In the ever-broadening field of public health it is becoming more and more evident that we must have comprehensive planning involving all agencies concerned in the provision of health services. It is also necessary that we provide for more training, both for those who plan and for those who provide service. In South Dakota our greatest difficulty has been the financing of our basic health programs and assistance is needed in this area rather than in the area of control of certain specific diseases. This assistance is especially needed at the local level. We therefore urge that favorable consideration be given to S. 3008, the provisions of which will make it possible for us to provide more and better health services to the citizens of our State. Sincerely, G. J. VAN HEUVELEN, M.D., STATE OF TENNESSEE, DEPARTMENT OF PUBLIC HEALTH, Hon. ALBERT GORE, Washington, D.C. DEAR SENATOR GORE: There has been introduced by Senator Lister Hill S. 3008, and I would like to strongly urge your favorable consideration of this legislation. This bill proposes a system of planning, programing, and budgeting for health in a manner which, I believe, will bring our Federal public health appropriations and legislation up to date. This reorganization is sorely needed. The bill as introduced by Mr. Hill needs some minor language change so as to require that the health officer of each State be a member of the planning agency in his State. There is another area of change that personally, I think would help the bill, but you will have to decide whether or not it will be constitutional. This would be a provision for areawide planning not only interstate but intrastate so that regions located in contiguous States could develop plans for an area wide service. (This may run into our constitutional prohibition against States making treaties without specific congressional approval.) In the bill there is a provision for incorporating the financial resources of nonprofit agencies into the general program. I believe that the bill would be materially strengthened if the statutes stipulated that such funds must be turned over to the Public Treasurer for disbursing. This bill is needed because at the present time we have a hodgepodge of categorical appropriations that make it extremely difficult to administer programs in a most efficient manner. Mr. Hill evidently has given serious thought to consolidation of these services and I hope that you will be able to support him on this bill. Sincerely yours, R. H. HUTCHESON, M.D., STATE OF TENNESSEE, DEPARTMENT OF PUBLIC HEALTH, Nashville, Tenn., March 22, 1966. HON. Ross BASS, Washington, D.C. Dear SENATOR BASS: There has been introduced by Senator Lister Hill S. 3008, and I would like to strongly urge your favorable consideration of this legislation. This bill proposes a system of planning, programing, and budgeting for health in a manner which, I believe, will bring our Federal public health appropriations and legislation up to date. This reorganization is sorely needed. The bill as introduced by Mr. Hill needs some minor language change so as to require that the health officer of each State be a member of the planning agency in his State. There is another area of change that personally I think would help the bill, but you will have to decide whether or not it will be constitutional. This would be a provision for areawide planning not only interstate but intrastate so that regions located in contiguous States could develop plans for an areawide service. (This may run into our constitutional prohibition against States making treaties without specific congressional approval.) In the bill there is a provision for incorporating the financial resources of nonprofit agencies into the general program. I believe that the bill would be materially strengthened if the statutes stipulated that such funds must be turned over to the Public Treasurer for disbursing. This bill is needed because at the present time we have a hodgepodge of categorical appropriations that make it extremely difficult to administer programs in a most efficient manner. Mr. Hill evidently has given serious thought to consolidation of these services and I hope that you will be able to support him on this bill. Sincerely yours, R. H. HUTCHESON, M.D., Commissioner. Hon. LISTER Hill, TENNESSEE NURSES' ASSOCIATION, INC., Chairman, Labor and Public Welfare Committee, DEAR SENATOR HILL: The Tennessee Nurses' Association wishes to record its support of S. 3008, to amend the Public Health Service Act to promote and assist in the extension and improvement of comprehensive health planning and public health service, to provide for a more effective use of available Federal funds for such planning and services, and for other reasons. We would further like to support the statement relative to S. 3008 presented to you by the American Nurses' Association on March 22, 1966. We believe that the need is urgent to make it possible for communities to plan comprehensive health services and render the same. Respectfully, (Mrs.) REBECCA CLARK CULPEPPER, R.N., Executive Director. UTAH STATE DEPARTMENT OF HEALTH, Hon. LISTER HILL, Chairman, Senate Committee on Labor and Public Welfare, DEAR SENATOR HILL: S. 3008 is welcome legislation. While this type of legislation may be considered long overdue by some health officials and in some areas of the country it is most timely in others, particularly so in Utah. The nature of the work of State health agencies has always required and actually involved planning, especially with the impact of categorized Federal grants. But it is generally recognized that planning has been rarely adequate both as to extent or quality. S. 3008 will give definite stimulus to improving the quantity and quality of health planning in both the State and local activities and should result in coordinated planning rather than of categorical. S. 3008 is particularly timely for Utah, because of the recent Utah