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THE AMERICAN ASSOCIATION OF SOCIAL WORKERS

The American Association of Social Workers is a professional organization of practicing social workers. We are much younger than the medical or the bar association. We are celebrating this year our twenty-fifth anniversary.

We have approximately 1,000 members in all sections of the country. They are employed in both private and public welfare agencies. We are organized in 96 chapters. Though our members become members of a national organization, they can affiliate in groups in areas where there are a sufficient number for them to do so.

Our purposes are twofold. First of all, we are concerned about improving the quality of social work in the same way Dr. Butler told you the AMA tries to do. We make studies and collect data and publish reports. We issue a magazine which goes out to all of our members and others who wish to subscribe to it.

We have annual meetings at which papers are presented with the idea of bringing our members up-to-date information about the developments in practice and increase in knowledge.

Our second purpose is to make available the knowledge that_we have gained from our education and experience in terms of developing social programs.

When we first started we were concerned with what happened to the individual and thought that when people came to our agencies. for care that all we could do was to give them either financial or other kind of assistance to help them. It was a job of alleviation.

But in the last 25 years we have discovered that many of the problems we have to deal with-dependency, break-down of families, breakdown of individual morale-frequently are caused by outside facts, by environmental factors. For example, we are convinced that the low income from loss of a job has a very great effect on people, and we now believe that there is no substitute for a good job and decent wages and decent conditions. We see how overcrowded and bad housing, lack of education and recreation, can contribute to these problems. That is why we are concerned about seeing that the people get adequate medical and public health services, because the lack of those services also contributes to the many problems that we have to deal with; and we want to make available that knowledge first to this committee to say that we believe that there is a need for more adequate public health and medical care services.

We operate in this way in presenting testimony: We try not to, or very rarely, take action on specific legislation. We develop a statement of principles as other organizations do, and that serves as our platform to indicate what our position is in relation to developing programs.

We have been concerned for a long time with medical care and public health service, and in 1941 we first issued a very brief statement in which we stated that it is the responsibility of Government, together with the medical profession, to see that all the people who are in need of medical care and public health service receive that. We take such action at the annual delegates conference, to which the representatives

of our various chapters come, and then by majority vote at that coLference we adopt the statement of principles such and such.

Senator DONNELL. When was the most recent conference held?
Mr. ANDERSON. The most recent was in the middle of May of 1944.
We did not have one in 1945 because there were no conferences being
held. Our next is going to be held this coming May.

Senator DONNELL. Where was the May conference held in 1944?
Mr. ANDERSON. Cleveland.

Senator DONNELL. How many persons, approximately, were present?

Mr. ANDERSON. About 200.

Senator DONNELL. About 200. What is the total membership?
Mr. ANDERSON. 11,000.

Senator DONNELL. 11,000. How widely scattered were these 200? Mr. ANDERSON. They came from 72 of our chapters, which represented a minimum of 36 States.

Senator DONNELL. A minimum of 36 States. This 200 met in th conference in May 1944, in Cleveland?

Mr. ANDERSON. That is right.

Senator DONNELL. Is there any specific resolution or principle they adopted at that time?

ENDORSEMENT OF S. 1050

Mr. ANDERSON. Yes. At that time the original Wagner-MurrayDingell bill had not come up for hearings but had been introduced, ar the action we took was first to endorse in principle S. 1050, and also t urge that hearings be started on that immediately. Those resolutions were communicated to the appropriate committees in both Houses. Senator DONNELL. Would you provide for our records copies of those?

Mr. ANDERSON. Yes. I do not have them with me, but I shall be gla to furnish them.

Senator DONNELL. That is all right.

Mr. ANDERSON. Since that time we have been interested in continuing our study. This last year we had a committee that we call the Committee on Public Social Policies, which is composed of representatives of several chapters, which meets in Washington. It has looke at the social-security legislation. We looked again at S. 1050; ani then when the new National Health Act came in we looked at that. I can report I have read it not once but several times. I have als read a good many digests of it; and in terms of principles that we have outlined, and also in terms of the provisions of the present bili. our board-and I should make it clear that I am not speaking now for the entire delegate conference-our board which met in New York on February 28 and March 1 and 2 authorized me to represent the association in saying that we support the kind of legislation whic is in line with the principles that we have adopted, the board has adopted, and which will now come up for final action at our May 15th meeting.

