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the full extent that our knowledge l'ermits. 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
1. Air pollution.
8. Chronic disease.
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
rier activities would be combined—would then it: 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: l'rimary, 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 afficted. As an interim step in this direction. I will put responsibility in CDC for managing all of the pesticides activities of the present Burean. 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 Burea 11-wide, with elements of all program activities represented therein. Others, sinaller 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 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 trarel 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.
O. 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 nd 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 PHIS responsibilities for abatement and enforcement activities established in law. 4. Program planning
The Associate (hief 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. Erecutive officer
The executive officer would be responsible for participating in the development of recommended Bureau objectives and goals, for iusuring 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.
In summary, I see the mission of this new Bureau as one emphasizing the basic public health role of prevention-prevention through environmental controls and programs directed toward individual and community activities in order to reduce exposure to hazards or to improve the host's resistance to various pathogenic insults.
The successful acheivement of the Bureau's goals can only be the result of an appropriately balanced program of research and action. For this reason, the Bureau is envisioned to be one organized functionally to provide the necessary support to these functions and their major components.
At the same time, I believe that emphasis must be placed on major program categories of health significance, public concern, and political importance: air pollution, water supply, occupational health, chronic disease, communicable disease, radiological health, accident prevention and solid waste disposal. These, then, will be major organizational components.
Some of these programs are now deficient. I believe the organizational justaposition of various elements which have previously been functionally and administratively separated will provide considerable impetus to their more orderly development. These include such activities as those in pesticides, milk and food, human nutrition, and the relation of chronic diseases to chemical and environmental factors.
I firmly believe this proposal is only one step in a series. I propose to forward additional memoranda discussing specific areas of concern in the near future. In the meantime, I solicit your thoughts and recommendations with respect to these plans.
RICHARD A. PRINDLE, M.D.,
Assistant Surgeon General. Senator MUSKIE. If the activities are scattered among several divisions are we likely to lose the effect that no single person has responsibility to follow through on the coordination and implementation of this activity?
Secretary GARDNER. I want to say that we are now trying to create the arrangements which will make it certain that the Office of the Surgeon General has a strong overall concern for environmental health and the Office of the Secretary, too. There are three levels at which this will be pulled together. One is at the level of the Bureau Chief. As you know Richard Prindle will be the Bureau Chief. He has been in air pollution and is keenly interested in environmental health.
The Surgeon General is going to make arrangements to insure that he has a very close scrutiny over all the environmental health activities and then we are going to have a deputy assistant secretary in the Oflice of the Secretary who will concern himself with these activities.
Senator MUSKIE. We will study your memorandum closely. If we have any further questions, we will feel free to direct them to you.
Secretary GARDNER. Very well.
Senator MUSKIE. Mr. Secretary, would you identify for the benefit of the reporter the other people who are with you and then proceed in your own way?
Secretary GARDNER. Yes, sir; I have here Dean Coston, Deputy
Would you like me to proceed?
Secretary GARDNER. Mr. Chairman and members of the subcommittee, it is a pleasure to be here today to comment on some of the
problems of environmental contamination, about which you will be receiving detailed testimony during this and the coming week.
During this century we have by chance and by choice drastically altered the human environment in our country. The character of our contemporary environment is being shaped by powerful forces. It is shaped first, by our rapidly accelerating rate of scientific and technological development and second, by national growth with its attendant problems caused by urbanization, the growth of industry, increases in population, density, and other such conditions. In very recent years it has become more and more widely recognized that we, and not just the vagaries of nature, are responsible for the quality of our environment.
We now recognize that we are contaminating and depleting our environment at an unprecedented rate. But we also recognize that it is within our power to halt that trend and to create a healthful and fulfilling environment.
This subcommittee, Mr. Chairman, through its efforts in developing the Clean Air Act, the Clean Air Act Amendments, the Solid Waste Disposal Act and the Water Quality Act, has contributed greatly to the opportunity we now have to create a better environment for all Americans. These hearings are a welcome indication of your continuing interest in the problem.
During the next several days, you will hear testimony on bills to improve the national air pollution control efforts and to improve our means of dealing with the disposal of junked automobiles. You will hear testimony on problems which derive from the use of lead and other hazardous substances which may reach man through the air he breathes, the water he drinks, or the food he eats and these questions are all related, and bear on a fundamental problem.
We have not yet learned how to use our accelerating scientific and technical knowledge properly and safely within the framework of our social, political and economic structures.
Each year we add new radioactive, chemical, and physical hazards to our environment. The benefits of urbanization and technology have been so great that we have overlooked their undesirable byproducts. As a result, we know much less than we should about the many ways in which we may harm ourselves. Air pollution is particularly deplorable because there is no longer, if there ever was, any real excuse for it. At the same time we were moving vigorously to prevent the introduction of harmful substances into our food and drugs, we were allowing concentrations of air borne contaminants to increase dramatically in all our cities.
The need for increased attention to the problems of environmental contamination is imperative. Today, more than one-half of the Nation's population of more than 190 million people lives on about onetenth of the land area. By 1975 we can expect that three-fourths of 235 million persons will be living on this same land area. And our capacity to contaminate our environment increases with every passing year.
President Johnson recently said, "We want to grow and build and create but we want progress to be the servant and not the master of man."
If we are to live by that standard, we have some major tasks ahead.