mental health matters deep within a Bureau of Disease and Injury Con trol and Prevention is hardly dynamic leadership on the part of the Public Health Service. In fact the present plan clearly indicates that the persons responsible for it are not sympathetic to the need for an effective program in Environmental Health which has been clearly justified by the findings of various expert groups. Rather they are content to relegate serious environmental control matters of national concern to a position of minor importance under a medically oriented bureau. As a matter of qualifying my remarks, I have been employed in the professional practice of Sanitary Engineering for 16 years. Since 1957 I have been involved in Sanitary Engineering education and research and have served as a con sultant to industry, state and federal agencies. In addition I have had the op portunity of viewing national problems of environmental health research and training by serving on several research and training grant review panels. In my present position as Head of a relatively large Department of Civil Engineering which has an active program of graduate and undergraduate training and research. I am often called upon by persons from cities and state and federal agencies. Their common plea is for graduate trained engineers and for answers to engineering problems dealing with control of a healthful environment. Development of effective programs to fulfill these and other needs by using the talents of the universities as well as the dedicated employees of federal and state agencies will require progressive leadership. It is unlikely that such leadership will develop when the environmental health programs are buried in a Bureau of Disease and Injury Prevention and Control. I therefore urge that your committee strive for the establishment of a Bureau of Environmental Health within the U.S. Public Health Service in order that these important programs will receive the attention they deserve. Sincerely, FRED J. BURGESS, Head, Department of Civil Engineering. EXHIBIT 5 NORTH WESTERN UNIVERSITY, Hon. Senator ABRAHAM RIBICOFF, Washington, D.C. DEAR SENATOR RIBICOFF: I am writing you concerning the re-organization plan number three, which the President sent to Congress on April 25, 1966 and the memorandum which Surgeon General William H. Stewart sent to Secre tary Gardner regarding ideas for the re-organization of the U.S. Public Health Service, April 18. This plan relegates environmental health and the engineering of man's environment for the betterment of his health to a Bureau of Disease and Injury Prevention and Control. There has been several reports during the past years made by committees of highly qualified people which have recommended that there be a Bureau of Environmental Health in the U.S. Public Health Service. While a member of the National Health Advisory Council from 1956-1960, I served for a time on a committee which made a study and recommended a Bureau of Environmental Health in the Public Health Service. Like all people in the area of environmental health and sanitary engineering, I feel strongly that this important area of public health activity should be set up as a bureau. For many years it has existed under such areas as the Bureau of State Services, without proper recognition. The results of inadequate recognition and consideration for environmental health activities have led to the breaking off of many areas of environmental health and sanitary engineering from public health leadership. The fields of water resources, water supply, waste disposal. and water pollution are examples. Environmental health embraces much more than disease control and injury prevention. Many deleterious aspects of environment do not involve disease control. In fact, many undesirable air pollution conditions do not have a direct relationship to disease control. Nor do they affect health to a significant degree other than to make persons uncomfortable in an atmosphere which is polluted and disagreeable to the senses. We need-through engineering and other physial controls-measures to maintain a desirable environment not only from the viewpoint of health but also from the viewpoint of decent living. The knowledge we need to obtain through research to control man's environment does not relate only to disease prevention. The Public Health Service, in dealing with man's environment, should consider the entire problem of environmental control and should identify one bureau with all aspects of the control of man's physical environment. The maintenance of public health is related to two major areas of endeavor. One is the medical aspects of public health through which professional people in medical science attempt to adapt man to his environment. This may include a variety of health activities, such as vaccination, innoculation, and other medical endeavors which improve man's ability to cope with environment. The second area is that of environmental control which is related to engineering and physical control of the environment. This might be referred to as hygiene of the physical environment. I urge that you obtain the judgment and advice of able practitioners in the field of environmental health. Members of the sanitary engineering and environmental scientific groups, who have had experience and have seen the strict relegation of environmental activities to disease-related medical groups, certainly do not agree with the concept of a Bureau of Disease and Injury Prevention and Control. I hope that in your important position in government you will see that the area of environmental health is adequately handled in the reorganization of the U.S. Public Health Service. Sincerely yours, EXHIBIT 6 HAROLD B. GOTAAS, Dean. Hon. ABRAHAM RIBICOFF, DUKE UNIVERSITY, DEPARTMENT OF CHEMISTRY, Chairman, Senate Subcommittee on Executive Reorganization of the Committee on Government Operations, U.S. Senate, Washington, D.C. DEAR SENATOR RIBICOFF: Professor Emil T. Chanlett of the Department of Environmental Sciences and Engineering, the University of North Carolina at Chapel Hill, has written me about the hearing which you chaired on Friday, June 17, relating to the issue of the place of environmental health in a reorganized Public Health Service, and has suggested that I write you giving my own views of this matter. Before doing so I should first advise you of the background of my own interest and connection with environmental health matters. I became involved in these in the Summer of 1961 when the former Surgeon General, Dr. Luther Terry and Dr. Jerome Weisner, the Science Advisor to the late President Kennedy, asked me to organize and chair a broadly constituted committee to study and project the national problems in the environmental health area. In the late Fall of 1961 this committee issued a report on environmental health problems, commonly referred to as the "Gross" report, which you have, no doubt, seen. The major burden of this report