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The original documents are located in Box 47, folder "6/23/76 S1466 National Consumer
Health Information and Health Promotion Act of 1976" of the White House Records
Office: Legislation Case Files at the Gerald R. Ford Presidential Library.
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Exact duplicates within this folder were not digitized.
86/23/16
APPROVED JUN 23 1976
THE WHITE HOUSE
DECISION
WASHINGTON
Last Day: June 23, 1976
June 22, 1976
TORREVIUBS
MEMORANDUM FOR THE PRESIDENT
FROM:
JIM CANNON
SUBJECT:
Enrolled Bill S. 1466 - National Consumer
Health Information and Health Promotion
posted
Act of 1976
6/24/76
Attached for your decision is S. 1466, which extends
through FY 1978 existing communicable, venereal
disease and lead-based paint poisoning prevention
programs, as well as authorizing HEW to conduct under
new authority health information and promotion programs.
BACKGROUND
The legislative authority for communicable disease
control programs conducted by HEW expired June 30, 1975,
and since then has been carried out under the authority
of a continuing resolution. S. 1466 would renew the
authority for these ongoing programs and also provide
authorization for a new program to increase the
individual's knowledge on how to use health care.
This is the first piece of legislation to emerge from
the Congress that would continue a categorical program
included in your health block grant proposal. We expect
that several other bills will be passed this year which
will continue other categorical grants. We do not expect
the block grant proposal to become law during this session.
The National Influenza Immunization Program against
swine flu is operated under one of the authorities in
this bill. Although the programs involved could still
be operated under continuing resolution this fiscal
year, the visibility of the swine flu immunization program
may make a veto difficult for the public to understand.
Also, the same Committees that developed this legislation
are the ones that will consider the Administration's
request for special indemnity legislation for swine flu
vaccine manufacturers.
Digitized from Box 47 of the White House Records Office Legislation Case Files at the Gerald R. Ford Presidential Library
2
During floor consideration of the legislation, it was
noted that OMB strongly opposed the bill but no veto
signal was given.
STAFF AND AGENCY RECOMMENDATIONS
HEW
Approval. Strongly recommend that the
President approve the enrolled bill in a
private signing ceremony. "S. 1466 represents
a negotiated compromise on the issues involved,
in which our major objections have been met.
These prevention and control activities may
well do more in the long run to limit the
continuing increase in health care costs in
this country than other programs which require
levels of funding much higher than those
authorized by S. 1466.'
OMB
Disapproval. "Would serve as an occasion to
stress your opposition to the proliferation of
categorical grant programs
because S. 1466 is
inconsistent with your block grant proposal
chances of sustaining a veto are very slim. "
(Jim Lynn's memorandum is attached at Tab A.)
HUD
Defers to HEW and CPSC on lead-based paint
provisions.
CPSC
Favors veto of regulatory provisions concerning
lead-based paint and defers on bill as a whole.
Buchen
Approval. "Veto would be a futile gesture."
(Lazarus)
Friedersdorf - Approval. "The bill passed both Houses by
a voice vote. Veto would, of course, be difficult
if not impossible to sustain."
Both Tim Lee Carter and Jim Broyhill supported the
bill and believe their combined efforts with Paul
Rogers (and HEW) succeeded in a bill the President
could sign.
RECOMMENDATION
I recommend that you sign S. 1466.
DECISION
my
Approve (enrolled bill attached at Tab B).
Disapprove (sign veto message at Tab C, which
has been cleared by Doug Smith).
APPROVED JUN 23 DF THE STATE
PRESIDENT
and
EXECUTIVE OFFICE OF THE PRESIDENT
UNITED
OFFICE OF MANAGEMENT AND BUDGET
WASHINGTON, D.C. 20503
JUN 17 1976
MEMORANDUM FOR THE PRESIDENT
Subject: Enrolled Bill S. 1466 - National Consumer
Health Information and Health Promotion
Act of 1976
Sponsor - Sen. Kennedy (D) Mass. and 7 others
Last Day for Action
June 23, 1976 - Wednesday
Purpose
Authorizes HEW to conduct a new health information and
health promotion program; extends through fiscal year
1978 and expands existing communicable disease, venereal
disease and lead-based paint poisoning prevention programs.
Agency Recommendations
Office of Management and Budget
Disapproval (Veto
message attached)
Department of Health, Education,
and Welfare
Approval
Department of Housing and Urban
Development
Defers to HEW and
CPSC on lead-based
paint provisions
Consumer Product Safety Commission
Favors veto of
regulatory provisions
concerning lead-based
paint, but defers on
bill as a whole
Discussion
Legislative authorizations for the communicable disease
and disease control programs conducted by HEW expired
on June 30, 1975 and, since then, have been carried out
2
under the authority of a continuing resolution. S. 1466
would amend the Public Health Service (PHS) Act by
extending and expanding these categorical health programs,
and by authorizing HEW to initiate and conduct a new program
of health information and health prevention.
Specifically, S. 1466 would:
-- extend for three years and expand the program
of grants for the control and prevention of a number of
communicable diseases, e.g., venereal diseases, rat
control, and immunization,
-- extend the lead-based paint poisoning prevention
program through fiscal year 1978 and redefine the respon-
sibilities of the agencies involved in administering that
program, and
-- authorize grants and contracts in the area of
health education, and require the establishment of an
Office of Health Information and Health Promotion in
HEW.
Communicable and venereal diseases. S. 1466 would expand
or modify communicable disease programs by:
-- authorizing new training and demonstration grants
and contracts in the area of disease prevention and
control,
-- broadening the definition of "disease control
program" to include, in addition to communicable diseases,
diseases or health conditions which are preventable or
subject to amelioration, e.g., arthritis, diabetes,
hypertension, pulmonary and cardiovascular diseases and
RH disease, and
-- repealing the formula grant authority of the
venereal disease program.
Your 1977 Budget proposed the "Financial Assistance for
Health Care Act, to consolidate Medicaid with these
other health programs into a single health block grant
program. Draft legislation was submitted to Congress in
February 1976. Under the Administration's legislative
proposal, States would have the flexibility to determine
priorities of health care in the communicable disease and
disease prevention area. The Administration therefore
3
strongly opposed S. 1466, since it runs directly counter
to the concept of the health block grant.
Lead-Based Paint Poisoning Prevention Act. S. 1466 would
also modify the existing Lead-Based Paint Poisoning
Prevention Act (first enacted in 1971 and extended in
1973), in several respects. It would:
-- require that the Consumer Product Safety Commission
(CPSC), within six months of the enactment of S. 1466,
determine whether or not a level of lead in paint which is
greater than 0.06% but not in excess of 0.5% is safe.
(If such a determination is not made, after 12 months
the term "lead-based paint" would automatically be defined
by S. 1466 to mean paint containing anything greater than
0.06% rather than the definition of 0.5% in present law.)
-- prohibit the application of lead-based paint to
any cooking, drinking or eating utensils, toys or furniture
manufactured after the date of enactment, or the use of
such paint in residential structures built or rehabilitated
with Federal assistance,
-- transfer from HEW to the Department of Housing
and Urban Development (HUD) responsibility for controlling
the application of lead-based paint to federally con-
structed or assisted housing, and
- require that local governments give priority to
the removal of lead-based paint hazards in dwellings where
children with diagnosed lead-paint poisoning reside.
The Administration had proposed to include the lead-based
paint poisoning prevention program in the health block
grant proposal and therefore did not support its extension
as a separate program or any amendments to the existing
Act.
Health information and promotion. A principal purpose of
S. 1466 is to increase public knowledge of the appropriate
use of health care. Accordingly, the enrolled bill would
add a new title to the Public Health Service Act which
would:
-- authorize HEW to make grants and enter into contracts
for research, community demonstration and training programs,
and information programs in the area of health education,
4
-- require HEW to submit to the Congress within two
years, and annually thereafter, a report on the status of
health information and health promotion, preventive health
services and education in the use of health care,
-- require the establishment of an Office of Health
Information and Health Promotion under the Assistant
Secretary for Health to coordinate all HEW activities
designed to educate the public in the appropriate use of
health care, and
-- require the establishment of a national health
information clearinghouse.
The Administration strongly opposed the establishment of
this new categorical health program since it conflicts
with the Administration's objective of consolidating
numerous existing health programs and since HEW already
was using its general authority to conduct health informa-
tion activities. Moreover, the effectiveness of health
information activities in changing behavior is questionable.
Budget impact. Attached to this memorandum is a table
comparing the appropriations authorizations in S. 1466
with the Administration's budget requests for fiscal
years 1976 and 1977 and the levels projected for fiscal
year 1978 in the 1977 Budget. In total, the authoriza-
tions in the enrolled bill for the three fiscal years
amount to $307 million. This compares with $99 million
requested or projected by the Administration. For fiscal
year 1977 alone, the bill would authorize $103 million
compared to the budget request of $33 million as part of
the block grant for the programs involved.
Although the authorizations in S. 1466 are far above the
requests, they are not sharply out of line with recent
congressional appropriation trends.
Arguments For Approval
1. S. 1466 would specifically authorize HEW to
continue its existing disease control and prevention
programs. HEW argues that the bill is necessary at least
until the Administration's proposed Financial Assistance
for Health Care Act can be effected; enactment of that
proposal does not appear likely in this session of the
Congress.
5
2. The new health education categorical program has
a relatively small authorization and, although it duplicates
existing legal authority, it would not disrupt HEW organiza-
tional structure or require HEW to carry out an expensive
new program.
3. According to HEW, S. 1466 "incorporates major
concessions agreed to by the Congress after considering
the Administration's objections. HEW cites those
concessions as:
-- deletion of authority for a National Center
for Health Promotion,
--- excision of all administrative authority of
the Office of Health Education and Health Promotion,
-- deletion of authority for an interdepartmental
health education committee,
-- elimination of authority for new water
treatment and dental programs, and
-- lowering of appropriations authorizations to
amounts below those originally provided in both
House and Senate versions of the bill.
4. Congressional sponsors of the legislation indicated
on the House and Senate floors that there had been
negotiations with Administration representatives and
that it was their understanding that the final version of
S. 1466 which emerged from conference was acceptable to
the Administration and that you would sign it.
Arguments Against Approval
1. S. 1466 runs directly counter to the efforts of
the Administration over the past two years to consolidate
the many fragmented health programs administered by HEW.
Approval of S. 1466 would undermine your commitment to
enactment of the Administration's health block grant
proposal. This is the first such bill to emerge from
Congress that would continue a categorical program that
you included in your health block grant. Moreover,
approval of S. 1466 would leave virtually no alternative
but to approve two other bills extending narrow categorical
health programs under final consideration by the Congress,
i.e., Emergency Medical Service and alcoholism grants.
6
2. Extension of the appropriation authorizations to
continue the programs pending enactment of the health
block grant is not necessary. The programs involved
are operating under continuing resolution this fiscal
year without new authorizations. Disapproval of the enrolled
bill could help maintain pressure on the Congress to enact
the block grant proposal and would, at the same time,
keep funding of the programs at lower levels under the
continuing resolution than might be provided under the
authorizations in the bill.
3. Over the three years, the authorization levels
in S. 1466 exceed by $208 million the levels requested in
the 1976 and 1977 budgets. The authorizations in the
Emergency Medical Services and alcoholism bills likely to
be enrolled before July 1 could, if fully funded, result
in additional budget outlays of approximately $116 million
in fiscal year 1977 and $189 million in 1978.
4. OMB staff believe there are very few "concessions"
in the compromise version of the bill. The only significant
change is that new water treatment and dental programs
would not be included. In addition, the authorization
levels in the final "compromise" bill were, in some cases,
higher than those in the original House and Senate bills
and in total are still about 3 times more than the Adminis-
tration request.
5. Statutory establishment of a new health informa-
tion program and a new Office of Health Information and
Health Promotion in HEW is clearly unnecessary and without
program merit. HEW states that the main effect of these
provisions "would be to give increased visibility to the
area of health education." HEW already has an Office of
Health Education in the Center for Disease Control, and
carries out numerous health education activities.
6. The Consumer Product Safety Commission states
that there are serious objections to the administrative
process provided by S. 1466 for establishing and enforcing
a safe level of lead in paint, depending on whether an
agency proceeded under the Lead-Based Paint Act, the Consumer
Product Safety Act or the Federal Hazardous Substances Act.
CPSC states that S. 1466 could lead to differing federal
standards and "undoubtedly will require duplicative pro-
ceedings on the precise same matter resulting in a massive
waste of tax dollars." CPSC also concludes that "the
7
confusion which would result from different federal levels
would be compounded by the statutory provisions applicable
to preemption of various state and local laws and regula-
tions."
Recommendations
HEW strongly recommends approval. The Department states
that "S. 1466 represents a negotiated compromise on the
issues involved, in which our major objections have been
met. Actual funding levels will, of course, be determined
through the appropriations process." HEW recommends "a
private signing ceremony to which the principal Congressional
participants in the development of S. 1466 would be
invited."
HUD states that it has "no objection to the transfer to
HUD of HEW's responsibility for controlling the applica-
tion of lead-based paint to Federally constructed or assisted
housing." HUD defers to HEW and CPSC on the other provisions
relating to lead-based paint.
CPSC, in its letter, offers the following comment:
"Only insofar as the provisions of S. 1466 impact
on the Consumer Product Safety Commission by
amending the process for establishing a safe level
of lead in paint does the Commission favor veto
of the bill. The regulatory process which results
from this portion of S. 1466 will be more costly and
duplicative than is necessary without any increase in
benefit to the public."
CPSC defers to HEW on the other provisions of S. 1466,
but requests Administration support of efforts to amend
the procedural provisions, should the bill be signed.
We have strongly opposed S. 1466 because it is so clearly
inconsistent with your proposal to consolidate categorical
health programs into a single block grant. Moreover,
S. 1466 does not contain authorities that we believe to
be essential at this time. Disapproval of S. 1466 would
serve as an occasion to stress your opposition to the
proliferation of categorical grant programs by the
Congress. We disagree with HEW that Congress made
"major" concessions in the conference bill.
8
We realize that this enrolled bill was apparently viewed
as noncontroversial, since it was passed by voice vote
in both Houses. Chances of sustaining a veto are very
slim. Nevertheless, we believe the policy considerations
involved are sufficiently important to warrant your
disapproval of S. 1466. We have attached a draft veto
message for your consideration.
Pall Onein Paul H. O'Neill
Acting Director
Enclosures
Attachment
S. 1466 Appropriations Authorizations
Compared with Budget Levels
($ in millions)
Fiscal
S. 1466
Budget
Program
year
Authorizations
levels
Difference
Health education
1977
7
--
+7
1978
10
--
+10
1979
14
--
+14
Venereal disease
1976
37
20
+17
1977
48
20
+28
1978
51
20
+31
Rat control
1976
13
5
+8
1977
14
5
+9
1978
14
5
+9
Lead-based paint
poisoning
prevention
1976
10
3
+7
1977
12
3
+9
1978
14
3
+11
Immunization and
other control
programs
1976
13
5
+8
1977
22
5
+17
1978
28
5
+23
Total, all years
307
99
+208
Total, 1976
73
33
+40
Total, 1977
103
33
+70
Total, 1978
117
33
+84
Total, 1979
14
--
+14
to
©
C
3
period. At a time when the overall Federal deficit is
estimated at over $74 billion, I must oppose such excessive
authorization levels.
Other bills now pending would also continue current
narrow categorical Federal health programs. Rather than
proceeding to extend and expand such programs, I urge the
Congress to hold hearings and rapidly enact my proposed
"Financial Assistance for Health Care Act. "
THE WHITE HOUSE,
TO THE SENATE OF THE UNITED STATES:
I am returning, without my approval, S. 1466, a
bill which would authorize duplicative health information
and health promotion programs and would reauthorize and
expand programs dealing with venereal disease, rat control,
lead-based paint poisoning and other disease prevention
and control.
This bill is based on a policy of perpetuating the
existing maze of Federal health programs. Such an
approach is a disservice to those who need effective
delivery of health services and those who must pay the
bills -- the taxpayers. In my 1977 Budget, I proposed
a consolidation of 16 existing Federal health programs
into a single block grant which would enable States and
localities to assure that people in need receive com-
prehensive health care. I share the objectives of S. 1466
to assure the provision of important preventive health
services, but I firmly believe that under my proposed
health block grant those services would be provided in
a more effective manner.
Fewer Federal programs, and a reduction in the various
rules and regulations accompanying each of them, would allow
States and local governments to respond more quickly to the
particular health needs of their residents. Consolidation
into a block grant will also better target Federal health
assistance on those with low incomes, and distribute Federal
funds more equitably among the States. Funding from the
existing 16 categorical programs proposed for consolidation
in the block grant varies from $200 per low-income individual
in some States to over $800 in others. This inequity should
not be continued.
2
In addition, the many Federal requirements imposed
upon States and localities prevent them from bringing
about needed efficiencies and coordination in their health
programs. If the proposed health block grant were enacted
instead of bills such as S. 1466, more Federal health dollars
could go toward providing health services for our citizens
rather than for the cost of burdensome administration.
S. 1466 would also create unnecessary and duplicative
health education programs. The Department of Health,
Education, and Welfare alone now spends more than $80
million a year on health education of the public. The
activities proposed in S. 1466 would only add to the already
complicated array of Federal health education programs.
The bill would, moreover, create a special problem
in the lead-based paint poisoning prevention program. It
would require the determination of safe lead levels in
paint but provides little, if any, guidance with respect
to the procedures determining those levels. This could,
accordingly, lead to the highly undesirable situation of
differing Federal standards for lead in paint, depending
on whether an agency proceeded under the Lead-Based Paint
Poisoning Prevention Act, the Consumer Product Safety Act
or the Federal Hazardous Substances Act. Thus, S. 1466
could not only create confusion in this area, but could
require duplicative administrative proceedings on the same
subject matter resulting in a massive waste of tax dollars
as well as unnecessary delay and red tape, without any
real benefit to the public.
Lastly, S. 1466 is objectionable since it would
authorize appropriations of $307 million -- more than
three times my requested levels -- over a three-year
EXECUTIVE OFFICE OF THE PRESIDENT
CELLING
OFFICE OF MANAGEMENT AND BUDGET
WASHINGTON, D.C. 20503
9:30 a.m.
JUN 17 1976
MEMORANDUM FOR THE PRESIDENT
Subject: Enrolled Bill S. 1466 - National Consumer
Health Information and Health Promotion
Act of 1976
Sponsor - Sen. Kennedy (D) Mass. and 7 others
Last Day for Action
June 23, 1976 - Wednesday
Purpose
Authorizes HEW to conduct a new health information and
health promotion program; extends through fiscal year
1978 and expands existing communicable disease, venereal
disease and lead-based paint poisoning prevention programs.
Agency Recommendations
Office of Management and Budget
Disapproval (Veto
message attached)
Department of Health, Education,
and Welfare
Approval
Department of Housing and Urban
Development
Defers to HEW and
CPSC on lead-based
paint provisions
Consumer Product Safety Commission
Favors veto of
regulatory provisions
concerning lead-based
paint, but defers on
bill as a whole
Discussion
Legislative authorizations for the communicable disease
and disease control programs conducted by HEW expired
on June 30, 1975 and, since then, have been carried out
Attached document was not scanned because it is duplicated elsewhere in the document
THE WHITE HOUSE
ACTION MEMORANDUM
WASHINGTON
LOG NO.:
Date: June 18
Time: 1100am
FOR ACTION: Spencer Johnson Oiga CC (for information): Jack Marsh
Ken Lazarus sign
Jim Cavanaugh
Max Friedersdorf Dign
Ed Schmults
Dawn Bennett sign
Steve McConahey syn
FROM THE STAFF SECRETARY
DUE: Date:
June 19
Time: noon
SUBJECT:
S. 1466 - National Consumer Health Information
and Health Promotion Act of 1976
ACTION REQUESTED:
For Necessary Action
For Your Recommendations
Prepare Agenda and Brief
Draft Reply
X For Your Comments
Draft Remarks
REMARKS:
Please return to Judy Johnston, Ground Floor West Wing
PLEASE ATTACH THIS COPY TO MATERIAL SUBMITTED.
If you have any questions or if you anticipate a
delay in submitting the required material, please
K. R. COLE, JR.
telephone the Staff Secretary immediately.
For the President
TO THE SENATE
I am returning, without my approval, S. 1466, a
bill which would authorize duplicative health information
and health promotion programs, and reauthorize and
expand venereal disease, rat control, lead-based paint
poisoning and other disease prevention and control programs.
This bill is based on a policy of perpetuating the
existing maze of Federal health programs. Such an
approach is a disservice to those who need effective
delivery of health services and those who must pay the
bills--the taxpayers. In my 1977 Budget, I proposed a
consolidation of 16 existing Federal health programs into
a single block grant which would enable States and localities
to assure that people in need receive comprehensive health
care. I share the objectives of S. 1466 to assure the
provision of important preventive health services, but I
firmly believe that under my proposed health block grant
those services would be provided in a more effective manner.
Fewer Federal programs, and a reduction in the various
rules and regulations accompanying each of them, would allow
States and local governments to respond more quickly to the
particular health needs of their residents. Consolidation
into a block grant will also better target Federal health
assistance on those with low incomes, and distribute Federal
funds more equitably among the States. Funding from the
existing 16 categorical programs proposed for consolidation
in the block grant varies from $200 per low-income individual
in some States to over $800 in others. This inequity should
not be continued.
HEALTH.
OF
EDUCATION
DEPARTMENT OF HEALTH, EDUCATION. AND WELFARE
U.S.A.
JUN 1 1 1976
The Honorable James T. Lynn
Director, Office of Management
and Budget
Washington, D. C. 20503
Dear Mr. Lynn:
This is in response to your request for a report on S. 1466,
an enrolled bill "To amend the Public Health Service Act to
provide authority for health information and health promotion
programs, to revise and extend the authority for disease
prevention and control programs, and to revise and extend
the authority for venereal disease programs, and to amend
the Lead-Based Paint Poisoning Prevention Act to revise and
extend that Act."
We strongly recommend that the President sign the enrolled
bill; the bill would authorize important activities in the
area of disease control and represents a compromise in which
our major objections have been met. We also recommend a
private signing ceremony to which the principal Congressional
participants in the development of the bill would be invited.
S. 1466 would authorize a small program in the area of
health education through fiscal year 1979, to include grants
and contracts for research, community demonstration programs,
and information programs. The bill would establish an
Office of Health Information and Health Promotion within
this Department to coordinate Departmental health education
activities; the Office would not be charged with direct
administrative responsibility for any program.
S. 1466 would also extend our programs concerned with lead-
based paint poisoning, venereal diseases, and other diseases
amenable to reduction through fiscal year 1978. These
programs would also be modified by:
The Honorable James T. Lynn
2
-- permitting training and demonstration grants and
contracts in the area of disease prevention and
control,
-- broadening the concept of disease control programs
to include diseases and other conditions which are
of national significance and which are amenable to
reduction, but are not of the traditional communicable
type,
-- repealing the venereal disease formula grant authority,
-- redefining the respective roles of this Department,
the Department of Housing and Urban Development and
the Consumer Product Safety Commission (CPSC) as to
the use of lead-based paint on certain products, so
as to parallel the missions of these Departments and
the CPSC, and
-- requiring the CPSC, during the six-month period
following enactment of the enrolled bill, to
determine whether or not a level of lead in paint
which is greater than 0.06 percent but not in excess
of 0.5 percent is safe.
Appropriation authorizations in the bill (and Budget requests
in the same areas) are set out in Tab A.
S. 1466 would enable us to continue the important disease
control and prevention activities which this Department
is currently carrying out. These prevention and control
activities may well do more in the long run to limit the
continuing increase in health care costs in this country
than other programs which require levels of funding much
higher than those authorized by S. 1466. Until we are able
to effect enactment of our Financial Assistance for Health
Care Act, we must have other authority to carry out these
vital prevention and control activities.
The enrolled bill would also authorize a small program in
the area of health education; this new authority essentially
duplicates legal authority we already have, but without
The Honorable James T. Lynn
3
disrupting our Departmental organizational structure or
requiring us to carry out a new and expensive program. The
main effect of the enrolled bill would be to give increased
visibility to the area of health education, which is all to
the good.
S. 1466 as passed by the Congress incorporates major concessions
agreed to by the Congress after considering the Administration's
objections. For example, the establishment of a private
center for health promotion, to be funded in part with
Federal funds, was deleted; all administrative authority of
the Office of Health Education and Promotion was excised; a
provision for an interdepartmental health education committee
was removed; programs related to water treatment and dental
health were eliminated; and the total amount of appropriations
authorized is below that originally provided in both the
House and Senate versions of the bill.
S. 1466 represents a negotiated compromise on the issues
involved, in which our major objections have been met. Actual
funding levels will, of course, be determined through the
appropriations process.
We therefore strongly recommend that the President sign the
enrolled bill. We also recommend a private signing ceremony
to which the principal Congressional participants in the
development of S. 1466 would be invited.
Sincerely,
Larjone Gynch
Under Secretary
Enclosure
TAB A--S. 1466 APPROPRIATION AUTHORIZATIONS
AND RELATED BUDGET REQUESTS
(figures in millions of dollars)
S. 1466
Budget
Continuing Resolution or
Authorization
Request
Currently Authorized
Health Education--1977
$ 7
0
1978
$10
0
1979
$14
0
Rat Control--
1976
$13.5
$ 5.41*
$20
1977
$14
$ 5.41
1978
$14.5
Venereal Disease
Research--
1976
$ 5
0
0
1977
$ 6.6
0
1978
$ 7.6
Venereal Disease
Project Grants-1976
$32
$19.84
$19.84
1977
$41.5
$19.84
1978
$43.5
Lead-Based Paint--1976
$10
$ 3.5
$ 3.5
1977
$12
$ 3.5
1978
$14
Immunizations
and other
control
programs--
1976
$13
$ 4.96
$
4.96
1977
$22
$ 4.96
1978
$28
*$13.1 appropriated for FY 1976
DEPARTMENT
OF
U.S.
HOUSING
*
THE GENERAL COUNSEL OF HOUSING AND URBAN DEVELOPMENT
AND
WASHINGTON, D.C. 20410
URBAN
JUN 14 1976
Mr. James M. Frey
Assistant Director for
Legislative Reference
Office of Management and Budget
Washington, D. C. 20503
Attention: Ms. Ramsey
Dear Mr. Frey:
Subject: S. 1466, 94th Congress (Kennedy, et al)
Enrolled Enactment
This is in response to your request for our views on the
enrolled enactment of S. 1466, the proposed "National
Consumer Health Information and Health Promotion Act of
1976".
The enrolled bill would provide for a program of research,
information and demonstrations with respect to health
promotion, preventive health services, and education in
the appropriate use of health care, to be administered by
an Office of Health Information and Health Prevention
established in the Department of Health, Education and
Welfare under the bill.
This bill would also extend and make some revisions in
HEW's disease control and prevention programs. Of these
revisions, the ones of particular interest to this
Department are the proposed amendments to the Lead-Based
Paint Poisoning Prevention Act.
These amendments to the Lead-Based Paint Poisoning
Prevention Act would authorize additional appropriations
through fiscal year 1978 for purposes of carrying out
that Act. They would require that local detection and
2
treatment programs funded by HEW include a lead based paint
hazard elimination component, with priority to be given to
hazard elimination in dwellings in which reside children.
with diagnosed lead based paint poisoning.
The bill would also, in the case of paint manufactured one
year after enactment, define lead based paint as paint
having a lead content of more than 0.06 percent, or more
than such higher level (but not in excess of 0.5 percent)
as the Consumer Product Safety Commission determines to be
safe. The 0.5 percent lead level under current law would
continue to be used for establishing the safe level of
lead in existing paint.
Finally, the amendment would reassign various responsibilities
for controlling the use of lead based paint, and would
specifically assign to this Department the responsibility for
prohibiting the application of lead based paint in
residential structures constructed or rehabilitated by the
Federal government or with Federal assistance after the date
of enactment of the bill. This overall responsibility for
this function is assigned to the Secretary of Health,
Education and Welfare under existing law, with various
responsibilities assigned under HEW regulations to
appropriate Federal agencies, including HUD. The Senate
Committee Report accompanying S. 1664 (Report 94-634)
indicates that the purpose of this provision is to clarify
the respective jurisdiction of these agencies with respect
to existing responsibilities, and we would interpret the
provision as assigning HEW's current lead responsibility
with respect to Federal and Federally assisted housing
directly to HUD.
The Department has no objection to the transfer to HUD of
HEW's responsibility for controlling the application of
lead based paint to Federally constructed or assisted
housing. We defer to HEW and the Consumer Product Safety
3
Commission, as appropriate, with respect to the
desirability of the other provisions of the bill,
including those provisions relating to the establishment
of an acceptable level of lead in paint to be manufactured
in the future.
Sincerely,
RohutPillott
Robert R. Elliott
U.S. CONSUMER PRODUCT SAFETY COMMISSION
WASHINGTON, D.C. 20207
JUN 1 0 1976
Honorable James T. Lynn
Director
Office of Management and Budget
Washington, D.C. 20503
Attention: Assistant Director for Legislative Reference
Dear Mr. Lynn:
This letter is in response to the Office of Management
and Budget's request for the views and recommendations of
the Consumer Product Safety Commission on S. 1466, an
enrolled bill
"To amend the Public Health Service
Act to provide authority for health
information and health promotion
programs, to revise and extend the
authority for disease prevention and
control programs, and to revise and
extend the authority for venereal
disease programs and to amend the
Lead-Based Paint Poisoning Prevention
Act to revise and extend that Act."
Inasmuch as the provisions of section 204 of S.1644,
more particularly subsections (b) and (c), are the only
provisions of the bill which would impact on or involve
the Consumer Product Safety Commission, the Commission
will confine its comments to those provisions and will
defer to the other affected departments with respect to
other provisions of the bill.
Section 204 (b) of S. 1466 would amend section 401 of
the Lead-Based Paint Poisoning Prevention Act (LBPPPA,
42 U.S.C. 4831) to require the Secretary of Health, Education
and Welfare to "take such steps and impose such conditions
Page 2--Honorable James T. Lynn
as may be necessary or appropriate" to prohibit the application
of lead-based paint to any cooking, drinking or eating
utensil; to require the Secretary of Housing and Urban
Development to take similar action with respect to the use
of lead-based paint in residential structures constructed or
rehabilitated by the Federal Government, or with federal
assistance; and to require the Consumer Product Safety
Commission to take similar action with respect to the applica-
tion of lead-based paint to any toy or furniture article.
This provision, by assigning responsibility with respect to
toys and furniture articles to the Commission, conforms the
LBPPPA to existing law with respect to jurisdiction over the
safety of these products, which is vested in the Commission.
Section 204 (c) of S.1466 would, inter alia, amend
section 501 (3) of the LBPPPA (42 U.S.C. 4841(3)) to provide
that the term "lead-based paint" shall mean any paint con-
taining more than .5 percent lead by weight. Further, the
Commission would be required to determine, within six months
of enactment of S. 1466, on the basis of available data and
information and after providing for an oral hearing and
consideration of other agencies' recommendations, whether
another level of lead, greater than .06 percent by weight
but not to exceed .5 percent is safe. If the Commission
determines, in accordance with the requirements set forth
above, that a level of lead other than .5 percent is safe,
the term "lead-based paint" shall mean, with respect to
paint which is manufactured after the expiration of six
months from the date of the Commission's determination,
paint containing more than such level of lead as the Commis-
sion has determined is safe. In the absence of such a
determination by the Commission, the term "lead-based paint"
shall mean, with respect to paint manufactured after the
expiration of twelve months from the date of enactment of S.
1466, paint containing more than .06 percent lead.
This provision is similar to existing law, except that
under the present provision, the Chairman alone rather than
the full Commission is charged with the responsibility for
determining the safe level of lead, and is presently not
required to consult with the Secretary of Health, Education
and Welfare or the National Academy of Sciences.
The Commission supports the goal of protecting the
public, particularly children, from the hazards associated
with lead-based paint. The Commission is currently conduct-
ing a rulemaking proceeding pursuant to a petition under the
Federal Hazardous Substances Act (FHSA, 15 U.S.C. 1261 et
seq.) to determine whether paint containing more than .06
Page 3--Honorable James T. Lynn
percent lead should be banned. The same petition also
requests that the Commission issue a consumer product safety
rule pursuant to its authority under the Consumer Product
Safety Act (CPSA, 15 U.S.C. 2051 et seq.) requiring that the
composition of such paints contain not more than .06 percent
lead.
The Commission, however, has several reservations
concerning the approach of S.1466. First, the provision
contained in section 204 (c) of S. 1466, amending section
501(3) of the LBPPPA regarding the definition of "lead-based
paint" offers little guidance with respect to the procedure
to be followed in making the determination of a safe level
and fails to indicate either the character of the proceeding
or whether such determination is subject to judicial review.
Since there appears to be no grant of rulemaking ppower,
either express or implied, in the LBPPPA, the Commission
presumes that the Administrative Procedure Act is not intended
to apply. Similar uncertainty with respect to the appli-
cable procedure under the present LBPPPA has led to a suit
attacking Chairman Simpson's report to Congress regarding
the safe level of lead in paint. (Consumer's Union of the
United States, Inc., et al., V. Richard O. Simpson, Chairman,
Consumer Product Safety Commission, et al., Civil Action No.
75-0243, D.D.C. filed February 24, 1975.)
Secondly, once the level of "lead-based paint" is
established, S. 1466 directs the Commission to "take such
steps and impose such conditions as may be necessary or
appropriate" to prohibit the application of lead-based paint
to toys or furniture articles. While congressional intent
that the level found to be safe in the LBPPPA proceeding
should apply to such articles is clear, the Commission is
not specifically granted any substantive regulatory authority
to implement this level. Under S. 1466 it would appear that
the Commission would still have to make its determination on
the safe level of lead in paint for toys and furniture
articles as well as other paint sold to consumers under the
pending FHSA or CPSA proceedings. Given the different
procedures under the FHSA, the CPSA and the LBPPPA, there is
a very real possibility that the lead levels arrived at in
these various proceedings could be entirely different. This
would lead to the highly anomalous and undesirable situation
of differing federal standards for lead in paint depending
on the act under which the paint is regulated. Moreover the
LBPPPA, as drafted, undoubtedly will require duplicative
proceedings on the precise same matter resulting in a massive
waste of tax dollars. Finally, the confusion which would
Page 4--Honorable James T. Lynn
result from different federal levels would be compounded by
the statutory provisions applicable to preemption of various
state and local laws and regulations.
To avoid the difficulties in the implementation of the
LBPPPA, which enactment of S.1466 will create, to facilitate
enforcement by the CPSC and the states and to provide the
paint industry and consumers with a single standard, the
Commission recommended that it should be permitted to make
a single determination on the safe level of lead in paint in
one proceeding. One means of achieving this would have been
to include the following provision in the LBPPPA:
The determination by the Consumer Product
Safety Commission with respect to the meaning
of the term "lead-based paint" shall simul-
taneously constitute the establishment of a
consumer product safety standard under the
Consumer Product Safety Act. (15 U.S.C.
2051 et seq.) Such standard shall have the
same force and effect as any consumer product
safety standard promulgated and established
under the Consumer Product Safety Act and
shall become effective concurrent with the
provisions of section 401 of the Lead-Based
Paint Poisoning Prevention Act. No further
proceeding shall be necessary to make the
standard effective. The level of lead in
paint established by such standard shall
be the maximum permissible level for the
following consumer products (as the term
"consumer product" is defined in section
3 (a) (1) of the Consumer Product Safety
Act 15 U.S.C. 2052 (a) (1) )
(a) Any paint or similar surface-coating
material;
(b) Any toy or other article intended for
use by children; and
(c) Any furniture article.
Provided, however, that, upon a finding
that any special use for "lead-based
paint" or that any product bearing such
paint does not present an unreasonable
risk of injury, the Commission may, by
Page 5--Honorable James T. Lynn
rule in accordance with the procedures of
5 U.S.C. 553, exempt such product from
the standard. Any existing exemption
under the Federal Hazardous Substances
Act 15 U.S.C. 1261 et seq. shall continue
in effect and be treated as an exemption
under this section unless withdrawn by
rule.
Unfortunately, the Commission's suggestion was not
adopted by Congress. Only insofar as the provisions of
S.1466 impact on the Consumer Product Safety Commission by
amending the process for establishing a safe level of lead
in paint does the Commission favor veto of the bill. The
regulatory process which results from this portion of
S.1466 will be more costly and duplicative than is necessary
without any increase in benefit to the public. However, the
numerous other provisions of the bill affect the responsi-
bilities of the Secretary of Health, Education and Welfare in
the area of public health and safety. The Commission cannot
properly assess the impact of or need for these provisions.
If these other provisions of the bill are necessary and
desirable, the Commission understands the need to approve
the entire bill. Should such approval be forthcoming, CPSC
would appreciate Administration support of our efforts to
amend section 204 pursuant to the above language during this
session.
The Commission is unable to estimate first-year or
recurring costs or savings which may result from enactment
of S.1466.
AbyL
CC:
Speaker of the
House of Representatives
CC: President of the Senate
THE WHITE HOUSE
WASHINGTON
June 18, 1976
MEMORANDUM FOR:
JUDY JOHNSTON
FROM:
DAWN D. BENNETT
RE:
S. 1466 - National Consumer Health
Information and Health Promotion Act
of 1976
The above-entitled bill would essentially: amend the Public Health
Service Act by extending and expanding the categorical health programs;
authorize HEW to initiate and conduct a new health information and
prevention program; give the Consumer Product Safety Commission
jurisdiction over permissable lead paint levels; and transfer to HUD
from HEW, the enforcement of lead base paint levels in federal
housing.
I recommend approval for several reasons, inter alia:
a. The new categorical health education program is relatively
small, authorization-wise, and does not disrupt the HEW organizational
structure, nor require HEW to carry out an expensive new program.
b. S. 1466 would authorize HEW to continue its existing disease
control and prevention programs i.e. Swine Flu type situations.
C. The bill appears to be a negotiated compromise which differs
substantially from the original.
Though the bill is not perfect, i.e., it calls for categorical grants as
opposed to the block grant scheme which the President prefers, the
good outweighs the bad, and on balance, I feel the President should sign
it.
THE WHITE HOUSE
WASHINGTON
June 18, 1976
MEMORANDUM FOR:
JIM CAVANAUGH
mL
FROM:
MAX FRIEDERSDORE
SUBJECT:
S. 1466 - National Consumer Health Information
and Health Promotion Act of 1976
The bill passed both Houses by a voice vote. Veto would, of course, be
most difficult if not impossible to sustain.
Both Tim Lee Carter and Jim Broyhill supported the bill and believe their
combined efforts with Paul Rogers succeeded in watering down Title I
enough that President could sign bill.
OMB was ambivalent on veto signal during Floor consideration and no
veto signal given.
I recommend President sign S. 1466.
THE WHITE HOUSE
ACTION MEMORANDUM
WASHINGTON
LOG NO.:
Date:
June 18
Time: 1100am
FOR ACTION: Spencer Johnson
CC (for information):
Jack Marsh
Ken Lazarus
Jim Cavanaugh
Max Friedersdorf
Ed Schmults
Dawn Bennett
Steve McConahey
FROM THE STAFF SECRETARY
DUE: Date:
June 19
Time: noon
SUBJECT:
S. 1466 - National Consumer Health Information
and Health Promotion Act of 1976
ACTION REQUESTED:
For Necessary Action
For Your Recommendations
Prepare Agenda and Brief
Draft Reply
X For Your Comments
Draft Remarks
REMARKS:
Please return to Judy Johnston, Ground Floor West Wing
Veto would be a futile gesture. Recommend
approval for reasons set forth at pp. 4-5.
Ken Lazarus 6/18/76
PLEASE ATTACH THIS COPY TO MATERIAL SUBMITTED.
If you have any questions or if you anticipate a
Jumes M. Canoon
delay in submitting the required material, please
For 1:10 President
telephone the Staff Secretary immediately.
Steve McConahey's comments: S. 1466
Agree with concern over inclusion of certain block grant
components, however, I understand this bill contains
the swine flu appropriations and therefore feel we
should sign it.
6/17
THE WHITE HOUSE
WASHINGTON
June 18, 1976
MEMORANDUM FOR:
JIM CAVANAUGH
mL
FROM:
MAX FRIEDERSDORE
SUBJECT:
S. 1466 - National Consumer Health Information
and Health Promotion Act of 1976
The bill passed both Houses by a voice vote. Veto would, of course, be
most difficult if not impossible to sustain.
Both Tim Lee Carter and Jim Broyhill supported the bill and believe their
combined efforts with Paul Rogers succeeded in watering down Title I
enough that President could sign bill.
OMB was ambivalent on veto signal during Floor consideration and no
veto signal given.
I recommend President sign S. 1466.
TO THE SENATE
I am returning, without my approval, S. 1466, a
bill which would authorize duplicative health information
would
and health promotion programsy and reauthorize and
expand venereal disease, rat control, lead-based paint
pragrams dealing with
poisoning and other disease prevention and control. programs.
This bill is based on a policy of perpetuating the
existing maze of Federal health programs. Such an
approach is a disservice to those who need effective
delivery of health services and those who must pay the
bills--the taxpayers. In my 1977 Budget, I proposed a
consolidation of 16 existing Federal health programs into
a single block grant which would enable States and localities
to assure that people in need receive comprehensive health
care. I share the objectives of S. 1466 to assure the
provision of important preventive health services, but I
firmly believe that under my proposed health block grant
those services would be provided in a more effective manner.
Fewer Federal programs, and a reduction in the various
rules and regulations accompanying each of them, would allow
States and local governments to respond more quickly to the
particular health needs of their residents. Consolidation
into a block grant will also better target Federal health
assistance on those with low incomes, and distribute Federal
funds more equitably among the States. Funding from the
existing 16 categorical programs proposed for consolidation
in the block grant varies from $200 per low-income individual
in some States to over $800 in others. This inequity should
not be continued.
2
In addition, the many Federal requirements imposed
upon States and localities prevent them from bringing
about needed efficiencies and coordination in their health
programs. If the proposed health block grant were enacted
instead of bills such as S. 1466, more Federal health
dollars could go toward providing health services for our
citizens rather than for the cost of burdensome administration.
S. 1466 would also create unnecessary and duplicative
health education programs. The Department of Health,
Education, and Welfare alone now spends more than $80
million a year on health education of the public. The
activities proposed in S. 1466 would only add to the already
complicated array of Federal health education programs.
The bill would, moreover, create a special problem
in the lead-based paint poisoning prevention program. It
would require the determination of safe lead levels in paint
but provides little, if any, guidance with respect to the
procedures determining those levels. This could, accordingly,
lead to the highly undesirable situation of differing federal
standards for lead in paint, depending on whether an agency
proceeded under the Lead-Based Paint Poisoning Prevention
Act, the Consumer Product Safety Act or the Federal Hazardous
Substances Act. Thus, S. 1466 could not only create confusion
in this area, but could require duplicative administrative
proceedings on the same subject matter resulting in a
massive waste of tax dollars as well as unnecessary delay
and red tape, without any real benefit to the public.
Lastly, S. 1466 is objectionable since it would authorize
appropriations of $307 million--more than three times my
requested levels--over a three-year period. At a time
when the overall Federal deficit is estimated at over $74
3
billion, I must oppose such excessive authorization levels.
Other bills now pending would also continue current
narrow categorical Federal health programs. Rather than
proceeding to extend and expand such programs, I urge the
Congress to hold hearings and rapidly enact my proposed
"Financial Assistance for Health Care Act."
THE WHITE HOUSE
June , 1976
Education
TO THE SENATE OF THE UNITED STATES:
I am returning, without my approval, S. 1466, a
bill which would authorize duplicative health information
and health promotion programs and would reauthorize and
expand programs dealing with venereal disease, rat control,
lead-based paint poisoning and other disease prevention
and control.
This bill is based on a policy of perpetuating the
existing maze of Federal health programs. Such an
approach is a disservice to those who need effective
delivery of health services and those who must pay the
bills -- the taxpayers. In my 1977 Budget, I proposed
a consolidation of 16 existing Federal health programs
into a single block grant which would enable States and
localities to assure that people in need receive com-
prehensive health care. I share the objectives of S. 1466
to assure the provision of important preventive health
services, but I firmly believe that under my proposed
health block grant those services would be provided in
a more effective manner.
Fewer Federal programs, and a reduction in the various
rules and regulations accompanying each of them, would allow
States and local governments to respond more quickly to the
particular health needs of their residents. Consolidation
into a block grant will also better target Federal health
assistance on those with low incomes, and distribute Federal
funds more equitably among the States. Funding from the
existing 16 categorical programs proposed for consolidation
in the block grant varies from $200 per low-income individual
in some States to over $800 in others. This inequity should
not be continued.
2
In addition, the many Federal requirements imposed
upon States and localities prevent them from bringing
about needed efficiencies and coordination in their health
programs. If the proposed health block grant were enacted
instead of bills such as S. 1466, more Federal health dollars
could go toward providing health services for our citizens
rather than for the cost of burdensome administration.
S. 1466 would also create unnecessary and duplicative
health education programs. The Department of Health,
Education, and Welfare alone now spends more than $80
million a year on health education of the public. The
activities proposed in S. 1466 would only add to the already
complicated array of Federal health education programs.
The bill would, moreover, create a special problem
in the lead-based paint poisoning prevention program. It
would require the determination of safe lead levels in
paint but provides little, if any, guidance with respect
to the procedures determining those levels. This could,
accordingly, lead to the highly undesirable situation of
differing Federal standards for lead in paint, depending
on whether an agency proceeded under the Lead-Based Paint
Poisoning Prevention Act, the Consumer Product Safety Act
or the Federal Hazardous Substances Act. Thus, S. 1466
could not only create confusion in this area, but could
require duplicative administrative proceedings on the same
subject matter resulting in a massive waste of tax dollars
as well as unnecessary delay and red tape, without any
real benefit to the public.
Lastly, S. 1466 is objectionable since it would
authorize appropriations of $307 million -- more than
three times my requested levels -- over a three-year
3
period. At a time when the overall Federal deficit is
estimated at over $74 billion, I must oppose such excessive
authorization levels.
Other bills now pending would also continue current
narrow categorical Federal health programs. Rather than
proceeding to extend and expand such programs, I urge the
Congress to hold hearings and rapidly enact my proposed
"Financial Assistance for Health Care Act."
THE WHITE HOUSE,
Calendar No. 323
94TH CONGRESS
SENATE
REPORT
1st Session
No. 94-330
NATIONAL DISEASE CONTROL AND CONSUMER HEALTH
EDUCATION AND PROMOTION ACT OF 1975
JULY 24 (legislative day, JULY 21), 1975.-Ordered to be printed
Mr. KENNEDY, from the Committee on Labor and Public Welfare,
submitted the following
REPORT
[To accompany S. 1466]
The Committee on Labor and Public Welfare, to which was referred
the bill (S. 1466) to amend the Public Health Service Act to extend
and revise the program of assistance for the control and prevention
of communicable disease, and to provide for the establishment of the
Office of Consumer Health Education and Promotion and the Center
for Health Education and Promotion to advance the national health;
to reduce preventable illness, disability, and death; to moderate self-
imposed risks; to promote progress and scholarship in consumer health
education and promotion and school health education; and for other
purposes, having considered the same, reports favorably thereon with
amendments and recommends that the bill as amended do pass.
I. BILL SUMMARY
PURPOSE
The proposed Act has three titles: Titles I and II respectively
revise and extend expiring communicable and other disease control
programs and venereal disease prevention and control programs; and
Title III authorizes consumer health education and promotion pro-
grams. The legislation would authorize the programs involved for
fiscal years 1976 through 1978, with authorizations of appropriations
as hereinafter indicated,
57-010-75-1
2
3
ESE
TITLE I-DISEASE CONTROL
(6) Enables minors to seek and receive treatment for venereal
diseases on their own, in conformance with current statutes in
Section 101. This title, which is to be cited as the "Disease Control
49 of our 50 States.
Amendments of 1975," revises and extends existing authorities for
(7) Authorizes;
disease prevention and control programs found in section 317 of the
(a) $5,000,000 for each of fiscal years 1976, 1977, and 1978
PHS Act, for fiscal years 1976 through 1978.
for grants to States, political subdivisions of States, and any
Amendments Respecting Disease Control
other public or nonprofit private entity for projects for the
conduct of research, demonstrations, and training for the
Section 102. Amends section 317 of the PHS[Act with the following
prevention and control of venereal disease.
substantive modifications;
(b) $5,000,000 for fiscal year 1976, $10,000,000 for fiscal
(1) Authorizes disease control programs for additional diseases
year 1977, and $15,000,000 for fiscal year 1978, to enable the
and conditions by. adding mumps, diabetes mellitus, and other
Secretary to make grants to State health authorities to assist
diseases or conditions (other than venereal diseases) which are
the states in establishing and maintaining adequate public
amenable to reduction and are determined by the Secretary to be
health programs for the diagnosis and treatment of venereal
of national significance. This amendment is intended to expand
disease!
the scope of activities now carried out by the Center for Disease
(c) $31,000,000 for fiscal year 1976, $33,000,000 for fiscal
Control.
year 1977, and $36,000,000 for fiscal year 1978 for project
(2) Adds the word project before grant or grants each time it
grants to States and, in consultation with states, to political
appears, to assure that grants for disease control (as provided
subdivisions of States, for venereal disease control activities
under section 317 of the Public Health Service Act) are used for
described under 317(d)(1) of the Public Health Service Act,
this purpose.
as amended by this bill.
(3) The bill authorizes $30,000,000 for fiscal ycar 1976, $35-
000,000 for fiscal year 1977, and $40,000,000 for fiscal year 1978.
TITLE III-HEALTH EDUCATION AND PROMOTION
TITLE II-VENEREAL DISEASE
Section 301. States that the title may be cited as the National
Consumer Health Education and Promotion Act of 1975.
Section 201. This title, which is to be cited as the "National Venereal
Section 302. Amends the Public Health Service Act by adding the
Disease Prevention and Control Amendments of 1975," revises and
following new title:
extends existing authorities for venereal disease prevention and con-
trol programs found in section 318 of the PHS Act.
TITLE XVII-OFFICE OF CONSUMER HEALTH EDUCATION
Section 202. This section sets forth the findings and declaration of
AND PROMOTION AND THE CENTER FOR HEALTH
purpose of Congress respecting venereal disease.
EDUCATION AND PROMOTION
Amendments Respecting Venereal Disease
Section 203. Amends section 318 of the PHS Act, "Projects and
Section 302. Also amends the Public Health Service Act by adding
Programs for the Prevention and Control of Venereal Diseases,"
the following sections:
with the following substantive modifications:
1
(1) Expands technical assistance respecting research, training,
PART A-OFFICE OF CONSUMER HEALTH EDUCATION AND PROMOTION
and public health programs for the prevention and control of
New Section 1701. Establishes within HEW Office of Consumer
venereal disease to include nonprofit private entities in addition
to public authorities and scientific institutions which are cur-
Health Education and Promotion under the direction of a director,
rently eligible.
appointed by the Secretary and supervised by the Assistant Secretary
(2) Specifies that project grants for States for venereal disease
for Health. To develop a health education and promotion strategy for
the Nation, the Office would: engage in health education and promo-
prevention and control may include routine laboratory testing
and follow-up.
tion research, develop community health education programs, stimu-
(3) Provides that grants for research, training and public
late and coordinate communications in health education and promo-
health venereal disease prevention and control programs "oon-
tion, and overview and coordinate Federal health education programs.
tribute to national objectives."
New Section 1702. The Secretary, acting through the Office, is
(4) Deletes, as a method of diagnosis of gonorrhea and syphilis,
authorized to undertake various programs to achieve a national
"dark-field microscope techniques."
health education and promotion strategy.
(5) Expands the definition of venereal disease, to include other
New Section 1703. Provides that the Secretary shall make grants
sexually transmitted diseases in addition to syphilis and gonor-
and contracts to public and nonprofit private entities regarding health
rhea.
education programs.
4
5
The section also provides that the Secretary cannot make grants
under either the Public Health Services Act or the Community Mental
New Section 1716. Authorizes appropriations for expenses of the
Health Centers Act unless the application contains assurances that
Center of $1,000,000 in fiscal year 1976, $1,000,000 in fiscal year 1977,
consumer health education services will be provided during the period
and $1,000,000 in fiscal year 1978. In addition to the sums authorized
when assistance would be made available.
to be appropriated, the Center is authorized to receive income, grants,
New Section 1704. Provides for the establishment of an Interdepart-
donations, bequests, or other contributions from non-Federal sources.
mental Committee on Consumer Health Education and Promotion
New Section 1717. Provides that the accounts of the Center shall be
comprised of various Federal agencies and offices administering pro-
audited annually by independent public accountants certified or
grams directly affecting health education and promotion. The Secre-
licensed by a regulatory authority of a State or other political sub-
tary of Health, Education, and Welfare would chair the Committee.
division of the United States.
New Section 1705. Establishes a nineteen member Advisory Council
New Section 1718. Authorizes $2,000,000 for fiscal year 1976,
to be appointed by the Secretary, to advise the Secretary on matters
$3,000,000 for fiscal year 1977, and $4,000,000 for fiscal year 1978 to
of general policy with respect to the functions of the Office, and sets
be used by the Secretary for grants to public and private nonprofit
forth appropriate controls for selection of the members.
entities to assist in initiating programs in elementary and secondary
New Section 1706. Requires reports to be made to the President
schools, and in communities, to reduce the incidence of oral disease
and the Congress by the Secretary regarding health education and
and dental defects.
promotion including recommendations for legislative initiative. The
New Section 1719. Defines health education and promotion.
Office of Management and Budget may not revise the reports or delay
Section 303 of the bill authorizes the National Center for Health
their submission to either the President or the Congress.
Statistics to make continuing surveys regarding consumer health
New Section 1707. Authorizes appropriations for health education
education, and to report its findings, together with finding of other
and promotion: $11,000,000 for fiscal year 1976, $11,000,000 for fiscal
surveys and appropriate survey analyses to the Secretary, the Assistant
year 1977, and $24,000,000 for fiscal year 1978.
Secretary for Health, and the Office of Consumer Health Education
and Promotion. Of sums appropriated by Sec. 308 of the PHS Act,
PART B-CENTER FOR HEALTH EDUCATION AND PROMOTION
not less than $1,000,000 for each of fiscal years 1977, 1978, and 1979
New Section 1708. Sets forth findings and declarations, concluding
shall be available for the purposes authorized in. this section.
that:a private corporation should be created to facilitate the develop-
ment of a health education and promotion strategy for the Nation.
II. THE NEED FOR GREATER EMPHASIS ON DISEASE CONTROL AND
New Section 1709. Provides that the new Center shall have a 25
CONSUMER HEALTH EDUCATION AND PROMOTION
member board of directors appointed by the President with the advice
Between 1960 and 1974, annual expenditures for health increased
and consent of the Senate, with broad representation of various regions
from slightly less than $26 billion to slightly over $104 billion. Public
of the country and of various kinds of bills and experiences appro-
expenditures for health each year increased from $6.4 billion to $41.3
priate to the functions and responsibilities of the Center. The members
billion. Private health insurance benefits increased in that time period
initially selected would serve as incorporators.
New Section 1710. States the terms and conditions of Board
from $4.7 billion to $23.1 billion annually, while the percentage of
out-of-pocket costs to consumers decreased from 55 percent of personal
membership.
New Section 1511. Provides that the Center shall have a President
health expenditures to 35 percent. Persons employed in the health
industry increased from 2.5 million workers to almost five million
and other officers that may be appointed by the Board.
today. Last year, the health industry provided over one billion physi-
New Section 1712. Provides that the Center shall have no power to
cian and dentists visits and over 30 million short-term hospital
issue any shares of stock or to declare or pay dividends; that no part
services, alone.
of the income or assets of the Center shall inure to the benefit of any
Despite these accomplishments, it is clear to the Committee that
director, officer or employee of the Center; and that the Center may
progress in improving the health of the American people has not im-
not contribute to or otherwise support any political party or candidate
for elective office.
proved in proportion to our growing investment. Increasingly, ques-
New Section 1713. Describes the objectives of the Center and the
tions are being raised regarding the efficacy of therapeutic medicine,
which is the predominant emphasis of the health industry today, in
specific programs which the Center is to undertake to achieve its
improving the health of the American people.
objectives.
New Section 1714. Provides that the Board shall appoint an Advisory
In June of this year, the American College of Medicine and the
Fogarty International Center of the National Institutes of Health
Panel of 100 individuals with appropriate competencies and abilities
to provide advice for members of the Board.
jointly sponsored a National Conference on Preventive Medicine. An
New Section 1715. Provides that the Center shall submit an annual
important outcome of the Conference were a series of Task Force
Reports. One of the most valuable was the report of the Task Force on
report to the President for transmittal to Congress on its activities
during the year, together with any recommendations it considers
Consumer Health Education chaired by Annie R. Somers, a nationally-
recognized expert in health care. In addressing the issue of the adequacy
appropriate.
of therapeutic medicine, which consumes the great majority of our
7
6
health resources, the Task Force on Consumer Health Education
Finally, the Task Force chose to comment on the performance of
noted the following:
our health industry in the context of the limitations mentioned
previously. They noted:
Despite the vast increase in health care expenditures and
the greatly improved access to care on the part of most
This judgment relates not only to the large amount of
Americans, illness, disability, and premature death show
preventable illness but to the inadequacy of medical inter-
little-if any-signs of improvement. The statistics with
vention per se in the management of serious illness. The
respect to death rates are particularly disturbing. After
reported exposés of miserable patient care in many nursing
half a century of steady and dramatic improvement, the total
homes now expensively reimbursed under Medicare and
or "crude" death rate for the U.S. ceased to improve during
Medicaid, the growing public demand for more professional
attention to the humanities and even the amenities of death
the Sixties. It remained almost stable, fluctuating between
9.4 and 9.7 per 1000 population. The rate for 1973 is still 9.4.
and dying, the renewed interest in euthanasia, and the
increasing realization that technical virtuosity is not neces-
The Task Force noted problems hidden beneath these general
sarily synonymous with effective care. All these developments
statistics:
indicate the public's growing impatience of the patient as a
The differential between male and female life expectancies
responsible agent in the treatment of his or her own illness.
has increased from one year in 1920 to 7.5 years in 1970.
The Committee concurs with the thrust of the Task Force on Con-
The stability of the total death rate in the Sixties is
sumer Health Education. The findings of the Task Force are consistent
primarily a function of changes in the population composi-
with the conclusions of an increasing number of experts who have
tion, not stable rates across time for all age groups. When this
looked at the performance of the health care field. The issue has been
effect is controlled, substantial increases in the death rates
addressed in a variety of ways including the Administration's ques-
for all age groups, 4-44, are revealed. Although there were
tioning of increases in the numbers (not the specialty or geographic
some increases for women, the increases were primarily for
distribution) of physicians, the numbers of hospital beds, the numbers
males, and the upturn was even higher for blacks than for
of all forms of health manpower, and the numbers of prescription
whites.
drugs. Increasingly, emphasis is shifting from overall quantities of
The death rate for homicides rose from 4.7 per 100,000 in
resources to issues of the performance of those resources and their
1960 to 9.4 in 1972 and seemed destined to continue rising.
distribution. The Committee considers the recent increase in intérest
The Task Force noted the continuing ineffectiveness of therapeutic
in preventive medicine and health education as another reflection of
medicine to deal with our major health problems:
this shift.
The Committee commends this new emphasis; but it does SO with a
The principal causes of death for the whole population in
major caveat. Although the Committee considers the resurgence of
the late Sixties were still the familiar trio-heart disease,
interest in health education overdue, it does not intend to encourage
cancer, and stroke-plus accidents. In 1970, cardiovascular
"therapeutic nihilism." While there is justifiable concern regarding
diseases accounted for 53 percent of all deaths. During the
the inappropriate and excessive use of certain procedures such as
later Sixties, however, other causes accounted for most of the
certain surgical procedures, the great majority of therapies, at the
rising death rates for young men. The principal cause for men,
minimum, relieve pain and suffering. In many instances, they limit
15-44, was automobile accidents; homicide and suicide were
disability, and in some instances, are responsible for the cures and
also important. None of these three phenomiena is directly
the prevention of death. The Committee considers present efforts to
affected by the health care delivery system.
improve the quality of therapeutic medicine, and to make it more
[Morbidity data is]
the best reported. But it is only
widely available as essential components of our efforts to improve the
the tip of the iceberg. For every youngster killed in an auto
health of Americans. But the Committee has also concluded that there
accident, thousands are injured each year; many permanently
must be far greater emphasis on finding ways to reduce the incidence
disabled. For every middle aged man who dies of cirrhosis,
of diseases and conditions which result in suffering, disability, and
there are thousands of alcoholics or near-alcòhelics, For every
death from an overdose of heroin, hundreds are hooked
death. The control of communicable diseases through immunization,
perhaps for life, to a habit that will not only wreck their own
sanitation and pesticide programs has proven to be a successful
lives but almost surely cause crime and other problems for
demonstration of what scientists and health professionals, with
their communities.
adequate public support, can accomplish.
Thus, it appears that therapeutic medicine, important as
Although -the etiology of disease is extremely complex, and the
it is, may have reached a point of diminishing returns. The
increases and decreases in the incidence of disease difficult to pinpoint
12-15 percent increases that we are adding to our hundred
precisely, there appears to be little question that scientific discoveries
billion dollar health care bill each year-even the portion
and the application of disease prevention and control programs have
that is not caused by inflation-apparently have only a
had a substantial impact in the reduction of many serious diseases.
marginal utility.
It is difficult for the Committee to imagine that malaria was still
8
9
prevalent in the South as late as the 1930's, that polio was dreaded
and in the process to stimulate them to adopt more healthful behavior.
until the 1950's, and a vaccine for measles was not developed until the
University workers, researchers, and counselors examined three com-
1960's. The fact that heart disease, cancer, and stroke are the major
munities: One a control with no health education efforts, one using
causes of death today is the result, in part, of our highly effective
the media only for health education, and a third using both the media
efforts against diseases which were major killers in the early part of
plus more intensive person-to-person efforts. The preliminary findings
this century. Death rates in 1900 were 17.2 per thousand; today they
revealed that improvements were detected by using the media only.
are less than 10 per 1,000. In 1900, about 15 percent of all babies
Using the media plus other person-to-person health education,
would die by the end of their first year; today, the figure is approxi-
however, showed more dramatic results. For example, the number of
mately 2 percent.
cigarettes smoked per day declined by forty percent in the maximum
Although dreaded infectious diseases have been virtually eradicated,
saturation town, during the period studied. Dr. Nathan Maccoby,
there is no justification for complacency. Programs to control and pre-
director of the project, concluded that educational campaigns directed
vent infectious diseases must be continually monitored to assure their
at an entire community can produce striking increases in the level of
continued effectiveness. Immunization levels against such diseases as
knowledge about heart disease and risk factors and marked improve-
polio and measles are below what is considered by the Center for
ments in risk factor levels.
Disease Control to be safe from the standpoint of preventing such
Most health education experts acknowledge that there is a great
diseases. A June 26, 1975 article in the New York Times reported that
need for greater understanding of how persons can be encouraged to
the immunization rate for polio for children between the ages of one
adopt more healthful behavior and to retain a healthy life style. The
and four was only 63 percent, while a minimum safe level is considered
Committee recognizes that imparting information alone is not sufficient
to be 80 percent. Polio immunization rates declined from 78.6 percent
to cause people to change their behavior. There is also apt to be great
in 1964 to 60.4 percent in 1973. In some poor communities, rates as
skepticism, particularly among the young, concerning any information
low as 15 percent have been found. In 1969-1971, there was a resur-
provided, and the recognition that there are strong interests and
gence of measles owing to inadequate immunization levels.
pressures to adopt unhealthy life styles, including smoking, drinking,
In addition to immunization and other public health control
using drugs, and eating fatty foods. The Committee considers health
measures, the greatest hope for reducing and delaying the incidence
education and promotion, despite these limitations and obstacles, an
of the diseases affecting people today rests with health education
essential part of a national effort to improve the health of people in
programs. The evidence is conclusive that the environment and in-
this country. It is our opinion that there is a great need for more
dividual life styles are major determinants of such afflictions as heart
health education and promotion information.
disease, cancer, stroke, and accidents.
In addition to the task of educating the public to the benefits of
A study of the relationship between health practices and physical
healthier lifestyles, there is a great need for a better understanding
health status reported by Belloc and Breslow in Preventive Medicine
of how better to use the health system. Despite widespread avail-
in 1972 showed that persons engaged in good health practices lived
ability of screening programs for breast and cervical cancer, only
longer. Health practices included hours of sleep, regularity of meals,
half of American women over 17 had such tests in 1973 and nearly
physical activity, and smoking and drinking. The association between
one-fourth had never had a breast screening examination. As men-
good health practices and good health, furthermore, was found to be
tioned earlier, immunization levels, in some cases, are dropping.
independent of age, sex, and economic status. Belloc also reported on
There are still far too many persons, even those with adequate in-
the relationship between health practices and mortality in Preventive
comes, who fail to see a dentist regularly and to practice good dental
Medicine in 1973, and found "a striking inverse relationship" between
hygiene. We eat the wrong foods, drive too fast and drink too much.
poor health practices and longer life. He further reported that the
Ours is a generation of excess. Providers of health care are not able to
average life expectancy of men aged 45 who reported six or seven
do their job to educate us with regard to negative health behavior.
four. "good" practices was 11 years more than men reporting fewer than
Finally, the Committee considers it essential that the general public,
the potential users of health services produced by the health industry,
A major issue considered by the Committee was not the potential
gain a more realistic picture of the values and limitations of the
benefit of health education, but the effectiveness of health education
health industry, regarding its potential to cure illness, eliminate dis-
to cause or contribute to the changes necessary to improve health,
ability, and prolong life. Such a picture should include the limitations
Patient education programs, such as those associated with diabetes,
of both preventive and therapeutic medicine to redress the harm done
heart disease, pain after surgery, and hemophilia have shown en-
by environmental hazards and unhealthy individual lifestyles.
couraging results. Persons with disease or other disabling conditions
clearly can be motivated to lead healthier lives.
III. DISEASE CONTROL AND PREVENTION
An ongoing demonstration by Stanford University reports promis-
ing results in changing health behavior such as reducing weight,
1. TITLE I
cholesterol levels, and smoking. The objective of the study was to
teach individuals between the age of 35 and 69 about heart risk factors,
Title I of the Committee's bill, Disease Control Amendments of
1975, would continue a national program of assisting States in carrying
out programs which are needed to protect the American people from
10
11
unnecessary suffering from communicable diseases, and to build upon
achieved through 318(d) project grants, and is recommending a
our successes in communicable disease control by including an attack
funding authority for the next three years which will avoid retrench-
on other preventable conditions. These programs are an essential
ment at this critical phase of our all-out attack on venereal disease.
element in forging a truly effective health care policy for our country,
In fiscal year 1976, $31,000,000 is authorized for 318(d) grants, with
and have the potential for undergirding work in reforming our system
of health care financing and the delivery of personal health services.
$33,000,000 in 1977, and $36,000,000 in 1978.
The bill authorizes $31,000,000 for project grants and contracts in
The funding authorizations for each of the programs under Title I
fiscal year 1976 to carry out these programs, with $35,000,000 and
and Title II of the bill have been developed after careful consideration
of the needs of the nation in disease control and the demands for
$40,000,000 being authorized for fiscal years 1977 and 1978 respectively.
These grants are to support projects at the State and local level, and
restraint in Federal spending. Funding levels are lower than those
authorized for the period 1972-1975, and are lower than our original
are to be awarded on the basis of the extent of the problem in the
State or local area and on the soundness of the applicant's proposed
estimates of the need for the next three years. They represent in each
instance reasonable and minimal investments which must be made if
control program. The bill re-emphasizes the importance of carrying
out public awareness programs in these projects SO that, to the extent
we are to achieve the level of success in preventing illness which we,
possible, citizens will be properly informed of disease risks and the
as a nation, have both the financial and technical capability to
achieve.
services available to them to prevent illness. Grantees will continue
3. HEARINGS
to be able to draw on personnel and other resources of the Department
of carry out these projects in lieu of receiving direct financial assistance.
The need for the extension of the authority contained in section
The definition of disease control program has been broadened to
317 and 318 of the PHS act in respect to disease control and the need
permit the Administration and the Congress to address other problems
for a special authority for venereal disease was supported by testimony
of national significance which are amenable to control through orga-
from Mrs. Dale Bumpers, Chairperson, "Every Child by 1974," Little
nized State and community programs such as those authorized by this
Rock, Arkansas, Dr. Eugene Fowinklé, Commissioner of Public
bill. Venereal disease control programs, however, are addressed
Health, State of Tennessee, Mr. Donald P. Clough, Executive Direc-
separately under Title II of the bill in recognition of the importance
tor of the American Social Health Association, Dr. Leonard L. Heimoff,
of a special attack on this problem. Similarly, lead based paint poison-
Associate Professor of Medicine, Cornell University Medical School,
ing prevention grants are, in the Committee's view, best undertaken
Mr. Samuel R. Knox, Director of the Association of Venereal Disease
in the context of a comprehensive attack. This approach is reflected
Programs, and Dr. James N. Miller, Professor of Microbiology and
in Senate Bill 1664 which was ordered reported by the Committee on
Immunology, UCLA School of Medicine. The Administration recom-
July 16, 1975.
mended against the enactment of both titles I and II of the Com-
2. TITLE II
mittee's bill.
Title II of the Bill, National Venereal Disease Prevention and
4. BACKGROUND
Control Amendments of 1975, continues and strengthens the national
In 1974, four American families were afflicted with polio. In 1952,
campaign against venereal disease under Section 318 of the PHS Act,
which was formulated by this Committee in 1972. The bill extends
there were over 55,000 cases in the United States. Yet, today, far too
authority for the Secretary to provide technical assistance to other
many one to four year olds are not fully protected against this dread
organizations in their conduct of research, training and public health
disease, and in some population groups the level of protection is
probably well below 50 percent, The major rubella epidemic predicted
programs for the control of venereal disease, and emphasizes the key
role of private non-profit organizations in the national control effort.
for 1971-1972 did not materialize, thanks to a massive nationwide
Research, demonstration, and training grants are also authorized to
rubella immunization campaign which was undertaken between 1969
enable the Secretary to meet national needs in developing and up-
and 1971. The percent of the population protected against rubella,
grading control programs. The Committee has authorized $5,000,000
however, has shown signs of declining since 1972. Levels of protection
annually for these grants in fiscal years 1976, 1977, and 1978.
against the other childhood vaccine-preventable diseases also show
In addition, the bill extends Section 318(c) formula grant authority
signs of slipping. Since the early 1940's, deaths due to syphilis have
for upgrading diagnostic and treatment services, and adds an addi-
declined 97 percent; first admissions to mental institutions due to
tional requirement that the providers of clinic services begin to meet
syphilitic psychoses have declined 98 percent; and congenital syphilis
the needs of patients with genito-urinary diseases other than those
has declined 92 percent. Yet, we continue to witness an increase in
which have been traditionally defined as venereal diseases. The
the incidence of syphilis, which portends a resurgence in serious com-
funding authorizations for this program are $5,000,000 for fiscal
plications in 10-20 years unless something is done now.
year 1976, $10,000,000 for 1977, and $15,000,000 for 1978.
This history of communicable disease control contains grim lessons.
Project grants for control programs under 318(d) of the Act are
It took a major epidemic in 1964 to direct the attention of the nation
also continued with revisions to clarify the purposes of these grants.
to the necessity for the control of rubella. Steady successes in syphilis
The Committee is encouraged by the early results which have been
control were eroded in the late 1950's because of the premature con-
clusion that the job was finished. We are still reaping the benefits of
12
13
syphilis control investments in the 1940's and early 1950's. The number
of deaths and debilitating consequences of syphilis are still much
sibility. Tuition charges will certainly weaken the ability of the
below the pre-penicillin era. However, we lost the edge in containing
Center to help those States and cities which are in greatest need of
the incidence of the diseases in the late 1950's, and between that time
assistance.
and the passage of the Communicable Disease Control Amendments
5. Formula grant authority under Section 318(c) to assist States in
of 1972, we ran hot and cold in our attention to this problem. Until
upgrading diagnostic and treatment services has been extended. The
gonorrhea surpassed a half million reported cases, the Federal govern-
Committee views the lack of appropriations for this grant program
ment did not spend a penny in project grants to help States and
with great concern. We agree with the testimony presented by the
cities carry out control programs.
American Social Health Association stating that "re-emphasis of the
In 1970, the Communicable Disease Control Act was passed, setting
formula grant mechanism to assist states in establishing and main-
up a project grant program under Section 317 of the Public Health
taining adequate public health programs for the diagnosis and treat-
Service Act to assist States and cities address communicable disease
ment of venereal disease is but an honest recognition of the
control problems on a consistent, nationwide basis. This legislation
shortcomings of our current VD patient care delivery system." The
was specifically designed to establish a Federal leadership role in the
Committee views improvement in public diagnostic and treatment
control of communicable diseases, and to signal to the States that we
programs as essential to the control of venereal disease, and sees
were serious about working with them in achieving control. It was a
the failure of many clinics to provide medical care to persons who
specific response to the existing Federal approach, which was to fund
seek care for genito-urinary diseases other than syphilis and gonorrhea
projects under the general health services project grant authority
as a major weakness in the system.
contained in Section 314(e) of the Public Health Service Act. That
approach not only undermined the purpose of 314(e), but it created
IV. CONSUMER HEALTH EDUCATION AND PROMOTION
serious confusion in the States, because the nature of the Federal
commitment to comunicable disease control and the likelihood of
1. LIFESTYLE AND HEALTH STATUS
continued funding remained in a state of flux.
The 1972 amendments strengthened Section 317 grant programs,
Americans are paying-in the form of taxes, insurance contribu-
and specifically authorized for the first time a comprehensive attack
tions, and direct out-of pocket expenses-over $116 billion a year for
on venereal disease under Section 318 of the Act. Funding of the various
health care and related expenditures. Of this staggering total, only
components of the new law, however, has never matched the amounts
about four percent go for prevention and health education combined.
which the Committee authorized, and which we believed to be neces-
Why the anomaly?
sary. In many instances no funds have been provided to carry out
Throughout recorded history, responsibility for health was placed
parts of the law.
on the individual. However, as better knowledge of the human body
5. COMMITTEE CONSIDERATION
and disease mechanisms were acquired and medical practice became
more scientific, society came to place increasing dependence on medical
The Committee wishes to draw attention to several other key
intervention. Concomitantly, decreasing emphasis was placed on
changes in the law which are contained in Senate Bill 1466.
individual behavior and individual responsibility. Society soon came
1. The word "project" is inserted throughout Section 317, as
to accept the curative role of the physician and the preventive role
appropriate, to avoid any possible misconception about the purpose
of the public health official as the appropriate avenue to health.
of grants and the criteria to be used in making awards. These grants
Yet, despite the vast increase in health care expenditures, illness,
are to be awarded on the basis of the problem and according to the
disability and premature death rates have shown little improvement.
soundness of the program to be supported.
The statistics with respect to death rates are particularly disturbing.
2. Public awareness programs are to be considered integral parts
After half a century of steady and dramatic improvement, the total
of any control program funded under Section 317.
or "crude" death rate for the U.S. ceased to improve during the 1960's.
3. HEW should expand its focus in providing technical assistance in
It remained almost stable, fluctuating between 9.4 and 9.7 per 1,000
venereal disease control to working with the many private non-profit
population. The rate for 1973 is still 9.4.
organizations engaged in combatting these diseases. These citizen
The principal causes of death for the whole population in the late
groups and service agencies are vital allies to Federal, State, and local
1960's were still the familiar trio of heart disease, cancer, and stroke,
disease control agencies.
to which we should add accidents. In 1970, cardiovascular diseases
4. The technical assistance capabilities of the Center for Disease
accounted for 53 percent of all deaths. During the later 1960's,
Control should be fully utilized in helping States and localities
however, other causes accounted for most of the rising death rates for
strengthen each of their control programs. The Committee was very
young men. The principal cause for men, aged 15 to 44, was auto-
concerned in hearing testimony about the Department's plan to
mobile accidents with homicide and suicide following close behind.
require tuition payments from persons receiving technical training
The committee recognizes that none of these three phenomena is
at the Center. It is a major objective of this bill to upgrade States
directly affected by the health care delivery system.
and local control capabilities, and we view this as a Federal respon-
Thus, it appears that therapeutic medicine, important as it may be,
may have reached a point of diminishing return. The 12 to 15 percent
14
15
increase that we yearly add to our hundred billion dollar health care
A large proportion of patient education is done on an informal one-
bill apparently has only a marginal utility. The committee believes
to-one basis by physicians in their own offices, nurses, therapists, and
that a health education and promotion strategy offers hope, a hope
other health professionals. They are usually under severe time con-
manifested by shifting emphasis from curative medicine, currently
straints and cannot provide either in-depth coverage of the instruc-
the predominant and extraordinarily expensive modality, to pre-
tional material or follow up.
vention and health maintenance.
