969, p. 27; and a paper on "Vital and Health Statistics within the Context of Social Security" prepared by ILO, Geneva, for 2nd International Conference of National Commit- tees on Vital and Health Statistics, Copenhagen, 1973, DHSS/C/7 3. 32, p. 2 Disability 1. 2nd Report of WHO Expert Committee on Medical Rehabilitation, TRS 419, 1969, p. 7. Also in TRS 469, 1971, pp. 54 and 55 2. M. Jefferys and others, Journal of Chronic Diseases, Vol. 22, 1969 3. This sequence is suggested by Dr P.H. N. Wood in his Preliminary Draft Proposals for H. Code for Handicaps, prepared under the aegis of ICD/WHO, Geneva, May 197 4. Disabled person 1 . Glossary of Special Education, prepared by UNESCO 's International Bureau of Education. 2. 2nd Report of WHO Expert Committee on Medical Rehabilitation, TRS 419, 1969, p. 7 410 • Disabling illness 1 . Paper prepared by WHO Secretariat for Joint ECE/WHO Meeting on Health Statis t ics, G eneva, 1971, EURO 4913/2, p . 4 Di s charg e (from hospital) 1. Estimation of Hospital Bed Requirements: Report on a Symposium, Cop enhagen , 1 965, E URO 295, p. 4 2 . Re port on Hospital Inpatient Enquiry 1956-57, Ministry of Health, London, 1 961 Di sinsec tion 1. 11th Re por t of WHO Expert Committee on Insecticides, TRS 206 , 1 961, p. 15 Dis p ensary 1 . 2. 3. 2nd Report (on the Role of Hospita ls in Ambulator y and Domici li ary Medic a l C a re) of WHO Expert Committee on Or ganization of Medica l Ca r e, TRS 17 6 , 1959, p . 17 Op. cit. at 1, pp. 19-20; Training of the Physician for Fami ly Practice: 11th Report of WHO E xpert Committee on Professiona l a nd T e chnical Education of Medical and Auxiliary P e rsonne l, TRS257, 1 963 , p. 20 M . I. Roemer, Evaluation of Community Health Centres , FHP 48, 197 2, p. 11 District physician 1. Psychiatry and Primary Me dical Care: Report on a Working Group, Lysebu, 1973, EURO 5427 I, p. 32 Double - blind tri a l 1. Report of WHO Scientific Group on Principles for the Clinical Evaluation of Drugs, TRS 403, 1968, p. 24 Drug 1. Unpublished WHO paper, DMO / RDM / 72. 23 411 Drug (contd) 2 . First proposed in Report of WHO Scientific Group on Principles for Pre-Clinical Testing of Drug Safety, TRS 341, 1966, p . 7. Also adopted in Report of WHO Meeting on International Drug Monitoring: the Role of the Hospital, TRS 425, 1969, p. 6; Report of WHO Scientific Group on Principles for the Testing and Evaluation of Drugs for Carcinogenicity, TRS 426, 1969, p. 6; and Report of WHO Meeting on International Drug Monitoring: the Role of National Centres, TRS 498, 1972, p. 9 3. WHO, Pharmacopoeia Internationalis, 2nd edition, 1971; Report of • WHO Study Group on Use of Specifications for Pharmaceutical Pre- parations, TRS 138, 1957, p. 14; Report of WHO European Technical Meeting on Quality Control of Pharmaceutical Preparations, TRS 249, 1962, p . 4; 22nd Report of WHO Expert Committee on Specifications for Pharmaceutical Preparations, TRS 418, 1969, p. 18 4 . Report of WHO European Technical Meeting on Quality Control of Pharmaceutical Preparations, TRS 249, 1962, p. 4 5. Report of WHO Study Group on Use of Specifications for Pharma- ceutical Preparations, TRS 138, 1957, p. 14; Report of WHO European Technical Meeting . on Quality Control of Pharmaceutical Preparations, TRS 249, 1962, p. 4; Consumption of Drugs: Report on a Symposium, Oslo, 1969, EURO 3102, p. 7 6. Consumption of Drugs: Report on a Symposium, Oslo, 1969, EURO 3102, p. 8 7. 16th Report of WHO Expert Committee on Drug Dependence, TRS 407, 1969, p. 6; 20th Report of the Committee, TRS 551, 1974, p. 14. Also adopted in Report of WHO Study Group on Youth and Drugs, TRS 516, 1973, p. 8 8. Terminology and Criteria of Drug Dependence: Report on a Study by G. Edwards and D. Hawks, 1973, EURO 5422 IV, pp. 8-9 Drug abuse 1. 14th Report of WHO Expert Committee on Dependence-Producing Drugs, TRS 312, 1965, p. 7 2 . 16th Report of WHO Expert Committee on Drug Dependence, TRS 407, 1969, p. 6 3. Terminology and Criteria of Drug Dependence: Report on a Study by G. Edwards and D. Hawks, 1973, EURO 5422 IV, pp. 10-11 412 • Drug addiction 1. 2nd Report of WHO Expert Committee on Addiction-Producing Drugs, TRS 21, 1950, pp. 6-7 2. 3rd Report of WHO Expert Committee on Addiction-Producing Drugs, TRS 57, 1952, p. 9 3. 7th Report of WHO Expoert Committee on Addiction-Producing Drugs, TRS 116, 1957, p. 9 4. 13th Report of WHO Expert Committee on Addiction-Producing Drugs, TRS 273, 1964, p. 9 5. See Dr M. M. Glatt, WHO Chronicle , 21, 1967, p. 294 Drug control 1. 19th Report of WHO Expert Committee on Drug Dependence, TRS 526, 197 3, p. 16 Drug dependence 1. 13th Report of WHO Expert Committee on Addiction-Producing Drugs, TRS 273, 1964, p . 9 2. Report of WHO Scientific Group on Evaluation of Dependence - Producing Drugs, TRS 287, 1964, p. 4 3. 16th Report of WHO Expert Committee on Drug Dependence, TRS 407, 1969, p. 6; 20th Report of the Committee, TRS 551, 1974, p. 14 4. 19th Report of WHO Expert Committee on Drug Dependence, TRS 526 , 1973, p. 16; 20th Report of the Committee, TRS 551, 1974, p. 14 5. N . B. Eddy, H. Halbach, H. Isbell and M . H. Seevers, WHO Bulletin, 32, 1965, p. 723 6. See Dr M. M. Glatt, WHO Chronicle, 21, 1967, p. 294 Drug habituation 1. 7th Report of WHO Expert Committee on Addiction-Producing Drugs, TRS 116, 1957, pp. 9-10 2. 13th Report of WHO Expert Committee on Addiction-Producing Drugs, TRS 273, 1964, p . 9 413 Drug habituation (contd ) 3. SeeDrM.M. Glatt, WHO Chronicle, 21, 1967, p . 294 Drug monitoring 1 . Report of WHO Meeting on International Drug Monitoring: the Role of the Hospital, TRS 425, l 969, p. 6 2. Report of WHO Me e ting on International Drug Monitoring: the Role of National Centres, TRS 498, l 97 2, p. 9 Early disease detection 1. J . M. G. Wilson and G . Jungner, Principles and Practice of Screening for Disease, FHP 34, 1968 , p. 12; Report of WHO Expert Committee on Early Detection of C a ncer, TRS 422, 1969, p . 6 Economic 1. Planning Terminology, p. 4 Effect 1. Professor M. Schaefer, "Concepts and Issues of Programme Evaluation in Environmental Health": paper prepared for WHO Scientific Group on Evaluation of Environme ntal Health Programmes, 1972, DHS/WP/72 . 2, p . 48 Effectiveness/ efficacy / efficiency 1. 14th Report of WHO E xpert Committee on Health Statistics, TRS 472, 1 971 , p . 11 2. "Classification and Working Definition of Health Services Functions and Terminology", Appendix to Resolutions of WHO Executive Board, 51st Session, 1973, Official Records of WHO, No. 206, p.114 3. Planning Terminology, p. 5 4. Planning and Programming for Nursing Serv i ce s , FHP 44 , 19 71 , p. l 04 414 Effe cti vene s s /efficacy/efficiency (c ont d ) 5 . The Efficiency of Medical Care: Report on a Symposium, Copenhagen, 1966, EURO 294. 2, pp. 4, 33-38; Methods of E valua ting Public Health Programmes: Report on a Symposium, Kiel, 1967, EURO 0375, p. 34; Planning and Evaluating Dental Health Service s: Report on a Working Group, Oslo, 1971, EURO 5505, p. 6: Health Planning in National Development: Report on a Working Group, Stockholm, 1972, EURO 4104, p. 3; The Efficiency of Medical Care: Report on a Symposium, Brussels, 1972, EURO 4308, p. 3; Professor M. Schaefer, "Concepts and Issues of Programme Evaluation in Environmental Health": paper prepared for WHO Scientific Group on Evaluation of Environmental Health Programmes, 1972, DIS/WP/72. 2, p. 48; Evaluation of MCH Services in Certain Countries of the European Region: Report on a Working Group, Copenhagen, 197 3, EURO 5103(2), p. 4; Health Information Systems: Report on a Conference, Copenhagen, 1973, EURO 4914, p. 35 Emergency call service 1. Psychiatry and Primary Medical Car e : Report on a Working Gr oup , Lysebu, 1973, EURO 5427 I, p. 33 Environmental health 1. Professor M. Schaefer, "Concepts and Issues of Programme Evaluation in Environmental Health": paper presented to WHO Scientific Group on Evaluation of Environmental Health Programmes, 1972, DIS/WP/72.2, p. 48 2. Report of WHO Expert Committee on Development of Environmental Health Criteria for Urban Planning, TRS 511, 1972, p. 6 3. Report of WHO Expert Committee on National Environmental Health Programmes, TRS 439, 1970, pp. 10-11 4. 1st Report of WHO Expert Committee on Environmental Sanitation, TRS 10, 1950, p. 5. Quoted in a number of later reports 5. 2nd Report of WHO Expert Committee on Environmental Sanitation, TRS47, 1952, p . 4 6. Op. cit . at 4, p. 6; op. cit. at 5, pp. 4-5 415 Epidemiological surveillance 1. J. M, G. Wilson and G. Jungner, Principles and Practice of Screening for Disease, PHP 34, 1968, p. 12 2. A. D. Langmuir, New England Journal of Medicine, 269, 1963, pp. 182-192 3. Seminar on Methods of Surveillance of Communicable Diseases, The Hague, 1969, EURO 3872, pp. 2-3 Epidemiological survey 1. Definition based on J.M. G. Wilson and G. Jungner, Principles and Practice of Screening for Disease, PHP 34, 1968, p. 12, and Report of WHO Expert Committee on Early Detection of Cancer, TRS 422, 1969, p. 8 Epidemiology 1. 2. 3. 4. 5 . 6. C.R. Lowe and J. Kostrzewski (eds), Epidemiology: a Guide to Teaching Methods, London and New York, 1974 The Application of Epidemiology to the Planning and Evaluation of Health Services: Report on a Working Group, Copenhagen, 1973, EURO 4905(6), p. 3 The Teaching of Epidemiology in Medicine and Public Health: Report on a Symposium, Brussels, 1967, EURO 0393, p. 2 8th Report (on Epidemiology of Mental Disorders) of WHO Expert Committee on Mental Health, TRS 185, 1960, pp. 4-5 Op. cit. at 3, p. 3 See The Education of the Public Health Physician in Relation to his Work in the Community: Report on a Symposium, Lisbon, 1966, EURO 337, p. 17 Ergonomics 1. Glossary of Work Study Terms, European Productivity Agency of OEEC, 1958 2. W. T. Singleton, Introduction to Ergonomics, WHO, Geneva, 197 2, p. 9 3. F. N. Dukes-Dobos, in Lectures delivered at Training Course on Occupational Health in Agriculture, Dundee, 1 968, OH/7 0. 1, p. 24 416 Evaluation 1. E.g. 2nd Report of WHO Expert Committee on Maternal and Child Health, TRS 115, 1957, p. 19 ; Report of Joint FAO/WHO Te chnical Meeting on Methods of Planning and Evaluation in Applied Nutrition Programs, TRS 340, 1966, pp. 15-16; Report of WHO Expert Committee on Planning and Evaluation of Health Education Services, TRS409, 1969, p. 27; unpublished WHO paper, DHSS/WP/70.7; Professor M. Schaefer, "Concepts and Issues of Programme Evalu- ation in Environmental Health": paper prepared for WHO Scientific Group on Evaluation of Environmental Health Programmes, 197 2, DIS/WP/72. 2, p. 48; Report of WHO Study Group on Education and Training for Family Planning in Health Services, TRS 508, 197 2, p. 19; The Evaluation of Public Health Programme s: Report on a Working Group, Burgas, 1972, EURO 4004, p. 3; The Efficiency of Medical Care: Report on a Symposium, Brussels, 1972, EURO 4308, p. 3; Report of WHO Expert Committee on Organization of Local and Intermediate Health Administrations, TRS 499, 1972, pp. 6-7; Evaluation of MCH Services in Certain Countries of the Europea n Region: Report on a Working Group, Copenhagen, 197 3, EURO 5103(2 ), p. 2; Glossary prepared by Professor M. R . Alderson for Conference on Health Information Systems, Copenhagen, 1973, EURO 4914, p. 36; Food and Nutrition Terminology, p . 