The Bureau of Disease and Injury Prevention and Control will be made up of the Communicable Disease Center, the Arctic Health Research Center, the Offices of Pesticides and Solid Waste Disposal, and the Divisions of Accident Prevention, Environmental Engineering and Food Protection. Air Pollution, Occupational Health, Radiological Health and Foreign Quarantine, plus the disease control programs of the Division of Chronic Diseases. D. National Institute of Mental Health Establishment of an expanded National Institute of Mental Health as a Bureau of the Public Health Service will give additional recognition and stimulus to the rapidly developing national program for dealing with mental illness. The problem of mental illness is particularly suited to a unified attack encompassing research, manpower training, demonstration programs and delivery of services within a single organizational component. The evolving national mental health program, stressing delivery of services in a community setting, constitutes a special system within the general health care field. It is characterized by commonality of purpose, personnel and clientele. The National Institute of Mental Health, as a Bureau, will incorporate the present activities of the existing Institute plus the Public Health Service hospitals for drug addiction at Lexington and Fort Worth. The intramural research activities in mental health now being conducted on the campus of the National Institutes of Health will be administered under a special relationship designed to maintain existing associations with other NIH intramural research. Inclusion of the hospitals for drug addiction will benefit the patients of these institutions and at the same time provide the Service with clinical facilities for demonstrating new developments in the delivery of mental health care. The new mental health bureau will also serve as the principal focus for research and control programs related to alcoholism. E. National Institutes of Health The National Institutes of Health will remain a bureau of the Service in parallel with the other bureaus already described. To the present structure of the Institutes will be added a National Institute of Environmental Health Sciences. The proposed Environmental Health Sciences Center to be built in North Carolina will constitute the base of the intramural research program of the new Institute, which will also administer a program of extramural grants. The administrative framework of the National Institutes of Health provides the most appropriate and efficient setting for the major research effort urgently needed in the environmental health field. At the same time, major emphasis will be given to the development of effective bridges linking the new Institute. which represents the basic science component, with those categorical programs of the Bureau of Disease and Injury Prevention and Control which will exercise responsibility for surveillance and control of enviornmental hazards. Except for this major addition and the previously described designation of the National Institute of Mental Health as an independent Bureau of the Service, the composition of the National Institutes of Health will remain essentially unchanged. F. National Library of Medicine The National Library of Medicine will remain in its present organizational setting and retain its existing functions including the programs initiated under the Medical Libraries Act of 1965. Consideration will be given to further strengthening and consolidating the scientific and professional communications functions of the Service, including the production and use of audiovisual materials, at a future date. G. National Center for Health Statistics The National Center for Health Statistics will remain in its present organizational setting and retain its existing functions as the principal national source of reliable statistical data related to health. Its relationship to other datagathering units of the Service will be the object of future study. H. Office of the Surgeon General To provide efficient administration for the numerous and diverse programs of the Service, the Office of the Surgeon General will be strengthened and to a certain extent reorganized. Details of this internal reorganization are now under study and will shortly be resolved. The Office of the Surgeon General will include all the activities it now conducts, with the exception of the Division of Health Mobilization which will be located in the Bureau of Health Services. Several of these existing activities— notably those dealing with program planning and analysis, international health, scientific and public communications, and inter-agency liaison-will require substantially increased resources to deal effectively with the scope of present and projected programs. In addition, the new system now being developed for management of grant activities will place additional central responsibilities in the Office of the Surgeon General. These will be designed to provide an organizational focus for the maintenance of uniform policies and procedures for the extramural programs of all Service components, and to establish a central point of contact and information for all PHS clientele. A coordinated means of processing statistical data will be devised to provide necessary Service-wide information to the OSG and to provide each Bureau with the information necessary to carry out its program responsibilities. Study sections and review committees will be administered at the Bureau level to assure that each Bureau receives full benefit of the scientific competence represented by these expert groups. Conclusion The rapid growth of Federal involvement in health