IQ OI OS. Department of Health, Education, and Welfare Annual Report HDFLOS UAL 4q64 U.S. GOVERNMENT PRINTING OFFICE WASHINGTON : 1962 For sale by the Superintendent of Documents, U.S. Government Printing Office Washington 25, D.C. - Price $1.25 (Paper Cover) U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE As of June 30, 1961 ABRAHAM Ruszicorr, Secretary Ivan A. NESTINGEN, Under Secretary OFFICE OF THE SECRETARY Wirzur J. COHEN ......... Assistant Secretary (for Legislation). Puitie H. Des Marals..... Deputy Assistant Secretary. Amant. CUIGLEY. .... se 3 Assistant Secretary. TIBDEEMOARTER, JE: os ssc ce Deputy Assistant Secretary. HorUaeH. MILES, JR. « ... i. Administrative Assistant Secretary. eRe NC RCELY 5 ee ete ec 3 ee Deputy Administrative Assistant Secretary and Comptroller. BOISHEUILLET JONES ....... Special Assistant to the Secretary (Health and Medical Affairs). INGIWAT OES ICENT™ . 6. sca sae Special Assistant for Aging. TiPeeeeOOHTLIN . 2.060 8 ee Special Assistant to the Secretary (Juvenile Delinquency). REMI PAIKIN: <5 eo ete +... Congressional Liaison Officer. omeas: INBWMAN ....-0- . . Assistant to the Secretary. WeanmACH TURNER . «i <°) 0% foley Assistant to the Secretary (for Public Affairs). ALANSON W. WILLcCOx...... General Counsel. OBESEERIB. LONDii. 6 se ee. Director of Field Administration. IRV A. DUSH s).<.s.s: 2 « o Director of Public Information. FREDERICK H. SCHMIDT ..... Director of Security. JAMES W. GREENWOOD, JR. .... Directory of Management Policy. WATS. CHOMPSON ... «0 Director of General Services. eatree eo. (OQ DRIEN : . <. «hat . Director of Personnel. DEAN SNYDER..... «+... Defense Coordinator. Ropert A. KEVAN .....:. . . - Departmental Coordinator for International Affairs. SOCIAL SECURITY ADMINISTRATION WiruiAM L. MITcHELL ...... Commissioner of Social Security. JOSEPH H. Mryers........ Deputy Commissioner of Social Security. Victor CHRISTGAU ...... Director, Bureau of Old-Age and Survivors Insurance. KATHRYN D. Goopwin ... Director, Bureau of Public Assistance. J. DEANE GANNON ...... Director, Bureau of Federal Credit Unions. KATHERINE B. OETTINGER . Chief, Children’s Bureau. 1 Appointed after June 30. PUBLIO HEALTH SERVICE LUTHER 1b. TERRY, - eae eel - . - Surgeon General. JOHN D. PoRTERFIELD...... Deputy Surgeon General. JAMES V. Lowry ....... Chief, Bureau of Medical Services. CHARLES HE. BURBRIDGE ... Superintendent, Freedmen’s Hospital. THEODORE J. BAUER..... Chief, Bureau of State Services. JAMES A. SHANNON ..... Director, National Institutes of Health. Forest B®. LINDER..... . Director, National Center for Health Statistics. PRANK) B. ROGERS yo. +. 6.» Director, National Library of Medicine. e OFFICH OF EDUCATION Ster~tine M. McMorrin ..... Commissioner of Education. WaYNE O. REED..... ~ «ee Deputy Commissioner of Education. FOOD AND DRUG ADMINISTRATION GrorcE P. LARRICK ....... + Commissioner of Food and Drugs. JoHN L. HarvEy.........- Deputy Commissioner of Food and Drugs. OFFICH OF VOCATIONAL REHABILITATION Mary E. Switzer ........-. Director of Vocational Rehabilitation. BH. Emory FEREBEE........ Deputy Director of Vocational Rehabilitation. SAINT ELIZABETHS HOSPITAL WINFRED OVERHOLSER...... Superintendent. Dae C. CAMERON ......... Assistant Superintendent. FEDERALLY AIDED CORPORATIONS Fints DAvIs....... - ++. Superintendent, American Printing House for the Blind. - Leronargp M. Evstap....... President, Gallaudet College. JAMES M. Nasrit, JB...... - President, Howard University. REGIONAL DIRECTORS LAWRENCE J. BRESNAHAN .... Region I, Boston, Mass. JosEPH B. O’CONNOR......- Region II, New York, N.Y. EpMuNp W. BAXTER....... Region III, Charlottesville, Va. Ricuarp H. Lyre......... Region IV, Atlanta, Ga. MELVILLE Hy HOSCH). cic cece = Region V, Chicago, Iil. JAMES W. DOARBN ........ . Region VI, Kansas City, Mo. JAMES H. Bonp..........- Region VII, Dallas, Tea. ALBERT H. ROSENTHAL ..... .« Region VIII, Denver, Colo. Fay W. HuUNTER..... ....- Region IX, San Francisco, Calif. Letter of Transmittal DEPARTMENT OF Heatru, EpucaTion, AND WELFARD, Washington, D.C., December 1, 1961. Dear Mr. Preswwent: I have the honor to submit herewith the annual report of the Department of Health, Education, and Welfare for the fiscal year ending June 30, 1961. Respectfully, Secretary. Tue PRESIDENT, Tue Waite Howse, Washington, D.C. VASVIV asinsueh arelivtooso-gced Sis! fe Fey Food and Drug Administration. . ........4.. Office of Vocational Rehabilitation . ......... Saree cavetis Hospital seer Pay) a American Printing House for the Blind. ....... i OTE cll SATE SI a a AY ae cP EMIRIEEEROTIEVETSILY 0 0181S A. ONLM ORE OE LIRR, SC aeS A detailed listing of the contents of this report, ra; topic headings, will be found on pages 407-418. Vii In the middle of fiscal year 1961, a new administration came into office. There came to the Department a new Secretary and with him a new direction for the Department. The body of this report, in which the operating agencies of the Department present specific accounts of their work, covers the entire fiscal year (July 1, 1960, through June 30, 1961). This, the Secre- tary’s portion of the report, however, deals principally with the second half of the fiscal year—the first months of steward- ship—and beyond into the continuing plans for the Department in 1962. The Secretary’s Report A BEGINNING is a time for clarity, for reexamination, and under- standing. When I came into the Department, I knew it was a complicated and sometimes controversial organization—a busy department with over 100 different programs—but a department of great interest to me and to the American people because its activities concern the human everyday problems of men, women, and children. As Governor of Connecticut, I was familiar with the pattern of Federal-State cooperation by which this Department has played such a helpful role. Now that it had become my responsibility, it was necessary to see exactly what was being done, what should continue, and in what direction. I wanted to look at the Department’s past commitments, at its problems and priorities, and at its traditional solutions—to measure past answers against today’s problems. We Take Inventory The primary interests of the Department of Health, Education, and Welfare are implicit in its name—the health, the education, and the welfare of all the people. It is the department of everyday concerns. The programs of its five major operating agencies—the Public Health Service, the Office of Education, the Social Security Administration, the Food and Drug Administration, and the Office of Vocational Rehabilitation—are con- cerned with the home, the school, the hospital, the community, the air around us, the water in the tap, the food on the shelf, the drugs in the medicine chest, the lipstick in the purse, the bank account, and the hope for tomorrow. Taken together, these things add up to the happiness or unhappiness, the meaning of the future for men, women, and children. There can be little welfare without health, and the deprivations and frustrations of unsatisfactory environment or insecure economic posi- tion can lead to physical ailments, mental illness, and delinquency. Inadequate education is often the reason for the financial problem— lack of training leading to unemployment or failure to advance. 2 Depariment of Health, Education, and Welfare, 1961 The Department administers programs of its own and supports— with money and advice—promising projects and research of others. Nearly 90 percent of its appropriation went out as grants-in-aid to the States, non-Federal institutions, and individuals in 1961. They serve greatly to strengthen State departments of health, of education, and of public welfare. In addition to the direct aid they afford these activities, the grants have considerable impact upon the economy through the dollars channeled into many communities and the protec- tion and restoration of productivity of the individuals kept in health, returned to self-support, or advanced in learning. The policy of the Department in these grant programs—as laid down by the Congress and the Executive and endorsed and enforced by tradition—is not to dictate, control, or interfere but to provide means and inspiration, guidelines, and stimulation for the greatest possible range of ingenuity and enterprise in improving the conditions of the people. Before we began our inventory, we had decided that we would not be satisfied with generalities. We were—and are—interested in the specifics of action; not rigid, arbitrary specifics, but feasible and developing ways of moving for- ward on many fronts toward long-time gains. The specifics of action are always simple in the past tense—what we did, how we did it. The specifics of the future are more difficult. What do we want to ac- complish? What is important for us, in this contemporary world, toaccomplish? How can we accomplish it? What We Seek We believe the Department should be idealistic in philosophy and in program goals, practical in program operations. Our objective remains the same—helping to improve the conditions and prospects of man. The means change because the problems change. We cannot afford to be bound by tradition that makes fine history but no current progress. As to the meaning of our words—when we say “aid” to education, we mean exactly that—help for education, not control. Control re- mains with the States and localities as it always has in the long Federal-State partnership in education. When we say “welfare,” we do not mean only financial assistance. Welfare should not be just relief money spent each month and needed again the next. To us, welfare should mean a return to self-help, self-reliance—wherever possible—through training, retraining, and rehabilitation for young people, for old people, for middle-aged people, for handicapped people—in short wherever needed. Until this past session of Congress, for example, aid was not available to a family The Secretary’s Report 3 with dependent children if the father were present in the household— even if he were unemployed. If the father deserted, however, his family could become eligible. If he stayed and tried desperately to cope with family problems, he and the rest of the family were penal- ized for his presence. ‘This just does not make sense. We want to hold families together, not drive them apart. For the truth is that the social welfare or the security of an indi- vidual depends upon many factors other than money. For almost everyone, there is little security possible without a sense of having a place in the world. For the child, that usually means a place in a family. For the elderly, it can mean a place in the familiar surround- ings of the home community and the continuation of some activity or responsibility to give meaning to living. For the adolescent, both family and community relationships are important in this transition period of life. The Department seeks to help people—child, youth, or adult—find or maintain their place in the world. Point of Vantage The Department enjoys a perspective for viewing—beyond its own activities and programs—all interests engaged in the search for solu- tions to problems of health, education, and welfare. Such a point of vantage should make it possible to see things whole—the achieve- ments and the gaps, the possibilities and the difficulties. This could be an exciting view to have, a stimulating, prodding summary—moving citizens, professions, and government to action. The Department has long been a collector and reporter of informa- tion on what others are doing in the fields of its interest, but too often this has seemed a mere statistical delivery service, without adequate assessment of the information and its significance to the national interest. It seems to us that the Department of Health, Education, and Wel- fare, as policy adviser to the President and as a resource for the Congress and the people, should be more creative, more critical, take more initiative, and seek to stimulate a ferment of ideas. It should make available reports of progress and problems encountered in spe- cific operating projects in certain communities to help other commun- ities and organizations know what is being done and thought and found to work elsewhere. Citizens should know what the national situation is in health, education, and welfare. They should look at the problems and recognize the needs. Programs of Prevention Wherever possible we seek preventive measures—preventive medi- cine, preventive education, preventive welfare. The first, preventive 4 Department of Health, Education, and Welfare, 1961 medicine, is a fairly familiar phrase covering quarantine activities, sanitation, safety campaigns, inoculations, annual checkups, and other medical care in health as well as in sickness. The other two are per- haps strange to the eye and ear but not to our planning. What is preventive education? Education can obviously prevent ignorance and illiteracy. In addition, education of quality and train- ing keyed to the needs of the individual student can help prevent the economic distress suffered by the untrained person who cannot find employment or cannot advance. Education and training can help prevent delinquency arising out of resulting frustrations and despair. They can prevent the waste of talents needed by the Nation and aban- donment of hope by the retarded and handicapped, cruelly and mis- takenly termed “uneducable.” Preventive welfare is a strange and—to the ear—rather contradic- tory phrase. Perhaps it would be better expressed as anticipatory welfare. It means social services—not necessarily money and cer- tainly not money alone—given in time, before a family breaks up or a person breaks down from accumulated distresses and crises—services designed to prevent ultimate dependency. It means also services designed to prevent continuing, lifetime dependency by providing rehabilitation and training to dependent persons already on public assistance rolls to restore them to self-support, self-care, and self- esteem. Restoration services should not be limited to persons capable of returning to gainful employment; they should be available to any- one able to reach a goal of even partial self-care. The dollar value of the prevention of anything is impossible to estimate, for it is difficult to prove just what has been prevented or the degree to which a problem has been retarded. But we have seen enough notations of school dropouts and of broken homes on the rec- ords of juvenile delinquents to know that these things can lead to delinquency and are worth trying to prevent. The lack of education revealed by the chronically unemployed and the inability of the professions and the Nation to obtain well-trained people show us the need for preventive education. It is too costly to do without. To prevent scarring and wasting of lives—by improving health, increasing educational opportunity, and advancing economic secu- rity—seems a noble and rewarding mission to us. A Time of Change It is not surprising to us that many parts of our program must change, that new things must be tried, for we live in a time of accel- erating change, The Secretary’s Report 5 The texture of society is different, the design for living so altered in the last few years that even the stages of the change have been obliterated. It is as though the patterns were destroyed and new ones were made from different materials by different beings for dif- ferent beings. We have faced changes century to century before, and generation to generation, but these were usually gradual changes in which traces of the origins remained. The shadow of each day’s change grew a little wider but did not suddenly blot out the past beyond remembrance. This is no longer true today. Space is wholly new as far as ordinary human understanding and “occupancy” are concerned. Automation is new beyond any previous technology. Radioactive fallout from man-made weapons is new. ‘The dimensions of time and space have changed. And so it is not entirely a criticism of the past operations in the Department that we seek so many new approaches in our programs today. The necessity for some could not be anticipated, and many are very difficult to achieve. A few of our new problems are caused by evils or by failures or by neglect and callous disregard for human needs, but most are ac- tually the products of our successes. In the field of food and drugs we are faced with continuing change growing out of the progress of technology—new methods of growing, processing, and packaging foods for our convenience, new discoveries in drugs which save lives, but which also can have dangerous side effects. The sales of medicinal chemicals and of cosmetics more than doubled between 1948 and 1958. Chemical additives are used in proc- essing and packaging food. Farmers use pesticides on their crops. If they didn’t, we would not have our present abundance of food; but, if food were not checked and pesticides regulated for safety, abundance could well be a serious health hazard for us. Environmental health problems change because of developments and improvements in manufacturing, which give us essential products but which also necessitate disposal of waste products, chemicals, and gases. The crowding of population into “convenient” urban centers multiplies the problems of disposal of human waste materials. Radi- ation hazards exist not only from weapons testing but also from our greatly increased use of nuclear energy in medicine, industry, and else- where. The automobile adds exhaust fumes to the “fresh air” of our cities. Stephen Vincent Benet said of the early days of this con- tinent, “There was... in the air...a medicinal quality that brought health to those who breathed it.” Even allowing for poetic license, this is no longer true. Education faces not only pressure of numbers but necessity for constantly updating its information and adding new subject matter. 6 Department of Health, Education, and Welfare, 1961 Here, too, it is man’s progress—our fantastically successful conquest of time and distance—that causes problems. As the world contracts and once faraway, strange places are no longer far in time and must not be allowed to remain strange in understanding, the need for new language studies expands. The new sciences and the world of space require whole new curriculums of studies and teachers qualified and equipped to teach them. Medical advance often brings change upon itself. The lengthening of the lifespan has brought a higher proportion of elderly persons in the population. This in turn has brought additional problems in the treatment of chronic diseases and ailments of the aging, and a conse- quent need for better home care, nursing homes, and methods of care outside of already crowded hospitals. Improvements in therapy for the mentally ill make it possible for many to return to their home communities. There they and their families need access to guidance, assistance in adjustment, employment help, and frequently the services of day hospitals or outpatient mental health clinics. Thus every time we solve a problem, we seem to pose another—and sometimes several. We never quite catch up, because, before we get where we are going, the destination changes. The various agencies of the Department came into existence because of change and problems. They pioneered; almost everything they did was “a first.” They are finding stimulation in pioneering again. Forward Movement—1961 Our new appraisal and our new plans are bearing fruit. Within these few short months a number of concrete results are apparent. * A new and more comprehensive program providing greatly strengthened aid to communities in the development and improvement of health services outside the hospital got underway. Designed to increase the availability, scope, and quality of health facilities and services—nursing homes and halfway houses, visiting nurses and homemakers—the program has particular significance for the aged and the chronically ill. All too often such “patients” must remain in a hospital or institution whose intensive services they do not need, which they cannot afford, and where they take up room needed by others, only because they have no other place or way to obtain the simple services they do require. The new community services program cannot, of course, suddenly put an end to such problems but it can stimulate a real examination and attack, community by community and State by State. It can re- sult in better care for more people and serve the additional purpose of freeing needed hospital beds for the acutely ill. The Secretary’s Report 16 * Environmental health problems—particularly the dangers of wa- ter and air pollution—came under stepped-up attack in coordinated programs covering whole regions and industries. Under the new water pollution act signed by President Kennedy in July 1961, the most far-reaching approach in history is being made to stream pollution abatement. The new law strengthens the long exist- ing Federal-State partnership making it possible for communities to receive greater Federal aid in building waste-treatment works and— because of an extension of Federal enforcement powers—affording them an opportunity for more effective action to control pollution reaching their community from upstream neighbors. Regional research facilities are being established in recognition of the fact that, although water pollution is a national problem, its spe- cifics differ greatly from one part of the country to another and re- quire different scientific knowledge and engineering application. The concept of air as a limited resource is vital. As air pollution threatens 90 percent of our urban communities, the Department is seeking wider application of all known methods of control and ad- ditional research into better methods and instruments for abating it. Negotiations with the automotive industry in 1961 resulted in an agreement for factory installation in all new automobiles, beginning with 1963 models, of a device to reduce the amount of motor fumes re- leased into the atmosphere. * In education—although the major fight for Federal aid is still to be won—there was a new concentration on the search for excellence at all levels, elementary through college, and in vocational as well as academic instruction. Two-year extensions of the National Defense Education Act and of aid to federally impacted areas were enacted by Congress. In vocational education, a special panel of outstanding men and women was appointed to work with the Department in an effort to update the character and quality of this field of education. As the country moves into an age of advanced technology and increased industrialization and automation its young people must be prepared and its manpower needs must be satisfied. * For the first time since the depression days of the thirties, a re- examination of the policies and structure of public welfare has been made, focused upon the causes of dependency rather than on its symptoms. Ten administrative changes were made in the Department’s public welfare program in December 1961 to provide a substantial start toward a reorientation of the Federal-State public assistance pro- gram. Emphasis will be upon the rehabilitation and restoration to self-support of persons on public assistance wherever possible. For 8 Department of Health, Education, and Welfare, 1961 those who will continue to need assistance, an approach more realistic and less restrictive than the present categorical division of aid will be sought. Family services will be added to money aid. Incentives will be provided for young people receiving aid as dependent children to help secure their own future through earnings without jeopardiz- ing necessary current assistance to their families. Indicative of this new focus, the Bureau of Public Assistance has been renamed the Bureau of Family Services. Within the Bureau a new major unit, the Division of Welfare Services, has been estab- lished to give special attention to States’ activities designed to reduce dependency, provide family counseling and services, and remove any abuses of trust which may exist on assistance rolls. * For the first time since the public assistance program began a quarter of a century ago, the Federal Government provided aid to dependent children whose parents are the victims of unemployment. This is a significant breakthrough in the welfare field. Proposals in one form or another to fill this gap in public assistance coverage have been before Congress for the past 10 years. The new law is effective only until July 1, 1962, but it is hoped that before that time the general revision of welfare programs will provide for continuing assistance to such families. * A number of strengthening social security measures filled gaps in the old-age, survivors, and disability insurance program. Requirements for insurance benefit eligibility were relaxed, making it possible for approximately 160,000 previously ineligible persons to qualify for benefits in the first 12 months following passage of the legislation. The retirement age for men was lowered from 65 to 62. Minimum insurance benefits paid to retired workers and to aged widows were increased. Additional incentive was provided for re- tired workers to increase their own earnings on jobs, without losing so much of their social security payments. * A more comprehensive approach to juvenile delinquency has been made possible by new legislation in which the Congress gives recog- nition to the national nature of the problem. The Department is seeking cooperation not only from law-enforce- ment agencies but also from citizens and organizations in the com- munities who can give employment or encourage further schooling— the real preventives in this area of waste and tragedy. Demonstration projects designed to show how communities can take coordinated and effective action to aid youth are being supported. Funds are being provided to train additional personnel in this field. * For the aging, the Department has moved with enterprise and dispatch, acting as spokesman and advocate of the interests of elderly persons wherever support is needed or possible—in health, in employ- ment opportunities, in education, and in welfare. The Secretary’s Report 9 In seeking employment opportunities, the interest of the Peace Corps has been enlisted in balancing some of its youth with the experi- ence and maturity of older men and women, particularly in the teach- ing field. In welfare, preparation of a series of “case histories” of successful community projects and social services for the aging was begun for distribution as a guide for other communities. Social services are being sought for those elderly persons able to pay for them as well as for those in financial need. Interagency cooperation has offered unexpected opportunities and advances. For example, the Housing and Home Finance Agency, constructing and financing housing for the aged, ran into problems of management concerned with the social and welfare needs of its ten- ants. The Agency sought help from the Department, and the Depart- ment is now helping to train project managers for such housing developments. * A new concentration in vocational rehabilitation on fundamental aspects of disability and rehabilitation can be reported. The Department’s program includes psychological aspects of dis- ability, the attitudes of communities toward disabled people and those of employers toward hiring them, the adaptation of electronics and powered devices to artificial limbs and sensory aids, special rehabilita- tion needs of older disabled persons, disabled mothers with dependent children, and severely disabled persons whose rehabilitation may be beyond the means or facilities of their State agencies. * Strengthened regulations will permit the Food and Drug Admin- istration to provide more complete protection to the public against hazards of unsafe foods and drugs and the economic losses occasioned by quack remedies, false labeling, and deceptive packaging. Regulations have been issued requiring that labeling and promo- tional literature accompanying new drugs will provide the physician with full information about the hazards as well as the potential benefits of the drugs. Preliminary work is underway to establish a badly needed national repository of drug-reaction information. The new Hazardous Substances Labeling Act requires safety infor- mation in the labeling of chemical products used in the home. A Special Program for Survival The same coordination of many parts and many activities of the Department, and the same community wide focus in planning which we seek in our programs concerned with everyday, normal events, are also valuable to us in planning to meet that most abnormal eventuality— a thermonuclear attack upon this country. 626936—62——2 10 Department of Health, Education, and Welfare, 1961 Every discussion of both the possibility of such an attack and the advisability of having fallout shelters comes around eventually to a third point. If we survive the attack, how do we go about the daily business of living when we come out of our shelters? To a certain extent the answer to that question must come from the Department of Health, Education, and Welfare, and the Department has been moving in the past months to provide it. The Department’s Bureau of Family Services and Children’s Bu- reau have been developing guidance materials for the States on emer- gency feeding, emergency lodging, emergency clothing, emergency registration and inquiry (designed to locate separated members of families), and emergency social services, including financial assistance. These services would be required in postattack situations wherever there are persons in need, At the end of the fiscal year, the first of the emergency welfare publications was being reviewed by the 50 State welfare departments. Since then, three additional volumes have been completed—as review and working drafts—and two more are now in process. The Department’s Division of Health Mobilization has stockpiled 1,930 complete emergency hospitals and $200 million worth of medical supplies and equipment, ranging from bandages to blood derivatives and surgical instruments, throughout the country. It has, within the past fiscal year, completed a publication, “Family Guide—Emergency Health Care,” designed to tell all citizens clearly and simply how to care for themselves and their families in fallout shelters or in emer- gency situations beyond the reach of medical help. A complete course has been prepared for use in training American families in the basic principles of medical self-help. These health and welfare publications are guidelines to survival, concerned with the basic and essential minimums—trying hard to assay realistically what it would be like and how such new problems could be met. The programs they suggest will require the cooperation of all levels of government and of private organizations and indi- viduals. Today: The National Situation As we put our first months behind us, what is the national situation in health, education, and welfare? What do we see from our national vantage point ? Health The American people are—in general—in good health, but to main- tain and raise this level of health we need more doctors, nurses, hospi- tal facilities, community health services. The Secretary’s Report il We are in some difficulty at both extremes of life. The United States has slipped to 10th place among nations in prevention of infant mortality. And for all our good start in many important things necessary to the health progress of the American people, we are still sadly lacking an effective method by which older people can purchase essential health care. We know more than we ever have about the nature of disease and how to save lives. Many of the old scourges have been defeated or controlled throughout the Nation, but new dangers, such as accidents and environmental pollution, have been spawned by our urban indus- trial civilization. In medical research, we are on the brink of important discoveries in cancer, respiratory diseases, mental illness. Yet we have not been able to apply, as widely as we should, many long-known and thoroughly proved results of earlier research. Dramatic results have been reported during the year in the use of cancer chemotherapy in the treatment of certain types of malignancies. New therapies in mental illness continue to reduce the number of pa- tients in public mental hospitals. Demonstration projects show that the majority of stroke patients can be restored to self-care. Thirty- five to 40 percent of all known diabetics now safely substitute oral medication for the tyranny of the daily insulin injection. Yet against these research advances we must place certain gaps in the Nation’s use of its medical knowledge. In the seventh year of the effective Salk vaccine, nearly 80 million people under 40 still have not completed the recommended course of injections. Every year nearly 13,000 die of cervical cancer, a disease which can almost infallibly be detected in its curable stages by a simple test. Twenty thousand American lives are taken each year by rheumatic fever and rheumatic heart disease—a disease caused by a chain reaction which can be broken at the beginning and in the middle. Many are blind whose sight could have been saved. It is not enough to discover and develop through research new reme- dies unless they can be brought within the reach of the people—all the people. If false remedies and quack devices reach the market, the ends of research and legitimate medicine are defeated. In rehabilitation, we are moving into a period of fulfillment. In 1962, after more than 40 years of growth, the public program of voca- tional rehabilitation will reach a significant milestone—the rehabilita- tion of more than 100,000 disabled people in a single year. Voluntary rehabilitation agencies are growing in size and effective- ness. Dozens of new rehabilitation centers and sheltered workshops are now in operation. 12 Department of Health, Education, and Welfare, 1961 New legislation will make possible help in training teachers of the deaf and in providing more funds for the work of the American Printing House for the Blind so that blind children may have the Braille books and other educational supplies they need. Although a number of projects designed to aid the mentally retarded are in operation, we still need to do more and to know more about what can be done to help in this special field. Education In education, ours is a time of reckoning. We have suddenly been brought up short and made to realize that we have actually been losing a race, not just against Russia but against ourselves. It has been shocking to wake to the fact that having our hearts in the right place and meaning well will not automatically keep us champion. A first look is perhaps deceiving. We have more boys and girls in school than ever before—and more go on to college than ever before in any country. More go beyond a first degree to graduate study. We expect to have 7 million students in our colleges in 1970. We have fine educational institutions, many dedicated educators, and at least a vocal commitment to education by the great majority of our citizenry. New classrooms have been built, new teachers have entered the profes- sion—but not enough of either. There is no guarantee that all our bright boys and girls will be able to get inside the doors when they come in 1970, or that, if they do, they will find the trained teachers they need waiting to receive them. And in spite of the zooming enrollment figures, we lose many of our finest students before college because of lack of funds or motivation to continue their schooling. We are losing also the potential talents of thousands of boys and girls, some to delinquency, because we do not have the kind of vocational education to equip them to compete in the marketplace. We have an appalling record of school dropouts in every State. Of the 10,800,000 students enrolled in high school grades 9 through 12 in the Nation’s public and nonpublic schools in 1961-62, 214 million will drop out before graduation. This is a tragic way to prevent further crowding of classrooms. There are not enough teachers today to teach our children in the first grades, the high schools, or in the universities. But even more serious is the fact that many of those we do have are not properly qualified. It is this quality of teaching that is our basic educational problem. It has much to do with the dropouts and with the lack of motivation for going on to college. It has much to do with the defi- ciencies which even earnest and talented students take with them to The Secretary’s Report 13 higher grades and into professions and careers. It is the good teacher who catches a child up in the excitement of learning, who makes the borderline case a student, who inspires the talented and creative to work against all odds to become “educated.” We do not have enough good teachers. It is not wholly a matter of inadequate salaries that has affected the quality of our teaching, though this has certainly been one cause of failure to attract outstanding students to the teaching profession or to hold them in it. We have—under pressure of need for numbers— failed to set and maintain high enough standards for teachers—both for entrance to the profession and in classroom performance. Nor have we been effective everywhere in teaching teachers how to teach. It is easy to say we need better education. It is harder to decide what better education is—how we get it—what should be spent in dollars, in hours, in creativity, and effort to get it. It is apparently hard for even the educational community to make a commitment to education as a whole. The institutions of higher learning are not really much interested in the problems of the elementary and secondary schools, although that is where their students come from. The aca- demic specialists do not concern themselves with the needs of voca- tional schools, although both are necessary for a balanced community. Many who oppose Federal aid for a// schools as Federal control sup- port Federal aid for the schools of their own districts—the so-called federally impacted areas. In truth, the total Nation is impacted when it comes to education. Welfare In our national program of social insurance, we are doing well. Beginning its second quarter century, social security, as it is com- monly known, provides a floor of economic support to 15,624,182 men, women, and children. Nine out of 10 employed persons in the Nation, and their dependents, are protected under old-age, survivors, and dis- ability insurance. Eighty-five percent of the people now becoming 65 years of age are eligible for retirement benefits under the program, and in the future this proportion will rise to 95 percent or more. Yet a most serious gap still exists—the failure to provide health insurance for the aged under the program. A beginning to progress against juvenile delinquency can be seen. The waste of youth, growing out of unbearable home environments and lack of community care which make crime seem a boy’s or girl’s best opportunity, is too expensive for the Nation to bear. The Con- gress has recognized it as a national problem, and forward-looking programs are getting underway. 14 Department of Health, Education, and Welfare, 1961 Improvement in protection for children in adoptive situations, in the courts, in communities, and within families is enlisting, and needs, much effort. New ideas and increasing resources are being brought to bear upon various facets of the needs of older citizens—in health, in housing, in employment, in social services. But these are only beginnings. The speed and effectiveness with which Federal, State, and local public and voluntary welfare organizations have cooperated in aiding refugees from Cuba during the past year provide heartening proof of the ability of our welfare structure to meet serious emergency sit- uations, yet everywhere it is undermanned and undertrained. In the field of public assistance—“relief’—there is serious trouble. Here, the most encouraging thing to report is that a reassessment las been made, a searching look taken at the national situation and plans made for changes. It could not be otherwise. The cynicism and pub- licity overtones of the Newburgh “plan,” the District of Columbia cut- backs in aid to large families, and other welfare “cases” all combine to endorse our belief that we have been supporting a social welfare structure in need of major revision rather than further patching. Public assistance programs are concerned with the needs of depend- ent persons not covered under social insurance or those whose minimum needs exceed their insurance benefits. These are the needy aged, blind, and disabled, and dependent children in families broken by death, incapacity, or absence of a parent, and more recently in fami- lies hard pressed because of unemployment. Assistance has, to date, consisted largely of pouring out money— private and public, local, State, and Federal—tremendous in total but tragically inadequate in individual cases. The 6.2 million persons on public assistance rolls in 1961 were largely frozen there, sustained at a minimal level of decency by monthly relief payments but with little hope or opportunity for guid- ance or rehabilitation services which might eventually return many of them to self-support. Social work staff—inadequate in number and training (1 caseworker with full professional training to every 23,000 public assistance re- cipients)—has been unable to make the home visits and provide coun- seling and other family services needed as much as the monthly money payments. The new Federal-State program, proposed to the States, seeks to meet the actual needs of families—whether this means their retention on the rolls or help in getting off. It will require a major effort in recruitment and training of profes- sional staff. It could be greatly aided by coordination of public and private voluntary welfare agency activities within each community. The Secretary’s Report 15 Tomorrow This then is our national situation today, in health, in education, and in welfare. Tomorrow we must do better—each tomorrow we must do better. The gap between acquiring knowledge and putting it into action for people must be narrowed. The Department seeks to publicize developments in medicine, in education, and in welfare. It tries to advance the use of new findings in these fields through pilot projects and demonstration programs. It is incredible that the citizens most in need of medical care should be denied it. People 65 years of age and over have medical costs twice those of younger people, yet their annual income, on the average, is only half as large. During any year they can expect to spend be- tween 2 and 3 times as many days in the hospital as a younger person. They need protection against the high cost of hospitalization and other health services and they want it, not as a gift but as a right earned and established during their productive years. The program we propose is simply a means of paying for hospital costs and related health services, not a means of providing these serv- ices. It is not a program of socialized medicine but a program pro- viding for prepayment of health costs with freedom of choice of doc- tor and hospital. Arrangements for paying for the services would be much the same as those now used under private hospitalization in- surance plans. No other method is as feasible or as fair to everyone. We are fully aware that virtually all responsibility for the conduct of American education rests outside the Federal Government. This is as it should be, but the Federal Government would be derelict in its duty to its citizens and to the Nation if it did not do all in its power to aid American education, which is in trouble generally. We cannot be satisfied with any educational endeavor that is not genuinely com- mitted to the highest standards of which we are capable. We have sought, and we will continue to seek, to strengthen our schools in facilities, curriculum, counseling, and the quality and sal- aries of our teachers. We will stress the arts and humanities as well as science, for both are essential. We hope to broaden the improvement of language teaching under the National Defense Education Act by providing assistance to teachers of English as well as teachers of foreign languages. Many of our young people enter college unable to speak, write, spell, punctu- ate, or understand their own language properly. This failure in a single subject hampers and holds them back in all subjects. We are interested in education of all kinds, for there must be op- portunity for instruction and achievement in all fields. We hope to obtain revisions and extensions in vocational education which will 16 Department of Health, Education, and Welfare, 1961 place it in proper relationship to general education and will provide the necessary flexibility to meet shifting employment patterns. We will seek other legislation from Congress, with one of our first concerns the necessary measures to extend and complete the general reorientation of our welfare program which we have begun through administrative changes. We are seeking congressional authority to establish a new position, that of Assistant Secretary for International Affairs, to coordinate our growing responsibilities and opportunities in the international field. The exchange of ideas, experimental methods, research findings, and personal skills between nations is beneficial to health, education, and welfare everywhere and contributes beyond its immediate results to human understanding. The President has proposed the establishment of an Institute for Child Health and Human Development at the National Institutes of Health. The new Institute would concentrate on problems of birth defects, infant mortality, mental retardation, and maternal factors in- fluencing child health and development. It would study the process of aging as part of the program of human development. The Department also looks hopefully to the Congress for final passage of two bills designed to provide educational and health serv- ices to migratory workers and their children. They would make possible some lifting of the burden of neglect, ostracism, and hope- lessness long suffered by these people. We will advocate and support legislation to extend and strengthen the consumer-protection activities of the Food and Drug Administra- tion. We will seek legislation to aid the health professions in training urgently needed manpower through construction of educational fa- cilities and provision of scholarships and educational grants. The expenditure of money by itself will not automatically bring progress in health research, in education, or in welfare. If it did, we could simply buy an end to cancer, to heart disease, to mental ill- ness—indeed, to disappointments and dependency. We could pur- chase wisdom and security over the counter. It is, however, the talent and quality of people, the direction, pur- pose, and focus of research and community projects, and the ex- cellence of facilities that make the money count. So we will support the projects which will stimulate creativity in others, the education and training that will produce more educators and leaders, the dem- onstrations that will be so clear and well thought through that many can follow their paths. We can reorient our welfare objectives, but it is the States which make the final plan and administer the program and ultimately the caseworker in the home who must find answers for the distressed. The Secretary’s Report 17 We can sponsor educational improvements, but it is the States and the local school boards and, in the end, the teacher who make them work. We can support and prod on matters of health, but it is in the doctor’s office, the research laboratory, and the home community that lives are saved and services rendered. All citizens are needed in this new world of our time. And yet the sick man, the hopeless man is lost. The frightened or insecure man has no strength to lend his Nation. The juvenile delinquent destroys all the years of his youth which might have offered most, in time, in courage, and in daring. The neglected aged waste their bonus hours. The Department of Health, Education, and Welfare is looking for new answers and seeking new knowledge with a particular urgency: The realization that some of the new answers and new knowledge it seeks could mean the difference between life and death for many men, women, and children; the difference between full realization of their gifts by the talented and a mere plodding existence of little interest to themselves or others; the difference between a grim waiting out of empty years by older men and women isolated in their last days and a happy, successful living of longer life in familiar and beloved surroundings. To have value, beginnings must stretch into continuity. So, for tomorrow, we plan to continue what we have started in our search for human successes. 18 Department of Health, Education, and Welfare, 1961 Table 1.—Grants to States: Total grants under all Department of Health, Edu- cation, and Welfare programs, fiscal year 1961 [On checks-issued basis] Ameri- Office of | White can States, Territories, Social Secu- Public Office of | Vocational] House | Print- and possessions Total rity Admin- Health Education | Rehabili- | Confer- ing istration Service ! tation ence on | House ging | for the Blind 2 Total so. eeee $2, 890, 122, 796) $2, 218, 508, 079)$244, 206, 612)$372, 075, 573/$54, 932, 040) —$9, 508] $410, 000 Alabams==.--<.5..- 80, 181, 949 63, 342,607} 6,726,484] 7,937,737] 2, 167, 428]_________ 7, 693 Alaska.____ 12, 461, 873 2,177,115} 2,800,982| 7,370,278} 113, 498 ATIZONR Soe seen eee 27, 566, 565 17, 649, 642 2, 403, 688 6, 995, 770 513, 862 Arkansas._ 46,631,209] 36,098,243] 4,950,459] 3, 829,659] 1, 747, 960 California=cs_ 2222.2 314, 532,595} 244,798,381] 11, 502,139] 55, 260,093) 2 935, 542 Colorado.ses seats 49,784,413] 40,630,284] 2,443,570) 6,915,792} 690, 767 Connecticut__.------ 23,173,735} 16, 444,188] 1, 753,959) 4, 545,596] 419, 910 Delaware__.._..---- 4, 882, 258 2, 665, 364 884,681] 1,154,775] 176, 133 District of Columbia_-------- 10, 532, 184 9, 263, 390 797, 773 221,021 248, 750 Piloridg ean. een 74, 853, 263 59, 064,653) 5,822,137] 8, 135,079) 1, 823, 606 Georpin ea. seen 89, 711, 932 69, 027, 133} 7, 788, 325) 10, 153, 324] 2, 731, 790 Hawali.c) 22 Fe 16, 960, 200 8, 733, 490 2, 801, 146] 10, 058, 623 365, 330 ToahOwes. sa eee 12, 229, 220 8, 132, 615 1, 424, 890 2, 482, 959 187, 978 Tlinoises: 20-5 bee 117, 897, 881 98) 349, 905| 8, 382, 234] 9009; 484] 2, 136, 414 Indiarias seemorees 35, 410, 788) 27,174,410] 4,451,419] 3,249' 452] +” 528" 064 Towa sciee tee Se 40, 877,599] 33,541/235} 3,676,317] 2,676,750 978, 992 IR ANSAg: meee eee 39, 941, 956 28, 167, 364 3, 872, 651 7, 187, 912 709, 363 Kentncky_-..------- 60,078,589) 49,575,061] 6,385,085} 3,474,802) 638, 753}_ owisian aie seso- no. 117, 526, 663 107, 759, 606 5, 596, 679 2, 828,481) 1,334, 815}_ Maine es steno 18, 629,937] 14,010,042] 1, 239,837| 3,038,766] 340, 348 Maryland___- 39, 437, 703 19, 625,134] 3, 806,624) 15, 378, 851 618, 179 Massachusett 91, 836, 179 76, 268, 236 4, 761, 422 9, 682, 464) 1, 105, 782 Michigan 84, 752,224} 68, 133, 709] 6, 252,611} 8, 822, 994] 1, 524, 586 i 50, 832,699} 41, 574, 468} 4, 710,334] 3, 399, 704] 1; 140, 166 53, 378, 331 42,451,699] 5, 976,238] 3, 695,090) 1, 251, 383 102, 421,196] 90, 435,603] 5, 710,314| 5,419, 460| "848, 432 5 5 11, 916,63 6, 476, 636| 1, 705,845} 3,516,680] 214, 878 21, 157,719] 13,312/540] 3,085,972] 4; 402" 395 Novadavsaces sauce a. 6, 194, 453 3,038) 161] 1, 1327335] 1, 941, 413 New Hampshire-___ 8, 108, 632 4,801,418] 1,346,538} 1, 855, 087 New Jersey. -_------ 44, 733, 826 32,037,151] 3,918,077) 7, 699, 940 New Mexico_.__- 30, 346, 148] 18, 243,213] 2, 746,337] 9, 123, 015 New Work= = sesceen 175, 305, 025) 143, 948, 724] 18,694,413) 13, 851, 347 North Carolina 75, 798, 347 54, 709, 152} 11, 668, 423} 6, 911, 656 North Dakota__- 11, 548, 866 8, 051, 763 1, 401, 229 1, 754, 510 nid ie. Lee SPE 111, 772,798} 88, 955,939] 9, 918,069] 11, 511, 160 Oklahoma. 99, 507, 864) 83, 757,740} 3, 608, 514] 10, 721, 173 Oregon eee 24,849,175] 19, 469,234] 2,678,261] 2, 139, 283 Pennsylvania. ______ 123, 810, 882} 95,774,766] 13, 267,049] 10, 371, 733 Rhode Island_-____-- 14, 005, 143 9, 867,406] 1,116,622} 2, 694, 084 South Carolina.___-- 34,854,198} 23, 238,987] 5, 114, 728] 5, 327, 170 South Dakota__.___- 13, 909, 776 8, 948, 483} 1, 206,992} 3, 448, 831 Tennessee 59, 763, 588] 45, 047,583] 8, 374,836] 4, 692, 804 TOXaS cee be “| 158; 749; 693] 12770947 594| 11,857,107] 18,072, 492 Utah! Sees 15, 695,221] 10, 590, 887] 1,955,992] 2. 835 649 Vermont._. d 7, 474, 725 5,821,468} 1,451, 330|.--_-__--___ Virginia______ | 49, 182,395] 21, 860, 199] 7,315,764] 18, 663, 639 Washington_- : 60, 024,859] 45, 260,646] 3, 157,475] 10, 576, 918 West Virginia. 39, 273,878] 30,634,857] 5,777,242] 1, 503, 295 Wisconsin 42,794,627 33, 256,990] 4,936,879] 3, 607, 971 Wyoming 5, 326, 786 3, 222, 008 691,981} 1,316, 429 Canal Zone-....---- 720) Ss Ree Ps See aa [bya SOE, Guamta es. cueek ss 1, 316, 184 231, 711 48, 465 973, 972 Puerto Rico___-_--_- 16, 584, 132| 10, 154,532} 3, 927,365] 1, 763, 164 Virgin Islands 1, 020, 365) 607, 694 180, 571 199, 678 Wake Island_------- 105, 40) Re eee oes | 2s eee oe 105, 401 Undistributed 8, 468, teal oa te Pe 8, 468, 858 1 Includes permanent annual appropriation of $10,000. 2 Excludes $248,844 paid to water pollution interstate agencies. Social Security Administration Social Security in 1961 Tue YEAR 1961 saw a new determination to move the social security programs forward in helping to build the Nation’s social and economic strength. On June 80, President Kennedy signed into law the Social Security Amendments of 1961. On that occasion the President emphasized the part that social security plays in providing for families, children and older persons in time of stress. The amendments, he noted, rep- resent an additional step toward eliminating many of the hardships resulting from old-age, disability, or death of the family wage-earner. Provisions of the 1961 amendments liberalizing old-age, survivors, and disability insurance will especially help some groups in the popu- lation who have the smallest incomes and other resources aside from their benefits to fall back on. Minimum benefits were raised from $33 to $40, aged widows’ benefits were increased 10 percent, old-age benefits were made payable to men at age 62 on an actuarially reduced basis, the quarters of coverage required for insured status for people at or near retirement age were reduced, and the retirement test was liberalized. It was expected that in the first 12 months in which the amendments were effective about 4,770,000 people would receive $815 million in new or increased benefits. The changes will be financed by additional income from increased contribution rates. The 1961 amendments also provided for an increase in Federal participation in public assistance payments by the States to recipients of old-age assistance, aid to the blind, and aid to the permanently and totally disabled for the period October 1, 1961, through June 30, 1962. A decrease in the need for public assistance in some instances, however, was expected to result from the more liberal old-age, sur- vivors, and disability insurance benefits provided in the amendments and reduction of the insured-status requirement. The Social Security Amendments of 1960, which became law shortly after the beginning of the fiscal year, reflected growing 19 20 Department of Health, Education, and Welfare, 1961 national concern with economic problems associated with health and medical care. To provide improved protection against economic loss caused by disability, the age-50 requirement for eligibility to disability benefits under old-age, survivors, and disability insurance was elimi- nated. Further to assist the States in meeting the health-care costs of the needy aged, Federal sharing in State payments to suppliers of medical care to old-age assistance recipients was increased. Also a new Federal-State program of medical assistance for the aged was authorized for older people who can meet living expenses but cannot afford the medical care they need. By the end of August 1961, 14 States had new medical assistance for the aged programs, 4 States had completed plans for new pro- grams, and 15 States were in the process of developing program plans. The medical assistance for the aged measure, President Kennedy declared in his February 9, 1961, health program message to Congress, recognized the problem of those needy aged requiring public assist- ance to meet their medical costs. But, the President indicated, the main problem—that of preventing dependency arising from the costs of health care in old age—must now be met by using the old-age, survivors, and disability insurance system, called by his task force on health and social security “the only sound and practical way of meeting the health needs of most older people.” By providing pro- tection against the costs of medical care through the basic national system of contributory social insurance, “it will be possible for our older people to get the vital hospital services they need without ex- hausting their resources or turning to public assistance,” the President said. Benefits under the health insurance program recommended by the President would be available to all persons 65 and over who are eligible for old-age, survivors, and disability insurance or railroad retirement benefits. The program would provide payment, within certain limits, for the cost of inpatient hospital care (after a deduct- ible), skilled nursing-home care after hospitalization, hospital out- patient diagnostic services (after a deductible), and visiting-nurse and related home-health services. Congressional hearings on the benefit, financing, and administra- tive features of the program worked out by the administration, which the President stressed was “a very modest proposal cut to meet abso- lutely essential needs,” were held after the close of the fiscal year. The recession confronting the Nation as the new administration took office focused attention on another aspect of the economic security of the worker and his family—the protection afforded by the Federal- State unemployment insurance system. The Temporary Extended Unemployment Compensation Act, one of the first antirecession meas- Social Security Administration 21 ures proposed by the administration, was passed by Congress on March 24, 1961. The law provided additional benefits up to 13 weeks for workers who exhaust their regular unemployment benefits under existing State and Federal programs after June 30, 1960, and before April 1,1962. Upto theend of June 1961, about 1,155,000 individuals had qualified for the extended benefits. Other administration proposals advanced as recession turned to recovery stressed the need for long-range measures to improve and strengthen the unemployment insurance system. The proposals in- clude a permanent standby Federal program of extended benetits for technologically displaced workers, benefits equal to at least one-half of an individual’s average weekly wage (subject to maximums related to statewide averages) to bring benefit levels more nearly into line with those originally intended, and extension of the system’s coverage in recognition of the fact that the risk of lost wages due to unemploy- ment is common to all wage and salary workers. Another proposal, passed by Congress in May 1961, made new Federal funds available to States that extend their child aid programs to help needy children in families in which a parent is unemployed. Inclusion of unemployment as an eligibility factor in Federal-State aid to dependent children will work toward the Nation’s goal of ena- bling children to grow up in normal, secure homes. It will help meet need in many families, such as those for example where the bread- winner is not covered by the unemployment insurance program or has exhausted his benefits. Temporary action was taken pending completion of study by the Administration looking toward permanent changes in present laws. The measure expires June 30, 1962. Twelve States had adopted this measure at the end of August 1961. The amendments and proposals sketched here and detailed along with others in subsequent sections of this report were designed to put the Nation in a position to deal more effectively with longstand- ing or emerging problems. Recognized as still urgently needed, how- ever, was wider application of present knowledge and development of new. A new approach toward finding better ways to help people to help themselves by searching out the causes of dependency was made in March 1961, when the first grants under a program of cooperative research and demonstration projects were announced by the Social Security Administration. The cooperative research and demonstra- tion grant program was authorized by Congress to add to existing knowledge or devise and evaluate new methods of applying knowl- edge with regard to such problems as the prevention and reduction of dependency, coordination and planning between private and public 22 Department of Health, Education, and Welfare, 1961 welfare agencies, or improvement in the administration and effective- ness of programs carried on in relation to the Social Security Act. Sixteen grants totaling about $350,000 were awarded, with the advice of an outstanding group of experts, to educational and nonprofit institutions. The Social Security Administration also conducted an intensive review of its own research and statistical activities. As part of the review, Commissioner of Social Security William L. Mitchell invited a distinguished group of experts from the social science research community outside Government to advise him concerning the future scope and objectives of the research program. “After 25 years,” Mr. Mitchell told the advisory group, “the social security programs have reached a degree of maturity, and new or unsolved social problems are pressing upon the Nation with a degree of urgency that makes it highly desirable for us to reassess our responsibilities for research and research planning.” The advisory group was in unanimous agreement that a continuing program of long-range research in addition to basic statistical activ- ities and current program-related research is needed if the Social Security Administration is to make further significant contributions to the understanding and solution of persistent human problems and of new problems that lie ahead. The basic recommendation con- tained in the report of the group to the Commissioner was that the Social Security Administration “accept responsibility for carrying out, stimulating, and supporting long-range research in the broad field of human resources and social welfare.” Indicative of a widely shared, constructive concern of the American people with questions of income security, health security, and the social needs of older persons was the White House Conference on Aging. After 2 years of preparation, involving hundreds of groups through- out the Nation and probably more than a quarter-million individuals, the Conference was held January 9-12, 1961, in Washington, D.C. It was attended by 2,565 official delegates, The purpose of the deliberations, as summarized by the Chairman of the National Advisory Committee for the Conference, was to reach agreements and make recommendations on four basic problems: (1) the older person’s economic situation; (2) his health and medical problems; (3) his pattern of living; and (4) the mobilization of re- sources, public and private, to improve the three preceding situations. The “pluralistic approach” to providing for the security of older persons and to the problem of financing medical care was strongly advocated by the interested delegates. It was the consensus that the proper approach to the medical care problem was through a combi- Social Security Administration 23 nation of patient payments, private health insurance plans, and Fed- eral and State government participation. One of the most specific conference developments was the majority recommendation of the income-maintenance section that the old-age, survivors, and disability insurance mechanism should be the basic means of financing health care for the aged. At the end of fiscal year 1961, total payments under social security and related programs were made at an annual rate of more than $31 billion. The payments represented 7.5 percent of total personal in- come in June, compared with 6.4 percent a year earlier. Rising old-age, survivors, and disability insurance benefits and larger un- employment insurance payments accounted for the major part of the increase. Under old-age, survivors, and disability insurance, the number of beneficiaries in current payment status increased by 1,362,000 from June of the previous year to 15,624,000. The number of disability insurance beneficiaries and their dependents rose 376,000, the largest annual increase since disability benefits became payable in 1956, pri- marily because benefits were extended to disabled workers under age 50 and their dependents beginning November 1960. The number of beneficiaries 65 and over increased by 799,000 to 11,328,000. Total benefits paid out during June 1961 amounted to more than $1 billion. In federally aided assistance for persons 65 and over, 2.3 million were receiving old-age assistance and 46,000 received medical assist- ance for the aged in June 1961. Nearly 3.4 million children and their adult caretakers received aid to dependent children—including 112,000 recipients in the newly added unemployed-parent group—106,000 received aid to the blind, and 384,000 received aid to the permanently and totally disabled. In addition, more than a million persons re- ceived general assistance financed from State and local funds. Pay- ments for all types of assistance for the month were $337 million. Federal grants to States for maternal and child health and welfare programs under the Social Security Act for fiscal year 1961 were $18,113.9 million for maternal and child health services, $19,797.4 million for crippled children’s services, and $13,618.1 million for child welfare services. The 1960 report of Federal credit union operations noted that in 1960 Federal credit unions made 414 million loans totaling nearly $3 billion. During fiscal year 1961, 626 new credit unions were chartered. The Social Security Administration had 32,100 employees on duty at the end of the fiscal year. The great majority of the employees were in district offices and other offices of the Bureau of Old-Age and Survivors Insurance. 24 Department of Health, Education, and Welfare, 1961 Hearings and Appeals Old-age, survivors, and disability insurance claimants are guaran- teed the right to hearing and review. The number of hearings con- tinued to increase in 1961. During the fiscal year, 14,105 requests for hearings were received— a 6-percent increase over the previous year. Requests for hearings on disability cases, however, climbed 29 percent in the last 4 months of the fiscal year. The increase was attributable in large part to the Social Security Amendments of 1960. The upward trend was ex- pected to continue since the full impact of the amendments had not. yet been realized. Because of the accelerated tempo of requests for hearings, 17 percent more cases were pending on July 1, 1961, than on that date a year earlier. Thirty-four hearing examiners were added to the Office of Hearings and Appeals staff to handle the increased workload. Requests for Appeals Council review of hearing examiners’ de- cisions declined from 7,300 in fiscal year 1960 to 5,210 in fiscal year 1961. Thenumber of cases pending at the end of the year was reduced 36 percent. However, the impact on the council’s workload of the upward trend in hearings was anticipated for early fiscal year 1962. The Appeals Council issued decisions on 224 cases remanded by the courts. Although 163 new cases were remanded during the year, the number of cases pending was reduced from 219 to 158. A substantive survey of the operations of the Office of Hearings and Appeals was conducted by private legal consultants at the request of the Department. The purpose of the survey was to assure that the administrative processes of the office provide fair and impartial hearings. International Activities The Social Security Administration International Service planned training programs or conducted training sessions for 932 persons from 81 countries during fiscal year 1961. Requests for the training came through the International Cooperation Administration, the United Nations, the World Health Organization, the Organization of Ameri- can States, numerous embassies, and a variety of voluntary agencies, foundations, and universities. Referrals of foreign leaders and spe- cialists through the Department of State continued to increase with the growth of the cultural exchange program and its extension to newly developing countries. Of the nations represented by the trainees, 21 were Asian or Middle Eastern countries, 15 were African, 19 were European, and 19 were Social Security Administration 25 Latin American. Six—all newly developing countries—were repre- sented for the first time: Afghanistan, Cyprus, Nepal, Nigeria, Sene- gal, and Somalia. The Palau Islands of the Trust Territory were also represented. In addition to training, the Social Security Administration engaged in a broad spectrum of international cooperative activity related to its fields of interest. The Commissioner participated in the Eleventh Meeting of the Bureau Executive Committee of the International So- cial Security Association in Leningrad, and other officials represented the Social Security Administration at the association’s working group meeting on old-age insurance and on the American Regional Com- mittee of Social Security Actuaries and Statisticians. The Tenth Session of the International Conference of Social Work in Rome, in which Social Security Administration officials also participated, at- tracted social workers from 60 countries, many from the newly in- dependent nations in Africa attending for the first time. Cooperation with the Department of State in connection with ses- sions of the United Nations Economic and Social Council, the Social Commission, and UNICEF contributed to increased recognition for social development in United Nations’ programs, Emphasis on social development in the new Act of Bogota program was a basis for in- creased cooperation with the Organization of American States. A recommendation of the Social Security Administration was influen- tial in the creation of a separate department of social affairs within the organization. The Social Security Administration also carried on a number of activities in connection with the International Labor Organization, including furnishing advisors to U.S. delegations to conferences in Buenos Aires and Geneva. The Division of Program Research con- tinued to participate, on behalf of the Department, in the regular work of the Interdepartmental Committee on International Labor Policy. Cooperation with voluntary agencies interested in international social welfare included participation in the National Social Welfare Assembly’s Washington workshop on international affairs and in the session of the International Committee of the Council of Social Work Education in New York. A consultant served with the Com- mittee on International Social Welfare of the National Association of Social Workers. As in past years, the Social Security Administration cooperated with the International Cooperation Administration in recruiting so- cial welfare and maternal and child health experts. Twelve experts were assigned to ICA overseas missions for some period during the year. The experts served in seven countries. The Social Security Administration undertook to advance a co- operative research program on social welfare questions through a re- 626936—62——3 26 Department o} Health, Education, and Welfare, 1961 quest for foreign currency under the activities authorized by the Agricultural Trade Development and Assistance Act of 1954, as amended. Funds were requested for fiscal year 1962 in seven coun- tries. The studies proposed encompass such questions as urban social problems, social services and social security, medical care for the aged, juvenile delinquency, community development, and training of social welfare personnel. Old-Age, Survivors, and Disability Insurance The old-age, survivors, and disability insurance program provides continuing income for workers and their families as a partial replace- ment of earnings lost when the family earner retires in old age, becomes permanently and totally disabled, or dies. It does this in a way that enhances the dignity of the individual, fosters self-reliance, and helps to prevent dependency. The program is supported by the contributions of covered workers and their employers and covered self-employed people. Benefits are earned through work and are related to past earnings. Payments under the program serve as a base to which the individual may add savings and income from private insurance, private pension plans, and other sources. Thus the worker is encouraged to supplement the basic protection afforded by his social insurance benefit with what- ever additional protection he can afford to buy. In the 26 years since the original Social Security Act was enacted the old-age, survivors, and disability insurance program has become firmly established as by far the largest program for assuring income to individuals and families who suffer a loss of earnings when the worker retires, becomes disabled, or dies. More than 9 out of 10 mothers and children are protected against the loss of income result- ing from the death of the family breadwinner. Nearly 86 million people in the Nation have worked long enough to be insured for retirement and survivors benefits under the program; more than half of these have worked long enough to meet the requirements for dis- ability protection and this number will increase rapidly each year. Eighty-five percent of the people now becoming 65 are eligible for retirement benefits and in the future this proportion will rise to 95 percent or more. At the end of June 1961, benefit checks were being sent out each month to over 15.6 million beneficiaries. It is clear that the program as now constituted is playing a major role in assuring that people who have been self-supporting during Social Security Administration 27 their working years will be able to remain independent when they no longer have income from work. Nevertheless there are gaps in the protection afforded by the program that need attention. Health insurance for older people would fill the most serious of these gaps. The benefits provided under old-age, survivors, and dis- ability insurance, even when supplemented by other income and sav- ings, do not and cannot afford protection against the large and unpredictable costs of major illness for most people. The high health costs and low incomes of the aged as a group preclude a satisfactory solution of the problem through private insurance, and the Nation has long since decided to use social insurance as the basic approach in meeting economic problems that affect the majority of the people. The President has proposed that the social insurance method be used to help finance the health needs of the aged. Providing health insurance for the aged under old-age, survivors, and disability insur- ance would enable people to contribute during their working years toward protection against certain major health costs in old age, just as they now build protection against other major risks. Another area that will need attention is how to keep the benefit structure in line with changes in the economy. Most people now coming on the benefit rolls have their benefit amounts based on recent years of work. Over the long run, though, under present law, benefit amounts will be based on a lifetime average of the person’s earnings in covered work. If there is no provision for benefit change as earn- ings go up, the average earnings on which benefit amounts are based will more and more reflect the lower wages paid a person in his earlier years of work. Even if the benefit structure were changed so that a benefit was up-to-date when it was first awarded, there would still be a need to revise benefit levels periodically so that beneficiaries can share in the higher levels of living that active workers enjoy. Basic to any consideration of the problem of keeping the program in line with the changing economy is the matter of adjusting the ceiling on the amount of earnings that can be taxed and credited toward benefits. Adjustments in the earnings ceiling to correspond with rises in earnings are important from the standpoint not only of keeping benefits up to date but also of keeping the financial base of the program from shrinking. While the program now affords effective protection for workers of all ages and their families against the risk of severe, long-term dis- ability, there is still a significant gap in this protection. Under present law, a worker who has been totally disabled throughout an extended period of time is not eligible for benefits unless his condition will be of long-continued and indefinite duration. Disabled workers and their families however have great need for benefit income during an extended period of total disability even though the worker may be 28 Department of Health, Education, and Welfare, 1961 expected to recover, and they should be afforded protection under the program. Increasing attention should be given to the vocational rehabilitation of disabled beneficiaries. The restoration of such beneficiaries to pro- ductive work is clearly in the best interest of the individual and the economy, and results in savings to the social security trust funds. To this end, legislation should be enacted to permit limited expenditures from the trust funds to reimburse the States for rehabilitation services for disabled beneficiaries. Making available a certain amount of full Federal financing for rehabilitation of social security disability beneficiaries would encourage the States to extend services to a greater number of such beneficiaries than is practicable under the financial limitations of the present matching fund programs, with consequent advantage to the beneficiaries and little if any cost to the social security trust funds. Another gap in the protection of the program occurs because there is no provision in present law for the payment of benefits to a child who is dependent on a worker who is not the child’s parent. As a result there are cases where a child who has been living with and being supported by an insured worker cannot get benefits on the worker’s record when deprived of his support as a result of the worker’s re- tirement, disability or death. Consideration will need to be given to the possibility of paying child’s insurance benefits to a dependent child based on the earnings record of the worker who supported him even though the parent-child relationship now required by law does not exist. The coverage of the old-age, survivors, and disability insurance program, broad as it is, still leaves unprotected some gainfully em- ployed people and their families. Extension of coverage under the program to essentially everyone employed would provide assurance to all workers that the protection of the program would follow them from one job to another. Especially important is the extension of coverage to the approximately 2 million civilian employees of the Federal Government who are under staff retirement plans—the largest group still lacking social security protection. This protection can be provided without undue cost to employees or the Government, in a way that assures that every employee affected will have combined protection under social security and a staff retirement system that is at least as good as—and, in most instances, much better than—his present protection under only a staff retirement system. The inde- pendence of the staff retirement systems need in no way be impaired. The plan could also provide that present employees would have the opportunity to choose to continue their existing coverage under a staff retirement system without change, or to come under social security coverage and adjusted staff retirement provisions. Social Security Administration 29 A large group of workers whose employment is covered under the program nevertheless has inadequate protection under the program because a large part of their earnings is in the form of tips, which are not counted as wages for social security purposes. Because much of their income is not counted their benefits have little relation to their true level of earnings. The Department of Health, Education, and Welfare and the Department of the Treasury have recommended to the Congress that tips received by an employee in the course of his employment for an employer be treated like wages paid directly by the employer insofar as possible and have suggested a plan for securing reports and collecting taxes on tips. The old-age, survivors, and disability insurance program has now become firmly established as the basic program in the Nation for pro- tecting American families against economic dependency arising from loss of income as a result of retirement in old-age, disability, or death of the family breadwinner. The past year brought unusually heavy legislative activity. KEnactment of the Social Security Amendments of 1960 at the beginning of the fiscal year and the 1961 amendments at the end of the year resulted in needed improvements in the pro- gram, broadening its scope and increasing its effectiveness and flexibility. The Bureau of Old-Age and Survivors Insurance moved ahead during the year to put into effect the new provisions of the 1960 amendments as well as changes which studies have indicated will im- prove its administrative effectiveness, while maintaining a high quality of service to the public. Meantime, the Bureau is continuing to study and evaluate the program and its administration. What the Program Is Doing BENEFICIARIES AND BENEFIT AMOUNTS Old-age, survivors, and disability insurance benefit payments in the fiscal year ended June 30, 1961, totaled $11,889 million, 10 percent more than the amount paid during the preceding fiscal year. Benefit payments under the disability insurance part of the program were one-third larger than in fiscal year 1959-60 and totaled $704 million. Old-age and survivors insurance monthly benefits rose 9 percent to $11,018 million and lump-sum death payments amounted to $167 million, about $1 million higher. The number and amount of monthly benefits in current-payment status increased sharply. In June 1961, 15.6 million beneficiaries were receiving benefits at a monthly rate of $992.0 million—increases from June 1960 of 1.4 million in number of beneficiaries and $102.2 million in amount of monthly benefits. The increase in number was 10 per- Department of Health, Education, and Welfare, 1961 30 Savad TVOSI4 S9, 09, ss, SLN3QN3d30 8 SYOAIANNS qaoVv Zl SMOCIM SNNOA ® NAYGTIHD mi<— SU UOK aatavsia 91 SAlINVIDSISANAG ga1gvsid 40 SLN3QN3d30 0z SNOITTIW SaldVISI4INAG GNV SLNIWAVWd LIJANad JONVYNSNI ALIIAGVSIG GNV “SPs1DMO WAS dwn; %F 4nogo sepnjru;, ZL 9 0z suv110d 40 SNOIT1NI9 ‘SUOAIAUNS ‘3DV-C1O—'L LaVHD Social Security Administration 31 cent, and the rise in the monthly amount almost 12 percent. The in- crease in the monthly rate resulted from (1) the growth in the total number of beneficiaries, (2) the rising proportion of benefits based on recent higher earnings with as many as 5 years of lowest earnings and periods of total disability omitted from the benefit calculation, and (8) the 1960 legislation increasing the benefit for each child of a deceased worker to three-fourths of the primary insurance amount. Men aged 65 or over and women aged 62 or over made up 12.3 million (79 percent) of the beneficiaries—8.4 million of them were retired workers and 3.9 million were the wives and dependent hus- bands of retired or disabled workers and the widows, dependent widowers, and dependent parents of workers who had died. Of the remaining 3.3 million (21 percent), 2.1 million were children, about 616,000 were mothers, and 558,000 were disabled workers under age 65. About 2.6 million monthly benefits were awarded in fiscal year 1961, 364,000 more than the number awarded in the preceding year. A record number of 540,000 monthly benefits were awarded to disabled workers under age 65 and their wives, husbands, and children. About 121,000 of these benefits were awarded to disabled workers under age 50 (first eligible in November 1960) and about 137,000 to their de- pendents. New highs were also reached for mother’s benefits (96,000) and for benefits awarded to children of deceased or retired workers (331,000). About 122,000 monthly benefits attributable to the liberal- ized insured-status provision in the 1960 amendments were included in the year’s awards. Old-age (retired-worker) benefits accounted for about three-fourths of the awards under this provision; the aver- age monthly amount was $39.35 compared with $83.85 for awards under the earlier provision. Lump-sum death payments during fiscal year 1961 numbered 825,000, about 5,000 more than the previous high established in fiscal year 1960; this was the 11th consecutive year in which a new record for lump-sum awards was set. About 794,000 deceased workers were represented in these awards, The average lump-sum amount per worker was $210.36, about the same as in the preceding year. In June 1961, the average old-age insurance benefit paid to a retired worker who had no dependents also receiving benefits was $70.40 a month. When the worker and his wife both received benefits, the average family benefit was $124.90. Families consisting of a widowed mother and two children received on the average $190.70. Among beneficiaries on the rolls at the end of June 1961 whose benefits are based on earnings after 1950 the average for a retired worker with no dependents receiving benefits was about $78.90, for an aged couple about $133.90, and for a widowed mother and two children about $214.20. 32 Department of Health, Education, and Welfare, 1961 DISABILITY PROVISIONS During the fiscal year, a period of disability was established for about 220,000 workers, 30,000 more than in the preceding fiscal year and about 13,000 more than the previous record number in 1957-58. About 22,000 disabled persons aged 18 or over who had applied for child’s monthly benefits were found to have a disability that began before they had reached age 18; the number was about 6,000 smaller than in 1959-60. Since the beginning of the program in 1955, about 1,185,000 workers and dependent children have been found to be severely disabled and to meet the other requirements for a period of disability. The number of disabled workers receiving monthly benefits rose 50 percent in the fiscal year and totaled 558,000 at the end of June. About 340,000 benefits were being paid to the wives, husbands, and children of these beneficiaries—a 125 percent increase. (As men- tioned earlier, benefits were first payable to disabled workers under age 50 and their dependents for November 1960.) By the end of June 1961 child’s monthly benefits were being paid at a monthly rate of $5.0 million to 113,000 disabled persons aged 18 or over—depend- ent sons and daughters of deceased, disabled, or retired insured workers—whose disability began before age 18. About 15,000 women—who would not otherwise be eligible for benefits—were re- ceiving wife’s or mother’s benefits as the mothers of disabled persons receiving child’s benefits. During the fiscal year, there has been a growing volume of litiga- tion in connection with the disability program, with a resulting troublesome proportion of reversed decisions. The Bureau is study- ing the situation carefully in the hope that with improved procedures, both the volume of litigation and the number of reversals may be decreased. By the end of 1960, the latest date for which this information is available, about 94,800 persons were receiving old-age benefits in- creased by an average $8.40 a month because their social security rec- ords were frozen for periods while they were disabled before reach- ing retirement age. About 32,800 wives, husbands, and children of retired workers and about 45,300 widows, widowers, children, and parents of workers who had their social security records frozen before death were also receiving larger monthly benefits because of the freeze. For the same reason, lump-sum death payments in 1960 based on the earnings records of 18,850 deceased workers were increased by an average of $23.36 per worker, Social Security Administration 33 THE PROTECTION PROVIDED Of the population under age 65, an estimated 77 million were insured at the beginning of the calendar year 1961. Some 38 million of these people were permanently insured—that is, whether or not they con- tinue to work in covered jobs, they will be eligible for benefits when they reach retirement age, and their families are protected if they die. (Included in this total were about 900,000 women aged 62-64 who were already eligible for old-age benefits but on a reduced basis.) The remaining 39 million were insured but must continue in covered work for an additional period to be insured permanently. If the father should die, the mother and young children in 9 out of 10 families in the Nation can count on receiving monthly survivors insurance benefits. An estimated 48 million of the insured persons under age 65 also met the insured status requirements for protection against the risk of long-term and severe disability. Of the 17.0 million people aged 65 or over in the United States at the beginning of 1961, 73 percent were eligible for benefits under the program. Sixty-four percent were actually receiving benefits, and 9 percent were not receiving benefits because they or their husbands were receiving substantial income from work. Taking into account the liberalization in the requirement for fully insured status provided by the 1961 amendments, the percentage of aged persons who will be eligible for benefits at the beginning of 1962 is estimated to be 76. This percentage is expected to rise to 83 by the beginning of 1966. THE COVERAGE OF THE PROGRAM An estimated 73 million persons worked under old-age, survivors, and disability insurance during the calendar year 1960. In addition, about 1 million persons employed in the railroad industry had, in effect, joint coverage under the railroad retirement and old-age, sur- vivors, and disability insurance programs. Altogether, including em- ployees of State and local governments and nonprofit organizations for whom coverage is available on a group-election basis and members of the Armed Forces, nine-tenths of all persons in paid employment in the United States were covered or eligible for coverage under the program. Of workers not covered and not eligible for coverage during a typical week, about one-third were covered by Federal, State, or local retirement systems. The remaining two-thirds—7 percent of the Nation’s paid employment—consisted generally of persons who are not regular workers and are for the most part self-employed persons and domestic and farm workers who did not meet certain requirements of the law as to the amount of their earnings or the length of time worked. 