and therefore within the sphere of Government health services, and those which are in the area of so-called curative health services, and considered to be within the sphere of the voluntary health services. Thus, the legislation suggests a bringing together of preventive and curative medicine with an expanded interpretation of "public health." The role of government, and especially the Federal Government, in the Nation's health affairs is growing and it is obvious from the number of Federal programs developed over the past few years that Federal financing is essential if we are to meet the needs of the public. With this degree of governmental involvement, it is well that we develop a philosophy and policy of partnership between the governmental sector and the voluntary sector. Such a partnership is essential if we are to provide health services of high quality in the most economic and effective manner. S. 3008 appears to us to suggest various means for developing such a partnership. The bill used the term comprehensive health services which can be taken to mean anything and everything. It might be well to provide a specific definition for the purpose of this legislation. The bill proposes three major programs following the general recommendations included in the President's domestic health message. SECTION 314, GRANTS TO STATES FOR COMPREHENSIVE STATE HEALTH PLANNING AND PUBLIC HEALTH SERVICES It is our understanding of this section of the bill that it proposes one agency responsible for the administration and supervision of health planning throughout the State. To accomplish this end, it is proposed that a variety of health programs now carried on in the States, and which involve planning for such services, will be brought together and coordinated in one planning agency. This should be an effective method for coordinating planning for health services so as to avoid duplication and gaps and to provide the most economic development of health facilities and services for the most efficient use of health personnel. Whereas in the past, planning has really been limited in scope and pertained largely to the development of facilities, this bill proposes expanding planning so as to encompass all health services and health personnel as well as planning for health facilities. A State health planning agency is provided for, to be made up of representatives of the State government. The planning agency established under the bill appears to be limited in function and authority to the role of planning and does not appear to participate in any way in the carrying out of the plan or in the provision of health services by any agency of government or otherwise. We believe the function of the planning agency as described in the bill is quite obscure as to the carrying out of the State plan once it is agreed upon. An advisory council made up of government and nongovernment representation also is established. This council is advisory to the single State planning agency. The authority and responsibility of the advisory council appears to be limited to advising on the development of a plan. It has no authority in respect to carrying out the plan. The bill apparently proposes to encompass the planning of a number of health activities which presently carry on their own planning, such as, the State departments of public health, the mental health program, the Hill-Burton program, the medical school and the nursing school construction programs. For example, the bill is not clear as to whether the heart, cancer, and stroke program or the rehabilitation programs are to be included under the planning activities of this new planning council. Thus, it is questionable whether the bill, at present, does provide for all-inclusive authority over planning. Each of the health activities mentioned above has its own advisory council and quite likely the planning activities in respect to each of these programs carry a responsibility to the individual advisory council. A basic question arises as to whether this legislation proposes to abolish the individual advisory councils. It raises particular question as to the future role and authority of the State boards of public health which exist in certain States. We believe the bill needs to be much clearer and more specific in respect to the relationship of each of these programs and their advisory councils to the State planning agency proposed under the bill. Otherwise, a great deal of confusion, we feel, will be generated. Though the bill provides for a State advisory council to the State planning agency, there is no provision for an advisory council at the Federal level. It would appear to us that provision should be made for a Federal advisory council related to planning to guide the decisions of the Surgeon General in evaluating the State plans which are submitted to him. We wish to make clear that this association is not opposed to coordinated planning. In fact, quite to the contrary. When the Mental Health Act was being considered by the Congress, we urged that the planning phases of that program be coordinated with planning under the already existing Hill-Burton programs, pointing out that it made little sense to attempt to plan for mental health services completely apart from the essential planning for general health services. We face enormous shortages of essential health personnel. Our ability to carry out various health programs which are needed will be curtailed unless there is a substantial increase in available personnel. The Federal Government has already recognized this fact as it has supported several programs to provide increased numbers of health personnel. It would appear to be essential that planning for facilities and services must be related to planning for essential personnel within the States. This bill suggests a basic approach in this direction. These efforts may well lead to increased controls over the provision of health services. If these controls become excessive, they could become a handicap to efficient administration of health programs. (b) PROJECT GRANTS FOR AREA WIDE HEALTH PLANNING This section of the bill authorizes the Surgeon General to make project grants to public or private nonprofit agencies or organizations to enable them to develop comprehensive regional plans for health services and to provide for the coordination of such planning. It also proposes, just as it has under the State plan, to incorporate not only facilities but services and personnel under the regional coordinated plans. At the present time, the Federal Government is providing assistance for the development of regional planning agencies. The grants by the Surgeon General at the present time may be made on the approval of the State Hill-Burton agency. S. 3008 provides that the Surgeon General may make project grants which will be approved by the State planning agency. Thus, the activities of regional planning groups may be controlled