PUBLIC HEALTH SERVICE UPDATE BY C, EVERETT Koop, MD SURGEON GENERAL AND DEPUTY ASSISTANT SECRETARY FOR HEALTH U.S, PUBLIC HEALTH SERVICE U.S.DEPARTMENT OF HEALTH AND HUMAN SERVICES vs urs Fiast? YF ar coess >.297 F/ PLeasvat Fo JSON biter SOs Wes YAVe SCOLEN PHEvIUICE Piw€ Mid © whor 7/ wert CHCl aA CyYE, Fare vos LAN A PLES OFEATAL POC}MOINTIE Wie DO Wor ROE Zrhvu LAM (ff YoU COAW 2VER CHOOSE COME In AT WE P ONLI OoMMEA SEs SUBSEC7F To DseQnues 7 SWE oF Pea yes YS? SHEN CONFIRMED SOB - APACHE c, I WANT TO GIVE YOU AN IDEA OF THE MISSION OF THE PUBLIC HEALTH SERVICE AND A SEIISE OF THE WAY IT 1S ORGANIZED TO CARRY OUT THAT MISSION, © 1 WANT TO TALK A BIT ABOUT HOW WE FUNCTION TODAY. HOW WE DID SOME THINGS IN PRIOR DAYS, AND FINALLY, I'LL MAKE A FEW EDUCATED GUE SES AS TO HOW THE P.4.S. MIGHT LOOK AND FUNCTION IN THE FUTURE. Tucey 1D Lite To Tee Ya fr Bout wirtaTz atHE S6- USFS psé> at F A SINGLE ORGANIZATION WITH BUREAUS, DIVISIONS, AND BRANCHES. IT MIGHT BETTER BE THOUGHT OF AS A “FEDERATION” OF FIVE INDIVIDUAL AGENCIES, EACH WITH ITS OWN SPECIAL SPHERE OF EXPERTISE, ITS OWN CONSTITUENCIES. AND ITS OWN UNIQUE RECORD OF CONTRIBUTIONS TO THE PUBLIC HEALTH OF THIS COUNTRY. " . THE P.H.S. IS A NON-COMBATANT UNIFORMED SERVICE WITH A PROUD TRADITION THAT REACHES BACK TO 1798 AND THE VERY BEGINNINGS OF MILITARY MEDICINE IN THE UNITED STATES. OUR MEN AND WOMEN HAVE BEEN ON ACTIVE DUTY IN ALL THE FAMILIAR “HOT SPOTS" AROUND THE WORLD, SERVING SIDE BY SIDE WITH OUR COLLEAGUES FROM ALL FOUR SISTER SERVICES. WE'VE BEEN IN SOUTHEAST ASIA...THE MIDDLE EAST. ..CENTRAL AMERICA. . AERICA.. WHEREVER AMERICAN INTERESTS HAVE REQUIRED THE PRESENCE OF THE AMERICAN UNIFORM, YCU WILL FIND CAREER, UNIFORMED PUBLIC HEALTH PERSONNEL “PULLING DUTY.” WE ALSO SERVE IN MANY PLACES WHERE OUR RECORD IN PUBLIC HEALTH 1S RESPECTED AND REQUESTED FOR SOMETIMES VERY COMPLICATED REASONS. FOR EXAMPLE, A TEAM OF THREE P.H.S, EPIDENIOLOGISTS WENT TO THE WEST BANK OF THE JORDAN, AT THE REQUEST OF THE STATE OF ISRAEL, TO DISCOVER THE CAUSE OF A MYSTERIOUS EPIDEMIC THAT HAD HOPSITALIZED LARGE NUMBERS OF YOUNG WOMEN FROM THE AREA'S ARAB COMMUNITIES, OUR TEA PRESENTED TO THE AUTHORITIES ITS CONCLUSION THAT THE EPIDEIC WAS A MASS PSYCHOLOGICAL PHENOMENON, A RARE BUT NOT UNKNOWN EVENT IN MCDICINE. YOU MAY REMEMBER READING ABOUT THAT IN THE NEWSPAPERS. 