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RADIOLOGICAL HEALTH

The radiological health training grant program provides support to teaching institutions designed to help meet the national needs for radiological health trained personnel. The activities include:

(1) Institutional grants for the development of curriculums and support of graduate students in radiological health training;

(2) Assistance to academic institutions to develop and incorporate radiological health subjects into the curriculums for physicians, dentists, engineers, and others whose professional responsibility include radiological

health hazards. The fiscal year 1963 budget of $2 million permitted supporting 20 continuing and 3 new training programs. This has included support for 79 full-time stu. dents. With the addition of part-time support for students, the program is providing some training assistance to at least 127 students. This is short of meeting the manpower needs in radiological health. The National Advisory Committee on Radiation has pointed out that at least 150 specialists will be needed per year for the next 10 years, and that 3 technicians will be needed for each specialist.

WATER SUPPLY AND POLLUTION CONTROL Training grants in water supply and pollution control are awarded to training institutions for the purpose of (1) establishing new or expanding existing curriculums in areas directly concerned with the water field, and in related areas where needed specialists may study their disciplines in relation to the problems of water supply and pollution control, (2) upgrading and expanding the teaching faculty in order to improve a given training program, and (3) furnishing financial support to students selected for the training in question, who fulfill the requirements of the institution for enrollment.

In fiscal year 1963, the budget of $1,100,000 will permit supporting 23 continuing and 11 new training programs, leaving a backlog of 9, totaling $280,000.

The research fellowship program in water supply and pollution control is basically designed to train individual scientists and engineers for research careers. The fiscal year 1963 budget of $300,000 will permit supporting 48 fellows—25 continuing and 25 new ones, with a backlog of 5, totaling $30,000,

ENVIRONMENTAL HEALTH SCIENCES

The environmental health sciences training grant program is intended to improve the quality and quantity of research and teaching personnel. The objectives of the program are (1) to enhance the potential of the training institutions in developing graduate programs in the environmental health sciences and (2) to encourage and aid the flow of high-quality students through these programs, particularly at the predoctoral and postdoctoral levels.

The complex nature of environmental health problems makes an interdisciplinary approach to training fundamental. The research training grant program provides support to institutions for developing graduate programs and subsistence stipends to trainees. The institution is free to propose programs of any nature which best reflect particular research training needs and provide the best grouping of the institutions' facilities and abilities to satisfy these needs.

At present, grants are being made to 19 institutions covering the following areas: Environmental microbiology, biological ecology, industrial toxicology, instrumentation development, mathematics and systems analysis, epidemiology, and chemistry. These are interdisciplinary projects in environmental health sciences which are beyond the scope of existing categorical training grant programs of the Public Health Service. These projects include the support of 94 students.

A modest beginning was made in the support of graduate training programs during fiscal years 1961 and 1962 when 10 grants were made, totaling $523,187. From then through the November 1962 approvals, 34 additional grants were made, bringing the total to $1,122,000. At the next review committee meeting this fiscal year, 13 new applications totaling $765,613 will be considered.

SUMMARY

Among agencies of the Federal Government the Public Health Service is unique in the number and scope of its responsibilities in environmental health. While activities relating to this field are carried on in all three of its operating bureaus, the principal programs are presently in the Bureau of State Services. We now face a number of problems in the administration of these, particularly in regard to interagency and internal coordination, staffing, and laboratory and other facilities. Looking to the future, social and economic forces will increase environmental health problems. One can predict major growth in State and local government expenditures and activities, and by industry for facility construction, operation, and for other controls.

The need for a high-level organizational unit to carry out the environmental health mission of the Public Health Service is apparent. This need has been the subject of congressional interest, and has been studied intensively by advisers to the Surgeon General, as well as Service personnel. The most recent analysis of the problems, and of Federal programs required to meet its challenge, was completed in November 1961. This study was carried out by a committee of individuals skilled in environmental sciences, with Dr. Paul Gross, immediate past president of the American Association for the Advancement of Science, as its chairman. This group reviewed ongoing and proposed programs of the Service, developed long-range objectives for the environmental health programs, and gave special attention to manpower needs, the role of intramural and extramural research efforts, and the relationship of current and proposed Service programs to those of other agencies. Their conclusions and recommendations are as follows:

CONCLUSIONS AND RECOMMENDATIONS The committee has reviewed the problems which face this Nation in the field of environmental health, particularly as they relate to the mission of the Public Health Service. The Service has established programs dealing with certain aspects of environmental health. However, the growth of our technology and the urbanization of American society have proceeded at a pace with which the Service's current programs are not prepared to cope. From its total evaluation of the problem, the committee concludes

That a national need exists for establishment and maintenance of a vigorous and integrated effort to maintain controls over the human environment compatible with projections of change in both population and the environment itself.

That the current "categorical" approaches represented by Public Health Service divisional programs are incapable of providing either (a) the necessary cognizance of combined multiple effects of environmental impacts or (b) the depth of effort required by individual divisional programs.

That accommodation to the national needs in environmental health will require the establishment of a strong focal center adequately staffed and equipped to prosecute an effective and integrated program within the Public Health Service and to manage and coordinate a strong extramural research, training, and technical support program utilizing the available institutional resources of the Nation.

