f — é \ Annual Re port we eT A 7 " j \ 1 } \ a ; } \ ; ' { j . ? & 4 y, j \ 13 I. pe Cc es ibe. t 7 4 J y j a a) f > 7 we : ce p \ ~~ \ \ Department of Health _- Education, { i Fi H Annual Report 1962 UNITED STATES DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE For sale by the Superintendent of Documents, U.S. Govern Washington 25, D.C. - Price $1.25 _ U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE As of June 30, 1962 ABRAHAM Ristcorr, Secretary Ivan A, Nestincen, Under Secretary OFFICE OF THE SECRETARY WiteUE J. COHEN...-—---4—=—— Assistant Secretary (for Legislation). Puimie H. Des MaRals -_----- Deputy Assistant Secretary. JAMES M. QUIGLEY L.2.0..2-- =; Assistant Secretary. Pisin O.OARTER, JR. Soa+53-Ls-< Deputy Assistant Secretary. MOBERT A. ISEVAN —..———...._.—— Deputy Assistant Secretary for International Affairs. Rourvs BH. Miss, JR. ~--------- Administrative Assistant Secretary. Pn APe ELLY 2 s— oe Deputy Administrative Assistant Secretary and Comptroller. BOISFEUILLET JONES ~--------~-- Special Assistant to the Secretary (Health and Medical Affairs). DowaArmue. CN oo. Sls keeL Special Assistant for Aging. Peo hi, OU LIN Acne nee Special Assistant to the Secretary (Juvenile Delinquency). DER Gre A ENS 1k Se Oe ee Congressional Liaison Officer. JON O. NEWMAN —------.---_~- Assistant to the Secretary. Bess FURMAN ARMSTRONG ~---~ Assistant to the Secretary (for Public Affairs). ALANSON W. WILLCOX ~--~--~-- General Counsel. OuEsTiies, WOUND —2t- sessed Director of Field Administration. PUARVIEt A. DUBH s— 2 2 Director of Public Information. FREDERICK H. SCHMIDT ______-__ Director of Security. JAMES W. GREENWOOD, JR. ---~- Director of Management Policy. Date §S. THOMPSON ~--------~~ Director of General Services. PaMnaeO. O'BRIEN —.--2.2—aa2 Director of Personnel. RAN OSNY DER, 22-42. oo Defense Coordinator. SOCIAL SECURITY ADMINISTRATION ROBrrt Ms DALI «2.2 26son2 cee Commissioner of Social Security. WOsmpH EL. MEYERS. 2.222 Deputy Commissioner of Social Security. VICTOR CHRISTGAU —_______ Director, Bureau of Old-Age and Survivors Insurance. KATHRYN D. GooDWIN_____ Director, Bureau of Family Services. J. DEANE GANNON ____-__- Director, Bureau of Federal Credit Unions. KATHERINE B. OrTrIneerR — Chief, Children’s Bureau. lii PUBLIC HEALTH SERVICE LUTHER LL LERE Ye! 2 ee Surgeon General. JOHN D.. PORTERFIEDLD So ee Deputy Surgeon General. JAMES V. UOWRY 22s ooae= Chief, Bureau of Medical Services. CHARLES E. BURBRIDGE _-__ Superintendent, Freedmen’s Hospital. THEODORE J. BAUER —_______ Chief, Bureau of State Services. JAMES A. SHANNON ~______ Director, National Institutes of Health. Forrest EH. LINDER________- Director, National Center for Health Statistics. FRANK B. RoGErs__________ Director, National Library of Medicine. OFFICE OF EDUCATION STERLING M. McMourRIN __----~- Commissioner of Education. VIA Ya Os BED fee ee eee ee Deputy Commissioner of Education. FOOD AND DRUG ADMINISTRATION GEORGH | Ps GARRICK 2 = =e oe Commissioner of Food and Drugs. JOT NGL ELARVE Yio = oe eee Deputy Commissioner of Food and Drugs. OFFICE OF VOCATIONAL REHABILITATION MARY. SWITZER] e-- = eee Director of Vocational Rehabilitation. Hi; EMOgyY WERERER) 22 oes Deputy Director of Vocational Rehabilitation. SAINT ELIZABETHS HOSPITAL WINFRED OVERHOLSER ___------~ Superintendent. OAT aC A MERON fe eee Assistant Superintendent. FEDERALLY AIDED CORPORATIONS MINIS IDAVIS 222222 42s8=" See Superintendent, American Printing House for the Blind. EONAR D SIV eH i SoA D pense President, Gallaudet College. JAMES M, NABRIT, JB) e22—222== President, Howard University. REGIONAL DIRECTORS LAWRENCE J. BRESNAHAN --_-~- Region I, Boston, Mass. JOSEPH B. O’CONNOB -_----~--- Region II, New York, N.Y. EpMunND W. BAXTER —22==2-S-2= Region IIT, Charlottesville, Va. RICHARD SE. OY Lie ee Region IV, Atlanta, Ga. Marivitiam EH. Hosom e222 e- cee Region V, Chicago, Ill. JAMESHVV sel OARN cae =e Region VI, Kansas City, Mo. AMES seen DON Dg) === eee Region VII, Dallas, Tez. ALBERT Ep ROSENTEHAD 2 sae ee Region VIIT, Denver, Colo. MAYS WA UNTER jee eee Region IX, San Francisco, Calif. iv Letter of Transmittal DEPARTMENT OF Heattu, EpucaTIon, AND WELFARE Washington, D.C., December 1, 1962. Dear Mr. Presipent: 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, 1962. Respectfully, Secretary. THE PRESIDENT, Tue Waite Houser, Washington, D.C. VASVIV < liVMVH Qos a nynjouoH => © aderoyouy VNVISINOT | ES aeiied yg IIA (rer a gd \ Al \ | \ Nano | SGN'v1Si NIDYIA “O38 OLYINd : \ WT “ssi vO pee SL | \ Kia | I \ * qouv2 I \ yuo ; ! NS ——— wo. 4 ALNaA 7 / ES ayrasenel is AHO . Ay9 sesuey + / —— SVSNVH ew. | evant THNOSSIN SIWYWN)S 1GNI - . 1 A \y o3uot4yd omol IN ——* ¥ - SV HSN Nv DIHOIN eS es ONINOK, —e s M ave VLOMVd Hinos — -—___... ee e. NISNODSIM ~ Vv LOSANNIW SadijjQ pue Saljepunog jeuoisay JUVITIM ONY ‘NOWWONGT “HLIWIH 40 LNIWLYVd30 SN Contents mmensecrctary’s Report... .... +. = poctal Security Administration. . . .... 2... MEEEI COE SCTULCE. ew ks ss Bek es eR SLELCOLL Orda ener ee ens Pea fe Food and Drug Administration . ... 1... 1... Office of Vocational Rehabilitation . . ........ submeeetzabeths Fospital ¥.. 625) ..cf- ron oo: sXe oe oi a) American Printing House for the Blind. ....... TE LODE Stes veered) are yyne ate SORA! TR ON BRAS UNIIVETSILY eis sme eye ee i detailed listing of the contents of this report, tae iopic headings, will be found on pages 421-433 — Anthony J. Celebrezze of Cleveland, Ohio, was nominated by the President on July 16, 1962, as the new Secretary of Health, Education, and Welfare. He was confirmed by the Senate on July 20, 1962, and was sworn in by the President on July 31, 1962. He replaced Abraham Ribi- coff of Connecticut. The Secretary's Report THE DIMENSIONS of progress are varied and changing, and the meas- ure of progress an intricate task. It requires looking both to the past and to the future. This report reflects the many dimensions of progress in the Depart- ment of Health, Education, and Welfare during the fiscal year 1962. Looking back over a year of effort, it seeks to measure advances in health, education, and welfare through the Department’s 112 pro- grams. It tries also to assess the present and to anticipate the future— to identify shortcomings, realign perspectives, and to fix new sights. To Promote the General Welfare The responsibility of this Department—simply stated—is to help promote the general welfare of the 185 million men, women, and children who make up our national family. It is concerned with their present well-being—their hope for the future. Its constant aim is to improve the conditions of life in which we all share, to enlarge the capacity of individuals to create for themselves and their society a good—a better—life. This is no simple task, for the conditions of modern life are increas- ingly complex and the problems affecting our national well-being seldom are easily solved. ; We are living in an era of change—rapid, revolutionary change— in which the patterns of relationships between man and his environ- ment and between man and his fellow man are in process of trans- formation. We are living in a time in which new concepts and new technologies are born in such swift succession that the stability of a society is no longer measured by its constancy but by its ability to move and adapt itself to the new conditions it has created. 2 Department of Health, Education, and Welfare, 1962 The great surge forward in science and technology has not been accompanied by an equal advance in the conditions of human welfare. Social progress lags behind the achievements of our scientists and technicians. Science has given us powerful new tools for the conquest of dis- ease and the further expansion of human knowledge, but it has also presented mankind with new problems and new perils. The swift advance of technology in agriculture and industry has brought new prosperity to our people—new comforts and new wealth—but the increased efficiency of machinery, which brings us better products at reduced cost, has created severe personal problems for workers whose skills are displaced or made obsolete. The extension of the average lifespan from 47 years at the beginning of this century to a record 70 years is a notable achievement, but the value of this progress in human terms is diminished by the fact that these added years of life do not always bring added years of happiness. Our population growth, the expansion of knowledge, the unleash- ing of nuclear power to build or to destroy, the economic and tech- nical revolutions of the 20th century—all these are among the complicating factors which contribute to the massive problems in- volved in our effort to “promote the general welfare.” This Department’s approach to these problems is at once positive and constructive. It combines humanity and commonsense. It is rooted in the traditional American respect for independence and self- reliance. It seeks to lift the shackles that bind and handicap an indi- vidual, that prevent him from accomplishing all that he might be capable of. In short, we view our responsibility as guarding and conserving the human resources of this Nation—protecting the well-being of the individual citizens whose combined strength is the measure of our national strength today and in the generations to come. Organization for Action Since its establishment in 1953, the Department has exercised its responsibilities through five major operating agencies: The Public Health Service, the Office of Education, the Social Security Admin- istration, the Food and Drug Administration, and the Office of Voca- tional Rehabilitation. Late in 1962 plans were announced for the establishment of a sixth major agency—the Welfare Administra- tion—to bring together the Department’s principal welfare programs under the direction of a new Federal Commissioner of Welfare. Pro- grams concerned with the welfare of children, the aging, and fami- lies and individuals in need had previously been attached to the Social The Secretary’s Report 3 Security Administration or to the Secretary’s immediate office. Their regrouping under a central Welfare Administration reflects the new responsibilities placed on the Federal-State welfare programs by the Public Welfare Amendments of 1962 and the need for full-time lead- ership and direction for both the welfare and social security pro- grams to insure their careful administration. The old-age, survivors, and disability insurance program, which now employs nearly half the Department’s personnel, will have top-level administrative status as the primary mission of the Social Security Administration. The work of all these agencies involves 112 separate programs and, in 1962, accounted for a total Federal expenditure of nearly $4.5 billion. Some of these programs—such as social security and the inspection of food and drugs—are carried out directly by the De- partment. The majority of the Department’s programs, however, are cooperative undertakings with the States which share our re- sponsibilities for the welfare of the people. Most of the Department’s money goes out across the country in the form of grants to the States, local communities, and institutions to support local projects in health, education, and welfare, and to aid in research that promises new benefits to all people. In 1962 almost 90 percent of its budget was devoted to these purposes. The largest single expenditure was in grants for public assistance. We do not work alone, and neither do we seek to dictate policies or to control the actions of responsible agencies—public or private— which have joined with us in this broad effort on behalf of all the American people. The fundamental philosophy underlying all the Department’s programs is one of respecting, preserving, and encour- aging local initiative—for here lies the true strength of America. We provide the mechanisms for cooperative action on health, educa- tion, and welfare programs throughout the land. We respond to local needs wherever possible with money and expert technical as- sistance. 'The success of our undertakings is determined not by how many programs we administer or how much money we expend but by the degree of cooperation we achieve with States and communities and with public-spirited organizations and individuals in all walks of life. Past as Prologue The work of the Department is based on two fundamental concepts: (1) the prevention of human suffering and waste of human potential, and (2) the rehabilitation and restoration to productive capacity of individuals who have fallen victim to the age-old scourges of disease and poverty or to newer hardships born of progress. 4 Department of Health, Education, and Welfare, 1962 Our programs of prevention and rehabilitation reach across all fields of endeavor. In the field of health this kind of activity has long been familiar to the public through the efforts of the Public Health Service to control or eliminate the agents of disease. For many years the Public Health Service has worked to help insure the physical well-being of the American people through improved sanitation, accident prevention campaigns, mass inoculations against contagious diseases, insect eradication programs, and other measures essentially preventive in character. Today these programs have been extended to meet new health hazards created by man himself— among them the contamination of our atmosphere by automobile exhaust fumes and radioactive fallout, and the pollution of our water- ways by manmade chemicals which have come to plague as well as protect us. The Food and Drug Administration, too, has long played a protec- tive role in guarding the Nation’s health. Its ward is the consumer; its statutory responsibility is the protection of the public against unsafe drugs and cosmetics, contaminated foods, medical quackery, and dishonest labeling of commercial products. In many ways it serves to complement and reinforce the preventive measures of its sister agency, the Public Health Service. The concept of rehabilitation as a public responsibility and as sound public welfare policy has been successfully pioneered by the Office of Vocational Rehabilitation in close cooperation with State agencies. This joint Federal-State program has demonstrated beyond all doubt the enormous gains in personal happiness and economic well- being that are possible for both the individual and the Nation when disabled or handicapped persons are given the opportunity to reduce their impairments, to learn new skills, to find useful employment, and to take their places as self-supporting, self-reliant members of society. Progress—1962 In 1962 this pattern of prevention, protection, and rehabilitation was carried further into the fields of education and welfare. In this way, we have begun to knit together allied programs in separate fields, giving to each and to all greater strength and effectiveness. Adequate education, for example, is a concept as old as civilization itself: the idea that man must learn in childhood and adolescence to provide for himself and his family in adult life. In this modern age, an individual’s ability to work, to earn a living, and to enjoy the cultural benefits of the world around him depend in large part The Secretary’s Report 5 on formal education and training. Without the basic educational skills—reading, writing, and simple arithmetic—he cannot carry out his responsibilities as a worker, a parent, and a citizen. In today’s highly developed industrial society, individuals with educational deficiencies are the last to be hired and the first to be fired. Among their ranks is found the greatest incidence of disease, poverty, and crime. They make up the largest number of public welfare recipients. Our new look in welfare, then, involves preventive health measures ; adequate education; rehabilitation programs for those with physical, emotional, or educational handicaps—and, undergirding all this, a new emphasis on family and community services. These efforts re- quire a degree of cooperation within the Department and among State, local, and private welfare agencies never before attempted on such a broad scale. Actually, there is hardly a program in the Depart- ment that is not concerned in one way or another with helping to reduce dependency—helping every citizen, old and young, to achieve the sense of personal security that is the foundation of freedom. Building upon the past and laying new foundations for the future we have strengthened the Department’s program on many fronts and in many fields: —A focal point for cooperative health services was established with the creation of a new Division of Community Health Services in the Public Health Service. This new administrative unit works with local communities to help find ways to coordinate public and private health and medical services, and to improve and expand preventive, curative, and restorative services wherever they are needed. Under the Community Health Services and Facilities Act of 1961, we have been able to support widespread research on ways to improve out-of- hospital services, particularly for the aged and the chronically ill. —In the vast area of medical research important gains have been made in our continuing quest for deeper understanding of the com- plex processes of life. The partial cracking of the “genetic code” by scientists at the National Institutes of Health and elsewhere has brought us to the threshold of understanding long-hidden mysteries involved in the systematic reproduction of all living matter and bears far-reaching implications for the future health and well-being of mankind. —A National Institute of Child Health and Human Development was created by the Congress to provide a central facility for research on unsolved problems relating to child health, maternal health, pre- natal development, and aging. At the same time the Division of General Medical Sciences was elevated to Institute status, giving added recognition to a Federal program which supports research in sciences basic to medicine and biology. 6 Department of Health, Education, and Welfare, 1962 —In the area of environmental] health, additional safeguards were established to protect the public from the growing dangers of air and water pollution. Amendments to the Federal Water Pollution Control Act have enabled us to increase the amount of Federal aid to States and munici- palities for construction of sewage-treatment plants so that 754 proj- ects received Federal funds in 1962, compared with 590 the previous year. The new amendments also strengthened the enforcement pro- visions of the act and provided for an expanded program of research to find new ways of combating this national health menace. New protective measures against air pollution were put into effect, and surveillance programs were intensified. An important step toward clearing the air—particularly in urban areas—was an agree- ment by automobile manufacturers to install blowby devices on all 1963 model cars to help reduce the amount of potentially harmful exhaust fumes from the millions of automobiles traveling the Nation’s roadways. The Federal-State Radiation Surveillance Network, which moni- tors the level of radioactive fallout throughout the country, was expanded from 45 to more than 65 stations, and, with the resumption of nuclear weapons testing by the U.S.S.R. in the fall, all stations were placed on a round-the-clock schedule. —Additional protection for the consumer was provided by impor- tant changes in regulations under the Food, Drug, and Cosmetic Act. Among these are requirements for more complete and accurate infor- mation on the dangers as well as the usefulness of prescription drugs, revised inspection procedures to insure their purity, and strengthened controls over testing in clinical trials. Public attention was focused on the need for these changes when a new drug, thalidomide—which may produce tragic deformities in babies when taken by mothers dur- ing pregnancy—was widely used in clinical investigations in spite of the fact that it had been withheld from the market because its safety was questioned by Dr. Frances O. Kelsey, the responsible Federal review officer. New legislation to provide more adequate authority to control the manufacture and marketing of drugs was enacted by the Congress. —Wider enforcement of food and drug laws covering the amount of toxic residues that may safely remain on raw foods was made possible by an increase in the FDA inspection staff and the develop- ment of improved methods of detecting and measuring agricultural poisons. Still, inspections cover only a minute fraction of the total 214 million annual interstate shipments of fresh fruit and vegetables. Before the end of next year, by more than tripling the current num- ber of samplings, we will bring our inspection coverage up to 1 percent The Secretary’s Report 7 of all shipments. Appraisal of the results of this intensified program will enable us to determine whether a still further increase in the sampling and inspection coverage is necessary to assure protection of the public from unsafe residues on foods. —A concerted effort was made to alert the public to frauds con- nected with medical and nutritional quackery, which cost the Ameri- can consumer an estimated $1 billion a year. New regulations have been proposed on labeling of special dietary foods to prevent exploi- tation of the consumer by false or misleading claims. In addition, the first National Congress on Medical Quackery was called in Octo- ber and brought together representatives from private and Govern- ment agencies and the communications media to design special information projects to protect the public from hucksters of pseudomedicine. —Programs to alleviate the problems faced by the Nation’s 17.5 mil- lion senior citizens have been strengthened throughout the Depart- ment. The Special Staff on Aging was doubled in size and given an increased budget so that it could better coordinate our programs on aging and provide special services to State, community, and volun- tary organizations working in this field. A 29-member panel of nationally known specialists was appointed to advise the Secretary on problems of the aging, and, upon the recommendation of this Department, a President’s Council on Aging was established in May 1962 to coordinate all Federal programs in this field. —The new amendments to our welfare laws, coupled with sweeping administrative changes in the public assistance program, have allowed us to make substantial progress in the welfare field. The newly designated Bureau of Family Services now offers a family-centered approach to welfare problems and provides a broader framework for preventive and rehabilitative services designed to help move people off the welfare rolls. Special stress has been brought to bear on meet- ing problems of illegitimacy, desertion, and protection of children, and on community planning responsibilities. —There has been broad and significant expansion of child health and welfare services. Increased appropriations for 1962 permitted States to expand and extend maternal and child health, crippled children’s, and child welfare services. For the first time, in 1962, Federal funds were made available for research and demonstration projects in child welfare. The 1960 amendments to the child health and crippled children’s provisions, to permit special project grants to be made directly to institutions of higher education, were also im- plemented in 1962. The 1962 amendments to the Social Security Act represent the most important changes in the child welfare program since 1935. These 8 Department of Health, Education, and Welfare, 1962 changes provide for gradually doubling the amount authorized for annual appropriations from $25 million to $50 million per year; for special project grants for training personnel in the field of child wel- fare, including traineeships, so that insofar as it is possible there will be full geographical coverage in the child welfare services field by July 1, 1975; and for earmarking up to $10 million of Federal child welfare funds for day-care services. Since no supplemental ap- propriation for day-care services during fiscal 1963 was made before Congress adjourned, this latter provision has not been implemented. —Several important improvements were made in the old-age, sur- vivors, and disability insurance program by the 1961 amendments to the Social Security Act. A reduction in eligibility requirements for insurance benefits brought additional thousands of elderly persons under the protective shield of social security. The new amendments increased the minimum benefits paid to retired workers in general, and increased aged widows’ benefits by 10 percent. They also lowered the retirement age for men from 65 to 62 and gave added incentive to workers to continue part-time employment after retirement. —TIn the field of education, although legislation to give much needed assistance to the States and to higher education failed, notable prog- ress was made in our drive to stimulate new efforts toward excellence in the Nation’s schools and colleges. A stepped-up research and devel- opment program in the field of English has set the pace for a new national appraisal of instruction in this basic subject and serves to complement the very successful programs for expansion and im- provement of instruction in mathematics, science, and foreign lan- guages operating under the National Defense Education Act. —The passage of the Manpower Development and Training Act in March 1962 was a singular achievement in vocational education and carries important implications for the future. Here vocational edu- cation is being supported by the Federal Government on a broad na- tional scale in an attempt to solve the problem of unemployment and consequent dependency among workers with obsolete skills or limited educational attainment. At the same time, this legislation has stimu- lated new approaches to the entire field of vocational and technical training. Under this program, vocational training is being directed to specific jobs in fields where manpower is in short supply. The whole field of vocational and technical education and its relationship to national manpower needs was under study during the year by a special panel of national representatives from industry, labor, and education. Their recommendations for new directions in vocational education were presented near the end of the year and provide a basis for reshaping the Federal vocational acts and the programs to which they are directed, The Secretary’s Report 9 —The Federal-State vocational rehabilitation program passed an important milestone this year by providing physica] restoration, new skills, and economic independence to more than 100,000 disabled per- sons. This marks the passage of the halfway post on the road to 200,000 rehabilitations a year—a goal set for the program when the rehabilitation legislation was enacted in 1954. The Office of Voca- tional Rehabilitation, which administers this program, was renamed the “Vocational Rehabilitation Administration” early in 1963, and its head was given the title of “Commissioner of Vocational Rehabilitation.” —Efforts to prevent and cure juvenile delinquency have been stepped up during the year under the overall direction of the Presi- dent’s Committee on Juvenile Delinquency and Youth Crime, which consists of the Attorney General, the Secretary of Labor, and the Secretary of Health, Education, and Welfare. Grants under the Juvenile Delinquency and Youth Offenses Control Act of 1961 have been made to support 15 community planning projects in which cities are preparing broad action programs, 26 training programs for youth workers, and a major demonstration project—the Mobilization for Youth program in New York’s lower East Side. Under the direction and coordination of the President’s Committee, Federal youth-service agencies—including those of this Department—are giving technical assistance to the communities which have received grants under the act. —By the end of 1962, over 155,000 Cuban refugees who had fled the Castro regime had registered at the Department’s Cuban Refugee Center in Miami and had been provided with a variety of health, wel- fare, educational, and employment services. As the result of an in- tensive campaign conducted by the Department, with the assistance of a number of volunteer agencies, more than 52,000 of these refugees have been resettled in over 1,100 communities throughout the Nation, where they have opportunities to put their skills to use, to continue their education, and to build new lives for themselves during their exile from their homeland. The urgent need for continued resettle- ment efforts is underlined by the fact that two out of three of the 100,000 refugees still in the Miami area require public assistance be- cause of the limited job opportunities there. Tasks for Tomorrow Against the backdrop of the past, it can truthfully be said that the American people have never been as well served—in health, education, and welfare—as they are today. But comparison with the past is an imperfect measure of progress, for we are living in a changing 665171—63-—2 10 Department of Health, Education, and Welfare, 1962 present and we face an uncertain future. Our efforts of today merge with our tasks for tomorrow—and with our hopes for a better life for ourselves and our posterity. We are not content to see the costly burden of medical care clouding the latter years of life for most of the Nation’s 17.5 million people over the age of 65. The high and still-rising costs of illness in old age present a fearful specter to our older people—and to their families—for when illness strikes the elderly it can reduce otherwise independent people to poverty almost overnight. The problem we must resolve is how to provide needed health services to all older people—how to prevent illness from forcing them into the poverty and dependency which can tarnish the “golden years” of life. This administration’s proposed solution to this problem is a program of health insurance for the aged, financed through social security—a plan which would make it possible for people to acquire paid-up health insurance at age 65 through small regular contributions during their working years. In addition, we will continue to encourage those States that have not done so to establish medical assistance plans for the aged under the Kerr-Mills Act of 1960. We do not accept as inevitable and insoluble the appalling waste of human lives and the incalculable cost and suffering resulting from mental retardation among some 5.4 million American children and adults. We recognize the need to concentrate greater effort on re- search into the causes and prevention of mental retardation, as well as the need to make better use of our present resources and present knowledge. With the report of the President’s Panel on Mental Retardation serving as a blueprint, we plan to establish a compre- hensive, long-range program to prevent, treat, and alleviate this major national problem. We are not content with our national posture in the field of edu- cation, and we will continue to press for measures to strengthen our schools and colleges. We have long recognized our obligation to protect the public interest in matters regarding public health and the quality, safety, and effectiveness of such tangibles as foods, drugs, and cosmetics. Education—although it is not manufactured, pack- aged, and labeled—is no less tangible a commodity for public use and no less vital to the Nation’s well-being. If our young people are shortchanged in the quality of education they receive and if their educational opportunities are limited, the Nation as a whole suffers— in loss of talent and productive energy, in blighted hopes and wasted lives. Adequate education, then, is an essential corollary to preventive measures in health and welfare. It involves increased efforts to wipe out adult illiteracy and to provide the American people—young and The Secretary’s Report 11 adult—with the skills and knowledge essential for independent, pro- ductive lives. It requires broad retraining opportunities for men and women whose skills are made obsolete by technological advances. It calls for measures to eliminate the financial barriers to higher edu- cation for young people of limited resources but unusual ability. It means putting an end to discriminatory practices in education. It means increased attention to the quality of education our children receive. It means assurance that adequate space is available in our schools and colleges, that the schools are staffed with a sufficient num- ber of well-trained teachers, and that the tools of education—materials and equipment—are up to date. We are dissatisfied with our present efforts in accident prevention and public safety. During 1961 alone, 45 million people suffered accidental injuries—from motor vehicles, home accidents, poisoning, and other causes. Accidents are the fourth leading cause of death for Americans of all ages, following heart disease, cancer, and stroke. For persons aged 1-35, accidents are the leading cause of death. We believe that this needless source of human suffering—this appalling waste of life—can and must be prevented. Just as research and tech- nology have provided us protection against the fatal and crippling effects of disease, so must they now seek out and define the real causes of accidents and develop new means of prevention. A similar program of research and prevention needs to be launched against the problems of alcoholism and drug addiction. These costly and debilitating afflictions, which strike alike at rich and poor, have for too long been shrouded with mystery and misunderstanding. Much more can and should be done by health, education, and welfare agencies to aid in their prevention and control. We are, in fact, not satisfied with resting on our accomplishments in any field or any program. Too many questions remain unan- swered ; too many problems remain unsolved. How we ourselves have fulfilled the public trust is the final dimen- sion to our measure of progress. We are acutely aware of the huge responsibility we bear to the American public for effective, efficient. administration of the programs entrusted to our care. Weare respon- sible for the investment of billions of dollars of public funds, and we bear a continuing responsibility to see that the public receives full returns on its investment. This means efficient management of our programs, careful expenditure of the tax dollar, resourceful use of our personnel, effective coordination among our agencies. It is not possible in this fast-moving age to stop and say we are done. We can only pause from time to time to say that we have begun—knowing that other beginnings, other tasks, await our atten- tion tomorrow. 12 Department of Health, Education, and Welfare, 1962 Table 1.—Grants to States: Total grants under all Department of Health, Education, and Welfare programs, fiscal year 1962 [On checks-issued basis] States Tota District of Columbia__-_--- HMloridas= see Georgia <2. 222.20 Hawaii. 3 2. 53 idahoe Si. ee Maryland._______ Massachusetts- - - Michigan. --___-_- Minnesota--._---- Mississippi_------ Missouri: -taoece New Hampshire- New Jersey------ New Mexico- ---- Oregon. 325 Pennsylvania-__- Rhode Island- --- South Carolina__ South Dakota___- ‘Tennessee__...-..- Virginia me. se Washington West Virginia__-- Wisconsin..<29 28-6 Wyoming_-___-___ Puerto Rico_..._. Virgin Islands___- Undistributed___- 90, 078, 370 15, 089, 559 27, 488, 912 50, 462, 654 330, 628, 600 56, 341, 752 29, 170, 597 6,078, 610 12, 633, 261 84, 899, 464 92, 888, 391 18, 032, 719 13, 883, 734 144, 4038, 814 38, 120, 325 43, 068, 207 40, 941, 438 64, 676, 368 180, 581, 384 19, 592, 253 40, 504, 810 98, 859, 859 97, 099, 575 53, 438, 422 51, 699, 232 105, 081, 945 11, 869, 195 22, 491, 446 7, 150, 762 9, 024, 148 50, 924, 167 28, 265, 892 249, 136, 174 83, 293, 191 14, 686, 441 121, 243, 198 105, 822, 373 29, 529, 064 141, 656, 989 17, 350, 470 38, 037, 801 15, 849, 441 61, 232, 582 178, 301, 681 16, 522, 808 7, 417, 059 52, 871, 969 61, 777, 796 52, 076, 932 46, 333, 301 5, 780, 851 128, 491 8, 383, 981 18, 381, 232 604, 680 10, 918, 405 Social Security Adminis- tration 72, 690, 489 2, 273, 273 18, 027, 287 37, 466, 788 266, 248, 284 42, 477, 847 22, 258, 445 3, 297, 747 10, 951, 274 64, 606, 081 71, 336, 812 28, 297, 812 34, 043, 994 28, 334, 260 53, 919, 970 120, 785, 880 14, 700, 171 23, 810, 276 80, 327, 783 77, 806, 289 43, 873, 938 39, 824, 141 91, 722, 344 6, 846, 659 15, 478, 274 3, 141, 089 5, 227, 501 35, 643, 240 17, 734, 091 214, 468, 265 63, 244, 124 9, 160, 921 98, 027, 086 89, 715, 142 22, 660, 650 111, 600, 418 12, 698, 724 24, 043, 689 9, 659, 013 46, 836, 688 142, 790, 014 11, 165, 007 5, 354, 638 24, 362, 816 45, 864, 424 45, 817, 432 34, 905, 620 3, 265, 806 128, 411 1, 750, 669 9, 223, 612 3038, 771 Public Health Service ! 5, 565, 156 4, 032, 144 2, 308, 172 5, 548, 279 11, 732, 450 2, 963, 365 1, 783, 150 1, 287, 446 1, 048, 797 7,761, 615 8, 304, 343 1, 541, 439 4, 330, 878 5, 256, 330 7, 958, 318 5, 094, 442 6, 842, 519 5, 919, 687 1, 503, 835 1, 958, 477 1, 3238, 068 1, 640, 136 5, 046, 480 2, 713, 192 14, 735, 094 8, 376, 818 2, 661, 535 8, 986, 488 4, 238, 034 2, 836, 451 13, 525, 561 1, 443, 062 6, 032, 868 1, 929, 610 7, 067, 078 14, 164, 483 1, 384, 575 1, 077, 820 8, 327, 140 3, 152, 190 2, 745, 407 5, 726, 305 718, 977 Office of Education $3,217,801,775 |$2,498,729,820 |$255,670,997 |$397,674,578 9, 249, 636 8, 667, 002 6, 592, 762 5, 487, 674 49, 252, 341 10, 160, 191 4,721, 344 1, 323, 575 348, 393 10, 111, 498 9, 707, 697 9, 978, 681 2,481, 514 9, 530, 681 4, 025, 773 3, 387, 133 7, 862, 532 3, 884, 331 3, 199, 848 2, 996, 998 11, 639, 456 11, 867, 828 9, 671, 211 8, 931, 557 7, 544, 989 14, 982, 889 9, 066, 815 2, 462, 995 12, 538, 008 10, 305, 571 3, 324, 094 10, 950, 904 2, 760, 116 6, 583, 910 3, 952, 873 5, 487, 145 19, 307, 414 3, 685, 580 736, 501 18, 665, 073 11, 870, 037 1, 920, 531 4, 558, 708 1, 679, 842 1, 762, 498 1, 730, 009 204, 270 10, 872, 405 1 Excludes $252,447 paid to water pollution interstate agencies. 2 Includes permanent annual appropriation of $10,000, Office of |American Vocational | Printing Rehabili- tation $65,077,625 2, 560, 487 117, 704 559, 730 1, 953, 272 3, 333, 797 734, 068 393, 050 174, 095 283, 157 2, 401, 748 3, 522, 857 2, 075, 946 352, 045 710, 078 1, 382, 419 1, 278, 607 269, 229 4, 888, 358 2, 585, 752 399, 710 1, 659, 652 1, 559, 545 699, 028 5, 533, 700 445, 288 1, 370, 333 305, 945 1, 829, 469 2, 016, 287 292, 040 247, 260 1, 503, 138 879, 437 1, 585, 399 1, 132, 416 115, 066 House for the Blind 2 $680, 000 White House Confer- ence on Aging Social Security Administration Social Security in 1962 Significant new emphases stemming from the conviction that we can and must do more to shape our public welfare programs toward the goals of preventing and reducing dependency marked develop- ments during fiscal year 1962. That conviction and the emphases it generated found concrete expression in actions on a broad front— in legislative developments, in administrative changes, and in new directions in social welfare research. Achievement of a new emphasis in public welfare began with a comprehensive review of the public welfare programs of the Social Security Act. State and local welfare officials and leaders in volun- tary organizations contributed to the study. This activity culminated in a number of administrative changes, detailed in subsequent sec- tions of this report, and in the development of legislative proposals for submittal to Congress. The proposals were embodied in the Public Welfare Amendments of 1962, enacted shortly after the close of the fiscal year. ‘The amendments emphasize provision of services to help families become self-sufficient. The States will be enabled to provide incen- tives that will contribute to reduction in the need for continued pub- lic assistance. This approach recognizes the importance of rehabili- tation in helping welfare recipients better to be able to care for themselves and, wherever possible, to become self-supporting. The amendments also have the objective of maintaining and strengthening family life for children. In addition, emphasis is placed on training to increase the supply of adequately qualified pub- lic welfare personnel to provide some of the services that can help to reduce the need for and the cost of the public assistance programs. Signifying the increased emphasis on the importance of welfare services directed toward strengthening family life and the self-re- liance of individuals, the name of the Bureau of Public Assistance was changed to Bureau of Family Services effective January 1, 1962. Other action on the administrative and legislative fronts that made our social security programs better suited to serving the Nation’s 13 14 Department of Health, Education, and Welfare, 1962 social and economic needs included implementation of the Social Security Amendments of 1961. Provisions of the 1961 amendments reduced some of the hardships resulting from old age, disability, or death of the family wage-earner by liberalizing the Federal old-age, survivors, and disability insurance program and by increasing Fed- eral sharing in State assistance payments to the aged, the blind, and the disabled. Also, under the provisions of Public Law 87-31, 15 States extended the coverage of their aid to dependent children pro- grams to help children of unemployed parents. The Public Welfare Amendments of 1962 included a provision making Federal funds available for such aid through fiscal year 1967. The Juvenile Delinquency and Youth Offenses Control Act of 1961 authorized a 3-year program that provides for (1) grants to finance projects that will demonstrate and evaluate techniques and practices for the prevention and control of juvenile delinquency and youth offenses, (2) grants for the training of personnel, and (3) technical assistance services to public and private agencies working in this field. Funds were appropriated and the program was put into effect before the end of calendar year 1961. Although important social security legislation was passed and im- plemented, the President’s proposal for adding health insurance for the aged to the protection provided by the old-age, survivors, and disability insurance program was tabled in the Senate and remained a major issue. Continuing efforts were made to improve and extend the medical care available to needy aged persons through the regular old-age assistance program and the more recently enacted medical assistance for the aged program. But “social security protection, fi- nanced by payments made during the working years, supplemented by private programs and backed up by the Federal-State public assist- ance provisions for medical care,” said the Secretary of Health, Edu- cation, and Welfare, “is the only way to a truly effective solution of the problem.” President Kennedy announced that a bill incorporat- ing this approach to meeting the problems arising from the costs of health care in old age would be introduced again early in the next session of Congress. In the Social Security Administration’s research program, emphasis on searching out the causes of dependency was continued from pre- vious years. The absence of a research effort having as its main focus increased knowledge relating to the prevention or reduction of dependency was long cited by the Social Security Administration as a major gap in the total research effort in this country. The 1956 amendments to the Social Security Act provided authorization for a program of research and demonstration grants to help fill this gap. It was not until Sep- Social Security Administration 15 tember 1960, however, that funds were appropriated to implement the program. At the close of fiscal year 1962, the Social Security Admin- istration had made thirty-nine grant awards totaling more than $1 million to educational institutions, public agencies, and other nonprofit organizations for a broad range of research of significance to social security programs and social welfare. Federal funds for a new program of child welfare research and demonstration grants were made available for the first time in 1962. The purpose of this grant program, which was authorized by Con- gress in 1960, is to provide support for (1) special research and dem- onstration projects in the field of child welfare that are of regional or national significance, and (2) special projects for the demonstration of new methods or facilities that show promise of substantial contri- bution to the advancement of child welfare. Seventeen grant awards were approved for the fiscal year. A new international cooperative social welfare research program of the Social Security Administration is reported on in the section on international activities. The intramural research activities of the Social Security Adminis- tration were strengthened during 1962 by steps taken in accordance with the recommendations of an advisory group of experts from out- side Government. The major recommendation of the group in its August 1961 report to the Commissioner of Social Security was for the creation of a new unit in the Division of Program Research in the Commissioner’s Office with responsibility for long-range research, that is, research into fundamental questions relating to the nature of poverty and insecurity in modern society, the character and dimen- sions of poverty, and the social and other factors involving depend- ency and independence. A continuing advisory committee on research development estab- lished on the recommendation of the expert group met for the first time toward the fiscal year’s close. The purpose of the committee is to assist the Commissioner in formulating a research program for the Social Security Administration—including the work of the new long- range research unit—and in stimulating close working relationships with research personnel in universities and private research centers. Work was initiated on another major research project—a nation- wide cross-section survey of persons 62 years and over, designed to provide information on the demographic characteristics, living ar- rangements, economic circumstances, and health care costs of old-age, survivors, and disability insurance beneficiaries and other aged per- sons. Among other uses, the survey will help meet the detailed information needs of the Statutory Advisory Council on Social Secu- rity, which will be appointed in calendar year 1963. It will, in addi- 16 Department of Health, Education, and Welfare, 1962 tion, provide much of the information requested by the 29-member Panel of Consultants on Aging to the Secretary of Health, Education, and Welfare. Asa supplement to this study, similar information on social and economic circumstances will be obtained for a sample of mother-child beneficiaries under the old-age, survivors, and disability insurance program. Field collection and tabulation will be under- taken by the Bureau of the Census under contract with the Social Security Administration. At the end of fiscal year 1962, social insurance, related payments, and public assistance accounted for about 7 percent of total personal income in the United States. The social insurance and related pay- ments portion amounted to $27.2 billion on a seasonally adjusted an- nual basis. The payments went to beneficiaries covered by public retirement, disability, unemployment, and veterans’ programs and included benefits for work injuries under Federal employer liability acts and cash and medical payments made under workmen’s compen- sation and temporary disability insurance laws. Public assistance payments in the same month, excluding vendor payments to suppliers of medical care, were made at an annual rate of $3.5 billion. Under old-age, survivors, and disability imsurance—the largest so- cial insurance program by far—the number of beneficiaries in current payment status increased 11 percent during the fiscal year to 17,280,- 000. The monthly benefit rate increased 14 percent from $992 million in June 1961 to $1,128 million in June 1962. The number of disability insurance beneficiaries increased from 200,400 at the end of fiscal year 1958—the fiscal year when such bene- fits first became payable—to 679,300 at the end of fiscal year 1962. The provision in the Social Security Amendments of 1960 which extended benefits to disabled workers under age 50 and to their de- pendents, beginning November 1960, spurred the rate of increase. Over the 4-year period from July 1957 to June 1961, the proportion that retired workers were of total old-age and survivors insurance beneficiaries rose slightly, from 56.4 percent to 57.1 percent. At the end of fiscal year 1962, the proportion was 58.0 percent, reflecting the effect of the provision in the 1961 amendments making benefits pay- able to men aged 62-64. By June 30, 1962, old-age benefits had been awarded to 525,000 men aged 62-64 and wife’s or child’s benefits to 195,000 dependents of these men. In federally aided assistance for persons 65 and over, 2.2 million were receiving old-age assistance, and more than 102,000 received med- ical assistance for the aged in the 27 States that were administering such programs in June 1962. Almost 3.7 million children and their adult caretakers received aid to dependent children, including 237,000 recipients in the unemployed-parent group; 100,000 received aid to Social Security Administration 1 by the blind, and 417,000 received aid to the permanently and totally disabled. In addition, 812,000 persons received general assistance financed from State and local funds. Payments for all types of public assistance for the month totaled $365 million. The 1962 appropriation of about $70 million for the maternal and child health, crippled children’s, and child welfare programs of the Children’s Bureau, which marked its 50th anniversary on April 9, 1962, was an increase of about $17 million over the amount available for these programs during fiscal year 1961. More than 1,000 new members on the average joined Federal credit unions each business day in fiscal year 1962. More than $3 billion was lent to individuals in a total membership of 614 million in these mutually owned institutions. Following the precedent set in naming his predecessor, Robert M. Ball, a career Social Security Administration official, was sworn in April 17, 1962, as Commissioner of Social Security to succeed William L. Mitchell. The Social Security Administration had 35,304 employees on duty at the end of the fiscal year. The great majority of the employees were in the Federal program of old-age, survivors, and disability insurance. International Activities The Social Security Administration initiated new international activities during the fiscal year and cooperated in making facilities available for other programs administered by the Department of State, the United Nations, the Organization of American States, and the many voluntary agencies operating overseas exchange programs. The SSA planned for experts and participants coming to the United States from 92 countries, an increase of 11 countries over the last fiscal year, and 17 over fiscal year 1960. Newly independent countries are looking to the U.S. for guidance in establishing their welfare and social security programs or for training of administra- tive or technical personnel. A majority of the participants sponsored by governmental organizations come through the United Nations programs or the Department of State’s Cultural Exchange, with the Agency for International Development sending relatively few partici- pants in the social welfare or social security field. The training pro- grams planned for the participants and experts reflect new trends, both in the use of U.S. training resources and in areas of interest in social welfare. A greater number of the participants attended full- time graduate schools and remained to complete work for the degree. These persons were preparing for key posts in their own governments or to train personnel in their own universities, Other visitors, experi- 18 Department of Health, Education, and Welfare, 1962 enced administrators coming for a shorter period, had observation programs in the several different fields of competence of the Social Security Administration—family and child welfare, planning and administration of social insurance, prevention and treatment of ju- venile delinquency, training of personnel, and credit cooperatives. Requests for programs combining several areas of the social field included social services in public housing and urban development, coordinated planning for social and industrial development, and leg- islative planning for social security and social services. The Social Security Administration began a new partnership in cooperation with other countries when an international research pro- gram using U.S.