3- T 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, EVEN BY THE HEAVILY ACRIMONIOUS AIR OF GENEVA, CERTAINLY ONE OF THE GREAT TRIUMPHS OF MODERN MEDICAL SCIENCE HAS BEEN THE VIRTUAL ELIMINATION OF SMALLPOX AS A COMMUNICABLE DISEASE. AND ONCE AGAIN, THE PEOPLE WHO HAD BEEN ON THE FRONT LINES OF THE FIGHT AGAINST SMALLPOX...BOUNCING THROUGH THE VILLAGES AND SAVANNAHS OF AFRICA AND ASIA AND ADMINISTERING TENS OF THOUSANDS OF DOSES OF THE SMALLPOX VACCINE...WERE GUR P.H.S. PHYSICIANS, NURSES, AND SANITATION ENGINEERS, Awd ANE P.H.o. PERSONNEL HAVE ALSO BEEN, STATIONED AT POINTS OF EMBARKA- TION IN SOUTHEAST ASIA. I TRULY BELIEVE THAT THEIR PROFESSIONAL COMPETENCE HAS BEEN AMERICA'S BEST DEFENSE AGAINST THE IMPORTATION OF NEW AND HIGHLY CONTAGIOUS DISEASES, DURING THIS PERIOD WHEN OUR COUNTRY HAS BEEN CARRYING OUT A HUMANITARIAN PROGRAM OF ACCEPTING REFUGEE “BOAT PEOPLE” FROM THAT PART OF THE WORLD. P.H.S, PERSONNEL HAVE ALSO BEEN CARING FOR THE HEALTH NEEDS OF CUBAN AND HAITIAN REFUGEES WHEN THEY FIRST ARRIVE ON OUR SHORES, Y THE PUBLIC HEALTH SERVICE IS UNIQUELY QUALIFIED TO DO THIS KIND OF WORK FOR TWO REASONS: ITS HISTORY OF PROFESSIONAL MEDICAL EXCELLENCE AND ITS RECORD AS A CARING AND COMPASSIONATE ORGANIZATION RIGHT HERE AT HOME. mm THE P.H.S. HAS BEEN AT THE HEART OF OUR NATIONAL COMMITHENT 10 PROVIDE QUALITY HEALTH CARE TO THE POOR AND THE DISADVANTAGED CITIZENS OF OUR COUNTRY. OUR COMMISSIONED MEDICAL OFFICERS HAVE BEEN FOUND IN THE COMMUNITY HEALTH CENTERS OF OUR INNER CITY AND RURAL GHETTOS, IN MIGRANT LABOR CAMPS, IN COAL MINING COUNTRY, AND ON THE SEACOASTS AND WATERWAYS OF AMERICA. FOR NEARLY 36 YEARS WE HAVE ALSO STAFFED THE HOSPITALS, CLINICS, AND HEALTH STATIONS SERVING MORE THAN 200 INDIAN TRIBES AND ALASKAN NATIVE VILLAGES. WE GOT THIS ASSIGNHENT FROM THE CONGRESS Th 1955. DURING THE NEXT 25 YEARS, THE MEDICAL PERSONNEL OF THE P.H.S. WERE PRIMARILY RESPCNSIBLE FOR LOWERING THE INFANT MORTALITY RATE FOR INDIANS FROM 62.7 DEATHS PER 1,000 LIVE BIRTHS DOWN TO ONLY 13.2 DEATHS PER 1,000 NEWBORNS...AN SO PERCENT DECREASE. DURING THE SAME PERIOD, 1955 THROUGH 1980, THE INFANT MORTALITY RATE FOR THE UNITED STATES AS A WHCLE WAS CUT BY 52 PERCENT, FROM 26.4 70 12.6. INCIDENTALLY, I'M PLEASED TO REPORT THAT OUR