Brown examines health care system

by Emily Laidlaw '02

Brown

heodore Brown, chair of the history department and professor of community and preventive medicine at the medical school, recently completed a video project sponsored by the National Library of Medicine. "Health Services Research: A Historical Perspective" examines the relatively new field of health services research and its importance to the American public.

Brown currently is editing a new series of books on the history of public health for the University of Rochester Press and is a co-contributing editor for the American Journal of Public Health. He also serves as a member of the executive committee and advisor for the Health and Society Program, and is professor of medical humanities.

What exactly is health services research?

Health services research is a field of study that examines the organization, financing, dynamics, and effectiveness of the health care system based on the assumption that we don't always know if health services are doing what they claim they're doing. The field attempts to understand the various settings in which care is delivered and determine how those systems of delivery can be most efficiently and effectively organized.

What is the purpose of the video project for the National Library of Medicine and how did you become involved?

The National Library of Medicine was required by congressional mandate in the early 1990s to promote public knowledge of the field of health services research. The Library eventually decided that a video history of the field would help the public better understand its importance. I was asked to become involved in early 1999, after a number of attempts had failed to turn out a video that the library was satisfied with.

I felt that before I could set to the task of actually writing a script, however, I needed to learn the history of the field myself. So I researched the field in primary and secondary documents and read all the material the library turned over to me. I then summarized what I felt was a coherent story in an essay of a dozen pages or so, and then moved on to writing the script. This process involved writing the narrator's text and interweaving clips from already taped interviews, arranging additional interviews to fill gaps, and coming up with recommendations about the visuals.

The final version was done in June 2000, and the feedback I've gotten from the National Library of Medicine is that people in the field are very pleased with the video. They feel it is so effective that it will be useful when they lobby Congress for additional funds for the field, and I hope it will be. I feel that it tells an important story, and if it tells a story in a way that's persuasive to Congress, so much the better.

Can you talk a bit more about the importance of health services research and what the resulting data is used for?

The research should be important because it will tell you how you can get the most valuable output for whatever input of resources. But the resulting recommendations of health services research aren't necessarily translated into health policy. There is often this frustrating sense that there are these wonderful insights coming out of the research but decisions are being made on political criteria, and thus aren't always implemented. Politics plays a large a role in health policy, often with not enough attention being paid to results of health services research. So one of the big questions in the field is how we can make those who set health policy take notice of the results of our research.

Can you discuss the new book series you're editing for the University of Rochester Press and what audience it targets? Will it complement the video in any way?

The book series is pretty disconnected from the video project, in that it focuses on more distant, historical developments in the history of public health going back to the 19th and early 20th century. So although I think it's legitimate to consider health services research under the umbrella of public health, there's really not much overlap between the two projects.

In doing the book series, we decided to focus on an area within the history of medicine that other university presses aren't dealing with. We have a number of books in progress right now and should have a couple of volumes out in the next year or so.

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