Annual Report U.S. Department of = ae Health, Education, and Welle i M 4 i rte ae : Lae Wate ‘ Ns hy eee gc i vie eer rs th ait i or Sin eS a LE SET TE : Che he * D i BT AES By teh ' 4 bait eae s i 4 ; M.C. MIGEL LIBRARY AMERICAN PRINTING HOUSE FOR THE BLIND U.S. Department of PARROT ANCE A PUBLIC HEALTH SERVICE VU CHER ue DORR Y oss. seas ee ene Surgeon General. DAVID MMe RICK Se se oe ee Deputy Surgeon General. JAMES) VanOWRY2—5.-----— Chief, Bureau of Medical Services. CHARLES E. BURBRIDGE_-_-_~_~ Superintendent, Freedmen’s Hospital. Rosert J. ANDERSON__---- Chief, Bureau of State Services. JAMES A. SHANNON-~_---- Director, National Institutes of Health. Forrest H, LINDER_-~-~---~ Director, National Center for Health Statistics. FRANK B. Roaerrs_-_------- Director, National Library of Medicine. OFFICE OF EDUCATION WRANOIS, IKEPPRGs o2 eee se Commissioner of Education. WANE) O.. EORED- 2 eee eee Deputy Commissioner of Education. FOOD AND DRUG ADMINISTRATION GrorGce P. LARBICK. 24.2225 Commissioner of Food and Drugs. JON. ELARVEY=22——.....-_ = Deputy Commissioner of Food and Drugs. VOCATIONAL REHABILITATION ADMINISTRATION MARY: Dl, SWITZER oo=-2-=—2 ea Commissioner of Vocational Rehabilitation. BH. EMory FEREBEB___-------~-- Deputy Commissioner of Vocational Rehabilita- tion. SAINT ELIZABETHS HOSPITAL IDATAHO.OAMWRON225-22-2s2e= Superintendent. WAGANOY 22 221) Lae See Assistant Superintendent. FEDERALLY AIDED CORPORATIONS INENTS DAVIS= oo oe Superintendent, American Printing House for the Blind. Lronagp M. Histap__________- President, Gallaudet College. JAMES M. NABRIT, JR-----__=-- President, Howard University. REGIONAL DIRECTORS LAWRENCE J. BRESNAHAN_____~ Region I, Boston, Mass. JOSEPH B. O’ConNnNoR__------~-- Region II, New York, N.Y. EDMUND W. BAXTER__--_______ Region III, Charlottesville, Va. RIGHARD HH. Lyte Sesre eae Region IV, Atlanta, Ga. MELVILLE H. Hoson__.____-__- Region V, Chicago, Iil. JAMESiWiDOARN] 222 22 ee Region VI, Kansas City, Mo. VANES RE BOND se ee eee Region VII, Dallas, Tex. ALBERT H. ROSENTHAL _________ Region VIII, Denver, Colo. TAC Vics COUN Re = eee eee Region IX, San Francisco, Calif. iv Letter of Transmittal DEPARTMENT OF HEALTH, EpucATION, AND WELFARE, Washington, D.C., December 1, 1963. 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, 1963. Respectfully, Secretary. Tue Present, Tue Wurre Hous, Washington, D.C. VusSVIV G) livMVH Qs Mormon oO adeioyouy VNVISINOT | . “ aa wrIreG Dg. aS ete \ Al ! | SANV1SI NIDYIA -O31N OLYINd IIA AS x \ : eweny »\ | 5 == — | ‘ . Be . \ . SS =o\_ wd. st | : 1 \ Wsier\ [_ svxa. \ VWOHV INO: ! \ AS I AWD sesuey + ! " ae a © Jaaueg | bas 30 * | |wvno ——2.B2x07109/ f cy ee Wusv aan — — NIA | | — . ONIWOK _—- 4a ~, NVDIHOIN VLONV pe HLS | V.LOSANNIN \ ‘ e. NISNOOSIM ~ VLONVG HLYON SOdI}JQ pue SalJepunog jeudisey JUVITIM GNV ‘NOWWONGS HLWIH 40 LNIWLYVd30 Sl Contents The Secretary’s Report Social Security Administration . Welfare Administration . Public Health Service . Office of Education . ody Food and Drug Administration . Vocational Rehabilitation Administration Saint Elizabeths Hospital . ; American Printing House for the Blind . Gallaudet College . Howard University . re detailed listing of the contents of this report, et topic headings, will be found on pages 415-427 a 5 x A an ae oh 7 " ae » re y | A2* rq ams) on ws Stiksa0 we ' ’ fi ~. 7 ; | { toquft saa x preity haa io Ari i “ Lot Mistityihe , : gS! i, ye Es a 5 er) sdoreqgeam aly Lip Dat I deer TM-SIt eopeq fo he > be y a e f 4 , me - — i _ es ‘. 4| - i io | ——_- vUSits Abcaisitd sro pases +s “= “es | Pi het) ene . » pute esi _-_ an | Mat tatt sts Visvinqenl aileadlg stove meant Lue stt rs —, ml t ow wr yy ott tee qestaell Jodie oo) Ulw .qntbewd y The Secretary's Report THis YEAR MARKS the 10th anniversary of the creation of the Depart- ment of Health, Education, and Welfare. Although only a decade has passed since its establishment, that decade has been one of remarkable social progress. While the Department is the youngest in the Government, its history dates back to the very early days of our Republic—a history marked by a growing concern for the well-being of each individual citizen. As early as 1785, only 4 years after the Articles of Confederation went into effect as the first American constitution, grants of public lands were made to the young States for public schools. Thus, the Nation adopted at its very beginning a policy of providing to all citizens opportunities for individual growth through education. And for the first time in history the now generally accepted worldwide ideal of free public education for masses of people began to sink its first tentative roots in American soil. In 1867 the Office of Education was established “to promote the cause of education” in a nation now deeply committed to education—a nation needing all the intellectual capacities of its people to fulfill new national purposes. Our educational system constantly changes. It must—to meet the requirements of a constantly growing and changing nation and the human aspirations of the American people. Today more than 414 million young people are in college and more than 47 million are attending elementary and high schools. Their numbers grow—and so do their opportunities. Thousands of talented young people now obtain Federal loans to attend college. And re- cently enacted legislation will enable our colleges to expand their facilities to accommodate the increasing flood of young Americans seeking higher education. Nearly $1.2 billion in “bricks and mortar” assistance to colleges, universities, public junior colleges, and technical institutions was authorized for a 8-year period. It was urgently 1 2 Department of Health, Education, and Welfare, 1963 needed legislation, for our Nation needs all the brainpower and skills that can be developed in our people. _ Now we must move on. We need especially to inject new quality in the schools of city slums and depressed