LATEST PROVISIONAL INFANT MORTALITY RATE FOR The NATION WHOLE FOR THE 12 HONTHS ENDING IN HAY 83 IS NOW DOWN TO 11.0. »- GE COURSE, NO SINGLE GROUP CAN CLAIM ALL THE CREDIT FOR SUCH A DRAMATIC TURN OF EVENTS. NEVERTHELESS, THE DEDICATED HARD WORK OF THE COMPMISSIONED CORPS OF THE PUBLIC HEALTH SERVICE WAS CRUCIAL TO THAT ACHIEVEMENT IN INDIAN HEALTH. AAD 2 87 Fav We ow wre ACHE W OF coWwenéss 7M WEXT FEY wee Xs “TOV yf CUAME Fram Wate Fo TOMt€ Wwe Ate CHnceckto CHIN Fo FALE LEAD (WV SOME ECURAtwT OS Pa Pha ~ AS Fort EkLamne — AIDS SINCE JUNZ CE Sol. WHEN WE BEGAN TO TRACK The APPEARANCE OF “AIDS” IN THE U.S.» THE P.H.S. HAS RECEIVED REPORTS OF MORE THAN 9,260 CASTS. CF THAT NUMBER, THERE HAVE ALREADY DEEN S00 DEATHS. THERE 1S NO KNOWN CURE FOR “AIDS.” THE EVIDENCE SO FAR SUGGESTS Tat A VICTIM HAS PERHAPS THO CA THREE YEARS OF LIFE LEFT, ONCE He HAS THE DISEASE. ANID I SAY “HE” DECAUSE THREE OF EVERY FOUR CASE OF "AIDS" CSCUR IN HOMOSEXUAL OR BISEXUAL von. ° “AIDS” 1S sopmeesee THA TOUGHEST MEDICAL MYSTERY TO HAVE BLEi WASZp TO THE P.H.S. TO SOLVE, Al THAT IN ICLUDE'S LEGIONNAIRE'S DISEASE, TOXIC SHOCK SYNDROME, AnD The TYLENOL TAMPERING SCARE. ) tow AAT 367% Latico CFatf . nates ge. a & ALL THIS INFORMATION MAY BE VERY INTERESTING, BUT JUST WHO IN THE PUBLIC HEALTH SERVICE DOES WHAT -- AND HOW? I CAN BEST ANSWER THOSE QUESTIONS BY QUICKLY RUNNING THROUGH OUR ORGANIZATION, FIRST, LET ME START WITH THE 5 P.H.S,. AGENCIES, I'LL BEGIN WITH “A,” THE ALCOHOL, DRUG ABUSE, AND MENTAL HEALTH A DAMHA)ADMINISTRATIONS 1 THINK THE TITLE SAYS IT ALL. THIS AGENCY HAS THREE NATIONAL INSTITUTES -- CF MENTAL HEALTH, OF DRUG ABUSE, AND OF ALCOHOLISM AID ALCOHCL ABUSE. THEY CARRY OUT RESEARCH AND PUCLIC EDUCATICN PROGRAMS AND, UNTIL RECENTLY, THEY ALSO SUPPORTED A WIZE RAGE OF SCRVICE DELIVERY PROGRAMS AT THE LOCAL LEVEL...800 MENTAL HEALTH CENTERS,..300 STATE AND LOCAL DRUG ABUSE PROGRANS,..AND ABOUT 1,000 LOCAL ALCUHOLIST] PROJECTS. HORE ABOUT THOSE PROJECTS LATER. CMe v7 aver Yeo THE FISCAL 1983 APPROPRIATION FOR A.D.A.M.ALA, IS S889 MILLION DOLLARS. NexT, ARE THE CENTERS FOR DISEASE CONTROL, OR C.D.C. THE CENTERS ARE HEADQUARTERED IN ATLANTA AND, AS THE NAME IMPLIES, THEY'RE CONCERNED PRIMARILY WITH CONTROLLING OR PREVENTING COMMUNICABLE AND VECTOR-BORNE DISEASES, C.D.C.'s MORTALITY