GOVERNMF.N I

S t o r a g e GRADUATE PUBLIC HEALTH TRAINING A M E N D ^ o O ^

MENTS OF 1964

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P 9^/25 H E A R I N G

BEFORE TH E

SUBC OMM ITTEE ON PU BL IC HE AL TH 

AN D SA FE TY

1 OF TH E

COMM ITTEE ON

INT ER STAT E AND FO RE IGN COMMER CE 

HOUSE OF RE PR ES EN TA TIVE S

EIGH TY -EIGHT H CONGRESS

SECOND SESSION

ON

H.R. 10043

A BILL TO AMEND THE PUBLIC HEALTH SERVICE ACT TO 

EXTEND THE AUTHORIZATION FOR ASSISTANCE IN THE 

PROVISION OF GRADUATE OR SPECIALIZED PUBLIC HEALTH 

TRAINING, AND FOR OTHER PURPOSES

APR IL 22, 1964

U.S . GOVERNMEN T PR INTING OFFIC E

32-438 O WASHINGTON : 1964
w La t .

COMMITTEE ON INTE RSTA TE AND FOREIGN COMMERCE

OREN HARRIS, Arkansa s, C hair m an

JOH N BEL L WILL IAMS , Miss issip pi

KENN ETH A. ROBERTS, Alab ama

HARLEY O. STAGGERS, West Virginia

WALTER ROGERS, Texas

SAMUEL N. P RIED EL , Maryland

TOR BER T H. MACDONALD, M ass achusetts

JOH N JARMAN, Oklahoma

LEO W. O’BRIEN , New York

JOH N E. MOSS, Califo rnia

JOH N D. DINGELL, Michigan

PAU L G. ROGERS, Florida

ROBERT W. HE MP HILL, Sou th Ca rolina

DAN ROST ENKOWSKI, Illino is

JAMES C. HEALEY, New York

HORACE R. KORNEGAY, N orth Ca rolina

W. R. HIL L, J r„ Missouri

GILL IS W. LONG, Louisiana

LIO NEL VAN DEE RLIN, Ca lifornia

JOH N B. BEN NETT, Michigan 

WILLIAM L. SPR ING ER, Illi nois 

PAU L F. SCHENCK, Ohio 

J. ARTHUR YOUNGER, Califo rnia 

MILTON W. GLENN, New Jer sey 

SAMUEL L. DEV INE, Ohio 

ANCHER NELSEN, Minnesota 

HASTIN GS KEITH , Massac husetts 

WILLAR D S. CURTIN, Pennsylva nia 

ABNER W. SIBAL, Co nne ctic ut 

GLENN CUNNINGHAM, Neb rask a 

JAM ES T. BROYHILL, No rth Carolina 

DONALD G. BROTZMAN, Colorado

J. J . PIC KL E, Tex as

W. E. William son, C le rk

Kenneth J. P aint er, A ssis ta nt. C le rk

Andrew Stevenson

Kurt Borchardt

Professional Staff

George W. Perry

J ames M. Menger, J r.

Subcommittee on Public Health and Safety

KENNETH A. ROBERT S, Alabama, Chairma n

LEO W. O’BRIEN, New York PAU L F. SCHENCK, Ohio

PAU L G. ROGERS, Florida ANCHER NELSEN, Min nesota

J. J. PIC KL E, Texas DONALD G. BROTZMAN, Colorado

♦

n
C O N T E N T S

Text of H.R. 10043_______________________ ________ ________ ____

Report of—

Bureau of the Budge t________________________________________

Health, Education, and Welfare De partm ent_____________________

Statem ent of—

Fleming, Dr. William L., chairm an, dep artment of preventiv e medicine, and assistant dean for education and research, School of 

Medicine, University of North Carolina_______________________

Jones, Boisfeuillet, special assistan t to the Secretary, Hea lth and 

Medical Affairs, Department of Hea lth, Education, and W elfare..

Peterson, Paul Q., Associate Director for Operations, Bureau of State 

Services, Public Hea lth Service, Department of H ealth, Educatio n, 

and Welfare_______________________________________________

Prather, Dr. Perry F., representing Association of S tate & Territorial 

Health Officers____________________________________________

Terry, Dr. Luther L., Surgeon General, Public Health Service, Departm ent of H ealth, Educatio n, and Welfare___________________

Thompson, Julia, Washington representative, American Nurses’ Association __________________________________________________

Walsh, Patricia, American Nurses’ Association___________________

Additional information submitted for the record by—

American Association of Dental Schools, statem ent of_____________

American Board of Prev entive Medicine, Inc., letter from Dr. John

C. Hume, secreta ry-treasurer________________________________

American Dental Association, statem ent of______________________

American Public Health Association, Inc., letter from Dr. Charles E.

Smith, chairman, comm ittee on professional edu cation __________

Ashe, Dr. William F., letter fro m_______________________________

Association of Schools of Public Health :

Wegman, Dr. Myron E., president:

Letter from__________________________________________

Statem ent of________________________________________

Association of Teachers of Prev entiv e Medicine, le tte r from Dr. Henry

J. Bakst, president_________________________________________

Clark, Dr. Duncan W., letter fro m_____________________________

Evan s, Dr. Alfred S., letter from _______________________________

Feldm an, Dr. Harry A., lette rs fro m____________________________

Fleming, Dr. William L., lett er from____________________________

Gibson, Dr. Count D., Jr., letter from __________________________

Goerke, L. S., l etter from_____________________________________

Hea lth, Edu cation, and Welfare Department:

Estimate of cost at 1964 level of operation, tab le_____________

Estimate of cost, 1965-69, tab le____________________________

Median annual salaries of public health nurses in selected agencies,

by type of agency and position, 1957-62, ta ble ................. .......

Second National Conference on Public H ealth Training, report to 

the Surgeon General

Hinm an, Dr. E. Harold, letter from.

Johnson, Dr. J. Garth, letter from.

Jord an, Dr. William S., J r., letter from.

Lepper, Dr. Mark H., letter from.

Mayes, Dr. W. F., letter from.

Packer, Dr. II., letter from.

Payne, Dr. Anthony M. M., letter from.

Rogers, Dr. Kenneth D., letter from 

Rutstein, Dr. David D., lett er from.

Sappenfield, Dr. Robert W., letter from.

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GRADUA TE PUB LIC HEAL TH TRA INING AMENDMENTS 

OF 1964

W ED N ESD A Y , A P R IL 22 , 19 64

H ou se of R epr e se n t a t iv e s,

S u b c o m m it tee on P ub lic H e a l t h and S afe ty

of t h e C o m m it t ee on I nterst ate and F ore ig n C om m erce,

Wasking ton, D.G.

The subcommittee met at 2 p.m., pursuant to call, in room 1334, 

Longworth Building, Hon. Kenneth A. Roberts (chairman of the sub- 

• committee) presiding.

Mr. R ob er ts. I might state at the outset that we are going ahead 

with hearings today on H.R. 10043, introduced by the distinguished 

chairman of this committee, Mr. Harris of Arkansas.

(H.R. 10043 and reports follow:)

[H.R. 10043, 88th Cong., 2d sess.]

A BILL To amend the Public H ealth Service Act to extend the authorization for assistance 

in the provision of graduate or specialized public health training, and for other purposes

Be it enacted by the Sena te and House o f R epresentative s of the United States

of America in Congress assembled, That this Act may be cited as the “Graduate 

Public H ealth Train ing Amendments of 1964”.

Sec. 2. (a) Subsection (a) of section 306 of the Public Health Service Act (42 

U.S.C. 242d), rela ting to traineeship s for professional public health iiersonnel, 

is amended by striking out “seven” and inse rting in lieu thereof “twelve”.

(b) Subsection (e) of such section is amended by adding at the end thereof 

the following new sentence: “The Surgeon General shall, between Jun e 30, 1967, 

and December 1, 1967, call a similar conference, and shall submit to the Congress, 

on or before January 1, 1968, a reix>rt of such conference, including any recommendations by it rela ting to the limitation, extension, or modification of thi s 

section.”

Sec. 3. (a) Subsection (a) of section 309 of the Public Hea lth Service Act 

(42 U.S.C. 242g), rela ting to project gra nts to schools for grad uate public hea lth 

trainin g, is amended bv striking out “June 30, 1965” and inserting in lieu thereof 

“June 30, 1964, $2,500,000 fo r the fiscal y ear ending Jun e 30, 1965, $4,000,000 fo r 

the fiscal vear ending Jun e 30, 1966, $5,000,000 for the fiscal year ending J une 30, 

1967, $7,000,000 for the fiscal yea r ending Jun e 30, 1968, and $9,000,000 f or the 

fiscal yea r ending June 30,1969”.

(b) Effective in the case of grants from appropriations for any fiscal y ear beginning after J une 30, 1964, such subsection (a) is amended by striking out “and 

to those schools of nursing or engineering which provide gra duate or specialized

< training in public health for nurses or engineers, for the purpose of strengthen ing

or expanding graduate public health training in such schools” and inserting in 

lieu thereof “and to other public or nonprofit priv ate institutions providing graduate or specialized training in public health, for the purpose of strengthening or 

expanding g raduate o r specialized public health training in such ins titu tions”.

(c) Subsection (b) of such section is amended by striking out “schools” whe rever it appe ars therein and inserting in lieu thereof “institutions”.

1
2 PUBLIC HEALT H TRAINING AMENDMENTS OF 19 64

Executive Office of the President.

Bureau of the Budget, 

Washington, D.C., April 27, 1964. Hon. Oren Harris,

Chairman, Committee on Inte rstate and Foreign Commerce,

Bouse of Representatives, Washington, D.C.

Dear Mr. Chairman : This is in reply to your request for the views of the Bureau of the Budget on H.R. 10043, a bill to amend the Public Health Service Act 

to extend the auth oriz atio n for assistance in the provision of graduate or specialized public health training, and for oth er purposes.

This bill will extend and expand the present autho rity of the Public Health 

Service to improve the training of professional public health personnel, support 

the education of stud ents in public health schools, and stren gthen those ins titutions. This proposal and the Nurse Tra ining Act of 1964, H.R. 10042, are the 

measures needed to supplement the Health Professions Educational Assistance 

Act of 1963 and were recommended by the President in his health message.

Enactme nt of this legislation would be in accord with the program of the 

President.

Sincerely yours,

Phillip S. Hughes,

Ass ista nt Director for Legislative Reference.

Department of Health, Education, and Welfare,

Washington, March IS, 1964. Hon. Oren Harris,

Chairman, Committee on Interstate and Foreign Commerce,

House of Representatives, Washington, D.C.

Dear Mr. Chairman : This l etter is in response to your request of Feb ruary 27, 

1964, for a report on H.R. 10043, the proposed Gradua te Public Hea lth Training 

Amendments of 1964.

This bill embodies a legislative proposal subm itted to the Congress by this Departme nt on Feb ruary 10 to carry out recommendations of the President contain ed in his recen t health message. A copy of the letter to the Speaker, and 

of the cost estimates submitted therewith, is enclosed herewith for your convenience.

For the reasons sta ted in our letter to the Speaker, we urge enactment of this 

bill.

Sincerely,

Anthony J. Celebrezze, Secretary.

/

Department of Health, Education, and Welfare,

Washington, D.C., February 10,1964-

Hon. J ohn W. McCormack,

Speaker o f the House of Representatives,

Washington, D.C.

Dear Mr. Speaker : I am enclosing fo r your consideration a dr aft bill to extend 

and improve existing legislation relatin g to gra duate and specialized training in 

public health. The authorization for public health train eesh ips contained in 

section 306 of the Public Health Service Act will expire on June 30, 1964. The 

authorization in section 309 of that act for project grants to schools of public 

health, schools of nursing, and schools of engineering for public hea lth training 

will e xpire on June 30,1965.

The proposed legislation would extend the authorization of section 306 for 5 

years, and the authorization for section 309 for 4 years. These complementary 

programs would then carry identical expiration dates of Jun e 30, 1969.

The bill would also strengthen and improve the program of project grants for 

public hea lth training by amending the provisions of section 309 of the Public 

Hea lth Service Act to—

(a) Broaden the eligibility for project gra nts to include other types of 

institu tions and agencies which provide gradu ate or specialized public health 

training, in addition to schools of public health, schools of nursing, and 

schools of engin eering;

(b) Broaden the purpose of the project gra nts to include the strengthening and expansion of specialized training in public health, in addition to 

the presently authorized gr adu ate tra ining in public he al th ; and
PUBLIC HEALTH TRAINING AMENDMENTS OF 196 4 3

(c) Increase the ann ual appropriation authorization from its pre sen t 

level of $2 million to a maximum of $9 million for fiscal year 1969. The bill would also provide for a conference to be called by the Surgeon Gen­ eral between Jun e 30 and December 1, 1967, to consider and make recommenda­ tions on f urther extension or modification of the traineeship program. A report of the conference would be submitted to the Congress on or before Janu ary 1, 1968. Similar conferences were held in 1958 and 1963 durin g the term inal fiscal 

years of the earlier authorization periods for these programs. In conformance with the requirem ents of section 306 of the Public Hea lth 

Sendee Act, the Second Natio nal Conference on Public Hea lth Tra ining was 

held in August of 1963. The 80 conferees were selected on the basis of the ir autho rita tive knowledge of public health programs, public health training, and public health manpower needs. The Conference evaluated the adequacy of the existing national public health manpower pool and public hea lth training programs in rela tion to c urrent and fut ure needs. It concluded that there must be an increasing number of adequately prep ared personnel capable of utiliz ing 

past, present, and developing knowledge to ada pt hea lth organization s and other social institution s to the solution of existing and emerging hea lth problems. It also concluded th at the requirements of application of new knowledge in public health programs can only be met through improved gradua te and specialized training programs in institu tions and agencies which provide public hea lth training. The proposed bill is based upon recomm endations made by the 

Conference in these regards. The Conference report stresses the effectiveness of public hea lth train eesh ips 

as a means of increasin g the number of trained professional public hea lth personnel and of the project gra nts in improving the qua lity of public health 

training in institu tions eligible to receive them. The report provides soundly conceived, practical guidance for designing and carryin g out m easures to increase the qna ntity and improve the quality of the Nation’s professional public health 

manpower. Under the provisions of the dr af t bill, the Public Health Service would con­ tinue to support indiv iduals engaged in long- and short-term gra dua te or special­ ized training in public hea lth by making traineeship awards directly to individu als and through gra nts to institution s for this purpose. These traineeship s will be used to increase the supply of critically needed professionally trained 

public health personnel, and to equip members of all professional hea lth disciplines to serve more effectively the needs of modern public hea lth programs. Project gra nts would continue to be made to schools of public health, engineering, and nursing. However, the national potential for public hea lth training 

would be significantly enhanced by making such gra nts also available to other public or nonprofit education al institutions, operatin g agencies, or professional 

associations which could and should be encouraged to provide gradua te or spe­ cialized training in public health. Examples of education al institu tions which are now ineligible for project gra nts are such professional schools as medicine, dentistry, social work, and pharmacy. The Conference placed much stre ss upon 

the need to improve the capa bility of departm ents of preventive medicine in schools of medicine to increase and update the public hea lth content in their in­ stru ctio nal programs. The need to maintain the currency of professional edu­ cation is made even gre ate r by the vast expansion of scientific knowledge. Re­ freshe r courses, semin ars, and other proven methods of short-term instruction s for professional health personnel are needed to fill this void. The Conference 

emphasized the importance of making project gra nts for this purpose to schools of medicine, dentistry, social work, to some health agencies, and professional 

associations, as well as to schools now eligible for these g rants. Extension and expansion of these training activities along the lines recommended by the Conference and provided for in this proposed legislation would significantly contribute to alleviation of the critica l shortage of adequately 

traine d professional public health manpower. We shall appropriate it if you will refer the enclosed dr af t bill to the appropri ate committee for consideration.

In compliance with Public Law 801, 84th Congress, there is enclosed a sta te­ ment of estim ated costs and personnel requ irem ents which would be entailed by 

enactmen t of the proposed legislation.

The Bureau of the Budget advises that enactmen t of this legislation would be 

in accord with the program of the President.

Sincerely,

Ant ho ny J. Celebkezze, Se cr et ar y.
4 PUBLIC HEA LTH TRAINING AMENDMENTS OF 19 64

Graduate P ublic Health Training Amendments of 1964 

Estima te of additional cost, 1965-69

[In th o u s a n d s of d o ll ars ]

I te m 1965 1966 1967 1968 1969

A p p ro p ria tio n re q u ire m e n ts : 

P u b lic H e a lth tr a in e e sh ip s.

P ro je c t g r a n ts _______ ______

A d m in is tr a tio n 1 2

.....................

T o t a l . . . _________________

E x p e n d it u re s:

P u b lic H e a lth tr a in ee sh ip s.

P ro je c t g r a n ts _____________

A d m in is tr a tio n ____________

T o ta l........... .......... ...................

M a n -y e a rs o f e m p lo y m e n t____

4, 50 0 

« 500 

153

5, 15 3

4,5 00

500

153

5, 15 3

12

7,00 0

4,00 0

223

8, 00 0

5,00 0

298

10,00 0

7,00 0

368

10 ,000

9,00 0

443

11 ,223 13 ,298 17 ,368 19 ,44 3

7,00 0

4,00 0

223

8,00 0

5,00 0

298

10 ,000

7,00 0

368

10 ,000

9, 00 0

443

11 ,223

20

13 ,298

27

17 ,368

33

19 ,443 

40

1

 In cre a se o v e r $2,0 00,00 0 a u th o riz e d fo r fi sc al y e a r 1965 u n d e r ex is ti n g l aw .

2

 In cre a se o v e r fi sc al y e a r 1964 a p p ro p ria tio n le v e l of $27 2,0 00.

Mr. Roberts. There seems to be little if any opposition to this bill, 

which, as you know, will extend the authorization for public health 

traineeship. This is now carried under section 306 of the Public Health 

Service Act.

We will have special permission to sit this afternoon, and we are 

going to try our best to complete the list of witnesses, so that we can 

try to get this bill in executive session at a very early date.

I believe this authorization will expire on June 30, 1964, so it is 

imperative that we get along with our work.

Our first witness, I believe, today, is Dr. William L. Fleming, assistant dean, School of Medicine, University of North Carolina at Chapel 

Hill, representing the Association of Teachers of Preventive Medicine.

Dr. Fleming.

STATEMENT 0E WILLIAM L. FLEMING, M.D., CHAIRMAN, DEPARTMENT OF PREVENTIVE MEDIC INE AND ASSISTANT DEAN FOR

EDUCATION AND RESEARCH, SCHOOL OF MEDICINE, UNIVERSITY

OF NORTH CAROLINA

Dr. Fleming. I am William L. Fleming, chairman of the Department of Preventive Medicine, and assistant dean for education and 

research, School of Medicine, University of North Carolina.

I am testifying on behalf of the Association of Teachers of Preventive Medicine, of whose executive committee I am a member, in the 

temporary absence from the United States of Dr. Henry J. Bakst, 

president of the association. The Association of Teachers of Preventive Medicine represents the departments of preventive medicine in 

almost all of the medical schools of the United States and Canada and 

has a total of almost 500 individual memberships.

I would like to urge passage of the Graduate Public Health Training 

Amendments of 1964, H.R. 10043, which would extend and strengthen 

sections 306 and 309 of the Public Health Service Act.

The serious shortage of trained public health personnel in meeting 

present demands in the United States has been amply documented by 

the U.S. Public Health Service and other agencies. This shortage is
PUBLIC HEALTH TRAINING AMENDMENTS OF 196 4 5

all the more serious because it is intensified by the ever-increasing need 

for the expansion of public health and related community health activ­ ities due to population growth and development of more adequate 

health facilities. The Public Health Service Act has already strengthened training in this area in schools of public health, engineering, and nursing. H.R. 10043 would further augment training activities in these schools and would in addition strengthen public health training in other institutions, particularly schools of medicine. Since I am most familiar with medical schools, I would like to spend 

most of my time on this aspect. Trainea public health personnel of diverse types are needed, but few would question the particu lar need for, and the p artic ular shortage of, properly qualified public health physicians. While the Public Health Service Act has helped to prevent a bad situation from becoming even worse, there are actually fewer public health physicians employed by 

State and local agencies now than in 1950. Departments of preventive medicine in medical schools have varied responsibilities, but their more essential ones include: training physi­ cians going into practice in preventive measures and community health needs, interesting a sufficient number in the career possibilities of aca­ demic and preventive medicine, public health, and other community health activities, and giving postprofessional training to some in these latter groups and recruiting others for training in schools of public 

health. It has been recognized for some years tha t research and associated graduate training activities of departments of preventive medicine were weaker than those of most medical school departments, and tha t this has seriously hampered training physicians fo r academic preven­ tive medicine as well as indoctrinating future practicing physicians in the importance of prevention and recruiting and training physicians 

for public health careers. Prepa rations of the Association of Teachers of Preventive Medicine over a period of several years culminated in a workshop conference of the association at Saratoga Springs, N.Y., in June 1963 on research, graduate education, and postdoctoral training in departments of preventive medicine. The 5-day conference was attended by the chairmen of departments 

of preventive medicine and key resource individuals from medical schools, schools of public health, the U.S. Public Health Service, pri­ vate foundations, and other agencies. We felt tha t the conference, which I had the honor to serve as cochairman along with Dr. Tom F. Whayne of the University of Kentucky, accomplished a great deal. One of the specific recommendations of the conference brought up by several of the workshops and approved in plenary session is stated in the preliminary conference report in the November 1963 issue of the 

Archives of Environmental Health as follows:

It was felt highly desirable to broaden the Public Health Service Act to pro­ vide supp ort to all institu tions engaged in the trainin g of public hea lth workers. Such changes should potentiate dep artm enta l efforts in securing funds to 

strengthen tra ining programs.

This recommendation was taken to the Second National Conference 

on Public Health Training, convened at the direction of the Congress, in August 1963 and one of the recommendations of this conference
6 PUBLIC HEA LTH TRAINING AMENDMENTS OF 19 64

provided for making schools of medicine eligible for project grant 

and traineeship support in public health training.

Passage of H.R. 10043 should help departments of preventive medicine to strengthen their staffs, to develop more effective research programs needed for dynamic development and use in ongoing public 

health training programs, to improve the training in preventive practices of future practicing physicians, to help recruit more medical 

students for academic preventive medicine and for public health, to 

train in public health young physicians in the departments themselves, 

in schools of public health or in institutions, like ours, which have both 

schools of medicine and public health, in programs which combine 

the efforts of schools of medicine and public health.

Finally, we will all have to work at it, by expansion of training opportunities and in many other ways, if we are going to put into effect 

the aphorism of the famous surgeon and author, Dr. Harvey Cushing, 

which goes as follows:

Dr. Po und of Cure Lan e is bein g sup erseded by his you ng disciple, Dr. 

Ounce of P rev entio n Stree t.

Thank you.

Mr. Roberts. Thank you, Dr. Fleming.

I have no questions. I appreciate very much your taking the time 

out of your busy life to come here to testify in behalf of this very 

worthwhile legislation.

Dr. Fleming. Thank you, Mr. Chairman.

Mr. Roberts. Dr. Prather, commissioner of health, Baltimore, Md., 

representing the Association of the State & Territorial H ealth Officers.

STATEMENT OP PERRY F. PRATHER, M.D., COMMISSIONER OP

HEALTH, BALTIMORE, MD., REPR ESENTING ASSOCIATION OP

STATE & TERRITORIAL HEALTH OFFICERS

Dr. P rather. Thank you, Mr. Chairman.

I am Dr. Perr y F. Prather, commissioner of health of the State of 

Maryland, and a member of the legislative committee of the Association of State & Territorial Health Officers.

I was a general practitioner of medicine from 1925 to 1946 and have 

been a health officer since then—5 years a local health officer and 12 

years a State health officer. I am a member of the faculty of the 

Johns Hopkins School of Hygiene and Public Health and a consultant to the Surgeon General on medical, hospital, and rehabilitation 

facilities and community mental health services.

I speak here today not only as a public servant of Maryland, but I 

also represent officially the health officers of the 50 States and 3 

territories. Our views are shared by those directing health departments in cities, counties, and towns.

As “consumers” of the product of educational institutions that train 

health professionals, we are seriously affected by the critical shortage 

of health personnel. In our work we are keenly aware of the need 

to extend the scholarship and gra nt program to train more students.

In the face of rapidly increasing responsibilities of State and local 

health agencies for a wide range of environmental and community 

health problems, there is a tremendous need for well-trained public 

health personnel from a variety of professional groups.
PUBLIC HEA LTH TRAINING AMENDMENTS OF 19 64 7

At present this is due to shortages of the manpower pool in this 

field. The present law has been effective in helping us to recruit and 

train local health officers, public health nurses, health educators, and 

other public health personnel. I strongly support the provisions to 

extend this traineeship program for 5 years.

In addition to the official health agencies there are others who are 

vitally concerned with the shortage of trained health personnel, others 

who are employing in increasing numbers specially trained persons in 

public health; for example, industry, hospitals, large volunteer health 

agencies, Army, Navy, and Air Force, U.S. Public Health Service, 

departments of public welfare who have responsibility for medical 

care programs, universities, and medical schools tha t teach preventive 

medicine.

In Maryland, as well as in many other States, we feel that specialized 

training in public health is so important that many job specifications 

are written to require this training before employment.

Everyone is familiar with the fact tha t a new doctor just out of 

medical school is not ready to practice surgery, pediatrics, or other 

medical specialties until he has undergone specialized training. Likewise, the medical specialty of public health calls for specialized train ­

ing in a school of public health after medical school.

I would like now to mention some of the more important emerging 

problems in public health which must be met but to do so requires 

especially trained personnel. Health departments will not be able 

to meet their obligations in these and other areas without such qualified personnel.

In the field of environmental health which has to do with the air 

we breathe, the water we drink, the food we eat, and where we live, 

we are involved in such things as radiation health, industrial health, 

air pollution, provision of safe and adequate water and sewage, 

especially in the rapidly growing metropolitan areas, and we are 

now confronted with the problems of pesticides and detergents.

To cope with these problems, we need especially trained engineers, 

physicists, chemists, and sanitarians.

Mental health: The use of the tranquilizers and other modern treatment methods has made it unnecessary for many patients to remain 

in mental hospitals for long periods of time. The large State mental 

hospitals are outmoded. More patients could be returned to their 

community and treated at home or on an out-patient basis in clinics, 

day care facilities, et cetera.

Persons trained in public health administration play an important 

role in the development of these community facilities.

Mental retardation: The development of community facilities, 

close to the home of patients, is the order of the day with the management of the mentally retarded.

The aging population: The problems concerning this group who 

need special housing, rehabilitation, and various medical care services are increasing at a rapid rate.

Increased appropriations from Congress for maternal and child 

care programs will require increased public health trained personnel 

as well as increased interest and funds for the prevention of mental 

retardation.
8 PUBLIC HEA LTH TRAINING AMENDMENTS OF 19 64

We in the United States were once prideful tha t we were among 

the top nations in low infant mortality rate. We are now 11th. 

To recapture our former position will require the efforts of trained 

public health personnel.

Venereal disease, which we thought was well under control a few 

years ago, is on its way back, and we must now concentrate on this 

problem.

Accident prevention: Public health is becoming increasingly involved in this, especially with motor vehicle accidents. The schools 

of public health are doing important research into the causes and 

the means of preventing accidents in the home, in industry, and in 

transportation, and are developing teaching programs to prepare 

specialists in accident prevention to staff our health departments.

The high cost of hospital care is one of the most acute problems in 

this country today. I do not believe the per diem costs of general 

hospitals will come down—if anything, they are apt to rise.

In order to make effective use of these high-cost facilities and to 

ease the financial strain on patients, their families, and the sources 

of public assistance, people should not remain hospitalized longer 

than absolutely necessary, especially if they can be cared for in less 

costly facilities, such as home-care programs, convalescent and rehabilitation centers, and nursing homes.

It is a responsibility of public health officials to assist in the development of these supporting facilities.

Medical care for indigent and/o r medical indigent : The administration of medical care for the low-income group of our citizens 

takes especially trained people.

We must take steps now to insure a steady supply of physicians, 

nurses, sanitarians, and others who are trained in preventive medicine and in public health, otherwise our ability as public health agencies to cope with the issues I have mentioned will be weakened.

The State and Territorial Health Officers Association, which I am 

representing, strongly endorses H.R. 10043 as very necessary legislation to help in solving the problem of public health personnel 

shortage.

Among other things, this legislation carries out recommendations 

which were strongly urged by the Association of State and Territorial Health Officers as far back as October 1960, at their annual 

meeting in San Francisco.

Thank you, Mr. Chairman.

Mr. Roberts. Thank you, Dr. Prather.

I appreciate your attendance and the support of your fine association for this legislation.

I was quite pleased that you brought to our attention the new approaches being made in the mental health and mental retardation 

fields. I am hoping that we will be able to swing into action in new 

approaches to these twin problems.

I recently had the opportunity of visiting in Denmark, and I was 

quite impressed with the effort that is being made in tha t small 

country. Of course, they have a much smaller laboratory, I might 

say. Their people do not move around as much as we do.

But I visited one of their installations outside of Copenhagen, 

Montebello, and I was really quite taken with the way they handled 

their patient load.
PUBLIC HEA LTH TRAINING AMENDMENTS OF 19 64 9

Dr. P rather. Wha t is the name of it ?

Mr. Roberts. Montebello.

Dr. Prather. The reason I ask is because my deputy just came 

back from a tr ip over there, too, Mr. Chairman.

Mr. Roberts. I s that right? Well, I was of course quite pleased 

with what I saw a t this institution, which was small, and they had 

three resident psychiatrists.

Of course, the thing that seems to impress you is the fact they have 

a plentitude of trained personnel, and they have a much better situa ­

tion, I think, than perhaps we will ever have, really, because of the 

small country as compared to this large number of people tha t we have.

But I think that we perhaps have institutions in this country tha t 

do just as good or better jobs. This just happened to be one of the 

applications that I saw tha t I believe could work in almost every 

community in our country.

I think that we are just beginning, really, to get into this problem. 

We are late. But I think that your statement that the large concentrated mental hospital is outmoded and is on its way out is correct.

I recognize, too, th at we have people there who work hard and are 

doing, under the older approach, a good job, as good as they can do 

under the circumstances. But I am glad to see tha t your association 

is thinking about these problems, and I am also pleased to see the 

emphasis you placed on accident prevention.

This has been a concern of our subcommittee for many, many years. 

We felt many, many times that our efforts were frustrated and tha t 

we were not making a great deal of headway. But I think that we have 

served one purpose, and that is to try to keep this problem before the 

American people, and while we are still not making the progress tha t 

was hoped for, I think we are beginning to get people to choose up and 

take sides and to try to put some emphasis on this terrible problem, 

which is so expensive as f ar as the young people of the country are 

concerned.

I recently introduced a bill trying to set standards in the field of 

automobile tires. We are finding a lot of these tires that are on the 

market today are not adequate, are not safe, and we believe that we 

can do the same thing with this as we have done in other fields, of 

setting standards where the consumer will know what he is buying, 

and that we are getting a product tha t has passed at least a minimum 

safety set of standards.

I did not mean to get off on that, but I do appreciate your 

appearance.

The gentleman from Texas?

Mr. Pickle. I enjoyed the testimony, Doctor.

What is the increase of the appropriations you are asking this year? 

Are you familiar with the figure?

Dr. P rather. The bill calls for an extension, inserting $ 2^ million 

for the fiscal year ending June 30, 1965, $4 million for the fiscal year 

1966, $5 million for the fiscal year ending 1967, and $7 million for 

1968, and $9 million for the year ending Ju ne 1969.

That is I think considerably more than at present. That is to the 

best of my knowledge. I am not too familiar with th at part of it, but 

I would guess that this proposal is certainly adequate.

Mr. P ickle. This would make an increase of $171£ million over the 

present level of expenditures. Is that correct ?
10 PUBLIC HEA LTH TRAINING AMENDMENTS OF 19 64

I)r . Pratiier. I am sorry. I did no t add it up.

The tot al increase ?

Mr. Pick le. Yes, not the tot al amoun t, but the tot al increase.

Dr. P ratiier. I hav e not ad ded it up.

Mr. Roberts. If the gen tlem an will yield, we will have Mr. Jones, 

who will be th e De partm ent witn ess, on his way up here, a nd I believe 

he will pro bab ly be ab le to answer the gentlem an’s questions.

Dr . Prather. Someone fro m the service, here, would be b ett er able 

to ans wer as to this part of it.

Mr. Pickle. The only o ther statem ent I would v enture at th is poin t: 

I notice in your testimony t hat you say you need this prog ram because 

of the v ery str on g sho rtage of t rained h ealth officers. W ith in the las t 

mo nth or two, we have ha d testim ony from nurses th at the re is a 

gr ea t shortage in tha t field, and indeed, most medical fields.

I t concerns me th at in yo ur prog ram , as in all these others, you are 

coming to the Congres s because of this short age of pers onnel, and 

ask ing fo r th e specific help o f the G ove rnm ent, sometimes separa te and 

ap ar t fro m the State pro gra m.

I do not t hink yo ur case is ex actly the same as the n ursin g s ituation, 

because yo ur officers, I assum e, are all gradua tes of medical schools.

Dr. P rather. Our health officers, yes, sir.

Mr. Pick le. So yo ur av ail ability, yo ur supply, w ould be much more 

res tricte d than in other fields. So 1 would say this would be an exception in th at respect.

I would just say it looks to me like the gene ral allied medical fields 

are n ot pu ttin g on prop er public rel ations program s o f their own and 

are rel ying too muc h on the Con gress to furnish the fun ds, and 

pe rhaps the pro gra m. 

#

I do no t know what the answer is, but I jus t think we a re becom ing 

too dep endent on the Fe de ral level ra th er than the State level.

Mr. Roberts. I think th e comment the gentlem an fro m Texas has 

sta ted is tru e—I agree with him —t hat we are called on every year 

to pro vid e ad dit ion al people. How ever, it is a lso tru e, is it not, Doctor, th at these people, a ctu ally, if th ey w ant to go into p riv ate medical 

wor k or want to work as practition ers, gen eral practition ers , or for 

corpo ration s, or fo r pr ivate enterpri se, would be able to make man y 

times more, even in sal ary , than the y mak e in the pub lic healt h field ? 

Tha t is genera lly t rue , is i t not ?

