Imágenes de páginas
PDF
EPUB

and in the process to stimulate them to adopt more healthful behavior. University workers, researchers, and counselors examined three communities: One a control with no health education efforts, one using the media only for health education, and a third using both the media plus more intensive person-to-person efforts. The preliminary findings revealed that improvements were detected by using the media only. Using the media plus other person-to-person health education, however, showed more dramatic results. For example, the number of cigarettes smoked per day declined by forty percent in the maximum saturation town, during the period studied. Dr. Nathan Maccoby, director of the project, concluded that educational campaigns directed at an entire community can produce striking increases in the level of knowledge about heart disease and risk factors and marked improvements in risk factor levels.

Most health education experts acknowledge that there is a great need for greater understanding of how persons can be encouraged to adopt more healthful behavior and to retain a healthy life style. The Committee recognizes that imparting information alone is not sufficient to cause people to change their behavior. There is also apt to be great skepticism, particularly among the young, concerning any information provided, and the recognition that there are strong interests and pressures to adopt unhealthy life styles, including smoking, drinking, u-ing drugs, and eating fatty foods. The Committee considers health education and promotion, despite these limitations and obstacles, an essential part of a national effort to improve the health of people in this country. It is our opinion that there is a great need for more health education and promotion information.

In addition to the task of educating the public to the benefits of healthier lifestyles, there is a great need for a better understanding of how better to use the health system. Despite widespread availability of screening programs for breast and cervical cancer, only half of American women over 17 had such tests in 1973 and nearly one-fourth had never had a breast screening examination. As mentioned earlier, immunization levels, in some cases, are dropping. There are still far too many persons, even those with adequate incomes, who fail to see a dentist regularly and to practice good dental hygiene. We eat the wrong foods, drive too fast and drink too much. Ours is a generation of excess. Providers of health care are not able to do their job to educate us with regard to negative health behavior.

Finally, the Committee considers it essential that the general public, the potential users of health services produced by the health industry, gain a more realistic picture of the values and limitations of the health industry, regarding its potential to cure illness, eliminate disability, and prolong life. Such a picture should include the limitations of both preventive and therapeutic medicine to redress the harm done by environmental hazards and unhealthy individual lifestyles.

III. DISEASE CONTROL AND PREVENTION

1. TITLE I

Title I of the Committee's bill, Disease Control Amendments of 1975, would continue a national program of assisting States in carrying out programs which are needed to protect the American people from

unnecessary suffering from communicable diseases, and to build upon our successes in communicable disease control by including an attack on other preventable conditions. These programs are an essential element in forging a truly effective health care policy for our country, and have the potential for undergirding work in reforming our system of health care financing and the delivery of personal health services. The bill authorizes $31,000,000 for project grants and contracts in fiscal year 1976 to carry out these programs, with $35,000,000 and $40,000,000 being authorized for fiscal years 1977 and 1978 respectively. These grants are to support projects at the State and local level, and are to be awarded on the basis of the extent of the problem in the State or local area and on the soundness of the applicant's proposed control program. The bill re-emphasizes the importance of carrying out public awareness programs in these projects so that, to the extent possible, citizens will be properly informed of disease risks and the services available to them to prevent illness. Grantees will continue to be able to draw on personnel and other resources of the Department of carry out these projects in lieu of receiving direct financial assistance. The definition of disease control program has been broadened to permit the Administration and the Congress to address other problems of national significance which are amenable to control through organized State and community programs such as those authorized by this bill. Venereal disease control programs, however, are addressed separately under Title II of the bill in recognition of the importance of a special attack on this problem. Similarly, lead based paint poisoning prevention grants are, in the Committee's view, best undertaken in the context of a comprehensive attack. This approach is reflected in Senate Bill 1664 which was ordered reported by the Committee on July 16, 1975.

2. TITLE II

Title II of the Bill, National Venereal Disease Prevention and Control Amendments of 1975, continues and strengthens the national campaign against venereal disease under Section 318 of the PHS Act, which was formulated by this Committee in 1972. The bill extends authority for the Secretary to provide technical assistance to other organizations in their conduct of research, training and public health programs for the control of venereal disease, and emphasizes the key role of private non-profit organizations in the national control effort. Research, demonstration, and training grants are also authorized to enable the Secretary to meet national needs in developing and upgrading control programs. The Committee has authorized $5,000,000 annually for these grants in fiscal years 1976, 1977, and 1978.

