Senator COOPER. Would this be made-would it be paid from the highway trust fund? Senator DOUGLAS. No, this is to be paid from the General Treasury but the sum is not to exceed the revenues from the 1 percent tax which is at present a permanent tax. I don't think the $190 million would be needed. We hope that the cost of reducing the junked cars to steel could be reduced through the development of new techniques and the steel industry could be given encouragement to purchase those cars at a price which would keep the scrap moving. It may be that the addition of $10 per ton would make it profitable to get rid of the cars under present processes. Senator COOPER. I think it would be valuable if you could furnish to the committee such statistical information as you may have about the cost to private industry for buying and transporting this steel and iron scrap to industrial plants so that we would have some idea of the amount of the subsidy that would be necessary. Senator DOUGLAS. We will try to assemble that. I think if the price of the steel would be increased by $10 that it would be worthwhile for the processors to process most of them. If that is so-I think that is the best estimate I can get then $50 million would provide for the disposal of about 5 million cars that cannot be handled now. Senator COOPER. I assume that you consider this not one problem not as one that will be dealt with once and solved. The turnover in cars this will be a continuing problem. Senator DOUGLAS. That is quite right but new techniques in processing could promote full utilization of scrap steel. Senator MUSKIE. Have you assembled any data, Senator Douglas, from the steel companies? Senator DOUGLAS. We have material for the steel processing industry and for the steel companies. As I have said, there is a diminishing demand for scrap steel, not only because of the spread of the oxygen process but also because of the overcapacity of pig iron. They have apparently a greater pig iron capacity than can presently be absorbed so that they want to utilize the pig iron capacity rather than buy additional quantities of steel scrap. Senator MUSKIE. Thank you very much, Senator Douglas. The committee will give serious attention to this legislation as a sensible first step toward the solution of the problem. Senator DOUGLAS. Thank you very much. Senator MUSKIE. It is a pleasure to welcome again the distinguished Secretary of Health, Education, and Welfare, Secretary Gardner. Mr. Secretary, before you get into your statement on the subject of this hearing I wonder if I might ask you a question about the water pollution activities of the Department under the new reorganization which has taken effect. I have with me a proposed organization chart of the Public Health Service. There is nothing in the chart to indicate where the continued water pollution activities of the Public Health Service will be located. As you recall the new organization contemplates a new water pollution program of the Public Health Service in relation to public health. I wonder if you could identify that activity in the Public Health Service and under the new organization? 64-886-66- 2 STATEMENT OF HON. JOHN W. GARDNER, SECRETARY OF HEALTH, EDUCATION, AND WELFARE; ACCOMPANIED BY DEAN COSTON, DEPUTY UNDERSECRETARY; DONALD SIMPSON, ASSISTANT SECRETARY FOR ADMINISTRATION; AND PHILIP R. LEE, ASSISTANT SECRETARY FOR HEALTH AND SCIENTIFIC AFFAIRS Secretary GARDNER. Yes, Mr. Chairman. There are two locations in the new organization at which the water pollution control activities will be carried out: First, the research activities will be in the National Institutes of Health, in the new Environmental Health Sciences Center. Second, the enforcement activities will be in the Bureau of Disease and Injury Prevention Control. This is one of the five new Bureaus to be created. Those are the two places at which water pollution control will be dealt with. As I have indicated in earlier testimony, the Department will continue to take a very keen interest in the health aspects of water. Senator MUSKIE. Now in the Bureau of Disease and Injury Prevention Control, the following programs are listed, Division of Accident Prevention, Division of Chronic Disease, Communicable Disease Center, Arctic Health Research Center, Division of Environmental Engineering and Food Protection, Office of Solid Wastes, Office of Pesticides, Division of Air Pollution, Division of Occupational Health, Division of Radiological Health, and Divison of Foregn Quarantine. Those do not on their face indicate where this program is located. Secretary GARDNER. Yes. I have a new memorandum which I can submit which will clarify this considerably. Would you like me to put that memorandum in the record? Senator MUSKIE. Yes, if you would. But I will say now that water quality is dealt with at several points in the division which you listed. It is dealt with in the Division of Environmental Engineering and Food Protection. It is dealt with in the Communicable Disease Center because there are some aspects of this which relate directly to the work of that organization. Those are the two main ones. Senator MUSKIE. We will study your memorandum. Secretary GARDNER. I will supply it. (Subsequently the following memorandum was submitted:) MEMORANDUM JUNE 6, 1966. From: Surgeon General. To: Chief, Bureau of State Services. Subject: Reorganization of the Bureau of Disease and Injury Prevention and Control. In the light of your memorandum of April 18, 1966, on the subject of the reorganization of the Public Health Service, I have had discussions with a number of persons with respect to the Bureau of Disease and Injury Prevention and Control. Whether or not that particular title is retained, I believe it is now appropriate to present to you some thoughts for your consideration on how this Bureau might be organized. The functional reorganization which you envision for the Service provides a unique opportunity for focusing this Bureau on the primary mission of the Public Health Service: protecting human health. This Bureau's contribution must be the preventing of disease, disability, defect, and premature death to the full extent that our knowledge permits. Traditionally, our approach has concentrated individually on the components of the classic triad of "agent, host, and enviroment," and for many years this has