CONCERNS FACING THE P.H.S.,

BY
C. EVERETT Koop, MD
DEPUTY ASSISTANT SECRETARY FOR HEALTH
AND SURGEON GENERAL
U.S, DEPARTMENT OF HEALTH AND HUMAN SERVICES

PRESENTED TO THE 61ST INTERAGENCY INSTITUTE FOR
FEDERAL HEALTH CARE EXECUTIVES
CLAYTON, MISSOURI
SEPTEMBER 24, 1982
(GREETINGS TO HOSTS, GUESTS)

IT'S A PLEASURE TO BE HERE, REPRESENTING THE U.S. PUBLIC HEALTH
SERVICE. AND TO BE AGAIN IN THE COMPANY OF MY COLLEAGUES FROM THE
OTHER SERVICES. THIS HAS BEEN A SPECIAL YEAR FOR THE P.H.S. AND FOR
ME.PERSONALLY, AS FAR AS INTER-SERVICE COOPERATION IS CONCERNED. FOR
THE YEAR ENDING THIS OCTOBER, I HAVE HAD THE PRIVILEGE OF SERVING AS
PRESIDENT OF THE ASSOCIATION OF MILITARY SURGEONS OF THE UNITED STATES.

WHEN I TOOK OVER THAT POST LAST OCTOBER. I WAS THE PROVERBIAL "NEW ©

KID ON THE BLOCK.” I HAD JUST COMPLETED MY CONFIRMATION HEARINGS
BEFORE THE SENATE COMMITTEE -- BUT I HAD NOT YET BEEN SWORN IN AS THE
SURGEON GENERAL. SO I WAS ESPECIALLY TOUCHED BY THE WARM RECEPTION
GIVEN TO ME BY MY COLLEAGUES IN FEDERAL MEDICINE IN THE OTHER SERVICES
WHEN I TOOK OVER THE A.M.S.U.S. GAVEL IN SAN ANTONIO LAST YEAR.

IT HAS BEEN A GOOD YEAR FOR A.M,S.U.S. ALL THE SURGEONS GENERAL
KNEW EACH OTHER EITHER PERSONALLY OR BY REPUTATION AND WE HAVE WORKED
TOGETHER AND CONSULTED TOGETHER ON A VARIETY OF MATTERS THAT AFFECT
NOT ONLY OUR OWN ORGANIZATIONS BUT THAT MAY ALSO ENHANCE THE QUALITY
OF CIVILIAN HEALTH AND MEDICAL CARE IN REMOTE RURAL AREAS.
-2-

A WIDE RANGE OF ACTIVITIES WILL BE DISCUSSED AT OUR NEXT A.M.S.U.S.
ANNUAL MEETING IN ORLANDO, FLORIDA, DURING THE WEEK OF OCTOBER 17. ONE
REASON THIS ORGANIZATION HAS SUCH A BROAD AGENDA IS THAT THERE ARE
ACTUALLY VERY FEW “MILITAY SURGEONS” AS SUCH IN A.M.S.U.S., BUT THERE
ARE A GREAT MANY OTHER MEDICAL SKILLS REPRESENTED -- INTERNISTS,
NURSES, TECHNICIANS, DENTISTS, AND SO ON. IN FACT, DISCUSSION IS NOW
GOING ON WITHIN A.M.S.U.S. REGARDING THE POSSIBILITY OF ADOPTING A
MORE ACCURATE NAME FOR THE ORGANIZATION,

BUT LET ME RETURN TO THE IMMEDIATE BUSINESS OF THIS MORNING'S PANEL
wee THAT IS, TO GIVE YOU A PICTURE OF WHAT THE PUBLIC HEALTH SERVICE
LOOKS LIKE NOW, WHAT IT MAY LOOK LIKE IN A YEAR OR SO, AND WHAT ITS
MAJOR CHALLENGES SEEM TO BE FOR THE NEXT FIVE YEARS.