Dr. P rather. That is right. At least for our health officers who ar e 

phy sicians. In man y Sta tes , and pa rti cu larly in my own State , our 

specifica tions say th at a man in orde r to be a healt h officer must have 

this special tra ining.

In oth er word s, he must at lea st have his M.D., have his license to 

practic e in t he St ate , and in addit ion to t ha t, he m ust have a ma ster of 

public he alth degree, which means he must have this special education before we can employ him. These are p ar t of ou r specifications

We have fou nd this prog ram in the past to be very he lpf ul fo r a 

phy sician who is thinking in terms of wa nting to be a healt h officer, 

because he perha ps w ant s to be a public s erv ant, but kno win g th at his 

financial rew ard s would not be as grea t. W ith th is prog ram, we have 

been able to at trac t a numb er of young phy sicians to be our hea lth 

officers, because this enables them to get th at special edu cation tha t we 

req uir e before we can employ them .
PUBLIC HEALTH TRAINING AMENDMENTS OF 19 64 11

An d we have h ad a numb er to whom it has been quite he lpf ul. That 

is why I very strongly recommend t ha t th is prog ram be extend ed.

Mr. Roberts. We ll, I think ju st as a gen era l proposi tion, th is same 

th in g is tru e all along. The President has asked for salar y increases. 

Some of the m embers of this body just can not make it on the salaries 

the y receive, and the same th in g is qui te t ru e when you get to spec ialized 

fields of Government.

It is a very difficult th ing to keep young people, p artic ul arly , in the 

Publi c Hea lth Se rvice. I am in tou ch with peop le out at the N ati on al 

In sti tutes, and a young doctor, u nless he is tr em end ously int ere ste d in 

doing research, would not n ecessarily be intere ste d in sta ying in Gov ­

ernme nt, because the other fields are so much r icher.

If he is intere sted in really a ccu mu lating money—and the re is a lot of 

ded ication in priv ate prac tice, too. I do not mean by th at th at th ere is 

an ything w ron g with ma kin g a lar ge amount of money in practic e.

Tha t is all I have.

Mr. Roberts. Miss W als h I believe is o ur next witn ess, o f t he Am eri ­

can Nurse s’ A ssociation, accompanied by Miss Ju lia Thompson.

STATEM ENT OF MISS PA TR ICIA WALSH , R.N., AMERICAN NURSE S’

ASSOCIATION; ACCOMPANIED BY MISS JU LI A THOMPSON, WAS HINGTON RE PRES EN TA TIVE

Miss W alsh. I am Pa tric ia W als h, d ire cto r of public h ealth nu rsing 

of the Wash ten aw County He alth De pa rtm ent, An n Ar bo r, Mich. 

I am also a mem ber of the board of dir ector s of the A me rican Nu rse s’ 

Ass ocia tion, the na tio nal pro fessional org aniza tio n of reg istere d 

nurses.

W ith me is Miss Ju lia Tho mpson , W ash ington repres entat ive o f o ur 

association.

I welcome the op po rtu nity to ap pe ar here tod ay on behalf of the 

Am erican Nurse s’ Ass ocia tion to su pp ort H.R. 10043, the Gradu ate 

Public He alth T ra in in g Am end ments of 1964, and to urg e you t o give 

the bill your prompt an d favo rab le consideration.

I wish to add here th at I speak pr im arily as an employer of public 

healt h nurses in an agency prov idi ng n ursin g care and he alt h instr uc ­

tion to resident s of a com mun ity.

My focus is sim ila r to th at o f a larg e grou p of nurse ad minist rators 

in th is country.

In a dd ition to p rovid ing servic e, we offer op po rtu nitie s for stu dents 

to obtain experience as pa rt of th ei r educa tional prog ram s in a community agency. We see a conti nuing need for well qualified pub lic 

he alt h nu rses to do a varie ty o f things in c omm unities.

One of these is to m ain tain present prog rams of he alth care, and to 

plan fo r the f ut ur e to meet the h ealth need s o f a grow ing population .

Mr. Pickle. Will you l et me i nte rr upt you ?

Are you reading from your script ?

Miss Walsh. No, I asked if I might add. Th is was no t in the 

scr ipt.

I wante d to po int out some of the th ings th at public he alth nurses 

do, pa rticul ar ly in co mm unity h ealth program s.

An othe r is to help people in the com mu nity un de rst an d how to use 

the services th at ar e a vailable to im pro ve th ei r he alth, to help imp rove
12 PUBLIC HEA LTH TRAINING AMENDMENTS OF 19 64

sta nd ards of care in t he ir own homes, as well as in nu rsing homes, and 

with the grow ing num ber of persons in the aged group and with 

chronic disease, th is is a pa rti cu la r need.

To extend the care th at is ava ilable , and to make best use of facilities, to give care to mothers and infants, both to give n ursin g care and 

he alt h ins tru ction , in a varie ty of areas, pa rti cu larly in stress ing the 

are a of acc ide nt preven tion, which is an im po rta nt one with infants 

and y oung child ren .

Pu blic healt h nurse s also in corporate menta l health inf orma tio n into 

all their program s.

We are intere sted in the conti nu ing established pro gra ms , such as 

communicable disease control and work in relati on to in fa nt hea lth, 

because of th eir value in preventin g long-term illness.

An d I did wish to ask you to keep some of these in mind as I comment 

on the prov isio ns o f thi s bill.

I am pic kin g up in line 10 o f the testim ony th at has been print ed 

and is before you.

H.R. 10043 prop oses to extend the public healt h traine eship s pr ogram fo r an ad dit ion al 5 ye ars, to con tinue autho riz ati on for pro ject 

gr an ts to educational insti tut ion s p roviding public healt h trai ni ng fo r 

an ad dit ion al 4 yea rs, to str ength en the p roject gr an ts p rogram by expa nd ing a uth oriza tio n to schools not prese ntly eligib le for g rants, such 

as schools of medicine, de ntist ry, social work , and pharm acy , to increase the ap prop riation ceiling f or th e pro jec t gr an t prog ram to $2.5 

million fo r fiscal 1965, $4 m illion for fiscal 1966, $5 million for fiscal 

1967, $7 millio n f or fiscal 1968, and $9 million for fiscal 1969.

The pub lic healt h traine eship p rogram es tablishe d un de r the H ealth 

Am endmen ts Ac t of 1956 provide d fina ncial assistance to phy sicians, 

enginee rs, nurses, a nd othe r pro fessional personnel un de rta king g ra duate t ra in in g in pub lic h ealth.

The numb er of persons pr ep ar in g fo r public healt h pos itions declined 50 percent between 1947 a nd 1955, and it was the inten t of Congres s to reve rse this tre nd a nd increase t he n um ber o f ade qua tely pr epa red pub lic healt h specialists so urge ntly needed by State and local 

health a gencies an d by agencies of the Fe de ral Governm ent.

A t otal of 4,281 pub lic h ealth tra ine eship s were aw ard ed du ring the 7 

years of the pro gra m. Fi fty- ei gh t perce nt of these went to profe ssion al personnel witho ut previo us public health experience, an ind ica ­

tion of the impact the prog ram ha d in recruitin g ind ivi duals for 

tra ining.

Al thou gh the traine esh ips co ntr ibute d to increa sing the number of 

prep ared pub lic healt h personnel, the increase h as not kep t pace with 

the population gro wth nor with the dem and s mad e on public healt h 

agen cies to ad d new pro gra ms to meet new needs.

Many im porta nt program s autho riz ed by the Con gress are im ple ­

mented in part, throug h local he alth agencies. Th e 1960 am end ments 

to the Social Sec urity Act enc ourage d State s to set up prog rams of 

medical assistan ce for the aged and to imp rove existing program s or 

initiate new pro gra ms of medical care for recipient s of old-age 

assistance.

If State s elected to pa rti cip ate, Fe deral ma tch ing fund s were provided for a wide ran ge o f services, inc lud ing c are o f the sick at home 

on a pa rt- tim e basis. The Comm unity Hea lth Serv ices and Facili-
PUBLIC HEA LTH TRAINING AMENDMENTS OF 19 64 13

ties Act of 1961 provided funds to stimulate State and local health 

departments to improve and extend community health services for the 

aged and chronically ill outside the hospital. The mental retardation 

legislation passed in 1963 provided for grants to establish comprehensive maternal and child health services fo r low-income families where 

the incidence of retardation is greater because of insufficient health 

supervision.

The success of all these programs depends to a great degree on increasing the number of qualified public health nurses, nurses who must 

be prepared in college and university schools of nursing.

Although nurses are the largest group of professional workers in 

public health, and half of the public health traineeships were awarded 

to nurses preparing for public health staff positions, the need for 

more and better prepared nurses is acute.

A generally accepted minimum standard for public health work in 

a local area is one public health nurse to 5,000 population, a figure 

which does not provide for care of the sick at home. At this level, 

43,000 qualified public health nurses would be needed in 1970.

An additional 43,000 registered nurses would be needed if agencies 

provided a program for care of the sick at home. (“Toward Quality 

in Nursing,” report of the Surgeon General’s Consultant Group on 

Nursing, U.S. Department of Health, Education, and Welfare, Public 

Health Service, 1963.)

The present number of nurses employed in public health agencies is 

approximately 34,000, but only 36 percent are fully qualified fo r public health nursing practice. (“Facts About Nursing,” 1962-63 edition, American Nurses’ Association.)

Public health nurses carry increasing responsibilities. In addition 

to working with other disciplines to further community health and 

provide direct service to individuals and families in the home, school, 

clinic, and in industry, they must also train and supervise the large 

numbers of registered nurses, practical nurses, and nursing aids now 

being employed by public health agencies.

As one means of insuring effective and safe community and individual health services, we urge the Congress to act favorably on the 

extension of the public health traineeship program.

Another means of increasing the supply of public health nurses is 

through the enactment of H.R. 10042, the Nurse Training Act of 1964, 

which this committee is now considering.

As of January 1, 1964, all accredited baccalaureate programs in 

nursing prepare students for beginning public health nurse positions. 

(National League for Nursing, Department of Baccalaureate and 

Higher Degrees.)

The public health traineeship program recruits nurses already registered and practicing into the field of public health. Proposals in 

H.R. 10042 for construction grants to collegiate schools of nursing and 

for scholarships and loans to students entering baccalaureate programs 

would permit the schools to enroll more students and attract collegebound young people into nursing.

It would result in an appreciable increase in the pool of qualified 

public health nurses ready for employment in local, State, and national 

health services. The American Nurses’ Association strongly supports 

H.R. 10042 and urges its prompt enactment.

32- 438 0 —64- 2
14 PUBLIC HEA LTH TRAINING AMENDMENTS OF 19 64

II.R. 10043 proposes to continue project grants to schools of public 

health and to schools of nursing and engineering offering specialized 

public health training. These were first authorized in 1960. The 

purpose of these grants was to assist the schools in meeting the needs 

of public health programs, and have been used to enrich curricula, 

strengthen train ing programs, and develop improved methods of 

training.

h ifty-seven grants have been awarded to schools of nursing. In 

addition, nurses have participated in projects in schools of public 

health.

The grants have established programs for preparing faculty for 

teaching in college and university schools of nursing, for identifying 

the contribution of nursing in the provision of comprehensive medical 

care services, for preparing at the post-master’s level nurse practitioners and teachers in the fields of chronic illness and gerontology, 

and for studies of the most effective way to provide content and public 

health experience for students in baccalaureate programs in nursing.

We strongly support the continuation of the project grant awards 

in sufficient quantity and of such amounts that their purpose of improving education of public health personnel will be realized. Improving the preparation of practitioners results in improved health 

services.

To conclude, the participation of Federal and State Government in 

the financing of training programs for professional public health personnel was established with the passage of the Social Security Act. 

It was recognized then that if public health agencies were to perform 

their necessary functions in protecting and promoting the health of the 

people of this country, they must have prepared professional staff.

In authorizing the public health traineeship program in 1956 and 

in 1959, Congress was instrumental in increasing the number of qualified public health personnel.

Additional prepared workers are needed if public health agencies 

are to expand their programs to meet present and emerging health 

needs. We therefore again urge you to continue the public health 

traineeship program.

On behalf of the American Nurses’ Association, may I thank the 

committee for the privilege of presenting our views on this legislation.

Air. Roberts. Thank you very much, Aliss Walsh.

I am sorry I had to step out of the committee while you were testifying, but 1 want to thank you for your statement and for your support of this legislation.

I have no questions.

The gentleman from Texas?

Air. P ickle. You made the statement, Aliss Walsh, that when they 

passed this previous act, it was the intent of Congress to reverse the 

trend of shortage in the public health nursing field, and I assume by 

your statement that in th at 7-year period they graduated some 4,281 

public health trainees. Is this correct ? Are there that many nursing 

graduates ?

Aliss Walsh. We said on page 2 that about 58 percent of those 

4,281 traineeships went to professional personnel without previous 

public health experience.

I do not believe I have the figure on the number of those awarded 

to nurses. Were you asking that, Air. Pickle?
PUBLIC HEA LTH TRAINING AMENDMENTS OF 19 64 15

Mr. Pickle. Yes, in the time the present program has been going, 

how many nurses have you actually turned out to work in tha t field ?

Miss Walsh. Do you have that figure ?

Miss T hompson. About ha lf the traineeships went to public health 

nurses.

Mr. Pickle. About half of this figure here ?

Miss T hompson. Yes.

Miss Walsh. Mr. Pickle, the figure is 2,513 trainees in nursing.

Mr. P ickle. And you would say, based on this total of 2,513, that 

there is still a continued shortage, and that is why you need to continue this program ?

Miss Walsh. With a step-up level due to population gro wth; pr imarily population growth and new programs.

Mr. P ickle. Now, I want to ask you this: You endorse the Professional Nurse Trainin g Act?

Miss Walsh. Yes.

Mr. P ickle. Which is before our committee now. And you ap parently hope to draw from that source nurses who will be interested in 

entering the public health nursing field.

Now, under your present program, can they go to one of these 

schools, under the apprenticeship training program ? Can they go to 

one of your schools and take a re gular course ? They do not have to 

go to regular nursing school first, do they ?

Do we have two different kinds of program ? That is what I am 

driving at.

Miss Walsh. We do have programs for the nurse who goes right 

out of high school into a 4-year college prrgram to become a nurse, 

to become a graduate nurse. And she c? learn public health nursing 

there.

Mr. P ickle. She is just a regular RN ?

Miss Walsh. Yes, a registered nurse, with a baccalaureate degree.

Then you have a program for nurses who graduate from a 3-year 

program, a hospital school—maybe you are familiar with tha t 

terminology. I f they wish to obtain preparation for public health 

nursing, they would need the provisions of H.R. 10043 which we are 

considering now. They would be covered by the provisions in this 

biH.

Now, one of the provisions in the bill which we mentioned, H.R. 

10042, prepares the teachers and the supervisors in public health nu rsing; teachers, administrators, and supervisors. So there is need for 

both proposals.

I am afraid I have not made it clear.

Mr. Pickle. You stated you had 2,513 in this 7-year time who were 

nurses specifically trained ?

Miss Walsh. For public health. Right.

Mr. Pickle. Of that number, were they previous graduates ?

M iss Walsh. They were previous graduates.

Mr. Pickle. You do not take yours from high school and give 

them a 4-year course and train them just for public health. You 

take them from the R.N. field. Is that right?

Miss Walsh. They can be prepared in two ways. They can be 

prepared after they become RN’s in a school of nursing under this type 

of a program, or they can go through a 4-year program and come 

out prepared for public health nursing as well as other nursing.
16 PUBLIC HEA LTH TRAINING AMENDMENTS OF 19 64

And 1 think we refer to that here in one of the pages of the testimony, if 1 might find that.

Mr. Pickle. I might make this observation, and it is just strictly 

an observation, because I certainly do not support it now by facts.

If the total of public health traineeships were 4,281 in a 7-year 

period, and of that number 2,513 were public health nurses, it looks 

to me that as fast as we tra in nurses, regular registered nurses, some 

allied field will grab them up other than the hospitals.

It looks to me like this is true of public health. It looks to me like 

it might be true of the Veterans’ Administration. And it might be 

true of many other governmental agencies. And I am not sure but 

what that is one of the main reasons for the shortage of nurses.

Is that correct, or do you have any feeling about that?

Miss Walsh. Well, we do need them in all of these places you 

mentioned. We need them in the hospitals as well as in the public 

health field. And we are concerned that we are not attracting a 

sufficient number of the 18-year-old girls into nursing when they 

finish high school. We still have to attract a good many more of 

them, because we need them in a variety of areas.

Mr. Pickle. Well, we are getting a little afield from the purpose 

of this bill, Mr. Chairman.

I thank you very much for the comments.

Mr. Roberts. I thank the gentleman from Texas.

Thank you very much, Miss Walsh, for your statement and for 

your appearance, and Miss Thompson, also.

Mr. R oberts. Mr. Boisfeuillet Jones, special assistant to the Secretary, Department of Health, Education, and Welfare, accompanied 

by Dr. Luther L. Terry, Surgeon General, Public H ealth Service.

It is always a pleasure to welcome you here, and we are glad to have 

you.

You may proceed with your statement.

STATEMENT OF BOISFEUILLET JONES, SPECIAL ASSISTANT TO THE

SECRETARY, HEALTH AND MEDICAL AFFAIRS, DEPARTMENT OF

HEALTH, EDUCATION, AND WELFARE; ACCOMPANIED BY DR.

LUTHER L. TERRY, SURGEON GENERAL, PUBLIC HEALTH

SERVICE; AND PAUL Q. PETERSON, ASSOCIATE DIRECTOR FOR

OPERATIONS, BUREAU OF STATE SERVICES, PUBLIC HEALTH

SERVICE

Mr. Jones. Thank you, Mr. Chairman.

As you have indicated, I am accompanied by Dr. Luther L. Terry, 

Surgeon General of the Public Health Service, and by Dr. Paul Q. 

Peterson, who is Associate Director for Operations of the Bureau of 

State Services of the Public Health Services.

Mr. Chairman and members of the committee, I appreciate the opportunity to appear before this committee on behalf of Secretary 

Celebrezze and the Administration in support of II.R. 10043, the 

Graduate Public Health Training Amendments of 1964.

This bill, which was introduced by the chairman of the House In ­

terstate and Foreign Commerce Committee, would carry out the recommendations of President Johnson in his health message for
PUBLIC HEALT H TRAINING AMENDMENTS OF 19 64 17

str en gthe ning and im proving gr ad ua te and specialized trai nin g in 

public health .

Th e success of modern healt h prog ram at all levels of governm ent 

and in a wide varie ty of public and pr ivate agencies is dependent on 

the avail ability of an ade qua te supp ly of high ly tra ined pro fes sional 

pers onnel. Fu rth ermore, the pro vision of h ealth services to the A merican people involves a close rel ationship between public he alt h or ga nizations and mem bers of the practic ing he alt h pro fessions. Pr of es ­

sion al pers onnel at all levels mu st be high ly skilled if the po tential 

benefits of modern science are to be tra ns lated into be tte r he alt h fo r 

all Americans.

Th e Congres s ha s recognized the seriousness of the s horta ge o f pu blic healt h manpower and has a uth ori zed p rogram s aimed at its r eduction. Section 306 of the Public He alth Service Act, which was first 

enacted as tit le 1 of the He alth Am end ments Ac t of 1956, autho rizes 

a prog ram of traine eship s to supp ort phy sician s, eng inee rs, nurses, 

an d othe r pro fessional healt h person nel in grad ua te or spec ialized 

public he alt h tr aining .

Section 309, which became law in 1960, auth orize s the S urg eon G enera l to make proje ct gr an ts for the purpo se of str en gthe ning or expa nd ing gr ad ua te public healt h tra in in g to schools of public healt h 

an d to those schools of nu rsi ng or engin eering which pro vid e gra duate or specialized trai ni ng in public he alt h fo r nur ses or engineers.

Th e au thoriza tio n fo r pub lic he alt h tra ineeships conta ine d in sectio n 306 of the Pub lic H ea lth Se rvice A ct will expire on J un e 30,1964. 

Th e au tho riz ati on in section 309 of th at act fo r pro jec t gr an ts to 

schools of public h ealth, schools of n ursin g, and schools of e ngine ering 

fo r pub lic healt h tra in in g will exp ire on Ju ne 30, 1965.

Th e pro posed legisla tion would extend the au tho riz ation of section 

306 fo r 5 years, and the au tho riz ati on for section 309 for 4 years. 

These com plementary pro gra ms would the n ca rry ide ntical exp ira tio n 

dat es o f J une 30,1969.

Th e bill would also str ength en and improve the prog ram of proje ct 

gr an ts for public health tra in in g by am endin g th e p rov isions of section 

309 of the P ublic Hea lth Service Act to—

(а) bro ade n the eli gib ilit y for pro ject gr an ts to include oth er 

typ es of insti tut ion s and agencies whi ch pro vid e gr ad ua te or specialized public healt h tra ining, in ad dit ion to schools of public 

healt h, schools of nu rsi ng, and schools of engin eerin g;

(б) broaden the pur pose of the proje ct gr an ts to include the 

str en gth en ing and expansion of spec ialized trai ni ng in public 

he alt h, in ad dit ion to the pre sen tly au tho riz ed g radu ate trai ni ng 

in public h ea lth; and

(<?) increase the annual ap pr op riation au thoriza tio n fro m its 

pre sen t level of $2 million to a maxim um of $9 million for fiscal 

year 1969.

The bill would also pro vid e fo r a co nfer ence to be called by the Surgeon General between ,lun e 30,1967, and Dec ember 1, 1967, to co nsider 

and make recomm endations on f ur th er extens ion or modific ation o f th e 

tra ineeship pro gra m. A rep ort of the c onference would lie subm itte d 

to the Congress on or before Ja nu ar y 1,1968.
18 PUBLIC HEA LTH TRAINING AMENDMENTS OF 19 64

Simi lar conferences were held in 1958 and 1963 du ring th e terminal 

fiscal years of the earlier au tho riz ati on periods for these pro gra ms.

At the confe rence on public h ealth tra in in g held in Au gu st of 1963, 

the a utho rit ative know ledg e o f 80 leade rs in the fields of public health 

and public he alth training was focused on public healt h manpo wer 

problems. Th e conference me asured th e adeq uacy of the ra te at which 

tra ined personnel are bein g deve loped by ev alu ati ng the staffing of 

healt h agencies over th e pa st 10 years .

It is cle ar th at the su pply of tra in ed healt h p rofess ion als is not keeping pace with population grow th. I t w as also foun d th at the presen t 

rate of tra in in g barely offsets attrition an d p rogram expansion , permittin g lit tle ga in again st the backlog of more than 20,000 inadeq uately 

tra ined personn el.

Fo r exam ple, in 1958, sli gh tly less than ha lf of all pro fessional 

pers onnel in S tate and local h ealth depart me nts had received the trai ning necessary to qualify th em full y for th eir public h ealth res ponsibilities. In 1963, 5 years later, only 51 perce nt were adequa tely tra ine d. 

In addition , more than 5,000 budget ed pos itions are now vacant.

To maintain even the prese nt inadeq uate staffing pa tte rn in State 

and local healt h departm ents in relati on to populat ion grow th and to 

offset attritio n, a t leas t 17,000 m ore tra ined workers must be produc ed 

by 1970.

Many more will be nee ded by v olun tar y healt h agencies and Federa l 

agencies, such as our De partm ent, the De partm ent of Defense, and 

oth er departm ents which have h ealth res ponsibilities an d int ern ation al 

health p rog ram s.

An additio na l critic ally i mpo rta nt b asic need is to overcome the acute 

shortage of teachers , so th at the fac ulties of the schools which must 

trai n th ese workers may be au gmented.

Th e activities which have been carried out under the two curre nt 

pro gra ms a re described in some detail in the r eport of the conference. 

I will, the ref ore, only sum marize them briefly.

Un de r the tra ine eship prog ram , more than 5,000 tr ain eeships have 

been aw ard ed since 1957 to su pp ort ind ivi duals in lon g-term pub lic 

healt h tra ining. In addit ion , gr an ts hav e alread y been mad e du rin g 

the l ast 2 years to supp ort appro xim ate ly 3,500 train ees in short-term 

continuation t raining.

Inclu ded among the short courses which thes e ind ivi du als have 

att ended with such t rai neeship s are courses in chronic diseases, denta l 

pub lic health, accident pre vention, pa tie nt ca re in nu rsing homes, and 

pub lic h ealth trai ni ng fo r phy sic al the rap ists.

Train ees un de r these prog rams hav e come from all of the States, 

Pu erto Kico, Gua m, and the Vi rg in Islands. They hav e attended a 

tot al of 12 schools of public healt h, 71 schools of n ursin g, and 83 other 

schools, inc lud ing schools of engin eer ing , departm ents of nu tri tio n, 

microbiology , and othe rs.

One of the goals of this prog ram is to br ing new people into pu blic hea lth. Th e fac t th at 58 perce nt of all traine es had not pre vio usly been employe d in pub lic he alt h att ests to the effectiveness o f these 

traine esh ips in r ecruiting stud en ts into the field.

Un der the pro ject gr an t prog ram autho rized by section 309, the 

Public Hea lth Service has supp orted nearly 100 different pro jects 

to str ength en or expand pub lic he alt h trai ni ng in 60 schools of pu blic health, en gineering, an d n urs ing .
PUBLIC HEA LTH TRAINING AMENDMENTS OF 19 64 19

The se pro jec ts have enriched and impro ved ma ny diffe ren t cu rriculu m areas im po rta nt to pub lic healt h, such as chronic disease 

services, nu tri tio n, acciden t pre vention, ger ontology, metro plita n 

healt h planning , a nd epidem iology.

By ma kin g possible the a dd ition of f aculty mem bers an d th e acqu isitio n of scientific and teac hin g equipm ent, these g rant s h ave co ntr ibute d 

significantly to increa sing the qu an tity and qu ality of public he alth 

trai ni ng availa ble to stu dents in these schools.

The conference fou nd that altho ug h the c ur re nt program s hav e accom plished all th at could be expected of the m at th eir prese nt levels 

of operation* and wi thin the frame wo rk of the cu rren t au tho riz ation , 

their full poten tia ls have not been realized .

Th e conference recognized in these two prog ram s the esse ntial 

appro ach es needed to overcome the cri tic al public he alt h ma npow er 

sho rtag e. W ith a pp ro pr iate extension an d expansion, these prog rams 

can increase the numb er of tra ined pro fessional he alth personnel, im ­

pro ve the q ua lity of tra ining, a nd increase n ati onal resources fo r pr ovid ing th e tra ining.

Mr. Ch air ma n, with the com mittee’s permission , I sho uld like to 

have the conference rep ort incl uded in the record of this heari ng.

Mr. Roberts. W ith ou t objection.

(Co nfer ence report referre d to follows :)

SECOND NATIONAL CONFERENCE

ON

PUBLIC HEALTH TRAINING

August 19 —22 , 19 63

Report to The Surgeon General

U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE 

Public Health Service 

Washington, D.C., 20201

21
22 PUBLIC HEA LTH TRAINING AMENDMENTS OF 19 64

Luther L. Terry, M.D.

The Surgeon General

Pub lic Health Service

Dear Dr. Terr y:

I am tran smitting herewith the report of th e Second

National Conference on Public Health Train ing which

you called pursuant to Section 306(e) of the Public

Hea lth Service Act. Included are the reco mmendation s of the Conference for your transm ittal to the

Congress.

The responsibility for public health training is

shared by many agencies, institu tions, and organization s in addition to the Federal Government. Although the Conference consid ered and discussed the

requirements for public health training in the broadest

context, formal recommendations are presented only

on issues in which the Federal Government was con ­

sidered to have significant responsibility.

I trust tha t the recom mendations and considerations

of the Conference will be as useful to the Public Hea lth

Service and the Congress as the opportunity to reflect

upon and discuss the man y facets of public health

training was beneficial to us as conferees.

Sincerely yours,

William R. Willa rd, M.D., Chairman.

Sept emb er 30, 1963.

iii
PUBLIC HEALT H TRAINING AMENDMENTS OF 19 64 23

Con tent s

Page

Letter of Transmitta l................................................ iii

I. Charge to Conference....................................... 1

II. Review of Progr am............................................ 3

III. Eva luation of Program..................................... 7

IV. Conference Recommenda tion s....................... 12

App end ix....................................................................... 27

A. Le gislation ..................................................... 29

B. Conference Organ ization ............ ............. 35

C. Selected D ata ............................................... 39

D. List of Conferees......................................... 62

E. Conference Perso nnel................................. 67

v
24 PUBLIC HEALTH TRAINING AMENDMENTS OF 19 64

I. Charge to Conference

The Second National Conference on Public Health Training was 

charged by the Congress under Section 306(e) of the Public Health 

Service Act with the responsibility of—

1. Appraising the effectiveness of the traineeships in meeting the needs 

for trained public health personnel;

2. Considering modifications in the legislation, if any, which may be 

desirable to increase its effectiveness; and

3. Considering the most effective distribution of responsibilities between

Federa' and State Governments with respect to the administration 

and support of public health training.

Preparations for the Conference began early in 1962. The 14 members 

of the National Advisory Committee on Public Health Training served 

as the Steering Committee. Four pre-Conference Study Committees 

composed of 25 consultants participated in planning the agenda of the 

Conference, and in the preparation of a Conference Working Paper and 

a Background Data book. Eighty conferees—32 of whom were involved 

in some aspect of the pre-Conference activity—atte nded the Conference 

held Monday through Thursday, August 19-22, 1963, in Washington, 

D.C.

The conferees were selected by the Surgeon General of the Public 

Health Service in consultation with the Steering Committee. They came 

from all sections of the Nation and were "broadly representative of the 

professional and training groups interested in and informed about training 

of professional public health personnel.” They represented State and 

local health departments and other official agencies with health responsibilities; schools of public health, nursing, medicine, engineering, dentistry, veterinary medicine, social work, hospital administration, and 

other university departments; research organizations, hospitals, health 

insurance plans; and other voluntary national and community health 

agencies. The Conference pursued its task through seven concurrent 

discussion groups, drafting of recommendations by four groups meeting 

simultaneously, and final synthesis of these recommendations into their 

present form by the Conference Executive Committee, utilizing the 

records o f the working groups, recommendation groups, and the plenary 

sessions.

Throughout its deliberations, the Conference sought to evaluate the 

effectiveness of the program with reference to the continuously changing

1
PUBLIC HEALTH TRAINING AMENDMENTS OF 19 64 25

role of public health in society. The conferees considered the issues 

within the scope of the growing complexities and widening dimensions 

of public health problems and responsibilities. Training was also evaluated within the context of a changing society: growth and changes in 

the character of the population; geographic mobility; urbanization; a 

rising standard of living; higher educational attainments; more sophistication in matters pertaining to health; the vast growth in numbers and 

kinds of community health services, encompassing both public and 

private organizations and institutions; and the constantly changing environment characterized by expanding industry, developing technology, 

and new health hazards.

The population of the United States is expected to increase by approximately 35 million persons during the current decade, with the highest 

increases among the groups which are the highest utilizers of health 

services—children under 9 years and persons 65 years of age and over. 

The population profile is characterized further by a relative contraction 

in the proportion of individuals between the ages of 20 and 64 years— 

a fact of special significance since most professional and technical services 

are provided by individuals in these age groups. All of these factors 

were considered to have implications for public health programs and 

resulting manpower requirements.

The Conference recognized that in a dynamic field such as public 

health, success tends to be trans itory, since each achievement presages 

new challenges. Accordingly, there must be increasing numbers of adequately prepared public health personnel capable of utilizing past, present, and developing knowledge to adapt health organizations and other 

social institutions to the solution of existing and emerging health 

problems.

In view of the scope, content, and responsibilities of publi health, the 

Conference reaffirmed the necessity for comprehensive and coordinated 

education and training. Accordingly, the Conference considered the 

responsibilities of State and local health departments, national and community voluntary health agencies, colleges and universities, professional 

associations, and other organizations which are providing and must continue to provide initiative, economic resources, and personnel. Only 

through a cooperative effort on the part of many organizations and 

institutions, including the Federal Government, will sufficient health 

manpower be developed to meet the health needs of all citizens in the 

years ahead.

Since the charge to the Conference was concerned specifically with an 

existing Federal program, the recommendations of the Conference were 

confined to the conduct of tha t program. The recommendations represent a consensus concerning the necessity for continuing the program, 

with pertinent expansions and modifications designed to increase its 

effectiveness.

2
26 PUBLIC HEALT H TRAINING AMENDMENTS OF 19 64

II. Review of Program

Title I of the Health Amendments Act of 1956 authorized public health 

traineeships which support "professional health personnel” in "graduate 

or specialized training in public health.” Title II of this act authorized 

advanced training for professional nurses to prepare them as teachers, 

supervisors, and administrators. * 1

 In 1958, Congress authorized the 

award of formula grants to schools of public health in recognition of their 

unique character, special needs, and national responsibility for comprehensive training in public health. The award of project grants to 

strengthen or expand graduate public health training in schools of 

nursing, engineering, and public health was authorized in 1960. All of 

these provisions have served to strengthen the Nation’s resources for 

public health training and to increase the numbers of critically needed 

health manpower.

PUBLIC HEALTH TRAINEESHIP S2

Public health traineeships provide for the award of financial aid either 

directly to individuals or through grants to training institutions. Traineeships in schools of nursing have been and are awarded through more th an 

60 institutions with accredited programs in public health nursing. Originally, traineeships to support students in the 12 schools of public health 

were awarded directly to individuals and in a few instances through 

institutional grants. Beginning in fiscal 1963, all such traineeships are 

awarded through these institutions. The Public Health Service continues 

to award traineeships directly to various categories of personnel who elect 

training offered by other university departm ents or schools; e.g., schools of 

engineering, departments of nutrition, and programs in dental hygiene. 

During the 7 fiscal years, 1957-63, $15 million has been appropriated to 

support almost 4,300 trainees.

The initial appropriation in fiscal 1957 of $1 million was increased to $2 

million in fiscal 1958. The annual appropriation remained at $2 million 

until fiscal 1963 when it was increased to $4 million. With this expansion,

1

 The Division of Nursing of the Public Health Service held an E valuation Conference

as required by law, on the "Professional Nurse Traineeship Programs” (sec. 307 of the

Public Health Service Act) on July 17, 18, and 19, 1963, in W ashington, D.C.

1

 Sec. 306 o f the Public Health Service Act. See app. A for the tex t of this section.

3
PUBLIC HEA LT H TRAINING AM EN DM EN TS OF 1 9 6 4 27

new act ivities were inititated to broaden the scope and increase the effe ctive ness of the traineeship program.

