TRENDS
By JOHN P. HUBBARD, M.D., C o t i t r i b ~ / i ~ g 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 statemettts d o not necessarily repert the opinion of the writer nor are they t o be interpreted as oficial opinion of the Academy.
T H E LOCAL PUBLIC HEALTH
UNITS BILL
A
MONTH ago in this column, we drew attention to the status of the Local Public Health Units Bill as it stood in early December in the 81st Congress. W e have been watching with special interest the further course of this Bill in view of its direct relationship to the oft' expressed objective of the Academy to extend child health services into areas of need. One of the needs most clearly demonstrated by the Academy's study results from the inequity of health services in rural and isolated areas in comparison with metropolitan areas. The Local Public Health Units Bill proposes to stimulate the de- velopment of local health departments, one of the recognized functions of which would be an extension of maternal and child health services. The support which this Bill has received and the fate of this Bill in the 81st Congress may be summarized by the fol- lowing quotations:In his presidential address, presented at the Fourth Annual Clinical Session of the
AMA in Cleveland, December 5 to 8,* Dr. E. L. Henderson said: "The American Medi-
cal Association has long believed that the existence of effective and properly operated pub-
lic health units is basic to the maintenance and improvement of the health of the people. As early as 1883, a report was made at the annual meeting of the Association covering a survey conducted to ascertain what states and counties had health departments. In the years that have followed, our interest in the subject has remained unabated. Reso- lutions have been adopted by the House of Delegates urging complete coverage of the nation's population by county, district or regional full time modern health units. Point
6 of our 12 point program gives proper and additional emphasis to the important role that public health departments must continue to fill in our ever-expanding and untiring efforts to provide the people with better and better health care. Tremendous progress has already been made; much more needs to be done.
"I stress this subject because, unfortunately, action taken by the House of Delegates at the San Francisco meeting in June 1950, with reference to a bill in Congress to authorize federal financial aid for the development of health departments, has led to misunderstand- ing of the present point of view of American Medicine toward the development of such programs.
"Did the San Francisco action, in effect, reverse the previous and long-established posi- tion of the Association? This is a question that is being asked. In order to remove any doubt about the matter, I should like to suggest that the House give consideration at this session to reviewing the action taken earlier this year for the purpose of clarification. In my judgment, such a review now would be most timely."
In his weekly colunin in the Sunday Neru York Titnest Dr. Howard A. Rusk said, in
J.A.M.A. 144: 1268 (Dec. 9 ) 19JO.
260 J O H N P. HUBBARD
reference to civil defense plans: "As W. Stuart ~ ' ~ m i n ~ t o n reported to the President in September, all planning done on the health and medical aspects of civil defense is based on using state commissioners of health as directors of civil defense health services, and local health officers as directors of local civil defense health services. This plan has been accepted as a most practical and effective administrative mechanism, but unfortunately, nearly 30 per cent of our citizens live in communities in which there are no full-time local health services.
"Only six states in the nation now have complete local health services coverage in all counties. They are Maryland, Delaware, New Mexico, South Carolina, Alabama and North Carolina, which added its final county recently.
"There is almost complete coverage in California, Michigan, Florida and Virginia. Kentucky, Louisiana and Tennessee have organizations for nearly every county, but have many health officer vacancies.
"Steps toward remedying this situation were taken last year when the Senate, with bipartisan sponsorship and wide public support, unanimously adopted a bill authorizing Federal grants-in-aid specifically for local public health departments. The act provides Federal funds for at least six minimum functions of a local health department: vital statistics, communicable disease control, maternity and child hygiene services, environ- mental sanitation, public health laboratory services and public health education.
"As Dr. William P. Shepard, president of the American Public Health Association, said recently, 'Public Health services are the administrative backbone of civil defense. The immediate development of such services is not only requisite to the safeguarding of the health of the nation in normal peacetime, but is given even greater urgency by the current demands for the establishment of adequate civilian defense against possible acts of aggression, including atomic, biological, chemical and other devices of warfare di- rectly affecting the civilian population.'
"That there is urgent necessity for immediate action by the House of Representatives is clear. One-third of the nation is without the administrative organization for providing even normal local health services, let alone those necessary for civil defense. The pro- vision of those services is as essential to our civil defense as weapons are to our fighting men."
In the Washington Report on the Medical Sciences for December 11, 1950, Gerald Grosi comments as follows: "House Rules Committee on Friday 'postponed action' on the question of increased Federal support of local public health units, thereby adding to the list of shelved bills branded as undesirable by American Medical Association. Twenty- four hours earlier, in Cleveland, AMA's trustees had turned thumbs down on bill in question (HR 5865) and its action was the decisive factor in committee's rejection of an appeal by J. Percy Priest, House leader on health legislation, for granting of a rule that would permit a floor vote on HR 5865 by the full membership."
to oppose HR 5865, although continuing to endorse the general principles contained therein.
"The objections to HR 5865 fell into two principal categories: (1) The bill placed local health units under the direct and complete control of the Surgeon General of the Public Health Service. No advisory council was provided to check the power vested in the Surgeon General. ( 2 ) Public Health services were defined, in part, as 'the detection and diagnosis of chronic diseases and such other services concerned with the maintenance, - protection or improvement of the public health as the Surgeon General may prescribe.' The American Medical Association consistently opposed this vague terminology which would have permitted any kind of federally subsidized health activity by local health departments. For example, the diagnosis and treatment of cancer, heart disease, arthritis and other chronic disease, previously considered outside the proper scope of public health departments, could have become a health unit activity. The Association opposes the use of federal grants-in-aid to the states for initiating local programs that have never been considered within the province of public health. There are many noncontroversial projects such as communicable disease control, sanitation, public health education and others for which there is need for local expansion, without moving into new areas.
"On December 8 the House Rules Committee voted not to report HR 5865 to the floor of the House, partly because of the objections of the American Medical Association to the provisions cited above and partly to other objections raised by committee mem-
bers. It has been reported that these latter objections were based on the urgent necessity
to conserve federal funds for those activities related to national defense and the belief that federal financial support of local health units should be restricted to defense areas. "Mr. Priest, the Chairman of the House Committee on Interstate and Foreign Com- merce, introduced on December 10, 1950, HR 9914 which answers some of these objec- tions. This bill was an improvement over the previous one, but it still contained certain objectionable provisions and omitted protective measures that the Association considers essential. For example, under the term 'basic public health services' were included 'laboratory services.' W e believe this should be amended to read 'public health laboratory services.' Also, under this section provision was made for excluding medical and dental treatment except as necessary for communicable disease control and epidemic or other emergency situations. W e feel that medical diagnosis as well as treatment should be ex- cluded. Finally, and most important, the bill still did not include an advisory council which could serve as a check on the broad grant of power given to the Surgeon General. "It should be appreciated that all current legislation needs to be reexamined in the light of the present grave international situation to assure that our total effort is directed to the strengthening of the national defense. The Priest bill, HR 9914, provided that federal funds for local health units be allocated primarily to areas in which civil defense needs are paramount. This provision was a step in the right direction.
"A bill similar to HR 9914 will be introduced at the beginning of the 82nd Congress and conferences between Congressman Priest, the Public Health Service, the American Medical Association, and other interested groups will continue for the purpose of de- veloping a bill that will be satisfactory to everyone concerned.
1951;7;259
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TRENDS: THE LOCAL PUBLIC HEALTH UNITS BILL
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