was to point out the magnitude of the grave problems which the nation would face from various environmental hazards as it moved ahead industrially and technologically, and to urge that these be studied from a broad integrated point of view. The committee further pointed out that the magnitude of the problems was such that their solution would require cooperation from both public and private agencies and that adequate machinery and organizational structures at the federal level should be developed to give focus and leadership to the over-all effort in the environmental health field. While recognizing the proper and appropriate interest of other groups, such as conservationists, those interested in the development of our water resources and many others, it was the committee's thesis that the primary consideration in this area should be that of human health. In consequence, we strongly recommended that the leadership effort should be centered in the Public Health Service in H.E.W. While the developments of the past five years, in terms of public awareness of environmental health problems, have been gratifying in terms of the lack of such in terest in many governmental areas in 1960, many of us who have been involved actively in this area are now concerned that the integrated approach, referred to above, will become so fragmented that an over-all fundamental attack on environmental health problems may prove to be very difficult. Because of this situation I wrote Dr. John W. Gardner, the Secretary of H.E.W., this past March about the matter. in view of the proposed reorganization of the Public Health Service, which I presume by now Congress has authorized him to proceed with. Rather than going over the same ground in this letter to you, I am enclosing a copy of my letter to Secretary Gardner, which sets forth the direction which many of us concerned with this area feel should be taken in relation to any reorganization of the Public Health Service. I gather from Professor Chanlett's letter to me that your own view of the proper course which this reorganization should take is close to that which I have expressed in my letter to Secretary Gardner. Furthermore, developments in the past few days and weeks indicate to me that it is important to have this view strongly presented in relation to the proposed reorganization of P.H.S. The most recent plans of which I am aware are that the Public Health Service would contemplate combining its activities in the environmental health field, together with those of the present Bureau of Communicable Diseases, in some type of combined organization, as yet, not clearly defined under the title of a Bureau or element within the Public Health Service to be known under the title of Disease Prevention and Environmental Control. In my own judgment, this coalition is a move in the wrong direction nad will surely deemphasize the importance of the environmental health sector. Many of those in the professions concerned, labor and community groups involved have become aware of the hazards which we face from the environment and have associated these with the term "environmental health." To dilute this now within the activities of the Public Health Service would, in the view of many of us, result in the loss of much ground that has been gained in focusing government and public attention on the over-all problem in recent years. Furthermore, as I point out in the enclosed letter to Secretary Gardner the segment of the scientific and technical professions which has done so well in the disease oriented activities of N.I.H. and the communicable disease center is not the most appropriate group to give the needed leadership in the environmental health areas where the problems range all the way from the natural and physical sciences through many of the disciplines of the social sciences. Those of us interested in the matter are indeed pleased to learn of your own interest and activities in assuring that a sound, federal structure will be developed so that effective federal leadership can be given to the many agencies that are now deeply concerned with the broad and complex problems of the environmental health area. Very truly yours, PAUL GROSS, William Howell Pegram, Professor Emeritus of Chemistry. Hon. JOHN W. GARDNER, Secretary, Department of Health, Education, and Welfare, MARCH 23, 1966. DEAR JOHN: Knowing the pressures which you must be under, in view of the expanding activities of H.E.W., it is with some hesitation that I write to bring to your attention some current trends in the area of environmental health activities. I do so not in my present capacity as a member of the National Advisory Environmental Health Committee, but as one who has been heavily involved in various advisory capacities in this area since I was asked to chair the former Surgeon General's Committee on national environmental health problems in August, 1961. It is from this standpoint that I am passing on to you the following comments. 1. In the Fall of 1961 when the report of the Committee, referred to above, was issued, there were encouraging signs of increasing interest and concern in the mind of the public, and even in Congress, about the development of effective measures to meet the rapidly mounting problems in the environmental health area. Following the issuance of our report I was involved in a number of hearings and discussions with top level advisory scientific groups and representatives of the Bureau of the Budget concerning federal planning for action in the area. In relation to these, I would be less than frank if I did not say that I encountered considerable lethargy and lack of understanding in the scientific and technical groups involved, though not in the Bureau of the Budget, about the nature and magnitude of possible courses of action which should be taken with respect to federal activity and support in this area. 2. The five years that have elapsed since have seen a dramatic change in this attitude. This is perhaps best typified by the recent issuance of the P.S.A.C. Panel Report endorsed by the President, entitled "Restoring the Quality of Our Environment," and by the various acts passed by Congress during the past several years. Those of us who have been heavily involved in discussions relating to this area are greatly gratified by this broadened interest and concern. With these remarks as background, let me return to the matters which bring me to write you at this time. 3. Our Committee in 1961 was broadly representative of a wide scope of interests concerned with the changes taking place in our environment. Its members included those interested in recreation, wildlife and conservation, in the problems arising from rapid metropolitan area growth and similar matters. In spite of this wide divergence of interest and allegiance one of the unanimous points of agreement in our discussions was that human health in the broader sense should be given primacy among the considerations which had to be taken into account in projecting future plans for federal leadership and participation in the environmental health field. 