both in our established programs and in our new activities stemming from last year's important series of legislative actions in health. Since this is my first appearance before you as Surgeon General and because I am convinced that we are at a vitally important crossroads in the history of health and medicine, I thought it might be helpful if I spoke briefly of my own views as to the changing role of the Public Health Service in moving toward the health goals of the future. STATUS OF HEALTH OF AMERICAN PEOPLE The statistical indexes of the Nation's health suggest the directions in which we must move. The death rate in the United States has remained almost level for a decade; it now stands at 940 deaths per 100,000 people, while the average rate for the last 10 years is 954. Life expectancy increased in 1964-the last year for which complete figures are available to 70.2 years as compared with 69.9 years-a very modest gain. Infant mortality rates also declined slightly in 1964, but we remain well down the list of nations in this important measure of health. The national health interview survey shows that some 84 million people in the United States, about 45 percent of the civilian population, suffer from one or more chronic conditions. About 23 million are limited in their activities by chronic illnesses or impairments. These figures, no less than the death rates, represent a continuing challenge to the national health resource. The past year was free from major epidemics. Only 44 cases of paralytic polio were reported in 1965. For the 18th successive year, the United States was successfully protected against the importation of quarantinable diseases from abroad. NEED TO TRANSLATE SCIENTIFIC KNOWLEDGE INTO HEALTH CARE But the broad trends make it clear that, despite major advances in medical research and a general rise in national standards of living, we cannot afford to be satisfied with the present level of health of the American people, proud though we may be of our accomplishments. I am convinced that we can move ahead significantly if we improve the quantity and efficiency of health manpower, the element basic to all health services; if we find new and better ways of removing the remaining barriers blocking access to health care for all; and if we develop new methods and resources for the rapid conversion of scientific knowledge into health care. And I believe further that public recognition of these unfilled needs underlies much of the recent health legislation. 1965 HEALTH LEGISLATION Last year's health legislation did more than increase the size of the Federal commitment to health in quantitative terms. It altered the nature of that commitment in several significant ways. In conjunction with other enactments of the immediate past, last year's actions. call for a new kind of health leadership in the Federal Government, in partnership with physicians, hospitals, medical schools, and other agencies and institutions. It is this call which we are seeking to answer as we examine the structure of the Public Health Service and the assumptions on which that structure is based. ROLE OF FEDERAL GOVERNMENT Legislation has expressed a public decision that the Federal ment shall be involved, far more deeply and broadly than eve in making health services more widely and readily attainable the central thrust of titles 18 and 19 of the social security ame and of the heart disease, cancer, and stroke amendments. the accent is on quality as well as accessibility of care. Ther Public Health Service needs to use its own medical care ac demonstrate promising innovations. We need to use our res ties in connection with medicare not only to establish sta quality but also to help in assuring that those standards are Recent legislation has strengthened and diversified our ro ing to supply the resources to care for the health of the people. The Hill-Burton program has been amended to p stress on planning and to permit an attack on the critical of modernizing obsolete facilities in our major cities. We greater emphasis to long-term care facilities. Last year's the Congress permitted us, through supplemental appropr stimulate the creation of home health services where none ha before. HEALTH MANPOWER Another significant advance has been the development o lic Health Service role as a full partner in the developmen manpower. The Health Professions Educational Assista 1963, the Nurse Training Act of 1964, and the Health Amendments of 1965 enable us to support a nationwide ef manpower shortages in the professional categories and the quality of the manpower produced. NATIONAL SYSTEM OF MEDICAL LIBRARIES Many other new opportunities and challenges have bee to us. We are now able to foster the dissemination of rese edge through the creation of a national system of medic We are able to support the operation of community mental ters, thereby giving an urgently needed impetus to this pro will revolutionize the treatment of the mentally ill. W given new and needed authorities to control air pollution a take a frontal attack on the disposal of solid wastes. The central point I wish to stress is the growth and di of the Federal role in health. These responsibilities are dif many agencies at the Federal level, and this diffusion ter similar patterns in the States and communities. Many health are waiting upon a strong focus of leadership fo sided program. ORGANIZATION OF PUBLIC HEALTH SERVICE Yet, as you know, the Public Health Service is work restricting organizational framework that has been froze 1944-a time when the nature and scope of Federal he were vastly different. It is for this reason that we hav going a strenuous process of self-analysis, at the direction of the President and with the leadership and support of Secretary Gardner. We have been assisted by a highly competent group of consultants under the chairmanship of Dr. John Corson of Princeton. We have tried as hard as possible to hold nothing sacred, to leave no assumption unexamined. Our aim has been to design a Public Health Service that can attract and retain the kind of competence our responsibilities require, and that will make the fullest use of the resources we have. We intend to shape an agency that will deliver its full measure of the Federal responsibility for the health of the American people. FUNCTION OF PUBLIC HEALTH SERVICE This work is nearing completion. I believe that we can polarize our activities around specific functions, aimed at the basic health goals of the Nation: The delivery of the best in health care to the American people; The development of manpower necessary for this task; The further advance and maturation of biomedical research; The assurance of an environment free from significant threats to health; The most productive possible service to groups with special problems our children, the aged, the mentally ill are examples; The fullest possible application of existing knowledge to control, prevent or eradicate disease; The sharing of American knowledge and skills so that nations around the world can raise their levels of health. Further, I believe that we can modify our existing