We have two bills, one in the Senate and one in the House. One is a 3-year bill. One is a 5-year bill. The Senate bill that I introduced is a 5-year bill, really modest amounts, gentlemen, when you compare it with expenditures for other things. (Public Laws 87-692 and 89-109, and S. 2688, follow:) Public Law 87-692 87th Congress, S. 1130 AN ACT To amend title III of the Public Health Service Act to authorize grants for family clinics for domestic agricultural migratory workers, and for other purposes Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled, That title III of the Public Health Service Act (42 U.S.C., ch. 6A, subch. II) is amended by inserting at the end of part A thereof the following new section: "GRANTS FOR FAMILY HEALTH SERVICE CLINICS FOR DOMESTIC AGRICULTURAL MIGRATORY WORKERS "SEC. 310. There are hereby authorized to be appropriated for the fiscal year ending June 30, 1963, the fiscal year ending June 30, 1964, and the fiscal year ending June 30, 1965, such sums, not to exceed $3,000,000 for any year, as may be necessary to enable the Surgeon General (1) to make grants to public and other nonprofit agencies, institutions, and organizations for paying part of the cost of (i) establishing and operating family health service clinics for domestic agricultural migratory workers and their families, including training persons to provide services in the establishing and operating of such clinics, and (ii) special projects to improve health services for and the health conditions of domestic agricultural migratory workers and their families, including training persons to provide health services for or otherwise improve the health conditions of such migratory workers and their families, and (2) to encourage and cooperate in programs for the purpose of improving health services for or otherwise improving the health conditions of domestic agricultural migratory workers and their families." Approved September 25, 1962. Public Law 89-109 89th Congress, S. 510 August 5, 1965 AN ACT To extend and otherwise amend certain expiring provisions of the Public Health Service Act relating to community health services, and for other purposes Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled, That this Act may be cited as the "Community Health Services Extension Amendments of 1965". IMMUNIZATION PROGRAMS SEC. 2. (a) The first sentence of subsection (a) of section 317 of the Public Health Service Act is amended by striking out "and" before "June 30, 1965" and by inserting "and each of the next three fiscal years," immediately after "June 30, 1965,". The second sentence of such subsection is amended by striking out "the fiscal years ending June 30, 1963, and June 30, 1964" and inserting in lieu thereof "any fiscal year ending prior to July 1, 1968". The third sentence of such subsection is amended by striking "and tetanus" and inserting in lieu thereof "tetanus, and measles", and by striking out "under the age of five years" and inserting in lieu thereof "of preschool age". (b) Subsection (a) of such section is further amended by adding at the end thereof the following new sentence: "Such grants may also be used to pay similar costs in connection with immunization programs against any other disease of an infectious nature which the Surgeon General finds represents a major public health problem in terms of high mortality, morbidity, disability, or epidemic potential and to be susceptible of practical elimination as a public health problem infancy. Doctor, is it your thought-I think it is as you expressed it-that in its infancy it should be sheltered in a sense and not be lost in a still amorphous comprehensive health program which is not yet fully established? Dr. VENABLE. In my judgment, it would be far better at the moment to keep the two programs separate, but I would want to comment also that comprehensive planning properly developed within the States will certainly work closely with the separate program of migrant health and begin to incorporate it into the comprehensive whole. Senator WILLIAMS. But at this point, they shouldn't be lumped together? Dr. VENABLE. That is right. Senator WILLIAMS. After it is fully established and fully operative, then it would be good administration to include it? Dr. VENABLE. That would be my judgment. Senator WILLIAMS. But not at this point? Dr. VENABLE. Yes, sir. Senator WILLIAMS. We certainly thank you. By the way, how is the migrant health program working in Georgia? Dr. VENABLE. We have a very small problem in Georgia. They seem to jump across us from Florida to South Carolina and back again. Senator WILLIAMS. You know, there isn't a great deal of migrant worker harvesting in Georgia, is there? Dr. VENABLE. Not much; in fact, very little. Senator WILLIAMS. Who picks those peaches? Dr. VENABLE. Well, peaches, of course, are a little bit out of their line of travel for the migrant crop. They are usually done with local labor. It is a