PUBLIC HEALTH SERVICE UPDATE

BY

C, EVERETT KOOP, MD

SURGEON GENERAL

       AND

DEPUTY ASSISTANT SECRETARY FOR HEALTH

     U.S. PUBLIC HEALTH SERVICE

CLDEPARTI~ENT OF HEALTH AND HUI.IAN SERVICES



                                    , I WA!lT TO
GIVE YOU Af4 IDEA CF THE T4ISSION OF THE PUBLIC HEALTH SERVICE AI43 A
SEIE OF TH E h'AY IT IS ORGAMZED TO CARRY OUT 'THAT NISSIOk I \JA!iT
TO TALK A 31T ABNT HOlJ NE FUI";CTIOTJ TODAY, HOW 1JE DID SOME THIIJGS I/J
PRIOR DAYS, AiID FIllALLY, I'LL IlAKE A FE2 EDUCATED GUESSES AS TG HO\!
THE P,H,S, :lIGHT LOOK AI-ID FUfICTIOTd 114 THE FUTURE,


A SINGLE ORGANIZATION WITH BUREAUS, DIVISIONS, ArID BRANCHES, IT
MIGHT BETTER BE THOUGHT OF AS A "FEDERATION" OF FIVE INDIVIDUAL
ASEKIES, EACH WITH ITS OWN SPECIAL SPHERE OF EXPERTISE, ITS OWN
CONSTITUENCIES, AliD ITS OWli UNIQUE RECORD OF CONTRIBUTIOKS TO THE

PUBLIC HEALTH OF THIS COUNTRY,                                                     -

   THE P.H.S. IS A NON-COMBATANT UNIFORMED SERVICE WITH A PROUD

TRADITIOI4 THAT REACHES BACK TO 179:: AND THE VERY BEGINNINGS OF
MILITARY MEDICINE IN THE UNITED STATES,  OUR MEN AND WOMEN HAVE BEEN
ON ACTIVE DUTY 114 ALL THE FAMILIAR "HOT SPOTS" AROUND THE \JCRLD,
SERVING SIDE BY SIDE WITH OUR COLLEAGUES FROM ALL FOUR SISTER

SERVICES.  WE'VE BEEN 114 SOUTHEAST ASIA,,,THE MIDDLE EAST..,CENTRAL

AMERICA, a, AFRICA,,,WHEREVER AMERICAN II-ITERESTS HAVE REQUIRED THE
PRESEiICE GF THE AMERICAN UNIFORM, YCU WILL FIND CAREER, UNIFORMED
PUZLIC HEALTH PERSONNEL "PULLING DUTY."

  WE ALSO SERVE Iti MATIY PLACES WHERE OUR RECORD 111 PUBLIC HEALTH
IS RESPECTED A;JD RECUESTED FOR SOflETIMES VERY CQMPLICATED REASONS,
F9R EXAMPLE, A TEAM OF THREE P,H,S, EPIDE!1I3LOGISTS WE:JT TO THE :IEST
BAIIK OF THE JORDAN, AT THE REQUEST OF THE STATE OF ISRAEL, TO

DISCOVER TH E CAUSE OF A 3YSTERIOU S EPIDEIlIC THAT IiAD HOFSITALIZED
LARGE T4U11BERS 2F YOUNG ',IOklEil FRO1'l THE AREA'S ARAB CO17lUilITIES, OUR
TEA(l PRESE:iTED TO THE ALIT/-;ORITIES ITS CONCLUSION THAT Ti1E E?IDEElIC
WAS A YASS PSYCHOLOGICAL PtiE~~O~lEI401~, A RARE NT I-IOT UIdKNO\ITI EVE:Y'T I:4

M3ICIflE I  Ycjz MAY REMEllBfR READ1 NG ABOUT THAT IN THE X3'S?~?f?S,


  I SHOULD ADD THAT WHEN THIS REPORT WAS TAKEN TO THE WORLD HEALTH
ASSEMBLY IN GENEVA, IT WAS GREETED WITH MUCH HOT POLITICAL RHETORIC
FROM MANY THIRD WORLD DELEGATES,  HOWEVER, OUR PEOPLE HAD DONE THEIR
USUAL SOLID JOB OF SCIENTIFIC INQUIRY AND THEIR RESULTS COULD NOT BE
EASILY SMOTHERED, EVE11 BY THE HEAVILY ACRIMONOUS AIR OF GETIEVA,

