AGENCY HEARINGS

THURSDAY, MARCH 2, 1967

HOUSE OF REPRESENTATIVES,

COMMITTEE ON INTERSTATE AND FOREIGN COMMERCE,

Washington, D.C. The committee met at 10 a.m., pursuant to notice, in room 2123, Rayburn House Office Building, Hon. Harley O. Staggers (chairman) presiding.

The CHAIRMAN. The committee will come to order.

Yesterday we had the Health, Education, and Welfare Department with us. This is a continuation today with some of our most important people in the health field.

I made the statement yesterday, Mr. Surgeon General, that the Greeks promoted the idea of a sound mind and a sound body. We are certainly trying to promote that idea today. Certainly the health of the Nation is important.

Today is the second day of these hearings on the agencies and I think they have been very informative.

There is also an old adage that the most successful person in life is the person who has a good clean conscience and good health. Now I believe in that, and I believe that in America if we can get to that point of view we probably would be better off.

Today we are scheduled to hear from Dr. William Stewart, the Surgeon General of the Public Health Service. Dr. Stewart is accompanied by the chiefs of the various bureaus of the Department established under the recent organization of the Public Health Service.

Dr. Stewart, we are pleased to have you with us today and you may present your testimony in your own fashion.

STATEMENT OF DR. WILLIAM H. STEWART, SURGEON GENERAL, PUBLIC HEALTH SERVICE; ACCOMPANIED BY DR. MARTIN M. CUMMINGS, DIRECTOR, NATIONAL LIBRARY OF MEDICINE; DR. LEONARD FENNINGER, DIRECTOR, BUREAU OF HEALTH MANPOWER; DR. FORREST E. LINDER, DIRECTOR, NATIONAL CENTER FOR HEALTH STATISTICS; DR. RICHARD A. PRINDLE, DIRECTOR, BUREAU OF DISEASE PREVENTION AND ENVIRONMENTAL CONTROL; DR. JAMES A. SHANNON, DIRECTOR, NATIONAL INSTITUTES OF HEALTH; DR. CARRUTH J. WAGNER, DIRECTOR, BUREAU OF HEALTH SERVICES; DR. STANLEY F. YOLLES, DIRECTOR, NATIONAL INSTITUTES OF MENTAL HEALTH

Dr. STEWART. Thank you, Mr. Chairman.

Mr. Chairman and members of the committee, it is a pleasure and a privilege for us to appear before this committee to discuss with you

the mission, structure, and operation of the Public Health Service. This opportunity is particularly welcome because of the leadership and guidance this committee has provided over the years in reshaping the Federal contribution to the health of the American people.

The committee has sensed the rising aspirations for health on the part of the public we serve. It has understood the implications of the great explosion of biomedical knowledge in recent years. And it has been instrumental in designing programs which enable the Federal Government to add its great strength to the American health partnership, so that the people's aspirations may be met and health knowledge may be used for the benefit of all.

For this wisdom and foresight the American people are deeply in your debt. We in the Public Health Service owe to this committee a special measure of gratitude for the encouragement and guidance provided to us in planning and carrying out the recent major reorganization of the Service.

As you will note in the general presentation with which I plan to begin our discussion, ou major organizational components are now directly relevant to our primary missions as a Federal health agency. We are deeply appreciative of your assistance in realining our forces to meet our responsibilities more effectively and efficiently.

Now, with your permission, may I begin with a brief presentation of the Public Health Service as it exists today. It is our hope that this will provide a general background of understanding against which your specific interests and questions may be projected.

The Public Health Service today.

What are the needs of the American people? What is the role of the Public Health Service in the general partnership through which health care is brought to the needs of the Nation?

The needs can be basically identified, I believe, as:

Health care: To keep people well and to treat them when they are ill or injured: and

Health protection: To protect individuals and communities against disease, injury, and environment hazards.

There are two basic resources for meeting these needs:

Health knowledge: To find and unlock the biomedical secrets of the cause, prevention, and cure of illness; and

Health manpower: Professional workers in health and medicine, to provide care, protection, and new knowledge.

The health system of the United States involves the private physician, hospitals and nursing homes, universities-through medical centers and biomedical research laboratories, voluntary health agencies, and Government agencies, at the Federal, State, and local levels.

The Federal Government, over the years, has played a growing role in supporting and augmenting the efforts of all these partners.

The Public Health Service, of the Department of Health, Education, and Welfare, as the principal Federal health agency, is now deeply involved in:

Health care: Through programs of direct services to those people Congress has declared eligible for care, through studies of new methods of organizing and financing health care, and through support for services provided through public and private organizations. Health protection: Through programs for the control or eradication of diseases, and for protection against injuries and environmental hazards.

