I think in respect to your first question, how many children die of malnutrition, that figure is probably very very low in the United States in terms of the numbers of children who are affected by malnutrition, however

Senator KENNEDY. What is "low"? What do you mean by "low"? Mr. SUGARMAN. I would guess that it is, oh, under a thousand, nationwide, in terms of deaths from malnutrition. And in those casesSenator KENNEDY. Have you done a study on this?

Mr. SUGARMAN. We have some information. I personally feel that it is not fully reliable information. One of the things that the Department is now trying to do is to greatly improve its health and social services statistics, and we would be happy to provide for you for the record what information we have. There are some limitations to it.

Mr. FARMER. May I comment on that, too. It is very difficult to get those facts, Senator, because if a child is undernourished, and he might contract tuberculosis, he might contract any number of other diseases, and it is difficult for us, then, to say that that child's death is a direct result of malnutrition, though that has been a contributing factor.

Senator KENNEDY. But I suppose what you are really trying to acquire is the dimension of the need, and I don't see how you can really develop a program, unless you are able to adequately detect and determine the nature of the need.

I am trying to ascertain the kinds of materials which you have available to you, which I think would be valuable to this committee, so that we can balance what is recommended or suggested by the administration in terms of the need.

Mr. FARMER. Senator, your point is very well taken, and one of the points which I tried to make in my testimony is that we are now conducting a study through the Office of Child Development, as to the dimensions of the need, and that study we expect will be completed within 6 months, and then we will be able to make our recommendations to this committee and to the Congress.

Senator KENNEDY. When did that study start?

Mr. SUGARMAN. Well, parts of it have been underway continuously as part of the functions of the Children's Bureau. But the Secretary's directive came with the establishment of the Office of Child Development on July 1.

Senator KENNEDY. Mr. Chairman, I would hope that we could at least obtain from the Department the information that is available at the present time on which they are making their calculations and judgments about the dimensions of the needs of programs, and also an indication as to what studies are taking place the nature of such studies, when they will be available, and so forth.

Senator MONDALE. I would like to add to that, if I might. Maybe I could put this question to Mr. Sugarman. Would you supply for the record a list of all pilot programs, research projects, experiments and demonstration efforts in early childhood development that have been funded and are being funded in all or in part by different agencies of the Federal Government? Please include the funds spent, and a very brief summary of the results of each project.

Mr. SUGARMAN. We will be happy to do that.

(The materials requested appear at the conclusion of this hearing.) Senator MONDALE. Senator Prouty?

Senator PROUTY. Thank you, Mr. Chairman. I have no questions, merely one or two observations. It seems to me that the administration is taking a very sound and logical approach in trying to get the facts by making these studies which should have been made years ago.

I also think that when the President's welfare message is sent to the Congress, it is going to be very impressive. I think it is going to touch upon many aspects of the problems discussed at this hearing this morning. I believe, therefore, that we should wait until we have had an opportunity to examine the President's recommendations before we attempt to draw sound conclusions with respect to this proposed legislation.

Obviously, all of us agree with the objectives. We want these things to happen. We want to improve services in all of these fields.

I remember several years ago when I submitted an amendment to this committee to earmark a definite percentage of OEO funds for the Headstart program. It was defeated overwhelmingly. We finally passed it on the floor of the Senate, but over the violent opposition of many of the people who now say that Headstart has been neglected. It is one of the most popular programs throughout the country.

However, we also want to make certain that it is achieving its overall objectives. That it is doing the job we intended it to do."

We had the same problem with respect to the Job Corps. All of us wanted that program to succeed. Finally, out of a sense of frustration, I submitted an amendment on the floor which required the General Accounting Office to investigate this program, not to determine how the money was being spent, but to find out whether this program was achieving its overall objectives. We found that most of these young people in these camps were not getting the benefits that we all hoped and anticipated would be the case, when the Comptroller General submitted his report.

I want to commend you gentlemen, and the administration, for trying to get the facts first, and then attempting to work out sound and realistic program based on the facts. I think that is the only way we are going to achieve the results we all hope will be forthcoming in the reasonably near future.

Thank you, Mr. Chairman.

