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while attending meetings of the committee or otherwise serving at the request of the Secretary, shall be entitled to receive compensation at a rate to be fixed by the Secretary of Health, Education, and Welfare, but not exceeding $100 per diem, including travel time, and while away from their homes or regular places of business they may be allowed travel time, and while away from their homes or regular places of business they may be allowed travel expenses, including per diem in lieu of subsistence, as authorized by law (5 U.S.C. 73 B-2) for persons in the government service employed intermittently.

Mr. ROGERS. I do think, too, that it is important to let people know what the public health services are doing, as you said.

Dr. REIZEN. That is what you are getting for your money.

Mr. ROGERS. People don't know. I think they have kind of lost sight of that and it needs to be clearly enunciated and articulated. I think anything you do in that area will be cery helpful. I think this committee would be interested in setting forth what is being done.

You might get us up a concise statement that really-maybe this is. Mr. ERVIN. That is the beginning of a statement, but we have more

to come.

Mr. ROGERS. I think if you could get for us a concise as possible statement of inventory on what is done and what people look to to the public health sector to provide, I think that would be very helpful.

Mr. ERVIN. Part of the problem as we have experienced it is that when we look at the $90 million which represents 5 percent of those services the tendency has been for HEW to say, what are we getting for the $90 million and it doesn't represent at all what is going on in the country.

Mr. ROGERS. I understand that.

Thank you for your presence. We are grateful to you for being here. Our last witness this morning represents the U.S. Conference of Mayors, and the U.S. Conference of City Health Officers. Dr. Christopher Buttery, director of public health of Portsmouth, Va.

STATEMENT OF DR. C. M. G. BUTTERY, DIRECTOR, PUBLIC HEALTH, PORTSMOUTH, VA., REPRESENTING THE NATIONAL LEAGUE OF CITIES, THE U.S. CONFERENCE OF MAYORS, AND THE U.S. CONFERENCE OF CITY HEALTH OFFICERS

Dr. BUTTERY. Good morning, Mr. Chairman. Sitting behind me is the executive director of the U.S. Conference of City Health Directors, Mr. Bergheim.

Mr. ROGERS. We welcome you.

Dr. BUTTERY. I have a fairly short statement but as a practicing health administrator, what I call the end point administrator, I would like to make a few remarks after the prepared statement.

I am Dr. C. M. G. Buttery, public health director of Portsmouth, Va. I am speaking today in behalf of three organizations that represent those who have a vital concern for public health in the cities. They are the National League of Cities, which is composed of 15,000 municipalities and 50 States municipal leagues; the U.S. Conference of Mayors, which speaks for the chief elected officials of nearly 800 of our largest cities; and the U.S. Conference of City Health Officers, which represents the directors of the public health departments in those cities. About two-thirds of those health departments are city agencies, the rest are consolidated city-county organizations.

At the outset, I would like to commend the chairman, the members, and the staff of this committee on your good perception of the health needs of our Nation and its communities. You have been responsible for much legislation in the past that has saved the lives and protected the good health of countless citizens. The Nation is very much in your debt. The measures you are considering today, H.R. 11511 and the almost identical H.R. 11845, have been drafted in the tradition of your compassion and foresight.

Before I discuss the substance of the proposed Health Revenue Sharing and Health Services Act, I would like to dwell briefly on the problems and responsibilities I face at home in Portsmouth, which like all major Virginia cities, is independent in the sense that we are not enveloped within a county. My citiy is not a large one-its population is about 111,000-but its public health problems, proportionate to its size, are massive.

About 40 percent of our citizens are nonwhite. About 30 percent of our residents are poor. One of every four children born in Portsmouth is raised in a home without two parents living together.

Since the bills you are considering today deal, in part, with alcoholism, you may be interested in knowing that my department took a close look at the impact of alcoholism on our community during the last fiscal year, and we found there had been 3,573 arrests for drunkenness, 2,000 additional arrests for such related offenses as assault and disorderly conduct, and another 418 arrests for driving while under the influence of alcohol. Those figures, of course, represent only the tip of the iceberg because they report only arrests, not other kinds of alcohol-related contacts with law enforcement officers not resutling in arrests, nor do they measure our considerable drug abuse problem.

As for the responsibilities of my department, we run an ambulatory clinic and diagnostic center next door to the Portsmouth General Hospital. We are deeply involved in health maintenance-that is health education, disease prevention, and environmental health. We inspect food, milk, rental housing, service stations, barber shops, beauty parlors, mobile home parks. We see to the sanitary disposal of liquid and solid wastes. We sample the air and the water supply. We have a large housing hygiene code enforcement program. We try to control insects and rodents. We see to it that abandoned vehicles are removed. We try to cope also with stray dogs and to control rabies. We run family planning clinics, mental clinics, venereal disease clinics. We collect and analyze vital statistics and other public health data. We are becoming more involved in occupational health.

Mr. ROGERS. I might say right there that you have set forth a pretty good inventory of what the public health sector is doing which many people don't realize.

Dr. BUTTERY. Thank you.

All this we do and more—with not enough money and the feeling that, despite our best efforts, the health needs of our citizens and our community are expanding at a faster rate than our ability to keep up with them.

I have gone into some detail on my department's responsibilities to demonstrate, in part, that much of our work is of a nature that cannot be supported by service charges or third-party payments. We note with great concern that President Nixon's budget for fiscal year 1975, despite its apparent commitment of greater resources to health than

this year, actually seeks less money both for the traditional public health activities in which we are engaged at the local level, and for the newer programs, such as mental health, alcoholism, and drug abuse, with which the members of this committee, as well as local officials concerned with public health, have been deeply involved.

