tion to these training programs at the present time. Exceptions to the rule are the schools in two Federal hospitals which are under the Federal Security Agency: Freedmen's and St. Elizabeths. Together the two institutions graduate from 30 to 40 nurses annually.

The veterans' educational program (Public Law 346) aids in the training of nurses indirectly. The Veterans' Administration reports that 4,000 were enrolled in 1948-49 for undergraduate courses.

During World War II, the Federal Government, through the Cadet Corps Nursing program, did provide training which resulted in the graduation of 124,000 nurses. The program terminated in 1948 and the volume of training declined to prewar levels.

SPECIALIZED TRAINING FOR GRADUATE NURSES

Throughout the country, schools offer a variety of programs for training special types of nurses, such as teachers of nursing, administrative personnel, publichealth nurses who will engage in community nursing services, and psychiatric nurses. In this area the Federal Government is offering some assistance.

Public Health Service grants-in-aid to States are used in part for the training of public-health nurses. The number of such students this year is 2,384. Their courses vary from 6 weeks to a year in length.

In the field of psychiatric nursing, traineeships are being provided this year for 86 nurses for advanced training through the National Institute of Mental Health in the Public Health Service of the Federal Security Agency. There is also a small subsidy to schools for expanding their facilities. St. Elizabeths Hospital graduates about 15 nurses each year for psychiatric duty. Under the veterans' educational program, there are 3,100 enrolled for advanced training in university schools of nursing.

When considered in relation to the need-more than 150,000 practical nurses or nurses' assistants and about 50,000 trained nurses-it is apparent that the Federal Government's participation in meeting the need is relatively minor.

Senator SPARKMAN. By the way, the statement was further made to me I think I remember this correctly-that the average service of a nurse after she was trained was only about 5 years; and that the cost for that short period of service is rather heavy. It takes, I believe, a couple or 3 years to train a nurse, and you get only about 5 years of service, and the inroads of the Federal Government just about use up

Mr. THURSTON. There is no doubt, Senator, that the replacement rate among nurses is very high. There is no doubt that it is one of the major problems in the nursing field.

I do not know whether the 5-year figure is right or wrong. I suspect that it is more nearly right than it is wrong. Inevitably there is a high replacement rate. It is one of the major problems in meeting the shortage. There is no getting around it.

I suspect we may have to make use of less well-trained nurses to do some of the jobs, perhaps.

Senator SPARKMAN. Well, now, let me ask you this last question, using that as a predicate for it. Do you not believe that one of the most essential parts of any health program that the Government participates in would be one directed toward making it possible for us to have additional doctors and additional nurses?

Mr. THURSTON. Yes; I do.

Senator SPARKMAN. For instance, they say that all of these hospitals we are building over the country under the Hill-Burton Act and this is a very fine program, and I am for it, but they come back and say— "What are you going to do with these hospitals without nurses to perform the necessary services in them and without doctors to perform the functions that will be required?"

Mr. THURSTON. That is why we are very hopeful that the House will act promptly with respect to that aid-to-medical-education bill which has in it provision for increasing the number of nurses.

Mr. RICH. You do not mean that socialized medicine bill?

Mr. THURSTON. I am referring to the aid to medical education bill. Mr. RICH. May I ask a question here in reference to the nurses? We have organizations of various kinds, and the nurses have theirs in the hospitals. For instance, I think in Pennsylvania a nurse is not supposed to work in a hospital unless she is a registered nurse. She is not supposed to take any charge. We have made the requirement so strict and so strong that it is difficult to aid in conducting a hospital because of the high standards that they have made.

As someone mentioned here, the practical nurse is almost outlawed in many, many institutions. Do you think that our restrictions have become so great in that respect that that is one reason or one cause why we have such difficulty in finding nurses?