-owned local currencies under Public Law 480 was undertaken. Negotiations with the seven countries in which funds are available—Burma, India, Israel, Pakistan, Poland, UAR-Egypt, and Yugoslavia—resulted in the approval by the end of the fiscal year of projects in social services, juvenile delinquency, child care, and maternal and child health. Projects approved will contribute new knowledge to the United States. As an illustration, it is antici- pated that one of the projects accepted will produce data useful in evaluating successful methods of working with young delinquents. Another project, a study of toxemia of pregnancy, will be of value as toxemia of pregnancy is the leading cause of maternal death in the U.S. and little is definitely known as yet of its cause. Cooperation with the Agency for International Development re- flected new aspects as a result of the foreign aid legislation which underwent drastic revision during the fiscal year. With specific language in the legislation emphasizing social as well as economic aspects of development and the “development of human resources,” a base was provided for more attention to social welfare. In response to a request from the Agency for International Development Ad- ministrator, the Social Security Administration detailed a senior social welfare officer for full-time duty in the agency with a view to effective utilization of Social Security Administration resources in the foreign aid program. In July 1961, a member of the staff of the International Service of the Social Security Administration was appointed by the President to serve as the U.S. Representative on the Directing Council of the Inter-American Children’s Institute. This Council held its annual meeting at the Pan American Union in October 1961. One of its major achievements was the formulation of a proposed agreement with the Organization of American States. This agreement, which will have the effect of merging the administrative and fiscal organi- zation of the Institute with that of the OAS while respecting its complete technical autonomy, was signed by the Director General of Social Security Administration 19 the Institute and the Secretary General of the OAS in Washington in May 1962. The 1962 conference of the International Labor Organization adopted a new convention on the subject of equality of treatment in social security. A staff member of the Division of Program Re- search served as advisor on the U.S. delegation. The International Social Security Association general meeting in Istanbul in September was attended by social security officials from every industrialized country of the world and many of the less de- veloped as well. The U.S. delegation, headed by the Commissioner of Social Security, invited the conference to hold its next meeting in the United States in 1964. This will be the first such session ever held in this country. Research in social security systems to serve as a basis for providing technical assistance in this field was carried on cooperatively by the Social Security Administration and the Agency for International Development. Experts in social security financing and administra- tion served as Social Security Administration consultants on the study. At the United Nations, the 14th Session of the Social Commission in April and May 1962 marked resumption of annual Commission meetings for consideration of international social questions, social policies, and technical assistance. Chief accomplishments of the Commission were the recommendations for establishment for the first time of an international committee on housing, requests for a re- vamped and strengthened international social welfare program, and the development of an expert report on social and economic planning with particular attention to allocation of resources. The UNICEF Executive Board Meeting approved increased requests for funds for projects in new fields such as social services, vocational training, and education as well as continuing substantial grants in the health field. The Social Security Administration provided technical advisers for the U.S. Delegations to both the Social Commission and the UNICEF Board Meetings. Cuban Refugee Program In the past 2 years, the United States has become a country of first asylum for large numbers of political refugees from Cuba. The U.S. Government has found it necessary to develop a program of help for refugees from a neighboring republic and to assume major responsi- bility for the health, education, and welfare needs of these unfor- tunate people. By June 30, 1962, about 150,000 Cubans had found political refuge in the United States. 20 Department of Health, Education, and Welfare, 1962 The principal port of entry for Cuban refugees is Miami, where many remain. A number of the refugees are professionally or tech- nically trained; they were not permitted to take any resources when they left Cuba. On reaching the United States, most need assist- ance of one kind or another—financial aid, employment counseling, retraining, English language instruction, or help in resettlement and adjustment to American customs. The severity of the Cuban refugee problems became evident near the end of 1960. President Kennedy early in 1961 expressed his concern and directed Secretary Ribicoff to undertake a study of the situation and to develop a program of assistance. The program as it has developed since 1961 provides: (1) Financial assistance, supplemented by surplus commodities, to provide food, clothing, and shelter to needy refugees registered at the Miami Cuban Refugee Center and who are living in Florida or who resettle outside Florida with the help of voluntary agencies. (2) Financial assistance in relocating refugees to homes and jobs elsewhere in the United States. (3) Health services and long-term hospitalization. (4) Assistance to the public schools of Dade County, Fla., in provid- ing instruction to the refugee children as well as English instruction and vocational training to adults. (5) Loans to refugee students in college and funds for English and refresher courses for lawyers, doctors, and other professional persons. (6) Care of children unaccompanied by relatives. Administration and coordination of the program are assigned to the Commissioner of Social Security. In operating the program, the Commissioner has made full use of existing resources, as, for example, the Office of Education, the Public Health Service, the Children’s Bureau and the Bureau of Family Services within the Social Security Administration, the Bureau of Employment Security of the Depart- ment of Labor, the Dade County Board of Education, the Florida State Department of Public Welfare, and the Florida State Board of Health. Four voluntary agencies (National Catholic Welfare Conference, International Rescue Committee, Church World Service, and United Hebrew Immigrant Aid Society) are under contract with the Social Security Administration to handle the resettlement of Cubans to homes and jobs away from the Miami area to other parts of the country and overseas, During the fiscal year 1961, the program was carried out under authorities contained in the Mutual Security Act of 1954, as amended, with expenditures of nearly $5 million. During the fiscal year 1962, the program operated under authority contained in the Foreign Assist- Social Security Administration 21 ance Act of 1961, with expenditures of $38,502,000. On June 28, 1962, the Migration and Refugee Assistance Act of 1962 (Public Law 87- 510) was enacted. This law authorizes assistance to refugees and an appropriation of $71,110,000 for providing such assistance during fiscal 1963 was made. Increasing emphasis is being placed on the resettlement of refugees from the Miami area to other places in the United States and overseas. New entrants from Cuba have ranged from 1,600 to 1,800 per week for the last year. By June 30, 1962, there were about 95,000 refu- gees living in greater Miami. Roughly 60 percent of the refugees in Florida were on assistance. Successful resettlements are essential if the refugees are to become self-supporting and the public assistance load reduced. Thirty-two thousand two hundred fifty-five Cuban refugees had been resettled by June 30, 1962, to over 900 communities in 49 States, Puerto Rico, the Virgin Islands, and 23 other countries. The rate of resettlement has risen in fiscal year 1962 from 1,259 persons during July 1961, to 3,454 during June 1962. A transition resettlement allowance averaging $80 to persons receiv- ing assistance in Miami who resettle elsewhere was authorized in May 1962. This allowance is designed to promote resettlement by allaying the fears of the refugees over being stranded without funds in a strange city. This allowance is also intended to increase the number of sponsors; by lessening their personal financial obligations, they can be asked to place greater emphasis on providing personal services. The intensive efforts made to accelerate resettlements and to stimu- late employment opportunities are reflected in the approximately 8,800 public assistance cases closed between January and June 1962. About 38 percent of the cases closed represented resettlements, and 31 percent represented reemployed persons. During the fiscal year, some 28,000 individuals, or 12,700 refugee family groups, were resettled in communities outside Florida. Rela- tively few of the resettled refugees (about 400 in June 1962) had to apply for assistance from local welfare agencies in the new communi- ties; and, in most cases, the duration of assistance payments was relatively short. Plans were completed for the Cuban Refugee Emergency Center in Miami to move into much larger quarters on July 1, 1962. It will now be possible to step up resettlement work because more workers can be added by the voluntary agencies for this purpose. The Center was established in Miami as a focal point for Cuban refugee regis- tration and resettlement activities and to coordinate the local aspects of the Federal Government’s general program of aid to Cuban refugees. 22 Department of Health, Education, and Welfare, 1962 At the beginning of fiscal year 1962, 35,000 Cuban refugees had registered at the Center, and registrations were at the rate of 5,600 a month. Registrations at the end of the fiscal year were at the rate of 7,400 a month, and 90,000 refugees registered at the Center during fiscal year 1962. ASSISTANCE PROVIDED TO CUBAN REFUGEES By request of the Commissioner of Social Security, the Bureau of Family Services became an active participant in the emergency pro- gram of assistance to Cuban refugees in January 1961, when mem- bers of the Bureau’s staff made an initial reconnaissance visit to Miami. The Bureau also participated in the Department’s task force which developed basic data for a comprehensive Federal pro- gram of health, education, employment, welfare, and resettlement services for needy Cuban refugees. In February 1961, the Bureau was assigned operating responsibility for temporary financial assistance and related social and welfare services. Under an agreement with the Social Security Administration, the Florida State Department of Public Welfare administers the Bureau’s part of the program, using assistance standards similar to those estab- lished for other Florida residents in providing the basic necessities of life and hospital care. Other State public welfare agencies provide assistance to refugees whose resettlement plans, for a variety of reasons, are not fulfilled or who need other services. By the end of June 1961, approximately 8,700 cases had received assistance under the program in the Miamiarea. By September 1961, this number had increased to 12,600 and to 28,000 by the end of June 1962. During this 9-month period, 31,500 applications were re- ceived—an average of 715 per week. Many were emergencies. Dur- ing August and September, the number of boat cases averaged 100 per week. These were persons who escaped Cuba in small craft and who needed immediate assistance and services, often medical care due to dehydration, overexposure, and injuries incurred en route. UNACCOMPANIED CUBAN REFUGEE CHILDREN’S PROGRAM By delegation from the Commissioner of Social Security, the Children’s Bureau is responsible for child welfare services, including the care and protection of unaccompanied Cuban children. These were described by the President as “the most defenseless and troubled group among the refugee population.” The Florida State Depart- ment of Public Welfare acts as agent for the Department of Health, Education, and Welfare and bears responsibility for the overall supervision and administration of the Cuban Child Welfare Pro- Social Security Administration 23 gram, implemented by contracts with voluntary agencies which ac- cept children for placement in group care or in foster family care. The four voluntary agencies under contract with the Florida State Department of Public Welfare are the Catholic Welfare Bureau, Miami; Jewish Family and Children’s Service, Miami; United He- brew Immigrant Aid Society, Inc.; and the Children’s Service Bureau of Dade County, Miami. These agencies have arranged placement for the children through cooperating child-placing agencies or institutions in the various States licensed or approved by appropriate State authorities. On June 30, 1962, more than 6,100 Cuban children had received either group care or been placed in foster family homes since the beginning of the program. More than 2,400 Cuban children, or about 40 percent of the total number placed had been reunited with their parents or with the family group as it was constituted in Cuba. Of the almost 4,000 children remaining under care on June 30, 1962, 71.2 percent were in group care and 19.7 percent in foster family homes. ‘Thirty-eight percent of the children were being cared for in the Miami area while 62 percent had been placed outside the Miami area in 38 States and 85 communities. The majority of the children under care on June 30, 1962, were adolescent boys; over 60 percent of the total number of children under care were boys, and over 85 percent were over 10 years of age. The large number of children arriving and the emergency nature of the program made it necessary to place over 75 percent of them in institutions or group homes until foster family homes became avail- able or until the children could be returned to their own parents or relatives. Since it has been assumed that these children will even- tually be returning to their parents who still have guardianship, the children cannot be placed for adoption. Old-Age, Survivors, and Disability Insurance The federally administered old-age, survivors, and disability in- surance program plays a major role in achieving our national goal of eliminating dependency and want. It provides the base upon which almost every American builds his plans for family security in old age and in the event of his death or disablement. Under the program about 9 out of 10 gainfully employed people—self-employed as well as employees—contribute toward providing income for themselves and their families when their work income is cut off or greatly reduced by retirement or is cut off by disability or death. In the course of a year about 74 million earners contribute to the program. More than 24 Department of Health, Education, and Welfare, 1962 9 out of 10 mothers and children are protected against loss of income resulting from the death of the family breadwinner. Eighty-seven percent of the people reaching age 65 in 1962 were eligible for retirement benefits and, based on present projections, this proportion will rise to about 95 percent by 1985. Two-thirds of the insured group under age 65—over 50 million workers—have enough credits to meet the work requirements for disability insurance bene- fits and this proportion will also increase each year. By the end of fiscal year 1962 over a billion dollars in benefits was being paid each month to about 17.3 million beneficiaries. These benefits make up a critical part of the income on which the retired aged, the permanently and totally disabled, and widows and orphans must rely for support. They are an especially important source of support for old people. A survey conducted by the Bureau of Old-Age and Survivors Insurance in 1957 indicated that for more than half of the aged social security beneficiaries the benefit is the only significant source of regular income, and for the great majority of the others the benefit is the major source of regular income. (Chart 1.) Of course, a survey of old-age and survivors insurance beneficiaries taken today would be expected to show that more beneficiaries CHART 1.—82 PERCENT OF AGED BENEFICIARIES HAD HALF OR MORE OF THEIR RETIRE- MENT INCOME FROM BENEFITS* Only 4% had less than 4 of their retirement income from benefits (median income, $4500) 18% had less than half of their retirement income * from benefits (median sence Sees income $2310) 38% had all their retirement income from benefits (median income, $680) 44% had half to 99% of their retirement income from benefits (median income, $1240) *Data from a nation-wide survey of aged beneficiaries made in 1957. Social Security Administration 25 have additional sources of retirement income. The number of people getting payments under private pension plans, for example, has in- creased substantially in recent years. Since the number of aged old- age and survivors insurance beneficiaries has grown at about the same rate, though, the proportion of old-age and survivors insurance bene- ficiaries getting such income would not be very much different today than it was in 1957. And, even though vesting provisions are becom- ing more common in private pension plans and the coverage of such plans is growing, old-age and survivors insurance benefits will con- tinue to be the main reliance of a majority of retired persons in the foreseeable future as it is today. Providing this regular social security income to many millions of families that might otherwise have been unable to provide for them- selves is not only vital to their welfare, it is also important in protect- ing society from the many evils bred by widespread poverty. In addition, the benefits paid under the program provide an assured source of purchasing power, in bad times as well as good times, and thus have an important stabilizing effect on our economy. The program also reinforces the American traditions of independ- ence and self-help. It provides the way for a person to earn his future security as he earns his living. He pays toward the cost of his protection out of his earnings. Since a person’s right to benefits does not depend on his current need but arises out of his past work, and since the benefit amount is related to earnings, the program is in line with our system of incentives. Furthermore, since benefits are pay- able regardless of the person’s financial resources, they serve as a base upon which he is encouraged to build additional income protec- tion for himself and for his family. Thus, by providing a continuing income for workers and their fam- ilies when earnings are cut off or greatly reduced by retirement in old age or are cut off by disability or death, the program increases the social and economic stability of our society, and it does this in a way that enhances the dignity and self-reliance of the people whose lives it touches. Because it has this tremendous social and economic im- pact on the American people, the program cannot be allowed to remain static. It must be responsive to the needs of the people in the face of changing social and economic conditions. If the program were allowed to remain static—for example, if bene- fits were not increased as wages, prices, and levels of living increase— it could not fulfill the role intended for it. In reporting on the bill that created the program in 1935, the Committee on Ways and Means of the House of Representatives spoke of benefits “. . . in amounts which will insure not merely subsistence but some of the comforts of 665171633 26 Department of Health, Education, and Welfare, 1962 life . . .”; and the Committee on Finance of the Senate spoke of bene- fits “. . . which will provide something more than merely reasonable subsistence. .. .” Although benefit increases and other improve- ments made over the years, reflecting changes in the economy and experience with the program, have gone a long way toward fulfilling this promise of security to the American people, much remains to be done. The Congress has recognized the need for periodic re-evaluation and improvement in the program and has given the Secretary of Health, Education, and Welfare responsibility (section 702 of the Social Se- curity Act) for “studying and making recommendations as to the most effective methods of providing economic security through social insurance, and as to legislation and matters of administrative policy concerning old-age pensions .. . and related subjects.” The effec- tiveness of the Department in carrying out this statutory duty is dependent to a large degree on research designed to evaluate the effec- tiveness of the protection provided by the program and to identify new trends and problems. There are now under way several major studies designed to supply basic information about the adequacy of present provisions and to point up areas in which provisions need to be strengthened. Unmet Needs HEALTH INSURANCE FOR THE ELDERLY A serious shortcoming in the protection afforded by the present program is the failure to protect the elderly against the tragic hard- ships resulting from expensive illness. In 1935 the great need of the aged was for income loss protection; the great need today is for pro- tection against the cost of health care. More people are living longer and so more people are exposed to the risk of the diseases that attack the aged. In 1935, there were 7.8 million people aged 65 and over (6.1 percent of the total population). By 1962 the aged numbered 17.4 mil- lion (9.3 percent of the population). Improved techniques and fa- cilities for providing health care are expensive. Since 1935, hospital charges have gone up 500 percent; during the same period, the cost of living has risen 200 percent. While the cash social security benefits go a long way in helping to meet regular and recurring expenses like food, clothing, and rent, the impact of health costs varies greatly from month to month and even from year to year. A person over 65 may have no appreciable health costs for several years and then in a short time have health costs running into thousands of dollars, costs that often mean financial disaster. And the problem of meeting high health care costs is one Social Security Administration 27 that confronts virtually all aged people—not just the very poor. (Chart 2.) Cash social security benefits, even when supplemented by other retirement income and savings, clearly cannot be expected to meet the costs of an expensive illness. Obviously, it would not be possible to increase cash social security benefits sufficiently to cover the large health care expenses that many aged people incur. While necessary for filling certain gaps, public assistance cannot be a good primary basis for financing the health needs of the elderly ; an assistance program is designed primarily to meet the problem of dependency after it occurs. Also, public assistance is seriously hand- icapped in meeting the medical care needs of even the very poor be- cause of the inadequacies of State financing. During fiscal year 1962, four high-income States accounted for about 90 percent of the payments made under the medical assistance for the aged provisions of the 1960 public assistance legislation. When confronted with a risk to which all are subject but which falls unevenly on those exposed, it is only natural to turn to insurance for protection. Unfortunately, the elderly have not been able to pro- tect themselves adequately through the existing health insurance ar- rangements as younger people have. The biggest obstacle is simply that most older people cannot afford adequate health insurance. In CHART 2.—WHEN HOSPITALIZATION BECOMES NECESSARY, MEDICAL COSTS FOR THE AGED RUN HIGH Mesieet Geared Medical costs of aged couples - husband or wife hospitalized - for 1961 $3,000 $2,890 2,000 ? 1,000 1-14 15-30 31-60 61 and over Number of days in hospital. Source: 1957 OASI Beneficiary Survey, adjusted for increases in medical care prices. 28 Department of Health, Education, and Welfare, 1962 1960, the average income of aged couples in this country was only about $2,500—less than one-half the average income of younger couples. For aged people living alone, the average annual income was about $1,050 a year as compared with about $2,570 for younger people living alone. There are, of course, other factors that put ade- quate health insurance out of reach of most of theaged. Their above- average hospital use results in high health costs which tend to make health insurance much more expensive for the aged than for younger people. (Chart 3.) Also, the aged, unlike working people who can CHART 3.—OLD PEOPLE GO TO THE HOSPITAL MORE OFTEN AND STAY LONGER THAN YOUNGER PERSONS RATIO OF PERSONS HOSPITALIZED DURING A YEAR 65 OR OVER ff: AVERAGE DAYS IN HOSPITAL PER PATIENT WME 65 OR OVER f: UNDER 65 get group coverage, must generally be insured on an individual basis, a form of health insurance that sometimes costs twice as much as group coverage offering the same protection. It is not surprising that only about one-half of the elderly have any health insurance, or that the insurance even this group can afford is often inadequate. The Administration has concluded that the social security mechan- ism offers the most practical solution to the problem of insuring the elderly against the cost of expensive illness. Through social secu- rity people would provide for the high health costs they will face in retirement by making contributions while they are working. Also, use of the social security mechanism would put coverage of the elderly on a group basis and avoid the high administrative costs which most elderly people must now pay under their individual enrollment poli- cies. Similarly, the sound and proven method of financing the exist- ing program, the work-related and dynamic character of social se- curity benefits and the principle of paying benefits as an earned right, the practically universal coverage of the program—all these charac- teristics are a part of the Administration’s health insurance proposal. Like the present social insurance program, the proposed health in- Social Security Administration 29 surance program would not provide more than basic protection. Since for the aged who need medical care the heaviest financial burden generally falls upon those needing hospitalization, it was concluded that insurance against the cost of hospital care was the proper point of concentration. As in the case of the present retirement, survivors, and disability benefits, the individual could build on his basic social insurance protection and by his own means obtain protection against the cost of physicians’ services, drugs, and other health needs that would not be covered under the proposed plan. And, like the present cash benefits program, the proposed health insurance program would depend upon public assistance to fill in the gaps that would remain. In fact, with a health insurance program for the aged, the financial problems faced by the States in their efforts to aid the aged with their medical costs would be greatly reduced; and it seems reasonable to expect that the States would be able to move toward a more effective health care program for the aged who would still need help in meet- ing their health care costs. Thus, the proposal would carry on the threefold attack against indigency in old age that has been so success- ful in the area of income maintenance—an attack carried out by social insurance, voluntary insurance, and public assistance—all working in partnership. KEEPING BENEFITS UP TO DATE Another problem now under study is that of keeping the amount of the benefits paid under the program up to date. While benefits have more than kept up with the changes in prices over the years, the program, in spite of the many improvements that have been made, has not kept up with the increased productivity of the American econ- omy, as reflected by higher wage levels, and the consequent rise in the level of living of the American worker. (Chart 4.) The basic structure of the program now has built into it only a small measure of response to changing wage levels. Under present law, benefit amounts over the long run will be based on a lifetime average of the worker’s earnings in covered work. As earnings go up, the average on which the benefits are based will be held below current wage levels by the lower wages paid in the past. This is not a problem at present because as new groups of workers have been brought into the program, the social security law has been changed so that, in the period immediately after these extensions of the program, benefit amounts could be based on earnings over a rela- tively short and recent period. This was done to avoid disadvantag- ing the newly covered workers who reached retirement age or died shortly after they came under the program. As a result, benefits awarded over the past decade have generally been based on fairly 30 Department of Health, Education, and Welfare, 1962 CHART 4.—BETWEEN 1940 AND 1961 THE PERCENTAGE INCREASE IN AVERAGE EARNINGS EXCEEDED THE PERCENTAGE INCREASE IN AVERAGE BENEFITS Percentage Increase 300 280 Earnings YYW: Benefits 260 240 220 200 180 PERIOD current wage levels. In 1961, for example, most of the benefits awarded were related to an average of no more than the worker’s highest 5 years of earnings after 1950; benefits awarded in 1962 were typically related to no more than the highest 6 years. Unless the law is changed, though, retirement benefits will eventually be based on a person’s average earnings over virtually all of his working life and the generally higher earnings level at the time of retirement will be offset by lower earnings in earlier years. Social Security Administration 31 Various ways in which benefits reasonably related to fairly current earnings could be provided, including the costs that most such plans involve, are being studied. Providing a benefit that is based on rea- sonably current earnings at the time it is awarded, though, will not, in itself, ensure the adequacy of benefits as wages and prices go up. The worker who retires today may still be living—and depending primarily on his social insurance benefit—10, 20, or even 30 years hence. The adequacy of his benefit will depend on whether it keeps pace with changes in the economy after he retires. This involves more than merely adjusting his benefits so that they will retain their original purchasing value. During this period of his retirement not only the price level but also the average level of living in the United States undoubtedly will rise. Basic to any consideration of the problem of keeping the program in line with the changing economy is the matter of adjusting the ceil- ing on the amount of earnings that can be taxed and credited toward benefits under the program. Only people whose annual earnings do not exceed $4,800—the upper limitation on earnings creditable for benefits—will have their benefit amounts related to their full earnings. Unless the ceiling on the amount of earnings that can be taxed and credited toward benefits is raised as earnings levels rise, more and more people will be earning above the ceiling and fewer people will have their benefit amounts related to their total earnings. In 1938, when the ceiling was $3,000, about 94 percent of all regularly employed men had all their earnings taxed-and counted toward benefits. In 1963, despite three increases in the ceiling since 1938, only about 39 percent of such workers will have all of their earnings taxed and counted toward benefits. (Chart 5.) While it is generally agreed among responsible individuals and groups who have studied the ques- tion that the ceiling does have to be raised from time to time as earn- ings go up, there have been differences of opinion on the amount and timing of increases. There is also a question of how these adjustments to keep the benefit structure of the program in line with changes in the economy should be made—that is, should automatic changes in benefits and the benefit base be provided for or should we continue to depend on periodic amendments to keep the program up to date? Some foreign systems have adopted provisions of the former kind, and the desirability and feasibility of adopting some automatic method of adjustment in this country is now under study. EXTENSION OF PROGRAM COVERAGE Also under study are the problems of extending coverage under the program to those who are still without its protection. Today about 32 Department of Health, Education, and Welfare, 1962 CHART 5.——-THE EARNINGS BASE COVERS THE TOTAL ANNUAL EARNINGS OF A SMALLER PERCENTAGE OF REGULARLY EMPLOYED MEN THAN IN THE PAST* EARNINGS BASES ZA 4,800 prea $4,200 RES] $3,600 $3,000 1937 1951 1955 1959 1963 (Estimated) *Year shown is the first year for which the higher earnings base was effective (except 1963). 9 out of 10 workers are covered. But there are still gaps in the cover- age of the program. The desirability of extending the protection of the old-age, survivors, and disability insurance program to virtually all regular workers of the Nation and their families has been recognized ever since the establishment of the program, and coverage extension proposals have received active consideration and support by the Con- gress and this Department. To the extent that progress is made toward permitting everyone employed with some degree of regularity to earn protection under the program, more and more workers and their families will of course obtain the valuable protection of the old- age, survivors, and disability insurance program and can look forward to benefits that are related to the level of past earnings from practically all gainful work. The largest group of workers still without social security coverage are the more than 2 million civilian employees of the Federal Govern- ment who are covered under Federal staff retirement programs. (Chart 6.) Many of these Federal employees switch once or more between the Federal service and work outside the Government, with the result that their retirement, survivor, and disability protection de- pends largely on chance. Some ultimately qualify for benefits under Social Security Administration 33 CHART 6.—9 OUT OF 10 WORKERS ARE COVERED UNDER THE OASDI PROGRAM FEDERAL CIVILIAN EMPLOYEES OTHERS * EMPLOYEES IN INDUSTRY AND COMMERCE FARM, DOMESTIC SERVICE, AND NONPROFIT EMPLOYEES ARMED FORCES STATE AND LOCAL GOVERNMENT EMPLOYEES (Covered or can be covered by state action) RAILROAD EMPLOYEES (Joint Coverage, OASDI - * Includes -- Railroad Retirement) Self Employed Physicians; ys FARM AND URBAN Persons earning less than minimum ired f A SELF EMPLOYED required for coveroge both a Federal staff retirement program and the old-age, survivors, and disability insurance program. Many others qualify under one program or another for benefits that reflect only part of their working lifetime and thus provide inadequate protection. Some fail to qualify under any program. If their employment with the Federal Government were covered by social security, people who spend part of their working lives in Fed- eral employment would be assured of retirement, survivors, and dis- ability insurance that would follow them as they shift from one job to another. Social security coverage for Federal employees, supple- mented by coverage under a staff retirement program, would provide them with protection comparable to that afforded many workers in private industry, employees of State and local governments, and mem- bers of the uniformed services. This improved protection can be furnished without impairing in any way the independence of the Fed- eral staff retirement programs and without undue cost to employees of the Government or the Government itself. Self-employed physicians are also excluded from social security coverage. Many self-employed doctors have become aware of the value of old-age, survivors, and disability insurance protection and 34 Department of Health, Education, and Welfare, 1962 many desire coverage. The position of their principal organiza- tion, however, continues to be opposed to social insurance coverage. Aside from civilian employees of the Federal Government and self- employed physicians, the great majority of workers for whom cover- age is not available under the Federal law are those who are irregularly employed, or have earnings which do not meet the minimum require- ments for coverage. While some of these workers will, over their working lifetimes, obtain old-age, survivors, and disability insurance protection as a result of their coverage under the program during periods of more regular employment or on the basis of the coverage of a member of their family, many will have no protection unless the law is changed to provide wider coverage of marginal workers. DISABILITY INSURANCE Continuing study is being made of the effectiveness of the protec- tion afforded disabled workers and their families under the program. Although the provisions for disability insurance benefits are still relatively new, the program now provides a large measure of protec- tion to workers and their families against loss of earnings due to severe long-term disability of the worker. As of June 30, 1962, over 114 million persons were receiving benefits amounting to more than $80 million a month on account of their own disabilities or that of the family earner. During the fiscal year definite progress was made in improving procedures and plans for obtaining more comprehensive evidence relating to the medical and vocational limitations of claimants. The Social Security Administration has also been developing more effec- tive techniques for giving due weight to vocational and other non- medical factors in evaluating disability. Regulations to this effect are being expanded. There remain several significant gaps in the protection provided by the disability provisions. For example, some workers are totally disabled over many months or even several years but cannot receive benefits for themselves or their families only because their disability is one from which they may be expected to recover. Another gap in the protection afforded disabled persons is repre- sented by wives and widows who are totally disabled before reaching age 62. These disabled wives and widows cannot qualify for any benefits under the present law unless they have a child in their care, although they are, of course, in much the same position as those aged 62 and over. Benefits are payable at age 62 to wives and widows without children because it seems reasonable to assume that at age 62 a large number of persons, for health or other reasons, may no longer be able to support themselves by working. Social Security Administration 35 Under present law, in the case of applications for disability pro- tection filed after June 30, 1962, the starting date of a period of dis- ability can be established only as far back as 18 months before the date of application, even though the actual onset of disability occurred much earlier. As a result, where filing of application is delayed, the benefits of disabled workers and their dependents may be substantially reduced, and some workers and their families may lose all rights to social security protection. The Department has recommended elimi- nation of the restriction in present law. THE RETIREMENT TEST There are strong pressures to liberalize, or to eliminate entirely, the provision in the law—generally called the retirement test—that is designed to assure that the funds available for the old-age, sur- vivors, and disability insurance program are used to pay benefits only to people who meet a reasonable test of retirement from full-time work and to their dependents and survivors who do not have sub- stantial earnings from work. In the 87th Congress more bills were introduced on the retirement test than on any other provision of the social security law. Included in the total of 629 social security bills are 32 bills to eliminate the test, 71 bills to raise the exempt amount, and 15 to change other provisions of the test. Under the present retirement test, $1 in benefits is withheld for each $2 of annual earnings between $1,200 and $1,700 and for each $1 above $1,700 (except that benefits are not withheld for any month in which the beneficiary neither earned wages of more than $100 nor rendered substantial services in self-employment, regardless of the amount of his annual earnings). The present test is a decided improvement over the test in effect before 1961, because it adjusts benefits in proportion to the amount of earnings above $1,200, thus reducing the deterrent to work and removing certain inequities that existed under the previous test. Under the present test, a beneficiary will always have more combined income from work plus benefits if he earns between $1,200 and $1,700 than if he earned only $1,200. However, there is no incentive, and even some deterrent, for a bene- ficiary to earn above $1,700 (unless he earns a good deal more than $1,700), since for every $1 in taxable earnings above $1,700 he loses $1 in tax-exempt benefits. It is, of course, desirable that the test be framed so as not to dis- courage beneficiaries from working. On the other hand, it does not seem desirable to use the limited funds of the program to provide benefits for people who have not suffered a loss of work income. An ideal retirement test for the old-age and survivors insurance program would be one that would not deter any retired person from seeking 36 Department of Health, Education, and Welfare, 1962 an opportunity to do all the work he wants to do and would also pre- vent the payment of benefits to people who are not retired but are working full time at their regular jobs after the age at which bene- fits are payable. Unfortunately, it is not possible to devise a test which in all respects meets both of these criteria. A test which in- cluded an annual exempt amount of more than $1,200 would allow people to do more work and still get all of their benefits for the year, but raising the exempt amount would be relatively costly and would result in paying benefits to additional people who had not suffered any reduction in earned income. Raising to $2,400 the present $1,700 limit on the area in which the $1-for-$2 reduction applies would im- prove incentives for older people to work, at a considerably smaller cost. No doubt the retirement test will continue to be an important area of concern to the Department, to Congress, and to the public. OTHER OBJECTIVES Another proposal now under consideration would cover tips as wages for social security purposes. Because tips are generally not counted as wages under the program, employees who receive a size- able part of their work income in the form of tips have only partial protection. As a result, their benefits do not reflect their true level of earnings. The Department of Health, Education, and Welfare and the Department of the Treasury have recommended a plan to provide that tips received by an employee in the course of his em- ployment, whether paid over to the employee by his employer or received directly from a person other than the employer, be con- sidered wages for purposes of the old-age, survivors, and disability insurance program and for income tax withholding. These are only some of the major projects now under way; many others are in various stages of development. In addition, numerous problems and proposed program changes of a minor and technical nature are always under study. What the Program Is Doing BENEFICIARIES AND BENEFIT AMOUNTS During the fiscal year ended June 30, 1962, benefits paid under the old-age, survivors, and disability insurance program totaled $13,- 669 million—an increase of $1,781 million over the amount paid in the preceding fiscal year. Benefit payments to disabled workers and their dependents were 44 percent higher than in fiscal year 1960-61 and totaled $1,011 million. Old-age and survivors insurance monthly benefits rose 13 percent to $12,484 million and lump-sum death pay- ments amounted to $174 million, about $7 million higher than in the previous fiscal year. Social Security Administration 37 About 3.2 million monthly benefits were awarded: in fiscal year 1962, almost half a million more than the previous record number made in fiscal year 1957. New highs were set for awards of old-age benefits (1,490,000), child’s benefits (590,000), and mother’s benefits (98,000). The record number of awards stemmed largely from (1) the 525,000 old-age benefits awarded to men aged 62-64, (2) the 195,000 wife’s or child’s benefits awarded to dependents of these men, and (3) the 169,000 monthly benefit awards attributable to the liberalized insured-status provisions in the 1960 and 1961 amend- ments. Old-age (retired-worker) benefits accounted for almost three- fourths of the awards under the new insured-status provisions; the average monthly amount for beneficiaries who became insured only because of the change in the law was about $43 compared with $80 for all other old-age benefit awards made in the fiscal year. The 492,000 monthly benefits awarded to disabled workers and their wives, husbands, and children was only 48,000 less than the record number awarded in the preceding fiscal year. The 851,000 lump-sum death payments awarded in fiscal year 1962 were 26,000 more than the previous record number in fiscal year 1961. About 823,000 deceased workers were represented in the awards. The average lump-sum amount per worker was $211.43, about a dollar higher than the average for the preceding year. The number and amount of monthly benefits in current-payment status increased sharply during fiscal year 1962. The number of monthly benefits went up nearly 1.7 million (11 percent)—294,000 more than the increase in fiscal year 1961—and the monthly rate of payment rose $136.1 million (14 percent). The growth in the number of beneficiaries produced most of the increase in the monthly rate. Other factors were the provisions in the 1961 amendments which raised the minimum monthly benefit and increased benefits for most aged survivors. At the end of June 1962, about 17.3 million beneficiaries were receiving benefits at a monthly rate of $1,128.2 million. A year earlier, monthly benefits totaling $992.0 million were going to 15.6 million beneficiaries. (Chart 7.) At the end of June 1962, about 13.5 million persons aged 62 or over were receiving old-age and survivors insurance monthly benefits—1.2 million more than in June 1961. Old-age (retired-worker) benefits were going to 69 percent of the aged group, wife’s or husband’s benefits to 17 percent, widow’s or widower’s to 13 percent, and the remainder— primarily parent’s benefits—to less than one-half of 1 percent. An increase of 351,000 for the 12 months brought the number of mothers and children receiving monthly benefits to 3.1 million. Disabled- worker beneficiaries under age 65 numbered 679,000, an increase of 121,000. 33 Department of Health, Education, and Welfare, 1962 CHART 7.—BOTH BENEFIT PAYMENTS AND NUMBER OF BENEFICIARIES HAVE INCREASED RAPIDLY SINCE 1950* BILLIONS OF DOLLARS MILLIONS 20 20 DEPENDENTS OF DISABLED BENEFICIARIES AGED SURVIVORS & DEPENDENTS Z Mish iat AGED WORKERS 0 ‘50 FISCAL YEARS *The 1950 amendments made major improvements In the program. **Payments in fiscal year. Includes a small percentage of lump-sum death payments. ***Beneficiaries on the rolls at the end of the fiscal year. In June 1962, the average old-age benefit being paid to a retired worker who had no dependents also receiving benefits was $72.40 a month. When the worker and his wife were both receiving benefits, the average family benefit was $127.10. For families composed of a disabled worker, his young wife, and one or more children, the average was $191.70, and for families consisting of a widowed mother and two children the average benefit was $191.40. The average monthly benefit for an aged widow alone was $65.40 in June; the rise of $7.20 from the average at the end of June 1961 resulted mainly from the higher rate provided by the 1961 amendments. Among beneficiaries on the rolls at the end of June 1962 whose benefits were based on earnings after 1950, the average family benefits being paid were $79.90 for a retired worker with no dependents receiving benefits, $135.20 for an aged couple, $200.70 for a disabled worker, his young wife, and one or more children, $212.70 for a widowed mother and two children, and $76.50 for an aged widow alone. At the end of June 1962, about 73 percent of all retired-worker families were re- ceiving benefits based on earnings after 1950. DISABILITY PROVISIONS During the fiscal year, a period of disability was established for about 245,000 workers, 25,000 more than the previous record number in fiscal year 1960-61. About 26,500 disabled persons aged 18 or over Social Security Administration 39 who had applied for child’s monthly benefits were found to have a disability that began before they were 18 years of age; the number was about 4,500 greater than in 1960-61. Since the beginning of the pro- gram, about 1,450,000 persons have been found to meet the disability requirements under the law. The number of disabled workers receiving monthly benefits rose 22 percent in the fiscal year and reached 679,000 at the end of June. Almost 473,000 benefits were being paid to the wives, husbands, and children of these beneficiaries—a 39 percent increase. By the end of June 1962 child’s monthly benefits were being paid at a monthly rate of $6.2 million to 135,000 disabled persons aged 18 or over—dependent sons or 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 receiving wife’s or mother’s benefits as the mothers of disabled persons receiving child’s benefits. A preliminary estimate indicates that by the end of June 1962, about 150,000 persons were receiving old-age benefits that had been increased by an average of $8 a month because their social security records were frozen for periods while they were disabled before reach- ing retirement age. About 55,000 wives, husbands, and children of retired workers and about 85,000 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 fiscal year 1962 based on the earnings records of almost 24,000 deceased workers were increased by an average of about $24 per worker. THE PROTECTION PROVIDED At the beginning of 1962, more than 89 million people had worked long enough in covered employment to be insured for benefits under the program (53 million of them permanently insured so that they could get benefits even if they had no more covered work). Of the population under age 65, an estimated 80 million were insured at the beginning of the calendar year. Some 44 million of these people were permanently insured—that is, whether or not they continue 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 1.8 million men and 1.1 million women aged 62-64 who were already eligible for old-age benefits but on a reduced basis.) The remaining 36 million were insured but must continue in covered work for an additional period to be insured per- manently. Nine out of 10 mothers and young children in the Nation can count on receiving monthly survivors insurance benefits if the 40 Department of Health, Education, and Welfare, 1962 family breadwinner should die. An estimated 51 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 17.3 million people aged 65 or over in the United States at the beginning of 1962, 76 percent were eligible for benefits under the program. (Chart 8.) Sixty-seven percent were actually receiving benefits, and 9 percent were not receiving benefits because they or their husbands were receiving substantial income from work. The percent- age of eligible aged persons is expected to rise to 84 by the beginning of 1966. INCOME AND DISBURSEMENTS Expenditures from the Federal Old-Age and Survivors Insurance Trust Fund during the fiscal year totaled $13,259 million, of which $12,658 million was for benefit payments, $350 million for transfers to the railroad retirement account and $251 million, including Treasury Department costs, for administrative expenses. Total receipts were $11,985 million including $11,455 million in net contributions and $530 million in interest on investments. Disbursements exceeded re- CHART 8.