Senator MONDALE. Thank you, Senator Prouty.
Senator Dominick?

Senator DOMINICK. I have no further questions.

Senator MONDALE. We have two more witnesses now, Dr. Cooke, chairman of the first Headstart Planning Committee, one of the top experts in the country, and Doctor Zigler, a member of the Headstart Planning Committee. We will continue with their statements. I regret that this committee, under the rules of the Senate, will have to adjourn very soon because the Senate convenes at 11 a.m. this morning to continue consideration of the ABM. I'm afraid the deadline will preclude any questioning at this time of these eminent witnesses. I would hope the committee could hear their testimony now and hopefully find a time in the future when Dr. Cooke and Dr. Zigler could appear again for questioning and discussion.

Senator PROUTY. I have no objection, Mr. Chairman. I also ask unanimous consent to submit a brief statement of my own to appear in the record.

Senator MONDALE. Without objection.

STATEMENT BY HON. WINSTON L. PROUTY, U.S. SENATOR FROM THE STATE OF VERMONT

Senator PROUTY. Mr. Chairman, I am very pleased to be here today for hearings on S. 2060, the Headstart Child Development Act, introduced by Senator Mondale. Unfortunately, I have had many committee meetings in the past several days and was unable to attend the previous hearings on this bill. I have, however, perused some of the testimony and see that the problem has been well defined and the need to reach an early solution amply stated.

The subject of maximizing human resources through comprehensive early child development programs has long been of interest to me. I might remind the committee that such thinking is not new—James Dewey discussed the comprehensive nature of developing full human potential in the early 1920's.

Since that time, however, our society has become increasingly complex and it has become ever more difficult to coordinate the many factors of medical care, nutrition, physical, and mental stimulation that contribute to a child's full development. The problem is particularly acute for those people in our country who do not have enough adequate money to obtain the resources and services commonly available to the majority of us. In essence, those that need enrichment most don't get

it.

The bill before this committee now is an attempt to solve this significant problem. It comes at a time when it is most needed, indeed, solutions were needed long ago. I am grateful to those who have already appeared before this committee for the meaningful testimony they have presented. I look forward to hearing from our distinguished visitors today, and am certain their thoughts will be equally helpful

to us.

STATEMENT OF DR. ROBERT E. COOKE, PROFESSOR OF PEDIATRICS, JOHNS HOPKINS UNIVERSITY, BALTIMORE, MD., FORMER CHAIRMAN, PLANNING COMMISSION ON PROJECT HEADSTART; ACCOMPANIED BY MRS. MARY ROBINSON, DIRECTOR, MARTIN LUTHER KING, JR., PARENT AND CHILD CENTER, BALTIMORE, MD.

Dr. COOKE. Thank you very much. Mr. Chairman, it is a great pleasure and privilege to appear before the Committee on Labor and Public Welfare of the U.S. Senate to testify in behalf of the Headstart Child Development Act of 1969 introduced by Senator Mondale and a prominent group of Democratic and Republican Senators. I am the pediatrician-in-chief of the Johns Hopkins Hospital: professor of pediatrics, The Johns Hopkins University School of Medicine; a former member of President John F. Kennedy's Panel on Mental Retardation; a present member of the President's Committee on Mental Retardation; chairman of the Scientific Advisory Board of the Joseph P. Kennedy, Jr. Foundation; and chairman of the original

Planning and Steering Committee of Project Headstart in the Office of Economic Opportunity.

As director of the Children's Medical and Surgical Center of the Johns Hopkins Hospital, I am responsible for the care of approximately 40,000 children of the poor of east Baltimore, and am physician-in-chief of an outpatient care program that provides services for approximately 120,000 patient visits each year. I have had firsthand opportunities to observe the operation of Headstart centers in various parts of this Nation. I have also had the good fortune of developing, in a cooperative venture with the poor of east Baltimore and the Johns Hopkins Hospital, the Martin Luther King, Jr. Parent and Child Center.

These practical experiences have convinced me, as they would convince every member of this committee and Congress, that feasible, workable, effective programs can be carried out in early childhood development with enormous impact on the well-being of our society both from an economic as well as social standpoint.

