to elaborate upon the reasons why we believe that enactment of such legislation is so urgently needed. While we are in complete accord with the basic provisions of these bills, we should like to have the opportunity, at your convenience, to suggest several minor amendments for your consideration. While these amendments are primarily of a technical or clarifying nature, we should like particularly to call your attention to the desirability of some changes in the present wording of the definition of "basic public-health services.” The changes that we have in mind would not affect the substance of the present definition in the bills but are designed to avoid any possible confusion between the program contemplated by the bills and other Federal grant programs now authorized by law. We also believe that it might be wise to insert language which would make it clear that the purpose of this definition is to define the scope of Federal aid and that it does not in any way seek to invade the right of States or their political subdivisions to determine what health services they may provide to the people of their communities. We should be glad to submit suggested language to accomplish these changes if you so desire. Let me repeat, however, that the suggested changes we have in mind are entirely of a technical or clarifying nature and do not in any way limit the endorsement of this Agency of the objectives and basic provisions of H. R. 274 and H. R. 913. The Bureau of the Budget has advised us that the enactment of this legislation would be in accord with the program of the President. Sincerely yours, MY DEAR MR. CHAIRMAN: Reference is made to your letters of January 9, 1951, acknowledged by telephone January 10 and January 11, requesting reports on H. R. 274 and H. R. 913, respectively, which are for all practical purposes identical bills each entitled "A bill to amend the Public Health Service Act to authorize assistance to States and political subdivisions in the development and maintenance of local public health units, particularly in national defense areas, and for other purposes." * ** * The policy and purpose of the proposed legislation are set out in subsections 2 (d) of the bills as follows: "(d) it is the policy of the Congress, and the purpose of this Act, in the promotion of the general welfare and in the interest of national security, to assist the States, through the measures provided for in this Act, in developing and maintaining local public health units organized to provide basic full-time public health services as rapidly as practicable in all areas of the Nation and particularly in national defense areas, and in the training of all types of personnel for local public health unit work.” Under date of December 28, 1950, this Office made a report to you on H. R. 9914 and H. R. 9928, Eighty-first Congress, the provisions of which bills were practically identical to those of the pending bills H. R. 274 and H. R. 913. In the said report it was stated: "This Office has no information as to the need or desirability of legislation of the type here proposed and no general information with respect thereto other than that contained in House Report No. 2480, Eighty-first Congress, accompanying H. R. 5865, Senate Report No. 925, Eighty-first Congress, accompanying S. 522, House Report No. 2327, Eightieth Congress, accompanying H. R. 5644, hearings on S. 132, S. 522, title V of S. 1581, and title V of S. 1679, Eighty-first Congress, held before a subcommittee of the Committee on Labor and Public Welfare, United States Senate, on May 10 and 11, 1949, and hearings on H. R. 5644 and H. R. 5678, Eightieth Congress, held before the Committee on Interstate and Foreign Commerce, House of Representatives, on April 8, 1948. Accordingly, I make no recommendation with respect to the merits of H. R. 9914 and H. R. 9928. * * *"" The quoted statements are applicable to the subject bills H. R. 274 and H. R. 913 and I have nothing to add thereto at this time as to the merits of the proposed legislation. It is noted, however, that subparagraph "(e)" commencing on line 20, page 8 .of H. R. 274, and on line 19, page 8 of H. R. 913 should be relettered subparagraph "(d)." Also, with respect to H. R. 274, lines 1 and 2, page 6, are transposed, and in line 1, page 10, the word "expenditures" is mispelled. In addition it is believed that line 4 on page 1 of H. R. 913 should read "Services Act of 1951." Since the report on each bill is requested in triplicate, five carbon copies of this report are enclosed herewith. Sincerely yours, LINDSAY WARREN, Comptroller General of the United States. TREASURY DEPARTMENT, Hon. ROBERT CROSSER, Chairman, Committee on Interstate and Foreign Commerce, House of Representatives, Washington, D. C. MY DEAR MR. CHAIRMAN: Further reference is made to your request for the views of the Treasury Department on H. R. 913 and H. R. 274, similar bills to amend the Public Health Service Act to authorize assistance to States and political subdivisions in the development and maintenance of local public health units, particularly in national defense areas, and for other purposes. The subject matter of the bills is not of primary concern to the Treasury Department. It is assumed that appropriations to carry out this function would be made to the Federal Security Agency. If this is done, the certifications to the Secretary of the Treasury of the estimated amounts to be paid to States provided for in the proposed subsection 315 (e), page 10, which would be added to the Public Health Service Act by sections 