rural areas—for here are children who need the best educational opportunities our society can afford but who generally receive the poorest. As in education, the history of Federal concern for health dates back to the late 18th century, when a hospital for merchant seamen was established by the Fifth Congress. Today the Public Health Service conducts the largest health research operation in the world and, through a myriad of programs, helps to bring health knowledge to benefit all people. It helps to build hospitals, nursing homes, and diagnostic and treatment centers; it conducts mass vaccination and disease control programs. And following recent legislation, com- munity projects are beginning to bring health care into the homes of the chronically ill and aged, and the mentally ill and mentally retarded are finally being given new help—and hope. Today our great health concern—along with the ultimate goal of wiping out major killing diseases—is to control environmental health problems arising from our technological growth and rapid industrialization. Other years mark other beginnings, other advances. In 1907 the Bureau of Chemistry in the Department of Agriculture pioneered in providing the nationwide consumer protection now afforded by the Food and Drug Administration. In 1912 the estab- lishment of the Children’s Bureau “to prevent babies dying like flies” expressed the Nation’s concern for its children—an assumption of Federal responsibility that has grown and changed to meet the chang- ing needs of children. In 1920 the predecessor of the Vocational Rehabilitation Administration began its work in helping disabled and handicapped men and women attain productive, satisfying lives. Nearly three decades ago the social security system was born of a great forging of sensible economics and humanitarian motives. From both standpoints, this program has proved its worth. To earn a meas- ure of individual or family financial security as one earns a living is accepted today as a basic social right of Americans. More than 9 out of 10 people in paid employment and self-employ- ment today are covered by the program. Nearly 90 percent of the men and women who reached age 65 in 1963 were eligible for benefits, and 9 out of 10 young children and their mothers could count on monthly payments if the breadwinner of the family died. During the year, benefit payments totaled $15 billion—money that went directly into the economy for food, clothing, shelter, and other basic needs. The Secretary’s Report 3 Our public assistance programs—born along with the social security system in the wake of the Great Depression—now recognize that cash payments, while necessary, are no longer enough to meet the need of a society committed to humanitarian objectives. The 1962 Public Welfare Amendments gave legislative authority not only to new goals of helping people climb out of dependency but also of helping to keep them from becoming dependent. A number of programs are under- way providing services leading to employment, strengthening of family life, and improvement in the homes and lives of children who are poor. In 1939 Federal health, education, and welfare agencies were brought together to form the Federal Security Agency in recognition of their close interrelationship in promoting the well-being of the people. Ten years ago, with the establishment of the Department, concerns for health, education, and welfare gained recognition at the highest level of Government. This has been a decade of astonishing change and technological growth, characterized by the continued urbanization and mobility of the American people, and the continued advance of knowledge. Astro- nauts circle the globe; scientists probe the ocean depths. More dra- matic changes will come, for the years ahead show promise of being the most exciting and challenging in the long history of civilization. But our social growth has not kept pace with the great scientific advances that are changing the world. This lag we must overcome. We have reached a high plateau in our social development, but higher ground is visible and can be attained. Our goal will be to com- plete a variety of tasks that will build what President Johnson en- visions as the “Great Society”—a richer life for all Americans. Asa result a stronger America will emerge. 4 Department of Health, Education, and Welfare, 1963 Table 1.—Grants to States: Total grants under all Department of Health, Education, and Welfare programs, fiscal year 1963 [On checks-issued basis] Vocational | American] White Welfare Public Rehabili- | Printing}/House States Total! Adminis- Health Office of tation tration Service 12 | Education | Adminis- tration $3, 629, 835, 300 ]$2, 802,987,385 |$296, 246,943 |$456, 732,980 |$73, 160, 503 104, 063, 541 86, 818, 336 5, 509, 054 8,405,239 | 3,317, 669 12, 613, 841 1,947,799 1, 164, 587 9, 418, 122 1333 29, 941, 432 19, 620, 799 2,145,003 7, 571,725 598, 103 56, 512, 692 45, 263, 928 4,928, 711 3,937,214 | 2,375, 524 434, 939, 091 348,086,123 | 15,167,328 | 68,076,629 | 3,542, 251 61, 240, 660 45, 554, 752 4,147,744 | 10,250,067 | 1,280,488 38, 318, 865 29, 517, 985 2, 508, 241 5, 897, 159 379, 337 6, 528, 038 3, 267, 937 1, 617, 707 1, 459, 262 181, 072 12, 048, 522 9, 834, 185 1, 579, 807 297, 341 334, 919 96, 224, 188 71, 126, 187 9,679,968 | 12,880,356 | 2,516,951 101, 723, 341 78, 836, 912 8,068,773 | 10,822,498 | 3,977,039 18, 325, 717 6, 505, 425 3, 984, 261 7, 458, 520 374, 652 16, 376, 133 9, 743, 588 2, 624, 145 3, 754, 201 253, 253 155, 240, 389 131,430,731 | 10,767,436 | 10,917,647 | 2,094,180 39, 949, 898 29, 583, 253 4,978, 796 4, 740, 956 631, 002 44, 855, 508 35, 179,139 4, 576, 465 3, 964, 884 | 1,126, 864 43, 950, 536 29, 560, 467 4, 239, 857 9, 430, 664 708, 323 69, 280, 972 58, 417, 561 5, 442, 263 4,367,233 | 1,045,465 ‘Louisiana. .