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H E A R IN G S

BEFORE THE

COMMITTEE ON

INTER STATE AND FOREIGN COMMERCE 

HOUSE OF REPRESENT ATIVES

EIGHTY-NINTH CONGRESS 

SECON D SESSIO N

ON

H .R . 1 2 4 5 3

A BILL TO AMEND THE PUBLIC HEALTH SERVICE ACT 

SO AS TO HE LP TRA IN AND OTHERW ISE PRO VID E PROFESSIONAL HEALTH PERSON NEL FOR HEALTH WORK 

ABROAD, AND FOR OTHER PUR POS ES

Serial No. 89-29

FEBRUARY 15 AND 16, 1966

*

S j

A Si

Printed for th e use of the Committee on I nt er stat e anc n Commercj

59-494

TJ.S. GOVERNMENT PRINTING OFFICE

WASHINGT ON: 1966
r

' -

COMMITTEE ON INTERSTATE AND FOREIGN COMMERCE

HAR LE Y O. ST AG GE RS , W es t V irgi ni a, Ch ai rm an

W ALT ER RO GE RS, Tex as W IL LIA M L. SPRIN G ER , Illino is

SA MUE L N. FR IE D EL, M ar yl an d J . ARTHUR YO UN GE R, Cal ifor ni a

TO ItB ERT H. MACDO NAL D, M ass ac huse tts SA MU EL L. DEVIN E, Ohio 

JO H N JARM AN , Oklah om a AN CH ER NEL SE N, M in ne so ta

LE O W. O’BR IE N, New Yo rk

JO H N E. MOSS, C al if orn ia

JO H N D. DI NG EL L, M ichiga n

PA UL G. RO GE RS, F lo ri da

HO RA CE It. KORN EGAY , N or th Car ol in a

L IO N EL VAN DEER LI N, C al if orn ia

J . J . PIC K LE, Te xa s

FR E D D. ROO NEY , Pen nsy lv an ia

JO H N M. MU RP HY , New York

DA VI D E. SA TTERFIE LD III , V ir gi nia

DA N IE L J. RON AN, Il lino is

J. OL IV A HU OT , New H am psh ire

JA M ES A. MACKAY, Ge orgia

JO H N J. GI LL IG AN , Oh io

CH ARL ES P. FA RN SL EY , K en tu ck y

JO H N BELL W IL LI AM S, M ississ ippi

HAST IN GS K E IT H , M as sa ch use tts 

W IL LA RD S. CU RTI N, Pen nsy lv an ia 

GL EN N CU NN INGH AM , Neb rask a 

JA M ES T. BR OY HI LL , N or th Car ol in a 

JA M ES HA RV EY , M ichiga n 

ALB ER T W. WA TS ON , Sou th Car ol in a 

TI M LEE CA RT ER , K en tu ck y

W. E. Wil liam so n, C le rk

Ken n eth J . P ai nt er, A s s is ta n t C le rk

P ro fe ssio n a l S ta ff

Andrew Ste ve ns on

Kurt Borchardt

J am es M. Men ge r, Jr. 

Wil li am J . Dixon

H
C O N T E N T S

Hearings held— Page

Feb ruary 15, 1966____________________________________________ 1

Feb ruary 16, 1966____________________________________________ 47

Text of H .R. 12453________________________________________ 1

Repor t of—

Comptroller General of the United States_______________________ 5

Hea lth, Educatio n, and Welfare, De partm ent of____________________ 4

Labor, Departme nt of________________________________________ 4

State, Dep artm ent of_________________________________________ 5

Sta tem ent of—

Donelan, Paul R. M., legislative dep artment, American Medical

Association________________________________________________ 87

Fraser, Hon. Donald M., a Representative in Congress from the S tate

of Min nesota______________________________________________ 47

Gardner, Hon. John W., Secretary of Health, Education, and Welfare.. 6

Heath, Dr. Gordon, professor of optometry, Ind ian a University_____ 75

Hudson, Dr. Charles L., president-elect, American Medical Association______________________________________________________ 87

Hu nte r, Dr. Thomas, chancellor for medical affairs, University of

Virginia------------------------------------------------------------------------------ 65

Hyde, Dr. Henry Van Zile, executive director, Association of American

Medical Colleges------------------------------------------------------------------ 65

Kerr, Dr. I. Lawrence, representing the American Dental Association

and the American Association of Dental Schools_______________ 80

Lee, Dr. Philip R., Assistant Secretary for Health and Scientific Affairs, 

De par tment of Health, Edu cation, and Welfare________

Margulies, Dr. Harold, associate director, intern ational division,

Association of American Medical Colleges_____________ X-2____ 65

McCracken, William P., Jr., Wash ington counsel, American Optometric Association____________________________________ j ____ . 75

Peterson, Harry N., legislative dep artm ent, American Mej&al

Association------------------------------------------------------------------87

Pom eran tz, Dr. Max M., president, American Association ohjColleges

of P od iatry ------------------------------------------------------------________ 93

Stebbins, Dr. Ern est L., dean, School of Hygiene and P ubliojf td th ,

Johns Hopkins University, representing the American PublicTsipalfli 

Association and th e Association of Schools of Public Hea lth .

Stewart, Dr. William, Surgeon General, Public Health Service, Departm ent of Health, Education, and Welfare____________________ 6

Taussig, Dr. Helen B., president, American He art Association______ 90 "

Additional material submitted for the record by—

American Association of Colleges of Pharmacy, let ter from Jose ph B

Sprowls, chairm an, executive com mittee_____ ________________ 100

} American Association of Dental Schools, statem ent of, presented by

Dr. I. Lawrence Kerr----------------------------------------------------------- 80

American Den tal Association, sta tem ent of, presented by Dr. I.

Lawrence Ke rr-------------------------------------------------------------------- 80

American Optom etric Association, statem ent of, presented by Dr.

Gordon G. Hea th---------------------------------------------------------------- 75

American Public Health Association, statem ent of________________ 54

American Veterin ary Medical Association, statem ent of, submitted by

D. H. Spangler, D.V.M., president----------------------------------------- 94

Association of American Medical Colleges, statem ent of, presented bv

Dr. Thomas H. Hun ter------------------------------------------------------- - 65

Association of Schools of Public Health, letter from Dr. Myron E.

Wegman, president-------------------------- ------------------------------------ 99

n i
IV CONTENTS

Additional material subm itted for the record by—Continued 

Hea lth, Educatio n, and Welfare, Depar tment of:

Comparable rank s of naval, Public Health Service, and Foreign P fl£

e

Service officers (table)__________________________________ 13

Estim ate d numbers of schools, stud ents, and cost of gra nts to

schools of health (tab le)_________________________________ 20

Foreign Service Reserve salary schedule ( tab le)_______________ 13

Public H ealth Service commissioned corps salary schedule (table) _ 14

Staffing requirements, 5-year projection, Int ern ational Hea lth

Act of 1966 (table )_____________________________________ 17

Lane, Dr. Warren Z., member of the Research and Clinical Study

Committe e of the Norwalk Hospital, Norwalk, Conn.:

“H uman Ecology and Regional Development,” paper presented

before the Connecticut chapter, R.E.S.A., Jan uary 7, 1966___ 97

Statem ent of____________________________________________ 96

White, Dr. Kerr L., director, School of Hygiene and Public Health,

Johns Hopkins University, letter from ________________________ 100
INTERNATIONAL HEALTH ACT OF 1966

TUESDAY, FEBRUARY 15, 1966

H ouse of Representatives,

Committee on I nterstate and F oreign Commerce,

W ashing ton, D.G.

The committee met at 10 a.m., pursuan t to call, in room 2123, Ray ­

burn House Office Building, Hon. Harley O. Staggers (chairman) 

presiding.

The Chairman. The committee will come to order.

We are beginning hearings this morning on H.R. 12453, the pro ­

posed Internatio nal Health Act of 1966, which I introduced Feb ruary 2 at th e request of the administration in order to carry out recommendations made by the President in the health field in his message on 

international education and health.

The bill establishes a program of gran ts to schools of health to 

establish, expand, and operate programs for specialized training of 

persons to serve as members of any of the health professions for health 

work in foreign countries. The bill also provides authority for the 

appointment of members of the health professions to serve in the 

regu lar corps or the Reserve corps of the Public Health Service fo r 

the purpose of acquiring trainin g and experience in matters relatin g 

to health work in foreign countries, to obtain advanced tra ining in the 

field of international health, or to serve on detail to another executive 

department, international organization, or foreign country, to carry 

out matters relating to health work in foreign countries.

The first-year goal under this program will be to increase by at 

least 500 the number of graduate students preparing to participate in 

international health activities: to provide for the recruitment of 100 

outstanding young Americans to serve as international health associates, and to establish 50 special fellowships in international health.

At this point in the record there will be included the text of the 

bill and the agency reports thereon.

(The bill and reports follow:)

[H.R. 12453, S9th Cong., 2d sess .]

A BIL L To amend the Publi c Hea lth Service Act so as to help tr ai n and otherw ise p rovide 

professio nal he alth p ers onnel f or he alth work abroa d, an d fo r ot he r purpo ses

Be it enacted by the Senate and House of Representatives of the United

States of America in Congress assembled, Tha t this Act may be cited as the 

“Internationa l Health Act of 1966”.

DECLAR ATION OF PU RP OS E

Sec. 2. The Congress hereby finds and declares that in keeping with the highest 

American traditions of offering hope and help to other nations, and to strengthen 

worldwide efforts to rid mankind of the scourge of disease, it is in the interest of 

this Government to develop and strengthen the capability of the United States
2 INTERNATIONAL HE ALTH ACT OF 19 66

to provide assistance to those countries who are working to help themselves 

• develop needed health services; and that, therefore, it is both necessary and 

desirable for this Government to assist in providing our share of the health 

workers needed to man the post of the health battle throughout the world.

Sec. 3. Section 308 of the Public Health Service Act is amended by—

(1) changing the heading to read

“ TR AI NI NG FOR IN TE RN AT IO NA L HE ALT H WO RK ; IN TE RN AT IO NA L COOPERATION IN

HEA LT H RESEA RCH AN D SERVICE S” J

(2) redesignating subsections (b), (c), and (d) as paragraphs (2), (3), 

and (4), respectively, and by redesignating paragraphs (1), (2), (3), (4), 

(5), and (6) of such subsection (b) as subparagraphs (A), (B), (C), (D), 

(E), and (F ), respectively, and paragraphs (1) and (2) of such subsection 

(d) as subparagraphs (A) and (B), respectively;

(3) striking out “section” where it appears in such redesignated paragraphs (2), (3), and (4) and inserting in lieu thereof “subsection” ;

(4) striking out “Sec. 30S. (a )” and inserting in lieu thereof “ (b )( 1) ” ; 

and

(5) inserting immediately below the heading of such section the 

following:

“ GRANT S TO SCH OOL S FOR TR AI NI NG FOR IN TE RN AT IO NA L HE ALTH WOR K

“Sec. 308. (a) (1) In order to develop and expand the capacity of institutions 

of higher education to train professional health personnel for work in international health, there are authorized to be appropriated for the fiscal y ear ending 

June 30, 1967, $10,000,000, and for each of the next four fiscal years such sums as 

may be necessary. Sums so appropriated shall be used for grants to any school 

of health whose application therefor is approved by the Surgeon General upon 

his determination that—

“ (A) such school is an accredited public or nonprofit private school of 

he alth;

“ (B) such grant will assist in carrying out the purposes of the Inte rnational Health Act of 1966;

“(C) the application contains or is supported by assurances satisfactory 

to the Surgeon General that Federal funds made available under this subsection for any fiscal year will be so used as to supplement and, to the extent 

practical, increase the level of funds which would, in the absence of such 

Federal funds, be made available for the training aided by such grants, and 

in no case will supplant such non-Federal fund s;

“ (D) the application contains such additional information and assurances 

as the Surgeon General may find necessary to carry out the purposes of this 

subsection;

“ (E) the application provides for such fiscal control and accounting procedures as the Surgeon General may find necessary to assure proper disbursement of and accounting for Federal funds paid to the applicant under this 

subsection; and

“ (F) the application provides for making such reports, in such form and 

containing such information, as the Surgeon General may require to carry out 

his functions under this subsection, and for keeping such records and affording such access thereto as the Surgeon General may find necessary to assure 

the correctness and verification of such reports.

“ (2) In considering applications for grants under this subsection, the Surgeon 

General shall take into consideration the relative financial need of the applicant 

for the grant and the relative effectiveness of the applicant’s plan in carrying out 

the purposes of the International Health Act of 1966.

“ (3) Grants under this subsection may be used to pay all or par t of the cost 

of establishment, expansion, and operation of programs for the specialized t rain ­

ing of persons who are, or are in train ing to become, members of any of the health 

professions for health work in foreign countries, including the cost of grants to 

the staff of the school for travel in foreign areas, regions, or countries, and the 

cost of travel of foreign scholars to teach or assist in teaching in such programs 

and the cost of their return, and such grants shall be made on such conditions 

as the Surgeon General finds necessary to carry out the purposes of this subsection. Such grants may also include funds for stipends (in such amounts as may 

be determined in accordance with regulations) to individuals undergoing training
INTERNATIONAL HEALTH ACT OF 19 6 6 3

in such programs, including allowances for dependents and for travel here and 

abroad.

“ (4) For purposes of this subsection—

“ (1) the term ‘school of health’ means a school of medicine, school of 

dentistry, school of osteopathy, school of pharmacy, school of optometry, 

school of podiatry, school of public health, or school of nursing, as defined for 

purposes of pa rt B of title VII, or any other school providing training, leading to a baccalaureate or higher degree, in any of the other health professions, or allied health professions, or other professions related thereto, which 

are included in regula tions; and

“ (2) the term ‘nonprofit’ as applied to any such school means a school 

which would be accredited and nonprofit within the meaning of such par t B ;

“ (3) the term ‘accredited’ as applied to any such school means a school 

which would meet the requirements for accreditation under section 721(b) 

(1) (B ), ‘International Cooperation in Health Research’.”

INTER NATIONAL HEALTH ASSOCIATES AND FELLOWS IN INTERNATIONAL HEALTH

Sec. 4. The Public Health Service Act is further amended by inserting afte r 

section 212 the following new section:

“INTERNATIONAL HEA LTH ASSOCIATES AND FELLOWS ; EST ABL ISHMENT OF A CAREER

SERVICE IN INTER NATIONAL HEA LTH

“Sec. 213. (a) For the purpose of increasing the number of experienced professional health personnel available for health work in foreign countries and 

related health work, any person who is a member of one of the health professions 

may be appointed in the Regular Corps or the Reserve Corps pursuant to section 

207, for duty with the Service or for detail, to any other executive department 

or to any international organization (entitled as such to enjoy the privileges, 

exemptions, and immunities under the Internationa l Organizations Immunities 

Act), for the purpose of acquiring train ing and experience in matters related to 

health work in foreign countries. Any person so appointed shall, for the period 

of such appointment, be designated as an associate in international health.

“ (b) (1) For the purpose of securing outstanding members of the health professions to serve in positions of leadership with the Public H ealth Service in the 

field of international health, any person who is a member of any of the health 

professions, who has had some experience in health work in a foreign country or 

work related thereto, may be appointed to a special fellowship in the Service to 

enable him to secure advanced training, in matters related to such health work, 

at any accredited public or nonprofit private school of health. For such purpose, 

such advanced training may also be provided for commissioned officers of the 

Service pursuant to section 218. For purposes of this paragraph—

“ (A) the term ‘school of health’ means a school of medicine, school of 

dentistry, school of osteopathy, school of pharmacy, school of optometry, 

school of podiatry, school of public health, or school of nursing as defined 

for purposes of part B of title VII, or any other school providing training, 

leading to a baccalaureate or higher degree, in any of the other health professions, or allied health professions, or other professions related thereto, 

which are included in regulations; and

“ (B) the terms ‘accredited’ and ‘nonprofit’ as applied to any school mean 

a school which would be accredited and nonprofit within the meaning of 

such part B.

“ (2) Any such fellowship shall include the cost of tuition and fees at the 

school plus such stipend and allowances, including allowances for dependents 

and for travel, as may be prescribed in accordance with regulations.

“(3) The provisions of subsection (b) of section 218 shall apply in the case of 

any person appointed to a fellowship under this subsection to the same extent as 

they apply in the case of a person receiving train ing under subsection (a) of 

section 218, except that, for purposes of such subsection (b), service by any such 

person with any other executive department or international organization 

(entitled as such to enjoy the privileges, exemptions, and immunities under the 

International Organization Immunities Act) in connection with matters related 

to health work in foreign countries shall be regarded as service for the Public 

Health Service.

“ (c) (1) Any person who is a member of any of the health professions may be 

appointed to the Regular Corps or the Reserve Corps for detail to another execu-
4 INTERNATIONAL HEALTH ACT OF 1966

tive department or to an international organization (entitled as such to enjoy 

the privileges, exemptions, and immunities under the International Organizations 

Immunities Act) to assist in carrying out responsibilities of such department or 

organization in matters related to health work in foreign countries.

“(2) Any person who is a member of any of the health professions may be 

appointed to the Regular Corps or the Reserve Corps for detail to any foreign 

country a t the request of the Department of State.

“ (3) Any person detailed pursuant to paragraph (1) to another executive 

department shall be deemed to have been detailed under subsection (a) of section 214. The provisions of subsection (d) of such section shall be applicable 

in the case of any other person detailed under paragraph (1) or (2) to the 

same extent as they apply in the case of a person detailed under subsection (b) 

or (c) of such section 214, except that, in accordance with agreements with the 

country or organization to which any such person is detailed, provision may be 

made for reimbursement, in whole or in part, to the Service for his salary and 

allowances.

“ (d) Any person appointed under subsection (a) or (c) shall not, while serving as provided in such subsection, be counted as a commissioned officer of the 

Regular Corps for purposes of the limitations in the applicable appropriation 

Act on the number of commissioned officers who may be on active duty in the 

Regular Corps.”

Department of Health, Education, and Welfare,

Washington, D.C., February 14, 1966. Hon. Harley O. Staggers,

Chairman, Committee on Interstate and Foreign Commerce,

House of Representatives,

Washington, D.C.

Dear Mr. Chairman : This is in response to your request of F ebruary 4, 1966, 

for a report on H.R. 12453, a bill to amend the Public Health Service Act so as 

to help train and otherwise provide professional health personnel for health 

work abroad, and for other purposes.

This bill was sent by us to the Speaker of the House of Representatives in order 

to carry out the recommendations fo r legislation relating to this Department’s 

responsibilities in international health, described in the President’s message 

on international health and education.

A more detailed justification for this legislative proposal will be presented in 

testimony before your committee.

We urge that your committee give favorable consideration to this bill and 

that it be enacted by the Congress.

We are advised by the Bureau of the Budget that enactment of this proposed 

legislation would be in accord with the program of the President.

Sincerely,

Wilbur J. Cohen,

Under Secretary.

U.S. Department of Labor,

Office of the Secretary,

Washington, D.C., February 14, 1966. Hon. Harley O. Staggers,

Chairman, Committee on Interstate and Foreign Commerce,

House of Representatives,

Washington, D.C.

Dear Mr. Chairman : This is in response to your request for comments on 

proposed legislation, H.R. 12453, International Health Act of 1966.

The bill would authorize $10 million for the fiscal year ending June 30, 1967, 

to develop and expand the capacity of institutions of higher education to train 

professional health personnel fo r work in international health.

The Department favors the enactment of this legislation, which is designed 

to carry out a recommendation in the President’s special message on world 

health and education. We defer to the Department of Health, Education, and 

Welfare for detailed comment on the need for and provisions of this proposal.

The Bureau of the Budget advises tha t it has no objection to the submission 

of this report.

Sincerely,

W. Willard Wirtz, 

Secretary of Labor.
INTERNATIONAL HE ALTH ACT OF 19 66 5

Department of State, 

Washington, D.C., February 15,1965.

Hon. Harley O. Staggers,

Chairman, Committee on Interstate and Foreign Commerce, House of Representatives, Washington, D.C.

Dear Mr. Chairman : Thank you for the opportunity to comment on H.R. 

12453, a bill entitled “International Health Act of 1966.”

The Department of State strongly supports the bill’s declaration of purpose— 

“to provide assistance to those countries who are working to help themselves 

develop needed health services.” To assure tha t foreign assistance programs 

are effectively integrated and that the foreign policy of the United States is best 

served thereby, the Secretary of State under such provisions of law as section 

622(c) of the Foreign Assistance Act, and section 4(c) of the Peace Corps Act, 

already coordinates and reviews U.S. internationa l health programs such as 

those financed by AID, Peace Corps health projects, contributions to WHO, 

and regional hea lth organizations, and the like.

The Department understands tha t the proposed legislation is not intended to 

create additional authority for the Public Health Service to detail its personnel 

abroad. Rather, it is intended to provide au thority to hire additional personnel 

in order to establish a “career service in in terna tional health.” In this context, 

it is assumed, therefore, that the specific reference in section 213(c) (2) to “detail 

to any foreign country at the request of the Department of State” is meant to 

affirm tha t any details abroad of the new international health associates and 

fellows appointed under section 213 will be pursuant to authorities under other 

legislation and tha t they will require the approval of the Secretary of State 

as par t of his general coordination and review responsibility for U.S. international health programs.

The Department wishes to note also that the auth ority conferred by the bill 

would not affect the existing authority of agencies other than the Department 

of Health, Education, and Welfare to carry out training for international health 

work.

The Bureau of the Budget advises t ha t from the standpoint of the administration’s program there is no objection to the submission of this report and enactment of this bill is in accord with the program of the President.

Sincerely yours,

Douglas MacArthur II,

Assistant Secretary for Congressional Relations

(For the Secretary of State).

Comptroller General ofthe United States,

Washington, D.C., March 1,1966.

Hon. Harley O. Staggers,

Chairman, Committee on Inter state and Foreign Commerce,

House of Representatives.

Dear Mr. Chairman : Reference is made to your letter of February 23, 1966, 

requesting our comments on H.R. 12453 which, if enacted, would be cited as the 

“Internationa l Health Act of 1966.”

1 The bill would amend the Public Health Service Act, 42 U.S.C. 201 et seq., by 

authorizing the Surgeon General to make grants to schools of health to be used 

to help train and otherwise provide professional health personnel for health 

work abroad. Since the question whether grants should be made for such 

purpose appears to be a matter primarily for the Congress to determine, we make 

no recommendations regarding the merits of the bill.

We should like to point out, however, tha t while section 308(a) (1) (F) of the 

bill would require recipients of g rants to keep such records as may be required 

by the Surgeon General and to afford him access thereto, the bill makes no 

provision for access to grantees’ records by the Comptroller General. In view 

of the large sums tha t will be involved in this program, we firmly believe that 

provision fo r such access should be made. This could be accomplished by inserting in the bill a subparagraph (G) following section 308(a) (1) (F) as follows:

“ (G) the application provides that the Comptroller General of the United 

States or his duly authorized representatives shall have access fo r the purpose 

of audit and examination to the records specified in subparagraph (F) of this 

section.”
6 INTERNATIONAL HEALTH ACT OF 19 66

This suggested provision is similar to those contained in a number of other 

acts providing grants for various purposes. See, for example, section 604 (a) (11) 

of the Public Health Service Act as added by Public Law 88-443, approved 

August 18, 1964, 78 Stat. 453.

Sincerely yours,

Frank H. Weitzel,

Acting Comptroller General of the United States.

Our first witness this morning wi ll be th e Se cretary of Hea lth , 

Ed uc ation, a nd W elf are , Mr. Gardn er. Th is will be Se cretary G ar dne r’s first ap peara nce before th is com mittee. We wan t to welcome 

you he re to day, Mr. Secre tar y, an d to assure y ou of our cooperation in 

wo rking to ge ther to tr y to make a mo re h ea lth y A me rica.

You may proceed.

STATEMENT OF HON. JOHN W. GARDNER, SECRETARY OF HEALTH,

EDUCATION, AND WELFARE; ACCOMPANIED BY DR. WILLIAM

STEWART, SURGEON GENERAL, U.S. PUBLIC HEALTH SERVICE;

AND DR. PHILIP R. LEE, ASSISTANT SECRETARY FOR HEALTH

AND SCIENTIFIC AFFAIRS, DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE

Se creta ry G ardner. Th an k you , Mr. Ch air ma n.

Th is is no t only my firs t appeara nce before th is com mittee, th is is 

my fir st appeara nce as Se creta ry before any com mittee. Thi s is my 

bapti sm . I hav e a statem ent . May I read this sta temen t ?

Th e Chairm an. You may read it or pu t it in th e rec ord an d ta lk 

fro m it, an y way you want. Yo u may p roceed.

Se cretary Gardner. I th in k i t is no t too le ng thy. Per ha ps I sh ould 

rea d it.

Th e Chairman. Al l rig ht.

Se cretary Gardner. Mr. Ch airm an and members of th e committee, 

I am pleased to prese nt testim ony in be ha lf of t he propose d In te rn atio na l Hea lth A ct of 1966, H.R. 12453, i ntrodu ced by th e dis tin guish ed 

ch air man o f th is com mittee.

The P reside nt m ade clear in his in tern ationa l ed uc ation a nd h ea lth 

mes sage why thi s leg islation is im po rta nt. He sa id :

We would be shortsighted to confine our vision to this Nation’s shorelines. 

The same rewards we count at home will flow from sharing in a worldwide 

effort to rid mankind of this slavery of ignorance and the scourge of disease.

We bear a special role in this liberating mission. Our resources will be wasted 

in defending freedom’s frontiers if we neglect the spirit that makes man want 

to be free.

One of the necessities of ou r tim e is to cre ate th e kind of relatio nships w ith other countrie s which will ena ble all of u s to live in peace. 

Mo re th an ever before, all of us recognize th at th e ha za rd of war is 

gr ea te r th an any other.

Th ere may be ma ny ways to red uce t hi s ha za rd , bu t there are few 

wh ich are be tte r th an estab lishin g constru cti ve wo rking relatio nships in tho se fields of hu man endeavor in wh ich all men share the 

same aims, the same hopes, th e same goals. H ea lth is such a field. 

Th ere are no be tte r grou nd s on which we can meet othe r natio ns and 

demo nstra te our own c oncern fo r peace an d the b etterm en t o f m ankind 

th an in a common ba ttle aga inst disease.
INTERN ATION AL HEALTH ACT OF 196 6 7

To this field, we can bring special competence. We can address ourselves to the alleviation of serious but soluble problems. We can relate 

ourselves constructively to others in improving international understanding and cooperation.

Furthermore, when we engage in such shared work with the health 

professions in other lands, particula rly in the developing nations, w’e 

are relating ourselves to key groups and individuals, destined to play 

vitally important roles in shaping the future of their countries.

It is important to note that any aid to improve the health of people 

in other countries—especially in the developing nations—will be a 

substantial contribution not only to their health status and their f reedom from disease, but also to th eir educational status, their food production, their economic strength, their social stability, and the attain ­

ment of tha t level of social and economic development which will permit them to be self-sufficient and self-supporting.

We could bring these grea t benefits to many nations simply by 

exporting our know-how, at relatively little cost to ourselves.

Much of the assistance so desperately needed by the developing 

nations will require no new discoveries, no new drugs or vaccines, no 

major scientific breakthroughs. Hundreds of millions of people are 

crushed under the pressures of rap id population grow th; yet today 

we know effective family pla nning techniques.

Hundreds of millions of people—many of them young children— 

are weakened, crippled, and destroyed by hunger and malnutrition; 

yet today the control of starvation poses no majo r mysteries for our 

experts.

Hundreds of millions are sickened and even killed by diarrheal 

infections, measles, smallpox, cholera, and a host of other infectious 

diseases; yet today we have methods which can prevent or control 

most of them.

Millions are weakened and killed by malaria; yet today we have 

techniques which cannot merely control malaria but eradicate it 

completely.

Where these methods have been applied—and they have been applied in many countries, including our own—the results have often 

been dramatic. But they are not yet being adequately applied in 

many areas of Asia, Africa, and Latin America today.

As I said, we could be of great help and at relatively little cost to 

ourselves. But there is one obstacle. At present we do not have the 

trained manpower to furn ish the essential skills, guidance, instruction, and leadership.

The proposed legislation we are considering today is intended to 

make that trained manpower available. It is designed to overcome 

the obstacles which now exist to the recruitment, training, and participation of top-quality American healthworkers in these vitally important programs.

This cannot be done under existing legislative authority. The 

agencies operating under our foreign assistance programs have never 

developed a career program for health professionals, and because of 

this they have been able to retain only a limited number of the expert 

healthworkers required. The United States provides more th an onethi rd of the funds to support the World Health Organization and 

the Pan American Health Organization, yet these organizations have
S INTERNATIONAL HE ALTH ACT OF 19 66

only a handful of Americans working in their programs because we 

have not created an adequate means to supply more.

Past efforts to recruit and retain top-quality healtliworkers in 

international careers have been thwarted because of the limited trai ning opportunities and the lack of an adequate career program.

In international public health, specialized training and experience 

is an absolute necessity. The trainin g most American students receive 

in our universities and professional schools today simply does not provide them with the foundation required for the exacting tasks in 

the field.

Consider the specifications for positions which we must fill now. 

Our present requirements range from the Public Health Service 

surgical teams in Vietnam to the scientist in the cholera research laboratory in Pak ista n; from the young medical officer protecting the 

health of Peace Corps volunteers in Ira n to the sanitary expert coping with infant diarrheal disease in northeast Th ail and: from the 

parasitologist studying tropical diseases in Panama to the veterinarian 

needed to fight rabies in Latin America.

Across the globe other specialists are needed to cope with other 

assignments. The worldwide malaria eradication program currently 

receives U.S. support in 15 countries, and experts are needed to man 

key positions in this program. The program to control measles and 

eradicate smallpox in 19 West African countries needs leadership 

which must be provided by Public Health Service officers.

Programs now being developed in family planning, maternal and 

child health, and nutritio n require increasing numbers of healthworkers who must be specifically qualified to cope with health projects 

in remarkably different geographical and cultural areas. Add the 

steadily increasing need for surgical teams, nurses, malaria eradication 

workers and other public health specialists in Vietnam alone, and it 

is clear t ha t we must double the size and capabilities of our international public h ealth team within the year.

We must not forget that these international health programs are 

also of direct benefit to the American people. The international aspects of communicable disease control have never been better demonstra ted than during the past year—a case of suspected smallpox from 

Africa appears in the Distric t of Columbia: a rabid dog in Mexico 

bites a child who dies in San Diego; migratory birds from Central 

America carry encephalitis virus to our shores; our troops in Vietnam 

are threatened by strains of drug-resistant mala ria tha t they carry 

back to this country; a famous American correspondent dies of a 

tropical disease acquired abroad: and thousands of Americans work 

and travel in once remote areas of the world where they may be exposed to a variety of diseases unknown in or long banished in this 

country.

The bill before you today, H.R. 12453, is designed to provide requisite academic foundations, supervised field experience, advance 

train ing, and multiple career opportunities in international public 

health.

The first step, to be accomplished by amending the Public Health 

Service Act, would authorize a new program of gran ts to American 

institutions of higher education. The grants would make possible the 

basic educational foundation fo r the entire effort. They would permit
INTERNATIO NAL HE ALTH ACT OF 19 66 9

the develop me nt or expansion of the schools to tr ai n pro fes sio nal 

he althwo rkers an d stu de nts in the va rie ty of dis cip lines inv olv ed in 

th is field. Th ro ug h such gr an ts, the institu tio ns wou ld prov ide special educational op po rtu nitie s fo r Am eri can stu de nts an d facu lty to 

stu dy here an d abroad .

Thi s academ ic tr ai nin g would be of lit tle significance unless there 

■were also op po rtu nitie s fo r th e individu als trai ne d in this prog ram 

to put th eir kno wle dge an d skills to work. Ac cording ly, H.R . 12453 

would ad d a n ew section of the P ub lic H ea lth Service Act to i ncrease 

th e nu mber of exp erie nce d pro fes sio nal he alth person nel available 

fo r pu blic he alth wo rk in foreign coun tries an d related activ ities at 

hom e. Th e new section of th e act w ould ma ke possible t he fo llow in g:

1. Associates in i nter na tio na l he alth ;

2. Fellows in in tern ationa l he alth ;

3. Ca reer serv ice in in tern ationa l he alt h.

Let me go o ver those th ree .

Fir st , fo r associates, the P ub lic H ea lth Service would r ec ru it yo un g 

pro fes sio nals in th e he alth discip lines to be av ail able fo r ass ign me nt 

at home an d overseas fo r pe rio ds up to 2 yea rs. The ir ap po intm en t 

would be i n either t he R eg ul ar Corps o r Reserve Co rps of the Pu blic 

H ea lth Service; the y would be detai led to th e Agenc y fo r In te rn atio na l Developm ent or t he Peace Corps, or to in tern ationa l or ga niza ­

tio ns such as th e W orld Hea lth Organ ization an d th e Pan Am erican 

H ea lth O rgan iza tio n to g ain field ex perience.

Th ey wou ld be assi gne d to pr og rams in wh ich the y would prov ide 

serv ice un de r sup erv ision so th at the y wo uld benefit gr ea tly by the 

experie nce .

Th e secon d grou p, a som ewhat more m atur e grou p pro fes sio nally , 

the fellows in in tern ationa l he alth, alo ng with selected c omm issioned 

officers of the Pu blic Hea lth Serv ice, would be chosen fo r advance d 

midca reer trai ni ng to pr ep ar e the m fo r lead ership in in tern ationa l 

pu blic he alth and its ma ny specialties. Th e fellow s would be dr aw n 

from those who ha d alr eady rece ived profe ssion al he alth exp erie nce 

oversea s, either as associates in in tern ationa l he alth, or as he alth pro ­

fes sional s in the Pea ce Corps , the Agenc y fo r In te rn at io na l De velopme nt, or othe r publi c or pr iv at e prog ram s. Fo llo wing com ple tion 

of th is adv anced trai ni ng , th e fellow s an d th e com missioned officers 

in th is prog ram would be read y fo r lea dersh ip position s in op erating 

prog ram s.

Fi na lly, the pro posed leg islati on would cre ate a career service in 

in tern ationa l he alt h, to be estab lished in th e Pu blic H ea lth Service . 

Th e leg islati on would pe rm it th e Pu blic H ea lth Ser vice to r ec ru it an d 

ap po in t officers in th e Re gu lar or Reserve Co rps fo r de tail to othe r 

exe cut ive de pa rtm en ts and in tern atio na l organiz ati ons. Suc h spe ­

cia lly qu alified officers could also be d eta ile d d ire ctly to a f oreign countr y at th e req ues t of th e St at e De pa rtm en t.

A t p res ent, the number of intern atio na l h ea lth workers now a ssigne d 

to tas ks in Vi etn am an d elsewh ere fro m the Pu blic H ea lth Ser vice is 

lim ite d by th e dom estic pr og ra m ceiling s on commission ed officers. 

U nd er th e pro posed leg islati on, the Pu blic H ea lth Ser vice officers 

ap po inted an d detai led to oversea he alth prog rams would no t be 

counted ag ains t these ex isting lim ita tio ns.

Th ere is agree me nt am ong th e agencies con cern ed th at the gr ea t 

bu lk of ou r caree r in tern atio na l he alth pro fes sio nals must be based
10 INTERN ATION AL HEA LT H ACT OF 19 66

in the Public Health Service. Other alternative approaches have been 

tried for the past 20 years without success.