Special Purpose Traineeships are awarded through institut ion s to individu als desiring training in certain priority programs which the Pub lic

Health Service has determined to require emp hasis. These programs at

present include: medical care adm inistration, environmental health

science, and expanding pu blic health programs such as accident prevention

and chronic disea se control.

Grants for Short-Term Traineeships, also in fiscal 1963, were made

available to public and private nonprofit institu tions to assist in increasing

the competence of professional health personnel presently employed.

These programs are designed to bring the personnel up t o date in know ledge and skills related to their professional responsibilities and to decrease

the lag betw een discovery and application in the field of public health.

PROJECT GRANTS3

Since 1960, project grants hav e been awarded to schools of public

health, nursing, and engineering for projects to strength en or expand

graduate or specialized public health training. Project grants are made

to assist the schools in meeting the need s of chan ging and emerging

public health programs, and may thus be used to enrich curricula,

strength en training programs, and develop im proved methods o f training.

Th ey may also be used to enlarge faculties and supp orting staff need ed

as a result of increased enrollment. Grants are made for 1 year, but are

renew able up to 4 years con tingen t on the availa bility of funds and the

satisfactory development of the project. Dur ing the first 3 year s of

the program, $5.4 million has been awarded through 233 grants covering

approximately 100 projects in 21 different curriculum areas. Training

program s in the increasingly important areas of air and water pollutio n,

radiological health, accident prev ention, chronic diseases, health

economics, and medical care administration hav e received and are

receiving support under this section of legislation.

FORMULA GRANTS4

Formula grants to public or nonprofit accredited schools of pub lic

health hav e been in effec t since 1958. In 1961, the authorization ceiling

was raised from $1 million to $2.5 million per annum. These gran ts are

intended to support the provision of public health training in schools

of public health by offsettin g a portion of th e difference betw een income

from tuition and the cost of instruction of federally sponsored students .

Therefore, in the alloc ation of funds by the Surgeon General, primary

consid eration is give n to the number of federally sponsored train ees

3

 Sec. 309 of the Public Health Service Act. See app. A for text of this section.

4

 Sec. 314(c)(2) of the Public Health Service Act, as amended. See app. A for the 

tex t of this section.

4
28 PUBLIC HEA LTH TRAINING AMENDMENTS OF 19 64

enrolled in such schools of public health. The effect of the grants is to 

expand and improve the public health training offered by these schools, 

and to enable them to accept increased enrollments.

The institutions which meet the legal qualifications a t the present time 

are the 12 schools of public health accredited by the American Public 

Health Association for granting the degree of master of public health. 

It is to these schools tha t the Nation must look for the formal training 

of the basic cadre of professional public health personnel, broadly prepared 

in the biological, physical, and social sciences. These 12 schools serve 

not only the 50 States but also have a large portion of students from 

other countries.

One-third of the grant funds are allotted equally among the 12 eligible 

schools; the remaining two-thirds are allotted according to a formula 

based on a 3-year average of the number of federally sponsored students. 

Funds are made available after approval of an application from an 

eligible school showing how and to what extent the proposed expenditures represent improvement in existing teaching programs or the initiation of new ones.

During the 5 fiscal years since the inauguration of the formula grants, 

$5.6 million has been distributed to the 12 schools. The 1963 formula 

grants distributed totaled $1,900,000, with individual grants varying 

from $80,100 to $270,800. More than four-fifths of the total moneys 

budgeted under this program were expended for teaching and other 

personnel; the remaining one-fifth was expended for special conferences, 

continuing education, travel, and equipment.

A ppro pri ati ons fo r P u b li c H ea lt h T rain in g

[Thou san d of dollars]

Leg islative au thor ity (PH S Act)

Fiscal yea r

Traineeships, 

sec. 306

Projec t 

grants, 

sec. 309

Form ula

gra nts ,

sec. 314(c)(2)

1957.................................................................... $1,000

1958.................................................................... 2,0 00

1959.................................................................... 2,0 00 $450

1960.................................................................... 2, 000 1,000

1961.................................................................... 2, 000 $1,43 0 1,000

1962.................................................................... 2, 000 2, 000 1,173

1963.................................................................... 4,0 00 2,0 00 1,9 00

5
PUBLIC HEA LTH TRAINING AMENDMENTS OF 19 64 29

III. Evaluation of Program

The Conference evaluation of sections 306, 309, and 314(c)(2) of the 

Public He alth Service Act was based in part on two original questionnaire 

surveys which were undertaken in the spring of 1963. The first was a 

survey of the 3,123 title I trainees who received training between the 

inception of the program in 1956 and the end of the 1961-62 academic 

year. The second survey concerned the manpower and training needs 

of official health agencies in the 50 States. Additional data were derived from unpublished official reports, from information made available 

by non-Federal agencies and private persons, and from published studies.

APPRAISAL OF EFFECTIVENESS

A tota l of 4,281 title I traineeships have been awarded during the 

7 years of the program. Approximately one-half of the trainees have 

been nurses preparing for beginning staff positions in public health 

agencies. Of the remaining 14 categories of trainees, 429 were sanitary 

engineers, 335 were health educators, 311 were physicians, and 252 were 

sanitarians. Less than 100 trainees comprised each of the remaining 

categories. There is no question that the 4,281 trainees represent a 

significant increase in the number of trained public health personnel av ailable for administrative, research, teaching, and service positions. The 

previously existing downward trend in public health enrollments represented by a 50-percent decrease in the annual number of public health 

trainees between 1947 and 1955 has been reversed.

Approximately three-quarte rs of the trainees who were surveyed completed and returned the questionnaire. Of these, 80 percent had entered 

employment in public health following the completion of the program of 

study sponsored by this award. Over 90 percent of the trainees who 

entered public health employment did so within the year following the 

completion of their traineeship; the remainder did so following an interval 

of further graduate study or work experience. The majority of those not 

working in public health are employed by academic institutions or other 

agencies with some health responsibilities. Less tha n 5 percent of those 

employed are in practice, consulting work, or other employment of a 

strictly private nature. State and local health departments have 

benefited markedly from the traineeship program, since

employ over 60 percent of the trainees who are working in/

32-4 38 0 — 64------ 3
30 PUBLIC HEA LTH TRAINING AMENDMENTS OF 19 64

The fact th at 58 percent of all title I trainees had no previous public 

health experience is an indication of the impact of this program on the 

recruitment of individuals into public health training.

MEASURES OF NEED

Although there is little question that this program has contributed 

impressively toward increasing the numbers of adequately prepared 

public health personnel, the achievement must be evaluated in terms of 

the needs, both for the numbers of personnel and the quality of their 

preparation. The dimensions of need are extremely difficult to define and 

for the present reliance is placed on the informed opinion of experts in the 

field. Numerous studies conducted in recent years have shown th at the 

preparation of professional health personnel is not keeping pace with 

population growth. It is generally accepted by experts that there are 

even more severe shortages of personnel qualified for leadership and 

professional service in the Nation’s changing and expanding public health 

programs.

Public health requires personnel with a wide and increasing range of 

special qualifications. The primary need is for organizational leaders who 

are drawn from the pool of academically qualified individuals possessing a 

comprehensive education in the basic disciplines of public health and 

additional preparation in depth in one of the related substantive areas. 

Furthermore, the increasing demands for personal health services point to 

the need for many more community-based programs staffed by physicians, 

dentists, nurses, therapists, social workers, and other personnel, all of 

whom need a knowledge of the principles of community health and 

comprehensive care.

Qualified personnel in the above categories are needed by official 

agencies with statutory responsibilities for health and welfare at the 

Federal, State, and local levels. These include departments of health, 

departments of welfare, crippled children’s agencies, mental health 

agencies, water supply and pollution control agencies, rehabilitation 

agencies, and others. Personnel are also required by an increasing 

number of community health programs under voluntary auspices, which 

are concerned with the financing, planning, and provision of health 

services. In all of these situations, the full need for personnel is difficult 

to quantify because most programs have not developed to the fullest 

extent necessary. Shortages of personnel have inhibited expansion of 

programs and placed severe restrictions on needed and desirable activities.

The Conference concluded that the information available indicates 

needs in programs at their present level of operation. The data on 

needs were further considered to represent an underestimate because, first, 

they are concerned with the present level of operation, which was considered to be less than necessary; and second, data were available only

8
PUBLIC HEALT H TRAINING AMENDMENTS OF 19 64 31

from official health agencies, which comprise only a portion of the total 

of community health programs.

MANPOWER FOR OFFICIAL HEALTH AGENCIES

Examination of the staffing patterns of Sta te and local health dep artments over the past decade reveals failure to keep pace with population 

growth. In some areas the departments are either losing ground or 

virtually standing still. In 1950, there were 2, 317 public health physicians 

and 1,183 engineers employed full time by State and local health dep artments. By 1954 these figures had declined to 2,085 and 1,030, respectively. This occurred in the face of a national population increase of 

approximately 12 million. In 1962, there were 2,166 public health 

physicians and 1,263 engineers employed full time by these agencies. 

Although this represents an improvement, there are still significant 

shortages when personnel to population ratios are taken into account. 

The 2,317 public health physicians and 1,183 engineers employed in 1950 

provided services for a population of 151.7 million. The 1962 national 

population of 186.6 million requires significantly increased numbers of 

professional public health personnel if the availab ility of health services is 

to be commensurate with emerging health needs.

Public health is faced with the necessity of preparing approximately 

17,000 additional personnel by 1970 for the staffs of State and local health 

departments, merely to keep pace with projected population growth and 

an attrition rate of 4 percent per annum. The needs for physicians can 

be expected to be even more critical. Since over three-fourths of those 

presently engaged in public health work are over the age of 45 years, an 

attrition rate in excess of 4 percent annually is to be anticipated in this 

category. The necessity to develop programs th at will be concerned with 

newly emerging health problems and older problems which have long 

been neglected requires many more personnel in all categories.

A study of the 269 official health departments employing 30 or more 

full time, professional personnel was undertaken in October 1961. Among 

the 131 departments completing the questionnaire, 11.3 percent of the 

budgeted positions for professional personnel were vaca nt. The percentage of vacant positions was 7.2 for engineers, 7.9 for nurses, 9.6 for 

physicians, and 15.8 for social workers. Counts of budgeted vacancies 

do not accurately reflect need. Nevertheless, if this proportion of 

vacancies can be assumed to exist among the categories of professional 

personnel in all State and local health departments, there were at least 

5,000 vacant positions in 1962.

Another dimension of need relates to number and proportion of positions 

which are being filled with inadequately trained or untrained personnel. 

A comparison of data from State and local health departments in 1958 

and 1963 reveals only a slight increase in the proportion of professional 

full-time personnel who were considered to have the education and

9
32 PUBLIC HEA LTH TRAINING AMENDMENTS OF 19 64

training necessary for their jobs. While 49 percent had such training in 

1958, 51 percent were considered to be adequately prepared in 1963. 

This slight difference indicates that much more needs to be done toward 

correcting the deficiency in the level of training of personnel employed 

in public health.

QUALITY OF TRAINING

The quality, content, and depth of public health training also have 

been improved as a result of this program. Although it it difficult to 

evaluate the degree or impact of these changes, it is worth noting the 

contributions which have been made by the training program. During 

the past 3 fiscal years, the project grants for graduate training in public 

health have contributed to improvements in 21 different curriculum 

areas, through the provision of faculty and program support. This 

support has been distributed to 47 schools of public health, nursing, and 

engineering through 63 separate grants in fiscal year 1961; to 58 schools 

through 87 grants in 1962; and to 55 schools through 83 grants in 1963. 

The number of individual curriculum areas indicates the breadth of the 

training needs in public health, as well as the scope of requirements for 

future development.

Support to enhance the quantity and quality of instruction in public 

health has been provided through formula grants to the 12 schools of 

public health. These schools collectively, and in some instances individually, provide instruction in all of the 21 curriculum areas referred to 

above. During the 5 years that these grants have been made to schools 

of public health, they have been used in a variety of ways to strengthen 

the quality as well as the quantity of general training programs in public 

health. Additional faculty members have been brought in to add new 

values to teaching, to handle increased numbers of students in the basic 

courses, and to improve training in a whole series of specialized curriculum 

areas.

ROLE OF FEDERAL AND STATE GOVERNMENTS

The Conference concluded that it is highly appropriate for Federal 

resources to be used to support the higher levels of education and training 

essential for preparation of leadership personnel, without which other 

public health activities cannot reach full fruition. The primary responsibility of Sta te governments resides appropriately in the area of inservice 

training where programs can be more adequately tailored to local needs. 

There is a large area in which responsibilities are shared by the Federal 

and State Governments, with respect to administration and support of 

public health training. Accordingly, programs in continuation education, 

residency training, and field training should and do receive support from 

both sources. In many situations, programs which are supported primarily with Federal funds are augmented through the contribution of

10
PUBLIC HEA LTH TRAINING AMENDMENTS OF 19 64 33

teaching time and administrative services by professional personnel working in S tate and local health organizations.

The identifiable expenditures by State health agencies for public health 

training have increased from $2.8 million in 1956, the year title I traineeships were first awarded, to a high of over $6 million in 1961. The Federal Government expended approximately $11 million for traineeships 

from fiscal 1957 through 1962. During this same period, State health 

agencies increased their efforts and expended almost $30 million for pub ­

lic health training, of which $11.5 million was derived from State and local 

sources. All of the 50 States have had public health workers who have 

received training under this program. Colleges and universities in 40 

States have had trainees enrolled as students.

This endeavor has enjoyed extensive participation of institutions and 

individuals at Federal, State, and local levels. The relative successes of 

this program have been largely achieved through this widespread contribution of energy and resources.

11
34 PU B L IC H E A L T H T R A IN IN G A M E N D M E N T S O F 1 9 6 4

IV. Conference Recommendations

The recommendations, offered for the consideration of the Surgeon 

General and the Congress, are presented in the order in which subjects 

were discussed at the final plenary session of the Conference. Taken 

together, these recommendations represent a comprehensive approach to 

the problem of increasing the numbers of adequately trained public 

health personnel required to meet the Nation’s health needs. The recommendations concern the following areas:

1. Ex tens io n of P ub lic H ea lth T ra in in g Pr og ra m

2. H ea lth M an po wer Tra in in g an d R ec ru itm en t

3. Pub lic H ea lth Train ee sh ip s

4. Pro je ct G ra nt s for G ra duat e or Sp ecialize d Tra in in g

5. For m ul a G ra nts to Schoo ls of P ub lic H ea lth

6. Gra nt s-in -A id to Sta te s

7. C ar ee r Dev elop m en t Aw ards for Fac ulty

8. Tea ch in g Fac ili tie s Con st ru ct io n Aid

9. Tra in in g Pro gr am O pe ra ting Fun ds

T he Se co nd N at io nal C on fe re nce on P ublic H ea lt h T ra in in g re com m end s th at:

12
PUBLIC HEALT H TRAINING AMENDMENTS OF 19 64 3 5

RECOMMENDA TIO N 1

T he ex is ti ng P ublic H ea lth T ra in in g Pro gr am , as auth ori ze d in

se ct io ns 306, 309, an d 314(c)( 2) o f th e P ublic H ea lth Se rv ice A ct , be

ex te nd ed at le ast th ro ugh 1970, an d a th ir d N ati onal C on fe re nce

on P ublic H ea lth T ra in in g be he ld i n 1968, to evalu ate pro gr es s an d

to m ak e re co m m en dati ons as to th e su bse qu en t co urs e o f th e

pr og ra m .

Sup por ting Statement

The appropriation of approximately $26 million from fiscal 1957 through 

1963 under sections 306, 309, and 314(c)(2) of the Public Health Service 

Act has contributed significantly to increasing the supply of adequately 

trained public health personnel and improving the quality of their prep aration. However, the needs are so great at this time that the Conference 

could not anticipate a solution to the problem of manpower shortages 

within the foreseeable future. Accordingly, extension of the program at 

least through 1970 was recommended. The Conference recognized the 

implicit desirability of continued review and evaluation, with subsequent 

public accountability, for a program of this scope and importance. 

Consequently, the calling of a third National Conference on Public Health 

Training in 1968 was recommended.

Since the public health traineeships (sec. 306), project grants for cur ­

riculum development and faculty support (sec. 309), and the formula 

grants to schools of public health (sec. 314(c)(2)), are all interrelated and 

deal with the problem of shortages in manpower for pubic health, they 

were considered to be components of a coordinated approach for the 

correction of these shortages. For this reason, all three sections of the 

legislation were reviewed and evaluated as a group. Subsequent review 

and evaluation of these authorizations as a group were recommended.

To insure continuity of the interrelated training program, the Conference urged that there be a review of each of the sections by the Congress 

at least 1 year prior to expiration of the respective authorizations. The 

calling of a Conference a year or more in advance of the scheduled expiration of legislative authority would permit earlier review of the program 

by the Congress and the subsequent implementation of any authorized 

modifications without a loss in the continuity of training activities.

The Conference recognized that these sections of the Public Health 

Service Act do not represent all of the public health training activities 

supported by the Public Health Service. However, they were considered 

to represent a comprehensive program which is basic to adequate training 

for public health.

13
36 PUBLIC HEALTH TRAINING AMENDMENTS OF 19 64

RECOMMENDATION 2

A health manpower unit in the Pub lic Health Service, closely

related to operating programs and training activities, be responsible for—

(a) Collection and analysis of pertinent data on a continuing

basis; „

(b) Conduct and support of studies and demonstrations related to training and recruitment; and

(c) Dissemin ation of information on all aspects of health

manpower.

Suppo rtin g Statement

The requirement for qualitative and quantitative data concerning health 

manpower needs and resources will steadily increase. Rapidly changing 

characteristics of society, increasing recognition of the importance of 

health, and vast growth of community health services necessitate the 

development of accurate and meaningful data to guide intelligent programing for the recruitment and optimal utilization of health manpower. 

Rational organization and provision of health services require detailed 

knowledge of factors affecting the supply of health manpower and its 

deployment in society.

The development of more effective public health training programs 

requires data concerning the interrelationships among the functions of 

various professions, the range of skills required to perform certain tasks, 

and the characteristics of the health services to be provided. Appropriate 

study of the factors which influence the selection of health careers is of 

utmost importance at this time, since high birth rates in the 1940’s 

forecast increased numbers of college and graduate students from which to 

draw candidates for the health professions in the immediate future. 

Failure to recruit and prepare a significant proportion of these students 

for careers in the health professions, including public health, will severely 

handicap health organizations in their efforts to provide sufficient health 

services of high quality.

Needed activities of the health manpower unit include, but are not 

limited to—

(а) Regular assessment of national needs for health manpower, 

factors influencing need, and resources for meeting these needs;

(б) The support and conduct of (1) studies of the effectiveness of 

educational and training programs for the preparation and 

recruitment of health personnel, and (2) evaluation and demonstration of the recruitment potential of specific training programs

14
PUBLIC HEALTH TRAINING AMENDMENTS OF 19 64 37

for students preparing in the health professions, and special 

preparation for public health at the prebaccalaureate level; and 

(c) Stimulation and support of experimentation with recruitmen t 

for training among selected groups by official and voluntary 

health organizations.

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38 PUBLIC HEA LTH TRAINING AMENDMENTS OF 19 64

REC OMMENDA TION 3

Appropriations under section 306 of the Pub lic Health Service

Act be sufficiently increased to per mit :

(o) Augmentatio n of the number of traineeships to levels

commensurate with the Na tio n’ s public hea lth needs;

(b) Broadening of the traineeship program to include other

types of graduate training, besides those now covered, the

basic criterion being adequacy of public hea lth con ten t;

(c) Provision of part-tim e stipends and special traineeships

for the supp lemental preparation in public health of

studen ts at the postbaccalaureate level in the basic hea lth

professions;

(d) Support of additional persons in extended academic programs and residency training;

(e) Forward financing of all traineeships;

( f ) Reservation at the Federal level of a number of traineeships to be centrally awarded in con sultation with Sta te

operating agencies; and

(g) Restudy and revision of the level of stipends and allowances to trainees, particularly at the postdoctoral level.

Supporting Statem ent

The Conference concluded tha t the public health traineeships represent 

only an impressive beginning in the correction of severe shortages of 

health manpower. There was unanimity of opinion as to the need for 

increasing this effort. Conferees from all types of institutions currently 

responsible for the long-term academic preparation of trainees noted the 

lack of sufficient traineeships to support all qualified and deserving 

applicants. This situation exists even with the increase in appropriations 

from $2 million to $4 million in fiscal 1963.

Recognizing the acutely competitive situation which exists with respect 

to all professional manpower, the Conference recommended broadening 

the criteria of eligibility for traineeships to permit the support of supplementary preparation in public health at the postbaccalaureate level for 

students in the health professions through part-time stipends and special 

traineeships. This broadening will encourage students in dentistry, 

medicine, social work, and other of the health professions to supplement 

their basic professional education with additional preparation in public 

health.

16
PUBLIC HEALT H TRAINING AMENDMENTS OF 19 64 39

Broadening was also recommended to include additional postbaccalaureate programs subject to the evaluation of the public health content 

of the proposed study. This broadening would encourage the utilization 

of appropriate university departments and graduate schools in such fields 

as metropolitan planning, hospital administration, and public administration.

The importance of evaluation of the public health content of a program 

of study was emphasized. At present there are few mechanisms for 

accrediting or approving the public health content of such programs. 

Accordingly, extended accreditation mechanisms or careful review by 

the National Advisory Committee on Public Health Training of individual 

proposals for the support of such training would need to accompany the 

broadening of eligibility criteria for traineeships.

The rapid accumulation of scientific knowledge has resulted in the 

necessity of extended preparation in depth for individuals who will 

occupy positions of leadership in administration, research, service, and 

teaching in public health. The Conference noted the desirability of 

supporting such individuals for 3 or 4 years in those instances where 

this represents the time required to complete a defined and acceptable 

program. Such extended preparation would include residency training, 

approved by the appropriate examining body, and demonstrably relevan t to public health; e.g., community dentistry, community medicine, 

maternal and child health, and occupational health.

An additional nonrecurring appropriation for one or more years was 

urged in order to forward finance the traineeship program. Forward 

financing is needed to permit early confirmation of awards to promising 

individuals who must plan 6 months to a year ahead because of professional obligations, commitments to employing agencies, and family 

responsibilities. At the present time, a prospective trainee who plans 

to begin an academic program in September of a given year usually does 

not receive final confirmation of his award until August of the same 

year. This delayed notification impedes the recruitment of outstanding 

candidates and frequently causes a disruption in the services of operating 

agencies because of the last-minute release of key personnel.

It was deemed advisable that augmentation in the number of traineeships be accompanied by the reservation at the Federal level of a few of 

these to be awarded centrally in consultation with State operating 

agencies. This mechanism, in combination with the award of traineeships through grants to academic institutions, would achieve a balance 

between the priorities for training assigned by schools and operating 

agencies.

The desirability of creating a uniform schedule of awards among 

comparable Federal training programs indicated the need for study 

and, where appropriate, revision of the level of stipends and allowances 

to trainees. Such a schedule should reflect various factors, including 

the individual needs of trainees; e.g., age, family size, level of training,

17
40 PUBLIC HEALT H TRAINING AMENDMENTS OF 19 64

professional position, and cost of living. At present, stipends under 

this program are higher th an those of some Federal programs for certain 

postbaccalaureate students, but are significantly lower for postdoctoral 

students. The questionnaire survey of trainees revealed that one-half of 

the students in this latter category (physicians, dentists, and veterinarians) sustained a considerable reduction in monthly income. These 

individuals are among the most critically needed in public health. Fu rthermore, their subsequent careers in public health will at an income 

significantly below that which they could obtain in private practice.

18
PUBLIC HEALT H TRAINING AMENDMENTS OF 19 64 41

RECOMM ENDAT ION 4

The authority for project grants for graduate or specialized

train ing in public hea lth be expanded and the appropriation

authorization be sub stantially increased to permit—

(а) Con tinuation of existing projects of high quality, as well

as award each year of project grants to meritorious new

proposals;

(б) Broad ening of e ligib ility for project grants to depa rtm ent s

of preventive medicine in medical schools and to other

pub lic and nonprofit institution s and agencies, with

provision for evaluation of adequacy of the public health

con ten t of the proposed training;

(c) Making project grants available for the stimu lation and

developm ent of trainin g programs in interdisciplinary

settings;

(d) Making project grants available to support con tinuation

education and specialized trainin g jointly developed and

sponsored by educational ins titu tions, o perating agencies,

and professional associations; and

(e) Formation of expert review co' amittees, or study sections,

for tech nical review of grant applications prior to final

review by the Nationa l Advisory Commi tte e on Pu blic

Health Trainin g.

Sup portin g Statement

A higher authcrization and increased appropriations are essential if 

the Public H ealth Service is to award grants to new and needed proposals, 

in addition to maintaining these projects which warrant continued 

Federal support. There are insufficient funds available under the 

current authorization ceiling and appropriation of $2 million to permit 

the awarding of any additional grants after fiscal 1963.

The Conference recommended broadening the eligibility for grants to 

include institutions and agencies, in addition to schools of public health, 

nursing, and engineering, to which present legislation is limited. Grants 

to other kinds of organizations would encourage them to expand and 

strengthen graduate or specialized training in public health and would 

contribute toward bringing new individuals into the field of public health.

The importance of dramatically strengthening and expanding the public 

health content of the curricula in professional schools such as dentistry, 

medicine, social work, and veterinary medicine, from which public health

19
42 PUBLIC HEALT H TRAINING AMENDMENTS OF 19 64

personnel may be recruited, was repeatedly emphasized. The lack of 

public health content in the curricula of such schools has resulted in the 

graduation of dentists, physicians, social workers, and veterinarians 

whose preparation is so deficient in knowledge of the principles and content of community health services and organization, that these individuals 

have little stimulation to select careers in public health. Furthermore, 

increased strength in departments of preventive medicine and departments of community dentistry would provide students with an awareness 

of public health sufficient to favorably influence their subsequent provision 

of health services in clinical practice.

Departm ents of preventive medicine receive specific mention because 

of the urgent need for recruitment and preparation of physicians for 

leadership positions in public health. To date, the impact of the public 

health training program in this respect has been minimal. A 1961 health 

manpower survey revealed that among physicians 35 years of age and 

under, only 33 were receiving residency training in public health. Comparable figures for other specialties were 1,827 in psychiatry, 3,718 in 

general surgery, and 4,375 in internal medicine. Support for programs 

of public health and preventive medicine in medical schools must receive 

high priority if this severe imbalance is to be corrected.

Efforts to strengthen and expand academic programs, departments, or 

schools require stability of funds if competent faculties are to be attracted 

and held. Accordingly, the tentative commitment of project funds for 

up to 7 years was recommended, subject to annual evaluation and the 

demonstration of satisfactory progress, with the possibility of extension 

beyond this period. A grant of less than 2 years’ duration was considered 

to be unsatisfactory except in very special circumstances.

Critical manpower requirements necessitate an increase in the numbers 

of specialized ancillary health personnel. There is a significant need for 

the exploration and design of new training programs concerned with the 

preparation of individuals to work under professional supervision and to 

assist in the provision of health services. To this end, the Conference 

recommended that project grants be made available to public and private 

nonprofit organizations for the support of specialized training programs.

The Conference recognized the importance of graduate or specialized 

training in interdisciplinary settings utilizing un.que combinations of 

training resources, and recommended tha t grants be made available to 

stimulate the development of interagency, interdepartment, and inte runiversity programs. At present most interdisciplinary programs are 

found in the Natio n’s 12 schools of public health. These schools are not 

distributed evenly throughout the United States. However, there is a 

wide distribution of academic and operating institutions which possess 

many of the essential resources which could be effectively utilized for the 

creation of interdisciplinary training programs in public health.

Continuation education is universally accepted as a high priority area, 

but it lacks a natural habitat. Efforts directed at shortening the lag

20
PUBLIC HEA LTH TRAINING AMENDMENTS OF 19 64 43

period between the development of new knowledge and its application 

require effective programs of continuing education. Furthermore, the 

exponential expansion of scientific knowledge necessitates an institutional 

focus for effective organization and presentation of programs in con tinu ­

ation education. Universities are reluctant to divert their already limited 

resources from their primary mission of the acquisition of new knowledge 

and preparation in depth of the full-time student. Likewise, operating 

agencies generally lack appropriate personnel or sufficient resources to 

develop programs in continuation education. The availability of projec t 

grant funds would stimulate and assist educational institutions, operating 

agencies, and professional associations to sponsor jointly anu to collaborate in the development of programs to meet this need. This approach 

is comparable to that presented as Recommendation 13 by the First 

National Conference on Public Health Training.

The role of the National Advisory Committee on Public Health Train ­

ing at present is twofold: to advise the Surgeon General on policy, administration, and priorities in program areas; and to serve as an expert 

study group in the review of applications for project grants. The expansion of the project grant program and the necessity for evaluation of 

the adequacy of the public health content of proposed training would 

place additional demands for review of projects and conduct of site visits 

on the time of consultants. The creation of review committees is w arranted so tha t the National Advisory Committee on Public Health Training can devote its efforts to the purpose originally set forth in the Health 

Amendments Act of 1956; namely, to advise the Surgeon General on 

policy and administration of the training program.

The Conference further suggested tha t the Public Health Service 

consider the desirability of combining trainee stipends with funds for 

faculty support and curriculum development into training grants to 

institutions. These individual elements are available separately under 

sections 306 and 309, respectively. A broadening of the legislation to 

include institutions, in addition to schools of public health, nursing, and 

engineering, woidd result in a high proportion of applications which 

require both program and student support. The availability of training

grants would relieve the applicant institution of the burden of preparing 

multiple proposals and would contribute to efficient administration. The 

Conference specified tha t training grants be limited to the postbaccalaureate level a t this time, since this area has needs which require priority 

attention. It was deemed advisable tha t the grantee institution be per ­

mitted to use a portion of training grants funds for the reimbursement of 

unusual expenses incurred bv a student as a result of training, such as 

travel and additional living expenses connected with field experiences, 

and the recruitment expenses connected with a training program.

21
44 PUBLIC HEALTH TRAINING AMENDMENTS OF 19 64

RECOMM END ATI ON 5

The authorization ceiling for formula grants to schools of

pub lic hea lth be increased to at least twice the present level, and

there be annual increments in appropriations adeq uate to reach

the proposed authorization by 1970, in order to assist these schools

in e nrichin g their curricula and increasing enrollm ent of federally

sponsored students.

Sup portin g Statement

The 12 schools of public health h ave unusual needs and limited financial 

resources. Neithe r Sta te legislatures nor private endowments alone can 

keep pace with the high costs of keeping a school strong in the many and 

varied elem ents th at const itute the cur ren t complex public health program. Such stre ngth is essential if these schools are to continue their 

role as the prim ary national resource for public hea lth training.

In recom mending progressive and sub stantial increase in authorization 

and app ropriations for formula gra nts, the Conference recognized the 

need to compensate the schools of public hea lth in pa rt for the grea t 

discrepancy between instruc tion al cost per stu dent and tuition received 

by the university. Recen t figures suggest th at , on the average, tuition 

fees cover less tha n one-seventh the cost of basic operations and instruc ­

tion. At present, well over half the stu den ts in the schools of public 

health are federally sponsored. The net costs to these schools on behalf 

of federally sponsored stu dents exceeded §5 million during the 1962-63 

academic year.

Review of the use of form ula gra nts to date indicated th at four-fifths 

of the gra nt moneys have gone to pay salaries of personnel, mostly 

academic staff, bu t also secretarial and other supporting staff. Fund s 

have also been used for essential materials and teach ing aids. Documented planning by individ ual schools shows th at curre nt urgent needs 

are far in excess of the presen t authorized ceiling. Fur thermore , these 

needs are expected to increase as enrollm ent grows and initial gradua te 

study is extended beyond 1 academic year. Several programs are 

already of 2 years’ duration , and others contem plate an increase to at 

least 3 semesters or 18 months in order to encom pass sufficient instru ctio n in the ever-w idening field of public health.

A reasonable projectio n of needs, con cen trating prim arily on necessary 

increases in professional staff, indicates th at a doubling of the present 

formula grant authorization of $2.5 million to $5 million is the minimum 

increase required. The Conference recommended annual increme nts in 

appropriations to reach the new authorization by 1970, to assure orderly 

growth of the schools c omm ensurate with increased dema nds.

22
PUBLIC HEALT H TRAINING AMENDMENTS OF 19 64 4

RECOMM END ATI ON 6

Earmarked training and recruitm ent gra nts-in-a id be made to

the several States, to assist the development of needed training

programs geared to local public hea lth requirements. These

gra nts -in-aid would he awarded on a matc hing basis, with provision for the submission of a Sta te plan for review and approval

by the Surgeon General.

Suppo rtin g Statement

The prim ary responsibility of the States for public hea lth training is in 

the areas of inservice and short-term training not carryin g academic 

cred it. The Conference noted, however, th at the inaugu ration of such 

programs by Sta te hea lth depar tments was being impeded because of 

insufficient resources to develop and adm inister effective training. 

Grants-in-aid are, therefore, recom mended to assist Sta tes to meet more 

effectively their responsibilities for public hea lth training. The initial 

app ropriation should be no less tha n $4 million, based on an estimate of 

an average of approximate ly $80,000 for each of the 50 Sta tes, with a 

basic minim um to each Sta te as has been found practical in oth er grantin-aid programs. These moneys would stre ngthen training piograms in 

Sta te health departm ents and would enable Sta tes where no training 

programs exist to staff a training and rec ruitment unit.

The impo rtance of gran t-in-aid funds to the States for training was 

recognized by the First National Conference on Public Health Tra ining 

in 1958. Subsequent experience has further dem ons trated a continuing 

need. Sta te health dep artments are faced with the task of correcting 

the deficiencies arising from the emp loym ent of inadequate ly tra ine d or 

untrained personnel. At the present time, almost 50 perc ent of the 

employees of Sta le health dep artments have not had ade quate public 

health trainin g. This represents a burden w hich the Sta tes may partia lly 

allev iate thro ugh extensive inservice training.

Grants-in-aid would assist States in the provision of public health 

training closely geared to local requirem ents. Such training would 

include the supp lemental preparation essential for the adaptat ion of 

existing personnel to new health programs and specialized training based 

on an analysis of the skills utilized in the provision of health services. 

