this year, actually seeks less money both for the traditional public health activities in which we are engaged at the local level, and for the newer programs, such as mental health, alcoholism, and drug abuse, with which the members of this committee, as well as local officials concerned with public health, have been deeply involved. Now, Mr. Chairman, with that as background, I would like to mention briefly the views of the National League of Cities, the U.S. Conference of Mayors, and the U.S. Conference of City Health Officers on H.R. 11511 and H.R. 11845. Our first-and overriding concern is the adequacy of the funding for health revenue sharing, or block grants. As you know, the funding for section 314(d) has remained at $90 million since 1970, and the President's budget for next year is at the same level. With inflation eating into our city budgets, a level funding rate over a 5-year period results in an erosion of half of the purchasing power of the same amount of money in the fifth year. The city of Portsmouth has one of the highest effective tax rates in the Commonwealth of Virginia. Because of both economic and statutory limitations, we are at or near the limit of our ability to tax our citizens and their property in order to provide the services essential to the health, safety, and well-being of our community. Given the magnitude of our needs, the paucity of our resources, and the terrible drain of inflation, we in Portsmouth believe-as do the mayors, health officers, and other responsible leaders of our Nation's cities that the time has come for special revenue sharing to deal with our special problems. We believe, therefore, that funding for special revenue sharing for health should be multiplied by 10. The great advantage of block grants, as we see it, is that they allow us to set our own priorities and target on our own problems as we define them. Another community may have migrant worker camp sanitation problems. Mine does not. My city's greatest single health need is provision of health services to women-health education, family planning, maternal and child health. Another city may not have to place so high a priority on dealing with this need. Whatever the needs, wherever they exist, block grants would give us the flexibility and the resources to deal with them. We are concerned not only with the amount of money needed for public health but also with the conditions associated with the awarding of the grants. Above all, we are of the strong opinion that block grants intended for local governments should be made available to them directly, and not passed through the State capitols. To illustrate both the need for the funds as well as the desirability of direct funding to localities, you should be aware that the funds passed through Richmond to our public health departments in Virginia under section 314(d) constitute only 4.1 percent of the budgets of our local health. departments. I should add that Virginia is one of the most faithful States in passing through 314(d) grants to its local constituent health departments. Permit me to make just a few more comments on other titles of H.R. 11511 and H.R. 11845. Title II on community mental health centers is a far-sighted legislative effort. We especially concur in the language in section 202(d): Until such time as legislation is enacted and becomes effective which assures all Americans financial access to the mental health services which are presently available through community mental health centers, Federal funds should continue to be made available for the purposes of initiating new community mental health centers. . . We also welcome the sensitivity of title II to the problems of alcoholism and drug abuse and the needs of children and the elderly. In section 201 (c) (1), we would recommend that a place for local elected officials or their representatives be mandated on the governing body of community mental health centers. We believe this is necessary because local governments have a large and growing responsibility for financing these needed facilities. Also, on the issue of composition of policymaking bodies, we would suggest that you reconsider the requirement in section 310 (a) (3) that the governing body of a migrant health center must have a majority of its members chosen from among its clientele. By its very definition, the clientele is migratory and not likely to produce leadership that will be on hand on a continuing basis. Otherwise, Mr. Chairman, we again commend this committee for its fine legislative craftsmanship and its dedicated commitment to community health. Thank you for your time this morning. 1 These end my prepared remarks and we thank the chairman and the committee for the legislative craftsmanship. I thank you for your time and I would like to add a couple of words. I did not realize we were going to have availability of "The State of the City." 1 I would like to enter this for the record and make additional copies available. Mr. ROGERS. I think we will receive it for our files and not the record. Dr. BUTTERY. We are particularly interested in extending the dollars, making sure we get the most impact for the money. As the block grant comes down to us through the State it is shared among all the programs. In our city we have just completed what we term "The State of the City." This is a program report of all the resource activities divided up by activities and human resources-60 percent or morepolice, fire and civil defense, finance administration, and community development, all under community development. We program these and analyze them as to their costs and the benefits, and the data is available. We believe this planning document allows us to present to the community so all people in the community can understand and take part in a community assessment of needs and where to place our priorities so we don't get lost in small categories that may have emotional appeal to someone. We can show the costs and benefits to the community. Last year with family planning programs, we have some 8,000 women should be receiving these services in the poorer sections of our community but only 2,100 can receive them. We have had indigent children born in the community and many will stay on the rolls. It will cost us $60,000 to educate these children and another $200,000 to maintain them if they stay on the welfare rolls. One particular fact I would like to bring up in educational programs: We run special detention centers. I should particularly like to mention our educational programs. We run special educational centers involving the minorities where we are dealing with such subjects as lead poisoning, prematurity, lack of 1 "The State of the City," 1973, city of Portsmouth, Va., may be found in the committee's files. maternal health care. Problems in this area remain a burden to the community. I don't believe third-party resources are going to provide the kind of care we need. We have detailed these out, program by program, with cost/benefit analyses for them, and we feel this information would be very useful. Mr. ROGERS. We appreciate that very much. We are grateful for your presence and your testimony will be most helpful. This concludes the hearing for this morning, and we will stand adjourned until 10 o'clock Tuesday morning. The subcommittee is now adjourned. [The subcommittee was adjourned at 12:40 p.m., to reconvene at 10 a.m., Tuesday, February 19, 1974.] HEALTH SERVICES AND HEALTH REVENUE SHARING HEARINGS BEFORE THE SUBCOMMITTEE ON PUBLIC HEALTH AND ENVIRONMENT OF THE COMMITTEE ON INTERSTATE AND FOREIGN COMMERCE HOUSE OF REPRESENTATIVES NINETY-THIRD CONGRESS SECOND SESSION ON H.R. 11511, H.R. 11518, H.R. 11845, [and all similar and identical bills] BILLS TO AMEND THE PUBLIC HEALTH SERVICE ACT AND FEBRUARY 14, 15, 19, 20, 21, AND 22, 1974 Serial No. 93-87 Printed for the use of the Committee on Interstate and Foreign Commerce 31-151 O U.S. GOVERNMENT PRINTING OFFICE WASHINGTON: 1974 COMMITTEE ON INTERSTATE AND FOREIGN COMMERCE HARLEY O. STAGGERS, West Virginia, Chairman TORBERT H. MACDONALD, Massachusetts JOHN JARMAN, Oklahoma JOHN D. DINGELL, Michigan LIONEL VAN DEERLIN, California J. J. PICKLE, Texas FRED B. ROONEY, Pennsylvania DAVID E. SATTERFIELD III, Virginia W. S. (BILL) STUCKEY, JR., Georgia SAMUEL L. DEVINE, Ohio JAMES T. BROYHILL, North Carolina BARRY M. GOLDWATER, JR., California |