This is a modest program in financial terms, but it will solve a critical manpower problem. It will help to attract more of our best young 

people into the health professions and keep them there. Moreover, 

the proposed program will enable this country to establish a vital set 

of relationships with people in other lands, to help achieve our goal 

of a peaceful, healthy world.

Before I close, I would just like to reiterate the statements with 

which I began this testimony. It seems to me at the very top of our 

agenda is to try to create the kind of world in which we can live at 

peace with other nations. I can’t think of any program or any means 

of doing this more effectively than to engage in constructive cooperative activities with other nations in those fields in which all men share 

the same goals, the same purposes.

This is such a field. This is a field in which we can make a unique 

contribution at relatively little cost to ourselves simply by exporting 

the know-how which we already have.

I urge your favorable consideration of this legislation.

Mr. Chairman, I have Dr. William Stewart, Surgeon General of 

the U.S. Public Health Service, and Dr. Philip R. Lee, Assistant 

Secretary for Health and Scientific Affairs with me. We would be 

pleased to answer any questions you or other members of the committee may have.

The Chairman. Thank you, Mr. Secretary.

I intended to mention that you did have with you the Surgeon 

General of the United States, Dr. Stewart, and Dr. Philip R. Lee, 

your Assistant Secretary for H ealth and Scientific Affairs. I wonder 

if either of these two gentlemen has a statement he would like to make.

Dr. Stewart. No, sir, Mr. Chairman; I have no statement.

Dr. Lee. No additional statement, Mr. Chairman. Thank you.

The Chairman. Fine. Than k you.

Mr. Secretary, we are very happy to have you with us and I would 

like to just ask one or two questions.

I notice on page 7 of your statement th at you mentioned public and 

private programs. I just wonder if this program will be limited to 

public organizations abroad, or will it go into private or religious 

organizations in any way ?

Secretary Gardner. I believe that the point at which I mentioned 

public or private programs was when I was enumerating the kinds of 

programs tha t these fellows might be drawn from.

The Chairman. That is true.

Secretary Gardner. We would not send our people into programs 

other than Federal programs or the programs of multilateral agencies such as the World Health Organization or occasionally the detailin g of someone to a foreign government at the request of the State 

Department.

The Chairman. Then it would not in any way be connected with 

private organizations operating abroad ?

Secretary Gardner. No, sir.
INTERNATIONAL HEALTH ACT OF 196 6 11

The Chairman. It would either be with our Government agencies 

or another government ?

Secretary Gardner. That is right, or the multilateral agencies.

The Chairman. I notice the bill mentions a certain amount of 

money to be expended in grants. Do you have any idea what the 

cost of the bill would be and what is the time limit on it ?

Secretary Gardner. May I speak to the time limit first? We are 

thinking of this as a continuing pa rt of our internatio nal relations. 

This is not a large program and we are thinking of something th at 

continues as a pa rt of the texture of our international relations, as a 

part of our normal dealings with people over the years.

Just as we carry on educational exchange and cultural exchange, 

so we would carry on this exchange in a field in which we can make 

these special contributions.

With respect to the cost, Dr. Lee, do you have the figures on that?

Dr. Lee. As to the projected costs fo r the first year of the program, 

we estimate that the gran ts to the schools will be $10 million and for 

the remainder of the program approxim ately $1.7 million.

The Chairman. Fo r the remainder?

Dr. Lee. Fo r the associates and the fellowship phases of the pro ­

grams.

The Chairman. Give that again, Doctor.

Dr. Lee. $10 million for the gran ts to the schools of health; $1.7 

million is the estimated cost fo r the first year of the program for the 

associates and for the fellows.

The Chairman. In the total program do you have a lim it in years ?

Dr. Lee. On the projects for aid to the schools of health, the 

requested authorization is for 5 years. Fo r the associates and for th e 

fellows and for the detail of commissioned officers, tha t would be a 

continuing program.

The Chairman. Mr. Secretary, ordinarily this committee has p ut a 

time limitation on new programs so tha t we can keep in touch with all 

of these things. It has been sort of a custom and I was ju st wondering 

about consideration of the time limit, because tha t is meant for the 

purpose of Congress keeping in touch w ith what is going on.

Secretary Gardner. I am sorry. I did not intend to ask for a permanent authorization.

The Chairman. All right.

Mr. Friedel.

Mr. F riedel. Mr. Secretary, I want to commend you for your very 

fine statement. I thought it was very good. There is one thin g tha t 

I would like to have cleared up.

You say tha t—

This is a modest program in financial terms, bu t it will solve a critical manpower problem. It will help to at trac t more of our best young people into the 

health professions and keep them there.

Have you had trouble before because of salaries or do you contemplate having trouble recruiting these individuals?

Secretary Gardner. Let me say tha t that sentence was not a very 

precise sentence. There are special problems in recruitment that in-
12 INTERNATIONAL HEALTH ACT OF 19 66

volve considerable periods of service overseas, very often in what the 

State Department would describe as hardship posts, in assignments 

which lift one out of the normal pattern of practice and the building 

of a career th at medical people expect. It is in these terms as well as 

salary tha t it has been difficult and it is for these reasons necessary to 

create the kinds of careers th at will permit young people to see what 

the onward pattern is likely to be if they accept a 2-year period of 

service in Vietnam, or in Africa, or Latin America.

Mr. F riedel. Do you have any set schedule of salaries?

Dr. Lee. The salaries for the associates or for the others will be the 

same as for other Public Health Service officers at tha t equivalent 

level.

When Public Health Service officers are detailed to a foreign country at the request of the State Department, they are senior officials 

ordinarily. The assignment of these officers is authorized under a 

separate act tha t makes i t possible to provide them salaries tha t are 

equivalent to the salaries of the people in the Foreign Service. Under these circumstances they would have a higher salary during tha t 

period of time than they would have as domestic Public Health Service officers.

This same condition prevails for the young medical officers assigned 

to the Peace Corps. In the Peace Corps Act they come under the 

same provisions as those detailed to other countries at the request 

of the State Department.

With respect to those individuals detailed at the request of the State 

Department, the major group are the people assigned to the Agency 

for Internationa l Development.

Mr. Friedel. What schedule would they be under or what would 

the range of salaries be in the foreign country ?

Dr. Lee. This would depend on the position tha t they occupy and 

it would be equivalent to tha t which a Foreign Service officer would 

have at that position. The salaries vary and I can’t tell you the 

various ranges.

Perha ps Dr. Stewart has some specific figures on the salary range. 

I am sure we could obtain the figures.

Dr. Stewart. Mr. Friedel, if they are there as commissioned officers 

of the Public Health Service they would have salaries in the same 

range as the military. We are tied into the military rank basis and 

I don’t now remember those numbers, but they range somewhere from 

$7,000 to the top of the equivalent of a two-star general, so they go 

from the equivalent rank of a second lieutenant to a two-star general.

Tha t is the range for commissioned officers of the Public Health 

Service. If they are there at the request of AID or the Peace Corps 

then they would have the equivalent rank and pay of a Foreign Service officer, and I don’t know what those ranges are.

Mr. Friedel. Tha t will be all. Thank you, Mr. Chairman.

The Chairman. Could you supply this information for the committee?

Dr. Stewart. Oh, certainly.
INTERNATIONAL HE AL TH ACT OF 19 6 6 13

(The information, requested follows:)

Table I.— Comparable ranks of naval, Public Health Service, and Foreign

Service officers

N av al ra nk

C ap ta in ________________

C om m an de r____________

L ie ut en an t C om m an de r..

Lie ute nan t_____________

L ie ute nan t (ju nior grade).

Ju ni or e ns ign.................

PH S co mpa rable ra nk Ye ars

Dire ctor g rade officer____________ 20-30.............

Senior g rade officer______________

14-18.............

2-12................

2 . . . ................

18-30_______

Full grad e officer_______ _______

10-16..............

2-8 .................

18-30...........

Sen ior as sistan t gra de officer...........

Assistant g rad e officer ________

10-16........ .

2-8..................

10-30_______

4 -8 .. ........ .

2-3..................

8 -3 0 .. ......... .

Ju nio r as sistan t grad e officer_____

3-6 ................

2 .....................

8-16 _______

3-6 ........... .

2.....................

Fo reign Service 

co mpa rable ra nk

FSR-2 .

FS R-3 .

FS R-4 .

FS R-5 .

FS R-3 .

FSR-4 .

FSR-5 .

FSR-3 .

FSR-4 .

FSR -5 .

FSR-4 .

FSR-5 .

FSR -6 .

FSR-5 .

FSR -6 .

FSR-7 .

FSR -6 .

FSR-7 .

FSR -8 .

Table II .—Foreign Service Reserve salary schedule

Step 1 St ep 2 St ep 3 St ep 4 St ep 5 Step 6 St ep 7

FS R-1 $23,465 $24,284 $25,382

FSR -2 18,954 19; 612 20; 270 $20,928 $21, 586 $22, 244 $22,902

F S R -3 ................... 15; 395 15; 929 16,643 16,997 17,531 18, 065 18,599

F S R -4 ................... 12,510 12,945 13,380 13,815 14,250 14,685 15,120

FS R -5 10^303 10,661 11,019 11,377 11, 735 12,093 12,451

FSR -6 8,594 8,889 9,184 9, 479 9, 774 10,069 10,364

FS R -7 _______ 7^262 7, 506 7,750 7,994 8,238 8,482 8,726

F S R -8 ................... 6; 269 6,476 6,683 6,890 7,097 7,304 7, 511

5 9 -4 9 4 — 6< -2
4^

T ab le I I I . — Pub lic Health Service commissioned corps salary schedule

Me dic al cat ego ry U nd er 2 Ov er 2 Ov er 3 Ov er 4 Ov er 6 Ov er 8 Ov er 10 Ov er 12 Ov er 14 Ov er 16 Ov er 18 Ov er 20 Ov er 22 Ov er 26 Ov er 30

D ire ct or _________ . $11 ,999

10,209 

9,0 38 

8, 469 7,3 26 6,631

$13, 412

11,9 58

10,8 33

9,6 70

8,7 03

7,6 05

$13 ,999

12,480 11,2 86 

10,062 

9,6 83 

8,5 85

$13,9 99

12, 480 11,286 10, 718 

9,8 77 

8,5 85

$13 ,999

12,480 11,4 16 11, 042 

10,007 

8,5 85

$15 ,199

12, 480 12,9 44 12, 501 

11,207 

9,7 85

$15 ,199

13, 939 

13, 462 12,8 93 11, 207 

9,6 85

$15 ,199

14,3 93 13,919 13,2 82 11,2 07 

9,7 85

$15 ,527

14,9 83 14,312 13,480 11,2 07 

9,7 85

$17 ,089

15, 699 

14, 704 

13,480 

11,207 

9,7 85

$18 ,876

17,4 86 16,1 63 14, 680 12,4 07 

10,985

$19,1 39

17,8 10 16,163 14,6 80 

12,4 07 10,985

$19 ,855

18,2 03 16,1 63 14, 680 12,4 07 10, 985

$20,9 60

18,203 16,1 63 

14, 680 12, 407 

10, 985

$20,9 60

18,203 16,1 63 14,680 

12, 407 10,985

Se ni or ______F u ll ___________

Senio r ass is ta nt____

A ss is ta nt_________Ju ni or as si st an t___

INTERNATIONAL HE ALTH ACT OF 19 66
INTERNATIONAL HEALTH ACT OF 19 6 6 15

The Chairman. Mr. Devine.

Mr. Devine. Yes. Mr. Secretary, what is the overall cost of this 

program as you anticipate it ?

Secretary Gardner. In this year the cost is $11.7 million.

Mr. Devine. Have you projected the years ?

Dr. Stewart. No. For the gran ts to the schools the bill authorizes $10 million for fiscal year 1967 and such sums thereafter as may be 

necessary.

Mr. Devine. And 4 more years thereafter ?

Dr. Stewart. With 4 years thereafter.

Mr. Devine. That is a total of five?

Dr. Stewart. That is right.

Mr. Devine. I s this open end, or does this have a termination?

Dr. Stewart. It has a termination date then afte r 5 years. That 

is, grants to the schools. There is an authorization ceiling for the 

first year of $10 million and then such sums thereaf ter as may be necessary. There is no ceiling now in the bill for the subsequent 4 years.

We would anticipate that the funds needed would increase, but it is 

difficult to know how much beyond $10 million, because it depends 

really on the initiative the schools of health take in getting into training in the international health field.

Mr. Devine. Are these amounts included in the budget?

Dr. Stewart. Yes, sir; they are.

Mr. Devine. Are they also included in the Presiden t’s projected 

or predicted deficit?

Dr. Stewart. They are included in the Pres iden t’s budget fo r fiscal 

year 1967.

Mr. Devine. I suppose this is a question t ha t should not be asked, 

but does the Department recommend any additional tax sources being 

tapped in order to finance these additional programs ?

Dr. Stewart. The Department recommends what we think should 

be the health programs for the Department to carry out, and these are 

reviewed by the Bureau of the Budget, and the President. The 

President’s budget does contain these figures fo r 1967.

Mr. Devine. Dr. Stewart, we have had testimony year in and year 

out before this committee by your predecessor and others about the 

shortage of medical personnel, nursing personnel, and things of that 

nature.

How would this program affect our domestic shortage in the medical 

field? Are we going to be drawin g from our sources, sending them 

out across the world, and compounding our own shortages?

Dr. Stewart. There is a shortage of health personnel which, we 

have been talking about for a good many years. There has been 

action by the Congress in developing the Hea lth Professions Educational Assistance Act throug h which we are beginning to do something 

about this shortage.

This shortage will continue for some period of time, since it takes 

a good many years to train a doctor or a nurse. These people will 

be drawn from the pool of tra ined manpower we have, but we do have, 

even with our shortages, so much more than the countries we are talking about, th at it seems quite appropriate to share some of our trained 

manpower to train thei r people so they can begin to develop and solve 

their problems of disease and misery.
16 INTERNATIONAL HEALTH ACT OF 19 66

Mr. Devine. Do you anticipate tha t the persons that are trained 

under this proposed program are going to be obligated in some way 

or other to go into the international health field, or can they get the 

training then and do as they see fit? Is there any obligation here 

at all?

Dr. Stewart. The program is designed to train people who are 

making a commitment to work in the international health field.

Mr. Devine. Is there any way to enforce tha t commitment?

Dr. Stewart. There is no way to enforce the commitment. If a 

person, after he has had a fellowship, decides he does not want to work 

in the international health field, there is no way to force him to do this.

If he is a commissioned officer of the Public Health Service and he 

is sent away for training there is an obligation to pay back to the 

Public Health Service time for the time spent in train ing, and this 

can be spent within the Public Health Service or on detail to another 

agency. I would think only in the instance of a non-Public Health 

Service fellow the person in training might decide not to go on in 

international health. But I do thin k tha t the person who has on his 

own initiative, and with a school where he is going to get his train ing, 

applied for a fellowship, and has gone throu gh it, is a person who is 

pretty far down the line toward a commitment in working in the international health field.

Mr. Devine. The thing tha t concerns me here, Doctor, and Mr. 

Secretary, is with the overwhelming number of good and excellent 

causes, with the compassion of the American people, the do-gooders 

and bleeding hearts, of all the wonderful causes, we run into situations 

continuously.

I recall just a little over 2 years ago when the Surgeon General 

of the United States at tha t time on Janu ary 11,1964, issued his report 

on the possible harmful results of the consumption of tobacco and we 

enacted legislation which required the announcement on the cigarette 

package th at this may be harmful.

Yet, in the same Congress we turn around and appropriate millions 

of dollars to subsidize the very industry tha t may cause this harmful 

result.

You say this is part of our foreign relations program through the 

Department of State. We spent billions of dollars in this area to 

help our friends. This is a help-friends proposition, and what have 

they done. They pillage our libraries; they burn our embassies; they 

spit on our flag; and they say, “Yankee, go home.”

We are talking about helping people to live longer here and yet 

we have another program on international birth control, and we don’t 

seem to be completely consistent in our compassions.

Secretary Gardner. I don’t see this as inconsistent. I think it would 

be a grea t mistake to pretend th at this will be anything but a fu rthe r 

burden upon our medical manpower. The shortages that have existed 

at home will certainly not be helped by drawing additional people for 

overseas activity, but really basically it is a question of what we do 

with the resources available to us, in this case the resources of medical 

manpower, and we want to use those resources to protect our children 

against hazards o f diseases at home and to protect our old people in 

their infirmities.
INTERNATIONAL HEA LTH ACT OF 19 66 17

We also, it seems to me, can very well use a tiny fraction of that 

medical manpower to help us to try to create the kind of world in 

which our young people will not have to go and fight in far-off wars 

because we will have constructed a world tha t is knit to ge ther.

How you do tha t is not easy to say and you just have to keep trying.

Mr. Devine. You try to repeal the old Malthusian doctrine of population control by wars and pestilence? You are trying to overcome 

that?

Dr. Ler. I might add one thing to this tha t relates to the medical 

manpower needs at home, and tha t relates to the Peace Corps volunteers who have worked in the health field—these are young people with 

no previous specific health experience—20 percent of these young people when they retu rn to the United States choose to pursue professional careers in the health field. These are outstanding young people 

and it has been a very interesting and unexpected development as a 

result of that program.

Mr. Devine. Speaking of people, how many do you anticipate this 

program will employ in th e 4- or 5-year period?

Dr. Lee. We have some figures on the present requirements. At the 

present time I think we have the figures available here, don’t we, 

Bill?

Yes. We can supply you with the figures.

Mr. Devine. Would you supply that for the committee record, 

please ?

Dr. Lee. Surely.

(The information requested follows:)

Table IV.—Staffing requirements, 5-year projection, International Health Act of

1966

Fis ca l ye ar 

1967

po si tion s

F is ca l ye ar 

1968

posi ti ons

F is ca l yea r 

1969

posi tions

Fis ca l year 

1970

po si tion s

F is ca l y ear 

1971

pos itio ns

Sec. 21 3(a)_________________ _______ ______ 100 150 200 200 200

Sec. 21 3( b) ___________________ ___________ 50 75 100 100 100

Sec. 21 3( c- l):

Sta ff a ss ig ne d to A I D ________________ 528 625 625 625 625

Sta ff a ss ig ne d to Pea ce C o rp s_________ 167 185 200 200 200

Sta ff a ss ig ne d to W H O a n d P A H O ___ 25 40 50 50 50

Se c. 21 3(c-2 )......... ..... ............................................ 10 15 20 20 20

T o t a l........................................... ........... — 880 1,09 0 1,195 1,195 1,195

Mr. Devine. Thank you, Mr. Chairman.

The Chairman. Mr. Moss.

Mr. Moss. Mr. Chairman, I would like to welcome the Secretary 

and his new team here to the committee. I thin k the initia l offering 

is a most interesting one, and I am tr yin g to determine a fter the reading of the legislation itself whether it is intended to require these 

schools of public health to actually increase the output of students, of 

graduates.

In the Health, Education, and Facilities Act of 2 years ago we wrote 

in a requirement as a condition for grants that there be a fixed minimum improvement in the capacity of the schools each year or we prohibited the making of grants.

Is anything similar anticipated in this program?
18 INTERNATIONAL HEALT H ACT OF 19 66

Dr. StfAvart. Mr. Moss, there is no fixed minimum in the bill at the 

present time. Since there are only some places in the country now 

where one can obtain training in international health—there are not 

very many—you are really starting from zero and going toward another number.

These training programs do not lead to a degree in international 

health. They include physicians who are going to have some specialized training in the international aspects of health o r nurses who 

are having some special training.

It is not related to the number of nurses or the number of physicians. 

What I think is more important is the number of training programs 

tha t develop from this, rathe r than the actual number of students.

There will be almost entirely, with certain exceptions, new types 

of training programs which do not now exist within our schools of 

health.

By the way, it is intended to include more than schools of public 

health—it is schools of health.

Mr. Moss. If it merely constitutes an enrichment of existing programs without producing additional graduates, what have we gained?

Dr. Stewart. Mr. Moss, we will have gained people who will have 

an educational experience which they they cannot now get and which 

they are going to apply in these international health programs.

Mr. Moss. Well, will not the programs attract the curious as well 

as the dedicated, those who might want to have a better understanding 

of a different field of subjects rath er than to commit themselves to 

participate in an international health program either as an associate, 

a fellow, or as a career in itself ?

Secretary Gardner. Yes. I am certain tha t you cannot devise a 

pattern that will keep out the curious and the ones who will not 

necessarily commit themselves.

I backed a lot of different graduate programs and there is no 

way to prevent a certain fringe from entering, but Dr. Lee referred 

to this 20 percent of Peace Corps volunteers 'who on return wish 

to enter into health careers.

We believe tha t there is a significant group of people who are 

interested in international health and who will become interested 

wTho would not become interested in normal medical practice, who 

w’ant to get into this field particularly and if we open up opportunities 

will get into it.

One of the problems with this group of Peace Corps volunteers 

returning who wTant to enter is that we do not have the facilities which 

can easily move them into international health careers, so we hope to 

tap at least one possible new source of personnel here for the medical 

field.

Mr. Moss. Do you have any targ et figures as to the number you 

would hope would be trained and available as the result of these 

programs?

Dr. Stewart. We have in mind, as fa r as the associates go, about a 

hundred people a year, keeping in mind a 2-year period as an associate. There would be about 50 fellowships a year and such fellowships 

would range from 1 to 3 years’ duration, depending on the type of 

training and educational experience the person is getting.
INTERNATIONAL HE ALTH ACT OF 19 6 6 19

Then they go from there—this is the training and experience at 

different levels—into the career program. The number here will 

really depend on the demand tha t is placed on the Public Health 

Service to furnish health professional people in a variety of our 

own Government programs, in international activities, and other 

governments which ask for our personnel through the State Department, or in multilateral agencies such as the World Health Org anization.

At the present time we have about 234 commissioned officers involved 

in international health activities, of which about 85 or 90 percent 

are overseas. Most of these people have learned by doing. They 

have just sort of arrived there by getting there. Some have had a little education or training in internatio nal health. The rate of requests fo r health personnel to the Public Health Service for international activities is increasing.

At the present time we are working on a request from the Peace 

Corps for 60 more physicians f or fiscal 1967, as an example. We will 

probably get other requests because soon we may be delegated the 

function of carrying out the worldwide malaria eradication program 

for the Agency fo r International Development. We have no program 

in the United States which is training people who have an interest 

in international health, to replenish these individuals who are already 

there, to improve them, or to bring these people back so they can get 

advanced training to develop a career in international h ealth service.

This is what we are tryi ng to do.

Mr. Moss. I have great sympathy with the objective. I am concerned, however, with the means of achieving it. Fo r instance, as 

I read the bill, the normal lim itations on grants, even grants to schools 

of public health, are not present in this legislation, are they ? Are they 

incorporated by reference ?

I haven’t had the oppo rtunity of researching some of the referred 

to sections and, therefore, I am not certain as to the provisions incorporated into this legislation by reference, but, as I recall, in making 

grants to schools of public health there is a limit on the amount of 

sharing which can be underwritten by a Federal grant. Th at would 

not be true here ?

Dr. Stewart. No, sir, it would not.

Mr. Moss. You could approve a hundred percent gra nt for the construction of physical facilitie s; is tha t correct ?

Dr. Stewart. No, si r; this money is not for construction.

Mr. Moss. Not any of it for construction ?

Dr. Stewart. That is right.

Mr. Moss. I am glad to know th at because this was not clear to me. 

The bill seems rather broad and I am n ot certain that it couldn’t be 

used, or a gran t couldn’t be made, under the term s of the legislation fo r 

construction.

Dr. Stewart. Certainly the intention was not to use it for construction. It is intended for the purpose of p utting together th e train ing 

programs in inte rnational health that are necessary.

Mr. Moss. Would you anticipate any kind of commitment from the 

participating institution, giving reasonable assurances that at least 

it had enrolled persons who were interested in giving pa rt of their 

time to some international organization ?
20 INTERN ATIONAL HEA LT H ACT OF 19 6 6

Dr. Stewart. Certainly, Mr. Moss, I think tha t the institution 

would apply and in the process of reviewing what they propose to do, 

we would seek as much assurance of this as possible before a program 

starts.

These grants would be reviewed annually for many things, as well 

as for those you are bringing out.

Mr. Moss. I would strongly urge tha t there be an effort made to 

develop some targe t figures of the number of participating students 

or institutions and some estimate of the overall cost for a 3-year program.

Mr. Chairman, I would like to ask tha t tha t information be supplied to the committee.

Dr. Stewart. Yes, sir.

(The information requested follows:)

T able V.—Estima ted numbers of schools, students, and cost of grants to schools

of health

Fis ca l year 

1967

Fis ca l ye ar 

1968

F is ca l yea r 

1969

Fis ca l year 

1970

Fi sc al yea r 

1971

E sti m ate d n u m b er of s ch oo ls___

E sti m ate d n u m b er of s tu d e n ts .. 

E sti m ate d c o st_________________

60

500

$10 ,000,000

80

1,000 

$15,000,00 0

100

1,500

$20 ,000,0 00

100

1,500

$20 ,000,000

100

1,500

$20 ,000 ,000

Mr. Moss. Thank you.

Secretary Gardner. May I just say a word on Mr. Moss’ point ?

The Chairman. Mr. Secretary.

Secretary Gardner. If a school of public health or a school of health 

sets up an effective program in international health it would n aturally 

want to train not only people fo r this program who will go overseas 

and follow the career pattern outlined here, but a variety of other 

people who will be active in fields such as tropical medicine and teach 

it in our medical schools and the like and not be a part of this program.

Mr. Moss. Thank you.

The Chairman. Mr. Secretary, in relation to that, the others who 

were not committed to the international field would not participate in 

the grants ?

Secretary Gardner. Th at is right.

The Chairman. Thank you.

Mr. Nelsen. Mr. Secretary on page 4, with reference to grants to 

the schools that will train the fellows to participa te in the program, it 

says at the bottom of the pag e:

All or part of the cost of establishment, expansion, and operation of programs.

I just wondered, as Mr. Moss has indicated, just what does tha t 

mean ? Will this include bricks and mo rtar and if you expand the program is it not going to be necessary to have more bricks and mortar in 

order to expand the capacity of any school to take on train more 

personnel ?

Secretary Gardner. Sir, that does not include funds for bricks and 

mortar and in general these will not be large programs in terms of 

personnel, and scope of laboratories and clinical facilities, and the 

like.
INTERNATIONAL HE AL TH ACT OF 19 6 6 21

These can, as a rule, ride on the backs of the general facilities av ailable in the other programs in the school of health.

Mr. Nelsen. 1 notice also on page 5—

the term “school of health” means a school of medicine, school of dentistry, 

school of osteopathy, school of pharmacy, school of optometry, school of podiatry, 

school of public health, or school of nursing * * *.

As I recall, this is identical language to H.R. 12, is it not? It 

would seem to me the purpose of H.R. 12 is to tra in personnel in those 

fields, and so many times it seems also true that we pile programs 

on top of programs and finally accumulate more personnel than pro ­

duction. I am wondering if a little of that might not happen under 

this bill, because certainly the purpose of training under H .R. 12 does 

not limit the field to which the persons may go after being trained.

I wonder i f you have any comment about that?

Secretary Gardner. Would you like to try tha t?

Dr. Stewart. The Hea lth Professions E ducational Assistance Act, 

Mr. Nelsen, provides construction money for the various health professional schools that are listed there, and also loans for certain students 

before attaining the M.D. degree, or the D.D.S. degree, or the other 

professional degrees.

Also the 1965 amendments provide for educational improvement 

grants, both formula grants and project g rants. These were and are 

more to meet the problem of shortage of health personnel on the 

domestic scene.

We are trying to increase the pool of trained health professionals 

for all of our needs in this Nation. The international health training 

really is in addition to this. The Health Professions Educational 

Assistance Act did not spell out and say this was a p articu lar kind of 

nurse or a particular kind of doctor. It is intended to produce doctors, nurses, dentists, and other h ealth professionals, the basic health 

professions we start with.

Then they become a certain kind of specialist after that.

Mr. Nelsen. On page 7 it say s:

For the purpose of securing outstanding members of the health professions 

to serve * * *.

It goes on to point out that—

* * * any person who is a member of any of the health professions who has 

had some experience in health work in a foreign country or work related 

thereto, may be appointed to a special fellowship * * ♦.

Will this include persons from a foreign country that might have 

been in health professions, or does this simply mean some of our 

own citizens tha t have worked in foreign countries?

Secretary Gardner. Our own citizens, sir.

Mr. Nelsen. Did I hear some mention made of 50 persons intended 

per year ?

Dr. Stewart. Yes. The fellowship program is set at 50 per year 

with a term of fellowship ranging from 1 to 3 years, depending on 

what it is tha t they are getting education and training experience in.

Fo r the associates it would be about a hundred p er year for a period 

of appointment of approximately 2 years.

Mr. Nelsen. Of course, the thin g that runs through my mind is 

the fact tha t under H.R. 12 when persons are trained in the various
22 INTERNATIONAL HEALTH ACT OF 19 66

fields that I mentioned, there is nothing t hat would deny any of those 

persons from practicing in a foreign country.

However, this bill will provide stipends a nd travel allowance which 

presently is not available. When we talk about 50 fellowships, t hat 

is a pretty small number. I recall the statement made on the floor 

in debate during the last session tha t we passed a lot of slogans.

Now, we need to go beyond 50 if we are going to do anything effectively. I wonder if this is another slogan.

Dr. Stewart. Mr. Nelsen, it will be more than 50 because there will 

be longer than 1-year training periods. Let us say the average is 2. 

It would be around a hundred fellows in tr ain ing at any one time, or 

50 people each year that we would have.

Perha ps you are talking about the man with more experience in the 

international health field, who has gotten some education in inte rnational health and now is ready to, say, advise the minister of health 

of a developing nation on how he can p ut in a family planning program for the entire nation, or perhaps he would advise a m inister of 

health on methods to improve water supplies so diarrheal disease will 

go down. Thus we are talking about top level kinds of jobs in 

foreign nations which have tremendous influence and importance, and 

the number is not as important as the quality of persons and the tra ining they have had.

Mr. Nelsen. I only will mention this : That some of us are becoming 

rath er weary as our objectives seem to miss the mark. I have supported programs of this kind and I want to be sure th at when we star t 

digging deeper and deeper with more and more programs th at we don’t 

miss the mark and duplicate. There is so much duplication of effort 

in so many fields that a thorough examination of this is certainly 

necessary. If our dollar is going to do the maximum good we certainly 

don’t want to pile programs on top of programs.

I have no more questions, Mr. Chairman.

The Chairman. Mr. Kornegay.

Mr. K ornegay. Thank you very much, Mr. Chairman.

Let me extend my personal greetings to the Secretary and Dr. Stewart and Dr. Lee. We are certainly happy to have you with us this 

morning. We look forward to your return on other occasions.

I am very much impressed, Mr. Chairman, with the laudable aims 

and ideas behind this proposal. I have long felt tha t we would be 

better off if greater emphasis in our foreign aid p rogram were placed 

on the exportation of our techniques, knowledge, and scientific 

abilities.

However, I do have some questions that I would like to ask and some 

points I would like to raise.

One thing that comes to my mind right away is the fact that in the 

last couple of weeks my office has been deluged with letters from constitutents and others about the budgetary cutback on the school lunch 

program, the milk fund, and g rants to our la nd-grant colleges, which 

have gone on for many, many years.

Apparently there is a shortage of funds to keep existing programs 

up to the expected levels. That is not a question. I don’t know tha t 

tha t you care to comment on it, Dr. Gardner. If you do. I would be 

glad to hear anything you might have to say about it.
INTERNATIO NAL HE ALTH ACT OF 196 6 23

Se cretary Gardner. Th is is a very difficult question. Thi s h as been 

a v ery tig ht b ud ge t year . We have ha d to w ork very severe r es trai nt s, 

an d wo rking w ith in those re stra in ts we have made the m ost serious an d 

respon sible effort th at we could possibl y make to hold with in th e 

bu dg etary lim ita tio ns th at were requ ire d an d at th e sam e tim e no t 

neglect fo rw ar d movem ent in a gr ea t va rie ty of are as whi ch seem 

to us quite essent ial, an d one of the are as where a very mo des t outla y 

could move us ah ead was the are a un de r conside ration here.

I th in k th at you will rarely encounter a field in which you can ge t 

mo re lev era ge fo r yo ur do lla r th an th is one. Thi s is tr ue of ma ny 

of the tec hnica l assistance fields overseas, bu t pa rtic ul ar ly in the 

medical field where ou r own know-how is so v ery much bey ond many 

of thes e countrie s with which we dea l, so much so th at a single in di ­

vidu al wo rking with key officials o f th e co un try can wo rk gr ea t gains 

fo r the country.

We fe lt th at th is k ind of lev erage sim ply could n’t be overloo ked in 

allo ttin g our dolla rs in this difficult year.

Mr. K ornegay. T hat is a good ans wer. I see yo ur po int. Of 

course, those of u s on this com mittee are put in a little different posision , an d it is pr et ty h ar d to e xp lai n to o ur fol ks w hy we are sending 

th is m oney overseas and no t pr ov iding wh at so m any th in k are necessa ry fo r th e sustena nce of our own people.

Th e next question I w an t to ra ise is the ob viou s shortag e of medical 

an d parameclical person nel in t his countr y. Thi s committee, la st yea r, 

spen t most of its tim e in list en ing to te stimo ny re la tin g to bills to t ry 

to corr ect t hat situ ati on , to try to do some thing ab out it.

I believe it was the day af te r the medic are bill was signed i nto law 

th at Dr. St ew ar t’s predecesso r ann ounce d th at it wo uld be necessa ry 

to dou ble th e m edical and pa ram edica l p ersonnel o f th e countr y, an d so 

we have in this co untry a gr ea t sho rtage.

I t seems ra th er str an ge to ma ny peo ple to st ar t ex po rti ng trai ne d 

me dic al person nel fro m th is coun try whe n there is such a dir e 

shortage here.

Th ere is an othe r question I wa nt to ask an d th at is, is it necessa ry 

to have new leg islati on in or de r to ca rry ou t th e purpo ses of th is b ill 

or th is pro posal?

Let me ad d a little bi t to th at sta tem ent. Is th er e any restr ictio n 

in the presen t law th at would prev en t a pr og ram of th is type fro m 

being ca rri ed on now among the pu bli c he alth schools an d othe r 

facil ities of the country ?

Se cretary Gardner. Yes, th er e are. Dr. Stew art.

Dr . Stewart. Th e Pu blic H ea lth Service at th e presen t tim e—the 

Su rgeon Ge neral —does n ot ha ve a ut ho rity i n th e in tern ationa l he alth 

field. We have t he au thor ity to de tai l per son nel to othe r agencie s of 

the Fe de ra l Go ver nm ent , an d to St ate he alth de pa rtm en ts, an d th is 

so rt of th in g, bu t n ever h ave h ad a defined ro le in int er na tio na l h ealth .

Th e Office of In te rn at io na l H ea lth in my office serves as a staff office, 

pr in ci pa lly fo r th e functio ns of th is Go vernme nt’s role in the W or ld 

Hea lth Or ga niza tio n, an d I serv e as the chief U. S. deleg ate to its 

directing bod y. It does manage, fo r A ID , foreign stu de nts who come 

to t hi s coun try , to a rran ge the ir schedules, get th em to th e school, and 

th at t yp e of thing , bu t exce pt fo r t h at we do not have an in tern ationa l 

he alth role.
24 INTERN ATIONA L HEA LT H ACT OF 1966

The proposed bill would provide authority beyond tha t I now have 

to assign people on detail to an agency such as AID.