—THE NUMBER AND PERCENTAGE OF POPULATION AGED 65 AND OVER ELIGIBLE FOR OASDI BENEFITS ARE INCREASING* Number (in mittions) 20 Total aged population 15 WW, yj Population eligible for WA OASDI benefits Zi 1950 1960 *Figures as of January 1. Social Security Administration 41 ceipts by $1,274 million, the amount of the decrease in the trust fund during the year. At the end of June 1962 this fund totaled $19.6 billion. Total assets of the old-age and survivors insurance trust fund, except for $1,191 million held in cash, were invested in United States Government securities as required by law; $3.4 billion was invested in public issues (identical to Treasury securities owned by private investors), and $15.1 billion was 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 2.87 percent. Expenditures from the Federal Disability Insurance Trust Fund during fiscal year 1962 totaled $1,086 million, of which $1,011 million was for benefit payments, $11 million for transfers to the railroad retirement account, and the remainder—some $64 million—for admin- istrative expenses. Total receipts were $1,088 million, including $1,021 million in net contributions and $67 million in net interest on investments. Receipts exceeded disbursements by $2 million, the amount of increase in the fund during the year. At the end of June 1962, the fund totaled $2,507 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 $2,407 mil- lion in United States Government securities and a cash balance of $101 million. The invested assets consisted of $102 million in public issues and $2,304 million in securities of varying maturities issued for pur- chase 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 2.94 percent. Administering the Program During fiscal year 1962, the Bureau of Old-Age and Survivors Insurance faced two major administrative tasks; processing increased workloads growing out of the 1961 amendments, and continuing its program to improve administration and provide a higher quality of service to the public. Provisions of the 1961 amendments which added substantially to the Bureau’s growing workloads were those which permitted men to become entitled to old-age insurance benefits as early as age 62 with the benefits actuarially reduced to take account of the longer period of payment; liberalized the eligibility requirements and retirement test provisions; and raised the minimum and widows’ benefits. The application of electronic data processing to the Bureau’s operations 665171—63-—4 42 Department of Health, Education, and Welfare, 1962 was used to special advantage in implementing the latter provisions, as the benefit rates for about 3.7 million individuals whose benefits were increased by law were converted electronically. In the limited time allowed by the legislation, it would have been impossible to accomplish the conversion without the use of electronic equipment. The Bureau of Old-Age and Survivors Insurance received a total of 3,438,000 applications for old-age and survivors insurance during the year, plus 659,000 claims for disability insurance benefits. Social security account numbers were established for 3,902,000 persons, and approximately 3,220,000 duplicate account number cards were issued to individuals who had lost their cards or needed new cards for one reason or another. Approximately 264,726,000 earnings items were received from employers or the self-employed for posting to the indi- vidual accounts. The district offices handled more than 14,166,000 inquiries about the old-age, survivors, and disability insurance program. These are massive figures and they indicate why substantial num- bers of well-trained employees are necessary to administer the pro- gram properly—to pay benefits on time and in the right amount. Bureau staff on duty at the end of the year totaled 33,454, an increase of 2,482 employees during the year. Although there has been a series of significant amendments to the Social Security Act—in 7 out of the last 12 years—which have greatly increased the continuing level of Bureau work and the complexity of the job to be done, the Bureau of Old-Age and Survivors Insurance has demonstrated a capacity to do a larger and more involved job without a proportionate increase in manpower. Although Bureau workloads are more than four times as great as they were in 1950, Bureau staff required to handle these workloads is only some three times as large as in 1950. Thus, 77 employees now perform about the same amount of work as 100 did in 1950. This improvement in productivity has been achieved in spite of the increasing complexity of the program and the necessity of training large numbers of new personnel. Continuing efforts to improve the quality and timeliness of service to the public set the tone for all endeavors during the year. As an example of these efforts to improve public service, 17 additional dis- trict offices were opened in various sections of the country where surveys indicated the most pressing need. The new offices are located in the following cities: White Plains, Flushing, and Freeport, N.Y.; Butler, Pa.; Glen Burnie, Md.; Goldsboro and Greenville, N.C.; Elizabethtown and Campbellsville, Ky.; Cookeville, Tenn.; LaSalle, Ill.; East Liverpool, Ohio; Mt. Pleasant, Mich.; Big Spring, Tex.; Helena, Ark.; Whittier, Calif.; and Hilo, Hawaii. At the end of the fiscal year, the program was being administered through a network of Social Security Administration 43 601 district offices, 11 regional offices, 7 payment centers, and the central headquarters in Baltimore. In addition, public service visits are made on a regular and recurring basis to more than 3,600 com- munities, in order to bring a personalized service to as large a share of the population as is possible. A special service initiated during the year was a nationwide cam- paign to notify through the press, radio, and television all people over 65 who were made eligible for benefits by the 1960 and 1961 amend- ments but who had so far failed to apply for them. In the latter part of the fiscal year, a program was begun to advise by personal letter those aged insured workers who had not claimed benefits because they were unaware of their entitlement to them. This special program, which is being continued in fiscal year 1963, resulted in the filing, during fiscal year 1962, of almost 38,000 additional claims by workers and their dependents or survivors. An example of the Bureau’s continuing efforts to improve its serv- ices to beneficiaries already on the rolls is the special study of bene- ficiaries aged 85 and over whose numbers have been increasing at a rate of about 40,000 annually. At the beginning of 1961, there were approximately 285,000 such beneficiaries. Because the Bureau’s chan- nels of communication with them were limited, a question existed as to the situation of persons in the group. The Bureau, therefore, conducted a nationwide survey during the period from June through September 1961 to determine the extent to which benefit checks might be going to individuals who (1) were in need of a rep- resentative payee (i.e., who were incapable of managing their own funds and were in need of someone to receive and expend benefits on their behalf), or (2) had died without their deaths being reported to the Bureau. Personal contact was made with a sample of 1,937 bene- ficiaries over age 85. The results of the survey indicated that there was no problem of unreported deaths. Nor in any case was evidence found that benefits had been misappropriated or misused by persons responsible for the beneficiaries’ monthly checks. There were a num- ber of cases, however, in which the beneficiaries were not capable of handling their own funds and whose inability had not been previously reported. To safeguard benefit rights and to verify the continuing eligibility of this and other groups of beneficiaries, procedures have been developed for a permanent survey program to be conducted on an annual basis. Late in fiscal year 1962, the Bureau of Old-Age and Survivors In- surance initiated a 14-month pilot project in the State of Maryland to test the design for a nationwide study of the representative payee pro- cedures, under which the benefits of minor children and incapable adults are paid to another person for the beneficiary’s use. Data will 44 Department of Health, Education, and Welfare, 1962 be collected concerning the management of the benefit by the payee, the current situation and needs of beneficiaries, and the availability and use of community protective services and welfare facilities. The findings will provide a basis for appraising both the policies govern- ing the selection of representative payees and the procedures for safe- guarding the interest of beneficiaries having payees. The nationwide survey is scheduled for late 1963, upon completion of the Maryland pilot project. During the year, the Bureau successfully completed the installation of its data communications system, which interconnects the district offices, the regional offices, the payment centers, and the central head- quarters. ‘This system has made it possible for the Bureau to processs and pay insurance claims more rapidly than would otherwise be possi- ble and is an important part of the Bureau’s integrated data process- ing system for the handling of claims and related activities. The use of computers is, likewise, an integral part of this system and, during the year, the processing capabilities of the Bureau were substantially enlarged. The programs developed for these computers have sim- plified the process of certifying to the Treasury Disbursing Offices the payment of old-age, survivors, and disability insurance benefits, and are replacing statistical operations previously performed on electric accounting machines. The Bureau has further expanded its use of computer facilities by integrating the preparation of the award form with the certification of the earnings record in its claims operations. This process has reduced the clerical effort pre- viously devoted to forms preparation and the manual calculation of benefit amounts, and has reduced errors stemming from manual caleu- lations and transcriptions. Work to accomplish a total, Bureau-wide integration of claims proc- essing will proceed in fiscal year 1963 with simultaneous and inter- related attention being given to further development of electronic data processing and long-range total systems planning. A feasibility study was completed for the Bureau of Old-Age and Survivors Insurance in February 1961 by a research team from Johns Hopkins University to determine whether operations research tech- niques could be profitably applied to processing and organizational problems in the long-range aspects of the Bureau’s work. The feasi- bility study was thoroughly considered during the first half of fiscal year 1962 and, after an analysis of the detailed proposals submitted by six research organizations, a contract was signed on January 30, 1962, with Dunlap and Associates, Inc., Stamford, Conn., for opera- tions research assistance in the Bureau’s long-range studies of the claims process. The objectives established for the operations research program are, through use of the highly technical assistance supplied Social Security Administration 45 by the Dunlap firm, to: (1) determine the best size and number of claims review points and the best organizational structuring for claims development, adjudication and review; (2) supplement the Bureau’s studies of those aspects of the claims process requiring exer- cise of sound judgment; and (3) develop within the Bureau a staff capable of employing operations research techniques on a long-range basis. For purposes of the third objective, the Bureau selected five employees to form the nucleus of the internal operations research group. Detailed plans for on-the-job and academic training for the group were developed and initiated. In addition, the trainees are working as research assistants on the project. Karly in fiscal year 1962, the Bureau established a Foreign Claims Branch as a component of the Division of Claims Control, with re- sponsibility for the centralized administration of the old-age, survi- vors, and disability insurance program abroad. The establishment of this new Branch was prompted by numerous considerations, the most important of which were: (1) the increasing number of beneficiaries who reside abroad; and (2) a number of special problems in this area which have come to the Bureau’s attention in recent years. Many areas have been defined in which additional effort to improve Bureau operations abroad is required and in fiscal year 1963 the Bureau will be engaged in the solution of these problems. The Form SS-5 file of account number applications, record changes, and indicators of claims actions now contains approximately 175 million forms and is growing at the rate of 7,772,000 forms annually. The file now occupies about 40,000 square feet of floor space. At- tempts to find a method for converting this file to a more efficient sys- tem were continued and, during fiscal year 1962, the Bureau collabo- rated with systems engineers from seven companies in the development of a film-medium substitute for the Form SS-5 file. Schemes devel- oped by these companies range from sophisticated microfilm systems to video tape processes, with a considerable degree of automation of updating and reference operations. Serious consideration is now being given to each of the proposals for converting the file and it is expected that one system will be adopted if it can be shown con- clusively that any increase in cost would be offset by increased efficiency in updating and reference operations. By agreement between the Department of Health, Education, and Welfare and the Treasury Department, the Bureau of Old-Age and Survivors Insurance has incurred a substantial new workload in the issuance of social security account numbers for Internal Revenue Serv- ice identification purposes. This enumeration project for Internal Revenue Service involves the Bureau in four distinct phases. The first phase was concluded on March 30, 1962, and resulted in the proc- 46 Department of Health, Education, and Welfare, 1962 essing of 116,312 applications for account numbers that had been filled out by Federal Civil Service employees. The second phase, started near the end of the fiscal year, will involve the processing of applications for account numbers to be completed by approximately 2 million people who filed 1961 and who will file 1962 income tax re- turns. The third phase will start in the second quarter of fiscal year 1963 and will involve the processing of approximately 2,750,000 appli- cations for account numbers to be completed by the recipients of divi- dends, interest, and other income subject to income tax reporting. The last phase of this enumeration project is expected to start in the first half of fiscal year 1964 and will involve those taxpayers and recip- ients of dividends, interest, etc., who did not obtain account numbers in the earlier phases. Details of this entire project are being devel- oped jointly by the Internal Revenue Service and the Bureau. In continuing its efforts for greater operating economy and effi- ciency, the Bureau implemented new and revised procedures and ob- tained new and improved equipment for its earnings record activities. Two of the Bureau’s older computers were replaced by newer models with greater speed and capacity. Experience with this new equip- ment is extremely gratifying. Under the improved system, a number of programs have been combined to save processing time, to produce the end product at an earlier date, and to take advantage of the greater memory capacity of the newer model. Further improvements in the operations of these new computers were achieved when the newer high speed tape units, which record data at a density of 800 characters to the inch, were placed in operation during the fourth quarter of the fiscal year. During the year, there was an increase in employers’ use of mag- netic tape reporting of employees’ earnings. By the end of fiscal year 1962, over 4 million employee earnings items per quarter from 28 private companies, 6 State and local governments, and 4 military organizations were being reported on magnetic tape. This method of reporting employee earnings saves time and money both for the Government and for the employers who make use of it. A total of 258 employers, each having 10,000 or more employees, are currently participating in the Bureau’s direct submittal plan (re- porting employees’ earnings direct to the Social Security Administra- tion rather than through the Internal Revenue Service). Asa result, 7,600,000 earnings items are being received early each quarter, thereby enabling the Bureau to get a correspondingly early start on updating individual earnings accounts. Both the magnetic tape reporting and direct submittal plans have been used only by employers reporting 10,000 or more employees. In fiscal year 1963, the Bureau is planning to extend each of these plans to employers who have between 5,000 and 10,000 employees. Social Security Administration 47 An electronic data processing system for payroll and leave account- ing for central office personnel was implemented during the year. The transition to the new system was accomplished in the latter half of fiscal year 1962 in a series of steps, beginning with a data verifica- tion and clean-up project, and concluding with a period of parallel operations to verify the accuracy of the new system before discon- tinuing the old procedures. Adequate space for Bureau personnel and equipment continues to be a problem, although alleviated somewhat in Baltimore by con- struction of an Annex (largely completed during the fiscal year) to the Social Security Building. The Annex was ready for occupancy in August 1962 and most of the Bureau personnel located in down- town Baltimore buildings have been moved into the new space. Plans are now being developed to construct a 5-bay enlargement of the Annex, to alleviate further crowded conditions in the Social Security Building and to meet additional space needs. Lack of adequate space for district offices and payment centers remains a serious problem. Research Activities In cooperation with the Division of Program Research of the Social Security Administration and the Bureau of the Census, the Bureau of Old-Age and Survivors Insurance participated in the planning and preparatory work for a survey of all persons 62 years of age and over and a companion study of mother-child old-age and survivors insurance beneficiaries. The Bureau of Old-Age and Survivors In- surance is also participating with the Bureau of Family Services in planning or carrying out a number of studies designed to determine: (a) why a significant number of public assistance recipients are not qualifying for old-age, survivors, and disability insurance benefits, and (b) why old-age, survivors, and disability insurance beneficiaries require public assistance. The Bureau also advanced preparations for a longitudinal study of aged beneficiaries, which is now scheduled to be launched with an initial survey in the spring of 1964. During the year the Bureau released additional analyses based on data from the 1957 cross-section survey of beneficiaries. Data from the 1960 survey of disability beneficiaries and of disabled workers who were awarded a period of disability for benefit computation purposes in the eight largest metro- politan areas were tabulated in preparation for analysis and release of the survey findings. The Bureau published a monograph on average and aggregate paid manhours of employment of wage workers in covered employment, by industry division. 48 Department of Health, Education, and Welfare, 1962 During the year the Bureau also made progress in its continuing survey of applicants for old-age benefits designed to provide data on, among other things, the factors affecting the worker’s decision to apply for benefits. A study of persons who failed to meet the requirements for a period of disability or disability benefits in 1957, 1958, and 1959 was con- tinued. Reports of findings from this study will be prepared during the coming fiscal year comparing the characteristics and subsequent experience of workers who were denied a period of disability in these years. The Bureau, in cooperation with the Office of Vocational Rehabilita- tion, continued its study of the rehabilitation experience of 2,100 dis- abled persons who were referred by the Bureau to State rehabilitation agencies and who were reported as rehabilitated in 1957-58. A report is scheduled for completion in fiscal 1963. The Bureau published an analysis of provisions for survivor benefits in private pension plans. Work advanced on an analysis of findings from the Bureau’s survey of State and local retirement systems. Dur- ing the coming fiscal year the Bureau, jointly with the Bureau of Labor Statistics, will continue to develop a program of studies in the private pension and welfare field. Work on other socio-economic research studies was advanced during the year, including studies of the taxation of income of the aged, and a cohort study of 61,000 men and women wage earners with earnings in 1957 that shows changes in the cumulative employment and cumula- tive wage credits of these wage earners as they aged from 1937 to 1957. Financing the Program The old-age, survivors, and disability insurance system has an esti- mated benefit cost that is very closely in balance with contribution income. In enacting the 1961 amendments Congress again made clear its intent that the program continue to be self-supporting from con- tributions 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 experi- Social Security Administration 49 ence may vary from the actuarial assumptions. Nonetheless, the intent that the system be actuarially sound can be expressed in law by a contribution schedule that, according to the intermediate-cost estimate, results in the system being substantially in balance. The Department, in carrying out its policy of continually reexamining the cost estimates of the program, is now conducting a complete review of its cost estimates in the light of the latest information available. 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 actu- arial 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 financ- ing of old-age and survivors insurance benefits. The estimated level- premium cost of the disability benefits (adjusted to allow for adminis- trative expenses and interest earnings on the existing trust fund) on an intermediate basis is 0.56 percent of payroll. Contribution income has been specifically allocated to finance these benefits; this income is equivalent to 0.50 percent of payroll, leaving a small actuarial in- sufficiency of 0.06 percent of payroll. Future experience with this program will be studied carefully to determine whether the actuarial cost factors used are appropriate or if the financing basis needs to be modified. Summary and Conclusions The old-age, survivors, and disability insurance program is a major institution in the economic and social life of the Nation. Over the years, this “social utility” has proven to be an effective and efficient method of preventing widespread dependency and want that is in every way consistent with the principles of our free society. If it is to fully realize its potential contribution toward eliminating poverty in our society, though, it can not be allowed to remain static. It must respond to changing conditions and emerging problems. The Depart- 50 Department of Health, Education, and Welfare, 1962 ment of Health, Education, and Welfare will continue carefully to evaluate the effectiveness of the present program and to plan for its improvement. The legislative history of the program gives us every reason to believe that the program will be kept effective and responsive to changing needs and by efficient administration that it will be able to fulfill its promise of security to the American people. Bureau of Hearings and Appeals Prior to 1939, when the Bureau of Old-Age and Survivors Insur- ance denied an application for social security benefits, the determina- tion was final. Recognizing that a claimant who disagreed with such determination was entitled to an opportunity to protect his rights, Congress in that year amended the Social Security Act so as to pro- vide for administrative hearings and judicial review on claims for benefits. To implement that provision there was established within the Social Security Administration an office which was charged with responsibility of conducting quasi-judicial proceedings and issuing decisions which would be subject to review by the courts. These adjudicative responsibilities are carried out through hearing examiners stationed in the various States and certain territories, and through the Appeals Council sitting in Washington, D.C. The hear- ing examiners conduct hearings during which the claimant has the right to a representative of his own choosing. Sworn testimony is recorded verbatim by a reporter, documentary evidence is admissible, and oral and written arguments may be presented. After a full record has been made, the hearing examiner issues a written decision which may aflirm, reverse or modify the determination of the Bureau of Old-Age and Survivors Insurance. Such decision is subject to full review by the Appeals Council at its option. If the Council decides to review a case it then issues a written decision. Thereafter, a claimant who continues to feel aggrieved may appeal to the courts. Following enactment of the disability provisions of the Social Se- curity Act, the number of requests for hearings filed by claimants increased sharply until a high of 23,450 was reached in fiscal 1959— an increase of 500 percent over 1955. The number declined in 1960 and 1961; but statutory amendments in those years resulted in 21,400 requests for hearings in fiscal 1962, an increase of 52 percent over the preceding fiscal year (Chart 9). The goal is to afford each claimant a prompt hearing and a decision by the hearing examiner within 90 days thereafter. Efforts to achieve that goal have been made through a substantial increase in the size of the hearing examiner corps, the maintenance of a continuing program of technical training. and the use of such devices as overtime and reassignment of cases. 51 Social Security Administration (-153)P96L (1S3)€961 7961 196L 096 6S6L Ls6l 9S6L ONION3d WLOL Ss, 4 a3uv3a1d Wwi0l alls Pa [/ fi y aad a | Sy i ¢ e | WY \— canaose Wwio1L i = - +f 1 \ ] i md i 4 vs Ni BIE id a / S| E i NeeR\ al SS = a -—/ cs 4 Sea! ; \. | 7 a eel 4 | ALNG NO SYININYX3 SNISVSH ONIGN3d GNV ‘GauxVva1d ‘G3AIZIIY IVLOL *SLSINDIY ONIYVIH—6 LaVHO py ‘s4u P®zO499'7 1961 BOIL sjucwasnbey s6ujui03 Auyiqosig pezos0q!9 - gs6l “Soy Syuowpuowy Asj1qos1g YF0D - 9S6L 40 sjuoupu amy ozo014 Ayj1q051g - ps6 “SOY 4 pe spuosno oz 8t nes 52 Department of Health, Education, and Welfare, 1962 The tremendous increase in hearing requests has also brought about concomitant increase in the workload of the Appeals Council (Chart 10). Thus, whereas 970 requests for review of hearing examiners’ de- cisions were filed in 1956, the number rose to 7,300 in 1960. After a decline in 1961, new statutory amendments contributed in part to an increase in requests for review to 6,400 in 1962. It is estimated that over 9,000 such requests will be filed in fiscal 1963 and a comparable number in fiscal 1964. In addition, the greatly increased volume of litigation has added special burdens (Chart 11). The drastic increase in workload has created major problems in maintaining our goal of avoiding “delayed” justice, while continuing to render proper and fair decisions. In addition to the staff increase, and step-up in technical training, other innovations have been made. For example, in order to obtain as complete a record as possible in disability cases, plans have been made to facilitate the appearance of physicians and vocational specialists as witnesses at hearings. ‘Their expert testimony should contribute greatly to the decisional process. In 1960, a Subcommittee of the House Ways and Means Committee issued a preliminary report on the social security disability program, in which some of the problem areas which had arisen in the appeals process were considered. The Commissioner thereupon selected an outstanding law firm experienced in administrative law to survey the operation of the Office of Hearings and Appeals. The report of this study, submitted to the Commissioner in December 1960, while making recommendations for certain changes and reorganization, stated in its conclusions: “We are impressed, moreover, with the efforts now being made further to reduce the time required to dispose of claims.” The culmination of the reviews of the appeals process was the Secre- tary’s action during the past year in creating the Bureau of Hearings and Appeals to replace and assume the functions of the Office of Hear- ingsand Appeals. The Secretary stated that elevation of the appeals organization to Bureau status would “emphasize its importance and its independence from the initial adjudicating body, the Bureau of Old-Age and Survivors Insurance,” and would “give increased em- phasis to the management needs of what has become a large organi- zation by providing the framework for full management staffing.” The important changes in internal organization during the year were the establishment of the position of Deputy Director, who also serves as Deputy Chairman of the Appeals Council, in order to relieve the Director and Chairman of many responsibilities of administration; the separation of general administrative functions from those relating to field operations, through the creation of the Division of Adminis- tration and the Field Division with increased responsibilities; and the expansion of the Program Division. Social Security Administration 53 CHART 10.—REVIEWS BEFORE APPEALS COUNCIL: RECEIPTS, DISPOSALS, AND PENDING Thousands TOTAL RECEIVED 1962 196! 1969 1959 1958 1957 1956 Z96L 1961 O96 6S6L & G3 14 SNOIL: ice Sv MAID faa pi — s = NOILDV LYNOD ONION3d Department of Health, Education, and Welfare, 1962 x G3 114 SNOILDV TIAID ALITSVSIC 34 ae oort ce : 0091 00zz oorz 009z 7 — | 008z oo00c =) ooze Z96L ANNF HONOYHL ZS61 WadW3DTO ‘ONIGN3d GNV ‘d3q0194q ‘d3ild SNOILOV MAID JAILVINWNI— LL LYVHO Social Security Administration 55 Public Assistance Public assistance is intended to help individuals and families meet their essential needs when they are unable to do so themselves, and other resources, including social insurance, are not adequate or avail- able to them. Federal governmental aid, first provided in the early 1930’s to meet emergency financial need due to unemployment, was replaced by long-range preventive measures under the Social Security Act passed in 1935 and subsequently amended. By 1950 the measures included (1) social insurance against the risks of unemployment, old-age, and dependency of widows and children because of the death of the wage earner; and (2) federally aided State public assistance to help meet basic unmet needs of certain dependent persons—the needy aged, blind, or disabled, and needy children deprived of parental care or support because of the death, incapacity, or absence of a parent. Through subsequent legislative changes, the scope and coverage of the Federal-State public assistance programs were broadened, and the amount of Federal financial participation increased to enable States to raise assistance payments to keep pace more fully with rising costs of living. In 1950, the permanently and totally disabled were included, and measures were added to extend and improve medical care for the needy. In 1956, clarification was made of the availability of Federal financial participation in the costs of providing services to help needy persons increase their capacity for more independent living. Federal funds were also authorized, but not appropriated, for training to upgrade the qualifications of public welfare personnel. In 1960, a separate program of medical assistance for the aged was established, and in 1961, the aid to dependent children program (ADC) was temporarily broadened to provide assistance to needy children in families with an unemployed parent, and to pay for foster family care for certain ADC children. Legislative changes made during the past quarter century to meet more adequately the needs of a growing population (especially the aged and children) in a period of rising prices contributed to increased welfare caseloads and expenditures. (See chart 12.) In recent years, public concern about welfare expenditures and de- pendency of welfare recipients has been reflected in widespread publicity about individual instances of fraud, unmarried parenthood, desertion, and other social problems. But there has also been an increasing recognition that the economic need of some groups is a consequence of a healthy, growing industrial society in which tech- nological change and automation have produced economic and social problems with which some individuals, families, and even communities, can no longer cope. 56 Department of Health, Education, and Welfare, 1962 CHART 12.—WHY INCREASED PUBLIC ASSISTANCE EXPENDITURES? 1949-1561 Ly (AMOUNTS IN MILLIONS) INCREASE IN UMBER OF RECIPIENTS FEDERAL SHARE OF ASSISTANCE PAYMENTS INCREASED BY FEDERAL On semviceeal LEGISLATION - ADDED BY FEDERAL LEGISLATION 2 1 Represents 131 percent increase over 1949. 2 Includes $199 million vendor medical payments in OAA, ADC, and AB; $166 million in APTD; $142 million for the adult caretaker in ADC; $31 million in MAA; $8 million for Guam, Puerto Rico, and the Virgin Islands; $7 million for additional State plans; and $3 million for children of unemployed parents in ADC. Public concern over rising welfare costs, as well as wide interest in welfare methods and goals, led in 1961 to a concerted departmental effort to find new and better ways of dealing with dependency. Soon after taking office, Secretary Ribicoff announced that improvement of welfare programs would be one of his principal objectives. Early in the year, he sought and received advice and reports from several groups of experts in welfare and related fields on how welfare pro- grams could be more effectively used as a constructive force in pre- venting and alleviating dependency and other related social problems. According to Secretary Ribicoff: “What has emerged from this review is a clear recognition of the fact that today in 1961 the outlook of 1935 isnot uptodate. Born of depression emergencies, the original Federal welfare legislation well met the problems of that time. But the quarter of a century that has passed has taught us many new things. We are not satisfied with our welfare programs, and we know there is much that can be done to improve them. We must move toward two objectives: eliminating whatever abuses have crept into these programs and developing more constructive approaches to get people off assistance and back into useful roles in society.” To accomplish these goals, there was general agreement of the need for: (1) greater emphasis on rehabilitation and family-centered social services; (2) more adequate protection and support of needy children ; (3)an administrative structure more helpful to the States in achieving Social Security Administration 57 these objectives, including better qualified public welfare personnel, and methods of dealing more effectively with fraud and location of deserting parents; and (4) increased development and utilization of community resources in dealing with social welfare problems. Administrative Actions in Fiscal 1962 A substantial start in modifying the public assistance program was made under existing legislative authority in December 1961 when Secretary Ribicoff directed the Commissioner of Social Security to: change the name of the Bureau of Public Assistance to the Bureau of Family Services to reflect the increased emphasis on family-centered welfare services; establish a new Division of Welfare Services (absorbing the functions of the former Division of Program Standards and Development) to implement the welfare services emphasis, to assist the States in the development of their services programs, and to study work and training activities and other incen- tives to employment ; modify existing Federal policy to permit and encourage the States to allow income of children to be conserved for appropriate future needs (such as the costs of education, and training for employment) without deduction from the public assistance payment; and require State agencies to: identify needy families with problems such as unmarried parenthood, deser- tion, and children in other hazardous home situations; and assign such cases to qualified staff for the provision of services, including frequent home visits, and close coordination to assure maximum use of the child welfare staff for consultation and services; improve staff training and development programs through an assessment of personnel and training needs to carry out the objectives of the proposed family-welfare-service-oriented program ; establish a special unit responsible for locating deserting parents of needy children, assisting law enforcement officers and others in their efforts to require effective discharge of family responsibilities, reuniting families whenever feasible, and obtaining support; and include in the State plan pertinent points relating to methods, procedures, and placement of responsibility for dealing with instances of suspected fraud, and submittal of periodic reports on the nature and extent of this problem. In January 1962, Secretary Ribicoff announced the following addi- tional administrative actions: extension of the earlier policy change allowing conservation of income of ADC children for future educational and training purposes to permit the in- come of the ADC mother also to be used for this purpose, and identification 665171—63——5 58 Department of Health, Education, and Welfare, 1962 of specific steps to be taken by the States to assure that ADC children obtain the full educational opportunities available to them; organization of a work group to assist the Department in simplifying and improving welfare forms and procedures, and in eliminating unnecessary paperwork to allow more staff time for work with recipients ; establishment of a work group to develop further informaton on the causes of illegitimacy and the most effective methods of dealing with it, to review existing programs to see where further study is needed, to highlight promising areas of research, and to develop programs that will help combat illegitimacy and the economic dependency of children; and expansion in the Social Security Administration’s research facilities to assure continuing attention to developing and carrying out studies in the broad field of human resources and social welfare, and appointment of a continuing com- mittee to advise on the Department’s research planning responsibilities, espe- cially in finding ways to reduce dependency and to stimulate self-care and self-support. Cooperative effort was also encouraged with the following newly established groups: the Children’s Bureau’s special Youth Development Unit, to help local com- munities plan for improved coordination of welfare services to meet special problems of youth, particularly those on ADC; the Office of Education’s Youth Development Section, to promote better co- ordination between school authorities and welfare agencies in working on school problems of children, especially those on welfare rolls, and on the school drop-out problem ; the Office of Vocational Rehabilitation’s task force established to determine what administrative steps can be taken under present law to expand and improve vocational rehabilitation services for disabled persons on welfare rolls; and the special committee of deans of schools of social work, to increase the supply of adequately trained personnel for public welfare. A further policy change announced by the Secretary in March was designed to help mental patients return to community living by per- mitting Federal financial participation in assistance payments to them or on their behalf on their conditional release from a mental insti- tution, if the patient goes to his own home, the home of a relative, a boarding home, or to a nursing home not specifically established for psychiatric care. STATE AGENCY REACTION TO ADMINISTRATIVE CHANGES State agency administrators meeting in Washington the latter part of January to discuss the implications of the earlier administrative Social Security Administration 59 actions and to plan for their implementation at the State and local level reported “basic agreement between the two levels of government, an eagerness to move forward on a broad front in improving and strengthening public welfare programs, and satisfaction in the far- reaching progressive leadership given by Secretary Ribicoff, Wilbur Cohen, and other members of the Department.” They pointed up areas needing further clarification; asked for help in developing in-service training programs, in preparing plan material, and in case classification; and urged the Department to give strong leadership in helping social work gain increased recognition. They also asked for guide materials in planning for social services on a statewide basis, recognizing the lack of community resources in remote areas and the differences in staff capabilities. They cautioned that a sound service program must be based upon adequate financial assist- ance and expressed concern that an increased emphasis on services to children not result in diminished services for the aged, blind, and disabled. While there was unanimous support for the goals and objectives of both the administrative directives and the overall legislative proposals, the State administrators pointed out that “such changes take much time . . . we will of necessity be slow in implementation of many of the facets; we will not promptly reduce the caseloads or costs, and there are many factors which indicate we will always have high, and perhaps higher, caseloads and increased costs. . . .” Some of the Secretary’s directives and many of the recommendations made by the State administrators and other groups, including the White House Conference on Aging, were subsequently reflected in amendments to the Social Security Act passed in 1962. Public Welfare Amendments of 1962 Public Law 87-543, approved July 25, 1962, provides a legislative base for implementing the Administration’s goals to help needy per- sons attain or retain capability for self-care and self-support, and to maintain and strengthen family life for children. Through new financial incentives, the States were urged to provide welfare services that are likely to prevent or reduce dependency, and -to develop training programs to increase the number and skill of workers providing such services. Increased Federal funds were al- located for the adult assistance programs to enable the States to in- crease payments to recipients. In aid to families with dependent children (AFDC formerly ADC), Federal financial participation was authorized in expenditures for work performed by adult relatives under community work and training programs that provide opportunities 60 Department of Health, Education, and Welfare, 1962 for conserving and developing work skills. Special protection for the child was provided in the event his parent or other relative does not spend the assistance money for the benefit of the child. Several new provisions also were directed toward more effective administration of the welfare programs. In approving the Public Welfare Amendments of 1962, President Kennedy said, “the new legislation marks a real turning point in the Nation’s effort to cope realistically and helpfully with pressing welfare problems.” The major provisions of the law, directed to certain objectives, are outlined below. To Promote Self-Reliance Federal participation in the State’s administrative costs of providing pre- scribed or specified services in all the assistance programs was increased to encourage States to provide social services to alleviate economic or personal dependency or contribute to its prevention. Services to persons formerly but not now receiving assistance, or considered likely to become dependent within a specified time, however, are to be provided only upon request. In the period September 1, 1962, through June 30, 1963, 75-percent matching is available for certain services designated by the Secretary. Beginning July 1, 1963, the Secretary is authorized to prescribe these minimum services. If the minimum prescribed services are provided, 75-percent matching is available in the costs of such services and also in other specified, but optional, services that may prevent or reduce dependency. If a State does not provide the prescribed minimum services, Federal participation will be 50 percent, as before. As previously, in all programs, the choice remains with the State agency as to whether services are to be provided, but the State plan must include a de- scription of any services that are made available and steps to assure maximum use of related agencies. Beginning July 1, 1963, in the aid to families with dependent children program (AFDC) the State plan must also provide for the development and application of such welfare and related services as may be necessary because of home conditions and the specific needs of each child, and for the coordination of services provided under the public assistance program with those provided by the State’s child welfare program. Services generally are to be provided by public assistance staff. If the State public assistance agency determines, within the limits prescribed by the Secre- tary, that it cannot offer welfare and related services economically or effi- ciently and such services are not reasonably available otherwise to persons in need of them, these services may be purchased, by agreement, from other State agencies. There is further provision concerning vocational rehabilita- tion services (as defined in the Vocational Rehabilitation Act, e.g., counseling, training, and placement for the physically or mentally handicapped) available through the State vocational rehabilitation agency, or which this agency is willing to provide pursuant to agreement. Social Security Administration 61 To Upgrade Staff Skill in Providing Services A major objective of the new legislation—to help people move from dependency toward self-reliance—is largely dependent upon personnel capable of providing necessary services. To upgrade staff skill, Federal participation was increased from 50 to 75 percent in a State’s expenditures for training personnel employed or preparing for employment in public assistance. This applies to the admin- istrative costs of in-service training programs, training grants for prospective employees, and stipends to welfare staff on educational leave, effective Sep- tember 1, 1962, for States with an approved staff development plan. Be- ginning July 1, 1963, the 75-percent matching of a State’s costs for staff development will be available only to those States which also provide the minimum prescribed services to recipients. Funds were also authorized for other training to be administered by the Department directly or through grants to or contracts with institutions of higher learning without State financial participation, but no appropriation was made under this authority in 1962. To Provide Work Incentives and Encourage Efforts To Achieve Self-Support To encourage States to provide useful work experience and constructive train- ing for adults receiving assistance under aid to families with dependent chil- dren, Federal participation was provided in the form of payments for work by those employed on community work and training projects that meet pre- seribed working conditions and safeguards. All specified requirements became effective October 1, 1962. However, States were permitted to claim Federal matching for work payments in any period beginning July 1, 1961, through September 30, 1962, if specified conditions, with certain exceptions, were met. This program was authorized for a tempo- rary period, ending June 30, 1967. Other work incentives were afforded through provisions that (1) require tak- ing into account necessary expenses that can reasonably be attributed to the earning of income in determining need under all the federally aided assistance programs; (2) permit exemption of some earned income in determining need under the old-age assistance program; (3) require disregarding, for not more than 12 months, income and resources in determining need for an aid to the blind recipient who has a plan for achieving self-support in addition to the amount of earned income otherwise exempt; and (4) permit States to set aside earned or other income of an AFDC family for future identifiable needs. Thus, in determining need and the amount of an old-age assistance payment, States are permitted to disregard the first $10 of earned income plus one-half the remainder of the first $50, effective January 1, 1963. In the aid to the blind program, in addition to the provision of a 1960 amend- ment, effective July 1, 1962, which requires disregarding the first $85 per month of earned income plus one-half of earned income in excess of $85, further provision was made to disregard additional amounts of other income and resources for a period not to exceed 12 months to enable a blind individual to fulfill a State-agency-approved plan for achieving self-support. 62 Department of Health, Education, and Welfare, 1962 To Extend the Adequacy and Scope of Public Assistance The formula for determining the amount of Federal participation in State publie assistance payments to the aged, blind, and disabled was liberalized, effective October 1, 1962. The Federal share of the average monthly assistance payment in old-age assistance, aid to the blind, and aid to the permanently and totally disabled was raised from 44 of the first $31 to 2%p5 of the first $35, and the average maximum was increased from $66 to $70. In approving the 1962 amendments, President Kennedy pointed out that, “The reports of both the Ways and Means Committee of the House of Representa- tives and of the Committee on Finance of the Senate make it clear that the States are expected to pass these additional funds on to the recipients under these programs. It would truly be a miscarriage of justice and a frustration of the legislative intent if these new Federal funds merely replaced existing State funds, and those for whom the increase was intended were denied the full benefit.” Assistance to dependent children of unemployed parents, authorized in 1961 for a 14-month period ending June 30, 1962, was extended for 5 years, to June 30, 1967. Also, the aid to families with dependent children program was broadened to include both parents as eligible recipients when deprivation of parental care or support is due to incapacity or unemployment. To assure that an assistance payment made on behalf of a child is spent in his best interests, in instances where there is evidence that the money is being used in ways that are detrimental to or threaten the well-being of the child, the State agency may take any of the following actions. It may provide counseling and guidance services to the relative payee on the proper use of such payment; it may advise the relative that continued failure to use the payment for the benefit of the child may result in court appointment of a legal representative or guardian, or in criminal or civil penalties imposed by a court of competent jurisdiction ; or under specified conditions, it may make a “protective payment” without loss of Federal funds. A “protective payment” is a money payment to a substitute payee—a third party, such as a relative, friend, or individual who is a member of a church, community service group, or public or voluntary agency who is interested in the welfare of the family. When such payments are made, safeguards are included to assure that (1) consideration is given in the selection of a sub- stitute payee to qualifications for assuming this responsibility and accept- ability of the individual to the family, the needs, and problems in the home and the nature of the difficulties that led to the present need for help in money management; and (2) special efforts or services are directed toward helping the relative payee develop his ability to manage funds, since the purpose of the protective payment is to strengthen the child’s own family rather than to provide care for the child in a foster home. The State may receive full Federal financial participation in protective pay- ments made to a limited number of recipients (not exceeding 5 percent of the number of other AFDC recipients in the State for such month) during the period October 1, 1962, through June 30, 1967. To increase resources for the care of children removed from the home, the following actions were taken. ‘Social Security Administration 63 (1) The 1961 amendment, which temporarily provided Federal financial participation in State expenditures for a dependent child in a foster family home, was made permanent. (2) The limitation that responsibility for placement and care be only in the State or local agency administering AFDC was modified until June 30, 1963, to include responsibility for placement and care by other public agencies. However, a current interagency agreement must assure the development of a plan for the children that will accomplish the objectives of the AFDC program. Before Mareh 1963, the Secretary is to report on the effectiveness of this provision and recommend further action. (3) Federal participation was also temporarily authorized in State AFDC payments in the form of foster care for children who must be removed from their home and placed in a licensed or approved private nouprofit child-care institution (from October 1, 1962, through September 30, 1964). Payments for maintenance, such as board and room, clothing, medical care, and other needs—but not overhead costs of the institution—may be made to the institution. The program of assistance to Americans repatriated to the United States from abroad was extended from June 30, 1962, through June 30, 1964. This pro- gram was authorized by Congress in 1961 because of the need for emergency aid that might result from international crises or severe personal problems which befall the increasing number of Americans living or traveling abroad. To Assure More Effective Administration A move toward a noncategorical approach was reflected in title XVI added to the Social Security Act to permit replacing the present separate State plans with a single plan consolidating all adult programs, effective October 1, 1962. (In States which have a separate agency for the blind under title X, that agency may be designated to administer or supervise as a separate plan the portion of the State plan under title XVI which relates to blind individuals. ) The new title does not, in most instances, modify existing provisions in titles I, X, and XIV, but to the extent that eligibility conditions are the same for aged, blind, or disabled persons, the new program under a single State plan permits simplification. The single State plan would have a common standard for determining need and payment, except for the disregard of earned income of those in the aged and blind groups; and assistance payments for the aged, blind, or disabled would be averaged in computing the amount of Federal financial participation under the new program. Also, the separate and additional Federal financial participation for medical care authorized under title I will be available under title XVI for medical care for the blind or disabled, as well as the aged. Medical care for the first 42 days of an aged individual’s stay in a general medical institution as a result of a diagnosis of psychosis or tuberculosis is also extended to blind or disabled persons. To stimulate experimental projects to test new ideas and ways of dealing with public welfare problems, the Secretary is permitted to waive State plan require- ments that may interfere with such demonstrations, such as the requirement that a plan must be in effect throughout the State, since such projects usually are not statewide, The law also authorizes use of not more than $2 million 64 Department of Health, Education, and Welfare, 1962 a year, for 5 years, of funds appropriated for public assistance to assist in paying that portion of the costs of projects not otherwise subject to Federal participation. A 12-member Advisory Council on Public Welfare is to be appointed in 1964. This group, representing the general public and various interests concerned with public and voluntary welfare programs, is to review and make recom- mendations on the Federal-State public assistance and child welfare services programs; and to study the relationship between the public assistance and the old-age, survivors, and disability insurance programs. The first Advisory Council is to submit a report to the Secretary by July 1, 1966. Subsequent similar councils are also authorized. Trends in Caseloads and Expenditures In June 1962 assistance was available in all 54 jurisdictions of the country (including the District of Columbia, Guam, Puerto Rico, and the Virgin Islands) under federally aided programs of old-age as- sistance (OAA), aid to the blind (AB), and aid to families with dependent children (AFDC). Fifteen jurisdictions administering AFDC also made payments to unemployed-parent families, compared with 6 in June 1961, and 13 jurisdictions made payments for the foster-family care of children, compared with 1 in June 1961. Federally aided programs for the permanently and totally disabled were administered by 50 jurisdictions, and an additional APTD program was started in Arizona on July 1, 1962. Twenty-seven jurisdictions, compared with 10 in June 1961, had a program of medical assistance for the aged, now in its second year. General assistance (wholly State and/or locally financed), in some form for some persons, was available in all 54 jurisdictions. CASELOADS About 7.3 million persons were receiving aid in June 1962 under the six public assistance programs—old-age assistance, medical assistance for the aged, aid to families with dependent children, aid to the per- manently and totally disabled, aid to the blind, and general assistance. With increases in MAA, AFDC, and APTD more than offsetting de- creases in OAA, AB, and GA, the net increase in June 1962 over June 1961 was 180,000 recipients (or 2.5 percent)—considerably less than the 432,000 (or 6.3 percent) increase in June 1961 over June 1960. There were 101,600 recipients of MAA in the 27 States with such programs in June 1962 compared with 46,000 receiving such assistance in June 1961, when only 10 States had such