and influenced by a new planning group and one which is representative of a variety of agencies which has not been the case in the past. This may have certain strengths in relationship to centralized control and does bring about more comprehensive planning by these independent groups. On the other hand, a weakness may be that the State planning group may be less sympathetic to regional planning groups and wish to take much greater authority upon itself. This would weaken the independence of regional planning groups and local initiative and responsibility. As we have already mentioned, the heart, cancer, and stroke program establishes a planning body for the development of programs for these three diseases; and the Federal Government is providing the financing for such planning efforts. In the law, this planning is not related in any way to the work of any other planning group. It would appear that consideration should be given to amending S. 3008 so as to require that planning for the heart, cancer, and stroke program be coordinated with planning at both the State and regional levels. (C) PROJECT GRANTS FOR TRAINING, STUDIES, AND DEMONSTRATIONS This section of the bill is highly desirable, we feel, as it would provide grants to both public and private nonprofit agencies, institutions, and organizations to encourage projects for training, studies, and demonstrations. These are aimed toward the development of improved, or more effective, comprehensive health services throughout the Nation. We feel, however, that this section does not go far enough. We would urge that greater assurance is given that the results of such studies, demonstrations, and research will be made available to the entire health field. The results of much of the research carried on at the present time are not made readily available to the health field. There should be a clearinghouse or an information center provided for, so that duplication of projects may be avoided and so that the results of all such projects may be readily accessible. (d) (2) STATE PLANS FOR PROVISION OF PUBLIC HEALTH SERVICES As we understand this section of the bill, it is intended to permit the States to do a much more meaningful job of providing public health services through a system of block grants rather than the existing system of categorical grants. We recognize that this has been a subject of basic concern on the part of the public health officials for a good many years. It has been pointed out repeatedly that, though categorical grants have had certain benefits in terms of obtaining greater support for specific disease areas, they have also been the means of seri ously limiting the wise allocation of funds in relationship to major public health problems within the States. Therefore, it is our belief that this section of the bill would provide for a greatly improved administration of public health services by the States. (f) (1) INTERCHANGE OF PERSONNEL WITH STATES As we understand this section of the bill, it would facilitate the interchange of health personnel between the States and the Federal Government, between the States themselves, and among areas within the States. It appears to us that such interchange is limited to various levels of government. Inasmuch as the legislation establishes a basic policy that any barriers which may exist between the governmental sector and the voluntary sector of health services should be reduced, we believe it may be well if this basic policy were extended to provide, also, for the interchange of health personnel between levels of government and the voluntary health institutions. (g) GENERAL The bill contains provisions which would preserve the existing authorization which provides for training grants to schools of public health. When this section was added to the public health service law, we had expected that the schools providing for master degree training for administrators of hospitals and other health care institutions would be included in the provision. We believe strongly that a hospital administrator is an administrator of a community health service and, thus, should be assisted with training grants in a manner similar to that now provided to public health trainees. We urge, therefore, that this section of the bill be amended so as specifically make students in university programs of hospital administration eligible to receive training grants irrespective of whether their course is part of the school of public health or of business administration. We would appreciate your making this statement a part of the record of the hearings on S. 3008. Sincerely, KENNETH WILLIAMSON, Associate Director. NATIONAL ASSOCIATION OF COUNTIES, Washington, D.C., March 29, 1966. Hon. LISTER HILL, Chairman, Senate Committee on Labor and Public Welfare, U.S. Senate, Washington, D.C. DEAR CHAIRMAN HILL: On behalf of the National Association of Counties, I should like to express our support of S. 3008, a bill to amend the Public Health Act to promote and assist in the extension and improvement of comprehensive health planning and public health services, to provide for a more effective use of available Federal funds for such planning and services and for other purposes. The concepts embodied in this legislation are in keeping with the American county platform, the official policy statement of our association, specially our position on regional cooperation and county planning. I am enclosing a copy of our policy statement and we would appreciate section 2-10 and 2-11, along with this letter, be made a part of the committee record on this legislation. (The sections referred to above follow:) 2-10. Incentives in State and Federal grant programs to encourage joint efforts to resolve common problems. Numerous services performed by local government are best provided when undertaken on a territorial basis broader than the individual unit of local government. Experience in such fields as open space land acquisition, public health, urban planning, and airports has shown that grant programs can be designed to achieve more effective local services through joint undertakings by more than one unit of local government. The National Association of Counties believes that State and Federal grant programs, where appropriate, should contain provisions to encourage joint undertakings among local units of government. "2-11. State and Federal legislation needed.