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When the Tuberculosis Control Act was added to Public Law 410, we submitted to the Budget and to the Appropriations Committee estimates of additional officers, 50 or 60, needed to carry out the provisions of that act of whom ten or a dozen were to have been in grades above that of captain of the Army.

The Appropriations Committee increasingly, as you know, is unwilling to put into appropriations what it considers new legislation, and this additional authorization was considered possibly as new legislation, but because of the urgency of the matter, no objection was raised.

I would hope, therefore, that in connection with this bill, that there be added an amendment which would authorize the appointment of regular commissioned officers in addition to those regularly authorized in the appropriation act, and that such appointment be authorized in the several grades without regard to the limitation of three per year in grades above that of captain.

Mr. BROWN. What limit?

Dr. PARRAN. We estimate that there will be needed 50 or 60 officers to carry out this program to be appointed in the several grades and that they would be appointed during the next, say, 18 months after the Act is passed.

Mr. PRIEST. Dr. Parran, in line with that suggestion, I am just mindful of a situation that seems to have been developing here, I do not want to delay the hearings, but to ask you one question on that subject of personnel.

Assuming that we pass this bill, we have scheduled for House consideration this week, either Thursday or Friday, the Mental Health Bill, and I am just wondering, in view of the situation today, if you are having any difficulty in obtaining the personnel that you need; and, if so, what might be done to help that situation.

Dr. PARRAN. We have never been faced with a personnel situation as critical as the present and the future outlook is very bleak.

The cost of medical education has increased over the years. It requires, normally, after a boy graduates from high school, nine years of training, four years in college, four years medical school, and one year internship, at a cost of about $12,000 to attain a medical education.

The demand for doctors is very great, even with the demobilization. There does not seem to be any let-up in the pressure for personnel. We are in a very bad competitive position as compared with the employment opportunities on the outside.

Mr. PRIEST. That was my question, the competitive position that you are in, and that is why I felt I should ask you the question at this time.

Dr. PARRAN. It is a problem that gives us more concern than any other. I am sure the Committee realizes that whatever the Public Health Service has been able to accomplish in the past has been due not only to legal authorization, but it has been due to our ability to employ and train and develop a competent corps of medical officers of health along with engineers, dentists, and other personnel.

However, the quality of personnel, after all, makes or breaks any organization, and I look to the future with a great deal of concern.

During the war, the Congress authorized temporary promotions as the result of which we were able to promote our younger officers who

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were carrying increased responsibilities to grades above that which they would normally attain, but as soon as the war emergency is declared over, they will revert to their regular grades.

For example, it requires a boy, 21 years after he leaves high school, before he can attain to the grade of that corresponding with Major in the Army,

Mr. PRIEST. If there were some modification, some amendment to the basic act in connection with promotions in the various grades, would that, in your opinion, be of some help to you?

Dr. PARRAN. It would be of tremendous help.

Mr. PRIEST. Let me ask this one further question: Is there some considerable difference in the Public Health Service promotion system and we will say, for example, in the new Medical Corps in the Veterans' Administration?

Dr. PARRAN. The Veterans' Administration, fortunately for them, have been able to offer, as the result of their recent law, a very much more attractive condition of employment.

Mr. PRIEST. That was my opinion.
Is there anything else you wish to say to the Committee, Doctor?
Dr. PARRAN. That is all I have to say, Mr. Chairman.

Mr. Brown. I have a question or two that I would like to ask the Doctor. You said it would take fifty or sixty additional officers to implement this program. Would you want to write that limitation into this law?

Dr. PARRAN. I would not object to having that written in.

Mr. Brown. Would you furnish the Committee with a schedule of the different grades you think would be necessary to implement this program?

Dr. PARRAN. I shall be very glad to do that, Mr. Brown. I hope, if the amendment is put in, that the exact distribution in the several grades would not be spelled out but that a limitation be put on the total number to be employed and then an additional limitation, if you wish, of those to be employed in the higher grades, that is, grades above that of captain.

