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port for vocational education at the 1966 level, more than six times the amount appropriated in 1964. In addition, we are requesting the remaining amount authorized for area vocational schools under the Appalachian Regional Development Act. The total appropriation requested for vocational education in 1967 is slightly below the 1966 amount because a portion of the vocational education work-study program will be shifted to the Office of Economic Opportunity.
One of the most successful programs of the Office of Education, support for library services and construction provides expanded opportunities for individual self-development. Since its inception, new or improved public library services have been made available to 65 million persons. With construction grants, assistance was made available in 1965 to support the construction and renovation of 363 libraries serving an estimated 23 million persons: an additional 400 projects will be supported each year in 1966 and in 1967.
HEALTH Improvement of the Nation's health is a central aspect of our investment in human resources. The last 3 years have seen major legislative gains in all aspects of our national health programs, culminating in the Social Security Amendments of 1965.
SOCIAL SECURITY AMENDMENTS OF 1965 The Social Security Amendments of 1965 provide for comprehensive health care programs for the aged and for major changes and expansions of child health and other welfare programs. Of greatest significance are the medicare sections of the amendments which provide a basic program of hospital insurance, extended care, and home health services for the aged, financed through social security; a voluntary supplemental program covering doctors' fees and some other health services; and an expanded program of Kerr-Mills medical assistance for the needy aged, dependent children, the blind, and the disabled.
The Social Security Administration has sent information on the medicare program to over 17 million of the 19 million who will be eligible for benefits in July, and another 1 million of those receiving old age assistance will be reached through local welfare agencies. To reach the remaining persons, special projects are being undertaken in cooperation with the Office of Economic Opportunity, the Department of Agriculture, and with senior citizens groups. We are particularly concerned that all eligible persons be given an opportunity to sign up for supplementary medical insurance by the March 31 deadline. In the new medical assistance programs under public assistance, we estimate that increased 1967 requirements will be devoted particularly to health care for dependent children.
The 1965 amendments also provided major expansion in support for maternal and child health services and crippled children's services, and they established a new program of project grants to provide comprehensive health care and services for needy children of school and preschool age. In 1967, we are requesting the full authorization for these programs.
COMMUNITY HEALTH PROGRAMS The new health programs may be expected to have a tremendous impact on the provision of health care in the community. It is in anticipation of this impact that we have established in the Public Health Service a program to deal with medical care administration. The pur pose of this new program is to improve the quality and expand +
availability of medical care, especially to older persons, in all settings, the hospital, the clinic, the physician's office, the home, and in extended care facilities. To make home health services more readily available, a new grant program is administered by the Public Health Service to offer assistance to States in the development of home health services under the health insurance program. This new program also includes standard setting, coordination of the health insurance activities with other State and local medical care activities, and other activities related to the providers of medical services.
Under new legislation in the 1967 budget, we propose to reorient support of health activities to provide effective coordination between Federal health programs and those of State and local groups. The purpose is to achieve more effective utilization of scarce manpower and other resources through cooperative arrangements among the Federal Government, the States, local government, and nonprofit agencies. Grants would be available for comprehensive State and local area planning for services, facilities, and manpower. Several of the existing categorical grant programs would be converted to provide a more effective base for support and stimulation of comprehensive health services. Under new legislation we would also propose to support new programs aimed at improving the quality and efficiency of medical services by developing new ways of providing them.
HEALTH FACILITIES AND MAN POWER If we are to fulfill the promise of recently enacted legislation for expanded health services we must insure that the facilities and trained manpower are available to make this possible.
The Hospital and Medical Facilities Amendments of 1964 expanded the hospital construction program and authorized a far-reaching new grant program for modernization or replacement of existing facilities, particularly in urban areas where the greatest need exists. The first of these modernization grants was awarded recently. In 1967, we are requesting the maximum authorization for all parts of the facilities construction and modernization program.
One of the most pressing needs we face in the provision of health care is for substantial growth in the number of trained medical and paramedical personnel. It was to meet this need that the Health Professions Educational Assistance Act was enacted 3 years ago and expanded last year. It is our goal under this act to provide partial support for the creation of 20 to 25 new medical schools over the next decade. We hope to increase the number of physicians each year from the present 8,800 to 12.700 by 1971.
In 19967, we are requesting a very substantial increase for construction of health educational facilities for medical, dental public health, nursing, and other health personnel. The response to this program far exceeds the amounts available; we have already approved grants to aid in the construction of facilities for eight new medical schools. In the health research facilities program of the National Institutes of Health we will give first priority to those facilities required by new and expanding medical schools.
The largput increase in operational support for health education requested in 1967 is in the grants for improvement of educational qualv. Health professions wcholarships were newly authorized in the 165 Health Profeunions Amendments, and we are requesting a pronam expansion in 1967. Under proposed legislation, we would begin an acuation and training program to overcome existing critical sionals. Also under new legislation, we proposed to convert the existing student loan programs to guaranteed loan programs utilizing private capital, retaining all the special features of the present programs.
PUBLIC HEALTH SERVICE HOSPITALS
Turning to our own medical services programs, our long-term goal is to convert the Public Health Service Hospitals into centers of excellence. Our 1967 budget request will enable us to move in this direction by providing additional funds to plan for modernizing the facilities, to improve staff patient ratios, to expand the training capability of the hospitals, and to develop their operational and clinical research capability.
Mr. Chairman, I would now like to touch briefly upon some of our health programs aimed at specific problem areas.
HEALTH OF MIGRATORY WORKERS
Migratory workers represent a group with inadequate access to health care services. For this reason, the Congress established the migratory workers health service program in 1962. This program was extended last year and expanded to include for the first time necessary short-term hospital care. Our 1967 budget includes a sub
a stantial increase for this program.
