from Missouri, some of his programs sounded outstanding. When you think about help that you need-it is 3 o'clock in the morning and you have a cardiac problem; you don't need a seminar, you need someone to give you some help. It sounded like this aspect of his program was very exciting.

Mr. ROGERS. Thank you so much. We appreciate the benefit of your advice.

Our next witness will be Dr. Carl Brumback, who is appearing for the American Public Health Association.

Dr. Brumback is from my own home county of Palm Beach County, Fla. He has done an exceptional job, and really some of the pilot projects with migrant health programs, and I am particularly pleased to have you appear before the committee again, because you were helpful in our previous legislative hearings.

You may proceed.

STATEMENT OF DR. CARL L. BRUMBACK, MEMBER, EXECUTIVE BOARD, AMERICAN PUBLIC HEALTH ASSOCIATION

Dr. BRUMBACK. Thank you.

The American Public Health Association appreciates this opportunity to present our views of H.R. 15758. I am here as an executive board member of this association, which now has over 20,000 members.

I have a prepared statement which has been given to the staff, and I would like to have your permission to summarize these remarks. Mr. ROGERS. Certainly, and your prepared statement will be made part of the record, following your remarks.

Dr. BRUMBACK. My comments refer to the migrant health portion of the bill. It is unnecessary, probably, to recall the fact that nearly one-fourth of the Nation's 3,100 counties depend upon migrant labor to harvest the crops. We all depend on this labor for much of our food. Approximately 1 million men, women, and children migrate each year in response to this need.

Although these people perform essential work, their annual income, $1,400 average per worker in 1965, seldom allows them to rise above the poverty level.

Furthermore, the places in which they work and live are usually far removed from sources of health care, and clinics are usually held at a time when they are working, and they seldom qualify under welfare residence requirements for usual forms of assistance.

Treatment of illness becomes difficult. Actually, the migrants' need for health care is greater than that of the rest of the population. Environmental conditions predispose them to illness and injury. Lack of education and knowledge of where to turn for help compounds these problems. Statistics confirm the fact that migrants have more health problems than the rest of the population.

Infant mortality was over 30 per thousand live births in 1964 among the migrants, compared with less than 25 for the national average. The rate from tuberculosis and other infectious diseases was 26 per thousand, compared with 10 for the Nation as a whole.

Through the Migrant Health Act, health services specifically designed to meet the migrants' needs have become available in many

parts of the Nation. Recent figures indicate 115 projects in 36 States and Pureto Rico. The number of migrants having access to these services is now estimated to be over 300,000. However, it should be pointed out that this is still less than one-third of the total migrant population.

Also those migrants now reached by existing projects receive only basic or minimal services for the most part, and these are available to them throughout the year.

Migrant progress has been essential to make a beginning to give these people resources, but it takes a long time to make up for years of neglect. We are only now beginning to see benefits from our projects in Palm Beach County, which have been underway for 12 years.

Services must be made available and acceptable. This is a strong argument for keeping this program separate. The absorption into the general program at this time would destroy the most beneficial settlements that have been achieved. The fact that only part of the migrant population is being reached in a minimal way, indicates that the program should be continued and be expanded.

Thank you.

(Dr. Brumback's prepared statement follows:)

CLARENCE L. BRUMBACK, M.D., M.P.H., MEMBER, EXECUTIVE BOARD, AMERICAN PUBLIC HEALTH ASSOCIATION

Mr. Chairman, Members of the Committee: The American Public Health Association appreciates this opportunity to present its views on H.R. 15758, a bill to extend the authority for the Regional Medical Programs, for migrant health services and to initiate a much more active program dealing with the severe problems of both alcoholism and narcotic addiction. I appear before you as spokesman of the APHA in my capacity as a member of its Executive Board. I shall spare you the details of a description of our Association-we, and I, have appeared before you sufficiently often in the past to acquaint you with both— except to tell you that our membership now totals in excess of 20,000.

MIGRANT HEALTH

The APHA has traditionally expressed a deep concern for the welfare of the nation's migratory workers. Prior to the passage of the Migrant Health Act of 1962, the APHA advocated health services for migrant laborers including: child care; pre-natal assistance; control of communicable diseases through vaccination, and dental health. In the past, the extreme mobility of the nation's migrant workers, together with their dire economic need, prevented them from enjoying adequate medical attention.

Since the passage of the Migrant Health Act, important strides have been made in providing essential health facilities for the seasonal agricultural worker. These accomplishments were made possible through joint Federal, State and local funds. During the past five years, migrant health projects have provided remedial care for workers and their dependents, immunization, family planning services, nutrition counseling and the continuing of medical care when workers move from one area to another. Additionally, during this time span, the workers' environment has improved through the joint efforts of employers and local health workers working to improve housing and sanitation facilities.