concentrated activity, as you know, and in a very few weeks out of the season and I wouldn't say they don't have labor problems in that harvest, but it is usually done by local people. Senator WILLIAMS. You don't have a real heavy concentration of migrant farmworkers? Dr. VENABLE. No, sir. We are able to cope with what we do have through our local health activity which is rural in these areas and set up to handle rural situations and there are no serious problems in relation to residency and this sort of thing, so we do work it in our total program. Senator WILLIAMS. I found when I was handling legislation that, if I had the support of Georgia, from the mayor of Atlanta to Herman Talmadge and Dick Russell, the legislation was in excellent company. I know that you have another engagement to keep, so I will ask no further questions. We do thank you very much for coming here today. Dr. VENABLE. Thank you, Senator. Senator WILLIAMS. Now, who is chairman of the board now that Dr. Venable has left? Who is chairman of the board? Dr. PEAVY. I suppose I am, Senator; Dr. Peavy of Texas. Senator WILLIAMS. Dr. James Peavy, you are the president-elect of the Association of State and Territorial Officers? Dr. PEAVY. Yes. Senator WILLIAMS. Where are you from in Texas, Doctor? Dr. PEAVY. My home is in Austin, Tex. I am the commissioner of health in Texas. Senator WILLIAMS. Do you ever get down Rio Grande way? Dr. PEAVY. Oh, yes, sir. In fact, as you know, we just had a terrific problem in that area with all the flooding. Senator WILLIAMS. We were down there. Dr. PEAVY. Yes, I know. I believe I met you there, Senator. Senator WILLIAMS. We are honored with your presence here and we know that you know what it is all about. Dr. PEAVY. Thank you. Senator WILLIAMS. The forum is yours. Dr. PEAVY. The first one we would like, if we may, to testify is Dr. Wilson Sowder from Florida. If this is agreeable with you, Senator Williams, I will call on Dr. Sowder. Senator WILLIAMS. It certainly is and from coast to coast, border to border, on our travels, I have commended Florida for its enlightened approach to the problems of these very poor people. STATEMENT OF DR. WILSON SOWDER, STATE HEALTH OFFICER OF FLORIDA Dr. SOWDER. We appreciate that, Senator, and I want to say for Florida that we feel that this is a very good law, a badly needed law, and it is doing a tremendous amount of good. It in my judgment needs more money than we are presently getting. We need more money. We think the bill should not only be extended, but that more money should be put into the program. It is particularly important to Florida because out of the estimated million migrants, we get about 100,000 of them, about 10 percent. Now, of course, we share those at certain parts of the year with other States. Some of those migrants are located and work in counties where they actually outnumber the resident population and it is a little difficult for the State to cope with the problems without Federal aid. On the makeup of our migrants-some of these come from Georgia, the Negro and white natives, and many of them come from the South into the migrant stream-about 60 percent are Negro, about 17 percent from Dr. Peavy's State of Texas or else direct from Mexico. They call them Texas Mexicans in Florida. Fifteen percent are Puerto Ricans and about 8 percent are what they call Anglos. They come down there in September and stay whether there is work or not until about April and then they go north into the migrant stream along up to your State of New Jersey and even farther on. They are, in essence, the same type of people that the Congress is trying to help out in the urban areas, the poverty group. They are a rural poverty group. They are people, however, who are doing useful work. They are essential to the agricultural economy and they are earning their way. So I think that they deserve the help that we are giving them and more. Out of our 67 counties, 17 are in this program. Senator WILLIAMS. Out of 67 counties? Dr. SOWDER. Sixty-seven counties. Senator WILLIAMS. How many are in the program? Dr. SOWDER. Seventeen. Senator WILLIAMS. These are the areas of high concentration of farm migrants? Dr. SOWDER. Yes, sir. Senator WILLIAMS. Dade County also has agriculture. In fact, it is one of the big ones. Palm Beach County is a big one. Then we have places like Collier County where they have 19,000 migrants at the peak of the season and about that many permanent residents. We have about five other counties to which we need to extend this program. We did ask for about $1.1 million this year in the central project which takes care of all but two counties. Two of our counties, Palm Beach and Dade, have separate projects. The others are lumped together. We wanted this year about $1,100,000 to run the program properly but there was only enough money for approximately $650,000. So we endorse the program. We think it is badly needed. We think a lot of