34 Department of Health, Education, and Welfare, 1961 INCOME AND DISBURSEMENTS Expenditures from the Federal Old-Age and Survivors Insurance Trust Fund during the fiscal year totaled $11,743 million, of which $11,185 million was for benefit payments, $322 million for transfers to the railroad retirement account and $236 million, including Treas- ury Department costs, for administrative expenses. Total receipts were $11,814 million including $11,293 million in net contributions and $522 million in interest on investments. Receipts exceeded disburse- ments by $72 million, the amount of the increase in the trust fund during the year. At the end of June 1961 this fund totaled $20.9 billion. Total assets of the old-age and survivors insurance trust fund, except for $1,377 million held in cash, were invested in United States Govern- ment securities as required by law; $3.4 billion were invested in public issues (identical to Treasury securities owned by private investors), and $16.2 billion were invested in securities of varying maturities issued for purchase by the trust fund. The average interest rate, figured on the coupon rate and face amount of all investments of this fund at the end of the fiscal year, was 2.74 percent. Expenditures from the Federal Disability Insurance Trust Fund during fiscal year 1961 totaled $745 million, of which $704 million was for benefit payments, $5 million for transfers to the railroad retire- ment account, and the remainder—some $36 million—for administra- tive expenses. Total receipts were $1,082 million, including $1,022 million in net contributions and $60 million in net interest on invest- ments. Receipts exceeded disbursements by $337 million, the amount of increase in the fund during the year. At the end of June 1961, the fund totaled $2,504 million. (Contributions to this fund first became payable in January 1957 and benefit disbursements began in August of that year.) Assets of the disability insurance trust fund consisted of $2,386 million in United States Government securities and a cash balance of $119 million. The invested assets consisted of $87 million in public issues and $2,299 million in securities of varying maturities issued for purchase by the trust fund. The average interest rate, figured on the coupon rate and face amount of all investments of this fund at the end of the fiscal year, was 2.85 percent. Administering the Program The Bureau entered fiscal year 1961 with normal workload backlogs, the amount of work pending at various work stations being generally no more than necessary to keep work flow current. With a relatively stable workload situation and more favorable workload-to-staff rela- Social Security Administration 35 tionship than had existed for several years, the Bureau appeared to be in a good position to put into effect improvements in operations which had been successfully tested and would make for improved adminis- tration and a higher quality of public service. This highly favorable situation was altered, however, with enactment of amendments to the old-age, survivors, and disability insurance program in September 1960. Once again the Bureau was faced with a heavy influx of addi- tional workloads and had to make preparations to recruit and train the necessary additional staff. At the same time, plans were being put into effect to proceed with further study and implementation of the long-range integrated data processing and electronic data process- ing programs to which the Bureau was committed. The 1960 amend- ment provisions which resulted in immediate, substantial workload increases were those which changed the retirement test, eliminated the age-50 requirement for disability insurance benefits, and liberalized insured status requirements. The additional workloads resulting from the amendments necessi- tated substantial staff increases and made it imperative that the Bureau recruit and train new personnel as rapidly as feasible. Addi- tional personnel requirements were measured against expected work- load increases, recruitment potential, Bureau capacity to effectively train and absorb into regular operations the added staff, and pro- jected requirements after fiscal year 1961. Employees on duty at the end of the fiscal year totaled 31,391. This end-of-the-year staffing total reflects not only the increase due to 1960 amendment workloads, but also normal program growth, some scheduled advanced recruitment to secure the best college graduates available, and a stepped-up recruitment activity carried out in antici- pation of the latest amendments to the program enacted on June 30, 1961. In addition to the staffing indicated above, the Bureau also used 2,129 man-years of overtime during the fiscal year. In addition to workload impacts, the 1960 amendments also pre- sented a number of administrative problems that had to be resolved promptly, to ensure effective implementation of the changes made in the law. Priority was given to training on the amendment provisions, essential for both experienced and newly recruited personnel. The Bureau was also faced with the task of issuing and coordinating a considerable volume of instructional material and forms essential for the implementation of the amendments. Initial emphasis was given to those areas in which the amendments had immediate effect. A com- prehensive informational campaign on the amendments to inform the public of the changes in the law was conducted. A few key workload figures best illustrate the magnitude of the operating task faced by the Bureau during the year. Approximately 36 Department of Health, Education, and Welfare, 1961 2,690,000 claims for old-age and survivors insurance benefits and about 935,000 for disability insurance benefits were received. New social security accounts were established for 3,451,000 persons and duplicate account number cards were issued to 3,039,000 people. Approxi- mately 273,800,000 earnings items were received for posting to indi- vidual accounts and more than 2,650,000 requests for changes in personal record data were processed. About 2,300,000 statements of earnings accounts were issued to individuals who inquired about the status of their earnings records. On January 1, 1961, a new Division, designated as the Division of Management, became operative. In this new organizational entity, the management functions formerly performed by the Division of Administrative Management and the Division of Public Information and Personnel Management, with the exception of the Office of Infor- mation, were consolidated. The Office of Information now reports directly to the Office of the Director. The new Division serves as the staff arm of the Director for man- agement analysis and appraisal, financial management, personnel management, training, employee health and communications, procure- ment, and general management services. Consolidation of these func- tions in one Division permits greater coordination of the management activities involved, places them under the control of one Assistant Director, and makes possible a unified and more effective leadership in top-level Bureau management functions. For the past few years, the Bureau has been exploring the use of electronic equipment to handle its rapidly increasing workloads with- out increasing staff at a proportionate rate. By 1955, electronic equipment had been developed to the point where installations were made in the Division of Accounting Operations for the maintenance of earnings records and making initial benefit computations. Sub- sequently, in 1958, computers located in the Division of Accounting Operations were used to convert old-age, survivors, and disability insurance benefits to the new rates resulting from amendments to the law and, in 1959, to facilitate the recertification of benefit payments for the Baltimore Payment Center. Based on this earlier experience with electronic computers, the Bureau launched a long-range program of developing an integrated data processing system in its claims operations to provide better serv- ice to the public through increased speed and accuracy, plus reduced costs. The broad concept envisioned a claims operation in which in- formation and decisions would be recorded in machine language at early points in the process, transmitted automatically with maximum speed and accuracy, and translated electronically into final products. A thorough investigation of the many types of data processing equip- Social Security Administration 37 ment was conducted and notable progress was achieved in the imple- mentation of the long-range integrated data processing system. Full development is expected by 1964. During the year, computers and related equipment were put into operation at the various payment centers. Computers were installed in the Philadelphia, Chicago, Kansas City, and Birmingham Payment Centers. Peripheral equipment was installed in the New York and San Francisco Payment Centers. The Philadelphia Payment Center provides computer service to New York, and the Kansas City Payment Center services San Francisco. ‘The Baltimore Payment Center is serviced by the computer in the Division of Accounting Operations. During the year, the entire accounting records for the Bureau’s old-age, survivors, and disability insurance beneficiary rolls, representing some 15 million items, were converted to magnetic tape. Electronic data processing systems and programs were placed in regular operation to create media for issuing initial benefit checks, mechanically prepare award certificates, prepare checkwriting media for recurring payments, and mechanically update beneficiary records by additions, deletions, and changes of address. These techniques now make it unnecessary for the Treasury Disbursing Offices to estab- lish and manually maintain records on new additions to the beneficiary rolls. The creation of master record tapes will permit the recording of monthly payment history. In addition, it will permit the introduc- tion of methods for mechanically processing beneficiaries’ annual re- ports of earnings, suspensions and reinstatements of benefits, terminations of entitlement, and change of address items. Testing of high-speed wire communications between Kansas City and San Francisco, designed to transmit data from magnetic tape to magnetic tape, has been completed. This was a venture into a rela- tively uncharted area of transmitting data over telephone lines from one tape station to another tape station over 1,800 miles away. The tests were conclusively successful and the system was put into opera- tion. Recording on magnetic tape of payment histories for all beneficiaries was started in January 1961, and included actions taken in December 1960. All benefit actions are now added to the tape records on a daily basis through the regular daily updating operations. This provides current benefit, payee, address, and payment history data for all in- cluded beneficiaries. At the same time that it was investigating and planning for com- puter applications to the claims process, the Bureau conducted a Data Transmission Pilot test in 1960. The Pilot installation, involving 26 district offices, 2 relay centers, 8 payment centers, 2 regional offices, 38 Department of Health, Education, and Welfare, 1961 and the Central Office in Baltimore was observed and thoroughly tested during fiscal year 1961. Based on the results of this study, the Bureau decided to proceed with the establishment of the entire Na- tional Data Transmission System which will include all Regional and district offices, payment centers and Bureau Headquarters in Balti- more. In June 1961, contracts were let for the special equipment needed for the Baltimore Transmission Terminal, 6 Communications Control Centers, and 48 relay centers to be established as key elements in the National System. One Communications Control Center will be located in the Social Security Building in Baltimore and the others will be located in the payment centers at Chicago, Philadelphia, Bir- mingham, Kansas City, and San Francisco. Schedules for the orderly linking of all the Bureau’s processing points during fiscal year 1962 have been drawn up and additions to the system are being made on a regular basis. Late in the fiscal year, a Telecommunications Man- agement Branch was established in the Division of Management to provide unified control and management of the National Data Trans- mission System. In connection with studies concerning the use of electronic equip- ment and data transmission systems, the Bureau is also studying other aspects of the claims process. For example, a contract was made with The Johns Hopkins University in Baltimore for a 3-month explora- tory Operations Research Study to determine whether operations research techniques could be profitably applied to processing and organizational problems in the long-range aspect of the Bureau’s work. The study, conducted by a research team from the University, was started in November 1960 and completed in February 1961. A comprehensive report of findings and recommendations was published in April and reviewed by the top staff of the Bureau to determine whether and how operations research might be used most advanta- geously in decision-making processes. Asa result, a decision was made to develop a Bureau operations research capability. Outside profes- sional assistance will be utilized to augment and complement available Bureau skills in the development of this program. The Bureau continued its activity in studying proposals to provide health insurance for beneficiaries aged 65 and over. Issues and prob- lem areas involved in the administration of such a program are being studied to permit development of possible solutions and alternative courses of action. In January 1961, a small group of Bureau per- sonnel was detailed to study and develop plans for the administration of a health insurance program. This staff is working in coordination with other organizations within the Department of Health, Educa- tion, and Welfare and other government agencies. Discussions were also held with representatives of other national organizations in the Social Security Administration 39 health field concerning various alternatives and problems presented by the proposed legislation. The large variety of complex questions and problem areas encountered by this group during its investigations in the last 6 months indicate a need to continue these studies, so that the Bureau will be properly prepared to provide advice on the admin- istrative feasibility of proposals and to step into actual administration if health insurance for the aged is enacted. In the last few years, the administration of the old-age, survivors, and disability insurance program in foreign countries has been the subject of considerable review and study. Surveys have been con- ducted in Europe and the Far East to identify problem areas and to explore ways and means of facilitating the claims process and ex- pediting service to claimants. In fiscal year 1959, an agreement was negotiated with the Veterans Administration, whereby Veterans Ad- ministration staff and facilities in the Philippines are utilized on a re- imbursable basis for services in connection with old-age, survivors and disability insurance affairs originating in that area. Another step was taken last year to accomplish additional improvements in this area of Bureau operations. A decision was reached to bring together in one central office location as many as possible of the diverse activi- ties related to the administration of this phase of the program, In May 1961 establishment of a new Branch in the Division of Claims Control was approved to provide overall responsibility for old-age, survivors, and disability insurance program administration in foreign countries. During the past year, the Bureau has been engaged in the process of settling down in the new Social Security Building on the outskirts of Baltimore and working out the many necessary adjustments. As of the end of the year, one unresolved problem was that of space require- ments—the new building is filled to capacity and certain segments of the Bureau are still located in downtown Baltimore. A series of amendments, with the resulting growth of staff, has made it difficult to keep pace with the demands for space. Construction of an Annex to the Social Security Building to house those segments of the Bureau still downtown has proceeded according to plan. It appears that there will be no difficulty in meeting the contract completion date of June 1962 for this addition to the building. As of the end of June 1961, work was proceeding ahead of schedule. Increasing space needs have led to a recommendation for expan- sion of the Annex to provide sufficient space for all of the disability and Baltimore Payment Center functions. Accordingly, an appro- priation request has been submitted to Congress to obtain funds to provide additional space in the Annex. 40 Depariment of Health, Education, and Welfare, 1961 At the end of fiscal year 1961, 30 large employers, with about 4 million employees, were either reporting employees’ earnings on mag- netic tape, or had plans to report by this method in the near future. There are savings to both the employers and to the Government in this system. The employer is able to eliminate the time-consuming listing of lengthy wage reports, often running as high as 1,000 pages per employer, along with the transcription errors which are costly to correct—both for the employer and for the Government. The taped wage reports, prepared automatically from the employer’s payroll records, also eliminate steps in the Government’s processing of the reports, such as punching cards for each employee reported. At present, 253 employers having 10,000 or more employees are submitting reports of their employees’ earnings directly to the Social Security Administration rather than through the Internal Revenue Service. The direct submittal of these reports permits the earnings records of the nearly 7 million employees affected to be processed and updated about 15 days earlier than under conventional methods. An additional 39 employers with approximately 1 million employees are considering the adoption of this plan. During the year, the Bureau continued to work with the Internal Revenue Service to obtain more complete and accurate earnings re- porting, particularly in the areas of migrant farm laborers and domestic service workers and self-employed persons and to secure more prompt processing and forwarding of earnings reports to the Bureau. Asa result of the negotiations conducted during the past year, previous agreements were firmed up and agreement was reached on a program for increased Internal Revenue Service audit and compliance activ- ities. The details of this program will be worked out in fiscal year 1962. A significant recent accomplishment was the inauguration of a formal accounting procedure by which certain representative payees are required to submit annual reports as to the stewardship of the funds they have received on behalf of minor children and adults found to be unable to handle such funds. This development grows out of extended Bureau experience in this area. The accountability procedure augments but does not supplant personal interviews with certain representative payees at stated intervals. The significance of the annual accounting is that it requires a representative payee, under a system of administrative guardianship, to make appropriate report- ings of his use of the funds received on behalf of beneficiaries in a trust relationship. All necessary forms, internal instructions, and formal regulations have been developed, and district office personnel are now engaged in interviewing, interpreting, and implementing this procedure with Social Security Administration 41 accountable payees. Further administrative refinements are contem- plated, particularly in the early years of the activity when careful policy review and control will be required. Legislative Developments During the Year The Social Security Amendments of 1961, P.L. 87-64, mark still another step forward in providing American workers and their fam- ilies with basic protection against the hardships that can result from loss of earnings when the breadwinner retires, becomes disabled or dies. This legislation was enacted June 30, 1961. PROVISIONS OF THE 1961 AMENDMENTS Reduction in the minimum eligibility age for retirement benefits for men.—The age at which men are first eligible for old-age and sur- vivors insurance benefits is lowered from 65 to 62, with benefits for those who claim them before age 65 reduced to take account of the longer period over which they will get their benefits. It is estimated that benefits amounting to $440 million will be paid during the next 12 months to about 560,000 people who would not have been eligible for insurance benefits if it were not for this change. Under the new provision, the insurance benefits for a man worker are reduced at the same rate as now applies for a woman worker (5 of 1 percent for each month before age 65 for which a benefit is payable) ; husband’s insurance benefits are reduced at the same rate as now applies to wife’s insurance benefits (254, of a percent for each month before age 65 for which a benefit is payable) ; and widower’s and surviving father’s insurance benefits are payable in full as widow’s and surviving mother’s insurance benefits now are. A man who be- gins getting old-age insurance benefits in the month in which he reaches age 62 will get a benefit amounting to 80 percent of the amount he would get if he stopped working then but waited until his 65th birthday before applying for benefits; a man getting husband’s insur- ance benefits at age 62 will get 75 percent of what he would have gotten at age 65. As is now true for women, the percentage reduction in the insurance benefit payable before age 65 will continue to apply after 65, except that if the person works and earns enough before he reaches 65 to cause any of his benefits to be withheld the reduction in his benefit will be refigured at 65 to reflect the fact that benefits were not paid for as many months before 65 as was contemplated when the original computation was made. As originally proposed, the provision to lower the minimum eligi- bility age for insurance benefits for men would have involved some 626936—62——4 42 Depariment of Health, Education, and Welfare, 1961 additional cost (estimated at 0.10 percent of payroll on a level- premium basis). This additional cost would have arisen because the computation of both fully insured status and the average monthly wage (from which benefit amounts are figured) would have been liberalized for men as they were for women when insurance benefits were made available to them at age 62. The measuring period for determining the number of quarters of coverage required to be fully insured for benefits and for determining the number of years to be included in the computation of the average monthly wage would have been based on the period ending with the beginning of the year of attainment of age 62 instead of age 65—a 3-year-shorter period than under present law. Using a smaller number of years in the computa- tion permits the dropping of more years of low earnings and thus may have given a higher average monthly wage and a higher benefit amount even where the person works right up to age 65. In the amendments as adopted, an increase in the cost of the program is avoided by continuing to use age 65 as the ending point for deter- mining insured status and computing the average monthly wage for a man. Because the period for computing the average monthly wage for men extends to age 65 even though men may claim benefits before that age, in some cases where coverage was Very recent as many as 3 years without earnings may have to be included in the computation. Where the man works after entitlement to reduced benefits, therefore, the new law provides for a special automatic recomputation without an application at age 65, or death before age 65, to pick up such earn- ings and, in death cases, to shorten the period used. The minimum benefit increased —The minimum insurance benefit payable to a retired insured worker who begins to get benefits at or after age 65 or to a disabled insured worker, and to the sole survivor of a deceased insured worker, is increased from $33 to $40 per month (the minimum primary insurance amount), with corresponding in- creases for people getting other types of insurance benefits—for example, wives and children—based on primary insurance amounts of less than $40. This provision will put an additional $170 million in the hands of 2,175,000 people in the first 12 months of its operation. The provision for increase in minimum benefits makes an improve- ment in the old-age, survivors, and disability insurance program that is much needed at the present time. People coming on the benefit rolls in the future will generally get benefits above the minimum level because they will have had a chance to work in covered employment during their best working years. Right now, though, many of the people on the rolls are getting benefits at or near the minimum level not because they had a low level of lifetime earnings but because they Social Security Administration 43 were already old when their jobs were covered and their earnings under the program were lower than their average earnings over their lifetime. The increase in the minimum makes the protection of the program more effective for these people. Insured status requirements changed.—The insured status require- ment—the proportion of time that a person must work under social security to be eligible for old-age, survivors, and disability insurance benefits—is changed from 1 quarter of covered work for each 3 calendar quarters elapsing after 1950 to 1 quarter for each calendar year (equivalent to 1 for each 4 calendar quarters) up to the year in which he reaches age 65 (age 62 for women). This change makes the insured status requirements for people who are now old comparable to that which will apply in the long run for people who will attain retire- ment age in the future. These latter will be fully insured if they are in covered work for the equivalent of 10 years out of an adult work- ing lifetime of about 40 years. This change will help many people who are uninsured because the work they did during their working years was not covered and by the time their jobs were covered they were already so old that they could not work regularly enough to meet the insured status requirements then in the law. About $65 million will be paid during the first 12 months to 160,000 people who would not otherwise have qualified for insurance benefits. The aged widow’s benefit increased —The insurance benefit payable to an aged widow of a deceased insured worker is increased by 10 percent, from 75 percent of the worker’s primary insurance amount (the basic amount on which all old-age, survivors, and disability insurance benefit amounts are based) to 8214 percent. (A similar increase is made in the insurance benefit payable to a widower and to a surviving dependent parent where only one parent is entitled to benefits.) This change will result in $105 million in additional bene- fits being paid to 1,525,000 older people during the first 12 months of operation. Under the law in effect up to this time, when a man died his widow had to get along with one-half of the benefit income that the family had while the man was living. If the retirement benefit for a man bears a reasonable and adequate relationship to his previous earn- ings, as it is intended to, then 34 of that benefit is not adequate for his widow in terms of the man’s earnings. The increase provided in the legislation will produce a more reasonable relationship between the widow’s benefit and her deceased husband’s earnings. The retirement test liberalized—The provision for withholding benefits from beneficiaries whose earnings exceed $1,200 a year (gen- erally referred to as the retirement test) is changed so that $1 in 44. Department of Health, Education, and Welfare, 1961 benefits will be withheld for each $2 of earnings between $1,200 and $1,700, rather than between $1,200 and $1,500 as under previous law. (One dollar in benefits will be withheld for each $1 earned over $1,700.) Expanding the area over which the $1-for-$2 adjustment applies means that older people have a positive incentive to increase the part-time work they do up to the $1,700 point. There is thus a substantial improvement in the effect of the program on incentives for older people to contribute their skills and energy to the economy and to improve their own economic status through such current work as they are able to obtain and perform. Under the new test, about 350,000 people will start to get insurance benefits or will get more benefits for 1961 than they would get if the law had not been changed. Extension of the time for filing fully retroactive applications for establishing disability periods—The legislation extends for 1 year— through June 30, 1962—the time within which insured workers with long-standing disabilities may file applications for disability protec- tion on the basis of which the beginning of a period of disability can be established as early as the actual onset of disablement (as far back as October 1941). Many of those benefited by this provision are per- sons who only recently—through the 1960 amendment that provided cash disability benefits for disabled workers under age 50—were af- forded the opportunity to become eligible for monthly disability benefits. Some of these new eligibles only now are learning of their rights to disability benefits. In some instances these rights would have been lost if the time for filing fully retroactive applications had not been extended. As in the previous law, where an application is filed after the deadline (now June 30, 1962), a period of disability can be established no earlier than 18 months before the date of filing application even if the applicant stopped working because of his dis- ability much earlier than that 18th month. Employees of State and local governments——The 1961 amendments afforded employees of the States and localities additional time to elect social security coverage under the provision permitting specified States to cover only those retirement system members who desire coverage, with all future members being covered compulsorily. The amend- ments also added New Mexico to the list of States to which the pro- vision applies; it now applies to 17 States. Giving survivors of certain ministers opportunity to elect cover- age-—The 1961 amendments extended the provision of the 1960 amendments which permits ministers to elect coverage before April 16, 1962, to the survivors of certain ministers. Survivors of ministers (or Christian Science practitioners) who die on or after the date of enactment of the 1960 amendments (September 13, 1960) and before April 16, 1962, without having elected coverage, may file certificates of election before April 16, 1962. Social Security Administration 45 Contribution rates increased.—The social security contribution rates payable by employers and employees are increased by 1% of 1 percent each, and the contribution rate for self-employed people is increased by %. of 1 percent and rounded to the nearest tenth of 1 percent, beginning with 1962. In addition, the tax increase scheduled for 1969 will be moved up to 1968. Since the amendments would increase the level-premium cost of the program by 0.27 percent of payroll, and since these changes in the social security contribution rate schedule provide for additional income to the trust funds which is also esti- mated at 0.27 percent of payroll, the legislation does not change the actuarial balance of the insurance program and the insurance system will remain on a sound financial basis. The changes in the contribution schedule are shown below: Employers and Self-employed employees, each Calendar years Percent | Percent | Percent | Percent 3 316 4 % 4.7 3% 358 54 5.4 4 44 6 6.2 4 45% 6 6.9 44% 454 634 6.9 Research Activities A major survey research project conducted during the fiscal year 1961 was a survey of the characteristics and resources of 3,400 dis- ability insurance beneficiaries and disabled persons in the eight largest metropolitan areas whose social security records were frozen to pro- tect their benefit rights. The findings of this survey are now being tabulated. Other studies of disability beneficiaries were begun during the year, utilizing nonsurvey data; these studies concern the charac- teristics of persons who have been denied a period of disability, and the characteristics of disabled persons who were rehabilitated by State agencies in the 1957-58 period. Reports were issued during the year on data collected in a 1957 survey of aged beneficiaries and mother-child groups. ‘These reports analyzed the impact of hospitalization costs on the aged, as well as the sources of income, employment status, and living arrangements of retired beneficiaries. In the coming fiscal year, the Bureau plans to begin a study of a sample of aged beneficiaries who will be revisited over a period of years in order to determine how their situation changes as they grow older and the kind of adjustments they make to such changes. The Bureau conducted a survey of State and local retirement sys- tems, and began preparation of a report on the benefit-contribution 46 Department of Health, Education, and Welfare, 1961 characteristics of such systems before and after old-age, survivors, and disability insurance coverage was obtained. Several pretests were made in a survey of reasons why persons apply for old-age benefits; the survey questionnaire was revised in the light of the pretest results, and plans were made for full-scale quarterly surveys in fiscal 1962. A number of other socio-economic research studies were completed during the year, utilizing nonsurvey techniques. Reports were issued on the characteristics of persons separating and withdrawing contri- butions from the Federal Civil Service Retirement System; the re- habilitation implications of activity limitations among disabled workers; and the employment of women under the program. Program Simplification Progress continues to be made by the Bureau in its efforts to make the old-age, survivors, and disability insurance program easier to un- derstand, accept, and administer. Many of the proposals for sim- plifying the program that were developed over the last few years were included in the Social Security Amendments of 1960. During the last year, the Bureau completed studies and developed recommenda- tions for simplifying the insured status requirements for benefits and the provisions for paying reduced benefits before age 65. Some of these proposals, along with others of the same nature developed by the Chief Actuary of the Social Security Administration, were in- corporated in the amendments of 1961. Further progress along these lines was made in the area of paying reduced benefits before age 65 as a result of a major redrafting effort by the Legislative Counsel’s Office of the House of Representatives. Late in fiscal 1961, the Bureau got underway a long-term simplifica- tion project to reorganize and rewrite title II of the Social Security Act. The objectives of this project are to: (1) improve the organiza- tion and format of the statute; (2) eliminate unnecessary verbiage; and (3) eliminate minor inequities and inconsistencies. Although the Bureau took the initiative in setting up this project, the new title will be prepared in cooperation with the staffs of the Legislative Counsel’s Office and the Committee on Ways and Means of the House of Representatives. Financing the Program The old-age, survivors, and disability insurance system, as modified by P.L. 87-64, has an estimated benefit cost that is very closely in bal- ance with contribution income. In enacting the 1961 amendments Congress again made clear its intent that the program be self-support- Social Security Administration 47 ing from contributions of covered workers and employers. Careful review was given to intermediate-range and long-range actuarial cost estimates prepared for use of the congressional committees in their legislative considerations. 'The program as amended continues to be financed on an actuarially sound basis, both for the next 15 to 20 years and for the distant future. The difficulties involved in making exact predictions of the actuarial status of a program that reaches into the distant future are widely recognized. If different assumptions as to, say, interest, mortality, retirement, disability, or earnings had been used, different results would have been obtained. Accordingly, no one set of estimates should be looked upon as final, in view of the fact that future ex- perience may vary from the actuarial cost estimates. Nonetheless, the intent that the system be actuarially sound can be expressed in law by a contribution schedule that, according to the intermediate-cost schedule, results in the system being substantially in balance. OLD-AGE AND SURVIVORS INSURANCE BENEFITS The level-premium cost of old-age and survivors insurance benefits after 1961, on an intermediate basis, assuming interest of 3.02 percent and earnings at about the levels that prevailed during 1959, is esti- mated at 8.79 percent of payroll (after adjustments to allow for ad- ministrative expenses and interest earnings on the existing trust fund). The level contribution rate, equivalent to the graduated rates in the law, is estimated at 8.55 percent of payroll, leaving a small actuarial insufficiency of 0.24 percent of payroll. In view of the very long range over which these projections are made, and the many variable factors included, the insufficiency is so small that the system may be considered in actuarial balance. DISABILITY INSURANCE BENEFITS The Social Security Amendments of 1956 established a system for financing disability benefits which is entirely separate from the financing of old-age and survivors insurance benefits. The estimated level-premium cost of the disability benefits (adjusted to allow for administrative expenses and interest) on an intermediate basis is 0.56 percent of payroll. Contribution income has been specifically allo- cated to finance these benefits; this income is equivalent to 0.50 per- cent of payroll, leaving a small actuarial insufficiency of 0.06 percent of payroll. Future experience with this program will be studied care- fully to determine whether the actuarial cost factors used are appro- priate or if the financing basis needs to be modified. The use of slightly less conservative cost factors would result in cost estimates showing the disability insurance system in complete actuarial balance. 48 Department of Health, Education, and Welfare, 1961 Summary and Conclusion In the years since the adoption of the Social Security Act the Ameri- can people have moved a long way toward attainment of the goal of freedom from want. Establishment of the old-age and survivors in- surance program and improvements that have been made in it through- out the years have contributed in large measure to the progress that has been made. Because under this social insurance system the right to benefits is earned through work and paid for in part by contribu- tions from the worker’s earnings, the system goes hand-in-hand with our American traditions. The social insurance program that has proved so successful thus far can and should be improved so as to meet the challenge of changing conditions and applied to emerging problems, so that in the future it will continue to make a major con- tribution to the welfare of the American people. Public Assistance Public assistance, complementary to social insurance, attempts to meet minimum essential needs of individuals and families when, for various reasons, they are unable to do so themselves. It is the basic underpinning program in the social security system of the Nation, dealing with unmet individual needs that generally are not insurable because of their unpredictability, or are beyond the scope or level of benefits considered actuarially sound under social insurance. This dual attack on unmet basic human needs—social insurance and public assistance—was born out of the stark realization that the process of industrialization and urbanization which, within less than a century, had transformed a major part of our farms and countryside into factories and cities, had also created social problems with which individuals could no longer deal within the family or local community. Industrialization brought greater productivity, higher standards of living, better nutrition, improved medical care, and many other comforts and luxuries for those who had the money to buy them. But economic progress also brought social changes in addition to increases in population. There were disproportionate increases in the de- pendent age groups—the aged and children—and a shrinking pro- portion of wage earners to support them. Family responsibility, of necessity, also lessened as the large farm family was replaced by the smaller parent-children unit in the cities dependent largely on in- come from wages. Mass unemployment in the early 1930’s left millions without the means of buying the basic necessities of life. Federal governmental Social Security Administration 49 aid, first designed to meet immediate emergency financial need due to unemployment, was later channeled into long-range preventive meas- ures—social insurance against the risks of unemployment, old age, de- pendency of children because of the death of the wage earner, and disability. Legislative changes in the Federal old-age, survivors, and disability insurance program have extended its coverage until today 9 out of 10 persons in the working population come within this broad umbrella of economic protection. Role of PA Programs It is with the needs of dependent persons no¢ covered under social insurance or whose minimum needs exceed insurance benefits that public assistance programs are concerned. Less than 4 percent of the population received public assistance in June 1961, and despite the increased dollar cost of public assistance over the years, expendi- tures for this purpose in fiscal 1961 represented less than a cent per dollar of total personal income in the Nation during 1960. (See chart 2.) Assistance to sustain and strengthen individual and family life are vital to those who need it. The provision for financial assistance, medical care, and other social services under federally aided public assistance programs available in most of the local communities of the United States has assured the minimum essentials of living to the needy aged, blind, disabled, and children in families broken by death, incapacity, or absence of a parent, and more recently, in families hard-pressed because of unemployment. (See chart 3.) It has also contributed much to strengthening family ties that might otherwise have been irreparably scarred by anxiety and poverty or broken by separation of children from their home and parents. The basis on which Federal-State public assistance programs are administered is also significant in sustaining principles fundamental to our democracy. Initial provisions of the public assistance titles of the Social Security Act reflect respect for the dignity of the indi- vidual and recognition of his rights as well as of his responsibilities. The definition of assistance as a money payment leaves with the needy person responsibility, like that of others in the community, for decid- ing how best to use his income. Provision for a hearing before the State agency protects individual rights when a needy person has been denied aid or is dissatisfied with the amount of his assistance payment, or when his application has not been acted upon with reasonable promptness. His privacy is safeguarded by preventing disclosure by the agency of personal information that would subject him to indignity or embarrassment, 1961 0sé! Ya4pl ys dav O0G6T U! yUaduad UyIM pasedwoo T96T Ul adURYSISse peAlaces uolzeindod PLIYD [e307 yO yUadued T96T-OS6T ‘UOIze Ndod PL!YyD U! aseaidu! yUuaoued Department of Health, Education, and Welfare, 1961 8| 4apun uolzeindog 02 SUO!LLIH 0961 — ewoouy 50 S°€ ps 0 € L *swes6oid [e900 pue aye4S$ iapuN aouejsisse [esauab sapniou) , *T96T pue OS6T 4z0q U! SwWesboid YyIM SUO!4DIpSIuNnf TG , sjuaidioes yyo OS6T U! JUaosad 9°7Z YIM pasedwoo T96T U! aouRyS!sse palaces uo! ze_ndod pate (230, JO juaoued SET T96T-OS6T ‘uO!yendod € pebe u! aseasou! yuaoued T*8é * [euossad jeuolzeu | ezOL —[“—— 1961 OS6I 49A0 pue GQ uo!je|Ndog awoo -U} [euosuad (Le yO 4seLLop 4ad jue auo upyy ssa, aue sjuawded aoueysisse 211 qnd 196] aeak jeosiy ‘@OUR}SISSe 91 (qnd wo1y auoou; *L96L ‘SLHDITHSIH JINVISISSV DITIGNd—Z LYVHD 02 0g Oh 0s 09 OL Suo!L {IW Social Security Administration 51 —————— CHART 3.—MAJOR CAUSES OF DEPENDENCY OF PUBLIC ASSISTANCE RECIPIENTS,* JUNE 1961 6.2 Million Disabled DISABILITY 1.4 M (APTD) ve Z 3, o A %, Sy Father incapacitated (ADC) OLD AGE 2.3 M Aged (0AA) Median age 76 years DEATH OF PARENT 0.3 M Father dead (ADC) 23% bedridden or need ee personal care Estrangement or other absence of father (ADC) UNEMPLOYMENT OF PARENT O.1M ABSENCE OF PARENT 2.1m * Excludes general assistance recipients under State and local programs. The availability of Federal funds to the States and the placement of responsibility for the program with a single State agency has served as an impetus in establishing or strengthening State depart- ments of public welfare throughout the country. The flexibility inherent in the public assistance program has also permitted its adaptation to meet some of the changing needs of the American people. Through subsequent legislative changes, the scope and coverage of the public assistance programs were broadened to include the per- manently and totally disabled; the aged, the blind or disabled recipi- ents who are patients in public medical institutions; the costs of medical care or other remedial care paid directly to doctors, hospitals, and other suppliers of such services; needy adults responsible for the care of dependent children; children aged 16 and 17, without regard to school attendance; and children living with first cousins, nieces, and nephews (in addition to previously specified relatives). 52 Department of Health, Education, and Welfare, 1961 The amount of Federal financial aid to States has been increased on several occasions through various devices to make it possible for assistance payments to keep pace with rising costs of living. Meas- ures were added to improve medical care provisions for the needy. Clarification was also made of the availability of Federal financial participation in the costs of providing staff services to help needy persons find and use their own strengths and available resources to develop their potential for more satisfying and independent living. New Legislation Although the public assistance titles of the Social Security Act were amended by almost every Congress since 1935, an unprecedented amount of legislation was passed during the closing days of the 86th Congress and the first session of the 87th Congress. The legislation passed in fiscal 1961, outlined below, continued to strengthen existing provisions, but also charted paths new to the public assistance program. Public Law 86-571, July 1960 The Department of Health, Education, and Welfare was authorized for the first time to provide reception service and hospitalization at Saint Elizabeths Hospital, or elsewhere, for certain repatriated mentally ill nationals of the United States. Public Law 86-778, September 1960 A new program of medical assistance for the aged was established. Federal funds were made available to enable the States to help those older persons not receiving old-age assistance who are able to meet normal expenses but do not have sufficient income or resources to meet the costs of necessary medical services. Increased Federal financial participation was made available to States that made payments to suppliers of medical care in behalf of recipients of old-age assistance. In addition to the usual share in assistance payments up to a monthly maximum of $65 per aged recipient, additional Federal sharing was provided based on expenditures for payments to suppliers of medical care up to a monthly maximum of $12 per recipient. Federal financial participation was permitted for the first time in State vendor medical care payments (under both the new medical care program and the old-age assistance program) in behalf of patients in a medical institution as a result of a diagnosis of tuberculosis or psychosis for 42 days after such diagnosis. Dollar limitations on the total annual amount of Federal funds for Puerto Rico, the Virgin Islands, and Guam were increased for medical care payments made in behalf of recipients of old-age assistance. Effective July 1, 1962, a State agency, in determining need for blind assistance, must disregard the first $85 of earned income per month plus one-half of earned income in excess of $85. Until then, beginning October 1, 1960, a State is per- Social Security Administration 53 mitted to disregard the first $85 per month and one-half of the excess or to continue to apply the $50 per month exemption as under the old law. Special legislation providing for the approval of the Missouri and Pennsylvania blind assistance plans, due to expire June 30, 1961, was extended to June 30, 1964. Public Law 87-31, May 1961 The aid to dependent children program was temporarily broadened to provide assistance to needy children in families where the breadwinning parent is unemployed. (From May 1, 1961, through June 30, 1962.) Federal financial participation was permitted in the State’s expenditures for foster care for a child receiving aid to dependent children who, as a result of a judicial determination is removed from his own home because he lacked proper care and protection, and placed in an approved family home; and for whose placement and care the agency administering the State plan for aid to dependent children is responsible. (From May 1, 1961, through June 30, 1962.) September 1, 1962, was set as the date after which Federal funds will be withheld from a State whose plan, as required by State legislation, provides for denying assistance to a needy child living in a home considered by the State to be detrimental to his well-being. (Date postponed from June 30, 1961.) Training grants for public welfare personnel authorized by amendments in 1956, effective July 1, 1957, for 5 years, were extended through June 30, 1963; and the Federal share of State expenditures for training purposes was raised from 80 percent, as authorized in 1956, to 100 percent, effective for allotments through June 30, 1963. (No appropriation was made for this purpose for fiscal 1962.) The average amount of vendor medical payments in which there is additional Federal participation for old-age assistance was raised from an average monthly expenditure per recipient of $12, as provided under the 1960 amendments, to $15. Public Law 87-64, June 1961 The Federal share of assistance payments under programs of old-age assistance, aid to the blind, and aid to the permanently and totally disabled was tempo- rarily increased. The first $30 per recipient per month, in which Federal partici- pation is 80 percent, was raised to $31, and the maximum average payment in which the Federal Government will participate (exclusive of the special pro- vision for additional Federal participation in vendor medical payments in old-age assistance) was raised from $65 to $66. (From October 1, 1961, through June 30, 1962.) Dollar limitations on the total annual amount of Federal funds for Puerto Rico, the Virgin Islands, and Guam were increased to facilitate their imple- menting liberalizations authorized by the new legislation. Assistance was provided for United States citizens and their dependents repatriated from a foreign country because of personal misfortune or inter- national crisis, who are in need of temporary assistance after reaching a port of entry in the United States. Trends in Caseloads and Expenditures In June 1961 assistance was available in all 54 jurisdictions of the country (including the District of Columbia, Guam, Puerto Rico, and 54 Department of Health, Education, and Welfare, 1961 the Virgin Islands) under the federally aided programs of old-age assistance, aid to the blind, and aid to dependent children (6 juris- dictions administering aid to dependent children also made payments to unemployed-parent families, and 1 jurisdiction made payments for the foster care of children). Federally aided programs for the permanently and totally disabled were administered by 50 jurisdic- tions, and 9 States made payments under the new program of medical assistance for the aged. General assistance (wholly State and/or locally financed), in some form for some persons, was available in all 54 jurisdictions. A total of 7.2 million persons received aid in June 1961 under the six public assistance programs (including general assistance). The increase of 442,000 persons over the number aided in June 1960 largely reflects the impact of the 1960-61 recession. The year’s greatest changes in number of recipients were increases of 360,000 in the Federal-State aid to dependent children program and 80,000 in State- local general assistance—the two programs most sensitive to changes in economic conditions. The size of the aid to dependent children program is undoubtedly also affected by the continuing rise in child population; by July 1961, there were 67,063,000 children—more than a third of the total population in the 54 jurisdictions of the country— under 18 years of age. In aid to dependent children, the 3,383,000 recipients, including 2,613,000 children in 878,000 families, assisted in June 1961 repre- sented an increase from June 1960 of 11.9 percent. Part of this increase was due to the addition of 112,000 recipients in unemployed- parent families, the majority of whom had been transferred from general assistance programs. The 1,049,000 persons, in 406,000 cases, receiving State and/or locally financed general assistance in June 1961 represented an 8.2- percent increase, over June 1960. Beginning in April, however, there was a sharp decline in the number receiving general assistance, which continued steadily through the end of the fiscal year (from 1,607,000 persons in 525,000 cases in March to 1,049,000 persons in 406,000 cases in June). The number in unemployed-parent families transferred from general assistance to the extended aid to dependent children program accounted for less than a fifth of this decline. The number of recipients of aid to the permanently and totally disabled also rose, from 363,000 in June 1960 to 384,000 in June 1961, an increase of 5.8 percent. By June the new program of medical assistance for the aged was aiding 46,000 persons, most of whom had formerly received care in medical institutions or nursing homes under old-age assistance programs. The other federally aided programs showed decreases; old-age assistance, from 2,359,000 to 2,296,000 per- Social Security Administration 55 sons—a drop of 2.6 percent; and aid to the blind, from 108,000 to 106,000 persons—a drop of 2.2 percent. Total assistance expenditures, including vendor payments for medi- cal care, for all six programs for the fiscal year 1961 were $3,944 million—a 5.7-percent increase over expenditures in 1960. Total pay- ments rose $97 million or 9.5 percent in aid to dependent children; $29 million or 10.7 percent in aid to the permanently and totally dis- abled; $12 million or 0.6 percent in old-age assistance; and $2 million or 1.7 percent in aid to the blind. In the State and/or locally financed programs of general assistance, total payments (excluding vendor payments for medical care) increased $28 million or 8.3 percent. Pay- ments under the new program of medical assistance for the aged totaled $40 million in fiscal 1961. Although the national average assistance payment did not increase in all programs, higher total expenditures reflect in part other efforts to offset the continuing rise in living costs, with the medical care component showing the greatest relative increase. For example, cost standards were raised in one or more programs in about a third of the States; in old-age assistance, 7 States raised their maximum on individual monthly payments, and a smaller number liberalized maxi- mums in each of the other programs; several States broadened the scope of medical care provided through vendor payments; and a few States made their first medical care vendor payments in behalf of old- age assistance recipients. In aid to dependent children, the national average payment was $30.30 per recipient in June 1961, compared with $29.11 a year earlier. Average payments ranged from $9.32 in Alabama (except for $3.82 in Puerto Rico) to $51.61 in Connecticut. In old-age assistance, the average payment was $67.85 per recipient in June 1961, compared with $68.01 in June 1960. Average payments ranged from $35.40 in Mississippi (except for $8.30 in Puerto Rico) to $96.51 in Colorado. In medical assistance for the aged, the aver- age medical cost paid per recipient in the 9 States making payments in June 1961 was $200.59. For all States, the median medical care vendor payment under old-age assistance increased from $7.54 per recipient in June 1960 to $11.32 in June 1961. In aid to the permanently and totally disabled, the average payment per recipient was $68.19 in June 1961, compared with $65.96 a year earlier. Average payments ranged from $34.85 in Mississippi (except for $8.70 in Puerto Rico) to $132.90 in Massachusetts. In aid to the blind, the average payment per recipient was $73.36 in June 1961, compared with $72.85 a year earlier. Average payments ranged from $38.43 in Mississippi (except for $8.27 in Puerto Rico) to $126.45 in Massachusetts. 56 Department of Health, Education, and Welfare, 1961 For the 53 jurisdictions reporting on State and/or locally financed general assistance programs, excluding medical care vendor payments, the average payment per case was $65.13 in June 1961, compared with $67.44 in June 1960 (46 percent of all cases were family cases, includ- ing an average of 4.4 persons per family). Average payments ranged from $12.89 per case in Alabama (except for $7.27 in Puerto Rico) to $110.76 per case in New Jersey. The number of persons receiving both old-age, survivors, and dis- ability insurance benefits and old-age assistance payments continued to increase. In February 1961, about 715,400 old-age assistance re- cipients, or 31 percent (compared with 28.5 percent in 1960 and 19.2 percent in 1955) were receiving assistance because their insurance benefits and other resources were insufficient to meet their basic and/or special needs, such as medical care. The percentage of re- cipients of other types of public assistance who also received old-age, survivors, and disability insurance benefits was considerably smaller— 18.1 percent of those receiving aid to the blind, 8.6 percent of those recelving aid to the permanently and totally disabled, and 5.4 percent of the families receiving aid to dependent children. SOURCE OF FUNDS FOR PUBLIC ASSISTANCE PAYMENTS Of $3,939 million expended for the six public assistance programs in fiscal 1961, about 52 percent, or a little over $2,049 million, came from Federal funds; 35.9 percent, or $1,413 million, from the States; and 12.1 percent, or $477 million, from the localities (of which $209 million was spent for general assistance). For the five special types of public assistance, the Federal share of total costs was 59 percent; the State share, 33.3 percent; and the local share, 7.7 percent. Assistance payments during 1961 repre- sented about 0.9 of a cent per dollar of total personal income in the Nation during 1960. Program Developments Major program changes resulted from legislation passed during fiscal 1961. Significant developments also occurred in other areas. INCREASED PROVISIONS FOR MEDICAL CARE Federal funds were made available for the first time to help States meet the cost of medical care needs unrelated to the need for main- tenance through the establishment of a new program of medical assist- ance for the aged. Additional Federal funds (beyond the usual share in assistance payments) were also made available to States that make vendor medical payments in behalf of old-age assistance recipients. Social Security Administration 57 PROVISIONS OF THE NEW MAA PROGRAM The new program of medical assistance for the aged authorized by legislation passed in September 1960 provided Federal funds to enable the States to help pay for medical care for the older persons not receiv- ing old-age assistance who are able to meet regular living expenses but cannot meet the costs of unusual medical services. Federal par- ticipation under the new program, limited to expenditures paid in behalf of eligible recipients to suppliers of medical or remedial care, ranges from 50 to 80 percent, depending upon the relationship between the per capita income in the State and the national per capita income. No maximum is set on the amount of the payment made by a State with Federal participation. The States are given considerable lati- tude in determining the scope of the program, including both the con- ditions of eligibility and the kinds and extent of services for which costs will be assumed. However, among conditions imposed by the Federal act were the inclusion of both institutional and noninstitu- tional care and services; and several prohibitions including: a dura- tional residence requirement; the placing of a lien against the property of any individual prior to his death on account of medical assistance properly paid in his behalf or recovery of such assistance from his estate until after the death of the surviving spouse, if any; and any charge, such as an enrollment fee or premium, as a con- dition of eligibility. Congress also directed the Department of Health, Education, and Welfare to develop guides and standards on the level, content, and quality of medical care and services for States to use in evaluating and improving their medical care programs; and to evaluate the effec- tiveness of the new legislation and make recommendations for improv- ing State medical care programs. ADDITIONAL PROVISION FOR OAA RECIPIENTS In September 1960 increased Federal funds also were made avail- able to States that make vendor medical payments in behalf of old- age assistance recipients to provide an additional amount (beyond the usual share in assistance payments) based on expenditures for these payments up to a monthly maximum of $12 per recipient. In May 1961 this maximum was increased to $15. The establishment of a medical care program for the aged not re- ceiving assistance, plus the provision of additional money specifically for medical care for old-age assistance recipients, greatly augmented the amount of medical care available previously under federally aided public assistance programs. Although most of the Nation’s juris- dictions (44 out of 54 in June 1960) had some provision in their 626936—62——_5 58 Department of Health, Education, and Welfare, 1961 public assistance programs for costs of medical care through the vendor payment, and some of the jurisdictions provided for some items of medical care in the money payment to the recipient (including 6 of the 10 that did not use the vendor payment), the majority of the States provided for only limited medical care, financing one or more services, but not the broad scope of services needed by most sick people. IMPLEMENTING THE MEDICAL CARE LEGISLATION The early effective date of the medical care legislation (passed in September 1960 and effective October 1, 1960) spurred action by Federal and State agencies. The day the President signed the 1960 amendments, a group of State representatives met with Bureau staff to advise on the medical care provisions. Representatives of the American Medical Associa- tion, the American Hospital Association, and the Bureau also held special meetings in Washington on the new program. The American Medical Association, which gave full support to the 1960 legislation, encouraged their State organizations to urge action in their respective States, and the American Hospital Association ap- pointed a committee to work with the Bureau in relation to the new program. Many inquiries came from State welfare agencies and medical societies asking for consultation on various aspects of medical care under consideration in State planning, and for interpretation of the clause in the amendment requiring “reasonable standards” of financial need. A new Division of Medical Care Standards was established in the Bureau, and a group of 16 physicians and specialists in paramedical areas was appointed to advise on medical matters. Consideration of major policy issues, development of instructional material for State use, and issuance of interpretive materials on the new provisions were given high priority. Policy and administrative questions were dis- cussed with departmental, regional, and State agency staff and with other interested agencies and groups. Broad national policies were developed against which States could prepare their plans, and pro- cedures were shortcut wherever feasible. Consultation was provided to State agencies on the development of necessary State legislation and plans to put the new medical care provisions into effect. State officials met with Bureau staff in Wash- ington to consider specific State situations, and special legislative sessions were held in several States to obtain a legal base and appro- priations for initiating new, or modifying existing, programs. Within a month after the effective date of the legislation, 12 States started action to put the new program into effect. In March 1961, when close to 50 State legislatures were in session, some 20 States Social Security Administration 59 considered measures to establish programs of medical assistance for the aged. By the end of August 1961 legislation establishing such programs had been passed or was in process in 33 States—14 States had new programs in operation, 4 States had completed plans for new programs, 8 States had enacted legislation but had not yet completed their plans, 4 States were still working on legislation to provide a legal base or appropriation for the program, and 3 States had obtained legal authority but no appropriation. Data obtained by the Bureau from the 14 States with programs of medical assistance for the aged on August 31, 1961, revealed that all but 4 began on a conservative basis; 10 set a maximum on the amount of income recipients may receive, ranging from a low of $1,140 for a single recipient with no dependents, to a high of $3,000, with varying allowances for dependents; and 11 States placed major limi- tations on the care for which they would pay. All 14 States exempt real property used as a home but take into account the resource value of other real estate in determining the value of assets, although most do not require its liquidation. Most exempt a life insurance policy with a small cash surrender value, but consider as assets medical in- surance policies and similar resources designed to meet medical costs. A reserve of cash or “resources convertible to cash,” ranging from $300 to $5,000, is permitted in 9 States. The hospital stay to be paid for ranges from 10 days per year in 1 State to as many as are neces- sary in others. Hospital care is limited by 7 States to acute, life- endangering, or traumatic conditions requiring hospital care; and 7 others provide hospital care as recommended by the physician. The cost of nursing home care is included by 8 States, but 4 of these re- strict it to post-hospital or convalescent care. In 11 States, the noninstitutional-care provisions include physicians’ services in the home and office; some of these States limit the services to acute conditions or to treatment necessary to prevent hospitaliza- tion. The most frequently covered services, in addition to those of the physician, are dental services to relieve pain or treat acute infections, and prescribed drugs, which in some States are limited to drugs needed for acute or life-endangering conditions. In five States costs are assumed for the four basic medical care needs (hospital care, nursing home care, physicians’ services, and prescribed drugs) ; in nine States, one or more of these services is not included. The additional Federal funds made available for medical care costs of old-age assistance recipients was used by 23 States to improve the content or coverage of medical care provisions in their old-age assist- ance programs, and 1 planned to do so by January 1962. Of the 11 States with no previous provision for medical care vendor payments, 8 either added such provision, or planned to do so by January 1962. 60 Department of Health, Education, and Welfare, 1961 In some of the 18 States that did not add or improve vendor medical care provisions in their old-age assistance programs, the additional Federal funds made it possible to avoid cuts in provision for medical services by preventing or eliminating deficits in State funds, or en- abled an increase in grants to recipients of other public assistance by the release of State funds. The content of medical care service for which costs are assumed for recipients of old-age assistance is considered comprehensive or rela- tively so in 26 States. These States provide for hospitalization, nurs- ing home care, and physicians’ services without significant limitations as to the nature of the patient’s illness, unit cost of care, number of days of care, or number of visits to or from a doctor. While several of these States have some limitations, most of them meet the cost of practically any needed and available care. The 21 States with more limited provisions most frequently pay only for hospitalization and nursing home care. In some of these States, responsibility for the cost of hospitalization is further restricted to cases of acute illness and emergencies. PROVISIONS FOR NEEDY CHILDREN EXTENDED The number of children dependent on public aid is at an all-time high. However, even with a 37-percent increase in total child popu- lation, and with extensions in the aid to dependent children program that include additional needy children, there was only a slight in- crease—from 3.5 to 3.7 percent—in the proportion of children receiv- ing aid in June 1961 compared with a decade ago. In the 50th anniversary year of the initiation of the first State mother’s aid pro- gram, legislation passed in 1961 contributed several major, although limited, extensions in the Nation’s provisions for these needy children. Extension of ADC to Unemployed-Parent Families As part of national planning to stimulate recovery from recession, the aid to dependent children program was temporarily extended to children in families where the breadwinning parent was unemployed. This was the first time since 1935 that Federal funds were made avail- able through public assistance to help children in families hard- pressed because of unemployment. Provision was also made for co- operative arrangements with State employment and vocational educa- tion agencies to help the unemployed parent secure employment and to have more training if he needs it, as well as for denial of aid when a bona fide job offer is declined without good cause. The ADC legislation enacted in May and effective May 1, 1961, (through June 30, 1962) required early administrative action to help 1 Percentages are related to the 51 jurisdictions for which comparable data are available for 1961 and 1950. Social Security Administration 61 States implement its provisions, as well as development of national policy and establishment of new program relationships. Bills had been prepared by some States to permit temporary extension of ADC to needy children of unemployed parents in anticipation of passage of this proposal while it was still before Congress, and a few States passed such extension bills contingent upon Federal action. By the end of August 1961, 12 States had made provision for aid to children of unemployed parents in their ADC programs, 3 States planned to do so in the near future, and legislation was still in process in 1 State. The implementation of this provision in several States raised ques- tions about the use of Federal funds for work relief projects. In re- sponse to expressions of public concern about providing assistance to employable persons, a departmental policy was publicized in June 1961 stating that, if a local community wants to require the unem- ployed parent to work on a public project for assistance given him, it may do so. However, Federal funds may not be used to pay any part of the individual’s wages, since the Social Security Act does not authorize the use of Federal funds to match amounts paid by States as work relief; but Federal funds may be used to pay a share of the payment that covers the difference between the parent’s earnings on the project and the family’s need as determined under the State’s assist- ance standard. (This is similar to the provision for Federal partici- pation in assistance payments which supplements wages from private employment insufficient to meet a family’s need.) Provision for Foster-Family Care The ADC program was also extended in May 1961 to provide foster- family care for a child receiving aid to dependent children who, as a result of a judicial determination, is removed from his own home be- cause he lacks proper care and protection and is placed in a State- approved or licensed family home, and for whose placement and care the agency administering the State plan for aid to dependent children is responsible. Under the new foster-family care legislation, the State must provide for developing a plan for each child to assure proper care while he remains with a foster family (including periodic review of the neces- sity for continuing in foster care); the provision of services to im- prove the conditions in the home from which he has been removed, or to arrange for his placement in the home of another close relative; and the use of public child welfare services staff to the maximum extent practicable in the placement of the child. To help States implement this temporary extension of ADC (from May 1, 1961, through June 30, 1962) a joint Bureau of Public Assist- ance and Children’s Bureau committee immediately began work on 62 Department of Health, Education, and Welfare, 1961 developing national policies and procedures, and exploring ways in which the two Bureaus could work cooperatively with the States. Draft materials were reviewed in joint meetings of regional and central office staff. By the end of August 1961, the foster-family care provision was incorporated by 10 States in their aid to dependent children programs, 7 States planned to do so in the next few months, 12 States that did not expect to need legislation to implement the provision were still considering it, and in 6 States, legislatures con- sidered but did not adopt the provision. Relation of foster-family care legislation to State action around “unsuitable homes.”—The foster-family care legislation was precipi- tated by the denial of aid by several States to needy children living in so-called “unsuitable homes.” Although 24 State ADC plans carry some reference to “suitable homes,” most of them include provisions to enable public welfare agencies to help make plans for the child’s best. interests, and continue assistance until the plan has been carried out. Eight State plans, however, denied assistance without assurance that an arrangement suitable for the child’s upbringing is worked out. In these States, if the child’s home was found to be “unsuitable” the child could be left in the home, deprived of needed support. The plan provisions in these States raised grave question as to whether they were consistent with the intent of the aid to dependent children and child welfare provisions of the Social Security Act. The issue was brought to a head in July 1960 when one State (Louisiana) enacted legislation under which the State terminated aid to about 23,000 needy children—ostensibly because they lived in “un- suitable homes.” In this instance, State legislation denied assistance to children if the adult caretaker was living with, but not legally married to, a mate; or if the mother had had an illegitimate child at any time since first receiving assistance, unless she could prove to a parish welfare board that she had ceased illicit relationships and was maintaining a suitable home for her children. Public reaction to the withdrawal of assistance from such a large group of needy children resulted in widespread public protest. A large number of national welfare agencies and citizens’ groups urged the Department to take appropriate action to protect needy children against such hardships. Many individuals and agencies expressed indignation over the injustice of denying children aid because of the conduct of their parents, and concern about the effect of deprivation on the children as well as its long-run harmful effect on the Nation. The Commissioner of Social Security held a hearing on the State’s action in the fall of 1960 in order to determine whether the State’s ADC plan was being administered substantially in accordance with the requirements of the Social Security Act. A large number of na- Social Security Administration 63 tional welfare and church organizations united in expressing their concern; many adopted resolutions or prepared statements expressing their opinions and philosophy in relation to the issue; and several presented briefs as “amicus curiae” in connection with the hearing. Some also expressed concern about other needy children in the State in the event of withdrawal of Federal funds. Following the hearing, the State revised its plan, eliminating its more serious program defects and providing for skilled protective services to be available to the children affected by the suitability pro- vision. In the absence of any Federal requirement prohibiting States’ use of “suitable home” as an eligibility factor, and with acceptable revisions in the State plan, the Commissioner in January 1961 ruled that the State plan for aid to dependent children provided a basis for continued receipt of Federal payments. Subsequently, the Secretary of the Department concluded that . . . when a needy child who otherwise fits within the ADC pro- gram of the State is denied the funds that are admittedly needed to provide the basic essentials of life itself because of the behavior of his parent or other relative, the State plan imposes a condition of eligi- bility that bears no just relationship to the ADC program . . . [and] that eligibility conditions with the effect described above are not compatible with entitlement for continued Federal grants.” The Commissioner of Social Security subsequently approved the following requirement issued by the Bureau effective July 1, 1961: “ A State plan for aid to dependent children may not impose an eligibility condition that would deny assistance with respect to a needy child on the basis that the home conditions in which the child lives are unsuitable, while the child continues to reside in the home. Assistance will therefore be continued during the time efforts are being made either to improve the home conditions or to make arrangements for the child elsewhere. The foster-family care legislation passed in May 1961 confirmed and supported this departmental policy, but postponed its effective date from July 1, 1961, to September 1, 1962, to allow additional time for any State that required legislative action to make necessary plan changes. Five of the 8 States were able to amend their plans to con- tinue assistance until children in homes found “unsuitable” were re- moved from their homes. Three States (Louisiana, Michigan, and Mississippi) were unable to meet the requirement under their existing legislation, and qualified for the extension of time. Other Developments in ADC During the year, the school attendance requirement for children 16 and 17 years old was eliminated in Illinois and South Dakota; and Nevada raised the eligibility age limit from 16 to 18, with the provi- 64. Department of Health, Education, and Welfare, 1961 sion that the child between 16 and 18 be regularly attending school and receiving passing grades. There are now only 2 States in which as- sistance is not continued to age 18, at least for children attending school—Georgia has an age limit of 16 years, regardless of school attendance, and Texas limits assistance to children under 14. How- ever, all but 10 States still have a durational residence requirement; 11 States still do not include children living with first cousins, nephews, or nieces; and 1 State (Texas) excludes a child who is not a United States citizen. WELFARE SERVICES STRENGTHENED Consultation to States and preparation of informational, interpre- tive, and in-service training materials continued on various ways of providing services to persons dependent on public assistance. Coop- erative relationships were maintained with various national public and voluntary agencies concerned with families and children, the aging, homemaker services, or community planning, with participa- tion on various committees of these organizations in joint effort to develop new methods of providing help to those in need. Primary emphasis was given to strengthening welfare services appropriate to social and economic problems of families and older persons. In relation to families, activities centered around services to strengthen family life, and to deal with special problems such as illegitimacy, neglect of children, inadequate home management, and care of children. A pamphlet, Unmarried Parents—A Guide for the Development of Services in Public Welfare, was prepared jointly by the Children’s Bureau and the Bureau of Public Assistance to provide guidelines for public welfare agencies in developing or improving services to unmarried parents. Similarly, an addendum to the 1958 Directory of Homemakers published in the Homemaker Service Newsletter was prepared jointly with the Children’s Bureau and the Public Health Service. Work also was initiated on a project to teach ADC mothers housekeeping skills. States generally are concerned about the need for earlier recognition of conditions detrimental to children or disruptive of family life. Some States are instituting experimental or demonstration projects to help families improve their situation and increase their capacity for self-care, more independent living, or self-support. To assist States in these developments, consultation was provided on family-centered services, with emphasis on preventive measures such as adequate care and guidance of children, and planning with parents to assure the health and education of their children. Materials were also developed illustrative of the role of the public welfare worker in providing specific, concrete services to improve the home and strengthen family life. States were also given help in evaluating their efforts. Social Security Administration 65 Attention to the problems and needs of the aging was accentuated by the White House Conference on Aging. Bureau staff participated in the Conference held in January 1961 by serving as technical di- rectors for the sections on Social Services, and Family Life, and in taking active roles in sections on Medical Care, Income Maintenance, Community Planning, and the Role and Training of Personnel. They also assisted in the preparation and distribution of Background Papers on Family Life and Social Services ; in providing statistical and other background material used by the delegates; and in drafting some of the Conference reports. Pertinent Conference recommendations were summarized and made available to the States; their implications were also considered in Bureau work planning. Technical assistance was provided to the American Public Welfare Association’s Project on Aging, including the planning and con- ducting of institutes on public welfare program planning and staff development in behalf of older persons. The Bureau joined with the APWA, National Committee on Aging, and Family Service Associa- tion of America in sponsoring a Seminar on Casework Services for Older People at Arden House in the fall of 1960 for selected staff from public and voluntary agencies. The summary of the Conference has had wide distribution. Bureau staff also continued to serve on committees of the APWA’s Committee on Aging, and the National Council on Aging (formerly the National Committee on Aging). Other efforts in strengthening welfare services included participa- tion in planning for a national structure to promote homemaker serv- ices, working with a State in preparing a publication on its home- maker services in small or rural areas; drafting a document on the public assistance caseworker’s role in services to the il] and disabled; and developing guides for use in the administrative review of State welfare services. Also a listing was made of the location of special studies and numerous experimentations on improving case services and their results, and assistance was provided to several States on adminis- trative considerations in establishing specialized casework units and other organizational arrangements for staff providing direct services to individuals. EFFORTS TO IMPROVE STANDARDS OF ASSISTANCE Pamphlets were issued on L'stablishing Money Amounts for Fuel for Heating, discussing factors to be considered in applying the fuel formula developed by the U.S. Weather Bureau; and State Methods for Determining Need in the Aid to Dependent Children Program, describing how States’ standards and income policies govern need determination in the eligibility process. Both reports were prepared as part of Bureau follow-up on recommendations made in 1960 by 66 Department of Health, Education, and Welfare, 1961 the Advisory Council on Public Assistance. Technical assistance was also provided on request to the Department of Agriculture in their planning for the food stamp plan. Administrative Developments Legislation passed in fiscal 1961 added broad responsibilities to Bureau activities and substantially increased its workload. In addi- tion to providing assistance to States in administrative and fiscal changes involved in implementing the new legislation, statistical, financial, and other reporting systems were initiated for operational purposes and for keeping the Secretary, the Commissioner, Congress, and the public informed as to program developments. Federal review of State practice under the new provisions was undertaken to assure that it was in keeping with congressional intent and used methods re- quired for proper and efficient administration. The Bureau’s limited resources were stretched to prepare interpre- tive materials and correspondence in response to public interest heightened by the controversial nature of some of the social issues emerging in the implementation of the new legislation, and to co- operate with other groups, as requested, on special projects. For example, the Department was asked by the Senate Special Committee on Aging to cooperate in a special inquiry addressed to all State agen- cies on plans and accomplishments to date in their programs of medical care for the aged and provisions for medical care under old- age assistance.? Effort was also made to obtain data about the effectiveness of the new legislation. For example, Selected Characteristics, covering financial eligibility and the scope of medical services provided, initially developed for the States with such plans in operation, was kept current as additional States revised or added new programs; and information is being obtained for a more comprehensive publica- tion on the characteristics of medical and remedial care provisions of State public assistance plans. Planning was also initiated for evalu- ating the experience gained in administering the new provisions as a basis for recommending future improvements. Other assistance was provided to the States on methods of issuing and accounting for payments to suppliers of medical care in behalf of assistance recipients, administration of urban agencies, manual and records management systems, field services, and methods of super- vision. To meet increasing interest of States, efforts were intensified in developing caseload standards, including evaluation of work done 2 The Staff Report to the Senate Committee on Aging, State Action To Implement Medi- coal Programs for the Aged, based on their inquiry in March, was issued in June 1961. Social Security Administration 67 in other fields and its applicability to public assistance operations, and preparation of guides for use of States. A management conference was held in San Francisco in November 1960 focused both on im- proving services to urban agencies and on methods of organization and administration. PUBLIC ASSISTANCE STAFF TRAINING The preliminary report, 1960 Survey of Salaries and Working Conditions of Social Welfare Manpower, based on a study made by the Bureau of Labor Statistics, in cooperation with the National Social Welfare Assembly and the Department of Health, Education, and Welfare, reveals the following pertinent data about State and local public assistance personnel : 34,500 persons in executive and social work positions in State and local public welfare agencies primarily on public assistance (a 15-percent increase from 1950 to 1960) ; 13 percent of the supervisory group (an increase from 10 percent in 1950), and slightly more than 1 percent of the casework group (a decrease from 2 percent in 1950), had full professional social work training ; nearly two-fifths of the supervisory group had some graduate social work training, as did 10 percent of the casework group (a decrease from 17 percent in 1950) ; 65 percent of the casework group had an undergraduate degree (an increase from 60 percent in 1950) ; and the 1960 median supervisor’s salary was $5,797 a year, and the median case- workers’ salary was $4,338. Salary increases ranged from 60 to 75 percent over the 10-year period with 23 percent reflecting rising living costs. The situation in 1960 represents a slight gain since the first welfare manpower survey was made in 1950, but it also reveals the inadequate preparation of the majority working in social work positions in the public assistance programs: Slightly more than a third have not completed college ; 89 percent of the caseworkers have had no study in any graduate school of social work ; 19 out of 20 have not completed graduate professional training (99 percent of the caseworkers and 87 percent of the supervisory staff) ; and there is only 1 caseworker with full professional training for every 23,000 assistance recipients. The limited number of professionally qualified staff administering the public assistance programs is considered by many groups a major obstacle in the provision of more effective services that could help lessen dependency, prevent further deterioration, and mitigate the effect of need on individuals, families, and communities. 68 Department of Health, Education, and Welfare, 1961 With Federal funds paying half the cost, some in-service training is provided by most State agencies, and during the past year about 550 public assistance workers in 39 jurisdictions were on educational leave (4 out of 5 were receiving some Federal or State money to help pay for their training). An Educational Standards Project was established by the Bureau to determine more clearly the scope and level of performance which can reasonably be expected of the worker with a bachelor’s degree. Work undertaken toward this objective has included (1) identifying specif- ically the variety of functions which make up the public assistance caseworker’s job, and (2) determining which of these functions a worker with a bachelor’s degree can perform acceptably. Profes- sional judgment is being utilized in making tentative decisions, and research designs are being developed to test these judgments. While concentrating first on the job of the caseworker, such determinations will be made subsequently for other jobs. The preparation of a textbook to serve as a guide for in-service training of new public assistance workers was initiated, and plans made for developing appropriate teaching materials on casework con- cepts for staff without professional education. Work continued on developing and testing of in-service training materials to help staff improve services provided to the aging. As part of its plan initiated in 1960 to provide short-term training seminars for State agency staff, the second session for State welfare field representatives was held in October and November 1960. In collaboration with the Children’s Bureau, a Handbook of Staff De- velopment is being prepared containing suggested standards and guides for State welfare agencies. Wyoming’s training plan for po- tential county directors was published in the Bureau’s “How They Do It” series and distributed to State agencies. States were encouraged to extend opportunities for academic train- ing under the 50-50 Federal matching provisions for the costs of administration, to develop other methods of improving staff compe- tence, and to make more effective utilization of professionally trained staff. Consultation and other resources were also provided to schools of social work and others, as requested, including participation on various committees of the Council on Social Work Education, and on the American Public Welfare Association’s Committee on Social Work Education and Personnel. Cooperative activity was also under- taken with other units within the Department on training aspects of areas of mutual concern. The Bureau’s training plans for its Federal employees were both long-range, in relation to program needs; and short-term, in relation to training opportunities appropriate to job duties provided under the Government Employees Training Act. Long-range planning in- Social Security Administration 69 volved full-time outside training of selected staff members to achieve objectives in knowledge essential to program development; short-term planning brought special seminars to Bureau staff, and provided training opportunities for 8 employees in government-sponsored train- ing activities, and for 34 employees in non-government facilities. Related Program Activities INCREASED RESPONSIBILITY FOR CIVIL DEFENSE EMERGENCY WELFARE SERVICE PROGRAMS The Emergency Preparedness Order No. 5 signed by the Director of the Office of Civil and Defense Mobilization on January 10, 1961, assigned certain civil defense mobilization functions concerning edu- cation and welfare to the Secretary of Health, Education, and Welfare. These functions were delegated by the Secretary to the Commissioner of Social Security, and are carried out by the Bureau of Public Assistance, working with the Children’s Bureau. Emphasis during the past year was focused on organization, re- cruitment, orientation to emergency welfare services responsibilities, and preparation of national guidance materials to help State welfare departments in developing State-local emergency welfare service pro- grams, including training activities. Progress was made in establish- ing working relationships with constitutent units in the Department of Health, Education, and Welfare, the Office of Civil and Defense Mobilization, and other Federal departments and agencies having competencies related to emergency welfare services. Arrangements were made for participation of national voluntary welfare and related agencies to facilitate participation by local vol- untary agencies in Emergency Welfare Service activities. “Memo- randa of Understanding” were completed with 12 national voluntary and related agencies* incorporating their role in support of the Government in pre-attack planning and post-attack operations. Negotiations continue with other such agencies. Copies of the com- pleted “Memoranda of Understanding” have been distributed through voluntary and public channels. Work was also initiated on a nationwide inventory of welfare man- power and other basic welfare resources. Information about these resources will be stored on punchcards or magnetic tape for use by 3The Order was not rescinded by Executive Order 10952 (dated July 20, 1961) assigning certain civil defense responsibility to the Secretary of the Department of Defense. 4 American National Red Cross, Child Welfare League of America, Council of Jewish Federations and Welfare Funds, Council on Social Work Education, Family Service Asso- ciation of America, National Association of Social Workers, National Catholic Welfare Conference, National Conference of Catholic Charities, National Council of the Churches of Christ in the United States of America, National Travelers Aid Association, The Sal- vation Army, and United Community Funds and Councils of America. 70 Department of Health, Education, and Welfare, 1961 the Office of Emergency Planning’s National Resource Evaluation Center in identifying and locating resources still existing after an attack, and in developing estimates of casualties. Identification of the location and number of State and local public assistance offices and personnel has already been completed. The Bureau was also assigned responsibility for developing information about requirements for items relating to body protection and household operations needed for survival. This information also will be used to determine where shortages or surpluses now exist. Progress was made on the development of guidance materials. A document, Hmergency Welfare Service—Guidelines and Structure, was released in draft form in March for review and preliminary testing to State and local public welfare agencies, national voluntary agencies, and to State civil defense directors. F%scal Policies and Federal-State Agreements, which was issued in April, includes model forms by which States could amend or supersede their 1956 agree- ments to accept responsibilities under the expanded emergency welfare service program assigned to D/HEW. (Several States have signed these new agreements to strengthen and support the Emergency Welfare Service programs.) States were encouraged to undertake Emergency Welfare Service training of State and local welfare staff as part of their regular staff development activities. Outline Plan for Development of Emergency Welfare Service Training Materials, a syllabus of source material for training persons who will carry emergency social service respon- sibility in local welfare centers, was drafted to facilitate such training. Federal civil defense informational materials also were made available to States, and a bibliography of materials pertinent to training in emergency welfare services was initiated. Plans were developed with OCDM ° for a coordinated and compre- hensive training plan with their Office of Training and Education under which EWS was given responsibility for providing the emer- gency welfare services content for courses given at OCD—DOD college and instructor training centers. An orientation document for key individuals in civil defense was developed for use in conjunction with regular and specialized courses. Work is underway on “how-to-do-it” materials on emergency lodging, emergency feeding, emergency clothing, emergency social services, and emergency welfare registration and inquiry. A hand- book, Civil Defense Emergency Planning in Welfare Institutions, is being prepared for the guidance of superintendents of welfare institu- tions. Those aspects of emergency social services which deal with the 5On August 1, 1961, the training and education function was transferred to the new Office of Civil Defense, Department of Defense (OCD—DOD). Social Security Administration 71 care of children, especially those separated from their parents, are being prepared by the Children’s Bureau representative and the emer- gency welfare services staff. Staff was assigned to five D/HEW regional offices to facilitate communication between the central office and the States, with plans to staff the remaining regions in 1962. Two regional and three bi- regional meetings were held during the year with representatives of State public welfare agencies; highlights of the guidance materials were presented and discussion was held on the responsibility of public welfare in providing technical leadership in developing and carrying out essential welfare service functions in time of emergency. Policy material was prepared on the use of Federal matching funds by State and local welfare departments for civil defense purposes, and merit system examinations were prepared for State emergency welfare services personnel. An exhibit on emergency welfare serv- ices was prepared for use at the National Conference on Social Welfare held in Minneapolis in May. A pilot project on natural disaster training was conducted by the American National Red Cross Disaster Services for emergency welfare services staff to assist in evaluating the adaptability of the course content and its method for training pur- poses for a war emergency. EWS staff also participated in the first phase of the 1961 “Operations Alert” exercise. ASSISTANCE PROVIDED TO CUBAN REFUGEES The break in diplomatic relations between Cuba and the United States led to a heavy influx of Cuban refugees in the United States. Although many of the refugees were professionally or technically trained, a large proportion needed assistance of one kind or another— financial aid, employment counseling, retraining, or help in resettle- ment and adjustment to American customs. Until February, a large part of the burden of providing care, maintenance, and shelter in the greater Miami area was borne by voluntary agencies and individuals. Recognizing that the problem was one affecting not only Florida but the entire Nation, President Kennedy, in January 1961, assigned responsibility to the Department of Health, Education, and Welfare for coordinating, intensifying, and expediting governmental and private aid to Cuban refugees. Federal funds from the Mutual Security Program were authorized for this activity. With responsibility for developing and administering the program assigned to the Secretary, a 9-point program of assistance was formu- lated within 3 weeks, setting a precedent in speed. Working closely with the office of the Commissioner of Social Security, Bureau staff served on the survey team which made the initial reconnaissance visit 42 Department of Health, Education, and Welfare, 1961 to Miami in late January. They also were members of the Depart- ment’s task force which developed the basic data for a comprehensive Federal program of health, education, employment, welfare, and re- settlement services for needy Cuban refugees. Assistance standards similar to those established for local residents by the Florida State Department of Public Welfare were used in the provision of the basic necessities of life, hospital care, and child welfare services. Surplus food commodities also were made available. To help relieve the Miami area of the impact of its refugee concentration, contracts were made with voluntary agencies for resettlement of refugees in other parts of the country, including help in obtaining jobs and in adjusting to new locations. In February, the Bureau was assigned operating responsibility for temporary financial assistance, hospital care, and related social and welfare services to Cuban refugees. Policies and procedures were developed for use of State welfare agencies in administering this phase of the program as representatives of the Federal Government. Regional and central office staff worked closely in its implementation, and in making plans for the distribution of surplus commodities. Agreements were initiated with the Florida State Department of Public Welfare. In less than a week of intensive planning and re- cruiting of a bilingual staff, the State agency was prepared to accept immediate transfer of cases of needy refugees from voluntary agencies in Miami and from the long list of applicants registered at the Cuban Refugee Emergency Center. First payments were made on February 27. A week later some 2,800 adults and 840 children were receiving financial aid. By the end of March, about 3,800 cases in the Miami area had received financial aid; about 42 percent of them were single-person cases. The average family payment was around $85 a month. Resettlement of refugees through voluntary agencies under contract with the Federal Government averaged about 250 families a month; from November through June, 4,672 refugees were resettled. ‘The cooperation of other States was enlisted to provide help for relocated families who, for various reasons, were unable to maintain themselves. By the end of June approximately 8,700 cases had received assistance under the program in the Miami area. Of the $2,275,000 allotted the Bureau between February 27 and June 30 for assisting Cuban ref- ugees, all but $5,000 was used in Florida.