programs. The MAA pro- gram was initiated in October 1960 under an amendment passed in September 1960. Social Security Administration 65 In AFDC, the 3,692,600 recipients (including 2,853,400 children in 944,000 families) assisted in June 1962 represents an increase of 310,000 over June 1961. This 9.2-percent increase is attributable in part to the increase of 125,000 recipients in unemployed-parent fami- lies, and also reflects the continuing growth in child population. The 417,000 persons receiving APTD in June 1962 represents an increase of 8.7 percent over the 384,000 aided a year earlier. The increase in 1962, slightly higher than the 5.8-percent increase in June 1961 over June 1960, is a continuation of the gradual but steady in- crease in the number aided under this program since its initiation in 1950. The 2.2 million recipients of old-age assistance in June 1962 repre- sents a 59,000 (or 2.6 percent) decrease from June 1961, due largely to liberalizations in eligibility requirements for the old-age, survivors, and disability insurance program (OASDI) and transfers of aged persons in medical institutions and/or nursing homes to newly es- tablished programs of MAA. A similar 2.6-percent decline in OAA recipients in June 1961 from June 1960 is part of the slow but steady decline in the number receiving OAA since 1951. However, the 34 percent of OAA recipients receiving both public assistance and social insurance in June 1962 because their insurance benefits and other resources were insufficient to meet their basic needs, such as medical care, is a continuation of the steady increase in con- current receipt of assistance and insurance. Since 1950 when OAA and OASDI were concurrently received by less than one-tenth of the total OAA caseload, the number receiving both has steadily grown until they represented slightly more than one-third of all OAA re- cipients in 1962. The 100,400 recipients of aid to the blind in June 1962 represents a 4.9-percent decline from the 106,000 aided in June 1961. The June- to-June decline in 1962 is greater than the 2.2-percent decrease for the same period between 1961 and 1960. The 812,000 persons in 340,000 cases receiving general assistance in June 1962 represents a 16-percent decrease from the 1,040,000 persons in 405,000 cases receiving general assistance a year earlier. One in 25 persons in the total population was a recipient of public assistance in June 1962. The recipient rate varied widely by program. One out of every 8 aged persons received old-age assistance; only 1 out of every 24 children received AFDC. The recipient rate also varied by State, due in part to variations in per capita income. States with relatively high per capita income are likely to have a relatively small proportion of their population in need; conversely, States with low per capita income usually have a high incidence of need. 66 Department of Health, Education, and Welfare, 1962 Although a majority of persons applying for assistance do not receive OASDI benefits (e.g., voluntary reports from 29 States in- dicate that of the cases approved January—June 1961, 97 percent in AFDC, 97 percent in GA, 90 percent in APTD, 86 percent in AB, and 53 percent in OAA were not receiving OASDI benefits), a State’s as- sistance recipient rate is usually inversely related to the proportion of persons in the State who do receive OASDI benefits. In general, in States where more persons receive OASDI benefits, the proportion of the aged receiving OAA is lower than in States with smaller numbers of OASDI beneficiaries. Voluntary reports from 29 States also indicate that one out of every six applicants for whom old-age assistance was approved during the last 6 months of fiscal 1961 found it necessary to apply for assistance because of increased need for medical care or because of exhaustion or reduction of assets to meet medical care expenses during the 6 months preceding application. For persons who have been receiving OASDI benefits and have found it necessary to ask for old-age assist- ance, the proportion for whom medical care is the immediate reason was more than twice as high (29.3 percent) as that for persons ap- proved for assistance who are not receiving OASDI benefits (12.2 percent). EXPENDITURES Total assistance expenditures, including vendor payments for medical care, for all six programs for the fiscal year 1962 were $4,269 million—an 8.4-percent increase over expenditures in 1961. Total expenditures in June 1962 compared with a year earlier reflect both inereases of $220 million or 19.6 percent in AFDC, $153 million or 357.2 percent in MAA, and $33 million or 11.0 percent in APTD; and decreases of $16 million or 0.8 percent in OAA, $1 million or 1.2 percent in AB, and $58 million or 12.4 percent in GA programs in 52 States. Assistance payments during 1962 represented about a cent per dollar of total personal income in the Nation during 1961. The cost per person in the United States was $22.92. In aid to families with dependent children, the national average monthly payment was $31.48 per recipient in June 1962, compared with $30.30 a year earlier. Average payments per recipient ranged from $9.15 in Mississippi (except for $3.76 in Puerto Rico) to $47.52 in New Jersey. In old-age assistance, the average payment was $72.55 per recipient in June 1962, compared with $67.85 in June 1961—an increase of nearly $5. Average payments ranged from $36.03 in Mississippi (except for $9.05 in Puerto Rico and $33.89 in the Virgin Islands) to $103.42 in California. For all States, the average medical care vendor Sacial Security Administration 67 payment per recipient of old-age assistance increased from $11.12 per recipient in June 1961 to $14.49 in June 1962. In medical assistance for the aged, the average vendor payment per recipient, as reported by 26 of the 27 States with programs in June 1962, was $171.36, compared with $201.83 per recipient in the 9 States making payments in June 1961. Average MAA payments ranged from $18.40 in Kentucky (except for $18.10 in the Virgin Islands *) to $394.15 in Louisiana. In aid to the permanently and totally disabled, the average payment per recipient was $72 in June 1962, compared with $68.21 a year earlier. The nearly $4 increase was centered Jargely in vendor pay- ments. Average payments ranged from $34.44 in Mississippi (except for $8.75 in Puerto Rico, $24.85 in Guam, and $34.08 in the Virgin Islands) to $131.77 in Massachusetts. In aid to the blind, the average payment per recipient was $77.47 in June 1962, compared with $73.36 a year earlier, Average payments ranged from $38.13 in Mississippi (except for $8.33 in Puerto Rico *) to $121.72 in California. In State and/or locally financed general assistance programs, the average payment per case excluding medical care vendor payments, was $65.78 in June 1962, compared with $65.13 in June 1961 for 52 jurisdictions (Idaho and Indiana excluded). Average payments per case ranged from $12.65 in Alabama (except for $8.31 in Puerto Rico *) to $123.94 in New Jersey. Thirty-seven percent of all cases were family cases, including an average of 4.4 persons per family. The wide variation in average monthly payments between States is closely related to per capita income and willingness to support public assistance programs. States with relatively high per capita income usually have a rela- tively small proportion of their population in need, but a relatively greater fiscal capacity to meet needs that occur. States with relatively high per capita income, thus, usually make relatively higher payments than States with low per capita income in which there is both a high incidence of need and low fiscal capacity. Some States with low per capita income make a strong effort to finance public assistance, and as a result, their expenditures per in- habitant are larger than other States with similar per capita income. In general, however, States with low per capita income provide smaller average amounts of assistance. Therefore, matching formulas for Federal participation in State expenditures for public assistance 1Too few recipients in Guam and New Hampshire to compute a reliable average pay- iene few recipients in Guam and the Virgin Islands to compute a reliable average payment. * Too few recipients in Guam to compute a reliable average payment. 68 Department of Health, Education, and Welfare, 1962 have been designed to be of relatively greatest help financially to low-income States. Factors contributing to increased expenditures in 1962 include: the increase of 125,000 persons in the unemployed segment of the AFDC program, growth in existing MAA programs and initiation of new programs in 17 States, initiation of vendor payments in OAA for certain types of medical care in 6 States, an increase in rates for vendor medical services in several States due to the rising cost of medical care, and an increase in the level of money payments to meet the rising cost of living. Higher level of payments in several States resulted from actions taken to utilize additional Federal funds made available for OAA, AB, and APTD under the 1961 amendments to the Social Security Act. Cost standards used in determining eligibility for and the amount of assistance payments, for example, were also increased in one or more programs in about a fourth of the States, a few States raised their maximums on individual monthly payments, and some States removed or lessened percentage reductions in need met. SOURCE OF FUNDS FOR PUBLIC ASSISTANCE PAYMENTS Of $4,269 million expended for the six public assistance programs in fiscal 1962, about 54.0 percent, or $2,304 million, came from Federal funds; 34.7 percent, or $1,482 million, from the States; and 11.3 per- cent, or $483 million, from the localities. For the five special types of public assistance, the Federal share of total costs was 59.7 percent; the State share, 32.7 percent; and the local share, 7.7 percent. Program Developments In addition to the new program provisions provided through admin- istrative action or legislative change during the year, significant developments have occurred in several program areas. DEVELOPMENTS IN MEDICAL CARE By 1960, more than four-fifths of the Nation’s jurisdictions had some provision in their public assistance programs to pay for medical care directly to the suppliers of such services, commonly known as the vendor payment, and many of the jurisdictions provided for some items of medical care in the money payment to recipients. However, the majority of the States are not yet providing the broad scope of services needed by most sick people. In September 1960, two additional medical care provisions for the aged were authorized by Congress under Public Law 86-778, popularly known as the Kerr-Mills legislation. These included: (1) a new Social Security Administration 69 Federal-State program of medical assistance for the aged with Federal funds to help the States pay for medical care for older persons whose income and other resources are above the financial level of eligibility for old-age assistance, but not sufficient to meet the costs of their medical care needs; and (2) increased Federal funds to enable the States to improve medical care services in their existing old-age assistance programs, or to develop such medical care services. The 1960 provisions augmented the amount of medical care that could be made available previously under federally aided public assistance programs. As a result, payments by States to suppliers of medical care under the federally aided public assistance programs, including medical assistance for the aged, have increased from less than $400 million in fiscal 1960 to about $712 million in fiscal 1962. About $195 million of the 1962 expenditures are attributable to the new medical assistance for the aged program. Medical Assistance for the Aged (MAA) The Federal provisions of the MAA program are liberal and flexible. The Federal Government shares with the States in the total cost of the program without any limitation on the individual payment or on total State expenditures. The amount of Federal participation ranges from 50 to 80 percent of medical care expenditures paid to suppliers of medical care in behalf of eligible recipients, the higher percentages going to the States with lowest per capita income. Under this new program States may make available a broad scope of medical services: inpatient hospital services; skilled nursing-home services; physicians’ services; outpatient hospital or clinic services; home health care services; private-duty nursing services; physical therapy and related services; dental services; laboratory and X-ray services; prescribed drugs; eyeglasses, dentures, and prosthetic de- vices; diagnostic, screening, and preventive services; and any other medical or remedial care recognized under State law. Although the law specifies a broad scope of care and services that may be provided as medical assistance for the aged, the States deter- mine the kinds and extent of services for which costs will be assumed and the conditions of eligibility for such services. Relatively few conditions are imposed by the Federal act: the State must include both institutional and noninstitutional care; a durational residence requirement is not permitted; a lien may not be placed against the property of any individual prior to his death on account of medical assistance properly paid in his behalf, and recovery of such assistance cannot be made except from his estate after the death of the surviving spouse, if any; no charge, such as an enrollment fee or premium, is permitted as a condition of eligibility; and disclosure of information 70 Department of Health, Education, and Welfare, 1962 concerning applicants and recipients is restricted to purposes directly connected with the administration of the program. State implementation of the MAA program.—By August 31, 1962, nalf the States and 3 other jurisdictions had MAA programs in opera- tion; the number had doubled from 14 States in August 1961 to 28 States *in August 1962. The number of recipients under this program nearly doubled during the year, from 59,100 in August 1961 to 108,900 in August 1962. About a third of the recipients for whom MAA was authorized since it began came from other assistance programs pri- marily in States that paid for nursing-home care, and whose average payments under OAA exceeded the maximum amounts in which Fed- eral financial participation is available. There is considerable range among the participating States both in the number and proportion of persons receiving medical care under MAA and in the average payment per recipient. For example, in August 1962, the number aided ranged from 20 in New Hampshire to 30,503 in New York, and 2 States made no payments during the month. Nearly two-thirds of the recipients were in three States. Average MAA payments ranged from $20.86 in Kentucky to $418.47 in Illinois. The average payment for all States was $215.61. The States, in most instances, began on a conservative basis. Of the 28 States (25 States and 3 other jurisdictions) operating medical assistance for the aged programs in August 1962, 3 provided for comprehensive care in each of the 5 major areas of medical services (hospitalization, nursing-home care, physicians’ services, prescribed drugs, and dental care). Four additional States gave some care in each of the major areas but with significant limitations on the condi- tion for which care would be provided or the extent of such care. Six States provided only two services, one institutional and one non- institutional, the minimum required by law. All 28 jurisdictions provided for hospitalization on some basis, but with varying limitations as to the number of days of hospital care and the nature of the medical need, e.g., emergency or life-endangering conditions. Nursing-home care was included in 18 of the State programs. In four of these States, care was restricted to post-hospital care. In the other 14 States, re- strictions related largely to rates of payment. Twenty-six States provided physicians’ services but in two of these States, such services were available only as outpatient clinic services. In 17 programs, 4 Alabama, Arkansas, California, Connecticut, Guam, Hawaii, Idaho, Illinois, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, New Hampshire, New York, North Dakota, Oklahoma, Oregon, Pennsylvania, Puerto Rico, South Carolina, Tennessee, Utah, Vermont, Virgin Islands, Washington, and West Virginia. Social Security Administration ed physicians’ services were limited as to the number of visits during a given period or the nature of the illness or condition covered. Prescribed drugs were included in 16 States, and were available without narrow limitations in 8 of these States. Dental care was covered in 11 States but with restrictions; most of the States did not provide for dentures. Five of the 28 States provided for more medical services in MAA than in OAA; 13 provided substantially the same breadth of service ag was available in old-age assistance through vendor-payment provi- sions; 8 provided for less service than for OAA recipients, usually omitting dental care, prescribed drugs, or nursing-home care; and in 2, the variations prevented classifications under any of the above headings. The extent to which States are reaching into the group of medically indigent through this program is limited. The basis on which eligi- bility for MAA is determined by the different States is only slightly higher than that used for old-age assistance, as evidenced by the con- sideration given by the States to income and other resources, such as personal property, life insurance, and real property in determining eligibility. In addition, in more than half the 28 States, persons otherwise eligible can receive help under MAA only after health insurance or such other potential resource has been utilized. Eight States also include a deductible feature—an amount, such as $50 or $100, which must have been obligated by an individual in a year for medical care before he can be eligible for participation in the program. Consideration of income.—Generally, the States with MAA pro- grams use a specified level of income in determining financial eligibil- ity. In most States, a person with income in excess of a specified amount is ineligible. In six States, the income figure represents the amount considered as needed for living expenses, and income or avail- able assets beyond that amount are evaluated against the probable cost of medical care needed by the individual. The most liberal annual income figure used by a State is $2,000 for a single person. The most common amount is $1,500, and the next most common amount is $1,200, with two States below this figure. The most common figure of $1,500 approximates the highest figure—$1,587—in a State OAA pro- gram (excluding Alaska) for a single person living alone for essential maintenance costs, in January 1961. Consideration of life inswrance.—T wenty-six of the 28 States exempt life insurance under specified conditions, such as: 1 State, a reasonable cash surrender value; 15 States, within a dollar maximum ranging from $500 to $2,000, with $1,000 the most usual limit; and 10 States, within the dollar maximum for all personal property. The other two 72 Department of Health, Education, and Welfare, 1962 States provide for full utilization of any cash resource available from the insurance. Consideration of other personal property—All 28 States take into account the availability of other personal property to meet medical care costs. In 26 States, there are dollar limits on the amount that may be held without affecting eligibility. These range from $50 to $2,800, with most between $1,000 and $2,500. Nine include both real and personal property within the stated limit. Consideration of real property.—All States exempt the property used as a home but six States require that equity in the home not ex- ceed a stated amount. With respect to real property other than that used as a home, five States do not allow holding such property, and four States set limits on the value of such property that can be held but require it to be income-producing. Of the other States, some re- quire the value of such property in excess of certain limits to be ap- plied to medical costs, and others specify limits on the value of such property which may be held. In general, States have been more liberal in the limits set for real and personal property which an individual may retain and remain eligible for medical assistance for the aged than is true for old-age assistance. However, with but 28 of the 54 jurisdictions utilizing Federal aid available for MAA, the limited scope of medical services being provided, and limitations imposed on income and resources, the benefits of the MAA program are reaching a relatively small segment of the elderly of the Nation, and the potential of the Federal legisla- tion is not yet being realized. With more experience in this area, some States will probably expand their MAA programs, and others will establish programs, but the cost factor could continue to be a deterrent to expansion. The Secretary of Health, Education, and Welfare, in transmitting to the House Ways and Means Committee the “Report on Medical Care Under Public Assistance” covering the first year’s experience under the Kerr-Mills legislation (October 1960-October 1961), con- cluded that “to rely on existing public assistance legislation alone as a means of meeting the medical-care needs of aged persons would not only fail to cover many aged people in need, but would also be very costly in general revenues. The legislation could, and in my judg- ment should, be a supplement to the type of protection which would be afforded under the administration’s proposals for health insurance for the aged through social security.” Increased Medical Care Provisions Under Old-Age Assistance (OAA) The 1960 legislation provided for a substantial expansion in Federal participation in payments to suppliers of medical care for old-age Social Security Administration 73 assistance recipients. In addition to the usual share in assistance payments, the Federal Government provided an additional amount based on expenditures for payments to suppliers of medical care up to a monthly maximum of $12 per recipient (raised to $15 in 1961). The additional funds were intended to enable States to improve or to ini- tiate medical care services in old-age assistance programs. Between October 1, 1960, (the effective date of the new legislation) and August 31, 1962, of the 48 States which were already making some vendor payments for medical care costs of old-age assistance recipients, 25 expanded or improved the coverage or content of medical care serv- ices, 4 broadened the scope by including persons only in need of medi- cal care, and 14 continued the level of services previously offered. Ten of the other 11 jurisdictions provided medical care services for the first time through vendor payments, and 1 secured legislative author- ity for vendor payments for old-age assistance recipients. Scope of medical care provided—Of the 53 jurisdictions making vendor payments for medical care services for OAA recipients in August 1962, 22 were providing a relatively comprehensive scope of services—15 made vendor payments in each of the five major kinds of medical care (hospital care, nursing-home care, physicians’ serv- ices, dental care, and prescribed drugs) ; and 7 used the vendor-pay- ment method for all of these services except nursing-home care (for which payment was made through the money payment to the recipient). Of the other 31 States providing vendor-medical care payments, 11 provided 4 of the major services (2 of them used the money payment for nursing-home care) ; 5 provided hospital and nursing-home care plus other physicians’ services or prescribed drugs; and 15 provided 1 or 2 of the major services, usually hospitalization. Content of medical care provided—Hospitalization, the kind of care most frequently provided through the vendor payment, was available in 47 States, although usually limited as to the nature of illness or duration of care needed. (One State used the money pay- ment for hospital care.) Nursing-home care was provided through the vendor payment by 36 States (14 used the money payment for this—in 4 of these States, the maximum on the individual money payment was $100 or less per month, and in the others, the limitations were related to rates for specified kinds of care). Payments to physicians, the service next most frequently provided through the vendor payment, was available in 38 States (6 used the money payment for physicians’ services), although usually restricted the number of physicians’ visits. 665171636 74 Department of Health, Education, and Welfare, 1962 Dental services were provided by 30 States through the vendor payment (9 used the money payment), but frequently were limited to relief of pain or necessary extractions; some States which include dentures limited the circumstances under which such services may be authorized. Prescribed drugs were provided by 31 States primarily through the vendor payment (9 used the money payment). Many States also provided for other medical services through the vendor payment, such as special nursing care in the patient’s own home, transportation to receive medical care, or rehabilitative serv- ices (physical or speech therapy, outpatient laboratory and diagnostic services, and prosthetic apphances or special equipment). States with high average vendor payments presumably provide a more adequate level of medical care to aged recipients. Chart 13 shows that in June 1962 States having high average vendor pay- ments per recipient under the MAA program were widely scattered throughout the country. For OAA, States with relatively high aver- age vendor payments for medical care were largely concentrated in the Northeast, the North-central, and the Pacific Northwest areas. Averages were generally low in the South. As indicated in chart 14 the amount of expenditures for medical services provided to recipients of the different federally aided assist- ance programs varies greatly. This is clearly evident in the wide CHART 13.—MEDICAL ASSISTANCE FOR THE AGED: AVERAGE PAYMENT PER RECIPIENT FOR VENDOR PAYMENTS FOR MEDICAL CARE, JUNE 1962 DOLLARS [J wo proanaw - PROGRAM IN OPERATION BUT NO PAYMENTS IN JUNE, OR NUMBER OF PAYMENTS TOO SMALL TO COMPUTE VALIO AVERAGE LESS THAN 100 UZZZA 100-198 ESS HAWAII £00 OF MORE Mm Social Security Administration . 75 CHART 14.—-VENDOR PAYMENTS FOR MEDICAL CARE AVERAGE PAYMENT PER RECIPIENT PAYMENTS, FISCAL YEAR 1962 JUNE 1962 _ly IN MILLIONS—TOTAL $712 PROGRAM AMOUNT MAA $171.65 APTD 15,58 OAA 14.49 AB 8,08 AFOC 2.29 1 Except for MAA, averages based on cases receiving money payments, vendor payments for medical care,or both. range in the average monthly medical vendor payment per recipient in June 1962—from $2.29 in aid to families with dependent children to $171.36 in medical assistance for the aged. These averages, however, not only reflect differences in medical care available under the pro- grams, but also differences in utilization of services, availability of treatment through other sources, and relative costs of similar care for different types of cases. Efforts To Improve Medical Care Programs High priority was given to consideration of major policy issues under the 1960 medical care provisions, development of instructional material for State use in improving the scope and quality of their medical services, and issuance of interpretative materials. Consulta- tion 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 also met with Bureau staff in Washington to consider specific State situations. The Bureau released to the States a statement entitled “Financial Eligibility: Medical Assistance for the Aged,” summarizing the cri- teria and methods governing financial eligibility requirements devel- oped by the first 10 States to begin MAA programs. “Casework Serv- ices in Public Assistance Medical Care,” issued by the Bureau in May 1962 as a guide for the use of State agencies, discusses the skills and services frequently necessary to enable those requiring medical atten- tion to obtain early treatment, to use the opportunity fully, and to maintain the benefits of such care. This publication, available from the U.S. Government Printing Office, is now in its second printing. 76 Department of Health, Education, and Welfare, 1962 Work continued, with the help of the medical advisory group ap- pointed in 1961, on developing the content for guides and recom- mended standards in the provision of medical care by public assist- ance agencies. Policy was also developed to implement the administrative actions taken by the Secretary on March 5, 1962, liberalizing the interpreta- tion governing Federal financial participation in assistance to or on behalf of persons on conditional release from institutions for mental illness. A modification in the definition of “inmate” permits Federal financial participation in assistance payments to or on behalf of per- sons who are on conditional release from mental institutions without regard to the kind of control still exercised by the institution. After October 1, 1962, the State public assistance agency must develop an agreement with the State agency or agencies responsible for the care of the mentally ill. A report of a study of selected content of State provisions for the blind in four States was prepared as a basis for strengthening services for this group of recipients. Work materials were also developed for a review of State practice in the administration of medical care pro- visions on a comparable base throughout the Nation. Discussions of mutual benefit were undertaken with State super- vising ophthalmologists associated with aid to the blind programs to exchange ideas about their role in this category of public assistance; and with an ad hoc committee of the American Hospital Association to discuss plans for a study of hospital utilization by aged assistance recipients. Joint field visits were made with the Community Health Services Division of the Public Health Service to four States and two other jurisdictions to study relationships between State health and welfare departments that have contracts or agreements for the pro- vision or purchase of medical care for public assistance recipients. Information was supplied in 1961 for the report, “Medical Resources Available to Meet the Needs of Public Assistance Recipients.” A subsequent report, “Medical Care Under Public Assistance,” covering the first year of operation under the 1960 amendments (October 1960- October 1961) was prepared and submitted to Congress in March 1962. Both reports were published by the House Ways and Means Committee. “Characteristics of State Public Assistance Plans Under the Social Security Act: Provisions for Medical and Remedial Care,” Public Assistance Report No. 49, was issued in March 1962. To promote better public understanding, a pamphlet on “Medical Aid for Older Persons Through Public Assistance,” was prepared; and medical care in public assistance, as provided by the two Federal- State assistance programs for the aged, was the theme of an exhibit, “Public Assistance Helps the Elderly To Meet Their Needs,” first Social Security Administration L606 shown at the White House Conference on Aging in January 1961, and subsequently requested for use in various parts of the country. Since enactment of the Kerr-Mills legislation, requests for infor- mation about medical care under public assist&nce have come from individuals seeking guidance for themselves, their families, and ac- quaintances; from editors, reporters, and writers; from a wide range of government and private organizations; and from schools. Efforts have been made to obtain up-to-date information on State develop- ments as changés occurred. The constant stream of requests from national organizations, congressional committees, and the press for reports on the progress of the medical care program is evidence of the great public interest in providing help and services for the medically needy. FROM WORK RELIEF TO WORK AND TRAINING Work relief—a form of governmental assistance in which needy unemployed persons earn all or part of the assistance payment through employment—was widely used during the thirties to maintain work habits and morale. In the sixties, its objective shifted to rehabilitation through work, education, and training. When Federal funds became available in May 1961 for assistance to children in families with unemployed parents, States transferred some needy families from their general assistance programs to the amended ADC program. Of the 13 States that provided aid to families with unemployed parents during September 1961, 12 included work relief projects in their general assistance program. In 7 of these 12 States, employable ADC fathers were assigned to work relief projects to earn the State and/or locally financed portion of their assistance payment which was above the maximum amount for which Federal financial participation was available. A nationwide inquiry into the nature and extent of work relief was made by the Bureau in September 1961. According to the published report of this study, “Work Relief—A Current Look,” work relief projects in 438 local jurisdictions in 27 States employed some 30,400 persons. Of those assigned to work relief projects, 86 percent were concentrated in seven States—California, Illinois, Michigan, Ohio, Pennsylvania, West Virginia, and Wisconsin. Work relief recipients represented only a small proportion of the general assistance caseload in these States. Projects ranged from brush-cutting along remote country roads to training-oriented projects in big-city hospitals. The most prevalent projects, in the order named, were maintenance of streets and roads, custodial work in public buildings, care of park and recreation facili- 78 Department of Health, Education, and Welfare, 1962 ties, and distribution of surplus food commodities. Urban areas of- fered a greater variety of work than rural areas. . The average monthly amount credited toward the assistance pay- ment of those on work relief was about $92, and most recipients—92 percent—received their remuneration in the form of an assistance payment; the remaining 8 percent received wages, usually limited by the family’s needs as budgeted by the welfare agency. The value of the assistance worked for and wages paid on all work relief projects was about 12 percent of the total spent for general assistance and comparable programs in the 27 States with work relief programs. The cost of providing work relief beyond assistance was estimated by the Bureau, in the absence of other available data, at $15 a month per employed recipient to cover expense of transportation, extra food, and clothing; and about $4 a month per recipient for coordi- nating the program and assigning recipients to projects. Other costs—materials, tools, and supervision—were usually borne by project sponsors. Even though relatively few ADC parents were assigned to work relief projects, several States asked that Federal participation be extended to assistance in the form of wages earned under work relief by unemployed parents with dependent children. A subsequent provision was, therefore, made in the Public Welfare Amendments of 1962 for community work and training programs, for a temporary period ending June 30, 1967, to encourage the education, employment, reemployment, retraining, conservation of work skills, and the development of new skills for potentially employable recip- ients of the federally aided program of aid to families with dependent children. The new legislation also provides safeguards, many of which were suggested from earlier experience with work relief. Provision must be made for adequate protection of the health and safety of workers, and appropriate arrangements must be made for the care and pro- tection of children during the absence of parents doing such work. Payment for work done must be at rates not less than those for similar work in the community, and in determining need, consideration must be given to reasonable expenses attributed to such work. Work per- formed must serve a useful purpose and not interfere with or displace regular employees. Opportunity must be given the worker to seek regular employment and to secure available training. Cooperative arrangements must also be established and maintained with State employment and vocational and adult education agencies for maximum utilization of their resources to improve opportunities of such recip- ients for regular employment. Social Security Administration 79 EFFECT OF FEDERAL AID TO THE UNEMPLOYED A temporary measure effective May 1961, for a 14-month period, extended the aid to dependent children program to include families of needy unemployed persons. To determine the extent to which this provision was meeting needs and helping the unemployed parent use community resources to regain employment, a study of its first 7 months’ operation was also undertaken by the Bureau. In addition to reviewing State plan provisions and statistical information reported by the States, a review and evaluation of practice was made in 45 localities in the 13 States® making payments under this provision from May through November 1961. During this period assistance had been granted to 66,100 of the 86,300 unemployed parents who applied in 12 of the 13 States making such payments; nearly half (46 percent) had been transferred from State or local general assistance programs operative in 12 of the States. Unemployment insurance benefits were much less frequently a resource for this group of recipients. Only 12 percent of the families were receiving unemployment compensation at the time of approval of their application for assistance. An additional 19 percent had received such benefits during the 6 months prior to the approval of their application, and 20 percent of the applicants had filed a claim which was pending at the time of approval of the application. In November 1961, under this new provision, $6.7 million reached 43,200 unemployed-parent families with 157,000 children; 95 percent of these families lived in 6 States (Connecticut, Ilinois, New York, Pennsylvania, Washington, and West Virginia). ‘The average pay- ment per family was $155, the average payment per recipient, $34. The average payment per recipient ranged from $18 in Delaware to $48 in Illinois. Most of the States aiding unemployed-parent families made higher payments per recipient to families receiving assistance for reasons other than unemployment than because of the unemploy- ment of a parent. Nearly 40 percent of the cases approved for assistance during the period of the study were closed by the end of the seventh month of operation of the program usually because of employment. About a third of these parents returned to a former job and about two-thirds found work on their own initiative or with the help of friends or relatives; only 3 percent obtained employment through a public em- ployment service referral. The small number who obtained work through such referral highlights the difficulties unemployed persons 5 Connecticut, Delaware, Hawaii, Illinois, Maryland, Massachusetts, New York, Okla- homa, Pennsylvania, Rhode Island, Utah, Washington, and West Virginia. (Subse- quently, North Carolina and Oregon initiated such payments. On June 39, 1962, Dela- ware and Washington discontinued them.) 80 Department of Health, Education, and Welfare, 1962 with low education and limited or no skill undoubtedly have in com- peting with other job applicants. A few welfare agencies in the communities studied established their own employment divisions. Nearly all the 13 States also gave training courses for practical nursing, supervision of food preparation and handling, machine operation, sewing, and typing. From a review of 1,800 case records of unemployed-parent families in the communities included in the study, it appeared that at the end of September 1961, the unemployed parents aided could be broadly classified into three major groups: (1) unskilled laborers with physical, mental, or emotional handicaps in addition to little educa- tion and poor work experience, whose reemployment opportunities seem limited; (2) fathers unemployed less than 3 months, mainly under 45 years of age, with stable work records (many were steel, construc- tion, or seasonal workers) who were already moving toward reem- ployment on their own initiative; and (38) a larger number of unemployed fathers whose chances of returning to work could prob- ably be improved with training, retraining, or other special services— this group included school “drop outs” and young persons recently discharged from military service with no previous work experience or skills; young workers with several children, limited education, and no skills who had moved from one short-term job to another, with no vocational goal; and older men, generally with large families, education below the eighth-grade level, and, with little, if any, skill transferable to other jobs. The provision of financialaid under this program undoubtedly pre- vented family breakup and sharpened public awareness of the needs of families affected by unemployment. But it also made clearly evi- dent the urgent need for more effective mobilization or development of training and other community resources, if significant inroads are to be made on the basic and underlying difficulties facing this segment of the unemployed today. ASSISTANCE TO U.S. CITIZENS RETURNED FROM FOREIGN COUNTRIES Americans who become stranded, ill, or destitute in foreign coun- tries are helped to re-establish themselves in the United States through a year-old Federal program. Under this program, assist- ance and other services are provided for Americans and their depend- ents identified by the Department of State as having been returned to the United States because of destitution, illness, or international crisis. In cooperation with State and local welfare departments and voluntary welfare agencies, arrangements are made for reception and transportation, temporary financial aid, and necessary social services or medical care. Social Security Administration 81 The first year’s operation provided assistance and services to 505 cases of U.S. citizens returned from foreign countries: 153 cases (236 people), including 55 mentally ill persons, referred by the Department of State; 291 cases of U.S. citizens repatriated from Cuba; and 61 mentally ill persons receiving care at St. Elizabeths Hospital. In- formation or service was provided to 11 additional cases. =) Ss wo So i) delinquency cases (in thousands) nwo So S 100 1940 1945 1950 1955 1960 child population 10-17 years of age (in thousands) The total number of young men and women between 16 and 25 who will enter the labor force in the 1960’s is a staggering 26 million, a volume unprecedented in our history. In 1965 alone, 3.8 million young people will become 18 years of age, an increase of 1.2 million over 1960. Large numbers of youth of this age are now and probably will continue to be unemployed and out of school. Legislative Developments Fiscal year 1962 saw the introduction of Administration proposals for far-reaching amendments to Title V of the Social Security Act which, if enacted, would enable the Children’s Bureau to expand very substantially its services in behalf of children. These included rec- ommendations for major changes in the child welfare provisions of the act, as part of the President’s proposals on public welfare, which were enacted soon after the close of the fiscal year. They also included proposals for extending the Bureau’s research authority to permit making grants or entering into other cooperative financial arrange- ments for research relating to maternal and child health and crippled children’s services. These amendments were not acted on by Congress prior to adjournment. ' Social Security Administration 93 PUBLIC WELFARE AMENDMENTS OF 1962 These Amendments incorporate the President’s recommendations for changes in the child welfare provisions of the Social Security Act, and, as stated by the President in approving them on July 25, 1962, make “possible the most far-reaching revision of our Public Welfare program since it was enacted in 1935.” The law increases the amounts authorized for annual appropriation for grants to the States for child welfare services from the previous level of $25,000,000 as follows: $30,000,000 for the fiscal year ending June 30, 1963. $35,000,000 for the fiscal year ending June 30, 1964. $40,000,000 for the fiscal years 1965 and 1966. $45,000,000 for the fiscal years 1967 and 1968. $50,000,000 for the fiscal year 1969 and each year thereafter. Coordination with dependent children program and extension of child welfare services—Part 3 of Title V of the Social Security Act continues to provide for grants to States for the use of cooperating State public welfare agencies in carrying out the State plan developed jointly by the State agency and the Secretary. The new law adds to these provisions, effective July 1, 1963, so as to require: 1. Inclusion in the State child welfare plan of provision for co- ordination between the services provided under it and those which are provided for children under the State plan relating to dependent children which is approved under Title IV of the Social Security Act. 2. A satisfactory showing by the State that it is extending the pro- vision of child welfare services in the State, with priority being given to communities with the greatest need for such services after giving consideration to their relative financial need, and with a view to making available by July 1, 1975, in all political subdivisions of the State, for all children in need thereof, child welfare services provided by the staff (which shall to the extent feasible be composed of trained child welfare personnel) of the State public welfare agency or of the local agency participating in the administration of the plan in the political subdivision. The new law also requires, effective July 1, 1963, with respect to day-care services (including the provision of such care) provided under the State child welfare plan that the State plan shall provide: 1. For cooperative arrangements with the State health authority and the State agency primarily responsible for State supervision of public schools to assure maximum utilization of such agencies in pro- viding necessary health services and education for children receiving day care. 2. For an advisory committee, to advise the State public welfare agency on the general policy involved in the provision of day-care 94. Department of Health, Education, and Welfare, 1962 services under the State plan, including representatives of other State agencies concerned with day care or related services and persons repre- sentative of professional or civic or other public or nonprofit private agencies, organizations, or groups concerned with the provision of day care. 3. For such safeguards as may be necessary to assure provision of day care under the plan only in cases in which it is in the best interest of the child and the mother and only in cases in which it is determined, under criteria established by the State, that a need for such care exists; and, in cases in which the family is able to pay part or all of the costs of such care, for payment of such fees as may be reasonable in the light of such ability. 4. For giving priority in determining the existence of need for day care, to members of low-income or other groups in the population and to geographical areas which have the greatest relative need for exten- sion of day care. Day care-—The law further provides that beginning June 30, 1962, the excess above $25 million, up to a maximum of $10 million, of the annual appropriation for child welfare services, shall be earmarked for the provision of day care under the State child welfare plan. (In fiscal 1963, the maximum earmarked could not exceed $5 million since $30 million is authorized to be appropriated for that fiscal year for all child welfare services.) Such care may be provided only in facil- ities (including private homes) which are licensed by the State, or are approved (as meeting the standards established for such licensing) by the State agency responsible for licensing facilities of this type. The law adds to the section of the act, which authorizes grants for research or demonstration projects in the field of child welfare under Title V, part 3, provisions to authorize grants to institutions of higher learning for special projects for training personnel for work in the field of child welfare, including traineeships. The definition of child welfare services for which Federal funds may be used under State child welfare plans is clarified and somewhat broadened. No supplemental appropriation to implement the day care and training provisions of the 1962 amendments was made by the Congress before adjournment. During the fiscal year 1962, the Congress acted upon two other pieces of legislation covering subjects on which the Bureau and the Department had been recommending legislation for several years and on which there had been considerable activity and interest on the part of Congress. These two pieces of unfinished legislative business were acted on early in the fiscal year and before the first session of the Social Security Administration 95 87th Congress ended on September 26, 1961. They related to inter- country adoptions and to juvenile delinquency. INTERCOUNTRY ADOPTIONS In September 1961, legislation (P.L. 87-301) was enacted which incorporated in the basic immigration law provisions for nonquota visas for eligible orphans, thereby making these provisions permanent. The Department of Health, Education, and Welfare does not carry any responsibility in the administration of these provisions. JUVENILE DELINQUENCY In May 1961, President Kennedy transmitted to the Speaker of the House the Administration juvenile delinquency proposal. On September 22, 1961, the President approved the Juvenile Delinquency and Youth Offenses Control Act of 1961 (P.L. 87-274). As finally enacted, the law authorizes a 3-year program, beginning with the fiscal year 1962, of: (1) grants for demonstration and evalua- tion projects; (2) grants for the training of personnel; and (3) tech- nical assistance services. An annual appropriation of $10 million is authorized for carrying out the Act for each of the fiscal years 1962, 1963, and 1964. On September 30, 1961, the President approved a supplemental appropriation bill (P.L. 87-332) which contained an appropriation to enable implementing the new legislation immediately. The grants are administered by the Secretary’s office but, under this appropria- tion, the Children’s Bureau received funds for expanding its technical assistance services. 1962 APPROPRIATIONS FOR THE CHILDREN’S BUREAU The amounts appropriated for the Children’s Bureau for fiscal 1962 under P.L. 87-290 were: Nal titosanUGck Ppensesa 20.3. list pielon mew pi tei. fattest $2, 668, 000 Grants for maternal and child welfare__.___________________- 69, 100, 000 Maternal and child health services_.«. +. ——.-___+___+_____ 25, 000, 000 PDE entlg ren §(SCnViCeS 2258. se so Se 25, 000, 000 MnMGmye LAnCeSCrVICCS eee. 2,442.8 | 3,558.1 |_...<_2- re 1, 677.4 1, 677. 4 64. 90 1, 527.3 1, 527.3 57.70 Aged widow and 1 or more children____- 17.3 35.4 122. 90 14.2 29. 2 112. 90 Aged widow and 1 or 2 aged dependent PATON eee ree ee Oe .3 -5 153. 80 3 6 131.00 Aged dependent widower_____---------- 2.3 2.3 62.10 2.0 2.0 54.10 Widower and 1 or more childern_______- eal zal 91. 30 (4) au 84. 40 Widowed mother only 3______--______-- 11 iT5al 61. 50 1.4 1.4 64. 20 Widowed mother’ and 1 aged de- Gopbhiini hi) 0 0 0 (4) (4) 173.70 Widowed mother and 1 child___________ 184.6 369. 2 135. 00 171.9 343.9 131.70 Widowed mother and 2 children________ 120.3 361.0 189. 30 113.4 340.1 188. 00 Widowed mother and 3 or more chjldren_ 121.3 587.5 182. 80 113.8 547.6 181.70 Widowed mother, 1 or more children, and 1 or 2 aged dependent parents __ .4 1.4 231.00 5 1.8 214. 70 Widowed mother, divorced wife, and STOR ka (4) rail 247. 90 0 0 Divorced wife and 1 or more children___ 4 1.0 170. 10 4 1.0 163. 40 STU (ial hie 5, Sas Se 302. 2 802. 2 60. 70 296. 4 296. 4 58. 50 pinyin 2 <4 Sl a ra 104.6 209. 2 124. 60 106. 6 213.2 122. 50 mire eee 40.8 122.5 160. 10 38.3 115.0 155. 00 marmorecoudren. —--.._..--.-.---=< 23.1 104.8 168. 30 22.6 102. 5 157. 20 1 or more children and 1 or 2 aged de- MoneGentmerents. 2 5 11 145. 30 7 1.5 137. 60 1 aged dependent parent_______________- 32.5 yes 68. 10 31.6 31.6 60. 90 2 aged dependent parents___..____--_-_- 1.5 3.1 111.00 1.5 3.0 107. 90 Disabled-worker families_ _______________- 618.1 PoUets bee 455. 4 O87. Balk 2 See 0 a i ree 459.3 459.3 87.70 356. 8 356. 8 87. 90 Mal 332.0 332.0 91. 50 261.3 261.3 91.90 127.3 127.3 77.70 95. 5 95.5 76. 90 Worker and aged wife 1____.___________- 24.5 48.9 136. 50 21.7 43.5 135. 60 Worker and young wife 23______________ t if 156. 90 2 4 143. 20 Worker and aged dependent husband___ .3 6 115. 80 2 4 120. 70 Worker and 1 or more children ________- 40.6 106. 4 154. 90 22.0 55.8 154. 40 Worker, aged wife,! and 1 or more (GOW RGI 9 2 kena alia ae 2 6 186. 60 1 .3 186. 20 Worker, young wife,? and 1 or more tO). = 2spSdeblt SSSEE IE ES 93. 2 411.2 191.10 54.4 230.3 189. 10 1 Wife aged 65 or over or wife aged 62-64 with no entitled children in her care. 2 Wife under age 65 with 1 or more entitled children in her care, 3 Benefits to children were being withheld. 4 Less than 50. 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Bk CONLOSCONUIAON. ose ‘6 T80 ‘02 ZOE ‘8ze‘T | SOL ‘ser‘T | ZE0°L 0°96 246 ‘SIT 8 ‘819 ‘T $16 ‘221 8°602 ‘T es a ee es Se eek ae eee OR MON, £9 ‘e ¥9¢ 108 ‘Fe 868 ‘8 892 | 1g 196 % 6 ‘Eo 622 ‘8 O69 we cu we ees eh eee STI we eS “OOTXOT, MON, 988 ‘Ze Ocy ‘L LE¥ ‘68h 612 ‘62S Ore ‘S £18 PST ‘TF F199 POF ‘eh a an te abe 2a Aosiof MON 128 Department of Health, Education, and Welfare, 1962 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 26, 1962] Calendar year 1959 Employers reporting taxable Workers Reported taxable State wages July-| reported earnings 3 September with Contribu- 19611 taxable tions 4 earnings 2 Amount Average per worker otal -pe dete 2h neee eee 4, 260 71, 500 | $202, 346, 000 $2,830 | $9, 884, 400 Aa baa 5 - ee nee aa ee a ee 64 1,090 2, 419, 000 2, 220 118, 300 i 4 80 205, 000 2, 560 10, 000 Arizona....... 28 490 1, 220, 000 2, 490 59, 700 Arkansas_-_-_-- 40 580 1, 114, 000 1, 920 53, 400 California 383 6, 270 18, 256, 000 2,910 891, 500 Colorado--_--- 42 680 1, 665, 000 2, 450 80, 300 Connecticut___ 66 1, 150 3, 406, 000 2, 960 167, 300 mMelaware-s.oo2.25230 eee 13 210 567, 000 2,700 27, 900 District of Columbia---____.