5. Coordinate curricular offerings with regional allied health manpower needs.

6. Maximize vertical and horizontal mobility within and among programs.

7. Expedite faculty and/or student exchange to make maximum use of faculty

8.

manpower.

Coordinate use of available clinical training facilities.

9. Develop common definitions of general education requirements in "Core" Curriculum.

10.

Design and coordinate student recruitment program.

11. Respond to requests for consultation.

12. React to and recommend approaches to current disparities in state regulations affecting allied health manpower in Missouri and Illinois.

Selection of Students

Millions of dollars are lost each year in the form of "drop outs" from the various technical programs as students find out that they aren't interested in a particular program or that they aren't suited or qualified for that particular program. This kind of mismatch between student and curriculum causes student unrest and discouragement and is costly to all concerned.

A very extensive and exhaustive study needs to be made to develop methods of measuring aptitude and predicting success in courses, curricula, and in later employment. The information secured from such a study, of course, would necessarily need to be accompanied by a very effective counseling program. Some say every student should have a right to enter any curricula he chooses and fail, if he is not adapted to that particular field. This certainly isn't a very efficient way to spend the limited budget in a career program, especially when there may be a waiting list of qualified students, and in an inner city situation the thing the student needs least is "another failure".

Necessity for New Techniques

Community Colleges, having appeared relatively recently on the scene, are not bound by tradition and hence can afford to be innovative. Certainly in the training of allied health personnel, we need to explore new techniques. Why shouldn't career courses be "open ended" with no particular time reference? Why can't much of the instruction material be made available on video-tapes, audio-tapes, and cartridge projectors? Might it not be possible to abolish a grading system and indicate just pass, fail, or withdraw and not advance a student until he masters at least 80% of the material. The student could remain in the class long enough to achieve this goal. Should we eliminate course prerequisites as "absolute"? We might be shocked to find that some absolute prerequisites are not necessary at all. In fact prerequisites in some instances have been shown to screen out the very students best suited to a particular two year career program.

Retention of Allied Health Personnel

In some ways the shortage of health personnel may not be as acute as it might seem. A greater effort needs to be made to keep health personnel in the profession. In the St. Louis area there is a shortage of about 3,000 nurses. We are graduating 750 nurses each year from our schools. This should in a few years relieve the shortage except that the average nurse stays in the profession less than three years. The radiological technologist averages less than two years. We do not know how many return after a time to their field of training. This is an inefficient use of

training and manpower.

Government Health Funds

With the acute shortage of operating funds, particularly for the 19701971 year, it appeared for a time that the allied health programs would have to be maintained at the same level or even cut back in the St. Louis Junior

College District. However, an allied health grant through H.E.W. of $25,617 has enabled us to greatly increase the size of the health programs for which these funds are applicable. A continuation of this kind of support is necessary if our health programs are to be expanded. Again Vocational Education Funds are an absolute necessity for the continued growth of Para-Medical Programs.

Role of the Medical Center in Delivering Health Care

The concept of Health Service Centers to supervise and take the responsibility for providing and delivering health care is an excellent one. Since the large medical schools are largely research oriented, I am not sure that they would make the delivery of health care their number one priority. Might not the Regional Medical Programs provide the kind of leadership needed in this area?

It has been a distinct privilege to report to this Committee. Be assured that the providing of health personnel is one of the major aims of the Community Colleges. With your assistance they will continue to do so.

OHD: jk

Senator EAGLETON. We have one more witness, Dr. Max Pepper, Department of Community Medicine, St. Louis University.

STATEMENT OF MAX PEPPER, M.D., DEPARTMENT OF COMMUNITY MEDICINE, ST. LOUIS UNIVERSITY

Dr. PEPPER. Thank you for allowing me to testify, Senator. Senator EAGLETON. I understand you have been here all day, so you are a remarkable man, too. Go ahead.

Dr. PEPPER. So are you.

Senator EAGLETON. I asked for it.

Dr. PEPPER. Senator, I did submit a brief statement (appended) and I don't want to take your time to read that now, but I do want to make a few comments on what I have heard today and coming out of our own experience in the new department of community medicine. In the statement we highlighted one of the things that we have already begun to learn, and some of the people mentioned today. I recall Dean Felix and Mr. Henley both talked about the efforts of some of our students in the community with the lead project. One of the things that we have learned is that there can be an integrating force in medical education, quite aside from all the sciences the students learn, the biomedical and-what we feel is equally important-the social and behavioral sciences. What we have begun to do in our teaching program is to try to link up our medical students with groups in the community. We are experimenting with having paid consumers who both come in to lecture didactically in the classrooms of our medical school and also work with the students in field experiences in the community.

None of the kinds of projects that we have been beginning, as for example the case finding in lead poisoning, could have been possible, either in their design or implementation, without the active collaboration of community residents.

Senator EAGLETON. Is this the lead and paint in old buildings, is that what you meanby the lead poisoning?

Dr. PEPPER. That's correct. I would comment further on the lead paint poisoning, Senator.

This is a really great problem that has been overlooked for a long time. The current president of the American Public Health Association conservatively estimates that there are some 225,000 children in the country suffering with one form or another of this affliction.

