A task force on social work manpower and education has just completed an extensive study of the problem. I have asked the Secretary of Health, Education, and Welfare to consult with educational leaders and other specialists and to submit recommendations to me to overcome this shortage in the ranks of our social workers.

IV. TO IMPROVE THE NATION'S LIBRARIES

Those who do not read are not much better off than those who cannot read. More than 100 million Americans have inadequate public library services. More than 15 million have none at all.

A library must be a living institution with trained staff and funds to obtain new books, periodicals, films, records, and other material. As the boundaries of learning are pushed back, our need for storehouses of knowledge grows greater. They offer man his link with the past and his vision of the future.

Most public libraries in the United States are poorly equipped to perform this vital role.

I recommend that Congress extend the Library Services and Construction Act for 5 more years, authorizing $57.5 million for fiscal 1967.

DEPARTMENT OF THE PEOPLE

Through the programs entrusted to its care, the Department of Health, Education, and Welfare exercises continuing concern for the social well-being of all our people. Already, as I have indicated in this message, it has become possible to set ambitious goals for the future.

To improve our ability to chart our progress, I have asked the Secretary to establish within his Office the resources to develop the necessary social statistics and indicators to supplement those prepared by the Bureau of Labor Statistics and the Council of Economic Advisers. With these yardsticks, we can better measure the distance we have come and plan for the way ahead.

In health and education, we build with a double purpose: to meet today's needs, and to match tomorrow's hopes.

We look toward the time

when every disease which need not happen will not happen; when every citizen can confidently expect care competent, convenient care if he is ill or injured; and

when every American receives the education and training he wants to enrich his life and fulfill his hopes.

With pain and ignorance no longer such fearsome enemies, our people will find a new freedom. Our society will be great as never before.

It is too early for self-congratulations. We must continue to plan and act. We march in a campaign which can have no retreats, no truce, no end, only new victories.

THE WHITE HOUSE, March 1, 1966.

LYNDON B. JOHNSON.

The CHAIRMAN. The first program of Federal health grants was authorized in 1918 by the Chamberlain-Kuhn Act, but it was not until 1935 that legislation was enacted to provide Federal support on a continuing basis for public health activities through grants-in-aid.

In contrast to the $3 million awarded in formula grants in 1936, the 1967 budget proposes $108 million to be awarded through 15 separate grants-in-aid on a formula or project basis to fund the Federal share of public health programs against cancer, chronic illness, heart disease, mental illness, tuberculosis, veneral diseases, dental diseases, neurological diseases, and mental retardation In addition, these grants at the State and local level would contribute to the general support of public health programs, to community health services, to radiological health programs, and to the training of personnel for home health services.

Despite the fact that the categorical grants are a most valuable source of financial support to States and communities, there is increasing realization among health officers and other leaders in the field of health that the Federal funds could be most effectively used if the purposes for which the funds can be spent were expanded and if provision was made for comprehensive planning. Such planning would give recognition to health problems of particular significance in the individual States and communities.

In recognition of the need for comprehensive health planning, S. 3008 would authorize formula grants and project grants to assist in financing comprehensive health planning at State, regional, metropolitan, and local levels. In addition, the bill would authorize training, studies, and demonstrations to improve comprehensive health planning.

Effective July 1, 1967, the Surgeon General would be authorized to award grants-in-aid on a formula basis to State health and mental health authorities to establish and maintain adequate public health services so that the health needs identified in the planning might be met.

To supplement the grants to States, the Surgeon General would be authorized to award project grants (a) to assist in meeting health needs of limited geographic scope, (b) to stimulate new health services, and (c) to develop new or improved methods of furnishing health services.

Finally, S. 3008 would provide for the exchange of personnel between the States and the Department of Health, Education, and Welfare. We are very happy to have with us Secretary Cohen, Under Secretary of Health, Education, and Welfare, and we will be delighted to hear from you at this time, Secretary Cohen.

