Venereal Disease Project Grants Effective It is clear that one of the effective elements of any federal venereal disease program is the availability of funds for grants to States. During the years when these grants were derived from specifically designated venereal disease appropriations, the ground rules for the award of project grants were clear. For many years, project grants were made to States for venereal disease control activities based on the size of the venereal disease problem, interest and willingness of the State to initiate a program, and financial resources of the individual State, assuming that a satisfactory venereal disease control plan and application for funds was submitted. Partnership for Health Legislation The field of health is no different from other areas of our national political scene. There are always proponents of greater decentralization of decision-making and of the pulling together of more and more small programs into a smaller number of larger programs in terms of legislation, appropriation and administration. Such moves also have their bitter opponents. The mid-sixties saw the first of these groups gain supremacy and the Partnership for Health legislation was passed. Among other purposes, the thrust of this legislation was to eliminate categorical health program appropriations for aid to States and transfer authority for the planning of health programs and utilization of federal grant funds for these activities to State and regional planning agencies. In theory, at least, this has many attractions. It relieves the federal executive branch from responsibility for certain detailed planning and initiatives. It should relieve the Congress to some extent of hearings on a large array of categorical programs. Conversely, more responsibility is forced upon States and regions for the planning and implementation of its health programs and presumably they should be more aware of local needs and conditions. In theory, the States submit plans for these programs and the use of the federal funds, which are reviewed by the cognizant federal authorities for adequacy before the funds are released. Unfortunately, it does make for great difficulty in maintaining a nationwide categorical program with minimal qualitative and quantitative standards. There is no assurance that federal funds in any quantity will be directed in a given State towards a specific program even one with a high national priority. It seems to be impossible to establish and enforce any sort of minimum standards for the various elements of a comprehensive health plan. It is generally conceded that total appropriations for health grants to States are less than the sum of a series of more categorical and understandable programs. From the standpoint of some federal legislators, it has the undesirable effect that the Federal Government loses much of its ability to exercise control over the expenditure of federally appropriated funds for which it is responsible to the taxpayer. Earmarked Funds and Minimum Program Standards It seems evident to the Commission that, if an organized national venereal disease control program is to be successfully carried out, some device either within or without the comprehensive health planning mechanism, must be invoked which results in all of the State and local governments having adequate venereal disease control programs meeting some minimum standards established by the Federal Government if federal funds are to be made available to the State and local governments. There should also be a requirement that federal funds be used to supplement and not to supplant State and local funds. This could be accomplished by a return to specific venereal disease control appropriations for grants-in-aid to States or by the earmarking of funds within the comprehensive health planning appropriations but in either event a federal review mechanism should be established and minimum program standards set. Funding of Educational Programs and Research The several recommendations regarding the control programs, including public education, research of both a basic and applied character and professional education have underlined the multitude of fronts on which this particular war must be waged. The channels through which federal funds may flow in support of venereal disease control with the exception of State grants discussed in the preceding paragraphs are reasonably clear. Even in the case of research, research training and health manpower education grants, however, it seems clear that specifically earmarked funds will be required if capable individuals are to be attracted to the field in adequate numbers. The Commission does not believe that it should attempt to detail the exact manner in which funds should be allocated to the various administrative units of the Department of Health, Education, and Welfare, but does, in its various recommendations on appropriations, attempt to list the various elements of the total program and place a reasonable cost figure on each of these elements. RECOMMENDATIONS FOR FUNDING The Commission strongly recommends that appropriations and expenditures for the venereal disease control activities of the Department of Health, Education, and Welfare be substantially increased. While all elements of the program require augmented appropriations, it is recommended that significantly higher proportions be allocated to public and professional education and research than has previously been the case. In strengthening the operational control program, State and local governments should be persuaded to assume financial responsibility for an increasingly large proportion of the total effort. |