(2) One million dollars (included in the mutual security budget) for a special U.S. contribution to an expanded World Health Organization research program. In addition, there are two other items that can be identified on the basis of available data: (3) One million dollars (approximate) representing that portion of the U.S. contributions to the regular operating budgets of the World Health Organization and the Pan American Health Organization which may be chargeable to research and related activities (based on the ratio of the research budgets to the total budgets of these organizations). (4) One hundred and seventy-five thousand to two hundred thousand dollars for ICA grants for health research projects (based on the level of such grants in recent fiscal years). Apart from these identifiable items there will undoubtedly be other scattered items that will be related to the purposes of Senate Joint Resolution 41, but it is not feasible to identify them or to translate them ino dollar esimates. In any event, the total expenditures for such activities will probably not be large. In summary, our best estimate is that, within the President's budget proposals for fiscal year 1960, total expenditures for purposes related to the provisions of Senate Joint Resolution 41 will probably be between $7 million and $7.5 million. Sincerely yours, L. E. BURNEY, DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE, Hon. LISTER HILL, Chairman, Committee on Labor and Public Welfare, DEAR MR. CHAIRMAN: At the hearing before the Committee on Labor and Public Welfare on March 10, 1959, at which Secretary Flemming and other officials of this Department presented testimony on Senate Joint Resolution 41, you asked that I furnish you information showing what portion of the estimated $100 million to be spent during fiscal year 1960 for international health activities would be devoted to the kind of research in vocational rehabilitation contemplated under Senate Joint Resolution 41. A small amount of funds would be devoted to various international rehabilitation activities in 1960, some of which I mentioned in my testimony. However, there are no identifiable funds projected for 1960, to my knowledge, which would relate directly to the purposes and activities of Senate Joint Resolution 41, i.e., research, research training, or research planning in rehabilitation. Sincerely yours, MARY E. SWITZER, Director. The CHAIRMAN. Are there any other questions? Well, we want to thank all of our witnesses this morning. We are deeply grateful and appreciate your contributions very, very much. (Whereupon, at 12:15 p.m., the committee recessed, subject to the call of the Chair.) APPENDIX (By direction of the chairman the following statements and communications were ordered to be printed in the record:) AMERICAN HOSPITAL ASSOCIATION, Hon. LISTER HILL, U.S. Senator, Senate Office Building, DEAR SENATOR HILL: As you are aware, the American Hospital Association has had a long and continuing interest in health affairs, not only within the United States but throughout the world. In fact, the association because of its particular relationship to the hospitals of Canada is itself international in character. We have through the years participated in the International Hospital Federation, an organization worldwide in nature, and have been one of its contributing members. We have also had a particular interest in the Latin American countries through the development of the Inter-American Hospital Association and through the Latin American program of the association which was carried on for several years under contract with the International Cooperation Administration. The association has been the recipient of grants from private foundations, and particularly the Kellogg Foundation, which have financed a variety of international programs. Also, the association has contributed liberally of its own limited resources to the furtherance of international health programs and has been instrumental in developing the interest of an increasing number of outstanding health leaders and national organizations within the United States in international health affairs. In all of the above activities, the association's objective has been the exchange of knowledge and information based upon experience, study, and research between the United States and other countries. Our objective has been to contribute in every way we could to the betterment of hospital and health standards and the organization and administration of health facilities. Inherent in this has been a primary objective of assuring high quality medical care and better health. Voluminous correspondence from foreign countries attests to the fact that our work has met with considerable success. The American Hospital Association is privileged to support Senate Joint Resolution 41, the "Health for Peace Act." We do, however, suggest several amendments which, in our opinion, broaden the scope of the bill or make its provisions more consistent with its stated objectives. It is our deep-seated conviction that this legislation will have a profound effect upon the progress of health research and training throughout the world. In time, it will be regarded as one of the great hallmarks in the advance of health and in the translation of the products of health sciences to the peoples of the world. It is a vehicle to establish and promote better health for people everywhere. It is a means by which the prestige of the United States will be greatly enhanced and our place in the affections of our neighbors firmly established. The bill has great vision and possesses many splendid features to mobilize the health sciences in the United States as a force for peace, progress, and good will among people of the world. It is of paramount significance to observe that in structuring this bill, you and your distinguished colleagues have designed it in such a way that it will promote better international relations not only with the nations of the free world and underdeveloped countries, but also with the Soviet Union and her allies. This legislation rightfully becomes a new weapon in the arsenal of democracy and brings greater versatility to our foreign policy. Recognition is made in the bill that of necessity much clinical research will be done in hospitals. However, hospitals have another essential role which is not so clearly recognized. Many of the benefits of clinical research can only be translated into patient care through other studies and research undertaken by hospitals. This would include in part a preparation of personnel educated in hospitals which are essential members of an effective health team. We believe that the suggested amendments we make will assist in more fully carrying out the purposes which we are sure you intend for this very worthwhile legislation. I wish to present the suggested amendments of this association in two parts. First, those that concern the broad aspects and scope of the legislation and second, those that are more technical in nature and deal essentially with specific language changes which would carry out the thought of the first group of amendments. First: This is a bill to promote international cooperation in health research and training and in the exchange of information relating to the health sciences. This bill does not merely concern itself with one or even some of the health sciences but indeed covers all. The objectives