-_----- 30 480 1, 141, 000 2, 380 56, 400 AOMGA. > Jane ees = ee 133 1, 940 4, 268, 000 2, 200 207, 900 ne eee ee 94 1, 450 3, 098, 000 2,140 151, 500 eet Se Oe. 2S Me eet 13 230 600, 000 2,610 29, 400 te ee a ee = ee eee 15 280 634, 000 2, 260 30, 200 15 2 ee es. Sere eee 227 4, 500 13, 332, 000 2, 960 652, 300 seecegee cae 100 1, 930 5, 585, 000 2, 890 273, 100 eeapeees SEN! NS Bee. ee 66 1, 090 2,751, 000 2, 520 129, 700 els ee Peet tee ee 54 880 2, 110, 000 2, 400 i See 61 980 2, 183, 000 2, 230 105, 300 oe ee Os a ee 67 1, 050 2, 449, 000 2, 330 119, 700 eee ee ele ee Ae 2 Sd See 25 3 8, 000 2, 200 41, See a ORR SE Se 77 1,190 2,931, 000 2, 460 143, 400 oie. ee Oe 122 2, 240 6, 234, 000 2, 780 306, 600 eS SB TG SS Be eS 159 3, 150 9, 941, 000 3, 160 488, 200 BR ine ope ae Bde 74 1,310 3, 453, 000 2,640 166, 400 AAS SL ee Sek 38 640 1, 228, 000 1,920 59, 500 Be Fe Se 108 1, 840 4, 753, 000 2, 580 231, 000 6 Ss ees x 16 280 706, 000 2,520 33, 2 OP . 55, 39 600 1, 392, 000 2, 320 65, 400 B SERS URES Sele 8 150 356, 000 2, 370 17, 400 Sita a SEF cael 17 280 740, 000 2,640 36, 300 aie Se SB 158 2, 700 7, 885, 000 2, 920 386, 900 See, Se 20 340 3, 000 2, 130 35, 100 New: York 2:42 2 ee SS 481 8, 100 24, 470, 000 3,020 1, 202, 200 North! Oaroling == > ee ee 104 1,740 3, 809, 000 2,190 185, 700 North’ Dakotassan-u2-seaeeeecon sees 14 230 509, 000 2,210 23, 300 OR ee eee 203 3, 850 11, 550, 000 3, 000 566, 200 Or lanonie®, 6: cote oe 49 900 2,071, 000 2, 300 100, 000 Oregon. 23 Se 43 790 2, 033, 000 2, 570 98, 600 ‘Pennsylvania.2. Lf See es 257 4, 680 18, 662, 000 2,920 669, 900 Puerto Ricds. 228. = oases 19 470 543, 000 1, 160 26, 500 INOS TSANG once ne ee 21 360 944, 000 2, 620 46, 300 South Garotings2. = > pees ee 51 830 1, 769, 000 2, 130 86, 600 Souph Dakotase. a2 oes. sae ecru 18 250 547, 000 2, 190 25, 300 IVGHRGESOGs. a0, acs adeno a hoes 7 1, 270 2, 865, 000 2, 260 139, 500 MORAG a bee 2 as eee ee, Be 236 3, 740 8, 614, 000 2, 300 418. 200 CLC eS Se eee eee eee eae 17 360 870, 000 2, 420 42. 400 Mermontew | patna ese eee eoetas ll 150 331, 000 2,210 16, 000 Wivein Aslenas. 92. A 2 3s oe 1 10 15, 000 1, 500 800 gio ea ee, en aoe ae Se 91 1, 400 38, 282, 000 2, 340 160, 600 Washington 2 wa eee 65 1, 150 3, 230, 000 2, 810 157, 400 Wiest. Virginia- == 23 sae ee 37 650 1, 660, 000 2, 550 81, Wisconsittt o2sc.2-5 . Fe Oe se 17, 749 7, 254 Bat Vos Sancaete 10, 196 70.9 PrRansas.. eos s_. 36, 586 27, 584 1,020 3,171 36, 656 74.9 California el 288, 115 161, 555 7, 558 10, 487 314, 459 49.6 Colorado--_--- : 41, 749 29, 280 143 3, 136 60, 677 50.7 Connecticut_--_---- 19, 857 8, 070 152 1,355 20, 074 42.0} Delaware. -.----+--- 2, 960 514 149 265 764 66.9 Dist, of Cole... 10, 271 1, 957 102 1,495 3, 250 59. 4 Words. <. ates eases 62, 485 38, 035 1,319 6, 766 52, 918 1. 7% 68, 951 41,740 1,725 11, 282 56, 537 73.7 125 25 2 17 42 50.0 4,749 732 51 525 1,096 65.8 8, 721 3,741 81 1,027 5, 477 69.7 | 120, 743 42,765 1,691 12, 681 72, 739 59.3 | 27,090 14, 149 V,104 |S 32 22, 525 65. 2 |; 33, 140 21, 588 801 474 35, 296 61.8 27, 855 17, 897 336 2,416 28, 852 61.8 KONtUCKY. 2 eee =e §2, 722 27,141 1, 336 4, 854 36, 833 73.4 Boeuisiana.. 2s 2s 2... 118, 088 82, 149 1, 659 9, 320 119, 034 70. 5 VERINO Sons ts Sass acl 14, 146 6, 675 230 1, 333 9, 590 va ial Maryland. .c2-2.... 22, 402 4,998 216 3,312 7,945 64.3 | Massachusetts-____-- 84, 227 37,105 1, 205 5, 734 67, 902 57.3 Michigan__.-_-__.-_ 75, 147 32, 375 895 3, 126 55, 323 60. 2 Minnesota__--...--- 42, 295 29, 267 612 1,455 54, 553 55. 2 Mississippi-_-----.-- 41,769 27,601 1,516 4, 552 35, 758 76.9 Seissourh.. = sss on 90, 403 57, 240 2,195 8, 048 85, 186 67.1 Montana: . /2.~5..-< 6, 394 3, 434 181 745 5, 356 65.9 Nebraska. 7225525 13, 998 8, 767 421 1,305 13, 793 65.0 NGVAadS Wnc4scoe son 2, 862 1, 459 110) Ae ee 2, 574 58.7 New Hampshire_-___ 4, 927 3, 158 143 288 5, 439 59.3 New Jersey--------- 34, 705 10, 490 522 3, 803 20, 184 53.7 New Mexico__------ 17, 196 6, 820 214 1,715 9, 574 71.9 New York---------- 203. 023 36, 118 2, 054 20, 534 67, 507 58. 4 North Carolina_-____ 59, 616 21, 571 2,712 10, 845 29, 018 74.4 North Dakota_-____. 8, 627 4,706 59 728 7, 220 66. 1 OIG ss eee 95, 322 50, 839 1, 939 8, 066 88, 906 59.7 Oklahoma. s22>-4... 88, 846 61, 107 1,047 6, 444 89, 248 68. 4 Oreson sos dee eee soe 22, 034 10, 038 1,187 7, 889 152 2,768 17, 569 59.7 Pennsylvania_______ 119, 569 26,608 | 4,395 77,012 3, 064 8, 491 44, 548 61.9 8, 875 na fe ee Sa 5, 431 101 1,345 4,492 46.2 11, 414 4,062 |.zaeee.. 5, 634 66 1, 653 6, 855 60. 3 22, 447 11, 926 770 5, 509 769 3, 482 15, 884 75.7 9, 329 5,498 jzzeeee 3,058 93 680 8, 021 70.6 44, 852 22,108 244 16, 473 1,121 4,906 29, 798 75.1 137, 702 126, 251 +) woes 15, 371 3, 227 3, 852 160, 591 71.3 11, 670 , 493 396 4,835 107 1, 838 6, 979 67.9 ; 5, 458 2) 611 eyes 1,372 63 512 5,070 70.4 Virgin Islands-_-__-- 310 143 14 121 5 27 261 49.9 Wircinia i= Seren sos 22, 599 7,015) | teee_ 4 10, 552 669 3, 864 10, 125 74.8 Washington___..... 50, 140 28, 738 565 16, 432 386 4,018 51,173 55.9 West Virginia_..___. 44, 954 7,304 | 4,377 29, 615 407 3, 251 9, 465 76.9 Wisconsin ___.-_---- 33, 360 20; 308 || 222822 10,001 498 2, 463 37, 541 56.0 Wayoming— ioe et 2, 947 1, 745i )2 reece 839 31 332 2, 895 61.4 1 Based on cash advanced for the year; may differ slightly from fiscal-year expenditures from Federal funds reported by States. 2 Less than $500. Social Security Administration 133 the Social Security Administration: Federal grants to States and total by program and State, fiscal year 1962 in thousands; data corrected to October 15, 1962] Expenditures for assistance and administration—Continued Medical assistance for Aid to dependent Aid to the blind Aid to the permanently the aged children and totally disabled Percent from Percent from Percent from Percent from Amount Federal Amount Federal Amount Federal Amount Federal funds funds funds funds eis | ($1,130, 515 58.9 $100, 203 48.9 $302, 925 55.8 $45, 899 49.8 1, 240, 092 57.8 102, 212 47.6 335, 615 54.7 208, 752 50. 7 1, 488, 491 56.8 101, 493 46.9 373, 350 54.0 12,162 79.4 888 74,2 6, 494 74.3 1, 776 60.8 99 1) Stefi [eat teehee bat a ee Pe 13, 430 73.6 793 OST aie vee ae eT en ee 5, 290 79.8 1, 411 72.1 4,324 72.9 206, 966 44,7 19, 926 37.0 25, 119 42.3 14, 973 60. 6 53.3 5, 303 59. 5 23, 623 43.9 410 39. 2 3, 945 34.3 2, 765 20 256 58.4 406 62.3 10, 897 60.3 185 59. 5 2,710 55. 7 20, 593 79.4 1, 974 68. 0 10, 132 66.7 _ Se 18, 655 75.6 2, 323 72.4 15, 786 (2A () 50.0 155 50. 0 2 49.9 31 50.0 839 53, 2 5, 547 57.6 114 48.6 1, 283 42.1 1, 955 65.0 4, 800 54.3 127 64.0 1, 481 70, 2 675 50.0 187, 943 45.3 3, 567 47.1 29, 146 42.7 17, 545 67.9 2,010 GOL One ee lh poe gue ete 16, 749 60.8 1, 763 45.6 717 64.3 12, 419 57.1 643 52.1 4, 816 50.7 25, 065 75.3 1,864 7125 6, 753 70.9 30, 231 73.9 2, 834 58.6 13, 463 69.6 7, 720 73.5 355 68. 2 2, 057 65.1 19,175 66. 4 352 63.3 5, 426 62.7 38, 755 44.2 3, 457 35.1 17, 578 33.0 56, 580 52.4 1, 737 51.9 6, 757 45.7 23, 335 47.3 1, 448 42.1 2, 153 67.4 10, 240 77.9 2, 020 75.3 6,119 74.7 32, 798 71.8 4,171 53.5 12, 372 65.1 3, 320 61.2 323 57.8 1, 305 58.8 4, 971 68. 7 884 47.9 2, 237 56.8 1, 940 65.8 244 Fo a re Sr eel |e tenes, pa 2, 323 52.0 286 49.4 662 44.8 43, 475 44.6 gt | 48. 4 8, 786 44.8 12, 346 69.1 307 71.4 2, 674 64.5 212, 811 47.4 4, 820 44.3 54, 109 39.7 31, 359 76.5 3, 863 70.3 15, 608 71.2 3, 780 54.5 97 61.0 1, 593 47.4 51, 510 66.3 3, 733 53.8 14, 567 55. 4 29, 636 66. 7 2,136 49.2 13, 158 49.1 : 15, 819 50. 4 324 46.7 5, 921 47,2 2, 935 50.0 118, 664 63. 2 17, 030 18.6 15, 122 59.8 341 50.0 11, 633 46.3 214 47.1 2, 846 47.1 SSeS ee J 10, 219 52.4 129 50.9 3, 299 49.3 1,054 74.3 6, 843 79.5 1, 068 72.6 4, 827 72.9 5. See oe 4,095 72. 5 130 70.1 959 69. 9 379 62.5 20, 763 78.2 1, 582 73.4 6, 716 72.9 awiattee - rbisers 19, 688 77.8 4,493 69. 7 5, 513 69. 4 534 62.8 7, 686 61.6 182 58.1 3, 361 56. 2 aot Soe 1,910 71.3 87 70.6 727 70.0 43 50.0 256 49.8 8 50.0 47 49.5 ae 14, 035 73.8 961 70.4 5, 484 69.8 1, 467 49.8 27, 383 56.5 872 43.4 8, 636 47.1 4, 67.7 38, 893 74.8 550 73.7 4, 225 73.0 soo 21, 482 47.4 1, 046 48.5 6, 002 41.8 ee 1, 514 64.0 54.0 594 53.8 134 Department of Health, Education, and Welfare, 1962 Table 9.—Maternal and child health and welfare services: Grants for maternal and child health services, services for crippled children, child welfare serv- ices, and research or demonstration projects in child welfare under the Social Security Act, by program and State, fiscal year 1962 * {In thousands] Maternal and! Crippled Child State child health | children’s welfare services services services ‘United Statess se ees Se een $23, 851. 7 $24, 093. 5 $18, 645.9 Alabama: -- <2. ode oa eee ee i a Jee eee 684. 4 766. 4 472.5 AJASKS ae nob ooo ccna mone 173.9 148.8 69. 7 Arizona___ 282. 5 |\S2nb—seeaceee 184.8 Arkansas_-_ 386. 9 403. 6 283. 5 California =o eae 1, 338. 0 1, 080.9 1, 027.6 @olorado..-etse son aeee eee nee 423.2 304.6 208. 2 Connecticut sa22 aso. ee on 396. 2 286. 2 182.9 Dla wares sry nee bee een 130.1 129.6 77.4 District of Columbia 311.2 280. 2 89. 2 Wiorids ee = a ee ee ee ee 774.1 584.3 453.7 ClOOr PIS ews 2 2. ean tt sac BR eet aco as ee ae = eee 734. 2 841.9 533.9 Guam _222-- 68. 7 52.0 7.8 Hawaii_____- 180. 4 181.9 115.4 Idsho-..+.- 190. 6 162.9 95.3 PN OIS He ee 673.3 748.0 700.9 Indiana_____- 373. 6 572. 2 444.5 ROW S2o sao = 307.0 498.7 315.9 Kansas_._---=- 260. 5 287.3 251.5 Kentucky__- 548.7 526. 7 430.5 TEOUISIANG « -96 races ce 30 ee ero so ee eS ee 480.5 569. 7 446.0 IMISING 25 2252 ee See ee es eee eee LTT. 2 155. 2 149.7 Maryland__-__--- 451.3 465.7 296. 6 Massachusetts__- 416.3 452.3 404. 4 Michigan_-____- 920.9 954.3 733.9 Minnesota___-_- 509. 4 693. 7 380.9 Mississippi-_- 625. 4 565. 0 362. 3 Missouri____--- 523.3 442.1 411.4 Montana___- 141.7 193.3 119.6 Nebraska___- 140.5 121.3 184. 2 INGVAd G2 fee ccna nee eee ae ee ere pee ne ae wee 123.2 82.3 Wau New Hampshire 108.9 124.0 100. 1 New Jersey_----- 354. 7 276.6 418.1 New Mexico_-_- 254.9 217.7 160.5 New York-----.. 1,179.3 894.5 1, 010. 7 North Carolina_- 889. 0 1, 011. 4 631.6 North Dakota__- 140. 2 145.1 130.1 Ohio ss = 2.52 1, 005. 0 910.5 818.8 Oklahoma._- 381.1 366.9 283. 7 Oregon... -3_- 212.3 239.0 206. 3 Pennsylvania 1, 091.1 1, 130.8 939. 5 Puerto Rico 531.3 654.3 440.5 Rhode Island___- 220.1 178.0 120.9 South Caroling. es. 527.0 583.1 400. 4 POULHMDAKOUR ieee se eee eee. 63. 4 140.5 130. 5 SR ENNOSSOAWbi2 oops oe eon anes 666. 8 727.0 471.7 SPOXAS Saka Eo ee eee 1, 036. 0 1, 485. 0 1, 039. 6 ‘Did eS Ses on 5 eS ae ee 138.8 164.4 156.8 Wermont.. S-reaenee o-oo eee deine 125. 7 126.0 91.9 Varein Isiands o.oo eee 108. 7 108. 6 56.3 WAT RIDIS hoe to on ee ie than eee bok eee a ne ee 753.1 695.1 472.4 WASHING LON 2 «ah oo oe eee So aad Se pee en ee ae 389. 4 320.3 284.9 DVESt, Vititinih 2 gas coccsa ene no 431.1 404. 4 278.8 Rmseonsin «5 eee = ee eee 417.5 513. 4 413.2 ASE aie oe ae Ss se eee 128.6 125.8 82.7 1 Based on checks issued basis. Additional payments were made for special project grants to institutions of higher learning and to public or other non-profit agencies and organizations as follows: maternal and child health services, $986.0; services for crippled children, $544.1; research or demonstration projects in child welfare, $131.3. Social Security Administration 135 es Table 10.—Federal credit unions: Assets, liabilities, and capital, Dec. 31, 1960, and Dec. 31, 1961 Amount Percentage distribution Assets, liabilities, and capital Dee. 31, 1961 Dee. 31, 1960 Change Dee. 31, | Dee. 31, during year 1961 1960 ee ee Number of operating Federal credit to 10, 271 9. 905 BOG) 2-s4aeeee=|o-aeeaaea PR otaueesotss = a-scc~s-5-2~---- $3, 028, 293, 938 | $2, 669, 734, 298 | $358, 559, 640 100. 0 100.0 Loans to members------------------- 2, 245, 223,299 | 2,021, 463,195 | 223, 760, 104 74.2 75.7 Sei) -- ------=-----<-----~-- 190, 190, 576 157, 615, 757 32, 574, 819 6.3 5.9 U.S. Government obligations__---.-- 94, 652, 577 93, 577, 264 1, 075, 313 3.1 3.5 Savings and loan shares------------- 412, 428, 717 306, 249, 764 106, 178, 953 13.6 11.5 Loans to other credit unions__------- 54, 943, 499 61, 701, 066 —6, 757, 567 1.8 2.3 Land and buildings----------------- 11, 861, 150 9, 699, 908 2, 161, 242 4 4 ther assets__._--------------------- 18, 994, 120 19, 427, 344 —433, 224 6 ai Total liabilities and capital_._-} 3, 028, 293,938 | 2, 669, 734, 298 | 358, 559, 640 100. 0 100.0 Notes payable----------------------- 59, 698, 027 71, 275, 679 | —11, 577, 652 2.0 2.7 Accounts payable and other liabil- ee eee es fot Sos. -------- 16, 151, 362 12, 372, 686 3, 778, 676 5 4 ne ee 2, 673, 488, 298 | 2, 344,337,197 | 329, 151, 101 88. 3 87.8 Regular reserve 133, 939, 870 111, 703, 332 22, 236, 538 4.4 4.2 Special reserve for delinquent loans_- 4, 604, 374 4, 456, 218 148, 156 32 -2 Other reserves !_--------------------- 7, 645, 471 5, 899, 292 1, 746, 179 2 2 Undivided earnings ?__-------------- 132, 766, 536 119, 689, 894 18, 076, 642 4.4 4.5 1 Reserve for contingencies and special reserve for losses. 4 Before payment of yearend dividends. Table 11.—Federal credit unions: Selected data on operations, as of Dec. 31, for each year 1934-61 * etree SS eee Number of operating | Number of Loans outstand- Year Federal members Assets Shares ing credit unions 39 3, 240 $23, 300 $23, 100 $15, 400 772 119, 420 2, 372, 100 2, 228, 400 1, 834, 200 1, 751 309, 700 9, 158, 100 8, 510, 900 7, 343, 800 2, 313 483, 920 19, 264, 700 17, 649, 700 15, 695, 300 2, 760 632, 050 29, 629, 000 26, 876, 100 23, 830, 100 3, 182 850, 770 47, 810, 600 43, 326, 900 37, 673, 000 3, 756 1, 127, 940 72, 530, 200 65, 805, 800 55, 818, 300 4, 228 1, 408, 880 106, 052, 400 97, 208, 900 69, 484, 700 4,145 | 1,356,940 119, 591, 400 109, 822, 200 43, 052, 500 3,938 | 1,311,620 127, 329, 200 117, 339, 100 35, 376, 200 3, 815 1, 306, 000 144, 365, 400 133, 677, 400 34, 438, 400 3, 757 1, 216, 625 153, 103, 120 140, 613, 962 35, 155, 414 3, 761 1, 302, 1382 178, 166, 459 159, 718, 040 56, 800, 937 3, 845 1, 445, 915 210, 375, 571 192, 410, 043 91, 372, 197 4, 058 1, 628, 339 258, 411, 736 235, 008, 368 137, 642, 327 4, 495 1, 819, 606 316, 362, 504 285, 000, 934 186, 218, 022 4, 984 2, 126, 823 405, 834, 976 361, 924, 778 263, 735, 838 5,398 | 2, 463, 898 504, 714, 580 457, 402, 124 299, 755, 775 5, 925 2, 853, 241 662, 408, 869 597, 374, 117 415, 062, 315 6, 578 3, 255, 422 854, 232, 007 767, 571, 092 573, 973, 529 7, 227 3, 598, 790 1, 033, 179, 042 931, 407, 456 681, 970, 336 7, 806 4, 032, 220 1, 267, 427, 045 1, 135, 164, 876 863, 042, 049 8, 350 4, 502, 210 1, 529, 201, 927 1, 366, 258, 073 1, 049, 188, 549 8, 735 4, 897, 689 1, 788, 768, 332 1, 589, 190, 585 1, 257, 319, 328 9, 030 5, 209, 912 2, 034, 865, 575 1, 812, 017, 273 1, 379, 723, 727 9, 447 5, 643, 248 2, 352, 813, 400 2, 075, 055, 019 1, 666, 525, 512 9, 905 6, 087, 378 2, 669, 734, 298 2, 344, 337, 197 2, 021, 463, 195 10,271 | 6,542,603 | 3, 028, 293,938 | 2, 673, 488, 298 2, 245, 223, 299 1 Data for 1934-44 on membership, assets, shares, and loans outstanding are partly estimated. 2 First charter approved Oct. 1, 1934. 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We a ened gal Se ee ae Sem eae olrTysdure FE MON ee ee TINOSSTJAT ---------------------------------------------- TddISsIssIAy 665171—63—_10 Public Health Service Health of the Nation As THE Freprrat AcENcy principally concerned with protecting and advancing the Nation’s health, the Public Health Service has a two- fold obligation. It must concentrate on the urgent health needs of today, while looking to and preparing for emerging needs and long range goals. Both parts of this obligation are heavily affected by the change and growth which are such notable characteristics of our present society : growth of the population, and change in its composition; growth of industries and cities, of medical science and health knowledge, of techniques and resources; change in the way people live and work and use their leisure time. Responding to this changing scene and its implications for the fu- ture, the Public Health Service is placing major emphasis on several broad problem areas. They include environmental health and community health services. Last year’s annual report called special attention to these two topics, and the progress that has been made on them is discussed in detail in the appropriate sections of this report. Other broad areas which are receiving major attention include health manpower, where the need is great and will become more seri- ous; research, which must be continued and accelerated; scientific communications, where the object is to speed the application of new knowledge in the health care of the people; the chronic conditions— heart disease, mental illness, cancer, and the others high on the list of causes of death or disability and of special import to the aged. The Service’s attacks on such problems are multifaceted. Typically they cut across more than one of the three major Bureaus and involve Divisions of the Office of the Surgeon General. Illustrative of both the need for this approach and the conduct of it is the realm of scientific communications. Here, the rapidly accel- erating research effort—world wide in scope—is reporting results in 139 140 Department of Health, Education, and Welfare, 1962 such scope and volume that existing communication systems are not adequate to cope with the torrent of information. The Service’s response includes a vital action by the National Li- brary of Medicine—the design, development, and installation of an electronic storage and retrieval system known as MEDLARS (Med- ical Literature Analysis and Retrieval System). The completion of this project will give the medical sciences in the United States access to a powerful tool unequaled elsewhere in the world. MEDLARS will provide a base for the centralized prelim- inary processing of information now conducted under circumstances of duplication and economic waste by multiple independent secondary publications. Further, it will constitute a new key to medical libraries generally, and, when coupled with photoduplication service, will en- able libraries to meet modern research requirements for information with unprecedented effectiveness. The impact of the MEDLARS system on future developments in electronic storage and retrieval in particular, and on the structure of medical communication in general, is expected to be considerable. At the same time, the National Center for Health Statistics has com- pleted installation of its computer facilities—modern data processing equipment which will result in more timely reporting of the health intelligence embodied in the national vital and health statistics pro- duced by the Center. Also, during the year the National Institutes of Health published for the first time a Research Grants Index. This is a comprehensive listing of the scientists supported through PHS research grants pro- grams, and it contains an index to the content of their work. It is unique in that it refers to work in progress rather than work that is described—months or even years after its completion—in published papers. Since the Service supports about half of all the medical re- search in the United States, plus some in other countries, the Index will help greatly to solve the mounting problem of keeping up with who is doing what and where it is being done. Other programs in all three Bureaus are aimed at the scientific com- munications problem. The importance of the subject has been recog- nized organizationally by the formalization in the Office of the Sur- geon General of the Office of Information and Publications, and the Surgeon General has scheduled for the fall of 1962 a meeting at which representatives of the health professions can discuss PHS actions and proposals and relate them to the responsibilities of other organizations and groups. Another broad area which provides an example of action on several fronts is that of health manpower—which has been the subject of con- EE ——— 141 Public Health Service Z961 “1 AAP S@DiNOsay PUD S@1}{]J204 YIDEsay S9D|AJaS YoIDEsay SJUDIC) YoIDasay S82UBI9 |DDIPeW |O12ua5 spsopunys s21Bojo1g ISUOISIAIG 49jua> [091UN/> ssaupul|g puo saspasiq |02!5o0jqunayy Ys}O8H |UEW 4408}, yoivasay }ojuaq 4a2u0>, sasoesig 21 CqUeW es Se qYy sasoasig snoljsaju py ABsal|7 $S94N414SU] [OUOIFON) 4H]29H JO SAN}IJSU] |OUOIJONY *upjd uojjozjuD6s0as ayy Jepun snDsing aworaq pjnom sBuydnas6 asoul/Z *upjd uojjozjuD61081 ayy Jepun pasodaid s1 aujajpay yo Asaiqi] JOUO!JONY ay OY JO) JW]s sNyOJs ;DUO!}OZjUDB10 ajo 4odasg/| $22144O |OUo!BaY SHd 6 uoljDsuedwo> saahojdug jo nosing 41042941 |D2]pew suos|ig JO NO@ing 440j2941Q |OD1PaW pions 4s00> £49213JO |221PAW 39149 Ssensevasecssevecsorececncesecseesend YyPOeH Uo|pUl sjoyidsoy BUIWUBIOND UBjaJso4 ISUOISIAIG Sad!AJaS poo!peyw jo noaing BU>1paW Jo Aso4g!] [OUO!HON 4831JJO PA1WNDAXq [D18Uad UosBing Ayndaq 4J245 [o1IDeds puo sdnoig AsosiApy |DUsajul }Ouauas uoaBing [Dsauas suoabing juDdjsissy Buysinny SO}4)1204 JDO1PEW puD |o4\dsoy sadinosey PUD Yj}OAH PI|gNd |4UEq S@dJAIaS Yj{Oa} Ay;uNWWOo> dayuaz asoasiqg 3j)qo>}unWwwo> sasoesig oyuaiuy) uoljUaAalg jUsPIDIV JO1JUO} UO!}N] | Og pun A\ddng say 0,4 4Yy]23H [22160] 01ppy Ys]03H joUE}jodN290 UO}4}Da4A!g Pooy puo BujiseujGuj joyuawualAug Uo!4N|/Od Jz suorsiaig Yi [OFH JOyUsWUIIAUZ Je SUOISIAIG yypDayH Ayjunuwo> SODIAJAS ayDJS yO NDBINg *AIG ABAINS Y4]DA}H |OUOIFDNY “AIG SOHSHOYS [OHA |OUOLION, J| S2HSHOIS YO9H 4Oj Jayuay [OUOCIJON Jauuosiad jo 2210 SPOUEW 4N[°8H >119%d Yj] D2} |OUO!}OUJa4U} YOHEZI/1GOW 4] 29H) eoubUul4 SODJAIIS SAI{OIJS|UIW PY ISUOISIAIG | SUOJJOI}|GNg PUD UOJJOWWOYU] 4O 331}}O [Qsauas uoabins #227130 Josauasd uoabinsg sdnais AsosiApy |DUse4x9 Ys JO 9914jO F4DIpauyy $182|}1O [OUO|SSE}O1g $2149 796L—3DIANAS HLIVIH SI1T8Nd— Ll LYVHD 142 Department of Health, Education, and Welfare, 1962 tinuing and increasing Public Health Service attention. The Service recognizes that the need is both quantitative—in terms of the greater number of people that are required—and qualitative—in terms of the kinds and varieties of personnel needed—and is working on the prob- lem accordingly. The PHS has worked to increase the supply of physicians and den- tists. At the same time, the Division of Public Health Methods has completed two more of its series of health manpower studies—Sec- tion 12 on Medical and Psychiatric Social Workers and section 13 on Hospital House Staffs. It has also cooperated with the National League for Nursing in a study of practical nurse education published as “Education for Practical Nursing, 1960.” Many service programs support training of professional and technical personnel in a wide variety of disciplines. The institution of the NIH Research Career Award Program has given the Service a means of providing stable incomes for research careers in academic and research environments; and since the inaugu- ration of the program in January 1962, awards have been made to 106 individuals in 61 institutions. A variety of Service programs are designed to promote more efli- cient use of existing manpower. For example, experimental projects demonstrated that dentists who work with a chairside assistant can treat substantially greater numbers of patients than can those who work alone; and the demonstrations have now been followed by a grants program to support the training of dental students in the use of chairside assistants. Toward a better utilization of its own manpower, the Surgeon Gen- eral requested, and the Secretary of Health, Education, and Welfare appointed, an Advisory Committee on Public Health Service Person- nel Systems. The Committee made its report in March 1962, and the Office of Personnel has begun the implementation of its recommendations. The Service is working in a comprehensive manner also on some of the more circumscribed but equally important topics, such as the problem of infant mortality. In this area, where there remains a great deal we do not kmow, the research programs of the National Institutes of Health and the Communicable Disease Center are con- tinuously increasing medical knowledge of the factors contributing to infant mortality. The cooperative study now being sponsored by NIH, for example, is accumulating data related particularly to asphyxia in the newborn and congenital malformations. This study is certain to produce find- ings that will lead to the prevention of many infant deaths due to these causes. The Communicable Disease Center is conducting research Public Health Service 143 and developing control measures affecting the infectious diseases of infancy, particularly infant diarrhea and hospital-acquired infections. The accident prevention program also is cooperating in efforts to re- duce the toll of accidental poisoning and home conflagrations which account for a large number of deaths among infants and young chil- dren. Other work is going forward in other parts of the PHS. The Service carries out its programs through the Divisions of the Office of the Surgeon General, such organizational units as the Na- tional Center for Health Statistics, the National Library of Medicine, and the three major Bureaus—Bureau of Medical Services, Bureau of State Services, and National Institutes of Health. While each of the organizational entities has its own particular program responsibilities, certain types of activities are common to many of the organizational units. Thus, research activities are as- sociated with all areas of PHS responsibility. Cooperation with other agencies—State and local health departments, international organizations, public and private institutions, voluntary organiza- tions—is a conspicuous aspect of many programs. Grants-in-aid for a wide variety of objectives are administered by many Divisions. Many different programs are sources of technical aid, consultation, and training assistance. Health Record Latest data from the continuing National Health Survey indicate that Americans, except those in resident institutions, experienced 359 million acute illnesses and injuries in a year. This equals about two conditions per person per year. These statistics refer largely to short- term conditions involving either medical attention or at least a day of restricted activity. The 359 million acute conditions included 50 million accidental in- jury diagnoses among 45 million persons injured. Of the injured, 2.9 million were in accidents involving motor vehicles. The bulk of the remainder, 20.2 million, occurred in the home. In the same year, the average American’s activity was restricted some 16 days due to illness and injury. Six of the 16 days involved bed disability. Persons 17 years of age and older lost 5.4 days of work due to ill health, and children from 6 to 16 averaged 4.8 days lost from school. An estimated 74 million Americans—42 percent of the population— were reported to have 1 or more chronic conditions of varying sever- ity. About 1 person in 12—14,217,000 in all, was limited in his major activity by chronic disease or impairment, and 1 in about 200—some 915,000 in all—was confined to the house continually by a chronic ailment. 144. Department of Health, Education, and Welfare, 1962 SO ee eee After a long period of decline, the trend of the crude death rate appears to have leveled off. This phenomenon is not peculiar to this Nation: it seems to be occurring also in such countries as England and Wales, Finland, Norway, Sweden, Denmark, Japan, and Chile. The 1957 rate for the United States—9.6 per 100,000 population was CHART 2.—DEATH RATES BY AGE AND SEX, 1945-61 {Rates per 100,000 population) 400.0 a] Sa OA w eT I T 4000 Male Female 85 years ond over | Ss 85 yeors and over a eae —_ | 200.0 Pe 2000 75-84 years 1000 ee wee KH, Cotsen, L | 100.0 75-84 years : me 800 — ese 800 60.0 1 65-74 yeors W. bee a te me, 100 | 400 Poe ee, 65-74 yeors tee ee ey amen t oary =, 55-64 yeors 20.0 200 eee 95-54 years 100 eet ~nseenoee 1 oe 8.0 oe) 5-54 yeors "= 60 - == Ua + A 60 “ a 35-44 years ee eae ‘= ‘2mm, 40 ad ‘Sh r Sie S rie ji “* ve, 35-44 yeors aie lw, k 25-34 years Tl epatere 2.0 a 15-24 yeors 20 0, bed i SSeS pNcomne 1 “, 25-34 yeors Fistor, mma \ “ate, ie. | q ~ ny, Mrasvsenvevsancadnraisey, ~~ ony, 1-4 be See : Lo years [J ee anne 1.0 eae | : A = | ~ | SS 15-24 yeors 8 5-14 years ie & | = + & 4 4 2 é a 1945 1950 1955 1960 1965 1945 1950 1955 1960 1965 Public Health Service 145 almost 5 percent larger than the 1954 rate of 9.2, which was an all- time low. In 1961, the crude rate stood at 9.3.1 Crude rates are calculated on the total] population of each period covered. This population almost invariably changes in composition over the years in ways that may affect crude rates. ‘Thus, the great- est risk of dying occurs in infancy and in old age, and our present population is simultaneously growing both older and younger in com- position. The proportion of the population over 65 probably has been increasing since the 18th century, while the proportion under 5 years of age has been increasing for more than 25 years. Since the leveling off of the crude death rate is also evident in the age-adjusted rate, the failure to decline cannot be ascribed to the changing age composition of the population. The 1961 age-adjusted death rate stands at 7.3 compared to the 1954 rate of 7.7. In recent years both the crude and the age-adjusted rates have varied only slightly from year to year, and almost entirely according to the presence or absence of respiratory disease outbreaks during the year. Obviously it is impossible for the death rate to decline indefinitely. But present levels of death rates in various countries do not seem to be at the irreducible minima, nor do they appear to be due to artifacts of registration or other technicalities; and an intensive study and evaluation of the situation is in order. For the United States, a primary reason cannot be found in the fact that death rates already are extremely low, since a number of countries have still lower rates. A general resistance to decline in recent years is evident as far as age and sex are concerned. Since the curves of the chart are drawn on a uniform logarithmic (ratio) scale, direct comparison between curves or any of their parts can be made by comparing degrees of slope. In no age group is the rate of decline greater since 1954 than before. The chart also shows that male death rates by age in general have declined less rapidly since 1954 than the rates for females. Closer study of the data also shows that the divergence between the sexes by age and color groups is greater over the 7 years since 1954 than over the 7 preceding years, except for persons aged 15-34 (whites) and 15-24 (nonwhites). Males, then, not only have lagged behind females but at present they are falling even further behind. In what areas? The four leading causes of death are now diseases of the heart, malignant neoplasms (“cancer”), vascular lesions affecting the central nervous system (“strokes”), and accidents. In terms of age-adjusted rates, these four causes accounted for a little over 68 percent of all deaths about 10 years ago, compared to about 72 percent now, so 1 All vital data are for calendar years, 146 Department of Health, Education, and Welfare, 1962 that their importance is increasing. While sizeable declines were recorded for white and nonwhite male groups when the four leading causes were excluded, these declines were nevertheless smaller than those scored by the female groups. For each of the four leading causes of death, males in each color group have fared less well in recent years than females. For dis- eases of the heart there was virtually no change in the male rates while each of the female rates was decreasing about 10 percent. For cancer, male rates increased while female rates were unchanged or decreased. For stroke, a decline for white males was surpassed by a greater decline for white females, while nonwhite males had an increase compared to a decrease for \onwhite females. For acci- dents, the decline registered by each temale group was greater than those scored by the comparable male group. About 1 infant in 40 died within a year of birth in 1961, com- pared to 1 in 10 during 1915. But while the infant death rate de- clined by 25 percent or more for every 10-year period until 1950, since then this rate of decline has been sharply reduced. Although the 1961 rate of 25.3 per 1,000 live births is the lowest yet recorded in the United States, the curve nevertheless is declining more slowly over recent years; nor is the rate as low as that in some other countries. The maternal death rate—31.7 per 10,000 live births in 1941— reached 7.5 in 1951 and 3.7 in 1961. This rate has declined so far that it may be pressing against a virtually irreducible lower limit. As a summary expression of all the forces working to extend or shorten life, in 1961 for the first time the life expectancy of the country’s total population at birth exceeded 70 years, reaching 70.2. This compares to 68.4 in 1951 and 64.8 in 1941, giving gains of 2.6 and 5.6 percent for the later and the earlier periods. In 1960, life expectancy by color and sex was as follows: white males, 67.4 years; white females, 74.1 years; nonwhite males, 61.1 years; and nonwhite females, 66.3 years. In recent years the average length of life has been increasing at a faster rate for women than for men, and at a faster rate for the nonwhite population than for the white population. Births, Marriages, and Divorces The total of 4,268,326 live births registered in 1961 were only slightly more than the 4,257,850 births of 1960. Since the number of births has not changed much during the past 5 years, and the population has continued to grow, the crude birth rate has declined somewhat each year since 1957. The rate was 25.0 per 1,000 live births in that year, 23.7 in 1960, and 23.3 in 1961. Public Health Service 147 The fertility rate, or number of live births per 1,000 women 15-44 years of age, also has declined somewhat annually since 1957. The 121.2 rate of that year was higher than any rate since World War I. The 1961 rate of 117.3 is slightly below the 1960 rate of 118.0. In recent years the fertility rate for nonwhites has been about 40 births per 1,000 above the rate for whites. In 1961, about 1,547,000 marriages were performed, an increase of 1.3 percent over the 1960 figure of 1,527,000. Because of con- current changes in the country’s total population, however, the crude marriage rate remained constant for 1959, 1960, and 1961 at 8.5 mar- riages per 1,000 population. Divorces were estimated at 391,000 in 1960, compared to 395,000 in 1959. The crude divorce rate was 2.2 per 1,000 population in 1959, 1960 and 1961. Funds The total funds available to the Public Health Service in fiscal year 1962 amounted to $1,633.4 million (see table 1, p. 226). Appropria- tions and authorizations accounted for about $1,392.4 million of this amount. The balance was made up of repayments for services given to other agencies and of unobligated balances from previous years. About 72 percent of the total funds available was allocated to others, in the form of grants to State and local agencies, private in- stitutions, universities, hospitals, and individuals outside the Federal Government. The remainder was used to support the direct respon- sibilities of the Public Health Service, such as hospital and medical eare for legally designated beneficiaries, foreign and interstate quar- antine, and Indian health services. Office of Personnel At the request of the Surgeon General, the Secretary of the Depart- ment of Health, Education, and Welfare appointed an Advisory Com- mittee on Public Health Service Personnel Systems to study the re- cruitment and retention of personnel. The Committee, headed by former DHEW Secretary Marion B. Folsom, began its study in October 1961 and completed it in March 1962. In brief, the recommendations of the Committee were: (1) that the Surgeon General personally accept responsibility for the direction of personnel management in the Service; (2) that personnel staff services be reorganized and strengthened; (3) that personnel opera- tions be substantially improved; and (4) that pay and rank be care- fully examined and if inadequate, to explore the possibility of legislation that would make them more equitable. 148 Department of Health, Education, and Welfare, 1962 _ A new Assistant to the Surgeon General for Personnel has been | named, and under his direction, the Office of Personnel has begun the implementation of the recommendations of the Committee. PERSONNEL At the close of the fiscal year 1962, the Public Health Service had a © total staff of 32,638. (See table 2, page 228.) This number includes © 4,501 Commissioned Corps Officers, 26,808 full-time and 1,329 part- | time Civil Service employees. (See table 3, page 230.) Commissioned Officers on duty included 1,909 members of the Regular Commissioned Corps, 2,366 members of the Reserve Corps on Active duty, and 226 Commissioned Reserve on temporary training duty. National Center for Health Statistics The National Center for Health Statistics, nearing the end of its second year in July 1962, has modernized its data processing by in- stalling computer facilities. This has resulted in more timely report- ing of Center activities. Another result is far better use of the Center’s professional manpower. When not being used for Center programs, the computer equip- ment is available to other elements of the Public Health Service, principally in the area of health statistics. As an experiment, the Center has undertaken negotiation of con- tracts with statisticians of foreign nations to provide analyses of mortality trends in those countries. This probably will be expanded to bring otherwise unavailable professional resources to bear on the Center’s statistical problems. NATIONAL HEALTH SURVEY During the year, the National Health Survey accelerated work on its newest data collection program—the Health Records Survey. With help from the Bureau of the Census, a master list of all types of resident institutions and hospitals in the Nation was constructed. This list will be used as a base for sampling studies. Next, pretesting be- gan in the first of a series of surveys based on the master list. This is a survey of Resident Places Providing Nursing or Personal Care, de- signed to produce up-to-date knowledge of a population known to consist almost entirely of old people. The National Health Survey Division also operates a program of studies to improve health survey methods. Among these are projects to develop new methods of gathering information on personal health expenditures and to evaluate and refine the collection of data on health insurance ceverage in the general population. A third continues the Public Health Service 149 Health Survey’s series of studies to evaluate chronic disease informa- tion reported in the Health Interview Survey. By the end of the fiscal year, full-scale operation of the Health Examination Survey was beginning to be achieved. Data collection on the first cycle, primarily concerned with certain chronic diseases in the adult population, was more than three-fourths completed and work on the pattern of tabulation and analysis of these data was well under way. Meanwhile, plans were being completed for the second eycle, a nationwide probability sample of children from 6 through 11 years of age. The Health Interview Survey produced reports on several topics not previously reported on by the National Health Survey: (1) Persons receiving care in the home, (2) Proportion of hospital bill paid by insurance, (3) Duration of limitation of activity due to chronic condi- tions, and (4) Selected impairments by etiology and activity limita- tion. Estimates for topics discussed in earlier reports were updated with more recent data. Health interview data also served as the basis of a report on the health characteristics of currently employed persons. NATIONAL VITAL STATISTICS DIVISION During the year, the Division made substantial progress to reduce the lag between receipt and publication of data from the States. Considerable mortality and natality statistics for the 1961 data year were released well before the end of 1962. In fiscal year 1962 the Division published annual and provisional monthly data in vital statistics and six special studies: (1) Occupa- tional mortality, (2) Number and type of medical care institutions, (3) Matching birth certificates and census information, (4) Charac- teristics of Georgia marriages, (5) Improving national divorce sta- tistics, and (6) Standard error of age-adjusted death rates. The Division undertook its largest single reimbursable project to date, involving more than $300,000, to provide technical assistance for a series of monographs sponsored by the American Public Health Association to synthesize data of concern to public health and demog- raphy drawn from a wide array of sources. The Division’s computer programmer staff, built entirely during the year, is largely complete and trained. The Division and other Center components are developing ideas to use the computer facilities to strengthen vital statistics programs in the States. The ninth national meeting of the biennial Public Health Confer- ence on Records and Statistics in June 1962 was singularly successful in improving vital and health statistics and makng them more useful and usable. 150 Department of Health, Education, and Welfare, 1962 | The Division is in the second year of the national mortality sample | survey, based on a sample of deaths occurring throughout the country. Plans have been developed to begin a continuing national natality — sample early in 1963. The third phase of a cystic fibrosis study is — nearing completion. For the 1960 census year, marriage and divorce statistics were based on nationwide samples of marriage and divorce records collected from States and local areas. For 1961 and 1962, the samples are being col- ~ lected only from the registration areas, which at the end of the fiscal year contained 35 States and 4 other areas for marriages and 21 States and 1 other area for divorces. The Division stimulated discussion and provided technical and con- sultative advice as required on the need for retaining the item on race- color on vital records, beginning with a panel discussion at the annual meeting of the American Public Health Association. Efforts have been intensified, cooperating with State and Federal agencies, to develop minimum safeguards to reduce fraud associated with vital records and promote the integrity of vital records. . oli aed a a IUTSITA {SOM Z6L 192 ‘T 69 $9 62 LY 16 G06 GF (nae ine ae -e aeeee TOYSUTYSE AA £9 18L ‘9 OOT 86 9L GL 9&T O€€ 08 if ie ae Me ee Ss SO VIOUS ILA £07 LIP €& 96 ¥L 96 L9 ¥g WE ewe © ee en ee ee ke ae le Se ari VUOULLIO A 288 CALE se ‘all AIREY eae 8T 6 9 6& 90T nn 1 ee ae a Pe a NNT ey oe BS Re yen $92 ‘T 969 ‘OT 602 C61 GES SLT 828 918 PST CVs, |G se. Oe, oe ene re ed Le ~~sBxoT PSI T 88 ‘F 8g €0L LEI FL €&T 16€ 16 13 ee gen i. 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The redirection has been focused on these principal concerns—that the highest quality educational program of which our Nation is cap- able be assured through all possible avenues, and that opportunities for desired education be extended to all the people. Recognizing the need for trained technical manpower, the high level of unemployment among youth who leave school early, and the nationally pressing need for expanding and improving training op- portunities for youth and adults, the Office of Education initiated a reassessment of existing vocational education programs with a view to their adaptation to the needs of the coming decade. Following the pattern of successful programs in science and foreign languages, the Office of Education embarked on a project for the im- provement of quality in the teaching of English. The combination of curriculum development and improved instructional practice is the objective of the project. The Office also planned a similar program in the social studies and surveyed means by which it might strengthen education in the arts. Project English provides an illustration of the more effective co- ordination of Office and extramural resources. A broad approach to the problem of teaching English has been initiated with specialists of the Office in English, research, and administration working closely to- gether. In this project, instruction at all levels is being considered through study, research, and demonstration in curriculum develop- ment and instructional technique. Research contracts in colleges and universities are coordinated with the Office staff work. The multilat- 235 236 Department of Health, Education, and Welfare, 1962 eral approach in the Office has accelerated similar types of coopera- tion among professors of English, education, and other disciplines within the participating institutions. The Office turned its attention also to the relationship of educational and social problems, such as those of education for expanding urban areas and adult literacy. It conducted a comprehensive review of current grant and contract programs in order to assure that they are supporting equal educational opportunity for all, and began to stimu- late research and studies related to problems of desegregation, edu- cation of migrant children, the disadvantaged, and culturally different youth. It brought together responsible leaders to consider the need for educating the American people more effectively for the attainment of the goals of a free society, and the ways in which American ideals might be given better expression in education. As the Federal interest in education has grown, so has the variety of programs and the number of departments and agencies responsible for their operation. Because of its concern that educational institu- tions be continually strengthened as they participate in Federal pro- grams, the Office of Education laid the foundation for a pattern of relationships with Federal agencies for the purpose of promoting a more coherent Federal educational policy and better coordination of the educational activities of these agencies. This concern with the effects of Federal programs was included in a special study of the Federal Government and higher education, two parts of which were completed during the year. These new directions have been accompanied by a change in the Office structure. The organization of the Office, which had largely reflected the levels of education or major grant-in-aid legislation, was revised with the formation of three bureaus concerned with: (a) ed- ucational research and development encompassing all levels of edu- cation; (6) financial assistance program administration; and (ce) international education program administration. This bureau struc- ture will enhance the ability of the Office to concentrate its resources more effectively for the solution of major problems that cut across educational levels. It will promote more uniform administration of financial assistance programs and thereby ease the administrative tasks of the State and local education agencies. It will assure more effective coordination of Office activities in the support of the over- seas programs of the Federal Government. The reshaping of Office activities has sharpened the accomplish- ments of the programs with which the Office has been entrusted over the years. Among the latter are financial assistance to improve the quality of education in specialized fields, as in vocational education, mathematics, science and foreign languages; administration of a Office of Education 237 financial aid to students in institutions of higher education; con- sultative service on a wide range of educational matters; the collection and dissemination of statistics describing the condition of American education, its needs and accomplishments; the advancement of funda- mental research for the progress of education; the administration of the large and intricate program of assistance to the Nation’s schools in federally impacted areas. These programs constitute the most substantial portion of the responsibilities placed upon the Office of Education. They are avenues through which the Federal Govern- ment contributes to a strengthening of the leadership as well as of the educational programs of the State and local education agencies and institutions of higher education. The Office of Education has a responsibility to view from a national perspective the large educational needs that affect the Nation as a whole—the regions, the States, and the communities. It has a re- sponsibility to report such needs and recast its efforts to assist in ful- filling these needs. In 1962, the Office initiated new programs that focused, as its continuing activities focus, on support and supplemen- tation of State, local, and institutional efforts. It has done so with the constant concern that the pluralistic structure of American edu- cation be judiciously preserved and strengthened. | Social Problems and Education PROBLEMS OF URBAN AREAS As the result of a social and economic revolution leading to urbani- zation, almost two-thirds of the people of the United States are concen- trated in 212 metropolitan areas. This upheaval of home and family and social organization has, of course, brought great problems to the cities. They are problems of education, health, and housing; of sani- tation and transportation; of social adjustment and employment; of delinquency and crime. To an extent greater than in the past, the Office of Education is widening its field of vision to recognize more clearly the effects of social-demographic problems on education. The changing nature of urban centers is a source of many problems in education. One of the problems has been that of coping with the educational needs and opportunities created by Federal action in such areas as public welfare, public housing, urban renewal, and freeway construction. In December 1961 a group of educators met with the Commissioner of Education to discuss the impact of Federal programs on education, and their meeting led to the May 1962 Conference on the Impact of Urbanization on Education, at which representatives of Federal agencies concerned with public housing, urban renewal, city freeways, child welfare, education and labor, and 238 Department of Health, Education, and Welfare, 1962 ——_ youth employment and delinquency met with school board members | and superintendents from the 15 large cities that form the Research Council of the Great Cities Program for School Improvement. A valuable opportunity was thus provided for Federal and local officials to discuss and better understand their mutual problems and responsibilities. A series of intensive case studies will be undertaken in a limited number of large cities where effective work has been done in coordi- nating school system planning with the planning and programs of urban renewal and other related urban development projects. School facilities planning problems, which exist in every metro- politan area, were the subject of a conference held in the spring of 1962. Asa result of this conference, an effort is underway to identify and to analyze the characteristic problems of planning school facilities in metropolitan centers. In addition, the financing of urban schools was the subject of a conference called in May which resulted in a study concerned with the improvement of State school fund distribution formulas. Two other conferences held in May directly attacked the problem of teaching hard-to-reach youngsters: “Teaching Children and Youth Who are Educationally Disadvantaged,” and “Improving Eng- lish Skills of Culturally-Different Youth in Large Cities.” At these meetings there was a review of promising efforts in the field, identification of significant problems hindering progress, and pro- jection of new approaches to the problems. The high rate of mobility of families has often contributed to a breakdown in the school-community rapport so necessary to the success of the school program. The need to identify, attract, and develop sources of support and leadership among new residents is recognized by a current project on the improvement of school-home programs in disadvantaged neighborhoods in selected large city school systems. Still another study, a cooperative research project, is designed to evaluate the effectiveness of all-day neighborhood schools in New York City. When completed, these studies may pro- vide information concerning a more effective educational approach to culturally deprived children. The Office of Education has also participated in the joint task force established by the Department of Health, Education, and Wel- fare and the Housing and Home Finance Agency to promote concerted and improved health, education, and welfare services in public hous- ing projects and urban development areas. This joint task force is designed to help public housing families on relief rolls work their way out of dependency. 