STATEMENT OF HON. WILBUR J. COHEN, UNDER SECRETARY OF THE DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE, ACCOMPANIED BY: RALPH K. HUITT, ASSISTANT SECRETARY FOR LEGISLATION; DR. PHILIP R. LEE, ASSISTANT SECRETARY, HEALTH AND SCIENTIFIC AFFAIRS; DR. LEO J. GEHRIG, DEPUTY SURGEON GENERAL, PUBLIC HEALTH SERVICE; AND DR. PAUL PETERSON, ASSOCIATE CHIEF, BUREAU OF HEALTH SERVICES Mr. COHEN. Thank you, Chairman Hill.

I have with me today Assistant Secretary for Health and Scientific Affairs, Dr. Philip Lee; the Acting Surgeon General, Dr. Leo Gehrig;

Ralph Huitt, the Assistant Secretary for Legislation; and Dr. Paul Peterson, the Associate Chief of the Bureau of State Services of the the Public Health Service.

The CHAIRMAN. We are happy to have all these gentlemen.
You may proceed in your own way, sir.

Mr. COHEN. I am pleased to be here today to give the Department's wholehearted and enthusiastic support to S. 3008, the "Comprehensive Health Planning and Public Health Services Amendments of 1966," introduced by the distinguished chairman of this committee, Senator Hill.

S. 3008 embodies one of three major health legislation proposals made by President Johnson in his March 1, message on health and education. These measures deal with three vital areas; the organization and delivery of health services; the modernization of obsolete facilities; and the training of additional manpower.

The President in his March 1, 1966, message on health and education said that:

The focus of our efforts is the individual and his family, living in their own community. To meet their health needs requires the cooperation of many agencies, institutions, and experts of State and local government, of doctors, nurses, and paramedical personnel.

These are the frontline fighters in our battle against disability, and death. As in military battle, a winning strategy demands wise and well planned use of manpower. It demands coordinated use of all the resources available.

The President recommended that State and community planning for health be broadened and strengthened; and that a system to assure comprehensive public health services be developed through a redirected and flexible State grant program. S. 3008 would carry out those recommendations.

It would add to and strengthen the capacity of the States to provide public health services in two ways: By emphasizing comprehensive health planning and by providing funds in such a way that health resources can be used flexibly and efficiently.

Mr. Chairman, our Nation is committed to promoting and assuring the best level of health attainable for every person. The magnitude and complexity of this commitment requires that we marshal all our available health resources-public and private; local, State, and Federal in a vital partnership to achieve this objective.

We must strengthen and expand our partnership for health.

We must extend and improve the kind of partnership in a dynamic Federal-State system that has been demonstrated so effectively in the Hill-Burton hospital construction program.

This kind of partnership, embodied in S. 3008, will allow us to pursue national goals through State and local planning and decisionmaking.

The expansion and the wise and efficient use of our health manpower and facilities is one of the primary purposes of this important legislation. The Social Security Amendments of 1965, including titles XVIII, medicare, and XIX, medical assistance to the needy aged, which supersedes the Kerr-Mills program, as well as those amendments to title V providing for comprehensive medical services for preschool and school aged children in low income areas, have highlighted the need for additional personnel, facilities, and services, for careful planning and for effective use of our scarce manpower resources.

In

addition, they have again emphasized the great importance of effective and energetic State and local health agencies in the carrying out of many of the important health programs passed by Congress.

S. 3008 is designed to serve as a new legislative basis for expanding the capabilities of States and communities to plan, develop, and provide public health services.