Sta tes placing high prio rity on the midcareer development of an ind ividual thro ugh long-term academic training or on prebac cala ureate 

academic training to meet local needs, would be per mitted to elect this 

use of funds by so indicating in the plan s ubmitted to the Surgeon General.

32 -4 38 0 — 64------4

23
46 PUBLIC HEA LTH TRAINING AMENDMENTS OF 19 64

REC OMMENDA TION 7

Special fellowships and career development awards be initiated

to assist in the development of critically needed fac ult y in the

disciplines essential to public health. These awards would he

comparable with those now offered by the Federal Government in

other fields, and would enhance all public health train ing.

Supporting Statement

The shortages of com pete nt faculty in the subjects essential to public 

hea lth training and the need to develop adequa te numbers of new training 

programs withou t sacrificing qua lity were two of the most critical problems noted by the Conference. College and university enro llments of 5 

to 7 million stu den ts are predicted for 1970. A dynamic program of 

faculty deve lopment must be initiat ed, if a significant num ber of these 

students are to be recruited and prepared for careers in public hea lth.

Significant increases in the numbers of facu lty were considered essential 

since seminars, tuto rials, research preceptorships, and supervised field 

experiences m ust be offered stu dents at the graduate level in approximately 

2 dozen different subject areas. The Conference considered such a program to be an important compone nt of any effort to stre ngthen and expand 

public health training. The app ropriation of funds would permit the 

award of special fellowships for th e career developm ent of faculty in such 

essential disciplines as community dentistry, environ men tal hea lth, 

preven tive medicine, and public hea lth nursing.

In addition to keeping pace with needed expansion, faculty development is required for positions in existing programs. As an illustration, a 

question naire survey of departm ents of preventiv e medicine during the 

1962-63 academic year revealed th at among the 62 depa rtm ents respon ding, there w’ere 53 full-time budgete d vacancies for assis tant, associate, or 

full professors. A significant portion of the positions for public hea lth 

facu lty in schools of medicine are thu s vac ant, since departm ents of 

preventive medicine are characteristically small. It is not unusual to find 

a departm ent consisting of only one or two full-time faculty members. 

Com parable shortages exist for public health faculty in numerous oth er 

health professional schools. Moreover, the faculties of such schools are 

looked to for advice and consultation at local, Sta te, Nation al, and international levels. These demands for public service represen t an additional 

burd en on existing faculties and fur the r necessitate an increase in the ir 

numbers.

24
PUBLIC HEA LT H TRAINING AM ENDM ENTS OF 19 6 4 47

RECOMMENDA TIO N 8

There be auth orization and appropriatio n of sufficient funds

on a continuing basis to assist in the construction of needed

teaching facilities to accommodate more adequately present and

future enrollments in the disciplines essential to pub lic health.

Sup porting Statem ent

The First National Conference on Public Health Training recommended 

the authorization and appropriation of funds to assist in meeting construction costs of additional teaching facilities for schools of public health and 

those schools of nursing accredited for the preparation of nurses for public 

health. The construction section of proposed legislation for health 

professions educational assistance in 1963 (H.R. 12) incorporated in part 

the recommendations of the First Conference.

As passed by the House of Representatives on April 24, 1963,* H.R. 12 

provided for the appropriation of $175 million for a 3-year period, subject 

to renewal. The aggregate appropriation includes: fa) $105 million for 

the construction of new teaching facilities for the training of physicians, 

pharmacists, optometrists, podiatrists, nurses, and other professional 

health presonnel; (6) $35 million for the construction of new teaching 

facilities to train dentists; and (c) $35 million for the replacement or 

rehabilitation of existing teaching facilities for the training of all health 

personnel mentioned in (a) and (6) above.

The Second Conference endorsed H.R. 12 as essential to meeting the 

pressing demand for additonal teaching facilities in the numerous academic 

institutions engaged in graduate or specialized public health training. 

The Conference further recommended tha t modifications in the authorization be considered by the Congress when renewal of the program is 

discussed. Needed modifications include a recognition of the growing 

public health activities in schools of engineering and veterinary medicine 

by the extension of eligibility for construction aid to the public health 

phase of such programs. Furthermore, the unique and comprehensive 

training provided by the schools of public health warrant the consideration 

of their construction needs in a category apa rt from the institutions 

responsible for training other professional health personnel.

* Passed the Senate, Sept. 12, 1963; approved Sept. 24, 1963, as Public Law 88-129.

25
48 PUBLIC HEALTH TRAINING AMENDMENTS OF 19 64

RECOMMENDATION 9

Ade quate funds be appropriated to the Pub lic Hea lth Service to

provide for the continued effective operation of this training

program in its expanded form and for the utilization of contracts

and cooperative agreements to stimula te and support new types

of training programs and related recruitm ent activities.

Supp ortin g Statement

The Conference noted that the administrative procedures evolved by 

the Public Health Service have resulted in the efficient operation of this 

program despite a limited appropriation for administrative costs; i.e., less 

than 2.5 percent of the total appropriation for sections 306, 309, and 314 

(c) (2) in fiscal 1963. However, in view of the expansions recommended by 

the Conference, and the growth of the program over the past several years, 

it was considered to be essential that additional funds be made available 

to assure effective program management.

The Conference also recommended the appropriation of direct operating 

funds to permit the utilization of contracts, cooperative agreements, and 

other mechanisms to assist in the development of new training programs 

and related recruitment activities. Such flexibility would enable the 

Public Health Service to exercise initiative through the support o f experimentation in training and related recruitment. Increased operating 

funds for these purposes would significantly enhance program accomplishments under sections 306, 309, and 314(c)(2) of the Public Health Service 

Act.

26
PUBLIC HEA LT H TRAIN ING AM EN DM EN TS OF 1964 49

APPENDIX

A. Legislation

B. Conference Organization

C. Selected Data

D. List o f Conferees

E. Conference Personne l

A. Legislation

1. Tr aine es hips (Section 306 of the Public Health Service Act, Public 

Law 84-911, July 1, 1956; as amended by Public Law 86-105, approved 

July 23, 1959, and Public Law 86-720, approved September 8, 1960).

To improve the health of the people by assisting in 

increasing the number of adequately trained 

professional and practical nurses and professional 

public health personnel, assisting in the development of improved methods of care and trea tme nt 

in the field of mental health, and for other purposes.

Be it enacted by the Senate and House of Representatives

of the United States of America in Congress assembled,

That this Act may be cited as the "’Health Amendments 

Act of 1956.”

TIT LE I—GRADUATE TRAIN ING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL 

TRAINEESHIPS

Sec. 101. Title III of the Public Health Service

Act (42 U.S.C., ch. 6A, subch. II) is amended byadding a t the end of pa rt A the following new section:

"trainees hips for professional public health

PERSONNEL

"S ec. 306. (a) There are hereby authorized to be 

appropriated for the fiscal year ending June 30, 1957, 

and for each of the next two 1 fiscal years, such sums 

as the Congress may determine, to cover the cost of 

traineeships for graduate or specialized training in 

public health for physicians, engineers, nurses, and 

other professional health personnel.

"(b) Traineeships imder this section may be awarded 

by the Surgeon General either (1) directly to individuals 

whose applications for admission have been accepted 

by the public or other nonprofit institutions providing

1

 Amended to read "seven” by Public Law 86-105, approved July 23,1959. Current 

authorization expires June 30, 1964.

29
50 PUBLIC HEA LT H TR AINING AM ENDM ENTS OF 1964

the training, or (2) through grants to such institutions.

"(c) Payments under this section may be made in 

advance or by way of reimbursement, and at such 

intervals and on such conditions, as the Surgeon

General finds necessary. Such payments to institu ­

tions may be used only for traineeships, and payments 

under this section with respect to any traineeship 

shall be limited to such amounts as the Surgeon 

General finds necessary to cover the cost of tuition 

and fees, and a stipend and allowances (including travel 

and subsistence expenses) for the trainee.

"(d) The Surgeon General shall appoint an expert 

advisory committee, composed of persons representative of the principal health specialties in the fields of 

public health administration and training, to advise 

him in connection with the administration of this 

section,2

 including the development of program standards and policies.2

 Members of such committee who 

are not otherwise in the employ of the United States, 

w hile attending meetings of the committee or otherwise 

serving at the request of the Surgeon General, shall be 

entitled to receive compensation at a rate to be fixed 

by the Secretary of Health, Education, and Welfare, 

but not exceeding .*50 per diem, including travel time, 

and while away from their homes or regular places of 

business they max be allowed travel expenses, including 

per diem in lieu of subsistence, as authorized by law 

(5 U.S.C. 73b-2) for persons in the Government service 

employed intermittently.

"(e) The Surgeon General shall, between June 30,

1958, and December 1, 1958, call a conference broadly 

representative of the professional and training groups 

interested in and informed about training of professional 

public health personnel, and including members of the 

advisory committee appointed pursuant to subsection 

(d), to assist him in appraising the effectiveness of the 

traineeships under this section in meeting the needs 

for trained public health personnel; in considering 

modifications in this section, if any, which may be 

desirable to increase its effectiveness: and in considering 

the most effective distribution of responsibilities between Federal and State governments with respect to

2

 Amended by Public Law 86-720, approved September 8, 1960, lo insert "and 

section 309, here, and adding at the end of the sentence, before the period, "and 

including, in the case of section 309, certification to the Surgeon General of projects 

which it has reviewed and approved.”

30
PU B L IC H E A L T H T R A IN IN G A M E N D M E N T S O F 1 9 6 4 51

the administration and support of public health training.

The Surgeon General shall submit to the Congress, on 

or before Janua ry 1, 1959, a report of such conference, 

including any recommendations by it relating to the 

limitation, extension, or modification of this section.3

"(f) Except as otherwise provided in this section, 

nothing contained in this section shall be construed as 

authorizing any department, agency, officer, or employee of the United States to exercise any direction, 

supervision, or control over the personnel or curriculum 

of any training institution.”

EFFECTIVE DATE

Sec. 102. The amendment made by this title shall 

become effective July 1, 1956.

2. Pr ojec t G ra nt s (Section 309 (a) and (b) of the Public Health Service 

Act, Public Law 86-720, approved September 8, 1960).

To amend title III of the Public Health Service Act, to 

authorize project grants for graduate training in 

public health and for other purposes.

Be it enacted by the Senate and House of Representatives

of the United States of America in Congress assembled,

That (a) pa rt A of title III of the Public Health Service 

Act, as amended (42 U.S.C., ch. 6A, subch. II), is 

amended by inserting at the end thereof the following 

new section:

" project grants for graduate training in public

HEALTH

"S ec. 309. (a) In order to enable the Surgeon General to make project grants to schools of public health, 

and to those schools of nursing or engineering which 

provide graduate or specialized training in public health 

for nurses or engineers, for the purpose of strengthening 

or expanding graduate public health training in such 

schools, there are hereby authorized to be appropriated 

not to exceed 42,000,000 for each fiscal year in the 

period beginning July 1, 1960, and ending June 30,

1965.

3

 Am ended by Pu blic La w 86—105, ap pr ov ed Ju ly 23 , 1959, to in se rt a t th e end of 

this su bs ec tion , th e following: "T he Su rgeo n Gen eral sh all, be tw ee n Ju ne 30, 1963, 

an d De ce mbe r 1, 1963, call a sim ila r co nferen ce , an d sh all su bm it to Co ng ress, on or 

before Ja nuar y 1, 1961, a re po rt of such co nferen ce , in clud ing an y re co m m en da tio ns 

by it re la ting to th e lim ita tio n, ex tens ion, or mod ifi ca tio n of th is section.

31
52 PUBLIC HEA LT H TRAINING AM ENDM ENTS OF 19 64

"(b) Grants to schools under subsection (a) of this 

section may be made only for those projects which are 

recommended by the advisory committee appointed 

pursuant to section 306(d). Any grant for a project 

made from an appropriation under this section for any 

fiscal year may include such amounts for carrying out 

such project during succeeding years. Payment pursuant to such grants may be made in advance or byway of reimbursement, and in such installments as the 

Surgeon General shall prescribe by regulations after 

consultation with representatives of such schools.”

Approved September 8, 1960.

3. For m ul a G ra nt s (Section 314(c) of the Public Health Service Act, 

Public Law 85-544, approved July 22, 1958; as amended by Public 

Law 86-720, September 8, 1960, and Public Law 87-395, October 5, 

1961).

To amend section 314(c) of the Public Health Service 

Act, so as to authorize the Surgeon General to 

make certain grants-in-aid for provision in public 

or nonprofit accredited schools of public health of 

training and services in the fields of public health 

and in the administration of State and local pub ­

lic health programs.

Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled, That the last sentence of subsection (c) of section 

314 of the Public Health Service Act, as amended (42 

U.S.C. 246(c)), is amended by inserting "(1 )” immediately after "available” , and by striking out the period 

at the end thereof and inserting in lieu thereof a comma 

and the following: "and (2) an amount, not to exceed 

$1,000,000 1

 to enable the Surgeon General to make 

grants-in-aid, under such terms and conditions as may 

be prescribed by regulations, for provision in public 

or nonprofit schools of public health accredited by a 

body or bodies recognized by the Surgeon General, of 

comprehensive professional training, specialized consultive services, and technical assistance in the fields of 

public health and in the administration of State and 

local public health programs, except tha t in allocating 

funds made available under this clause (2) among such

1

 Amended to read "$2,500,000” by Public Law 87-395, approved Oct. 5, 1961. 

Current authorization expires Jun e 30, 1966.

32
PUBLIC HE AL TH TRAIN ING AM EN DM EN TS OF 19 64 53

schools of public health the Surgeon General shall give

primary consideration to the number of federally sponsored students attending each such school.”

Sec. 2. The amendment made by the first section of

this Act shall be applicable only to the fiscal years beginning July 1, 1958, and July 1, 1959.2

Approved July 22, 1958.

2

 Sec. 2 repealed by Public Law 86-720, approved Sept. 8, 1960.

33
54 PUBLIC HEALTH TRAINING AMENDMENTS OF 19 64

B. Co nference Org an iza tio n

Planning for the Second National Conference on Public Health Tra ining began in April 1962 when the National Advisory Committee on 

Public Health Training assumed its role as the Steering Committee and 

held preliminary discussions concerning the scope of the forthcoming 

Conference. Subsequent meetings of the Steering Committee were 

concerned with defining the data needed, the methods for its collection 

and presentation, the selection of conferees, and the formulation of agenda 

items for discussion at the Conference.

Steering Committee

Dr. Paul Q. Peterson, Chairman, Division of Community Health 

Services

Miss L. Ann Conley, Wayne S tate University, Detroit

Mrs. Pearl P. Coulter, University of Arizona, Tucson

Dr. Edward Davens, State Department of H ealth, Baltimore

Dr. John W. Fertig, Columbia University, New York

Dr. John A. Ixigan, Rose Polytechnic Inst itute, Terre Haute, Ind.

*Dr. Berwyn F. Mattison, American Public Health Association,

New York

*Dr. Malcolm H. Merrill, State Department of Health, Berkeley

Mr. Sewall Milliken, Public Health Federation, Cincinnati

*Dr. Charles E. Smith, University of California, Berkeley

*Dr. Tom F. Whayne, University of Kentucky, Lexington

Dr. Wesley 0. Young, Idaho Departm ent of Health, Boise

Dr. Elmer L. Hill, Executive Secretary, Training Resources Branch

The preparations for the Conference assumed increased proportions 

early in 1963 with the appointment of four pre-Conference Study Committees. Each committee met in March and May 1963. These meetings 

were devoted to the preparation of the Conference Working Paper and 

the Background Data book, and the suggestion of agenda items for the 

consideration of the Steering Committee.

Committee on Mission of Public Health T raining

*Dr. Myron E. Wegman, Chairman, University of Michigan, Ann 

Arbor

*Dr. Walter D. Atkins, New Mexico D epartment of Public Health, 

Santa Fe

*Dr. Roger Egeberg, Los Angeles County Department of Charities, 

Los Angeles

♦Denotes members of the Executive Committee.

35
PUBLIC HEA LTH TRAINING AMENDMENTS OF 19 64 55

*Dr. George James, New York City Health Dep artm ent, New York 

*Dr. Hugh R. Leavell, Harvard University, Boston 

*Dr. Gerard A. Rohlich, University of Wisconsin, Madison 

*Dr. Margaret L. Shetland, University of North Carolina, Chapel 

Hill

Committee on Training Needs and Resources

*Dr. Kerr L. White, Chairman, University of Vermont, Burlington 

Dr. Franklyn B. Amos, New York State Dep artm ent of Health, 

Albany

Mrs. Bess Dana, Council on Social Work Education, New York 

Dr. Daniel A. Okun, University of N orth Carolina, Chapel Hill 

Dr. Anthony M.-M. Payne, Yale University, New Haven 

Miss Doris R. Schwartz, Cornell-New York Hospital, New York 

Miss Jeanette Simmons, American Heart Association, New York 

Committee on Perso nnel Needs and Resources

*Dr. David Striffler, Chairman, University of Michigan, Ann Arbor 

Mr. Harold Adams, Indiana University, Indianapolis 

Dr. Howard L. Bost, University of Kentucky, Lexington 

Dr. Ralph Dwork, Pennsylvania Department of Health, Harrisburg 

Dr. Cecil Sheps, University of Pittsburgh, Pittsburgh 

Miss Jean Stair, Western Reserve University, Cleveland 

Committee on Policy and Administration

*Dr. John D. Porterfield, Chairman, University of California, 

Berkeley

Dr. Bernard Bucove, Washington State Department of Health, 

Olympia

Dr. Robert Dyar, California State Departm ent of Health, Berkeley 

Dr. Lenor S. Goerke, University of California, Los Angeles 

Mr. Don M. Hufhines, American Public Health Association, San 

Francisco

Mrs. Margaret Shackelford, University of Oklahoma, Oklahoma 

City

Confe rence Schedule

The Conference was called to order at 9:30 a.m., Monday, August 19,

1963, by the Chairman, Dr. William R. Willard, Vice President and Dean, 

University of Kentucky Medical Center, Lexington. The opening 

plenary session consisted of remarks by Dr. James M. Hundley, Assistant 

Surgeon General for Operations; Dr. Aaron W. Christensen, Deputy 

Chief, Bureau of State Services; and Dr. W illard.

Following the plenary session, the 80 conferees were distributed among 

seven working groups, such that each working group had representation

’Denotes members of the Executive Committee.

36
56 PUBLIC HEALTH TRAINING AMENDMENTS OF 19 64

from the Steering Committee and the four pre-Conference Study Committees. The work groups met concurrently for four sessions, totaling 

approximately 10 hours, during Monday and Tuesday, August 19 and 

20, 1963. The Chairmen of the seven working groups were all members 

of the pre-Conference Committee on Mission of Public Health Training. 

Two members of the Public Health Service were assigned to each working 

group as recorders. All groups used the same agenda topics b ut covered 

them in different sequence to insure adequate coverage of all topics.

Working Group Chairmen

I. Dr. Walter D. Atkins

II. Dr. Roger Egeberg

III. Dr. George James

IV. Dr. Hugh R. Leavell

V. Dr. Gerard A. Rohlich

VI. Dr. Margaret L. Shetland

VII. Dr. Myron E. Wegman

On Wednesday, August 21, 1963, the 80 conferees were redistributed 

among four recommendation groups, such tha t each recommendation 

group had equal representation from each of the seven working groups. 

These groups met concurrently to formulate draft recommendations 

on separate topics, for the subsequent consideration and discussion by 

the Conference in plenary session and ultimate synthesis into the final 

recommendations by the Executive Committee. Again, each group 

had two recorders from the Public Health Service.

Recommendation Group Chairmen

Administration and Policy—Dr. John D. Porterfield 

Academic Training—Dr. Kerr L. White

Nonacademic Training—Dr. Malcolm H. Merrill 

Recruitment—Dr. David Striffler

The final plenary session was held on Thursday morning, August 22,

1963, and consisted of reports of the draft recommendations by the 

Chairmen of the four recommendation groups followed by discussion 

from the floor. Dr. R obert Dyar, California State Department of Health, 

delivered a summary of the Conference, and the Conference was concluded 

with remarks by Dr. David E. Price, Deputy Surgeon General.

The Executive Committee was composed of the representatives of 

the Steering Committee, the Chairmen of the four pre-Conference Study 

Committees, who also chaired the four recommendation groups, and the 

Chairmen of the seven working groups. The Executive Committee, 

with the Conference Chairman presiding, met Thursday afternoon and 

evening, August 22, 1963, and Saturday, September 7, 1963, to prepare 

the Report of the Conference to the Surgeon General.

37
PUBLIC HEA LTH TRAINING AMENDMENTS OF 19 64 57

C. Selected Data

The data presented herein have been selected from the Background 

Data book because of their pertinence for the evaluation of the public 

health training program.

Nu mb er Page

1. Demographic Trends in the Unite d States, by Age

Group, for Selected Years 1900-1962; Projections

to 1970 and 198 0............................................................. 41

2. Population of the United States, by Age and Sex, 1950

and 1960, 1957, and 1980 .............................................. 42

3. Trends in Expenditures for Health and Medical Care

in the United States, for Selected Years, 1950-60. . . 43

4. Educational Manpower—Degrees Earned, 1948-62. . 44

5. Ten Leading Causes of Death in the United States,

for Selected Years, 1900 and 1961............................... 46

6. Reduction in Infant Mortality, Selected Countries,

1950-62 .............................................................................. 47

7. Identifiable Expenditures by State Health Agencies

for Public Health Training and Percent Derived

From Each Fund Source, Fiscal Years 1948-62. . . . 48

8. Graduates in the Health Professions, for Selected

Years, 1948-62 ................................................................. 49

9. Number of Full-Time Personnel of Different Classifications Employed by State and Local Health Departments, for Selected Years, 1950-62 ..................... 50

10. Number of Budgeted Positions—F illed and Vacant—

Requiring Specified Education and Training as Reported by 131 State and Local Health Departments,

October 1961.................................................................... 51

11. Age Distribution of Selected Full-Time Medical Spe ­

cialists, 196 1..................................................................... 52

12. Total Number and Number in Training of Full-Time

Medical Specialists, by Selected Categories, 1961. . 53

13. Degrees in Public Health Awarded by Schools of Public Health in the United States, 1953-62 ................... 53

14. Number of Trainees, by Professional Category, 1957-

63 ........................................................................................ 54

15. Number of Trainees, by Years of Prior Public Health

Experience, 19 57-63....................................................... 55

16. Number of Trainees by Age Group, 1957-63................ 55

17. Number of Individuals Awarded Public Health

Traineeships, by State of Residence and Fiscal

Years, 195 7-6 3................................................................. 56

18. Traineeship Awards to Individuals by Type of School

Attended for Training, 195 7-6 3................................... 57

39
58 PUBLIC HEALTH TRAINING AMENDMENTS OF 196 4

Number Page

19. Distribu tion of Project Grants by Ty pe of School,

1961, 1962, 1963 .............................................................. 57

20. Distrib ution of Project Grants by Curriculum Area,

1961, 1962, 1963 .............................................................. 58

21. Dis trib ution of Formula Grants by Specific School of

Public He alth, for Fiscal Years 1959-63 ................... 59

22. Formula Grants: Budgeted Figures, by Ty pe of Ex ­

penditure, 1959-63 .......................................................... 60

23. Form ula Grants: Actual Expenditures, by Ty pe of

Expenditure, 1959-62 ..................................................... 61

M)
Tab le 1. D em ogra phic T re nds in th e U nit ed S ta te s, by Age G ro up , for S el ec te d Yea rs 1900-19 62; P ro je ct io ns

to 1970 and 1980

Po pulat ion of the United St at es , includ ing Arm ed Fo rces overseas, by age

Year Nu mb er (millions) Per ce nt1

All ages 0- 4 5- 19 20-44 45-64 65 + All ag es 0-4 5-19 20-44 45-64 65 +

1900_____ 76. 1 9. 2 24. 5 28. 8 10. 5 3. 1 100. 0 12. 1 32. 1 37. 9 13. 8 4. 1

1910_____ 92. 4 10. 7 28. 0 36. 2 13. 6 4. 0 100. 0 11. 5 30. 3 39. 1 14. 7 4. 3

1920_____ 106. 5 11. 6 31. 7 41. 0 17. 1 4. 9 100. 0 10. 9 29. 8 38. 5 16. 1 4. 6

1930_____ 123. 1 11. 4 36. 2 47. 2 21. 6 6. 7 100. 0 9. 2 29. 4 38. 4 17. 5 5. 4

1940_____ 132. 1 10. 6 34. 7 51. 6 26. 2 9. 0 100. 0 8. 0 26. 3 39. 0 19. 9 6. 8

1950_____ 151. 7 16. 3 35. 1 57. 1 30. 8 12. 3 100. 0 10. 8 23. 2 37. 7 20. 3 8. 1

1960_____ 180. 7 20. 3 49. 2 58. 3 36. 2 16. 7 100. 0 11. 3 27. 2 32. 3 20. 0 9. 2

1961_____ 183. 6 20. 6 50. 8 58. 5 36. 7 17. 0 100. 0 11. 2 27. 6 31. 9 20. 0 9. 3

1962_____ 186. 6 20. 7 52. 3 59. 0 37. 3 17. 3 100. 0 11. 1 28. 0 31. 6 20. 0 9. 3

1970:

I I ___

Projections ’

214. 2 25. 1 61. 5 65. 3 42. 3 20. 0 100. 0 11. 7 28. 7 30. 5 19. 7 9. 4

I I I . . . 208. 9 21. 6 59. 8 65. 3 42. 3 20. 0 100. 0 10. 3 28. 6 31. 2 20. 2 9. 6

1980:

II___ 259. 6 32. 5 76. 3 82. 1 41. 2 24. 5 100. 0 12. 5 29. 4 31. 6 17. 0 9. 4

I I I . . . 245. 7 27. 9 67. 0 82. 1 44. 2 24. 5 100. 0 11. 4 27. 3 33. 4 18. 0 10. 0 O*1

> Percents not round ed to a dd to 100.0.

> Projection II based on 1956-57 level of fertility to continue throu gh 1958-60. Pro- ectton III based on 1955-57 level of fertility to decline to 1949-51 level by 1965-70. Sources: U.S. De par tment of Health, Education, and Welfare, Ofllce of the Secre­ tary, Trends, I96t Edition, pp. 3 an d 4 for years 1900-1961. For 1962, Depar tment of Commerce, Bure au of the Census, Current Population Reports, “ Population Esti­ mates," Series P-25, No. 265, May 21, 1963.

CO
60 PUBLIC HEALT H TRAINING AMENDMENTS OF 19 64

Ta ble 2. Pop ul at ion of th e United St at es , by Age and Sex,

1950 a ud 1960, 1957 and 1980

A. 1950 and 1960

N ot e: Series II , 1955-57 fertility rat e to 1975-80; Series IV , 1955-57 level down to 1942^4 level by 1965-70, 

the n cons tant to 1975-80.

Sources: U. 8. Departm en t of Com merce, Bu rea u of Cen sus , Fig ure A, Statistical Abstract, 1961, p. 3; 

Figure B, Current Population Reports. Population Estimates, “ Illustra tiv e Pro jection s of th e Po pu lat ion o f 

the Un ite d State s, by Age an d Sex, 1960 to 1980, Series P-25 , No. 187, N ov. 10, 1958, cover page.

42
T a b le 3 . T r en d s in E x p en d it u res f or H e a lt h a n d M ed ic al C ar e in th e U n it e d S ta te s, fo r S e le c te d Y ears, 1 95 0-60 *

Year

Private and governm ental exp end itur es combined Private e xpe nditures

Aggregate

ex pe nd itu res 2

(millions)

Average 

per cap ita 

ex pe nd itu re 2 (dollars)

Gross

national

pro duct (billions)

Medical 

care as a 

percent of GN P

Total

exp end itur es

(millions)

Pe rce nt of dispo sable 

personal income

Per capita 

exp end itur es 

(dollars)

1950 . . _____________________ $12, 365 $81. 51 $271. 4 4. 6 $8, 645 4. 2 $57. 56

1955... __________________ - -- 17,738 107. 31 380. 3 4. 7 12, 849 4. 7 79. 17 1956___________________________ 19, 183 114. 05 408. 4 4. 7 14, 288 4. 9 86. 44

1957___________________________ 21, 008 122. 71 431. 0 4. 9 15, 488 5. 0 91. 971958___________________________ 22, 826 131. 11 443. 7 5. 1 16, 596 5. 2 96. 83

1959 . .- ___ ________ 24,942 140. 68 463. 7 5. 4 18, 020 5. 3 103. 09

1960___________________________ 26, 503 146. 67 493. 6 5. 4 19, 566 5. 6 109. 80

1 For private and governmental expenditures combined, fiscal years are used, i.e., from July 1 to Ju ne 30: health and medical care expenditures in year en ding June 30; population, July 1; ON P average for 2 calendar years. For priv ate expenditures, calendar years are used. 2 Includes public a nd priv ate expenditures. Source: U.S. Departme nt of Health, Educatio n, and Welfare, Public Health Service, Division of Community Health Services, Health Economics Branch, Medical Care Financing and Utilization, Health Economics Series, No. 1, PHS Pub. No. 947, 1962, tables 2 (p. 4) and 40 (p. 48).
o

to

J

Table 4. E d ucati onal M an po wer —Deg re es Ear ne d, Sel ec te d Years 1948-62

Academic year (ending Ju ne 30)

Level of degree by level of stu dy 1948 1950

All bac helor’s *--------------------------------------------

All mas ter’s 

1

______________________________ All d oc tor’s 

2

_______________________________ Do cto r’s: 

2

Edu ca tio n_____________________________ Engineering____________________________ He alth prof essions______________________ Biological sci ences.:.____________________ Physical sciences_______________________ Social scie nces_________________________ All o th er s_____________________________ Doctor of Medicine 

2

________________________ Doctor of De ntal Surg ery 

2

---------------------------

Do ctor of Veteri nary Med. 

2 _________________ Nursing: Diploma, associate 

4

____________________ Bache lor’s 

2

____________________________ Master ’s 

2

_____________________________ Do cto r’s 

2

----- ------- -------------------------------

272,311 

42,449 

3, 989

433, 734

58, 219 

6, 420

502

257

(’)

(’) (»)

(

3) , 3, 230 

6, 867 

1, 689 

243

(’) 3, 351 

200

861

417

(’)

(

3

)

(

3

)

(

3

) 5, 142 

5, 612 

2, 579

803

(’) 3, 292 

368 

2

Public he al th : 

2

Bac helo r’s_____________________________ Master ’s ______________________________ Do cto r’s______________________________ 298 46774 440 52325 Other healt h professions: 2 5 Ho spi tal Ad minist rat ion------------------------- Social work, Social ad min istra tio n----------- Ph arm ac y_____________________________ Optom etry____________________________ Physical th er ap y__________________.. .___ Occup atio nal th er ap y___________________

(

3

) 1, 233

2, 104 

1, 425

(

3

)109

(’) 1,269 

5, 751 

1, 801 

(’)

(

3

)

1952 1954 1956 1958 1960 1961 1962

331, 924 292, 880 311, 298 365, 748 394, 889 401, 113 420, 485 63, 587 56, 823 59, 294 65, 614 74, 497 78, 940 84, 889

7, 683 8, 996 8, 903 8, 942 9, 829 10, 575 11, 622

1, 146 1, 498 1, 583 1, 638 1, 590 1, 743 1, 900

529 594 610 647 786 943 1, 207

152 202 144 147 107 133 148

764 1, 077 1, 025 1, 125 1, 205 1, 193 1,3 38

1, 720 1, 686 1, 667 1, 655 1, 838 1, 991 2, 122

1, 049 1, 195 1, 124

2, 750

1, 106 1, 237 1, 355 1, 365

2, 323 2, 744 2, 624 3, 066 3, 217 3, 542

6, 201 6, 757 6, 853 6, 861 7, 074 6, 986 7, 183

2, 918 3, 102 3, 009 3, 065 3, 247 3, 289 3, 209

1, 005 803 910 845 825 821 833

(’) 26, 141 27, 080 26, 739 25, 977 26, 228 26, 886 4, 137 5, 109 5, 315 6, 052 6, 661 6, 574 6, 370

478

1

327

482

2

240 479 599 555 504

185 152 211 168 303 251

637 455 477 602 527 369 376

26 29 23 29 24 26 21

(») (

3

) 128 177 150 246 243 1, 075 2, 163 1, 770 1, 994 2, 259 2, 513 2, 986

3, 896 4, 321 3, 885 3, 337 3, 782 3, 492 3, 482

844 706 352 334 339 315 291

(») (’) 389 441 439 454 500

(

3

) (’) 385 407 348 318 318

PUBLIC HE ALTH TRAINING AMENDMENTS OF 19 64
Sources fo r table 4, Ed ucationa l Ma npow er— Degrees Earne d, Selected Years 1948-62

1 Figures for 1948-60 from Office of Education, Department of Health, Education , and Welfare, Earned Degree) Conferred, 1959-60, table 1, p. 3 (1962). Figures for 1961 from Office of Education, De partme nt of Health, Educatio n, and Welfare, Summ ary Report on Bachelor’s and Higher Degrees Conferred During Year 1960-G1, ta ble, pp. 3-7 (November 1662).

2 Source for degrees earned from Office of Education Annual Summ aries, Earned Degrees Conferred. Unless otherwise specified, doctor’s degrees cover only doctoral degrees in philos ophy, education, engineering, etc. Doctoral degrees in the medical professions are listed separately. ’ Data not available.

< Source for nursing diplomas and associate degrees from American Nurses’ Association annual publicatio n, Facts About Nursing, for years 1948-60. For 1961 and 1962, figures from Public Health Service, Division of Nursing, Source Book, Eraluation Conference, May 1963, ta ble 6, p. 94. (Unp ublished data). Recipients of diplom a a nd associate degrees are eligible for R.N . licensure.

2 Thi s level of degree covers first professional degree.

Note: These da ta have been furnished to the Office of Education by the diverse academic and professional ins titution s and differ in some instances from those in table 8 because of midye ar graduatio ns and o ther variables.

