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hours of service of employees and the safety of operation and equipment. With respect to common carriers, whether by rail or highway, the Commission administers the so-called Transportation of Explosives Act.

We believe that the encouragement and coordination of research in the field of accident causes and prevention which the proposed Center and Advisory Board would undertake would be of benefit to all of the Federal agencies concerned with accident prevention, and also to other agencies, organizations, and individuals. The proposed financial assistance to the research projects, in the form of grants-inaid, would, of course, provide tangible encouragement in this important field. The results and findings of the researchers, duly published and made available to those interested and concerned, should be useful to all those charged with promoting safety and reducing accidents of all types. In addition, the making available of research facilities, the maintenance of an information center, and the advice and assistance of experts-all of which are contemplated by the bill—would be of material benefit.

Illustrative of the potential usefulness which the Center could be to this Commission is the fact that in the discharge of its responsibilities in the field of motor carrier safety the Commission often needs the counsel and advice of experts on such matters as standards of eyesight, hearing, and the effects of organic, nervous, and functional diseases on the human body. It also needs information as to the effect of fatigue and drugs on driving ability. Research in such areas promoted and aided by the Center and Advisory Board would undoubtedly be of benefit to this Commission in its task of prescribing motor carrier safety regulations.

While we favor the objectives of this proposed measure, we believe, at least insofar as this Commission is concerned, that it should be amended to make it clear that nothing contained therein should be construed as affecting its jurisdiction in the fields of railroad and motor carrier safety, or as requiring submission of proposed regulations, for which the Commission has statutory responsibility, to the Surgeon General, the Center, or the Advisory Board, for prior approval.

Editorially, it' is not clear what is intended by the reference made to "the Council,” in line 19, page 2, of the bill. Elsewhere in the bill the duty of recommending the recipients of grants-in-aid is placed upon the proposed Advisory Board. It appears, therefore, that reference to "the Council" was inadvertent, and that a phrase such as “the Accident Prevention Advisory Board, hereinafter provided for,” should be substituted in lieu thereof.

If amended as suggested above, we would have no objection to the enactment of H.R. 133. Respectfully submitted.



Washington, D.C., April 8, 1963.
Chairman, Committee on Interstate and Foreign Commerce, House of Representatives,

Washington, D.C. DEAR MR. CHAIRMAN: This Department has given consideration to the request for a report on H.R. 133, a bill to amend title III of the Public Health Service Act to establish a National Accident Prevention Center.

This measure would establish within the Public Health Service a National Accident Prevention Center which would:

1. Conduct, assist, and foster research, investigations, studies relating to the causes, and methods of prevention of accidents;

2. Promote the coordination of research and control programs conducted by public and private agencies, organizations, and individuals; authorities, health officials, and scientists;

4. Maké grants-in-aid to universities, hospitals, laboratories and other agencies and institutions for such research projects;

5. Establish an information center on causes and prevention of accidents, and collect and make available, such information;

6. Secure the assistance and advice of persons who are experts in the field of accident prevention. The bill would also establish an Accident Prevention Advisory Board with the Surgeon General, or an officer designated by him, as Chairman, and 12 non

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Federal employee members who are concerned with the accident prevention field. The Board would review research projects or programs, review and make recommendations for grants-in-aid and make recommendations to the Surgeon General with respect to carrying out the program. This Department recognizes the need for positive action to reduce accidents and to eliminate the causes of accidents, and wholeheartedly agrees with the principles of the bill to coordinate research and control programs and assist in the advancement, dissemination, and exchange of knowledge concerning the causes and prevention of accidents as it relates not only to Federal agencies but to private agencies, organizations, and individuals as well. However, H.R. 133 as presently drafted is not clear with respect to the following areas:

(1) The general language of the bill indicates that the fields of traffic and industrial accidents (where programing applies primarily to damage to equipment or property) are included, as well as those accidents posing medical problems. The placement of this program within the Public Health Service would appear to imply limited jurisdiction with respect to the health and medical areas only.

