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The HHFA has a number of loan and loan guarantee programs which have a direct effect on the construction of certain health-related facilities. These are loans for public works planning, college housing, and public facilities and a loan guarantee program for nursing homes.

The Housing Act of 1954, section 702, authorizes the Federal Government to provide advances to State and local public agencies in order to encourage them to prepare and maintain a current and adequate reserve of planned public works as well as to promote economy and efficiency in planning and building public works. These advances are repayable without interest when construction is started. Among the eligible public works which are customarily assisted under this program are sanitation and water facilities. Advances for 336 projects were made in the fiscal year 1962 for a total amount of $5.8 million. Hospitals and similar public health facilities, including clinics, nursing homes and laboratories are also assisted. In the fiscal year 1962, 13 advances were made for this purpose for a total amount of $0.4 million.

The college housing loan program is intended to assist institutions of higher education in providing housing and related facilities for students and faculty where such assistance is not otherwise available on equally favorable terms. Among the "related facilities" which are assisted have been health centers and infirmaries. In the fiscal year 1962, three loans, for a total amount of $4.1 million, were approved for these facilities. In addition, these loans are made to hospitals to provide housing facilities for student nurses and interns. In the fiscal year 1962, 20 loans for a total of $12.2 million were approved for this type of health-related housing.

Public facility loans are made to municipalities and other political instrumentalities of States to finance basic public works for which there is an urgent need. Communities with a population of less than 50,000 persons (150,000 in area redevelopment areas) are eligible. Water treatment and distribution systems and sewer collection and treatment systems are among the most common types of projects which have been given such loans. In the fiscal year 1962, 199 loans were made for water, sewer, or combination purposes for a total amount of $89.6 million. In addition, one loan was made for a hospital in the amount of $0.4 million.

The Federal Housing Administration is authorized to insure up to 90 percent of the amount of mortgages on nursing homes. Administratively, the agency has established a minimum of 20 beds for eligibility and has also established minimum standards of basic safety and health requirements equal or greater than the standards established by the States for licensing. In 1962, this program aided in the provision of 4,324 additional beds. It is estimated that this will rise to 12,100 in 1964.

Finally, it is expected that the Community Facilities Administration will be allocated $494 million in 1963 from the accelerated public works program. It is estimated that 64 percent, or $316 million, of these funds will be used for the construction of nearly 2,000 new municipal water and sewer systems. With local financial participation, this will mean construction of systems costing over $600 million.

In cooperating on these activities, HHFA and HEW have joint membership on three important interagency committees dealing with physical fitness, aging, and migratory labor. In addition, these agencies have set up two special task forces to deal with the social welfare aspects of public housing and residential housing for the aged. It is also the practice of HHFA to refer all applications for loans involving health and sanitary facilities to the Public Health Service regional offices for comment.

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Health-related activities of the Department of the Interior are primarily related to health and safety factors in mines. However, activities in the Geological Survey, Bureau of Sport Fisheries and Wildlife, Bureau of Commercial Fisheries, and the Office of Territories are health related.

The Bureau of Mines health research program is concerned primarily with workers in the mineral industries. The program consists of (1) research on dust and approval and testing of drill dust collectors, (2) respirator approval testing and research, (3) environmental surveys in metal mines, and (4) health and safety inspections in metal and nonmetallic mines.

The Geological Survey, as a byproduct of projects that investigate the quality of the Nation's surface and ground-water resources, compiles and analyzes data on the occurrence and distribution of elements in water that Other projects investigate the behavior of are, or may be, health related. pollutants, including radioactive wastes, which are released into the soilmoisture environment of natural water systems, compile radiometric data, and study the variations of plants and soil composition under changing environments for the purpose of correlating these factors with the incidence of certain human diseases or other health problems and to determine the effects on other biological systems.

The Bureau of Commerical Fisheries conducts a research program to determine the possible uses, including health uses, of selected fish oils and to determine the nutritional value of certain fishery products. In addition, the Bureau reimburses the Public Health Service for the cost of medical and dental services furnished the residents of the Pribilof Islands. Grants are made to American Samoa and the Trust Territory of the Pacific Islands for the operation of the local government. Part of these funds is used for general public health purposes and the operation of hospitals and dispensaries.

Health-related activities of the Bureau of Sport Fisheries and Wildlife are limited to the indirect benefits resulting from suppression of rabies among wild animals and reduction of rodent filth in grain intended for human consumption. The major committees in the health area to which both Interior and HEW belong include: Interdepartmental Committee on Water Resources, the Committee on Water Research of the Federal Council for Science and Technology, and the Technology Advisory Committee for the Uranium Mines Study. Funds for medical and health-related activities

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The Bureau of Prisons provides an extensive health system for the medical and mental treatment of approximately 24,000 Federal prisoners. This service is operated and staffed by Public Health Service personnel with assistance from Bureau of Prisons staff and from inmates.

Facilities range from the Medical Center for Federal Prisoners at Springfield, Mo., through accredited hospitals at 14 other prison institutions to very limited services, operated by medical and technical assistants, at the remaining institutions. In-house capacity is augmented, where necessary, by use of private medical resources on a contract basis. Funds for construction of a new psychiatric prison hospital, to be located at Butner, N.C., are included in the 1964 budget.

Anticipated patient load for 1964 is estimated to be 421,000 patient-days and over 1 million outpatient treatments.

The physical and mental health activities in the Federal prison system are a major part of Prisons' efforts to rehabilitate its inmates. Special efforts are required to correct deficiencies in the physical condition of incoming prisoners (e.g., dental deterioration) and in mental rehabilitation.