Senator EAGLETON. It is somewhat analogous, isn't it, in its effect to mercury poisoning? Doesn't it affect the brain?

Dr. PEPPER. Yes, the central system, and it can lead to irreversible damage, mental retardation, and other central nervous system symptoms.

Father Drummond earlier in the day talked about attitudes, and then Dr. Whittico and the black students talked further about some of the racist attitudes in our society. I would like to make a few comments about white racism.

In testimony before Congressman Symington's hearings here a few months ago the House Subcommittee on Science and Technology—I tried to develop the following point in greater length: namely, in my opinion, white racism is a very central health problem in and of itself in our society.

This is not to minimize the effects of racism in jobs, in housing, and in educational and other efforts throughout our society. However, I do feel that very central and special attention must be given to the effects of racism in the health field-not only in terms of what you have been focusing on a good bit here today vis-a-vis black admissions to medical schools, but also in terms of many other institutional and personal forms of white racism in the health field.

I think that there is too often the tendency to blame the victim here rather than to label the perpetrator. I truly believe that we can and must first of all identify and diagnose the condition which is fundamental to develop some kind of prescription and cure, and that this must be done not only morally-the preachments we know over the years have not led to much change-but that in and of itself white racism as a health problem deserves scientific attention. It deserves the careful scrutiny of legislators and physicians and other professionals. I truly believe that the problem must be made explicit, labeled and recognized, and its implications and outcomes made clear to the white community-that is, that the white community is also suffering from this condition, and that it is not only the black population who are the victims. Like any other malignant process or condition, it is just not going to go away through "benign neglect," as one of the administration officials has suggested, and some very active mechanisms for cure are needed.

One of the things that we are learning in our work in community medicine is that the prescription is going to have to come not only from professionals, but from a partnership with nonprofessionals and consumers in the community.

Senator EAGLETON. Do you feel that your experiences in this community health field where medical students, white physicians have, many for the first time in their lives, had their first exposure to the black community other than just driving through it or around it, have you seen any breakthrough in terms of such racial prejudice or racial distrust as we all know exists?

Dr. PEPPER. Yes, I think so, Senator. You heard one graduate of the school talk about some of his feelings. But there are other students like those that the black students talked about, who have been involved in these programs and who haven't had the same kinds of experiences and the same kinds of feelings of distrust. I am talking now about our white students who have worked with black people in the community. I think that this is a real ray of hope.

I don't, by the way, mean to suggest that community medicine is concerned only with poor people or black people or urban people. Our charge and mission goes beyond that. We are truly concerned with communities of people, but we certainly put very high priority on what we feel is-whether we call it a disease or condition or malignant social process-white racism as deserving our continuing attention. Senator EAGLETON. Well, I think what you are saying, Doctor, perhaps we all don't use the same semantics, but you have said it, that these racial barriers that have been with us two centuries, at least, in this country, pervade the totality of our lives, whether it be in medicine, housing, other forms of education, employment, a simple

understanding by one person of another. They are very deep, very pervasive, and no one Federal program, however honorably motívated, is going to wipe it off by the printing of the statute and the signing of it by the President of the United States. It is too deep. It does not lend itself to any simple statute that just makes all the past evaporate.

Dr. PEPPER. I truly believe that partnerships at the local level have to be part of the prescription for change.

Senator, I want to thank you again, and on behalf of our colleagues, thank you and the committee for all your work. We urge you to continue these kinds of hearings and, if possible at all in the future, to extend them to include not only professional groups but take the case to the people and talk to consumers as well.

Senator EAGLETON. That is a pretty good idea.

Thank you, Doctor.

(Dr. Pepper's prepared statement may be found on p. 758.) Senator EAGLETON. Well, ladies and gentlemen, let me say in brief summary, we have had eight and a half hours of hearings, 25 witnesses, by my reckoning. It is not the quantity that counts, it is the quality. Based on previous records that I have read and that I know my staff has read on this question of health manpower, this is the best testimony on the subject matter that I think has been assembled to date. We hope it is equally as good in Kansas City and, more importantly, this doesn't go for naught.

This isn't just for the purpose of compiling another printed book and putting it on somebody's shelf. The question of reorganization of health care, what to do with it, how to keep up with it, how to improve it, is an idea whose time has come, and it is no longer going to be just the debating topic at medical conventions or debating topic at political conventions for a plank to be put in the platform. The demands of the country are such that Congress, for better or for worse, properly or improperly, is going to have to take some action.

The purpose of these hearings is to try to find out which is the proper way to go. We are going to go, we are going to move, because we are being pushed that hard, that the system is about to break. Unless we have the advice of people such as the 25 witnesses today, we will undoubtedly make mistakes. Even with their advice we will probably make some. Maybe we will keep them to a level of tolerability and acceptability.

My thanks to all who have participated, and my special thanks to the officials and Mr. Jackson, who is still with us, and Father Drummond of St. Louis University, who have been so courteous to us, both for the facilities and for the fine lunch.

The subcommittee is adjourned.

(Whereupon, at 6:30 p.m., the hearing was adjourned, to reconvene September 4 in Kansas City, Mo.)