36; Report of European Conference on National Health Planning, Bucharest, 197 4, EURO 4107, pp. 24-25; Evaluation of Dental Health Services, 1974, EURO 5504, pp. 1-2 2. "Clarification and Working Definition of Health Services Functions and Terminology", Appendix to Resolutions of WHO Executive Board, 51st Session, 1973, Official Records of WHO, No. 206, p. 114 3. Schaefer, op. cit. at 1, p. 5 4. Schaefer, op. cit. at 1, pp. 16-17 5. Dr M. D. Warren, paper prepared for Symposium on Methods of Evaluating Public Health Programmes, Kiel, 1967, EURO 037 5, p . 35 Family 1. Unpublished WHO paper, DSI/SAF/71. 3 2 . Demographic Dictionary, pp. 4-5. Also in Family Planning Glossary, p. 7 3. Family Planning Glossary, p. 7 417 Family planning 1. Report of WHO Scientific Group on Health A spects of Family Planning, TRS 442, 1970, p. 9 2. Unpublished WHO paper, HE / WP / 70. 2. Compare a similarly wide definition in Report of WHO Scientific Group on Human Development and Public Health, TRS 485, 1972, p. 19 3. Demographic Dictionary, p. 1 9 4. Op. cit. at 3, p . 38 Feedback 1. Professor M. Schaefer, "Concepts and Issues of Programme Evaluation in Environmental Health": paper prepared for WHO Scientific Group on Evaluation of Environmental Health Programmes, 1972, DIS / WP/72.2, p. 48 2. A. Chandor, J. Graham and R. Williamson, A Dictionary of Computers, Penguin Books, Harmondsworth, 1972, p. 159 Fee-for-service 1. See M. I. Roemer, The Organisation of Medical Care under Social Security, ILO, Geneva, 1969, p. 28 Fertility 1. Demographic Dictionary, p. 38 2. TRS 435, 1969, Annex, pp. 40-41 Fertility rate 1. Family Planning Glossary, pp. 8-9 Fetal death 1. Official Records of WHO, No. 28, 1950, p. 17; 2nd Report of WHO Expert Committee on Health Statistics, TRS 25, 1950, pp. 4, 12 2. 2nd Report of WHO Expert Committee on Health Statistics, TRS 25, 1950, p. 13 418 Fetal death (contd) 3. Report of WHO Expert Committee on Prevention of Perinatal Mortality and Morbidity, TRS 457, 1970, p. 54 4. Family Planning Glossary, p. 9 5. Official Records of WHO, No. 28, 1950, p. 17; 2nd Report of WHO Expert Committee on Health Statistics, TRS 25, 1950, pp. 4, 14 6. Family Planning Glossary, p. 12 Field trial 1. Report of WHO Expert Committee on Schistosomiasis Control, TRS 515, 1973, p. 7 Food 1. 4th Report (on Food Hygiene) of WHO Expert Committee on Environ- mental Hygiene, TRS 104, 1956, p. 5 2. Food and Nutrition Terminology, p. 10 Food additive 1. Food and Nutrition Terminology, p. 44 Food-borne disease 1. Report of European Technical Conference on Food-Borne Infections and Intoxications, TRS 184, 1959, p. 4 Food J::iandling 1. Food and Nutrition Terminology, p. 43 2. 4th Report (on Food Hygiene) of WHO Expert Committee on Environ- mental Hygiene, TRS 104, 1956, p. 5 Food hygiene 1 . Food and Nutrition Terminology, p. 44 419 Food hygiene (c ontd) 2. 4th Report (on Food Hygiene) of WHO Expert Committee on Environ- mental Hygiene, TRS 104, 1956, p. 5 Food poisoning 2. Food and Nutrition Terminology, p . 28 1st Report of Joint FAO / WHO Expert Committee on Meat Hygiene, TRS 99, 1955, p. 7; 4th Report (on Food Hygiene) of WHO Expert Committee on Environmental Hygiene, TRS 104, 1956, p. 5; Report of WHO European Technical Conference on Food-Borne Infections and Intoxications, TRS 184, 1959, p. 5 Food sanitation 1. Food and Nutrition Terminology, p. 44 Food standards 1. Food and Nutrition Terminology, p . 44 Function 1. Planning and Programming for Nursing Ser vices, FHP 44, 1971, p. 104 General practitioner 1. Report of WHO Expert Committee on General Practice, TRS 267, 1964, p. 4. Other definitions on similar lines: Report of Conference on Public Health Training of General Practitioners, TRS 140, 1957, p. 3; 11th Report of WHO Expert Committee on Professional and Technical Education of Medical and Auxiliary Personnel, TRS 257, 1963, p. 6 2. Psychiatry and Primary Medical Care: Report on a Working Group, Lysebu, 197 3, EURO 5427 I, p. 32 3. op·. cit. at 2, p. 3 4. WHO Expert Committee on Planning of Medical Education Programmes TRS 547, 197 4, p. 10 (with references to 11th Report of WHO Expert Committee cit. at 1) 420 Geriatric home 1. Unpublished WHO paper, HS / 133, 1962 Geriatrics 1. Report of WHO Expert Committee on Planning and Organization of Geriatric Services, TRS 548, 1974, pp. 11 -12 Gross national produc t 1. Planning Terminology, p. 7 Group practice 1. The Role of the Primary Physician in Health Services: Report on a Conference, Noordwijk-aan-Zee, 1970, EURO 0380, p. 5. The definition was accepted by a EURO Working Group on Trends in the Development of Primary Care, Moscow, 197 3, EURO 4309, ·p. 3 2. Report of WHO Expert Committee on General Practice, TRS 267, 1964, p. 9 Habit-forming drug 1. 2nd Report of WHO Expert Committee on Addiction-Producing Drugs, TRS21, 1950, pp. 6-7 2. 3rd Report of WHO Expert Committee on Addiction-Producing Drugs, TRS 57, 1952, p. 9 3. 7th Report of WHO Expert Committee on Addiction-Producing Drugs, TRS 1 J 6, 1 957, pp. 12-15 Half-way house 1. Report of WHO Meeting on Cerebrovascular Diseases, TRS 469, 1971, p. 55 Health 1 . Constitution of the World Health Organization: Basic Documents, 15th edition, 1 961 421 Health care 1. Higher Education in Nursing: Report on a Symposium, The Hague, 1972, EUR O 4408, p. 4 2. Report of WHO Expert Committee on Organization of Local and Intermedia te Health Admini strations, TRS 499, 1972, p. 6; Glossary pr e par ed by Professor M. R. A lder son for Conference on Health Information Systems, Copenhagen, 197 3, EURO 4914, p. 33 Health centre 1. M. I. Roemer, Evalu ation of Community Health Centres, PHP 48, 197 2, p. 11 2. 16th Report (on the Use of Health Service Facilities in Medical Education) of WHO Expert Committee on Professional and Technical Education of Medical and Auxiliary Personnel, TRS 355, 1 966, p. 16 3. Psychiatry and Primary Medical Care: Re port on a Working Group, Lysebu, 197 3, EURO 5427 I, p. 33 4. The Role of the Primary Physician in Health Services: Report on a Conference, Noordwijk-aan-Zee, 1970, EURO 0380, p. 5 5. P. Backer, N. H. Fisek, J. H. Grant and E. Aujaleu, Future Organisati on of Medica l Practice in E urope, Council of Europe, Strasbourg, 1973, p. 13 6. Trends in the Development of Primary Care : Report on a Working Group, Moscow, 1973, EURO 4309, p. 3 Health education 1. Report of WHO Scientific Group on Research in Health Education, TRS 432, 1969, pp. 5- 6 2. Report of WHO Expert Committee on Planning and Evaluation of Health Education Services, TRS 409, 1969, p. 8 Health information system 1. Information on Health and Medical Services: Report on 3rd European Conference on Health Statistics, Turin, 1971, EURO 4910, p. 2 2. Report on European Conference on National Health Planning, Bucha rest, 1974, EURO 4107, pp. 15-16 422 Health information system (c ontd) 3. Health Information Systems: Report on a Conference, Copenhagen , 197 3, EURO 4914, p. 2 Health infrastructure 1. 9th Report of WHO Expert Committee on Malaria, TRS 243, 1962, p. 5 Health insurance 1. Definition based on unpublished WHO paper, CHS/WP/70. 2 Health laboratory service 1. 3rd Report of WHO Expert Committee on Health Laboratory Services, TRS 236, 1962, p. 5 Health manpower 1. Report of WHO Scientific Group on Development of Studies in Health Manpower, TRS 481, 1971, pp. 9-10 Health manpower planning 1. Report of WHO Scientific Group on Development of Studies in Health Manpower, TRS 481, 1971, p. 10 Health planning 1. H. E. Hilleboe and M. Schaefer, "Planning for Community Health by Problem Areas", unpublished WHO paper NHP/INF /66 . 1, 1966; quoted in Planning and Programming for Nursing Services, FHP 44, 1971, p. 15 2. Report of WHO Expert Committee on Training in National Health Planning, TRS 456, 1970, p. 8 3. Planning Terminology, p. 13 4. Report of European Conference on National Health Planning, Bucharest, 197 4, EURO 4107, p. 11 423 Health practice 1. F. Grundy and W. A. Reinke, Health Practice Research, PHP 51, 197 3, p. 15 Health practice research 1 . Report of Consultation on Health Practice Research, Geneva, 1968, unpublished WHO paper OMC /6 9. 1, p. 5 . Quoted in Planning and Programming for Nursing Services, PHP 44, 1971, p. 21 2. F. Grundy and W. A. Reinke, Health Practice Research, PHP 51, 1973, p. 15 Health profile 1. Report of WHO Expert Committee on Planning of Medical Education Programmes, TRS 547, 1974, p. 6 Health protection 1. 2nd Report of WHO Expert Committee on Public Health Administration, TRS 83, 1954, p. 4 Health services 1. Planning Terminology, p . 7 2. Report of WHO Study Group on Integration of Mass Campaigns against Specific Diseases into General Health Services, TRS 294, 1965, p. 5 3. Planning and Programming for Nursing Services, PHP 44, 1971, p. 103. Similar definition in WHO paper on "Basic Health Services", WHO / PHA /6 9. 39, p. 2 Health service system 1 . Report of WHO Scientific Group on Development of Studies in Health Manpower, TRS 481, 1971, p . 8 Health status 1 . Cf. 7th Report of WHO Expert Committee on Health Statistics, TRS 218, 1961, p. 4 424 Health survey 1 . Health Information Systems: Report on a Conference, Copenhagen, 197 3, EURO 4914, p. 37 2. 7th Report of WHO Expert Committee on Health Statistics, TRS 218, 1961, p. 4 Home care 1. Unpublished WHO paper, WHO/HS/133, 1962 Hospital 1. 2. 3 . 4. 1st Report of WHO Expert Committee on Organization of Medical Care, TRS 122, 1957, p. 4 Op. cit. at 1, p. 17 8th Report of WHO Expert Committee on Health Statistics, TRS 261, 1963, p. 10 . Defintion adopted in Estimation of Hospital Bed Requirements: Report on a Symposium, Copenhagen, 1965, EURO 295, p. 2. Also in paper on "Health Statistics" prepared by EURO Secretariat for Joint ECE/WHO Meeting on Health Statistics, EURO 4913/2, p. 5. On the distinction between general and specialized hospitals, cf. R. Llewelyn-Davies and H. M. C . Macaulay, Hospital Planning and Administration, WHO Monograph No. 54, 1966, p. 19 Report of WHO Expert Committee on Hospital Administration, TRS 395, 1968 Incidence 1 . This definition and the subsequent notes are taken from an article on "Prevalence and Incidence" in the WHO Bulletin, 35, 1966, Index pp. 783-784, summarizing the recommendations in the 6th Report of the WHO Expert Committee on Health Statistics, TRS 164, 1959. The definition is reproduced in the Food and Nutrition Terminology, p. 19 1. Demographic Dictionary, p. 8 2. The Efficiency of Medical Care: Report on a Symposium, Copenhagen, 1966, EURO 294. 2, p. 12 425 Index (contd) 3. 3rd Report (on Local Health Service) of WHO Expert Committee on Public Health Administration, TRS 194, 1960, p. 24 Infant mortality 1. Demographic Dictionary, p. 27 2. Report of WHO Expert Committee on Prevention of Perinatal Mortality and Morbidity, TRS 457, 1 97 0, p. 56 3. Unpublished WHO paper, DSI/72.1 4. Manual of the International Statistical Classification of Diseases, Injuries and Causes of Death, 1965 revision, Vol 1, Geneva, 1967, p. xxvii 5. Op. cit. at 2, p. 55 In -patient 1. 8th Report of WHO Expert Committee on Health Statistics, TRS 261, 1963, p. 15 2. Adapted from definition in EURO Questionnaire on Mental Health Resources, EURO 0192, 1 969 1 . Planning Terminology, p. 9 2. Planning and Programming for Nursing Services, FHP 44, 1971, p. 104 Insured person 1. Definitions based on a paper prepared by Secretariat for Joint ECE / WHO Meeting on Health Statistics, Geneva, 1971, EURO 4913/2 . Also in a paper on "Vital and Health Statistics within the Context of Social Security" prepared by ILO, Geneva, for 2nd International Conference of National Committees on Vital and Health Statistics, Copenhagen, 1973, DHSS / C / 73 . 