Mr. Brown. And what, in your opinion, would be the cost of administration, in your office, of this act ?

Dr. PARRAN. That is a question I have not anticipated, Mr. Chairman. May I ask for information? May I ask Dr. Hoge on that?

Mr. Brown. It would be considerable, of course, if you are going to have to have 60 additional officers to carry it out.

Dr. PARRAN. In addition to the commissioned officers, I think we shall need some people who are expert in hospital construction and administration. In order to save the committee's time, I shall be very glad to file a statement as to our estimates of the administrative cost.

Mr. Brown. If with it we might have a statement as to the personnel costs of the Public Health Administration in the last prewar year and what they are now or will be in the first postwar year, in your opinion.

Dr. PARRAN. That is, the cost of commissioned officers, or both?

Mr. BROWN. The cost of administration all over, both the commissioned officers and otherwise.

Dr. PARRAN. We can get that.
Mr. PRIEST. We will be very glad to have that.

Dr. PARRAN. Would it be satisfactory if we gave you that figure for the civil grant-in-aid programs? It is very difficult, when it comes to


appraising one of our marine hospitals, what is administration and what is service.

Mr. Brown. That is right.

Dr. Parran. If I may limit it to the civil grant-in-aid programs, we can do it.

Mr. Brown. I would like to know where we are going with our Public Health Administration, and how much of an increase we have had in the cost of the Public Health Administration, not during the war itself, but in comparison to the prewar cost and with the anticipated postwar cost.

Dr. PARRAN. I have the following figures, Mr. Chairman, covering the actual expenditures during the fiscal year 1941, the last full year before the war, and the estimated costs, that is, the amounts requested in our budget estimate for the fiscal year 1947.

In 1941, grants to States were confined almost entirely to aid for general public health purposes and for venereal disease control. Since that time the grants program has expanded to include, in addition to these, assistance also in tuberculosis control, cancer control, and industrial hygiene.

In 1941, total grants amounted to $16,236,070. Administrative expenses incident to this program amounted to $509,420 or 3.137 percent of the total.

For the fiscal year 1947, our budget estimates for the total grants program amounts to $33,636,876, with administrative expenses of $1,134,637 or 3.373 percent of the total.

The increase in percentage cost for 1947 over 1941 is attributable primarily to increases in pay of personnel under the more recent Federal Employees' Pay Act.

Mr. Priest. Are there any further questions?
Thank you, Doctor.

Is Mrs. Weagly of the Associated Women of The American Farm Bureau Federation here?

Will you step forward, please.
Will you give your name and identify yourself for the record.



Mrs. WEAGLY. The Associated Women of the American Farm Bureau Federation is a national organization of farm women with a membership representing nearly one million farm families.

Both the Associated Women and the parent organization have been vitally concerned for many years with the inadequacy of medical care and hospital facilities in rural areas.

Great numbers of farm people are unable to obtain adequate medical care and hospital service for their families, partly because adequate facilities and services are not available to them and partly because the costs of services, where available, are frequently out of line with ability to pay:

The Associated Women, since its inception, has promoted group health associations and hospital insurance as a means of securing more adequate care at more equitable cost to low and middle income groups. In many States, much has been accomplished through volun

tary, cooperative prepayment plans for hospital and medical care where hospital facilities are available. Unfortunately, however, in many rural communities there are no hospital facilities to service such plans and, consequently, a dearth of physicians and nurses has also resulted.

Adequate hospital facilities are indispensable in the proper care of the sick and, unless such facilities are made available, physicians will not locate in rural communities.

The rural areas are rearing millions of youth who go to the cities to live. The urban areas, therefore, cannot afford to be indifferent to the health of the people in rural areas. If, through a series of years, the health of our rural children is neglected, a period of great weakness will follow in which the quality of both rural and urban people and their efficiency will deteriorate.

