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HEALTH OF SCHOOL CHILDREN

WEDNESDAY, JULY 16, 1947

HOUSE OF REPRESENTATIVES,

SUBCOMMITTEE OF THE COMMITTEE ON
INTERSTATE AND FOREIGN COMMERCE,
Washington, D. C.

The subcommittee met at 9:30 a. m., in room 414 of the Old House Building, Hon. James I. Dolliver (chairman of the subcommittee) presiding.

Mr. DOLLIVER. The subcommittee will please be in order.

This hearing is called on H. R. 1980, a bill to provide for the general welfare by enabling the several States to make more adequate provision for the health of school children through the development of school health services for the prevention, diagnosis, and treatment of physical and mental defects and conditions. A copy of the bill will be inserted in the record at this point.

(The bill is as follows:)

[H. R. 1980, 80th Cong., 1st sess.]

A BILL To provide for the general welfare by enabling the several States to make more adequate provision for the health of school children through the development of school health services for the prevention, diagnosis, and treatment of physical and mental defects and conditions

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 "National School Health Services Act of 1947."

DECLARATION OF POLICY

SEC. 2. The Congress hereby declares that in order that no American child shall come to adult life with physical or mental defects or conditions which can be prevented or corrected at an early age, it shall be the national policy to provide assistance to the several States to enable them to establish and develop school health services for the prevention, diagnosis, and treatment of physical and mental defects and conditions of school children, with special reference to the correction of defects and conditions likely to interfere with the normal growth and development and educational progress of children. Such school health services shall utilize and develop, insofar as feasible, the qualified public health, medical, dental, and hospital facilities already established in each community.

APPROPRIATION

SEC. 3. For the purpose of enabling the United States, through the Federal Security Agency, to cooperate with each State in providing and maintaining school health services for the prevention and diagnosis of physical and mental defects and conditions, and (especially in rural areas and in areas suffering from severe economic distress) the treatment of such defects and conditions, including demonstrations and the training of personnel for such State and local school health services and the training and supervision of school personnel in utilizing the findings of health examinations, but excluding health instruction other than 1

that given as part of examination, diagnostic, or corrective procedures there is hereby authorized to be appropriated for the fiscal year commencing July 1, 1947, the sum of $12,000,000, for the fiscal year commencing July 1, 1948, $18,000,000, and for each succeeding fiscal year such sums as may be necessary to carry out the purposes of the Act. Of the sum appropriated for each fiscal year pursuant to this section there shall be available $2,000,000, or 10 per centum of the sum appropriated, whichever is greater, to enable the Children's Bureau (a) to provide demonstrations; and (b) to provide for the training of personnel for State and local school health services, through grants to accredited schools of public health or other professional institutions; and (c) to pay salaries and expenses of personnel detailed, at the request of State agencies, to cooperate with and assist such agencies in carrying out the purposes of this Act; and (d) to provide for expenses of the Federal Security Agency in the administration of this Act. The remainder of the sum appropriated for each fiscal year pursuant to this section shall be available for allotment, in accordance with section 5, to States with approved State plans for such services.

NATIONAL ADVISORY COMMITTEE

SEC. 4. A National Advisory Committee on School Health Services shall be created, without regard to the civil-service laws, to consist of twelve members appointed by the Federal Security Administrator on recommendation of the Chief of the Children's Bureau, the Commissioner of Education, and the Surgeon General of the Public Health Service. The members shall be persons representative of the fields of health, education, and child welfare, and the public at large; one-half of the members shall be selected from panels of at least five names each submitted by representative national organizations and at least three members shall be doctors of medicine and at least one shall be a doctor of dental surgery. Of the members first appointed, one-third shall be appointed for a one-year term, one-third shall be appointed for a two-year term, and one-third shall be appointed for a three-year term; and thereafter all appointments shall be made for threeyear terms and no member shall be eligible for immediate reappointment. Vacancies occurring for any cause in the membership of the Committee shall be filled for the unexpired term by the Federal Security Administrator upon recommendations, as provided for in the case of original appointments. The National Advisory Committee shall annually elect one of its members as Chairman. It shall meet from time to time upon the call of the Chairman or upon the written request of not less than four members or on call by the School Health Services Board, but at least once each year, to advise with respect to the administration of this Act. Members of the National Advisory Committee shall receive no compensation for their services on the Committee but shall be reimbursed for necessary travel expenses and receive a per diem in lieu of subsistence not to exceed $25 while away from their respective places of residence on the business of the said Committee. The recommendations of the National Advisory Committee, or a summary thereof, shall be included in the annual report of the Federal Security Administrator.

ALLOTMENTS TO STATES

SEC. 5. (a) Out of the sums made available for allotment to the States for each fiscal year pursuant to section 3, the Federal Security Administrator shall allot one-half as follows: He shall allot to each State $20,000, and shall allot to each State such part of the remainder of such one-half as he finds that the number of children in the State between the ages of five and seventeen, inclusive, bore to the total number in the United States, and the latest calendar year for which the Administrator has available statistics.