32, p. 5 426 Integration 1. "Classification and Working Definition of Health Services Functions and Terminology", Appendix to Resolutions of WHO Executive Board, 51st Session, 1973, Official Records of WHO, No. 206, p. 115 2. Report of WHO Study Group on Integration of Mass Campaigns again st Specific Diseases into General Health Services, TRS 294, 1965, p. 5 3. 2nd Report of WHO Expert Committee on Public Health Administra- tion, TRS 83, 1954, p. 4 Intensive care 1. Nursing in Intensive Care: Report on a Seminar, Copenhagen, 1969, EURO 0409, p . 34 (Annex I, by Dr E. Sherwood Jones); definition, p. 83 Intensive care unit 1. Nursing in Intensive Care: Report on a Seminar, Copenhagen, 1969, EURO 0409, pp. 83-84 Intermediate area 1. Report of WHO Expert Committee on Organization of Local and Intermediate Health Administrations, TRS 499, 1972, p. 7. Also in Health Information Systems: Report on a Conference, Copenhagen, 1973, EURO4914, p . 38 Intermediate health administration 1. Report of WHO Expert Committee on Organization of Local and Intermediate Health Administrations, TRS 499, 1972, p. 7. Also in Health Information Systems: Report on a Conference, Copenhagen, 197 3, EURO 4914, p. 38 Invalidity 1. Dr P.H . N. Wood, Preliminary Draft Proposals for H Code for Handicaps, prepared under the aegis of ICD/WHO, Geneva. 2. 2nd Report of WHO Expert Committee on Medical Rehabilitation, TRS 419, 1969, p. 7 427 Job 1. H. A. Goddard, Principles of Administration applied to Nursing Service, WHO Monograph No . 41, 1958, p. 45 Job analysis 1. Nursing in Intensive Care: Report on a Seminar, Copenhagen, 1969, EURO 0409, p. 8 4. The definition is quoted from 0. Tead and H. C. Metcalfe, Personnel A dministration, New York, 1920 2. Nursing in Intensive Care, cit. at 1, p. 84; definition quoted from J. Pantall and R. Cond, "The use of job descriptions in hospital management", Nursing Times, 64, 1968, No. 28 (Occasional Papers, pp. 105-108) 3. Nursing m Intensive Care, cit. at 1, p. 84 4. Nursing in Intensive Ca r e, cit. at 1, p. 84; defintion quoted from H. A. Goddard, Principle s of Administration applied to Nursing Servic e , WHO Monograph No. 41, 1958 Linear programming 1. Planning Terminology, p. 11 2. Planning and Programming for Nursing Services, PHP 44, 1971, p. 104 Line rel a tionships 1. L. Urwick, Elements of Administration, London, 1947; quoted in 3rd Report of WHO Expert Committee on Nursing, TRS 91, 1954, pp . 17 -18 Live birth 1. Definition recommended in 2nd Report of WHO Expert Committee on Health Statistics, TRS 25, 1950, p. 12, and adopted by 3rd World Health Assembly, 1950. The definition is given in the Manual of the International Statistical Classification of Diseases, Injuries and Causes of Death, 1965 revision, Vol. 1, 1967, p. 469 2. Report of WHO Expe rt Committee on Prevention of Perinatal Mortality and Morbidity, TRS 457, 197 0, p. 54 428 Local health area 1 . Report of WHO Expert Committee on Organization of Local and Intermediate Health Administrations, TRS 499, 1972, p. 7. Also in Health Information Systems: Report on a Conference, Copenhage n, 1973, EURO 4914, p. 38 Local health unit 1. 3rd Report of WHO Expert Committee on Nursing, TRS 91, 1954, p. 27 Long-term care 1. Education and Training in Long-Term and Geriatric C a re: Report on Working Group, Florence, 1970, EURO 5301, p. 2 Management accounting 1. Glossary of Manageme nt Techniques, H. M. Stationery Office, London, 1 967, p. 11 Management by exception 1. Planning Terminology, p. 10 Management by objectives 1. P.lanning Terminology, p. 10 2. Glossary prepared by Professor M. R. Alderson for Conference on Health Information Systems, Copenhagen, 197 3, EURO 4914, pp. 38-39 Management information system 1 . Planning and Programming for Nursing Services, PHP 44, 1971, p. 105 Management techniques 1. Introduction to Work Study, ILO, Geneva, 1960, p. 26 • 429 Management technologist 1. Modern Management Methods and the Organization of Health Services, FHP 55, 1974, p. 43 Manpower 1. Report of WHO Scientific Group on Development of Studies in Health Manpower, TRS 481, 1 97 1, p. 9 Mass campaign 1. Report of WHO Study Group on Integration of Mass Campaigns against Specific Diseases into G enera l Health Services, TRS 294, 1965, p. 5 Maternity care 1. The d e finition was originally proposed by the WHO Expert Committee on Maternity Care, 1st Re p o rt, TRS 51, 1 952 , p. 3 . It was adopted by the WHO Expe r t Committee on the Midwife in Maternity Care, which amended " postnata l examination' ' (lin e 5) to read "postnatal car e and examination" (TRS 331, 1 966, p . 4), and with this amend- ment was adopted in the 5th Report of the WHO Expert Committee on Maternal a nd Child Hea.lth Ser vices, TRS 428, 1969 , p . 6 Medical advice 1 . Unpublished WHO paper, WHO / HS / NAT. COM. / 31. b y OMC / EURO Definition used Medica l assistant 1. 17th Report (on Training of Medical A ssistants a nd Similar Personnel) of WHO Expert Committee on Professional and Technical Education of Medic a l and Auxiliary Personnel, TRS 385, 1968, p. 6. For briefer definitions on simila r line s, see 9th Report of the Expert Committee, TRS 212, 1961, p. 5; Planning and Programming for Nursing Services, FHP 44, 1971, p. 105 2. Medical Dental and Pharmaceutic a l Auxiliaries: a Survey of E xisting Legislation, WHO, G e neva, 1968, pp. 7 - 8. Condensed version in WHO Chronicle, 22, 1968, pp. 501-502 43 0 Medical audit 1. Planning Terminology, p . 1 0 Medical c a re 1. 2nd Report of WHO Expert Committee on Publi c Health Admini strat ion, TRS 8 3, 1 954, p. 4; unpubli she d WHO pa per, CHS/WP / 70. 2 2 . 2nd Report of WHO Expert C ommittee on Organizat ion of Medical Ca r e , TRS 17 6 , 1 959, p. 5 3. ILO, G e ne va , 1972, Vol. 2, p. 839 Medical education 1 . Psychiatry and Primary Medical Care : Report on a Working Group, Lysebu, 1973, EURO 5427 I, pp. 34-35 2 . Gloss a ry of Terms prepar e d for EURO Semina r on Modern Teaching Methods, Madrid, 1 970, EURO 0428 / 15, p. 1 Medical physics 1. Unpublished WHO p a per, RHL / 7 2. 2 Rev. 1 , p. 7 Medical school 1. Official Records of WHO, No. 198, 1 972, p. 80 Mental health 1. 2nd Report of WHO E xpert Committe e on Mental Health, T RS 31, 1951, p . 4 Mental hygiene 1. 2nd Report of WHO Expert Committee on Mental Health, TRS 31, 1951, p . 4 Mental illness 1. Psychiatry and Primary Medical Care: Report on a Working Group, Lysebu, 1973, EURO 5427 I, p. 35 431 Mental illness (c ontd) 2 . EURO 0 1 92 , p. 3 3. World Health Statistics Report, WHO, Geneva, 26, 1973, p. 66 4. Chambers's Dictionary of Psychiatry, Edinburgh and London, 1967, p. 144 Mental retardation 1. M a nua l of the International Statistical Classification of Diseases, Injuries and Causes of Death, 1965 revision, WHO, Geneva, 1967, pp. 1 54-155 2. Glossary of Mental Disorders and Guide to their Classification, WHO, Geneva, 1974, p. 59 3. Report of WHO / UN / ILO / UNESCO Joint Expert Committee on the Mentally Subnormal Child, TRS 75, 1954, pp. 6-8 4. EURO108.2 / WP. 6 , 1 9~9 5. EURO 0192, p. 3 6. World Health Statistics R e port, WHO, Geneva, 26, 1973, p. 66 Midwife 1. Report of Conferenc e on Midwifery Education and Services, Moscow, 1964, EURO 265, p. 7 2. R e port of WHO Expert Committee on the Midwife in Maternity Care, TRS 331, 1966, p. 8 3. Liaison Meeting with Nursing / Midwifery Associations on WHO's European Nursing / Midwifery Programme , Copenhagen, 1974, EURO 4 41 1 , p. 2 Miscarriage 1. Family Planning Glossary, p. 12 2 . Report of WHO Scientific Group on Spontaneous and Induced Abortion, TRS 461, 1970, p. 9 432 Model 1. Plannin g T erminology, p . 10 2. F. Grundy and W. A. Reinke, Health Practice Research, PHP 51, 1 97 3 , p. 40 3 . Plannin g and Progr ammin g for Nursing Se rvices, PHP 44, 1971, p. 105. Cf. definition in Health Information Systems : Report on a Conference, Copenhagen, 1973, EURO 4914, p. 39 4. Op. cit. at 1, p . 11 Monitoring 1. Report of WHO Expert Committee on Environmental and Health Monitoring in Occupational Health , TRS 535 , 1 973, p . 7 2. Manage ment Arrangements for the Reorganised National Health Service, Department of Health and Social Security, London, 1972, p. 120 Morbidity 1 . 6th Report of WHO Expert Committee on Health Statistics, TRS 164, 1959, p. 5; 12th Report of the Committee, TRS 389, 1968, p. 5 2 . 6th Report of WHO Exp ert Committee on Health Statistics, TRS 164, 1959, p. 5 M orbidity rate / ratio 1. Demographic Dictionary, p. 29 Mortality 1. Generalized from a definition in Report of WHO Meeting on Cerebrovascular Diseases, TRS 469, 1971, p. 55 2 . Family Planning Glossary, p . 12 National development planning 1 . Planning and Progr amming for Nursin g Services, PHP 44, 1971, p . 15 433 National health servic e 1. Unpublished WHO paper, CHS/WP / 70. 2 Need / demand 1. E.g. (in addition to referen ce s cited below) Estimation of Hospital Bed Requirements: Report on a Symposium, Copenhagen, 1965, EURO 295, pp. 5-6; The Efficiency of Medical Ca r e : Report on a Symposium, Copenhagen, 1 966 , EURO 294. 2, p. 11; Methods of Estimating Health Manpower; Report on a Symposium, Budapest, 1968 , EURO 0289, p. 12; Planning and Pro grammin g for Nur sin g Services, PHP 44, 1971, pp. 11-12; WHO Glossary of PS A Terms, 1971, PSA /7 1.4 ; Glossary prepared by Professor M.R. Alderson for Conference on Health Informat ion Systems, Copenhagen, 197 3, EURO 4914, p. 35; Evaluation of MCH Services in Certain Countries of the European Region: Report on a Working Group, Copenhagen, 1973, EURO 5103(2), p. 2; F. Grundy and W.A. Reinke, Health Practice Research, PHP 51, 1973, p. 29; Planning Terminology, p . 4 2 . "Clarifica tion and Workin g Definition of Health Services F unctions and Terminology", Appendix to Resolutions of WHO E xecutive Board, 51st Session, 1973, O ff icial Records of WHO, No . 206 , p. 115 3. 14th Report of WHO Expert Committee on Health Statistics, TRS 47 2, 1 971 , pp. 21 - 2 2 Network analysis 1. Planning and Programming for Nursing Services, PHP 44, 1971, p. 105 Night hospital 1. Unpublished WHO paper, 1962, WHO / HS/133 Night hostel 1. 2nd Report (on the Role of Hospitals in Ambulatory and Domiciliary Medical Care) of WHO Expert Committee on Organization of Medical Care, TRS 176, 1959, p. 25 2. 1st Report (on the Role of Hospitals in Programmes of Community Health Protection) of WHO Expert Committee on Organization of Medical Care, TRS 122, 1957, pp. 22-23 434 Non-medical use of drugs 1. Report of WHO Working Group on Youth and Drugs, TRS 516, 1973, p. 9 2 . In the Working Group ts definition of dependence-producing drug (q. v . ). Norm 1. 2. 3. 4. 5. Nurse Also in 20th Report of WHO Expert Committee on Drug Dependence, TR S 5 51 , 1 97 4, p. 1 6 Quoted from a p aper by Professor M . Schaefer on 11 C oncepts and Issues of Programme Evaluation in Environmental Health11 submitted to the Group, 1972, DIS/WP / 72.2 , pp. 5-6 11 Clarification and Working Definition of Hea lth Service s Functions and Terminolo gy" , Appendix to Re solutions of WHO E xecutive Board, 51 st Session, 1 97 3, Official Records of WHO, No. 206, p. 11 5 The Efficiency of Medical Care : Report on a Symposium, Copenhagen , 1966, EURO 294. 2, p. 1 5 Planning Terminology, p. 11 Op. cit. at 1, p. 6 . Se e G . A . Popov , Principles of Health Plannin g in the USSR, PHP 43, 1971 1. International Council of Nurses, Spe ci al ;md Committee Reports, 1965, p. 6; 5th Report of WHO Expert Committee on Nursing, TRS 347, 1966 , p. 9; Nursing in Intensive Care: Report on a Seminar, Copenhagen, 1969, EURO 0409 , p. 82 . Similar definition in Planning and Programming for Nursing Services, PHP 44, 1971, p. 105 2. International Council of Nurses, Constitution and Regulations (amended 1973), Article V, p. 2 3. Report of Liaison Meeting with Nursing / Midwifery Associations on WHO 's E uropean Nursing /Midwifery Programme, Copenhagen, 1974, EURO 4411, p. 4 4 . 