  CERTAINLY ONE OF THE GREAT TRIUMPHS OF MODERN MEDICAL SCIENCE
HAS BEE14 THE VIRTUAL ELIIW~ATIO~~ OF SMALLPOX AS A COMMUNICABLE

DISEASE.  AND ONCE AGAIN, THE PEOPLE WHO HAD BEEN ON THE FRONT LINES
OF THE FIGHT AGAIFIST SIIALLPOX . . .GOUT!CING THROUGlH THE VILLAGES AIlC
SAVAtlt'4AHS OF AFRICA AFJD ASIA AND ADTW'~ISTERIF~G TENS OF THOUSANDS OF
DOSES OF THE SMALL?OX VACCITK,, MRE GUR P.H.S. PHYSICIANS, NURSES,
AND SANITATION ENGINEERS,
                A&b c)fLc
  P,H.S. PERSGNNEL HAVE ALSG BEEN,,STATIONED AT POINTS OF EMBARKA-
TI0r-I IN SOUTHEAST ASIA,  I TRULY BELIEVE THAT THEIR PROFESSIONAL
COMPETENCE HAS BEE/d AMERICA'S BEST CEFETtSE AGAINST THE IMPORTATIOI1
OF NEW AND HIGHLY CO~~JAGIOUS DISEASES, DURING THIS PERIOD WHEN OUR
COUNTRY HAS BEEN CARRYIK OUT A HUMANITARIAN PROGRAl~1 OF ACCEPTING
REFUSEE "BOAT PEO,PLE" FROM THAT PART OF THE WORLD. P.H,S, PERSONNEL
HAVE ALSO BEEtd CARIrIS FOR THE HEALTH NEEDS OF CUBAN Alli) HAITIA/;
REFUGEES WHEN TItEY FIRST ARRIVE ON OUR SHORES,


  THE PUBLIC HEALTH SERVICE IS UIjICUELY QUALIFIED TO DO THIS KItlD
OF WGRK FOR TWO REASOfd: ITS HISTORY OF PROFESSIOCAL MEDICAL
EXCELLEbCE Afr'D ITS RECORD AS A CARIldG AND COMPASSIONATE ORGANIZATION

RIGtiT HERE AT HOtIE,

  THE P,H.S, HAS BEEil AT THE HEART OF OUR NATIOIJAL COMtlITIlEFIT TO
PROVIDE QUALITY HEALTH CARE TO THE POOR AND THE DISADVANTAGED

CITIZEi.4S OF OUR COUl'!TRY.  OUR COflt1ISSIOTdED t-1EDICAL OFFICERS HAVE
BEEN FOUfiD IN THE COIWJNITY HEALTH CEtjTERS OF OUR INNER CITY AllD

RURAL LiiETTOS,  111 T.lIGRAi`lT LABOR CAf:PS,  IFJ COAL f~IIdINS COUFJTRY, A:dD

G/j TIiE SEACOASTS AND liATERllAYS OF AI.!ERICA,

  FOR ?jEARLY 30 YEARS ME tIAVE ALSO STAFFED THE ;iGSPITALS, CLINICS,
AND HEALTH STATIONS SERVING IlORE TtiAM 200 ItjDIAN TRIBES AND ALASKAN
IIATIVE VILLAGE:, iY'E GGT THIS ASSISlJiiEFiT FRGI: THE CGrlGRESS 11: 1955,
DURING THE t:EXT 25 YEARS, THE IlEDICAL PEKSOtItdEL OF THE P,H,S, lJERE
PRIF~IAIIILY RESPCIJSIBLE FGR LOh'ERIfdG TH E I:1FANT F,lORTALITY RATE FOR
INDIANS FRGt,l 62.7 DEATHS PER 1,000 LIVE BIRTHS DOWkTO ONLY 13.2

JEATHS PER 1,033 tJE\JBOR:IS, . . API 20 PERCEIiT DECREASE. DCRIIjS TtIE SA'IE
PZRIGD, 1955 THRGUSii 198G, THE IrlFAtiT ?lORTALITY RATE FOR THE UNITED

STATES AS A WHCLE WAS CUT BY 52 F'ERCEtjT, FRO# 2S,4 TO 12.G.