3 (b) of each bill, would not serve a useful purpose so far as the Treasury is concerned since the Treasury Department performs the disbursing for the executive departments of the Government only on vouchers duly certified pursuant to the act of December 29, 1941, as amended (U. S. C., title 31, secs. 82b-82g). Accordingly, it is suggested that proposed subsection 315 (e) be revised as follows so that payments to States will be made by the "Federal Security Administrator" or "Surgeon General" in accordance with standard practice: "(e) The shall, prior to the beginning of each period for which a payment is to be made, estimate the amount to be paid to the State for such period pursuant to subsection (d), increased or decreased, as the case may be, by any sum by which he finds that his estimate for any prior period was greater or less than the amount which should have been paid to the State, and shall thereupon, through the disbursing facilities of the Treasury Department, pay such amount to the State." The Department has been advised by the Bureau of the Budget that there is no objection to the submission of this report to your committee. Very truly yours, JOHN W. SNYDER, Secretary of the Treasury. GOVERNMENT OF THE DISTRICT OF COLUMBIA, Hon. ROBERT CROSSER, Chairman, Committee on Interstate and Foreign Commerce, MY DEAR MR. CROSSER: Reply is made to your request for reports on the following bills: H. R. 274, H. R. 913, and S. 445. All these bills provide for Federal financial assistance to States and political subdivisions in the development and maintenance of local public health units. The District of Columbia is included within the scope of the legislation. 83290-51--2 The Commissioners have received from the Director of Public Health of the District of Columbia a recommendation that they endorse this legislation. The Commissioners therefore recommend enactment of this legislation. Time has not permitted ascertainment of advice from the Bureau of the Budget as to the relationship of this legislation to the program of the President. Respectfully, JOHN RUSSELL YOUNG, President, Board of Commissioners, D. C. AMERICAN HOSPITAL ASSOCIATION, Mr. ROBERT CROSSER, Chairman, Committee on Interstate and Foreign Commerce, Washington, D. C. DEAR MR. CROSSER: We have received your notice of hearings on H. R. 274 and H. R. 913, local public-health units, to begin on April 10. You are probably aware that the American Hospital Association presented testimony to your committee in the Eighty-first Congress in support of legislation for local public-health units. We are informed that the legislation presently before your committee is essentially the same as that which we supported in the Eighty-first Congress. We do not wish to intrude upon the time of your committee by repeating our statement again. The American Hospital Association generally favors Federal aid for improvement of local public-health facilities and services. We shall be pleased to provide such further information as may be within our power, and the wish of your committee. Yours sincerely, JOHN H. HAYES, Chairman, Council on Government Relations. NATIONAL TUBERCULOSIS ASSOCIATION, Mr. ELTON J. LAYTON, Clerk, Committee on Interstate and Foreign Commerce, New House Office Building, Washington, D. C. DEAR SIR: Confirming my telephone conversation with you on the morning of April 9, attached is another copy of the letter I sent to Mr. Crosser on April 4, together with a statement in support of H. R. 274 and H. R. 913. Since from your statement your schedule is such that it probably would be impossible for me to testify personally, I should appreciate it very much if you see that this statement is inserted in the record and comes to the attention of the members of the Interstate and Foreign Commerce Committee. Sincerely yours, Mr. ROBERT CROSSER, JAMES E. PERKINS, M. D., APRIL 4, 1951. Chairman of the House Interstate and Foreign Commerce Committee, House Office Building, Washington, D. C. DEAR MR. CROSSER: I should like to request the privilege of testifying at the hearing on H. R. 274 and H. R. 913 to be held in Washington on April 10 by the House Interstate and Foreign Commerce Committee. Attached is an abstract of the statement which I wish to present. Sincerely yours, JAMES E. PERKINS, M. D., Managing Director. STATEMENT IN SUPPORT OF H. R. 274 AND H. R. 913, EIGHTY-FIRST CONGRESS The board of directors of the National Tuberculosis Association adopted the following resolution on February 5, 1949: "Whereas the executive committee of the National Conference of Tuberculosis Secretaries and the meeting of the executives of State tuberculosis associations have again expressed their interest in the need for complete coverage of States and communities by adequate local health units; and "Whereas the establishment of such units has been endorsed by the American Medical Association, the American Public Health Association, and the State and Territorial Health Officers Association and an offer of cooperation in this project has been made to the National Health Council by the board of directors of the National Tuberculosis Association: "Resolved, That the National Tuberculosis Association hereby reemphasizes its policy favoring the establishment of local health units and approves the principle of Federal grants-in-aid as assistance to States to complete the coverage of their respective populations and areas with full-time local health units under professional direction." The National Tuberculosis Association is directly affiliated with tuberculosis