—We recommend that in order to strengthen county and regional planning that applications from local governments within a metropolitan area for Federal grants-in-aid for airport construction, waste treatment works, urban renewal, public housing, hospital construction, and urban highways be reviewed and commented on by a legally constituted planning agency with responsibility for comprehensive planning for the metropolitan area or region and that such planning agencies be composed of or responsible to the elected local government officials of the metropolitan area.' We would urge that program grants for areawide health planning as provided for in section 314(b) include a requirement that where comprehensive planning for the area is being carried out, that planning for health facilities under this section be consistent with any such comprehensive plan. Very truly yours, W. W. DUMAS, President. AMERICAN SOCIAL HEALTH ASSOCIATION, Hon. LISTER HILL, Chairman, Senate Committee on Labor and Public Welfare, DEAR SENATOR HILL: Since the board of the American Social Health Association does not meet until April 30, our president, executive committee chairman, and I, as chairman of the board, have read S. 3008, which you introduced, and we wish to express our support for it. We feel sure that the board will confirm our action when it meets. As we understand the intent and probable consequences of this bill's passage, it would: encourage local and State planning in light of particularized health needs, integrate public health services into a whole man approach, yet provide opportunities to work intensively and flexibly in such hazardous problem areas as control of venereal diseases and of drug abuse. This seems to us to open up the possibility of planning and appropriations more suited to differing geographic areas and to the changing needs of changing times. We hope that our organization may be helpful to its passage and greatest usefulness. Sincerely, PHILIP R. MATHER, THE JOHNS HOPKINS UNIVERSITY, SCHOOL OF HYGIENE AND PUBLIC HEALTH, OFFICE OF THE DEAN, Baltimore, Md., March 28, 1966. Hon. LISTER HILL Chairman, Senate Committee on Labor and Public Welfare, Washington, Ď.C. DEAR MR. CHAIRMAN: In the absence of our president, Dr. Myron Wegman, who is in Vietnam with the Gardner group, I write on behalf of the Association of Schools of Public Health concerning S. 3008 now before your committee. The Association approves the principles of the legislation but would propose a slight change to the effect that the authorization of Hill-Rhodes formula grants be placed in section 306 with the traineeships rather than in section 309 with the project grants as proposed in S. 3008. There is, as you know, a direct relationship between the number of public health trainees and the teaching costs in the schools of public health. The Hill-Rhodes formula grants are allocated primarily on the basis of numbers of federally sponsored students in the schools of public health and most of these are public health trainees. There is no such relationship between, on the one hand, the project grants which are made for specific training purposes in several kinds of health institutions and, on the other hand, the Hill-Rhodes formula funds which are made exclusively to schools of public health as partial reimbursement for the costs incurred in training federally sponsored students. We feel that it would be logical and advantageous both to the Congress and to the schools of public health to have the traineeships linked with the formula grants by placement in the same section of the Public Health Service Act. Such an arrangement would avoid any possible confusion in the future as to the exact nature of project grants and formula grants, as each would be considered sepa rately. It would tend to eliminate any question of duplication as regards the two distinctly different forms of support for public health training and would facilitate the process of adjusting the level of formula funds to the current volume of teaching costs as determined by the numbers of public health trainees and other federally sponsored students in any given period. We would be glad to discuss this recommendation with you or members of your staff, if you wish. We trust that the proposed change will be relatively easy to make, if you agree that our suggestion has merit. As always, we turn to you with confidence that you will decide in the best interests of public health to which you have contributed so much. As ever, in deep gratitude, I am, Sincerely yours, ERNEST L. STEBBINS, M.D., Vice President, Association of Schools of Public Health, Inc. AMERICAN MEDICAL ASSOCIATION, Hon. LISTER HILL, Chairman, Committee on Labor and Public Welfare, DEAR SENATOR HILL: We understand that your committee is presently holding hearings on S. 3008, the Comprehensive Health Planning and Public Health Services Amendments of 1966. This bill is now receiving our attention and study. Because of its interest in health legislation, the American Medical Association appreciates each opportunity to appear before congressional committees on such matters. While it would appear that the deemphasis on categorical health grants to States would be consistent with the policy of the AMA, we regret we cannot, within the time allotted, prepare an evaluation of this bill which would be commensurate with its significance. We would welcome an opportunity to submit our views to you at a later date when we have a more complete understanding of the legislation. Sincerely, F. J. L. BLASINGAME, M.D. NORTH AMERICAN ASSOCIATION OF ALCOHOLISM PROGRAMS, Hon. LISTER HILL, Chairman, Committee on Labor and Public Welfare, DEAR SENATOR HILL: By direction of President David J. Pittman and the executive board of the North American Association of Alcoholism Programs, I should like to bring to your attention some factors concerning alcoholism which we consider to be pertinent with regard to your bill, S. 3008, for comprehensive health planning. We know that it is your intention that the illness of alcoholism be included in this legislation to share with the other major medical-social problems in the Federal Government's comprehensive health plans. It is, therefore, felt appropriate to bring these matters to your attention. 1. Currently some 42 States and the District of Columbia operate tax-supported alcoholism programs at the State level. Of these existing programs, 10 are organizationally independent commissions; 1 is located within the department of social welfare and the others are listed as divisions or sections within State departments of public health or mental health. These programs vary extensively in terms of financial support, level of activity, and focus of programing. 2. Our experience with the Community Mental Health Centers Act of 1963 has not been entirely satisfactory. Alcoholism and narcotics addiction was listed as one of the concerns in plans for planning. However, only 26 of the 50 States had specific task forces to cope with these significant health and social problems. We are concerned that this not happen in the case of S. 3008. 3. Two very significant decisions have been handed down recently by the courts concerning the disposition of chronic alcoholic offenders. On January 22, 1966, the Fourth U.S. Circuit Court of Appeals ruled in favor of the appellant, Joe B. Driver, of North Carolina. The unanimous opinion written by Judge Albert V. Bryan included the following statement: |