*® The speed and effectiveness of the cooperative effort of Federal, State, and local public and voluntary welfare agencies in aiding needy 6° The total amount allotted to the Bureau of Public Assistance included $440,000 for the care of unaccompanied children but, except for fiscal aspects, responsibility for this segment of the program was assigned to the Children’s Bureau. Social Security Administration 73 Cuban refugees is both a tribute and a true test of the strength of the American social welfare structure and its ability to adapt its resources to meet serious emergency problems affecting the well-being of people. ASSISTANCE TO U.S. NATIONALS REPATRIATED FROM OTHER COUNTRIES The Bureau has continued to assist the Department of State in ar- ranging for the reception and care of those American nationals and their dependents repatriated from other countries who need special help upon arrival in this country. During the past year, assistance was requested by the Department of State in behalf of 120 cases in- cluding 231 individuals from 32 countries. Thirty-nine of these cases involved mental illness. Through the cooperation and help given by public and private welfare agencies, primarily in New York, arrange- ments were made for emergency reception service, transportation, hospitalization, and other needed services. Assistance was also provided to needy United States citizens and their dependents who fled to this country from Cuba. Many were without cash resources because they were prevented from taking money out of Cuba. Some had resided there for many years and had lost contact with relatives or friends in this country. With a special au- thorization of $30,000 from the President’s Emergency Fund, assist- ance was provided to help these repatriates return to the place where they formerly lived, or to join relatives who could assist them in re- establishing themselves in the United States. In July 1961 about 140 American families repatriated from Cuba were helped; about $29,000 of the $30,000 authorized for this purpose was used by Florida, and most of the remaining $1,000 by other States. During the year, the Bureau also developed plans for implementing legislation passed in July 1960, when funds are appropriated, to pro- vide for reception and hospitalization at Saint Elizabeths Hospital, or elsewhere, of certain repatriated mentally ill United States citizens. The legislation, passed in June 1961, amended title XI of the Social Security Act to provide temporary assistance (through June 30, 1962) to other repatriated U.S. citizens who need help upon arrival in this country. This amendment is an outgrowth of a long period of pro- gram development and interdepartmental consideration. INTERNATIONAL ACTIVITIES Cooperative work with the SSA Office of International Activities during the past year included central office planning for and con- sultation to foreign visitors, and interpretation of U.S. social welfare programs to individuals and international groups referred by various Government agencies. Bureau regional staff also provided consulta- 626936—62——6 74 Department of Health, Education, and Welfare, 1961 tion and planned or arranged observation programs in cooperation with State and local public and voluntary welfare agencies for visitors from other countries. Comments were prepared on United Nations’ documents, and suggestions made for social welfare projects to be included in the program financed through the purchase of foreign currencies excess to the normal requirements of the United States in accordance with Public Law 83-480, the Agricultural Trade De- velopment and Assistance Act of 1954, as amended. Bureau staff also participated in the annual Seminar for Foreign Service Officers of the Department of State, and in the 10th International Conference of Social Work held in Rome. A Look Ahead Public assistance has played an important role in the social security system in assuring needy people the right to live at a level of minimal decency. To the extent the need for this kind of assurance is con- sidered a consequence of a healthy, growing industrial society will the full potential of public welfare measures be utilized in achieving the balanced social and economic development essential to a strong democracy. Although significant gains have been made in the relatively short history of the Federal-State public assistance programs, tremendous forward strides could be made under a fuller utilization of existing legislative provisions. Other gaps in program provisions require legislative change. ASSISTANCE PAYMENTS NOT MEETING “NEED” Although Federal, State, and local governments have substantially increased their expenditures, with rising costs and the shrinking value of the dollar, public assistance payments are not meeting “need” in many instances. Fewer than half the States are fully meeting “need,” judged by standards they themselves have set. (Need is defined here as the gap in income between the total cost of living essentials set by the State and the individual’s resources to meet that cost.) The other States either impose maximums on the monthly amount of assistance any individual or family may receive or meet only a specified proportion of need. In some States, the standards themselves are inadequate. As indicated in chart 4, although the average assistance payment has increased in dollar terms, the increased cost of public assistance in the past 25 years has been due more to monetary inflation than to expansion in the purchasing power of the assistance payment. Social Security Administration 75 CHART 4.—PURCHASING POWER OF AVERAGE OLD-AGE ASSISTANCE PAYMENT. DOLLAR AMOUNTS ARE ADJUSTED FOR CHANGES IN THE BUREAU OF LABOR STATISTICS CONSUMER PRICE INDEX. $67.85 Average payment ae JUNE 1936 JUNE 1950 JUNE 1961 INADEQUATE PROVISION TO MEET MEDICAL CARE COSTS Although recent Federal legislation increased provisions for costs of medical care, and significant gains have already been made in some States, the majority still provide for only limited medical care, and not the broad scope of services needed by most sick people. 76 Department of Health, Education, and Welfare, 1961 | NEEDY CHILDREN ARE BEING “SHORT-CHANGED” Provisions for needy children are not keeping pace with the in- creased child population. As indicated in Chart 2, about the same proportion of the child population received assistance in 1961 as in 1950; program changes during this period have not resulted in a } significant relative increase in the proportion of children receiving aid to dependent children. Inequities between provisions for the needy aged and those for dependent children also highlight the restrictive effect of the attitudes of many toward certain causes of dependency of children such as the socially unacceptable behavior of parents. These inequities also compound the damaging effects on children of serious social problems—dependency, family breakdown, illegitimacy, ill health, and disability. Chart 5 highlights facts concerning widespread fallacies as to the impact of illegitimacy on the aid to dependent children program. Only about Y4 of 1 percent of the total child population are illegiti- mate and receiving aid to dependent children, even though about 41% percent of the Nation’s child population are illegitimate. NEED FOR PREVENTIVE AND REHABILITATIVE SERVICES BY QUALIFIED STAFF Although the importance of providing other social services by qualified staff is recognized through legislative provisions, many fac- tors hinder their effective implementation. Because of staff limitations and heavy workloads (e.g., 1 caseworker with full professional training to every 23,000 assistance recipients— see other detailed information in chart 6), the States’ services plans, in general, realistically define their responsibility by limiting the problems for which services would be provided, limiting services to those required in the determination of eligibility for money payments, or limiting services to those that could be provided only during regu- lar contacts for eligibility determination. High caseloads and lack of staff skills also limit the quality of services that can be provided by most agencies, since this kind of help usually needs the knowledge and skill that comes from professional social work training. Provision is also needed for skilled staff services before eligibility for assistance is established, as well as for aiding those who can be helped to utilize their own resources and resources available elsewhere in the community, to prevent their ultimate need for public assistance. These are but some of the areas that could be strengthened if public assistance measures are to be used as a constructive force in dealing with the many social problems facing our productive and growing V7 Social Security Administration rd ‘day Bulalieoos NaYxdIHD T1V JO LNIDY3d L AO b FE teres ogy BulAleoas uaspiiys 93eW131607 BF cert ogy Bulasaoas uaspyiyo ze) 316941] "ee "00V BulAledas JON Uaspi iyo ozewW!z169))) 240 sezew) zs] TVNOA N3YGIHD LNFGN3dIG OL GIV ONIAIZDIY NaYGIIHD FJLVWILISATII—'S LYVHD Department of Health, Education, and Welfare, 1961 78 *swesboid |e90| pue a3e}$ JapuN adUe}SIsse |esaueh UO HUIyx10M Suayx41OMaSed Sopn{douU| 196] ‘neaing s,uaspl!y) - aoueysissy O1[qng yo neaing ‘uol!zeszS!ulwpy AZIunoag je!o0g ‘fazey| aM x Puy ‘uolzeonpz ‘yz[eaH yO zUaUysedag “S*N ‘4amodunY asvf7aM 701905 fo suo1Z1pUO) SuLy40K puD Satsp7vg fo Kansng og6T :39yN0S pee é 661 ‘S-00h ‘ng $2 666 ‘S- | 002 ‘G$ %95 aaibap s ,40,ayoerq 40 Apnjs azenpesb6 19430 4LE 66E ‘h-009 ‘E$ £92 Apnys a6a| [09 awos wEl 665 ‘E-008 ‘Z$ 46 : H4OM [B1D0S a}eNpesH awos ye/ \ 48 “I SSa} 40 [OOYyds ybiIY 43A0 008 ‘z$ ae4bap pue 4apun 440M 000 ‘9$¢ {e120 $}U9!1d1994 000‘EZ Asana 40} Bulutesy ‘ BEE he SE IP {BUOISSasoud [{ {NJ YIM 4axIOMaSeD | AYVITVS NOTLVONGS O96L ATYVI *'SYANYOMASVD JONVISISSY DITGNd—9 LYVHD Social Security Administration 79 economy. ‘The extent they are used for prevention and rehabilitation, as well as for sustaining life at a level of minimal decency, will deter- mine the degree to which the human resources of the present and future will be conserved. Measures to strengthen the individual and the family are sorely needed today, as never before, to add strength to a nation carrying grave responsibilities of leadership in a world seething with rapid economic and social change. Children’s Bureau By law and tradition, the Children’s Bureau serves the children of the United States and its current program reflects its concern for the well-being of all children. The legal base for its service is contained in two acts, and in dele- gations of responsibilities to the Bureau by the Secretary of Health, Education, and Welfare, and by the Commissioner of Social Security. Under its basic act of 1912, as amended, the Bureau is charged to investigate and report “upon all matters pertaining to the welfare of children and child life among all classes of our people.” Under title V of the Social Security Act, 1935, as amended, the Bureau, by delegation, assists the States through technical and finan- cial aid, in enhancing and protecting the well-being of many children through child health and welfare services. All of the Bureau’s activities are related and interwoven at many points. They reach out beyond the strict borders of social services and health services into many phases of child life that make for or interfere with the development and well-being and normal growth of children in their families, neighborhoods, and communities. Stemming from these two acts but interwoven into one program are the purposes of the Children’s Bureau today : to assemble facts that will keep the country informed about children and matters adversely affecting their well-being ; to recommend measures that will be effective in advancing the wholesome development of children, and in preventing and treating the ill effects of adverse conditions ; to give technical assistance to citizens and to voluntary and public agencies in improving the conditions of childhood ; and to administer the financial aid that the Federal Government appropriates each year to aid in building the child health and welfare services for children. Overall goals for the Nation’s children and youth were projected by the 1960 White House Conference on Children and Youth as the basis for national action, public and voluntary, Federal, State, and local for the next 10 years. 80 Department of Health, Education, and Welfare, 1961 The overall goal of the Children’s Bureau, reflecting society’s con- cern for its children, is that every child in our Nation have an op- portunity for healthy growth, for maximum development of his potentials, and for a productive and satisfying living experience. The Bureau’s focus on the whole child and the health and welfare services he requires for his well-being includes seeing him in his family and community setting and encourages the development of a whole gamut of essential services. The problems of children and youth with which our society is dealing make a multiprofessional ap- proach essential, as for example, in juvenile delinquency, mental re- tardation, adoption, illegitimacy, foster care, day care, homemaker service, and guides to parents on child rearing. Though directed to investigate all matters relating to child life, obviously a small agency such as the Children’s Bureau (at present its staff numbers less than 250) has to be selective. Over the years, children with disadvantages of many kinds have claimed the major attention of the Bureau. The social, environmental, and health haz- ards which affect the lives of children and prevent children from reaching their maximum potentials are constantly under review in the Bureau. Goals then must provide for meeting the needs of increased num- bers of children, for continuing the present trends toward better cover- age of their needs, dealing effectively with new needs as they arise, and for bringing to services for mothers and children the benefits from new developments in research. Changes taking place in patterns of family and community life are affecting lives of children profoundly. Among the most significant of these changes is the trend toward urbanization. Two-thirds of our population now live in metropoli- tan areas. At the same time, financially adequate families, especially those with children, are moving out of the central cities into the suburbs. In many instances, our sprawling metropolitan areas over- ride State and local governmental boundaries and essential services needed by children and families living in these outlying areas have not been developed. The core city, though having authority and structure, is left with reduced resources to deal with a population which has a high proportion of families presenting health and welfare problems. Family life may be expected to continue to be affected by mobility of our population, by employment changes resulting from automation and mechanization, by rising standards of living, and by a continuing trend toward employment of women outside the home. Admittedly there are still many gaps in the health and welfare services for children and many aspects of these programs require strengthening and improving. Social Security Administration 81 There are large geographic areas without special types of health and medical care that many mothers and children need and without child welfare workers to help children with family and other social problems. Great shortages exist in personnel especially trained for work with children. Too few young people are choosing careers in health and welfare services for children. To conserve children’s abilities and potentialities, the pool of skilled workers must be expanded substantially. Needs are pressing for more research into causes and treatment of children’s physical, emotional, and social problems. Research and demonstration programs are needed to advance the development of sound programs of service to children and their families. New patterns of community services for children are an urgent need - in order to serve families and children more expeditiously without debasing quality of service. Many States lack adequate legal protections for children or fail to enforce what protections exist. During fiscal 1961, the attention of the Department, the Bureau, and State and local agencies was focused on the need to take stock and evaluate health and welfare programs for children. Much of the impetus for this reevaluation in State and local agen- cies comes from the 1960 White House Conference on Children and Youth. Present programs are being critically examined and plans are being made to expand the services to meet, the needs of our in- creasing population of children who represent the wealth of our hu- man resources. The Children’s Bureau in common with these many agencies and organizations was analyzing its own functions and ac- tivities against the backdrop of the Conference. Another event lead- ing to reevaluation was the advent of the new administration which stimulated Government agencies and the country at large to reex- amine health and welfare programs generally. | Some Facts and Figures About Parents and Children Births continue to be more than 4 million a year, but the crude birth rate and the rate per thousand women of child bearing age have dropped slightly since the peak of the 1950’s, The estimated number of children under 18 in the resident popula- tion of the United States—50 States and the District of Columbia— in 1960 was 64.2 million, 35.8 percent of the total population. Provisional statistics indicate that the infant mortality rate for 1960, and the early months of 1961 (25.7 per 1,000 live births), has decreased appreciably from the high point of 27.1 per thousand live 82 Department of Health, Education, and Welfare, 1961 births in 1958. Death rates for babies less than 8 days old have changed very little in the past two decades. Nonwhite infants still have a higher mortality rate than white infants, and the excess is now greater than in 1950. Numbers, rates, and ratios of births out of wedlock continue to in- crease. The estimated number for 1959 was 221,000. The ratio per 1,000 live births increased over 1958 from 49.6 to 52 and the rate per 1,000 unmarried women age 15-44 years from 21.0 to 22.1. Forty percent of births out of wedlock in 1959 were to mothers under 20 years of age. In March 1960, there were 52.4 million married, divorced, and widowed women in the United States, of which almost one-third, or 17.1 million were in the labor force. Of those in the labor force, 5.1 million, or 42.5 percent, had children between the ages of 6 and 17; 2.9 million, or 20.2 percent, had children under 6. The number of working mothers with children under 18 years increased by about 500,000 since March 1958. In 1960, for the twelfth consecutive year, juvenile court delinquency cases increased over the previous year. The increase for 1960 was 6 percent when traffic cases are excluded. The rise exceeded the 2 percent estimated increase in the child population. Arrest data for 1960 reported by the Federal Bureau of Investigation for 1,614 cities show that the arrests of children under 18 years increased by 9 per- cent over 1959. Juvenile arrests in rural areas, tabulated by the Federal Bureau of Investigation for the first time in 1960, increased by 8 percent over 1959. Report to the Congress on Children in Migrant Families A report entitled Children in Migrant Families, prepared by the Children’s Bureau at the request of the Senate Appropriations Com- mittee, was transmitted to the Committee by Secretary Flemming on January 19, 1961. The report summarized information about the conditions, prob- lems, and unmet needs of children in migrant families. It gave particular attention to their needs for health services and for child welfare services, including day care. In preparing this report, the Bureau drew upon material and studies developed by a wide variety of groups. New information, elicited through a schedule submitted to national voluntary organizations and State public health and wel- fare agencies, was correlated with the Bureau’s own experience in working with public, voluntary, and civic agencies and organizations to promote the well-being of children in migrant families. Social Security Administration 83 Although admittedly a wide variety of provisions impinging on or affecting migrant children, such as education, child labor, housing, and sanitation are urgently needed, the recommendations in this report were focused on specific child welfare and child health measures that would contribute to alleviating the adverse conditions of children of migrant workers, especially children of working mothers. The Bu- reau recommended a program of immediate action, including: (1) Expansion of child welfare services and maternal and child health services so as to make these services readily available and accessible to migrant children and their families; (2) increased technical assist- ance to agencies and organizations engaged in helping migrant chil- dren; (3) increased encouragement of and assistance in research and demonstrations relating to new or improved measures for helping migrant children, in the fields of child welfare and child health; (4) increased investigating and reporting activities relating to the develop- ment of effective measures for improving the welfare and health of migrant children; and (5) a nationwide information-education cam- paign, to acquaint the public with the findings that result from these various activities. President’s Committee on Juvenile Delinquency and Youth Crime On May 11, 1961, President John F. Kennedy established by Execu- tive Order the President’s Committee on Juvenile Delinquency and Youth Crime. This Committee is composed of the Attorney General, the Secretary of Labor, and the Secretary of Health, Education, and Welfare. The Executive Order states, “The Committee (1) shall review, eval- uate and promote the coordination of the activities of the several departments and agencies of the Federal Government relating to juvenile delinquency and youth crime; (2) shall stimulate experi- mentation, innovation and improvement in Federal programs; (3) shall encourage cooperation and the sharing of information between Federal agencies and State, local and private organizations having similar responsibilities and interests; (4) shall make recommendations to the Federal departments and agencies on measures to make more effective the prevention, treatment, and control of juvenile delinquency and youth crime.” Also on the same date, the President announced the appointment of the Attorney General as chairman of the Committee, and the appoint- ment of David L. Hackett, a special assistant to the Attorney General, as Executive Director of the Committee. The Bureau cooperated with the Committee and provided a substantial amount of staff service to the Committee during the balance of the fiscal year. 84. Department of Health, Education, and Welfare, 1961 Juvenile Delinquency Legislation On May 11, 1961, President Kennedy transmitted to the Congress an administration proposal for a 5-year program of grants for demon- stration and evaluation projects and for training, and of technical assistance services, relating to the prevention and control of juvenile delinquency or youth offenses. As finally passed by both Houses, legislation—which was substantially in accord with the President’s recommendations—authorized appropriations for 3 years, beginning with the fiscal year 1962 for grants and technical assistance services. This legislation was approved by President Kennedy on September 22, 1961, and became P.L. 87-278. A supplemental appropriation bill was enacted which provided an appropriation of $8,200,000, thereby enabling immediate implementation of this new legislation. Appropriations The 1962 appropriation request of the Department provided for funds enabling the Bureau to implement two new programs which were authorized by 1960 legislation enacted in the early part of the 1961 fiscal year. The first piece of this legislation was the Inter- national Health Research Act. The second piece was contained in the 1960 amendments to the Social Security Act and was an authorization for a new program of grants for research or demonstration projects in the field of child welfare. As finally approved by the President on September 22, 1961, the 1961 Appropriation Act for the Department not only contained funds for these two new programs, but also contained increases of roughly $5 million apiece in each of the three programs of grants to the States which are administered by the Bureau. For maternal and child health services and for crippled children’s services, respectively, the amount appropriated for the fiscal year 1962 was $25 million as compared with appropriations of $18,167,000 and $20,000,000, respectively, for the fiscal year 1961. These two appropriations for 1962 thereby reached the full amount authorized under the increased ceilings con- tained in the 1960 Amendments to the Social Security Act. With respect to child welfare services, the amount appropriated for grants to the States for 1962 was $18,750,000 as compared with $13,666,000 for 1961. Federal Interdepartmental Committee on Children and Youth The work of the Interdepartmental Committee on Children and Youth during fiscal 1961, its 13th year, featured followup on the 1960 White House Conference on Children and Youth. Member agencies Social Security Administration 85 of the Committee analyzed White House Conference recommendations related to their programs to determine those on which they could take action within the framework of their present authority, obligations, policies, and resources. They found that many of the recommenda- tions parallel their ongoing agency activities, and have expanded their services toward achievement of White House Conference objec- tives in a number of specific instances. These have included con- ferences and workshops sponsored by member agencies or participated in by such agencies, material developed, published, and disseminated, consultation service given, speeches made, and participation in a variety of activities related to White House Conference goals. In carrying forward the purposes of the White House Conference, the Interdepartmental Committee on Children and Youth worked closely with the Special Unit for White House Conference Follow Up established in the Office of the Chief of the Children’s Bureau on November 1, 1960. With the assistance of staff of the Special Unit, the Interdepart- mental Committee on Children and Youth completed the revision of its publication, Programs of the Federal Government Affecting Chil- dren and Y outh, originally published in 1951. Four subcommittees of the Interdepartmental Committee were ac- tive along the lines of White House Conference recommendations. The Subcommittee on Transition from School to Work developed a report, Outline for a Work and Service Program for Young Persons 16-21 Years of Age. This report has been widely used by various groups concerned with the development of programs to provide for youth opportunity for work, training and service. Many of the features of this report were incorporated in the Administration’s Youth Employment Opportunities Bill. The Subcommittee on Juvenile Delinquency stressed the need for more material in popular form to explain the multiple causes of de- linquency, for concrete action on preventive programs and for support | of appropriations at all levels for basic programs for children. The Subcommittee on Families and Children of Agricultural Mi- grants devoted its attention to studying the proposals for legislation | affecting migrant workers and their children under consideration in the Congress. A special subcommittee considered the White House Conference recommendation that a study be made of the effects of the draft law | In peacetime on the youth of the Nation and on the Nation. This subcommittee recommended that although such a study was beyond | the scope of the Interdepartmental Committee, the Committee might | well consider ways of following up on youth rejected for physical and | educational reasons. A subcommittee is now at work on proposals | along this line. 86 Department of Health, Education, and Welfare, 1961 The Special Unit for White House Conference Follow Up The Special Unit, financed by a special Congressional appropriation for White House Conference follow up, operated until the end of the fiscal year, June 30. The purpose of the Special Unit was two-fold: (1) to stimulate and reinforce activities by other agencies, organizations, and groups to achieve White House Conference objectives, and (2) to interweave White House Conference philosophy, materials, and forward view- point into ongoing substantive programs of the Federal agencies both at Washington headquarters and in regional offices. To carry forward this purpose, the Special Unit worked along five major lines: (1) regional workshops; (2) consultation service to regional representa- tives of Federal agencies, and, upon request, to State Committees for Children and Youth and others; (3) preparation and dissemination of new material; (4) acquisition and distribution of material pre- pared by others; (5) cooperative activities with the Interdepartmental Committee on Children and Youth and the National Committee for Children and Youth. Five special consultants, a principal consultant from the Washing- ton office, and four consultants assigned to regional offices in Boston, Dallas, New York, and San Francisco, devoted their major attention to developing methods of assisting State committees for children and youth and to open and broaden channels through which information and services can flow from various Federal agencies and national organizations in the regions to State committees. Partly as a result of this consultation service, several regional inter- — departmental committees on children and youth may be established ; a meeting of the first one, in San Francisco, is scheduled for September. The National Workshop on Consultation to State Committees, spon- sored by the Children’s Bureau in October 1960, was followed in the spring of 1961 by four regional workshops in San Francisco, Chicago, Oklahoma City, and Boston. In cooperation with the Division of Reports, six new publications were projected—Youth Today—Tomorrow’s Adults, The Lebanon Story, and four pamphlets comprising the Headliner Series by Margaret Mead, Walt Kelly, Margaret Hickey, and Edgar Frieden- burg. Three of these were in the process of being printed at the close of the fiscal year. The Special Unit enabled‘the Interdepartmental Committee on Children and Youth to expand greatly its continuing service in mail- ing selected publications to State Committees for Children and Youth. Social Security Administration 87 Some 450 pieces of material from Federal agencies, national organiza- tions, and State and local agencies and organizations were supplied to State committees. The Special Unit and the Interdepartmental Committee on Chil- dren and Youth also maintained close working relationships with the _ National Committee for Children and Youth. This included sharing of information, reports, and materials of mutual interest; participa- tion by the Executive Director of the National Committee for Chil- dren and Youth in the Interdepartmental Committee on Children and Youth meetings; and joint participation in various special conferences. The addition of a consultant for fiscal year 1962 for community planning will enable the Bureau with the assistance of its regional staff to give limited consultation services to State committees and to regional representatives of other Federal agencies in furthering objec- - tives of the States for children and youth. | Programs of the Bureau | RESEARCH IN CHILD LIFE The Bureau’s research staff has a major responsibility for carrying out the legislative mandate “to investigate and report upon all matters pertaining to the welfare of children.” In addition to its own studies and cooperating in joint studies, the Bureau stimulates other agencies to undertake research in child life by formulating questions needing | study, developing research methods, and providing technical assist- ance. ) Technical Research Some of the technical research studies conducted by the Bureau | follow: 1. Cultural Studies of Youth The pilot anthropological study of American youth culture has com- pleted its first data-gathering stage in St. Louis. Material from inter- views, observation, and questionnaires has been brought back to | Washington for analysis. Meanwhile plans are underway for drawing | on the experience of the pilot study to design a number of larger | studies in other centers. 2. Study of Cystic Fibrosis Studies directed toward determining the incidence and prevalence of cystic fibrosis, conducted in collaboration with the National Office of Vital Statistics and under contract with the Institute of Allergy and Infectious Diseases, continue. The first. of these studies, initiated at the end of the calendar year 1958, provided national estimates of the number of hospitalized cases 88 Department of Health, Education, and Welfare, 1961 | of cystic fibrosis, the number of discharges, and the number of deaths in hospitals resulting from the disease for each year, 1952 through 1957. A report of findings was published in the September 1, 1959, issue of Public Health Reports. A supplementary final report on demographic characteristics of patients hospitalized because of the disease in 1957 was published in the July 1961 issue of Pediatrics. In order to develop and test procedures for making a national study of the incidence and prevalence of the disease, a pilot survey of cases in Massachusetts, New Hampshire, and Vermont was made. A preliminary analysis of findings revealed that during the period 1952-58, inclusive, approximately 650 children residing in the pilot area were known to have cystic fibrosis. Based on cohorts of children born during each of those years, the incidence rate for the disease was estimated to be about 42 per 100,000 live births or 1 in 2,300. 3. Outcome of Independent Adoptions in Florida This study was conducted jointly by the Florida Department of Welfare and the Children’s Bureau and was financed by the Russell Sage Foundation. Findings concern the kind of homes found for the children, the way the children seem to be getting along, and the © characteristics or conditions that seem to be associated with favorable or unfavorable adoption outcomes. The report will be published in book form by the Russell Sage Foundation in 1962. 4, Trends in Infant Mortality Studies on infant mortality trends in the United States since 1950 were carried forward. Three articles were published : “Recent Trends in Infant Mortality in the United States (1950-1957)” in the Feb- ruary 1961 issue of the American Journal of Public Health; an account of current trends in the November—December 1960 issue of Chaldren; and a study of current problems in perinatal and maternal mortality reported in the Bulletin of the National Association of Maternal and Infant Health. Infant mortality in 1960 and in the first quarter of 1961 continued to be elevated about 5 percent above the level expected on the basis of trends established during 1950-57. Currently the postneonatal mortality rate (1-11 months) is showing greater departure from expected levels in 1960 and 1961 than the neonatal rate (under 28 days). 5. Children Who Receive Services from Public Child Welfare Agencies Published under the above title, this report (Children’s Bureau Publication No. 387) deals with the first study of the characteristics of these children made by the Children’s Bureau since 1945. This was a study of 220,812 children in 45 States. In addition to data on age, sex, color, marital status, and living arrangements, the study | Social Security Administration 89 yielded some facts about agency practices and length of service to children. 6. National Survey of Social Welfare Manpower in 1960 A preliminary report has been issued jointly by the Children’s Bureau and the Bureau of Public Assistance on the National Survey of Social Welfare Manpower which the Department conducted in 1960 in cooperation with the National Social Welfare Assembly and the Bureau of Labor Statistics. The Department’s part of this sur- vey was planned by a working group set up by the Office of the Sec- | retary, composed of representatives of the Children’s Bureau, Bureau ) of Public Assistance, the Office of Vocational Rehabilitation, and the | Public Health Service. The Department’s survey covered all social welfare personnel in the Department and in State and local public welfare agencies administering programs for which the Department carries Federal responsibility, except those engaged in vocational rehabilitation. Statistical Reports During the year, the Bureau compiled and published current sta- tistical data received from State agencies administering the maternal and child health, crippled children’s and child welfare programs. It | also published statistical data on children who receive services from public child welfare agencies, adoptions, the Cuban refugee program, licensed day-care facilities, juvenile court statistics, statistics from public institutions for delinquent children, staff losses in child welfare and family service agencies, recent trends in public child welfare | personnel, distribution of personnel and expenditures, and organiza- tion for public child welfare services. A number of revisions of the | Bureau’s statistical reporting were underway. | Research Interpretation As part of its research interpretation, the Bureau completely rewrote ) and had in press at the end of the fiscal year two of its major publica- | tions—Your Child from One to Six and Prenatal Care. Bulletins | were printed and distributed by the Clearinghouse for Research in Child Life. | Consultation and Conferences The research staff worked with or gave consultation requested by | State health and welfare departments, national organizations, and universities on such subjects as evaluation of programs, delinquency statistics and studies, statistics and studies in child welfare, planning 626936—62——7 90 Department of Health, Education, and Welfare, 1961 health surveys, shortages of research manpower and what to do about it, parent education and family life. A number of conferences on various aspects of research was planned by or participated in by the Children’s Bureau research staff. Notable among these were the following: 1. Conference on Research in Child Welfare At the invitation of the Chief of the Children’s Bureau, 21 experts in research and practice in the field of child welfare met in Washing- ton on December 15 and 16, 1960, to discuss various aspects of the recent amendment to Title V of the Social Security Act authorizing grants for research or demonstration projects in child welfare. The discussion included the role of the Children’s Bureau, methods of regional participation, definitions of research and demonstration, grants for research planning and exploratory research, consultation on design, continuity of research, research in an operating agency, research personnel, and priorities in subject matter of research. A report of this conference has been published (Children’s Bureau Publication No. 389, Research in Child Welfare). 2. Conference on State Research and Statistical Personnel The biennial conference of research and statistical personnel of State departments of public welfare sponsored jointly by the Bureau of Public Assistance and the Children’s Bureau was held in Denver, Colo., September 26-30, 1960. Representatives of 38 States attended. 3. Conference on Juvenile Delinquency Research The Division called a 1-day conference on delinquency research at which Professor D. H. Stott, Department of Psychology, University of Glasgow, presented findings from his research on the prediction of children’s social adjustment in general and of delinquency in particular. MATERNAL AND CHILD HEALTH SERVICES All States, the District of Columbia, Puerto Rico, the Virgin Is- lands, and Guam received Federal funds to improve services for pro- moting the health of mothers and children. For the fiscal year 1961, the appropriation for maternal] and child health increased to $18,167,000 with $1,000,000 earmarked for services to mentally retarded children. Because the great bulk of infant deaths now occur very early in the first year of life, more than one-third on the first day, approx- imately half in the first 3 days, 9 out of 10 in the first 5 months, and because nearly 3 times as many deaths are due to prenatal and natal causes as to postnatal causes, major efforts are being directed toward services to the mother before the birth of her child. Prenatal services Social Security Administration 91 are being extended especially to population groups where great need for public services exists in both urban and rural communities. The problems of urban mothers and children receiving maternal and child health services are becoming analogous to those living in rural areas: the ratio of services to population is a decreasing one; services are not always acceptable for cultural, financial, educational, geo- graphic, and, no doubt, other reasons. The increasing need for public prenatal services, the lack of progress in preventing prematurity and congenital anomalies, the question of why patients do not seek or accept prenatal care are being explored. Examples of such activities are: the medical-social project for unwed mothers and their babies in Hartford, Conn.; the studies of deterrents to prenatal care particularly in the young unmarried mother in New York City; the Philadelphia Health Department study of deterrents to utilization of prenatal care services. Cooperative ventures in providing services locally involving health, welfare, and other agencies such as county hospitals are increasing in number. Striking examples are noted in Imperial, Madera, and San Mateo Counties in California, and Thurston County, Wash. Interestingly, in contrast to the prominence of large metropolitan area health problems but probably also part of the changing compo- sition of the population in our large cities, as well as the continuing rural and semirural health needs, is the interest in decentralization of | services. For example, in Connecticut, plans are underway for small | residential institutions for the mentally retarded to be located in various communities throughout the State. In California, local | health department clinics for mentally retarded children are being | established with consultation from a central clinic in a university | center. In Pennsylvania, the first regional maternal and child health | director has been appointed to carry out program administration and planning for the State health department’s regional office. The interest in the evaluation of program activities continues. For | example, in Washington and California, studies are being designed | to determine the effectiveness of children’s services. Oregon is ex- | ploring methods of evaluating local health services in general. Ari- zona has a small study of maternal and child health services underway ) In one county concerned primarily with efficiency. | The rapid increase in the school-age population in both elementary | and secondary schools is causing educators and health personnel to | review critically their current health programs. Service demands | have multiplied not only in amount but in scope and in depth. Problems of emotionally disturbed children are receiving con- siderable attention in State maternal and child health programs. In Florida and South Carolina, maternal and child health directors are 92 Department of Health, Education, and Welfare, 1961 participating on committees whose objectives include development of services for these children. In connection with two medical schools, Emory and Vanderbilt Universities, new psychiatric facilities for children have recently been opened. In both, the primary objective is training of professional staff. Agencies are reporting increasing demands for maternal and child health and crippled children’s services in midwestern States because of greater unemployment, which is partly due to the shift of unskilled laborers from rural to urban areas, and also due to continued drought and crop failure. Several States as a result are receiving requests for additional well child conferences and prenatal clinics. Complete maternity care for medically indigent maternity patients in depressed areas of West Virginia has increased from two to seven areas. Two hundred and sixty patients were delivered without a fatality though the majority were considered a high-risk group. Public health nursing service, referrals of infants for well child super- vision, consultation by a district nutritionist and by a maternity nursing consultant have been part of the demonstration. The first national meeting on adolescent medicine was held in Denver in April. The 75 participants included pediatricians, inter- nists, psychiatrists, nurses, nutritionists, social workers, and psycholo- gists, who discussed the needs of the adolescent and how these can be met. The principal concern was the large proportion of youngsters who came to the clinics because of school failure, reading problems, psychosomatic complaints, and other indications of emotional mal- adaptation. During fiscal 1961 the special services rendered to mentally re- tarded children and their families by State health departments con- tinued to increase. A summary of the report of services provided by 38 States is as follows: Average per Item Number State Applications: Total handled this year-_—*_.- 2 eee 6, 485 171 IN Ware ae ae ee en ee ee ee 8, 054 212 Carriediover to. next) year_UtLeas ewe eter ees 1, 646 43 Cases: Totaliadmitted this yearo-— a 2 eee eee a ees 5, T47 151 Total. served.~ =. 32ers ee ey A ee ea 10, 644 280 Carrientover to next: Verne ee a ee eee ee 6, 404 169 Age Distribution of New Cases Item Age Group. Number Percent Total® feb tts 2b se DR ee 5, 646 100. 0 Under. yeatise 2 22 CEL de ee eee 138 2.4 1-4 years See ce ee eo ee ee ee ee 1, 787 31. 7 5~9 yearsl.. At Pl a ae oe c 2, 432 43.1 10-14. yeatstaack $tlks bot Roe chen nenenatancnas 981 17.4 15-20 yearse sie oe en aa ncedaadasnentaoccena 808 5.4 1 Wxcluded cases for which age was not stated, Social Security Administration 93 This is a 32-percent increase in new applications and approximately a 20-percent increase in the total number of cases served. The number of children requiring continuing services showed an 80-percent in- crease over 1958. Efforts to reach more new cases and to spread the services and consultation available through these services are evident through such new developments as: 1. New mental retardation clinics have been established—A new consultation and evaluation clinic in the Children’s Hospital of Louis- ville, Ky., despite rapid expansion, had 50 children on the waiting list by June. In April, a new mental retardation clinic opened for service in Columbia, 8.C. 2. Greater geographic coverage has been achieved—For example, in Georgia, the special project area had been expanded from three to six counties; in Alabama, the special project is offering consultation and some clinic services statewide. 3. New approaches are underway.—The California special project clinical team at Children’s Hospital, Los Angeles, is successfully training local health department staffs to carry out services inde- pendently. The Connecticut Community Program for Retarded Children has developed activities of diagnostic and counseling serv- ices for young children, community planning and education of pro- fessional and lay groups. 4. Critical evaluation of the program is underway in a number of States—For example, the Maine mental retardation clinic has re- ported on its first 3 years of experience. Since the percentage of severely retarded declined each year, the possibility of habilitation is greater. 5. Training activities have been undertaken in many States —For example, the Florida State Board of Health, through the Dade County Developmental Evaluation Clinic, was host to the first National Work- shop for Social Workers in Mental Retardation Projects held at Miami Beach, Fla., April 4-7, 1961. Some 26 States have set up programs to detect and treat phenyl- ketonuria—an inherited metabolic disorder associated with mental retardation. More than 25 infants with this condition were detected the past year and placed under treatment for prevention of mental retardation. For example, Michigan has had a program of casefind- ing, diagnosis, and treatment of PKU. In Indiana, legislation has been passed which requires the State Board of Health to carry out an educational program for physicians, nurses, hospitals, and the public on phenylketonuria. To implement this legislation, 10,000 copies of the Children’s Bureau pamphlet Phenylketonuria have been purchased for distribution to all physicians and hospitals. In Region 94. Department of Health, Education, and Welfare, 1961 IIT, all States except North Carolina have adopted a test for the detection of phenylketonuria in the well-child and pediatric services. CRIPPLED CHILDREN’S SERVICES All the States (excepting Arizona), the District of Columbia, Puerto Rico, the Virgin Islands, and Guam are participating in the crippled children’s programs. Although the State agency auspices vary, the objective is uniform; namely, to locate children who require care and to provide restoration through diagnosis, medical and surgi- cal treatment, and alleviation of unfavorable social and psychological influences which adversely affect the degree and duration of the dis- ability. The appropriation for crippled children’s services in fiscal 1961 was $20 million. State crippled children’s programs throughout the country provided care to 339,000 children in 1959 with many different impairments. For every 1,000 children under 21 years of age in the general population, 4,9 children were under care in crippled children’s programs. Children with other than orthopedic defects now constitute the largest group in the crippled children’s programs. Although the actual number of children with orthopedic defects has not declined, each year the States broaden their programs to include other handi- capping conditions such as cystic fibrosis, nephrosis, epilepsy, hearing, and certain neurological defects. A new pilot program designed to reduce the high mortality of in- fants born with congenital defects incompatible with life has been established at the Children’s Hospital in Philadelphia with special Children’s Bureau funds. The unit has highly trained staff and is patterned after a similar facility in Liverpool, England, which has proved the life-saving value of prompt, experienced surgical correc- tion and intensive pre- and post-surgical nursing and medical care. Among the nonorthopedic diagnoses reported by State agencies to the Children’s Bureau, congenital malformations of the circulatory system have shown a striking increase, attributable in large measure to the significant advances in heart surgery in recent years. From a little more than 2,200 children with congenital heart disease served in 1950, the number has grown to 14,450 by the close of the decade. Each year additional States develop their own facilities with spe- cially trained personnel for the care of their own children with congenital heart defects. For example, Hawaii engaged a team from the University of Minnesota to review the diagnostic and treatment services available for children with congenital heart disease. The team advised that the diagnostic services needed strengthening but that treatment, including open heart surgery, appeared to be satis- factory. Washington has further developed its program. The Cali- Social Security Administration 95 fornia Regional Congenital Heart Project was adjusted during the year to permit acceptance of children from American Samoa. The trend toward developing services for the multiply handicapped and for children with various handicaps continues. The increasing acceptance of treatment of the child rather than his disorder, the large number of children in mental retardation clinics with additional handicaps, the shortage of trained personnel and funds to staff spe- cialized clinics, and the increasing knowledge about neurological disorders contribute to the consolidation of services and the application of multidisciplinary services. The trend is particularly evident in Pennsylvania, Kansas, New York, Maryland, Maine, and Connecticut. While States continue to expand their services in hearing conser- vation for the school-age population, there is an especially marked increase in interest in screening procedures for the infant and pre- school child. Institutes are being planned to instruct health per- sonnel in nonaudiometric screening techniques. Tape recorded tests have been devised to conduct screening at the ages of 3 and 4. For example, the Alaska study of prevention of hearing loss by control of chronic otitis media has been completed. The Alaska speech and hearing consultant has drafted a manual on hearing testing to be used primarily with nurses and will conduct training workshops for them. This is part of the effort to extend service to areas in the State beyond southeast where most of the program activity has been concentrated to date. Colorado and Oregon have produced films for both lay and pro- fessional viewers on their hearing conservation work. As part of a hearing conservation project in Hawaii, a study of etiology is under- way in Oahu. A statewide clinic for children who have a marked hearing impair- ment has been established in Atlanta, Ga., for children referred from the regular crippled children’s clinics; a team of otologist, speech therapist, audiologist, psychologist, and public health nurse partici- pate. The clinic is held at the Atlanta Speech School where various services are available on a fee basis. The program plans to develop similar diagnostic clinics in two centers as funds and clinical resources become available. Hearing aids are now being provided on a limited basis. Maryland has initiated a program of dental treatment for physi- cally handicapped and mentally retarded children at the Children’s Hospital in Baltimore. Diagnostic treatment, and follow-up services for children on an out-patient as well as in-patient basis are provided. Federal and State staff continue to participate in conferences, work- shops, and other forms of training. The following are examples: A biregional institute on Neurologically Handicapping Conditions in Children was sponsored by the University of California, School 96 Department of Health, Education, and Welfare, 1961 of Public Health and the California Department of Public Health, and financed by a special grant from the Children’s Bureau. The Children’s Bureau Division of Health Services, in cooperation with the Georgia Department of Public Health, sponsored a regional meeting of personnel working in crippled children’s programs. A variety of diagnostic and administrative problems was discussed in both general and group sessions. A regional conference on hearing conservation was held in Eliza- bethtown, Ky., to provide inservice training for public health nurses and health officers. A biregional conference of maternal and child health and crippled children’s staffs of the 10 States in Regions I and II was held to pro- mote professional communication among these geographically selected States. Four service areas were of particular interest: cystic fibrosis, phenylketonuria, multiple handicaps, and hospital consultation. CHILD WELFARE SERVICES Fiscal year 1961 brought new opportunities—and new challenges— to the Bureau in the field of child welfare. The authorization for these services was raised to a new high and in addition, new research and demonstration grants in child welfare were authorized by the 1960 amendments to Title V, Part 3. RESEARCH AND DEMONSTRATION PROJECTS IN CHILD WELFARE General plans for the administration of this program have been set up. The 1962 Departmental appropriation bill provides $350,000 for research and demonstration projects in child welfare. As a first step in implementing this program, 21 nationally known research and program consultants met with Children’s Bureau staff in December 1960 to consider areas of child welfare needing research and demonstration, methods of developing worthwhile projects, and priorities to be considered. Priorities were urged in such broad subject matter fields as removal of children from their homes, juvenile delinquency, administration and organization of child welfare services, information to strengthen direct services to children at the local level, and criteria for decision making in services for children. Participants indicated that great weight should be given to studies of the whole process of the “child removed from home.” The group stated its conviction that the Children’s Bureau has a strong role of leadership, stimulation, and coordination in this new program. Social Security Administration 97 FINANCING CHILD WELFARE PROGRAMS Major developments in the Federal grant-in-aid program for child welfare services during fiscal 1961 included: 1. An increase in the appropriation to $13,666,000—$666,000 over the amount appropriated for the fiscal year 1960. 2. Only a minimum amount left as balance in the Federal Treasury (0.4 percent), with a record set in the amount paid out to the States of the total appropriation. This balance represents an all-time low. 3. The amount of $64,467 released by two States (Guam $52,467 and Idaho $12,000) and reallotted to 23 States on February 6, 1961. The amounts so reallotted ranged from $413.00 (Vermont) to $9,864 (New York). 4. Participation of Guam in the program the last quarter of fiscal 1961. Even though the beginning child welfare program is limited, a start has been made, with promise of future expansion. State legislatures in most areas of the country have provided some increases in appropriations for operating the child welfare program this past year. Most of these State funds continue to be absorbed in meeting the costs of the regular, on-going programs however. PERSONNEL The 1960 study on Salaries and Working Conditions of Social Wel- fare Manpower provides current information on the 116,000 workers in welfare, health, rehabilitation and recreation settings in govern- mental and voluntary agencies. Personnel in child welfare programs, in which large employment increases over 1950 were recorded, ac- counted for 21 percent of these workers. Over the 10-year period, child welfare employees in professional social work positions increased 74 percent. This represented a rise in numbers from 4,163 in 1950 to 7,264 in 1960. The number of employees with full professional education working primarily in public child welfare programs more than doubled in the decade—from 820 in 1950 to 1,881 in 1960. In 1960, 26 percent of all employees had full professional social work education as com- pared with 19.7 percent in 1950. But this increase by no means kept abreast of the increase in need for services with the result that the proportion of employees with no graduate education in social work rose to 46.2 percent as contrasted with 39.9 percent in 1950. Salaries rose 68 percent in the decade. In 1960, one caseworker in four received an annual salary of $5,200 or more. Professional social workers are still at a competitive disadvantage with other professional groups in the public services. The need for qualified personnel continues to be acute. Gains have been made in the proportion of trained staff in administrative, con- 938 Department of Health, Education, and Welfare, 1961 sultative, and supervisory positions; a smaller proportion of trained child welfare workers are found at the local level. Stipends for educational leave have been the chief means used by the States of increasing the proportion of supervisors with full pro- fessional training. Many States have not been able to provide enough stipends for educational leave to maintain a total staff of trained workers. Expansion of services and coverage in most areas of the country has only been possible through the addition of workers with- out training. States are taking steps to face this situation realistically through expanded educational leave and in-service training oppor- tunities and efforts to improve the existing bases for staff assignments. LEGISLATION The Children’s Bureau’s new legislative guides on termination of parental rights and responsibilities and the adoption of children were completed during this fiscal year. In preliminary form, copies were distributed to all State welfare departments and to a limited number of voluntary agencies. These guides are now at the Government Printing Office and printed copies will be available shortly. In addition to the September national ad hoc meeting on the new guide material, two legislative workshops were held. One in Atlanta with the six States participating together with representatives of the Office of General Counsel and the Children’s Bureau, the other in San Francisco and participants included representatives from eight States. State representatives included staff members from State attorney general offices. Many of the States and certain voluntary groups are already using these guides in studying, developing, and drafting proposals for improving present adoption laws; for consultation and advisory service to State and local officials, commissions and agency boards; and in developing and improving official] State and local manuals in this important area. PROGRAM REVIEW AND ASSESSMENT A number of separate developments seem to forecast a critical “new look” at child welfare and welfare programs in general. These developments have many dimensions and stem from numerous sources. Some of them include: 1. The increasing costs of programs and the inadequacies of State and local public and voluntary financing. 2. No appreciable gain in closing the gap between mounting needs and resources. 3. Critical reappraisal of practices in certain areas which in turn affect the structure for administering services. Social Security Administration 99 4, A resurgence of interest on the part of citizens in the needs of children, and how they are being met, attributable to the 1960 White House Conference on Children and Youth. 5. Increasing availability of research funds from foundation and governmental sources. 6. Steps to develop, refine, and adapt cost analysis and work meas- urement techniques to the social service field. 7. Continuous stimulation given by Bureau specialists and regional staff to attain more positive direction and leadership at the State level. The role of the national voluntary agencies should be recognized here also. Review of current practice this fiscal year has been directed pri- marily to foster care. State agencies are trying to improve adminis- trative policies and practices, after having some type of review of their children in foster care. CHILD WELFARE SERVICES IN SPECIAL AREAS The continued pressure for providing services to children in foster care and adoption, along with limited staff resources has continued to deter any marked development of basic services for children in their own homes. In those States which have initiated a “suitable home” provision in their ADC programs, child welfare staff have worked closely with the public assistance personnel to encourage policy which will reflect adequate protections for families and children. The relationship between the two programs has been thrown into sharp focus with passage of Federal legislation authorizing a limited program of foster care (effective May 1, 1961—June 30, 1962) for chil- dren receiving ADC who are removed from their own homes by a court of competent jurisdiction because they lacked proper care and protection. The amendment also provides that States choosing to come under this program shall use to the maximum extent practicable staff in the child welfare program. A joint Children’s Bureau-Public Assistance committee was ap- pointed to work on policies and procedures to implement the new amendment. The draft material was reviewed and discussed by a selected group of State administrators, public assistance and child welfare directors. Regional and central office staff of both Bureaus met together in Washington on June 27-28 to consider the draft ma- terial developed by the work group. The protection of children and their families was the paramount concern and interest of everyone participating in these two days of meetings. The plight of young children in families seeking divorce and a growing realization of the importance of strengthening and preserving 100 Department of Health, Education, and Welfare, 1961 family life have spurred greater interest in court counseling services. Both Colorado and Maine have expanded such services after successful demonstration project phases. Establishment of new homemaker programs under public aegis this year has also been primarily on a pilot basis. It is encouraging that where such services have been established, agencies have been success- ful in demonstrating their value. For example 25 homemakers are now employed under the public program in nine counties in Colorado. The Knox County, Tenn., homemaker service is looking forward to expansion and the Tennessee department plans to establish a similar service in Memphis. On the national level, the Advisory Committee to the National Com- mittee on Homemaker Service on which the Children’s Bureau has a representative, has developed a detailed plan for an ongoing national mechanism for promoting homemaker service. The National Health Council and the National Social Welfare Assembly are the agencies responsible for seeking foundation funds to support a new independent national homemaker organization. Three hundred and ninety thou- sand dollars is being requested for a 5-year experimentation period. It is expected that after two years, the amount needed from founda- tions will decrease as provision for member agency fees, individual fees, and the like is made. The report of the National Conference on Day Care for Children (November 17-18, 1960) is completed and will be distributed in the early fall of 1961. The report is a compilation of the speeches, discus- sion groups, content, and recommendations made by the Conference. All the regions report that much interest was generated “back home” by the Conference. A genuine awakening seems to be occurring in many communities as to the seriousness of the needs in this area. Lack of public financing to underpin the service remains one of the major blocks to any real establishment of day-care programs. “Children of Change,” the film on day care produced jointly by the Pennsylvania State Department of Public Welfare and the Children’s Bureau for the national conference, has been used effectively for com- munity group discussions. With few exceptions a regional roundup shows that major State activity this year was devoted to improving licensing functions rather than initiation of new day-care programs by way of facilities. The publication of Deterrents to Farly Prenatal Care and Social Services Among Women Pregnant Out of Wedlock, 1 New York State Department of Social Welfare Study made with the use of Federal child welfare services funds in cooperation with the Com- munity Council of Greater New York, was an important development in the area of services to unmarried mothers, This survey is a first Social Security Administration 101 phase of a larger research demonstration project, with the second phase to deal with the development of “reaching out” techniques to overcome the obstacles to obtaining social services and early prenatal care. The major reason for failure for the unmarried mother to use avail- able social agencies for guidance and aid is that they see no need to do so. Only one-fifth seek help from a social agency in making plans for the baby. The majority of white mothers expect to place the babies for adoption, but 87 percent of Negro unmarried mothers and 94 percent of unmarried Puerto Rican mothers plan to keep their babies. This and other studies show that social, medical and legal resources for services to unmarried mothers remain inadequate. Although vol- untary and public welfare agencies indicate that services are available, they are often limited to community residents and to adoptive services for the baby. Funds are generally lacking for maternity home care, making it possible for individuals to arrange for hospital and medical care in return for adoptive placement of the child. An interesting trend seems to be developing with respect to the “demand” for children for adoption. For the last decade, the trend in the number of adoptions has been steadily upward. The estimated number of adoptions reached 102,000 in 1959. From opposite ends of the country, and from both public and voluntary agencies, information comes of a considerable decrease in the number of adoptive applicants. This decrease in adoptive applicants is being attributed variously to economic trends, world tensions, increased medical knowledge re- garding fertility, and public impatience with long waiting lists. One of the natural results of the decrease in applications and an increase in the number of children available for placement has been a shortening of the waiting period. The improvement of specific adoption services, including adequate legislation, is seen as an important goal by States. Many States seem to be unaware of the interrelatedness of one service area with other program areas, however, nor do they appear to recognize the im- portance of this element in planning for improved services. Very little work has been done, for example, in exploring the situations of children with families, who are given up for adoption. In the field of unprotected adoptions, the California State Depart- ment of Social Welfare study of black market operations with particular emphasis on interstate rings, has driven home how far we are from correcting the root causes for this situation. Practices harm- ful to the welfare of children and against sound public policy were revealed, such as traffic in babies; attorneys and doctors placing chil- dren in violation of State laws; fees ranging from $3,000-$7,500; and 102 Department of Health, Education, and Welfare, 1961 advertising for mothers who would release their babies for adoption. Strengthened adoption legislation in at least one State is attributed to the California investigation which was partially financed through Federal child welfare services funds. Greater public awareness of the extent of the need for facilities for mentally retarded children (sparked by parental demands for im- proved services) has resulted in expanded residential facilities. In- formation available within the past year indicates that the number of State institutions in the United States has increased in the past three years from 99 to 111. The number of known private institutions has more than doubled—from 182 to nearly 400.° Studies in various States indicate, however, that the addition of new facilities has not served to reduce the size of waiting lists, and that in many instances States have outstripped their fiscal capacity to build more institutions. These developments have focused attention on the need for more selective criteria in admissions, stepped up place- ment programs and expanded community services in foster family care, group day care, and other social services. A number of States are reexamining their standards and licensing procedures relative to residential and day-care facilities for retarded children. In the main, these resources are sponsored by commercial interests or parent associations. Many facilities are substandard or in some instances exempt from licensing. This has led to the for- mulation of new standards, in which the Bureau’s specialist in this area and some of the regional child welfare representatives have participated. The Bureau has continued to work with national organizations, State agencies, and schools of social work in regard to training and education in mental retardation. In line with the objective of enriching the curriculum of schools of social work with content on mental retardation, emphasis has been given to the development of case records and other teaching material. Immigration of Cuban citizens and unattached children has become a problem of huge proportions in Miami, Florida. At the end of June, there were 657 unaccompanied Cuban children in foster care; 198 in the Miami area and 459 in 33 communities in 19 States. The vast majority of the children were under care of Catholic agencies. The Florida State Department of Public Welfare agreed to be the agent for the Department of Health, Education, and Welfare in plan- ning for these children and in the use of Federal funds for their care. The administrative task is a very heavy one and the Florida State Department of Public Welfare has contributed an outstanding serv- ° Based on statistics collected by the National Institute of Mental Health (1959), and the 1960 American Association on Mental Deficiency Directory. Social Security Administration 103 ice to the Nation in arranging care for these Cuban children. The Children’s Bureau staff from both its central office and regional office has spent considerable time in consultation, both in the early plan- ning for the program and now with the Srey where the children are being placed. The Bureau has participated in the development of the Emergency Welfare Service Program by preparing guides and material on Care and Protection of Children as a part of the Emergency Social Serv- ices document. The report by Dunlap and Associates on Protection of Institutionalized Population Against Fall Out, which included five institutions for children, has been reviewed and changes recom- mended. Staff is also assisting in the development of a handbook for superintendents of welfare institutions, Civil Defense Emergency Planning in Welfare Institutions, related to the findings of the Dunlap Study. Five Emergency Welfare Services regional or biregional meetings were held; one purpose of the meetings was to introduce to the States the basic document Emergency Welfare Services—Guidelines and Structure and its Supplement A: Fiscal Policies and Federal-State Agreements. JUVENILE DELINQUENCY SERVICE During the last half of the fiscal year, the Bureau’s staff spent a great deal of time meeting with officials of the President’s Committee on Juvenile Delinquency and Youth Crime, in securing and develop- ing information for use by this Committee, and in developing the Administration’s legislative program in the field of juvenile delinquency. Juvenile delinquency continues to be a subject of great public interest and concern. Both Congress and State Legislatures were active. State Legislation The trend to the “get tough” attitude continued. In at least three States, bills were introduced to lower the juvenile court age. In one, a bill was introduced to raise it from 16 years to 18 years. Apparently none of these bills were passed. In at least five States, bills were introduced which would have opened delinquency hearings to the public and permitted publica- tions of names; in two of these jurisdictions, the bills were voted down, in three no action was taken. Legislation imposing a financial liability on parents for the delin- quent acts of children was introduced in at least six States; one law was passed but vetoed by the Governor, two laws were not passed, 104 Department of Health, Education, and Welfare, 1961 and as far as it is known, no action was taken on the rest. About one- third of the States have now passed such laws. As far as is known, none of them have been tested as to constitutionality even though serious questions have been raised as to their legality and social desirability. At least five States introduced legislation which would permit the establishment of camp programs; in four the legislation passed, and in one it was defeated. In at least seven States, considerable activity has taken place with respect to the establishment of a family court. In at least nine juris- dictions, legislation was introduced amending the existing juvenile court statutes, some related to the strengthening of probation service and at least three to the improvement of detention facilities and proce- dures. Probably the most important State legislation in this area was that passed in California, which brings about major improvements in the juvenile court law. This was the result of a long, careful, well- documented study by the Governor’s Committee on Criminal Justice. The legislation incorporated many of the newer standards advo- cated by the Children’s Bureau in Standards for Specialized Courts Dealing with Children and the new revision of the Standard Juvenile Court Act. The Interstate Compact on Juveniles was passed in four more States. This brings the number of States that joined the Compact to 34. Consultation The volume of consultation was greater this fiscal year than in previous years. Consultation in the field, by correspondence, or office interviews was provided in response to 815 requests. AI] but 12 of the States received some type of consultation service during the year. Over 80 foreign visitors were provided program information and tech- nical assistance through office interviews. Program Trends Increased emphasis was evident on the community organization approach to achieve better planned and coordinated programs to re- duce juvenile delinquency and to strengthen these programs. The urgent need for coordination and the spread of community organiza- tion concepts to achieve this were given impetus by the 1960 White House Conference on Children and Youth. Interest and activity in planning and operating services and pro- grams designed wholly or in part to prevent delinquency is very much on the increase. The conviction seems to be growing around the coun- try that dollars and human resources channeled into sound preventive work are likely to yield more visible returns in checking the rise of juvenile delinquency. Social Security Administration 105 The problem posed by the mounting number of unemployed out-of- school youth was of widespread concern during the past year, par- ticularly in terms of the impact on the tota] delinquency problem. (The present unemployment rate is roughly 5 percent for all age brackets while unemployment among youth under 20 years of age is 20 percent or four times greater.) As the population of sprawling metropolitan areas continues to grow, communities are intensifying their effort to develop an effective planning and coordinating mechanism. Hopefully, this will bring about more interagency teamwork and clarify functions among the many public and private programs concerned with juvenile delinquency. The role of girl gang auxiliaries to hostile, aggressive boy gangs received attention in a number of urban areas. Recent newspaper stories calling attention to the existence of girl gangs have reminded the public that juvenile delinquency is not exclusively a male youth problem. The contribution of citizen leaders to the overall national effort to reduce delinquency is growing. The effectiveness of strong lay com- mittees having sound professional guidance in generating legislative and other action in behalf of children continues to be demonstrated in a large number of States and communities. The battle against juvenile delinquency continues to be fought with inadequate weapons. Too few personnel, most of whom are inade- quately prepared, have failed to stem the tide. Training courses on the local and State level, short courses at universities and colleges, stipends for students, graduate fellowships, curriculums for various kinds of police training—all represent major needs. Professional staff of juvenile institutions are eager to learn how to introduce group services and apply principles of group living to strengthen institutional treatment programs. There seems to be a tendency among institutional workers to regard group programs as treatment shortcuts to what individual counseling and casework seek to accomplish. Another tendency is to lump group counseling, group therapy, leisure time activities, and group living concepts together without understanding wherein each is different. Several States without a permanent statutory agency responsible for actively coordinating efforts in the youth field moved closer to this. These States are aware of the need for strengthened coordina- tion and communication among all agencies and groups working on behalf of children and youth. Significant progress was made toward consolidating the interest in delinquency prevention of official city, metropolitan (city-county) and State youth commissions throughout the country. Sustained consul- tation was given by the Bureau’s delinquency staff during the year 626936628 106 Department of Health, Education, and Welfare, 1961 to the Planning Committee established by these Commissions at their initial joint meeting in Washington in March 1960. This Committee was instructed to draft a statement of purpose together with recom- mendations for organization. The name “Conference of Public Youth Agencies” was adopted by the organization to enable youth commissions such as those in Chicago and Detroit with a concern for youth welfare generally as well as delinquency prevention to be active members. The publication Police Contacts with Juveniles: Perspectives and Guidelines is in draft form for reviewing purposes. It is being de- veloped in cooperation with the International Association of Chiefs of Police, International Juvenile Officers’ Association, International Association of Women Police, and the National Council on Crime and Delinquency. The trend to building camps continues as a means of providing group care for delinquent boys. Reducing the average length of stay in a training school is a technique employed by many States to cope with the increased size of their institutional populations. Research con- tinues to be a growing enterprise in the institutional field. Group counseling and group psychotherapy command considerable attention in the field in spite of the lack of personnel to carry it out. Increasing concern is reflected by the States about the institutional treatment of the older more aggressive youth. Other areas of interest in institu- tional problems include the function of halfway houses, adequate staff patterns for various kinds of institutions, how to effect necessary changes in a traditional program without disrupting the complete program, the development of an adequate intake and orientation program, etc. A great number of courts, including judges and probation staff, continue to be concerned about the degree to which they are meeting their responsibilities. Difficulties are encountered in applying theo- retical concepts to daily practices because many of the intervening steps—between the theory and daily practice—have not been spelled out; poorly trained court staff; inadequate budget and, in some in- stances, a lack of court leadership. Although the clear statements of the definition of detention, the criteria of admission to detention, and the standards of good detention care (contained in the National Council on Crime and Delinquency’s Standards and Guides for Detention Care of Children and Youth) are “accepted” on the surface, practice continues to reflect a wide divergence of thought with respect to the nature of detention care, which children should be detained, and what detention should accom- plish. The number of detention homes continues to grow; unfortu- nately, the number of children held in jail does not seem to decrease. Social Security Administration 107 International Activities UNITED NATIONS INTERNATIONAL CHILDREN’S FUND This was the first year for the new cycle of meetings—a program session in December and a major policy and program session in June. At the mid-winter session (postponed from December to January because of the prolongation of the General Assembly) allocations were approved for $16 million to 122 projects bringing the total allocation for 1960 to $25,800,000. Increasing aid to Africa was emphasized. An emergency allocation of $286,000 was made to the Congo. The Chief of the Bureau headed the U.S. Delegation to this meeting and the Deputy Chief served as Special Adviser. The main Board session was held in June. From the standpoint of program orientation this meeting was one of the most important in UNICEF’s history. Major changes in policy were before the Board and were accepted in toto with strong support from the U.S. Delegation. Stated simply, instead of having a limited “line” of kinds of aid which countries may have, UNICEF will encourage countries to sur- vey their own needs, come up with their priorities for children, and request aid in these terms. The Board had before it surveys of chil- dren’s needs produced by the Specialized Agencies of the United Nations and some countries, which pointed up the wide range of prob- lems and the different priorities assigned to these in different parts of the world. This survey of needs was the basis for a policy change toward greater flexibility in programs with a wider spectrum from which a country might choose. On the basis of another survey—that of training in UNICEF- assisted projects—the policy of greater assistance to training, espe- cially for training facilities within countries was adopted. The kinds of aid UNICEF may extend to training projects have been expanded to include payment of salaries of instructors, stipends, and fellowships for trainees, as well as equipment and supplies. Continuing aid to malaria eradication with the current ceiling of $10 million per year was accepted, after considerable debate as to its appropriateness, as well as concern for the failures of some campaigns. At this session about $10 million was allocated to 83 projects in 51 countries and territories. The only unusual project was a program for the Congo (Leopold- ville) to initiate training for unemployed youth and to stimulate self- help at the village level. The Deputy Chief of the Bureau served as Special Adviser on the Delegation; Mr. Fred DelliQuadri, as U.S. Representative. 108 Department of Health, Education, and Welfare, 1961 On the invitation of the Mexican Government, the Program Com- mittee of UNICEF spent a week in Mexico preceding the Board meeting, to visit health programs. Seventeen representatives from as many countries spent a very profitable as well as pleasurable time seeing the “grass roots” of UNICEF aid. The Deputy Chief of the Bureau represented the United States. The group saw urban and rural health centers, visited training centers, village sanitation proj- ects, malaria eradication programs, hospitals, nurseries, and even homes. The malaria eradication program, assisted by UNICEF, provided opportunity for observation of house spraying in remote rural areas. Land once uninhabitable because of malaria is now free of the disease, and people are now living there. The group visited several of these projects—small communities of about 100 families. The group visited a number of health centers, which are being opened at the rate of one a day in Mexico. UNICEF provides equipment and assists with training of staff for these centers. MATERNAL AND CHILD CARE AND RELATED RESEARCH MISSION TO THE U.S.S.R. In mid-October the mission went to the Soviet Union for a 30-day study of research relating to the perinatal and early infancy periods of life. Sponsored by the National Institute of Neurologica] Diseases and Blindness, this mission was the first of five in the field of Public Health and the Medical Sciences for the 1960-61 period. The mission was composed of the Deputy Chief of the Bureau, Dr. Stewart Clifford, Chairman, of Children’s Hospital, Boston; Dr. Allan C. Barnes, Professor and Chairman of the Department of Obstetrics and Gynecology, Johns-Hopkins Hospital; Dr. Bernard G. Greenberg, of the University of North Carolina School of Public Health; Dr. Edith L. Potter, Professor of Pathology, University of Chicago; and Dr. Fred S. Rosen, Research Fellow in Medicine at Children’s Hospital in Boston. During their 4-week stay the mission visited about 30 institutions in the four cities of Moscow, Leningrad, Kiev, and Tbilisi. Hospitals, clinics, research institutes, creches, kindergartens, and a collective farm were seen and many research workers interviewed. INTERNATIONAL RESEARCH (FOREIGN CURRENCY PROGRAM) Under authority of sec. 104(k) of P.L. 480 delegated to the De- partment of Health, Education, and Welfare and redelegated by the Secretary to the Commissioner of Social Security, the Children’s Bu- reau developed a program and budget proposals for 1962 for projects in its sphere of responsibility. Eight are in maternal and child health in six countries, two are for child welfare in four countries, and one Social Security Administration 109 project is for juvenile delinquency. The program is implemented through the use of excess foreign currencies. The International Health Research Act of 1960 (P.L. 610) which would have provided a somewhat broader program in child health research was not activated. CONSULTANT SERVICES Six professional people recruited by the Children’s Bureau worked abroad under the International Cooperation Administration during the year: three social workers, one physician, and two nurses. One of these nurses, in Guatemala, has participated in the planning of a nationwide maternal and child health program, for which the Chil- dren’s Bureau is at present training a doctor and a nurse from Guatemala. TRAINING During the year the Children’s Bureau planned and arranged train- ing programs for 64 specialists from 28 countries. Thirty-one of these were physicians, 1 was a dentist; there were 12 nurses, 10 social work- ers, 5 police officials, 1 judge, 2 lawyers, and a minister and his wife. The large majority of the physicians pursued a clinical specialty, 12 in obstetrics and gynecology and 9 in pediatrics. The others studied in the field of maternal and child health. Ten of the 12 nurses attended a college of nursing and followed a program which emphasized either pediatric or maternity nursing. Four of these are candidates for a degree—two for the B.S. and two for the M.S. Of the 11 trainees who had a primary interest in welfare services for children, 10 were social workers and 1, a lawyer, was an adminis- trative official in the French Ministry of Labor and Social Security. Five police officials, a judge, and one lawyer all came to the Bureau for program planning because their major interest was juvenile delinquency. The largest group of trainees (48) was sponsored by ICA and physicians accounted for the majority of these trainees. Both the number of professions represented by the students for whom programs are planned and implemented, and the type of sub- specialty training requested, demonstrate the need for continuing ex- ploration of academic and observation training resources. For example, two pediatricians wished further specialization—one in the study of tuberculosis in children and one in neurology. Several of the social workers requested that a major part of their observation experi- ence be devoted to the organized use of volunteers and programs for training volunteers. The administration of recreation programs not 110 Department of Health, Education, and Welfare, 1961 only in neighborhood houses, but those organized on a city- or county- wide basis was an important item for several of the child welfare students. Vietnam sent the largest number of students from a single country— eight, of whom six were physicians—followed by India and Thailand with seven each. Vietnam, Thailand, and India sent 14 of the 31 physicians. The concentration in these countries is probably a re- flection of their plan to upgrade the quality of medical schools and medical care. The fact that all three of the Iraqi physicians received degrees in public health in the maternal and child health sequence is indicative of Iraq’s interest in extending maternal and child health services throughout the country. Twenty-eight of the 64 students had programs which lasted 12 months, the most frequent time period, and the programs for 8 were from 6 to 12 months’ duration. Fifteen of the students, all of them sponsored by ICA, either completed or are still following programs of 18 months or longer. Of these, 10 are physicians, all in clinical specialties, 4 are nurses and 1 is a social worker. At the end of the fiscal year, 38 students were continuing their pro- grams into the new year. A number of these will return to their homelands in the early fall to be replaced by new students beginning training in the United States. International visitors come to the Bureau from a number of sources, governmental and private, and many come on their own. They are interested in learning about the function and programs of the Bureau or have a specific interest in one or more of the Bureau’s areas of responsibility. During the year, 170 different visitors came from 70 countries. Appointments programmed for visitors ranged from conferences of an hour or two to programs extending several days to nearly two weeks. They sometimes included observation in and around Wash- ington or in and around the locale of a regional office. The Bureau’s visitors represent. a wide variety of professions, backgrounds and interests. Agencies such as the American Council on Education, the Govern- mental Affairs Institute and the National Social Welfare Assembly, which have contracts with the International Educational Exchange Service of the Department of State for training of foreign specialists, sometimes ask for guidance in selecting appropriate resources to which to send their visitors. CONSULTATION TO AMERICAN SPECIALISTS EN ROUTE TO FOREIGN ASSIGNMENTS While the number of American specialists who came to the Bureau for briefing before undertaking foreign assignments is small, it Social Security Administration 111 represents an interesting recognition of the Bureau’s international interests. For example, among these specialists was a social worker going to India to work in a child guidance clinic; another was a psy- chiatric social worker going to Afghanistan, Pakistan and Iran under the auspices of the State Department; another, a USIA Women’s Ac- tivities Adviser who came to the Bureau for orientation. TRANSLATIONS Last year a social worker in E] Salvador made a Spanish transla- tion of the Children’s Bureau pamphlet, Child Caring Institutions, by Martin Gula, but was unable to make arrangements to have it published. The Inter-American Children’s Institute took over the task of editing and publishing the translation titled /nternados de Bienestar Infantil and has distributed it through the Spanish-speak- ing countries. The Instituto San Gabriel Arcangel, a school for mentally retarded children in Lima, Peru, is in the process of translating the Children’s Bureau pamphlet, he Mentally Retarded Child at Home. OTHER ACTIVITIES Work was done on the development of material for the Peace Corps in relation to services in the fields of child welfare and maternal and child health that might be given abroad by members of the Corps. A publication, Z’he International Activities of the Children’s Bu- reau, was written in cooperation with the Division of Reports. Summary Fiscal 1961 brought many new and challenging opportunities to the Children’s Bureau. These were expressed in amendments to title V of the Social Security Act that raised the authorization of the three grant programs to a new high, authorized new research and demonstration project grants in child welfare, and provided that special project grants in the maternal and child health and crippled children’s programs could be made directly to institutions of higher learning. The recommendations of the 1960 White House Conference on Children and Youth were furnishing the impetus for many State and local agencies to reevaluate what they were doing to meet the needs of children and youth. In concert with these agencies the Children’s Bureau was analyzing its own functions in terms of 10-year goals. The advent of the new administration also was a potent force leading to the general reexamination of health and welfare programs. Fiscal 1961 was a year of steady progress and development for the Children’s Bureau and its programs. 112 Department of Health, Education, and Welfare, 1961 Federal Credit Unions The need for a Federal credit union program that existed in 1934 when the program was established still exists today. Established to provide a source of credit for persons of small means and to stimulate systematic savings, the program continues to promote sound credit and thrift practices among credit union members. The extent to which the program has strengthened family life, raised the standard of living of the members, and increased their self-reliance measures its effectiveness, but these are intangibles that are difficult, if not impossible, to measure. People were faced with financial problems in 1934, and they are faced with similar worries in 1961. An effective credit union program has helped to ameliorate these difficulties for its members in depression times and in times of economic prosperity. During 1960 alone, more than 414 million loans amounting to nearly $3 billion were made to members of Federal credit unions, and the 6.1 million members had savings in their credit unions in excess of $2.3 billion as the year ended. Loans have been made for a vast variety of provident and produc- tive purposes. Members have financed a better education for them- selves or their children, paid for needed medical, hospital, or dental care, bought livestock and equipment to operate their farms, and used the proceeds of a loan for numerous other necessary or desirable purposes. Other members have used their savings to accomplish these purposes, making a loan unnecessary. Savings have been encouraged in amounts as small as 25 cents, and the bulk of the savings accumu- lated in credit unions has come from small amounts set aside regularly. Average savings in Federal credit unions amounted to nearly $400 per member at the end of 1960, and since these savings were accumu- lated in small amounts at a time, much of it would have been frittered away had it not been for the existence of a convenient place to save in the credit union. There are at the present time two major gaps in the program. While there are now more than 6 million families participating in the Federal credit union program, potential membership exceeds 11 million. Thus, only slightly more than half—54 percent at the end of 1960—of the potential members actually belong to their credit unions. Continuing educational programs are needed to accomplish wider participation in the program, although slow but steady im- provement has been noted. Where only 39 percent of the potential members were actually participating in the program at the end of 1950, the proportion grew to 46 percent by the end of 1955, and continued up to 54 percent on December 31, 1960. Credit union service to low income groups is the other area that can and should be expanded. Chartering has been predominantly in factories and other industrial establishments, among workers who Social Security Administration 113 have shifted out of the low income category since the depression days of the 1930’s. Federal credit unions today serve the middle-income group, for the most part. Means to accomplish successful operation of credit unions among low income groups are being explored, and an early solution is anticipated that will make possible the chartering of Federal credit unions for these groups. Moving forward to fill in the gaps already noted and further exten- sion of credit union service to millions of our citizens are challenges that will remain with the Bureau far into the future. Growth has been encouraging up to now—it behooves us to do all we can to accelerate that growth. Usurious money lenders continue to take a heavy toll of the worker’s income, and with the continually mount- ing pressure on consumers to go into debt, the need for consumer education in the wise use of credit becomes increasingly more impor- tant. The expansion in consumer credit has not lessened the need for savings, and continuing stimulation of systematic savings by the mem- bers will go far to allay their fears of financial insecurity. Realiza- tion of these objectives will aid in stabilizing the credit structure of the United States, and will provide a further market for securities of the United States. Issuance of the 10,000th active Federal credit union charter in March 1961 marked an important milestone in credit union history. In presenting the charter to employees of the Inter-American Develop- ment Bank, Secretary Ribicoff said, “This charter has special significance since your credit union now becomes the 10,000th active Federal credit union and a part of a program which since June 26, 1934, has effectively demonstrated that these free enterprise institu- tions owned, controlled and managed by their members do render a genuine thrift service to the people of America and other lands as well.” Some 6,300,000 members had accumulated $214 billion in savings (shares) in their Federal credit unions as fiscal year 1961 ended. Although savings in Federal credit unions represent only a small frac- tion—less than 1 percent—of the total investments of individuals in savings accounts, U.S. Government bonds, and life insurance reserves, an accumulation of this magnitude represents a significant achieve- ment in thrift among the members. These savings have been amassed slowly, often in amounts of a dollar or so at a time, and because of this, it is quite likely that very little of this amount would have been saved had credit union facilities not been available. Savings not only benefit the savers, but the borrowers as well, since these savings represent the bulk of the funds available to the credit unions for lending purposes. Stimulated by the 1959 amend- ments to the Federal Credit Union Act, borrowings are now at an all-time high. In 1960, Federal credit union lending approached the $3-billion level, and on December 31, 1960, loans outstanding topped the $2-billion mark for the first time. A stepped-up demand for loans, which has outpaced the growth in savings in the past 2 years, 114 Department of Health, Education, and Welfare, 1961 CHART 7.