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million in 1951, and in 1932 $36 million, and 1953 $32 million, and a departments of health, who support in principle in 1954, which is this year, of course, it dropped down to $22 million. roof fact, speaking for the group, I can say we and now you propose to drop it down to $19 million, approximately. His is a great improvement over the arrangement
fel Is that right? Secretary HOBBY. Yes, sir. That is right.
arutive committee of the Association of State Senator Hul. You can write all the legislation you want on the
, I participated in that executive combooks, but if you do not provide the money I do not know how you are
La action on, the bill. Unfortunately, due to lack going to do it. I am not going to ask Dr. Scheele to comment on that,
"smilble to get the specific recommendations of each but I think I know what his comment will be.
Di Territorial health officer, as had been planned, You talk about being dynamic and looking forward, but you do not
mert of the 28 States at the end of this document. move unless you have gas in your car. Certainly in these prograins
• a frer, has authority to make this statement, and you do not move unless you have the funds with which to move.
meterts as faithfully as we are able to put it the That is all, Mr. Chairman. Senator PURTELL. Thank you, Mrs. Secretary, and we thank your
bial responsibility for the advancement of the associates for being here. We look forward to your visit tomorrow,
w with particular emphasis on the prevention of at which time we will discuss the rehabilitation and vocational
az ideaths rests with the State health departments. program.
public health services, varying in each State, is Dr. Erickson was to be our next witness. He is not here but I
lity of local health departments. For many am informed Dr. Norton, a member of the executive committee of the Association of State and Territorial Health Officers, will appear in
r tren dereloping an increasing effective Federalplace of Dr. Erickson. Is that correct?
Spurred by this Federal-State-local part
Stole have been made in the reduction of such STATEMENT OF DR. J. W. R. NORTON, NORTH CAROLINA STATE the venereal diseases, tuberculosis, and the in
safe drinking water, milk, and unsafe sewHEALTH OFFICER AND MEMBER OF THE EXECUTIVE COMMITTEE
be printly there has been progress in reducing the OF THE ASSOCIATION OF STATE AND TERRITORIAL HEALTH
firart disease and in the prevention of aftereffects OFFICERS
2:41. es in children. There have been other sig. Dr. NORTON. Yes, sir.
butter health for our people such as better nu
ufant health. dental health, and so on. Senator PURTELL. Dr. Norton, we welcome you here and we are
21 betulit from these activities is tremendous. glad to hear you. You have a prepared statement?
cestvities and returns on this joint Federal-StateDr. XORTON. Yes, sir.
im Bent are only getting well started. 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 location of State and Territorial Health Officers is a group that does not have a Washington staff
, or a full-time oflice 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 cretary is from Wyoming. Being from North Carolina, it was a little more convenient for me as a member of the
Tupe effectively in the public interest under the
a 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.
tarying local needs, and bookkeeping and audDr. NORTON. Mr. Chairman and members of the committee, it is my
sal support provision, the bill encourages States privilege to represent, and to speak for, the directors of the official
came their existing services and to study and develop
of these forward steps toward better health, ya mpetus of the grant-in-aid Federal-Statea' has made possible the strengthening of exist*** of new, preventive services. Congress in its ni fuwls for attacks on specific disease problemis ... mental, tuberrulosis, and cancer. These have
ategorival grants. S. 2778 amalgamates these same with that for general health in one package si lo lare with the State and local health departont of public health services.
as we have been aware of the need for the ** Lew mechanism would provide in the interest 114 wronomical use of the funds. Relative needs it lities vary greatly from State to State beyond "uple with them through a single formula. We
's of S. 2778. Each State will be freer to use
day prore more effective and economical.
State and Territorial departments of health, who support in principle $.278. 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
The committee, however, has authority to make this statement, and
ition of our members.
, injuries, and deaths rests with the State health departments. Jetual 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-Stateluval 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 windon 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 terned a block grant to share with the State and local health departtuents in meeting the cost of public health services.
Is 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.
1-. ful zient, too, has a clear-cut responsibility to assist
lequate health services within the State for
نه تنها یک سر
::11 Het is definitely a responsibility of the Federal ན་ rajta a cing the health of the civil population during
Ing. Lately an integral phase of national defense. Å
sential to adequate production of the sinews - in lmvernment in times of national emergency does
of the tramwer for the defense of the Nation. By the 1-3 ani w logical that the Federal Government should
Ins the health departments in the execution of a sound bana (f:
ou des gned to produce physically, mentally, and the sot fr!!
z robust individuals to serve in an emergency. sisi 1. for..
