MOVE OF SURGEON GENERAL'S OFFICE TO BETHESDA

Mr. FOGARTY. Dr. Stewart, what would seem like a small thingyour move to Bethesda-has caused about as much comment as anything since you have been in office. Whose idea was the move? yours or the Secretary's.

Dr. STEWART. I proposed it to the Secretary.

Mr. FOGARTY. Why?

Dr. STEWART. Several reasons, Mr. Fogarty. When I came into office I found that the Bureau of Community Health was scheduled to move to the two buildings in Virginia, the Surgeon General's Office was scheduled to move out of the north building, all of this the result of the space needs of an expanding department, and the Bureau of Medical Services had moved to Silver Spring about 2 years earlier. When the Bureau of Community Health moves to Virginia, the elements of Community Health which are in Silver Spring will be moved to Virginia to consolidate that Bureau together. At the present time we are located in six buildings in Southeast Washington, two of which are scheduled to be torn down, two temporary buildings, in 1966. Then there is an expansion of the entire Department involved.

At that time my office was scheduled to move to the south building.

RELATIONS OF SURGEON GENERAL'S OFFICE AND NIH

Secondly, we began to look at the problems of the Public Health Service. There is one which I was well aware of before I came into office; it is still there and we are addressing ourselves to it. This has been the unhappy relationships between the Surgeon General's Office and NIH. It seemed to me that with the experience that I have had in NIH and with the cordial and mutual respect that Jim Shannon and I have for each other that by moving to NIH I could work more informally with Jim and his staff and make our organization more efficient in the whole area.

This I think can be done without changing any organizational charts around.

Mr. FOGARTY. You have not given me a good reason yet. What is the next reason?

Dr. STEWART. The next reason is that Dr. Shannon feels, has felt, and I think with a fair amount of justification, that in the role of NIH in the total field of bioscience he has had the problem of what he calls layering. The Surgeon General's Office was in the way if he needed to work with the Office of Education, the National Science Foundation, on the major supporters of the biosciences in the university area. He is quite right. I think by this move and working closer together I could help with that problem which Jim has. I intend to use Jim as the principal scientific man for the Public Health Service.

Mr. FOGARTY. So you will not run both?

Dr. STEWART. I have no intention of running both. NIH is part of the Public Health Service, a major research bureau. Dr. Shannon is the Director of it.

PHS OFFICES IN WASHINGTON METROPOLITAN AREA

Mr. FOGARTY. At how many different locations are Public Health Service offices located in the metropolitan area?

Dr. STEWART. I can't give you an exact figure, Mr. Fogarty in the twenties. It is 25 or 26, I believe.

Mr. FOGARTY. Do you have any long-range plans for cen tion?

Dr. STEWART. No; we have no long-range plans at all, moment, in facilities development.

Mr. FOGARTY. Do you think some study should be made of thi Dr. STEWART. Yes, sir. There will be proposals.

REORGANIZATION OF THE SERVICE

Mr. FOGARTY. What plans do you have for reorganizing the Of course, I get the Environmental Health Letter every two Dr. STEWART. So do I.

Mr. FOGARTY. Mr. Fishbein has a bestseller here, I guessdated February 1. His entire front page talks about the story he has on the sweeping reorganization of the Public Hea ice.

Dr. STEWART. Mr. Chairman, I did write the memorandu Secretary. This was giving my ideas as to what is neede reorganization of the Public Health Service. There are ma memorandums which have been prepared, and staff papers these are being looked at, reviewed, studied, analyzed by the C headed by Dr. Corson. They have not finished their study ye are pretty close to it.

ENHANCING FLEXIBILITY OF STATE HEALTH GRANTS

Mr. FOGARTY. Then you are familiar with this article in Street Journal of January 19, I presume, "Federal Thera Surgeon General Seeks Measures To Widen Health Careclude Strengthening State Health Units and Less Stress Diseases."

What did they mean by that? That may not be in your It is written by a writer named Spivak.

Dr. STEWART. I believe what he has reference to is the de of a legislative proposal we will have. You will recall Congress extended section 314 (c) for 1 year, the catego grants, directed a study of the formual grants, and directed up with a proposal for the State grant programs in the fu

So far as the categorical diseases go, one of the problem health departments have been complaining about is that grants, many of them, are for a specific disease, like he control, cancer control, or something else, so they must ther money directly for these purposes and they have no flexi into what they see as the needs in their State.