people would suffer unnecessarily if the program were cut out and I personally think it meets the requirement of a special type program in that it is geographically limited. We have here a high-risk group with all their problems, so I am not quite so convinced as Dr. Venable that it will ever be a program that can be easily merged into, you might say, the generalized program. This problem needs special treatment. Senator WILLIAMS. We certainly appreciate that. Dr. SOWDER. Thank you. Senator WILLIAMS. You head up the State health program in Florida? Dr. SOWDER. Yes, sir. Senator WILLIAMS. How long have you been in this position? Senator WILLIAMS. You have survived many administrations, haven't you? Dr. SOWDER. About eight or nine. I forget how many. Dr. KANDLE. Don't push that. Senator WILLIAMS. You must know what you are doing. Dr. SOWDER. Maybe they don't know what I am doing. Senator WILLIAMS. We are happy to share your view. As I indicated earlier to Dr. Venable, in its infancy this program should grow on its own foundation and not be lumped in with a lot of other very necessary programs for better health, and you put it very forcefully. You indicated that we have been short in our numbers on dollar amounts for this program. Would you mind if I recall your testimony to Senator Holland and Senator Smathers? Dr. SOWDER. I would be very happy for you to; yes, sir. STATEMENT OF DR. JAMES PEAVY, PRESIDENT-ELECT, ASSOCIA- Dr. PEAVY. Senator Williams, let me again express to you our very deep appreciation for the opportunity of appearing before this committee. In Texas, as you know, we have something over half of all the migrants in the country home-based in our State. This was a terrific problem with us prior to the enactment of the bill in 1962. I do want all of the committee to know that we are grateful for the bill itself and for giving us the opportunity to provide some of the badly needed health care services in the State of Texas. We had terrific public health problems prior to 1962. Health care was almost nonexistent for this type of person and this bill has been of tremendous help to us. At the present time we have 27 projects, one of which is statewide, and the remaining 26 are local projects in areas where the migrants are concentrated. We do have a great need to extend the type of program that we have. We feel quite sure that if we had double the present amount of funds, we could use them in a very effective manner. The big problem that we have, of course, is health care. Tuberculosis is a problem. We also have prenatal problems, in fact the whole gamut, and this bill allows us to provide health care. In about half of these 26 projects we do have a provision for hospitalization of the migrant worker himself. I think everyone in our State from all the reports I get is tremendously grateful for the opportunity of providing health care to the migrants and we have nothing but good reports every week throughout our State where we have projects. We are certainly grateful to you and we hope you will see fit and find the means of at least doubling the program and we feel that the whole Nation will benefit by this extension of the migrant health bill. Again, we appreciate the opportunity very much for being here, Senator Williams. I will be glad to try to answer any questions that I can. Senator WILLIAMS. Bringing health care to people who are on the road, who travel, and who have no permanent residence, presents a great problem to you men, doesn't it? Dr. PEAVY. Yes, sir; it does. Senator WILLIAMS. It is obviously a greater problem than serving people who are settled in a community. You almost have to find the people that you want to immunize or test for tuberculosis or whatever it is. It is a hard job. Dr. PEAVY. Yes, sir; it certainly is. We have had some outbreaks. We had an outbreak prior to the enactment of this program in 1962. We had a big outbreak of diphtheria because the susceptible population were not immunized against diphtheria. They migrated to the plains area and we had an outbreak as a result of that. Now with the financial means to give the necessary immunizations early, we think it goes a long way not only to help the migrant himself, but to help the entire population. Senator WILLIAMS. But again you couldn't expect them to come to the community clinic. You almost have to go where they are. Dr. PEAVY. Yes, sir; and it takes a health education program along with it, as you know. It's not just making the services available, you have to convince them that this is a necessary procedure. Senator WILLIAMS. You have the cure for tuberculosis; do you not? Dr. PEAVY. Yes, sir; we certainly do. Senator WILLIAMS. I can remember as a kid delivering milk to my uncle up in the Adirondacks to Trudeau Sanitarium, and the treatment for tuberculosis then wasn't really treatment. Well, it was Trudeau's pioneering effort. It was a fresh air treatment. Dr. PEAVY. Yes, sir. |