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Senator Hill, Therefore you feel the Federal Government should make those appropriations directly to your State mental health departments for mental health programs, rather than going through the general State health departments, or in some other way?

Mr. GORMAN. In answer to that, I feel the Federal Government ought to consider the wishes of the 48 State governors.

Senator Hill. Of all the State governors?
Mr. GORMAN. Yes, sir.
Senator Hill. That is all, Mr. Chairman.
Senator PURTELL. Thank you very much, Mr. Gorman.

The committee will stand in recess until 10 a. m. tomorrow, Tues-
day, at which time we will discuss vocational rehabilitation, and
our witness will be Mrs. Oveta Hobby, Secretary of Health, Educa-
tion, and Welfare.
(The following were later received for the record:)

AMERICAN SOCIAL HYGIENE ASSOCIATION,

Veu York, N, Y., March 25, 1955.
Mr. Roy E. JAMES,
Staff Director, Senate Committee on Labor and Public Health,

The Capitol, Washington, D. C.
DEAR MR. JAMES: I hope that you received our wire of March 24, which read
as follows: "Thank you for your wire of March 22. Deeply regret that it will
be impossible for us to testify on March 29, but we will forward statement for
the record."

Let me say again that we regret that it was impossible for us to testify on
S. 2778. We hope, however, that the enclosed statement which we have prepared
on the subject of Public Health Grant-in-Aid Amendments of 1954 may be placed
before the committee and in the record of hearings.
Sincerely,

CONRAD VAN HYNING, Erecutire Director.
P. S.-On the chance that the enclosed joint statement on the current status
of the renereal disease control program may be of some interest to you and your
committee, I am enclosing it herewith.
STATEMENT OF CONRAD VAN HYNING, EXECUTIVE DIRECTOB, AMERICAN SOCIAL

HYGIENE ASSOCIATION, NEW YORK CITY The national organization, of which I am executive director, has been actively interested in the nationwide venereal disease control program for 40 years, during the better part of which progress has been made toward the ultimate goal of control, under the leadership of the Congress, which has always recogDized the seriousness of these diseases to our national health and strength. It is to urge that the Congress continue to give such leadership and to suggest a means of so doing within the framework of S. 2778 that this statement is submitted.

Progress toward the goal of venereal disease control has not been steady during the years since World War I, when we first realized the need for nationwide control measures. Progress in the 1920's was followed by a rise in rates in the depression years of the 1930's. In World War II and the years that immediately followed it rates again rose. Beginning, however, in fiscal 1947 with the modern control program based on active case finding, contact tracing, and the use of penicillin therapy, brilliant successes were achieved. In fiscal 1933, however, venereal disease rates rose again in 17 States and the District of Columbia, evidence that the situation calls for continued vigilance and, in our opinion, for continued Federal responsibility and congressional leadership.

I want to make it very clear that we believe that the grant-in-aid to the States is an admirable device for equalizing the financial burden of control as between the States in the case of a health problem of national significance. I want to make it equally clear that we have the greatest contidence in the ability of the Nation's distinguished State health officers to deal with the problem of venereal disease within their own jurisdictions. The point that I wish to stress in these remarks is that the venerval diseases are national

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L' NITED STATES DEPARTMENT OF LABOR,

OFFICE OF THE SECRETARY,

Washington, March 30, 1954.

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probleins in a way and to a degree that is not true of any other serious communicable disease, We believe that the vital importance of their effective control to the United States as a nation provides a strong argument for the continued leadershin of the Congress in all efforts directed at their control.

Let me refer bri fiy to some of the factors that remove the venereal diseases from the category of limited State or local health problems:

(1) The mobility of our ppulation : As our seiple move from south to north, from east to west, seeking employment opportunities or simply seeing the country, sume numbers of them arry with them across State lines and often very much farther than that the spirochete of syphilis and the gonococcus of gonorrhea. The prinence of this diffusion of these highly infectious diseases is very clear in every small epidemic that is reported. Here is a problem that transcends State boundaries and becomes thereby a matter of national concern.

(2) Syphilis and gonorrhea are essentially diseases of youth: It is upon the Fouth of the Vation that we must depend for our defense, both in military sírvice and in considerable part in our great defense industries, and our defense and the factors on which it depende innst be a matter of national concern,

(3) Syphilis and gonorrhea are the most numerous of the serious communicable diseamp*: Gonorrhea ranks second among the leading notifiable communicable disease, and ss philis third (measlps ranks first). Here is a problem the vers weight of volume of which calls for thoughtful consideration at the highest level, i. e. the national level.

