Indeed, domestic and international programs are really indivisible, in the world community in which we live, as you gentlemen would well be aware. Developments in the health, education, welfare, and rehabilitation fields abroad inevitably have an impact on similar programs in this country. The converse is equally true. It is virtually impossible to plan for and discuss American activities in this field without recognizing that the country's same resource of personnel and skills must serve both our domestic and international needs. On this basis it will be disastrous for us to ignore the full interests of the United States, both domestic and foreign, in the development of policies in the social field.

To enable us to undertake our varied international activities with most success, there is now a clear need for a top-level policy official devoting his full time to participation in the formulation and planning of foreign policy in programs related to our own needs, or supporting our multilateral and bilateral efforts to assist other nations.

Our Department is working closely with many of the components of of the Department of State, including the Bureau of Educational and Cultural Affairs, the Bureau of International Organization Affairs, the Bureau of Administration, the Office of the Science Adviser, AID, the Peace Corps and, in addition, the USIA. Frequently, these day-today contacts require extensive followup consideration and discussion on policy issues at the Assistant Secretary level. The same situation is true to a considerable extent in our relations with other Departments, including Labor, Agriculture, and Commerce, all of which have Assistant Secretaries in the international field.

The need for full-time supervision and direction of our international activities by an Assistant Secretary can perhaps be better realized by a review of the scope of our commitment to these programs within the Department. In monetary terms, funds available to the Department's international programs, including grants, in the fields of health, education, welfare, and rehabilitation for fiscal year 1958 totaled $16 million. Approximately $8.5 million of that was by way of transfer from other departments. By fiscal year 1961 this figure had risen to $45 million and for fiscal year 1962 the estimated total is $63.5 million, by way of comparison. As I indicated, in 1958 roughly $8.5 million of the $16 million was transferred to HEW from other agencies and departments. For fiscal year 1962 the amount of transferred funds is still less than $9 million, whereas the $16 million total has increased to $63.5 million. In terms of personnel there are approximately 1,000 full-time HEW employees engaged in the international aspects of our programs. In addition, a significant portion of the time of other Department staff members is spent on international activities including hundreds of professional people in the various substantive fields assisting the full-time international staff in planning programs, backstopping Department of State and AID and other related activities.

Another major aspect of this problem is the fact that in many foreign countries and international organizations there is a considerable interrelationship in all the fields represented by our Department. This means the need for coordination within the Department itself is extensive and requires continuing attention.

For these reasons, authorization of this Assistant Secretary would very materially strengthen the contributions of the Department of Health, Education, and Welfare to U.S. efforts in international affairs.

For these various reasons, Mr. Chairman, we strongly support enactment of S. 2073.

May I add, Mr. Chairman and members of the committee, by way of additional comment to the prepared statement, you gentlemen are in the position in which you are keenly aware of the importance of the international activities of this country. The Department of Health, Education, and Welfare is growing very rapidly and has a wide range of activities in the fields on which I have made comment this morning.

As this country is growing, whether it be in South America with the programs that we have there which touch very heavily in the social and welfare fields, or whether it be in the Southeastern part of Asia, or whether it be in the Near East, or whether it be in Europe, or whatever the area of the world it is that might be involved, whether it be in the Public Health Service, whether it be in the Office of Vocational Rehabilitation, whether it be in the Food and Drug Administration, whether it be in the Office of Education, or within those agencies, whatever those activities might be, they are increasing and they are increasing with considerable importance and with considerable impact.

Now, it strikes me and it seems to me that on this question of the Assistant Secretary for International Affairs, that it is incumbent upon us to attend to it, to grant to the particular field of work, the attention that should be devoted to it in the real sense of the word.

The trend that is going on in this world from the standpoint of urgency of acting in the social and welfare fields and the movement that is very rapid in the underdeveloped countries and the attention that is devoted to this country from the standpoint of how those foreign countries look at our activities, this activity is of keen and considerable importance to us.

We will recognize, we will give recognition to a field of activity in a rapidly growing Department which should be given to it in the real sense of the word.

