the nation.

According to former Commissioner of the Department as a major force on New York's

Lowell Bellin, the Department "has been cited
In some localities, health depart-
ments are the only providers of such
services as family planning, mater-
nal and child care, home care,
school health and chronic disease
programs
in American Schools of Public Health as an Olym-
pus of professional excellence." (9). Historically,
it was the nation's largest local health depart-
ment, and was instrumental in the introduction
of many public health innovations, especially
in the realm of free personal services.
Because of its distinguished record, the Depart-
ment has enjoyed wide respect both locally and
nationally. Many of its programs and innovations
were widely copied and indeed many of its admini-
strators went on to head other health depart-
ments throughout the country.
Since 1974, however, a combination of
three factors has led to the virtual dismantling
health scene:
1. the serious ramifications of the fiscal crisis;
2. the philosophical opposition by the Depart-
ment's Commissioners to providing direct
personal services; and
3. the steady erosion by the New York State
Health Department of the City Depart-
ment's regulatory and standard setting
functions.
In Commissioner Bellin's view, a great many
public health services are already delivered in the
private sector, and this shift toward private care
is occuring throughout the country. Similarly,
Commissioner Imperato felt that DOH should
only provide services where there were no other
providers available. They argued that DOH facili-
ties were never meant to be comprehensive, and
that a growing number of the poor and indigent
were already using hospitals, Neighborhood Health
Centers, Neighborhood Family Care Centers and
related facilities that provide more comprehensive
care.
Both Commissioners saw the fiscal crisis as a
result of too many city services. In Dr. Imperato's
view, the fiscal crisis resulted from rising costs
of services combined with a shrinking tax base (6).
As he saw it, the influx of poor people demanding

Table 2

Distribution of Budget Cuts and Their Impact (New York City Department of Health, 1974-1978)

Clinics and Personal Health Services Number of Facilities % Reduction Patient Visits % Change
July, 1974 Jan., 1978 FY 73-74 FY 77-78

Child Health Stations and Pediatric

Treatment Centers 78 57 -27 330,163 305,985'
Dental Health (including school
clinics) 191 138 -30 217,470+ 45,920 -79
School Health (all levels) 1,537 1,300 (est.) -15 197,716 115,966 -41
Chest (tuberculosis and Combined) 26 16 -38 193,407+ 156,233 -19
Venereal Disease 14 12 -14 174,635 196,087 + 11
Eye 21 8 -62 29,047 16,020* -45
Tropical Disease 4 3 -25 24,571 + 14,450 -41

+Fiscal Year 1974-5

*Fiscal Year 1976-7

Sources: Mustalish, A.C. Working Paper for the Health and Hospital Corporation Considering the Assumption of Opera-
tional Responsibilities of District Health Services of the New York City Department of Health. New York:
Health and Hospital Corporation, May 1978.
14 Nestlebaum, Z. Review of Department of Health documents.