HEALTH

Contributions for health purposes in the United States in 1955 were almost 11 times what they were a decade and a half earlier. Furthermore, during the 15 years the share of the philanthropic dollar going for health purposes more than doubled; the $71 million contributed in 1940 represented 6 percent of all philanthropic giving compared with 13 percent in 1955, when $775 million was contributed. The increase is attributable primarily to the growth in private hospital construction and to the increase in the number and size of national health agencies.

The $775 million in contributions represents 6.7 percent of the $11.6 billion spent by consumers in 1955 for medical care (including expenditures for hospital construction). Comparable expenditures from public funds or under public programs amounted to $4.7 billion in the fiscal year 1954–55.

Hospital construction.-On the average, total hospital construction in the United States from 1930 through 1945 cost about $100 million a year; about twothirds of this cost was financed by State and local governments. Most of the balance (about $30 million a year) was financed by philanthropic contributions. Total hospital construction increased sharply after World War II rising from $170 million in 1946 to a peak of $867 million in 1952. One reason for this sharp increase is the Hospital Survey and Construction Act of 1946, which authorized. for the first time, Federal financial aid for a nationwide hospital construction program. Private expenditures for hospital construction increased from $85 million in 1946 to $351 million in 1955. About half the funds for private hospital construction came from philanthropic contributions.

National health agencies.-National health agencies and the American Red Cross received an estimated $290 million in philanthropic contributions in 1955. Of the total, 76.7 percent ($222 million) was received by the six largest agencies: The American Red Cross-$94.5 million; the National Foundation for Infantile Paralysis-$52.5 million; the American Cancer Society-$26.1 million; the National Tuberculosis Association-$25.8 million; the American Heart Association-$13.6 million; and the National Society for Crippled Children and Adults$10 million. The balance was raised by the more than 60 other health agencies that solicit funds nationally. Excluded are the amounts raised by local health agencies, associations, societies, and so on that are not affiliated with any national agency and that do not solicit on a national basis; data or estimates on contributions to these agencies are not available.

The total of $290 million was $5 million greater than the estimated amount contributed in 1954. Most agencies reported some increase during the year. The largest percentage increase was reported by the National Association for Mental Health; its 1955 contributions amounted to $2.4 million, or 61 percent more than the amount received in 1954. The American Red Cross reported an increase of $12.5 million-the result of a special appeal conducted in the fall of 1955 for flood victims, which brought in $16.3 million. The American Cancer Society and the American Heart Association reported increases of $3.4 million (14 percent) and $2.2 million (19 percent), respectively. The National Foundation for Infantile Paralysis reported a decline in contributions of $14.4 million or 22 percent from the amount received in 1954.

The large national health agencies do not participate to any great extent in federated fund-raising drives. Of the $222 million received in contributions by the six major agencies, only $38.1 million or 17.1 percent was channeled through united funds or community chests, according to the reports of the United Community Funds and Councils of America.

National health agencies, in addition to providing services and care to individuals and supporting training and educational programs, have also played an increasingly important role in supporting research activities. In 1955 their expenditures for research amounted to more than $20 million-a third more than in 1954. Cancer research led the way, with $7.3 million spent by the American Cancer Society and $0.9 million spent by the Damon Runyon Memorial Fund for Cancer Research. Three other agencies spent more than $1 million each on research: The American Heart Association ($5.2 million), the National Foundation for Infantile Paralysis ($2.7 million), and the Muscular Dystrophy Association ($1.5 million).

TABLE 3.-Expenditures for health and welfare purposes from philanthropic contributions, by purpose, selected years 1930–55

1 Estimates by the Division of Program Research, based on source data. Not available.

Source: See text, p. 18.

OTHER PURPOSES

Philanthropic contributions for education ranked third. The Office of Education reports that $418 million was contributed during the 1954 school year for higher education in the United States; $191 million was contributed for educational and general purposes, $104 million for building funds, $107 million for endowment funds, and $17 million for student-aid funds.

The amount contributed for higher education represents the bulk of contributions for this purpose, since only small amounts are contributed to primary and secondary schools. Contributions for higher education probably amounted to about $475 million in 1955, representing about 8 percent of all philanthropic contributions.

Small amounts went for other purposes, such as foreign relief (about 2 percent) and museums and libraries.

FEDERATED FUND RAISING

Federated fund raising is of greatest importance in the fields of health and welfare. United funds and community chests are the outstanding examples. In 1956, the United Community Funds and Councils of America reported that 1,873 campaigns in the United States raised $322 million. In 1940, 561 campaigns raised $86 million.

The growth in federated fund raising has been stimulated by the vast number of nonprofit organizations seeking contributions throughout the year by such methods as personal solicitations, letters, television, and radio appeals, entertainment, and prize contests. The Internal Revenue Service estimates that, for 38,000 national and local organizations in the United States, contributions from individuals and corporations would be considered tax deductible. The Service also estimates that there may be an additional 70,000 organizations that have never applied for tax-exempt status and that are engaged in soliciting contributions.