7 Office of Education 239 FREEDOM AND WORLD UNDERSTANDING In March 1962 approximately 140 leaders in American education met at the Office of Education to consider the state of American edu- eation in the light of the traditional ideals of freedom and the present | need for achieving a greater understanding of other cultures, and to discuss methods of educating more effectively for the attainment of the goals of a free society. This conference on “The Ideals of Ameri- can Freedom and the International Dimensions of Education,” was addressed by the Secretary of Health, Education, and Welfare, the Assistant Secretary of State, and the Commissioner of Education. Their addresses and a summary of the salient ideas evolved from the deliberations of several committee sections have been published under the title, Education for Freedom and World Understanding. Discus- sion at the conference was characterized by the acknowledgment of shortcomings and an eagerness to strengthen and improve the educa- tional resources of the United States. The conferees sought to define that common core of ideals which should command the allegiance of all Americans, and to discover ways and means to give those ideals more effective expression in education. EQUAL OPPORTUNITY FOR EDUCATION On March 30, 1962, the Commissioner of Education announced before a subcommittee of Congress plans for a clearinghouse on the educational problems of school desegregation. The establishment of this clearinghouse in the Office of Education provides a means for disseminating to interested citizens reliable information on educational practices used successfully by various school systems. Professional advice of the highest quality can thus be made available to the com- munity, and significant research on the educational implications of desegregation can be stimulated. The clearinghouse will become active in fiscal year 1963. Further, the Office of Education has concerned itself with the matter of civil rights and education. A1l colleges and universities conducting institutes for high school language teachers and guidance counselors under titles V and VI of the NDEA starting in 1962-63 have agreed that in selecting individuals for attendance at the institute and in otherwise conducting the institute, no discrimination will be made on account of sex, race, creed, color, or national origin of an applicant or enrollee. Advances toward the goal of equal education have been made through the administration of the programs of school assistance in federally affected areas, A policy has been adopted under which segregated schools will, in the fall of 1963, be deemed unsuitable for the dependents of military or civilian personnel living on a military 240 Department of Health, Education, and Welfare, 1962 installation and attending off-base schools; appropriate steps will be taken, where necessary and feasible, to provide suitable education for these children on the installation. As a part of its annual review of State vocational education pro- grams supported with Federal funds, the Office this year is inquiring for the first time into the availability of courses of training in pre- dominantly Negro and predominantly white schools. A directive will be sent to all States advising that any program for training in a voca- tion offered with the assistance of Federal funds must be equally avail- able to all children of the school system in which it is offered. Special Programs EXCEPTIONAL CHILDREN Of the approximately 6 million school-age “exceptional” children in the United States in need of special education, it is estimated that not over one-fourth have access to it. Exceptional children are usually defined as those who are blind, partially seeing, deaf, or hard of hear- ing; those with impaired speech; those who are crippled or who have ~ special health problems; those who are socially maladjusted or emo- tionally disturbed, mentally retarded, or highly gifted. Statistical surveys made by the Office of Education in 1948 and 1958 show that progress is being made, for during that decade the estimated percent- age of those receiving specialized help rose from about 10 percent to about 25 percent, although the progress was rather uneven from one area of exceptionality to another. All States now have made some provision for meeting the needs of at least some types of exceptional children. Developments in State legislation and programs for children suggest that in the relatively near future a large number of States will offer special education op- portunities to all types of exceptional children. The extension of programs into some of the more sparsely populated areas is also en- couraging. Of significance too is the increase of special education staffs in the various State departments of education. Special Educa- tion Personnel in State Education Departments, a directory issued by the Office of Education in September 1961, listed about 270 such posi- tions, or an average of over 5 persons per State. Special programs are developing in new or neglected areas of educa- tion, especially for emotionally disturbed or multihandicapped chil- dren. Some of these programs are on an experimental basis. Attention is also being given to children of a wider age range, including those in nursery and kindergarten or those in the older age bracket for whom school-work programs are being developed increasingly. Office of Education 241 | |+——1,000 PUPILS ——| Note: Data are for 48 States and the District of Columbia. Source: U.S. Department of Health, Education, and Welfare, Office of Education, Biennial Survey of Education in the United States. goal a ratio of one full-time counselor for each 800 students. In 1958, the national ratio for all high schools was 1 counselor to 750 students as compared with the current ratio of 1 to less than 550. Prior to NDEA (1957-58) the equivalent of approximately 12,000 full-time secondary school counselors served a public secondary school population of more than 10 million students. At the current rate of expansion in guidance, counseling, and testing programs, it is esti- mated that the number of full-time equivalent counselors in public secondary schools will have increased from 21,800 during 1961-62 to an approximate 33,000 counselors by 1964. Notwithstanding these gains, however, there is still an urgent need for additional qualified counselors to meet the increasing enrollment and to provide counseling services at the recommended ratio of 1 to 300. The projected increase f . ] Office of Education 267 in enrollment for 1964 will require about 51,000 counselors, leaving an anticipated shortage by that date of more than 18,000 full-time equivalent counselors. Statistics indicate that there is a current short- age of more than 20,000 guidance and counseling personnel at the public secondary school level, and 2,200 at the undergraduate college level. Even though full- and part-time professional guidance personnel in State departments of education increased from 99 in 1958 to 256 dur- ing the 1961-62 school year, additional State supervisory personnel will be necessary to provide more adequate supervision of local guid- ance and testing programs. The most recent statistics indicate that in addition to approximately 9,000 counselors employed in schools which are not participating in the NDEA program, only 256 full- and part-time State supervisory personnel are dealing with approximately 26,000 persons engaged in scheduled guidance activities in 7,229 NDEA-approved programs. Higher Education ADMINISTRATIVE PROBLEMS AND SERVICES One of the basic responsibilities of the Office of Education is to provide services designed to strengthen higher education at regional, State, and institutional levels. Through the dissemination of the results of its own research and data gathering, the Office multiplies the effectiveness of all who are responsible for institutions and agen- cies of higher education. The Office stimulates through direct services furnished in response to specific requests by national and State agen- cies and organizations, and by individual institutions, and encourages progress also. The following examples will serve to illustrate the scope and thrust of such activity and services. Statewide Survey.—During 1962, the Office was asked by the Gov- ernor and State Legislature of Hawaii to conduct a comprehensive survey of higher education in that State, including the University of Hawaii and five private colleges, to afford a blueprint for progress. The report of the findings and recommendations growing out of this survey will be completed in November 1962 and submitted for action by executive offices of the State government, the legislature, and the board of regents of the university. Information on State Legislation—The annual Survey of State Legislation Relating to Higher Education is extensively used by both individuals and organizations desiring information on the status of higher education legislation in the several States and Territories. The current issue was completed in March 1962. Clearinghouse of Studies on Higher Education.—Since 1958 the Office of education has compiled, analyzed, and interpreted data on 268 Department of Health, Education, and Welfare, 1962 educational research and experiments related to programs reported by colleges and universities and utilized by similar institutions, man- agement consultants, national and regional educational committees and commissions, State and local education systems, private industry, and individuals engaged in educational research. Inanumber of cases, institutions unable to send representatives to the Office of Education clearinghouse have invited the Office to send a consultant to them. The concerns of the institutions, as reflected in their inquiries, encom- pass problems concerned with learning and teaching practices, insti- tutional management, student personnel services, and professional — education. The interests of international agencies and of foreign universities are to establish working arrangements with a source of information in this country that can continuously inform them of cur- rent developments in higher education in the United States. Through the Reporter, issued on a recurring basis, recently com- pleted research on higher education is identified, listed, and annotated. Through the various issues of the Vew Dimensions series, trends in research on timely subjects are reported in considerable detail. The usefulness of this series is evidenced by the substantial number of copies requested by colleges and universities, national and regional education agencies, and philanthropic foundations; copies are also requested as resource materials for conferences. Institutional Organization and Administration—The Office pub- lished and disseminated a research report entitled Organization and Administration of Institutions of Higher Education. This book describes and analyzes the organizational patterns of 608 institutions. It deals also with issues, techniques, and procedures involved in achiey- ing efficient internal organization and administration of institutions of higher education. Assistance in Accreditation and Institutional Research Efforts — Utilizing its substantial file of institutional self-surveys and related materials, the Office has given wide assistance to colleges conducting their own surveys for accreditation purposes. Interinstitutional Cooperation—Cooperative undertakings by groups of institutions of higher education have become increasingly significant in recent years. In 1962, the Office of Education published Cooperative Projects Among Colleges and Universities, a report iden- tifying and describing a number of such interinstitutional projects cur- rently in operation. This publication was used as a basic resource item at two national conferences on higher education. Consultative services.—A. substantial part of the work of the Divi- sion of Higher Education during fiscal 1962 was devoted to providing consultative services to State governing and coordinating boards of higher education, as in Oklahoma, Kentucky, Colorado, and a dozen ¢ Office of Education 269 other States, to nonpublic higher education boards and related agen- cies, and to other governmental and nongovernmental organizations and officials. Similar services related to matters of administration, planning, finance, and curriculum were furnished to institutional higher education boards and officials. Organization and Administration of 2-Year Colleges.——The most dramatic developments in the 2-year college movement continue to be the rapid increase in the number of public junior colleges, the increases in enrollments in 2-year institutions of all types, and the heightened emphasis on developing 2-year college campuses and facilities. In the past 5 years, of the 90 new institutions of higher education established in the United States, 69 are 2-year institutions: 15 established in 1956, 11 in 1957, 19 in 1958, 10 in 1959, and 14 in 1960. Less dramatic than the expansion of these colleges, but perhaps equally important, is the improvement in their administration. In 1962, the Office of Education assisted in several ways in the strengthening of 2-year college admin- istration. Included in the annual Survey of State Legislation Relat- ing to Higher Education was a listing of State legislation affecting 2-year colleges. During the year, the Office also completed the data- gathering phase of a study, Patterns of State Support for 2-Year Colleges, and assisted in organizing and conducting a conference of State directors of 2-year colleges. A report of the conference appeared in the Office publication, State Directors of Junior Colleges and Coordinators of State Systems of 2-Y ear Colleges. Business Administration of Higher Education—In 1961-62 col- leges and universities spent approximately $7.2 billion for current operations and $1.2 billion for additions to the plant, a total of $8.4 billion. Although earmarked funds financed slightly more than one- third of the total expended for current operating purposes, such as auxiliary enterprises, organized research, and student assistance pro- grams, there was considerable concern over the fact that no more than $4.8 billion came principally from student tuition, Government appro- priations, and gifts. By 1970 the cost of operating the institutions of higher education may be expected to reach an annual total of $18.0 billion, with $15.5 billion required to finance current operations and $2.5 billion to finance capital additions. To help identify the magni- tude of the economic problems of financing higher education and to examine the major issues involved, the Office prepared a publication entitled Z’conomics of Higher Education. Salary payments require about 60 percent of the total current operat- ing expenditures of institutions of higher education. To note the significance of salary levels, the Office makes an annual study entitled Higher Education Planning and Management Data. 'The study has also furnished salary data for use in special areas, such as land-grant 270 Department of Health, Education, and Welfare, 1962 colleges, State universities, junior colleges, and private colleges affili- ated with religious denominations. Identification of sources of income and items of expenditure is obtained from a biennial study of income, expenditures, and property. The Casebook on Campus Planning and Institutional Development reports the varied experiences of 10 institutions in building and expanding their campuses. This casebook was developed on the assumption that many higher education officials would be stimulated to do more effective planning by studying the experiences of others who had faced comparable problems. A manual to assist those who have administrative responsibilities related to physical plant in making decisions regarding the rehabilita- tion, modernization, alteration, expansion, or abandonment of existing buildings is in preparation by the Office. Urbanization and Higher Education—The increasing urbanization of this country and the problems created thereby have caused the Of- fice of Education to become deeply concerned with the effect of this social force on American education. During the year the Office of Education held a staff seminar based on a staff document setting forth the general characteristics, major problems, and noteworthy develop- ments of higher education in urban settings. In addition to the rapidly increasing demand for higher education in the cities and the associated problems of physical and financial expansion, it seems that urban universities are finding it necessary to assume more and more responsibility for the social, cultural, and intellectual welfare of their communities. Faculty Shortage—The problem of increasing enrollments already described has lead to a critical shortage of qualified teaching person- nel in several important instructional areas. To assist in the solution of this critical problem, this office has undertaken a study to provide for institutions of higher education reliable estimates, by major field, of the demand for instructional staff during the next decade. Re- curring studies provide data on faculty salaries, fringe benefits, and working conditions. It is expected that the Office of Education status and projections reports on faculty personnel will be useful to graduate schools in developing programs for preparing college teachers, as well as to the college and university officials who select and appoint college teachers. STUDENTS AND CURRICULUM Student Services.—In the fall of 1961 there were 3,891,000 students enrolled in American institutions of higher education, 1,026,000 of them (26.4 percent) enrolled for the first time. It is well known that even more students will be enrolled in the next 5-year period. As Office of Education 271 CHART 6.—PERCENTAGES OF DEGREE-CREDIT STUDENTS ENROLLED IN VARIOUS TYPES OF INSTITUTIONS OF HIGHER EDUCATION: UNITED STATES AND OUTLYING PARTS, FALL 1961 Other professional, 1.5% Schools of art, 0.5% Theological, BY. religious, 1.1% ff Technological k schools, 2.9% “#: “colleges % #9: 19.49 56 colleges 28.5% Source: U. S$. Department of Health, Education, and Welfare, Office of Education, Survey of Opening (Fall) Enrollment in Higher Education, 1961. enrollments increase, the problems related to meeting the diversified needs of a larger and more heterogeneous student population will multiply at an accelerating pace. Several activities of the Office of Education have been devoted to the study and solution of these problems. Staff members at the re- quest of institutions have consulted with them on problems relating to student financial assistance and the management of their student service programs; two studies were undertaken: one analyzing institu- tional expenditures for student services and the other devoted to the staffing and administration of student services. Preliminary findings from the first of these studies indicate that exclusive of housing and other auxiliary enterprises, publicly controlled institutions of higher education annually spend for student services an average of $38 per student. The comparable figure for privately controlled institutions is $46 per student. Information Services ——The rapidly increasing number and quality of high school students planning to enter college has added to the 272 Department of Health, Education, and Welfare, 1962 complex problems related to college admission and financial assistance and has demonstrated the need for improved and expanded informa- tion about post high school opportunities. Traditional patterns of selecting a college are no longer adequate for today’s high school graduate facing the increasingly selective admissions competition. Rising college costs make the financing of higher education difficult for many students and their parents; for some, impossible. Financial Assistance.—During the year the Division of Higher Education completed a national survey of institutional student finan- cial assistance—scholarships, loans, and student employment financed by funds controlled by the colleges and universities. Based upon returns submitted by 1,677 institutions, the total volume of such as- sistance for the academic year 1959-60 was $211,011,345. Of this total, approximately $98.5 million was disbursed as compensation to students, $98.2 million in the form of scholarship grants, and $14.4 million as institutional student loans (not including loans under the National Defense Student Loan Program). As a byproduct of this study, the Office completed and published another directory of under- graduate student aid resources, Financial Assistance for College Stu- dents: Undergraduate. On the invitation of the Rhode Island State Board of Education, the Office of Education completed an evaluation of the several State scholarship programs. The principal problems studied involved the rapid increase in scholarship costs, the need for and effectiveness of certain categorical scholarships, the administrative problems of mul- tiple scholarship awards, standards for renewals, institutional transfer of scholarship students, and the administration of the financial needs test in setting stipends. Following the preparation of extensive statistical and documentary materials, consultation, and conferences with educational leaders and groups, a report of the findings and rec- ommendations for the improvement of the scholarship programs was presented to the board and the administrative staff of the State de- partment of education in January 1962. The board accepted the principal recommendations of the report and proceeded with their implementation. Graduate Study—A report, Doctoral Study: Fellowships and Capacity of Graduate Schools, documents the number, value, type, and major source of graduate fellowships recently awarded by major universities in all principal academic fields. The report also concerns the capacity of graduate schools for further expansion and the prin- cipal barriers to such expansion. Two statistical reports have been prepared showing the number of students obtaining advanced graduate degrees from two major groups of institutions. The institutions are the 39 United States members Office of Education 273 of the Association of Graduate Schools in the Association of American Universities and the 68 land-grant colleges and universities. Summer Sessions.—A. preliminary report of summer session pro- grams in colleges and universities was prepared and distributed in April, in reply to numerous requests for summer-session data. Two publications, Regular-Year Scholarship Programs of Institutions of Higher Education Applicable for Summer Session Study, 1960, and Travel Programs Sponsored by Institutions of Higher Education in Summer Sessions, 1960, have been issued ; three additional publications are in the final stages of preparation. Teacher Education.—A major contribution has been made in the area of fifth-year programs of classroom teacher education: Fifth- Year Programs of Classroom Teacher Education: A Survey Report, will soon be off the press; meanwhile, three prepublication issues have been issued on the Z'eacher Education Series, “The Teaching Intern- ship Program,” “Fifth-Year Preservice Programs for Graduates of CHART 7.—TOTAL DEGREE-CREDIT ENROLLMENT IN RELATION TO POPULATION AGED 18-21: UNITED STATES, FALL 1939 AND FALL 1946 THROUGH FALL 1961 Millions (ratio scale) 20 Degree-credit students . a= ~~ of 1939 1945 1950 1955 1960 1961 Fall of year for enrollment - July 1 for population Source: U.S. Department of Health, Education, and Welfare, Office of Education, Surveys of Opening (Fall) Enrollment in Higher Education. 274 Department of Health, Education, and Welfare, 1962 Liberal Arts Colleges,” and “Fifth-Year Programs of Classroom Teacher Education.” Toward the solution of problems in staffing higher education, the - Office published a survey of placement services as a 2-part directory entitled Placement Services for Personnel in Higher Education. In addition to the directory it includes an analysis of the problems in- volved. It was used along with a parallel Office-developed working paper as basic material for a cooperatively sponsored professional conference. Education for Public Service—Following a series of meetings be- tween the Commissioner of Education and the Chairman of the Civil Service Commission and their respective Washington and field staffs, a Committee on Education for Public Service was established within the Office of Education. This Commitee will collaborate with repre- sentatives of the Civil Service Commission on educational programs designed to strengthen and improve Government service through the Government Employees Training Act. Public Administration—A 1961 publication, Graduate Study m Public Administration, became during 1962 a standard reference source concerning all graduate programs in the field of public admin- istration offered in the colleges and universities of the United States. Providing information never before available in a single volume, this new publication has been circulated widely throughout the United States and the countries of the free world. Upon special invitation, a related paper was presented by the author at the XIIth Internation- al Congress of the Administrative Sciences in Vienna in July 1962. Degree Requirements in Mathematics—The Office has undertaken a nationwide survey of mathematics requirements and programs for both baccalaureate and advanced degrees. Several articles have been published dealing with earned-degree trends in mathematics and the physical and biological sciences. Organized Occupational Curriculums.—The Office completed during fiscal 1962 its fifth annual survey of Organized Occupational Curricu- lums in Higher Education. Such curriculums, primarily for the education of technician and semiprofessional workers, are becoming more and more a function of 2-year colleges. Whereas in 1955-56 2-year institutions provided only slightly more than half of the graduates and enrolled a somewhat larger portion of the students than did 4-year institutions, in 1959-60 organized occupational curriculum graduates from 2-year institutions outnumbered those from 4-year institutions by almost 2 to 1 (33,148 to 18,217) and the 2-year colleges enrolled close to 70 percent of the students (170,831 of 246,496) in these curriculums of at least one but less than 4 years in length. Office of Education 275 Engineering Education—The Office continued its annual study of engineering enrollments and degrees, leading to the publication Zngi- neering Enrollments and Degrees, 1961. A report on transfers to schools or colleges of engineering was also published. The Office also contributed to the preparation of a 3-volume publi- cation, Report on Education and Training of Professional Engineers, prepared under the auspices of the Conference of Engineering Socie- ties of Western Europe and the United States of America. It deals with systems of engineering education in the participating countries. CHART 8.—TRENDS IN DEGREE-CREDIT ENROLLMENT FOR 4-YEAR INSTITUTIONS AND JUNIOR COLLEGES, BY TYPES OF INSTITUTIONAL CONTROL: UNITED STATES AND OUT- LYING PARTS, FALL 1939 AND FALL 1947 THROUGH FALL 1961 2,000,000 1,800,000 1,600,000 1,400,000 1,200,000 4-year PRIVATELY controlled institutions 1,000,000 500,000 FS 8 =? 8 8 eo PUBLICLY controlled junior colleges need -" - - =e 8 8 po 3 a elie ol Total Degree-Credit Enrollment (ratie scale) 100,000 PRIVATELY controlled junior colleges 30,000 25,000 [aaa ees CE Se 1939 1947 1948-1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 Fall of Year Source: U.S. Department of Health, Education, and Welfare, Office of Education, Surveys of Opening (Fall) Enrollment in Higher Education. 276 Department of Health, Education, and Welfare, 1962 Table 4.—Earned degrees conferred by institutions of higher education: United States, 1869-70 to 1961-62 Earned degrees conferred Academic year Bachelor’s Master’s All degrees and first except first Doctor’s professional | professional 9, 372 9, 371 0 1 13, 829 12) 896 879 54 16,703 15,539 1, 015 149 29, 375 27, 410 1 583 382 39, 755 37, 199 2113 443 53, 516 48, 622 4/279 615 139, 752 122; 484 14’ 969 2, 299 216, 521 186, 500 26, 731 3; 290 496, 874 432, 058 58, 183 6, 633 401, 203 329, 986 63, 534 7, 683 356, 608 290, 825 56, 788 8) 995 376, 973 308, 812 59, 258 8, 903 436, 979 362, 554 65, 487 8, 938 TORO—O0 Re a sacs ee ee eee 2 ene 476, 704 392, 440 74, 435 9, 829 LOBI=89 Ices pore ee a eee a 515, 200 425, 000 78, 800 11) 400 1 Data for 50 States and the District of Columbia. 2 Estimated. Note: Unless otherwise indicated, data are for 48 States and the District of Columbia. More bachelor’s degrees were conferred in 1949-50 than in any other year, since many veterans of World War II completed their education that year. Source: U.S. Department of Health, Education, and Welfare, Office of Education, Biennial Survey of Education in the United States, and Circulars on Harned Degrees Conferred by Higher Educational Institutions. LAND-GRANT INSTITUTIONS The specific contribution of the Office to the Centennial Celebration of the establishment of the Land-Grant Colleges was a publication entitled, Land-Grant Colleges and Universities 1862-1962. Along with a reprinting of the first Morrill Act of 1862, and all subsequent legislation and amendments, as well as administrative rulings per- taining thereto, the bulletin presents a brief chronology of the develop- ment of each of the 68 institutions of higher education now constitut- ing the “land-grant” system. A survey of enrollment in agricultural curriculums in the land- grant colleges and universities for the 1961-62 academic year showed an increase of 3 percent in undergraduate enrollment and an increase of 2.5 percent in graduate enrollment over the previous year. For the first time in recent years the proportion of agricultural enroll- ment to total enrollment in these institutions did not decrease. The Office has provided United States representation in the meet- ings of the Organization for Economic Cooperation and Develop- ment, including a study and discussion of the Structure and Orientation of Intellectual Investments in Agriculture in Relation to Economic and Social Developments in the 14 member countries. FEDERAL PROGRAMS In view of the Federal Government’s extensive support of programs in higher education, it is important that the impact of its activities Office of Education 277 in universities and colleges be clearly understood. Accordingly, the Commissioner of Education in February 1960 instituted a survey of Federal programs in higher education to consist of the following three parts: (a) A report on Federal programs in higher education and participating institutions, to be compiled on the basis of data from Federal agencies. (b) A study of the effects of Federal programs in 36 institutions of higher education. (Later contracted by the Of- fice of Education to the Brookings Institution.) (c) Observations and recommendations on the Federal role in higher education based on the evidence of parts a and b as well as opinions of administra- tors of the programs. A few of the preliminary findings of the director’s report, which is nearing completion: Federally sponsored programs in higher education are designed generally to increase the Nation’s productivity and potential in special fields such as agriculture, health, national security, science, engineering, and world affairs. Federal programs emphasize research and graduate education. Between 1955 and 1960 about 75 percent of all Federal income reported by colleges and universities was for research and development. Funds for Federal activities in higher education are largely concen- trated within 100 institutions. In 1959, 100 institutions received more than 93 percent of all the funds for programs of research, graduate fellow- ships, and grants for facilities and equipment; 100 institutions received 88 percent of the funds for ‘education and training” programs. The 100 major participants, as measured by total Federal income in 1960, included 54 public and 46 private institutions. In general, faculty members and administrators participating in federally sponsored programs reported that in their opinion the Federal activity was appropriate, beneficial, and constructive; that its deficiencies arose primarily from its piecemeal nature; that most of the difficulties were being eliminated with experience; that its dangers lay more in the policies and standards of participating institutions than in any dictatorial tendencies on the part of Federal agencies and departments. Educational Statistics During fiscal year 1962 the Office of Education conducted two basic recurring surveys of State school systems: One, conducted biennially for those school years ending in an even number, reported detailed data on the organization, staffing, enrollment, and financing of public schools and basic information on the status of nonpublic schools; the other reported findings on the fall enrollment, teachers, and school- housing in the public schools. Studies of local school systems provided data for reports on cur- rent expenditures per pupil, elementary and secondary school pro- grams, teacher turnover, and the beginning public classroom teacher. The Office also developed projections of public and nonpublic ele- 278 Department of Health, Education, and Welfare, = mentary and secondary school enrollment, investigated the best pos- sible methods for gathering meaningful statistics on school facilities, and provided advance estimates for college enrollments and resulting — professional staff needs. The Office continued its survey of nonpublic elementary and sec- ondary schools resulting in a classified universe of the 4,000 secondary schools and a tentative group of some 13,000 elementary schools. From findings of these surveys, work was begun on a directory listing accredited and nonaccredited high schools. A study of subject offerings and enrollments in private and paro- chial high schools was also launched. The data collected were largely comparable with similar information collected the previous year from a substantial sample of public secondary schools. In 1963 separate statistical reports will be prepared on the two levels of nonpublic schooling below college. At the same time, nationwide information on courses offered and the extent to which they are being utilized in both public and private schools will be available for the first time in 80 years. The Office of Education conducts a broad and comprehensive pro- gram of statistical surveys in higher education. Needs are recognized both for prompt publication of data for immediate use and for anal- yses which require more preparation time. An example of a fast- moving survey, confined to only a few basic data items, is the annual survey of early fall enrollment. Data are collected as of late Septem- ber and October, are reviewed and processed as received, and are published in early December. The publication gives for each of ap- proximately 2,000 institutions the total enrollment of men and women students in work creditable toward bachelor’s degrees and also the number of such students who are entering college for the first time. Both sets of figures are needed for establishing trends and projecting future changes. Another effort to provide current data in higher education is the annual reporting of higher education data needed for institutional planning and management. Questionnaires were mailed to colleges and universities in July 1961 asking for information on student charges and staff and faculty salaries for the coming school year (1961-62). Institutional listings and summaries of the data were provided by type of institution, control, and region. This published report was supplied to administrative personnel in institutions of higher learning in Sep- tember 1962. New statistics prepared during the year included a projection of col- lege enrollment which distinguished full-time enrollment for the first time and which analyzed the effect of increasing levels of education among parents on the college attendance rates of their children. Pro- Office of Education 279 jections of earned degrees by major field of study were prepared for use in manpower studies stimulated by the Manpower Development and Training Act. Other surveys included studies of engineering enrollments and de- grees by field of concentration; graduate students enrolled for advanced degrees by field of study, years of study completed, and whether enrolled on a full-time or part-time basis; faculty and other professional staff by type of position; detailed financial statistics on receipts, expenditures, and property; junior-year enrollments in selected fields within the sciences, mathematics, and foreign lan- guages; opening fall enrollment in degree-credit courses; data on organized occupational curriculums; and a detailed analysis of land- grant institutions, showing enrollment, degrees conferred, faculty, current-fund income and expenditures, and plant assets and obligations. Sponsored Research COOPERATIVE RESEARCH PROGRAM During fiscal year 1962 the Cooperative Research Program assumed an expanded national role in pursuance of its charge to stimulate and support the study of problems facing American education. The Program’s support for basic and applied research continues to provide a source of new knowledge and new applications of existing know]l- edge on an ever-increasing variety of topics at all levels. A study com- pleted during this fiscal year, for example, revealed that up to 44 percent of some teachers’ verbal behavior in the classroom was de- voted to the control of pupils. Such behavior is believed to impede rather than facilitate learning. Although the researcher who con- ducted this study believes that little can be done to change the be- havior of teachers who emphasize control, instruments now available could be used to screen out teacher training candidates who are likely to exhibit such behavior. Research proposals in all areas continued to be received in in- creasing quantity and improved quality. Projects approved covered a wide range of topics and problems of import for education, as indi- cated by the following examples: Academic achievement of adult stu- dents; the technology of programed instruction; comprehension of rapid speech by the blind; dynamics of personality development dur- ing the college years; relationship of group counseling to academic performance; development of sensitivity to esthetic values; commu- nity attitudes toward educational change; financial analysis of college operations; cross-national study of educational attainment ; retraining of unemployed workers. 280 Department of Health, Education, and Welfare, 1962 — During fiscal year 1962 the Cooperative Research Program paid increasing attention to the problem of reducing the tremendous time lag that occurs between the results of research and their application — in the classroom. In addition to continuing to distribute brief de- scriptions, summaries, and monographs, the Program made arrange- ments with the Library of Congress to have final reports of projects microfilmed. Microfilmed copies of many reports are now available through the Library of Congress to interested individuals at a modest fee. Two crucial areas requiring a concentration of research and devel- opment efforts were identified in this fiscal year: the teaching of English and the utilization of talent. Project Talent The purpose of this program of research and demonstration is to attack the deplorable condition which allows 70 percent of the talented young people in the United States to remain unidentified and dor- mant. Following research conferences, seminars, and research devel- opment contracts, basic and applied research and demonstration studies in this area are now underway with support from the Cooperative Research Program. As a major effort in Project Talent 440,000 secondary school chil- dren throughout the country are being tested, studied, and followed through their school experiences. Some of the results now available indicate, for example, that when the same achievement tests are given to children in the ninth grade and twelfth grade, the upper 25 percent of the ninth-grade students score higher than the average twelfth graders. This of course has important implications for curriculum planning. Illustrative of other studies in the utilization of talent are projects to determine the value of various problem-solving strategies and to follow up on the career patterns of college graduates. As a part of the latter program a research development conference was held to review and reassess research aimed at devising better tests to measure creativity, problem-solving ability, and underachievement. Project English English is basic to all other fields of study and important as well in the adult lives of all American citizens. Through research, improve- ment of teacher preparation, and dissemination of what is already known about effective teaching materials and practices, “Project English” is intended to support and extend the work already being done on the local and State levels by various professional organiza- tions. It is not in any way an attempt by the Federal Government to control the content of the curriculum. Office of Education 281 An increasingly important feature is the collaboration between staff members of departments of English in colleges and universities and their counterparts in colleges of education, State education depart- ments, and elementary and secondary schools. Curriculum Study Centers —The purposes of these centers are (a) to redefine the nature and aims of the English curriculum at all levels, (6) to develop instructional methods and materials that will achieve specific aims, (¢) to experiment with, evaluate, and revise these meth- ods and materials, and (d) to disseminate information concerning the most promising methods and materials. Six centers have been established. One, at the Carnegie Institute of Technology, will develop and test a curriculum for all college-bound students in grades 10, 11, and 12. A second, at Northwestern Uni- versity, will work on a sequential curriculum for all students in grades 7 to 14, with special emphasis on composition. The third, at the Uni- versity of Nebraska, will also stress composition, but will cover all grades from kindergarten through the first year of college. The fourth, at Hunter College, called “Gateway English” by its initiators, proposes to develop and try out English materials for children from culturally deprived urban environments. It will concentrate on teaching reading in grades 6 to 11 (with special emphasis on the _ junior high school years), but will devote some attention to speaking and listening. Another center, at the University of Minnesota, is to prepare and evaluate curricular materials for grades 7 to 12. The sixth, at the University of Oregon, will direct its efforts toward im- proving the curriculum in language, literature (including reading), and written and ora] composition in grades 7 to 12. Each center has secured the cooperation of a number of elementary or secondary schools in its area. Its study will continue for approximately 5 years, after which it will make its reports available to all interested schools. Basic and Applied Research—Twelve research studies are under way in Project English. These deal with such important topics as the teaching of reading, the development of unfamiliar concepts, the implications of linguistics for the junior high school, the relationships between grammar and writing, the teaching of the blind and the deaf, and ways to alter nonstandard dialects. Research Planning and Development.—A conference on needed re- search in the teaching of English, involving approximately 50 leaders of the profession, has made it possible to proceed more systematically than before in planning and conducting research. Another confer- ence, on English for the culturally different, has focused attention on the special needs of substantial numbers of American students. A study of the relationship between the language of children and that in their textbooks has been completed. Under way are a study of the 665171—63—_19 282 Department of Health, Education, and Welfare, 1962 state of knowledge in the teaching of composition and the preparation of a series of annotated bibliographies on research in the teaching of reading. From Project Talent, Project English is obtaining much statistical information available nowhere else. Finally, Project English authorized a detailed evaluation of the English institutes sponsored in the summer of 1962 by the Commission on English of the College Entrance Examination Board. Project Social Studies During the year the Office planned Project Social Studies, which will be launched in fiscal year 1963. This project is a substantial effort to improve the curriculums and teaching of the social sciences, ele- mentary, secondary, and higher. Like Project English, this under- taking will endeavor to make a significant improvement in teaching in this critical curriculum area through research and through broad dissemination of information about effective teaching practices and materials. NEW EDUCATIONAL MEDIA Research Of the 175 applications submitted for research grants on the educa- tional uses of the new communications media during fiscal year 1962, the Advisory Committee on New Educational Media recommended for support 34 projects in 23 institutions of higher education, 3 non- profit private agencies, and 1 State department of education. These projects were located in 11 States and the District of Columbia. The 34 grants bring the total number of approved projects since the pro- gram began to 184, of which 62 have been completed, 20 during fiscal 1961 and 42 during fiscal 1962. In addition to the research grants, four research contracts were negotiated during the fiscal year. Of the $9.9 million obligated for research from the beginning of the title VII program of the National Defense Education Act through 1962, approximately $2.5 million was obligated for research grants and contracts during fiscal 1962. Approximately $950,000 was obli- gated for the newly approved projects; the remaining $1.55 million was available for continuing projects. A majority of the approved research grants focused on finding more effective ways of programing instructional materials in teacher education, the humanities, mathe- matics, and the social and physical sciences. For the first time, the advisory committee in 1962 recommended the activation of title VII contract provisions for research, since it had become evident that certain selective studies of major research issues can be implemented more effectively through contracts than through a grant program based solely on a variety of investigator-initiated projects. As a result, two types of contractual activities were sup- Office of Education 283 ported this year, in addition to the continuing research-grant pro- gram. ‘These contracts represent the first of a series of contemplated research studies on the relationship of the educational media to fundamental issues in human learning. The first contracts involved two studies on the feasibility of estab- lishing regional centers for programmatic research on the role of new media in education. One study was conducted by Pennsylvania State University in cooperation with other universities throughout _ the country, the second by the Oregon State Department of Educa- tion in cooperation with other State departments of education. Another contract research activity consisted of two long-term projects, one involving the relationship of media to the psychological process of transfer of learning and the other concerning the influence of educational media on the role of the school as a social organization. These contracts have been arranged with the Colorado State Univer- sity Research Foundation and the University of Chicago, respectively. Dissemination of Information Slightly more than $2.2 million was obligated for the support, under contract, of dissemination activities during fiscal year 1962. Approximately $500,000 of this was for continuation costs of projects contracted for in previous years. During the past fiscal year, 32 contracts were negotiated with 28 institutions, agencies, and individ- uals in 15 States and territories, at a cost of almost $1.75 million. An estimated $350,000 in additional support will be needed during fiscal years 1963 and 1964; thus, it is estimated that these 32 contracts will require approximately $2.1 million for completion. During fiscal 1962, a major emphasis under title VII activities was placed on studies and dissemination activities relating to the future of educational television in the United States. Early in the year a comprehensive document entitled, Hducation: The Next Ten Years, was published. This was a report of several task forces operating under the general direction of the Stanford Institute of Communi- cation Research, which summarized the thinking of outstanding specialists in the United States as to the future of educational tele- vision in the United States during the next 10 years, including the Nation’s needs for better educational television programing, resources and facilities, financing, and operating personnel. In addition, major studies were initiated to explore problems of copyright, royalty, and compensation of teachers in the educational television field (through contract with the American Council on Edu- cation) ; to study in depth the personnel needs of educational tele- vision in the future, and to examine the nature of the personnel pool available for new stations (under contract with the National Associa- 284. Department of Health, Education, and Welfare, 1962 | tion of Educational Broadcasters); and to study the economics of educational television now and in the future (contract with Brandeis University, Boston). As part of a major survey conducted under ~ contract by the National Association of Educational Broadcasters to ascertain the needs of education for new television channels in the future, a comprehensive report was issued complete with engineering maps and charts indicating areas where new channels would be needed in order to offer complete nationwide educational television coverage. These data are presently being further refined, with the use of electronic digital computer methods, to assist State and local authorities in planning for the use of Federal matching funds for new stations under Public Law 87-447. During the year, a demonstration was conducted by the WGBH Educational Foundation (Boston) to show the use of FM radio net- working to facilitate the conference technique of communicating among institutions of higher education. Many of the major uni- versities in the northeast States shared in a series of conference activi- ties on each campus via this unique educational FM network, estab- lished on a pilot basis for the demonstration. For example, students participating in a nonwestern studies pro- gram at institutions in the Boston area have been able to listen to and ask questions of lecturers at Brandeis, Harvard, and the Massachu- setts Institute of Technology. In one program of another series on “The Challenge of Higher Education,” the presidents of MIT, Am- herst, Pennsylvania State University, and Johns Hopkins were able from their own institutions to participate in a discussion moderated by James Killian of MIT. A second major emphasis during fiscal year 1962 continued to be programs to make new-media materials more accessible and available to institutions of higher education, to school systems, and to teachers. In the television area, three pilot television materials libraries were established, one regional library for the Great Plains States at the University of Nebraska, another one for the New England States at the Eastern Educational Network in Boston, and a national library at the National Educational Television and Radio Center in Washington to work closely with the regional libraries and to serve States where no pilot regional library now exists. Before these pilot demonstration libraries were established, there was no mechanism by which the various stations could locate or exchange instructional tele- vision materials. Also during fiscal 1962, the title VII program issued the first com- prehensive catalog or annotated bibliography of programed instruc- tion materials available for distribution during the 1962-63 school year. Prepared under contract by the Center for Programed In- q | Office of Education 285 struction in New York City, the book listed over 122 courses or segments of courses in programed instruction form, complete with a sample of two or three pages of the program. Similarly, a series of status papers were issued under the Technological Development Project (National Education Association), including a catalog of teaching machines presently on the market and a critical analysis of systems of instruction used in the Armed Forces, industry, some in- stitutions of higher education, and school systems. Well underway during 1962 was the preparation of the country’s first comprehensive “educational media index,” a cross-reference direc- tory of available educational media materials including films, film- strips, slide sets, teaching machine materials, sets of charts, kinescopes, videotapes, voice recordings, etc. The directory is being prepared under the general supervision of the Educational Media Council, using latest automatic data storage and retrieval equipment, through a sub- contract with a textbook publisher. A third major emphasis during the year was a concern for improved teacher and professional education in the educational media field. With the help of title VII funds, the Florida State Department of Education has conducted a demonstration workshop in new media for methods teachers in the various teacher-training institutions in Flor- ida. The Texas State Education Agency has continued its demon- stration of teacher teams and institutes for the inservice training of teachers in that State. The University of Pittsburgh has conducted demonstration workshops in the use of the overhead projector in a new technique of teaching English composition in large group classes. Alameda State College in California is undertaking a series of semi- nars to establish content and pattern guidelines for the professional training of teachers and specialists in new media techniques. A continuing emphasis under the program is the dissemination of information concerning research conducted not only under the title VII program but also by other research groups. . 5.0 8.89 ek ec ee 78 9 1 MUA NEATH ANG OLOOIMATPANING. o.oo on nme ese nee eee 6 Dl secticasnaene COORD bass 2. Se eS ee ee eee ee 46 || ee eee Vegetables and vegetable products_._-_._..__--__--_-__-_----_---_- 92 6 2 Miscellaneous foods (mixed lots)_.._--_-_-._-_-_--.-_1--.----.---- 7 yal eee eee WENN Gy Gy (tet Ec Se ee 106 SY Eo keceeree tte Foods for special dietary uses !____..___.___- 42 2 1 Miscellaneous chemicals (food adjuncts) 2 DD) seseaeeenes 1 Includes vitamin products intended as food supplements. Voluntary destruction or conversion to nonfood use by owners of filthy and decomposed foods totaled 4,626 tons in 1962. These actions were taken under the observation of Federal or local inspectors after the goods were found during inspections to be subject to seizure if distributed. There has been widespread use of field bacteriology during inspec- tions of food processing plants where bacteriological contamination is a real possibility. Crabmeat, dressed shrimp, nut meats, and other foods partly prepared by hand, and frozen precooked food are par- ticularly susceptible to such contamination, which may lead to food poisoning outbreaks. One Texas crab packer was sentenced to 3 months in jail and fined because he shipped crabmeat contaminated with /. coli. A State health official had traced a food poisoning out- break to crabmeat from this firm. Two other criminal proceedings terminated by fines were based on Z. coli found in pecans shelled under insanitary conditions. After injunction of a bakery in Atlanta the other bakeries in the Southeast reevaluated their flour-handling equipment, housekeeping practices and other sanitation programs, and accelerated those that were lagging. In 14 criminal actions terminated during the year bakeries and their officers or managers were fined for operating under insanitary conditions. One manager was fined $2,000 for a second offense. The firm moved its plant after the first violation to rid the bakery of rodent contamination, but permitted insects at the new location to become progressively worse despite FDA inspectors’ warnings. 