Migrant workers have slowly been educated as to the availability of health services at their disposal. So successful has this instruction been, that today the services of existent projects are deficient in relation to the demand. Despite advances made in this field, current health services fall short of their goals. One principal handicap to the migrant health program is the hardship it places on local participating hospitals, resulting from the payment, on the average, of only 60 percent of total hospital costs. Many communities find it difficult to make up this deficiency due to the rising costs of hospital care.

At present, the number of medical professionals is insufficient to adequately meet growing medical needs. In order to cope with health problems of migrant laborers, more physicians and dentists must be employed to narrow the gap between the medical and dental care received by migrant workers and those services received by the nation as a whole. In addition to the expansion of the professional ranks, it is also necessary that more aides be trained as liaisons to serve as a link between the professional health worker and the migrant laborer. These aides would assist the worker in utilizing health services created for his benefit. With this goal achieved, the migrant worker would then become more of an economic asset to his country rather than a liability. A healthy labor force will alleviate costly health emergencies, thus reducing economic drain as a consequence of unnecessary illness and disability.

In order to illustrate the need for increased funds, I would like to use an example with which I am most familiar-the health program of Palm Beach County, Florida.

The migratory health projects in my county have expanded greatly since 1962. At the outset of these projects we were faced with the same problems plaguing the rest of the nation in administering to its migrant workers' health needs. These problems were partially solved by services furnished by Federal, State and local money. These funds provided the means for developing services tailored to the specific needs of the worker. As the program progressed, more migrant laborers became aware of the facilities open to them. As a consequence of the 1962 Migratory Health Act, significant advances were achieved in environmental health. State laws and regulations have established guidelines for migrant housing and sanitation; such programs would not have been possible without the assistance of the Migrant Health Act. Migrant workers are finally learning where to turn for assistance in treating their illnesses. Yet we have only begun to teach them the value of the preventive measures and positive health. Much has been done to aid the migrant, but more must be done if his environment is to be raised to acceptable standards. Once accomplished, it will require continual effort to maintain these levels.

In the case of Florida, funds for extended hospitalization and the staffing of physicians are completely inadequate. Consequently, obtaining adequate treatment is often difficult except in the case of extreme emergency. In some instances hospitals and their physicians have provided medical care without reimbursement. Therefore, if local health facilities are to furnish satisfactory medical care for migrants in the future, more funds must be made available through amendments to the Migrant Health Act. Speaking in behalf of the APHA, I strongly urge that the increase in funds conform at a minimum with the amounts recommended in H.R. 12756, introduced by Congressman Paul Rogers of Florida. Only when we meet the overwhelming task at hand with sufficient resources will the migrant worker then achieve the same degree of medical aid now available to the general populace.

ALCOHOLISM PROGRAMS

The interest and concern of the American Public Health Association in the promotion of alcoholism programs is well established:

1. In 1963, the Association adopted a resolution recognizing alcoholism as a major public health problem and urging all State and local health departments to initiate programs.

2. The Association has prepared a "Guide to the Community Control of Alcoholism" which will be published later this year.

3. Through its regional offices, the Association has conducted a series of training programs intended to stimulate local health workers to implement their skills in dealing with the problems of alcoholism in their communities. 4. The staff of the Association has served in advisory and consultative capacities to national agencies, voluntary organizations and state agencies in the development of programs for dealing with alcoholism.

5. The APHA previously has testified before Congress concerning alcoholism bills.

The need for a major effort to combat alcoholism is apparent. Great numbers of persons are afflicted with the condition. The toll that it takes in terms of broken homes, lost man hours, employee inefficiency and physical suffering, is unmeasurable. In addition, the Supreme Court is presently considering the case

of Powell vs. Texas which may change our courts' methods of dealing with chronic drunkenness offenders. If the Court rules in favor of Powell, it will be held unconstitutional to sentence alcoholics to correctional institutions. The resulting increased need for clinical facilities for treatment of these alcoholics will have to be met by the health care system.

The establishment of such centers as proposed in H.R. 15758 will provide a portion of the resources needed for meeting the crucial treatment needs of the alcoholics in this country. However, we respectfully submit that the present bill meets only a small portion of the total requirement. Treatment faciltiies also should be supported in conjunction with other health care units such as general hospitals and health departments. In addition, consideration must be given to the following, if a truly comprehensive public health approach to the problem is to be successfully initiated:

1. Research in the etiology, treatment, rehabilitation and prevention of alcoholism. Research in the cause, effect and prevention of alcohol problem. Training of appropriate professionals to apply new and existing knowledge in the control of alcoholism and alcohol-related problems.