-2->-- 143, 440, 329 130, 298, 592 7, 921, 219 3,331,654 | 1,877,219 Mame vis. 82224 22, 269, 819 16, 506, 314 1, 969, 592 3, 384, 252 407, 559 Maryland--_----- 48, 153, 627 27, 977,739 4, 246, 816 14, 934, 687 978, 199 Massachusetts_..} 113,133,963 93, 583, 987 5,408,196 | 12,729,604 | 1,384,513 Michigan..._---- 101, 352, 960 81, 695, 296 9, 702, 332 8, 183, 749 1, 741, 566 Minnesota--.---- 58, 177, 659 46, 503, 150 6, 183, 400 4, 037,411 1, 440, 539 Mississippi------- 60, 325, 152 47, 401, 296 7, 881, 140 8,688,504 | 1,347,023 Missouri.---.---- 101, 727, 252 88, 127,775 6, 498, 020 5,838,549 | 1,250,926 Montana....---.- 15, 022, 185 6, 970, 773 2, 267, 639 5, 467, 765 313, 654 Nebraska..-.---- 23, 498, 999 138, 476, 032 3, 569, 861 5, 973, 664 474, 860 Nevada..-------- 7,271,477 3,417, 035 1,061, 532 2, 680, 718 111, 267 New Hampshire_ 9,120, 896 4,828,960 1, 815, 443 2, 329, 585 144, 638 New Jersey------ 59, 501, 709 41,061, 719 5,605,571 | 11,210,085 | 1,596,882 New Mexico-..--- 32, 006, 247 19, 746, 863 3, 667, 805 8, 288, 395 298, 265 New York.------ 278, 351, 490 242,532,049 | 14,658,297 | 15,716,334 | 5,376,326 North Carolina-_- 89, 836, 182 66, 791,689 | 11,099, 532 8,732,774 | 3,189,023 15, 454, 074 9, 591, 469 1, 842, 884 3, 567, 803 450, 657 133, 769, 692 107,606,095 } 11,911,724 | 12,271,773 | 1,945,333 113, 948, 088 93, 838, 765 5,546,126 | 12,566,142 | 1,991,716 30, 201, 634 22, 764, 622 3, 613, 285 3, 126, 658 687, 862 170, 068, 541 135,484,721 | 15,738,775 | 12,187,086] 6,607,300 Rhode Island ---- 16, 763, 366 11, 164, 400 1,428, 099 3, 596, 355 570, 602 South Carolina__- 45,108, 979 26, 087, 914 9, 327, 092 7,800,224 | 1,880,594 South Dakota__-- 17, 758, 842 9, 670, 312 1, 896, 061 5, 847, 017 342, 888 ‘Tennessee..-._._. 64, 176, 198 48, 461, 828 7, 942, 819 5, 923, 534 1, 834, 691 TOROS 2. -s>2too= 205, 222, 204 164,970,157 | 15,654,234 | 21,969,211 | 2,600,725 Utah 22-esse4>-5 21, 660, 215 14, 573, 300 2, 238, 549 4, 510, 460 334, 543 Vermont ee ee ae 9, 135, 205 7,022, 427 1, 139, 827 688, 816 283, 210 Witg nia eens a 58, 059, 137 24, 887, 720 6,571,519 | 24,921,044 | 1,663,089 Washington -_---- 73, 986, 884 56, 225, 718 3,428,196 | 13,412,226 907, 627 West Virginia___- 54, 427, 845 46, 154, 766 4,460, 289 1,943,995 | 1,859, 672 Wisconsin-.._-__- 49, 833, 402 37,700, 251 6, 342, 683 4, 654, 052 1,124,771 Wyoming=32.-_ 2 5, 715, 066 3,401, 816 758, 526 1, 460, 615 92, 890 Canal Zone_____- 42 Eee See | ae oa eo | Guameteeeee 1, 525, 870 238, 426 113, 686 1,119, 949 Puerto Rico..--__ 24, 058, 659 11, 401,085 9, 433, 481 2,090, 533 Virgin Islands__._ 957, 503 527, 217 172, 547 212, 496 Undistributed___- 42; 685, 044) Sooes -Saeeeae eee ee 12,686,644 | Uo oeeeeee Porelen sexe s0 52 |e ere | ae Se | Sel eel eee ae le 1 Includes $1,800,995 expended for construction of Indian health year 1963 and not reported previously. niger? facilities proea 2Pxcludes $252,557 Sila to water pollution interstate agencies. * Includes permanent annual appropriation of $10,000. Social Security Administration Introduction Tue Ferperat social security program—old-age, survivors, and dis- ability insurance—now provides protection for practically all working people and their families. More than 9 out of 10 people in paid employment and self-employment are covered or eligible for coverage under the program. Nearly 90 percent of the people reaching age 65 in 1963 were eligible for benefits; this percentage will rise in the future to 95 percent or more. Nine out of ten young children and their mothers are eligible for monthly benefits if the breadwinner of the family dies. Also, at the beginning of 1963, 52 million people were insured against the loss of income resulting from long-term and severe disability—and this 52 million is increasing by approximately 2 million a year. At the end of June 1963, benefits were being paid to more than 1814 million people—about 1 out of 10 Americans. The beneficiaries include about 1414 million older people (retired workers and their aged spouses, and widows, widowers, and parents of deceased work- ers); about 214 million children of retired, deceased, or disabled workers and about 34 million mothers of those children; and about 800,000 disabled workers under age 65 and their spouses aged 62 or over (chart 1). How the program does its job, as well as what it does, is of great importance. Under social security, the worker earns his future secu- rity as he earns his living. A worker’s entitlement to benefits and the amount of benefits he and his family will get are related to his earnings in covered work, on which social security taxes are paid. Basing eligibility on a record of past work and providing variable benefits related to the level of a worker’s earnings adds to and strengthens our general system of economic incentives. Benefits are paid regardless of a beneficiary’s income from savings, pensions, investments, and the like. Consequently, workers are en- 5 6 Department of Health, Education, and Welfare, 1963 CHART 1.—18.6 MILLION BENEFICIARIES DISABLED WORKERS WIVES AND CHILDREN OF DISABLED WORKERS CHILDREN OF RETIRED AND DECEASED WORKERS WOMEN WORKERS RETIRED MEN WORKERS RETIRED JUNE 1963 couraged to supplement the basic protection afforded by social security with whatever additional protection they can afford to buy. The social security approach to preventing dependency thus largely eliminates any basis for the old fear that making governmental provision for economic security will decrease incentives to work and save. Under social security, the very mechanism for preventing dependency rein- forces the individual’s incentives. Since the security he derives under the program grows out of his own work, the person who is covered views his social security benefits as an earned right. He can feel good about taking his benefits, just as he does about accepting wages for the work he does; he has earned the right to both. The concept of an earned right is reinforced by the fact that workers make contributions in the form of social security