Mr. Kornegay. But you do actually have people working in this 

role a t the present time ?

Dr. Stewart. No; that role goes purely on the fact th at on request 

I can assign people, detail people, to AID, the Labor Department, 

Agriculture, or the Peace Corps, or to whatever other department asks 

for them, but they are not part of a career in international health. 

They are going as professionals to work in AID programs because 

they have a certain skill.

Mr. Kornegay. When they would a rrive in a foreign country they 

do the same th ing tha t you would intend for them to do under the 

terms of this bill, wouldn’t they ?

Dr. Stewart. Yes, but when they finish their foreign service what 

do they come back to? When they come back to the Public Health 

Service after 7 or 8 years on this foreign assignment what kind of a 

career can they fit into in the Public H ealth Service ? This is the problem. They are detailed to another agency’s programs and they bring 

their skills with them, but it is not p art of a career tha t this man has. 

It becomes a career in itself and some become lost in these oth er agencies when they have completed what they were assigned there for.

They must then come back and fit into some domestic program 

within the Public H ealth Service. Some do and do very well and contribute a great deal, but others have great difficulty.

In addition, we are not producing the officers in the Public Health 

Service who will replenish these people with better trained and more 

experienced people, so that we are improving our international health 

activities. We conduct it throu gh AID programs. Peace Corps, and 

all the others, but we are providing a different kind of person tha t 

we have at the present time.

Mr. Kornegay. In other words, this would be setting up a new shop 

in which they would be working or functioning? They would be 

assigned to, say, some foreign country, and they come back for reassignment and either stay here or go to some other foreign country, 

wherever they m ight be needed ?

Dr. Stewart. Yes. Fo r example, if there has been a tra inin g p rogram developed in a health school under the training gra nt program 

of this bill and it has attra cted some, say, medical students who are 

interested in international health and they get an educational experience at that level of tra inin g and they want to become an international 

associate in the Public Hea lth Service after their internship, then 

we can begin here in the medical school to train the person who will 

eventually serve in an AID program, advising the minister of health 

of some developing nation on his health problems.

We have a spectrum here of development of people and a career 

for them in international health which we do not have a t the present 

time. If a person were to go for 2 years then, with the Peace Corps as 

his assignment for training and experience, and he comes back and he 

w ants then to go and get some further train ing in population dynamics, 

or in nutrition, or something else tha t is going to be his interest in the 

international field, then he could be assigned to one of the schools that 

are providing the desired kind of training.

In this way we begin to develop a career service in international 

health.
INTERNATIONAL HE AL TH ACT OF 19 66 25

Secretary Gardner. May I make an additional comment on the first 

pa rt of your question ? I would like to make it clear tha t even if you 

delete from the objectives of this program all of the objectives which 

have to do with constructive cooperation with other countries, we 

would still need a vigorous international health corps in our own selfinterest.

You cannot live in a world in which you can get on a plane in Cairo 

in the morning and have dinner in Washington without having the 

kind of people who have command of international health problems, 

whether they are communicable disease problems or whatever else, so 

tha t in any case we must have a vigorous field of international health 

as a part of our total health activities.

Mr. Kornegay. What I am getting at is th at we are, of course, appropriatin g and spending millions and in fact billions every year in 

the area of medical education, train ing, research, and that type of 

thing, and I was wondering whether or not any thought had been 

given to carrying out this type of program within the present framework and under present law without setting up an entirely new 

bureau or entirely new shop, and I gather from your answer tha t in 

your opinion it cannot be done.

Dr. Stewart. That is correct, Mr. Kornegay.

Mr. Kornegay. This training p rogram is limited to American citizens, is tha t righ t ?

Secretary Gardner. Th at is right.

Mr. Kornegay. No pa rt of it will provide that foreign citizens be 

brought to the U nited States and trained and then sent back to their 

own land ?

Secretary Gardner. No, sir.

Mr. Watson. Mr. Chairman, would the gentleman yield at tha t 

point ?

Mr. Kornegay. I will be happy to yield.

Mr. Watson. Why don’t you provide for that? It seems elementary to me that if you would brin g these natives in here and train them 

and send them back they would have far better acceptance on the pa rt 

of the natives, and additionally we would not have this additional 

training with the shortage of the medical profession here. Why isn’t 

tha t very logical?

Dr. Lee. This is presently authorized and such programs are carried out by the Agency for Internationa l Development. They are 

training a limited number of professionals from other countries for 

leadership roles on their return.

In addition, of course, there are thousands of physicians who come 

to this country on their own for advanced tra ining.

Mr. Watson. Doctor, don’t you agree with me that a local doctor 

would have better acceptance than an American doctor?

Dr. Lee. We found that, for example, in programs such as malaria 

eradication in In dia a very small number of American personnel have 

made an immense contribution working with the Indians, a contribu ­

tion tha t could not have been made by a local individual, and this has 

been true in other programs.

Mr. Watson. Doctor, could contributions have been made by the 

local individual if he had been trained properly by our experts over 

here? That is the point we are trying to make.
26 INTERNATIONAL HE ALTH ACT OF 19 66

Dr. Lee. These are people many of whom, the Indians in this pa rticular program, had been trained in this country. This has also been 

true in many other countries where Americans do have a unique contribution. They have talent, and skills, and know-how that combined 

with people in the countries have made and can make very significant 

and continuing contributions.

Mr. Watson. One final question, and I thank my colleague from 

North Carolina for yielding.

Then I am to conclude from your statement the inference th at some 

of these foreigners do not have the capability for learning and developing these programs on their own and it is absolutely necessary th at we 

send Americans over there ? Is tha t your position ?

Dr. Lee. No; I think tha t we find tha t it is a team effort. The 

World Health Organization is an example of the team type of effort in 

international health programs. There are many highly qualified, 

very talented people in other countries who have learned and can continue to learn by training in this country. I don’t in any way imply 

tha t they don’t have these skills, but I think that America does have the 

genius.

We have people who have made tremendous contributions and I 

think tha t one purpose of this program is to continue this essential 

element.

Secretary Gardner. May I add a point there ?

Beyond th e purpose of simply increasing the supply of manpower 

available for international health problems, one of the purposes of this 

bill is to develop a corps which would be p art of the Public Health 

Service, trained international health people who will be at the service 

of the United States in accomplishing its purposes, whatever they are, 

whether this is quarantine, or problems relating to AID, or whatever.

They will be available for assignment by the Surgeon General.

Mr. Kornegay. In pursuing that line of questioning, next comes 

the question, Would one of the functions of this American citizen who 

is trained by the Public Health Service and goes to a foreign country 

be to train the local people in that country ?

Secretary Gardner. Yes, sir.

Mr. Kornegay. To carry out malaria control and control of many 

other scourges that they experience in foreign lands ?

Dr. Lee. Very definitely. An example of this which is, I think, 

fresh in the minds of many of us is the measles control program in 

west Africa. Two or three Public Health Service officers went over 

first on a very small experimental program to test out the effectiveness 

of measles vaccine under these circumstances.

They trained the people locally. They are now expanding the program at the request of the governments in Africa to 19 countries, 

again with an expanded number of Public H ealth Service officers, but 

also with a tremendous number of other personnel th at they are tra ining in this program with a very significant benefit not only to the health 

of the people in that country, but benefiting the view that the people in 

those countries have of the United States.

It has had a very significant impact and again, it could not have 

been carried out without these few Public Health Service officers who 

did the training and who supervised the local people who were actually 

doing the work.
INTERNATIONAL HEALTH ACT OF 19 6 6 27

Mr. Kornegay. One final question. That is, does the Department, 

the Surgeon General, see this bill as sending physicians? In other 

words, does a person have to be a physician in order to get into the 

program ?

Dr. Stewart. No, sir, a person does not have to be a physician. It 

can be anyone who is in a health field who has a skill which is 

related to health programs carried out in foreign countries. It could 

be a nurse. It could be a sanitary engineer. It could be a health 

educator, a nu tritio nist, or any one of a long list of people who could be 

included in this career.

Mr. Kornegay. I am glad to hear that because I have felt that, 

while we have to have highly trained experts in the medical field, 

there are certain bad situations, health conditions, th at can be helped 

with people who don’t have an M.D. degree or aren’t specialists in 

many of the fields, and their talents, and their desires, and their ambitions, and the ir enthusiasm ought to be used.

Sometimes I thin k the guidelines or standards which the dep artments set up, not only in this area, b ut other areas, prohibit and disqualify a lot of people who are qualified to do a particu lar job.

Thank you very much, gentlemen. I want to yield to my good colleague from California.

Mr. Moss. Mr. Secretary, I am interested in the language on page 7 

of the bill, lines 19 throu gh 22, which would appear to exclude the 

schools of nursing giving associate degrees. Is tha t the intent of tha t 

language?

Secretary Gardner. May I t urn th at over to the Surgeon General ?

Dr. Stewart. I believe that a school of nursing as defined in part 

B, title V II, includes the associate degree schools.

Mr. Moss. We appear to have a difference of opinion as to th e lim itation of title V II, p art B. Is it intended to include within the scope 

of this program the schools of nursing giving the associate degree ?

Dr. Stewart. No, I am sorry, Mr. Moss. I am wrong about that. It 

excludes the associate degree schools.

Mr.Moss. Why?

Dr. Stewart. Well, I don’t know why.

Mr. Moss. I can’t un derstand why it would be wise to exclude them. 

I know at the Sacramento City College in my home State we have had 

a course for many years, and the graduates compare very favorably 

with th e baccalaureate graduates in being qualified under the laws of 

our State, which are rather demanding. It would seem to me that, 

rather than limiting the opportunity to participate, the effort should 

be to extend assistance to al of those appropriately qualified.

Dr. Stewart. I think, Mr. Moss, one of the difficulties is tha t the 

fellowships tha t we are talking about, advanced train ing, will generally be at the graduate level beyond the baccalaureate degree level. 

It will be at the master’s level.

A girl who is a graduate of an associate degree nursing school would 

not have the baccalaureate degree and therefore could not enter into 

advanced training.

Mr. Moss. I understood that this was a definition of the term “school 

of h ealth” in the section I am re ferring to, and it is anticipated tha t 

you might make gran ts to broaden the programs offered to these students and tha t if you did you could offer it in the baccalaureate program, but not in the associate program ?
28 INTERNATIONAL HE ALTH ACT OF 19 66

Dr. Lee. Tha t is true at the present time, as the law is written, but I 

think certainly as we gain experience we may find th at this would be 

an a ppropriate group of schools, particularly in the field of nursing, 

and if limited to tha t area, to include.

I think when we initiated the program, our thinking was t hat we 

did not want to extend it initially. We wanted to sta rt with a modest 

program.

Mr. Moss. I want to alert you to the fact tha t I will make an effort 

in the markup session of the committee to amend this so that it does 

embrace the associate degree schools of nursing.

Thank you, Mr. Kornegay. I return the floor to the gentleman.

Mr. Kornegay. I am glad you brought this out, because I think 

it is in the very areas I was talking about a while ago.

That is all, Mr. Chairman. Thank you.

The Chairman. Mr. Curtin.

Mr. Curtin. Thank you, Mr. Chairman.

Mr. Secretary, do I understand th at you have loaned certain of your 

public health personnel to various foreign aid programs and also 

to the Peace Corps and tha t those people are now doing the type of 

work overseas that you ask for in this bill ?

Secretary Gardner. Yes, sir.

Mr. Curtin. Have you any idea about how many ?

Secretary Gardner. Yes ; we have those figures.

Dr. Stewart. We have 234 commissioned officers in international 

health, of which about 90 percent of these individuals are overseas. 

As examples, 97 with the Peace Corps-----

Mr. Curtin. How many did you say ?

Dr. Stewart. 234.

Mr. Curtin. Thank you.

Dr. Stewart. We have 169 civil service employees involved in international health, but they are with the international agencies here in 

the United States, like the AID headquarters here.

Mr. Curtin. Then this legislation you are now asking for would 

not inaugurate an entirely new program.

Secretary Gardner. Let me make a beginning of an answer.

One of the interesting things is t hat almost all of the agencies, in 

fact I think every agency, which we have loaned personnel to and 

which has been faced with this problem of finding health personnel 

for its overseas activities has concluded tha t these health people ought 

to have a professional base in the Public Health Service and tha t the 

best way they can assure themselves a continuous supply and a continuing flow of younger people coming along to work into this is to 

get th e Public Health Service to develop this kind of career program 

so that you are not always engaged in ad hoc recruitment and trying 

to pry people into this deal.

You will have a steady flow of people moving into it who will have 

a professional base when they go back, and this is the only new feature.

Mr. Curtin. Has there been any problem in reference to presently 

taking care of the requests for such personnel ?

Secretary Gardner. Oh, yes; it is very difficult to staff these overseas activities with first-class people.

Mr. Curtin. Why?
INTERNATIONAL HEALTH ACT OF 19 6 6 29

Dr. Stewart. Mr. Curtin, we just went throu gh the process of recruiting six physicians to replace the physicians who are on our two 

surgical teams in Vietnam and it was a very difficult job to find physicians who were willing to go to Vietnam.

Mr. Curtin. How is it gong to be less difficult if the program is 

handled through an international health service rather than being 

done as it presently is ?

Dr. Stewart. Because we can in effect s tar t them much younger 

in the international health field, give them experiences in international 

health, develop their training and education as they go along, so that 

assignments like this surgical team or something similar would be part 

of a career rath er than an isolated assignment.

We have some difficulty in replacing the individual who has been, 

say, with AID , 6 or 7 years and then comes back to the United States.

Mr. Curtin. Why?

Dr. Stewart. It is difficult to find the person who has had the tra ining and experience that would replace this person. More or less we 

look around to see who might have been in this field some way or an ­

other. We are not at the present time training a cadre of people coming along with the interest, with the education, and with training and 

experience in the international health field. They sort of grow up 

topsy-turvy.

Mr. Curtin. Assuming that this legislation is enacted into law and 

you train these people, what guarantee do you have that they are going 

to go into this international health field and stay in it for any indefinite 

period ?

Dr. Stewart. One never has an absolute guarantee. The person 

is always free to change his career as he goes along, but I think if we 

sta rt in the health professional schools, with these training grants, 

and get the individuals who are interested, and then they get experience 

as international associates and then they indicate a career desire, tha t 

we can then begin to develop a cadre of dedicated individuals for a 

career in international health. Of course there will always be that one 

tha t tried it out and decided he didn’t like it or the one that wants it 

but doesn’t really qualify.

Mr. Curtin. Are these people who you desire to recruit for these 

schools going to be trained any differently than they would be trained 

in the ordinary medical schools ?

Dr. Stewart. Yes.

Mr. Curtin. What are they going to be ta ught that is not offered 

to the reg ular student in a medical school ?

Dr. S tewart. I think that if a medical school is developing an international health training program under this training grant, they would 

start to emphasize in their training program the problems of working 

in other cultures, the ways of getting across the idea of modern medicine to a culture that is still living with witchcraft, for example. Or 

they might start getting into a kind of train ing in nutrition which is 

now no longer news in this country, or they would seek to create an 

understanding of the impact of a lack of water supply in an area and 

what might be done about it. They would teach an approach to the 

problems based on methods of helping these people do these things for 

themselves. How do we train the indigenous; how do we handle other 

cultures? This is the kind of area we are talking about.

59 -4 94 — 61 3
30 INTERNATIONAL HEALT H ACT OF I9 6 0

Dr. Lee. The type of disease problem, of course, too, differs very 

greatly.

As the Secretary pointed out in his testimony, Ihe range of problems 

faced in the developing countries differs significantly from those in 

this country. For example, m alnutrition among infants and young 

children is a very serious and significant problem. It hardly exists in 

this country.

The problems of rural medicine when there is massive poverty and 

unsanitary environments; the problems of resource allocation with 

very limited manpower and limited financial resources; under these 

circumstances what we refer to as community medicine will have much 

more emphasis.

Preventive medicine must have a much greater emphasis than in the 

ordinary clinical tra ining programs or even in the public health tra ining programs in this country. We deal with chronic diseases, with 

overweight rather than malnutrition. We deal with chronic illness 

rath er than acute infection such as malaria, smallpox, and tha t type 

of thing, so that tropical medicine, nutrition, problems related to population growth, these are the substantive, significant problems that will 

require emphasis.

As Dr. Stewart pointed out, too, the cultural problems, the sociological aspects that they must have training in, in this area, require a 

really much different type of tra ining than is required for work in this 

country.

Mr. Curtin. Does this mean you plan to s tart with 50 fellows and 

100 associates the first year?

Dr. L ee. The start, of course, would be in the schools of health and 

we might take as an example a school of public health. Health educators, sanitarians, sanitary engineers, physicians, and nurses, public 

health nurses, all might be trained and receive training overseas in the 

environment in which these problems exist as well as getting the 

academic training here a t home.

Mr. Curtin. But I mean, as I understood a previous answer, there 

are going to be approximately 100 associates and 50 fellows to start 

with ; is tha t correct ?

Dr. Lee. That is correct.

Mr. Curtin. Tha t is the first year?

Dr. Lee. That is the first year goal.

Mr. Curtin. How many additional do you anticipate in the second 

year ?

Dr. Lee. As to the associates, there would be 100 associates each year 

and this is a 2-year program. These are assigned overseas in the 

Public Health Service, so the maximum number there would likely be 

200,100 each year. You have a 2-year program so it would be 200.

Mr. Curtin. As I read the biff, there is no authorization for any 

sum for the associates or fellowships provided for therein; is that 

correct ?

Dr. Stewart. That is correct.

Mr. Curtin. I believe you said, however, th at you estimate the cost 

for the first year would be about $1.7 million?

Dr. Stewart. That is correct.

Mr. Curtin. How much is i t going to be for the following year ? 

Is the cost going to double each year? Would you seek to recruit the
INTERNATIONAL HE ALTH ACT OF 19 6 6 31

same number for the second year that you have recruited for the first 

year, and, if so, would the amount to train them double ?

Dr. Stewart. Yes.

Mr. Curtin. I s that going to keep doubling indefinitely ?

Dr. Stewart. No, it would not because the term of appointment of 

an associate would be approximately 2 years and a fellowship would 

range from 1 to 3.

If the average is 2 years in the fellowship, then it would double 

the second year, but then level off.

Mr. Curtin. Does this bill provide for a 5-year period for the fellowships and associates, or an indefinite period ?

Dr. Stewart. It would be an indefinite period for the associates and 

fellowships.

Mr. Curtin. And, have you estimated the costs—how the costs are 

going to accelerate from the original $1.7 million over the following 

years?

Dr. Stewart. We only have the figure for 1967, the $1.7 million.

Mr. Curtin. You don’t know what the prog ram will cost afte r the 

first year?

Dr. Stewart. No, sir; only as it relates to the number of associates 

and fellows, and the idea here is 150, as we mentioned before.

Mr. Curtin. There is no provision in the bill, as I unde rstand it, 

as to the ultimate maximum number of such associates and fellows ?

Dr. Stewart. That is correct.

Mr. Curtin. In other words, you could have a thousand, two thousand, three thousand, a nything th at you fe lt was rig ht in the following 

years ?

Dr. Stewart. That is correct.

Mr. Nelsen. Would the gentelmen yield at tha t point ?

Mr. Curtin. Yes, I yield.

Mr. Nelsen. On this training cost, tra ining is not what -we are t alk ­

ing about.

Dr. Stewart. The associates would be tra ining by doing. They will 

be providing a service after being commissioned in the Public H ealth 

Service.

Mr. Nelsen. After they have been trained and then have gone into 

practice, then how are they salaried ?

Dr. Stewart. They will come under the Public Hea lth Service. 

They will be commissioned officers in the Public H ealth Service and if 

they are assigned to work in the Peace Corps, for example, the ir salary 

shows up in the Peace Corps budget.

Mr. Nelsen. The salary after they have been trained will then without question continue in amount, but it will be taken out of some other 

operation o f Government ?

Dr. Stewart. Yes. This is no different tha n it is at the moment. 

Most of the 234 individuals tha t we have assigned to other agencies— 

well, for example, we have this 97 with the Peace Corps. We detail 

them, but the Peace Corps pays for them.

Mr. Nelsen. Getting back to my original observation that people 

can be trained to do these things under H.R. 12-----

Dr. Stewart. No, sir.

Mr. Nelsen. Why can’t they be assigned to the Peace Corps if the 

Peace Corps is authorized to spend money to pay their salaries ?
32 INTERNATIONAL HE AL TH ACT OF 19 66

Dr. Stewart. Mr. Nelsen, some of them may have th eir experience 

with the Peace Corps. We are tr yin g to define a group of individuals 

who are committed, as much as one can be committed, to a career in 

international health and they will have 2 years.

Some of them will be assigned to the Peace Corps as p art of their 

experience as an international associate. In addition to this, will be all 

the Peace Corps doctors fully trained, tha t we assign to carry out the 

obligations tha t we have to the Peace Corps, which are there now for 

the medical care of the Peace Corps volunteers wherever they are.

Mr. Nelsen. Thank you.

Mr. Curtin. Mr. Secretary, there have been a number of articles 

in the papers since medicare was passed—one as recently as a week 

or two ago—about the tremendous shortage of doctors tha t is going 

to result when the full impact of th e medicare program is felt.

Have you any figures to tell us what th at shortage is going to be in 

numbers ?

Secretary Gardner. No, sir. We have made efforts to project the 

shortages and we will continue to do so, but it is very difficult at this 

point to be precise about the shortages tha t will hit us.

Mr. Curtin. Could you approximate it ?

Secretary Gardner. I don’t have the figures. Perhaps the Surgeon 

General does.

Dr. Stewart. No, Mr. Curtin ; the supply of physicians really relates to the demands that people are putting on them, the number 

tha t want to go and use the physician. We do know tha t people will 

use physicians, if they have selected pa rt B of medicare, more than 

they have before. There will be an increased utilizatio n of physicians.

Mr. Curtin. Of course, there is going to be an increased need for 

physicians whether the people select part B of the medicare program 

or not.

Dr. Stewart. This is true. There will be an increased use of admissions to hospitals. We estimate tha t this increase will be of such 

an order tha t the present supply of hospitals and physicians will 

absorb this increased demand.

There will be areas where this is difficult to estimate because we 

don’t have an even distribution in our supply of physicians and hospitals, and some areas will have some difficulty. My own impression, and I can’t prove this in any way, is that on J uly 1 there suddenly won’t be long lines of people waiting to go to the hospital, but 

tha t the increase will be a g radu al affair as people learn about i t and 

as they get ill.

They won’t all get ill on July 1 either.

Mr. Curtin. Do you think we can safely assume tha t within the 

next year or two there is going to be thousands of extra physicians 

needed in this country ?

Dr. Stewart. We have difficulty in meeting all of the demands now 

for physicians. We have to draft physicians for the military services. 

We have difficulty in hiring physicians for public jobs, and for running 

mental institutions, for example. In all of these fields, and in many 

of the rural areas of the country there is a definite difficulty in getting 

physicians into the area to practice medicine now.

We have, from the H ealth Professions Educational Assistance Act, 

some 15 medical schools about to emerge. This will begin to increase
INTERNATIONAL HE AL TH ACT OF 196 6 33

the supply. Of course, it takes 10 to 12 years before a person finally 

becomes a doctor; and so this will gradually help.

There has been an expansion of the existing schools. I think we will 

meet this difficulty as we go along.

Mr. Curtin. Do you thin k this new prog ram you are now advocating will increase tha t need for doctors and further add to the shortages we presently have ?

Dr. Stewart. No, I don’t think we are talking about tha t kind 

of number, Mr. Curtin.

Mr. Devine. Will the gentleman yield ?

Mr. Curtin. Yes, I yield.

Mr. Devine. Mr. Secretary, the papers, just the last few days, indicated you are going to need literally thousands of new employees 

in the immediate futu re to administer the provisions of the Medicare Act as recently passed. Is that correct ?

Secretary Gardner. Yes.

Mr. Devine. Can you give an accurate figure that you anticipate 

on your needs there ?

Secretary Gardner. We have done a good deal of tha t recruitm ent 

already. I believe that this was in the neighborhood of 7,000, was 

it? Seven thousand.

Mr. Devine. Seven thousand. How soon ?

Secretary Gardner. Within the past year we have started recru iting as soon as the act was passed.

Mr. Devine. I believe the newspapers indicated tha t in the next 

year or so you are going to need 10,000 or more to administer the 

provisions of the act ?

Secretary Gardner. You understand tha t this is not all health personnel. In fact, a very high percentage of them are administrative 

people.

Mr. Devine. Yes. I understand that, b ut it is in the general health 

field.

Mr. Curtin. Have you any idea how many additional employees 

you are going to have to recru it for the purposes of carrying out the 

medicare program ?

Secretary Gardner. As I said, our initial estimate was 7,000 tha t 

we needed recruited immediately.

Nlr. Curtin. You haven’t estimated the ultim ate number ?

Secretary Gardner. I don’t remember the projections over the next 

2 or 3 years.

Mr. Curtin. Tha t is all. Thank you, Mr. Chairman.

Mr. Pickle. I want to compliment the Secretary for the approach 

he has taken in this area.

At this stage of the game when it gets to the second level most of 

the questions have either been answered or there is more confusion 

and I think that is p artially the situation this morning, but even at 

the risk of repetition let me ask you with reference to your own 

statement, Mr. Secretary, on page 6 when you list item No. 3: Career 

Service in Internationa l Health, how many do you envision will be 

trnined in this field?

Secretary Gardner. This is page 6 of my statement ?

Mr. Pickle. As T recall the President’s message, and as you said 

earlier this morning, in the field of associates you want to train 100,
34 INTERNATIONAL HE AL TH ACT OF 19 66

and 50 fellows. How many in the career category ? Of the 500 you 

are going to recruit, how many in tha t category ?

Dr. Lee. Dr. Stewart has mentioned, Mr. Pickle, in several statements th at he has made about the present demand for health workers 

tha t the number in the international careers program will depend on 

the program requirements, and, as the Secretary indicated, these have 

expanded. They have doubled within the past year, and it is difficult 

to say today what the requirements will be 5 years from now.

Mr. Pickle. It may be difficult, bu t it is awfully difficult for us to 

try to appropriate money with some degree of fiscal responsibility. 

About how many are you going to train ? What number of you think 

you are going to train ?

Dr. Lee. In the grants to the schools we would hope th at about 500 

students would be trained at that level. We estimate about 100 associates a year and about 50 fellows. Within the career service the estimate for next year for Public Health Service personnel is approximately 620.

Mr. P ickle. Are you saying th at you are going to train the balance 

of the approximate 500,350 then in the field of career service ?

Dr. Lee. There will be people trained each year and these will go 

in to fill these career positions as some people retire. We will strike 

a balance within a few years I think.

Mr. Pickle. You don’t satisfy me so far as being definite. I am 

willing to give you some running room. I am just try ing to get something down with respect to specific sums, because the bill provides for 

$10 million the first year and “such sums thereafter as may be 

necessary.”

That is a mighty big phrase to just toss out on the floor of the Congress. We want to be more specific—I do—if we can.

Is it your intent to take these 500 and train these numbers and 

will you give us a number of career service to be trained? Is it your 

intent this first year to train tha t many and then the same number 

for the next 4 years?

Dr. Lee. As their programs develop in the schools, the grants to 

the schools will, in part, of course, be dependent upon what they-----

Mr. Pickle. On the program to expand, and do you expand these 

numbers ?

Dr. Lee. The expansion of the program would, of course, be reviewed each year by Congress.

Mr. Pickle. What is your intent? What is the Department’s 

intent ?

Dr. Lee. The intention is to try to develop a base in the schools 

tha t would provide the number of people required, and it is difficult 

at this time, as we are just getting into the program, to say what th at 

number would be, but I would not estimate now tha t there would be 

a large expansion of the program within a few years.

I think it would stay at somewhat the same level.

Mr. Pickle. Wha t you are tryi ng to do is get the program underwav?

Dr. Lee. Yes.

Mr. Pickle. In a sense make legal what you are doing, in a ra ther 

loose sense, your training in public health. You want to make career 

public officials out of them but give them no different status so they
INTERNATIONAL HE ALTH ACT OF 196 6 35

have a place to come home to. I think the Congress would want to 

try to cooperate in this general field, but I think the Congress will 

ask you to be more specific.

Are you willing to say you will take this $10 million and tha t will 

be the same sum the next 4 years ?

Dr. Lee. As we indicated earlier, we will try to come up with this 

estimate. Mr. Moss made this request. The estimates that we will 

submit to the committee will include the 3-year program for the 

schools, for the associates, for the fellows, and for the career service in 

international health.

Mr. Pickle. I didn’t know Air. Moss asked you to have it for the 

3-year estimate, but I ask you to have it before the markup because 

I thin k that is important to us.

With respect to the sum, let us assume t hat it is the $10 million 

figure. How many schools have you said you will set up to give 

these grants to?

Dr. Lee. There has been no specific determination on that. This 

would be determined by the Surgeon General depending on the schools 

that come in, the quality of th eir request, and-----

Mr. Pickle. You did not grab the $10 million figure out of the 

air. Where did you get the $10 million?

Dr. Lee. There have been discussions during the last 3 years, 

tha t I have been aware of, with schools of public health and medical 

schools and other professional schools interested in the field of inte rnational health.

Mr. Pickle. You don’t have any idea whether you will give these 

gran ts to 10 schools o r 50 schools?

Dr. Lee. Well, I th ink it would be much more likely to be 10 than 50.

Mr. Pickle. Tha t is a little closer. We are a little more specific 

than we have been. I appreciate that.

Dr. Lee. We hope to come in with tha t estimate at the time th at we 

answer Mr. Moss’ request.

Mr. P ickle. Let us say it is 10 or 20. Let us say 15, approximately. 

Is that a fair estimate ?

Dr. Lee. Yes.

Mr. Pickle. Your degree of training would be perhaps less th an 

an M.D., but more than a 2-year course in some instances, with the 

possibility tha t associate nursing might be an exception. What you 

are trying to do is take a person then who is a graduate student. If 

this is so, when you speak in terms of school of health, aren’t you 

saying in effect tha t you might do that training a t a major university 

rather than a t a medical school ?

Dr. Lee. This would depend. The emphasis certainly would be 

on those schools t ha t had schools of public health, for example, and 

these usually also have medical schools and nursing schools, and some 

of them have schools for medical technology. Some of them have 

schools in nutritio n science, so tha t you could combine this training .

Mr. Pickle. I am thinking specifically of the University of Texas 

which is the major university within our State. It would seem to 

me tha t under the terms of the bill these public health officials mig ht 

get sufficient tr ain ing r igh t on the campus there rather than setting 

up a separate school such as the U niversity of Texas Medical School 

in Galveston, which is already limited in space and which we already 

asked to train additional doctors this last year.
36 INTERNATIONAL HE ALTH ACT OF 19 66

I am just wondering about your intent. There again, are you just 

saving it depends?

Dr. Lee. The intent is at this stage to provide the g rants to schools 

of health and these in general are within universities, of course, because 

this is where the health people in general are trained.

Mr. P ickle. T want to be sure tha t we understand each other on another point that Dr. Stewart mentioned earlier and that was if we set up 

a separate category of a trained public health official for world health 

problems, one of the reasons for it is so tha t this man has a place to 

come back to.

When he has spent 4, or 5, or 6 years he comes back to the United 

States and he has an official status with the agency. Your real purpose, of course, is alleviating problems of disease and illness and poverty throughout the world and not just give him status. In proper 

perspective this happens to be an incidental arrangement.

The emphasis was almost the other way around earlier this morning, 

and I think i t is fine to have a career status, but th at is not what you 

are asking for in this bill, is it?

Dr. Stewart. No; the career status is the means to the end that 

you pointed out. I th ink the Secretary, in his testimony, was talking 

to th at end.

Now, when we are getting into the bill we are really examining the 

means to these ends.

Secretary Gardner. May I just add one point to the career status. 

This bears on a question raised by Mr. Curtin earlier as to what is new 

in this bill.

One important thing in the career status is for them to have a place 

to come home to. Another very important point of the plan is to 

catch them young. If you want people to take on serious international assignments that are most disruptive in terms of moving your 

family and spending years in hardship posts, you really have to begin 

to get them used to it early. You have to get thei r wives used to it. 

You have to have people who see the ir career pattern as involving 

periods of such service.

Mr. Pickle. If they are trained in the schools like pharmacy, or 

medicine, or optometry, or various health fields, would these trainees 

upon completion be used as public health commissioned officers? Is 

this what I understand you were saying to Mr. Curtin, that they 

would be ?

Dr. Stewart. Yes ; they would.

Secretary Gardner. Many of them would.

Mr. P ickle. One last question: You would be limited in funds and 

numbers of schools and trainees that you can start off with under this 

program Would it be your intent tha t some particular emphasis 

should be given to those countries that are closest to us ?

Though we have a world health program, would it not be reasonable 

to assume tha t tryi ng to help conditions in Latin America, South 

America, and Mexico might more properly command first priority?

Secretary Gardner. Mr. Pickle, the final use of these people will 

depend a good deal upon the going purposes of other agencies at the 

time because these people will be available for assignment overseas for 

AID , for the Peace Corps, for the World He alth Organization, and so
INTERNATIONAL HEALTH ACT OF 19 66 37

forth, and how they are used will depend a grea t deal upon our national objectives in the year in which you happen to be talk ing about.

This will govern their use. There is not in this bill any mechanism 

for deciding direction of use.

Mr. Pickle. I can understand tha t and I think I agree with you. 

but from a practical standpoint I hope tha t if this measure is acted 

upon favorably you bear in mind that one of the priorities should be 

our neighbors to the south, and as such I assume th at if this is so, 

one of your schools would be in the g reat Southwest, such as the University of Texas.

Tha t is all, Mr. Chairman.

The Chairman. Dr. Carter wanted to know if you would yield to 

him.

Mr. P ickle. Mr. Chairman, I will yield to you and you may recognize the doctor.

Mr. Carter. Thank you, sir.

It seems to me t ha t quite an important place for the use of such 

an international agency at the present time would be in South Vietnam. 

Did you have South Vietnam in mind in the formation of this inte rnational organization of which you have been talking ?

Secretary Gardner. Mr. Carter, I have had South Vietnam brought 

quite sharply to my attention recently and I think it is a marvelous 

example of the problems we face in recruitment without a career 

service.

As Dr. Stewart indicated, it has been very difficult. I must say 

tha t this program has been long in the making and involved a great 

many considerations besides the current problem of stepping up health 

activity in Vietnam.

Air. Carter. Having seen the health situation in that area, certainly I can see the need of assistance there. With the problems of 

disease, diseases which have been eradicated here in the United States 

years ago are extremely prevalent there and, of course, men who go 

there need to have a great deal of training.

I don’t think we should confine such operations to just this hemisphere, but right now there, in winning the minds and hearts of the 

people and helping restore them to their health, certainly we are helping to win the war, or would be.

Secretary Gardner. Yes, sir.

Mr. Carter. I thin k tha t the objective of this international agency 

could certainly be helpful.

I thank you.

Dr. Lee. I might add to that. Air. Chairman, of the current requests 

for personnel, approximately half of the health personnel are requested for service in Vietnam.

The Chairman. Air. Secretary, I m ight tell you that the gentleman 

you were ta lking to is Dr. Carter who is our medical adviser on the 

committee. He is a medical doctor with a grea t deal of experience and 

we rely on him.

Secretary Gardner. Thank you, sir. Thank you. Dr. Carter.

The Chairman. Mr. Broyhill.