PUBLIC HEA LTH TRAINING AMENDMENTS OF 19 64

cn

05

00
£

§

Table 5. 10 Lea di ng C au se s o f D ea th in th e U nit ed S ta te s, for Sel ec te d Yea rs , 1900 an d 1961 

1

Cause of de ath

1900’

Cause of death

1961

Nu mber

Rate

per 100,000

Percent 

of all 

death s

Nu mber

Ra te

per

100,000

Perce nt 

of all 

death s

All causes . . . 343, 217 1, 719. 1 100. 0 All causes 1, 701, 522 930 0 100 0

Pneum onia and influenza . 40, 362 202. 2 11. 8 Diseases of heart 663, 391 362 6 39 0 Tub ercu lo sis.. . __ 38^ 820 194. 4 11. 3 Malignant neoplasms 273, 502 149 5 16 1 Diarrhea , enteritis , etc . . 28^ 491 142. 7 8. 3 Vascular lesions affecting CNS 192 951 105 5 11 3 Diseases of hea rt . ____ 27; 427 137. 4 8. 0 Accidents. __ __ 92, 249 50 4 5 4 Senility (ill-defined)__ _ 23; 463 117. 5 6. 8 Diseases of infa ncy (selected) R5' 679 35 9 3 9 Vascular lesions (in tra cran ial ). 2L 353 106. 9 6. 2 Influenza and pne umonia __ o5, 175 30. 2 3. 2 Nephritis_____ 17, 699 88. 6 5. 2 Gen eral arteriosclerosis 35^ 388 19 3 2 1 All acciden ts . ___ . . . 14; 429 72. 3 4. 2 Dia betes mellitus . 30, 098 16. 5 1. 8 Ma lignant neo plasms___ 12; 769 64. 0 3. 7 Con gen ital ma lformatio ns 21, 922 12 0 1 3 Diphthe ria ____ . Si 056 40. 3 2. 3 Cirrhosis of liver 20; 737 11 3 1 2

1 Exclusive of still births.

• Death registration States.

Sources: For 1900 data, Federal Security Agency, Public Health Service, National Office of Vital Statistics, Vital Statistic), Special Reports, U.S. Sum mary, vol. 34, 1948, No. 50, p. 909, table 16.

For 1961 data, U.S. Departme nt of H ealth, Education, and Welfare, Public Health Service, National Vital S tatistics Division, Vital Statistics of the United States (Advance Report), “ Fina l Nata lity and Mo rtality Statistics,” November 1962, table 4. (Proc­ essed.)

PUBLIC HEALT H TRAINING AMENDMENTS OF 19 64
PUBLIC HEA LTH TRAINING AMENDMENTS OF 19 64 65

Ta ble 6. Red uc tio n of In fa nt M or talit y, Se lected Cou nt ries,

1950-62 or La test Year

[Ra tes are d eaths u nde r 1 year per 1,000 live b irths]

Cou ntries ran ked on 1962 or 

latest rate

1962 1950 Pe rce nt

decre ase

since

Ran k Ra te Ran k Rate 1950

Netherlands __ _____ - 1 * 15. 3 3 25. 2 39. 3

Sweden . ______ ________ 2

1

 15. 3 1 21. 0 27. 2

Norway (1960)_______________ 3 (196 0) 18.9 5 28. 2 33. 0

F in la n d __ _______ - ____ . 4

1

 19. 2 11 43. 5 55. 9

Austra lia (1961)___ ____ ___ 5 (196 1) 19.5 2 24. 5 20. 4

Denm ark ___ . . _____ . . 6

1

 20. 1 7 30. 7 34. 5

New Zea la nd ., . - 7 * 20. 3 4 27. 6 26. 5

Switzerland (196 1)__ 8 (1961) 21.0 8 31. 2 32. 7

United Ki ngdom_______ __ . - 9 '

1

 22. 1 9 31. 4 29. 6

Irel an d. . - __ ______ - 10 1

 24. 2 13 46. 2 47. 6

United S ta te s ______ - . . . 11 1

 25. 3 6 29. 2 13. 4

Luxembourg (1961)___ - - 12 (1961) 26 .2 12 45. 7 42. 7

Canad a (19 61).- . _ . . 13 (1961) 27.2 10 41. 5 34. 5

Japa n (1961)_______ _ _ ____ 14 (196 1) 28. 6 15 60. 1 52. 4

Fed eral Republic of G er m an y. .. 15 > 29. 2 14 55. 6 47. 5

* Provisional.

Sources: U.S. Dep artm ent of Health, Education, and Welfare, Regional and Field Letter, No. 544, 

Sept. 9,1963, based on data from United Nations, Statistical Office, and U.S. Departme nt of Healt h, E du ­

cation, and Welfare, National Vital Statistics Division.

47
O i

C i

£

Ta ble 7. Id en tif iable Ex pe nd itu res o f S ta te H ea lth Age nc ies for Pu bl ic H ea lth Tr aining an d Per ce nt Derived

From Each Fu nd So ur ce, for Se lected Fiscal Yea rs 1948-62

[In th ou sa nd s]

Fu nd source 1948 1950 1952 1954 1956 1958 1960 1961 1962

T ota l_______________________________ $2, 102 $3, 153 $3,185 $2, 596 $2, 862 $4, 355 $5, 396 $6, 029 $5, 382

Percentage from each source: State and local fu n d s,. _ ________ 21. 9 31. 9 25. 2 27. 1 31. 6 34. 8 48. 7 48. 7 44. 2 Federal fund s.- . ___ . . ____ 78. 1 68. 1 74. 8 72. 9 68. 4 65. 2 51. 3 51. 3 55. 8 Pub lic He alt h Service. . . . . (4 6. 7) 

(31. 4) (48. 6) (19. 5) (42. 3) (32. 5) (35. 4) (37. 5) (27. 0) (4 1. 0) 

(. 4 )

(29. 2) (36. 0) (24. 1) (27. 2) (27. 5) (23. 8) (38. 3) (17. 5) 

(0)

Children’s B urea u. . ___ _O th e r________ . . .

1

Sources: 1948-56 figures from 1958 Nationa l Conference on Public Health Training Source Book, ta ble 5, p. 22; 1958-61 figures from Pu blic Health Service, Bureau of State Services, Office of Grants Management (unpublished), as of Oct. 18, 1962; 1962 figures also from the Office of Grants Management (unpublished), as of Ju ly 15, 1963, w ith a reminder that expenditu re reports from the States “ do not reflect the tota l training expenditures, since it is known that funds spent for tra inin g activities are sometimes reported as part of the expenditures for specialized programs rather than identified specifically as training projects."

PUBLIC HEA LT H TR AINING AM ENDM ENTS OF 1964
Tab le 8 . G ra duat es in th e H ealt h P ro fe ss io ns, for Sel ec te d Yea rs , 194 8-6 2

Professional category Year of graduation

Physicians (M.D.)________________________ Physicians (D.O.)_____ ______ ____ _______ Den tists_____________________________ ___ V eterinarians _.................. ....... ........... . ......... ..... Professional nurses 2______________________ Pharmacists....... ......... ......... .................................

Optome trists_____________________________

19 48 19 50 19 52 19 54 19 56 19 58 19 60 196 1

5, 54 3 

143

1, 75 5

5, 55 3 

37 3

2, 56 5 

695 

25 , 79 0

5, 84 2

1, 57 2

6, 080 

42 7

2, 975 

81 1 

29 , 016

4, 24 7 

63 6

6, 88 1 

44 9

3, 804 

86 9 

28 , 53 9

3, 86 7 

67 4

6, 84 5 

46 7

3, 03 8

6, 86 1 

43 9

3, 08 3

1 85 1 

30 , 410

3, 68 3 

34 9

7, 081 

42 7

3, 25 3

1 826 

30 , 113

3, 49 7 

31 7

6, 99 4 

50 6

3, 290

1 824 

30 , 26 7

3, 438 

31 9

34 , 26 8

2, 29 9

1, 42 8

2 9 ,5 9 1

3, 31 9 

33 3

19 62

7, 16 8 

36 2

3, 21 7 

1 81 9

3, 69 9

* Seniors.

’ Includes s tud ent s in Hawaii an d Puerto Rico since 1950.

Source: Maryla nd Y. Pennell, Division of Public Health Methods, Public Health Service, July 1963. (Processed.) These data have been furnished to the Public Health Service by the American Association of Medical Colleges and similar organizations for the othe r health professions.
Ui

©

0500

Tab le 9. N um ber o f F u ll -T im e P er so nnel o f D iffe re nt C la ss if ic at io ns Em plo ye d by S ta te an d Lo ca l H ea lt h

D ep art m en ts , fo r Sel ec te d Yea rs , 195 0-6 2

Classification 1950 1952 1954 1956 1958 1960 1962

Public healt h physicians_____________ Public healt h nurse s________________ Clinic nurses_______________________

Public healt h de ntist s_______________ Denta l hygienists___________________ Engin eers__________________________

Professio nal san ita ria ns and other

person nel________________________

Ve terina rians______________________ Labo rat ory perso nnel_______________ He alt h educato rs___________________

Nutritionists _______________________

Medical and psy chiatric social workers Psy cho logists______________________ Ana lysts and statistic ians ___________ Public health inv estig ato rs__________ X-ray tec hnicians__________________

Physica l th er ap ists____________„ ____ Admin istrative manageme nt pers onnel. Clerks_____________________________

Mainte nan ce, custodial, and service___ Others_____________________________

san ita tio n

Total

2,3 17 2,1 48

13, 044 14, 055

356 307 

1, 183

380 

441 

1, 168

2, 085

13, 802 

654 358 411 

1, 030

2, 095

14, 273 

663 

393 

417 

1, 037

2, 088

15, 223 

743 

423 

450 

1, 028

2, 082

15, 471 

735 

464 

451 

1, 185

2, 166

15, 894 

922 

587 

389 

1, 263

7, 530 

310

3, 108 

460 221 

363237449

14, 653

4, 064 3, 503

52, 105

7, 725 

375

3, 099 

516 

240 

377570

(*)

15, 435

3, 894 3, 248

8, 037

363

2, 968 

494 

233 340

74

364 688 633 

162

1, 063

14, 843

3, 6362, 017

8, 139 

347

2, 931 

490 245 395

91 

426 607 

641 

186 

1, 116 

15, 173

3, 803 

1, 924

8, 973 

343

3, 149 

496 

260 

523 

137

443 622 

665 224

1, 217 

16, 403

3, 6392, 693

9, 705 

299

3, 385 

527 281 607 

157 

483 

712 

623 

219

1, 330 

17, 147

4, 252

2, 460

10, 304 

290

3, 393 

544 

300 699 205 543 727 

584 

234

1, 546

18, 099

4, 157

2, 898

53, 671 54, 255 55, 392 59, 742 62, 575 65, 744

> Included in “ Others.”

Source: U.S. Departme nt of Health, Education , and Welfare, Public H ealth Service, Bureau of State Services, Office of Grants Mana gement. Unpublished data, as of June

PUBLIC HEA LTH TRAINING AMENDMENTS OF 19 64
PUBLIC HEA LTH TRAINING AMENDMENTS OF 19 64 69

Tab le 10. N um ber o f Budge te d P osi ti on s— F ille d an d V aca nt—

R eq uir in g Sp ec ifi ed E duca tion an d T ra in in g as R ep or te d by

131 S ta te an d Lo ca l H ea lt h D ep art m ents , O ct ob er 1961

Category 1

Nu mb er positions report ed Perce nt

va cant

positions

Filled Vacant Total

N urse__ _ 5, 544 477 6, 021 7. 9

Sanitary inspector _ __ . _ 349 38 387 9. 8

S a n it a ri a n ____ . . 2, 143 102 2, 245 4. 5

Engineer___ _ . ___ . 363 28 391 7. 2

Ve terina ria n____ _______ 95 7 102 6. 9

Phy sician ____ _____ 506 64 570 11. 2

Den tis t__ - ____ __ . . 46 2 48 4. 2

He alth ed uca to r.. _ ____ 206 21 227 9. 3

N ut rition ist., ___ . ____ 86 13 99 13. 1

Sta tist ic ia n. . . . . . ______ 131 16 147 10. 9

Disease inv estigato r. . . . . 118 12 130 9. 2

A dm in is tr at or____ . . . . 153 9 162 5. 6

La boratory worker . . . . 568 62 630 9. 8

Social worker ______ _______ . 139 26 165 15. 8

Total_________ ______ 10, 447 877 11, 324 7. 7

1

 Supervisory personnel included.

Source: From unpublished d ata in the Division of Community Health Services, Oct. 9, 1962. 49 percent 

(131 of269) of the health departments eligible under the 30or more full-time employee require ment responded 

to the October 1961 questionnaire of Association of M anagement in Public Health.

51
ca

hs

^1

O Ta ble 11. Age D istr ib ut io n of Se lected Ful l-Tim e Medica l Sp ec ia lis ts, 1961

Catego ry

Total Age (years)

Number Per­ cen t

Under 35 35-44 45-54 55-6 4 65 and over

Nu mber Per­ cent Nu m­ ber Per­ cen t Num­ ber Per­ cen t Num­ ber Per­ cen t Nu m­ ber Per­ cen t

Internal medicine_____ 28, 797 

21, 987 

13, 170 

13, 074 

11, 317

7, 327

5, 396

2, 050 

41, 710

100

100

100

100

100

100

100

100

100

8, 451

5, 654 

3, 260 

3, 457

3, 507

1, 987

1, 774 

140

8, 822

29

26

25

26 

31 

27 

33

7

21

9, 732 

6, 804 

4, 280 

4, 417 

4, 088 

2, 625

1, 883 

350 

12, 397

34

31

33

34 

36 

36

35 

17 

30

6, 103

5, 146 

3, 172 

3, 066 

2, 054

1, 650

1, 065 

684 

10, 619

21

23

24 

23 

18 

22 

20 

33 

26

3, 068 

2, 962

1, 746

1, 520

1, 096 

724 

468 

588

6, 381

11

14 

13 

12 

10 

10

8

29

15

1, 443

1, 421 

712 

614 

572 

341 

206 

288

3, 491

5

6 

5 

5 

5 

5 

4

14

8

Gen eral sur gery____ P sy c h ia tr y __

Obstetric s and gynecology __ Ped iatrics ______ ____ Ra diolog y.. . . . . . Pat holo gy_____ Pub lic health

All o th ers .. . _ .

Total___ __ __ ___ 144, 828 100 37, 052 26 46, 576 32 33, 559 23 18, 553 13 9, 088 6

Internal medicine_____________ General sur gery______________ Ps yc hiatr y___________________ Obstetric s and gynecology _____ Pe dia trics____________________ Rad iolo gy___________________ Patho log y___________________ Public he alth_________________ All o thers..... ..................................

To tal.

Perce nt Distribution

19.9

15.2

9.1

9.0

7.8

5.1

3.7

1.4

28.8

22.8

15.3

8.8

9.3

9.4

5.4

4.8

.4

23.8

20.9

14.6

9.2

9.5

8.8

5.6

4.0

.8

26.6

18.2

15.3

9.5

9.1

6.1

4.9

3.2

2.0

31.7

16.5

16.0

9.4

8.2

5.9

3.9

2.5

3.2

34.4

15.9

15.6

7.8

6.7

6.3

3.8

2.3

3.2

38.4

100.0 100.0 100.0 100.0 100.0 100.0

PUBLIC HEALTH TRAINING AMENDMENTS OF 19 64

«!TM,^?iuTt

:

-

U S,VD»

e ?.V °o 

H n

a

.

l t u,’ 

E i u c ?,

t

,

io/?’ P u b l l c Health Service, Health Manpower Source Book, sec. 14, Paul'Q . Peterson and Maryla nd Y. Pennell, “ Med ical Specialists,” p. 15, table 9; all tables C; (D.C., GPO , PHS Publication No. 263, sec. 14, 1962). » . m j
PUBLIC HEA LT H TRAIN ING AM ENDM ENTS OF 19 64 71

Tab le 12. T ota l N um be r an d N um ber in T ra in in g o f F u ll -T im e

M ed ic al S pec ia list s, by Sel ec te d C at eg or ie s, 1961

Category To tal

num ber

Number

in

tra ining

Ra tio of 

trainees 

to t ot al 

num ber

Internal medicine - ___ _____ ___ 28, 797 4, 623 1:6

General surgery _ __ __ . ______ . 21, 987 4, 024 1:5

Ps yc hiatr y_____ . . __ ________ __ 13, 170 2, 435 1:5

Obstetrics and gyn eco logy.. _____ ___ 13, 074 1, 963 1:7

Pedia tri cs. __ ______ . ___________ . . 11, 317 1, 481 1:8

Radiology . . . __________ . _ __ __ 7, 327 1, 256 1:6

Pathology . . . . . ___ ___ . 5, 396 1, 270 1:4

Public health . . . __ . _____ 2, 050 43 1:48

Source: U.S. Dep artm ent of Health, Education, an d Welfare, Public Health Service, Division of Publi c 

Health Methods, Health Manpower Source Booh, sec. 14, “ Medical Specialists,” Paul Q. Peterson and 

Maryland Y. Pennell, PHS Pub. No. 263, 1962, 233 pp. For tota l numbers, table 9, p. 15; for numbers in 

training, table B under each specialty.

Tab le 13. Deg re es i n P ublic H ea lth A war de d by Sch ool s o f P ublic

H ea lth in th e U nit ed S ta te s, 195 3-6 2 1

Academic year

Level of degree

1953-

54

1954-

55

1955-

56

1956-

57

1957-

58

1958-

59

1959-

60

1960-

61

1961-

62

Doctoral degree ___ 29 26 23 17 24 27 31 27 29

Master ’s degree . _. 396 368 391 502 586 582 517 565 547

Bac helor’s d e g re e .__ 105 116 102 122 137 138 108 99 87

T ota l________ . 530 510 516 641 847 749 656 691 663

1

 Does not include University of Puerto Rico.

Source: Based on questionnaire, dated April 1963, prepared by Conference Stall to the 12 schools of public 

health in the United States.

53
72 PUBLIC HEA LTH TRAINING AMENDMENTS OF 19 64

Table 14. Num ber of Trainees, by Professional Category, 1957-63

Professional categ ory Fiscal years

1959 1960 1961 1962

Nurses____________________

Health edu cators___________

Sanitary engineers__________

Sanitarians ________________

Sanitation field (ot her)______

Ph ysician s,_______________

Lab oratory perso nnel_______

De ntists__________________

Veterinarians______________

Dental hyg ienists __________

Nu tritionis ts_______________

Sta tisticia ns_____ __________

Medical social workers______

Miscellaneous______________

1957 1958

199 367

36 60

27 42

2

 24 2

 45

21 51

13 19

10 18

9 15

8 6

6 11

2 9

1 7

7 15

349

51

68

39

13

45

11

13 

15

2

14

15 

6

13

327

47

55

35

12

51

12

17 

15

2

18 

12

1

20

299 252

52 38

79 78

39 35

9 12

42 57

11 14

16 16

6 10

1 4

9 11

15 5

4 2

25 34

Tota l- 363 665 654 624 607

1963' Tota l

568

385 2, 178

51 335

93 442

35 252

33 79

44 311

14 94

9 99

8 78

5 28

21 90

16 74

6 27

80 194

800 4, 281

ap'proprUt?onlr e S M °f J u n e 3°’ 1 963’ A ^

d i t i o n a l appointm ents will be made under fiscal year 1961 

2

 Includes “ Sanitation field (other)” category.

»Ln in f? R es o,

urc <s Branch of the Division of Com munity Health Services in the Public 

Health Service is the source for all the unpublished da ta contained in this table. *

54
ca

Table 15. Number of Tra inee s, by Years of Prior Public Health Experience, 1957-63

Pri or public health experience

Fiscal y ear To tal

1957 1958 1959 I960 1961 1962 1963

Nu mber Pe r­ cent Nu m­ ber Per­ cen t Nu m­ ber Per­ cent Nu m­ ber Pe r­ cent Nu m­ ber Pe r­ cent Nu m­ ber Per­ cen t Nu m­ ber Pe r­ cen t Nu m­ ber Per­ cent

None - ____ - 172 47. 4 349 52. 5 358 54. 2 338 54. 2 355 58. 5 367 64. 6 523 65. 4 2, 462 57. 5 Some, bu t less

th an 2 years 100 27. 5 211 31. 7 205 31. 3 175 28. 0 124 20. 4 95 16. 7 61 7. 6 971 22. 7

2-5 years . 62 17. 1 90 13. 5 76 11. 6 95 15. 2 107 17. 6 88 15. 5 155 19. 4 673 15. 7 More th an 5

yea rs ----------- 29 8. 0 15 2. 3 15 2. 4 16 2. 6 21 3. 5 18 3. 2 61 7. 6 175 4. 1

T ota l_______ 363 100. 0 665 100. 0 654 100. 0 624 100. 0 607 100. 0 568 100. 0 800 100. 0 4, 281 100. 0

Source: Same as for table 14.

Tab le 16. Number o f Trainees by Age Group, 1957-63

Age group

Fiscal year To tal

1957 1958 1959 1960 1961 1962 1963

Nu mber Pe r­ cent Nu m­ ber Pe r­ cen t Nu m­ ber Pe r­ cen t Nu m­ ber Pe r­ cent Nu m­ ber Pe r­ cen t Nu m­ ber Pe r­ cen t Nu m­ ber Pe r­ cent Nu m­ ber Pe r­ cen t

Under 35 years . 282 77. 7 512 77. 0 500 76. 5 492 78. 8 472 77. 7 434 76. 4 561 70. 1 3, 253 76. 0 35-45 ye ars__ - 78 21. 5 148 22. 2 141 21. 5 122 19. 6 117 19. 3 122 21. 5 211 26. 4 939 21. 9

Over 45 ye ars__ 3 0. 8 5 0. 8 13 2. 0 10 1. 6 18 3. 0 12 2. 1 28 3. 5 89 2. 1

T ota l 363 100. 0 665 100. 0 654 100. 0 624 100. 0 607 100. 0 568 100. 0 800 100. 0 4, 281 100. 0

Source: Same as for table 14.

PUBLIC HEA LT H TRAIN ING AM EN DM EN TS OF 19 64^4

00
74 PUBLIC HEA LT H TRAINING AM ENDM ENTS OF 19 6 4

Table 17. Nu mbe r o f In dividu als Awarded Pu blic H ea lth Tr ain eesh ip s, by St at e o f Re sid en ce and Fiscal Ye ars , 1957—63

Sta te

Ala bam a__________

Alaska____________

Arizo na___________

Ark ansas__________

California_________

Colorado.....................

Co nne cticut_______

Delawa re__________

District of Columbia

Flo rida___________

Georg ia......................

Hawaii____________

Idaho_____________

Illinois____________

Ind ian a.......................

Iow a_____________

Ka nsas___________

Ke ntu cky_________

Lou isiana......... ..........

Maine____________

M ary la nd________

Ma ssachu setts_____

Michigan _________

Minn eso ta________

Mississippi________

Missouri__________

Mon tan a__________

Nebra ska _________

Nevad a___________

New Hamp shi re___

New Jerse y________

New Mexico_______

New Yo rk_________

No rth Carolina ____

No rth Dakota _____

Ohio______________

Oklahoma_________

Oregon____________

Pennsylvania______

Rhode Island______

South Carolina ____

Sou th Dak ota_____

Tenn essee___ . ____

Texas _____________

Ut ah _______ ______

Vermon t__________

Virginia............ ..........

Washington_______

West Virginia______

Wisconsin_________

Wyo ming_________

Gu am____________

Pue rto Rico_______

Virgin Islands_____

Canal Zone________

Tr ust Te rri tor y____

Total.

Number of trainees, by fiscal years

To tal

1957 1958 1959 1960 1961 1962 1963

6 6 9 6 4 7 4 42

5 3 1 6 1 1 17

2 6 8 1 2 2 8 29

2 6 2 6 4 2 22

28 54 78 55 73 74 115 477

7 14 12 6 12 5 9 65

9 25 12 10 10 16 18 100

1 1 2 4

5 6 2 2 5 1 2 23

4 9 11 12 10. 10 11 67

1 14 9 12 9 8 7 60

5 5 5 5 2 4 4 30

3 4 2 4 5 1 1 20

11 18 26 11 23 14 25 128

7 8 17 3 11 3 19 68

4 8 14 8 6 6 13 59

1 5 7 6 2 8 5 34

11 8 10 14 9 8 20 80

2 4 3 2 3 2 2 18

4 2 3 3 3 1 6 22

7 16 11 13 13 7 22 89

13 31 28 26 24 22 30 174

27 34 22 26 23 14 35 181

17 35 36 36 36 29 31 220

2 5 7 2 1 4 5 26

6 12 13 10 10 11 11 73

1 9 7 2 2 2 23

5 3 3 4 3 5 23

1 2 1 2 1 1 8

2 1 1 1 1 1 2 9

3 13 18 15 19 18 14 100

6 10 10 5 4 6 5 46

29 71 60 79 65 74 107 485

17 23 25 25 24 20 23 157

4 2 4 2 4 3 19

10 25 22 23 24 26 33 163

7 11 10 9 10 7 7 61

12 10 18 15 8 16 12 91

18 37 38 44 41 33 45 256

4 4 6 6 7 8 35

6 5 5 6 2 4 12 40

3 3 1 6 5 3 1 22

8 17 9 14 13 11 11 83

8 10 10 19 11 13 17 88

6 8 4 5 2 2 6 33

1 3 1 2 4 2 13

6 13 10 12 7 13 13 74

4 11 12 15 11 13 22 88 2 2 3 3 9 3 22

11 18 17 17 19 20 22 124

1 2 1 2 6

1 1

5 12 9 14 6 10 15 71

1 1 1 3

1 1 1 1 2 6

2 1 3

363 665 654 624 607 568 800 4. 281

Source: Sam e as for tab le 14.

56
PUBLIC HEA LT H TRA INING AM ENDM ENTS OF 19 64 75

Table 18. Traineeship Awards to Individuals by Type of School

Attended for Training, 1957-63

Type of school

Fiscal year

To tal

1957 1958 1959 1960 1961 1962 1963

Schools of public healt h______

Departm ents of nurs ing in

129 235 224 228 219 231 290 1, 556

schools of public healt h,.. _ 57 91 86 61 57 46 58 456

Schools of nursing__________ 142 276 263 266 242 206 327 1,722

Schools of en gineering. ------- 27 42 68 55 79 78 91 440

Other sch ools.. . . . . . ___ 8 21 13 14 10 7 34 107

To tal ________________ 363 665 654 624 607 568 800 4, 281

Source: Same as (or table 14.

Table 19. Distribution of Project Grants by Type of School, 1961,

1962,1963

Type of school

Number of 

schools 

awarded 

gra nts

Number of 

gra nts

Amount of g ran ts

1961 1962 1963 1961 1962 1963 1961 1962 1963

Public he alt h__ 10 11 11 21 33 34 $621, 254 $965, 578 $990, 550

Nursing ______ 15 20 19 15 21 21 278, 438 395, 137 435, 134

Engineering___ 22 27 25 27 33 28 529; 643 639; 224 562; 189

Tot al ______ 47 58 55 63 87 83 1, 429, 335 1, 999, 939 1, 987, 883

Source: Same as for table 14.

57
Oi

§3

Table 20. Distr ibu tion of Pro ject Grants by Curric ulum Area, 1961, 1962, 1963

Curricu lum area

Air po llu tio n_____________________Accident prev en tio n_______________ Bio statistics and epid emiolo gy______ Chronic diseases__________________ Field traini ng _____________________ He alth econom ics_________________

Internationa l h e a lt h _____ ________

Medical care ad minist ratio n________ Me tropolita n pla nn ing_____________ N ut ritio n_________________________

Po pulation pro ble ms ______________

Pub lic health ad mi nis tra tio n prac tice . Public health de nt istry__ 1_________ Pub lic health ed uc ation____________ Public health nursing______________Radiological hea lth________________ Sanit ary biology, ch em istry________ Sa nit ary engin eering_______________ Sh ort-term________________________

Teach er pr ep ar atio n_______________

Wa ter supply /po llution/r eso urc es____

Total________ ______________

Source: Same as for table 14.

Nu mb er of gra nts Am oun t of gran ts

1961 1962 1963 1961 1962 1963

5 4

2

33

$102, 308 $68, 788

60, 261 

40, 966

$55, 911

71, 829 

42, 750 3 3 3 47, 530

3 6 5 87, 694 141, 599 124, 017

9 12

1

12

1 229, 375 215, 455 18, 441 

75, 573

233, 420 

13, 041 

84, 816 1 2 3 46, 197

3 5 5 99, 219 156, 688 159, 995

1 1

1

1

1 20, 110 20, 110 48, 778 

40, 765

20, 110 

39, 340 

42, 686 1 1 1 38, 846

4 5 6 115, 317 168, 677 197, 223

2 2 2 52, 469 52, 889 53, 815

1 1 1 12, 500 12, 176 13, 000

4 5 5 51, 634 114, 477 111, 962

2 3 2 22, 081 25, 975 8, 3839 7 7 199, 850 170, 992 16, 453

3 11 11 52, 748 264, 791 289, 204

3 4 3 64, 854 105, 060 113, 880

3 3 4 52, 221 65, 553 106, 6666 8 4 134, 382 131, 925 44, 382

63 87 83 1, 429, 335 1, 999, 939 1, 987, 883

PU BLIC HEA LT H TRAINING AM ENDM ENTS OF 1964
32-43 8 0 —64- Ta ble 21. Distr ib ut io n o f Fo rm ul a Gra nts by Sp ecific Sc ho ol o f P ub lic H ea lth, for Fi scal Yea rs, 1959-63

o School of pub lic health

Fisc al years To tal

1959 1960 1961 1962 1963

SO

California (Be rkeley)__ California (Los Angeles)

Colum bia____________ Harva rd_____________ Johns Hop kins________

Michigan ____________ Minnesota___________ No rth Carolina _______

Pitt sb ur gh ___________ Pu ert o Rico__________ Tul an e_______________

Ya le_ ......... .................

Total.

Source: Same as for table 14.

$51, 300

25, 300 38,30 0 

40, 800 

63, 800 

60, 700 

51, 300 32, 500 32, 400 29, 900 

23, 700

450, 000

$114, 000

56, 200 

85, 200 

90, 700 

141, 900 134, 900 114, 000 

72, 200 72, 000 

66, 300 52, 600

1, 000, 000

$93, 000

58, 000 

80, 800 

85, 800

150, 300 

164, 500 103, 700 

76, 800 

61,200 

66, 10059, 800

$118, 100 

43, 200 70, 700 93, 300 

107, 000 

162, 400 

169, 200 

126, 300 

79, 400 

70,400 

72, 900 

60, 100

$180, 900 

80, 100 

121, 200 

147, 300 169, 600 

261, 400 270, 800 215, 300 

127, 600 111, 700 122, 700 

91, 400

$557, 300 

123, 300 

331, 400 

444, 900 493, 900 779, 800 

800, 100 

610, 600 

388, 500 347, 700 

357, 900 287, 600

1,0 00 ,00 0 1, 173, 000 1, 900, 000 5, 523, 000

PUBLIC HEA LTH TRAINING AMENDMENTS OF 19 64

^4
*4

00

s

Tab le 22. F orm ula G ra nts : B udget ed Fig ure s, by Typ e o f E xp en diture , 1959- 63

Type of exp end itur e Fiscal year

1959 > 1960 1961 1962 1963 Total

Teaching personnel__ _____________ _ . . $239, 136 

35, 500 

9, 750 

124, 819 

71, 035

$724, 151 

112, 874 

29, 100 69, 350 64, 525

$689, 932 

139, 672 

28, 020 63, 500 78, 876

$799, 123 

194, 616 

30, 558 48, 172 

100, 531

$1, 207, 693 

335, 490 

41, 700 

123, 108 192, 009

$3, 660, 035 

818, 152 

139, 128 

428, 949 506, 976

Oth er pers onn el_______ ___ Travel___ __ ___________

Eq uipm en t___ . . _______Other expenses __ ______

To tal____ __ . . . . 480, 240 1, 000, 000 1, 000, 000 1, 173, 000 1, 900, 000 5, 553, 240

1 Budgeted on basis of requested appropriation; $450,000 act ually become available.Source: Same as for Ta ble 14.

PUBLIC HEALT H TRAINING AMENDMENTS OF 19 64
PUBLIC HE AL TH TRA INING AM ENDM ENTS OF 19 64 79

Tab ic 23. For m ula G ra nts : A ct ual E xp en diture s, by Typ e of

Exp en di tu re , 1959-62

Type of expenditure

Teaching personnel

Oth er person nel__

Tr avel___________

Eq uip me nt_______

Other expenses 1__

To tal______

Fiscal year

1959 1960 1961 1962

$180,135 $564, 982 $468, 471 $677, 832

23, 558 127, 749 145, 639 202, 515

3, 118 31, 137 35, 078 32, 102

138, 274 117, 877 146,012 81, 391

38, 844 107, 752 121, 305 123, 063

383, 929 949, 497 916, 505 1, 116, 903

1

 Includes moneys spent for conferences, continuing education, etc. 

Source: Same as for table 14.

61
80 PUBLIC HEALT H TRAINING AMENDMENTS OF 19 64

Mr. Harold Adams

Associate Professor of Sanitary Science 

Indiana University Medical Center 

Indianapolis 7, Ind.

Dr. Wendell R. Ames

Director

County of Monroe Department of 

Health

Rochester 2, N.Y.

Dr. Frank lyn B. Amos

Director

Professional Education, New York 

State Department of Health

Albany 8, N.Y.

Dr. Walter D. Atkins

Director

Division of Dental Health

New Mexico Department of Public 

Health

Santa Fe, N. Mex.

Miss Maude C. Bailey

Director of Public Health Nursing 

South Carolina State Board of Health 

Columbia 1, S.C.

Miss Eleanor M. Barnett

Professor

School of Social Work

University of Denver

Denver 10, Colo.

Mr. Arthur N. Beck

Chief Engineer and Director 

Bureau of Sanitation 

Alabama Department of Public Health 

Montgomery 4, Ala.

Miss Julia P. Brandeberry

Chief

Public H ealth Nursing Section 

Michigan Department of Health 

Lansing 4, Mich.

Mr. James Brindle

President

Health Insurance Plan of Greater 

New York

New York 22, N.Y.

D. List of Conferees

Mr. Ray E. Brown

Vice President for Administration 

University of Chicago 

Chicago, Ill.

Dr. Bernard Bucove

Director of Health

Washington State Departmen t of 

Health

Olympia, Wash.

Dr. Louis J. P. Calisti

Dean

School of Dentistry

Tufts University

Boston 11. Mass.

Mr. J. Douglas Colman

President

Associated Hospital Service of New 

York

New York 16, N.Y.

Mrs. Pearl P. Coulter

Director

School of Nursing

University of Arizona

Tucson, Ariz.

