majority of agencies which dispense some form of health education to consumers, this activity is not their primary purpose and therefore does not receive top priority for their allocation of funds and program attention. Thus, very little of the current consumer health education efforts are as effective or efficient as they could be, were there some national focal point to improve communications and cooperation among the major programs within the private sector. Clearly a nationally recognized source of policy development, guidance and technical assistance, cooperative program planning and coalition building, evaluation and advocacy could make a major impact on the kinds and quality of health education efforts in the private sector without a net increase in overalll expenditures simply by reducing the fragmentation and discontinuity of current efforts. Testimony given to the Committee strongly indicates the existence of considerable support from private sector sources for the creation of such an organization. The granting of a Congressional charter to such an organization would improve opportunities for: 1. Supporting private leadership in policy exploration and program development by the creation of an entity with quasi-official legitimacy and stability; 2. Integrating utilization of private and public resources in the development of concerted national strategies for improving consumer health education nationwide; and 3. Maintaining formal channels of communication, information exchange and public accountability between the governmental and private sectors. C. Activities of the Private Center.-The mission of the Center will be to improve the health of people by encouraging and supporting the improvement and expansion of health educational activities throughout the nation. The Center should be a mechanism which links together primarily non-governmental organizations and agencies involved in health education, including those which engage in health care, education, business and industry, social and civic purposes, consumer and labor representation and communications. The widest possible range of participants should be given significant, structured opportunities to debate, select and influence the development of Center policies and strategies. The Center should manage an open decision-making process for the development of national private sector policy concerning key issues in the field of health education. The Center should coordinate the review and analysis of consumer health education needs, provider resources, the impact of alternative health education approaches and other factors on health status to determine which lines of development offer the best opportunities for the improvement of the nation's health through educational means. Through participatory processes it should seek to identify the locus of responsibility for addressing identified consumer needs and for the development of the resources required to meet these needs. The Center should also provide a forum for the determination of the most appropriate and acceptable roles it can play in stimulating and energizing the actions required to secure widespread endorsement and implementation of its goals and policies. Policy guidance alone cannot secure the improvement of program services; frequently there are challenging impediments to the development of improved methods which require extended problem-solving and strategy design efforts. The Center, therefore, should coordinate a variety of activities, programs, and developmental projects which draw upon external sources of support and expertise to develop improved methodologies, especially concerning appropriate and acceptable ways to influence positive consumer behavioral changes, and concerning realistic and acceptable criteria for evaluation of health education programs. To encourage similar activities by other organizations, the Center also should organize a national network of technical assistance in the planning, implementation and evaluation of health education programs utilizing not only its own but the expertise available for other cooperating agencies. D. Board of Directors.-The Center for Health Education and Promotion will be directed by a twenty-five member Board of Directors to be appointed by the President of the United States. Its functions should include: (1) Final Center policy and strategy design determinations; (2) Center program direction; (3) Center financial policy determinations, including direction of the basic funding strategy for Center programs and approval of budgets and resource allocations; (4) Representation of the Center to and liaison with outside organizations; (5) Charge and appointments to committees, task forces and study groups; and (6) Appointment of the Center's President. Members of the Center's Board should serve as individuals and not as the official representatives of outside organizations. The Board as a whole should reflect a balanced mix of experts representing the fields of health education, health services delivery, education, consumer representation and advocacy, news media and communications, business and industry, organizational management, and public and private finance. In addition, the Board as a whole should reflect a diversity of personal backgrounds and interests which assures not only the development of broad policy direction but facilitates the acceptance of its findings and recommendations by those asked to implement these recommendations. During its deliberations this Committee considered a number of specific nominations for appointment to this Board. The following individuals are suggested as representative of the type and quality of members the Board should reflect: Stanley Bergen, Newark, New Jersey; Lisle Carter, Atlanta, Georgia; Paul Ellwood, Minneapolis, Minnesota; Howard Ennes, Craryville, New York; Paul S. Entmacher, New York, New York; Robert H. Felix, Saint Louis, Missouri; Evalyn S. Gendel, Topeka, Kansas; William Griffiths, Berkeley, California; M. Alfred Haynes, Los Angeles, California; Howard Hiatt, Boston, Massachusetts; Magda Hinojosa, San Antonio, Texas; Robert L. Johnson, Berkeley, California; Philip M. Klutznick, Chicago, Illinois; A. M. Lilienfeld, Baltimore, Maryland; J. Alexander E. Advisory Panel.-In addition to the Board of Directors, there should be a large panel of at least one hundred individuals representing the same kinds of competencies and abilities as those described for Board membership. The principal function of this panel should be to provide advice to the Board. The Advisory Panel should routinely be requested to review and comment on Center reports and policy drafts. The Panel should also be the primary source for appointments to special committees and study groups created by the Policy Board to explore a particular problem or subject area in depth. F. Program Priorities.-In a field as diverse and fragmented as health education there are no immediately obvious, generally acceptable, and logically appropriate priority rankings among the long list of potential specific program objectives the Center could select for action in its first years of operation. Consequently an organizing phase is indicated for the Center's initial activities. In this period, the open, in-depth analysis of alternative opportunities to achieve nationally significant impacts and the consensus selection of initial program priorities by the Board based on input from the Advisory Panel and a large sample of outside organizations and agencies should be the Center's top priority objective. G. External Relationships.