Air. Broyhill. Air. Secretary. I have been reading figures recently 

about world population and as I recall, the article said that in the 

mid-1800‘s the population of the world was about 1 billion, and in the
38 INTERNATIONAL HE AL TH ACT OF 19 66

next 100 years, tha t figure increased by 2 billion, tha t the present population figure is about 3 billion, and th at within the next 40 to 50 years 

the world population will increase another 3 billion. It has taken 

tens of thousands of years fo r the world to produce 3 billion people and 

it is astounding to visualize tha t 3 billion additional people will be 

living in the year 2000.

In view of this tremendous population explosion, do you anticipate that enrollees in this program will be given training in birth 

control methods and techniques and how to train other people in this 

area?

Secretary Gardner. This is now a well-established feature of international health programs. Most of the nations are keenly interested 

in the problems of population and certainly it will be a distinctive 

feature of this program.

Mr. Broyhill. Then you are saying tha t these people will be b irth 

control experts that go to these countries as advisers to various ministers and whatnot?

Dr. Lee. The people who have been involved in the programs, Mr. 

Broyhill, and who have been requested, I don’t think we would describe in that fashion exactly.

Many are people who have broad experience in public he alth administration, who are advising on the administration of overall programs.

There will be some people in obstetrics, fo r example, a professor of 

obstetrics, who might be tra ining obstetricians in specific techniques. 

There will be people who are specialists in maternal and child health 

who are providing the public health supervision in maternal and childhealth programs.

There will be health educators who are talented in the techniques of 

education of illiterate populations or populations in rural areas and 

other types of populations that might be involved in such programs. 

In every instance in which the United States has been involved, 

the programs involving family planning or birt h control have been 

within a health program context, prim arily programs to improve maternal and child health. This has been the context within which 

this program has been and will be conducted.

Mr. Broyhill. Another committee of Congress at this very moment 

is exploring ways and means to feed the world. We in this country 

have obligated ourselves in great part to protect the world from a 

military standpoint and in this committee we are exploring ways and 

means to improve the health and the lifespan of th e world. Now, it 

could be tha t we are overextending our own resources and neglecting 

our own problems here at home. But, be th at as it may, I just wonder when you consider the world population explosion, if there is 

enough work going on in research and training in the birth control 

field and I am wondering if this program on world health that we are 

talking about today will emphasize this enough. I feel very strongly 

that any such program tha t attempts to a ttack and solve world health 

problems must include population control training as an integral pa rt 

of such a program.

I am just making those comments. Maybe you may want to make 

some comments.

That is all I have, Mr. Chairman.
INTERNATIONAL HE ALTH ACT OF 196 6 39

Dr. Lee. We might just add a word on the research. There is a 

changed emphasis in the Public Health Service in the Institu te of 

Child Hea lth and Human Development. This has been reorganized 

within the last 6 months with a specific division set up to conduct and 

support expanded research programs in the whole area of human 

reproduction, which, of course, relates directly to this effort.

Mr. Broyhill. Thank you, Mr. Chairman.

The Chairman. Mr. Farnsley.

Mr. Farnsley. Thank you.

I don’t have any questions, but I am all for you. I thin k it is not 

a criticism, but, if there is anything, it is mighty little and mighty 

late. If my five children are sick, or my wife, I want help. When I 

am sick, or think I am sick, which is usually the case, I want help. 

I am ju st worried and sorry for anyone in the world that has trouble.

Bless your heart. Thank you.

The Chairman. Dr. Carter.

Mr. Carter. Thank you, Air. Chairman.

In South Vietnam, in Saigon, not too long ago I saw a medical 

school which had been built by USAF, a very fine school, by the 

way, but as I understand it there is not enough personnel to man that 

school.

Wh at are we going to do about tha t ?

Dr. Stewart. Yes; there was an announcement I believe last Monday, tha t the American Medical Association has signed a contract 

with AID , with the AMA acting as the agent, in a sense, for finding 

faculty members within U.S. medical schools to go over there and to 

begin to staff the Saigon Medical School, but, more importantly, to 

begin to train the Vietnamese faculty that will eventually take over 

the medical school.

As I understand, there is a team from the AMA going out to Saigon 

within the next week or so. We look on this as a real service tha t the 

American Medical Association is providing in this field.

Air. Carter. I know that we do have an increased demand for 

physicians going into the Armed Forces. Th at is quite evident today, 

that more and more are being drafted, that we get calls every day 

and young physicians particularly are being drafted. Do you think 

that the number of physicians you are requiring will further embarrass us in tha t respect? Will it put a greater demand upon the 

number of physicians needed ?

Dr. Stewart. No, sir; I don’t think we are talking about th at great 

a number of physicians. When we talk about health personnel we are 

talking about a whole variety of professions.

Air. Carter. Yes.

Dr. Stewart. Also, we are not talking for the most pa rt of physicians, as we visualize physicians acting in practice here. We are 

really visualizing physicians acting as, say, advisers to the minister of 

health or advisers to the dean and faculty of a developing medical 

school, or some other function different from the 1-to-l relation that 

one sees between physicians and patients so often in this country.

Air. Carter. I still think that we should do something to attr act 

more physicians to medical schools because there is going to be a 

grea ter need for physicians.

Dr. Stewart. There isn’t any question about tha t, Dr. Carter.
40 INTERNATIONAL HE AL TH ACT OF 19 66

Mr. Carter. What percentage of these fellowships will go for 

podiatrists in the international agency Will the podiatrists perform 

their usual functions in this agency ?

Dr. Stewart. I would be unable to say what proportion would go 

for podiatrists. I think it would be a small proportion, if at ail. 

Second, they would be perform ing functions mostly in public health— 

how to organize a large water supply program, or how to eliminate 

filariasis from some area, or how to develop a malaria eradication 

program.

It they are qualified for this then they would be qualified.

Mr. Carter. Actually they are not trained in tha t way. Podiatrists are foot, doctors.

Dr. Stewart. Yes.

Mr. Carter. It would be quite unusual for them to expand into 

tha t area.

Dr. Stewart. I think it would be, but there may have been one 

who has gotten interested.

Mr. Carter. It is highly improbable, I would think, sort of on the 

outer fringe. At least we see the need now in many, many places of 

this agency, there is no doubt about it, and the amount of moneys as 

I see in this, while, of course, we are putting more and more in dif ­

ferent things, comparatively speaking it is not too much.

Ten million dollars is a lot of money, but in comparison to the 

amount of money we are using in other agencies for different things 

for help of less importance it is only a drop in the bucket, I should 

think.

Thank you, Mr. Chairman.

The Chairman. Mr. Watson.

Mr. Watson. Thank you, Mr. Chairman.

Mr. Secretary, I am sure th at everyone on this committee shares the 

thinking of our colleague, Mr. Farnslev, tha t certainly there is no 

more important need than tying to eradicate disease unless perhaps 

it would be to feed the hungry mouths throughout the world, but 

I think we all should be aware of the fact that we are not going to 

be able to do it totally.

Would you not agree with me that this very modest appropriation 

of $10 million, even if it should jump to $100 million the next year, 

would virtually be as trying to dam the ocean with a shovel?

Secretary Gardner. It is a modest sum. I think tha t you have to 

keep in mind the great leverage which I mentioned earlier. We are 

not thinking in terms o f doctors to man a 1-to-l patient relationship 

with the sick people of the world.

We are thinking of advisers. We are thinking of people who go 

in and serve as the sparkplugs, for all the technical assistance rightly 

done involves this kind of leverage, the kind of teaching, the kind of 

starting of something tha t permits a small number of personnel to 

achieve a great result because they bring with them a great backlog 

of know-how.

I agree with you t hat the total need is very, very great, but as I 

observe the programs which exist to date, with the verv modest numbers of personnel available and the variable quality of those personnel, 

T think that this program represents a great advance. Even as to 

tha t number of 50 fellows that we mentioned, if I could set? 50 first-
INTERNATIONAL HE ALTH ACT OF 19 6 6 41

class people going into making a career training in this field each 

year I would be very pleased.

Mr. Watson. Mr. Secretary, I notice in the preamble in section 2 

of the bill you state an objective of tryin g to provide our share of the 

health workers.

Wh at is our share ? This is page 2 of th e bill. What is our share ? 

If we can relate tha t to page 4 in the first par agraph of your testimony where presently we are providing one-third of the funds for 

the World Health Organization and for the Pan American Health 

Organization, apparently one-third is inadequate. Wh at is our share ?

Secretary Gardner. I don’t think that I could answer th at question 

and I don’t think there is any figure or any standard that you can set.

I think tha t in the multilateral organizations we probably should be 

supplying a high er percentage of the personnel th an we are supplying 

to date: the reason we are not is that we soak up our own health 

personnel in domestic needs very heavily.

Mr. Watson. I don’t want to belabor this point, but it really disturbs me. As I have listened to the testimony I believe the doctor 

has pointed out that the principal difference between internatio nal 

health and national health is the matter of the severity of the need 

in other countries and your custom and language barrier. Is tha t 

not basically it?

Secretary Gardner. This is very true.

Mr. Watson. Malaria here is the same as m alaria other places. I 

can understand the difference in cost, but basically the difference 

between national and international is a matter of language barriers, 

customs, and the severity of the need.

Is tha t not correct?

Secretary Gardner. This is quite true, although in these developing nations a medical man will run into far more problems—the phy ­

sician or sanitary engineer—than he would encounter here.

Mr. W atson. Tha t would relate to th e severity of need.

That brings me to the next question in the depressed areas. I have 

heard the name Peace Corps used quite often, so app aren tly this is a 

postgraduate program for members of the Peace Corps when they 

fulfill their term, and I am not objecting to that because they have 

done some invaluable service, bu t the thing that disturbs me is why 

is it necessary for us to send or tra in American people, first, in the 

language; second, in the customs and traditions of the area, when 

a native would have better acceptance in the country than would 

an American.

We inject ourselves in so many countries now, perhaps that is a 

contributing factor to so many of the problems. Why don’t we bring 

these natives over here who do no t have the barrie r of the language, 

who do not have the b arrier primarily of th e customs, and t rain them 

and send them back to try to meet these health needs ?

It seems axiomatic to me t ha t that would be the prop er approach 

to it, but maybe I am oversimplifying it.

Dr. Lee. Mr. Watson, as I indicated earlier, we have trained for 

the last 20 years a large number of health workers in various disciplines from many countries. They have returned to their own countries as teachers, administrators, and in positions of leadership, but 

it is a total approach.
42 INTERNATIONAL HEALTH ACT OF 19 6 6

It is a combined program. There isn’t one single approach such 

as training other personnel in this country. The main effort, of 

course, has to be to build up their capacity in their own countries to 

solve their own problems and we can make an essential contribution 

to tha t partly through training the ir people here, partly throu gh a 

limited number of highly trained Americans working abroad.

Mr. Watson. What would be a bette r way to build up that country ’s capacity than to train its own citizens, rath er than to send an 

American over there?

I think we are really missing the boat on this. Perhaps it is too 

elementary and I am missing the mark, but I would like you to amplify 

tha t a little bit.

Secretary Gardner. Let me say that we are doing this. We are 

doing just exactly what you would have us do and have been doing it 

for some time.

Mr. Watson. But, Mr. Secretary, this program doesn’t include an 

expansion of that training of local people. It only includes the train ­

ing of Americans, and tha t is the point I can’t understand.

Secretary Gardner. What we have discovered is tha t over and above 

the training which we have been doing and must continue to do of 

foreign nationals whom we send back to work on th eir own programs, 

we must at all times have at our own disposal a career service to serve 

the purposes which this Nation regards as important at any given 

time.

When we decide in our national interest and to serve the purposes 

tha t Congress and the American people want to serve we must send 

surgical teams to Vietnam, we cannot pick up various foreign nationals whom we have educated in the past and say, “Go to Vietnam.”

We can in the Public Health Service and send some surgical teams 

to Vietnam, and tha t is th eir duty.

Mr. Watson. Mr. Secretary, you must understand tha t Vietnam 

is a rather unusual situation now. Even in that connection I have a 

doctor in my district, a young man, who is eligible for the dra ft and 

has been so notified and he is now awaiting call and has sought my 

assistance in tryin g to expedite the call in order to go over there and 

serve.

However, the thing tha t disturbs me is you say that we will need 

these trained Americans in order to meet our demand in the international health field.

Is it not axiomatic that our demand would lessen in proportion to 

the number of trained indigenous or local natives tha t we train ?

Secretary Gardner. Yes, sir ; it is.

Mr. Watson. Why don’t we approach it from t hat angle at far less 

cost th an the matter of training our own people and the doctor and 

his family have to go over there and still face the b arriers ?

Dr. Lee. In the foreign aid program there will be a request to double 

or triple the funds to expand training of health manpower in the developing countries. That authorization exists in the Agency for International Development and the funds will be requested by AID in their 

presentations to the Congress. That is where tha t segment of the 

program will be handled.

Mr. Watson. Should not tha t properly be handled throu gh this 

Department throu gh the program tha t you started here ? Where will
INTERNATIONAL HEALTH ACT OF 196 6

same schools of health I guess.

Dr. Lee. There is a limited number of foreign physicians, erayaeers, 

and others who are train ed in our schools of public healt hp*qg%xK>^^/

ample, at John s Hopkins where they have an outstanding interfla 2"

-11^ 

tional division for training. They will be trained at such schools.

They will re turn to their own countries and initiate or expand existing 

programs there. In many countries we have trained the key leaders in 

medical schools, nursing schools, schools of public health.

We have helped to establish those schools with foreign aid funds, 

and the reason it isn’t in the Department of Health, Education, and 

Welfare is because we are not in th at business.

There is the State Department and the Agency for Inte rnationa l Development and they have carried out those programs in the past and 

continue to do so.

Mr. Watson. Doctor, vou say you are not in tha t business? As I 

recall, there are 234 commissioned health officers now serving thro ughout the world. You are not in that business ?

Dr. Lee. We detail people to other agencies.

Mr. Watson. But you initiate it, I assume.

Dr. Lee. The request comes from the Agency for Internationa l 

Development for many types of health personnel. The requests from 

the Peace Corps are particularly fo r medical officers to provide health 

protection and medical care for the volunteers.

Mr. Watson. But you supply th e health officers I assume, or so far 

as you are able to ?

Dr. Stewart. That is correct.

Mr. Watson. From these requests from the other agencies, so you 

can’t say you are not in the business, and in a very substantial manner,

234 commissioned officers.

Dr. Stewart. We are not in the business of supporting nationals 

of other countries for training in this country. I think tha t is w hat 

the doctor meant.

Dr. Lee. Yes.

Mr. Watson. You do not feel th ere is any duplication in this bill 

with the Health Professions Educational Assistance Act we passed a 

year ago ?

Dr. Stewart. No, sir.

Mr. Watson. You believe the mere creation of this program will 

give added incentive to these young people to enter the health service 

that they would not have under existing programs ?

Secretary Gardner. Yes, sir.

Mr. Watson. If they are interested in international health and we 

have broad educational benefits under this professional health service, 

the National Defense Education Fun d, what is i t otherwise th at they 

will need in order to incite them? You stated earlier tha t we have 

so many young people who are not interested in domestic health fields, 

but are interested in international health fields.

Did you not say tha t, Doctor ?

Dr. Stewart. Yes. Und er the health professions bill.

Mr. Watson. That is right. Help me to understand what is there 

in this program tha t would encourage them if they have such an 

interest over and above what we presently have in existence.
44 INTERNATIONAL HE ALTH ACT OF 19 66

Dr. Stewart. Presently, let me say in the medical field, for the man 

obtaining his M.D., he may be at a medical school t hat does not have 

any program of international health whatsoever.

Mr. Watson. Yes, but if he is interested in international health he 

would go to t ha t school.

Dr. Stewart. There are very few which have a program designed 

for international health. Some may have one or two aspects of it, 

but they have not concentrated on the whole. This is the purpose of 

a great pa rt of this program.

Beyond t ha t when a man graduates and finishes his internship, he 

has now no way of entering a career service in international health 

tha t he might be interested in at the present time.

Mr. Watson. You are in it through your program. You have 234.

Dr. Stewart. He can apply for a commission in the Pu blic Health 

Service, but we cannot say that by doing so and so he can look forward 

to a career in international health.

Mr. Watson. Obviously with the demands tha t you have, and you 

say they are great, any young man grad uating from one of these 

schools you could use righ t now, couldn’t you, Doctor?

Dr. Stewart. Yes, but we have demands for staffing in 52 Indian 

hospitals, and in other general hospitals, and everywhere else, too, and 

most of this is the international program. We do have the ability 

of detailing on request from other agencies. We try to meet these 

details as well as we can.

Mr. Watson. I want to say again that I think the substance of the 

program is good, the objective, but I think the mechanics are very 

impractical. I think we are approaching it from the wrong angle. 

We are going to get into trouble. We are going to have a further 

drain upon our own shortage of health officials, and officers, and personnel, and it would be far better to do the job by tra ining these locals 

and do it a t far less expense because all we would have to do is bring 

them over there, train them, and then let them go back.

I assume they are interested in the health of th eir own people, and 

I thin k it would be rather difficult for us to go over and try to reindoctrinate them in the health o f their people if they are not presentlv 

interested.

Thank you very much.

The Chairman. I s that all, Mr. Watson?

Mr. Watson. Thank you, Mr. Chairman.

The Chairman. Mr. Secretary, we deeply appreciate you and your 

associates here taking the time to provide us with this information. 

You have been very informative to the committee.

I believe there was one specific request t ha t you brin g back to the 

committee a 3-year estimate. If you will give th is to us we will appreciate it because th at has been the policy of this committee through 

the years, not to have open end authorizations, and for Congress to 

come back and take a look at these programs as the time goes by.

Again I want to compliment you and to say that you and your 

associates certainly have done a very able job in presenting your 

case. We wish you well.

Secretary Gardner. Thank you, Mr. Chairman.

The Chairman. This committee will stand adjourned until tomorrow at 10 o’clock. As our witnesses we will sta rt off tomorrow with
INTERNATIONAL HEALTH ACT OF 19 66 45

those that should have been heard today, Dr. E rnest L. Stebbins, dean 

of the School of Hygiene and Public Health, John s Hopkins University; Dr. Thomas Hun ter, chancellor for medical affairs, University of Virginia, and chairman of the Committee on Internationa l 

Medical Education Association; Warren Zeph Lane, M.D., the Norwalk Hospital, Norwalk, Conn.; and Mr. David Whatley, Washington, D.C.

If any of you gentlemen are present and wish to present your statement for the record, you might do tha t at the present time, bu t if you 

wish to come back tomorrow at 10 o’clock you will be heard first before the others will be heard.

The committee will adjou rn until tomorrow at 10 o’clock.

(Whereupon, at 12:36 p.m. the committee adjourned until 10 a.m. 

Wednesday, F ebru ary 16, 1966.)

59 -4 94 — 66------ 4

INTERNATIONAL HEALTH ACT OF 1966

WEDNESDAY, FEBR UARY 16, 1966

H ou se of R ep re se nta ti ves ,

C om m it te e on I nt er st at e an d F or eign Com mer ce ,

Washing Ion, D.G.

The committee met at 10 a.m., pursuant to recess, in room 2123, 

Rayburn House Office Building, Hon. Harley O. Staggers (cha irman) presiding.

The C h a ir m a n . The committee will come to order.

Yesterday when the committee adjourned we had not heard all the 

witnesses scheduled on H.R. 12453, known as the International H ealth 

Act of 1066. When we adjourned the next witness to be he ard was 

Dr. Ernest L. Stebbins, dean of the School of Hygiene and Public 

Health of J ohns Hopkins University, Baltimore, Md.

However, we have with us at this time our colleague from Minnesota, 

the Honorable Donald Fraser, who wishes to make a short statement. 

You may proceed Mr. Fraser.

STATEM ENT OF HON. DONALD M. ER AS ER , A RE PR ES EN TA TIVE IN 

CONGRESS FROM TH E STA TE OF MIN NES OTA

Mr. F ras er. Mr. Chairman, members of the committee, I am happy 

to give mv enthusiastic support to H.R. 12453, the Intern ational Health 

Act of 1966.

I was very much impressed by the following language in President 

Johnson’s message on international health.

Control or eradication of animal diseases could increase the meat supply by 

more than 25 percent in a number of developing nations. As many as threefourths of the rural population suffer from debilitating diseases that originate 

in animals.

Here certainly is a challenge to the United States where we have 

learned to control diseases in animals so that they will not spread to 

people who must handle animals nor to the consumer of milk. I would 

certainly hope th at the In tern atio nal Health Act of 1966 will be broad 

enough "to address itself squarely to this problem.

Certainly a greatly expanded dollar figure would be necessary if we 

really intend to have an im pact in this typ e of health activity.

In" addition, it is not enough fo r us to only tra in doctors and nurses 

to treat the people after they become ill. If we are wise, we will 

train the veterinarians who can go overseas and help establish proper 

disease control and proper steps for eradicating these debilitating diseases. In addition, our veterinarians can help train local people 

to become veterinarians.

Diseases transmitted directly from animals—such as rabies—and 

those spread by consuming contaminated food—such as tuberculosis,

47
48 INTERN ATIONA L HEA LT H ACT OF 1966

brucellosis, and tapeworms—need the expert skills and training of 

veterinarians to provide maximum health protection for the people.

For these reasons, I was most impressed by the statement of the 

American Veterinary Medical Association in support of H.R. 12453. 

It says, in p art :

The social and economic progress of a developing natio n depends first of all 

upon th e health and vigor of its human population. Human hea lth and welfare 

depend to a very great extent upon the adequacy of man’s food supply and the 

effectiveness of measures to protect his hea lth. Stable institu tions cannot 

be expected to m aterialize among sick a nd hungry people.

That certainly is an excellent statement of the problems we face in 

tryin g to bring political stability and economic progress to the underdeveloped nations.

I am convinced that the International Health Act of 1966 can be an 

important means of advancing our foreign policy. I certainly feel 

that veterinarians should be among the health professions covered 

in this legislation.

The Chairman. Thank you for your views Mr. Fraser.

Mr. F raser. Thank you for the opportunity, Mr. Chairman.

The Chairman. If there are no questions we will now hear from 

Dr. Stebbins. Doctor, would you take the stand please, sir, and you 

may proceed. You may insert your prepared statement in the record 

and give it extemporaneously, or do as you please.

STATEMENT OF EENEST L. STEBBINS, M.D., DEAN, SCHOOL OF

HYGIENE AND PUBLIC HEALTH, JOHNS HOPKINS U NIV EES ITY

Dr. Stebbins. Thank you, Mr. Chairman.

I want to first express my appreciation to the committee for this 

opportunity to testify concerning H.R. 12453. I am here not in my 

capacity as dean of tiie school of public health, b ut rather as a representative of the American Public Health Association of which I am 

president, and the Association of Schools of Public Health. I would 

like to submit the statement of the American Public Health Association along with my own prepared statement.

(The material referred to will be found at the end of Dr. Stebbins’ 

testimony.)

Both of these organizations have taken the position of support for 

legislation for the development and improvement of the international 

health activities of the U.S. Government. Our activities have involved 

international relations in the health field for many years.

Since the beginning of the American Public Health Association 

over 90 years ago it has had an international flavor in tha t Canada 

and Mexico have been a p art of the organization. For example, each 

year a vice president is named from our Canadian membership and 

from our Mexican membership. The two associations have also been 

closely related with the various activities of the U.S. Government in 

the international health field, at the present time working closely with 

AID as well as with the U.S. Public Health Service in its broad international interests.

I would like to comment on three points: First, the importance of 

health in international relationships; second, the importance of this 

legislation in furth ering the development of our Government’s activi-
INTERNATIONAL HEALTH ACT OF 19 66 49

ties in international health grow th; and, finally, the advantage to the 

United States tha t would result from the enactment of th is legislation.

In doing this, with your permission, I would like to draw somewhat 

from my own personal experience.

Over the last 35 years I have been involved in a number of in ternational programs sponsored by the World Health Organization, Pan 

American Health Organization, and the various foundations, pa rticularly the Rockefeller Foun datio n and the Ford Foundation.

In the various capacities in which I have served I have had an opportunity to observe the impact of our Federal Government health 

assistance to other nations, particularly the developing nations, and I 

have been impressed with the acceptance by the peoples of underdeveloped countries of these activities on the part of the Agency for 

International Development.

In many instances where there has been evidence of anti-American 

feeling, the health activities have been given high praise by the same 

groups tha t have criticized other phases of our international policy.

In other words, I believe tha t the corps of international health 

workers would in essence be ambassadors of good will for the United 

States. I have seen so many examples of this in various par ts of the 

world.

Another important consideration I believe in the development of a 

career corps of international health workers, which would be provided 

by this legislation, is the advancement of other aspects of our aid 

program.

There are innumerable examples of where the health program of 

our Federal international agencies have been effective in improving 

the general condition of the population.

The control of such diseases as malaria, schistosomiasis, m aln utrition, has materially contributed to the economic development in the 

countries where these activities have been carried out.

Ju st to cite two examples, one in the Amapa territory on the Amazon. 

It was impossible to develop a very rich source of manganese which 

was of vital importance to tha t country, Brazil, and to the United 

States.

It was not until a health program was developed by a g radu ate of 

one of the schools of public health in this country t hat it was possible 

to fully develop this very majo r economic resource for that country 

and to supply urgent needs to our country for th at product.

Fo r example, it was economically unacceptable to the people in B razil who were to develop this resource because it required three times 

as many railroad workers to operate the railroad that carried the ore 

from the site to the ports from which it would be shipped. When 

malaria was eradicated from tha t particu lar section of the country, 

they were able to reduce the number of persons that had to be employed in order to have personnel healthy enough to operate the rai lroad at one-third the previous number.

This has been extended to broad health services for the workers in 

this industry and it is a th riving industry pro viding greatly increased 

resources for the country.

Another example is in the rubber industry. During World W ar I I, 

as you all know, there was an urgent need fo r an increased supply of 

rubber to meet the war needs.
50 INTERNATIONAL HEALTH ACT OF 19 66

It was impossible to produce this rubber without providing health 

services because the rubber workers were constantly ill with the various 

diseases tha t were endemic and epidemic in tha t part of the world.

Another indication of the importance of our participation in international health work is the desire expressed on the part of the peoples 

of the underdeveloped country for improved health conditions.

In India not long ago in a community in which we have been working 

for a grea t many years the villagers were asked to name the things 

tha t had meant the most to them during the period of our assistance 

to the community. In every instance health factors, such as improved 

water supply, the development of health clinics, the provision of services for population control, were listed highest by the people who had 

been served by various programs to improve th eir lot and provide for 

the development of their economic resources.

I feel very strongly tha t in no other field do we have more opportunity for the development of good, friendly working relationships 

with the peoples of the underdeveloped countries than in the field 

of health.

It has been said tha t health work detracts nothing from those who 

give it and it is an unadulterated blessing to those who receive it, and 

this is reflected in the attitudes of the peoples of the developing 

countries.

I would like to comment on the specific provisions of this bill and 

why I believe, and the two associations th at I represent believe, that 

it is extremely important.

Over the years I have observed the difficulty of the various AID 

agencies, whether ICA or AID, in recruiting competent health workers 

to go into the sometimes rather unpleasant areas where our international health programs have been carried out.

One of the difficulties was that they would go for a period of 2 

or sometimes more years and then -would return to the United States 

where, having been separated from their professional colleagues for 

a period of time, they found it very difficult to get back into their 

professsional work.

This has led some of them to continue in international health service 

because they could not readily readjust to practice in this country.

Another reason that I believe that this legislation is extremely 

important is t hat this would provide a highly trained corps of Public 

Health Service personnel that could be assigned to various parts of the 

world.

The problems of the developing countries, while n ot identical, certainly are similar and the experience in one underdeveloped country 

is o f tremendous value in working in another. The health problems 

in the underdeveloped or developing countries are quite different from 

those of the United States for which special tra inin g is needed. The 

development of a career service in this field will do much to improve 

the quality of the service that we can give and the effect of our health 

assistance to the developing countries.

Ju st to give you an example of the difference in the training that 

is needed, in the United States we have 1 physician for every 700 of 

the population, or approximately that. In many of the developing 

countries there is 1 physician for 40,000 or 50,000 people and his role 

is quite different under those differing circumstances.
INT ERN ATION AL HEA LT H ACT OF 19 6 6 51

The same is tru e of the oth er he alth professions. Th ere is a tr emendous difference between the av ail ab lity of denta l servic es, nu rsing 

services, engin eering services, in the dev elopin g countries so th at a 

quite different appro ach mu st be ma de to the pro blems o f these countri es tha n w ould be made in th is cou ntr y.

An othe r problem th at we have in pr ep ar in g intern ationa l healt h 

wor kers is th at ma ny of th e diseases th at a re of prim e concern in the 

develop ing cou ntries, such as cholera , kw ash iorkor, vario us pa rasit ic 

infe ctio ns, do no t exi st in the Uni ted State s and I th in k it un de rsta ndable th at lit tle a tte ntion is giv en to the se diseases in o ur medical 

schools unless the y are delibera tely trai ni ng p eople fo r serv ice in the 

dev eloping countries.

One o f th e im po rta nt a spects of ou r intern ationa l he alth activ ity is 

the assistance to th e dev eloping n ati on s in dev eloping th ei r own tr ain ­

ing program s. Most of the em erg ing natio ns wa nt to have medical 

schools. Th ey wan t to h ave nu rsing schools, engin eerin g schools.

Th ey h ave trem end ous difficulty m staffing by in dig enous person nel 

because they haven’t been tra ined . Th e lack of trai nin g is a very 

serio us pro blem, and one of the thing s th at ou r in tern ationa l healt h 

effo rts have done is to s upply fac ulty fo r these schools u nt il such tim e 

as they can grad ua te th ei r own we ll-traine d per son s to fill these 

positions.

F or exa mple, in Nigeria abo ut h al f of the facu lty o f the Universi ty 

of Lagos came fro m outside of the country because there were no t 

trai ne d Nigerians to hea d the vario us de pa rtm en ts of the med ical 

school.

We hav e an exchang e p rogram i n which our facu lty a re as sis tin g in 

th e development of the prog ram of trai ni ng in preventive med icine 

wh ich is so v ita lly im po rta nt to a country th at has so few p hysician s 

an d o ther hea lth personnel.

W ith a c areer service in internationa l he alt h such as w ould be made 

possible by thi s legisla tion the Pu blic Hea lth Ser vice could assign 

persons with a hi gh degree of tra in in g in th ei r own sp ecialty fields, b ut 

also with an un de rst an din g of the sp ecial pro blems of the develop ing 

countries.

Th is is true in a n um ber of fields and I w ould like to emphasize th e 

nee d fo r trai ni ng in po pu lat ion dynamic s, po pu lat ion control. Ma ny 

of the emerging nations recognize th at th eir most serious problem is 

overp opula tion and it is im po rta nt t hat the re be a new kind of he alt h 

wo rker specially tra in ed to assi st in the dev elopment of pro gra ms 

of population control.

Th e adv ant age s to th is co un try : In the firs t pla ce we need, as was 

pointed ou t yesterda y, p ersons kno wledgeable in th e problem s o f i nt er ­

na tio na l hea lth. Our own qu aran tin e activitie s are beco ming more 

an d more im porta nt.

W ith rapi d tran sp ortatio n, p eople can im po rt th ese r are and exotic 

diseases into the Un ite d State s in such a short perio d th at the incu bation of the disease wou ld no t hav e tak en place, the sym ptoms would 

no t be ap pa rent, and we will undoubted ly have the intro ducti on into 

th is country of many of th ese exotic diseases th at ha ve been conside red 

no longer im po rta nt in the Un ite d Sta tes. W ith a tra ined corps of 

Publi c He alth personnel knowledgeable in thes e fields we will benefit 

in the prote ction of o ur own peoples.
52 INTERNATIONAL HE AL TH ACT OF 19 66

AA e need people with this type of training for some of the newer 

programs of the Federal Government, the poverty program, the Appalachia program, the Indian health services, which have been in the 

past most inadequately developed. Persons trained in this field would 

be of tremendous value in these programs.

I would like to make one or two comments on questions that were 

raised ye sterday: Why not bring all these people to the United States 

for training ?

The tremendous number of health w’orkers that are required for the 

developing nations would completely swamp our schools. We couldn’t 

possibly train all the nurses tha t would be needed in all the countries 

that need them.

Therefore, what we would hope would result in stimulation of the 

development of training schools in these other countries, benefiting 

from the advice of experienced and competent people from the U.S. 

Public Health Service assigned to these programs.

True, we do train many health workers in this country. As you 

know, we depend very largely on the graduates of foreign medical 

schools to staff, in terms of interns and residents, some of our hospitals 

in this country and they do get trainin g tha t would be of great value 

to them on their return to their own countries.

Unfortunately, many of them want to stay in this country and a 

rath er surprising proportion of the newly licensed physicians in this 

country are coming from other countries.

And, you have heard the complaints of the brain drain from the 

developing countries. Still, we want to tra in as many of them as 

we can.

In the schools of public health 30 percent of the grad uate students 

in public health for a number of years have come from other countries 

and they go back to their countries and become leaders.

In India, for example, the Minister of Health and the Director 

General of Health and the Assistant Director General of Health—all 

of them had train ing in the School of Public Health in Baltimore. 

They are leaders in their field, and this could be cited for other schools 

of public health throughout the world. We want to continue this and 

this is something tha t is especially important in this career program 

of the Public Health Service.

I would like to just read the last paragraph of my prepared statement because I think th at it is an important consideration in reviewing this legislation.

To sum up, the development of a career service and training program in international health will enable the United States to fulfill 

its role of extending the benefits of modern medical science to the 

peoples of the developing nations of the world. In my opinion, it 

will be a major step toward international understand ing and eventually world peace.

Thank you, Mr. Chairman. If there are questions I would be glad 

to answer them.

(Dr. Stebbins’ full statement and tha t of the American Public 

Health Association follow:)
INTERNATIONAL HEALTH ACT OF 19 6 6 53

Statem en t of Db. E rnes t L. Steb b in s, M.D., D ea n, S ch oo l of H y g ie n e an d

P ubli c H e a l t h , J o h n s H o p k in s U n iv er si ty, R epr esen tin g t h e A m er ic an

P ubli c H ea lth A ss ocia ti on an d t h e A ss ocia ti on of S ch oo ls of P ubl ic

H ea lt h

I am Dr. Erne st L. Stebbins, dean of the Johns Hopkins School of Hygiene 

and Public Health. I wish to speak in support of House Resolution 12453 

introduced by Congressman Staggers. I represent the American Association 

of Schools of Public Health as the past presiden t and the American Public 

Health Association as the current president. My 35 years of experience in 

the health held includes service as health commissioner of Henrico County, 

Va., and assi stan t commissioner of the New York State Health Department, 

and h ealth commissioner of New York City.

In the field of intern ational health, I served as consultant to the health 

activities of the American Military Government in Italy during World War II, 

and served as a consul tant to the Armed Forces in Korea during the Korean 

war. I have served as a consul tant to health projects in the Philippines, 

Brazil, Nigeria, Turkey, Ethiopia, India, Pakistan, Yugoslavia, Germany, 

Greece, and Italy. I am a member of several world health organization 

expert committees and have served as U.S. delegate to the World Health 

Assembly. From this background, I would like to present the following 

facts th at may be of use to you in your deliberations on House Resolution 

12453.

There are three main points which I wish to stress. First, the importance 

of intern ational health activity to the United States. Second, the specific 

need for this traini ng bill, and third, the importance of this train ing bill for 

the field of h ealth in the United States.