associations in all of the States and Territories, and indirectly affiliated through the State organizations with 3,000 city and county associations. The National Tuberculosis Association and its affiliated State and local associations have long held the opinion that effective tuberculosis control can be achieved ultimately only where adequately staffed and adequately financed fulltime local health services exist. The association has for many years cooperated with other voluntary and official national health organizations in promoting this objective. Its affiliated State and local associations have cooperated similarly with State and local organizations in their areas toward reaching this objective. I believe that H. R. 274 and H. R. 913 meet the principles enunciated in the above resolution by the board of directors and urge upon you favorable consideration of these bills. Mr. ELTON LAYTON, HOUSE OF REPRESENTATIVES, Clerk, Committee on Interstate and Foreign Commerce, House of Representatives, Washington, D. C. DEAR ELTON: I am enclosing my letter from the legislative committee, district No. 9, International Association of Machinists, St. Louis, Mo., with reference to pending legislation before the committee dealing with public health. I would appreciate this letter being made a part of the committee record. J. PERCY PRIEST. INTERNATIONAL ASSOCIATION OF MACHINISTS, DISTRICT No. 9, Hon. J. PERCY PRIEST, St. Louis, Mo., April 6, 1951. House Office Building, Washington, D. C. DEAR SIR: As hearings will open April 10, 1951, before the House Interstate and Foreign Commerce Committee, and we will be unable to have anyone present to state our views on local public-health bills (S. 445, H. R. 274, H. R. 913), we wish to make them known at this time. The need for Federal aid to establish local public-health departments is a vital necessity, especially in small towns and rural areas. In larger cities, the people have a better opportunity of receiving some aid, because there are church, charitable, and civic organizations, clinics, etc., in their home vicinity that can help them, and they are better able to take advantage of what they offer. Great strides have been made in the thicker populated areas in health improvements and in combating disease, but they still have a long way to go. If one part of the population is left out, then your programs in other parts are going to be less successful, and it will be more expensive. The military records show that a great number of men called for duty were in poor health; this being the case, what of the aged and the children of the country? The emergency that now exists and the possibilities that confront us, with a large percentage of the country not having the knowledge, facilities, or trained officials available to direct civilian defense against disasters and emergencies affecting human health and medical care, is something to be concerned about. We sincerely hope that you will realize the need of local health departments and support this legislation which will make them possible, and vigorously oppose any amendments which would weaken the objectives of this legislation so that it would not be effective. Again let us urge for the good of civil defense that you support these bills. LEGISLATIVE COMMITTEE, DISTRICT NO. 9, INTERNATIONAL ASSOCIATION OF The CHAIRMAN. Oscar R. Ewing, Administrator, Federal Security Agency, will be our first witness. STATEMENT OF HON. OSCAR R. EWING, ADMINISTRATOR, FEDERAL SECURITY AGENCY, ACCOMPANIED BY DR. W. P. DEARING, DEPUTY SURGEON GENERAL, UNITED STATES PUBLIC HEALTH SERVICE, WASHINGTON, D. C. Mr. EWING. Mr. Chairman and members of the Committee; I appreciate this opportunity to present the views of the Federal Security Agency on H. R. 274, introduced by Mr. Priest, and H. R. 913, introduced by Mr. Dolliver, bills to amend the Public Health Service Act to authorize assistance to States and political subdivisions in the development and maintenance of local public health units, particularly in national defense areas, and for other purposes. I will also comment briefly on the Senate-passed bill, S. 445, which, while different in some important respects from the House bills, is directed toward the same basic objective of aiding in the development and maintenance of local public health units. The need for Federal legislation to stimulate the establishment and maintenance of adequate local health departments has long been recognized. This committee has favorably reported on comparable bills in both the Eightieth and the Eighty-first Congresses. Each year as our knowledge in the health sciences increases and as new techniques for protecting the public health are developed, our communities are more urgently in need of local mechanisms through which they may apply this new knowledge and these new techniques not only to prevent illness but to promote better health among their citizens. The purpose of these bills is to help support local health units, that is, health departments or boards of health in cities and counties throughout the Nation. The bills would help in the provision of health services to local people by local people. Yet, the obejctive of these bills is a national objective, for the sum total of local improvements in health is a stronger and more vigorous nation. Health-or conversely, illness cannot be confined within geographical boundaries; inadequate public health services anywhere jeopardize public health everywhere. An undetected case of tuberculosis in a factory worker on the west coast can easily produce other |