4. The Committee further agreed that prior approaches to the scientific and technical aspects of environmental health problems had been quite fragmentary in nature and that there was a need for a broadly integrated approach on the scientific side to undergird and back up the heavily categorical approach through the divisions of air and water pollution, occupational health, etc., traditional in the Public Health Service activity in environmetnal health. The Committee's proposal for development of such an integrated approach was the establishment of a high level environmental sciences group within the Public Health Service which has since emerged after many vicissitudes in the form of the Environmental Health Sciences Center now being developed in the Research Triangle in North Carolina. The Committee's hope in proposing such a unit was not only that it would be free to carry out the basic mission related to research needed to undergird the existing somewhat fragmented categorical activities within the Public Health Service, but that it would also supply back-up services to the various categorical technical groups within the service. The ability of such a Center to perform the latter functions is obviously diminished by its separate location in North Carolina away from the main body of U.S.P.H. environmental health activities in the Washington area. However, this is a decision that has been taken and, as such, is water over the dam. 5. Beyond the diminution in functional effectiveness just mentioned, there is a more serious matter relating to this Environmental Health Sciences Organization which comes from the rumored news of the impending reorganization of the U.S.P.H.S. in the February 1 Environmental Health Letter. This, for what the information from such a source may be worth, outlines a multi-bureau structure under which environmental health activities in the U.S.P.H.S. would be put under a Bureau of Disease Control and the new Environmental Health Sciences Center would come under a Bureau responsible for the National Institutes of Health and become another of such institutes. 6. In commenting on this reorganization the following quotation appears: "The greatest need in environmental health is for scientific information on the impact of contaminants on human health. This is essentially a research challenge, susceptible to organization and administrative methods which have proved successful in other health fields. The N.I.H. structure would provide the most appropriate and efficient setting for this environmental research program". The statement in the first sentence, though obvious to many today as it was not five years ago, is correct in substantial measure. This is still a great need in environmental health and will continue to be for some decades ahead. However, I and many of my colleagues involved in environmental health activities have grave doubt that such a research activity should be placed under the N.I.H. organizational structure as proposed in the statement. This is not to be construed as any reflection on the fine record of the Institutes in the medical research field under the policy guidance of the university medical groups and with cooperation from the private sector through the pharmaceutical industry. The achievements of this team in disease control and "crisis medicine" (as in surgery) are indeed impressive. However, the problems of environment health are of a much broader type and their solutions will require cooperation from a much wider range of disciplines from mathematics through the social sciences. 7. If such a reorganization of the U.S.P.H.S. goes forward, it is the strong feeling of many, including myself, that the focus on health which we would like to see as a primary consideration in federal environmental health planning and activity could best be achieved through the establishment within the U.S.P.H.S. of a bureau or similar organizational entity for environmental health headed by a top official reporting directly to the Surgeon General and to the Secretary of H.E.W. Without such clear identification and assignment of federal health responsi bilities in the environmental health area the current trend toward fragmenta. tion of these, both within H.E.W. and throughout other federal departments, will almost surely continue. Within such a proposed bureau or other structural identification as suggested here, consideration should be given to the designation of a Center in North Carolina, not as another N.I.H. institute, but as a "National Laboratory of Environmental Health Sciences". As such, it would retain a real measure of integration with other environmental activities with U.S.P.H.S. and report administratively to the same top official that headed a Bureau of Environmental Health or other organizational entity. This type of organizational pattern has been effective in A.E.C. in promoting both basic and applied research and would be better adapted to solve the varied problems encountered in the environmental health area than one which divides the U.S.P.H.S. "health" component within the area between a Bureau of Disease and one of the NIH Institutes. This has turned out to be a much longer letter than I intended to burden you with, but I felt I must put these comments before you for your consideration and that of your associates in the interest of achieving the best organizational pattern to handle the heavy problems that lie ahead in the environmental health field. Sincerely yours, PAUL GROSS, Professor Emeritus of Chemistry. DEAR SIR: In reporting a recent hearing of a subcommittee on Government Operations, the Sunday Times of June 19, 1966 had a brief "AP" item which ended as follows: "Senator Ribicoff complained about a plan that would put environmental health services in a new bureau of disease and injury prevention and control. 'It's downgraded as far as a name is concerned', he said. 'You do the cause of elimination of environmental hazards a great disservice". I write to you now to tell you that I agree with these views that you were said to have expressed. I do this as a former career medical officer in the Public Health Service from which I retired after over 21 years. My last two assignments in the Service were 1). Chief, Division of Occupational Health and 2). Assistant Chief, Division of Air Pollution. My interest in environmental hazards to health continues in my current position at the Harvard School of Public Health. I saw the "birth" of the unified concept of environmental health and was greatly impressed by its potential for the public health. The current trend indicates to me that this unified concept will not be allowed to mature. To me, and many others in public health, designations do matter. Respectfully yours, HARRY HEIMANN, M.D., Senior Research Associate in Environmental Health. |