That an adequate leigslative basis for a sufficient national program in environmental health does not exist at present. One of the factors missing in the current efforts of the Service is a place at which primary responsibility for the control of enviromnental hazards comes to a focus. The committee believes that immediate action should be taken to establish a center where the operational, research, and training programs of the Service in environmental health can be brought together. This is not to say that all of these functions of the Service should be centralized. On the contrary, many must remain close to the place where environmental hazards exist. However, the complexity of the problem requires that the Service's programs be designed with a total perspective toward the environmental health needs of the Nation. This perspective can best be gained by a concentration of primary effort at a center.

Therefore, the committee makes the recommendations given in the following paragraphs: 1. Public Health Service responsibility in environmental health

(a) A major national effort, both governmental and nongovernmental, must be started if the environmental health problems resulting from the rapid growth of our highly technological civilization are to be adequately understood and if measures for their control and ultimate prevention are to be developed.

(6) It is essential that the Federal Government assume leadership in the research and development effort required to supply knowledge and techniques to the discrete State and local agencies of all types engaged in prevention and control activities for alleviation of threats to health from the environment.

(C) The focus of this national effort should be centered in the U.S. Public Health Service.

(d) The leadership of the Public Health Service in the prosecution of a national environmental health program should utilize to the fullest possible extent existing university, industrial, governmental, and other research and technological capabilities through grants and contracts for research, demonstrations, and educational and training facilities. Extramural extensions of the Federal activity should comprise a major fraction of the total annual effort. 2. Manpower needs

(a) In undertaking a national program in environmental health, high priority should be given to the early initiation of adequate training programs for a wide range of personnel in the physical, biological, and social sciences. These efforts should include the strengthening of the divisional training programs, the creation of a new program of institutional grants for comprehensive environmental health training, and the continued support of the Service's short-term, internal programs. Funds in excess of $25 million are urgently needed to place these programs in full operation. Training effort of this magnitude will not create an imbalance with other scientific needs of the United States.

(b) Strong efforts are needed to improve the status and income levels of environmental health scientists to permit Federal, State, and local health agencies to recruit needed personnel. 3. Need for a National Environmental Health Center

To implement effectively the development of a focal point within the U.S. Public Health Service for an enhanced and major national effort in environmental health, the committee recommends the establishment of a Center for Environmental Health, which should include the following elements :

(a) The headquarters activities of the present operational programs, including their administration, fundamental and applied research, and the national pool of resource personnel who supply information and assistance relating to control activities to the dispersed regional laboratories and instrumentalities operating wherever preventive and control measures are required.

(b) The administrative headquarters of a unified environmental health grants program in support of fellowships, university training programs, universityrelated research projects, and demonstration grants to properly constituted agencies. (c) Appropriate facilities for the conduct of special training programs.

(d) A new "Office of Environmental Health Sciences," independent of the divisional structure and with separate budgetary provision, consisting of scientific groups reporting to the scientist who is Director of the Office of Environmental Health Sciences. These groups, which would include biological, physical, and social scientists as well as mathematicians, would study basic problems in environmental health, undertake research on probl of common interest to the several divisions where desirable, provide central services in mathematics, statistics, data processing, information storage and retrieval, instrumentation and analytical laboratory procedures, etc., and provide advice and consultation to the Bureau of Environmental Health with respect to the overall direction of research. Beyond these functions, these groups would be specifically charged with the continuing responsibility for an overall purview of the entire field of environmental health. 4. Location of the Environmental Health Center

The committee recommends that the Environmental Health Center, including the Office of Environmental Health Sciences, be located in the Washington area. 5. Programs in environmental health

(a) The Bureau of State Services (Environmental Health) is presently organized into five working divisions, a structure which evolved as needs were recognized. It is recommended that, as soon as possible, each of the operating programs be strengthened materially with respect to staff and facilities, so as to accomplish their specific missions more effectively.

(b) In view of the growing environmental health hazards resulting from rapidly changing technology and increasing population the country over, the committee recommends the continuing development of regional facilities, supplementary to the Center, with adequate staff and facilities to conduct applications research, training and control activities appropriate to the regions involved.

(c) The committee recommends that as the Public Health Service moves toward the broader and more comprehensive effort here proposed, every effort be made to conserve the real strengths of the present program during the transition period and that intensive study be given to an optimal organization pattern for environmental health activities within the U.S. Public Health Service. 6. Relationship of programs of Bureau of Environmental Health to those of

other Federal agencies The broad scope of the problem of environmental health relates to virtually all of man's activities. It is to be expected, therefore, that the specific programs of the Bureau of State Services (Environmental Health) will frequently be contiguous with those of other agencies. It is imperative therefore that continuing effective liaison be maintained between the Bureau and other national, State, and local agencies so as to maximize the effectiveness of each while avoiding unnecessary duplication of effort. 7. Need for legislation

(a) The committee recommends that the Public Health Service seek such legislation as may be required to establish a Bureau of Environmental Health with necessary authorization to conduct research, training and technical support activities, and to administer a broad program of extramural training, research, demonstration, and institutional support grants and contracts. Such authorization should be in addition to existing legislation governing operation of the divisional programs. It should be designed to supplement, rather than limit, the existing authority for divisional operation.