328 Department of Health, Education, and Welfare, 1962 There has been encouraging improvement in sanitation in the grain industry in recent years. Close cooperation with State officials con- tinues to foster such improvement. Industry groups have shown their interest by making more requests for FDA speakers at their meetings and for more literature on grain sanitation. Seizures of rodent-contaminated bulk wheat increased from 53 actions against 2,249 tons in 1961 to 74 actions against 3,820 tons in 1962. An additional 323 tons of insect-infested wheat were seized in 4 actions. Five injunctions were requested of the courts to prevent shipment of unfit wheat and barley from elevators and other storage facilities where adequate ventilation was not maintained. Three were granted and two, forwarded to the Department of Justice near the end of the year, are awaiting action. A serious situation with respect to rodent and insect filth in several rice mills in the southeastern region of Louisiana resulted from in- adequate storage facilities for rough rice, infrequent cleaning of equipment, and improper storage of milled rice. Approximately 237 tons shipped from this area to Alabama were seized, and criminal prosecutions are pending against three shippers. Incubator rejects are still being diverted to food use, but persons engaged in this illegal practice have gone further underground. Fifty-four tons of decomposed frozen eggs in 30-pound cans and a truckload of 600 cases of reject shell eggs were seized in 14 actions. A west coast egg dealer was sentenced to 6 months in jail and as- sessed court costs of more than $5,600 for shipping rotten eggs. The judge said that the defendant “has been getting away with the use of contaminated putrid eggs for a number of years.” ‘The first case against a hatchery in connection with the incubator reject program was terminated with a fine. Companion cases against two dealers in incubator rejects are still pending. They have filed motions to dis- miss on the grounds of illegal search and seizure and because stand- ards for decomposition have not been issued. State officials are cooperating increasingly in tracking down incu- bator rejects shipments and securing the evidence necessary to convict conspirators in the racket. The increased surveillance of the New England fishing industry began in 1961 to protect consumers from decomposed fish. The num- ber of violative lots still being encountered points to the need to con- tinue the stepped-up program. In addition to decomposed fish, the amount of parasitized fish encountered has also increased. This prob- lem is especially troublesome in ocean perch (red fish). ‘Twenty-four percent of the lots of imported whitefish examined had to be detained because of the presence of cysts. Two prosecution cases based on preparation of food oil under in- sanitary conditions were terminated with fines. Two new prosecu- * Food and Drug Administration 329 tions were filed against other firms and individuals, and several others are being prepared for filing. The breakdown of controls formerly exercised in parts of the Near East resulted in detention of more than 3.6 million pounds of dates because of insect infestation. Educational work was undertaken to tell the foreign control officials why the dates were refused entry and what steps would be required to bring the dried fruit into compliance. Pocketbook Protection Total seizures to protect consumers from economic violations reached 350 in 1962 in comparison with 92 in 1961. The intensified program against short-weight and inconspicuously labeled foods that was started late in the 1961 fiscal year was continued in full force throughout 1962. More than 70 different foods and beverages were seized in 183 actions because of short-weight or volume. One puffed cereal product ranged up to 15 percent short-weight. The manufacturer started to use an “improved” puffing process which increased the volume beyond the capacity of the carton to hold the stated weight of the old product, but the weight declaration for the new, lighter product was not changed. The Food, Drug, and Cosmetic Act gives the consumer “the right to choose,” by requiring certain information that will assist in intel- ligent purchasing to appear prominently on the label in understand- able terms. There was a sharp increase in the number of seizures charging failure of mandatory labeling to appear conspicuously on the label. Eighty-five seizures were made because this information was hard to find, hard to read, or was partly or entirely missing. Common causes of “hidden” labeling were the use on transparent bags of printing ink the same color as the product in the background, and other packaging features which did not provide adequate printing contrast. In some cases the type was too small or too blurred to be easily read. Promotional items, gifts, “2-cents off” stickers, etc., were sometimes attached to the original package in such a way as to cover mandatory labeling. The press focused public attention on FDA reports of seizure of well-known and popular packaged 5-cent candies short-weighted to maintain the customary cost. It also publicized other “pickpocket packaging” and labeling of items displayed to attract selection by customers. Some were soaps, scouring powders, paper goods, and other items not subject to the Food, Drug, and Cosmetic Act. However, foods, drugs, and cosmetics are also sometimes involved in extravagant and misleading promotions via the labeling and then may be subject to control under the Food, Drug, and Cosmetic Act. An example encountered during the year was instant coffee labeled 665171—63——_22 330 Department of Health, Education, and Welfare, 1962 “Giant Economy Size,” which actually cost more per ounce than the same product in smaller containers. It was seized on charges of false and misleading labeling. Court actions were also taken against foods that were below official standards, or did not have the composition claimed on their labels. The 1961 report discussed an episode in which the “pure orange juice” was adulterated with sugar and water by surreptitious operations in the warehouse and factory. In September 1961, the president of the firm was fined $1,000 for perjury in the trial reported last year and received a suspended 5-year jail sentence. The previous sentence had been a 6-month jail term for this defendant and fines totaling $20,000 for the firm and its principals. Both sentences are on appeal. After a 9-day trial, a chain store and one of its employees were convicted of shipping enriched bread deficient in enrichment, and were fined $5,500 and $2,000 costs. The court instructed the jury to disregard charges of failure to declare the minimum daily require- ments statements called for by the regulations, since he did not agree that enriched bread could be considered a dietary food. Among the other substandard items seized were noodles containing less egg solids than the quantity fixed by standards, “early June” peas prepared from soaked dried peas, low-fat butter, canned peaches and other fruits not packed in heavy sirup as labeled, canned beans with excess fibers, artifically colored canned cauliflower, strawberry pre- serves containing cherries in lieu of strawberries, and an avocado salad dressing that did not meet the official specifications for salad dressing. Charges that foods did not meet their labeled composition were made in seizures of low-quality salmon deceptively labeled as the pink variety, grouper fillets labeled “red snapper,” broken pieces of shrimp instead of the whole shrimp promised by the label, an arti- ficially colored product declared to be paprika, cheese with artificial holes sold under a “swiss” label, imitation lemon-flavored crystals palmed off as dehydrated lemon juice, grapefruit juice with a sodium compound added to make it appear to be the juice of mature fruit, and frozen orange juice concentrate adulterated with sugar and water. FOODS FOR SPECIAL DIETARY PURPOSES Of about 100 seizures of vitamin products and other foods for special dietary uses, 16 were substandard in labeled potency, 6 failed to bear the special labeling required of such products, and 2 were con- taminated with filth. Sixteen seizures were based on folic acid con- tent in excess of 0.4 milligram of folic acid per daily dose and not labeled for sale upon prescription only. The principal violation of the labeling requirements of foods for special dietary uses involved low calorie claims for foods not entitled to such designation. Recently published proposals for revised regu- a Food and Drug Administration $31 lations for special dietary foods contain specific provisions aimed at curbing abuses in labeling foods for use in weight-control diets. The remaining seizures were based on false and misleading claims for the cure or prevention of disease. Some of the most significant are discussed below. Nutritional Quackery An estimated $500 million is wasted by the public each year on unneeded vitamins and faddist food products. Most of them are foisted upon the public by false representations that sound health is impossible without the addition to the diet of the special item pro- moted. Usually the myth is propounded that our soils are depleted because of years of intensive cultivation, and our food supply is poor because of modern commercial methods of production and processing. Contrary to this propaganda, the fact is that the American food sup- ply is unsurpassed in quality and nutritional value. - te Office of Vocational Rehabilitation 383 Similar advances are recorded in residency training programs for physicians. In 1955, four physicians received stipends for their res- ideney study in physical medicine and rehabilitation. By 1962, this number had grown to 129, with 24 others pursuing training on a part- time basis. The Rehabilitation Counselor The rehabilitation counselor has emerged as the key worker in the public program. It is the counselor who first hears the story of the disabled person and who makes many evaluations and decisions of consequence. The counselor is liaison between the realities of the pub- lic program and the individual needs of the disabled person and is a person of growing stature in private and public operations in rehabili- tation. The counselor guides the client through the growing complex- ities and the many technical and social considerations that are involved in the rehabilitation process, balancing its operations with the personal problems of the disabled person and, in many cases, his family. Consequently, the counselor must have a knowledge of social work, of psychology, of public health and welfare procedures, of medical, surgical, and hospital practices in relation to physical and mental res- toration, and of employment practices, especially in his own area. This last factor carries a special responsibility, for it is upon the suc- cess of the counselor in matching the abilities of the disabled person with work opportunities that the ultimate success of the public pro- gram depends. There is another growing responsibility in the training program for counselors, brought about by a necessity for specialization. The en- larged category of disabilities with which the public program is con- cerned—mental illness and retardation are conspicuous among them— is stimulating the provision of training for counselors in the special implications of certain disabilities. State agencies are placing special counselors in mental hospitals, in rehabilitation centers, sheltered workshops, and a variety of special programs, where they work with the medical profession, social work- ers, specialists in mental troubles, and vocational experts to evaluate and prepare disabled persons for the prospect of employment. These are some of the considerations that impel the Office of Voca- tional Rehabilitation to encourage educational institutions to establish or broaden curricula for counselor training. Its efforts have given rise to two results. One is that the total of training grant awards for counseling is second only to those for medicine. The second is that the number of grants in support of counselor training has risen from 25 in 1955 to 34 in 1962, but with the number of traineeships making the startling gain from 53 to 639 in that period. 384 Department of Health, Education, and Welfare, 1962 Even so, the growing number of persons attracted to counseling as a vocation is not meeting the requirements of the public program. The rate of graduation from these courses is about 250 a year, and the estimated need is two to three times that number. The potential employers of counselors—State agencies, clinics, hos- pitals, rehabilitation centers, and others—recognize the need for well- trained counselors, and the salary scale is coming into line with the extent of training and the capacities of graduates of counseling courses. Meeting Other Shortages There are serious shortages in other disciplines that are allied to the public program of vocational rehabilitation. One of them is the number of trained persons in the field of speech and hearing. An estimated 8 to 9 million of our people have speech and hearing difficulties. Currently there are about 10,000 clinicians to serve them, half the number needed to provide an adequate volume of services. Here again is a situation in which the Office of Vocational Rehabilita- tion’s training program has made great advances through grants in this area over the past 3 years. Since the training program began to emphasize courses in speech and hearing therapy in 1959, the number of grants for this purpose has multiplied three times; the total amount of awards has increased al- most three times; and the number of trainees has increased three times. Yet to come close to the need for personnel in this field the number of graduates for this discipline must grow six times over the number of those who finished their courses in 1962. There are grave shortages in physical therapy, occupational therapy, in psychologists, in prosthetists, in social workers. In occupational therapy the estimated need is for 16,000, the number in practice is about 6,000, and there are about 500 graduates each year. The shortage of physical therapists is acute. The present number of 8,400 in practice should be one-third more. Enrollments in ap- proved courses are far below capacity. In consequence the Office of Vocational Rehabilitation has initiated a system of undergraduate trainee grants to attract students, and in 1962 all but 4 of 40 approved schools had such projects in operation. The Rehabilitation Team Since orthopedic impairments constitute the major disability among persons seeking rehabilitation services, the facilities for training pros- thetists (specialists in the design and fitting of artificial limbs and Office of Vocational Rehabilitation 385 other assistive devices) and orthotists (specialists in the making and fitting of braces) are of significant interest in the program. It was a constant preponderance of orthopedic cases on the rolls of State rehabilitation agencies that led to development of “team” therapy for physical restoration. For a decade practitioners of several disciplines that since have grown into integration with the rehabilitation program attended col- lege courses that provided instruction in orthopedic practices. In 1957, the Office of Vocational Rehabilitation began to make grants to several universities where such courses were given, so as to extend knowledge of orthopedic practices. There immediately arose the feeling that, if all these disciplines could be brought together in re- habilitation centers and hospitals, their combined effect would speed up the rehabilitation process immeasurably. It became evident to workers in the public program several years ago that the impact of disability of the individual had wide ramifica- tions. Loss of income, strains on family relationships, physical shock, mental depression—these and other matters had great bearing on the success of rehabilitation services. So there were added to the team the physical therapist to restore physical functions and teach the uses of prostheses; the occupational therapist to test, evaluate, and re- store manipulative abilities; the psychologist and psychiatrist to ex- amine and improve the mental state; and the social] worker to help with the inevitable personal problems that arose. The growth of this concept has brought greater demand for ortho- pedic specialists. They are needed in the growing number of re- habilitation centers that are being established or expanded, in hospitals that are getting into rehabilitation work, and in clinics and other in- stitutions where they can help the orthopedically disabled regain or improve their bodily functions. In 1962 almost 1,400 people associated with rehabilitation were en- rolled in 78 short-term courses that had OVR support, to become acquainted with orthopedic and orthotic principles. At the same time, several universities and other groups were delving deeper into re- search designed to enrich all the services that are available for orthopedically handicapped persons. The Social Worker in Rehabilitation In the modern concept of rehabilitation there is no room for neglect of the implications that disability has on the individual lives of those who are vocationally and socially handicapped. The social worker has been called into the rehabilitation scheme to provide skilled assistance in helping to relieve the anxieties that arise with disability—to relate the disabled person to his situation, to his 386 Department of Health, Education, and Welfare, 1962 family, and to the community, and to resolve any difficulties that are created or intensified. The social worker also has a place in the broader aspects of State and community rehabilitation programs, in activities that help to sell the rehabiltation program itself to the community, and to organize the resources of the area for meeting its rehabilitation problems. Social work in rehabilitation requires, of course, a special knowl- edge of the public and voluntary programs for helping the disabled. In recognition of this, the Office of Vocational Rehabilitation makes teaching grants to accredited schools of social work. In 1962, 34 of 56 accredited schools were awarded such grants, and 40 schools had traineeship grant awards for 169 students. This amout of training is far below the level that will produce an adequate number of social workers for the program, for at least 1,500 graduates are needed each year for vacancies in health and rehabilitation work. The Rehabilitation Facility In the rapid expansion of the public program of vocational reha- bilitation and the evolution of new concepts of disability, of a new image of the disabled, and the purposes and uses of the program, there developed naturally a new concept of rehabilitation facilities. A facility, in the usual language of the public program, is an in- clusive term embracing many kinds of places where rehabilitation services are available. New kinds of facilities come into being for many reasons, and, over the years other kinds have faded away. In the beginning, rehabilitation facilities were almost always medi- cal in nature. But, as physical restoration grew in accomplishment, there came a natural query about work for those who became employable. The answer is in facilities that are now available. There was orga- nization of centers which specialized in vocational services, and this led to development of vocational counseling, of work evaluation of the disabled, and other special vocational services. Yet there was need for another kind of facility, and there evolved the psycho-social center. It was concerned with the increasingly baffling problems of motivation, where mental and emotional problems of many persons lowered their probabilities for employment. It became obvious, too, that all disabled persons cannot be placed in private, competitive employment after physical or mental restora- tion. Many persons are revealed as having little possibilities for open jobs. Others need specific training, work experience, and personal adjustment. So many new sheltered workshops came into being, and they are of two principal types. One provides work experience and adjustment leading to private al neta Office of Vocational Rehabilitation 387 employment. The second deals with disabled persons who, for any of a variety of reasons, need long-term jobs doing work compatible with their condition, in terms of physical capacity and daily hours. There are, too, workshops that provide services of both kinds. Some are created and maintained by private or community groups—for which Government financial aid is available—and others by State rehabili- tation agencies. Another kind of facility that is growing in usefulness is the halfway house. This kind of facility is an adjunct to rehabilitation of the mentally ill. Halfway houses are built around a homelike atmosphere where selected patients who are discharged from mental hospitals may spend a transitional period between institutional care and life in the community. Still another type is the evaluation center, which specializes in high- ly intensive rehabilitation diagnoses and evaluations, to chart courses in individual cases for the reaching of specific goals through the variety of services available. Many hospitals are creating rehabilitation facilities as part of their services. Not all attempt to be comprehensive but are especially con- cerned with getting indicated rehabilitation measures started as early as possible. With the broadened scope of the public program there has risen a good measure of response from State rehabilitation agencies—and from private and community sources, too—in building a variety of large rehabilitation centers. These also vary in types and purposes. Some centers serve persons with one type of disability. Others work among larger categories of handicaps, and many offer a virtually complete series of services to persons with most types of disabilities. Some are operated by State rehabilitation agencies, using portions of their basic grants in combi- nation with their own funds. Others may be created with the help of funds that are available through the Medical Facilities Survey and Construction Act, enacted in 1954. This legislation was an amend- ment of the Hill-Burton hospital construction legislation of an earlier date and allowed Federal funds to be granted to aid the construction of rehabilitation facilities. Thirty-nine new facilities of various kinds, sizes, and types were established or expanded in 1962 with the aid of Hill-Burton grants. Their total cost was $26.8 million, of which the Federal contribution was approximately one-third. There are large rehabilitation centers operated by six States— Pennsylvania, Virginia, Iowa, West Virginia, Georgia, and Arkansas, as well as one in Puerto Rico. But there are other large centers—no- tably in Mobile, Ala.; the Institute of Physical Medicine and Reha- bilitation in New York City; the Rehabilitation Center of Minneapo- lis; the Goodwill Industries in Omaha, Cincinnati, and the District of 388 Department of Health, Education, and Welfare, 1962 Columbia; the National Orthopaedic and Rehabilitation Hospital in Arlington, Va.; and the Carruth Center in Dallas, among others— where rehabilitation is practiced according to modern concepts and practices, with the preponderance of construction and operating funds arising in private sources, but with Federal aid in most cases. The role of the large rehabilitation center is essentially to provide an appropriate setting where specialized staffs can apply modern tech- niques and provide adequate services to more people, rapidly and conveniently. This role is reaching greater fulfillment with new kinds of activi- ties. New York University and The University of Minnesota received grants from the Office of Vocational Rehabilitation to create reha- bilitation research training centers within the clinical settings they afford. Similar regional centers may be established soon. The objective is to combine, in schools of medicine where physical medicine and rehabilitation can be taught, their resources for research and training and develop new methods of rehabilitation under the most favorable circumstances. Rehabilitation Around the World A general awakening to the needs and possibilities for rehabilitation of the disabled has been noted in many countries in the past few years, particularly in new nations that have arisen as political entities, and some older countries that have recognized need for more attention to health and rehabilitation. In some of these countries rehabilitation research and activities had begun in 1960, and others stood ready to begin but lacked funds and guidance. In that year the Office of Vocational Rehabilitation was given authority to spend more than $900,000 in counterpart funds in several countries to establish research resources for investigation of rehabilitation problems pertinent to their own needs, with the proba- bility of international interest as well. The counterpart funds are available for international research under provisions of Public Law 480—the Agricultural Trade Development and Assistance Act. Surplus commodities sold by the United States to certain countries build up these foreign currency credits, which are expendable within their borders for beneficial purposes, with approval of the U.S. Congress. Counterpart funds for international research are now available in India, Israel, Pakistan, UAR-Egypt, Brazil, Burma, Poland, Yugo- slavia, Indonesia, and Syria. The Office of Vocational Rehabilitation has approved 26 research projects in these countries—11 in Israel, 9 in India, 3 in Brazil, and 1 each in UAR-Egypt, Burma, and Pakistan. Others are being prepared. Office of Vocational Rehabilitation 389 The legislation also provides the way for an exchange of scientists between the United States and various countries which are capable in disciplines related to rehabilitation. Arrangements have been made under which 18 surgeons from some of the outstanding medical schools of the United States will perform research in plastic surgery with victims of leprosy at the Christian Medical College in Vellore, India. Six have gone to India in the past 10 months, each for a 2-month period. Many of the techniques they have perfected for these people have been used successfully in the United States in treating similar disabling conditions arising from disease or accidents. In the other direction, two Indian experts in cerebral palsy are to perform research in two U.S. rehabilitation centers, and plans are in the making for exchanges of other experts with other countries. Programs of study, consultation, and observation were arranged by OVR for 110 individuals from 42 countries interested in rehabili- tation of the disabled who were brought to the United States by the Agency for International Development, the United Nations, World Health Organization, the Department of State, by voluntary agencies and foundations, or were sent by their own governments. Among these were officials from newly independent countries such as the Congo, Senegal, and Somalia and administrators and specialists from Malaya, Ceylon, and Turkey, where programs for the disabled are being established or expanded, who came to study program administra- tion and operation. The Hard Fight Against Dependency The public program of vocational rehabilitation has been a crusade in many respects, and a great deal of the spirit of the crusader, as well as the pioneer, remains in the program. The movement toward an ultimate goal of 200,000 rehabilitations of the disabled each year into employment and other satisfactions of life requires an even greater amount of imagination, of expediency, and determination to encompass all the complexities inherent in the kind of rehabilitation structure that is being built. There are, in reality, three facets of the vocational rehabilitation program. One is the humanitarian side, concerned with the personal problems of the individual. The second is the economic worth of vocational rehabilitation. And the third is the inroad that the pro- gram is making into the haunts of dependency. The humanitarian side of the program is obvious. There is great warmth in the knowledge that more than 600,000 disabled persons have been helped to overcome their handicaps in the past 8 years and are pursuing their own forms of happiness in their own ways. It is when we look at rehabilitation measures as a defense against 390 Department of Health, Education, and Welfare, 1962 the further encroachment of dependency on human dignity, as well as on the public purse, that the course of rehabilitation becomes more clearly marked. Already the Congress has moved to realine the relationship between public welfare and vocational rehabilitation agencies so that the devel- oping facilities of the rehabilitation program can be used to reduce the costs of public assistance and its eroding effects on the human spirit. President Kennedy summed up the aims of new public welfare amendments when he signed the measure in July 1962. He said: “This measure embodies a new approach—stressing services in addition to support, rehabilitation instead of relief, and training instead of prolonged de- pendency. This important legislation will assist our States and local public welfare agencies to redirect the incentives and services they offer to needy families and children and to aged and disabled people. Our objective is to pre- vent and reduce dependency and to encourage self-care and self-support—to maintain family life where it is adequate and to restore it where it is deficient.” This new legislation underlines an unprecedented challenge to those concerned with vocational rehabilitation—both public and private agencies—to serve disabled persons who get public assistance and to serve them well. Several hundred thousand adults with physical or mental disabilities get public assistance. How many of them could be restored to employment cannot be foretold. But a large number of referrals to State rehabilitation programs come from public welfare sources, and a considerable part of rehabilitation energy will go toward services for them. There is another facet of dependency that arises from disability. Most of those who are acquainted with rehabilitation matters know that disability often involves a whole family and its relationships. For a long time there have been cooperative agreements in every State between their welfare and rehabilitation agencies, so that, where disability strikes hard at families to bring dismaying financial circum- stances, there will not be unrelieved suffering. This relationship between welfare and rehabilitation activities has come under renewed scrutiny in recent years. Now, greater emphasis is being placed on cooperative measures designed to strengthen this relationship—to reduce family frustrations, to provide food, clothing, and shelter where these are lacking, to hold families together, and to counsel the members in living with a disability in the family while the rehabilitation process is going on with a disabled member. This is a necessary direction for the program to take. It requires service out of the normal range of the rehabilitation program. Intensive social services that can be performed best by State welfare agencies come into play here, so that a climate can be maintained for the disabled person that is conducive to rapid restoration of physical abilities and a return to work. Office of Vocational Rehabilitation 391 Table 1.—Number of referrals and cases, by agency, fiscal year 1962 Referrals Cases oR a fe ee ee ns During fiscal year During fiscal year Closed from active load Agency ! Remain- Re- ing at Total main- Accepted} Not ac- | end of | active After | Before | ing at Total for cepted | year? | load (re- reha- | reha- | end of services for ceiving | Reha- bili- bili- | year ® services 2 services)| bili- tation | tation tated plan plan initi- | initi- ated 4 | ated 5 United States, ie 439, 401 | 148,763 | 150,903 | 189,735 | 345,635 | 102,377 | 14,524 | 20,649 | 208,085 PISSING. esa = 7, 176 4,022 937 2,217 9, 901 3, 059 427 601 5, 814 fA ee 371 139 70 162 342 77 19 18 227 Arizona (Ca Gr: a re! 1, 854 588 548 718 1, 350 405 99 91 755 lind =... = 134 60 45 29 186 32 il 3 140 Arkansas... --- g 7, 840 2,979 3, 240 1, 621 5, 806 2, 500 226 124 2, 956 California_. 29, 980 7, 594 17, 202 5, 184 17, 331 2,670 1,249 2, 927 10, 485 Colorado-___ 4, 584 1, 884 1, 261 1, 389 4, 299 1, 243 517 223 2,316 1, 561 621 836 4,211 907 211 307 2, 786 &6 62 31 212 58 21 0 133 554 351 211 1, 242 527 20 61 634 24 20 6 48 18 6 3 yal 1, 288 1, 873 850 2, 915 847 261 228 1,579 6, 009 8, 918 5, 248 11, 303 4,000 611 613 6, 079 491 2, 500 1,347 1, 183 301 61 42 779 7,485 5, 874 $), 417 13, 596 6, 105 424 484 6, 583 3 32 31 77 13 5 3 46 528 863 652 1, 134 240 76 51 767 10 6 13 48 4 2 2 40 470 931 602 1,029 385 49 7 588 20 14 4 57 15 3 3 36 6, 193 3, 132 2, 283 15, 310 3, 926 978 1, 370 9, 036 1,945 904 817 4, 809 1, 434 138 186 3, 051 39 38 64 185 31 18 17 119 1, 789 1, 756 2,692 4,285 1, 293 185 17 2, 632 79 39 71 230 50 3 7 170 1, 523 883 1, 203 8,415 1, 087 130 237 1, 961 389 122 110 157 304 85 an 13 195 ACONTRCKW — 5. 555-6-.-< 7,171 2,103 2,726 2, 342 4,370 1,776 120 248 2, 226 Louisana: Ktencralees...s-.=.>- 5, 370 3, 124 1, 208 1, 038 8, 750 2, 037 318 591 5, 804 2G a oe 825 187 210 428 713 122 8 13 570 Maine: eneraliee 8. - 2,026 486 644 896 1, 221 360 48 88 725 Blind <-.-..- 246 131 81 34 303 72 22 52 157 Maryland 6, 628 2, 638 1, 909 2,081 6, 361 1, 691 342 696 3, 632 Massachusetts: 2,496 4,479 4,153 5, 809 1, 661 214 537 3, 397 141 28 140 428 88 26 20 294 4,074 2,270 3, 626 10, 258 3,181 487 169 6, 421 165 76 101 454 81 35 31 307 2,048 2, 607 2, 289 5, 964 1,377 314 164 4,109 192 403 513 507 99 32 21 355 1, 695 774 1,093 8, 772 1,392 96 145 2,139 347 538 233 953 283 82 42 546 2, 852 8, 078 2,752 5, 924 1, 930 235 234 3, 525 183 294 283 522 187 26 30 279 921 ite 703 2,012 456 40 92 1, 424 36 286 92 8 24 3 0 60 795 267 601 2, 554 634 64 112 1, 744 63 115 64 152 57 8 5 82 235 457 72 393 120 62 46 165 21 5 24 56 16 2 3 35 See footnotes at end of table. 392 Department of Health, Education, and Welfare, 1962 Table 1.—Number of referrals and cases, by agency, fiscal year 1962—Con. Referrals Cases During fiscal year During fiscal year Closed from active load Agency ! Remain- ee TS ing at Total main- Accepted| Not ac- | end of | active After | Before | ing at Total for cepted | year | load (re- reha- | reha- | end of services for ceiving | Reha- bili- bili- year 6 services ? services)| bili- tation | tation tated plan plan initi- | initi- ated 4 | ated 5 New Hampshire: General-s2-22== 4-5 —- 626 353 181 92 789 198 88 19 484 ‘Blinds Saeco: -eaaecee 73 29 4 40 76 15 2 6 53 New Jersey Goneralisee sees see ne 7, 706 2, 963 2,198 2, 545 5, 872 1, 888 252 253 3,479 203 323 404 541 143 33 9 356 328 569 448 668 286 43 17 322 45 66 108 127 35 5 i 80 10, 571 10, 226 10, 948 23, 355 7, 008 733 1, 493 14, 121 525 266 627 1, 154 332 47 73 702 6, 303 3, 360 1, 648 15, 485 5, 647 450 542 8, 796 640 602 346 1, 549 455 17 103 974 495 478 926 1, 336 372 40 72 852 3,916 3, 068 2,907 8, 452 2, 391 281 620 5, 160 425 213 298 1, 153 201 61 101 790 3, 091 1, 944 2, 257 8, 886 1,913 161 512 6, 300 Oregon: 6, 032 1, 200 2, 603 2, 229 2, 698 670 186 214 1, 628 245 58 116 71 156 40 6 8 102 General... ee Se 37, 139 12, 760 10, 867 13, 512 27, 578 9, 060 1, 215 800 16, 503 iBlind SS 2235 See 2, 020 309 668 1, 043 998 251 26 41 680 Puerto Rico-.---4£--s- 9, 900 1, 653 1, 967 6, 280 5, 702 1, 226 116 282 4, 078 Rhode Island General-2._ >. 229 2 3, 891 1, 329 653 1, 909 2, 891 871 158 20 1, 842 Blind 2-s-ese ssn 129 100 9 20 289 59 16 20 194 South Carolina General bowed nslees 12, 193 4,144 5, 079 2,970 8, 196 2, 380 169 309 5, 338 162 168 72 375 113 10 19 233 357 229 686 1, 033 276 45 6 706 49 216 248 121 27 5 2 87 3, 253 2, 966 3, 471 7, 540 2, 612 276 269 4, 383 334 400 477 868 302 23 37 506 4, 457 6, 686 3, 209 11, 754 2, 931 748 1, 164 6,911 390 526 319 849 378 18 26 427 851 556 556 2,318 581 87 38 1, 612 283 170 810 828 226 53 31 518 21 27 8 50 18 4 2 26 4, 384 7,343 4, 395 9, 436 3, 517 219 646 5, 054 138 198 368 299 107 11 6 175 27 0 75 86 31 0 0 55 1, 536 2, 221 1, 335 4, 052 1, 100 217 354 2, 381 117 109 76 283 68 17 13 185 5, 451 4, 063 7, 641 13, 477 3, 710 69 1, 283 8, 415 Generalsss2..4-5 225 9, 480 2, 846 3, 914 2, 720 7, 367 1, 811 226 74 5, 256 lind 153 86 31 36 236 53 14 8 161 488 133 158 197 391 119 32 4 236 1In States with 2 agencies, the State division of vocational rehabilitation is designated as “general, ” and the agency under the State commission or other agency for the blind is designated as “blind.” 2 Services declined, services not needed, individual not eligible, individual needing services other than vocational rehabilitation, referred to other agencies, migratory shifting of the individual, ete. 3 Eligibility for rehabilitation not yet determined. 4 Closed after rehabilitation plan was initiated; received rehabilitation service but never reached the point of employment because of personal factors, illness, aggravated disability, etc. 5 Closed prior to initiation of rehabilitation plan’ because of indifference of individual, increase in degree of disability, loss of contact, etc. 6 In process of rehabilitation on June 30, 1962. Office of Vocational Rehabilitation 393 Table 2.—Vocational rehabilitation grants, 1962, State divisions of vocational rehabilitation State or territory Massachusetts Michigan. Tey UL En | SEES Se ee eee New Jersey New Mexico-- Rhode Island-_-- Ghyiulo Cua,

taper ose ae See SR Rens ae eee a I 21, 752 New Hampshires® .2_ 2 9). Bell See 30, 757 New ersey <2 scncevtee con dece 191, 632 New Mexico 55, 303 New York------ 589, 984 North Caroling. -8 . seen ee ee eee 87, S874... -ee ee 587, 597 0): ()- <. eees eenee ee see: Te See ty ee eee oe 349, 245 8, 595 357, 840 Orégone.h: 2... et eo 2 106; 381i cn. ceee eee 106, 381 Pennsylvania. | 28 2... tS Pe 404, 995 66, 482 471,477 Rhode-island:. 2240.7. _.._... | Se ee 81.927.) ee cee 81, 927 South Carolina 02, 18) al sd. 22s eee 92, 131 South Wakotes:-c2 5 oe eee ee ee ee ee 66, 558 1, 106 67, 664 “FORNBSSOO. = 6. 2otae ew nc nec ee Soc sere eeeeoe 3707181 lacucssanbeeeee 379, 181 Mexds ies —<_. 205, 265)1|- 32. eae 295, 265 Vermont-. 47, 787 500 48, 287 Virginia. -____ 125, 000 9, 656 134, 656 Washington _-_ a 122, 806 23, 185 145, 991 Wisconsin. 2730.5. eee ee 1S ee eee 04, 661 i}.-....,5aebeene 94, 651 Saint Elizabeths Hospital PsYCHIATRY as a specialty of medicine continues to evolute rapidly. New ideas, some of them rediscovered from past experience, are being proposed in the care of patients. Research into the causes of mental disorder is progressing rapidly, as is the training of much-needed personnel. In all these fields Saint Elizabeths is active and is en- deavoring in every way possible to further its traditional position of leadership. Much of the care of the mentally ill takes place in the com- munity at the hands of private practitioners, but there still is a need of mental hospitals, and presumably there always will be. In the treat- ment of mental illness the social concepts are gaining strength. There is a greater use of community resources such as foster homes, nursing homes, halfway houses, and outpatient clinics. The role of public education is an important one; the understanding and tolerance of the community have increased markedly, thanks to the attempts of various agencies to bring about a greater public under- standing of the nature of mental disorder. At present some debate is underway as to the relative merits of the small and the large mental hospitals, and it is being urged that no hospitals of over 1,000 beds be maintained or established. The fact is, however, that some hospitals, Saint Elizabeths among them, are considerably larger than that allegedly ideal maximum. It has been suggested, too, that large hos- pitals be broken down into smaller units. There is much of value in the smaller units, but it should not be forgotten that structure in an organization is necessary and that the various parts cannot be allowed to go their separate ways without control or coordination. The trend is toward reducing, rather than increasing, the population of mental hospitals by more intensive early treatment, by establishing new hos- pitals, and by sending more patients back to the community for care there rather than keeping them in the institutions. Saint Elizabeths 395 396 Department of Health, Education, and Welfare, 1962 has not been unmindful of this tendency and actually during the year reduced its resident population by 160 in spite of the highest admission rate since 1945. For the first time in 17 years the admissions to the hospital ex- ceeded 2,000, the actual number being 2,024. During the same period 1,649 patients were discharged, or 81 percent as many as were received. Somewhat more voluntary patients were admitted informally, namely, 251. This rate of only 12.3 percent is far below what it should be. Through an arrangement with the District of Columbia Health Department, voluntary patients may now be admitted at any time, including weekends and evenings. An increase in the voluntary admissions is much to be desired, especially in view of the fact that the commitment laws of the District of Columbia continued to be among the most legalistic, cumbersome, and traumatic to the patient of any jurisdiction in the United States. It is encouraging to note that a bill has been introduced in the Congress which would moderate some of the inequities and undesirable features of the present com- mitment laws. The aged continue to be a serious problem, as does the chronicity of a considerable number of the patients. At the close of the fiscal year, 63 percent of the patients in the hospital had been in residence for 5 years or more. The difficult problems of the care of the chronically mentally ill and of the aged are receiving much attention and hopefully some satisfactory arrangement can be worked out. Desirable as it is to reduce the population of mental hospitals, it should not escape attention, as it sometimes seems to do, that the aged and the chronically mentally ill are sick persons and are entitled to suitable medical care. They should not be relegated to some modern equivalent of the oldtime “poor farm.” The principal problems of the hospital continue to be overcrowding and understaffing. During the year, thanks to an increased appropria- tion by the Congress, there were over 233 net additions to the hospital personnel. Ten physicians were among these, as were 23 graduate nurses, an encouraging state of affairs. There are many needs, how- ever, in all the activities of the hospital. A survey recently made would indicate that instead of the present 3,515, the hospital should ideally have a total personnel of as many as 8,200. An active recruiting program has been underway during the past year in all fields, with particular emphasis on the ward personnel. Under Civil Service rules physicians now receive salaries at the “top of the grade,” but it is highly doubtful whether the salaries are yet on a really competitive basis with the States or with private practice. It should be pointed out, indeed, that one Government agency is permitted by law to pay a 15-percent premium to diplomates of speciality boards. Saint Elizabeths Hospital 397 A bill has finally been proposed which would extend this provision to Saint Elizabeths Hospital; such legislation has not yet been enacted. The general health of the hospital population has been good, thanks to the continuing efficient efforts of the physicians, nurses, dietitians, sanitarians, and the rest of the hospital personnel. All the accepted types of treatment are being utilized, among them individual and group psychotherapy, milieu therapy, drug therapy, electroshock, habit training, and various methods of resocializing the patients. One habit-training program was developed during the year very suc- cessfully, but there have been others as well, both recently and in the past. One project was that of interesting a group of patients in repairing toys which might be given to the needy children at the District of Columbia Village or other institutions. Much has been done in recreation, and in the John Howard Pavilion a “Gavel Club” was organized. ‘The rehabilitation activities have been extended and amplified, and the number of patients released to the community, many of them on a self-supporting basis, is most gratifying. In a number of areas remotivation programs have been undertaken very successfully. The number of open wards has been increased; self- government activities have been encouraged; and in every way an effort has been made to create a permissive, encouraging, and opti- mistic atmosphere among the patients. A special program has been set up to deal with the young adults, children, and adolescents. There are in the hospital 5 children under 12, 46 adolescents (13 to 18), and 6 young adults (19 years of age or slightly older). In an institution designed primarily for adults, these patients have not benefited to the full from the programs which were available, but it is now expected that much more can be done for them in the line of education and training. One problem which has caused much concern at the hospital is the continued very free use by the patients of petitions for writs of habeas corpus. The right to file such writs is, of course, guaranteed by the Constitution, but some of the petitions are repeated frequently and are quite obviously frivolous. During the year, for example, 187 orders to show cause were served on the hospital, and 169 orders to produce the patient in court on a writ of habeas corpus. Only eight releases were granted, a fact which in itself suggests that most of the writs had little if any basis. Since every hearing calls for the presence of a physician and sometimes of several, the drain on the physicians’ time is inordinate. During the year, in fact, 1,084 hours were spent in court by the doctors. The hospital has suggested formally to the court that arrangements be made to hold the hearings at the hospital. This would save much time, both on the part of the judges and of the physicians. Some administrative improvements have been made in 398 Department of Health, Education, and Welfare, 1962 the court, thanks to the interest of the chief judge, but much improve- ment is yet possible. In the field of public education the hospital has taken its part. In May “Mental Health Week” was held, with suitable community ar- rangements in the line of lectures and sermons, a public dramatic production, and an “open house.” The total number of visitors on the two latter occasions was about 3,000. A program was prepared and distributed to approximately 450 radio stations. In addition, State and county hospitals and mental health associations have re- quested the transcriptions for their libraries. This is a series of 5-minute talks, and the reception seems to have been very favorable. Indeed, considerably over 300 stations have indicated their desire for an extension of the program. The Information Officer has been very active; 10 feature articles appeared in the local papers, plus many news items, and a TV presentation of the activities of the hospital is being prepared. A publication known as the “Saint Elizabeths Re- porter,” designed primarily for hospital personnel, was established during the year. As usual the hospital has been visited by many pro- fessional persons, physicians, social workers, and others from many foreign countries, 23 nations being represented this year. It is always a source of satisfaction and stimulation to have such visitors. Many Government agencies, and those of the District Government, have cooperated with the hospital and to them thanks are extended. The same is true of various private groups and individuals, notably vol- unteers. These groups are altogether too numerous to mention, but the value to the patients, to the hospital, and to the public’s under- standing is inestimable. The program of training has been not only continued but expanded during the year. The accreditation by the Joint Commission has been renewed. A third-year chaplaincy residency has been set up, as has a residency in psychodrama. Training is given at the hospital in these fields among others: internships (the only public mental hospital in the United States so approved), residencies in psychiatry, path- ology, surgery, radiology, physical medicine, psychology, occupational therapy, psyhcodrama, and field training in social work and recrea- tional therapy. Some of these activities will be detailed below. Forty percent of the costs of training are now borne by the Federal Government. This in itself is a recognition of the national impor- tance of the hospital. Research activities of the hospital have been very considerably ex- tended. The joint project between the National Institute of Mental Health and the hospital, known as the Clinical Neuropharmacology Research Center, has been in operation for 5 years with most gratify- ing results. In addition, a behavioral studies program operated Saint Elizabeths Hospital 399 largely with hospital funds is in successful operation. In that pro- gram some criminological studies have been undertaken during the past year, as well as some researches in experimental psychology. It is proposed to set up a third division (the others being the Medical and the Administrative Divisions) in the hospital to be known as the Behavioral and Clinical Studies Division, but final approval has not yet been given by the Department on that proposal. Psychiatric Services Brief comments relative to the clinical activities of the hospital fol- low herewith. There are four admission services, each under a clini- cal director: Dix Pavilion for civil patients under 64, the Geriatric Service for patients over 64, the John Howard Pavilion for male prisoner patients, and the William A. White Service, which is basically a research service operated jointly with the National Institute of Mental Health. The other wards and services of the hospital are di- vided between two clinical directors. The general supervision of the activities of the clinical directors is vested in the first assistant physician. MEDICAL AND SURGICAL BRANCH This Branch, although not an admission service, plays an extremely important part in the operation of the hospital. It furnishes special- ized medical and surgical services to the patients of the hospital, both of an inpatient and outpatient nature. The present main building of this Branch, the so-called Medical and Surgical Building with a capacity of 179 patients, is over 30 years old and with the advancing techniques and activities of medicine is, at present, highly inadequate. A recent study was made by a firm of hospital consultants, and it is hoped that in the very near future funds may be forthcoming for plans for a building to replace or supplement the present building. Considerable improvement of the operating rooms has been under- taken during the past year. A neurology service has been added, and the dental services have been much expanded. During the year 2,222 inpatients were cared for in the Branch (a total of 186,386 patient- days), and 62,000 patients received outpatient care. In the podiatry clinic, 4,350 patients were seen; and in the dental service there was an increase of 1,500 over the preceding year, a total number of 4,528 patients receiving care. A speech and audiology clinic has been added recently ; much research work is planned in this interesting but some- what neglected field. The staff has been increased in the Medical and Surgical Branch, and care of a high order is being given to the patients who come under its attention. Much better service can be rendered, however, when the new building becomes a reality. 