Specifically, the Department would be authorized to

(a) Aid, stimulate, and encourage the development throughout the Nation of services and facilities, both public and voluntary, in the fields of health, education, security, and related fields;

(b) Promote, foster, and encourage State, community, and voluntary activity in those fields;

(c) Advise and cooperate with other departments and agencies of the Federal Government, with State governments and agencies, and with voluntary agencies functioning in those fields;

(d) Collect and analyze statistics and make studies, investigations, and reports on conditions, problems, and needs in those fields in the United States and in other countries, and disseminate and make available information in those fields;

(e) Make reports and recommendations with respect to the most effective policies and methods for the promotion of health, education, security, and related services, including recommendations with respect to legislation and matters of administrative policy;

(f) Advise and cooperate with international organizations functioning in those fields; and

(g) Administer such Federal programs, including grants-in-aid, and such powers, functions, and duties in those fields as are assigned to it or provided through this or subsequent legislative enactment.

The office of the Federal Security Administrator and the Federal Security Agency, and its constituent units, together with all their functions, would be transferred to the Department and, subject to the exceptions noted, would be allocated, distributed, and administered under the direction and supervision of the Secretary, who would be authorized to abolish such office and agency and any such unit in the interest of administrative efficiency.

To the Division of Health would be specifically transferred the United States Public Health Service, the Freedmen's Hospital, the Food and Drug Administration, and the Federal Board of Hospitalization. To the Division of Security, the Under Secretary of which will be a person experienced in the field of social security and welfare, will be transferred the Committee on Economic Security and the Children's Bureau. The Office of Education and the functions of the Federal Security Agency, relating to the administration of Howard University and the Columbia Institution for the Deaf, will be transferred to the Division of Education.

Essentially, it would seem that the effect of this legislation would be to transform the Federal Security Agency with its various and not too closely related functions into an executive department with a relocation of the several functions of that agency. While the house of delegates has repeatedly urged that a national department of health be established, it has recognized the dangers incident to the mingling in one department of health and other functions. At a special meeting held in 1937, at a time when the reorganization of governmental activities in the executive departments was under consideration, the board of trustees prepared a statement expressing the opinion that "health activities of the Government, except those concerned with the military establishments, should not be subservient to any other departmental interests." This action of the board of trustees was approved by the house of delegates at its meeting in Atlantic City in June 1937.

The pending bill, if enacted, might serve to bring about such subserviency; its consideration by the Congress will demand close attention by the medical profession.

The CHAIRMAN. Dr. Getting, proceed with your testimony, so we can conclude this hearing today.

Dr. GETTING. The conclusions reached by the Association of State and Territorial Health Officers are as follows:

1. That a separate Department of Public Health would be preferable but, if this does not seem possible, that a combined Department of Health and Education or a combined Department of Health, Education, and Security may be a practical but less desirable alternative. 2. Such a Department of Health or a combined Department of

Health and Education or Health, Education, and Security should be headed by a Secretary of Cabinet rank.

3. The association recommends that the Department be assigned responsibilities pertaining to the general public health of the civilian population of the United States, and if it is a combined Department, such other duties pertaining to education and security and related

fields as may be proper so as to integrate the related services contributing to individual, family, and community well-being.

4. The association further recommends that a short bill be substituted for S. 140 and that S. 712 be expanded to provide (a) a general clause defining the duties of the Department; (b) a clause which would protect the State rights; and (c) a clause to provide for the inclusion of all health services in a single division.

5. The association believes that the transferring of other functions to the Department should be referred for subsequent legislative action or Executive action by the President under his powers dealing with governmental reorganization.

6. The association recommends that Congress indicate in whatever fashion possible the greatest latitude in the organization of the Department without setting forth specific organization detail but at the same time providing that all health activities be coordinated in a single division. We specifically recommend that the Children's Bureau be incorporated in the United States Public Health Service, possibly under the direction of an Assistant Surgeon General. The specific details relative to this recommendation may be found in a perusal of the portion of the minutes of the executive committee pertaining to this subject. See appendix E.

7. The committee recommends that the Secretary of the new Department should be authorized to establish offices, bureaus, and divisions as he deems necessary or desirable to carry out the duties of the Department, but that the legislation should specifically provide for the creation of separate divisions of health, education, and security and to assure that the major functions will be so grouped.