FIRST, YOU SHOULD KNOW THAT THE PUBLIC HEALTH SERVICE IS FAR FROM
BEING A MONOLITH. IT IS MADE UP OF FIVE AGENCIES, EACH ONE DEMONSTRAT-
ING WHAT IS BY A NOW A TRADITIONAL STREAK OF STUBBORN INDEPENDENCE.
THAT QUALITY MAY HELP EXPLAIN WHY ITS PERSONNEL CHASED OFF TO AFRICA
AND ASIA TO WIPE OUT SMALLPOX -- AND DID. AND IT MAY ALSO EXPLAIN WHY
THE P.H.S. TOOK OFF AFTER CIGARETTE SMOKING -- NO MINOR CHALLENGE
CITHER -- AND HAS APPARENTLY CONVINCED MORE AMERICANS TO QUIT SMOKING
THAN THE NUMBER WHO START SMOKING EACH YEAR. SO THAT IS TURNING
AROUND, ALSO,
-3-

LET ME BRIEFLY REVIEW THE FIVE P.H.S. AGENCIES AND ADD A SIXTH,
THE OFFICE OF THE ASSISTANT SECRETARY FOR HEALTH, WHICH HAS LINE
AUTHORITY OVER THE PUBLIC HEALTH SERVICE AND WILL BE PLAYING A MORE
SIGNIFICANT ROLE IN THE FUTURE.

TAKING THEM IN ALPHABETICAL ORDER, I'LL START WITH THE ALCOHOL,
DRUG ABUSE, AND MENTAL HEALTH ADMINISTRATION. THE TITLE SAYS IT ALL.
THIS AGENCY HAS THREE NATIONAL INSTITUTES -- OF MENTAL HEALTH, OF DRUG
ABUSE, AND OF ALCOHOLISM AND ALCOHOL ABUSE. THESE INSTITUTES HAVE
CARRIED OUT RESEARCH AND PUBLIC EDUCATION PROGRAMS AND, UNTIL RECENTLY,
SUPPORTED A WIDE RANGE OF SERVICE DELIVERY PROGRAMS AT THE LOCAL LEVEL
»++800 MENTAL HEALTH CENTERS...300 STATE AND LOCAL DRUG ABUSE PROGRAMS -
«AND ABOUT 1,000 LOCAL ALCOHOLISM PROJECTS. BUT MORE ABOUT THOSE
PROJECTS LATER.

THE FISCAL 1983 APPROPRIATION THAT THE PRESIDENT PROPOSED FOR
A.D.A.M.H.A. IS $373 MILLION DOLLARS,

THE CENTERS FOR DISEASE CONTROL, OR C.D.C., ARE HEADQUARTERED If
ATLANTA, AS THE NAME IMPLIES, THE CENTERS ARE CONCERNED PRIMARILY
WITH CONTROLLING OR PREVENTING COMMUNICABLE AND VECTOR-BORNE DISEASES.
-4-

YOU HAVE PROBABLY READ C.D.C.'s MORTALITY AND MORBIDITY WEEKLY REPORT,
THE BAROMETER OF INFECTIOUS DISEASE ACTIVITY IN THIS COUNTRY,

C.D.C.'s HISTORY IS ROOTED IN THAT STRONG TROPICAL DISEASE FRATER-
NITY 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
CHILD INMUNIZATIONS, TO CONTROL SEXUALLY TRANSMITTED DISEASES, AND TO
PROVIDE THE EPIDEMIOLOGICAL EXPERTISE TO UNRAVEL THE MYSTERIES OF
LEGIONNAIRE'S DISEASE, TOXIC SHOCK SYNDROME, AND THE LATEST STRAIN OF
INFLUENZA,

C.D.C,. PERSONNEL ARE NOT ONLY ON TEMPORARY DUTY WITH STATE HEALTH
AGENCIES, BUT ARE ALSO ON DUTY OVERSEAS SCREENING SOUTHEAST ASIAN
REFUGEES, SOLVING SPAIN'S OLIVE OIL SCARE, OR HELPING THE W.H.O. PLAN
ITS “EXTENDED CHILD IMMUNIZATION PROGRAMME,”

THE C.D.C. ANNUAL BUDGET IS JUST UNDER A QUARTER OF A BILLION °
DOLLARS...$217 MILLION IS PROPOSED FOR FISCAL '83, TO BE EXACT.
THE FOOD AND DRUG ADMINISTRATION -- THE F.D.A. -- HAS BEEN, FOR
MOST OF ITS 7& YEARS, ONE OF THE MOST WIDELY PUBLICIZED, PRAISED, AND
VILLIFIED AGENCIES OF GOVERNMENT. THE TWO WATCHWORDS OF ITS LAW,
SAFETY AND EFFECTIVENESS, PLACE THE F.D.A. AS THE ARBITER FOR PUBLIC
HEALTH IN THE MARKETPLACE OF DRUGS, VACCINES, MEDICAL DEVICES, HEALTH
SUPPLIES, RADIOLOGICAL GEAR, AND CERTAIN HEALTH AND MEDICAL PRACTICES,
SUCH AS NUTRITION AND DIET COUNSELING, PRESCRIPTION DRUG ADVERTISING,
DRUG PRESCRIBING, AND ANTENATAL FETAL DIAGNOSIS.