-The organizations, groups and individuals to be involved in any given phase in the Center's policy process will vary depending on the nature of the needs or problems being explored. Although the Center will not be a membership organization, it should be linked to a comparatively large number of external organizations by a variety of both formal and informal mechanisms. The Center should seek ties with representative health, education, welfare, and civic organizations and associations. It should also seek the support and endorsement of major corporations in business and industry, labor unions, and private foundations. The Center should involve these constituents in all aspects of its policy and program development both on an individual basis and through the formation of special purpose coalitions and consortia. The Center also should. develop mechanisms to involve outside organizations in its processes for the periodic review and assessment of its policies and performance. Private and public financial supporters of the Center should be publicly identified in the Center's annual report. Outside organizations unable to support the Center financially but wishing to affiliate with its goals and policies should be given the opportunity to formally signify their endorsement after action by the Center's and the respective agency's policy body. All organizations, groups and individuals who participate in Center activities, advisory groups, and projects should be listed in relevant reports. H. Center Funding.-The Center should be funded by varying combinations of private and public funds, including direct appropriations, grants, contracts and unrestricted donations as appropriate for its general support and the financing of various special projects and activities. The authorized $1 million of core support for the Center for its first three years of operation is intended to provide for the establishment of its core policy process and staffing; i.e. to provide for the costs associated with the meeting and other expenses of the Board and its communications with the Advisory Panel, and to support the acquisition of a competent core staff. The Center's internal staff organization should be headed by a President to be named by the Board and such other members as he selects. The staff organization should be modeled on a matrix (rather than a bureaucratic) organizational design which stresses the accomplishment of tasks by ad hoc teams and special project activity in combination with routine program functions. The initial core staff should be small in number and emphasize coordinative, program design and management, group process, and communication skills. Members of the Board and advisory panel, staff on loan from cooperating organizations and outside. consultants should be utilized in addition to Center staff to complete special project activities. It is estimated that full scale Center operation will require approximately $5 million annually. Funds to support the increased costs should be raised from private sources. In addition to support for core operating costs of the Center, it is expected that the Center will also seek variable additional amounts in grants and contracts from both private and public sources in order to accomplish a variety of special projects. Thus the total annual income required to achieve the Center's program objectives in any given year should vary substantially depending on changes in program priorities and on the extent to which external organizations voluntarily undertake the performance of Center designed projects. without using the Center as a fiscal intermediary. A modest but relatively secure core operating budget combined with the necessity to secure additional, earmarked financial support to accomplish non-routine tasks and special projects is inherent to our concept of the Center as a non-bureaucratic, private sector based problem-solving mechanism. The Committee recognizes that the burden of securing the support and resources required to perform projects on a case-by-case basis can be quite high. The Committee believes, however, that the quality, feasibility, and general acceptability of proposed Center projects should be tested "realistically"; i.e. by their ability to attract endorsement and allocation of resources from outside organizations. 3. GRANTS FOR WATER TREATMENT PROGRAMS Section 178 of the Committee's bill provides a modest authorization of $9 million for communities which wish to seek partial Federal assistance in order to treat their water supplies. The Committee is convinced of the safety and effectiveness of fluoridation as a powerful preventive weapon in the battle against dental disease. The efficacy of fluorida tion has been widely known for many years, and the Committee has received overwhelming testimony from both scientific and professional groups to this effect. Dental caries is the most prevalent disease in the United States today and one of the most costly of all chronic diseases. By age two, approximately one-half of the children in this Nation have experienced tooth decay. By age fifteen, the average child has 11 decayed, missing, or filled teeth. Bringing the level of fluoridation in community water supplies to the optimum level is the safest, most effective, and most economical way to prevent tooth decay. Fluoridation prevents 40-60 percent of the dental caries usually experienced by children. The effects of fluoridation have been studied in the United States since 1945 and all communities involved have reported significant reduction in tooth decay as a result of this public health measure. Fluoride occurs naturally in most water supplies and raising it to the optimum level to prevent tooth decay, usually one part per million, has never been proved to be hazardous to health. Adjusting the fluoride content of the water will not increase the likelihood of cancer, heart disease, kidney disease, allergies, or any other physical or mental illness. Indeed, fluoride is considered an essential trace element vital to proper nutrition, growth, and development. Adjusting the fluoride level in a community's water supply costs a maximum of 10 or 15 cents per person annually. It results in a 50 percent or more savings in a family's dental bill. For every dollar spent on fluoridation, $30-50 can be saved in dental care costs. Other methods for the prophylactic application of fluoride are available, however, none are as effective or as economical as fluoridation of drinking water. Its benefits are conferred on everyone, regardless of socio-economic level. It is effective without the need for any action by the individual. A report released this year by the Director-General of the World Health Organization renewed that organization's support of water fluoridation and said that "unless there are overriding technical reasons, no nation can afford the luxury of not fluoridating every central water supply system containing less than the optimum concentrations of fluoride." The WHO report affirmed that fluoridation of the water supply should be the cornerstone of any national program of dental caries prevention. The need for this provision is expressed by the professional organizations concerned with dental health care, as follows: AMERICAN DENTAL ASSOCIATION, Hon. JACOB JAVITS, DEAR SENATOR JAVITS: It is my understanding that you are planning to offer as an amendment to S. 1466, the Disease Control Amendments Act, a provision authorizing grants for water treatment programs which is identical to that contained in section 1702 of S. 2026, the Children's Dental Health Act of 1975. I am writing to express the support of the American Dental Association for this amendment. |