(1) The venereal diseasee more far and fast, as stated above, within the con tinental l’nited States. They also more undetected across international houndares and over the oceans, entering this country at our ports and across our long undefended land frontiers. Are the individual horiler States, the seaport cities, to hear the whole burden of this invasion Is it not also a matter of uncern to our Fouleral Government, to which all our pwple look when they come face-toface with a problem heyond their ability to (u.ntrol?

Venereal-tisease control is a long job, as is the pertive public health control of every serious communicable disease for which no immunizing agent is avail. alile It is an expensive job, just as is the maintenance of other defenses against dinger. On the other hand ther are unione among our still-unsolveul poble health problems in that the means of diagnosis and of treatment is available to our hand. The only serious problem here is locating the patient and his contacts, That is a very difficult task to which our health services at every level must continue to aildress themselves for at least a decade to come. It cannot be stic cessfully accomplished by one State unless all its neighbors are also at work on a parallel course. There must, in our opinion, be national leadership, national ivorilination, national responsibilite if the job is to be well and truly done.

It is apparent from the above that this gesociation is fearful that the propard dere neralization of grants in-nid for specific health problems mas be taken by the

11.11 at large as an evidence of loss of interest in the problem at the national Devol Night it therefore not be possible and desirable to write in S. 277* a prins nion not only for an annual report to the Congress on progress but also for an annual rotfrw big that bouds or an appropriate committee on our advance toward the goal of practicable controls It seems to us that it is only through some stich device is this that we as a nation mas avoid the fragmentation of effort that rilght otherwin** accompany decentralization of control.

H. w" on Labor and Public Welfare, yungte, Washington 25, D. C. 117. This is with reference to your request for my comments sed the Public Health Service Act, to promote and assist 10. Sement of public health services, to provide for a more Federal funds, and for other purposes.

would authorize grants to the States to assist them, milf public health services: (2) in initiating extension of, cal services; and (3) in meeting the costs of projects zustion of public health problems of regional or national

pals would have to meet standards prescribed in regulagain General, after consultation with State health officials fetary of the Department of Health, Education, and

Du of Federal funds to be available for these grants - wonal appropriations.

Superamental Labor Officials from the various States has **** xrd of its members that this bill might adversely affect expartments. They fear that under the proposed formula

several funds, State health departments would be free to at their activities. I understand their interest and anderstand it is not intended that funds allocated under

duplicate the recognized functions of the State labor istration of laws governing conditions of employment rdainty. It is my further understanding that in States 2. Tuote industrial bygiene units are in labor departments, the

of anderal funds for general health to these departments for estszene activities could be continued under the proposed

and clarify the rarious health and welfare grants now Westzent of Health, Education, and Welfare by replacing 5 steirization for public health grants for venereal disease & Netmi and general bealth and heart disease control (in

eams for mental health and cancer control). I am in Pelinho would simplify the present system of public health Tad the operation of State public health services and

A health problems of regional or national significance. Paident recommended in his message to the Congress on ***ilaplex system of grants in this field be simplified, and *. y love rendered to the States for projects of regional or

Ostermining better methods for serving the health needs y designed to effectuate these recommendations and, si bebant advises that it has no objection to the submission of

Se of its enactment.

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AMERICAN Vins4 A HAGWIATION, INC.

Wrir York 16. V. Y., March ?5.1955 Ion IFTADIR SNITI,

Bowle omir Butkiling, Washington, D.C. Dran MR Sun: The Ameriran Vurspa Avsnelstion, an organization of 170,000 rrug!toped profesjonal nur with constituent units in 13 States and Territories winies to record its erirport of $ 2774 to amend the Publie Health Service Art to promote and a swint in the extension and improvement of publle bealth services. to provide for a more effective use of available Fueral funds, and for other purte

We believe that the oblectivo*** presented in this blll will provide for a more efficient alministration of leveral funds alleated to States for their public health programs. Sincerely yours,

ELIZABEU K Portfr, RN.

President

Committee om Labor and Public Welfare,
Mos Moatie. Washington, D.C.

WO UBEZEN OF THE COMMITTEE: You will recall that I wat op the passage of H. R. 7397 and S. 2778 as the way as por cation and admiration for the courteous and under

s doswiation of State and Territorial Health Officers.

med at these hearings.

Hopes to all bealth officers or even the executive compend of hylth and North Carolina health officer.

of time, I'm writing now personally and as secretary

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UNITED STATES DEPARTMENT OF LABOR,

OFFICE OF THE SECRETARY,

Washington, March 30, 1954.
Hon, R. ALESANDER SMITH,
Chairman, Committe on Labor and Public Welfare,

United States Senate, Washington 25, D. C.
DEAR SENATOR SMITH: This is with reference to your request for my comments
on S. 2778, a bill to amend the Public Health Service Act, to promote and assist
in the extension and improvement of public health services, to provide for a more
Pflective use of available Federal funds, and for other purposes.