Hospital health education programs are scarce and inadequate. In
those hospitals that do have formal programs, they commonly start
2. DEFINITION OF HEALTH EDUCATION
in one of three types of activities: Classes for diabetics, cardiac patients,
or others with serious chronic diseases or disability; classes for expect-
The Committee found that there was no single acceptable definition
ant parents; and pre-operative instruction. For each of these topics
of health education. Several were offered, all contributing to an
there is a large potential "student body" and the information and
understanding of its potential application.
procedures are fairly well established. Instruction is usually provided
In view, then, of the frequent inconsistency in use of the terms
upon referral by a doctor or nurse, on a group basis, and by a member
"health education" and "consumer health education," the Committee
of the professional staff. Good programs, however, go beyond teach-
felt it essential to develop what it has chosen to call a "mega-defini-
ing assorted courses. In some hospitals, the committee learned, there
tion." The term "consumer health education and promotion" sub-
is a fulltime health education coordinator to identify problem areas,
sumes a set of activities which:
gather resources, and coordinate ongoing efforts as there is in the
(1) inform people about health, illness, disability, and ways
United Hospitals of St. Paul, Minnesota. Such hospitals also assume
in which they can improve and protect their own health, including
responsibility for teaching the teachers-nurses, and mid-level health
more efficient use of the delivery system;
practitioners.
(2) motivate people to want to change to more healthful
Some health maintenance organizations and clinics are also oper-
practices;
ating formal health education programs. For many years, the Health
(3) help them to learn the necessary skills to adopt and main-
Insurance Plan of Greater New York (HIP) operated a large-scale
tain healthful practices and lifestyles;
educational program under an experienced educator and several of
(4) help other health professionals to acquire these teaching
the Kaiser-Permanente units operate health education activities-the
skills;
Oakland program, with its large-scale audio-visual equipment, achiev-
(5) advocate changes in the environment that facilitate health-
ing particular fame.
ful conditions and healthful behavior; and
A major theme in recent patient education efforts is that individuals
(6) add to knowledge via research and evaluation concerning
must take responsibility for their own health. Diabetes programs, for
the most effective ways of achieving the above objectives.
example, attempt to formalize a patient's responsibility for health
In brief, consumer health education is a process that informs, moti-
maintenance. Consider the treatment. What are the respective roles
vates, and helps people to adopt and maintain healthy practices and
for the doctor and the patient? Ideally the disease should be discovered
lifestyles, advocates environmental changes as needed to facilitate this
early. The physician makes a diagnosis and prescribes therapy. The
goal, and conducts professional training and research to the same end.
patient must inject himself with the correct dosage of insulin every
For purposes of this Report, the definition agreed to by the
day, interpret his own urine samples and decide when a change is
Committee is as follows:
sufficient to warrant calling his physician. The patient must be moti-
"Health education and promotion" is a process that
vated to lose weight, recognize and report side effects, learn proper
favorably influences understandings, attitudes, and conduct,
techniques for foot and toenail care to avoid the devastating complica-
including cultural awareness and sensitivity, in regard to
tion of infection and gangrene, recognize early symptoms of complica-
individual and community health. Specifically, it affects and
tions, and visit his physician when scheduled. The physician's role is
influences individual and community health behavior and
essential to effective treatment; SO too is the patient's. No amount of
attitudes in order to moderate self-imposed risks, maintain
resources devoted to physician or hospital care can substantially
and promote physical and mental health and efficiency, and
reduce the cost of diabetes if the patient has not been adequately
reduce preventable illness, disability, and death.
trained and motivated to do his part. The Committee recognizes,
however, that there are and will continue to be very significant
3. HEALTH EDUCATION TARGET GROUPS AND PROGRAMS
problems with regard to the management of diabetes. Education alone
will not resolve the problems attendant to this disease, but it is an
A. Patient Education.-A consumer becomes a patient when he or
important aspect that needs emphasis.
she recognizes a health problem or a potential problem and turns to a
When patient education programs are well thought out they have
physician, clinic, hospital, or some other component of the health care
proved to be very successful. In the Los Angeles County Medical
delivery system for assistance. This is an important distinction:
Center diabetes education program, a telephone "hotline" was intro-
Patients have recognized a problem and made a commitment of time
duced for information, medical advice and for obtaining prescription
and frequently of money. They are, therefore, more receptive to medi-
refills. Patients were educated to use this service through an aggressive
cal intervention and health education efforts.
campaign of pamphlets, posters and counseling sessions by physicians
17
16
A major problem in all screening programs is the difficulty of
and nurses. When the program was evaluated, it was found that the
obtaining follow-up compliance.
incidence of diabetic coma was reduced from 300 to 100, the number of
The informational "hot line" is another approach to community
emergency visits by the diabetic patients were reduced by half, and
education that has been successfully used in some communities. At
that 2,300 clinic visits were avoided. Over two years, total savings
Monmouth Medical Center in Long Branch, N.J., a VD hotline gave
was estimated at more than $1.7 million.
diagnostic and treatment information and directed callers away from
A modification of present education programs is the "self-help
the hospital emergency room to the less costly olinic. The Committee
preventive medicine" offered by Georgetown University's Community
favors the development and implementation of a model toll-free tele-
Health Plan at Reston, Virginia. This organization has crystallized a
phone system.
concept, employed by a small but growing number of physicians,
A unique example of targeted community education is the Stanford
into an organized course consisting of seventeen weekly evening
Heart Disease Prevention Program. The objectives of this large five-
sessions of two hours each. Patients are taught what behavior practices
year interdisciplinary study are to teach individuals between the ages
are healthful; how to use basic medical equipment such as stetho-
of 35 and 69 about heart risk factors and to stimulate them to adopt
scopes, sphygmomanometers, and otoscopes; and what to do in emer-
more healthful behavior. The study compared risk factor decreases in
gencies. The goals of the program are to create "activated patients"
three similar California communities exposed to different mixes of
with a positive sense of their ability to affect their health, and to
television spots, printed materials, and personal instruction. The
reduce some of the unnecessary, time-consuming, burdens currently
conclusion was that educational campaigns directed at an entire com-
placed upon the physician.
munity could produce striking increases in the level of knowledge
There is also a recognition in industry of the potential value of
about heart disease and risk factors and marked improvements in risk
health education. Several companies, for example, have entered the
factor levels.
field with films, tapes, cassettes, slides, models, teaching texts, and
It is research of this type that the Committee believes most im-
other audio-visual and printed teaching aides.
peratively should be funded. Changing behavior is a very complex
B. School health education.-The long run success of consumer
phenomena and requires a series of longitudinal studies to identify
health education programs rests on the behavior and health habits
the most effective methods. Funding should be available to qualified
of children and youth. The public school system has the potential to
researchers from private nonprofit and public agencies and institu-
influence these children, but the potential has not been adequately
tions for these purposes.
developed and, in general, the record is not impressive.
D. Occupational Health Education.-Individuals are exposed to
It is difficult to determine which states have effective school health
environmental hazards in their place of work that can have severe
education programs. Many have enacted legislation or issued ad-
implications for their health. The Occupational Safety and Health
ministrative directives mandating health education in public schools.
Administration (OSHA) identifies two categories of risk: (1) Safety
Frequently, however, funds have not been appropriated to imple-
hazards or dangerous physical conditions such as inadequate guards
ment and enforce these regulations.
on machines; and (2) health hazards or unsafe levels of toxic substances
School health education programs are faced with three major
and harmful physical agents such a asbestos and carbon monoxide.
constraints: A tradition of low visibility and priority, a narrow
Over the years, great progress has been made in reducing occupa-
definition of the appropriate jurisdiction for health education efforts,
tional safety and health hazards affecting American workers. It has
and a shortage of adequately trained health educators. The Committee
been pointed out that for every industrial accident death there are
considered the problems of school health education and decided to
now 50 cardiovascular casualties. However, in a dynamic technological
focus their attention on inservice education, establishing a program
society such as ours new hazards constantly arise and old ones reappear
of grants to local education agencies and institutions of higher educa-
in new forms. In scattered instances, employers are still resistent to
tion for education opportunities for elementary and secondary school
government- or union-inspired efforts to control toxic substances.
teachers in a broad scope of health education areas.
To detect and control new hazards and to inculcate in the employee
c. Community Health Education.-The goal of targeted community
better understanding of his own responsibilities and rights under the
programs is to identify individuals who are at risk, make them aware
Federal occupational safety and health laws, OSHA has undertaken
of the risk and steps they can take to reduce that risk, and, if symp-
an extensive employee educational program. Employees can obviously
toms are brought to light, to direct them to the appropriate care
affect the safety of their environment by following recognized safety
setting. Targeted community programs frequently start with screen-
practices such as wearing hard hats and ear plugs. However, in the
ing for hypertension, tuberculosis, breast cancer, and sickle cell
more subtle area of health hazards, which are often difficult to detect
anemia.
without sophisticated equipment, their only protection often is know-
The value of multiphasic screening has been debated and recently
ing and acting on their legal rights. They can also request OSHA
preliminary results from a randomized controlled evaluation have
inspections when they suspect a hazardous health condition exists (and
become available. The results, from a study begun in 1964 by the
have their names withheld from their employers), and can review their
Kaiser-Permanente Medical Care Program, for example, indicate that
employers' records for monitoring and measuring hazardous materials.
screening can reduce the number of "potentially postponable" deaths
and reduce medical costs for older men by $800 a year.
57-010-75-3
18
19
In fiscal years 1974 and 1975, OSHA allocated $6.6 million for
fifteen grants related to health education projects that test models
be attributed primarily either to management or the unions. The
of occupational health education. The formats and curricula OSHA
major culprits are the same four that hamper other forms of health
obtains from these projects can be adapted by employees and em-
education-individual ignorance, public apathy, commercial pressures,
ployee groups to their own particular needs. A substantial multiplier
and lack of any strong, positive leadership on the part of either the
effect is anticipated.
government or the health professions.
The largest contract, for $3 million, was let to the National Safety
The Committee expects that programs authorized under this legis-
Council, which has developed four short courses and implemented
lation will receive proper attention by the Office.
them through 39 participating local safety councils. The courses
include orientation to rights and responsibilities under the Act and
4. NUTRITION
instructions on setting up safety and health programs within establish-
ments. Over 100,000 individuals have already been reached by this
During the Great Depression it was a common fact that nearly
massive, geographically dispersed, program.
one-third of the Nation was malnourished. Today, we have developed
Another contract demonstrates the feasibility of using community
a neologism to describe the fact that the entire Nation may very well
and junior colleges as part of the job safety and health education
be "misnourished." We have the resources to buy sufficient food, but
delivery system, while another entails the creation of thirty-minute
lack the knowledge to choose which foods are the best for us.
television programs on selected job safety and health topics.
Many who are not hungry are the "new misnourished." They are
Training individuals to recognize health hazards is complex because
the overweight who eat empty calories and consume too many
the problems vary by occupations. OSHA has selected five "target
processed foods. They are our children; they our often ourselves.
industries" in which the disability and death rates are substantially
Jean Mayer, chairman of the White House Conference on Food,
above average including, longshoring, meat and meat products, roofing
concluded that the "new misnourished" cost the Nation about $30
and sheet metal, lumber and wood products, and miscellaneous trans-
billion a year. A fraction of this large sum could be spent on nutrition
portation equipment.
education. A tax dollar spent to give consumers a sensible scientific
OSHA's work has been supplemented by that of a number of unions
guide to spending their food dollars is an investment in our children.
and companies that have initiated their own education programs in
It is an investment with a dollar and cents return for spending more
areas not related to occupational safety but using the workplace as
for nutritional education now will mean less sickness and lower costs
a focus for more general health education. For example, the United
later.
Mine Workers Union, which administers its own prepaid health in-
Often bills would encourage and expand nutrition education pro-
surance plan, has hired full time health educators in several regions,
grams in schools of medicine and dentistry. The Committee believes
and conducts programs in preventive care and specialized classes for
it is important for physicians and dentists to understand the relation-
diabetics and others.
ship between nutrition and health to better provide their patients with
The Connecticut Mutual Life Insurance Company in Hartford,
necessary nutritional information.
Connecticut, and the Scoville Manufacturing Company in Waterbury,
Such bills are presently pending before the Congress and it is
Connecticut, each have a program to help workers with alcohol or
anticipated that they will be the subject of hearings in September 1975.
other drug problems. In addition, Connecticut Mutual offers employees
The Committee recognizes this important subject and has included
periodic voluntary physical examinations, occasional videotape
nutrition and nutrition experts in all of the appropriate policy design
presentations during the lunch hour on topics such as heart disease
and implementation sections in the bill.
or alcoholism, and frequent health articles in company publications.
The programs of both companies direct their promotional efforts
5. MEDIA
largely toward supervisory personnel in the hope that they will
refer workers who appear to have problems. Scoville no longer considers
The media are important vehicles for disseminating information
their program a cost item, because of the savings resulting from
and influencing behavior. Physicians and other health professionals
increased worker output. In fact, savings in the Waterbury plant
are involved in presentations that reach a large audience. "House
alone, which employs about 4,000 of their 24,000 workers nationwide,
Call WCVB", a prime time television show in Boston, features a
are estimated to be more than $200,000 for 1974.
physician answering questions about health and medicine, and is
Annual health examinations and counseling programs for executives,
viewed in 152,000 homes each week. Television and radio spots are
periodic screening of blue-collar employees, lunch-hour lectures on
used frequently to promote programs and to make consumers aware
a variety of health topics for both blue-collar and white-collar workers:
of particular problems. For example, Pearl Bailey is featured in a spot
these and many other general health maintenance and educational
to create public awareness of a new Federal Drug Administration
activities are currently taking place throughout American business
labeling program.
and industry. Such efforts, successful as they have proved to be in
Unfortunately, the positive impact of these media efforts are largely
individual situations, have scarcely made a dent in the general
offset by the misinformation often carried on TV advertising. A
health problems of American workers. The blame, however, cannot
recent analysis of one week of television in a major metropolitan area
concluded that five percent of the total broadcasting time was used
to transmit inaccurate or misleading health information.
21
20
point. Although there is the necessity of greater involvement in
The Public Broadcasting System and other networks have pro-
patient and other health education programs it is obvious that the
duced several specials on important health issues. The Children
nation must look to other professions to supply most of its health
Television Workshop has created an innovative television series
education needs, even for those who are already patients.
focusing on health education. "Feeling Good" opened on PBS stations
C. Nurses.-The one profession that is doing-the most consumer
in November, 1974. The show, which was an attempt to combine
health education in the U.S. today is nursing. This is evident in the
health education and entertainment, was intended to appeal to adults,
figures. In 1972, there were 748,000 active registered nurses; of whom
especially parents in low income families. Unhappily, the program
failed. Dr. Carter Marshall, who testified before the Committee on
54,000 were in public health and school nursing and 35,000 in occupa-
tional health nursing. Much of their work is educational.
May 8, 1975, stated that its basic difficulty was that "Feeling Good"
Many, perhaps most, of the 526,000 working in hospitals and
was developed for low income audiences, when in fact viewers of
public television are upper middle class and well educated. Media
nursing homes have extensive technical responsibilities and limited
research, the Committee believes, is an important feature of the
time to give to patient education. Nevertheless, for nurses, unlike
HEW-based Office of Consumer Health Education and Promotion.
physicians, patient education is now generally assumed to be an
explicit part of the job responsibility, generally SO stated in the state
Media programming is expensive, but well worth the effort.
nursing practice acts and a component of all state licensing examina-
tions. Moreover, the nurse, unlike the doctor, does not have the same
6. HEALTH EDUCATION MANPOWER
professional and emotional preoccupation with diagnosis and inter-
The wide range of comsumer health education programs is carried
vention. The nurse is frequently more interested in the patient as a
on by an even wider range of professional and occupational groups and
person and looks on maintenance and educational activities as a major
individuals. These occupational groups include, in addition to health
challenge rather than evidence of failure.
education specialists, physicians, hospital nurses, public health
Nurses today are not only doing more health education than any
nurses, school nurses, physical education teachers, dentists, dental
other group but they also constitute the most significant potential pool
hygienists, pharmacists, dietitians, therapists of all types, psychol-
of professionals available for rapid upgrading toward expanded health
ogists, public health personnel, midwives, communications and audio-
education responsibilities.
visual personnel, and appliance and drug manufacturers.
D. Other Professionals.-Among the other professional and occupa-
A. Health Education Specialists.-Dr. Scott Simonds, a well known
tional groups that are contributing in some degree to health education,
health educator and member of the President's Committee on Health
the following are especially important: Dentists and dental hygienists,
Education, has written that:
physical, speech, and occupational therapists, pharmacists, nutrition-
ists and dietitians. The average dentist and dental hygienist seems
*
*
* the total number of individuals prepared in health
more concerned with prevention and patient education than the aver-
education at the baccalaureate, masters, or doctoral levels
age physician. The dental profession as a whole has received too little
and working actively in the field of either public health
credit for its consistent support of preventive and maintenance activi-
education or school health education [is] no more than 12,500
ties, including proper diet.
[including] no more than 2,000 prepared in community or
The 133,000 pharmacists come into frequent contact with consum-
public health education.
ers. Often the consumer will question the pharmacist about the impact
Comparing Dr. Simonds outside estimate of 12,500 with the 1974
or side-effects of prescription drugs and request advice on over-the-
resident civilian population-approximately 210 million-this comes
counter drugs. The role of the pharmacist in providing information and
to one health educator for over 16,800 persons. By comparison, there
monitoring drug use could be upgraded; indeed, the Secretary's Task
were, in 1973, one active physician for every 648 persons and one nurse
Force on Prescription Drugs urged pharmacists to become drug infor-
for every 281.
mation specialists.
Based on the information provided to the Committee, these training
The Committee is also aware of the real and potential contributions
programs emphasize sophisticated educational, planning, and research
of other types of personnel such as the licensed practical nurse, the
techniques. The field needs these health education specialists; it also
newly emerging group of physician assistants and nurse practitioners,
needs. health education practitioners trained for actual community,
as well as numerous volunteers, such as the 10,000 volunteer teachers
patient and student contact.
participating in the National Safety Councils Defensive Driving
B. Physicians.-Despite the impressive record of physician involve-
Course. Effective health education and promotion will depend on a
ment, it is clear that we can look to the medical profession for only a
wide variety of skilled practitioners, all making important contribu-
small proportion of the nation's total health education needs. Physi-
tions. The Committee does not foresee any primary role for any one
cians now considers their primary tasks to be diagnosis and thera-
specialty that currently exists, nor is the Committee anxious to develop
peutic intervention. Too frequently they turn to maintenance and
such a specialty. Nevertheless, the Committee recognizes the need for
education when intervention fails or has limited results. Thus, to
adequately trained health education practitioners who will be engaged
some extent the need for education is associated with therapeutic
in health education teaching and research and in health education
failure, and it is not surprising that many doctors lose interest at this
practice:
22
23
The Committee believes that emphasis should be placed on raising
the level of training given to those who will enter the field of health
appears to be considerable leeway for educational activities, but not
education practice. Additionally, support should be given to those who
SO with medicare recipients. Any activity that can be labelled "pre-
are engaged in theoretical research in the field of health education and
ventive" has to be disallowed for reimbursement under existing
promotion since it is this group who develop the conceptual frame-
legislation.
works from which sound practice derives. Short-term continuing educa-
In August 1974, the Blue Cross Association approved a position
tion programs should also be included to upgrade skills of a variety of
paper strongly. endorsing the concept of patient education and urging
health providers, including doctors, nurses, educational specialists, and
member plans reimburse hospitals for such activities. The Committee
midlevel health practitioners. The Committee places highest priority
welcomes this useful document, but BCA guidelines are one thing and
on multidisciplinary and cooperative approaches which will do the
individual plan implementation is another. There are only two-such
best job possible.
plans now reimbursing for patient education, one is New Jersey and
7: FINANCING
the other is Montana.
8. EFFECTIVENESS
Despite their low costs, health education programs face a constant
struggle for funds. Most medical services are refunded almost auto-
Current health education programs are rarely evaluated. Despite
matically because their value is taken for granted and past budgets
compulsory instruction in many schools, young people are probably
not only serve as precedents but are expected to increase as both quan-
smoking, drinking, using more drugs and otherwise engaging in more
titative growth and qualitative. improvement are assumed to be de-
health-threatening behavior than ever before. Despite the tremendous
sirable. But because health education programs are new-at least to
anti-smoking campaigns, 41 percent of those 17 to 25 years old were
the mainstream of the health care economy-they are constantly in
regular smokers in 1970. Screening programs for breast and cervical
the position of having to prove themselves and justify their existence.
cancer are universally available; yet only half of American women over
Traditionally, public and community programs. were financed by
17 had such tests in 1973 and nearly one-fourth had never had a breast
grants or direct allocations from government, philanthropic, vol-
examination. The proportion of individuals taking advantage of any
untary agencies, or industry. This is still true of most of the new TV
such screening is reported to be levelling off at about three-fourths.
programs. "The Killers," "Feeling Good," "Drink, Drank, Drunk"
Immunization rates also seem to have reached a peak and some, such
and others have been supported by grants from the Robert Wood
as polio and DPT, have dropped significantly.
Johnson Foundation, the Commonwealth Fund, Public Broadcasting
Even when positive results appear to be forthcoming, as in the recent
Corporation, Exxon, the 3M Company, and others.
decline in heart disease, it is virtually impossible to know whether to
The President's Committee reported $30 million spent for "spe-
attribute this to the campaigns against cholesterol and other risk-
cific" health education programs in 1973 and $14 million for "general,"
factors or not.
altogether less than one quarter of 1 percent of that year's HEW
In short, we do not know whether the record would have been better,
budget. Many feel those figures are generous. Presumably most of
or worse, or no different, if there had been no educational effort. Yet
this went for programs involving smoking, drug addiction, alcoholism
some progress has been achieved. Professor Lawrence Green of the
and related conditions. According to the same source, state govern-
Johns Hopkins School of Hygiene and Public Health, one of the fore-
ments spend less than one half of one percent for health education. In
most exponents of health education evaluation strategies, has reviewed
comparison, the annual budget for a well-known analgesic is $28
the results and concludes that "the payoff is more than proportionate
million.
to the effort and costs."
A major potential source of health education support is third party
The Blue Cross Association arrived at the same tentative conclusion,
reimbursement, now the principal method of paying for patient care
at least with respect to patient education. In a succinct summary of
in the United States. As long as patient education was provided by
evaluation literature, the BCA 1974 policy statement concludes, that:
doctors, nurses, and other health professionals as a routine and
On balance, organized patient education has demonstrated
nonidentifiable part of patient care, most third-party payors did not
its effectiveness in reducing the unnecessary utilization of cer-
question reimbursement. Today, however, as more and more separate
tain health care services and in encouraging the use of the
programs are established and other personnel become involved, it is
most appropriate, least cost settings for care.
harder to "bury" the educational costs, small as they are, in routine
Similar reports reveal conclusions that patient and health education
care. A move has been under way to persuade all third-party payors,
programs pay off, in reduced hospital and emergency room readmis-
governmental and private, to recognize patient education as a legiti-
sions, reduced morbidity and mortality and reduced costs. Research
mate component of patient care, one that need not hide itself but can
and evaluation of such programs, and the development of new demon-
appear as a separate item in the hospital budget or the physicians' bill.
strations, are important features of S. 1466.
The Health Insurance Benefits Advisory Council (HIBAC) ad-
dressed itself to this issue in a report to the Secretary in 1974. The
THE NEED FOR NATIONAL LEADERSHIP
report added nothing new but helped to clarify the position of Medi-
care and Medicaid. As far as Medicaid patients are concerned there
Recently, health promotion and prevention have become major
planning concerns of the Assistant Secretary for Health of HEW.
25
24
The Committee has studied the Presidential messages and task
The Division of Health Protection has developed proposals to shift
force and Committee reports on health education, and is convinced
the focus of analytic activities toward broad health problem areas
that there is still no national recognition of the importance of this
requiring comprehensive prevention efforts. The Committee is im-
field and no adequate central force to stimulate and coordinate a
pressed with such developments, and awaits implementation of such
comprehensive health education program. Efforts toward this end are
programs.
fragmented. The moneys spent for health education and promotion
The Committee also notes that the Administration has taken other
are miniscule. There is no informational exchange between those in
cautious steps. Such programs as have been developed, however, the
public and private agencies concerned with health education and
Committee finds do not match the magnitude of the problems. The
promotion. There has been little evaluation of results among similar
official statement of mission of CDC's Bureau of Health Education,
or related health education programs sponsored by different organiza-
for example, is broad and comprehensive. However, its subordinate
tions. Information about health education theory, programs, and
location in HEW and lack of visibility and resources contradict its
methods is not easily accessible. There is presently no public or private
broad mandate. The Bureau, however, has made a number of contri-
agency which is systematically reviewing the broad range of expe-
butions both within and without the Federal structure, including
rience theoretical experimentation in health education and pro-
support and leadership in the development of a private-sector Center
motion! And, there is no focal point or forum to facilitate communica-
for Health Education, the initiation of cooperation among Federal
tion and cooperation among the significant health public and private
agencies in need of common health education objectives, and the
organizations which must work together if substantial improvement
development and funding of innovative health education projects.
in health education and promotion is to be achieved.
The Committee acknowledges the important work of the Bureau but
The Committee recognizes that the needs and problems are so major
favors an HEW-based Office of Consumer Health Education and
and complex that progress will depend upon a major long-term commit-
Promotion. Organizationally located in the Assistant Secretary for
ment by both the public and private sectors of society. Itis to meld such
Health's office, given visibility, resources and authority, the Office of
efforts, provide for a focal point for the Nation's multiple but disparate
Consumer Health Education and Promotion will better be able to
health education and promotion activities, improve the health status
establish a national strategy and new directional emphasis with
of Americans,' design a mechanism by which we may establish a na-
respect to health education and promotion.
tional health education and promotion strategy, that parts A and B of
title III of S. 1466 have been proposed.
V. THE RESPONSE TO THE CHALLENGE
The concept of a complementary national public and private strategy
to improve consumer health education and promotion is the result of
The cluster of concerns outlined and described in the preceding
four years of study and development. This concept was originated by
sections of this report urge us to continue our efforts to reorganize and
the President's Committee on Health Education and has been further
restructure our health services delivery system and to continue to
amplified by a study performed by the National Health Council, Inc.
experiment with innovative financing mechanisms. Concurrent with
under the contract to the Center for Disease Control. Both studies
our efforts to develop a better and more efficient system, however, the
based their findings and recommendations on the input of hundreds
Committee sets forth a new strategy, one which shall assist us to
of citizens, including health educators, other health professionals
understand the nature and causes of self-imposed risks, adds to our
and educators, consumers, and representatives of business and in-
knowledge of illness, and educates patients and consumers about
dustry, labor unions and government drawn from all parts of the
health maintenance and prevention.
country.
The strategy is based on recent data which is both startling and
The President's Committee on Health Education was charged to
troubling. The Committee has learned that in 1972, 92% of the $95
describe the "state of the art" in health education of the public and
billion spent for medical, hospital or health care was spent for treat-
to propose a comprehensive, nation-wide plan to raise the level of
ment after illness occurred and that more than half of the remainder
health consumer citizenship: Through seven subcommittees, eight
was spent for biomedical research. Prevention of illness and consumer
regional hearings and one national forum the Committee involved
health education and promotion share the meager balance. The
many hundreds of individuals of different backgrounds and expertise
Committee has additionally learned that hundreds of thousands of
from all parts of the country in the development of their findings.
Americans have died prematurely from causes primarily related to
After two years of study, the President's Committee recommended
lifestyles. Alcohol addiction, abusing pharmaceuticals, addiction to
the creation of two separate but complementary entities: (1) A
psychotropic drugs, cigarette smoking, overeating, high fat and carbo-
governmental unit within HEW to 'make the federal government's
hydrate intake, lack of recreation, promiscuity, and careless driving-
involvement in health education more visible, effective, and efficient,
an imposing litany of some of our more destructive habits-leads to
and (2) a publicly chartered, private organization which would be a
the inevitable conclusion that for the majority of Americans morbidity
source of innovative problem-solving and policy guidance for health
and mortality rates will not be noticeably improved unless lifestyles
education efforts:
are modified, self-imposed risks reduced and the social and physical
environment changed.
26
27
1. THE OFFICE OF CONSUMER HEALTH EDUCATION AND PROMOTION
specifically designed to test health education hypotheses, such as the
Nestled in the bosom of the Center for Disease Control is the Bureau
Stanford Heart Disease Prevention Program.
of Health Education, presently the Administration's major force point
Closely related is the need for expanison of the present valuable
for better education activities. The committee recognizes the creditable
surveys and studies of the National Center for Health Statsitics to
performance of the Bureau which despite very limited resources in
include more information on consumer health status, health behavior,
terms of both budget and personnel has made a number of creditable
and related data useful and necessary for planning and evaluation of
contributions both within and outside the Federal structure. A number
health education programs and techniques. Relevant resources of
of witnesses have applauded the Bureau for programmatic, consultative,
CDC should also be fully explored and utilized.
and monetary assistance; others, however, are gravely concerned that
C. Regional and State Systems.-Even with the severely limited
the Bureau is an anomaly, pointing out that the subordinate location
funds and personnel now available for health education, there is con-
in CDC, its miniscule budget, and lack of resources contradict the
siderable duplication and waste. More importantly, most American
Bureau's broad mandate. The Committee was persuaded by those
communities lack access to any comprehensive consumer health
skeptical of the Administration's commitment and by the apparent
education.
discrepancy between the Administration's promise (for bold health
To avoid these inefficiencies, to promote optimum utilization of
education and promotion initiatives) and reality.
both money and manpower, and to help develop a stable infrastructure
A. High-Level Office of Consumer Health Education and Promotions.-
for community and other programs, it is highly desirable to develop
The Committee considered a number of loci for the proposed Office of
local, regional, and/or State networks. This can be accomplished
Consumer Health Education and Promotion, including a Center-model
through the coalescence of existing programs, new regional and state-
akin to the National Center for Health Statistics or the National Cen-
wide initiatives under the leadership of a State health department, a
ter for Health Services Research or creating an organization similar
university extension system, a State hospital or professional associa-
to the National Science Foundation, Ultimately, the Committee opted
tion, a medical school, regional medical program, or other organization
for a locus in the Office of the Secretary with adequate status, author-
with the concern and resources to play the coordinator role, or through
ity and resources to carry out policy design and implementation and
a combination of various approaches.
other collaborative, oversight and coordinating functions. Policy direc-
The National Health Planning and Resource Development Act of
tion and design, the Committee believed, could only be attained and
1974 provides a potential mechanism for promoting such networks.
implemented in a high-level Office of Consumer Health Education and
D. Health Education Training.-Both quantitative and qualitative
Promotion. The proposed Office may very well consult with CDC and
improvements in health education manpower are essential if the
other organizations in HEW that have health education components
national efforts recommended in this report are to be effectively
to execute the programmatic aspects of health education, but the locus
implemented. As a first step, we recommend a high-level review of
of policy activity must be in the Office of the Consumer Secretary
personnel in all the extensive varieties noted in this report. Such a
for Health and not in an operating agency.
review would apply not only to health education specialists but to all
B. Research Activities.-Despite the considerable number of sig-
the health and related professions currently involved in some aspect
nificant health education programs scattered across the country and
of health education and should address itself to the numbers and types
the efforts of thousands of dedicated professionals, the general state-
needed, their preparation, credentialing, distribution, and continuing
of-the-art is in need of greater precision and development. The large-
education.
scale program of public and private support recommended in this
Special attention should be given to the introduction and develop-
report must be accompanied by intensive efforts directed to improve-
ment of health education concepts and methodologies into basic
ment of health education principles, techniques, and methodologies,
education for the various health professions, including medicine,
and the formulation of more precise criteria and protocols both for
dentistry, nursing, pharmacy, and public health. The time is ripe for
implementation and evaluation. This should include a delineation of
such a new initiative. Witness the special attention paid to health
areas of strength and weakness in knowledge, looking toward devel-
education at the 1974 annual meeting of the Association of American
opment of a national statement of priorities and realistic goals.
Medical Colleges and the fact that most state nursing practice acts
Much of the support, as well as initiative, for these efforts should
now specifically mandate patient education as a routine aspect of
come from the private sector. But there is a special need for Federal
nursing care. Explorations, looking to increased health education
leadership. Federal support, with special emphasis on evaluation,
content, are now in order with the American Association of Medical
should be made available to qualifying institutions, organizations
Colleges, the American Medical Association, the Coordinating
and agencies.
Council on Medical Education, the National Board of Medical
The Committee notes the existence of a number of community
Examiners, the American Dental Association, the American Pharma-
"laboratory" populations for the study of problems in health educa-
ceutical Association, the American Nurses Association, National
tion. Such communities should be encouraged to participate in the
League for Nursing, the Association of Schools of Allied Health
development and evaluation of health education methodologies. The
Professions, the National Commission for Accrediting, and other
Committee also endorses the development of large scale programs,
professional organizations.
29
28
SO that when broader, more comprehensive school health degislation is
Moneys should be made available for the training of health educa-
enacted in the future there will be no delay, owing to a lack of qualified
tion specialists. For this group, special efforts are needed to determine
personnel, in implementing the health education curriculae in the
the numbers of students required at entry levels, baçcalaureate,
schools of the nation.
master's, and 'doctor's levels, as well as the types of educators needed
F: Media Programming.-The impact of television as an informa-
in the schools, health care institutions; industrial settings, com-
tional and motivational force in contemporary U.S. society, especially
munity agencies, national health agencies, and the media; also the
in relation to children and individuals with less-than-average schooling,
need for special research personnel and future teachers.
can hardly be exaggerated. With respect to health-related behavior,
Finally, the Committee urges that in considering health educa-
it is difficult to say whether the net impact has been positive or
tion manpower, special attention be given to the definition and
development of a new occupational category of indigenous com-
negative.
The positive can be documented by a growing list of first-rate
munity health education aides, advocates, or facilitators to act as a
health documentaries, public service "spots", and even some of the
bridge between the community, especially in low-income areas, and
theatrical programs presented by the Public Broadcasting Systemiand.
health providers, including health educators. The success of programs
the three commercial networks. The negative has been convincingly
utilizing such individuals, under various names, has been demon-
documented by a number of carefully designed professional studies
strated in a number of locations, but the concept needs more precise
including two prestigious national commissions looking into the rela-
definition, more standardized training, and some form of academic
tionship between. televised violence and individual behavior
certification:
Despite this anomalous record, the Committee believes that
E. School Health Education Training.-The Committee considered
with more consistent and accountable attention from the leadership
S. 544 at some length with a view to including this Comprehensive
of the industry, with more high-level assistance from representatives:
School Health Education provision. in this bill. The Committee recog-
of the public and the health and education professions, and with
nizes that S. 544 is essential legislation if a meaningful preventive
identification of adequate sources of financing for constructive pro-
program to.improve the health of the American people is to be a reality.
The Committee has included a portion of S. 544 as Section 1703d(1),
grams-the positive potential can be greatly enhanced and the nega-
tive minimized.
(2), '(3)' of S. 1466. The language establishes & program of grants to
The Committee's emphasis on TV. is by no means intended to be-
local education agencies and institutions of higher education for in-
little the influence of the press, radio, and other media which have
service education opportunities for elementary and secondary school
also produced some excellent material and whose continuing. par-
teachers in a broad. scope of health education areas. The Committee
ticipation should be enlisted in the national effort to improve con-
believes this to be a pressing need at this time and recognizes that no
sumer health education. Since TV's capacity for both positive and
program can be successfully developed in the schools until a cadre of
negative impact is so crucial, however, we think the primary effort,
career teachers is well prepared to deal professionally with the issues
involved.
at the present time, should be aimed in this direction.
The Committee hopes that through Section 1703(c), the resources
The will thus make available to presently employed teachers
of television and advertising will be mobilized in the development of
workshops, seminars and courses during summer and evening sessions.
a long-range, multi-audience, multi-format series of programs, utilizing
The workshops, seminars and courses will deal with the broad scope of
documentaries, theatrical programs, cartoon and news programs,
issues including dental health, disease control, environmental health,
public service spots, and all other appropriate formats, aimed at
human ecology, mental health, nutrition, physical health, safety and
helping the American people increase their understanding of, and
accident prevention, smoking and health, substance abuse, consumer
ability to cope with, health and health-related problems, Both com-
health and such others as may be deemed appropriate. The Director
merical and public TV should be involved. Assistance in funding
is required to confer with, and receive the approval of, the Commis-
through public and private sources should be explored. The existence
sioner of Education in determining the recipients of the grants and the
of such a formally designated industry council working through the
scope of the program.
Center for Higher Education (infra.) would also provide a. body to
Because. of the alleged surplus of teachers the bill emphasizes in-
which the public and the health and education professions could relate.
service education rather than preservice education for persons who
The Committee is aware that the National Advertising Council
later may not be employed. The Committee feels this is a practical
shares many of our concerns. The Advertising Council, however, is
approach to the solution of the problem which presently exists in most
not intended to carry out the kind of concentrated systema health
schools where comprehensive health education programs are non-
education program outlined.
existent. It is essential that school health education begin in the pri-
Another objective of sections 1703(e) and 1703(f) is to encourage
mary grades and extend through the secondary curriculum. Too often
the industry, the Food and Drug Administration, the the
health education is confined, if indeed provided at all, to students in
FTC to intensify their efforts-through voluntary advertising codes,
their teens. It is the Committee's purpose to correct the situation by
"Family viewing hours," and other means-at effective self regulation.
providing a practical, although somewhat limited opportunity, for
The Committee expects that, through the use of fact-finding, pub-
inservice education in school health education for persons who are
licity, non-governmental sanctions, and all the moral and political
and will continue to be employed as elementary and secondary teachers
30
31
force the Office of Consumer Health Education and Promotion
commands, the elimination of material deemed, by objective profes-
4. Budget.-The Committee has tried to reconcile the competing
sional opinion, to be injurious to the nation's health will be secured.
claims of a non-inflationary Federal budget and the necessity of
G. Federal Programs.-Areas that should come under such con-
providing at least enough financial support to give the new program
tinuous monitoring include agricultural supports for harmful products
a chance of succeeding. Major elements of the projected first year
such as tobacco, or those potentially harmful if used to excess, such as
budget might include:
beef with high-fat content; school lunch and food assistance programs;
food and drug advertising; and speed limits and other energy conserva-
Cost estimate-Office of Consumer Health Education and Promotion
tion measures. The conflicts or apparent conflicts between a number
Extramural grants and contracts:
Millions
of existing programs in these areas and the goals of health promotion
Basic research programs
$1. 0
have been increasingly publicized in recent years.
Academic centers
1.0
The monitoring should extend not only to areas where harmful
State networks
1.0
or allegedly harmful policies now exist but to those currently marked
Experimental media research
1.0
by the general absence of essential health promotion policies, includ-
Consumer health education training
4.0
School health education training
3.0
ing low-income housing, the control of violence, and public service
employment. The irony of spending billions of Federal dollars to
Total
11. 0
patch up the victims of big city violence, squalor, and frequently
The estimated cost of the basic research programs is related to the
intolerable living conditions, while refusing to face up to the root
cost of a number of successful programs, including the Stanford
causes cannot be indefinitely sustained as general economic condi-
Heart Disease Prevention Program and the Diabetes Control Program
tions deteriorate, budgetary constraints increase, and various safety
of the Los Angeles County General Hospital. The cost of the state net-
valves disappear.
works is derived in part from the experience of the College of Medicine
The Committee is aware that policy development in health educa-
and Dentistry of New Jersey.
tion and production cuts across Departmental lines and that HEW
The media projection is far less than the $7 million that it cost
can do little or nothing alone. However, we feel strongly that the
Public Broadcasting System's "Feeling Good."
Department should be continuously engaged inmonitoring such
With respect to the long-term costs, including those that might be
policies, in advising the President, the Congress, and the American
met through third-party payments, school budgets, and voluntary
people with respect to such policies, and in representing the health
agencies, the Committee has set a tentative goal of 6 percent of total
point of view in interdepartmental decision-making. Primary respon-
national health care expenditures. Obviously, the Committee needs a
sibility for policy design and staff work should be lodged in the pro-
more precise figure as well as a timetable for moving from the present
posed Office of Consumer Health Education and Production.
one-quarter to one-half of 1 percent, the sum presently being spent by
The importance of HEW involvement in broad policy issues, beyond
the Federal government, toward 6 percent and a study of alternative
the usual definition of health and medical care, was emphasized both
methods of financing. For example, should the financing of health
by the Surgeon General's Committee on Smoking and Health and the
education and promotion programs be closely related to that of
subsequent Committee on Television and Social Behavior. Some would
national health insurance? How much reliance should there be on
have preferred to see strong recommendations included in their re-
social security taxes or general revenues? Should there be special
ports. But, even without recommendations, the carefully documented
taxes on cigarettes, alcohol, other health-threatening products certain
findings, emerging from such a prestigious source, have been useful.
non-prescription drugs where overuse or other abuse is common?
In initiating such a large new undertaking, an essential first step
The Committee recommends that the office consider such a study
would be establishment of a list of goals and priorities. Criteria, both
one of its priorities.
immediate and long-run, should include the firmness of the presump-
tive causal relationship between the policy in question and national
2. THE CENTER FOR HEALTH EDUCATION AND PROVISION
health status, the financial cost to the nation of failure to take correc-
action. tive action where needed, and the reasonable possibility of corrective
As defined by the President's Committee, health education is a pro-
cess that bridges the gap between health information and health prac-
For example, in the case of tobacco, the causal relationship between
tices and motivates the change of behaviors destructive to health
cigarette smoking and health has been professionally and officially
maintenance. The Committee saw this process as applying to institu-
determined. The health care costs resulting from cigarette smoking is
tions as well as to individuals. In order to improve the nation's health
currently estimated by the National Center for Health Statistics at
through educational means, the President's Committee concluded that
$11.5 billion a year. Some corrective action, while difficult, has not
fundamental changes in the attitude and behavior of our social insti-
proved insuperable, at least with respect to one form of advertising.
tutions in general and within the health industry in particular are
The Surgeon-General acted reasonably a decade ago in alloting top
required. They saw a primary need to heighten awareness of and re-
priority to this area. It is now time for further initiatives.
sponse to health needs as a major shift in emphasis and expansion of
effort beyond the current focus on the treatment of disease and injury.
It was their finding that such fundamental change would not occur
32
33
unless some mechanism could be created which would address and
Thus, much of the content of consumer health education is con-
resolve complex and controversial issues of individual and social values
cerned with precisely those areas which have traditionally been
and behaviors in a nón-bureaucratic and non-coercive manner. They,
regarded as private matters. These are, however, also matters of
therefore, recommended the establishment of a unique national private
growing public concern and rising medical costs. Whether through
institution which they called a national Center for Health Education
public tax payments or through insurance premiums, our society
as the key component in the plan they presented to the President in
has assumed an increasing responsibility for the treatment of the in-
1973.
dividual's diseases and injuries. Society, therefore, also has an in-
A. The National Health Council's Project a follow-up to the
creased stake in affecting-to the extent possible-the frequency and
Report of the President's Committee on Health Education the De-
severity of the individual's need for such treatment.
partment of Health, Education and Welfare took two actions in 1974:
While governmental programs can and must be substantially im-
(1) a Bureau of Health Education was administratively created as a
proved and expanded, governmental action alone cannot provide
new unit of the U.S. Center for Disease Control in Atlanta, Georgia to
the kind and scope of leadership and initiatives required to realize
coordinate federal health education efforts; and (2). a contract was
the potential benefits of improved consumer health education. Direct
awarded by C.D.C. to the National Health Council, Inc. to explore in
governmental efforts to modify citizens' behaviors, mass media con-
detail the most appropriate and feasible objectives, functions, struc-
tent, and school curricula in ways that are scientifically sound,
ture, staffing and financing pattern for a National Center for Health
effective, and culturally acceptable represent extremely difficult
Education.
issues. On the one hand the current state of the art of health
The Council's project was designed to build upon the work already
education is probably inadequate to deliver effective and reliable
accomplished by the President's Committee and to involve a large
results in the public interest from such interventions. On the other,
sample of organizations and individuals not limited to the Council's
to be effective, such action by a governmental agency may conflict
member agencies. Through the work of the project's Policy Commit-
with constitutionally guaranteed private freedoms.
tee, study groups and subcommittees, mail surveys and conferences,
Therefore, organized private action is needed to explore contro-
this project developed a model design for a private national Center
versial issues and develop national guidance which reflects a general
which is complementary to and non-duplicative of either an expanded
professional and consumer consensus on appropriate and acceptable
federal governmental program or of any existing private sector re-
directions of effort. Because such private policy does not have author-
sources. The recommended design is for an open, non-bureaucratic
ity to compel compliance, it must necessarily include development
problem-solving mechanism incorporating innovative elements of
of voluntary support and resolution of realistic constraints which are
policy development and action program planning processes which
a fundamental part of the problem. Once the efficacy and acceptability
have been tested in business and industry as well as community health
of such privately developed initiatives has been demonstrated, then
planning agencies during the past decade. The project's findings and
the need for and exact nature of additional governmental support to
recommendations were provided to the Committee and are a primary
extend implementation will be both clearer and less likely to encounter
source of referrel for additional information concerning the intended
opposition.
nature and character of the Center for Health Education and Pro-
The voluntary health promotional agencies and health professional
motion.
associations have traditionally carried the burden of consumer health
B. The Need for a Private Center for Health Education and Promo-
education in this country. While much is being done in the private
tion.-The arguments supporting the need for a private national
sector to inform the public about the actions they can take to protect
Center for Health Education and Promotion focus on the advantages
and maintain their own health, the results can not be considered good.
and benefits of voluntary, non-governmental leadership and action
The reasons for this are numerous.
to improve the nation's health through educational means.
There is no consistent thread which defines and articulates health
Health education is concerned with every. facet of consumer be-
education content or methods. There are no generally recognized
liefs, attitudes, and behaviors which contribute to the maintenance
standards, guides and measures for evaluation of health education
or self-destruction of health. This includes especially those choices
efforts. It is, therefore, virtually impossible to objectively discriminate
the individual exercises concerning his or her private life-what
against the ineffective, confusing or even potentially misleading in-
and how much the individual eats and drinks, how much rest and
formation and education the consumer receives in great quantity
excercise he or she gets, habits of personal hygiene, how the individual
from a multiplicity of sources.
handles anger and frustration, how fast he or she drives, how early
There is no common frame of reference shared by the various
and often medical care is sought, career and family formation de-
disciplines and interests working in this field. There is little continuing
cisions, choice of dwelling, etc, It is also equally concerned with the
communication, cooperative program planning or comparative
content and quality of information and guidance the individual
evaluation of results among similar or related health education pro-
receives from health and social institutions, commercial enterprises,
grams sponsored by different organizations. There is no unified or
labor unions, civic associations, and from the mass media concerning
comprehensive perspective from which to assess results and determine
appropriate and inappropriatë health maintenance behaviors.
which of alternative approaches is most appropriate to a given situa-
tion. And finally, with some notable exceptions, for the overwhelming
57-010-75-5
34
35
majority of agencies which dispense some form of health education to
consumers, this activity is not their primary purpose and therefore
Policy guidance alone cannot secure the improvement of program
does not receive top priority for their allocation of funds and program
services; frequently there are challenging impediments to the develop-
attention. Thus, very little of the current consumer health education
ment of improved methods which require extended problem-solving
efforts are as effective or efficient as they could be, were there some
and strategy design efforts. The Center, therefore, should coordinate
national focal point to improve communications and cooperation
a variety of activities, programs, and developmental projects which
among the major programs within the private sector.
draw upon external sources of support and expertise to develop im-
Clearly a nationally recognized source of policy development, guidance
proved methodologies, especially concerning appropriate and accepta-
and technical assistance, cooperative program planning and coalition
ble ways to influence positive consumer behavioral changes, and
building, evaluation and advocacy could make a major impact on the
concerning realistic and acceptable criteria for evaluation of health
kinds and quality of health education efforts in the private sector
education programs. To encourage similar activities by other organi-
without a net increase in overalll expenditures simply by reducing the
zations, the Center also should organize a national network of technical
fragmentation and discontinuity of current efforts.
assistance in the planning, implementation and evaluation of health
Testimony given to the Committee strongly indicates the existence
education programs utilizing not only its own but the expertise
of considerable support from private sector sources for the creation of
available for other cooperating agencies.
such an organization. The granting of a Congressional charter to
D. Board of Directors.-The Center for Health Education and Pro-
such an organization would improve opportunities for:
motion will be directed by a twenty-five member Board of Directors
1. Supporting private leadership in policy exploration and pro-
to be appointed by the President of the United States. Its functions
gram development by the creation of an entity with quasi-official
should include:
legitimacy and stability;
(1) Final Center policy and strategy design determinations;
2. Integrating utilization of private and public resources in the
(2) Center program direction;
development of concerted national strategies for improving con-
(3) Center financial policy determinations, including direction
sumer health education nationwide; and
of the basic funding strategy for Center programs and approval
3. Maintaining formal channels of communication, informa-
of budgets and resource allocations;
tion exchange and public accountability between the govern-
(4) Representation of the Center to and liaison with outside
mental and private sectors.
organizations;
C. Activities of the Private Center.-The mission of the Center will
(5) Charge and appointments to committees, task forces and
be to improve the health of people by encouraging and supporting
study groups; and
the improvement and expansion of health educational activities
(6) Appointment of the Center's President.
throughout the nation.
Members of the Center's Board should serve as individuals and not
The Center should be a mechanism which links together primarily
as the official representatives of outside organizations. The Board as a
non-governmental organizations and agencies involved in health edu-
whole should reflect a balanced mix of experts representing the fields of
cation, including those which engage in health care, education, business
health education, health services delivery, education, consumer
and industry, social and civic purposes, consumer and labor repre-
representation and advocacy, news media and communications, busi-
sentation and communications. The widest possible range of partici-
ness and industry, organizational management, and public and private
pants should be given significant, structured opportunities to debate,
finance.
select and influence the development of Center policies and strategies.
In addition, the Board as a whole should reflect a diversity of per-
The Center should manage an open decision-making process for the
sonal backgrounds and interests which assures not only the develop-
development of national private sector policy concerning key issues
ment of broad policy direction but facilitates the acceptance of its
in the field of health education. The Center should coordinate the
findings and recommendations by those asked to implement these
review and analysis of consumer health education needs, provider
recommendations.
resources, the impact of alternative health education approaches and
During its deliberations this Committee considered a number of
other factors on health status to determine which lines of develop-
specific nominations for appointment to this Board. The following
ment offer the best opportunities for the improvement of the nation's
individuals are suggested as representative of the type and quality of
health through educational means.
members the Board should reflect:
Through participatory processes it should seek to identify the locus
Stanley Bergen, Newark, New Jersey; Lisle Carter, Atlanta,
of responsibility for addressing identified consumer needs and for the
Georgia; Paul Ellwood, Minneapolis, Minnesota; Howard Ennes,
development of the resources required to meet these needs. The
Craryville, New York; Paul S. Entmacher, New York, New York;
Center should also provide a forum for the determination of the most
Robert H. Felix, Saint Louis, Missouri; Evalyn S. Gendel,
appropriate and acceptable roles it can play in stimulating and
Topeka, Kansas; William Griffiths, Berkeley, California; M.
energizing the actions required to secure widespread endorsement and
Alfred Haynes, Los Angeles, California; Howard Hiatt, Boston,
implementation of its goals and policies.
Massachusetts; Magda Hinojosa, San Antonio, Texas; Robert L.
Johnson, Berkeley, California; Philip M. Klutznick, Chicago,
36
37
Illinois; A. M. Lilienfeld, Baltimore, Maryland; J. Alexander
H. Center Funding.-The Center should be funded by varying
McMahon, Chicago, Illinois; Lois Michaels, Pittsburgh, Penn-
combinations of private and public funds, including direct appropria-
sylvania; Walter J. McNerney, Chicago, Illinois; Mary Mulvey,
tions, grants, contracts and unrestricted donations as appropriate
Providence Rhode Island; Arthur C. Nielsen, Jr., Northbrook,
for its general support and the financing of various special projects
Illinois; Eva M. Reese, New York, New York; Samuel Sherman,
and activities.
Los Angeles, California; Elena M. Sliepcevich, Carbondale,
The authorized $1 million of core support for the Center for its
Illinois; Anne Somers, Princeton, New Jersey; Frank N. Stanton,
first three years of operation is intended to provide for the establish-
New York, New York; James Howard Walker, Charleston, West
ment of its core policy process and staffing; i.e. to provide for the
Virginia; and Harold M. Wiseley, Indianapolis, Indiana.
costs associated with the meeting and other expenses of the Board and
E. Advisory Panel.-In addition to the Board of Directors, there
its communications with the Advisory Panel, and to support the
should be a large panel of at least one hundred individuals representing
acquisition of a competent core staff. The Center's internal staff
the same kinds of competencies and abilities as those described for
organization should be headed by a President to be named by the
Board membership. The principal function of this panel should be to
Board and such other members as he selects. The staff organization
provide advice to the Board. The Advisory Panel should routinely be
should be modeled on a matrix (rather than a bureaucratic) organiza-
requested to review and comment on Center reports and policy drafts.
tional design which stresses the accomplishment of tasks by ad hoc
The Panel should also be the primary source for appointments to
teams and special project activity in combination with routine pro-
special committees and study groups created by the Policy Board to
gram functions. The initial core staff should be small in number and
explore a particular problem or subject area in depth.
emphasize coordinative, program design and management, group
F. Program Priorities.-In a field as diverse and fragmented as
process, and communication skills. Members of the Board and advi-
health education there are no immediately obvious, generally ac-
sory panel, staff on loan from cooperating organizations and outside
ceptable, and logically appropriate priority rankings among the long
consultants should be utilized in addition to Center staff to complete
list of potential specific program objectives the Center could select
special project activities.
for action in its first years of operation. Consequently an organizing
It is estimated that full scale Center operation will require approxi-
phase is indicated for the Center's initial activities. In this period,
mately $5 million annually. Funds to support the increased costs
the open, in-depth analysis of alternative opportunities to achieve
should be raised from private sources.
nationally significant impacts and the consensus selection of initial
In addition to support for core operating costs of the Center, it is
program priorities by the Board based on input from the Advisory
expected that the Center will also seek variable additional amounts
Panel and a large sample of outside organizations and agencies should
in grants and contracts from both private and public sources in order
be the Center's top priority objective.
to accomplish a variety of special projects. Thus the total annual
G. External Relationships.-The organizations, groups and individ-
income required to achieve the Center's program objectives in any
uals to be involved in any given phase in the Center's policy process
given year should vary substantially depending on changes in pro-
will vary depending on the nature of the needs or problems being
gram priorities and on the extent to which external organizations
explored. Although the Center will not be a membership organization,
voluntarily undertake the performance of Center designed projects
it should be linked to a comparatively large number of external
without using the Center as a fiscal intermediary.
organizations by a variety of both formal and informal mechanisms.
A modest but relatively secure core operating budget combined
The Center should seek ties with representative health, education,
with the necessity to secure additional, earmarked financial support
welfare, and civic organizations and associations. It should also seek
to accomplish non-routine tasks and special projects is inherent to our
the support and endorsement of major corporations in business and
concept of the Center as a non-bureaucratic, private sector based
industry, labor unions, and private foundations. The Center should
problem-solving mechanism. The Committee recognizes that the bur-
involve these constituents in all aspects of its policy and program
den of securing the support and resources required to perform projects
development both on an individual basis and through the formation
on a case-by-case basis can be quite high. The Committee believes,
of special purpose coalitions and consortia. The Center also should
however, that the quality, feasibility, and general acceptability of
develop mechanisms to involve outside organizations in its processes
proposed Center projects should be tested "realistically"; i.e. by their
for the periodic review and assessment of its policies and performance.
ability to attract endorsement and allocation of resources from out-
Private and public financial supporters of the Center should be
side organizations.
publicly identified in the Center's annual report. Outside organiza-
tions unable to support the Center financially but wishing to affiliate
3. GRANTS FOR WATER TREATMENT PROGRAMS
with its goals and policies should be given the opportunity to formally
signify their endorsement after action by the Center's and the re-
Section 178 of the Committee's bill provides a modest authorization
spective agency's policy body. All organizations, groups and in-
of $9 million for communities which wish to seek partial Federal assist-
dividuals who participate in Center activities, advisory groups, and
ance in order to treat their water supplies. The Committee is convinced
projects should be listed in relevant reports.
of the safety and effectiveness of fluoridation as a powerful preventive
weapon in the battle against dental disease. The efficacy of fluorida-
38
39
tion has been widely known for many years, and the Committee has
received overwhelming testimony from both scientific and professional
The preventive benefits of water fluoridation have long been recog-
groups to this effect.
nized by the dental profession. Water fluoridation programs such as
Dental caries is the most prevalent disease in the United States
those which would be promoted under your amendment would be
today and one of the most costly of all chronic diseases. By age two,
extremely helpful in preventing oral disease for the citizens of this
nation.
approximately one-half of the children in this Nation have experienced
As Senator Magnuson indicated in his introductory remarks on
tooth decay. By age fifteen, the average child has 11 decayed, missing,
S. 2026 "it has been estimated that at least $2.6 billion could be saved
or filled teeth.
over the first fifteen years of a national health insurance program
Bringing the level of fluoridation in community water supplies to
the optimum level is the safest, most effective, and most economical
provided universal fluoridation were in effect at the start of that
way to prevent tooth decay. Fluoridation prevents 40-60 percent of
program." Monetary savings of that magnitude, as well as the po-
tential for improved oral health, are examples of the significant
the dental caries usually experienced by children. The effects of fluori-
dation have been studied in the United States since 1945 and all
benefits which can be gained from a general water fluoridation
communities involved have reported significant reduction in tooth
program.
On behalf of the American Dental Association, let me again express
decay as a result of this public health measure.
Fluoride occurs naturally in most water supplies and raising it to
my support for this amendment which you will be proposing. If I or
the optimum level to prevent tooth decay, usually one part per million,
my Association can provide you with any further information, please
do not hesitate to call on us.
has never been proved to be hazardous to health. Adjusting the
fluoride content of the water will not increase the likelihood of cancer,
Sincerely yours,
PAUL W. KUNKEL, Jr., D.M.D.,
heart disease, kidney disease, allergies, or any other physical or mental
Chairman, Council on Legislation.
illness. Indeed, fluoride is considered an essential trace element vital
to proper nutrition, growth, and development.
VI. COMMITTEE VIEWS
Adjusting the fluoride level in a community's water supply costs a
maximum of 10 or 15 cents per person annually. It results in a 50
TITLE I
percent or more savings in a family's dental bill. For every dollar spent
on fluoridation, $30-50 can be saved in dental care costs. Other
1. The lessons of the history of communicable disease control are
methods for the prophylactic application of fluoride are available,
several. First, apparent success has fostered premature relaxation. This
however, none are as effective or as economical as fluoridation of
complacency has resulted in a resurgence of disease and untold unnec-
drinking water. Its benefits are conferred on everyone, regardless of
essary personal suffering. The Committee is concerned, after reviewing
socio-economic level. It is effective without the need for any action by
the Administration's funding level proposal, as set forth in their hear-
the individual.
ing testimony and their bill (Senate Bill 1756), that this lesson has not
A report released this year by the Director-General of the World
been learned well. We are particularly concerned that while measles,
Health Organization renewed that organization's support of water
rubella, and polio are at their lowest points ever, too much of the popu-
fluoridation and said that "unless there are overriding technical
lation is not protected against these diseases and a relaxation of our
reasons, no nation can afford the luxury of not fluoridating every
national commitment to support efforts to immunize children will have
central water supply system containing less than the optimum con-
dire, totally preventable, consequences. This also characterizes the
centrations of fluoride." The WHO report affirmed that fluoridation
Administration's commitment to tuberculosis control. In addition to
of the water supply should be the cornerstone of any national program
not requesting appropriations for tuberculosis control project grants,
of dental caries prevention.
the Administration is requesting that 314(d) public health formula
The need for this provision is expressed by the professional organi-
grant funding be terminated as well. That program is the only existing
zations concerned with dental health care, as follows:
source of Federal funding available to States to support tuberculosis
AMERICAN DENTAL ASSOCIATION,
control programs. Rather than turn our attention away from tubercu-
Washington, D.C., July 15, 1975.
losis, the committee believes we should seize the opportunity to
Hon. JACOB JAVITS,
accelerate the decline and eventual eradication of this disease.
Russell Senate Office Building,
2. The second lesson is in many ways the most critical, and is
Washington, D.C.
certainly one that experience has taught time after time. The control
of communicable disease is not and should not be solely the responsi-
DEAR SENATOR JAVITS: It is my understanding that you are planning
bility of State and local governments. They cannot do the job alone
to offer as an amendment to S. 1466, the Disease Control Amendments
and communicable disease does not recognize State boundaries. The
Act, a provision authorizing grants for water treatment programs
prolonged debate over the appropriateness of Federal help in control-
which is identical to that contained in section 1702 of S. 2026, the
ling these diseases has been a key factor in many of our missed oppor-
Children's Dental Health Act of 1975. I am writing to express the
tunities of the past. The Committee reiterates its conviction that
support of the American Dental Association for this amendment.
States acting singly and according to their own financial capabilities
and interests will not result in the control of these diseases.
40
41
3. The Center for Disease Control should strengthen its role in
of the Center for Disease Control and the American Social Health
providing leadership in achieving the national elimination of prevent-
Association, a voluntary agency-and achieved through a separate
able diseases and conditions. Its full technical and personnel capabil-
categorical program authorized in law. Furthermore, it is encouraging
ities should be mobilized to achieve this goal. This will necessitate
the Committee notes, that the National Institute of Allergy and
support of on-going disease control programs and the ability to respond
Infectious Disease, through numerous research grants and awards in
to disease outbreaks and health emergencies which, by their unpredict-
the area of venereal disease, is aggressively seeking to broaden our
able nature, few States are equipped to address. In testimony before the
understanding of these conditions. The Committee hopes that the
Committee, the Association of State and Territorial Health Officers
acquisition of such knowledge will someday permit the development
testified to the effectiveness of the CDC system of assigning personnel,
of effective vaccines against the venereal diseases.
upon request, to the States to assist them in carrying out disease
2. Title II of the Committee reported bill, based on legislation
control programs and in responding to disease outbreaks and health
authored by Senator Javits (S. 1454), would continue to authorize
emergencies. The Committee supports and wages the continuation of
essentially the same sound public health approach (research, tech-
that unique and effective approach to Federal/State cooperation.
nical assistance, pilot and demonstration projects, improved clinical
4. Finally, the challenge before us is not soley to apply all available
services, prevention and control activities such as screening, contact
technology to the job of controlling communicable diseases, and to
tracing, and public information and education) to the VD problem
ensure this through sustained leadership at the national level, but to
as in the past three years. In addition, this title would redefine the
use this approach to eliminate or ameliorate other diseases and
term "venereal disease", as provided in S. 1454, to include all sexually
conditions which are susceptible to reduction through organized
transmitted diseases that are of public health significance. To con-
community programs. As we as a nation address inequities in the
tinue to ignore these other serious diseases would tend to foster the
quality and accessibility of health care services, we must invest
same condition that originally permitted gonorrhea to reach epidemic
appropriate resources in the prevention of disease, disability, and
proportions.
premature death. Some preventive health services can be delivered
3. It is the findings of this committee that the authorities created
on a personal, one-to-one, basis in the health care system, and can be
by this bill stem from and support a sound and logical public health
financed accordingly. Other preventive health services, such as the
approach to the venereal disease epidemic. The committee notes
types of programs carried out in the areas of disease control, including
with some dismay that not all of the authorized resources available
health education, must be carried out on a communitywide and
to combat these diseases were utilized during the past three fiscal
nationwide basis, and financed accordingly. It is the Committee's
years. The Committee urges that serious consideration be given to
conviction that preventive health programs are essential to improving
employing all authorities and means available to prevent and control
the health of the American people, and they will be a major factor in
venereal disease in the three fiscal years covered by this bill.
containing cost and improving the quality of health services. Senate
Bill 1466 as reported by the Committee is intended to lay the ground-
TITLE III
work for an expanded effort in disease prevention.
1. The Committee was impressed the important and often crucial
TITLE II
role the individual can play in maintaining his own health, a role
rarely clearly explained or adequately described.
1. The Committee recognizes that epidemic venereal disease is still
2. Similarly, the Committee believes that while the need and
very much a problem. The magnitude of the problem of venereal
demand for health care services have been rising, health education
disease, with its particular inability to recognize state boundaries, and
and promotion has been neglected. Many, perhaps the major causes
the unique social implications of venereal disease, the Committee
of sickness and death can be affected, certainly prevented, by moder-
believes necessitates a separate categorical program to attack the
ating self-imposed risks. This could be greatly facilitated if the field
problem. The combined reported incidence of infectious syphilis and
of health eductiaon were not SO fragmented, uneven, and lacking a
gonorrhea has risen to an unprecedented level of nearly 900,000 cases
focal point. Until quite recently, no agency inside or outside of govern-
annually. Evidence suggests that the actual incidence level, which
ment has been responsible for, or assists in setting goals, developing
includes those cases of venereal disease that are not reported to public
national policy, maintaining criteria of performance of measuring
health authorities, is much greater. While this level of disease poses a
results.
most serious threat to the health and welfare of the public, the Com-
3. The Committee focused on nutrition as a major area of concern,
mittee notes it is encouraging that efforts to control this epidemic
recognizing that what is taught to children about this subject is
have not been in vain. Specifically, gonorrhea, while still increasing is
inadequate. Nutrition studies reveal that teenagers often damage
doing SO at a smaller rate. In addition, infectious syphilis incidence
their health through poor eating habits. One researcher has pointed
has declined for the first time in six years. These positive indications
out that if intervention to modify coronary risks is put off until
are largely due to the various control and prevention activities—
adulthood, it is too late. Such risks are directly related to nutrition.
screening, contact tracing, information and education diligently
The Committee considers nutrition education an important feature
pursued by public health authorities with the support and assistance
of the reported bill and intends that nutritionists will affect the policy
42
43
direction of both the Office of Consumer Health Education and
education projects. The proposed Office of Consumer Health Educa-
Promotion and the Center for Health Education and Promotion.
tion and Promotion may very well rely upon the Center for Disease
The Committee looks for guidance in this endeavor to the Select Com-
Control as well as the other organizations in HEW that are responsible
mittee on Nutrition and Human Needs. A nutrition education pro-
for health education activities to execute the programmatic aspects
posal will be the subject of Senate hearings in September 1975.
of health education but the Committee believes a higher level focus,
4. The Committee recognizes that over 88% of the people look to
as provided in the Committee reported bill, is essential.
their physicians or rely upon television commercials for information
9. The Committee considered S. 544 with a view to including this
about health. Evidence reveals that physicians are too busy to do an
Comprehensive School Health Education provision to S. 1466. The
effective job in educating their patients and that too many television
Committee recognizes that S. 544 is essential legislation if a meaning-
messages are primarily concerned with product promotion rather
ful preventive program to improve the health of the American people
than with true consumer health education. Providers of care, including
is to be a reality. A portion of S. 544, accordingly, has been included
hospitals, do little to overcome deficiencies even though such pro-
in S. 1466. The language establishes a program of grants to local
grams of patient health education have proven to be cost effective.
education agencies and institutions for inservice education oppor-
Neither voluntary health organizations nor insurance carriers (private
tunities for elementary and secondary school teachers in a broad
or non-profit) have exploited fully their opportunities.
scope of health education areas.
5. The Committee has reviewed research studies of patient and
10. The Committee recognizes that dental caries is the most
community health education programs and is encouraged by the re-
prevalent disease in the United States and one of the most costly
sults. The studies reveal that as a result of sound programs, morbidity
of all chronic diseases. By age two, approximately one-half of the
and mortality, hospital days, emergency visits, and costs have been
children of this nation have experienced tooth decay. By age fifteen,
significantly reduced. Other evaluations showed the nutritional
the average child has eleven decayed, missing, or filled teeth. Section
status and knowledge about other risk factors were markedly increased
1718 of the Committee reported bill therefore provides a modest
as a result of carefully developed programs. Such research is vitally
authorization for communities voluntarily wishing to seek partial
necessary and will serve to determine the directional emphasis for
federal assistance in order to fluoridate their water supplies, which is a
policy design in both the Office and the Center.
proven effective health prevention methodology.
6. The Committee was troubled by the lack of adequate data about
11. The Committee considered who should serve as members of the
the needs, attitudes, knowledge, and behavior of the American public
Board of Directors for the publicly chartered, private Center for
regarding health. Through the reported bill the Committee directs
Health Education and Promotion. A sampling of these have been
the National Center for Health Statistics to make continuing surveys
listed in an earlier part of this report as a guide for the President in
to obtain such information.
selecting a Board representative of the prerequisite skills, compe-
7. The Committee recognizes the need for adequately trained health
tencies and disciplines necessary for fulfillment of the Committee's
education practitioners who will be engaged in health education teach-
objectives, as provided in the reported bill.
ing research and in health education practice. Emphasis should be
12. The Committee has determined that current funding levels
placed on raising the level of training given to those who will enter
for health education programs are grossly inadequate by every
the field of health education practice. Additionally, support should
measure applied, including comparison with total U.S. health care
be given to those who are engaged in theoretical research in the field
expenditures, the Federal health budget, individual hospital budgets,
of health education and promotion since it is this group who develop
the cost of individual programs, and-most dramatically-by com-
the conceptual frameworks from which sound practice derives. Short-
parison with the advertising budgets of over-the-counter drugs.
term continuing education programs should also be included to up-
Health education expenditures, as a percentage of national health
grade skills of a variety of health providers, including doctors, nurses,
expenditures or individual hospital budgets are in the order of magni-
educational specialists, and mid-level health practitioners.
tude of one-fourth to one-half of one percent, which the Committee
8. The proposed creation of an Office of Health Education in the
believes is not sufficient to do the job.
Department of Health, Education, and Welfare is not intended by
13. While the effectiveness of health education as a whole is widely
the Committee to reflect negatively upon the efforts of the new
debated, the Committee believes that there is now evidence from a
Bureau of Health Education in the Center for Disease Control which
number of studies that well-designed programs, incorporating the
was assigned initial responsibility for developing a health education
various elements of health education included in the reported bill
focus but rather to emphasize the Committee's concern with the need
definition, can be effective in producing desired behavior change if
for greater focus and commitment by the Department of Health,
accompanied by national policies and mass communications programs
Education, and Welfare. The Bureau, in its ten months of existence
designed to reinforce, rather than undermine, the educational goals.
with very limited resources in terms of both budget and personnel,
14. Authorizations of appropriations in the Committee reported
has made many important contributions both within and outside the
bill have been consistently reduced from the bills as introduced and
Federal structure, including support and leadership in the develop-
upon which the reported has been based. Committee action in this
ment of a private-sector National Center for Health Education, the
regard is not intended to express the need for funding of such programs
initiation of cooperation among Federal agencies in pursuit of common
but rather to provide realistic funding levels in line with congressional
health education objectives, and the development of innovative health
appropriations.
44
45
VII.-ADMINISTRATION VIEWS
trol programs each fiscal year through 1980. The bill adds a new sec-
tion 318(i), which defines venereal disease as syphilis and gonorrhea
DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE,
and any other sexually transmitted diseases which the Secretary finds
July 16, 1975.
to be of national significance and which, with respect to project grants
Hon. HARRISON A. WILLIAMS, Jr.,
under 318(d), is amenable to control. A new subsection is added to
Chairman, Committee on Labor and Public Welfare,
section 318(c), formula grants for venereal disease diagnostic and
U.S. Senate, Washington, D.C.
treatment services, to require that recipients of grants provide to the
DEAR MR. CHAIRMAN: This is in response to your requests of April
extent feasible diagnostic and treatment services for a wide range of
23 and 24 for reports on S. 1466, a bill "To amend the Public Health
gastro-urinary conditions. It also eliminates the requirement that
Service Act to extend and revise the program of assistance for the
grantees provide darkfield microscopic techniques for diagnosis of
control and prevention of communicable diseases," to be cited as the
both syphilis and gonorrhea.
"Disease Control Amendments Act of 1975;" and S. 1454, a bill "To
In addition, section 318(d) is expanded to add to the list of support-
revise and extend the Public Health Service Act, and for other pur-
able activities routine testing, including attendant laboratory and
poses," to be cited as the "National Venereal Disease Prevention
follow-up system costs. It also changes the purpose of special studies
and Control Amendments, 1975."
and demonstrations from evaluation of control to evaluation of
S. 1466 would amend the Public Health Service Act to expand the
prevention and control strategies and activities. The bill also adds
scope of the present section 317 by eliminating the word communica-
nonprofit private entities as eligible recipients for technical assistance.
ble each time it appears, and to authorize grants for control of "other
As Dr. Cooper testified on May 7, 1975, the Department opposes
conditions," rodent control and lead poisoning control. Project grant
enactment of these two bills. First, we oppose the continuation of
funds are authorized to be appropriated in the amount of $111 million
separate categorical grant authorities. The two bills would extend seven
for the fiscal year ending June 30, 1976, and for each of the next two
different categorical grant authorization ceilings from three to five
succeeding fiscal years. For each of these fiscal years there are author-
fiscal years. The establishment of several legislative authorities causes
ized $11 million for tuberculosis control; $25 million for vaccine-
considerable hardship on State and local health agencies trying to
preventable diseases; $35 million for rodent and lead poisoning con-
carry out well balanced, effective preventive programs and continues
trol; and $40 million for other diseases or conditions (except those
to make Federal assistance unnecessarily complicated. In addition, we
already specified). In addition, it continues the appropriation ceiling
strongly oppose the funding authorizations in S. 1466 and S. 1454
of $5 million for health emergencies for the fiscal year ending June 30,
which, at $203 million per year, are nearly six times the President's
1976, and for each of the next two succeeding fiscal years.
budget request of $34 million for 1976. The appropriation authoriza-
The bill also provides that nonprofit organizations which received
tions should recognize the demonstration nature of Federal lead and
grants during 1975 for rat control and lead based paint project grants
rat-control project grants and place greater reliance on the discretion
will be eligible for continuation.
and capabilities of State and local governments and the private sector
The bill defines a disease control program as a program which is
in disease control. Federal spending commitments must be consistent
designed and conducted so as to contribute to national protection
with the need to reduce Federal spending and to generate increased
against tuberculosis, rubella, measles, Rh disease, poliomyelitis,
commitment to these programs by State and local governments.
diphtheria, tetanus, whooping cough, mumps, diabetes mellitus, lead
We therefore recommend against enactment of these bills. We recom-
poisoning, rodent infestations, or other diseases or conditions (other
mend, instead, enactment of S. 1756 introduced by Senator Schweiker
than venereal disease) which are amenable to reduction, and are
on behalf of the Administration. The bill combines sections 317 and 318
determined by the Secretary to be of national significance. The
into a single authority and authorizes amounts adequate to meet pro-
definition includes vaccination programs, casefinding programs, public
gram objectives.
and professional education programs, other preventive health pro-
We are advised by the Office of Management and Budget that there
grams, laboratory services, and studies to determine the communicable
is no objection to the presentation of this report from the standpoint of
disease control needs of States and political subdivisions of States and
the Administration's program and that enactment of S. 1466 and
the means of best meeting their needs.
S. 1454 would not be consistent with the Administration's objectives.
S. 1454 would amend section 318 of the Public Health Service Act
Sincerely,
to extend the authorization for grants for the prevention and control
CASPAR W. WEINBERGER,
of venereal diseases. The proposed legislation reauthorizes and extends
Secretary.
grants for venereal disease control and authorizes a total of $87 million
VIII. COST ESTIMATE
for grants for the fiscal year ending June 30, 1976, and for each of the
four succeeding fiscal years. Of this total $12 million is authorized for
The Committee's bill include authorization for:
project grants for research, demonstration, and training for each fiscal
1976
$83,000,000
year through 1980; $30 million is authorized for formula grants for
1977
95,000,000
venereal disease diagnostic and training services for each fiscal year
1978
121,000,000
through 1980; and $45 million is authorized for project grants for con-
279.
46
47
IX. TABULATION OF VOTES CAST IN COMMITTEE
Subsection 102(e) amends subsection (f) (1) of such section by-
(1) striking "communicable";
Pursuant to section 133(b) of the Legislative Reorganization Act
(2) inserting "or conditions" after "disease"; and
of 1946, as amended, the following is a tabulation of votes in
(3) inserting "project" after "grants" each time it appears.
