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, 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 rend 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 DIzonoz, AmericAS POBAL HYGIENE ASSOCIATION, NEW Yox CITY The national organization, of which I am executive diretor, ban bera ne^ively interested in the nationwide venereal diwave Coers. VIVIam for 4) genie, during the better part of which progress Las been made toward the skimatk goal of control, under the leadership of the Colquem, wi ́s to* *.*ge th 11 nized the seriousness of these discams to our Latina. 12' and 'L is to urge that the Congress contose to give ass later) YA a means of so doing within the framewer of bir yana **** submitted. Progress toward the goal of regere dwa weny during the years sie Wind War I vies were Progress in the 1921 var 19 ore wide control measures in the depression years of the 2837& I want to make it was meet ability of the SALE LE 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 must 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 rauks 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 available. It is an expensive job, just as is the maintenance of other defenses against danger. On the other hand they are enique among our still- unsolved public 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 sue 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 accompany decentralization of control. Hon Arxander Smit AMERICAN NURSES ASSOCIATION, INC. Renate Office Building, 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 effelent administration of Federal funds allocated to States for their public health programs Sincerely yours, ELIZABETH K PORTER, RN. 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 $. 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 (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. 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 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. 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. Bookkeeping 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 publichealth program have no such fears. We now have many more projects 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, radiological 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, tuberculosis, mental health, cancer or heart would suffer as they are gradually incorpo rated 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 conndence 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 sugest 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. Hon WILLIAM A. PURIELL, AMERICAN PSYCHIATRIC ASSOCIATION, Senator from Connecticut, Senate Office Building, Washington, DC. DEAR SENATOR FURTELL I respectfully call your attention to this association's of position 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 rant. It would w pe out separate mental health grants in-aid for community services chental health elimies). Federal grants in aid for community mental health services have been the greatest single stimulus to the development of mental health clinics in the various States in the past decade In the rapid development of such services lies the man hope for reducing gradually the growing burden of mental hospitalization in this country If responsit ility for the utilization of such moneys is transferred from the "mental health authorities" in the States to public health departments, it can only the in that mental health will be placed in a competitive pos tion with other public health needs This would not be a matter of such concern if standards for the treatment and care of the mental y ill in this country approached anything like the stand ards we take for „tanted in other health felds But they do not, and until they do singular methods must be utilized to deal with a× ngular need Last October, representatives of this and other leading national organizations and agencies textiled at reat length on the metal health needs of the nation before the Wolverton committee Webel ve 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. C. 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. 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. |