(b) Out of the sums made available for allotment to the States for each fiscal year pursuant to section 3, the Federal Security Administrator shall allot onehalf (in addition to the allotments made under subsection (a)), according to the financial need of each State for assistance in carrying out its State plan, as determined by him after taking into consideration the number of children between the ages of five and seventeen, inclusive, in such State.

(c) The amount of any allotment to a State under subsection (a) for any fiscal year remaining unpaid to such State at the end of such fiscal year shall be available for payment to such State under section 7 until the end of the second succeeding fiscal year. No payment to a State under section 7 shall be made out of its allotment for any fiscal year until its allotment for the preceding fiscal year has been exhausted or has ceased to be available.

APPROVAL OF STATE PLANS

SEC. 6. (a) A State plan for school health services must (1) provide for financial participation by the State; (2) provide for the administration or the supervision of the administration of the plan by either the State health agency or the State education agency, or jointly by these two State agencies, as the laws of the State shall provide (or, in the absence of provision in State law, as the Governor shall determine) for the administration of school health services as defined in section 3; (3) show that it is concurred in by both the State health agency and the State education agency; (4) provide such methods of administration (including methods relating to the establishment and maintenance of personnel standards on a merit basis, except that the Chief of the Children's Bureau shall exercise no authority with respect to the selection, tenure of office, and compensation of any individual employed in accordance with such methods) as are necessary for the proper and efficient operation of the plan; (5) provide that the State agency will make such reports, in such form and containing such information, as the Federal Security Administrator may from time to time require, and comply with such provisions as he may from time to time find necessary to assure the correctness and verification of such reports; (6) provide for carrying out the purposes specified in section 3; (7) provide for cooperation with medical, dental, health, nursing, education, and welfare groups and organizations, and where necessary for working agreements with State or local public agencies having authority under State law for the care of crippled or otherwise physically handicapped children, or for other necessary health services; (8) provide for the designation of a State advisory committee which shall include representatives of nongovernment organizations or groups, and of State agencies, concerned with health, education, and child welfare, and the public at large, to consult with the State agency or agencies in carrying out such plan; and (9) provide that the health services described in the State plan shall be available to children without regard to race, color, creed or nationality, on a basis that is equitable in view of need for services.

(b) The Chief of the Children's Bureau, acting with the advice of a board (referred to in this Act as the "School Health Services Board") composed of himself as Chairman, the Commissioner of Education, and the Surgeon General of the Public Health Service, shall approve any plan which fulfills the conditions specified in subsection (a); except that if a State plan or any portion thereof is to be administered by the State education agency it shall not be approved by the Chief of the Children's Bureau unless the plan, or such portion of it, shall have been approved by the Commissioner of Education.

PAYMENTS TO STATES

SEC. 7. (a) From the sums appropriated therefor and the allotments available under section 5 (a), the Secretary of the Treasury shall pay to each State which has an approved plan for school health services, for each quarter, beginning with the quarter commencing July 1, 1947, an amount, which shall be used exclusively for carrying out the State plan, equal to one-half of the total sum expended during such quarter for carrying out such plan.

(b) The method of computing and paying such amounts shall be as follows: (1) The Federal Security Administrator shall, prior to the beginning of each quarter, estimate the amount to be paid to the State for such quarter under the provisions of subsection (a), such estimate to be based on (A) a report filed by the State containing its estimate of the total sum to be expended in such quarter in accordance with the provisions of such subsection and stating the amount appropriated or made available by the State and its political subdivisions for such expenditures in such quarter, and if such amount is less than one-half of the total sum of such estimated expenditures, the source or sources from which the difference is expected to be derived, and (B) such investigation as he may find

necessary,

(2) The Federal Security Administrator shall then certify the amount so estimated by him to the Secretary of the Treasury, reduced or increased, as the case may be, by any sum by which the Federal Security Administrator finds that his estimate for any prior quarter was greater or less than the amount which should have been paid to the State for such quarter, except to the extent that such sum has been applied to make the amount certified for any prior quarter greater or less than the amount estimated by the Federal Security Administrator for such prior quarter.

(3) The Secretary of the Treasury shall thereupon, prior to audit or settlement by the General Accounting Office, pay to the State, at the time or times fixed by the Federal Security Administrator, the amount so certified.

(c) The Federal Security Administrator shall from time to time certify to the Secretary of the Treasury the amounts to be paid to the States from the allotments available under section 5 (b), and the Secretary of the Treasury shall, prior to audit or settlement by the General Accounting Office, make payments of such amounts from such allotments at the time or times specified by the Federal Security Administrator.

OPERATION OF STATE PLANS

SEC. 8. In the case of any State plan for school health services which has been approved by the Federal Security Administrator, if the Federal Security Administrator, after reasonable notice and opportunity for hearing to the State agency or agencies administering or supervising the administration of such plan, finds that in the administration of the plan there is a failure to comply substantially with any provision required by section 6 to be included in the plan, he shall notify such State agency that further payments will not be made to the State until he is satisfied that there is no longer any such failure to comply. Until he is so satisfied he shall make no further certification to the Secretary of the Treasury with respect to such State.