  INCIDENTALLY, I'PI PLEASED TO REPORT THAT OUR LATEST PROVISIONAL
IF1FAI;T t'IG?TALITY RATE FOR TiiE IIATIOtt AS A MHOLE FGR THE 12 f;O/iTtiS
ENDING IN tlAY 33 IS NOW DOlJN TO 11.0,


GF COURSE, NO SINGLE GROUP CAN CLAIM ALL THE CREDIT FOR SUCH A
D?,AIIATI C TURi: OF EVEldTS, T;EVERTtlELESS, THE DEDICATED HARD IlORK OF
THE CONFlISSIG~4ED CORPS OF THE PUBLIC HEALTH SERVICE WAS CRUCIAL TO

SINCI JIlli:: CF IS;:, WIjEfJ WE 3EGA;l TO TRACI: TttE A?PEAMbCE OF
"AIDS" IN THE U,S,r THE P.H.S. tiAS RECEIVED REPORTS OF FIORE THATI
2,2G3 ZASX,  CF THAT l1UI3ZR, TiiEt?E tiAVC ALREADY 2EEi'i 293 DEATNS,
THERE IS ii0 t:i4ObJIJ CURE FOR "AI3S. M  THE EVIXNCE SO FAR SWESTS
TiM A VIZ111 3% ?E;;, YAPS T!!G C? TIjREE YE/X OF LIFE LEFT, GT!CE HZ
HAS TiiE DISEASE, AI!D I SAY "HE" ZCALISE THREE OF EVERY FOUR CASES
OF "AI'JS" 093 I:i HGICOSEXUAL OR WWUAL I::::, '

"AIDS" IS $B++MW Ttd TGUSHEST f.l:DICAL MYSTERY TO HAVE 3CEil
Iir?\;';ZZi! TO THC P,H,S, TO SGLVE, Ai; THAT ITJCLLjDE'3 LEGI bJJ;iAI 27 ' 5

DISEA3E, TOXIC SHOCK SYNDRGW Ai;D THE TYLEdOL TAfZ'ERNG SCA;!,


  ALL THIS II1FGRMATIGN 14AY BE VERY INTERESTING, BUT JUST lJHO IN
THE PUBLIC HEALTH SERVICE DOES \JHAT -- AND H01:? I CAN BEST AlJS1IER
TttGSE GUESTIONS BY QUICKLY RUNNING THROUGH OUR ORGANIZATION, FIRST,
LET 1% START WITH TllE 5 P,H.S, AGETiCIES,

  I'LL BEGIN WITH "A," THE ALCOHOL, DRUG ABUSE, AND k!ENTAL HEALTH
          I THiF11: THE TITLE SAYS IT ALL, THIS ASENCY HAS

THREE NATIONAL 114STITUTES -- GF MEiiTAL tiEALTH, OF DRUG AXSE, Af;lD OF

ALCGHOLIStl AI"43 ALCOHCL A3USEe  THEY CARRY GUT RESEARCH AT,'D PUCLIC
EDUCATICN PRGGRAT4S AIID, UI'iTIL RECET;TLY, THEY ALSO SUPPORTED A I4I:E
R,qijGC GF SERVICE DELIVCRY F'ROGiiXiS AT THE LOCAL LEVEL.. 18GO FlEr!TAL

HEALTH CEFITERS . . ,390 STATE AND LOCAL DRUG ABUSE PROGRAX,, IAND A3OUT

1,OGO LCCAL ALCbHGLISt1 PROJECTS,  tlGRE A;3GUJ TiiOSE PRGJECTS LATER,

    cu/cfy NI               dti61c 460
  THE FISCAL 1923 APPROPRIATIG/4 FOR A,D,A/l/%A. IS @!2!f7 F'IILLIOI4

DOLLARS.

  14irXT, ARE THE CEt~TERS FGR EISEASE CGI1TKGL, OR C.C.C, TIiE
CENTERS ARE HEADQUARTERED IN ATLANTA ANC, AS THE FIA14E IXPLIES,
TiiEY'RE COtXERt;ED PRI?tARILY \JITt-t CGliTRGLLIi,'G OR PREVE,PITII`&

