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DEPARTMENT OF AGRICULTURE The Department of Agriculture in pursuit of its responsibility to "acquire and diffuse among the people * * * useful information on subjects connected with agriculture in the most general and comprehensive sense of the word,” carries out three major types of activity which have a direct effect on human health : scientific research, inspection, control and eradication programs, and educational services.
The scientific research activities of the Department are carried out in 10. divisions of the Agricultural Research Service, the Agricultural Marketing Service and the Economic Research Service. These diverse activities are aimed at the following purposes: (1) learning how the infectious diseases and parasites of domestic animals are transmitted to man and developing methods for diagnosis, prevention, or control-some 90 domestic livestock diseases are transmissible to man; (2) the toxicological effects of agricultural chemicals in animal and human food chains; (3) improvement of plants that yield steroid chemicals for making cortisone and related drugs drugs which are preventing and ameliorating the effects of old-age diseases; (4) understanding the biology, ecology, and prevalence of insects affecting man and animals and their role as vectors of disease; (5) establishing the physiological availability of nutrients in foods-a departmental activity since 1893; (6) studying the metabolic responses of humans to different dietary combinations; (7) surveying the diets of population groups and determining their nutritive value--the fourth nationwide survey will begin this year; (8) maintaining a culture collection for identification and screening of micro-organisms for the production of antibiotics and vitamins—the development of penicillin came from Department research in the micro-organisms field ; (9) developing dairy plant methods for removing strontium 90 from milk; (10) statistical analyses of health care expenditures by farm families and special field studies on rural health-in cooperation with State experiment stations.
Last year the Department's Meat Inspection Division of the Agricultural Research Service examined the production of 1,511 establishments located in 623 cities and towns. The inspection of poultry moving in interstate commerce is compulsory under the act of August 28, 1957. Other activities include (1) eradication of diseases such a brucellosis and tuberculosis_transmissible to man; (2) quarantine services to prevent introduction of animal diseases from foreign countries which may affect man; and (3) the regulation of pesticides-over 5,000 new products were registered last year and more than 1,800 official samples of economic poisons were analyzed and tested.
The Cooperative Extension Service of the Department and the land-grant universities through its more than 14,000 agents located in almost every county of the Nation assists in meeting educational needs, including the needs of youth through the 4-H program. This program is supported jointly by Federal, State, and local governments and interested groups. Through these agents, technical information is made available on health hazards of pesticides, food preservation, meal planning and preparation, home sanitation, and other health problems.
These activities of the Department are coordinated with HEW through eight major interagency committees including the Federal Pest Control Review Board, Interdepartmental Committee on Community Air Pollution, and the Interagency Committee on Nutrition and Education; joint projects such as prevention of radioactive contamination of milk and research to identify, collect and isolate cancer-retarding plant materials; and cooperation on enforcement efforts especially in the registration of agricultural pesticides.
ATOMIO ENERGY COMMISSION
Medical and health-related activities of the Atomic Energy Commission arise mainly in connection with its research program and its protective activities. By far the largest part of the research program is in the Division of Biology and Medicine; smaller health-related activities are carried out in the reactor development program.
Aside from small amounts paid to overcome the annual deficit at the AECowned Los Alamos community hospital and for radiological and health physics fellowships, AEC's programs are entirely composed of basic and applied research on the effects and usage of radiation. Approximately 60 percent of this research is in the biological sciences, 25 percent in the medical sciences, with the balance in applied fields such as agriculture and radiation sanitary engineering.
In the biological sciences, AEC conducts research on the effects of radiation on plants and animals with interest ranging from total behavior to the specific behavior of certain systems and organs. In addition, AEC conducts fundamental research at the molecular and cellular level and on the study of radiation genetics.
AEC's program in the medical sciences is principally in the areas of somatic effects of radiation, combating the detrimental effects of radiation, and health physics. AEC also conducts cancer research and radiological environmental health, coordinating its activity with that of PHS, and generally providing the basic research backup for the national program in this area.
In carrying out these activities, HEW and AEC cooperate through (1) the Federal Radiation Council, and (2) the National Committee on Radiation Protection, a private organization which includes HEW and AEC as sponsoring institutions. Further, there are bilateral contracts and joint projects between the agencies, such as an AEC-National Cancer Institute cancer research effort on cocarcinogenesis conducted at AEC's Oak Ridge National Laboratory. Finally, there has been established a close professional relationship between AEC and PHS scientists at the senior staff level as well as at the scientitie working level.