of the bill are clearly set forth in section 2. They focus on the means by which maximum health resources of the United States would be effectively mobilized to cooperate with and support international research and training. The broad vision stated is the full spectrum of the health sciences, research and training, covering the included important lifesaving disciplines. As we read Senate Joint Resolution 41, it is to us abundantly clear that the axis upon which this bill is placed is that of health and not upon any single one of its included disciplines. For example, the bill discusses health standards, health research, health resources, health planning, and health sciences. The next 25 years will undoubtedly see the term "health" used to more aptly describe man's endeavors and inquiries into the causes of his diseases, impairments, and disabilities as well as their cure, treatment, and care. Only a few years ago, one of the most distinguished scientists of this century, the late Dr. Alan Gregg, made this observation to your committee. As evidence of this growing tendency, it should be noted that the National Institutes of Health are appropriately characterized as health institutes. The World Health Organization significantly carriers the word "health" in its title. Congress in its establishment of the Department of Health, Education, and Welfare wisely insisted upon the use of the term "health" in the name of this Agency. Hence, in the title to Senate Joint Resolution 41, and in sections 3(b), 4, and 5 of the bill, we would recommend that the National Institute and the National Advisory Council referred to would be called respectively the National Institute for International Health Research and the National Advisory Council for International Health Research. In such fashion, we feel that the names of these two bodies would more accurately reflect and be more consistent with the objectives of the legislation. We also recommend that in section 15, the title of this resolution should be changed to read "The International Health Research Act of 1959.” Such change would more accurately accord with the short title of the legislation, "The Health for Peace Act" in the same section. In section 5, provision is made to establish a 16-man Advisory Council. Consistent with the reasons advanced heretofore we believe that the skills and talents demanded of the members should include leaders in the fields of health science, health research, and administration. Explicit in the language of this bill are the programs that this Council would undertake with the World Health Organization and other international bodies. Without including the competences suggested above, we feel that the National Advisory Council would not be adequately represented in dealing with its opposite numbers in international organizations. As the legislation is now cast, a broad representation of the health sciences would not be assured, and such a representation is essential to the purposes of the bill. Hence, we recommend that on page 7, line 9, the word "medical" be deleted and the words "health administration and" be inserted. Also on page 7, line 10, the words "medical or biological sciences" be deleted and the words "health sciences" be inserted. Section 5(b) vests the approval authority for grants, contracts, or loans for research projects with the Surgeon General, the Director of the Office of Voca tional Rehabilitation, or the Secretary, after review and recommendation by the Council. In the best interests of more effective administration, we feel that the approving authority should rest solely with the Secretary. The division of this authority among three officials would make the administration of the program unnecessarily unwieldy. Second: The group of amendments which we now propose would carry out the objectives of the first group of amendments. Page 3, line 21, after the word "diagnosis." insert the words "provision of care and." On page 4, line 19, strike the word "and" and after the word "practitioners" insert the words "and health organizations." On page 10, line 3, strike the word "and" and insert the words "the provision of care and." On page 11, line 15, after the word "research" insert the word "and." On page 12, line 5, strike the words "medical and biological" and insert the word "health." On page 12, line 23, strike the words "medical-biological" and insert the word "health." On page 13, change section 10 to read as follows: "The activities authorized herein shall not extend to the support of public health programs of an operational nature in other countries." On page 11, line 5, strike the word "medical" and insert the word "health." On page 11, line 6, after the word "for" insert the word "health." The American Hospital Association appreciates the opportunity of presenting its views on this vital legislation and respectfully asks that serious consideration be given the recommendations made. It would also be appreciated if you would include this letter in the record of your hearing on Senate Joint Resolution 41. Sincerely yours, KENNETH WILLIAMSON, Associate Director. STATEMENT OF THE AMERICAN OSTEOPATHIC ASSOCIATION BY DR. CHESTER D. SWOPE, CHAIRMAN, DEPARTMENT OF PUBLIC RELATIONS, ON SENATE JOINT RESOLUTION 41, 86TH CONGRESS, MARCH 4, 1959 The American Osteopathic Association supports the enactment of Senate Joint Resolution 41, entitled "The International Health and Medical Research Act of 1959." Senate Joint Resolution 41, the short title for which is "The Health for Peace Act," should enable our Government, our institutions, and our individual researchers the more effectively to shoulder our responsibilities and share in the efforts of others in the fields of international health and medical research. Location of a National Institute for International Medical Research in the Public Health Service as part of the National Institutes of Health, as proposed in the joint resolution will further recommend the legislation. The constituent members and affiliated organizations of the association are devoted to the promotion of the public health at home and abroad. As recently pointed out to another Senate committee engaged in the study of international health programs, as an international organization the association publishes and disseminates monthly scientific literature to its constituent foreign divisional societies. Article II of the constitution of the association provides: "This association shall be a federation of divisional societies organized within State, provincial, or foreign country boundaries, which may be chartered by this association as provided in the bylaws, and all such organizations or divisions now a constituent part of the American Osteopathic Association are declared to be chartered as federated units of this association." [Italic supplied.] The 1958 yearbook and directory of the association lists the British Osteopathic Association, the Australian Osteopathic Association, and five Canadian provincial osteopathic associations as foreign divisional societies. All six colleges of osteopathy and surgery in the United States are listed among the educational institutions approved by the Attorney General for purposes of alien students desiring to come to the United States to pursue courses of study. The above yearbook and directory of the association shows that graduates of approved colleges of osteopathy and surgery in the United |