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, Tuesday, at which time we will discuss vocational rehabilitation, and our witness will be Mrs. Oveta Hobby, Secretary of Health, Education, and Welfare. (The following were later received for the record:) Mr. ROY E. JAMES, AMERICAN SOCIAL HYGIENE ASSOCIATION, New York, N. Y., March 25, 1954. 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, Executive Director. P. S.-On the chance that the enclosed joint statement on the current status of the venereal disease control program may be of some interest to you and your committee, I am enclosing it herewith. STATEMENT OF CONRAD VAN HYNING, EXECUTIVE DIRECTOR, 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 recognized 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 1953, 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 confidence 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 venereal diseases are national 306 problems 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 leadership of the Congress in all efforts directed at their control. Let me refer briefly 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 population: As our people move from south to north, from east to west, seeking employment opportunities or simply seeing the country, some numbers of them carry with them across State lines and often very much farther than that the spirochete of syphilis and the gonococcus of gonorrhea. The evidence 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 youth of the Nation that we must depend for our defense, both in military service and in considerable part in our great defense industries, and our defense and the factors on which it depends inust be a matter of national concern, (3) Syphilis and gonorrhea are the most numerous of the serious communicable diseases: Gonorrhea ranks second among the leading notifiable communicable diseases, and syphilis third (measles ranks first). Here is a problem the very weight of volume of which calls for thoughtful consideration at the highest level, i, e., the national level. (4) The venereal diseases move far and fast, as stated above, within the continental United States. They also move undetected across international boundaries and over the oceans, entering this country at our ports and across our long undefended land frontiers. Are the individual border States, the seaport cities, to bear the whole burden of this invasion? Is it not also a matter of concern to our Federal Government, to which all our people look when they come face-toface with a problem beyond their ability to control? Venereal disease control is a long job, as is the effective public health control of every serious communicable disease for which no immunizing agent is avail able It is an expensive job, just as is the maintenance of other defenses against danger. On the other hand they are unique among our still-unsolved publie 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 address themselves for at least a decade to come. It cannot be suc 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 coordination, national responsibility if the job is to be well and truly done It is apparent from the above that this association is fearful that the proposed decentralization of grants in-aid for specific health problems may be taken by the Nation at large as an evidence of loss of interest in the problem at the national level Might it therefore not be possible and desirable to write in S. 2778 a provision not only for an annual report to the Congress on progress but also for an annual review by that body or an appropriate committee on our advance toward the goal of practicable control? It seems to us that it is only through some such device as this that we as a nation may avoid the fragmentation of effort that might otherwise necompany decentralization of control. HoD ALPANder Smith, AMERICAN NURSES ASSOCIATION, INC. Senate Offer Budding, Washington, D. C. DEAR MR. SMITH The American Nurses Association, an organization of 170,000 registered professional nurses with constituent units in 53 States and Territories, wishes to record its support of 8. 2778 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 effective use of available Federal funds, and for other purposes, We believe that the objectives as presented In this bill will provide for a more efficient administration of Federal funds allocated to States for their public health programs. Sincerely yours, ELIZABETH K PORTER, R. N.. Hon. H. ALEXANDER SMITH, UNITED STATES DEPARTMENT OF LABOR, Chairman, Committe on Labor and Public Welfare, 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 effective 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 regulations 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 expressed 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 8. 2778 would be used to duplicate the recognized functions of the State labor departments in the administration of laws governing conditions of employment hazardous 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 (including 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. $. 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 this report. Yours very truly, JAMES P. MITCHELL, NORTH CAROLINA STATE BOARD OF HEALTH, 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 understanding 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. . he wishes of a great majority of as over the last several years at dom and adaptability to handle HR. 7397 and S. 2778. Bookrams included in this "block A feeling of State and local evaluation will be stimulated. ry proponents will feel that their ciple and greater State and local all-rounded and balanced public. have many more projects under red in the categorical grant-in-aid 4 health" grant has enabled gratifydental health, other communicable ygiene of aging, occupational health, afor, air and water pollution control, water supply, sewage disposal, radiovident prevention, health education, e. training, and vital statistics. There services in venereal disease, tubercud suffer as they are gradually incorpo! health program envisioned and pro ents have been heard from those with a e category advocating killing these good yor loss of support as a member of the We have no such lack of faith and confand their advisory board and councils. to drop one of the categories from the cased block grant, may we suggest leaving the separate authorization and appropriation for rainly fewer, objections would have arisen ! ncreasing Federal appropriations and this --aintaining the Federal State local partnerhe Nation " J. W. R. NORTON, M. D., ition of such moneys is transferred from the ache States to public health departments, it can A wid be placed in a competitive pós tion with other vt of such concern of standards for the treatment this country approached anything like the standher health Felds". But they do not and until they ted to deal with angular need f this and other leading national organizations vat vn,then the metal health needs of the nation be We belive 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. DANIEL BLAIN, M. D., Medical Director. Hon. WILLIAM A. PURTELL, COMMONWEALTH OF KENTUCKY, 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 bealth portion be awarded as specific grants directly to the mental health authorities in each State. Sincerely yours, FRANK M. GAINES, M. D. STATE OF NEW JERSEY, Trenton 7, April 14, 1954. STATE BOARD OF CONTROL OF INSTITUTIONS AND AGENCIES, 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 Smith 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. |