In addition, the bill extends Section 318 (c) formula grant authority for upgrading diagnostic and treatment services, and adds an additional requirement that the providers of clinic services begin to meet the needs of patients with genito-urinary diseases other than those which have been traditionally defined as venereal diseases. The funding authorizations for this program are $5,000,000 for fiscal year 1976, $10,000,000 for 1977, and $15,000,000 for 1978.

Project grants for control programs under 318 (d) of the Act are also continued with revisions to clarify the purposes of these grants. The Committee is encouraged by the early results which have been

achieved through 318(d) project grants, and is recommending a funding authority for the next three years which will avoid retrenchment at this critical phase of our all-out attack on venereal disease. In fiscal year 1976, $31,000,000 is authorized for 318 (d) grants, with $33,000,000 in 1977, and $36,000,000 in 1978.

The funding authorizations for each of the programs under Title I and Title II of the bill have been developed after careful consideration of the needs of the nation in disease control and the demands for restraint in Federal spending. Funding levels are lower than those authorized for the period 1972-1975, and are lower than our original estimates of the need for the next three years. They represent in each instance reasonable and minimal investiments which must be made if we are to achieve the level of success in preventing illness which we, as a nation, have both the financial and technical capability to achieve.

3. HEARINGS

The need for the extension of the authority contained in section 317 and 318 of the PHS act in respect to disease control and the need for a special authority for venereal disease was supported by testimony from Mrs. Dale Bumpers, Chairperson, "Every Child by 1974," Little Rock, Arkansas, Dr. Eugene Fowinkle, Commissioner of Public Health, State of Tennessee, Mr. Donald P. Clough, Executive Director of the American Social Health Association, Dr. Leonard L. Heimoff, Associate Professor of Medicine, Cornell University Medical School, Mr. Samuel R. Knox, Director of the Association of Venereal Disease Programs, and Dr. James N. Miller, Professor of Microbiology and Immunology, UCLA School of Medicine. The Administration recommended against the enactment of both titles I and II of the Committee's bill.

4. BACKGROUND

In 1974, four American families were afflicted with polio. In 1952, there were over 55,000 cases in the United States. Yet, today, far too many one to four year olds are not fully protected against this dread disease, and in some population groups the level of protection is probably well below 50 percent. The major rubella epidemic predicted for 1971-1972 did not materialize, thanks to a massive nationwide rubella immunization campaign which was undertaken between 1969 and 1971. The percent of the population protected against rubella, however, has shown signs of declining since 1972. Levels of protection against the other childhood vaccine-preventable diseases also show signs of slipping. Since the early 1940's, deaths due to syphilis have declined 97 percent; first admissions to mental institutions due to syphilitic psychoses have declined 98 percent; and congenital syphilis has declined 92 percent. Yet, we continue to witness an increase in the incidence of syphilis, which portends a resurgence in serious complications in 10-20 years unless something is done now.

This history of communicable disease control contains grim lessons. It took a major epidemic in 1964 to direct the attention of the nation to the necessity for the control of rubella. Steady successes in syphilis control were eroded in the late 1950's because of the premature conclusion that the job was finished. We are still reaping the benefits of

syphilis control investments in the 1940's and early 1950's. The number of deaths and debilitating consequences of syphilis are still much below the pre-penicillin era. However, we lost the edge in containing the incidence of the diseases in the late 1950's, and between that time and the passage of the Communicable Disease Control Amendments of 1972, we ran hot and cold in our attention to this problem. Until gonorrhea surpassed a half million reported cases, the Federal government did not spend a penny in project grants to help States and cities carry out control programs.