Good health is universally and urgently desired by all people. You, as 

representatives of the American people, have recognized the demands of your 

constituents for improved health services and facilities. The desire for better 

heal th is equally as evident in the developing nations. In India, a recent 

village survey indicated th at health clinics, wat er supplies, and malaria control were invariably among the most urgent needs expressed by the villagers.

The universa l importance of health services was also demonstrated in Vietnam, where in the initial phases of the war, Government malaria spray teams 

were permitted to enter Vietcong controlled areas as the Vietcong recognized 

the importance of this healt h service to the villagers. As the war progressed, 

the Vietcong realized tha t this service was so effective tha t it was gaining 

support for the Free Vietnamese Government. For this reason, they then 

chose to block the malaria eradication work in the areas they controlled.

Not only are health services urgently desired by all the world’s people, but 

healt h services often spur economic development. A familiar example is the 

building of the Panama Canal, where uncontrolled disease defeated the best 

efforts of an expertly engineered, well-financed, well-directed, French attem pt 

at canal construction. In marked contra st was the success story of the American canal construction made possible by the well-planned and extensive health 

program under Dr. Gorgas. Present-day indu stria l development is replete 

with similar examples. I will mention only the joint Brazilian-American 

project for manganese mining in the backward, pestilential Amapa terr itor y 

along the banks of the Amazon. Here, the development of the world’s richest 

supply of manganese ore was made possible by an effective, comprehensive 

health program. This health program was designed by a Brazilia n gradu ate 

from one of our American schools of public health who insisted tha t the health 

of the workers was essential for the development of this unique natura l 

resource. Time ha s proved this health expert right. Today, much of the profit 

of the Icomi Corp, is being plowed back into Amapa terr itor y in a broad 

program of education, agricul ture, and community development.

The United States has the innate capacity to make the benefits of modern 

medical science available to the people of the developing na tions of the world. 

In terms of financial resources we are the wealthiest Nation in the world. Fa r 

more important than this in terms of resources of dedicated young men and 

women with good basic education, we are so well endowed tha t we can afford 

to help in the improvement of the health of mankind throughout the world.
54 INTERN ATIONAL HEA LT H ACT OF 1966

This leads us to my second point, the needs for this training bill. Although 

there is no lack of dedicated young men and women with real inte rests in 

internatio nal health, there is a real shortag e of workers with the special tra ining necessary for work in this field. As an example of this inte rest, large 

numbers o f medical studen ts inquire at our school for information on oppo rtunities for work in intern ational health. The Smith, Kline & French Co. offers 

trav el fellowships to medical stud ents wishing to work in developing nations. 

Invaria bly there are many more requests than this company can answer.

In the past, efforts of the Agency for International Development in the field 

of hea lth have often been limited by the lack of qualified expe rts. It is easy 

to see why young physicians with training in public hea lth are reluctant to 

enter AID service, for there has been no sense of continuity, no career. As 

the Agency for Int ern ational Development, the Peace Corps and other governmental agencies expand the ir programs in health, nutrition , and family planning, 

we must provide the needed tra ine d manpower to staff these programs. The 

Public Hea lth Service must provide a career development prog ram to offer welltrained physicians some sense of secu rity and the chance for professional 

advancement.

The U.S. role in inte rna tional health is not new. The American 

medical missionaries have been working in foreig n fields fo r over a century. 

The Rockefeller Foundation has been carryin g out its intern ational hea lth 

program for over 50 years. These agencies have learned thro ugh experience 

th at they must provide trainin g facilities and opportunities in the career service 

in orde r to have successful programs. Examples of the provision of training 

facilitie s are the medical school of the Seventh-day Adventists and the broad 

supp ort of the Rockefeller Foundation to the development of schools of public 

hea lth in the United States. We have much to learn from the splendid example 

provided us by the Rockefeller Foundation.

Of most immediate urgency in the intern ational hea lth field is the problem 

of rapid population growth. The field is so new th at our gre atest deficiencies 

a re in terms of personnel who h ave the knowledge to pioneer the new approaches 

that are needed. Associated with this is the major field of nutrition and the 

evident lacks that have appeared in our ability to meet the needs of providing 

app ropriate qua lity as well as quantity of food for the rapidly increasing 

numbers of people in the developing countries.

The thi rd and final point is th at our “bread cas t upon the waters in the field 

of intern ationa l hea lth training will be return ed to us.” International health is 

one of the most attra cti ve roots for recruitment of young physicians and nurses 

to the field of public health. With our expanded responsibilities for medicare, 

and the prov erty program, we will have a great demand for persons with career 

commitments and good basic training in the fields of public health and community medicine. Pa st experience has shown th at persons retu rning from 

foreign service frequently enter the service of our Sta te and local health programs. The U.S. Public Health Service programs, such as foreign qua rantine , 

the Indian service, development of health programs in Appalachia will all 

benefit from the retu rning young men and women who have received experience 

in hea lth programs in the developing nations.

In closing, I will point out th at we in the United States owe a gre at debt to 

other nations for the high level of hea lth in this country. All of our early 

medical schools were founded by graduates from schools in Europe. Much of 

our whole public health movement is based on concepts developed abroad.

To sum up, the development of a career service and training program in inter ­

national hea lth will enable the United States to fulfill its role of extending the 

benefits of modern medical science in th e peoples of the developing n ations of the 

world. It will, in my opinion, be a major step toward intern ational und erstanding and eventually world peace.

Sta tem ent of t h e A m er ic an P ubl ic H ea lth A ss oci ation

The legislation which you are now considering is, in our opinion, one of the 

most imp ortant to come before the Congress in many years. It forsees the joining of our forces in an attem pt to, as President Johnson sa id : “reduce the incidence of these diseases through new knowledge and more complete utilization 

of the medical knowledge we alre ady have.” The promise of wh at can be accomplished to improve the health and well-being of world citiz enry and the opportunity it provides for better relations between the United States and foreign
INTERNATIONAL HEALTH ACT OF 196 6 55

countries through improved health conditions mandates most careful study and 

consideration of this proposal.

The American Public Health Association, whose members are actively concerned with the prevention and control of diseases throughout the world and 

whose membership includes physicians, scientists, nurses, and medical care 

administrators, among others, is, as you are undoubtedly aware, extremely 

interested in health needs the world over. We are proud of the health care 

provided to U.S. citizens. This pride only intensifies our inte rest in health 

conditions everywhere. Our association has been convinced for some time that there is fa r too large 

a gap between medical and scientific discoveries and their application. We in 

the United States are priviledged to enjoy among the best medical care in the 

world. At the same time, however, due to poorly or inadequately trained personnel and an inadequate supply of health facilities, other nations are paying a 

terrible price in human life, human suffering, and financial loss. We must find a 

better system for train ing and delivering health services to people everywhere. 

Hence, our support of the premise of H.R. 12453, which would extend high quality 

medical care beyond the confines of the United States to the world community.

Public Health agencies have had long experience with problems of prevention, 

control, and treatment of both communicable and chronic diseases. The legislation which you are now considering would serve to spread our increased knowledge for the treatment of these diseases throughout the world so tha t malnutrition, tuberculosis, malaria, and other major diseases may be rendered less potent 

to stunt and destroy life.

The primary intent of the legislation is the training of personnel and spread 

of health knowledge. In this connection while the importance of training cannot be minimized, the APHA would like to point out that there already exist, 

in the medical community, professionally trained and experienced individuals 

who have worked in international health programs and who already have the 

skills and experience to serve abroad. For these the train ing period may well 

be unnecessary.

In the view of the APHA, this program must necessarily involve three aspects : 

(a) a complete evaluation of medical needs beforehand to most effectively utilize the appropriated funds, (ft) the training of health personnel to deal with 

specific problems in specific countries, and (c) the exchange of U.S. and foreign 

health personnel.

As we have suggested, an essential element in the success of this program is 

early and comprehensive planning. This would include determining the basic 

health needs in specific areas and countries of the world as an assessment of the 

potential contribution of already existing facilities and their full involvement. 

It would involve a program aimed at training American health personnel to 

go abroad to teach and train health personnel to, in turn, teach and tre at their 

own people. Health problems vary from country to country. Therefore, we should make 

maximum use of train ing facilities in the United States by utilizing schools 

with facilities relating directly to specific health problems in other countries. 

We suggest the advisability of providing for a segment of the training program, 

of U.S. trainees, in the country in which they will serve.

In conclusion, then, the American Public Health Association supports this 

legislative proposal which, with appropriate amendments, we reel certain can 

be a means of uniting our Nation’s total health competencies for the benefit of 

all nations. The program has tremendous potential and could play a large role 

in the eradication of suffering and disease throughout the world. We are 

in complete accord with the intent of the proposal and are fully prepared to 

assist in implementing this im portant project.

The Chairman. Dean, we certainly thank you for coining and 

giving us the benefit of your views.

I see you have had a great deal of experience abroad in some of 

these fields. I gath er tha t you feel t hat this program would help to 

deal with some of the anti-Americanism and keep it down abroad if 

we have our people helping in this field ?

Dr. Stebbins. Yes; I think we have seen a good deal of evidence of 

this. At one time in the Phil ippines when the newspapers were 

criticizing the United States very bitterly for maintaining Clark Air 

Force Base, there was in the same newspaper a long article praising
56 INTERNATIONAL HE ALTH ACT OF 19 6 6

the assistance from the U nited States in the development of the program of training at the University of the Philippines and it was a 

completely opposite point of view. The health assistance was being 

praised and editorials in the same newspaper were criticizing other 

activity of the United States.

I think this helps the overall balance, and I could cite a number of 

other instances where the health program of AID , limited as it has 

been in recent years, is still one of the most effective means of making 

friends in a number of countries.

The Chairman. I notice you gave as an example, t hat when some 

villagers were asked about the thin g they considered most important, 

they said it was the health aspects of aid tha t came to them ?

Dr. Stebbins. That is right.

The Chairman. Then there is a great opportunity, as I gather 

from your testimony, fo r us.

Dr. Stebbins. I believe it is a great opportunity at relatively small 

expense. It was brough t up yesterday that this would increase the 

problem of shortage of health personnel in the United States.

Well, this small number of career personnel tha t was discussed is 

just infinitesimal in relationship to the overall picture.

For example, there are nearly 200,000 physicians in the United 

States. This would take away less than 500 and probablv less than 

300, so I don’t think that this is going to materially impair the developmen of health services in the United States, but it will have a tremendous impact on health services in other nations.

The Chairman. It seemed to me that you emphasized the need 

abroad and that this would not be a hit or miss program, as we perhaps 

have to do now, but personnel would be trained in specific areas, who 

would then knowT something of the philosophy of the people and so 

forth.

Dr. Stebbins. That is right. That is part of the proposed tra ining. We have at the university I am associated with in a small way 

attempted this. We have a training program in international health. 

It is necessarily limited to a very small number of individuals and 

it is not as extensive a training program as would be proposed by 

this legislation, and this legislation would increase the numbers and 

would increase the depth of trainin g tha t they would be able to obtain.

The Chairman. Thank you very kindly.

Mr. Friedel.

Mr. Friedel. Mr. Chairman, I really welcome the dean of the H ygiene and Public Health Service from Johns Hopkins University. I 

don’t know i f you are a native o f Baltimore.

Dr. Stebbins. I am one of your constituents.

Mr. F rtedel. Thank you.

You are held in high esteem. Your statement is very, very good. 

I was greatly impressed with the last paragraph when you said:

It will, in my opinion, be a ma jor step tow ard int ern ational understanding 

and eventually world peace.

If we come anywhere near tha t objective it would be wonderful. 

However, can you elaborate jus t a little bit on this? On page 2 you 

mention in your statem ent:

* * * government ma laria spray team s were permitted to enter Vietcongcontrolled are as as the Vietcong recognized the importance of the health service 

to the villagers.
INTERNAT IONAL HE ALTH ACT OF 196 6 57

T hat is a. major step if we can ge t into the Vi etn am are as an d 

the y peace ful ly allow us to do the se things , bu t I wou ld lik e to he ar 

more about tha t.

Dr . Stebb ins. Th is was a re po rt by an A ID represen tativ e in 

Vietn am . He gav e a semi nar in Ba ltimore repo rtin g on his activ itie s the re. In the ea rly stages o f the war h e said th at m al ar ia team s 

were welco med in th e vil lag es contr olled by the Vie tcong. Lat er , 

because the villagers wer e so impre ssed with this, the eli mi natio n of 

th is disease wi th wh ich they ha d lived fro m tim e immemorial , the y 

said “T he peo ple th at do th is fo r us must be good peo ple.” Th is 

infiltra tio n of public he alth into Vietc ong vil lag es was res ented by 

Vie tcong an d fol low ing that o ur peop le ha d gr ea t difficulty in ge tti ng 

th ei r m alar ia sp ray tea ms into th e vil lag es th at wer e contr oll ed by 

the Vietcon g.

Mr. F riedel. I wan t to th an k you fo r yo ur sta tem ent. I thou gh t 

it was excellent. T hat is a ll, Mr. Ch air man.

Th e Chairm an. Mr. Cur tin .

Mr. Cur tin. Tha nk you, Mr. Cha irm an .

Docto r, pre vio us tes tim ony was to the effect th at the plan ne d tr ain ­

in g prog rams wer e for, I believe, 50 associates an d 100 fello ws.

Dr. Stebb ins. I th in k it was th e reverse, 50 fellows an d 100 

associates.

Mr. Cur tin . Th an k you . T hat was each year. Ho w ma ny ad di ­

tio na l m edical schools wo uld be necessary t o tak e c are of th at num ber?

Dr. Stebb ins. Well, it wo uld no t be ad ditio na l med ical schools. 

Th e in tent of th is leg islati on, as I un de rstand it, is th at th is would 

make possible th e dev elopment in the vario us schools of he alt h, me dical schools, nu rsin g schools, engin eerin g schools, schools of public 

he alth, or the expansion o f a n e xisting tr ai nin g pr og ram , to better p re ­

pa re h ea lth worke rs to w ork in the intern ationa l he alth field.

I t would pro vid e special trai ni ng fo r physicians in the exotic dis ­

eases that the y have to deal with in ma ny o f the develop ing co untries . 

I t would pr ep ar e the m in th e un de rstand ing of the cu ltu re of these 

peoples in othe r natio ns, th e po litica l sit ua tio n, so th at the y could 

work more effectively to ward im prov ing th e he alth services of th at 

country , and im po rta nt ly assis tin g thes e natio ns in estab lishin g th ei r 

own scho ols and pr ov iding facu lty fo r th ei r schools un til they cou ld 

ma n them th emselve s a nd p rod uce th e lar ge nu mbe r of he alth w ork ers 

th at will be needed.

Mr. Cur tin. Th is would b e 150 new stu de nts in 1 y ea r trai ne d fo r 

the in tern ationa l he alth service. Co uld n’t you ha nd le those at Jo hn s 

Hop kins alone?

Dr. Stebb ins. No ; I am af ra id we could n’t.

Mr. C ur tin. H ow many of them could be ha nd led a t Joh ns Ho pk ins 

wi th a new de pa rtm en t ?

Dr. Stebb ins. Th ere is co nstan t press ure on all of th e schools to 

develop new p rog ams.

For exa mple, the C ong ress h as en acted the M edicare bill an d we a re 

being alm ost pus hed into develop ing a spe cialize d tr ai nin g prog ram 

fo r those who will ad minist er thes e pr ogram s.

In po pu latio n con trol, there is the dema nd fro m va rio us nations 

fo r trai ne d person nel, spe cia lly tra in ed in po pu latio n con trol. We 

can take some 15 or 20 in each one o f th ese spec ial fields a nd we have 30
58 INTERNATIONAL HEALTH ACT OF 19 66

such special fields, and we have in international health now a limited 

number, and it has been very interesting and encouraging to me tha t 

many of our American students who tho ught they were going to be 

county health officers or city health officers when they get to the school 

decide tha t they would like to go into international health and they 

transfer over to the international health training program.

Many of the medical students just across the street from us come 

over and take their three quarters in international health. This is a 

sign that there are many people th at are interested, but no one school 

could supply all of the personnel required for this career service.

And I would hope that it would not be in a limited number of schools, 

but this concept of training in international health would be very 

broad throughout the country.

Mr. Curtin. Do I understand you to say tha t Johns Hopkins now 

provides courses in international health for a certain number of students ?

Dr. Stebbins. Yes.

Mr. Curtin. For how many?

Dr. Stebbins. I think this year we have 10.

Mr. Curtin. Do you have facilities to increase tha t substantially?

Dr. Stebbins. Yes; we could increase it some. We certainly couldn’t 

double it or triple it in many of the schools if we are going to meet the 

demand.

Mr. Curtin. In the event tha t this bill is enacted into law, would 

you increase your facilities and take in a certain number of these 

associates and fellows?

Dr. Stebbins. I would certainly recommend tha t to my faculty 

and to the university authorities.

Mr. Curtin. About how many more would you try to take in ?

Dr. Stebbins. Oh, I think t ha t we possibly could double the number 

to 20 or 30, a maximum of 30. Our physical facilities just wouldn't 

permit us to take a large number.

Mr. Curtin. Tha t is all. Thank you, Mr. Chairman.

The Chairman. Mr. Moss ?

Mr. Moss. No questions.

The Chairman. Mr. Broyhill ?

Mr. Broyhill. Just one question, Dr. Stebbins, 

ou mentioned population control. Do you feel th at this program

we are discussing here today includes trainin g in population control, or 

do vou feel that this is a very vital pa rt of world health?

Dr. Stebbins. I think undoubtedly this is the inten t of this legislation, to greatly expand the number of well trained persons to direct 

and stimulate and train others to carry on population control methods.

I mentioned th at this was one of the specialized programs tha t we 

have, and we have requests from other countries for the training of 

their physicians in population control, many times the number th at we 

can possibly accept.

A number of countries, as you know, India, Pakistan, Turkey—well, 

a half dozen countries, have established a national policy of population 

control. They urgently need trained personnel.

We have been working prim arily with Ind ia and Pakistan and the 

numbers that they need are so colossal that the only solution is to train 

people in this country who will help them develop the ir own schools.
INTERNATIONAL HEALTH ACT OF 19 6 6 59

The Ford Foundation, as you know, is strongly supporting training 

institutions in In dia, and also in Pakistan.

Mr. Broyhill. Thank you very much.

The Chairman. Mr. Rogers?

Mr. Rogers of Florida. Thank you, Mr. Chairman.

Doctor, I have been interested in your testimony, too, and appreciate 

your helping the committee. I am somewhat concerned about the manpower problem th at would be involved.

Dr. Stebbins. The manpower problem ?

Mr. Rogers of Florida. Yes. Don’t you feel that we have a shortage 

of physicians and medical personnel in this country now ?

Dr. Stebbins. We certainly do, but we have 200,000 physicians, or 

roughly that, and this is talking about a few hundred.

Mr. Rogers of Florida. I realize th at, but what I am talking about 

is th at here we have medicare just about ready to be launched in Ju ly 

of this year. We passed legislation in this committee to tr y to increase 

the number of doctors, and dentists, and so forth, to increase nurses, 

because of the critical shortage to handle the health of our own people 

to the standard that we think it should be.

Do you think it is well for us to put that program aside to the degree 

tha t this bill would envision ?

Dr. Stebbins. Certainly I would not recommend that you put tha t 

aside. I think it is fai r to say, though, tha t the increasing number of 

trained health workers in the United States is such tha t we can afford 

this very small number for international health activities.

Mr. R ogers of Florida. How many do you envision, you say ?

Dr. Stebbins. Well, the Secretary and the Surgeon General yesterday indicated tha t there would be 50 fellows and perhaps 100 associates 

a year, 150, and then they will be coming back and contributing to the 

Public Health Service activity in this country.

Mr. R ogers of Florida. How long will i t take to train them ?

Dr. Stebbins. The fellowship is for 1 ye ar for a person with a pro ­

fessional degree; tha t is, a physician, a professional nurse, an engineer, a dentist. For the fellows, these would be people who would be 

rendering service in the country, with perhaps 1 year of training and 

2 years ot service overseas.

These 100 individuals would be distributed around the world and 

would be at a very senior level and would serve as advisers to the country, would serve as faculty in training schools being developed in these 

countries. It would not be a large number that would be withdrawn 

from the services for this country.

Mr. Rogers of Florida. Don’t we have any personnel doing tha t 

type of work now ?

Dr. Stebbins. We have some; yes.

Mr. Rogers of Florida. Do you know the number?

Dr. Stebbins. The Surgeon General reported yesterday tha t 234 

staff members of the Public Health Service are now assigned to various 

activities in other branches of the Government, primarily to the Peace 

Corp and to AID.

Mr. Rogers of Florida. So actually in this whole activity, there 

would be not 50, but 150 additional to the 234 now working ?

Dr. Stebbins. Th at is right.
60 INTERNATIONAL HE ALTH ACT OF 19 66

Mr. Rogers of Florida. And 500 people working outside of our country gets to be a f airly good number when you consider the number of 

doctors we turn out a year, wouldn’t you thin k ?

Dr. Stebbins. In my opinion it is not an unreasonable number for 

the benefits th at would accrue to the United States from an international health program.

Mr. Rogers of Florida. How will this work in with the program that 

is going on with the World Health Organization ? Isn ’t this counter to 

the cooperation that we have indicated we would give to the World 

Health Organization ?

Dr. Stebbins. No; this is supportive to the program of the World 

Health Organization.

Mr. Rogers of Florida. Would this be administered by the World 

Health Organization ?

Dr. Stebbins. No; this would be administered by the Department 

of Health, Education, and Welfare.

Mr. Rogers of Florida. Is there any reason why it shouldn’t be 

administered by the World Health Organization, by those member 

nations who are participating in decisions to be made by tha t organization?

Dr. Stebbins. The World Health Organization is a very efficient 

and effective mechanism of developing multilateral health services, 

but I think one of the advantages of this program would be tha t these 

people would be identified as U.S. citizens, public health workers, 

health workers, in the broad field, whereas i f we do this through the 

World Health Organization, important as tha t is, and I thin k tha t 

should be expanded; a relatively small proportion of the staff of the 

World Health Organization comes from the United States.

Mr. Rogers of Florida. Maybe it should be bolstered and we should 

call on nationals of other countries to come in and maybe help train 

some.

I have been concerned, too, by the statistics given this committee 

about how many foreign doctors are in our country actually practicing 

and, for instance, runn ing emergency rooms and this sort of thing, 

particu larly in New York City.

I am sure you are aware of th at problem, too. Is there any reason 

why the nationals of those countries couldn’t do this sort of work with 

a little tra ining ?

Dr. Stebbins. A great many nationals of those other countries are 

doing this work throug h the World Health Organization. This is a 

source of recruitment for the W orld Health Organization.

Mr. Rogers of Florida. Also, we have a Pan American Health Organization, don’t we ?

Dr. Stebbins. That’s correct.

Mr. R ogers of Florida. Aren’t we going to work there, too?

Dr. Stebbins. Yes.

Mr. R ogers of Florida. Isn ’t tha t organized to help meet the health 

problems of the nations in this hemisphere ?

Dr. Stebbins. Tha t is right.

Air. R ogers of Florid a. It is more specialized in this area, isn’t it?

Dr. Stebbins. The Pan American Health Organization is the regional office of the World Health Organization for this hemisphere 

and it receives support from the American nations over and above 

that from the World H ealth Organization.
INTERNATIONAL HEALTH ACT OF 19 6 6 61

Mr. Rogers of Florida. How do you thin k they would look upon 

this? They are tr ying to do a job and we come in and send personnel 

in without coordinating with them.

Dr. Stebbins. It is coordinated throu gh the international health 

division of the Public Health Service and will be with this expansion. 

The World Health Organization, the Pan American Health Organization, which is the regional office of the World Health Organization, and the international health division, AID , are working very 

closely together.

If I may give one further example from personal experience, in 

the Philippines every month under the chairmanship of the director 

of health for the Philippines representatives of the World Health 

Organization, AID , the various foundations working there, meet 

to report on their programs so as to avoid duplication and to provide 

an integration of all of these activities.

Mr. Rogers of Florida. Don’t you feel th at those organizations are 

putting the proper emphasis on the health problems ?

Dr. Stebbins. I think they are.

Mr. Rogers of Florida. Then what could we do tha t would better 

what they are doing ?

Dr. Stebbins. I wouldn’t say that we could do something better, 

but they are limited in their staff, in thei r personnel. The problems 

tha t exist in these developing countries are so great that we could 

double what WHO is doing, double w hat AID is doing, and double 

what the Public Health Service is doing and still-----

Mr. Rogers of Florida. Right, and double what we are doing for 

our own people, too, almost, couldn’t we, in the health field?

Dr. Stebbins. I wouldn’t say double, but I th ink we could do much 

more than we are doing.

Mr. Rogers of Florida. Because a lot of our schools told us when 

we passed the Health Education Act that the schools couldn’t take 

very many more. They didn’t have the personnel to teach them and 

they didn’t have the facilities. How is this going to affect the situation if we can’t even tra in our own people, with many of the schools 

objecting when we asked them for a 21^-percent increase of their 

freshman class?

They didn’t even want to do that.

Dr. Stebbins. Some of the schools are at the ir maximum now. 

With increased faculty and with increased facilities they could expand.

Mr. Rogers of Florida. Where do we get the faculty ?

Dr. Stebbins. There are still some people who are willing to work 

for universities.

Mr. Rogers of Florida. Well, I am j ust concerned because we are 

trying to do so much in our own country in train ing personnel where 

there is a great shortage and now come in and say we can start training 

people from all over the world. It causes us some concern. This is 

my feeling. Also, I notice in this bill they haven’t even considered 

using the junior colleges as a possible source of training.

Wh at is your feeling on that ?

Dr. Stebbins. I think tha t for the career service assigned to advise 

governments we need highly trained people. There is no reason why 

the junior colleges could not prepare people fo r fur the r train ing and 

eventually those people would become very useful in an international

5 9 -4 9 4— 66 ------- 5
62 INTERNATIO NAL HEA LT H ACT OF 19 66

program, but most of the developing countries look to the United 

States for leadership and not just service.

The person in a junio r college is an extremely valuable person in 

providing service, but not in this high level advisory capacity tha t we 

are talking about in this legislation.

Mr. Rogers of Florida. Then you envision this as simply a high level 

advisory capacity to be developed ?

Dr. Stebbins. Tha t is the prim ary purpose, as I understand it, to 

provide highly trained people.

Mr. Rogers of Florida. Not to render any services other than advice ?

Dr. Stebbins. Advice yes and to teach in the developing schools, if 

you call that service, and to provide by example the training that these 

underdeveloped countries need for their own personnel.

Mr. Rogers of Florida. And you don’t think tha t can be accomplished under the existing organizations tha t we have such as the 

World Health Organization, the Pan American Health Organization, 

our programs in AID, the Peace Corp, and so forth ?

Dr. Stebbins. I think th at there is need for a career service to pro ­

vide these people and this has been clearly demonstrated by the problems tha t AID has had in recruiting personnel to serve overseas.

Mr. Rogers of Florida. Haven’t we let the Public Health people go 

into these services ?

Dr. Stebbins. Some of them.

Mr. Rogers of Florida. Aren’t they commissioned officers ?

Dr. Stebbins. Yes, they are.

Mr. Rogers of Florida. Don’t they have a career ?

Dr. Stebbins. Those do.

Mr. Rogers of Florida. How many others don’t ?

Dr. Stebbins. Other than the commissioned corps, and during most 

of the period of AID as far as I have observed it, many of them were 

just recruited without any assurance tha t they would have a job at the 

end of the 2-year contract they signed for work in this country.

Mr. Rogers of Florida. Wouldn’t these people be in a commissioned 

corps?

Dr. Stebbins. Many of them were not.

Mr. Rogers of Florida. Would not th is bill bring them into the commissioned corps ?

Dr. Stebbins. That is the intent.

Mr. R ogers of Florida. So actually the purpose of this is simply to 

waive the limitation on the commissioned corps in the Public Health 

Service, isn’t it ?

Dr. Stebbins. Well, it would certainly expand by this number.

Mr. Rogers of Florida. Well, it says in paragraph (d) on page 9 

tha t it waives it, so this is probably the thrust of the legislation, isn’t it ?

Dr. Stebbins. Yes, I think it is one of the most important features.

Mr. Rogers of Florida. Imp orta nt because they are doing everythin g righ t now through the Public Health Service. They are having 

officers assigned to the Pan American Health Organization, to AID 

to the World Health Organization. They are doing this now, and all 

this does is simply waive the limitation ?

Dr. Stebbins. But provide a training program for-----

Mr. Rogers of Florida. We tra in them now, don’t we? We pay for 

their education in the commissioned corps ? There is such a program ?

Dr. Stebbins. Fo r a limited number.
INTERNATIONAL HEA LTH ACT OF 196 6 63

Mr. R ogers of Florida. And this waives the number—that is, what 

I am saying—doesn’t it ?

Dr. Stebbins. That is one interpretation of it, yes. It would expand 

the training program for international health and increase the numbers 

of persons.

Mr. R ogers of Florida. And you feel it is essential that we increase 

the numbers, that we are not devoting enough to Public H ealth Service 

in the international field ?

Dr. Stebbins. I feel that very strongly, sir.

Mr. Rogers of Florida. Thank you.

Thank you, Mr. Chairman.

The Chairman. I don’t believe tha t when the Secretary was here 

yesterday, he gave any thrust to the remark tha t we are tryin g to commission these people. There was a need for training of these people 

and that was the main thrust of this bill.

Mr. Rogers of Florida . I was just reading the bill, Mr. Chairman.

The Chairman. I know, but I think that all the testimony given by 

the Surgeon General and by the Secretary of H ealth, Education, and 

Welfare concerned the need of a trained corps to do this, and incentives 

for people to be in it, and having some place to come back home to.

Mr. Rogers of Florida. Maybe I am in error in reading the bill, but, 

as I understand it, it would bring them into the commissioned corps of 

Public Health.

The Chairman. Th at was incidental and is one of the things to give 

them an incentive.

Dr. Stebbins. That is right.

Mr. Rogers of Florida. The point I was making, Mr. Chairman, 

was tha t this waives that limitation. Therefore, they simply bring 

them into the commissioned corps, and this seems to me the thrust 

of the bill.

The Chairman. Dr. Carter?

Mr. Carter. Dr. Stebbins, most of the training to which you referred I believe in part would be postgraduate train ing, would it not, 

after they received their M.D. degrees ?

Dr. Stebbins. I believe the intent of the bill is to strengthen the 

training in international health at an undergraduate medical level, 

perhaps nursing and dentistry, but primarily to give training in depth 

in international health as postgraduate training.

Mr. Carter. As applies to physicians it would be beyond the M.D. 

degrees ?

Dr. Stebbins. I think i t is, and to strengthen the teaching of inte rnational health at the undergraduate level in medical schools. That 

is my interpretation.

Mr. Carter. How many schools of public health do we have now 

in the United States ?

Dr. Stebbins. Thirteen.

Mr. Carter. How many of these have international health 

programs ?

Dr. Stebbins. I would say that three or four have an identifiable 

international health training program. Others provide training in 

diseases prevalent in the underdeveloped countries and some tra inin g 

in problems of cultural differences, but I think only three have identifiable courses in international health.
64 INTERNATIONAL HE ALTH ACT OF 19 66

Mr. Carter. It shouldn’t be too hard to convert these schools to 

staff these courses, would it, particularly at Tulane where we have 

a good school of tropical medicines and so on.

I believe you stated tha t your school might absorb 20 more, that you 

might take 30. Perhaps it shouldn’t be too g reat a problem to train 

100 or 150 more medical men in this field, as I see it. Wh at would be 

the impact of having trained public health people go into South 

Vietnam at the present time?

Dr. Stebbins. Well, there are some there now.

Mr. Carter. Yes, sir ; but more of them.

Dr. Stebbins. More are needed and I think the impact would be 

in making the South Vietnamese feel that we are concerned with th eir 

own health problems. There are some South Vietnamese t ha t have 

been trained in this country in health, bu t they are limited in number 

and they must be greatly supported by assistance.

Mr. Carter. It would give us a better image in that country if we 

did this, wouldn’t it, if we showed we were t ryi ng to help them in 

eradication of th eir diseases ?

Dr. Stebbins. Tha t certainly is true.

Mr. Carter. If we go ahead with the medical school which we 

built in Saigon, help staff them, for instance, tha t would help, would 

it not?

Dr. Stebbins. Very much.

Mr. Carter. Another thing. Don’t you thin k it would be wise if 

in this corps we spearheaded an effort to ward population control, if 

we perhaps assisted them with leadership for the establishment of 

birth control clinics throughout the world? Recently I visited one in 

New Delhi and it seemed they were doing very well.

After all, the expense of this is not too much, is it? About $10 

million the first year is the cost of this bill.

Dr. Stebbins. Compared to the values t hat it would have it seems 

to me that this is a very small amount. I would have to work on a 

budget, and $10 million sounds like a lot of money, but in my opinion 

this is so important tha t tha t would be a very minor factor in consideration.

It is rather what -we can do to improve our image in developing 

nations th rough assisting them in handling their owm. liealth problems.

Mr. Carter. I agree with you, Doctor. Thank you so much.

The Chairman. Mr. Murphy ?

Mr. Murphy. I have no questions.

The Chairman. Mr. Devine?

Mr. Devine. I have no questions, Mr. Chairman.

The Chairman. Mr. Satterfield ?

Mr. Satterfield. I have no questions.

The Chairman. Mr. Keith?

Mr. Keit h. No questions.

The Chairman. Doctor, we thank you very kindly fo r coming and 

giving us the benefit of your views. I think it has been enlightening 

to the committee and we appreciate it very much.

Dr. Stebbins. Than k you.

The Chairman. Our next witness will be Dr. Thomas Hunter, 

chancellor for medical affairs at the University of Virginia.
INTERNATIONAL HEALTH ACT OF 1966 65

D r. H unte r, we ar e ve ry happy to ha ve yo u w ith us. Yo u may 

proc ee d as yo u see fit by ei th er re ad in g your stat em en t or in se rt in g 

it in th e r ec or d an d gi vin g a su mmary.

STATEMENT OF DR. THOMAS HUNTER, CHANCELLOR FOR MEDICAL

AFFAIRS, UNIVER SITY OF VIRG INIA; ACCOMPANIED BY DR.

HEN RY VAN ZILE HYDE, EXECUTIVE DIRECTOR; AND DR.

HAROLD MARGULIES, ASSOCIATE DIRECTOR, INTERNATIONAL

DIVISION, ASSOCIATION OF AMERICAN MEDICAL COLLEGES

D r. H unte r. M r. Cha irm an , I pre fe r, if I may , to in trod uc e my 

st at em en t an d th en discuss it, an d per hap s use less tim e th an ju st 

re ad in g it.

T he Cha ir man . T h a t will b e ve ry go od because we ar e pr es se d fo r 

tim e. How ev er, we w an t all wi tnesses to under st an d th a t we do n’t 

w an t t o do a nyth in g to c urt ai l yo u, b ut we ar e tr y in g t o pr es er ve tim e 

as mu ch as possib le.

D r. H unte r. T hank you.

(D r. H u n te r’s fu ll stat em en t f oll ow s:)

Statement Submitted by Dr. Thomas H. Hunter, Representing the

Association of American Medical Colleges

I am Dr. Thomas H. Hunter, chancellor for medical affairs of the University 

of Virginia Medical School in Charlottesville, Va. I am here today in my 

capacity as chairman of the Committee on Internation al Relations in Medical 

Education of the Association of American Medical Colleges. The AAMC represents the combined interests of the 88 American medical colleges, all of whom 

have a keen interest in the Interna tional Hea lth Act of 1966.