served us well. However, the increasing sophistication of technology and the steadily mounting complexity of our civilization have pushed the problems of health hazards beyond the reach of the old approaches. Thus it becomes essential for the newly organized Bureau to work at the interface of the three elements-agent, host, and environment-in order to achieve a new dimension in its attack. Along with the primary mission of protecting human health, there is an inherent further aim of enhancing human well-being. To the extent that this includes secondary goals such as preventing economic losses, ameliorating social ills and otherwise improving the quality of life, the Bureau will pursue these aims within the limits of its capabilities, resources, and authority, and in full recognition that others have duties and responsibilities therein. Our emphasis, however, as a component of the Public Health Service is and must be upon human health. A. FUNCTIONS OF THE PROPOSED BUREAU The objectives of the Bureau are (1) to eliminate, when we know how to do it, otherwise to reduce environmental hazards and the exposure thereto, (2) reduce the incidence of and exposure to infectious diseases, (3) to reduce accidental injury and death, and (4) to provide means of early identification and diagnosis of conditions (usually of cause unknown) so that further disability, or death, may be prevented or, at least, the illness alleviated. Functionally, the Bureau accomplishes these purposes through two mechanisms-research and action. Research is aimed at identifying the causes of disease, or conversely, discovering the effects of agents and hazards, through epidemiologic and laboratory research. This subsumes the development of analytical tools, diagnostic approaches, and measurement methods requisite to such studies. The development, then, of protective methods follows, designed to reduce exposure or adapt the host to render him less susceptible. Testing and evaluation of these methods will lead to standards and criteria designed to protect health. The second function, action, is aimed at applying this knowledge by assuring that standards, criteria, and guides are met and, where necessary, enforced. Education of health workers and the public, technical assistance and consultations are, of course, the methods of choice. Obviously, these methods alone cannot perform the entire job, especially as more and more of the complex problems requiring action now involve some interference with, or at least circumscription of, the activities of groups, communities and institutions. Hence, enforcement will become an increasingly important segment of our activities. We intend to organize to pursue this function vigorously. B. PROGRAM COMPONENTS OF THE PROPOSED BUREAU The following units are proposed as program entities within the Bureau. The proposal is made in recognition of facts having to do with size, political importance, contribution to mission, program status and position. I would anticipate that all these proposals are not static and that further realinement will be desirable and necessary: 1. Air pollution. 2. Water supply. 3. Solid waste. 4. Accident prevention. 5. Radiological health. 6. Occupational health. 7. Communicable disease. 8. Chronic disease. The activities to be placed in the new Bureau will bring together organization elements which are now separated, but which have complementary competencies and assignments. The program components will be strengthened by this regrouping, which will permit more effective coordination and better targeted efforts by particular units in relation to the larger program goals. Such strengthening is particularly expected in accident prevention and occupational health. Three components are not shown above: Environmental engineering and food protection, foreign quarantine, and pesticides. In the case of EEFP, two of its major activities, water supply and solid waste, are listed above as separate program entities. The remainder includes urban planning, which, because of its Bureau-wide significance, should be incorporated at the Bureau level in general program planning: Interstate carrier activities, which will be split between water supply and milk and food; and milk and food activities. The last of these-milk and food activities, with which some of the interstate carrier activities would be combined-would then itself be divided into two parts. The activities related to microbiological contamination would go to the Communicable Disease Center (CDC), while those related to chemical contaminants as well as those planned in nutrition would be placed in the chronic disease program. Foreign quarantine activities need the laboratory and epidemiologic services of CDC, and appropriate administrative structuring is planned accordingly. Finally, the present pesticides activity is envisioned as the forerunner of a program of chemical epidemiology, devoted to discovereing relationships between toxic agents and health problems in the community. I propose that it be placed in the chronic disease program. Its purpose would be to carry out epidemiological studies, to establish the relationships between chemical or other toxic agents and disease, and to develop the necessary techniques for the measurement of the agents. It would assist the other units of the chronic disease program in the development of techniques for the identification of disease conditions and of action programs aimed at prevention. These activities, many of which are related to categorical disease problems-the control of cancer, heart disease, neurological conditions and metabolic problems-work at three levels of prevention: Primary, to prevent onset of disease; secondary, to identify, through screening techniques, early cases; and tertiary, to prevent further development of disability and handicap in persons already afflicted. As an interim step in this direction, I will put responsibility in CDC for managing all of the pesticides activities of the present Bureau. I propose to accomplish this immediately, with the remainder of that reorganization to be carried out some months from now. The proposed new Bureau will have many field components. Some, such as CDC and the research and training activities in Cincinnati, will be operated Bureau-wide, with elements of all program activities represented therein. Others, smaller in