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undergraduate programs, 33 would expand graduate programs, and 32 would expand postgraduate.

In the field of auxiliary personnel 11 schools have plans to expand existing dental hygiene school, 16 schools plan to star new dental hygiene programs, 15 schools expect to start new dental assistant programs and 17 schools are contemplating establishment of programs for dental laboratory technicians.

Mr. ROBERTS. How many of the graduates of dental schools go into some type of public health work?

Dr. BURKET. I think a relatively small percentage, if you call public health work organized public health activity, approximately 30 percent of our graduates go into the Armed Forces and if we could consider that public health work they are there for a period of at least 2 years.

Mr. ROBERTS. I would assume that a good many of them qualify for fellowships and that type of work probably through NIH grants, do they not?

Dr. BURKET. Yes, sir. That has been a very stimulating influence, particularly in developing research scientists and individuals interested in teaching and academic careers. The program will start to bear fruit in the next few years.

Mr. ROBERTS. Thank you very much. We appreciate your appearance.

Are there any questions?

Mr. BROCK. Yes.

Mr. ROBERTS. The gentleman from Nebraska.

Mr. BROCK. You stated a need for construction funds. If we were building a dental college and a medical college, would we need less: funds to set up a dental college than we would a medical college?

Dr. BURKET. I think we come down to a definition of terms there. If you include the teaching hospital as a part of the cost of the medical school, it is likely that the costs would be comparable. If you do not include the construction costs of your teaching hospital or you have affiliated hospitals, it would be my impression that these costs would be less for medicine than for dentistry.

In dentistry the major portion of our clinical teaching is done with the framework of the dental school so that the school must bear the cost of equipping these facilities and maintaining them and, speaking as an administrator who has to battle with these maintenance costs, I can assure you that they are extremely high for teaching clinical dentistry.

Mr. BROCK. The chairman just propounded a question regarding the number of dentists per 100,000 civilians. Could you give me the number of dentists that we have in the armed services per 100,000 servicemen?

Dr. BURKET. I cannot give you that exact figure. I am sure that there are people in the room who can. It is, of course, much higher. Mr. BROCK. Mr. Chairman, I would make a request that for the record we have the number of dentists and doctors in the services per 100,000.

The reason I make this request is that several years ago before coming to Congress our dentist passed away in my home town and I wrote to the commanding officer of the hospital in which this young

dentist who was the son of the deceased dentist was and requested that they discharge this young dentist because he had written to me and said he had absolutely nothing to do in the services and would like to take over his father's practice and that he was certainly available to come because he was busy only one day a week at this hospital.

I would like to see just how many of the dentists and doctors our services are using per 100,000 personnel.

Dr. BURKET. It is 2 per 1,000 in the services. Of course, you must understand that all of the men in the services get what we consider to be complete dental care and that all of the public per 100,000 do not receive this same care.

Mr. BROCK. You do not have that for doctors, do you?

Dr. BURKET. I do not have it for physicians.

Mr. BROCK. That is all I have, Mr. Chairman.

Mr. ROBERTS. Thank you very much.

Our next witness will be Dr. Malcolm H. Merrill, director of public health, the California State Department of Health and president of the American Public Health Association, Washington, D.C.

Dr. Merrill, we are glad to have you.

STATEMENT OF DR. MALCOLM H. MERRILL, PRESIDENT, AMERICAN PUBLIC HEALTH ASSOCIATION, AND DIRECTOR OF PUBLIC HEALTH, CALIFORNIA STATE DEPARTMENT OF PUBLIC HEALTH Dr. MERRILL. Thank you, Mr. Chairman and members of the committee. As has been indicated by Mr. Roberts, I am Dr. Malcolm Merrill.

I am here in my capacity as president of the American Public Health Association and I am also a director of the State Department of Public Health in California.

You may be interested in just a little information about the American Public Health Association. It is a professional organization of public health workers in the United States. We have 29 affiliated societies and branches covering every State in the Union. Our total membership in the association and the affiliated societies is approximately 25,000. This represents the largest such voluntary organization in the country and also in the world.

We, as an association, appreciate this opportunity to present some of our views concerning the four bills that are before you here now for consideration.

Mr. ROBERTS. Doctor, I know you have a good statement and I appreciate your appearance, but I am wondering if you would be willing to file your statement and make an oral statement for us?

Dr. MERRILL. I would appreciate having that opportunity, Mr. Roberts, to present the written statement for the record and then just briefly touch a few of the highlights.

Mr. ROBERTS. Thank you, sir.

