TRENDS
By JOHN P. HUBBARD, M.D., Contributing Editor
This and subsequent descriptions of events and trends are intended to be unbiased and factual, pre-senting both sides of controversial matters so that conclusions may be formed from critical appraisal of things as they are. These statements do not necessarily reflect the opinion of the writer nor are they to be interpreted as official opinion of the Academy.
ANNUAL REPORT OF THE FEDERAL SECURITY AGENCY
O
N THE first of February, the Federal Security Agency submitted to the President and Congress its tenth annual report, for the fiscal year 1949, that is, the year ending June 30, 1949. The Administrator’s Summary reviews briefly the activities of the Agency’s constituent organizations.* The following excerpts are quoted directly from this summary report.THE PUBLIC HEALTH SERVICE
No brief summary can cover the vast range of activities performed by the Public Health Service. It cannot suggest the close working relationships of the Service with State and local health authorities, voluntary ‘health agencies, research and training institu-tions, hospital agencies, and professional organizations. Technical and consultative assistance, together with financial aid, from the Public Health Service has become so much a part of State and local health activity throughout the country that these services are taken for granted.
Much of the work of the Public Health Service, as in medical research and the development of new methods for the control of serious diseases, is necessarily long-term. But results are constantly being obtained and more widely applied in state and local programs which directly affect the lives of millions of Americans.
During the fiscal year, for example, Public Health Service teams took chest x-rays of more than 1.5 million persons in tuberculosis surveys sponsored by some of our large cities. In 35 States, more than 150,000 school children had their teeth examined and treated with sodium fluoride solution to prevent decay. Public Health Service dental
health teams provided these services in demonstrations for State and local health depart-ments and private dentists. More than 1 500 public health workers from all over the Nation and from 37 foreign countries received special, training at the Service’s Com-municable Disease Center in Atlanta, Ga., and 640 of these were trainees from public
and private laboratories, who desired training in the performance of diagnostic tests.
Besides these and other special services in aid to state and local health agencies, the Public Health Service continued its fundamental programs of health protection and promotion. The Nation’s official vital statistics were collected and compiled, thus making available the basic data on which national health problems can be defined and progress measured. Foreign and interstate quarantine activities ensured protection against the introduction of epidemic diseases from abroad and their spread from state to state.
Through its system of standards, inspection, and licensing, the Public Health Service
* The Administrator’s summary and separate reports of the Agency’s constituent organizations are
available at nominal cost from the U. S. Government Printing Office, Washington 25, D.C.
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ensured the interstate sale of safe and potent vaccines, serum, and other biologic products. . .
State and local appropriations for general public health work, tuberculosis, venereal diseases, cancer, and mental health were the largest in history. Federal grants-in-aid to the States for these purposes also were larger, totaling $36.4 million, excluding grants for hospital construction.
Heartening gains were also made in the hospital construction program. By the end of
the fiscal year, all states and territories had completed their surveys and plans, and 791
projects had been approved for grants. Of these, 35 projects had been completed and
355 were under construction. These projects represent 450 health centers and more than
38,000 hospital beds to be added, chiefly in rural areas, to the Nation’s health resources. The total amount of construction so far approved will involve some $150 million in Federal funds. Under the Hospital Survey and Construction Act of 1946, however, this sum represents only one-third of the total cost of these facilities ; the remainder 15
contributed by the state and local sponsors of the projects.
Another significant advance is the increase of regional planning for state and community hospital service, including nursing service. The hospital construction plans of the states are based on the concept that hospitals should be located so as to provide facilities for a ‘‘hospital service area,” that is, for several communities. Many professional and civic groups have expanded this concept to plan for regional service, as well as for regional
facilities. Under such plans, several hospitals or communities may agree to pool their medical, hospital, and nursing services to care for a larger group of people than would be possible through separate programs. Although few such regional services are as yet in operation, the Public Health Service has received so many requests for consultation in this
field that it is evident the professions and the public are becoming convinced that joint planning and action for the provision of medical, hospital, and nursing services are essential. . .