size, such as the radiological health laboratories, shellfish sanitation laboratories, occupational health field facilities, and certain field study stations for heart disease, cancer control, and other chronic diseases, will be primarily or exclusively single-mission oriented and will be operated directly by an individual program. The Arctic Health Research Center is a special-purpose facility cutting across several areas of effort. Both types of field units are necessary to fulfill the purpose of the Bureau. The larger and more comprehensive facilities can permit the development of a national resource of the highest competence in one broad area of the Bureau's concern. They can also provide for technical assistance and training in environmental hazards, across the board, so as to assure proper emphasis on the areas of discovery, prevention, and control that can only be developed by the intertwining of parts of several programs, or by their close juxtaposition. We have such a center of national competence in Atlanta, in CDC, which is known worldwide for its work in infectious diseases. We have another major base in Cincinnati. This we plan to develop into a major center for work on chemical and engineering hazards commensurate with the problems and demands of the last third of the century, as the Robert A. Taft Sanitary Engineering Center and its predecessor activities have done so well for the problems of the first two-thirds of the century. Both centers will carry a full range of technical assistance and training programs, thus permitting some geographic specialization and offering a greater convenience in travel for trainees than now exists. Smaller field stations may provide limited training courses as well as carrying on their primary mission, be it research, technical assistance, or other activity. Staff in the regional offices will more and more become generalists offering assistance and advice in the planning and execution of State and local health programs on a broad front. Detailed assistance on particular programs will more and more be provided by field station personnel, as has been so successfully done by CDC. We plan to continue to develop effective and efficient means of providing administrative services for field stations. Both the CDC network of field stations and the environmental health network have made significant strides in this area. These will be adjusted as required and built upon in the new Bureau. C. ORGANIZATION OF THE OFFICE OF THE BUREAU CHIEF The role of the office of the Bureau Chief would appear to me as containing two major functions-providing the overall policy and procedural guidance needed to integrate the programs; and providing the framework and base so that the programs can best accomplish their missions and meet their objectives. These two functions are not always viewed as compatible, but I believe much of the incompatibility may be reduced by organizing the office of the Bureau Chief functionally much as I view the reorganization of the Service. I would propose that the office of the Bureau Chief provide staff positions to cover the principal functions implicit in the outline above-specifically: Research and development; compliance and control; standards and intelligence; program planning; and administration. I would envision an Associate (or Assistant) Bureau Chief responsible for each of these. Because the titles (which are not necessarily final) are not adequately descriptive, the following is intended to lay out more clearly the roles proposed. 1. Research and development This Associate Chief would advise the Bureau Chief on all elements of research to assure coordinated plans, minimizing gaps and overlaps. He would see to it that projects are in keeping with mission and objectives and that proper balance between in-house, contract, and extramural research is developed. Scientific staff would include five to seven recognized scientists representing such disciplines as epidemiology, engineering, medicine, and chemistry. This group would be acquainted with research and development activities in the Bureau, NIH, other agencies, universities, and other institutions, in order that all resources available may be drawn upon to support our mission. They would then serve as the principal liaison with NIH and its component National Environmental Health Sciences Center. 2. Standards and intelligence This Associate Chief would see to it that through the activities of our divisions, through cooperation with other governmental agencies, and with interested nongovernmental groups, standards and criteria were established on environmental injury and disease hazards to prevent undue exposure to the general population. He would also provide Bureau leadership for the development of integrated Bureau intelligence and surveillance programs. 3. Compliance and control This Associate Chief would be directly concerned with the development of action programs to be carried out by the Federal Government or to be implemented by States and localities with PHS guidance. These action programs include the development of technical assistance programs, with particular emphasis on new approaches, assessment of manpower needs and provision for training to meet the needs in the light of compliance and control requirements and for overseeing PHS responsibilities for abatement and enforcement activities established in law. 4. Program planning The Associate Chief for program planning would be responsible for developing recommended Bureau objectives and goals, for insuring that technical program content is appropriate to these goals, for assessing program accomplishments in relation to plans and goals, and for developing legislative proposals to meet new needs. He would implement the procedures of the PPB system. 5. Executive officer The executive officer would be responsible for participating in the development of recommended Bureau objectives and goals, for insuring that resources necessary to carry out programs are effectively acquired and utilized, for providing a management information system in support of all Bureau operations for the PPB systems design and systems analysis, and for oversight and evaluation of administrative management activities throughout the Bureau. In addition, the office of the Bureau Chief would provide a small staff for information activities. |