CGi"likMICAXE A!lD VECTOR-ZGME XSEASES, C.D,C,'s T:ORTALITY AtlD

1lGi;3IDITY XEKLY RE?ORT IS REGARDED $5 TIiE i3EST LIARCFETER !IE iiA\lL

MFECTICUS DISEASE ACTIVITY IN THIS COUFIITRY,

OF


  C.D,C,'s HISTORY IS ROOTED IN THAT STRONG TROPICAL DISEASE FRATERN-
ITY WHO LABORED WITH WILLIAM CRAWFORD GORGAS AND CJALTER REED IN THE
CARIBBEAN, CEf1TicAL AMEKICA, AND THE PHILIPPI14ESt TODAY, THE CE11TERS
WORK PRIMARILY THROUGH STATE AND LOCAL HEALTH AUTHORITIES TO CARRY OUT
SUCH ACTIVITIES AS CHILD IMMUNIZATIOldS, THE CONTROL OF SEXUALLY TRAI'IS-
MITTED DISEASES, AND THE EPIDEMIGLGGICAL DETECTIVE WORK TO SOLVE THE
MEDICAL MYSTERIES I MENTIOTiED EARLIER, FOR EXAMPLE, IT IS OUR -- ArdD

THE COUNTRY'S -- LEAD AGENCY Iri THE FIGHT AGAINST "AIDS,"

  CmD,C, PERSONNEL ARE Gil T,D,Y. 1JITI-1 STATE HEALTH AGENCIES AND ARE
USUALLY THE GIIES OVERSEAS WHO SCREEN REFUGEES HEADING THIS WAY, YOU
MIGHT BE INTERESTED TO K1'101J THAT THE PUBLIC HEALTH SERVICE IS INVOLVED
IN HEALTH-RELATED TECHNICAL ASSISTANCE AGREEMENTS lJITH 38 OTHER

NATIONS,  INTERNATIONAL HEALTH HAPPEliS TO BE ONE OF THE SURGEON
GENERAL'S RESPONSIBILITIES, BUT WE USUALLY TURN TO THE CENTERS FOR
DISEASE CONTROL FOR THE PERSONNEL 1JHO DO THE ACTUAL kGRK Ir4 TtiE IHOST

COUNTRIES,

                    k&o& 2 fl
  THE CD&  BUDGET           S m FIILLIGN,


  THE FOOD AND DRUS ADMINISTRATION -- OR F,D,A, -- HAS 3EEk FOR MOST

OF ITS 77 YEARS, ONE OF THE MOST WIDELY PUBLICIZED, LOVED, AND HATED

AGE NC I ES OF GOVERNI~IE NT.  THE T1JO CJATCHWORDS OF ITS LAW, SAFETY AND

EFFICACY, MAKE THE F.D.A. THE ARBITER OF PUBLIC HEALTH IN THE MARKET-

PLACE OF DRUGS, VACCINES, MEDICAL DEVICES, HEALTH SUPPLIES, RADIO-

LOGICAL GEAR, AND CERTAIN HEALTH At'jD MEDICAL PRACTICES, SUCH AS

NUTRITION ArjD DIET COUNSELING, PRESCRIPTION DRUG ADVERTISING, DRUG

PRESCRIBING, AriD ArlTENATAL FETAL DIAGNOSIS,
                @Jo

  THE F,D,A,'s CUDGET FC': XXX '63 IS m T.lILLIOr4, THAT'S REALLY

NOT MUCH MONEY, CONSIDERING THAT THE MISSION OF THE F,D,A,, WHICH IS

TO REGULATE ABOUT $465 BILLION WORTH OF AMERICAN COMMERCE, MORE THAN

100 TIMES THE FoD.A,'S SUDGET.

  THE HEALTH RESOURCES AND SERVICES ADMII~ISTRATION IS COi'1CERTIED WITH

A VARIETY OF PROGRAMS.  LET ME GO THROUGH THEM QUICKLY WITH YOU.

     Q   FIRST, IfI SHEER SIZE ATiC IMPACT, IS THE MATERNAL ATID CHILD

HEALTH PRGGRAIA -- RUTJ1411dG AT A LEVEL OF .9t;r; MILLION THIS FISCAL YEAR,
                  JQH 04`3 cq 373-


9

     1JEXT WOULD BE THE EDUCATION AND TRAINING OF HEALTH PROFES-

SIGt'dALS: PIHYSICIANS, DETiTISTSt NURSES, THERAPISTS, TECHNICIANS, AND

MAtJY OTHERS,  THE MAJOR COMPONENT OF THIS PROGRAFI, THE f4ATIGNAL HEALTH
SERVICE CORPS, ASSIGM 2,600 HEALTH PERSOMEL -- PHYSICIANS, MJRSES,