Close working relationships exist between the Bureau of Prisons and the Department of Health, Education, and Welfare through the use of PHS medical and technical staffs for Prisons' hospital system and the use of PHS facilities where more advanced or complex treatment is required. Inmates at Federal prisons participate, on a voluntary basis, in various HEW medical research products. The Bureau of Prisons is also a member of the Interagency Committee on Narcotics. Funds for medical and health-related activities [Fiscal years-In millions of dollars]

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Activities of the Department of Labor which may be considered health related are concerned primarily with accidents to workers employed by the Government and in various industries.

The Federal Employees' Compensation Act authorizes medical and hospital expenses to be paid for Federal employees injured or contracting disease in the performance of their duty. During fiscal year 1962 a total of 126,000 payments were made on behalf of approximately 100,000 employees. It is anticipated that the 1964 experience will be about the same.

Under the terms of the Longshoremen's and Harbor Workers' Compensation Act, the Department of Labor directs the vocational rehabilitation of permanently disabled longshoremen. This is done in cooperation with, and mostly through, the facilities of the States' vocational rehabilitation system.

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National Aeronautics and Space Administration medical and health-related projects are all in the research area related to space activities. Specifically, they are concerned with aerospace medicine, human factors research, biosciences, and the biological satellite flight program.

The objectives of the first two activities are: (1) To obtain a better understanding of man's capabilities and limitations and to determine his utilization

in advanced aerospace systems, (2) to determine design requirements for equipment and subsystems which will guarantee an environment adequate for maintaining the high operating efficiency of crews during programed and emergency phases of advanced aerospace missions, (3) to determine overall human requirements and integrate them into the design of advanced aeronautical, astronautical, and ground support systems, and (4) to provide operational medical support to space flight missions and to conduct development and testing of systems and components to insure the effective performance and safety of the astronauts in flight and on the ground.

The bioscience program is being developed to provide this country with biological knowledge that can be gained only in the environment of space, and with the basic biological knowledge pertinent to space exploration and operations. Research is being conducted and planned on matters such as the detection and study of extraterrestrial life and its impact on evolutionary theories, and the effects of the space environments on the behavior and functioning of living organisms.

The objectives of the biosatellite flight project are to investigate the biological effects of decreased gravity and weightlessness, with additional studies on the effects of high energy heavy particle cosmic radiation, and the effects on biological rhythms of removal from the earth's rotation.

NASA conducts some research in its own facilities but also contracts with industry, finances research by other Government agencies, and awards research grants to universities in support of medical and health-related research.

NASA has assigned an employee to follow NIH research activity and to study its applicability to that of the Administration. This has produced close working relationships between the two agencies. NASA and NIH have also embarked on a joint project entitled "Computer development for health-related research."

Funds for medical and health-related activities

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The National Science Foundation, as part of its statutory responsibility to initiate and support basic research in all fields of science through grants primarily to colleges and universities, finances a significant volume of research in the life sciences, amounting to $38 million in the 1964 budget. That portion of the Foundation's activity in the life sciences, which is considered to be particularly germane to the medical and health-related fields, will amount to an estimated $31 million in 1964. These expenditures support basic investigations in such scientific disciplines as molecular biology, genetics, immunochemistry, and metabolic biology.

Proposed project applications must pass a review, involving the use of panels of consultants who are experts in the field in which grants are requested. The NSF grant programs are administered with an awareness of the activities of other agencies in the support of research, so as to avoid duplication of effort in the support of specific research proposals and to assist in achieving balance in the support of basic sciences. This is particularly true of NSF's relations with NIH where the two agencies have cross-representation on each other's grant reviewing bodies and exchange information on grant applications.

In addition to supporting the conduct of research and facilities related to health, the Foundation also assists in the support of science education, including fellowships. A portion of the funds for these purposes involve the support of life sciences.

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The business loan program of the Small Business Administration is intended to help small businesses obtain adequate financing on reasonable terms. Privately owned hospitals, convalescent and nursing homes, and medical and dental laboratories which are operated for profit are eligible for these loans which can be used for expansion, improvement, and general operations. Eligibility is restricted to

(a) Hospitals with a capacity of less than 100 beds at the time of application;

(b) Convalescent or nursing homes with annual dollar volume of receipts of not more than $1 million; and

(c) Medical or dental laboratories operating in connection with an eligible proprietary hospital or, if independent, with an annual dollar volume of receipts of not more than $1 million.

In addition, private physicians may also qualify for these loans in connection with their practice of medicine. In fiscal year 1962, loans were made to 56 physicians and surgeons, 36 dentist and dental surgeons, 13 osteopathic physicians and chiropractors, 14 medical or dental laboratories, 14 hospitals, 70 sanatoriums and convalescent rest homes, and 14 other health service businesses, for a total of $12.9 million.

These loans may not be made for an amount exceeding $350,000 or for a term longer than 10 years.

The SBA is a member of the Subcommittee on Nursing Homes of the President's Council on Aging. This Subcommittee is chaired by HEW.

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The health-related activities of the Department of State, including the Agency for International Development and the Peace Corps, are part of the international activities of these agencies. These activities are carried on through (1) bilateral programs arranged directly between the United States and the governments of 41 countries participating in foreign assistance and (2) various international organizations and other multilateral arrangements in which the United States is a participant.

International organizations with health programs, such as the World Health Organization and the Pan American Health Organization, benefit from U.S. support in the form of assessed annual contributions financed by the State Department and voluntary contributions financed by AID. These organizations carry

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