5 . 5th Report of WHO Expert Committee on Nursing, TRS 347, 1966, p. 13 Op. cit. at 3, p. 2 435 Nursing 1. Planning and Programming for Nursing Services, PHP 44, 1971, pp. 12-13 2. Report of Liaison Meeting with Nursing/Midwifery Associations on WHO 's European Nursing / Midwifery Programme, Copenhagen, 197 4, EURO 4 411 , p. 2 Nursing audit 1. National Library of Medicine (U.S.A.), M e SH Scope Notes, 1972-73 Nursing care 1. 5th Report of WHO Expert Committee on Nursing, TRS 347, 1966, p. 31; the quotation is from Virginia Henderson, Basic Principles of Nursing Care, Int e rnational Council of Nurses, London, 1961, p. 3. Also quoted in part in The Evaluation of Nursing Education : Report on a Working Group, Copenhagen, 1 968 , EURO 0342, p. 93, and Nursing in Intensive Car e : Report on a Seminar, Copenha gen, 1969, EURO 0409, p. 83 2. Nur sing in Intensive Care: Report on a Seminar, Copenhagen, 1969, EURO 0409, p. 83 Nursing education 1. International Council of Nurs es, Constitution and Regulations (amended 1973), Article V, p. 2. This is an amended version of a definition adopted by the ICN, Special and Committee Reports, 1965, p. 6. Al so in Nursing in Intensive Care : Report on a Seminar, Copenhagen, 1969, EURO 0409 , p. 82; Higher Education in Nursing: Report on a Symposium, The H a gue , 197 2, EURO 4408, p. 34 2. 5th Report of WHO Expert Committee on Nursing, TRS 347 , 1966, p. 32; Higher Education in Nursing: Report on a Symposium, The Hague, 197 2, EURO 4408, p. 34 3. World Directory of Postba sic a nd Post g r a dua t e Sc hools of Nursing, WHO, 1965, p. 9; 5th Report of WHO Expert Committee on Nur sin g , TRS 347, 1966, p. 32; Nursing in Intensive Care: Report on a Seminar, Copenhagen, 1969, EURO 0409, p. 82; Higher Education in Nur sing: Report on a Symposium, The Hague, 1972, EURO 4408, p. 34 436 Nursing education (contd) 4. Guidelines for the Develo:pment of Postbasic Education for Nurses, WHO/NURS/Tech. Guide/69. 5 , 1969, p. 3; Nursing in Intensive Care : Report on a Seminar, Copenhagen, 196 9 , EURO 0409, ·P• 8 2; Higher Education in Nursing : Report on a Symposium, The Hague , 197 2, EURO 4408, p. 34 Nursing home 1. Unpublished WHO paper , WHO/HS/133, 1 962 Nursing personnel 1. 2. 3. 4. 5 . 6 . 7. 3rd Report of WHO Expert Committee on Nursing , TRS 91, 1954, p. 27 Planning and Programming for Nursing Services, PHP 44 , 1971, p. 81 Report of Liaison Meeting with Nursing/Midwifery Associations on WHO 1s European Nursing / Midwifery Programme , Copenhagen , 1 97 4 , EURO 4411 , p. 2 5th Report of WHO Expert Committee on Nursing, TRS 347 , 1 966 , pp. 12-1 3 Anne xed to Report cit. a t 3 , p. 12 Op. cit. a t 3 , p. 3 Op. cit. at 3 , pp. 3, 10 Nursing personnel system 1 . 5th Report of WHO Expert Committee on Nursing , TRS 347 , 1966, p. 32; The Evaluation of Nursing Education : Report on a Working Group, Copenhagen, 1968 , EURO 0342, p . 93; Higher Education in Nursing: Report on a Symposium, The Hague, 1972, EURO 4409, p. 35. Definition approved at Liaison Meeting with Nursing/ Midwifery Associations on WHO's European Nursing / M idwi fe ry Programme, Copenhagen, 1974, E URO 4411 , pp. 3-4 Nursing practic e 1. 5th Report of WHO Expert Committee on Nursing, TRS 347, 1966, p. 31; The Evaluation of Nur sing Education : Report on a Working Group, Copenhagen, 1968, EURO 0342, p. 93; Higher Education in Nursing: Report on a Symposium , The Hague, 1972, EURO 4408, p. 35 437 Nursing serv i ce 1. 3rd R e port of WHO E xpert C ommitt ee on Nursing , TRS 9 1, 195 4 , p. 4 2. 5th R e port of WHO Expert Committee on Nursing , TRS 347 , 1966, p, 31; The E valua tion of Nursing E duc ation: R e port on a Working Group , C ope nhagen , 196 8 , EURO 0 342, p. 9 3; Highe r E ducation in Nursing: Report on a Symposium, The Hag ue , 19 72, EURO 4408 , p, 3 5 Nutrition 1. Food and Nutrition Terminology, p. 8 Nutritional disorder 1. Food and Nutrition Terminology, p. 1 9 Nutritional status 1. Food and Nutrition Terminology, p. 8 Objective 1. Professor M. Schaefer, " Concepts and Issues of Programme Evaluation in Environmental Health"; paper prepared for WHO Scientific Group on Evaluation of Environmental Health Progra mme s, 1972, DIS / WP/7 2.2, p. 5 2. Planning and Programming for Nursing Services, PHP 44, 1971, pp. 104, 105 and 107. The definitions of goal and objective, in abridged form, appear in "Clarification and Working Definition of Health Services Functions and Terminology", Appendix to Resolutions of WHO Executive Board, 51 st Session, 1973, Official Records of WHO, No. 206 , p. 114 3. Planning Terminology, pp. 6, 11 and 15 4. Methods of Evaluating Public Health Programmes: Report on a Symposium, Kiel, 1967, EURO 037 5, p. 34. (Definitions modified from American Journal of Public Health, Vol. 50, No. 2, 1960) Occupational health 1. Official Records of WHO, 1948, No. 13, p. 308 2. Encyclopaedia of Occupational Health and Safety, ILO, Geneva, 197 2, Vol. 2, p. 967 438 Oc c upation a l health (contd) 3. 4. Unpublished WHO paper, WHO / Occ. Health/2, p. 3 The Teaching of Occupational Health and Safety : R eport on an ILO/WHO C onference , Milan, 1972, EUR O 5203 , p. 3 5. Op. cit. at 2, p. 966 Occupationa l therapy 1. 2nd Report of WHO Expe rt Committee on Me dical Rehabilitation, TRS 419, 1969, pp. 7 - 8 Old age 1. Report of WHO Scientific Group on Psychogeriatr i cs, TRS 507, 1 972 ,p.1 1 Operational r e s earch 1. Paper by Dr M . D. Warren , prepared fo r Symposium on Methods of Evaluating Public Health Programmes, Kie l, 1 967 , EURO 0375 , p. 41. Quotation from C . W . Churchman , R. L . A ckoff and E . L. Arnoff , Introduction to Operations Re search, New York, 1957 2. "Clarification and Working Definition of Hea lth S ervices F u nction s anq T e rminolo gy" , Appendix to Re solutions of WHO E xecutive Board, 51 st Session, 1 97 3, Official Rec ords of WHO , No. 206, p. 114 3. Health Ope rational Research : Re por t on a Seminar, B ucha rest, 1 969 , EUR O 0408 , p. 5. Fi rst defintion by WHO Secretariat; second by Dr R . D. Smallwood 4. F. Grundy and W. A . Reinke , Health Pr actice Research , PHP 51, 1973, pp. 41-42 5. W. E. Duckworth, A Guide to Operational Research, London, 1965, ,P• 15 Organization 1 . Modern Management Methods and the Or ganization of Health Services, PHP 55, 197 4 , pp. 1 4 -1 5 439 Organization and methods 1. Planning and Programming for Nursing Services, PHP 44, 1971, p. 105 2. Planning Terminology, p. 1 2 3. The Practice of Or ganisation and Methods, H. M. Treasury, London, 1 96 5, p. 9 Outcome 1. Health Information Systems: Report on a Conference, Copenhagen, 1973, EURO 4914, p. 4;0 2. Evaluation of MCH Services in Certain Countries of the European Region: Report on a Working Group, Copenhagen, 197 3, EURO 5103 (2 ), p. 4 Out-pa tien t 1. Dr M. A . Heasman, M a nual of Hospital Morbidity Statistics. Definition used by OMC /E URO. 2. Adapted from definition in EURO Questionnaire on Mental Health Resources, EURO 0192, 196 9 Out-patient clinic/ d e partme nt 1. 2nd Report of WHO Expert Committee on Professional and Technical Education of Medical and Auxiliary Personnel, TRS 69, 1953, p. 26 Output 1. Planning Terminology, p. 12 2. Planning and Programming for Nursing Services, PHP 44, 1971, p. 105 Output budgeting 1. Glossary of Management Techniques, H. M. Stationery Office, London, 1967, p. 18 440 Paediatrics 1. Report of WHO Study Group on Paediatric Education, TRS 119, 1957, p . 18 2. Paediatric Education: Report on a Conference, Berg en Dal, 1965 , EURO 277, pp . 4-5 Pararniedical (profes sions ) 1. Official Records of WHO, l 963 , No . 127, p, 184 2. The Early Detection and Treatment of Handicapping Defect s in Young O:hildren: Report on a Working Group, C openhagen , 1 966, EURO 0332, p. 10 3. Official Records of WHO, 1 972, No . 198, p. 8 l I Parameter l . P,lanning Terminology, p. 1 2 Parity 1. Family Planning Glossary, p. 14 Pathology l. Report of WHO E xpert Group on Internationally accepted Minimum Standards of Medical Education, TRS 239, 1962, pp. 29-30 P a tient 1. Estimation of Hospital Bed Requirements: Report on a ~ymposium, Cdpenhagen, 1965, EURO 295, - p. 4 2. 2nd Report of WHO Expert Committee on Professional and T echnical Ed,ucation of Medical and Auxiliary Personnel, TRS 69, 1953, p. 26 441 Patient care 1. 5th Report of WHO Expert Committee on N1..1rsing, TRS 347, 1966, p. 31 2. Glossary prepared by Professor M. R. Alderson for Conference on Health Information Systems, Copenhagen, 197 3: Report, E URO ·4914, p. 40 Personal health services 1. Unpublished WHO paper, CHS/WP/7 0. 2 2. Professor B . A b e l-Smith, "The Health Sub-System in the Systems of National Accounts and Balances and of Social Service Accounts for Health": paper prepa red for Consultation on Health Statistics, Geneva, 1972, EURO 4913(2)/4 PERT 1. Planning and Programming for Nursin g Services, PHP 44, 1971, p. 106 2. A. Chandor, J. Graham and R. Williamson, A Dictionary of Com- . puters, Penguin Books, Harmondsworth, 1972, p. 95 Physical fitness 1. Report of WHO Meeting on Exercise Tests in Relation to Cardio- vascular Function, TRS 38 8 , 1 968, p. 6 Physical medicine 1. Education and Training in Medical Rehabilitation: Report on a Conference, Konstancin, 1971, EURO 4802, p. 9 Physician 1. 3rd Report of WHO Expert Committee on Professional and Tech- nical Education of Medical and Auxiliary Personnel, TRS 109, 19.56, p . 5 2. 2nd Report of WHO Expert Committee on Professional and Tech- nical Education of Medical and Auxiliary Personnel, TRS 69 , 1953, p. 26 442 Physician (contd) 3. 4. Official Records of WHO, 1972, No. 198, pp. 14, 80-81; No. 201, p. 20 The role of the Primary Physician in Health Services: Report on a Conference, Noordwijk-aan-Zee, 1970, EURO 0380, p. _5; Trends in the Development of Primary Care: Report on a Working Group, Moscow, 197 3, EURO 4309, p. 3; Psychiatry and Primary Medical Care: Report on a Working Group, Lysebu, 1973, EURO 5427 I, p. 32 Physiology 1. Report of WHO Study Group on Internationally Acceptable Minimum Standards of Medical Education, TRS 239, 1962, pp. 28 -29 Physiotherapy 1. The Training of Physical Therapists, World Confederation for Physical Therapy, London, 1967. Definition accepted in 2nd Report of WHO Expert Committee on Medica l Rehabilitation, TRS 419, 1969, p. 9 Pilot programme 1. Unpublished WHO paper, CVD/WP/7 1. 3 Plan 1. Based on a United Nations definition quoted in Report of WHO Expert Committee on Environmental Health A spects of Metropolitan Planning and Development, TRS 297, 1965, pp. 18-19 Planning 1. Planning Terminology, p. 13 2. Report of European Conference on National Health Planning, Bucharest, 1974, EURO 4107, p. 8 3. Health Planning in National Development: Report on a Working Group, Stockholm, 197 2, EURO 4104, p. 7 443 Planning (contd) 4 . J. Stringer , "Techniques of Planning": paper presented to European Conference on National Health Planning, Bucharest, 1 97 4, reproduced as Annex III to Report on Conference , EURO 4107, p. 50 Planning Terminology, p. 10 Op. cit. at 3 , p. 10 Op. cit. at 3, p. 9 5 . 6 . 7. 8 . 14th Report of WHO Expert Committee on Health Statistics, TRS 47 2, 1971, p. 9 Polyclinic 1, Psychiatry and Primary Medical Care : Report on a Working Group, Lysebu, 1 973, EUR O 5427 I , p. 33 2 . M. I. Roemer, Evaluation of Community Health Centres, PHP 48, 1972, p. 11 Population 1. 