We have carefully reviewed the bill under consideration today and find ourselves in full approval of its contents and intent. As you know, medical educators in the United States have played an active role in international health 

affairs for many decades. Their activities are summarized in a study carried 

out by the AAMC entitled “A World Program for Health Manpower,” a copy 

of which I would like to submit to this committee for their consideration. The 

report was completed during the latter par t of 1965 and was presented to the 

Agency for International Development which had requested the AAMC to carry 

out the study.

Since the beginning of this century, w© have been involved in a wide variety 

of international activities designed to increase the world’s supply of medical 

manpower. These activities have been supported by private foundations, by 

the U.S. Government, and by various international health agencies. Since 

1951 AID has supported contracts involving 9 American universities in 10 differe nt projects planned, to strengthen medical institutions in developing countries. 

In addition, many individual faculty members have been associated with both 

short- and long-term assignments throughout the world. For the past several 

years, the AAMC has had a division of international medical education which 

was established to broaden the role of our medical colleges in this worldwide 

effort to improve the availability of skilled health personnel everywhere. 

Through the efforts of this division, a complete roster of American medical 

faculties was established to determine the availability of competent individuals 

to serve in international health activities in any of the medical disciplines, 

including those allied with but separate from the medical schools themselves. 

You will be interested to know that there are approximately 6,000 names on this 

roster, all full-time medical teachers who have expressed willingness to devote 

a significant amount of time to international health work with the majority 

willing to serve for 1 year or longer in projects where the ir skills will be of value.

The present bill thus represents a logical extension of our activities and 

interests. It provides a device for increasing the effectiveness of our participation in U.S. programs abroad. In the past, there has been relatively little 

opportunity to fully utilize the increased knowledge gained from overseas
66 INTERNATIONAL HEALTH ACT OF 19 66

service because there has been a very limited international career service and 

an inadequate mechanism for utilizing the vast experience gained through our 

global efforts. Almost all of the participation by members of our medical 

faculties has represented a departure from their domestic responsibilities to 

which they must retu rn with the disadvantages of having been abroad while 

rapid progress continues at home. Many American universities have become 

increasingly concerned over their inability to take advantage of these unique 

opportunities to add to their own knowledge and to enrich the entire university 

through their international activities. On every university campus many students and faculty members have a sense of devotion to the problems of the world 

and a desire to help in the efforts to improve the well-being of their fellow men. 

Until now the opportunities to be of service have been restricted and there has 

been little reason to encourage their laudable interests.

Our contributions to developing countries have not been limited to service 

overseas. Even more significant has been the training of health personnel 

from other countries. At present there are over 13,000 foreigners, mostly from 

developing countries, studying in various health programs in the United States. 

Many of these are in the universities and their affiliated hospitals where 

foreign medical graduates are learning the arts and skills necessary to develop 

effective health programs in their own countries. We have felt handicapped in 

our own universities by the absence of curriculums which are designed specifically for the special needs of physicians from developing countries. We welcome the opportunity to provide an atmosphere better suited to their eventual 

needs.

We have become fully convinced tha t international medical problems are 

strikingly different from our own and require a level of understanding which 

cannot be satisfactorily obtained through existing programs of instruction. 

It has also become clear to us tha t international health problems require the 

ful attention of highly competent people who can work here and abroad with 

full support by our Government and the health professions both within and 

outside the universities. Programs which depend entirely upon brief service 

abroad by even the most competent experts have very limited value and are too 

often insufficient or even unsuccessful. It seems likely tha t in the future all 

American medical schools will add to their curriculums studies in international 

health and tha t some will have relatively large programs in what has heretofore 

been an occasional activity.

We are pleased with the support provided to improve our utilization of knowledge and skills through the presence in our universities of highly devoted 

individuals who have already become fam iliar with international health. If we 

are to train physicians and others for careers in international health, we must 

design a new concept of education which will draw on the total resources of the 

university. Although this will add new burdens to faculties which are already 

under great stress to meet growing responsibilities, we are willing to meet this 

important commitment. However, you will appreciate the fa ct tha t new responsibilities cannot be met without concern for other responsibilities we have for 

training, research, and service within the country. Every medical school, 

whether private or State supported, has long-term plans which require careful 

attention to the growing demands for expansion of faculty in the further development of existing programs and in response to expressed needs for the university 

to play a greater role in the provision of total health care to the community. 

Any diminution of support in other phases of their programs will have an 

inevitable deleterious effect on our ability to participate in the development of 

an international health corps.

We do believe that the American medical colleges and Public Health Service 

can establish an increasingly effective partnership in a better program for world 

health manpower. The International Health Act of 1966 is an important step 

toward strengthening tha t partnership. It has our full support and our pledge 

of full cooperation.

Dr. H unter. I think perhaps, sir, it would be useful to identify myself a little bit further as well as the organization I am representing.

I am chancellor for medical affairs at the University of Virginia 

in Charlottesville. I have had a deep interest in international aspects 

of medicine for many years, startin g with part of my own education 

in England in medicine before tran sferring to medical school in this
INTERNATIONAL HEALTH ACT OF 19 66 67

country. Lat er on, at the beginning of World War II , I was sent to 

Latin America to learn something about tropical medicine at the time 

when we suddenly found ourselves involved in the South Pacific with 

diseases and problems tha t we were not equipped to face. A crash 

program was instituted at that time in which I took part, taking a 

course in tropical medicine and military medicine at Walter Reed 

followed by 6 weeks’ field experience in Central America.

Then, in 1960 afte r going through the various steps to becoming a 

dean of a medical school I became president of the Association of 

American Medical Colleges, which I am representing today.

I felt as president that one of the things I wished to stress were the 

opportunities tha t existed, it seemed to me, fo r exerting much more 

influence on a world scale in the field of health and medicine than 

we were doing at tha t time.

At the annual meeting of the association all of the deans of Latin 

American medical schools were invited in the interest of establishing 

better relationships with them. Some 35 deans came to that meeting.

Following this, the Association of American Medical Colleges, 

which is the organization of medical schools in this country, comprising some 88 medical schools now as you know, established an inte rnational division and I have here with me Dr. Van Zile Hyde, who is 

the executive director of tha t division of the association, and Dr. 

Harold Margulies, who is the associate director.

Both of these gentlemen have had extensive experience in the 

foreign field. Following this I had the opportunity to spend 1 year 

of sabbatical in South America in Colombia working for the Rockefeller Foundation as a visiting professor of medicine in the Universidad del Valle, a new medical school in Cali, Colombia, and had 

the opportunity to experience at first hand some of the things I had 

been interested in and talking about before.

I felt that, having talked so much, I should find out for myself what 

was involved. All of these things have led me to feel all the more 

strongly tha t it is not only for humanitarian reasons, which I give 

great emphasis to—I think the people of the United States are humanitarian and tha t their genuine humanitarian interest needs to be expressed—but, I believe also from the point of view of enlightened 

self-interest that it is highly important for us, no matter what the 

domestic pressures upon us (and I agree with all of you tha t these 

exist), no matter what domestic pressures we feel, a certain proportion of our effort must be devoted to our contribution to world p roblems and especially in the field of health in which I am interested.

I believe tha t the very survival of the race depends almost above 

anything else on helping the developing nations to enter the 20th 

century with us ; that contributions of health to this are inescapable, 

inextricably mixed up with the population problem, and with economic 

and social development in these countries.

For these reasons I am delighted to be here representing medical 

education, medical schools in this country, in support of this legislation which I think is an important step in the right direction.

I must register one slight reservation and it has to do with the other 

pressures on the medical schools to which you have already referred.

The Secretary yesterday used a very apt simile. He said that this 

program did not require new construction, as you remember, but tha t
6S INTERNA TIO NA L HEA LT H ACT OF 19 6 6

it could ride on the back of other programs. I believe that was the 

phrase he used, and th at is what is envisioned here.

This is fine so long as the back is a strong back and I am expressing 

the sentiments, I believe, of most of the deans of medical schools in this 

country in being firmly behind this legislation, provided th at the other 

commitments to strengthen medical schools in this country are carried 

forward and that, in the efforts underway to attack the manpower 

problem which is at the heart of all of these programs, tha t other 

measures are not jeopardized in expanding our efforts in any field.

So, with the reservation th at the medical schools need all the support 

tha t has been envisioned for them in order to carry out the multiplicity 

of new demands upon them, this international effort has a priority of 

its own and deserves our attention no m atter what the other pressures 

are, and I do feel tha t the numbers of people involved here will not be 

a substantial drain on the medical manpower of this country.

You must remember tha t already we are in negative balance, if you 

will, with 2,000 foreign physicians being licensed in this country every 

year and contributing to our own domestic services, and we are, as 

you know, training many others who do go back.

So, I feel th at this program is very important, tha t the train ing of 

these high-level people for the Career Corps in the Public Health 

Service is of central and catalytic importance in tha t these people can 

be assigned to the World Health Organization in much greater numbers than they have in the past and strengthen tha t body which I agree 

with you, Mr. Rogers, is of great importance in this whole field.

There are some other activities of the Association of American 

Medical Colleges, that I should like to mention very briefly, which I 

think are directly pertinent to your understanding of the setting of 

this legislation.

One is a document I am holding in my hand and of which I unfortunately do not have copies sufficient to distribute at the moment, 

entitled “A World Program for Health Manpower.”

This is a report of the Association of American Medical Colleges to 

the Director of AID , Mr. David Bell, prepared afte r a study which 

the association undertook a year and a half ago with extensive deliberations on this central problem, with recommendations to Mr. Bell as 

to the efforts in the field of medical education which A ID might make.

The central theme of this is that we cannot possibly provide the 

health manpower for the whole world. That is clear. We can’t tra in 

them all here. We can’t send our own people all over the world, and 

the main thru st of our effort, therefore, must be in helping with the 

development of institutions in the developing countries themselves to 

train, on the spot, their own manpower of the type tha t they need.

In essence tha t is the theme behind this report, which I think is a 

very carefully considered statement. I believe that the program we 

are considering here fits in very nicely with this, that the high-level 

people envisioned for the corps of the Public Health Service are 

central to the staffing of key spots in our own services in the World 

Health Organization, the Pan American Health Organization, and 

so on, in order to make the implementation of this sort of thing 

possible.

There are many other things tha t I might say, Mr. Chairman. I am 

obviously enthusiastic about this and I hope very much that you will 

see fit to recommend this legislation.
INTERNATIONAL HEALTH ACT OF 196 6 69

I will now be glad to entertain any questions. I don’t propose to 

be able to answer them all, but I shall do my best.

Mr. Moss (presidin g). Mr. Rogers.

Mr. Rogers of Florida. Thank you, Doctor, for your statement.

I quickly scanned your prepared statement and I would share your 

feeling tha t, of course, we can’t ignore world health. We must pa rticipate in it. We have tried to do t ha t I thin k fairly well in this 

country.

I thin k you say in your statement we are now training some 13,000 

foreign nationals in the health field in this country presently. Some 

2,000 are licensed—2,000 foreign physicians.

Dr. Hunter. Per year.

Mr. R ogers of Florida. Per year ?

Dr. H unter. Yes.

Mr. Rogers of F lorida. And many more are practicing that are not 

yet licensed.

Dr. H unter. In residencies.

Mr. Rogers of Florida. In residency capacity, which has caused a 

concern in my own feeling. What are your feelings on th at?

Dr. Hunter. I thin k this is shocking, frankly. I think for this 

grea t Nation to be a debtor nation in a field such as this is shocking. 

There is no easy solution to it. I believe, on the other hand, tha t it 

bears very definitely on all of our plans for expanding our own facilities for health education and th at we constantly are faced by this added 

deficit when we look at the needs in our own country, and I believe that 

we should go much f arther than we have.

I must, sir, register deep concern about some of the cuts tha t I see 

in the President’s budget that are going to hamper our effort in expending the development of newr

 medical schools now underway in this 

country and the expansion of existing schools.

Mr. Rogers of Florida. This causes me concern when we are presented with newT programs and having difficulty, perhaps, fulfilling 

existing programs for our own country.

Dr. Hunter. I share your concern, sir, but I must say that, in the 

balance, I feel no matter what our domestic situation, and it isn’t that 

desperate in the spectrum of the whole world, we have an overriding 

obligation to do more than we have been doing in the field of international health, not that we haven’t been doing a grea t deal in some 

ways, but the need is immense on a world scale and pressing beyond 

belief and I truly believe t hat the stability of the world to come depends on this facet of the total developmental scheme and tha t w’e 

must contribute to that.

Mr. Rogers of Florida. I understand tha t and we have been contrib uting to the World Health Organization, Pan American, AID , 

Peace Corps.

Dr. H unter. But on the manpower side we have not been contributing much.

Mr. Rogers of Florida. About 250 I guess.

Dr. Hunter. No, to the World He alth Organization, only a handful.

Mr. Rogers of Florida. But I thin k we have about 250 working 

overseas.

Dr. Hunter. Yes.

Mr. Rogers of Florida. And these are of the Public Health Service?

Dr. Hunter. Right.
70 INTERNATIONAL HEALTH ACT OF 19 66

Mr. Rogers o f Florida. Le t me ask you th is : Do you have a school 

of int ern ation al he alt h in yo ur medical college?

Dr. Hunter. No, we do not.

Mr. R ogers of F lorid a. Would you establis h one?

Dr. H unter. I would like very much to, sir. I don’t know whether 

it will be possible or not. I wou ld no t envision a school of internat ional health. I am glad yo u rai sed th at question and I wou ld like 

to say a word about wh at I think med ical schools might do.

Schools of p ublic h ealth h ave been extrem ely active in th is field, as 

you know, and Dr . Ste bbins has ma de a sup erb statem ent. I would 

subscribe t o eve rything he has s aid a nd he is muc h more knowledg eable 

in thi s field th an I am, havin g been involve d in schools of public 

health.

I am an example of the defic it th at exists in the medical schools. 

We do no t hav e the same kind of emp hasis in medical schools on 

edu cation in these ma tters. We need a gr ea t deal more of it. I 

would hope th at one very good feature of this leg islation would be 

the stimu lus it wou ld pro vid e to medical schools to develop pro gra ms 

rel ati ng to this sort of trai ni ng and th at the Dep artm en t of Pre ­

ventive Medicine, fo r exam ple, might be encouraged to establish an 

inter natio nal division to build up th eir ex chan ges with selec ted f oreign 

schools, a nd so on, on a more active basis.

Mr. Rogers of Florida. Do you envision th at thes e people we are 

talking abo ut now would be tra in ed in any medical schools?

Dr. Hunter. I th in k the re is room fo r a ra th er wide spectru m of 

tra ining. After all, we are ta lk in g about people all the way from 

medical ass istants and nurses and technicians of vario us sor ts up to 

the advanced type o f consult ant referre d to by D r. Stebbins, which is 

the i nitia l thrust.

Mr. R ogers of Florida. Dr . Stebbins said th at this was going to be 

pr et ty m uch confined to consultants?

Dr . H unter. Rig ht ; this specific p rogra m.

Wh ene ver a specific prog ram designed to pro duce person nel of this 

sort is insti tut ed there a re alw ays effects th at fan out fro m it.

Mr. R ogers of Fl orida. Ye s; I un derst and.

Le t me ju st ask you th is if I m ay and I will keep my questions sh ort 

so we can do it in a yes-or-no sort of way because I don ’t wa nt to 

impose on the tim e o f th e c ommittee any m ore th an I have.

Since you rep res ent the Ass ocia tion of Am erican Colleges, the 

Com mittee on In tern ationa l Medical Ed uc ation, how ma ny of the 

medical colleges act ually trai n fo r Pu blic Hea lth Service?

Dr. H unter. Th ere is no specific trai ni ng in a medical college for 

the. Pu blic Hea lth Service.

Mr. Rogers of Florida. We have specific colleges for th at , do we 

not?

Dr . H unter. No; the P ub lic H ea lth Service tak es on its staff m any 

M.D.’s, you see.

Mr. Rogers of Florida. I realize th at. I am talk ing abo ut specializing in public health.

Dr. H unter. Th ere ar e two medical schools th at I am fam ili ar with 

th at have essen tially schools of pub lic he alt h withi n the frame wo rk of 

the medical school. Tu lane has a lre ady been men tioned. That is, th e
INTERNATIONAL HEALTH ACT OF 196 6 71

school of public health is part of it there, but there are only two tha t 

have specific programs that I am familiar with.

Is that right, Dr. Van Zile Hyde ?

Dr. Van Zile Hyde. Yal e.

Dr. Hunter. Yale and Tulane and Minnesota, three.

Mr. Rogers of Florida. How would the other schools handle this 

situation ?

Dr. Hunter. I think within departm ents of preventive medicine 

prim arily in medical schools, affiliated, of course, with other parts of 

the university. We have talked about the great importance of demography, and population, and so on.

Mr. Rogers of Florida. You feel there would be no basic problem 

getting staff ?

Dr. Hunter. I think the Department of Preventive Medicine will 

have to develop this kind of capability.

Mr. Rogers of Florida. Would you anticipate th at the University of 

Virginia would do this ?

Dr. Hunter. I would anticipate trying very hard to establish a 

division of international health within our Department of Preventive 

Medicine.

Mr. R ogers of Florida. If we cannot get the other colleges to do this 

and we have only the three tha t are giving the training , how is this 

going to work out for the program ?

Dr. Hunter. I think it is going to be ra ther slow in starting. In 

my judgment it would only be a few schools initially, but I would hope 

very much that there would be a stimulus from this legislation to other 

schools to develop this capacity.

Mr. Rogers of Florida. I am concerned mainly about our manpower, as in our own State. I read a report tha t you are critically 

short 2,600 nurses. I think you had a study made in your State recently. So this begins to build in proportion that causes me concern.

Thank you very much, Doctor.

Thank you, Mr. Chairman.

Mr. Moss. Mr. Devine?

Mr. Devine. Dr. Hunter, are you aware of the speech made by 

Francis Keppel the night before last in connection with this overall 

problem ?

Dr. Hunter. No, si r; I am not.

Mr. Devine. He is quoted as saying among other things th at Americans must admit that we have slipped behind the best of which we 

are capable in the health field. He says the re are indicators that we 

are not doing our best. He says this specifically:

To lick th e problem in the next 10 yea rs the U nited States will need to develop 

an average of 10,000 new jobs a month for a decade in the medical and hea lth 

fields. This would include such categories as physicians, dentists, nurses, technicians, in variou s professional fields and medical electronics.

This is 10,000 p er month for the next decade. Are you more interested in international humanity than taking care of our domestic 

problems in this area ?

Dr. Hunter. I certainly am n ot ; I certainly am not. I think they 

are inextricably mixed up.

Mr. Devine. Who is mixed up ?

Dr. Hunter. That they are intertwined. I used the wrong word.
72 INTERNATIONAL HE AL TH ACT OF 19 66

I think that if one takes the long view of the welfare of the American 

public, which I do as my prime concern, one facet of this inescapably 

is a proper contribution to the solution of world problems and I think 

that one of these is our making a reasonable contribution to the development of the developing countries.

I think tha t if we try to take care of our own problems and close 

out the rest of the world we shall ultimately end up in a holocaust, I 

truly believe this and I think th at health is a very important part of 

this whole business.

Mr. Devine. I think very few of us would disagree with you that 

the need does exist, particularly in countries like Ind ia and places of 

that nature, but we then get to the very meaty practical question of 

whether or not we, the great United States, are in a position to pick 

up a check for the world.

Dr. H unter. We can’t do the whole thing. I would agree heartily 

on th at; hence, the importance of selecting the areas in which we can 

put in some effective licks.

Mr. Devine. Tha t is right.

Dr. H unter. And tha t is exactly what this program is designed to 

do as far as I am concerned.

Mr. Devine. It is just a question of where th e line can be drawn.

Dr. Hunter. Yes; I agree completely.

Mr. Devine. Thank you.

Mr. Moss. Mr. Keith?

Mr. Keith. No questions.

Mr. Moss. Mr. Broyhill ?

Mr. Broyhill. No questions.

Mr. Moss. Dr. Carter?

Mr. Carter. If through the establishment of this program we could 

help in guiding some of our underdeveloped nations to control their 

population explosion, don’t you think i t would be a great help to our 

country and to the world ?

Dr. Hunter. I do indeed, sir. I think this is a critical problem, 

and manpower sophisticated in this methodology is something tha t 

we must do our very best to foster. It is an importa nt facet of this 

program.

Mr. Carter. Yes, sir. Don’t you think that more help in South 

Vietnam through this agency or thro ugh the appropriate health service would do much to establish a better rap port with the Vietnamese 

people ?

Dr. Hunter. I have no expertise on Vietnam, b ut speaking in general I would agree entirely with your statement.

Mr. Carter. The cost of $10 million for the first year is relatively 

small considering the many other programs tha t we have in our country a t the present time, don’t you think?

Dr. Hunter. I believe so, sir, and that is precisely what I meant 

when I said on the balance I do not believe that this is out of line with 

the question raised by Mr. Devine.

Mr. Carter. Thank you so much, Doctor.

Mr. Moss. Mr. Satterfield ?

Mr. Satterfield. Mr. Chairman, I just want to take this opportunity to welcome Dr. Hunter here representing the University of 

Virginia,
INTERNATIONAL HEALTH ACT OF 19 6 6 73

Dr. Hunter. Thank you. I was called on such short notice that 

I had no time to get in touch with you. I apologize.

Mr. Satterfield. That is perfectly all right. I am glad to see you 

and I want to congratulate you f or your forthright and frank statement here this morning.

Dr. Hunter. Thank you.

Mr. Satterfield. Th at is all I have, Mr. Chairman.

Mr. Moss. Mr. Watson.

Mr. Watson. Mr. Chairman, just one or two questions.

Doctor, I apologize for not being here for most of your testimony, 

but I have scanned through your written statement.

Dr. Hunter. I am afraid my testimony as given here bore no relation to what was on the written sheet.

Mr. Watson. I was quite impressed with the written portion of it, 

anyway. 1 am concerned, as is everybody, with the health of the 

peoples of the world.

You say tha t we have 13,000 foreigners presently being trained in 

Public H ealth Service in this country ?

Dr. Hunter. No, not in the Public Health Service. This is in 

training in internships, and residencies, and so on, in the medical field. 

That is quite apart.

Mr. Watson. What percentage of t ha t 13,000 would be in training 

for Public Hea lth Service ?

Dr. H unter. Oh, very small, very small indeed; an almost insignificant proportion. These are mostly physicians getting graduate 

training and internships and residencies, the vast majority.

Mr. Watson. Since you say the percentage interested in public 

health is practically nonexistent, then we could conclude tha t of these 

13,000 foreigners training here there was little interest demonstrated 

in public health ?

Dr. Hunter. I should modify this statement by saying tha t our 

schools of public health have about 30 percent of the ir student body 

from abroad and, while this is a small proportion of that total figure, 

nevertheless, it is a very significant contribution to the very issue you 

raised yesterday, which I agree with : the question of bring ing people 

here for train ing rather tha n try ing to train our own people to go out.

Could I say a word to that ?

Mr. Watson. I was wondering whether or not they could do the 

job better and more economically.

Dr. Hunter. I heard your question yesterday and listened with 

great interest to the exchange and I would like to say that I believe 

your point is very well taken, tha t we need to do a grea t deal of this, 

as much as we possibly can, as we already are, but that the other facet 

is also meaningful.

I believe that we must help them to develop their own schools in 

the countries we are discussing. I thin k th is is a very prime concern. 

We can’t possibly bring all of the people to this country nor send all 

of ours out to handle the problem.

Ultim ately the solution to the health manpower problem for the 

world is going to depend mostly on the development of local facilities 

for trainin g in the countries in question.

Now, how does one go about fostering this? It is a complicated 

tiling. I think we have to bring people here, train them to go back
74 INTERNATIONAL HE ALTH ACT OF 19 66

and stall schools in their own countries. We have to have a certain 

number of our own people out there helping, a limited number, in key 

positions.

We need statf of the Public Health Service who are assigned to the 

various other agencies all around the world who know what the score 

is and they have to be trained here in order to implement the other 

programs in which you and I are interested.

This kind of person is needed.

Mr. Watson. I am sure.

Dr. Hunter. Very badly.

Mr. Watson. I agree with you, Doctor.

Another question. Are these 13,000 foreigners all being trained to 

return to their native countries, or what has been your experience as to 

a number of them remaining in the United States ?

Dr. Hunter. This, of course, is one of the very serious problems and 

as of the present time approximately 2,000 per year are staying in this 

country. India alone, I believe, is exporting every year the total output of the equivalent of seven of their medical schools who are going 

abroad, and a good many coming to this country.

Mr. Watson. Doctor, would it not be advisable then tha t we place 

some stipulations on th is: “If you are coming over here to train then 

you must return to your native country ?”

Now, actually through this program we are contributing to the 

health problem or the medical problem in the other countries of the 

world. We shouldn’t be the only one concerned about the health of 

the emerging nations. We bring people over here and they are not 

concerned about the health problems of their own people. Apparently 

they are interested in setting up a lucrative practice here in the United 

States and not returning to their people.

I think we are contributing to the aggravation of the problem.

Dr. Hunter. I agree with you and I said earlier in my testimony 

tha t I think it is shocking tha t we are at the moment importing 2,000 

physicians from other countries every year for our own needs.

I don’t propose tha t I know how to solve this. It is not that easy. 

You can’t just say “Go home,” or “Don’t come i f you don’t intend to 

go home.” This has to do with immigration regulations which I 

frankly don't understand.

Mr. Watson. Doctor, do you feel we are making much headway 

today in combating this health problem through out the world ?

Dr. Hunter. Oh, yes; indeed I do.

Mr. Watson . We are ?

Dr. Hunter. I certainly do, but I thin k we can make much more 

headway if we mobilize ourselves.

Mr. Watson. Purely through the passage of this measure ?

Dr. Hunter. I think this is a very important step in the right 

direction. I don’t thin k it is going to solve all of the problems.

Air. Watson. We are training 13,000 foreigners. We are now contributing one-third to the World Health Organization and the Pan 

American Health Organization.

Dr. Hunter. Not in personnel.

Air. Watson. No, sir; but in money, and it takes money in order to 

get the personnel. We are contributing some 234 health officers 

throughout the world, but yet you believe t ha t the passage of this
INTERNATIONAL HEALTH ACT OF 196 6 75

bill, which will not train any additional foreign personnel, but just a 

$10 million program a year to tra in American personnel, really would 

have all of tha t impact ?

Dr. H unter. I thin k it would have a very important central impact 

in providing key people to implement the other programs which are 

absolutely essential for the AID program tha t I am talking about 

here in this pamphlet.

With out the support of this kind of staff in our own Public Health 

Service tha t kind of larger program of train ing people back and forth 

can’t go forward properly.

Mr. Watson. Thank you.

Dr. Hunter. I believe this is important.

Mr. Watson. Thank you.

Mr. Moss. Doctor, I want to thank you for an excellent statement.

I share your feeling of shock to learn tha t we are a debtor nation in 

this field of medicine and i f we talk here of a temporary loan of manpower, an export of know-how’, an assumption of leadership, tha t we 

are still talking of only about 10 percent of our annual net gain from 

the rest of the world throu gh the retention of th eir nationals as p art 

of our medical community.

I think this is a very significant fact which should be carefully 

considered by this committee as it pursues the legislation furth er. I 

want to thank you for your appearance before the committee.

Dr. Hunter. Thank you, sir.

Mr. Moss. Our next witness will be Dr. Gordon Heath, professor 

of optometry, University of Indiana.

Dr. Heath.

STATEMENT OE DR. GORDON HE AT H, PROFESSOR OF OPTOMETR Y,

INDIAN A UNIV ER SITY ; ACCOMPAN IED BY WILLIAM P. McCRACKEN, JR ., WA SHI NGTON COUNSEL, AM ERICA N OPTO METRIC

ASSOCIATION

Dr. Heath. Mr. Chairman, members of the committee, I have submitted a written statement and in the interest of time I think I will 

simply offer a few supplementary comments in summary and then 

answer any questions tha t may be asked.

Mr. Moss. Fine, Doctor. Would you like to have your written 

statement incorporated in the record at this point ?

Dr. Heath. Yes, sir.

Mr. Moss. If there is no objection tha t will be done.

You may proceed.

(Dr. H eath ’s full statement follows:)

Statem ent of th e American Optometric Association Presented by Dr. Gordon

G. Hea th, O.D., P h . D.

Mr. Chairman and members of the committee, I am Dr. Gordon G. Heath, 

optometrist, professor of optometry at Indiana University, and chairman of the 

graduate school program in physiological optics. I am also immediate past 

president of the Association of Schools & Colleges of Optometry, an association 

of all the institutions accredited by the Council on Optometric Education.

I serve on two committees of the American Optometric Association, and am 

here today as a representative of tha t organization. The committees I serve on 

are the committee on visual problems of children and youth and the committee
76 INTERN ATION AL HEA LT H ACT OF 19 6 6

for new academic facilities. The latter committee being concerned with the 

much-needed establishment of additional optometric educational facilities in 

the United States.

The bill under consideration offers assistance in the development and improvement of health services throughout the world. One of those services, desperately needed but sadly inadequate or unavailable in many countries, is vision 

care. As education has advanced around the globe, as literacy rates have increased, as modern technology has brought its benefits to mankind, so has the 

need for good vision become a pressing one among peoples of the underdeveloped 

nations.

This is illustrated in a lette r written in 1960 by Optometrist S. M. Dadce of 

Accra, Ghana. He sta ted: “A little over 10 years ago Ghana had no qualified 

optometrists, and spectacles were sold by Syrian merchants. With the advancement of education more and more people are using their eyes more, and 

older people who, in the good old days, had no need for glasses, now need them 

to read their school books, because the mass education unit for adults has turned 

out. and is still turning out, a lot of literate old men and women.”

The optometric profession in this country has recognized the international need 

for vision services. Through its organizations and through the direct efforts 

of many individual optometrists it has attempted to provide some of the assistance requested by agencies, groups, and individuals of other countries. For the 

most part, these efforts have been frustr ated because of insufficient funds and 

limited personnel. There are inadequate or ineffective organizations of optometris ts in many countries. Governmental restrictions, and, most especially, the 

lack of optometric educational facilities impede our efforts to serve when requested. The committee on international affairs of the American Optometric 

Association has an extensive file of correspondence with persons and groups who 

have requested aid in foreign countries. The committee is providing information and advice to the limit of its capabilities.

The American Optometric Association and the American Academy of Optometry are both members of the International Optical League, which is a member of the Union of International Associations, and has exerted effort to advance 

optometric and optical education throughout the world. Recently, the Association of Schools and Colleges of Optometry surveyed all of the optometric educational institutions in the world and is compiling a summary list of the courses 

and requirements of those institutions.

The Association of Schools and Colleges of Optometry has, on request, provided library materials to many institutions in other nations. The American 

Academy of Optometry has extended its membership privileges to optometrists 

in other countries. Through its journal, it provides them with an increased 

awareness of the current developments in optometric and visual science.

Too few optometrists, however, have the means to visit foreign countries and 

serve as the consultants and advisers in providing the courses of instruction 

or the educational materials which have been requested of us.

Wherever in the world vision care exists you will find optometrists providing 

such services. They are often designated by other names such as ophthalmic 

optician or augenoptiker. But, whatever they are called, they are in drastically 

short supply and in many nations completely nonexistent.

International surveys show the great need for additional optometric facilities 

in most countries. For example, from Lebanon through the Middle East and 

the Far East, with the single exception of the Philippines, there are probably 

less than 100 fully qualified optometrists in the entire area. By fully qualified 

optometrists I mean those who have taken a formal course offered by a recognized optometric educational institution.

In the Philippines, as a contrast, there are five schools of optometry. In 

Japan there are no schools of optometry, but in the la st few years there have been 

intensive efforts on the part of a Japanese association to establish a school 

at one of the Japanese universities. This group has developed an extensive 

and commendable self-education program. It has been in correspondence and 

sent visitors to optometric institutions in this country attempting to obtain the 

help it needs in establishing a formalized course of instruction.

On other continents such as Africa, for example, in Basutoland the vision care 

of the entire country is supplied by one general variety store owner who advertises himself as a pharmacist and chemist, as well as an optometrist. In 

Liberia there does not appear to be any kind of optometric service in the major 

city of Monrovia except that provided to a few of the workers in the rubber 

plants.
INTERN ATION AL HEALTH ACT OF 19 6 6 77

Many countries are making efforts to develop optometric institutions. The 

Spanish Government has authorized the establishment of a school of optometry 

at the University of Madrid. Recently, the Indian Government asked for our 

assistance when they authorized the establishment of six schools of optometry 

at state universities.

In New Zealand, the University of Aukland recently established a school of 

optometry. New Zealand received our help. Its school is headed by an American-trained optometric educator, Dr. Ted Grosvenor. A school of optometry is 

in the process of being established in Italy.

In Western Europe there are approximately 20 schools related to optometry. 

Most of them are now changing from what was essentially technical or craft 

schools and colleges. They are asking for American guidance and assistance.

As a result of an international meeting held 2 years ago, the representative 

of European schools manifested great interest in American optometric education. As an outgrowth of that meeting, we are now attempting a seminar 

of optometric educators at Salzburg, Austria, as a p art of the Salzburg seminars 

in American studies.

The only latin speaking nation with a school of optometry was University of 

Havana. It was closed when Fidel Castro became dictator of Cuba. During the 

last 2 years, three American universities; Pacific University, the Optometric 

Center of New York City, and Indiana University, have provided special courses 

for displaced Cuban optometrists to bring their education qualifications up to 

those of American graduates, and to qualify them for State licensure in the 

United States. We hope some of them may form the nucleus for optometric 

faculty in Latin American nations.

We have had requests from optometrists in Colombia, Venezuela, Peru, Chile, 

and other Latin American countries, who are anxious to create schools of 

optometry or optometric educational facilities. In many of these countries, 

there are U.S.-trained optometrists who could follow through in maintaining 

educational facilities after receiving our initial help.

A program of special importance to me has been our graduate program at 

Inidana University, which trains individuals for careers in optometric education 

and vision research. As another par t of our effort, we provide training facilities for foreign optometrists who return to their countries and teach in existing 

optometry schools or sta rt newT optometric educational programs. In the last 

8 years, we have had graduate students from Australia, England, Canada, Kenya, 

Ghana, Tanzania, the Philippines, France, Malysia, Denmark, and Thailand. We 

believe, that in this manner, we have been aiding the advancement of optometric 

education on an international scale much more than would be possible by 

train ing individuals who would only maintain private optometric practices in 

their homelands.

An important program which we suggest might be supported under this 

proposed act would be the train ing of foreign optometric educators who would 

return to their homes and institute the much-needed educational programs they 

need to elevate the level of vision care in their home countries.

Under this act, we also hope th at we can respond to the many countries who 

have requested direct, on-the-spot consultations, services or advice in establishing schools of optometry. And so, the provisions in the bill for funds for qualified advisors to travel to those countries would be of great value.

In the President’s February 2 message to Congress concerning the Inte rnational Health Act of 1966 he stated tha t “the struggle for better health is 

crippled by severe shortages not only of physicians but of all health workers” 

and that “we must work for the day when each country will be able to train in 

its own institutions the health workers it needs.” The President, recognizing 

tha t this goal was not possible right now said, “Meanwhile, we must assist in 

relieving critical manpower needs now.”

Speaking for the American Optometric Association, I offer our services to 

assist in this humanitarian project.