The health of the individual is more than a matter of personal advantage; it is of paramount importance to the Nation because it is our greatest national resource.

Due to the enormous concentration of population and taxable wealth in urban and industrial areas, we face a condition of great inequality as between the States with respect to their ability to provide public health and other services which are vital to the wellbeing of our people. Accordingly, the assistance of the Federal Government through grants in dealing with these problems effectively.

Legislation to extend public health facilities, rural hospitals, and health centers, and assistance in providing health services and medical care to persons unable to obtain these services should safeguard the rights of the States to develop their own local programs to meet local needs, and the Federal Government should not assume burdens that the States can and should bear.

We request that qualified farmer representation be included on the Advisory Board on Hospital construction.

These and other safeguards as suggested by Mr. W. R. Ogg, on behalf of the American Farm Bureau Federation, have the approval of our organization. They were developed through collaboration of the two organizations and based upon their resolutions.

We respectfully urge the enactment of legislation embodying the principles of S. 191.

Mr. PRIEST. We appreciate your statement.
We will next hear from Mr. Nelson Cruikshank.
Will you please identify yourself for the record ?



Mr. CRUIKSHANK, Mr. Chairman and Members of the Committee: The opportunity you afford me to express the position of the American Federation of Labor on the important legislative proposals you have before you, relating to the construction of health facilities is much appreciated.

It is not necessary for me to bring before the members of this Committee factual data relating to the urgent need for the construction of hospitals and health centers. During the past months this need has become a matter of common knowledge due in no small measure to the amount of public understanding of the problems engendered by the extensive hearings held before the Senate Committee on Education and Labor relating to the proposals now before you and by the wide dissemination of information gathered by the Senate Subcommittee on Wartime Health and Education. This need is now generally recognized. The problem is how best to meet it.

The American Federation of Labor supported S. 191 in the Senate with certain recommendations for amendment. We note with pleasure that some of our recommendations were adopted and are retained in the measure approved by the Senate.

We are particularly pleased that our suggestion to include the requirement for the payment of prevailing wages to laborers and mechanics engaged in the construction of projects approved under the terms of this bill has been followed. On the basis of extensive experience in this field we can assure you that this provision will not only safeguard the workers who will construct the hospitals but will protect the public interest as well since it will remove the incentive to cut wages in the preparation of contractors' estimates and bids.

We feel, however, that a number of other changes made by the Senate tend to weaken rather than strengthen this measure. The adoption of H. R. 2755 introduced by Congressman Patrick or H. R. 2498 introduced by Congressman Neely is preferred to the adoption of the measure in the form passed by the Senate.

We are pleased that the distinguished Chairman of this Subcommittee, Mr. Priest, has recently introduced a measure, H. R. 5628, that incorporates the desirable features of both the above measures introduced in the House and those added to the Senate measure while eliminating for the most part the undesirable features of both. In other respects this bill represents some additional improvements over any of the measures previously considered and we are therefore glad to endorse and support it.

The proposals of the American Federation of Labor for meeting the health needs of the people of this country go much further than does this bill. Our endorsement of it and the support we give to it are based on our opinion that the bill represents a commendable and practical step in the right direction. The analysis of health needs that has been placed before this committee and other committees of the Congress concerned with these matters together with other competent studies in the field have shown the interrelation of all the problems involved. From a study of these findings the conclusion is inescapable that the Nation is confronted by a vicious cycle of poverty, sickness, lack of adequate facilities, and personnel unrelated to the needs of the people. It is our feeling that the bill introduced by Mr. Priest warrants wholehearted support because it presents a practical way of breaking this vicious cycle. It provides a sound program for providing additional health facilities in response to need as revealed by careful analysis and study conducted in each locality. We hope and confidently predict that the enactment of this bill will set in motion forces in each locality that will have far-reaching beneficial effects on the health and security of our people.

I should like to indicate some of the specific points on which in our opinion H. R. 5628 represents improvements over the bill enacted by the Senate.

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