10th Report (on Sampling Methods in Morbidity Surveys and Public Health Investigations) of WHO Expert Committee on Health Statistics, TRS 336, 1966, p. 4 Populat ion laboratory 1. 11th Repor t (on Epidemiolpgical Method s in the Study of Chronic Disease s) of WHO Expert Committee on Health Statistics, TRS 365, 1967, p. 27 Post-partum peri od 1. Unpublished WHO paper, MCH / 70. 3 PPBS 1. Planning T e rminology, p. 14 2 . Planning and Programming for Nursing Services , PHP 44, 1971, p . 106 444 Prematurity 1. Manual of the International Statistical Classification of Diseases, Injuries and Causes of Death, 1948, Vol. 1, p. 212 2. Final Report of WHO Expert Group on Prematurity, TRS 27, 1950, p. 4 3. 3rd Report (on Public Health A spects of Low Birth Weight) of WHO Expert Committee on Maternal and Child Health, TRS 217, 1961, p. 6 4. Report of WHO Expert Committee on Nutrition in Pregnancy and Lactation, TRS 302, 1965, p. 15 Pre-term 1. Report of WHO Expert Committee on Prevention of Perinatal Mortality and Morbidity, TRS 457, 1970, p. 20 2. TRS 485, 1972, p. 17 Prevalence 1. This definition and the subsequent notes are taken from an article on "Prevalence and Incidence" in the WHO Bulletin, 35, 1966, pp. 783-784, summarizing the recommendations in the 6th Report of the WHO Expert Committee on Health Statistics, TRS 164, 1959. The definition is reproduced in the Food and Nutrition Terminology, p. 18 Preventive medicine 1. Report of WHO Conference on Public Health Training of General Practitioners, TRS 140, 1957, p. 6 2. Psychiatry and Primary Medical Care: Report on a Working Group, Lysebu, 1973, EURO 5427 I, pp. 33-34 3. The Role of the Psychologist in Mental Health Services: Report on a Working Group, Cracow, 1973, EURO 5428 I, p. 5 4. Public Health Practice and the Prevention of Mental Illness: Report on a Seminar, London, 1964, EURO278, pp. 7-9 (by Professor A. Querido); Measures for the Prevention and Control of Drug Abuse and Dependence: Report on a Working Group, The Hague, 1971, EURO 5412 IV, p. 3; EURO paper, ITALY 4101 445 Preventive medicine (contd) 5. Public Health Practice and the Prevention of Mental Illness: Report on a Seminar, London, 1964, EURO 278, p. 27 (chapter 3, by Dr Lebedev, Director of Bekhterev Institute for Psychiatric Re- search, Leningrad) Preventive services 1. Methods of Evaluating Public Health Programmes: Report on a Symposium, Kiel, 1967, EURO 037 5, p. 34 2. The Role of the Primary Physician in Health Services: Report on a Conference, Noordwijk-aan-Zee, 197 0, EURO 0380, p. 5. Defini- tion accepted by Working Group on Trends in the Development of Primary Care, Moscow, 197 3, EURO 4309, p. 3 Primary care 1. 2. 3. 4. 5. 6. "Clarification and Working Definition of Health Services Functions and Terminology", Appendix to Resolutions of WHO Executive Board, 51 st Session, 197 3, Official Records of WHO, No. 206, p. 113. Also in Planning Terminology, p. 8 Trends in the Development of Primary Care: Report on a Working Group, Moscow, 1973, EURO 4309, p. 2 D. Flahault, "The training of front line health personnel - a crucial factor in development", WHO Chronicle, 26, 1973 ~ Health Information Systems: Report on a Conference, Copenhagen, 1973, EURO4914, p. 40 Report of WHO Expert Committee on Planning of Medical Education Programmes, TRS 547, 197 4, p. 9 Psychiatry and Primary Medical Care: Report on a Working Group, Lysebu, 1973, EURO 5427 I, p. 33 446 Primary care centre 1. Trends in the Development of Primary Care: Report on a Working Group, Moscow, 1973, EURO 4309, p. 3 2. M.I. Roemer, Evaluation of Community Health Centres, PHP 48, 1 972, p. 11 3. "Clarification and Working Definition of Health Services Functions and Terminology", Appendix to Resolutions of WHO Executive Board, 51 st Session, 197 3, Official Records of WHO, No. 206, p. 113 Primary medicine 1 . Psychiatry and Primary Medical Care: Report on a Working Group, Lysebu, 197 3, EURO 5427 I, p. 33 Primary physician 1 . The Role of the Primary Physician in Health Services: Report on a Conference, Noordwijk-aan- Z ee, 1970, EURO 0380, p. 5. Definition adopted by Working Group on Trends in the Development of Primary Care, Moscow, 1973, EURO 4309, p. 3 2 . Psychiatry and Primary Medical Care: R e port on a Working Group, Lysebu, 1973, EURO 5427 I, p. 32 Professional 1. 9th R e port of WHO Expert Committee on Profes sional a nd T echnic a l Education of Medic al and Auxiliary P e rsonn e l , TRS 212 , 1961, p. 4 I 2 . Report of Consultation on C l a ssification of A uxili a ry Health Personnel, Geneva, 19 72, WH O/ EDUC / 72. 154, pp. 5 - 6 Programme 1. 2nd Report of WHO Expert Committee on Maternal and Child Health, TRS 115, 1 957, p. 6 447 Programme (contd) 2. Planning and Programming for Nursing Services, FHP 44, 1971, p. 106. Similar definitions in Methods of Evaluating Public Health Programmes: Report on a Symposium, Kiel, 1967, EURO 037 5, p. 34; and Professor M. Schaefer, "Concepts and Issues of Prog- ramme Evaluation in Environmental Health": paper prepared for WHO Scientific Group on Evaluation of Environmental Health Prog- rammes, 1972, DIS / WP/ 72. 2, p. 50 3. Schaefer, op. cit. at 2, p. 50 Programming 1. Planning and Programming for Nursing Services, FHP 44, 1971, p. 106 2. Unpublished WHO paper, ISD/7 3 / 8 3. Planning Terminology, p. 14 Progressive patient care 1. Report on a Conference on the Organization of General Hospitals, Oxford, 1966, EURO 327, p. 21 2. Report on a European Conference on Nursing Administration, Bad Homburg, 1959, EURO 331, p. 11 3. Nursing in Intensive Care: Report on a Seminar, Copenhagen, 1969, EURO 0409, p. 83 4. 5. 6. 7. Op. Op. Op. Op. Project cit. at 1, cit. at 1, cit. at 1, cit. at 1, p. 22 pp. 1 3, 22 pp. 4, 13 p. 4 1. Methods of Evaluating Public Health Programmes: Report on a Symposium, Kiel, 1967, EURO 037 5, p. 34 2. Unpublished WHO paper, ISD/7 3. 8 448 Project (contd) 3. Professor M. Schaefer, "Concepts and Issues of Programme Evaluation in Environmental Health": paper prepared for WHO Scientific Group on Evaluation of Public Health Programmes, 1972, DIS/WP/72. 2, p. 50 Projection 1. Report of WHO Expert Committee on National Health Planning in Developing Countries, TRS 350, 1967, p. 27 2. F. Harbison, "Human resource assessment", in Economic and Social Aspects of Educational Planning, UNESCO, Paris, 1964, pp. 122-123 Protected residence 1. Report of WHO Meeting on Cerebrovascular Diseases, TRS 469, 1 971, p. 56 Psychogeriatrics 1. Report of WHO Scientific Group on Psychogeriatrics, TRS 507, 197 2, p. 11 Psychosomatic 1. Report of WHO Scientific Group on Biochemistry of Mental Disorders, TRS 427, 1969, pp. 24-25. See also 13th Report of WHO Expert Committee on Mental Health, TRS 27 5, 1964, pp. 4-5 Psychotropic drug 1. Report of WHO Scientific Group on Research in Psychopharmacology, TRS 371, 1 967, p. 7 2. Psychiatry and Primary Medical Care: Report on a Working Group, Lysebu, 1973, EURO 5427 I, p. 35 449 Public health 1, Report of WHO Conference on Public Health Training of General Practitioners, TRS 140, 1957, p. 6 2. E.g . 1st Report of WHO Expert Committee on Public Health A dministration, TRS 55, 1952, pp. 5-6; Report of WHO Conference on Public Health Nursing, TRS 167, 1959, pp. 3-4; 4th Report of WHO Expert Committee on Public Health Admini s tration, TRS 215, 1961, pp. 4-5; Report of WHO Expert Committee on Occupational Health Problems in Agriculture, TRS 246, 1962 , p. 6; Re port of WHO Expert Committee on National Health Planning in Developing Countries, TRS 350, 1967, pp. 6 - 7; Re port of WHO Expert Com- mittee on Planning and Evaluation of Health Education Services , TRS 409, 1969, p. 9 3. C. -E. A. Winslow, The Evolution and Significance of the Mode rn Public Health Campaign, New Haven, 1923, p. 1 4. C. -E. A. Winslow, The Cost of Sickness and the Price of Health, WHO Monograph No. 7, 1 951, p. 28 5. The Education of the Public Health Physician in Relation to his Work in the Community: Report on a Symposium, Lisbon, 1966, EURO 337, p. 3 6. Report of WHO Expert Committee on Postgraduate Education and Training in Public Health, TRS 533, 1973, p. 6 Public health field studies 1. 15th Report (on Statistical Principles in Public Health Fie ld Studies) of WHO Expert Committee on Health Statistics, TRS 510, 1972, p. 5 Public health nurse 1. Report of European Conference on Nursing Administration, Bad Homburg, 1959, EURO 331, p. xv Public health nursing 1. Public Health Nursing: Report on a European Conference, Helsinki, 1958, EURO 132, p. 8 4 50 Public health officer 1. 11th Report (on the Role of Public Health Officers and General Practitioners in Mental Health Care) of WHO Expert Committee on Mental Health, TRS 235, 1962, p. 6 Public health ophthalmology 1. Report of WHO Study Group on Prevention of Blindness, TRS 518, 1973, p. 1 5 Public health physician 1. The Education of the Public Health Physician in Relation to his Work in the Community: Report on a Symposium, Lisbon, 1966, EURO 337, p. 3 Public health, school of 1. 10th Report of WHO Expert Committee on Professional and Tech- nical Education of Medical and Auxiliary Personnel, TRS 216, 1961, pp. 4-5 2. Report of WHO Expert Committee on Postgraduate Education and Training in Public Health, TRS 533, 1973, p. 7 Public health training 1. Report of WHO Expert Committee on Postgraduate Education and Training in Public Health, TRS 533, 1973, p. 7 Public relations 1. 3rd Report of WHO Expert Committee on Nursing, TRS 91, 1954, p. 28 Queueing theory 1. Planning Terminology, p. 11 451 Radiation medicine 1. Report of WHO/IAEA Seminar on Training of Radiographers and Other Technical Staff in Medical Uses of Ionizing Radiation and Radioisotopes, Teheran, 1971, RHL / 72.1, p. 8 2. Report of Joint IAEA/WHO Expert Committee on Medical Uses of Ionizing Radiation and Radioisotopes, TRS 492, 1972, p. 6 Radiologist 1. Report of WHO/IAEA Seminar on Training of Radiographers and Other Technical Staff in Medical Uses of Ionizing Radiation and Radioisotopes, Teheran, 1971, RHL/7 2. 1, p. 8 Rate/ratio 1. Demographic Dictionary, p. 7 2. Report of WHO Scientific Group on Spontaneous and Induced Abortion, TRS 461, 1970, p. 17 Record linkage 1. Health Information Systems: Report on a Conference , Copenhagen, 1973, EURO4914, p. 41 2. Professor Alwyn Smith, "Linkage of Child Health Records", EURO 0215(7 ), 1969, p. 2 3. Op. cit. at 2, p. 26 Reference man/woman 1. Report of Joint F AO / WHO Ad Hoc Expert Committee on Energy and Protein Requirements, TRS 522, 1973, p. 12 Region 1. The Health Aspects of Planning for Regional Socio-Economic Develop- ment: Report on a Conference, Montpellier, 1967, EURO 2882, p. 6. Also, in almost identical terms, in Report of WHO Expert Committee on Organization of Local and Intermediate Health Administrations, TRS 499, 1972, and in Health Information Systems: Report on a Conference, Copenhagen, 1973, EURO 4914, p. 41. 4 52 Region (contd) 2. Planning Terminology, p. 14 3. Report of European Conference on National Health Planning, Bucharest, 1974, Annex IV (by Professor I. V. Pustovoj), EURO 4107, p. 58 Regional planning 1. Report of WHO Expert Committee on Organization of Local and Intermediate Health Administrations, TRS 499, 1972, p. 7 Regionalization 1. 