taxes which are ear- marked to help finance the benefits. They make their payments while they are working and receive the benefits when they have stopped, or substantially stopped, working. This financial participation encour- ages a responsible attitude among those covered by the program. The contributor knows that the benefits for him and his family are made possible by the payment of social security taxes, and this knowledge gives him a personal interest in the soundness of the program. Both the Congress and the executive branch have been scrupulous in providing for full financing of all program liberalizations. The very nature of the contributory program, with its huge commitments to the future welfare of the aged, the disabled, and the widows and orphans of the Nation, demands this kind of financial responsibility. The social security program is in actuarial balance when expected fu- Social Security Administration 7 ture income from contributions and from interest on the investments of the accumulated trust funds will support the expected disbursements for benefits and administrative expenses. And the program meets this test. The social security program is currently being studied in detail by an advisory council made up of distinguished citizens from outside Government. There is a long tradition, going back to the planning for the original Social Security Act, of seeking the advice and guidance of private citizens in the planning and development of the national social security program. In 1934, President Roosevelt named a 23- member advisory council, representing labor, industry, and the gen- eral public, to advise the Committee on Economic Security (a Cabinet committee), which the President had established to study various pro- posals and develop recommendations for a social security program. In 1938, shortly after the social security system began operating, a second advisory council was appointed, this time jointly by a Special Senate Committee on Social Security and the Social Security Board, to study the advisability of amending the Social Security Act. Some 10 years later, in September 1947, the Senate Committee on Finance appointed an advisory council to help that committee make a full and complete investigation of the various programs provided for under the Social Security Act. In 1953, a group of 12 consultants from outside Government was appointed by the Secretary of Health, Education, and Welfare to study ways of extending coverage to addi- tional workers. Finally, in recognition of the contributions made by past advisory councils and also of the fact that practically all Americans have a financial stake in the social security program, the Congress set a statu- tory requirement, in the 1956 amendments to the Social Security Act, for periodic review of the financial soundness of the social security program by advisory councils. The first such council was appointed in the fall of 1957. In his special message relative to the elderly citizens of our Nation, presented on February 21, 1963, President Kennedy stated: As required by the Social Security Act, the Secretary of Health, Education, and Welfare will soon appoint an Advisory Council on Social Security Financing. {I am directing him to charge this Council with the obligation to review the status of the social security trust funds in relation to the long-term commitments of the social security program, and to study and report on extensions of pro- tection and coverage at all levels of earnings, the adequacy of benefits, the de- sirability of improving the present retirement test, and other related aspects of the social security system. The results of the Council’s work should provide a sound basis for continued improvement of the program, keeping it abreast of changes in the economy. 8 Department of Health, Education, and Welfare, 1963 Subsequently, on June 9, 1963, the Secretary announced the appoint- ment of a 13-member advisory council. The Council convened on June 10, 1963. The Advisory Council appointed this year is the second in the series of councils provided for under the 1956 amendments. The law pro- vides for the appointment of subsequent councils in 1966 and every fifth year thereafter. All of these councils are required by law to study and report on the financing of the program. However, the cur- rent Advisory Council is, in addition, directed under the amendments of 1960 to study all other aspects of the program. It is, therefore, the first group since the 1947 Advisory Council on Social Security to be charged with making a comprehensive review of the social security program. What the Program Is Doing Beneficiaries and Benefit Amounts During the fiscal year ended June 30, 1963, benefits paid under the old-age, survivors, and disability insurance program totaled $15,015 million—an increase of $1,346 million over the amount paid in the preceding fiscal year. Benefit payments to disabled workers and their dependents were 16 percent higher than in fiscal year 1962 and totaled $1,171 million. Old-age and survivors insurance monthly benefits rose 9 percent to $13,649 million, and lump-sum death payments amounted to $195 million, about $21 million higher than in the previous fiscal year (chart 2). Almost 2.9 million monthly benefits were awarded in fiscal year 1963, 324,000 less than the record number awarded in fiscal year 1962, but more than in any other year. The large number of awards included many (1) old-age benefits awarded to men aged 62-64, (2) wife’s or child’s benefits awarded to dependents of these men, and (3) monthly benefit awards attributable to the liberalized insured-status provisions in the 1960 and 1961 amendments. Old-age (retired-worker) benefits numbered 1,238,000, accounting for two-fifths of the awards. Mother’s benefit awards numbered 102,000, about 4,000 more than the previous record. The 482,000 monthly benefits awarded to disabled workers and their wives, husbands, and children were only 10,000 less than the number awarded in the preceding fiscal year. The 952,000 lump-sum death payments awarded in fiscal year 1963 were 101,000 more than the previous record number in fiscal year 1962. Almost 922,000 deceased workers were represented in the awards. The average lump-sum amount per worker was $211.88. Social Security Administration 9 CHART 2.