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for a hundred years, appropriated money to the States so that such essential jobs could be done. There are Federal grants-in-aid to the States to build roads, to protect our forests against fire, for land-grant colleges, for hospital construction, for venereal-disease control, and so forth. Why should there not be such grants-in-aid to the States to conserve the most important asset America has, the health of its school children, its future citizens?

Federal programs of grants-in-aid to the States are necessary because of the inequality of wealth among the States. Many States have so few wealthy citizens and so little industrial and agricultural' wealth that sufficient money cannot be raised in taxes to finance necessary work, such as school-health services. A thoroughly adequate job in school-health services is not now being done by any State, and in the poorer States it probably never will be done without the assistance of Federal money. We provide money to the States to do many jobs far less important than that of improving the health of school children. Congress seems to find money for nearly every important activity. Certainly we should not economize on America's most important asset-its children.

The program of Federal grants to the States provided for in the National School Health Services Act (H. R. 1980) will, in the long run, be an economy move for the Federal Government and for the States. If the physical- and mental-health defects of school children are corrected we shall need less hospitals and less mental institutions when our children grow up to be adults. It costs infinitely less to correct these physical and mental defects among school children than it costs to take care of physically and mentally ill adults.

Some years ago the United States Public Health Service conducted a very important study in Hagerstown, Md. This study showed that a large percentage of the young Americans who were rejected for military service during the past war because of physical defects had these same defects many years before. These defects had been discovered in school health examinations, but in most cases nothing had been done about correcting these physical defects which years later disqualified the young men from military service.

I would like to file for the record for whatever use you wish to make of it this statement on Hagerstown, Md., made by the United States Public Health Service.

The program of Federal grants-in-aid to the States for school health services is also a national defense measure. The available manpower of the United States to fight and to produce will be substantially increased if the boys and girls of this country are made physically fit. Then no longer will more than one-third of our young men be rejected for military service for physical defects.

The need for school health services really should require no detailed testimony. Of the 30,000,000 school children in the United States, more than a quarter of them have defects in vision; 75 percent of them need dental care. According to the United States Children's Bureau there are more than 175,000 children who have active tuberculosis; a million with hearing defects and a half million with orthopedic defects; and thousands with cerebral palsy and epilepsy.

Mr. DOLLIVER. May I interject at this point? The Reprint No. 2338, Child Health and the Selective Service Physical Standards, will be received as an exhibit in connection with your testimony.

Mr. HECHT. I just wanted it there for reference.

Mr. DOLLIVER. It is already in print.

Mr. HECHT. Yes.

(The reprint referred to is filed with the committee.)

Mr. HECHT. The job of safeguarding the health of American school children simply is not being done. The health of our boys and girls is being shamefully neglected. If we are to be a healthy, strong Nation in the future, we must give prompt and adequate attention to the health of our school children today.

According to a 1942 report of the National Youth Administration and the United States Public Health Service, 9 out of 10 young men, who participated in the National Youth Administration out-of-school work program, had one or more "health defects" for which examining physicians and dentists recommended some sort of medical and dental service. One of every two draftees from the 13 Southern States were rejected for physical and dental defects as compared to one out of three for the non-Southern States, according to Medical Bulletin No. 3 of Selective Service, published in 1944. There is a particular need for school health services among farm boys. A report of the Bureau of Research and Statistics of the Social Security Board, Bureau Memorandum No. 57, second edition, stated that the Selective Service rejection rate for farm boys was 41 percent higher than for other occupational groups. More than half of the American school children are in rural areas where all health services, particularly school services, are exceptionally meager. This bill will give preference to the poorer States and as far as treatment is concerned, to school children in rural areas.

Senate findings in 1944 disclosed that more than 4,000,000 young men were rejected for physical and dental defects, some 700,000 had health defects which could have been but which were not corrected. This bill would establish as a national policy that—

No American child shall come of adult life with physical or mental defects. which could be prevented or corrected at an early age.