AND MOKBIDITY WEEKLY REPORT 1S REGARDED AS THE BEST BAROMETER ME HAVE OF INFECTIOUS DISEASE ACTIVITY IN THIS COUNTRY, } C.D.C.'S HISTORY IS ROOTED IN THAT STRONG TROPICAL DISEASE FRATERN- ITY WHO LABORED WITH WILLIAM CRAWFORD GORGAS AND WALTER REED IN THE CARIBBEAN, CENTRAL AMERICA, AND THE PHILIPPINES. TODAY, THE CENTERS WORK PRIMARILY THROUGH STATE AND LOCAL HEALTH AUTHORITIES TO CARRY OUT SUCH ACTIVITIES AS CHILD IMMUNIZATIONS, THE CONTROL OF SEXUALLY TRANS- MITTED DISEASES, AND THE EPIDEMIOLOGICAL DETECTIVE WORK TO SOLVE THE MEDICAL MYSTERIES I MENTIONED EARLIER. FOR EXAMPLE, IT IS OUR ~- AND THE COUNTRY'S -- LEAD AGENCY IN THE FIGHT AGAINST “AIDS.” C.D.C, PERSONNEL ARE Ol T.D.Y. WITH STATE HEALTH AGENCIES AND ARE USUALLY THE ONES OVERSEAS WHO SCREEN REFUGEES HEADING THIS WAY. YOU MIGHT Be INTERESTED TO KNOW THAT THE PUBLIC HEALTH SERVICE IS INVOLVED IN HEALTH-RELATED TECHNICAL ASSISTANCE AGREEMENTS WITH 38 OTHER NATIONS. INTERNATIONAL HEALTH HAPPENS TO BE ONE OF THE SURGEON GENERAL'S RESPONSIBILITIES, BUT WE USUALLY TURN TO THE CENTERS FOR DISEASE CONTROL FOR THE PERSONNEL WHO DO THE ACTUAL WORK IN THE HOST COUNTRIES, Apo? 2 5 THE C.D.C. BUDGET BOREEESERESTES TS SRE MILLION, -G- THE FOOD AND DRUG ADMINISTRATION ~- OR F.D.A. -- HAS BEEN, FOR MOST OF ITS 77 YEARS, ONE OF THE MOST WIDELY PUBLICIZED, LOVED, AND HATED AGENCIES OF GOVERNMENT. THE TWO WATCHWORDS 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 AND MEDICAL PRACTICES, SUCH AS NUTRITION AND DIET COUNSELING, PRESCRIPTION DRUG ADVERTISING, DRUG PRESCRIBING. AND ANTENATAL FETAL DIAGNOSIS. _ gee THE F.D.A.'S BUDGET POR-PEGGAtm=O3 1S SREY MILLION. 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 F.D.A.'S BUDGET. THE HEALTH RESOURCES AND SERVICES ADMINISTRATION IS CONCERNED WITH A VARIETY OF PROGRAMS. LET ME GO THROUGH THEM QUICKLY WITH YOU. * FIRST, IN SHEER SIZE AND IMPACT, IS THE MATERNAL AMD CHILD HEALTH PROGRAM -- RUNNING AT A LEVEL OF S83 MILLION THIS FISCAL YEAR. Just vMOEN 29y° -G- * NEXT WOULD BE THE EDUCATION AND TRAINING OF HEALTH PROFES- SIONALS: PHYSICIANS, DENTISTS, NURSES, THERAPISTS, TECHNICIANS, AND MANY OTHERS. THE MAJOR COMPONENT OF THIS PROGRAM, THE NATIONAL HEALTH ScRVICE CORPS, ASSIGNS 2,600 HEALTH PERSONNEL -- PHYSICIANS, NURSES, AND DENTISTS FRESH OUT OF GRADUATE