The continuing need of additional Federal aid to the states for local health services
underscores, in general, the difficulties under which our communities are trying to set up and expand their public health departments. More or better-staffed local health units are needed in almost every part of the country. The fact that only about 1600 of our 3000 counties and 250 of the largest cities have full-time health units, and that less than 5 percent of these are fully staffed, is one measure of how far we are from our goals. Congressional action to increase Federal funds for this purpose is urgent. . .
The continuing financial crisis in medical education, including the training of physicians, nurses, dentists, and graduate public health workers, points up another critical need in the Nation’s health services. Shortages of trained personnel in all fields continue. Con-ferences with medical educators and professional leaders during the past year brought
Out the urgent need for general Federal aid in this field. Not only must our existing annual supply of professional workers be maintained, but also the future supply must be increased to meet increasing needs.
Legislation was introduced in the Eighty-first Congress proposing grants to accredited medical, dental, nursing, and public health schools, for scholarships for qualified students, and for the construction of teaching facilities. At the close of the fiscal year, the proposed
bills had not been acted upon. ...
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our Nation-wide research effort, there must be an adequate supply of research facilities and of well-trained scientists.
During the fiscal year, the Public Health Service allocated approximately $2 million in grants and contract authorizations to seven institutions for the construction of additional research facilities. These expanded facilities will be devoted to research in cancer,
cardio-vascular diseases, mental and nervous diseases. The Clinical Center of the National In-stitutes of Health, now being constructed at Bethesda, Md., also will add to the Nation’s facilities for basic and clinical research in diseases that take the highest tolls of life and cause the largest volumes of disability.
Through the research fellowships program of the National Institutes of Health, the Nation’s supply of scientists in the medical fields is being steadily increased. In 1948-49,
432 fellows were appointed to receive advanced research training in institutions of their own choosing. Since 1945, more than 300 other scientists have completed their fellow-ships. ...
THE CHILDREN’S BUREAU
The high birth rate of recent years presents problems not only for the educator but for the child health and welfare authorities as well. Since 1940, the number of children under the age of 5 has increased by more than 40 percent, and between the ages of 5 and
9, by more than 20 percent. For the fiscal year, grants-in-aid by Congress in support of these Federal-State maternal and child health and child welfare services, administered under the general supervision of the Children’s Bureau of the Social Security Administra-tion, amounted to $22 million.
Of the Federal money in this field, $11 million is earmarked each year for grants to the states for maternal and child health services. These services range all the way from pre-natal clinics, public health nursing services, and well-child clinics to immunization services and examination of children of school age by physicians and dentists. On a limited basis, many states also provide medical and dental care for some expectant mothers and also for a considerable number of children.
During the current year, well over 1 50,000 expectant mothers attended the medical clinics operated by these services, and more than 220,000 received public health nursing services during pregnancy. Some 640,000 infants and children of preschool age had the benefit of medical supervision at well-child clinics, and over a million received public health nursing services. Physicians’ examinations of school children totaled more than 2 million, and inspection by dentists or dental hygienists ran half that number. Public health
nursing reached nearly 2#{189}million, and nearly 3 million immunizations against smallpox and diphtheria were given.
Most of these areas of activity showed significant increases during the year. But it is fair to say that, throughout the whole Nation, the funds available were so limited as to prevent the services from reaching more than a fraction of the mothers and children who stood in genuine need of them.
For the Federal share in services to crippled children during the fiscal year, Congress appropriates $7.5 million each year. An estimated 175,000 children received diagnostic treatment services under these Federal-State programs. About 30,000 were hospitalized; nearly 5000 were cared for in convalescent homes. Reports toward the end of the fiscal year showed a waiting list of 30,000 who needed care but for whom no funds were available. To ease this situation Congress made a supplementary appropriation of