Testifying in 1944 on the implications of draft rejections during the recent war, the Surgeon General of the United States Navy told a Senate committee:

Prevalence of physical defects at selective-service age, defects which in many instances existed in childhood and youth, indicates that school health programs have not been as effective as they might be, both in discovering defects and in following through to assure that appropriate corrective measures are taken. Careful periodic physical examinations, together with adequate follow-up and correction in the schools and high schools of the Nation are the best insurance a community can have against a repetition of the situation the Nation faced in this war when 40 to 50 percent of the young men were found physically unfit for general military service.

This bill provides not only for the prevention, diagnosis, and treatment of physical defects in school children but also provides similar mental hygiene services for them. Mental disorders in children need early detection and treatment. Our mental hospitals are filled with adults who need not have been there if mental hygiene services had been rendered them when they were of school age. And, may I point out to you, that this bill specifies that in respect to treatment of mental and physical defects found, that services should be rendered especially in rural areas and in areas suffering from severe economic distress.

May I urge that this House subcommittee conform the bill to the bill which bears the same name in the Senate (S. 1290). The bill was introduced into the Senate several months after it was introduced into the House and thus gave opportunity for further study. The appropriation provided was reduced from $12,000,000 to $10,000,000 for the first year and from $18,000,000 to $15,000,000 for the second year. While I do not think this appropriation is anywhere near adequate, it is enough to make a start and to demonstrate to the country the usefulness of such a program. I am presenting herewith a copy of the House bill with the changes that have been made in the Senate bill marked on it.

One-half of the money appropriated for distribution to the States must be matched by the States. The other half of the money is to be distributed on a nonmatching basis. The formula for the nonmatching grants is somewhat different in the House and Senate bills. I urge that the same formula be adopted by both the House and the Senate. It is important that more funds be provided to the less-wealthy States. I suggest that the nonmatching grants be made on the basis of— (1) The number of children in the State between the ages of 5 and 17, inclusive.

(2) The relative wealth of the respective States. (The wealth factor should not be determined by income-tax payments which frequently vary greatly from year to year.)

(3) The size of the problem as determined by the school health services board. A factor in determining the size of the problem would be the number of rural schools. This threefold distribution formula is similar to that in the Public Health Service law No. 410.

The bill, as drawn, contains a plan of administration on the Federal level that, it seems to me, adequately meets the need and gives due consideration to the functions and responsibilities of both the educational authorities and the health authorities. On the national level, the funds are to be administered by a board consisting of the Chief of the United States Children's Bureau, the United States Commissioner of Education, and the Surgeon General of the United States Public Health Service; all three of whom serve in the Federal Security Agency.

As to the administration in the States, it is left up to the discretion of each State as to whether the school health services should be administered through its educational agency or through its health agency. The bill, however, provides that the State plan must be concurred in by both the State educational and State health agencies. This is a big step forward and is an assurance that the State plans for school health services will get the ideas and approval of both the education and health agencies in the State. I do not think it is the function of the Federal Government to tell the States which of their departments should administer the funds within the State. This bill leaves it up to the States but provides that both the State health agency and the State education agency shall have their proper say as to the plan used by the State.

This bill furthermore leaves it up to the States as to whether or not a means test should be applied for any corrective work that is done. The bill contains no provision which prohibits the States from applying the means test if they wish to do so.

The national school health services bill has widespread support of the public. Only one morning has been allotted for testimony and so time does not permit you to hear the endorsement of the bill by the executives of the many organizations that support it. Among these organizations are the following, in addition to those represented this morning: The National Committee for Mental Hygiene, the National Farmers Union, the American Federation of Labor, the CIO, the American School Health Association (formerly called the American Association of School Physicians), the Health Council of Greater New York, the Friends Committee on National Legislation, Spokesmen for Children, Inc., the National Urban League, and the National Association of Colored Graduate Nurses.

In addition to that list, I would say the American Council on Education, through its committee on relationships, has authorized support of the bill.