Committee:
Subsection 102(f) amends subsection (g) of that section by-
Motion to report the measure to the Senate carried unaminously.
(1) inserting "or conditions" after "diseases" in clauses (1) a
(2), and
X. A SECTION-BY-SECTION ANALYSIS
(2) inserting "and conditions" after "diseases" in clauses
and (4).
TITLE I-DISEASE CONTROL
Subsection 102(g) amends subsection (h) (1) to read as follow
"(1) The term 'disease control program' means a program which
SHORT TITLE
designed and conducted so as to contribute to national protect
against tuberculosis, rubella, measles, Rh disease, poliomyeli
Sec. 101 states that this title may be cited as the "Disease Control
diphtheria, tetanus, whooping cough, mumps, diabetes mellitus,
Amendments Act of 1975".
other disease or conditions (other than venereal disease) which
amenable to reduction, and are determined by the Secretary to be
AMENDMENT TO THE PUBLIC HEALTH SERVICE ACT
national significance. Such term includes vaccination programs, ca
Subsection 102(a) amends subsection (a) of section 317 of the Public
finding programs, public and professional education programs, ot
Health Service Act (42 U.S.C. 247b) by-
preventive health programs, laboratory services, and studies
determine the communicable disease control needs of States
a
(1) inserting "project" before "grants" in the first sentence;
(2) inserting "project" before "grant" each time it appears;
political subdivisions of State and the means of best meeting su
needs.".
(3) striking "communicable" each time it appears in the second
Subsection 102(h) amends (i) of such section by-
sentence;
(4) inserting "or conditions" after "diseases" in the second
(1) striking "communicable"; and
sentence; and
(2) inserting "project" before "grants".
(5) striking "disease" in the second sentence.
Subsection 102(i) is amended by adding after subsection (i)
Subsection 102(b)(1) amends subsection (b) of such section by
following new subsection:
inserting "project" before "grant" each time it appears.
"Subsection 102(j) provides that for the purpose of payments p
Subsection 102(b)(2) amends subsection (b) (B) of such section
suant to project grants and contracts under section 317 of the Act th
by-
are authorized to be appropriated $30,000,000 for the fiscal year end
(A) inserting "or conditions" after "diseases";
June 30, 1976, $35,000,000 for the fiscal year ending June 30, 19
(B) striking "of the importance of immunization against such
and $40,000,000 for the fiscal year ending June 30, 1978."
diseases, to encourage such persons to seek appropriate immuniza-
TITLE II-VENEREAL DISEASE
tion and to facilitate access by such persons to immunization
services" and inserting in lieu thereof "including the methods and
Sec. 201 states that this title may be cited as the "National Vener
services available to prevent these diseases or conditions".
Disease Prevention and Control Amendments of 1975."
Subsection 102(b)(3) provides that the amendment made by para-
graph (2) shall be effective for fiscal years beginning after June 30,
FINDINGS AND DECLARATION OF PURPOSE
1975.
Subsection 102(c) amends subsection (b) (C) of such section by-
Subsection 202(a) states that the Congress finds and declares tha
(1) striking "communicable" each time it appears;
(1) the number of reported cases of venereal disease continues
(2) inserting "or condition" after "disease" the first time it
epidemic proportions in the United States;
appears; and
(2) the number of patients with venereal disease reported
(3) striking "disease" the second time it appears and inserting
public health authorities is only a fraction of those actua
in lieu thereof "related".
infected;
Subsection 102(d)(1) amends subsection (c) by inserting "project"
(3) the incidence of venereal disease is particularly high in
before "grant" each time it appears.
15-29-year age group, and in metropolitan areas;
Subsection 102(d) (2) amends subsection (c) (2) of such section by
(4) venereal disease accounts for needless deaths and leads
inserting before the period at the end thereof", and such amount
such severe disabilities as sterility, insanity, blindness,
-
shall be deemed as part of the grant and deemed to have been paid
crippling conditions;
to the recipient".
(5) the number of cases of congenital syphilis, a preventa
disease, tends to parallel the incidence of syphilis in adults;
48
49
(6) it is conservatively estimated that the public cost of care
Subsection 203(h) amends subsection 318(d) (1) (D) of such Act by
for persons suffering the complications of venereal disease exceed
inserting "targeted" before "professional".
$80,000,000 annually;
Subsection 203(i) amends subsection 318(d)(1) (E) of such Act by
(7) medical researchers have no successful vaccine for syphilis or
striking "control" and inserting in lieu thereof "prevention and con-
gonorrhea, and have no blood test for the detection of gonorrhea
trol strategies or activities".
among the large reservoir of asymptomatic females;
Subsection 203(j) amends subsection 318(d)(2) of such Act by in-
(8) school health education programs, public information and
serting before the period at the end thereof "and $31,000,000 for the
awareness campaigns, mass diagnostic screening and case followup
fiscal year ending June 30, 1976, $33,000,000 for the fiscal year ending
activities have all been found to be effective disease intervention
June 30, 1977, and $36,000,000 for the fiscal year ending June 30,
methodologies;
1978".
(9) knowledgeable health providers and concerned individuals
Subsection 203(k) amends subsection 318(h) of such Act by striking
and groups are fundamental to venereal disease prevention and
"treated or to have any child or ward of his".
control;
Subsection 203(1) amends section 318 of such Act by adding at the
(10) biomedical research leading to the development of vac-
end thereof the following:
cines for syphilis and gonorrhea is of singular importance for the
"(m) As used in this section, the term "veneral disease' means
eventual eradication of these dreaded diseases; and
syphilis and gonorrhea and any other sexually transmitted disease
(11) a variety of other sexually transmitted diseases, in addi-
which the Secretary finds to be of national significance and which,
tion to syphilis and gonorrhea, have become of public health
with respect to grants under subsection (d), the Secretary finds to be
significance.
amenable to control.".
Subsection 202(b) states that in order to preserve and protect the
health and welfare of all citizens, it is the purpose of this Act to
TITLE III-HEALTH EDUCATION AND PROMOTION
establish a national program for the prevention and control of venereal
disease.
SHORT TITLE
Subsection 203(a) amends subsection 318(a) of the Public Health
Service Act (42 U.S.C. 247c) by inserting "and nonprofit private
SEC. 301 states that this title may be cited as the "National Con-
entities" after "authorities".
sumer Health Education and Promotion Act of 1975".
Subsection 203(b) amends subsection 318(b)(1) of such Act by in-
serting "which will contribute to national objectives" after "training".
AMENDMENT TO THE PUBLIC HEALTH SERVICE ACT
Subsection 203(c) amends subsection 318(b)(2) of such Act by
SEC. 302 amends the Public Health Service Act by adding after
inserting before the period at the end thereof "and $5,000,000 for the
title XVI the following new title:
fiscal year ending June 30, 1976, $5,000,000 for the fiscal year ending
June 30, 1977, and $5,000,000 for the fiscal year ending June 30, 1978".
"TITLE XVII-OFFICE OF CONSUMER HEALTH EDUCA-
Subsection 203(d) amends subsection 318(c)(1) of such Act by
TION AND PROMOTION AND THE CENTER FOR
adding at the end thereof "and $5,000,000 for the fiscal year ending
June 30, 1976, and $10,000,000 for the fiscal year ending June 30, 1977,
HEALTH EDUCATION AND PROMOTION
and $15,000,000 for the fiscal year ending June 30, 1978.".
"PART A-OFFICE OF CONSUMER HEALTH EDUCATION AND PROMOTION
Subsection 203(e) amends subsection 318(e)(2)(C) of such Act by
striking "(including dark-field microscope techniques for the diagnosis
"ESTABLISHMENT OF OFFICE OF CONSUMER HEALTH EDUCATION AND
of both gonorrhea and syphilis)".
PROMOTION
Subsection 203(f). Paragraphs (D), (E), (F), (G), and (H) of section
318(c)(2) of such Act are redesignated as (E), (F), (G), (H), and (I),
"SEC. 1701. (a) Establishes in the Department of Health, Education,
and the following new paragraph is inserted after paragraph (C) as
and Welfare the office of Consumer Health Education and Promotion
follows:
(hereafter in this Act referred to as the 'Office') which shall be under
"(D) to the extent feasible as determined by criteria developed
the direction of a Director who shall be appointed by the Secretary
by the Secretary, the provision of clinical services for persons
of Health, Education, and Welfare (hereafter in this Act referred to as
affected with venereal disease which includes diagnosis and care
the (Secretary') and supervised by the Assistant Secretary for Health
for persons with a wide range of genitourinary diseases and con-
(or such other officer of the Department as may be designated by the
ditions, which, because of their symptoms and clinical presenta-
Secretary as the principal adviser to him for health programs),
tions, are commonly present in persons with actual or suspected
Subsection 1702(b), provides that the Office, in order to facilitate
venereal disease;".
the development of health education and promotion strategy for the
Subsection 203(g) amends subsection 318(d)(1)(B) of such Act by
Nation, shall carry out the following functions: Engage in research
inserting before the semicolon at the end thereof the following: "and
in health education programs, stimulate and coordinate communica-
routine testing, including attendant laboratory and followup systems
tions in health education, and overview and coordinate Federal
costs thereof".
programs.
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51
GENERAL AUTHORITY
Subsection 1703(b)(2)(B) provides that projects which receive
Federal funds under this subsection shall-
Sec. 1702 provides that the Secretary, acting through the Office
(1) utilize in a coordinated manner such health education
shall-
methods as may be appropriate to provide effective health educa-
(1) design and implement national goals and strategies with
tion services to the population of the applicable region; and
respect to health education and promotion;
(2) evaluate the effectiveness of each health education method
(2) determine health education and promotion needs and
utilized and identify its particular advantages or disadvantages.
resources, and recommend appropriate educational certifying
policies for health education and promotion manpower;
Health Education Training
(3) incorporate appropriate health education and promotion
strategies into every facet of our society and increase the appli-
Subsection 1703(c) provides that the Secretary acting through the
cation of health knowledge, skills, and practices by the general
Director is authorized to make grants and contracts to public or non-
population in their patterns of daily living;
profit private entities to provide for the training for health personnel
(4) increase the effectiveness and efficiency of health education
in health education and promotion.
and promotion programs through improved planning, implemen-
tation of tested models, and evaluation of results;
School Health Education Training
(5) establish systematic processes for the exploration, develop-
ment, demonstration, and evaluation of innovative health
Subsection 1703(d)(1) provides that the Secretary acting through
education concepts; and
the Director may make grants to local educational agencies and in-
(6) foster information exchanges and cooperation among health
stitutions of higher education for teacher training with respect to the
education providers, consumers, and supporters.
provision of comprehensive health education programs in schools. The
The Secretary shall carry out this title in a manner consistent with the
subsection describes the manner in which such grants may be used, and
national health priorities set forth in section 1502 of the Public Health
the scope of the term 'health education and health problems' for
Service Act and with activities undertaken under title XV of the
purposes of this subsection.
Public Health Service Act (relating to health planning and
Subsection 1703(d)(2) provides that the Director, in exercising
development).
authority with respect to (a) determination of criteria for the selec-
SPECIFIC FUNCTIONS
tion of grants, and (b) selection of grants from eligible applicants,
shall consult with, and obtain the approval of, the Commissioner of
Research Programs
Education.
Subsection 1703(d)(3) provides that in establishing criteria for the
Subsection 1703(a)(1) provides that the Secretary shall by grants
award of grants under this section, such criteria must include priority
and contracts to public or nonprofit private entities conduct and
for applications for support of programs which provide: (1) inservice
support research in health education and promotion in the manner
rather than preservice training, except in such cases where an applicant
described in this subsection.
has demonstrated that: (A) inservice training is not practicable, and
Subsection 1703(a)(2) provides that the Secretary in carrying out
(B) reasonable opportunity exists for persons undergoing preservice
his responsibilities under this section, shall use the findings of the
training to obtain positions in which they shall apply such training,
continuing surveys of the needs, interests, attitudes, knowledge, and
and (2) training of persons who, as a result of such training, will have
behavior of the American public regarding health as conducted by the
as their major responsbility, work in health education in schools.
National Center for Health Statistics as a basis for formulating
policy with respect to health education and promotion.
Requirements Applicable to Providers of Institutional Care
Community Programs
Subsection 1703(e) provides that the Secretary may not approve an
application of any health care facility for a grant or contract under
Subsection 1703(b)(1) provides that the Secretary shall support and
the Public Health Service Act or the Community Mental Health
encourage innovative programs in health education and promotion in
Centers Act for a fiscal year beginning after the date of enactment of
the manner described in this subsection.
this act unless the application contains or is supported by assurances
Subsection 1703(b)(2)(A) provides that the Secretary is authorized
satisfactory to the Secretary that, during the period for which the
to make grants and contracts to public or nonprofit private entities
assistance is applied is to be made available, the applicant will pro-
for the purpose of developing programs of health care education for a
vide such consumer health education for individuals receiving in-
defined geographic region pursuant to and in accordance with those
patient or outpatient services through such health care facility as
established in section 1511 of the Public Health Service Act and with
the Secretary shall by regulation prescribe.
activities undertaken under title XV of the Public Health Service Act
(relating to health planning and development). In awarding such grants
and contracts the Secretary shall assure an equitable geographic and
demographic distribution of all funds appropriated.
52
53
Communications in Health Education and Promotion
such programs and actions, including recommendations for legisla-
Subsection 1703( provides that the Secretary shall establish
tion and administrative action within the executive branch.
liaison with the Office, providers of health education services, and the
Subsection 1704(e) provides that the Secretary shall provide the
communications media and prescribes the manner in which the
Committee with such full-time professional and clerical staff, informa-
Secretary shall effect such liaison.
tion, other support, and the services of such consultants as máy be
This subsection also provides that in the case where materials are
necessary to assist in carrying out effectively its functions under this
developed, through activities funded under this title and/or through
section.
activities of the Office and where the materials have commercial
Advisory Council
value, the moneys which result from the license, sale, rent, grant or
Subsection 1705(a) establishes the Consumer Health Education
other. transaction of said materials shall be paid into the public
and Promotion Advisory Council to bel appointed by the Secretary,
treasury. The Director with consultation of the Secretary shall
prescribes its make-up, and terms and conditions of membership. This
determine the fair market value of such materials and shall have the
subsection also provides that the Secretary may appoint, in addition,
authority to authorize such transactions.
special advisory and technical committees.
Subsection 1705(b) provides that it shall be the function of the
Federal Programs
Advisory Council to provide advice and recommendations for the
Section 1703(g) provides that the Secretary, in conjunction with the
consideration of the Secretary on matters of general policy with respect
Interdepartmental Committee on Consumer Health Education and
to the functions of the Office. The Advisory Council shall make an
Promotion established by section 1704, shall make recommendations
annual report to the:Secretary and to the Congress on the performance
to the Congress for the inclusion in appropriate legislation of pro-
of its functions, including any recommendations it may have with
visions respecting health education and promotion. The Secretary
respect thereto:
shall-
Subsection 1705(c) provides that the Advisory Council is authorized
(1) promote the coordination, communication, and collabora-
to engage such technical assistance and receive such additional support
tion of health education and promotion programs within the
as may be required to carry out its functions.
Department of Health, Education, and Welfare;
(2) establish a liaison with other Federal agencies engaged in
Reports
health education and promotion, including the Consumer Product
Safety Commission, the Department of Agriculture, the Environ-
Subsection 1706(a) provides that the Secretary shall make an annual
report (not later than December 1 of each year except in the year this
mental Protection Agency, the Department of Transportation,
and the Defense; and
title is enacted into law) to the Congress on the activities and policy
recommendations of the Office.
(3) identify and make public those Federal programs and actions
which are not in the interest of public health and determine
Subsection 1706(b) provides that the Secretary, acting through the
methods for reviewing and commenting on such programs and
Office, shall assemble and submit to the President and the Congress
actions as identified pursuant to section 1704(d).
not later than December 1 of each year+
(1) a report of the activities, findings, and recommendations of
Interdepartmental Committee on Consumer Health Education and
the Office, and
Promotion
(2) recommendations, based on the findings and recommenda-
tions of the Office, and the Interdepartmental Committee on
Subsection 1704(a) establishes an Interdepartmental Committee
Consumer Health Education and Promotion for legislation and
on Health Education and Promotion (hereinafter referred to in this
administrative action within the executive branch.
section as the "Committee") which shall be responsiblé for overview
Subsection 1706(c) provides that the Office of Management and
and coordination of all Federal programs and activities relating to
Budget may review any report, recominendations or submission made
health education and promotion to assure the adequacy and effective-
by the Secretary, the çommittee, or the Advisory Council in regard to
ness of such programs and activities and to provide for the communica-
this Act before its submission to the Congress, but the Office of Man-
tion and exchange of information necessary to promote these functions.
agement and Budget may not revise the report or delay its submission,
Subsection 1704(b) provides that the Secretary or his designee
and it may submit to the Congress its comments (and those of other
shall serve as Chairman of the Committee, and prescribes the member-
departments or agencies of the Government) respecting such sub-
ship of the Committee.
mission.
Subsection 1704(c) provides that the Committee shall meet at the
Authorization of Appropriations
call of the Chairman, but not less often than four times a year.
Subsection 1704(d) provides that the Committee shall identify
Sec. 1707 provides that to carry out this title there are authorized
Federal programs and actions which are not in the interest of public
to be appropriated $11,000,000 for the fiscal year ending June 30,
health and determine methods for reviewing and commenting on
1976, $11,000,000 for the fiscal year ending June 30, 1977, and
$24,000,000 for the fiscal year ending June 30, 1978.
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54
Functions
PART B-CENTER FOR HEALTH EDUCATION AND PROMOTION
Subsection 1713(a) prescribes the functions that the Center shall
Congressional Declaration of Policy
carry out to facilitate the development of a health education and pro-
Sec. 1708 states that the Congress finds and declares that-
motion strategy for the Nation.
(1) it is in the public interest to inform the public about health
Subsection 1713(b) provides that the Center in carrying out its
and about ways to best protect and improve personal health;
functions under this section may prescribe such regulations as it
(2) the public must develop the ability to examine, and weigh
deems necessary.
consequences of personal decisions respecting health;
Advisory Panel
(3) the public must be motivated to desire changes supportive
Sec. 1714 provides that the Board shall appoint an advisory panel
of more healthful lifestyles;
comprised of one hundred individuals with appropriate competencies
(4) impediments that inhibit the voluntary adoption and
and abilities. The principal function of the advisory panel shall be to
maintenance of more healthful practices by the public must be
provide advice for members of the Board. Additionally, it shall serve
identified and mitigated or removed;
as a primary source for appointments to special committees, task
(5) to achieve these goals it is necessary for the Federal Govern-
forces, and conferences. The advisory panel shall receive all Center
ment to complement, assist, and support a national policy that
will advance the national health, reduce preventable illness,
reports.
Report to Congress
disability, and death, moderate self-imposed risks, and promote
progress and scholarship in consumer health education and
Sec. 1715 provides that the Center shall submit an annual report to
promotion; and
the President for transmittal to the Congress. The report shall include
(6) a private corporation should be created to facilitate the
a comprehensive and detailed report of the Center's operations, ac-
development of a health education and promotion strategy for
tivities, financial condition, and accomplishments under this title and
the Nation.
may include such recommendations as the Center deems appropriate.
Board of Directors
Financing
Subsection 1709(a) provides that the Center shall have a Board of
Directors consisting of twenty-five members appointed by the Presi-
Subsection 1716(a) provides that there are authorized to be appro-
dent, by and with the advice and consent of the Senate.
priated to the Center for the purposes of carrying out the functions
Subsection 1709(b) prescribes the methods of selecting board
enumerated in section 1716 of this Act $1,000,000 for fiscal year
members, who shall serve as incorporators, and shall develop a non-
ending June 30, 1976; $1,000,000 for the fiscal year ending June 30,
profit corporation within sixty days from the effective date of this
1977; and $1,000,000 for the fiscal year ending June 30, 1978.
title.
Subsection 1716(b) provides that in addition to the sums authorized
Sec. 1710 provides that the members of the Committee shall serve
to be appropriated by paragraph (a) of this subsection, the Center is
as first members of the Board, and prescribes the terms and conditions
authorized to receive income, grants, donations, bequests, or other
of Board membership.
contributions from non-Federal sources.
Officers and Employees
Records and Audits
Subsection 1711(a) provides that the Center shall have a President,
Sec. 1717 provides that the accounts of the Center shall be audited
and such other officers as may be named and appointed by the Board
annually, and prescribes the method and content of such audits.
for terms and at rates of compensation fixed by the Board, and
prescribes the terms and conditions of employment for such officers.
Grants for Water Treatment Programs
Nonprofit and Nonpolitical Nature of the Center
Subsection 1718(a) authorizes appropriations of $2,000,000 for the
fiscal year ending June 30, 1976; $3,000,000 for the fiscal year ending
Subsection 1712(a) provides that the Center shall have no power to
June 30, 1977; and $4,000,000 for the fiscal year ending June 30, 1978;
issue any shares of stock or to declare or pay any dividends.
which shall be used by the Secretary to make grants to States, political
Subsection 1712(b) provides that no part of the income or assets of
subdivisions of States, and other public or nonprofit private agencies,
the Center shall insure to the benefit of any director, officer, employee,
organization, and institutions to assist them in initiating water treat-
or any other individual except as salary or reasonable compensation
ment programs designed to reduce the incidence of oral disease or
for services.
dental defects among residents of communities or the students in
Subsection 1712(c) provides that the Center may not contribute to
elementary and secondary schools.
or otherwise support any political party or candidate for elective
public office.
56
57
Subsection 1718(b) provides that grants under this section may be
utilized for (but are not limited to) the purchase and installation of
PUBLIC HEALTH SERVICE ACT
water treatment equipment,
Definitions
TITLE III-GENERAL POWERS AND DUTIES
Sec. 1719 defines health education and promotion as
OF PUBLIC HEALTH SERVICE
"(A) 'Health education and promotion' is a process that favorably
influences understandings, attitudes, and conduct, including cultural
awareness and sensitivity, in regard to individual and community
GRANTS FOR VACCINATION PROGRAMS AND OTHER COMMUNICABLE DISEASE
health. Specifically, it affects and influences individual and community
CONTROL PROGRAMS
health behavior and attitudes in order to moderate self-imposed risk,
maintain and promote physical and mental health and efficiency,
SEC. 317. (a) The Secretary may make project grants to States and,
and reduce preventable illness, disability, and death.".
in consultation with the State health authority, to agencies and politi-
cal subdivisions of States to assist in meeting the costs of [communi-
Technical Amendments
cable] disease control programs. In making a project grant under this
section, the Secretary shall give consideration to (1) the relative ex-
Subsection amends subsection (c):of section 306 of the Public
tent, in the area served by the applicant for the grant, of the problems
Health Service Act by redesignating subsection (c) (2), and inserting
which relate to one or more of the [eommunicable] diseases or condi-
a new subsection (c)(2) immediately preceding subsection (c)(2),
tions referred to in subsection (h) (1), and (2) the design of the
to read as follows:
applicant's [communicable disease] program to determine its
"(c) (1) The Center shall make a continuing survey of the needs,
effectiveness.
interests, attitudes, knowledge, and behavior of the American public
(b) (1) No project grant may be made under this section unless an
regarding health. The Center shall transmit the findings of such
application therefor has been submitted to, and approved by, the Sec-
surveys and of the findings of similar surveys contracted for or
retary. Except as provided in paragraph (2), such application shall be
otherwise obtained by the Center and conducted by national health
in such form, submitted in such manner, and contain such information,
education organizations and community health education organi-
as the Secretary shall by regulation prescribe.
zations accompanied by appropriate Center analysis; if any, to the
(2) An application for a project grant for a fiscal year beginning
Secretary, the Assistant Secretary for health, and to the Office of
after June 30, 1973, shall-
Consumer Health Education and Promotion for their use in formulat-
(A) set forth with particularity the objectives (and their
ing policies respecting health education and promotion."
priorities, as determined in accordance with such regulations as
Subsection 303(b) amends subsection (i) of section 308 of the Public
the Secretary may prescribe) of the applicant for each of the
Health Service Act by adding the following new paragraph (3) after
programs he proposes to conduct with assistance from a project
paragraph (2):
grant under this section;
(3) Of those sums appropriated by Congress under section 308 of
(B) contain assurances satisfactory to the Secretary that, in
the Act not less than $1,000,000 for the fiscal year ending June '30',
the fiscal year for which a project grant under this section is
1976, $1,000,000 for the fiscal year ending June 30, 1977, and
applied for, the applicant will conduct such programs as may be
$1,000,000 for the fiscal year ending Juné 30, 1978, shall be made
necessary to develop an awareness in those persons in the area
available to carry out the activities of section 306(c)(1)."
served by the applicant who are most susceptible to the diseases
or conditions referred to in subsection (h) (1) [of the importance
XI. CHANGES IN EXISTING Law
of immunization against such diseases, to encourage such persons
In compliance with subsection (4) of Rule XXIX of the Standing
to seek appropriate immunization, and to facilitate access by such
Rules of the Senate, changes in existing law made by the bill as
persons to immunization services] including the methods and
repeated are shown as follows (existing law proposed to be omitted
services available to present these diseases or conditions; and
is enclosed in black brackets. new matter is printed in italic, existing
(C) provide for the reporting to the Secretary of such infor-
law in which no change is proposed is shown in roman)
mation as he may require concerning (i) the problems, in the
area served by the applicant, which relate to any [communicable]
disease or condition referred to in subsection (h) (1), and (ii) the
[communicable disease] related control programs of the applicant.
(3) Nothing in this section shall be construed to require any State
or any agency or political subdivision of a State to have a commu-
nicable disease control program which would require any person, who
objects to any treatment provided under such a program, to be treated
or to have any child or ward of his treated under such a program.
59
58
$5,000,000 for the fiscal year ending June 30, 1975; for costs incurred
(c) (1) Payments under Project grants under this section may be
in succeeding fiscal years, for costs incurred in ntilizing such resources
made in advance on the basis of estimates or by way of reimburse-
in accordance with such plan.
ment, with necessary adjustments on account of underpayments or
(f) (1) Except as provided in section 318(g), no funds appro-
overpayments, and in such installments and on such terms and con-
priated & under any provision of this Act other than subsection (d)
ditions as the Secretary finds necessary to carry out the purposes of
may be used to make project grants in any fiscal year for [commu-
this section.
nicable] disease or conditions control programs if (A) project grants
(2) The Secretary, at the request of a recipient of a project grant
for such programs are authorized by this section, and (B) all the
under this section, may reduce such project grant by the fair market
funds authorized to be appropriated under that subsection for that
value of any supplies (including vaccines and other preventive agents)
fiscal year have not been appropriated for that fiscal year and obli-
or equipment furnished to such recipient and by the amount of the pay,
gated in that fiscal year.
allowances, travel expenses, and any other costs in connection with
(2) No funds appropriated under any provision of this Act other
the detail of an officer or employee of the Government to the recipient
than subsection (e) may be used in any fiscal year for costsincurred in
when the furnishing of such supplies or equipment or the detail of
utilizing resources of the Service in accordance with a plan developed
such an officer or employee is for the convenience of and at the request
in accordance with that subsection if all the funds authorized to be
of such recipient and for the purpose of carrying out the program
appropriated under that subsection for that fiscal year have not béen
with respect to which the project grant under this section is made.
appropriated for that fiscal year and obligated in that fiscal year.
The amount by which any such project grant is SO reduced shall be
(g). The Secretary shall submit to the President for submission to
available for payment by the Secretary of the costs incurred in furnish-
the Congress on January 1 of each year a report (1) on the effective-
ing the supplies or equipment, or in detailing the personnel, on which
ness of all Federal and other public and private activities in prevent-
the reduction of such project grant is based and such amount shall be
ing and controlling the diseases or conditions referred to in subsection
deemed as part of the grant and deemed to have been paid to the
(h) (1), (2) on the extent of the problems presented by such diseases
recipient.
or conditions, (3) on the effectiveness of the activities, assisted under
(d) (1) There is authorized to be appropriated $11,000,000 for the
project grants under this section, in preventing and controlling such
fiscal year ending June 30, 1973, $11,000,000 for the fiscal year ending
diseases and conditions, and (4) setting forth a plan for the coming
June 30, 1974, and $11,000,000 for the fiscal year ending June 30, 1975,
year for the prevention and control of such diseases and conditions.
for grants under this section for communicable disease control pro-
(h) For the purposes of this section:
grams for tuberculosis.
[(1) The term "communicable disease control program" means
(2) There is authorized to be appropriated $6,000,000 for the fiscal
a program which is designed and conducted SO as to contribute to
year ending June 30, 1973, $6.000,000 for the fiscal year ending June 30,
national protection against tuberculosis, rubella, measles, Rh dis-
1974, and $6,000,000 for the fiscal year ending June 30, 1975, for grants
ease, poliomyelitis, diphtheria, tetanus, whooping cough, or other
under this section for communicable disease control programs for
communicable diseases (other than venereal disease) which are
measles.
transmitted from State to State, are amenable to reduction, and
(3) There is authorized to be appropriated $23,000,000 for the fiscal
determined by the Secretary to be of national significance. Such
year ending June 30, 1973, $23,000,000 for the fiscal year ending
term includes vaccination programs, laboratory services, and
June 30, 1974, and $23,000,000 for the fiscal year ending June 30, 1975,
studies to determine the communicable disease control needs of
for grants under this section for communicable disease control pro-
States and political subdivisions of States and the means of best
grams other than communicable disease control programs for which
meeting such needs.]
appropriations are authorized by paragraph (1) or (2).
(1) The term *disease control program' means a program which
(4) Not to exceed 50 per centum of the amount appropriated
is dèsigned and conducted so as to contribute to national protec-
for any fiscal year under any of the preceding paragraphs of this sub-
tion against tuberculosis, rubella, meastes, Rh disease, polio-
section may be used by the Secretary for project grants for such fiscal
myelitis, diphtheria, tetanus, whooping cough, mumps, diabetes
year under (A) programs for which appropriations are authorized
mellitus, or other diseases or conditions (other than venereal dis-
under any one or more of the other paragraphs of this subsection if
ease) which are amenable to reduction, and are determined by
the Secretary determines that such use will better carry out the pur-
the Secretary to be of national significance. Such term includes
poses of this section, and (B) section 318.
vaccination programs, casefinding programs, public and pro-
(e) The Secretary shall develop a plan under which personnel,
fessional education programs, other preventive health programs,
equipment, medical supplies, and other resources of the Service and
laboratory services, and studies to determine the communicable
other agencies under his jurisdiction may be effectively utilized to
disease control needs of States and potitical subdivisions of States
meet epidemics of, or other health emergencies involving, any disease
and the means of best meeting such needs.
referred to in subsection (h) (1). There is authorized to be appro-
(2) The term "State" includes the Commonwealth of Puerto
priated to the Secretary $5,000,000 for the fiscal year ending June
Rico, Guam, American Samoa, the Trust Territory of the Pacific
30, 1973, $5,000,000 for the fiscal year ending June 30, 1974, and
Islands, the Virgin Islands, and the District of Columbia.
60
61
(i) Nothing in this section shall limit or otherwise restrict the use
(D) to the extent feasible as determined by criteria developed
of funds which are granted to a State or to an agency or a political
by the Secretary, the provision of clinical services for the persons
subdivision of a State under provisions of Federal law (other than
affected with venereal disease which includes diagnosis and care
this Act) and which are available for the conduct of [communicable]
for persons with a wide range of genitourinary diseases and con-
disease control programs from being used in connection with pro-
ditions, which, because of their symptoms and clinical presenta-
grams assisted through project grants under this section.
tions, are commonly present in persons with actual or suspected
(j) For the purpose of payments pursuant to project grants 'and
venereal disease;
contracts under section 317 of the Act there are authorized to be
[(D)] (E) contain or be supported by assurances satisfactory
appropriated $30,000,000 for the fiscal year ending June 30, 1976,
to the Secretary that (i) not less than 70 per centum of the funds
$35,000,000 for the fiscat year ending June 30, 1977, and $40,000,000
paid to the State under this subsection will be used to provide and
for the fiscal year ending June 30, 1978.
strengthen public health services in its political subdivisions for
the diagnosis and treatment of venereal disease; (ii) such funds
PROJECTS AND PROGRAMS FOR THE PREVENTION AND CONTROL OF
will be used to supplement and, to the extent practical, to increase
VENEREAL DISEASE
the level of funds that would otherwise be made available for the
purposes for which the Federal funds are provided under this
SEC. 318. (a) The Secretary may provide technical assistance to
subsection and will not supplant any non-Federal funds which
appropriate public authorities and nonprofit private entities and scien-
would otherwise be available for such purposes; and (iii) the
tific institutions for their research, training, and public health pro-
plan is compatible with the total health program of the State;
grams for the prevention and control of venereal disease.
[(E)] (F) provide that the State health authority will from
(b) (1). The Secretary is authorized to make grants to States, po-
time to time, but not less often than annually, review and evaluate
litical subdivisions of States, and any other public or nonprofit private
its State plan approved under this subsection, and submit to the
entity for projects for the conduct of research, demonstrations, and
Secretary appropriate modifications thereof;
training which will contribute to national objectives for the preven-
tion and control of venereal disease.
[(F)] (G) provide that the State health authority will make
such reports, in such form and containing such information, as
(2) For the purpose of carrying out this subsection, there is au-
thorized to be appropriated $5,000,000 for the fiscal year ending
the Secretary may from time to time reasonably require, and will
keep such records and afford such access thereto as the Secretary
June 30, 1976, $5,000,000 for the fiscal year ending June 30, 1977, and
finds necessary to assure the correctness and verification of such
$5,000,000 for ,the fiscal year ending June 30, 1978.
reports;
(c) There is authorized to be appropriated, $5,000,000 for the
[(G)] (H) provide for such fiscal control and fund account-
fiscal year ending June 30, 1976, $10,000,000 for the fiscal year ending
June 30, 1977 and $15,000,000 for the fiscal year ending June 30,
ing procedures as may be necessary to assure the proper disburse-
1978, to enable the Secretary to make grants to State health author-
ment of and accounting for funds paid to the State under this
ities to assist the States in establishing and maintaining adequate pub-
subsection; and
lic health programs for the diagnosis and treatment of venereal
[(H)] (J) contain such additional information and assur-
disease. For purposes of this subsection, the term "State" means each
ances as the Secretary may find necessary to carry out the pur-
of the several. States of the United States, the District of Columbia,
poses of this subsection.
the Virgin Islands, Guam, American Samoa, the Trust Territory of
The Secretary shall approve any State plan and any modification
the Pacific Islands, and the Commonwealth of Puerto Rico.
thereof which meets the requirements of this paragraph.
(2) Any State desiring to receive a grant under this subsection shall
(3) (A) Grants under this subsection shall be made from allotments
submit to the Secretary a State plan for a public health program for
to States made in accordance with this paragraph. For each fiscal year
the diagnosis and treatment of venereal disease. Each State plan
the Secretary shall, in accordance with regulations, allot the sums
shall
appropriated under paragraph (1) for such year among the States on
(A) provide for the administration or supervision of adminis-
the basis of the incidence of venereal disease in, and the population of,
tration of the State plan by the State health authority;
the respective States; except that no State's allotment shall be less
than $75,000 for any fiscal year.
(B) set forth the policies and procedures to be followed in the
expenditure of the funds paid to the State under this subsection
(B) Any amount allotted to a State (other than the Virgin Islands,
American Samoa, Guam, the Trust Territory of the Pacific Islands,
(C) provide that the public health services furnished under
the State plan will include the provision of Statewide laboratory
and the Commonwealth of Puerto Rico) under subparagraps (A) for
a fiscal year and remaining unobligated at the end of such year shall
services [(including dark field microscope techniques for the diag-
nosis of both gonorrhea and syphilis) which services will be pro-
remain available to such State, for the purposes for which made, for
the next fiscal year (and for such year only), and any such amount
vided in accordance with standards prescribed by regulations,
shall be in addition to the amounts allotted to such State for such
including standards as to the scope and quality of such services;
purpose for such next fiscal year; except that any such amount, re-
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62
1976, $33,000,000 for the fiscal year ending June 30, 1977, and $36,-
maining unobligated at the end of the sixth month following the end
000,000 for the fiscal year ending June 30, 1978.
of such year for which it was allotted, which the Secretary determines
(e) (1) Grants made under subsection (b) or (d) of this section
will remain unobligated by the close of such next fiscal year, may be
shall be made on such terms and conditions as the Secretary finds
reallotted by the Secretary, to be available for the purposes for which
necessary to carry out the purposes of such subsection, and payments
made until the close of such next fiscal year, to other States which
under any such grants shall be made in advance or by way of reim-
have need therefor, on such basis as the Secretary deems equitable
bursement and in such installments as the Secretary finds necessary.
and consistent with the purposes of this subsection, and any amount
(2) Each recipient of a grant under this section shall keep such
SO reallotted to a State shall be in addition to the amounts allotted
records as the Secretary shall prescribe including records which fully
and available to the States for the same period. Any amount allotted
disclose the amount and disposition by such recipient of the proceeds of
under subparagraph (A) to the Virgin Islands, American Samoa,
such grant, the total cost of the project or undertaking in connection
Guam, the Trust Territory of the Pacific Islands, or the Common-
with which such grant was given or used and the amount of that por-
wealth of Puerto Rico for a fiscal year and remaining unobligated at
tion of the cost of the project or undertaking supplied by other sources,
the end of such year shall remain available to it for the purposes for
and such other records as will facilitate an effective audit.
which made, for the next two fiscal years (and for such years only),
(3) The Secretary and the Comptroller General of the United States,
and any such amount shall be in addition to the amounts allotted to
or any of their duly authorized representatives, shall have access for
it for such purposes for each of such next two fiscal years; except that
the purpose of audit and examination to any books, documents, papers,
any such amount, remaining unobligated at the end of the first of such
and records of the recipients of grants under this section that are
next two years, which the Secretary determines will remain unobli-
pertinent to such grants.
gated at the close of the second of such next two years, may be re-
(4) The Secretary, at the request of a recipient of a grant under
allotted by the Secretary, to be available for the purposes for which
this section, may reduce such grant by the fair market value of any
made until the close of the second of such next two years, to any other
supplies or equipment furnished to such recipient and by the amount
of such named States which have need therefor, on such basis as the
of pay, allowances, travel expenses, and any other costs in connection
Secretary deems equitable and consistent with the purposes of this
with the detail of an officer or employee of the United States to the
subsection, and any amount so reallotted to any such named State shall
recipient when the furnishing of such supplies or equipment or the
be in addition to any other amounts allotted and available to it for
detail of such an officer or employee is for the convenience of and at
the same period.
the request of such recipient and for the purpose of carrying out the
(4) The amount of any grant under this subsection for public
program with respect to which the grant under this section is made.
health programs under an approved State plan shall be determined
The amount by which any such grant is so reduced shall bè available
by the Secretary, except that no grant for any such program may
for payment by the Secretary of the costs incurred in furnishing the
exceed 90 per centum of its cost (as determined under regulations of
supplies, equipment, or personal services on which the reduction of such
the Secretary). Payments under grants under this subsection shall
grant is based; and, in the case of a grant under subsection (c), such
be made from time to time in advance on the basis of estimates by the
amount shall be deemed a part of the grant to such recipient and shall,
Secretary or by way of reimbursement, with necessary adjustments
for the purposes of that subsection, be deemed to have been paid to
on account of previous underpayments or overpayments.
such recipient.
(d) (1) The Secretary is authorized to make project grants to States
(5) All information obtained in connection with the examination,
and, in consultation with the State health authority, to political sub-
care, or treatment of any individual under any program which is being
divisions of States, for-
carried out with a grant made under this section shall not, without
(A) venereal disease surveillance activities, including the re-
such individual's consent, be disclosed except as may be necessary to
porting, screening, and followup of diagnostic tests for, and
provide service to him. Information derived from any such program
diagnosed cases of, venereal disease;
may be disclosed—
(B) casefinding and case followup activities respecting venereal
(A) in summary, statistical, or other form, or
disease, including contact tracing of infectious cases of venereal
(B) for clinical or research purposes,
disease and routine testing, including attendant laboratory and
but only if the identity of the individuals diagnosed or provided care
followup systems costs thereof;
or treatment under such program is not disclosed.
(C) interstate epidemiologic referral and followup activities
(f) Except as provided in section 317 (d) (4), no funds appro-
respecting venereal disease;
priated under any provision of this Act other than this section may
(D) targeted professional and public veneral disease education
be used to make grants in any fiscal year for programs or projects
activities; and
respecting venereal disease if (1) grants for such programs or projects
(E) such special studies or demonstrations to evaluate or test
are authorized by this section, and (2) all the funds authorized to be
venereal disease [control] preventive and control strategies or
appropriated under this section for that fiscal year have not been
activities as may be prescribed by the Secretary.
appropriated for that fiscal year and obligated in that fiscal year.
(2) For the purpose of carrying out this subsection, there is author-
ized to be appropriated $31,000,000 for the fiscal year ending June 30,
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65
(g) Not to exceed 50 per centum of the amounts appropriated for
any fiscal year under subsections (b), (c), and (d) of this section
(2) determine health education and promotion needs and re-
may be used by the Secretary for grants for such fiscal year under
sources, and recommend appropriate educational and certifying
section 317.
policies for health education and promotion manpower;
(h) Nothing in this section shall be construed to require any State
(3) incorporate appropriate health education and promotion
or any political subdivision of a State to have a venereal disease pro-
strategies into every facet of our society and increase the appli-
gram which would require any person, who objects to any treatment
cation of health knowledge, skills, and practices by the general
provided under such a program, to be [treated or to have any child
population in their patterns of daily living;
or ward of his] treated under such a program.
(4) increase the effectiveness and efficiency of health education
(i) As used in this section, the term "venereal disease" means syphilis
and promotion programs through improved planning, implemen-
and gonorrhea and any other sexually transmitted disease which the
tation of tested models, and evaluation of results;
Secretary finds to be of national significance and which, with respect
(5) establish systematic processes for the exploration, develop-
to grants under subsection (d), the Secretary finds to be amenable to
ment, demonstration, and evaluation of innovative health educa-
control.
tion concepts; and
(6) foster information exchanges and cooperation among health
CONSUMER HEALTH EDUCATION AND PROMOTION
education providers, consumers, and supporters.
The Secretary shall carry out this title in a manner consistent with
SHORT TITLE
the national health priorities set forth in section 1502 of the Public
SEC. 301. This may be cited as the "National Consumer Health Edu-
Health Service Act and with activities undertaken under title XV
cation and Promotion Act of 1975".
of the Public Health Service Act (relating to health planning and
development).
AMENDMENT TO THE PUBLIC HEALTH SERVICE ACT
SPECIFIC FUNCTIONS
SEC. 302. The Public Health Service Act is amended by adding after
Research Programs
title XVI the following new title:
SEC. 1703. (a) (1) The Secretary shall by grante and contracts to
TITLE XVII-OFFICE OF CONSUMER HEALTH EDUCA-
public or nonprofit private entities conduct and support research in
TION AND PROMOTION AND THE CENTER FOR
health education and promotion. The Secretary shall-
HEALTH EDUCATION AND PROMOTION
(A) determine the scope and nature of health education re-
search;
PART A-OFFICE OF CONSUMER HEALTH EDUCATION AND PROMOTION
(B) rank research projects in order of priority;
(C) initiate, stimulate, and fund projects that are determined
ESTABLISHMENT OF OFFICE OF CONSUMER HEALTH EDUCATION AND PROMOTION
to be necessary;
(D) provide consultation to persons preparing research pro-
SEC. 1701. (a) There is established in the D'epartment of Health,
posals or those who are conducting research;
Education, and Welfare the Office of Consumer Health Education and
(E) determine the best methodologies to disseminate informa-
Promotion (hereafter in this Act referred to as the 'Office') which
tion on the value of preventive measures in health care and to
shall be under the direction of a Director who shall be appointed by
implement health education and promotion strategies;
the Secretary of Health, Education, and Welfare (hereafter in this
(F) determine the best methods to increase the awareness of
Act referred to as the "Secretary") and supervised by the Assistant
health providers regarding the cultural sensitivities of popu-
Secretary for Health (or such other officer of the Department as may
lation groups which may affect such groups willingness or ability
be designated by the Secretary as the principal adviser to him for
to seek and accept services, including preventive health services;
health programs).
(G) ascertain the costs and cost-benefit of disseminating such
(b) To facilitate the development of health education and promo-
information and of implementing health education and promo-
tion strategy for the Nation, the Office shall carry out the following
tion strategies;
functions: Engage in research in health education and promotion,
(H) determine factors in social behavior which impact on
develop community health education programs, stimulate and coordi-
health and determine the interaction of sociological determinants
nate communications in health education, and overview and coordinate
with the field of health education:
Federal programs.
(I) review those factors which affect environmental and occu-
GENERAL AUTHORITY
pational health. ascertain those programs and areas for which
educational and preventive measures could be implemented to
Sec. 1702. The Secretary, acting through the Office, shall-
improve environmental and occupational health, and engage in
(1) design and implement and national goals and strategies
research and policy formulation in such areas as accidents, nutri-
with respect to health education and promotion;
tion, dental care, occupational health and safety, and environ-
mental stress; and
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67
(J) conduct a review of biological-genetic factors which, act-
Health Education Training
ing independently or in concert with environmental factors, can
affect health and ascertain whether education of the public con-
(c) The Secretary acting through the Director is authorized to make
cerning these factors, and their detection, can improve health.
grants and contracts to public or nonprofit private entities to provide
(2) The Secretary in carrying out his responsibilities under this
for the training for health personnel in health education and
section, shall use the findings of the continuing surveys of the needs,
promotion.
interests, attitudes, knowledge, and behavior of the American public
School Health Education Training
regarding health as conducted by the National Center for Health
Statistics as a basis for formulating policy with respect to health
(d) (1) The Secretary acting through the Director may make grants
education and promotion.
to local educational agencies and institutions of higher education for
teacher training with respect to the provision of comprehensive health
Community Programs
education programs in schools. Such grants may be used by such agen-
cies and institutions to develop and conduct training programs for
(3) (1) The Secretary shall support and encourage innovative pro-
elementary and secondary teachers with respect to teaching methods
grams in health education and promotion and shall specifically-
and techniques, information, and current issues relating to health and
(A) support demonstration programs, including training, in
health problems. For purposes of this Act the term 'health education
health education and promotion, which programs (a) are within
and health problems' includes dental health, disease control, environ-
hospitals, ambulatory care settings, and other appropriate set-
mental health, human eçology, mental health, nutrition, physical
tings, (ii) focus on goals and objectives that are measurable, and
health, safety and accident prevention, smoking and health, substance
(iii) emphasize the prevention or moderation of illness or acoi-
abuse, consumer health, and such others as may be deemed appropriate
dents that appear controllable through individual behavior;
by the Director in concurrence with the Commissioner of Education.
(B) provide consultation to organizations in planning or eval-
(2) The Director, in exercising authority with respect to (a) deter-
uating health education and promotion programs;
mination of criteria for the selection of grants, and (b) selection of
(C) develop health education and promotion model curricula
grants from eligible applicants, shall consult with, and obtain the
with appropriate representatives from medical, dental, and nurs-
approval of, the Commissioner of Education.
ing schools, schools of public health, and other institutions en-
(3) In establishing criteria for the award of grants under this sec-
gaged in training health personnel for the purpose of implement-
tion, such criteria must include priority for applications for support
ing such curricula within these institutions;
of programs which provide: (1) inservice rather than preservice train-
(D) establish continuing education programs to disseminate
ing, except in such cases where an applicant has demonstrated that.
the most recent research findings in the field; and
(A) inservice training is not practicable, and (B) reasonable oppor-
(E) support by grant or contract the development and imple-
tunity exists for persons undergoing preservice training to obtain
mentation of a model toll-free telephone system to provide the
positions in which they shall apply such training, and (2) training of
public with health information, information on available health
persons who, as a result of such training, will have as their major
services, crisis information, and directions for obtaining health
responsibility, work in health education in schools.
related publications.
(2) (A) The Secretary is authorized to make grants and contracts
Requirements Applicable to Providers of Institutional Care
to public or nonprofit private entities for the purpose of developing
programs of health care education for a defined geographic region
(d) The Secretary may not approve an application of any health
pursuant to and in accordance with those established under section
care facility for a grant or contract under the Public Health Service
1511 of the Public Health Service Act and with activities undertaken
Act or the Community Mental Health Centers Act for a fiscal year
under title XV of the Public Health Service Act (relating to health
beginning after the date of enactment of this Act unless the applica-
planning and development). In awarding such grants and contracts
tion contains or is supported by assurances satisfactory to the Secre-
the Secretary shall assure an equitable geographic and demographic
tary that. during the period for which the assistance applied is to be
distribution of all funds appropriated.
made available, the applicant will provide such consumer health educa-
(B) Projects which receive Federal funds under this subsection
tion, for individuals receiving innatient or outpatient services through
shall-
such health care facility as the Secretary shall by regulation prescribe.
(1) utilize in a coordinated manner such health education
methods as may be appropriate to provide effective health educa-
Communications in Health Education and Promotion
tion services to the population of the applicable region; and
(2) evaluate the effectiveness of each health education method
(e) The Secretary shall establish liaison with the Office, providers
utilized and identify its particular advantages or disadvantages.
of health education services, and the communications media. The Sec-
retary shall-
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68
INTERDEPARTMENTAL COMMITTEE ON CONSUMER HEALTH EDUCATION AND
(1) inventory the existing health education information data
PROMOTION
systems, encourage further development of such systems, and work
to coordinate the efforts of all major groups involved in health
SEC. 1704. (a) There is established in the Office of the Secretary an
education formation data systems;
Interdepartmental Committee on Health Education and Promotion
(2) make health information available to the public and to
(hereinafter referred to in this section as the 'Committee') which shall
organization involved in health education and promotion;
be responsible for overview and coordination of all Federal programs
(3) continually evaluate the effectiveness of existing health
and activities relating to health education and promotion to assure
information and health education and promotion services to
the adequacy and effectiveness of such programs and activities and
enhance their scope and quality;
to provide for the communication and exchange of information neces-
(4) encourage pretesting and expert evaluation of health
sary to promate these functions:
information materials;
(b) The Secretary or his designee shall serve as Chairman of the
(5) bring together the major national health educational or-
Committee, the membership of which shall include appropriate repre-
ganizations to share ideas, to identify gaps and overlaps in health
sentation from the Department of Agriculture, the Environmental
education and promotion programs and research, and to find ways
Protection Agency, the Department of Transportation, the Depart-
in which the organizations can cooperate to make efforts more
ment of Defense, the Veterans' Administration, the National Science
effective;
Foundation, the Federal Communications Commission, the National
(6) find ways in which the communications media and the Of-
Academy of Sciences, the Consumer Product Safety Commission, and
fice can cooperate to provide effective public service programming
such other Federal agencies and offices (including appropriate agen-
in health education and promotion;
cies and offices of the Department of Health, Education, and Welfare,
(7) seek ways of promoting general public health education and
including the Office of Education and the National Institute for Occu-
promotion programs and of reducing misleading media advertis-
pational Safety and Health, the Office of Child Development, the
ing and other health-threatening behavior in communications
National Institute of Drug Abuse, and the National Institute of Alco-
programs designed for children and families; and
holism and Alcohol Abuse) as the Secretary determines administer
(8) establish the Office as a source of information and expertise
programs directly affecting health education and promotion;
which can be used in planning and creating both commercial and
less often than four times a year;
noncommercial material in health education and promotion.
(c) The Committee shall meet at the call of the Chairman, but not
In the case where materials are developed, through activities funded
(d) The Committee shall identify Federal programs and actions
under this title and/or through activities of the Office and where the
which are not in the interest of public health and determine methods
materials have commercial value, the moneys which result from the
for reviewing and commenting on such programs and actions, in-
license, sale, rent, grant or other transaction of said materials shull
cluding recommendations for legislation and administrative action
be paid into the public treasury. The Director with consultation of
within the executive branch; and
the Secretary shall determine the fair market value of such materials
(e) The Secretary shall provide the Committee with such full-time
and shall have the authority to authorize such transactions.
professional and clerical staff, information, other support, and the
services of such consultants as may be necessary to assist it in carrying
Federal Programs
out eff fectively its functions under this section.
(f) The Secretary, in conjunction with the Interdepartmental Com-
ADVISORY COUNCIL
mittee on Consumer Health Education and Promotion, in accordance
with section 1704, shall make recommendations to the Congress for
SEC. 1705. (a) There is established the Consumer Health Education
the inclusion in appropriate legislation of provisions respecting health
and Promotion Advisory Council (hereafter in this section referred to
education and promotion. The Secretary shall-
as the "Advisory Council") which shall consist of nineteen members
(1) promote the coordination, communication and collabora-
appointed by the Secretary. The Secretary shall from time to time
tion of health education and promotion programs within the
appoint one of the members to serve as Chairman. The members shall
Department of Health, Education, and Welfare;
include persons who have distinguished themselves in the fields of
(2) establish a liaison with other Federal agencies engaged in
medicine (including preventive medicine), dentistry, health education,
health education and promotion, including the Consumer Product
nursing, the social and behavioral sciences, nutrition, and the provision
Safety Commission, the Department of Agriculture, the Environ-
of health services; persons who are representative of the interests of
mental Protection Agency, the Department of Transportation,
the general public (including representatives of business, labor, and
and the Department of Defense; and
consumer groups); and persons from government. Each member shall
(3) identify and make public those Federal programs and
hold office for a term of four years, except that the Secretary may stag-
actions which are not in the interest of public health and deter-
ger the terms of members first appointed to the Advisory Council, and
mine methods for reviewing and commenting on such programs
any member appointed to fill a vacancy occurring prior to the expira-
and actions as identified pursuant to section 1704(d).
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71
tion of the term for which his predecessor was appointed shall be ap-
AUTHORIZATION OF APPROPRIATIONS
pointed for the remainder of such term. A member shall not be eligible
to serve continuously for more than two terms. The Secretary may, at
SEC. 1707. To carry out this title there are authorized to be appro-
the request of the Director, appoint such special advisory professional
priated $11,000,000 for the fiscal year ending June 30, 1976, $11,000-
or technical committees as may be useful in carrying out this title.
000 for the fiscal year ending June 30, 1977, $24,000,000 for the fiscal
Members (other than members who are officers or employees of the
year ending June 30, 1978.
United States) of the Advisory Council or of such committees, shall
be entitled to receive for each day (including traveltime) during which
PART B-CENTER FOR HEALTH EDUCATION AND PROMOTION
they are engaged in the actual performance of duties vested in the
Advisory Council or committee compensation at rates fixed by the
CONGRESSIONAL DECLARATION OF POLICY
Secretary, but not exceeding $100 per day, and while so serving away
from their homes or regular places of business each member may be
SEC. 1708. The Congress finds and declared that-
allowed travel expenses, including per diem in lieu of subsistence, as
(1) it is in the public interest to inform the public about health
authorized by section 5703 of title 5, United States Code, for persons
and about ways to best protect and improve personal health;
in the Government service employed intermittently. The Advisory
(2) the public must develop the ability to examine and weigh
Council shall meet as frequently as the ,Secretary deems necessary.
consequences of personal decisions respecting health;
pon request of five or more members, it shall be the duty of the Secre-
(3) the public must be motivated to desire changes supportive
tary to call a meeting of the Advisory Council.
of more healthful lifestyles;
(3) It shall be the function of the Advisory Council to provide
(4) impediments that inhibit the vobuntary adoption and main-
advice and recommendations for the consideration of the Secretary on
tenance of more healthful practices by the public must be identi-
matters of general policy with respect to the functions of the Office.
fied and mitigated or removed;
The Advisory Council shall make an annual report to the Secretary
(5) to achieve these goals it is necessary for the Federal Gov-
and to the Congress on the performonce of its functions, including any
ernment to complement, assist, and support a national policy that
recommendations it may have with respect thereto.
will advance the national health, reduce preventable illness, dis-
(c) The Advisory Council is authorized to engage such technical
ability, and death, moderate self-imposed risks, and promote
assistance as may be required to carry out its functions, and the Secre-
progress and scholarship in consumer health education and pro-
tary shall, in addition, make available to the advisory council such
motion, and
secretarial, clerical, and other assistance and such pertinent data ob-
(6) a private corporation should be created to facilitate the
tained and prepared by the Department of Health, Education, and
development of a health education and promotion strategy for
Welfarè, as the advisory council may require to carry out its functions.
the Nation.
REPORTS
CREATION OF CORPORATION
SEC. 1706. (a) The Secretary shall make an annual report (not later
BOARD OF DIRECTORS
than December 1 of each year except in the year this title is enacted
into law) to the Congress on the activities and policy recommendations
SEC. 1709. The Center shall have a Board of Directors (hereinafter
of the Office.
in this tițle referred to as the 'Board') consisting of twenty-five mem-
(b) The Secretary, acting through the Office, shall assemble and
bers appointed by the President, by and with the advice and consent of
submit to the President and the Congress not later than December 1
the Senate.
of each year-
(3) The members of the Board (1) shall be selected from among
(1). a report of the activities, findings, and recommendations of
citizens of the United States (not regular full-time employees of the
the Office, and
United States) who are eminent in such fields as, and represent, health
(2) recommendations, based on the findings and recommenda-
education, health care services delivery, nursing, nutrition, general
tions of the Office, and the Interdepartmental Committee on Con-
education, consumer representation and advocacy, communications,
sumer Health Education and Promotion for legislation and ad-
labor and business, planning and organizational management, and pub-
ministrative action within the executive branch.
lic and private finance, and (2) shall be selected so as to provide as
(c) The Office of Management and Budget may review any report,
nearly as practicable a broad representation of various regions of the
recommendations or submission made by the Secretary, the commit-
country and of various kinds of skills and experiences appropriate to
tee, or the Advisory Council in regard to this Act before its submission
the functions and responsibilities of the Center. They shall serve as
to the Congress, but the Office of Management and Budget may not
incorporators and shall take whatever actions are necessary to create
revise the report or delay its submission, and it may submit to the Con-
a nonprofit corporation to be known as the Center for Health Educa-
gress its comments (and those of other departments or agencies of the
tion and Promotion (hereafter in this title referred to as the 'Center')
Government) respecting such submission.
under the District of Columbia Nonprofit Corporation Act within
sixty days from the effective date of this title. The Center and its
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73
articles of incorporation, bylaws, and all other rules and regulations
shall incorporate by reference and be subject to this title.
FUNCTIONS
SEC. 1710. (a) The members of the Committee shall serve as the
members of the first Board.
Sec. 1713. (a) to facilitate the development of a health education
(b) The term of office of each member of the Board shall be four
and promotion strategy for the Nation the Center shall carry out
years; except that (1) any member appointed to fill a vacancy occur-
the following functions:
ring prior to the expiration of the term for which his predecessor was
(1) The Center shall establish communications with, provide
appointed shall be appointed for the remainder of such term; (2) the
a forum for the involvement of, and seek the advice and support
terms of office of members first taking office shall begin on the date of
of, organizations, agencies, and groups involved in health care,
incorporation and shall expire, as designated at the time of their ap-
education, labor and business, social and civic organizations, con-
pointment, nine at the end of one year, eight at the end of two years,
sumer organizations, and communications. The Center shall re-
and eight at the end of four years; and (3) a member whose term has
view and analyze the need, and resources available, for health
expired may serve until his successor has qualified. No member shall
education and promotion and the effectiveness of alternative health
be eligible to serve in excess of two consecutive terms of four years each.
education methods and procedures on health status to determine
(c) Any vacancy in the Board shall not affect its power, but shall be
which methods and procedures offer the best opportunities for
filled in the manner in which the original appointments were made.
improving the Nation's health. Specifically, the Center shall-
(d) The members of the Board shall elect one of their members as
(4) provide a private focal point for the coordination of
Chairman; thereafter the members of the Board shall annually elect
a structured national exchange on health education issues and
one of their number as Chairman. The members of the Board shall also
problems involving all of the various concerned disciplines and
elect one or more of them as a Vice Chairman or Vice Chairmen.
interests;
(e) The members of the Board shall not, by reason of such member-
(B) identify and express the superordinate health educa-
ship, be deemed to be employees of the United States. They shall, while
tion polices and guides to which many different organizations,
attending meetings of the Board or while engaged in duties related to
agencies, and groups can subscribe and incorporate volun-
such meetings or in other activities of the Board, be entitled to receive
tarily into their own health education forts;
compensation at the rate of $100 per day including traveltime, and
(C) stimulate, sponsor, coordinate, and support the devel-
while away from their homes or regular places of business they may be
opment of new health education initiatives and programs in
allowed travel expenses, including per diem in lieu of subsistence, equal
which many organizations and agencies can participate;
to that authorized by law (5 U.S.C. 5703) for persons in the Govern-
(D) develop national policy recommendations which are
ment service employed intermittently.
supportive of long-range preventive approaches to national
health improvement; and
OFFICERS AND EMPLOYEES
(E) provide a forum for nongovernmental organizations to
participate in comprehensive national planning, action, and
SEC. 1711. (a) The Center shall have a President, and such other
evaluation of health education efforts.
officers as may be named and appointed by the Board for terms and at
(2) The Center. shall coordinate and stimulate a variety of
rates of compensation fixed by the Board. No individual other than a
projects involving other organizations, agencies, and groups to
citizen of the United States may be an officer of the Center. No officer of
develop such strategy designs or design components as are re-
the Centèr, other than the Chairman and any Vice Chairman, may re-
quired to increase the appropriateness, acceptability, and effective-
ceive any salary or other compensation from any source other than the
ness of health education efforts nationwide. In the performance of
Center during the period of his employment by the Center. All officers
this function, the Center shall-
shall serve at the pleasure of the Board.
(4) in order to indicate directions for improving the
Nation's health, develop a perspective and definition of the
NONPROFIT AND NONPOLITICAL NATURE OF THE CENTER
role of health education, its placement in the health and
education systems, and its relationships to prevention and
SEC. 1712. (a) The Center shall have no power to issue any shares
general health maintenance practices;
of stock or to declare or pay any dividends.
(B) review, analyze, and summarize unmet consumer
(b) No part of the income or assets of the Center shall inure to the
health education needs and identify the critical gaps or de-
benefit of any director, officer, employee, or any other individual except
ficiencies in personal preventive practices, in the use of health
as salary or reasonable compensation for services.
and related social services, and in programs to improve so-
(c) The Center may not contribute to or otherwise support any
cial and environmental conditions and other conditions
political party or candidate for elective public office.
affecting health care and education:
(σ) review, analyze, and assess the state of health educa-
tion and promotion theory and practices in relation to identi-
74
75
fied consumer needs andvidentify the possibilities for the
development of new or improved technologies and practices;
deficiencies generally ourrent in health education practices
(D) identify the types and availability of the resources
and develop programs or projects for the correction of such
required to mèet consumer needs; and
deficiencies.
(E) develop action plans for the development or increased
(5) The Center shall encourage the development and utilization
allocation of resources required to produce significant re-
of valid and acceptable research and evaluation methods for a
sults in meeting consumer health education needs.
wide variety of health education programs and technologies. It
(3) The Center shall assist in stimulating, developing, im-
shall develop coalitions and consortium arrangements with other
plementing, and assessing a total communications program
organizations and agenoies for cooperative efforts in model design
utilizing. a full range of media available to reach diversified
and testing and for joint sponsorship and exchange of informa-
groups in order to increase national understanding and support
tion on comparable research and evaluation projects. In the per-
for the value of health education and the role each citizen and
formance of this function, the Center shall-
every organization, institution, and agency can and should play
(A) stimulate and support the development of valid tech-
to improve individual, community, and, ultimately, the national
niques and strategies to measure the appropriateness, accept-
health through educational means. In performance of this func-
ability, and effectiveness of the process and outcomes of ex-
tion, the Center shall
perimental and demonstration health education projects;
(A) be an active participant in the efforts of organized
(B) establish mechanisms for continuing communication
elements at all levels in the health and educational systems
concerning program test experience, modifications, and eval-
and work with all interested organizations, agencies, and
uation;
groups to assist in the development of more concerted, co-
(C) analyze, summarize, and disseminate information re-
operative approaches to meeting consumer needs;
garding experiences of diversified applications of recom-
(B) publicize the latest information on technological
mended models, components, and evaluation approaches; and
developments in health education and on effective health
(D) selectively field test measures, instruments, techniques,
education practices;
and model components as required for Center strategy design
activities.
(C) develop opportunities which will enable consumer's
and citizen's groups to become effective advocates for health
(6) Included in the activities of the Center authorized for ac-
education in their communities: and
complishment of the purposes set forth in this section are among
(D) publicize and work with other public or private or-
others not specifically named-
ganizations, agencies (including the Office), and groups to
(A) to obtain grants from and to make contracts with indi-
secure widespread endorsement and implementation of the
viduals and with private, State, and Federal agencies, orga-
nizations and institutions.
Center's policies and recommendations.
(4) The Center shall assist in accelerating the incorporation
(b) The Center in carrying out its functions under this section may
of improved technology into health education practice by estab-
prescribe such regulations as it deems necessary.
lishing a system of technical assistance and training and by mak-
ADVISORY PANEL
ing available the expertise of other cooperating organizations,
as well as its own staff, in response to the needs of National,
SEC. 1714. The board shall appoint an advisory panel comprised
State, and local groups for assistance in improving the planning,
of one hundred individuals appropriate competencies and abili-
implementation, and evaluation. of their health education pro-
ties. The principal function of the advisory panel shall be to provide
grams. In the performance of this function, the Center shall-
advice for members of the Board. Additionally, it shall serve as a
(A) identify individuals with specialized skills, knowledge,
primary source for appointments to special committees, task forces,
and experience for involvement in the Center's policy and
and conferences. The advisory panel shall receive all Center reports.
strategy functions, for work on specialized cooperative proj-
ects, and for response to external requests for assistance;
REPORT TO CONGRESS
(B) develop a cadre of consultants and trainers and estab-
lish mechanisms for their use by organizations, agencies, and
SEC. 1715. The Center shall submit an annual report to the President
groups requesting the Center's assistance;
for transmittal to the Congress. The report shall include a comprehen-
(C) stimulate and assist in the development and provide
sive and detailed report of the Center's operations; activities, financial
practical and tested models, intsruments and procedures for
condition, and acéomplishments under this title and may include such
health education program planning and assessment, for train-
recommendations as the Center deems appropriate.
ing of health education providers, and for consumer and com-
munity involvement in the planning, implementation, and
FINANCING
evaluation of health education strategies and programs; and
(D) identify information, training, research, and planning
Sec. 1716. (α) There are authorized to be appropriated to the Center
for the purposes of carrying out the functions enumerated in section
77
76
TECHNICAL AMENDMENTS
1716 of this Act $1,000,000 for fiscal year ending June 30, 1976;
$1,000,000 for the fiscal year ending June 30, 1977; $1,000,000 for the
SEC. 303. (a) Subsection (c) of section 306 of the Public Health
fiscal year ending June 30, 1978.
Services Act is redesignated subsection (c) (2), and a new subsection
(b) In addition to the sums authorized to be appropriated by
(c) (1) is inserted immediately preceding subsection (c) (2), to read
paragraph (a) of this subsection, the Center is authorized to receive
as follows:
income, grants, donations, bequests, or other contributions from non-
(c) (1) The Center shall make a continuing survey of the needs, in-
Federal sources.
terests, attitudes, knowledge, and behavior of the American public re-
RECORDS AND AUDIT
garding health. The Center shall transmit the findings of such surveys
and of the findings of similar surveys contracted for or otherwise ob-
SEC. 1714. The board shall appoint an advisory panel comprised
tained by the Center and conducted by national health education orga-
in accordance with generally accepted auditing standards by inde-
nizations and community health education organizations accompanied
pendent licensed public accountants certified or licensed by a regu-
by appropriate Center analysis, if any, to the Secretary, the Assistant
latory authority of a State or other political subdivision of the United
Secretary for Health, and to the Office of Consumer Health Education
States. The audits shall be conducted at the place or places where the
and Promotion for their use in formulating policies respecting health
accounts of the Cenater are normally kept.
education and promotion.
(b) The report of each such independent audit shall be included in
(b) Subsection (i) of section 308 of the Public Health Service Act is
the annual report required by section 208. The audit report shall set
amended by adding the following new paragraph (3) after paragraph
forth the scope of the audit and include such statements as are neces-
(2) :
sary to present fairly the Center's assets and liabilities, surplus or
(3) Of those sums appropriated by Congress under section 308 of
deficit, with an analysis of the changes therein during the year, supple-
the Act not less than $1,000,000 for the fiscal year ending June 30,
mented in reasonable detail by a statement of the Center's income and
1976, $1,000,000 for the fiscal year ending June 30, 1977, and $1,000,000
expenses during the year, and a statement of the sources and appli-
for the fiscal year ending June 30, 1978, shall be made available to
cation of funds, together with the independent auditor's opinion of
carry out the activities of section 306 (1).
those statements.
GRANTS FOR WATER TREATMENT PROGRAMS
SEC. 1718. (a) There are hereby authorized to be appropriated
$2,000,000 for the fiscal year ending June 30. 1976; $3,000,000 for the
fiscal year ending June 30, 1977, and $4,000,000 for the fiscal year
ending June 30, 1978; which shall be used by the Secretary to make
grants, only in such instances where the applicant voluntarily requests
such assistance, to States, political subdivisions of States, and other
public or nonprofit private engencies, organization, and institutions
to assist them in initiating, in communities, or in public elementary or
secondary schools, water treatment programs designed to reduce
the incidence of oral disease or dental defects among residents of such
communities or the students in such schools (as the case may be).
(b) Grants under this section may be utilized for (but are not
limited to) the purchase and installation of water treatment
equipment.
(c) Grants under this section shall not exceed 80 per centum of the
cost of the treatment program with respect to which such grant under
this section is made.
DEFINITIONS
SEC. 1719. For purposes of this Act-
(A) "Health education and promotion" is a process that
favorably influences understanding. attitudes, and conduct. in-
cluding cultural awareness and sensitivity, in regard to individual
and community health. Specifically, it affects and influences indi-
vidual and community health behavior and attitudes in order to
moderate self-imposed risks, maintain and promote physical and
mental health and efficiency, and reduce preventable illness, dis-
ability and death.
Calendar No. 606
94TH CONGRESS
SENATE
REPORT
2d Session
94-634
LEAD-BASED PAINT POISONING PREVENTION
AMENDMENTS OF 1976
FEBRUARY 17, 1976.-Ordered to be printed
Mr. KENNEDY, from the Committee on Labor and Public Welfare,
submitted the following
REPORT
[To accompany S. 1664]
The Committee on Labor and Public Welfare, to which was referred
the bill (S. 1664) to amend the Lead-Based Paint Poisoning Preven-
tion Act having considered the same, reports favorably thereon with
an amendment and recommends that the bill as amended do pass.
I. PURPOSE
The purpose of the Committee reported bill, S. 1664, is to extend
the provisions of the Lead-Based Paint Poisoning Prevention Act,
P.L. 91-695, and to improve the procedures to achieve that goal.
The provisions of the committee reported bill do not revise the
principal purpose of existing legislation.
The Lead Based Paint Poisoning Prevention Act, Public Law 91-
695, was enacted into law January 13, 1971, and seeks to eliminate
childhood lead based paint poisoning by screening and testing children
for high blood lead levels. The law also authorizes the Department of
Health, Education, and Welfare to conduct programs to eliminate the
hazards of lead based paint poisoning. Under the provisions of the
Lead Based Paint Poisoning Prevention Act, the Secretary of the
Department of Health, Education, and Welfare is authorized to make
grants to units of local and State government for community based
testing, screening, and hazard elimination programs.
In addition, the Secretary of the Department of Housing and Urban
Development (in consultation with the Secretary of the Department
of Health, Education, and Welfare) is authorized to conduct research
to determine the most effective means for removing the hazards of
lead poisoning in those residences that present a high risk to the health
of young children. Under the Appropriations Act of August 10, 1971,
57-010
2
3
for the Departments of Labor and Health, Education, and Welfare
5. Doctor Ellen Silbergeld, a Joseph P. Kennedy Fellow in
and related agencies, $7.5 million were appropriated to carry out the
provisions of Titles I and II of the Lead Based Paint Poisoning Pre-
Neurosciences, Department of Environmental Medicine, The
Johns Hopkins University.
vention Act for FY 1972; and for these same titles $7.5 million were
6. Dr. Laurence Finberg, Montefiore Hospital and Medical Cen-
appropriated for FY 1973, under a continuing resolution.
ter, Bronx, New York, American Academy of Pediatrics.
The appropriations act for the Departments of Labor, Health, Edu-
7. Doctor Nahman Greenberg, Medical Director, Childhood
cation, and Welfare and related agencies dated December 18, 1973
allocated $9 million for these titles for FY 1974, the same amount was
Health. Lead Poisoning Control Program, City of Chicago Board of
allocated for FY 1975, and $3.5 million is the budget request for FY
1976. However, because no authorization was approved for FY 1976,
8. Mr. Mark Silbergeld, Counsel Consumers' Union, Washing-
ton, D.C.
funding remained at the level approved for the previous fiscal year.
9. Robert A. Roland, Executive Vice President, National Paint
The Administration requested appropriations of $8.5 million under
the authority of Section 314(e) of the Public Health Service Act for
and Coatings Association, accompanied by John M. Montgomery,
General Counsel, and Rayla A. Brown, Technical Director.
fiscal year 1973. The Congress appropriated $12 million for program
operations during 1973 as authorized by Titles I and II of P.L. 91-695.
Panel consisting of
However, as a result of the presidential veto of HEW appropriations
10. Robert Klein, Director, Massachusetts Childhood Lead
for fiscal year 1973, Lead Poisoning programs were continued at the
Poisoning Prevention Program;
1972 level.
11. Ronald R. Jones, Director, Massachusetts Lead Poisoning
Appropriations have never been provided for the research authority
Prevention Program;
specified under Title III of the Act, which provides an authorization
12. Mrs. Grace Dalton;
of $3 million per year. However, the Secretary of the Department of
13. Mrs. Carolyn Gibbs, Director, Childhood Lead Poisoning
Housing and Urban Development conducted research as directed by
Prevention Program, Lynn, Massachusetts.
Title III during fiscal years 1971, 1972, and 1973, utilizing general re-
search authorities of the Department.
III. SUMMARY OF S. 1664
II. COMMITTEE CONSIDERATION
The provisions of S. 1664 are essentially designed to:
1. Provide assistance for protecting against the lead based paint
S. 1664 was introduced on May 6, 1975 by Senator Kennedy for him-
poisoning hazard in homes where cases of childhood lead based
self, Mr. Bayh, Mr. Brooke, Mr. Case, Mr. Clark, Mr. Philip A. Hart,
paint poisoning have been actually identified.
Mr. Haskell, Mr. Humphrey, Mr. Inouye, Mr. Jackson, Mr. Javits,
2. Authorize the Dept. of Health, Education & Welfare to safe-
Mr. McGee, Mr. McGovern, Mr. Magnuson, Mr. Pell, Mr. Percy, Mr.
guard against the application of lead based paints to any cooking,
Randolph, Mr. Ribicoff, Mr. Schweiker Mr. Hugh Scott, Mr. Staf-
drinking or eating utensil.
ford, Mr. Stevenson, Mr. Cranston and Mr. Williams.
3. Authorize the Dept of Housing and Urban Development to
The Senate Subcommittee on Health received testimony on the pro-
restrict the application of lead based paint in residential struc-
visions of S. 1664 in a hearing on June 16, 1975.
tures constructed or rehabilitated by the federal government, or
Witnesses appearing before the Health Subcommittee on S. 1664
with federal assistance.
included:
4. Authorize the Consumer Product Safety Commission to pro-
1. David J. Sencer, M.D., Director, Center for Disease Control
Public Health Service, Department of Health, Education, and
article. hibit the application of lead based paints to any toy or furniture
Welfare, accompanied by Vernon N. Houk, M.D., Director, En-
5. Limit the amount of lead contained in residential interior
vironmental Health Services Division, Bureau of State Services,
paints to no more than .06 percent, unless a majority of the mem-
Center for Disease Control.
bers of the Consumer Product Safety Commission agrees to an-
2. Claude Barfield, Deputy Assistant Secretary, Office of Re-
other level, not to exceed one half of one percent lead by weight.
search and Demonstration, Division of Policy Development and
This provision stipulates that such recommendation must be made
Research, Department of Housing and Urban Development, ac-
within six months after the date of enactment of the bill.
companied by Donald G. Glascoff, Jr., Associate Deputy General
These provisions are designed to seek needed support for those
Counsel; David Engel, Program Manager of the Department's
programs that local authorities insist must be adequately reinforced
Lead-Based Paint Research Project.
if the hazards of lead based paint poisoning are to be reduced.
3. Barbara Hackman Franklin, Commissioner, U.S. Consumer
Product Safety Commission, accompanied by Constance B.