—AVERAGE MEMBERSHIP PER FEDERAL CREDIT UNION AND AVERAGE SHARE HOLDINGS PER MEMBER, DECEMBER 31, 1948-60 Average membership Average shareholdings 700 Mies | Average membership mm @em Average shareholdings per member 600 500 400 $400 300 $300 200 $200 100 $100 1948 1950 1952 1954 1956 1958 1960 has resulted in increased borrowing by credit unions, liquidation of some of their investments, or both, in order to raise cash for lending purposes. Moving up 22 percent over the 1959 level, notes payable in Federal credit unions in 1960 represented 2.7 percent of their total liabilities, the largest proportion in 10 years. Total investments of Federal credit unions fell sharply in 1960, dropping not only below the 1959 level, but below the 1958 amount as well. This was the first year-to-year decline in investments since 1948. In the past 10 years, Federal credit unions have doubled in number, and resources have increased sixfold. Membership has tripled, and shareholdings are now some seven times the amount a decade ago. Communication between the Bureau and the Federal credit unions has been improved during the past year with publication of a new Bulletin. The first issue was sent to all Federal credit unions in March 1961, and numerous credit union officials have sent in favorable comments and many worthwhile suggestions for future issues. The Bulletin keeps officials currently informed on program developments. Social Security Administration 115 Two other major strides in improving communications with Federal credit unions were taken during the fiscal year with completion of a new Handbook for Federal Credit Unions and with the drafting of a new Supervisory Committee Manual. Both of these manuals are scheduled for distribution before the end of 1961. Recognition by the President of the value of self-help cooperatives and credit unions in helping to solve the social and economic problems of other countries gave impetus toward greater participation by the Bureau in international activities. The Bureau is working closely with the ICA Cooperative Review Committee, which is developing plans and policies to assist these self-help cooperatives in other countries of the free world. By continuously streamlining and improving procedures, the Bu- reau continues to meet its expenses of operation through fees paid by the Federal credit unions, and without appropriation of general funds. Increasing costs of operations, primarily resulting from periodic pay increases and other benefits for Bureau employees, have been absorbed without a corresponding increase in fees, and the fee schedule established in August 1958 remains unchanged as fiscal year 1961 ended. There were no amendments to the Federal Credit Union Act during the year. Table 1.—Social Security Administration: Funds available and obligations incurred, fiscal years 1961 and 1960 * {In thousands, data as of June 30, 1961} Funds available 2 Obligations incurred 1961 1960 1961 1960 POL aieeawete ener. nee tee ca eee waco cen oe aane $2, 471,014 | $2, 274, 364 | $2,470,676 | $2, 268, 911 Spe Oise Ce coe te Sa a ee a 2, 228, 833 2, 084, 000 2, 231, 990 2,079, 979 RCIA ISLAND gee eee Fee Se nes eee en 2,177,000 | 2,037,500 | 2, 180, 466 2, 033, 761 MACE ETaSH INET Come en nert ae ocean ae meee tee | ate ete asco lnen ate ee ee 1, 211, 709 1, 157, 523 CODES Tey sa ays it ae Saale Ae ae he AR es See 48, 517 48, 824 SLT iG Bey er8 eta COI OAR TN MR alee pe Se IR as ee ee a 704, 108 660, 232 Aid to the permanently and totally disabled___|__......_.__|-.---------- 182, 625 167, 182 MEpMEAneaSINvaNnce fOr. tNO:ASCG-as._—. son an dau n| dee see ee asalhete ee ceeee Oo, OUT Lanetcomecets Maternal and child health and welfare services_____ 51, 833 46, 500 51, 524 46, 218 Maternal and child health services____...------ 18. 167 17, 500 18,114 17, 443 Services for crippled children____.___..-.--_---- 20, 000 16, 000 19, 797 15, 873 Mnilotwelfsre'servicess. £4522... ...--__-2_-- 13, 666 13, 000 13, 613 12, 902 Cooperative Research and Demonstration Projects ____- FT ee ee 347i| 425. ae Agministrayive oxpouses 4). | 2202 l0e2-22-.-.-------.-_- 241, 831 190, 364 238, 339 188, 932 Office of the: Commissioner’. ..............-=-<2----. 669 613 659 602 Bureau of Old-Age and Survivors Insurance ®____-_-. 232, 200 181, 600 228, 909 180, 476 urea of Public Assistance... -.=...0-5.--s.0- 2, 727 2, 345 2, 677 2, 280 COLE (ekg 3 eC ees be Se RS ee 6 ke 2, 494 2, 300 2, 486 2, 278 White House Conference on Children and Youth_- 150 200 146 198 Bureau of Federal Credit Unions___.....-...-__-__- 3, 591 3, 306 3, 462 3, 098 1 Funds available and obligations reported by administrative agencies. 2 Funds made available by regular and supplemental appropriations, authorizations, transfers, allotments, recoveries, and fee collections for services rendered. 3 Includes $3,465,750 used from 1962 appropriation to complete 1961 requirements. 4 Funds made available and obligations incurred for salaries, printing and binding, communications, traveling expenses, and all other objects of expenditure. 5 Appropriations by Congress from general revenues accounted for approximately 50 percent of the ad- ministrative expenses of the Office of the Commissioner in 1960 and 1961; balance from old-age and survivors insurance trust fund. 6 Administrative costs of the old-age, survivors, and disability insurance program which involved benefit payments of $10,798,000,000 in 1960 and $11,884,000,000 in 1961. Does not include construction costs of new igecate ale Funds available: 1960, $7,633,744; 1961, $5,179,585. Obligations incurred: 1960, $2,454,189 1961, $4,212,692. 7 Includes expenses for investigating and reporting on matters pertaining to the welfare of children au- thorized by the act of 1912, as well as expenses for administration of grants to States. 116 Department of Health, Education, and Welfare, 1961 Table 2.—Financing social insurance under the Social Security Act: Contri- butions collected and trust fund operations, fiscal years 1959-61 {In millions; independently rounded] Item 1961 1960 1959 Contributions collected under— Federal Insurance Contributions Act !12_..___.---.-..---------- $12, 315 $10, 830 $8, 460 Federal Unemployment Tax Act 3 345 341 324 State unemployment insurance laws 45___.___-___----.---------- 2, 361 2, 165 1,675 Old-age and survivors insurance trust fund: \ Receipts, toga) sacces soeseae ee 11, 815 10, 342 8,105 | Net appropriations and deposits 11, 293 9, 843 7, 565 Net interest and profits on investments__..--___- 522 500 540 Expenditures, tOtal co sen - aa ce cence seee nee seen cnet aeee 11, 743 11, 055 9, 377 Monthly benefits and lump-sum payments. __ 11, 185 10, 270 9, 049 Transfers under financial interchange with railroad retire- ment account 3... eee ee, See. See Sees 322 583 121 Administration. -- 236 202 206 Assets, end of year....= ae ae ee ee ee. Bee 20, 900 20, 829 21, 541 Disability insurance trust fund: Receipts, total. -neeasr: (sete. eeeean tee eene eee. anes See. 1, 082 1,061 928 Net appropriations and deposits_...-..-..-------_- 1, 022 987 895 Transfers from railroad retirement account §___......----_._]_-------...- Pi ae 3 Net interest and profit 60 48 33 Expenditures, totale s.— oo 22s. cee. 746 560 360 Monthly ibenefitsu. seeks lean. (Saas See = 704 528 339 Transfers to railroad retirement account ® § | -ndewmcoctpalscapenepedee Administration_-_- 36 32 21 Assetsvend ofveartes. Se ee - Se Se UR ee 2, 504 2, 167 1, 667 State accounts in unemployment trust fund: Receipts, total ease. . eee. 5 ees See ee eee nates oe 2, 614 2, 351 2, 126 Deposits § 2, 417 2, 169 1, 946 Anterestiee: {eee eee. eee 196 182 179 Withdrawals for benefit payments-_-_-_. 3, 558 2, 366 2, 797 Assots, endiol years. Se. . opead ates 5 ete ee. See 5, 729 6, 673 6, 688 1 Contributions on earnings up to and including $4,200 a year in 1958 and $4,800 a year beginning Jan. 1, 1959. Contribution rate paid by employers and employees: 24 percent each beginning Jan. 1, 1957; 214 percent each beginning Jan. 1, 1959; 3 percent each beginning Jan. 1, 1960. Contribution rate paid by self- employed: 334 percent beginning Jan. 1, 1957; 334 percent beginning Jan. 1, 1959; 414 percent beginning Jan. 1, 1960. Includes deposits by States under voluntary agreements for coverage of State and local employees. Includes deductions to adjust for reimbursements to general funds of the Treasury of the estimated amount of employee taxes subject to refund on wages in excess of wage base. 2 Includes old-age and survivors insurance and, beginning Jan. 1, 1957, disability insurance contributions. 3 Prior to 1957 tax could be paid in quarterly installments by employers of 8 or more; beginning Jan. 31, 1957, tax payable annually on preceding year’s wages by employers of 4or more. Rate is 3 percent (be- ginning Jan. 1, 1961, 3.1 percent) on first $3,000 a year of wages paid to each employee by subject employer. Because of credit offset, permitted for contributions paid under State unemployment insurance laws (or for full contribution if reduced by State experience rating provisions), effective rate of 0.3 percent (beginning Jan, 1, 1961, 0.4 percent) of such wages. 4 Contributions plus penalties and interest collected from employers and contributions from employees, reported by State agencies, 5 Contributions and deposits by States usually differ slightly, because of time lag in making deposits. Deposits in the State accounts also include loans from the Federal unemployment account of the unemploy- ment trust fund and the distribution of Federal tax collections among the States under the Employment Security Administrative Financing Act of 1954. 6 Under the financial interchange with the railroad retirement account the two social security trust funds are to be placed in the financial position in which they would have been had railroad employment always been covered under the Social Security Act. Source: Compiled from Final Statement of Receipts and Expenditures of the United States Government, other Treasury reports, and State agency reports. Social Security Administration 117 Table 3.—Old-age, survivors, and disability insurance: Number of families and beneficiaries receiving benefits and average monthly benefit in current- payment status, by family group, end of December 1960 and December 1959 [In thousands, except for average benefit] Dec. 31, 1960 Dec. 31, 1959 Family classification of beneficiaries Number | Average Number | Average Number of monthly | Number of monthly of benefici- | amount of benefici- | amount families aries per families aries per family family ON oo a 10, 959.6 | 14, 844.6 |_...-_____ 10, 112.8 } 13, 703.9 |_-..-=-___ Retired-worker families__....._.__-___---- 8, 061..5.-}-10, 509.0 |. c---os0e JOO FS O5L6 tee eS Worker Jouly te 5223S 3 2. -.- 5, 741.8 5, 741.8 $69. 90 5, 320. 7 5, 320. 7 $68. 70 WAG Sse oe 22 282 22-2 2, 921.7 2,921.7 79. 90 2, 755.3 2, 755. 3 78. 00 LN eee a ee 2,820.2 | 2,820.2 59. 60 2, 565. 4 2, 565. 4 58. 70 Worker and aged wife____._- 2,122.0 | 4,243.9 123.90 | 2,029.4 | 4,058.8 121. 60 Worker and young wife ! 1.0 2.0 111.00 -8 1.6 118. 60 Worker and aged dependent husband- 14.3 28. 6 105. 50 14.7 29.3 103. 60 Worker and 1 or more children___----- 50. 2 113.4 119. 40 44.8 102.5 118. 90 Worker, wife aged 65 or over, and 1 or TS Cn 1G DE aa ae 22.0 67.4 157. 60 13.0 39.9 157. 30 Worker, young wife, and 1 or more PUN Grote ee eee oe 109.9 401.2 152. 30 102.1 378.3 151. 70 Worker, husband, and 1 or more chil- [ei ele ee -2 -6 115. 70 2 «6 123. 70 Survivor families 2; 449. S| 3, O68. Weil eee 2, 252:8 }| 3,312: 0: |.26.-2._ INS ALGS s e 1, 527.3 1, 627.3 57.70 1, 380.1 1, 380.1 56. 70 Aged widow and 1 or more children__- 14.2 29.2 112. 90 11.4 23.6 111. 20 Aged widow and 1 or 2aged ale ati AE ee Sa a us 3 -6 131.00 ok 3 130. 50 Aged dependent widower-_-__---.------ 2.0 2.0 54.10 1.9 1.9 53. 40 Widower and 1 or more children---__-- (3) ae 84. 40 () (2) 92. 60 Widowed mother only !___--__-------- 1.4 1.4 64. 20 a Re | BB 55. 40 Widowed mother! and 1 aged depen- Gentwateiitsssssscisss-2-~-4 5226252 (3) (2) 173. 70 0 0 0 Widowed mother and 1 child_______.-_ 171.9 343.9 131.70 159.7 319.4 129. 70 Widowed mother and 2 children_____-_ 113.4 340.1 188. 00 106. 4 319.2 170.70 Widowed mother and 3 or more ORIG lu i 113.8 547.6 181.70 108.2 620.1 178. 60 Widowed mother, 1 or more children, and 1 or 2 aged dependent parents-_-- 56 1.8 214. 70 4 1.6 219. 40 Divorced wife and 1 or more children_- 4 1.0 163. 40 «3 9 166. 80 MOET WTA Oe 296. 4 296. 4 58. 50 282.6 282. 6 56. 90 DiCMNGTGH Mean Jcancsanstans 106.6 213.2 122. 50 110.4 220.8 101. 30 Bist Me tca oe 38.3 115.0 155. 00 36.1 108. 4 129. 50 4 or more children 22.6 102. 5 157. 20 21.6 97.1 148. 00 1 or more children and 1 or 2 aged de- SoM hi: i: ar “Yi 1.5 137. 60 -8 1.8 136. 80 1 aged dependent parent_-__--- pi 31.6 31.6 60. 90 29.8 29.8 59. 60 2 aged peo parents--_--- 1.5 3.0 107. 90 137 3.3 104. 80 Disabled-wor es PETOOS coos a 455.4 O80) Gileacaetosns 334.4 A604: Powe Worker only_-._.---.--- 356. 8 356. 8 87.90 275.3 275.3 87.90 Male... 261.3 261.3 91. 90 206. 3 206. 3 91.90 Memale 2-222... 95. 5 95.5 76. 90 69.0 69.0 76. 10 Worker and aged wife____- 4 21.7 43.5 135. 60 17.4 34.8 135. 90 Worker and young wife 1_____-._______ a2 «4 143. 20 52 5 133. 20 Worker and aged dependent husband- z2 4 120. 70 +2 “Re 116. 60 Worker and 1 or more children___._... 22.0 55.8 154. 40 11.2 28. 2 153. 90 Worker, wife aged 65 or over, and 1 or Of Ue ok .3 186. 20 (?) a1 204. 00 nial young wife and 1 or more chil- Co) ee ee 54.4 230.3 189. 10 30.1 121.1 185. 60 1 Benefits to children were being withheld. 2 Less than 50. z ~ S mo 8s 2 £99 | 062 ‘FF 980 ‘LF SI NG 682 ‘¢ £'8¢ 06‘ 0'19 i aa. 2 Le BUR DON a 6F2 {AT 261 *F 06F ‘162 16 ‘ZI G6F ‘T 9°%% 199 ‘Fa £‘10F OFT ‘9% 6 tr Tie ees ae OOS, o TLL ‘2 992 ‘T S6I ‘es TEZ ‘26 689 Ze $60 ‘2 08ST $82 ‘2 GUE ~--1ddIsstsstyAq 8 688 ‘8 119 ‘% 696 ‘0% 916 ‘1% FL 201 02 ‘ST 8 "86% PLP ‘61 SNC ME git |S mere 8 OSOUUT TL ~ 62 ‘08 OLT ‘2 602 ‘OTS £29 ‘P99 £89 ‘% £98 OIL ‘EF 1°929 668 ‘OF 0 "E99 Ore aes uestIqor a) 962 ‘Iz 998 ‘9 06 ‘0% 199 ‘Teh eS2 ‘T £°FS £82 ‘£8 T 96h gee ‘ce #61 ar eae aa syjosnqovsse AL & 899 ‘6 028 ‘% 18 ‘FFL 620 ‘2ST oz8 i a £82 ‘ZI F861 890 ‘EL 190% Mae aera pur[Areyy 840 ‘F £70 ‘T 829 ‘TL P92 ‘OL 988 rs 886 ‘¢ £66 ze ‘9 L701 3 LOF ‘ZT COL % FI9 ‘FIT $80 ‘621 260 ‘T £61 08 ‘6 9 ‘281 $68 ‘OT 6 10% e G08 ‘OT PIS ‘Z 20 ‘L9T 068 ‘98T 8oF ‘T Sle LOT ‘FT 0 692 999 ‘OT b'16Z 3 099 ‘9 910 ‘% ge ‘SET 990 ‘2bT £89 WES, 992 ‘TL + P61 888 ‘ZI 180% Pe 9ge ‘2 169 ‘% PE ‘861 STS ‘802 0s9 16 0¢8 ‘9T T02z TOS ‘ZT 8 622 ~ T¥9 ‘LT 189 ‘6 OFZ ‘618 896 ‘TEE Teo ‘T 81% 188 ‘92 8 ‘SIF STF ‘8% 9 Ser 2 296 ‘98 682 ‘OT eee ‘189 68¢ ‘8zZ 281 ‘e 9G 198 “19 9 ‘6E8 69 ‘09 Z 288 3 G98 ‘T 80g 892 ‘68 IF9 ‘IF SOT o% 828 ‘¢ ZFS £6 ‘€ ig GY Daa eee as oo aera oyepl 5 2S ‘T 282 8&2 ‘0Z GPS ‘2 Set 1% 9L ‘T Z ‘08 206 ‘T G come ie Vp ae SPS ae ae Trea ey 3 (5) if 19 29 (y) (s) g ia g ey gr ae ps cease sat 3231803) s TOT ‘AT Ors ‘% 996 ‘SFI 9£9 ‘SOT £09 ‘T 8°92 98 ‘ZI (ard 686 ‘81 T 022 sa G19 ‘Fz 0F ‘F ZI ‘898 GPT ‘268 110% € 0g sie ‘Te L ‘78h 968 ‘ee oes ""sesueyly ™ 108 ‘9 198 96S ‘T9 SoZ ‘89 G2 rL 862 ‘¢ 6 £8 FB ‘¢ SIG Ar us eke oak Tea aee Buoziy ° 0 (5) II II 0 0 T (e) I (s) alee BollRg UBOLIEULy 2 SIZ LOT 812 F Shs ‘F LT Be 198 | 19 PLE #9 figs. Wes Gaiae BysELy & 186 ‘ST 061 ‘% 18h ‘OST 809 ‘FST 968 ‘T £ FS 209 ‘TT 0622 966 ‘ZI eng ke | eS Fe Ge aa suleqely § 966 ‘E0L$ £66 ‘99T$ 6eS ‘L10 ‘TI$ | 229 ‘888 ‘II$ | 2zE ‘09S 1168 GOL ‘TE6$ 9 ‘9CL ‘FT 80 ‘266$ CORA ee we | esas Sao e- 1810.L 5 = sjusurded =) qje8ep sygeueq qunoure JoquinNn yunoure Iequin Ny yunoure Jaquinn uins-durn’T ATWQUOYL ATWUOYT ATW WOT ATW WUOPL 11d | [810.L | 9o0uepIsel | 1IS¥O 11a 1ISVO 1e}0L Jo 07899 s,ArelOyoueg < 1961 ved [vOSy Ul SyudMTARd YOUN T96I ‘Og unr ‘snjeqs yueUTARd-jUeLM) UT syyouNg ATYAUOTY ([spuesnoy4 uy] ammig AQ ‘T96[ 1994 yooslf ut szuawcnd jifauag fo Junowp pun [Q6[ aunt fo pua ip Snjojs quawADdd-Juasind ur spifauag ApyWuow fo yuNOWD puv saqunyy :aouvsnsur ANpQqvsip pun ‘s1oaiasns ‘a3v-pjgQ—'*f 214%], 118 TLS istration Social Security Admin “O0S$ UBL] SSO'T + -o1d oy} Jo yd (Iq) euBINsuT ABT[IGQEsIp 44 Jopun s}youeg ‘“SIex1OM pesewooop “0G UB SSOT ¢ 3 7 ; ' -paywurtyse aqeag Aq WOLINATISTCL « Jo SIOATAIMS 0} pus pe cad pus ee apa 911491) et plo 04 ‘syuapuadap Jay} puB puny isn} ISVO 94} Wo e[qvded ore UreloOI aouvinsut AUTIGesIp pues ‘SIOATAIMS soleloyoued (1ayx1J0M-pe[qestp) AqIqestp 03 puny 4sn1z Tq 9} ULoly aqvAed ore UBS ‘g8v-plo oy} Jo syed (Ig YO) euRINsUl SIOATAINS pUB 23B-p[O 9} IOpUN S}YFoUuI_ 1 IIPS 069 190 ‘92 Z9T ‘62 681 vz 08? ‘9 L201 699 ‘9 1 °S0T eh ed ee —_— = ~-usTelog G8 | 962 Ges ‘OT 200 ‘8T 6L oT OFF ‘T 6 2 819 ‘T 0'F% eit oe SuTutos M ILP ‘81 098 ‘g 280 ‘982 ETF ‘208 6ET ‘T @'91 P00 ‘FZ 0 GLE P98 ‘9% F980 —— ae ripe ie ~~~ UTSMOOSTM. 290 ‘LT 969 ‘T O€h ‘OT SLT ‘681 oF ‘T ZS 820 ‘OT "821 Zeo ‘IT Seer Wrap eae BIUTSITA 1S0M 626 ‘OT 198 ‘% 969 ‘E61 262 ‘90% £18 6 IT 022 ‘OT SF PPL ‘LT nn (eee eS ee uoysUTgSeM 260 ‘LT ell E 190 ‘TAT 928 ‘T6T gor ‘T 9% Soh FI 0 49% £16 ‘ST i a ene > 77777 BUTS ILA, gI g 989 09 I (e) ¥o a1 gg oat eo Spuvys] UISILA £02 ‘T PIF 911 ‘26 £68 ‘62 Sia! b% 6ge g'88 88h ‘% 620) = Se yee Soe es, ee UOT 288 ‘T 979 | 960 ‘ah 648 ‘FF £91 b% oF ‘e 9 °9¢ 80L ‘€ 0°89 pemcart 5S eS ial 230 890 ‘6z 689 ‘9 902 ‘068 £08 ‘Sar 699 ‘% aig £69 ‘Es 6 209 Zor ‘98 z #9 Tae A eee 490 ‘ST ogg % 099 ‘891 PPT ‘OLT ¢0e ‘I 0% 66F ‘81 1 "99% £08 ‘FT 1882 : cs er, 38 gasseuue,L, 82h ‘T Plo 849 ‘CP 099 ‘bP 821 1% 2F9 ‘6 g'T9 OLL 8 ¢"€9 Sr ge BOE aes Leg ‘OT Z£9 ‘T $96 ‘98 EIT ‘86 126 g°9T 608 ‘2 hat 082 ‘8 8 ‘E91 fee a a ee. 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Seo ee euroyeL{O 629 ‘88 119 ‘6 889 ‘089 PES ‘BL9 962 ‘8 19 620 ‘89 T ‘882 928 ‘9g Z PE8 oe ee oro 10 ‘T LIP 902 ‘98 £99 ‘LE 16 er $80 ‘€ 9°19 I8T ‘€ €'e9 eae, ot Sa edt OT SCRION 21S ‘I £28 ‘E 66h ‘L8T PEE ‘O1Z 999 ‘T £62 16 ‘ST L gig 929 ‘LT Tee see te ey SOOO ON 920 ‘89 926 ‘61 STL ‘183 ‘T TT ‘618 ‘T 892 ‘¢ 6°9L $90 ‘FOT 0209 ‘T £28 ‘GOT 0°69 ‘T Saw he we ee ln AON HUGS Lgh £82 ‘62 $96 ‘Ie 961 oe 129 ‘% a Lb 812% 9°09 etek wae COO EeN GLS ‘8% 696 ‘9 28h ‘LEP 910 ‘89% 486 ‘T 0'9% PLL ‘98 1 029 892 ‘88 1 ‘969 See eee ON 113 ‘% 89L 6IL ‘LF ¥9L ‘09 681 L% £10‘ 1°29 102 ‘F 849 wrecree or 7c eargsduleH AON 628, lB ge ‘ZI £89 ‘ET i 6° $20 ‘T Z 91 SPL 'T T*L1 es Ge ete ew UOUAEN ve 'E 082 ‘T 62 “86 £82 ‘66 882 ey 820 8 Leet g9e ‘8 0 S&T Sry an Ik BysBIqeN 120 Department of Health, Education, and Welfare, 1961 Table 5.—Old-age, survivors, and disability insurance: Selected data on em- ployers, workers, taxable earnings, and contributions, by State for specified periods [In thousands, except for average taxable earnings. Preliminary, corrected to October 24, 1961] Calendar year 1958 2 Employers reporting taxable Workers Reported taxable State wages reported earnings 3 July- with ee September | taxable butions # 1960 1 earnings Total Average per worker Total Seaton tenenan a eeere cae 4, 230 70,000 | $180, 892, 000 $2,580 | $7, 942, 900 Alabama: 5.526225... Stee ee 62 1,060 2, 195, 000 2,070 96, 600 Alaska-- iS 4 70 172, 000 2, 4 7, 600 Arizona_ _ 28 440 1,015, 000 2,310 44, 700 Arkansas_. 4 39 570 976, 000 1,710 42,000 California 2 371 5, 950 15, 745, 000 2, 650 691, 400 Colorado- -_- = 42 700 1, 489, 000 2, 130 64, 800 Connecticut_ 3 65 1,120 3, 159, 000 2, 820 139, 600 Delaware...-.=-=-- = 13 230 , 000 2, 610 26, 600 District of Columbie ed 460 1, 002, 000 2, 180 44, 600 Mlonid he nsssca-nss-25> 3 130 1,790 3, 490, 000 1, 950 152, 600 Georgia_._. = 89 1, 430 2, 789, 000 1, 950 122, 500 Hawaii___... 12 210 526, 000 2, 500 23, 200 Tdsho-22...6 2 15 280 606, 000 2, 160 25, 900 Dlingiss=222e-2 a 235 4,340 11, 872, 000 2, 740 521, 500 Indiana. .....- a 93 1, 880 5, 050, 000 2, 690 221, 600 TOWaL ose ackes be 68 1,110 2, 576, 000 2, 320 108, 100 Kansase...- 5-5 _ 53 2,031, 000 2, 7, Kentucky---_--- = 60 950 1, 961, 000 2, 060 85, 000 Louisiana... .._- . 64 1,010 2, 178, 000 2, 160 95, 800 Maine <2. S: . 25 10 761, 000 1,900 33, 300 Maryland__..... . 76 1,170 2, 894, 000 2, 470 127, 800 Massachusetts-_-_- 2 121 2,170 5, 536, 000 2, 550 244, 900 Michigan_______- as 160 2, 960 8, 369, 000 2, 830 369, 800 Minnesota...._-- a 75 1, 280 3, 094, 000 2, 420 133, 400 Mississippi-_--_--- “ 40 630 1, 043, 000 1, 660 , 500 Missouri-_-..--.- = 107 1, 830 4, 336, 000 2, 370 189, 200 Montana-_-__..--. os 17 290 635, 000 2,190 , 200 Nebraska_.._..-- E 38 640 1, 292, 000 2,020 54, 300 Nevadas.—.2-2-2=5 ¥ 8 140 , 000 2, 160 13, 300 New Hampshire-__- a 17 260 570, 000 2,190 25, 100 New Jersey-...--.-- 2 157 2, 600 7,017,000 2, 700 309, 700 New Mexico--. “I 19 300 , 000 2,010 26, Now Yorke.) 22.2 x 496 7, 880 22, 255, 000 2, 820 983, 300 North Carolina. __- Z 100 1, 690 3, 408, 000 2,020 149, 200 North Dakota_____ 2 14 240 483, 000 2,010 19, O)IOr ore aasasee a 202 3, 700 10, 133, 000 2, 740 447, 200 Oklahoma_.. E 50 820 1, 738, 000 2, 120 75, 100 Orrefors. ..22-2 5 2 44 730 1,778, 000 2, 440 77,700 Pennsylvania____ A 255 4, 650 12, 686, 000 2, 730 559, 800 Puerto Rico._.-- ae 18 90 479, 000 810 21, 100 Rhode Island-__.-- ai 21 360 867,000 2, 410 i South Carolina. ___ ae 48 790 1, 530, 000 1, 940 67, 300 South Dakota_.-_. z. 18 260 524, 000 2,020 21, 300 Tennessee-_..--...- ei 78 1, 260 2, 589, 000 2,050 113, 400 "Texas ce 95, 325 Guam fooe.2583 = 99 Hawelisesc.ice “ 1, 489 Tdaho....s.ss54 = 7, 253 Tllinois__--. wonseesne 70, 259 Indiana-_.__--- ied 26, 157 OS eee --| 33,480 Kansas__._..- -| 27,531 Kentucky---- ==-| 55, 727, Louisiana.._..------ 126, 040 Maing... fsseaee 11, 072 Maryland... tosses 9, 615 Massachusetts------ 62, 766 IMichigan®= ..----22.. 56, 494 Minnesota--...-.---- 45, 627 Mississippi-_ 81, 1382 issouri___ 118, 361 Montana. 6, 484 Nebraska, 14, 377 Nevada_....--- 2, 585 New Hampshire---- 4, 834 New Jersey--------- 18, 952 New Mexico. -.-__--- 11, 061 New York-2....... 61, 297 North Carolina----- 47, 593 North Dakota------ 7, 075 Ohig- Bcc eae 89, 814 Oklahoma 88, 161 Oregon 16, 469 Pennsylvania---_--_- 49, 977 Puerto Rico....--<= 37, 926 Rhode Island---___- 6, 615 Noireiniiti eee ten eee Washington West Virginia-.__--- Wiisconsins= Ss eee... 18, 678 394. 96 40. 98 89. 12 75. 44 64. 66 $42, 899 |878, 332 |3, 382, 865 Aid to dependent children Number of recipients, June Fam- ilies Total! | Children 777, 632 |2, 929, 986 |2, 794, 396 |3, 023, 311 x 330, 168 86, 829 68, 096 4, 055 3, 044 35, 617 27, 421 27, 091 20, 917 310,936 | 244, 977 31, 519 24, 734 29, 096 21, 820 7, 102 5, 535 24, 624 19, 485 87, 391 69, 517 60, 218 46, 577 900 74 9, 577 7, 596 9, 092 6, 731 187, 584 | 146, 245 45, 100 34, 172 37, 649 4 25, 219 19, 916 76, 539 57, 506 91, 126 70, 788 15, 361 33, 363 41, 240 79, 093 29, 317 63, 711 77, 772 5, 799 9, 479 7 1, 138 4, 407 3, 343 3 34, 660 61, 582 2) 265 1 Includes as recipients the children and 1 parent or other adult relative in families in which the require- ments of at least 1 such adult were considered in determining the amount of assistance. Social Security Administration 123 Social Security Administration: Number of recipients and average payment, recipients, by program and State, fiscal year 1961 receiving only such payments; data corrected to October 15, 1961] Aid to dependent children— Aid to the blind Aid to the permanently and Continued totally disabled Payments to recipients Payments to Payments to recipients recipients Number Number of recip- of recip- Average | Average Total ients, Average Total, ients, Average Total, payment | payment fiscal June pay- fiscal June pay- fiscal per per year (in ment, year (in ment, year (in family, | recipient, | thousands) June | thousands) June | thousands) June June $106. 94 $28. 38 $956, 380 | 109, 445 $69. 04 $89, 066 339, 214 $63. 37 $244, 664 110. 78 29.11 | 1,021,097 | 107,978 72. 85 92, 309 362, 815 65. 96 271, 208 116. 68 30.30 | 1,118,991 | 105,608 73. 36 93, 991 383, 952 68.19 301, 361 41.05 10.16 10, 176 1,577. 42.01 775 12, 215 37. 55 5, 389 111.35 32. 24 1, 590 99 72. 98 Ci ES. ee | Boe eee se F 121. 66 30. 03 11, 560 877 72. 54 (howe 2-5 Se Bee Seer eee 61. 66 16.14 5, 108 1, 998 58.18 1, 369 7,477 41. 86 3, 538 167. 56 47.18 162, 623 13, 589 106. 92 17, 486 13, 202 99. 90 12, 335 129. 95 33. 62 11, 962 270 80. 41 275 5, 665 Agl? 4,717 178. 57 51. 61 15, 822 300 79.14 371 2, 287 93. 47 3, 347 87. 71 22.75 1, 754 264 70.79 214 418 66. 70 291 150. 45 33. 50 9, 189 208 68. 76 178 2, 762 75, 55 2, 540 61. 37 16.77 17, 222 2, 465 62. 84 1, 852 10, 223 65. 45 7, 490 86. 95 23. 41 16, 363 3, 583 52. 67 2, 253 23, 206 51. 52 18, 784 80. 48 14,31 110 2) 1 72 22.79 16 135. 08 34. 88 3, 951 80 78. 41 75 979 81. 89 977 153. 31 40.77 4,107 148 72.38 134 1,186 75. 62 990 171. 67 40.17 75, 915 2,941 86. 23 2,989 19, 750 87.78 19, 431 106. 07 28. 49 14, 706 1, 862 76. 36 1661: |S SO Be. 5c Pee rcerans beet eee eeee 126, 31 34, 21 15, 656 1, 410 98. 53 1, 664 714 75. 52 563 140. 59 36. 56 10, 688 591 85. 79 6 4, 200 87.47 4, 331 86.78 24. 26 21, 303 2, 407 53. 07 1, 512 8, 006 54. 92 5, 049 96.17 23. 42 24, 284 2,773 80. 79 2, 687 16, 526 56. 40 11,010 92. 59 26. 08 6, 651 415 65. 27 333 2, 143 69.19 1, 761 126. 35 30. 00 13, 793 43 65. 00 350 6, 435 65. 00 4, 943 152. 39 44.49 28, 537 2,172 126. 45 3, 080 9, 941 132. 90 15, 997 131. 59 36. 65 42, 654 1, 733 80. 62 1,710 5, 248 102. 41 5, 952 160. 61 46.25 19, 323 1, 050 106. 65 1,310 2, 574 61. 51 1,819 36. 38 9. 32 8, 762 5, 421 38. 43 2,815 12, 799 34. 85 5,144 93. 48 24, 29 28, 271 4,929 65. 00 3, 919 15, 484 64. 04 11, 691 125. 99 33. 92 2, 816 315 72.76 282 1, 246 72,41 1,085 118. 89 30. 49 4,175 775 92. 59 878 2,151 73, 94 1, 761 95. 24 27.48 1, 380 179 100. 87 PANTS Ee 2 9 Sel eee ere be ot 160. 58 41.47 2, 000 246 86. 50 249 441 100. 63 508 167. 98 47.13 31, 912 925 88. 35 980 7, 406 95. 32 7, 951 126. 50 32. 37 11, 933 359 59. 88 267 2, 686 70. 67 2, 142 172. 67 42. 26 146, 047 3, 481 96. 39 4, 905 36, 419 107. 40 46, 148 79. 93 20. 04 25, 631 5,179 55. 49 3, 361 20, 166 50. 90 11, 662 151. 25 40. 38 3, 360 92 70. 96 83 1,138 100. 23 1,319 122. 75 30. 79 40, 549 3, 509 77.67 8, 135 13, 771 75.41 11, 259 122. 76 34.11 25, 707 1, 810 89.15 2, 222 10, 033 80.13 10, 830 146.15 41.16 11, 516 261 93. 16 281 5, 049 93.69 5, 463 120. 62 29. 56 80, 162 17, 884 73. 33 15, 780 17, 825 58. 64 12, 644 14. 85 3. 82 10, 217 1, 830 8.27 185 22, 587 8.70 2, 298 143. 79 38. 58 8, 051 116 79. 94 117 2, 971 86. 88 3, 034 61.25 15. 36 6, 395 1, 701 49.75 950 7, 975 50. 38 4,231 114.12 32. 85 4,139 163 62. 55 120 1,140 65. 22 883 70.13 18.73 18, 463 2, 644 47.45 1, 540 10, 482 46.07 5, 415 76.99 18. 54 17, 044 6, 326 58. 41 4,470 7, 351 54. 37 4, 488 135. 89 36. 42 6, 063 193 78.01 182 2, 683 79. 71 2, 441 110.15 30. 66 1, 640 112 62. 67 93 842 65.17 665 59. 81 18. 59 170 19 2 6 8 35.17 38 98. 15 24.19 11, 092 1, 230 59. 78 850 6, 641 61. 94 4, 494 3 167. 21 3 48. 82 24, 620 3700 | 3103.95 853 37,440 | 3100.08 8, 665 97. 92 25. 33 22, 887 985 44.21 508 7,319 43. 81 3, 664 162. 91 44. 46 17, 679 918 94. 35 978 4, 047 110. 84 4, 662 141.01 38. 24 1, 261 55 84. 69 54 583 76. 66 2 Average payment not computed on base of fewer than 50 recipients. *Estimated. 124 Department of Health, Education, and Welfare, 1961 Table 8.—Special types of public assistance under plans approved by the tures and percent from Federal funds, by {Includes vendor payments for medical care; amounts Expenditures for Federal grants to States ! assistance and administration Aid to | Old-age assistance the State Medical assist- | Aid to | Aid to | perma- Total Old-age ance | depend- the nently assistance | for the ent blind and Percent aged jchildren totally | Amount from disabled Federal funds Fiscal year: 1959 etter $1,182,194 |-5 2 ee $626, 546 | $47,619 |$150, 739 |$1, 973, 089 58.3 2, 083, 761 | 1,157,523 |--.------ 660, 232 48, 824 | 167,182 | 2,014, 736 58.1 2,180, 466 | 1,211,709 | $33,507 | 704,108 | 48,517 | 182,625 | 2,035, 554 59.9 61, 200 47, 511 734 1, 845 Ly al Seow 1, 201 62.3 17, 227 600 Pils. ccd 10, 533 72.6 35, 064 1, 036 2,811 36, 322 74.3 239, 515 142, 926 7, 802 6, 717 294, 785 48. 2 ©olorado..-+22.222.- 39, 246 166 3, 197 63, 062 43.0 Connecticut__...----- 17, 317 162 1, 259 21, 870 39.3 Delaware. 2) 2-2. 2, 332 139 218 0 66.1 District of Columbia-_- 9, 469 121 1, 540 2,779 57.3 Mlorida. ..< 33.223 57, 229 1, 349 5, 562 50, 930 70.9 Georgia... 38. 4c e= 67, 393 1,720 | 10,740 56, 939 73.3 Guam_.. 8 1 10 34 50.0 Hawaii-- 3, 951 43 569 1, 300 62. 2 Idaho---- 7,672 90 651 6, 867 67.4 Tilinois__- 95, 638 1,684 | 10,617 73, 330 58.1 Indiana__ 25, 854 1,042 ben 2k 22, 673 63.7 Towa....- 32, 144 848 308 36, 551 59.6 Reanses.. 2. agensecke 27, 239 343 2,411 29, 101 61.4 Kentucky.) 2b ssce5~ 48, 247 1, 098 3, 934 34, 961 73.1 . Louisiana... =~... -- 106, 597 1, 645 8, 990 111, 786 66.9 Maine... 24.406 =~ 13, 551 239 1, 271 9, 612 71.3 Maryland) 236. dec--- 18, 364 240 3, 465 7, 697 64.6 Massachusetts_------- 75, 695 1, 138 5, 999 82, 239 49.7 Michigan... 2224... 65, 708 922 2, 693 58, 654 58.2 Minnesota-.---------- 39, 887 586 1, 348 53, 734 53.7 Mississippi----------- 41, 029 2, 240 4, 328 35, 247 76.5 Missouri... 234 tk. 89, 342 2, 280 8, 024 87, 144 66. 2 Montana... 5 33.48. .1. 5, 991 187 677 5, 511 65.1 Nebraska... J.26.. 24. ~2. 14, 005 469 1, 207 14, 064 67.4 Ne@Vedsoo.sce- mann eek 2, 678 108.j6.. 53 2, 635 56.9 New Hampshire-_-_--- 4, 442 139 267 5, 109 59. 4 New Jersey------ 30, 847 535 3, 891 21, 668 50.9 New Mexico. 17, 607 209 1, 541 9,714 70.8 Neway ork 23: 4e-5 5. 165, 371 2, 248 20, 539 108, 735 44.2 North Carolina______- 52, 407 2, 67: 9,013 26, 751 74.5 North Dakota______-- 7,670 0, 725 8, 450 57.8 Ohio. 2) ee 86, 107 1, 927 7,029 85, 824 58. 4 Okishoma: 2 47/282... 81, 393 1, 069 5, 799 91, 109 63.1 Oregon 22-5. et eek. 18, 586 134 2, 735 18,176 55.9 Pennsylvania__._..._- 92, 545 3, 458 8, 690 43, 680 61.4 Puerto Ricol 2S. 3-2. 9, 004 100 1, 288 4, 300 47,2 Rhode Island-_-_---_-_- 10, 215 69 1, 651 7, 073 56. 3 South Carolina_______- 21, 950 751 3, 325 16, 421 75.3 South Dakota_-___-__- 8, 667 95 685 6, 970 70.7 Tennessee---..-------- 43, 438 1, 187 4, 340 29, 709 74.6 WOSBS.. cccaccAte doesn 124, 331 3, 288 3, 501 144, 846 71.3 Utah. 222 eee oes 10, 049 116 1, 452 7, 210 68.1 Vermont_2 =. 2225-2. 5, 060 69 501 4,770 Zi bik Virgin Islands-_-_------ 275 3 23 3 49.9 Virginia; - 22a 28 20, 437 673 3, 625 9, 576 74.3 Washington__.------- 44, 074 387 3, 830 57, 005 48.7 West Virginia__--__--- 29, 543 392 2, 940 9, 291 76.6 Wisconsin-.___------- 32, 030 534 2,078 37, 736 54.9 Wyoming,.-0 25-4. ._- 2, 899 33 288 3,076 60.8 1 Based on cash advanced for the year; may differ slightly from fiscal-year expenditures from Federa funds reported by States. Social Security Administration 125 Social Security Administration: Federal grants to States and total expendi- program and State, fiscal year 1961 in thousands; data corrected to October 15, 1961] Expenditures for assistance and administration—Continued Medical assistance for the aged Amount Aid to dependent Aid to the blind Aid to the permanently children and totally disabled Percent Percent Percent Percent from Amount from Amount from Amount from Federal Federal Federal Federal funds funds funds funds $1, 056, 620 59.1 $96, 806 49.6 $278, 288 55.3 1, 130, 515 58.9 100, 203 48.9 302, 925 55. 8 1, 240, 092 57.8 102, 212 47.6 335, 615 54.7 11,077 79.6 814 74.8 5, 811 75.1 1, 680 61.8 100 {if iirs tot [tees cai bean St oy ceed 2 11, 939 75.4 772 Leite be | spre tara | eee 5, 476 79.9 1, 419 72.0 3, 880 73.4 187, 381 44.1 19, 380 38.1 14, 608 45.2 13, 549 61.3 309 53.0 5, 341 59.8 17, 094 43.4 400 41.2 3, 683 35.5 1, 972 72.5 246 57.8 360 60.9 10, 068 59.9 192 59.7 2, 723 54.4 19, 303 78.9 1, 967 68. 4 8, 364 67.0 17, 586 75.6 2, 373 72.4 14, 816 T251 120 50.0 2 49.9 21 50.0 4, 507 58.1 84 52.7 1,113 50. 4 4, 424 54.6 143 63. 4 1,097 61.7 83, 507 51.7 3, 459 49.3 21, 841 48.8 16, 365 67.2 1, 928 Bar eacee fae a (Seen a 17, 044 58.6 1, 827 46.5 675 53.2 11, 603 58.7 647 53. 4 4, 685 52.3 22, 624 75.9 1, 622 72.2 5, 496 71.6 27, 656 74.0 2, 853 57.4 12, 625 69.9 7,089 74.3 348 71.0 1, 942 67.1 15, 304 66.6 372 63.0 5, 393 62.7 31, 720 44.4 3, 264 35.5 17, 501 33.6 45, 595 55.9 1, 784 51.2 6, 291 42.2 21, 195 48.3 1, 402 43.2 2, 001 67.3 10,077 78.1 2, 964 75.3 5, 845 74.6 30, 523 72.6 4, 283 52.9 12, 445 65.1 3, 126 61.7 330 57.8 1, 232 58.0 4, 559 wah 941 50. 4 1, 980 61.5 1, 621 67.3 252 SE ee rear verre ee ale 2, 204 52.4 270 62.2 592 46.1 35, 202 44.7 1,117 53.9 9, 139 44.1 12, 891 68. 3 290 72.4 2, 373 65.3 168, 325 47.7 5, 766 39.6 53, 414 40.9 7, 623 Tied 3, 801 70.5 12, 510 72.3 3, 694 55.5 62.2 1,479 48.6 44, 324 65.9 3, 524 54.8 12, 526 55.8 26, 972 69.2 2, 301 46. 4 11, 513 60.8 12, 948 49.6 300 46.5 6, 015 46.2 88, 084 64. 5 16, 645 19.9 14, 315 59.2 11, 248 46.1 219 47.1 2, 692 47.1 8, 799 53.1 185 52.1 3, 382 48.6 7,021 79.5 1,021 72.9 4, 622 72.8 4, 544 69. 4 135 70.0 977 69.8 20, 042 78.3 1, 630 73.1 5, 940 72.6 18, 560 78.8 4, 667 70.0 5, 053 69. 2 6, 637 58. 4 190 61.2 2, 581 56.8 1, 796 71.0 100 70.4 720 70.1 214 49.8 8 49.9 47 49.9 12, 339 74.2 949 70.5 5, 081 70.1 26, 440 43.3 908 42.1 9, 246 41.2 23, 636 76.0 534 73.9 3, 948 73.6 19, 338 48.0 1,074 49.5 5, 132 41.7 1, 423 53. 4 59 54.2 548 53.5 126 Department of Health, Education, and Welfare, 1961 Table 9.—Maternal and child health and welfare services: Grants to States for maternal and child health services, services for crippled children, and child welfare services under the Social Security Act, by program and State, fiscal year 19617* [In thousands] State Colorado x2 Bae} 22 oe rena ee casteeadetoeassap-skescones Oonnectien toca. seteas ont a ew nes dade les mateo nse gates es WALA WATO set eee ee oe an coe ea soe kode enee ade ces aay ae District of Oolnanbin = one oo eee enn oa See ees AGT 8 2 eon ee ee eee ee ee Hawaii Maryland 22 ooo ann akan cdcandewaencs ca cpeatenaee conse aaseeee Massachusetts Michigan. = So eoneo. Minnesotat cu. cgeecs Mississippi. --_..__- Missouri =o eotee nce INGW: JQPSOY: cose cen ook epee oe cae eee occas bareneac aan New Mexico-.-.--.- North Carolina North Dakota_...___- Ohio cei 5-5 eee Oregons. tae Pennsylvania_____ Hhode Tslanid ee re ora ae sn acteacaugcnnecseeeeeeceas= South Carolina: -£o-. s aaa SSeS aS OTS ura BLOND a aa ae a a ee ---"TIMOSST AL Celtic: eat rae ae a ee ae ae TAISSISSTPAL a a ere male eats syqosnpesse AL Sk oe es ee SoS ee ae ee puetAreyl x = = s TL. EE tome ws % es ’ & ww - * o 7 1 ial oo % ot Pinten i i] v ‘ me ‘ \ < ye ' ™ heli i = 3 wi 2 n + : i = . a 7 = re | * aS : : ] 7 vane | A nae Mera ows 7 ? a = +) on a | é nay ee x "4, oo i¥ = Public Health Service Health of the Nation THE GREAT PROBLEMS of providing the best possible health services for all of America’s citizens continue to occupy the attention of the Public Health Service. As new knowledge is developed, its benefits must be made available to the people who need them. While the people of the United States have a high level of health, the higher levels which can be achieved as medical knowledge increases remain as a challenge and a hope for the Nation’s future. The Public Health Service is the Federal agency principally con- cerned with protecting and advancing the Nation’s health. In work- ing toward this goal, it cooperates with many other health interests, including private medicine and its allied disciplines, local and State public health authorities, voluntary agencies, colleges and universities, and research organizations. Great changes in the health needs of the Nation, since the establish- ment of the Public Health Service in 1798, have resulted chiefly from brilliant advances of medical science. These advances have taken place at an accelerating rate. Today, as we begin the decade of the 1960’s, health care of the highest possible quality for all the people of this Nation is no longer an unrealistic dream. From its earliest responsibility of providing medical care for merchant seamen, the Service has added responsibilities for foreign quarantine, the care of a number of groups including American In- dians and Alaskan Natives, and the administration of Federal hos- pitals for victims of narcotics addiction and leprosy. These programs comprise the Bureau of Medical Services, one of the three major subdivisions of the Public Health Service. Assistance to State and local health departments began with the infectious disease epidemics of the nineteenth and early twentieth centuries. These services have increased and diversified greatly over the years. Through its Bureau of State Services, the Service now administers extensive programs of grants-in-aid to States and communities for many purposes, including the construction of hospitals and other 131 Department of Health, Education, and Welfare, 1961 132 $B2UE19¢ [OZIPEW [O19UeD saspasig snoijoajul 'y ABsayiy SeojAles tpioesey syudJS) yDsDasoy Spaopunjs s2150}01g ISUOISIAIG uoljosuadwo7 seaXojdug yo nosing £4042241¢ |D21IPaW suosiig Jo NDBINg 4ejueD [O>141[D sseupuljg puod poss UOHN|}Og ses0951q [22150jounany puo Ajddng sayoy AMA SEOR GND Renn eReeenenNeH ENDS SeeeEESS ES ees EEESeEnes Ys |22H Py oa ee idteticene O1poy 1yDdn25, yosoasey [0jU9q 44821440 J21PEW J®!4D W01}2ej0Ng woes oo puo Buijeeuj6uq jojuauuos)Au3 peomie rhe er Pei Ms fiat ed D1OGDIEW 'P SHYLY euljUDIDNg) UBle104 SUOISIAIG sUOISIAIG {SB4N{LYSU] [OUOLJORY 182 1PeW pu |Dj1dsoH4 Pue W}O9H P119Ng |OjUEq P214901g Yy]Oa} AyjunWWo> @s025!q @)qQD9! uNWWo> sesoasiq 2}u014> 44]09H |Ojuewuas)Aug i 4yy]OoH Rivintate $821A195 |02|P2W jo noeing YW |P®H JO SODIAL seinilOPH 10 !Alag @10)5 yo noeing ta Bursuny SOP [IPD4 sa2unosay 4ajue> “AIg Aaaing Y4jDa} joUoIjoKy “AID SPHSHOIS JO1IA |DUOLON, SOUSHOIS W|D2H 40j 48jU9> JOUOIJOKY Jeuuosiag yo 391450 SPOWPW Yi/9H 211GNg Yi]28}] |OUo}joUs9;U} YOHOZITIGOW 44/09} eoupuly $82 /AJ@¢ 9A} O44s1UI Wp 2SUOISIAIG eujo1pey jo Aspiqyy ouorsony 429130 @ALNDExXy |242U9d suoaBing juojsissy |24aUed uoaBing Ayndag |Puauad uoabing J ©7130 4304S [219edg puo sdnaic Asosiapy [Owseyuy sdnais) Asos}apy jouse4x3 [®49Uua5 uoeBung |2ueued uoabing SUy JO 291440 eyO1pauuy SBWNNO JuOlssajoug je! yy L96L ‘NOILVZINVOYO JDIAYRS HL1V3H DI1aNd—L LYVHD Public Health Service 133 health facilities, construction of municipal sewage treatment works, and direct support of State programs in the control of many diseases. Technical assistance, loans of personnel or training of professionals and technicians employed at the State and local level, and research and guidance in public health practices are other means used to aid in public health protection. The National Institutes of Health is the third component of the Public Health Service. Maintaining a wide variety of medical re- search projects in its own laboratories, the Institutes also support an extensive research effort in universities and other medical research institutions in this country and abroad. Federal and non-Federal scientists, in partnership, administer this massive attack on the re- maining problems of health and disease. The 1960’s hold great promise for the elimination or control of some of the great remaining health problems of man. The next great nationwide health efforts may be expected in two broad areas: the physical environment and comprehensive health care. During the present decade, 1960-70, major national efforts, comparable with the great expansions of medical research and hospitals in the 1950’s, will be required in each of these areas. The former will in- volve the development and application of new, more efficient tech- niques to measure, evaluate and control natural and artificial factors in the environment which affect health and safety. The latter will involve the development of adequate supplies of well-qualified person- nel, appropriate facilities, new and more efficient methods to render comprehensive health services to the American people. To meet these challenges of the immediate future, the Public Health Service has been carrying out a substantial reorganization during the past year, based on the recommendations of a Task Force appointed in 1960 to study the mission and organization of the Service. The most fundamental changes proposed are designed to make the Service’s programs more effective in the development of comprehensive health services, giving special attention to the chronic diseases, and the pro- tection of the public against environmental threats such as water pollution, air pollution and radiation. Details of the organizational changes are contained in the reports of the units and programs concerned. The Public Health Service had a change of leadership during 1961 when, on January 30, Dr. Luther L. Terry was appointed by President Kennedy to succeed Dr. Leroy E. Burney as Surgeon General. Dr. Terry is the ninth Surgeon General since that office was created in 1871. 134 Department of Health, Education, and Welfare, 1961 HEALTH RECORD According to National Health Survey studies, the American people experience about 368 million acute health conditions—conditions last- ing less than 3 months which involve either medical attention or at least 1 day of restricted activity—in a year, or a little over 2 per person per year. About 47 million persons are injured in a year, or 280 per 1,000 population. In addition, about 72 million Americans (or 41 percent of the population) suffer from one or more chronic conditions. About 1 person in 14, or 18,500,000 in all, has a chronic limitation affecting his major activity; and about 1 in 200 is confined to the house. The average person has about 16 days of restricted activity per year due to illness or injury, of which about 6 days involve bed disability. Persons 17 years of age and over show 5.6 days of work loss per year for these reasons, while school-loss days among children 6-16 years of age average 5.3. In the first half of the past decade, 1951-55,1 the downward trends of mortality which had generally characterized the preceding 50 years continued. Since 1956, however, death rates have not changed very much, except at ages 15-24 years, where the decline has continued, and at 65 years and over, where the death rate has increased. The infant death rate dropped 9 percent from 28.4 per 1,000 live births in 1951 to 26.0 in 1956, rose in the next two years, and was lower in 1959. The rate in 1960, 25.7 per 1,000 live births, was 1 percent below the 1956 rate. The maternal mortality rate has de- clined steadily throughout this period, from 7.5 per 10,000 live births in 1951 to 3.2 in 1960, a drop of 57 percent. The infectious diseases were once the chief causes of death among children. The principal communicable diseases of childhood—scarlet fever, diphtheria, whooping cough, and measles—for which the com- bined death rate had declined from about 243 per 100,000 population under 15 years of age in 1900 to 5 in 1950, accounted for 1 death per 100,000 population in this age group in 1960. The death rates for a number of infectious diseases which once affected mortality significantly at all ages have also dropped since 1951. Thus, the death rate for tuberculosis, which was 20.1 per 100,000 population in 1951, was 5.9 in 1960; and the death rate for syphilis, which began its rapid decline in 1939, at 15.0 per 100,000 population, dropped to 4.1 in 1951 and to 1.7 in 1960. The death rate for influenza and pneumonia in 1960 was 36.6 per 1 All vital data are for calendar years. Figures and rates for 1960 are provisional. Public Health Service 135 CHART 2.—DEATH RATES, 1930—60 (Per 1,000 Population) 1930 1940 1950 1960 CHART 3.—DEATH RATES FOR THE 10 LEADING CAUSES OF DEATH, 1900 AND 1960 (900 1960 ie} 100 200 300 400 Vascular lesions of central nervous system All accidents Certain diseases of early intancy Vascuiar lesions of central nervous Chronic system nephritis Influenza and pneumonia All accidents General arteriosclerosis Malignant neoplasms Diabetes mellitus Certain diseases of early Infancy Diphtheria Congenital malformations Cirrhosis of liver S80%0 Chronic noninfectious RTE ° Qecces Ar Deaths per 100,000 population 1900 1910 1920 1930 1940 1950 1960 136 Department of Health, Education, and Welfare, 1961 — 100,000 population, higher than in any of the previous 11 years. For the first quarter of the year, severe localized outbreaks of respiratory illness were reported throughout most of the country. As a result, the death rate for the first 8 months of 1960 was almost the same as for the first 8 months of 1958, when Asian influenza was prevalent. Mortality from the major chronic diseases has generally remained stable during the past 4 years, with death rates higher than those reported for the previous 5 years. The death rate for cardiovascular- renal diseases was 518.9 in 1960, compared with 518.0 in 1951. The 1960 cancer death rate was 147.4, about the same as the rate in 1956, but substantially higher than the 140.5 rate in 1951. Death rates for suicide have fluctuated within a narrow range since 1951, and rates for homicide have remained practically unchanged since 1955, slightly below the rates reported for 1951-54. The rate CHART 5.—POPULATION GROWTH BY AGE GROUPS, 1900 AND 1960 Year Millions Percent of increa persons ease Under age 20 1900 1960 105 Age 20-64 1900 1960 140 Age 65 and over 1900 1960 435 18 10 Population (in millions) 1950 1970 1980 Public Health Service 137 for suicide rises to ages 75-84 years, while the rate for homicide reaches its peak at 25-34 years. Mortality from accidents has de- clined since 1951. Death rates for this cause fall to a low in early childhood, and then rise with increasing age. The death rate for motor vehicle accidents was 24.1 per 100,000 population in 1951, and 20.6 in 1960. No clear trend is apparent, but the level of death rates for this cause has been lower in the past 5 years than from 1951 to 1955. The death rate for nonmotor vehicle accidents declined from 38.4 per 100,000 in 1951 to 31.2 in 1960. _ As the mortality data suggest, life expectancy increased more in the first half than in the last half of the decade 1950-60. The average length of life for the entire population was 68.4 years in 1951, 69.6 years in 1956, and 69.7 years in 1960—a net gain of about 1.2 percent for the entire period. In 1959, life expectancy by color and sex was as follows: white females, 73.9 years (a 1.2 percent gain over 1951); white males, 67.3 years (a 1.0 percent gain) ; nonwhite males 60.9 years (a 1.3 percent gain) ; and nonwhite females, 66.2 years (a 1.5 percent gain). Thus, average length of life increased at a faster rate for women than for men, and for the nonwhite than for the white population. BIRTHS, MARRIAGES, AND DIVORCES In 1960, about 4,247,000 live births were registered, virtually the same number as in 1959. Although the number of births in recent years has remained fairly constant, the crude birth rate—the number of births per 1,000 popula- tion—has declined somewhat. The 1960 rate of 23.6 represents a drop of 2.1 percent from the 24.1 rate for 1959, and of 3.7 percent from the 24.5 rate for 1951. All these rates, however, are above any that prevailed from the late 1920’s through 1945, even when the earlier figures are adjusted for underregistration. In 1960, about 1,527,000 marriages were performed, an increase of 2.2 percent over the 1959 figure of 1,494,000. The marriage rate, how- ever, remained constant for the 2 years at 8.5 per 1,000 population. The 1951 rate was 10.4. Divorces totaled 395,000 in 1959, as compared with 368,000 in 1958, for an increase of 7.3 percent. The divorce rate was 2.2 per 1,000 population in 1959, 2.1 in 1958, and 2.5 in 1951. Funds and Personnel The total funds available to the Public Health Service in fiscal year 1961 amounted to $1,233.5 million (see table 1, page 233). Appropria- tions and authorizations accounted for about $1,039.6 million of this 626936—62——10 138 Department of Health, Education, and Welfare, 1961 amount. The balance was made up of repayments for services given to other agencies and of unobligated balances from previous years. Over 70 percent of the total funds available was allocated to others, in the form of grants to State and local agencies, private institutions, universities, hospitals, and individuals outside the Federal Govern- ment. The remainder was used to support the direct responsibilities of the Public Health Service, such as hospital and medical care for legally designated beneficiaries, foreign and interstate quarantine, — and Indian health services. At the close of fiscal year 1961, the Public Health Service had a full-time staff of 28,630 (see table 2, page 235). This number included 1,803 members of the Regular Commissioned Corps, 2,025 members of the Reserve Corps on active duty, 151 of the Commissioned Reserve on temporary training duty, and 24,651 full-time Civil Service per- sonnel. Part-time personnel totaled 1,364. National Center for Health Statistics The National Center for Health Statistics was established in August 1960 following the recommendations of the Task Force which studied the mission and organization of the Public Health Service. Objectives in setting up the Center were to bring together the major components of Public Health Service competence in the measurement of the Nation’s health status; to identify significant associations be- tween characteristics of the populations and health-related problems; to stimulate optimal use of technical and methodologic innovations in the collection, processing and analysis of health statistics; to create a resource for technical assistance in statistical data processing; to associate closely the functions of collection, analysis, interpretation and dissemination; to permit expansion of health intelligence pro- grams to correlate and interpret data from various sources; and to give better visibility to the national and international leadership of the Public Health Service in vital and health statistics. The Centers contains two divisions: the National Health Survey Division, formerly located in the Division of Public Health Methods; and the National Vital Statistics Division, formerly entitled the Na- tional Office of Vital Statistics, and located in the Bureau of State Services. In addition, the Center includes an Office of Electronic Sys- tems and an Office of Health Statistics Analysis. NATIONAL HEALTH SURVEY The National Health Survey is a continuing program which makes studies to determine the extent of illness and disability in the popu- lation of the United States and to gather related information. Public Health Service 139 During the year the National Health Survey began the development of its third major data-collection mechanism, the Health Records Survey. Much of the information gathered through this undertaking will come from the records of institutions which provide medical, nursing, or personal care. The first project is a survey of nursing homes and similar places to obtain an estimate of the older persons in these institutions, their demographic characteristics, and their health status. The Health Examination Survey—the first cycle of which consists of a special, standarized health examination given to a representative sample of the adult population—had conducted 15 of the 42 “stands” in its national sample of localities, as of the end of fiscal year 1961. With the acquisition of a second mobile examination center, this Sur- vey is moving through the sample localities at the rate of about 20 stands per year. The second cycle of the Survey, in which a sample of the population aged 6 through 17 years will be examined, is now being planned. The Health Interview Survey, now in its fifth year of data collec- tion, provided information for eight publications on topics not previ- ously reported on by the National Health Survey: arthritis and rheumatism; diabetes; hernias; acute conditions by geographic distri- bution; seasonal variations of acute conditions; edentulous persons; health insurance; and distribution and use of hearing aids, wheel chairs, braces, and artificial limbs. Health interview data also became the basis for reports on selected health characteristics of older persons, and selected health characteristics of the population by geographic regions and urban-rural residence and by geographic divisions and large metropolitan areas. In line with its obligation to develop and test new or improved methods, the National Health Survey Division continued a number of methodological studies already underway and initiated several new projects. The latter included a study to develop a method of gathering information on personal health expenditures, and another to evaluate and refine the household interview collection of data on health in- surance coverage in the general population. NATIONAL VITAL STATISTICS DIVISION On July 1, 1961, the National Office of Vital Statistics became the National Vital Statistics Division. It collects, tabulates, analyzes, and publishes the official U.S. vital statistics of births, deaths (including fetal deaths), marriages, and divorces on the basis of transcripts of certificates that are filed with non-Federal registration officials acting under State laws. This Division also constructs the official U.S. life tables and related actuarial tables; conducts health and social-research 140 Department of Health, Education, and Welfare, 1961 studies based on vital records and on sampling surveys linked to rec- ords; conducts research and methodological studies in vital-statistics methods including the technical, administrative, and legal aspects of — vital-records registration and administration; and maintains a con-_ tinuing program to improve the quality and rishfuleee of vital sta-_ tistics through technical assistance and professional training at the | Federal, State, local and international levels. | N Rison vital data are used in medical, demographic and educa- 5 tional research, in social welfare, business and government, and in | planning programs in public health and other areas. During the year, the Division and the Bureau of the Census, in co- operation with the University of Chicago, began a study of socio- economic factors in mortality for 1960. With the approval of State vital statistics offices, the Division selected copies of certificates for deaths occurring from May to August 1960. These records will be matched to the Census of Population data taken as of April 1960 to analyze mortality by the characteristics enumerated for the decedents in the Census when they were still alive. Among surveys that were completed or started during the year were 2 phases of a study of the incidence of cystic fibrosis, a study of radiological exposures of mothers during pregnancy, and a cardio- vascular-renal mortality study. Technical help was given for a na- tional polio inoculation study. Plans were worked out and initiated so that national marriage and divorce statistics for 1960 will be based for the first time on nationwide samples of marriage and divorce records collected from State and local vital statistics offices. These samples will yield detailed marriage and divorce figures for the United States as a whole, the four regions of the United States, the Marriage Registration Area, and the Divorce Registration Area, as well as for States that participate in the two registration areas. In previous years, detailed marriage and divorce data were available only for reporting registration area States. At the close of the fiscal year, the Marriage Registration Area (es- tablished in 1957) contained 35 States and 4 other areas; the Divorce Registration Area (established in 1958) contained 20 States and 1 other area. The Model State Vital Statistics Act (1959 Revision) was enacted in six areas during the fiscal year, and has been adopted in part or is receiving consideration in a number of other areas. | The Division cooperated with agencies of the Departments of State, Defense, and Justice, and representatives of State health officers and State vital registrars in arriving at a common ground for improving the birth registration of citizens born abroad and of alien-adopted children. A committee of the Council of State Governments con- Public Health Service 141 sidered and endorsed the actions that were taken by the cooperating group, and recommended repeal of conflicting State laws. OFFICE OF ELECTRONIC SYSTEMS Established toward the close of the fiscal year, the Office of Elec- tronic Systems has been engaged in the planning, site preparation, stafling, training, and programming activities incident to installation of computer facilities. | OFFICE OF HEALTH STATISTICS ANALYSIS This Office was also constituted during the latter part of the fiscal year. The Office will: study and interpret health and vital statistics to assess the health status of the population; develop measures and indexes of health; study problems in disease classification and coor- dinate national proposals for revision of the International Classifica- tion of Diseases; and act as secretariat for the U.S. National Com- mittee on Vital and Health Statistics in its program to promote | technical developments in the field of vital and health statistics. National Library of Medicine The National Library of Medicine continues to provide service to the world medical community through published bibliographical guides, an extensive interlibrary loan program, reader services, and | reference research assistance. Its conventional systems for the organ- ization, storage, retrieval, and dissemination of information are be- coming severely taxed with the acceleration of medical research and the resulting increasing amount of scientific publications. As a consequence, the Library has responded by developing two new pro- | grams for the improvement of medical communication services. Work started in 1961 on a 2-year program for the design and testing of an electronic data processing system to improve the Library’s capacity to store, retrieve, and disseminate information useful to workers in medicine and public health. Termed MEDLARS (Medi- cal Literature Analysis and Retrieval System), the new system should | improve the Library’s responsiveness to the current and continuing needs of multiple research groups, reduce the duplicative effort now involved in literature screening, offer more prompt and more eflicient literature reference services, and enlarge, improve, and speed publi- cation of the /ndex Medicus. In addition, plans were made for an extramural program utilizing grant and contract mechanisms. This program is designed to support traditional publication media, strengthen services and resources of medical libraries, and encourage research and development in new and improved medical communication systems. 142 Department of Health, Education, and Welfare, 1961 BOARD OF REGENTS The Board of Regents met on November 5, 1960, and April 7, 1961. At the November meeting the Board received the Director’s report on the status of the Library, and discussed the development of extra- mural programs. At the April meeting the Medical Literature Analysis and Retrieval System project and Library program and budget plans for fiscal year 1963 were presented and approved. NEW BUILDING The new building was 80 percent complete at the end of the year, and planning was underway for dedication ceremonies on December 14-15, 1961. In anticipation of increasingly heavy work loads in the reference and interlibrary loan area, plans were completed for rearrangement of the collections and the application of mobile micro- photographic equipment in the photoduplication process to facilitate user services when the new building is occupied. PROGRAM STATISTICS In fiscal year 1961 the Library acquired 16,951 books, 69,968 serial pieces, and added 1,336 new serial titles, increasing its collections to 1,066,068 items. The History of Medicine collection was increased by 288 old and rare volumes. The staff cataloged 27,186 titles, and 813 pictures were added to the art collection. There were 152,768 volumes circulated, and 10,090 reference questions were answered. Main entries published in the Wational Library of Medicine Catalog totaled 18,219. The Zndew Medicus published 130,000 items from 1,775 journal titles. Interlibrary loan requests increased to 109,258 from the prior year experience of 95,595. Microfilm production amounted to 2,775,552 pages of which 689,954 pages were for preserva- tion purposes and 2,085,598 pages for interlibrary loan. PUBLIC HEALTH METHODS The Division of Public Health Methods provides staff services to the Surgeon General, develops and conducts research studies of health and related problems in the population, and participates in planning public health activities to meet current and foreseeable needs. The Division edits and publishes Public Health Reports, the official journal of the Public Health Service in public health practice and administration. MANPOWER AND MEDICAL EDUCATION Guides for the planning and construction of new medical schools were developed in cooperation with the Division of Hospital and Medical Facilities and the Ad Hoc Committee on Medical School Public Health Service 143 Architecture of the Association of American Medical Colleges and the American Medical Association. One volume, “Medical School Facilities: Planning Considerations,” examines the role and responsi- bilities of the medical school and the composition of its faculty and curriculum, summarizes general architectural requirements, and pre- sents cost estimates and elements in planning. The companion vol- ume, “Medical School Facilities: Planning Considerations and Archi- tectural Guide,” presents the same background material, but deals technically in architectural and engineering terms with the amount and type of space needed for the various medical school activities. The eleventh in the series of health manpower source books, pub- lished during the year, presents basic data on medical school alumni as of mid-1959. The data include State of practice, type of practice, and full-time specialization for all graduates (living in 1959) of each of the 78 active 4-year medical schools in the United States, by year of graduation. Relationship between State of practice and State where medical school was attended is also shown. The baccalaureate origins of 1950-59 medical graduates were studied to find out which and what kinds of colleges have been im- portant in preparing medical students. The study, to appear shortly as Public Health Monograph No. 66, shows the relationship between the proportion of graduates who became physicians and such characteristics of the undergraduate college as type of program, administrative control, tuition, and location. A survey of 1950 medical school graduates, conducted in cooperation _ with the Council on Medical Education and Hospitals of the American Medical Association, relates current data to earlier data to show _ trends in medical practice. Type and method of practice, location of practice, place of residence before medical school, and graduate training for this group of physicians are reported. | A nationwide survey of social welfare manpower as of 1960 was | conducted jointly with the Bureau of Labor Statistics of the Depart- | ment of Labor, the National Social Welfare Assembly, and the | Social Security Administration. Detailed analysis of employment characteristics, levels of education, and annual salaries for the 11,700 medical and psychiatric social workers included in the survey is underway. WORK IN OTHER FIELDS The editing of a comprehensive textbook on administration of community health services, sponsored by the International City Managers’ Association and prepared in consultation with a special advisory committee of the American Public Health Association, was completed for publication. The book consists of 26 chapters by a | 144 Department of Health, Education, and Welfare, 1968 authorities in various phases of community health services. It is. intended to serve chief administrators and health officers in cities and counties as a guide to public health policies, problems, and } administrative methods. Additional reports and studies published or scheduled for publica | tion during the year include the eighth listing of the Clearinghouse on Morbidity | Projects; an article analyzing health needs of the aged and > current proposals for meeting these needs; a chapter on current meth-_ ods of financing hospital care for a book on hospital administration; the first study for the United States on a national basis of work loss i due to illness in selected occupations and industries; a study of the | causes of death responsible for recent increases in sex mortality differ- _ entials in the United States; an epidemiological diet study in North | Dakota; an article on illness in the United States as estimated from the Monthly Report on the Labor Force; and a paper on death rates” for coronary heart disease in metropolitan and other areas. In connection with a study of medical group practice in the United States, three preliminary papers and a directory of medical groups practicing in 1959 have been published. A comprehensive report on the study is in preparation. Other projects underway include a survey of medical and health resources in the Cleveland metropolitan area; analysis of factors affecting the use and effectiveness of medical care in the absence of major financial barriers to care; a study of the undergraduates origins of 1950-59 medical graduates of individual medical schools; and preparation of a revised directory of homemaker services. The Division provided staff services for a committee on medical care of the National Advisory Health Council and other technical assistance and consultation to congressional committees and to State, regional, and professional organizations. Division of International Health The Division of International Health arranges for Public Health Service participation and official United States representation in in- ternational health organizations, particularly the World Health Organization (WHO) and the Pan American Health Organization (PAHO) ; provides program and policy guidance to the Department of State on international health matters; gives technical advice to the International Cooperation Administration (ICA) and assigns tech- nical personnel to its overseas missions. It is the responsibility of the Division to negotiate with the Soviet Ministry of Health for exchanges of scientists under the U.S.-U.S.S.R. exchange agreement and, in cooperation with the National Institutes of Health and research | Public Health Service 145 | facilities outside the government, to plan itineraries of visiting Soviet | delegations or individual scientists. ‘The Division develops studies of health conditions and resources in various countries of the world and arranges for widespread circulation of technical publications of inter- national health organizations to interested groups in the United States. During the year, the Division arranged for the official United States Delegations to the 14th World Health Assembly in New Delhi in February 1961, the 12th Meeting of the Directing Council of the Pan American Health Organization, Washington, October 1960, and the 48d Meeting of that Organization’s Executive Committee in Washington in May 1961. The Division, in consultation with the Department of State, developed official United States policy on topics discussed at these meetings, including the global malaria eradication campaign, intensified international medical research program, public health aspects of ionizing radiation, and worldwide community water supply program. The Chief of the Division was appointed by the President of the United States to be the U.S. Member on the WHO Executive Board and the Assistant Chief was appointed U.S. Member on the PAHO _ Executive Committee. In addition, an officer of the Division served as Alternate United States Commissioner on the South Pacific Com- mission, a consultative body composed of representatives of the six metropolitan governments administering territories in the South Pacific area. The Commission’s purpose is to encourage and strengthen international cooperation in promoting the economic and social welfare and advancement of the South Pacific peoples. The Division also acted in an advisory capacity with respect to health-related matters which came before meetings of other interna- tional organizations, such as the Food and Agriculture Organization, United Nations Children’s Fund, and the International Labor Organization. Public Health Service officers also served international organiza- tions as members of WHO expert panels or as short-term consultants to WHO or PAHO. For example, approximately 80 service officers are members of WHO panels in 38 health specialties. The Division assisted the Office of Public Health, ICA, in preparing a series of 10-year health plans for Africa, including plans for the eradication of smallpox and malaria and for control of trachoma, yaws, and treponematosis. More than 100 Public Health Service officers served with ICA overseas missions during the year. The Division also worked with the U.S. Peace Corps in arranging for assignment of medical officers to serve either as medical advisors in the Peace Corps headquarters or to provide medical care for volun- 146 Department of Health, Education, and Welfare, 1961 — teers at project sites. In this connection, four medical officers and . three civil service employees from the Service were on duty at the Peace Corps in Washington during the latter half of the year and one of the medical officers made a trip to Tanganyika to survey health and medi- cal care facilities in preparation for a Peace Corps project in that country. Negotiations under the U.S.-U.S.S.R agreement resulted in the exchange of 3 delegations from each country for a period of 30 days. The U.S. delegations, comprising 17 scientists, were in the fields of metabolic diseases, maternal and child care, and infectious diseases. The three Soviet delegations, with a total of 15 scientists, were in industrial medicine and hygiene, cardiovascular diseases, and onccl- ogy. In addition to the exchange of missions, the program brought five Soviet cancer specialists to the United States for a cancer meeting; sent six U.S. heart specialists to a joint heart meeting in Moscow; and assigned a National Cancer Institute scientist to spend 6 months in research at the Institute of Experimental Pathology and Therapy of Cancer at the Academy of Science in Moscow. The Division assisted in preparation and staffing of an exhibit on health and medicine in the United States at the First International Health Exhibition, sponsored by the Government of Italy and held in Rome from November 10, 1960 to January 8, 1961. Studies of health conditions and resources in the Philippines, Venezuela, Egypt, Guatemala, and El Salvador were compiled from published material during the year, bringing to 26 the number of such studies completed by the Division. One function which has increased in scope in recent years is the extensive distribution of a variety of technical publications of the World Health Organization, Pan American Health Organization, and South Pacific Commission. During fiscal year 1961, the Division distributed more than 7,500 such publications on a complimentary basis throughout this country. Division of Health Mobilization The health mobilization program of the Public Health Service is intended to carry out Federal responsibilities for health services under the national plan for civil defense and defense mobilization. The objective is to meet the health needs of the civilian population in the event of a national emergency. In July 1960, the Division of Health Mobilization, which is responsible for administering this program, was transferred from the Bureau of State Services to the Office of the Surgeon General. During the year, work was continued on plans for an emergency health service which would serve as the health arm of the Federal Public Health Service 147 emergency civilian government in a national disaster. This service combines personnel of the Public Health Service, Food and Drug Ad- ministration, Office of Vocational Rehabilitation, medical personnel from the Children’s Bureau, and personnel from the Veterans Admin- istration and other Federal agencies with health responsibilities. De- lineation of organization and functions neared completion and key positions were staffed. Processes were continued to develop data on calculating potential bomb damage; providing maximum facility protection ; computing re- quirements for community medical supplies and equipment; analyzing the available resources; inventorying holdings of survival items. Effective October 1, 1960, management of the national emergency medical stockpile was tranferred to the Public Health Service from the Office of Civil and Defense Mobilization. The stockpile includes some $169 million in equipment and supplies, including 1,930 civil defense emergency hospitals. Most of these hospitals are in strategic non-target locations throughout the country and the other inventories are stored at 34 different warehouse facilities. Four national training courses were prepared and presented on the health mobilization aspects of civil defense. Assistance was given to the presentation of 4 similar courses sponsored by the health depart- ments in 4 States. The division also aided the States in conducting training exercises in the setup and operation of civil defense emer- gency hospitals. Staff assigned to Public Health Service Regional Offices worked closely with State health organizations to aid in devel- oping community health capabilities for emergencies. A research project was completed under contract from the Office of Civil and Defense Mobilization on what a person needs to know to survive a national disaster and meet his own health needs if deprived of a physician’s services. Working in cooperation with the American Medical Association, a medical self-help training course including an instruction kit, was developed and tested; and a reference manual for use by householders, Family Guide—Emergency Health Care, was completed. Other research completed includes development of (1) scale models of civil defense emergency hospitals; (2) plans for a prototype mutual aid water supply; (3) methods of mobilizing and managing health manpower in a national emergency; and surveys of (1) water utilities and sewage utilities; (2) medical supplies on drug racks in grocery stores and warehouses. Projects in progress but not completed during the fiscal year were (1) creation of an austere medical care procedures manual to be used as a guide in training all health personnel; (2) survey of current avail- ability of medical survival items in private physicians’ offices. 148 Department of Health, Education, and Welfare, 1961 Bureau of State Services This Bureau was vitally affected by the decision to reorganize the Public Health Service so that greater emphasis could be put upon the two major health problems of today: how to build comprehensive health care programs and how to safeguard the environment against — hazardous pollutants. Because the solution to both problems depends primarily upon State and local actions, the challenge to this Bureau was how to improve its services to States and community health agencies. Asa first step in meeting this challenge, the Bureau has strengthened its own administrative and program staffs in both the environmental and the community health fields and has regrouped its Divisions to assure a tighter coordination of all activities in each of these two major areas. The Robert A. Taft Sanitary Engineering Center, formerly a unit of one of the divisions, was brought directly under Bureau adminis- tration. This center conducts research, gives technical training and assists States and communities with problems of water and air pol- lution, radiological health and milk and food sanitation. Its activi- ties are reported under the divisions it services. The reorganization of the Bureau program is described in the fol- lowing division reports. Division of Community Health Practice Established February 1, 1961, this new Division supersedes the former Division of General Health Services. The year’s activities included the coordination and management of $274 million appro- priated for grants-in-aid and $2 million for training professional public health personnel. Technical assistance and consultation were provided throughout the country on State and community health programs and field research, health programs for schools and migrant workers, health education, and planning for professional training, in- cluding the education programs scheduled in the United States for foreign students and visitors from 89 nations. The Arctic Health Research Center, which does basic research on health problems in low- temperature areas, was transferred at year’s end from this Division to the Bureau’s environmental health administration, A new activity was added: the administration of a special grant of $86,320, transferred from the President’s contingency fund, to en- able Florida and Dade County to set up comprehensive health services for 25,000 to 50,000 Cuban refugees. Included were diagnostic screen- ing, dental and medical care, hospitalization, and other needed services and clinics in which Cuban medical personnel assisted county health personnel. Public Health Service 149 GRANTS MANAGEMENT For fiscal year 1961, a total of $274,100,000 was available for grants- in-aid to States and territories to conduct public health programs and | to build hospitals and other health facilities. This reflected an in- crease over the preceding year of $4,625,000 which was shared among four programs: $2 million for general health programs; $1,250,000 for cancer control; $1 million for mental health activities; and $375,000 for heart disease control. | Actual payments from total available funds were distributed as follows: eC MENUMNERE EU ICH S28 ec ce Se ee ee $16, 755, 443 Wenereal disease special’ projects__.__.__-_-__________ 72, 379, 805 SC EETIGMMECOMLE Ola ats ser eer a ser AU 6 Le Si ee le 3, 982, 055 Speers Meare mem cil Vities Shs hor fel’ oles CS Lael lc Leelso sk 5, 941, 888 MEU ECCHMOUTIOK Omer trae: tt Jvie Ls Pol yt ieee fee A) 3, 313, 568 Be NTU BOI SO SeTO OT EE Ole: 2 1 ik ee ee ek ee 3, 300, 482 Hospital and medical facilities construction______________________ 157, 004, 031 BEIVASLe LCoaLmMen. works Construction_.__*___-__=_-_ = 44, 085, 200 BEV LenSpO tubron COntrol=--=22— 2) 2 eee ? 2, 891, 860 1Includes $847,754 in supplies and services furnished in lieu of cash. 2Includes $248,844 paid to interstate agencies. Other payments helped to strengthen public health training and build up the supply of qualified personnel needed in modern health programs. A total of $1,991,819 was distributed for traineeships for professional public health workers, and $6,099,858 for professional nurses preparing for administration, supervision, and teaching. For training and demonstration projects in air pollution control, payments totaled $122,287; grants for radiological health training, $134,559 ; grants to accredited schools of public health, $951,210; and project grants for expanding graduate and specialized curricula, $446,892. In addition, community cancer demonstration projects received $1,257,164 in funds and $48,970 in personal services furnished in lieu of cash. From the appropriation for construction of mental health facilities in Alaska, a total of $2,801,482 had been paid through June 30, 1961. PUBLIC HEALTH ADMINISTRATION The Public Health Administration Branch gave technical assist- ance and consultation to State and local health agencies on several major concerns assigned to the Division, such as metropolitan health problems, programs related to general health grants, the develop- ment of comprehensive community health services, and training and demonstration activities. Staff assistance was also provided for a number of interdepartmental committees. The Branch conducts intramural studies on community health needs and resources, health attitudes, and survey techniques. One such 150 Department of Health, Education, and Welfare, 1961 study was published: The Impact of Asian Influenza on Community © Life. Another was prepared for publication: A Health Study in — Kit Carson County, Colorado. A study of physicians’ attitudes and practices with respect to smok- ing was started. The findings will be used to develop an educational program for patients affected by heavy smoking. An investigation of the psychological effects of fear-arousing information was begun to help formulate better educational materials on diseases such as cancer. Other studies were underway on public acceptance of im- munization programs; penicillin prophylaxis among college students with rheumatic fever; health problems in economically depressed areas; and medical care costs and administration. School health staff members participated in many working confer- ences with representatives of State and regional agencies and volun- tary groups. Two regional institutes, cosponsored with the American Association for Health, Physical Education, and Recreation, were held in Los Angeles and Seattle, with about 100 participants from 8 western States. The institutes were designed to bring together professors of health education in teacher-training institutions and key education and health officials; and to provide discussions on new developments in the health sciences. Additional regional institutes are being planned to meet requests from other areas. National attention to problems of agricultural migrant workers and families has accelerated State and regional interests in health pro- grams for migrants. At the request of the Association of State and Territorial Health Officers, a personal health form was designed for uniform recording of data important to physicians and agencies pro- viding medical services for migrant family members as they travel from place to place. Thirty-four States requested a supply of the forms shortly after they became available. Current studies deal with the health aspects of a social service program, the crew-leader’s role in migrant health, and a project linking community health services for migrants along one migratory route between Texas and Michigan. EXTRAMURAL RESEARCH DEVELOPMENT Community-based research to find more effective patterns for the de- livery of modern health services continued to gain support among pub- lic and private agencies and schools of public health. More than a dozen State health departments now have a director or coordinator specifically responsible for developing such research projects through- out their departments. To help meet increasing requests for consultative and liaison serv- ices, the Division recently established a separate Research Grants Branch. Its staff provides consultation for individual investigators, Public Health Service 151 and works closely with other research staffs and committees, both within and outside the Department, on matters of promotion, policy, and training related to research in public health practice. The Branch collects and disseminates nationwide data on com- munity-based research projects, resources, and needs. In one regional office a research development staff has been set up on an experimental basis to determine if consultation services to State and local health departments can be provided more effectively from a decentralized location. Other regional offices have been cosponsors for several con- ferences held for State and local health officials interested in research programs. PUBLIC HEALTH EDUCATION The Health Education and Information Branch completed com- prehensive reviews of health education programs in several State | health departments; leadership training projects were organized; | staff services to international organizations concerned with health education research were provided, as well as speakers and consultants | for meetings of public health workers; and health educators were recruited for Public Health Service programs. To exchange ideas and coordinate efforts, joint planning confer ences were conducted with State directors of health education, pre- fessors of health education from schools of public health, and staffs of voluntary health agencies. Three Branch health educators were loaned to States: one to develop the educational phases of a state medical care program, another to obtain experience in a local health department, and the third to serve as State director of health education. TRAINING | ‘Traineeships were awarded to support the graduate and specialized public health training of 607 physicians, dentists, nurses, sanitary | engineers, health educators, veterinarians, and many other categories | of professional personnel essential to modern public health practice. | In August 1960 the Congress authorized a new program of project | grants designed to help eligible schools enlarge their capacity and improve curricula for training professional health workers. More | than half of 138 eligible schools responded with 164 proposals that included stronger programs in sanitary chemistry and biology; im- proved field training ; preparation of teachers in public health nursing ; and curriculum expansion in medical care administration, rehabilita- | tion, metropolitian planning, radiological health, and air hygiene | and pollution. Out of the total proposals, 92 projects were approved | and 63 could be supported from the $1,430,000 appropriated for the | first year. 152 Department of Health, Education, and Welfare, 1961 i INTERNATIONAL EDUCATION AND EXCHANGE A total of 605 international health students and visitors from 89 | countries received program assistance for 3,109 months of study and observation in the United States. The program involved 136 training | centers, of which 86 were academic institutions. Major support for these activities comes from the International Cooperation Adminis-— tration, which sponsors the largest single group of students and visitors. Those sponsored by the United Nations and other agencies © are also given advisory and technical assistance. Comparison of 1961 with 1960 showed that the number of foreign students training in our medical schools increased 50 percent, while — those sent to schools of public health declined about 50 percent. By countries of origin, 199 came from 15 Far East countries; and 181 — came from 26 Latin American countries, representing a sharp increase over 1960 as well as broader sponsorship. Twenty-nine countries in the Near East, Africa, and South Asia sent 146 students and visitors; 18 European countries sent 78; and Canada, 1. ARCTIC HEALTH RESEARCH CENTER The only research unit of its kind in the United States, the Arctic Health Research Center is concerned with health problems related to life in low-temperature areas. Study fields include environmental — sanitation, biochemistry and nutrition, entomology, epidemiology, : physiology, and zoonotic disease. | During the year several investigations dealt with epidemic out- breaks—principally hepatitis, trichinosis, and respiratory infections. A study was completed on an outbreak at Fort Yukon, where more than 40 percent of the populace was affected; and influenza Type B was established as the cause. Requests increased for consultation on small institutional-type waste disposal methods in remote areas, where central water distribution is not available. Water supply studies included testing for reservoir liner materials that will withstand ice and frost action; well jetting; experiments in air lock installations, and low-cost hypochlorite feeder systems. Other studies of the Center involved aquatic biology, entomologic identifications, nutrition surveys, social and educational observations, tuberculosis chemotherapy, brucellosis, tularemia, hydatid disease, and rabies. Studies on adaptation to cold were extended, with observa- tions of human subjects for determination of indiviual adaptation by age, sex, and occupation. Public Health Service 153 Division of Hospital and Medical Facilities Planning activities of the Hill-Burton Program were highlighted during fiscal 1961 by the completion of two significant reports: “Plan- ning of Facilities for Mental Health Services,” which presented find- ings of a special committee selected by the Surgeon General; and “Areawide Planning of Hospitals and Related Health Facilities,” which presents the conclusions of a joint committee of the American Hospital Association and the Public Health Service. A third report, “Medical School Facilities—Planning Considera- tions and Architectural Guide,” was nearing completion as the fiscal year ended. This publication was prepared in cooperation with the Division of Public Health Methods and the Ad Hoc Committee on Planning Medical School Architecture of the Association of American Medical Colleges and of the American Medical Association. Other problem areas were also explored by special committees, with assistance provided by the Division staff. These committees, which are continuing their work into next year, are concerned with such problems as long-term care, rehabilitation, and tuberculosis. The Division continued its program of providing construction and research grants, participating in surveys and studies, preparing and |} disseminating guide materials for hospitals and related health fa- cilities, and providing consultation to those involved in health facility | planning, construction and administration. | CONSTRUCTION PROGRAM Since the first allocation was made in 1947, some 5,688 Hill-Burton health facility projects have been approved for Federal assistance. This represents a total cost of $4.9 billion of which the Federal con- tribution was $1.6 billion. A total of 238,946 beds for inpatient care and 1,596 health units for outpatient care will be available as a result of these projects. Thus, earlier shortages, particularly in the area of general hospital beds, have been substantially reduced by the pro- gram. In addition to general hospitals, which represent 61.3 percent - of all Hill-Burton projects to date, other types of facilities provided aid include: mental hospitals, 2.4 percent of the total projects; tu- berculosis facilities, 1.3 percent; chronic disease hospitals, 3.3 percent; nursing homes, 5.5 percent; public health centers and State health laboratories, 15.6 percent; diagnostic centers, 7.2 percent; and re- habilitation centers, 3.4 percent. Although sizable gains have been made in general hospital con- struction (79 percent of the need has been met compared with 59 percent in 1948), a number of health facility problems continue to confront many communities. New needs have been created by 626936—62——_11 154 Department of Health, Education, and Welfare, 1961 | scientific advances, new patterns of care, shifts in population, length- ening life span, and obsolescence of existing facilities, particularly in metropolitan areas. To meet these needs requires continued sound State planning with strong community support. The Nation’s greatest gap in health facilities is in the area of long- termcare. There are great differences in the present level of availabil- ity of long-term care facilities among the States. The five States which currently have the highest ratio of nursing home beds per 1,000 elderly, proportionately have seven times more long-term beds than the five States with the lowest ratio. If the country as a whole were to be brought to the level of the five highest ranking States we would need a half-million more long-term beds. Another great need is the development of small community or regional facilities for the mentally ill which would eventually replace the large State-owned institutions which now primarily serve a custodial function. RESEARCH GRANTS Hospital research is a growing activity in the Hill-Burton program. During the past fiscal year funds were provided for 34 extramural research projects, 22 of which were begun prior to June 1960. The grants, totaling $1,015,690, were made to universities, associations, and other nonprofit organizations interested in investigating means for providing effective patient care by the most efficient means at the lowest possible cost. The grants were made in five general areas: (1) the development of more effective organizational patterns for pro- viding services; (2) better community planning and coordination of hospital facilities and operations; (3) studies of hospital admissions and utilization of hospital services; (4) architectural and equipment design; and (5) methods for improving and simplifying working procedures. In the area of intramural research, the primary focus continued on Progressive Patient Care. Preliminary reports were completed on three studies—“Estimating Bed Needs in a Progressive Patient Care Hospital,” “Progressive Patient Care Cost Methodology,” and “Personnel Evaluation, Training and Procedures in Progressive Patient Care.” In addition, several new studies were begun during the year. The Division has found through its surveys that a growing per- centage of hospitals throughout the Nation are incorporating one or more of the elements of progressive patient care into their organiza- tional and operational structure. The staff has, through orientation, guide material, exhibits, speeches and consultation, given widespread distribution to this concept of care which emphasizes “the tailoring of services to meet the patient’s needs.” | Public Health Service 155 COOPERATIVE STUDIES Many studies have been undertaken by the Division—some in col- laboration with other agencies and organizations concerned with the same problems. For example, the Division has joined forces with the American Hospital Association and the State of Georgia Department | of Health in a pilot study to develop a methodology for uniform joint | reporting of basic hospital statistics. Such uniform reporting will be an aid in State licensure and planning, in the gathering and com- pilation of National statistics, and in Civil Defense planning. An- other example is the assistance provided to John Hopkins University in its examination of physical plant and operating needs of 10 Penn- sylvania general hospitals which were built in former coal mining communities. Still another cooperative effort was the joint develop- ment with the American Nursing Home Association of a manual for expense accounting in nursing homes, based on experience gained in a study of nursing home costs conducted jointly at the invitation of the Pennsylvania Department of Public Welfare. Approximately 200 publications have been prepared by the Division over the past several years. During the past year alone, approxi- mately 200,000 requests for these publications were answered. A. growing number of visitors from the U.S. and abroad come to the Division for advice and consultation. Foreign visitors during the past year included representatives. from England, Scotland, Pakistan, Paraguay, Yugoslavia, Poland, Costa Rica, Japan, the Philippines, Australia, and Viet Nam. Division of Chronic Diseases Established February 1, 1961, the Division of Chronic Diseases has as its overall mission the prevention of the occurrence and progres- sion of chronic disability and dependency. The Cancer Control and Heart Disease Control Programs were transferred from the former Division of Special Health Services into the new Division without organizational change. The Chronic Disease Program of the Division of Special Health Services was expanded into three separate program branches within the new Division. These branches are: Arthritis and Diabetes, Vision and Hearing Conservation, and Health Services for Long Term Illness (including problems of the aged). HEART DISEASE CONTROL The Heart Disease Control Program supports and promotes the use of research products and new techniques to reduce the effects of cardio- vascular disease. One hundred twelve medical and other professional personnel—a 50-percent increase over last year—are assigned to States to further heart disease control programs. 156 Department of Health, Education, and Welfare, 1961 Heart Disease in Children Laboratory technicians from all 50 States, 4 territories, and 5 citi were trained at the Communicable Disease Center in the fluorescent | antibody technique for the rapid identification of the organism associ-_ ated with the onset of rheumatic fever and rheumatic heart disease. Nine States conducted 12 in-State training courses for 210 tech- nicians, and equipment and training personnel are scheduled solidly _ through December 1962. A test utilizing tape-recorded heart sounds to screen 33,000 school children for heart disease was completed in Chicago, and is stimulat- ing other areas to initiate screening projects. Plans are under way to test inexpensive, portable equipment, and to develop electronic meth- ods for initial screening of the tapes. Heart Disease in Adults To identify and measure the role of various factors in coronary artery disease, epidemiologic, clinical and laboratory studies are in progress in 12 States. As background data, coronary death rates by counties and other geographic areas are being computed for the 10-year period 1950-59 for several States. Through a series of projects in several States, it has been demon- strated that most stroke patients can be restored to self-care; restora- tive services for stroke patients are being improved and extended. A long-term community study in Mercer County, W. Va., is en- deavoring to provide a scientific basis for deciding whether treatment reduces morbidity and mortality of moderate hypertensives. Else- where, the effect of sodium in drinking water on the management of patients with congestive heart failure is being investigated. Institutes and workshops were held in many places to teach heart disease control to health and related personnel. For example, the Program was instrumental in stimulating a series of cooperative training workshops for health and welfare workers in New Jersey, Colorado, Massachusetts, Kentucky, and Puerto Rico. A laboratory unit to standardize procedures and tests used in heart disease studies has been established at the Communicable Disease Center in Atlanta. A computer program for automated electrocardiographic analysis has successfully classified electrocardiograms by statistical techniques. A test on a larger scale is planned. Preliminary studies in electro- cardiographic telemetry and in computer analysis of phonocardio- grams are in process. CANCER CONTROL For the first time in more than a decade, Federal assistance to State health departments for cancer control was increased this fiscal Public Health Service 157 | year. Federal funds rose from $2.25 million to $3.5 million, with a $25,000 minimum per State. In those States able to budget the in- crease immediately, most of the additional funds were put to use for clinic and casefinding activities and for program development. Demonsiration Projects Seventy-nine Community Cancer Demonstration Project Grants were awarded, totaling $1,781,153. These projects are hastening the application locally of current knowledge for controlling cancer. Six- teen projects planned to examine some 50,000 women for uterine | cancer. To bolster programs such as these, the education of nearly 200 cytotechnicians was aided through grants to approved schools of cytotechnology. Other grants supported projects in professional and public education, collection and analysis of data to improve care, in rehabilitation, and in other activities. Both the Cancer Control Program and the Association of State and Territorial Health Officers encouraged and emphasized cancer examinations among the comparatively high risk group of women recelving medical care from public agencies. Cytologic smears are being processed by the Washington Cytology Unit, the Cancer Con- trol Program’s laboratory, to help other Federal agencies to increase the number of beneficiaries being examined for uterine cancer. “Shoptalk,” a technique to aid professional] education, passed from an experimetal to an operation stage. Perfected with the cooperation of the American Academy of General Practice, this technique uses filmstrips and tape-recordings of family physicians and specialists discussing practical problems of cancer control. The Academy is using these films and tapes to promote further discussion among other groups of physicians on the problems and opportunities in their daily practice in applying cancer detection and diagnostic techniques. The Public Health Service position on smoking and lung cancer was presented to medical and public health groups, in national, regional, and local meetings, including the annual meeting of the American Medical Association. HEALTH SERVICES FOR LONG-TERM ILLNESS Some 25 contracts and agreements related to health services for the chronically ill had been approved as of June 30, 1961 with State and local health and welfare agencies and nonprofit organizations. They were mainly training, survey, and research projects planned to pre- pare the way for broad service programs. Major areas of interest are: Nursing Care of the Sick at Home.