(2) It is understood that several Departments and agencies of the Federal Government, such as the Department of Labor, Department of Interior, Interstate Commerce Commission, Federal Aviation Agency, and others already have statutory authority and responsibility in accident prevention with respect to the operation of the Federal Government, State governments and private business. The responsibilities of these agencies involve many of the functions identified for the National Accident Prevention Center such as research, investigations and studies relating to the causes and methods of accident prevention, the dissemination of information on all aspects of the prevention of accidents, and the like. It does not appear that the proposed legislation differentiates between those responsibilities which are already assigned to Departments and agencies and those which would be assigned to the Public Health Service.

It is believed that unless the responsibilities of the agencies involved are clarified a situation could develop which would result in duplication of effort and consequent added expense in the operation of an accident prevention program. In addition, numerous administrative problems would be created among the various Federal agencies required by 5 U.S.C. 784(c) to operate a safety promotion program.

We have been advised by the Bureau of the Budget that from the standpoint of the administration's program there is no objection to the submission of this report to the committee. Sincerely yours,

LOUIS J. DOYLE, General Counsel. Mr. ROBERTS. Our first witness will be Mr. Wilbur J. Cohen, Assistant Secretary of the Department of Health, Education, and Welfare. He is accompanied by Dr. Luther L. Terry, Surgeon General and Dr. Paul V. Joliet, Chief, Division of Accident Prevention.

Mr. Secretary, we are glad to have you appear before our subcommittee and you may proceed with your statement.


Mr. COHEN. Thank you.

Mr. Chairman, as you indicated, I am accompanied by the distinguished Surgeon General of the Public Health Service, Ďr. Terry, and by the Chief of the Division of Accident Prevention in the Public Health Service, Dr. Paul V. Joliet. We are available to answer any questions that the subcommittee might wish to make.

I appreciate this opportunity to present to you the views of the Department of Health, Education, and Welfare on H.R. 133, a bill to


establish a National Accident Prevention Center in the Public Health Service.

I know that the members of this subcommittee, through your intensive study of the accident problem in all its aspects, are very familiar with the scope and ramifications of the problem.

However, I would like to outline briefly some of the principal factors, as we see them, in order to put my discussion of the bill itself into proper context.

The history of the advancement of medical science illustrates over and over that the major obstacle to progress bas often been a tendency to regard the problem-whatever it waswas unconquerable. This has been the case with almost every disease we have overcome or substantially reduced by the process of research, investigation, application, analysis and refinement.

This has equally been the case with accidents. Public opinion, not only in the United States but throughout the civilized world, has tended to regard accidents as an unfortunate occurrence to be accepted as inevitable.

I do not believe that we who are officially concerned with the problem of the public health, can accept over 90,000 deaths and some 45 million injuries every year without intensifying the efforts now underway to reduce this constant, tragic toll and loss in our community.

On the basis of our admittedly brief experience in treating accidents as a health problem, we know that many, and probably most, of these accidental deaths and injuries can be prevented. The national significance of the above figures is brought into sharper focus if we look at the type of accidents which add up to these dreadful totals.

First, let us examine the deaths. These include 15,000 children under 15 years of age-more than the total of deaths in this age group from the next four leading causes combined.

For people 15 through 35 years of age, accidents continue to be the principal killer—with about 24,000 deaths. In 1 year, more than 28,000 Americans between the ages of 35 and 65 and 24,000 of our senior citizens 65 years of age and older, lose their lives by accidents. These tragedies are repeated year after year, with only slight variance.

Now, let us consider injuries. Each year some 45 million American men, women, and children sustain accidental injuries severe enough to require medical care or to incapacitate them beyond the day of injury.

Thousands of these injuries produced lifelong handicaps, including blindness, loss of limbs, and disfigurements. Accidents are the leading cause of impairments in the United States. Each year over 2 million persons are hospitalized for the treatment of accidental injuries.

The economic loss from accidents is over $13 billion every year. Part of this loss is visible to everyone who drives along our country's streets and highways. Much of it is not, however, except to the victims, their families, and medical and hospital personnel.

When you consider the toll that accidents inflict among our young people from whom the Nation must draw the bulk of its productive strength, you see a loss of life every year greater than the size of an Army division.