IV. AUTHORIZATIONS
Newman, Commissioner, Consumer Product Safety Commission.
4. Doctor Herbert Needleman, Childrens' Hospital Center,
As introduced on May 6, 1975, the bill amending the Lead Based
Boston, Massachusetts.
Paint Poisoning Prevention Act authorized appropriations that sub-
stantially exceeded the level of appropriations authorized under pre-
4
5
vious legislation in order to provide funding authorizations necessary
to begin addressing the increase demand for aid to communities that
First, the Act is intended to spearhead the campaign for the elimi-
are seeking adequate help in the battle against the continuing hazards
nation of the hazards caused by existing lead based paint on the sur-
of childhood lead poisoning. However, the Committee reported bill
faces of residential structures housing those young children who are
sets forth revisions to the authorizations provided in the original bill
exposed to environmental health hazards. The Act also is intended to
in an effort to realistically accommodate the restraints that such health
provide resources to support programs that will search out those
programs have met in attempting to improve their funding. The total
youngsters already sickened by lead poisoning SO that they may receive
annual authorization approved in the bill reported by the committee
appropriate medical attention.
amounts to $91.5 million for three years beginning with fiscal year
Since 1971 when the Lead Based Paint Poisoning Prevention Act
1976: $37.5 million for Title I-testing and screening programs ad-
was enacted it has been clear to the Committee that we do not need
ministered by the Department of Health, Education, and Welfare;
extensive research to determine how to protect America's young chil-
$45 million for Title II-hazard elimination programs administered
dren from lead based paint poisoning. We have the technology to
by the Department of Housing and Urban Development; and $9 mil-
eliminate this pollutant and we know how to halt the damaging effects
lion for Title III-research and demonstration programs administered
of the disease.
by both The Departments of Health, Education, and Welfare and
Limiting the content of lead in paint has been the subject of con-
Housing, and Urban Development.
tinuing debate by many in the health field. The Committee seeks to
establish the minimum feasible paint lead level content that will both
V. COMMITTEE AMENDMENTS
safeguard the health of children and meet technological manufactur-
ing standards.
The committee reported bill includes two significant revisions to the
Witnesses testified before the committee that a majority of those
bill originally introduced on May 6, 1975.
paints currently produced for use in residences contain safe lead levels.
First, the committee bill amends the original bill to establish the
According to the testimony latex paints contain no more than 0.06%
lead content in paint at no more than 0.06% after six months from the
lead. Today's latex paints are used on most interior residential surfaces
date of enactment of this bill unless a majority of the members of the
and are reported to account for at least 75% of all paints used in
Consumer Product Safety Commission recommends another level of
America's homes. The testimony of consumer advocates and medical
lead in paint, that does not exceed 0.5% lead in paints intended for
experts support a lead content that includes no more than 0.06% lead
use on interior residential surfaces.
in paint. It is the committee's intention to require that limit for all
Second, the committee bill revised the authorized funding levels to
interior residential paints. Thus, the Consumer Product Safety Com-
provide:
mission has been directed to obtain available evidence for establishing
For screening programs under Title I: $10 million in fiscal year
a safe lead level that might range between 0.06% and 0.5% lead in
1976; $12.5 million in fiscal year 1977; and $15 million in fiscal
paint. Because the committee intends for an acceptable lead level to be
year year 1978.
established as efficiently as possible, the committee bill mandates the
For hazard elimination programs under Title II $5 million in
0.06% lead limit if a majority of the Consumer Product Safety Com-
fiscal year 1976; $15 million in fiscal year 1977; $25 million in
mission members have not recommended a different lead limit not to
fiscal year 1978.
exceed 0.5% lead content, within six months of the date of enactment
For research programs: $3 million during each of the fiscal
of this legislation.
years from fiscal year 1976 through 1978.
At the same time, the executive departments charged with the re-
The committee bill also specifies the jurisdiction for each of the
sponsibility for administering the lead poisoning programs must also
appropriate federal agencies that are involved in helping to guard
continue to implement the provisions of the law. The committee there-
against the hazards caused by lead based paint poisoning. Accord-
fore detailed the specific lines of concern and jurisdiction for the rele-
ingly, the Department of Health, Education, and Welfare is charged
vant agencies of the Federal government. Hopefully, by timely
with the responsibility to guard against the use of lead based paints
establishment of safe lead levels and with vigorous implementation
on any cooking, eating or drinking utensil. The Department of Hous-
of provisions for cleaning up the lead poisoning hazard in the homes
ing and Urban Development is responsible for safeguards that will
of sick children, there will be fewer and fewer lead poisoning victims.
prohibit the use of lead based paints on the surfaces of any residences
The committee was deeply impressed by those witnesses who insist
that are constructed or rehabilitated with federal assistance. And the
that the effort to search out lead sick victims must continue in concert
Consumer Product Safety Commission is responsible for safeguards
with programs that are designed to remove the lead poisoning hazard
that can prohibit the use of lead based paints on any toy or item of
from exposure to young children who have been lead sickened.
furniture.
VI. COMMITTEE VIEWS
Revised Lead Content Requirements
The allowable amounts of lead in paint have been reviewed since
Throughout the life of the programs authorized by this legislation,
1973 when amendments to the Lead Based Paint Poisoning Prevention
it has been the committee's intention that two fundamental purposes
Act established levels of lead content for residential interior paints
be advanced by the Lead Based Paint Poisoning Prevention Act:
under the existing statute. Under the present law such paints are re-
6.
7
quired to contain no more than .5% lead, prior to December 31, 1974;
concludes that there is no need for a .06 percent standard because no
and after December 31, 1974, such paints would be required to contain
unreasonable hazard is shown at the current (0.5 percent level).
no more than .06% lead, unless, the Chairman of the Consumer Prod-
Essentially the controversy about .5% versus .06% centers on two
uct Safety Commission (hereinafter referred to as CPSC) recom-
fundamentals; first, there is the technological issue of whether the
mended to the Congress "that another level of lead, not to exceed five
lower limit can be actually attained using current manufacturing pro-
tenths of 1 per centum, is safe." And, if SO recommended, the other
cedures. And second, there is the medical demand to maximize the
level would then become effective.
safety of young children by minimizing those health hazards to which
The CPSC Chairman, Richard O. Simpson, submitted recommenda-
young children may be exposed. The subcommittee had received testi-
tions to the Congress on December 23, 1974, in which he called for a
mony in 1972 that "lead free" paints can be and are being produced.
continuation of the existing requirement that lead levels for interior
Officials from the DHEW testified in 1975 that approximately 70%
residential paints remain at .5%. Immediate criticism of the Chair-
of all interior residential paints currently produced in this country
man's report was received by the Health Subcommittee from the med-
contain no more than 0.06% lead. And medical authorities insist that
ical community, from consumer groups and from authorities in the
the maximum possible safe limit ought to be provided if we are seri-
Chicago, Illinois Department of Health, where the lower lead level of
ously committed to the demand to guard against the lead poisoning
.06% had already been enacted under a city ordinance.
hazard.
Criticism of Chairman Simpson's decision centered on the research
Since the Congress intended to involve all the members of the CPSC
and methodology used in the experiments, conducted by the New York
in the determination of what constitutes a safe level of lead in paint
University Medical Center Department of Environmental Medicine
under provisions of the 1973 amendments to P.L. 91-695, and since it is
and the Southwest Foundation for Research and Education. Experts
clear that only the Chairman was involved in issuing a recommenda-
testified in hearings before the subcommittee that the conclusions of
tion to the Congress, the Committee reported bill adopted an amend-
the CPSC Chairman may not be validly applied to the effects of lead
ment requiring the CPSC to submit a recommendation to the Congress
in small children.
based upon a majority vote of all members of the Commission, within
As Dr. Lawrence Feinberg, who represented the American Academy
six months of the date of enactment of the 1975 amendments. To de-
of Pediatrics, indicated in his testimony, "
a
significant
number
of
velop its evaluation, the Commission is authorized to obtain public
children would ingest a good deal more in the way of paint chips or
testimony, and available scientific evidence including recommendations
painted plaster than they assumed for the purpose of the experiment.
from the Center for Disease Control, the American Academy of Pedi-
Moreover, many children would ingest at an irregular rate, rather
atrics and the National Academy of Sciences. In the absence of a rec-
than at a slow steady rate, with large, transintestinal gradients and
ommendation from the Commission within six months from the date
sudden influxes of lead. Moreover the animals used in the experiments
of enactment of the amendment, the lower level, 0.06%, will become
were fed an iron-rich diet which increases their tolerance of lead
effective.
whereas the characteristic lead poisoned child has a deficient diet to
Prohibitions Against the Use of Lead Based Paint
begin with and thereby has an even lower resistance to lead."
The 1973 amendments to the Lead Based Paint Poisoning Preven-
Other objections to the studies were concerned with the age of the
tion Act prohibited the application of lead paints to toys, furniture,
animals used for the experiments. Dr. Feinberg's testimony indicated
utensils used for eating, cooking, and drinking, and to the interior
that "the age in the animals of the studies would not necessarily be
surfaces of federally controlled residential structures. The committee
comparable for lead absorption as it relates to children. There are some
favorably considered an amendment to assign authority for providing
good data showing that absorption of lead from the intestine varies
safeguards against the use of lead paint to specific federal agencies
with age. The younger the animal, the higher the percent absorption."
and the bill reported by the committee-
This information is crucial since the threat of lead paint poisoning is
1. Authorized the Department of Health, Education, and Wel-
more prevalent among children under the age of five where the condi-
fare to develop procedures that will prohibit the application
tion known as pica is more prevalent. Critics contended that the age
of lead based paint to any utensil used for cooking, eating or
factor was not adequately considered during the review of the effects
drinking;
of lead on young children in the studies upon which the CPSC Chair-
2. Authorized the Department of Housing and Urban Develop-
man based his recommendations.
ment to control the application of lead paints to residential struc-
Mr. Robert R. Roland, Executive Vice President, of the National
tures receiving federal assistance for any purpose including
Paint and Coatings Association, in his testimony before the subcom-
assistance for construction and rehabilitation; and
mittee, supported the evaluation of CPSC Chairman Richard Simpson.
3. Authorized the Consumer Product Safety Commission to take
Mr. Roland said, "I do not think there is a risk, and I do not think
the steps necessary to prohibit the application of lead based paints
that empirical data, outside human data, epidemiological data, has
on any toy or an article of furniture.
shown that the half percent presents a risk." He added, "
This
These agencies had already assumed the responsibilities described
evaluation by the Chairman and the staff of the government agency
and the purpose of this provision is to clarify their respective
whose prime purpose is to make determinations of product safety,
jurisdictions.
8
9
Grants For Hazard Elimination Programs
screening and follow-up hazard elimination programs are conducted
The Lead Based Paint Poisoning Prevention Act authorized the
by those local authorities receiving funds for that purpose.
Department of Health, Education, and Welfare to conduct programs
Section (d) amends Section 401 of such Act by authorizing the
in local communities that would eliminate the lead poisoning hazard
following agencies to provide safeguards against the use of lead based
in those homes where the risk of lead poisoning is greatest. Upon
paint as follows:
enactment of the law, the Department of Health, Education, and
The Secretary of Health, Education, and Welfare shall take steps.
Welfare sought to establish programs that would identify those
necessary to prohibit the application of lead based paint to any utensil
youngsters suffiering from the effects of this disease. Since enactment
used for eating, cooking or drinking; the Secretary of Housing and
of the law in 1971, local health officials have realized that the treat-
Urban Development shall take appropriate steps to prohibit the use
ment of lead sick children cannot be effective without eliminating the
of lead based paints in any residential structure receiving federal
lead hazard from the homes in which the affected children reside.
assistance for any purpose including construction or rehabilitation;
Authorities from Boston City Hospital testified that lead sick child-
and the Consumer Product Safety Commission shall take appropriate
ren received direct medical attention in their treatment facility. Dur-
steps to prohibit the application of lead based paint to any toy or to
ing hospitalization, Boston City Hospital employees are assigned to
any article of furniture.
remove the lead paint hazard from the walls of the child's home. Once
Section (e) amends Section 501 (3) of such Act by establishing
they are returned home, those children receive continued protection
allowable limits of lead contained in paints intended for use on interior
because the source of the disease has been removed. Doctors know that
residential structures. Under the provisions of this section such paints-
paint chips peeling from the walls of deteriorating homes can be the
may contain no more than 0.06% lead within six months from the date
principal source of lead poisoning for those young children whose
this amendment is enacted.
parents cannot prevent them from swallowing the sweet tasting parti-
During that period, the Consumer Product Safety Commission is
cles. For that reason, the reported bill authorizes the Department of
authorized to obtain evidence from public testimony to determine
Health, Education, and Welfare to allow local lead poisoning screen-
whether the allowable level of lead in paint should be established
ing programs to include a hazard elimination component, that can
beyond .06%, but not to exceed 0.5%. By a majority vote of all the
operate in concert with the local effort to search out and refer for
Commissioners, the allowable level will be determined based upon
treatment, those youngsters who are found to be lead sick.
the Commissioner's review of available scientific evidence including
recommendations of the Center for Disease Control, the National
VII. TABULATION OF VOTES CAST IN COMMITTEE
Academy of Sciences and the American Academy of Pediatrics.
Section (f) (1) amends Section 503 (a) of such Act by extending
Pursuant to section 133 (b) of the Legislative Reorganization Act of
the authorization levels to $10 million for FY 1976; $12.5 million for
1946 as amended, the following is a tabulation of votes in committee:
FY 1977, and $15 million for FY 1978.
Motion to report the bill to the Senate carried without objection.
Section (f) (2) amends Section 503 (b) of such Act by extending the
authorization levels to $5 million for FY 1976; $15 million for FY
VIII. COST ESTIMATES PURSUANT TO SECTION 252 OF THE LEGISLATIVE
1977 and $25 million for FY 1978.
REORGANIZATION Acr OF 1970
Section (f) (3) amends Section 503 (c) of such Act by extending the
authorization levels to $3 million for each fiscal year until June 1978.
Millions
1976
$18. 0
CHANGES IN EXISTING LAW
1977
30. 5
1978
43. 0
In compliance with paragraph 4 of the rule XXIX of the Standing
Total
91. 5
Rules of the Senate, changes in existing law made by the bill, as
reported, are shown as follows (existing law proposed to be omitted
IX. SECTION BY SECTION ANALYSIS
is enclosed in black brackets, new matter is printed in italic, existing
Section (a) labels this bill as the "Lead Based Paint Poisoning
law in which no change is proposed is shown in roman)
Prevention Amendments of 1976."
LEAD-BASED PAINT POISONING PREVENTION Act, AS AMENDED
Section (b) amends section 101 (c) (3) of the Lead Based Paint
Poisoning Prevention Act by authorizing the Department of Health,
Education, and Welfare to conduct hazard elimination programs as
[Public Law 91-695, January 13, 1971]
follow-up procedures that can clean up those areas most likely to
[Public Law 93-151, November 9, 1973]
cause lead poisoning in the homes of children who have been found
to be lead sick.
AN ACT To provide Federal financial assistance to help cities and communities
Section (c) amends Section of such Act by requiring the
to develop and carry out intensive local programs to eliminate the causes of
Secretary of Health, Education, and Welfare to insure that local
lead-based paint poisoning and local programs to detect and treat incidents of
such poisoning, to establish a Federal demonstration and research program to
S. Rept. 94-634-2
10
11
study the extent of the lead-based paint poisoning problem and the methods
(f) (1) No grant may be made under this section unless the Secre-
available for lead-based paint removal, and to prohibit future use of lead-based
tary determines that there is satisfactory assurance that (A) the
paint in Federal or federally assisted construction or rehabilitation.
services to be provided will constitute an addition to, or a significant
Be it enacted by the Senate and House of Representatives of the
improvement in quality (as determined in accordance with criteria of
United States of America in Congress assembled, That this Act may be
the Secretary) in, services that would otherwise be provided, and (B)
cited as the "Lead-Based Paint Poisoning Prevention Act".
Federal funds made available under this section for any period will
be so used as to supplement and, to the extent practical, increase the
TITLE I-GRANTS FOR THE DETECTION AND TREAT-
level of State, local, and other non-Federal funds that would, in the
MENT OF LEAD-BASED PAINT POISONING
absence of such Federal funds, be made available for the program
described in this section, and will in no event supplant such State,
GRANTS FOR LOCAL DETECTION AND TREATMENT OF LEAD-BASED PAINT
local, and other non-Federal funds.
POISONING
(2) No grant may be made under this section unless the Secretary
determines that there is satisfactory assurance that the services to be
SEC. 101. (a) The Secretary of Health, Education, and Welfare
provided will be curried out in accordance with subsections (c) and
(hereafter referred to in this title as the "Secretary") is authorized to
(d) of this section.
make grants to public agencies of units of general local government in
any State and to private nonprofit organizations in any State for the
TITLE II-GRANTS FOR THE ELIMINATION OF
purpose of assisting such units in developing and carrying out local
LEAD-BASED PAINT POISONING
programs to detect and treat incidents of lead-based paint poisoning.
(b) The amount of any such grant shall not exceed [75] 90 per
SEC. 201. The Secretary of Health, Education, and Welfare is
centum of the cost of developing and carrying out a local program, as
authorized to make grants to public agencies of units of general local
approved by the Secretary, during a period of three years.
government in any State and to private nonprofit organizations in any
(c) A local program should include-
State for the purpose of assisting such units in developing and carry-
(1) educational programs intended to communicate the health
ing out programs that identify those areas that present a high risk
danger and prevalence of lead-based paint poisoning among chil-
to the health of residents because of the presence of lead-based paints
dren of inner city areas, to parents, educators, and local health
on interior surfaces, and then to develop and carry out programs to
officials;
eliminate the hazards of lead-based paint poisoning.
(2) development and carrying out of intensive community
(a) A local program should include:
testing programs designed to direct incidents of lead-based paint
(1) development and carrying out of comprehensive testing
poisoning among community residents, and to insure prompt
programs to detect the presence of lead-based paints on surfaces
medical treatment for such afflicted individuals;
of residential housing;
(3) development and carrying out of intensive followup pro-
[(2) the development and carrying out of a comprehensive pro-
grams to insure that identified cases of lead-based paint poisoning
gram requiring the prompt elimination of lead-based paints from
are protected against further exposure to lead-based [paints]
all interior surfaces, porches, and exterior surfaces to which chil-
paint hazards in their living [environment; and] environment
dren may be commonly exposed, of residential housing on which
by eliminating lead-based paint hazards from surfaces in and
lead-based paints have been used as a surface covering, including
around residential dwelling units or houses when the owner of
those surfaces on which non-lead-based paints have been used to
said units or houses is financially unable to eliminate such lead-
cover surfaces to which lead-based paints were previously applied;
based paint hazards. Priority for local lead elimination programs
and]
shall go to units or houses where there reside children with ele-
(2) the development and carrying out of procedures to re-
vated body lead burden or diagnosed lead-based paint poisoning,
move from exposure to young children all interior surfaces of
or both; and
residential housing, porches, and exterior surfaces of such housing
(4) any other actions which will reduce or eliminate lead-based
to which children may be commonly exposed, in those areas that
paint poisoning.
present a high risk for the health of residents because of the pres-
(d) Each local program shall afford opportunities for employing
ence of lead based paints. Such programs should include those
the residents of communities or neighborhoods affected by lead-based
surfaces on which non-lead-based paints have been used to cover
paint poisoning, and for providing appropriate training, education,
surfaces to which lead based paints were previously applied; and
and any information which may be necessary to inform such residents
(3) any other actions which will reduce or eliminate lead-based
of opportunities for employment in lead-based paint poisoning
paint poisoning.
elimination programs.
(b) Each such program shall-
(e) The Secretary is also authorized to make grants to ,State agen-
(1) be consistent with the appropriate local program assisted
cies for the purpose of establishing centralized laboratory facilities
under section 101, and
for analyzing biological and environmental lead specimens obtained
(2) afford, to the maximum extent feasible, opportunities for
from local lead based paint poisoning detection programs.
employing the resident of communities or neighborhoods affected
13
12
may present such hazards and which is covered by an application for
by lead-based paint poisoning, and for providing appropriate
mortgage insurance or housing assistance payments under a program
training, education, and any information which may be necessary
administered by the Secretary. Such procedures shall apply to all such
to inform such residents of opportunities for employment in lead-
housing costructed prior to 1950 and shall as a minimum provide for
based paint elimination programs.
(1) appropriate measures to eliminate as far as practicable immediate
(c) Any public agency, of a unit of local government or private
hazards due to the presence of paint which may contain lead and to
nonprofit organization which receives assistance under this Act shall
which children may be exposed, and (2) assured notification to pur-
make available to the Secretary and the Comptroller General of the
chasers and tenants of such housing of the hazards of lead based paint,
United States, or any of their duly authorized representatives, for
of the symptoms and treatment of lead based paint poisoning, and of
purposes of audit and examination, any books, documents, papers, and
the importance and availability of maintenance and removal tech-
records that are pertinent to the assistance received by such public
niques for eliminating such hazards. Such procedures may apply to
agency of a unit of local government or private nonprofit organization
housing constructed during or after 1950 if the Secretary determines,
under this Act.
in his discretion, that such housing presents hazards of lead based
paint. The Secretary may establish such other procedures as may be
TITLE III-FEDERAL DEMONSTRATION AND RESEARCH
appropriate to carry out the purposes of this section. Further, the
PROGRAM; FEDERAL HOUSING ADMINISTRATION
Secretary shall establish and implement procedures to eliminate the
REQUIREMENTS
hazards of lead based paint poisoning in all federally owned proper-
ties prior to the sale of such properties when their use is intended for
FEDERAL DEMONSTRATION AND RESEARCH PROGRAM
residential habitation.
SEC. 301. (a) The Secretary of Housing and Urban Development, in
TITLE IV-PROHIBITION AGAINST FUTURE USE OF
consultation with the Secretary of Health, Education, and Welfare,
LEAD-BASED PAINT
shall develop and carry out a demonstration and research program
to determine the nature and extent of the problem of lead-based paint
poisoning in the United States, particularly in urban areas, [and the
PROHIBITION AGAINST USE OF LEAD BASED PAINT IN CONSTRUCTION OF
methods by wich lead-based paint can most effectively be removed
FACILITIES AND THE MANUFACTURE OF CERTAIN TOYS AND UTENSILS
from interior surfaces, porches, and exterior surfaces to which chil-
[Sec. 401. The Secretary of Health, Education, and Wèlfare, in
dren may be commonly exposed, of residential housing. Within one
consultation with the Secretary of Housing and Urban Development,
year after the date of the enactment of this Act the Secretary shall
shall take such steps and impose such conditions as may be necessary
submit to the Congress a full and complete report of his findings and
or appropriate-
recommendations as developed pursuant to such program, together
(1) to prohibit the use of lead based paint in residential struc-
with a statement of any legislation which should be enacted, and any
tures constructed or rehabilitated by the Federal Government, or
changes in existing law which should be made, in order to carry out
with Federal assistance in any form, after the date of enactment
such recommendations.] including the methods by which the lead based
of this Act, and
paint hazard can most effectively be removed from interior surfaces,
(2) to prohibit the application of lead based paint to any toy,
porches, and exterior surfaces of residential housing to which children
furniture, cooking utensil, drinking utensil, or eating utensil man-
may be exposed.
ufactured and distributed after the date of enactment of this
(b) The Chairman of the Consumer Product Safety Commission
Act.
shall conduct appropriate research on multiple layers of dried paint
film, containing the various lead compounds commonly used, in order
PROHIBITION AGAINST USE OF LEAD-BASED PAINT IN CONSTRUCTION OF
to ascertain the safe level of lead in residential paint products. No
FACILITIES AND THE MANUFACTURE OF CERTAIN TOYS AND UTENSILS
later than December 3, 1974, the Chairman shall submit to Congress
a full and complete report of his findings and recommendations as
SEC. 401. (a) The Secretary of Health, Education, and Velfare shall
developed pursuant to such programs, together with a statement of
take such steps and impose such conditions as may be necessary or ap-
any legislation which should be enacted or any changes in existing law
propriate to prohibit the application of lead-based paint to any cook-
which should be made in order to carry out such recommendations.
ing utensil, drinking utensil, or eating utensil manufactured and dis-
tributed after the date of enactment of this Act.
FEDERAL HOUSING ADMINISTRATION REQUIREMENTS
(b) The Secretary of Housing and Urban Development shall take
SEC. 302. The Secretary of Housing and Urban Development (here-
such steps and impose such conditions as may be necessary or appropri-
after in this section referred to as the "Secretary" shall establish
ate to prohibit the use of lead-based paint in residential structures
procedures to eliminate as far as practicable the hazards of lead
constructed or rehabilitated by the Federal Government, or with Fed-
based paint poisoning with respect to any existing housing which
eral assistance in any form after the date of enactment of this Act.
14
15
(c) The Consumer Product Safety Commissions shall take such steps
CONSULTATION WITH OTHER DEPARTMENTS AND AGENCIES
and impose such conditions as may be necessary or appropriate to pro-
SEC. 502. In carrying out the authority under this Act, the Secretary
hibit the application of lead-based paint to any toy or furniture article.
of Health, Education, and Welfare shall cooperate with and seek the
advice of the heads of any other departments or agencies regarding
TITLE V-GENERAL
any programs under their respective responsibilities which are related
to, or would be affected by, such authority.
DEFINITIONS
SEC. 501. As used in this Act-
APPROPRIATIONS
(1) the term "State" means the several States, the District of
SEC. 503. (a) There is hereby authorized to be appropriated to carry
Columbia, the Commonwealth of Puerto Rico, and the territories
out the provisions of title I of this Act not to exceed $10,000,000 for
and possessions of the United States;
fiscal year 1976; $12,500,000 for fiscal year 1977 and $15,000,000 for
(2) the term "units of general local government" means (A)
fiscal year 1978;
any city, county, township, town, borough, parish, village, or other
(b) There is hereby authorized to be appropriated to carry out the
general purpose political subdivisions of a State, (B) any com-
provisions of title II of this Act not to exceed $5,000,000 for the fiscal
bination of units of general local government in one or more
year 1976, $15,000,000 for the fiscal year 1977, and $25,000,000 for the
States, (C) and Indian tribe, or (D) with respect to lead-based
fiscal year 1978"; and
paint poisoning elimination activities in their urban areas, the
(c) There is hereby authorized to be appropriated to carry out the
territories and possessions of the United States; and
[(3) the term "lead based paint" means—
provisions of title III of this Act not to exceed "$3,000,000 for each of
(A) prior to December 31, 1974, any paint containing
the fiscal years 1976, 1977, and 1978".
more than five-tenths of 1 per centum leda by weight (calcu-
(d) Any amounts appropriated under this section shall remain
lated as lead metal) in the total nonvolatile content of liquid
available until expended when so provided in appropriation Acts;
paints or in the dried film of paint already applied;
[and any amounts authorized for the fiscal year 1971 but not appro-
(B) after December 31, 1974, any paint containing more
priated may be appropriated for the fiscal year 1972.] and any
than six one-hundredths of 1 per centum lead by weight (cal-
amounts authorized for one fiscal year but not appropriated may be
culated as lead metal) in the total nonvolatile content of
appropriated for the succeeding fiscal year.
liquid paints or in the dried film of paint already applied,
ELIGIBILITY OF CERTAIN STATE AGENCIES
except that if prior to December 31, 1974, the Chairman of
the Consumer Product Safety Commission, based on studies
SEC. 504. Notwithstanding any other provision of this Act, grants
conducted in accordance with section 301 (b) of this Act,
authorized under sections 101 and 201 of this Act may be made to an
determines that another level of lead, not to exceed five-
agency of State government in any case where State government pro-
tenths of 1 per centum, is safe, then such other level shall be
vides direct services to citizens in local communities or where units of
effective after December 31, 1974.]
general local government within the State are prevented by State law
(3) the term "lead-based paint" means-
from implementing or receiving such grants or from expending such
(A) within 6 months of the date of enactment of this
grants in accordance with their intended purpose.
amendment any paint containing more than five-tenths of
ADVISORY BOARDS
1 percentum lead by weight (calculated as lead metal) in the
total nonvolatile content of lead paints, or the equivalent
SEC. 505. (a) The Secretary of Health, Education, and Welfare, in
measure of lead in the dried film of paint already applied,
consultation with the Secretary of Housing and Urban Development,
or both;
is authorized to establish a National Childhood Lead Bosed Paint
(B) after 6 months from the date of enactment of the
Poisoning Advisory Board to advise the Secretary on policy relating
amendment, any paint containing more than six-hundredths
to the administration of this Act. Members of the Board shall include
of 1 percentum lead by weight (calculated as lead metal) in
residents of communities and neighborhoods affected by lead based
the total nonvolatile content of lead paints, or the equivalent
paint poisoning. Each member of the National Advisory Board who
measure of lead in the dried film of paint already applied, or
is not an officer of the Federal Government is authorized to receive an
both, except that
amount equal to the minimum daily rate prescribed for GS-18, under
(C) the Consumer Product Safety Commission shall on the
section 5332 of title 5, United States Code, for each day he is engaged
basis of public testimony and available scientific evidence
in the actual performance of his duties (including traveltime) as a
(which shall include the recommendations of the Center for
member of the Board. All members shall be reïmbursed for travel, suò-
Disease Control, the American Academy of Pediatrics and
sistence, and necessary expenses incurred in the performance of their
the National Academy of Sciences) determine within 6,
duties.
months of the date of enactment of this amendment whether
(b) The Secretary at Health, Education, and Welfare, in consulta-
another level of lead, not to exceed five-tenths of 1 percentum,
tion with the Secretary of Housing and Urban Development, shall
is safe, in which case such other level shall be effective after
promulgate regulations for establishment of an advisory board for
6 months from the date of enactment of this amendment.
each local program assisted under this Act to assist in carrying out this
16
program. Two-thirds of the members of the board shall be residents of
communities and neighborhoods affected by lead based paint poison-
ing. A majority of the board shall be appointed from among parents,
who, when appointed, have at least one child under six years of age.
Each member of a local advisory board shall only be reimbursed for
necessary expenses incurred in the actual performance of his duties as
a member of the board.
EFFECT UPON STATE LAW
SEC. 506. It is hereby expressly declared that it is the intent of the
Congress to supersede any and all laws of the States and units of local
government insofar as they may now or hereafter provide for a re-
quirement, prohibition, or standard relating to the lead content in
paints or other similar surface-coating materials which differs from
the provisions of this Act or regulations issued pursuant to this Act.
Any law, regulation, or ordinance purporting to establish such dif-
ferent requirement, prohibition, or standard shall be null and void.
TITLE III-GENERAL POWERS AND DUTIES
OF PUBLIC HEALTH SERVICE
PART A-RESEARCH AND INVESTIGATION
IN GENERAL
*
Project Grants for Health Services Development
(e) There are authorized to be appropriated $90,000,000 for the
fiscal year ending June 30, 1968, $95,000,000 for the fiscal year ending
June 30, 1969, $80,000,000 for the fiscal year ending June 30, 1970,
$109,500,000 for the fiscal year ending June 30, 1971, $135,000,000 for
the fiscal year ending June 30, 1972, and $157,000,000 for the fiscal
year ending June 30, 1973, for grants to any public or nonprofit private
agency, institution, or organization to cover part of the cost (includ-
ing equity requirements and amortization of loans on facilities ac-
quired from the Office of Economic Opportunity or construction in
connection with any program or project transferred from the Office
of Economic Opportunity) of (1) providing services (including
related training) to meet health needs of limited geographic scope or
of specialized regional or national significance, or (2) developing and
supporting for an initial period new programs of health services (in-
cluding related training). Any grant made under this subsection may
be made only if the application for such grant has been referred for
review and comment to the appropriate areawide health planning
agency or agencies (or, if there is no such agency in the area, then to
such other public or nonprofit private agency or organization (if any)
which performs similar functions) and only if the services assisted
under such grant will be provided in accordance with such plans as
have been developed pursuant to subsection (a).
No funds appropriated pursuant to the authorization of this sub-
section shall be available for lead based paint poisoning control of
the type authorized under the Lead Based Paint Poisoning Prevention
Act (84.Stat.2078).
S. 1466
Ainety-fourth Congress of the United States of America
AT THE SECOND SESSION
Begun and held at the City of Washington on Monday, the nineteenth day of January,
one thousand nine hundred and seventy-six
An Act
To amend the Public Health Service Act to provide authority for health informa-
tion and health promotion programs, to revise and extend the authority for
disease prevention and control programs, and to revise and extend the authority
for venereal disease programs, and to amend the Lead-Based Paint Poisoning
Prevention Act to revise and extend that Act.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
TITLE I-HEALTH INFORMATION AND HEALTH
PROMOTION
SHORT TITLE
SEC. 101. This title may be cited as the "National Consumer Health
Information and Health Promotion Act of 1976".
AMENDMENT TO PUBLIC HEALTH SERVICE ACT
SEC. 102. The Public Health Service Act is amended by adding at
the end thereof the following new title:
"TITLE XVII-HEALTH INFORMATION AND HEALTH
PROMOTION
"GENERAL AUTHORITY
"SEC. 1701. (a) The Secretary shall-
"(1) formulate national goals, and a strategy to achieve such
goals, with respect to health information and health promotion,
preventive health services, and education in the appropriate use
of health care;
"(2) analyze the necessary and available resources for imple-
menting the goals and strategy formulated pursuant to para-
graph (1), and recommend appropriate educational and quality
assurance policies for the needed manpower resources identified
by such analysis;
"(3) undertake and support necessary activities and programs
to-
"(A) incorporate appropriate health education compo-
nents into our society, especially into all aspects of education
and health care,
((B) increase the application and use of health knowledge,
skills, and practices by the general population in its patterns
of daily living, and
"(C) establish systematic processes for the exploration,
development, demonstration, and evaluation of innovative
health promotion concepts;
(4) undertake and support research and demonstrations
respecting health information and health promotion, preventive
health services, and education in the appropriate use of health
care;
S. 1466-2
"(5) undertake and support appropriate training in, and
undertake and support appropriate training in the operation of
programs concerned with, health information and health pro-
motion, preventive health services, and education in the appro-
priate use of health care;
"(6) undertake and support, through improved planning and
implementation of tested models and evaluation of results, effec-
tive and efficient programs respecting health information and
health promotion, preventive health services, and education in
the appropriate use of health care;
(7) foster the exchange of information respecting, and foster
cooperation in the conduct of, research, demonstration, and train-
ing programs respecting health information and health promo-
tion, preventive health services, and education in the appropriate
use of health care;
'(8) provide technical assistance in the programs referred to in
paragraph (7) ; and
(9) use such other authorities for programs respecting health
information and health promotion, preventive health services, and
education in the appropriate use of health care as are available and
coordinate such use with programs conducted under this title.
The Secretary shall administer this title in a manner consistent with
the national health priorities set forth in section 1502 and with health
planning and resource development activities undertaken under titles
XV and XVI.
"(b) For payments under grants and contracts under this title there
are authorized to be appropriated $7,000,000 for the fiscal year ending
September 30, 1977, $10,000,000 for the fiscal year ending Septem-
ber 30, 1978, and $14,000,000 for the fiscal year ending September 30,
1979.
"(c) No grant may be made or contract entered into under this title
unless an application therefor has been submitted to and approved
by the Secretary. Such an application shall be submitted in such form
and manner and contain such information as the Secretary may pre-
scribe. Contracts may be entered into under this title without regard
to sections 3648 and 3709 of the Revised Statutes (31 U.S.C. 529; 41
U.S.C.5).
"RESEARCH PROGRAMS
"SEC. 1702. (a) The Secretary is authorized to conduct and support
by grant or contract (and encourage others to support) research in
health information and health promotion, preventive health services,
and education in the appropriate use of health care. Applications for
grants and contracts under this section shall be subject to appropriate
peer review. The Secretary shall also-
'(1) provide consultation and technical assistance to persons
who need help in preparing research proposals or in actually con-
ducting research;
(2) determine the best methods of disseminating information
concerning personal health behavior, preventive health services
and the appropriate use of health care and of affecting behavior
SO that such information is applied to maintain and improve
health, and prevent disease, reduce its risk, or modify its course or
severity;
"(3) determine and study environmental, occupational, social,
and behavioral factors which affect and determine health and
ascertain those programs and areas for which educational and
preventive measures could be implemented to improve health
as it is affected by such factors;
S. 1466-3
"(4) develop (A) methods by which the cost and effectiveness
of activities respecting health information and health promotion,
preventive health services, and education in the appropriate use
of health care, can be measured, including methods for evaluating
the effectiveness of various settings for such activities and the
various types of persons engaged in such activities, (B) methods
for reimbursement or payment for such activities, and (C) models
and standards for the conduct of such activities, including
models and standards for the education, by providers of institu-
tional health services, of individuals receiving such services
respecting the nature of the institutional health services provided
the individuals and the symptoms, signs, or diagnoses which
led to provision of such services;
" (5) develop a method for assessing the cost and effectiveness
of specific medical services and procedures under various condi-
tions of use, including the assessment of the sensitivity and
specificity of screening and diagnostic procedures; and
'(6) enumerate and assess, using methods developed under
paragraph (5), preventive health measures and services with
respect to their cost and effectiveness under various conditions
of use.
(b) The Secretary shall make a periodic survey of the needs,
interest, attitudes, knowledge, and behavior of the American public
regarding health and health care. The Secretary shall take into con-
sideration the findings of such surveys and the findings of similar
surveys conducted by national and community health education
organizations, and other organizations and agencies for formulating
policy respecting health information and health promotion, preven-
tive health services, and education in the appropriate use of health
care.
"COMMUNITY PROGRAMS
"SEC. 1703. (a) The Secretary is authorized to conduct and support
by grant or contract (and encourage others to support) new and inno-
vative programs in health information and health promotion, pre-
ventive health services, and education in the appropriate use of health
care, and may specifically-
"(1) support demonstration and training programs in such
matters which programs (A) are in hospitals, ambulatory care
settings, home care settings, schools, day care programs for chil-
dren, and other appropriate settings representative of broad
cross sections of the population, and include public education
activities of voluntary health agencies, professional medical
societies, and other private nonprofit health organizations, (B)
focus on objectives that are measurable, and (C) emphasize the
prevention or moderation of illness or accidents that appear
controllable through individual knowledge and behavior;
"(2) provide consultation and technical assistance to organiza-
tions that request help in planning, operating, or evaluating
programs in such matters;
"(3) develop health information and health promotion mate-
rials and teaching programs including (A) model curriculums
for the training of educational and health professionals and
paraprofessionals in health education by medical, dental, and
nursing schools, schools of public health, and other institutions
engaged in training of educational or health professionals, (B)
model curriculums to be used in elementary and secondary schools
and institutions of higher learning, (C) materials and programs
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for the continuing education of health professionals and parapro-
fessionals in the health education of their patients, (D) materials
for public service use by the printed and broadcast media, and
(E) materials and programs to assist providers of health care in
providing health education to their patients; and
"(4) support demonstration and evaluation programs for
individual and group self-help programs designed to assist the
participant in using his individual capacities to deal with health
problems, including programs concerned with obesity, hyperten-
sion, and diabetes.
"(b) The Secretary is authorized to make grants to States and
other public and nonprofit private entities to assist them in meeting
the costs of demonstrating and evaluating programs which provide
information respecting the costs and quality of health care or infor-
mation respecting health insurance policies and prepaid health plans,
or information respecting both. After the development of models pur-
suant to sections 1704(4) and 1704(5) for such information, no grant
may be made under this subsection for a program unless the informa-
tion to be provided under the program is provided in accordance with
one of such models applicable to the information.
"(c) The Secretary is authorized to support by grant or contract
(and to encourage others to support) private nonprofit entities work-
ing in health information and health promotion, preventive health
services, and education in the appropriate use of health care. The
amount of any grant or contract for a fiscal year beginning after Sep-
tember 30, 1978, for an entity may not exceed 25 per centum of the
expenses of the entity for such fiscal year for health information and
health promotion, preventive health services, and education in the
appropriate use of health care.
"INFORMATION PROGRAMS
"SEC. 1704. The Secretary is authorized to conduct and support by
grant or contract (and encourage others to support) such activities as
may be required to make information respecting health information
and health promotion, preventive health services, and education in
the appropriate use of health care available to the consumers of medical
care, providers of such care, schools, and others who are or should be
informed respecting such matters. Such activities may include at least
the following:
"(1) The publication of information, pamphlets, and other
reports which are specially suited to interest and instruct the
health consumer, which information, pamphlets, and other reports
shall be updated annually, shall pertain to the individual's abil-
ity to improve and safeguard his own health; shall include
material, accompanied by suitable illustrations, on child care,
family life and human development, disease prevention (particu-
larly prevention of pulmonary disease, cardiovascular disease,
and cancer), physical fitness, dental health, environmental health,
nutrition, safety and accident prevention, drug abuse and alco-
holism, mental health, management of chronic diseases (including
diabetes and arthritis), and venereal diseases; and shall be
designed to reach populations of different languages and of dif-
ferent social and economic backgrounds.
"(2) Securing the cooperation of the communications media,
providers of health care, schools, and others in activities designed
to promote and encourage the use of health maintaining infor-
mation and behavior.
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(3) The study of health information and promotion in adver-
tising and the making to concerned Federal agencies and others
such recommendations respecting such advertising as are
appropriate.
" (4) The development of models and standards for the publica-
tion by States, insurance carriers, prepaid health plans, and others
(except individual health practitioners) of information for use
by the public respecting the cost and quality of health care, includ-
ing information to enable the public to make comparisons of the
cost and quality of health care.
"(5) The development of models and standards for the publi-
cation by States, insurance carriers, prepaid health plans, and
others of information for use by the public respecting health
insurance policies and prepaid health plans, including informa-
tion on the benefits provided by the various types of such policies
and plans, the premium charges for such policies and plans,
exclusions from coverage or eligibility for coverage, cost sharing
requirements, and the ratio of the amounts paid as benefits to the
amounts received as premiums and information to enable the
public to make relevant comparisons of the costs and benefits of
such policies and plans.
(6) Assess, with respect to the effectiveness, safety, cost, and
required training for and conditions of use, of new aspects of
health care, and new activities, programs, and services designed
to improve human health and publish in readily understandable
language for public and professional use such assessments and,
in the case of controversial aspects of health care, activities, pro-
grams, or services, publish differing views or opinions respecting
the effectiveness, safety, cost, and required training for and con-
ditions of use, of such aspects of health care, activities, programs,
or services.
"REPORT AND STUDY
"SEC. 1705. (a) The Secretary shall, not later than two years after
the date of the enactment of this title and annually thereafter, sub-
mit to the President for transmittal to Congress a report on the status
of health information and health promotion, preventive health services,
and education in the appropriate use of health care. Each such report
shall include-
"(1) a statement of the activities carried out under this title
since the last report and the extent to which each such activity
achieves the purposes of this title;
(2) an assessment of the manpower resources needed to carry
out programs relating to health information and health promo-
tion, preventive health services, and education in the appropriate
use of health care, and a statement describing the activities cur-
rently being carried out under this title designed to prepare
teachers and other manpower for such programs;
" (3) the goals and strategy formulated pursuant to section
1701 (a) (1), the models and standards developed under this
title, and the results of the study required by subsection (b) of
this section and
"(4) such recommendations as the Secretary considers appro-
priate for legislation respecting health information and health
promotion, preventive health services, and education in the appro-
priate use of health care, including recommendations for revisions
to and extension of this title.
S. 1466-6
"(b) The Secretary shall conduct a study of health education
services and preventive health services to determine the coverage of
such services under public and private health insurance programs,
including the extent and nature of such coverage and the cost sharing
requirements required by such programs for coverage of such services.
"OFFICE OF HEALTH INFORMATION AND HEALTH PROMOTION
"SEC. 1706. The Secretary shall establish within the Office of the
Assistant Secretary for Health an Office of Health Information and
Health Promotion which shall-
"(1) coordinate all activities within the Department which
relate to health information and health promotion, preventive
health services, and education in the appropriate use of health
care;
"(2) coordinate its activities with similar activities of organiza-
tions in the private sector; and
"(3) establish a national information clearinghouse to facilitate
the exchange of information concerning matters relating to health
information and health promotion, preventive health services,
and education in the appropriate use of health care, to facilitate
access to such information, and to assist in the analysis of issues
and problems relating to such matters.".
TITLE II-DISEASE CONTROL
SHORT TITLE
SEC. 201. This title may be cited as the "Disease Control Amend-
ments of 1976".
AMENDMENTS TO SECTIONS 311 AND 317
SEC. 202. (a) Effective with respect to grants under section 317 of
the Public Health Service Act made from appropriations under such
section for fiscal years beginning after June 30, 1975, section 317 of
such Act is amended to read as follows:
"DISEASE CONTROL PROGRAMS
"SEC. 317. (a) The Secretary may make grants to States and, in con-
sultation with State health authorities, to public entities to assist them
in meeting the costs of disease control programs.
"(b) (1) No grant may be made under subsection (a) unless an
application therefor has been submitted to, and approved by, the
Secretary. Such application shall be in such form, be submitted in
such manner, and contain such information as the Secretary shall
by regulation prescribe and shall meet the requirements of para-
graph (2).
(2) An application for a grant under subsection (a) shall-
"(A) set forth with particularity the objectives (and their
priorities, as determined in accordance with such regulations as
the Secretary may prescribe) of the applicant for each of the
disease control programs it proposes to conduct with assistance
from a grant under subsection (a)
((B) contain assurances satisfactory to the Secretary that,
in the year during which the grant applied for would be available,
the applicant who are most susceptible to the diseases or conditions
to develop an awareness in those persons in the area served by
S. 1466-7
the applicant who are most susceptible to the diseases or conditions
referred to in subsection (f) of appropriate preventive behavior
and measures (including immunizations) and diagnostic pro-
cedures for such diseases, and (ii) to facilitate their access to such
measures and procedures; and
"(C) provide for the reporting to the Secretary of such infor-
mation as he may require concerning (i) the problems, in the area
served by the applicant, which relate to any disease or condition
referred to in subsection (f), and (ii) the disease control programs
of the applicant for which a grant is applied for.
In considering such an application the Secretary shall take into
account the relative extent, in the area served by the applicant, of
the problems which relate to one or more of the diseases or conditions
referred to in subsection (f) and the extent to which the applicant's
programs are designed to eliminate or reduce such problems. The
Secretary shall give special consideration to applications for programs
which (A) will increase to at least 80 per centum the immunization
rates of any population identified as not having received, or as having
failed to secure, the generally recognized disease immunizations, and
(B) to the fullest extent practicable, will cooperate and use public
and nonprofit private entities and volunteers. The Secretary shall
give priority to applications submitted for disease control programs
for communicable diseases.
"(c) (1) Each grant under subsection (a) shall be made for disease
control program costs in the one-year period beginning on the first
day of the first month beginning after the month in which the grant
is made.
"(2) Payments under grants under subsection (a) may be made
in advance on the basis of estimates or by way of reimbursement, with
necessary adjustments on account of underpayments or overpayments,
and in such installments and on such terms and conditions as the
Secretary finds necessary to carry out the purposes of this section.
"(3) The Secretary, at the request of a recipient of a grant under
subsection (a), may reduce the amount of such grant by-
"(A) the fair market value of any supplies (including vaccines
and other prevention agents) or equipment furnished the grant
recipient, and
"(B) the amount of the pay, allowances, and travel expenses
of any officer or employee of the Government when detailed to
the recipient and the amount of any other costs incurred in
connection with the detail of such officer or employee,
when the furnishing of such supplies or equipment or the detail of
such an officer or employee is for the convenience of and at the request
of such recipient and for the purpose of carrying out a program with
respect to which the recipient's grant under subsection (a) is made.
The amount by which any such grant is SO reduced shall be available
for payment by the Secretary of the costs incurred in furnishing the
supplies or equipment, or in detailing the personnel, on which the
reduction of such grant is based, and such amount shall be deemed as
part of the grant and shall be deemed to have been paid to the
recipient.
"(d) (1) The Secretary may conduct, and may make grants to and
enter into contracts with public and nonprofit private entities for the
conduct of-
"(A) training for the administration and operation of disease
prevention and control programs, and
"(B) demonstrations and evaluations of such programs.
S. 1466-8
"(2) No grant may be made or contract entered into under para-
graph (1) unless an application therefor is submitted to and approved
by the Secretary. Such application shall be in such form, be submitted
in such manner, and contain such information, as the Secretary shall
by regulation prescribe.
(e) The Secretary shall coordinate activities under this section
respecting disease control programs with activities under other sec-
tions of this Act respecting such programs.
(f) For purposes of this section, the term 'disease control pro-
gram means a program which is designed and conducted SO as to con-
tribute to national protection against diseases or conditions of national
significance which are amenable to reduction, including tuberculosis,
rubella, measles, poliomyelitis, diphtheria, tetanus, pertussis, mumps,
and other communicable diseases (other than venereal diseases), and
arthritis, diabetes, diseases borne by rodents, hypertension, pulmonary
diseases, cardiovascular diseases, and Rh disease. Such term also
includes vaccination programs, laboratory services, studies to deter-
mine the disease control needs of the States and the means of best meet-
ing such needs, the provision of information and education services
respecting disease control, and programs to encourage behavior which
will prevent disease and encourage the use of preventive measures and
diagnostic procedures. Such term also includes any program or proj-
ect for rodent control for which a grant was made under section 314 (e)
for the fiscal year ending June 30, 1975.
"(g) (1) (A) For the purpose of grants under subsection (a) for
disease control programs to immunize children against immunizable
diseases (including measles, rubella, poliomyelitis, diphtheria, per-
tussis, tetanus, and mumps), there are authorized to be appropriated
$9,000,000 for fiscal year 1976, $17,500,000 for fiscal year 1977, and
$23,000,000 for fiscal year 1978.
"(B) For the purpose of grants under subsection (a) for disease
control programs for diseases borne by rodents there are authorized to
be appropriated $13,500,000 for fiscal year 1976, $14,000,000 for fiscal
year 1977, and $14,500,000 for fiscal year 1978.
"(C) For the purpose of grants under subsection (a) for disease
control programs, other than programs for which appropriations are
authorized under subparagraph (A) or (B), and for the purpose of
grants and contracts under subsection (d), there are authorized to be
appropriated $4,000,000 for fiscal year 1976, $4,500,000 for fiscal year
1977, and $5,000,000 for fiscal year 1978.
"(D) Not to exceed 15 per centum of the amount appropriated for
any fiscal year under any of the preceding subparagraphs of this para-
graph may be used by the Secretary for grants and contracts for such
fiscal year for programs for which appropriations are authorized
under any one or more of the other subparagraphs of this paragraph if
the Secretary determines that such use will better carry out the purpose
of this section, and reports to the appropriate committees of Congress
at least thirty days before making such use of such amount his deter-
mination and the reasons therefor.
"(2) Except as provided in section 318, no funds appropriated under
any provision of this Act other than paragraph (1) of this subsection
may be used to make grants in any fiscal year for disease control pro-
grams if (A) grants for such programs are authorized by subsection
(a), and (B) all the funds authorized to be appropriated under this
subsection for that fiscal year have not been appropriated for that
fiscal year and obligated in that fiscal year.
'(h) The Secretary shall submit to the President for submission to
the Congress on January 1 of each year (1) a report (A) on the
S. 1466-9
effectiveness of all Federal and other public and private activities in
controlling the diseases and conditions referred to in subsection (f),
(B) on the extent of the problems presented by such diseases, (C) on
the effectiveness of the activities, assisted under grants and contracts
under this section, in controlling such diseases, and (D) setting forth
a plan for the coming year for the control of such diseases; and (2) a
report (A) on the immune status of the population of the United
States, and (B) identifying, by area, population group, and other
categories, deficiencies in the immune status of such population.
(i) (1) Nothing in this section shall limit or otherwise restrict the
use of funds which are granted to a State or to an agency or a political
subdivision of a State under provisions of Federal law (other than
this Act) and which are available for the conduct of disease control
programs from being used in connection with programs assisted
through grants under subsection (a).
"(2) Nothing in this section shall be construed to require any State
or any agency or political subdivision of a State to have a disease
control program which would require any person, who objects to any
treatment provided under such a program, to be treated or to have any
child or ward treated under such a program.".
(b) Section 311 (c) of the Public Health Service Act is amended
to read as follows:
'(c) (1) The Secretary is authorized to develop (and may take such
action as may be necessary to implement) a plan under which per-
sonnel, equipment, medical supplies, and other resources of the Service
and other agencies under the jurisdiction of the Secretary may be
effectively used to control epidemics of any disease or condition
referred to in section 317(f) and to meet other health emergencies or
problems involving or resulting from disasters or any such disease.
The Secretary may enter into agreements providing for the coopera-
tive planning between the Service and public and private community
health programs and agencies to cope with health problems (including
epidemics and health emergencies) resulting from disasters or any
disease or condition referred to in section 317(f).
"(2) The Secretary may, at the request of the appropriate State
or local authority, extend temporary (not in excess of forty-five days)
assistance to States or localities in meeting health emergencies of such
a nature as to warrant Federal assistance. The Secretary may require
such reimbursement of the United States for assistance provided under
this paragraph as he may determine to be reasonable under the circum-
stances. Any reimbursement SO paid shall be credited to the applicable
appropriation for the Service for the year in which such reimburse-
ment is received.".
(c) Section 311 (b) of such Act is amended by inserting at the end
thereof the following new sentence: "The Secretary may charge only
private entities reasonable fees for the training of their personnel
under the preceding sentence.".
AMENDMENTS RESPECTING VENEREAL DISEASES
SEC. 203. (a) The Congress finds and declares that-
(1) the number of reported cases of venereal disease continues
in epidemic proportions in the United States;
(2) the number of patients with venereal disease reported to
public health authorities is only a fraction of those actually
infected;
(3) the incidence of venereal disease is particularly high in the
15-29-year age group, and in metropolitan areas;
S. 1466-10
(4) venereal disease accounts for needless deaths and leads to
such severe disabilities as sterility, insanity, blindness, and
crippling conditions;
(5) the number of cases of congenital syphilis, a preventable
disease, tends to parallel the incidence of syphilis in adults;
(6) it is conservatively estimated that the public cost of care
for persons suffering the complications of venereal disease
exceed $80,000,000 annually;
(7) medical researchers have no successful vaccine for syphilis
or gonorrhea, and have no blood test for the detection of gonor-
rhea among the large reservoir of asymptomatic females;
(8) school health education programs, public information and
awareness campaigns, mass diagnostic screening and case fol-
lowup activities have all been found to be effective disease
intervention methodologies;
(9) knowledgeable health providers and concerned individ-
uals and groups are fundamental to venereal disease prevention
and control;
(10) biomedical research leading to the development of vac-
cines for syphilis and gonorrhea is of singular importance for
the eventual eradication of these dreaded diseases; and
(11) a variety of other sexually transmitted diseases, in addi-
tion to syphilis and gonorrhea, have become of public health
significance.
(b) (1) Section 318(b) (2) of the Public Health Service Act is
amended to read as follows:
"(2) For the purpose of carrying out this subsection, there are
authorized to be appropriated $5,000,000 for fiscal year 1976,
$6,600,000 for fiscal year 1977, and $7,600,000 for fiscal year 1978.".
(2) Subsection (d) (2) of such section is amended to read as follows:
(2) For the purpose of carrying out this section there is authorized
to be appropriated $32,000,000 for fiscal year 1976, $41,500,000 for
fiscal year 1977, and $43,500,000 for fiscal year 1978.'
(c) Subsection (a) of such section is amended by striking out
"public authorities and" and inserting in lieu thereof "public and non-
profit private entities and to".
(d) Subsection (d) (1) (B) of such section is amended by inserting
before the semicolon at the end the following: "and routine testing,
including laboratory tests and followup systems".
(e) Subsection (d) (1) (E) of such section is amended by striking
out "control" and inserting in lieu thereof "prevention and control
strategies and activities".
(f) (1) Subsection (c) is repealed.
(2) Subsection (e) (1) of such section is amended by striking out
"or (d)" and inserting in lieu thereof "or (c)".
(3) Subsection (e) (2) (C) of such section is amended by striking
out "(including dark-field microscope techniques for the diagnosis
of both gonorrhea and syphilis)".
(4) The last sentence of subsection (e) (4) of such section is amended
by striking out the semicolon and all that follows through "paid to such
recipient".
(5) The first sentence of subsection (e) (5) of such section is amended
by inserting before the period the following: "or as may be required
by a law of a State or political subdivision of a State".
(6) Subsection (g) of such section is amended by striking out ", (c),
and (d)' and inserting in lieu thereof "and (c)"
(7) Subsection (h) of such section is amended by striking out
"treated or to have any child or ward of his".
S. 1466-11
(8) Subsections (d), (e), (f), (g), and (h) of such section are
redesignated as subsections (c), (d), (e), (f), and (g), respectively.
(g) Subsection (e) of such section (as so redesignated) is amended
by striking out "317 (d) (4)" and inserting in lieu thereof "317 (g) (2)."
(h) Such section is amended by adding at the end thereof the follow-
ing new subsection:
'(h) For purposes of this section and section 317, the term 'venereal
disease' means gonorrhea, syphilis, or any other disease which can be
sexually transmitted and which the Secretary determines is or may
be amenable to control with assistance provided under this section and
is of national significance.".
(i) Section 318(b) (1) is amended by inserting "education," before
"and training".
EXTENSION AND REVISION OF LEAD-BASED PAINT POISONING PREVENTION
ACT
SEC. 204. (a) (1) Section 101 (c) of the Lead-Based Paint Poisoning
Prevention Act (42 U.S.C. 4801 (c)) is amended by inserting after
and below paragraph (4) the following:
"Follow-up programs described in paragraph (3) shall include
programs to eliminate lead-based paint hazards from surfaces in and
around residential dwelling units or houses, including programs to
provide for such purpose financial assistance to the owners of such
units or houses who are financially unable to eliminate such hazards
from their units or houses. In administering programs for the elimi-
nation of such hazards, priority shall be given to the elimination of
such hazards in residential dwelling units or houses in which reside
children with diagnosed lead-based paint poisoning.".
(2) (A) Section 101(c) of such Act is amended by striking out
"should include" and inserting in lieu thereof "shall include".
(B) Section 101 (f) of such Act is amended by (i) striking out
"and (B)" and inserting in lieu thereof "(B)", and (ii) by inserting
before the period at the end the following ", and (C) the services to
be provided will be provided under local programs which meet the
requirements of subsections (c) and (d) of this section".
(b) Section 401 of such Act (42 U.S.C. 4831) is amended to read
as follows:
"PROHIBITION AGAINST USE OF LEAD-BASED PAINT IN CONSTRUCTION OF
FACILITIES AND THE MANUFACTURE OF CERTAIN TOYS AND UTENSILS
"SEC. 401. (a) The Secretary of Health, Education, and Welfare
shall take such steps and impose such conditions as may be neces-
sary or appropriate to prohibit the application of lead-based paint
to any cooking utensil, drinking utensil, or eating utensil manufac-
tured and distributed after the date of enactment of this Act.
"(b) The Secretary of Housing and Urban Development shall
take steps and impose such conditions as may be necessary or appro-
priate to prohibit the use of lead-based paint in residential struc-
tures constructed or rehabilitated by the Federal Government, or with
Federal assistance in any form after the date of enactment of this
Act.
"(c) The Consumer Product Safety Commission shall take such
steps and impose such conditions as may be necessary or appropriate
to article.". prohibit the application of lead-based paint to any toy or furniture
S. 1466-12
(c) (1) Section 501 (3) of such Act (42 U.S.C. 4841 (3)) is amended
to read as follows:
"(3) (A) Except as provided in subparagraph (B), the term
lead-based paint' means any paint containing more than five-
tenths of 1 per centum lead by weight (calculated as lead metal)
in the total nonvolatile content of the paint, or the equivalent
measure of lead in the dried film of paint already applied, or
both.
"(B) (i) The Consumer Product Safety Commission shall,
during the six-month period beginning on the date of the enact-
ment of the National Health Promotion and Disease Prevention
Act of 1976, determine, on the basis of available data and infor-
mation and after providing opportunity for an oral hearing and
considering recommendations of the Secretary of Health, Educa-
tion, and Welfare (including those of the Center for Disease
Control) and of the National Academy of Sciences, whether or
not a level of lead in paint which is greater than six one-hun-
dredths of 1 per centum but not in excess of five-tenths of 1 per
centum is safe. If the Commission determines, in accordance
with the preceding sentence, that another level of lead is safe,
the term lead-based paint' means, with respect to paint which
is manufactured after the expiration of the six-month period
beginning on the date of the Commission's determination, paint
containing by weight (calculated as lead metal) in the total
nonvolatile content of the paint more than the level of lead deter-
mined by the Commission to be safe or the equivalent measure
of lead in the dried film of paint already applied, or both.
"(ii) Unless the definition of the term lead-based paint' has
been established by a determination of the Consumer Product
Safety Commission pursuant to clause (i) of this subparagraph,
the term 'lead-based paint' means, with respect to paint which
is manufactured after the expiration of the twelve-month period
beginning on such date of enactment, paint containing more than
six one-hundredths of 1 per centum lead by weight (calculated
as lead metal) in the total nonvolatile content of the paint, or
the equivalent measure of lead in the dried film of paint already
applied, or both.".
(2) Section 501 of such Act is amended (1) by striking out "the
term" in paragraphs (1) and (2) and inserting in lieu thereof "The
term", (2) by striking out the semicolon at the end of paragraph (1)
and inserting in lieu thereof a period, and (3) by striking out and"
at the end of paragraph (2) and inserting in lieu thereof a period.
(d) Section 502 of such Act (42 U.S.C. 4842) is amended by striking
out "In carrying out the authority under this Act, the Secretary of
Health, Education, and Welfare shall" and inserting in lieu thereof
"In carrying out their respective authorities under this Act, the
Secretary of Housing and Urban Development and the Secretary of
Health, Education, and Welfare shall each".
(e) (1) Section 503 of such Act (42 U.S.C. 4843) is amended by
striking out subsections (a), (b), and (c) and inserting in lieu thereof
the following:
'(a) There are authorized to be appropriated to carry out this Act
$10,000,000 for the fiscal year 1976, $12,000,000 for the fiscal year 1977,
and $14,000,000 for the fiscal year 1978.".
(2) Subsection (d) of such section is redesignated as subsection (b).
S. 1466-13
TITLE ILI-MISCELLANEOUS AMENDMENT
SEC. 301. (a) Section 2(f) of the Public Health Service Act is
amended to read as follows:
'(f) Except as provided in sections 314(g) (4) (B), 355(5), 361 (d),
1002 (c), 1201 (2), 1401(13), 1531(1), and 1633(1), the term 'State'
includes, in addition to the several States, only the District of Colum-
bia, Guam, the Commonwealth of Puerto Rico, and the Virgin
Islands.".
(b) (1) Section 361 (d) is amended by adding at the end thereof
the following: "For purposes of this subsection, the term 'State'
includes, in addition to the several States, only the District of
Columbia.".
(2) Section 1401 is amended by adding after paragraph (12) the
following new paragraph:
"(13) The term 'State' includes, in addition to the several
States, only the District of Columbia, Guam, the Commonwealth
of Puerto Rico, the Virgin Islands, American Samoa, and the
Trust Territory of the Pacific Islands.".
Speaker of the House of Representatives.
Vice President of the United States and
President of the Senate.
4
June 11, 1976
Dear Mr. Director:
The following bills were received at the White
House on June 11th:
B.J. Res 168
8. 532
8. 1466
S. 2760
B. 3187
Please let the President have reports and
recommendations as to the approval of these
bills as soon as possible.
Sincerely,
Robert D. Linder
Chief Executive Clerk
The Honorable James T. Lynn
Director
Office of Management and Budget
Washington, D.C.
