Page images

Department of Health, Education, and Welfare. In August of last
year I was appointed Director of the National Heart Institute, where
I had a long career of 6 weeks before I was appointed Surgeon

I am married and have two daughters and live out in Bethesda.
Mr. Flood. Do you go to church regularly?
Dr. STEWART. Yes, sir. I am junior warden of our church.
(The biographical sketch of Dr. Stewart follows:)

BIOGRAPHICAL SKETCH William H. Stewart, M.D., was named Surgeon General of the Public Health Service by President Lyndon B. Johnson on September 24, 1965. Six days later, the U.S. Senate confirmed his appointment as 10th Surgeon General in the 167year history of the Service.

As Surgeon General, Dr. Stewart will administer the 100-odd programs of the Public Health Service, whose 1965 budget approximates $2 billion and whose personnel numbers in excess of 38,000 persons.

Born in Minneapolis, Minn., on May 19, 1921, he attended the University of Minnesota and Louisiana State University, and received his medical degree from Louisiana State University School of Medicine in 1945. His internship at Philadelphia General Hospital was followed by 2 years' duty with the U.S. Army Medical Corps. Upon completion of his residency in pediatrics at Charity Hospital, New Orleans, he was in private practice in Alexandria, La., until he entered the Public Health Service in 1951. He was certified by the American Board of Pediatrics in 1953.

His first 2 years as a Public Health Service career officer were spent in Thomasville, Ga., where he headed the epidemiological unit of the Communicable Disease Center. He came to PHS headquarters in 1953 to serve the next 4 years with the National Heart Institute and the heart control program of the Bureau of State Services. The next 8 years, he spent in a staff capacity, first to the Surgeon General and, later, to the Secretary of Health, Education, and Welfare.

In 1957, he became Assistant to the Surgeon General and the following year was named Chief of the Division of Public Health Methods, major staff planning arm to the Surgeon General. During the 3 years he held that post, he also served as Executive Director of the Surgeon General's Committee on Medical Manpower which issued “Physicians for a Growing America"; was a member of the Study Group on the Mission and Organization of the Public Health Service, and was staff director for the study of environmental health, conducted by the National Advisory Health Council and for the special report of the same Council on the role of the Service in medical care.

In early 1963, after organizing the new Division of Community Health Services, he was named to the immediate Office of the Secretary of Health, Education, and Welfare as Assistant to the Special Assistant to the Secretary (Health and Medical Affairs). He left that post last August to become Director of the National Heart Institute, the office he held when he was named Surgeon General.

Dr. Stewart is author of scores of publications and presentations dealing with a wide range of public health issues including spread and control of various diseases, health status of the population, education for the medical and health professions and medical care administration.

He is a member of the American Academy of Pediatrics, the American Medical Association, the American Heart Association and the American Public Health Association. Dr. and Mrs. Stewart and their two daughters reside at 9108 Ewing Drive, Bethesda, Md.

Mr. FOGARTY. All right, Doctor; go ahead.

GENERAL STATEMENT OF THE SURGEON GENERAL Dr. STEWART. Mr. Chairman and members of the committee, I appreciate the opportunity to appear before you to support the budget request of the Public Health Service for the 1967 fiscal year. In doing so I shall review briefly the accomplishments of the past year, both in our established programs and in our new activities stemming from last year's important series of legislative actions in health.

Since this is my first appearance before you as Surgeon General and because I am convinced that we are at a vitally important crossroads in the history of health and medicine, I thought it might be helpful if I spoke briefly of my own views as to the changing role of the Public Health Service in moving toward the health goals of the future.

STATUS OF HEALTH OF AMERICAN PEOPLE The statistical indexes of the Nation's health suggest the directions in which we must move. The death rate in the United States has remained almost level for a decade; it now stands at 940 deaths per 100,000 people, while the average rate for the last 10 years is 954. Life expectancy increased in 1964—the last year for which complete figures are available—to 70.2 years as compared with 69.9 years—a very modest gain. Infant mortality rates also declined slightly in 1964, but we remain well down the list of nations in this important measure of health.

The national health interview survey shows that some 84 million people in the United States, about 45 percent of the civilian population, suffer from one or more chronic conditions. About 23 million are limited in their activities by chronic illnesses or impairments. These figures, no less than the death rates, represent a continuing challenge to the national health resource.

The past year was free from major epidemics. Only 44 cases of paralytic polio were reported in 1965. For the 18th successive year, the United States was successfully protected against the importation of quarantinable diseases from abroad.


But the broad trends make it clear that, despite major advances in medical research and a general rise in national standards of living, we cannot afford to be satisfied with the present level of health of the American people, proud though we may be of our accomplishments. I am convinced that we can move ahead significantly if we improve the quantity and efficiency of health manpower, the element basic to all health services; if we find new and better ways of removing the remaining barriers blocking access to health care for all; and if we develop new methods and resources for the rapid conversion of scientific knowledge into health care. And I believe further that public recognition of these unfilled needs underlies much of the recent health legislation.


Last year's health legislation did more than increase the size of the Federal commitment to health in quantitative terms. It altered the nature of that commitment in several significant ways. In conjunction with other enactments of the immediate past, last year's actions call for a new kind of health leadership in the Federal Government, in partnership with physicians, hospitals, medical schools, and other agencies and institutions. It is this call which we are seeking to answer as we examine the structure of the Public Health Service and the assumptions on which that structure is based.


Legislation has expressed a public decision that the Federal Government shall be involved, far more deeply and broadly than ever before, in making health services more widely and readily attainable. This is the central thrust of titles 18 and 19 of the social security amendments, and of the heart disease, cancer, and stroke amendments. Moreover, the accent is on quality as well as accessibility of care. Therefore the Public Health Service needs to use its own medical care activities to demonstrate promising innovations. We need to use our responsibilities in connection with medicare not only to establish standards of quality but also to help in assuring that those standards are met.