Mr. Chairman, I appreciate greatly this opportunity to appear before you 

and members of your committee. If there are any questions I will be pleased 

to endeavor to answer them.

Dr. Heath. I have with me this morning also Mr. William McCracken, Jr., the Washington Counsel for the American Optometric 

Association, the organization I am here as a representative of this 

morning.

5 9 -4 9 4— 66 ------ 6
78 INTERNATIONAL HE AL TH ACT OF 19 66

Mr. Moss. We welcome you also, sir.

Mr. McCracken. Thank you.

Dr. Heath. To identify myself and the special interest I have in 

this legislation, I am a professor of optometry at Indiana University 

and chairman of the graduate program in Physiological Optics at that 

school.

I have also served as the president of the Association of Schools and 

Colleges of Optometry which is the organization of all such institutions 

in this country.

I serve at present on the Committee for New Academic Facilities 

for the American Optometric Association.

We are concerned there, of course, with the establishment of trai ning institutions to meet the great domestic needs th at we have at the 

present time.

In the developing nations, vision, of course, has become a pressing 

need. Fo r good vision, the provision of visual care has become a 

really desperately needed service in countries around the world.

The American Optometric Association and the other institutions in 

this country have been made very much aware of this need through 

requests, through correspondence, through inquiries from individuals 

and organizations in other countries asking for help in providing 

these services. For the most part, these requests take the form of 

pleas for assistance in establishing regulatory legislation or in establishing educational programs in those countries. With our limited 

funds and our limited personnel we have been providing the assistance 

and answering these requests to the best of our ability.

We have, at the Indiana University, in the program that I am 

particularly associated with, been carrying out our own international 

aid program through training of foreign optometrists in the graduate 

program.

They get advanced degrees and additional training in our program 

and for the most p art return to their own countries to establish educational programs there. It is through a program of th is sort tha t I 

feel the most economical use of manpower can be made in expanding 

and providing vision care services to so many countries.

There are efforts being made by governments of other nations as 

well to provide such training facilities within their own confines. The 

Philippines represent one remarkable example. Tha t small country 

has no less than five optometry schools and is providing very well for 

its own population and the population of neighboring countries in 

the Pacific.

However, in the entire Middle East, F ar East, and Pacific countries 

there are probably at the present time, with the exception of the 

Philippines,, no more th an about a hundred qualified optometrists to 

provide vision care for all of those peoples. The remaining vision 

care, such as it is, is being provided by apprentice-trained opticians 

or by those with no previous training, simply merchants selling spectacles for the most part.

In Japan, a very intense effort has been made in recent years to 

establish suitable tra ining facilities. Mr. Fumio Morry, the president 

of the chief association of optometrists and opticians within Japan, 

has made several trip s to this country to seek advice and assistance 

and is at the moment, out of his own pocket, paying the expenses of 

two students at the University of California who will return to Japan
INTERNATIONAL HEALTH ACT OF 19 66 79

to become faculty members of the school which he is attempting to 

start there.

I could cite endless examples from other countries around the globe 

where efforts similar to these or on an even more elementary scale 

are being attempted. At the present time our finances and our personnel are so limited tha t most of the efforts to provide on-the-spot 

consultation, or to provide faculty members in such institutions on a 

visiting basis or even in an advisory capacity, have been far from 

meeting the need, and so, Mr. Chairman, we hope tha t within the 

structure of this proposed legislation at least a sizable part of the 

prelim inary efforts toward supplying such aid can be made.

The American Optometric Association supports this bill and offers 

its full cooperation and, as a member of the American Academy of 

Optometry and of the Association of Schools and Colleges of Optometry, I can also assure you of the cooperation of those organizations in 

this legislation.

Mr. Chairman, I thank you for the opportunity to say these few 

words and, if there are any questions, I will certainly attem pt to 

answer them.

Mr. Moss. Thank you, Doctor.

Mr. Rogers.

Mr. Rogers of Florida. What is your general feeling about the 

schools of optometry presently being able to turn out sufficient optometrists to serve the American public?

Dr. H eath. As I think you are surely aware, Mr. Rogers, our needs 

have been very desperate and the assistance provided through the 

Health Professions Education Assistance Act has been most welcome 

and is being used now to expand our training facilities.

This is, to my mind, the crux of the situation for us in providing 

assistance in international health. We cannot hope to train a sufficient number of optometrists here to go into practice in those foreign 

countries to provide the vision care that is needed, but we can, especially within our graduate training programs, offer the assistance to 

train educators, optometric educators, to go back to those countries 

and staff the schools that are so desperately needed all around the 

world.

Mr. Rogers of Florida. I would think tha t this might be a better 

approach all around for all of the schools.

Thank you.

Mr. Moss. Mr. Devine ?

Mr. Devine. No questions, Mr. Chairman.

Mr. Moss. Mr. Keith ?

Mr. Keith. No questions.

Mr. Moss. Mr. Satterfield ?

Mr. Satterfield. No questions, Mr. Chairman.

Mr. Moss. Mr. Broyhill ?

Mr. Broyhill. No questions.

Mr. Moss. Doctor, I want to thank you fo r your statement. We ap ­

preciate your appearance here.

Dr. Heath. Thank you, Mr. Chairman.

Mr. Moss. Our next witness will be Dr. I. Lawrence Kerr, Endicott, 

N.Y., a member of the Council on Legislation of the American Dental 

Association.

Dr. Kerr.
80 INTERNATIONAL HEALTH ACT OF 19 66

STATEMENT OF DR. I. LAWRENCE KERR, MEMBER OF TH E COUNCIL

ON LEGISLATION OF THE AMERICAN DENTAL ASSOCIATION,

REPR ESENTING THE AMERICAN DENTAL ASSOCIATION AND THE

AMERICAN ASSOCIATION OF DENTAL SCHOOLS

D r. K err. Mr. Cha irm an , I pe rs on al ly am ap pr ec ia tive of th e op ­

port unit y alon g w it h th e ex tens ion of th e ap pr ec ia tion of th e A m er ­

ican D en ta l As so ciation an d th e A m er ic an Ass oc iatio n of D en ta l 

Schools to te st if y be fo re th is committee on th is bill.

I wo uld lik e to sub m it t o th e co mmitt ee an e xp an de d ve rsion of som e 

re m ar ks th at I w ill m ak e in th e re ad in g th is m or ni ng , if I may d o th at , 

sir.

Mr. M oss. Th os e w ill be inc or po ra te d in th e reco rd.

D r. K err. An d, we w ill confine o ur re m ar ks to a v ery lim ite d am ou nt 

of tim e.

M r. Moss. T hank you.

(D r. K e rr ’s fu ll st atem en t follow s:)

Statem ent of th e American Dental Association and the American Association of Dental Schools, P resented by Dr. I. Lawrence K err, Member of the Council on Legislation of th e American Dental Association

Mr. Chairman and members of the committee, I am Dr. I Lawrence Kerr of

Endicott, N.Y., where I am in private practice as an oral surgeon. I am a 

member of the Council on Legislation of the American Dental Association. I 

am accompanied by Mr. Hal M. Christensen, director of the Washington office 

of the American Dental Association. I have been asked by the Secretary of 

the American Association of Dental Schools to speak for tha t association also. 

Both associations are in agreement that H.R. 12453, the President’s International Health Act of 1966, can contribute to existing Federal Government and 

private international health and health train ing activities.

H.R. 12453 would strengthen health services in foreign lands by sending 

specially trained American health workers to those countries strivin g to develop 

improved health services for their people. The special training of personnel for 

international health services would be accomplished through (1) Federal grants 

to schools of health to finance programs designed to train students for international health work, (2) authority for the Public Health Service to appoint 

members of the health professions to the Regular or Reserve Corps for assignment as trainees (associates in international health) for health work in a foreign 

country to special advanced training fellowships at schools of health and to 

make such advanced training available to commissioned PHS officers also, and 

(4) authority to appoint to the Public Health Service Regular or Reserve Corps 

members of the health professions for assignment to other Federal executive 

agencies or certain international organizations for duties related to health 

work in foreign countries or for assignment directly to a foreign country at the 

request of the Department of State.

The term “school of health” is defined to include dental schools. The grant 

program to schools of health would be for 5 years with authority to appropriate 

$10 million in fiscal 1967 and “such sums as may be necessary” for each of the 

next 4 fiscal years.

dentistry’s relation to international hea lth organization

The dental profession and the dental schools a re engaged in several international health activities. Most of this effort is a joint one with the Federation 

Dentaire Internationale, a worldwide organization of national and regional 

dental associations. The American Dental Association is one of the principal 

contributors to FDI and, because of its superior sources, has provided the leadership for many projects in international dentistry. One such activity was sponsorship of a “Conference on Public Dental Health: Worldwide,” held in San 

Francisco in November 1964 in conjunction with the annual sessions of the 

American Dental Association and Federation of Dentaire Internationale. Highlights of the conference were reports from southeast Asia and the western
INTERNATIONAL HEALTH ACT OF 196 6 81

Pacific regions, Africa and the eastern Mediterranean regions, and from the 

Latin American nations. America’s dental profession and dental schools also maintain active liaison with the World Health Organization, the World Medical Association, the Pan American Health Organization, the Agency for International Development, the Institu te of International Education, HOPE, MEDICO, and several private foundations concerned with international health. A noteworthy effort was recently initiated with the Inter-American Association of Sanitary Engineering to advance community fluoridation projects in the Latin American countries. There is, of course, a close relationship also with those agencies of the Public 

Health Service engaged in international activities.

EM PH ASI S ON TRAINING NATIVE PERSON NE L TO PROVIDE HE ALT H SERVICES

* In 1947, this committee conducted extensive hearings to assess the benefits flowing from international health activities of U.S. agencies, both Federal and 

private. In its report, the committee made the following com ments: “The greatest obstacle to the development and expansion of h ealth programs

, in other countries is the lack of professional personnel * * * . Most of the underdeveloped countries neither have such personnel now nor have the facilities for train ing them * * * . From the long-range viewpoint, it is most practical and economical to help countries develop their own national and regional tra in­ ing centers for most of the health personnel they need rather than have them depend indefinitely upon training facilities of the United States and 

Europe * * * .” 1

The committee report goes on to describe several successful examples of U.S. efforts in creating or expanding regional and national health train ing centers, notably in Lebanon, Pakistan, Egypt, the Philippines and, to a lesser extent, 

Thailand and Colombia. Unquestionably the key component of any plan to bring health services to 

those in the underdeveloped lands must be enlargement of native facilities for training competent native professions. The fact tha t our supply of health manpower is faced with an immense task of keeping up with domestic needs 

lends impetus to this point. Since the 1957 report of this committee, we under­ stand tha t progress in constructing and staffing native facities has been most 

heartening. Training competent personnel from the underdeveped nations in U.S. schools can also do much to expand health services in those lands. The 1957 report of this committee noted th at: “About 1.000 health traine es are in the United States in any given year: 800 on grants from the Inter national Cooperation 

Administrtaion and 200 on World Health Organization fellowships.”

INT ERNA TIO NA L AC TIV ITIES OF THE DENTAL SCHO OLS

For many years, the dental schools of the United States have been engaged in 

both student and faculty interchange with other countries throughout the world. By and large, these interchange activities have been sporadic and informal,

* mostly because there has not been adequate and consistent financial assistance available to support the establishment of a regular, continuing program. About 3 years ago, the American Association of Dental Schools made a survey of the dental schools in the United States to determine, among other things, the extent to which these schools were involved in teacher and student exchange programs.

* It was apparent at that time tha t relatively few institutions were actually en­ gaged in some form of interchange activity in dental education or dental teach­ ing, but nearly one-half of the dental schools in the United States indicated an interest in developing such programs if sources of financial support could be found. The following quotation from the 1963 report of the American Association of Dental schools is presented to illustrate the attitude which exists 

among the dental schools of this country: “There was considerable agreement of opinion on the obligation of American dental schools to provide education at the graduate and postgraduate level for foreign dental graduates which would permit them to retu rn to their native 

countries with increased capabilities to teach or to perform dental research. 

The chief barrier to these education services seemed to be finance.” Since its 1963 survey, the American Association of Dental Schools has con­ tinued its search for methods of strengthening intern ational educational exchange

1

 H. Rep t. 474, 85 th Cong., 1st sess.
82 INTERNATIONAL HEALTH ACT OF 19 66

activities in dentistry. Following 2 yea rs of study, the House of Delegates of 

the American Association of Dental Schools adopted a “Sta tement of Principles 

Regarding the Acceptance of Dental Graduates from other Countries” which 

states that “insofar as teaching resources, university policies, and governmental 

regulations will permit, the denta l schools of the United States and Canada will 

extend the ir education al and researc h programs to members of the dental profession throughout the world, und er the provisions outlined in this stateme nt.”

In 1964, the American Dental Association, the American Association of Dental 

Schools, and Federation Dentaire Intern ationale combined the ir common interests in th e development of an expanded intern ationa l educatio nal interchange 

program and established an ad hoc committee charged with the responsibility 

of developing principles and guidelines for th e a dministration of an international 

program in dentistry. At the present time, th at ad hoc com mittee is engaged in 

a worldwide study of dental educatio nal institu tions and dental organizations to 

determine (a) the na ture and extent of the interchange program which would 

be desirable, (b) the education al facilities available for utilization in an interchange program, and (c) possible sources of financial supp ort for educational 

preparatio n of dental manpower, including travel support for teac hers and 

resea rch scientists. Although the results of the study of the ad hoc committee will not be available until July of 1966, there is not the slightest doubt 

that the largest, most insoluble problem will prove to be the difficulty of financing 

training opportunities.

GRANTS TO SCHOOLS FOR TR AINING FOR INT ERNATIO NA L HE AL TH WORK

The associations which I represe nt are pleased to note th at schools of dentistry are specifically included in the institu tions which will be eligible for gra nts 

to establish, expand, and operate programs for the specialized traini ng of health 

personnel for service in foreig n countries. We are particularly pleased to note, 

as well, th at th e proposed legislation provides a uth ori ty for the payment of trav el 

both for dental educators from this country to others throughout the world 

where dental education is less well developed a nd for assistance to teac hers and 

scholars from other countries to travel to the United States. In this regard. I 

should like to quote again from the “Sta tement of Principle s Regarding the 

Acceptance of Dental Gra duates from Other Countries” of the American Association of Dental Schools with respect to the high priority which the dental schools 

in our country have placed on a teacher interchange program :

“The American Association of Dental Schools concurs with the basic philosophy 

expressed in the Report of an Expert Committee on Dental Hea lth (World Health 

Organization. Technical R eport Series, No. 244,1962) to th e effect th at the permanent solution of dental health problems through out the world will be achieved only 

through the development of adequately educ ated local personnel created by a 

cadre of dental educators in less well developed countries by means of formalized 

interchange programs for teach ers. The American Association of Dental Schools 

is willing and anxious to cooperate in the development of an effective intern ationa l teacher interchange prog ram.”

Both the American D ental Association and the American Association of Dental 

Schools have recorded their intention of par ticipating in the establishme nt and 

maintenance of a lis t of dental fac ulty members who are interested in teaching 

positions in o ther countries, including their qualifications for interchange teaching 

appointm ents. In addition, the two associations are prepared to cooperate with 

individual dental schools in the development of specialized training programs for 

dentists interested in foreign assignments and to serve, if the need develops, in 

a coordinating cap acity in this area.

DENTAL DIS EASE IN UNDERDEVELOPED NA TIO NS

The expansion and improvement of hea lth services in the underdeveloped 

lands is a goal this Nation, with the other advanced nations of the world, has 

striv en to accomplish for many years. Yet today, with all of the effort put 

forth, we must adm it th at millions of persons in the less developed countries 

are suffering and dying simply because health services are not available to them. 

There must be an intensified dedication by the United States as the leader of 

Western civilization to con tribute much more to alle viate unnecessary suffering 

and death in the African nations, India. Pak ista n. Vietnam and many other less 

fortun ate countries.

No one dies of dental disease, it has been said. With the exception of oral 

cancer, this may be almost a truism in the United State s. But in many other
INTERNATIONAL HEALTH ACT OF 19 6 6 83

countries, untreated dental disorders rapidly advance to such gross conditions 

tha t death may be a direct result. Where there is little or no professional dental 

services available, the dental disease problem approaches a magnitude beyond 

the belief of United States dentists. Let me illu stra te by quoting an oral surgeon, Dr. Herbert J. Bloom of Detroit, who has served aboard the S.S. Hope as 

dental director. In a report of Hope's 1961 mission to southeast Asia, Dr. Bloom 

recounted one of his experiences as follows : 2

“* * * The 60 dentists of Vietnam can no more cope with the oral problem of 

more than 12 million people than can the 300 dentists of Indonesia meet the 

requirements of population tha t exceeds 90 million. * * *

“Although Project Hope provided facilities and staff for a complete dental 

teaching-service program, the most urgent needs of the land visited fell within 

the scope of oral surgery. The problem of high incidence of oral disease is made 

worse by the almost total absence of advanced oral surgery teaching in the

• curriculums of the schools of dentistry. Lack of educators in this field, meager 

school equipment, few of even the minimal scientific publications and the sharp 

delineation and poor communication found betw’een the medical and dental professions have had a decidedly adverse effect on the professional personnel qualified to deal with the mass of oral infections, tumors, and deformities. The

' limited number of general surgeons are so overburdened with general surgery

that the oral and maxillo-facial disturbances are left untreated. These conditions often progress to fat al term ination ; other unfortunate victims who are 

left must adju st to living with terrible disfigurement and associated personality 

problems. * * *” In a lette r to one of his colleagues in the United States, Dr. Bloom dramatically 

summed up his southeast Asia experience on Hope in these wo rds :

“I will never forget the day I left Saigon; there were hundreds of people on 

the dock, holding up th eir children showing us the cases of cleft palate, tumors, 

malignancies that we had not the time to treat. If I could p ut in a word what 

the ir eyes so poignantly cried out, it was “hope.” We in the United States must 

'answer it because we are humanitarians, and we must answer it if we ourselves 

are to survive in this world.” 3 4

recommendation

The American Dental Association and the American Association of Dental 

Schools believe that H.R. 12453 can significantly contribute to the expansion 

and improvement of health services for people in foreign lands, principally in 

the underdeveloped and less developed nations of the world. The two associations believe that the policy stated in section 2 of H.R. 12453 is sound. It is “to 

provide assistance to those countries who are working to help themselves develop 

needed health services.” In 1957, the House Committee on Interstate and 

Foreign Commerce in its report on international health activities of the United 

States declared an almost identical position: “In helping a country build up its 

health facilities, emphasis is placed upon the self-help principle * * * the 

responsibility must be assumed by the people themselves. Time and again 

this approach has proved successful.” *

9 The American Dental Association and the American Association of Dental

Schools believe further tha t the training of native personnel to provide the 

needed health services in underdeveloped countries is a first priority. This 

should be done through expansion and improvement of programs in U.S. schools 

for training personnel from needy countries. Again to quote from the 1957

• report of this committee: “Eventually, all countries may have their own, indigenous facilities for tra ining th e health personnel they need. In the meantime, however, their progress 

toward self-sufficiency can be speeded up by providing key workers with the 

advanced train ing tha t is available only in the United States and other highly 

developed countries * * e

Dr. Kerr. Mr. Chairman and members of the committee, my name 

is Dr. I. Lawrence Kerr of Endicott, N. Y.

I am in private practice in tha t city and am, in addition, a member 

of the Council on Legislation of the American Dental Association.

2

 Jou rna l of the American Dental Association, vol. 65, August 1962, p. 277.

3

 The Alph Omegan, December 1961, p. 188. 4

 H. Rept. 474, 85th Cong., 1st sess.

B Ibid.
84 INTERNATIONAL HE ALTH ACT OF 19 66

I am here tod ay rep res entin g th at asso ciation as well as the Am eri ­

can Associa tion of Denta l Schools. Accom pan yin g me is Mr. Ha l 

M. Christensen, directo r of the W ash ington office of the Am eric an 

Den tal A ssociation.

In add ition to th at I have extend ed myself to certa in are as of health 

resources and so have been very int ere ste d in th is and othe r sim ilar 

types of legisla tion.

Ou r associations, Mr. Ch air ma n, favo r II. R. 12453 an d believe it 

will fu rthe r th e work be ing done in th e field o f i nterna tio na l he alt h by 

priva te and gov ernme ntal agencies. Th is measure , we believe, is in 

kee ping wi th the tra ditio n of th is Na tio n in he lping oth ers to help 

themselves.

Surely, the re can be no be tte r ap pli catio n of th is principle th an in 

the field of health, fo r th e diseases th at scou rge ma nkind respec t no 

national bou ndaries and the cure s we are seeking can be applied as 

effectively in Brazil or T ha ila nd as in Ca lif or nia or New York.

W ith in the prop er pro fessional sphere, the denti sts of the Un ite d 

State s have long tak en an active inter est in internationa l healt h 

matter s.

The Am eric an De nta l Ass ocia tion is a princ ipal co ntrib uto r to— 

and lea der of—the pro gra ms of Fe de ratio n De nta ire Internationa le, 

the worldwid e association of na tio na l den tal groups.

The association has, as well, support ed and helped iden tif y and secure personnel fo r such prog rams as Ho pe and Medico as well as 

main taining active liaison wi th the W orld Hea lth Or ganiz ati on , 

the P an Am eric an He alth O rganiza tio n, the Agency fo r I nterna tio na l 

Develop ment, and the In stitut e of Intern ationa l Ed ucati on.

One pre sen t pro ject of note is with the I nter-A merican A ssociatio n 

of S an ita ry E ng ineerin g a nd is dir ected tow ard advancing com munity 

fluoridat ion in La tin Am erican countries.

Fo r several years, in addit ion , the denta l schools of the Un ite d 

State s have been engaged in both stu dent and facu lty inte rchang es 

with oth er countri es o f the wor ld. Ju st a few years ago, the Am eric an 

Ass ocia tion of Denta l Schools mad e a s urvey of its m emb ers to d eter ­

mine th e ex ten t of th is involvement.

I t is ap pa rent from the stu dy th at the prog ram is more spo radic 

th an it should be, prim arily because the severely lim ited fund s av ailable to de ntal schools a re e xha usted by oth er, hi gh er p rior ity demands.

The survey, however, also made two other point s clear. Fi rs t, th at 

the denta l schools were agreed t hat they ha d an obligation to pro vid e 

edu cation at the graduate and po stg radu ate level to prep are some of 

ou r dentists to help underdev eloped natio ns to org anize educational 

systems a nd denta l public h ealth an d care pr og rams; always, of course, 

looking to t ha t tim e whe n such n ati ons would be ca pab le o f tak in g over 

the ent ire resp ons ibility fo r th ei r health care systems.

A numb er of the N ation’s d ental schools ind icated read iness, in the 

survey to which I have referre d, to un derta ke such program s quickly 

if sources of financial su pp or t could be fou nd. H.R . 12453 would 

pro vid e some help in th is regard.

Th e su pp ort th at H.R. 12453 would mak e ava ilab le, of course, 

does no t touch all aspects of the inter na tio na l he alt h effort. I t does 

not, fo r exam ple, pro vid e an exp and ed op po rtu nity for professional 

pers onnel fro m oth er l ands to seek g radu ate or po stg radu ate education 

in th is Na tio n’s health schools.
INTERNATIONAL HEALTH ACT OF 1966 85

This very committee, in 1957, identified as “the greatest obstacle 

to the development and expansion of health personnel in other countries,” the fact that “most of the underdeveloped comitries neither 

have such personnel now nor have the facilities for t raining them.”

We raise this point not necessarily to suggest any changes in H.R. 

12453 as it stands or to denigrate what is a worthwhile proposal, but 

simply to attemp t to realistically assess the p art this measure can play 

in the overall effort, in the field of international health.

H.R. 12453, in and of itself, will not meet many of the problems we 

face in international health but it will be helpful in ta king us fu rth er 

down the road toward our goal of making the presently underdeveloped nations strong enough to stand on their own feet in providing 

health care for their own people.

People, in the final analysis, are what we are talking about in the 

entire international health effort; people who are suffering and dying 

even though there exists elsewhere in the world the means to alleviate 

that suffering and even save those lives.

Though we face ourselves a very vexing problem in meeting the 

health needs of our own citizens, who righ tfully have a special claim 

on our attention, we are, as a nation, strong enough in talent and 

money to spare some effort for others.

A dentist from Detroit, Dr. Herbert J. Bloom, who has spent much 

time in recent years working on the SS Hope, put it this way in a 

letter written after the ship had been to South Vie tnam:

I will never forget the day I left Saigon; there were hundreds of people on the 

dock, holding up their children, showing us the cases of cleft palate, tumors, 

malignancies that we had not the time to treat. If I could put in one word what 

their eyes so poignantly cried out, it was “hope.” We in the United States must 

answer it because we are humanitarians, and we must answer it if we are ourselves to survive in this world.

Our association believe, with Dr. Bloom, th at we must answer this 

cry. We have already begun to do so in many ways. H.R. 12453 

will permit us to take one more step in that effort. We respectfully 

urge its passage.

Mr. Chairman, the American Association of Dental Schools and the 

American Dental Association are most grateful for this opportunity 

to appear before you.

This concludes our testimony and I would be happy at this time to 

attempt to answer any questions tha t you or members of your committee may have.

Mr. Moss. Thank you, Doctor.

Mr. Rogers ?

Mr. Rogers of Florida. Thank you, Mr. Chairman.

Thank you, Doctor, for your statement. How many dentists would 

you say we have now in the international field, in the World Health 

Organization representing this country or Pan American Hea lth Organization, in any activity, Peace Corps, AID. Do we have any ?

Dr. Kerr. It would be a difficult th ing to assess. Probably a small 

part of the 234 referred to by the Surgeon General. I would say very 

few in those particu lar areas besides those that are in the international 

religious mission type teaching efforts.

Mr. Rogers of Florida. Wh at would be the thrust ? Do you think 

we should try to train foreign nationals ? Do you think th at should be
S6 INTERNATIO NAL HEA LT H ACT OF 19 6 6

considered in this program and let them go back, or do you think it 

is still better to train our people and let them go over there?

Dr. Kerr. We believe tha t we should tra in the foreign nationals in 

the area of teacher education, tha t we should also train this small 

number of our people to educate them and it is this step-by-step 

process of education with the ultimate result being better health for 

the people of their own countries.

We could not attempt remedial care for the nations of the world; 

no, sir.

Mr. Rogers of Florida. What about equipment? Do you think it 

would be necessary for us to provide your equipment so that you could 

take it overseas to teach them how to use the equipment tha t we use 

over here ?

Dr. Kerr. I think that would be part of the program; yes, sir.

Many nations have developed th eir own technology and equipment 

and if we could educate them to use theirs or ours this would be a 

great step.

Mr. Rogers of Florida. Are we aware of their technology and equipment in this country ?

Dr. Kerr. Yes, sir. I spent the last few days just checking some 

of it myself.

Mr. Rogers of Florida. Do we have the competence to tell them 

how to use their own equipment ?

Dr. K err. Absolutely.

Mr. Rogers of Florida. Than k you.

Thank you, Mr. Chairman.

Mr. Moss. Mr. Devine ?

Mr. Devine. No questions.

Mr. Moss. Mr. Keith ?

Mr. Keith. No questions.

Mr. Moss. Doctor, I want to thank you for your appearance. I have 

no questions at this time.

Dr. Kerr. Thank you, sir.

Mr. Moss. The committee will now recess and will resume hearings 

at 1 :45 this afternoon.

I might add that at tha t time we will start with Dr. Charles Hudson, 

president-elect of the American Medical Association.

(Whereupon, at 12 o'clock, the committee recessed, to reconvene at 

1:45 p.m. the same day.)

AFT ERN OON SESSION

The Chairman. The committee will come to order.

We had finished hearing the last witness when we adjourned at 

noontime.

The next witness to appear would be Dr. Charles Hudson, presidentelect of the American Medical Association.

Dr. Hudson, would you take the stand, please? I want to congratulate you on being president-elect of the very important American 

Medical Association. We are glad to have you here and you may 

proceed as you see fit, to give your written statement or to put the 

written statement in the record and summarize it.

We would like for you to identify your two associates you have 

with you.
INTERNATIONAL HEALT H ACT OF 196 6 87

STATEMENT OP CHARLES L. HUDSON, M.D., PRESIDENT-ELECT,

AMERICAN MEDICAL ASSOCIATION; ACCOMPANIED BY PAUL

R. M. DONELAN AND HARRY N. PETERSON, LEGISLATIVE DEPARTMENT, AMA

Dr. Hudson. Mr. Chairman and members of the committee. I am 

Dr. Charles L. Hudson, president-elect of the American Medical 

Association, and a practicing physician from Cleveland, Ohio, where 

I have been in the practice of internal medicine for over 25 years.

We me are Mr. Paul R. M. Donelan, on my left, and Mr. Harry 

N. Peterson, on my righ t, attorneys on the legislative department 

staff of the AMA. I would like to read my statement into the record.

The American Medical Association is pleased to appear before this 

committee in support of H.R. 12453, the Internatio nal Health Act 

of 1966. Your bill, Mr. Chairman, is in recognition of the great need 

tha t exists throug hout many areas of the world for the amelioration 

of human suffering caused by disease.

As we understand it, H.R. 12453 would provide grants to schools 

of health to train professional health personnel to work in international health and would also augment the ranks of health personnel 

in the Public Health Service for work in foreign countries. Exporting 

knowledge to needed areas of the world through increased numbers 

of health personnel trained in this country would be a significant step 

in making modern medicine available to developing regions around 

the world.

This committee is aware that the excellence of medical education 

in the United States is not surpassed anywhere in the world. This 

Nation has become the medical train ing center to which students and 

physicians now come from all over the world.

Your bill, Mr. Chairman, recognizes the need for health personnel, 

trained in this country, to go directly into areas lacking adequate 

facilities, personnel, and the latest scientific know-how. With this 

humanitarian goal—to make available to these regions of the world 

the benefits of modern medicine—the medical profession has long 

been in accord.

I should like to briefly relate some of the activities of the AMA in 

the field of international health. The AMA interest in international 

health dates back to 1874, when the house of delegates proposed that 

representatives be sent to the International Medical Congress.

The expanded interest and activities of the AMA in recent years 

stimulated the creation in 1961 of the AMA Department of International Health. It is this department which coordinates and supervises the international health activities of the association.

One area of significance and increasing activity concerns the placement of U.S. physicians overseas. There has been a great upsurge in 

interest among American physicians to serve abroad. The dep artment maintains a greatly expanded registry of opportunities for such 

service. Various potential sources of such employment are contracted, 

including a host of industrial corporations, missionary societies, voluntary agencies, governmental organizations, steamship lines, and 

professional and educational groups.

The association also fosters assistance to physicians who are serving missions in foreign lands. Affiliate memberships in the AMA have
88 INTERNATIONAL HEALTH ACT OF 19 66

been approved for medical missionaries, and assistance and advice on 

problems encountered by medical missionaries are offered under this 

program. Hundreds of complimentary subscriptions to the Journal 

of the American Medical Association and the nine Archives publications are made available to these physicians of every denomination. 

The association also arranges speaking engagements and locates continuing medical education courses for furloughed missionary personnel, and will assist in locating used and surplus medical equipment, 

drugs, medical journals, and textbooks throu gh U.S. collection and 

distribution agencies.

The. AMA also forwards to the a ppro priate missionary agencies applications from volunteer physicians desiring to serve abroad in mission posts.

Additional activities of the association may be briefly listed as 

follows:

Clearinghouse and repository for international medical information;

Publication of a directory of international medical material collection programs;

Puilication in AMA News and the Jou rnal of reports on international health developments;

Designation of AMA members to attend international congresses 

and foreign medical society meetings, and the reporting of these proceedings in AMA publications;

Furnishing of simple, basic public health information scripts for 

transmission abroad;

Furnishing medical literature, radio spot materials and interviews, 

press releases, feature stories, library materials, and issues of the AMA 

Today’s H ealth magazine.

Pa rt of the association efforts in the area of international health 

have been devoted to the sponsorship and participation in conferences 

and meetings:

In 1962, and again in 1963, the AMA sponsored conferences on 

international health attended by representatives from over 200 diverse 

U.S. organizations engaged in international health activities abroad. 

These were the first time tha t so many international medical multidisciplinary groups had been convened^

The AMA is currently supporting the thir d World Conference on 

Medical Education to be held in India in November of this year. This 

conference recognizes the need to establish health services in nations 

at an early stage of development when rapid social change is taking 

place.

And in November of 1965, the association sponsored a Western 

Hemisphere congress on nutrition, designed to bring physicians and 

other informed persons from all nations of the hemisphere to share 

their experiences with nutrition problems.

The AMA was one of the founders and is a principal financial 

supporter of the World Medical Association, which has representation 

from national medical associations in some 57 countries. Physicians 

are brought together from all over the world for consideration of 

common problems in medicine and the means to improve its standards.

Mr. Chairman, -while I have mentioned some of the association 

activities in the field of international health, two additional endeavors
INTERNATIONAL HEALTH ACT OF 196 6 89

deserve mention, although you may already be aware of them because 

of recent publicity concerning them. One concerns the cooperation 

of the American Medical Association in Project Vietnam. The AMA 

responded to administration requests and has helped rec ruit physicians 

for Project Vietnam, which seeks to send volunteer U.S. physicians to 

serve civilians in that war-torn land.

The other is a project concerning participation by the American 

Medical Association with the U.S. Agency for In ternational Development in supporting the faculty of medicine at the University of Saigon. 

At the request of the U.S. Department of State, a four-member AMA 

team will make an on-site inspection in Saigon to consider the possibility of developing a program to supplement the Vietnamese teaching 

faculty at Saigon University with American-trained medical educators and consulting professors. Supporting faculty from the United 

States would cooperate with the existing faculty of medicine at the 

university, where a number of new facilities are being prepared for 

the medical school.

Mr. Chairman, in 1963 it was my privilege to address the second 

AMA Conference on International Health. I believe that the following from my remarks is pertinent here, and with your permission I 

would like to read them.

Today we need but look to our dedication as physicians to realize tha t the 

knowledge of the medical sciences belongs not to one group or to one nation but 

to the entire world, and the international meetings on health which are held with 

increasing frequency nowadays serve as means by which we can share new 

medical knowledge and techniques with our physician colleagues from every 

par t of the world.

Today the globe has so shrunken tha t the ills of our neighbor nations are our 

very own. To do unto them as we do unto ourselves has become a firm rule in 

the matter of world health. In the words of the American Medical Association, 

“* * * international medicine is a forte for truth, compassion and human 

service. And no political nor ideological considerations can obscure the fact 

tha t people and their everlasting need for new routes to healthfulness are tha t 

with which the physician—every physician, from every continent and speaking 

every language—is incessantly occupied.”

There can be no disagreement tha t there exists an urgent need for 

spreading available medical knowledge to many areas of the world 

in order to upgrade their existing quality of medical care. Within 

our resources to do so, our country should contribute its pa rt to accomplish this goal. Mr. Chairman, your committee should be commended for its consideration of legislation intending to help meet this 

grea t need.

We wish to tha nk you for this opportunity, sir, to express the views 

of the American Medical Association. I shall be pleased to attempt 

to answer any question which the members of the committee may wish 

to ask.

The Chairman. Thank you, Doctor.

I am very much interested in the grea t interest and activity tha t 

your association has had in international health. You have carried 

this on for a long period of time and i t looks to me like you have been 

a forerunner. I also would like to congratulate you on your statement 

you made before the conference of UNESCO.