THE PROPOSED F.D.A,. BUDGET FOR FISCAL '83 IS $356 MILLION -- NOT
AN EXTRAORDINARY SUM, CONSIDERING THE MISSION OF THE F.D.A. IS TO
REGULATE ABOUT $465 BILLION WORTH OF AMERICAN COMMERCE.

ON SEPTEMBER lst, WE COMBINED TWO AGENCIES, ONE CONCERNED MAINLY
WITH SERVICE DELIVERY, THE OTHER WITH HEALTH MANPOWER AND FACILITIES.
THE NEW AGENCY IS CALLED THE HEALTH RESOURCES AND SERVICES ADMINISTRA-
TION, OR H.R.S.A. THE NEW AGENCY HAS THE FOLLOWING FOUR MAIN
REPONSIBILITIES:
* IT ENSURES THE CONTINUED DELIVERY OF COMPREHENSIVE HEALTH
SERVICES FOR AMERICAN INDIANS AND ALASKAN NATIVES, WHICH IS A $613
MILLION PROGRAM THIS YEAR.

* IT IS THE FOCAL POINT FOR FEDERAL SUPPORT OF HEALTH PROFES-
SIONS EDUCATION. SINCE MOST SUPPLY ESTIMATES SHOW “SURPLUSES” OF
MANY MEDICAL SPECIALTIES FOR THE REST OF THIS CENTURY, THIS PARTI-
CULAR ACTIVITY HAS BEEN APPRECIABLY SLOWED DOWN, FROM $231 MILLION
IN 1981, FOR EXAMPLE, TO A PROPOSED LEVEL OF $117 MILLION IN
FISCAL '83,

* H.R.S.A. ALSO CONSOLIDATES THREE OTHER PROGRAMS NOW RUNNING
AT CONSIDERABLY REDUCED LEVELS: HEALTH PLANNING, CONSTRUCTION OF
HEALTH FACILITIES, AND SUPPORT FOR HEALTH MAINTENANCE ORGANIZA-
TIONS. FEDERAL SUPPORT FOR H.M.0.S IS DIMINISHED ONLY IN DOLLARS,
BUT THAT IS BALANCED BY THE PRIVATE SECTOR'S GREATER INTEREST AND
MORE AGGRESSIVE FUNDING.

* FINALLY, THE NEW AGENCY ASSURES THE AVAILABILITY OF HEALTH
SERVICES TO MEDICALLY UNDERSERVED AREAS AND TO SPECIAL POPULATIONS,
SUCH AS COAL MINERS, MIGRANT WORKERS, AND FEDERAL EMPLOYEES. THE
-/-

PRESIDENT ALSO PROPOSED THAT THE FOOD PROGRAM FOR WOMEN, INFANTS,

AND CHILDREN -- THE SO-CALLED “W.1I.€.” PROGRAM -- BE TRANSFERRED

FROM THE DEPARTMENT OF AGRICULTURE TO OUR DEPARTMENT AND BECOME

PART OF THE MATERNAL AND CHILD HEALTH PROGRAM ADMINISTERED BY

H.R.S.A. THE PROPOSED FUNDING FOR W.I.C. WOULD BE $650 MILLION IN
_ THE COMING FISCAL YEAR.

THE PROPOSED BUDGET FOR THE NEW COMBINED HEALTH RESOURCES AND SERVICES
ADMINISTRATION AS OF OCTOBER 1st WOULD BE 32.4 BILLION. THE SECOND
LARGEST SUM WITHIN THE P.H.S. TOTAL.