* oltrumber us quantitatively. We must rely for NH46.7V
T- ..; 1; ';
berrial a defenders. Thiirtoprofcrofiifiimmy FMRTI...I's of
s, if an act of Congress the United States Public the state rad tu erilari rend' meriti, as well as pengel with responsibility of preventing the interbard post to take part 17" "tofele 1. "ing pools prrallt me. It would manifestly be foolish to throw a -to-I!. rof 191.11:01..
ist each State for the purpose of keeping comMot Stutto ir ap: 17,toto ai pribifisere than crossing State borders. For a number of
. Iw-6,5 more 5 *rrent of t... appropriat:n. Fpse al fred for sal prvovente 5. Service
, in cooperation with various health We are of the options of sirene funds are a'rols arailable to the 138HW how best this legal responsibility of the National I1.-01.tranf Hrajer, for preparih ir. pube:-.ealth tehnique
pan be met. a 5 px pretit allow ation for -- al projects will love iftiiert. We za ed esperimentation it has been a joint conrreotomiend that p**a! prijart rules to public are other nonprofit ** way to prevent the interstate spread of disease 1911 zat jotz ar,agriste setzted to have the approval of State
Es wire. To accomplish this result some type of health, or state mental health a'thorities, as the cat may be in the interont of coordination and efiktive use of the funds within each group thinking the local health department, Stote.
mi personnel, has been found to be the ideal We rely on the wind judgment of Congre torme continuance of the excellent health progre- bv maintaining the effective partner
rytead of disease. Therefore, the allotment of whip upport with state and doxal appropriating budim. There are alırady mounting public expenditure to care för unfortunate older people in our agire population. A significant portion of that erpendi ture in due to ill health, a part of which could have been prevented.
it but as a just payment by the Federal GovIt is word proedure to enlarge the possibilities of prevention of the need to provide a con-iderable amount of those funds, particularly in view of the propert that the total load will continue to grow.
As we get people to take advantage of what is known about sound nutrition and the hazards of overweight as they contribute to heart d1-4, high blood promise, and diabetes, of early detection of caneer, of prevention of rheumatic fever, of the early diagnosis and care and eventual prevention of mental illness, of the prevention and early di-covery of tuberculornju, and so on, we can expect to reduce the need for fund to care for unfortunate older people.
There is much that can be accomplished through stimulation provided by Federal funds to advance fuller, more productive living that would not come about without them.
The responsibility of safeguarding the health of the citizens of each State repons in the State board of health. Local governments have rapidly increased their support to exceed, in some states, the State funda.' You saw the overall chart, which showed they had in the country overall e Preecled the State funds
eft is necessary
Soliferases at the source and consequently pre
funds for the maintenance of local health deS. State health departments should not be conpritlu departments for supplying a service which prom more efficiently and effectively than can Further two reasons it is definitely felt that the ** unde a moral and legal responsibility to render
y the States in supporting effective health iral agraphs were added also to emphasize the logic vidimuation and strengthening of the traditional pulportFederal, State, and local. Changing ielpful administratively as S. 2778 provides
. atoms, however, is even more important and with Site a rapidly improving buy this is the time to Spas it is a rapidly improving buy is because we
nevy areas where formerly we were
"por initial reaction to the provisions of S. 2778.
3 from the standpoint prevention.
will be forwarded to your chairman.
The Federal Government, too, has a clear-cut responsibility to assist in the maintenance of adequate health services within the State for the following reasons:
First, national defense is definitely a responsibility of the Federal Government. Safeguarding the health of the civil population during peace and war is definitely an integral phase of national defense. A healthy citizenship is essential to adequate production of the sinews of war. The Federal Government in times of national emergency does not hesitate to draft manpower for the defense of the Nation. By the same token it would seem logical that the Federal Government should aid the State and local health departments in the execution of a sound public-health program designed to produce physically, mentally, and emotionally sound and robust individuals to serve in an emergency. Our potential enemies outnumber us quantitatively. We must rely on the quality of our defenders. In the second place, by an act of Congress the United States Public Health Service is charged with responsibility of preventing the interstate spread of disease. It would manifestly be foolish to throw a cordon of oficers around each State for the purpose of keeping communicable diseases from crossing State borders. For a number of Jears the Public Health Service, in cooperation with various health departments
, has studied how best this legal responsibility of the Public Health Service can be met.