SCHOOL. -- TO DELIVER MEDICAL CARE IN UNDERSERVED AREAS. THIS IS HOW MANY YOUNG HEALTH PROFESSIONALS REPAY THE GOVERNMENT FOR THEIR STUDENT LOANS, * A THIRD PROGRAH HAS BEEN THE BUILDING AND MAINTAINING OF ANERICA'S HOSPITALS. THIS IS KNOWN AS THE HILL-BURTON PROGRAM, NAMED FOR ITS CONGRESSIONAL SPONSORS BACK IN 1946. IT WAS A VITAL PROGRAM, SINCE WE HAD DONE VERY LITTLE ABOUT HOSPITALS ON TIE HOME FRONT DURING WORLD WAR II, AND A GREAT MANY NEW THINGS HAD HAPPENED IN MEDICINE AS A RESULT OF THINGS WE LEARNED AS PART OF OUR WAR EFFORT. IT HAS BEEN A VERY SUCCESSFUL PROGRAM -- SO HUCH SO THAT WE APPARENTLY NOW HAVE ABOJT 100,000 SURPLUS HOSPITAL BEDS, A VERY COSTLY BUSINESS FOR THE NATION. THE HEALTH RESOURCES AND SERVICES ADMINISTRATION IS THE P.H.S. AGENCY THAT HAS ACTUALLY DELIVERED -- DIRECTLY OR THROUGH THIRD PARTIES -- A VARTETY OF HEALTH SERVICES TO CERTAIN SPECIAL POPULATIONS: AMERICAN INDIANS AND ALASKAN NATIVES, MIGRANT WORKERS, FEDERAL EMPLOYEES, COAL MINERS, AND PEOPLE LIVING IN MEDICALLY UNDERSERVED OR UNSERVED AREAS. -10 UNTIL RECENTLY MERCHANT SEAMEN, BARGEMEN, CANALLERS, RIVERBOATERS, AND FEDERAL RETIREES WERE ALSO INCLUDED: THEY RECEIVED THEIR CARE THROUGH EIGHT PUBLIC HEALTH SERVICE HOSPITALS AND 27 CLINICS -- ALL THAT RenAINED OF THE ONCE EATENSIVE NETWORK OF “MARINE HOSPITALS” BEGUN BY PRESIDENT JOHN ADAMS IN 1798. THE ONLY HOSPITALS THE P.H,.S. STILL RUNS ARC THe NATIONAL CENTER FOR HANSEN'S DISEASE -- A WORLD FAMOUS LEPROSARIUM -- IN CARVILLE, LOUISIANA, ST. ELIZABETHS HOSPITAL FOR THe MENTALLY ILL ON THE OUTSKIRTS OF WASHINGTON, D.C., AND, AS I MENTIONED A MOMENT AGO, THE INDIAN HEATH SERVICE SYSTEM OF 48 HOSPITALS ANo 120 CLIUiCS. THE HEALTH RESCURCES AWD SERVICES ADMINISTRATION HAS A@f-ESGA =e z APPROPRIATION CF Saee BILLION, wit gyror | THE AGENCY WITH THE LARGEST APPROPRIATICN IS THE NATIONAL INSTITUTES OF HEALTH. ITS BUDGET FORTE Trsear—+9s3 IS $4 BILLION a THE 11 INSTITUTES THAT ARE THE N.I.H. SUPPORT ABOUT 16,000 EXTRA- MURAL ReSEARCH PROJECTS AT ANY ONE TIME. N.I.H. ALSO CARRIES OUT SOME 2,00G INIRAWRAL PROJECTS EACH YEAR, SINCE 1937, WHEN THE NATIONAL CANCER INSTITUTE WAS ESTABLISHED, THE N.I.H. HAS SUPPORTED THE WORK OF HORE THAN 60 NOceL LAURCATES iff MEDICINE, PHYSICS, AND CHEMISTRY, OR ABOUT 1 OUT GF EVERY G WINNERS IN THOSE PRIZE CATEGORIE -]R- THAT, BRIEFLY. IS A “SNAPSHOT.” SO TO SPEAK, OF THE 5 P.H.S. AGENCIES. THE FINAL MAJOR ORGANIZAT TONAL UNIT WITHIN P.H.S: IS THE OFFICE OF THE ASSISTANT SECRETARY FOR HEALTH. WITHIN THIS OFFICE ARE SUCH ACTIVITIES AS DISEASE PREVENTION AND HEALTH PROMOTION, ANTI-SHOKING, o.'s, ADOLESCENT PREGNANCY PROGRAMS. PHYSICAL FITNESS ND STAFF ACTIVITIES SUCH AS PERSONNEL, PLANNING D BUDGET, PERSONNEL. AND SO ON. abot YEAR IS $1.5 BILLION. BUT OVER 80 DING OF FOUR BLOCK GRANTS. THE CHANGES THAT HAVE TAKEN THE PUBLIC HEALTH SERVICE SUPPORT FOR HM. AND SPORTS MEDICINE. A AND EVALUATION. MANAGEMENT AN THE O.A.S.H. BUDGET THIS (IT OF THAT IS EARMARKED FOR THE FUN PERCE: AND THAT LEADS FE TG SOME COMMENTS ABOUT PLACE AND PROBABLY WILL CONTINUE TO PLACE IN, DURING THE PAST 20 YEARS HAS BEEN THE IG CATEGORICAL GRANT PROGRAMS. AT TH IN JANUARY 1981. THE EXECUTIVE OGRAM THE GRONTH OF ThE P.H.S. RESULT MAINLY OF NEW AND EXPANDIT TIME PRESIDENT REAGAN WAS INAUGURATED G 534 CATEGORICAL GRANT-IN-AID PR BRANCH WAS FUNDING AND OPERAT II ONE-SEVENTH OF THOSE -- 74, TO BE EXACT -- WERE If P.H.S. “1 THE ADMINISTRATION SAID THAT IT WAS TIME FOR THE FEDERAL GOVERNMENT TO GET OUT OF THE BUSINESS OF DELIVERING HEALTH SERVICES. EITHER DIRECTLY OR BY PROXY THROUGH GRANTEES AND CONTRACTORS. IT HAD BECOME TOO COSTLY, TOO UNWIELDY, AND NOT AS EFFECTIVE AS ADVERTISED. HANDING _ OVER THOSE FEDERAL PROGRAMS TO STATE AND TERRITORIAL HEALTH AUTHORITIES SEEMED TO BE PREFERABLE. BUNDLING THEM INTO BLOCKS, WITH AS FEW STRINGS AS POSSIBLE, WAS TO BE THE METHOD. PRESIDENT REAGAN PROPOSED -- AND CONGRESS APPROVED -- THE NOTION OF GROUPING MANY SIMILAR CATEGORICAL GRANT-IN-AID PROGRAMS INTO A SERIES OF BLOCK GRANTS TO THE STATES: ONE FOR PREVENTIVE SERVICES, ANOTHER FOR THE A.D. A MHA PROJECTS, AND A THIRD FOR MATERRAL AND CHILD HEALTH. CONGRESS AUTHORIZED AND FUNDED THESE THREE AS OF AUGUST wt SS 1981. A FOURTH “PRIMARY CARE” BLOCK GRANT IS PRINCIPALLY CONCERNED WITH COMMUNITY HEALTH CENTERS. AS THE LAW NOW READS, THE P.H.S. STILL DIRECTLY FUNDS MOST OF THE 530 OR SQ COMMUNITY HEALTH CENTERS AROUND THE COUNTRY, BUT EACH STATE HAS THE OPTION 10 TAKE OVER THE CENTERS IN WITHIN ITS OW BORDERS. SO FAR, ALL BUT WEST VIRGINIA AND THE VIRGIN ISLANDS HAVE DECLINED THE OFFER. - 13- HOWEVER, THE PRESIDENT STILL