16th Report of WHO Expert Committee on Professional and Tech- nical Education of Medical and Auxiliary Personnel, TRS 355, 1 967, p. 21 2. J.B. Grant, Journal of Medical Education, 30, 1955, pp. 73- 8 0. Quoted in Report of WHO Expert Committee on Organization of Local and Intermediate Health Administrations, TRS 499, 1972, p. ~ ~ Registration (of disease) 1. 11th Report of WHO Expert Committee on Health Statistics, TRS 36 5, 1967, p. 11 Rehabilitation 1. 2nd Report of WHO Expert Committee on Medical Rehabilitation, TB.S 419, 1969, p. 6; Glossary of Terms on Cardiovascular Diseases, WHO, Copenhagen, 1970, p. 28. Quoted in Encyclopaedia of Oc- cupational Health and Safety, ILO, Gene va, 19 72, Vol . 2, pp. 1210- 1212 2. Psychiatry and Primary Medical Care: Report on a Working Group, Lysebu, 197 3, EURO 5427 I, p. 34 3. Recommended by International Labour Conference, 38th Session, 1955. Also references as at 1 Rehabilitative services 1 . Unpublished WHO paper, 1962, HS/133 453 Research 2. 3. Unpublished WHO paper, MPD/SMR/74. 29, p. 2 Unpublished WHO paper, CAN/7 3. 13, p. 5 Report of WHO Scientific Group on Health Aspects of Family Planning, TRS 442, 1970, p. 37 Op. cit. at 3, pp. 38-39 Op. cit. at 3, p. 38 4. 5. 6. The Role of the Psychiatrist in Mental Health Services: Report on a Working Group, Cracow, 197 3, EURO 5428 I, p. 11 Research and development 1. OECD, 1963 Resources 1, Planning and Programming for Nursing Services, FHP 44, 1971, p. 106 2. Glossary prepared by Professor M. R. Alderson for Conference on Health Information Systems, Copenhagen, 197 3: Report, EURO 4914, p. 41 3. Planning Terminology• p. 14 Safety (of a drug) 1. Unpublished WHO paper, WHO/PA/71. 63, p. 2 Sample 1. Professor M. Schaefer, "Concepts and Issues of Programme Evalu- ation in Environmental Health": paper presented to WHO Scientific Group on Evaluation of Environmental Health Programmes, 197 2, DIS/WP/7 2. 2, p. 50 454 Sampling 2. United Nations Statistical Papers, Series M . , Op. cit. at 1, p. 1 98 Sampling unit o. 19, Rev . l, p. 199 1. United Nations Statistical P aper s, Series M , N o. 1 9 , Rev . 1, p. 200 Sanitary engineer 1. WHO Chronicle, 25, 1 971, p. 25. The quotation is from Educational Qualifications of S a nitary Engineers engaged in th e Field of Public Health, American Public He a lth Association, New York, 1 955 . Sanitary inspe ction 1. Sanitary Inspe ction Services: Report on a Symposium, Cop en hagen, 1964, EURO 195. 2, p. 5 Sanitary inspector 1. See Sanitary Inspection Service s: Report on a Sympo sium, Copenhagen, 1964, EURO 1 95 . 2, p. 1 0 2. See op. cit. at 1, pp. 10-12; 2nd Report of WHO Expe rt Committe e on Environmental S ani t at ion, TRS 47, 1 952 , pp. 11-12 ; 3rd Report of the same Committee, TRS 77, 1954, p. 4; Medical, Dental and Pharmaceutical Auxiliaries: a Survey on Exist ing L egi slat ion, WHO, Geneva, 1968, pp. 13-14 (also in WHO Chronicle, 22, 1 968 , p. 504) Satisficing 1. Planning Terminology, p. 1 5 2. Report of European Conference on National Health Planning, Bucharest, 1974, EURO 4107, A nnex I, p. 32 4 55 Screening 1. Definition originally proposed by (U.S.) Commission on Chronic Illness: see Proceedings of Conference on Preventive Aspects of Chronic Disease, Baltimore, 1951. Quoted in J.M. G. Wilson and G. Jungner, Principles and Practice of Screening for Disease, PHP 34, 1968, p. 12; Report of WHO Expert Committee on Early Detection of Cancer, TRS 422, 1969, p. 7; Report of WHO Meeting on Cerebrovascular Diseases, TRS 469, 1971, p. 56 2. Wilson and Jungner, op. cit. a t 1; Report of WHO E xpert Committ, on Early Detection of Cancer• cit. at 1 3. Definition proposed in a publication of (U.S.) Commission on Chron Illness, Chronic Illness in the United States, Vol. I: Prevention of Chronic Illness, Cambridge, Mass.• 1957, p. 47. Quoted in Wils c and Jungner • op. cit. at 1, and Report of WHO E xpert Committee o Early Detection of Cancer, cit. at 1 (with reference to multi-step screening). Secondary care 1. "Clarification and Working Definition of Health Services Functions and Terminology", Appendix to Resolutions of WHO Executive Boar 51st Session, 1973, Officia l Records of WHO, No. 206, p. 113. Also in Planning Terminology, p. 8 2. Report of WHO Expert Committee on Planning of Medical Education Programmes, TRS 547 • 197 4, p. 9 Selective placement 1. 2nd Report of WHO Expert Committee on Medical Rehabilitation, TRS 419, 1969, p. 9 Simulation 1. Planning and Programming for Nursing Services, PHP 44, 1971, p. 106 2. Planning Terminology, p. 11 4 56 Situation analysis 1. Professor M. Schaefer, "Concepts and Issues of Programme Evaluation in Environmental Health": p a per prepared for WHO Scientific Group on Evaluation of Environment a l Health Programme s, 1972, DIS/WP/72. 2, p. 50 Social assistance 1. Based on an Introduction to Social Secu rit y, [LO, Geneva , 1970, p. 13 Social insurance 1. Unpublished WHO p a per, CHS/WP/70. 2 Social medicine 1. F. Grundy and J.M. Mackintosh, The Teaching of Hygiene and Public Health in Europe, WHO Monograph No. 34, 1 957 , pp. 55-56 2. The Effectiveness of Tuberculosis Control Programmes: Report on a Study, Copenhagen, 1970, EURO 1201, p. 5 Social psychiatry 1. 7th Report (on Social Psychiatry and Community Attitudes) of WHO Expert Committee on Mental Health, TRS 177, 1959, p. 3 Social security 1. Unpublished WHO paper, CHS/WP/70. 2 2. An Introduction to Social Security, ILO, Geneva, 1 970 , p. 15 Social work 1. Public Health Nursing: Report on a European Conference, Helsinki, 1958, EURO 132, p. 8 457 Specialist 1. Psychiatry and Primary Medical C a re: Report on a Working Group, Lysebu, 1973, EURO 5427 I, p. 32. Similar definitions in 11th Report of WHO Expert Committee on Professional and Technical Education of Medical and Auxiliary Personnel, TRS 257, 1963, p. 6; Report of WHO Expert Committee on General Practice, TRS 267, 1964, p. 4; The Role of the Primary Physician in Health Services: Report on a Conference, Noordwijk-aan-Zee, 197 0, EURO 0380, p. 5; Trends in the Development of Primary Care: Report on a Working Group, Moscow, 1973, EURO 4309, p. 3 Speech therapy 1. 2nd Report of WHO Expert Committee on Medical Rehabilitation, TRS 419, 1969, p. 8. The wording is taken from the Speech Therapists and Audiologists Act, 1964, of the Province of Quebec Statistics 1. Unpublished WHO paper, CD/WP/73. 5, p. 1 2. The Teaching of Statistics to Undergraduate Medical Students in Europe: Report on a Symposium, Geneva, 1962, EURO 207. 1, p. 5 3. Glossary prepared by Professor M.R. Alderson for Conference on Health Information Systems, Copenhagen, 1973: Report, EURO 4914, p. 35. (The definition is of demographic data) 4. United Nations Statistical Papers, Series M. _No. 19, Rev, 1, p. 10 5. Unpublished WHO paper, DSI/73. 4, p. 3 Stillbirth 1. 2, 3. 4. 5. Family Planning Glossary, p. 17 Unpublished WHO paper, IC D / 72. 3; cited in HS /NAT. C OM . / 73. 308, p. 89 Official Records of WHO, 1950, No. 28, p. 17 TRS 25, 1950, pp. 4, 14 Op. cit. at 2 458 Stomatologi st 1. Report of Study Group on Dental Health Services for Childr en, Brussels, 1958, EURO 151. 1, p. 22 System 1, Glossary prepar e d by Profe ssor M. R . Alderson for C onfer e nc e on Health Information Syste ms, C openhagen, 1 97 3, EURO 4 91 4/7, p. 8; Planning Terminology) p. 15 2. R e vised version of Glossary cit. a t 1, EURO 4 91 4 , p. 4 2 3. F. H. Allport, Th eori e s o f P e rc e ption and th e Concept of St ructu re , New York, 1955; quote d i n Pla n ning a nd Progr ammi ng for Nu r s ing Services, PHP 44, 1 971, pp. 1 06 -1 07 Systems analysis 1. "Clarification and W or k i ng Defi ni t i on of Hea lth Se r v i ce s Function s and Terminology", A ppen dix t o Re s olu t i ons of W HO E x ecu tive Board , 51st Session, 1973, Offi c i a l R e cords of WHO, No . 206, p. 11 4 2. Glossary prepar e d by Pr of e ss o r M . R . A ld e rs on fo r Confe r ence on Health Information Sys tem s, C openhagen , 1 973, EURO 49 1 4 , p . 4 2 3. F. Grundy and W. A . Re inke , H ea lt h Pr a ctice Re s earc h , P H P 51, 1973, p. 21. The d e finition quoted is by E . S. Qua d e . A lso quo t e d in Report of WHO E xpert C ommitt ee on Plan ni ng of Me d ica l E duca - tion Programmes, T R S 547, 1 974, p. 1 5 Systems design 1. Planning and Programmin g for Nursi ng Se r vic es, PH P 44 , 1 97 1, p. 107 Systems research l. See F. Grundy and W. A . Reinke, He a lth Pr a cti c e R e sear c h, P H P 51, 19,73, p. 21 Task 1. Planning and Programming for Nursi n g Services, PHP 44, 1 971, p. 107 4 59 Team 1 . Concise Oxford Dictionary 2. Trends in the Development of Primary Care : Report on a Working Group, Moscow, 1973, EURO 4309, pp. 2-3, 10 ff 3. The Role of the Primary Physician in Health Services: Report on a Conference, Noordwijk-aan-Zee, 1970, EURO 0380, p. 5 4. 3rd Report of WHO Expert C ommittee on Nursing, TRS 91, 1954, p. 28 Tolerance 1. N. B. Eddy, H. Halbach, H . Isbell and M . H. Seevers, WHO Bulletin, 32, 1965, p. 723 Training 1. Based on definitions adopted at WHO Regiona l Confe r ence on Auxiliary Nursing in South-East Asia, 1958 ; quoted in 9th Report of WHO Expert Committee on Professional and Technical Education of Medical and Auxiliary Personnel, TRS 212, 1961, p . 12 Universe 1. United Nations Statistical Papers, Series M, No. 19, Rev. 1, p. 200 Validity 1. G. A. Rose and H. Blackburn, Cardiovascular Survey Methods, WHO Monograph No. 56, 1968, p . 184; quoted in Glossary of Terms on Cardiovascular Disease, WHO, Copenhagen, 197 0, p. 41 2. Professor M. Schaefer, "Concepts and Issues of Programme Evalua - tion in Environmental Health": paper prepared for WHO Scientific Group on Evaluation of Environmental Health Programmes, 1972, DIS/WP/72.2, p. 51 Veterinary public health 1. 1st Report of Joint FAO/WHO Expert Group on Z oonoses, TRS 40, 1951, p. 3 460 Veterinary public health (c ontd) 2. Report of WHO Advisory Group on Veterinary Public Health, TRS 111, 1956, p. 5 Vital records 1. Demographic Dictionary. Also in Handbook of Vital Statistics Methods, United Nations, 1955, p. 3 2. Cf. previous definition. Also in United Nations Statistical Papers, Series M. No. 19, Rev. 1, p. 10 3. Handbook of Vital Statistics Methods, cit. at 1 Vocational counselling 1. 2nd Report of WHO Expert Committee on Medical Rehabilitation, TRS 419, 1969, pp. 8-9 Water pollution 1. Report of WHO Expert Committee on Water Pollution Control in Developing Countries, TRS 404, 1968, p. 22 Work study 2. 3. 4. 5. 6. Planning Terminology, p. 16 Introduction to Work Study, ILO, Geneva, 1960, p. 35 Op. cit. at 2, p. 7 3 Op. cit. at 2, p. 191 Pianning and Programming for Nursing Services, PHP 44, 1971, p. 107; paper prepared by Dr M. D. Warren for Symposium on Methods of Evaluating Public Health Programmes, Kiel, 1967, EURO 0375, pp. 39-40 Op. cit. at 2, pp. 36, 7 5 461 Youth advisory service 1. Report of Joint Steering Committee on Planning and Control of Long-Term Programmes in Child and Adolescent and Mental Health and Alcoholism and Drug Dependence, Copenhagen, 1974, EURO 5413 III (74) and EURO 5411 IV, p. 12 Zoonoses 1. 