little Hoover commission report on the organization of the executive branch of the government which specifically recommends a division of planning and research be established in the State department of health. The State board of health has already indicated interest in this function with the intention of carrying it out as soon as financially permissible. No criticism of this recommendation has been voiced. By reporting this latest Utah development, I am happy to be able to add it to my own view and those of the Association of State and Territorial Health Officers for your use in obtaining passage of S. 3008. Sincerely yours, G. D. CARLYLE THOMPSON, M.D., Hon. LISTER HILL, U.S. Senate, Washington, D.C. STATE OF VERMONT, DEPARTMENT OF HEALTH, Burlington, March 31, 1966. DEAR MR. HILL: It is a long time since you have heard from the "north country," but I did want to write to you to express my wholehearted support of S. 3008. At long last, it looks like we are going to get somewhere in being able to plan and finance health services in the States, in accordance with the needs of the individual States. It is extremely important at this time, because practically every new Federal program seems to have a health factor attached, and the result in the States is utter confusion, overlapping and even head-on collisions in planning. Perhaps this will start health departments back on the road to the role that they should play, of leadership, surveillance, and coordination in the field of health. I also feel very strongly that a similar move should be taken at the Federal level. I could name a half dozen programs, or even parts of the same program, being initiated independently by several Federal agencies. It is all right to straighten out confusion at the State level, quite a bit of which is due to Federal legislation, but it is also time it was straightened out at the Federal level. Best personal wishes. Sincerely, R. B. AIKEN, M.D., STATE OF WEST VIRGINIA, Hon. JENNINGS RANDOLPH, Member, U.S. Senate, Senate Office Building, Washington, D.C. DEAR SENATOR RANDOLPH. I am writing you in behalf of Senate bill 3008, which provides grants for comprehensive health planning beginning in fiscal year 1967, and grants for comprehensive public health services beginning in fiscal year 1968. West Virginia would be entitled to $100,000 for use in State and local health departments and for demonstration purposes for instigation of planning activities 1 year prior to activation of the new grant arrangement. Based on $0.50 per capita, the State would be entitled to $1,183,102 of the Federal Public Health Service comprehensive grant in fiscal year 1968. This almost doubles the composite 1966 fiscal year Public Health Service formula grants, amounting to $651,793. It is contemplated that this grant would eventually expand to $2,957,755 by fiscal year 1971. It is significant that 70 percent of this grant is earmarked for health services at the local level where the need is extremely great. We would appreciate your support of this legislation which in my judgment would provide a golden opportunity for the people of West Virginia to receive adequate and deserving public health services. Sincerely yours, N. H. DYER, M.D., M.P.H., STATE OF WEST VIRGINIA, Hon. ROBERT C. BYRD, Senate Office Building, Washington, D.C. DEAR SENATOR BYRD: I am writing you in behalf of Senate bill 3008, which provides grants for comprehensive health planning beginning in fiscal year 1967, and grants for comprehensive public health services beginning in fiscal year 1968. West Virginia would be entitled to $100,000 for use in State and local health departments and for demonstration purposes for instigation of planning activities 1 year prior to activation of the new grant arrangement. Based on $0.50 per capita, the State would be entitled to $1,183,102 of the Federal Public Health Service comprehensive grant in fiscal year 1968. This almost doubles the composite 1966 fiscal year Public Health Service formula grants, amounting to $651,793. It is contemplated that this grant would eventually expand to $2,957,755 by fiscal year 1971. It is significant that 70 percent of this grant is earmarked for health services at the local level where the need is extremely great. We would appreciate your support of this legislation which in my judgment would provide a golden opportunity for the people of West Virginia to receive adequate and deserving public health services. Sincerely yours, N. H. DYER, M.D., M.P.H., NATIONAL TUBERCULOSIS ASSOCIATION, Hon. LISTER HILL, Chairman, Senate Committee on Labor and Public Welfare, DEAR SENATOR HILL: I am pleased to forward this statement of the National Tuberculosis Association in support of the principles contained in S. 3008 which I am informed you are considering in your committee. It is our belief that the objectives of S. 3008 are consistent with the goals of this organization. I need not point out to you and the members of your committee that the NTA is particularly interested in the elimination of tuberculosis and control of other respiratory diseases. We are much indebted to you and to the Congress for the support given to tuberculosis control efforts in public health departments, whose responsibility it is to carry on the major efforts in control of this disease. We are also appreciative of your recent recognition of the need to increase the ability of health agencies to control the growing problem of emphysema, chronic bronchitis, and other respiratory diseases. We have always recognized the value of well-financed health departments staffed by competent and trained personnel. For years our tuberculosis associations have supported official State and local health programs; tuberculosis control programs cannot exist in a vacuum without their basic services, such as generalized public health nursing, nutrition programs, statistics, and laboratories. There can be no question of the fact