Mr. THURSTON. I know the nursing profession is giving a great deal of thought to that, as we are. We had some experience during the war when we used nurses' aides, not with an intent to lower the professional status of the nurses at all, because in my opinion that would be highly undesirable, but to identify certain activities which nurses now perform that other persons trained, but not perhaps as highly trained, could perform. I think that is a possibility. Certainly we have had some experience along that line.

Mr. RICH. I know there is a great need for some relaxation in some of the regulations that will permit the practical nurse to do a lot of work that really she is prohibited from doing today. We had it in the old days and we got along and there is a need for that. I find that is the situation in our own State.

Senator SPARKMAN. Anything further, Senator Flanders?
Senator FLANDERS. No, thank you.

Senator SPARKMAN. Thank you very much, Mr. Thurston, and all of those who came with you.

Mr. THURSTON. Thank you, Senator Sparkman, and members of the committee.

Senator SPARKMAN. The meeting will stand adjourned until 10 o'clock tomorrow morning when Mr. Blaisdell will be here.

(Whereupon, at 12: 40 p. m., the hearing was adjourned to reconvene on Tuesday, December 13, 1949.)

LOW-INCOME FAMILIES

TUESDAY, DECEMBER 13, 1949

CONGRESS OF THE UNITED STATES, SUBCOMMITTEE ON LOW-INCOME FAMILIES, JOINT COMMITTEE ON THE ECONOMIC REPORT, Washington, D. C. The subcommittee met, pursuant to adjournment, at 10 a. m. in room 224, Senate Office Building, Senator John Sparkman (chairman) presiding.

Present: Senators Sparkman and Flanders and Representatives Huber and Rich.

Also present: Grover W. Ensley, associate staff director, Joint Committee on the Economic Report; Samuel L. Brown, economist, Subcommittee on Low-Income Families; and Mrs. Elizabeth G. Magill, research assistant, Subcommittee on Low-Income Families. Senator SPARKMAN. Let the committee come to order, please. We have with us this morning Mr. Thomas C. Blaisdell, Jr., Assistant Secretary of Commerce. Mr. Blaisdell, we are very glad to have you with us. I understand you have a prepared statement and also a summary. You may proceed in your own way.

STATEMENT OF HON. THOMAS C. BLAISDELL, JR., ASSISTANT SECRETARY OF COMMERCE, ACCOMPANIED BY WILLIAM H. SHAW, DEPUTY DIRECTOR, OFFICE OF PROGRAM PLANNING; LOUIS J. PARADISO, CHIEF STATISTICIAN, OFFICE OF BUSINESS ECONOMICS; AND MATTHEW HALE, ACTING SOLICITOR

Mr. BLAISDELL. Mr. Chairman and members of the committee, I am here in response to the invitation in your letter of November 9 to discuss issues that have been raised in the study initiated by your Subcommittee on Low-Income Families. I shall try to answer such questions as you may have to the best of my ability, but I should like first to present a summary of the statement prepared for your subcommittee which was submitted by the Department of Commerce on December 9.

A sizable proportion of the Nation's families receive substandard incomes despite the achievement in recent years of the highest levels of real income and consumption in our history along with practically full employment. As indicated by materials assembled by the staff of the Joint Committee on the Economic Report, more than 912 million families received cash incomes below $2,000, about one-fourth of all families of two or more persons in the United States. In addition, almost 6,000,000 single individuals reported cash incomes below $2,000.

No single cause can be identified as creating this serious problem of low-income families. The 92 million families comprising it are a heterogeneous group. Farm, aged, and broken families account for about two-thirds of the total number. Because of the varied character of individuals and families comprising the low-income group, a multiplicity of approaches is suggested, each based upon a thorough understanding of the type of problem with which it is intended to deal. I will consider some of these measures, particularly those which appear significant in the experience gathered through the work at the Department of Commerce.

