CASWELL A. Evans, Jr, DDS, MPH, had a busy year in 1995. As president of the American Public Health Association (APHA), he presided over the nation's largest organization of public health workers and teachers at a time when federal assistance to state and local public health agencies was being scaled back and managed care organizations were beginning to compete with local agencies for publicly and privately insured patients.
Closer to home, where Evans serves as Director of Public Health Programs and Services for Los Angeles County, the public health infrastructure was quaking. California voters approved Proposition 187, a statewide initiative to deny public services to undocumented immigrants, sending a tremor through this community (JAMA. 1995;273:1642-1643). An injunction barred implementation of the new law and required all health care institutions and medical offices to post notices that care would be provided without scrutiny of immigration status, but the issue awaits final