The proposed legislation would authorize grants to the States to assist them, (1) in meeting the costs of public health services; (2) in initiating extension of, and improvements in such services; and (3) in meeting the costs of projects directed toward the solution of public health problems of regional or national significance. The State plans would have to meet standards prescribed in regulatious issued by the Surgeon General, after consultation with State health officials and approval by the Secretary of the Department of Health, Education, and Welfare. The total amount of Federal funds to be available for these grants would be specified in annual appropriations.

The Association of Governmental Labor Officials from the various States has cipressed to me the concern of its members that this bill might adversely affect the work of State labor departments. They fear that under the proposed formula for the allocation of Federal funds, State health departments would be free to use this money to duplicate their activities. I understand their interest and concern. However, I understand it is not intended that funds allocated under S. 2778 would be used to duplicate the recognized functions of the State labor departments in the administration of laws governing conditions of employment bazardous to health and safety. It is my further understanding that in States such as New York, where industrial hygiene units are in labor departments, the practice of allocating Federal funds for general health to these departments for carrying on industrial hygiene activities could be continued under the proposed legislation.

S. 2778 would simplify and clarify the various health and welfare grants now
administered by the Department of Health, Education, and Welfare by replacing
the present separate authorization for public health grants for venereal disease
control, tuberculosis control and general health and heart disease control (in-
cluding the separate programs for mental health and cancer control). I am in
favor of legislation which would simplify the present system of public health
grants, improve and extend the operation of State public health services and
aid in the solution of public health problems of regional or national significance.

As you know, the President recommended in his message to the Congress on
health that the present complex system of grants in this field be simplified, and
that federal assistance be rendered to the States for projects of regional or
national significance for determining better methods for serving the health needs
of our citizens. S. 2778 is designed to effectuate these recommendations and,
acordingly, I am in favor of its enactment.
The Bureau of the Budget advises that it has no objection to the submission of

LIBRARIES

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this report.

Yours very truly,

JAMES P. MITCHELL,

Secretary of Labor.

NORTH CAROLINA STATE BOARD OF HEALTH,

Raleigh, April 2, 1951.
Subject: Personal comment on S. 2778 and H. R. 7397.
Hon. H. ALEXANDER SMITH,
Chairman, Senate Committee on Labor and Public Welfare,

United States Senate, Washington, D. C.
MR. CHAIRMAN AND MEMBERS OF THE COMMITTEE: You will recall that I
recently testified in behalf of the passage of H. R. 7397 and S. 2778 as the
representatives of the Association of State and Territorial Health Officers.
May i express sincere appreciation and admiration for the courteous and under-
standing consideration accorded at these hearings.

Not having immediate access to all health officers or even the executive committee and in the interest of time, I'm writing now personally and as secretarytreasurer of the board of health and North Carolina health officer.

These proposed identical bills incorporate the wishes of a great majority of State health officers as expressed in discussions over the last several years at our annual meetings. Considerably greater freedom and adaptability to handle state and local problems is provided through H. R. 7397 and S. 2778. Book. keeping and auditing problems for the six programs included in this "block grant" are simplified and made more economical. A feeling of State and local responsibility for more careful planning and evaluation will be stimulated.

We sincerely hope that no specialized category proponents will feel that their program would suffer under the block grant principle and greater State and local autonomy. Those of us responsible for a well-rounded and balanced public health program have no such fears. We now have many more projerts under the heading of general health than are included in the categorical grant-in-aid programs and the freedom under the “general health" grant has enabled gratify. ing progress in the teamwork approach to dental health, other communicable diseases, hearing and vision, school health, hygiene of aging, occupational health, diabetes, other chronic diseases, migratory labor, air and water pollution control, food and milk sanitation, vector control, water supply, sewage disposal, radio logical health, hygiene, of housing, home accident prevention, health education, laboratory, public health nursing, nutrition, training, and vital statistics. There is, therefore, no good reason to expect that services in venereal disease, tubercu. losis, mental health, cancer or heart would suffer as they are gradually incorporated in the sound and balanced general health program envisioned and provided for under H. R. 7397 and S. 2778.

