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Association of State and Territorial Health Officers. On page 2 there is a paragraph with a plea for more money to go into support, and it is stated :

Should, for instance, as much as 25 percent of the total be allocated for extension and improvement, worthy as that is, with its biennial reduction of one-fourth of the Federal fund participation, many of the States would be embarrassed and possibly resentful, as well as hard put to take over so large a part of the load, under our present system of taxation.

They agree in there that more funds for support rather than for what you might call categorical programs should be allotted.

That is all I have.
Mr. ROCKEFELLER. Might I comment on that, Mr. Chairman?
Senator PURTELL, Yes.

Mr. ROCKEFELLER. I think what is back of the comment in that letter is this: They are worried about this total decline as shown on this chart since 19.30 down to here. That I think is the basic concern they have. They do not mind the idea of improvement, but they are worried about the total reduction of their support funds and the effect on the States.

That is a pretty substantial decline that has taken place. I think that is the basis for their fear.

Senator PURTELL. I want to make clear that the sheet showing the participation in the States is in the record.

Senator LEILIN. I want to ask one question. Under the expenditures, what are the figures on mental health?

Mr. ROCKEFELLER. It is a total Federal expenditure of $11 million. I am having a little trouble reconciling that figure with your $100 million, to tell you the truth. Dr. Scheele seems to know what the answer is,

Dr. SCHEELE. We do not, by regulation, permit the States to expend the funds they receive from our grant for the giving of custodial care in mental institutions. The big bulk of the expenditure in most States is for the operation of the mental institutions. Our funds are used more in the front end of the problem, such as in treatment and diagnostic clinies. They are mental-health clinics. Our funds may not be used in the actual care of patients.

Senator LEDAN. I thonght that chart purported to be a comparison of Federal grants for mental health with those of the States.

Mr. ROCKEFELLER. It does.

Senator LEJMAN. Due to the fact that New York has $100 million that $11 million does not seem very realistic.

Senator PURTELI.. They are matched funds.

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

Senator LEIMAX. 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. On the last sheet in the second column of Public Health you show $17,514,000. I 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 $13,135,000. 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 $13 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 $13 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 PubSic 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

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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, oflicial 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 Tears 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 specific 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.

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Piscal year 1955: State breakdown of proposed grants to States in 1955, assuming enactment of proposed legislation for programs which will use,

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Public health

grants

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State

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1135

1.135

131 1325

100) INO

349, 543

379,47
194.271
$3,310

ON ON

New York
North Carolina
North Dakota
(:)
Oklahoma
Oregon
Petrylvanis
Rhirle llard
Routi Carolina
South Dakota
Tennesse
Trus
t'tah
Veront
Virginia
Wisdiligion
Wellrain la
W Isconsin
Wyoming
ALK
Hawn
Puerto Rico
Virgin Islands

IN, 417
10.000

06. 3421
1.147.007

1024

5), (X)
243, 2015

30,00
332 6711
573, 504
51. (-32

100), (X)
759, 1994
3, 543

1, 520
1. ON7,049

100,00
49), 417
100,000

66.5, 342
1, 147,007

103, 284
100,000
581, 336
220, 821
357, 115
323 913
100,000
100,000
100,000
577, 666
100,000

435, 568
431, 135

50,000
379, 947
194, 271

K3, 310
543, 544

50,00
243, 204

50.000
332, 671!
573, 504
31, 632
50,000
200, 669
110, 411
17, 558
196, 956
50,000
50,000
50.000
205, 133
50,000

2, 216, 391
2, 193, 533

216, 631
1, 833, 365

Isk, 552

423, 925
2, 765, 632

204, 591
1, 237.570 !

224, 887
1,692, 900
2, 918, 200

262, 729

200,000
1, 479,068

561, 826

908, 593
1. 002, 214

200,000
200,000

201, 000
1, 469, 731

15, 726

150, 633
41, 628
25,000
82, 469
25,000
25,000
105, 247
25,00
25,000
25,000
32, 497
81, 581
25,000
25,000
35, 228
25,000
25,000
34. 970
25,000
25, 000 !
25,000
25,000
25,000

4,990, 43
4, 22, 2691

541, 631
4, 295, 516
2, 179, 180

945,785
6, 132, 345

529, 591
2, 721, 820

549, 887
3.721.323
6, 440,683

597.521

525,000
3, 258, 304
1, 249, 290
2,004, 939
2, 218, 922

525, 000
525, 000

525, 000
3, 227, 729

340, 726

1,363, 400

637,000
123, 100
$16, 200
320.000

204, 200
1,097, 700

107, 500
358, 700
128, 300
509, 800
986, 800
135, 200

S8, 600
469, 700
204, 200
282, 500
378, 700

90, 100
101, 900

90, 100
513, 100
34, 400

20 21
357, 115
323 913
100 000
10.000
100,000

200),
110, 411
17%, SIS
19,99

50,000
50.000
50 000

100,000

50,000

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1.6 11.0 38. 1 25.8 30. 3 29. 1 23. 2 31.9

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CON 11. 20.

CE). No 1.04, 377

NS. 223
1. 221, 820

694, 149
398, 150
316, 830
232, 103
6.59, 788
132, 354
339, 040
409, 043
985, 183
454, 944
516, 406
635, 418
120, 728
220, 250
34, 290
74, 806
541, 440

151, 426
1, 567, 055
1, 059, 819

121, 337
752, 8.59
517, 287

291, 289 1, 613, 256

118, 028

ON
CR), 480

11,
168, 680
77.620
60, 020
37. 867
53, 155
53, 263
16, 720
47. 778
SNO, 695
126, 879
67, 141
41, 101
76, 717
11, 179
25, 932

3, 405
10, 176
96, 521

13, 713
287, 104
79, 063

11, 349
154, 608
42, 841
30, 150
201, 762
15, 453

IN
IN IN
37., UN
O. 101

108. 074
1,010, 010

022, 018
821, 867
347. 189
613. 032
106, 004
177, 894
305, 523
181, 230
845, 653
541, 417
678, 805
659, 136
167. 075
275, 474
158, 654
161, 180
482, 014

168, 145
1. 493, 038

904, 637

196, 862 1, 055, 244

415, 510

250, 189 1, 296, 556

169, 577

1. ONO

2, 2013 5, 174,327

870, 21
0, 410, 051
3. 177, 335

784, 493

101, 701
4, 324, 441
1. 163, 663
1, 144, 115
2, 656, 715
3, 344, 966
5, 635, 465
3, 142, 093
4, 365, 857
3, 982, 130

843, 157
1, 473, 332

657, 565

751, 086
3, 266, 998
1, 128, 330
8, 522, 752
6, 744, 444

957, 265
5, 921, 444
3, 162, 510
1, 621, 809
9. 114, 951

890, 793

.
12. NO

100)
41, 070
7, 370, 203
1, 302, 350
3. 03. 966
2. 737. 969
5, 609, 144
6, 127, 019
1, 608, 810
2, 675, 654
4, 276, 671
6, 886, 460
4, 132, 320
5, 459, 443
5, 085, 554
1, 157, 320
1, 871, 131

970, 018
1, 057, 937
4, 102, 973
1. 400, 176
10, 305, 753
8, 643, 153
1, 221, 720
7, 854, 290
3, 915, 407
1, 986, 108
11, 371, 103
1, 125, 870

27. 9 22. 2 31.5 25. O 27. 7 37.3 27.0 47.5 40.9 25. 6 24. 1 12. 1 28. 2 27.6 32. 6 23. 8 22. 5 24.8 26.4

[graphic]

Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island

See footnotes at end of table.

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