Funds for medical and health-related activities
[Fiscal years-In millions of dollars)
CIVIL SERVICE COMMISSION As the personnel agency for the Federal Governanent, the Civil Service Commission has a concern for the health of civilian Federal employees.
As part of its general responsibilities in the recruitment of civilian employees and the administration of the personnel system, the Civil Service Commission establishes and reviews physical standards for civilian jobs in the Government, sets professional standards for doctors and other health personnel to be employed in civilian positions, and supervises and adjudicates claims for retirement on account of disability.
In addition, the CSC administers two large health insurance programs--one for active employees and one for retired employees. Under the Federal Employees' Health Benefit Act of 1959, the Commission qualifies insurance carriers to participate in the program. The individual employee is then given the opportunity to select among the insurance carriers for an insurance plan and level of services designed to meet his particular need. The Government will contribute a portion of the cost of such plan and payroll deductions are made from employees' salaries for the remainder of the cost. The health benefits plans provide, under various options, hospital, medical, surgical, obstetrical, and other supplemental benefits. At present, there are four basic insurance plans in which about 1.9 million employees are participating. This represents about 75 percent of total Federal employment.
The second insurance program is designed for retired employees who were not eligible for enrollment under the act covering active employees. Retirees may enroll in a uniform governmentwide health benefits plan or may retain or purchase non-Government health insurance plans. In either case, the Govern. ment and the retiree share on a specified basis the cost of either option. The benefits are generally similar to those provided under the employees' plan. On June 30, 1962, there were 244,600 participants in this program and 235,000 are expected to be participating on June 30, 1963. The decrease is expected primarily because of death of annuitants.
The Government's contributions to Federal employees and annuitants health benefit plans shall not exceed 50 percent of such cost according to law. Recent experience has been that the Government contribution on an overall basis averages about 37.5 percent of the insurance cost and the participants contribute about 62.5 percent of the cost. The figures below cover funds from both sources.
The primary mission of the Department of Defense health program is the provision of medical care and services to military personnel and their dependents. The responsibility for these services rests with each of the three major military services.
It is estimated that in 1964 the Department of Defense will be responsible for the complete medical and dental care of approximately 2.7 million active duty military personnel as well as a more limited amount of care for about 3.9 million dependents and, on a space available basis, for 411,000 retired personnel. This care will be provided in 25 Army, 87 Navy, and 123 Air Force hospitals and in other Federal and civilian institutions. It is estimated that the 235 military hospitals will have an average daily patient load of 32,000 and that outpatient visits in Defense medical and dental facilities will average about 212,000 daily.
The Dependents' Medical Care Act also authorizes medical care at Government expense by private physicians in community hospitals for wives, children, and dependent husbands of personnel serving on active duty in the military and other uniformed services of the Federal Government. It is estimated that in 1964 the dependents' medicare program will provide for 1,356,030 patient days in community facilities. In addition, military personnel may utilize community hospitals for emergency services where military or other Government facilities are not available.
Largely in support of its medical care program, the DOD supports health research and training programs. The research efforts relate to (1) preventive medicine, (2) unique military health problems, and (3) improved patient treatment and care.
Likewise, the training effort relates largely to insuring an adequate supply of health skills in support of the medical care program.
In addition, there are certain health activities of the DOD which do not directly relate to patient care. These activities are in the area of preventive medicine and environmental health.
In carrying out these responsibilities, the DOD and HEW cooperate by: (1) cross-servicing of hospitalization and patient services on a reimbursable basis, including, for example, the Army's administration of the medicare program for dependents of PHS uniformed personnel; (2) membership on more than 20 interagency committees, boards, and panels; (3) DOD participation on 28 study sections of NIH in such areas as surgery, dental study, biochemistry, general medicine, pathology, pharmacology, and visual serivces; (4) joint sponsorship of activities such as the medical education for national defense (MEND) program and joint studies of areas of common interest such as the NIH-Navy study of respiratory diseases at Great Lakes Naval Training Center and Camp Lejeune; and (5) cooperating in many other diverse areas of common interest in medical and dental techniques, biometrics, epidemiology, pest control, pathology, medical supplies, and medical training materials and facilities.
DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE The Department of Health, Education, and Welfare, through the Public Health Service, Food and Drug Administration, Welfare Administration, Vocational Rehabilitation Administration, St. Elizabeths Hospital, and Freedmen's Hospital, has the major responsibility in the Federal Government for safeguarding and improving the health of the people of this country. The health functions of the Department fall into three major categories : Health research; health and re lated consumer protection; and health and medical services.
The major health research activities of the Department and, for that matter, of the Government are primarily carried out through the National Institutes of Health. However, other parts of the Public Health Service, the Food and Drug Administration, Vocational Rehabilitation Administration, and St. Elizabeths Hospital carry out basic and applied health-related research in support of their operating responsibilities.
The National Institutes of Health, through nine Institutes and one Division, supports nearly two-thirds of national health research. The program operates primarily through grants to institutions and to individuals for support of re search in the medical and health-related sciences and training of individuals to increase the research manpower in the medical sciences.
The grants and related fellowships are awarded by the Institutes on the basis of merit as determined by study sections and advisory councils composed of nonGovernment scientists.
The Institutes conduct research mostly on the Bethesda campus, largely within the mission of each of the categorical Institutes. This research is conducted on cancer, heart disease, mental illness, arthritis and metabolic diseases, etc.
The environmental and community health programs of the Bureau of State Services, like NIH, utilize grant programs to support research. However, unlike NIH, a larger proportion of their research effort is conducted directly by the Government and a large share of the research is applied research.
The Communicable Disease Center at Atlanta, Ga., serves as the focal point for community health research; the Robert A. Taft Sanitary Engineering Center at present serves this function for environmental health. The characteristic of the research in this area is to protect man from the health hazards of his community and his environment.
The Food and Drug Administration, Vocational Rehabilitation Administration, and St. Elizabeths Hospital also have health-related research activities. Again, most of it is in support of their operating missions.
The health and related consumer protection activities of the Department are carried out by the Food and Drug Administration and environmental health pro grams of the Public Health Service.
These programs have the mission of protecting man from injuries by his environment. The Food and Drug Administration enforces laws designed to pro tect the consumer against misbranded and adulterated foods, drugs, cosmetics, and therapeutic devices. PHS has similar responsibility to proteet man against the health hazards resulting from water, air, radiation, occupation, and milk and food. However, enforcement authority to prevent hazards presently exists only in the water area. The PHS programs are designed to prevent and control environmental hazards through support of research training grants, and technical assistance to State and local programs in this field.
Various HEW programs help provide health service to many thousands of beneficiaries. Some of these services are provided directly to merchant seamen, Indians and Alaskan natives, patients in St. Elizabeths Hospital, and, most recently, to Cuban refugees. However, grants-in-aid to the States is the principal mechanism used by HEW to help provide health services. Federal public assistance grants, including the recently enacted program of medical assistance for the aged, provide funds to the States to support health service for special beneficiaries designated by law. Typically, these Federal assistance grants support payments by the States to vendors of medical service doctors, hospitals, nursing homesthough, to some small degree, the welfare recipient may receive a direct allowance in his monthly assistance payment which can cover purchase of minor medical drugs and supplies. Similarly, under the vocational rehabilitation program, grants are made to the States to support medical or health services provided to individuals undergoing rehabilitation under the State program.
Other grant programs, administered by HEW, such as TB and VD grants or grants for maternal and child health services and Hill-Burton hospital construction grants, help the States to provide resources, manpower, and facilities to carry out vital health services for its citizens. Finally, the Department also finances extensive training, demonstration, and technical services which supplement these State grants.
For administering the numerous health programs, HEW has established an extensive mechanism to coordinate its activities with other Federal agencies and outside groups. The statements of the other agencies give an indication of the numerous interagency committees which help to coordinate the activities of the various Federal health programs. In addition, extensive use is made by HEW of outside advisory committees to draw on a wide diversity of judgments and backgrounds in establishing program missions and goals and coordinating programs with those outside the Federal Government. The magnitude of this coordinating mechanism can be exemplified by the Public Health Service where it is estimated that, of about 2,000 consultants participating as members of advisory groups, about 1,700 were non-Federal employees.