(6) The committee recommends that a statutory Advisory Council on Environmental Health be established to advise the Surgeon General on matters concerning policy, operations, research and training in the field of environmental health. This Council would also serve as an advisory group for the Environ. mental Health Center, including the Off of Environmental Health Sciences.

Dr. TERRY. Mr. Chairman, our next witness is Dr. Shannon, the Director of the National Institutes of Health.

Mr. ROBERTS. You may proceed, Dr. Shannon. Dr. SHANNON. Mr. Roberts, I have with me Mr. Joseph Murtaugh, who is Chief of our Office of Program Planning. We arranged with your staff for him to accompany me on the possibility that if one may wish to get into certain technical aspects of legislation and the like, he would be available to answer questions.

Mr. ROBERTS. Thank you, sir.

Dr. SHANNON. Mr. Chairman, we have two statements, one of which was submitted for the record and contains a fair amount of detail on some of the program developments that we wish to present to you today.

The other is a rather historical summary of the development of our programs that covers the present program in its support of research, the breadth of expansions of resources, both physical resources and manpower resources, and the production of some measure of institutional stability.

Mr. ROGERS of Florida. Mr. Chairman, do we have copies of the detailed statement ?

Dr. SHANNON. I believe so; yes, sir.
Mr. Rogers of Florida. Is this the detailed statement?

Dr. SHANNON. I am told that you do not have copies, sir. I had been under the impression that these had been given to the committee.

Mr. Rogers of Florida. Could we get copies? I think it would be helpful to have the detailed statement, too. I would like to look at that, too.

a

Dr. HUNDLEY. The detailed statements, Mr. Rogers, are just now being cleared by the Department and we will make them available to you as soon as possible.

Mr. Rogers of Florida. That is fine. Thank you. (The statement referred to follows:)

SUPPLEMENTARY STATEMENT OF THE DIRECTOR OF THE NATIONAL INSTITUTES

OP HEALTH

1

BACKGROUND INFORMATION RELATING TO THE FEDERAL ROLE IN THE ADVANCEMENT

OF THE NATION'S MEDICAL RESEARCH

The National Institutes of Health, a Bureau of the Public Health Service, seeks to promote health and control disease through research. To accomplish this objective, NIH acquires new biomedical information in its own laboratories and through a much larger group of scientists and physicians supported by grants and fellowships. Essential to this objective is a broad-scale scientific approach to the mysteries of health and illness and a marshaling and development of results for attacks on specific disease problems. Early history of PHS research

The Public Health Service, formerly the Marine Hospital Service, has conducted medical research since 1887, when a laboratory of bacteriology was established at Staten Island, N.Y. There, Dr. Joseph Kinyoun, first director of the Hygienic Laboratory, applied the new concepts and techniques of European bacteriological science to problems of infectious disease. The laboratory was strategically located. Cholera, smallpox, yellow fever, and bubonic plague were constant national hazards; and Dr. Kinyoun was able to demonstrate the cholera organism in immigrants to America. He made several study tours in Europe, and did much to introduce into the United States the new science developed by Pasteur, Koch, Ehrlich, Roux, Van Behring, Wasserman, and Metchnikoff.

Thus, at the turn of the century, the Public Health Service, through the Hygienic Laboratory, was a major force in the Nation's scientific attack upon communicable disease. The Reorganization Act of 1902 (July 1) (Public Law 57-236) authorized the Public Health and Marine Hospital Service to strengthen and expand its bacteriological studies, and established an advisory board of experts (today's National Advisory Health Council). The Biologics Control Act (Public Law 57–244), passed the same day, gave the Hygienic Laboratory authority to control the purity, safety, and potency of commercial biologic products, a function now performed by NIH's Division of Biologics Standards. During this period notable advances were made in the production and application of diphtheria antitoxin and smallpox vaccine.

These early origins of the research function of PHS were part of a broader science. By the first decade of the 20th century, medical research support in this country had assumed its characteristic pattern of diversity of sources. Drug houses had undertaken chemical investigations as early as the 1860's when A. C. Abbott, of Chicago, first isolated pure alkaloids on a commercial scale. Private organized health research began with the founding of the Johns Hopkins Medical School in 1893 and expanded through private endowment. The Rockefeller Institute for Medical Research, McCormick Institute for Infectious Diseases, and Carnegie Institution of Washington were among the first large private contributors. In 1904 the voluntary health agency, another vehicle for private giving for health purposes, had its origin in the National Tuberculosis Association. Today nearly every major health problem is represented by a private national agency which raises funds for services and research.

Medical research by the Federal Government can be traced back to the Civil War. Expansion of the Army Medical Department established the nucleus of the Army Medical Museum and Library. When asked to list some of the great American contributions to medical science, William H. Welch (1850-1934), a leader in the development of medical research in the Nation's schools, named these : anesthesia, discovery of insect transmission of disease, development of the modern public health laboratory, and the Army Medical Library and its Index

1 See also committee print containing background statement on Public Health Service.

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