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"ocrText": "The original documents are located in Box 47, folder \"6/23/76 S1466 National Consumer\nHealth Information and Health Promotion Act of 1976\" of the White House Records\nOffice: Legislation Case Files at the Gerald R. Ford Presidential Library.\nCopyright Notice\nThe copyright law of the United States (Title 17, United States Code) governs the making of\nphotocopies or other reproductions of copyrighted material. Gerald R. Ford donated to the United\nStates of America his copyrights in all of his unpublished writings in National Archives collections.\nWorks prepared by U.S. Government employees as part of their official duties are in the public\ndomain. The copyrights to materials written by other individuals or organizations are presumed to\nremain with them. If you think any of the information displayed in the PDF is subject to a valid\ncopyright claim, please contact the Gerald R. Ford Presidential Library.\nExact duplicates within this folder were not digitized.\n86/23/16\nAPPROVED JUN 23 1976\nTHE WHITE HOUSE\nDECISION\nWASHINGTON\nLast Day: June 23, 1976\nJune 22, 1976\nTORREVIUBS\nMEMORANDUM FOR THE PRESIDENT\nFROM:\nJIM CANNON\nSUBJECT:\nEnrolled Bill S. 1466 - National Consumer\nHealth Information and Health Promotion\nposted\nAct of 1976\n6/24/76\nAttached for your decision is S. 1466, which extends\nthrough FY 1978 existing communicable, venereal\ndisease and lead-based paint poisoning prevention\nprograms, as well as authorizing HEW to conduct under\nnew authority health information and promotion programs.\nBACKGROUND\nThe legislative authority for communicable disease\ncontrol programs conducted by HEW expired June 30, 1975,\nand since then has been carried out under the authority\nof a continuing resolution. S. 1466 would renew the\nauthority for these ongoing programs and also provide\nauthorization for a new program to increase the\nindividual's knowledge on how to use health care.\nThis is the first piece of legislation to emerge from\nthe Congress that would continue a categorical program\nincluded in your health block grant proposal. We expect\nthat several other bills will be passed this year which\nwill continue other categorical grants. We do not expect\nthe block grant proposal to become law during this session.\nThe National Influenza Immunization Program against\nswine flu is operated under one of the authorities in\nthis bill. Although the programs involved could still\nbe operated under continuing resolution this fiscal\nyear, the visibility of the swine flu immunization program\nmay make a veto difficult for the public to understand.\nAlso, the same Committees that developed this legislation\nare the ones that will consider the Administration's\nrequest for special indemnity legislation for swine flu\nvaccine manufacturers.\nDigitized from Box 47 of the White House Records Office Legislation Case Files at the Gerald R. Ford Presidential Library\n2\nDuring floor consideration of the legislation, it was\nnoted that OMB strongly opposed the bill but no veto\nsignal was given.\nSTAFF AND AGENCY RECOMMENDATIONS\nHEW\nApproval. Strongly recommend that the\nPresident approve the enrolled bill in a\nprivate signing ceremony. \"S. 1466 represents\na negotiated compromise on the issues involved,\nin which our major objections have been met.\nThese prevention and control activities may\nwell do more in the long run to limit the\ncontinuing increase in health care costs in\nthis country than other programs which require\nlevels of funding much higher than those\nauthorized by S. 1466.'\nOMB\nDisapproval. \"Would serve as an occasion to\nstress your opposition to the proliferation of\ncategorical grant programs\nbecause S. 1466 is\ninconsistent with your block grant proposal\nchances of sustaining a veto are very slim. \"\n(Jim Lynn's memorandum is attached at Tab A.)\nHUD\nDefers to HEW and CPSC on lead-based paint\nprovisions.\nCPSC\nFavors veto of regulatory provisions concerning\nlead-based paint and defers on bill as a whole.\nBuchen\nApproval. \"Veto would be a futile gesture.\"\n(Lazarus)\nFriedersdorf - Approval. \"The bill passed both Houses by\na voice vote. Veto would, of course, be difficult\nif not impossible to sustain.\"\nBoth Tim Lee Carter and Jim Broyhill supported the\nbill and believe their combined efforts with Paul\nRogers (and HEW) succeeded in a bill the President\ncould sign.\nRECOMMENDATION\nI recommend that you sign S. 1466.\nDECISION\nmy\nApprove (enrolled bill attached at Tab B).\nDisapprove (sign veto message at Tab C, which\nhas been cleared by Doug Smith).\nAPPROVED JUN 23 DF THE STATE\nPRESIDENT\nand\nEXECUTIVE OFFICE OF THE PRESIDENT\nUNITED\nOFFICE OF MANAGEMENT AND BUDGET\nWASHINGTON, D.C. 20503\nJUN 17 1976\nMEMORANDUM FOR THE PRESIDENT\nSubject: Enrolled Bill S. 1466 - National Consumer\nHealth Information and Health Promotion\nAct of 1976\nSponsor - Sen. Kennedy (D) Mass. and 7 others\nLast Day for Action\nJune 23, 1976 - Wednesday\nPurpose\nAuthorizes HEW to conduct a new health information and\nhealth promotion program; extends through fiscal year\n1978 and expands existing communicable disease, venereal\ndisease and lead-based paint poisoning prevention programs.\nAgency Recommendations\nOffice of Management and Budget\nDisapproval (Veto\nmessage attached)\nDepartment of Health, Education,\nand Welfare\nApproval\nDepartment of Housing and Urban\nDevelopment\nDefers to HEW and\nCPSC on lead-based\npaint provisions\nConsumer Product Safety Commission\nFavors veto of\nregulatory provisions\nconcerning lead-based\npaint, but defers on\nbill as a whole\nDiscussion\nLegislative authorizations for the communicable disease\nand disease control programs conducted by HEW expired\non June 30, 1975 and, since then, have been carried out\n2\nunder the authority of a continuing resolution. S. 1466\nwould amend the Public Health Service (PHS) Act by\nextending and expanding these categorical health programs,\nand by authorizing HEW to initiate and conduct a new program\nof health information and health prevention.\nSpecifically, S. 1466 would:\n-- extend for three years and expand the program\nof grants for the control and prevention of a number of\ncommunicable diseases, e.g., venereal diseases, rat\ncontrol, and immunization,\n-- extend the lead-based paint poisoning prevention\nprogram through fiscal year 1978 and redefine the respon-\nsibilities of the agencies involved in administering that\nprogram, and\n-- authorize grants and contracts in the area of\nhealth education, and require the establishment of an\nOffice of Health Information and Health Promotion in\nHEW.\nCommunicable and venereal diseases. S. 1466 would expand\nor modify communicable disease programs by:\n-- authorizing new training and demonstration grants\nand contracts in the area of disease prevention and\ncontrol,\n-- broadening the definition of \"disease control\nprogram\" to include, in addition to communicable diseases,\ndiseases or health conditions which are preventable or\nsubject to amelioration, e.g., arthritis, diabetes,\nhypertension, pulmonary and cardiovascular diseases and\nRH disease, and\n-- repealing the formula grant authority of the\nvenereal disease program.\nYour 1977 Budget proposed the \"Financial Assistance for\nHealth Care Act, to consolidate Medicaid with these\nother health programs into a single health block grant\nprogram. Draft legislation was submitted to Congress in\nFebruary 1976. Under the Administration's legislative\nproposal, States would have the flexibility to determine\npriorities of health care in the communicable disease and\ndisease prevention area. The Administration therefore\n3\nstrongly opposed S. 1466, since it runs directly counter\nto the concept of the health block grant.\nLead-Based Paint Poisoning Prevention Act. S. 1466 would\nalso modify the existing Lead-Based Paint Poisoning\nPrevention Act (first enacted in 1971 and extended in\n1973), in several respects. It would:\n-- require that the Consumer Product Safety Commission\n(CPSC), within six months of the enactment of S. 1466,\ndetermine whether or not a level of lead in paint which is\ngreater than 0.06% but not in excess of 0.5% is safe.\n(If such a determination is not made, after 12 months\nthe term \"lead-based paint\" would automatically be defined\nby S. 1466 to mean paint containing anything greater than\n0.06% rather than the definition of 0.5% in present law.)\n-- prohibit the application of lead-based paint to\nany cooking, drinking or eating utensils, toys or furniture\nmanufactured after the date of enactment, or the use of\nsuch paint in residential structures built or rehabilitated\nwith Federal assistance,\n-- transfer from HEW to the Department of Housing\nand Urban Development (HUD) responsibility for controlling\nthe application of lead-based paint to federally con-\nstructed or assisted housing, and\n- require that local governments give priority to\nthe removal of lead-based paint hazards in dwellings where\nchildren with diagnosed lead-paint poisoning reside.\nThe Administration had proposed to include the lead-based\npaint poisoning prevention program in the health block\ngrant proposal and therefore did not support its extension\nas a separate program or any amendments to the existing\nAct.\nHealth information and promotion. A principal purpose of\nS. 1466 is to increase public knowledge of the appropriate\nuse of health care. Accordingly, the enrolled bill would\nadd a new title to the Public Health Service Act which\nwould:\n-- authorize HEW to make grants and enter into contracts\nfor research, community demonstration and training programs,\nand information programs in the area of health education,\n4\n-- require HEW to submit to the Congress within two\nyears, and annually thereafter, a report on the status of\nhealth information and health promotion, preventive health\nservices and education in the use of health care,\n-- require the establishment of an Office of Health\nInformation and Health Promotion under the Assistant\nSecretary for Health to coordinate all HEW activities\ndesigned to educate the public in the appropriate use of\nhealth care, and\n-- require the establishment of a national health\ninformation clearinghouse.\nThe Administration strongly opposed the establishment of\nthis new categorical health program since it conflicts\nwith the Administration's objective of consolidating\nnumerous existing health programs and since HEW already\nwas using its general authority to conduct health informa-\ntion activities. Moreover, the effectiveness of health\ninformation activities in changing behavior is questionable.\nBudget impact. Attached to this memorandum is a table\ncomparing the appropriations authorizations in S. 1466\nwith the Administration's budget requests for fiscal\nyears 1976 and 1977 and the levels projected for fiscal\nyear 1978 in the 1977 Budget. In total, the authoriza-\ntions in the enrolled bill for the three fiscal years\namount to $307 million. This compares with $99 million\nrequested or projected by the Administration. For fiscal\nyear 1977 alone, the bill would authorize $103 million\ncompared to the budget request of $33 million as part of\nthe block grant for the programs involved.\nAlthough the authorizations in S. 1466 are far above the\nrequests, they are not sharply out of line with recent\ncongressional appropriation trends.\nArguments For Approval\n1. S. 1466 would specifically authorize HEW to\ncontinue its existing disease control and prevention\nprograms. HEW argues that the bill is necessary at least\nuntil the Administration's proposed Financial Assistance\nfor Health Care Act can be effected; enactment of that\nproposal does not appear likely in this session of the\nCongress.\n5\n2. The new health education categorical program has\na relatively small authorization and, although it duplicates\nexisting legal authority, it would not disrupt HEW organiza-\ntional structure or require HEW to carry out an expensive\nnew program.\n3. According to HEW, S. 1466 \"incorporates major\nconcessions agreed to by the Congress after considering\nthe Administration's objections. HEW cites those\nconcessions as:\n-- deletion of authority for a National Center\nfor Health Promotion,\n--- excision of all administrative authority of\nthe Office of Health Education and Health Promotion,\n-- deletion of authority for an interdepartmental\nhealth education committee,\n-- elimination of authority for new water\ntreatment and dental programs, and\n-- lowering of appropriations authorizations to\namounts below those originally provided in both\nHouse and Senate versions of the bill.\n4. Congressional sponsors of the legislation indicated\non the House and Senate floors that there had been\nnegotiations with Administration representatives and\nthat it was their understanding that the final version of\nS. 1466 which emerged from conference was acceptable to\nthe Administration and that you would sign it.\nArguments Against Approval\n1. S. 1466 runs directly counter to the efforts of\nthe Administration over the past two years to consolidate\nthe many fragmented health programs administered by HEW.\nApproval of S. 1466 would undermine your commitment to\nenactment of the Administration's health block grant\nproposal. This is the first such bill to emerge from\nCongress that would continue a categorical program that\nyou included in your health block grant. Moreover,\napproval of S. 1466 would leave virtually no alternative\nbut to approve two other bills extending narrow categorical\nhealth programs under final consideration by the Congress,\ni.e., Emergency Medical Service and alcoholism grants.\n6\n2. Extension of the appropriation authorizations to\ncontinue the programs pending enactment of the health\nblock grant is not necessary. The programs involved\nare operating under continuing resolution this fiscal\nyear without new authorizations. Disapproval of the enrolled\nbill could help maintain pressure on the Congress to enact\nthe block grant proposal and would, at the same time,\nkeep funding of the programs at lower levels under the\ncontinuing resolution than might be provided under the\nauthorizations in the bill.\n3. Over the three years, the authorization levels\nin S. 1466 exceed by $208 million the levels requested in\nthe 1976 and 1977 budgets. The authorizations in the\nEmergency Medical Services and alcoholism bills likely to\nbe enrolled before July 1 could, if fully funded, result\nin additional budget outlays of approximately $116 million\nin fiscal year 1977 and $189 million in 1978.\n4. OMB staff believe there are very few \"concessions\"\nin the compromise version of the bill. The only significant\nchange is that new water treatment and dental programs\nwould not be included. In addition, the authorization\nlevels in the final \"compromise\" bill were, in some cases,\nhigher than those in the original House and Senate bills\nand in total are still about 3 times more than the Adminis-\ntration request.\n5. Statutory establishment of a new health informa-\ntion program and a new Office of Health Information and\nHealth Promotion in HEW is clearly unnecessary and without\nprogram merit. HEW states that the main effect of these\nprovisions \"would be to give increased visibility to the\narea of health education.\" HEW already has an Office of\nHealth Education in the Center for Disease Control, and\ncarries out numerous health education activities.\n6. The Consumer Product Safety Commission states\nthat there are serious objections to the administrative\nprocess provided by S. 1466 for establishing and enforcing\na safe level of lead in paint, depending on whether an\nagency proceeded under the Lead-Based Paint Act, the Consumer\nProduct Safety Act or the Federal Hazardous Substances Act.\nCPSC states that S. 1466 could lead to differing federal\nstandards and \"undoubtedly will require duplicative pro-\nceedings on the precise same matter resulting in a massive\nwaste of tax dollars.\" CPSC also concludes that \"the\n7\nconfusion which would result from different federal levels\nwould be compounded by the statutory provisions applicable\nto preemption of various state and local laws and regula-\ntions.\"\nRecommendations\nHEW strongly recommends approval. The Department states\nthat \"S. 1466 represents a negotiated compromise on the\nissues involved, in which our major objections have been\nmet. Actual funding levels will, of course, be determined\nthrough the appropriations process.\" HEW recommends \"a\nprivate signing ceremony to which the principal Congressional\nparticipants in the development of S. 1466 would be\ninvited.\"\nHUD states that it has \"no objection to the transfer to\nHUD of HEW's responsibility for controlling the applica-\ntion of lead-based paint to Federally constructed or assisted\nhousing.\" HUD defers to HEW and CPSC on the other provisions\nrelating to lead-based paint.\nCPSC, in its letter, offers the following comment:\n\"Only insofar as the provisions of S. 1466 impact\non the Consumer Product Safety Commission by\namending the process for establishing a safe level\nof lead in paint does the Commission favor veto\nof the bill. The regulatory process which results\nfrom this portion of S. 1466 will be more costly and\nduplicative than is necessary without any increase in\nbenefit to the public.\"\nCPSC defers to HEW on the other provisions of S. 1466,\nbut requests Administration support of efforts to amend\nthe procedural provisions, should the bill be signed.\nWe have strongly opposed S. 1466 because it is so clearly\ninconsistent with your proposal to consolidate categorical\nhealth programs into a single block grant. Moreover,\nS. 1466 does not contain authorities that we believe to\nbe essential at this time. Disapproval of S. 1466 would\nserve as an occasion to stress your opposition to the\nproliferation of categorical grant programs by the\nCongress. We disagree with HEW that Congress made\n\"major\" concessions in the conference bill.\n8\nWe realize that this enrolled bill was apparently viewed\nas noncontroversial, since it was passed by voice vote\nin both Houses. Chances of sustaining a veto are very\nslim. Nevertheless, we believe the policy considerations\ninvolved are sufficiently important to warrant your\ndisapproval of S. 1466. We have attached a draft veto\nmessage for your consideration.\nPall Onein Paul H. O'Neill\nActing Director\nEnclosures\nAttachment\nS. 1466 Appropriations Authorizations\nCompared with Budget Levels\n($ in millions)\nFiscal\nS. 1466\nBudget\nProgram\nyear\nAuthorizations\nlevels\nDifference\nHealth education\n1977\n7\n--\n+7\n1978\n10\n--\n+10\n1979\n14\n--\n+14\nVenereal disease\n1976\n37\n20\n+17\n1977\n48\n20\n+28\n1978\n51\n20\n+31\nRat control\n1976\n13\n5\n+8\n1977\n14\n5\n+9\n1978\n14\n5\n+9\nLead-based paint\npoisoning\nprevention\n1976\n10\n3\n+7\n1977\n12\n3\n+9\n1978\n14\n3\n+11\nImmunization and\nother control\nprograms\n1976\n13\n5\n+8\n1977\n22\n5\n+17\n1978\n28\n5\n+23\nTotal, all years\n307\n99\n+208\nTotal, 1976\n73\n33\n+40\nTotal, 1977\n103\n33\n+70\nTotal, 1978\n117\n33\n+84\nTotal, 1979\n14\n--\n+14\nto\n©\nC\n3\nperiod. At a time when the overall Federal deficit is\nestimated at over $74 billion, I must oppose such excessive\nauthorization levels.\nOther bills now pending would also continue current\nnarrow categorical Federal health programs. Rather than\nproceeding to extend and expand such programs, I urge the\nCongress to hold hearings and rapidly enact my proposed\n\"Financial Assistance for Health Care Act. \"\nTHE WHITE HOUSE,\nTO THE SENATE OF THE UNITED STATES:\nI am returning, without my approval, S. 1466, a\nbill which would authorize duplicative health information\nand health promotion programs and would reauthorize and\nexpand programs dealing with venereal disease, rat control,\nlead-based paint poisoning and other disease prevention\nand control.\nThis bill is based on a policy of perpetuating the\nexisting maze of Federal health programs. Such an\napproach is a disservice to those who need effective\ndelivery of health services and those who must pay the\nbills -- the taxpayers. In my 1977 Budget, I proposed\na consolidation of 16 existing Federal health programs\ninto a single block grant which would enable States and\nlocalities to assure that people in need receive com-\nprehensive health care. I share the objectives of S. 1466\nto assure the provision of important preventive health\nservices, but I firmly believe that under my proposed\nhealth block grant those services would be provided in\na more effective manner.\nFewer Federal programs, and a reduction in the various\nrules and regulations accompanying each of them, would allow\nStates and local governments to respond more quickly to the\nparticular health needs of their residents. Consolidation\ninto a block grant will also better target Federal health\nassistance on those with low incomes, and distribute Federal\nfunds more equitably among the States. Funding from the\nexisting 16 categorical programs proposed for consolidation\nin the block grant varies from $200 per low-income individual\nin some States to over $800 in others. This inequity should\nnot be continued.\n2\nIn addition, the many Federal requirements imposed\nupon States and localities prevent them from bringing\nabout needed efficiencies and coordination in their health\nprograms. If the proposed health block grant were enacted\ninstead of bills such as S. 1466, more Federal health dollars\ncould go toward providing health services for our citizens\nrather than for the cost of burdensome administration.\nS. 1466 would also create unnecessary and duplicative\nhealth education programs. The Department of Health,\nEducation, and Welfare alone now spends more than $80\nmillion a year on health education of the public. The\nactivities proposed in S. 1466 would only add to the already\ncomplicated array of Federal health education programs.\nThe bill would, moreover, create a special problem\nin the lead-based paint poisoning prevention program. It\nwould require the determination of safe lead levels in\npaint but provides little, if any, guidance with respect\nto the procedures determining those levels. This could,\naccordingly, lead to the highly undesirable situation of\ndiffering Federal standards for lead in paint, depending\non whether an agency proceeded under the Lead-Based Paint\nPoisoning Prevention Act, the Consumer Product Safety Act\nor the Federal Hazardous Substances Act. Thus, S. 1466\ncould not only create confusion in this area, but could\nrequire duplicative administrative proceedings on the same\nsubject matter resulting in a massive waste of tax dollars\nas well as unnecessary delay and red tape, without any\nreal benefit to the public.\nLastly, S. 1466 is objectionable since it would\nauthorize appropriations of $307 million -- more than\nthree times my requested levels -- over a three-year\nEXECUTIVE OFFICE OF THE PRESIDENT\nCELLING\nOFFICE OF MANAGEMENT AND BUDGET\nWASHINGTON, D.C. 20503\n9:30 a.m.\nJUN 17 1976\nMEMORANDUM FOR THE PRESIDENT\nSubject: Enrolled Bill S. 1466 - National Consumer\nHealth Information and Health Promotion\nAct of 1976\nSponsor - Sen. Kennedy (D) Mass. and 7 others\nLast Day for Action\nJune 23, 1976 - Wednesday\nPurpose\nAuthorizes HEW to conduct a new health information and\nhealth promotion program; extends through fiscal year\n1978 and expands existing communicable disease, venereal\ndisease and lead-based paint poisoning prevention programs.\nAgency Recommendations\nOffice of Management and Budget\nDisapproval (Veto\nmessage attached)\nDepartment of Health, Education,\nand Welfare\nApproval\nDepartment of Housing and Urban\nDevelopment\nDefers to HEW and\nCPSC on lead-based\npaint provisions\nConsumer Product Safety Commission\nFavors veto of\nregulatory provisions\nconcerning lead-based\npaint, but defers on\nbill as a whole\nDiscussion\nLegislative authorizations for the communicable disease\nand disease control programs conducted by HEW expired\non June 30, 1975 and, since then, have been carried out\nAttached document was not scanned because it is duplicated elsewhere in the document\nTHE WHITE HOUSE\nACTION MEMORANDUM\nWASHINGTON\nLOG NO.:\nDate: June 18\nTime: 1100am\nFOR ACTION: Spencer Johnson Oiga CC (for information): Jack Marsh\nKen Lazarus sign\nJim Cavanaugh\nMax Friedersdorf Dign\nEd Schmults\nDawn Bennett sign\nSteve McConahey syn\nFROM THE STAFF SECRETARY\nDUE: Date:\nJune 19\nTime: noon\nSUBJECT:\nS. 1466 - National Consumer Health Information\nand Health Promotion Act of 1976\nACTION REQUESTED:\nFor Necessary Action\nFor Your Recommendations\nPrepare Agenda and Brief\nDraft Reply\nX For Your Comments\nDraft Remarks\nREMARKS:\nPlease return to Judy Johnston, Ground Floor West Wing\nPLEASE ATTACH THIS COPY TO MATERIAL SUBMITTED.\nIf you have any questions or if you anticipate a\ndelay in submitting the required material, please\nK. R. COLE, JR.\ntelephone the Staff Secretary immediately.\nFor the President\nTO THE SENATE\nI am returning, without my approval, S. 1466, a\nbill which would authorize duplicative health information\nand health promotion programs, and reauthorize and\nexpand venereal disease, rat control, lead-based paint\npoisoning and other disease prevention and control programs.\nThis bill is based on a policy of perpetuating the\nexisting maze of Federal health programs. Such an\napproach is a disservice to those who need effective\ndelivery of health services and those who must pay the\nbills--the taxpayers. In my 1977 Budget, I proposed a\nconsolidation of 16 existing Federal health programs into\na single block grant which would enable States and localities\nto assure that people in need receive comprehensive health\ncare. I share the objectives of S. 1466 to assure the\nprovision of important preventive health services, but I\nfirmly believe that under my proposed health block grant\nthose services would be provided in a more effective manner.\nFewer Federal programs, and a reduction in the various\nrules and regulations accompanying each of them, would allow\nStates and local governments to respond more quickly to the\nparticular health needs of their residents. Consolidation\ninto a block grant will also better target Federal health\nassistance on those with low incomes, and distribute Federal\nfunds more equitably among the States. Funding from the\nexisting 16 categorical programs proposed for consolidation\nin the block grant varies from $200 per low-income individual\nin some States to over $800 in others. This inequity should\nnot be continued.\nHEALTH.\nOF\nEDUCATION\nDEPARTMENT OF HEALTH, EDUCATION. AND WELFARE\nU.S.A.\nJUN 1 1 1976\nThe Honorable James T. Lynn\nDirector, Office of Management\nand Budget\nWashington, D. C. 20503\nDear Mr. Lynn:\nThis is in response to your request for a report on S. 1466,\nan enrolled bill \"To amend the Public Health Service Act to\nprovide authority for health information and health promotion\nprograms, to revise and extend the authority for disease\nprevention and control programs, and to revise and extend\nthe authority for venereal disease programs, and to amend\nthe Lead-Based Paint Poisoning Prevention Act to revise and\nextend that Act.\"\nWe strongly recommend that the President sign the enrolled\nbill; the bill would authorize important activities in the\narea of disease control and represents a compromise in which\nour major objections have been met. We also recommend a\nprivate signing ceremony to which the principal Congressional\nparticipants in the development of the bill would be invited.\nS. 1466 would authorize a small program in the area of\nhealth education through fiscal year 1979, to include grants\nand contracts for research, community demonstration programs,\nand information programs. The bill would establish an\nOffice of Health Information and Health Promotion within\nthis Department to coordinate Departmental health education\nactivities; the Office would not be charged with direct\nadministrative responsibility for any program.\nS. 1466 would also extend our programs concerned with lead-\nbased paint poisoning, venereal diseases, and other diseases\namenable to reduction through fiscal year 1978. These\nprograms would also be modified by:\nThe Honorable James T. Lynn\n2\n-- permitting training and demonstration grants and\ncontracts in the area of disease prevention and\ncontrol,\n-- broadening the concept of disease control programs\nto include diseases and other conditions which are\nof national significance and which are amenable to\nreduction, but are not of the traditional communicable\ntype,\n-- repealing the venereal disease formula grant authority,\n-- redefining the respective roles of this Department,\nthe Department of Housing and Urban Development and\nthe Consumer Product Safety Commission (CPSC) as to\nthe use of lead-based paint on certain products, so\nas to parallel the missions of these Departments and\nthe CPSC, and\n-- requiring the CPSC, during the six-month period\nfollowing enactment of the enrolled bill, to\ndetermine whether or not a level of lead in paint\nwhich is greater than 0.06 percent but not in excess\nof 0.5 percent is safe.\nAppropriation authorizations in the bill (and Budget requests\nin the same areas) are set out in Tab A.\nS. 1466 would enable us to continue the important disease\ncontrol and prevention activities which this Department\nis currently carrying out. These prevention and control\nactivities may well do more in the long run to limit the\ncontinuing increase in health care costs in this country\nthan other programs which require levels of funding much\nhigher than those authorized by S. 1466. Until we are able\nto effect enactment of our Financial Assistance for Health\nCare Act, we must have other authority to carry out these\nvital prevention and control activities.\nThe enrolled bill would also authorize a small program in\nthe area of health education; this new authority essentially\nduplicates legal authority we already have, but without\nThe Honorable James T. Lynn\n3\ndisrupting our Departmental organizational structure or\nrequiring us to carry out a new and expensive program. The\nmain effect of the enrolled bill would be to give increased\nvisibility to the area of health education, which is all to\nthe good.\nS. 1466 as passed by the Congress incorporates major concessions\nagreed to by the Congress after considering the Administration's\nobjections. For example, the establishment of a private\ncenter for health promotion, to be funded in part with\nFederal funds, was deleted; all administrative authority of\nthe Office of Health Education and Promotion was excised; a\nprovision for an interdepartmental health education committee\nwas removed; programs related to water treatment and dental\nhealth were eliminated; and the total amount of appropriations\nauthorized is below that originally provided in both the\nHouse and Senate versions of the bill.\nS. 1466 represents a negotiated compromise on the issues\ninvolved, in which our major objections have been met. Actual\nfunding levels will, of course, be determined through the\nappropriations process.\nWe therefore strongly recommend that the President sign the\nenrolled bill. We also recommend a private signing ceremony\nto which the principal Congressional participants in the\ndevelopment of S. 1466 would be invited.\nSincerely,\nLarjone Gynch\nUnder Secretary\nEnclosure\nTAB A--S. 1466 APPROPRIATION AUTHORIZATIONS\nAND RELATED BUDGET REQUESTS\n(figures in millions of dollars)\nS. 1466\nBudget\nContinuing Resolution or\nAuthorization\nRequest\nCurrently Authorized\nHealth Education--1977\n$ 7\n0\n1978\n$10\n0\n1979\n$14\n0\nRat Control--\n1976\n$13.5\n$ 5.41*\n$20\n1977\n$14\n$ 5.41\n1978\n$14.5\nVenereal Disease\nResearch--\n1976\n$ 5\n0\n0\n1977\n$ 6.6\n0\n1978\n$ 7.6\nVenereal Disease\nProject Grants-1976\n$32\n$19.84\n$19.84\n1977\n$41.5\n$19.84\n1978\n$43.5\nLead-Based Paint--1976\n$10\n$ 3.5\n$ 3.5\n1977\n$12\n$ 3.5\n1978\n$14\nImmunizations\nand other\ncontrol\nprograms--\n1976\n$13\n$ 4.96\n$\n4.96\n1977\n$22\n$ 4.96\n1978\n$28\n*$13.1 appropriated for FY 1976\nDEPARTMENT\nOF\nU.S.\nHOUSING\n*\nTHE GENERAL COUNSEL OF HOUSING AND URBAN DEVELOPMENT\nAND\nWASHINGTON, D.C. 20410\nURBAN\nJUN 14 1976\nMr. James M. Frey\nAssistant Director for\nLegislative Reference\nOffice of Management and Budget\nWashington, D. C. 20503\nAttention: Ms. Ramsey\nDear Mr. Frey:\nSubject: S. 1466, 94th Congress (Kennedy, et al)\nEnrolled Enactment\nThis is in response to your request for our views on the\nenrolled enactment of S. 1466, the proposed \"National\nConsumer Health Information and Health Promotion Act of\n1976\".\nThe enrolled bill would provide for a program of research,\ninformation and demonstrations with respect to health\npromotion, preventive health services, and education in\nthe appropriate use of health care, to be administered by\nan Office of Health Information and Health Prevention\nestablished in the Department of Health, Education and\nWelfare under the bill.\nThis bill would also extend and make some revisions in\nHEW's disease control and prevention programs. Of these\nrevisions, the ones of particular interest to this\nDepartment are the proposed amendments to the Lead-Based\nPaint Poisoning Prevention Act.\nThese amendments to the Lead-Based Paint Poisoning\nPrevention Act would authorize additional appropriations\nthrough fiscal year 1978 for purposes of carrying out\nthat Act. They would require that local detection and\n2\ntreatment programs funded by HEW include a lead based paint\nhazard elimination component, with priority to be given to\nhazard elimination in dwellings in which reside children.\nwith diagnosed lead based paint poisoning.\nThe bill would also, in the case of paint manufactured one\nyear after enactment, define lead based paint as paint\nhaving a lead content of more than 0.06 percent, or more\nthan such higher level (but not in excess of 0.5 percent)\nas the Consumer Product Safety Commission determines to be\nsafe. The 0.5 percent lead level under current law would\ncontinue to be used for establishing the safe level of\nlead in existing paint.\nFinally, the amendment would reassign various responsibilities\nfor controlling the use of lead based paint, and would\nspecifically assign to this Department the responsibility for\nprohibiting the application of lead based paint in\nresidential structures constructed or rehabilitated by the\nFederal government or with Federal assistance after the date\nof enactment of the bill. This overall responsibility for\nthis function is assigned to the Secretary of Health,\nEducation and Welfare under existing law, with various\nresponsibilities assigned under HEW regulations to\nappropriate Federal agencies, including HUD. The Senate\nCommittee Report accompanying S. 1664 (Report 94-634)\nindicates that the purpose of this provision is to clarify\nthe respective jurisdiction of these agencies with respect\nto existing responsibilities, and we would interpret the\nprovision as assigning HEW's current lead responsibility\nwith respect to Federal and Federally assisted housing\ndirectly to HUD.\nThe Department has no objection to the transfer to HUD of\nHEW's responsibility for controlling the application of\nlead based paint to Federally constructed or assisted\nhousing. We defer to HEW and the Consumer Product Safety\n3\nCommission, as appropriate, with respect to the\ndesirability of the other provisions of the bill,\nincluding those provisions relating to the establishment\nof an acceptable level of lead in paint to be manufactured\nin the future.\nSincerely,\nRohutPillott\nRobert R. Elliott\nU.S. CONSUMER PRODUCT SAFETY COMMISSION\nWASHINGTON, D.C. 20207\nJUN 1 0 1976\nHonorable James T. Lynn\nDirector\nOffice of Management and Budget\nWashington, D.C. 20503\nAttention: Assistant Director for Legislative Reference\nDear Mr. Lynn:\nThis letter is in response to the Office of Management\nand Budget's request for the views and recommendations of\nthe Consumer Product Safety Commission on S. 1466, an\nenrolled bill\n\"To amend the Public Health Service\nAct to provide authority for health\ninformation and health promotion\nprograms, to revise and extend the\nauthority for disease prevention and\ncontrol programs, and to revise and\nextend the authority for venereal\ndisease programs and to amend the\nLead-Based Paint Poisoning Prevention\nAct to revise and extend that Act.\"\nInasmuch as the provisions of section 204 of S.1644,\nmore particularly subsections (b) and (c), are the only\nprovisions of the bill which would impact on or involve\nthe Consumer Product Safety Commission, the Commission\nwill confine its comments to those provisions and will\ndefer to the other affected departments with respect to\nother provisions of the bill.\nSection 204 (b) of S. 1466 would amend section 401 of\nthe Lead-Based Paint Poisoning Prevention Act (LBPPPA,\n42 U.S.C. 4831) to require the Secretary of Health, Education\nand Welfare to \"take such steps and impose such conditions\nPage 2--Honorable James T. Lynn\nas may be necessary or appropriate\" to prohibit the application\nof lead-based paint to any cooking, drinking or eating\nutensil; to require the Secretary of Housing and Urban\nDevelopment to take similar action with respect to the use\nof lead-based paint in residential structures constructed or\nrehabilitated by the Federal Government, or with federal\nassistance; and to require the Consumer Product Safety\nCommission to take similar action with respect to the applica-\ntion of lead-based paint to any toy or furniture article.\nThis provision, by assigning responsibility with respect to\ntoys and furniture articles to the Commission, conforms the\nLBPPPA to existing law with respect to jurisdiction over the\nsafety of these products, which is vested in the Commission.\nSection 204 (c) of S.1466 would, inter alia, amend\nsection 501 (3) of the LBPPPA (42 U.S.C. 4841(3)) to provide\nthat the term \"lead-based paint\" shall mean any paint con-\ntaining more than .5 percent lead by weight. Further, the\nCommission would be required to determine, within six months\nof enactment of S. 1466, on the basis of available data and\ninformation and after providing for an oral hearing and\nconsideration of other agencies' recommendations, whether\nanother level of lead, greater than .06 percent by weight\nbut not to exceed .5 percent is safe. If the Commission\ndetermines, in accordance with the requirements set forth\nabove, that a level of lead other than .5 percent is safe,\nthe term \"lead-based paint\" shall mean, with respect to\npaint which is manufactured after the expiration of six\nmonths from the date of the Commission's determination,\npaint containing more than such level of lead as the Commis-\nsion has determined is safe. In the absence of such a\ndetermination by the Commission, the term \"lead-based paint\"\nshall mean, with respect to paint manufactured after the\nexpiration of twelve months from the date of enactment of S.\n1466, paint containing more than .06 percent lead.\nThis provision is similar to existing law, except that\nunder the present provision, the Chairman alone rather than\nthe full Commission is charged with the responsibility for\ndetermining the safe level of lead, and is presently not\nrequired to consult with the Secretary of Health, Education\nand Welfare or the National Academy of Sciences.\nThe Commission supports the goal of protecting the\npublic, particularly children, from the hazards associated\nwith lead-based paint. The Commission is currently conduct-\ning a rulemaking proceeding pursuant to a petition under the\nFederal Hazardous Substances Act (FHSA, 15 U.S.C. 1261 et\nseq.) to determine whether paint containing more than .06\nPage 3--Honorable James T. Lynn\npercent lead should be banned. The same petition also\nrequests that the Commission issue a consumer product safety\nrule pursuant to its authority under the Consumer Product\nSafety Act (CPSA, 15 U.S.C. 2051 et seq.) requiring that the\ncomposition of such paints contain not more than .06 percent\nlead.\nThe Commission, however, has several reservations\nconcerning the approach of S.1466. First, the provision\ncontained in section 204 (c) of S. 1466, amending section\n501(3) of the LBPPPA regarding the definition of \"lead-based\npaint\" offers little guidance with respect to the procedure\nto be followed in making the determination of a safe level\nand fails to indicate either the character of the proceeding\nor whether such determination is subject to judicial review.\nSince there appears to be no grant of rulemaking ppower,\neither express or implied, in the LBPPPA, the Commission\npresumes that the Administrative Procedure Act is not intended\nto apply. Similar uncertainty with respect to the appli-\ncable procedure under the present LBPPPA has led to a suit\nattacking Chairman Simpson's report to Congress regarding\nthe safe level of lead in paint. (Consumer's Union of the\nUnited States, Inc., et al., V. Richard O. Simpson, Chairman,\nConsumer Product Safety Commission, et al., Civil Action No.\n75-0243, D.D.C. filed February 24, 1975.)\nSecondly, once the level of \"lead-based paint\" is\nestablished, S. 1466 directs the Commission to \"take such\nsteps and impose such conditions as may be necessary or\nappropriate\" to prohibit the application of lead-based paint\nto toys or furniture articles. While congressional intent\nthat the level found to be safe in the LBPPPA proceeding\nshould apply to such articles is clear, the Commission is\nnot specifically granted any substantive regulatory authority\nto implement this level. Under S. 1466 it would appear that\nthe Commission would still have to make its determination on\nthe safe level of lead in paint for toys and furniture\narticles as well as other paint sold to consumers under the\npending FHSA or CPSA proceedings. Given the different\nprocedures under the FHSA, the CPSA and the LBPPPA, there is\na very real possibility that the lead levels arrived at in\nthese various proceedings could be entirely different. This\nwould lead to the highly anomalous and undesirable situation\nof differing federal standards for lead in paint depending\non the act under which the paint is regulated. Moreover the\nLBPPPA, as drafted, undoubtedly will require duplicative\nproceedings on the precise same matter resulting in a massive\nwaste of tax dollars. Finally, the confusion which would\nPage 4--Honorable James T. Lynn\nresult from different federal levels would be compounded by\nthe statutory provisions applicable to preemption of various\nstate and local laws and regulations.\nTo avoid the difficulties in the implementation of the\nLBPPPA, which enactment of S.1466 will create, to facilitate\nenforcement by the CPSC and the states and to provide the\npaint industry and consumers with a single standard, the\nCommission recommended that it should be permitted to make\na single determination on the safe level of lead in paint in\none proceeding. One means of achieving this would have been\nto include the following provision in the LBPPPA:\nThe determination by the Consumer Product\nSafety Commission with respect to the meaning\nof the term \"lead-based paint\" shall simul-\ntaneously constitute the establishment of a\nconsumer product safety standard under the\nConsumer Product Safety Act. (15 U.S.C.\n2051 et seq.) Such standard shall have the\nsame force and effect as any consumer product\nsafety standard promulgated and established\nunder the Consumer Product Safety Act and\nshall become effective concurrent with the\nprovisions of section 401 of the Lead-Based\nPaint Poisoning Prevention Act. No further\nproceeding shall be necessary to make the\nstandard effective. The level of lead in\npaint established by such standard shall\nbe the maximum permissible level for the\nfollowing consumer products (as the term\n\"consumer product\" is defined in section\n3 (a) (1) of the Consumer Product Safety\nAct 15 U.S.C. 2052 (a) (1) )\n(a) Any paint or similar surface-coating\nmaterial;\n(b) Any toy or other article intended for\nuse by children; and\n(c) Any furniture article.\nProvided, however, that, upon a finding\nthat any special use for \"lead-based\npaint\" or that any product bearing such\npaint does not present an unreasonable\nrisk of injury, the Commission may, by\nPage 5--Honorable James T. Lynn\nrule in accordance with the procedures of\n5 U.S.C. 553, exempt such product from\nthe standard. Any existing exemption\nunder the Federal Hazardous Substances\nAct 15 U.S.C. 1261 et seq. shall continue\nin effect and be treated as an exemption\nunder this section unless withdrawn by\nrule.\nUnfortunately, the Commission's suggestion was not\nadopted by Congress. Only insofar as the provisions of\nS.1466 impact on the Consumer Product Safety Commission by\namending the process for establishing a safe level of lead\nin paint does the Commission favor veto of the bill. The\nregulatory process which results from this portion of\nS.1466 will be more costly and duplicative than is necessary\nwithout any increase in benefit to the public. However, the\nnumerous other provisions of the bill affect the responsi-\nbilities of the Secretary of Health, Education and Welfare in\nthe area of public health and safety. The Commission cannot\nproperly assess the impact of or need for these provisions.\nIf these other provisions of the bill are necessary and\ndesirable, the Commission understands the need to approve\nthe entire bill. Should such approval be forthcoming, CPSC\nwould appreciate Administration support of our efforts to\namend section 204 pursuant to the above language during this\nsession.\nThe Commission is unable to estimate first-year or\nrecurring costs or savings which may result from enactment\nof S.1466.\nAbyL\nCC:\nSpeaker of the\nHouse of Representatives\nCC: President of the Senate\nTHE WHITE HOUSE\nWASHINGTON\nJune 18, 1976\nMEMORANDUM FOR:\nJUDY JOHNSTON\nFROM:\nDAWN D. BENNETT\nRE:\nS. 1466 - National Consumer Health\nInformation and Health Promotion Act\nof 1976\nThe above-entitled bill would essentially: amend the Public Health\nService Act by extending and expanding the categorical health programs;\nauthorize HEW to initiate and conduct a new health information and\nprevention program; give the Consumer Product Safety Commission\njurisdiction over permissable lead paint levels; and transfer to HUD\nfrom HEW, the enforcement of lead base paint levels in federal\nhousing.\nI recommend approval for several reasons, inter alia:\na. The new categorical health education program is relatively\nsmall, authorization-wise, and does not disrupt the HEW organizational\nstructure, nor require HEW to carry out an expensive new program.\nb. S. 1466 would authorize HEW to continue its existing disease\ncontrol and prevention programs i.e. Swine Flu type situations.\nC. The bill appears to be a negotiated compromise which differs\nsubstantially from the original.\nThough the bill is not perfect, i.e., it calls for categorical grants as\nopposed to the block grant scheme which the President prefers, the\ngood outweighs the bad, and on balance, I feel the President should sign\nit.\nTHE WHITE HOUSE\nWASHINGTON\nJune 18, 1976\nMEMORANDUM FOR:\nJIM CAVANAUGH\nmL\nFROM:\nMAX FRIEDERSDORE\nSUBJECT:\nS. 1466 - National Consumer Health Information\nand Health Promotion Act of 1976\nThe bill passed both Houses by a voice vote. Veto would, of course, be\nmost difficult if not impossible to sustain.\nBoth Tim Lee Carter and Jim Broyhill supported the bill and believe their\ncombined efforts with Paul Rogers succeeded in watering down Title I\nenough that President could sign bill.\nOMB was ambivalent on veto signal during Floor consideration and no\nveto signal given.\nI recommend President sign S. 1466.\nTHE WHITE HOUSE\nACTION MEMORANDUM\nWASHINGTON\nLOG NO.:\nDate:\nJune 18\nTime: 1100am\nFOR ACTION: Spencer Johnson\nCC (for information):\nJack Marsh\nKen Lazarus\nJim Cavanaugh\nMax Friedersdorf\nEd Schmults\nDawn Bennett\nSteve McConahey\nFROM THE STAFF SECRETARY\nDUE: Date:\nJune 19\nTime: noon\nSUBJECT:\nS. 1466 - National Consumer Health Information\nand Health Promotion Act of 1976\nACTION REQUESTED:\nFor Necessary Action\nFor Your Recommendations\nPrepare Agenda and Brief\nDraft Reply\nX For Your Comments\nDraft Remarks\nREMARKS:\nPlease return to Judy Johnston, Ground Floor West Wing\nVeto would be a futile gesture. Recommend\napproval for reasons set forth at pp. 4-5.\nKen Lazarus 6/18/76\nPLEASE ATTACH THIS COPY TO MATERIAL SUBMITTED.\nIf you have any questions or if you anticipate a\nJumes M. Canoon\ndelay in submitting the required material, please\nFor 1:10 President\ntelephone the Staff Secretary immediately.\nSteve McConahey's comments: S. 1466\nAgree with concern over inclusion of certain block grant\ncomponents, however, I understand this bill contains\nthe swine flu appropriations and therefore feel we\nshould sign it.\n6/17\nTHE WHITE HOUSE\nWASHINGTON\nJune 18, 1976\nMEMORANDUM FOR:\nJIM CAVANAUGH\nmL\nFROM:\nMAX FRIEDERSDORE\nSUBJECT:\nS. 1466 - National Consumer Health Information\nand Health Promotion Act of 1976\nThe bill passed both Houses by a voice vote. Veto would, of course, be\nmost difficult if not impossible to sustain.\nBoth Tim Lee Carter and Jim Broyhill supported the bill and believe their\ncombined efforts with Paul Rogers succeeded in watering down Title I\nenough that President could sign bill.\nOMB was ambivalent on veto signal during Floor consideration and no\nveto signal given.\nI recommend President sign S. 1466.\nTO THE SENATE\nI am returning, without my approval, S. 1466, a\nbill which would authorize duplicative health information\nwould\nand health promotion programsy and reauthorize and\nexpand venereal disease, rat control, lead-based paint\npragrams dealing with\npoisoning and other disease prevention and control. programs.\nThis bill is based on a policy of perpetuating the\nexisting maze of Federal health programs. Such an\napproach is a disservice to those who need effective\ndelivery of health services and those who must pay the\nbills--the taxpayers. In my 1977 Budget, I proposed a\nconsolidation of 16 existing Federal health programs into\na single block grant which would enable States and localities\nto assure that people in need receive comprehensive health\ncare. I share the objectives of S. 1466 to assure the\nprovision of important preventive health services, but I\nfirmly believe that under my proposed health block grant\nthose services would be provided in a more effective manner.\nFewer Federal programs, and a reduction in the various\nrules and regulations accompanying each of them, would allow\nStates and local governments to respond more quickly to the\nparticular health needs of their residents. Consolidation\ninto a block grant will also better target Federal health\nassistance on those with low incomes, and distribute Federal\nfunds more equitably among the States. Funding from the\nexisting 16 categorical programs proposed for consolidation\nin the block grant varies from $200 per low-income individual\nin some States to over $800 in others. This inequity should\nnot be continued.\n2\nIn addition, the many Federal requirements imposed\nupon States and localities prevent them from bringing\nabout needed efficiencies and coordination in their health\nprograms. If the proposed health block grant were enacted\ninstead of bills such as S. 1466, more Federal health\ndollars could go toward providing health services for our\ncitizens rather than for the cost of burdensome administration.\nS. 1466 would also create unnecessary and duplicative\nhealth education programs. The Department of Health,\nEducation, and Welfare alone now spends more than $80\nmillion a year on health education of the public. The\nactivities proposed in S. 1466 would only add to the already\ncomplicated array of Federal health education programs.\nThe bill would, moreover, create a special problem\nin the lead-based paint poisoning prevention program. It\nwould require the determination of safe lead levels in paint\nbut provides little, if any, guidance with respect to the\nprocedures determining those levels. This could, accordingly,\nlead to the highly undesirable situation of differing federal\nstandards for lead in paint, depending on whether an agency\nproceeded under the Lead-Based Paint Poisoning Prevention\nAct, the Consumer Product Safety Act or the Federal Hazardous\nSubstances Act. Thus, S. 1466 could not only create confusion\nin this area, but could require duplicative administrative\nproceedings on the same subject matter resulting in a\nmassive waste of tax dollars as well as unnecessary delay\nand red tape, without any real benefit to the public.\nLastly, S. 1466 is objectionable since it would authorize\nappropriations of $307 million--more than three times my\nrequested levels--over a three-year period. At a time\nwhen the overall Federal deficit is estimated at over $74\n3\nbillion, I must oppose such excessive authorization levels.\nOther bills now pending would also continue current\nnarrow categorical Federal health programs. Rather than\nproceeding to extend and expand such programs, I urge the\nCongress to hold hearings and rapidly enact my proposed\n\"Financial Assistance for Health Care Act.\"\nTHE WHITE HOUSE\nJune , 1976\nEducation\nTO THE SENATE OF THE UNITED STATES:\nI am returning, without my approval, S. 1466, a\nbill which would authorize duplicative health information\nand health promotion programs and would reauthorize and\nexpand programs dealing with venereal disease, rat control,\nlead-based paint poisoning and other disease prevention\nand control.\nThis bill is based on a policy of perpetuating the\nexisting maze of Federal health programs. Such an\napproach is a disservice to those who need effective\ndelivery of health services and those who must pay the\nbills -- the taxpayers. In my 1977 Budget, I proposed\na consolidation of 16 existing Federal health programs\ninto a single block grant which would enable States and\nlocalities to assure that people in need receive com-\nprehensive health care. I share the objectives of S. 1466\nto assure the provision of important preventive health\nservices, but I firmly believe that under my proposed\nhealth block grant those services would be provided in\na more effective manner.\nFewer Federal programs, and a reduction in the various\nrules and regulations accompanying each of them, would allow\nStates and local governments to respond more quickly to the\nparticular health needs of their residents. Consolidation\ninto a block grant will also better target Federal health\nassistance on those with low incomes, and distribute Federal\nfunds more equitably among the States. Funding from the\nexisting 16 categorical programs proposed for consolidation\nin the block grant varies from $200 per low-income individual\nin some States to over $800 in others. This inequity should\nnot be continued.\n2\nIn addition, the many Federal requirements imposed\nupon States and localities prevent them from bringing\nabout needed efficiencies and coordination in their health\nprograms. If the proposed health block grant were enacted\ninstead of bills such as S. 1466, more Federal health dollars\ncould go toward providing health services for our citizens\nrather than for the cost of burdensome administration.\nS. 1466 would also create unnecessary and duplicative\nhealth education programs. The Department of Health,\nEducation, and Welfare alone now spends more than $80\nmillion a year on health education of the public. The\nactivities proposed in S. 1466 would only add to the already\ncomplicated array of Federal health education programs.\nThe bill would, moreover, create a special problem\nin the lead-based paint poisoning prevention program. It\nwould require the determination of safe lead levels in\npaint but provides little, if any, guidance with respect\nto the procedures determining those levels. This could,\naccordingly, lead to the highly undesirable situation of\ndiffering Federal standards for lead in paint, depending\non whether an agency proceeded under the Lead-Based Paint\nPoisoning Prevention Act, the Consumer Product Safety Act\nor the Federal Hazardous Substances Act. Thus, S. 1466\ncould not only create confusion in this area, but could\nrequire duplicative administrative proceedings on the same\nsubject matter resulting in a massive waste of tax dollars\nas well as unnecessary delay and red tape, without any\nreal benefit to the public.\nLastly, S. 1466 is objectionable since it would\nauthorize appropriations of $307 million -- more than\nthree times my requested levels -- over a three-year\n3\nperiod. At a time when the overall Federal deficit is\nestimated at over $74 billion, I must oppose such excessive\nauthorization levels.\nOther bills now pending would also continue current\nnarrow categorical Federal health programs. Rather than\nproceeding to extend and expand such programs, I urge the\nCongress to hold hearings and rapidly enact my proposed\n\"Financial Assistance for Health Care Act.\"\nTHE WHITE HOUSE,\nCalendar No. 323\n94TH CONGRESS\nSENATE\nREPORT\n1st Session\nNo. 94-330\nNATIONAL DISEASE CONTROL AND CONSUMER HEALTH\nEDUCATION AND PROMOTION ACT OF 1975\nJULY 24 (legislative day, JULY 21), 1975.-Ordered to be printed\nMr. KENNEDY, from the Committee on Labor and Public Welfare,\nsubmitted the following\nREPORT\n[To accompany S. 1466]\nThe Committee on Labor and Public Welfare, to which was referred\nthe bill (S. 1466) to amend the Public Health Service Act to extend\nand revise the program of assistance for the control and prevention\nof communicable disease, and to provide for the establishment of the\nOffice of Consumer Health Education and Promotion and the Center\nfor Health Education and Promotion to advance the national health;\nto reduce preventable illness, disability, and death; to moderate self-\nimposed risks; to promote progress and scholarship in consumer health\neducation and promotion and school health education; and for other\npurposes, having considered the same, reports favorably thereon with\namendments and recommends that the bill as amended do pass.\nI. BILL SUMMARY\nPURPOSE\nThe proposed Act has three titles: Titles I and II respectively\nrevise and extend expiring communicable and other disease control\nprograms and venereal disease prevention and control programs; and\nTitle III authorizes consumer health education and promotion pro-\ngrams. The legislation would authorize the programs involved for\nfiscal years 1976 through 1978, with authorizations of appropriations\nas hereinafter indicated,\n57-010-75-1\n2\n3\nESE\nTITLE I-DISEASE CONTROL\n(6) Enables minors to seek and receive treatment for venereal\ndiseases on their own, in conformance with current statutes in\nSection 101. This title, which is to be cited as the \"Disease Control\n49 of our 50 States.\nAmendments of 1975,\" revises and extends existing authorities for\n(7) Authorizes;\ndisease prevention and control programs found in section 317 of the\n(a) $5,000,000 for each of fiscal years 1976, 1977, and 1978\nPHS Act, for fiscal years 1976 through 1978.\nfor grants to States, political subdivisions of States, and any\nAmendments Respecting Disease Control\nother public or nonprofit private entity for projects for the\nconduct of research, demonstrations, and training for the\nSection 102. Amends section 317 of the PHS[Act with the following\nprevention and control of venereal disease.\nsubstantive modifications;\n(b) $5,000,000 for fiscal year 1976, $10,000,000 for fiscal\n(1) Authorizes disease control programs for additional diseases\nyear 1977, and $15,000,000 for fiscal year 1978, to enable the\nand conditions by. adding mumps, diabetes mellitus, and other\nSecretary to make grants to State health authorities to assist\ndiseases or conditions (other than venereal diseases) which are\nthe states in establishing and maintaining adequate public\namenable to reduction and are determined by the Secretary to be\nhealth programs for the diagnosis and treatment of venereal\nof national significance. This amendment is intended to expand\ndisease!\nthe scope of activities now carried out by the Center for Disease\n(c) $31,000,000 for fiscal year 1976, $33,000,000 for fiscal\nControl.\nyear 1977, and $36,000,000 for fiscal year 1978 for project\n(2) Adds the word project before grant or grants each time it\ngrants to States and, in consultation with states, to political\nappears, to assure that grants for disease control (as provided\nsubdivisions of States, for venereal disease control activities\nunder section 317 of the Public Health Service Act) are used for\ndescribed under 317(d)(1) of the Public Health Service Act,\nthis purpose.\nas amended by this bill.\n(3) The bill authorizes $30,000,000 for fiscal ycar 1976, $35-\n000,000 for fiscal year 1977, and $40,000,000 for fiscal year 1978.\nTITLE III-HEALTH EDUCATION AND PROMOTION\nTITLE II-VENEREAL DISEASE\nSection 301. States that the title may be cited as the National\nConsumer Health Education and Promotion Act of 1975.\nSection 201. This title, which is to be cited as the \"National Venereal\nSection 302. Amends the Public Health Service Act by adding the\nDisease Prevention and Control Amendments of 1975,\" revises and\nfollowing new title:\nextends existing authorities for venereal disease prevention and con-\ntrol programs found in section 318 of the PHS Act.\nTITLE XVII-OFFICE OF CONSUMER HEALTH EDUCATION\nSection 202. This section sets forth the findings and declaration of\nAND PROMOTION AND THE CENTER FOR HEALTH\npurpose of Congress respecting venereal disease.\nEDUCATION AND PROMOTION\nAmendments Respecting Venereal Disease\nSection 203. Amends section 318 of the PHS Act, \"Projects and\nSection 302. Also amends the Public Health Service Act by adding\nPrograms for the Prevention and Control of Venereal Diseases,\"\nthe following sections:\nwith the following substantive modifications:\n1\n(1) Expands technical assistance respecting research, training,\nPART A-OFFICE OF CONSUMER HEALTH EDUCATION AND PROMOTION\nand public health programs for the prevention and control of\nNew Section 1701. Establishes within HEW Office of Consumer\nvenereal disease to include nonprofit private entities in addition\nto public authorities and scientific institutions which are cur-\nHealth Education and Promotion under the direction of a director,\nrently eligible.\nappointed by the Secretary and supervised by the Assistant Secretary\n(2) Specifies that project grants for States for venereal disease\nfor Health. To develop a health education and promotion strategy for\nthe Nation, the Office would: engage in health education and promo-\nprevention and control may include routine laboratory testing\nand follow-up.\ntion research, develop community health education programs, stimu-\n(3) Provides that grants for research, training and public\nlate and coordinate communications in health education and promo-\nhealth venereal disease prevention and control programs \"oon-\ntion, and overview and coordinate Federal health education programs.\ntribute to national objectives.\"\nNew Section 1702. The Secretary, acting through the Office, is\n(4) Deletes, as a method of diagnosis of gonorrhea and syphilis,\nauthorized to undertake various programs to achieve a national\n\"dark-field microscope techniques.\"\nhealth education and promotion strategy.\n(5) Expands the definition of venereal disease, to include other\nNew Section 1703. Provides that the Secretary shall make grants\nsexually transmitted diseases in addition to syphilis and gonor-\nand contracts to public and nonprofit private entities regarding health\nrhea.\neducation programs.\n4\n5\nThe section also provides that the Secretary cannot make grants\nunder either the Public Health Services Act or the Community Mental\nNew Section 1716. Authorizes appropriations for expenses of the\nHealth Centers Act unless the application contains assurances that\nCenter of $1,000,000 in fiscal year 1976, $1,000,000 in fiscal year 1977,\nconsumer health education services will be provided during the period\nand $1,000,000 in fiscal year 1978. In addition to the sums authorized\nwhen assistance would be made available.\nto be appropriated, the Center is authorized to receive income, grants,\nNew Section 1704. Provides for the establishment of an Interdepart-\ndonations, bequests, or other contributions from non-Federal sources.\nmental Committee on Consumer Health Education and Promotion\nNew Section 1717. Provides that the accounts of the Center shall be\ncomprised of various Federal agencies and offices administering pro-\naudited annually by independent public accountants certified or\ngrams directly affecting health education and promotion. The Secre-\nlicensed by a regulatory authority of a State or other political sub-\ntary of Health, Education, and Welfare would chair the Committee.\ndivision of the United States.\nNew Section 1705. Establishes a nineteen member Advisory Council\nNew Section 1718. Authorizes $2,000,000 for fiscal year 1976,\nto be appointed by the Secretary, to advise the Secretary on matters\n$3,000,000 for fiscal year 1977, and $4,000,000 for fiscal year 1978 to\nof general policy with respect to the functions of the Office, and sets\nbe used by the Secretary for grants to public and private nonprofit\nforth appropriate controls for selection of the members.\nentities to assist in initiating programs in elementary and secondary\nNew Section 1706. Requires reports to be made to the President\nschools, and in communities, to reduce the incidence of oral disease\nand the Congress by the Secretary regarding health education and\nand dental defects.\npromotion including recommendations for legislative initiative. The\nNew Section 1719. Defines health education and promotion.\nOffice of Management and Budget may not revise the reports or delay\nSection 303 of the bill authorizes the National Center for Health\ntheir submission to either the President or the Congress.\nStatistics to make continuing surveys regarding consumer health\nNew Section 1707. Authorizes appropriations for health education\neducation, and to report its findings, together with finding of other\nand promotion: $11,000,000 for fiscal year 1976, $11,000,000 for fiscal\nsurveys and appropriate survey analyses to the Secretary, the Assistant\nyear 1977, and $24,000,000 for fiscal year 1978.\nSecretary for Health, and the Office of Consumer Health Education\nand Promotion. Of sums appropriated by Sec. 308 of the PHS Act,\nPART B-CENTER FOR HEALTH EDUCATION AND PROMOTION\nnot less than $1,000,000 for each of fiscal years 1977, 1978, and 1979\nNew Section 1708. Sets forth findings and declarations, concluding\nshall be available for the purposes authorized in. this section.\nthat:a private corporation should be created to facilitate the develop-\nment of a health education and promotion strategy for the Nation.\nII. THE NEED FOR GREATER EMPHASIS ON DISEASE CONTROL AND\nNew Section 1709. Provides that the new Center shall have a 25\nCONSUMER HEALTH EDUCATION AND PROMOTION\nmember board of directors appointed by the President with the advice\nBetween 1960 and 1974, annual expenditures for health increased\nand consent of the Senate, with broad representation of various regions\nfrom slightly less than $26 billion to slightly over $104 billion. Public\nof the country and of various kinds of bills and experiences appro-\nexpenditures for health each year increased from $6.4 billion to $41.3\npriate to the functions and responsibilities of the Center. The members\nbillion. Private health insurance benefits increased in that time period\ninitially selected would serve as incorporators.\nNew Section 1710. States the terms and conditions of Board\nfrom $4.7 billion to $23.1 billion annually, while the percentage of\nout-of-pocket costs to consumers decreased from 55 percent of personal\nmembership.\nNew Section 1511. Provides that the Center shall have a President\nhealth expenditures to 35 percent. Persons employed in the health\nindustry increased from 2.5 million workers to almost five million\nand other officers that may be appointed by the Board.\ntoday. Last year, the health industry provided over one billion physi-\nNew Section 1712. Provides that the Center shall have no power to\ncian and dentists visits and over 30 million short-term hospital\nissue any shares of stock or to declare or pay dividends; that no part\nservices, alone.\nof the income or assets of the Center shall inure to the benefit of any\nDespite these accomplishments, it is clear to the Committee that\ndirector, officer or employee of the Center; and that the Center may\nprogress in improving the health of the American people has not im-\nnot contribute to or otherwise support any political party or candidate\nfor elective office.\nproved in proportion to our growing investment. Increasingly, ques-\nNew Section 1713. Describes the objectives of the Center and the\ntions are being raised regarding the efficacy of therapeutic medicine,\nwhich is the predominant emphasis of the health industry today, in\nspecific programs which the Center is to undertake to achieve its\nimproving the health of the American people.\nobjectives.\nNew Section 1714. Provides that the Board shall appoint an Advisory\nIn June of this year, the American College of Medicine and the\nFogarty International Center of the National Institutes of Health\nPanel of 100 individuals with appropriate competencies and abilities\nto provide advice for members of the Board.\njointly sponsored a National Conference on Preventive Medicine. An\nNew Section 1715. Provides that the Center shall submit an annual\nimportant outcome of the Conference were a series of Task Force\nReports. One of the most valuable was the report of the Task Force on\nreport to the President for transmittal to Congress on its activities\nduring the year, together with any recommendations it considers\nConsumer Health Education chaired by Annie R. Somers, a nationally-\nrecognized expert in health care. In addressing the issue of the adequacy\nappropriate.\nof therapeutic medicine, which consumes the great majority of our\n7\n6\nhealth resources, the Task Force on Consumer Health Education\nFinally, the Task Force chose to comment on the performance of\nnoted the following:\nour health industry in the context of the limitations mentioned\npreviously. They noted:\nDespite the vast increase in health care expenditures and\nthe greatly improved access to care on the part of most\nThis judgment relates not only to the large amount of\nAmericans, illness, disability, and premature death show\npreventable illness but to the inadequacy of medical inter-\nlittle-if any-signs of improvement. The statistics with\nvention per se in the management of serious illness. The\nrespect to death rates are particularly disturbing. After\nreported exposés of miserable patient care in many nursing\nhalf a century of steady and dramatic improvement, the total\nhomes now expensively reimbursed under Medicare and\nor \"crude\" death rate for the U.S. ceased to improve during\nMedicaid, the growing public demand for more professional\nattention to the humanities and even the amenities of death\nthe Sixties. It remained almost stable, fluctuating between\n9.4 and 9.7 per 1000 population. The rate for 1973 is still 9.4.\nand dying, the renewed interest in euthanasia, and the\nincreasing realization that technical virtuosity is not neces-\nThe Task Force noted problems hidden beneath these general\nsarily synonymous with effective care. All these developments\nstatistics:\nindicate the public's growing impatience of the patient as a\nThe differential between male and female life expectancies\nresponsible agent in the treatment of his or her own illness.\nhas increased from one year in 1920 to 7.5 years in 1970.\nThe Committee concurs with the thrust of the Task Force on Con-\nThe stability of the total death rate in the Sixties is\nsumer Health Education. The findings of the Task Force are consistent\nprimarily a function of changes in the population composi-\nwith the conclusions of an increasing number of experts who have\ntion, not stable rates across time for all age groups. When this\nlooked at the performance of the health care field. The issue has been\neffect is controlled, substantial increases in the death rates\naddressed in a variety of ways including the Administration's ques-\nfor all age groups, 4-44, are revealed. Although there were\ntioning of increases in the numbers (not the specialty or geographic\nsome increases for women, the increases were primarily for\ndistribution) of physicians, the numbers of hospital beds, the numbers\nmales, and the upturn was even higher for blacks than for\nof all forms of health manpower, and the numbers of prescription\nwhites.\ndrugs. Increasingly, emphasis is shifting from overall quantities of\nThe death rate for homicides rose from 4.7 per 100,000 in\nresources to issues of the performance of those resources and their\n1960 to 9.4 in 1972 and seemed destined to continue rising.\ndistribution. The Committee considers the recent increase in intérest\nThe Task Force noted the continuing ineffectiveness of therapeutic\nin preventive medicine and health education as another reflection of\nmedicine to deal with our major health problems:\nthis shift.\nThe Committee commends this new emphasis; but it does SO with a\nThe principal causes of death for the whole population in\nmajor caveat. Although the Committee considers the resurgence of\nthe late Sixties were still the familiar trio-heart disease,\ninterest in health education overdue, it does not intend to encourage\ncancer, and stroke-plus accidents. In 1970, cardiovascular\n\"therapeutic nihilism.\" While there is justifiable concern regarding\ndiseases accounted for 53 percent of all deaths. During the\nthe inappropriate and excessive use of certain procedures such as\nlater Sixties, however, other causes accounted for most of the\ncertain surgical procedures, the great majority of therapies, at the\nrising death rates for young men. The principal cause for men,\nminimum, relieve pain and suffering. In many instances, they limit\n15-44, was automobile accidents; homicide and suicide were\ndisability, and in some instances, are responsible for the cures and\nalso important. None of these three phenomiena is directly\nthe prevention of death. The Committee considers present efforts to\naffected by the health care delivery system.\nimprove the quality of therapeutic medicine, and to make it more\n[Morbidity data is]\nthe best reported. But it is only\nwidely available as essential components of our efforts to improve the\nthe tip of the iceberg. For every youngster killed in an auto\nhealth of Americans. But the Committee has also concluded that there\naccident, thousands are injured each year; many permanently\nmust be far greater emphasis on finding ways to reduce the incidence\ndisabled. For every middle aged man who dies of cirrhosis,\nof diseases and conditions which result in suffering, disability, and\nthere are thousands of alcoholics or near-alcòhelics, For every\ndeath from an overdose of heroin, hundreds are hooked\ndeath. The control of communicable diseases through immunization,\nperhaps for life, to a habit that will not only wreck their own\nsanitation and pesticide programs has proven to be a successful\nlives but almost surely cause crime and other problems for\ndemonstration of what scientists and health professionals, with\ntheir communities.\nadequate public support, can accomplish.\nThus, it appears that therapeutic medicine, important as\nAlthough -the etiology of disease is extremely complex, and the\nit is, may have reached a point of diminishing returns. The\nincreases and decreases in the incidence of disease difficult to pinpoint\n12-15 percent increases that we are adding to our hundred\nprecisely, there appears to be little question that scientific discoveries\nbillion dollar health care bill each year-even the portion\nand the application of disease prevention and control programs have\nthat is not caused by inflation-apparently have only a\nhad a substantial impact in the reduction of many serious diseases.\nmarginal utility.\nIt is difficult for the Committee to imagine that malaria was still\n8\n9\nprevalent in the South as late as the 1930's, that polio was dreaded\nand in the process to stimulate them to adopt more healthful behavior.\nuntil the 1950's, and a vaccine for measles was not developed until the\nUniversity workers, researchers, and counselors examined three com-\n1960's. The fact that heart disease, cancer, and stroke are the major\nmunities: One a control with no health education efforts, one using\ncauses of death today is the result, in part, of our highly effective\nthe media only for health education, and a third using both the media\nefforts against diseases which were major killers in the early part of\nplus more intensive person-to-person efforts. The preliminary findings\nthis century. Death rates in 1900 were 17.2 per thousand; today they\nrevealed that improvements were detected by using the media only.\nare less than 10 per 1,000. In 1900, about 15 percent of all babies\nUsing the media plus other person-to-person health education,\nwould die by the end of their first year; today, the figure is approxi-\nhowever, showed more dramatic results. For example, the number of\nmately 2 percent.\ncigarettes smoked per day declined by forty percent in the maximum\nAlthough dreaded infectious diseases have been virtually eradicated,\nsaturation town, during the period studied. Dr. Nathan Maccoby,\nthere is no justification for complacency. Programs to control and pre-\ndirector of the project, concluded that educational campaigns directed\nvent infectious diseases must be continually monitored to assure their\nat an entire community can produce striking increases in the level of\ncontinued effectiveness. Immunization levels against such diseases as\nknowledge about heart disease and risk factors and marked improve-\npolio and measles are below what is considered by the Center for\nments in risk factor levels.\nDisease Control to be safe from the standpoint of preventing such\nMost health education experts acknowledge that there is a great\ndiseases. A June 26, 1975 article in the New York Times reported that\nneed for greater understanding of how persons can be encouraged to\nthe immunization rate for polio for children between the ages of one\nadopt more healthful behavior and to retain a healthy life style. The\nand four was only 63 percent, while a minimum safe level is considered\nCommittee recognizes that imparting information alone is not sufficient\nto be 80 percent. Polio immunization rates declined from 78.6 percent\nto cause people to change their behavior. There is also apt to be great\nin 1964 to 60.4 percent in 1973. In some poor communities, rates as\nskepticism, particularly among the young, concerning any information\nlow as 15 percent have been found. In 1969-1971, there was a resur-\nprovided, and the recognition that there are strong interests and\ngence of measles owing to inadequate immunization levels.\npressures to adopt unhealthy life styles, including smoking, drinking,\nIn addition to immunization and other public health control\nusing drugs, and eating fatty foods. The Committee considers health\nmeasures, the greatest hope for reducing and delaying the incidence\neducation and promotion, despite these limitations and obstacles, an\nof the diseases affecting people today rests with health education\nessential part of a national effort to improve the health of people in\nprograms. The evidence is conclusive that the environment and in-\nthis country. It is our opinion that there is a great need for more\ndividual life styles are major determinants of such afflictions as heart\nhealth education and promotion information.\ndisease, cancer, stroke, and accidents.\nIn addition to the task of educating the public to the benefits of\nA study of the relationship between health practices and physical\nhealthier lifestyles, there is a great need for a better understanding\nhealth status reported by Belloc and Breslow in Preventive Medicine\nof how better to use the health system. Despite widespread avail-\nin 1972 showed that persons engaged in good health practices lived\nability of screening programs for breast and cervical cancer, only\nlonger. Health practices included hours of sleep, regularity of meals,\nhalf of American women over 17 had such tests in 1973 and nearly\nphysical activity, and smoking and drinking. The association between\none-fourth had never had a breast screening examination. As men-\ngood health practices and good health, furthermore, was found to be\ntioned earlier, immunization levels, in some cases, are dropping.\nindependent of age, sex, and economic status. Belloc also reported on\nThere are still far too many persons, even those with adequate in-\nthe relationship between health practices and mortality in Preventive\ncomes, who fail to see a dentist regularly and to practice good dental\nMedicine in 1973, and found \"a striking inverse relationship\" between\nhygiene. We eat the wrong foods, drive too fast and drink too much.\npoor health practices and longer life. He further reported that the\nOurs is a generation of excess. Providers of health care are not able to\naverage life expectancy of men aged 45 who reported six or seven\ndo their job to educate us with regard to negative health behavior.\nfour. \"good\" practices was 11 years more than men reporting fewer than\nFinally, the Committee considers it essential that the general public,\nthe potential users of health services produced by the health industry,\nA major issue considered by the Committee was not the potential\ngain a more realistic picture of the values and limitations of the\nbenefit of health education, but the effectiveness of health education\nhealth industry, regarding its potential to cure illness, eliminate dis-\nto cause or contribute to the changes necessary to improve health,\nability, and prolong life. Such a picture should include the limitations\nPatient education programs, such as those associated with diabetes,\nof both preventive and therapeutic medicine to redress the harm done\nheart disease, pain after surgery, and hemophilia have shown en-\nby environmental hazards and unhealthy individual lifestyles.\ncouraging results. Persons with disease or other disabling conditions\nclearly can be motivated to lead healthier lives.\nIII. DISEASE CONTROL AND PREVENTION\nAn ongoing demonstration by Stanford University reports promis-\ning results in changing health behavior such as reducing weight,\n1. TITLE I\ncholesterol levels, and smoking. The objective of the study was to\nteach individuals between the age of 35 and 69 about heart risk factors,\nTitle I of the Committee's bill, Disease Control Amendments of\n1975, would continue a national program of assisting States in carrying\nout programs which are needed to protect the American people from\n10\n11\nunnecessary suffering from communicable diseases, and to build upon\nachieved through 318(d) project grants, and is recommending a\nour successes in communicable disease control by including an attack\nfunding authority for the next three years which will avoid retrench-\non other preventable conditions. These programs are an essential\nment at this critical phase of our all-out attack on venereal disease.\nelement in forging a truly effective health care policy for our country,\nIn fiscal year 1976, $31,000,000 is authorized for 318(d) grants, with\nand have the potential for undergirding work in reforming our system\nof health care financing and the delivery of personal health services.\n$33,000,000 in 1977, and $36,000,000 in 1978.\nThe bill authorizes $31,000,000 for project grants and contracts in\nThe funding authorizations for each of the programs under Title I\nfiscal year 1976 to carry out these programs, with $35,000,000 and\nand Title II of the bill have been developed after careful consideration\nof the needs of the nation in disease control and the demands for\n$40,000,000 being authorized for fiscal years 1977 and 1978 respectively.\nThese grants are to support projects at the State and local level, and\nrestraint in Federal spending. Funding levels are lower than those\nauthorized for the period 1972-1975, and are lower than our original\nare to be awarded on the basis of the extent of the problem in the\nState or local area and on the soundness of the applicant's proposed\nestimates of the need for the next three years. They represent in each\ninstance reasonable and minimal investments which must be made if\ncontrol program. The bill re-emphasizes the importance of carrying\nout public awareness programs in these projects SO that, to the extent\nwe are to achieve the level of success in preventing illness which we,\npossible, citizens will be properly informed of disease risks and the\nas a nation, have both the financial and technical capability to\nachieve.\nservices available to them to prevent illness. Grantees will continue\n3. HEARINGS\nto be able to draw on personnel and other resources of the Department\nof carry out these projects in lieu of receiving direct financial assistance.\nThe need for the extension of the authority contained in section\nThe definition of disease control program has been broadened to\n317 and 318 of the PHS act in respect to disease control and the need\npermit the Administration and the Congress to address other problems\nfor a special authority for venereal disease was supported by testimony\nof national significance which are amenable to control through orga-\nfrom Mrs. Dale Bumpers, Chairperson, \"Every Child by 1974,\" Little\nnized State and community programs such as those authorized by this\nRock, Arkansas, Dr. Eugene Fowinklé, Commissioner of Public\nbill. Venereal disease control programs, however, are addressed\nHealth, State of Tennessee, Mr. Donald P. Clough, Executive Direc-\nseparately under Title II of the bill in recognition of the importance\ntor of the American Social Health Association, Dr. Leonard L. Heimoff,\nof a special attack on this problem. Similarly, lead based paint poison-\nAssociate Professor of Medicine, Cornell University Medical School,\ning prevention grants are, in the Committee's view, best undertaken\nMr. Samuel R. Knox, Director of the Association of Venereal Disease\nin the context of a comprehensive attack. This approach is reflected\nPrograms, and Dr. James N. Miller, Professor of Microbiology and\nin Senate Bill 1664 which was ordered reported by the Committee on\nImmunology, UCLA School of Medicine. The Administration recom-\nJuly 16, 1975.\nmended against the enactment of both titles I and II of the Com-\n2. TITLE II\nmittee's bill.\nTitle II of the Bill, National Venereal Disease Prevention and\n4. BACKGROUND\nControl Amendments of 1975, continues and strengthens the national\nIn 1974, four American families were afflicted with polio. In 1952,\ncampaign against venereal disease under Section 318 of the PHS Act,\nwhich was formulated by this Committee in 1972. The bill extends\nthere were over 55,000 cases in the United States. Yet, today, far too\nauthority for the Secretary to provide technical assistance to other\nmany one to four year olds are not fully protected against this dread\norganizations in their conduct of research, training and public health\ndisease, and in some population groups the level of protection is\nprobably well below 50 percent, The major rubella epidemic predicted\nprograms for the control of venereal disease, and emphasizes the key\nrole of private non-profit organizations in the national control effort.\nfor 1971-1972 did not materialize, thanks to a massive nationwide\nResearch, demonstration, and training grants are also authorized to\nrubella immunization campaign which was undertaken between 1969\nenable the Secretary to meet national needs in developing and up-\nand 1971. The percent of the population protected against rubella,\ngrading control programs. The Committee has authorized $5,000,000\nhowever, has shown signs of declining since 1972. Levels of protection\nannually for these grants in fiscal years 1976, 1977, and 1978.\nagainst the other childhood vaccine-preventable diseases also show\nIn addition, the bill extends Section 318(c) formula grant authority\nsigns of slipping. Since the early 1940's, deaths due to syphilis have\nfor upgrading diagnostic and treatment services, and adds an addi-\ndeclined 97 percent; first admissions to mental institutions due to\ntional requirement that the providers of clinic services begin to meet\nsyphilitic psychoses have declined 98 percent; and congenital syphilis\nthe needs of patients with genito-urinary diseases other than those\nhas declined 92 percent. Yet, we continue to witness an increase in\nwhich have been traditionally defined as venereal diseases. The\nthe incidence of syphilis, which portends a resurgence in serious com-\nfunding authorizations for this program are $5,000,000 for fiscal\nplications in 10-20 years unless something is done now.\nyear 1976, $10,000,000 for 1977, and $15,000,000 for 1978.\nThis history of communicable disease control contains grim lessons.\nProject grants for control programs under 318(d) of the Act are\nIt took a major epidemic in 1964 to direct the attention of the nation\nalso continued with revisions to clarify the purposes of these grants.\nto the necessity for the control of rubella. Steady successes in syphilis\nThe Committee is encouraged by the early results which have been\ncontrol were eroded in the late 1950's because of the premature con-\nclusion that the job was finished. We are still reaping the benefits of\n12\n13\nsyphilis control investments in the 1940's and early 1950's. The number\nof deaths and debilitating consequences of syphilis are still much\nsibility. Tuition charges will certainly weaken the ability of the\nbelow the pre-penicillin era. However, we lost the edge in containing\nCenter to help those States and cities which are in greatest need of\nthe incidence of the diseases in the late 1950's, and between that time\nassistance.\nand the passage of the Communicable Disease Control Amendments\n5. Formula grant authority under Section 318(c) to assist States in\nof 1972, we ran hot and cold in our attention to this problem. Until\nupgrading diagnostic and treatment services has been extended. The\ngonorrhea surpassed a half million reported cases, the Federal govern-\nCommittee views the lack of appropriations for this grant program\nment did not spend a penny in project grants to help States and\nwith great concern. We agree with the testimony presented by the\ncities carry out control programs.\nAmerican Social Health Association stating that \"re-emphasis of the\nIn 1970, the Communicable Disease Control Act was passed, setting\nformula grant mechanism to assist states in establishing and main-\nup a project grant program under Section 317 of the Public Health\ntaining adequate public health programs for the diagnosis and treat-\nService Act to assist States and cities address communicable disease\nment of venereal disease is but an honest recognition of the\ncontrol problems on a consistent, nationwide basis. This legislation\nshortcomings of our current VD patient care delivery system.\" The\nwas specifically designed to establish a Federal leadership role in the\nCommittee views improvement in public diagnostic and treatment\ncontrol of communicable diseases, and to signal to the States that we\nprograms as essential to the control of venereal disease, and sees\nwere serious about working with them in achieving control. It was a\nthe failure of many clinics to provide medical care to persons who\nspecific response to the existing Federal approach, which was to fund\nseek care for genito-urinary diseases other than syphilis and gonorrhea\nprojects under the general health services project grant authority\nas a major weakness in the system.\ncontained in Section 314(e) of the Public Health Service Act. That\napproach not only undermined the purpose of 314(e), but it created\nIV. CONSUMER HEALTH EDUCATION AND PROMOTION\nserious confusion in the States, because the nature of the Federal\ncommitment to comunicable disease control and the likelihood of\n1. LIFESTYLE AND HEALTH STATUS\ncontinued funding remained in a state of flux.\nThe 1972 amendments strengthened Section 317 grant programs,\nAmericans are paying-in the form of taxes, insurance contribu-\nand specifically authorized for the first time a comprehensive attack\ntions, and direct out-of pocket expenses-over $116 billion a year for\non venereal disease under Section 318 of the Act. Funding of the various\nhealth care and related expenditures. Of this staggering total, only\ncomponents of the new law, however, has never matched the amounts\nabout four percent go for prevention and health education combined.\nwhich the Committee authorized, and which we believed to be neces-\nWhy the anomaly?\nsary. In many instances no funds have been provided to carry out\nThroughout recorded history, responsibility for health was placed\nparts of the law.\non the individual. However, as better knowledge of the human body\n5. COMMITTEE CONSIDERATION\nand disease mechanisms were acquired and medical practice became\nmore scientific, society came to place increasing dependence on medical\nThe Committee wishes to draw attention to several other key\nintervention. Concomitantly, decreasing emphasis was placed on\nchanges in the law which are contained in Senate Bill 1466.\nindividual behavior and individual responsibility. Society soon came\n1. The word \"project\" is inserted throughout Section 317, as\nto accept the curative role of the physician and the preventive role\nappropriate, to avoid any possible misconception about the purpose\nof the public health official as the appropriate avenue to health.\nof grants and the criteria to be used in making awards. These grants\nYet, despite the vast increase in health care expenditures, illness,\nare to be awarded on the basis of the problem and according to the\ndisability and premature death rates have shown little improvement.\nsoundness of the program to be supported.\nThe statistics with respect to death rates are particularly disturbing.\n2. Public awareness programs are to be considered integral parts\nAfter half a century of steady and dramatic improvement, the total\nof any control program funded under Section 317.\nor \"crude\" death rate for the U.S. ceased to improve during the 1960's.\n3. HEW should expand its focus in providing technical assistance in\nIt remained almost stable, fluctuating between 9.4 and 9.7 per 1,000\nvenereal disease control to working with the many private non-profit\npopulation. The rate for 1973 is still 9.4.