.Ifter years of trial and experimentation it has been a joint conclusion that the best way to prevent the interstate spread of disease is to control it at its source. To accomplish this result some type of public health machinery is necessary:
Finally, as a result of group thinking the local health department, manned by well-trained personnel, has been found to be the ideal agency for controlling diseases at the source and consequently preventing the interstate spread of disease. Therefore, the allotment of general health Federal funds for the maintenance of local health departments through the State health departments should not be considered a Federal subsidy but as a just payment by the Federal Goveniment to the local health departments for supplying a service which the agencies can perform more efficiently and effectively than can a Federal
agency. For these two reasons it is definitely felt that the Federal Government has a moral and legal responsibility to render adequate financial aid to the States in supporting effective health services State and local.
The above two paragraphs were added also to emphasize the logic of, and necessity for, continuation and strengthening of the traditional tripartite financial support--Federal, State, and local. Changing haines and formulas is helpful administratively as S. 2778 provides. The level of appropriations, however, is even more important and with preventive health services a rapidly improving buy this is the time to mcrease our investment.
The reason why we say it is a rapidly improving buy is because we can accomplish so much more in new areas where formerly we were unable to do anything from the standpoint prevention.
Following this statement we have attached a summarized report from 28 States on their initial reaction to the provisions of S. 2778. As others come in they will be forwarded to your chairman. .
sorterite mental health authority they have not been able to
ou their State of tiscal 1956 over fiscal 1955.
prin spite of the projected loss of $18,000 a year in Federal
Permit me to close with the regret that we could not more thoronghly go into the possible implications of S. 2778 and therefore are in a position only to state that we endorse it in principle with certain recommendations for modification and that adequate financial support for public health services is more vitally needed than even the admini-tratively helpful provisions of this proposed bill.
May I express our appreciation for this opportunity to bring these, our recommendations of the Association of State and Territorial Health Offices, to you.
Senator PURTELL. Thank you, Dr. Norton. Your document containing the State reactions will be made a part of the record at this point, without objection.
(The document is as follows:) STATE REACTIONS TO S. 2778 RECEIVED So Far (MARCH 29, 19.34) by EXHITE
COMMITTEE OF ASTHO
ortsion and improvement or type 2 grant until it is more
fies that the basic services which are not adequately pentru tine would need this additional support.
to make detailed comments but believes it has some Nate.
de given by block grants and the additional latitude to ***** I determining fiscal policy.
rjether funds received under the terms of the proposed Mappropriation by their State legislature before their T ise its share. If so, feel that they will fare at least satezorical allotment policy. 3 of the new formula.
Approves block grant and specifically goes along with the at. M. A susrestion of liimping type 1 and 2 funds.
Diaproves the fact that fiscal 1954; proposed funds show reductions as compared to fiscal 1957.
ARKANSAS Approves blok grant and would prefer the scă percent, 10 preent, 5 percent d.trilut on of type 1, 2, and 3 funds.
Oppunts direct allocation of public aid funds to any other ageniy than the patibile health agency.
(ALIFORNIA Approves block giants. Would prefer să percent, 10 percent, 5 fuperent des tribution.
D. mapproves the decrease in funds available to California which would amount to ali ainost 30 percent loss in - al 19. over fiscal 1:17.7.
Disapproses adopt100 of the bill as it now stands although agreeing that ureater it ribility in the use of funds would lip desirable. Agreps with Dektor Surton's March 12 matopent before House Committee on Interstate and l’orein Commerre on II. R. 18:17 in that adequate tinancial support for public health meru pos is more vitally needed than administratively helpful revisions such as eliminat:on of some of the categorical grant restriccions i refers the perent, 1) pirulit, u prir'nt d stribution among * 12, and 3.
D) kapp**** kranen leilig mide to projects in the states without bealali thrush the offiial state agen y
PIORIDA 1* not evit humantle alwut supporting S. 277* because it proposes to earmark Pinelw for tew categoriewer 12) and (3) Extension and improvement, and Spral fire jentn" when funds are not suithe tent for "xisting categoriens
spruded for in S. 2778 as funds will be more wisely spent & prefer si percent, 10 percent, 5 percent distribution.
Fagomiriple and likes the increased flexibility and adaptability
department areas. 111! amount, say 10 and 5 percent, respectively, under portare going to support (1). i be approved by State health department or mental
en support continuation in the Federal-State-local part
Azreen with the principle of holen k grants. Believes 0 percent to 15 percent mbonid le mode nia lubie to type 1 Banerai nupport grants,
Dihen loons of funds in application of new formulae of fiscal 1976 over fiscal 1935,
IHNA Feels that the boek grant could proside more flexibility to the individual State. aliprotes of this.
18.9175 as compared to categorical grants.
antages depend entirely on amounts appropriated and
three types of grants.
* Turin-aid fund instead of categorical grants. *** the Department of Health, Education, and Welfare to 'n 15e 2 extension and improvement and type 3 special