DIRECT PUBLIC PAYMENTS TO VOLUNTARY HEALTH AND WELFARE AGENCIES Voluntary health and welfare agencies receive funds from public agencies through lump-sum subsidies or through payment for services on behalf of a particular individual. The United Community Funds and Councils of America has reported that in 1952 voluntary agencies in 15 urban areas spent $239 million, of which 3.3 percent or $8 million came from public agencies as lump-sum subsidies. The importance of public funds varied considerably among the different types of agency. Voluntary agencies providing specialized services for children received 12.5 percent of their total income from public funds; private hospitals, 3.0 percent; and voluntary agencies providing recreation, 0.3 percent. Data or estimates are not available on the amounts received by voluntary agencies from public funds as payments for services on behalf of particular individuals.

FOUNDATIONS

There are about 5,000 foundations in the United States, with total assets of about $7.2 billion, that spent approximately $400 million in 1954. A foundation is defined as a nongovernmental, nonprofit organization having a principal fund of its own, managed by its own trustees or directors, and established to maintain or aid social, educational, charitable, religious, or other activities serving the common welfare. The largest is the Ford Foundation, which in September 1956 had assets with a market value of roughly $2.8 billion; some foundations, in contrast, have assets of less than $10,000. The 77 largest foundations own more than three-fourths of the asset value of all foundation assets and account for three-fourths of all expenditures made by foundations.

About three-fourths of the $400 million spent by all foundations in 1954 came from foundation income; the balance represented current giving by individuals and corporations channeled through foundations. This balance of $100 million is included in the tables. The expenditures from foundation income are excluded; there is no basis for estimating the distribution of this $300 million by specified purpose. In the same year an additional $100 million was contributed by individuals and corporations and added to foundation capital. These amounts are included in the total contributions of $5.9 billion shown in table 1.

In December 1955 the Ford Foundation allocated $500 million to be spent, beginning in 1956, as follows: $210 million, supplementing an earlier $50 million, to help raise college faculty salaries; $90 million to strengthen instruction in the Nation's private medical schools; and $200 million to assist nonprofit hospitals in the improvement of medical services to their communities. It is estimated that the heavy expenditures of the Ford Foundation will raise total foundation expenditures in 1956 to $600 million.

Foundations play a key role in supporting exploratory research directed to prevention and cure rather than treatment or relief. The National Science Foundation has estimated that foundation research expenditures in 1953 were roughly $33 million; 65 percent was for basic research and 35 percent for applied research and development. About 45 percent was for research in the social sciences and 43 percent for research in the medical and in the biological sciences. No data are estimates on foundations' fields of interest are available. Generally, however, the large foundations concentrate their spending on national and international affairs, including economic development projects abroad; education; international peace and understanding; research projects in agriculture, biology, medicine, the social sciences, the humanities, and public health; and public affairs. The smaller foundations are more concerned with local needs in the fields of health, welfare, religion, and education.

METHODOLOGY, SOURCES, AND LIMITATIONS OF THE DATA

Current data on total health and welfare expenditures in the United States made from philanthropic contributions are not available. Estimates of total philanthropic contributions are better than the estimates of contributions received by health and welfare agencies. The estimates of expenditures for the separate health and welfare categories should be used essentially as indications of voluntary agencies' major fields of interest in this area.

In the June 1944 issue of the Survey of Current Business, the Department of Commerce showed expenditures by national and local voluntary health and welfare agencies through 1942. From 1943 through 1952, however, the Survey of Current Business combined data for expenditures by national health agencies, national welfare agencies, and foreign relief agencies into one category-"social

welfare and foreign relief agencies." Currently, the Survey combines this total with religious expenditures by political organizations, museums and libraries, and foundations.

For recent years it is therefore necessary to estimate (1) total philanthropic contributions, (2) the proportion going to religious agencies, and (3) expenditures for health and welfare purposes by secular and religious agencies.

Estimates on total philanthropic contributions in 1930-45 were taken from F. Emerson Andrews, Philanthropic Giving, 1950. For 1950, estimates on total contributions came from J. P. Jones, the American Giver, 1954; for 1955, the estimates were made by the Division of Program Research, using Andrews' methods. The estimates are based on data from the Internal Revenue Service, Statistics of Income, parts I and II.

Data published yearly by the National Council of the Churches of Christ, showing the amounts received by various Protestant denominations, form the basis of the estimates of contributions to religious organizations. For the past 25 years, 14 Protestant denominations have reported yearly contributions. The 1926 and 1936 Censuses of Religious Bodies showed that contributions to these denominations made up nearly half of all contributions to all religious bodies. The projections of contributions to all religious denominations based on these data have been adjusted for the rates of growth of Protestant, Catholic, and Jewish church membership as reported yearly by the National Council of the Churches of Christ.