that the money which the Federal Government has given to State and local health departments has been a vital force in the improvement of health services throughout this country and as such has been of benefit to tuberculosis control. Although the precise language of your bill was not known at the time of our recent board of directors meeting, the intent of its provisions was available. On February 6, 1966, the board recommended that: "In relation to any reorganization of the Public Health Service grant program, the NTA board of directors reaffirms its support for continuation of the program and appropriations recommended by the task force on tuberculosis, as well as support of improved general health services." Having checked the bill, I take this opportunity to comment on it in the context of this action by the board of directors. We believe the planning provisions which would be authorized would be completely consistent with the objectives of the NTA and we therefore approve this section. The support grants to State and local health departments would be of material assistance in increasing the capacity of those agencies to better carry out their responsibilities, and such expansion would help the tuberculosis and respiratory disease control programs. Certainly, amounts of grant funds should be increased appreciably over what is presently made available for basic services. However, it is our experience that in some instances in the past it was necessary to use funds appropriated for tuberculosis control to maintain the general health program of the State. Therefore, the support of the association for this new grant arrangement can only be made with the understanding that the support for tuberculosis control activities will in no way be endangered. If a sufficient amount of money is appropriated to have well-staffed health departments, tuberculosis and respiratory disease control programs can be adequately financed through the project grant mechanism which has been found to be an acceptable method of approach. As you know, the Surgeon General's task force on tuberculosis control recommended that sizable project grants be made available for the tuberculosis control program over a period of a decade-8 years of this period are yet to come. The tuberculosis problem varies tremendously in degree between different geographic areas and between the rural and urban sections of the country, although it is found everywhere. The project grant authority which is proposed in S. 3008 would enable us to be responsive to the need where it does exist. I am confident that you will be sympathetic to our concern for continued emphasis on tuberculosis control at this particularly critical time of accelerated activities. The increase in amount for project grants is too recent to exert the type of impact anticipated by the task force and it would be extremely shortsighted to cut off the mainstream of Federal support at this time. I would appreciate it if you would make this statement of position by the NTA a part of the record of your hearings on S. 3008. Yours truly, Hon. LISTER HILL, AMERICAN NURSES' ASSOCIATION, INC., Chairman, Labor and Public Welfare Committee, DEAR SENATOR HILL: The American Nurses' Association wishes to record its support for S. 3008, to amend the Public Health Service Act to promote and assist in the extension and improvement of comprehensive health planning and public health service, to provide for a more effective use of available Federal funds for such planning and services, and for other reasons. Our interest and support stems from the members' deep concern for the provision of adequate health services for the American people. The system of public health services has developed piecemeal over the years to meet current problems without an assessment of the changing needs of society for these services. Programs have been built around and on top of each other, creating an unwieldy, inefficient operation. Local programs have developed only to the extent that local pressures will allow. Bold action is indicated if we are to meet the needs of the changing times. As interest in each disease category was stimulated, programs were established to prevent, and control the particular disease. Each program has grown into a totality and as the programs develop in depth, they have a tendency to become increasingly ingrown. Meaningful coordination of the multiple programs is essential for planning the total health needs of a community. S. 3008 will provide a focus for an integrated generalized program. Health service needs for any given area may vary widely. Such factors as age and educational level of the population, the economy, and the topography influence the kinds of programs which must be tailored to suit each community. Flexibility in the use of Federal grants will provide a stimulus for imaginative planning and reduce the emphasis on disease-oriented programs. S. 3008 provides for the development and improvement of home health services. The passage of the Health Insurance Benefits Amendments to the Social Security Act with the provision for paid home health services as a benefit, makes it imperative that community health services be developed, extended and improved. We believe that there is urgent need to enact S. 3008 so that, as the title of the bill states, planning for comprehensive health services can become a reality. Respectfully, JUDITH G. WHITAKER, R.N., Executive Director. AMERICAN HOSPITAL ASSOCIATION, Hon. LISTER HILL, Chairman, Senate Labor and Public Welfare Committee, DEAR SENATOR HILL: This statement is sent to you to express the views of the American Hospital Association in respect to S. 3008, Comprehensive Health Planning and Public Health Services Amendments of 1966. The bill appears to visualize a broadened scope for public health services and suggests various means for the coordination of those matters generally considered to be public health, |