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Fifth. Would establish both State and National advisory boards on which would serve representatives of health, education, child welfare, and the public at large.

Sixth. Provide for joint State planning for school health services by both State health and education authorities, but for administration of the plans by both or either or whatever State agency the State deemed appropriate. There would be no Federal interference whatsoever with the educational systems of the States.

The national school health services program already has a large measure of public support from nationally known organizations headed by Parents' magazine. This is a monthly publication with a circulation of more than 1,000,000, devoted to the welfare of children and their problems.

The publisher of Parents' magazine, George J. Hecht, is serving as chairman of a volunteer committee of public-spirited citizens working for the enactment of the national school health services bill. Members of this committee, representing their organizations, include Leonard W. Mayo, chairman, National Commission on Children and Youth, and president of the Child Welfare League of America; Dr. A. O. DeWeese, executive secretary of the American School Health Association; Nelson H. Cruikshank, director of social insurance activities for the American Federation of Labor; Nathan Cowan, legislative director of the Congress of Industrial Organizations; Russell Smith, legislative secretary, National Farmers Union; Miss Hazel Corbin, R. N., general director, Maternity Center Association; Lester B. Granger, executive secretary, National Urban League; Mrs. Theodore Oxholm, chairman, Spokesman for Children, Inc.; Kenneth D. Widdemer, acting executive director, Health Council of Greater New York; Mrs. Gertrude Folks Zimand, general secretary, National Child Labor Committee. .

Mr. Speaker, I am confident that as this bill is brought to the attention of the American public, as it deserves to be, and now that it is introduced, the proposed national school-health-services program will win the approval of every parent in the United States, and of every organization that is interested in American school children.

Services such as proposed in this bill are long overdue. Approximately 30 percent of the young men, 18 through 37 years of age, examined for military service in the recent war, were rejected for physical or mental defects which made them unfit to serve their country. These were the findings of the Selective Service System made public in December 1946.

The percentage of draft rejections in this war perhaps indicates no real deterioration in the health of our adult malé population since the last war. Then approximately 29.6 percent of the draftees were rejected. Differences in standards and policies of draft examinations make it difficult to compare the two periods precisely.

Yet, while there may have been no real deterioration in health, neither can we say, as we ought to be able to, that the health of our young men has improved since the last war, in a country wealthier and more advanced than any other in the world.

Many of the defects which disqualified millions of young men for military service could have been detected and corrected when the men were boys in school. But this preventive work was not done. Although we knew what ought to be done, as a nation, we failed to take steps to do the job.

A definitive study of the close tie-up between draft rejections and the health of school children was made by the United States Public Health Service in Hagerstown, Md., in 1941. In their analysis the Public Health experts found that relatively large numbers of Hagerstown young men rejected in the draft had given evidence during their childhood at school-health examinations of the very same defects which, uncorrected, 15 years later made them IV-F's in the draft.

Bad teeth, for example, were allowed to grow worse. Men with teeth so poor that they caused rejection in the draft, when boys of 10, already had double the number of decayed, missing, or filled permanent teeth as had the 10-year-olds who 15 years later went into the services instead of into class IV-F.

According to the United States Children's Bureau, which has the most reliable information now available on children's health, at least three-quarters of America's 30,000,000 school children need dental care. Approximately one-third need medical care. Ten million children have defective vision. One million have hearing defects. Half a million children have orthopedic defects or defects which could be corrected by plastic surgery. Approximately 175,000 children have active tuberculosis.

In our schools something can be done to correct most of these defects, and a whole lot can be done to correct many of them. The schools are a good place to begin. For under our laws the schools have contact with more children for longer periods than any other public agency.

Nevertheless, not even half of the school-age children and young people in the United States receive even a health examination, let alone corrective care. Only 1 out of every 10 high-school students receives a physical check-up. Where examinations are given there is rarely any provision for follow-up remedial work. Some States spend as little as 2 cents per child per year for school health services. Only 10 States report school health expenditures of more than $1 per year per pupil, according to the latest available figures of the United States Office of Education.

The national school health services bill which I have introduced today is addressed to this problem. It should not be confused with the large issue of providing health insurance for the whole population, with which my bill has nothing whatever to do. The national school health services bill would go straight to the heart of the Nation's health problem. It would make a modest beginning to start our school children off on the path to health.

The program which this bill would make possible represents the kind of economy which in the long run is a real economy. It would spend a relatively small sum today so that larger sums would not be needed later.