Estimates of contributions for secular health and welfare purposes combined were obtained from the 1950 Andrews study; for 1955 the ratios in that study were applied to the total estimates for the year. To obtain estimates for the year. To obtain estimates of contributions for health purposes and for welfare purposes and for the health and welfare categories listed in table 3, reliance was placed primarily on the surveys, Expenditures for Health and Welfare Services in Selected Urban Areas, 1952 and 1955, prepared by the United Community Funds and Councils of America. This material was supplemented by data prepared by the Council of Jewish Federations and Welfare Funds, the Catholic Charities, and the National Council of the Churches of Christ. The estimates in table 3 cover total expenditures from contributed funds by these agencies for all purposes, including such items as administrative expenses, rent, capital expenditures, and relief payments. Expenditures from public funds and from other receipts, such as payments for services, are excluded. Religious contributions for health and welfare purposes were estimated by applying ratios appearing in the Yearbook of American Churches to the estimates of total contributions for all religious purposes. Data on church construction are taken from the table presented each month in the Monthly Labor Review (table F).

Data on contributions for educational purposes are from the Office of Education, Biennial Surveys of Education in the United States, chapter 4, section 2. Estimates on foundation expenditures are taken from F. Emerson Andrews, Philanthropic Foundations (Russell Sage Foundation, 1956). Data on foundation research expenditures came from the National Science Foundation, Scientific Research Expenditures by the Larger Private Foundations, 1956.

Mr. CURTIS. Now to some specific questions. On page 11 you said that development of adequate day-care services has stood relatively still. I know in my own community it certainly has not stood still. I was wondering on what basis you made that statement?

Secretary RIBICOFF. We have a report here dated October 1960, the licensed day care facilities for children, which contains the information and I would like to insert in the record the full report, which indicates there were in the United States 4,426 licensed centers.

Mr. CURTIS. 4,000?

Secretary RIBICOFF. 4,426 licensed day care centers. The aggregate capacity of licensed centers is 141,138 children. These are broken down: Public, 276 licensed centers with a capacity of 15,561 children. Mr. CURTIS. What was it, say, 10 years before that, or 5 years? We are talking about a statement saying that this has stood relatively still. I was under the impression this was an area that we actually had been

moving ahead on, and we really had not in this area up until the past couple of decades, and that we have rapidly moved into it.

That is what I am trying to check, so there would be a comparative figure.

Secretary RIBICOFF. We will try to get you figures of what it was 10 years ago.

Mr. CURTIS. Whatever the applicable figure, so that we can get the rate and then possibly put out the figure of how much we still have to go, because even though we may be going on at a great rate, maybe we have a bigger problem than that rate will meet.

In this connection, I do think it is important to relate the extent to which kindergartens are being put into school systems because at least at the age of 5, the need disappears for the day care centers. In many communities there still are not kindergartens, so I am anxious to get an evaluation of that.

Secretary RIBICOFF. May I place in the record at this point the present status?

Mr. CURTIS. Yes, I would appreciate that very much. (The information referred to above follows:)

During World War II Federal funds were made available for day-care facilities because of the unprecedented number of women entering industry. Over 3,000 day-care centers were developed during the war, with funds appropriated under the Lanham Act. At the peak of this program, in 1944, these centers were caring for 105,000 children. Between 1942 and 1946, the period when funds were available under the Lanham Act, over $51 million of Federal funds were used for this purpose. Following the war, practically the entire program developed under the Lanham Act disappeared. As stated in a 1953 report on "Planning Services for Children of Employed Mothers," published by the Department of Labor and prepared by a subcommittee of the Interdepartmental Committee on Children and Youth: "The closing out of services due to cessation of Federal funds, brought to the foreground a need of long standing in hundreds of communities. Many parents who had found the wartime programs for children a good solution, providing supplementary care while they were employed, urged that their communities take action to keep them. But most communities found it impossible to carry on these services without assistance from other sources. The uncertainties of financing programs for children of employed mothers have greatly reduced the quality and number of these programs in the States at the present time."

During the decade 1950-60, the number of married women in the labor force with children under 18 years of age increased from 4.6 million to 8 million, a rise of 73 percent. The number of these women with children under 6 years of age rose from 1.7 to 2.9 million, while the number with children 6 to 17 years of age rose from 2.9 to 5.1 million.

Day-care facilities, of course, while primarily needed for children of working mothers, are also needed to meet other problems such as illness in the family.

All States participated in the national survey of licensed day-care facilities for children conducted by the Children's Bureau in 1960. The survey was limited necessarily to licensed facilities that were known to governmental authorities through the licensing process. It provides, nevertheless, a satisfactory approximate estimate of the number and the capacity of the day-care facilities that are now available. A total of 4,426 licensed day-care centers with a capacity to serve 141,138 children were reported in the survey. In addition, 13.577 licensed family day-care homes with an aggregate capacity to serve 42,194 children were reported. The combined capacity for both types of facilities was 183,332 children.

There is no past survey of a comparable kind that would permit a precise measurement of the rate of growth of day-care services in the United States. Evidence from various services shows, however, that these services, especially those under the auspices of public and voluntary social agencies, have stood relatively still in recent years and have not kept pace with the great increase in working mothers nor with the national need.