There is additional statistical information with respect to the activities of our department which I can recite, if the committee would wish, whether it be from the standpoint of position papers or background papers in relation to other departments. Illustrative of that is the fact that 35 international intergovernmental organizations in which the United States is a contributing member are concerned with one or more programs in HEW fields.

These organizations hold annual or biannual meetings. From 40 to 50 senior HEW officials serve as delegates or as advisers on U.S. delegations to such meetings. In addition, the Department of HEW assists in the formulation of approximately 500 policy papers annually for the use of U.S. delegations. In addition, we prepare annually an average of 15 comprehensive reports on substantive programs, whether it be in the field of education, whether it be in the field of health, or whether it be in the field of welfare or rehabilitation.

We need to afford in our own right recognition of the importance of this position in order that attention can be given to these programs on the scale that it should be in countries abroad in fields that are found to be particularly important with the trends that are going on in the world.

We feel quite strongly that this position should be approved and would be most appreciative of your support. I do wish to reiterate,

with respect to the Assistant Secretary for Health and Medical Affairs, the present position is a special assistant. It is subject to confirmation by the Senate. The appointment is by the President, subject to confirmation by the Senate.

There would be no change in the pay scale. It affords recognition, again. In that respect, it changes the position as a matter of form. It does not add a new position.

We would like and appreciate your favorable consideration in this respect in the field of health. With the tremendous activities going on in the Public Health Service, we feel that this recognition is well due to the Department and is well due to the position that is served in this respect.

I appreciate having the opportunity of making these observations, gentlemen, and would also appreciate having the chance to answer any questions that any of you would like to raise of me.

Thank you.

The CHAIRMAN. Thank you, Mr. Secretary.

Actually, what would be accomplished by the House bill would be that you would upgrade the present special assistant in the field of health and medical affairs to that of an Assistant Secretaryship, and you would create a new Assistant Secretary for International Affairs. Mr. NESTINGEN. The Senate bill does that, sir, not the House bill. The CHAIRMAN. Let me see.

Mr. NESTINGEN. Senate bill 2073 does what you just recited, sir. The CHAIRMAN. And the House bill simply provides for one additional Assistant Secretary of HEW?

Mr. NESTINGEN. That is right; yes, sir.

The CHAIRMAN. Without any attempt to provide for his name or duties; does it?

Mr. NESTINGEN. As I understand the bill, it does not designate. However, the transmittal letter from the President indicates it is anticipated the duties would be in the international field.

The CHAIRMAN. I would like very much to know what implementation there has been to the bill on international health research, which this committee strongly supported and passed in the last years of the Eisenhower administration.

Mr. NESTINGEN. Mr. Jones, special assistant, is here, and I would like to ask him to comment on that.

Mr. JONES. I think probably Dr. Shannon, who is Director of the National Institutes of Health and has this under direct cognizance, would be more specific and probably more useful to the committee.

Dr. SHANNON. First, I say, Mr. Chairman, that the new legislation did not really create wholly new authorities, but, rather, defined the authorities under which the National Institutes of Health operates in that it divided the general authorities in the international field into three broad areas. One was authority for the Surgeon General. Substantively, this had to do with the capability of supporting the development of new knowledge by research grants, by training and by fellowships in those fields of science that are directly relevant to the Public Health Service. Another provided the Secretary comparable authority for other areas of responsibility in the Department. The third authority was for the President, which related to the support of science for science's sake in terms of fostering the development of scientific programs in other countries in the interests of our own foreign policy.

This latter authority has been held in the President's office and has not been delegated to the Department, although in the basic legislation the indication was it could be delegated, but only to the Department of Health, Education, and Welfare.

Within such a setting, the programs of the National Institutes of Health have prospered, and in 1961, apart from the foreign currency programs and I will come to those activities in a minute-the annual expenditures in the international field were in the range of $12,296,000. This was through an array of research grants and contracts, for U.S. fellows training abroad, international research fellows, and the visiting scientist program.

This expenditure involved some, I believe it is 30-odd countries, and has been most productive, both in training and research, in those areas that relate to the mission of the National Institutes of Health.

I emphasize the latter point because this in no sense is in conflict with or duplication of the basic activities of the AID organization and its responsibility in the international field.