I might add here that on numerous occasions we have recommended in the past that the medical and research portions of the Children's Bureau be transferred to the United States Public Health Service, but that the welfare portion of the Children's Bureau be retained in the Social Security Administration.

8. The association further recommends that in addition to the Secretary of Cabinet rank, legislation should provide for the appointment of an Under Secretary and at least two Assistant Secretaries who shall assist the Secretary in the over-all management and direction of the affairs of the Department, and that there be no qualifications set forth for these positions.

I might say that in either instance we have the appointment of four positions by the President. Under our recommendation there would be four laymen who, in our opinion, better represent public opinion and the public and would not represent any vested interest. If, on the other hand, we have a Cabinet officer with three deputies-one for health, one for education, and a third for security-we would have again four political appointees, but in this instance only one would represent the public and three would represent each a different vested

interest, and there would be constant rivalry between those three deputies for their specific interests rather than the integrating interests of all the people.

I do believe, further, that the operating divisions should be permanent career people who are selected because of competent administrative experience rather than as deputy Cabinet' officers, which, I believe, would be a departure from the present form of government in all Cabinet departments.

The CHAIRMAN. I think the set-up you propose is similar to the one in the proposed merger bill of the armed services. That is, the Secretary of War, Secretary of Air, and the Secretary of the Navy would be civilians.

Dr. GETTING. That is correct.

9. The association believes that the functional operating divisions or other units of the Department should be headed by permanent career officers with high professional and administrative competence in their particular fields. These positions should be nonpolitical in character and should assure permanence of tenure and other civilservice or officer privileges.

10. The association recommends that legislation creating a Federal Department of Public Health or, as an alternative, a Department of Health, Education, and Security, be passed in the present Congress embodying the recommendations as noted above in order to further promote the public health of the citizens throughout the Nation so that all of the people might benefit from the new developments in medical science, primarily through the further organization of local health departments, the reinforcement of State health departments, and the coordination and reinforcement of health activities in the Federal Government.

11. The association has studied the organization of a national health agency, as proposed in S. 545, a bill introduced by Senators Taft, Smith, Ball, and Donnell, and known as the National Health Act of 1947. The executive committee in discussing this bill concluded that the organization of the National Health Agency as set forth in this bill has several shortcomings which may be summarized as follows: (a) The National Health Agency is not a department with a Cabinet secretary at its head.

(b) The Administrator of the National Health Agency is required to be a physician licensed to practice medicine in one or more States. It is our conviction that if there is to be a physician at the head of such an agency he should have had at least a minimum of 5 years of full-time medical administrative experience. We have seen numerous examples where excellent clinicians or teachers in medical schools have made extremely poor medical administrators.

(c) The bill provides that the Director of the Medical and Hospital Care Service shall be a doctor of medicine licensed to practice medicine in one or more States who has had at least 5 years of active medical practice and who is outstanding in the field of medicine. Here again we have the same criticism. A director should be a physician who is not only licensed to practice medicine but had at least 5 years of fulltime medical administrative experience of a responsibility and size which would warrant his competence to the position of director of

such an organization. A clinician or outstanding teacher in any of the specialties of medicine would not, in our opinion, be qualified for this position.

(d) We believe that the integration of the United States Public Health Service and the National Health Agency is not a designed as to improve the work of the United States Public Health Service and are convinced that if the National Health Agency were organized along the lines proposed in S. 545 it might diminish the effectiveness and efficiency of the United States Public Health Service.

For these reasons the executive committee of the association is convinced that the organization of a National Health Agency as proposed in S. 545, known as the National Health Act of 1947, is less desirable than that in the substitute bill which we have submitted in this testimony.

I might add that I have been disturbed by some of the remarks made by some of the witnesses. We have for a long time in public health been administering public health programs. We have TB hospitals. The Massachusetts Department of Public Health is responsible for the management of five institutions in my State. I will put any hospitals in my own department-those caring for TB, for cancer, for infantile paralysis, and other conditions-against any hospitals in the country for quality of medical care.

I think the implication that any hospital run by the Government ipso facto makes it bad is extremely wrong. We have been licensing hospitals for 4 years in Massachusetts, both Government and private institutions. We have had to close private hospitals because they did not meet minimum standards. You can have poor medicine whether it is Government or private. Conversely, you can have excellent medicine whether it is private or Government.

