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Action.-Take necessary steps to secure the appropriation of sufficient funds to meet this standard. IV. Periodic health services

Standard.-Periodic special services are vital to maintenance of public health, even in small communities. A minimum standard includes the holding at regular intervals of well baby, dental, rabies, and immunization clinics.

Action.-Provide the personnel and facilities to schedule these as necessary. V. Health board

Standard.—Every county should have an active board of health which meets regularly.

Action.-Secure appointment of board, if necessary, and encourage regular meetings. VI. Citizen participation

Standard.--There should be some type of health planning group (health council, health committee, etc.), with representation from various organizations, such as PTA, civic clubs, etc., and it should hold regular meetings.

Action.-Select individuals to take leadership positions in such a group. Encourage an active program-study, publicity, support of health functions, etc. VII. Voluntary health agencies

Standard.--Each county should have a number of voluntary agencies contributing to the public health, such as Cancer Society. Health Association, Tuberculosis Association, Mental Health Association, and similar community organizations. Financing may be by separate campaigns or by a united effort, such as United Givers Fund.

Action.- Organize as needed. VIII. Health personnel

Standard.-Physicians, dentists, and nurses in reasonable ratio to the population are necessary for maintenance of health of individuals.

Action. If such personnel are not available within reasonable distance and in reasonable ratio to the population, then perhaps special recruitment efforts should be undertaken, or even, as some smaller communities have done, special inducements may be extended, such as assurance of income, provision of facilities, etc. IX. Hospitals

Standard. There should be hospitals with sufficient capacity to serve the entire population within a reasonable distance.

Action.—Contact the Tennessee Department of Public Health for assistance in developing a program for any necessary constructing or expanding of public or nonprofit hospitals and related health facilities. Encourage and assist private organizations to provide facilities as required. X. Accreditation of hospitals

Standard.In addition to licensing by the State licensing board, a hospital should be accredited by the Joint Commission on Accreditation of Hospitals (composed of five national medical associations).

Action.—Urge hospital authorities to make improvements in facilities and quality of service which will obtain accreditation. XI. Prescriptions

Standard.-Prescription druggist (s) should be located within a reasonable distance.

Action.Provide inducements if necessary to make this service available within the immediate area of the city.


1. Governmental health agency

The city is served by : 8 a combined city-county health department 8

a county health department 3

separate city and county health departments 0 no health department

SCORE (Maximum 8)


II. Adequacy of staff

(a) The health department(s) serving the city: 5 has a full-time health officer 2 has a part-time health officer 0---- has no health officer

SOORE (Maximum 5) (b) The number of sanitarians in proportion to the county population is : 5 at least 1 to 15,000 2 1 per 15,000 to 1 per 25,000 0 1 to 25,000 or more

SCORE (Maximum 5) (c) The number of public health nurses in proportion to the county population is : 5 at least 1 to 5,000 2 1 per 5,000 to 1 per 10,000 0 1 to 10,000 or more

SCORE (Maximum 5) III. Financial support

Annual expenditures by the health department amount to: 5 at least $2 per capita 4 $1.50 to $2 per capita 3 $1 to $1.50 per capita 1 50¢ to $1 per capita 0 less than 50¢ per capita

SCORE (Maximum 5) IV. Periodic health services

The following clinics are held regularly for this city (check as applicable): 1 -- well baby 1 dental 1 rabies 1 immunization 0 no clinics are held

SCORE (Maximum 4) V. Health board

Does the city (county) have an active board of health which meets regularly? 3

yes 0

SCORE (Maximum 3) VI. Citizen participation

Is there a citizens group which meets regularly and actively supports the public health functions? 3

yes 0

SCORE (Maximum 3) VII. Voluntary health agencies The following agencies are active in this city (check as applicable) : (score

United Givers Fund (or similar title) each

Cancer Society 1

March of Dimes up to

Heart Association maximum Tuberculosis Association of 5)

Mental Health Association 0 ---- no such agencies are active

SCORE (Maximum 5) VIII. Health personnel

(a) The number of physicians in proportion to the county population is : 9. at least 1 to 800. 7.