Dr. James A. Crabtree

Dean

Graduate School of Public Health 

University of Pittsburgh 

Pittsburgh 19, Pa.

Mr. Norman A. Craig

Assistant Professor

School of Public Health

University of Minnesota

St. Paul, Minn.

Mrs. Bess Dana

Consultant on Educational Services 

Council on Social Work Education 

New York, N.Y.

Dr. Edward Davens

Deputy Commissioner

State Departmen t of Health 

Baltimore 1, Md.

62
PUBLIC HEALT H TRAINING AMENDMENTS OF 19 64 81

Dr. Robert Dyar 

Chief, Division of Research 

California State Department of Public Health

Berkeley 4, Calif.

Mr. George H. Eagle 

Chief Sanitary Engineer 

Ohio Department of Health 

Columbus 15, Ohio

Dr. Roger Egeberg 

Medical Director

Los Angeles County Departmen t of 

Charities

Los Angeles, Calif.

Dr. Lloyd C. Elam 

Chairman

Depa rtment of Psychiatry 

Meharry Medical College 

Nashville 5, Tenn.

Dr. Fedele F. Fauri 

Dean and Professor of Public Welfare 

Administration

University of Michigan 

Ann Arbor, Mich.

Dr. John W. Fertig 

Professor of Biostatistics 

Columbia University 

New York 32, N.Y.

Miss Maxine Geeslin 

Director of Nurses 

Amarillo Health Departmen t 

Amarillo, Tex.

Dr. John C. Glidewell 

Director of Research and Development 

St. Louis County Health Department 

Clayton 5, Mo.

Dr. Lenor S. Goerke 

Dean

School of Public Health 

University of California 

Los Angeles, Calif.

Dr. Robert H. Hamlin

Professor and Head

Depa rtment of Public Health Practice

Harv ard University

Boston 15, Mass.

Miss Helen E. Hestad 

Executive Director

The Visiting Nurse Association of 

Omaha

Omaha 5, Nebr.

Miss Atha M. Howell 

Director of Public Health Nursing 

Guilford County Health Depa rtment 

Greensboro, N.C.

Dr. Harold B. Hubbard 

Assistant Professor 

School of Veterinary Medicine 

The University of Georgia 

Athens, Ga.

Mr. Don M. Hufhines 

Field Coordinator for Continuing Education Program

American Public Health Association 

San Francisco 2, Calif.

Dr. George James 

Commissioner of Health 

New York City Health Departmen t 

New York, N.Y.

Miss B. Genevieve Johnson 

Associate Professor and Head of Public 

Health Nursing

South Dakota State College 

Brookings, S.Dak.

Dr. Herbert E. Klarman 

Associate Professor 

School of Hygiene and Public Health 

The Johns Hopkins University 

Baltimore 5, Md.

Dr. Hugh R. Lea veil 

Emeritus Professor of Public Health 

Practice

Harvard University 

Boston, Mass.

Dr. Robert L. Leon 

Associate Professor of Psychiatry 

The University of Texas 

Dallas 35, Tex.

Dr. Glen Leymaster 

Associate Secretary 

Council on Medical Education and 

Hospitals

American Medical Association 

Chicago 10, Ill.

Dr. Erich Lindemann 

Psychiatrist in Chief 

Massachusetts General Hospital 

Boston 14, Mass.

V A
82 PUBLIC HEALTH TRAINING AMENDMENTS OF 19 64

Dr. Carl J. Marienfeld 

Professor and Chairman 

Department of Community Health 

and Medical Practice 

University of Missouri 

Columbia, Mo.

Miss Florence E. Martin 

Assistant Professor 

Public Health Nursing 

University of Washington 

Seattle 5, Wash.

Dr. Berwyn F. Mattison 

Executive Director 

American Public Health Association 

New York 19, N.Y.

Mr. Peter G. Meek 

Executive Director 

National Health Council 

New York 19, N.Y.

Dr. Malcolm H. Merrill 

Director of Public Health 

State Departmen t of Public Health 

Berkeley 4, Calif.

Mr. Sewall Milliken 

Executive Director 

Public Health Federation 

Cincinnati 2, Ohio 

Dr. Marion I. Murphy 

Director of Public Health Nursing 

University of Minnesota 

Minneapolis 14, Minn.

Dr. Daniel A. Okun 

Professor

Sanitary Engineering 

University of North Carolina 

Chapel Hill, N.C.

Dr. Theodore A. Olson 

Professor

Public Health Biology 

University of Minnesota 

Minneapolis 14, Minn.

Dr. J. C. S. Paterson 

Chairman

Department of Tropical Medicine and 

Public H ealth

Tulane University 

New Orleans 12, La.

Dr. Anthony M.-M. Payne 

Chairman

Department of Epidemiologj' and 

Public Health

Yale University 

New Haven, Conn.

Mr. Jerome A. Pollack

Professor of Administrative Medicine

Columbia University

New York 17, N.Y.

Dr. John D. Porterfield 

Coordinator

Medical and Health Services 

University of California 

Berkeley 4, Calif.

Mr. Paul W. Purdom 

Director

Division of Environmental Health 

Philadelphia 46, Pa.

Dr. Dean W. Roberts 

Executive Director

National Commission on Community 

Health Services

Bethesda 14, Md.

Dr. Kenneth D. Rogers 

Professor and Chairman 

Department of Preventive Medicine 

University of Pittsburgh 

Pittsburgh 13, Pa.

Dr. Gerard A. Rohlich 

Professor of Civil Engineering 

University of Wisconsin 

Madison 6, Wis.

Dr. Paul R. Schnurrenberger 

Chief Public Health Veterinarian 

Illinois Department of Public Health 

Springfield, Ill.

Miss Doris R. Schwartz 

Assistant Professor of Nursing 

Cornell University 

New York Hospital 

New York, N.Y.

Dr. William K. Selden 

Executive Director 

National Commission on Accrediting 

Washington 6, D.C.

Mrs. Margaret Shackelford 

Assistant Professor

Departmen t of Preventive Medicine 

and Public Health

University of Oklahoma 

Oklahoma City, Okla.

64
PUBLIC HEA LTH TRAINING AMENDMENTS OF 19 64 83

Dr. Margaret L. Shetland

Professor and Director of Teacher 

Preparation Programs

University of North Carolina 

Chapel Hill, N.C.

Dr. Leslie Silverman

Director of Radiological Hygiene 

Program

Harvard University

Boston 15, Mass.

Miss Jean ette Simmons

Director of School Health

American H eart Association 

New York 10, N.Y.

Dr. Charles E. Smith

Dean

School of Public Health

University of California

Berkeley 4, Calif.

Miss Jean Stair

Associate Professor and Head 

Depa rtment of Public Health Nursing 

Western Reserve University 

Cleveland, Ohio

Dr. Ernest L. Stebbins

Dean

School of Hygiene and Public Health 

The Johns Hopkins University 

Baltimore 5, Md.

Dr. Elizabeth C. Stobo

Associate Professor of Nursing Education

Columbia University

New York 27, N.Y.

Dr. David Striffler

Associate Professor of Public Health 

Dentistry

University of Michigan

Ann Arbor, Mich.

Mr. John D. Thompson

Director

Program in Hospital Administration 

Yale University 

New Haven, Conn.

Miss Catherine W. Tinkham 

Associate Professor and Chairman 

Public Health Nursing Program 

Boston University 

Boston 15, Mass.

Dr. James L. Troupin

Director of Professional Education 

American Public Health Association 

New York 19, N.Y.

Dr. Ray E. Trussell

Commissioner

New York City Depa rtment of 

Hospitals

New York 13, N.Y.

Dr. Joseph F. Volker

Vice President for Health Affairs 

University of Alabama Medical Center 

Birmingham 3, Ala.

Dr. Myron E. Wegman

Dean

School of Public Health

University of Michigan

Ann Arbor, Mich.

Dr. Tom F. Whayne

Assistant Vice President for Medical 

Center

University of Kentucky

Lexington, Ky.

Dr. Kerr White

Chairman and Professor

Department of Epidemiology and 

Community Medicine

University of Vermont

Burlington, Vt.

Dr. Muriel B. Wilbur

Staff C onsultant

Rhode Island Council of Community 

Services

Providence 6, R.I.

Dr. W’illiam R. Willard

Vice President and Dean

Medical Center

Univeristy of Kentucky

Lexington, Ky.

Dr. Abel Wolman

Consulting Engineer

The Johns Hopkins University 

Baltimore 18, Md.

Dr. Wesley O. Young

Director

Child H ealth Division

Idaho Dep artm ent of Health 

Boise, Idaho

Note: The affiliations of th e conferees in this listing are those which were current at the time of the 

Conference.

65
84 PUBLIC HEA LTH TRAINING AMENDMENTS OF 19 64

E. Co nference Pe rs on ne l

C o n fer e n c e Sta ff

George E. Kreiner 

Elizabeth G. Pritchard

William L. Kigsick, M.D.

Executive Secretary 

Lucy M. Kramer, M.A.

Joseph E. Napolitano 

Margaret G. Senter

Selma Freedman, Administrative Assistant

C o n fer e n c e R ecorder s

Sydenham Alexander, M.D.

Division of Chronic Diseases

George Archambault, Sc.D.

Bureau of Medical Services

Eugene Confrey, Ph.D.

Division of Research Grants

Cecelia Conrath, M.P.H.

Division of Chronic Diseases

Evelyn Flook

Division of Community Health Services

Samuel C. Ingraham, M.D. 

Radiological Health Laboratory

Ruth I. Knee, M.A.

National Institutes of Mental Health

Arthur Lesser, M.D.

Children’s Bureau

Donald Martin, M.D.

Communicable Disease Center

Fred Mayes, M.D.

Bureau of State Services

Beverlee Myers, M.P.H.

Division of Community Health Services

Loyal C. Peckham, M.P.H. 

Environmental Health

Ruth Raup

Division of Public Health Methods

Dorothy Reese, R.N.

Division of Nursing

D iv is io n of C om m un it y H ea lth Ser v ic es

T r a in in g R eso urces B ra nc h

Elmer L. Hill, M.D., Chief 

James M. Hoeven

Raymond F. Dixon, Deputy Chief 

Annalu Jeffries William Koenig
PUBLIC HEA LTH TRAINING AMENDMENTS OF 19 64 85

Mr. J ones. Un de r the pro visions of H. R. 10043, the Publi c Hea lth 

Service would con tinu e to supp ort indiv iduals engaged in long- and 

short -te rm gradu ate or specializ ed trai ni ng in p ublic he alth by m ak ing 

tra ineeship aw ard s dir ectly to indiv iduals an d throug h gr an ts to insti tutio ns for th is purp ose.

These traine esh ips will be used to increase the supply of c rit ically 

needed pro fessional ly tra ined public he alth personnel, and to equip 

members of all professional h ealth disciplines to serve more effectively 

the needs of m odern public he alt h p rog ram s.

Pr ojec t grant s would continue to be made to schools of public he alt h, 

eng ineerin g, and nursing. W ith the inc rea sin g com plexity of pub lic 

healt h problem s and the increa sing needs and o pp ortun ities f or u til izing an expanding varie ty of pro fessional specialists in me eting these 

prob lems, it is no lon ger feasible, however, to look only to th ese three 

typ es of schools fo r the grad ua te and specialized trai ni ng of pub lic 

healt h personnel.

We mu st look also to oth er typ es of public and nonprofit trai ni ng 

ins titu tions, such as our medical schools, denta l schools, op erating 

he alt h agencies, and professional associations to pro vid e par t of the 

necessary grad ua te a nd specializ ed tra in in g so essential to the successful ac com plis hment of pu blic he alt h prog ram s.

Th e conferen ce placed special stre ss on the need to improve the 

ca pability of departm ents of pre ventive med icine in med ical schools 

to increase and up da te the public h ealth c onten t of th eir instructio nal 

pro gra ms. Th e co nference also emp hasized th e importance of p ro viding t ra in in g in public he alt h throug h refre sher courses, seminars, and 

oth er proven me thods of short-ter m i nstru cti on for profe ssional he alt h 

pers onnel.

In con cluding my statem ent , Mr. ( nairm an, I should like to emphasize the urgency of ear ly ena ctm ent of H.R. 10043, because of the 

term ina tio n this coming Ju ne 30 of the cu rre nt au tho riz ation fo r the 

pub lic h ealth train eeship p rog ram .

Tim ely acti on by the Congress in exten din g the au tho riz ation fo r 

this successful program and in ap prov ing the amend ments pro posed 

to the pro ject gr an t pro gra m fo r pub lic healt h trai ni ng will assu re 

con tinu ed imp rovements in the qu an tity and qu ali ty of pro fessional 

pers onnel ava ilab le for public healt h prog ram operation s.

On behalf of Secre tary Celebrezze and the admi nistr ation, I 

str ongly urge, there for e, th at H.R. 10043 be enacted prom ptl y. We 

sha ll be pleased at th is tim e t o am plify o r discuss any points on which 

the mem bers of the committee may wa nt fu rthe r infor ma tio n.

Th an k you , Mr. C hairm an.

Mr. Roberts. Th an k you, Mr. Jon es.

Ju st to get thi s bill in its prop er pers pec tive , if I am correc t, and 

the staff will c orrect me if I am wrong, this legisla tion first came into 

bein g as title I of th e H ealth Amendm ents Act o f 1956.

Is tha t righ t ?

Mr. J ones. Th at is correct.

Mr. Roberts. An d if I remember correc tly, we h ad, in all, five title s 

in t ha t pa rtic ul ar bill, and it seems to me t ha t we had held some ra th er 

tho rou gh heari ngs on the gen eral subject of nu rsi ng in connection 

with the He alth Am end ments A ct of 1956.
86 PUBLIC HEALTH TRAINING AMENDMENTS OF 19 64

Th at was under the chair ma nship of Mr. Pr iest, of Tennessee, and 

this was, as I said before, und er tit le I , was it not ?

Mr. J ones. Tha t is correct. Yes, sir.

Mr. Roberts. If 1 rememb er correctly, the re have been several 

survey s m ade, as to w het her o r not the re was a nu rsi ng sh ortage , some 

of the causes of shortage or sh orta ges.

Now, since the passage of th at legi slation, in 1956, th ere was a nothe r 

renewal ?

Mr. J ones. In 1959. Th e autho riz ati on was for 3 ye ars, in the 1956 

legisla tion. In 1959, the prog ram was exte nded fo r 5 yea rs.

Mr. Roberts. So th at we are faced now with anoth er renewal of this 

pro gra m.

An d, now, since the heari ngs in 1956, you have ha d how many 

surv eys of the sho rtage?

Mr. J ones. We have had two confe rences, Mr. Chairma n. Th e 

first was in 1958, as pro vided for in the legisla tion o f 1956, and a r ep ort 

of that conference was mad e ava ilab le to your committee, which then 

extended the prog ram for 5 m ore years, with a provision th at a sim ila r 

conference 1 y ear p rio r to the t ermina tio n of the auth oriza tio n, be held 

to review, to evaluate, to make recommendations, and to give you the 

da ta you would need to jud ge the effect, the resu lts and the weaknesses 

and str ength s, of the program .

An othe r conference was held, in 1963, as pro vid ed in the exte nded 

legisla tion , and it is t hat rep ort th at you have pe rm itted to be placed 

in the reco rd, copies of which have been made ava ilab le to members 

of the committee.

It is on the basis of the eva lua tions in th is ra th er deta iled stu dy of 

the pro gra m th at the administ ratio n has endo rsed a con tinuat ion for 

anoth er 5 yea rs of the train ees hip s, based on the recor d of acco mplishmen t, and the continuing need th at has developed in the subseque nt 

years, with some ame ndm ents th at would mak e the program more 

effective.

Th ere is one oth er point , Mr. Chairma n. In 1960, anoth er fea ture 

was add ed to the prog ram which has to do with pro jec t gr an ts to 

str ength en the quality of t ra in in g and the qu an tity of t ra in in g av ailable. Th is program would expir e next year.

We are ask ing now for a 4-v ear extension of th at pro gra m, so that 

the two would ter mi nate at the same time, in 1969, if the Congress, 

in its wisdom, ex tends both pr ogram s.

Mr. Roberts. So tha t the pr ese nt act t hat we h ave before us is really 

a two-p ron ged pr oposition ?

Mr. J ones. Tha t is corre ct.

Mr. Roberts. One directed to the t rainee ships, a nd the o ther to the 

pro ject grants?

Mr. J ones. Th at is r ight.

Mr. Roberts. An d the re wou ld be no fu rthe r sta gg ering o f the p ro ­

grams, but they will ta pe r off at the same time?

Mr. J ones. Th at is correct.

Mr. Roberts. Xow, why do you think it is necessary th at we include 

oth er schools; th at is, th at you broaden the p rogram at this pa rticul ar 

time?

Mr. J ones. It is esse ntial, we think , Mr. Ch airma n, and this ju dg ­

ment is backed by the conferen ce alr eady ref erred to ear lier. De
PUBLIC HEA LTH TRAINING AMENDMENTS OF 19 64 87

velopme nts in the field of public healt h have been so broad, par ticu ­

larly in recent yea rs, th at it would be to the advanta ge of the whole 

field of pub lic healt h th at those going into this field pro fes sio nally 

have an op po rtu nity to be t rained o ther t ha n ju st by the three schools 

to which the pr og ram has been res tricte d heretofore .

Th is is i mpo rta nt because in new are as of healt h, the so phistica tion, 

the competence, rests in, say, depa rtm en ts of pre ventive medicine of 

medical schools o r in oth er spec ialized a reas, where the i nstru ction , if 

given to traine es fo r the purposes of the legisla tion, wou ld be t he best 

th at could be available. In man y instances they would be the only 

places w here such in struction would be available.

I think offh and of t he new problem s o f radiation exp osure, whe rein 

medical schools, ra th er than in schools of public he alth exclusively, 

competencies exist to pro vide hig hly specialized trai ni ng in an are a 

where specialists are scarce, where the y rep res ent an im po rta nt field 

th at mu st be cov ered in prote ction of public health.

Mr. Roberts. Would any of the people or any o f the person nel th at 

would be affected by these train ees hip s or g ra nt s be especially eq uipped 

for th e h an dling of, say, a n ucl ear fall ou t problem, or a nuc lear attack 

in case of atomic wa r ?

Mr. J ones. Very definitely so. The people in public healt h ac tiv ­

ities, pro bab ly since the origi nal legisla tion in 1956, hav e been confro nted with the problem of pro tec tion fro m fal lou t hazards if the y 

exis t, ce rta inl y p otentia l h azard , and they need to be traine d to do this. 

Th e specialized tra in in g pro vid ed throug h th is legislation mak es this 

possible.

Mr. Roberts. Many of th ese wou ld be s an ita ry en gineers a nd people 

who would be in the fron t lines, so to spe ak, of protectin g w ate r su pply, 

food supply, an d o the r areas t hat wo uld be v ita l to the m ain ten anc e of 

the civilian popula tio n ?

Mr. J ones. Th at is quite correct, Mr. Ch airma n.

Mr. Roberts. W ha t oth er schools wou ld be elig ible for the traine eship s, oth er th an the th ree you have m entioned ?

Mr. J ones. Th ere would be the thr ee basic schools, of cours e, th at 

have been eligib le: the schools of public health, of nursing, and of 

engineerin g. Th e principa l new g roup of schools would be schools of 

medicine.

Medical schools in recent year s have developed departm ents of pr eventive medicine and com munity h ealth as a basic par t of the instr uc ­

tion of stu dents t ra in in g to be doc tors for pra ctice, but they hav e developed special competencies in such departm ents. These competencies sh ould be ma de available to those who a re s pec ializing in public 

healt h beyond the basic education of phy sicians. It is the utilizatio n 

of these competencies th at w ould be mad e possible by an e xten sion of 

the eligib ilit y to include this typ e of edu cation al ins tituti on.

We would also expect schools of de ntist ry to be included. De ntal 

healt h is a p ublic healt h problem which needs ve ry special emp hasis.

Schools of social work are very definitely invo lved, because he alt h 

relates to we lfa re problem s in a very exte nsive way.

Schools of pharm acy , which are involved in many of these aspects 

of public health, and oth er schools, such as osteop ath y, which wou ld 

be rela ted to the h ealth p rofe ssio ns in a c om par abl e manner.
88 PUBLIC HEALTH TRAINING AMENDMENTS OF 19 64

Mr. Roberts. I s th ere any danger th at by ex panding these funds to 

these othe r Helds, the three Helds t ha t have been un de r this pro gra m 

migh t be dep rived of fu nd s ?

Mr. J ones. I think no t, Mr. Chairm an, especially i f th e recommen dations for a grad ua ted increase in ap prop ria tio n au tho riz ati ons were 

likew ise ma de a policy of the Gov ernmen t.

Mr. Roberts. I go alo ng with the social worker field. I see there 

can be a relati onship, but it seems t o me th at th is wou ld be an aw ful ly 

big spon ge, if you got into su pp ortin g ins titution s who were tu rn in g 

out social workers.

Mr. J ones. It would not be rel ate d to the tra in in g of social w orkers 

per se, Mr. Chairma n. It wou ld be rel ate d only to th at aspect of a 

tra ining prog ram in a school of social w ork that h ad special relev ance 

to p ublic h ealth workers.

For exam ple, public he alt h nurses fre quently are confronted with 

problems of how to deal with low income fam ilies who have health 

prob lems, and who do not res pond to just the medical aspe cts of the 

public healt h pr ogram .

Th ere for e, if they ha d some specialized tr ai ni ng in how to deal with 

fam ilies of this kin d fro m the sta nd po int of the public healt h pr ogram , this would be a gr ea t boon to the q uality o f service ren der ed by 

the pub lic healt h workers. I t would be a very selective typ e of pr ogram in schools ot her th an those now included.

Mr. Roberts. Wo uld th at be pe rhap s in the field of migr ato ry 

workers ?

Mr. J ones. It could well be. Tha t is an excellent exam ple, Mr. 

Chairma n.

Mr. Roberts. Now wh at about the schools of pharm acy ? How 

wou ld they come into thi s par ticu la r pict ure ?

Mr. J ones. Th e schools of pharm acy have special competence in 

some areas th at a re pa rti cu larly part of public h ealth. For exam ple, 

the fields of clinical pharm aco log y or pharm acology of the effect of 

drug s on hum ans. Th e field of toxic ology, which inc reasingly is 

becoming im po rta nt in public he alt h work by virtu e of the extended 

use of chem icals in the environme nt which create public health hazards. We need specialized personnel th at know how to deal with 

these problems.

For example, the Pu blic Hea lth Serv ice coo rdinates a series of 

poison con trol centers where spec ialized personnel and inf orma tio n 

are ava ilab le to serve as a reference p oint fo r phy sician s who are confro nte d with accidents inv olv ing poiso nous substances th at are accidenta lly ingested by child ren an d by others. Schools of pharm acy 

have special competencies in t he field of toxicology and pharm acology. 

These should be made a vailable f or high ly selective trai ni ng of people 

who would be pub lic he alth worke rs in such fields as con trol of contamina nts in the environme nt, pesticid es, a nd the like.

Mr. Pickle. In th at connection, 1 wante d to ask about anoth er 

school where the re are possibilities o f funds being m ade ava ilable.

In yo ur testimony I believe on pag e 3, y ou mak e refe renc e to the 

lan guage th at would be inserted, the new lan guage th at would be 

inserte d, in this bill, and th at is shown on the last two lines o f pag e 2 

and the first two lines o f page 3, w hich reads, begin nin g with—

and to other public or nonprofit institu tions providing gra dua te or specialized 

training in public health, for th e purpose of stren gthening or expanding graduate 

or specialized public health train ing in such institutions.
PUBLIC HEALT H TRAINING AMENDMENTS OF 19 64 89

Now as I understand it, just as you have said, this would give your 

Department greater latitude in selecting institutions for grad uate 

training in public health.

Now I pose this question to you. I am wondering, if this language 

was inserted into the law, would some of these funds which are made 

available be utilized for public health training in vision care? And 

particularly in one or more of the Institutes where courses are available for optometrists, for public health institutions ? What would be 

your position on that ?

Mr. Jones. It could well be, Mr. Pickle.

Mr. Pickle. Do you have any personal feelings on that?

Mr. J ones. These training programs are adjudged on the basis of 

applications that come in. They are very carefully reviewed by the 

staff, and then they are referred to a National Advisory Council on 

Public Health Training which then looks at them from a policy standpoint as to whether or not there is a special need in the area for which 

the application is made. They will then judge these in relation to 

other applications.

But the answer is: “Yes, I would think there would be in many 

instances need for specialized trainin g.”

Mr. Pickle. Thank you.

I have questions in other areas, but I will yield back to the chairman.

Mr. Roberts. These programs have been in effect now since 1956. 

But according to your statement, and other statements before the committee, we still have rather dangerous shortages in these particular 

fields.

Do you think th at the money that is being sought with this authorization will be sufficient to meet the needs in the next 5 years?

Mr. J ones. Mr. Chairman, I do not think the amount of money 

being requested in this bill will meet the full need. But what the 

legislation, if enacted, would do, would be to support the more critical 

areas of need. By support of programs in institutional environments 

where they may be weak and need development and, thereby to encourage further development, not with Federal funds, but outside of 

the Federal program, through this kind of simulatory grant and support program.

We are not proposing that the Federal Government assume the 

whole burden by a considerable margin, but to provide the stimulation 

for meeting the special gaps, the special needs, and to encourage a 

development outside of the Federal Government in the field of public 

health training.

Mr. Roberts. The staff has just shown me the departm ental letter 

which came up with the bill which contains, I reallv think, a very clear 

breakdown of the appropriation requirements and the expenditures.

Now you start out in 1965 with $44^ million for public health 

traineeships, and in 1966 it goes to $7 million; in 1967 $8 million; in 

1968 to $10 million, and then it will stay at the same $10 million figure 

until 1969.

Then you asked on project grants for what looked like a half-milliondollar increase over the $2 million already authorized for fiscal 1965, 

so that if you start off with $2i/2 million, then you go to $4 million for 

fiscal 1966; $5 million for 1967; $7 million for 1968; and $9 million for 

1969.
90 PUBLIC HEALT H TRAINING AMENDMENTS OF 19 64

Those figures do not include, of course, the increase for administrative cost over the fiscal 1964 level of $272,000.

Now this would show, not including what is already authorized under existing law, a figure, I believe, of $19,443,000. Is th at correct ?

Mr. Jones. Tha t is correct.

We have a table, Mr. Chairman, which we could submit for the record, which shows an estimate of cost that is projected, the figures that 

you have referred to, and also an estimate of cost for the same years, if 

the present level of authorization were continued, and then the difference in cost beyond what is now being spent.

(The table referred to follows:)

E S T IM A T E O F C O S T 1965-69 

[D ol la rs i n thousa nds]

It em 1965 1966 1967 1968 1969 T o ta l

P u b li c h ealt h t ra in ee sh ip s ______________ $4,5 00

2,500

375

$7, 000

4,0 00

445

$8,0 00

5,000

520

$10,000 

7,000 

590

$10,000

9,0 00

665

$39,500

27,500

2,595

P ro je ct g ra n ts ___________________________

A d m in is tr ati o n _________________________

T o ta l ________ __ __________ _____ 7,375 11,445 13,520 17,590 19,665 69,595

M an -y ea rs of e m plo ym ent _____________ 36 44 51 57 64 252

E S T IM A T E O F C O S T A T 1964 L E V E L O F O P E R A T IO N

P u b li c h ealt h tr ain eesh ip s. _____________ $4,19 5

2,000 

i 222

$4,1 95

2,0 00

222

$4,195

2,000

222

$4,195

2,000

222

$4,195

2,000

222

$20,975

10,000

1,110

Pro je ct gra nts _______________ __________

A d m in is tr ati o n ........ ........... ..............................

T o ta l.........- ................. . ............................ 6,417 6,417 6,417 6,41 7 6,417 32,0 85

M an -y ea rs of e m p lo y m en t_________ _____ 3

 24 24 24 24 24 120

A dd it io nal co st .............. ......... ............. $958

12

$5,028

20

$7,103 

27

$11,173 

33

$13,248 

40

$37,510

132 A dd it io n al m an-y ea rs ..........- ...............

1

 Doe s n o t in cl ude $50,000 for 2d N ati o n al C on fe re nc e o n P u b li c H ealt h T ra in in g.

3

 D oe s n o t in cl ud e 4 m an-y ea rs for 2d N ati o n al C on fe re nc e o n P u b li c H ealt h T ra in in g .

Mr. Roberts. Now, do you anticipate the addition of a number of 

people to carry out this program ? Or what would be your estimate 

on the number of additional Federal workers that would have to be 

employed ?

Mr. J ones. To carry out this program, Mr. Chairman, would require, according to our estimate, an addition of 12 man-years in 1965, 

20 in 1966, 27 in 1967, 33 in 1968, and 40 in 1969, a relatively small 

increase to manage the increase proposed.

Mr. Roberts. Would that be for a total of 132 additional man-years?

Mr. J ones. Man-years for the full 5-year period. Is th at correct?

I might point out, Mr. Chairman, that the total cost over a 5-year 

period, of the proposed programs, would be $371/2 million, approximately, over the current cost, and the total program would cost $69,- 

600,000, approximately.

Mr. Roberts. The $69,600,000 would be a total cost ?

Mr. J ones. That is correct. So we are asking for $37 million over 5 

years, as opposed to what would be about $32 million if the program 

were continued at its current level.

Mr. Pickle. I did not get those figures. Would you mind repeating 

them?

Mr. J ones. It may be easier, Mr. Pickle, if you would refer to the 

chart, there.
PUBLIC HEALT H TRAINING AMENDMENTS OF 19 64 91

Mr. P ickle. One is coming up now, yes.

I wanted to ask you this question, Mr. Jones, along the same lines as 

I did the last witness. You indicate that there are 5,000 vacancies now, 

in the public health field, and the lady who just testified stated that of 

the number of nurses which have been made available in the public 

health traineeship, approximately 50 percent of them had come from 

the regular registered nurse field.

Obviously, if half of their number came from the regular R.N. field, 

then it would seem that th at is one reason why we have such a shortage 

of nurses now. Special agencies or fields are taking these nurses, or so 

it would seem to me.

Now, what is the salary comparison in your particular field? Let’s 

say a person who wants to work for the H EW as a nurse—would they 

get more than those who would be in the regular nursing field?

Mr. J ones. It would all depend, Mr. Pickle, as to the nature of the 

job.

Mr. Pickle. But would it not be a little higher wage level ?

Mr. J ones. Not necessarily. Some of the specialized nurses—well, 

if you compare the Public Health Service hospitals, which employ 

nurses, with the general community hospital, the comparison would 

be about the same. It would be roughly the same. And this is where 

the bulk of the nurses are utilized.

But then this is not a public health nurse, as such. The public health 

nurse, who has specialized responsibilities which require specialized 

training beyond just the R.N., generally receive somewhat higher 

compensation.

I think we could give you a table, Mr. Pickle, if it would be helpful, 

tha t would provide a comparison in three types of nursing positions, the 

nurse diretcor, the superivising nurse, and the staff nurse, in the public 

health nurse field, if this would be helpful to you.

Mr. Pickle. I would like very much to see the table.

Mr. J ones. We will give you that for the record.

(Table referred to follows:)

Median annual salaries of public health nurses in selected agencies,1

 by type of

agency and position, 1957-62

T y p e of ag en cy an d po si tion 1957 1958 1959 1960 1961 1962

Lo ca l off icial healt h u n it s:

N u rs e d ir ecto r............................ ................. $6,04 3

5,241

4,10 7

5,46 4 

4,77 0 

3,65 0

5,70 8

4,597

$6,600

5,348

4,301

5,90 0

4,981

3,881

6,263

4,854

$6,675

5,50 6

4,40 8

6,068 

5,21 4 

4,042

6,30 0 

5,26 7

$6,957

5,680

4,540

6,37 5 

5,453 

4,202

6,767 

5,442

$7,363

5,933

4,652

6,68 3 

5,659 

4,316

7,288

(’)

$7,5 60

6,233

4,902

6,963

5,85 9

4,44 2

7,70 0

6,090

Super vis in g n u rs e________________ _

Sta ff n u rs e___________________ ______

Non of fic ia l agen cie s:

N urs e d ir e c to r........... ......... .......................

Super vis in g n u rs e................... ........... .......

Sta ff n u rs e______ __________________

B oar ds of ed ucat io n:3

Super vis in g n u rs e___________________

Sta ff n u rs e_____________ ____________

1

 791 p u b li c h ealt h nurs in g agen cies r ep o rt ed in 1957, 836 i n 1958, 826 in 1959, 856 i n 1960, 772 i n 1961, an d 

810 i n 1962.

3

 N o d ir ecto r cl as sifica tion i n boa rd s of ed ucat io n.

3

 D ata n o t av ai la ble .

So ur ce : N L N y ea rl y r ev ie w s, 1957-62.

Mr. P ickle. I have been advised, Mr. Jones, that as soon as a nurse 

graduates from an accredited school, governmental agencies by and 

large are waiting in line to grab them up. This would be true whether
92 PUBLIC HEA LTH TRAINING AMENDMENTS OF 19 64

it is the Ar my or the Navy or the veterans hos pita ls, or the HEW , 

NA SA , and so forth .

If this is tru e, it looks to me like the Government is actua lly compe tin g ag ains t t he ho spital for t he ge ner al supply of nurses. Th is is a 

lit tle bi t remo ved fro m the pa rtic ul ar bill we are talk ing about, and 

yet the y are so rela ted. Do you have any fee ling about th at ? Am I 

inc orr ect in th at feeling, o r assum ption?

Mr. J ones. I would say th at you are q uite corr ect, Mr. P ickle. Bu t 

not on ly are Gove rnm ent agen cies wa iting to pick them up, bu t usually 

every othe r opera tion th at u tilizes a n urs e is w aiti ng.

Mr. Pickle. W ha t kin d of age ncies would th e “others ” be?

Mr. J ones. I t would be hos pitals, it would be nu rsing homes, it 

would be private physicians who would wa nt a reg istere d nurse in 

their office. I t would be all kin ds of local agencies. Th e St ate sanitar ium.

Mr. Pickle. I und erstood th at most, tho ugh, would go into g overn ­

me nta l agencies.

Mr. J ones. I am told, Mr. Pic kle , th at abo ut 20 percen t of nurses 

now emp loye d are in public agencies from all levels of governm ent.

Mr. Pick le. An d this would be all agencies?