HOPES THAT CONGRESS WILL NOT LEAVE THIS AS A STATE OPTION BUT WILL REVISE THE LAWN TO GIVE CONTROL OF © THESE IMPORTANT PROJECTS TO THE STATES AND LOCALITIES WHERE THE PEOPLE ARE ACTUALLY SERVED. THE RESULT OF THE BLOCK GRANT APPROACH 1S A NEW DIVISION OF LABOR WITHIN P.H.S. ONE TASK 1S SIMPLY TO ADMINISTER THE FISCAL ARRANGEMENTS EQR 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 WITH ANY TECHNICAL ASSISTANCE THEY MIGHT NEED OR IN OTHER WAYS BE HELP - FUL TO STATE PROGRAM PEOPLE AT THEIR REQUEST. THIS ALSO REQUIRES FEWER FEDERAL PERSONNEL IN SMALLER P.H.S. AGENCIES. THE PRESIDENT HOPES THAT THE BLOCK GRANT APPROACH. IN ADDITION 10 BREATHING NEW LIFE INTO AMERICAN FEDERALISM, WILL ALSO TEND TO REDUCE THE GROWTH RATE OF FEDERAL HEALTH FUNDING. WHICH HAS GROWN 14-FOLD IN THE PAST 15 YEARS. HEALTH HAS BEEN THE FASTEST GROWING LINE ITEM IN THE FEDERAL BUDGET. WHEN THE PRESIDENT LOOKS FOR "TARGETS OF OPPORTUNITY” FOR COOLING DOWN THE FEDERAL BUDGET. WHAT BETTER PLACE COULD HE CHOOSE TO START THAN THE NATION'S HEALTH BUDGET? mM -19- BUT EVEN THAT IS AN OVERSIMPLIFICATION, SOME HEALTH AGENCIES MAY GET REDUCED FUNDING, BUT SOME HEALTH EUNCTIONS WILL REQUIRE -- AND WILL RECEIVE -- MORE MONEY. THIS IS CLEARLY THE CASE IN RESEARCH. OWLY THE FEDERAL GOVERNMENT CAN ASSEMBLE THE EXTRAORDINARY RESOURCES OF PERSONNEL, MONEY, FACILITIES, AND TIME TO... UNLOCK THE GENETIC CODE... IDENTIFY THE FUNDAMENTAL MECHANISHS OF HUMAN IMMUNOLOGY... DEVELOP MONOCLONAL HYBRIDOMA TECHNOLOGY... AND, OF COURSE, KEEP UP THE BATTLE TO CONQUER THE MAJOR KILLERS IN SOCIETY: HEART DISEASE, CANCER, AND STROKE. Tre N.I.H. RESEARCH BUDGET FOR FISCAL 1983 IS $3.7 BILLION OR $337 MILLION HIGHER THAN LAST YEAR'S BUDGET. THE SAME IS TRUE FOR A.D.A.F HA. WHILE THAT AGENCY HAS ACTUALLY HAD A DROP IN ITS OVERALL TOTAL, A.D.A.H.HWA. HAS NEVERTHELESS HAD A NET INCREASE OF $27.3 MILLION THiS YEAR TQ SUPPORT BEHAVIORAL RESEARCH. SO, IN BOTH ABSOLUTE AND IN RELATIVE TERMS, THE RESEARCH ACTIVITY WILL CONTINUE TO BECOME CENTRAL TO THE LIFE OF THE P.H.S. IN The FUTURE. a IN WHAT OTHER WAYS WILL THE P.H.S. CHANGE? 