Senator DONNELL. Mr. Anderson, may I interrupt to ask you tw questions. First, how large a meeting was this that was held i New York?

Mr. ANDERSON. About 30 people.

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Senator DONNELL. About 30 people present at that board meeting. Did they specifically authorize you to appear here in behalf of S. 1606? Mr. ANDERSON. Well, at that time I can say that they did, yes, because I have the authority to appear at hearings in connection with legislation.

Senator DONNELL. You do not mean the particular bill.

Mr. ANDERSON. The number was not mentioned specifically.

Senator DONNELL. Was there a resolution passed by the board for authority to you?

Mr. ANDERSON. The principles were reviewed, and the minutes of the meeting indicate that these principles were adopted by the board. Senator DONNELL. Would you mind furnishing for our records a copy of whatever portion you deem appropriate from those minutes? Mr. ANDERSON. I would be glad to.

Senator DONNELL. Very well. Proceed, Mr. Anderson.

Mr. ANDERSON. Now, in terms of the statement, I do not think I need read that and take the time. It merely states that we support the provisions, we believe in S. 1606, because we believe in supporting progressive development of public social and health services. We believe that health is a basic right of our people in the community. We think that at the present time people are not getting these services. And then I mention the four factors, which I am sure have been presented before to this committee, as to why the services are not now available, and then we mention the principles which we believe any legislation should be based on.

And I believe that favorable action on this particular bill will represent a courageous and comprehensive attempt to break the old and vicious cycle of poverty begetting sickness and sickness begetting poverty.

Senator DONNELL. You desire to file your statement, I judge?

Mr. ANDERSON. That is right.

(The statement referred to is as follows:)

STATEMENT FOR THE SENATE COMMITTEE ON EDUCATION AND LABOR

Prepared for hearings on the National Health Act by Joseph P. Anderson, Executive Secretary, American Association of Social Workers, 130 East Twentysecond Street, New York 10, N. Y.

The American Association of Social Workers supports the provisions of the National Health Act, S. 1606, because it believes in and supports the progressive development of public social and health services. Since the founding of this democracy, such services have been recognized as a proper function of government. They now constitute one of the most important aspects of the relation of government to all the people. These services will not have reached a desirable level of operation until practical measures have been adopted which assure the economic, social, and physical well-being of every person in the United States, its territories and possessions. This objective requires national leadership and the combined resources and cooperation of all levels of government-Federal, State, and local It is the responsibility of the Federal Government to assure that these services are provided. State and local governments should take advantage of Federal provisions with appropriate implementation to assure benefit to all the people.

BARRIERS TO ADEQUATE MEDICAL CARE

We believe that good health is a basic right of all the people and a responsibility of the community. To obtain and preserve good health all of our people must have public health services and good medical care in addition to sufficient and satisfactory food, shelter, and clothing. At the present time the people of this country are not getting the public health and medical care services which they need.

There are many factors which create the gaps betwen the services which ar received and the services which are needed. I would like to reemphasize four of these factors:

1. The unpredicability of the individual case of illness in nature, occurren duration and severity which leads to the unpredicability of the variety, amoun: and cost of services and makes individual budgeting difficult or impossible for a large number of families.

2. The neglect of preventive measures and consequent increase in serious illness.

3. The inability of a large proportion of our people to pay for adequate hea and medical care services under the traditional method of payment throug fee for service at the time the services are needed.

4. The inability of many families to obtain hospitalization except for extreme!" serious conditions or emergency treatment and the inability of the smaller an less prosperous communities to provide adequate hospital and health facilitiefrom their own resources.

To overcome these barriers and to bring about the high level of national heal which this country can and should achieve, there is need for a comprehensi health and medical care program. Such a program should be based on the following principles:

PUBLIC HEALTH SERVICES

1. Provisions for public-health facilities and services should be extended ar strengthened. They should be made available in all communities according t their public health requirements.

2. The highest standards of public-health services must be assured to all persons and communities in every part of the nation.

3. Education and training of administrative, professional, and technical pe ̃sonnel should be encouraged to increase the supply of qualified staff for progra of public health services.