ADMINISTRATION

SEC. 9. (a) With the advice of the School Health Services Board and the National Advisory Committee on School Health Services, the Federal Security Administrator shall administer this Act through the Children's Bureau, except that he shall utilize the services of the Office of Education in matters involving State education agencies and in matters pertaining to the training and supervision of school personnel.

(b) The Federal Security Administrator shall make and publish such rules and regulations, not inconsistent with this Act, as may be necessary to the efficient administration of the functions with which he is charged under this Act. (c) All regulations and amendments thereto with respect to grants to States under this Act shall be made after consultation with the State health and education authorities, and on matters of general policy with the National Advisory Committee. Insofar as practicable, the Chief of the Children's Bureau shall obtain the agreement of such State authorities prior to the issuance of any such regulations or amendments.

DEFINITION

SEC. 10. As used in this Act, the term "State" includes the District of Columbia, Alaska, Hawaii, Puerto Rico, and the Virgin Islands.

Mr. DOLLIVER. We have two distinguished Members of Congress here this morning, each of whom has a very short statement to make in connection with this bill. We will hear first from the Congressman who introduced the bill, the Honorable Evan Howell, Member of the House of Representatives from Illinois. Following the testimony of Mr. Howell, we will hear from Senator Leverett Saltonstall of Massachusetts.

STATEMENT OF HON. EVAN HOWELL, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF ILLINOIS

Mr. HOWELL. Thank you, Mr. Chairman. This bill, H. R. 1980, I introduced in the House of Representatives on February 17, 1947. In the Senate, Mr. Saltonstall, for himself, Mr. Smith, Mr. Fulbright, Mr. Lodge, Mr. Baldwin, and Mr. Ives introduced a bill which was similar. It was a companion measure to 1980. Since then, there have been some amendments worked out which I am sure Senator Saltonstall will discuss in his remarks, so that I am not going

to trespass upon what he will say in his statement which will follow mine.

At the time I introduced the bill, I made a rather elaborate statement on the floor of the House of Representatives, emphasizing my profound interest in the subject of the health of our young Americans our country's greatest asset-and when this measure was first considered by the Interstate and Foreign Commerce Committee, I practically read again that statement into the record, so that it appears somewhere in the proceedings before the House Interstate and Foreign Commerce Committee; but, in order to make the record of these hearings complete, I would like to extend as part of my remarks today the remarks which I made in the House of Representatives on Monday, February 17, 1947.

Mr. DOLLIVER. It is so ordered, Mr. Howell. (The matter referred to is as follows:)

THE NATIONAL SCHOOL HEALTH SERVICES BILL

Speech of Hon. Evan Howell of Illinois in the House of Representatives, Monday, February 17, 1947

Mr. HOWELL. Mr. Speaker, I wish to address the House on the national school health services bill which I introduced today.

The national school health services bill would establish a national policy under which American children should not be permitted to grow up with physical or mental defects which could be prevented or corrected in childhood. With this long-run objective in view, the bill would assist the States to better the health of school children according to individual State requirements.

This bill calls for a Federal grants-in-aid program to assist the 48 States and the Territories to extend and improve their health services to school children between the ages of 5 and 17.

One-half of an initial Federal appropriation-$12,000,000-would be matched by State funds, dollar for dollar. The other half of the Federal funds would be allocated to the States according to their need, to provide pilot programs or demonstrations, training of personnel, and related activities. These funds need not be matched by the States. After the first year the Federal contribution would be increased to $18,000,000. Both Federal and State contributions would be spent to develop services for the prevention, diagnosis, and treatment of physical and mental defects among school children.

Federal funds earmarked for each State would:

First. Provide more thorough health examinations for school children. These examinations would determine whether the individual child is gaining weight and would discover defects of the eyes, teeth, ears, heart, lungs, throat, and posture. Second. Provide children with follow-up medical care to correct defects discovered in such health examinations. Recognizing that not enough money can be made available to correct the health defects of all school children at once, however, the bill would have remedial work begun first in rural areas and areas of severe economic distress, where the need is greatest.

Third. Apply to improvement of the Nation's present inadequate school health services the same general pattern of Federal-State cooperation embodied in title V of the Social Security Act. This has been successful in bettering maternal and child health, services to crippled children, and public child-welfare programs throughout the country.

States providing school health examinations or corrective work or both would be expected to undertake equitable service without regard to race, color, or creed. In developing their services, States would be expected to integrate programs with health activities already under way, and with the health and medical facilities presently available in the communities.

Fourth. Provide for administration of Federal funds by the Federal Security Administration, under a School Health Services Board. This Board would comprise the Chief of the Children's Bureau as Chairman, the United States Commissioner of Education, and the Surgeon General of the United States Public Health Service.

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