AND DENTISTS FRESH OUT OF GRADUATE SCHOOL -- TO DELIVER MEDICAL CARE

If4 UZDERSERVED AREAS.  THIS IS HOW tlANY YOUNG HEALTH PROFESSIONALS

REPAY THE GOVERNMENT FOR THEIR STUDENT LOANS,

     9   A THIRD PROGRAti HAS BEEF1 THE BUILDITIG A!dD rilAIrlTAI11Ir1G OF

AplERICA'S HOSPITALS,  THIS 1s mowu AS THE HILL-BURTON PROGRAM NAMED

FOR ITS CONGRESSIGIIAL SPONSORS BACK IN W&a IT WAS A VITAL PROGRAM,

SINCE WE HAD DGNE'VERY LITTLE ABGUT HOSPITALS ON TltE HOME FRGt'4T DURING

WGRLD WAR I I, AriD A SREAT tiATJY 14ECJ THI TdGS HAD HAPPENED Ii'1 MEDI CI F/E AS

A RESULT OF THIN% WE LEARtiED AS PART OF OUR WAR EFFORT.  IT HAS BEEN

A VEZY SUCCESSFUL PROI;RAK -- SO I-IUCH SO THAT WE APPARENTLY f4OW I-iAVE

ABGJT lGO,GOO SURPLUS HOSPITAL BEDS, A VERY COSTLY BUSINESS FOR THE

MT1 01`1 t

  THE HEALTH RESOURCES A:iD SERVICES ADPlINISTRATIOt1 IS THE P,H,S,

AGEFKY THAT HAS ACTUALLY DELIVERED -- DIRECTLY OR THROUGH THIRD PACTIES

-- A VAKIETY OF H;IALTH SERVICES TO CERTAIZ SPECIAL POP!JLATIO~lS:

AMERICAFi IFJDIANS AIJD ALASKAN TIATIVES, MIGRANT IJORKERS, FEDERAL

EriPLGYEES, COAL kiIIERS, AtID PEOPLE LIVIFIG Iii FIEDICALLY UfiDERSERVED OR

UNSERVED AREAS,


  Ut4TIL RECENTLY MERChANT SEAMEN, BARGEMEN, CANALLERS, RIVERBOATERS,
ATJD FEDERAL RETIREES WERE ALSO INCLUDED: THEY RECEIVED THEIR CARE
THROUGH EIGHT PUBLIC HEALTH SERVICE HOSPITALS Af1D 27 CLINICS -- ALL
THAT REtiAIf1ED OF THE ONCE EXTENSIVE IiETWORK OF "MARINE HOSPITALS"
BEGUN BY PRESIDENT JOHN ADAMS IN 1793, THE ONLY HOSPITALS THE ?,H,S,
STILL RUliS AR: THE i`JATIOI';AL CEfJTER FOR tiAr+'SErJ'S DISEASE -- A tiORLD

FAl1OUS LEPROSARIUl~I -- IN CARVILLE, LOUISIAM, ST, ELIZABETHS HOSPITAL

FOR THE f:Ll;TALL Y ILL 011 Ttl,' OUTSKIRTS OF \JASHINGTON, DC., ATiD, AS I
MEI'JTIOt1ED A MOMENT AGO, THE INDIAId HEATH SERVICE SYSTEM OF 48 HOSPITALS

AX 1X CLIiKS,

  THE IHtA,Tti iTiESCgRCES A;;D SERVICES A!X~lIfJISTRATIOIJ iiAS A        3

APPROPRIATIOI~ OF !GW BILLIOrd,
       d6w-1

  TttE ASETiCY 1IITI-l TIIE LARGEST APF'ROPRIATICN IS THE MTIO,rlAL
INSTITUTES CF HEALTH. ITS BUDGET -3 Is $4 fmnori

  THE li ItJSTITUTES THAT ARE THE PI,I,H, SUP?ORT ABOUT lG,OQO EXTRA-
flURAL RESEARCH PROJECTS AT Al1Y ONE TIME,  N, ImH, ALSO CARRIES OUT SOME
2,355 IIITRAi;UR;,L ?ROJCCTS EACH YEAR,  SINCE 1337, \/HE!4 THE NATIONAL
CAtjCER It4STITUTE :/AS ESTABLISHED, THE N, I et-18 HAS SUPPORTED THE WORK OF
ilc,",E THAI4 53 ijG;EL LAL'RZTES ITi IEDICII"lE, PHYSICS, A!JG CHEIlISTRY, OR
AXjUT 1 OUT OF EVERY G 1JIllNERS IN THOSE PRIZE CATEGORIES,


THAT, BRIEFLY, IS A "SNAPSHOT," SO TO SPEAK, OF THE 5 PaHaS,
AGENCIES.