Mr. J ones. Tha t is corr ect. An d 80 percen t are in oth er typ es of 

nu rsi ng a ctivity.

Mr. Pickle. Wo uld you classify let’s say the vetera ns hospitals as 

in th at 80-percent catego ry ? O r in the 20 percen t ? In wThich gro up 

would you classif y them ?

Mr. J ones. The y would be in th e 20, as employees of a public agency, 

Mr. Pickle. Tw enty perce nt would be all nonprofit pub lic agencies, 

such as com munity hospita ls supp orted with tax fun ds, in Veterans ' 

Ad minist ratio n hos pitals, Pu blic Hea lth Service, and the De partm ent 

of Defense.

I think there is one im po rta nt s tat ist ic to remember, M r. Pickle, and 

th at is th at the actual num ber s of nur ses in pra ctice have gone up 

throug h t he years, but the dem and has gone up fast er. W ha t our prob ­

lem is as we see it from the sta nd po int of the responsi bility of the 

Fe deral Gov ernment, which has a nationw ide res ponsibility for protection of the public he alt h throug h these various public healt h pr ogra ms —is a responsibility to assist in the spec ializ ed trai ni ng th at 

equips the registere d nurse, fo r example, as one catego ry of public 

he alt h worker, to do the specialized jobs for which the y are needed. 

Th is is quite a pa rt from the problem of increa sing the supply of reg ­

istered nur ses for all purpose s.

Mr. Pickle. Only 20 percen t o f the nurses act ually go into th e public he alt h field. I would no t think th at would be pa rti cu larly alarming, but if it was a majo rity, or even 50 percent o f them , I wou ld say it 

would be.

Mr. J ones. Yes, sir.

Mr. Pickle. I am glad to get y ou r figures, because the y are in contra diction with some figures I ha d received.

Mr. Roberts. Th an k you, Mr. Pickle.

Th is may n ot relate p ar tic ul ar ly to th is bi ll, bu t i t is a question th at 

can a rise when we bring this bill or the nur sin g bill t o the floor.

One of th e Members of Congres s, a very distin guish ed Member, who 

has been inte rested in nu rsi ng fo r ma ny, man y years, made a speech
PUBLIC HEALT H TRAINING AMENDMENTS OF 19 64 93

the other day, and the speech was alo ng th e line th at wh at wye need is 

bedside nurses, an d t ha t was p retty much th e th eme o f the sp ee ch : t hat 

wi th all o f the legislation t hat will be conside red in the nu rsin g field, 

this is the m ain need.

I would cha llen ge the statem ent, bu t I ju st won dered wh at w’ould 

be yo ur reac tion to that.

Mr. J ones. I think, Mr. Ch airma n, t he an swer to th at is th at no one 

wou ld disagr ee to the proposi tion th at bedside nurses are needed. 

Th en yo u mu st go on from the re to define more clear ly wh at is meant.

I am sure the one who ma de t his state me nt was concerned th at people 

who are sick in bed were no t gettin g as extensively as the y wou ld like 

the services of a reg istere d nu rse fo r al l th ei r needs.

Th e shortage of nur ses ha d led to effo rts to utiliz e the talents of 

those nurses who are pro fessional ly tra in ed in a more effective or 

efficient ma nner in terms of the sprea d of the service. Th e shortage 

of nurses who are p rofess ionally tra ined h as led to the practic al nurse 

pro gra m, the nurses’ aids prog ram , wa rd cler ks in hospitals, oth er 

typ es of p erso nnel whose trai ni ng is n ot as e xten sive as th at req uir ed 

fo r registe red p rofessional nurse, to do those services fo r pa tie nts th at 

can be done by oth ers who are no t pro fes sio nally tra ined , provide d a 

pro fessional ly tra ined nurse oversees the nu rsing activ ity an d is responsible fo r the patie nt.

Th ere has been a gr ea t deal of discussion about the relat ive needs 

fo r collegiate schools of nursing, fo r hospita l schools o f nu rsing, and 

for associate degree pro gra ms, as you hav e looked into in connection 

with other legisla tion, Mr. Ch airma n. But i t is ab un da ntl y cle ar th at 

we need n urse s at all levels of nu rsi ng service.

In the nu rsi ng homes, which are alm ost all short of nurses, if a 

nurse is t here availabl e to those who may be chron ically ill o r ag ed and 

infirm, and there fore in a nu rsing home, the pro fessional nurse does 

give bedside care in a sense, bu t when there are num bers of pa tie nts 

the re, she can not pro vid e ev ery pers onal need for every pa tient.

Bu t so long as she is there to oversee an d to do as much as she pe rsonally c an, she can use practic al nurse s and nurse s’ aids and at te nd ­

an ts and ord erlies to assi st in some of the prog ram s.

I do no t wa nt t o extend t his too long, Mr. Ch airma n, bu t one oth er 

factor is t hat m ore is being req uir ed of the nurse. Th ere was a time 

when nurses, as a matter of practic e, were no t allowed to give hypoderm ics. Th is w’as always done by the p hys icia n. But it is commonplace now an d is expected by a physicia n th at a nu rse do procedures 

of this kind after they are competentl y tr aine d to do it.

Th e professional req uir em ent f or n ursin g services has g ra du ally increased, which has tend ed, Mr. Pickle, to tak e nurses awa y sometimes 

from the typ e of bedside care which c ould be done by other people.

Mr. Roberts. Well, I certainly feel t hat you and c ert ain ly Dr. T er ry 

and yo ur other assoc iate are experts in thi s field, which makes me a 

little h esita nt to as k t his question, b ut we he ar a lot from tim e to tim e 

about the need fo r research in stud ies a lon g the lines of b etter ut ili za ­

tion, th at we ten d to give each pa tie nt a sort of a—well, kind of a 

checklist, lik e che cking out of a plane.

He comes in , an d reg ard less of what he is there for, fo r the first day 

or two, we give him a blood test, an X-ray , we check his pulse, we 

check his vision, we do just about ev erythin g to him, or at leas t th at 

has been my experience. It has happened th at way to me.

32-438 0 — 64-------7
94 PUBLIC HEALT H TRAINING AMENDMENTS OF 19 64

An d I won dere d, perhaps, if you have any views as to what these 

stud ies could do. Could we still do a good job fo r the pa tie nt and 

maybe do some things —are we doing some things th at may not be 

necessary in some cases ?

Mr. J ones. Th ere is a great deal of experim entation and dem onstratio n going on now in hos pita ls, pa rti cu larly in this cou ntry, Mr. 

Ch air ma n, designe d to determ ine whether or not there can be a more 

effective uti liz ati on of the tal en ts of nurses, and for othe r h ealth profess ional personnel, also.

One e xam ple I will give you is t he use of new techniques inv olving 

electronics in the measure men t of the physiological processes of pa ­

tients . Th is is mo nit ori ng their physiological ac tiv ity throug h devices which are com fortab ly att ached to the pa tie nt an d fed into one 

single co ntrol poi nt for m aybe a whole g roup of p atients.

You are familiar, I am sure, with the exp erim ents with nu rsi ng 

un its th at are b uilt in a circle, with the nu rsi ng sta tio n in the c enter 

and the patie nts aro und the perip hery. He re the nurse can observe 

dir ectly a numb er of dif fer ent pa tie nts and with the utilizati on of 

electronics techniques, can keep tra ck of the im porta nt developm ents 

affe cting th at pati ent.

Mr. Roberts. I rememb er a few years ago we go t some from the 

members of the conferen ce fo r con struction of one of thes e facilities 

th at it seemed like to me was being sponsored by the Mayo Clinic. 

Ha s th at been bu ilt ? Or do yo u know ?

Mr. J ones. It is u nd er c onstruction , I am told , at the pre sen t time , 

and has n ot been completed.

Dr . Terry. I think you are referri ng , Mr. Ch airma n, to the Me thodist Ho spita l in Rochester, M inn., which is associated w ith the Mayo 

Clin ic, and we have been v ery inti ma tel y involved in this.

It has received from our Hill -B ur ton fun ds both experim ental constructio n fun ds as well as some routi ne Hill-B ur ton fun ds. It is in 

the process of bu ild ing at the p res ent time. They have worked with 

some u nits pr eviously for demo nstration p urposes, but th e more extensive u nit is still un de r con struction a t this tim e.

Mr. Roberts. Dr. Te rry, wh at is the program being sponsored in 

Montgomery, kno wn as the medical ty pe fac ility ?

Dr . Terry. Yes, Mr. Ch air ma n. Th is is wha t might be refer red 

to as an exper iment al ho spita l facil ity , which involves several feature s.

One feature is the autom ation associated with it, sim ila r to wha t 

Mr. Jones has referre d to—v arious ways of rec ord ing vital sign s or 

other im po rta nt da ta about pat ien ts.

Also, this pa rticul ar ad ap tatio n has been made in such a way as to 

devise hospitals which are easily assem bled and disassembled and can 

be moved with some eye to p ar tic ul ar ly u sefulness, fo r instance, in the 

militar y.

So it is a study of hospita l design, which involves several typ es of 

features.

Mr. Roberts. Of course, I am g ettin g you off the t rac k, now. Th an k 

you very much.

I th ink thi s comp letes the list of witnesses.

I regret th at it w as impossible fo r th e subcomm ittee to conduct h ea rings y esterd ay, p artic ul arly in view of t he fac t th at Dr. Myron Wegman, dean of the School of Pu blic He alt h, Un iversity of Michigan,
PUBLIC HEALT H TRAINING AMENDMENTS OF 19 64 95

and president of the Association of Schools of Public Health, had 

journeyed from Ann Arbor to Washington to present the views of tha t 

association to the^ subcommittee. I am sure that we are all aware of 

the vital role of the schools of public health in training public health 

personnel and of the intense interest which Dr. Wegman and others 

associated with the schools of public health have in this legislation. 

I would like to include in the hearings a copy of his statement which 

he had prepared for this hearing.

(The statement referred to follows:)

Statement of Myron E. Wegman, M.D., M.P.H., Dean of the School of Public

Health, University of Michigan

I am Myron E. Wegman, clean of School of Public Health of the University of 

Michigan and president of the Association of Schools of Public Health. The association which I represent includes the 12 accredited schools of public hea lth of the 

United States, 6 of which are in private schools: Columbia, Harva rd, John s 

Hopkins, Pittsburgh, Tulane, and Ya le; and 6 at Sta te institu tio ns : Californ ia 

at Berkeley, C alifornia at Los Angeles, Michigan, Minnesota, North Carolina, and 

Pue rto Rico. As president of the association and on behalf of my colleagues, I 

am gratefu l for this opportunity to indicate our wholehearted supp ort for H.R. 

10043, the Public Health Gra dua te Training Amendments Act of 1064, as a wellplanned step toward the essential suppo rt of the balanced traini ng program our 

country needs to provide adequate numbers of properly prep ared public health 

workers.

Our schools have now had a good many years experience w ith Fed eral supp ort 

for the preparatio n of needed health workers and it is this experience which 

makes us endorse wholeheartedly the proposed bill as one of the key steps. You 

have alread y had introduced before you in the evidence the re port of the Second 

National Conference on Public Health Training, convened at the direction of 

the Congress. Recommendation 1 of this report called for extension and expansion of the existing program s of (a) traineeship support of students, section 306 

of the Public Health Service Act, (&) project gra nts for selected fields of public 

hea lth instructio n, section 309, and (c) form ula gra nts to schools of public 

hea lth for the broad supp ort of basic instructio n, section 314(c) (2) ; c harac terized by the recommendation as “interr elated ♦ * * components of a coordinated 

approach for the correction of * * * shor tage s” of “manpower for public 

hea lth.” The thre e asse ts constitute a complementary package but the present 

bill deals w ith the first two for logical reasons of immediacy and timing. I shall, 

therefore, deal first with these two aspects of the bill.

Time and again represen tatives of this association have appeared before committe es of the Congress to point out the urgent necessity for the public hea lth 

trainee ship program. Eight years of experience have now completely confirmed 

this need. The tr ain ing for which suppo rt is sought is traini ng a t the g rad uate 

level and candidates fo r admission must have completed the ir und erg rad uate programs and have at least a bacca laureate degree. Many stud ents in public health, 

furthermore, already have higher degrees and such candidates include doctors 

of medicine, dentists, and veterinarians. These people have alre ady invested 

larg e sums of money in the ir education and, by and large, are simply unable 

to underwrite the additional high costs of graduate training in public health. 

Furthermore, the rela tive age and ma turity of these studen ts must be ta ken into 

consideration. Many have already had a period of work in a community hea lth 

service before seeking gradua te training and are, thus, well beyond average 

studen t age. Many are married and alread y have family responsibilities.

Coupled with this is the fac t that the gre at majority of these gradua tes go 

into public service where the recompense is relatively low and there is little 

financial justificatio n for the heavy investment required. Our experience over 

the years has been confirmed once more this year and, at this writing, 45 studen ts 

alre ady accepted at our own school as meeting academic and personal requirements have indicated to us tha t the ir personal resources will not perm it them to 

atte nd the school of public health without some form of financial support.

In some gradu ate fields universities themselves have been able to offer studen t 

support in various ways, including part-time work and local scholarships. This 

has been true to only a very limited extent in schools of public health, in pa rt 

because the heavy academic load the stud ents must car ry makes part-tim e em-
96 PUBLIC HEALTH TRAINING AMENDMENTS OF 19 64

ployment quite inadvisable, and in part because the national cha rac ter of each 

of these schools makes local scholarship money often unavailable. In the State 

schools, furthe rmo re, only a minority of th e studen ts are from the State and the 

rest are not able to take adv antage of the s ubs tantially lower in-State tuition. At 

the University of Michigan, for example, roughly thre e-quar ters of our students 

are from out of State, far and away the highest proportion of any of the schools 

and colleges of the university.

These studen ts cover a wide variety of fields, including persons training for 

public health administration, medical care adm inistration, chronic diseases and 

aging, matern al and child health, nutritio n, health education, public health 

dentistry, biostatistics, epidemiology, public health laboratory practice, radiological health, ind ustrial health and other forms of environm ental health, population 

planning, and inte rnational health. This is the program of general support for 

the public health workers, who a re needed to form the solid base for community 

health services.

An indication of the kinds of health manpower needs which schools of public 

health and the specialized schools are being called upon to fill, with the help 

of these programs, may be had from a table prep ared for the Second National 

Conference. Ju st to maintain in the year 1970 the level of services provided 

to health departm ents in 1962 by physicians, nurses, engineers, health educators, 

nut ritionists, and others will requ ire some 5,000 additional trained personnel. 

And this figure does not take into consideration eith er existing shortages or 

attri tio n through death or retirement.

I should like at this time to call the atte ntio n of the committee and the 

Congress to. the extrem e urgency in timing for this legislation. The program 

has become well established over the past 8 years and applications have increased as the train eesh ip program has become bette r known. This momentum 

will be lost if there is interru ptio n or delay in the program. We already have 

in our institution alone a backlog of 85 applications for traineeship s already on 

file more than half of whom, as noted above, have alre ady been accepted for 

admission. We have had to inform all candidates, however, that no action can 

be tak en on their traineeship applications until the Congress has acted. While 

in previous years there has often been delay in appropriation , we had wellfounded confidence that the then existing legislative autho rity would be exercised. At the present time, however, authorization for traineeships expires on 

Jun e 30, 1964, and there is, thus, no legislative authority for appropriation for 

the 1964-65 academic year. At this time, then, it is exceedingly difficult to give 

any encouragement to prospective students.

A corollary factor of some im portance is the relation of this training program 

to other scholarship opportunities. By agreement among gradua te schools of 

this country, notice of aw ards of fellowships do not go to ap plicants until April 1, 

at which time the schools send out notices of awa rd or rejection. Successful 

stud ents then have until April 15 to make up their minds, and ente r into a firm 

commitment. These dates have alre ady passed, thus making it even more difficult for the field of public health to compete for bright young minds against the 

many other fields where fellowships are already available.

Like certain other institutions, our own school at the University of Michigan 

is in a partic ularly difficult s ituation with rega rd to this problem of timing. In 

a bold move to make maximum utilization of the un iversity’s facilities, our board 

of regents has voted to adopt the principle of year-round operation. To put this 

into effect and to carry out three full semesters of teaching with in a 12-month 

period, the board has adopted a new univ ersity calen dar, with registr ation on 

the 26th of August and the 1st day of classes on the 31st of August. As I mentioned earlier, a great many of our studen ts are mature people w ith established 

hom es; they must make the ir plans with some anticipation. This is obviously 

of even greater importance with rega rd to physicians and den tists who may just 

be coming into the public health field and must make plans for disposition of a 

practice as well as for movement of the family. Most applicants ask for a 

decision 6 months before school sta rts, but at a very minimum they should have 

at leas t 3 months notice tha t all is in order. Even such a period is essentially 

impossible thi s year. If there is any serious furth er delay in enacting this 

legislation and securing the requ isite appropriation, I am afr aid we shall lose 

to public health many excellent candidates who will be forced, often against 

their own basic desires, to make other plans in sheer protection for their families.

Our schools are completely unanimous in pleading that action be taken quickly. 

We should like to recall that even with such advance planning as we can do in 

the hopes that the legislation will pass and an appropriation be approved, appli-
PUBLIC HEA LTH TRAINING AMENDMENTS OF 19 64 97

cations from the schools will have to be processed by the Public Health Service, 

allocations made to the schools and awards processed by the schools to the ind ividual studen ts—all in time for them to arra nge their personal affairs and be on 

the campus by the la st week in August.

The second portion of this bill deals with project grants to supply fund s for 

essential faculty and equipment for a defined program. Up to now this has applied not only to schools of public health but also to schools of nursing and 

schools of engineering engaged in teaching public hea lth as a specialty for the ir 

students. These project grants have served a very useful purpose in pinpointing 

support in areas where special emphasis needs to be given. A w ide variety of 

subjects are covered and the Public Hea lth Service has thus been able to exercise 

leadership in stimulating development of education al facilities where, in the 

opinion of the Service, the greatest shortages existed. The program has been 

exceedingly popular from its very inception, quickly exhausting available funds. 

Ongoing projects have been so successful and so much in need of continuation that 

for the las t 2 or 3 years the Service has been unable to fund many worthwhile 

additional or new projects, despite a backlog of applications.

It thus becomes imperativ e that this phase of the program be expanded but it 

is also im portant, as pointed out forcefully by the Second National Conference on 

Public Health Training, that eligibility for participation in the project program 

be extended to other are as of specialized instruc tion in public health, notably 

medical schools and certain other institutions. Our association is particularly 

inte rested in this recommendation and wishes to endorse it strongly. Inclusion 

of medical schools as eligible for these gr ants will be most useful in helping meet 

the lack of well-trained physicians in the field of public health. We believe that 

an essential step to meet this shortage is improvement in the teach ing of preventive medicine in medical schools, in many of which there are serious inadequacies in this subject, both in teaching faculty and equipment. The proposed 

bill provides for expansion of the autho rity und er section 309 to allow project 

grants to be made to d epartments of preventive medicine for the express purpose 

of stren gthenin g their teach ing so that it may achieve the same sta tus in the 

eyes of s tudents as the presently more a ttrac tiv e clinical specialties.

The Association of Schools of Public Health believes th at the opportunity to 

increase the quality and quantity of education in preve ntive medicine in medical 

schools will benefit public health in this country in many ways. Not only will 

there thus be more likelihood of better stud ents entering public health as a career 

but more of the practicing physicians of the country will have acquired the 

knowledge to make the ir cooperation with community health services more 

effective. A reciprocal inte rrelati on exis ts between medical schools and schools 

of public health. As the former do a better job of teaching public health, more 

and better medical gradua tes will seek admission to schools of public health. 

More of these people, in turn, will, when they gra dua te from schools of public 

health, be in demand as fac ulty members of medical schools.

Similar observations might be made for the other professions which the newly 

expanded author ity will allow to participate in this program. Public h eal th services to the community are most effectively supplied through a team approach. 

The quality of services rendered by this team is direc tly affected by the level of 

preparatio n of professional members of the team.

I should like to comment at this time on the third aspect of the combination 

recommended by the Second National Conference on Public Hea lth Tra in in g; 

th at is, the recommendation for increase of formula gra nts (sec. 31 4( c)(2 ), 

Hills-Rhodes gra nts to schools of public healt h). These grants were originally 

authorized by the Congress in recognition of the fact that schools of public 

health, as essentially national schools preparing personnel for all of the States 

and constitu ent units of the United States, have so small a portion of the ir 

costs met by tuition that Federal aid in meeting the deficit was essential. The 

Second National Conference recognized this fac t and recommended strongly 

th at the formula gra nts be extended and expanded. The current author ization 

under which they are made, however, does not expire until 1966 and it is my 

understanding th at for this reason the Department of Hea lth. Education, and 

Welfare did not suggest action on this portion of the recommendation at the 

present time. Nevertheless, I am assured that the Departm ent recognizes the 

key natur e of this type of aid to preparatio n of hea lth personnel. I should 

make clea r that the expansion in project gra nts does not in?4n y Sense lessen the 

need for the formula grants. The purposes are quite d

gra nts proposed in H.R. 10043 are designed to aid trainii 

public health , as need is determined by the Public Hea lth S<

32-438 O—64---- 8 \

ifferent. The projects 

ig in special are as in i 

?rvice and its advisers..

»&//

&
98 PUBLIC HEALTH TRAINING AMENDMENTS OF 19 64

The formula grants, on the other hand, have as their purpose the broad underpinning of the multidisciplinary training obtainable only in schools of public 

health. At the proper time our association will be pleased to go into greater 

detail concerning the urgent and vital needs for the expansion of the formula 

grant program. All of the schools would wish me to emphasize their great 

needs for expanded formula grants.

May I close, Mr. Chairman, by referring once again to the importance of the 

time factor in the legislation now under consideration? Trainees who are planning to enter schools of public health this fall, and who have applied in the 

anticipation tha t the traineeship program would be continued, need assurance 

so tha t they may make their personal plans. We are today almost exactly 4 

months from the date students must be on the campus at our university and certain 

others in the country.

The 12 schools of public health of this country have steadily and dutifully 

expanded their teaching facilities to meet increased demands. The legislative 

and appropriation process through which this bill still must pass is long. Only 

prompt action of the Congress can avoid the serious setback to public health in 

our country which would result from an unexpected sharp decrease in the number 

of properly prepared public health workers the country so sorely needs. On 

behalf of my colleagues and myself, I respectfully ask and urge that action be 

taken as soon as possible.

Mr. R oberts. In addition, I have received letters from a number of 

individuals and organizations also supporting the enactment of this 

bill. These include the American Public Health Association and a 

letter from Dr. Charles E. Smith who is chairman of that association’s committee on professional education. These letters will, without objection, be included in the record of the hearings.

(The material referred to follows:)

The American Public Health Association, Inc.,

New York, N.Y., April 16, 196^.

Hon. Kenneth A. Roberts,

Chairman, Health and Sa fet y Subcommittee of the House Committee on Inter ­

state and Foreign Commerce, House of Representatives, Washington, D.C.

Dear Congressman Roberts : As chairman of the Committee on Professional

Education of the American Public Health Association, I strongly endorse the 

enactment of H.R. 10043, Graduate Public Health Training Amendments of 1964 

and respectfully request that this statement be included in the testimony of your 

hearings on this vital legislation. I deeply regret that I cannot be present to 

present it in person.

Our committee on professional education has the responsibility of accrediting 

the schools of public health and of establishing the educational qualifications 

of the various categories of professional health workers of our Nation. Thus 

we are keenly aware that the Federal traineeships are essential to provide educational preparation to properly qualify physicians, nurses, engineers, and the 

other recruits so sorely needed in the public service of public health.

We who participated in the Second National Conference on Public Health 

Training documented the great values of the traineeships during this past 

decade as provided by section 306 of the Public Health Service Act which H.R. 

10043 would continue. These traineeships converted a recession in number 

of professionally prepared public health workers to a moderate increase. However, the expanding national population and technological advance of public 

health make imperative even greater numbers and greater diversity of health 

workers essential at Federal, State, and local levels. Thus these traineeships 

direl.v need continuation and expansion.

To complement these traineeships for the post baccalaureate professional 

students, project grants (sec. 309) to extend and to expand the resources of 

the educational institutions are essential. The expanded authorizations as provided in H.R. 10043 are realistic and indeed conservative. Only if there is Federal support to aid the universities to expand their offerings in diversity and 

for increased numbers can the traineeships be justified. Through tuition and 

endowments of the private universities, through the tuition and tax support of 

our State universities our professional schools already provide the essential 

basic support of these educational programs. The project grants are indis-
PUBLIC HEALT H TRAINING AMENDMENTS OF 19 64 99

pensable for the vitally needed expansion. Our Committee on Professional 

Education of the American Public Hea lth Association is in close touch with 

educational institutions and with the employing public agencies and underscores the vita l importance of this legislation for the public hea lth of our 

Nation.

With the expiration June 30 of the authorization of the trainee ships (sec. 

306) there is gre atest urgency in enactment of H.R. 10043 and its funding. 

Indeed, unless this is accomplished most expeditiously, studen ts alread y admitted for next fall will not be able to attend. These dropouts would result 

in serious damage to public health. We look to the hearings of your honorable 

subcomm ittee to assure the Nation of its continued advancem ent in the recruit ­

ment of and training fo r care ers in public health.

Respectfully yours,

Charles E. Smit h, M.D., D.P.H., Chairman, Committee on Professional Education, American Public Health

Association; Member, National Advisory Comm ittee on Public Health

Trainin g; and Dean, School of Public Health, University of California,

Berkeley.

Association of Schools of Public Health, Inc.,

„ Ann Arbor, Mich., February 21, J.964. Hon. Kenneth A. Roberts,

i House Office Building, Washington, D.C.

Dear Congressman Roberts : I am writing on my own behalf, as well as that 

of the 12 member schools of our association, to express our stron g endorsement 

of H.R. 10043, Public Health Gradua te Tra inin g Amendments Act of 1964. As 

was stated so clearly in the final recommendations of the Second Natio nal Conference on Public Hea lth Train ing, convened at the direction of the Congress, 

the combination of (a) traineeship supp ort of students, (b) project gra nts for 

selected are as of public health instructio n, and (c) formula grants to schools of 

public health to supp ort basic instruction, constitute a balanced and complementary package. Our schools are vitally inte rested in all three parts of this 

package, but wish at this time to comment on the urgency th at requ ires action 

on H.R. 10043 at the, ea rlie st possible moment.

In our various appearances before your committee, represe ntatives of the Association of Schools of Public Health have emphasized again and again the vita l 

chara cter of trainee ship support for stud ents at schools of public health. Over 

the years, our students, three-quarters of whom, incidentally, come from outside 

Michigan, have had sharply limited personal resources. Our experience makes 

crystal clear that the gre at majority simply could not attend school in the 

absence of public health service traineeship support.

Not only do we endorse the priniciple of this legislation, but I should like to 

emphasize the urgency in timing with rega rd to the traineeship provisions. Our 

school y ear at Michigan will begin next academic year with reg istr ation on the 

26th of August and the first day of classes on the 31st of August. Since most 

of our studen ts are older, often with established families and homes, they obviously need time to arrang e the ir affa irs in orde r to spend an academic year 

at a graduate, school. This is obviously of particular importance with regard 

to physicians and dentists who are often ju st coming into the public hea lth 

field. Most fellowship programs notify successful applicants at least 5 months 

before the s ta rt of school and 3 months would seem to be an absolute minimum. 

All of our schools, therefore, are very much concerned that the bill not only pass, 

but pass quickly, so that we may notify promptly applicants whom we consider 

qualified for trainee ships and give them sufficient assurance, that they may proceed with the ir plans for atte ndance at school. If there is any significant delay 

« in the passing of the legislation and its corollary appropriation, we run the risk

of losing to public health many excellent candidates who will be forced to make 

other plans because of personal deadlines.

The second pa rt of the legislation and the second part of the package of 

recommendations by the National Conference on Public Health Tra ining has to 

do with project grants. These awards have been very useful not only to 

schools of public health but to oth er professional schools training people in siiecialized a rea s of the health sciences. Our association strongly endorses thi s section 

of the legislation; the expansion proposed is modest in rela tion to the needs 

brou ght out at the Second National Conference. The device of p roject grants is
100 PUBLIC HEA LTH TRAINING AMENDMENTS OF 19 64

an excellent way to stim ulate instruction in areas in which the Public Health 

Service has concluded that there is particular deficit. Furthermore, support 

may be given in this way to hea lth programs in schools not devoted prim arily to 

public health.

The proposed legislation does not include reference to the third part of the 

combination recommended by the Second National Conference on Public Health 

Training—formu la gra nts (Hill-Rhodes grants) to schools of public health. As 

you know, the Conference recommended th at these gra nts be extended and 

expanded, but since the curre nt authorization under which they are made does 

not expire until 1966 it is my und erstanding that the Departm ent of Health, 

Education, and Welfare did not suggest action on the Hills-Rhodes grants at 

this time. I have been assured by the Department th at they recognize the 

validity of the recommendations of the Conference rega rding formula grants to 

schools of public health and agree that these grants constitute an indispensable 

pa rt of the balanced supp ort by the Federal Government for preparatio n of 

public health personnel. As I have indicated to you on oth er occasions, our 

schools find the Hill-Rhodes gr ants a crucial aspect of F ederal aid.

In summary, I respectfully ask your support of House bill 10043 and express 

my hope tha t the committee will recognize not only the need for this legislation, 

but the fact th at “time is of the essence.”

Sincerely yours,

Myron E. Wegman, M.D., President and Dean, School of Public Health, University of Michigan.

The American Board of Preventive Medicine, I nc.,

Baltimore, Md., April 20, 196^.

Hon. Kenneth A. Roberts,

Chairman, Subcommittee on Health and S afety,

Committee on In terstate and Foreign Commerce,

House of Representatives, Washington, D.C.

Dear Congressman Roberts : This lette r is being sent to you to support the 

provisions contained in H.R. 10043, a bill to amend the Public Health Service Act 

to extend the authorization for assistance in the provision of gradua te or specialized public health training, and for oth er purposes.

The American Board of Preventiv e Medicine is a nonprofit organization incorporated under the laws of the Sta te of Delaware. It was cr eated in accordance 

with action of the advisory board for medical specialties and is recognized and 

approved by th e Council on Medical Education of the American Medical Association as a medical specialty board authorized to certify properly qualified specialists in preve ntive medicine. Specifically, it certifies individuals in the areas 

of public h ealth , aviation medicine, occupational medicine, and general preventive 

medicine.

Its principal purposes are to encourage the study, improve the practice, elevate 

the standards, and advance the cau se of preventive medicine. It does also gra nt 

and issue to physicians licensed by law to practice medicine, certificates of 

special knowledge in the various fields of preventive medicine as outlined above. 

Because of the purpose of the board, it has a very special inte rest in legislation 

which is designed to a ttr ac t qualified people into the general are a of preventive 

medicine and to provide education al experiences which are readily available and 

of high quality.

The provisions of this bill are designed to extend th e authorization for traineeships for gradua te or specialized training in public health for physicians and 

other professional health personnel. There is no question but wh at the availability of these traineeships has increased the number of capable young physicians 

entering the field of public health . This can be documented by studying the applications from physicians to schools of public hea lth in relation to the availability 

of these traineeships. The board is convinced that this type of suppo rt is essential, if adequ ate numbers of professional hea lth workers are to be recruite d to this 

imp ortant field.

Section 3(a ), subsection (a) of section 309 of the Public Health Service Act 

rela ting to project grants to schools for gradua te public hea lth training allows 

for an increase in the authorization stepwise to a maximum of $9 million for 

the fiscal year ending Jun e 30, 1969. The need for such an increase has been 

documented by the report of the Second National Conference on Public Health 

Tra ining held in August of 1963, which is I know available to the committee.
PUBLIC HEALTH TRAINING AMENDMENTS OF 19 64 101

They received data supporting their recomm endations from seve ral sources, 

including the schools of public health, which bear out this need. In view of the 

excellent use to which the public hea lth traineeship s and the project grants 

have been put in the past, and in view of the demonstrated growing need for 

such support, the board hopes that the Subcommittee on Hea lth and Safe ty and 

the House Committee on I ntersta te and Foreign Commerce will give a favo rable 

report on this bill.

While provisions are not included in this bill to amend section 314(c) of the 

act which provides formula grants to the schools of public health, the board 

wishes to point out that this is an imp ortant element in the support of schools of 

public health, and if they are to continue to do their excellent job of providing to 

the Nation high-caliber professional workers in the field of public health, it is 

essential tha t all three elements of F ederal supp ort—the traineesh ips, the project 

grants, and the form ula g ran ts—be continued.

I apologize for the delay in getting this lette r to you. Had there been time, 

I should have requested an opportunity to appear before the subcomm ittee on 

behalf of th e board. This does not appear to be feasible a t this time. However, 

I hope that this communication can be made a pa rt of the records of the subcommittee hearings.

Respectfully yours,

J ohn C. Hume, M.D., Secret ary-Treasurer.

University of Virginia,

School of Medicine, 

Department of Preventive Medicine,

Charlottesville, Va., April 2 1, 196Jf.

Hon. Oren Harris,

Chairman, Committee on Inte rstate and Foreign Commerce,

House o f Representatives, Washington, D.C.

Dear Congressman Harris : I am writing to supp ort H.R. 10043, a bill to 

exten d and improve existing legislation relatin g to gra dua te and specialized 

training in public health.

The Second National Conference on Public Health Train ing, held in August 

1063. stressed the effectiveness of public hea lth traineeship s as a means of increasing the number of trained professional public health personnel, and noted 

th at project grants have been effective in improving the quality of public health 

training in institu tions eligible to receive them. The proposed legislation would 

extend the authorization for public hea lth traineeships contained in section 306 

and broaden the eligibility for project gra nts authorized by section 309 to include 

other types of institu tions and agencies which provide gradua te and specialized 

public hea lth training.

Today’s changing patterns of medical care require the skills of professional 

personnel trained in the disciplines of preventive medicine and public health and 

skilled in coordination of community health services. Such personnel are now 

being traine d in schools of public health with the assistance of project gra nt 

funds. Schools of medicine could grea tly augment the output of the 12 schools 

of public health, but few such departm ents are adeq uately staffed and supported 

at present. In general, departm ents of preventive medicine have not been as 

successful in att racti ng financial supp ort as have other, more “glamorous” 

departm ents in medical schools. However, as documented at a conference of 

• teachers of preventive medicine in Jun e 1963, more and more departm ents of

preve ntive medicine are developing adeq uate pos tgra dua te teach ing programs 

and undertaking community oriented research projects. There is a great need 

to improve the capa bility of departm ents of preventiv e medicine in schools of 

4 medicine to increase and update the public hea lth content of the ir instruction al

programs. The training of physicians in preventive medicine would be greatly 

strengthened and improved by placing departm ents of preventive medicine in 

medical schools in the same category as other institu tions which provide specialized public health training, such as schools of public hea lth and schools of 

nursing.