\norganizations engaged in combatting these diseases. These citizen\nThe principal causes of death for the whole population in the late\ngroups and service agencies are vital allies to Federal, State, and local\n1960's were still the familiar trio of heart disease, cancer, and stroke,\ndisease control agencies.\nto which we should add accidents. In 1970, cardiovascular diseases\n4. The technical assistance capabilities of the Center for Disease\naccounted for 53 percent of all deaths. During the later 1960's,\nControl should be fully utilized in helping States and localities\nhowever, other causes accounted for most of the rising death rates for\nstrengthen each of their control programs. The Committee was very\nyoung men. The principal cause for men, aged 15 to 44, was auto-\nconcerned in hearing testimony about the Department's plan to\nmobile accidents with homicide and suicide following close behind.\nrequire tuition payments from persons receiving technical training\nThe committee recognizes that none of these three phenomena is\nat the Center. It is a major objective of this bill to upgrade States\ndirectly affected by the health care delivery system.\nand local control capabilities, and we view this as a Federal respon-\nThus, it appears that therapeutic medicine, important as it may be,\nmay have reached a point of diminishing return. The 12 to 15 percent\n14\n15\nincrease that we yearly add to our hundred billion dollar health care\nA large proportion of patient education is done on an informal one-\nbill apparently has only a marginal utility. The committee believes\nto-one basis by physicians in their own offices, nurses, therapists, and\nthat a health education and promotion strategy offers hope, a hope\nother health professionals. They are usually under severe time con-\nmanifested by shifting emphasis from curative medicine, currently\nstraints and cannot provide either in-depth coverage of the instruc-\nthe predominant and extraordinarily expensive modality, to pre-\ntional material or follow up.\nvention and health maintenance.\nHospital health education programs are scarce and inadequate. In\nthose hospitals that do have formal programs, they commonly start\n2. DEFINITION OF HEALTH EDUCATION\nin one of three types of activities: Classes for diabetics, cardiac patients,\nor others with serious chronic diseases or disability; classes for expect-\nThe Committee found that there was no single acceptable definition\nant parents; and pre-operative instruction. For each of these topics\nof health education. Several were offered, all contributing to an\nthere is a large potential \"student body\" and the information and\nunderstanding of its potential application.\nprocedures are fairly well established. Instruction is usually provided\nIn view, then, of the frequent inconsistency in use of the terms\nupon referral by a doctor or nurse, on a group basis, and by a member\n\"health education\" and \"consumer health education,\" the Committee\nof the professional staff. Good programs, however, go beyond teach-\nfelt it essential to develop what it has chosen to call a \"mega-defini-\ning assorted courses. In some hospitals, the committee learned, there\ntion.\" The term \"consumer health education and promotion\" sub-\nis a fulltime health education coordinator to identify problem areas,\nsumes a set of activities which:\ngather resources, and coordinate ongoing efforts as there is in the\n(1) inform people about health, illness, disability, and ways\nUnited Hospitals of St. Paul, Minnesota. Such hospitals also assume\nin which they can improve and protect their own health, including\nresponsibility for teaching the teachers-nurses, and mid-level health\nmore efficient use of the delivery system;\npractitioners.\n(2) motivate people to want to change to more healthful\nSome health maintenance organizations and clinics are also oper-\npractices;\nating formal health education programs. For many years, the Health\n(3) help them to learn the necessary skills to adopt and main-\nInsurance Plan of Greater New York (HIP) operated a large-scale\ntain healthful practices and lifestyles;\neducational program under an experienced educator and several of\n(4) help other health professionals to acquire these teaching\nthe Kaiser-Permanente units operate health education activities-the\nskills;\nOakland program, with its large-scale audio-visual equipment, achiev-\n(5) advocate changes in the environment that facilitate health-\ning particular fame.\nful conditions and healthful behavior; and\nA major theme in recent patient education efforts is that individuals\n(6) add to knowledge via research and evaluation concerning\nmust take responsibility for their own health. Diabetes programs, for\nthe most effective ways of achieving the above objectives.\nexample, attempt to formalize a patient's responsibility for health\nIn brief, consumer health education is a process that informs, moti-\nmaintenance. Consider the treatment. What are the respective roles\nvates, and helps people to adopt and maintain healthy practices and\nfor the doctor and the patient? Ideally the disease should be discovered\nlifestyles, advocates environmental changes as needed to facilitate this\nearly. The physician makes a diagnosis and prescribes therapy. The\ngoal, and conducts professional training and research to the same end.\npatient must inject himself with the correct dosage of insulin every\nFor purposes of this Report, the definition agreed to by the\nday, interpret his own urine samples and decide when a change is\nCommittee is as follows:\nsufficient to warrant calling his physician. The patient must be moti-\n\"Health education and promotion\" is a process that\nvated to lose weight, recognize and report side effects, learn proper\nfavorably influences understandings, attitudes, and conduct,\ntechniques for foot and toenail care to avoid the devastating complica-\nincluding cultural awareness and sensitivity, in regard to\ntion of infection and gangrene, recognize early symptoms of complica-\nindividual and community health. Specifically, it affects and\ntions, and visit his physician when scheduled. The physician's role is\ninfluences individual and community health behavior and\nessential to effective treatment; SO too is the patient's. No amount of\nattitudes in order to moderate self-imposed risks, maintain\nresources devoted to physician or hospital care can substantially\nand promote physical and mental health and efficiency, and\nreduce the cost of diabetes if the patient has not been adequately\nreduce preventable illness, disability, and death.\ntrained and motivated to do his part. The Committee recognizes,\nhowever, that there are and will continue to be very significant\n3. HEALTH EDUCATION TARGET GROUPS AND PROGRAMS\nproblems with regard to the management of diabetes. Education alone\nwill not resolve the problems attendant to this disease, but it is an\nA. Patient Education.-A consumer becomes a patient when he or\nimportant aspect that needs emphasis.\nshe recognizes a health problem or a potential problem and turns to a\nWhen patient education programs are well thought out they have\nphysician, clinic, hospital, or some other component of the health care\nproved to be very successful. In the Los Angeles County Medical\ndelivery system for assistance. This is an important distinction:\nCenter diabetes education program, a telephone \"hotline\" was intro-\nPatients have recognized a problem and made a commitment of time\nduced for information, medical advice and for obtaining prescription\nand frequently of money. They are, therefore, more receptive to medi-\nrefills. Patients were educated to use this service through an aggressive\ncal intervention and health education efforts.\ncampaign of pamphlets, posters and counseling sessions by physicians\n17\n16\nA major problem in all screening programs is the difficulty of\nand nurses. When the program was evaluated, it was found that the\nobtaining follow-up compliance.\nincidence of diabetic coma was reduced from 300 to 100, the number of\nThe informational \"hot line\" is another approach to community\nemergency visits by the diabetic patients were reduced by half, and\neducation that has been successfully used in some communities. At\nthat 2,300 clinic visits were avoided. Over two years, total savings\nMonmouth Medical Center in Long Branch, N.J., a VD hotline gave\nwas estimated at more than $1.7 million.\ndiagnostic and treatment information and directed callers away from\nA modification of present education programs is the \"self-help\nthe hospital emergency room to the less costly olinic. The Committee\npreventive medicine\" offered by Georgetown University's Community\nfavors the development and implementation of a model toll-free tele-\nHealth Plan at Reston, Virginia. This organization has crystallized a\nphone system.\nconcept, employed by a small but growing number of physicians,\nA unique example of targeted community education is the Stanford\ninto an organized course consisting of seventeen weekly evening\nHeart Disease Prevention Program. The objectives of this large five-\nsessions of two hours each. Patients are taught what behavior practices\nyear interdisciplinary study are to teach individuals between the ages\nare healthful; how to use basic medical equipment such as stetho-\nof 35 and 69 about heart risk factors and to stimulate them to adopt\nscopes, sphygmomanometers, and otoscopes; and what to do in emer-\nmore healthful behavior. The study compared risk factor decreases in\ngencies. The goals of the program are to create \"activated patients\"\nthree similar California communities exposed to different mixes of\nwith a positive sense of their ability to affect their health, and to\ntelevision spots, printed materials, and personal instruction. The\nreduce some of the unnecessary, time-consuming, burdens currently\nconclusion was that educational campaigns directed at an entire com-\nplaced upon the physician.\nmunity could produce striking increases in the level of knowledge\nThere is also a recognition in industry of the potential value of\nabout heart disease and risk factors and marked improvements in risk\nhealth education. Several companies, for example, have entered the\nfactor levels.\nfield with films, tapes, cassettes, slides, models, teaching texts, and\nIt is research of this type that the Committee believes most im-\nother audio-visual and printed teaching aides.\nperatively should be funded. Changing behavior is a very complex\nB. School health education.-The long run success of consumer\nphenomena and requires a series of longitudinal studies to identify\nhealth education programs rests on the behavior and health habits\nthe most effective methods. Funding should be available to qualified\nof children and youth. The public school system has the potential to\nresearchers from private nonprofit and public agencies and institu-\ninfluence these children, but the potential has not been adequately\ntions for these purposes.\ndeveloped and, in general, the record is not impressive.\nD. Occupational Health Education.-Individuals are exposed to\nIt is difficult to determine which states have effective school health\nenvironmental hazards in their place of work that can have severe\neducation programs. Many have enacted legislation or issued ad-\nimplications for their health. The Occupational Safety and Health\nministrative directives mandating health education in public schools.\nAdministration (OSHA) identifies two categories of risk: (1) Safety\nFrequently, however, funds have not been appropriated to imple-\nhazards or dangerous physical conditions such as inadequate guards\nment and enforce these regulations.\non machines; and (2) health hazards or unsafe levels of toxic substances\nSchool health education programs are faced with three major\nand harmful physical agents such a asbestos and carbon monoxide.\nconstraints: A tradition of low visibility and priority, a narrow\nOver the years, great progress has been made in reducing occupa-\ndefinition of the appropriate jurisdiction for health education efforts,\ntional safety and health hazards affecting American workers. It has\nand a shortage of adequately trained health educators. The Committee\nbeen pointed out that for every industrial accident death there are\nconsidered the problems of school health education and decided to\nnow 50 cardiovascular casualties. However, in a dynamic technological\nfocus their attention on inservice education, establishing a program\nsociety such as ours new hazards constantly arise and old ones reappear\nof grants to local education agencies and institutions of higher educa-\nin new forms. In scattered instances, employers are still resistent to\ntion for education opportunities for elementary and secondary school\ngovernment- or union-inspired efforts to control toxic substances.\nteachers in a broad scope of health education areas.\nTo detect and control new hazards and to inculcate in the employee\nc. Community Health Education.-The goal of targeted community\nbetter understanding of his own responsibilities and rights under the\nprograms is to identify individuals who are at risk, make them aware\nFederal occupational safety and health laws, OSHA has undertaken\nof the risk and steps they can take to reduce that risk, and, if symp-\nan extensive employee educational program. Employees can obviously\ntoms are brought to light, to direct them to the appropriate care\naffect the safety of their environment by following recognized safety\nsetting. Targeted community programs frequently start with screen-\npractices such as wearing hard hats and ear plugs. However, in the\ning for hypertension, tuberculosis, breast cancer, and sickle cell\nmore subtle area of health hazards, which are often difficult to detect\nanemia.\nwithout sophisticated equipment, their only protection often is know-\nThe value of multiphasic screening has been debated and recently\ning and acting on their legal rights. They can also request OSHA\npreliminary results from a randomized controlled evaluation have\ninspections when they suspect a hazardous health condition exists (and\nbecome available. The results, from a study begun in 1964 by the\nhave their names withheld from their employers), and can review their\nKaiser-Permanente Medical Care Program, for example, indicate that\nemployers' records for monitoring and measuring hazardous materials.\nscreening can reduce the number of \"potentially postponable\" deaths\nand reduce medical costs for older men by $800 a year.\n57-010-75-3\n18\n19\nIn fiscal years 1974 and 1975, OSHA allocated $6.6 million for\nfifteen grants related to health education projects that test models\nbe attributed primarily either to management or the unions. The\nof occupational health education. The formats and curricula OSHA\nmajor culprits are the same four that hamper other forms of health\nobtains from these projects can be adapted by employees and em-\neducation-individual ignorance, public apathy, commercial pressures,\nployee groups to their own particular needs. A substantial multiplier\nand lack of any strong, positive leadership on the part of either the\neffect is anticipated.\ngovernment or the health professions.\nThe largest contract, for $3 million, was let to the National Safety\nThe Committee expects that programs authorized under this legis-\nCouncil, which has developed four short courses and implemented\nlation will receive proper attention by the Office.\nthem through 39 participating local safety councils. The courses\ninclude orientation to rights and responsibilities under the Act and\n4. NUTRITION\ninstructions on setting up safety and health programs within establish-\nments. Over 100,000 individuals have already been reached by this\nDuring the Great Depression it was a common fact that nearly\nmassive, geographically dispersed, program.\none-third of the Nation was malnourished. Today, we have developed\nAnother contract demonstrates the feasibility of using community\na neologism to describe the fact that the entire Nation may very well\nand junior colleges as part of the job safety and health education\nbe \"misnourished.\" We have the resources to buy sufficient food, but\ndelivery system, while another entails the creation of thirty-minute\nlack the knowledge to choose which foods are the best for us.\ntelevision programs on selected job safety and health topics.\nMany who are not hungry are the \"new misnourished.\" They are\nTraining individuals to recognize health hazards is complex because\nthe overweight who eat empty calories and consume too many\nthe problems vary by occupations. OSHA has selected five \"target\nprocessed foods. They are our children; they our often ourselves.\nindustries\" in which the disability and death rates are substantially\nJean Mayer, chairman of the White House Conference on Food,\nabove average including, longshoring, meat and meat products, roofing\nconcluded that the \"new misnourished\" cost the Nation about $30\nand sheet metal, lumber and wood products, and miscellaneous trans-\nbillion a year. A fraction of this large sum could be spent on nutrition\nportation equipment.\neducation. A tax dollar spent to give consumers a sensible scientific\nOSHA's work has been supplemented by that of a number of unions\nguide to spending their food dollars is an investment in our children.\nand companies that have initiated their own education programs in\nIt is an investment with a dollar and cents return for spending more\nareas not related to occupational safety but using the workplace as\nfor nutritional education now will mean less sickness and lower costs\na focus for more general health education. For example, the United\nlater.\nMine Workers Union, which administers its own prepaid health in-\nOften bills would encourage and expand nutrition education pro-\nsurance plan, has hired full time health educators in several regions,\ngrams in schools of medicine and dentistry. The Committee believes\nand conducts programs in preventive care and specialized classes for\nit is important for physicians and dentists to understand the relation-\ndiabetics and others.\nship between nutrition and health to better provide their patients with\nThe Connecticut Mutual Life Insurance Company in Hartford,\nnecessary nutritional information.\nConnecticut, and the Scoville Manufacturing Company in Waterbury,\nSuch bills are presently pending before the Congress and it is\nConnecticut, each have a program to help workers with alcohol or\nanticipated that they will be the subject of hearings in September 1975.\nother drug problems. In addition, Connecticut Mutual offers employees\nThe Committee recognizes this important subject and has included\nperiodic voluntary physical examinations, occasional videotape\nnutrition and nutrition experts in all of the appropriate policy design\npresentations during the lunch hour on topics such as heart disease\nand implementation sections in the bill.\nor alcoholism, and frequent health articles in company publications.\nThe programs of both companies direct their promotional efforts\n5. MEDIA\nlargely toward supervisory personnel in the hope that they will\nrefer workers who appear to have problems. Scoville no longer considers\nThe media are important vehicles for disseminating information\ntheir program a cost item, because of the savings resulting from\nand influencing behavior. Physicians and other health professionals\nincreased worker output. In fact, savings in the Waterbury plant\nare involved in presentations that reach a large audience. \"House\nalone, which employs about 4,000 of their 24,000 workers nationwide,\nCall WCVB\", a prime time television show in Boston, features a\nare estimated to be more than $200,000 for 1974.\nphysician answering questions about health and medicine, and is\nAnnual health examinations and counseling programs for executives,\nviewed in 152,000 homes each week. Television and radio spots are\nperiodic screening of blue-collar employees, lunch-hour lectures on\nused frequently to promote programs and to make consumers aware\na variety of health topics for both blue-collar and white-collar workers:\nof particular problems. For example, Pearl Bailey is featured in a spot\nthese and many other general health maintenance and educational\nto create public awareness of a new Federal Drug Administration\nactivities are currently taking place throughout American business\nlabeling program.\nand industry. Such efforts, successful as they have proved to be in\nUnfortunately, the positive impact of these media efforts are largely\nindividual situations, have scarcely made a dent in the general\noffset by the misinformation often carried on TV advertising. A\nhealth problems of American workers. The blame, however, cannot\nrecent analysis of one week of television in a major metropolitan area\nconcluded that five percent of the total broadcasting time was used\nto transmit inaccurate or misleading health information.\n21\n20\npoint. Although there is the necessity of greater involvement in\nThe Public Broadcasting System and other networks have pro-\npatient and other health education programs it is obvious that the\nduced several specials on important health issues. The Children\nnation must look to other professions to supply most of its health\nTelevision Workshop has created an innovative television series\neducation needs, even for those who are already patients.\nfocusing on health education. \"Feeling Good\" opened on PBS stations\nC. Nurses.-The one profession that is doing-the most consumer\nin November, 1974. The show, which was an attempt to combine\nhealth education in the U.S. today is nursing. This is evident in the\nhealth education and entertainment, was intended to appeal to adults,\nfigures. In 1972, there were 748,000 active registered nurses; of whom\nespecially parents in low income families. Unhappily, the program\nfailed. Dr. Carter Marshall, who testified before the Committee on\n54,000 were in public health and school nursing and 35,000 in occupa-\ntional health nursing. Much of their work is educational.\nMay 8, 1975, stated that its basic difficulty was that \"Feeling Good\"\nMany, perhaps most, of the 526,000 working in hospitals and\nwas developed for low income audiences, when in fact viewers of\npublic television are upper middle class and well educated. Media\nnursing homes have extensive technical responsibilities and limited\nresearch, the Committee believes, is an important feature of the\ntime to give to patient education. Nevertheless, for nurses, unlike\nHEW-based Office of Consumer Health Education and Promotion.\nphysicians, patient education is now generally assumed to be an\nexplicit part of the job responsibility, generally SO stated in the state\nMedia programming is expensive, but well worth the effort.\nnursing practice acts and a component of all state licensing examina-\ntions. Moreover, the nurse, unlike the doctor, does not have the same\n6. HEALTH EDUCATION MANPOWER\nprofessional and emotional preoccupation with diagnosis and inter-\nThe wide range of comsumer health education programs is carried\nvention. The nurse is frequently more interested in the patient as a\non by an even wider range of professional and occupational groups and\nperson and looks on maintenance and educational activities as a major\nindividuals. These occupational groups include, in addition to health\nchallenge rather than evidence of failure.\neducation specialists, physicians, hospital nurses, public health\nNurses today are not only doing more health education than any\nnurses, school nurses, physical education teachers, dentists, dental\nother group but they also constitute the most significant potential pool\nhygienists, pharmacists, dietitians, therapists of all types, psychol-\nof professionals available for rapid upgrading toward expanded health\nogists, public health personnel, midwives, communications and audio-\neducation responsibilities.\nvisual personnel, and appliance and drug manufacturers.\nD. Other Professionals.-Among the other professional and occupa-\nA. Health Education Specialists.-Dr. Scott Simonds, a well known\ntional groups that are contributing in some degree to health education,\nhealth educator and member of the President's Committee on Health\nthe following are especially important: Dentists and dental hygienists,\nEducation, has written that:\nphysical, speech, and occupational therapists, pharmacists, nutrition-\nists and dietitians. The average dentist and dental hygienist seems\n*\n*\n* the total number of individuals prepared in health\nmore concerned with prevention and patient education than the aver-\neducation at the baccalaureate, masters, or doctoral levels\nage physician. The dental profession as a whole has received too little\nand working actively in the field of either public health\ncredit for its consistent support of preventive and maintenance activi-\neducation or school health education [is] no more than 12,500\nties, including proper diet.\n[including] no more than 2,000 prepared in community or\nThe 133,000 pharmacists come into frequent contact with consum-\npublic health education.\ners. Often the consumer will question the pharmacist about the impact\nComparing Dr. Simonds outside estimate of 12,500 with the 1974\nor side-effects of prescription drugs and request advice on over-the-\nresident civilian population-approximately 210 million-this comes\ncounter drugs. The role of the pharmacist in providing information and\nto one health educator for over 16,800 persons. By comparison, there\nmonitoring drug use could be upgraded; indeed, the Secretary's Task\nwere, in 1973, one active physician for every 648 persons and one nurse\nForce on Prescription Drugs urged pharmacists to become drug infor-\nfor every 281.\nmation specialists.\nBased on the information provided to the Committee, these training\nThe Committee is also aware of the real and potential contributions\nprograms emphasize sophisticated educational, planning, and research\nof other types of personnel such as the licensed practical nurse, the\ntechniques. The field needs these health education specialists; it also\nnewly emerging group of physician assistants and nurse practitioners,\nneeds. health education practitioners trained for actual community,\nas well as numerous volunteers, such as the 10,000 volunteer teachers\npatient and student contact.\nparticipating in the National Safety Councils Defensive Driving\nB. Physicians.-Despite the impressive record of physician involve-\nCourse. Effective health education and promotion will depend on a\nment, it is clear that we can look to the medical profession for only a\nwide variety of skilled practitioners, all making important contribu-\nsmall proportion of the nation's total health education needs. Physi-\ntions. The Committee does not foresee any primary role for any one\ncians now considers their primary tasks to be diagnosis and thera-\nspecialty that currently exists, nor is the Committee anxious to develop\npeutic intervention. Too frequently they turn to maintenance and\nsuch a specialty. Nevertheless, the Committee recognizes the need for\neducation when intervention fails or has limited results. Thus, to\nadequately trained health education practitioners who will be engaged\nsome extent the need for education is associated with therapeutic\nin health education teaching and research and in health education\nfailure, and it is not surprising that many doctors lose interest at this\npractice:\n22\n23\nThe Committee believes that emphasis should be placed on raising\nthe level of training given to those who will enter the field of health\nappears to be considerable leeway for educational activities, but not\neducation practice. Additionally, support should be given to those who\nSO with medicare recipients. Any activity that can be labelled \"pre-\nare engaged in theoretical research in the field of health education and\nventive\" has to be disallowed for reimbursement under existing\npromotion since it is this group who develop the conceptual frame-\nlegislation.\nworks from which sound practice derives. Short-term continuing educa-\nIn August 1974, the Blue Cross Association approved a position\ntion programs should also be included to upgrade skills of a variety of\npaper strongly. endorsing the concept of patient education and urging\nhealth providers, including doctors, nurses, educational specialists, and\nmember plans reimburse hospitals for such activities. The Committee\nmidlevel health practitioners. The Committee places highest priority\nwelcomes this useful document, but BCA guidelines are one thing and\non multidisciplinary and cooperative approaches which will do the\nindividual plan implementation is another. There are only two-such\nbest job possible.\nplans now reimbursing for patient education, one is New Jersey and\n7: FINANCING\nthe other is Montana.\n8. EFFECTIVENESS\nDespite their low costs, health education programs face a constant\nstruggle for funds. Most medical services are refunded almost auto-\nCurrent health education programs are rarely evaluated. Despite\nmatically because their value is taken for granted and past budgets\ncompulsory instruction in many schools, young people are probably\nnot only serve as precedents but are expected to increase as both quan-\nsmoking, drinking, using more drugs and otherwise engaging in more\ntitative growth and qualitative. improvement are assumed to be de-\nhealth-threatening behavior than ever before. Despite the tremendous\nsirable. But because health education programs are new-at least to\nanti-smoking campaigns, 41 percent of those 17 to 25 years old were\nthe mainstream of the health care economy-they are constantly in\nregular smokers in 1970. Screening programs for breast and cervical\nthe position of having to prove themselves and justify their existence.\ncancer are universally available; yet only half of American women over\nTraditionally, public and community programs. were financed by\n17 had such tests in 1973 and nearly one-fourth had never had a breast\ngrants or direct allocations from government, philanthropic, vol-\nexamination. The proportion of individuals taking advantage of any\nuntary agencies, or industry. This is still true of most of the new TV\nsuch screening is reported to be levelling off at about three-fourths.\nprograms. \"The Killers,\" \"Feeling Good,\" \"Drink, Drank, Drunk\"\nImmunization rates also seem to have reached a peak and some, such\nand others have been supported by grants from the Robert Wood\nas polio and DPT, have dropped significantly.\nJohnson Foundation, the Commonwealth Fund, Public Broadcasting\nEven when positive results appear to be forthcoming, as in the recent\nCorporation, Exxon, the 3M Company, and others.\ndecline in heart disease, it is virtually impossible to know whether to\nThe President's Committee reported $30 million spent for \"spe-\nattribute this to the campaigns against cholesterol and other risk-\ncific\" health education programs in 1973 and $14 million for \"general,\"\nfactors or not.\naltogether less than one quarter of 1 percent of that year's HEW\nIn short, we do not know whether the record would have been better,\nbudget. Many feel those figures are generous. Presumably most of\nor worse, or no different, if there had been no educational effort. Yet\nthis went for programs involving smoking, drug addiction, alcoholism\nsome progress has been achieved. Professor Lawrence Green of the\nand related conditions. According to the same source, state govern-\nJohns Hopkins School of Hygiene and Public Health, one of the fore-\nments spend less than one half of one percent for health education. In\nmost exponents of health education evaluation strategies, has reviewed\ncomparison, the annual budget for a well-known analgesic is $28\nthe results and concludes that \"the payoff is more than proportionate\nmillion.\nto the effort and costs.\"\nA major potential source of health education support is third party\nThe Blue Cross Association arrived at the same tentative conclusion,\nreimbursement, now the principal method of paying for patient care\nat least with respect to patient education. In a succinct summary of\nin the United States. As long as patient education was provided by\nevaluation literature, the BCA 1974 policy statement concludes, that:\ndoctors, nurses, and other health professionals as a routine and\nOn balance, organized patient education has demonstrated\nnonidentifiable part of patient care, most third-party payors did not\nits effectiveness in reducing the unnecessary utilization of cer-\nquestion reimbursement. Today, however, as more and more separate\ntain health care services and in encouraging the use of the\nprograms are established and other personnel become involved, it is\nmost appropriate, least cost settings for care.\nharder to \"bury\" the educational costs, small as they are, in routine\nSimilar reports reveal conclusions that patient and health education\ncare. A move has been under way to persuade all third-party payors,\nprograms pay off, in reduced hospital and emergency room readmis-\ngovernmental and private, to recognize patient education as a legiti-\nsions, reduced morbidity and mortality and reduced costs. Research\nmate component of patient care, one that need not hide itself but can\nand evaluation of such programs, and the development of new demon-\nappear as a separate item in the hospital budget or the physicians' bill.\nstrations, are important features of S. 1466.\nThe Health Insurance Benefits Advisory Council (HIBAC) ad-\ndressed itself to this issue in a report to the Secretary in 1974. The\nTHE NEED FOR NATIONAL LEADERSHIP\nreport added nothing new but helped to clarify the position of Medi-\ncare and Medicaid. As far as Medicaid patients are concerned there\nRecently, health promotion and prevention have become major\nplanning concerns of the Assistant Secretary for Health of HEW.\n25\n24\nThe Committee has studied the Presidential messages and task\nThe Division of Health Protection has developed proposals to shift\nforce and Committee reports on health education, and is convinced\nthe focus of analytic activities toward broad health problem areas\nthat there is still no national recognition of the importance of this\nrequiring comprehensive prevention efforts. The Committee is im-\nfield and no adequate central force to stimulate and coordinate a\npressed with such developments, and awaits implementation of such\ncomprehensive health education program. Efforts toward this end are\nprograms.\nfragmented. The moneys spent for health education and promotion\nThe Committee also notes that the Administration has taken other\nare miniscule. There is no informational exchange between those in\ncautious steps. Such programs as have been developed, however, the\npublic and private agencies concerned with health education and\nCommittee finds do not match the magnitude of the problems. The\npromotion. There has been little evaluation of results among similar\nofficial statement of mission of CDC's Bureau of Health Education,\nor related health education programs sponsored by different organiza-\nfor example, is broad and comprehensive. However, its subordinate\ntions. Information about health education theory, programs, and\nlocation in HEW and lack of visibility and resources contradict its\nmethods is not easily accessible. There is presently no public or private\nbroad mandate. The Bureau, however, has made a number of contri-\nagency which is systematically reviewing the broad range of expe-\nbutions both within and without the Federal structure, including\nrience theoretical experimentation in health education and pro-\nsupport and leadership in the development of a private-sector Center\nmotion! And, there is no focal point or forum to facilitate communica-\nfor Health Education, the initiation of cooperation among Federal\ntion and cooperation among the significant health public and private\nagencies in need of common health education objectives, and the\norganizations which must work together if substantial improvement\ndevelopment and funding of innovative health education projects.\nin health education and promotion is to be achieved.\nThe Committee acknowledges the important work of the Bureau but\nThe Committee recognizes that the needs and problems are so major\nfavors an HEW-based Office of Consumer Health Education and\nand complex that progress will depend upon a major long-term commit-\nPromotion. Organizationally located in the Assistant Secretary for\nment by both the public and private sectors of society. Itis to meld such\nHealth's office, given visibility, resources and authority, the Office of\nefforts, provide for a focal point for the Nation's multiple but disparate\nConsumer Health Education and Promotion will better be able to\nhealth education and promotion activities, improve the health status\nestablish a national strategy and new directional emphasis with\nof Americans,' design a mechanism by which we may establish a na-\nrespect to health education and promotion.\ntional health education and promotion strategy, that parts A and B of\ntitle III of S. 1466 have been proposed.\nV. THE RESPONSE TO THE CHALLENGE\nThe concept of a complementary national public and private strategy\nto improve consumer health education and promotion is the result of\nThe cluster of concerns outlined and described in the preceding\nfour years of study and development. This concept was originated by\nsections of this report urge us to continue our efforts to reorganize and\nthe President's Committee on Health Education and has been further\nrestructure our health services delivery system and to continue to\namplified by a study performed by the National Health Council, Inc.\nexperiment with innovative financing mechanisms. Concurrent with\nunder the contract to the Center for Disease Control. Both studies\nour efforts to develop a better and more efficient system, however, the\nbased their findings and recommendations on the input of hundreds\nCommittee sets forth a new strategy, one which shall assist us to\nof citizens, including health educators, other health professionals\nunderstand the nature and causes of self-imposed risks, adds to our\nand educators, consumers, and representatives of business and in-\nknowledge of illness, and educates patients and consumers about\ndustry, labor unions and government drawn from all parts of the\nhealth maintenance and prevention.\ncountry.\nThe strategy is based on recent data which is both startling and\nThe President's Committee on Health Education was charged to\ntroubling. The Committee has learned that in 1972, 92% of the $95\ndescribe the \"state of the art\" in health education of the public and\nbillion spent for medical, hospital or health care was spent for treat-\nto propose a comprehensive, nation-wide plan to raise the level of\nment after illness occurred and that more than half of the remainder\nhealth consumer citizenship: Through seven subcommittees, eight\nwas spent for biomedical research. Prevention of illness and consumer\nregional hearings and one national forum the Committee involved\nhealth education and promotion share the meager balance. The\nmany hundreds of individuals of different backgrounds and expertise\nCommittee has additionally learned that hundreds of thousands of\nfrom all parts of the country in the development of their findings.\nAmericans have died prematurely from causes primarily related to\nAfter two years of study, the President's Committee recommended\nlifestyles. Alcohol addiction, abusing pharmaceuticals, addiction to\nthe creation of two separate but complementary entities: (1) A\npsychotropic drugs, cigarette smoking, overeating, high fat and carbo-\ngovernmental unit within HEW to 'make the federal government's\nhydrate intake, lack of recreation, promiscuity, and careless driving-\ninvolvement in health education more visible, effective, and efficient,\nan imposing litany of some of our more destructive habits-leads to\nand (2) a publicly chartered, private organization which would be a\nthe inevitable conclusion that for the majority of Americans morbidity\nsource of innovative problem-solving and policy guidance for health\nand mortality rates will not be noticeably improved unless lifestyles\neducation efforts:\nare modified, self-imposed risks reduced and the social and physical\nenvironment changed.\n26\n27\n1. THE OFFICE OF CONSUMER HEALTH EDUCATION AND PROMOTION\nspecifically designed to test health education hypotheses, such as the\nNestled in the bosom of the Center for Disease Control is the Bureau\nStanford Heart Disease Prevention Program.\nof Health Education, presently the Administration's major force point\nClosely related is the need for expanison of the present valuable\nfor better education activities. The committee recognizes the creditable\nsurveys and studies of the National Center for Health Statsitics to\nperformance of the Bureau which despite very limited resources in\ninclude more information on consumer health status, health behavior,\nterms of both budget and personnel has made a number of creditable\nand related data useful and necessary for planning and evaluation of\ncontributions both within and outside the Federal structure. A number\nhealth education programs and techniques. Relevant resources of\nof witnesses have applauded the Bureau for programmatic, consultative,\nCDC should also be fully explored and utilized.\nand monetary assistance; others, however, are gravely concerned that\nC. Regional and State Systems.-Even with the severely limited\nthe Bureau is an anomaly, pointing out that the subordinate location\nfunds and personnel now available for health education, there is con-\nin CDC, its miniscule budget, and lack of resources contradict the\nsiderable duplication and waste. More importantly, most American\nBureau's broad mandate. The Committee was persuaded by those\ncommunities lack access to any comprehensive consumer health\nskeptical of the Administration's commitment and by the apparent\neducation.\ndiscrepancy between the Administration's promise (for bold health\nTo avoid these inefficiencies, to promote optimum utilization of\neducation and promotion initiatives) and reality.\nboth money and manpower, and to help develop a stable infrastructure\nA. High-Level Office of Consumer Health Education and Promotions.-\nfor community and other programs, it is highly desirable to develop\nThe Committee considered a number of loci for the proposed Office of\nlocal, regional, and/or State networks. This can be accomplished\nConsumer Health Education and Promotion, including a Center-model\nthrough the coalescence of existing programs, new regional and state-\nakin to the National Center for Health Statistics or the National Cen-\nwide initiatives under the leadership of a State health department, a\nter for Health Services Research or creating an organization similar\nuniversity extension system, a State hospital or professional associa-\nto the National Science Foundation, Ultimately, the Committee opted\ntion, a medical school, regional medical program, or other organization\nfor a locus in the Office of the Secretary with adequate status, author-\nwith the concern and resources to play the coordinator role, or through\nity and resources to carry out policy design and implementation and\na combination of various approaches.\nother collaborative, oversight and coordinating functions. Policy direc-\nThe National Health Planning and Resource Development Act of\ntion and design, the Committee believed, could only be attained and\n1974 provides a potential mechanism for promoting such networks.\nimplemented in a high-level Office of Consumer Health Education and\nD. Health Education Training.-Both quantitative and qualitative\nPromotion. The proposed Office may very well consult with CDC and\nimprovements in health education manpower are essential if the\nother organizations in HEW that have health education components\nnational efforts recommended in this report are to be effectively\nto execute the programmatic aspects of health education, but the locus\nimplemented. As a first step, we recommend a high-level review of\nof policy activity must be in the Office of the Consumer Secretary\npersonnel in all the extensive varieties noted in this report. Such a\nfor Health and not in an operating agency.\nreview would apply not only to health education specialists but to all\nB. Research Activities.-Despite the considerable number of sig-\nthe health and related professions currently involved in some aspect\nnificant health education programs scattered across the country and\nof health education and should address itself to the numbers and types\nthe efforts of thousands of dedicated professionals, the general state-\nneeded, their preparation, credentialing, distribution, and continuing\nof-the-art is in need of greater precision and development. The large-\neducation.\nscale program of public and private support recommended in this\nSpecial attention should be given to the introduction and develop-\nreport must be accompanied by intensive efforts directed to improve-\nment of health education concepts and methodologies into basic\nment of health education principles, techniques, and methodologies,\neducation for the various health professions, including medicine,\nand the formulation of more precise criteria and protocols both for\ndentistry, nursing, pharmacy, and public health. The time is ripe for\nimplementation and evaluation. This should include a delineation of\nsuch a new initiative. Witness the special attention paid to health\nareas of strength and weakness in knowledge, looking toward devel-\neducation at the 1974 annual meeting of the Association of American\nopment of a national statement of priorities and realistic goals.\nMedical Colleges and the fact that most state nursing practice acts\nMuch of the support, as well as initiative, for these efforts should\nnow specifically mandate patient education as a routine aspect of\ncome from the private sector. But there is a special need for Federal\nnursing care. Explorations, looking to increased health education\nleadership. Federal support, with special emphasis on evaluation,\ncontent, are now in order with the American Association of Medical\nshould be made available to qualifying institutions, organizations\nColleges, the American Medical Association, the Coordinating\nand agencies.\nCouncil on Medical Education, the National Board of Medical\nThe Committee notes the existence of a number of community\nExaminers, the American Dental Association, the American Pharma-\n\"laboratory\" populations for the study of problems in health educa-\nceutical Association, the American Nurses Association, National\ntion. Such communities should be encouraged to participate in the\nLeague for Nursing, the Association of Schools of Allied Health\ndevelopment and evaluation of health education methodologies. The\nProfessions, the National Commission for Accrediting, and other\nCommittee also endorses the development of large scale programs,\nprofessional organizations.\n29\n28\nSO that when broader, more comprehensive school health degislation is\nMoneys should be made available for the training of health educa-\nenacted in the future there will be no delay, owing to a lack of qualified\ntion specialists. For this group, special efforts are needed to determine\npersonnel, in implementing the health education curriculae in the\nthe numbers of students required at entry levels, baçcalaureate,\nschools of the nation.\nmaster's, and 'doctor's levels, as well as the types of educators needed\nF: Media Programming.-The impact of television as an informa-\nin the schools, health care institutions; industrial settings, com-\ntional and motivational force in contemporary U.S. society, especially\nmunity agencies, national health agencies, and the media; also the\nin relation to children and individuals with less-than-average schooling,\nneed for special research personnel and future teachers.\ncan hardly be exaggerated. With respect to health-related behavior,\nFinally, the Committee urges that in considering health educa-\nit is difficult to say whether the net impact has been positive or\ntion manpower, special attention be given to the definition and\ndevelopment of a new occupational category of indigenous com-\nnegative.\nThe positive can be documented by a growing list of first-rate\nmunity health education aides, advocates, or facilitators to act as a\nhealth documentaries, public service \"spots\", and even some of the\nbridge between the community, especially in low-income areas, and\ntheatrical programs presented by the Public Broadcasting Systemiand.\nhealth providers, including health educators. The success of programs\nthe three commercial networks. The negative has been convincingly\nutilizing such individuals, under various names, has been demon-\ndocumented by a number of carefully designed professional studies\nstrated in a number of locations, but the concept needs more precise\nincluding two prestigious national commissions looking into the rela-\ndefinition, more standardized training, and some form of academic\ntionship between. televised violence and individual behavior\ncertification:\nDespite this anomalous record, the Committee believes that\nE. School Health Education Training.-The Committee considered\nwith more consistent and accountable attention from the leadership\nS. 544 at some length with a view to including this Comprehensive\nof the industry, with more high-level assistance from representatives:\nSchool Health Education provision. in this bill. The Committee recog-\nof the public and the health and education professions, and with\nnizes that S. 544 is essential legislation if a meaningful preventive\nidentification of adequate sources of financing for constructive pro-\nprogram to.improve the health of the American people is to be a reality.\nThe Committee has included a portion of S. 544 as Section 1703d(1),\ngrams-the positive potential can be greatly enhanced and the nega-\ntive minimized.\n(2), '(3)' of S. 1466. The language establishes & program of grants to\nThe Committee's emphasis on TV. is by no means intended to be-\nlocal education agencies and institutions of higher education for in-\nlittle the influence of the press, radio, and other media which have\nservice education opportunities for elementary and secondary school\nalso produced some excellent material and whose continuing. par-\nteachers in a broad. scope of health education areas. The Committee\nticipation should be enlisted in the national effort to improve con-\nbelieves this to be a pressing need at this time and recognizes that no\nsumer health education. Since TV's capacity for both positive and\nprogram can be successfully developed in the schools until a cadre of\nnegative impact is so crucial, however, we think the primary effort,\ncareer teachers is well prepared to deal professionally with the issues\ninvolved.\nat the present time, should be aimed in this direction.\nThe Committee hopes that through Section 1703(c), the resources\nThe will thus make available to presently employed teachers\nof television and advertising will be mobilized in the development of\nworkshops, seminars and courses during summer and evening sessions.\na long-range, multi-audience, multi-format series of programs, utilizing\nThe workshops, seminars and courses will deal with the broad scope of\ndocumentaries, theatrical programs, cartoon and news programs,\nissues including dental health, disease control, environmental health,\npublic service spots, and all other appropriate formats, aimed at\nhuman ecology, mental health, nutrition, physical health, safety and\nhelping the American people increase their understanding of, and\naccident prevention, smoking and health, substance abuse, consumer\nability to cope with, health and health-related problems, Both com-\nhealth and such others as may be deemed appropriate. The Director\nmerical and public TV should be involved. Assistance in funding\nis required to confer with, and receive the approval of, the Commis-\nthrough public and private sources should be explored. The existence\nsioner of Education in determining the recipients of the grants and the\nof such a formally designated industry council working through the\nscope of the program.\nCenter for Higher Education (infra.) would also provide a. body to\nBecause. of the alleged surplus of teachers the bill emphasizes in-\nwhich the public and the health and education professions could relate.\nservice education rather than preservice education for persons who\nThe Committee is aware that the National Advertising Council\nlater may not be employed. The Committee feels this is a practical\nshares many of our concerns. The Advertising Council, however, is\napproach to the solution of the problem which presently exists in most\nnot intended to carry out the kind of concentrated systema health\nschools where comprehensive health education programs are non-\neducation program outlined.\nexistent. It is essential that school health education begin in the pri-\nAnother objective of sections 1703(e) and 1703(f) is to encourage\nmary grades and extend through the secondary curriculum. Too often\nthe industry, the Food and Drug Administration, the the\nhealth education is confined, if indeed provided at all, to students in\nFTC to intensify their efforts-through voluntary advertising codes,\ntheir teens. It is the Committee's purpose to correct the situation by\n\"Family viewing hours,\" and other means-at effective self regulation.\nproviding a practical, although somewhat limited opportunity, for\nThe Committee expects that, through the use of fact-finding, pub-\ninservice education in school health education for persons who are\nlicity, non-governmental sanctions, and all the moral and political\nand will continue to be employed as elementary and secondary teachers\n30\n31\nforce the Office of Consumer Health Education and Promotion\ncommands, the elimination of material deemed, by objective profes-\n4. Budget.-The Committee has tried to reconcile the competing\nsional opinion, to be injurious to the nation's health will be secured.\nclaims of a non-inflationary Federal budget and the necessity of\nG. Federal Programs.-Areas that should come under such con-\nproviding at least enough financial support to give the new program\ntinuous monitoring include agricultural supports for harmful products\na chance of succeeding. Major elements of the projected first year\nsuch as tobacco, or those potentially harmful if used to excess, such as\nbudget might include:\nbeef with high-fat content; school lunch and food assistance programs;\nfood and drug advertising; and speed limits and other energy conserva-\nCost estimate-Office of Consumer Health Education and Promotion\ntion measures. The conflicts or apparent conflicts between a number\nExtramural grants and contracts:\nMillions\nof existing programs in these areas and the goals of health promotion\nBasic research programs\n$1. 0\nhave been increasingly publicized in recent years.\nAcademic centers\n1.0\nThe monitoring should extend not only to areas where harmful\nState networks\n1.0\nor allegedly harmful policies now exist but to those currently marked\nExperimental media research\n1.0\nby the general absence of essential health promotion policies, includ-\nConsumer health education training\n4.0\nSchool health education training\n3.0\ning low-income housing, the control of violence, and public service\nemployment. The irony of spending billions of Federal dollars to\nTotal\n11. 0\npatch up the victims of big city violence, squalor, and frequently\nThe estimated cost of the basic research programs is related to the\nintolerable living conditions, while refusing to face up to the root\ncost of a number of successful programs, including the Stanford\ncauses cannot be indefinitely sustained as general economic condi-\nHeart Disease Prevention Program and the Diabetes Control Program\ntions deteriorate, budgetary constraints increase, and various safety\nof the Los Angeles County General Hospital. The cost of the state net-\nvalves disappear.\nworks is derived in part from the experience of the College of Medicine\nThe Committee is aware that policy development in health educa-\nand Dentistry of New Jersey.\ntion and production cuts across Departmental lines and that HEW\nThe media projection is far less than the $7 million that it cost\ncan do little or nothing alone. However, we feel strongly that the\nPublic Broadcasting System's \"Feeling Good.\"\nDepartment should be continuously engaged inmonitoring such\nWith respect to the long-term costs, including those that might be\npolicies, in advising the President, the Congress, and the American\nmet through third-party payments, school budgets, and voluntary\npeople with respect to such policies, and in representing the health\nagencies, the Committee has set a tentative goal of 6 percent of total\npoint of view in interdepartmental decision-making. Primary respon-\nnational health care expenditures. Obviously, the Committee needs a\nsibility for policy design and staff work should be lodged in the pro-\nmore precise figure as well as a timetable for moving from the present\nposed Office of Consumer Health Education and Production.\none-quarter to one-half of 1 percent, the sum presently being spent by\nThe importance of HEW involvement in broad policy issues, beyond\nthe Federal government, toward 6 percent and a study of alternative\nthe usual definition of health and medical care, was emphasized both\nmethods of financing. For example, should the financing of health\nby the Surgeon General's Committee on Smoking and Health and the\neducation and promotion programs be closely related to that of\nsubsequent Committee on Television and Social Behavior. Some would\nnational health insurance? How much reliance should there be on\nhave preferred to see strong recommendations included in their re-\nsocial security taxes or general revenues? Should there be special\nports. But, even without recommendations, the carefully documented\ntaxes on cigarettes, alcohol, other health-threatening products certain\nfindings, emerging from such a prestigious source, have been useful.\nnon-prescription drugs where overuse or other abuse is common?\nIn initiating such a large new undertaking, an essential first step\nThe Committee recommends that the office consider such a study\nwould be establishment of a list of goals and priorities. Criteria, both\none of its priorities.\nimmediate and long-run, should include the firmness of the presump-\ntive causal relationship between the policy in question and national\n2. THE CENTER FOR HEALTH EDUCATION AND PROVISION\nhealth status, the financial cost to the nation of failure to take correc-\naction. tive action where needed, and the reasonable possibility of corrective\nAs defined by the President's Committee, health education is a pro-\ncess that bridges the gap between health information and health prac-\nFor example, in the case of tobacco, the causal relationship between\ntices and motivates the change of behaviors destructive to health\ncigarette smoking and health has been professionally and officially\nmaintenance. The Committee saw this process as applying to institu-\ndetermined. The health care costs resulting from cigarette smoking is\ntions as well as to individuals. In order to improve the nation's health\ncurrently estimated by the National Center for Health Statistics at\nthrough educational means, the President's Committee concluded that\n$11.5 billion a year. Some corrective action, while difficult, has not\nfundamental changes in the attitude and behavior of our social insti-\nproved insuperable, at least with respect to one form of advertising.\ntutions in general and within the health industry in particular are\nThe Surgeon-General acted reasonably a decade ago in alloting top\nrequired. They saw a primary need to heighten awareness of and re-\npriority to this area. It is now time for further initiatives.\nsponse to health needs as a major shift in emphasis and expansion of\neffort beyond the current focus on the treatment of disease and injury.\nIt was their finding that such fundamental change would not occur\n32\n33\nunless some mechanism could be created which would address and\nThus, much of the content of consumer health education is con-\nresolve complex and controversial issues of individual and social values\ncerned with precisely those areas which have traditionally been\nand behaviors in a nón-bureaucratic and non-coercive manner. They,\nregarded as private matters. These are, however, also matters of\ntherefore, recommended the establishment of a unique national private\ngrowing public concern and rising medical costs. Whether through\ninstitution which they called a national Center for Health Education\npublic tax payments or through insurance premiums, our society\nas the key component in the plan they presented to the President in\nhas assumed an increasing responsibility for the treatment of the in-\n1973.\ndividual's diseases and injuries. Society, therefore, also has an in-\nA. The National Health Council's Project a follow-up to the\ncreased stake in affecting-to the extent possible-the frequency and\nReport of the President's Committee on Health Education the De-\nseverity of the individual's need for such treatment.\npartment of Health, Education and Welfare took two actions in 1974:\nWhile governmental programs can and must be substantially im-\n(1) a Bureau of Health Education was administratively created as a\nproved and expanded, governmental action alone cannot provide\nnew unit of the U.S. Center for Disease Control in Atlanta, Georgia to\nthe kind and scope of leadership and initiatives required to realize\ncoordinate federal health education efforts; and (2). a contract was\nthe potential benefits of improved consumer health education. Direct\nawarded by C.D.C. to the National Health Council, Inc. to explore in\ngovernmental efforts to modify citizens' behaviors, mass media con-\ndetail the most appropriate and feasible objectives, functions, struc-\ntent, and school curricula in ways that are scientifically sound,\nture, staffing and financing pattern for a National Center for Health\neffective, and culturally acceptable represent extremely difficult\nEducation.\nissues. On the one hand the current state of the art of health\nThe Council's project was designed to build upon the work already\neducation is probably inadequate to deliver effective and reliable\naccomplished by the President's Committee and to involve a large\nresults in the public interest from such interventions. On the other,\nsample of organizations and individuals not limited to the Council's\nto be effective, such action by a governmental agency may conflict\nmember agencies. Through the work of the project's Policy Commit-\nwith constitutionally guaranteed private freedoms.\ntee, study groups and subcommittees, mail surveys and conferences,\nTherefore, organized private action is needed to explore contro-\nthis project developed a model design for a private national Center\nversial issues and develop national guidance which reflects a general\nwhich is complementary to and non-duplicative of either an expanded\nprofessional and consumer consensus on appropriate and acceptable\nfederal governmental program or of any existing private sector re-\ndirections of effort. Because such private policy does not have author-\nsources. The recommended design is for an open, non-bureaucratic\nity to compel compliance, it must necessarily include development\nproblem-solving mechanism incorporating innovative elements of\nof voluntary support and resolution of realistic constraints which are\npolicy development and action program planning processes which\na fundamental part of the problem. Once the efficacy and acceptability\nhave been tested in business and industry as well as community health\nof such privately developed initiatives has been demonstrated, then\nplanning agencies during the past decade. The project's findings and\nthe need for and exact nature of additional governmental support to\nrecommendations were provided to the Committee and are a primary\nextend implementation will be both clearer and less likely to encounter\nsource of referrel for additional information concerning the intended\nopposition.\nnature and character of the Center for Health Education and Pro-\nThe voluntary health promotional agencies and health professional\nmotion.\nassociations have traditionally carried the burden of consumer health\nB. The Need for a Private Center for Health Education and Promo-\neducation in this country. While much is being done in the private\ntion.-The arguments supporting the need for a private national\nsector to inform the public about the actions they can take to protect\nCenter for Health Education and Promotion focus on the advantages\nand maintain their own health, the results can not be considered good.\nand benefits of voluntary, non-governmental leadership and action\nThe reasons for this are numerous.\nto improve the nation's health through educational means.\nThere is no consistent thread which defines and articulates health\nHealth education is concerned with every. facet of consumer be-\neducation content or methods. There are no generally recognized\nliefs, attitudes, and behaviors which contribute to the maintenance\nstandards, guides and measures for evaluation of health education\nor self-destruction of health. This includes especially those choices\nefforts. It is, therefore, virtually impossible to objectively discriminate\nthe individual exercises concerning his or her private life-what\nagainst the ineffective, confusing or even potentially misleading in-\nand how much the individual eats and drinks, how much rest and\nformation and education the consumer receives in great quantity\nexcercise he or she gets, habits of personal hygiene, how the individual\nfrom a multiplicity of sources.\nhandles anger and frustration, how fast he or she drives, how early\nThere is no common frame of reference shared by the various\nand often medical care is sought, career and family formation de-\ndisciplines and interests working in this field. There is little continuing\ncisions, choice of dwelling, etc, It is also equally concerned with the\ncommunication, cooperative program planning or comparative\ncontent and quality of information and guidance the individual\nevaluation of results among similar or related health education pro-\nreceives from health and social institutions, commercial enterprises,\ngrams sponsored by different organizations. There is no unified or\nlabor unions, civic associations, and from the mass media concerning\ncomprehensive perspective from which to assess results and determine\nappropriate and inappropriatë health maintenance behaviors.\nwhich of alternative approaches is most appropriate to a given situa-\ntion. And finally, with some notable exceptions, for the overwhelming\n57-010-75-5\n34\n35\nmajority of agencies which dispense some form of health education to\nconsumers, this activity is not their primary purpose and therefore\nPolicy guidance alone cannot secure the improvement of program\ndoes not receive top priority for their allocation of funds and program\nservices; frequently there are challenging impediments to the develop-\nattention. Thus, very little of the current consumer health education\nment of improved methods which require extended problem-solving\nefforts are as effective or efficient as they could be, were there some\nand strategy design efforts. The Center, therefore, should coordinate\nnational focal point to improve communications and cooperation\na variety of activities, programs, and developmental projects which\namong the major programs within the private sector.\ndraw upon external sources of support and expertise to develop im-\nClearly a nationally recognized source of policy development, guidance\nproved methodologies, especially concerning appropriate and accepta-\nand technical assistance, cooperative program planning and coalition\nble ways to influence positive consumer behavioral changes, and\nbuilding, evaluation and advocacy could make a major impact on the\nconcerning realistic and acceptable criteria for evaluation of health\nkinds and quality of health education efforts in the private sector\neducation programs. To encourage similar activities by other organi-\nwithout a net increase in overalll expenditures simply by reducing the\nzations, the Center also should organize a national network of technical\nfragmentation and discontinuity of current efforts.\nassistance in the planning, implementation and evaluation of health\nTestimony given to the Committee strongly indicates the existence\neducation programs utilizing not only its own but the expertise\nof considerable support from private sector sources for the creation of\navailable for other cooperating agencies.\nsuch an organization. The granting of a Congressional charter to\nD. Board of Directors.-The Center for Health Education and Pro-\nsuch an organization would improve opportunities for:\nmotion will be directed by a twenty-five member Board of Directors\n1. Supporting private leadership in policy exploration and pro-\nto be appointed by the President of the United States. Its functions\ngram development by the creation of an entity with quasi-official\nshould include:\nlegitimacy and stability;\n(1) Final Center policy and strategy design determinations;\n2. Integrating utilization of private and public resources in the\n(2) Center program direction;\ndevelopment of concerted national strategies for improving con-\n(3) Center financial policy determinations, including direction\nsumer health education nationwide; and\nof the basic funding strategy for Center programs and approval\n3. Maintaining formal channels of communication, informa-\nof budgets and resource allocations;\ntion exchange and public accountability between the govern-\n(4) Representation of the Center to and liaison with outside\nmental and private sectors.\norganizations;\nC. Activities of the Private Center.-The mission of the Center will\n(5) Charge and appointments to committees, task forces and\nbe to improve the health of people by encouraging and supporting\nstudy groups; and\nthe improvement and expansion of health educational activities\n(6) Appointment of the Center's President.\nthroughout the nation.\nMembers of the Center's Board should serve as individuals and not\nThe Center should be a mechanism which links together primarily\nas the official representatives of outside organizations. The Board as a\nnon-governmental organizations and agencies involved in health edu-\nwhole should reflect a balanced mix of experts representing the fields of\ncation, including those which engage in health care, education, business\nhealth education, health services delivery, education, consumer\nand industry, social and civic purposes, consumer and labor repre-\nrepresentation and advocacy, news media and communications, busi-\nsentation and communications. The widest possible range of partici-\nness and industry, organizational management, and public and private\npants should be given significant, structured opportunities to debate,\nfinance.\nselect and influence the development of Center policies and strategies.\nIn addition, the Board as a whole should reflect a diversity of per-\nThe Center should manage an open decision-making process for the\nsonal backgrounds and interests which assures not only the develop-\ndevelopment of national private sector policy concerning key issues\nment of broad policy direction but facilitates the acceptance of its\nin the field of health education. The Center should coordinate the\nfindings and recommendations by those asked to implement these\nreview and analysis of consumer health education needs, provider\nrecommendations.\nresources, the impact of alternative health education approaches and\nDuring its deliberations this Committee considered a number of\nother factors on health status to determine which lines of develop-\nspecific nominations for appointment to this Board. The following\nment offer the best opportunities for the improvement of the nation's\nindividuals are suggested as representative of the type and quality of\nhealth through educational means.\nmembers the Board should reflect:\nThrough participatory processes it should seek to identify the locus\nStanley Bergen, Newark, New Jersey; Lisle Carter, Atlanta,\nof responsibility for addressing identified consumer needs and for the\nGeorgia; Paul Ellwood, Minneapolis, Minnesota; Howard Ennes,\ndevelopment of the resources required to meet these needs. The\nCraryville, New York; Paul S. Entmacher, New York, New York;\nCenter should also provide a forum for the determination of the most\nRobert H. Felix, Saint Louis, Missouri; Evalyn S. Gendel,\nappropriate and acceptable roles it can play in stimulating and\nTopeka, Kansas; William Griffiths, Berkeley, California; M.\nenergizing the actions required to secure widespread endorsement and\nAlfred Haynes, Los Angeles, California; Howard Hiatt, Boston,\nimplementation of its goals and policies.\nMassachusetts; Magda Hinojosa, San Antonio, Texas; Robert L.\nJohnson, Berkeley, California; Philip M. Klutznick, Chicago,\n36\n37\nIllinois; A. M. Lilienfeld, Baltimore, Maryland; J. Alexander\nH. Center Funding.-The Center should be funded by varying\nMcMahon, Chicago, Illinois; Lois Michaels, Pittsburgh, Penn-\ncombinations of private and public funds, including direct appropria-\nsylvania; Walter J. McNerney, Chicago, Illinois; Mary Mulvey,\ntions, grants, contracts and unrestricted donations as appropriate\nProvidence Rhode Island; Arthur C. Nielsen, Jr., Northbrook,\nfor its general support and the financing of various special projects\nIllinois; Eva M. Reese, New York, New York; Samuel Sherman,\nand activities.\nLos Angeles, California; Elena M. Sliepcevich, Carbondale,\nThe authorized $1 million of core support for the Center for its\nIllinois; Anne Somers, Princeton, New Jersey; Frank N. Stanton,\nfirst three years of operation is intended to provide for the establish-\nNew York, New York; James Howard Walker, Charleston, West\nment of its core policy process and staffing; i.e. to provide for the\nVirginia; and Harold M. Wiseley, Indianapolis, Indiana.\ncosts associated with the meeting and other expenses of the Board and\nE. Advisory Panel.-In addition to the Board of Directors, there\nits communications with the Advisory Panel, and to support the\nshould be a large panel of at least one hundred individuals representing\nacquisition of a competent core staff. The Center's internal staff\nthe same kinds of competencies and abilities as those described for\norganization should be headed by a President to be named by the\nBoard membership. The principal function of this panel should be to\nBoard and such other members as he selects. The staff organization\nprovide advice to the Board. The Advisory Panel should routinely be\nshould be modeled on a matrix (rather than a bureaucratic) organiza-\nrequested to review and comment on Center reports and policy drafts.\ntional design which stresses the accomplishment of tasks by ad hoc\nThe Panel should also be the primary source for appointments to\nteams and special project activity in combination with routine pro-\nspecial committees and study groups created by the Policy Board to\ngram functions. The initial core staff should be small in number and\nexplore a particular problem or subject area in depth.\nemphasize coordinative, program design and management, group\nF. Program Priorities.-In a field as diverse and fragmented as\nprocess, and communication skills. Members of the Board and advi-\nhealth education there are no immediately obvious, generally ac-\nsory panel, staff on loan from cooperating organizations and outside\nceptable, and logically appropriate priority rankings among the long\nconsultants should be utilized in addition to Center staff to complete\nlist of potential specific program objectives the Center could select\nspecial project activities.\nfor action in its first years of operation. Consequently an organizing\nIt is estimated that full scale Center operation will require approxi-\nphase is indicated for the Center's initial activities. In this period,\nmately $5 million annually. Funds to support the increased costs\nthe open, in-depth analysis of alternative opportunities to achieve\nshould be raised from private sources.\nnationally significant impacts and the consensus selection of initial\nIn addition to support for core operating costs of the Center, it is\nprogram priorities by the Board based on input from the Advisory\nexpected that the Center will also seek variable additional amounts\nPanel and a large sample of outside organizations and agencies should\nin grants and contracts from both private and public sources in order\nbe the Center's top priority objective.\nto accomplish a variety of special projects. Thus the total annual\nG. External Relationships.-The organizations, groups and individ-\nincome required to achieve the Center's program objectives in any\nuals to be involved in any given phase in the Center's policy process\ngiven year should vary substantially depending on changes in pro-\nwill vary depending on the nature of the needs or problems being\ngram priorities and on the extent to which external organizations\nexplored. Although the Center will not be a membership organization,\nvoluntarily undertake the performance of Center designed projects\nit should be linked to a comparatively large number of external\nwithout using the Center as a fiscal intermediary.\norganizations by a variety of both formal and informal mechanisms.\nA modest but relatively secure core operating budget combined\nThe Center should seek ties with representative health, education,\nwith the necessity to secure additional, earmarked financial support\nwelfare, and civic organizations and associations. It should also seek\nto accomplish non-routine tasks and special projects is inherent to our\nthe support and endorsement of major corporations in business and\nconcept of the Center as a non-bureaucratic, private sector based\nindustry, labor unions, and private foundations. The Center should\nproblem-solving mechanism. The Committee recognizes that the bur-\ninvolve these constituents in all aspects of its policy and program\nden of securing the support and resources required to perform projects\ndevelopment both on an individual basis and through the formation\non a case-by-case basis can be quite high. The Committee believes,\nof special purpose coalitions and consortia. The Center also should\nhowever, that the quality, feasibility, and general acceptability of\ndevelop mechanisms to involve outside organizations in its processes\nproposed Center projects should be tested \"realistically\"; i.e. by their\nfor the periodic review and assessment of its policies and performance.\nability to attract endorsement and allocation of resources from out-\nPrivate and public financial supporters of the Center should be\nside organizations.\npublicly identified in the Center's annual report. Outside organiza-\ntions unable to support the Center financially but wishing to affiliate\n3. GRANTS FOR WATER TREATMENT PROGRAMS\nwith its goals and policies should be given the opportunity to formally\nsignify their endorsement after action by the Center's and the re-\nSection 178 of the Committee's bill provides a modest authorization\nspective agency's policy body. All organizations, groups and in-\nof $9 million for communities which wish to seek partial Federal assist-\ndividuals who participate in Center activities, advisory groups, and\nance in order to treat their water supplies. The Committee is convinced\nprojects should be listed in relevant reports.\nof the safety and effectiveness of fluoridation as a powerful preventive\nweapon in the battle against dental disease. The efficacy of fluorida-\n38\n39\ntion has been widely known for many years, and the Committee has\nreceived overwhelming testimony from both scientific and professional\nThe preventive benefits of water fluoridation have long been recog-\ngroups to this effect.\nnized by the dental profession. Water fluoridation programs such as\nDental caries is the most prevalent disease in the United States\nthose which would be promoted under your amendment would be\ntoday and one of the most costly of all chronic diseases. By age two,\nextremely helpful in preventing oral disease for the citizens of this\nnation.\napproximately one-half of the children in this Nation have experienced\nAs Senator Magnuson indicated in his introductory remarks on\ntooth decay. By age fifteen, the average child has 11 decayed, missing,\nS. 2026 \"it has been estimated that at least $2.6 billion could be saved\nor filled teeth.\nover the first fifteen years of a national health insurance program\nBringing the level of fluoridation in community water supplies to\nthe optimum level is the safest, most effective, and most economical\nprovided universal fluoridation were in effect at the start of that\nway to prevent tooth decay. Fluoridation prevents 40-60 percent of\nprogram.\" Monetary savings of that magnitude, as well as the po-\ntential for improved oral health, are examples of the significant\nthe dental caries usually experienced by children. The effects of fluori-\ndation have been studied in the United States since 1945 and all\nbenefits which can be gained from a general water fluoridation\ncommunities involved have reported significant reduction in tooth\nprogram.\nOn behalf of the American Dental Association, let me again express\ndecay as a result of this public health measure.\nFluoride occurs naturally in most water supplies and raising it to\nmy support for this amendment which you will be proposing. If I or\nthe optimum level to prevent tooth decay, usually one part per million,\nmy Association can provide you with any further information, please\ndo not hesitate to call on us.\nhas never been proved to be hazardous to health. Adjusting the\nfluoride content of the water will not increase the likelihood of cancer,\nSincerely yours,\nPAUL W. KUNKEL, Jr., D.M.D.,\nheart disease, kidney disease, allergies, or any other physical or mental\nChairman, Council on Legislation.\nillness. Indeed, fluoride is considered an essential trace element vital\nto proper nutrition, growth, and development.\nVI. COMMITTEE VIEWS\nAdjusting the fluoride level in a community's water supply costs a\nmaximum of 10 or 15 cents per person annually. It results in a 50\nTITLE I\npercent or more savings in a family's dental bill. For every dollar spent\non fluoridation, $30-50 can be saved in dental care costs. Other\n1. The lessons of the history of communicable disease control are\nmethods for the prophylactic application of fluoride are available,\nseveral. First, apparent success has fostered premature relaxation. This\nhowever, none are as effective or as economical as fluoridation of\ncomplacency has resulted in a resurgence of disease and untold unnec-\ndrinking water. Its benefits are conferred on everyone, regardless of\nessary personal suffering. The Committee is concerned, after reviewing\nsocio-economic level. It is effective without the need for any action by\nthe Administration's funding level proposal, as set forth in their hear-\nthe individual.\ning testimony and their bill (Senate Bill 1756), that this lesson has not\nA report released this year by the Director-General of the World\nbeen learned well. We are particularly concerned that while measles,\nHealth Organization renewed that organization's support of water\nrubella, and polio are at their lowest points ever, too much of the popu-\nfluoridation and said that \"unless there are overriding technical\nlation is not protected against these diseases and a relaxation of our\nreasons, no nation can afford the luxury of not fluoridating every\nnational commitment to support efforts to immunize children will have\ncentral water supply system containing less than the optimum con-\ndire, totally preventable, consequences. This also characterizes the\ncentrations of fluoride.\" The WHO report affirmed that fluoridation\nAdministration's commitment to tuberculosis control. In addition to\nof the water supply should be the cornerstone of any national program\nnot requesting appropriations for tuberculosis control project grants,\nof dental caries prevention.\nthe Administration is requesting that 314(d) public health formula\nThe need for this provision is expressed by the professional organi-\ngrant funding be terminated as well. That program is the only existing\nzations concerned with dental health care, as follows:\nsource of Federal funding available to States to support tuberculosis\nAMERICAN DENTAL ASSOCIATION,\ncontrol programs. Rather than turn our attention away from tubercu-\nWashington, D.C., July 15, 1975.\nlosis, the committee believes we should seize the opportunity to\nHon. JACOB JAVITS,\naccelerate the decline and eventual eradication of this disease.\nRussell Senate Office Building,\n2. The second lesson is in many ways the most critical, and is\nWashington, D.C.\ncertainly one that experience has taught time after time. The control\nof communicable disease is not and should not be solely the responsi-\nDEAR SENATOR JAVITS: It is my understanding that you are planning\nbility of State and local governments. They cannot do the job alone\nto offer as an amendment to S. 1466, the Disease Control Amendments\nand communicable disease does not recognize State boundaries. The\nAct, a provision authorizing grants for water treatment programs\nprolonged debate over the appropriateness of Federal help in control-\nwhich is identical to that contained in section 1702 of S. 2026, the\nling these diseases has been a key factor in many of our missed oppor-\nChildren's Dental Health Act of 1975. I am writing to express the\ntunities of the past. The Committee reiterates its conviction that\nsupport of the American Dental Association for this amendment.\nStates acting singly and according to their own financial capabilities\nand interests will not result in the control of these diseases.\n40\n41\n3. The Center for Disease Control should strengthen its role in\nof the Center for Disease Control and the American Social Health\nproviding leadership in achieving the national elimination of prevent-\nAssociation, a voluntary agency-and achieved through a separate\nable diseases and conditions. Its full technical and personnel capabil-\ncategorical program authorized in law. Furthermore, it is encouraging\nities should be mobilized to achieve this goal. This will necessitate\nthe Committee notes, that the National Institute of Allergy and\nsupport of on-going disease control programs and the ability to respond\nInfectious Disease, through numerous research grants and awards in\nto disease outbreaks and health emergencies which, by their unpredict-\nthe area of venereal disease, is aggressively seeking to broaden our\nable nature, few States are equipped to address. In testimony before the\nunderstanding of these conditions. The Committee hopes that the\nCommittee, the Association of State and Territorial Health Officers\nacquisition of such knowledge will someday permit the development\ntestified to the effectiveness of the CDC system of assigning personnel,\nof effective vaccines against the venereal diseases.\nupon request, to the States to assist them in carrying out disease\n2. Title II of the Committee reported bill, based on legislation\ncontrol programs and in responding to disease outbreaks and health\nauthored by Senator Javits (S. 1454), would continue to authorize\nemergencies. The Committee supports and wages the continuation of\nessentially the same sound public health approach (research, tech-\nthat unique and effective approach to Federal/State cooperation.\nnical assistance, pilot and demonstration projects, improved clinical\n4. Finally, the challenge before us is not soley to apply all available\nservices, prevention and control activities such as screening, contact\ntechnology to the job of controlling communicable diseases, and to\ntracing, and public information and education) to the VD problem\nensure this through sustained leadership at the national level, but to\nas in the past three years. In addition, this title would redefine the\nuse this approach to eliminate or ameliorate other diseases and\nterm \"venereal disease\", as provided in S. 1454, to include all sexually\nconditions which are susceptible to reduction through organized\ntransmitted diseases that are of public health significance. To con-\ncommunity programs. As we as a nation address inequities in the\ntinue to ignore these other serious diseases would tend to foster the\nquality and accessibility of health care services, we must invest\nsame condition that originally permitted gonorrhea to reach epidemic\nappropriate resources in the prevention of disease, disability, and\nproportions.\npremature death. Some preventive health services can be delivered\n3. It is the findings of this committee that the authorities created\non a personal, one-to-one, basis in the health care system, and can be\nby this bill stem from and support a sound and logical public health\nfinanced accordingly. Other preventive health services, such as the\napproach to the venereal disease epidemic. The committee notes\ntypes of programs carried out in the areas of disease control, including\nwith some dismay that not all of the authorized resources available\nhealth education, must be carried out on a communitywide and\nto combat these diseases were utilized during the past three fiscal\nnationwide basis, and financed accordingly. It is the Committee's\nyears. The Committee urges that serious consideration be given to\nconviction that preventive health programs are essential to improving\nemploying all authorities and means available to prevent and control\nthe health of the American people, and they will be a major factor in\nvenereal disease in the three fiscal years covered by this bill.\ncontaining cost and improving the quality of health services. Senate\nBill 1466 as reported by the Committee is intended to lay the ground-\nTITLE III\nwork for an expanded effort in disease prevention.\n1. The Committee was impressed the important and often crucial\nTITLE II\nrole the individual can play in maintaining his own health, a role\nrarely clearly explained or adequately described.\n1. The Committee recognizes that epidemic venereal disease is still\n2. Similarly, the Committee believes that while the need and\nvery much a problem. The magnitude of the problem of venereal\ndemand for health care services have been rising, health education\ndisease, with its particular inability to recognize state boundaries, and\nand promotion has been neglected. Many, perhaps the major causes\nthe unique social implications of venereal disease, the Committee\nof sickness and death can be affected, certainly prevented, by moder-\nbelieves necessitates a separate categorical program to attack the\nating self-imposed risks. This could be greatly facilitated if the field\nproblem. The combined reported incidence of infectious syphilis and\nof health eductiaon were not SO fragmented, uneven, and lacking a\ngonorrhea has risen to an unprecedented level of nearly 900,000 cases\nfocal point. Until quite recently, no agency inside or outside of govern-\nannually. Evidence suggests that the actual incidence level, which\nment has been responsible for, or assists in setting goals, developing\nincludes those cases of venereal disease that are not reported to public\nnational policy, maintaining criteria of performance of measuring\nhealth authorities, is much greater. While this level of disease poses a\nresults.\nmost serious threat to the health and welfare of the public, the Com-\n3. The Committee focused on nutrition as a major area of concern,\nmittee notes it is encouraging that efforts to control this epidemic\nrecognizing that what is taught to children about this subject is\nhave not been in vain. Specifically, gonorrhea, while still increasing is\ninadequate. Nutrition studies reveal that teenagers often damage\ndoing SO at a smaller rate. In addition, infectious syphilis incidence\ntheir health through poor eating habits. One researcher has pointed\nhas declined for the first time in six years. These positive indications\nout that if intervention to modify coronary risks is put off until\nare largely due to the various control and prevention activities—\nadulthood, it is too late. Such risks are directly related to nutrition.\nscreening, contact tracing, information and education diligently\nThe Committee considers nutrition education an important feature\npursued by public health authorities with the support and assistance\nof the reported bill and intends that nutritionists will affect the policy\n42\n43\ndirection of both the Office of Consumer Health Education and\neducation projects. The proposed Office of Consumer Health Educa-\nPromotion and the Center for Health Education and Promotion.\ntion and Promotion may very well rely upon the Center for Disease\nThe Committee looks for guidance in this endeavor to the Select Com-\nControl as well as the other organizations in HEW that are responsible\nmittee on Nutrition and Human Needs. A nutrition education pro-\nfor health education activities to execute the programmatic aspects\nposal will be the subject of Senate hearings in September 1975.\nof health education but the Committee believes a higher level focus,\n4. The Committee recognizes that over 88% of the people look to\nas provided in the Committee reported bill, is essential.\ntheir physicians or rely upon television commercials for information\n9. The Committee considered S. 544 with a view to including this\nabout health. Evidence reveals that physicians are too busy to do an\nComprehensive School Health Education provision to S. 1466. The\neffective job in educating their patients and that too many television\nCommittee recognizes that S. 544 is essential legislation if a meaning-\nmessages are primarily concerned with product promotion rather\nful preventive program to improve the health of the American people\nthan with true consumer health education. Providers of care, including\nis to be a reality. A portion of S. 544, accordingly, has been included\nhospitals, do little to overcome deficiencies even though such pro-\nin S. 1466. The language establishes a program of grants to local\ngrams of patient health education have proven to be cost effective.\neducation agencies and institutions for inservice education oppor-\nNeither voluntary health organizations nor insurance carriers (private\ntunities for elementary and secondary school teachers in a broad\nor non-profit) have exploited fully their opportunities.\nscope of health education areas.