pitalization formerly necessary to achieve this objective was expensive, and a grave hardship on the patient who was required to spend months away from his family and friends. With the discovery of antituberculosis drugs 2 decades ago, the future treatment of this disease was due to become revolutionized. Today it is rare for a patient to have more than a short hospital stay. Patients become noninfectious in a short period of time. Most are able to arrest their disease solely by the conscientious taking of medication over a period of 18 to 24 months, under the supervision of clinic personnel or private physicians. Obviously the more outpatient care, the less cost of tuberculosis control, particularly in these days of skyrocketing hospital charges. Unhappily, this optimistic picture does not tell the whole story. Patients must be found in order to be treated and before they have the chance to infect others. The fact that more than a third of all new active cases are found in a far advanced stage shows that much remains to be done in tuberculosis control. If allowed to go untreated, tuberculosis patients have as much risk of dying as did those of previous generations; the infant who becomes infected with the tubercle bacillus has the same astronomical risk of succumbing to death from meningitis or disseminated tuberculosis. Thus the availability of effective drug therapy makes it even more of a tragedy when tuberculosis control programs are cut back. IN CONCLUSION The Communicable Disease Act must be extended if we are to continue to make progress against diseases which are transmissable from man to man. Without it, we cannot take advantage of opportunities for eradication of these conditions. Our organization considers that S. 3442 is essential to a responsible national public health policy. We thank the committee for the chance to present our reasons for supporting this important bill. Senator HUGHES. Thank you very much, Dr. Anderson. Do you have any idea what you think the reasons might be for the administration to oppose the extension of this legislation, if the need is as great as you say? Dr. ANDERSON. I heard their stated reasons, that they believe it was unnecessary. I personally feel that it is very necessary. This matter of communicable disease control is the mainstay of governmental interest in public health. It is the thing that was recognized in the States, in the Federal Government, at the very outset. To make communicable disease control subject to the whims or desires of individuals who for one reason or another are interested in something else, to enable them to chuck communicable disease control is bad public policy. I believe the Congress in the legislation and in the appropriations process should examine what our posture is with regard to the dangers from communicable diseases, and the measures that are necessary to control them. Senator HUGHES. Doctor, I want to thank you and compliment you for your fine testimony, and specifically for your recommendation. The committee will consider carefully your testimony. I would simply like to express our appreciation to you for being with us and giving us the benefit of your testimony. Dr. ANDERSON. Thank you, Senator. Senator HUGHES. The Chair calls Dr. Mack I. Shanholtz, the commissioner of health from the Virginia Department of Health. Welcome to the subcommittee. Dr. Shanholtz, we may have a problem. There is a vote, we are getting near the end of the alphabet, and we are still short of 12 people. I hope you can be as brief as possible, as I may have to leave. STATEMENT OF MACK I. SHANHOLTZ, M.D., COMMISSIONER OF HEALTH, STATE OF VIRGINIA Dr. SHANHOLTZ. It is my intention to be brief. I would like to have the entire statement appear in the record, but I would be glad to highlight it. Senator HUGHES. If you would, we will include your statement as though given in its entirety, and you may highlight it. I apologize that I have to leave. I am going to let Senator Eagleton take over the chair while I go to the floor. Thank you, Dr. Shanholtz. Senator EAGLETON. You may proceed, Dr. Shanholtz. Dr. SHANHOLTZ. In addition to serving as the State health commissioner of Virginia, I am also a member and past president of the Association of State and Territorial Health Officers, and it is on behalf of that organization that I am presenting testimony today. First of all, I want to express the appreciation of our association for the leadership of the Senators who are sponsors of S. 3442 and S. 3187. We regret that the Department of Health, Education, and Welfare recommended against enactment of the Communicable Disease Control Amendments in 1970. Subsequently, the Department failed to request funds for implementation of the legislation. Since that act, Public Law 91-464, expires June 30, 1972, there is an urgent need for its extension. If this legislation is not extended there will be insufficient authorization under the Public Health Service Act for the 1973 budget request for the control of venereal diseases and vaccination assistance unless section 314(d), the authority for comprehensive public health services, is more fully funded. Unfortunately, the budget request for 314(d) is only $90 million for 1973, the same level as appropriated in 1971 and 1972, although the 1973 authorization is $165 million. Section 314(d) has been mentioned several times in this morning's discussions. The State department of health in Virginia is a recipient of this 314(d) formula grant, so I can speak with some authority as to what it is being used for. First of all, it represents a very small commitment, a very small financial commitment on the part of the Federal Government, to our overall budget in terms of dollars. We receive about $1.5 million from 314(d). Our total operating budget for the fiscal year, for the present year we are in, is about $150 million, so you can see this represents a little less than 1 percent of our overall operating budget. When Senator Hill introduced this legislation back in the middle 1960's, he visualized a gradual increase of 314(d) funds to the States after 5 years, reaching a level of