personnel systems so as to encourage productive and rewarding careers across a broad spectrum of Federal involvement in health. In achieving this, and in creating an organization oriented toward the future, I am convinced that health professionals of the highest quality will respond to the challenges of Federal service. ACCOMPLISHMENTS Against this backdrop of needs, let me now report on some of the more significant points of progress during the past year. You will, of course, hear more about our problems and our accomplishments from subsequent witnesses before your committee. MEDICAL CARE ADMINISTRATION Through a newly organized Division of Medical Care Administration, the Service is seeking improved methods of organizing and financing medical care. The new Division has specific responsibilities for professional health aspects of the health insurance for the aged program. We are making particular efforts at this time to insure the availability and quality of health insurance benefits, the first of which become redeemable as of July 1. The development of standards of provider participation is virtually complete. Plans from approximately half the States have been approved for participation in the new home health formula grant program designed to stimulate the development of new and improved home health services. MANPOWER ACTIVITIES To help overcome a critical shortage of education facilities for the health professions, 68 projects have been awarded grants totaling more than $150 million for the construction of teaching facilities in schools of medicine, dentistry, nursing, and other health professions. These projects will provide 2,442 additional first-year places for medicine, dentistry, public health, nursing, pharmacy, and optometry. New schools being established include eight medical; one dental; and one public health. Under the provisions of the Nurse Training Act of 1964 the Service is providing grant assistance to build new nursing schools, and to replace, renovate, expand, and equip existing facilities. The $3 million already invested in this program is creating space for up to 240 additional first-year nursing students. As of January 1966, 52 applications totaling more than $25 million have been submitted. Eleven have been approved. The Nurse Training Act also provides for continuation and expansion of the professional nurse traineeship program. Since 1956 this program has helped more than 25,000 nurses to prepare for teaching, supervision and administration or to improve and update professional skills. This fiscal year 100 schools of nursing have shared in $7,800,000 for long-term academic training to prepare an estimated 2,000 nursing teachers, supervisors, administrators, and specialists. A separate manpower program was established this year to investigate, estimate, and project national manpower needs for health services. Such action was recommended by the President's Commission on Heart Disease, Cancer, and Stroke and by the Second National Congress on Public Health Training. The program will join with other government, voluntary, and private allies in an effort to insure adequate numbers of medical and paramedical personnel in the right job at the right time and place. HEALTH FACILITIES Despite a reshaping of the Hill-Burton program and sound progress toward adequate health facilities, the tasks ahead require an intensification of present effort. Thus far the establishment of new programs and the revamping of old ones have permitted communities throughout the Nation to analyze and evaluate their health facility shortcomings. Tentative findings reveal a great number of hospitals in need of renovation, a problem especially grave in larger cities; a growing critical need in some areas for long-term care facilities; a lack of coordinated planning mechanisms for urban areas; and shortages and inadequacy of most facilities for the mentally retarded and mentally ill. Programs established by recent legislation are now beginning to bear fruit. The hospital modernization program, included in the HillBurton Amendments of 1965, is underway. State plans are being sub mitted and projects are being approved. Funds included in this budget request, however, will only begin the tremendous task of renovating the many hospitals which are structurally or functionally obsolete. Efforts to assist State and local groups in the realistic planning of needed health facilities have resulted in the approval of 37 area wide planning projects in 19 States. The Hill-Burton program, 20 years in operation this year, continues to make inroads into the backlog of needed health facilities. The 8,000th project was approved in December. ARTIFICIAL KIDNEY Dramatic new developments in the treatment of chronic kidney failure has lead to the establishment of a kidney disease program in the Service. We recognize this as one of the most sensitive and challenging programs we have undertaken. However, with clear proof of new abilities to sustain productive life in thousands previously doomed to death, the Service will this year move to increase support for artificial kidney centers. Eight to ten new centers will be financed in 1966. The cost-reduction promise of home dialysis will be investigated. We are also extending our research effort to gain a better understanding of problems of kidney failure and to improve existing technology of kidney treatment. MENTAL RETARDATION This is the first year of a greatly expanded program of mental retardation project grants. About 90 projects will be supported in 1966-67. The principal goal is to accelerate the training of professional personnel. We have already approved nine construction grants totaling approximately $16.7 million to university affiliated clinical facilities to aid in the training of professional and technical manpower to care for the mentally retarded. Another nine construction grants, totaling $19.9 million, have been awarded to date for construction of mental retardation research facilities. The program of community-based mental retardation facilities is also taking shape. Most State plans have been approved, and grants are being awarded for construction projects. The construction phase of this program will be in full operation by the end of the fiscal year. PREVENTIVE SERVICES The best health care is prevention. Toward this goal we continue to support research to develop and refine the early diagnostic methods so vital in combating disease and disability. One of the most promising approaches is being developed with our support by the KaiserPermanente Medical Group in Oakland, Calif. Now in its third year, this project combines a series of 30 or more automated screening tests and computer read-out with periodic health examinations by a physician. This marriage of automated screening to periodic health examination promises eventually to produce a practical means for reorienting health care from the curative to the preventive. It has great potential for freeing physicians and other professionals to per form those duties for which they are specially qualified. We intend to explore this promise to the fullest. |