\n5. The Committee has reviewed research studies of patient and\n10. The Committee recognizes that dental caries is the most\ncommunity health education programs and is encouraged by the re-\nprevalent disease in the United States and one of the most costly\nsults. The studies reveal that as a result of sound programs, morbidity\nof all chronic diseases. By age two, approximately one-half of the\nand mortality, hospital days, emergency visits, and costs have been\nchildren of this nation have experienced tooth decay. By age fifteen,\nsignificantly reduced. Other evaluations showed the nutritional\nthe average child has eleven decayed, missing, or filled teeth. Section\nstatus and knowledge about other risk factors were markedly increased\n1718 of the Committee reported bill therefore provides a modest\nas a result of carefully developed programs. Such research is vitally\nauthorization for communities voluntarily wishing to seek partial\nnecessary and will serve to determine the directional emphasis for\nfederal assistance in order to fluoridate their water supplies, which is a\npolicy design in both the Office and the Center.\nproven effective health prevention methodology.\n6. The Committee was troubled by the lack of adequate data about\n11. The Committee considered who should serve as members of the\nthe needs, attitudes, knowledge, and behavior of the American public\nBoard of Directors for the publicly chartered, private Center for\nregarding health. Through the reported bill the Committee directs\nHealth Education and Promotion. A sampling of these have been\nthe National Center for Health Statistics to make continuing surveys\nlisted in an earlier part of this report as a guide for the President in\nto obtain such information.\nselecting a Board representative of the prerequisite skills, compe-\n7. The Committee recognizes the need for adequately trained health\ntencies and disciplines necessary for fulfillment of the Committee's\neducation practitioners who will be engaged in health education teach-\nobjectives, as provided in the reported bill.\ning research and in health education practice. Emphasis should be\n12. The Committee has determined that current funding levels\nplaced on raising the level of training given to those who will enter\nfor health education programs are grossly inadequate by every\nthe field of health education practice. Additionally, support should\nmeasure applied, including comparison with total U.S. health care\nbe given to those who are engaged in theoretical research in the field\nexpenditures, the Federal health budget, individual hospital budgets,\nof health education and promotion since it is this group who develop\nthe cost of individual programs, and-most dramatically-by com-\nthe conceptual frameworks from which sound practice derives. Short-\nparison with the advertising budgets of over-the-counter drugs.\nterm continuing education programs should also be included to up-\nHealth education expenditures, as a percentage of national health\ngrade skills of a variety of health providers, including doctors, nurses,\nexpenditures or individual hospital budgets are in the order of magni-\neducational specialists, and mid-level health practitioners.\ntude of one-fourth to one-half of one percent, which the Committee\n8. The proposed creation of an Office of Health Education in the\nbelieves is not sufficient to do the job.\nDepartment of Health, Education, and Welfare is not intended by\n13. While the effectiveness of health education as a whole is widely\nthe Committee to reflect negatively upon the efforts of the new\ndebated, the Committee believes that there is now evidence from a\nBureau of Health Education in the Center for Disease Control which\nnumber of studies that well-designed programs, incorporating the\nwas assigned initial responsibility for developing a health education\nvarious elements of health education included in the reported bill\nfocus but rather to emphasize the Committee's concern with the need\ndefinition, can be effective in producing desired behavior change if\nfor greater focus and commitment by the Department of Health,\naccompanied by national policies and mass communications programs\nEducation, and Welfare. The Bureau, in its ten months of existence\ndesigned to reinforce, rather than undermine, the educational goals.\nwith very limited resources in terms of both budget and personnel,\n14. Authorizations of appropriations in the Committee reported\nhas made many important contributions both within and outside the\nbill have been consistently reduced from the bills as introduced and\nFederal structure, including support and leadership in the develop-\nupon which the reported has been based. Committee action in this\nment of a private-sector National Center for Health Education, the\nregard is not intended to express the need for funding of such programs\ninitiation of cooperation among Federal agencies in pursuit of common\nbut rather to provide realistic funding levels in line with congressional\nhealth education objectives, and the development of innovative health\nappropriations.\n44\n45\nVII.-ADMINISTRATION VIEWS\ntrol programs each fiscal year through 1980. The bill adds a new sec-\ntion 318(i), which defines venereal disease as syphilis and gonorrhea\nDEPARTMENT OF HEALTH, EDUCATION, AND WELFARE,\nand any other sexually transmitted diseases which the Secretary finds\nJuly 16, 1975.\nto be of national significance and which, with respect to project grants\nHon. HARRISON A. WILLIAMS, Jr.,\nunder 318(d), is amenable to control. A new subsection is added to\nChairman, Committee on Labor and Public Welfare,\nsection 318(c), formula grants for venereal disease diagnostic and\nU.S. Senate, Washington, D.C.\ntreatment services, to require that recipients of grants provide to the\nDEAR MR. CHAIRMAN: This is in response to your requests of April\nextent feasible diagnostic and treatment services for a wide range of\n23 and 24 for reports on S. 1466, a bill \"To amend the Public Health\ngastro-urinary conditions. It also eliminates the requirement that\nService Act to extend and revise the program of assistance for the\ngrantees provide darkfield microscopic techniques for diagnosis of\ncontrol and prevention of communicable diseases,\" to be cited as the\nboth syphilis and gonorrhea.\n\"Disease Control Amendments Act of 1975;\" and S. 1454, a bill \"To\nIn addition, section 318(d) is expanded to add to the list of support-\nrevise and extend the Public Health Service Act, and for other pur-\nable activities routine testing, including attendant laboratory and\nposes,\" to be cited as the \"National Venereal Disease Prevention\nfollow-up system costs. It also changes the purpose of special studies\nand Control Amendments, 1975.\"\nand demonstrations from evaluation of control to evaluation of\nS. 1466 would amend the Public Health Service Act to expand the\nprevention and control strategies and activities. The bill also adds\nscope of the present section 317 by eliminating the word communica-\nnonprofit private entities as eligible recipients for technical assistance.\nble each time it appears, and to authorize grants for control of \"other\nAs Dr. Cooper testified on May 7, 1975, the Department opposes\nconditions,\" rodent control and lead poisoning control. Project grant\nenactment of these two bills. First, we oppose the continuation of\nfunds are authorized to be appropriated in the amount of $111 million\nseparate categorical grant authorities. The two bills would extend seven\nfor the fiscal year ending June 30, 1976, and for each of the next two\ndifferent categorical grant authorization ceilings from three to five\nsucceeding fiscal years. For each of these fiscal years there are author-\nfiscal years. The establishment of several legislative authorities causes\nized $11 million for tuberculosis control; $25 million for vaccine-\nconsiderable hardship on State and local health agencies trying to\npreventable diseases; $35 million for rodent and lead poisoning con-\ncarry out well balanced, effective preventive programs and continues\ntrol; and $40 million for other diseases or conditions (except those\nto make Federal assistance unnecessarily complicated. In addition, we\nalready specified). In addition, it continues the appropriation ceiling\nstrongly oppose the funding authorizations in S. 1466 and S. 1454\nof $5 million for health emergencies for the fiscal year ending June 30,\nwhich, at $203 million per year, are nearly six times the President's\n1976, and for each of the next two succeeding fiscal years.\nbudget request of $34 million for 1976. The appropriation authoriza-\nThe bill also provides that nonprofit organizations which received\ntions should recognize the demonstration nature of Federal lead and\ngrants during 1975 for rat control and lead based paint project grants\nrat-control project grants and place greater reliance on the discretion\nwill be eligible for continuation.\nand capabilities of State and local governments and the private sector\nThe bill defines a disease control program as a program which is\nin disease control. Federal spending commitments must be consistent\ndesigned and conducted so as to contribute to national protection\nwith the need to reduce Federal spending and to generate increased\nagainst tuberculosis, rubella, measles, Rh disease, poliomyelitis,\ncommitment to these programs by State and local governments.\ndiphtheria, tetanus, whooping cough, mumps, diabetes mellitus, lead\nWe therefore recommend against enactment of these bills. We recom-\npoisoning, rodent infestations, or other diseases or conditions (other\nmend, instead, enactment of S. 1756 introduced by Senator Schweiker\nthan venereal disease) which are amenable to reduction, and are\non behalf of the Administration. The bill combines sections 317 and 318\ndetermined by the Secretary to be of national significance. The\ninto a single authority and authorizes amounts adequate to meet pro-\ndefinition includes vaccination programs, casefinding programs, public\ngram objectives.\nand professional education programs, other preventive health pro-\nWe are advised by the Office of Management and Budget that there\ngrams, laboratory services, and studies to determine the communicable\nis no objection to the presentation of this report from the standpoint of\ndisease control needs of States and political subdivisions of States and\nthe Administration's program and that enactment of S. 1466 and\nthe means of best meeting their needs.\nS. 1454 would not be consistent with the Administration's objectives.\nS. 1454 would amend section 318 of the Public Health Service Act\nSincerely,\nto extend the authorization for grants for the prevention and control\nCASPAR W. WEINBERGER,\nof venereal diseases. The proposed legislation reauthorizes and extends\nSecretary.\ngrants for venereal disease control and authorizes a total of $87 million\nVIII. COST ESTIMATE\nfor grants for the fiscal year ending June 30, 1976, and for each of the\nfour succeeding fiscal years. Of this total $12 million is authorized for\nThe Committee's bill include authorization for:\nproject grants for research, demonstration, and training for each fiscal\n1976\n$83,000,000\nyear through 1980; $30 million is authorized for formula grants for\n1977\n95,000,000\nvenereal disease diagnostic and training services for each fiscal year\n1978\n121,000,000\nthrough 1980; and $45 million is authorized for project grants for con-\n279.\n46\n47\nIX. TABULATION OF VOTES CAST IN COMMITTEE\nSubsection 102(e) amends subsection (f) (1) of such section by-\n(1) striking \"communicable\";\nPursuant to section 133(b) of the Legislative Reorganization Act\n(2) inserting \"or conditions\" after \"disease\"; and\nof 1946, as amended, the following is a tabulation of votes in\n(3) inserting \"project\" after \"grants\" each time it appears.\nCommittee:\nSubsection 102(f) amends subsection (g) of that section by-\nMotion to report the measure to the Senate carried unaminously.\n(1) inserting \"or conditions\" after \"diseases\" in clauses (1) a\n(2), and\nX. A SECTION-BY-SECTION ANALYSIS\n(2) inserting \"and conditions\" after \"diseases\" in clauses\nand (4).\nTITLE I-DISEASE CONTROL\nSubsection 102(g) amends subsection (h) (1) to read as follow\n\"(1) The term 'disease control program' means a program which\nSHORT TITLE\ndesigned and conducted so as to contribute to national protect\nagainst tuberculosis, rubella, measles, Rh disease, poliomyeli\nSec. 101 states that this title may be cited as the \"Disease Control\ndiphtheria, tetanus, whooping cough, mumps, diabetes mellitus,\nAmendments Act of 1975\".\nother disease or conditions (other than venereal disease) which\namenable to reduction, and are determined by the Secretary to be\nAMENDMENT TO THE PUBLIC HEALTH SERVICE ACT\nnational significance. Such term includes vaccination programs, ca\nSubsection 102(a) amends subsection (a) of section 317 of the Public\nfinding programs, public and professional education programs, ot\nHealth Service Act (42 U.S.C. 247b) by-\npreventive health programs, laboratory services, and studies\ndetermine the communicable disease control needs of States\na\n(1) inserting \"project\" before \"grants\" in the first sentence;\n(2) inserting \"project\" before \"grant\" each time it appears;\npolitical subdivisions of State and the means of best meeting su\nneeds.\".\n(3) striking \"communicable\" each time it appears in the second\nSubsection 102(h) amends (i) of such section by-\nsentence;\n(4) inserting \"or conditions\" after \"diseases\" in the second\n(1) striking \"communicable\"; and\nsentence; and\n(2) inserting \"project\" before \"grants\".\n(5) striking \"disease\" in the second sentence.\nSubsection 102(i) is amended by adding after subsection (i)\nSubsection 102(b)(1) amends subsection (b) of such section by\nfollowing new subsection:\ninserting \"project\" before \"grant\" each time it appears.\n\"Subsection 102(j) provides that for the purpose of payments p\nSubsection 102(b)(2) amends subsection (b) (B) of such section\nsuant to project grants and contracts under section 317 of the Act th\nby-\nare authorized to be appropriated $30,000,000 for the fiscal year end\n(A) inserting \"or conditions\" after \"diseases\";\nJune 30, 1976, $35,000,000 for the fiscal year ending June 30, 19\n(B) striking \"of the importance of immunization against such\nand $40,000,000 for the fiscal year ending June 30, 1978.\"\ndiseases, to encourage such persons to seek appropriate immuniza-\nTITLE II-VENEREAL DISEASE\ntion and to facilitate access by such persons to immunization\nservices\" and inserting in lieu thereof \"including the methods and\nSec. 201 states that this title may be cited as the \"National Vener\nservices available to prevent these diseases or conditions\".\nDisease Prevention and Control Amendments of 1975.\"\nSubsection 102(b)(3) provides that the amendment made by para-\ngraph (2) shall be effective for fiscal years beginning after June 30,\nFINDINGS AND DECLARATION OF PURPOSE\n1975.\nSubsection 102(c) amends subsection (b) (C) of such section by-\nSubsection 202(a) states that the Congress finds and declares tha\n(1) striking \"communicable\" each time it appears;\n(1) the number of reported cases of venereal disease continues\n(2) inserting \"or condition\" after \"disease\" the first time it\nepidemic proportions in the United States;\nappears; and\n(2) the number of patients with venereal disease reported\n(3) striking \"disease\" the second time it appears and inserting\npublic health authorities is only a fraction of those actua\nin lieu thereof \"related\".\ninfected;\nSubsection 102(d)(1) amends subsection (c) by inserting \"project\"\n(3) the incidence of venereal disease is particularly high in\nbefore \"grant\" each time it appears.\n15-29-year age group, and in metropolitan areas;\nSubsection 102(d) (2) amends subsection (c) (2) of such section by\n(4) venereal disease accounts for needless deaths and leads\ninserting before the period at the end thereof\", and such amount\nsuch severe disabilities as sterility, insanity, blindness,\n-\nshall be deemed as part of the grant and deemed to have been paid\ncrippling conditions;\nto the recipient\".\n(5) the number of cases of congenital syphilis, a preventa\ndisease, tends to parallel the incidence of syphilis in adults;\n48\n49\n(6) it is conservatively estimated that the public cost of care\nSubsection 203(h) amends subsection 318(d) (1) (D) of such Act by\nfor persons suffering the complications of venereal disease exceed\ninserting \"targeted\" before \"professional\".\n$80,000,000 annually;\nSubsection 203(i) amends subsection 318(d)(1) (E) of such Act by\n(7) medical researchers have no successful vaccine for syphilis or\nstriking \"control\" and inserting in lieu thereof \"prevention and con-\ngonorrhea, and have no blood test for the detection of gonorrhea\ntrol strategies or activities\".\namong the large reservoir of asymptomatic females;\nSubsection 203(j) amends subsection 318(d)(2) of such Act by in-\n(8) school health education programs, public information and\nserting before the period at the end thereof \"and $31,000,000 for the\nawareness campaigns, mass diagnostic screening and case followup\nfiscal year ending June 30, 1976, $33,000,000 for the fiscal year ending\nactivities have all been found to be effective disease intervention\nJune 30, 1977, and $36,000,000 for the fiscal year ending June 30,\nmethodologies;\n1978\".\n(9) knowledgeable health providers and concerned individuals\nSubsection 203(k) amends subsection 318(h) of such Act by striking\nand groups are fundamental to venereal disease prevention and\n\"treated or to have any child or ward of his\".\ncontrol;\nSubsection 203(1) amends section 318 of such Act by adding at the\n(10) biomedical research leading to the development of vac-\nend thereof the following:\ncines for syphilis and gonorrhea is of singular importance for the\n\"(m) As used in this section, the term \"veneral disease' means\neventual eradication of these dreaded diseases; and\nsyphilis and gonorrhea and any other sexually transmitted disease\n(11) a variety of other sexually transmitted diseases, in addi-\nwhich the Secretary finds to be of national significance and which,\ntion to syphilis and gonorrhea, have become of public health\nwith respect to grants under subsection (d), the Secretary finds to be\nsignificance.\namenable to control.\".\nSubsection 202(b) states that in order to preserve and protect the\nhealth and welfare of all citizens, it is the purpose of this Act to\nTITLE III-HEALTH EDUCATION AND PROMOTION\nestablish a national program for the prevention and control of venereal\ndisease.\nSHORT TITLE\nSubsection 203(a) amends subsection 318(a) of the Public Health\nService Act (42 U.S.C. 247c) by inserting \"and nonprofit private\nSEC. 301 states that this title may be cited as the \"National Con-\nentities\" after \"authorities\".\nsumer Health Education and Promotion Act of 1975\".\nSubsection 203(b) amends subsection 318(b)(1) of such Act by in-\nserting \"which will contribute to national objectives\" after \"training\".\nAMENDMENT TO THE PUBLIC HEALTH SERVICE ACT\nSubsection 203(c) amends subsection 318(b)(2) of such Act by\nSEC. 302 amends the Public Health Service Act by adding after\ninserting before the period at the end thereof \"and $5,000,000 for the\ntitle XVI the following new title:\nfiscal year ending June 30, 1976, $5,000,000 for the fiscal year ending\nJune 30, 1977, and $5,000,000 for the fiscal year ending June 30, 1978\".\n\"TITLE XVII-OFFICE OF CONSUMER HEALTH EDUCA-\nSubsection 203(d) amends subsection 318(c)(1) of such Act by\nTION AND PROMOTION AND THE CENTER FOR\nadding at the end thereof \"and $5,000,000 for the fiscal year ending\nJune 30, 1976, and $10,000,000 for the fiscal year ending June 30, 1977,\nHEALTH EDUCATION AND PROMOTION\nand $15,000,000 for the fiscal year ending June 30, 1978.\".\n\"PART A-OFFICE OF CONSUMER HEALTH EDUCATION AND PROMOTION\nSubsection 203(e) amends subsection 318(e)(2)(C) of such Act by\nstriking \"(including dark-field microscope techniques for the diagnosis\n\"ESTABLISHMENT OF OFFICE OF CONSUMER HEALTH EDUCATION AND\nof both gonorrhea and syphilis)\".\nPROMOTION\nSubsection 203(f). Paragraphs (D), (E), (F), (G), and (H) of section\n318(c)(2) of such Act are redesignated as (E), (F), (G), (H), and (I),\n\"SEC. 1701. (a) Establishes in the Department of Health, Education,\nand the following new paragraph is inserted after paragraph (C) as\nand Welfare the office of Consumer Health Education and Promotion\nfollows:\n(hereafter in this Act referred to as the 'Office') which shall be under\n\"(D) to the extent feasible as determined by criteria developed\nthe direction of a Director who shall be appointed by the Secretary\nby the Secretary, the provision of clinical services for persons\nof Health, Education, and Welfare (hereafter in this Act referred to as\naffected with venereal disease which includes diagnosis and care\nthe (Secretary') and supervised by the Assistant Secretary for Health\nfor persons with a wide range of genitourinary diseases and con-\n(or such other officer of the Department as may be designated by the\nditions, which, because of their symptoms and clinical presenta-\nSecretary as the principal adviser to him for health programs),\ntions, are commonly present in persons with actual or suspected\nSubsection 1702(b), provides that the Office, in order to facilitate\nvenereal disease;\".\nthe development of health education and promotion strategy for the\nSubsection 203(g) amends subsection 318(d)(1)(B) of such Act by\nNation, shall carry out the following functions: Engage in research\ninserting before the semicolon at the end thereof the following: \"and\nin health education programs, stimulate and coordinate communica-\nroutine testing, including attendant laboratory and followup systems\ntions in health education, and overview and coordinate Federal\ncosts thereof\".\nprograms.\n50\n51\nGENERAL AUTHORITY\nSubsection 1703(b)(2)(B) provides that projects which receive\nFederal funds under this subsection shall-\nSec. 1702 provides that the Secretary, acting through the Office\n(1) utilize in a coordinated manner such health education\nshall-\nmethods as may be appropriate to provide effective health educa-\n(1) design and implement national goals and strategies with\ntion services to the population of the applicable region; and\nrespect to health education and promotion;\n(2) evaluate the effectiveness of each health education method\n(2) determine health education and promotion needs and\nutilized and identify its particular advantages or disadvantages.\nresources, and recommend appropriate educational certifying\npolicies for health education and promotion manpower;\nHealth Education Training\n(3) incorporate appropriate health education and promotion\nstrategies into every facet of our society and increase the appli-\nSubsection 1703(c) provides that the Secretary acting through the\ncation of health knowledge, skills, and practices by the general\nDirector is authorized to make grants and contracts to public or non-\npopulation in their patterns of daily living;\nprofit private entities to provide for the training for health personnel\n(4) increase the effectiveness and efficiency of health education\nin health education and promotion.\nand promotion programs through improved planning, implemen-\ntation of tested models, and evaluation of results;\nSchool Health Education Training\n(5) establish systematic processes for the exploration, develop-\nment, demonstration, and evaluation of innovative health\nSubsection 1703(d)(1) provides that the Secretary acting through\neducation concepts; and\nthe Director may make grants to local educational agencies and in-\n(6) foster information exchanges and cooperation among health\nstitutions of higher education for teacher training with respect to the\neducation providers, consumers, and supporters.\nprovision of comprehensive health education programs in schools. The\nThe Secretary shall carry out this title in a manner consistent with the\nsubsection describes the manner in which such grants may be used, and\nnational health priorities set forth in section 1502 of the Public Health\nthe scope of the term 'health education and health problems' for\nService Act and with activities undertaken under title XV of the\npurposes of this subsection.\nPublic Health Service Act (relating to health planning and\nSubsection 1703(d)(2) provides that the Director, in exercising\ndevelopment).\nauthority with respect to (a) determination of criteria for the selec-\nSPECIFIC FUNCTIONS\ntion of grants, and (b) selection of grants from eligible applicants,\nshall consult with, and obtain the approval of, the Commissioner of\nResearch Programs\nEducation.\nSubsection 1703(d)(3) provides that in establishing criteria for the\nSubsection 1703(a)(1) provides that the Secretary shall by grants\naward of grants under this section, such criteria must include priority\nand contracts to public or nonprofit private entities conduct and\nfor applications for support of programs which provide: (1) inservice\nsupport research in health education and promotion in the manner\nrather than preservice training, except in such cases where an applicant\ndescribed in this subsection.\nhas demonstrated that: (A) inservice training is not practicable, and\nSubsection 1703(a)(2) provides that the Secretary in carrying out\n(B) reasonable opportunity exists for persons undergoing preservice\nhis responsibilities under this section, shall use the findings of the\ntraining to obtain positions in which they shall apply such training,\ncontinuing surveys of the needs, interests, attitudes, knowledge, and\nand (2) training of persons who, as a result of such training, will have\nbehavior of the American public regarding health as conducted by the\nas their major responsbility, work in health education in schools.\nNational Center for Health Statistics as a basis for formulating\npolicy with respect to health education and promotion.\nRequirements Applicable to Providers of Institutional Care\nCommunity Programs\nSubsection 1703(e) provides that the Secretary may not approve an\napplication of any health care facility for a grant or contract under\nSubsection 1703(b)(1) provides that the Secretary shall support and\nthe Public Health Service Act or the Community Mental Health\nencourage innovative programs in health education and promotion in\nCenters Act for a fiscal year beginning after the date of enactment of\nthe manner described in this subsection.\nthis act unless the application contains or is supported by assurances\nSubsection 1703(b)(2)(A) provides that the Secretary is authorized\nsatisfactory to the Secretary that, during the period for which the\nto make grants and contracts to public or nonprofit private entities\nassistance is applied is to be made available, the applicant will pro-\nfor the purpose of developing programs of health care education for a\nvide such consumer health education for individuals receiving in-\ndefined geographic region pursuant to and in accordance with those\npatient or outpatient services through such health care facility as\nestablished in section 1511 of the Public Health Service Act and with\nthe Secretary shall by regulation prescribe.\nactivities undertaken under title XV of the Public Health Service Act\n(relating to health planning and development). In awarding such grants\nand contracts the Secretary shall assure an equitable geographic and\ndemographic distribution of all funds appropriated.\n52\n53\nCommunications in Health Education and Promotion\nsuch programs and actions, including recommendations for legisla-\nSubsection 1703( provides that the Secretary shall establish\ntion and administrative action within the executive branch.\nliaison with the Office, providers of health education services, and the\nSubsection 1704(e) provides that the Secretary shall provide the\ncommunications media and prescribes the manner in which the\nCommittee with such full-time professional and clerical staff, informa-\nSecretary shall effect such liaison.\ntion, other support, and the services of such consultants as máy be\nThis subsection also provides that in the case where materials are\nnecessary to assist in carrying out effectively its functions under this\ndeveloped, through activities funded under this title and/or through\nsection.\nactivities of the Office and where the materials have commercial\nAdvisory Council\nvalue, the moneys which result from the license, sale, rent, grant or\nSubsection 1705(a) establishes the Consumer Health Education\nother. transaction of said materials shall be paid into the public\nand Promotion Advisory Council to bel appointed by the Secretary,\ntreasury. The Director with consultation of the Secretary shall\nprescribes its make-up, and terms and conditions of membership. This\ndetermine the fair market value of such materials and shall have the\nsubsection also provides that the Secretary may appoint, in addition,\nauthority to authorize such transactions.\nspecial advisory and technical committees.\nSubsection 1705(b) provides that it shall be the function of the\nFederal Programs\nAdvisory Council to provide advice and recommendations for the\nSection 1703(g) provides that the Secretary, in conjunction with the\nconsideration of the Secretary on matters of general policy with respect\nInterdepartmental Committee on Consumer Health Education and\nto the functions of the Office. The Advisory Council shall make an\nPromotion established by section 1704, shall make recommendations\nannual report to the:Secretary and to the Congress on the performance\nto the Congress for the inclusion in appropriate legislation of pro-\nof its functions, including any recommendations it may have with\nvisions respecting health education and promotion. The Secretary\nrespect thereto:\nshall-\nSubsection 1705(c) provides that the Advisory Council is authorized\n(1) promote the coordination, communication, and collabora-\nto engage such technical assistance and receive such additional support\ntion of health education and promotion programs within the\nas may be required to carry out its functions.\nDepartment of Health, Education, and Welfare;\n(2) establish a liaison with other Federal agencies engaged in\nReports\nhealth education and promotion, including the Consumer Product\nSafety Commission, the Department of Agriculture, the Environ-\nSubsection 1706(a) provides that the Secretary shall make an annual\nreport (not later than December 1 of each year except in the year this\nmental Protection Agency, the Department of Transportation,\nand the Defense; and\ntitle is enacted into law) to the Congress on the activities and policy\nrecommendations of the Office.\n(3) identify and make public those Federal programs and actions\nwhich are not in the interest of public health and determine\nSubsection 1706(b) provides that the Secretary, acting through the\nmethods for reviewing and commenting on such programs and\nOffice, shall assemble and submit to the President and the Congress\nactions as identified pursuant to section 1704(d).\nnot later than December 1 of each year+\n(1) a report of the activities, findings, and recommendations of\nInterdepartmental Committee on Consumer Health Education and\nthe Office, and\nPromotion\n(2) recommendations, based on the findings and recommenda-\ntions of the Office, and the Interdepartmental Committee on\nSubsection 1704(a) establishes an Interdepartmental Committee\nConsumer Health Education and Promotion for legislation and\non Health Education and Promotion (hereinafter referred to in this\nadministrative action within the executive branch.\nsection as the \"Committee\") which shall be responsiblé for overview\nSubsection 1706(c) provides that the Office of Management and\nand coordination of all Federal programs and activities relating to\nBudget may review any report, recominendations or submission made\nhealth education and promotion to assure the adequacy and effective-\nby the Secretary, the çommittee, or the Advisory Council in regard to\nness of such programs and activities and to provide for the communica-\nthis Act before its submission to the Congress, but the Office of Man-\ntion and exchange of information necessary to promote these functions.\nagement and Budget may not revise the report or delay its submission,\nSubsection 1704(b) provides that the Secretary or his designee\nand it may submit to the Congress its comments (and those of other\nshall serve as Chairman of the Committee, and prescribes the member-\ndepartments or agencies of the Government) respecting such sub-\nship of the Committee.\nmission.\nSubsection 1704(c) provides that the Committee shall meet at the\nAuthorization of Appropriations\ncall of the Chairman, but not less often than four times a year.\nSubsection 1704(d) provides that the Committee shall identify\nSec. 1707 provides that to carry out this title there are authorized\nFederal programs and actions which are not in the interest of public\nto be appropriated $11,000,000 for the fiscal year ending June 30,\nhealth and determine methods for reviewing and commenting on\n1976, $11,000,000 for the fiscal year ending June 30, 1977, and\n$24,000,000 for the fiscal year ending June 30, 1978.\n55\n54\nFunctions\nPART B-CENTER FOR HEALTH EDUCATION AND PROMOTION\nSubsection 1713(a) prescribes the functions that the Center shall\nCongressional Declaration of Policy\ncarry out to facilitate the development of a health education and pro-\nSec. 1708 states that the Congress finds and declares that-\nmotion strategy for the Nation.\n(1) it is in the public interest to inform the public about health\nSubsection 1713(b) provides that the Center in carrying out its\nand about ways to best protect and improve personal health;\nfunctions under this section may prescribe such regulations as it\n(2) the public must develop the ability to examine, and weigh\ndeems necessary.\nconsequences of personal decisions respecting health;\nAdvisory Panel\n(3) the public must be motivated to desire changes supportive\nSec. 1714 provides that the Board shall appoint an advisory panel\nof more healthful lifestyles;\ncomprised of one hundred individuals with appropriate competencies\n(4) impediments that inhibit the voluntary adoption and\nand abilities. The principal function of the advisory panel shall be to\nmaintenance of more healthful practices by the public must be\nprovide advice for members of the Board. Additionally, it shall serve\nidentified and mitigated or removed;\nas a primary source for appointments to special committees, task\n(5) to achieve these goals it is necessary for the Federal Govern-\nforces, and conferences. The advisory panel shall receive all Center\nment to complement, assist, and support a national policy that\nwill advance the national health, reduce preventable illness,\nreports.\nReport to Congress\ndisability, and death, moderate self-imposed risks, and promote\nprogress and scholarship in consumer health education and\nSec. 1715 provides that the Center shall submit an annual report to\npromotion; and\nthe President for transmittal to the Congress. The report shall include\n(6) a private corporation should be created to facilitate the\na comprehensive and detailed report of the Center's operations, ac-\ndevelopment of a health education and promotion strategy for\ntivities, financial condition, and accomplishments under this title and\nthe Nation.\nmay include such recommendations as the Center deems appropriate.\nBoard of Directors\nFinancing\nSubsection 1709(a) provides that the Center shall have a Board of\nDirectors consisting of twenty-five members appointed by the Presi-\nSubsection 1716(a) provides that there are authorized to be appro-\ndent, by and with the advice and consent of the Senate.\npriated to the Center for the purposes of carrying out the functions\nSubsection 1709(b) prescribes the methods of selecting board\nenumerated in section 1716 of this Act $1,000,000 for fiscal year\nmembers, who shall serve as incorporators, and shall develop a non-\nending June 30, 1976; $1,000,000 for the fiscal year ending June 30,\nprofit corporation within sixty days from the effective date of this\n1977; and $1,000,000 for the fiscal year ending June 30, 1978.\ntitle.\nSubsection 1716(b) provides that in addition to the sums authorized\nSec. 1710 provides that the members of the Committee shall serve\nto be appropriated by paragraph (a) of this subsection, the Center is\nas first members of the Board, and prescribes the terms and conditions\nauthorized to receive income, grants, donations, bequests, or other\nof Board membership.\ncontributions from non-Federal sources.\nOfficers and Employees\nRecords and Audits\nSubsection 1711(a) provides that the Center shall have a President,\nSec. 1717 provides that the accounts of the Center shall be audited\nand such other officers as may be named and appointed by the Board\nannually, and prescribes the method and content of such audits.\nfor terms and at rates of compensation fixed by the Board, and\nprescribes the terms and conditions of employment for such officers.\nGrants for Water Treatment Programs\nNonprofit and Nonpolitical Nature of the Center\nSubsection 1718(a) authorizes appropriations of $2,000,000 for the\nfiscal year ending June 30, 1976; $3,000,000 for the fiscal year ending\nSubsection 1712(a) provides that the Center shall have no power to\nJune 30, 1977; and $4,000,000 for the fiscal year ending June 30, 1978;\nissue any shares of stock or to declare or pay any dividends.\nwhich shall be used by the Secretary to make grants to States, political\nSubsection 1712(b) provides that no part of the income or assets of\nsubdivisions of States, and other public or nonprofit private agencies,\nthe Center shall insure to the benefit of any director, officer, employee,\norganization, and institutions to assist them in initiating water treat-\nor any other individual except as salary or reasonable compensation\nment programs designed to reduce the incidence of oral disease or\nfor services.\ndental defects among residents of communities or the students in\nSubsection 1712(c) provides that the Center may not contribute to\nelementary and secondary schools.\nor otherwise support any political party or candidate for elective\npublic office.\n56\n57\nSubsection 1718(b) provides that grants under this section may be\nutilized for (but are not limited to) the purchase and installation of\nPUBLIC HEALTH SERVICE ACT\nwater treatment equipment,\nDefinitions\nTITLE III-GENERAL POWERS AND DUTIES\nSec. 1719 defines health education and promotion as\nOF PUBLIC HEALTH SERVICE\n\"(A) 'Health education and promotion' is a process that favorably\ninfluences understandings, attitudes, and conduct, including cultural\nawareness and sensitivity, in regard to individual and community\nGRANTS FOR VACCINATION PROGRAMS AND OTHER COMMUNICABLE DISEASE\nhealth. Specifically, it affects and influences individual and community\nCONTROL PROGRAMS\nhealth behavior and attitudes in order to moderate self-imposed risk,\nmaintain and promote physical and mental health and efficiency,\nSEC. 317. (a) The Secretary may make project grants to States and,\nand reduce preventable illness, disability, and death.\".\nin consultation with the State health authority, to agencies and politi-\ncal subdivisions of States to assist in meeting the costs of [communi-\nTechnical Amendments\ncable] disease control programs. In making a project grant under this\nsection, the Secretary shall give consideration to (1) the relative ex-\nSubsection amends subsection (c):of section 306 of the Public\ntent, in the area served by the applicant for the grant, of the problems\nHealth Service Act by redesignating subsection (c) (2), and inserting\nwhich relate to one or more of the [eommunicable] diseases or condi-\na new subsection (c)(2) immediately preceding subsection (c)(2),\ntions referred to in subsection (h) (1), and (2) the design of the\nto read as follows:\napplicant's [communicable disease] program to determine its\n\"(c) (1) The Center shall make a continuing survey of the needs,\neffectiveness.\ninterests, attitudes, knowledge, and behavior of the American public\n(b) (1) No project grant may be made under this section unless an\nregarding health. The Center shall transmit the findings of such\napplication therefor has been submitted to, and approved by, the Sec-\nsurveys and of the findings of similar surveys contracted for or\nretary. Except as provided in paragraph (2), such application shall be\notherwise obtained by the Center and conducted by national health\nin such form, submitted in such manner, and contain such information,\neducation organizations and community health education organi-\nas the Secretary shall by regulation prescribe.\nzations accompanied by appropriate Center analysis; if any, to the\n(2) An application for a project grant for a fiscal year beginning\nSecretary, the Assistant Secretary for health, and to the Office of\nafter June 30, 1973, shall-\nConsumer Health Education and Promotion for their use in formulat-\n(A) set forth with particularity the objectives (and their\ning policies respecting health education and promotion.\"\npriorities, as determined in accordance with such regulations as\nSubsection 303(b) amends subsection (i) of section 308 of the Public\nthe Secretary may prescribe) of the applicant for each of the\nHealth Service Act by adding the following new paragraph (3) after\nprograms he proposes to conduct with assistance from a project\nparagraph (2):\ngrant under this section;\n(3) Of those sums appropriated by Congress under section 308 of\n(B) contain assurances satisfactory to the Secretary that, in\nthe Act not less than $1,000,000 for the fiscal year ending June '30',\nthe fiscal year for which a project grant under this section is\n1976, $1,000,000 for the fiscal year ending June 30, 1977, and\napplied for, the applicant will conduct such programs as may be\n$1,000,000 for the fiscal year ending Juné 30, 1978, shall be made\nnecessary to develop an awareness in those persons in the area\navailable to carry out the activities of section 306(c)(1).\"\nserved by the applicant who are most susceptible to the diseases\nor conditions referred to in subsection (h) (1) [of the importance\nXI. CHANGES IN EXISTING Law\nof immunization against such diseases, to encourage such persons\nIn compliance with subsection (4) of Rule XXIX of the Standing\nto seek appropriate immunization, and to facilitate access by such\nRules of the Senate, changes in existing law made by the bill as\npersons to immunization services] including the methods and\nrepeated are shown as follows (existing law proposed to be omitted\nservices available to present these diseases or conditions; and\nis enclosed in black brackets. new matter is printed in italic, existing\n(C) provide for the reporting to the Secretary of such infor-\nlaw in which no change is proposed is shown in roman)\nmation as he may require concerning (i) the problems, in the\narea served by the applicant, which relate to any [communicable]\ndisease or condition referred to in subsection (h) (1), and (ii) the\n[communicable disease] related control programs of the applicant.\n(3) Nothing in this section shall be construed to require any State\nor any agency or political subdivision of a State to have a commu-\nnicable disease control program which would require any person, who\nobjects to any treatment provided under such a program, to be treated\nor to have any child or ward of his treated under such a program.\n59\n58\n$5,000,000 for the fiscal year ending June 30, 1975; for costs incurred\n(c) (1) Payments under Project grants under this section may be\nin succeeding fiscal years, for costs incurred in ntilizing such resources\nmade in advance on the basis of estimates or by way of reimburse-\nin accordance with such plan.\nment, with necessary adjustments on account of underpayments or\n(f) (1) Except as provided in section 318(g), no funds appro-\noverpayments, and in such installments and on such terms and con-\npriated & under any provision of this Act other than subsection (d)\nditions as the Secretary finds necessary to carry out the purposes of\nmay be used to make project grants in any fiscal year for [commu-\nthis section.\nnicable] disease or conditions control programs if (A) project grants\n(2) The Secretary, at the request of a recipient of a project grant\nfor such programs are authorized by this section, and (B) all the\nunder this section, may reduce such project grant by the fair market\nfunds authorized to be appropriated under that subsection for that\nvalue of any supplies (including vaccines and other preventive agents)\nfiscal year have not been appropriated for that fiscal year and obli-\nor equipment furnished to such recipient and by the amount of the pay,\ngated in that fiscal year.\nallowances, travel expenses, and any other costs in connection with\n(2) No funds appropriated under any provision of this Act other\nthe detail of an officer or employee of the Government to the recipient\nthan subsection (e) may be used in any fiscal year for costsincurred in\nwhen the furnishing of such supplies or equipment or the detail of\nutilizing resources of the Service in accordance with a plan developed\nsuch an officer or employee is for the convenience of and at the request\nin accordance with that subsection if all the funds authorized to be\nof such recipient and for the purpose of carrying out the program\nappropriated under that subsection for that fiscal year have not béen\nwith respect to which the project grant under this section is made.\nappropriated for that fiscal year and obligated in that fiscal year.\nThe amount by which any such project grant is SO reduced shall be\n(g). The Secretary shall submit to the President for submission to\navailable for payment by the Secretary of the costs incurred in furnish-\nthe Congress on January 1 of each year a report (1) on the effective-\ning the supplies or equipment, or in detailing the personnel, on which\nness of all Federal and other public and private activities in prevent-\nthe reduction of such project grant is based and such amount shall be\ning and controlling the diseases or conditions referred to in subsection\ndeemed as part of the grant and deemed to have been paid to the\n(h) (1), (2) on the extent of the problems presented by such diseases\nrecipient.\nor conditions, (3) on the effectiveness of the activities, assisted under\n(d) (1) There is authorized to be appropriated $11,000,000 for the\nproject grants under this section, in preventing and controlling such\nfiscal year ending June 30, 1973, $11,000,000 for the fiscal year ending\ndiseases and conditions, and (4) setting forth a plan for the coming\nJune 30, 1974, and $11,000,000 for the fiscal year ending June 30, 1975,\nyear for the prevention and control of such diseases and conditions.\nfor grants under this section for communicable disease control pro-\n(h) For the purposes of this section:\ngrams for tuberculosis.\n[(1) The term \"communicable disease control program\" means\n(2) There is authorized to be appropriated $6,000,000 for the fiscal\na program which is designed and conducted SO as to contribute to\nyear ending June 30, 1973, $6.000,000 for the fiscal year ending June 30,\nnational protection against tuberculosis, rubella, measles, Rh dis-\n1974, and $6,000,000 for the fiscal year ending June 30, 1975, for grants\nease, poliomyelitis, diphtheria, tetanus, whooping cough, or other\nunder this section for communicable disease control programs for\ncommunicable diseases (other than venereal disease) which are\nmeasles.\ntransmitted from State to State, are amenable to reduction, and\n(3) There is authorized to be appropriated $23,000,000 for the fiscal\ndetermined by the Secretary to be of national significance. Such\nyear ending June 30, 1973, $23,000,000 for the fiscal year ending\nterm includes vaccination programs, laboratory services, and\nJune 30, 1974, and $23,000,000 for the fiscal year ending June 30, 1975,\nstudies to determine the communicable disease control needs of\nfor grants under this section for communicable disease control pro-\nStates and political subdivisions of States and the means of best\ngrams other than communicable disease control programs for which\nmeeting such needs.]\nappropriations are authorized by paragraph (1) or (2).\n(1) The term *disease control program' means a program which\n(4) Not to exceed 50 per centum of the amount appropriated\nis dèsigned and conducted so as to contribute to national protec-\nfor any fiscal year under any of the preceding paragraphs of this sub-\ntion against tuberculosis, rubella, meastes, Rh disease, polio-\nsection may be used by the Secretary for project grants for such fiscal\nmyelitis, diphtheria, tetanus, whooping cough, mumps, diabetes\nyear under (A) programs for which appropriations are authorized\nmellitus, or other diseases or conditions (other than venereal dis-\nunder any one or more of the other paragraphs of this subsection if\nease) which are amenable to reduction, and are determined by\nthe Secretary determines that such use will better carry out the pur-\nthe Secretary to be of national significance. Such term includes\nposes of this section, and (B) section 318.\nvaccination programs, casefinding programs, public and pro-\n(e) The Secretary shall develop a plan under which personnel,\nfessional education programs, other preventive health programs,\nequipment, medical supplies, and other resources of the Service and\nlaboratory services, and studies to determine the communicable\nother agencies under his jurisdiction may be effectively utilized to\ndisease control needs of States and potitical subdivisions of States\nmeet epidemics of, or other health emergencies involving, any disease\nand the means of best meeting such needs.\nreferred to in subsection (h) (1). There is authorized to be appro-\n(2) The term \"State\" includes the Commonwealth of Puerto\npriated to the Secretary $5,000,000 for the fiscal year ending June\nRico, Guam, American Samoa, the Trust Territory of the Pacific\n30, 1973, $5,000,000 for the fiscal year ending June 30, 1974, and\nIslands, the Virgin Islands, and the District of Columbia.\n60\n61\n(i) Nothing in this section shall limit or otherwise restrict the use\n(D) to the extent feasible as determined by criteria developed\nof funds which are granted to a State or to an agency or a political\nby the Secretary, the provision of clinical services for the persons\nsubdivision of a State under provisions of Federal law (other than\naffected with venereal disease which includes diagnosis and care\nthis Act) and which are available for the conduct of [communicable]\nfor persons with a wide range of genitourinary diseases and con-\ndisease control programs from being used in connection with pro-\nditions, which, because of their symptoms and clinical presenta-\ngrams assisted through project grants under this section.\ntions, are commonly present in persons with actual or suspected\n(j) For the purpose of payments pursuant to project grants 'and\nvenereal disease;\ncontracts under section 317 of the Act there are authorized to be\n[(D)] (E) contain or be supported by assurances satisfactory\nappropriated $30,000,000 for the fiscal year ending June 30, 1976,\nto the Secretary that (i) not less than 70 per centum of the funds\n$35,000,000 for the fiscat year ending June 30, 1977, and $40,000,000\npaid to the State under this subsection will be used to provide and\nfor the fiscal year ending June 30, 1978.\nstrengthen public health services in its political subdivisions for\nthe diagnosis and treatment of venereal disease; (ii) such funds\nPROJECTS AND PROGRAMS FOR THE PREVENTION AND CONTROL OF\nwill be used to supplement and, to the extent practical, to increase\nVENEREAL DISEASE\nthe level of funds that would otherwise be made available for the\npurposes for which the Federal funds are provided under this\nSEC. 318. (a) The Secretary may provide technical assistance to\nsubsection and will not supplant any non-Federal funds which\nappropriate public authorities and nonprofit private entities and scien-\nwould otherwise be available for such purposes; and (iii) the\ntific institutions for their research, training, and public health pro-\nplan is compatible with the total health program of the State;\ngrams for the prevention and control of venereal disease.\n[(E)] (F) provide that the State health authority will from\n(b) (1). The Secretary is authorized to make grants to States, po-\ntime to time, but not less often than annually, review and evaluate\nlitical subdivisions of States, and any other public or nonprofit private\nits State plan approved under this subsection, and submit to the\nentity for projects for the conduct of research, demonstrations, and\nSecretary appropriate modifications thereof;\ntraining which will contribute to national objectives for the preven-\ntion and control of venereal disease.\n[(F)] (G) provide that the State health authority will make\nsuch reports, in such form and containing such information, as\n(2) For the purpose of carrying out this subsection, there is au-\nthorized to be appropriated $5,000,000 for the fiscal year ending\nthe Secretary may from time to time reasonably require, and will\nkeep such records and afford such access thereto as the Secretary\nJune 30, 1976, $5,000,000 for the fiscal year ending June 30, 1977, and\nfinds necessary to assure the correctness and verification of such\n$5,000,000 for ,the fiscal year ending June 30, 1978.\nreports;\n(c) There is authorized to be appropriated, $5,000,000 for the\n[(G)] (H) provide for such fiscal control and fund account-\nfiscal year ending June 30, 1976, $10,000,000 for the fiscal year ending\nJune 30, 1977 and $15,000,000 for the fiscal year ending June 30,\ning procedures as may be necessary to assure the proper disburse-\n1978, to enable the Secretary to make grants to State health author-\nment of and accounting for funds paid to the State under this\nities to assist the States in establishing and maintaining adequate pub-\nsubsection; and\nlic health programs for the diagnosis and treatment of venereal\n[(H)] (J) contain such additional information and assur-\ndisease. For purposes of this subsection, the term \"State\" means each\nances as the Secretary may find necessary to carry out the pur-\nof the several. States of the United States, the District of Columbia,\nposes of this subsection.\nthe Virgin Islands, Guam, American Samoa, the Trust Territory of\nThe Secretary shall approve any State plan and any modification\nthe Pacific Islands, and the Commonwealth of Puerto Rico.\nthereof which meets the requirements of this paragraph.\n(2) Any State desiring to receive a grant under this subsection shall\n(3) (A) Grants under this subsection shall be made from allotments\nsubmit to the Secretary a State plan for a public health program for\nto States made in accordance with this paragraph. For each fiscal year\nthe diagnosis and treatment of venereal disease. Each State plan\nthe Secretary shall, in accordance with regulations, allot the sums\nshall\nappropriated under paragraph (1) for such year among the States on\n(A) provide for the administration or supervision of adminis-\nthe basis of the incidence of venereal disease in, and the population of,\ntration of the State plan by the State health authority;\nthe respective States; except that no State's allotment shall be less\nthan $75,000 for any fiscal year.\n(B) set forth the policies and procedures to be followed in the\nexpenditure of the funds paid to the State under this subsection\n(B) Any amount allotted to a State (other than the Virgin Islands,\nAmerican Samoa, Guam, the Trust Territory of the Pacific Islands,\n(C) provide that the public health services furnished under\nthe State plan will include the provision of Statewide laboratory\nand the Commonwealth of Puerto Rico) under subparagraps (A) for\na fiscal year and remaining unobligated at the end of such year shall\nservices [(including dark field microscope techniques for the diag-\nnosis of both gonorrhea and syphilis) which services will be pro-\nremain available to such State, for the purposes for which made, for\nthe next fiscal year (and for such year only), and any such amount\nvided in accordance with standards prescribed by regulations,\nshall be in addition to the amounts allotted to such State for such\nincluding standards as to the scope and quality of such services;\npurpose for such next fiscal year; except that any such amount, re-\n63\n62\n1976, $33,000,000 for the fiscal year ending June 30, 1977, and $36,-\nmaining unobligated at the end of the sixth month following the end\n000,000 for the fiscal year ending June 30, 1978.\nof such year for which it was allotted, which the Secretary determines\n(e) (1) Grants made under subsection (b) or (d) of this section\nwill remain unobligated by the close of such next fiscal year, may be\nshall be made on such terms and conditions as the Secretary finds\nreallotted by the Secretary, to be available for the purposes for which\nnecessary to carry out the purposes of such subsection, and payments\nmade until the close of such next fiscal year, to other States which\nunder any such grants shall be made in advance or by way of reim-\nhave need therefor, on such basis as the Secretary deems equitable\nbursement and in such installments as the Secretary finds necessary.\nand consistent with the purposes of this subsection, and any amount\n(2) Each recipient of a grant under this section shall keep such\nSO reallotted to a State shall be in addition to the amounts allotted\nrecords as the Secretary shall prescribe including records which fully\nand available to the States for the same period. Any amount allotted\ndisclose the amount and disposition by such recipient of the proceeds of\nunder subparagraph (A) to the Virgin Islands, American Samoa,\nsuch grant, the total cost of the project or undertaking in connection\nGuam, the Trust Territory of the Pacific Islands, or the Common-\nwith which such grant was given or used and the amount of that por-\nwealth of Puerto Rico for a fiscal year and remaining unobligated at\ntion of the cost of the project or undertaking supplied by other sources,\nthe end of such year shall remain available to it for the purposes for\nand such other records as will facilitate an effective audit.\nwhich made, for the next two fiscal years (and for such years only),\n(3) The Secretary and the Comptroller General of the United States,\nand any such amount shall be in addition to the amounts allotted to\nor any of their duly authorized representatives, shall have access for\nit for such purposes for each of such next two fiscal years; except that\nthe purpose of audit and examination to any books, documents, papers,\nany such amount, remaining unobligated at the end of the first of such\nand records of the recipients of grants under this section that are\nnext two years, which the Secretary determines will remain unobli-\npertinent to such grants.\ngated at the close of the second of such next two years, may be re-\n(4) The Secretary, at the request of a recipient of a grant under\nallotted by the Secretary, to be available for the purposes for which\nthis section, may reduce such grant by the fair market value of any\nmade until the close of the second of such next two years, to any other\nsupplies or equipment furnished to such recipient and by the amount\nof such named States which have need therefor, on such basis as the\nof pay, allowances, travel expenses, and any other costs in connection\nSecretary deems equitable and consistent with the purposes of this\nwith the detail of an officer or employee of the United States to the\nsubsection, and any amount so reallotted to any such named State shall\nrecipient when the furnishing of such supplies or equipment or the\nbe in addition to any other amounts allotted and available to it for\ndetail of such an officer or employee is for the convenience of and at\nthe same period.\nthe request of such recipient and for the purpose of carrying out the\n(4) The amount of any grant under this subsection for public\nprogram with respect to which the grant under this section is made.\nhealth programs under an approved State plan shall be determined\nThe amount by which any such grant is so reduced shall bè available\nby the Secretary, except that no grant for any such program may\nfor payment by the Secretary of the costs incurred in furnishing the\nexceed 90 per centum of its cost (as determined under regulations of\nsupplies, equipment, or personal services on which the reduction of such\nthe Secretary). Payments under grants under this subsection shall\ngrant is based; and, in the case of a grant under subsection (c), such\nbe made from time to time in advance on the basis of estimates by the\namount shall be deemed a part of the grant to such recipient and shall,\nSecretary or by way of reimbursement, with necessary adjustments\nfor the purposes of that subsection, be deemed to have been paid to\non account of previous underpayments or overpayments.\nsuch recipient.\n(d) (1) The Secretary is authorized to make project grants to States\n(5) All information obtained in connection with the examination,\nand, in consultation with the State health authority, to political sub-\ncare, or treatment of any individual under any program which is being\ndivisions of States, for-\ncarried out with a grant made under this section shall not, without\n(A) venereal disease surveillance activities, including the re-\nsuch individual's consent, be disclosed except as may be necessary to\nporting, screening, and followup of diagnostic tests for, and\nprovide service to him. Information derived from any such program\ndiagnosed cases of, venereal disease;\nmay be disclosed—\n(B) casefinding and case followup activities respecting venereal\n(A) in summary, statistical, or other form, or\ndisease, including contact tracing of infectious cases of venereal\n(B) for clinical or research purposes,\ndisease and routine testing, including attendant laboratory and\nbut only if the identity of the individuals diagnosed or provided care\nfollowup systems costs thereof;\nor treatment under such program is not disclosed.\n(C) interstate epidemiologic referral and followup activities\n(f) Except as provided in section 317 (d) (4), no funds appro-\nrespecting venereal disease;\npriated under any provision of this Act other than this section may\n(D) targeted professional and public veneral disease education\nbe used to make grants in any fiscal year for programs or projects\nactivities; and\nrespecting venereal disease if (1) grants for such programs or projects\n(E) such special studies or demonstrations to evaluate or test\nare authorized by this section, and (2) all the funds authorized to be\nvenereal disease [control] preventive and control strategies or\nappropriated under this section for that fiscal year have not been\nactivities as may be prescribed by the Secretary.\nappropriated for that fiscal year and obligated in that fiscal year.\n(2) For the purpose of carrying out this subsection, there is author-\nized to be appropriated $31,000,000 for the fiscal year ending June 30,\n64\n65\n(g) Not to exceed 50 per centum of the amounts appropriated for\nany fiscal year under subsections (b), (c), and (d) of this section\n(2) determine health education and promotion needs and re-\nmay be used by the Secretary for grants for such fiscal year under\nsources, and recommend appropriate educational and certifying\nsection 317.\npolicies for health education and promotion manpower;\n(h) Nothing in this section shall be construed to require any State\n(3) incorporate appropriate health education and promotion\nor any political subdivision of a State to have a venereal disease pro-\nstrategies into every facet of our society and increase the appli-\ngram which would require any person, who objects to any treatment\ncation of health knowledge, skills, and practices by the general\nprovided under such a program, to be [treated or to have any child\npopulation in their patterns of daily living;\nor ward of his] treated under such a program.\n(4) increase the effectiveness and efficiency of health education\n(i) As used in this section, the term \"venereal disease\" means syphilis\nand promotion programs through improved planning, implemen-\nand gonorrhea and any other sexually transmitted disease which the\ntation of tested models, and evaluation of results;\nSecretary finds to be of national significance and which, with respect\n(5) establish systematic processes for the exploration, develop-\nto grants under subsection (d), the Secretary finds to be amenable to\nment, demonstration, and evaluation of innovative health educa-\ncontrol.\ntion concepts; and\n(6) foster information exchanges and cooperation among health\nCONSUMER HEALTH EDUCATION AND PROMOTION\neducation providers, consumers, and supporters.\nThe Secretary shall carry out this title in a manner consistent with\nSHORT TITLE\nthe national health priorities set forth in section 1502 of the Public\nSEC. 301. This may be cited as the \"National Consumer Health Edu-\nHealth Service Act and with activities undertaken under title XV\ncation and Promotion Act of 1975\".\nof the Public Health Service Act (relating to health planning and\ndevelopment).\nAMENDMENT TO THE PUBLIC HEALTH SERVICE ACT\nSPECIFIC FUNCTIONS\nSEC. 302. The Public Health Service Act is amended by adding after\nResearch Programs\ntitle XVI the following new title:\nSEC. 1703. (a) (1) The Secretary shall by grante and contracts to\nTITLE XVII-OFFICE OF CONSUMER HEALTH EDUCA-\npublic or nonprofit private entities conduct and support research in\nTION AND PROMOTION AND THE CENTER FOR\nhealth education and promotion. The Secretary shall-\nHEALTH EDUCATION AND PROMOTION\n(A) determine the scope and nature of health education re-\nsearch;\nPART A-OFFICE OF CONSUMER HEALTH EDUCATION AND PROMOTION\n(B) rank research projects in order of priority;\n(C) initiate, stimulate, and fund projects that are determined\nESTABLISHMENT OF OFFICE OF CONSUMER HEALTH EDUCATION AND PROMOTION\nto be necessary;\n(D) provide consultation to persons preparing research pro-\nSEC. 1701. (a) There is established in the D'epartment of Health,\nposals or those who are conducting research;\nEducation, and Welfare the Office of Consumer Health Education and\n(E) determine the best methodologies to disseminate informa-\nPromotion (hereafter in this Act referred to as the 'Office') which\ntion on the value of preventive measures in health care and to\nshall be under the direction of a Director who shall be appointed by\nimplement health education and promotion strategies;\nthe Secretary of Health, Education, and Welfare (hereafter in this\n(F) determine the best methods to increase the awareness of\nAct referred to as the \"Secretary\") and supervised by the Assistant\nhealth providers regarding the cultural sensitivities of popu-\nSecretary for Health (or such other officer of the Department as may\nlation groups which may affect such groups willingness or ability\nbe designated by the Secretary as the principal adviser to him for\nto seek and accept services, including preventive health services;\nhealth programs).\n(G) ascertain the costs and cost-benefit of disseminating such\n(b) To facilitate the development of health education and promo-\ninformation and of implementing health education and promo-\ntion strategy for the Nation, the Office shall carry out the following\ntion strategies;\nfunctions: Engage in research in health education and promotion,\n(H) determine factors in social behavior which impact on\ndevelop community health education programs, stimulate and coordi-\nhealth and determine the interaction of sociological determinants\nnate communications in health education, and overview and coordinate\nwith the field of health education:\nFederal programs.\n(I) review those factors which affect environmental and occu-\nGENERAL AUTHORITY\npational health. ascertain those programs and areas for which\neducational and preventive measures could be implemented to\nSec. 1702. The Secretary, acting through the Office, shall-\nimprove environmental and occupational health, and engage in\n(1) design and implement and national goals and strategies\nresearch and policy formulation in such areas as accidents, nutri-\nwith respect to health education and promotion;\ntion, dental care, occupational health and safety, and environ-\nmental stress; and\n66\n67\n(J) conduct a review of biological-genetic factors which, act-\nHealth Education Training\ning independently or in concert with environmental factors, can\naffect health and ascertain whether education of the public con-\n(c) The Secretary acting through the Director is authorized to make\ncerning these factors, and their detection, can improve health.\ngrants and contracts to public or nonprofit private entities to provide\n(2) The Secretary in carrying out his responsibilities under this\nfor the training for health personnel in health education and\nsection, shall use the findings of the continuing surveys of the needs,\npromotion.\ninterests, attitudes, knowledge, and behavior of the American public\nSchool Health Education Training\nregarding health as conducted by the National Center for Health\nStatistics as a basis for formulating policy with respect to health\n(d) (1) The Secretary acting through the Director may make grants\neducation and promotion.\nto local educational agencies and institutions of higher education for\nteacher training with respect to the provision of comprehensive health\nCommunity Programs\neducation programs in schools. Such grants may be used by such agen-\ncies and institutions to develop and conduct training programs for\n(3) (1) The Secretary shall support and encourage innovative pro-\nelementary and secondary teachers with respect to teaching methods\ngrams in health education and promotion and shall specifically-\nand techniques, information, and current issues relating to health and\n(A) support demonstration programs, including training, in\nhealth problems. For purposes of this Act the term 'health education\nhealth education and promotion, which programs (a) are within\nand health problems' includes dental health, disease control, environ-\nhospitals, ambulatory care settings, and other appropriate set-\nmental health, human eçology, mental health, nutrition, physical\ntings, (ii) focus on goals and objectives that are measurable, and\nhealth, safety and accident prevention, smoking and health, substance\n(iii) emphasize the prevention or moderation of illness or acoi-\nabuse, consumer health, and such others as may be deemed appropriate\ndents that appear controllable through individual behavior;\nby the Director in concurrence with the Commissioner of Education.\n(B) provide consultation to organizations in planning or eval-\n(2) The Director, in exercising authority with respect to (a) deter-\nuating health education and promotion programs;\nmination of criteria for the selection of grants, and (b) selection of\n(C) develop health education and promotion model curricula\ngrants from eligible applicants, shall consult with, and obtain the\nwith appropriate representatives from medical, dental, and nurs-\napproval of, the Commissioner of Education.\ning schools, schools of public health, and other institutions en-\n(3) In establishing criteria for the award of grants under this sec-\ngaged in training health personnel for the purpose of implement-\ntion, such criteria must include priority for applications for support\ning such curricula within these institutions;\nof programs which provide: (1) inservice rather than preservice train-\n(D) establish continuing education programs to disseminate\ning, except in such cases where an applicant has demonstrated that.\nthe most recent research findings in the field; and\n(A) inservice training is not practicable, and (B) reasonable oppor-\n(E) support by grant or contract the development and imple-\ntunity exists for persons undergoing preservice training to obtain\nmentation of a model toll-free telephone system to provide the\npositions in which they shall apply such training, and (2) training of\npublic with health information, information on available health\npersons who, as a result of such training, will have as their major\nservices, crisis information, and directions for obtaining health\nresponsibility, work in health education in schools.\nrelated publications.\n(2) (A) The Secretary is authorized to make grants and contracts\nRequirements Applicable to Providers of Institutional Care\nto public or nonprofit private entities for the purpose of developing\nprograms of health care education for a defined geographic region\n(d) The Secretary may not approve an application of any health\npursuant to and in accordance with those established under section\ncare facility for a grant or contract under the Public Health Service\n1511 of the Public Health Service Act and with activities undertaken\nAct or the Community Mental Health Centers Act for a fiscal year\nunder title XV of the Public Health Service Act (relating to health\nbeginning after the date of enactment of this Act unless the applica-\nplanning and development). In awarding such grants and contracts\ntion contains or is supported by assurances satisfactory to the Secre-\nthe Secretary shall assure an equitable geographic and demographic\ntary that. during the period for which the assistance applied is to be\ndistribution of all funds appropriated.\nmade available, the applicant will provide such consumer health educa-\n(B) Projects which receive Federal funds under this subsection\ntion, for individuals receiving innatient or outpatient services through\nshall-\nsuch health care facility as the Secretary shall by regulation prescribe.\n(1) utilize in a coordinated manner such health education\nmethods as may be appropriate to provide effective health educa-\nCommunications in Health Education and Promotion\ntion services to the population of the applicable region; and\n(2) evaluate the effectiveness of each health education method\n(e) The Secretary shall establish liaison with the Office, providers\nutilized and identify its particular advantages or disadvantages.\nof health education services, and the communications media. The Sec-\nretary shall-\n69\n68\nINTERDEPARTMENTAL COMMITTEE ON CONSUMER HEALTH EDUCATION AND\n(1) inventory the existing health education information data\nPROMOTION\nsystems, encourage further development of such systems, and work\nto coordinate the efforts of all major groups involved in health\nSEC. 1704. (a) There is established in the Office of the Secretary an\neducation formation data systems;\nInterdepartmental Committee on Health Education and Promotion\n(2) make health information available to the public and to\n(hereinafter referred to in this section as the 'Committee') which shall\norganization involved in health education and promotion;\nbe responsible for overview and coordination of all Federal programs\n(3) continually evaluate the effectiveness of existing health\nand activities relating to health education and promotion to assure\ninformation and health education and promotion services to\nthe adequacy and effectiveness of such programs and activities and\nenhance their scope and quality;\nto provide for the communication and exchange of information neces-\n(4) encourage pretesting and expert evaluation of health\nsary to promate these functions:\ninformation materials;\n(b) The Secretary or his designee shall serve as Chairman of the\n(5) bring together the major national health educational or-\nCommittee, the membership of which shall include appropriate repre-\nganizations to share ideas, to identify gaps and overlaps in health\nsentation from the Department of Agriculture, the Environmental\neducation and promotion programs and research, and to find ways\nProtection Agency, the Department of Transportation, the Depart-\nin which the organizations can cooperate to make efforts more\nment of Defense, the Veterans' Administration, the National Science\neffective;\nFoundation, the Federal Communications Commission, the National\n(6) find ways in which the communications media and the Of-\nAcademy of Sciences, the Consumer Product Safety Commission, and\nfice can cooperate to provide effective public service programming\nsuch other Federal agencies and offices (including appropriate agen-\nin health education and promotion;\ncies and offices of the Department of Health, Education, and Welfare,\n(7) seek ways of promoting general public health education and\nincluding the Office of Education and the National Institute for Occu-\npromotion programs and of reducing misleading media advertis-\npational Safety and Health, the Office of Child Development, the\ning and other health-threatening behavior in communications\nNational Institute of Drug Abuse, and the National Institute of Alco-\nprograms designed for children and families; and\nholism and Alcohol Abuse) as the Secretary determines administer\n(8) establish the Office as a source of information and expertise\nprograms directly affecting health education and promotion;\nwhich can be used in planning and creating both commercial and\nless often than four times a year;\nnoncommercial material in health education and promotion.\n(c) The Committee shall meet at the call of the Chairman, but not\nIn the case where materials are developed, through activities funded\n(d) The Committee shall identify Federal programs and actions\nunder this title and/or through activities of the Office and where the\nwhich are not in the interest of public health and determine methods\nmaterials have commercial value, the moneys which result from the\nfor reviewing and commenting on such programs and actions, in-\nlicense, sale, rent, grant or other transaction of said materials shull\ncluding recommendations for legislation and administrative action\nbe paid into the public treasury. The Director with consultation of\nwithin the executive branch; and\nthe Secretary shall determine the fair market value of such materials\n(e) The Secretary shall provide the Committee with such full-time\nand shall have the authority to authorize such transactions.\nprofessional and clerical staff, information, other support, and the\nservices of such consultants as may be necessary to assist it in carrying\nFederal Programs\nout eff fectively its functions under this section.\n(f) The Secretary, in conjunction with the Interdepartmental Com-\nADVISORY COUNCIL\nmittee on Consumer Health Education and Promotion, in accordance\nwith section 1704, shall make recommendations to the Congress for\nSEC. 1705. (a) There is established the Consumer Health Education\nthe inclusion in appropriate legislation of provisions respecting health\nand Promotion Advisory Council (hereafter in this section referred to\neducation and promotion. The Secretary shall-\nas the \"Advisory Council\") which shall consist of nineteen members\n(1) promote the coordination, communication and collabora-\nappointed by the Secretary. The Secretary shall from time to time\ntion of health education and promotion programs within the\nappoint one of the members to serve as Chairman. The members shall\nDepartment of Health, Education, and Welfare;\ninclude persons who have distinguished themselves in the fields of\n(2) establish a liaison with other Federal agencies engaged in\nmedicine (including preventive medicine), dentistry, health education,\nhealth education and promotion, including the Consumer Product\nnursing, the social and behavioral sciences, nutrition, and the provision\nSafety Commission, the Department of Agriculture, the Environ-\nof health services; persons who are representative of the interests of\nmental Protection Agency, the Department of Transportation,\nthe general public (including representatives of business, labor, and\nand the Department of Defense; and\nconsumer groups); and persons from government. Each member shall\n(3) identify and make public those Federal programs and\nhold office for a term of four years, except that the Secretary may stag-\nactions which are not in the interest of public health and deter-\nger the terms of members first appointed to the Advisory Council, and\nmine methods for reviewing and commenting on such programs\nany member appointed to fill a vacancy occurring prior to the expira-\nand actions as identified pursuant to section 1704(d).\n70\n71\ntion of the term for which his predecessor was appointed shall be ap-\nAUTHORIZATION OF APPROPRIATIONS\npointed for the remainder of such term. A member shall not be eligible\nto serve continuously for more than two terms. The Secretary may, at\nSEC. 1707. To carry out this title there are authorized to be appro-\nthe request of the Director, appoint such special advisory professional\npriated $11,000,000 for the fiscal year ending June 30, 1976, $11,000-\nor technical committees as may be useful in carrying out this title.\n000 for the fiscal year ending June 30, 1977, $24,000,000 for the fiscal\nMembers (other than members who are officers or employees of the\nyear ending June 30, 1978.\nUnited States) of the Advisory Council or of such committees, shall\nbe entitled to receive for each day (including traveltime) during which\nPART B-CENTER FOR HEALTH EDUCATION AND PROMOTION\nthey are engaged in the actual performance of duties vested in the\nAdvisory Council or committee compensation at rates fixed by the\nCONGRESSIONAL DECLARATION OF POLICY\nSecretary, but not exceeding $100 per day, and while so serving away\nfrom their homes or regular places of business each member may be\nSEC. 1708. The Congress finds and declared that-\nallowed travel expenses, including per diem in lieu of subsistence, as\n(1) it is in the public interest to inform the public about health\nauthorized by section 5703 of title 5, United States Code, for persons\nand about ways to best protect and improve personal health;\nin the Government service employed intermittently. The Advisory\n(2) the public must develop the ability to examine and weigh\nCouncil shall meet as frequently as the ,Secretary deems necessary.\nconsequences of personal decisions respecting health;\npon request of five or more members, it shall be the duty of the Secre-\n(3) the public must be motivated to desire changes supportive\ntary to call a meeting of the Advisory Council.\nof more healthful lifestyles;\n(3) It shall be the function of the Advisory Council to provide\n(4) impediments that inhibit the vobuntary adoption and main-\nadvice and recommendations for the consideration of the Secretary on\ntenance of more healthful practices by the public must be identi-\nmatters of general policy with respect to the functions of the Office.\nfied and mitigated or removed;\nThe Advisory Council shall make an annual report to the Secretary\n(5) to achieve these goals it is necessary for the Federal Gov-\nand to the Congress on the performonce of its functions, including any\nernment to complement, assist, and support a national policy that\nrecommendations it may have with respect thereto.\nwill advance the national health, reduce preventable illness, dis-\n(c) The Advisory Council is authorized to engage such technical\nability, and death, moderate self-imposed risks, and promote\nassistance as may be required to carry out its functions, and the Secre-\nprogress and scholarship in consumer health education and pro-\ntary shall, in addition, make available to the advisory council such\nmotion, and\nsecretarial, clerical, and other assistance and such pertinent data ob-\n(6) a private corporation should be created to facilitate the\ntained and prepared by the Department of Health, Education, and\ndevelopment of a health education and promotion strategy for\nWelfarè, as the advisory council may require to carry out its functions.\nthe Nation.\nREPORTS\nCREATION OF CORPORATION\nSEC. 1706. (a) The Secretary shall make an annual report (not later\nBOARD OF DIRECTORS\nthan December 1 of each year except in the year this title is enacted\ninto law) to the Congress on the activities and policy recommendations\nSEC. 1709. The Center shall have a Board of Directors (hereinafter\nof the Office.\nin this tițle referred to as the 'Board') consisting of twenty-five mem-\n(b) The Secretary, acting through the Office, shall assemble and\nbers appointed by the President, by and with the advice and consent of\nsubmit to the President and the Congress not later than December 1\nthe Senate.\nof each year-\n(3) The members of the Board (1) shall be selected from among\n(1). a report of the activities, findings, and recommendations of\ncitizens of the United States (not regular full-time employees of the\nthe Office, and\nUnited States) who are eminent in such fields as, and represent, health\n(2) recommendations, based on the findings and recommenda-\neducation, health care services delivery, nursing, nutrition, general\ntions of the Office, and the Interdepartmental Committee on Con-\neducation, consumer representation and advocacy, communications,\nsumer Health Education and Promotion for legislation and ad-\nlabor and business, planning and organizational management, and pub-\nministrative action within the executive branch.\nlic and private finance, and (2) shall be selected so as to provide as\n(c) The Office of Management and Budget may review any report,\nnearly as practicable a broad representation of various regions of the\nrecommendations or submission made by the Secretary, the commit-\ncountry and of various kinds of skills and experiences appropriate to\ntee, or the Advisory Council in regard to this Act before its submission\nthe functions and responsibilities of the Center. They shall serve as\nto the Congress, but the Office of Management and Budget may not\nincorporators and shall take whatever actions are necessary to create\nrevise the report or delay its submission, and it may submit to the Con-\na nonprofit corporation to be known as the Center for Health Educa-\ngress its comments (and those of other departments or agencies of the\ntion and Promotion (hereafter in this title referred to as the 'Center')\nGovernment) respecting such submission.\nunder the District of Columbia Nonprofit Corporation Act within\nsixty days from the effective date of this title. The Center and its\n72\n73\narticles of incorporation, bylaws, and all other rules and regulations\nshall incorporate by reference and be subject to this title.\nFUNCTIONS\nSEC. 1710. (a) The members of the Committee shall serve as the\nmembers of the first Board.\nSec. 1713. (a) to facilitate the development of a health education\n(b) The term of office of each member of the Board shall be four\nand promotion strategy for the Nation the Center shall carry out\nyears; except that (1) any member appointed to fill a vacancy occur-\nthe following functions:\nring prior to the expiration of the term for which his predecessor was\n(1) The Center shall establish communications with, provide\nappointed shall be appointed for the remainder of such term; (2) the\na forum for the involvement of, and seek the advice and support\nterms of office of members first taking office shall begin on the date of\nof, organizations, agencies, and groups involved in health care,\nincorporation and shall expire, as designated at the time of their ap-\neducation, labor and business, social and civic organizations, con-\npointment, nine at the end of one year, eight at the end of two years,\nsumer organizations, and communications. The Center shall re-\nand eight at the end of four years; and (3) a member whose term has\nview and analyze the need, and resources available, for health\nexpired may serve until his successor has qualified. No member shall\neducation and promotion and the effectiveness of alternative health\nbe eligible to serve in excess of two consecutive terms of four years each.\neducation methods and procedures on health status to determine\n(c) Any vacancy in the Board shall not affect its power, but shall be\nwhich methods and procedures offer the best opportunities for\nfilled in the manner in which the original appointments were made.\nimproving the Nation's health. Specifically, the Center shall-\n(d) The members of the Board shall elect one of their members as\n(4) provide a private focal point for the coordination of\nChairman; thereafter the members of the Board shall annually elect\na structured national exchange on health education issues and\none of their number as Chairman. The members of the Board shall also\nproblems involving all of the various concerned disciplines and\nelect one or more of them as a Vice Chairman or Vice Chairmen.\ninterests;\n(e) The members of the Board shall not, by reason of such member-\n(B) identify and express the superordinate health educa-\nship, be deemed to be employees of the United States. They shall, while\ntion polices and guides to which many different organizations,\nattending meetings of the Board or while engaged in duties related to\nagencies, and groups can subscribe and incorporate volun-\nsuch meetings or in other activities of the Board, be entitled to receive\ntarily into their own health education forts;\ncompensation at the rate of $100 per day including traveltime, and\n(C) stimulate, sponsor, coordinate, and support the devel-\nwhile away from their homes or regular places of business they may be\nopment of new health education initiatives and programs in\nallowed travel expenses, including per diem in lieu of subsistence, equal\nwhich many organizations and agencies can participate;\nto that authorized by law (5 U.S.C. 5703) for persons in the Govern-\n(D) develop national policy recommendations which are\nment service employed intermittently.\nsupportive of long-range preventive approaches to national\nhealth improvement; and\nOFFICERS AND EMPLOYEES\n(E) provide a forum for nongovernmental organizations to\nparticipate in comprehensive national planning, action, and\nSEC. 1711. (a) The Center shall have a President, and such other\nevaluation of health education efforts.\nofficers as may be named and appointed by the Board for terms and at\n(2) The Center. shall coordinate and stimulate a variety of\nrates of compensation fixed by the Board. No individual other than a\nprojects involving other organizations, agencies, and groups to\ncitizen of the United States may be an officer of the Center. No officer of\ndevelop such strategy designs or design components as are re-\nthe Centèr, other than the Chairman and any Vice Chairman, may re-\nquired to increase the appropriateness, acceptability, and effective-\nceive any salary or other compensation from any source other than the\nness of health education efforts nationwide. In the performance of\nCenter during the period of his employment by the Center. All officers\nthis function, the Center shall-\nshall serve at the pleasure of the Board.\n(4) in order to indicate directions for improving the\nNation's health, develop a perspective and definition of the\nNONPROFIT AND NONPOLITICAL NATURE OF THE CENTER\nrole of health education, its placement in the health and\neducation systems, and its relationships to prevention and\nSEC. 1712. (a) The Center shall have no power to issue any shares\ngeneral health maintenance practices;\nof stock or to declare or pay any dividends.\n(B) review, analyze, and summarize unmet consumer\n(b) No part of the income or assets of the Center shall inure to the\nhealth education needs and identify the critical gaps or de-\nbenefit of any director, officer, employee, or any other individual except\nficiencies in personal preventive practices, in the use of health\nas salary or reasonable compensation for services.\nand related social services, and in programs to improve so-\n(c) The Center may not contribute to or otherwise support any\ncial and environmental conditions and other conditions\npolitical party or candidate for elective public office.\naffecting health care and education:\n(σ) review, analyze, and assess the state of health educa-\ntion and promotion theory and practices in relation to identi-\n74\n75\nfied consumer needs andvidentify the possibilities for the\ndevelopment of new or improved technologies and practices;\ndeficiencies generally ourrent in health education practices\n(D) identify the types and availability of the resources\nand develop programs or projects for the correction of such\nrequired to mèet consumer needs; and\ndeficiencies.\n(E) develop action plans for the development or increased\n(5) The Center shall encourage the development and utilization\nallocation of resources required to produce significant re-\nof valid and acceptable research and evaluation methods for a\nsults in meeting consumer health education needs.\nwide variety of health education programs and technologies. It\n(3) The Center shall assist in stimulating, developing, im-\nshall develop coalitions and consortium arrangements with other\nplementing, and assessing a total communications program\norganizations and agenoies for cooperative efforts in model design\nutilizing. a full range of media available to reach diversified\nand testing and for joint sponsorship and exchange of informa-\ngroups in order to increase national understanding and support\ntion on comparable research and evaluation projects. In the per-\nfor the value of health education and the role each citizen and\nformance of this function, the Center shall-\nevery organization, institution, and agency can and should play\n(A) stimulate and support the development of valid tech-\nto improve individual, community, and, ultimately, the national\nniques and strategies to measure the appropriateness, accept-\nhealth through educational means. In performance of this func-\nability, and effectiveness of the process and outcomes of ex-\ntion, the Center shall\nperimental and demonstration health education projects;\n(A) be an active participant in the efforts of organized\n(B) establish mechanisms for continuing communication\nelements at all levels in the health and educational systems\nconcerning program test experience, modifications, and eval-\nand work with all interested organizations, agencies, and\nuation;\ngroups to assist in the development of more concerted, co-\n(C) analyze, summarize, and disseminate information re-\noperative approaches to meeting consumer needs;\ngarding experiences of diversified applications of recom-\n(B) publicize the latest information on technological\nmended models, components, and evaluation approaches; and\ndevelopments in health education and on effective health\n(D) selectively field test measures, instruments, techniques,\neducation practices;\nand model components as required for Center strategy design\nactivities.