1 THINK WE WILL BE RETURNING TO WHAT HAD ONCE BEEN OUR TRADITIONAL ROLE OF PARTNER... OF EQUAL AMONG EQUALS...WITH COLLEAGUES IN HEALTH AND MEDICAL CARE AT OTHER LEVELS OF GOVERNMENT AND IN PRIVATE NON-PROFIT AND FOR-PROFIT ORGANIZATIONS. WITH A REDUCED FEDERAL PRESENCE. WE BELIEVE THAT MORE INITIATIVES FOR IMPROVED HEALTH AND MEDICAL CARE WILL ORIGINATE ELSEWHERE, OUTSIDE WASINGTON, THE OPPORTUNITIES WILL CERTAINLY STILL Be THERE. THE FEDERAL CONTRIBUTION WILL TEND TO BE MORE SUBSTANTIVE -- AGAIN, REFLECTING ITS RESEARCH STRENGTHS ~~ OR FACILITATIVE As. FOR EXAMPLE. THE NEGOTIATOR AMONG COMPETING HEALTH INTERESTS, AND PURPOSIVE, IN THE WAY IT PERFORMS AS STEWARD OF THE NATIONAL HEALTH AGENDA. THERE HAS ALSO BEEN ANOTHER CHANGE. THE GREAT FEDERAL HEALTH STRUCTURE WAS BUILT TO DELIVER HEALTH SERVICES. IT WAS PREDICATED ON THE TRADITIONAL PRACTICE OF MEDICINE AND THAT WAS ESSENTIALLY CURATIV AND REPARATIVE MEDICINE. 17 WAS ALSO LARGELY POST-FACTO MEDICINE: THAT IS, WE TREATED PEOPLE AFTER A DISEASE ARRIVED OR A DISABLING EVENT OCCURRED. 16 BUT ONE OF THE THINGS WE'VE LEARNED FROM RESEARCH AND EXPERTENCE LS THAT THE MOST EFFECTIVE TOOL WE HAVE TO IMPROVE HEALTH STATUS IS NH. THERE WOULD NEVER HAVE PREVENTION. COMBINED WITH HEALTH PROMOTIO L THE CHILDREN AND ADULTS IEY IN THE WORLD TO CARE FOR AL THEREFORE. WE DIPHTHERIA. MEASLES, AND TYPHUS. BEEN ENOUGH MOT STRUCK DOWN BY POLIO. IES AND A PROGRAM OF MASS IMMUNIZATION. HAD TO COME UP WITH NEW VACCIT N THE WORLD 10 TAKE CARE OF ALL SIMILALRLY- THERE'S NOT ENOUGH MONEY 1 CURRENT AND FUTURE HEART DISEASE. CANCER, AND STROKE VICTIMS. THERE- OKING. FORE, THERE WE MUST CONVINCE PEOPLE TO QUIT oM G THAT THE PREVENTION OF DISEAS THE LOGIC OF THIS 1S SO OVERWHELMIN ID WELL-BEING ARE NOb DISABILITY AND THE PROMOTION OF GOOD HEALTH AT AND KEYSTONES OF NATIONAL HEALTH POLICY. THE JOST EXCITING DEVELOPMENTS IN THE YEARS ANEAD. THERE - NG OF THIS CONCEPT AS THE FOUNDATION OF AMERICAN PUBLIC HEALTH POLICY AND PRACTICE. ENRICHING THIS PROCESS WILL BE AN IMPORTANT FUNCTION OF THE FEDERAL HEALTH ENTERPRISE. WHETHER BY ITs RESEARCH OR ITS PUBLIC EDUCATION PROGRAIS. ONE OF THE I FORE, WILL BE THE MATURI -1p- I HOPE THIS BRIEF OVERVIEW HAS HELPED YOU GET SOME PERSPECTIVE ON WHERE THE U.S. PUBLIC HEALTH SERVICE IS AND WHERE IT SEEMS TO BE HEADING. WE'VE COME A VERY LONG WAY OVER THE PAST 185 YEARS. WE BELIEVE WE'LL ENJOY A JOURNEY EVERY BIT AS EXCITING DURING THE NEXT 185. Yhuiven HHH # # tur Now - HAVE Yov Seen Wawd ExAs0 7 Aptis FG. poss ?