—BOTH OASDI BENEFIT PAYMENTS AND NUMBER OF BENEFICIARIES HAVE INCREASED RAPIDLY SINCE 1950* Annual Payments** Beneficiaries* ** BILLIONS OF DOLLARS MILLIONS 20 80 FISCAL YEARS *The 1950 amendments made major improvements in the program. **Payments in fiscal year. Includes lump-sum death payments. ***Beneficiaries on the rolls at the end of the fiscal year. The number and amount of monthly benefits in current-payment status increased substantially during fiscal year 1963. The number of monthly benefits went up 1.3 million (8 percent) and the monthly rate of payment rose $98.1 million (9 percent). At the end of June 1963, 18.6 million beneficiaries were receiving benefits at a monthly rate of $1,226.3 million. rari ail 40 42 44 46 48 50 52 '54 56 ‘58 60 ‘62 '64 NUMBER OF AFDC CHILDREN PER 1,000 POPULATION UNDER AGE I8 } 4 if ) | Wy Te /} : Ye 6 711-845—64 74 Department of Health, Education, and Welfare, 1963 An estimated 10,000 of the overall increase were persons authorized to receive what was generally a small payment under the APTD pro- gram at the same time they were receiving MAA. An additional 2,000 of the increase resulted from new APTD programs in Arizona and Indiana, increasing to 52 the total number of programs in States or other areas. The entire APTD caseload increased by 44,000 over June 1962, with the June 1963 total standing at 462,000. There was a rise of 33 percent or 34,000 persons in the MAA pro- gram. At yearend, 29 States and other areas had MAA programs. New programs began in the District of Columbia and Vermont. More than half of all 136,000 recipients in June 1963 lived in 3 States— California, Massachusetts, and New York. The OAA program decreased by 38,000 people, or 1.7 percent, con- tinuing the gradual decline that has been going on since 1954 as a result of expanding coverage by old-age, survivors, and disability insurance. Forty-three States were aiding fewer OAA recipients than they had a year earlier; of this number, 18 States had decreases of 5 percent and over. In the two States with the largest percentage de- clines, relatively large number of aged persons in nursing homes were transferred to MAA programs. There were 2,199,000 OAA recipients in June 1963. The number of persons receiving aid to the blind decreased by 2,000, or 2 percent, in June 1963, with 82 States reporting decreases. Proba- ble reasons for the decline include: Increases in old-age, survivors, and disability insurance benefits to blind persons; improved sightsaving efforts; and transfers of recipients or potential recipients to OAA and MAA. At yearend, there were 98,000 recipients. HOW MUCH THEY RECEIVED A total of $4.2 billion from Federal, State, and local sources was paid to recipients of federally supported public assistance in fiscal year 1963. This was a rise of $340 million, or 9 percent, over fiscal year 1962 and was the result of broadened programs and higher individual payments in the adult programs in most States. Individual payments in the AFDC program declined in most States during the year. Included in total payments were financial assistance paid directly to recipients and payments to physicians, hospitals, and others for medical care provided to recipients. The largest proportional increase for the year was the 53 percent, or $100 million, rise in payments on behalf of MAA recipients. For the 29 States that had MAA programs in June 1963, the average monthly payment per recipient was $195, ranging from $28 in Ken- tucky to $387 in Illinois. Welfare Administration 75 Total payments to OAA recipients also rose by $100 million over the previous year, but the proportional increase was only 5 percent. Na- tionally, the average monthly payment was $77—an increase of $4 for the year. There was an $87 million, or 6-percent, increase in total annual pay- ments to AFDC recipients, but the national average monthly payment per recipient declined 62 cents to $31. Payments under the APTD program rose by $51 million, or 15 percent, for the year, and the average monthly payment rose $3 to $75. Payments to recipients of aid to the blind increased $2 million, or 2 percent, and the average monthly payment went from $78 to $81. A number of States increased individual payments to recipients to meet rises in living costs. About half the States with maximums on individual monthly payments in OAA, AB, and APTD raised their maximums; only a few States took this action in their AFDC pro- grams. A large number of States made some increase in their cost standards, which had the effect of raising payments so that need was more nearly met. Some States that had reduced all payments by a percentage or flat amount because of lack of funds cut these reduc- tions, allowing payments to increase. Most of the above changes occurred in the autumn of 1962, re- flecting the impact of the 1962 amendments, effective in October. In addition to federally supported public assistance, States have general assistance programs which are financed wholly by State or local funds or a combination of both. Recipients of general assist- ance usually are persons not eligible for Federal-State public as- sistance because of age or residence. The Bureau estimates from reports by most of the States that there were in the Nation about 775,000 recipients of general assistance in June 1963. During the fiscal year, an estimated total of $282 million was paid to recipients. New Knowledge About Needy Families Completion of analysis and release of preliminary findings of an earlier Bureau survey of the people receiving aid to families with dependent children (AFDC) gave a revealing look into their lives. Households supported by AFDC had an average-per-person income of roughly $408 a year when the survey was made in late 1961. Per capita income for the United States as a whole then was $2,263. The average AFDC family consisted of about four persons and the average need budgeted by States for such a family was $158 a month for all the necessities of life. Income from all sources for all AFDC i i A é OL, 69, 89, 19, 99, 99, ¥9, £9, 29, 19, 09, 6S, 8S, LS, 95, GG, 5, eG, Z25, 1S, 0S, 6b, Bb, Lb, 9b, Sb, bb, Sh 2b, Ib Ob, EF, BE, LE, 9¢6) rr =e PL Ge ol es a ne es ee fo) C Se | 002 ~ laldy ar. 00+ 009 008 000‘! 