Now, Mr. Chairman, with that as background, I would like to mention briefly the views of the National League of Cities, the U.S. Conference of Mayors, and the U.S. Conference of City Health Officers on H.R. 11511 and H.R. 11845.

Our first and overriding concern-is the adequacy of the funding for health revenue sharing, or block grants. As you know, the funding for section 314(d) has remained at $90 million since 1970, and the President's budget for next year is at the same level. With inflation eating into our city budgets, a level funding rate over a 5-year period results in an erosion of half of the purchasing power of the same amount of money in the fifth year.

The city of Portsmouth has one of the highest effective tax rates in the Commonwealth of Virginia. Because of both economic and statutory limitations, we are at or near the limit of our ability to tax our citizens and their property in order to provide the services essential to the health, safety, and well-being of our community.

Given the magnitude of our needs, the paucity of our resources, and the terrible drain of inflation, we in Portsmouth believe-as do the mayors, health officers, and other responsible leaders of our Nation's cities that the time has come for special revenue sharing to deal with our special problems. We believe, therefore, that funding for special revenue sharing for health should be multiplied by 10.

The great advantage of block grants, as we see it, is that they allow us to set our own priorities and target on our own problems as we define them. Another community may have migrant worker camp sanitation problems. Mine does not. My city's greatest single health need is provision of health services to women-health education, family planning, maternal and child health. Another city may not have to place so high a priority on dealing with this need. Whatever the needs, wherever they exist, block grants would give us the flexibility and the resources to deal with them.

We are concerned not only with the amount of money needed for public health but also with the conditions associated with the awarding of the grants. Above all, we are of the strong opinion that block grants intended for local governments should be made available to them directly, and not passed through the State capitols. To illustrate both the need for the funds as well as the desirability of direct funding to localities, you should be aware that the funds passed through Richmond to our public health departments in Virginia under section 314(d) constitute only 4.1 percent of the budgets of our local health departments. I should add that Virginia is one of the most faithful States in passing through 314(d) grants to its local constituent health departments.

Permit me to make just a few more comments on other titles of H.R. 11511 and H.R. 11845.

Title II on community mental health centers is a far-sighted legislative effort. We especially concur in the language in section 202 (d):

Until such time as legislation is enacted and becomes effective which assures all Americans financial access to the mental health services which are presently

available through community mental health centers, Federal funds should continue to be made available for the purposes of initiating new community mental health centers. . .

We also welcome the sensitivity of title II to the problems of alcoholism and drug abuse and the needs of children and the elderly. In section 201 (c) (1), we would recommend that a place for local elected officials or their representatives be mandated on the governing body of community mental health centers. We believe this is necessary because local governments have a large and growing responsibility for financing these needed facilities.

Also, on the issue of composition of policymaking bodies, we would suggest that you reconsider the requirement in section 310 (a) (3) that the governing body of a migrant health center must have a majority of its members chosen from among its clientele. By its very definition, the clientele is migratory and not likely to produce leadership that will be on hand on a continuing basis.

Otherwise, Mr. Chairman, we again commend this committee for its fine legislative craftsmanship and its dedicated commitment to community health. Thank you for your time this morning.

1

These end my prepared remarks and we thank the chairman and the committee for the legislative craftsmanship. I thank you for your time and I would like to add a couple of words. I did not realize we were going to have availability of "The State of the City." I would like to enter this for the record and make additional copies available. Mr. ROGERS. I think we will receive it for our files and not the record. Dr. BUTTERY. We are particularly interested in extending the dollars, making sure we get the most impact for the money. As the block grant comes down to us through the State it is shared among all the programs. In our city we have just completed what we term "The State of the City." This is a program report of all the resource activities divided up by activities and human resources-60 percent or morepolice, fire and civil defense, finance administration, and community development, all under community development. We program these and analyze them as to their costs and the benefits, and the data is available. We believe this planning document allows us to present to the community so all people in the community can understand and take part in a community assessment of needs and where to place our priorities so we don't get lost in small categories that may have emotional appeal to someone. We can show the costs and benefits to the community.

Last year with family planning programs, we have some 8,000 women should be receiving these services in the poorer sections of our community but only 2,100 can receive them. We have had indigent children born in the community and many will stay on the rolls. It will cost us $60,000 to educate these children and another $200,000 to maintain them if they stay on the welfare rolls.

One particular fact I would like to bring up in educational programs: We run special detention centers.

I should particularly like to mention our educational programs. We run special educational centers involving the minorities where we are dealing with such subjects as lead poisoning, prematurity, lack of

1"The State of the City," 1973, city of Portsmouth, Va., may be found in the committee's files.

maternal health care. Problems in this area remain a burden to the community. I don't believe third-party resources are going to provide the kind of care we need. We have detailed these out, program by program, with cost/benefit analyses for them, and we feel this information would be very useful.

Mr. ROGERS. We appreciate that very much. We are grateful for your presence and your testimony will be most helpful.

This concludes the hearing for this morning, and we will stand adjourned until 10 o'clock Tuesday morning. The subcommittee is now adjourned.

[The subcommittee was adjourned at 12:40 p.m., to reconvene at 10 a.m., Tuesday, February 19, 1974.]