States to ex

Dr HOTE We du rot, by regulation, perit nerd te fid they reeve from our grant for the giv'! g of enstodil care : mental strutiors. The big bilk of the exper diture in meet States in for the otørst of of the mettį) ir stitutions, funds are used more'; the front end of the problem, such as in treatment and dig osteo! They are mental-health efnies. Our

find- may not be med r the actual care of patients,

Our

Serator Lampras Inght that chart purported to be a comparison of Federal grants for mental health with those of the States. Mr. ROKEEFTEP. It does,

Senator La HMAN. Due to the fact that New York has $100 million that $11 millon does not seem very realistie.

Senator Pup They are matched funds.

law.

Secretary HOBBY. It does not in the framework of the Federal Dr. Scheele made the important point that all of the States -pend in custodial care great sums for the care of the mentally ill. These are not shown as matching funds.

Senator LEHMAN May I ask you one other question which I failed to ask before ?

The statement was made by somebody here that all States would fare better under this program than they have. in the second column of Public Health you show $17,514,000. I On the last sheet realize perfectly well that that figure cannot possibly be binding and that it is dependent on a great many different ifs, ifs, and ifs. I realize that. But when I read the appropriations for the various

years from 1936 to 1954 of the Federal grants-in-aid published by the services, that amount seems completely inadequate, as do the amounts that have been appropriated in recent years, which were larger than that, which also appear to be inadequate.

In 1950 we appropriated for Federal grants-in-aid for the Public Health Services $43,135,000. From that time each year the appropriation was very substantially reduced, so that in the year 1954 we appropriated only $22 million for all of these grants-in-aid, as compared to $43 million in 1950.

Under this plan it is estimated, although I realize without any real finality, that the amount that would be available to grants-in-aid in public health would be only $17 million. What I am trying to do is to emphasize the complete inadequacy of the amount that is made available by the Federal Government in grants-in-aid to the States. I think if you really want to help the States and get them to welcome Federal aid, I think you have to make the program more attractive than it appears to me to be at the moment.

Mr. ROCKEFELLER. There is one point that should be called to your attention. That is, there is a 10 percent reduction from that figure because of the special project grants, which are not allocated on a State basis. Not that that answers your question, because you are talking in far bigger figures than that, I understand.

Senator LEHMAN. Thank you.

Senator COOPER. Mr. Chairman.

Senator PURTELL. Senator Cooper.

Senator COOPER. I notice you have a chart there which shows the appropriation in 1950 which Senator Lehman referred to, and which continues on from 1950 to 1954. Could you put in the record the appropriations in each of those categories beginning, let us say, in 1950 down to this year?

Senator PURTELL. You may have those included in the record.

Senator COOPER. Yes. Because we have a statement on 1950, and I think it would be proper to show what the various appropriations have been in all the years since then.

Senator PURTELL. I think that sheet accompanied the chart, Senator. Did you get one?

Senator COOPER. No.

Senator PURTELL. Federal grants-in-aid for Public Health Services. Senator COOPER. I will ask that that be placed in the record.

Senator PURTELL. Yes, and it is so ordered. I thought I had ordered it, Senator. I am very sorry if I haven't.

Senator COOPER. All right.

Senator LEHMAN. I think instead of 1950 to 1954 it should be from 1936 to 1954.

Senator COOPER. I think you are right.

Senator LEHMAN. That is the sheet I have.

(The table referred to was previously submitted.) Senator PURTELL. Are there any other questions?

Senator HILL. There is one thing. In reference to some of the figures, it seems the program is getting smaller each year because of the reduction in funds. Is that not true, Mrs. Secretary? In other words, Senator Lehman called attention to the fact that in 1950 there were $43 million appropriated and in the Korean war we had $38

million in 1951, and in 1952 $36 million, and 1953 $32 million, and in 1954, which is this year, of course, it dropped down to $22 million. and now you propose to drop it down to $19 million, approximately. Is that right?

Secretary HOBBY. Yes, sir. That is right.

Senator HILL. You can write all the legislation you want on the books, but if you do not provide the money I do not know how you are going to do it. I am not going to ask Dr. Scheele to comment on that, but I think I know what his comment will be.

You talk about being dynamic and looking forward, but you do not move unless you have gas in your car. Certainly in these programs you do not move unless you have the funds with which to move. That is all, Mr. Chairman.