2nd Report of Joint WHO / FAO Expert Committee on Z oonoses, TRS 169, 1959, p. 6 . This definition modified an earlier one by the addition of the words "and infections". The addition was criticized as being too wide , but the Committee decided in a later Report (TRS 378, 1 967) not to modify it. 46 2 I NDEX The main entries in the Glossary a r e und e rlined. For othe r t e r ms references are given to the main entry in which they a ppear . abortion, 13 abortion rate : abortion, 1 3 abortus: abortion, 13 accident, 15 action research, 16 activity, 17 activity studies, 18 acute (disease, illness), 19 addiction-forming drug: addiction-producing drug, 20 addiction-producing drug , 2 0 adequacy, 21 administration, 22 administrative resear ch: research, 346 admission (to hospital), 25 admission rate: admission, 25 advanced nursing education: nursing education, 252 adverse rea c tion (to a drug), 26 age-specific birth rate: birth rate, 46 age-specific fertilit y r a te: fertility rate, 142 age-specifi c mortality rate: mortality, 237 aide: aµxiliary personnel, 35 air pollution, 27 alcoholism, 28 allied health professions: auxiliary personnel, paramedical (professions), 35, 27 6 a lpha alcoho lism: a l coho lis m, 28 ambul atory care, 30 anal y tical epidemiology: e pidemio log y, 132 anci ll a r y : auxili a r y p e rso nne l, 35 app r a is a l: evaluation, 1 35 a ppropriateness, 3 1 arithmeti c ave r age / mean: ave r age, 37 assessment : evalu a t ion, 1 35 assistant : auxiliary personnel, 35 assistant nurse : auxili ary nursing personne l , 34 attendance : consultation, 6 7 audio logy, 32 autom ation, 33 auxiliary dental p e rsonnel: denta l auxiliary , 92 auxiliary nurse : aux iliary nurs i ng personne l, 34 auxiliary nursing p e rsonne l, 34 auxiliary p ersonne l , 35 auxili a r y worker : a uxiliary p e r sonnel, 35 average , 3 4 backwardness: mental retardation, 229 bacteriology, 39 baseline (data, etc .), 40 basic health s e r vices : health servi ces , 180 basic medical education : medical education, 222 463 b a sic medic a l sciences, 41 b as i c nursing education: nursing education, 252 basic r e search: research, 346 basic tr a ining: training, 38 2 bed, hospital, 42 chemical pathology: p athology , 280 chi ef admini str ative denta l officer: d enta l adminis tra t0r, 91 child guidance, 54 child guidance centre, 55 child health doctor, 56 bed complement: bed, hospital, 42 chronic (disease, illness), 57 bed occupancy, average: bed1 hospital, 42 b e d occupa ncy rate: b e d, hospital, 42 bed/popula tion ratio: b ed , hospit a l, 42 -- b e d turnover: bed, hospital, 42 bed turnover interval: bed, ho spital, 42 beha vioura l sciences, 43 beneficiary, 44 beta alcoholism: alcoholism, 28 billion, 45 birth: live birth, 205 ; s ti llbir th, 372 birth cohort: cohort, 58 birth control: family planning, 138 birth r a t e , 46 budget, 47 budgetary control, 48 capital expenditure, 49 capitation, 50 case fatality rate: morbidity r a te/ ratio, 236 case-finding, 51 central birth rate: birth r a t e, 46 centralization, 52 chairside assistant, 53 chronic alcoholism: alcoholis m , 28 client group: p a tient care, 282 clini cal assi stant, dental: chai rs ide a ssistan t, 53 clinical medi c al educ a ti on : medical education , 222 clinical pathology: patho l ogy, 280 clinical r esearch : r e search, 346 cohort, 58 cohort ana lysis, 59 community , 60 community c are , 6 1 community dentistry: community medicine, 63 community health, 62 community health care: community health , 62 community medicine, 63 completed ferti lity rate: fe rtil ity rate, 1 42 c omposite fami l y : family , 1 37 comprehe nsive health care: health c a re, 1 64 comprehensive medicine, 64 compr ehensive monitoring: drug monitoring, 122 congenital , 65 congenital anomaly: congenital, 65 congenital di sorde r: congenital, 65 464 congenital m alformation: congenital, 65 connatal: congenital, 65 constraints, 66 consultation, 67 consumption (of medical care) 69 decentralization, 86 d e duct i ve pl a nnin g : pl a nning, 292 defici e n c y disea s e , 8 7 d e linquency, 88 Delphi method , 8 9 delt a a lcoholi s m: a lc oholism, 28 dem a nd: n e ed / d e m a nd, 241 continuing medical e ducation : m e dical e ducation, 222 demographic data: statistics, 37 0 contrac e ption: family planning, 138 demogr a phic s t a tistics: statistics, contributor: i nsured person, 1 93 control, 70 cost-benefit analysis, 7 1 cost-effective ness ana lysis, 72 cost-efficiency, 7 3 costing, 7 4 costs, 7 5 coverage, 76 covered person: insured p e rs on, 193 criterion: norm, 246 critical path analysis, 77 crude birth rate : birth r ate , 46 crude mprtality rate: mortality, 237 cybernetics, 78 data bank, 79 data processing, 80 day care, 81 day care centre, 82 day care programme, 83 day hospital, 84 day nursery: day care centre, 82 day patient, 85 day patient facilities: d a y patient, 85 37 0 d e nt a l, 90 d e ntal a dministra tor , 91 d e nta l assista nt : cha irside assi s ta nt, 5 3 d e nt a l a uxili a ry, 9 2 dental a uxili a ry p e r s onne 1: dental auxil ia ry, 9 2 d e nt a l hea lth, 9 3 dental h e alth educ a tion, 94 dental h e alth ser vic e s, 95 denta l hea lth team, 96 dental hygi e ni s t, 97 dental laboratory technician, dental nurse , 99 dental practice , 1 0 0 dental practitioner : dentist, 98 1 01 dental public h e alth services: dental health services, 95 dental surgeon: denti s t , 1 01 dentist, 1 01 d e p endence- producing drug, 102 deputizing service: emergency call s e r vic e , 1 28 descriptive epidemiology: e pidemi- ~ 132 diagnostic radiologis t: radiologist, 336 465 diagnostic radiology : r a di at ion medicine, 335 diet, 1 03 direct cost: costs, 75 direct (pattern of providing m e dical care), 104 dis ab ility, 105 disability rate : morbidity rate/ ratio, 236 disabl e d person, 1 07 disablement: disability, 1 05 disabling illn e ss, 108 discharge (from hospital), 1 09 di sin s ection , 110 disinsectization : disinsection, 110 dispensary, 111 district physician, 112 doctor : physician, 287 domiciliary care : hom e care, 1 84 domiciliary consultation: consultation, 67 double - blind tria l, 11 3 drug, 114 drug abuse, 116 drug addiction , 117 drug control, 118 drug dependence, 11 9 drug habituation, 121 drug monitoring, 122 early abortion : abortion , 13 early disease detection, 123 early fetal death : fetal death, 143 early neonatal death: infant mortality, 1 89 early neonatal mortality: infant mortality, 189 early neona t a l mortality r a t e : in fan t mortality, 1 89 economic, l 24 edu cative ac tiviti e s: ed uc ation , 94 effect , 12 5 dental he a lth effectiveness/ e fficacy / efficiency, 1 26 emergen cy c a ll s ervic e , 128 environmental health, 129 environmenta l health officer : s a nit a ry inspe ctor, 355 environment a l sanita tion: en viron- m e ntal health, 1 29 epid emiologic a l r e s ea rch: research, 346 e pid emio l ogical surveillance, 1 30 e pid emio l ogica l sur ve y, 1 31 e pi demiology, 1 32 ergonomics, 134 evaluat i on , 1 35 evaluation a l re sea rch: evaluation , 1 35 evaluative research: evaluation, 13 5 exce ssi ve dr inkin g : alcoholism, 28 exp erimenta l epidemiol ogy : epidemiology, 1 32 family, 137 family doctor: general pr a ctitione r, 1 54 family physic ian: gene ral practitioner, 1 54 family planning, 1 38 fecundity: fertility, 1 41 feebl e -mindedness: mental r e - t a rdation, 229 feedb a ck, 139 fe e -for-s e rvice, 140 466 fee schedule: fee -for-service, 140 fertility, 141 fertility rate, 142 fetal death, 143 fetal death rate: fetal d eath, 143 fetal mortality rate: feta l death , 143 field trial, 144 file: data pro ce ssing , 80 fixed cost: costs, 7 5 foetal: see fetal death , 143 food, 165 \ '--1, food additive, 146 food-borne disease, 147 food handling , 148 food hygiene , 149 food poisoning , 150 food standards , 151 forecast: projection, 315 function, 152 fun c tional costing: output budgeting , 2 7 4 functional relations: line re - lationships . 2 04 functioning: organization, 268 gamma alcoholism: alcoholism, 28 general fertility rate: fertility rate , 142 general health servi ces: health services, 180 general hospital: hospital , 185 general practice, 153 general practitioner, 154 general r adiologist : radiologist, 336 geometric average/mean: average, 37 geriatric home, 1 56 geriatrics , 157 gerontology : geriatrics, 157 goal: obje c tive , 261 graduate (medical ) training: medical education, 222 gross national produ c t, 158 group practice, 159 guide: norm, 246 guideline: no rm , 246 habit-forming drug, 161 half-way house, 162 handicap: disability, 105 handicapped person: disabled person, 1 07 health , 163 health ca re , 164 health care professions : paramedical (pro fessions ) , 276 health centre, 165 health demands: need/demand, 2.41 health education, 167 health educator, 168 health information system , 169 health infrastructure , 17 0 health inspector: sanitary inspector, 355 health insurance, 171 health l abo ratory service, 17 2 health manpower, 17 3 health manpower planning, 17 4 health needs: need/demand, 241 467 health planning , 17 5 health pra c ti ce, 176 health pra ctice resear ch, 177 health profile , 17 8 health prote c tion, 17 9 health servi ce s, 18 0 health servi c e statistics: statistics, 3 7 0 health service system, 181 health statisti c s: statistics, 37 0 health status , 182 health survey, 183 home ca re , 18 4 hospital, 185 hospital bed: bed , hospital, 42 household: family, 1 3 7 human resour ce s: manpower , 2 1 5 idealisti c planning: planning, 2 92 idio cy : mental retardation, 229 illegal abortion: abortion, 13 illegitimacy ratio: birth rate, 46 illegitimate birth rate: birth rate , 46 illness: morbidity, 235 imbe cile: mental retardation, 229 immature: prematurity , 299 impairment: disability, 105 impressionistic planning: planning , 292 incapacitating illness: disabling illness, 108 incapacity: disability, 105 incidence , 187 incidence rate: incidence, 187 index, 18 8 indi cative planning : planning , 292 indica tor: index, 188 indir ect (patte rn of pro v iding medical care): direct attern of rovidin medi c a l care , 1 04 individu a l pr ac ti ce : gene ral practi c e, 1 53 individu a l reporting: drug monitoring, 122 indu ced abo rtion: abortion, 13 indu ct i ve planning: planning , 2 9 2 industrial health: occupational h ealth , 26 3 infant death: infant mortality, 189 infant mortality, 189 infant mortality rate : mortality, 189 infant infe cundity: fe rtility , 141 infertility : fertility, 141 information s y stem: h ealth informa- tion system, 16 9 ; management in- formation sys tem, 212 in - p atient, 19 1 in-patient facilities: in-patient, 191 input, 192 in -se r vice training: training, 382 insured person, 193 integrated health services , integration, 194 integration, 194 intensive care, 195 intensive ca re unit, 196 intensive monitoring: drug monitor- ing, 122 intensive nursing care: intensive care , 195; nursing care, 251 468 intensive therapy: intensive care, 195 intensive therapy unit: intensive care unit, 196 intermediate area, 197 intermediate care : progressive patient ca re , 313 intermediate feta l death: fetal death, 143 intermediate health administration, 19 8 intermediate hospital: hospital, 185 invalidity , 199 item-of-servi ce : fe e -for- service, 140 job, 20 1 job analysis, 202 job description: job analysis, 202 job evaluation: job analysis , 202 job specification: job analysis , 202 joint family: family, 137 late abortion: abortion, 13 late fetal death: fetal death , 143 lateral relations : line relation- ships , 204 legal abortion: abortion, 13 legitimate birth rate: birth rate , 46 linear programming , 203 line relationships , 204 live birth , 205 live birth rate: birth rate , 46 local health area, 206 lo cal health unit, 2 07 local hospital: hospital , 185 long-term ca r e, 208 long-term planning: planning, 292 low birth weight: prema turity, 299 macro planning: planning, 292 management: a dministr at ion, 22 management accounting , 2 09 management by exception, 210 management by obj ective s , 211 management information system, 212 management t e chnigues, 2 1 3 management