Federal expenditures for the health needs of children have always been small in comparison with appropriations for other purposes, improving the health of farm animals, for example. Nobody ever proposed an atomic-bomb-size Federal fund for children. Yet in the desperate necessity of war the Congress put $2,000,000,000 during a comparatively short period into atomic research.

If we want to have a healthy nation we must start with the children. Physically fit and productive adult citizens are the best investment a nation can have. That is the future dividend to be realized by investing now in the health of America's school children.


Mr. HOWELL. Mr. Speaker, under leave to extend my remarks, I include in the Appendix of the Congressional Record a summary of the national school health services bill, which I have proposed in legislation introduced in the House today. The summary follows:

"The Federal Security Administrator, through the United States Children's Bureau, as authorized by title V of the Social Security Act, now makes grants to the States for the purpose of extending and improving (1) maternal and childhealth services, (2) services for crippled children, and (3) child-welfare services. This proposed bill would establish a new grant-in-aid program for (4) school health services. School health services consist, in the main, of periodic school health examinations to discover physical and mental defects, and preventive and corrective services rendered by physicians, dentists, nurses, and mental hygiene specialists.


"The basic purpose of this bill is best expressed by its section 2 which consists of a proposed declaration of policy by the Congress :

""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.' "In respect to treatment of physical and mental defects found, the bill specifies that this shall be provided especially in rural areas and areas suffering from severe economic distress. The bill further specifies that funds may also be used for the training and supervision of school personnel in utilizing the findings of health examinations, but excludes health instruction other than that given as part of examination, diagnosis, or corrective procedures.


"This bill would apply to the problem of establishing and strengthening school health services, the same general pattern of Federal-State cooperation that has worked so successfully in improving maternal and child health services, services for crippled children, and public child-welfare services. Under this bill the States rather than the Federal Government would determine how they want to and can provide school health services. On the State level the program would be administered as provided by State law either by the State health agency or the State education agency, or jointly by these two State agencies, with the advice of a State advisory committee consisting of representatives of public and private agencies concerned with health, education and child welfare, and the public at large. Each State would determine how the health and education authorities will cooperate in making available all health services to school children provided for in the bill. Each State would draw up its own plan, according to its own needs.


"For the fiscal year commencing July 1, 1947, $12,000,000 is authorized to be appropriated. For the fiscal year commencing July 1, 1948, $18,000,000 would be appropriated, and for each succeeding fiscal year such sums as may be necessary to carrying out the purposes of the act.

"1. Half of the sum made available for allotment to the States each year would be apportioned among the States as follows: $20,000 to each State and the balance on the basis of the number of children between the ages of 5 and 17, inclusive. This amount would be matched dollar for dollar.

"2. Half of the sum made available for allotment to the States each year would be apportioned according to the financial need of each State for assistance in carrying out its State plan after consideration of the number of children between the ages of 5 and 17, inclusive. These funds would not be matched.

"3. Of the sum appropriated each year, $2,000,000 or 10 percent of the sum appropriated, whichever is greater, would be available to enable the Children's Bureau to administer and to provide demonstrations, to pay salaries and expenses of personnel detailed at the request of State agencies to assist them in carrying out this program, and for the training of personnel for State and local school health services, through grants to accredited schools of public health or other professional institutions.


"The chief of the Children's Bureau is required to approve any State plan for expenditure of these funds which meets the following conditions: (1) Financial participation by the State. (2) Administration or supervision of the plan by either the State health agency or the State education agency, or jointly by these two State agencies. (3) The plan must be concurred in by both the State health and the State education agencies. (4) Such methods of administration as are necessary for the proper and efficient operation of the plan, including maintenance of personnel standards and selection on a merit basis. (5) Provision for necessary reports and provision for carrying out the stated purposes of the act. (6) Provision for cooperation with medical, dental, health, nursing, education, and welfare groups and organizations in the State, 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. (7) Provision for the designation of a State advisory committee to 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 in carrying out the State plan. (8) 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. "The chief of the Children's Bureau, acting with the advice of a 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 condition specified above, except that if a State plan, or any portion thereof, is to be administered by a 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.

"A National Advisory Committee for School Health Services, consisting of 12 members, shall be 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 must be persons representative of the fields of health, education, and child welfare, and the public at large, one-half of whom shall be selected from panels of a least five names by representative national organizations, and at least three members shall be doctors of medicine and at least one a doctor of dental surgery.