AND THAT LEADS ME TO THE AGENCY WITH THE LARGEST APPROPRIATION,
THE NATIONAL INSTITUTES OF HEALTH. THE PROPOSED N.I.H. BUDGET FOR
FISCAL 1983 WOULD BE 33.75 BILLION,

THE 11 INSTITUTES OF THE N.I.H. SUPPORT ABOUT 15,000 EXTRAMURAL
RESEARCH PROJECTS AT ANY ONE TIME. N.I.H. ALSO SUPPORTS ABOUT 2,000
INTRAMURAL PROJECTS EACH YEAR. SINCE 1937, WHEN THE NATIONAL CANCER
INSTITUTE WAS ESTABLISHED, SO N.I.H. GRANTEES HAVE BECOME NOBEL
LAUREATES IN MEDICINE, PHYSICS, AND CHEMISTRY, OR ABOUT 1 OUT OF 5 IN

THOSE PRIZE CATEGORIES DURING THAT PERIOD.
-3-

THE FINAL MAJOR ORGANIZATIONAL UNIT WITHIN P.H.S. IS THE OFFICE OF
THE ASSISTANT SECRETARY FOR HEALTH, THE HIGHEST RANKING CIVILIAN HEALTH
OFFICER IN OUR GOVERNMENT. WITHIN THIS OFFICE ARE SUCH ACTIVITIES AS
DISEASE PREVENTION AND HEALTH PROMOTION, ANTI-SMOKING, ADOLESCENT
PREGNANCY PROGRAMS, INTERNATIONAL HEALTH, PHYSICAL FITNESS AND SPORTS
MEDICINE, AND SUCH STAFF ACTIVITIES AS PLANNING, EVALUATION, MANAGEMENT
AND BUDGET, PERSONNEL, AND SO ON. ORGANIZATIONALLY, THE OFFICE OF THE
SURGEON GENERAL OF THE PUBLIC HEALTH SERVICE IS ALSO LOCATED HERE, AS
IS THE RESPONSIBILITY FOR THE 5,858 MEMBERS OF THE UNIFORMED COMMIS-
SIONED CORPS ON ACTIVE DUTY.

THE 0.A.S.H. BUDGET IN FISCAL 1983 IS PROJECTED TO BE $700
MILLION. BUT OVER $500 MILLION OF THAT REPRESENTS THE FUNDING OF TWO
BLOCK GRANTS. AND THAT LEADS US TO SOME COMMENTS ABOUT THE FUTURE.

THE P.H.S. ORGANIZATION I JUST DESCRIBED IS WHAT WE HAVE DURING
THIS TRANSITION PERIOD EXTENDING THROUGH FISCAL YEARS 1981 AND 1982,
AS YOU KNOW, THE PRESIDENT 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.M.H.A. PROJECTS, A THIRD FOR MATERNAL AND CHILD
HEALTH, AND A FOURTH CONCERNED WITH PRIMARY CARE. WITH THE CENTERPIECE
BEING THE COMMUNITY HEALTH CENTERS PROGRAM. CONGRESS AUTHORIZED AND
-9-

FUNDED THE FIRST THREE FOR THIS FISCAL YEAR. THE FOURTH BLOCK GRANT
-~- FOR PRIMARY HEALTH CARE SERVICES -- GOES INTO EFFECT ON OCTOBER 1.
THE ADMINISTRATION HAS SUBMITTED CERTAIN REVISIONS FOR THIS BLOCK, BUT
THE CONGRESS HAS NOT YET ACTED ON THEM.

— THE BLOCK GRANTS -- AND THE PHILOSOPHY OF GOVERNMENT BEHIND THEM
-- ARE CHANGING THE CONFIGURATION OF THE P.H.S. THE GROWTH OF THE
P.H.S, DURING THE PAST 15 TO 20 YEARS HAS BEEN PRIMARILY THE RESULT OF
NEW AND EXPANDING CATEGORICAL GRANT PROGRAMS. AT THE TIME PRESIDENT
REAGAN WAS INAUGURATED, IN JANUARY 1931, THE EXECUTIVE BRANCH WAS
FUNDING AND OPERATING 534 CATEGORICAL GRANT-IN-AID PROGRAMS, ONE-
SEVENTH OF THOSE -- 74, TO BE EXACT -- WERE IN P.H.S. = THE ADMINISTRA -
TION SAID THAT IT WAS TIME FOR THE FEDERAL GOVERNMENT TO GET OUT OF
THE BUSINESS OF MANAGING THE DELIVERY OF HEALTH SERVICES, EITHER
DIRECTLY OR BY PROXY THROUGH GRANTEES AND CONTRACTORS. IT HAS BEEN
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.
-10-

AND P.H.S. HAS HAD ENOUGH EXPERIENCE WITH THIS NOTION TO MAKE US
OPTIMISTIC, FOR EXAMPLE, NEARLY ALL OF C.D.C.'s SERVICE PROGRAMS ARE
ADMINISTERED THROUGH STATES. THAT RELATIONSHIP INVOLVES IMMUNIZATION,
FLUORIDATION, DATA COLLECTION, RAT CONTROL, AND SIMILAR PROGRAMS. THE
RECORD ON THESE AND OTHER PROGRAMS IS VERY IMPRESSIVE.