(The statement follows:)

STATEMENT BY MALCOLM H. MERRILL, M.D., PRESIDENT, AMERICAN PUBLIC HEALTH

ASSOCIATION

I am Malcolm H. Merrill, president of the American Public Health Association with headquarters at 1790 Broadway, New York City. I am a physician trained in public health and am director of public health, California State Department

of Public Health, the agency in which I have served since 1937. For 13 of these years I was chief of the division of laboratories.

The American Public Health Association is a professional organization of public health workers in the United States. We have 49 affiliated societies and branches covering nearly every State in the Union. The total membership of the association and of our affiliated societies amounts to about 25,000 public health people-representing the largest such organization in the world. We appreciate the opportunity to make a statement to your honorable body concerning H.R. 6906, H.R. 10255, H.R. 11651, and H.R. 10341.

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The American Public Health Association through its committee on professional education is the accrediting body for schools of public health in the United States (including Puerto Rico) and Canada. In its 1959 annual survey of the 13 schools accredited, the association learned that even those schools of public health with strong budgets and new buildings were pressed for room to accommodate students in their programs. One school has had to limit its admissions for lack of classroom space. Almost every other school must make inadequate space serve as best it can. Lack of sufficient professional faculty in many areas of the curriculum was also found to be an added problem to that of space.

Both difficult conditions are being faced by school administrators at a time when there is unparalleled need for more and better trained public health workers. The growth of our population is outstripping by far the increase in the number of personnel required to serve them in the field of public health. This situation is all the more urgent when we realize that public health is now dealing with areas of public concern, such as the control of chronic diseases, mental illness and so on, which even 10 years ago had not yet clearly come under the purview of public health agencies as appropriate for their concern. There has been a lack of growth in the facilities to train public health workers and researchers to develop and apply newly available health knowledge for the benefit of the people.

PROFESSIONAL CONCERN EXPRESSED

Concern over this is deep and associationwide. This took one form of expression when the governing council of the American Public Health Association at the 87th annual meeting of the association in 1959 passed a resolution entitled "Financial Assistance to Educational Institutions."

"Whereas there is a critical need for additional support for existing educational facilities and for the development of expanded or new facilities for the preparation of physicians, dentists, and other professional personnel in the health field; and

"Whereas there is critical need for increased recruitment of competent persons to this field: Therefore, be it

"Resolved, That the American Public Health Association endorses and supports sound Federal legislation to provide financial assistance to qualified educational institutions to secure the physical facilities needed and scholarships to individuals as means of recruitment of needed personnel."

At the annual meetings of the association in 1957 and 1955 the governing council passed two resolutions on this subject, both of which were entitled "Federal Aid to Graduate Schools of Public Health." These were quoted to this subcommittee on June 8 a year ago by the executive director of APHA. Berwyn F. Mattison, M.D., when the APHA went on record as favoring the passage of H.R. 6871 which supported construction grants to schools of public health. At that time our executive director also cited the recommendations of the 1958 national training conference in support of that aid legislation. The conference reported that—

the majority of (public health) schools, in addition to expressing a need for additional facilities to handle any increase in enrollment, indicated a definite need for additional space for current enrollment. A few schools said that as much as 50 to 200 percent more space is needed to provide adequately for current enrollment. Almost half of the schools indicated that there did not appear to be any local source of funds for a building program of

any kind. A few schools indicated that perhaps as much as 50 percent of the amount needed could be raised locally (from "Source Book for the National Conference on Public Health Training, July 28-30, 1958," published by the Department of Health, Education, and Welfare, Public Health Service, 1958).

NEEDS STILL UNMET

The APHA has in fact been vocal in the area of Federal and State support for public health schools and their students for the last 10 years, having passed five resolutions on the subject since 1950. The needs for more adequate space and more effective training and recruitment continue to be unmet, although our school administrators are to be most highly commended for their continuing, undaunted efforts at obtaining funds for both private and public sources. The Federal Government has given substantially and well in response to the need.

In coming before you today, the association expresses the gratitude of the Nation's public health workers for the support they have received in their schools from both Government agencies and private groups. We come seeking more help, however, and give our support to the principles of H.R. 6906, the passage of which, we believe, is vitally necessary to the promotion and protection of the Nation's health.