THE FIfiAL fiAJOR ORGAf~IZATIOf~AL UflIT WITHIfJ P,H,Sn IS THE OFFICE OF
THE ASSISTAIJT SECRETARY FOR HEALTH, WITHIN THIS OFFICE ARE SUCH
ACTIVITIES AS DISEASE PREVENTION AfiD HEALTH PROf~?OTIOfJ, ANTI-Sf!OKIfJG,
SUPPORT FOR ti,f~"I,O. 's, ADOLESCEliJT PREGNAEJCY PROGRAflS, PHYSICAL FITfjESS
AflD SPORTS fqEDICINE, AfjD STAFF ACTIVITIES SUCH AS PERSOflNEL, PLAfafaING
AfiD EVALUATION, MAflAGEMEfjT AND BUDGET, PERSUf'JfJEL, AMD SO OfJ.

TI-IE O,A.S,H, BUDGET THIS YEAR IS $1`5 BILLIOfJ, BUT OVER 80
PERCEfiT OF THAT IS EARMARKED FOR THE FUlJDIfJG OF FOUR BLOCK GRANTS.
AND THAT LEADS f.;E TG SOlIE COI';If:Ef~TS ABOUT THE CttANGES THAT tlAVE TAKEN
PLACE AfJD PROBABLY WILL COFITITJUE TO PLACE Ifd,THE PUBLIC HEALTH SERVICE

  THE GROWTH OF THE P.H.Sa DURIK THE PAST 20 YEARS itAS BEEN THE
RESULT f:lAIiiLY OF NEW AND EXF'AIJDII~G CATEGORICAL GRAfjT PROGRAf,!S, AT THI
TIfiE PRESIDEfIT REAGAf1 WAS IfiAUGURATED, Ifa JAiJUARY 1921, THE EXECUTIVE
BRANCH WAS FUfQING AflD OPERATMG 534 CATEGORICAL GRANT-IfhAID PROGRAM
OljE-SEVEF;TK OF THGSE -- 74, TO BE EXACT -- WERE Itl P,H.S.


  THE AlXIl~ISTRATIOl~ SAID THAT IT MS TIME FOR THE FEDERAL GOVERNMENT
TO GET OUT OF THE BUSINESS OF DELIVERING HEALTH SERVICES, EITHER
DIRECTLY OR BY PROXY THROUGH GRANTEES Af1D CONTRACTORS. IT HAD CECOPIE
TOO COSTLY, TOO UNWIELDY, AND NOT AS EFFECTIVE AS ADVERTISED, HAFIDING
OVER THOSE FEDERAL PROGRAf% TO STATE ArdD TERRITORIAL HEALTH AUTHORITIES
SEEtiED TO BE PREFERABLE.  BUI`JDLING THEl.1 INTO BLOCKS, WITH AS FEW
STRINGS AS POSSIBLE, WAS TO BE THE METHOD,

  PRESIDEliT REAGAN PROPOSED -- A1tD CONGRESS APPROVED -- THE NOTION
OF GtiOUPIiJG P3AliY SIMILAR CATEGORICAL GRANT-IrkAID PROGRAklS II4TO A
SERIES OF BLOCK GRAd.TS TO THE STATES: ONE FOR PREVENTIVE SERVICES,
Al-IGTtiER FOR THE A.D,A,M,H,A, PROJECTS, Al13 A THIRD FOR t4ATER1iAL AND

CHILD HEALTH,  CONGRESS AUTHORIZED AND FUI;JDED THESE THREE AS OF AUGUST

1381 I

  A FGURTt-I "PRIblARY CARE u BLOCK GRANT IS PRINCIPALLY COlJCERlJED \IITI-I

COMI+JliITY HEALTH CEljTERS.  AS THE LA'J IdOW READS, THE P.H,S, STILL
DIRECTLY FU:jDS I;IOST OF THE 530 OR SO COF71%JflITY HEALTH CET1TERS AROU!D
THE COUI-ITRY, BUT EACH STATE HAS TIiE OPTION TO TAKE OVER THE CENTERS IN
WITHIIJ ITS Otiii BORDERS,  SO FAR, ALL CUT \JEST VIRGIMA AlaD THE VIRGI1J
ISLMDS HAVE DECLif1ED THE OFFER,