THE RESULT OF THE BLOCK GRANT APPROACH IS A NEW DIVISION OF LABOR
WITHIN P.H.S. ONE TASK IS SIMPLY TO ADMINISTER 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
WITH ANY TECHNICAL ASSISTANCE THEY MIGHT NEED OR IN OTHER WAYS BE
HELPFUL TO STATE PROGRAM PEOPLE AT THEIR REQUEST. FOR EXAMPLE, WE CAN
DETAIL A COMMISSIONED OFFICER TO A STATE HEALTH AGENCY, CONTINUE HIS
OR HER BASIC PAY AND BENEFITS, AND THE HOST STATE TAKES CARE OF
INCIDENTAL EXPENSES,

THE PRESIDENT HOPES THAT THE BLOCK GRANT APPROACH, IN ADDITION TO
BREATHING NEW LIFE INTO AMERICAN FEDERALISM, WILL ALSO TEND TO REDUCE
THE GROWTH RATE OF FEDERAL HEALTH FUNDING. THIS IS ONE OF THE FASTEST
GROWING LINE ITEMS IN THE FEDERAL BUDGET. IN 1955, A BENCHMARK LEGIS-
LATIVE YEAR, FEDERAL SPENDING FOR HEALTH TOTALED 35 BILLION. THAT
WOULD INCLUDE THE V.A. AND THE NATIONAL SCIENCE FOUNDATION, FOR
-ll-

EXAMPLE, AS WELL AS THE P.H.S. BY 1980 THE TOTAL HAD RISEN TO $71
BILLION -- A 14-FOLD INCREASE. OBVIOUSLY, IF THE PRESIDENT IS LOOKING -
FOR SO-CALLED “TARGETS OF OPPORTUNITY” FOR COOLING DOWN THE FEDERAL
BUDGET, WHAT BETTER PLACE TO START THAN THE PUBLIC HEALTH BUDGET.

_ BUT EVEN THAT IS AN OVERSIMPLIFICATION. WHILE SOME HEALTH AGENCIES
MAY ENDURE LOWERED APPROPRIATIONS, SOME PUBLIC HEALTH FUNCTIONS WILL
REQUIRE -- AND RECEIVE -- MORE MONEY. THIS IS SEEN MOST CLEARLY IN
THE RESEARCH AREA,

WHEN THE PRESIDENT GAVE HIS “STATE OF THE UNION” ADDRESS LAST
JANUARY, HE SPECIFICALLY NOTED THAT “RESEARCH AT THE NATIONAL
INSTITUTES OF HEALTH WILL BE INCREASED BY OVER $100 MILLION.” THE
SUBSEQUENT BUDGET PROPOSALS FOR FISCAL 1983 ACTUALLY SHOW A $109
MILLION INCREASE FOR THE BIOMEDICAL RESEARCH SUPPORTED BY N.I.H. AND A
$27 MILLION INCREASE FOR THE PREDOMINANTLY BEHAVIORAL RESEARCH
SUPPORTED BY A.D.A.M.H.A.

AND HAVING THAT INFORMATION, YOU MAY BEGIN TO SEE WHAT THE WORLD
OF P.H.S, WILL PROBABLY LOOK LIKE OVER THE NEXT FIVE YEARS. LET ME
OUTLINE THEM FOR YOU NOW:
-1]?-