Health knowledge, through basic research in the biomedical sciences, looking toward the causes and prevention of disease, and through dissemination of new knowledge to the professions and the public; and

Health manpower, through programs of support for building teaching facilities, training health workers, and providing financial support for students of the health professions.

All the programs of the Public Health Service are aimed at better health for the American people along one of those major avenues. It was not always so, for the Federal role in health began modestly. The first involvement of the Public Health Service was in health care-for sick and injured seamen, beginning in 1798, in the administration of President John Adams, through what was known as the Marine Hospital Service.

Years later, we became concerned with health protection, when we were authorized to enforce quarantine laws, and began to cooperate with States and communities in the control of epidemic diseases.

Still later, as the science of medicine advanced, we began our involvement in health knowledge-with the establishment of this laboratory under the guidance of Dr. Joseph Kinyoun at our Staten Island hospital. From this small beginning we can trace the development of the National Institutes of Health.

And finally, in the supply of health manpower, by beginning to furnish skilled people to States during epidemics, and through the training of State and local health workers.

A milestone in public health came with the passage of the Social Security Act of 1935, which systematized assistance to the States through grants-in-aid for disease control programs, training of health workers and, on a limited basis, for health care.

The National Cancer Act of 1936, which established the National Cancer Institute, is another milestone, which set the pattern for our continuing involvement in the generation of new knowledge.

After World War II, Congress began to give increased responsibility to the Service, to help it support the many institutions and organizations working to meet the needs of the Nation in health. More than 50 major new programs were given to the Service:

In health care, through aid in hospital construction, in providing health services for Indians, and through such programs as community health services, and the recent comprehensive health planning amend

ments.

In health protection, through measures for the control of air and water pollution, the Vaccination Assistance Act, and in control of solid

wastes.

In health knowledge, through the creation of new institutes and research divisions at the National Institutes of Health, including the regional medical programs which seek to apply new knowledge in clinical situations.

And in Health Manpower: Through the Health Professions Educational Assistance Act, the Nurse Training Act, and the recent Allied Health Personnel Training Act, passed in 1966.

In addition, the Public Health Service gained new responsibilities in the field of mental health-an area in which all these four elements are brought together in a unified attack on one of our major health problems through programs to help build and staff community mental

health centers; to train special workers in mental health care; and to conduct research in special mental health problems.

With the help of this committee, the Service was recently reorganized more effectively to carry out its missions.

As reorganized on January 1, 1967, the major operating bureaus of the Service are the Bureau of Health Services, the Bureau of Disease Prevention and Environmental Control, the Bureau of Health Manpower, the National Institute of Mental Health, and the National Institutes of Health.

The total staff of the Service, which has doubled since 1944 from 17,000 to 35,000, includes over 350 occupational specialties-from doctors, nurses, and scientists, to animal keepers, glass-blowers, and

artists.

Permanent Public Health Service installations spread from coast to coast. The majority of our employees, in fact, work outside the Washington area in hospitals, clinics, and quarantine stations-in training and demonstration centers, in evironmental laboratories, and in Indian health centers.

American Indians and Alaskan natives are just one of the special groups that are beneficiaries of health care provided directly by the Service.

Merchant seamen still receive such care in Public Health Service hospitals.

Federal employees are also provided care through arrangements with other Federal agencies.

These are direct services so authorized by the Congress. The Service also works, however, by other means to plan for and develop better ways of providing health services to all Americans.

Grants are made for demonstration projects involving the provision of personal health services especially for the chronically ill and aged, and the mentally retarded.

Research into new methods of organizing and financing health services is carried out.

Grants are made for building hospitals and clinics, such as this 139bed general hospital-this 40-bed nursing home-or this public health

center.

Within this area of health care, the Public Health Service also has centered its emergency health program, which, with other Federal agencies and the States helps provide aid in large-scale disasters such as floods or hurricanes.

All these functions, related to the mission of health care, are carried out by the Bureau of Health Services. It is organized into eight divisions (see chart, p. 250), each of which contributes in a special way to our efforts in the provision of health care-this Bureau employs, about 13,000 people, and has a budget of over $500 million.

This is the Bureau which administers the programs of health care that we carry out for the Coast Guard, the Peace Corps, and the Bureau of Prisons.

Providing health care is, of course, only one important aspect of the total job. Protecting people against disease, against injury, and the hazards of the environment-is an equally important job for the health professions.

Today, through accepted medical and public health techniques, refined through the years, we can control, prevent, and in some cases, eradicate many of the communicable diseases, some of the chronic