As further supporting evidence for this bill, I wish to submit editorials favoring the bill from the Washington Post, the Chicago Sun, the Illinois State Journal. And I submit also a copy of the New England Journal of Medicine, issue of February 1947, with an article by Dr. George M. Wheatley, formerly a member of the staff of the United States Children's Bureau and now associated with the Metropolitan Life Insurance Co., and a member of the school health committee of both the American Public Health Association and the American Academy of Pediatrics. His article deals with the need for and the usefulness of school health services. I also submit as evidence a school health survey made in the District of Columbia by the health committee of the District Tuberculosis Association. This points out the inadequate number of school-health nurses. It gives important and up-to-date figures for a selected list of cities throughout the United States.

Also for the record I have a number of copies here of a State-byState tabulation of State expenditures for school health services compiled by the United States Office of Education. It is for the last school year for which statistics were available, 1943-44, and shows total school health expenditures, the number of school-health physicians and nurses employed, and the average expenditure per pupil. This tabulation is for expenditures of which the United States Office of Education is cognizant. No information about such school-health expenditures through health departments could be obtained from the United States Public Health Service.

Mr. DOLLIVER. At this point, Mr. Hecht, let me say that the chairman will examine the various exhibits that you have offered and determine how they will be used in connection with your testimony.

Mr. HECHT. For many States in this tabulation of the Office of Education the expenditure figures are complete, but in those where no reports are given, the expenditures were doubtless made through health departments. While every State recognizes the need for school-health services, one can see from this table how shamefully inadequate their expenditures are for this important purpose.

As far as it is able to be ascertained, the average expenditure per year, the last year for which statistics are available, was 98 cents per year per pupil.

If the States were to spend out of their own funds such inadequate sums on the health of pigs and cattle raised within their borders, the

United States Department of Agriculture would be quick to give supplementary Federal funds so that an adequate job would be done. Are we going to do less for the health of our school children than we do for our pigs and cattle?

The children of America have been kept waiting far too long. The future of the United States will be determined by the physical and mental health of our school children. The United States cannot afford and must not keep our children waiting any longer.

Mr. DOLLIVER. Thank you very much, Mr. Hecht.

Mr. HECHT. Thank you.

Mr. DOLLIVER. Our next witness is Lawrence L. Gourley, legal counsel of the Osteopathic Association.

STATEMENT OF LAWRENCE L. GOURLEY, LEGAL COUNSEL, AMERICAN OSTEOPATHIC ASSOCIATION, WASHINGTON, D. C.

Mr. GOURLEY. May I express the appreciation of the American Osteopathic Association for the invitation and opportunity for advising with you today regarding the provisions of H. R. 1980, cited as the National School Health Services Act of 1947.

I am legal counsel for the department of public relations, of the association, and have been deputized by the chairman of that department, Dr. Chester D. Swope, to make this appearance.

You all know that osteopathic physicians or surgeons are legally licensed and rendering child-health services in all the States. Members of the profession serve on State boards of health, and as county, city, and town-health officers, as school physicians and as members of boards of education. Manifestly, the osteopathic profession is vitally interested in matters affecting the health of children.

We have several suggestions to make regarding the pending legislation. I understand the committee is pressed for time. Our observations will be as brief as it is possible to make them.

This is a Federal_grant-in-aid, on a matching basis, to the States to furnish free and complete medical care to all school children between the ages of 5 and 17, inclusive. Quite obviously, a large proportion of the services would not be rendered on the school premIt appears to us that a more suitable title for the bill would be "Health Services for School Children Act of 1947." The suggestion is strengthened by the fact that in numerous jurisdictions the State or local authority and responsibility for health services to school children is vested in the health department.

ises.

The bill provides coverage for all school children between 5 and 18 years of age. It may be of interest to observe that Ohio was the only State, according to a United States Office of Education survey, November 1945, requiring compulsory school attendance between that range of ages. Three-fourths of the States require compulsory attendance between 7 and 16 years of age.

An Office of Education Survey in 1941 showed that all States had State laws for medical inspection of school children except Michigan, New Mexico, and Wisconsin. The extent of examinations specifically mentioned in the laws range from communicable diseases only to any defect and deformity, physical and mental. In some States the ex

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