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REGIONAL MEDICAL PROGRAMS; ALCOHOLICS AND NARCOTICS ADDICTS FACILITIES; HEALTH SERVICES FOR DOMESTIC AGRICULTURAL MIGRATORY WORKERS

THURSDAY, MARCH 28, 1968

HOUSE OF REPRESENTATIVES,

SUBCOMMITTEE ON PUBLIC HEALTH AND WELFARE,

COMMITTEE ON INTERSTATE AND FOREIGN COMMERCE, Washington, D.C. The subcommittee met at 10 a.m., pursuant to notice, in room 2123, Rayburn House Office Building, Hon. Paul G. Rogers presiding (Hon. John Jarman, chairman).

Mr. ROGERS. The subcommittee will come to order.

We are continuing our hearings on H.R. 15758, and our first witness this morning is Mr. Clinton M. Fair, who is the legislative representative of the AFL-CIO here in Washington, D.C.

Mr. Fair, we are pleased to see you this morning, and thank you for being present to give testimony.

STATEMENT OF CLINTON M. FAIR, LEGISLATIVE REPRESENTATIVE, AFL-CIO; ACCOMPANIED BY RICHARD SHOEMAKER, ASSISTANT DIRECTOR, SOCIAL SECURITY DEPARTMENT

Mr. FAIR. Mr. Chairman, for the record, my name is Clinton Fair. I am with the legislative department of the AFL-CIO, and with me is Mr. Richard Shoemaker, who is the assistant director of our social security department, Mr. Chairman.

Mr. ROGERS. We are delighted to have you with us, too.

If you would like to, you can make your statement a part of the record, following your remarks, and you may sum up for us.

Mr. FAIR. Thank you, Mr. Chairman.

Let me read in part from the statement, only because I can then add the emphasis that I would like to add.

Through the extension and improvement of the regional medical programs, this legislation strikes at the cause of death for seven out of 10 Americans.

In extending the migrant health program, this legislation helps bring better health to some of the Nation's 1 million migrant farmworkers and their families and brings us closer to the day when we will have corrected what has been called America's shame.

The alcoholic rehabilitation amendments in this legislation will help provide proper treatment for the 5 million persons-more than twice wthe population of the entire Washington, D.C., area-who with their

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families suffer the physical and emotional problems which result from alcohol addiction. The narcotic addict rehabilitation amendments in H.R. 15758 will aid in carrying on and expanding what must be an aggressive effort to stem the rising number of drug addicts, especially among the Nation's young people.

I would like to make one comment, turning to page 2, with regard to the regional medical programs.

The regional medical program has within the short time it has been in operation in our opinion made remarkable strides in developing cooperative arrangements with the medical profession, our medical colleges, and our health institutions. This program holds great promise in making available to patients the latest advances in diagnosis of heart disease, cancer, stroke, and related diseases.

This coordination of effort also holds great promise of avoiding the needless cost of duplication and wasteful proliferation of diagnostic and treatment centers in our hospitals.

We realize, of course, that the evaluation of the program is quite difficult at this time. The program is new, and the great bulk of expenditures to date has been for planning activities.

But we would point out further examples, which are in our testimony, Mr. Chairman, and which we think spell great promise for the program.

The second part of our testimony deals with the migrant health program. The migratory provisions of H.R. 15758 would extend this 6-year-old migrant health program for another 2 years.

The plight of the migrant farmworker in this country has been widely publicized in recent years, but the publicity in no way cushions the shock that must be felt by every thinking American upon being reminded that people living in this country today, working amidst plenty, must endure such squalor.

I would point out on page 6 of our statement are some of the statistics in this area.

Of more than 1 million migrants, 650,000 still live and work outside the area served by existing migrant health projects. By conservative estimates, this group includes over 6,500 persons with diabetes who are without adequate medical care, over 5,000 migrants with tuberculosis, and over 3,000 children under the age of 18 who have suffered cardic damage as a result of rheumatic fever.

Many children have untreated iron deficiency anemia, and over 250 infants will die in the first year of life as a result of congenital malformation or disease.

Over 16,000 expectant mothers will find it difficult to obtain prenatal care, and beetween 20,000 to 30,000 individuals have enteric or parasitic infestations, resulting in most cases from poor sanitation.

I would point out, as the testimony does, that as these people move from crop to crop, the necessity for the program is greater because they move from one area where a program is now in operation to an area in which it is now nonexistent. And if they are to get the kind of medical care we think they need, the program needs the expansion so as these people move from one area to another they have the facilities available to them.

As you know, our migratory workers today may have a community in which he lives, but on the whole he is moving for long periods of time away from that area.

The alcoholism provisions in H.R. 15758 would authorize a 2-year grant program of building, staffing, and operating facilities for treating alcoholism, using the same types of mechanisms as provided in the Mental Health Centers Act. The local centers it will provide will aid the alcoholic, replacing the neglect and abuse which in the past resulted all too often in his eventual destruction.

It will also aid the less than 10 percent of alcoholics who are the homeless men and women, hopefully putting an end to the revolving door cycle of arrest, jail, release, drunkenness, and arrest again.