HO\/EVER, 1

'HE PRESIDEI

              'IT STILL HOPES THAT CO!jGRESS WILL flOT LEAVE
TiiIS AS A STATE OPT1011 3UT WILL REVISE THE LAW TO GIVE COlJTROL OF

THESE IllPORTAT1T PROJECTS TO THE STATES AND LOCALITIES l/HERE THE PEOPLE
ARE ACTUALLY SERVED,

  THE RESULT OF THE BLOCK GRAiiT APPROACH IS A l'lE1J DIVISION OF LABOR

WITHIN P,H,S,  ONE TASK IS SIMPLY TO ADMITJISTER THE FISCAL ARRANGEMENTS

FOR THE BLOCKS,  THAT CAN BE DONE WITH A RELATIVELY SMALL STAFF AT THE
ASSISTANT SECRETARY'S LEVEL.   THE OTHER TASK IS TO PROVIDE THE STATES
?JITH Al1Y TECHIIIICAL ASSISTANCE THEY f?IGHT flEED OR IFI OTltER lJAYS BE HELP-
FUL TO STATE PROGRAlj PEOPLE AT THEIR REQUEST, THIS ALSO REQUIRES FEWER

FEDERAL PERSOllFiEL IN Sl'iALLER P,li.S. AGEI1CIES.

  THE PRESIDENT HOPES THAT TtiE BLOCK GRAFiT APPROACH, IN ADDITIOld TO
BREATHIllG IiEll LIFE IfIT AMERICAN FEDERALISh liILL ALSO TEliD TO REDUCE
THE GRO:JTH RATE CF FEDERAL HEALTH FUNDING, WHICH HAS GRONI 14-FOLD IN

THE PAST 15 YEARS,  HEALTH HAS BEEN THE FASTEST GRO\/IKG LItliZ ITEb1 IN

THE FEDERAL BUDGET,  MEN THE PRESIDEIIT LOOKS FOR "TARGETS OF
OPPORTLMTY" FOR COOLIijS DOM THE FEDERAL BUDGET, WHAT BETTER PLACE
COULD HE CHOOSE TO START TWA11 THE NATION'S HEALTH BUDGET?


-l'-

  BUT EVEN THAT IS AN OVERSI~~PLIFICATIOM~ SOME HEALTH AGENCIES T"1AY
GET REDUCED FUNDNG, BUT SONE HEALTH FUNCTIOCS WILL REQUIRE -- AND

WILL RECEIVE -- i,lORE b1ONEY.  THIS IS CLEARLY THE CASE IN RESEARCH,

  0M-Y THE FEDERAL GOVERWENT CAT1 ASSEIIBLE THE EXTRAORDIMRY

RESOURCES OF PERSOlaNEL, MOrdEY, FACILITIES, AND TIb!E TO. I.

UI4LOCK THE GErlETIC CODE, em

IDEIdTIFY THE FUNDAl'4Ei4TAL NECHA/JISI*lS OF HUblAb IMMU~~OLOGY, I ,

DEVELOP PlONOCLOTIAL HYZRIDOT'IA TECHNOLOGY,, .

A;iD, OF COURSE, KEEP UP THE BATTLE TO CONQUER
SOCIETY: IiEA2T DISEASE, CATiCER, AND STROKE:

  TtiE N,I.H. RESEARCH ZJD3ET FOR FISCAL 1983 IS

[LIILLIO!~ HIGHER Tt-tAN LAST YEAR'S 3UDGET. THE SAPIE

THE MAJOR KILLERS IN

$3,7 3ILLIOfl OR $337

IS TRUE FOR

A,D,A.k H ,A,  1dHILE THAT AGENCY tlAS ACTUALLY HAD A DROP II! ITS OVERALL

TOTAL, A,D,A,Wi,~A, HAS /4EVERTHELESS HAD A ['4ET INCREASE OF $27.3

NIiiIGl"d Tti IS YEAR TO SUPPORT BEHAVIORAL RESEARCH, SO, II4 BOTH

ABSOLUTE AND IN RELATIVE TEMIS, THE RESEARCH ACTIVITY WILL COliTI!!UE TO

BECOW CEIITRAL TO THE LIFE OF THE P.H.S. I!4 THE FUTURE.