t echnologist, 214 manpower , 215 margina l cost : co sts , 7 5 marriage coho rt; cohort, 58 mass campaign, 216 mass s c reening: s c r eening, 3 37 maternity care, 21 7 mathematical model: model, 233 mean: ave r age, 37 mechanization: automation, 33 median : average, 37 medi cal advice, 218 medical ass ist a nt, 2 19 medical audit, 220 medical bacteriology : bacteriology, 39 medical care, 221 medical education, 222 medical physics , 223 medical prac titioner: physician, 287 medical re cord linkage: record linkage , 338 469 medical rehabilitation: rehabilita- tion, 344 medi cal s chool, 224 medi cal so cial work: 367 so cial work, medium-term planning: planning , 292 mental defe ct: mental retardation, 229 mental defi c iency: mental re- tardation, 229 mental dis a bility : mental tion, 229 mental disorde r , 225 mental handi c ap: mental tion, 229 mental health, 226 mental hygiene , 227 mental illness, 228 mental retardation, 229 retarda- r eta rda- mental subnormality : mental re - tardation, 229 method study : work study, 390 mi c robiolo gy: pathology, 280 mi c ro planning: planning , 292 midwife, 231 milliard: billion, 45 minimal care: progressive patient ~' 313 miscarriage, 2 32 mode: average , 37 morbidity r ateiratio, 236 morbidity survey: health m oro n: mental retardatio survey, 18 3 n , 229 mortality, 237 mortality rate: mortality , 237 motion and time stud y : work study, 390 motion study: work study , 390 multiphasic s c reening: s creening, 3 5 7 multiple screening: sere multi- step screening: SC ening, 357 r eening, 357 national development plan national health planning: planning, 1 7 5 national health servi ce, 2 need i demand , 241 neonatal death: infant mo ning, 239 health 40 neonatal mortality: rtality, 189 mortality, infant 189 neonatal mortality rate: i nfant mortality , 189 network analysis, 242 night hospital, 243 night hostel, 244 nomenclature: fee-for-se rvi ce, 140 non-medical use of drugs, 245 non-operating dental auxil iary: d ent al auxiliary, 92 model, 233 ~, 114 non-proprietary drug : dr monitoring , 234 moral defe c t: mental retardation, 229 morbid condition: morbidity , 235 morbidity, 235 norm, 246 normative: norm, 246 normative planning: plan ning, 292 notification: regist ration o f disease , 343 470 nuclear fami l y : family , 137 nuclear medicine: radiation medicine, 335 nuclear medicine specialist: radiologist, 3 36 ~. 248 nursery school: day care centre, 82 nursing, 249 nursing aide: auxiliary nursing personnel, 34 nursing audit , 250 nursing auxiliary: auxiliary nursing personnel , 34 nursing care , 251 nursing care team: nursing p ersonnel, 254 nursing education, 252 nursing home, 253 nursing personnel, 254 nursing personnel system, nursing pra ctice, 256 nursing service, 257 nutrition, 258 nutritional disorder , 259 nutritional status, 260 0 and M: organization and methods, 269 objective , 261 occupational health, 263 255 oc cupational phy siology : oc cupational health , 263 o ccupational ps ychiatr y : occupational health, 263 o ccupational psy chology: o ccupational health , 263 o ccupational therapy, 264 odontostomatological: dental , 90 old age, 26 5 oligophrenia: mental retardation, 229 on-the-job training: training, 382 operating dental auxiliary : dental auxiliary, 92 operational rese a rch , 266 opportunity cost: costs, 7 5 oral health : dental health, 93 organization, 268 organization and methods , 269 out come, 27 0 out-patient , 271 out-patient care : out-patient, 271; progressive patient care, 313 out-patient clinic/department, 27 2 out-patient facilities: out-patient, 271 output, 27 3 output budgeting, 27 4 over-the- counter drug: drug , 114 paediatri cs, 27 5 paramedi cal (professions), 276 oc cupational hygiene: occupational health, 263 parameter , 277 occupational medicine: occupational health, 263 occupational pathology : occupational health, 263 ~' 278 partnership , 279 pathological physiology: pathology, 280 471 pathology, 280 patient, 281 patient care, 282 patient care group: patient care, 282 percentage: rate / ratio, 338 performan ce budgeting: output budgeting , 27 4 perinatal death: infant mortality, 18 9 perinatal mortality: infant mortality, 189 perinatal mortality rate: infant mortality, 189 period cost: costs , 7 5 p eriod pre valence : prevalenc e , period prevalence rate: prevalence, 301 personal health services , 283 p ersonal preventive services : preventive services, 304 plan, 291 planning , 292 planning-programming-budgeting system: PPBS, 298 point prevalence : prevalence, 301 point preval ence rate: prevalence, 30 1 point prevalen ce survey: prevalence, 301 pollution: air pollution, 2 7 ; water pollution, 389 polyclini c, 294 populatio n, 295 population l a boratory, 2 96 population monitoring: drug 3 0 1 monitoring , 12 2 population survey : epidemiological survey, 1 31 post-basic nursing education : nursing edu cation, 252 post-basi c training : training, 382 p ersp ective planning: planning, 292 post -basic training, medical : PERT , 284 pharmaceutical preparation: drug , 114 p harmaceutical specialty: drug, 114 physi cal dependence: dr ug dependence , 119 physical fitness, 285 phys ical medicine, 286 physi cian, 287 phy si cian of first conta ct: physi cian, 287 physiology, 288 physiotherap y, 289 pilo t programme, 29 0 medical education, 222 postgraduate medical education: medical education, 222 postgraduate nursing education: nursing education, 252 postgra duate training, medi cal : medical education, 222 post-neonatal death: infant mortality, 1 89 pos t-neonatal mortality : infant mortality, 189 post -neonatal mortality rate: infant mortality, 189 po st- partum p eriod, 297 pos t-term: pre-term, 300 PPBS, 298 472 pra ctitioner: physician, 287 pre- clini cal medical e du cation: medical education, 222 prematurity , 2 99 pr esc ription drug: drug , 114 pre-te rm , 300 pre valen ce , 30 1 prevalen c e r a te: prevalence, 3 01 pr evention: preventive medicine, 302 preventive medicine, 302 pre v entive servi ce s , 304 primary care , 305 primary ca re centre, 307 primary health c ar e : primary care, 305 primary medical care: primary care , 305 p r imary medicine, 308 primary physician, 309 primary prevention: pre ventive medicine, 302 probability sampling: sampling , 351 problem s yndrome: drug a bus e, 116 professional, 310 professional training, medical: medical education, 222 programme , 311 programme budgeting: output budgeting , 2 7 4 programme evaluation and review technique: PERT, 286 programme-performance - budgeting system: PPBS, 298 programme plan: programme , 311 47 3 programme planning: programme, 3 11 programming, 312 progr essive p atient care, 313 proj ect, 3 14 proj ect systems analysis, 3 16 proj ection, 3 15 prophy l actic dispensar y : dispensary , 111 proportion: rate / ratio , 337 proprietary drug: drug, 114 prospective research: research, 346 prote cted p erson : insured person, 193 prot ected residence, 317 ps ychiatric illness: mental illness, 228 psychiatric morbidity: mental illness , 228 ps ychic dependence: drug dependen ce , 119 psy chogeriatrics, 318 ps ychological dependence: drug dependence, 119 ps ychosomatic, 3 19 ps ychotro pi c drug , 320 public dental health servi ces: dental health servi ce s , 95 publi c health, 321 publi c health field studies , 323 public health nurse, 324 publi c health nursing, 325 publi c health offi cer, 326 public health ophthalmology, 327 public health physician, 328 public health practice: health practice, 176 public health, school of, 329 public health training, 330 public relations , 3 3 1 puerperium: post-partum period , 297 purposive sampling: sampling , 351 queu eing theory , 333 radiation medicine, 335 radio-diagnostician: radiologist , 336 radiolog y, diagnostic: r adiation medicine, 335 radiotherapist: radiologist , 336 radiotherapy: radiation medicine, 335 random sampling: sampling , 351 rate / ratio , 3 37 record linkage, 338 referen ce man / woman , 339 region, 340 regional hospital: hospital, 185 regionalization, 342 regional planning, 341 registration (of dise ase ), 343 rehabilitation, 344 rehabilitative services, 345 replacement cost: costs, 7 5 research, 346 resear ch and development , resour ces, 348 347 retrospe ctive research: research, 346 roentgenolo gist: radiologist, 336 safety (of a drug ), 349 sample , 350 sampling, 3 51 sampling unit, 3 52 sanitarian: sani tary inspector, 355 anitary inspector, sanitary aide: s 355 sanitary as sis ta nt: sanitary inspector, 355 sanitar y bacteri olog y : bacteriology, 39 sanitary enginee r , 3 53 ion, 3 54 or , 355 sanitary inspe c t sanitary inspe c t satisficing , 356 s chool dental nu rse: dental nurse, 99 screening, 35 7 se condary care, 358 se condary medi cal care: secondary c are, 358 se conda ry preve ntion: preventive medicine, 302 sele c tive place ment, 359 sele c tive s c reen ing: screening, 357 r es sive pati ent care, self-care: prog 313 self-e valu at ion research: research, 346 senescence : old age, 265 short-term plan sickness: 1no rb ning: planning, 2 92 idity , 235 sickness insura nee: health insuranc e, 1 7 1 simulation, 360 474 simulation mo del: simulation, 360 ; model, 233 single-blind trial: double-blind trial, 11 3 situation analysis , 361 social assistance, 362 social insurance , 363 social medi c ine, 36 4 social psychiat ry , 365 social rehabilitation: rehabilitation, 344 so c ial se curity , 366 stomatological: dental , 90 stomato logist , 37 3 strategic planning : planning, 292 s tru ctu re: organization, 26 8 surgery consultation: consultation, 67 system, 3 7 4 systems analysis , 37 5 systems design, 377 systems r e s ea r c h, 37 8 social work , 36 7 ta c ti cal planning: pl anning, 2 9 2 somatops ychi c : psy cho somati c, 319 specialist , 368 spe cialist in health education· h ealth edu cator , 16 8 • spec ialist pra c ti ce : specialist , 368 specialized hospital: hospital , 185 speech therapy , 369 spontaneous abortion: abortion, 13 spontaneous monitoring: drug monitoring, 122 staff relations: line relationships , 204 standard: norm, 246 standard cost : costs, 7 5 standard costing: costing , 7 4 standardized birth rate: birth rate, 46 stati stics, 37 0 sterility: fertility , 141 stillbirth, 3 7 2 stillbirth rate: stillbirth, 372 target: objective, 26 1 task , 37 9 team , 380 team prac ti ce : te am, 380 teamwork: team, 380 term: pre-te rm , 300 tertiary ca re: secondary ca re , 358 terti a r y medical care: se condary care, 358 t e rtiary pre vention: preventive medicine, 302 th e r a peuti c abortion: abortion, 13 time and motion study: work study, 390 tol e r ance, 381 total abo rtion r a te: abortion, 13 total birth rat e : birth rate, 46 total fertility r a te: fertility rate , 142 training, 382 trillion: billion, 45 undergraduate education, medi cal: medical education, 222 47 5 unit costing: costing , 7 4 universe , 383 valid ity, 385 variable cost: costs , 7 5 ve terinary p ub li c health , 386 visi t: consultation, 67 vital event : vital records , 387 vital re cords , 38 7 v ital statisti c s: vi tal re cords , 387 vo cational counselling , 388 vocational guidance: vocational couns e lling , 388 vocational rehabilitation: rehabilitation, 344 vocational training , medi cal: medical education, 222 water pollution, 389 weighted average / mean: average , 3 7 work measurement: work study, 390 work study , 390 youth advisory servi ce, 39 1 zoonoses , 393 476 1111111 11111 11111 11111 1111111111111 11 1111111111111 .. n n n n 7 r:; 1 7 .. lllll~lllllllllllllllllllllllllllllll~I II IIIII .. nnnn?i:;17 ..