The narcotic addict rehabilitation provisions extend and make the very logical placement of narcotic addict rehabilitation activities in the mental health centers authorized under the community mental health centers programs. To enable the centers to absorb their new responsibility, the new legislation, would authorize a 2-year grant program for construction, staffing, and operation and maintenance of new facilities and for training of the necessary personnel. Drug addiction as a symptom of mental illness has been recognized in the act. As with the alcoholic the drug addict is a hazard to his family and his community as well as to himself.

Now, while the number of centers provided for treatment of addicts is small, the number of addicts is increasing. By providing this as part of the complex of mental health centers, it gets treatment to persons who need it in places where they can get it, and allows for efficient use of existing facilities.

Psychological dependence, if not addiction, is a problem for young people today, and I would add that there are other dangerous drugs in addition to narcotics, as this committee knows, which have become a problem in recent times.

We would hope that this program will be extended to them as well as to the narcotic drug addicts. We hope this committee will report favorably this program. We believe this legislation will stand as a model which the States may use in developing and modifying their own legislation, and certainly treatment of drug addicts and alcoholics and organization of medical service.

It includes incentives and assistance from which each State can benefit in assuring that the medical fields of its citizens are met.

Most certainly the Federal influence in the advance of medical knowledge and the application of that advance for the benefit of all citizens should continue.

In the past much of this influence took the form only of financial assistance to various State programs. Today this influence also assumes the form of acting as a clearinghouse, and as techniques are developed and tested by those closest to the problems.

We trust that approval of H.R. 15758 by this committee will indicate a continued willingness to maintain Federal support of health programs to the highest degree possible. And we urge your favorable consideration of the bill before you.

Mr. Chairman, we thank you kindly for the opportunity to appear in support of these various programs.

(Mr. Fair's prepared statment follows:)

STATEMENT OF CLINTON M. FAIR, LEGISLATIVE REPRESENTATIVE, AMERICAN FEDERATION OF LABOR AND CONGRESS OF INDUSTRIAL ORGANIZATIONS

Mr. Chairman, H.R. 15758, the Public Health Service Act Amendments which this committee is now considering, is a package of important extensions and improvements to existing legislation as well as extension of the Community Mental Health Centers Act to provide facilities for alcoholics and drug addicts. Through the extension and improvement of the Regional Medical Programs, this legislation strikes at the cause of death for seven out of ten Americans. In extending the Migrant Health Program, this legislation helps bring better health to some of the nation's one million migrant farm workers and their families and brings us closer to the day when we will have corrected what has been called "America's Shame." The Alcoholic Rehabilitation Amendments in this legislation will help provide proper treatment for the five million personsmore than twice the population of the entire Washington, D.C. area-who with their families suffer the physical and emotional problems which result from alcohol addiction. The Narcotic Addict Rehabilitation Amendments in H.R. 15758 will aid in carrying on and expanding what must be an aggressive effort to stem the rising number of drug addicts, especially among the nation's young people.

REGIONAL MEDICAL PROGRAM

The President's Commission on Heart Disease, Cancer, and Stroke, described three years ago the severe toll in human suffering which these diseases inflict on the American public, each diminishes the strength of our nation. The American worker looks forward to the day when major inroads will be made against these diseases through medical research and when the fruits of such research can be made available to him at a price he can afford.

The nation's poor, whose ill health is virtually inseparable from their way of life, look forward to the day when they can share fully in the fruits of modern medical science.

Since the Report of the Committe on the Costs of Medical Care was published in 1932, the regularization of health services has been considered necessary in order to bring about a more rational allocation of our health resources, but until the passage of P.L. 89-239, very little had been accomplished to implement such goals. The Regional Medical Program has, however, within the short time it has been in operation, made remarkable strides in developing cooperative arrangements with the medical profession, our medical colleges and other health institutions. This program holds great promise of making available to patients the latest advances in the diagnosis and treatment of heart disease, cancer, stroke and related diseases. This coordination of effort also holds great promise, not only of providing the best of care for those afflicted, but also of avoiding the needless costs of a duplication and wasteful proliferation of diagnostic and treatment centers in our hospitals.

We realize, of course, that evaluation of the program is difficult at this time. The program is too new and the great bulk of expenditures, to date, have been for planning activities. A total of 53 grants have been made for such planning, and it will be some time before plans can be implemented. However, the Surgeon General's Report on Regional Medical Programs to The President And The Congress, submitted by Dr. Stewart last June, indicated some of the program's early accomplishments.

A few special examples of programs already in operation deserve mention here. In the notorious Watts section in California, too large a proportion of the population has been virtually cut off from the mainstream of modern medicine. Under the Regional Medical Program proposed there, the medical schools of the University of Southern California and the University of California at Los Angeles and the Charles R. Drew Medical Association are cooperating to devise a plan for bringing some order into the health service vacuum now existing there. A 485-bed hospital and a proposed Postgraduate Medical School are later phases of the program's bold plan.

The Albany Regional Medical Program has developed a comprehensive program of education, organization, record-keeping, and follow-up examinations in an attack on cancer of the cervix. This disease, which now kills some 14,000 women each year, could be eliminated as a major cause of death if the disease is diagnosed and acted upon at an early stage. During the first year, the cancer control program is being inaugurated in seven hospitals in New York and Massachusetts.

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