400 Department of Health, Education, and Welfare, 1962 NURSING BRANCH The basic responsibility for the ward care of patients is vested in this Branch, which is effectively discharging this duty. There has been an increase in the number of registered nurses during the year and an increase of 84 in the total personnel. Much training is done in this Branch, both of affiliates and of postgraduate students, the latter coming from Catholic University and Howard University. An inservice training program is carried on, and the employee develop- ment program is being expanded. CLINICAL TRAINING BRANCH This Branch has the general supervision especially of the psychiatric resident training program but also coordinates the various other train- ing programs which are carried on. One of its functions is the super- vision of the Psychotherapy Section, in which we find not only many group and individual psychotherapeutic activities but also dance therapy and psychodrama. This latter form of group psychotherapy was introduced in Saint Elizabeths Hospital over 20 years ago. More recently this hospital, the first public institution to introduce psycho- drama, was the first to establish an approved training program. PSYCHOLOGY BRANCH This Branch operates in close connection with the various ward services in performing tests, in counseling, in participating in staff conferences, in doing psychotherapy, and in training psychologists. There has been an increased use of psychology on the wards, and a reorganization of the Branch has divided the hospital into five areas for purposes of more efficient service. During the year there was an increase of 51 percent in the patients referred to the Psychology Branch, and nearly 5,000 tests were performed on 1386 persons, mostly but not entirely patients. The speech pathology and audiology activi- ties referred to under the Medical and Surgical Branch are attached primarily to the Psychology Department. During the year 711 audio- metric tests were carried out. The psychology staff has been active in lectures and seminars, as well as in training. There have been two residents, nine interns, six field work students and volunteers, and three externs in speech pathology during the year. RECREATIONAL THERAPY BRANCH This Branch has been considerably expanded both as to staff and activities. It is active in the school program mentioned above and has engaged in various recreational activities such as dramatics, social activities, writing and speaking, music, and dance. Saint Elizabeths Hospital 401 OCCUPATIONAL THERAPY BRANCH The activities of the Branch have been numerous, one of those being the educational rehabilitation program, involving 213 patients. There has also been an educational program for the maintenance em- ployees. This has proved very helpful in orienting the maintenance personnel in the proper concepts and methods for working with mental patients, many of whom work with the maintenance areas. The indus- trial therapy activities carried out under this Branch have to do particularly with the placement of patients in activities which may be helpful to them in securing livelihood after they leave the hospital. The Branch also trains occupational therapy interns. VOLUNTEER BRANCH The development of this Branch has been most gratifying from many points of view. During the year an average of 864 volunteers have worked each month, giving a total of 40,000 hours of service. Some of these activities have been carried on through organizations and others by individuals, in many fields of contact with the patient. The value of volunteer service to the community, as well as to the patients, should not be underestimated; these workers carry back to their associates and friends a much sounder conception of a mental hospital than was formerly entertained by their associates. SOCIAL SERVICE BRANCH The staff of this Branch has been increased during the year from 25 to 32. A total of 1,817 patients was serviced and 28,500 interviews carried on. The Branch has been very helpful in finding placements for patients; 98, for example, were placed in foster homes and others in the D.C. Village, or referred to the Mental Health Clinic or the Public Assistance Division of the District. Another service was in relocating some of the Indian patients who were referred back to State hospitals in their own States. BIOMETRICS BRANCH This Branch has been extremely active and useful during the year. The hospital has been recognized as one of the model reporting areas, being the 29th jurisdiction thus to be recognized. The bills to the Dis- trict for the care of patients are now being prepared by this Branch. A thoroughgoing statistical system is being set up, and eventually there is every reason to believe that we shall know much more about the facts of the hospital care of mental disorder than has been known in the past. 402 Department of Health, Education, and Welfare, 1962 MEDICAL RECORDS BRANCH The Medical Records Branch not only files and reviews records but now abstracts them for other hospitals on appropriate request. The need of medical records is sometimes overlooked by physicians, but there is no question about the value of them for reference purposes, studies, and further knowledge concerning patients. LABORATORY BRANCH The demands on this Branch continue to increase, but they have been met very well, thanks to a considerable increase in automation. No less than 264,000 tests were carried on during the year, this amount- ing to almost 30-percent increase. Autopsies came to 45.1 percent of the deaths. A residency in pathology has been approved, and there are two residents in this program. An isotope laboratory is in operation, and it is planned to do cytological investigations routinely on female patients who are admitted to the hospital, this method being valuable in giving early evidence of cancer of the uterine cervix. SANITARY ENGINEERING BRANCH This Branch has operated most effectively on a hospitalwide basis, not only as to insect and rodent control but to food preparation and serving and general housekeeping. CHAPLAINS BRANCH This Branch operates under the auspices of the three major faiths, namely, Jewish, Protestant, and Roman Catholic. The patients of all these faiths are served as to worship and pastoral counseling, each new patient being seen very shortly after admission by a clergyman of his own faith. The senior Protestant chaplain reports a consider- able increase in the worship services, including two services in the chapel on Sunday mornings, and an increase in the training program with the addition of a third year of clinical pastoral training resi- dency. There were 11 full-time trainees plus 58 part-time trainees during the year including seminarians and community clergy. Dur- ing the year the members of the Protestant Branch gave no less than 305 addresses and lectures. The senior Protestant chaplain was elected president of the Association of Mental Hospital Chaplains during the year. A director of chaplain studies was added to the staff, who will make studies concerning the various relationships of religion to mental health in a hospital setting. The Roman Catholic program has likewise been increased, espe- cially as to training. There were six full-time interns during part of the year, and four of them remained all of the year. In addition, seminarians from a number of seminaries have received instruction, Saint Elizabeths Hospital 403 and of the community clergy approximately 79 have received instruc- tion in this section. During the year the senior Catholic chaplain celebrated his 25th Jubilee as a priest. The Jewish program deals with a much smaller group of patients, but much attention has been given to the worship and festival aspects of their religion. In this field the volunteers have been of inestimable value. LIBRARY SERVICES The Services are divided into services to the medical staff and to patients, both of these activities being under the supervision of trained medical librarians. The Medical Library gives service to the medical staff and to other staff members of the hospital in the line of references, bibilographies, and of providing books. The collection of Saint Elizabeths is an excellent one, totaling now about 19,000 volumes with a total of accessions during the year of 1,314. There were 314 periodi- cals subscribed to. It is unfortunate that some of the other libraries in the area are actually cutting their services, so that interlibrary loans are becoming somewhat more difficult to manage. Space is at a pre- mium, but there will be some relief when the new wings of the Adminis- tration Building are completed. The Patients’ Library now numbers 68,000 volumes, with a gain during the year of almost 2,800, much of the latter by gifts. In addition to having the central reading room and storage of books, the patients’ librarian keeps active a considerable number of ward libraries and maintains active circulation of books among the wards. The library is also involved in bookbinding, shorthand, and other classes with the assistance of volunteers. Office of Personnel During the year the Office of Personnel was made directly respon- sible to the Office of the Superintendent, partly as a result of the report of the Civil Service Commission inspectors who carried out inspection in the spring. A very active program of recruiting was carried on during the year, somewhat to the disadvantage of some of the other programs. The number of disciplinary actions is increas- ing substantially, and the requests, not to say demands, from various credit stores occupy a great deal of the attention of the Office. There are now 3,511 positions in the hospital which are filled. One hundred and nineteen summer students were recruited, this being a part of the campaign to interest more young people in possibly entering Government service. The employee development and training pro- gram has been substantially expanded during the year. Space is 404. Department of Health, Education, and Welfare, 1962 crowded, but some relief is expected when the wings of the Adminis- tration Building are completed. Division of Administration The various branches of this Division are essential to the proper operation of the hospital, and during the year they have functioned very effectively. The activities include such things as purchasing, warehousing, the dietary department (which prepared over 7 million meals during the year), registrar’s office, maintenance office, laundry, garage, grounds, sewing room, payroll, and patients’ funds. The Division has been greatly aided during the year by the services on a part-time basis of a lawyer detailed by the General Counsel’s Office of the Department. A new section on managament analysis was set up during the year. Construction underway involves the wings of the Administration Building, the Continued Treatment-9 Building due for occupancy about April 1963. Plans for a Rehabilitation Building are being developed. The Anacostia Freeway is being con- structed on the hospital grounds; this resulted in the loss of about 15 acres to the hospital. Needs of the Hospital The future of the hospital should be clarified at an early moment. It seems clear to all who are familiar with the history of the hospital, its international reputation, and the consistent support which has been given to it by Congress that the founders intended that there should be a national institution to set the pace for the various States in the lines of patient care, training, and research. Saint Elizabeths is In a unique position to do this, yet there are certain forces which appear to be interested in downgrading the institution to that of a District hospital. The hospital has exerted leadership through more than a century, and at this moment, when mental health is securing so much public attention, it would be little short of a tragedy not to emphasize the national goal of an institution, the example of which State and local institutions do not resent. The program already underway of replacing antiquated facilities with new should be con- tinued, and it is to be expected that the advancing needs of psychiatry and the correlative advancing needs of personnel and equipment will be recognized by the Bureau of the Budget and by the Congress. The organic act passed in 1855 set forth the aims of the hospital as the “most humane care and the most enlightened curative treatment” of the mentally ill. Toward these aims the hospital has always striven and will continue to do so in the future. Saint Elizabeths Hospital 405 Table 1.—Patients, admissions, and discharges, fiscal years 1935-62 Average number of Discharges patients as percent Fiscal year ___| Admissions] Discharges | of admis- Deaths sions On rolls | In hospital B;:624 slosece bas 987 474 48 296 6 O40 see ee 1, 885 1, 295 69 387 O.882 i. a fot aa 1, 815 1,477 81 431 7,175 6, 896 1, 481 920 62 440 7, 458 7, 039 1, 501 951 63 524 6, 897 6, 587 1, 648 960 58 495 7, 053 6, 783 1, 412 928 66 424 7,172 6, 915 1, 438 814 57 431 7, 361 7,079 1, 524 977 64 436 7, 392 7, 117 1, 385 921 66 416 7, 461 7, 216 1, 349 748 55 502 7, 438 7, 120 1, 327 884 67 600 7, 413 6, 994 1, 615 1, 014 63 507 7, 466 6, 965 1, 605 1,076 67 532 7, 512 6, 900 1, 607 1, 034 64 479 7, 691 6, 983 1, 894 1, 101 58 504 7, 933 6, 976 1, 981 1, 395 70 440 7, 940 6, 838 12,024 11, 649 81 484 1 Differs slightly from comparable numbers for earlier years in that the earlier figures include ‘‘paper’’ discharges and readmissions made in order to change legal categories. Table 2.—Patients on the rolls, by status and by sex, time since admission, ethnic group, and age, June 30, 1962 Resident patients 1 Patients On con- On Sex, time since admission, on rolls, On valescent | unauth- ethnic group, and age total In On tem- | vacation leave orized Total | hospital | porary leave visit SRO nee eee 7, 883 6, 894 6, 617 277 83 837 69 IWR CL ol 3, 987 3, 587 8, 446 141 34 314 52 Gore 3, 896 3, 307 3,171 136 49 523 tf Time since admissions Less than 6 months---________- 773 686 625 61 5 74 8 Galas: 474 326 311 15 6 133 9 S year 223... 780 562 529 33 18 187 13 2 years...... 587 439 406 33 13 120 15 3-4 years___- 719 576 539 37 19 lil 13 5-9 years_-____- 980 866 824 42 9 100 5 10-19 years 1, 574 1, 483 1, 439 44 10 76 5 20' years and over......-.......- 1, 996 1, 956 1, 944 12 3 36 1 Median time since admission UVORTS eee one ccc 8 10 il 3 3 2 2 Ethnic group ili oe a2) 4,160 3, 765 3, 618 147 43 322 30 TSCA 0 tones, | a a 3, 723 3,129 2, 999 130 40 515 39 Age (years) DSO a rr 15 11 10 1 0 4 0 lV 36 24 22 2 0 il 1 LOC er 267 219 194 25 3 42 3 ROR 854 650 587 63 16 160 28 Gh. a 1, 304 1, 039 958 81 21 227 17 2 1, 508 1, 284 1, 223 61 20 193 11 Uae a 1, 623 1, 470 1, 445 25 12 136 5 (ive. 2 So ee a ee 1,172 1,119 1, 106 13 7 42 4 (OA ean 831 807 801 6 4 20 0 OCG LGS cs ea a 273 271 271 0 0 2 0 TAGS yts 2s nl 55 56 57 41 46 44 36 1 Resident patient status should not be confused with the D.C. resident legal category. The former is defined as patients in the hospital plus those on temporary visit. 4.06 Department of Health, Education, and Welfare, 1962 Table 3.—Movement of patients on the rolls, by sex, time since admission, ethnic group, and age, fiscal year 1962 Patients Patients Sex, time since admission, ethnic group, on rolls Admis- | Discharges} Deaths on rolls and age June 30, sions June 30, 1961 1962 etal poo. Sts de cee gece eee 7, 992 2, 024 1, 649 484 7, 883 Mises. 5 oe en ccrhe = oo nok 4, 047 1,129 962 233 3, 981 MOMAIOS. os estes oo tla ean eeeseeseeat eee 3, 945 895 687 251 3, 902 Time from admission to June 80, 1962 less than '6'months_2-2—) 250.22. 4 se eee |e eee 1, 080 290 19 773 G2) MONS co scn ake a> ceee eeaemnenemr ed nas 2 944 402 65 474 eS RS © ee a a REE ae BS ee Bl 472 77 780 2 years... 165 50 587 3-4 years. 117 52 719 5-9 years_-_ 86 71 980 IO-19 YOars so se eee eres oe a ceeea | eee eee eeeeians 72 64 1, 574 20 years and. over... tee ee 2k eae ee ee eee 45 86 1, 996 Ethnic group White 22 ge Sole 2 RA eee 4, 244 1, 036 836 284 4, 160 Nonwhite. 225 32.2532 82 ees ace eee 3, 748 988 813 200 3, 723 Less than 15 16 12 20 0 15 NG -24F a 280 235 150 3 303 95-34 Shires 873 446 393 5 854 eet Eee 1,345 434 447 19 1, 304 45-34 3S 1,610 303 323 29 1, 508 eee 1, 608 192 171 69 1, 623 Cy Ppa late em mle 1,197 175 104 109 1,172 Y higes ee 799 158 35 155 1 85 and over-__-_-_- 264 69 6 95 273 Median age 54 42 41 75 55 1 For individual age groups, the number of patients at the beginning of the year plus admissions minus discharges and deaths do not equal the number of patients at the end of the year. This is because some patients age from one group into the next during the year. For example, 7 patients who were less than 15 years of age on June 30, 1961, became 15 years old by June 30, 1962. Saint Elizabeths Hospital 407 Table 4.—Patients on the rolls by status and legal category, June 30, 1962 Resident patients ! Patients On On un- on On conva- | author- Legal category rolls, On vacation | lescent ized total In tempo- leave leave Total | hospital rary vist SOUS len ieertamtrancres 7, 883 6, 894 6, 617 277 83 837 69 PeumbUrsAbles=—--6--25--------~ 6, 228 5, 378 5, 144 234 77 741 32 .C. resident...---.-.=-.--- 5, 382 4,714 4, 534 180 58 587 23 Cy yotuntary.......--.. 310 187 158 29 il 106 6 Veterans’ Administration -- 411 364 341 23 5 39 3 U.S. Nationals from aboard_ 59 55 54 1 1 3 0 U.S. Soldiers Home 41 35 34 1 0 6 0 idianisi@rieis),.-b 4... ___- 21 21 21 0 0 0 0 Other reimbursable 4 2 2 0 2 0 0 Nonreimbursable---.---------- 1, 655 1, 516 1, 473 43 6 96 37 Total, excluding pris- CoD LS ee 803 757 731 26 4 42 0 D.C. nonresident. ----- 313 275 261 14 2 36 0 MNT co. i 252 250 248 2 0 2 0 Virgin Islands__._---- 134 132 132 0 1 1 0 Federal reservation 36 33 26 7 if 2 0 Public Health Service-.---- 17 17 16 1 0 0 0 Coast Guard ss. 2=-: =--=---- 14 14 14 0 0 0 0 Canal wonew--— ~~ ..2.5-~ 15 15 15 0 0 0 0 Other, excluding prisoners_ 22 21 19 2 0 1 0 PrigoliptGes...-----22------- 852 759 742 17 2 s4| 87 IMO! Cr 782 689 672 17 2 54 37 For examination--.-.-- 87 81 81 0 0 2 4 Mentally incompetent_ 248 238 235 3 0 6 4 Not gulity by reason of a 296 240 233 Yi 2 32 22 Under sentence-_--- 90 89 89 0 0 0 1 Sex psychopath 61 41 34 7 0 14 6 eee priconers——--—.=--5=-- 49 49 49 0 0 o 0 Military prisoners_-----_-- 21 21 21 0 0 0 0 1 Resident patient status should not be confused with D.C. resident legal category. The former is defined as patients in the hospital plus those on temporary visit. 408 Department of Health, Education, and Welfare, 1962 Table 5.—Movement of patients on the rolls by legal category, fiscal year 1962 Patients , : Net Patients Legal category on rolls, | Admis- Dis- Deaths | changes | on rolls, June 30, sions charges in legal | June 30, 1961 category 1962 A) | OR fe ae ae at eS ok 2 2. yee 7, 992 2, 024 1, 649 484 >| ee 7, 883 FReim bursa bleis.c2 <2 se ea a ee 6, 265 1, 432 948 432 —89 6, 228 IDHO, ResiGen tis snca, seat nese snes 5, 464 1, 213 618 401 —276 5, 382 D.C, voluntary...35.....- 292 192 227 10 +63 310 Veterans’ Administration 406 12 58 16 +67 411 U.S. Nationals from abroad_-__--__-_-- (4) 3 il 1 +58 59 U.S. Soldiers Home 51 7 15 3 +1 41 daidians (PES )62-=5-". == 45 0 23 1 0 21 Other reimbursable._-=—2-- 2 2-2-2 7 5 6 0 —2 4 Nonreimbursable.--<-*--------2 2--2.-_.) 1, 727 592 701 52 +89 1, 655 Total, excluding prisoners_---_---~-- 889 186 385 38 +151 803 1D). Cenonresident- sans --2 ==> ses ence= 313 0 248 14 +262 313 Milltary.2c2es0—..n5s=~<2-5- asi 272 0 7 12 —1 252 Virgin Islands-.-..----------- een 138 4 3 5 0 134 Canadian insane--_----------- 5: 51 0 0 0 —51 () Federal reservations- -~._----- cate 37 83 75 3 Z26 36 Public Health Service- -------- a. 28 2 12 2 aril 17 Const Guard... 4.-2ase=2> 2. ae, 14 0 0 0 0 14 (oT 4s eo sa 16 0 0 1 0 15 Foreign Service (Employees) - - ae 10 0 4 0 —6 Q Other, excluding prisoners- ----------- 10 97 36 1 —48 22 IPTISONGTS | == = 5 ae ne ee ease 838 406 316 14 —62 852 DO. total. ot ee ees 786 364 295 13 —60 782 For examination... --.2-22---=-_ 342 { 188 146 2 } 0 { 87 Mentally incompetent----_- =s 53 91 9 248 Not guilty by reason of insanity__ 229 79 23 1 +12 296 Under: sentencess.-= =-ssssen-S-5.- 151 39 27 1 —72 90 Sexipsychopath. 2.2. 2c2222—.-.- 6 eo pat nondeae i> soilne. lefee dH oft vet hebivme of see - = , a » tl inn fh o ren Lady wig ratty “> Bat ist d 2iwebsata atanhaisg edict et rt Pepelae m.’ : A 4 J Pe. Fn f ats => ie Totericituuba bie aronanel ae: 200i TOT Lite } é. # ae! _ te ALLA 2) rote .G fete Hight ich) big sive MA . ¢ etd alt Ye. beer “‘etontied A deb” Yo sscifio: Ge ' ; 7 ey irre ren wivellabackt ao ets i was i s oe a Howard University Howarp Untversiry, located in the District of Columbia, was chartered by an act of Congress, dated March 2, 1867. The university consists of 10 schools and colleges, offering 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, dentistry, pharmacy, fine arts (including the school of music and the departments of art and drama) and the schools of engineering and architecture, social work, law, and religion. (The school of religion receives no support from Federal funds.) The educational program of the university is conducted in keeping with the democratic purposes of land-grant colleges and State univer- sities, with the low tuition fees and living costs which characterize these 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 undertakes to discharge a spe- cial responsibility for the admission and training of Negro students. ENROLLMENT OF STUDENTS During the school year 1961-62, the university served a total of 8,704 students as follows: 6,338 during the regular academic year and 2,366 in the summer session of 1961. The total net enrollment, exclud- ing all duplicates, was 7,118 distributed in the 10 schools and colleges as follows: liberal arts, 3,552; graduate school, 805; engineering and architecture, 778; fine arts, 375; social work, 126; medicine, 377; dentistry, 726; pharmacy, 177; law, 128; and religion, 74. The enroll- 415 416 Department of Health, Education, and Welfare, 1962 ment of Negro professional students at Howard continues to be greater than in all the public-supported universities in all the Southern States. GEOGRAPHICAL DISTRIBUTION OF STUDENTS Of the total of 6,699 students seeking degrees, 5,762 or 86 percent came from the States and the District of Columbia, while 937 students or 14 percent came from outside the continental United States includ- ing 2 possessions of the United States, 58 foreign countries, and 13 island possessions of the British, French, and Dutch West Indies. The percentage of foreign student enrollment to the total student en- rollment at the university continues to be the highest in any American university. The students from the United States were distributed as follows: New England States, 2 percent; Middle Atlantic States, 17 percent; East North Central States, 6 percent; West North Central States, 2 percent; Mountain States, 0.5 percent; South Atlantic States, 58 per- cent; East South Central States, 7.5 percent; West South Central States, 6 percent; and Pacific States, 1 percent. The 937 students from outside the continental United States came from 58 foreign countries including Greenland, Canada, and Mexico, 5 countries in the Caribbean area, 3 countries in South America, 9 countries in Europe, 17 countries in Africa, 12 countries in the Near and Middle East, and 9 countries in the Far East. In addition, there were students from Puerto Rico, the Virgin Islands, and 13 of the British, French, and Dutch possessions in the West Indies. VETERANS During the 1961-62 school year, the student enrollment included 291 veterans and dependents of deceased veterans receiving allowances from the Veterans’ Administration. One hundred eighty-nine of them were enrolled in the four undergraduate divisions of the university, and 102 were enrolled in the graduate and advanced professional schools. The number of enrolled veterans is steadily decreasing, and unless there is new legislation providing benefits for “peacetime vet- erans,” there will be few veterans who have educational benefits still available to them after the 1962-63 school year. ARMY AND AIR FORCE ROTC Army ROTC.—There were 610 students enrolled in Army ROTC during the 1961-62 school year. Of this number, 284 were in the first- year course, 245 were in the second year, 44 were in the third year, and 37 were in the fourth year. There were 33 students commissioned as reserve officers in the Army during the year. Air Force ROTC.—A total of 537 students was enrolled in Air Force ROTC. Of this number, 303 were in the first-year course, 201 were in the second vear, 19 were in the third year, and 14 were in the Howard University 417 fourth year. During the year, 8 students were commissioned as reserve officers in the Air Force. THE FACULTY There were 801 teachers serving the university during the school year. Of this number, there were 431 full-time teachers, while 370 were part-time. The full-time equivalent of the teaching staff was 533.6. Of this full-time equivalent, 472.7 were teaching in the rank of instructor and above. The university continues, as always, to seek for its faculty the most able persons who are selected on the basis of their competence and character, without regard to sex, race, color, creed, or national origin. It is to be noted, however, that the Howard University faculty has always included the largest group of Negro teachers and scholars at the university level found anywhere in the United States. Indeed, many of the most outstanding Negroes in public life have served at Howard University at some time during the course of their careers. Among such persons were the founder and operator of the first blood plasma bank, a governor of an American possession, an under secre- tary of the United Nations, and a member of the United States Court of Appeals. The faculty continues to remain active in making a valuable contri- bution to education and the advancement of knowledge through significant research and scholarly publications. GRADUATES During the 1961-62 school year, there were 731 graduates from the 10 schools and colleges. These graduates came from 36 States, the District of Columbia, Puerto Rico, the Virgin Islands, 22 foreign countries, and 7 island possessions of the British, French, and Dutch West Indies. The 22 foreign countries included Greenland, Haiti, Cuba, British Guiana, Panama, 4 countries in Europe, 4 countries in Africa, 3 countries in the Middle East, and 6 countries in the Far East. The 731 graduates were distributed among the 10 schools and col- leges as follows: liberal arts, 311; engineering and architecture, 93; fine arts, 19; the graduate school, 68; social work, 43; medicine, 72; dentistry, 57; dental hygiene, 11; pharmacy, 28; law, 19; and religion, 10. In addition, honorary degrees were conferred upon three persons. From the date of its establishment in 1867, Howard has graduated 23,174 persons. The great majority of these graduates have been Negroes. Throughout its 95-year history, Howard has been a pioneer in providing Negroes with educational opportunities which were either not available or offered in only a limited amount elsewhere. Among institutions in which Negro students are in a majority, the university 418 Department of Health, Education, and Welfare, 1962 still stands as the only one affording a complex system of under- graduate, graduate, and professional training. The largest number of graduates has entered the field of teaching, especially in the Southern States. In the field of medicine, there have been 3,239 graduates; 2,547 graduates have gone into dentistry and dental hygiene; 2,452 have entered the field of law; 822 have entered the ministry; 954 have gone into the fields of engineering and architecture; and 571 graduates have gone into social work. Numer- ous graduates of the university have been engaged in government activities, not only in the United States but also in many countries abroad. PUBLIC SERVICE AT HOME AND OVERSEAS Throughout the history of Howard, teachers and students have rendered valuable and distinguished service to government in the United States and overseas. This we view as being intimately related to the functions of a university—teaching, research, and public service. During the 1961-62 school year, the university systematically undertook programs to aid in the improvement and development of the local community. As an illustration of this, the Vice-President for Special Projects provided leadership in the establishment of an interdisciplinary program involving social work, sociology, religion, psychology, medicine, government, law, and other departments, which, together with the churches in the 49th census tract in Washington, are giving guidance and assistance to the people in that area in solving their most pressing social, economic, and cultural problems. A more limited program has also been initiated along similar lines in a second neighborhood area in the community. Early in the summer of 1962, Howard undertook an extensive Peace Corps training project which involved the training of volunteers going to Niger, Senegal, Togo, Sierra Leone, and Cyprus. In pro- viding training for programs in five countries simultaneously, Howard had a greater number and variety of Peace Corps training programs at one time than any other institution in the country. Many members of the faculties gave significant public service as individuals. A professor of law was on leave of absence to serve as chairman of the Public Utilities Commission of the District of Columbia, a professor of sociology was appointed to the Advisory Board of the National Capital Transportation Agency, an associate professor of government was appointed to the District of Columbia Board of Elections, and a professor of preventive medicine and public health was presented a “community service award” by the Health and Welfare Council of the National Capital Area. These examples are illustrative of the service being given by many other members of the staff. Howard University 419 In 1961-62 as in the past, there were teachers from Howard work- ing and studying abroad. An associate professor of government, with the aid of a Rockefeller grant, was engaged in studying guerilla war- fare in Laos and Viet Nam; a professor of English was working for the United States Information Agency in West Germany; the librarian of the university served as an adviser at the library of the University of Rangoon in Burma; the director of recording was on leave to serve as registrar in the establishment of a new educational institution in Sukka, Nigeria; and a professor of anatomy was working in India on the staff of the Agency for International Development. Members of the staff were studying and teaching abroad, including one in Japan and another in Italy. There were many students traveling and studying in other countries, including 18 members of the university choir who participated in a choral workshop in Puerto Rico. It is readily recognizable, therefore, that students and members of the staff are continuing the Howard tradition of significant service to people both at home and elsewhere. THE BUILDING PROGRAM During the school year 1961-62, construction proceeded on the new home economics building, which was expected to be ready for use in the fall of 1962. Work was begun on the construction of a new building providing for the physical education programs for men. The new physical education building will contain about 118,000 square feet and will include the following general categories of space: a gymnasium area for 2,500 spectators; a gymnasium for regular pro- gram work; two special exercise rooms; a standard intercollegiate-size swimming pool with seating for approximately 400 spectators; class- rooms and offices; locker space and shower rooms; and equipment storage and other related spaces. Plans and specifications were in preparation for the construction of a proposed new classroom building for the college of liberal arts and a new women’s residence hall. Construction is expected to begin near the end of this school year. In addition, the university leased a facility to serve asa warehouse service building. The university began a program of intensive study of its educational and physical plant needs for a number of decades in the future. The present master development program was completed in 1951. Its basis, however, rests essentially on a program which was designed in 1931. In view of the severe limitations placed upon its growth by the present limited campus, the university is endeavoring to make an even more intensive use of its present land resources, as well as exploring ways of expanding its campus area. ifine pate wamis Jem itt rine aentorip stinks mde gbaids anighe “rg iPt Aad athe en ret wil, ; 7 rs teraty ge: rehe = ’ ine ight Seo UT it sae fei nora ntad : as toa eben feet Sle : Lee ; U \. oft < ntliahbatee Hilt \ P| | fete] t irks alla to yay aly Th wantiee ae: OPS a ' 75 Sa ‘ tr af! ees atin gibliod Anita > ¥ } Ay} W : onda to “et Jind «unttetitelh 16 “s sf : ; t PUL 2118 i} Or wees iu nov ler ui One Y 7% i ‘ F fouey sion: heaslen sell 1erdeynerk ane erro habe ee aa rT $ , “a stil tt archagyt wrishedo wok di A +. F 4 J 2 yw) wet +h rere (i sorclentsaidh lot ay { yet cajeenreaet nt ee hes Ye : i” rT ‘at pair & @ cert Ame ae P fax i thr font t His 2 alman Tee Tye ena aac mirtiors weeepaipesl: (mea i ! Machel oat arwes eiip]@ 55 ys ieee sty Hels AUPE RI Sst tlised it > rh Tihs Firink i dl 2 Pe air Yow eur adigantntl ste oath pear hy een elt mea ae keer ~agiintiod evra othe ereran oven elt yuiifire treet q © aif Detailed Contents THE SECRETARY’S REPORT Page Mo PRoMOTH THE GENERAL WHLFARB_.---.~.--2 2-254 cause ese ell 1 MRO ANIZATION FOR ACTION... 222020 US web elites SI ee ena oe 2 Perse nOLOGUH 2. 0 le So see eee de seece ae SI 34 BerehenaermeoG ete. tel YS RGM SNe ee I eh rt So gos 4 PERO RweOMORRO Ws a2. eae. SERS Ue Po) ea hee (Ue ts 9 TaBLE 1.—Grants to States: Total grants under all Department of Health, Education, and Welfare programs, fiscal year 1962__________ 12 SOCIAL SECURITY ADMINISTRATION SoM UIRLLY. LN 1962f..c22e Nee As ee 13 DAMN nO NAL eA CITVI TINS. 2002. l Se Pee OL SL eee 17 PAM mC UGH Mr ROGRAMS.. 6625 422.04. 422.8208. See eee 19 mEmnuenceserovided to Cuban Refugees. ..2. 2.2.2... Sue eee 22 Unaccompanied Cuban Refugee Children’s Program___________________ 22 OLD-AGE, SURVIVORS, AND DISABILITY INSURANCE__-_-_____ 23 PSO See ee ok ed ed ey ce teenie So ME UE LAE 26 Hewinernsurance for the Elderly ...:...s.+--->- 44528. 101 Research Interpretation _ ....<234224-2-. eel eo eee 101 Health Services for Mothers and Children___ 9-__. 2392552) 22522252) ee 102 Maternal ‘and Child Health Programs ._- S26 Sass eee 102 Crippled Children’s Services-----.-_---.-__- Ai RMS SY ee 106 Child Welfare Services. ..2.0.. 2.42. 2-2)-2 24-28-22 ewe 2 eee 107 Research and Demonstration Projects in Child Welfare_________ 107 Teamwork To Improve Child Welfare and Family Services_____ 108 Financing the Ongoing Child Welfare Program_______________- 108 Improvement in Child Welfare Services_--.-..--..--------_-- 109 Steps To Meet Continuing Staff Shortages_.___.________________ 109 Changes in State Structure for Services_________-_______-__-_-- 109 Development of Child Welfare Services in Specialized Areas____ 110 Detailed Contents Juvenile Delinquency Service -__-_-_-_-__-- eet BY ee tet viernes ES ie mnntnneA GUINIULCS tes 2s 2 Sekt eee ces ace ns Soke International Research (Foreign Currency Program)__________- igemnanon al lrainin oaesters eh serene eer ee ee Fee Assistance to Other Training Agencies_..._=.__......--2L2..2. mUigeAw OVEN DERAL) CREDIT UNIONS:z-x<-22-2 42) 2222 be ConsumMmR? PROTECTIONS. =< -)2- 2204222 25-4 atic. Ale eae Wee i te Stupent Loans ror HicuEer EpvucaTion_________--___-----=-------- MANPOWER | UTILIZATION 222 222225 2. 2 Ra ceiontee buee eee hoger d SPL S. STRENGTHENING RESEARCH AND STATISTICS.._..----...--__.____.._.- CNR NATION AT, SACTIVITIES ets): _ bau beew.le ose byayt, hs sg BF oe EXTENDING CoVERAGE TO Low-INcoME GrouPs______.-_____-___-_-___- TasLE 1.—Social Security Administration: Funds available and obliga- monsmucmrredstfiscalvyears [962:and L961sse) 4. Hos. eee Ea Tasie 2.—Financing social insurance under the Social Security Act: Contributions collected and trust fund operations, fiscal years 1960-62 __ TasB_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 1961 and ME ae een eral) (3 (ee eet er PS ore pay rece eg: ary Bee, a Meh oe ee TasLE 4,—Old-age, survivors, and disability insurance: Number and amount of monthly benefits in current-payment status at end of June 1962 and amount of benefit payments in fiscal year 1962, by State____- Taste 5.—Old-age, survivors, and disability insurance: Selected data on employers, workers, taxable earnings, and contributions, by State for Se CM OULO CS seek te EF MIs Niet Pee: Pie Lae eee Me B. TABLE 6.—Old-age, survivors, and disability insurance: Selected data on benefits, employers, workers, and taxable earnings for specified periods, rete ee A eee ee ee ee eee ere ee, See SI, Fs b TABLE 7.—Special types of papi assistance ides plans approved Bi the Social Security Administration: Number of recipients and average pay- ment, June 1962, and total payments to recipients, by program and PORES ORV CAT EL OG 24 re tela hes oe eee eee ec eee ae ee TasLe 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 whedtas HGP) = sat See eset. enlace etal a nl ae Ne Pw tye) ate yey Taste 9.—Maternal and child health and welfare services: Grants for maternal and child health services, services for crippled children, child welfare services, and research or demonstration projects in child welfare under the Social Security Act, by program and State, fiscal year 1962__ TasLe 10.—Federal credit unions: Assets, liabilities, and capital, Dec. 31, AooemernanLec* 51. TOG1 ane ctr eS he eo as a ee tee AREER te TasLe 11.—Federal credit unions: Selected data on operations, as of como tOmeaCh Veer 1. 934—6 lum supe eee See eee eee eee eee TaBie 12.—Federal credit unions: Selected data on operations, by asset BOR Cg st Abe nel O lm Weees eee seine et en I OR ee See sere a Cuarr 1.—82 percent of aged beneficiaries had half or more of their retire- MICH uM COMmel 1romMPenehtsas-— e- =— e e e e ee ere Cuart 2.—When hospitalization becomes necessary, medical costs for fis ACS ERO TB LS lies eke aes Cee Sake eee eee ee es es le en nn 125 126 130 132 134 135 424 Department of Health, Education, and Welfare, Cuart 3.—Old people go to the hospital more often and stay longer than younger ‘persons*2s 220s bees ow .- sos eee eee Cuart 4.—Between 1940 and 1961 the percentage increase in average earn- ings exceeded the percentage increase in average benefits____________- Cuart 5.—The earnings base covers the total annual earnings of a smaller percentage of regularly employed men than in the past_-_-__-__--____- Cuart 6.—9 out of 10 workers are covered under the OASDI program____ CuHart 7.—Both benefit payments and number of beneficiaries have in- ereased rapidly since 1950_.. <..-. - Je@ Lee See Se eee Cuart 8.—The number and percentage of population aged 65 and over eligible for OASDI benefits are increasing__________________________- Cuart 9.—Hearing requests: total received, cleared, and pending__-____ CuHart 10.—Reviews before Appeals Council: receipts, disposals, and pending es 282 eee et eee: 6. See eee Cuart 11.—Cumulative civil actions filed, decided, and pending, Decem- Cuart 13.—Medical assistance for the aged: average payment per recipient for vendor payments for medical care, June 1962_2-22 -._-_ = 5222 fo Cuart 14.—Vendor payments for medical care_____-_---_----------_---- CuartT 15.—Salary, public assistance caseworker and other selected posi- tions; July*196202 2s sesvedk. 21lbbedh . dere _ pe boa _ ee Cuanrt16:—Increasing child populationss2s:- -f_ el hese! a 43 2452 ee CuHart 17.—Births out of wedlock are increasing. _____________________ Cuart 18.—Trends in juvenile court delinquency cases and child popula- tion! 10) to’ 17*years‘of,age;) 1940-60c. eae ns eb Ey ee ee Cuart 19.—Maternal and child health services are reaching more people_-_ Cuart 20.—Trend in the number of children served in the crippled chil- dren’s program and in the number per 1,000 children under 21, 1937—60_ Cuart 21.—Child welfare agencies provide social services for children_-_ PUBLIC HEALTH SERVICE HEALTH OP THE: NATIONScc_ eile Se Le oe eee Huatura” Recorpis 2.0916 ot je Le eo ie be bh ae OFFICESOFr s PERSONNEL 2:22 4423.9: bee. Fit ets 8s te eee Personnel Ss 22s Ae. Pies Sef ee National CENTER FOR HEALTH STATISTICS 2. -<~ 24-22 -5-b a - eee ee National Health Survey s2224 task se asiees Set 2A ee ee National) Vital Statisties Division’ sv). =<... 322.3 oe eee Office of Electronic Systems_ . -_..22 22... .2--2 2 eee Office’ of Health Statistics Analysis 2— 22.2. =) es ee NATIONAL LUTBRARY OF MEDICINE] 4 -- 25 2220 ee pale ee ee Board.of Recenten ae ee ee ce oa ee 2 ee SciencerLransiation Program... 2-2 = see eo Program [Statistics 2. -s2se2 ee 8 oe ee ee DIVISION,or PuBlic H warren MwrTHops 4 soe seen ee ee 2 Organizational Changes 2.2). = 6 oS Sea ao eee ee hae er Professional sHiducation....-. 222-2 essed tele ee ae eee Health Manpower....022 2526 =o ese ee cee ee ee ee 1962 Page 139 143 146 147 147 148 148 148 149 150 150 150 151 151 151 152 152 152 153 a Detailed Contents 425 Page DivigignmGre NTR NATIONAL HmaLrTH -> 2222-22-22. 2 2 ee 154 DivrenmmonrtteantHy MOBILIZATION. =222__-222_---L 2122-22 222 155 BUREA OOF MEDICAL SERVICES: :-.__-=2+22.2_-_2-__ ¢ Avonatea ” 157 Drvistonmor Ef OSPITALS___2-_----__=- Wes cs. See 158 ent Care > -* ees see cst Le eee eee 158 Cooperation Regarding Narcotic Problems__---_-________- we Pen 158 a eer So 0 EN Se ees eee eee 159 PEON raining 82 aris rest ce cesses eee Se 159 Peremermrgure 8 wk ose ccc stessdcese ee ae eee 160 Pedersernmployee Health Program. 222-222222-)2. 2 Oe eee 160 eae Ospital 22 es Ae SS ee ee et ere 160 enn ARAN TINE <2 - 22-2 >* - seek Sees ones APES 1 Pe ieiiee: - 161 Mam eGEeres D> IScases 2s = Ss eee ES Rye. My A eoye i 162 eer ineet at TAIO* & Mee oe eee Oe - soe EE? MOA) Be 162 MUS tenemENSeMnitin CONS. <8 os Flees sb oscceec sess ee oe = 163 Meaaolishmentrol Peew.! 552 #2225 = oS SOU) a Se eee 163 eemaral Program 45S stees ese yo 6 1 ES ee Bee 163 iamigration of Luberculous Aliens. “_-— _- 2) ees Se ererey 163 Additional Change in Immigration Law_____________________- 164 maveiory ©: ATM Labora 2855S <22<) 2s ss 5554 oh Se 164 Baromoury and: canitation Proprams:::2 452222222222. 2922222 164 PPB MAr ene A CULVItiCs= ==" 2-252 425. @t sl Se lt Oe Pees 164 HEALTH SERVICES FOR INDIANS AND ALASKA NATIVES_________=______ 165 Peet eS eee ae fowls wei Se Kes | ee eke oo Ses eee Tees SS 165 Sere i ene son sb en Se ies sisi f= SS =s* si nee see eee 165 Oe TES SSA TTL. SSI EH ep pase fe ald eR a oe EE 166 etretCer en iciteeee as 2 2 oe eee A eee ees 166 errr eSCLVICCsh soso tie Pe Rive AE Se ane ee ae 167 eet ee rcIMmenn cd Care* = 652 e 4 e826 oes eee == SU Oe ee 168 IND 22 S2) se auver eee See 168 Ue anretniieeete se ree ee Oe eS eos See pees ee bee fesse 168 Pear Tus Sani baAtOn. 2 of as As Aes 8s 8-9 ee ee eee 169 Training for Indians and Alaska Natives_-_-_—_- eeanes Wee See ree 169 DEE MMPACTIVILICS oe ne ne eS Se ee 170 eerrrCceune vn LUTE = 2 ee ee he Ck Oa, Te re eee 170 Mone sceoerRvIChS FOR T'kpeRAb AGENCIBS. 2 22_.2..-22.222¢_ 2122 82_ 170 United States Coast Guard, Treasury Department____________________- 170 Bureau of Employees’ Compensation, Department of Labor____________~ 171 Maritime Administration, Department of Commerce__________________- TZ Buresurcnelrisous, Deparsment of Justice. _ 7 = ee ea Pa Es OL NEW LSYCHIstriC LOSpiILal ee ees te see see SUES 172 Recommendations of Advisory Committee___________________-_ 173 PAOSDIOAL LI DrO VEIICIIUS == fee = | os eee eee soe eernees 173 MBlniCal SCTViCes= ones ae ees Sie es a eet RE 2 woe eee 173 WEMNONStrAviON COUTselINg=- #2 -S seers ees ese ees PTT 174 SAAT Cle eee ee ne eee ee eee eS eee a Sees se I 174 Rarcicipanion i Community wail aire*ae== == 552s ee mss oS 174 Peron okay hr ot Vi CHSess ses ss seats er eee E> ivs Pith Or WCOLENT t REVENTION...- 22225 5°60 eee eee 175 Peon CHRONIC TOISHASENS = So 52 22s Seeee wa Ss 2255 Ss ae 177 RE IACONtLOL Meee ees Se nae ee eee Wier eRe Bn euler Se 177 DIEMONStCAWMON ETO |CCIRS = ketone = aoe ees ee ee ee ee 177 irmioal ) rAInecsiipa, late Grantsae == ee eee eee ee 178 665171—63——28 426 Depariment of Health, Education, and Welfare, 1962 Page Diabetes and Arthritis, Program 9.2262) oo ae oe eee ee 178 Program Application.._.=< 22 3) 2 2 178 Applied. Research: 3225_¢.. 2. 9es ee seks 178 Heart Disease Control Program = 3.2 5 ta. =e oe ee 179 Heart Disease. in Children. < 2-226 2524 23 4-23 3 179 Heart ‘Disease in Adults... 22.2554. ot ae 179 Neurological and Sensory Disease Service Program_________.__----___- 180 Project Grants). 2242-5 a 180 Vision Conservation —< 2. 2 = ok ee 180 Hearing: Conservation=e. 2225. =2 soe ee ee 181 Health Services for Long-Term Illness Program________________--._.-- 181 Support. of Projects: 2.2.) -s2e. 8 es) ee ee 181 Development of Materials, Data Collection______________._.-- 181 COMMUNICABLE Dismasm CaNTHR__..—~-22---] 22-2 ee 182 Epidemic and) Disaster, Aid 2. = 22). =2 eet 2 SU ee Oe 183 Representative, Disease,Studies... __--_..+_ =. 2... 98 5.5 183 Quota, Sample, Surveys j= 5k os ee 183 Venereal .Diseasess seen Leet pte eto 183 Tuberculosisa g.< 2.322632 5p eet 4 184 Influenza. 23 tas i eee oo 8 ee 184 Poliomyelitisi:.2 .. 2420 bon! 32 seen ot! ee ee 185 Measles Vaccine Trials. 22202222420 -25 ete 185 Leprosy,,.Other) Diseases: 22... 4 - eee eS 185 Laboratory. eed. Sn Ben Ste ie Se ee ete ae tS ee 185 Audiovisual eb. 6 2 as 2S ep Oe ne ee ee 186 Twaining: 2. 2 ee ne oe ee 186 Divyiston or Community HmALTH SERVICESicc= <- 2202-2 186 Grants for Improving Community Health Services_______________-_-_-- 187 Special. Project Grants.) == 2-446 246 bs ee 187 Formula: Grantéi) fandes oe tenet eee Joe 187 ADpAININ Oke SS ey am ee Ye te ee ee Lo tudes eee 187 Misratory Agricultural Workers... 2_-.2-------~=--)=- 4544 =e 188 Other Division Activities: 322-5322 4 oe ee ae eee 188 Division or Dentrau Pusiic HEALTH AND RESOURCES_----------- —_-- 188 Strengthening Manpower and Educational Resources_______------. ---- 188 Special’ Patient (Care. soa Seg oe ee 189 Dental Care Financing Plans)... 3. 24 189 Abetude Studies” -! 4, PA se ee i 190 Combating: Dental Diseases.) = 8 bee ee ee eee 190 Improving Dental Public’ Health Practices = -- = 190 A National Dental Center for Research and Training_________------__- 190 Division or Hospiran AND MEDICAL HACILITINEg 3-5-0 -. soo) 191 Program Highlights: 2:20). Ne Seu ee ee ee 191 adhe Construction. Program. 2 sess. 0) ee oo ae ee ee 191 Research Activities: 4. 2-2 f= SU ee ee eee 192 Unmet Néeds2* Soe ee ee es ee ee eee 192 DIVISION OF INURSING.2- << 0} 6 oct a ee ee ee re 192 Training in Restorative Nursing os... = eer a ee 192 Out-of-Hospital Nursing) Care se =e ee ee 193 Hospital (Nursing. - ets eee oe en ee 193 Field Centeritor Nursing sc 16g eae ae ee 193 Manpower and) Related! Studies i. = = as =a ee 194 Professional "Nurse Traineeship) Program see = ee ee 194 Support of Extramural Research and Research Training____-__-___-_-_- 195 Detailed Contents 427 Page Intra-Agency Cooperation __------------------ eee ee 2p eae ie 195 DEVIStoNeOnPA IRC OMBUTIONAQ 2225-22552 24s22-2ntcanscccsete ltl. 195 TRLSTEON TEM 2a Sn aoe Or Re a 195 Insimumentation, sampling, and Analysis... +.- <2 ---- 22. 4.454 196 MechmenipAchislanee and Training. = 22. 2 be nae Sener Lok 196 OSE te A ae a ae a ee ce 196 Division oF ENVIRONMENTAL ENGINEERING AND Foop PRorEcTION____-. 197 DREMOULOOCRESTARIGI Bray A ee NB 197 PeRre Verse SMD ELONY TAN CH 2 os oe 8 a 197 mpecialmempineering Services, Branch _...--_.------=-<-2-----seesce 198 Rue Teidtemeerrien Branch! )a! ses tin. oon. eo ee neces eae ey rey 198 IDivaisrONTOr OCCUPATIONAL HBALTH: £022. UL 6. eee seek ea een 198 Pit sOnsOmesnADIOLOGICAL HRALTH..~. ful): sewooes Clee aes 200 Prmeamioencals ourveillancec.. J@2L00! 208 Sum ata_vdeelsi ed less 200 CCEA poe el keen Olmert ee ae 201 UE tr ti | OE ee hey Oem, Oe Se ee eee 201 JMG, 12 “4 ae eG See ee ee ee ee A ee 2 ee ee 201 Division OF WATER SUPPLY AND POLLUTION CONTROL___.______-____- 202 Seacwnicion. Grants,-Progrant Grants! 122. PAL _ 2a) Te AE 202 SICA Ee ese eceawen VOYTADUSL WES SOAS 203 RMU GUOC eee B am Sib. oo Saco ck enc wee eee Je ee 203 eC HeaG MUR AINING 2 ows eee clo et2cn Bees es 32 se Wl Anih 5 203 Comprehensive Programs, Interagency Coordination_-_-__.-___-_-------- 204 ui Stiny [Eon MS Stee Se ee ee ae ee a a a eeee Oe ET: it Rls 204 ieee allONAT INSTITUTES OF HEALTH.........29uuhi 2 los 204 INSTITUTE OF ALLERGY AND INFECTIOUS DISEASES__.._________-_---_- 208 INSTITUTE OF ARTHRITIS AND MertTaBotic DISEASES_.______-_____=_-- 209 GANGERSUNSTIDUTE: 225222220. koecc-6 as cene sx Se dae a Ae 210 IMEAMMLORCSOAL OH 2228. SS yal oe ene ces SLUR El Me a ae 211 Pam simoponted: Research £0996 ty 3 a ee el LL eS 212 Pana oeOr OUNTALY RESEARCH. 6 Osis see Soe oe SOLUS See 213 Ree NCeRRETCUBA WATS sO oo ae pers on oe I A FD 213 Pee UNS eT OTH > Sheesh SMASUUR SD. SAL SV OVP ES eRe) AOE. 214 Grant-Supported Research___________- SALAD SO east AOAC! 215 INSTITUTE OF MENTAL. HEALTH...__________- IG SRLS Ke TRAYS 216 SremeonpportedrActivities fa. bias sawn Jn cee eal golged 216 ibaserand,. ©linical Intramural Research... ..-1212--1~ J 8UUS ie 217 Community Services and Program Development___..------.----------- 218 Meat ere hse Pe Seng pe Se eh ep meres RE SO 218 INSTITUTE OF NEUROLOGICAL DISEASES AND BLINDNESS. _2____------_- 218 Paunporative. Perinatal Researchs..a.gsc55 2 eel eS ey we eee. 218 eELEOsLesearchiine Puerto) Ricosss.... saab he wee SU ee 5 219 Multiple Sclerosis, Muscular and Neuromuscular Diseases, Epilepsy_----- 219 MeGuMeLLOATi To. Lead aChesin 4 ..qeyyiiwe nd pee Beets) Loe gS 220 Pant stONwmORS DIOLOGICS .OTANDARDSinaasiason wanes. owas ass eee eS 221 Division. or GENERAL. MEDICAL SCIBNCES2. isle. oe Sew ete) eee 222 Lo eonel CCC 2 Senn ac eg) Ue eee) ee 2 ts stare he 3 nn SE. 222 PeeceAnc hn raining CPanis..5cmeeieskies tye) took ee) el Se ie eh eee 222 ibtonGeneral Glinical\Research: Centers... cae ee es SE 222 Gemetetors Research ny Child.Healthwes se. 5o5s ne Be ee 223 eamtonforesA cing) Research ises hese) See ARE. SURO Beli b 223 Gencralehescarch Support. Granteie.2cee oe DU Ce 223 Srecialshesource, Gen tersige. the ase oee a eee eee Ep es 223 DIVISTONG OF + RESEARCH s GRANTS: 25 iS ee re eek Se 224 428 Depariment of Health, Education, and Welfare, 1962 Page DIVISION OF RESHARCHYVSERVICHS. 2.2 =—0- 2-2 2 oe ee 224 GCrINIGAL CENTER. gee) 3 4.52 i ee ee ee 225 TaBLe 1.—Statement of appropriations, authorizations, and obligations, Public Health* Service; fiscal year 19625225 = ee 226 Tasuie 2.—PHS total paid employment by Bureau and Division, as of JUNE SOMI9G 2 Fee ee ee a ee ee 228 TasBiE 3.—PHS total paid employment by Bureau, commissioned o‘ficers, and) civil services as Of June SO L9G 2 aaa a 230 TasBuLE 4.—Research grants and awards, fiscal year 1962________________ 231 Tasie 5.—Payments to States or localities within States for public health Services: fiscaliyear 196250" 50 Sees a ero. Se ee 232 Guart 1:—Public Health Service——] 96255 Seepes ites ee eee 141 CxHart 2.—Death rates by ageand sex, 1945-61... =. bse See 144 OFFICE OF EDUCATION BIGHLIGE.TS, OF THE _ YEAR'S ACTIVELIBGs 22252 35eases ee 235 SOCIAL PROBLOMSAAND JIDUCATION, .— 25 a55-5 oe = eee 237 Problems ofiUrbangAreas.... = 2. = os oe er ee 237 Freedom and World Understanding_________________- _.sudstes? Dee 239 Equal Opportunity for Education<2!s5.2 + 22 sees95. 22 _22e- oil 239 PRHCIALL PROGRAMS 52 eects te ee 240 Exceptional,Children_2..... WSS Ee, See ey 22 eee 240 Captioned Films for the Deaf____________- oy gl ae Bie 241 Barly School. Leavers... (293230. .ee eer Kk ee 2 eee eee 242 Rhysical wBitness Surveyisaqu.e42 =-Saatth. Seen ence er 243 Prosrams and, service for Adults____--_--4.-.._»=___ .., .- 5 243 Training.the Unemployed. ..<2-..__- =. 241-44. dee 244 Civil: Defense Education.......... ......-... 49g aee ES eee 244 INGER AGHNCY oC OOPERATIONS = 2 a 245 INTERNATIONAL ORGANIZATIONS AND PROGRAMS. __---_______----_---- 247 EDUCATIONAL RESEARCH AND DEVELOPMENT. ____-_-----_- 248 ELEMENTARY AND SECONDARY EDUGATION.| 1. esses. 22592 ee 248 Strengthening State Departments of Education_____________________-_- 248 Staff. in:PubliciSchools. o)o5_. 2... --- hee et Ieee in ieee 249 Facilities: Needed... ..--. 1... Aeeucenievetl. oper t ee Geeta ee 251 Financing Public Education___________- Bo ie ee oe 254 Local School Revenue. ese eee ses. saorahssoe ee See 255 State; Funds:forSchoolsx..=3 == en 2 2 dies Eh ee ee 256 Federal Supportecs be 3-24, Shi ce Soe Get) ot de 258 Offerings and Hnrdéllments ase! selesepeueeeet Bee sel eb Uo ies eee 259 Hin @lighi. Siete pee bs) ae ee ae 259 The, Artes. 5 fb SE te geet oe een ep ee 259 Foreign Languages!.__... . .28ewaseB- ssc tA gaye) eee 259 SCIGNICC pear, ae ee ers em Fe ce pickin ic toes 261 Mathematics..2.9¢ 26h. eh os oe oe ee ee 263 Guidancerand) Testing Services.__ ee ee ee OE Fee ee 264 Identifying Talent: 2. 23. 2.52.0 abteeett SUE ot eae ee 264 Testing: Programs 34 -.fe2) 2 9 ee ee eee 265 Professional. Personneli«<=........ -} 5 eae ee eee 265 HiGHER: EDUCATION Sito seene: Bee 8 a See 267 Administrative Problems and Services__________- pes Caceeg a oe SE sere, oe 267 Students'and! Curriculum s2- 2) = See ee 270 Detailed Contents and=Granimlnstivu iiOnse = ee emae Mee ease ee oe Lat ae TRG lereel) LRIOy arab Se fee ay ee gs pe se a eat ie ek ee ee oe MEAG NA UE OLATISTICN Sect eee eels See, Se POU Le woe STEVI CRGLOTND RIO OUNG TYG sgt a ee eh igo Gao neMnive sTVCseal Cheb rOoTall ese. eee LET Oe eee “Re CHE OUME nlrb eS eetr eens = St, CONS VES Seo ee! ee Raye cielo lis iim st. Severe Meals g SOIT TT: IA SE oe 3 IBroyecthmociaiistudiestt= > =U rk A eee New Educational Media Prien MPAcCTHD ARKAS 10s WENO le? Wo Sete. Seah bs eS WOGATIONALVAND TECHNICAL EDUGATION Ufo 20 2S ete ee ee Area Vocational Education_________- 4 AREA HEY UCR NON) SG) ete ey Trade and Industrial Education Distributive Education PMCS WE UCADIONS ~ 22S a0 ce 4s Sees - es «oh oe ens soe eee eee Sarena ELUTE COT leer Sap ASN Re oe ey ts Bye ee ere Meme NGS RGlTAMING 2 fs Sao Me i tle ae Ce eee IAredmvcdovelopmentrA Chutes are ee eee ee Manpower Development and Training Act_____-_______________ PROGRAMS IN H1iGHER EDUCATION erica Oolegess_ Wit 286.4 elke ere Teachers of the Deaf We Aaa ORV OS, 64 teh so SIG! NEU ORS Tees oe Pio RNALTONA TY HDUCATION. uc. eee SE - EDUCATIONAL EXCHANGE AND TECHNICAL SERVICES___________----_-- Sercnometrxchancer PrOOTaAM eA hse ne a Le FV IS ee iheaener=Oevelopment) Program: <2. PE PS ecumicaleAssistance Training Program 2220+ 2 = 8 SE IL RoE Um VISIGOr E TOTAINS sor ek SOT es _ ee BO Le International Assignments for Specialists. ___________________--____- Ee Clearinghouse on Educational Exchange--._.-_-_. .. ---_-----_----.- p cere nel valuations ats l eS = TUDES _ SURE @ DOR E TaBLe 1.—Enrollment in grades 9-12 in public and nonpublic schools, and population 14-17 years of age: United States, 1889-90 to 1961-62__ TasBLeE 2.—Office of Education enrollment estimates: United States, 1960- Bumendet 0616222242. ss OR TRO Paes. SRA ATI EIS HOGER AT) 2h TABLE 3.—Gross national product related to total expenditures for educa- tion: United States, 1929-30 to 1961-62__________._---___---------- Tas_LE 4.—Earned degrees conferred by institutions of higher education: Wnited States:-t869—70 to-1961-62.8"-0 Ase uss: Bhs FA Bee et Pe TasuiE 5.—Grants and other financial assistance to States, administered by the U.S. Office of Education, fiscal year 1962_.__.__._.____.___-_------ Cuarr 1.—Changes within the public elementary and secondary school sysvem United states 195/—b8 to) 1959-60 eee 430 Department of Health, Education, and Welfare, 1962 Cuart 2.—Summary of expenditures for public elementary and secondary schools: United States: 1959-60222. 2.4 222-222). ee Cuart 3.—Revenue receipts for public elementary and secondary schools, by source: United States; 1959-60_—- =) 2 eee Cuart 4.—Trends in enrollment in full-time elementary and secondary day schools: United States, fall 1954 to fall 1961_________=__)_ 32 42a Cuartr 5.—Approximate retention, fifth grade through college entrance: United States, 1924-32 and 1954-62. -______. .t se 2 eee CuHart 6.—\Percentages of degree-credit students enrolled in various types of institutions of higher education: United States and outlying parts, fall JOG es oo oo ee oe A ee pl re ee Cuart 7.—Total degree-credit enrollment in relation to population aged 18-21: United States, fall 1939 and fall 1946 through fall 1961________ CuHarr 8.—Trends in degree-credit enrollment for 4-year institutions and junior colleges, by types of institutional control: United States and outlying parts, fall 19389 and fall 1947 through fall 1961_____________~- Cuart 9.—Vocational education enrollments and expenditures: United States, 1935-65-22. eee oe ce ee et osc re Se ee FOOD AND DRUG ADMINISTRATION INTRODUCTIONS Js 2 [is ete 8 ee ADMINISTRATIVE! PROGRESS_2< A-sqhcios)) Seng dl eee oe BHoop,. DRUG) AND «CosMpTic Act. =... 222 22645525 er Onuthec Food: (Wromt ime Th sre re ee Radioactivity in Moods.22. =. #2. 8 ne ee Chemicalsin: Foods... 2.25.3 <2 ged eee Other, Harmful: Contaminants... .........--- _._. Beoareess eae To Keep, Bood/Clean_._._.. =... 4% OA Oye eee. 2 eee Pocketbook Protettions