Public Health in a Retrenchment Era

An Alternative to Managerialism

By Helen J. Muller & Curtis Ventriss

Series: SUNY series in Public Administration
Paperback : 9780873959865, 162 pages, June 1985
Hardcover : 9780873959858, 162 pages, June 1985

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Table of contents




1. The Challenge for Public Health


Retrenchment as an Opportunity

Brief Historical Overview

Values of the Public Health Tradition

Human Service Organization Characteristics

Contemporary Organizational Issues

Contemporary Health Policy

Underlying Values of Retrenchment

The Challenge

2. Retrenchment: A Conceptualization


The Context

The Retrenchment Process: A Critique of the Levine Model

A Political-Ideological Model of the Retrenchment Process

Towards an Alternative Retrenchment Model: A Theoretical Construct

Co-Possibility Strategies: A Brief Theoretical Overview


3. The Los Angeles County Experience

The Los Angeles County Department of Health Services

Policy Making and the DHS

Evolving Fiscal Problems

The County Health Budget

Private Sector Contracting

Concluding Comments

4. Consequences of Cutback Management

Citizen Action

Martin Luther King, Jr, General Hospital

Pacoima Health Center

5. An Alternative: Investing with People

Lessons from Los Angeles

Alternative Frameworks for Service Delivery

The Managerial Disposition

Co-Possibility Strategies

A Model



Research Strategy

Events Attended





Public Documents and Reports: County of Los Angeles

Public Documents and Reports: Other

Other Written Materials



Public Health in a Retrenchment Era illustrates the political and economic reality of making cutbacks in traditional government-sponsored programs. This book critically examines the issues concerning cutbacks by focusing on Los Angeles County, which has one of the largest public health service systems in the nation, and explains how cutbacks were legitimized and implemented.

Muller and Ventriss propose that the retrenchment process offers an opportunity for policymakers and citizens alike to critically examine new choices which may not have existed in periods of fiscal expansion. They criticize the present focus on managerialism and propose an alternative approach. Called the co-possibility model, it enhances a more humane and substantive policy approach in making cutbacks. This model links the citizen, policymaker, and public organization in a new relationship, fostering an environment for policy experimentation and innovation in this retrenchment era.

Helen J. Muller is Assistant Professor at the University of New Mexico's Anderson School of Management. Curtis Ventriss is Associate Research Scientist; Program Director, Urban Planning and Policy Management Program; and, Academic Director, International Fellowship Program at the Center for Metropolitan Planning and Research, The Johns Hopkins University.


". imaginative and important contribution to the field of public administration and public policy. The authors' co-possibility model is a creative alternative to the orthodox bureaucratic doctrine for managing organizational retrenchment. " — William G. Scott, Professor, University of Washington at Seattle, Co-author, Organizational America

". ..a first rate critique of management and policy issues posed by public sector and health services retrenchment; examines the human consequences connected with managing fiscal cuts; the authors propose a unique problem solving model which challenges managers, policy makers and citizens to work together in resolving social problems—perhaps even to use retrenchment as an opportunity to form new coalitions less possible in periods of expansion. " — Robert P. Biller, Executive Vice Provost, University of Southern California