1 per 800 to 1 per 1,200. 5

1 per 1,200 to 1 per 1,500. 2

- 1 per 1,500 to 1 per 2,000. 0---- 1 to 2,000 or more.

SCORE (maximum 9)



(6) The number of dentists in proportion to the county population is : 7 1 to 1,000 or less. 5 1 per 1,000 to 1 per 1,500. 3 1 per 1,500 to 1 per 2,000. 2 1 per 2,000 to 1 per 2,500. 0 1 to 2,500 or more.

SCORE (maximum 7) (c) The number of registered nurses in proportion to the county population is : 6 1 to 500 or less. 4 1 per 500 to 1 per 1,000. 2 1 per 1,000 to 1 per 1,500. 1 1 per 1,500 to 1 per 2,000. 0 1 to 2,000 or more.

SCORE (maximum 6) IX. Hospitals

(a) Hospital(s) adequate to serve the population of the city is (are) located : 10 within the city or within 30 minutes traveling time. 0 at a distance requiring more than 30 minutes traveling time.

SCORE (maximum 10) (6) The number of general care hospital beds in proportion to the population served is: 17 4 or more to 1,000. 14 3 per 1,000 to 4 per 1,000. 10 2 per 1,000 to 3 per 1,000. 5 1 per 1,000 to 2 per 1,000. 0 1 or less to 1,000.

SCORE (maximum 17) X. Accreditation of hospitals

In respect to hospitals serving the city : 3 all are accredited by the Joint Commission on Accreditation of Hospitals. 1 some are accredited by the oint Commission. 0 none are accredited by the Joint Commission.

SCORE (maximum 3) XI. Prescriptions

Prescription druggist (s) is (are) available: 5 within the city or within 30 minutes traveling time. 0 at a distance requiring more than 30 minutes traveling time.

SCORE (maximum 5) Future program.-List measures to be taken to overcome deficiencies shown herein; then number to suggest priority.

Mr. BINGHAM. We are uttterly convinced, from observation and experience, that no community can hope to participate in the prosperity of our industrial economy if it does not meet reasonable standards of adequacy in its water, sewage, and health services. And looking at it from a national viewpoint, one of the factors which is slowing the expansion of the U.S. economy is inadequate basic public facilities and the accompanying and resulting waste and inefficiency.

I plead it as being a national problem of national interest. I visited Europe last summer. We are building sewer systems and water systems all over the world with low-interest loans and grants but we are confronted with this, and I will repeat it, disgraceful deficit in our own country and we are paralyzed and immobilized and I think it represents an almost fatal blindspot in the view of our National Government.

The discrimination through higher and higher interest rates imposed upon smaller local governments by American investment bankers is a national problem and deserves a congressional and Federal solution. For all of the reasons cited, I earnestly and sincerely urge this committee to approve H.R. 5944, in order that Federal credit may be extended to meet the essential public facility needs of the smaller communities of the country.

Low-cost Federal moneys are made available through loans to various segments of our private economy, and to foreign, national, and local governments, our farmers, our railroads, and so on, and I think historians will look at the United States in this postwar period and say the emphasis on aiding agricultural production in the hinterlands instead of aiding this area to switch over to industrial production will be viewed to have been the death knell of the nonmetropolitan areas of our country.

While a continuation of the present grant programs in the fields of hospital construction and sewage disposal plant construction are necessary and helpful, they have not and cannot, at present annual sums available, permit our local governments to gain on the ever-increasing accumulation of unmet public facility needs.

And then, Mr. Chairman, I have been requested to submit for the record with your permission a statement by the Honorable J. F. Crawford, the mayor of Abbeville, Ala., who intended to come but was unable to be here today due to matters beyond his control. This statement is on behalf of his city, the Alabama League of Municipalities, and the American Municipal Association.

Mr. SPENCE. That may be inserted in the record without objection. (The statement of Mr. Crawford follows:)



Mr. Chairman, I am J. F. Crawford, mayor of Abbeville, Ala.--a city of ap proximately 3,000 population. I feel that my city is a typical small Alabama community and that our community facilities needs are about like those of other towns and cities of our State.

I am glad to have this opportunity to express my views on the pending legislation now being studied by the Subcommittee of the House Banking and Currency Committee.