I urge th at favorable action on H.R. 10043 be take n by th e Committee on Int er ­

sta te and Foreign Commerce, and ask that my lette r by included in the records 

of the hea ring on the bill.

Sincerely yours,

William S. J ordan, Jr., M.D.,

Professor and Chairman.
102 PUBLIC HEALTH TRAINING AMENDMENTS OF 19 64

Statement of th e American Dental Association and the American

Association of Dental Schools

Mr. Chairman and members of the committee, I am Dr. Wesley O. Young of 

Lexington, Ky. I am here, as a representativ e of the American Dental Association a nd the American Association of D ental Schools.

I am tra ine d as a public health den tist and have worked on official health 

agencies for more than a decade. At present, I am an associate professor and 

chairman of the Department of Community D entistry at the College of Dentistry 

of the University of Kentucky. I also am a member of the Natio nal Advisory 

Committee on Public Health Training, estab lished under the provisions of the 

legislation setting up the public health training program.

On behalf of the American Dental Association and the American Association 

of Dental Schools, I am testifying in favor of imp orta nt changes in the public 

hea lth trainee ship gra nt legislation. In essence, these changes involve five 

factor s:

(1) Exte nding for an additional 5 years the authorization for traineeships to supp ort students preparing for full-tim e careers in public he al th ;

(2) Extending for 4 years the authorization for project gra nts to educational institution s providing public health training to strengthen their 

teaching pro gra ms ;

(3) Strengthening the project grant program for public hea lth training 

by auth orizing gra nts to education al institu tions not now eligible, such as 

schools of medicine and de ntistry ;

(4) Increasing the appropriation ceiling for the project gra nt program, 

and

(5) Providing for a thi rd conference on public health training to evaluate 

the continued effectiveness of the entire public health training program and 

to rep ort to the Congress by J anuary 1,1968.

The American Dental Association and the American Association of Dental 

Schools have long recognized the importance of public health programs. The 

effectiveness of these programs, however, is largely dependent upon the av ailability of competent, well-trained personnel and such personnel has been in short 

supply. For this reason, the associations supp ort the proposed amendments to 

implement the expansions in the total training program recommended by the 

Second National Traineeship Conference.

In addition to indicating supp ort for the basic program and the general 

changes that are now suggested, it seems appropriate to comment at grea ter 

length on the provision of the legislation which is of particular importance in 

stren gthening the contribution of dentists to public health programs.

Section 309 of the Public Health Service Act now provides for project gran ts 

for the expansion and enrichment of public health curriculums in “* * * schools 

of public hea lth and to those schools of nursing or engineering which provide 

gradua te of specialized training in public health for nurses or engineers.”

H.R. 10043 would amend this section to allow these project grants to be made 

to schools of public h ealth and “* * * to other public or nonprofit p rivate ins titu ­

tions providing graduate or specialized t rainin g in public h ealth.” This provision 

would, for the first time, make it possible to provide support to increase the 

effectiveness of public hea lth teach ing in schools of dentistry. This provision 

might well be one of the most imp ortant contributions the public health training 

program can make to the strengthening of public health programs.

Medical and dental schools are now teach ing various aspects of public health 

and preventive medicine and dentistry. Trad itionally, however, the dep artments responsible for the instruction have been underfinanced and understaffed. 

Rarely have these imp ortant subjects been accorded the time in the curriculum 

that would be desirable. Ofte n departm ents of preventive den tistry have been 

curric ular orphans, staffed largely by part-tim e teach ers. Strengthening these 

departments would provide important benefits in two ways.

First, such support would be an imp ortant factor in recruiting personnel for 

careers in public health. Trad itionally, specialties in den tistry have been dependent largely on stron g departm ents in the professional school to attrac t 

students to und erta ke advanced preparatio n. Public hea lth ordinarily has not 

had the advantage of being able to rec ruit at the prim ary source of students— 

the professional schools.

While I was in dental school, for example, I had no contact with a dentist 

trai ned in public health and received no indication that there were opportunities 

for a career in this field. Only after I had practiced general den tistry for 3
PUBLIC HEA LTH TRAINING AMENDMENTS OF 19 64 103

yea rs (lid I learn about dental public health. Even then I probably would not 

have been willing to undergo the sacrifice of disposing of a prac tice and enter ­

ing graduate school had I not been free of family responsibilities at the time. 

The lack of adequate opportunities to rec rui t to the field of public health du ring the years of preprofessional education is a serious block to increas ing the 

supply of public he alth personnel.

The second benefit of strengthening the teaching of public health in schools 

of den tistry is even more compelling. Many public health programs are dependent upon certain specialized skills of the clinician in prac tice—skills that 

might be termed the public health aspects of clinical practice. Although the 

programs of public agencies play an imp ortant pa rt in maintainin g the hea lth 

of the public, they must be teamed with the efforts of the d entist and physician 

in private practice. One of the major factors in obta ining community wa ter 

fluoridation, for example, has been the ability of local den tists to int erp ret this 

procedure to their patients and to community groups. Similarly, the extent to 

which the benefits of topical applications of fluoride and other preventiv e procedures used on an individual basis will reach our population will depend on 

the adequacy of the training dentists receive in their use. Unfortunate ly, restorative and repara tive procedures have tradition ally overshadowed preventive 

den tistry in the curriculums of many dental schools.

Pro ject gra nts could be used to encourage the development of departm ents 

of preventive and public health den tistry in schools of den tistry staffed with 

full-time specialists. They would also make it possible to experiment with new 

and more efficient methods of teaching the use of public hea lth procedures in 

clinical practice. Developments of this natur e would stim ulate more dental 

studen ts to prepare for care ers in public hea lth and increase the utilization 

of preventive and public hea lth procedures in clinical practice. The same benefits could, of course, be anticip ated from project gra nts made to schools of 

medicine.

Mr. Chairman and members of the committee, the public health traini ng program has proved to be wise legislation. On behalf of the American Dental Association and the American Association of Dental Schools, I urge that you approve the extension and that you supp ort the modifications recommended by the 

Second National Conference on Public Hea lth Training, as contained in H.R. 

10043.

State University of New York,

College of Medicine, 

Department of Preventive Medicine,

Syracuse, N.Y., April 8,1961/.

Hon. Oren Harris,

Chairman, Comm ittee on Int ersta te and Foreign Commerce,

House of Representatives, Washington, D.C.

Dear Congressman Harris : I und erstand th at hearings are to be held soon 

on H.R. 10043. Since my academic responsibilities are concerned with providing for courses in preventive medicine for both medical stud ents and gra dua te 

physicians, I am par ticula rly intereste d in this pending legislation. No field 

of medicine offers more hope for the future health of our citizenry.

I should like to urge in the strongest possible term s that favorable action be 

considered on this bill and, furtherm ore, th at this letter be included in the 

records of its hearing.

With kindest regards,

Sincerely,

Harry A. Feldman, M.D.,

Professor and Chairman, Department o f Pre ventive Medicine.

State University of New York,

Coli.ege of Medicine. 

Department of Preventive Medicine,

Syracuse, N.Y., April 8,196}.

Hon. Kenneth A. Roberts,

Chairman, Subcommittee on Health and Sa fet y of the Committee on Inte rstate

and Foreign Commerce, House of Representatives, Washington, D.C.

Dear Congressman Roberts : As one who is concerned with the education of

medical studen ts and gra duate physicians in preventive medicine, I would like
104 PUBLIC HEALTH TRAINING AMENDMENTS OF 19 64

to urge as strongly as possible th at favorable action be considered by your committee on H.R. 10043. This bill offers marked and imp ortant advantages for 

improving the t raini ng and recruiting of people into this most important health 

field. May I, also, ask th at this letter be included in the records of the hearings 

on H.R. 10043.

Sincerely,

H arry A. F eldm an, M.D.,

Professor and Chairman, Department of Preventive Medicine.

Stat e Unive rsity of New York,

College of Med icine,

Depa rtm ent of E nviro nm ental Med icine and Com mu nity H ea lt h,

Brooklyn, N.Y., April 20,1964.

Hon. Ken ne th A. R oberts,

Chairman, Subcommittee on Health and Safet y of the Committee on Interstate

and Foreign Commerce, 'House of Representatives, Washington, D.C.

Sir : This is to write in support of H.R. 10043 which has been introduced to 

renew and to extend the U.S. Public Health Service train eesh ip and project grant 

program s.

There is a serious need for supp ort of grant-in-aid programs th at promise to 

strengthen the training of physicians well in preventive medicine. Several 

conferences were held in 1963 which explored this need and which undoubtedly 

formed a basis for some of the present recommendations being considered by the 

Congress. Ju st as there has been a lag in applying what we know in preventive 

medicine, there has long been a lag in the level of Federal supp ort of arra nge ­

ments needed to improve the staffing of medical schools and rela ted institutions 

in the field of preventive medicine.

Most sincerely yours,

Duncan W. Cla rk, M.D.,

Professor and Chairman.

T h e Ohio Stat e Unive rs ity, 

Depa rtme nt of P reventive Med icine,

Columbus, Ohio, March SO, 1964-

Hon. Oren H arris,

Chairman, Comm ittee on Interstate and Foreign Commerce,

House of Representatives,

Washington, D.C.

Si r : I wish to communicate with you concerning the proposed bill S. 2530 

and its cou nterpart H.R. 10043 dealing with a revision of sections 306 and 309 

of the Public Health Service Act.

I am in full accord th at Congress should authorize the public health service 

to contin ue its activities in gra duate trainin g and project resea rch in the public 

hea lth field. I feel, however, th at it is necessary at this time to make certain 

other radical chances in the bill. These result from extensions in both inte rest 

and competence in a field which is now broader than the terminology implied in 

the original Public Health Service Act.

At the present time, the terminology which covers the promotion of health, 

prevention of illness or injury, the promotion of optimum productivity, and social 

adjustment is called preventive medicine. It involves all the usual vaccination, 

san itary, and therapeutic measures carried out by public health services in the 

past, but it also involves all phases of wh at is now known as environmental 

medicine or environmental health (the control of all real and potential haz ards 

to health and productivity, be they physical, chemical, biological, psychological, 

or sociological). The best gra duate traini ng and research in these are as has 

not been done solely or even prim arily in schools of public health. Furthermore, 

in the period from 1930 to 1965 emphasis on both research and training in a 

majority of public health schools has been directed to personnel in underdeveloped countries with problems vastly differen t from those in the United States. 

Courses have been watered down to meet the language deficiencies of people 

who must work in relatively primitive countries. Only a little of the to tal public 

health school effort in training has been directed toward Ph. D. level or equivale nt American personnel to deal with American problems of today and tomorrow.
PUBLIC HEALTH TRAINING AMENDMENTS OF 1964 105

During this period the American Board of Prev entive Medicine has come 

into being and now recognizes four specialties as follow s:

Aerospace medicine.

Occupational medicine.

Public hea lth administration.

General preventive medicine (microbiology, epidemiology, etc.).

The development of these specialties has not been prim arily in the schools of 

public health, but rather in departm ents of preventive medicine in medical 

schools, some of which have schools of public hea lth and many of which do 

not. There are a t least five depa rtments of preve ntive medicine offering master 

level and Ph. D. level trainin g in one or more of the are as of preventive medicine 

which are equal or supe rior to the training in the very best schools of public 

health. They are recognized by the American Board of Preventiv e Medicine and 

by the Council on Education and Hospitals of the AMA but not by the law. 

Special provisions are made for public hea lth schools which are not shared by 

the departm ents of preve ntive medicine who partic ipate in graduate researc h 

and train ing.

It is, therefore, recommended th at the terminology of the revised Public 

¥ Health Service Act be changed to include schools of public hea lth and/or departments of preventive medicine with accredited gradua te training programs in 

any of the specialties recognized by the American Board of Prev entive Medicine 

or equivalent. I commend this change to your serious consideration. 

Respectfully yours,

* William F. Ashe, M.D.,

Professor and Chairman.

Association of Teachers of Preventive Medicine,

April 8,1964-

Hon. Kenneth A. Roberts,

Chairman, Subcommittee on Health and Sa fety of the Committee on Inters tate

and Foreign Commerce, House of Representatives, Washington, D.C.

Dear Congressman Roberts : The multiplicity of health problems which face

our Nation are obvious and apparen t. The number of physicians trained in 

preventive medicine and public health is appallingly inadequate at the present 

time and the discrepancy will become more severe as the size o f the population 

continues to increase. It is of vital importance th at th e means for the training of 

more physicians in preventiv e medicine and public hea lth become increasingly 

app ropriate to and adeq uate for the natur e and magnitude of these necessary 

efforts.

I, threfore, desire to urge favo rable action on H.R. 10043 by the Subcommittee 

on Hea lth and Safety of the Committee on In terstate and Foreign Commerce. 

This legislation is essential for the development of the professional manpower 

required for the indicated public he alth effort.

It is requested th at this lett er be included in the records of the projected he arings on H.R. 10043.

Sincerely yours,

Henry J. Bakst, M.D., President.

The Jefferson Medical Collegeof Philadelphia,

Department of Preventive Medicine,

April 9,196Jt.

Hon. Oren Harris,

Chairman, Committee on Inter sta te and Foreign Commerce,

House o f Representatives, Washington, D.C.

Dear Sir : I should like to call to your att ention the importance for emphasizing 

the training of physicians in preventive medicine. The contribution of such 

traine d personnel should contribute significantly to the general health of our 

Nation.

Therefore, I would like to urge tha t favorable action on H.R. 10043 be ta ken by 

your committee.

Cordially yours,

E. Harold Hinma n, M.D.
106 PUBLIC HEALTH TRAINING AMENDMENTS OF 196 4

The University of Wisconsin, 

Department of Preventive Medicine,

Madison, Wis., A pril 3,1964- Hon. Kenneth A. Roberts,

Chairman, Subcommittee on Health and Safety,

Committee on Inters tate and Foreign Commerce,

House of Rep resentatives, Washington, D.C.

Dear Representative Roberts : This letter is to urge favorable action on the 

bill H.R. 10043 entitled ‘‘Gradua te Public Hea lth Training Amendments of 1964” 

and to request th at this lett er be included in the records of the h earin g on that 

bill.

There is a shortage of physicians traine d in the field of public health. For 

example, here in Wisconsin four of the eight distric t health officers of the State 

board of health are without physicians because of the shortage of such personnel. 

The shortage is a nationwide one. Two aspects of its solution ar e: (1) the 

stimulation and basic training of physicians in the ir medical school tra ining; 

and (2) provision for postgraduate education of both a formal and short term 

nature. The first of these requ ires the development of stron g departm ents of 

preventive medicine within the medical schools to at trac t physicians to the field 

of public health as a career and to provide a basic u nderstanding for all physicians 

of the importance of principles of public health and preve ntive medicine. Additional financial assistance to such departm ents is an inte gral p ar t of this requirement. The second are a is the need to support formal training of physicians 

through the nine schools of public health in the United State s. This, however, 

may not meet the requirements of postgra dua te education so th at other course 

work need be set up in departm ents of preve ntive medicine, in other healthrela ted teaching institutions, and in official health departments. Refresher 

courses, seminar and workshops are needed not only for physicians in the field 

of public hea lth bu t also fo r other professional help workers such as sanitarians, 

public health laboratory workers, etc. In my responsibility as director of a 

Sta te laboratory of public hea lth the need for intensive short-term training to 

improve the efficacy of laboratory procedures in both public hea lth and private 

laboratories is clearly evident.

Because of these considerations I urge that your committee approve the extension and improvement of existing legislation rela ting to gra dua te and specialized 

training in public health.

Sincerely yours,

Alfred S. Evans, M.D., Professor and Chairman; Director, Sta te Laboratory of Hygiene.

The Albany Medical College of Union University,

Department of Community Health,

Albany, N.Y., April 3,1964- Hon. Kenneth A. Roberts,

Chairman, Subcommittee on Health and Safet y of the Committee on Interstate

and Foreign Commerce, House of Representatives, Washington, D.C.

Dear Congressman : Successful efforts to solve the hea lth problems which face 

our Nation in both the immediate and more extended futur e will require th at the 

training of physicians in preventive medicine become increasingly appropriate 

to and adeq uate for the nature and magnitude of those efforts.

For this reason I strongly urge favorable action on H.R. 10043 by the Sub- *

committee on Hea lth and Safety of the Committee on Inter sta te and Foreign 

Commerce. This legislation is fundam ental to the development of the professional manpower required fo r the indicated public health effort.

I respectfully request t ha t this le tte r be included in the rec ords of the projected t

hearing on H.R. 10043.

Sincerely yours,

J. Garth J ohnson, Ph . D., M.P.H.,

Professor and Chairman, Department o f Community Health.
PUBLIC HEA LTH TRAINING AMENDMENTS OF 19 64 107

Tufts University,

School of Medicine, 

Department of Preventive Medicine,

Boston, Mass., A pril 3, 1964.

Hon. Kenneth A. Roberts,

Chairman, Subcommittee on Health and Sa fet y of the Committee on Inters tate

and Foreign Commerce, House of Representatives, Washington, D.C.

Dear Sir : The re markable resea rch efforts now being carried on in our medical

institution, much of it made possible by research support from the Federal Government, are providing us with increasing knowledge concerning the nature of 

human health and the steps by which disease develops. Unfo rtunately many 

of these discoveries are not being rapidly implemented at the present time. 

There is a serious shortage of physicians trained in preventive medicine at this 

time and it can be safely predicted that the requirement for such physicians 

w’ill sharply increase during the next decade. I am firmly convinced th at support must be available not only to strengthen tradition al programs in schools of 

public health but also in departm ents of preventiv e medicine in medical school.

Therefore I would like to urge favorable action on H.R. 10043 by your committee and that this letter be included in the records of the hearing on H.R. 10043. 

Sincerely yours.

Count D. Gibson, Jr., M.D., Cha irman.

University of I llinois at the Medical Center,

Department of Preventive Medicine,

Chicago, III., April 7, 1964-

Hon. Kenneth A. Roberts,

Chairman, Subcommittee on Health and Sa fet y of the Committee on Interstate

and Foreign Commerce, House of Representatives, Washington, D.C.

Dear Sir : As one who is responsible for the tra ini ng of physicians in preventive medicine and the specialized training of some of them for care ers in the 

field of public health and prevention of disease, I am greatly in favor of H.R. 

10043. During the gre at expansion of medical facilitie s, and supp ort for various 

types of training, the plight of th is field has become increasingly severe. Because 

of the limited number of gradua tes each year the re is keen competition among 

all of professional areas. The relative neglect of oppo rtunities to provide t ra in ­

ing for ca reers in preventive medicine with in the framework of the medical school 

has encouraged most students in the ir belief that this is an unimportant field and 

not one for serious consideration. Coupled with this has been a fa ilure of de partments to grow proportionately to most others w ithin the colleges since the growth 

of many departm ents have been financed by traini ng grants, train eesh ips, and 

sim ilar extra university support. Unless there are programs designed to reestablish a balance between preventive medicine and other programs only a worsening of the situation can be anticipated. Certainly money will not answ er all of 

the problems but without it a beginning cannot be made. Building a staff of 

enthus iastic and knowledgeable teachers who can give the stimulus to at trac t 

graduate students will take time and many of them will have to be trained from 

the recent grad uate s. To do this supp ort such as th at specified in H.R. 10043 

is desperately needed.

If there is any way that we could furnish more definitive information to the 

committee we shall be happy to do so. If not, we would apprecia te this lette r 

becoming pa rt of the committee’s record.

Sincerely yours,

Mark H. Lepper, M.D.,

Professor of Preventive Medicine and Head o f the Department.

J
108 PUBLIC HEALTH TRAINING AMENDMENTS OF 196 4

H arvard Unive rsity ,

Medical School,

Depar tment of Preventiv e Med icine,

Boston, Mass., March 31, 1964- Hon. Ken net h A. R oberts,

Chairman, Subcommittee on Safet y and Health, Committee on Interstate and

Foreign Commerce, House o f Representatives, Washington, D.C.

Dear Sir : As professor of preventive medicine and head of the depa rtment 

at the Ha rvard Medical School. I am constan tly handicapped in my efforts to 

inte rest medical students in a public health career. In contrast with the large 

sums available for the reserch and the treatm ent of imp orta nt diseases, funds 

are not available for adeq uate staff and facilitie s for departm ents of preventive 

medicine in schools of medicine to bring to bear preventive knowledge in medical 

education, teaching, and research.

Many medical students from the ir childhood are motived in the direction of 

the trea tment of patients and not toward the prevention of disease. It is difficult to make them aware of the increasin g complexity of modem society which 

carries with it such serious man-made thr eats to human hea lth as radiation, 

toxic insecticides, antibiotic resis tan t germs, and potent but potentially harmful new drugs. Moreover, m any natur al diseases such as cancer, heart disease, 

and arthrit is are better prevented tha n trea ted. Indeed, once their damage has 

been done, therapy in most cases has relatively little to offer.

The bill introduced by Congressman Harris —H.R. 10043—to renew and expand the U.S. Public Hea lth Service trainee ship and project grants, if enacted, 

would fill this serious gap in the protection of our citizens. I therefore urge 

favorable action on it by your subcomm ittee and request that this lette r be included in the records of the hearings to be conducted,by your Subcommittee on 

Safety and Health of th e House Committee on Inter sta te and Foreign Commerce.

Very truly yours,

David D. R ut st ei n, M.D.,

Professor of Preventive Medicine and Head of the Department.

T h e Univ ersit y of North Carolina,

School of P ubl ic H ea lt h,

Chapel Hill, March 3, 1964- Hon. Oren H arr is,

Chairman, Committee on Inte rstate and Foreign Commerce,

House Office Building, Washington, D.C.

Dear Mr. H arris : On behalf of this school of public health and its membership 

in the Association of Schools of Public Health, I bring to your atte ntio n our concerted endorsement of H.R. 10043, Public Hea lth Gradua te Training Amendment 

Act of 1964. We are wholeheartedly in favor of the three parts of this legislation but are partic ularly concerned at the moment with the urgency for action 

on H.R. 10043.

From the represen tatives of th e schools of public health appe aring before your 

committee from time to time, you are aw are that the majority of the students 

atte nding public health schools today could not do so were it not for Public 

Hea lth Service train eesh ip support. The fac t that this type of student is older 

tha n the normal age for gra duate stude nts in th at he may be a physician, d entist, 

statistician, nurse, etc., makes timin g in the assignment of traineeship s of utmost 

importance. It takes months of prior planning for such an individual to be able 

to retu rn to academic training. We would like to notify successful applicants 

at lea st 5 months in advance of opening of school. The m ajority o f these stud ents 

come to us from other States. For these and many other reaso ns we wish to 

emphasize the importance of timing with regard to the traineeship provisions. 

We are concerned, therefore, tha t th e bill not only pass, bu t pass quickly.

The second pa rt of the legislation, having to do with project grants, likewise 

concerns schools of public health. It is thro ugh the device of such gra nts that 

we are able to s timulate instruction in neglected area s of health programs.

It is our understanding th at formula gra nts (Hill-Rhodes gran ts) , a third 

inte rest in public health legislation, are n ot included in the immediate proposal. 

Suffice it to say, however, th at we consider the Hill-Rhodes grants a crucial 

aspect of Federal aid.

We shall apprecia te a nyth ing you can do toward the immediate supp ort of bill 

H.R. 10043.

Sincerely yours,

W. F. Mayes, M. D., Dean.
PUBLIC HEA LTH TRAINING AMENDMENTS OF 19 64 109

T he Unive rsity of North Carolina,

T he School of Med ic in e,

Depa rtme nt of P rev entive Med ic in e,

Chapel Hill, April 1, 1964-

Hon. Ken ne th A. R oberts,

Chairman, Subcommittee on Health and Sa fet y of the Comm ittee on Interst ate

and Foreign Commerce, House of Representatives, Washington, D.C.

Dear Cong ressma n R oberts : I am writing to urge passage of H.R. 10043 

which renews and expands the U.S. Public Health Service traineesh ip (sec. 

306) and project g ran ts (sec. 309) programs.

My position as chairman of the Departm ent of Preventive Medicine, University of North Carolina, may not be an unbiased but it should be an informed 

one. Also, in the capacity of cochairman of the national conference on research, 

graduate education, and postdoctoral training in departm ents of preve ntive 

medicine which was held in Saratoga Springs, N.Y., Jun e 10-14, 1963, I had 

an opportunity to do considerable thinking about as well as hear a great 

deal of discussion of, points covered in this act.

This bill should strengthen departm ents of preventive medicine in medical 

schools and enable them to carry out more adequately the ir functions of tra ining and indoctrinating undergradua te medical stud ents with the preve ntive 

viewpoint; of inte resting enough of such studen ts in public health as a ca re er ; 

of carryin g out app ropriate research ; of giving training in academic preventive medicine; and of partici pating app ropriately with schools of public 

health and other health professional schools in training in public health.

I am sending a similar let ter to the Honorable Oren Ha rris , chairman, Committee on Interstate and Foreign Commerce. I would appreciate it if one or 

both letters be appropriately included in the records of the hea ring on H.R. 

10043.

Sincerely yours,

William L. F le mi ng , M.D., 

Chairman, Departm ent of Preventive Medicine.

Lou isia na Stat e Unive rs ity,

School of Med ic in e,

Depa rtm ent of P ublic H ea lth and P reventive Med ic in e,

New Orleans, La., April 3, 1964-

Hon. Ken net h A. R oberts,

Chairman, Subcommittee on Health and Sa fety of the Committee on Inter sta te

and Foreign Commerce, House of Representatives, Washington, D.C.

Dear Sir : As professor and head of the departm ent of preventive medicine 

and public health at LSU School of Medicine, I feel th at it is my duty to write 

to you to ask your cooperation in doing anythin g you can to help eradicate the 

gre at need for strengthenin g and improving the training of physicians in preventive medicine. I believe that favorable action on H.R. 10043 by your committee would be a definite step in this direction. I hope th at thi s lette r along 

with the many others that you will receive supp orting this measure will be 

included in the records of the hearing on H.R. 10043.

Sincerely,

R obert W. Sappe nf ield , M.D.,

Professor and Head of the Department of Prev entive Medicine and Public

Hea lth and Professor of Pediatrics.

Unive rsity of P itts bu rg h.

School of Med icine,

Depar tm en t of P reventive Med icine,

Pittsburgh, Pa., March 31, 1961/.

Hon. Ken ne th A. R oberts,

Chairman. Subcommittee on Health and Sa fet y of the Committee on Inter sta te

and Foreign Commerce, House of Representatives, Washington, D.C.

Si r : I am writin g with respect to H.R. 10043 which, I understand, is being 

reviewed by your committee. A program such as proposed in this bill is badly 

needed. Currently , we are neither teaching the preventive aspects of medicine adequately to medical stud ents in our country nor att racti ng them to seek 

care ers in public health and preventive medicine. As you know, many of our
1 1 0 PUBLIC HEALTH TRAINING AMENDMENTS OF 19 64

majo r hea lth problems today could be eliminated if only we applied in preventive programs alre ady existing knowledge in the field of medicine. The 

establish ment of public hea lth and preventive medicine training programs 

within schools of medicine will greatly influence the country’s f utu re physicians 

to give more emphasis to prevention in the practice of medicine.

I strongly urge the support of you and your committee for this legislation. 

If it is appropriate, I request th at this lette r be included in the records of the 

hearing on H.R. 10043.

Very truly yours,

Kenneth D. Rogers, M.D., 

Professor and Chairman of the Department.

Pacific Palisades, Calif., March SO, 1964.

Hon. Oren Harris,

House of Representatives,

House Office Building,

Washington, D.C.

My Dear Congressman Harris : I am writing for your supp ort of Public 

Health Graduate Training Amendments Act of 1964 (S. 2530 and H.R. 10043). 

Early passage of this legislation is in the best inte rest of national health, welfare , and safety. Our schools of public hea lth draw stud ents from all States 

and, therefore, do not res tric t enrollment to studen ts from the respective supporting State.

The studen ts are at the gra duate level, generally older, with family responsibilities and commitm ents requ iring early planning and, frequently, traineeship support. At the present time we have 79 applications for train eeships 

and anticipate over 150 tota l applications before our closing filing date. Unfortunately, many of these potential futur e health service professionals will 

be denied the opportunity with out the supp ort of the pending legislation.

The schools of public hea lth cannot securely plan for staff, space, and equipment without a firm commitm ent to a specific number of students. The many 

professional and community orga nizations in which I actively par ticipate are 

concerned with any significant delay in passage of this legislation and its 

corollary appropriation , together with the risk of losing excellent candidates 

for professional training in the health field.

I respectfully beg your support of this imp orta nt legislation for early passage 

and its corollary appropriation.

Sincerely,

L. S. Goerke,

Dean, School of Public Health, University o f California, Los Angeles.

The University of Tennessee,

Department of Preventive Medicine,

Memphis, Tenn., March SO, 1964.

Hon. Kenneth A. Roberts,

Chairma/n, Subcommittee on Health and Sa fet y of the Committee on Interstate

and Foreign Commerce, House of Representatives, Washington, D.C.

Dear Sir : I am writing to you on behalf of H.R. 10043, and would like to request th at my lett er be included in the records of the he aring on th is legislation. *■

As a teache r of preventive medicine and public health in a medical school, I «■ am keenly aware of the severe shortage of physicians who have had adequ ate 

training in this field. It is urgent th at trainin g programs for physicians in this 

are a be implemented as fully as possible if the population of this country is to <

receive th e benefits of the many new developments in this field. Favorable action 

on th is bill by your committee will do a gre at deal toward meeting an important 

need, and your support of this measure is respe ctfully solicited.

Sincerely,

H. Packer, M.D.,

Professor and Chairman.
PUBLIC HEALTH TRAINING AMENDMENTS OF 1964 11 1

Yale U nive rsity School of Med icine, 

Depa rtme nt of E pidem iology and P ublic H ea lt h,

New Haven, Conn., March 6,1964-

Hon. Oren H ar ris,

House Office Building,

Washington, D.C.

B

J

1

>

Si r : I wish to express my strong endorsement of H.R. 10043, Public Hea lth 

Gra duate Training Amendments Act of 1004. As was stated so clearly in the 

final recommendations of the Second National Conference on Public Hea lth 

Training, convened at the direction of the Congress, the combination of (a) 

traineeship supp ort of students, (6) project gra nts for selected are as of public 

hea lth instruction, and (c) formula grants to schools of public hea lth to support basic instructio n, constitu te a balanced and complementary package. Our 

schools a re vita lly interested in all three parts of this package, but wish at this 

time to comment on the urgency th at requ ires action on H.R. 10043 at the 

ear liest possible moment.

In our various appearances before your committee, represe ntatives of the 

Association of Schools of Public Hea lth have emphasized again and again the 

vita l cha rac ter of train eesh ip supp ort for studen ts at schools of public health. 

Over the years, our students have had sharply limited personal resources. Our 

experience makes crystal clea r th at the gre at majority simply could not attend 

school in the absence of Public Health Service traineeship support.

Not only do we endorse the principle of this legislation, but I should like to 

emphasize the urgency in timing with regard to the tr aine eship provisions. Our 

school year will begin -next academic yea r with registr ation on the 15th of September and the 1st day of classes on the 16th of September. Since most of our 

students ar e older, often with established families a nd homes, they obviously need 

time to arrang e their affa irs in order to spend an academic yea r at a gradua te 

school. This is obviously of particular impo rtance with regard to physicians 

and den tists who are often just coming in to the public health field. Most fellowship programs notify successful applicants at leas t 5 months before the 

star t of school and 3 months would seem to be an absolute minimum. All of 

our schools, therefore, are very much concerned th at the bill not only pass, but 

pass quickly, so that we may notify promptly applicants whom we consider 

qualified for traineeships and give them sufficient assu rance that they may proceed with the ir plans for atte ndance at school. If th ere is any significant delay 

in the passing of the legislation and its corollary appropriation, we run the risk 

of losing to public health many excellent candidates who will be forced to make 

other plans because of personal deadlines.

The second pa rt of the legislation and the second part of the package of recommendations by the National Conference on Public Health Training has to do 

with project grants. These awa rds have been very useful not only to schools 

of public health but to other professional schools training people in specialized 

areas of the health sciences. I strongly endorse this section of the leg islation; 

the expansion proposed is modest in rela tion to the needs brought out at the 

Second National Conference. The device of project gra nts is an excellent way to 

stim ulate instruction in are as in which the Public Health Service has concluded 

that there is particular deficit. Furtherm ore, suppo rt may be given in thi s way 

to health programs in schools not devoted prim arily to public health.

The proposed legislation does not include reference to the third pa rt of the 

combination recommended by the Second National Conference on Public Health 

Training—formula grants (Hill-Rhodes grants) to schools of public health. 

As you know, the conference recommended that these gra nts be extended and 

expanded, but since the current authorization under which they are made does 

not expire until 1966, it is my und erstanding that the Departm ent of Health, 

Education, and Welfare did not suggest action on the Hill-Rhodes gra nts at this 

time. I understand th at the Departm ent recognizes the validity of the recommendations of the conference regarding formula gra nts to schools of public 

health and agree that these gra nts constitute an indispensable pa rt of the bal- 

<»f v

pul)li(' hea lth 

aspect of Federal

anced support by the Federal Government for preparation, 

personnel. Our school finds the Hill-Rhodes gra nts a crucial 

aid. Z* *-

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112 PUBLIC HEALTH TRAINING AMENDMENTS OF 1964

In summary, I respectfully ask your supp ort of the House bill 10043, and. 

express my hope th at the committee will recognize not only the need for this 

legislation, but the fact that “time is of the essence.”

Very truly yours,

Anthony M. M. P ayne, M.D., M.R.C.P., Chairman.

Mr. Roberts. I would like to ask if there are any other witnesses 

who had planned to appear.

Are there any witnesses who wish to file statements?

If not, this will conclude the hearings on this bill, and I want to 

thank all of the witnesses and their staff and those present for your 

kindness.

(Whereupon, at 3:50 p.m., the subcommittee was adjourned.)

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