about $300 million, where it could more rightly be called partnership. It has hardly gotten beyond the initial appropriation. A good many of the points that I have in this brief presentation have already been covered by other speakers, but it was brought out that communicable diseases are on the increase, and for the first 12 weeks of this year we note that there have been 9,100 cases of rubeola (red measles) reported; 7,785 cases of rubella (German measles); 5,615 cases of tuberculosis; 152,511 cases of gonorrhea; and 5,165 cases of syphilis just to give you a few statistics. We are also concerned with the immunization levels. You cannot control diseases with crash programs. We are becoming alarmed by the fact that among children under 5 years of age the national average of protected children is 69 percent in the case of polio, 47 percent in the case of rubella, and 67 percent in the case of measles. As to venereal disease, I have here a very recent clipping from the Richmond, Va., local paper. It states that venereal disease is the most common disease except for the common cold. For Virginia-I quote: There were 17,311 identifiable cases of VD in fiscal year 1971, a 15-percent increase over the previous year. The sorry VD rate in Virginia is consistent with that of the Nation as a whole. That was an article appearing April 6. Now to tuberculosis. In the case of venereal diseases, the Department of Health, Education, and Welfare resorted to a crash program to combat the crisis that developed with respect to syphilis and gonorrhea. We fear that a similar crisis will occur with respect to tuberculosis if Federal funds for tuberculosis control are eliminated as proposed by the Department. Tuberculosis, the No. 1 killer among communicable diseases, is already showing signs of a future increase due to reduced control programs. In 1970 the number of new cases per unit of population increased among the black population; for the country as a whole the rate of reduction dropped to 5 percent as compared to 8 percent in 1969. Thus, we hope that we will profit by past mistakes rather than repeat them. Our association strongly urges a national commitment to combating diseases that can be controlled or prevented. Such a commitment could be achieved if S. 3442 and S. 3187 were enacted and adequately funded. We believe, however, that there might be advantages to a consolidation of the provisions of S. 3442 and S. 3187 under a single measure. First returns from the uniform national health program reporting system being developed by our association show a need for additional health education funds. In the case of rubella, only 5 percent of the immunization program funds were spent for public educational activities. The new reporting system also showed that State and local funds constituted one-third of the rubella immunization costs. In the case of venereal disease control, the Federal share of 1971 expenditures amounted to only one-third of the total costs. Only 2 percent of the VD control costs were allocated to educational programs. Consequently, this association strongly supports the provisions of S. 3187 and S. 3442 that relate to health education programs. We endorse the formula and project grants of S. 3187 for the control of vene real diseases and also the project grants of S. 3442 for the control of tuberculosis and vaccination assistance. I will be glad to answer any questions. Senator EAGLETON (presiding pro tempore). Doctor, I take it, as was the case with every other witness not connected with the administration, you think the extension and continuation of this legislation is absolutely necessary. Dr. SHANHOLTZ. Yes, sir. I would say it is very urgent. Senator EAGLETON. And necessary even over the objections of the administration? Dr. SHANHOLTZ. I did not hear all of the objections. Senator EAGLETON. If they oppose the legislation, you think they are erroneous in such opposition? Dr. SHANHOLTZ. I mentioned the 1970 enactment. Senator EAGLETON. But if the current administration is opposed to the extension of this legislation, you would deem that opposition to be nonmeritorious? Are you for the opposition, or are you against it? Dr. ŠHANHOLTZ. I stated previously that we regretted HEW opposition to the enactment of this legislation in 1970 and I repeat I am for this bill, sir. Senator EAGLETON. On page 4 of your testimony you mention a uniform national health program reporting system being developed by your association. Could you elaborate a little bit further on what this uniform national health program reporting system is? Dr. SHANHOLTZ. We are developing a methodology for a uniform national health program reporting system, and we have already had a nationwide field trial on it. This type of information has never been collected about all health programs in the States on a uniform basis. The specialized bits and pieces of many programs collected by Federal agencies pursuing special interests are not necessarily what you and I need to know. Moreover, it is impossible to add up, to compare or to interrelate these bits and pieces. The Association of State and Territorial Health Officers with support from HEW has undertaken to do something about it, and we are looking forward to the continuing development of the system, and are confident that it will be able to provide Congress with the factual answers to many of its questions about public health which now remain unanswered for lack of information. Senator EAGLETON. Thank you very much, Dr. Shanholtz. At this point I order printed all statements of those who could not attend and other pertinent material submitted for the record. (The material referred to follows:) WASHINGTON OFFICE 1608 "K" STREET, N.W. WASHINGTON, D.C. 20006 ⭑ Senate Committee on Labor and Public Welfare Dear Chairman Kennedy: In accordance with the suggestion contained in It will be appreciated if you will include this statement in the record of the hearings now being conducted by your Subcommittee on S.3187 and S.3442. Your continued cooperation with The American Legion is appreciated. Sincerely yours, Huvit figu Herald E. Stringer, Director |