David and Goliath in development: small communities versus giant enterprises.
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Data emanating from the community services component of the Third National Study of Public Spending for Mental Retardation and Developmental Disabilities was analyzed. An empirical model of community services spending in the states was tested in a hierarchical regression analysis using cumulative community services fiscal effort in the states across 1977-1988 as the dependent variable. Strength of consumer advocacy organizations in the states coupled with states' historical orientations toward the adoption of policies promoting racial equality were highly significant predictors of state-by-state variance in community spending patterns. The implications of this and other findings emerging from the national study were discussed.
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The high incidence of eye abnormalities among blacks, coupled with the relative unavailability of ophthalmic services, has resulted in excessive rates of blindness otherwise preventable or curable. As a consequence, incidence rates for blindness are higher for the black population than the white population.Statistics show that black children requiring eyeglasses are less likely to receive eyeglasses than similar age-matched white children. In virtually every state surveyed, blacks were more frequently and severely afflicted with eye diseases and were less likely to receive treatment than whites. Yet, no programs exist in any state specifically targeted to promote eye care among blacks and reverse the ever-worsening trend. Additional data characterizing the scope of the problem shall be presented.An initial strategy for approaching the problem, namely, community ophthalmology, has been developed. Community ophthalmology represents a new discipline promoting eye health and blindness prevention through programs utilizing methodologies of public health, community medicine, and ophthalmology. Basically, the use of community ophthalmology strategies is critical to positive out-come, when given a population composed of blacks and other minorities who are chronically underserved with regard to all sectors of health.The evolution and rationale for these concepts are discussed from national, as well as international, perspectives.
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