It is not necessary for me to detail the evidence supporting the importance of early childhood in determining the future characteristics of the individual. I am sure that adequate evidence has been presented by other witnesses as well as by members of the Senate including Senator Mondale in his introductory speech to the Senate.

The work of J. Piaget in Europe, of J. McV. Hunt in the United States, of Susan Gray, Benjamin Bloom, and many others, including Bruner and Kagan at Harvard, Eisenberg at the Massachusetts General, formerly at Hopkins, as well as others, is well known to students in the field. The enormous effect of experiences in early childhood can be best appreciated by brief reference to less known work carried out a number of years ago by Hampson, Hampson, and Money in our department at Johns Hopkins.

These psychologists and psychiatrists studied children with abnormalities of external sex organs caused by chemical changes during pregnancy. Their studies clearly showed that the way in which these children were handled by parents established the concept the child had of himself as a male or female, independently of his genetic sex or even of his physical appearance. This concept was established within the first 2 years of life, and the individual is fixed in this pattern for the balance of his life, regardless of efforts later, even though these may be extremely intensive.

It is not surprising, therefore, that less fundamental characteristics such as attitudes toward success, ability to concentrate, to abstract, and to verbalize may be impaired even more by inadequate experiences in the early months and years of life.

It was this concern with the enormous influence of environment which led me to organize the planning and initiation of Headstart under Mr. Sarget Shriver's direction in December 1964. I should like to read from the initial letter of our group, which was composed of some of this country's most outstanding action-oriented people in the fields of pediatrics, child development, education, social service, psychology, and psychiatry.

To Mr. SARGENT SHRIVER,

Director,

Office of Economic Opportunity.

Subject: IMPROVING THE OPPORTUNITIES AND ACHIEVEMENTS OF THE CHILDREN OF THE POOR.

Several weeks ago you asked me to assemble a panel of experts to consider the kinds of programs which might be most effective in increasing achievement and opportunities for the children of the poor. Our panel has held a number of meetings and through its members has consulted with numerous other experts in search of ideas and programs. The attached report, which has the endorsement of all committee members, represents our best judgment on the ways in which the Office of Economic Opportunity might most effectively support programs for children.

I believe several points deserve particular emphasis in your consideration of this report.

1. The overriding goal of each program should be to create an environment in which every child has the maximum opportunity and support in developing his full potential.

2. Programs must be comprehensive in nature in order to achieve maximum effectiveness. This requires extensive activities in the fields of health, social services and education.

3. Careful attention must be given both to the evaluation of the child's abilities and deficiencies and to the correction of deficiencies and strengthening of abilities.

4. Programs should focus on the parent as well as the child.

5. There should be support for a variety of programs tailored to fit local community conditions. OEO should specifically encourage innovative and experimental ideas. There should, of course, be adequate evaluation and research to accompany these programs.

6. These programs can and should be initiated very quickly. There already exists adequate understanding of the problems and processes involved to permit an immediate and massive intervention in the poverty cycle.

The panel is enthusiastic about prospects for extensive OEO support of these programs. It stands ready to work with you and your organization in the implementation of these proposals.

DR. ROBERT COOKE, Chairman, Planning Committee, Project Headstart.

Dr. COOKE. The report referred to in the letter I just read is attached as an addendum to this statement.

I wish to emphasize that the major concept underlying Headstart was that this approach to the child and his family had to be a comprehensive one. Headstart was not simply an educational program— it was a medical care program, a nutritional support program, a social rehabilitation effort, a family involvement effort, indeed, an employment and career development activity.

Criticisms of Headstart have been leveled only at the educational component and this, as I will discuss at the end of my presentation, cannot be interpreted in the way that it has been so frequently by the rather shallow analysis which came forth with the Westinghouse Learning Corporation study.

The importance of this comprehensive child development approach can be adequately documented in many ways and the great strength of the proposed legislation exists in the provision of funding for all aspects of child development, not simply educational, social, or medical.

Let me tell you our experiences with the comprehensive medical care of 20,000 children of low-income families in East Baltimore. This program which is designed to cover a series of census tracts, termed the "Hopkins Corridor of East Baltimore," has been funded