Recent legislation has strengthened and diversified our role in helping to supply the resources to care for the health of the American people. The Hill-Burton program has been amended to put further stress on planning and to permit an attack on the critical problem of modernizing obsolete facilities in our major cities. We are giving greater emphasis to long-term care facilities. Last year's action by the Congress permitted us, through supplemental appropriations, to stimulate the creation of home health services where none have existed before.

HEALTH MANPOWER Another significant advance has been the development of the Public Health Service role as a full partner in the development of health manpower. The Health Professions Educational Assistance Act of 1963, the Nurse Training Act of 1964, and the Health Professions Amendments of 1965 enable us to support a nationwide effort to meet manpower shortages in the professional categories and to upgrade the quality of the manpower produced.


Many other new opportunities and challenges have been presented to us. We are now able to foster the dissemination of research knowledge through the creation of a national system of medical libraries. We are able to support the operation of community mental health centers, thereby giving an urgently needed impetus to this program which will revolutionize the treatment of the mentally ill. We have been given new and needed authorities to control air pollution and to undertake a frontal attack on the disposal of solid wastes.

The central point I wish to stress is the growth and diversification of the Federal role in health. These responsibilities are diffused among many agencies at the Federal level, and this diffusion tends to create similar patterns in the States and communities. Many advances in health are waiting upon a strong focus of leadership for this manysided program.


Yet, as you know, the Public Health Service is working within a restricting organizational framework that has been frozen in law since 1944–a time when the nature and scope of Federal health activities were vastly different. It is for this reason that we have been undergoing a strenuous process of self-analysis, at the direction of the President and with the leadership and support of Secretary Gardner. We have been assisted by a highly competent group of consultants under the chairmanship of Dr. John Corson of Princeton. We have tried as hard as possible to hold nothing sacred, to leave no assumption unexamined.

Our aim has been to design a Public Health Service that can attract and retain the kind of competence our responsibilities require, and that will make the fullest use of the resources we have. We intend to shape an agency that will deliver its full measure of the Federal responsibility for the health of the American people.


This work is nearing completion. I believe that we can polarize our activities around specific functions, aimed at the basic health goals of the Nation:

The delivery of the best in health care to the American people;
The development of manpower necessary for this task;
The further advance and maturation of biomedical research;

The assurance of an environment free from significant threats to health;

The most productive possible service to groups with special problems our children, the aged, the mentally ill are examples;

The fullest possible application of existing knowledge to control, prevent or eradicate disease;

The sharing of American knowledge and skills so that nations around the world can raise their levels of health. Further, I believe that we can modify our existing personnel systems so as to encourage productive and rewarding careers across a broad spectrum of Federal involvement in health. In achieving this, and in creating an organization oriented toward the future, I am convinced that health professionals of the highest quality will respond to the challenges of Federal service.


Against this backdrop of needs, let me now report on some of the more significant points of progress during the past year. You will, of course, hear more about our problems and our accomplishments from subsequent witnesses before your committee.


Through a newly organized Division of Medical Care Administration, the Service is seeking improved methods of organizing and financing medical care. The new Division has specific responsibilities for professional health aspects of the health insurance for the aged program.

We are making particular efforts at this time to insure the availability and quality of health insurance benefits, the first of which become redeemable as of July 1. The development of standards of

provider participation is virtually complete. Plans from approximately half the States have been approved for participation in the new home health formula grant program designed to stimulate the development of new and improved home health services.


To help overcome a critical shortage of education facilities for the health professions, 68 projects have been awarded grants totaling more than $150 million for the construction of teaching facilities in schools of medicine, dentistry, nursing, and other health professions. These projects will provide 2,442 additional first-year places for medicine, dentistry, public health, nursing, pharmacy, and optometry. New schools being established include eight medical; one dental; and one public health.

Under the provisions of the Nurse Training Act of 1964 the Service is providing grant assistance to build new nursing schools, and to replace, renovate, expand, and equip existing facilities. The $3 million already invested in this program is creating space for up to 240 additional first-year nursing students. As of January 1966, 52 applications totaling more than $25 million have been submitted. Eleven have been approved.

The Nurse Training Act also provides for continuation and expansion of the professional nurse traineeship program. Since 1956 this program has helped more than 25,000 nurses to prepare for teaching, supervision and administration or to improve and update professional skills. This fiscal year 100 schools of nursing have shared in $7,800,000 for long-term academic

training to prepare an estimated 2,000 nursing teachers, supervisors, administrators, and specialists.

A separate manpower program was established this year to investigate, estimate, and project national manpower needs for health services. Such action was recommended by the President's Commission on Heart Disease, Cancer, and Stroke and by the Second National Congress on Public Health Training. The program will join with other government, voluntary, and private allies in an effort to insure adequate numbers of medical and paramedical personnel in the right job at the right time and place.


Despite a reshaping of the Hill-Burton program and sound progress toward adequate health facilities, the tasks ahead require an intensification of present effort. Thus far the establishment of new programs and the revamping of old ones have permitted communities throughout the Nation to analyze and evaluate their health facility shortcomings. Tentative findings reveal a great number of hospitals in need of renovation, a problem especially grave in larger cities; a growing critical need in some areas for long-term care facilities; a lack of coordinated planning mechanisms for urban areas; and shortages and inadequacy of most facilities for the mentally retarded and mentally ill.

Programs established by recent legislation are now beginning to bear fruit. The hospital modernization program, included in the HillBurton Amendments of 1965, is underway. State plans are being sub

« PreviousContinue »