In 1970, the Communicable Disease Control Act was passed, setting up a project grant program under Section 317 of the Public Health Service Act to assist States and cities address communicable disease control problems on a consistent, nationwide basis. This legislation was specifically designed to establish a Federal leadership role in the control of communicable diseases, and to signal to the States that we were serious about working with them in achieving control. It was a specific response to the existing Federal approach, which was to fund projects under the general health services project grant authority contained in Section 314(e) of the Public Health Service Act. That approach not only undermined the purpose of 314(e), but it created serious confusion in the States, because the nature of the Federal commitment to comunicable disease control and the likelihood of continued funding remained in a state of flux.

The 1972 amendments strengthened Section 317 grant programs, and specifically authorized for the first time a comprehensive attack on venereal disease under Section 318 of the Act. Funding of the various components of the new law, however, has never matched the amounts which the Committee authorized, and which we believed to be necessary. In many instances no funds have been provided to carry out parts of the law.

5. COMMITTEE CONSIDERATION

The Committee wishes to draw attention to several other key changes in the law which are contained in Senate Bill 1466.

1. The word "project" is inserted throughout Section 317, as appropriate, to avoid any possible misconception about the purpose of grants and the criteria to be used in making awards. These grants are to be awarded on the basis of the problem and according to the soundness of the program to be supported.

2. Public awareness programs are to be considered integral parts of any control program funded under Section 317.

3. HEW should expand its focus in providing technical assistance in venereal disease control to working with the many private non-profit organizations engaged in combatting these diseases. These citizen groups and service agencies are vital allies to Federal, State, and local disease control agencies.

4. The technical assistance capabilities of the Center for Disease Control should be fully utilized in helping States and localities strengthen each of their control programs. The Committee was very concerned in hearing testimony about the Department's plan to require tuition payments from persons receiving technical training at the Center. It is a major objective of this bill to upgrade States and local control capabilities, and we view this as a Federal respon

sibility. Tuition charges will certainly weaken the ability of the Center to help those States and cities which are in greatest need of

assistance.

5. Formula grant authority under Section 318(c) to assist States in upgrading diagnostic and treatment services has been extended. The Committee views the lack of appropriations for this grant program with great concern. We agree with the testimony presented by the American Social Health Association stating that "re-emphasis of the formula grant mechanism to assist states in establishing and maintaining adequate public health programs for the diagnosis and treatment of venereal disease is but an honest recognition of the shortcomings of our current VD patient care delivery system." The Committee views improvement in public diagnostic and treatment, programs as essential to the control of venereal disease, and sees the failure of many clinics to provide medical care to persons who seek care for genito-urinary diseases other than syphilis and gonorrhea. as a major weakness in the system.

IV. CONSUMER HEALTH EDUCATION AND PROMOTION

1. LIFESTYLE AND HEALTH STATUS

Americans are paying-in the form of taxes, insurance contributions, and direct out-of pocket expenses-over $116 billion a year for health care and related expenditures. Of this staggering total, only about four percent go for prevention and health education combined. Why the anomaly?

Throughout recorded history, responsibility for health was placed on the individual. However, as better knowledge of the human body and disease mechanisms were acquired and medical practice became more scientific, society came to place increasing dependence on medical intervention. Concomitantly, decreasing emphasis was placed on individual behavior and individual responsibility. Society soon came to accept the curative role of the physician and the preventive role of the public health official as the appropriate avenue to health.

Yet, despite the vast increase in health care expenditures, illness, disability and premature death rates have shown little improvement. The statistics with respect to death rates are particularly disturbing. After half a century of steady and dramatic improvement, the total or "crude" death rate for the U.S. ceased to improve during the 1960's. It remained almost stable, fluctuating between 9.4 and 9.7 per 1,000 population. The rate for 1973 is still 9.4.

The principal causes of death for the whole population in the late 1960's were still the familiar trio of heart disease, cancer, and stroke, to which we should add accidents. In 1970, cardiovascular diseases accounted for 53 percent of all deaths. During the later 1960's, however, other causes accounted for most of the rising death rates for young men. The principal cause for men, aged 15 to 44, was automobile accidents with homicide and suicide following close behind. The committee recognizes that none of these three phenomena is directly affected by the health care delivery system.

Thus, it appears that therapeutic medicine, important as it may be, may have reached a point of diminishing return. The 12 to 15 percent

« AnteriorContinuar »