When you consider the accidental casualties among our senior population, you see a loss of experience and mature judgment that no nation can long afford.

The Public Health Service has long been concerned by this needless toll of death and disability and is engaged in developing certain preventive measures.

Before I go on, Mr. Chairman, with your permission, I would like to show you these charts that we have prepared, which present somewhat the same information, but in a more graphic form.

The first chart shows the accidental death rate in the United States from 1935 to the present and the rate is computed per 100,000 population.

You will see that the top red line, which is the total of all accidental deaths, has been going down somewhat as a rate, so that we have been making some progress, but the significant factor is that the rate with respect to deaths due to motor vehicles has been remaining fairly consistent. That remains an area for very important research.

I think this chart deinonstrates two important factors: That the accident rate can be brought down by study and research, and work and community action; and that we still have a lot to do with respect to work on the motor vehicle area.

This second chart looks at the problem from the number of hospital bed-days that are required to take care of different kinds of diseases or disabilities. In this case we have a rather interesting fact; that accidents take up 20 million bed-days in hospitals per year.

Twelve percent of the total bed-days of hospitals in the United States at the present time are occupied due to accidents, whether they are fatal or nonfatal. The impressive thing is that this is larger than taking care of the deliveries of the 4 million babies which are born each year. It is more than the hospital bed-days caused by people who have heart disease. It is more than four times the number of bed-days required to take care of cancer, and more than 12 times the number of bed-days caused to take care of diabetes. You have some appreciation here of the tremendous load that accidents cause in terms of not only using hospital beds, but also the skilled personnel that is required to provide service in the hospital.

The third chart demonstrates an interesting point: How the accidental death rate varies by age. You will notice from this chart that the accidental rate is very high, of course, when children are very young, and then it is low during the period of the age from 1 to 7 or 8, when I suppose the parents are very solicitous of the welfare of their children and very careful about them.

As they become teenagers, you can see that the death rate from accidents begins to go up very appreciably. When a young boy or girl is 15 or 20 years old, and his parents have spent $15,000 or $20,000 to educate him so that he will be a productive citizen, to have his life snuffed off at age 20 or 24, means the loss of productive capacity of about $500,000 in terms of the loss of the contribution of that individual after society has invested so much in his education and preparation. This is a tremendous loss.

When we look at accidental deaths by age and by cause, we find that there are significant differences, and this shows the areas of research that would be necessary to undertake to find out how to prevent these deaths.

In the first group, for the children under 1 year, the largest single factor is inhalation and ingestion causing suffocation, tragedies which you read about quite frequently in the newspapers.

For the group 1 to 14 years old, this large bar here shows motor vehicles as the principal cause of death, but drowning, and water transport, and fires are very large. The need for community-type programs to deal with these young people is very important.

Two-thirds of the accidental deaths in the age group 15 to 24 are caused by motor vehicles. Research in the motor vehicle area as to what will bring down the fatalities among young people when they get into a motorcar, is one of the most fruitful avenues that we have to decrease this wasteful economic loss among our young people.

Another area that certainly shows the need for further research and development is among our aged people. Fifty-five percent of their accidental deaths are caused by falls. I think that when you get into it, you will find that it is not as simple as it may seem. Is it the physiological development of the individual that causes him to fall, or does the fall cause the fracture or the death? And a lot more needs to be done with respect to the causative factors as to why so many of our senior citizens do not die of old age in the traditional sense, but die because they fall. This get us into the whole problem of the restructuring of our homes and our offices so that old people won't slip or fall in the bathtub, and preventive measures that can be built into homes and offices.

This last chart illustrates the place of nonfatal injuries. The important thing here is that nearly half of these injuries occur in the home, and so again research is necessary to determine what is it that causes these accidents in the home and what can be done to prevent these accidents in the home.

As to the family or the human factor, certainly those are worthy of very considerable research.

Nr. ROBERTS. At this point, Mr. Secretary, without any questions, I would like you, if you would, to offer these charts for inclusion in the record.

Mr. Cohen. Thank you, Mr. Chairman. (The charts follow:)

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