We hope we can devise a system of State grants which w State health departments the responsibility and some mor in carrying out the health services programs.

PROPOSED REORGANIZATION OF PHS

Mr. FOGARTY. Regarding the Fishbein letter, I will inse page at this point in the record.

(The information referred to follows:)

[From the Environmental Health Letter, vol. 5, No. 8, Feb. 1, 1966]

EXCLUSIVE: SWEEPING REORGANIZATION OF PUBLIC HEALTH SERVICE

Surgeon General William H. Stewart has submitted a top-to-bottom reorganization plan for the Public Health Service which would establish six bureaus and make the National Environmental Health Sciences Center in North Carolina a part of the National Institutes of Health, Environmental Health Letter has learned exclusively.

Dr. Stewart submitted his proposal to HEW Secretary John Gardner in midJanuary, based on a draft of the Corson Committee's recommendations and other advisory opinions. We have seen a copy of the memorandum, which seems certain to be adopted, and this is what it establishes:

Bureau of Disease Control, to include all current environmental and community health programs, the Communicable Disease Center, and quarantine activities of the present Bureau of Medical Services. It would be charged with surveillance of illness and death associated with disease, monitoring of contaminants in the environment, establishment of human tolerance levels of such contaminants, and to conduct and support research in these fields.

Bureau of Health Services, to include participation in titles 18 and 19 of the medicare program and other provisions of the new law applicable to PHS, the current Division of Hospitals, the Indian health program and other direct service activities. The Bureau would work closely with private medicine at the local, State, and Federal levels and would be comparable, says Dr. Stewart's memo, to NIH's role in biomedical research.

Bureau of Health Manpower, which would administer all health manpower programs, school construction, student scholarships and other forms of educational support to improve the quality and quantity of health manpower.

Bureau of Mental Health, including elevation of the present National Institute of Mental Health, the drug addiction hospital at Lexington, Ky., and St. Elizabeths Mental Hospital.

Bureau of Child Health, consisting of the present National Institute of Child Health and Human Development, the mental retardation control programs of PHS and certain medical programs of the U.S. Children's Bureau. This Bureau would hopefully serve as the focal point of a massive attack on children's diseases comparable to the effort in mental health.

National Institutes of Health would continue as a Bureau, minus the National Institute of Mental Health and the National Institute of Child Health and Human Development, but adding the National Institutes of Environmental Health Sciences, the North Carolina facility. Of the latter move, the memorandum states:

"The greatest need in environmental health is for scientific information on the impact of contaminants on human health. This is essentially a research challenge, susceptible to organization and administrative methods which have proved successful in other health research fields. The NIH structure would provide the most appropriate and efficient setting for this environmental health research program."

The Office of the Surgeon General would be strengthened by expanding the present Division of Public Health Methods into a Service-wide organization and renaming the Division of Program Planning. Other steps would create the Division of Grant and Contract Support by combining the present Division of Research Grants of NIH and the Office of Grants Management of the Bureau of State Services. The Office of International Health would also be expanded to carry out expected additional responsibilities in this field.

Environmental health activities would be supervised, along with other consumer protection activities, by an Assistant Secretary of HEW for Environmental Health, still to be named. This would presumably open the way for a special section at the HEW level dealing with enforcement activities of all kinds, including air and water pollution.

The memorandum dealt only with organizational matters, and therefore did not include one of the most far-reaching and controversial recommendations of the top-level advisory Corson Committee (Environmental Health Letter, Nov. 1). This recommendation calls for abolition of the Commissioned Corps and creation in its place of a Health Service Corps taking in all PHS employees working, how

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ever remotely, in the health field. Dr. Stewart has appointed a comm study details of this proposal before taking any action, which would d require new legislation and therefore unlikely to become effective for so The present strategy is to include the PHS reorganization as part of bus reorganization plan for the executive branch, to be submitted by I Johnson, and thus no new legislation would be required in the absence tion by Congress.

NOTE. After Dr. Stewart submitted his memorandum, he also re recommendation from the National Advisory Committee on Radiation f lishment of a National Center for Radiological Sciences, under PHS expanding and coordinating the widely dispersed activities in this field man of NACOR is Dr. Russell Morgan of Johns Hopkins.