"With the advice of the School Health Services Board and the National Advisory Committee, the Federal Security Administrator shall administrate 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. The Chief of the Children's Bureau must consult State health and education authorities before issuing regulations with respect to grants to States and in matters of general policy with the advice of the National Advisory Committee, and insofar as possible to obtain their agreement. The Chief of the Children's Bureau is authorized to provide demonstrations and for the training of personnel for State and local school health services, and to detail technical staff upon the request of the State agency for consultation, advice, and assistance to the State and its local communities in planning, organizing, and improving school health services for the prevention, diagnosis, and treatment of physical and mental defects and conditions likely to interfere with the normal growth and development and educational progress of school children."

Mr. HOWELL. Now, there is no need for me to burden the record with extensions of editorials from various newspapers and magazines throughout the country. I know that the chairman of this committee, as well as the members of the Interstate and Foreign Commerce Committee and the Members of Congress, including the House and the Senate, realize that the problem of child health is one of the most important ones which faces our country today.

The figures on the various ailments of school children are absolutely amazing in some cases, and the remarks which I have already put in the record will present in detail the various disabilities that are suffered by school children and the general condition of their health as a result of numerous surveys that have been conducted on that subject. Therefore, there is no question about the need to improve the school children's health in this country. As I indicated, there is ample evidence to support the point; and rather than putting any additional testimony in on that point, I am going to refer to the statement again which I previously put into the record and which I delivered on the floor of the House of Representatives.

Now, as I indicated, Senator Saltonstall is here and he will follow me, as I understand it, in connection with S. 1290, to which certain amendments have been worked out. Therefore, in view of his statement and the more elaborate statements of the witnesses who are to follow me, I think that I will conclude my statement at this point. Mr. DOLLIVER. Thank you, Mr. Howell.

Now, Senator Saltonstall of Massachusetts will be heard.


Senator SALTONSTALL. Mr. Chairman, may I first present to you a letter from Senator Baldwin, which he asked me to deliver to you. I also talked with Senator Lodge and one or two of the others sponsoring the bill in the Senate; and while they will not appear here this morning, I can assure you of their wholehearted interest in this bill.

Now, Congressman Howell was the pioneer in introducing this legislation. His bill was presented to me, and I was asked to get some sponsors among the Members of the Senate for a companion bill. I mention that because before agreeing to do so, I looked into the matter as carefully as I could. I had always been interested in it for reasons that I will tell you in just a moment. Before introducing the bill in the Senate, I discussed the matter with the Children's Bureau. I also went over the bill with my public health commissioner in Massachusetts, in whom I have great faith, perhaps because I appointed him to his present job, but more especially because of the recommendations which were given to me when I did appoint him. He, Dr. Getting, is here to testify this morning.

I also discussed this proposed bill with an eminent doctor who was working on the over-all health problem from a private citizen's point of view.

The amendments that we made in Congressman Howell's bill, very slight at the time, were the result of those conferences. The Senators whom I asked to sponsor the bill with me were all enthusiastic in doing so.

Now, I would say this, Mr. Chairman, that hearings have not been held on the Senate side on this bill this year deliberately, because I asked them not to do so. Senator Smith of New Jersey is heading up the subcommittee of the Committee of Labor and Education in the Senate which is hearing all the health bills. His committee, he told me, would not report out a bill before Congress recessed this year, but would hope to do so before Congress completed its work next year, in the early part of the next session.

He asked me, under those circumstances, whether we wanted to go forward with hearings this July or would rather put forward our best foot next January or February. I told him, after consultation with some of the proponents of this measure, that I thought it was wiser to put forward our whole case at one time next January rather than start hearings this year and then continue into January. I say that because that is the reason why no hearings have been held on this bill on the Senate side. It is not because of lack of interest.

I have been interested in the child-health problem for a great many years. My brother-in-law, who is no longer on this earth, was public health commissioner of Massachusetts when public health was a pioneering matter. I remember very well his telling me that he had to make a decision when he was in the medical school in about 1916 as to whether he was going to specialize on public health or on medicine. I think he was the first man or second man in his class at Harvard Medical School. He decided to be one of the pioneers in public health. At that time there were only, I think, three men specializing in it.

He said that his reason was that while the layman thought service of doctors was to help the sick, he looked upon it in the broader aspect

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