GENERAL BUSINESS PROSPERITY MAJOR REQUIREMENT

To a very large extent, the facts presented by the committee print suggest that low incomes are the result of depressed general business conditions and are raised substantially in periods of business prosperity. The increase in real income in the lowest fifth from 1935 to 1936, a period of moderate depressed business, to 1948 was more than 50 percent; that of the second lowest fifth more than doubled. This evidence suggests forcefully that our main attack upon the problem should be the maintenance of high and rising levels of production and employment.

Achievement of sustained business prosperity would constitute the most effective means of dealing with the low-income problem on a broad front. This approach clearly involves a multiplicity of programs, but there is no other single direct approach capable of eliminating such a large part of the low-income problem. Moreover, this over-all approach is obviously beneficial to all economic groups, not merely to low-income families. At the same time, the remaining poverty is reduced to proportions which seem more manageable in terms of more specific programs. The achievement of high and stable levels of production and employment has become an accepted goal of national economic policy; the proposed method is thus in harmony with the major lines of our general national program.

PROSPERITY MUST BE SUSTAINED TO YIELD MAXIMUM BENEFITS

Despite the impressive improvement in the position of low-income groups, an intolerable amount of poverty has so far persisted even in prosperous years. This, in essence, is the main lesson of detailed 1948 data assembled by the committee.

It should be pointed out, however, that the data reflect only the short-run effects of prosperity upon the status of low-income groups. While admittedly some low incomes in 1948 were of the type that will not yield to the ameliorative effects of prosperous business conditions, it is probable that continued prosperity over a number of years would have substantial effects in improving the position of low-income families.

Sustained job security would enable even low-income families to. take advantage of better educational opportunities, better medical care, improved housing, and so forth. Old, established habits, subject only to gradual change, will yield as the stability of an improved income seems assured. Similarly, better job opportunities will be embraced in no small measure to the extent that they offer stable as

well as increased income. Finally, it seems reasonable to conclude that assurance of steady profit on a stable volume of business might induce producers to be satisfied with lower profit margins than under conditions of business instability. Over the long run, a tendency toward increasing purchasing power would result which would benefit the lower-income groups among others.

THE CONTRIBUTION OF BUSINESS

If we are successful in adopting policies which maintain high levels of production, we will continue to improve the position of the lowincome families. In itself, however, it will not be enough and supplementary measures are needed. While all major groups in our society-business, labor, agriculture, and other groups-must cooperate in seeking democratic ways of raising the income of substandard groups, I would now like to mention the considerable contribution which business can make to this problem.

INCREASING PRODUCTIVITY A BASIC CONTRIBUTION OF BUSINESS

The long-term increase in productivity, from which low-income groups have benefited, has to a great extent, though not entirely, stemmed from the initiative of private business. The growth of science, technology, education, and government has been fundamental to these developments. But it has been American business geared to a production and distribution system which has provided an increasing volume of goods at lower prices for the mass consumers. In spite of serious and recurrent declines and depressions, national output has always been subsequently raised so that, on the average, production per capita has doubled every 40 years. As a result, American families in all strata have, in varying degrees, slowly and progressively improved their standards of living.

Even in the low-income groups, families of today enjoy considerably enhanced living standards over families in corresponding groups of 50 years ago. They have access to a wide range of products not available then at any price. In some respects perhaps, there has been only slight improvement. Thus, for some families, housing facilities may not be better today than for their counterparts 50 years ago. Despite unmistakably over-all progress, business can still do much to raise productivity and standards of living to even higher levels and, in so doing, improve the existing status of low-income groups. Improved American living standards have resulted basically from technical innovations, greater worker efficiency, and improved managerial methods. For the whole economy, production per hour has increased on the average by better than 2 percent per year, substantially more in manufacturing, less in other major economic segments, such as retail and wholesale trade.

To some extent wide variation in the productivity of various industries accounts for the varying income status of many workers. Generally speaking, the industries which show the larger increases in productivity have tended to be the higher-wage-paying industries. The variations arise partly because of the nature of the industry— opportunity is greater in some, in others managements have not sufficiently exploited all possible methods of increasing productivity.