In 1961, we had authorization to expend funds, U.S.-owned foreign currencies, under the so-called Public Law 480 program. There was appropriated to the National Institutes of Health that year $3.7 million for the purchase of such currencies.

In the subsequent year-that is, the current fiscal year of 1962in addition to the National Institutes of Health, these currencies were appropriated for the use of other areas of the Public Health Service, primarily the Bureau of State Services. The total PHS appropriations of U.S.-owned currencies in fiscal year 1962 covering eight countries is in the aggregate of $10 million.

At the present time we have programs underway in the aggregate, the dollar value, sir, I can furnish for the record; I do not have it with me-but these programs are in eight countries.

I believe that summarizes the generalities of the program, sir. The CHAIRMAN. It appears, then, that the lines of authority between the State Department and HEW have not been absolutely agreed upon and clearly defined at the present time.

Dr. SHANNON. I believe, sir, the lines of authority are quite clearly agreed upon and understood. I think the question is whether it is advisable to assign for purposes of effective programing in HEW certain of the authorities that are held in the President's office. But I think that in respect to those authorities that are contained within HEW now, there is no conflict and no problems.

We enjoy cordial and very effective relationships with the State Department.

The CHAIRMAN. Have there been any international meetings or conferences of scientists and people in the medical fields growing out of this bill?

Dr. SHANNON. Specifically out of this bill, no, sir.

The CHAIRMAN. Do you contemplate that there will be any held this year or next year?

Dr. SHANNON. Mr. Roberts, as the program evolves, since this bill clarifies our authorities rather than conferring new authorities upon us, it would be difficult to say what international activities will be developed specifically as the result of this new legislation.

The CHAIRMAN. Could you supply for the record a list of the activities in the various countries you mentioned?

Dr. SHANNON. We would be delighted to do so, sir.

The CHAIRMAN. I think it would be very helpful to the committee. Dr. SHANNON. Yes, sir.

(See insert, p. 24.)

The CHAIRMAN. Do you believe that the creation of the additional Secretary for International Affairs would stimulate this program somewhat, Dr. Shannon?

Dr. SHANNON. I do not think it would stimulate the program, sir, nearly so much as I think it would give us an administrative framework within which our program would operate more effectively, more simply and, consequently, more productively.

The CHAIRMAN. Thank you very much.

Dr. SHANNON. Yes, sir.

The CHAIRMAN. The gentleman from Minnesota.

Mr. NELSEN. If this new position is granted, is there contemplated additional personnel in the Department because of this position beyond the Assistant Secretaries involved?

Mr. NESTINGEN. On the Assistant Secretary for International Affairs, there is no contemplated addition by virtue of creation of this position, no.

Excuse me, sir, the observation is made that secretarial help will be needed, but within that framework other than the immediate office, by virtue of the creation of the position in itself, no.

Mr. NELSEN. I noted in your testimony that actually in one instance there is a change of title, but the person who is presently performing the work that would be continued as Assistant Secretarythat work is presently being done, and, in effect, what this would do is to give him an official title, and he is presently doing the work, is that not true?

Mr. NESTINGEN. He is currently doing that work, yes, sir.

Mr. NELSEN. How many additional employees have been added to HEW in the last year?

Mr. NESTINGEN. I think the figure will show that for fiscal year 1961 that there were for fiscal year 1962 that the increase is about 7,600, approximately, that is correct.

Mr. NELSEN. I am concerned some about the added employees. I have heard the figure used that you have added 9,900 in the last year.

Now, I used to run a Department of Rural Electrification and we made many changes in organization to do these things which you are seeking to do. But I think you can perhaps give some careful examination to the trend that seems to exist in all Departments to add and add and put layer upon layer.

Certainly, the objective cited in this testimony is laudable, but sometimes we forget that we run rampant in other areas. It seems to me that the number of additional employees in all phases of government is getting rather alarming.

That is all, Mr. Chairman.

Mr. NESTINGEN. May I make comment on that observation?
Mr. NELSEN. Yes.

Mr. NESTINGEN. My feeling is essentially in the same line as yours, sir. I am Chairman of the Budget Committee in the Department, and. as far as I am concerned, when requests for an increased number of people come to that Budget Committee, my own attitude is to