—Professional nurses and assist- ants from both official and voluntary health agencies render services 158 Department of Health, Education, and Welfare, 1961 to that major proportion of the chronically ill and aged not residing in institutions. Homemaker Services—Home help is supplied when illness or dis- ability creates a family need for such service. Coordinated Home Care—Selected patients at home receive physi- cian-directed medical, nursing, social, and related services through a plan based on coordination, evaluation, and follow-up. Information and Referral—tInformation concerning community health and medical care resources is made available from a central source, and consultation and guidance are offered to patients, families, and professional personnel. Periodic Health Appraisal—tThe detection of disease in apparently well persons, the determination of the individual’s health status, and the early prevention of disability are furthered by periodic appraisals that include health history, physical examination, and clinical and laboratory tests and procedures. Nursing Home Services—Many chronically ill and aged persons not in need of hospital care are accommodated in facilities that are designed, staffed, and equipped to provide nursing care and related medical services under State license. Technical assistance was supplied in the formulation of State Plans regarding grant expenditures for community health activities and services. More than 10,000 nursing aides in nursing homes have been trained through coordinated training activities developed in cooperation with the American Red Cross. Projects supported in eight communities have provided hospital guidance and consultation services to nursing homes, and a docu- mentary film on this operation has been produced. Over 10,000 copies of the “Nursing Home Standards Guide” have been distributed to State and local public and private agencies, Staff assistance was contributed for planning and conducting the White House Conference on Aging. National and Regional Institutes and Seminars were sponsored for the study of home care, nursing homes, and coordinated home care. Nursing home personnel will be trained in accounting techniques at Regional Seminars organized by the Program. DIABETES AND ARTHRITIS The Diabetes and Arthritis Branch cooperates with the National Institute of Arthritis and Metabolic Diseases by applying new re- search developments in community programs as soon as feasible. Public Health Service 159 Diabetes Blood Testing Diabetes detection and field research activities have been advanced. A preliminary report of blood test screening projects shows that 59 health agencies in 16 States and one territory screened over 74,000 persons during the fiscal year 1961. Employees of 27 federal agencies were included in a diabetes detec- tion program conducted by the Federal Employee Health Program and the Diabetes and Arthritis Branch. Results of 20,000 tests made in the Washington, D.C., area are under study, and screening is continuing. A continuing study of abnormal] carbohydrate metabolism in preg- nancy conducted by a field research staff in Boston has disclosed that there is a reduction in the frequency of births of large weight babies among women treated with insulin during pregnancy. Followup examinations of 307 pregnant women treated with insulin, 307 posi- tive controls, and 319 negative controls have resulted in the diagnosis of diabetes in 36 insulin treated women, 45 positive controls, and one negative control patient. Automated Diabetes Instruction Time consumed by busy physicians instructing diabetes patients in self-care may be reduced significantly by an automated instructional course in diabetes being developed in cooperation with manufac- turers of a self-instruction machine. The machine has been success- fully used in industrial and armed forces training. The automatic teaching device will be tested in several health department clinics - during the next fiscal year. Arthritis Control Though early detection of arthritis has not yet progressed to the same degree as diabetes control activities, attention and study have been given to possible utilization of several promising uric acid screen- ing methods. A number of communities are being explored as possible sites for field research in screening for gout—a disease that can be controlled with the prophylactic use of certain drugs. VISION AND HEARING CONSERVATION The Vision and Hearing Conservation Branch works closely with official State and local health agencies, national voluntary agencies, and the National Institute of Neurological Diseases and Blindness to develop a nationwide program for the early detection and management of vision and hearing impairments. Increasing awareness of the effectiveness of early detection of glau- coma in preventing blindness or serious sight impairment has resulted 160 Department of Health, Education, and Welfare, 1961 a ener ca EON AN in widespread adoption of glaucoma screening programs by State and local health departments. Nearly half of all the State and territorial health departments have glaucoma detection programs, Approxi- mately 100,000 persons were screened during the fiscal year. National Reporting System In cooperation with the National Society for the Prevention of Blindness, the Branch has developed a national reporting system to obtain definitive information on glaucoma screening methods being used in local programs. The reports will supply valuable data on prevalence of the disease nationally, the types of population most susceptible to glaucoma, and the most effective screening methods. _ Validation of various screening tests in predicting the development of definite simple glaucoma was continued in a Glaucoma Collabora- tive Study involving five university ophthalmologic centers. This 5-year study is supported by grants from the National Institute of Neurological Diseases and Blindness. About 600 patients already have been evaluated. The specificity and sensitivity of the Schigtz type tonometer is being studied at the University of Tennessee School of Medicine. Tonometer Sheath Developed A. disposable, latex-rubber sheath called a “tonofilm” that keeps the footplate of a tonometer sterile during glaucoma screening tests has been developed. The device shows promise of reducing the hazards of eye contamination in large-scale screening operations where instruments have to be used repeatedly and kept sterile. Conventional methods of sterilizing tonometers are not very effective. The “tono- film” is being evaluated at two clinics before production is permitted for general use. Hearing Conservation A committee of expert consultants in audiometry and audiology was formed to develop criteria for hearing measurements that can be used in programs. Studies are being planned to develop information on the extent to which hearing loss is preventable or remediable, the effect of the aging process on hearing loss, and the types of hearing tests and standards that can be applied to community screening programs. Communicable Disease Center The Communicable Disease Center, Atlanta, Ga., carries out Public Health Service programs in the control of infectious diseases, It Public Health Service 161 conducts epidemiological, field, and laboratory studies and provides various types of technical assistance to State health departments. Because of the global nature of infectious diseases, CDC also partici- pates in health efforts around the world. It provides technical sup- port and personnel for the health programs spearheaded by the Inter- national Cooperation Administration. It also cooperates with the World Health Organization through representation on expert ad- visory panels and committees and as a laboratory diagnostic and study center. This year, CDC brought all its central activities together in new headquarters buildings adjacent to Emory University, which were dedicated on September 8, 1960. The Southeastern Rabies Field Station was moved from Montgomery, Ala., to Chamblee, Ga., and established as a National Rabies Laboratory. In April, a new labora- tory building adjoining the University of Kansas Medical Center was dedicated to house the Kansas City Field Station. This installation conducts investigations of the systemic mycoses and respiratory and enteric viral infections. With the transfer of the tuberculosis program to CDC this year, control activities for all infectious diseases became centralized. In addition, responsibility for collecting and publishing morbidity and mortality reports of communicable diseases was transferred from the National Office of Vital Statistics to CDC on January 1, 1961. EPIDEMIC AND DISASTER AID Epidemic aid was extended in 88 instances to 23 States, and addi- tionally to West Berlin and American Samoa. Several other States, the District of Columbia, and Puerto Rico sought consultations in connection with epidemics. Infectious and serum hepatitis epidemics accounted for 11 calls for aid, poliomyelitis for 5. Other diseases included infantile diarrhea, diphtheria, encephalitis, staphylococcal infections, streptococcal infec- tions, rabies, trichinosis, erythema infectiosum, anthrax, and typhoid fever. A localized concentration of leukemia in Cook Co., Ill., was studied in conjunction with the National Cancer Institute. Disaster aid was furnished to eight States in nine instances, pri- marily in connection with emergency vector control. REPRESENTATIVE DISEASE STUDIES Quota Sample Surveys The “quota sample survey” developed at CDC in 1959 was im- proved and modified, and its use was extended to a number of com- | 162 Department of Health, Education, and Welfare, 1961 } municable diseases. Originally designed to assess polio immunization | levels of different population groups within a community, it was used | this year to study epidemiological patterns of polio and several other }) : diseases and to investigate factors possibly related to a concentration | of cases of leukemia. When broadly applied, this technique promises |) | to be a useful adjunct to guiding and evaluating many types of local | health programs. Venereal Diseases Infectious syphilis morbidity climbed to 18,781 reported cases | during fiscal year 1961—the greatest number recorded in any year since 1950. Increased incidence involved both sexes and all age and racial groups. Thirty-seven States reported an upswing in cases, both among clinic and private patient groups, with 10 large cities contributing 42.3 percent of the total number of infectious cases. In an effort to reverse the tide, the Venereal Disease Control Pro- gram supported epidemiologic and casefinding services in 45 States and Territories through 82 project grants and through assignment of 226 doctors, nurses, health program representatives, and public health advisors to health departments. In addition, 123 public health workers were hired under cooperative agreements between the Public Health Service and other agencies. In the States, programs to visit private physicians and stimulate them to report all syphilis cases and permit epidemiological follow-up were vigorously pursued. Nearly 75 percent of infectious cases re- ported by physicians last year were subjected to the same rapid and intensive investigation in regard to contacts that is applied to most clinic cases. Every infectious case is regarded as an emergency. Since one out of four patients reports out-of-State contacts, epidemiologic information is transmitted by long-distance telephone. In some in- stances, outbreaks stemming from a single source have been found to span the continent and even cross oceans. Re-interviewing and cluster testing are used to locate, examine, and bring to treatment as many contacts as possible. A revealing study of the sexual and social behavior of 600 teenagers who came to New York City’s venereal disease clinics during a 2-year period was completed during 1961. This study was conducted by the American Social Health Association in cooperation with the New York City Department of Health and financed by the Public Health Service. A limited edition of “Teenagers and Venereal Disease: A Sociological Study,” the detailed report of these findings, has been published by CDC. Inability to diagnose gonorrhea in the female has been an obstacle to the development of effective gonorrhea control programs. The | Public Health Service 163 fluorescent antibody test has been adapted to the identification of the organism and is now being evaluated in field trials. Nine State health departments are using the Fluorescent Treponemal Antibody test to differentiate between biologic false positive reactions and those gen- uinely indicative of syphilis. Evaluation of therapeutic agents indicates that penicillin is still effective in the treatment of syphilis. Some decrease in the suscepti- bility of the gonorrhea organism has been noted; however, a number of alternate antibiotics have been evaluated and are available. Influenza Acting upon recommendations of the Public Health Service Ad- visory Committee on Influenza, CDC mounted a campaign to stimulate | the annual vaccination of high-risk groups against this disease. The elderly, the chronically ill, and pregnant women consistently account for a major portion of the excess influenza-associated mortality during epidemic periods. | The campaign was aimed at the medical profession and others re- sponsible for the care of high-risk individuals. Its success was evident | in the increased demand for vaccine. __ CDC prepared and distributed nearly 40,000 copies of an Influenza Fact Sheet to Regional Medical Directors, medical specialty groups, medical journals, State health officers, pharmaceutical houses, and other interested groups. | Poliomyelitis The changing trend in poliomyelitis incidence in the United States | was brought more clearly into focus during 1960. Only two major _ epidemics occurred, one in metropolitan Providence, R.I., and the | other in Puerto Rico. However, there were numerous moderate urban / and rural outbreaks and several localized concentrations of cases | throughout the country. | After the severity of the 1959 polio season, the dramatic drop in | number of cases was particularly gratifying. Out of 2,218 paralytic cases reported to CDC’s Poliomyelitis Surveillance Unit,? 57.6 per- cent were concentrated in totally unvaccinated individuals and only 7.4 percent occurred in fully vaccinated persons. The effectiveness of the Salk vaccine was thus reaffirmed. A reversion to the infantile form of polio was seen, with 43 percent of the cases occurring in preschool children, peaking among one- and two-year olds. Also notable was the increased incidence in the 20- to 35-year age group. 2 Best available count. 164 Department of Health, Education, and Welfare, 1961 The Surgeon General’s Polio Advisory Committee took these find- ings into consideration when it met at CDC in October and January. Prominent among the Committee’s comprehensive recommendations for polio control were the intensified use of Salk vaccine as an immedi- ate goal and of oral vaccine for use in curbing epidemics as soon as it should become available. The Committee endorsed the Public Health Service plan to encourage local community drives to reach lower socioeconomic and younger age groups through “Babies and Bread- winners” campaigns. The first demonstration of an all-out community immunization effort was staged in Columbus, Ga., in cooperation with the State and county health departments. Although a preliminary Quota Sample Survey showed that this city of 120,000 population had a better than average immunization level, approximately 80,000 doses of Salk vac- cine were given in three 1-week periods. As the program proceeded, it was documented step-by-step. The Columbus campaign served as a prototype for others throughout the country. Community groups, the Advertising Council, and other organizations on the local and national level contributed talent, pub- licity, and manpower to the Columbus campaign and to others that followed it. At the end of the fiscal year, when licensing of oral polio vaccine Type I appeared imminent, the President of the United States requested and Congress appropriated $1 million to purchase oral vac- cine as it was licensed. The supply is to be used to study the effec- tiveness of the vaccine in controlling epidemics. Encephalitis (Arthropod-Borne) Studies in Colorado have uncovered a link between warm spring temperatures and the transmission rate of St. Louis encephalitis (SLE) and between cool springs and western encephalitis. If these findings hold true elsewhere, a means may have been found for pre- dicting outbreaks of encephalitis and the probable type. An unsus- pected enzootic vector of western encephalitis may be spreading the virus in high altitudes. Chicken flocks, placed strategically to serve as sentinels of viral activity, have demonstrated a high rate of trans- mission of this virus even when the mosquito Oulea tarsalis, the pre- sumed vector, was essentially absent. Tuberculosis Many communities are hard pressed to provide clinic and out- patient services to tuberculosis patients, the majority of whom receive part, and sometimes all, of their treatment at home. The Tuberculosis Program made a special effort this year to help States with high case Public Health Service 165 rates and inadequate funds. By assigning professional workers, it enabled a number of areas to expand and intensify their services. In demonstration projects, nurses’ aids and specially trained investigators relieved public health nurses of routine tasks, freeing them for more professional functions. In another project, home- makers were employed to see if this would encourage patients to | continue treatment. A major research activity dealt with the identification of unclassi- fied mycobacteria, which cause clinical disease similar to tuberculosis | but do not respond to present drugs. More than 500 strains have been | collected; 64 of these were subjected to tests in guinea pigs. Eleven new mycobacterial antigens were prepared and used for studies of | human population groups, and others are now being developed. New | findings from studies of tuberculin sensitivity and chemotherapy evaluation were reported and the large-scale study to determine whether isoniazid is effective in preventing tuberculosis was continued. Plague A new technique, involving fluorescein labeling, was developed for | use in the field to permit immediate checks of dead rodents for plague infection. | Schistosomiasis Field studies in Puerto Rico demonstrated the effectiveness of | the predator snail Marisa cornuarietis as a biological control agent | against the snail intermediate host of schistosomiasis, Australorbis | glabratus. A chemical, acrolein, was found to be a good combined | herbicide and molluscacide in Puerto Rico field tests. VECTOR CONTROL Aedes aegypti, the urban vector of yellow fever, is being eliminated initially in a 5-square-mile area of Pensacola, Florida, in a CDC | project to determine the cost and feasibility of eradicating this species. Studies on the release of sexually-sterile adult male Ae. aegypti as an aid to eradication have been initiated. | Improved formulations of solid spontaneous vaporizers for DDVP | have been developed for use in the residual fumigation method of | vector control. Field tests of this method of controlling malaria | mosquitoes, together with studies on the toxicity of DDVP vapor to | humans, have been initiated in Upper Volta, Africa. The use of | DDVP vapor for disinfecting aircraft while in flight has been found | to be biologically feasible in tests on commercial planes. Studies have been started to determine if the vapor, as used in the tests, has | any adverse effect on human volunteers. 166 Department of Health, Education, and Welfare, 1961 / i LABORATORY SERVICES AND NEW TECHNIQUES Nearly 56,000 disease specimens were referred for identification — to the CDC laboratories by State and local health departments, by — various Branches of the Center, and by Federal agencies other than — CDC, research groups and foreign countries. In addition to the amounts required in its own programs, the | Center produced and distributed more than 155,000 ml. of diagnostic _| reagents, and over 12,000 shipment lots of tissue culture media to health departments here and abroad, to other Federal agencies, universities, hospitals, and research groups. These materials are not available commercially. Conjugates for the nine important serotypes of enteropathogenic Escherichia coli found in the United States have been prepared and fully evaluated. Sensitivity and specificity were so encouraging that a field study was undertaken in San Juan, Puerto Rico, where incidence of infantile diarrhea is high. Additional work indicated — by the study has been completed and the method now shows great promise for rapid diagnosis needed in the control of this disease. Under an agreement with the Division of Chronic Diseases, a labora- tory has been established to work out procedures for standardization of tests used in heart disease research and control. The first program of the new laboratory is a cholesterol program to support lipid epidem- iologic research in public health laboratories. Fifty-two laboratories in the United States and Canada are participating in this continuing program which is designed so that others may join the program. INTERNATIONAL COOPERATION In collaboration with the World Health Organization, a refer- ence skin test antigen for the diagnosis of schistosomiasis was prepared and distributed to workers in Japan, Philippine Republic, Africa, Lebanon, and India for evaluation. A protocol for the standardiza- tion of the skin test and methods for analyzing the results of these trials was prepared for use by WHO. Under a cooperative agreement between the governments of Colom- bia, South America, and the Republic of Lebanon, with the Public Health Service, members of the Audiovisual Section of CDC surveyed and secured film footage on nutritional standards of the civilian and military population in those countries. TRAINING Nearly 6,000 persons from State and local health departments, Fed- eral agencies, academic institutions, industry, and organizations attended 373 CDC courses in communicable disease control presented throughout the United States and at CDC headquarters. Over 26,000 Public Health Service 167 audiovisual aids were loaned in response to requests, and more than 100,000 pieces of training literature were distributed. Two venereal disease control seminars were held which attracted an additional 1,300 persons. Thirty-seven training publications were prepared and 69 audiovisual productions were completed during the year. Division of Accident Prevention Accidents are the first cause of death from age 1 to 36 and fourth for allages. The Division of Accident Prevention, established Febru- ary 1, 1961, supports a broad program of research to identify human factors in accident causation which can be modified or compensated for. Its recent and ongoing activities include: Cooperation with the Greater Cleveland Safety Council on a public action program over a full year beginning September 8, 1961, the first attempt of its kind in any metropolitan center. Participation in a national seat-belt campaign launched by the | Advertising Council of America. Provision of seat-belt anchor points for at least two seat belts in all American 1962 cars, partly asa result of PHS activity. A study in five rural Virginia counties to try to reduce accident rates through community organization and strong publicity. The results are being published as a valuable guide for other rural areas. Participation in a program on fire deaths and injuries in Mississippi County, Ark. Injuries from fires dropped dramatically in 1 year. The State health department is extending the work on a statewide, permanent basis. Other activities included sponsorship of a Conference of State Motor Vehicle and Health Officers which led to permanent committees to foster close cooperation of their departments on driver licensing, driver examinations for intoxication or drug addiction, and related medico-legal problems. A conference on driver simulation projects brought together all interested disciplines and opened a campaign for a wide range of devices. A successful Conference on Alcohol and Traffic Safety was held to compile all known facts on this subject. The first textbook on accident prevention for physicians and health workers was published, with PHS cooperation, by the American Public Health Association. The National Clearinghouse for Poison Control Centers, with 460 centers affiliated as of July 1, started pilot studies on preventing child- hood poisoning. A “safe medicine chest,” developed in the Division, is being consid- ered for production by several manufacturers. 168 Department of Health, Education, and Welfare, 1961 Other interests include mouth-to-mouth resuscitation, emergency care of accident victims, accidents of aged persons, safety standards for home appliances, epidemiology of traffic deaths, and effective home inspection for fire prevention. Division of Nursing The Division of Nursing was established in September 1960 by com- ~ bining the Division of Public Health Nursing with the Division of Nursing Resources. All major program goals and objectives of the two former divisions are being continued and expanded and new objectives will be added as new health programs develop. The Divi- sion is responsible for the continuing appraisal of nursing needs and available resources to meet these needs. It also stimulates the develop- ment of new resources and assists health agencies, hospitals and other institutions to make the most effective use of nursing services. This work is carried out through: (1) systematic collection and analysis of data on nursing needs and resources; (2) consultation to State health departments, and through them to local health agencies, on all aspects of nursing programs for which they are responsible; (3) consultation on the application of study methods, as requested, to health agencies, nursing organizations, hospitals, both voluntary and tax-supported, and others; (4) intramural studies to develop new methods of improving nursing practice; and (5) grant operations, both for advanced training and for research. The Surgeon General’s Consultant Group on Nursing, appointed this year and comprising 24 leaders from health professions, industry, and civic groups, is considering the Nation’s nursing needs in order to make recommendations on the appropriate role of Federal and local governments and private agencies in the provision of adequate nursing care. The Division has primary responsibility for the prep- aration of materials and other staff services for this Group. The Division also gave leadership in nursing and health through the Division Chief’s service as an official adviser for the U.S. dele- gation to the 1961 World Health Assembly; loan of one nursing con- sultant to the World Health Organization for 3 months to prepare a nurse staffing guide for public health agencies; and loan of two consultants to universities to teach courses in nursing research. SYSTEMATIC ANALYSIS OF NEEDS In addition to the recurring biennial estimates of total nurse supply and the census of public health nurses, the Division has underway a series of related surveys and analyses to obtain information needed to guide program development. For example, the latest estimates re- Public Health Service 169 ported employment of 80,000 part-time nurses, but there was no in- _ formation on the amount of time these nurses work annually. The Division is conducting a study to provide information on the work patterns of this important group. More than 6,000 questionnaires from a sample of these nurses were received and coded; data analysis will be completed in 1962 and a report published. An estimated 200,000 professional nurses maintain a current li- cense to practice although they are not actually nursing. These nurses could form an important corps to augment the national supply. To determine the availability—readiness and willingness—of inac- tive registered nurses to return to nursing posts full- or part-time, the Division is undertaking an extensive survey of a sample of these nurses. To provide data for the 1963 evaluation of the Professional Nurse Traineeship Program and other training activities, work was begun on the development of a questionnaire for use in obtaining detailed information on the present educational level of professional nurses and their potential for and interest in further preparation. NURSING CARE OF THE SICK AT HOME The Division continued to promote and encourage local health agen- cies in the development of programs to provide nursing care to sick and disabled persons in their homes. Vast expansion of home nurs- ing services can be predicted as demands grow due to the increasing numbers of chronically ill who are best cared for in their own homes. Technical assistance from both regional nursing consultants and headquarters staff has been accelerated because of the urgent need to develop these services in States which passed legislation including home nursing care for the aged as permitted under the 1960 Social Security Act Amendments. Assistance was requested on a variety of problems, such as the conditions necessary for the initiation of such a program, ways and means of recruiting and training personnel, organizational patterns for the new service, and ideas for publicizing this additional community resource. One major administrative problem raised was the determination of costs of providing nursing care in the home as a basis for fee sched- ules. The Division assisted two States to develop workable cost procedures. With the assistance of the regional nursing consultants, the Divi- sion of Public Health Methods, and the Bureau of Public Assistance, a statement, “Medical Assistance for the Aged and Nursing Services in the Home,” was developed and distributed to both health and welfare agencies nationwide. It has proved to be helpful to health and welfare departments in the development of cooperative programs. 626936—62——12 170 Department of Health, Education, and Welfare, 1961 A countywide nursing care of the sick program including a | hospital-health department referral system was launched by the Rockland County Health Department in New York. Funds to make— this program possible were transferred to the Division by the Heart sonnel fou the State Health Deparivaat aiid the regional nursing consultant, with overall direction by the Division. Ten additional agencies were assisted with instituting work meas- | urement procedures. In one State, procedures were adapted for | application on a statewide basis. ) NURSING SERVICES IN OUTPATIENT DEPARTMENTS The hospital outpatient department has a significant position in total medical care programs. It plays a key role in early discharge from the hospital, in the expanding programs of home care, and in care of the ambulatory patient, often preventing hospitalization. The Division has developed a method for improving nursing in an outpatient department through several interlocking studies designed to give a comprehensive picture of nursing services. These studies also afford a means of analyzing some aspects of patient experience, for example, patient “waiting” time, continuity of care between clinic and home, and patient teaching, which are influenced by the nursing administration of the outpatient department. This year, arrangements were made to assist in making such studies at three university hospitals in the South which recognize the urgency of their own problems relating to outpatient care. STATEWIDE STUDIES OF HOSPITAL NURSING Studies of inpatient nursing units continue to be an effective tool for self-evaluation by demonstrating how hospital nurses can better spend their time in patient care. Approximately 200 hospitais have now studied nursing activities with consultation from the Division. Workshops to teach the study method were conducted in Indiana, California, and Pennsylvania, and consultation was given in Kansas and New Jersey. These last three States are planning studies on a statewide basis in cooperation with local hospital associations and other health organizations. NURSING RESOURCES SURVEYS Consultation was given six States during various stages of initial or reappraisal studies of their nursing resources. These were West Virginia, Montana, South Dakota, Louisiana, Kansas, and Mississippi. Mississippi's reappraisal in 1959-60 pointed out that a contributing cause of their meager professional nurse supply might be the high Public Health Service 171 percentage of nursing students (more than 50 percent) who either withdrew or failed to pass the State licensing examination. The Division cooperated with representatives of the schools of nursing in conducting a study of over 1,000 students to determine the relation- ship between results on various pre-admission tests and the eventual success of students, both in school and in obtaining licenses. Findings were studied thoroughly by school representatives and the reappraisal committee in a three-day workshop and plans were made for better selection of students and other program improvements. This study underscored the value of using high school grades and | performance on admission tests as predictors of a student’s success in a school of nursing. It also demonstrated the high cost of training poorly qualified students. INTRAMURAL RESEARCH Reports of two completed studies by staff members were published. These were A Study of Student Nurse Perception of Patient Attitudes and Behavior Patterns of Premature Infants. In cooperation with the Boston Public Health Service Hospital, an experimental study of the comparative costs, durability, and accept- ability of reusable and disposable surgical gloves showed that use of disposable gloves saved personnel time which could then be reassigned to activities more closely related to patient care. A patient progress study was undertaken, designed to develop a technique by which public health nurses might define the health needs of patients and then measure response to each service given in terms of the ultimate goal the patient is expected to attain. This year, data were obtained from four agencies in Ohio, Wisconsin, and New York. Where the methodology has been tested, agencies have been enthusi- astic about its usefulness in helping them focus on the patient’s progress in relation to his problems. It is also considered to be an effective supervisory and self-evaluation tool. An evaluation of the Children’s Bureau demonstration of health services for migrant laborers in Florida is to be based on this study method, as are several other evaluation projects. GRANTS FOR TRAINING AND RESEARCH The Professional Nurse Traineeship Program, between September and March, awarded grants to 1,421 trainees through 94 schools, for long-term preparation in teaching, administration, and supervision. In the short-term training program, started last year, 117 short courses were approved and grants awarded to course sponsors in the amount of $792,000. Over 4,200 trainees participated in these courses. 172 Department of Health, Education, and Welfare, 1961 The Division is also responsible for consultative services to the Di- vision of Community Health Services on nursing applications for public health traineeships and on project grants for graduate training in public health. Thirty project grant applications were approved for training nurses in public health; about 250 nursing applications for public health traineeships were reviewed and acted upon. Through the Research Grants and Fellowships Program, a total of $1,700,000 was awarded for 19 studies of importance to nursing and for 26 full-time predoctoral fellowships to as many nurses to prepare for independent research. Project applications reveal a significant trend toward studies in clinical nursing as exemplified by a grant to study the relationship of nursing care to pain patterns following heart surgery. Approved projects deal with both hospital and public health nursing; nursing education and student health; nursing in other nations; patient teach- ing and activity patterns; maternal and child health; and assessment of nursing home care. Division of Dental Public Health and Resources The Division of Dental Public Health and Resources was established on September 1, 1960. Previously, responsibility for dental health ac- tivities had been divided between the Division of Dental Public Health and the Division of Dental Resources. Dental diseases are the most prevalent of all disorders, but only 4 people in 10 receive dental care annually. Accumulated treatment needs alone are great enough to employ the dental force full-time for five years. To provide the needed care and direct programs of disease prevention, the nation must rely upon a dental force which has di- minished in proportion to population for a generation. RESEARCH AND TRAINING CENTER In a major effort to reduce the time lag between the discovery and utilization of knowledge of dental diseases and their control, the Division obtained facilities in San Francisco for a Dental Health Center. The Center will be the first national facility to conduct applied research programs in the prevention and control of dental diseases and to train public health workers in the use of research findings. CONTROLLING DENTAL DISEASES The incidence of dental caries can be substantially reduced by the increased utilization of available and already proven methods of prevention. Through informational services and technical assist- ance to health departments, the Division encouraged the adoption Public Health Service 173 of water fluoridation, the most effective caries preventive. As of June 30, 1961, some 38,864,000 people in 2,008 communities were served by controlled fluoridation. An additional 7,000,000 lived in the 1,903 communities where the water is naturally fluoridated. Preventive programs initiated included a study of the effective- ness of stannous fluoride dentifrices in preventing decay among school children and the field testing of fluoridators for use in homes utilizing individual wells. Continuing activities included projects for testing different concentrations of topical stannous fluoride solu- tions and studies of the practicality of fluoridating school water supplies in rural areas where central water systems are not used. REMOVING BARRIERS TO DENTAL CARE In any year 60 percent of the population do not receive dental care. The cost of dental services, physical conditions such as chronic, disabling illnesses which make it impossible for people to go for care, and psychological and sociological influences which make people fear or ignore the need for care are among the factors which bar people from needed services. Activities originated or supported by the Division are designed to eliminate these barriers. Financing Dental Services Privately sponsored prepaid dental care plans are effectively lowering the cost barrier and increasing the utilization of dental services. The Division encouraged the growth of prepayment by serving as an informational and consultative center for consumer groups and dental societies establishing prepayment programs. This year the revised “Digest of Prepaid Dental Care Plans 1960,” summarizing the benefits, eligibility requirements, and other perti- nent information on programs already in operation, was published. A collection of fee schedules used in various prepayment plans was prepared for publication. An outgrowth of interest in prepayment has been the development of dental service corporations, nonprofit agencies through which State dental societies administer prepaid care plans. Under a cooperative agreement with the Michigan State Dental Association, the Division participated in the organization and administration of the society’s service corporation, gaining practical experience which will be useful in assisting other dental societies. Services for Special Groups In most communities, facilities and programs to provide dental care for the chronically ill and aged, the mentally and the physically handicapped are nonexistent. 174 Department of Health, Education, and Welfare, 1961 Three pioneering projects completed on June 30 produced basic data on dental care needed by the mentally and chronically ill and the aged and developed techniques and equipment for use in providing care for them. Two of the projects, at the West Virginia State Hospital in Huntington, W. Va., and at the Beth Abraham nursing home in New York City, will continue the treatment phases of those programs. The third project, a 4-year study of dental care for the chronically ill and aged in Kansas City, brought dental services to both the homebound and nursing home patients. The prototype program demonstrated how community service programs can meet the dental treatment needs of a neglected group. One phase of the project, the training of dental students at the University of Kansas City School of Dentistry in the use of portable dental equipment and the special techniques of care for the aged and ill, will be continued by the dental school. In cooperation with the State health departments of Idaho and Illinois, the Division initiated projects designed to assess the dental care needed by handicapped children. These projects will provide needed care and collect data necessary to the establishment of State and local service programs. Indifference to the need for dental care and fear of treatment are reflected not only in the failure of individuals to utilize dental services but also in public apathy toward dental public health programs. Studies underway in the Division continued the attempt to ascertain why certain population groups make, or do not make, dental visits and why people join various financing programs. DEVELOPING DENTAL RESOURCES Activities aimed at increasing the utilization of dental services must be accompanied by the building of a dental force adequate to meet the greater demand for care. Within 30 years the national dentist-population ratio has declined from a high of 58 dentists per 100,000 persons to 46. Just to maintain the current ratio, the nation must double, within 15 years, its capacity to educate dentists. Greater numbers of dental auxiliary personnel must be recruited and trained, and ways to increase the productivity of the dentist developed and utilized. Division studies in the space requirements and space relationships of dental schools were designed to learn how these facilities can be planned and constructed more efficiently and economically. The preparation of dental school planning guides undertaken this year should assure that new schools are built not only in accordance with Public Health Service 175 the most modern teaching concepts but with enough flexibility to be adapted to future innovations in curriculum and technology. | Educational Programs The use of chairside assistants is an effective method of stretching available dental services, for it enables the dentist to treat more pa- tients. An experimental program to teach dental students to work with chairside assistants, originally initiated under cooperative agree- ments with six dental schools, culminated this year in a grants program available to all schools. Already 40 schools have indicated that they will participate in the grants programs, administered by the Division for the National Institute of Dental Research, in the coming academic year. Seven technicial and vocational high schools, junior colleges, and dental schools will participate in a continuing cooperative pro- gram, started in 1956, to establish standards for training chairside assistants. ASSISTING OTHER HEALTH AGENCIES Assistance to State and local health agencies in the planning of dental programs is a continuing activity. This year a comprehen- sive study of State dental health programs, covering administration, resources, and program content, was initiated. The survey will serve as a basis for formulating recommendations and establishing standards to be used in guiding the future growth of these programs. Division of Water Supply and Pollution Control Fiscal year 1961 was the 5th year of administration of the water supply and pollution control program under Public Law 660. At the end of the year Congress enacted major revisions to the Water Pollu- tion Control Act, strengthening the Federal role and providing addi- tional aid to State and local governments. Two events during the year also focused attention on the gravity of the water situation: the first National Conference on Water Pollution (December 1960) and the release in January 1961 of a report by the Senate Select Com- mittee on National Water Resources based on a comprehensive two- year study. The legislation amending Public Law 660 was signed by the Presi- dent on July 20, 1961. It provides for: (1) intensified research and establishment of field laboratories; (2) inclusion of storage for water quality control in new Federal reservoirs; (3) extended and increased grants to States for their control programs; (4) liberalized and in- creased grants to further stimulate construction of municipal waste treatment facilities; and (5) broadened Federal enforcement pro- 176 Department of Health, Education, and Welfare, 1961 cedures to abate pollution. The Act declares it to be the policy of Congress to “recognize, preserve and protect the primary responsibili- ties and rights of the States in preventing and controlling water pollu- tion,” pointing out that the Federal role is one of leadership and pro- viding “technical services and financial aid to State and interstate agencies and to municipalities.” CONSTRUCTION GRANTS During fiscal 1961 grants totaling $45 million were approved for 590 municipal sewage treatment construction projects. During the entire 5-year period ending June 30, 1961, grants totaling $225 mil- lion were made in support of construction totaling $1.3 billion. Of the 2,746 projects approved, 1,580 were completed and 710 under con- struction. These will serve a population of 27 million and abate municipal pollution in over 33,000 miles of streams. PROGRAM GRANTS Grants to State and interstate agencies to assist them in establish- ing and maintaining adequate water pollution control programs have encouraged the States to increase their appropriations from $4.2 million in 1956 to $6.7 million in 1960. BASIC DATA To determine pollution trends, the National Water Quality Network of stream sampling stations was enlarged from 79 to 91, with 300 as the ultimate goal. Continuing data are collected, analyzed, and pub- lished on water and waste treatment facilities and needs. A report- ing system on pollution-caused fish kills was initiated. An inventory of Federal establishments to determine the extent of, and remedial measures for, pollution coming from these installations is in progress and due for completion in July 1962. ENFORCEMENT The enforcement procedure has been invoked in 15 interstate water pollution situations under the 5-year program of the Federal Water Pollution Control Act. One new enforcement action during the 1961 fiscal year was initiated on the North Fork of the Holston River (Vir- ginia, Tennessee). Additional steps in the enforcement procedure were taken in the following pending cases: the Bear River (Idaho, Utah, Wyoming) ; the Colorado and all its tributaries (Colorado, Utah, Arizona, Nevada, California, New Mexico, Wyoming) ; and the Missouri River, St. Joseph, Missouri. Also, as the fiscal year ended, preparations were near completion to hold a conference involving the Public Health Service 177 Raritan Bay (New York, New Jersey). Continuing files are main- tained on some 2,000 additional pollution areas. Enforcement actions to date are effecting pollution abatement in more than 4,000 miles of streams. The resulting remedial measures agreed upon include waste treatment facilites to cost in excess of $500 million. RESEARCH AND RESEARCH GRANTS Research continued at the Sanitary Engineering Center in problems of wastes origin, characterization, treatment and disposal, and in stream monitoring, water treatment, and the supplementation and conservation of water supplies. A major project in advanced waste treatment was undertaken to develop entirely new processes which will approach 100-percent purification of wastes. Direct responsibility - was assumed for the support and administering of water supply and pollution control research grants formerly funded by the National Institutes of Health, and to support the training of urgently needed personnel through research fellowships and training and project grants. COMPREHENSIVE PROGRAMS The technical staff continued work in comprehensive river basin programming. New projects were initiated in the Columbia and Colo- rado River Basins and the Great Lakes-Illinois Waterway Basins. An earlier project continued in the Arkansas-Red Basin. INTERAGENCY COORDINATION Coordination of programs with water resources plans and projects of other agencies continued. Technical services under such inter- agency agreements represent a major and expanding activity. Thirty- eight evaluations of water supply requirements have been completed under the Water Supply Act of 1958 in conjunction with impound- ments planned by the U.S. Army Corps of Engineers, and 48 others are in progress or scheduled. The Division has also provided staff tech- nical services in support of the Department’s membership in the South- east River Basin Study Commission and the Texas River Basin Study Commission. ADVISORY BOARD Six meetings of the Presidentially appointed Water Pollution Control Advisory Board were held in fiscal 1961. In response to a request from the Surgeon General, the Board conducted a detailed study of existing program resources and projected future require- ments in water pollution control. 178 Department of Health, Education, and Welfare, 1961 Division of Air Pollution On September 1, 1960, in recognition of increasing public concern about air pollution, the existing air pollution medical and engineering programs were combined in a single Division of Air Pollution. Following the approval, late in fiscal year 1960, of Public Law 86— 493—which directs the Public Health Service to make a thorough study and report to Congress by June, 1962 on the health effects of motor vehicle exhausts—the Division has sharply accelerated its research in this area. AUTO EXHAUST RESEARCH The research projects set up to implement P.L. 86-493 involved complex procedures and required painstaking advance planning. By close of fiscal year 1961, however, many major studies were underway. In one group of studies, colonies of experimental animals are being exposed in the laboratory to irradiated and nonirradiated motor vehicle exhaust and to concentrations of auto exhaust pollutants as they occur in the ambient air on city streets. In six large cities, arrangements were completed for continuous measurement of exhaust-related gaseous pollutants to determine their ranges of concentration. In three cities, lead in the ambient air, and lead levels in the blood and urine of selected population groups, are being measured for correlation with traffic density and other parameters. To help determine the pollutant contributions of gasoline- and diesel-powered trucks and buses, their operating modes are being surveyed in several cities. The particulate fraction of gasoline and diesel engine exhaust is also being analyzed for a variety of poly- nuclear hydrocarbons and oxygenates for correlation with analyses of potential carcinogens in emissions from other combustion sources. A cooperative survey is underway in Los Angeles to determine ex- haust concentrations of hydrocarbons, carbon monoxide, carbon di- oxide, and nitrogen oxides in a representative sample of registered motor vehicles under prescribed operating conditions. The Division is also supporting, through its intramural research program and its research grants program, a number of other projects which should further help to determine the effects of motor vehicle emissions on human health. OTHER RESEARCH ACTIVITIES In 50 stations of the National Air Sampling Network, gaseous pol- lutants such as sulfur dioxide and oxides of nitrogen are now being sampled. Formerly, only particulates were sampled. Public Health Service 179 Further advances were made in designing and improving instru- || ments for sampling pollutants or assessing their effects, for example, a portable transistorized particle counter and size analyzer. For industrial-type installations, improved filter devices were developed. Chemical research was oriented toward analytic methods for aromatic and aliphatic hydrocarbons and inorganic gases. Special sampling for assay of potential cancer agents was conducted in six cities. The previously developed analytic technique for measuring certain potential carcinogens, particularly 3,4-benzpyrene, was applied to air samples of 103 cities and 28 nonurban sites; city ) levels averaged 16 times those found in nonurban areas. To further | gauge the potential carcinogenicity of polluted atmosphere, the geo- graphic distribution of lung cancer according to the histological type | of tumor is being studied to test the theory that the different cell | types may result from different causative agents. The following are typical of many field studies of air pollution’s | health effects. Tests in a large industrial firm indicated a relationship between absenteeism due to certain respiratory diseases and total sulfate pollution in the air. Further study of results of a survey | previously done in Nashville, Tenn., disclosed a similar association between asthmatic attacks and airborne sulfates. In studies of two | small towns, which differed only in the degree of air pollution preva- lent, preliminary analysis of data suggests corresponding differences | in the residents’ lung function and breathing capacity. Laboratory studies on health effects were also expanded. In fur- | ther animal studies, conjugated nitro-olefins were found to be potent irritants, with not only eyes and respiratory tracts affected but also circulatory and nervous systems. An especially significant study revealed that the resistance of mice to respiratory infection was markedly decreased after exposure to ozone, as demonstrated by in- creased mortality rate and lowered survival time. Pulmonary func- | tion tests revealed that human beings exposed under laboratory conditions to certain inhaled substances experienced reactions similar _ to those described in animals. | TECHNICAL ASSISTANCE AND TRAINING Statewide air pollution surveys were completed, in cooperation with | the State health agency, in Florida, Pennsylvania, and Georgia. De- | tailed reports were published on earlier surveys in Minnesota and | North Carolina. Substantial assistance was also given in surveys conducted by State or local health departments in Hamilton, Ohio; | Charleston, S.C.; Lynchburg, Va.; Washington, D.C.; and Berlin, N.H. Equipment loans or consulting services were provided to many other areas. 180 Department of Health, Education, and Welfare, 1961 Intensive technical courses in air pollution were given at the Sani- tary Engineering Center to 180 trainees from 82 States and 8 foreign countries. Two field courses were presented 6 times to 289 trainees. Support was also continued for the graduate-level air pollution cur- ricula being developed at 10 universities. NATIONAL GOALS Late in calendar 1960, an important report was published: National Goals in Air Pollution Research. This report was prepared by a highly competent group of consultants outside the Federal Govern- ment, who were invited by the Surgeon General to identify goals for air pollution research over the next decade and to recommend a fair apportionment among the Federal Government, State, and local gov- ernments, and industry of the efforts necessary to reach these goals. The Division has set its sights accordingly. Division of Radiological Health The Division of Radiological Health is responsible for development and implementation of ways and means of controlling and, wherever possible, reducing radiation exposure. With the rapid multiplication of sources, applications, and users of radiation, it is imperative that the States assume increasing responsibilities for radiation protection and control. Therefore, particular attention is placed on providing technical assistance to bolster the radiological health competency of the States. Technical personnel from the Division are currently as- signed as radiological health consultants to the Regional Offices and additional personnel have been assigned directly to State health departments. A new mail survey technique (Sur-pak) has been developed for evaluating dental X-ray units used in private offices and clinics. The Division furnishes the State health departments with survey packets, which are then distributed to each individual dentist or organization in the survey area. After exposure of the film packets to the X-ray units, they are returned through the State Health Department to the newly developed Radiological Health Laboratory at Rockville, Md., for interpretation and report of findings back to cooperating offices. The new Rockville Laboratory was established for the primary purpose of developing methods for the effective control of radiation hazards from medical, dental and industrial X-ray units as well as providing training in radiological health. At the request of the Navy Department, the Division established a radiation monitoring station at the site of a proposed Navy Reactor Public Health Service 181 at McMurdo Sound, Antarctica. Public Health Service personnel as- signed there are collecting background data from air, water, and algae samples in order to assure other nations that treaty requirements and safety regulations against contamination of the environment in that | area are being rigidly observed. RESEARCH Fundamental and developmental research is being augmented in an effort to close the gaps of knowledge on the effects of radiation onman. Anexample of this effort is the “San Juan Research Project,” where continuing studies are being made of selected families in that area, evaluating food and water relationships to ingestion and reten- tion of radionuclides. Radon breath trailers have been obtained and construction of a radon air removal system is almost completed. An- other project vital to a large segment of our population is the “Late | Effects of Radioiodine Therapy Follow-up Study.” The purpose of this study is to investigate the late effects of treatment with radioactive iodine among patients with thyroid diseases. Contracts have been signed with 16 hospitals to help conduct this work. The extension of research activities through the medium of extra- mural grants by the Division was made possible for the first time during the 1961 fiscal year with a $918,000 budget. Requested appro- priations were $1,198,000 for the 1962 fiscal year. These grants make possible use of laboratory and research facilities of universities, in- | dustrial organizations, and official and nonofficial agencies through- out the country. TRAINING Training grants were also made available for the first time in fiscal | year 1961 by Congressional approval of an initial disbursement of $500,000 to colleges, universities, and other institutions of higher learning, to improve, expand, or establish radiation health specialist | curricula. Fifteen universities were selected, from applicants re- questing almost $2 million, to receive grants for staff, equipment, and student assistance. During fiscal year 1961, short training courses in the health aspects of radiation exposure were attended by over 1,000 Federal, State, and local governmental officials, foreign students and representatives of industry and private agencies. A Symposium on “University Curricula in Radiological Health,” with more than 100 educators and public health officials in attendance, was held at Princeton, N.J., during the year under sponsorship of the Division. The symposium proceedings underscored the acute shortage of trained radiological health personnel at all levels of professional 182 Department of Health, Education, and Welfare, 1961 competence. Nationwide radiation specialist training activities were revealed and clarified by this opportunity for an exchange of ideas on future planning. SURVEILLANCE The environmental radiation surveillance programs of the Division have expanded with the support of the Sanitary Engineering Center at Cincinnati, Ohio, and the regional laboratories at Las Vegas, Neyv., and Montgomery, Ala. These regional facilities analyze environ- mental and biological samples collected by Federal, State, and local health authorities. Comprehensive data on radiation levels present in the surrounding environment, including air, water, milk and other foods are then published each month in the Division’s “Radiological Health Data” periodical. A Radiation Intelligence Network has been established with the purpose of assessing all sources of ionizing radiation in the environ- ment. A computational group has been organized as part of this net- work. A pilot study of environmental radiation sources in Montgom- ery County, Md., is being conducted in cooperation with the county health department. Air sampling stations were installed in nine loca- tions in the county. Samples of drinking water from public and pri- vate wells were obtained, and information about food intake and X-ray exposure was secured through household interviews. The primary purpose of the survey is to develop methodology and check the validity of methods for obtaining accurate records of total radiation exposure of a population group. Division of Occupational Health An increase of over 100 percent in direct operating funds for the Division of Occupational Health in fiscal year 1961 gave new thrust to research, consultation, and training activities to help meet more adequately the pressing needs in this complex field. In the research area, this increase permitted expanded effort in the development of better techniques, materials, and equipment for use in the prevention, diagnosis, and treatment of occupational disease. Impetus was given to activity in toxicology and in related fields of clinical medicine, engineering, chemistry, and physics. Physiologic and psychologic factors in the work environment were also brought under study. The Division also assumed responsibility for the administration of research grants in occupational health. To stimulate needed research, a conference was held to consider epidemiologic investigations that might profitably be developed in industry. Public Health Service 183 Field investigations conducted during the year ranged from sili- cosis among metal miners to the possible health effect of handling animal feeds containing a wide variety of additives. The findings of a recently completed study will aid in establishing standards for conditions under which men can be employed for their | entire working lifetime without developing hearing impairment due to excessive noise. In the study of uranium miners, now in its 12th year, more conclu- sive evidence points to a lung cancer hazard. Among miners with more than 3 year’s underground experience, deaths are occurring in ex- cessive numbers due to this disease. As part of the triennial exami- nation of 1,700 uranium miners, cytologic analyses of the sputum were made to determine their value in the early detection of lung cancer. Contracts were also negotiated with the States of New Mexico and Colorado and with private research facilities to complement the | clinical studies and control efforts. Further attention to the problem and the need for effective control measures have been directed by special meetings and training courses. Among these, a meeting called by the Secretary of Health, Education, | and Welfare brought together the governors and other officials of the seven uranium-mining States. Heads of State mining associations | and governmental agencies concerned also met to consider action. In | addition, 3 courses for 200 uranium mine and mill operators and | monitors were conducted by the Division, and over 10,000 copies of an educational pamphlet were distributed to mine personnel. Studies of the mechanism of toxic stress included a continuing evaluation of the long-term effects of toluene diisocyanate (TDI), | a chemical responsible for strong immunologic reactions. Dermatitis studies of epoxy, polyester, and polyurethane resins have led to the development of nonirritating patch testing concentrations | and diluents as a diagnostic aid in distinguishing between allergic and primary irritant dermatitis. | As part of an intensified training program 15 separate courses were | presented with a combined attendance of 485 persons. Basic 2-week | training courses for industrial hygiene engineers and chemists, for | many years offered once anually, were presented four times. In addi- tion, four advanced courses in lead analysis, analysis and control of noise, analysis of free silica, and dust evaluation techniques were offered. Special courses were held for various groups, including governmental occupational health directors and local health officers. During the year, field consultations and technical services were provided on over 100 different occasions in 30 States. Department of Health, Education, and Welfare, 196 Division of Environmental Engineering and Food Protection This newly organized division takes over most of the functions performed by the former Division of Engineering Services. These include the milk, food, and shellfish sanitation programs; the water supply, food service, waste disposal and general sanitation problems of interstate carriers; metropolitan planning and development, solid waste (refuse) disposal; and a variety of general sanitary engineering activities. The division carries out and supports research, training, technical assistance, standards development, equipment review, pro- gram planning and promotion and regulatory functions under the Interstate Quarantine Regulations. ENGINEERING RESOURCES AND TRAINING The Public Health Service, because of its expansion of environmen- tal health programs, has been acutely affected by the manpower shortage in these fields. Consequently, major activities of this unit have involved the recruitment of qualified personnel for all divisions that are working on environmental health programs and the develop- ment of current staff through on-the-job training and through assign- ments for specialized studies in colleges and universities. To advance research on environmental health problems, assistance was given to the National Institutes of Health in evaluating and awarding grants for the construction of research facilities, particu- larly in schools of engineering. GENERAL ENGINEERING In carrying out PHS regulatory functions under the Interstate Quarantine Regulations, Special Citations and Letters of Commenda- tion for excellence in sanitation were awarded to 18 railroads and 43 — vessel companies. Certificates of Sanitary Construction were issued to newly built aircraft, vessels, and railroad dining cars. The “List of Accepted Equipment” for Interstate Carrier use was increased by 503 new items. Modification prior to acceptance was required on 32. Studies of water pollution by vessels operating on the Great Lakes were intensified and areas were designated where vessels now are pro- hibited from discharging wastes. Technical assistance in metropolitan planning was given to Fort Wayne, Ind.; Omaha, Nebr.; and Lake County, Ill. A new techni- cal manual dealing with metropolitan planning for environmental health was published as were other manuals dealing with individual water supply systems, refuse sanitation, sewage disposal, school sani- tation and mobile home parks. The PHS-sponsored Committee on | Public Health Service 185 Plumbing Standards completed proposed changes in the National Plumbing Code. Organic chemical analyses by PHS established for the first time the occurrence patterns of these chemicals in finished water with a view toward relating it to chronic disease incidence. Work was intensified on the role played by water supply in the spread of infectious hepatitis. | MILK AND FOOD PROGRAM Participation by States in the Cooperative State-PHS Program for the Certification of Interstate Milk Shippers increased for the ninth consecutive year. The July 1961 list of milk shippers who were com- plying with PHS sanitation compliance ratings contained the names of 752 firms in 37 States and the District of Columbia. Over 1,400 shippers were certified by producing States as meeting the sanitary | requirements for the interstate shipment of shellfish. During the year, some of the cases in two outbreaks of infectious hepatitis were associated with the consumption of raw oysters and clams harvested from sewage-polluted waters. The Service is assist- ing States to strengthen their shellfish sanitation control programs to prevent recurrences. 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[spuvsnog} uy] 1 196[ 4vak yoosyf ‘saywig 07 squawd i |i, oe : : ‘ : S| Be | | Office of Education SECTION | Introduction: Quality Education WE CANNOT Now BE SATISFIED with any educational endeavor that is not genuinely committed to the highest standards of which we are capable. Whatever may be the disposition of some individuals, the Nation cannot afford anything less than excellence in every aspect of education. At every step of the educational ladder we must make those demands for achievement that will call forth the full capabilities of every student. We have frequently been guilty of following a path of inordinate ease and comfort in our educational policy and practice. All too often we have sacrificed excellence to a large measure of mediocrity, because we have been unwilling to pay the price that excellence demands— rigor, discipline, and genuinely hard work. Mastery of Fundamentals Necessary We are in some difficulty at every level, because in our effort to relate education effectively to the lives of the students we have too often divided and splintered until far too much of our energy is dissipated on unrewarding peripheral detail or trivial matters that deserve no place in the economy of a serious formal education. An intensive mastery of fundamental principles and techniques that will have general theoretical application or practical usefulness should replace the not infrequent expansiveness that has made the curriculum attractive and interesting, but sometimes somewhat superficial. We have done well to encourage broad general education. But it is wise to remember that one cannot know anything in general without knowing something in particular. It is education in the most basic sense, whether it be in the humanities, the social or natural sciences, in technology or the professions that will be most rewarding to the individual and at the same time will best satisfy the needs of our 241 242 Department of Health, Education, and Welfare, 1961 society in providing adequate manpower for our trades and pro- fessions and in guaranteeing the expansion of knowledge and the disciplined habits of mind that are so crucial to the well-being of our people. Students’ Capabilities Must Be Challenged To the extent that we have failed to challenge the full capabilities of our students, from kindergarten through graduate school, we have betrayed the domocratic ideal that is so precious to us. The meaning of democracy in education is not found in a dead-leveling process that attempts to conform all men to a simple equality. We believe not that all men are of equal capacity, but that all are entitled to the opportunity to develop fully such capacities as they have. We combine this with a belief in the inherent dignity of the individual person. These are powerful ideas with tremendous implications. They mean, certainly, that the creative artist, the professional person, and the artisan alike deserve the full esteem of their fellow men and that every man is entitled to his measure of self-respect who is doing his best in a vocation that contributes to the total life of our society. When we demand in our schools and elsewhere something less than the individual is capable of doing, we rob him of his self-respect and we corrupt our most basic ideals. We have been too often guilty on this count, and our schools must bear a large measure of responsi- bility for that guilt. A Twofold Task The task facing the leaders of American education is so to organize and administer our educational institutions that the best interests of every individual will be served and that this process will at the same time contribute to the fundamental quality of our culture and add genuine strength to our national character. We must make sure that the maximum cultivation of the individual’s intellectual, moral, artistic, and spiritual capacities that makes of him a genuinely free person yields also the protection and perpetuation of those in- stitutions that are essential to a free society. Here two things should be kept foremost in our thinking. First, that the total education of an individual is a task in which all of our social institutions participate. The schools should not be expected to do everything. Their primary task is the achievement and dis- semination of knowledge and the cultivation of the intellect. It is only when this task is firmly established as the central purpose of Office of Education 243 a school that it will produce effectively those results in personal and civic character that we rightly expect of it. Secondly, we must guard against the tendency to suppose that our national well-being is served primarily by advances in technology, | however important and timely these may be. Knowledge is of value for its own sake as well as for its uses, and unless the sciences are supported in their own right the capital of knowledge on which our technology is nourished will surely diminish. The social sciences and the humanities and fine arts are as important to the quality of our culture and eventually to the strength of our Nation as are engineering and the physical sciences. The study of politics, history, and philos- ophy is fundamental to our cultural life, and no nation can achieve a lasting strength unless its character is expressed in great literature, art, and music. We should not fear that a more effective accommodation of education to social needs and national goals must destroy the freedom and in- dividual initiative and creativity of our people. On the contrary, countless persons would thereby find a new freedom: through in- stitutions designed for their peculiar abilities on the one hand and the needs of our social and economic order on the other, they would be brought into the educational process on a higher level. Teaching, the Basic Problem The quality of teaching is our basic educational problem. It will not be solved until all our teachers have the competence that is now enjoyed by those whom we all recognize for their great and inspiring work in our classrooms, seminars, and laboratories. The identification and education of teachers for our schools is now a matter of major concern for the Nation. It is a national tragedy that the generality of our teachers are not fully qualified to assume the burden of responsibility that we must place upon them in the future. Many are lacking the native talent demanded by the art of teaching. Others in large numbers are inadequately prepared by general education or education in their teaching specialities. The responsibility for this rests partially upon our society as a whole, for it has failed to raise the teaching profession to that level of stature and esteem that would make it attractive to highly talented people in numbers adequate to fully satisfy the demand for qualified teaching personnel, and our public leaders have not insisted that our colleges and universities devote their best efforts to the education of teachers. It would be unwise to suppose that this predicament of the teaching profession is due simply to inadequate salaries for teachers, even Department of Health, Education, and Welfare, 196. though the problem will never be solved until the average sala level of the profession is made competitive with that of other employed professions. It is due in part at least to the fact that the educatio of prospective teachers in our society has quite commonly failed to fully challenge the intellectual abilities and creative talents of * more capable segment of our students. Persons of high ability loo to a profession that demands rigorous preparation ban high compe- tence. The range of students entering our professional luca schools is far too wide for the good ft our Nation. It encompasses _ many who enjoy the highest eee but also many who are near — failures in any scholastic endeavor. | In the future every effort must be made to identify persons of high intellectual competence and talent in the art of teaching and to attract them to the teaching profession. And the standards of our colleges of education must be raised to exclude those who do not have real promise. The finest education must be made available to those who qualify: first, a genuine and rigorous liberal education in the full sense of that word, an education in the arts and the sciences of the kind that frees the mind, that acquaints it with at least the rudiments of the world’s basic knowledge, and cultivates critical and creative intelligence. To insure this kind of education, the education school must become a part of the mainstream of the intellectual life of our universities. The education of teachers is properly the task of the entire faculty, not simply of those who specialize in the teaching art and its related sciences. It is a national scandal that large numbers of our teachers are inadequately prepared in the subject matter that they teach. We should not be satisfied until this situation is entirely corrected, as its perpetuation is the surest guarantee of mediocrity in the classroom. There will never be a substitute for a teacher’s full mastery of his subject. Finally, education in the art of teaching has too commonly been narrowly conceived in terms of psychological studies descriptive of the learning process. Teaching is an art that must be rooted in the entire gamut of the behavioral sciences as well as in psychology, involving such disciplines as sociology, descriptive ethics, and cultural anthropology. But far more than this, even a simple comprehension of the proper aims of education involves necessarily an intimate knowledge of the value structure of the culture and entails some acquaintance with the essentials of its intellectual and moral tradition. For the meaning of education is found in part in the great task of Office of Education 245 understanding, appreciating, criticizing, and perpetuating the culture of which we are a part and in which are lodged our value traditions and commitments. To put it briefly, there is no easy road in the preparation of teachers of the kind that we must now guarantee our |schools. Our society will make heavy demands upon them in the future. Educational excellence, as a goal, is never realized. It is neither visible nor tangible. Perhaps it is not, strictly speaking, a goal at all, but an attitude that informs the total process of education. In any event, we can approach excellence in education only by demanding of all—administrators, teachers, students, and the general public—all that they are capable of achieving. If ever in the past there were reason for asking less, there is none now, for our times are perilous and will accept no less—Adapted from a statement by Sterling M. McMurrin, U.S. Commissioner of Education, before the Subcommittee of the Committee on Appropriations, House of Representatives, Eighty-Seventh Congress, First Session, May 8, 1961. The Role of the Office of Education The Office of Education operates in a society in which virtually all responsibility for the conduct of American education rests outside the Federal Government. States and communities have the right to organize and manage their schools and the chief responsibility for financially supporting them. The function of the Office of Education is to “aid the people of the United States in the establishment and maintenance of efficient school systems, and otherwise promote the cause of education throughout the country.” Cooperation and assistance by the Office are carried on principally | through publishing its research findings, studies, and survey reports; through consultation and field work; through participating in con- tracting with colleges, universities, State departments of education, other public or private agencies, organizations, groups, and individuals to conduct research; and through administering financial assistance programs as directed by the Congress. From 1867, the year of its founding, to near the middle of the present century, the Office of Education was regarded principally as an agency for the collection and dissemination of information describing the state of American education. But as the educational system became increasingly complex, the Office began analyzing and inter- preting this descriptive information. During the past decade, new responsibilities have come to the Office, supplementing but not re- 246 Department of Health, Education, and Welfare, 196 placing its historic duties. These responsibilities reflect a change i public conviction of the role of the Federal Government in education. While the American people have never swerved from the belief or the practice of the belief that responsibility for the conduct of Amer- ican education should remain outside the Federal Government, they have come to use the one Government they have in common to aug- ment and strengthen the activities of the several governments they have separately. Thus the Office is responsible for the execution of public policy as expressed in over 20 separate pieces of legislation, with grant and contract responsibilities amounting to approximately half a billion dollars a year. Included among the other responsibilities of the National Defense Education Act of 1958, was that given under title X for advising and consulting “with the heads of departments and agencies of the Federal Government responsible for” various “educational programs with a view to securing full information concerning” such programs and “to developing policies and procedures which will strengthen the educa- tional programs and objectives of the institutions of higher education utilized for such purposes... .” Thus, out of the expanded role of the Federal Government in our society, a new function and respon- sibility of the Office of Education has emerged. Still another new dimension of Office responsibility has come to focus during the last decade. The character of world developments affects educational practices and educational organization. The mod- ern foreign language development program authorized by the NDEA reflects but one area of those practices. The deeper involvement of the United States in international affairs will inevitably lead to identi- fication of other educational needs. Concurrently and continuously, the Office must be in a position to stimulate, encourage, develop, and strengthen professional leadership in education throughout the Nation. It must help to provide to educational leaders the informational resources essential to the identification and solution of educational problems, in the con- stant improvement of educational programs, and in securing under- standing, cooperation, and support of professional groups and lay citizens of the Nation. Whatever may be the problems facing the American people in defining the substance of education or in the administration of its educational system, it is the responsibility of educational leaders at all levels to work together to secure that degree of excellence and pro- ductivity which the good of society and of our Nation demands. Office of Education 247 Section II Examples of Office of Education Leadership in Fiscal Year 1961 The activities cited in this section do not constitute a complete description of Office programs; but rather, they represent the manner in which the Office performed its assignments. The report of princi- pal continuing or recurring Office activities and their part of the gen- eral American educational scene will be found in section III. The projects of programs of section II originated, were completed, or were unusually active during 1961. IDENTIFICATION OF NrEeps or AMERICAN EDUCATION The traditional task of the Office has been the collection and dissemination of information vital to “promoting the cause” of Ameri- can education. This past year saw two major studies completed which placed before the people a measure of the next decade’s educa- tional problems. Two Critical Needs of Our Schools and Colleges: People and Build- ings.—The professional staffing and physical facilities of our public schools and our colleges were deemed to be goal areas of prime im- portance in achieving a higher base of educational development. In 1960 the Office undertook staff studies designed to determine the mag- nitude of the Nation’s requirements in terms of teachers and other pro- fessional personnel to be recruited and trained, and in terms of public school and higher education physical facilities to be constructed or restored. ‘These requirements were translated into dollars of national need, without specific reference to the respective shares that would have to be met by Federal, State, local, and private sources. The studies were completed during fiscal 1961 and were released to the public as the discussion documents (1) Zen-Year Aims in E'du- cation, Staffing and Constructing Public Elementary and Secondary Schools, and (2) Ten-Year Objectives in Education, Higher Edu- cation Staffing and Physical Facilities. Each of the papers was developed with the assistance of outside technical experts and received critical review by leaders outside of government, representing the edu- cational community. There was considerable authority, therefore, behind the goal figures they proposed with respect to the number of school teachers, professors, and university researchers needed over the next decade, the average salary levels they would require, and the resultant aggregate national expenditures indicated for educational 248 Department of Health, Education, and Welfare, 196. manpower and for bricks-and-mortar support of the educational establishment. Educational Needs in Relation to the Employment Economy: V oca- tional Education —Recognizing that changes in occupational patterns and in the demands of the economy were occurring faster than were the educational adaptations needed to meet them, the Office undertook to identify the kind of education required to eliminate the shortages and imbalances. The resulting document, Vocational Education in the Next Decade, was released to the public and will be a major source paper for a panel of consultants on vocational education, to be con- vened in 1962. ORGANIZATION AND DISSEMINATION OF EDUCATIONAL STATISTICS AND ResearcH RESuuts Through the years statistical and research programs have been at the core of Office programs. The following examples indicate devel- opments in fiscal year 1961 to improve and accelerate the process by which new educational knowledge is applied to educational practice: Dissemination of Results of Educational Research—F¥or a number of years, the Office of Education has maintained a clearinghouse of studies in higher education which compiles, analyzes, and interprets data on educational research and experiments by colleges and uni- versities with respect to their own programs. During the past year the clearinghouse released its first monographs. Included were titles on college admission with advanced standing and independent study programs. College and University Inventory of Physical Facilities—During 1961 the editing and coding of this Inventory was completed. The data provide details of all building facilities for institutions enrolling almost 96 percent of the students in higher education. Analysis of these data can yield information including type of control, esti- mated value, condition, function of assigned areas, and total cost of physical plant. Periodic reports of new construction will be added to this basic inventory. The Office thus will be able to maintain a current file of almost all higher education facilities in the Nation. Dissemination of Results From Office Sponsored Research Pro- grams.—The Office’s extramural research support programs, partic- ularly projects under Cooperative Research and title VII of the NDEA (Educational Media), occupy critically important positions with respect to the responsibility for extending the frontiers of basic and applied educational knowledge. The final results of all projects completed by 1961 were circulated through the Library of Congress Office of Education 249 Documents Expediting Project. Some results were published in the following 1961 Office monographs: The Gifted Student, Motor Char- acteristics of the Mentally Retarded, Social Climate in High School, Influence of Voter Turnout on School Board and Tax Elections, and Research Problems in Mathematics Education. A National Cooperative System of Educational Data—An intel- ligent facing of educational problems requires, on the part of all authorities concerned—Federal, State, local, and private—adequate information on a national scale. These data are not available at the present time; serious obstacles stand in the way of making them avail- able. During 1961 the Office studied this problem and developed the main conceptual features of a program proposal which would estab- lish, under the leadership of the Federal Government, a national coop- | erative system of educational information which would employ the resources of electronic technology for storage, retrieval, and analysis of data. | Both the internal technical problems and the field relationships and | processes involved were carefully thought through. Appreciable | progress was also achieved in establishing rapport with the principal | field agencies—school administrators and university registrars— | through which raw data would be channeled and upon which national cooperation must ultimately be based. Progress was made in coop- eration with the States to standardize educational information through development of publications designed to establish standard termi- | nology for use in reporting pupil and school staff information. MosinizaTIon or LEADERSHIP ror Sotvine EpucaTionaLt Propiems A third activity of the Office traditionally has been the encourage- ment and coordination of efforts to handle difficult educational issues which are increasing both in scope and number. In the following examples, it may be seen that the Office has strengthened the effective- ness of a variety of organizations by providing the vehicle for them to meet common problems with mutual support and understanding. Cooperative Planning for the Educational Media.—An Educational Media Study Panel of prominent citizens appointed by the Commis- sioner has collected evidence on educational uses of television during the past 15 months. The findings will assist the Office in formulating a national policy for this medium. A series of Office media conferences led to the establishment of the Educational Media Council, the first national organization encompass- ing all major professional and industrial groups directly concerned with educational media. 626936—62——17 250 Department of Health, Education, and Welfare, 1961 The Media Program sponsored a conference among educators and equipment manufacturers on new and emerging equipment require- ments of the schools. A conference supported under contract with the National Associ- ation of Educational Broadcasters identified the feasibility and role of State and regional networks in educational broadcasting. Adult Literacy Education—The Office recognized adult education for literacy as a major educational problem. In cooperation with the National Commission for Adult Literacy, it sponsored a con- ference to seek methods of strengthening and expanding educational provisions for the Nation’s functional illiterates. The conference dealt with the responsibility and role of the public school, private and voluntary agencies and the Federal Government in fundamental and literacy education and with community approaches to the problem. Regional Conference on Cooperation in Educational Research— The stimulation of interstate cooperation and communication has been a key objective of the Office in promoting research programs. An example of such action was a conference of chief State school officials, their staff members and university representatives from Michigan, Illinois, Wisconsin, and Indiana. The conference, planned by the regional representative of the Commissioner of Education and attended by members of the Office staff, explored ways and means by which greater coordination of educational research programs within and between States could be realized and by which the findings of educational research could be more effectively translated into educational practice. Encouraging developments since the conference include: organi- zation of a Wisconsin Educational Research Council, organization of a Michigan Educational Research Council, creation of full-time positions of Research Coordinator and assistant in the Illinois State Department of Education, establishment of a Division of Research in the Indiana State Department of Education, and formulation of plans for a cooperative relationship between State departments of education and the Inter-Institutional Research Council of the Big Ten Universities (plus the University of Chicago). Conference of State Supervisors of Mathematics—An Office- sponsored National Conference of State Supervisors of Mathematics was held for exploration of the theme, “Strengthening the Leader- ship of the State Supervisor of Mathematics.” The purpose of this conference was to find ways to improve the State supervisor’s work in developing mathematics curriculums, strengthening inservice and preservice training, supporting research in teaching of mathematics, and in evaluating State programs in mathematics. Office of Education 251 | CoNSULTATIVE SERVICE | Jn addition to the thousands of inquiries directed to Office specialists | by organizations, institutions, Governmental agencies, and individuals, major consulting services are sought from time to time by the States. Higher Education in South Dakota.—In 1961, the results of a survey of South Dakota’s entire system of higher education were published. The survey was requested and supported by the South Dakota Legis- _ lative Research Council and public and private institutions. Each of the State institutions was visited and evaluations of facilities, students, | faculties, and curriculums completed. Reports of the survey recom- | mended not only a statewide program in higher education, but also a program for each institution. PROGRAMS FOR SPECIAL EpuCcATIONAL PROBLEMS With increasing frequency the American people have turned to the Federal Government for assistance on issues that are beyond the scope of their other governing bodies. Some examples of assistance by the Office of Education in fiscal year 1961 follow. Actwities Relating to the Cuban Situation—In support of the decision to provide direct assistance to the thousands of Cuban refugees who have fled the Castro regime and who are residing in this country, the Office of Education has administered a number of programs designed to facilitate adjustment of Cuban refugees in this country. Funds have been provided to the Dade County (Florida) School System to make possible the employment of additional teachers to accommodate some 5,000 children and to engage special personnel for their instruction. Assistance has been provided to the Dade County School System in establishing adult education programs to aid Cubans in acquiring English language training and orientation in American principles. A special program of loans to needy students has enabled 300 Cubans studying in American universities to continue their education. Additional funds already made available have enabled many students to continue or begin their college education in this country during the summer months. Funds granted to the University of Miami have been instrumental in training Cuban lawyers and doctors in United States practices. A project involving the study of economic problems of Cuban refugees has been supported with Federal funds. Instruction in English—The Office planned and gained budget support for a major attack on the deficiencies in the teaching of English. Taking guidance from the National Science Foundation 252 Department of Health, Education, and Welfare, 1961 efforts in science teaching and the NDEA programs in foreign lan- guage, mathematics, and science instruction, the Office has begun planning for the support of research, conferences, and the preparation and demonstration of curriculum materials and instructional practices. Developments Affecting Latin America—Using the authority of title VI of the National Defense Education Act, the Commissioner declared Latin-American Spanish to be a critical language, thus mak- ing possible a program of language and area study centers, teacher training institutions in Latin-American countries, fellowships, and research, all dealing with Latin-American language and area studies. The Organization of American States, by contract with the Com- missioner of Education, has completed a study entitled Latin-Ameri- can Higher Education and Inter-American Cooperation and made recommendations to the Commissioner. The report, made in June 1961, is now under study in the Office. Review or FEDERAL PROGRAMS IN EDUCATION As the Federal Government has increased the number and size of programs in education, the necessity for analysis of the effect of such programs has grown. International Educational Activities of the Federal Government.