1. WE WILL BE RETURNING TO WHAT HAD BEEN OUR TRADITIONAL ROLE AS

A PARTNER...AN EQUAL AMONG EQUALS...WITH COLLEAGUES IN HEALTH

AND MEDICAL CARE AT OTHER LEVELS OF GOVERNMENT AND IN PRIVATE
NON-PROFIT AND FOR-PROFIT ORGANIZATIONS. MORE INITIATIVES FOR
IMPROVED HEALTH AND MEDICAL CARE WILL ORIGINATE AMONG THOSE GROUPS
~ THAN MAY HAVE BEEN THE CASE IN THE RECENT PAST. THE OPPORTUNITIES
WILL BE THERE, SINCE THE FEDERAL ROLE AS PRINCIPAL SOURCE OF FUNDS
IS BEING REDUCED, BROUGHT BACK DOWN TO A MORE REASONABLE SCALE.
FEDERAL EXPERTISE WILL RESIDE MORE IN SUBSTANCE, IN THE ABILITY TO
NEGOTIATE AMONG COMPETING INTERESTS ON THE PUBLIC'S BEHALF, AND IN
THE STEWARDSHIP OF THE NATIONAL HEALTH AGENDA,

2. ASIDE FROM THE “HOUSEKEEPING ROLE” OF FISCAL MANAGEMENT OF
THE BLOCKS, THE P.H.S. RETAINS -- AND IS EXPECTED TO
STRENGTHEN -- ITS ROLE AS PRINCIPAL SUPPORTER OF BASIC

BIOMEDICAL AND BEHAVIORAL RESEARCH. ONLY THE FEDERAL GOVERNMENT

CAN ASSEMBLE THE EXTRAORDINARY RESOURCES OF PERSONNEL, MONEY,

FACILITIES, AND TIME AND INVEST THEM OVER THE LONG TERM IN SUCH

PROJECTS AS UNLOCKING THE GENETIC CODE, IDENTIFYING THE FUNDA-

MENTAL MECHANISMS OF HUMAN IMMUNOLOGY, DEVELOPING MONOCLONAL

HYBRIDOMA TECHNOLOGY, AND, OF COURSE, THE RESEARCH REQUIRED TO

BEAT THE MAJOR KILLERS IN SOCIETY: HEART DISEASE, CANCER, AND

STROKE.
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3. THE GREAT STRUCTURE BUILT TO CARRY OUT THE DELIVERY OF HEALTH °
SERVICES WAS PREDICATED ON MEDICAL PRACTICE THAT WAS
ESSENTIALLY CURATIVE AND REPARATIVE. IT WAS ESSENTIALLY POST-

FACTO MEDICINE. ONE OF THE THINGS WE'VE LEARNED FROM RESEARCH AND

EXPERIENCE, HOWEVER, IS THAT THE MOST EFFECTIVE TOOL WE HAVE TO

IMPROVE HEALTH STATUS IS PREVENTION, COMBINED WITH HEALTH PROMO-

TION. THERE WOULD NEVER HAVE BEEN ENOUSH MONEY IN THE WORLD TO

TAKE CARE OF HEART DISEASE AND CANCER VICTIMS -- IF THERE HAD BEEN

NO CAMPAIGN TO GET PEOPLE TO QUIT SMOKING. WE WOULD NEVER HAVE

BEEN ABLE TO CARE FOR THE CHILDREN AND ADULTS, STRUCK DOWN BY

POLIO, DIPHTHERIA, MEASLES, AND TYPHUS, HAD THERE BEEN NO PROGRAY

OF MASS CHILDHOOD IMMUNIZATION. THE LOGIC OF THIS IS SO OVERWHELM-

ING THAT THE PREVENTION OF DISEASE AND DISABILITY AND THE PROMOTION .

OF GOOD HEALTH AND WELL-BEING ARE NOW THE KEYSTONES OF NATIONAL

HEALTH POLICY. ONE OF THE MOST EXCITING DEVELOPMENTS IN THE YEARS

AHEAD, THEREFORE, WILL BE THE MATURING OF THIS CONCEPT AS A FUNDA-

MENTAL TENET OF AMERICAN PUBLIC HEALTH POLICY AND PRACTICE. AND

CONTRIBUTING TO THIS PROCESS WILL BE AN IMPORTANT FUNCTION OF THE

FEDERAL HEALTH ENTERPRISE. WHETHER FROM ITS RESEARCH OR ITS PUBLIC

EDUCATION ELEMENTS,
-]4-

IT HOPE THIS BRIEF OVERVIEW OF WHERE WE ARE AND WHERE WE TEND TO BE
MOVING HAS HELPED YOU GET SOME ADDITIONAL PERSPECTIVE ON THE U.S.
PUBLIC HEALTH SERVICE. WE'VE COME A VERY LONG WAY OVER THE PAST 184
YEARS. WE ANTICIPATE A FRUITFUL JOURNEY FOR THE NEXT 184,

~ THANK YOU,
tH # HR if