002" OOv'|! 009"! oos'| 000‘2 002'2 j wu0 (Sap 3 Oor'2 | f' les /| | ies 009'2 f= —— } + + o0s‘z ra =i) f | + = ial ooo'¢ f| ‘ Q39V 3H 4O4 JONVISISSY TvoIGaW — vw or 5 = GNIN8 3HL OL div — av 1 00r'¢ G3718VSIG ATIVLOL GNY ATLNSNVWYad SHL OL Civ — Old i | coe" | | JONVLSISSVY Tv43N39 — v9 | 4 | FONVLSISSV 3ovV-GI0 — vvo | oos ¢ N3YGTIHD LNSGN3daG HLIM S3MIWV4 OL div — 904V 4 i 000'b *QN3937 ‘ | | | 002+ Department of Health, Education, and Welfare, 1963 t 00v'b + | + + 009'b T | iH 7 T T | 008'b T } = + 000'S | | al, + 4 o02's IE | 00's ul 4 o009's SGNVSNOHL 3J1VG OL 9€61 ‘YV3A HDVA AO YIGW3DIG GNV INNA ‘WVdDOYd AG SLNAldIDIY JONVLSISSV DIIGNMd JO YIaWNN—Z LYVHD 76 Welfare Administration “rs families in the study month averaged $139.78, leaving a gap of some $18 a month per family. The total income of AFDC families in- cluded assistance payments averaging $112 plus $2 per person for agency payments to suppliers of medical care. About 45 percent of the AFDC families had income averaging $60 a month from such sources as part-time work and support from absent fathers. Average family assistance payments per month including medical care ranged from $36.02 in Mississippi to $198.89 in Illinois. More than two-thirds of the AFDC families lived in towns and cities of 2,500 population and up. The rate of dependency on AFDC was highest in the big cities and lowest in the suburbs. While the average family consisted of four persons (typically a mother and three children), about 22 percent of the families had six or more persons. By race, 49 percent of the families were white, 40 percent Negro, 5 percent other nonwhite (including American Indians), and 6 percent were of unreported racial origin. Some 70 percent of all AFDC families lived in rented quarters. Fully half of all AFDC families lived under crowded conditions. Nearly half of the families who have received AFDC required this help for 2 years or less, the study showed. Two-thirds of the re- cipient families had never received help through AFDC before the time of their application. One-fifth had been on the rolls in only one earlier period. Mothers—and fathers, when they were in the home—were found by the study to be undereducated and lacking in work experience or skills. The typical AFDC mother was about 35, had completed less than 9 years of schooling, and did not work outside her home because of child-care demands or disability. More than one-third of the AFDC mothers had not completed ele- mentary school, compared with less than one-eighth of all women 20-54 years of age in the population. Only 16 percent of the mothers had completed high school, while 56 percent of women in general had done so. Four out of five of the AFDC mothers who had job experience were unskilled farm and domestic workers. Of the more than 800,000 mothers living with their families and helped by AFDC, about 70 percent were not regarded as employable, most because of child-care responsibilities but some because of dis- ability. Of the other 30 percent, half were working, most of them part time. 73 Department of Health, Education, and Welfare, 1963 MOST JOBLESS FATHERS WERE DROPOUTS The great majority of the jobless fathers of dependent children were school dropouts, the study showed. The only work that many were equipped to do was unskilled labor. No father was present in almost 78 percent of the 910,000 family units receiving AFDC at the time of the study. He was present but incapacitated in about 15 percent of the cases and at home but unemployed in another 5 percent. The unemployed AFDC fathers had a median age of about 35. Incapacitated AFDC fathers were older, with a median age of 47 years. They were disabled mainly by chronic conditions and had finished an average of 6 years of school. Only 8 percent of all AFDC fathers had been white-collar em- ployees, compared with almost 35 percent in this category among all employed males. Only 7 percent had worked in industry in such jobs as craftsmen or foremen, compared with 20 percent of all workingmen. About one in five of all children born out of wedlock receives public assistance, according to estimates based upon the survey. In December 1961, there were approximately 3 million American children under 18 who had been born out of wedlock. An estimated 21 percent of them were receiving AFDC and another 2 percent were cared for in institutions or foster homes. In contrast, 3 percent of all legitimately born children were supported by AFDC. The vast majority of illegitimate children are supported in full or in part by their natural or adoptive families. Possibly as many as 70 percent of the white but less than 5 percent of the nonwhite illegit- imate children are placed for adoption. Children’s Bureau The legal base for the Children’s Bureau’s services to the children of the United States is contained in two acts. Under its basic act of 1912, the Bureau is charged with investigating and reporting “upon all matters pertaining to the welfare of children and childlife among all classes of our people.” The Bureau studies many types of condi- tions affecting the lives of children, makes recommendations to im- prove practices in child health and child welfare programs, and helps establish standards for the care of children. Under