— The Office has been seriously concerned for some time with the extent to which education is being used as an instrument of foreign policy without adequate concern for the substance of the education involved. Inasmuch as our relationships with other peoples are vitally affected by our Nation’s international assistance programs, it is important that the education undergirding these programs be of the highest order. This end will be achieved only as we use the full resources of our domestic educational establishment. For this purpose, the Office has made careful analyses of various problems in this area. Review of the National Defense Education Act of 1958—A panel of distinguished consultants was convened to assess the effectiveness of the National Defense Education Act in accomplishing its purposes. One major conclusion reached was that the Government will have a continuing role to play in helping students to finance college study. It was recommended, therefore, that the Student Loan and Graduate Fellowship Programs be extended indefinitely, with the latter substantially enlarged, and that a program of undergraduate scholar- ships be started to help talented but needy students attend college. Survey of Federal Programs in Higher Education—During fiscal year 1961, the Office was engaged in a major study of the effect of Federal activities on institutions of higher education. This will pro- vide for the Office an opportunity to be a genuinely constructive force | Office of Education 253 in the programing of Federal activities of concern to institutions of higher education. Because of the scope and size of Federal programs affecting all areas of education, it has been proposed that the Office be given continuing authority to conduct studies and make recommendations concerning | all activities of the Federal Government affecting education at any level. New ReEspoNSIBILITY AND CHANGE IN THE OFFICE OF EDUCATION An administrative agency must change to be current in its execution | of responsibility. As the requirements of the American people have , increased in range and size, so has the Office responsibility shifted to | meet them. Examples of increase in authority and facilities are cited | below: Improvement of Office Administration Through New Authority.— ' Considerable thought was given to new authority which might im- prove the administration of the Office and needed changes were formu- | lated. These include the authority to. interchange personnel with | States so that persons with special competencies can be used to their best advantage on both the Federal and State levels, to accept gifts for the Office that in no way conflict with the expressed will of Con- | gress, to enable delegation of authority by the Commissioner, and to broaden the authority of the Office of Education to make contracts | and grants for the conduct of research and demonstrations. | New Facilities for the Office of Education—During the summer of | 1961 the Office of Education moved into Federal Office Building No. 6, a new building located at 400 Maryland Avenue SW. This new | building will provide not only for additional space needed by the | Office, but also facilities for demonstrating the use of television as an educational medium. During the 1930’s the Office of Education | was actively engaged in the utilization of radio for educational pur- | poses. The educational television operation will be an extension | of that early concern for educational media, and of the operations under title VII of the National Defense Education Act. * * * * * As an agency’s function is enlarged, it must, from time to time, reexamine its structure and mission and report to its constituents the understanding of deficiencies and suggestion for change that would provide maximum performance of current and predicted demands. Analysis of the Role and Organization of the Office of Education — In October of 1960, the Commissioner of Education appointed a com- mittee to study the role proper to the Office of Education as well as the organizational structure of the Office. After completing its de- 254 Department of Health, Education, and Welfare, 1961 liberations in April 1961, the Committee issued recommendations which are being carefully studied and evaluated as a part of a general review of the effectiveness of the Office of Education in meeting its responsibilities to the Government, the educational institutions, and the general public. Section LI] Major Activities of the Office of Education In the preceding section examples of the kinds of service which the Office rendered in fiscal year 1961 were presented. In this section the impact of the Office on various aspects of American education and its relationship with other agencies will be indicated. Elementary, Secondary, and Adult Education ADMINISTRATION State educational agencies are the administration centers of public education in the United States. While the schools are actually oper- ated by local agencies, the States retain supervisory responsibility. In recent years, State administrative agencies have expanded their direc- tive, supervisory, and advisory functions. The Office of Education, at the request of State agencies, has frequently given its leadership and cooperation to assist States in the formulation of policies and programs for the strengthening of these functions. State Departments of Education Consultants to Local School Systems—Most local school systems in the United States are not large enough to employ on a full-time basis all the highly trained professional specialists that are needed to pro- vide quality education programs. Since no school should be denied the services of these skilled consultants, it is imperative that each State make some provision to fill this need. States have found that the most economical as well as the most efficient means of making such services available to local school systems is to provide them through the State department of education. The average State department has, since 1955, more than doubled its staff of consultants. A sub- stantial part of the gain has resulted from the expansion of State pro- grams that receive no financial support from the Federal Government. In all but a few States, specialists in science, mathematics, modern foreign languages, and guidance, have been added to department staffs through provisions of the National Defense Education Act. - Office of Education 255 Fiscal year 1961 was the third year of substantial Federal aid to State educational agencies. During the year under title III of the NDEA, the Office of Education paid $1.7 million to the States for supervisory, adminstrative, and other services related to the strength- ening of instruction in science, mathematics, and modern foreign languages. With these funds, which the States matched dollar for dollar, State educational agencies continued to increase their leader- ship to the local school districts. Approximately 200 specialists in science, mathematics, and modern foreign languages accelerated their programs to improve the quality of instruction through support for higher teacher certification standards, demonstrations of effective uses of new instructional equipment and methods, production and dis- tribution of curriculum guides, and the organization of inservice train- ing of teachers. Approximately 265 State guidance supervisors, about 200 of whom have been added since title V(A) of the NDEA became operative, continued to work for improved counselor-pupil ratios and for higher standards for counselor certification. Statistical Reports and Services-—=With the operational responsi- bility for public education vested in the States, the State education agency has taken the key role in establishing and maintaining systems for recording and assembling the statistical data needed for solving educational problems. The Office, working with State and local leaders, has long been making efforts to provide the resource materials, consultative and technical assistance, and leadership toward strength- ening State and local data systems so that they might provide accurate, complete, comparable, and timely information at local, State, and national levels. Standardization of educational terminology throughout the Nation received major attention during this year. Forty-three States and Territories were taking steps toward initial implementation or ex- panded use of the standard terms, items, and definitions which have been cooperatively developed. Excellent progress was made toward production of two additional handbooks of standard terms and definitions—one in pupil accounting and one in staff accounting. While the implementation, evaluation, and ultimate revision of these basic handbooks will require continuing staff effort, some attention in the next few years can be devoted to handbooks in program and service areas. Under title X of the National Defense Education Act, the office assisted the States in establishing record and report systems embracing standard terminology and in developing appropriate manuals and guides. Concerted efforts were devoted to encouraging the utilization of modern automatic data processing. 256 Department of Health, Education, and Welfare, 1961 — Title X provides that States, on the basis of approved State plans — may receive up to $50,000 in Federal funds to be matched equally with State funds. In fiscal year 1961, there were 53 approved plans under section 1009, title X. Fund requests totaling $1,278,658.97 were received from 46 States. Thirteen States requested the full $50,000 of Federal matching funds and several of these will overmatch the Federal funds. For the fiscal year 1962, it is estimated that at least 50 States will request Federal funds in an estimated total amount of $1,550,000. The grants available, along with the Office of Education staff efforts, have provided during this fiscal year a sorely needed stimulus toward the development of modern programs of educational information. Local School Board Effectiveness Increase of citizen interest in improving the schools has placed responsibilities on local boards of education, unparalleled in the history of public education. Plans and programs to assist boards of education in functioning more effectively received widespread attention in 1961. State school board associations expanded their program to include inservice training specially designed for new board members. They published handbooks, manuals, and periodi- cals; maintained close relationships with State legislatures; and organized workshops. During the fiscal year the Office virtually completed a nationwide survey of local school board organization, operating procedures, and characteristics of board members. This study, the first of its kind in more than a decade, is presented by size of district enrollment and geographical region, and will provide information to school board members and other citizens seeking information about board organization and practices. Variations in practices and trends will be analyzed and described. School Problems in Metropolitan Areas The trend toward concentration of the Nation’s population in a relatively few centers has continued over the past 10 years. The 1960 census reported that over one-half of the population resides in some 209 metropolitan areas. The bulk of the increase has been in the areas surrounding the central cities, with suburban school districts frequently reporting five-fold enrollment increases in the last 10 years. In large city school districts school enrollments have also continued to mount, often while the population of the city itself was declining. Growth of the population in the suburbs, coupled with heavy popu- Office of Education 257 Jation shifts within the city proper, has created severe problems for long-range planning. The problems facing cities are numerous and critical. The limited funds available for the construction and operation of the schools, the competition with more attractive suburbs for staff, and the constant mobility and shift of population within the city present deterrents _ toeducational progress. But perhaps the problem of first importance is the general change in characteristics of the student population within our larger cities. The migration to metropolitan areas of large numbers of low-income families has created large student pop- ulation segments whose members are severely handicapped in their ability to adjust to an urban community. Of particular concern are those students who lack proper background in basic skills and the motivation necessary to profit from a comprehensive school program. Some of the metropolitan areas continue to provide leadership to educational progress throughout the Nation. The Higher Horizons Project of the New York City School Board and its Case Study Units in the Bureau of Attendance exemplify the use of curriculum adjustment, professional noninstructional services, and school-agency coordination efforts to improve education for the low-income, cultur- ally disadvantaged student. Looking toward a coordinated effort to benefit such students with programs of real significance, representatives from all national social agencies and from 38 States convened May 24-26, 1961, in Washington for the Conference on Unemployed Out-of-School Youth in Urban Areas. Dr. James B. Conant, chairman of the conference, referred to the thousands of out-of-school and unemployed youth in the large cities as “social dynamite.” Others who addressed or supported the conference were Vice President Lyndon B. Johnson, Secretary of Labor Arthur J. Goldberg, Attorney General Robert F. Kennedy, and Secretary of Health, Education, and Welfare Abraham Ribicoff. In an endeavor to find solutions to this problem, the Office of Education has encouraged the collaboration of specialists from various fields to formulate out-of-school programs of guidance and counseling for these youth. The Office has also sponsored informal meetings of representatives of national organizations of pupil personnel service professions and educational administration organizations. A na- tional commission to conduct studies of the functions, organization, and practices of inschool pupil personnel services and to carry on experimental research in these areas is being considered. Not least of the problems facing large city schools is that of main- taining a close relationship between patrons and schools. The rel- atively high mobility rate of our present society has had adverse implications for the traditional “neighborhood school.” The sheer 258 Department of Health, Education, and Welfare, 1961 increase in the size of our school districts, both urban and suburban, is acting to increase the distance between the school and its community. Many citizens to whom the schools have historically looked for support and leadership have moved to the suburbs. The need to identify, attract, and develop new sources of community support and leadership among citizens who have superseded the schools’ former patrons is well recognized. The Office of Education is initiating a study of methods by which schools in depressed areas of large cities are organizing activities which will encourage lay participation in the growth of the school program. STAFFING The growth of school enrollments has continued to pose a problem of staffing the public schools with sufficient numbers of well-qualified teachers. In the fall of 1960 there were 1,410,000 full- and part-time classroom teachers in the public schools: 861,000 in elementary schools and 549,000 in secondary schools. The public schools have been able for several years to meet their current needs for increased staff without an increase in the number of emergency teachers, but a chronic backlog of between 90,000 and 100,000 teachers with sub- standard State teaching certificates has existed for a number of years. Other “hidden shortages” are to be found in the continued existence of schools on double shifts and schools with curtailed pro- grams and services. The postwar increase in birthrates is now being felt in the secondary schools, and the greatest needs for increased staff are now found at that level. At the same time there is a lack of balance between the number of secondary school teachers being trained in various subjects and specialties and the number needed in each field. These and other problems in connection with staffing the public schools were reviewed in the report, Z’en-year Aims in Education: Staffing and Constructing Public Elementary and Secondary Schools. This report, which had the benefit of review by technical and sub- stantive experts of national prominence, outlines a program for the improvement of public school teaching staffs through increases in teachers’ salaries and through improvement of selection for teacher education and preservice and inservice education. The report suggests a staffing program over the next decade, with a goal for providing a professionally qualified and competent teacher in each classroom of the Nation’s public elementary and secondary schools. To achieve this goal, the reports recommends (a) staff salaries that are competitive with those in other occupations requiring equivalent training and experience, and (b) an improvement of procedures for the selection of teachers. The report further recom- Office of Education 259 mends that programs of preservice and inservice education for teachers be increased. In order to attain the levels of teachers’ salaries recommended for the next 10 years, average salaries by 1963-64 will have to in- crease 50 percent in purchasing power over average salaries of 1958-59, and those salaries must then be further increased approximately 2 percent yearly over the next 5 years in order to maintain the estab- lished salary status. The challenge of the second part of this goal—improvement of teacher selection procedures—is not chiefly a financial one (although the report assumes it will require an average of $100 million a year over the 10-year period), but it is rather a challenge directed toward the educational profession for mobilizing resources and for expanding cooperative action at the occupational level. Public concern must also be developed if this part of the goal is to be achieved. During the year, the Office issued a detailed study, entitled The Beginning Teacher: Status and Career Orientations. This study showed some of the professional, social, and economic characteristics of beginning teachers, and related these factors to differences in career plans, job satisfactions and occupational values. Viewpoints and goals of men and women beginning teachers were often found to be different, but neither group tended to look upon classroom teaching as a lifelong career. Many women, of course, expected to leave teaching either temporarily or permanently because of family responsibilities, but large numbers of men also expected to leave, either for nonteaching positions in education or for noneducational positions. A follow-up study of this same group showed that only 68 percent were still teaching in the same school district the following year, and that 14 percent had left educational positions altogether. This latter group included 12 percent of the men and 15 percent of the women. The conditions revealed by this study emphasize the need to achieve the goals stated above. FINANCING PUBLIC EDUCATION Revenues for public school purposes have increased 20.6 percent in the past 2 years, but this must not be construed to mean that the increase has been available for improvement of school services. Gen- eral price levels rose an average of about 2 percent and consumed a portion of the increase in school revenue. Enrollment in the public schools increased more than 7 percent in the 2-year period and this accounted for absorption of an additional portion of the increased funds. Over and above these two factors, however, it appears that a 260 Department of Health, Education, and Welfare, 1961 a Chart 1.—REVENUE RECEIPTS FOR PUBLIC ELEMENTARY AND SECONDARY SCHOOLS, BY SOURCES: 50 STATES AND THE DISTRICT OF COLUMBIA, 1959-60 Federal Government $651,091,000 ~ State Government $5,819, 464,000 39.4 Total Revenue Receipts: $14,759,007,000 The proportions of revenue receipts from these sources have remained relatively constant in recent years. net gain has been made in revenues for improving public school serv- ices. This gain was approximately 5 percent per year for the period. For the 1959-60 school year 56.2 percent of the school revenue was derived from local and intermediate district taxation, 39.4 percent from State sources, and 4.4 percent from Federal appropriations. 'These proportions which have remained relatively constant in recent years are shown on chart I. Chart II indicates portions of expenditures for the current school program, for capital outlay, and for interest on school debt which was incurred in the provision of school facilities. Sources and problems of school revenue and school expenditures are discussed in the following paragraphs, beginning with the source of greatest revenue—local jurisdictions. Local School Revenue Somewhat more than half the school funds are provided from local taxes levied usually by the local boards of education. These are often by Office of Education 261 Chart Il1—SUMMARY OF EXPENDITURES FOR PUBLIC ELEMENTARY AND SECONDARY SCHOOLS: 50 STATES AND THE DISTRICT OF COLUMBIA, 1959-60 Interest on School Debt $459, 238,000 ——~ Capital Outlay $2, 659,484,000 ue Total Expenditures: $15,643,519,000 Total expenditures for public school education increased in 1959—60 approximately 15 per- cent over those of 1957-58. Current expenditures were up approximately 20 percent over the same 2-year period; interest on school debt rose nearly 34 percent during the 2-year period; but, for the first time during the postwar period, capital outlay declined. Despite a continuing need for additional instruction rooms and school plants, this expenditure decreased nearly 7 percent in the 2 years ending in 1959-60. discussed in terms of property taxes and nonproperty taxes for schools. Property Taxes——Public funds obtained within the school district or received from county or intermediate district taxes are derived chiefly from the property tax. Effective tax rates on property have been rising during the 1950’s, and the school property tax rate increase has been two and one half times as great as that for other local govern- ment services. The importance of the property tax as a revenue producer has been maintained, and property taxes have more than doubled from 1950 to 1960, despite acknowledged inequalities and other weaknesses of this tax in our present complex economy. A study by the Office of Education indicated that revenue require- ments of the public elementary and secondary schools in the decade 262 Department of Health, Education, and Welfare, A ahead will rise faster than revenue can be expected from property — taxes. Property tax revenue generally increases more slowly than _ gross national product. With the property tax as the main revenue source for schools, general price level increases—and particularly rises in the teacher salary level required to maintain the competitive position of schools in a growing economy—are likely to lead to con- tinued fiscal crises for the schools. Nonproperty Taxes.—Proceeds of nonproperty taxes for schools such as local taxes on amusements, deed transfers, hotel occupancy, motor vehicles, sales, wages, and various business transactions, have increased only slightly in recent years. Pennsylvania remains the only State in which local school districts derive significant amounts from these sources. They now produce about 20 percent of local taxes for schools in that State. A number of other States have authorized _ the use of some limited types of nonproperty taxes for schools but these have produced relatively small amounts of school revenue. In school districts for which the local legislative authority, other than a school board, allots funds for school operation from general revenue, some broadening of the local tax base is evident through the additional nonproperty tax sources available to these governments. School Debt.—School facilities are financed very largely through the issuance of bonds. For assistance to local boards of education in the issuance of school bonds and the management of debt service, the Office of Education is reporting monthly and annually in School Life the average net interest costs on new school bond sales for each State and for the Nation. These reports supply boards of education with information of great significance on problems of offering bonds for sale, accepting or rejecting bids, and levying taxes required for debt | service. According to the Moody ratings, the average net interest cost declined steadily from 3.94 to 3.42 percent during the 21-month period ending in June 1961. Nevertheless the total expenditure for debt service is a rapidly expanding item in school budgets. It includes amounts required for repayment of loans as well as for the payment of interest. Receipts from the sale of bonds are designated as nonrevenue receipts. School bond sales reached a peak of $2.420 billion in 1957-58, declined 20 percent in 1958-59, but came within 2.5 percent of the peak in 1960- 61 when sales totaled $2.360 billion. Bonded debt for public school purposes has risen from less than $5 billion in 1950 to more than $15 billion in 1961. The annual sale of school bonds has increased from $1.87 billion to $2.36 billion over the 5-year period ending in 1960-61. The total amount of school bond sales for that period was $10.8 billion. Office of Education 263 Debt service expenditures have risen from less than $.5 billion in 1949-50 to nearly $2 billion in 1960-61. While bonded debt was in- creasing about 200 percent, debt service expenditures were increasing about 300 percent. This is due partly to the fact that interest rates have increased from under 2.50 percent to approximately 3.50 percent. Another reason for this disproportionate increase in debt service may be the substantial increase in the sale of shorter term bonds in recent years. In 1954-55 the average net interest cost. on school bonds was 2.32 compared to 3.91 in 1959-60. The average rate in 1960-61 has declined to 3.52 percent. State Funds for Schools Since 1947-48, school revenue from State sources has amounted to approximately 40 percent of total revenue collections for schools. Be- tween 1957-58 and 1959-60 State funds increased 20.4 percent. This increase was very similar to the 20.6 percent increase in total revenue for public schools during the same period. It indicates that the States have kept the same pace of increase that has occurred overall. Increased appropriations of State money have been provided not only for general improvements in education, but also for improvements for special school purposes. A current example of this latter use of State funds relates to the improvement of mathematics, science, and modern foreign language instruction, promoted under the National Defense Education Act, which provides that Federal funds be matched by State funds for the same purpose. Sources of tax income for the programs of State support generally include individual and corporate income taxes, sales taxes, death and gift taxes, taxes on natural resources, and motor vehicle licenses. However, these taxes are usually adopted by the States for the gen- eral support of all governmental services rather than the support of specific areas of service such as education. As much as 75 percent of the State funds for schools are from State taxes collected for this kind of general support. The remaining 25 percent of the funds are from taxes earmarked for schools by constitutional or legislative mandate. Federal Funds for Schools Federal support of education in State and local school systems increased 31.3 percent from the 1957-58 to the 1959-60 school year. Although the proportion of total school funds provided by Federal appropriations has remained relatively constant (approximately 4. percent), the scope and variety of Federal programs have been greatly expanded in the last decade. In addition to support of edu- cation through State and local school systems, Federal agencies 264 Department of Health, Education, and Welfare, 1961 provide funds through fellowship, traineeship, training grant, and research grant and contract programs. These programs recognize the Nation’s school system as the basic institution for the development of manpower resources to meet national defense and other needs. Programs of the National Science Foundation and the U.S. Office of Education provide significant support for teacher training, facilities for improved instruction, and studies in improving the content of courses. The National Defense Education Act of 1958 is providing assistance to State and local school systems, institutions of higher education, and to individuals to achieve its purposes. Other Federal programs provide support for school lunches, for agricultural research and extension services, for instruction in land-grant colleges, for the education and training of veterans, and for many other purposes. Expenditure Patterns Raising the standards of educational services wanted by the general public can be achieved through increases in expenditures, but modi- fications in expenditure patterns also offer opportunities for improve- ment. School superintendents and boards of education are constantly making decisions on apportioning funds among items of the school budget, decisions on reductions or eliminations when revenue is re- duced, and decisions on adjustments to be made when additional funds are available. Those having responsibilities for making these deci- sions are aware that more effective budgeting is extremely important in raising the standards of school services. Studies are being made of the relationship of the cost of instruction per pupil and the teacher-pupil ratio; also average daily attendance and the teacher-pupil ratio. These studies may help in the deter- mination of relationships between expenditure patterns and the quality of educational services. FACILITIES FOR PUBLIC EDUCATION Needs In the fall of 1960, there were 36,305,000 pupils enrolled in the Nation’s public elementary and secondary schools in the 50 States and the District of Columbia. Of this number, 1,868,000, or 5.1 percent of the total enrollment, were in excess of the normal capacity of the acces- sible publicly owned school plants in use. This number represented an increase of 122,000 pupils over 1959 figures. Not only were the pupils in excess of normal capacity affected by the shortage of classrooms, but also their classmates. The Office of Education estimated that approximately 8 million pupils were affected by overcrowding, by half-day sessions, and by the use of improvised Office of Education 265 or makeshift facilities. An estimated 2 million others were housed in obsolete or otherwise inadequate buildings. The total number of pupils, therefore, whose education was impaired in varying degrees by the classroom shortage is estimated to be at least 10 million. Chart IIl.—CHANGES WITHIN THE PUBLIC ELEMENTARY AND SECONDARY SCHOOL SYSTEM: 1957-58 TO 1959-60 Percent decrease Percent increase H=30 -20 -10 0 +10 +20 +30 +40 Local school districts l-teacher schools Total instructional staff Enrollment: Grades K-8 Grades 9-12 and postgraduate High school graduates Current expenditures Capital outlay Interest Average annual salary of instructional staff Current expenditure per pupil in average daily attendance Source: U.S. Department of Health, Education, and Welfare, Office of Education. School Life, Sep- tember 1961. Most of the increases represented below are either desirable or expected. The high per- centage increase in interest payments reflects the large amounts borrowed in recent years for school construction. The decreases in the number of local school districts and 1-teacher schools are the result of reorganization and consolidation of small and nonoperating districts. Although the number of 1-teacher schools decreased 6,000 during the 2-year period ending in 1959-60, there were still 20,000 such schools in operation, or about 22 percent of all elementary schools. The decline in capital outlay (money used for sites, buildings, and new equipment) was the first in the postwar period, and developed in spite of the well-known lag in construction of school facilities. 626936—62——_18 266 Department of Health, Education, and Welfare, 1961 The accumulated shortage of instruction rooms (classrooms, lab- oratories, and shops) for the 5 years ending in 1959-60 remains high despite the fact that 843,000 were completed during that period. Although 69,600 rooms were scheduled for completion in 1960-61, only a small part of this total can be applied against the reduction of the backlog of 142,200 additional instruction rooms (reported by the States in the fall of 1960) needed to house adequately the pupils who were located in overcrowded or otherwise unsatisfactory facilities. This is due to the fact that thousands of rooms were needed in the fall of 1961 merely to provide for population shifts, the estimated annual enrollment increase of more than a million pupils, and for replacements of rooms abandoned during the year. Enrollments in public elementary and secondary schools will in- crease from 36 to 44 million during the decade 1959-60 to 1969-70. New facilities will be needed to accommodate these new students. In addition, hundreds of existing school plants will need to be remodeled and expanded. Current developments in new processes of teaching and learning—teaching machines, educational television, language laboratories, and new concepts of individual, small group, and large group instruction—make it imperative that these new and remodeled facilities be planned, constructed, and equipped to accommodate anticipated educational programs. In order to meet these needs, careful attention will have to be given to designing facilities that are adaptable to a variety of uses. The magnitude of the task of planning, designing, and providing instructional facilities for educational programs is compounded by steadily increasing costs of construction and equipment. To com- pensate for these rising costs, school plant planners will need to keep abreast of economical developments. The Office of Education will share information on technical advances with State departments of education, and through them, with local systems. Federal Funds for Facilities Under Public Law 815 —¥ rom the end of World War I to the be- ginning of fiscal year 1961, the American people spent approximately ———> This chart shows the trends in a number of key areas of elementary and secondary education. A steady increase of more than 1 million students per year is evident. Until 1959 there was a slight decline in the ‘‘number of pupils in excess of normal capacity’ roughly paralleling the general decline in ‘number of additional instruction rooms needed’’; figures for 1960 show an increase over 1959. As would be expected, ‘‘total full- and part-time teachers” parallels and is only slightly more than the ‘number of instruction rooms available at be- ginning of year.’’ The “number of instruction rooms scheduled for completion’’ has not varied from year to year more than about 8,000—the approximate 1960 increase over the previous year. The ‘‘number of teachers with substandard certificates’ steadily increased from 1954 to 1959; but in 1960 the number decreased. Office of Education 267 Chart IV.—TRENDS IN ENROLLMENT, TEACHERS, AND SCHOOLHOUSING IN FULL-TIME ELEMENTARY AND SECONDARY DAY SCHOOLS, 50 STATES AND THE DISTRICT OF COLUM- BIA: FALL 1954 TO FALL 1960 Number 38,000,000 36,000,000 34,000,000 32,000,000 2S Ee SSS [(e Seen es eee eees | 2,500,000 Pupils in excess of normal capacity 2,000,000 1,500,000 Total full-time and part- time teachers =——_ —_--” —_— instruction rooms Silane quem) =: Pies es ake win pee 500,000 _}———_+ 175,000 Additional instruction rooms needed 150,000 Full-time teachers with sub-standard certificates 1 ! Instruction rooms scheduled for completion 1954 1955 1956 1957 1958 1959 * 1960 Source: U.S. Department of Health, Education, and Welfare, Office of Education. Fall 1960 Statistics on Enrollment, Teachers, and Schoolhousing. 268 Department of Health, Education, and Welfare, 196 $28 billion for public elementary and secondary school buildings. Of — this amount, the Federal Government, under provisions of Public © Law 815, contributed more than $948 million. Under the NDEA.—The Office of Education, through its authoriza- tion to administer funds appropriated by Congress under the National _ Defense Education Act, has assisted many school systems in improving © facilities and purchasing equipment that should improve the quality of education in instructional areas designated by the Act. For example, from 1959 to 1961, NDEA funds under title III were used to remodel 7,000 classrooms to accommodate Jaboratory and other equipment essential for quality instruction in science, mathematics, and modern foreign languages. During 1960, approximately 56,000 proj- ects for the purchase of materials and equipment costing $105 million were approved. Fiscal year 1961 ended with evidence that projects were approved in even more impressive numbers and at greater costs than those approved in 1960. The tendency among the States partici- pating in title III funds of the NDEA is to spend approximately 75 percent of these funds on science facilities and equipment, about 8 percent on equipment and facilities for improved instruction in mathematics, and about 17 percent on foreign language laboratory facilities. School authorities have increased the number of foreign language laboratory systems from 64 in 1958 to more than 2,500 at the beginning of fiscal year 1961. In addition to these laboratory systems, many schools have acquired audiovisual equipment such as tape re- corders and projectors for their language programs. CURRICULUM Experimental Programs The curriculum of the public schools is being increasingly influenced by technological developments which involve the use of new com- munications media within the classroom. Where these media are used as supplementary aids by a teacher, they offer much promise. Only in instances where the course would not be otherwise available is it considered advisable to use the filmed course, the TV course, or the teaching machine as a substitute for a teacher. Many educators feel that great care must be exercised in developing the content of and in programing filmed courses, TV courses, and courses for use in teaching machines, lest they lead to an undesirable uniformity of the curriculum or to an undesirable type of curriculum control by nonschool and commercial sources. English During the past year individuals and groups called attention to the need for improvement in the teaching of English. In a signifi- Office of Education 269 cant report, titled Zhe National Interest and the Teaching of English, a committee of the National Council of Teachers of English stated that the teaching of English is not as effective as it should be and that the task of the English teacher is becoming increasingly difficult. The committee also called attention to the inadequate preparation of at least half of the persons now teaching English. To improve the teaching of English, the committee declared that, with the help of the Federal Government, “bold and immediate action must be undertaken on a national scale.” Instruction in reading is a major concern of teachers of English. As the first step in a long-range project to improve the teaching of reading, the Office of Education began collecting data on research in reading completed between 1955 and 1960. From these data pro- fessional bulletins on various aspects of reading will be published to illustrate how sound research findings may be used to improve classroom instruction. In conjunction with selected high school and college teachers, the Commission on English of the College Entrance Examination Board is developing and trying out sample curriculums and in- structional materials, grades 9-12, for college-bound students. Through summer institutes at colleges and universities, the Com- mission on English plans to upgrade the qualifications of English teachers. One of the primary concerns of English teachers is composition instruction. More writing assignments, especially during class time, were made possible in some places by a lighter teaching load and the hiring of lay readers to correct and evaluate themes. Ar- ticulation of high school and college composition programs was improved through State and regional conferences of high school and college English instructors. Office of Education concern with the teaching of English has been reported in an earlier section of this report. Youth Fitness On February 21, 1961, the Secretary of Health, Education, and Welfare, serving as Chairman of the President’s Council on Youth Fitness, called a meeting of national leaders in various fields related to youth fitness for the purpose of studying recommendations for using Federal resources more effectively on fitness programs through- out the Nation. This meeting was addressed by the President, the Attorney General, and other Cabinet officers. A Consultant to the President on Youth Fitness was appointed at this meeting. During the year a guide, Youth Physical Fitness, Suggested Elements of a School-Centered Program, was prepared. This pub- 270 Department of Health, Education, and Welfare, 196 lication emphasizes the importance of health appraisals and identification of the physically underdeveloped pupil and gives man practical suggestions for tests and activities. Conferences also were : ee Science One of the most significant developments in science education during — the past year was the expansion of the efforts of various national curriculum study groups. Two separate groups, supported finan- cially by the National Science Foundation, have developed new courses in chemistry. The Chemical Bond Approach project, intro- duced experimentally in certain schools in 1959, has continued to furnish revised materials; and curriculum materials developed by the Chemical Education Materials Study was introduced into some schools in 1960. Experimental work in revising high school biology has been directed by the Biological Science Curriculum Study. The National Science Foundation has given financial assistance to hun- dreds of summer and inservice institutes for science and mathematics teachers. Three conferences, sponsored by the American Association for the Advancement of Science and supported financially by the National Science Foundation, were held to determine the feasibility of up- grading science instruction in grades K-9. These conferences sought ways of measuring the achievements of senior high school students who had studied various science courses, recent developments in the psychology of learning, and the problem of introducing major im- provements in science teaching into the elementary and junior high school. The Office of Education science staff has launched a program through which local school personnel, State supervisors, and Office of Education specialists work cooperatively to improve teaching in local schools. This program referred to as STEPS (Science Teach- ing-Exploration for Excellence—Program Steps) includes sugges- tions for evaluating and strengthening the school science program. The program emphasizes the formation of advisory committees of local persons with science backgrounds, the use of facilities provided through the National Defense Education Act, enlisting the cooperation of teachers in sharing with other teachers the new information they have gained while attending institutes, and the use of physical resources of the community. Pilot projects are underway in halfa dozen States, and approximately 20 additional State supervisors of — science are interested in the program. Office of Education 271 Mathematics Mathematics received major emphasis in elementary schools during the past year. Experimental centers throughout the country, spon- sored by the Federal Government and by private foundations or grants, reflected this increased attention to the structure and meaning of mathematics. Institutes held throughout the country for ele- mentary teachers and educational leaders in mathematics pro- vided training in a variety of new developments in the teaching of mathematics. In the area of secondary education, there was increased emphasis on the structure and meaning of school mathematics. Recent activities in improving secondary school mathematics include the work of the School Mathematics Study Group (SMSG). The SMSG, which is financed by the National Science Foundation, had previously made textbooks and teachers manuals available for use in the experimental programs in mathematics, grades 7-12. During the past year, SMSG prepared instructional materials for grades 4-6 which have been tried in selected experimental centers, as were instructional materials designed for slow achievers in grade 9. The mathematics programs of SMSG and other groups are cur- rently being evaluated by the Minnesota National Laboratory at the University of Minnesota. Educational Testing Service is also work- ing with SMSG in evaluating the new mathematics materials. A1- though SMSG is the largest experimental program ever undertaken in mathematics, there are many other significant experimental programs being carried on at a number of institutions of higher education. A number of eminent psychologists are engaged in studying patterns of concept formations. The Office of Education, in cooperation with the National Council of Teachers of Mathematics, sponsored a national conference on inserv- ice education programs, held March 17-19, 1960, in Washington, D.C. The conference report, Znservice Education of High School Mathematics Teachers, was published by the Office during the year. State departments of education have been active in improving in- service education at the local level. To assist in this effort, the Office of Education sponsored the National Conference of State Supervi- sors of Mathematics held in Washington, D.C., June 19-23, 1961. Foreign Languages As of July 1961, 53 State supervisors or consultants in foreign languages were functioning in 88 States and the District of Columbia. All but six of these posts were created between 1958 and 1960. In August 1960, a 2-week Research-Study Conference, attended by rep- 272 Department of Health, Education, and Welfare, 1961 __ to discuss problems of State-level supervision of instruction in modern foreign languages. One significant outcome of the conference was the establishment of the National Council of State Supervisors off Foreign Languages. Stimulated by the experiences and recommen- dations of the Research-Study Conference, the supervisors have played _ a strong leadership role for the improvement of foreign language 4 instruction in their individual States. ; The NDEA Summer Language Institutes for elementary and sec- : ondary school teachers have retrained an increasing number of lan- { guage teachers, as have inservice training courses in local areas. Many ~ colleges and universities have also offered’ special summer programs and a few have already revised their regular teacher-training pro- grams to meet the changing pattern of foreign language study. All of this, in turn, has begun to stimulate research in the foreign lan- guage field. resentatives from the States, was sponsored by the Office of — Vocational Education Area Vocational Education Programs.—V ocational education pro- grams for the training of highly skilled technicians under title VIII of the National Defense Education Act are making a significant impact. In fiscal year 1961 all of the 50 States, the District of Co- lumbia, and Puerto Rico conducted programs designed to alleviate the technical manpower shortage. An increased number of State legis- latures provided needed funds to accelerate this type of training. State technical institutes and area schools were constructed in a num- ber of States to make training available to more students. Under title VIII approximately 300,000 students have benefited from technical training programs during the past 3 years. Prepar- atory curriculums, generally 2 years in length, in broad fields of tech- nology included: electronics, mechanics, electricity, chemistry, aeronautics, production, instrumentation, and data processing. Elec- tronic technology programs accounted for approximately 40 percent — of the total enrollment. About two-thirds of all preparatory enroll- ments were at the post high school level. Extension courses provided training for adults already engaged in technical occupations to improve their technical knowledge and skills for advancement in their occupations or for upgrading into new or more difficult jobs. Curriculum guides in mechanical, chemical, and data processing technologies are being prepared by the Office of Education. These follow the pattern of the curriculum guides in electronic and electrical technologies previously published by the Office and distributed to the States. | Office of Education 273 Seven regional conferences, attended by over 400 State and local ) personnel from 48 States and the District of Columbia, were con- } ducted to develop ways and means of achieving quality in the basic | elements of technical education programs. | Advisory committees and consultants assisted State and local voca- tional educators with curriculum design and many other phases of program development. The Bureau of Employment Security coop- erated with the States in screening prospective students for technician | training programs. States gave attention to the development of grad- uate follow-up procedures and some schools reported 100-percent placement of their first graduates. Trade and Industrial Education—Trade and industrial education continued to contribute through preparatory and extension programs in over 200 occupational fields to the needs of youth, as well as to the | skilled manpower requirements of the Nation. States reported an expansion of trade and industrial education especially for out-of- | school youth and for adults, and particularly in new area vocational | schools. Enrollment gains occurred in cooperative work training programs and other occupational fields, especially the service trades and health occupations. A majority of all vocational education | enrollments occurred in the fields of trade and industrial education. Enrollments in practical nurse training continued to grow. Prog- ress was made in curriculum development, several States reporting workshops in this area. Research in nursing education was carried on through cooperative action with other Federal agencies and na- tional associations concerned with the health occupations, Several Office programs have contributed to the manpower needs of industry. Emphasis on training of the unemployed as well as the underemployed resulted in a readiness to expand facilities to meet these growing problems. Enrollments in supervisory training vir- tually doubled in the past 5 years. Enrollment of apprentices, re- flecting results of the joint efforts of education, labor, and manage- ment, gained substantially. Expanded course offerings and technological change have placed heavy demands on curriculum development. Several States estab- lished curriculum laboratories, indicating an awareness for expanding and updating their instructional materials. Needs for improving skills in vocational education were studied. Differences in the requisites of full- and part-time instructors have brought about changes in teacher training programs in many sections. A number of State-initiated leadership development conferences, as part of long-range plans to meet State and local needs for adminis- trators and supervisors, were held during the year. ! 274 Department of Health, Education, and Welfare, 1961 i | Distributive Education—The Office of Education distributive education program provides instruction in marketing and distribution, — It emphasizes economic concepts and judgment skills that apply not_ only to occupations but also to functions in marketing. Its in- structional materials encourage career development from beginning» jobs to management and business ownership. All the trainees in distributive education are employed or have | definite promise of employment in the field. At the high school level, entry jobs assist the trainee in learning how to become a productive — employee, in studying marketing functions within a business and a_ community, and provide opportunity for the instructor to analyse © individual potentials and career objectives of trainees. In their endeavor to assist individuals who plan careers in distri- bution, States and communities used evaluative criteria to establish quality standards of instruction and program operation, emphasized research to recognize economic developments significant in curriculum and learning activities, and strengthened curriculums and expanded opportunities for preparatory inservice teacher education. Most of the enrollments in distributive education are in adult ex- tension courses which stress small business management and the mar- keting of locally important products. Distributive education has gained recognition with management and labor groups and trade and business organizations as a vehicle through which training and re- training programs may be offered successfully. Office Education—The office-education program continued its ef- forts to encourage and promote education for office careers. This program services the second largest employment classification in the Nation (clerical and kindred workers), representing about 15 percent of the total number in all types of employment. Material of interest to office educators was widely distributed through Office of Edu- cation releases, professional journals and speeches. Home E’conomics.—The Office of Education is concerned with the extension and improvement of public school programs of home eco- nomics for young people and adults, of research in home economics education, and of home economics teacher education programs. In carrying out these activities during 1960-61, extensive use was made of the findings from a study of home economics in public secondary schools made by the Office in the spring of 1959. Data from the study have given direction on evaluation and revision of curriculums at State and national levels. Reports of the findings were given and — implications for action considered at (a) three regional home eco- nomics education conferences organized by the Office of Education, — Office of Education 275 Chart V.—VOCATIONAL EDUCATION ENROLLMENTS AND EXPENDITURES: 1940-60 Enrollment in Vocational Education by Type of Program Millions Home economics Trade and industry ote emo 1 oa 6 P ene 2st oe — .——— cas — — Agriculture = Distributive occupations 0 Expenditures for Vocational Education by Level of Government Percent 50 Local 40 “= 6a ee ewes a a ieee pais fo ay a el bi. Me = Peed —— ier 20 fe = Semen f Behera! 10 0 1940 1945 1950 1955 1960 Source: U.S. Department of Health, Education, and Welfare. Health, Education, and Welfare Trends, 1961. In 1960 there were 3.8 million students enrolled in vocational education courses. Of these students, approximately 42 percent took courses in home economics, 21 percent in agricul- ture, 25 percent in trade and industry, and 8 percent in marketing. The remaining 4 percent were some 101,000 students who took courses in science, mathematics, and other related courses under Area Vocational Education Programs, and 40,000 who took courses in practical nursing. In 1960, of the approximate $239 million expended for vocational education pro- grams, State and local funds furnished 81 percent. 276 Department of Health, Education, and Welfare, 1961_ (b) State meetings of teachers and administrators, and (c) meetings of professional organizations. F STUDENTS 4 Public High School Graduates In 1959-60, there were 1,764,237 pupils enrolled in the last year of | high school o whom 92.2 percent were graduated. These 1,627, 060. graduates represented 68.7 percent of the class which had entered grade 9 in 1956-57—an increase of 8.3 percentage points over the rate of graduation in 1949-50 as compared with enrollments in grade 9 four i years earlier. Identifying Talent The National Defense Education Act under title V(A) grants funds to States to improve and extend their guidance, counseling, and testing services. Reports from the States indicate that the NDEA program has been effective in helping many students who were plan- ning to drop out of high school or not planning to go to college, set their goals, plan their careers, and take poaene of educational opportunities. Most States have adopted a counselor-pupil ratio of 1 to 300 as their goal. In 1958, the national ratio for all high schools was 1 to 750; at the present it has dropped to below 1 to 600. Over 7,000 new counsalal have been added since the beginning of the NDEA. Current statis- tics indicate that there is a shortage of approximately 20,000 guidance and counseling personnel at the secondary school level, and 2,200 at the undergraduate college level. Exceptional Children Exceptional children include those who are blind or partially seeing, deaf or hard of hearing, those who have impaired speech, who are crippled, who have special health problems, who are socially maladjusted, emotionally disturbed, mentally retarded, or who have above-average talent. These children now number approximately 6 million, only about one-fourth of whom are receiving the specialized education they need. One index of the increasing public understanding and acceptance of special means of education for exceptional children and youth is shown in data from a forthcoming statistical report of the Office of Education. Percentage gains in enrollments for the decade 1948- 1958 are shown below: Office of Education O77 Percentage gain Area of exceptionality in enrollment LocaLt Pusiic ScHOOLS: aN al Eo oe 441 eabditiellic: SVEN 0 Te ses an ile lite apa pei. 4 aie cas cptalliles sal Spe elie 11 aCe ee ene re he LES Soe? A SEO eV PRA S 81 Aer LMMORmrertitriree ee Stee St helt eb eae eee 1 ee eran reat 25 BPO MBETTN LTO ets 28 8 EE 8 os he erry FB el ct eee 167 Crippled and. special health problems_____+_______ 5. se 14 Socially and emotionally maladjusted_______._.__.__________.__________ 84 DTA LUR EEA oo ie LUD ECD CS 6 Ugo al a ila peti centile aed ea ie stalls Ptashne sin 152 Re OC enone eget eS TS OO I OB ee ee oe ee 153 RESIDENTIAL SCHOOLS : USSURGL oo oo cee a ieee appa inal let itl lena lg ake lil bee as 32 Line pi eeeeneenmres meee creat Se Ue ee ES Oe es ee 22 Socially and emotionally maladjusted_____________________________ 63 UGSAIEDI NS? VGar hth eS i oe oe i a a ee oe ae eee ay ee eae ee 31 Likewise, the number of localities or operating units in which programs were carried on grew from about 1,500 in 1948 to nearly 3,700 in 1958. The increase was more than the total number of localities in 1948. Adequate preparation of teachers is probably the major key to quality education. In 1953 only about 120 colleges offered a minimum sequence of preparation in one or more areas of exceptionality. A study is now underway to ascertain the current status of teacher preparation programs in these areas. There is much interest in curriculum development at the graduate | and undergraduate college levels. This interest was accelerated by a nationwide series of studies conducted by the Office of Education | on teacher competencies in the various areas of special education. When the Congress passed Public Law 85-926, a large forward step was taken toward the expanding of opportunities and programs, particularly at the graduate level, for the preparation of teachers of the mentally retarded. This law provides for the establishment of a fellowship program for preparation of (1) instructors and | directors of college or university programs for the training of teachers of the mentally retarded, or (2) supervisors and directors of edu- cational programs for mentally retarded children in State and local school systems. About 170 fellowships have been available each year. During fiscal 1961 the Office of Education issued three publications | in the area of the gifted student: a bulletin entitled Teachers of | Children Who are Gifted, a report on a Cooperative Research Program | project, entitled The Gifted Student, and a study entitled Hducating | the More Able Children in Grades Four, Five and Sia. 278 Department of Health, Education, and Welfare, 1961 Dropouts The average age for graduation from high school is about 18 years. The average age of the high school dropout is 16+ years. High school graduates, based on enrollments 4 years before their graduation, have been increasing steadily since 1948 (from 62 percent in that year to approximately 67 percent in 1960). But larger enrollments have actually increased the number of dropouts. Employment problems for these dropouts are further complicated by the growing number of aging workers who frequently compete with young workers for the same marginal jobs. Although some talented students and many with average ability are — among dropouts, the majority are slow learners and pupils from homes of low-level education and culture. Pupils from these groups lack motivation to continue in school, but through the encouragement — which is being provided by expanded guidance and counseling pro- grams under title V(A) of the National Defense Education Act, many of the talented and those with average ability complete their © high school education and enter college, and a great number of those with below-average ability are led to continue their training in courses adapted to their capabilities. Three general approches to a solution of the drop-out problem are currently being tried out in school systems: 1. Attempts to raise the cultural level of children who are culturally deprived. 2. Better teaching with emphasis on acquiring basic skills in the elementary grades and junior high school with remedial instruction provided for slow learners. 3. School-work program where pupils spend one-half day in school and one-half day on a school supervised job. ADULT EDUCATION The concerns of adult education relate to some of the major prob- lems of our time. These problems involve the training and retraining of adults to meet the challenge of scientific and technological develop- ments; the growing educational needs of older people; and the pro- vision of educational opportunities for undereducated and uneducated American adults. During fiscal 1961 emphasis was on the development of more qualified adult education leadership in the States. Office of Education staff members provided assistance in strengthening adult education programs and services of State departments of education, universities and colleges, public schools, libraries, and voluntary citizen organiza- tions. The National Conference on Aging held in 1950 and the one Office of Education 279 | held in 1961 included sections on education. From these conferences has come a clear delineation of the role of education for the aging. | The Office of Education, in cooperation with committee members, | prepared the supporting document, “Background Paper on Education | for Aging,” used by the education section of the 1961 White House | Conference on Aging. Office staff members also contributed the | education section of a final conference report entitled “The Nation | and Its Older People,” as well as a final conference report on “Educa- | tion for Aging.” In cooperation with the National Commission for Adult Literacy, | the Office called a national conference on June 1-2, 1961, for the purpose of studying ways and means of increasing and expanding | educational opportunities for foreign-born and native adult citizens. An Office of Education bulletin released in 1961 entitled Hducation of the Adult Migrant analyzed the difficulty of absorbing migrants | from farms and small villages in urban areas. This study will assist urban communities interested in providing special educational opportunities for new residents. Civil Defense Education The Civil Defense Adult Education Program was designed to teach the techniques of individual, family, and community survival in disasters, both manmade and natural. This educational program is conducted by instructors who have completed 15 hours of technical studies, and is offered to adults in a 12-hour course, through the public school systems. The course includes the study of defensive measures against radiological, chemical, and biological warfare, community planning for such emergencies, and protective measures against natural disasters. Instruction in Civil Defense—Under contract with the Office, the States of California, Florida, Kentucky, Louisiana, Minnesota, Nebraska, and Texas prepared instructors to teach these courses. Hight more States have contracted to participate in the program during 1962. Higher Education INSTITUTIONAL NEEDS General Needs of All Institutions Of the 2,028 institutions of higher education listed in the Office’s Education Directory, Part Ill, Higher Education, 1960-61, 1,325 operate under private or denominational control, and 703 under public control. A substantial share of the Office’s effort during fiscal 1961 280 Department of Health, Education, and Welfare, 196 was devoted to providing services to these institutions, their officials, — their boards of control, and to governmental agencies, denominations, |} and other organizations. A survey of the colleges and universities : of South Dakota (7 public, 9 private), conducted at the request of a committee of the State legislature with the full cooperation of the private colleges, was the ees single effort of this kind. In addi- tion to providing consultive and professional services to scores of — institutions, and to their duly constituted officials, the Office conducted — comprehensive surveys of approximately a dozen individual colleges q and universities in as many States. ‘ During fiscal year 1961, the problems of these institutions continued to relate primarily to dite steady rise of enrollment and the prospect of a sharp upturn of the rate of rise between 1964 and 1969. The | Office completed, and on January 19, 1961 the Secretary of Health, Education, and Welfare released a staff paper entitled Z’en-Year Objectives in Education: Higher Education Staffing and Physical Facilities, which sketched in detail the requirements of the Nation’s colleges and universities for professional staff and physical facilities. The Office gave increasing attention to the needs of and trends in graduate education, completing the following studies: Graduate Education in Business Administration, Graduate Degrees Awarded by Members of the Association of Graduate Schools, Bibliography on Graduate Education, and Graduate Fellowships and Capacities of Graduate Schools. Several special studies designed to assist those responsible for higher education administration and planning were in progress or completed during fiscal 1961. Among them were Advance Planning for Higher Education, Internal Organization and Administration of Colleges and Universities, and Cooperative Projects Among Colleges and Universities. The Office also compiled and published a compre- hensive bibliography on Zhe Administration of Higher Education. Higher Education Staffing Needs—The prospective shortage of professional staff is one of the two most serious problems facing higher education. Today about 383,000 professional persons (about 298,000 full-time equivalent) are engaged in providing the teaching, research, management, and administrative services in higher education. During the next 10 years about 336,000 new, trained professional staff members must be recruited by the Nation’s colleges and universi- ties (at the master’s and doctor’s degree levels) to replace those lost by death, retirement, and resignation and to accommodate increases in enrollment (see chart VI). The Nation’s graduate schools must train not only these persons but similarly the far larger numbers of people required for business, industry, Government, and other areas. In order to keep pace with mounting enrollments, these schools must Office of Education 281 Chart VI.—PROJECTED HIGHER EDUCATION PROFESSIONAL STAFF TOTALS (FULL-TIME EQUIVALENT): 1959-60 TO 1969-70 Thousands 400 350 Research Staff 300 250 i Administrative Staff 150 100 50 0 1959-60 1961-62 1963-64 1965-66 1967-68 1969-70 Source: U.S. Department of Health, Education, and Welfare, Office of Education. Ten-Year Objectives in Education: Higher Education Staffing and Physical Facilities, 1960-61 Through 1969-70. The chart indicates the number of full-time persons required to meet the projected demands for instructional and administrative services and for the growing program of organized re- search. Of the total staff of 402,000 required in 1970, approximately 64 percent will be engaged in teaching; 16 percent in administrative services; and about 20 percent in organized research. 626936—62——_19 282 Department of Health, Education, and Welfare, 1961 produce persons on the doctorate level at a greatly increased rate in order to avert serious deterioration in the level of academic training. © The Office led in developing during fiscal 1961 a pilot project for — encouraging competent youth to prepare for careers in college teach- ; ing. Fifty colleges in Wisconsin are cooperating with the University _ of Wisconsin and Marquette University in the project, in which 150 4 top sophomore students participated in a workshop on college teaching — as a career, and in which plans for university-supervised paid intern- ships coordinated with graduate study are planned. The percentage of doctor’s degree holders among entering staft members in institutions of higher education declined from 31.4 percent in 1953-54 to 23.8 percent in 1958-59. It was estimated that to es- tablish the proportion at 30 percent for the decade 1960 to 1970, the Nation’s graduate schools would have to award an average of 16,800 doctor’s degrees annually during that period. When this number is compared with the current rate of about 9,800, and a projected 10- year average of 13,300 based on present increasing graduate enroll- ments (see chart VII), the staffing crisis is clear. Even the goal of 16,800 new doctor’s degree holders per year will be insufficient unless improved balance between supply and need by fields is achieved, and unless at least 60 percent of those receiving the doctor’s degree accept positions in higher education. During the year the Office investigated staffing problems of colleges and universities in surveys of faculty turnover, faculty load, staffing in selected subject fields, and studies of career characteristics and motivation. Higher Education Salary Problems.—The problem of recruitment of staff for higher education will become increasingly serious, at both master’s and doctor’s degree levels, unless salaries in colleges and uni- versities are increased during the next decade at an unprecedented rate. The increases in salary of professional staff in higher education dur- ing the last 5 years fall far short of restoring the economic ground lost by the profession since 1940. The Office’s report, Higher Education Planning and Management Data, 1959-60, completed and published during fiscal 1961, provides data for use in evaluating the status of instructional and administrative salaries in the Nation’s colleges and universities. Higher Education Facilities Needs.—The Secretary’s staff paper, Ten-Year Objectives in Education, previously referred to, indicates that the colleges and universities need to spend $9 billion for facilities by 1965 and an additional $10 billion by 1970 to accommodate the anticipated rise in enrollment and to replace outmoded or obsolescent facilities. Projections of presently anticipated income indicate that even with full utilization of the Federal Government’s College Housing Program funds at the rate of $250 million a year, the funds Office of Education 283 Chart VII.—CUMULATIVE OUTPUT OF AND NEED FOR DOCTOR’S DEGREES FOR HIGHER EDUCATION STAFFING: 1959-60 TO 1969-70 Thousands 200 175 150 125 100 15 50 1959-60 1961-62 1963-64 1965-66 1967-68 1969-70 Source: U.S. Department of Health, Education, and Welfare, Office of Education. Ten-year Objectives in Education: Higher Education Staffing and Physical Facilities, 1960-61 Through 1969-70. Projection of cumulative need is based on two assumptions: (1) that 30 percent of new staff members should hold the doctorate in order to insure quality, and (2) that 60 percent of all doctor’s degree recipients can be counted upon fo fill such positions. The comparisons of projected need with estimated cumulative oufput during the decade ending in 1970 identifies the ‘‘quality gap”’ (a shortage of approximately 35,000) threatening higher education if the output of doctorates is not both accelerated and increased. for facilities will fall short of needed expenditures by $1.5 billion by 1965 and $2.5 billion by 1970 (see chart VIII). During fiscal 1961 the Office completed and published part 3 of its College and University Facilities Survey: Znventory of College and University Physical Facilities, December 31,1957: A Preliminary Report. In continuing the effort to provide information on the support of higher education, the Office planned or initiated surveys in college and university endowment investment and facilities needs. Chart VIII.—CUMULATIVE NEED IN HIGHER EDUCATION FOR PHYSICAL PLANT: 1959-60 284. Department of Health, Education, and Welfare, 1961 TO 1969-70 , Billions of dollars 20 $2.5 billion gap at end of 1969-70 16 Cumulative Need (Annual Total ) — 12 $1.5 billion gap at end of 1964-65 0 1959-60 1961-62 1963-64 1965-66 1967-68 1969-70 Source: U.S. Department of Health, Education, and Welfare, Office of Education. Ten-year Objectives in Education: Higher Education Staffing and Physical Facilities, 1960-61 Through 1969-70. . These projections take into account the following factors: (1) enrollment increases, (2) condi- tion of plant—obsolescence and substandard conditions, (3) instructional facilities, (4) resi- Lz dential facilities, (5) construction costs, (6) cost of additional, special needs. Note that the size of the gaps projected for 1965 and 1970 would be approximately doubled if College Housing Loan Program funds were not available. Trends in 2-Year Institutions The importance of 2-year colleges (community or junior colleges and technical institutes) to higher education is seen by the steady increase in the number of such institutions over the last 10 years as well as by the fact that an increasing number of these institutions are being operated under public control. Several important developments on the 2-year college scene occurred during fiscal 1961. In many States new laws affecting 2-year colleges were passed in the 1960-61 sessions: Missouri and Kansas provided Office of Education 285 State financial aid for 2-year colleges for the first time; Michigan, Colorado, and Maryland passed laws strengthening and clarifying the legal structure of 2-year colleges; and Ohio passed laws enabling different types of public 2-year colleges to be established. These and other legislative developments affecting 2-year and other colleges are cited in the Office’s annual summary: State Legislation Relating to Higher Education. In addition, the Office published during fiscal 1961, a definitive report bearing on the 2-year college movement: Cvi- teria for the E'stablishment of 2-year Colleges. Trends in Professional Education The Office gave attention during fiscal 1961 to trends in engineering, and in technical, agricultural, and professional education. Among the related studies completed during the year were: 7’rends in Engi- neering Education, Organized Occupational Curriculums, 1958 and 1959, The 3-2 Plan of Engineering Education, Transfer Students in Engineering, and College Enrollments and Degrees in Agriculture. Several titles were added to the series, “New Dimensions in Higher Education”: No. 8, Advanced Standing; No. 9, Reappraisal of the Credit System; and No. 10, Quality in the Undergraduate College. The Office also identified for priority treatment and drew plans to attack the problem of improving the quality of teacher education. STUDENT FINANCIAL NEEDS Non-Federal Assistance During fiscal 1961, the Office completed and prepared for final re- porting a comprehensive study of institutional undergraduate student financial assistance for the academic year 1959-60. Scholarships from non-Federal sources constitute the largest single block of student assistance, estimated by leaders in the field at between two-thirds to three-fourths of the total volume of scholarship assist- ance. In the following tabulation the total value of institutional scholarships for 1959-60 and other related statistics are compared with the data of 4 and 10 years earlier: 1949-50 1955-656 1959-60 Number of higher institutions that awarded scholarships -_ __ 1, 198 1, 341 1, 559 Total value of institutional Reholarships. fz 2 opec des. 2 $27, 000, 963 $65, 736, 950 $98, 157, 498 Number of students awarded BONOMSIADIDS 922-6 ee ee 124, 223 237, 370 288, 521 Average institutional scholar- shipreran tiaieaint SO cut eebhes $217 $277 $340 286 Department of Health, Education, and Welfare, 1961 Another student financial assistance project of the Office of Educa- tion, nearing completion at the close of fiscal 1961, was a study of State administered and financed scholarship programs. This study — deals with: (a) scholarships authorized by State legislation and sup- ported by specific appropriations, which are not a part of institutional scholarship assistance; and (b) programs of State administrative agencies (such as education, health, highways, and welfare), which enable students to attend a college or university with an option of repaying the agency either in money or in service. Based upon data for the fiscal year 1958-59, the study reveals that 33 States, the District of Columbia, and Puerto Rico operated 104 scholarship grant programs which assisted 55,178 students with a total volume of scholarship awards of $19.5 million at an average grant of $355 per student. The programs of the States of California, Florida, Illinois, Maryland, New York, and Virginia account for the scholar- ship assistance to approximately four-fifths of all State-aided scholars and a corresponding portion of State scholarship expenditures. In recent years several States, including Georgia, New Jersey, Rhode Island, and Virginia, have adopted general (noncategorical) scholarship programs. Moreover, California has amended its legis- lation to enlarge its general competitive scholarship program and has authorized a new scholarship program for agricultural students. Another substantial volume of scholarship assistance is awarded by a variety of business firms, corporations, labor unions, churches, civic organizations, parent-teacher associations, women’s clubs, and other voluntary organizations. It is estimated that for the year 1959-60, approximately 37,000 scholarship grants with a total stipend value of about $22.5 million were awarded. The largest segment of these scholarships is administered by the National Merit Scholarship Corporation. During 1959-60 this pro- gram provided scholarship aid to 830 first-year college students, who were awarded an average grant of $827, for a total of $686,150. The total scholarship payments to these students and to those of 3 previous years was almost $2.2 million and was in support of 3,937 students. Increases in Tuition and Required Fees—An important consider- ation of student financial assistance is the adequacy of stipends to meet college costs, which have been sharply increasing since 1954. During fiscal year 1961 the Office continued its study of this trend. A comparison of the average annual institutional charges for tuition and required fees in 196 representative colleges and universities between academic years 1949-50 and 1960-61 is given below: 1 1 Figures are for 196 representative institutions for which continuous data for the period indicated were available. These colleges and universities, each of which enrolled more than 1,000 full-time undergraduate students, accounted for approximately 55 percent of the Nation’s undergraduate students and for a larger proportion of graduate students. These data apply, therefore, to the majority of college students, Office of Education 287 Tuition Increase since 1949-50 Academic and Year Fees Amount Percent Pusuiic INSTITUTIONS it ty peeeeae 8 tt SLO se $207 $95 85 NGG AO). ES eae eee ee Se 194 82 75 LOS bH!. 6 Te re ee 179 67 60 baie)... 2s ae ee ae 168 56 50 HOOT meee Sse LUE Ae Lk 155 43 38 pep reree ee) e 8 JIM et es ee eke 147 35 31 BAS eee ef abst CR 135 23 21 iM OMRU ISTO) | a She ep ne 112) pe eee Se eh eae PRIVATE INSTITUTIONS VOQROSTR 5 er $938 $473 102 ‘G/U EGIU) coy, oll gael alten ee. seat 890 425 91 RS eee Lee CL ee 820 365 76 Gy ee) 2 PE as ae es See 741 276 59 NOE? oi. 2. oe a 690 225 48 (OSS... a a a 638 173 aie? LIS AES i AS, pl mr lig sa 590 125 Pf UO EM, — ep ply gl lp al Sle B65 eee Set Seer eee During the 11-year period, public colleges and universities increased their tuition fees by $95, or 85 percent, while private institutions increased theirs $473, or 102 percent. While the average scholarship grant during the last 4 years increased by $63 (from $277 to $340), during the same period the average increase in tuition fees increased $242, or almost four times as much. A conservative estimate of the total volume of non-federal under- graduate scholarship assistance from all sources for the next academic year (1961-62) would be $150 million. In view of recent increases in tuition charges and other college costs and the number of high school graduates who have the requisite ability for higher education, it is doubtful that this sum is adequate to overcome the economic barriers to higher education. Federal Assistance During 1961, the Office’s higher education programs under titles II, IV, V(B), and VI of the National Defense Education Act reached peak operation. Title I7—During fiscal 1961, 156,000 students borrowed $73.3 million. Loans totaling $108,360 were made to 390 Cuban students in 51 institutions in the United States. Title IV.—1,500 fellowships were awarded and 476 new and ex- panded graduate programs were supported during fiscal year 1961. Support of these projects, together with the continuing support of approximately 2,500 fellowships awarded in the previous 2 years, amounted to $6 million during the year. A total of $12.6 million 288 Department of Health, Education, and Welfare, 1961 was appropriated for the graduate fellowship program for fiscal year 1961, approximately 50 percent of which was paid in grants to fellows and 50 percent in stipends to institutions conducting the graduate programs. Title V(B).—A total of 2,744 counselors and teachers preparing to become counselors attended 83 summer institutes, and 612 attended 20 regular-session institutes. The experience of 2 years of NDEA guidance counselor training institutes led in 1961 to the following new approaches. 'To meet the demand of providing well-trained guidance counselors and better guidance programs, the Office improved the institutes by (a) placing greater emphasis on year-long training for regular enrollees, and (b) setting up short-term special-purpose institutes to provide an opportunity for persons who needed refresher training in new techniques, and for those who have not yet met certification requirements. At the suggestion of the Office of Education, the Association of Secondary School and College Administration Officers secured a grant that enabled the Association to send representatives from college ad- missions offices to the institutes conducted during the summer of 1960. These representatives were able to present the most current informa- tion on problems of college selection and admission. Special purpose institutes of 2 to 8 weeks’ duration will be estab- lished in 1962 to train counselors in handling new guidance problems. Concentration will be on problems associated with the increased num- ber of students aspiring to attend college—the wide ability range of these persons, the student’s choice of college and admission to college. These institutes will also stress the role of the counselor in developing and changing the school curriculum. Recognizing the necessity that the school administrator must under- stand and support the guidance program of a school, provision will be made at some of the special institutes in the summer of 1962 for a 1- or 2-day visitation by school administrators. Finally, a new program of full-year traineeships was proposed so that advanced training could be provided promising counselors and counselor supervisors. Title VI.—2,003 elementary and secondary school language teachers attended 87 summer institutes, and 117 attended 5 regular-session language institutes. Language fellowship awards were made to 472 graduate students studying 31 neglected languages. This included 112 renewals of fellowships awarded the previous year. A total of 46 language centers at 30 colleges and universities received support amounting to $1,575,000 for improving and strengthening instruction in 44 neglected languages. Office of Education 289 A total of 46 new language research projects were initiated at a total cost of $811,416, and another $1,118,205 was obligated to con- tinue the 115 projects begun in the 2 preceding years. Improvement of Auditing Procedure for NDEA Funds—The Office of Education has continued to improve its recently established program of auditing the expenditure of funds received under the National Defense Education Act by colleges and universities. This auditing program provides professional assistance and advice to insti- tutions which have received NDEA funds, in the establishment of adequate financial systems to assure accountability for Federal funds. International Education INTERNATIONAL EDUCATION AND THE NATIONAL CHALLENGE In earlier days the resources of an undeveloped country lay in the vast uncultivated land. These resources, in turn, demanded and pro- duced capital wealth. But today, the need is for trained manpower, which can be produced only through education. Indeed, there is a growing belief that man himself is the only permanent form of wealth, that societies become technically advanced, politically secure, and economically developed through the education and training of individuals. This idea of education as the foundation of economic, social, polit- ical, and cultural development, is a logical outgrowth of American tradition. But what was once regarded as an abstract right of the individual is now understood to be the foundation of national power, essential for national survival. Perverting this great concept to the uses of communism, Russia is using education as a political tool on the one hand, for creating “the new communist man,” and on the other, for building the power needed to support communism at home and abroad. Today this concept of education is of vital concern to mankind. Whether education is fostered by a nation as a means of teaching broad freedom of thought and action, thereby insuring self-govern- ment for its citizens, or is promulgated as an agency for suppressing those freedoms, thereby supporting totalitarian control over its sub- jects, is the choice many peoples of the world are now making or will make in the years immediately ahead. Since 1946 more than 800 million people have begun to govern themselves. In many new na- tions, only a small proportion of the children are in school. Their parents are generally convinced that only through education can they achieve a decent way of life. In some countries more than 40 percent of the government’s income is devoted to education. 290 Department of Health, Education, and Welfare, 1961 — The Office has served as a bridge between educational developments at home and overseas since it was established in 1867. In 1896 this role was formalized by legislation which gave the Commissioner of Education basically the same reporting responsibilities toward both foreign and domestic education. As education has increased in impor- tance as an instrument of both national and international policy, the responsibilities of the Office in international education have grown rapidly. Likewise, it has become apparent that the Office should take the leadership in convening representatives from Government, indus- try, and education to discuss the adequacy of present programs of education at all levels to meet the manpower needs for the Nation’s international activities, and to educate our people for the international responsibilities of the future. INTERNATIONAL EDUCATIONAL RELATIONS During 1960-61 the Office performed a variety of services for gov- ernmental and nongovernmental agencies, professional organiza- tions, and institutions and individuals both here and abroad. Services Relating to International Organizations The Office provided information on education in the United States to international organizations, ministries of education, and institu- tions and professional educators abroad. Among many projects undertaken were the evaluation of UNESCO’s proposed education program for 1961-62 and the develop- ment of project plans for inclusion in the organization’s program for 1963-64. An adviser from the Office of Education was appointed to the United States delegation to UNESCO’s General Conference in Paris. The Under Secretary of the Department of Health, Education, and Welfare was official spokesman for education on the delegation. Work with the International Bureau of Education included, in addition to the usual multilingual progress report on education in the United States, the development of official replies to questionnaires on the one-teacher school and on preprimary education. These questionnaires were the basis of discussions at the Twenty-fourth International Conference on Public Education in July 1961. The Office reprinted and distributed the recommendations adopted by the conference, and in various publications described its proceedings and significance. Upon request, the Office furnished the names of specialists in various branches of education and nominated persons for member- ship on international boards or committees of experts to such organi- zations as UNESCO, the United Nations, and ILO. The Office was Office of Education 291 also asked to recommend persons for awards of international fellow- ships in education. Major reports prepared by Office specialists for inclusion in UNESCO publications included material on correspondence education and the teaching of geography, and a report on the accessibility of the teaching profession to women. Credentials Evaluation During 1961 comparative education specialists of the Office evalu- ated 5,355 credentials for university admissions offices, boards of certification and licensure, State Departments of Education, and other institutions and agencies. This was an increase of 918 cases over 1960. Staff members continued to work closely with the American Associa- tion of Collegiate Registrars and Admissions Officers, the Council on Evaluation of Foreign Student Credentials, the National Association of Foreign Student Advisers, and the Institute of International Edu- cation on matters relating to credentials. The Office participated in conferences and meetings of these associations, in the development of materials, and in the dissemination of current information helpful in interpreting education programs of institutions abroad. These ac- tivities are essential in improving and expanding American support of education in the new nations. Conferences and Studies on Comparative Education In the summer of 1960 a conference was held on education in Com- munist China, at which several papers prepared by specialists in the field were presented and discussed, and later published. Government specialists with particular knowledge of Soviet education were re- cently invited by the Office to present papers on themes related to their common field of interest. These papers will be published during the coming year. A brief study, #ducation in England, developed for an earlier con- ference, and an account of a 1960 conference, Foreign Understanding and Interpretation of United States Education, were published during 1961. Among comparative education studies published in 1961 for the use of United States educators and specialists were Education for Africans in Tanganyika, Soviet Education Programs, and E'duca- tional Trends in the Caribbean. Other publications appearing during the year deal with aspects of education in Afghanistan, Libya, the United Arab Republic, Czechoslovakia, Rumania, the U.S.S.R., Switzerland, Communist China, Indonesia, Hong Kong, and the United Kingdom. 292 Department of Health, Education, and Welfare, 1961 These publications will promote understanding and comparison of programs and enable government and professional agencies to develop more effective educational aid to other countries. The studies have a special significance to American institutions accepting foreign stu- dents, and others whose widely divergent educational backgrounds and professional competencies need careful appraisal in order to place them in circumstances that will yield maximum value from their American experience. Clearinghouse of Educational Studies During the year the Educational Clearinghouse completed 122 statistical reports of the activities of approximately 8,000 exchange students, teachers, and other scholars on Government-sponsored pro- grams who were engaged in more than 200 fields of specialization. The following fields of study attracted the largest number of foreign grantees in the order indicated: medicine, elementary education, eco- nomics, government, law, journalism, American literature and civiliza- tion, English as a second language, physics, and chemistry. American grantees, who went abroad to study during the same period, came from all States and Territories and pursued their studies in more than 60 different countries. These grantees engaged in some 150 specialized fields of study, among which the following, in order, attracted the greatest numbers: Romance languages and literature, music, English as a second language, English language and literature, Germanic language and literature, political science, elementary education, art, physics, and physical education. Specialists for International Assignments Education is an important area in the programs of technical assist- ance to the underdeveloped areas of the world. The Mutual Security Program and a somewhat similar program operated by UNESCO, together require a continuing overseas staff of approximately 900 educational technicians. The Office of Education is responsible for recruiting education specialists for both programs. The Office also selects an increasing number of technical assistants for educational specialists overseas and, periodically, sends packets of professional educational materials to them. The Office increased its activity to provide training for Americans serving abroad in Govern- ment or private enterprises. This function of the Office of Education is illustrated by a major effort in 1961 to develop resources in the African languages through centers, advanced language fellowships, and research under title VI of the National Defense Education Act. Language study in the land in which the language is spoken was given new emphasis in Office planning in 1961. The lack of authority Office of Education 293 to provide such opportunities was recognized as a gap in the existing National Defense Education Act language training program, and it was proposed that this authority be added in order to improve further the preparation of language teachers. International Educational Exchange The Office continued to conduct three major programs under agree- ments with the Bureau of Educational and Cultural Affairs and the International Cooperation Administration of the Department of State: the Teacher Exchange Program, the International ‘Teacher Development Program, and the Technical Assistance Training Pro- gram in Education. It has worked with the Conference of Governors to develop State participation in international teacher exchanges. It has also provided nonscheduled advisory services to hundreds of individuals and institutions in this country and elsewhere. In addition, it provided extensive services for visitors who were not recipients of grants administered by the Office. The total number of participants in the four categories was 2,539. Teacher Hachange Program—The Teacher Exchange Program expanded slightly from a total of 619 in 1960 to 624 in 1961. The participants were distributed as follows: teacher interchanges, 155 pairs (310 teachers) ; other United States teachers assigned abroad, 130; other foreign teachers assigned in the United States, 45; summer seminars abroad for United States teachers, 139. Eight seminars were conducted as follows: teachers of Spanish in Spain and Co- lombia; teachers of history in France, in Brazil, and in India; teachers of the classics in Italy; teachers of German in Germany ; teachers of French in France. International Teacher Development Program.—The International Teacher Development Program increased from 486 visiting educators in 1960 to 529 in 1961. The number of participating countries in- creased from 65 to 67. Programs arranged at 16 colleges and uni- versities included four groups in the teaching of English as a second language; two groups each in elementary and secondary education; three groups in American civilization; an Irish teacher group; a Tunisian teacher group; and one group each in administration and supervision, science education, and vocational education. Individual itineraries were prepared for 12 participants at an advanced, specialized level. Two teacher-development workshops in elementary, secondary, and vocational education were held at the University of Puerto Rico— one in October and one in February 1961—for 113 educators from South and Central America. 294 Department of Health, Education, and Welfare, 1961 Technical Assistance Training Program.