The United States Public Health Service has likewise had a great deal to do with medical care, venereal disease, cancer, TB, mental programs, and the like.

I do not want the committee to believe that we in public health make arbitrary division between prevention and treatment. It is sometimes hard to tell where prevention stops and treatment begins. It is the combination of the two that makes it possible for people to have healthy lives.

I would like to bring to your attention that we in the field of Public · Health have done a great deal of research at State level and local level. Some of the greatest discoveries have been made at State level and local levels of government. We in Massachusetts on Wednesday are opening the first public whole blood and plasma fractionation program, whereby any fraction of blood will be made available free of charge. It is the only State in the Union that has done that.

Certainly, Government agencies can carry on research.

I again wish to thank the committee on behalf of myself and the Association of State and Territorial health officers for having the privilege of coming here and testifying on these bills.

I shall be glad to send any information you may desire relative to our mutual problems.

The CHAIRMAN. Thank you, Doctor.

(Dr. Vlado A. Getting submitted the following paper for the record :)

STATEMENT OF THE ASSOCIATION OF STATE AND TERRITORIAL HEALTH OFFICERS RELATIVE TO S. 140 AND S. 712, PRESENTED BY VLADO A. GETTING, M. D., SECRETARY

The Association of State and Territorial Health Officers is composed of the health officers of the 48 States, the Territories, and the District of Columbia. It is formed primarily to deal with those Federal agencies which are carrying on programs in public health and which may, through grants-in-aid, assist the several States and Territories in their work in public health; and to promote the interchange of information and coordinate the programs of public health between the several States. The work of the association has been chiefly with the Federal Security Agency and with its component organizations, primarily the United States Public Health Service and the Children's Bureau.

As secretary-treasurer of the association, I have been designated by vote of the association and more recently again by the president, Dr. F. C. Beelman, director of public health in the State of Kansas, to represent the State and Territorial Health Officers before congressional committees holding hearings on bills related to public health and medical care. Appendix A sets forth my training and qualifications.

The Association of State and Territorial Health Officers has for many years worked for the integration in a single Department of all of the health activities of the Federal Government. It is our objective to have centralized under the direction of a Cabinet officer all the civilian health activities exclusive of the medical services of the Army, Navy, and Veterans' Bureau at as early a date as possible.

On October 10, 1945, at the direction of the association, I sent a communication, appendix B, to His Excellency President Harry S. Truman, in which the association urged the formation of a Federal Department of Health or, as a possible alternative, a combined department in which health activities would be on a par with other functions in the Department. It has always been the feeling of the States and Territories that the public health activities of the Federal Government were sufficiently large to justify a separate and independent Department; and we have, therefore, urged this as our prime objective and have only suggested a combined department as a less desirable alternative.

On the submission of the Reorganization Plan Number 2 presented to the Seventy-ninth Congress by His Excellency President Harry S. Truman, the association authorized me as the secretary to write a communication appendix C, to the Commitee on Expenditures setting forth the fact that inasmuch as the formation of a Department of Public Health was not feasible at this time, the State and Territorial Health Officers favor the enactment of the Reorganization Plan Number 2 of 1946, inasmuch as this reorganization at least partially met the objectives set forth in our previous statements, relative to the organization of civilian public health activities of the Federal Government.

The executive committee of the Association of State and Territorial Health Officers, meeting in Washington on February 24 and 25, 1947, discussed S. 140 in detail and reached the opinion that a shorter bill might be presented, as is attached in appendix D. This short bill will in our opinion be more acceptable than S. 140 although it is somewhat longer than S. 712. Certain additions have been made to S. 712 and certain omissions of words have been noted and these are marked in the attached substitute bill.

The State and Territorial Health Officers believe that the organization of the Department of Health, Education, and Security, as proposed in S. 140, would actually defeat the purpose of the bill- namely, to develop an integrated Department devoted to the humanities. We believe, therefore, that in order to provide sufficient administration and integration of the program, the shorter bill, S. 712, as amended in appendix D, is by far preferable. The general objective as outlined in our amended bill also sets forth the duties in general of the Department, as noted on page 1, lines 15-21, of the substitute bill. "The Department shall promote the general welfare of the people of the United States by aiding the fostering progress throughout the Nation in the fields of health, education, security, and related services contributing to individual, family, and community well-being, and shall study and make recommendations and disseminate information with respect to such matters." The additions to the bill as noted