title V of the Social Security Act, as amended, the Bureau assists the States, through technical and financial aid, in enhancing and protecting the well-being of many children through child health and welfare services, Welfare Administration 79 Stemming from these two acts, but interwoven into one program, are the purposes of the Children’s Bureau today: To assemble facts needed to keep the country informed about children and matters adversely affecting their well-being. To recommend measures that will advance the wholesome devel- opment of children and will prevent and treat the ill effects of adverse conditions. To give technical assistance to public and voluntary agencies and to citizens’ groups in improving the conditions of childhood. To administer the grants appropriated each year under title V of the Social Security Act to aid in building the health and welfare of children. The Bureau’s approach to the problems of children proceeds from a concern for the child with his family or wherever else he may live. The interrelationship between the physical, emotional, and social factors in child growth, child health, and child welfare permeates all that the Bureau does, and that it stimulates others to do, in research and action for children. Some Facts and Figures About Children and Parents From many sources, the Children’s Bureau gathers the facts and figures that will help children’s workers and citizens in the United States know the size of their wealth in children, the extent of con- ditions that are adverse to them, and the trends in our society affecting childlife. In 1962, an estimated 4,167,000 babies were born in the United States—about 100,000 fewer than in 1961. However, the population increased by 2.4 million (there were more births than deaths). The crude birth rate (22.4 per 1,000) is now back at the level existing before the “baby boom” of 1946. Our population includes about 66 million children under age 18, distributed among some 27.5 million families. In 1961, the median income for these families ranged from $5,905 for those with one child to $4,745 among the million or so families with six or more children. The provisional infant mortality rate was the same in 1962 as in 1961—25.3 per 1,000 live births. The U.S. rate occupies 11th place among advanced countries of the world. The lowest rate, 15.3, was reported provisionally for 1962 by the Netherlands and Sweden. Next in order were Norway with 18.9 (1960) ; Finland, 19.2 (1962) ; and Australia, 19.5 (1961). In the United States, no State had an infant death rate under 20 per 1,000. The lowest rate in 1961 was that for Utah, 20.3 per 1,000. 80 Department of Health, Education, and Welfare, 1963 CHART 3.—MORTALITY RATES FOR INFANTS ARE STILL HIGH High Risks of the First Day Have Increased Since the Mid-1950’s 70 => 60 a = .--- NON-WHITE Ep 66% EXCESS * ae 82% EXCESS am t en ---- WHITE wu oo) = S ---UNDER 1 DAY 1 im = F = a ..-28DAYSTO = ” 11 MONTHS = 2 as = =z r= = re <= r) iS to ----1 DAY = ca > = TT DAS > ----3-6 DAYS E Si S 2 DAYS ; 1942 44 46 48 50 52 5456 58 ~=—s 60 Over the past 4 years, the marriage rate of 8.5 per 1,000 population and the divorce rate of 2.2 per 1,000 have remained almost steady. Births out of wedlock continued to increase in numbers and rate in 1961. The 240,200 illegitimate births in 1961 were 7 percent higher than illegitimate births in 1960. About 5.6 percent of all live births in 1961 were out of wedlock, as compared with 5.3 percent in 1960. The highest rate was for women 25-29 years of age—45 per 1,000 unmarried women. The rate for teenage girls 15-19 years of age was 16 per 1,000. The number of working mothers in the United States is approach- ing 9 million. One out of every three mothers with children under 18 years of age is in the labor force. In March 1962, there were 3.3 million working mothers with children under 6, and 5.5 million with children 6 to 17. Even the mothers of very young children often work; one out of five mothers with children under 3 years of age is in the labor force. In the year ending June 1961, which was probably a typical year, there were 169,892,000 acute conditions among children under 15— or a rate of 297.1 per 100 children—or 3 episodes of acute illness per year for every child. The incidence of acute conditions among chil- dren is much higher than that among adults. More than half of all Welfare Administration 81 CHART 4.—BIRTHS OUT OF WEDLOCK REMAIN A PROBLEM Estimated Illegitimate Live Births, United States, 1959 Unmarried Female Population, United States, 1960 20-24 YEARS 30.5% 20 YEARS AND OVER 32% “15-19 YEARS 38.2% UNDER 20 YEARS 25-29 YEARS 68% 14.5% 35 YEARS AND OVER UNDER 15 YEARS 2.1% acute conditions for children under 15 fell in the category of respiratory conditions. One child in every five under the age of 17 had at least one chronic condition in the year ending June 1961. Hay fever, asthma, other allergies, sinusitis, bronchitis, and other respiratory diseases accounted for almost half of these chronic conditions. Nonwhite children went to the hospital much less frequently than white children, but, when they did go, they stayed longer. As family income increased, the rate of hospitalization of children increased, but the average length of stay decreased. Farm children went to the hospital much less frequently than their city counterparts but tended to stay longer. Beginning in 1949, the indicators of juvenile delinquency—police arrests of juveniles and juvenile court delinquency cases—have steadily increased, except for a slight decrease in court cases in 1961. The increases have been higher generally than increases in the child population. This means that, in rates as well as numbers, more juvenile delinquents were being picked up by the police, more were appearing before courts, and more were being sent to training schools. The decade from 1950 to 1960 witnessed the continuing trend toward urbanization in this country. In 1950, 60 percent of the total youth population (16 through 20 years of age) was living in urban areas; in 1960, the percentage was 67. 