2. Appropriate measures to direct national attention to alcoholism as an important as an important medical-social problem-measures which will encourage the utilization of existing knowledge such as that concerning the treatment of alcoholics, and techniques of education of special groups about alcohol and alcoholism.

3. Efforts to insure that consideration of community alcoholism problems be a part of every comprehensive health plan.

4. Full use of the potential resources and services of governmental agencies. 5. Of particular importance in the implementation of Federal programs to deal with alcoholism and alcohol problems is the newly organized National Center for the Prevention and Control of Alcoholism in the National Institute of Mental Health. This Center should be given authority, finances, and responsibility for the coordination, implementation and development of comprehensive programs.

Unless and until each of these important program elements are fully implemented, efforts to cope with this serious health problem will be proportionately less than adequate. Therefore, although we support these provisions, we also must emphasize that a truly comprehensive program to deal with alcoholism must include a variety of concerted approaches on a multitude of fronts.

Again, we appreciate this opportunity to present our views on this important health legislation. We respectfully request your consideration of our recommendations. Thank you.

Mr. CARTER. No questions.

Mr. ROGERS. In the program there in Palm Beach County, could you just give me a brief summary of, for instance, the housing conditions in the camps, and what you have been able to do with this through the migrant program?

Dr. BRUMBACK. Yes, sir. We have over 100 camps. We actually have in Palm Beach County more agricultural migrants than in any other county in the United States. We have over 27,500, according to the last count. These people live in the county, all over the county, in all sorts of housing. Through the Migrant Health Act we have been able for the first time to acquire a staff through which we have actually been able to get into all of these places, inspect them and upgrade the housing.

As a result, environmental health situation for the migrants in Palm Beach County is immeasurably better now than it was. However, there is a great deal left to be done, and we have to continually provide supervision and maintenance of this program in order to keep the benefits that we have achieved.

Mr. ROGERS. What about your mobile unit? Don't you have a unit that can go to the field where the migrants are, with a doctor and nurse and so on?

93-453-68- -14

Dr. BRUMBACK. Yes, we do. This clinic was acquired through this program, and we can go out in the fields and provide the services there. In the beginning even though we took the services to them, they were afraid to come and take advantage of them. They had been abused and refused service so long that they didn't know what to expect.

Now they will come long distances to reach these services, and there is much more demand than we can see. We estimate that we have provided personal health services to only about 11,000 of our 27,000 migrants.

Mr. ROGERS. Does this include the children?

Dr. BRUMBACK. Yes. To some degree. Some of these services, of course, do reach other migrants.

Mr. ROGERS. I know that you put out a report each year on your particular program, and I would be interested in having a copy of that for the committee.

Dr. BRUMBACK. We will send you a copy, Mr. Chairman.

(The document requested was not available at time of printing.)

Mr. ROGERS. Thank you for coming to let us have the benefit of your views on this legislation.

There is a call for Members to come to the floor, and so I think with your concurrence, Dr. Carter, we will recess to allow Members to answer the call, and then we will begin again as soon as we can get back from the floor.

The committee will stand in recess for 10 minutes. (Brief recess.)

Mr. ROGERS. The committee will come to order.

Our next witness is going to be introduced by Mr. Staggers, chairman of our full committee. We are very pleased to have the chairman of our committee with us this afternoon. It is the chairman's bill that we are considering and taking testimony on, so it is a pleasure to have him recognize the gentleman now for introduction.

Mr. STAGGERS. Thank you.

We are glad to have Dr. Carter here, too.

At this time, I would like to present Mr. Louis S. Southworth. Would you come forward, sir, and take the stand.

Mr. Southworth is assistant supervisor of the Division of Alcoholism of the West Virginia Department of Mental Health, and he is presenting a statement regarding alcoholism on behalf of and for Gov. Hulett C. Smith. I know the Governor wanted to be here. He told me personally he felt this was important and he has appeared before this committee several times, but he selected the next best man to come over and present his views for him, and I guess they were prepared by you, Mr. Southworth.

I understand you also have statements by Dr. M. Mitchell-Bateman, the director of the West Virginia Department of Mental Health, and also a statement of Donald Dancy, supervisor of the Division of Alcoholism.

We are happy you are here, and we are pleased that West Virginia is taking an interest in these issues, and is going forward in this work. We are trying to complement what the States are doing. We realize it is not only a State problem, but a Federal problem all over the Nation. So we are happy to have you. And tell the Governor we are sorry he couldn't make it.

You may proceed.