I have already mentioned our program in education of the handicapped including the mentally retarded. We have also included in the 1967 budget funds to continue the program of grants to States to assist in the development of comprehensive community programs to combat the problems of mental retardation.
We have already made the initial awards for construction of mental retardation service facilities, and this program is expected to enter the full-scale construction phase within the next few months. We have also received a large number of requests for assistance in the construction of university-affiliated mental retardation facilities; with the 1967 budget request, a total of 16 such centers would be supported by the end of 1967. The complementary professional training program administered by the Children's Bureau will be initiated in 1967.
In the field of mental health, we have awarded the first community mental health center construction grant; we are requesting in 1967 a continuation at the same level of support as in 1966.
in 1966. By the end of 1967, construction assistance will have been provided for 230 community centers. The 1967 budget also includes a sizable increase in support for staffing these centers, as well as for staffing new services in existing mental health centers.
REGIONAL MEDICAL PROGRAMS
The Heart Disease, Cancer, and Stroke Amendments of 1965 authorized a new program of project grants to assist universities, medical schools, and research institutions to develop and disseminate new techniques for the diagnosis and treatment of heart disease, cancer, st mke, and related d. fup. This program will emphasize regional planning and coordination of medical resources, continuing education for doetors and other mediral personnel, and the rapid distribution of new knowledge and techniques. We are beginning to implement this program with a 1 *t supplemental appropriation: in 1907 we are requesting almost a doubling of funds.
HEALTH RESEARCH I would like now to discuss the other programs of the National Institute of Health,
Thanks to the interest and support of this committee, the appropriations for the National Institutes of Health have grown from about $70 million in 1954, the first year after the Department was created, to about $11 billion in 1:#6. And with these funds an organization of exorllence ha-twen created. Our health research expenditures have been credited as being among the most worthwhile of all Federal expenditurea. We have made every effort to continue the forward
, progrpus of recent years by applying the 1967 increases selectively. Our budget of over $1.3 billion for NIH will permit a considerable degree of progress in our health research effort.
The largest single increase for XIH in the 1967 budget is for remearch grants. This includes an increase in the regular research grant program to finance continuation projects, and increments of new and supplemental projects. The 1967 budget request for special research grants includes increases for the general research support program, the animal resources and primate center programs, and for multidiwciplinary research and training centers to study the possible toxic effects of drugs on man.
The NIH training grant and fellowship programs will be increased in the 1967 budget, particularly in the area of mental health.
Direct operations also receive a higher level of support in the 1967 budget, with the largest single increase for the intramural research program.
ENVIRONMENTAL HEALTH AND CONSUMER PROTECTION Mr. Chairman, I would now like to turn to the area of environmental health.
It is a grim fact that in this country today we are polluting our environment more quickly than we can devise ways of dealing with that pollution. The 89th Congress has already given this Department brond new authority to combat the problems of pollution including the establishment of a new Federal Water Pollution Control Administration but we will have an uphill struggle for some years to come.
WATER POLLUTION Since the Federal Water Pollution Control Act became law, over 5,000 waste treatment facilities have been constructed and an addi. tional ) now under construction will be completed by the end of 1967. Last year, the Congress amended the act to raise the author. ization for construction support. With the new maximum author. ization, which we are requesting in 1967, construction of an additional 1,070 waste treatment facilities can be supported. The 1965 amendments also authorized a new program of research and demonstration projects dealing with sewer overflow and storm water control, and our 1967 budget seeks the full authorization.
In direct Federal operations, the largest increases in the 1967 budget are for developing comprehensive river basin pollution control programs to provide å regulated supply of clean water for all legitimate uses. The 1967 budget provides for initiating four new development phase projects and expanding six existing projects. In addition, by the end of 1967 it is anticipated that five water laboratories will be completed and in operation. Under new legislation we propose to strengthen enforcement procedures, including registration of all wastes discharged into navigable rivers. Expansion of research, training, and control programs is also proposed, with greater support for demonstration of new techniques for advanced waste treatment.
AIR POLLUTION AND ENVIRONMENTAL SANITATION
The Clean Air Act Amendments and Solid Waste Disposal Act of 1965 are aimed at strengthening our ability to combat the contamination of our environment by giving us the authority to control air pollution from new motor vehicles and to support projects for the planning, development, and conduct of solid waste disposal programs. We have already published standards to control air pollution from new motor vehicles. The 1967 budget requests substantial increases for all parts of the air pollution program, and for the solid waste disposal program.
The authority of the Food and Drug Administration to control the illicit distribution of dangerous_psychotoxic drugs was expanded in legislation approved last year. In 1967, we are requesting a very substantial staffing expansion for the Food and Drug Administration, principally for drug abuse control activities, medical and scientific evaluation of drugs and other industry proposals, and education and voluntary compliance activities.
Our programs of vocational rehabilitation, social insurance, income maintenance, and the new programs for the aging all reflect the basic concern of this Department for human well-being and personal development.
VOCATIONAL REHABILITATION Development of the full potential of disabled persons is the purpose of the Department's vocational rehabilitation program. The Vocational Rehabilitation Act Amendments of 1965 will enable us to expand rapidly our potential for achieving rehabilitation. A change in the matching formula under the basic Federal-State support program will result in a very substantial increase in Federal support. The amendments also establish new programs to help States plan for expanding rehabilitation services, construct rehabilitation facilities and workshops, and improve workshop programs to bring about a capacity for rehabilitating larger numbers of persons. We estimate that with this