S. 3008 creates a new section 314(d) of the Public Health Service Act to provide formula grants to States for comprehensive health services which would replace the several categorical programs now carried out almost wholly under the present section 314, for which $55 million has been requested in the fiscal 1967 budget. The proposed new section 314(e), to provide project grants for health service development would replace existing authorities in the present section 316 and annual appropriation acts, for which $53 million has been requested in the fiscal 1967 budget. In addition, the authorization for areawide health facility planning now found in section 318, (for which present appropriations were $5 million) would be contained in the new planning provisions, and the authorization for assistance to schools of public health, with the present $3.5 million appropriation, would be transferred to section 309 of the act. In summary, there is a total of somewhat more than $116.5 million in the 1967 budget for the existing programs which would be covered by the provisions of this bill plus $10 million in the budget for the new authorizations in S. 3008 for planning. The 88th and 89th Congresses have enacted landmark health legislation, most of which came out of this committee. I need not detail the significant legislation for increasing our health facilities, or for financing medical care.

The important point is that State and local health agencies must shoulder the major responsibility for assuring the availability of high quality public health services. The proposed legislation will provide the State and local health departments with Federal financial support with which to meet their responsibilities and provide the leadership and coordination that is so urgently needed.

S. 3008 has two principal objectives:

First, to increase the capacity for continuing, comprehensive planning for health-statewide, regionally, and locally-in partnership with the Federal Government. This would form the foundation. The bill would provide support to enable States and communities to determine the needs in every area of health: services, manpower, and facilities; and it would enable them to develop plans and methods for meeting these needs, both in the short run and in the long run. It will permit expansion of regional and metropolitan health planning, and enable wide cooperation and coordination of health plans with agencies, both public and private, throughout the State.

Second, to redirect the focus of health-grant programs to revitalize local and State health effort and to focus program activities more clearly on bringing services to people. This would be accomplished by providing noncategorical formula grant support for comprehensive public health services. This approach will give localities and States greater flexibility in using Federal assistance to meet their most important problems. At the same time, S. 3008 provides a means of supporting programs to meet health problems which are nationally important, but not nationwide in their incidence. Through the project grants for developing health services, narrower, targeted

attacks can be mounted on such problems as narcotics and drug abuse, alcoholism, and venereal disease. The project grants offer a way to develop new approaches to combating particular health problems, and new approaches to the organization and delivery of health

services.

Mr. Chairman, our national health goals are but an expression of the justifiable expectations of the American people that this country can and will provide the best in health care to all its citizens; that it can and will, under the legislation already enacted, remove financial barriers to health care for our older citizens, and reduce the toll of major killer diseases; that it can and will reduce infant mortality and provide every child with the health care he needs to develop his capacities to the fullest.

These desires create demands-for manpower, for facilities.

We are moving to meet them; under the Health Professions Educational Assistance Act, and the Nurse Training Act, we are both training and expanding the capacity to train additional health workers; under the Hill-Harris amendments we have begun a limited amount of hospital modernization. And this year the President's program includes proposals to train people in the allied health professions, and to modernize a very large portion of this country's obsolete hospital facilities.

We have known since 1963, when the President's Consultant Group on Nursing made its report, that there would be a shortage of trained nurses; we also know that there are increasing shortages of subprofessional health manpower; and we can expect that there will be some pressure on hospitals and other health facilities when medicare becomes an operating program on July 1 of this year.

Thus, if we are to achieve our national health goals notwithstanding shortrun pressures, we must have an economy, not just of dollars, but of time and talent; economy of organization to make the most of the trained people and the facilities we now have and will have in the

future.

The provisions of S. 3008 seek to encourage the most efficient use of all our health resources through planning at the State, local, and regional levels. S. 3008 provides for the development of additional manpower, and of new ways to utilize existing manpower. It will allow the States to increase their role in training the public health workers we need.

Mr. Chairman, these are the important elements of this bill: planning, as the foundation for a rational and efficient use of all our health resources; flexibility, to put the kinds and amounts of resources where they are needed to serve the health of people in local communities; and development, to find new methods of organizing and delivering health services, new approaches to disease control, and to discover and use new sources of health manpower.

Mr. Chairman, I have here with me six tables which, with your permission, I would like to put in the record at the conclusion of my remarks.

The CHAIRMAN. Those tables will appear at the conclusion of your remarks.

Mr. COHEN. They deal with illustrative allotments by States, and some supplementary information about the development of appropria