4. Continuous, systematic study of health problems, and full application of existing knowledge of preventive medicine and sound public health practice an essential to attain public health services of a high quality.

5. A single responsible agency is a fundamental requisite to effective admin. tration at all levels, Federal, State, and local. The public health agenciesFederal, State and local-should carry major responsibilities in administeri: the public health services of the future. The Federal Government should responsible for joint financing, setting, standards, supervision, and coordinat 6. The activities of the multiple national, State and local agencies shou'd coordinated with the services provided by a federal program of public hea services.

MEDICAL CARE

1. Complete preventive and curative facilities and services should be availa! to all, under conditions that assure early diagnosis and treatment.

2. Such care should include the services of general practitioners and spe ists, hospitalization, and the services of dentists, nurses, medical social work and other appropriate personnel working under professional supervision. C valescent care, necessary drugs, medical supplies and all auxiliary services she be provided.

3. These services should be available for as long as a person requires them. 4. The highest quality of medical care must be assured to all persons a communities in every part of the Nation.

5. The conditions under which doctors function should encourage the ma nance and improvement of quality of service. The use of hospitals as med education centers and provision of service through group medical practice she be encouraged.

6. Basic laboratory and clinical research and administrative studies and adr istration designed to improve the quality and lessen the cost of services sho be continued. There should be a full application of existing knowledge to prevention of disease so that all medical practice will be permeated with 1 concept of prevention.

7. Quality of medical service depends on well-trained administrative, pro " sional and technical personnel, essential equipment and appropriate supplies medication both preventive and curative, appropriate organization to ins proper distribution of this personnel and facilities so that they will be read. " available regardless of cost to all the people.

8. Policy making in administration of medical care programs is a joint responsibility of consumers, physicians and related professional groups.

9. Federal leadership with decentralized administration is essential to insure that comprehensive medical services and facilities shall be physically and financially available to all the people.

10. All professional services in a plan for medical services must at all points be under the supervision of the appropriate professional personnel.

11. At the local level, medical care resources should be so coordinated and administered as to encourage their full use and to insure good quality of service. 12. Channels must be available for the patients, hospitals and physicians to obtain a fair and adequate hearing involving any of their rights in relation to medical care.

We believe that the provisions of the National Health Act are in keeping with the principles given above. It provides for adequate coverage; it provides for a program comprehensive in scope and of a high quality adequate to meet the needs of all the people; it provides for an organization and a system of administration to carry out the responsibilities which are accepted and it makes provision for personel qualified to offer the necessary services.

It represents a courageous and comprehensive attempt to break the old and vicious cycle of poverty begetting sickness and sickness begetting poverty.

Senator DONNELL. May I ask you, have you ever practiced medicine?

Mr. ANDERSON. No, sir.

Senator DONNELL. Of what institutions are you a graduate?

Mr. ANDERSON. Of Western Reserve University, where I have a master's degree.

Senator DONNELL. In Cleveland?

Mr. ANDERSON. Cleveland, Ohio.

Senator DONNELL. You have a master's degree?

Mr. ANDERSON. That is right. I might mention that our knowledge comes from the fact that we see what the effects are of the lack of adequate medical care, and we know, for example, that many of the people who come to social agencies come there because they either were not able to obtain the necessary health and medical care services, or did not have information about preventive measures which could have helped them maintain good health.

And I would like to say, also, that I am talking not only about the very poor. I am talking about people in fairly comfortable circumstances. We see time after time in the records of our agencies where a chronic appendicitis develops into an acute stage, where an ear trouble develops into a mastoid, where a severe accident or illness, particularly to the chief wage earner, means that the family which has been self-sustaining, has been going along on its own way, not asking for help, has as the result of that acquired large debts and then found it necessary to seek assistance. It is because we know what happens to people, because we know the break down that occurs, we know what happens to children, that we think we ought to have a better system than we now have of providing medical care and health services at the time they are needed.

Senator DONNELL. Thank you, Mr. Anderson. Do you desire to supplement your statement by any further statement? You may have that opportunity at this time. Your written statement, of course, will be filed and made a matter of record.

Mr. ANDERSON. I could not help overhearing some of the questions. that were raised before, and I would like to make one or two observations.

Senator DONNELL. Very well.

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