\n(C) develop opportunities which will enable consumer's\nand citizen's groups to become effective advocates for health\n(6) Included in the activities of the Center authorized for ac-\neducation in their communities: and\ncomplishment of the purposes set forth in this section are among\n(D) publicize and work with other public or private or-\nothers not specifically named-\nganizations, agencies (including the Office), and groups to\n(A) to obtain grants from and to make contracts with indi-\nsecure widespread endorsement and implementation of the\nviduals and with private, State, and Federal agencies, orga-\nnizations and institutions.\nCenter's policies and recommendations.\n(4) The Center shall assist in accelerating the incorporation\n(b) The Center in carrying out its functions under this section may\nof improved technology into health education practice by estab-\nprescribe such regulations as it deems necessary.\nlishing a system of technical assistance and training and by mak-\nADVISORY PANEL\ning available the expertise of other cooperating organizations,\nas well as its own staff, in response to the needs of National,\nSEC. 1714. The board shall appoint an advisory panel comprised\nState, and local groups for assistance in improving the planning,\nof one hundred individuals appropriate competencies and abili-\nimplementation, and evaluation. of their health education pro-\nties. The principal function of the advisory panel shall be to provide\ngrams. In the performance of this function, the Center shall-\nadvice for members of the Board. Additionally, it shall serve as a\n(A) identify individuals with specialized skills, knowledge,\nprimary source for appointments to special committees, task forces,\nand experience for involvement in the Center's policy and\nand conferences. The advisory panel shall receive all Center reports.\nstrategy functions, for work on specialized cooperative proj-\nects, and for response to external requests for assistance;\nREPORT TO CONGRESS\n(B) develop a cadre of consultants and trainers and estab-\nlish mechanisms for their use by organizations, agencies, and\nSEC. 1715. The Center shall submit an annual report to the President\ngroups requesting the Center's assistance;\nfor transmittal to the Congress. The report shall include a comprehen-\n(C) stimulate and assist in the development and provide\nsive and detailed report of the Center's operations; activities, financial\npractical and tested models, intsruments and procedures for\ncondition, and acéomplishments under this title and may include such\nhealth education program planning and assessment, for train-\nrecommendations as the Center deems appropriate.\ning of health education providers, and for consumer and com-\nmunity involvement in the planning, implementation, and\nFINANCING\nevaluation of health education strategies and programs; and\n(D) identify information, training, research, and planning\nSec. 1716. (α) There are authorized to be appropriated to the Center\nfor the purposes of carrying out the functions enumerated in section\n77\n76\nTECHNICAL AMENDMENTS\n1716 of this Act $1,000,000 for fiscal year ending June 30, 1976;\n$1,000,000 for the fiscal year ending June 30, 1977; $1,000,000 for the\nSEC. 303. (a) Subsection (c) of section 306 of the Public Health\nfiscal year ending June 30, 1978.\nServices Act is redesignated subsection (c) (2), and a new subsection\n(b) In addition to the sums authorized to be appropriated by\n(c) (1) is inserted immediately preceding subsection (c) (2), to read\nparagraph (a) of this subsection, the Center is authorized to receive\nas follows:\nincome, grants, donations, bequests, or other contributions from non-\n(c) (1) The Center shall make a continuing survey of the needs, in-\nFederal sources.\nterests, attitudes, knowledge, and behavior of the American public re-\nRECORDS AND AUDIT\ngarding health. The Center shall transmit the findings of such surveys\nand of the findings of similar surveys contracted for or otherwise ob-\nSEC. 1714. The board shall appoint an advisory panel comprised\ntained by the Center and conducted by national health education orga-\nin accordance with generally accepted auditing standards by inde-\nnizations and community health education organizations accompanied\npendent licensed public accountants certified or licensed by a regu-\nby appropriate Center analysis, if any, to the Secretary, the Assistant\nlatory authority of a State or other political subdivision of the United\nSecretary for Health, and to the Office of Consumer Health Education\nStates. The audits shall be conducted at the place or places where the\nand Promotion for their use in formulating policies respecting health\naccounts of the Cenater are normally kept.\neducation and promotion.\n(b) The report of each such independent audit shall be included in\n(b) Subsection (i) of section 308 of the Public Health Service Act is\nthe annual report required by section 208. The audit report shall set\namended by adding the following new paragraph (3) after paragraph\nforth the scope of the audit and include such statements as are neces-\n(2) :\nsary to present fairly the Center's assets and liabilities, surplus or\n(3) Of those sums appropriated by Congress under section 308 of\ndeficit, with an analysis of the changes therein during the year, supple-\nthe Act not less than $1,000,000 for the fiscal year ending June 30,\nmented in reasonable detail by a statement of the Center's income and\n1976, $1,000,000 for the fiscal year ending June 30, 1977, and $1,000,000\nexpenses during the year, and a statement of the sources and appli-\nfor the fiscal year ending June 30, 1978, shall be made available to\ncation of funds, together with the independent auditor's opinion of\ncarry out the activities of section 306 (1).\nthose statements.\nGRANTS FOR WATER TREATMENT PROGRAMS\nSEC. 1718. (a) There are hereby authorized to be appropriated\n$2,000,000 for the fiscal year ending June 30. 1976; $3,000,000 for the\nfiscal year ending June 30, 1977, and $4,000,000 for the fiscal year\nending June 30, 1978; which shall be used by the Secretary to make\ngrants, only in such instances where the applicant voluntarily requests\nsuch assistance, to States, political subdivisions of States, and other\npublic or nonprofit private engencies, organization, and institutions\nto assist them in initiating, in communities, or in public elementary or\nsecondary schools, water treatment programs designed to reduce\nthe incidence of oral disease or dental defects among residents of such\ncommunities or the students in such schools (as the case may be).\n(b) Grants under this section may be utilized for (but are not\nlimited to) the purchase and installation of water treatment\nequipment.\n(c) Grants under this section shall not exceed 80 per centum of the\ncost of the treatment program with respect to which such grant under\nthis section is made.\nDEFINITIONS\nSEC. 1719. For purposes of this Act-\n(A) \"Health education and promotion\" is a process that\nfavorably influences understanding. attitudes, and conduct. in-\ncluding cultural awareness and sensitivity, in regard to individual\nand community health. Specifically, it affects and influences indi-\nvidual and community health behavior and attitudes in order to\nmoderate self-imposed risks, maintain and promote physical and\nmental health and efficiency, and reduce preventable illness, dis-\nability and death.\nCalendar No. 606\n94TH CONGRESS\nSENATE\nREPORT\n2d Session\n94-634\nLEAD-BASED PAINT POISONING PREVENTION\nAMENDMENTS OF 1976\nFEBRUARY 17, 1976.-Ordered to be printed\nMr. KENNEDY, from the Committee on Labor and Public Welfare,\nsubmitted the following\nREPORT\n[To accompany S. 1664]\nThe Committee on Labor and Public Welfare, to which was referred\nthe bill (S. 1664) to amend the Lead-Based Paint Poisoning Preven-\ntion Act having considered the same, reports favorably thereon with\nan amendment and recommends that the bill as amended do pass.\nI. PURPOSE\nThe purpose of the Committee reported bill, S. 1664, is to extend\nthe provisions of the Lead-Based Paint Poisoning Prevention Act,\nP.L. 91-695, and to improve the procedures to achieve that goal.\nThe provisions of the committee reported bill do not revise the\nprincipal purpose of existing legislation.\nThe Lead Based Paint Poisoning Prevention Act, Public Law 91-\n695, was enacted into law January 13, 1971, and seeks to eliminate\nchildhood lead based paint poisoning by screening and testing children\nfor high blood lead levels. The law also authorizes the Department of\nHealth, Education, and Welfare to conduct programs to eliminate the\nhazards of lead based paint poisoning. Under the provisions of the\nLead Based Paint Poisoning Prevention Act, the Secretary of the\nDepartment of Health, Education, and Welfare is authorized to make\ngrants to units of local and State government for community based\ntesting, screening, and hazard elimination programs.\nIn addition, the Secretary of the Department of Housing and Urban\nDevelopment (in consultation with the Secretary of the Department\nof Health, Education, and Welfare) is authorized to conduct research\nto determine the most effective means for removing the hazards of\nlead poisoning in those residences that present a high risk to the health\nof young children. Under the Appropriations Act of August 10, 1971,\n57-010\n2\n3\nfor the Departments of Labor and Health, Education, and Welfare\n5. Doctor Ellen Silbergeld, a Joseph P. Kennedy Fellow in\nand related agencies, $7.5 million were appropriated to carry out the\nprovisions of Titles I and II of the Lead Based Paint Poisoning Pre-\nNeurosciences, Department of Environmental Medicine, The\nJohns Hopkins University.\nvention Act for FY 1972; and for these same titles $7.5 million were\n6. Dr. Laurence Finberg, Montefiore Hospital and Medical Cen-\nappropriated for FY 1973, under a continuing resolution.\nter, Bronx, New York, American Academy of Pediatrics.\nThe appropriations act for the Departments of Labor, Health, Edu-\n7. Doctor Nahman Greenberg, Medical Director, Childhood\ncation, and Welfare and related agencies dated December 18, 1973\nallocated $9 million for these titles for FY 1974, the same amount was\nHealth. Lead Poisoning Control Program, City of Chicago Board of\nallocated for FY 1975, and $3.5 million is the budget request for FY\n1976. However, because no authorization was approved for FY 1976,\n8. Mr. Mark Silbergeld, Counsel Consumers' Union, Washing-\nton, D.C.\nfunding remained at the level approved for the previous fiscal year.\n9. Robert A. Roland, Executive Vice President, National Paint\nThe Administration requested appropriations of $8.5 million under\nthe authority of Section 314(e) of the Public Health Service Act for\nand Coatings Association, accompanied by John M. Montgomery,\nGeneral Counsel, and Rayla A. Brown, Technical Director.\nfiscal year 1973. The Congress appropriated $12 million for program\noperations during 1973 as authorized by Titles I and II of P.L. 91-695.\nPanel consisting of\nHowever, as a result of the presidential veto of HEW appropriations\n10. Robert Klein, Director, Massachusetts Childhood Lead\nfor fiscal year 1973, Lead Poisoning programs were continued at the\nPoisoning Prevention Program;\n1972 level.\n11. Ronald R. Jones, Director, Massachusetts Lead Poisoning\nAppropriations have never been provided for the research authority\nPrevention Program;\nspecified under Title III of the Act, which provides an authorization\n12. Mrs. Grace Dalton;\nof $3 million per year. However, the Secretary of the Department of\n13. Mrs. Carolyn Gibbs, Director, Childhood Lead Poisoning\nHousing and Urban Development conducted research as directed by\nPrevention Program, Lynn, Massachusetts.\nTitle III during fiscal years 1971, 1972, and 1973, utilizing general re-\nsearch authorities of the Department.\nIII. SUMMARY OF S. 1664\nII. COMMITTEE CONSIDERATION\nThe provisions of S. 1664 are essentially designed to:\n1. Provide assistance for protecting against the lead based paint\nS. 1664 was introduced on May 6, 1975 by Senator Kennedy for him-\npoisoning hazard in homes where cases of childhood lead based\nself, Mr. Bayh, Mr. Brooke, Mr. Case, Mr. Clark, Mr. Philip A. Hart,\npaint poisoning have been actually identified.\nMr. Haskell, Mr. Humphrey, Mr. Inouye, Mr. Jackson, Mr. Javits,\n2. Authorize the Dept. of Health, Education & Welfare to safe-\nMr. McGee, Mr. McGovern, Mr. Magnuson, Mr. Pell, Mr. Percy, Mr.\nguard against the application of lead based paints to any cooking,\nRandolph, Mr. Ribicoff, Mr. Schweiker Mr. Hugh Scott, Mr. Staf-\ndrinking or eating utensil.\nford, Mr. Stevenson, Mr. Cranston and Mr. Williams.\n3. Authorize the Dept of Housing and Urban Development to\nThe Senate Subcommittee on Health received testimony on the pro-\nrestrict the application of lead based paint in residential struc-\nvisions of S. 1664 in a hearing on June 16, 1975.\ntures constructed or rehabilitated by the federal government, or\nWitnesses appearing before the Health Subcommittee on S. 1664\nwith federal assistance.\nincluded:\n4. Authorize the Consumer Product Safety Commission to pro-\n1. David J. Sencer, M.D., Director, Center for Disease Control\nPublic Health Service, Department of Health, Education, and\narticle. hibit the application of lead based paints to any toy or furniture\nWelfare, accompanied by Vernon N. Houk, M.D., Director, En-\n5. Limit the amount of lead contained in residential interior\nvironmental Health Services Division, Bureau of State Services,\npaints to no more than .06 percent, unless a majority of the mem-\nCenter for Disease Control.\nbers of the Consumer Product Safety Commission agrees to an-\n2. Claude Barfield, Deputy Assistant Secretary, Office of Re-\nother level, not to exceed one half of one percent lead by weight.\nsearch and Demonstration, Division of Policy Development and\nThis provision stipulates that such recommendation must be made\nResearch, Department of Housing and Urban Development, ac-\nwithin six months after the date of enactment of the bill.\ncompanied by Donald G. Glascoff, Jr., Associate Deputy General\nThese provisions are designed to seek needed support for those\nCounsel; David Engel, Program Manager of the Department's\nprograms that local authorities insist must be adequately reinforced\nLead-Based Paint Research Project.\nif the hazards of lead based paint poisoning are to be reduced.\n3. Barbara Hackman Franklin, Commissioner, U.S. Consumer\nProduct Safety Commission, accompanied by Constance B.\nIV. AUTHORIZATIONS\nNewman, Commissioner, Consumer Product Safety Commission.\n4. Doctor Herbert Needleman, Childrens' Hospital Center,\nAs introduced on May 6, 1975, the bill amending the Lead Based\nBoston, Massachusetts.\nPaint Poisoning Prevention Act authorized appropriations that sub-\nstantially exceeded the level of appropriations authorized under pre-\n4\n5\nvious legislation in order to provide funding authorizations necessary\nto begin addressing the increase demand for aid to communities that\nFirst, the Act is intended to spearhead the campaign for the elimi-\nare seeking adequate help in the battle against the continuing hazards\nnation of the hazards caused by existing lead based paint on the sur-\nof childhood lead poisoning. However, the Committee reported bill\nfaces of residential structures housing those young children who are\nsets forth revisions to the authorizations provided in the original bill\nexposed to environmental health hazards. The Act also is intended to\nin an effort to realistically accommodate the restraints that such health\nprovide resources to support programs that will search out those\nprograms have met in attempting to improve their funding. The total\nyoungsters already sickened by lead poisoning SO that they may receive\nannual authorization approved in the bill reported by the committee\nappropriate medical attention.\namounts to $91.5 million for three years beginning with fiscal year\nSince 1971 when the Lead Based Paint Poisoning Prevention Act\n1976: $37.5 million for Title I-testing and screening programs ad-\nwas enacted it has been clear to the Committee that we do not need\nministered by the Department of Health, Education, and Welfare;\nextensive research to determine how to protect America's young chil-\n$45 million for Title II-hazard elimination programs administered\ndren from lead based paint poisoning. We have the technology to\nby the Department of Housing and Urban Development; and $9 mil-\neliminate this pollutant and we know how to halt the damaging effects\nlion for Title III-research and demonstration programs administered\nof the disease.\nby both The Departments of Health, Education, and Welfare and\nLimiting the content of lead in paint has been the subject of con-\nHousing, and Urban Development.\ntinuing debate by many in the health field. The Committee seeks to\nestablish the minimum feasible paint lead level content that will both\nV. COMMITTEE AMENDMENTS\nsafeguard the health of children and meet technological manufactur-\ning standards.\nThe committee reported bill includes two significant revisions to the\nWitnesses testified before the committee that a majority of those\nbill originally introduced on May 6, 1975.\npaints currently produced for use in residences contain safe lead levels.\nFirst, the committee bill amends the original bill to establish the\nAccording to the testimony latex paints contain no more than 0.06%\nlead content in paint at no more than 0.06% after six months from the\nlead. Today's latex paints are used on most interior residential surfaces\ndate of enactment of this bill unless a majority of the members of the\nand are reported to account for at least 75% of all paints used in\nConsumer Product Safety Commission recommends another level of\nAmerica's homes. The testimony of consumer advocates and medical\nlead in paint, that does not exceed 0.5% lead in paints intended for\nexperts support a lead content that includes no more than 0.06% lead\nuse on interior residential surfaces.\nin paint. It is the committee's intention to require that limit for all\nSecond, the committee bill revised the authorized funding levels to\ninterior residential paints. Thus, the Consumer Product Safety Com-\nprovide:\nmission has been directed to obtain available evidence for establishing\nFor screening programs under Title I: $10 million in fiscal year\na safe lead level that might range between 0.06% and 0.5% lead in\n1976; $12.5 million in fiscal year 1977; and $15 million in fiscal\npaint. Because the committee intends for an acceptable lead level to be\nyear year 1978.\nestablished as efficiently as possible, the committee bill mandates the\nFor hazard elimination programs under Title II $5 million in\n0.06% lead limit if a majority of the Consumer Product Safety Com-\nfiscal year 1976; $15 million in fiscal year 1977; $25 million in\nmission members have not recommended a different lead limit not to\nfiscal year 1978.\nexceed 0.5% lead content, within six months of the date of enactment\nFor research programs: $3 million during each of the fiscal\nof this legislation.\nyears from fiscal year 1976 through 1978.\nAt the same time, the executive departments charged with the re-\nThe committee bill also specifies the jurisdiction for each of the\nsponsibility for administering the lead poisoning programs must also\nappropriate federal agencies that are involved in helping to guard\ncontinue to implement the provisions of the law. The committee there-\nagainst the hazards caused by lead based paint poisoning. Accord-\nfore detailed the specific lines of concern and jurisdiction for the rele-\ningly, the Department of Health, Education, and Welfare is charged\nvant agencies of the Federal government. Hopefully, by timely\nwith the responsibility to guard against the use of lead based paints\nestablishment of safe lead levels and with vigorous implementation\non any cooking, eating or drinking utensil. The Department of Hous-\nof provisions for cleaning up the lead poisoning hazard in the homes\ning and Urban Development is responsible for safeguards that will\nof sick children, there will be fewer and fewer lead poisoning victims.\nprohibit the use of lead based paints on the surfaces of any residences\nThe committee was deeply impressed by those witnesses who insist\nthat are constructed or rehabilitated with federal assistance. And the\nthat the effort to search out lead sick victims must continue in concert\nConsumer Product Safety Commission is responsible for safeguards\nwith programs that are designed to remove the lead poisoning hazard\nthat can prohibit the use of lead based paints on any toy or item of\nfrom exposure to young children who have been lead sickened.\nfurniture.\nVI. COMMITTEE VIEWS\nRevised Lead Content Requirements\nThe allowable amounts of lead in paint have been reviewed since\nThroughout the life of the programs authorized by this legislation,\n1973 when amendments to the Lead Based Paint Poisoning Prevention\nit has been the committee's intention that two fundamental purposes\nAct established levels of lead content for residential interior paints\nbe advanced by the Lead Based Paint Poisoning Prevention Act:\nunder the existing statute. Under the present law such paints are re-\n6.\n7\nquired to contain no more than .5% lead, prior to December 31, 1974;\nconcludes that there is no need for a .06 percent standard because no\nand after December 31, 1974, such paints would be required to contain\nunreasonable hazard is shown at the current (0.5 percent level).\nno more than .06% lead, unless, the Chairman of the Consumer Prod-\nEssentially the controversy about .5% versus .06% centers on two\nuct Safety Commission (hereinafter referred to as CPSC) recom-\nfundamentals; first, there is the technological issue of whether the\nmended to the Congress \"that another level of lead, not to exceed five\nlower limit can be actually attained using current manufacturing pro-\ntenths of 1 per centum, is safe.\" And, if SO recommended, the other\ncedures. And second, there is the medical demand to maximize the\nlevel would then become effective.\nsafety of young children by minimizing those health hazards to which\nThe CPSC Chairman, Richard O. Simpson, submitted recommenda-\nyoung children may be exposed. The subcommittee had received testi-\ntions to the Congress on December 23, 1974, in which he called for a\nmony in 1972 that \"lead free\" paints can be and are being produced.\ncontinuation of the existing requirement that lead levels for interior\nOfficials from the DHEW testified in 1975 that approximately 70%\nresidential paints remain at .5%. Immediate criticism of the Chair-\nof all interior residential paints currently produced in this country\nman's report was received by the Health Subcommittee from the med-\ncontain no more than 0.06% lead. And medical authorities insist that\nical community, from consumer groups and from authorities in the\nthe maximum possible safe limit ought to be provided if we are seri-\nChicago, Illinois Department of Health, where the lower lead level of\nously committed to the demand to guard against the lead poisoning\n.06% had already been enacted under a city ordinance.\nhazard.\nCriticism of Chairman Simpson's decision centered on the research\nSince the Congress intended to involve all the members of the CPSC\nand methodology used in the experiments, conducted by the New York\nin the determination of what constitutes a safe level of lead in paint\nUniversity Medical Center Department of Environmental Medicine\nunder provisions of the 1973 amendments to P.L. 91-695, and since it is\nand the Southwest Foundation for Research and Education. Experts\nclear that only the Chairman was involved in issuing a recommenda-\ntestified in hearings before the subcommittee that the conclusions of\ntion to the Congress, the Committee reported bill adopted an amend-\nthe CPSC Chairman may not be validly applied to the effects of lead\nment requiring the CPSC to submit a recommendation to the Congress\nin small children.\nbased upon a majority vote of all members of the Commission, within\nAs Dr. Lawrence Feinberg, who represented the American Academy\nsix months of the date of enactment of the 1975 amendments. To de-\nof Pediatrics, indicated in his testimony, \"\na\nsignificant\nnumber\nof\nvelop its evaluation, the Commission is authorized to obtain public\nchildren would ingest a good deal more in the way of paint chips or\ntestimony, and available scientific evidence including recommendations\npainted plaster than they assumed for the purpose of the experiment.\nfrom the Center for Disease Control, the American Academy of Pedi-\nMoreover, many children would ingest at an irregular rate, rather\natrics and the National Academy of Sciences. In the absence of a rec-\nthan at a slow steady rate, with large, transintestinal gradients and\nommendation from the Commission within six months from the date\nsudden influxes of lead. Moreover the animals used in the experiments\nof enactment of the amendment, the lower level, 0.06%, will become\nwere fed an iron-rich diet which increases their tolerance of lead\neffective.\nwhereas the characteristic lead poisoned child has a deficient diet to\nProhibitions Against the Use of Lead Based Paint\nbegin with and thereby has an even lower resistance to lead.\"\nThe 1973 amendments to the Lead Based Paint Poisoning Preven-\nOther objections to the studies were concerned with the age of the\ntion Act prohibited the application of lead paints to toys, furniture,\nanimals used for the experiments. Dr. Feinberg's testimony indicated\nutensils used for eating, cooking, and drinking, and to the interior\nthat \"the age in the animals of the studies would not necessarily be\nsurfaces of federally controlled residential structures. The committee\ncomparable for lead absorption as it relates to children. There are some\nfavorably considered an amendment to assign authority for providing\ngood data showing that absorption of lead from the intestine varies\nsafeguards against the use of lead paint to specific federal agencies\nwith age. The younger the animal, the higher the percent absorption.\"\nand the bill reported by the committee-\nThis information is crucial since the threat of lead paint poisoning is\n1. Authorized the Department of Health, Education, and Wel-\nmore prevalent among children under the age of five where the condi-\nfare to develop procedures that will prohibit the application\ntion known as pica is more prevalent. Critics contended that the age\nof lead based paint to any utensil used for cooking, eating or\nfactor was not adequately considered during the review of the effects\ndrinking;\nof lead on young children in the studies upon which the CPSC Chair-\n2. Authorized the Department of Housing and Urban Develop-\nman based his recommendations.\nment to control the application of lead paints to residential struc-\nMr. Robert R. Roland, Executive Vice President, of the National\ntures receiving federal assistance for any purpose including\nPaint and Coatings Association, in his testimony before the subcom-\nassistance for construction and rehabilitation; and\nmittee, supported the evaluation of CPSC Chairman Richard Simpson.\n3. Authorized the Consumer Product Safety Commission to take\nMr. Roland said, \"I do not think there is a risk, and I do not think\nthe steps necessary to prohibit the application of lead based paints\nthat empirical data, outside human data, epidemiological data, has\non any toy or an article of furniture.\nshown that the half percent presents a risk.\" He added, \"\nThis\nThese agencies had already assumed the responsibilities described\nevaluation by the Chairman and the staff of the government agency\nand the purpose of this provision is to clarify their respective\nwhose prime purpose is to make determinations of product safety,\njurisdictions.\n8\n9\nGrants For Hazard Elimination Programs\nscreening and follow-up hazard elimination programs are conducted\nThe Lead Based Paint Poisoning Prevention Act authorized the\nby those local authorities receiving funds for that purpose.\nDepartment of Health, Education, and Welfare to conduct programs\nSection (d) amends Section 401 of such Act by authorizing the\nin local communities that would eliminate the lead poisoning hazard\nfollowing agencies to provide safeguards against the use of lead based\nin those homes where the risk of lead poisoning is greatest. Upon\npaint as follows:\nenactment of the law, the Department of Health, Education, and\nThe Secretary of Health, Education, and Welfare shall take steps.\nWelfare sought to establish programs that would identify those\nnecessary to prohibit the application of lead based paint to any utensil\nyoungsters suffiering from the effects of this disease. Since enactment\nused for eating, cooking or drinking; the Secretary of Housing and\nof the law in 1971, local health officials have realized that the treat-\nUrban Development shall take appropriate steps to prohibit the use\nment of lead sick children cannot be effective without eliminating the\nof lead based paints in any residential structure receiving federal\nlead hazard from the homes in which the affected children reside.\nassistance for any purpose including construction or rehabilitation;\nAuthorities from Boston City Hospital testified that lead sick child-\nand the Consumer Product Safety Commission shall take appropriate\nren received direct medical attention in their treatment facility. Dur-\nsteps to prohibit the application of lead based paint to any toy or to\ning hospitalization, Boston City Hospital employees are assigned to\nany article of furniture.\nremove the lead paint hazard from the walls of the child's home. Once\nSection (e) amends Section 501 (3) of such Act by establishing\nthey are returned home, those children receive continued protection\nallowable limits of lead contained in paints intended for use on interior\nbecause the source of the disease has been removed. Doctors know that\nresidential structures. Under the provisions of this section such paints-\npaint chips peeling from the walls of deteriorating homes can be the\nmay contain no more than 0.06% lead within six months from the date\nprincipal source of lead poisoning for those young children whose\nthis amendment is enacted.\nparents cannot prevent them from swallowing the sweet tasting parti-\nDuring that period, the Consumer Product Safety Commission is\ncles. For that reason, the reported bill authorizes the Department of\nauthorized to obtain evidence from public testimony to determine\nHealth, Education, and Welfare to allow local lead poisoning screen-\nwhether the allowable level of lead in paint should be established\ning programs to include a hazard elimination component, that can\nbeyond .06%, but not to exceed 0.5%. By a majority vote of all the\noperate in concert with the local effort to search out and refer for\nCommissioners, the allowable level will be determined based upon\ntreatment, those youngsters who are found to be lead sick.\nthe Commissioner's review of available scientific evidence including\nrecommendations of the Center for Disease Control, the National\nVII. TABULATION OF VOTES CAST IN COMMITTEE\nAcademy of Sciences and the American Academy of Pediatrics.\nSection (f) (1) amends Section 503 (a) of such Act by extending\nPursuant to section 133 (b) of the Legislative Reorganization Act of\nthe authorization levels to $10 million for FY 1976; $12.5 million for\n1946 as amended, the following is a tabulation of votes in committee:\nFY 1977, and $15 million for FY 1978.\nMotion to report the bill to the Senate carried without objection.\nSection (f) (2) amends Section 503 (b) of such Act by extending the\nauthorization levels to $5 million for FY 1976; $15 million for FY\nVIII. COST ESTIMATES PURSUANT TO SECTION 252 OF THE LEGISLATIVE\n1977 and $25 million for FY 1978.\nREORGANIZATION Acr OF 1970\nSection (f) (3) amends Section 503 (c) of such Act by extending the\nauthorization levels to $3 million for each fiscal year until June 1978.\nMillions\n1976\n$18. 0\nCHANGES IN EXISTING LAW\n1977\n30. 5\n1978\n43. 0\nIn compliance with paragraph 4 of the rule XXIX of the Standing\nTotal\n91. 5\nRules of the Senate, changes in existing law made by the bill, as\nreported, are shown as follows (existing law proposed to be omitted\nIX. SECTION BY SECTION ANALYSIS\nis enclosed in black brackets, new matter is printed in italic, existing\nSection (a) labels this bill as the \"Lead Based Paint Poisoning\nlaw in which no change is proposed is shown in roman)\nPrevention Amendments of 1976.\"\nLEAD-BASED PAINT POISONING PREVENTION Act, AS AMENDED\nSection (b) amends section 101 (c) (3) of the Lead Based Paint\nPoisoning Prevention Act by authorizing the Department of Health,\nEducation, and Welfare to conduct hazard elimination programs as\n[Public Law 91-695, January 13, 1971]\nfollow-up procedures that can clean up those areas most likely to\n[Public Law 93-151, November 9, 1973]\ncause lead poisoning in the homes of children who have been found\nto be lead sick.\nAN ACT To provide Federal financial assistance to help cities and communities\nSection (c) amends Section of such Act by requiring the\nto develop and carry out intensive local programs to eliminate the causes of\nSecretary of Health, Education, and Welfare to insure that local\nlead-based paint poisoning and local programs to detect and treat incidents of\nsuch poisoning, to establish a Federal demonstration and research program to\nS. Rept. 94-634-2\n10\n11\nstudy the extent of the lead-based paint poisoning problem and the methods\n(f) (1) No grant may be made under this section unless the Secre-\navailable for lead-based paint removal, and to prohibit future use of lead-based\ntary determines that there is satisfactory assurance that (A) the\npaint in Federal or federally assisted construction or rehabilitation.\nservices to be provided will constitute an addition to, or a significant\nBe it enacted by the Senate and House of Representatives of the\nimprovement in quality (as determined in accordance with criteria of\nUnited States of America in Congress assembled, That this Act may be\nthe Secretary) in, services that would otherwise be provided, and (B)\ncited as the \"Lead-Based Paint Poisoning Prevention Act\".\nFederal funds made available under this section for any period will\nbe so used as to supplement and, to the extent practical, increase the\nTITLE I-GRANTS FOR THE DETECTION AND TREAT-\nlevel of State, local, and other non-Federal funds that would, in the\nMENT OF LEAD-BASED PAINT POISONING\nabsence of such Federal funds, be made available for the program\ndescribed in this section, and will in no event supplant such State,\nGRANTS FOR LOCAL DETECTION AND TREATMENT OF LEAD-BASED PAINT\nlocal, and other non-Federal funds.\nPOISONING\n(2) No grant may be made under this section unless the Secretary\ndetermines that there is satisfactory assurance that the services to be\nSEC. 101. (a) The Secretary of Health, Education, and Welfare\nprovided will be curried out in accordance with subsections (c) and\n(hereafter referred to in this title as the \"Secretary\") is authorized to\n(d) of this section.\nmake grants to public agencies of units of general local government in\nany State and to private nonprofit organizations in any State for the\nTITLE II-GRANTS FOR THE ELIMINATION OF\npurpose of assisting such units in developing and carrying out local\nLEAD-BASED PAINT POISONING\nprograms to detect and treat incidents of lead-based paint poisoning.\n(b) The amount of any such grant shall not exceed [75] 90 per\nSEC. 201. The Secretary of Health, Education, and Welfare is\ncentum of the cost of developing and carrying out a local program, as\nauthorized to make grants to public agencies of units of general local\napproved by the Secretary, during a period of three years.\ngovernment in any State and to private nonprofit organizations in any\n(c) A local program should include-\nState for the purpose of assisting such units in developing and carry-\n(1) educational programs intended to communicate the health\ning out programs that identify those areas that present a high risk\ndanger and prevalence of lead-based paint poisoning among chil-\nto the health of residents because of the presence of lead-based paints\ndren of inner city areas, to parents, educators, and local health\non interior surfaces, and then to develop and carry out programs to\nofficials;\neliminate the hazards of lead-based paint poisoning.\n(2) development and carrying out of intensive community\n(a) A local program should include:\ntesting programs designed to direct incidents of lead-based paint\n(1) development and carrying out of comprehensive testing\npoisoning among community residents, and to insure prompt\nprograms to detect the presence of lead-based paints on surfaces\nmedical treatment for such afflicted individuals;\nof residential housing;\n(3) development and carrying out of intensive followup pro-\n[(2) the development and carrying out of a comprehensive pro-\ngrams to insure that identified cases of lead-based paint poisoning\ngram requiring the prompt elimination of lead-based paints from\nare protected against further exposure to lead-based [paints]\nall interior surfaces, porches, and exterior surfaces to which chil-\npaint hazards in their living [environment; and] environment\ndren may be commonly exposed, of residential housing on which\nby eliminating lead-based paint hazards from surfaces in and\nlead-based paints have been used as a surface covering, including\naround residential dwelling units or houses when the owner of\nthose surfaces on which non-lead-based paints have been used to\nsaid units or houses is financially unable to eliminate such lead-\ncover surfaces to which lead-based paints were previously applied;\nbased paint hazards. Priority for local lead elimination programs\nand]\nshall go to units or houses where there reside children with ele-\n(2) the development and carrying out of procedures to re-\nvated body lead burden or diagnosed lead-based paint poisoning,\nmove from exposure to young children all interior surfaces of\nor both; and\nresidential housing, porches, and exterior surfaces of such housing\n(4) any other actions which will reduce or eliminate lead-based\nto which children may be commonly exposed, in those areas that\npaint poisoning.\npresent a high risk for the health of residents because of the pres-\n(d) Each local program shall afford opportunities for employing\nence of lead based paints. Such programs should include those\nthe residents of communities or neighborhoods affected by lead-based\nsurfaces on which non-lead-based paints have been used to cover\npaint poisoning, and for providing appropriate training, education,\nsurfaces to which lead based paints were previously applied; and\nand any information which may be necessary to inform such residents\n(3) any other actions which will reduce or eliminate lead-based\nof opportunities for employment in lead-based paint poisoning\npaint poisoning.\nelimination programs.\n(b) Each such program shall-\n(e) The Secretary is also authorized to make grants to ,State agen-\n(1) be consistent with the appropriate local program assisted\ncies for the purpose of establishing centralized laboratory facilities\nunder section 101, and\nfor analyzing biological and environmental lead specimens obtained\n(2) afford, to the maximum extent feasible, opportunities for\nfrom local lead based paint poisoning detection programs.\nemploying the resident of communities or neighborhoods affected\n13\n12\nmay present such hazards and which is covered by an application for\nby lead-based paint poisoning, and for providing appropriate\nmortgage insurance or housing assistance payments under a program\ntraining, education, and any information which may be necessary\nadministered by the Secretary. Such procedures shall apply to all such\nto inform such residents of opportunities for employment in lead-\nhousing costructed prior to 1950 and shall as a minimum provide for\nbased paint elimination programs.\n(1) appropriate measures to eliminate as far as practicable immediate\n(c) Any public agency, of a unit of local government or private\nhazards due to the presence of paint which may contain lead and to\nnonprofit organization which receives assistance under this Act shall\nwhich children may be exposed, and (2) assured notification to pur-\nmake available to the Secretary and the Comptroller General of the\nchasers and tenants of such housing of the hazards of lead based paint,\nUnited States, or any of their duly authorized representatives, for\nof the symptoms and treatment of lead based paint poisoning, and of\npurposes of audit and examination, any books, documents, papers, and\nthe importance and availability of maintenance and removal tech-\nrecords that are pertinent to the assistance received by such public\nniques for eliminating such hazards. Such procedures may apply to\nagency of a unit of local government or private nonprofit organization\nhousing constructed during or after 1950 if the Secretary determines,\nunder this Act.\nin his discretion, that such housing presents hazards of lead based\npaint. The Secretary may establish such other procedures as may be\nTITLE III-FEDERAL DEMONSTRATION AND RESEARCH\nappropriate to carry out the purposes of this section. Further, the\nPROGRAM; FEDERAL HOUSING ADMINISTRATION\nSecretary shall establish and implement procedures to eliminate the\nREQUIREMENTS\nhazards of lead based paint poisoning in all federally owned proper-\nties prior to the sale of such properties when their use is intended for\nFEDERAL DEMONSTRATION AND RESEARCH PROGRAM\nresidential habitation.\nSEC. 301. (a) The Secretary of Housing and Urban Development, in\nTITLE IV-PROHIBITION AGAINST FUTURE USE OF\nconsultation with the Secretary of Health, Education, and Welfare,\nLEAD-BASED PAINT\nshall develop and carry out a demonstration and research program\nto determine the nature and extent of the problem of lead-based paint\npoisoning in the United States, particularly in urban areas, [and the\nPROHIBITION AGAINST USE OF LEAD BASED PAINT IN CONSTRUCTION OF\nmethods by wich lead-based paint can most effectively be removed\nFACILITIES AND THE MANUFACTURE OF CERTAIN TOYS AND UTENSILS\nfrom interior surfaces, porches, and exterior surfaces to which chil-\n[Sec. 401. The Secretary of Health, Education, and Wèlfare, in\ndren may be commonly exposed, of residential housing. Within one\nconsultation with the Secretary of Housing and Urban Development,\nyear after the date of the enactment of this Act the Secretary shall\nshall take such steps and impose such conditions as may be necessary\nsubmit to the Congress a full and complete report of his findings and\nor appropriate-\nrecommendations as developed pursuant to such program, together\n(1) to prohibit the use of lead based paint in residential struc-\nwith a statement of any legislation which should be enacted, and any\ntures constructed or rehabilitated by the Federal Government, or\nchanges in existing law which should be made, in order to carry out\nwith Federal assistance in any form, after the date of enactment\nsuch recommendations.] including the methods by which the lead based\nof this Act, and\npaint hazard can most effectively be removed from interior surfaces,\n(2) to prohibit the application of lead based paint to any toy,\nporches, and exterior surfaces of residential housing to which children\nfurniture, cooking utensil, drinking utensil, or eating utensil man-\nmay be exposed.\nufactured and distributed after the date of enactment of this\n(b) The Chairman of the Consumer Product Safety Commission\nAct.\nshall conduct appropriate research on multiple layers of dried paint\nfilm, containing the various lead compounds commonly used, in order\nPROHIBITION AGAINST USE OF LEAD-BASED PAINT IN CONSTRUCTION OF\nto ascertain the safe level of lead in residential paint products. No\nFACILITIES AND THE MANUFACTURE OF CERTAIN TOYS AND UTENSILS\nlater than December 3, 1974, the Chairman shall submit to Congress\na full and complete report of his findings and recommendations as\nSEC. 401. (a) The Secretary of Health, Education, and Velfare shall\ndeveloped pursuant to such programs, together with a statement of\ntake such steps and impose such conditions as may be necessary or ap-\nany legislation which should be enacted or any changes in existing law\npropriate to prohibit the application of lead-based paint to any cook-\nwhich should be made in order to carry out such recommendations.\ning utensil, drinking utensil, or eating utensil manufactured and dis-\ntributed after the date of enactment of this Act.\nFEDERAL HOUSING ADMINISTRATION REQUIREMENTS\n(b) The Secretary of Housing and Urban Development shall take\nSEC. 302. The Secretary of Housing and Urban Development (here-\nsuch steps and impose such conditions as may be necessary or appropri-\nafter in this section referred to as the \"Secretary\" shall establish\nate to prohibit the use of lead-based paint in residential structures\nprocedures to eliminate as far as practicable the hazards of lead\nconstructed or rehabilitated by the Federal Government, or with Fed-\nbased paint poisoning with respect to any existing housing which\neral assistance in any form after the date of enactment of this Act.\n14\n15\n(c) The Consumer Product Safety Commissions shall take such steps\nCONSULTATION WITH OTHER DEPARTMENTS AND AGENCIES\nand impose such conditions as may be necessary or appropriate to pro-\nSEC. 502. In carrying out the authority under this Act, the Secretary\nhibit the application of lead-based paint to any toy or furniture article.\nof Health, Education, and Welfare shall cooperate with and seek the\nadvice of the heads of any other departments or agencies regarding\nTITLE V-GENERAL\nany programs under their respective responsibilities which are related\nto, or would be affected by, such authority.\nDEFINITIONS\nSEC. 501. As used in this Act-\nAPPROPRIATIONS\n(1) the term \"State\" means the several States, the District of\nSEC. 503. (a) There is hereby authorized to be appropriated to carry\nColumbia, the Commonwealth of Puerto Rico, and the territories\nout the provisions of title I of this Act not to exceed $10,000,000 for\nand possessions of the United States;\nfiscal year 1976; $12,500,000 for fiscal year 1977 and $15,000,000 for\n(2) the term \"units of general local government\" means (A)\nfiscal year 1978;\nany city, county, township, town, borough, parish, village, or other\n(b) There is hereby authorized to be appropriated to carry out the\ngeneral purpose political subdivisions of a State, (B) any com-\nprovisions of title II of this Act not to exceed $5,000,000 for the fiscal\nbination of units of general local government in one or more\nyear 1976, $15,000,000 for the fiscal year 1977, and $25,000,000 for the\nStates, (C) and Indian tribe, or (D) with respect to lead-based\nfiscal year 1978\"; and\npaint poisoning elimination activities in their urban areas, the\n(c) There is hereby authorized to be appropriated to carry out the\nterritories and possessions of the United States; and\n[(3) the term \"lead based paint\" means—\nprovisions of title III of this Act not to exceed \"$3,000,000 for each of\n(A) prior to December 31, 1974, any paint containing\nthe fiscal years 1976, 1977, and 1978\".\nmore than five-tenths of 1 per centum leda by weight (calcu-\n(d) Any amounts appropriated under this section shall remain\nlated as lead metal) in the total nonvolatile content of liquid\navailable until expended when so provided in appropriation Acts;\npaints or in the dried film of paint already applied;\n[and any amounts authorized for the fiscal year 1971 but not appro-\n(B) after December 31, 1974, any paint containing more\npriated may be appropriated for the fiscal year 1972.] and any\nthan six one-hundredths of 1 per centum lead by weight (cal-\namounts authorized for one fiscal year but not appropriated may be\nculated as lead metal) in the total nonvolatile content of\nappropriated for the succeeding fiscal year.\nliquid paints or in the dried film of paint already applied,\nELIGIBILITY OF CERTAIN STATE AGENCIES\nexcept that if prior to December 31, 1974, the Chairman of\nthe Consumer Product Safety Commission, based on studies\nSEC. 504. Notwithstanding any other provision of this Act, grants\nconducted in accordance with section 301 (b) of this Act,\nauthorized under sections 101 and 201 of this Act may be made to an\ndetermines that another level of lead, not to exceed five-\nagency of State government in any case where State government pro-\ntenths of 1 per centum, is safe, then such other level shall be\nvides direct services to citizens in local communities or where units of\neffective after December 31, 1974.]\ngeneral local government within the State are prevented by State law\n(3) the term \"lead-based paint\" means-\nfrom implementing or receiving such grants or from expending such\n(A) within 6 months of the date of enactment of this\ngrants in accordance with their intended purpose.\namendment any paint containing more than five-tenths of\nADVISORY BOARDS\n1 percentum lead by weight (calculated as lead metal) in the\ntotal nonvolatile content of lead paints, or the equivalent\nSEC. 505. (a) The Secretary of Health, Education, and Welfare, in\nmeasure of lead in the dried film of paint already applied,\nconsultation with the Secretary of Housing and Urban Development,\nor both;\nis authorized to establish a National Childhood Lead Bosed Paint\n(B) after 6 months from the date of enactment of the\nPoisoning Advisory Board to advise the Secretary on policy relating\namendment, any paint containing more than six-hundredths\nto the administration of this Act. Members of the Board shall include\nof 1 percentum lead by weight (calculated as lead metal) in\nresidents of communities and neighborhoods affected by lead based\nthe total nonvolatile content of lead paints, or the equivalent\npaint poisoning. Each member of the National Advisory Board who\nmeasure of lead in the dried film of paint already applied, or\nis not an officer of the Federal Government is authorized to receive an\nboth, except that\namount equal to the minimum daily rate prescribed for GS-18, under\n(C) the Consumer Product Safety Commission shall on the\nsection 5332 of title 5, United States Code, for each day he is engaged\nbasis of public testimony and available scientific evidence\nin the actual performance of his duties (including traveltime) as a\n(which shall include the recommendations of the Center for\nmember of the Board. All members shall be reïmbursed for travel, suò-\nDisease Control, the American Academy of Pediatrics and\nsistence, and necessary expenses incurred in the performance of their\nthe National Academy of Sciences) determine within 6,\nduties.\nmonths of the date of enactment of this amendment whether\n(b) The Secretary at Health, Education, and Welfare, in consulta-\nanother level of lead, not to exceed five-tenths of 1 percentum,\ntion with the Secretary of Housing and Urban Development, shall\nis safe, in which case such other level shall be effective after\npromulgate regulations for establishment of an advisory board for\n6 months from the date of enactment of this amendment.\neach local program assisted under this Act to assist in carrying out this\n16\nprogram. Two-thirds of the members of the board shall be residents of\ncommunities and neighborhoods affected by lead based paint poison-\ning. A majority of the board shall be appointed from among parents,\nwho, when appointed, have at least one child under six years of age.\nEach member of a local advisory board shall only be reimbursed for\nnecessary expenses incurred in the actual performance of his duties as\na member of the board.\nEFFECT UPON STATE LAW\nSEC. 506. It is hereby expressly declared that it is the intent of the\nCongress to supersede any and all laws of the States and units of local\ngovernment insofar as they may now or hereafter provide for a re-\nquirement, prohibition, or standard relating to the lead content in\npaints or other similar surface-coating materials which differs from\nthe provisions of this Act or regulations issued pursuant to this Act.\nAny law, regulation, or ordinance purporting to establish such dif-\nferent requirement, prohibition, or standard shall be null and void.\nTITLE III-GENERAL POWERS AND DUTIES\nOF PUBLIC HEALTH SERVICE\nPART A-RESEARCH AND INVESTIGATION\nIN GENERAL\n*\nProject Grants for Health Services Development\n(e) There are authorized to be appropriated $90,000,000 for the\nfiscal year ending June 30, 1968, $95,000,000 for the fiscal year ending\nJune 30, 1969, $80,000,000 for the fiscal year ending June 30, 1970,\n$109,500,000 for the fiscal year ending June 30, 1971, $135,000,000 for\nthe fiscal year ending June 30, 1972, and $157,000,000 for the fiscal\nyear ending June 30, 1973, for grants to any public or nonprofit private\nagency, institution, or organization to cover part of the cost (includ-\ning equity requirements and amortization of loans on facilities ac-\nquired from the Office of Economic Opportunity or construction in\nconnection with any program or project transferred from the Office\nof Economic Opportunity) of (1) providing services (including\nrelated training) to meet health needs of limited geographic scope or\nof specialized regional or national significance, or (2) developing and\nsupporting for an initial period new programs of health services (in-\ncluding related training). Any grant made under this subsection may\nbe made only if the application for such grant has been referred for\nreview and comment to the appropriate areawide health planning\nagency or agencies (or, if there is no such agency in the area, then to\nsuch other public or nonprofit private agency or organization (if any)\nwhich performs similar functions) and only if the services assisted\nunder such grant will be provided in accordance with such plans as\nhave been developed pursuant to subsection (a).\nNo funds appropriated pursuant to the authorization of this sub-\nsection shall be available for lead based paint poisoning control of\nthe type authorized under the Lead Based Paint Poisoning Prevention\nAct (84.Stat.2078).\nS. 1466\nAinety-fourth Congress of the United States of America\nAT THE SECOND SESSION\nBegun and held at the City of Washington on Monday, the nineteenth day of January,\none thousand nine hundred and seventy-six\nAn Act\nTo amend the Public Health Service Act to provide authority for health informa-\ntion and health promotion programs, to revise and extend the authority for\ndisease prevention and control programs, and to revise and extend the authority\nfor venereal disease programs, and to amend the Lead-Based Paint Poisoning\nPrevention Act to revise and extend that Act.\nBe it enacted by the Senate and House of Representatives of the\nUnited States of America in Congress assembled,\nTITLE I-HEALTH INFORMATION AND HEALTH\nPROMOTION\nSHORT TITLE\nSEC. 101. This title may be cited as the \"National Consumer Health\nInformation and Health Promotion Act of 1976\".\nAMENDMENT TO PUBLIC HEALTH SERVICE ACT\nSEC. 102. The Public Health Service Act is amended by adding at\nthe end thereof the following new title:\n\"TITLE XVII-HEALTH INFORMATION AND HEALTH\nPROMOTION\n\"GENERAL AUTHORITY\n\"SEC. 1701. (a) The Secretary shall-\n\"(1) formulate national goals, and a strategy to achieve such\ngoals, with respect to health information and health promotion,\npreventive health services, and education in the appropriate use\nof health care;\n\"(2) analyze the necessary and available resources for imple-\nmenting the goals and strategy formulated pursuant to para-\ngraph (1), and recommend appropriate educational and quality\nassurance policies for the needed manpower resources identified\nby such analysis;\n\"(3) undertake and support necessary activities and programs\nto-\n\"(A) incorporate appropriate health education compo-\nnents into our society, especially into all aspects of education\nand health care,\n((B) increase the application and use of health knowledge,\nskills, and practices by the general population in its patterns\nof daily living, and\n\"(C) establish systematic processes for the exploration,\ndevelopment, demonstration, and evaluation of innovative\nhealth promotion concepts;\n(4) undertake and support research and demonstrations\nrespecting health information and health promotion, preventive\nhealth services, and education in the appropriate use of health\ncare;\nS. 1466-2\n\"(5) undertake and support appropriate training in, and\nundertake and support appropriate training in the operation of\nprograms concerned with, health information and health pro-\nmotion, preventive health services, and education in the appro-\npriate use of health care;\n\"(6) undertake and support, through improved planning and\nimplementation of tested models and evaluation of results, effec-\ntive and efficient programs respecting health information and\nhealth promotion, preventive health services, and education in\nthe appropriate use of health care;\n(7) foster the exchange of information respecting, and foster\ncooperation in the conduct of, research, demonstration, and train-\ning programs respecting health information and health promo-\ntion, preventive health services, and education in the appropriate\nuse of health care;\n'(8) provide technical assistance in the programs referred to in\nparagraph (7) ; and\n(9) use such other authorities for programs respecting health\ninformation and health promotion, preventive health services, and\neducation in the appropriate use of health care as are available and\ncoordinate such use with programs conducted under this title.\nThe Secretary shall administer this title in a manner consistent with\nthe national health priorities set forth in section 1502 and with health\nplanning and resource development activities undertaken under titles\nXV and XVI.\n\"(b) For payments under grants and contracts under this title there\nare authorized to be appropriated $7,000,000 for the fiscal year ending\nSeptember 30, 1977, $10,000,000 for the fiscal year ending Septem-\nber 30, 1978, and $14,000,000 for the fiscal year ending September 30,\n1979.\n\"(c) No grant may be made or contract entered into under this title\nunless an application therefor has been submitted to and approved\nby the Secretary. Such an application shall be submitted in such form\nand manner and contain such information as the Secretary may pre-\nscribe. Contracts may be entered into under this title without regard\nto sections 3648 and 3709 of the Revised Statutes (31 U.S.C. 529; 41\nU.S.C.5).\n\"RESEARCH PROGRAMS\n\"SEC. 1702. (a) The Secretary is authorized to conduct and support\nby grant or contract (and encourage others to support) research in\nhealth information and health promotion, preventive health services,\nand education in the appropriate use of health care. Applications for\ngrants and contracts under this section shall be subject to appropriate\npeer review. The Secretary shall also-\n'(1) provide consultation and technical assistance to persons\nwho need help in preparing research proposals or in actually con-\nducting research;\n(2) determine the best methods of disseminating information\nconcerning personal health behavior, preventive health services\nand the appropriate use of health care and of affecting behavior\nSO that such information is applied to maintain and improve\nhealth, and prevent disease, reduce its risk, or modify its course or\nseverity;\n\"(3) determine and study environmental, occupational, social,\nand behavioral factors which affect and determine health and\nascertain those programs and areas for which educational and\npreventive measures could be implemented to improve health\nas it is affected by such factors;\nS. 1466-3\n\"(4) develop (A) methods by which the cost and effectiveness\nof activities respecting health information and health promotion,\npreventive health services, and education in the appropriate use\nof health care, can be measured, including methods for evaluating\nthe effectiveness of various settings for such activities and the\nvarious types of persons engaged in such activities, (B) methods\nfor reimbursement or payment for such activities, and (C) models\nand standards for the conduct of such activities, including\nmodels and standards for the education, by providers of institu-\ntional health services, of individuals receiving such services\nrespecting the nature of the institutional health services provided\nthe individuals and the symptoms, signs, or diagnoses which\nled to provision of such services;\n\" (5) develop a method for assessing the cost and effectiveness\nof specific medical services and procedures under various condi-\ntions of use, including the assessment of the sensitivity and\nspecificity of screening and diagnostic procedures; and\n'(6) enumerate and assess, using methods developed under\nparagraph (5), preventive health measures and services with\nrespect to their cost and effectiveness under various conditions\nof use.\n(b) The Secretary shall make a periodic survey of the needs,\ninterest, attitudes, knowledge, and behavior of the American public\nregarding health and health care. The Secretary shall take into con-\nsideration the findings of such surveys and the findings of similar\nsurveys conducted by national and community health education\norganizations, and other organizations and agencies for formulating\npolicy respecting health information and health promotion, preven-\ntive health services, and education in the appropriate use of health\ncare.\n\"COMMUNITY PROGRAMS\n\"SEC. 1703. (a) The Secretary is authorized to conduct and support\nby grant or contract (and encourage others to support) new and inno-\nvative programs in health information and health promotion, pre-\nventive health services, and education in the appropriate use of health\ncare, and may specifically-\n\"(1) support demonstration and training programs in such\nmatters which programs (A) are in hospitals, ambulatory care\nsettings, home care settings, schools, day care programs for chil-\ndren, and other appropriate settings representative of broad\ncross sections of the population, and include public education\nactivities of voluntary health agencies, professional medical\nsocieties, and other private nonprofit health organizations, (B)\nfocus on objectives that are measurable, and (C) emphasize the\nprevention or moderation of illness or accidents that appear\ncontrollable through individual knowledge and behavior;\n\"(2) provide consultation and technical assistance to organiza-\ntions that request help in planning, operating, or evaluating\nprograms in such matters;\n\"(3) develop health information and health promotion mate-\nrials and teaching programs including (A) model curriculums\nfor the training of educational and health professionals and\nparaprofessionals in health education by medical, dental, and\nnursing schools, schools of public health, and other institutions\nengaged in training of educational or health professionals, (B)\nmodel curriculums to be used in elementary and secondary schools\nand institutions of higher learning, (C) materials and programs\nS. 1466-4\nfor the continuing education of health professionals and parapro-\nfessionals in the health education of their patients, (D) materials\nfor public service use by the printed and broadcast media, and\n(E) materials and programs to assist providers of health care in\nproviding health education to their patients; and\n\"(4) support demonstration and evaluation programs for\nindividual and group self-help programs designed to assist the\nparticipant in using his individual capacities to deal with health\nproblems, including programs concerned with obesity, hyperten-\nsion, and diabetes.\n\"(b) The Secretary is authorized to make grants to States and\nother public and nonprofit private entities to assist them in meeting\nthe costs of demonstrating and evaluating programs which provide\ninformation respecting the costs and quality of health care or infor-\nmation respecting health insurance policies and prepaid health plans,\nor information respecting both. After the development of models pur-\nsuant to sections 1704(4) and 1704(5) for such information, no grant\nmay be made under this subsection for a program unless the informa-\ntion to be provided under the program is provided in accordance with\none of such models applicable to the information.\n\"(c) The Secretary is authorized to support by grant or contract\n(and to encourage others to support) private nonprofit entities work-\ning in health information and health promotion, preventive health\nservices, and education in the appropriate use of health care. The\namount of any grant or contract for a fiscal year beginning after Sep-\ntember 30, 1978, for an entity may not exceed 25 per centum of the\nexpenses of the entity for such fiscal year for health information and\nhealth promotion, preventive health services, and education in the\nappropriate use of health care.\n\"INFORMATION PROGRAMS\n\"SEC. 1704. The Secretary is authorized to conduct and support by\ngrant or contract (and encourage others to support) such activities as\nmay be required to make information respecting health information\nand health promotion, preventive health services, and education in\nthe appropriate use of health care available to the consumers of medical\ncare, providers of such care, schools, and others who are or should be\ninformed respecting such matters. Such activities may include at least\nthe following:\n\"(1) The publication of information, pamphlets, and other\nreports which are specially suited to interest and instruct the\nhealth consumer, which information, pamphlets, and other reports\nshall be updated annually, shall pertain to the individual's abil-\nity to improve and safeguard his own health; shall include\nmaterial, accompanied by suitable illustrations, on child care,\nfamily life and human development, disease prevention (particu-\nlarly prevention of pulmonary disease, cardiovascular disease,\nand cancer), physical fitness, dental health, environmental health,\nnutrition, safety and accident prevention, drug abuse and alco-\nholism, mental health, management of chronic diseases (including\ndiabetes and arthritis), and venereal diseases; and shall be\ndesigned to reach populations of different languages and of dif-\nferent social and economic backgrounds.\n\"(2) Securing the cooperation of the communications media,\nproviders of health care, schools, and others in activities designed\nto promote and encourage the use of health maintaining infor-\nmation and behavior.\nS. 1466-5\n(3) The study of health information and promotion in adver-\ntising and the making to concerned Federal agencies and others\nsuch recommendations respecting such advertising as are\nappropriate.\n\" (4) The development of models and standards for the publica-\ntion by States, insurance carriers, prepaid health plans, and others\n(except individual health practitioners) of information for use\nby the public respecting the cost and quality of health care, includ-\ning information to enable the public to make comparisons of the\ncost and quality of health care.\n\"(5) The development of models and standards for the publi-\ncation by States, insurance carriers, prepaid health plans, and\nothers of information for use by the public respecting health\ninsurance policies and prepaid health plans, including informa-\ntion on the benefits provided by the various types of such policies\nand plans, the premium charges for such policies and plans,\nexclusions from coverage or eligibility for coverage, cost sharing\nrequirements, and the ratio of the amounts paid as benefits to the\namounts received as premiums and information to enable the\npublic to make relevant comparisons of the costs and benefits of\nsuch policies and plans.\n(6) Assess, with respect to the effectiveness, safety, cost, and\nrequired training for and conditions of use, of new aspects of\nhealth care, and new activities, programs, and services designed\nto improve human health and publish in readily understandable\nlanguage for public and professional use such assessments and,\nin the case of controversial aspects of health care, activities, pro-\ngrams, or services, publish differing views or opinions respecting\nthe effectiveness, safety, cost, and required training for and con-\nditions of use, of such aspects of health care, activities, programs,\nor services.\n\"REPORT AND STUDY\n\"SEC. 1705. (a) The Secretary shall, not later than two years after\nthe date of the enactment of this title and annually thereafter, sub-\nmit to the President for transmittal to Congress a report on the status\nof health information and health promotion, preventive health services,\nand education in the appropriate use of health care. Each such report\nshall include-\n\"(1) a statement of the activities carried out under this title\nsince the last report and the extent to which each such activity\nachieves the purposes of this title;\n(2) an assessment of the manpower resources needed to carry\nout programs relating to health information and health promo-\ntion, preventive health services, and education in the appropriate\nuse of health care, and a statement describing the activities cur-\nrently being carried out under this title designed to prepare\nteachers and other manpower for such programs;\n\" (3) the goals and strategy formulated pursuant to section\n1701 (a) (1), the models and standards developed under this\ntitle, and the results of the study required by subsection (b) of\nthis section and\n\"(4) such recommendations as the Secretary considers appro-\npriate for legislation respecting health information and health\npromotion, preventive health services, and education in the appro-\npriate use of health care, including recommendations for revisions\nto and extension of this title.\nS. 1466-6\n\"(b) The Secretary shall conduct a study of health education\nservices and preventive health services to determine the coverage of\nsuch services under public and private health insurance programs,\nincluding the extent and nature of such coverage and the cost sharing\nrequirements required by such programs for coverage of such services.\n\"OFFICE OF HEALTH INFORMATION AND HEALTH PROMOTION\n\"SEC. 1706. The Secretary shall establish within the Office of the\nAssistant Secretary for Health an Office of Health Information and\nHealth Promotion which shall-\n\"(1) coordinate all activities within the Department which\nrelate to health information and health promotion, preventive\nhealth services, and education in the appropriate use of health\ncare;\n\"(2) coordinate its activities with similar activities of organiza-\ntions in the private sector; and\n\"(3) establish a national information clearinghouse to facilitate\nthe exchange of information concerning matters relating to health\ninformation and health promotion, preventive health services,\nand education in the appropriate use of health care, to facilitate\naccess to such information, and to assist in the analysis of issues\nand problems relating to such matters.\".\nTITLE II-DISEASE CONTROL\nSHORT TITLE\nSEC. 201. This title may be cited as the \"Disease Control Amend-\nments of 1976\".\nAMENDMENTS TO SECTIONS 311 AND 317\nSEC. 202. (a) Effective with respect to grants under section 317 of\nthe Public Health Service Act made from appropriations under such\nsection for fiscal years beginning after June 30, 1975, section 317 of\nsuch Act is amended to read as follows:\n\"DISEASE CONTROL PROGRAMS\n\"SEC. 317. (a) The Secretary may make grants to States and, in con-\nsultation with State health authorities, to public entities to assist them\nin meeting the costs of disease control programs.\n\"(b) (1) No grant may be made under subsection (a) unless an\napplication therefor has been submitted to, and approved by, the\nSecretary. Such application shall be in such form, be submitted in\nsuch manner, and contain such information as the Secretary shall\nby regulation prescribe and shall meet the requirements of para-\ngraph (2).\n(2) An application for a grant under subsection (a) shall-\n\"(A) set forth with particularity the objectives (and their\npriorities, as determined in accordance with such regulations as\nthe Secretary may prescribe) of the applicant for each of the\ndisease control programs it proposes to conduct with assistance\nfrom a grant under subsection (a)\n((B) contain assurances satisfactory to the Secretary that,\nin the year during which the grant applied for would be available,\nthe applicant who are most susceptible to the diseases or conditions\nto develop an awareness in those persons in the area served by\nS. 1466-7\nthe applicant who are most susceptible to the diseases or conditions\nreferred to in subsection (f) of appropriate preventive behavior\nand measures (including immunizations) and diagnostic pro-\ncedures for such diseases, and (ii) to facilitate their access to such\nmeasures and procedures; and\n\"(C) provide for the reporting to the Secretary of such infor-\nmation as he may require concerning (i) the problems, in the area\nserved by the applicant, which relate to any disease or condition\nreferred to in subsection (f), and (ii) the disease control programs\nof the applicant for which a grant is applied for.\nIn considering such an application the Secretary shall take into\naccount the relative extent, in the area served by the applicant, of\nthe problems which relate to one or more of the diseases or conditions\nreferred to in subsection (f) and the extent to which the applicant's\nprograms are designed to eliminate or reduce such problems. The\nSecretary shall give special consideration to applications for programs\nwhich (A) will increase to at least 80 per centum the immunization\nrates of any population identified as not having received, or as having\nfailed to secure, the generally recognized disease immunizations, and\n(B) to the fullest extent practicable, will cooperate and use public\nand nonprofit private entities and volunteers. The Secretary shall\ngive priority to applications submitted for disease control programs\nfor communicable diseases.\n\"(c) (1) Each grant under subsection (a) shall be made for disease\ncontrol program costs in the one-year period beginning on the first\nday of the first month beginning after the month in which the grant\nis made.\n\"(2) Payments under grants under subsection (a) may be made\nin advance on the basis of estimates or by way of reimbursement, with\nnecessary adjustments on account of underpayments or overpayments,\nand in such installments and on such terms and conditions as the\nSecretary finds necessary to carry out the purposes of this section.\n\"(3) The Secretary, at the request of a recipient of a grant under\nsubsection (a), may reduce the amount of such grant by-\n\"(A) the fair market value of any supplies (including vaccines\nand other prevention agents) or equipment furnished the grant\nrecipient, and\n\"(B) the amount of the pay, allowances, and travel expenses\nof any officer or employee of the Government when detailed to\nthe recipient and the amount of any other costs incurred in\nconnection with the detail of such officer or employee,\nwhen the furnishing of such supplies or equipment or the detail of\nsuch an officer or employee is for the convenience of and at the request\nof such recipient and for the purpose of carrying out a program with\nrespect to which the recipient's grant under subsection (a) is made.\nThe amount by which any such grant is SO reduced shall be available\nfor payment by the Secretary of the costs incurred in furnishing the\nsupplies or equipment, or in detailing the personnel, on which the\nreduction of such grant is based, and such amount shall be deemed as\npart of the grant and shall be deemed to have been paid to the\nrecipient.\n\"(d) (1) The Secretary may conduct, and may make grants to and\nenter into contracts with public and nonprofit private entities for the\nconduct of-\n\"(A) training for the administration and operation of disease\nprevention and control programs, and\n\"(B) demonstrations and evaluations of such programs.\nS. 1466-8\n\"(2) No grant may be made or contract entered into under para-\ngraph (1) unless an application therefor is submitted to and approved\nby the Secretary. Such application shall be in such form, be submitted\nin such manner, and contain such information, as the Secretary shall\nby regulation prescribe.\n(e) The Secretary shall coordinate activities under this section\nrespecting disease control programs with activities under other sec-\ntions of this Act respecting such programs.\n(f) For purposes of this section, the term 'disease control pro-\ngram means a program which is designed and conducted SO as to con-\ntribute to national protection against diseases or conditions of national\nsignificance which are amenable to reduction, including tuberculosis,\nrubella, measles, poliomyelitis, diphtheria, tetanus, pertussis, mumps,\nand other communicable diseases (other than venereal diseases), and\narthritis, diabetes, diseases borne by rodents, hypertension, pulmonary\ndiseases, cardiovascular diseases, and Rh disease. Such term also\nincludes vaccination programs, laboratory services, studies to deter-\nmine the disease control needs of the States and the means of best meet-\ning such needs, the provision of information and education services\nrespecting disease control, and programs to encourage behavior which\nwill prevent disease and encourage the use of preventive measures and\ndiagnostic procedures. Such term also includes any program or proj-\nect for rodent control for which a grant was made under section 314 (e)\nfor the fiscal year ending June 30, 1975.\n\"(g) (1) (A) For the purpose of grants under subsection (a) for\ndisease control programs to immunize children against immunizable\ndiseases (including measles, rubella, poliomyelitis, diphtheria, per-\ntussis, tetanus, and mumps), there are authorized to be appropriated\n$9,000,000 for fiscal year 1976, $17,500,000 for fiscal year 1977, and\n$23,000,000 for fiscal year 1978.\n\"(B) For the purpose of grants under subsection (a) for disease\ncontrol programs for diseases borne by rodents there are authorized to\nbe appropriated $13,500,000 for fiscal year 1976, $14,000,000 for fiscal\nyear 1977, and $14,500,000 for fiscal year 1978.\n\"(C) For the purpose of grants under subsection (a) for disease\ncontrol programs, other than programs for which appropriations are\nauthorized under subparagraph (A) or (B), and for the purpose of\ngrants and contracts under subsection (d), there are authorized to be\nappropriated $4,000,000 for fiscal year 1976, $4,500,000 for fiscal year\n1977, and $5,000,000 for fiscal year 1978.\n\"(D) Not to exceed 15 per centum of the amount appropriated for\nany fiscal year under any of the preceding subparagraphs of this para-\ngraph may be used by the Secretary for grants and contracts for such\nfiscal year for programs for which appropriations are authorized\nunder any one or more of the other subparagraphs of this paragraph if\nthe Secretary determines that such use will better carry out the purpose\nof this section, and reports to the appropriate committees of Congress\nat least thirty days before making such use of such amount his deter-\nmination and the reasons therefor.\n\"(2) Except as provided in section 318, no funds appropriated under\nany provision of this Act other than paragraph (1) of this subsection\nmay be used to make grants in any fiscal year for disease control pro-\ngrams if (A) grants for such programs are authorized by subsection\n(a), and (B) all the funds authorized to be appropriated under this\nsubsection for that fiscal year have not been appropriated for that\nfiscal year and obligated in that fiscal year.\n'(h) The Secretary shall submit to the President for submission to\nthe Congress on January 1 of each year (1) a report (A) on the\nS. 1466-9\neffectiveness of all Federal and other public and private activities in\ncontrolling the diseases and conditions referred to in subsection (f),\n(B) on the extent of the problems presented by such diseases, (C) on\nthe effectiveness of the activities, assisted under grants and contracts\nunder this section, in controlling such diseases, and (D) setting forth\na plan for the coming year for the control of such diseases; and (2) a\nreport (A) on the immune status of the population of the United\nStates, and (B) identifying, by area, population group, and other\ncategories, deficiencies in the immune status of such population.\n(i) (1) Nothing in this section shall limit or otherwise restrict the\nuse of funds which are granted to a State or to an agency or a political\nsubdivision of a State under provisions of Federal law (other than\nthis Act) and which are available for the conduct of disease control\nprograms from being used in connection with programs assisted\nthrough grants under subsection (a).\n\"(2) Nothing in this section shall be construed to require any State\nor any agency or political subdivision of a State to have a disease\ncontrol program which would require any person, who objects to any\ntreatment provided under such a program, to be treated or to have any\nchild or ward treated under such a program.\".\n(b) Section 311 (c) of the Public Health Service Act is amended\nto read as follows:\n'(c) (1) The Secretary is authorized to develop (and may take such\naction as may be necessary to implement) a plan under which per-\nsonnel, equipment, medical supplies, and other resources of the Service\nand other agencies under the jurisdiction of the Secretary may be\neffectively used to control epidemics of any disease or condition\nreferred to in section 317(f) and to meet other health emergencies or\nproblems involving or resulting from disasters or any such disease.\nThe Secretary may enter into agreements providing for the coopera-\ntive planning between the Service and public and private community\nhealth programs and agencies to cope with health problems (including\nepidemics and health emergencies) resulting from disasters or any\ndisease or condition referred to in section 317(f).\n\"(2) The Secretary may, at the request of the appropriate State\nor local authority, extend temporary (not in excess of forty-five days)\nassistance to States or localities in meeting health emergencies of such\na nature as to warrant Federal assistance. The Secretary may require\nsuch reimbursement of the United States for assistance provided under\nthis paragraph as he may determine to be reasonable under the circum-\nstances. Any reimbursement SO paid shall be credited to the applicable\nappropriation for the Service for the year in which such reimburse-\nment is received.\".\n(c) Section 311 (b) of such Act is amended by inserting at the end\nthereof the following new sentence: \"The Secretary may charge only\nprivate entities reasonable fees for the training of their personnel\nunder the preceding sentence.\".\nAMENDMENTS RESPECTING VENEREAL DISEASES\nSEC. 203. (a) The Congress finds and declares that-\n(1) the number of reported cases of venereal disease continues\nin epidemic proportions in the United States;\n(2) the number of patients with venereal disease reported to\npublic health authorities is only a fraction of those actually\ninfected;\n(3) the incidence of venereal disease is particularly high in the\n15-29-year age group, and in metropolitan areas;\nS. 1466-10\n(4) venereal disease accounts for needless deaths and leads to\nsuch severe disabilities as sterility, insanity, blindness, and\ncrippling conditions;\n(5) the number of cases of congenital syphilis, a preventable\ndisease, tends to parallel the incidence of syphilis in adults;\n(6) it is conservatively estimated that the public cost of care\nfor persons suffering the complications of venereal disease\nexceed $80,000,000 annually;\n(7) medical researchers have no successful vaccine for syphilis\nor gonorrhea, and have no blood test for the detection of gonor-\nrhea among the large reservoir of asymptomatic females;\n(8) school health education programs, public information and\nawareness campaigns, mass diagnostic screening and case fol-\nlowup activities have all been found to be effective disease\nintervention methodologies;\n(9) knowledgeable health providers and concerned individ-\nuals and groups are fundamental to venereal disease prevention\nand control;\n(10) biomedical research leading to the development of vac-\ncines for syphilis and gonorrhea is of singular importance for\nthe eventual eradication of these dreaded diseases; and\n(11) a variety of other sexually transmitted diseases, in addi-\ntion to syphilis and gonorrhea, have become of public health\nsignificance.\n(b) (1) Section 318(b) (2) of the Public Health Service Act is\namended to read as follows:\n\"(2) For the purpose of carrying out this subsection, there are\nauthorized to be appropriated $5,000,000 for fiscal year 1976,\n$6,600,000 for fiscal year 1977, and $7,600,000 for fiscal year 1978.\".\n(2) Subsection (d) (2) of such section is amended to read as follows:\n(2) For the purpose of carrying out this section there is authorized\nto be appropriated $32,000,000 for fiscal year 1976, $41,500,000 for\nfiscal year 1977, and $43,500,000 for fiscal year 1978.'\n(c) Subsection (a) of such section is amended by striking out\n\"public authorities and\" and inserting in lieu thereof \"public and non-\nprofit private entities and to\".\n(d) Subsection (d) (1) (B) of such section is amended by inserting\nbefore the semicolon at the end the following: \"and routine testing,\nincluding laboratory tests and followup systems\".\n(e) Subsection (d) (1) (E) of such section is amended by striking\nout \"control\" and inserting in lieu thereof \"prevention and control\nstrategies and activities\".\n(f) (1) Subsection (c) is repealed.\n(2) Subsection (e) (1) of such section is amended by striking out\n\"or (d)\" and inserting in lieu thereof \"or (c)\".\n(3) Subsection (e) (2) (C) of such section is amended by striking\nout \"(including dark-field microscope techniques for the diagnosis\nof both gonorrhea and syphilis)\".\n(4) The last sentence of subsection (e) (4) of such section is amended\nby striking out the semicolon and all that follows through \"paid to such\nrecipient\".\n(5) The first sentence of subsection (e) (5) of such section is amended\nby inserting before the period the following: \"or as may be required\nby a law of a State or political subdivision of a State\".\n(6) Subsection (g) of such section is amended by striking out \", (c),\nand (d)' and inserting in lieu thereof \"and (c)\"\n(7) Subsection (h) of such section is amended by striking out\n\"treated or to have any child or ward of his\".\nS. 1466-11\n(8) Subsections (d), (e), (f), (g), and (h) of such section are\nredesignated as subsections (c), (d), (e), (f), and (g), respectively.\n(g) Subsection (e) of such section (as so redesignated) is amended\nby striking out \"317 (d) (4)\" and inserting in lieu thereof \"317 (g) (2).\"\n(h) Such section is amended by adding at the end thereof the follow-\ning new subsection:\n'(h) For purposes of this section and section 317, the term 'venereal\ndisease' means gonorrhea, syphilis, or any other disease which can be\nsexually transmitted and which the Secretary determines is or may\nbe amenable to control with assistance provided under this section and\nis of national significance.\".\n(i) Section 318(b) (1) is amended by inserting \"education,\" before\n\"and training\".\nEXTENSION AND REVISION OF LEAD-BASED PAINT POISONING PREVENTION\nACT\nSEC. 204. (a) (1) Section 101 (c) of the Lead-Based Paint Poisoning\nPrevention Act (42 U.S.C. 4801 (c)) is amended by inserting after\nand below paragraph (4) the following:\n\"Follow-up programs described in paragraph (3) shall include\nprograms to eliminate lead-based paint hazards from surfaces in and\naround residential dwelling units or houses, including programs to\nprovide for such purpose financial assistance to the owners of such\nunits or houses who are financially unable to eliminate such hazards\nfrom their units or houses. In administering programs for the elimi-\nnation of such hazards, priority shall be given to the elimination of\nsuch hazards in residential dwelling units or houses in which reside\nchildren with diagnosed lead-based paint poisoning.\".\n(2) (A) Section 101(c) of such Act is amended by striking out\n\"should include\" and inserting in lieu thereof \"shall include\".\n(B) Section 101 (f) of such Act is amended by (i) striking out\n\"and (B)\" and inserting in lieu thereof \"(B)\", and (ii) by inserting\nbefore the period at the end the following \", and (C) the services to\nbe provided will be provided under local programs which meet the\nrequirements of subsections (c) and (d) of this section\".\n(b) Section 401 of such Act (42 U.S.C. 4831) is amended to read\nas follows:\n\"PROHIBITION AGAINST USE OF LEAD-BASED PAINT IN CONSTRUCTION OF\nFACILITIES AND THE MANUFACTURE OF CERTAIN TOYS AND UTENSILS\n\"SEC. 401. (a) The Secretary of Health, Education, and Welfare\nshall take such steps and impose such conditions as may be neces-\nsary or appropriate to prohibit the application of lead-based paint\nto any cooking utensil, drinking utensil, or eating utensil manufac-\ntured and distributed after the date of enactment of this Act.\n\"(b) The Secretary of Housing and Urban Development shall\ntake steps and impose such conditions as may be necessary or appro-\npriate to prohibit the use of lead-based paint in residential struc-\ntures constructed or rehabilitated by the Federal Government, or with\nFederal assistance in any form after the date of enactment of this\nAct.\n\"(c) The Consumer Product Safety Commission shall take such\nsteps and impose such conditions as may be necessary or appropriate\nto article.\". prohibit the application of lead-based paint to any toy or furniture\nS. 1466-12\n(c) (1) Section 501 (3) of such Act (42 U.S.C. 4841 (3)) is amended\nto read as follows:\n\"(3) (A) Except as provided in subparagraph (B), the term\nlead-based paint' means any paint containing more than five-\ntenths of 1 per centum lead by weight (calculated as lead metal)\nin the total nonvolatile content of the paint, or the equivalent\nmeasure of lead in the dried film of paint already applied, or\nboth.\n\"(B) (i) The Consumer Product Safety Commission shall,\nduring the six-month period beginning on the date of the enact-\nment of the National Health Promotion and Disease Prevention\nAct of 1976, determine, on the basis of available data and infor-\nmation and after providing opportunity for an oral hearing and\nconsidering recommendations of the Secretary of Health, Educa-\ntion, and Welfare (including those of the Center for Disease\nControl) and of the National Academy of Sciences, whether or\nnot a level of lead in paint which is greater than six one-hun-\ndredths of 1 per centum but not in excess of five-tenths of 1 per\ncentum is safe. If the Commission determines, in accordance\nwith the preceding sentence, that another level of lead is safe,\nthe term lead-based paint' means, with respect to paint which\nis manufactured after the expiration of the six-month period\nbeginning on the date of the Commission's determination, paint\ncontaining by weight (calculated as lead metal) in the total\nnonvolatile content of the paint more than the level of lead deter-\nmined by the Commission to be safe or the equivalent measure\nof lead in the dried film of paint already applied, or both.\n\"(ii) Unless the definition of the term lead-based paint' has\nbeen established by a determination of the Consumer Product\nSafety Commission pursuant to clause (i) of this subparagraph,\nthe term 'lead-based paint' means, with respect to paint which\nis manufactured after the expiration of the twelve-month period\nbeginning on such date of enactment, paint containing more than\nsix one-hundredths of 1 per centum lead by weight (calculated\nas lead metal) in the total nonvolatile content of the paint, or\nthe equivalent measure of lead in the dried film of paint already\napplied, or both.\".\n(2) Section 501 of such Act is amended (1) by striking out \"the\nterm\" in paragraphs (1) and (2) and inserting in lieu thereof \"The\nterm\", (2) by striking out the semicolon at the end of paragraph (1)\nand inserting in lieu thereof a period, and (3) by striking out and\"\nat the end of paragraph (2) and inserting in lieu thereof a period.\n(d) Section 502 of such Act (42 U.S.C. 4842) is amended by striking\nout \"In carrying out the authority under this Act, the Secretary of\nHealth, Education, and Welfare shall\" and inserting in lieu thereof\n\"In carrying out their respective authorities under this Act, the\nSecretary of Housing and Urban Development and the Secretary of\nHealth, Education, and Welfare shall each\".\n(e) (1) Section 503 of such Act (42 U.S.C. 4843) is amended by\nstriking out subsections (a), (b), and (c) and inserting in lieu thereof\nthe following:\n'(a) There are authorized to be appropriated to carry out this Act\n$10,000,000 for the fiscal year 1976, $12,000,000 for the fiscal year 1977,\nand $14,000,000 for the fiscal year 1978.\".\n(2) Subsection (d) of such section is redesignated as subsection (b).\nS. 1466-13\nTITLE ILI-MISCELLANEOUS AMENDMENT\nSEC. 301. (a) Section 2(f) of the Public Health Service Act is\namended to read as follows:\n'(f) Except as provided in sections 314(g) (4) (B), 355(5), 361 (d),\n1002 (c), 1201 (2), 1401(13), 1531(1), and 1633(1), the term 'State'\nincludes, in addition to the several States, only the District of Colum-\nbia, Guam, the Commonwealth of Puerto Rico, and the Virgin\nIslands.\".\n(b) (1) Section 361 (d) is amended by adding at the end thereof\nthe following: \"For purposes of this subsection, the term 'State'\nincludes, in addition to the several States, only the District of\nColumbia.\".\n(2) Section 1401 is amended by adding after paragraph (12) the\nfollowing new paragraph:\n\"(13) The term 'State' includes, in addition to the several\nStates, only the District of Columbia, Guam, the Commonwealth\nof Puerto Rico, the Virgin Islands, American Samoa, and the\nTrust Territory of the Pacific Islands.\".\nSpeaker of the House of Representatives.\nVice President of the United States and\nPresident of the Senate.\n4\nJune 11, 1976\nDear Mr. Director:\nThe following bills were received at the White\nHouse on June 11th:\nB.J. Res 168\n8. 532\n8. 1466\nS. 2760\nB. 3187\nPlease let the President have reports and\nrecommendations as to the approval of these\nbills as soon as possible.\nSincerely,\nRobert D. Linder\nChief Executive Clerk\nThe Honorable James T. Lynn\nDirector\nOffice of Management and Budget\nWashington, D.C."
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