You have said here that you are for the bill, and for the principles 

of it ?

Dr. Hudson. Yes, sir. We are for this bill.
90 INTERN ATION AL HEA LT H ACT OF 19 6 6

The Chairman. Well, we certainly are very happy to have the backing of the American Medical Association. We hope to refine the bill 

before it is over with, but th at will be at the will of the committee.

Mr. Moss?

Mr. Moss. Mr. Chairman, I have no particular question at the 

moment. I would like to reciprocate Dr. Hudson. I note on page 6 

that you commend this committee for its consideration of the legislation. I would like to commend you and your organization not only 

for support of the legislation, but for the substantial involvement already underway in aiding in the export of American medical knowhow.

Dr. Hudson. Thank you, sir.

The Chairman. Mr. Keith?

Mr. Keith. No questions, Mr. Chairman.

The Chairman. Mr. Kornegay ?

Mr. Kornegay. No questions, Mr. Chairman.

The Chairman. Dr. Carter ?

Mr. Carter. I just want to compliment Dr. Hudson for his excellent presentation.

The Chairman. Mr. Satterfield ?

Mr. Satterfield. No questions, Mr. Chairman.

The Chairman. Well, again, I want to say thank you for coming. 

I certainly was personally interested to know of your activities m 

the field.

Thank you again for taking your time in coming here and your 

associates for coming with you.

Our next witness will be Dr. Helen B. Taussig, president of the 

American Heart Association and professor emeritus of Johns Hopkins 

University, Baltimore, Md.

We are glad to have you with us, and you can proceed in any way 

you want to, reading your statement or inserting i t in the record and 

summarizing it.

We know of your great reputation in the field—in many fields, in 

fact—especially in the heart field. So, if you would proceed.

STATEMENT OF HELE N B. TAUSSIG, PRESIDENT, AMERICAN HEART 

ASSOCIATION

Dr. Taussig. Thank you very much. I am happy to be here. I 

have just a sh ort prepared statement and, as you say, I am president 

of the American Heart Association and professor emeritus of pediatrics of the Johns Hopkins Hospital.

I have long been interested in the training of foreign fellows in my 

clinic and have had the privilege of teaching in India for a month or 

more.

I also wish to say in the beginning tha t I am here primarily in 

behalf of the American Hear t Association and we are in strong agreement with the testimony presented before by Dr. Stebbins and by Dr. 

Hunter. It was very excellent testimony and I will not try to reiterate what they have said.

We are strongly in favor of the bill.

I believe that the International Health Act is a brilliant conception 

of a valuable and practical way in which the United States can coop-
INTERNATIONAL HE ALTH ACT OF 19 6 6 91

erate internationally to improve the health of less fortunate countries. 

I say “improve” because even though we should fail to atta in the 

entire objective of the bill, namely, the eradication of the major 

diseases, the undertaking will most certainly improve the health of 

these countries.

The bill favors the training of men and is designed to stimulate 

men to enter a career in the field of international health. I thin k it 

is a wonderful career; it has great satisfaction in helping mankind 

and also it acts as a strong force in international good will and understanding, one of the facts that has not been emphasized so much.

In our previous testimony the American Heart Association has 

stressed the need for increased manpower. Of course, as broug ht out 

this morning this calls for additional medical manpower and thus 

emphasizes the importance of increasing the number of medical schools 

in the country and expanding the schools t ha t we now already have. 

All our medical schools must remain of top quality. To maintain 

academic excellence, the school must no t only give good clinical tra ining but must also contribute to the advancement of knowledge and keep 

up their research work, which must not be curtailed.

Another point which may need clarification—and it was not clear 

to me—is the status of th e Commonwealth of Puerto Rico in this program. Puerto Rico not only has problems of its own th at are similar 

in many ways to those of the underdeveloped countries, but also they 

have contributed greatly to an unde rstanding of these problems. 

Their experience could be of great help in the problems which confront us in some of the underdeveloped countries. I believe it is the 

intention of the bill to include Puerto Rico, but just to make sure 

that there is no misunderstanding on th is point.

Actually, the bill calls for more money than men because the bill 

will support foreign men who can and will assist in the teaching and 

training of the special diseases in their country. Furtherm ore, this 

featu re of the bill insures one of its great objectives; namely, tha t the 

medical program will be of a true internatio nal character. From a 

purely selfish point of view, the program cannot help but benefit our 

own country as the study of disease and how it affects persons in other 

countries aids in our understanding of the manner in which the disease may affect persons in this country.

There is another aspect tha t I think is extremely important. Our 

Secretary of State, the Honorable Dean Rusk, in his address at the 

White House Conference on H ealth, emphasized the tremendous importance of in ternational cooperation in areas of mutual agreement in 

this world in which our differences have the potential danger of the 

annihilation of mankind.

The Secretary of S tate fu rth er emphasized that medicine was nonpolitical and tha t just as disease and germs know no international 

boundaries, so men who work in the field of health have a mutual interest in the welfare of mankind which surpasses all political consideration.

In the light of the constructive internatio nal cooperation created by 

this bill, the amount of money requested and the number of men required to make this program a success is indeed small. The measure 

should have the wholehearted support of th e Nation, as it does of the 

American Heart Association.
92 INTERNATIONAL HE ALTH ACT OF 19 66

I would be glad to answer any questions tha t I can.

The Chairman. I am sorry your Congressman, Mr. Friedel, is not 

here.

Mr. Moss, would you have any questions ?

Mr. Moss. Mr. Chairman, I have no questions. I join you in expressing the regret of Congressman Friedel, who asked th at I convey 

to you his regrets tha t he would not be able to be present. He assured 

me he had had the privilege of working with you when he served as a 

member of the City Council of Baltimore.

Dr. T aussig. Thank you very much.

Mr. Moss. I think you have made an excellent statement. I concur 

in your evaluation of the objectives of the legislation.

Dr. T aussig. Thank you. Than k you very much.

The Chairman. Mr. Keith?

Mr. Keith. No questions, Mr. Chairman.

The Chairman. Mr. Komegay ?

Mr. Kornegay. No questions, Mr. Chairman.

The Chairman. Dr. Carter?

Mr. Carter. Dr. Taussig, were you not one of the first people to do 

the heart surgery with Dr. Blalock at John s Hopkins? Did you do 

that by yourself ? Did you work with Dr. Blalock ?

Dr. Taussig. Yes, I did. I am not a heart surgeon; I am a very 

good parlor surgeon, but I do no actual operations myself.

Mr. Carter. Yes, ma’am. We have heard a great deal about you 

and we are, of course, honored to have you with us here today.

Dr. Taussig. Thank you.

Mr. Keith. Mr. Chairman, while we are on the subject of Dr. Blalock, is Dr. Bahnson still at Hopkins ?

Dr. Taussig. He is now at Pittsbur gh. He is doing heart surgery 

there. Dr. Gotts and Dr. Helen are doing heart surgery at Hopkins 

now.

My clinic has been doing the diagnosis, and still is.

Mr. Keith. Than k you, Mr. Chairman.

The Chairman. Mr. Satterfield ?

Mr. Satterfield. No questions, Mr. Chairman.

The Chairman. Well, Doctor, we are very honored to have you 

come before the committee, someone w ith the reputation you have in 

your field. We are granteful to you for taking your time to come over 

and give us the benefit of your views in this excellent statement you 

have given us.

Dr. T aussig. Thank you.

The Chairman. Thank you very kindly.

Dr. Taussig. Thank you very much for permitting us to come over. 

I am sure the Heart Association appreciates it also.

Thank you.

The Chairman. Our next witness is Dr. Max M. Pomerantz, president of the American Association of Colleges of Podiatry, and dean 

of the Ohio College of Podiatry .

Dr. Pomerantz, we are happy to have you with us, sir, and you may 

proceed as you wish, p ut your prepared statement in the record and 

summarize it or read it.
INTERNATIONAL HE ALTH ACT OF 196 6 93

STATEMENT OF MAX M. POMERANTZ, M.D., PRESIDENT, AMERICAN 

ASSOCIATION OF COLLEGES OF PODIATRY

Dr. P omerantz. Thank you very much, Mr. Chairman and members 

of the committee.

Since the statement is short, I will attempt to read it and then answer 

any question that may be present in your own minds.

Mr. Chairman and members of the committee. I am Max M. Pomerantz, M.D., president of the American Association of Colleges of 

Podiatry and dean of the Ohio College of Podia try in Cleveland, Ohio.

The Internationa l Health Act will add a new and important dimension to our country’s programs of international cooperation and 

the American Association of Colleges of Podiatry wholeheartedly supports the provisions of II.R. 12453.

For many years the colleges of podiatry in the U nited States have 

welcomed those from abroad who have an interest in foot health. 

These visitors seek our assistance because foot conditions, and their 

resultant disability and complications, are common to all p arts of the 

world, affecting the general population, but particularly the young and 

the aged.

In 1962, with the assistance of the Department of State, delegates 

from foreign countries were invited by the American Podiatry Association to a most successful international conference on foot health 

here in the Nation’s Capital. This was followed by a visit to the Ohio 

College of P odiatry in Cleveland which, incidentally, is observing its 

50th anniversary this year.

We have also gained some knowledge of the high prevalence of foot 

disorders throu gh the periodic visits of official representatives of the 

American Podiatry Association to countries in all parts of the world, 

including some in Eastern Europe.

In many cases, these visits resulted from invitations extended by 

foreign governments and their health agencies. This experience is 

best summarized by reports of three extended visits made by Dr. 

Marvin W. Shapiro, a past president of the association. Dr. Shapiro 

concluded tha t foot health is one of the most universally neglected pub ­

lic health problems and that the high standards of podiatric care in 

America do not exist in any other country.

The specialized program of education offered by American colleges 

of podiatry is fa r advanced above that which is available in other countries. Our five colleges are all private, accredited, nonprofit institutions and the educational period covers 6 years with a minimum of 2 

years of prepodiatry courses comparable to the premedical curriculum 

followed by a 4-year degree-conferring course of basic and clinical 

sciences and services.

Many graduates also acquire additional training through internship 

programs sponsored by our colleges and some hospitals in various parts 

of the country. In contrast, fo r example, the colleges in En gland offer 

only a 3-year training program at this time. Other countries spend 

even less time in their programs.

This brief statement is presented in order to identify the need for 

improving the foot health of the people in many parts of the world and 

to offer the cooperation and assistance of the American colleges of 

podiatry in meeting this need.
94 INTERNATIONAL HEALTH ACT OF 19 66

In conclusion, I am confident tha t the provisions of H.R. 12453 will 

help our colleges establish and implement specialized international 

health training programs in the field of foot health care.

I appreciate this opportunity of appearing before the committee in 

support of this bill and will be pleased to answer any questions at this 

time.

Thank you.

The Chairman. Thank you for giving us the benefit of your views 

and those of your organization and association.

Mr. Moss?

Mr. Moss. No questions.

The Chairman. Air. Keith ?

Mr. Keith. No questions?

The Chairman. Mr. Satterfield?

Air. Satterfield. No questions, Air. Chairman.

The Chairman. Dr. Carter?

Mr. Carter. No questions, sir.

The Chairman. Again, I want to thank you for taking the time to 

come and give us the benefit of your views and the views of your association. You, as I observe, are wholeheartedly in favor of the bill?

I)r. Pomerantz. Yes, si r; we are.

The Chairman. And its objectives?

Dr. P omerantz. Yes, si r; that is correct.

The Chairman. And you have made some moves in the international 

field before this time ?

Dr. P omerantz. Tha t is correct, sir.

The Chairman. Thank you again.

Dr. P omerantz. Thank you very much.

The Chairman. Is Air. David AArhatley present ?

(No response.)

The Chairman. If not, he was our last scheduled witness, and he 

will be allowed to present his statement for the record.

This concludes our hearings on H.R. 12453. The record will remain 

open for 5 days for additional information to be presented.

The committee hearing is now closed.

(The following material was submitted for the record:)

Sta teme nt by th e American Vete rinary Medical Asso cia tio n, Subm itted by D. H. Span gle r, D.V.M., P resident

The alleviation and eventual abolishment of global hunger, misery, and disease 

is one of the main goals of the proposed legislative measures of H.R. 12453.

The veterinary medical profession in the United States, repre sente d by the 

American Veterinary Medical Association, wishes to express its firm belief that 

it can make a sub stantial and sustained contribution to the achievement of this 

important national and internatio nal undertaking. For a health program of the 

magnitude as outlined in H.R. 12453, veterin ary medicine must be a partn er of 

consequence. This conviction is based on the fund ame ntal facts of life, health, 

and economics, on the lessons of history, and on the testimony of authoritie s of 

the highest reputation. Briefly, these facts are as follows :

The social and economic progress of a developing natio n depends first of all 

upon the health and vigor of its human population. Human health and welfare 

depend to a very gre at extent upon the adequacy of man’s food supply and the 

effectiveness of m easures to protect his health. Stable institutions cann ot he expected to mate rialize among sick and hungry people. Undernourished and debilitated people are not effective workers, and the ability of children to learn is
INTERNATIONAL HEALTH ACT OF 196 6 95

impaired by inadequate diet. Social and political institutions deteriorate. Economic development is impossible in the face of hunger and ill health.

Much of the ear th’s surface, particula rly in areas inhabited by developing 

nations, is unsuited for the production of crops tha t can be used as human food. 

These areas, however, lend themselves to the production of crops highly suited 

as feed for farm animals. A productive livestock industry as a source of nutrients of highest quality, particularly animal protein, therefore, is not only a desirable possibility, but a necessity for a large number of the world’s developing 

nations. Not only do people require adequate quantities of food, but of even 

greater importance is its quality. Foods of animal origin are irreplaceable 

sources of vitally needed high quality proteins.

No country in the world has ever developed a sound and productive livestock 

industry without establishing, at the same time, a comprehensive system of 

veterinary medical services. Moreover, no country has ever opened up markets, 

both domestic and foreign, for its livestock and livestock products unless it 

achieved reasonable freedom from animal diseases.

Meat, milk, and other food products from diseased animals cause malnutrition, 

disease, and death. More importantly, many animal diseases directly affect the 

health of man. The chief cripplers of people in many underdeveloped countries 

are diseases of animals transmissible to people, such as Chagas’ disease, hydatidosis, leishmaniasis, bovine tuberculosis, brucellosis, leptospirosis, and Japane se B 

encephalitis. People can be protected from these and other animal diseases only 

by controlling and eradicating them first in animals. Hence, the health of the 

people in underdeveloped areas depends upon the development of adequate veterinary medical services.

It is virtually impossible to develop a productive livestock industry in a country 

with inadequate veterinary medical service. The Pan-American Sanitary Bureau has estimated tha t the elimination of epizootic animal disease from South 

America would increase the food supply of animal origin in tha t continent by 

25 percent. Huge tracts of land in the tropics, highly suited to livestock production, are rendered nonproductive because of tropical animal diseases. It is 

not realistic to expect that animal production can be improved significantly before 

veterinary medical services are developed.

The United States offers the prime example of w hat veterinary medicine can 

contribute to a nation’s health and economic welfare. Here veterinarians, by 

employing all medical and scientific knowledge essential to the fight aga inst disease, both animal and human, have made American livestock the healthiest and 

most productive in the world. Doctors of veterinary medicine, caring for the 

health needs of farm animals, assure this Nation of a plentiful and wholesome 

supply of protein foods. By eradicating major livestock diseases many of which, 

such as tuberculosis and brucellosis, a re communicable to man, they have freed 

this country of major threats to human health and economic stability.

Veterinary leaders are convinced that veterinary medical science can become 

an effective force in programs of international health and economic development. 

Such a program should include veterinary medicine’s responsibility for animal 

disease co ntrol: for the controlled movement of livestock in the world today as a 

means of minimizing the spread of animal diseases internatio nally; for the protection of production capacity of domestic and foreign animal agriculture, and 

for the protection of the health of man against animal diseases.

To accomplish these goals requires, first of all, fur the r increases in developing 

veterinary medical resources in the United States. Second, it requires a wellconceived and coordinated master plan for the effective national and interna tional 

utilization of the profession’s services.

The veterinary profession in the United States possesses in its 18 colleges of 

veterinary medicine a reservoir of skills and knowledge which lends itself ideally 

to the implementation of these aims. Serving all 50 of the United States, these 

colleges represent a small bu t vitally important n ational resource. The American 

Veterinary Medical Association therefore proposes a program of grants to these 

colleges for the following purposes: To strengthen and enlarge their existing international prog rams; to increase the number of faculty members having experience with the conditions and requirements of foreign countries; and to establish programs which will trai n both undergraduates and graduates fo r service in 

developing countries.

Furthermore, the AVMA proposes that governmental agencies with responsibilities in the field of international economic development establish on their
96 INTERNATIONAL HEALTH ACT OF 19 66

central staffs positions for well-qualified veterinarians experienced in the international field and trained in the principles of preventive medicine. These 

veterinarians would be immediately available for backstopping of veterinary 

medical problems; they would accomplish needed liaison between health and 

agriculture, particularly in the fields of nutrition and the zoonoses. Moreover, 

these veterinarians would be needed for effective utilization of veterinary 

medical resources available from other Federal agencies, interna tional organizations, colleges of veterinary medicine, and appropriate foundations.

In summary, the AVMA proposes the expansion of teaching facilities and 

faculty of veterinary colleges in the United States as a means of opening up 

veterinary resources which, we believe, are necessary for the effectiveness of 

international programs in health and economic development. Second, the 

AVMA proposes that veterinary medicine be fully integrated into those national 

and international agencies which are responsible for carrying out these 

programs.

We offer our assistance to the Congress and its agencies in any effort tha t 

will enable the veterinary profession to assume fully its necessary role as a 

partner in our Nation’s concern for international health, and economic and 

political stability.

Statement of Warren Z. Lane, M.D., Member of the Research and Clinical Study Committee of the Norwalk Hospital, Norwalk, Conn.

Congressman Staggers, distinguished members of the committee, I am Dr. 

Warren Zepli Lane, a member of the Research and Clinical Study Committee 

of the Norwalk Hospital, Norwalk, Conn.

My purpose in presenting testimony to the committee is to urge your approval 

of H.R. 12453 and to suggest possible helpful additions to the language which 

is based on experience in international development.

The need in developing areas is for preventive measures against disease and 

malnutriation. The administration and planning for the application of such 

measures requires the best professional train ing as outlined by the bill. However, in order to meet the local requirements to provide the technical assistance 

indigenous personnel are required. They should be selected by the recipient 

country and sent for technical training to the United States.

The need is for medical assistants to give the medications and advise and 

educate concerning sanitation and diet. If the tribe is a nomadic pastoral 

group, this means travel with them to achieve this purpose. It means providing the medical assistant with radio communication, such as in Australia, so he 

is able to make decisions regarding tran sport to a regional hospital in emergent cases by conference with his supervisory professional. Needless to say, 

this work is difficult, dangerous, and most personal in its rewards.

Once field experience has been achieved, the medical assistants, as with any 

motivated group, should provide a cadre for advancing professionalism. It 

is from this group that future indigenous physicians will arise.

Needless to say, by sending in a team which will include a medical assistant 

as well as a veterinary assistant, and a teacher will provide the ultimate for 

this type of work. To assist the people and not their food supply is poor 

business. The teacher may be able to convince the young men to abandon tribal 

customs and become sufficiently literate to go to the regional school.

A practical example is the planning demonstrated by the illustrations submitted. (The material referred to will be found in the committee files.)

This represents an area of 30,000 square miles in Kenya. There are about 

35,000 Samburu in this area and 1,500.000 cattle, goats, and camels. The people 

are not pleased with any attempt to change their wray of life, and we feel it is only by systematic planning that their way of life will bend to technical and 

minimum health needs.

I therefore recommend that—

(a) A provision be made for community hospitals in the United States 

to participate in the training of medical assistants.

(h) A provision be made for coordination of activities with veterinary 

schools as well.

(c) A provision be made fo r teachers to be in the team of assistants.

Thank you for the privilege of presenting testimony. I am also presenting 

herewith a paper presented before the Connecticut chapter, R.E.S.A., January 7, 

1966.
INTERNATIONAL HEALTH ACT OF 1966 97

H uman E cology an d R eg io na l D ev el op men t : 1

 An I n terd is cip lin a ry P rogram

(By Warren Z. Lane, M.D.)

The social sciences, borrowing freely from more specialized disciplines for their 

methodology, have reached a maturity tha t promises to provide man with rational 

approaches to demographic and human ecological problems. Medical science has 

applied mass techniques for disease control; pharmacology has produced control 

medications at a cost tha t is not prohibitive to the poorest natio n; veterinary 

science has developd genetic varia nts to increase protein food ; agricultural 

science has developed disease resistan t and superproductive food pla nts; chemical 

engineers have responded with petrochemicals, insectides, and fer tili zers; and 

so it goes w ith a list tha t would take up the entire time. In each discipline, 

expansion of knowledge and the practical application of knowledge competes for 

the coordinating skills of administrators. In short, we are outdistancing the 

capabilities of the mind to encompass this needed data and creatively adap t this 

ratiocination to our general use. More could be said about computers here but 

it is another subject.

Developing countries recognize the urgency of providing food, education, and 

health facilities for their populations. The list of agencies and foundations t hat 

publish data on the developing nonalined states is long. The results that withstand scrutiny are those projects in which the human factors receive high priority. 

When the projects stray from these factors, the results are not adequate because 

of the venality, greed, and corruption tha t accompany them. Studies have been 

started, such as Project Camelot, to study human behavior; but the Communists 

prevented even superficial studies and created such a disturbance, the proposal 

was shelved. Project Camelot was in reality a study to determine what factors 

produce a desire for insurgency—which is, of course, the opening needed for wars 

of national liberation. When behavioral elements are accepted as the mores of 

the country, and projects designed to demonstrate how health, education, and 

welfare can be achieved, a quite different reaction occurs. The Communists will 

stand in line to receive their pill under those circumstances. Add to this a 

methodology that assures participation by the indigenous peoples and the project 

is well launched with a hope fo r viability and insulation from subversion.

Projects are not achieved by exporting American mores or our brand of 

democratic and socioeconomic development. The hue and cry of “neocolonialism” 

is raised before the first step is taken. Frequently, the loudest shouters are 

individuals with no technical or administrative training, but in whom the cancer 

of Communist doctrine has been implanted by the eternal promise of food and 

a place to sleep. The eternal desire for recognition and acceptance by U.S. 

agencies must be subtle and muted, or reactionary trends often obscure the main 

thrust of programs.

The great success achieved by Operation Crossroads Africa and the Peace Corps 

is primarily due to no publicity on the site, but recognition on a quiet basis at 

home by peers. The factor ©f personal participation on a shoulder-to-shoulder 

basis in which Yankee sweat is intermingled with indigenous sweat and food fads 

cannot be discounted. The same louse and the same flea bites Yankee skin as 

well and as deeply.

Data returned from many Agency for International Development projects, the 

Rockefeller Foundation and the Ford Foundation, to name but three of many, 

reaffirms the soundness of the human ecological approach. Policymakers in our 

Department of State have decided however, tha t we must “show the flag,” and 

therefore go against the evidence to design projects tha t are not as sensitive 

as those which deal with human need. The trend is emerging at last for 

reconsideration of the flashy show to one of concentrating projects for local food, 

health, and education. The Johnson administration now will submit legislation 

to replace Public Law 480 with the “Food for Peace Act of 1966.” The elements 

of this act will call for specific commitments in future programs for better seeds 

and fertilizer production at the site. Also, instead of stockpiling food and 

shipping, the policy may be to purchase in the open market. Finally, a food 

enrichment program in which vitamins, trace elements, and balanced amino 

acids will be used as additives should be accomplished a t the site by indigenous 

workers, as well as the regional development of food protein “on the hoof.”

To this end a consortium of U.S. companies have been negotiating with the 

Government of Kenya to develop a program based on the total ecological apPres ented to the Connecticut chapter, R.E.S.A .: J an. 7, 1966.
98 INTERN ATION AL HEA LT H ACT OF 1966

proach. This means th at the inte rfac e between man and his environment will' 

receive a systems analysis, just as the inte rfac e between his food animals, game, 

landscape, disease vectors, and the like w ill receive a sim ilar study. The physical 

factors will be assessed by a systematic inventory and where applicable, the 

isolation of controllable variables will be established. Finally, the application 

will include dependent variables analysis for the purpose of e stablishing math ematical modes. Using sample techniques and weighing the data, a digital code 

will he estab lished for recordkeeping and to relate to a hypo thetical programed 

hypothesis. In all candor, we realize that where single uni ts can be compared 

this system may work; but that when the whole system is on line the mass may 

come unhinged and create a blackout. But after all, this is one of the major 

objectives, and the program is projected for 30 years. The ultimate answer 

cannot be expected—only clarifications and indications of where the major 

problems are.

A preliminary survey in Kenya was done in Jan uary and Febru ary of 1964, and 

a planning conference was held at the Ministers’ level in Nairobi in October of 

1964. This conference produced a proposal which is seeking a sponsor and, hopefully, aid from our Government.

The area for development is a semiarid tra ct of 8,500 square miles w ith a mean 

altitude of 5,000 feet above sea level, of tableland, mountains, and valleys.

The trib e involved is a Nilo-JIamitic group called the Samburu. Except 

for local surveys no social stud ies in depth were completed until Dr. Paul 

Spencer of the Tavistock Insti tute lived with the Samburu for about 2 years 

from 1951 to 1953 on a nearly continuous survey. Their language is similar 

to Masai and they are actually considered to be a division of th at tribe that 

sepa rated more than a century ago. Their marria ge custom s are exogamic. 

The age grade system is presum ed to be line ar and not cyclic. Food customs 

are sim ilar to the Masai in t ha t they drink milk and eat meat occasionally. The 

meat is prim arily mutton and goat as cattle are sacred. A few camels are 

herded and used for pack anim als during their nomadic treks in search of grass. 

These movements are dictated by the need for grass and browse, salt, and 

water. Frequently, entire groups will move many miles when rain has fall en in 

that dis tric t which provides a growth of grass or improved browse.

Living conditions are primitive and the life is harsh, but except for trach oma 

and animal trauma, spear and knife wounds, and pneumonia, they are a very 

sturdy people. About 35,000 live in the area regularly with occasional increases 

from neighboring tribes, such as the Turkh ana and Boran. They have resisted 

any modernization and are hostile and suspicious when schools are proposed 

or range management programs or bore holes for a reg ular wa ter supply. The 

reasons for this is the ir reliance on a cattle economy. Also, the boys of school 

age are the herders. When they are read y for the circumcision ceremony, they 

join the ranks of juvenile delinquents and become “moran,” or w arriors. Having 

no b attles to fight to gain fav or with women, they go on cattle raids and raise 

hell in general. The young wives of the elders in this polygamous society are 

usually their source for sexual adventures. This is because the virgins are 

taboo and rape of virgins is punishable by death or dismemberment. The tu rmoil created is frequent and the elders lecture the morani frequently on the ir 

morals. This blissful existence ends at about age 35, when marria ge is possible 

by gifts of cattle from the ir mothers’ estates. Bachelors are few and widows 

become wife to the brother, bu t get no cattle dowry and little else but a roof 

and a child each year.

To solve some of the problems we propose that perm anent stations be built 

th at corresponded to trek routes and meteorological conditions. With sites 

developed and good range management they would have a steady source of income. By sending traveling team s with each clan, to teach medical aid and 

veterin ary aid, it was felt the educational process could be expedited and less 

pressure for using the school age boys as herders might be feasible. The chances 

to improve health in man and anim al were very good. An estimate of 8-10 years 

of education would be requ ired before any imprint, on the line ar moran system 

would be possible.

To develop more cultivation for a varied and balanced diet we recommended 

atomic power for desa linization and pure wa ter irrigation. Beside crops and 

tobacco there is an are a where dates would grow in the northeaste rn are a of 

the district. The date tra de with Somalia, a Moslem nation, and the Middle 

East has a real p otential. This because the da te fly has nearly destroyed the date 

industry in Iraq and Iran. Similarly by th e development of a slau ghter facility,
INTERNATIONAL HE AL TH ACT OF 19 66 99

dressed beef could be flown out to external markets. Electrical power is there ­

fore needed for pumping, irrigation, and refrigeration.

In conclusion, we believe that this program may tak e 30 years to come to final 

stages. To presume to present the Samburu with Western or even local African 

socioeconomic programs is doomed to fail unless the scheme is adjusted to their 

way of life. When a sufficient number can be convinced of the worth of a cash 

economy, the clans will develop on their own. This may be far from a Texas 

style development, but the need for protein food and resettlement in a developing country may supercede the traditional way of life.

Ann Akbob, Mich.,

February 21,1966.

Hon. Harley O. Staggers,

Chairman, House Committee on Interstate and Foreign Commerce, House Office

Building, Washington, D.C.

Dear Mr. Chairman : I am writing to express my strong approval, both as 

dean of the School of Public Health of the University of Michigan and as president of the Association of Schools of Public Health, for H.R. 12453, the Int ernational Health Act of 1966.

The general purposes of this act are most important and I tru st the Congress 

will approve it speedily. Almost 9 years of full-time experience in international 

health, as a staff member of the World H ealth Organization and the Pan American Health Organization, have fully convinced me of the great value of international health activities, not only for their intrinsic worth in saving lives 

and improving human resources but also as a medium of international 

understanding.

It has frequently been said, but cannot be repeated too often, that disease 

knows no boundaries. Vivid personal experiences of the speed with which 

bacteria can cross great distances move me to cite the benefit to the American 

people themselves, as well as to their brothers overseas, from such health activities. The goal of erradicating smallpox will mean in the long run not only 

saving in lives but great financial benefit to the American people as w’e reach 

the stage when control programs will not longer be needed. This, to be sure, 

is still far in the fu ture but a beginning is vitally important.

Establishment of an international health career service is an exciting move 

for which most of us have wished devoutly these many years. Such a career 

service will allow interchange of personnel and will provide enormously valuable 

experience in preparation of health workers in our own country as well as 

elsewhere. The career service will also make much easier our task of recruiting faculty for international health.

The emphasis on training activities, and particularly participation of schools 

such as ours, is very welcome. All of the 13 accredited schools of public health 

in the United States are vigorously engaged in internationa l health work, but 

this bill opens the opportunity for meaningful expansion and improvement.

In one respect I trust your committee will make an important deletion. Under 

section 213(c)2 (p. 9, line 6) I strongly urge deletion of the words “at the 

request of the Department of State.” While I have great respect for the 

opinions of the State Department officers I respectfully submit that knowledge 

of health affairs does not fall within their range of competence. My experience 

abroad and in this country and my years as secretary-general of the Pan 

American Health Organization lead me to point out that involvement of the 

Department of State in such details as personnel assignment or approval of 

health projects can vitiate many of the gains. Furthermore, there is no need 

for such involvement. The influence of the State Department can and should 

be made at the policy level and through consultation with directors of the program. Insertion of the Department of State at an operating level with regard 

to individual career officers or individual programs can resu lt in nothing but 

confusion and often ill will. I strongly urge deletion of these words.

I know that I speak on behalf of our member schools when I say that we 

shall welcome the opoprtunity to work with the Congress and the Public Health 

Service in implementing this highly worthwhile legislation.

Very sincerely yours,

Myron E, Wegman, M.D.,

President (Dean, School of Public Health, the University of Michigan).
100 INTERNATIONAL HEALTH ACT OF 19 66

The Johns Hopkins University,

School of Hygiene and Public Health,

Baltimore, Md., February 24,1966.

Hon. Harley O. Staggers,

Chairman, House Interstate and Foreign Commerce Committee, House of Representatives, Washington, D.C.

Dear Congressman Staggers : I am writing you to support the International 

Health Act of 1966, H.R. 12453, which you recently introduced. I hope that your 

committee and the Congress will give favorable consideration to this creative 

piece of legislation.

My experience with medical personnel from other countries has been in the 

conduct of research in which representatives of several countries participated 

as a team. In one particular study, we have been especially interested in comparing the utilization of health services under varying circumstances. The 

opportunity to work with, teach, and learn from colleagues in other countries 

was a most rewarding experience and resulted in lasting friendships.

Apart from these contributions to peace, there are important opportunities for 

Americans to increase the capacity for other countries, particula rly the developing 

countries to improve the valume and quality of the health services they provide 

their citizens. Able individuals are available in these countries but they need 

instruction and assistance. Too frequently, the assistance has been given by 

individuals from the United States who for one reason or another were not always 

our best representatives. The opportunity through the proposed legislation to 

provide young physicians, nurses, and other health personnel to work in these 

countries is a most important feature of the legislation.

In addition to experiences in other countries, the frequent contacts we have 

here at Johns Hopkins University with students from other lands, reinforces 

their desire to obtain the kind of help and assistance from their young American 

colleagues which your proposed legislation would provide.

I urge your committee and the Congress to act favorably on this legislation. 

Yours sincerely,

Kerr L. White, M.D., 

Professor and Director.

American Association of Colleges of Pharmacy,

Washington D.C., February 23,1966.

Hon. Harley O. Staggers,

Chairman, Committee on Interstate and Foreign Commerce,

House of Representatives, Washington, D.C.

Dear Mr. Staggers : H.R. 12453, the International Health Act of 1966, is designed to produce within the Public Health Service a category of career personnel whose function will be to assist foreign countries in developing health 

services essential to the well-being of their people.

Grants to schools of the health professions will provide the essential specialized academic programs including firsthand knowledge through visitations to 

foreign lands. Secondly, the legislation will provide for an increase within the 

Public Health Service in the number of international health workers for assignment to foreign countries and for related activities in the United States.

The provisions of H.R. 12453 would add a new and important dimension to the 

concern we hold fo,r people of other countries, and the American Association of 

Colleges of Pharmacy, through its executive committee, wishes to go on record 

as approving and supporting the objectives of this legislation.

The schools of pharmacy have, through the years, provided training for foreign 

students at both the undergraduate and the graduate level. Currently 200 (1.5 

percent of our student body) are enrolled in undergraduate courses and 398 

(approximately 25 percent of our graduate student population) are enrolled in 

advanced courses leading to the master of science or to the doctor of philosophy 

degree. Most of these students return to their native lands and utilize their 

health knowledge to the benefit of their people. Thus, schools and colleges of 

pharmacy are now aiding in international health work by training foreign students who will have the knowledge and ability to cooperate closely with U.S. 

health workers provided by this legislation.

The undergraduate educational program of schools of pharmacy requires a 

minimum of 5 years and provides an excellent training in the basic sciences and 

in professional courses concerned not only with the drugs uoed in the cure of
INTERNATIONAL HEALTH ACT OF 1966 101

disease but with the cause of disease and with its significance in the well-being 

of a population. Certainly it is a program broad in scope which, with a minimum 

of specialized advanced training, would provide personnel capable of providing 

a broad spectrum of health services.

At the present time there are 241 pharmacists on active duty with the U.S. 

Public H ealth Service serving in many capacities: as administrators, as pharmacists in hospitals, and as scientists in highly specialized programs. In the past, 

at least some have served overseas with the Public Health Service.

This legislation embraces all of the health professions as evinced by the definition of the term “school of health.” We wish to assure you of the interest and 

of the support of schools of pharmacy in the objectives of the legislation and, 

should it become law, in its implementation to the end tha t direct assistance 

through health service to peoples of foreign lands may decrease the hazards of 

disease and thereby contribute to the peaceful aims of our people.

Sincerely yours,

J oseph B. Sprowls, 

Chairman, Executive Committee.

(Whereupon, at 2 :30 p.m., the hearing was adjourned.)

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