Senator PURTELL. Thank you, Mrs. Secretary, and we thank your associates for being here. We look forward to your visit tomorrow, at which time we will discuss the rehabilitation and vocational program.

Dr. Erickson was to be our next witness. He is not here but I am informed Dr. Norton, a member of the executive committee of the Association of State and Territorial Health Officers, will appear in place of Dr. Erickson. Is that correct?

STATEMENT OF DR. J. W. R. NORTON, NORTH CAROLINA STATE HEALTH OFFICER AND MEMBER OF THE EXECUTIVE COMMITTEE OF THE ASSOCIATION OF STATE AND TERRITORIAL HEALTH OFFICERS

Dr. NORTON. Yes, sir.

Senator PURTELL. Dr. Norton, we welcome you here and we are glad to hear you.

You have a prepared statement?

Dr. NORTON. Yes, sir.

Senator PURTELL. Is it your intention to read that complete statement, or do you wish to read just excerpts from it?

Dr. NORTON. I can read this in about 13 or 14 minutes, if you would like me to do so.

Senator PURTELL. We are very happy to have it, if that is the way you want it, Doctor.

Dr. NORTON. All right, sir.

I would like to say that the Association of State and Territorial Health Officers is a group that does not have a Washington staff, or a full-time office anywhere. It is just the official directors of public health in the various States and Territories who get together with the Department of Health, Education, and Welfare, particularly the Public Health Service and the Children's Bureau.

The reason why I am appearing today is because our president is from Oregon and our secretary is from Wyoming. Being from North Carolina, it was a little more convenient for me as a member of the executive committee to appear here.

Senator PURTELL. We had another excellent witness from North Carolina. I believe it was Dr. Farrell, who helped us a great deal. Dr. NORTON. Mr. Chairman and members of the committee, it is my privilege to represent, and to speak for, the directors of the official

State and Territorial departments of health, who support in principle S. 2778. As a matter of fact, speaking for the group, I can say we wholeheartedly feel this is a great improvement over the arrangement we have had.

As a member of the executive committee of the Association of State and Territorial Health Officers, I participated in that executive committee's study of, and action on, the bill. Unfortunately, due to lack of time, it was not possible to get the specific recommendations of each individual State and Territorial health officer, as had been planned, but we do have a statement of the 28 States at the end of this document. The committee, however, has authority to make this statement, and I assure you that it reflects as faithfully as we are able to put it the position of our members.

By and large, official responsibility for the advancement of the health of our people with particular emphasis on the prevention of illnesses, injuries, and deaths rests with the State health departments. Actual provision of public health services, varying in each State, is largely the responsibility of local health departments. For many years now there has been developing an increasing effective FederalState-local partnership. Spurred by this Federal-State-local partnership, noteworthy strides have been made in the reduction of such disabling diseases as the venereal diseases, tuberculosis, and the intestinal diseases due to unsafe drinking water, milk, and unsafe sewage disposal. More recently there has been progress in reducing the toll of cancer and of heart disease and in the prevention of aftereffects of emotional disturbances in children. There have been other significant advances in better health for our people such as better nutrition, maternal and infant health, dental health, and so on.

The potential health benefit from these activities is tremendous. So far, however, the activities and returns on this joint Federal-Statelocal partnership investment are only getting well started.

Inherent in many of these forward steps toward better health, there has been potent impetus of the grant-in-aid Federal-Statelocal partnership that has made possible the strengthening of existing, and the initiation of new, preventive services. Congress in its wisdom has provided funds for attacks on specific disease problems such as venereal and mental, tuberculosis, and cancer. These have been designated as categorical grants. S. 2778 amalgamates these specifie support funds with that for general health in one package termed a block grant to share with the State and local health departments in meeting the cost of public health services.

As State health officers we have been aware of the need for the greater flexibility the new mechanism would provide in the interest of more effective and economical use of the funds. Relative needs for specific health activities vary greatly from State to State beyond the ability to best cope with them through a single formula. We can adjust to them more effectively in the public interest under the more flexible provisions of S. 2778. Each State will be freer to use funds according to the varying local needs, and bookkeeping and auditing costs will be reduced markedly.

In addition to the vital support provision, the bill encourages States to extend and improve their existing services and to study and develop new techniques that may prove more effective and economical.