-1 - !c

IIPJ 'JHAT OTHER WAYS WILL THE PaHaS, CHANGE? I THINK WE WILL BE

RETURNING TO WHAT HAD OrJCE BEEN OUR TRADITIOpiAL ROLE OF PARTriER., ,OF

EQUAL Al"~lONG E3JALS,, a WITH COLLEAGUES IN HEALTH AND FIEDICAL CARE AT

OTHER LEVELS OF GOVERMlE!iT ATiD If1 PRIVATE NON-PROFIT AND FOR-PROFIT

ORGANIZATIOF6,

WITH A REDUCED FEDERAL PRESENCE, WE BELIEVE THAT MORE INITIATIVES

FOR IMPROVED HEALTH AND MEDICAL CARE WILL ORIGIf4ATE ELSEWHERE, OUTSIDE

WASII~GTON,  THE OPPORTUt4ITIES WILL CERTAINLY STILL BE THERE. THE

FEDERAL CO14TRIBUTION WILL TEFiD TO BE r4ORE SiJBSTAIiTIVE -- AGAIN,
REFLtCTIiJG ITS RESEARCH STRENGTHS -- OR FACILITATIVE AS, FOR EXAMPLE,

THE NEGOTIATOR AMONG COt.'lPETING HEALTH MTERESTS, AND PURPOSIVE, IN THE

lJAY IT PERFORb:S AS STEkARD OF THE NATIONAL HEALTH AGENDA,

TtiERE HAS ALSO BEEN ANOTHER CHAFJGE, THE GREAT FEDERAL HEALTH
STRUCTURE WAS BUILT TO DELIVER HEALTH SERVICES, IT WAS PREDICATED ON
THE TRADITIONAL PRACTICE OF T~EDICINE AIiD THAT WAS ESSErlTIALLY CURATIV'
ArlD REPARATIVE TlEDICII`iE,  IT WAS ALSO LARGELY POST-FACTO MEDICINE:
THAT IS, WE TREATED PEOPLE AFTER A DISEASE ARRIVED OR A DISABLIrlG

EVEIiT OCCURRED,


-l&

  BUT ONE OF THE THINGS WE'VE LEARNED FROM RESEARCH AND EXPERIENCE
IS THAT THE MOST EFFECTIVE TOOL WE HAVE TO ITlPROVE HEALTH STATUS IS
PREVEr4TIOk COM3INED UTH HEALTH PR01lOTIOk THERE WOULD NEVER HAVE
BEEN ENOUGH MOrIEY It'1 THE WORLD TO CARE FOR ALL THE CHILDRErJ AND ADULTS
STRUCK DOW14 BY POLIO, DIPHTHERIA, IqEASLES, AND TYPHUS, THEREFORE, WE
HAD TO COI'lE UP CJITH NEW VACCIfJES AND A PROGRAtl OF MASS Ir"lk2JT~IZATIOk
SI~IILALRLY, THERE'S t40T EfIOUGH MOt4EY IN THE 1JORLD TO TAKE CARE OF ALL
CURRENT AI4D FUTURE HEART DISEASE, CANCER, AI'JD STROKE VICTIMS, THERE-

FORE, THERE WE tlUST COfJVII4CE PEOPLE TO QUIT SMOKING,

  TttE LOGIC OF THIS IS SO OVERCJHELMItJG THAT THE PREVENTIOt'd OF DISEAS
AliD DISABILITY AIiD THE ?ROTlOTION OF GOOD HEALTH AND \JELL-BEItdG ARE NO\\
THE KEYSTONES OF NATIOE4AL HEALTH POLICY.

  OIiE OF THE IlOST EXCITING DEVELOPME1JTS IN THE YEARS AHEAD, THERE-
FGRE, WILL BE THE klATURIT4G OF THIS COllCEPT AS THE FOUNDATION OF
AMERICAN PUBLIC HEALTH POLICY A1JD PRACTICE. ENRICHING THIS PROCESS
WILL BE AN IflPORTAI4T FUNCTIOr! OF THE FEDERAL HEALTH ENTERPRISE,
WHETHER BY ITS RESEARCH OR ITS PUBLIC EDUCATION PROGRATlSs


-lji!-

I HOPE THIS BRIEF OVERVIEW HAS HELPED YOU GET SOME PERSPECTIVE Oh
WHERE THE UnS. PUBLIC HEALTH SERVICE IS AbD WHERE IT SEEMS TO BE
HEADING,  WE'VE COI.1E A VERY LONG WAY OVER THE PAST 185 YEARS, WE
BELIEVE WE'LL ElIJOY A JOURI'iEY EVERY BIT AS EXCITING DURING THE NEXT
185.

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