THE CHANGING FACE OF PUBLIC HEALTH

We in public health have special responsibilities in a culture and society that is dynamic in its every aspect. We are constantly facing new problems, acquiring new functions, and working under new circumstances in our practice. For example, we are finding that in community after community major population shifts are taking place. This has tremendous significance for the changing face of public health practice. We must now learn what these suburban shifts and urban repopulations will mean as far as the provision of health services is concerned. We must find out what the actual demands for services resulting from the shifts of age and ethnic groups from one locality to another will be and what these people will need and want. All this will require intensive studies and a new look at our school curriculums. We see the need for new disciplines to become involved in public health, for example, the social scientists. This in turn means expansion of school programs, which of course means more space and more professional teaching personnel. It will require is already requiring adequate financial support, which is sufficient for the demand and need. It would be a sound investment in the improved health status of our people to provide facilities that can take care of the new teaching programs being offered. Later in this statement we comment on H.R. 10341, having to do with general research grants. We would like to point out that some of the breakthrough to knowledge that would result from more support for research would come through the schools of public health. Many of them have either no or sadly limited facilities for the conduct of this research. The university, with its multidisciplined resources presents an ideal setting for the designing and carrying out of many public health research activities, and can so become a small decentralized institute of health.

More wisely planned and executed research and the improvement of public health practice by the integration of new professional disciplines are but two examples of ways in which we can expect public health in America to do a better and better job for its thousands of communities. H.R. 6906, if passed, would undoubtedly help bring this about by making the required more adequate workshop facilities available. Our association's support of the bill is based on recognized need as expressed by our school administrators and public health leaders. As to the financial formula used in the bill the American Public Health Association expresses no opinion since this basically is outside its special competence.

H.R. 10255 AND H.R. 11651

The comment on financial formula in the preceding paragraph may be taken as a first expression of the association's opinion on the principles embodied in these two bills. Therefore we do not express a preference for either since both have the most commendable objective of meeting a very substantial need. However, we might say that the "matching" mechanism has been a traditional one in support of publicly administered health activities.

THE PUBLIC HEALTH PROFESSION'S INTEREST

The need for more people in the health field was touched upon in our comments on H.R. 6906. The American Public Health Association, of course, goes on record in favor of financial encouragement for our Nation's high school students to go into medicine and dentistry. They should have every possible encouragement in view of our expanding population, and of the dynamic growth of scientific knowledge that will be mounting. It is almost a truism of the day also to say that no type of education is more expensive and necessarily prolonged than that for professions like medicine and dentistry with their growing complexity. The public health profession has a special interest in the strength of our health From the medical and dental schools come our supply of qualified health officers, dentists, epidemiologists, occupational health physicians, commu̟nity psychiatrists, and many of our laboratory specialists and medical care program administrators. Part of the extension of their training comes in the Nation's schools of public health.

resources.

As active as we are in recruiting them (and in studying how to-APHA project) there are still far from enough available to do the work that must be done. We must expect to depend heavily for our future practitioners on the reservoir of today's top high school students.

PUBLIC HEALTH DIRECTORS EXPRESS CONCERN

Our association conducted a nationwide panel of public health directors at the end of 1959. All State and territorial health officers were included in the survey as well as a sampling of directors of city and county health departments and the regional medical directors of the Public Health Service. They listed the securing and training of competent public health personnel as their top problem in relation to the efficient administration of their current programs.

May we direct your attention again to the resolution quoted above in support of the plan of H.R. 6906? In addition to supporting grants for construction of facilities, the resolution notes the critical need for increased recruitment of competent persons to the field and endorses Federal legislation to provide "scholarships to individuals as a means of recruitment of needed personnel." Again, too, may I point out that our executive director's testimony on H.R. 6871 before your committee last year was substantiallly in support of a bill, the basic intent of which is similar to the bills here under discussion?

DATA ON MEDICAL STUDENT SUPPLY

I should like to point up some significant and serious conditions in the medical education picture which the passage of this act would help to alleviate. The following notes are based on information in "Physicians for a Growing America" (PHS publication No. 709, 1959):

"The number of applicants for medical schools per 1,000 population 20 years old decreased from 10 in 1950 to 6.6 in 1958, in an almost steady downtrend. "Evidence exists that the scholastic level of medical students is not as high as it has been. In recent years the withdrawal rate from medical schools for poor academic standing has increased, whereas the withdrawal rate for all other reasons has remained static practically. In other words, competing professions requiring a Ph. D. have been succeeding in drawing off students that might have entered the medical profession.

"Presuming, as we cannot, that all those interested in pursuing a medical education had the opportunity to do so, the cost of education is not only higher but 'can be expected to grow higher.' Student earnings, family support, and present scholarship programs help but do not solve the expense problem.

"To achieve a graduation rate considered desirable, 11,000 a year by 1975, there must be some 12,000 admissions to schools of medicine and osteopathy in 1971, or an increase of 50 percent over the present number of admissions. To assure such a supply, the Nation must increase and equalize 'opportunity for young people by very substantial increases in funds available to make it possible to finance a medical education.'"

It appears to us that the passage of either of these bills would be another of the Government's giant steps forward in brightening the outlook for the future of medical education, and thus the future of the public's health.

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