Letters have been received and statements have been heard from those with a narrow, specialized interest in only one category advocating killing these good bills because of fear of losing identity or loss of support as a member of the team rather than in standing apart. We have no such lack of faith and contidence in State and local administrators and their advisory board and councils. Should it become desirable, however, to drop one of the categories from the teamwork approach under the proposed block grant, may we suggest leaving the remainder intact and setting up a separate authorization and appropriation for such a category. Probably no, or certainly fewer, objections would have arisen to these proposed bills in a period of increasing Federal appropriations and this emphasizes again the importance of maintaining the Federal-State-local partner. ship support for health services in the Nation. Respectfully submitted,

J. W. R. NORTON, M. D., Secretary and State Health Officer.

AMERICAN PSYCHIATRIC ASSOCIATION,

Washington 6, D. C., -1pril 8, 1955. Hon. WILLIAM A. PURTELL, Senator from ('onnecticut, Senate Ofice Building,

Washington, D. ('. DEAR SENATOR PURTELL : I respectfully call your attention to this association's opposition to Senate bill S. 2778, now under consideration by the Senate Subcommittee on Health. This bill would replace separate categorical grants with one general health grant. It would wipe out separate mental health grants-in-aid for community services (mental health clinics).

Federal grants-in-aid for community mental health services have been the greatest single stimulus to the derelopment of mental health clinics in the various States in the past decade. In the rapid development of such services lies the main hope for reducing gradually the growing burden of mental hospitalization in this country.

If remponsibility for the utilization of such moneys is transferred from the "mental bealth authorities" in the States to public health departments, it can only mean that ineutal health will be placed in a competitive position with other public health needs,

This would not be a matter of such concern is standards for the treatment and care of the mentally ill in this country approached anything like the standards we take for granted in other health celds. But they do not; and until thes do singular methods must be utilized to deal with a singular needl.

List October, representatives of this and other leading national organizations and a gencies testified at great length on the metal health needs of the nation before the Wolverton committee. We bel: "re that any member of the Congress who

reviews this testimony, now published, will agree that the meager headway now being made in tackling mental illness should not be further jeopardized by placing mental health needs in competition with other health needs for Federal funds. We should be appy to offer further testimony in support of our position. Sincerely yours,

DANIEL BLAIN, M. D.,

Medical Director.

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COMMONWEALTH OF KENTUCKY,
DEPARTMENT OF MENTAL HEALTH,

Louisville 2, Ky., March 26, 1954. Hon. WILLIAM A. PURTELL,

United States Senate, Washington 25, D. O. DEAR SENATOR PURTELL: In lieu of making a statement at the scheduled hearings of the Senate Subcommittee on Health on H. R. 7397, I would like to present the following statement for inclusion in the record :

The Department of Mental Health of Kentucky recommends that a special appropriation be made for the mental health grant-in-aid program, rather than combining this appropriation with grants-in-aid for other health purposes.

Kentucky has recognized that mental health is such a great problem that it has established a separate state department to administer the hospital and clinic program for mental health.

The mental health activities previously carried on by our Department of Public Health have been transferred to the Department of Mental Health in order to centralize and strengthen our effort, not only to treat the mentally ill but to provide out-patient clinics for the early detection and prevention of mental illness, and for the education of the public in sound mental health principles.

The unification of all the categorical grants would tend to nullify these efforts to strengthen our program. Therefore, we recommend strongly that the mental health portion be awarded as specific grants directly to the mental health authorities in each State. Sincerely yours,

FRANK M. GAINES, M. D.

Commissioner.

STATE OF NEW JERSEY,
STATE BOARD OF CONTROL OF INSTITUTIONS AND AGENCIES,

Trenton 7, April 14, 19.5.4. Hon. H. ALEXANDER SMITH,

United States Senate, Washington 25, D. C. DEAR ALEX: The State board of control, on April 8, recorded its opposition to H. R. 7397 and S. 2778 by the adoption of the following resolution:

Whereas for more than 35 years activity in the field of mental health, both in the conduct of institutions and in clinical and prevention activities, had been lodged in the department of institutions and agencies; and

"Whereas knowledge of the subject and experience in the field had therefore been acquired in the department of institutions and agencies; and

"Whereas it is now proposed to require that whatever Federal matching funds for mental hygiene should be made from Congress would have to be put in a single package with other health funds to the possible detriment of the prosecution of adequate mental health activities in this State: Therefore be it

"Resolved, That the State board of control of the department of institutions and agencies desires to record its opposition to the passage of H. R. 7397 and S. 2778 and the provision in these bills for including mental hygiene funds in with all other types of health funds be omitted or amended so that the State of New Jersey may continue to decide its own problems in this regard and carry on the mental hygiene activities as heretofore; and be it

** Resolved further, That copies of this resolution be forwarded to Senators Swith and Hendrickson. to our Representatives of the State delegation, and to the Senate Subcommittee on health which has these measures under consideration." Very truly yours,

REEVE SCHLEY, President.

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