In my opinion the community facilities problem is one of the most serious problems facing our communities at this time. Even now the blunt truth is that we are falling far behind in our constant efforts to provide the public works and community facilities which our expanding community needs require.

The community facilities problem did not appear overnight-it is a problem which has been brewing for years; and, unfortunately, it is a problem which will greatly intensify in magnitude in the decade of the 1960's when family formation will skyrocket. We desperately need local public works

Our communities desperately need sewer facilities, water facilities, roads, parks, public buildings, hospitals—in other words all of the facilities essential to a growing community.

The mass exodus to the suburbs of our central cities is no temporary phenomenon—the problem will continue to be with us and will approach a truly sensational rush in the next decade. This, of course, will aggravate the community facilities program still further.

We recognize that these facilities must be paid for and nothing would please us greater than to finance all the facilities we need from strictly local resources. But the plain truth is that our cities are already in difficult financial straits. It is an open fact of life that the Federal Government through the income tax has staked a claim upon the great bulk of the Nation's tax revenue. There is just nothing new left for us to tax locally.

Put simply, we need these additional facilities and yet we cannot pay for all we need from current revenue. And another hard fact of life is that we cannot


borrow funds to finance our community facilities at a reasonable interest rate and on reasonable terms in the private capital market. Last year's bill would provide solution

We believe that community facilities legislation along the lines of last year's legislation will provide the solution. Passage of either of this year's bills would also be extremely helpful to the Nation's towns and cities.

If our communities can obtain long-term loans up to 50 years at an interest rate provided for in the bills before you, I can think of no greater helping hand in assisting us to cope with the community facilities problem. I think also that the very existence of legislation of this kind would help bring down interest rates in the private capital market. We hope for favorable congressional action

We were most favorably impressed by the forceful and persuasive speech in favor of community facilities legislation recently made by Congressman Albert Rains, one of our great Alabama legislators, before the annual convention of the National Association of Home Builders. I am hopeful that the Congress will see the wisdom of the principal objectives of Chairman Spence's proposed legislation and adopt it and Mr. Rains' bill in this Congress.

In expanding the present community facilities loan program (authorized in the Housing Amendments of 1955) of the Housing and Home Finance Agency, the new bills would provide a fund of $1 billion for loans to eligible projects.

The interest rate in the pending bills would amount to 25/8 percent, the lowest rate practicable to cover the cost of the money to the U.S, Government.

Under the bill a borrowing municipality can specify a loan maturity of 50 years or, if it choooses, a term of shorter duration. All cities could participate

Who is eligible to borrow this money? While smaller communities will be among the principal beneficiaries of the program, the bill removes priorities in existing law and extends eligibility without regard to population size. The unemployment problem is general throughout the country, affecting cities of all population ranges, and it is our belief that the economic stimulant of this loan program should be available to all entities of local government, from the smallest to the largest. At the same time we recognize the crying need for such projects as last year's bill would permit, from the town square to the largest metropolitan municipal center, Type of projects eligible

What kind of projects could be undertaken? Under existing law, priority is given to applications involving the construction of basic public works, such as waterworks and sewer systems. Realizing that this priority system excluded many worthwhile and important community projects which could be started at once if liberal loans were available, the Rains and Spence bills spell out the eligible projects. They would permit loans for

(1) The construction, repair, and improvement of public streets, sidewalks, highways, parkways, bridges, parking lots, airports, and other public transportation facilities.

(2) Public parks and other public recreational facilities.

(3) Public hospitals, rehabilitation and health centers, public nursing homes, and public convalescent homes.

(4) Public refuse and garbage disposal facilities, water, sewage, and

sanitary facilities, as well as other public utility facilities. Police and fire facilities

(5) Public police and fire protection facilities, civil defense needs, public wholesale farm produce markets, public libraries and offices and other public buildings (other than schools), and public land, water, and timber conservation facilities.

(6) In addition, the bill would allow loans to nonprofit hospitals to finance specific projects for hospital construction, repair, or improvement. I hope this review of the importance of a community facilities loan program will serve to point up its importance to the Nation's cities and towns, small and large.

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