PROPOSED SUPPLEMENTAL FOR OCCUPATIONAL HEALTH

Mr. FOGARTY. You will ask for $6 million more for occu health. Did you ask for that?

Dr. STEWART. No; we did not.

Mr. FOGARTY. Was he wrong in this article?

Dr. STEWART. He is partially right and partially wrong.
Mr. FOGARTY. Generally he is a pretty good writer.
Dr. STEWART. He certainly is.

Mr. FOGARTY. I don't know where he gets his information.
Dr. STEWART. Neither do I.

Mr. FOGARTY. He gets some pretty good information.
Dr. STEWART. Mr. Fishbein is a good reporter.

Mr. Fogarty, there was

Mr. FOGARTY. Is the front page pretty factual?
Dr. STEWART. Yes; until it gets to the next side.

My memorandum did not go into the personnel change there on out he must also have seen an earlier draft of th report which has some of those things in it. Since they finished their activity yet, it is accurate from what he sa point.

Mr. FOGARTY. I have not seen the Corson report.

Dr. STEWART. There isn't any Corson report yet finalized.

RESEARCH ON AGING

Mr. FOGARTY. I have an article here which is headed "Dr. Is Unhappy."

Dr. James Shannon, the Director of the Institutes of Health, said seminar for science writers on the subject of NIH aging research tha unhappy with the progress which has been made so far.

Then the article goes on to say:

Well may he be unhappy. The following curves based on the N Life Insurance Co.'s historical statistics depict changes in life ex the age of 60 which have taken place from 1789 until 1955 and brought up to 1963 on the basis of "U.S. Vital Statistics."

From your statement you are a little unhappy with th made, also?

Dr. STEWART. Yes. Most of the progress in life expe been saving lives at the younger age groups.

When they get up to that age, what has been increase of ancy after age 60, there has been very little change over t

Mr. FOGARTY. This article goes on to say:

If these curves were depicting the rate of progress of an industrial project, of sales, or of military research, there would have been an upheaval and the research manager in charge would have been released long ago.

I cut it out of something I was reading.

Would you care to comment on it?

Dr. STEWART. I had not seen the article. He is quite right about the projections of life expectancy of the older age groups.

Mr. FOGARTY. You feel about the same way?

Dr. STEWART. I am not so sure it is the sole measure of the success of research. Much of research now in the aging area is trying to understand the process of aging, what actually happens.

MEASURING THE HEALTH OF THE NATION

Mr. FOGARTY. Have you developed any method of measuring the health of the Nation so that we can tell how much it is improving, or even whether it is improving?

Dr. STEWART. There are two classical measures: the overall mortality rate and the more sensitive one which is accepted by everyone as a measure of the health of the people, the infant mortality rate. Mr. FOGARTY. You mentioned that in your opening statement. How does this country stand-10th, 11th, 12th?

Dr. STEWART. I think it was 14th in 1964.
Mr. FOGARTY. It is getting worse.

Dr. STEWART. Yes. In 1963 it was 12th.

The 14 shows a decrease in mortality but the other nations decreased at a more rapid rate.

NATIONAL HEALTH SURVEY

Mr. FOGARTY. You speak about mortality. I was thinking more about measuring how healthy people are.

Dr. STEWART. I think here we get into the measures of morbidity and disability. The national health survey is invaluable there. It has established a base for us to measure the progress through the household interview. We now have completed the second phase of the health examinations survey of the population, and we are about to embark on a third measure which is hospital discharge by diagnosis. We begin to get a base line of data of the amount of morbidity there is in a population within the limitations of the sensitivity of the measurement devices.

Secondly, in the amount of disability we have a measure. Disability has been measured mainly on inaction, inability to get out of the house, inability to get around.

AMERICAN HEALTH TODAY COMPARED TO 5 YEARS AGO

Mr. FOGARTY. Are we a healthier people as a nation than we were 5 years ago? That is the thing I am getting at. Can we measure to determine that?

Dr. STEWART. If you use these measures as an indication of whether we are, yes; we have improved some. The infant mortality has gone down in the last 5 years, not astoundingly. Infant mortality rate has stayed about the same.