affairs has made our present organizational structure obsolete and dictated the need for reorientation. There is every reason to expect that this involvement will continue to grow and diversify. Therefore, any structure must be adaptable to change. Flexibility is an essential ingredient. The Public Health Service structure just described is ready for adoption. Meanwhile two proposals not included in this plan, suggested by the Corson Committee and mentioned in my January 18 memorandum, should be examined thoroughly for future consideration. The first of these would create a bureau of the Public Health Service designed to deal comprehensively with the health problems of children. Child health is an area of great ferment. The past three years have seen the emergence of major new programs in mental retardation, the creation of an Institute of Child Health and Human development, and the enactment of Title 19 of the Social Security Amendments with its far-reaching implications for the health of chil dren. Still greater emphasis can be anticipated in the immediate future. I would urge, therefore, that existing organizational patterns be carefully examined in the light of changing responsibilities of the Department, looking toward a possible reorientation of the total Federal effort in the field of child health as these responsibilities become clarified. The second of these proposals would create a Bureau of Health Systems Development to apply the systems methodology which has proved successful in other complex fields to the delivery of health services. This Bureau would have its nucleus in the regional medical programs established by the Heart Disease, Cancer and Stroke Amendments of 1965 and might eventually incorporate other Service programs. This is a challenging and promising concept. I feel, however, that the regional medical programs are well placed at the National Institutes of Health for the period of initial development, and that this organizational move should also await further study. APPENDIX J LIST OF MAJOR FUNCTIONS OF THE PUBLIC HEALTH SERVICE 1. To provide leadership and direction in the national health scene. 2. To contribute to the advancement of health knowledge through research. 3. To contribute to the improvement and extension of community and personal health services. 4. To help promote and maintain a healthier environment. 5. To enlarge and improve manpower resources for health. 6. To increase and improve health facilities. 7. To provide direct health and medical services for its legal beneficiaries and and for special groups in the population. 8. To work with other national and international agencies in the solution of international health problems. 9. To participate with other agencies of the Federal Government in discharging their various health functions. 10. To collect, evaluate, and present statistical data and other intelligence relating to the health status of the Nation. 11. To provide library services to advance communication in medicine and the health sciences. 12. To provide information on health and well-being to the health professions, health agencies, and the general public. Senator RIBICOFF. Dr. Lee, do you want to start? STATEMENT OF DR. PHILIP R. LEE, ASSISTANT SECRETARY (HEALTH AND SCIENTIFIC AFFAIRS); DONALD F. SIMPSON, ASSISTANT SECRETARY (ADMINISTRATION), DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE; DR. WILLIAM H. STEWART, SURGEON GENERAL OF THE UNITED STATES; AND HAROLD SEIDMAN, ASSISTANT DIRECTOR FOR MANAGEMENT AND ORGANIZATION OF THE BUREAU OF THE BUDGET Dr. LEE. Gentlemen, Mr. Chairman, I submit the statement for the record, but there are several points I think should be emphasized in this statement. On page 3, a very short couple of paragraphs in the middle of that page emphasize the great change that has occurred in the responsibilities which the Public Health Service has undertaken in the last 20 years. In the last 20 years the Congress has assigned 50 major new responsibilities to the Public Health Service. The budget has increased more than 4,000 percent-from $52 million in fiscal year 1943 to $2.4 billion in fiscal year 1966. The staff has doubled, increasing from 17,000 to 34,000 employees. In short, the Service has undergone enormous growth in the past two decades. Yet, an outdated statutory restriction prevents us from making the basic structural changes necessary to accommodate this growth. The rapidly increasing pace of change also is another important factor. The legislation passed by the 1st session of the 89th Congress highlights the added responsibilities for the Public Health Service, and other agencies in the Department. We have, for example, such major new responsibilities as the medicare program. Here it was possible in the Social Security Administration to organize a new bureau to deal with this major new responsibility. The Public Health Service was given major responsibilities in the development of standards for the providers of services but, we did not have the same kind of organizational flexibility there that we had in the Social Security Administration. I think this is the basic problem with these rapidly increasing responsibilities. We have not had the organizational flexibility in the Public Health Service to rapidly respond to these new demands. The second major point I would like to make—and this relates to the discussion which begins on page 6—is that a committee under John Corson, of Princeton University, with a number of distinguished citizens working with him, worked with the Surgeon General and the Public Health Service to develop a series of alternative organizational proposals. These were thoroughly reviewed in a series of hearings |