—The number of partici- pants supervised during the year 1960-61 totaled 768. The trend toward emphasis on degree programs, first noted in the previous year, was again reflected in the Near East-African training projects. There was a slight decrease in the number of participants from the Far East, from 338 to 302. Countries with the largest number of representatives were Indonesia, the Philippines, Thailand, Vietnam, the United Arab Republic, Iraq, Turkey, and the Sudan. Training was arranged for educators in approximately 60 different fields of education involving 150 training centers located in almost every State, the District of Columbia, and Puerto Rico. Secondary and Non-Grant Visitor Progrums.—Secondary visitors are recipients of United States Government grants administered by agencies other than the United States Office of Education, but who are referred to the Office to pursue their interests in education. Non- grant visitors do not hold United States Government grants. They may be sponsored by their own governments, private foundations, or educational institutions, or may be traveling entirely at their own expense. The Office provides services for these visitors, ranging from single appointments to complete itineraries, including travel and hotel reservations and appointments with local sponsors in many communities. In 1961, the number of secondary and non-grant visitors reached 618, an increase of 170 over 1960 and almost double the figure for 1959. EDUCATIONAL MATERIALS LABORATORY The Educational Materials Laboratory is a collection of educa- tional materials of some 11,000 items—textbooks, supplementary reading materials, curriculums, professional literature, records, films, and filmstrips—published in the United States and abroad. These resource materials are used by United States and foreign educators as well as by specialists in the Office of Education and in other Government agencies. More than 1,700 visits to the Laboratory were recorded during 1961. The Office arranged for consultation periods, seminars, and work- shops for members of the Community Development Education Section of the Philippines, representatives of the Ministry of Educa- tion of Cambodia, several administrators from Costa Rica, and more than 500 participants in programs for foreign educators. For United States educators the Laboratory developed a program on educational materials for suburban librarians from Maryland and Virginia. A 5-day workshop was also arranged for a group of New York State teachers engaged in a project to improve teaching Office of Education 295 in world affairs. Such activities are increasing as more States re- quire teaching about world affairs. Annotated listings of educational materials are published in Z'du- cational Materials Laboratory Report. The Report is issued about 10 times annually and provides current information on Laboratory holdings and recently published materials. Library Services LIBRARY NEEDS The problems facing the Nation’s library services fall into two groups: those related to securing recognition of the increasing needs for materials, facilities, and staff to serve our growing population and those related to the financing necessary for obtaining these services. Various aspects of these two needs, together with accomplishments in the field of library services during the past year, will be presented in the following discussion. PUBLIC LIBRARIES Although considerable progress has been made in the past 4 years in overall public library development, many serious deficiencies still remain. For example, there are still some 25 million Americans with- out direct access to local public library service. Many additional millions receive only token service. The basic components of factors necessary for adequate public library service are: trained and experi- enced leadership; an adequate number of professional and other li- brary personnel ; good physical facilities; book and nonbook resources in all fields and at all reading levels; and continuing and adequate financial support. The absence of any one factor affects the impact and strength of the total program. The lack of adequately trained staff is now critical. The concentration of population in our urban areas has resulted in an increased use of the services and facilities of public libraries particularly by the growing number of students and by research work- ers in specialized fields. Because of the demands for public library service to children and youth, adult library services in support of self- education beyond school years are frequently underdeveloped and understaffed. Increased library use has rarely been matched by in- creased financial support. How the public library serves as an educational agency is described in a new U.S. Office of Education publication titled The Public Li- brary—F or Lifelong Learning. This 36-page illustrated brochure describes many specific ways in which the public libraries serve as vital community agencies of informal education and makes recom- 296 Department of Health, Education, and Welfare, 1961 mendations for improving library services in this area. However, not until recent years has the profession at large begun to accept and im- plement these recommendations. In order to assist the States in pre- paring or revising library standards including recommendations for larger units of service and interlibrary cooperation, the Office of Edu- cation published State Standards for Public Libraries, a compilation of State standards for public libraries together with the American Library Association standards of public library service. The Library Services Act (Public Law 597, 84th Congress), passed in 1956 and now extended until 1966, authorizes an appropriation of $7.5 million annually for the period of the legislation for grants to the States for the extension of public library services to rural areas without any service or with inadequate service. State Library Fa- tension Services: A Survey of Resources and Activities of State Library Administrative Agencies, 1955-56, containing basic informa- tion on State library extension activities for the year prior to the passage of the Library Services Act, was published during the past year. This bulletin provides a bench mark for evaluating the effective- ness of this grant-in-aid program. A progress report of the participating States and Territories for the first 3 years of the act was issued under the title, State Plans Under the Library Services Act: Supplement 2. The basic statistics of the first 4 years are impressive: more than 34 million rural people now have new or improved services; State funds for development of rural library services have increased 75 percent since 1956, and local appro- priations for such services have increased 50 percent since that date: more than 6 million books and other materials have been added to the resources of rural communities; and approximately 250 new book- mobiles are now operating. In the wake of county and regional de- velopments over 114 million rural people have library service for the first time. State library agencies have added over 100 field con- sultants to their staffs. Scholarship programs under the act are now in effect in 17 States. There is still much to be done. Fourth-year reports from the States indicate that the number-one concern is adequate State and local support; the number-one problem, the shortage of trained staff ; and the number-one goal, the achievement of library service which maintains high standards in staffing and resources to meet the needs of the users. It is expected that the extension of the Library Services Act to 1966, will permit some 2414 million people living in rural areas (as yet unserved) to participate in the benefits of this program. SCHOOL LIBRARIES Two significant developments in the school library field occurred in 1961. The first was the establishment of the School Library Office of Education 297 Development Project, with a grant of $100,000 from the Council on Library Resources to the American Library Association for a project of the American Association of School Librarians. The purpose of the study is to assist in the promotion of higher standards for school libraries through the implementation of Standards for School Library Programs published in 1960 by the American Library Association. The project provides financial assistance to programs for implementing the standards and consultative service and materials to organizations and groups planning programs. As of June 1961, 21 grants had been awarded to State groups for conferences, studies, and special activities for the improvement of school library service. AJ] States have been provided with newly developed materials designed to im- prove leadership in school library development. The Office of Education staff served as consultants in the develop- ment of a project which resulted in publication by the Council of Chief State School Officers of a policy statement, Responsibilities of State Departments of Education for School Library Services, pre- pared by the Study Commission of the Council. This statement supports the principle that school libraries are basic to instruction, recognizes the concept of the school library as part of an integrated center for storing and disseminating all types of instructional mate- rials, and states principles of relationships between school and public libraries. At the request of the American Library Association, the Office of Education is conducting a comprehensive survey of school libraries in the United States for 1960-61. This survey is collecting data on county, city, and town school library supervisory services; on cen- tralized processing services; on school library quarters; and on methods of use of the school library—areas which are valuable in planning for school library development but which have not been previously studied. In the past year, four State departments of education have for the first time included the position of State school library supervisor in their budgets. Twenty-four State departments of education now employ one or more school library supervisors. COLLEGE AND UNIVERSITY LIBRARIES In 1959-60, academic libraries spent approximately $136 million to serve students and faculty in 1,951 institutions of higher education. This expenditure represented an average of approximately 3 percent of the estimated total expenditures for educational and general pur- poses in these institutions. Most academic libraries, however, were hard-pressed to furnish library materials and staff services for ade- quate instructional and research programs. 626936—62——20 298 Department of Health, Education, and Welfare, 1961 A comparison of present conditions with the proposed standards promulgated by the American Library Association reveals the fol- lowing facts. While minimum standards for libraries in 4-year in- stitutions specify 50,000 well-selected volumes, a staff of three full- time professional librarians with adequate clerical help, and a budget amounting to 5 percent of total institutional expenditures for educa- tional and general purposes. The libraries in 55 percent of the 4-year institutions have fewer than 50,000 volumes; 52 percent have fewer than the recommended three full-time professional librarians; and only 3 percent of total institutional expenditures were spent for library purposes. The minimum standards for libraries in 2-year institutions specify a collection of 20,000 well-selected volumes, a staff of two full-time professional librarians, and the same 5-percent budget specified for 4-year institutions. The libraries of 87 percent of the 2-year colleges have fewer than 20,000 volumes, and 78 percent fall short of the number of librarians recommended. Academic libraries as a group would have to receive an additional $90 million for materials and professional staffing to reach the recom- mended level of 5 percent of total institutional expenditures for edu- cational and general purposes. Only 3 percent of total institutional expenditures were spent for library purposes. While academic libraries currently receive inadequate support, their problems will be magnified during the next 10 years when enrollments in institutions of higher education are expected to rise from 3.4 million to over 6 million students. At present, far too many institutions house their libraries in fa- cilities that are inadequate or unsuitable. In the next 10 years, li- braries will require upwards of 6 percent of the estimated $12 billion required for instructional physical facilities in higher education in- stitutions. According to a recent Office of Education study, the cost of library buildings planned for 1956-70 was only about $300 million, which represents less than half the actual need. Research and Statistics COOPERATIVE RESEARCH PROGRAMS The Cooperative Research Program continued through 1961 to be a prime source for support of educational research in the United States. As the results from studies commenced earlier under the Program have begun to be available, the direct educational implica- tions of these studies are becoming apparent in such fields as the Office of Education 299 teaching of the mentally retarded, the detection and encouragement of students with special abilities, and improved instructional methods in mathematics and science. The objectives of the Cooperative Research Program are to stimu- late and support high quality educational research. To enhance these objectives three new types of activity have been undertaken : 1. Three programs for research development have been initiated: _ (a) Contracts are being made for surveying the status of research in selected fields; (b) a series of conferences of prominent researchers has been commenced for identifying major needs in areas where re- search is lacking; and (c) seminars for the purpose of analyzing the status of the research and devising new approaches to troublesome problems have been planned. Leading experts in areas where con- siderable research has been done are expected to participate in these conferences. 2. For the first time, the Program requested and reviewed proposals for field testing of research findings. Forty proposals were received, and seven of them were recommended and contracted. These field tests are based on the results of laboratory and classroom research and experimentation and are designed to translate these results into educational programs which are then tested in natural situations. 3. In view of the growing requirements of researchers and of the education community for information on the latest developments in educational research, the Program is expanding its dissemination activities. A series of monographs drawing together recent studies in areas of particular interest has been initiated. Among those pub- lished in fiscal 1961 were the following: The Gifted Student, Motor Characteristics of the Mentally Retarded, Social Climates in High School, Influence of Voter Turnout on School Board and Tax Elec- tions, and Research Problems in Mathematics Education. Summaries of the final reports of all the research projects completed under the Cooperative Research Program are also being written. Copies of the complete final reports are available in over 59 key libraries through- out the country serviced by the Documents Expediting Project of the Library of Congress. Clearinghouse of Studies in Higher Education Since 1958 the Office of Education has compiled, analyzed, and interpreted data on educational research and experiments related to programs of the colleges and universities which furnished the data. During fiscal year 1961 the Office published a number of monographs based on these data. Among these were titles on college admission with advanced standing and independent study programs. 300 Department of Health, Education, and Welfare, 1961 NEW EDUCATIONAL MEDIA Grants Approved The Advisory Committee on New Educational Media considered 221 separate applications for research grants during fiscal year 1961. Of these, 836 were approved by the committee and have been supported by grants of varying size. These 36 grants bring the total of National Defense Education Act, title VII research projects supported to 150. Final reports on 20 approved projects were submitted during this year. Approximately $3.41 million was expended during fiscal year 1961 for the support of new grants and continued support of grants ap- proved in previous years. Grants from preceding years required slightly over $2.4 million of 1961 funds, and the 36 projects approved in 1961 were supported with a little more than $1 million from 1961 funds. An estimated $360,000 was required in 1962 to bring these new projects to completion. These 36 grants were awarded to 25 separate institutions and nonprofit agencies in 15 States. Areas of major interest to researchers concerned with the newer educational media are television, teaching machines, conventional audiovisual materials used singly and in combination, and the de- velopment of systems of instruction which would utilize the various educational media and teaching techniques. It is evident at this time that the research conducted under title VII will lead to more definitive statements concerning the production and use of educational televi- sion, and the instructional role of teaching machines and other newer media. This research is focused on programed self-instructional media, including teaching machines and specially programed printed materials, on investigations of learner-teacher variables involved in the most effective use of instructional materials, and on application of the principles of autoinstructional programing to such other media as motion pictures, television programs, and filmstrips. Dissemination of Media Information Slightly more than $1.3 million was obligated for the support, under contract, of dissemination activities during fiscal year 1961. Approxi- mately $131,000 was required for continuation costs of projects con- tracted for in previous years. During the past fiscal year, 44 contracts were negotiated with 31 institutions, agencies, and individuals in 11 States and territories and 2 foreign nations. These 44 projects re- quired the expenditure of almost $1.19 million during 1961 and are estimated to require $275,000 in additional support during fiscal year 1962. Thus, it is estimated that these 44 contracts will require ap- proximately $1.46 million to bring them to completion. ‘ . Office of Education 301 A major emphasis during fiscal year 1961 was the dissemination of research information, both on title VII activities and on nonfederally supported research completed or in progress. Final reports on title VII research are deposited in each State department of public instruc- tion and in libraries throughout the country which participate in the Documents Expediting Project of the Library of Congress. In addi- tion, these reports may be purchased on microfilm or Xerox print from the University Micro-Films, Inc., Ann Arbor, Mich. Under contract with the Department of Audio-Visual Instruction of the National Education Association, each title VII project is also being abstracted, and quarterly accumulations of these abstracts are published in co- operation with the Office of Education. A second emphasis in the dissemination program during fiscal year 1961 focused on making instructional materials more available and accessible. The Educational Media Council investigated means for providing a comprehensive catalog of new issues of films, filmstrips, tapes, recordings, and slide sets. A contract has been made with the Council to develop a comprehensive media research cross-index. A pilot study was initiated at Western Reserve University by the Office of Education to determine the feasibility of electronic storage and retrieval of research in education. A number of high priority dissemination projects were completed in 1961. Some of these were solutions to immediate problems. Others were part of a long-range information program aimed at pro- viding the means for modifying and improving educational practices. Still others provided the basis for resolving fundamental problems regarding the role of communications media in the schools. A special bibliography project, undertaken by Syracuse University, is valuable primarily to teacher-educators. This project produced a catalog of instructional materials, coded for quick and accurate reference, for teaching audiovisual courses. The American Library Association issued Guides to Newer Educational Media, which like- wise includes annotated references to catalogs or lists in the new media field, issued between 1950 and February 1961. The capstone of fiscal 1961 activities may well be the report of a major study contracted with and begun during the year by the Na- tional Education Association. This project on the impact of tech- nology on education will culminate in memorandums, monographs, and a major study report which deal intensively with implications for the use of new media and technology in education. Surveys of media used throughout the United States and other countries which will aid in establishing national goals, standards, and guidelines, have moved forward. Information is being collected through surveys which are being made by the National Council on Visual Aids in London and 302 Department of Health, Education, and Welfare, 1961 by the International Christian University in Tokyo. These surveys — of media research in Europe and the Far East, coupled with the Purdue University International Seminar on Instructional Television, — will assist in assessing American programs and practices, CAPTIONED FILMS FOR THE DEAF The first full year of actual captioned film service to groups of deaf persons ended June 30, 1961. The program by that date had 572 registered users in all States except Nevada and Alaska. Approxi- mately 100 prints of feature-length captioned films became available as the year progressed and provided 948 bookings for a total audi- ence of 92,550 viewers. Many registered users were unable to secure films because of the heavy demand upon the limited supply. At — present, there are approximately 472 more groups registered than there are prints available, and more groups are being added to the list weekly. These groups are served on a first-come-first-served basis, and many requests must be turned down. Operating under a contract budget of $150,000, the Office of Edu- cation negotiated 5-year leases with motion picture companies to cover 44 new feature titles. When completed, this will add 176 new prints. EDUCATIONAL STATISTICS During fiscal 1961 the Office conducted 40 basic, general-purpose surveys of American education, and reported data from them. It also conducted a total of 20 recurring surveys in the field of higher education, relating to enrollment, faculty and other professional staff, earned degrees, receipts and expenditures, property, research and de- velopment activities, and organized occupational curriculums. Two surveys of State school systems were made, dealing with problems of organization, enrollment, teachers, schoolhousing, and finances of public elementary and secondary education. Studies of local school systems provided data for reports on current expenditures per pupil, secondary school programs, teacher turnover, adult education pro- grams, and the beginning public classroom teacher. The Office also developed projections of elementary and secondary instructional staff requirements and salaries, school construction, and college enrollment. The first scientific national study of programs of adult education conducted in local school districts was completed during the year. The Office also began the first definitive survey of the status of college faculty members and how they regard and accept their careers. The study was based on a scientific sample of full-time instructional — - i +a? Office of Education 303 staff. This study should provide important insight into reasons for entry into and causes for separation from college teaching. Such information will enable higher education institutions to meet more readily their requirements for increased numbers of faculty members in the 1960’s. The Office initiated two important surveys of nonpublic education below the level of higher education. Assisted by funds provided by the National Science Foundation, and utilizing mailing lists grow- ing out of National Defense Education Act programs, basic surveys of organization, support, kinds of curriculums offered, number of graduates, teaching staff, and accreditation were begun for 5,000 sec- ondary and 12,000 elementary schools. During 1962 a study will be made of the course offerings of the secondary schools. The informa- tion obtained will provide the first national data on offerings and enrollments of nonpublic schools conducted on a comparable basis and at a comparable period with a survey of the public secondary schools, in progress during 1961. Under an agreement with the National Science Foundation, the Office began a complete survey of financial assistance received by graduate students attending American universities. When the amounts contributed from various sources are evaluated and com- pared with costs of graduate education, more complete data will then be available to assist in evaluating the financial resources for graduate education. During 1961 a special Office task force completed a proposal for a new cooperative record and reporting system involving educational institutions and organizations of all States and using modern high- speed computing and tabulating equipment for the production of educational statistics, which would provide with a minimum of delay the information needed on the condition and progress of education. Reorganization of the Statistical Operations Staff Reorganization of the statistical operations staff of the Office of Education was initiated and progressed satisfactorily during the year. The new arrangement reflects a clear definition of the role of the central statistical operation in the Office. This role will essen- tially have two parts: (a) the rendering of professional statistical service to those conducting surveys, and (b) the conduct of the bench mark, basic type recurring statistical surveys. When this reorganization is complete, it will strengthen, particu- larly, the capacity of the Office to plan and schedule its operations and to utilize efficiently electronic and electro-mechanical data-editing and processing equipment. 304 Department of Health, Education, and Welfare, 1961 Section LV Summary and Selected Goals This report has set forth first a statement of the Nation’s most urgent educational need: excellence—not expressed altogether in terms of buildings, equipment, and the necessary number of adequately paid teachers, but as an attitude which affects “the total process of education.” A new focus is thus given to quality as it relates primar- ily to the curriculum and the teacher. Excellence, though never fully reached, demands of all—‘administrators, teachers, students, and the general public—all that they are capable of achieving.” In fulfilling its obligation “to promote the cause of education in the United States,” the Office of Education offers its leadership through assistance to all and cooperation with all in their commitment and dedication to this purpose. Summary of Achievements Among achievements of the Office of Education in five selected areas of activity during fiscal year 1961, the following are summarized: 1. The completion and release to the public of staff studies identify- ing the needs of American education on all levels. 2. The organization and dissemination of educational statistics and research results including (a) continued progress toward establishing a national cooperative system of educational data, (b) publishing of monographs on the results of educational research, and (ce) continua- tion of the compilation and analysis of a nationwide inventory of physical facilities of colleges and universities. 3. The mobilization of professional leadership (and in some in- stances, lay leadership) to help solve educational problems in the areas of (a) educational media, (b) adult literacy, (c) coordination of educational research programs within and between States, and (d) the improvement and supervision of State programs in mathematics. 4. The administration of special educational programs such as (a) assistance to Cuban refugees, (b) Latin American language and area studies under title VI of the National Defense Education Act, and (c) the planning of corrective measures in the teaching of English, involving research, conferences, and the preparation and demonstra- tion of curriculum materials and instructional practices. 5. The review of Federal programs in education involving (a) in- ternational educational activities, (b) higher education in the United = EEE ——— Office of Education 305 States, and (c) the effectiveness of the National Defense Education Act of 1958. Summary of Shortages The focus on quality in education, which was perhaps the outstand- ing characteristic of the educational year, revealed many inadequacies in American education. Educators, it would seem, are now more ready than formerly to entertain and to evaluate objectively, criticism of educational policies and programs, teaching and administration. They are coming to realize that such criticism is one of the bases of sound reevaluation and that healthy criticism of the status quo is necessary for progress toward excellence. 1. This report has pointed out in its introduction what must be considered a “major concern of the Nation”—the identification of in- dividuals who have the native talent for teaching and the education of these individuals in a manner that fully qualifies them to assume the responsibility of teaching. Supplying the necessary number of certificated teachers to take care of present and projected shortages will not in itself fill the need for qualified teachers. There are requirements for talent, personality, culture, and educational background which go far beyond the course requirements necessary for certification. Our society as a whole must place such a high regard on the teaching profession and must accord it such status and salaries that proper individuals will be attracted and committed to teaching, and the institutions that train teachers must revise their selection procedures to exclude those who have neither the talent nor the capacity to become teachers. 2. The need for adequate facilities for our elementary and secondary schools—instruction rooms and instructional materials—is a second area of shortage. The number of construction projects completed in fiscal 1961 and the number scheduled for the next few years will barely reduce the present backlog of approximately 142,000 instruction rooms reported by the States in the fall of 1960. The Federal Gov- ernment, by present legislation, must restrict its aid in school building and classroom construction to areas where school attendance is in- creased because of Federal activities within those areas. Funds approved under title III of the National Defense Education Act for improving facilities and purchasing equipment to improve the quality of instruction in science, mathematics, and modern for- eign languages have contributed to improvements in thousands of schools since 1958-59, and students in these schools have benefited from the higher quality of instruction thus provided. But this kind 306 Department of Health, Education, and Welfare, 1961 of improvement needs extension to certain other areas of instruction as well. 3. Allied to the needs for teachers and facilities in our schools are needs for providing opportunity for every student to develop his abil- ities to the highest degree of which he is capable. These needs are revealed in the unequal opportunities resulting from failure to identify students’ potentials (from the talented to the slow learner); and in those caused by cultural and economic disadvantage, physical handi- cap, and mental retardation. The needs are further reflected in prob- lems related to juvenile delinquency, unemployment conditions, and adult literacy. 4. The shortages in higher education institutions are in areas similar to those in elementary and secondary schools—an insufficient number of adequately prepared staff members and a lack of adequate facilities for housing and instructing the increasing numbers of students. The Federal Government has provided loans and scholarships to students (particularly those planning to teach), loans for housing construc- tion, and grants and loans to institutions for numerous other purposes. However, unless additional funds are available to meet the demands of the decade ahead, there will be critical shortages of teachers and facilities. 5. In the general area of research and statistics, there is great need for a more comprehensive program covering all aspects of the edu- cational process—administration, teaching, and learning—including plans for more effective dissemination of results. Research through- out the Nation must be coordinated to avoid dissipation of effort and to achieve direction toward essential objectives. Research must be coupled with rapid application of results of established value. Through demonstration and other means of dissemination of these results teachers should continuously be made aware of the best current methods of instruction. These needs are closely related to need for improvement of teaching services in specific curriculum areas—notably English and modern foreign languages. 6. With a recognition by the principal foreign policy makers that education is a key aspect of foreign policy, it is now evident that to formulate successful programs of international education there must be closer cooperation among the various Federal agencies in the de- velopment of policies and programs for more effective use of the resources of our own educational system. 7. Furthermore there is great need that in our educational planning we consider certain broad social issues which affect the lives of all Office of Education 307 citizens. Problems in this area are suggested by the need for a bal- anced education-manpower program which, while assuring the right of individual choice, would at the same time insure the Nation’s strength. These problems are seen in the growth of urban popula- tions and in the need for education in civil defense. Selected Goals Some of the major activities of the Office of Education for fiscal ' year 1961 have been summarized and certain shortages in the schools and higher education institutions of the Nation have been reviewed. The Office has formulated goals which it believes are necessary to meet the needs of the future. A selected list of goals covering some of the crucial areas and problems of American education follows. Goat Arga I: GENERAL Support FoR Pusiic ScHOoLs AND ASSISTANCE TO COLLEGES FoR CONSTRUCTION General School Aid.—The establishment of general Federal aid for public schools through the enactment of a school aid bill, or equivalent legislation for equalization of educational opportunity, and raising of the level of educational support. Higher Education Physical Facilities —Enactment of proposals for loans to construct academic facilities. This goal recognizes the fact that funds necessary for the construction of these facilities cannot be supplied wholly from present sources of income. Goat Arga IT: ADVANCEMENT OF KNOWLEDGE AND DISSEMINATION OF INFORMATION RELATING TO EDUCATION Educational Research: Organization and Program Scope.—Broad- ening of the Office’s extramural research program, and of its working relationships with the total enterprise of educational inquiry, so that it will stimulate far more research and development than it directly supports, and so that every area of major educational concern will experience a ferment of reexamination resulting from the interaction of research, planning, analysis, and appraisal engendered by the pro- gram. Greater enlistment of top-quality research effort in developing ways to identify and nurture talent; to find corrections for develop- mental deficiencies arising from deprived economic and social back- ground; and to eliminate barriers which mental and physical handi- caps impose against social and economic productivity and personal self-realization. Establishment and maintenance of an effective pro- gram of basic and applied research, field testing, and demonstration of educational media, 308 Department of Health, Education, and Welfare, 1961 Acceleration of national dissemination of research results and edu- cational practice. ae Progress Toward a Nationwide System of Educational Data— Adoption of the proposal for a national cooperative system of educa- tional information, based on scientifically precise reporting and machine processing of basic items of raw data; and the development of a calendar of Administration-approved steps to carry out this proposal. Substantial and tangible progress, in cooperation with the States and private institutions, in developing common definitions of educa- tional terms and other prerequisites to common reporting practices. Goat Arga III: Action Programs ror CONSERVATION oF HumMAN RESOURCES The National Logistics of Manpower in Relation to Education.— The planning and initiation of studies in cooperation with other agen- cies calculated to yield concrete policy propositions for achieving a balanced education-manpower program for long-range national strength. Talent Development in Regular School and College Programs.— Confirmation of the favorable trends now tentatively indicated in the identification and guidance of able secondary students. General acceptance of the principle that nurture of talent must begin systematically in the elementary grades and that it must be a continuous process throughout formal schooling; application of this principle also to the first two post-secondary years, by extension of the NDEA title V provisions to those years. Enactment of provisions for a higher education Federal Scholar- ship Program. Prevention and Correction of Underachievement Related to Cul- tural and Economic Disadvantage—Provision of educational assist- ance to children and adults of migrant labor families. Salvage and Rehabilitation of Persons Disabled by Mental or Phys- ical Handicaps——Expansion of existing laws to include additional categories of exceptional children. (It is estimated that only one- fourth of the children who need such services are now receiving them.) Lack of adequately prepared personnel is a major obstacle to the de- velopment of proper programs for these children. Occupational Training and Retraining to Meet Problems of (a) Per- sistent Local Unemployment Conditions and (b) Obsolescence of Skills Through Automation and Other Technological Developments.— Development of close working relationships with Department of Office of Education 309 Labor under the Area Redevelopment Act and under proposed acts which would assist in the adjustment of occupational skills to employ- ment opportunities. Youth Programs Related to Problems of Unemployment and Juve- nile Delinquency.—Establishment of interagency cooperation for the Office’s role in implementation of the pilot projects and training pro- grams of the Juvenile Delinquency Act of 1961. The Nation’s Adult Education—Instigation of action, in an ap- preciable number of States, to provide trained leadership for adult education as an integral part of public education. Adoption by a sizeable number of States of new or expanded programs for adult literacy. The planning and initiation of national clearinghouse serv- ice for information on action programs in education for aging. Selection of urgent research problems, from the recommendations of the White House Conference on Aging, which fall in the area of adult education ; and promotion of research on these problems through the Office’s extramural research programs and through stimulation of institutions and other sponsors of research in education. Goat ArraA IV: ImprovEMENT or Provisions ror INTERNATIONAL EpucatTion Federal Cooperative Planning—Our position among the nations and the increasing role played by education in relation to foreign policy and international affairs requires a new dimension in our think- ing about the problems of education. We must cultivate a knowledge and an appreciation of our relation to other countries and other cul- tures, while at the same time we maintain a loyal though critical understanding of our own. The responsibility of the Federal Government for providing lead- ership to insure these achievements rests heavily upon the Department of Health, Education, and Welfare and the Office of Education. These agencies should lead out in cooperative planning and the formu- lation of policies and programs among Federal agencies concerned, whereby these goals may be realized. Education in International Understanding.—Early in 1962 the Com- missioner of Education will convene a conference of outstanding persons from a number of areas of American life, who are vitally interested in American education, to discuss the impact of our inter- national relations on American education. This conference will do much to clarify issues and to suggest approaches toward updating the curriculum of American schools and colleges and otherwise orient- ing it to changes throughout the world and to the position of the 310 Department of Health, Education, and Welfare, 1961 United States in international affairs. The conference will also con- sider the basic differences between American and _ totalitarian institutions. Goat Arna V: Action ProGrRaMs FoR IMPROVEMENT OF INSTRUCTION Coordinated Attacks upon Instructional Deficiencies in Particular Fields, English and Foreign Languages Being Major Examples.— Strengthening the NDEA Language Development Program by add- ing opportunities for foreign study to the existing resources of the program, and by introducing a special focus upon Latin-American studies. The infusing into the curriculum of our schools and colleges of an overall recognition of our relation to other nations and cultures. Successful initiation of “Project English,” a closely articulated program of providing appropriate Federal stimulation and assistance to the national effort for improvement of English instruction. Extension to the field of English, by amendment to NDEA title VI, of the program of teacher training institutes. Extension of the benefits of the NDEA teacher institutes to teachers of English as a foreign language, in order to help American pupils whose native language is not English to receive proper language instruction in English. Reappraisal of Vocational Education Field and of Related Legisla- tion.—The rendering of advice and/or staff assistance to the Presi- dent’s proposed national advisory body on vocational education, to enable it to advance practical proposals to accomplish the following objectives: (a) provide vocational education with a flexibility to meet shifting employment patterns, (b) define the proper place of vocational in relation to nonvocational or general education, (c) estimate expenditure needed for the total vocational education effort. Study of Teacher Recruitment and Retention—Develop the know]- edge to recommend teacher personnel policies offering promise of improvement in staff quality and performance. As one example, the compilation of the most significant developments throughout the Nation relating to the recognition of individual merit in the compen- sation of teachers. School and Academic Libraries —The enactment of legislation to eliminate the lack of school libraries in many of the Nation’s public elementary and secondary schools; eliminate the critical shortage of trained librarians; and improve the poor quality of a large percentage of the libraries in junior colleges, 4-year colleges, and universities. “ Office of Education 311 Goat Arga VI: Epucationan ApAPprations Basep Upon Oruer Broap Soctau Issurs The Urbanization of American Life—Substantial progress in ana- lyzing the educational implications of urban growth, in identifying solutions to urban educational problems, and in delineating the desir- able Federal role in these solutions. Educational Problems Attendant to School Desegregation.—Devel- opment of a program of research and analysis on the educational problems a school system faces when desegregation begins, and dis- semination of the results in a timely and appropriate manner. Cuil Defense Hducation—Strengthening of the Office’s civil defense educational activities by (a) increasing its capacity to pro- vide educational materials to elementary and secondary schools, and (b) extending its coverage of adult education in civil defense from the present 15 States to every State in the Union. Table 1.—Enrollment in 50 States and District of Columbia, 1959-60 and 1960-61 [Office of Education estimates] Grade level and type of school 1959-60 1960-61 Kindergarten through grade 8: Public school system (regular full-time)_.......-...._.....-....<.-..-- 27, 800, 000 28, 400, 000 Nonpublic schools (regular full-time) _-..-....--..--.............-.-- 5, 400, 000 5, 200, 000 PODER RIIOO US rE. nie. ate nS oe SO} 180, 000 200, 000 Totaly kindergarten through’ grade 8..-s.=---2s-.5=--.-~...---2=.- 33, 380, 000 33, 800, 000 Grades 9 through 12: Public school system (regular full-time) -........-...-..-..----------- 8, 400, 000 8, 900, 000 Nonpublic schools (regular full-time)__-.-.....-..........-...--.---- 1, 100, 000 1, 100, 000 TSS SE ES So ere ee ek eee ee 90, 000 100, 000 POLAPIETROGS ONGNLOUGO 12.2. a2. scene n nae eae on oneescnesan 9, 590, 000 10, 100, 000 Kindergarten through grade 12: Public school system (regular full-time) -....-..-_------.-------------- 36, 200, 000 37, 300, 000 Nonpublic schools (regular full-time) --..---------------------------- 6, 500, 000 6, 300, 000 SREB CNOOLS lope soe. Mis eee we 8 et coe _ 2 RY, it 270, 000 300, 000 Total, kindergarten through grade 12__--__--.---------------------- 42, 970, 000 43, 900, 000 Higher education: Universities, colleges, professional schools, junior col- leges, normal schools, and teachers colleges (degree-credit enrollment) -- 3, 750, 000 4, 000, 000 Total, elementary, secondary, and higher education__-_-.---------- 46, 720, 000 47, 900, 000 1 Includes Federal schools for Indians, federally operated elementary-secondary schools on posts, model and practice schools in teacher training institutions, subcollegiate departments of colleges, and residential schools for exceptional children. 312 Department of Health, Education, and Welfare, 1961 Table 2.—Grants and other financial assistance to States, administered by the Office of Education, for fiscal year 1961 * Colleges States and outlying | for agri- parts of the United | culture States and the mechanic arts Totaliss = aae= 5, 051, 500 Alabama =22ssseess 100, 541 Alaska. .__ & 71, 283 Arizona___ 4 77, 477 Arkansas_-~- = 89, 047 California__-_ 175, 599 Colorado- ----- 83, 218 Connecticut_ a 90, 022 Delaware..---...-=.-. 73,172 District of Columbia-|_________ Florida..---2-<---=- 97, 644 Georgis.w 62s ce esee 104, 360 Hawaii-_--_- ~-|52,299, 985 Tdshoussce ee 75, 871 Dlinois: -222-- 22-3 =~ 156, 905 Indians: . .o6e-.ce~~5 109, 244 Iows..2.-22 96, 145 KSNS08 2: 223 aweneunes 89, 005 Kentucky--- 99, 374 Louisiana 24.5 96, 768 Maino-22s-220 sees =.= 79,115 Maryland.22-2-— 93, 371 Massachusetts__ 116, 788 Michigan-2__224_--=3]) 133,650 Minnesota_- as 99, 750 Mississippi-- 2 £4 91, 735 Missouri-_--- ---| 109, 448 Montana----_ ee 75, 895 Nebraska---- —_ 83, 222 Novada222e-. 2-2--- 71, 596 Washington___ West Virginia_ Wisconsin Guamsese-s- Wake Island__ Undistributed 77, 899 91,117 76, 511 102, 835 146, 920 76, 871 73, 768 103, 104 93, 730 90, 005 104, 260 72, 898 1 On a checks-issued basis. Coopera- tive vocational education 39, 797, 724 1, 060, 159 105, 652 1, 127, 357 178, 475 234, 186 1, 677, 681 70, 816: 839, 274 568, 505 1, 041, 688 914, 629 231, 863 437, 681 724, 412 1, 402, 973 914, 682 908, 749 1,120,191 208, 601 442, 032 181, 990 177, 220 843, 663 230, 955 748, 626 297, 069 1, 126, 372 1, 966, 395 192, 098 187, 028 1, 017, 822 589, 354 644, 329 989, 755 168, 333 Mainte- nance and operation of schools (Public Law 874) 3 207,639, 466 School construc- tion (Public Law 815) Defense Library |educational services | activities 59, 248, 636 4, 271, 452 6, 027, 884 4, 467, 295 941, 269 38, 421, 578 4,109, 053 2, 080, 633 668, 678 5, 158, 191 4, 896, 258 4, 502, 517 1, 434, 198 3, 236, 587 1, 058, 263 613, 681 4, 571, 963 1, 128, 988 762, 209 1, 912, 536 9, 675, 877 6, 374, 189 1, 506, 463 404, 564 1, 245, 006 2, 528, 242 1, 503, 335 2,172, 308 1, 097, 452 1,178, 898 3, 746, 583 4, 835, 049 6, 312, 333 2,191, 066 459, 215 4, 745, 438 6, 706, 965 911, 525 5, 331, 567 1, 751, 448 3, 194, 899 8, 497, 217 107, 701 725, 150 8, 468, 858 553, 142 1, 009, 446 2, 017, 414 1, 089, 905 10, 840, 539 557, 201 880, 920 1, 302, 700 1, 320, 036 2, 844, 890 246, 120 923, 064 664, 119 105, 606 1, 036, 504 00 228, 409 429) 420 4, 133, 342 812, 195 1, 977, 564 205, 198 945, 015 498, 417 1, 358, 726 914, 137 406, 353 189, 228 1, 247, 677 3, 394, 298 1, 017, 762 894, 605 743, 801 1, 089, 004 1, 878, 772 370, 018 12, 880 169, 625 708, 280 833, 962 13, 884 198, 110 274, 986 204, 139 7, 414, 221|4 50,189, 647 207, 576] 1, 734, 665 49, 191 97, 954 72,485] 154, 130 164, 544} 756, 661 239, 322) 3, 342, 851 88,084] | 808, 258 74,755] 1, 046, 073 51,585] 181, 449 eharal ts 187, 768 133,235] 740, 415 221, 848] 2, 471, 262 55,087| 158, 316 75,211| 405, 704 230,178] 2, 769, 566 60, 341] | 386, 667 173, 427| 835, 214 75,902} 826, 332 221,203] 975, 497 158,010} 662, 605 83,021] 297, 710 170,000] 868, 576 86, 000} 1, 558, 276 214, 885} 3, 574, 758 165, 888] 1, 596, 483 191,340] 313, 243 185,931] 431, 165 72,427] 285, 498 108,519} 676, 476 50,395] 123, 823 62,087] 172, 333 103,153] 1, 633, 281 73, 042| ” 497, 407 249,152) 3, 482, 012 302, 331] 1, 970, 039 126, 436 51, 552 270, 635} 3, 501, 571 134, 239] 1, 249, 461 127,216] | 225, 959 341, 396} 2, 303, 339 59, 769 55, 594 196,082} 388, 161 82, 462 311, 196 219,097] 858, 625 285, 264 63, 275 63, 385 211, 253 125, 287 167,674} 469, 499 180, 736] 1, 398, 357 54, 209 67, 358 15, 495 79, 856 209,077] 664, 465 11, 079 56,175 Men- tally retarded 813, 682 Total 372, 822, 569 7, 937, 737 7, 370, 278 6, 995, 770 3, 829, 659 55, 294, 293 6, 051, 061 4, 545, 596 1, 154, 775 221, 021 8, 135, 079 10, 164, 324 3, 038, 766 15, 378, 851 9, 682 1, 855, 087 7, 710, 140 9, 123, 015 13, 944, 097 6, 911, 656 1, 754, 510 11, 530, 026 10, 721, 173 2, 139, 283 10, 403, 620 2, 694, 084 5, 327,170 ’ 'y 295 3, 630, 371 1, 316, 429 973, 972 1, 763, 164 199, 678 105, 401 8, 468, 858 Does not necessarily agree with allotments or expenditures for a given year. 2 Inasmuch as the cents have been dropped from this table, a totaling of any column may or may notequal the total given for that column. 3 Does not include payments made to Army, $5,174,772.85; Navy, $1,772,784.92; Air Force, $1,520,300.79; and Veterans Administration, $999.50. 4 Does not include amounts paid for loans and repayable advances or amounts paid to institutions under the National Defense Education Act for $93,057,049.15; or to jurisdictions other than States to assist Cuban refugees in educational pursuits for $442,690. 5 Includes $2,225,000 special land-grant college aid paid under Public Law 86-624, ? Food and Drug Administration Introduction Tue Foop anp Drua Administration is a unique agency. There is nothing quite like it in any other nation of the world. It isa scientific institution devoted to law enforcement to protect the consumer of foods, medicines, cosmetics, and common household chemical aids. Its charter was first established in the Federal Food and Drugs Act of 1906. This pioneering consumer protection law was the product of a budding industrial revolution, which saw the processing of food moving out of the home kitchen into the commercial cannery and which found the charlatan far ahead of medical science in his blatant claims for the “wonder drugs” of the day. But the original charter has been expanded many times by moderni- zation and extension of the law to keep pace with industrial and scientific progress in the production of new products. The courts have interpreted the law in full recognition of its original high pur- pose. The keynote of the philosophy of the Food and Drug Adminis- tration in carrying out its mission was sounded in the language of a Supreme Court decision interpreting the law as modernized in 1938: “The purposes of this legislation . . . touch phases of the lives and health of people which, in the circumstances of modern indus- trialism, are largely beyond self-protection. Regard for these pur- poses should infuse construction of this legislation if it is to be treated as a working instrument of Government and not merely as a collection of English words.” ? The Food and Drug Administration’s philosophy for the accom- plishment of its mission, consistent with this interpretation by the Supreme Court, is simply: To enforce the laws entrusted to it firmly but evenhandedly and without partiality; to seek prevention of violations to the fullest extent possible; and to inform consumers of 1U.8. vs. Dotterweich, 1943, 320 U.S. 277. 626936—62——_21 313 314 Department of Health, Education, and Welfare, 1961 Chart 1.—RETAIL SALES OF FOOD IN THE UNITED STATES, 1951—60 Billions $100 80 60 20 195] 1952 ae 1953 e954 Ike) Wale) — ORY 1958-1959 Soo Chart 2.—RETAIL SALES OF DRUGS IN THE UNITED STATES, 1951—60 Billions $5 1951 1952 Iya tieyiies Mheys) ieleyeys hols v74 1958 1959 1960 means by which they can help themselves to get the most protection with the least help from the Government. But if the Food and Drug Administration’s mission and philosophy can be so simplified, the accomplishment of the mission is tremen- dously complex. It requires the meshing together of law, science, and administrative judgment to assure a maximum of consumer protection, a minimum of interference with legitimate business, and a fostering of the progress which has made our Nation great. This is the task which confronts the Food and Drug Administration. The Food and Drug Administration has in the past decade seen fundamental changes in the laws it enforces and in the industries subject to these laws. During this period there has also been a Food and Drug Administration 315 Chart 3.—RETAIL SALES OF COSMETICS IN THE UNITED STATES, 1951—60 Billions $2.0 130 0.5 1951 1952% 1953 1954 1955 = 1956 1957 E258 SS 59® 81760. growing awareness of the agency’s responsibilities by the Congress and by the consuming public. The regulated industries are growing at an amazing rate. Sales of foods in the decade from 1951 to 1960 increased from $63.4 billion to $82.1 billion (see Chart 1). Expenditures for drugs showed an even more dramatic increase, rising from $1.8 billion in 1951 to $4.4 billion in 1960 (see Chart 2). During the same decade cosmetic sales nearly doubled, increasing from $913 million to $1.8 billion (see Chart 3). During this period, American consumer expenditures as a whole in- creased about 57 percent. It is estimated that about 30¢ out of every dollar now spent by consumers is for products falling under the juris- diction of FDA, and it is expected that this rate of increase for sales of foods, drugs, cosmetics, and household chemicals will be at least as great during the decade of the sixties. Some new developments are related only to the increasing volume of production required to supply a rapidly expanding population which is changing its patterns of living. But the putting to work of the discoveries of modern science itself is making these changes in living patterns possible. Producers and handlers of foods use more than 3,000 chemical additives. These additives are used in the processing and packaging of food so that it can be transported for thousands of miles and remain in good condition for long periods— a wonder of modern civilization. They are used in the commercial preparation of convenience foods which have brought a revolution in the domestic kitchen and freed homemakers of several hours a day to devote to other occupations. They have also eliminated seasonal restrictions on the widest variety of nutritional foods ever available to consumers, 316 Department of Health, Education, and Welfare, 1961 Manufacturers of 40 million tons of “special formula” commercial feeds each year add a variety of chemicals to promote growth, increase feed utilization, and control diseases of farm animals. Some are safe vitamins, others toxic chemicals, such as arsenicals and hormone- like substances that must be properly mixed at the plant and properly used by the farmers so that the meat, milk, and eggs these animals produce will be free of harmful chemicals. Farmers must also avoid illegal residues in crops on which they use 600 million pounds of pesticides a year to produce the abundant variety of fruits and vege- tables found in every supermarket. The pharmaceutical industry has provided new drugs that have brought startling advances in medicine since 1938 when safety clear- ance before marketing was first provided by law. New drugs cleared by FDA after reviewing the manufacturers’ scientific studies during the 23-year span account for more than 90 percent of the prescriptions written today. Many dreaded and often fatal diseases are now readily and successfully treated. The hundreds of millions of dollars industry spends on research every year will continue to produce new technological developments that will bring new foods, drugs, and cosmetics. But every new development brings the need to know whether hazards are involved, and if so, how to solve the problems presented. There are and will be new hazards as well as benefits. Dangerous side effects often develop after the use of potent drugs. As more new chemicals are added to food the probability of misuse increases. Careful safety testing is required of cosmetics containing many new synthetic materials. Errors have occurred, recalls of dangerous drugs and cosmetics have been necessary, patients have had serious drug reactions. For- tunately, there have been no cases of spectacularly poisonous foods in the United States that have injured large numbers of people. Some other countries have not been so fortunate. In 1959 the deliberate addition of motor oil to cooking oil in one country caused paralysis of 10,000 consumers. In 1957 the use of an untested new emulsifier in margarine resulted in 50,000 illnesses in another country. However, in this country nitrite was used to “revitalize” stale fish fillets and caused a little boy to die and several others to become ill. And, in 1957, poisonous fat added to feed killed millions of chickens. Studies are still in progress to learn the nature and origin of the toxic factor or factors, and whether there are any implications for fats used in human foods. In the early days of food-law enforcement, chemists were dealing with crude and flagrant adulterations that did not require elaborate analytical techniques. Now, FDA scientists must contend with Food and Drug Administration 317 radioactive contamination and organic pesticide residues in food crops, the possibility of the addition to food of cancer-producing sub- stances, the bacteriological contamination of frozen precooked foods, and many other problems that are discussed in this report. For- tunately, the technological advances which have revolutionized the food and drug industries have also given the food and drug scientist new laboratory and inspection tools which can be applied to new enforcement problems. The major legislative changes in the past 7 years have centered around chemicals in foods, drugs, cosmetics, and household items— new products, new uses, and the urgent need for safety controls. The trend has been to establish the basis for preventive safeguards, so that the Government does not have to carry the full burden of proof of safety, as it did when the Food, Drug, and Cosmetic Act became the basic law in 1938. Those petitioning for regulations to establish safe use of chemicals under the Pesticides Chemicals Amendment of 1954, the Food Ad- ditives Amendment of 1958, and the Color Additive Amendments of 1960, must present their own scientific evidence that such uses will not endanger consumers—provisions similar to the new-drug safety clearance provided by the 1938 law. After these regulations are established by administrative pro- cedures—based on FDA/’s evaluation of the safety studies reported, and consultation with outside scientific experts when necessary— the limits of use established become the yardstick for all to follow. This includes the manufacturers who label the chemicals with di- rections for use, the agricultural experts who advise the growers, the growers themselves, the control chemists in processing plants, FDA in its enforcement activities, and the courts in judging compli- ance with the law. Where deep conflicts develop between economic interests and the health of the American people, Federal, State, and local food and drug agencies must give health considerations top priority. They must make the best use of present knowledge and facilities but take a bold, enlightened approach—a look ahead to meet the problems that new developments will bring. Additional personnel, more and better scientific law enforcement facilities, and amendments to the basic Jaws where experience shows they are not strong enough are going to be necessary if adequate con- sumer protection is to be provided. Public support—the support of an aroused and intelligent public opinion—is essential to achieving these goals. People demand continuing improvements in their foods, drugs, and cosmetics, but when they know the hazards that may be 318 Department of Health, Education, and Welfare, 1961 associated with some commercial applications of new scientific dis- coveries, they also demand protection from these hazards. Progress in Enforcement Operations To carry out FDA’s enforcement responsibilities—and this is the hub of all its activities—the coordinated efforts of all of its Bureaus and Divisions are required. The Bureau of Program Planning and Appraisal acquires basic data on the areas of FDA responsibility, such as size and location of various industries subject to the Federal laws, number and types of violations being encountered in each industry, and the comparative seriousness of violations in the whole spectrum of consumer protec- tion. These data, along with the pulse-taking of consumers’ needs through the Consumer-Consultant Program, are used in formulating enforcement policy ; in determining the best use of available manpower for attention to various types of violations; and in locating areas needing more attention when additional inspectors, analysts, admin- istrative staff, and facilities will permit. The Consumer-Consultant Program was expanded through a series of FDA-Consumer conferences arranged by Consumer Consultants in 16 of the FDA Districts, with programming assistance by the Dis- trict staffs. At these conferences the FDA’s enforcement programs were explained to consumers, and participants were given an oppor- tunity to express the viewpoints of their organizations about addi- tional areas of protection needed by consumers of foods, drugs, and cosmetics. The Bureau of Enforcement consults with industry representatives to assist in compliance and reviews cases forwarded by the Districts to determine whether or not they should be recommended to the De- partment of Justice for prosecution. It also establishes guidelines for the Districts to provide uniform enforcement criteria throughout the country. Food and Drug specialists in the Department’s Office of the General Counsel participate in these decisions, and also act in liaison capacity with the Department of Justice on court cases recom- mended for prosecution. The Bureaus of Medicine and Biological and Physical Sciences furnish scientific facts on which policies are based, both in regulation- making and in enforcement. Their scientists must keep abreast of the ever-changing developments and plan research that will serve as a sound basis for FDA activities. Never before in the history of food and drug enforcement have these Bureaus played such a crucial role. The later sections “Scientific Investigations” and “New Drugs” outline some of their scientific work in this area. Food and Drug Administration 319 The Bureau of Medicine and the Division of Nutrition also have the responsibility of separating the true from the false—a fact-finding process on which the FDA programs against quackery are based. Medical and nutritional quackery, now estimated to result in a billion dollar-plus annual “take” on the American pocketbook and, even more important, an untold burden on the public health, are deemed by public health experts to constitute a major problem in consumer protection. The Office of the Commissioner, which furnishes overall] leadership in establishing and announcing policies after the Bureaus present and translate the facts and their long-range implications, has a number of staff divisions to assist in carrying out its functions. The Division of Public Information serves both consumers and industry in its information and education activities. All of the recent independent studies of the overall needs and deficiencies of the Food and Drug Administration have pointed to the public benefits to be derived from industry and consumer education programs. Often an inquiry from a consumer reflects the questions or views of a whole group. Prompt and helpful replies to such inquiries assist FDA regulatory work, because well-informed consumers can help protect themselves by intelligent reading of the material the law requires in labeling, and by refusing to become victims of quackery and fraudulent schemes. Consumers also need background and knowl- edge to benefit from new protective laws, such as the Federal Hazard- ous Substances Labeling Act which was designed to provide warning labeling and directions needed for the safety of the family. Industry education is aimed at explaining the law, regulations, and new programs to achieve better compliance. Informational services include news releases for the trade press, distribution of regulations and official notices published in the Federal Register, preparation of special publications and reports, and cooperation with trade associ- ations that are seeking to stimulate voluntary self-policing. In the fiscal year 1961, new food-additives regulations, changes in effective dates of food-additives regulations, and new color-additives regula- tions required many interpretive releases. In addition, the regula- tions under the Federal Hazardous Substances Labeling Act brought new educational responsibilities, because many industries never before subject to FDA enforcement were concerned. Increased emphasis has been placed on coordinated work with the States by expansion of the Division of Federal—-State Relations. At the annual conference of the Association of Food and Drug Officials of the United States, held in Washington in June, emphasis again was placed on the benefits to the public of continued integration of Federal and State resources, the need for uniform food and drug 320 Department of Health, Education, and Welfare, 1961 legislation in the States that have not yet adopted the provisions the Association recommends, and the strengthening of State facilities. The Division of Administrative Management—among its other re- sponsibilities, such as budget, fiscal operations, procurement, and housekeeping work—has in its personnel activities a key task in the FDA expansion program. The increase in the staff in the past 6 years has required a program of recruitment designed to attract the best of the graduating scientists, who are often offered better financial returns from industry, and of training the recruits so that their skills may be used in this specialized field without undue delay. Personnel training is not limited to recruits, since the older mem- bers of the staff require continuous training in new techniques that must be employed, as for example, the use of new analytical tech- niques, such as spectrophotometry, chromatography, and radiological detection and measurement. Inspectors are given advanced courses in such areas as drug inspections, sanitation, and use of the senses of taste and smell to detect spoilage, all to increase their abilities to detect trouble spots during factory inspections. The clerical staff, too, requires training courses to keep records, travel, inventory, and other supporting activities operating efficiently with a growing staff. These basic training programs will be expanded in the next fiscal year. FDA has had a long tradition of vigorous enforcement of the laws assigned to it, but has long been aware of the fact that its stewardship must be reviewed from time to time by representatives of various interested groups of the public as a whole, in addition to the annual review by their representatives in Congress. Progress has continued during the fiscal year—in size of staff (see Chart 4), building construction for Washington and the field offices, in educational activities, and in streamlining administrative work for better efficiency as recommended by the 1955 Citizens Advisory Com- mittee. However, basic changes in the laws administered have brought new obligations not contemplated in the recommendations of that Com- mittee. A new overall study is underway by a new Citizens Advisory Committee appointed by the Secretary in October 1961 so that total current responsibilities may be taken into account, and a new evalu- ation made of the amount and kind of protection consumers need and how the desired objectives may be attained. A committee appointed by the President of the National Academy of Sciences and its National Research Council was requested to review the policies and procedures used by FDA in reaching decisions con- cerning the approval of new drugs and the certification of antibiotics. This Committee concluded that FDA decisions in these areas have been in the interest of public health. The Committee pointed to weaknesses in the current law and deficiencies in staff and funds and Food and Drug Administration 321 Chart 4.—-BUDGETED POSITIONS FOR FOOD AND DRUG ADMINISTRATION ENFORCEMENT OPERATIONS (EXCLUDING FEE-SUPPORTED CERTIFICATION SERVICES), 1951—61 Thousands 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 recommended that FDA be given statutory authority to improve its protective controls over the production and distribution of drugs, including antibiotics, that pretesting procedures be extended to other important drugs in addition to antibiotics, and that more funds and staff be given to FDA to strengthen its overall drug program and related research projects. Another group, appointed by the Secretary to investigate certain charges involving FDA employees and operations, reported to him that the inquiry did not develop evidence that any present employee of FDA has personal financial interests conflicting with the objectives of his employment. Among the conclusions reported were: “We conclude that the essential functions of the Food and Drug Administration have been and are being performed. “We conclude that FDA personnel are more than ordinarily dedi- cated to the purposes of the agency. “We conclude that decisions have not been made in defiance of the public interest or to conform with considerations of personal gain or aggrandizement.” The total budget for fiscal year 1962 is $21,854,000, compared with $18,848,000 for fiscal year 1961—a net increase of $3,006,000. This budget provides for an increase in personnel of 213 positions so that the total staff authorized for 1962 is 2,412. The 1962 budget reflects increases occasioned by two major factors: (1) the rapidly growing demand placed on existing services of the FDA resulting from large increases in our population and corresponding increases in the number and volume of consumer products falling within the authority of 322 Department of Health, Education, and Welfare, 1961 the FDA, and (2) new programs and responsibilities of the FDA resulting from advancing technology and new legislation. About two-thirds of these new positions will go into areas particu- larly needing strengthening, the pesticides and drug programs. By an increase in sampling the estimated annual 2,500,000 interstate shipments of food crops, approximately 8,500 shipments can be sampled to test for toxic residues in 1962 in contrast to about 5,000 in 1961. Recommendations for staff increases for the drug program were discussed earlier in this report. Other staff increases will be made in field supervision, adminis- trative activities, enforcement review of cases, consumer and industry information and education services, and program planning activities. Provisions for special research include work on frozen foods, bacteriological training for inspectors, sanitation techniques, food sample analysis, cosmetics, fats, and fatty acids. The 1962 appropriation provides $1,397,000 for continued improve- ment of FDA field facilities. Renovation of the offices in Boston, Cincinnati, Minneapolis, and Kansas City (begun in 1961) will be completed in 1962. Partial first year costs to renovate New York facilities were supplemented. The appropriation also provides funds to begin construction in Baltimore, Chicago, New Orleans, and Seattle. The new Dallas District facility was dedicated in January 1961. (This new District brought FDA’s total to 18.) Completion of new buildings for Detroit and Atlanta were mentioned in previous reports. Construction was started in midwinter on the new FDA headquar- ters-laboratory building in Washington. The target date for occu- pancy of this badly needed structure is the fall of 1963. Meanwhile the staff is handicapped by dispersal into widely scattered locations with antiquated facilities. Some Bureaus have units in as many as three locations. An 195-acre site for the construction of a new animal research facility at Beltsville, Md., has been made available through the cooperation of the Department of Agriculture. The building is ex- pected to be completed in 1963. The facility will furnish housing for experimental animals and a laboratory building for conducting animal research work. Food, Drug, and Cosmetic Act ON THE FOOD FRONT Hurricane “Donna” caused commercial food losses along the Atlan- tic Coast in September 1960, from the Florida Keys to Rhode Island. Inspectors from FDA Districts assisted State and local officials in Food and Drug Administration 323 protecting the public from contaminated products through segrega- tion of stocks and supervision of cleaning and destruction operations. In most affected areas the major damage was to retail and wholesale stocks that were inundated or spoiled because of power failure. Polluted harbor water from Donna’s force damaged large quantities of food awaiting import entry or export loading on piers in lower Manhattan and Brooklyn. Local embargoes were placed on domestic products and FDA detentions on imported merchandise to permit an orderly handling of affected lots. Fifty-four domestic lots, aggre- gating 189 tons, were seized, and some 337 import lots—including more than 1,300 tons of coffee and cocoa beans and large quantities of tea and spices—were denied entry into the country. Torrential rains in February and March 1961 brought several Alabama and Mississippi rivers to their highest levels in 30 or 40 years. Close cooperation with State officials resulted in the sorting and destruction of damaged foods, drugs, and cosmetics valued at $100,000. Heavy losses of bulk wheat resulted from three large fires. At Portland, Oreg., State officials supervised salvage operations on 6,700 and 9,000 tons, respectively. A fire in a Colorado elevator resulted in seizure of 1,269 tons so that salvage could be monitored and proper disposition made of damaged wheat. Radioactivity in Foods Tn order to carry out the responsibilities assigned to the Department by the President and delegated to the Food and Drug Administration by the Secretary, FDA increased its radiological program staff to 116, a boost of 90 positions over fiscal year 1960. This staff is assigned to determining, establishing, and enforcing permissible levels of radioactivity in foods, drugs, and cosmetics, and monitoring these products by collection and examination of samples to determine current levels; conducting research for indentification, evaluation, and decon- tamination of radioactivity in such products; and regulatory and information work related to radioactivity. Equipment to test food for individual radioisotopes was installed in the Washington and 10 field District laboratories. Samples of 200 domestic and imported foods collected by all 18 field Districts were analyzed for strontium 90 and cesium 137. The highest values for strontium 90 and cesium 137 found in foods were well within the safe limits as suggested by the Federal Radiation Council. With the resumption of large-scale nuclear weapons-testing in the summer of 1961 the sampling and testing of foods for radioactive fallout is being increased several fold. 324 Department of Health, Education, and Welfare, 1961 Chemicals in Foods Food Additives—FDA announced on December 1 that a scientific committee appointed by the Secretary had found that safrole is a “weak hepatic carcinogen.” Immediate action was taken to stop the use of safrole and oil of sassafras in root beer, sarsaparilla, and other beverages and foods, since the Food Additives Amendment prohibits use in foods of any substance which has been found by feeding or any other appropriate tests to produce cancer in man or animals. A year earlier upon hearing that the safety of these flavors was being questioned many manufacturers of soft drinks began to switch to other flavors. Also, the American Bottlers of Carbonated Bever- ages called for voluntary industry steps to eliminate these flavors from soft drinks. Thus when the harmful character of the flavors was definitely established, their use had already been discontinued. An extensive survey by FDA inspectors completed late in November, covering 3,200 bottlers and suppliers, disclosed that the industry had withdrawn safrole and oil of sassafras from use before the require- ment that they do so was published. Seizure was required of only one small lot of oil of sassafras located in a beverage plant several months later. : Fifteen seizures were made between March and June of vitamin preparations and food supplements containing more than 0.4 milli- gram of folic acid per daily dose and not labeled for sale upon pre- scription only. The statement of policy announcing the application of the Food Additives Amendment to vitamins containing folic acid is discussed under “Regulation Making Activities.” One other seizure for violation of the food additives provisions involved mineralized cookies containing iodine and boron from kelp, for which no tolerance or exemption had been prescribed. As the number of tolerances established increases, the inspection load will grow proportionately, since checking on the proper use of food additives is now one of the essential elements of food establish- ment inspections. Pesticides—In 1938, farmers commonly used less than a dozen pri- mary chemicals to control insects and other farm pests. Today, they use over 200 primary chemicals in more than 45,000 formulations, at the rate of 600 million pounds a year. To assure use of these pesti- cides so that they will not leave illegal residues in or on agricultural commodities, FDA surveys practices of growers, collects and examines samples for regulatory action if required, assists other groups in teaching farmers the importance of proper application of pesticides, and develops and improves analytical methods for their detection and measurement. Food and Drug Administration 325 Sixteen seizures totaling 385 tons were made during the year of raw agricultural commodities containing unpermitted pesticide chemicals or residues in excess of established tolerances. Eight of the seizures involved carload lots of grain contaminated with seed grain that had been treated with poisonous mercurial fungicides. Seven seizures were made of leafy vegetables with illegal residues of parathion, toxaphene, and DDT. Peanuts with excess DDT were also seized. The vegetable seizures all resulted from failure to follow recom- mended practices on the amount or timing of the insecticide applica- tion, or both. A West Coast artichoke grower, for example, entrusted spraying of the crop to an individual who was uninformed as to the U.S. Department of Agriculture recommendations. The applicator used whatever pesticide he wished, whenever he wished, and in what- ever amount he wished. The grower entrusted another individual to harvest the crop, which he did without attempting to correlate pick- ing times with spraying times. As a result, until two shipments of his high-residue artichokes were seized in Massachusetts, the grower had no knowledge that he was distributing violative products. In many cases growers withheld shipments when they learned that FDA had found that the produce contained excess residues. An in- novation, operated on a trial basis at the urging of several grower groups, was notification to the grower of the results of FDA exam- ination of samples of his crop for the presence of pesticides. These results are also reported to appropriate State officials to help prevent intrastate shipments of lots bearing illegal residues. Many States have intensified educational and enforcement activ- ities; this has increased awareness of hazards involved in poor spray practices and in the feeding of field wastes to food-producing animals. In contrast to the previous year, no seizures were required of dairy products containing pesticides or antibiotics residues. Continued pressure is a “must,” however, if these gains are to be maintained. Color Additives—FD&C Red No. 1 was removed from the provi- sional list of color additives on November 22 after new experiments had shown that it produced liver damage in test animals. This color was used in a variety of foods, including maraschino cherries, hot dog casings, and ice cream. Previously issued certificates for this color were cancelled on the same date to prevent any further use in foods, drugs, or cosmetics for internal consumption. Food color pastes were voluntarily recalled in June by a manufac- turer who had mixed certified color with vegetable fat without having the mixture recertified. Other Harmful Contaminants Soybeans contaminated with poisonous crotalaria seeds were seized in 34 Federal court actions involving 47 carloads containing 2,322 326 Department of Health, Education, and Welfare, 1961 tons. Twenty-three of the carlots originated in South Carolina, 18 in North Carolina, and 6 in Arkansas. In addition, Virginia State officials embargoed 49 carloads. Since the 1920’s, State and Federal agronomists have recommended planting crotalaria, a legume, as a soil-improving crop for sandy soil. This soil, originally used primarily for cotton, was later used more extensively for soybeans, particularly in the Southeastern States. Following reports that mortalities in poultry flocks were due to crotalaria remaining in feed, FDA investigated the extent to which the seed remained in grains and soybeans during harvest and its toxicity to experimental rats. When it was found injurious to rats, it was generally recognized by State and Federal agencies that the planting of crotalaria must be discouraged, since its presence in soybeans makes it a deleterious ingredient under the Federal law. The problem will be a continuing one since the plant is self-seeding and many fields are contaminated with it. The six Arkansas lots seized, for example, were grown on fields that had not been seeded since 1956. Food Poisoning —Forty-four outbreaks of food poisoning involv- ing 937 persons were investigated. Bakery items produced under insanitary conditions and held without refrigeration were responsible for four outbreaks involving over 200 persons, and crabmeat from an insanitary plant was responsible for the illness of over 50 persons. The crabmeat plant discontinued operations and the case has been filed in Federal court. Canned seafood was suspected in five outbreaks of food poisoning; canned foods from abnormal cans were implicated in two outbreaks; and canned chicken, subsequently recalled by the Department of Agri- culture, was responsible for one outbreak. Six outbreaks of botulism resulted in the illness of 17 persons and 8 deaths. Home prepared foods were involved in most cases. One out- break was caused by smoked fresh-water fish prepared commercially in vacuum-packed plastic bags. After many consumer complaints about red-hot candy jawbreakers, an investigation showed that the mislabeling of oil of capsicum for oil of cinnamon had resulted in the use of 450 times the amount of oil of capsicum intended per batch of jawbreakers. Outstanding stocks were promptly recalled. Just after the close of the fiscal year, FDA put out a warning on hollandaise sauce contaminated with salmonella organism when a food poisoning outbreak was traced by California State officials to this product. Food and Drug Administration 327 To Keep Food Clean Approximately 77 percent of the food seizures and 90 percent of the criminal actions against violative shippers and storers of food were filed on charges of filth and decomposition. Although seizures dropped from 571 in 1960 to 516 in 1961, the number of tons of un- fit food seized increased from 6,898 tons to 8,109 tons, respectively. More than half of the filth seizures involved food that became unfit after interstate shipment. In addition, owners voluntarily destroyed 20,726 tons of unfit food in 1,519 operations or converted it to suitable non-food use. These actions, which resulted from FDA inspections disclosing merchandise that would be subject to seizure if distributed, were conducted under the observation of Federal or local inspectors. Twenty-seven criminal actions were filed against 53 warehouses, wholesale groceries, and their owners and operators for storage of food under insanitary conditions that resulted in filth contamination. Penalties in 17 cases terminated during the year ranged from nominal fines, with probationary periods, to $4,000 assessed against a wholesale grocery and one of its partners. The defendants had received small fines and a severe lecture from the court in a case tried on similar charges in 1958; since the second action they have spent more than $7,000 in an effort to eliminate objectionable conditions. Many of the other concerns prusecuted for insanitary storage of food have also been taking corrective measures to provide protection to the food stored in their establishments. Sixty-four other criminal actions were filed against manufacturers or shippers of unfit food and 25 cases terminated during the year were based on preparation of food under insanitary conditions or use of unfit ingredients. With these notable exceptions, continued sani- tary improvement was found in most plants. A major exception was a bakery which a judge, in sentencing operating partners to fines and short jail terms, pronounced was operated under the dirtiest condi- tions he had had before him in 10 years. Bacteriological standards have been used in enforcement activities on nut meats and crabmeat for many years. A regulatory program was adopted in fiscal year 1961 for frozen precooked foods. It is designed to improve the overall sanitation of manufacturing plants preparing the growing number of frozen foods that are consumed with little or no heating. Two court actions were taken against operators of frozen food plants found during inspections to be operating under grossly in- sanitary conditions. One firm and its owners were permanently en- joined from shipping precooked frozen seafood until the plant is cleaned, rodent- and insect-proofed, all foods on the premises are 328 Department of Health, Education, and Welfare, 1961 destroyed or denatured, and a sanitary program—including the hiring of expert personnel—is established. The second case was based on violation of a 5-year probation ordered in 1957 by the owner of a precooked frozen food plant. When inspections in September 1960 showed that the plant was currently being operated under filthy conditions and was shipping filthy frozen foods, the judge ordered the defendant to get out of the food business within 30 days or serve a jail sentence. Table 1.—Actions on foods during the fiscal year 1961 | Criminal | Injunction Projects Seizures | prosecutions] petitions instituted Totalaveset ea ee ee I ee eee 707 106 11 Beverages and beverage materials_.....----.---------------------- 8 3. [ance Bakery, ready to eat cereal, and macaroni products--_------------- 14 22 1 Cereals and grain products: PL umNaN Sele ss 8 2 ee ce oon oe ns vae cece cue ane cateesouees! 139 14 6 ‘Anims) use 5.26%. fs eog encen sede an ns eee ane eee ee eee 9 8 [esasceee sa. Chocolates, sugars, and related products_____.-__.---------------- 25 4 1 Dairy products: Butter aid churning cream - cso ean sea sere noe daeeceae= 17 10" |e otesacente Cheese and other dairy products): -22. <_s - 9 0 1 EEQER SNC Oar PROUUCiS ie nccee eee eee eens eee 27 6 Flavors, spices, and condiments_-.-___--------- ° 16 VT Fruits and fruit products---- . 61 1 Meat products and poultry-- 34 ll 0 Nuts and nut products-_---_- 2 59 0 Oils, fats, and oleomargarine_....._..-_.__-_-- q 6 1 Seafood 2252. < soso ate ae cen ee en ae ee en ee ee 62 4 Vegetables and vegetable products_____..--.---------------------- 106 9 Miscellaneous foods (mixed Tots) i224 02) es se eee sae ccnaoee ene 4 1 Wsrebouse foods...) 2 3a -o5 Se ee we ee ee a 112 27 Foods:for'special dietary tises 1S es Se ee eae ee: 9 0 Wood Ginnie 2 oo ee ea ee ere 13 0 1 Includes vitamin products intended as food supplements. Increased surveillance during cold weather months resulted in the seizure or voluntary destruction of a larger quantity of decomposed fish in New England than in previous years. This is attributed to longer periods the vessels are at sea in winter and the cutting of costs by using less ice. Detentions of whitefish at Great Lakes ports be- cause of cyst infections were also higher than in any recent year. The self-policing plan of the canned salmon industry in the Pacific Northwest generally affords the public protection from unfit canned salmon, but FDA surveillance over these voluntary operations needs to be maintained. A series of inspections of one cannery turned up grossly insanitary conditions and practices. Shipments of its canned and frozen salmon were seized. The racket of diversion of incubator reject eggs to food channels has been discussed in previous reports. The last of the organized ring of rotten egg dealers which operated seven frozen-egg packing firms was sentenced in January. Also in January, an undercover egg-break- ee Pee ee Food and Drug Administration 329 ing and freezing operation using incubator-reject eggs was uncovered in New Jersey by State health and police officers and Federal Justice Department and FDA men who were cooperating in investigation of the counterfeit drug racket. All eggs on hand were placed under supervision of State sanitarians and the building was padlocked. In April, Delaware police and U.S. marshals apprehended a truckload of incubator rejects enroute from Maryland to New York City food plants. Six new criminal prosecution cases were filed during the year charging traffic in decomposed eggs in various parts of the country. Sampling of rail and truck shipments of bulk wheat was expanded during the fiscal year to obtain more uniform coverage of wheat moving from the largest producing States. Seizures of rodent con- taminated bulk wheat increased from 27 actions against 1,395 tons in 1960 to 53 actions against 2,249 tons in 1961. An additional 150 tons of insect-infested wheat were seized in 2 actions. While these increases reflect increased regulatory attention they also attest to the need for a continuance of the Clean Grain Program. Inspection of country elevators and terminal grain storage facili- ties is continuing. Six injunctions were requested; two were granted and four were held without court order being filed pending correction of insanitary conditions and elimination of contaminated grain. This regulatory pressure, coupled with educational programs in cooperation with the U.S. Departments of Agriculture and Interior, State officials and agricultural colleges, county agents, and industry groups, has raised the general level of grain quality and helped pro- vide the consumer cleaner wheat products. Four seizures, involving 988 tons of malting barley were made be- cause of insect or rodent filth, or both, and storage under insanitary conditions. Another seized shipment consigned to breweries consisted of 55 tons of brewers rice contaminated by rodents and insects and prepared under insanitary conditions. A major survey of the sanitary quality of cocoa beans offered for importation was made by the examination of 6,000 samples from 32 producing countries. Based upon the facts obtained, importation re- quirements that had been in effect since 1933 were raised to permit not more than a 6 percent total of moldy or insect-infested beans, but not more than 3 percent of either. Under the previous requirement, shipments containing up to 10 percent moldy and wormy beans, but not more than 5 percent moldy, have been allowed to enter the country. The new tolerance will go into effect February 22, 1963. This will allow producing countries time to make necessary adjustments in their grading systems. 626936—62—_22 330 Department of Health, Education, and Welfare, 1961 Pocketbook Protection Continued reports of short-weight packages, or packages on which the required label information was “hidden” by small print or other device, led to an extensive survey beginning late in June. Each of the 18 field districts collected and examined samples and the results were reported weekly to be compiled later into a 5-week report to serve as the basis for regulatory actions. During the year, 18 products were seized on short-weight charges. These included coffee, bakery products, confectionery, seafood, condi- ments, and peas. A prosecution case, started in 1960 against a creamery which was deliberately making short-weight butter, re- sulted in a fine of $500 against the firm. While a Congressional committee was investigating industry prac- tices relative to short-weight and other types of deceptive packaging, a Federal court for the second time ruled against the Government in a case involving candy in what FDA charged was a deceptive con- tainer. (See Court Interpretations.) In another case FDA charged, among other things, that the package of a shortening product was misleading. The product was labeled “made by a revolutionary new process that actually whips out calo- ries.” The only difference between the old and the new product was that the new had been “fluffed up” with 22 percent nitrogen gas so that a cupful actually contained less shortening. The package was misleading because the 1-pound can familiar to consumers held only 14 ounces of the new product and the 3-pound can held only 2 pounds 10 ounces. Swiss cheese into which eyes were cut to give the appearance of a more expensive grade was seized on charges of concealment of inferiority. In cheats where the debasement is deliberate the adulterators often use surreptitious means to avoid detection. FDA laboratory analysts found that a “pure orange juice” product was adulterated with sugar and water. FDA inspectors visited the plant many times but never were able to locate the sugar because the plant was either shut down or it was packing pure orange juice. Finally the inspectors rented an apartment which overlooked the plant and nearby sheds, and by using binoculars observed an unmarked truck pulling up to a shed. The operators carried sugar from the truck into the shed then began a sort of bucket brigade in which the sugar was carried into the plant. The inspectors’ telephoto lens recorded the maneuvers. Conviction of the firm resulted in fines totaling $20,000, suspended jail sentences with long probations for three of the firm’s principals, and a 6-month jail term to be served by one defendant. The defendants also con- Food and Drug Administration 331 sented to aninjunction. The case further led to another indictment of three defendants for perjury. In other economic cheats where cheaper ingredients than the labels led the purchaser to expect were added, one firm and its president were fined a total of $1,500 for adding salt to monosodium glutamate, and another firm was fined $1,000 for shipping black pepper adul- terated with ground buckwheat hulls and packing the product short weight. One firm was placed on a 1-year probation and another fined $100 for selling colored oleomargarine labeled as butter. Two firms were fined $400; one shipped oysters containing excessive water, and the other shipped cottonseed meal deficient in protein and containing an excess of fiber. A cooking oil labeled as containing 25 percent pure olive oil was seized on charges that it contained little or no olive oil but a blend of cheaper oils, and another purporting to be corn oil was actually cottonseed oil. An industry complaint led to the seizure of grouper fish which were substituted for the more expensive red snapper. Other seizures included “pure” sorghum sirup which was blended with invert sugar sirup, “pure” vanilla in which imitation vanilla was added, and sauerkraut which contained excessive brine. Among the products seized for failure to comply with official stand- ards were butter that was low in milk fat; cheese that was high in moisture and made from unpasteurized milk; nonfat dry milk solids in which sodium caseinate was added; evaporated milk with vitamin D omitted; tuna that was below standard for fill of container—it also contained bone pieces and scales; canned apricots, beans, peas, toma- toes, and peaches which fell below standards of identity, quality, or fill; and enriched flour deficient in enrichment and failing to bear mandatory labeling information as to its vitamin and mineral properties. Foods for Special Dietary Purposes Within the year 900-calorie diet products for weight control have expanded into sales exceeding $100 million a year. FDA collected and examined 90 samples which resulted in seizures from 6 manufac- turers. Two actions were based on low protein content and other deviations from the declared ingredients. Four were based on charges of misleading dietary representations and unwarranted claims. Other actions against so-called dietary products are discussed with misbranded drugs because of their promotion for therapeutic uses. 332 Department of Health, Education, and Welfare, 1961 DRUGS AND DEVICES Recalls——Forty-nine defective or misbranded drugs were recalled by manufacturers during the year, either on their own initiative or at the request of FDA. Twenty-six were defective because of such things as low potency, high moisture, nonsterility, off-flavor and odor, and gas pressure that caused bottles to explode. Fourteen of the re- calls were made because of improper labeling resulting from label mixups or absence of declared ingredients. Eight were shipped with- out clearance through antibiotic or new-drug requirements. For only one product recalled had FDA received injury reports: it consisted of eye drops that caused immediate unfavorable reaction. Patients recovered within 1 to 2 days after discontinuance of the medication. Illegal Sales of Prescription Drugs Illegal sale of dangerous drugs and their diversion into bootleg channels continue to be a serious problem. Most frequently involved are the amphetamine drugs. Abusive use of these drugs may cause highway deaths, mental and physical deterioration, juvenile delin- quency, and crime. Of 144 criminal cases terminated during the year on charges of illegal sales, 78 involved unlicensed outlets, such as truckstops, cafes, and peddlers, some of whom operated on a wholesale basis. Sixty- two were based on sales by drugstores or licensed pharmacists without prescription. Three physicians were involved in sales without a bona fide doctor-patient relationship, and in another case, involving use of drugs in reducing treatments in a beauty parlor, a “doctor front” was used. Fourteen unlicensed individuals and three pharmacists were re- quired to serve prison sentences ranging from 10 days to 4 years. Thirty-four others received jail sentences which were suspended on condition that illegal sales be discontinued. Many of the defendants fined were also placed on probation. Amphetamines are followed by the barbiturates in the drugs most often involved in both bootleg and unauthorized pharmacy sales. Other medicines sometimes sold originally or on refilled prescrip- tion in pharmacies without authorization of a physician are tranquil- izers, hormone preparations, antibiotics, sulfonamides, and thyroid. New criminal cases filed during the year numbered 137. Particular attention was given to investigating the primary points of diversion from legitimate channels to bootleg distribution of these dangerous drugs. In a criminal case pending at the end of the year, Federal and State investigators found that a North Carolina wholesale drug- gist had purchased and illegally distributed about 6 million units of et a a Food and Drug Administration 333 drugs, largely amphetamines, within the past 3 years. It was esti- mated that this would supply all of the drugstores of the State with their legitimate needs for 12 years, In an attempt to apprehend as many of the big-time operators as possible, simultaneous arrests were made in various judicial districts. In one case where 8 criminal cases were brought in 4 Southeastern States, 15 individuals forming a syndicate were charged with con- spiracy as well as direct sales of dangerous drugs. Jail sentences of 21% and 1 years have been imposed on two of the conspirators and the remaining were awaiting trial at the end of the year. At the time of the arrest, about 122,000 drug tablets were found in the trunk of one of their cars and seized. Counterfeit Drugs Counterfeit drugs present a potential hazard. The genuine drugs they imitate are usually expensive new drugs often prescribed for serious illnesses. The genuine drugs are manufactured under new- drug safety clearances that take into account the rigid manufacturing controls that will be exercised. The counterfeit drugs are not made under these control procedures, and may or may not be of standard potency. Some of the counterfeits seized had been transported in unlabeled paper bags, and later delivered in unlabeled bottles, a situ- ation lending itself to dangerous mixups. Tablet dies and punches with the monogram of the original manu- facturer are closely copied, and in some cases authentic ones have been stolen for use in duplicating drug tablet faces. The imitations are often so close that the spurious tablets can be distinguished only by microscopic examination and chemical analysis. Drug counterfeiting has been a recurrent problem through the years and is now one of increasing intensity. In the early 50’s a counterfeit racket in imitation hormone tablets was broken up by criminal and seizure actions. Efforts to control counterfeiting were renewed in the late 50’s and two more drug counterfeiters were con- victed in 1959. In the summer of 1960 an investigation began to develop evidence of suspected large-scale distribution of counterfeits of well-known trademarked drugs. New Jersey State officials and the Department of Justice cooperated in the investigation. Most of the counterfeits whose origin has thus far been determined have been linked with a New Jersey drug firm which was charged in a 24-count information filed in March with shipping counterfeit prescription drugs. A Long Island firm and eight individuals were included in the charges. All 10 were charged with conspiracy to violate the Food, Drug, and Cos- 334 Department of Health, Education, and Welfare, 1961 metic Act. Among the individuals were a Texas druggist and his son who were also indicted for shipments from Houston, Tex., and for bootleg sales from an automobile in two Louisiana cities. These cases have not yet been tried. Separate criminal cases charging counterfeiting were filed against 10 other individuals and 5 firms. Nine seizures were made of counterfeit drugs in retail drugstores. It is hoped that the backbone of the major counterfeit racket in the country has been broken by the 1961 actions, but constant vigilance must be maintained. Druggists have been urged in FDA press re- leases and in their own association bulletin to accept drugs only in the original, sealed manufacturer’s packaging, and to do business only with reputable firms whose representatives they know and respect. Repacked Physicians’ Samples Another situation inviting mixups and mislabeling is a mushroom- ing business in repacking physicians’ samples and prescription drugs collected from physicians and drug salesmen. Hundreds of thousands of samples initially prepared for distribution to physicians are involved. The repackers frequently destroy the essential labeling, such as “Caution: Federal law prohibits dispensing without prescription,” the common or usual name of the drugs, the identifying lot or control number, and the name and address of the manufacturer, packer, or distributor. New drugs or antibiotics requiring official FDA release before distribution are frequently involved. Some who do the re- packing are wholly untrained people. FDA investigators uncovered two serious mixups where potent drugs had been substituted for milder ones named on the labels. The seizure program initiated in mid-June was expanding rapidly at the end of the fiscal year. False and Misleading Claims The last remaining major source of the discredited Hoxsey cancer treatment, which has been discussed in many previous reports, was eliminated by a Federal court order in September. The decree against Harry M. Hoxsey, the original promoter, called for “complete and final discontinuation,” and a supplementary decree ordered him to cease sharing the profits of his former clinic in Texas which he had been leasing for 50 percent of the profits, for continued use of his cancer treatment. Another decree ordered the lessors to stop per- manently the sale of the Hoxsey medications. It is estimated that cancer patients or those who feared they had cancer, paid over $10 million for the worthless treatment since its inception, including 10 years of almost continuous litigation. Food and Drug Administration 335 A rapid halt was brought to the revival of the worthless Koch in- jection, a product sold until the midforties to unorthodox medical practitioners for the treatment of cancer patients. Its originator left the country after two long criminal trials terminated in mistrials. In November, a seizure of the injection equipment and promotional literature was made in possession of an unlicensed chiropractor who was operating a treatment clinic and a mail-order business in do-it- yourself injection kits. Use of such equipment by untrained persons would endanger their very lives. A temporary injunction was granted but by January it was necessary to bring a criminal contempt action for continued distribution. The defendant was fined and sentenced to jail. The penalties were suspended and he was placed on probation for 2 years on condition that he not violate the per- manent injunction simultaneously ordered by the court. A worthless arthritis “remedy” was forced off the market in March 1961 after 7 years of litigation by a permanent injunction in February prohibiting the introduction into interstate commerce of Tri-Wonda or any similar article claiming usefulness in treating or relieving any form of arthritis or rheumatism or their symptoms. Court action against the product began in 1953 with a seizure action. In 1954, FDA requested an injunction. This was granted in 1958, but permitted continued distribution of the product under label representations objectionable to FDA. On appeal, the circuit court ruled for the Government and remanded the case for further pro- ceedings. This protracted case illustrates the difficulty of providing prompt and adequate consumer protection and the need for more effective public education in this field, where laymen are not capable of self- diagnosis or proper treatment. The Arthritis and Rheumatism Foundation estimates that a quarter of a billion dollars is spent an- nually on falsely promoted “remedies” for these diseases. Seizures of vitamins and dietary supplements claiming to be effec- tive in curing or preventing almost every type of serious disease con- ditions included large bulk lots and literature from mail-order houses. One consisted of 26 mail sacks containing more than 1,000 individual parcel post shipments labeled for the treatment of 32 physical and mental conditions. It was also falsely claimed that each capsule was nutritionally equivalent to milk, meat, eggs, vegetables, and other foods that would have totaled 30 pounds. Another mail-order house shipment consisted of 7 million capsules misbranded with claims for circulatory, nervous, digestive, and mental ailments, damaged liver, as well as resistance to infection, sound teeth, nerves, bones, and muscles. In common with most of the vitamin and mineral products seized, “vim and vigor” was also promised. 336 Department of Health, Education, and Welfare, 1961 Vitamin seizures included products of some of the large firms whose products had traditionally been legally labeled but who had suc- cumbed to the financial lure of the exaggerated claim for prevention or treatment of serious diseases. The 1960 report mentioned seizures of Honegar, a combination of honey and vinegar, launched through a big publicity campaign re- volving around the popular interest in a book called “Folk Medicine” in which a New England physician attributed great healing powers to the product. In another seizure of this product, made in August, 700 copies of this best-seller book were seized on charges that it con- stituted false and misleading labeling because it was displayed near the product. The court permitted the claimant to take the Honegar involved in the first seizure out under bond and relabel it to bring it into compliance with the law; the claimant posted a bond but has not attempted to salvage the product. Several other seizures of honey and vinegar, separate or mixed, were based on promotional tie-ins with the folk medicine book. Although medical authorities long ago concluded that there are no health benefits to be obtained by adding sea water to the diet, a wave of sea water products appeared on the market during the year, labeled with cure-all claims. Distribution was stimulated by a series of syndi- cated articles by a physician claiming that sea salt added to the diet would benefit such conditions as colds, middle-age diseases, diabetes, grey hair, baldness, multiple sclerosis, etc. He attributed the rejuve- nation of his 97-year-old father-in-law to sea salt. Concentrations of both Atlantic and Pacific sea water were seized, as well as sea salt. Ordinarily such products swindle the purchasers and threaten the health of those using them for treating conditions that should have medical care. Direct injuries were caused to a cardiac patient who developed a serious edema after taking sea salt for several days for pernicious anemia and cataracts, and to her hus- band whose ankles started swelling after using some of the salt for rheumatism. Multiple seizures were made of a number of brands of the ocean water products accompanied by reprints of the syndicated articles. Some concentrates sold for $3.75 a gallon, others for $1.95 a pint, and one brand of sea salt for $1.50 a pound. One of the articles re- printed and distributed with Atlantic ocean water promised that “by taking a little sea water per day, we can offer our glands a ‘chemi- cal smorgasbord.’ Figuratively, therefore, the pancreas, liver and spleen, bone marrow, thyroid, adrenals and other organs can march around this chemical smorgasbord helping themselves to whatever they require to produce the manufactured secretions that guard your health.” Food and Drug Administration 337 An injunction recommended to the Department of Justice in May 1961 to restrain one of the largest producers from distribution of misbranded Sea Brine resulted in a temporary decree early in June. Another drug injunction restrained a self-styled health and nutrition expert from offering various foods as treatments for serious disease conditions to persons who attended his lectures. Many pro- moters, aware of FDA activity in this area, go to extreme length to disguise their claims in subtle statements still designed to sell their wares to the gullible on the basis of curing the ill and making well people feel even better. Promoters have more opportunity in house-to-house sales of making direct curative claims for “health foods” than do public lecturers. One agent for pills and capsules containing such ingredients as alfalfa, watercress, parsley, wheat germ, mint leaves, beets, buckwheat, yeast, rose hips, rice polishings, oyster- and egg-shells, clay, unsaturated fatty and amino acids, in addition to vitamins and minerals, was con- victed for claims in her home sales talk that the products were of value in the treatment of arthritis, high blood pressure, heart disease, goiter, etc. The defendant had even tried to persuade an FDA In- spector to become a distributor, and described to him in glowing terms the profits he could make. These are examples of several types of promotion of worthless sup- plements for serious diseases. In all, 145 seizures of such items and medicines misbranded with direct false and misleading claims were made, in addition to many others which were charged to be inade- quately labeled because they did not furnish directions in the labeling for uses for which they were promoted by other means. Substandard Drugs The 55 drug seizures made on charges of failure to meet official or labeled standards of composition included 34 subpotent vitamin and nutritional items, 8 drugs for human use, and 13 veterinary drugs and medicated feeds. Other substandard drugs, removed from the market by manufacturers’ recalls, are reported earlier in this section. Devices Devices seized included 45 charged to be misbranded and 19 to be adulterated because of defects. The defective items were 17 ship- ments of rubber prophylactics with holes, one of nonsterile bandages, and one of clinical thermometers that did not register accurately. Among the misbranded devices were 14 consignments of air puri- fiers, filters, and humidifiers with claims not only to improve the air but also to ward off various diseases, including respiratory ailments, asthma, sinusitis, hay fever and other allergies; and to screen out air- 338 Department of Health, Education, and Welfare, 1961 borne bacteria and viruses. One also was promoted with claims for the lowering of high blood pressure, and another for preventing diphtheria, smallpox, measles, anthrax, and tuberculosis. Nine of the devices seized were massagers, vibrators, and “passive exercisers” promising weight reduction, figure control, toning of the muscles, and elimination of wrinkles. Many also were promoted with misleading claims for the relief of arthritis and bursitis aches and pains. A tenth seizure of a massager was a vibrator for the gums, with claims for preventing loosening of the teeth, pyorrhea, and the promotion of strong health. Thirty contour chairs were seized for labeling suggesting their effectiveness in the treatment of arthritis, cardiac maladies, acute infectious diseases, nervous exhaustion, and other serious conditions. Among the other devices misbranded with false curative claims were “electronic” and “frequency” instruments to give pulsations when applied by pads to the patients’ bodies; porous clay discs to be used to add natural cosmic rays to water for consumption by man and beast; and bracelets to convert thermal energy into electric energy. All of these were seriously misbranded through diagnostic or curative claims, or both, for a variety of diseases but worthless for any medical purpose. One of the “frequency” instruments was claimed to de- vitalize “micro-living organisms detrimental to mankind” and thus overcome cancer, colds, ulcers, cataract, glaucoma, tuberculosis, bu- bonic plague, polio, and leprosy. These misbranded devices were innocuous apart from claims that turned people away from competent medical treatment, but a number of others seized were potentially dangerous. One was a head-harness traction device that had caused at least two fatalities from asphyxia due to strangulation. Other users were rescued after they had “blacked out.” Another dangerous device was a syringe for the self- administration of insulin on which improper dosage scales were in- scribed. An ultrasonic device was seized in possession of a beauty parlor operator who intended to use it to treat arthritis. This is a prescription device that could cause serious injury when operated by untrained persons. Also potentially dangerous were breast “re- juvenators” employing hydro massage. New Drugs During the fiscal year 463 new drug applications were received, 201 of which were for veterinary drugs. Within this period 223 appli- cations became effective including 68 for veterinary drugs. Favor- able action was taken also on 931 supplemental applications which included 145 for veterinary drugs. Five effective applications were suspended without issuance of notice of hearing and with the consent ay Food and Drug Administration 339 of the distributors. One administrative hearing was held to deter- mine whether or not an application should be suspended; the decision is still pending. No drugs were changed from prescription to over- the-counter labeling. Among new products introduced were six drugs for mental condi- tions; an injection for pre-anesthetic sedation and one to stimulate depressed respiration; two antibiotics, one useful for systemic infec- tions caused by gram-negative bacteria and some gastrointestinal infections, and one for Candida infections of the vagina; three anti- inflammatory steroids, two for topical use in skin conditions, and one for oral use; a steroid to reverse wasting processes and to promote tis- sue building and weight gain; a diuretic for the treatment of edemas; two drugs to depress cough; five drugs for gastrointestinal conditions, three which reduce spasm and stomach acid recommended for the treatment of peptic ulcer, one for diarrhea, and one to control vomit- ing; an appetite depressant ; a remedy for pinworms; an enzyme taken by mouth to treat various inflammatory conditions; an antithyroid drug; a drug for the treatment of arthritic conditions; two new anti- histamines; a hormone preparation to counteract overdosage of insulin; a drug for the treatment of high blood pressure; two skin antiseptics and two for fungal infections of the skin; a pain-relieving drug; an anticancer drug useful for the palliation of Hodgkin’s dis- ease; a drug for tuberculosis; and one for treating certain types of epilepsy. Veterinary drugs cleared included a coccidiostat for chickens; injectable iron preparations for swine to correct iron deficiency anemias, a considerable economic problem in the past decade; an anti- biotic combination of oleandomycin and oxytetracycline in animal feeds as growth promotants; and, for use in chicken feeds, the anti- biotic hygromycin, which is effective against three species of internal parasites that cause considerable economic loss in meat and egg production. COSMETICS AND COLORS Discovery on the market of eyebrow pencils containing synthetic organic (coal-tar) colors which are banned under the law and had not been encountered for many years led to an urgent collection and testing program by FDA/’s inspectional and analytical staffs. Within a month in the spring of 1961, about 2,000 samples of pencils, refills, and cores were tested and more than 900,000 were seized. Nearly every major cosmetic house immediately recalled outstanding stocks, since 95 percent of the pencils on the market contained cores manu- factured by a single firm that had turned to the use of nonpermitted colors. This firm notified all customers to withdraw from the market 340 Department of Health, Education, and Welfare, 1961 all shades involved, for replacement, and within a short period all retail stocks contained permitted colors only. FDA inspectors witnessed the voluntary destruction of several million eye pencils and cores. Serious eye injuries that had occured before cosmetics were brought under Federal control in 1938 had led to the banning of coal-tar colors in cosmetics to be used in the area of the eye. The first seizures under the 1938 law—made within 3 weeks of its enactment—were of eyelash and brow dyes containing the potentially injurious colors. Another cosmetic recall removed from the market a shampoo containing a chemical that was dangerous to eye mucosa. Other cosmetics seized were lipsticks falsely claimed to contain colors derived from raspberries and beets and to contain no coal-tar colors; a fingernail corrective and beautifier; dusting powder claimed to contain milk solids from Tyrolean goats, the secret of “life-giving nourishment”; and a consignment on the Brooklyn docks contami- nated by polluted harbor water during hurricane Donna. Also seized were 2,000 pairs of hosiery with claims to beautify the legs; labeling indicated that they contained turtle and mink oils, royal jelly, lanolin, and a secret formula. A number of other misbranded cosmetics were seized on charges that they violated the drug provisions of the law by promising correc- tive treatment for acne, skin regeneration, healing poison oak, altering body circulation, etc. CERTIFICATION SERVICES Color additives—All color additives used in foods, drugs, and cosmetics (except hair dyes) must be from batches certified by FDA as harmless. In 1961, 5,844 batches representing over 4,092 tons were certified, and 35 batches representing 16 tons were rejected. Insulin.—All batches of insulin must be tested and certified before distribution. Examination of 343 samples resulted in the certifica- tion of 279 batches of insulin drugs and 61 batches of materials for use in making insulin-containing drugs. One trial mixture of prota- mine zinc insulin was not approved because it did not meet the require- ments for a satisfactory biological reaction test. Antibiotics —The predistribution testing and certification of certain antibiotics also is provided for by amendments to the act. Examina- tions were made of 12,937 batches of penicillin, tetracycline, chlortetracycline, bacitracin, chloramphenicol, streptomycin, dihydro- streptomycin, neomycin, novobiocin, nystatin, oleandomycin, triacetyl- oleandomycin, polymyxin, erythromycin, amphotericin B, and paro- momycin intended for commercial distribution. The last nine anti- biotics are not included in the certification amendments, but are tested Food and Drug Administration 341 when they are mixed with those requiring certification. One hundred and fifteen batches were found unsatisfactory by either FDA or the manufacturer for failing to meet the following standards: potency (48), moisture (35), pH (9), high streptomycin content (8), sterility (7), pyrogens (5), melting point (2), and syringeability (1). An additional 16 batches were refused certification when factory inspec- tional evidence indicated that the samples submitted were not representative of the batches. Other Government agencies submitted 475 batches of antibiotic preparations for potency testing before extending their expiration dates. In addition, 222 dairy samples were tested for content of antibiotics and 75 antibiotic medicated feeds were tested for labeled potency. During the last quarter of the fiscal year, provisions were made for the certification of antibiotic sensitivity discs which are used to aid physicians in choosing the best drug to treat specific infections. Of the 207 batches tested, 41 were rejected for failure to meet potency and uniformity standards. _ Enforcement of Other Acts A total of 107,029,133 pounds of tea was examined under the Tea Importation Act, a drop of more than 7 million pounds below last year’s imports. Rejections amounted to 232,050 pounds for failure to measure up to the standards set by the U.S. Board of Tea Experts. Four rejections were appealed to the U.S. Board of Tea Appeals. but the decision of the FDA examiner was upheld in all four cases. A bowl cleaner was seized because the word “poison” on the label was in smaller type than that required by the Caustic Poison Act. No actions were taken under the Filled Milk Act; one application under the Import Milk Act is pending a report from Canadian officials as to sanitary practices and tuberculin certification of the herds. No court actions were taken under the Federal Hazardous Sub- stances Labeling Act, since this was a preparatory year for surveys of the scope the program should cover, regulation formulation, and edu- cational activities. It is estimated that 5,000 to 8,000 manufacturers _ produce about 300,000 household items falling within the definitions _ of the act. Civil Defense er er ee Eleven civil defense positions were financed by funds appropriated _ for the Office of Civil Defense and Mobilization. _ The Biological Warfare Research Program proceeded beyond the _ planning stage which was developed in fiscal year 1960 to study the 342 Department of Health, Education, and Welfare, 1961 vulnerability of wholesale packages of foods and drugs to bacterio- logical agents which may be introduced by an enemy during overt or covert attacks, and to devise simple procedures for decontamination of affected products. Biological warfare stimulants were used in a specially equipped laboratory on food packaging materials to test the effects. Preliminary studies were undertaken with two stimu- lants. FDA started conducting studies using biological warfare agents m food products. Decontamination studies in this project are under- way. Fluorescent antibody antisera for detecting certain biologi- cal warfare agents in food were prepared and studies to develop detection techniques were begun. A project was set up to determine the amount of contamination of an average total diet caused by fallout of radioactive materials. The normal diet of a 19-year-old boy is being used as the test diet because it represents the largest customary food intake for this purpose (19-year-old boys eat more than any other comparable group in the population). Samples are being collected from four food stores in the metropolitan Washington area during 2-week periods and the food is being analyzed for radioactive material. The tests will be made quarterly for a year and may be extended later to other parts of the country. 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Ve Ubes ieveggpen aa bal} ky inf fate’ , iteli'oa “Al Cuties phone ort Arel«, hocke @ Wiig, dig: temeibat ent, Veale " Office of Vocational Rehabilitation Rehabilitations of Disabled Persons Grow in Number as Research, Training, and Facilities Expand IN THE FIscAL YEAR that ended June 30, 1961,! another new high was reached in the number of disabled persons who were helped to over- come their handicaps and placed in satisfactory employment through the services of their State rehabilitation agencies. The 1961 total of persons rehabilitated through the State-Federal program was 92,500, almost five percent more than the year before. Despite a generally high level of unemployment during 1961, the placement of 92,500 handicapped workers in jobs for which they were prepared through the public program of vocational rehabilitation is a large step toward the ultimate goal of the national program—pro- vision of opportunity for all handicapped persons to make the most of their abilities. 1961 was a year in which there was a great amount of progress— and an even greater amount of consolidation of previous gains—in the three basic elements which do most to move the national rehabilitation program forward: Research and demonstration; a training program producing more and better qualified workers in the disciplines whose principles contribute to the art of rehabilitating disabled persons; and the addition of rehabilitation centers, workshops, and other facilities, where new rehabilitation knowledge can be applied with greater effectiveness. These advances were a high point in the march of vocational re- habilitation into the nation’s pattern of health and welfare activities. The State-Federal relationship for aid to the disabled began in 1920. In four decades it has progressed from training designed pri- marily for vocational objectives into services under a greatly expanded philosophy which holds that before vocational training is attempted 1 Unless otherwise indicated, all subsequent references to 1961 will be to the fiscal year, that is to say, the period between July 1, 1960, and June 30, 1961. 357 358 Department of Health, Education, and Welfare, 1961 disabilities should first be removed or reduced; that disabled persons be aided in adjusting, if need be, to new sets of circumstances in their personal lives; and that rehabilitation services should be both more personalized and more comprehensive. There were several legislative actions along the way as ex- perience was gained, and as rehabilitation began to be viewed as a part of the national health program, and a measure having economic as well as social importance. Rehabilitation of the disabled was in- cluded as part of the social security laws of the early thirties; mental troubles were recognized as targets for rehabilitative measures, and physical restoration was added as a program objective in the Barden- LaFollette amendments of 1943; and the State-Federal partnership was given a sounder financial base and improved resources for bringing disabled persons to productive employment in Public Law 565, enacted in 1954, Since 1954, advances have come more swiftly. The more severe disabilities are under harder attack. State rehabilitation agencies and private groups are concentrating on the effects of mental illness and retardation as handicaps to employment; communities are par- ticipating to a greater extent in activities for helping their disabled and a dynamic program of research is pouring new riches of informa- tion into the public knowledge. The research and demonstration program expanded in every way in 1961. There were 116 projects approved for action during the year, approximately a quarter of the total of 460 for which grants have been made since the first award in 1955. The geographical spread among project locations has grown from the 8 States and the District of Columbia where the initial 18 projects of 1955 were located, to 48 States, the District of Columbia, Puerto Rico and the Virgin Islands. Expenditures for the 18 projects of 1955 amounted to less than $300,000. Grants for the 116 projects of 1961, and for continu- ation of prior projects amounted to $8.17 million. This brought the Federal investment in rehabilitation research and demonstration to approximately $26 million. The training program grew in several directions. A significant action was a series of institutes, for which the Office of Vocational Rehabilitation contributed support, that brought organized labor and community agencies into closer relationships with State rehabilitation agencies, for ultimate benefits to handicapped or industrially injured workers. There was renewed response within the training program to the need for more social workers to cope with the impact of disability on individuals, families, and communities. There was a study of professional preparation in speech pathology and audiology, and ini- 359 Office of Vocational Rehabilitation T96L “pak yoosy, ‘aansojo yo dnodd qpuUo1ndnaovo wofpue fiq pun eounjdoa0on yn fyyransyp fo sodhy fla ‘sxunpnqnyod fo 7Wa040d % LT Sa1VS GNV IWOTYAT9 WIYIDVNYW “WWNOISSIIONdI WAS “WNOILSSIAONd HR JUNLININYIV % Le Qa11IASI Was QNV G3T1INS % YT SIAIMISNOH *SYaAYOM AVWY4 SNOILVdNDDO YOrVW SdNOUD IWNOILVdNDDO AOFVW GNV SAILIIGVSIG—L LYWHO WILSAS SNOAYAN 4¥O IWINIW %S oOVIddVo % 81 YIHLO V1V % 01 NOILVINdWY SaILIMIAVSIC 360 Department of Health, Education, and Welfare, 1961 tial planning for academic training to prepare persons for modern rehabilitative work with deaf persons. There were special training activities to prepare instructors for teaching the blind to get about with greater facility, and for other objectives. There was renewed emphasis on the training of counselors, which, next to the funds granted in support of instruction in rehabilitation medicine, received the most financial support. Forty schools of medicine and osteopathic medicine—almost half the total of such schools—received training grant funds in 1961 for instruction of undergraduate medical students in rehabilitation principles. The approximate level of construction of rehabilitation facilities that has spurred the progress of rehabilitation in recent years was maintained during the year. Two more States were added to the list of those that own and operate rehabilitation facilities for their own particular objectives. Seven States are now in this category— Virginia, West Virginia, Pennsylvania, Iowa, Kansas, North Caro- lina, and Arkansas. The 36 projects for construction of rehabilitation facilities that were approved during the year for partial support from the Federal government through the Hill-Burton Act—which was amended in 1954 to include rehabilitation facilities in its provisions—brought the total of facilities built with that support to a total of 176, a good indication of surging community interest in rehabilitation. REHABILITATIONS IN 1961 The new record in the number of persons rehabilitated into employ- ment—5 percent more than in the previous year—reflected gains in a majority of the States, and in the District of Columbia, Puerto Rico, and Guam. The preponderance of these persons continued to be those with orthopedic disabilities—amputations and other crippling conditions. About 41 percent (38,000) were disabled by such conditions, and, of these, about three-fifths resulted from accidental injuries, about one- fifth were from poliomyelitis, osteomyelitis, or arthritis, and the re- mainder from other orthopedic impairments. Referrals came from many sources, but the largest proportion (34 percent) came from physicians, health agencies, or hospitals. An- other 14 percent was referred by public welfare agencies, and 7 per- cent by State employment service offices. About 12 percent applied for services on their own initiative. The remainder came from such sources as educational institutions, employers, and unions. Nearly half of the rehabilitants had dependents, and 63 percent were male. The occupations in which rehabilitants of 1961 were placed included nearly all types of work, including more than 4 percent who went into such short-supply professions as teaching, engineering, and medicine. Office of Vocational Rehabilitation 361 The proportions employed in other major occupational groups remain similar to those in previous years—skilled and semiskilled, 27 percent; clerical and sales, 17 percent; service workers, 19 percent; family workers and housewives, 14 percent; professional, semiprofessional, and managerial, 8 percent; agriculture, 8 percent; and unskilled, 7 percent. At the close of the fiscal year, 197,000 other disabled people were receiving services from State rehabilitation agencies, against a total of 180,000 in 1960. ECONOMIC VALUE OF THE PROGRAM The extent to which the public vocational rehabilitation program can improve the economic status of handicapped persons, increase the Nation’s productive potential, and relieve some of the dependency upon public assistance was strikingly shown in 1961. About 70,000 of the 92,500 handicapped persons prepared for and placed in employment during 1961 were unemployed when their re- habilitation began. The group that had been working at the time they were accepted for service was earning at a rate of about $70 million a year and generally the individuals were employed in unsafe, unsuitable, or part-time work. In the first full year of employment for the entire group after rehabilitation, it is estimated that they will have earnings at the rate of $180 million. Nearly 18,500 of those who were rehabilitated received public assist- ance at some time during the process, at the estimated rate of $18 million a year. The estimated total cost of the rehabilitation of these persons was about $18 million, a one-time outlay. It is estimated further that those who were established or placed in employment through the public rehabilitation program will pay, during the remainder of their working lives, from seven to ten dollars in Federal income taxes for every Federal dollar invested in their rehabilitation, so that the conversion of so many persons from tax consumers to taxpayers is of pronounced economic benefit to the Nation. Research Points Out New Objectives The genera] nature of the research and demonstration projects for which the Office made supporting grants during the year revealed some sharpened objectives of the public program which are leading it into new paths. Rehabilitation research, in the first years after it was initiated under provisions of 1954’s Public Law 565, was, in a high proportion, di- rected toward developing means of assistance that voluntary groups 626936—62——_24 362 Department of Health, Education, and Welfare, 1961 could give to State rehabilitation agencies, to help them to examine their on-going programs, and to improve their content and method. The need for such projects continues. Yet, in the increasing num- ber of project proposals submitted to the Office, there is evidence of a much stronger drive toward research into fundamental aspects of disability and rehabilitation. The psychological aspects of dis- ability, the attitudes of communities toward disabled people and those of employers toward hiring them, the adaptation of electronics and powered devices to artificial limbs and sensory aids, the special re- habilitation needs among the growing proportion of older disabled people in the population and among disabled mothers with dependent children, special help for severely disabled persons whose rehabilita- tion may be beyond the means or facilities of their State agencies— these are examples of the directions in which research and demon- stration are leading the program. In these ways the public program is reaching beyond specific tech- niques of treating ordinary forms of disability, and has gotten well into an unfolding three-fold set of objectives (1) to direct more atten- tion to the severer forms of disability, (2) to demonstrate in com- munities that disabilities can be helped more substantially and in better fashion by local application of new techniques and knowledge, and (3) to help communities to establish rehabilitation facilities and services on a sound basis so that they may continue when Federal support is ended. There are, for example, 83 special demonstration projects over the country for which the Office has given supporting grants so that communities and States may have greater opportunity to apply new knowledge in coping with forms of disability. Nine of them are now operating without Federal aid. At the end of the year, 460 research and demonstration projects had been completed, or were in operation, or approved for activation. They were about half the number of proposals that have been made to the Office of Vocational Rehabilitation. The approved projects represent a total Federal investment of approximately $26 million. Fifty-two percent of the grant awards were to private, nonprofit agencies; 31 percent went to colleges or universities; and 17 percent went to public groups, including State rehabilitation agencies, which has been a growing trend in the program. The selection and approval of projects is through a National Ad- visory Council of 12 members, a statutory body appointed by the Secretary. The members are leaders in those phases of scientific, educational, and public affairs whose attainments qualify them for responsible judgments on the suitability of research grants for the particular purposes of the national rehabilitation program. Miss Office of Vocational Rehabilitation 363 Mary E. Switzer, Director of the Office of Vocational Rehabilitation, is chairman of the Council. The growing volume of applications for grants brought the neces- sity during the year for a preliminary screening process within the Office. Many applications propose ventures into areas where rami- fications of the many disciplines used in rehabilitation become in- volved, so that expert opinions in those fields are needed to relate the value of the proposals to rehabilitation objectives. Within the year, two Study Sections were established. One panel advises the Council on applications involving the psycho-social sci- ences, and the other gives preliminary consideration to applications concerning sensory disabilities. A third Section, which will consider applications primarily involving medicine, was being established as the year closed. NEW SERVICES FOR THE SEVERELY DISABLED A new type of research and demonstration project designed to in- crease and intensify rehabilitation services for persons with extremely severe disabilities was initiated during the year. Five of the new kind of projects were put into operation in Massa- chusetts, Texas, West Virginia, Michigan, and Pennsylvania. They are directed primarily toward services for people receiving disability cash payments under the disability provisions of Old Age, Survivors, and Disability Insurance legislation. Persons with such disabilities as cardiovascular, neuromuscular, or respiratory conditions are expected to be the chief beneficiaries of the services, extended to them because the severity of their conditions requires intensive and long-term services, generally at high cost, and frequently out of their residence area. The Federal government will bear part of the costs of these projects, which will include special surgery and other rehabilitative measures not ordinarily available to such disabled persons from their State rehabilitation agencies. Grants totaling almost $381,000 were awarded for the projects. Applications have been received from other States for grants to enable the adaptation of these projects as prototypes. SCIENTIFIC ADVANCES APPLIED TO REHABILITATION The application of scientific advances and principles to help dis- abled persons to cope with their handicaps was undertaken at two technological schools during the year. Basic and applied research is being undertaken at the Massachusetts Institute of Technology and at the Case Institute of Technology to discover ways in which elec- tronics, pneumatics, hydraulics, and other sciences may be used for $64 Department of Health, Education, and Welfare, 1961 alleviation of various forms of disability; and to construct devices for practical application of theoretical principles. A part of this research will be in aids for blind persons. Studies will be made of the probing patterns of blind persons using guide canes, and ways will be sought to improve communication by Braille, including a high-speed machine which can operate at electric type- writer speeds for simultaneous Braille typing. Case Institute has a project for development of electronic and re- lated equipment capable of guiding a powered prosthetic device through several predetermined patterns. With such a device, a per- son having a completely paralyzed arm could perform several ac- tivities, such as feeding himself and meeting other personal daily needs. Another project will experiment with a device which will record differences in pressure produced on various parts of the body of a person lying in bed. There is no successful device of the sort avail- able, and its development would greatly benefit physical medicine and rehabilitation by more knowledge of the prevention and cure of “bed sores.” A fourth project will experiment with a tiny electronic device which, when permanently implanted in living tissue, could pick up and transmit nerve impulses, and in return activate an artificial limb or brace. MENTAL RETARDATION The widespread interest in mental retardation was accelerated during the year by increased activity in research and demonstrations relating to this disability. About one in every ten projects approved for activation has been in the field of mental retardation, and cumulative grant funds for projects concerned with social, psychological, and vocational prob- lems of retarded persons rank first in relation to other research areas. In all, 49 projects dealing with mental retardation have been approved since the beginning of the OVR research program. Of these, 20 are research and demonstration and 29 are selected demonstrations— which are occupational training centers to apply on a national basis the new procedures and services that were developed through research. Heavy emphasis was placed on helping mentally retarded high school students. A project in the Minneapolis public schools is estab- lishing facilities and developing techniques to give vocational guid- ance, training, and on-the-job experience to mentally retarded youths during their last year of high school. The project will serve as a prototype for extension to other school systems. A similar project to develop on-the-job work situations for retarded adolescents is in progress in Maryland. New York’s rehabilitation Office of Vocational Rehabilitation 365 agency is studying the early application of vocational services for retardates in a large urban area, and the Georgia agency is preparing a program to assist its public schools in developing skills and advancing maturity in mentally retarded youths prior to their entering the labor market. There are studies along related lines in Wisconsin, Missouri, and Oklahoma, and a New Are project has the purpose of discovering ways in which vocational rehabilitation can be used among emotionally disturbed children who show tendencies toward delinquency. AID FOR DISABLED MOTHERS An experimental project which has nationwide implications was initiated in the District of Columbia during the year, designed to aid a category of disability that had been untouched—disabled mothers with dependent children. The purpose of the project is to prepare disabled mothers who receive public assistance for their children to become self-supporting and to care for their families. A mother must have a physical, mental, or emotional disturbance to be eligible for these services. With her children, she moves into a training center, where they continue to live until the mother is trained for and placed in employment, and finds a new home. Physical restoration services, hospital care, and medical treatment are available as required, and instruction is given in personal hygiene, homemaking, and child care. The project is assisted by teachers from public schools, public health nurses, recreation agencies, and the U.S. Employment Service; and the D.C. Department of Public Wel- fare shares responsibility with the District’s Department of Voca- tional Rehabilitation for the full operation of the endeavor. MENTAL ILLNESS AND PERSONALITY DISORDERS The role of the public rehabilitation program in the restoration of the mentally ill to community life and to employment was stressed more than ever during the year. The final report of the Joint Commission on Mental IIness and Health, “Action for Mental Health,” was published during the year. ‘Jn it was the following statement: “The objective of modern treatment of persons with major mental illness is to enable the patient to maintain himself in the community in anormal manner. To do so, it is necessary (1) to save the patient from the debilitating effects of institutionalization as much as possible, (2) if the patient requires hospitalization, to return him to home and community life as soon as possible, and (8) thereafter to maintain him in the community as long as possible. Therefore, aftercare and rehabilitation are essential parts of all services to mental patients, 366 Department of Health, Education, and Welfare, 1961 and the various methods of achieving rehabilitation should be inte- grated in all forms of service, among them day hospitals, night hospitals, aftercare clinics, public health nursing services, foster family care, convalescent nursing homes, rehabilitation centers, work services, and expatient groups. We recommend that demonstration programs for day and night hospitals and the more flexible use of mental hospital facilities, in the treatment of both the acute and the chronic patient, be encouraged and augmented through institutional, program, and project grants.” The research and demonstration grants that have been approved in the field of mental illness—including 18 during 1961—show a marked parallel to these recommendations. There have been projects concerned with establishing, developing, and improving therapeutic and vocational techniques of the community hospital, such as those at the Vermont State hospital and the Massachusetts Mental Health Center, and in the day hospital at the last-named institution; half-way houses, as in Vermont, and those established during the year in West Virginia, Kentucky, and Missouri; greater use of work therapy, as in mental hospitals in Kentucky, Illinois, and the Goodwill Industries in Fort Worth, Texas; the screening of hospital patients for potential vocational rehabilitation, as is done by the agencies in Arkansas and Georgia; outpatient counseling and rehabilitation aftercare, as is done by the Manhattan Aftercare Clinic and the Butler Health Center, of Providence; and the training and placement of emotionally disturbed persons in eight selected demonstrations. These projects illustrate a strong trend to weld together in the community a complete series of the services developed and tested in specialized projects. It will eventually be done through well- designed large-scale combined research and demonstration projects which have as a primary objective the logical organization and the controlled testing of cooperation and coordination of existing services of various types, as well as provision of additional services not yet available but needed to complete a basic sequence. OLDER DISABLED WORKERS AND THE CHRONICALLY ILL A project previously reported is a “Demonstration of Feasibility of Vocational Rehabilitation of Disabled Persons 60 Years of Age and Older,” initiated by the Federation Employment and Guidance Service of New York City. Recent statistics from this project cover- ing the past two years report 406 clients served with a median age of 64, a 75-percent placement rate for clients considered placeable, and a median gross pay of $44.50 per week (despite many part-time place- ments) as compared to a median weekly income of less than half this amount from all sources prior to entering the project. More than 60 percent of these older disabled clients had a secondary disability. Office of Vocational Rehabilitation 367 In fiscal 1960 this project and its established pattern of services was designated as a prototype around which other agencies could de- velop similar programs. To date the OVR has provided funds for five additional projects, in as many localities, of this nature. One of these is sponsored by the Kiwanis Opportunity Workshop in Mil- waukee, and is a good example of a service organization assisting in meeting the rehabilitation needs of a community. A similar project is being sponsored by the Mankato Rehabilitation Center, Mankato, Minn. The 1954 amendments to the Social Security Act give State voca- tional rehabilitation agencies a key role in the cash disability benefits program. It is essential that those responsible for administering such a program have available the best techniques and procedures with which to facilitate the screening of large numbers of applicants for OASI disability benefits. Recently the OVR approved projects with a university and two rehabilitation facilities, including the Sister Kenny Foundation in Minneapolis, to carry out, simultaneously in three regions, duplicate research programs which will provide quantitative as well as precise information on how the process of evaluation and determination of disability and the rehabilitation potential may be made more efficient. MOBILE REHABILITATION TEAMS The Oklahoma Division of Vocational Rehabilitation during the year inaugurated a mobile team of rehabilitation experts which is extending services of the agency to severely disabled persons in their own communities. The project is supported by a research grant, and the results will be evaluated for use in other States, particularly in extension of services to rural areas. A principal objective of the team is to stimulate community interest in rehabilitation and to create awareness of its potentialities. The team, in its visits, mobilizes all elements of the community that can help with the rehabilitation of disabled persons, and assists local counselors in cases that present special problems. STUDIES IN DEPRESSED AREAS A study of the rehabilitation needs of disabled persons residing in economically depressed areas was initiated during the year with a grant to West Virginia’s Division of Vocational Rehabilitation. The project is undertaking to study the prevalence of disability in depressed sections of the State; the need for rehabilitation services among the residents; the drain that unrehabilitated disabled persons are on the community; and the contribution that vocational rehabili- tation can make in solving these problems. The project is regarded as a pilot endeavor for guidance of other States. 368 Department of Health, Education, and Welfare, 1961 ALCOHOLISM There was increasing activity in research relating to alcoholism as a personality disorder, and in several projects there are studies of work therapy and vocational counseling as means of countering alcoholism, and in applying general rehabilitation methods to this disability. INCREASING EMPLOYMENT FOR DEAF PERSONS Increased employment opportunities for deaf persons is the goal of three research grants made during the year. The Michigan Department of Public Health inaugurated a 3-year program to distinguish deaf persons from retarded persons in State training schools to determine whether the major disability is in hear- ing or retardation. The findings will shape the course of training in communications and in vocational skills. Another Michigan project is the establishment of a center by the Association for Better Hearing, which will make a 4-year effort to provide special personal adjustment and job training for about 100 deaf men now considered unemployable. A year-long study is in progress at the University of Pittsburgh to determine the extent that hearing loss caused by nerve impairment destroys the ability to localize sounds. Significant findings in this field could help development of hearing aids of greater use and adaptability. SELECTED DEMONSTRATIONS IN 1961 The number and geographical spread of selected demonstration projects grew during the year. These projects are in special cate- gories of severe disability, and are now operated in 83 communities in 40 States and the Virgin Islands to utilize new rehabilitation knowl- edge and methods. The number of projects had doubled since the first was established in 1958. The totals now: Occupational centers for mentally retarded_________________________-____ 29 Work classification and evaluation centers for cerebral palsied___________ x Work adjustment centers for disabled persons with emotional problems___ 8 Occupational adjustment services for epileptics______________________--__ Zz Services for the homebound: Industrial | homework) 20 SOU seh ee Os ae ee eee 3 Vocational adjustment in a community home-care program____________ a Blind and visually handicapped: Optical aids clinies____._-_______._________ 18 Work evaluation of older disabled workers_____________-___-_--_--_--_.-- 9 Rehabilitation of the chronically, 12. eee ee ee eee eee Pe Services to blind’ farmets2oo—2- oo + hee ee eee se eee 1 Réhabilitationio£ thementallyiliies 2a ee ee eee ee 3 Office of Vocational Rehabilitation 369 Medicine and Counseling Are Emphasized in Training Program 1961 was a year of consolidation of the gains of the training program in previous years, rather than one of expansion, for the increase of only $1,060,000 over the 1960 appropriation permitted comparatively small increases in assistance to educational insti- tutions and scholarship assistance to students preparing for careers in rehabilitation. Of the $7,260,000 appropriated for training, grants totaling $7,253,- 719 were made. Teaching grants numbered 209, as compared with 201 in 1960. Traineeships were granted for 1,586 students, as com- pared with 1,460 in the previous year. Medicine received the largest proportion of support—27 percent of the total granted for long-term training. Rehabilitation counseling was next, with 25 percent of the total. Speech pathology and audi- ology received 10 percent. Sixty-two of the 91 State vocational rehabilitation agencies received grants for staff development, largely to assist them in conducting organized in-service training for their staff. OWVR funds supported 187 short-term courses which reached nearly 4,000 individuals and 26 persons received rehabilitation research fellowships. Definite strides have been made in improving the content of instruc- tion in rehabilitation counselor and undergraduate medical student training programs, through the medium of short-term training courses for faculty members. In rehabilitation counseling a workshop on occupational information and job placement was held during the year, supplemented by committee work in eight other aspects of the rehabil- itation counseling curriculum. REHABILITATION COUNSELING Training programs designed to prepare graduate students for work in State vocational rehabilitaton agencies and other community re- habilitation programs received OVR support in 32 universities, with a full-time enrollment of 531. Students receiving OVR traineeships numbered 459 (86 percent). The estimated number of graduates in 1961 was 225, or only 37 percent of the 600 graduates estimated to be needed annually for employment in expanding agencies or as re- placements for those leaving the field. The 1960 study of graduates of the training programs since 1954 indicated that about 800 students had been graduated from rehabilita- tion counselor training programs. Nearly 80 percent were employed in rehabilitation programs. Eight percent were enrolled in graduate 370 Department of Health, Education, and Welfare, 1961 study. Less than 5 percent were employed in work unrelated to rehabilitation of the disabled. MEDICINE Forty of the 87 schools of medicine and osteopathic medicine received teaching grants for instruction of undergraduate medical students in rehabilitation principles. These 40 schools have an enrollment of about 12,830 students, or about 40 percent of the total enrollment. Traineeships have been awarded to 182 physicians enrolled in residency training programs, chiefly in physical medicine and reha- bilitation and to 145 undergraduate medical students interested in a special training experience in research or clinical service in rehabilitation. OCCUPATIONAL THERAPY Grants in 1961 were made to 16 of the 831 AMA-approved schools of occupational therapy to permit them to employ additional faculty, to develop new teaching materials, or to strengthen the integration of the classroom courses with the students’ clinical experience. OVR traineeships were awarded to 230 students in the basic curricula, or 12 percent of the 1,850 enrolled in the schools in 1960-61. The graduate traineeship program, initiated in 1960 to produce personnel for teaching positions, gave scholarship assistance to 21 individuals in the 1960-61 academic year. A training grant for the instruction of occupational therapists in psychiatric aspects of rehabilitation was awarded to the University of Pennsylvania’s School of Occupational Therapy. if e a |e |8 mB 12 ® og |e Id J8 a. 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Only those pupils may be registered whose vision comes within the accepted definition of blindness as follows: “Central visual acuity of 20/200 or less in the better eye with correcting glasses, or a peripheral field so contracted that the widest diameter of such field subtends an angular distance no greater than 20 degreees.” The Printing House maintains large catalogs of Braille books, Talking Books, recorded tapes, Braille music publications, large-type texts, and tangible apparatus. A rich collection of educational ma- terial is thereby provided for the kindergarten through the high school grades. A total of 7,396 blind pupils was enrolled in the residential schools for the blind and 7,366 in public schools—a total of 14,762 blind pupils being served by the Printing House—for the fiscal year ending June 30, 1961. During the 1961 fiscal year, Braille books, educational periodicals, and music made up approximately 46.8 percent of the materials re- quired by the schools; Braille slates, Braillewriters, maps, and other mechanical devices about 19 percent; Talking Books about 2.7 per- cent; recorded educational tapes about 1.5 percent; and large-type books about 28 percent. Approximately 8 percent was used for miscellaneous items. 397 Srriinit) MROrEoime batll oct tet senolt t a iid aft ao? Visine EC Tart SH uriinixl ansrtonsdé od? to aaotindst fais x alt toe tesube lainaga Yo wolkiverd oi? 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Lancraorba ee <0) beet azw Jmoyey & qltemtizoungqA Ananieqg 2S ii 2isit aoa Gallaudet College GaLLAupber Corixer, established in 1857, is the only institution of higher learning in the world devoted exclusively to the education of the deaf. Public Law 420, 83d Congress, approved June 18, 1954, clearly defines its status as a college, its relationship with the Federal Government, and its responsibility to provide education and training to deaf persons and otherwise to further the education of the deaf. KENDALL SCHOOL Primary and secondary schooling is provided for deaf children in the Kendall School, which also serves as a laboratory school for teachers training in the college. The oral method of instruction is used for all pupils except those who make no progress under it. En- rollment last year was 94, of which 85 came from the District of Columbia. GALLAUDET COLLEGE In addition to the 4-year undergraduate college, Gallaudet offers a 1-year preparatory course which bridges the gap between the second- ary schools for the deaf in the United States and the freshman class in the college. Deaf children of nursery age are taught in the Hearing and Speech Center. Elementary and secondary education for deaf children of the District of Columbia and adjacent States is provided by the Kendall School, a laboratory school serving the college’s De- partment of Education. This department, established in 1891, trains graduate students, both deaf and hearing, for positions as teachers and administrators in schools for the deaf. For the past 4 years the college has offered a summer session for graduate students who wish to earn the master’s degree in this field over a period of 4 years. Total enrollment in the college last year was 471, with students from 44 States, the District of Columbia, and 7 foreign countries. In addition to instruction, the college is also engaged in basic and applied research into deafness. The Office of Psycho-Educational Research and the Office of Social and Environmental Research are concerned with psychological aspects of deafness and with the deaf person’s relations to his society. In cooperation with the American 399 400 Department of Health, Education, and Welfare, 1961 Speech and Hearing Association, the college publishes a quarterly journal of abstracts of current literature in the fields of deafness, speech, and hearing. Research into the communicative abilities of deaf people is a continuing function of the Hearing and Speech Center, as acoustics and electronics are a concern of the Department of Physics. Basic linguistic research into the language of signs used by deaf people has been undertaken for the first time at Gallaudet College and has been in progress for the past 4 years. Howard University Howarp Untversiry, located in the District of Columbia, was char- tered by Act of Congress on March 2, 1867. The university offers programs of higher education on the undergraduate, graduate, and professional levels. Undergraduate students are registered in the college of liberal arts; graduate students seeking the master’s and doctor of philosophy degrees are registered in the graduate school; professional students are registered in the colleges of medicine, den- tistry, pharmacy, fine arts (of which the school of music and the departments of art and drama are parts) and the schools of engineer- ing and architecture, social work, law, and religion. (The school of religion receives no support from Federal funds. ) The educational program of Howard University is conducted in keeping with the democratic purposes of the land-grant colleges and State universities with the low tuition fees and living costs which characterize these State institutions and with an educational program resting upon and permeated by the content and spirit of a general or liberal education. The university admits students of both sexes, from every race, creed, and national origin, but it accepts and under- takes to discharge a special responsibility for the admission and train- ing of Negro students. ENROLLMENT OF STUDENTS During the school year 1960-61, the university served a total of 7,898 students as follows: 5,972 during the regular academic year and 1,926 in the summer session of 1960. The total net enrollment, excluding all duplicates, was 6,910, distributed in the 10 schools and colleges as follows: liberal arts, 3,472; graduate school, 723; engineer- ing and architecture, 826; music, 316; social work, 135; dentistry, 722; medicine, 868; pharmacy, 179; law, 105; and religion, 64. This en- rollment included a larger number of Negro professional students than in all universities of public support in all the Southern States com- bined. 401 402 Department of Health, Education, and Welfare, 1961 GEOGRAPHICAL DISTRIBUTION OF STUDENTS Of a total of 6,340 students seeking degrees, 5,373, or 84.7 percent, came from 46 States and the District of Columbia while 967 students, or 15.8 percent, came from outside the continental United States in- cluding 2 possessions of the United States, 53 foreign countries, and 17 island possessions of the British, French, and Dutch West Indies. This percentage of foreign student enrollment was the largest in any American university. The 5,373 students from the United States were distributed as fol- lows: New England States, 92; Middle Atlantic States, 878; East North Central States, 321; West North Central States, 83; South Atlantic States, 3,218; East South Central States, 404; West South Central States, 319; Mountain States, 15; and Pacific States, 43. The 967 students from outside the continental United States came from 53 foreign countries including Canada, 2 countries in the West Indies, 3 countries in Central America, 3 countries in South America, 10 countries in Europe, 15 countries in Africa, 19 countries in Asia and the Middle East, and 17 island possessions of the British, French, and Dutch West Indies. VETERANS During the 1960-61 school year, the student enrollment included 475 veterans receiving educational benefits from the Veterans Ad- ministration. These veterans were distributed among the 10 schools and colleges as follows: 217 in liberal arts, 31 in the graduate school, 6 in music, 80 in engineering and architecture, 11 in pharmacy, 43 in medicine, 59 in dentistry, 7 in social work, 18 in law, and 3 in religion. ARMY AND AIR FORCE ROTC Army ROTC.—There were 494 students enrolled in Army ROTC during the school year 1960-61. Of this number, 264 were in the first- year course, 137 were in the second year, 40 were in the third year, and 53 were in the fourth year. During the year, 36 students were commissioned as reserve officers in the Army. Air Force ROTC .—There were 445 students enrolled in Air Force ROTC. Of this number, 256 were in the first-year course, 158 were in the second year, 16 were in the third year, and 15 were in the fourth year. During the year 13 students received commissions as reserve officers in the Air Force. THE FACULTY A total of 686 teachers served the university during the school year 1960-61. This number included 385 full-time teachers and 301 part- Howard University 403 time teachers. The full-time equivalent of the teaching staff was 457.3. Of this number, 408.3 were teaching in the rank of instructor and above. From its establishment in 1867, the university has continued to have on its faculty the most learned and able men and women available, selected on the basis of their competence and character, without regard to sex, race, creed, color, or national origin. It was a major purpose of the founders of the university, however, to employ Negro teachers, among others, on every faculty. The Negro members of these faculties continue to constitute a larger group of professional teachers than all Negroes so employed in all other American universities combined. Many of the most outstanding Negroes in the public life of the United States have served on faculties of the university. Such persons in- clude the founder and operator of the first blood-plasma bank, the first Negro governor of an American possession, the first Negro in the Secretariat of the United Nations, and the first Negro member of the United States Court of Appeals. THE BUILDING PROGRAM Construction was completed on the auditorium-fine arts building during the fall of 1960, and the building was put into operation at the beginning of the second semester of the 1960-61 school year. Work was begun in the construction of the home economics build- ing, which is expected to be ready for use at the beginning of the 1962-63 school year. This new building will contain 22,000 square feet of usable space and will provide facilities for work in the general areas of foods and nutrition, clothing and textiles, household furnish- ings and household equipment, and child development. In addition, work was begun toward providing plans and specifica- tions for a new classroom building for the college of liberal arts and a new women’s residence hall. GRADUATES During the 1960-61 school year, there were 673 graduates from the 10 schools and colleges. These graduates came from 37 States, the District of Columbia, the Virgin Islands, Puerto Rico, 20 foreign countries, and 9 island possessions of the British and Dutch West Indies. These 20 foreign countries included Panama, British Guiana, Haiti, 7 countries in Africa, 7 countries in Asia and the Middle East, and 3 countries in Europe. The 673 graduates were distributed among the 10 schools and col- leges as follows: liberal arts, 304; engineering and architecture, 77; music, 15; the graduate school, 42; sacial work, 49; medicine, 83; den- 404 Department of Health, Education, and Welfare, 1961 tistry, 48; dental hygiene, 5; pharmacy, 11; law, 24; and religion, 15. Three honorary degrees were also conferred. Since its establishment in 1867, the university has graduated 22,443 persons. The large majority by far of these graduates have been Negroes. Their number represents a larger body of graduates in medicine, dentistry, pharmacy, engineering, music, law, and social work than the entire output of Negro professional graduates in all the publicly supported colleges and universities in the South. The largest number of graduates has entered the field of teaching, primarily in the Southern States. In the field of medicine there have been 3,167 graduates; 2,479 have entered the practice of dentistry and dental hygiene; 2,433 have entered the field of law; 812 have entered the ministry; 861 have gone into engineering and architecture; and 528 have entered the field of social work. In addition, a large number of graduates has been engaged in government activities. SERVICE IN FOREIGN COUNTRIES Teachers and students from Howard University have continued to render distinguished service in foreign countries. They have worked and studied in many parts of the world including West Germany, Italy, Israel, Iran, Iraq, India, Ceylon, Burma, Vietnam, Japan, In- donesia, Egypt, Ethiopia, the Sudan, Kenya, Liberia, Ghana, Nigeria, the Congo, the British West Indies, and British Guiana. Fulbright scholars from Howard University have served in such countries as England, France, Norway, Sweden, Denmark, Italy, Greece, Egypt, Iraq, India, and Ghana. During the year 1960-61 a number of members of the staff worked abroad in various capacities. The dean of the school of social work served as visiting lecturer and consultant on social work education at the University College of the West Indies. The dean of the college of medicine served as adviser on medical education to aid American and Vietnamese architects in designing a medical center for the faculty of medicine and pharmacy at the University of Saigon. The head of the department of preventive medicine and public health acted as a medical consultant for the United States Operations Mission in Ghana. A professor of architecture completed 2 years of service as architecture-engineering education adviser of the United States Operations Mission in the Sudan. In September 1960 the university choir completed a tour of more than 11 weeks, during which it visited and gave performances in 18 countries and 84 cities of South and Central America. Some 75,000 Colombians heard the singers during their 2 days in Bogota; 12,000 were on hand for a concert at Mexico City; 10,000 in Buenos Aires; and a standing-room-only audience of 9,000 at Fortaleza, Brazil. Howard University 405 Among the comments made by the press regarding the appearances of the choir, “El Universal” of Mexico City described a performance as “one of the greatest musical events to be applauded by the Mexican capital in the last decade.” “El Nacional” of Caracas stated that “this choir should give all Venezuelan students a great example of young, artistic unity, of love for music and culture.” It is apparent that by their services and performances abroad, both students and faculty are continuing to make a valuable contribution to international understanding and are aiding in the improvement of relationships with people in many parts of the world. dom ep lead? err g ware ewes @ MH tocfiperekin a see 2108 7S CER J2o RT e Ore (i>! oheostr dele ai ie yg - r . (Seno y¥ bid Pah blot chee fall yer - + OTC Oniae ‘ [4 ty Z 5 7 q Chl SORES rN SET FR ita 4 Bay 3 i z f fer gee {RiGee i \eaete F t f ir SS" LOPS merke, Some Detailed Contents THE SECRETARY’S REPORT Page PCN VONTORY = <220us.. > 5.28 Chee oe as 2 _abiensd . 1 Mist SK se to 24. Oe os oo Seee eae SEO ee eal ett” 2 eI IORMRRULU NA GIG 6 = tle Sos rs So ese ee See 3 BLAM SeOR ORO VONTION sos)... liuesee 26 essen ae es 3 SUURREMEMROROTUAN Glo co Sao Soe as oni a ee Pe ee 4 PORWR VCOVOMENT—LOG).. 2.2 anon ane we eu to Se 6 BE SPUGIATE EROGRAM. FOR SURVIVALss<-ss<-n0u cet euotk bee Le io 9 Topsy eon NATIONAL SITUATION. Sous so. 204 Lelie ue lL ee 10 ene eh OES Se a chs a te i as wah ee a Sw oe 10 PEON ee oe a aan Se Oe See Et Bae 12 SRL IE Ave: Hi eens. eye Scull te der ed Soe tate tee) eee ee sel use 13 MGR ON. 1h i ee are SE see ee oe ae tcl ees eela sae ot 15 TABLE 1.—Grants to States: Total grants under all Department of Health, Education, and Welfare programs, fiscal year 1961_____-_-----_----_-_ 18 SOCIAL SECURITY ADMINISTRATION Rivne emer Y “LN 1961S 2422.8 ee 2 eek ee cis oe 19 GU Mri GnmANimeA PPHALS 2: S525 4 us escent! en eeeensen doe eee eet = 24 nhs MAT BA CTT VITIOGS i: oc- 537 sad hoe cach ae ae ouemcolt oeee 24 OLD-AGE, SURVIVORS, AND DISABILITY INSURANCE__--__-- 26 Wit GerineEGOGRAM Is DOING..._.....-----.--------=-----seseees 29 Panereororsang sRencnit AMOUnts.. 2 cseiu sols seececueeesenseesd. 28 29 amit veLTOVISlONSis ha: ree oa kro lk ey Ot ee eae oo wasa 32 [Rr menereChIOnmETOVICCK. 2. a a eee ee ee, oe 33 Mac overscelor the Propram...__...-....-.------~--asbsaett) eich 33 PeoIGeAnde MIshUTrsements.26-- ..-____-- -- - nn chwaeseet beta sao t= 34 EES TORING THI PROGRAM... ----_- ._o eeewet dost tees 34 LEGISLATIVE DEVELOPMENTS DURING THE YEAR_._.------------------ 41 Panneronsror thie 1961 Amendments..__- — saeneesece) fee, eo See 41 PC HMmACTIVITIES.: .- 5° 5 a gee ate AOE) TES Boce. Fic 45 Meanie SIMPLIFICATION = 2— tes. 23-2 a ono eee ete oe 46 PERE TH TY PROGRAM Se) 8 ee a oe 46 Old-Age and Survivors Insurance Benefits_........_.__.-------------- 47 Poesuoevernsiirance Benetite:...——.- 2. =eersae ect ea BEES 47 BumentnrarN Ty © ONCLUSION... - 2 ee ee cee ee ee ee oe aes 48 PURE IGMP SUS LOAN CHS eer ne ee ee se a eed 48 oremC Hm LACE RO GRAMS Janie. ee 2 ea tl ee. Spoeees Pig 5 See oe 49 mn SES ATION ec) Soe kee Os od pete poe o 52 Bc Law 56-57 1,.July 1900uc . 250. 25——- 45-4 - Hee ese eee 66 Public Assistance Staff Training-=_ =~. == ee 67 RELATED PROGRAM ACTIVITINS 22-5250 o 5 Sea eeen ae Se ae eee 69 Increased Responsibility for Civil Defense Emergency Welfare Service PPO STAINS Le ea a eae as len a 69 Assistance Provided to Cuban Refugees. _-..--.-._-_-_-__-____--. se 71 Assistance to U.S. Nationals Repatriated From Other Countries_______- 73 Triternational Activities: 5-2-2285. 60 see ee ae oe eee 73 A. LOOK AWB AD Pio Se Sete Aon oe ee ten ee 74 Assistance’ Payments Not Meeting “Need” = = -_--._-----—- e 74 Inadequate Provision To Meet Medical Care Costs__._.__--..-----_---- 75 Needy Children Are Being “‘Short-Changed’’____-__------.------------ 76 Need for Preventive and Rehabilitative Services by Qualified Staff______- 76 CHILDREN S:BURBAU2 fee one. 62. 52 See ee ee 79 Some Facts anp Fiacures ABOUT PARENTS AND CHILDREN_____-----__-_- 81 ReEepPorT TO THE CONGRESS ON CHILDREN IN MiGrRANT FAMILIBS-----~- 82 PRESIDENT’S COMMITTEE ON JUVENILE DELINQUENCY AND YOUTH CRIME_ 83 JUVENILE DELINQUENCY LEGISLATION ® —2 5222 -22_ 22 22 eee ee 84 APPROPRIATIONS: - 232 2S82 2 saSesece ooas sor sesee ee eee 84 FEDERAL INTERDEPARTMENTAL COMMITTEE ON CHILDREN AND YOUTH_- 84 Tue Specrau Unit ror Wuite Housr Conrerencr Foutow Up_-_---- 86 PROGRAMS OF THE, BURDAU2 22222 222s ee soon ss seo EES eee 87 Research: in ‘Child. Lifec-2s2ssaees oases eee SE Ot eee 87 ‘Technical -Research222 22s 2se eee ee a ee 87 Statistical Reports: bone ee AE eee 89 Research Interpretation S=._2U2_ Seay Sree ees eee 89 Consultation and Conferences=.-===-220 22 Se 22a 22 et See 89 Maternal and Child-Health Servicesceaeeo 2 oe eee oe ee eee eee 90 Crippled-Children’s Services2-s22 3-25-22 See eee 94 Child Welfare ‘Services: =2:..cwetes oe a eS 96 Research and Demonstration Projects in Child Welfare_______---------- 96 Emancing:Child-Welfare. Programsss222 22-2 ee See 97 Personnel ste. 23 see Sr ne ee 97 Legislation: 220 -sa 235 So oN ee ee eee eee 98 Program-Reviewsand Assessments .2c sae eee eee 98 Child Welfare Services:in Specialy Areass-23 52s >e eee oe eee eee 99 Juvenile-Delinquency- Services... ss a oe ee ee eee 103 State Legislation-2> 2 ee Se ee eee 103 Consultation 22 325 es ee EE SR ee NAS See 104 Detailed Contents IERIE NIAE! CONPenwA CTEVIGTE Seiten tc ous ose eee Se eee Sele dee ce ck United Nations International Children’s Fund_____________________-_- Maternal and Child Care and Related Research Mission to the U.S.S.R__- International Research (Foreign Currency Program) -__--_---_-__------- Riana eets EMEN EES OTV1C CS sis Sembee pit eee Sg af 88 a ye a, oe ee To ytaaines. oo SS Oe ee ne ee a ee Consultation to American Specialists En Route to Foreign Assignments_- lier rit 1iga 11 eemee rter 2 ee ea 4 s p eee ee Tas_E 1.—Social Security Administration: Funds available and obliga- tonskneunredtiscal years 1961. and.1960..-.-.-.2-.-.tL-eeseol_ felt Tasite 2.—Financing social insurance under the Social Security Act: Contributions collected and trust fund operations, fiscal years 1959-61 __ Tas_Le 3.—Old-age, survivors, and disability insurance: Number of fam- ilies and beneficiaries receiving benefits and average monthly benefit in current-payment status, by family group, end of December 1960 and Dee eMMCUmNG OSes 2a ae a a Sk ee Oe et SE SS Taste 4.—Old-age, survivors, and disability insurance: Number and amount of monthly benefits in current-payment status at end of June 1961 and amount of benefit payments in fiscal year 1961, by State____ TaBLE 5.—Old-age, survivors, and disability insurance: Selected data on employers, workers, taxable earnings, and contributions, by State for og Cd TRTITTGGYG FS aS seep es eae eg en pens er eI 9 2 Be ie TasiE 6.—Old-age, survivors, and disability insurance: Selected data on benefits, employers, workers, and taxable earnings for specified periods, TaBLE 7.—Special types of public assistance under plans approved by the Social Security Administration: Number of recipients and average pay- ment, June 1961, and total payments to recipients, by program and MIMPINanRve At OOUIe ooo - ace acoscul jee eee eae TasBLE 8.—Special types of public assistance under plans approved by the Social Security Administration: Federal grants to States and total ex- penditures and percent from Federal funds, by program and State, fiscal Taste 9.—Maternal and child health and welfare services: Grants to States for maternal and child health services, services for crippled chil- dren, and child welfare services under the Social Security Act, by pro- Romumanousuace discal year 1O61...2...- 22... 22. 2 a Taxsie 10.—Federal credit unions: Assets and liabilities, Dec. 31, 1959, PareLOP—SUREL OG) © Sen ao an ce coo eee ae ee! Agee! TaBueE 11.—Federal credit unions: Number of members, amount of assets, amount of shares, and amount of loans outstanding, Dee. 31, 1934-60__ TasBLEe 12.—Federal credit unions: Selected data on operations, by asset Bea ES UA CO;p LOGO 22 one eminem oe Ee ee ot eee 2 Cuart 1.—Old-age, survivors, and disability insurance benefit payments RrEICIOEAIIO ML CLATI CHAM even 6) NE gaa athe inet enh 8 ob aoe) ee oe = Cuart 2.—Public assistance highlights, 1961... ...._._.._.-______-_-- Cuart 3.—Major causes of dependency of public assistance recipients, ETE ILO Gt pepereneh eee ee eve. CEI es op he aes sani ga aeaioan 6269386—62 20 nye 122 124 410 Department of Health, Education, and Welfare, 1961 Cuart 4.—Purchasing power of average old-age assistance payments____ Cuart 5.—Illegitimate children receiving aid to dependent children equal } of -l-percent/of/all*ehildrén’. 9 R_ Dela bose ses Bin pee Cuart 6.—Publiec assistance caseworkers, early 1960__________________- Cuart 7.—Average membership per Federal ciedit union and average share holdings per member, December 31, 1948-60_______._._______- PUBLIC HEALTH SERVICE EBEALTH OF TH BRN ACTION Se oe ee ee ee Health Record ee teen. oo ne Sees a eee eee Births, “Marriagess and /Divorcéss 2 7478-4 seetee 2 eye Eee BOUNDS AND PERSONNEL_._-_..---.-— Hues ee ee) Se oe Ieee eee National Health Survey#2et , S2airaeette the) me hs a SIS ee Nationali Vital Statistics: Division’ 42 ee ee ee Office of) Electronic Systems22.0- 24a" 2 Be kee eee eee eee Office of Health Statistics! Analysis tis = 2595 yt) = eee National LIBRARY OF M@DpICINH.._22_-22---550---_ ee Board ofiRegeritstt) Sas ee seh Seer ets ee ee oe ee New Building: test 22 Sate: Teer 2 eae ee Program, Statisticstl220t beer. bee be eee eee Public’ Health» Methods 4s. 23 5sh8 = tise fee ee eee Manpower*and’ Medical Hducation_222>_S¢2o552. soe 2) eee eee Work in‘:Other Hields 702 ee 2 oe ee ee Grants» Mansigementiigs AY e6 Se We sete eee eee Public Health*Administration@e 22) 25) Se nents ne hee ee eee Extramural Research Development==_----- == = See See eee Public! Héalth'Hducation@®2 te 22642) 22h 2" tn Shee Ye So eee Training's. Ustek Poe 2S See seh oS ae Yee eT ee a ae. eee International Education and Exchange! be 2550 so 8 ee ee eee Arctic’ Health Research @enters=2- 2-2 =. ene ae eee Division or HospiraL AND MEpICcAL FACcILitres___________-.-.-------- Construction: Programe 25-2 e4e- See ee ea ie ee ee Research» Grants: 2. cL Sse Jat eet eek err etn sae the hae Stee eee Cooperative Studies... 5 22 ee = ee eek She Ce oe DIvViIsionoF CHRONIC DIsmASDS. So eee eee Stee ee ee Meéart:Disease Controle. 22. 5 se a os ee ee ee ee Heart Diseasein: Childrens 222 yaaa" see ie ek Fe ee Heart? Diséasetin: Adtltsh tp eee ee Se ees See et Cancer Gontrolit-222 i! ae et ee eee eer 164 eee Demonstration, Projects... =. - sae Se eee Healthservices for Long-Term ll Iness222-2 5-25 = ae eee ee Diabetes'and*Arthritis=. ooo ee eee oe Pe en ee ees eee Diabetes Blood’ Testing 922-2 >= + 2: Seer << eee eee Automated Diabetes Instruction®. sss. _ 22 oe oa ee Arthritis "Controls 2222 a ee eee 131 134 137 137 138 138 139 141 141 141 142 142 142 142 142 143 144 146 148 148 149 149 150 151 151 152 152 153 153 154 155 155 155 156 156 156 157 157 158 159 159 159 Detailed Contents 411 Page Wieroneangeblearing- Conservation s.r ee 159 NeiOnalncpoOrting System — ene 160 Shanomever sheath Developed. sos ee ee ee 160 Perro eC ONSCL VAULON sr er ee ee ee 160 CGMMuUNIClsuM DIshAsmh CHNTER. 2.05 222222222 sl eee 160 SP PIERSLOD AlCl a eo eee eae ee 161 Pere mente tinease Studies. 2 ess 161 DERREND IG UPVOY Assn cs Le ee 161 One ne ISCASCS et et ee ne ae ene thse Nee oe ee 162 STEVE IIS rt tc pe a a Pi ae pil Bae 163 aCe ibLoes eee Se a SS ae ee eee 163 icennalivis: (Arthropod-Borne)) 22 32 ee 164 Se eTENIO SIS setae ates aes teen thd A ee i eee 164 EE eter ter ree os At eee 165 MEA SPS OERICS 1S See eet te ae ot nett WS oh Bt eee 165 Wigeliga® (CiOvNSIO Dee ca gescyeegeset ye a i ge ee eRe RE al A= 165 heporavory services and New Techniques: = 2_~ 2 22... == Shs tle 166 Tee MOn ee OODETA vole sea rerern = on oe Se eee 166 Sieeeir ii ere tre nena ers 2s ES ee oe ee eee 166 MLO NRORMACCIDEN] CRE VENTION]: 2 cs 2 55 Seles eae Se 167 rota NEC NICER SIN G22 So Se pee a oo oe SS eee 168 ERsteiannioman alysis or Needs Sosa s 2 oo gee ee eee 168 INUmsmoacareroithe| Sick at) Homes sce 2 asses stesea2- eee eee 169 Nursing Services in Outpatient Departments_______------------------- 170 Siatewade studies:of Hospital Nursing s 2o2 2-222 e222 22h Ss k Se 170 MpeeLVecOUrCes SULVeCYS= 922-2 toa sas DEE BR See 170 Memeasiiemerosoaro ney sae! heel Pale Foe Se} ee ee 171 ramon iraining and Researchiza< -vste2 28 2-25-22 sssse2ee eo le ee 171 Division or DenTAL Pusiic HEALTH AND RESOURCES----------------- 172 nrecurnimandeernainino Center: #5. -22asaeosea- see = a se 172 Mri rollxom MontalsDiscascsuesstl os ine ee eee eee 172 Peay ties barriers to Dental) Care s2122 sae eee ee ee ee 173 HioeacingsLentaliServices A= ease eres Seas Sas ns ee 173 Bemicestornopeciali Groups aw ate ee ee ee eee ree 173 Deyciopigepental: Resources stunt See oe eee ee eee Ee 174 PecArIONAl ETOLTAINS!s «ee sees Sh Sow eee ees ae ee eee 175 Aasistiimewine: Llealth Agenciess==s2eee+ se os- hese en eee eee eae 175 Division oF WATER SUPPLY AND POLLUTION CONTROL_-_-_------------- 175 Worn wean ts er ae eee mee ene ee ee eee oe ee 176 TRcayme Vn) (CSO Sec pe eR eta pe tee pe eg a gel a col ge 176 Vesswsthy, LD ahah, ~ gS ee ap I al i pin, Scars Miler ba ace gel og eh Ry ee a 176 by GEl OTH TELIA i a pie alley Re SAE Pll | Spc 5. ten ek be A analy ga 176 ereorgimanceresearch Grants ses css eee oe ee ee ee ee ee ee ulifeey Cia cerenslyOeLTOSTAING: Sf Seton s Se on tke ee eee eee eee Lie ee eraret iva COOTUINatiON =o" —< 32a au ce oe ee see eae Perea ew eneie a eAe colle start LBYOgSS i WIR sesdedace asta spp t Ay Mae add ada be Rn Dal peel hecly air Re NEO EVATR) POLLUTION. 22 52 222 SS ae et ae ee ee ee 178 PPomeAM SL TLCSCATC te to eos + eee ee oe ee See ee Pee A 178 Wiremmitecenrch Activities 2-3-2 s soe 5a enn a ye EIU 178 MenmncaleAssistance and Lraining 902252 sere aan nso eee seen 179 Pea COGS Re > Sa 2 9 Se eS Oe tn en oR eet ns ie Eee 180 412 Department of Health, Education, and Welfare, 1961 Research... Ps. 2t cated scree Ao ieee ey Ee ce ee ne sDrainin gt isd ee ies ee eee at ea le eee Simveillancén..) ht) Ae eA So ih eee eee, ee i DiNISION OMOCCUPRATIONADL HWAL@H. 222 = Sia. eee os ee DivistoN OF ENVIRONMENTAL ENGINEERING AND Foop PROTECTION ___.-- Engineering) Resources ands raining 322-2. 2828 2. k ee Bs General Engineering.“ 5222.5 = 26290 stale 28 ee ee ee Milk ‘and. Pood) Pro garages ee 2 a ee BUREAU OF MEDICAT, SERVIC BS== 226.) 22 eee ee Pusyic HEALTH SERVICE Hospitans AND@CIINIGSS = = 22 Volumecof Services. 2 ssa 6 2 5 os et ee oe General Hospitals. 22 28. +. to oe ee ee ee Narcotic Addiction 2.22.2: 4-5 eee oe ee | oe 15725 6 0) = aa a yt Be ec as reel be ny sc lps ee bn Se IWC CET oem se i mr re om Draining of Personnel =. 223.50. 2 ee eS ee ee ee Glinical, Investigations: " ... == - 2°25 — See eee 8 eee Federal Himployee Health Progrant.o. 922 es 2e- 8 eee eee Hreedinen’s Tospitale . ot. so en ee ne ee ee DIVISION, OF ORHIGN) QUARANTINE. 22 ose es eee ee ee Quarantinable Diseases=... o22 oe ce ee es ee Other"Communicable Diseases: -- 2-722 S222 -= 2 eee eee BEutomolosy and Sanitation Programs. 292. 125. 9 Other ‘Quarantine: Activitiegs: 23.02. = eee ee = oe HEALTH SERVICES FOR INDIANS AND ALASKA NATIVES___--------------- Medical “Facilities: 3S Ets) - by see ok) ou seer 2 besser 218 Peinecupoorveds Lesearcias 2 ff) BOPin 2 ude eee 2 eek ese bes lig 221 PSvMoT oO GReNLAN DAL HBALUTHULO{L 22 Llse Wl so Pease eees _ sees 222 emt POO TCedwhenearchice. So sceeceesucccccccbee lesa]. nee 222 Pre cemrmeelenical esearch... l= ol oth oe ee Wei pot a) ae 223 emt eeeemn a Le See ce cc ee cic a Sees bed ool wun lene Foe 224 Community Services and Program Development_-_____-________-_-_-_-- 224 InstTituTE oF NEUROLOGICAL DISEASES AND BLINDNESS________-_-_-__- 225 Melavoraiive rerinatal Research... .20.ce22<-2-.s-2ansisqubllecdethos 225 nm en IM CSO tlOh wai Sos.= essa eso olds soo ue Joel bag) * f 225 imenoarelmaeoensonry Disorders... 2 JL. 2 eee au bebe oiew< = 226 Cooperative and International Research__-___2222--2-.--.---L2L4.cL-- 226 MivistoneONebrtOLOGICS STANDARDS - == 2-=---2--82uuse ss beset 227 DivistonsomGONDRAL MppicaL Scrmpncems......-8oue2.l_l cl orld 228 iantomionsiceearcnvins Child Healthssice2cesccessN en ee ee 230 CLETUS Pot On CE | ) ee ee ee as eee hae Sears eer ry she eee 230 Wimin ONsOnshnSeARCH GRANTS......<- ~~ 2<- one ee ee SE 230 PevIptGhrGbee ESOARCH SHERVICKS....<..—--...-S¢uos65 2h ee ee 231 Nig ou ES UTE: = a a reir. :!) yim 232 SNES ENS I ie arp ie cage ins ge Sen SEMI Oe 232 TaBLE 1.—Statement of appropriations, authorizations, and obligations, irats ee he mere goers erie. t See NE SO Oe Bako ae 233 TaBLE 2.—Commissioned officers and civil service personnel as of June 30, tc nena eye Aone Trl he Weer oa a en eae 235 TABLE 3.—Research grants and awards, fiscal year 1961_______--_______- 237 TABLE 4.—Payments to States, fiscal year 1961______________________- 238 CuHarr 1.—Public Health Service organization, 1961___________________ 132 CHa Menuarates, LO80=6000. USL LLU LeeLee 135 Cuartr 3.—Death rates for the 10 leading causes of death, 1900 and 1960_ =—-135 Cuart 4.—Death rates from chronic diseases and acute infections_ ______ 135 Cuart 5.—Population growth by age groups, 1900 and 1960____________ 136 Cuart 6.—Population of the United States 65 years of age and over_____ 136 OFFICE OF EDUCATION Secrion I.—IntTropvuction: Quatiry EDUCATION._______________----_- 241 Mastery of Fundamentals Necessary__..........---=-.-.--_-. 241 Students’ Capabilities Must Be Challenged___________-_______ 242 PMV OLOLG LAG ont Soe a a dD See ee he en 242 ibeaching. the Basich Probleme oi a ee ee 243 iiiewolesor the Ofice ol Wducstlone. sess ee ee 245 Secrion I]—ExXamp.izs oF Orricr or Epucation LEADERSHIP IN Fiscau “unis TOG ga ee ee Oe eee ee eee 247 Identification of Needs of American Education______._._...__..._-_---- 247 Organization and Dissemination of Educational Statistics and Research Cegeulls. 2 Ee Pe ee a ee eee Pheer 248 Mobilization of Leadership for Solving Educational Problems__-_.__ ~~ -_- 249 EER TUANEVG. SOT VICOl: ak ape eee eee I ee eee eee 251 414 Department of Health, Education, and Welfare, 1961 Page Programs for Special Educational Problems.__-2s22ee255 93aee5 2 eee 251 Review. of Federal Programs in Education=-2=— 2-2 2. eee 252 New Responsibility and Change in the Office of Education_____________ 253 Srecrron III].—Masor ActivitTiEs oF THE OFFICE OF HDUCATION________- 254 ELEMENTARY, SECONDARY, AND ADULT EDUCATION__---_---__-------- 254 Administrationssuses. 2S. 1 Sess ese 2 eh ee ee eee 254 State Departments of bducation_-—-- =. 12) See eee 254 iocal SchoolBoard Hffectiv.eness..c2-2225--_---- 2222] eee 256 School Problems in Metropolitan Areas__________------------ 256 Staffing Sia. 22. eseeeee i eet bes per 3 ese as eee 258 HKinancing Bublic/Mducation_.--...2.2..--._ Set Jee eee 259 Local School, Revenue... =. 2.4.22 452 3-0... {eee eee 260 Statemfunds for Schools. __ <= eee eee 263 Federal Funds for Schools: _.—_aaeeeeee leer eee. oe eee 263 Expenditure Patterns. <.--- 2-22. Sees Se ee 264 Pacilities:for Public. Education. _<___ - =e se eee ee eee eee 264 INeeds2tt Seo. (ence mace ch ae ee ee ee eee 264 Federal Hundsforsbacilities___ 2 ee 266 Curriculum t2aytss oe. Se oe be a eee ee ee eee 268 Experimental Programs )22 ... =. 22. 3ee ee ee ee 268 inplis hte ss eo a ce eee ee 268 Y.OUthwHitn Css Meester 269 Sclencew me case ys 2 0 tg eee ee ee 270 Mathematics. 22228 ce eee ae ence ee 271 Foreign shan pus ces) 25 eetess — ote eee ee 271 Mocationalehidweatilone te) ee ee Bie, Studentsa svtche 255 1 Seee ys fe A ee ees ee 276 Rubliogiioh SchooliGra dite tes... se 276 ldentifying Valente. 22. e haw eee 276 Exceptional Childrens 3.2. = oe oO ee 276 Dropouts bres eee ohn a ee ee 278 Aduitrhidutation seek 2 a 2p ce ae ee ee ee 278 @ivil Defense Mducation--2 se 222 Se ee 279 HiGuERehDUCGATIONS#e Se: son ee ee ee 279 Institutional i Needs: 352. oo52h= See ge 279 Ceneral) Needs-ore All Ts tat tins see ee 279 Trends\in 2-Year Institutionsess2s- = 2 422525555 -2. 5552 5 284 ‘Trendssins Professional viiducation= = sae) see ee eee 285 Student Financial Needstie 4.6202 tees FS ee he eee 285 INon=HederalvAssistance.. seo) eee ee ee ee 285 Federal Assistancesos22-2¢ ae ee ee ee eee 287 INTERNATIONAL BDUCATIONS=2 ett ee ee eee 289 International Education and the National Challenge.___._______-___-_-- 289 International Educational*Relationsees-ceneeeee- 2-2 eee eee 290 Services Relating to International Organizations_____________-_- 290 Credentials\Hvaluation=ee 2-0 tenet ee ee ee 291 Conferences and Studies on Comparative Education___________- 291 Clearinghouse of Educational Studies___..______.___--_----_--- 292 Specialists for International Assignments___....___-_-----_--- 292 International Educational Exchangesses2-- 2) oe eee 293 Educational Materials Laboratory_-2__ 22222 22<-2----2<2---seecce ee 294 LIBRARY [SPRVICES foc sacce eee eoee Oe eo ee eh a eee 295 Detailed Contents 415 Page PEN OU S MEME ee ee te ke oe oe eee es 295 PCIE NICSE ie a = aie etd enatt. Bn abe cae 295 Siac 0! Usisyitth. 22. 2) a a a ears ee eee ere 296 Golepcmmosumiversity Libraries... _.-. = -asbesed ase les lSt dete 297 PneeeN DO CATISTICN= . 9-2-2 2 oo oe eed eet beat tht Fles en 298 Barner donmemttescarch PrOpsTams._.- -. —.---- e o o eei -beleg att 298 Clearinghouse of Studies in Higher Education____________-_--_- 299 oan Lvehieh a ain Wel a a eee ee 300 eeBIEEA TOTOVCO 5 = Se so Oe seen 2 Soe et Be oe 300 Dissemmation.of Media Information. ........-..-.cie29-sauas 300 Mamiomeneenimsitorthe Deaf. 2... -------sSe Ss. sees s~4e- seen 302 eM ORE term AISI GS ee ee 302 Reorganization of the Statistical Operations Staff_....---.----- 303 Secrion [V.—SumMary AND SELECTED GOALS. ._----.---------------- 304 SirmminnvaOLeAChICVEMeNts2an25 2 one cae 5-7 - Sooo a oe ee eee 304 SARE oVe Ona SOT PAC CS Sr eee n= Se ee eee a 305 SEC CUM CO HS ei Aes see eo os a Se et en een 307 TaseE 1.—Enrollment in 50 States and District of Columbia, 1959-60 and 7G = (5 een ae EES ey SS SL Be ke A oS 311 TaBuE 2.—Grants and other financial assistance to States, administered by the Office of Education, for fiscal year 1961._.......---..-------- 312 Cuart 1.—Reyenue receipts for public elementary and secondary schools, by sources: 50 States and the District of Columbia, 1959-60___.____-- 260 CuHart 2.—Summary of expenditures for public elementary and secondary schools: 50 States and the District of Columbia, 1959-60______--_---- 261 Cuart 3.—Changes within the public elementary and secondary school EYE pene —OS tO 1959-O0'. 0s ee eee ee SO ee eee 265 Cuartr 4.—Trends in enrollment, teachers, and schoolhousing in full-time elementary and secondary day schools, 50 States and the District of Mommie Wale O54>to-falls 19G02 Sees Se. Sees eas. te 267 Cuart 5.—Vocational education enrollments and expenditures: 1940-60_-__ 275 Cuart 6.—Projected higher education professional staff totals (full-time Bomiraionty) 1059-60 to.1969-70.. 2.222222 cca cckesnnbeccoeccucccne 281 Cuarr 7.—Cumulative output of and need for doctor’s degrees for higher eaucation svating: 1959-60'to 1969-702 -.--2L 2 = Sa fee 283 Cuart 8.—Cumulative need in higher education for physical plant: 1959- LD Cig) UNO UND <7 Ue Se Re ili lo AA 2 Set oc Sy dpe 2 Sra A ey 284 FOOD AND DRUG ADMINISTRATION ooh hl, Sa a re ea err Ae SS as a ee 313 PROGRESS IN ENFORCEMENT OPERATIONS. ..---~------+------------_- 318 MnovmoruG, AND CosMbTIC AQT) «iecetes) ods tees anodes Redoek! 322 PEPE OOCEE TONG. <= cso -os ee eee a) See ae Ae 322 OMe bivItY Wy! 0008. = a. - na eee a eee eee were se 2 323 Pe OReCHISRIN aH OOUS 2. oc. c= 5 Ss Se es ore oe em = eee 324 miromrarmil Contaminants... — =e eee eae a ek ee oe 325 Mme One OOd Clean. 2 eo oj ete Ne ee ee deere PE Fe BAG See DOOR ErOLeCHON 14 2) «was aust) wee h-a wads ne nen) ox4n wee 330 416 Department of Health, Education, and Welfare, 1961 Page Drugs and Devicesz\: * ee a2beee. Vee beess Sheet tne cde de ee eee 332 Ilegal:Sales,of. Preseription Drugs ss_-=.22<<-:..---===-25 5s eee 332 Counterfeit: Drugs 4=.a2secde = Mie toes CO one eee 333 Repacked. Physicians/sSamples2-e24 229S9RIEe oe See eee 334 False and Misleading Glaimsi-o-22-L22bsee=e5 <2 ee Se 334 Substandard: Drugss:2=+::sssechcc2ceex= eee eee ae 337 Devites sz tacuececesil elie) SUR BT BOE: 29 Sa a 337 New*Drugszd22d2kse ss cent geese cee ete ~~. See epee 338 Cosmetics-and /Colorsaee. o- ose e848 ee eee eee eee 339 Certification Services2..--2=+2