82 Department of Health, Education, and Welfare, 1963 During the 1960's, the youth population will increase, and 26 million new young workers will enter the labor force. Legislative Developments PUBLIC WELFARE AMENDMENTS OF 1962 In the closing months of the 87th Congress, the public welfare amendments were passed, and President Kennedy signed the bill on July 25, 1963, saying, “I have approved a bill which makes possible the most far-reaching revision of our public welfare program since it was enacted in 1935.” The amendments provided for the extension of child welfare services into all political subdivisions by 1975; for increasing the amount au- thorized for annual appropriations for child welfare services from $25 million, in steps of $5 million, to $50 million; for earmarking, up to $10 million, for day-care services the excess of the child welfare appropriation above $25 million; and for grants for special projects to train personnel in the field of child welfare. MATERNAL AND CHILD HEALTH AND MENTAL RETARDATION PLANNING AMENDMENTS OF 1963 The maternal and child health and mental retardation planning amendments introduced in Congress in February 1963 incorporate five of the recommendations in the President’s message on “Mental Illness and Mental Retardation.” In a separate health message, President Kennedy again stressed the urgency of the maternal and child health provisions. The amendments would provide for: Increasing the authorization for annual appropriations for ma- ternal and child health services from the present $25 million, in steps of $5 million, to $50 million by fiscal year 1970. Similarly increasing the authorization for annual appropriations for crippled children’s services. Maternity care to women of high risk and their infants. Grants for research projects relating to maternal and child health and crippled children’s services. These amendments were passed and signed into law on October 24, 1963. Interdepartmental Committee on Children and Youth Within the Federal Government, 38 agencies have programs con- cerned with children or youth. The Interdepartmental Committee on Children and Youth was established to coordinate related efforts of Welfare Administration 83 these agencies and to serve as the Government’s liaison with national organizations and State committees for children and youth. The Chief of the Children’s Bureau is Acting Chairman of the Committee, by delegation of the Secretary of Health, Education, and Welfare, whoisitsChairman. The Bureau also provides the secretariat for the Committee. In this year’s programs, the Interdepartmental Committee focused on some of the rapid changes in our national life and the impact of these upon youth. The monthly meetings studied new patterns of community planning, the population crisis, poverty, the inadequacies of programs to prepare youth for employment and parenthood, and the “tertiary society” of large government institutions, labor unions, and big business with which youth must learn to deal. A 2-day seminar in May discussed the social and economic pressures upon youth and the special problems of the school dropouts who lack sufficient training to make them employable. The Interdepartmental Committee’s Subcommittee on Transition from School to Work was particularly active because of the many developments relating to school dropouts and youth employment and with its proposal for a National Service Corps. Because 85,000 young men each year are found ineligible for mili- tary service for physical or psychiatric reasons, the Interdepartmental Committee’s Subcommittee on Community Services for Selective Serv- ice Registrants recommended remedial educational programs for these rejectees. Public Health Service grants for three pilot demonstration projects are awaiting official approval. A Subcommittee on Parent and Family Life Education was created. The HEW regional offices in Atlanta and San Francisco have estab- lished Regional Interdepartmental Committees on Children and Youth. United Nations International Children’s Fund (UNICEF) UNICEF has continued to expand its programs as a result of the two policy decisions taken at the June 1961 Executive Board meeting. The first of these broadened the program areas which can be sup- ported by UNICEF. The effect was noted in increased support for education and for vocational training. About $2 million was allo- cated for 21 projects in education, and $500,000 was allocated for 4 projects in vocational training. New long-range commitments for education amounted to about 19 percent of the total commitments made at the June 1963 session. 84 Depariment of Health, Education, and Welfare, 1963 The other policy decision related to the way funds are expended. As UNICEF is supported by voluntary contributions and a steady volume of support could not be assured in its early years, the estab- lished practice had been to use the “full funding” principle when mak- ing commitments for projects extending beyond 1 year. Thus, funds were accumulated beyond the amount necessary for current expendi- tures. With UNICEF firmly established and with a rising income, the United States pressed for more rapid use of available funds. As a result, in 1962 UNICEF allocated $44 million and committed an additional $50 million. This represented an increase of 25 percent in expenditures. This rate of increase is also expected in 1963. The in- creased rate of expenditures has permitted the start of new programs without jeopardizing support for the traditional ones in health and nutrition. Mr. Frederick DelliQuadri continued to serve as U.S. representa- tive on the Executive Board of UNICEF. In March 1963, Dr. Kath- erine Bain, the Deputy Chief of the Children’s Bureau, was appointed alternate U.S. representative by the President. Programs of the Bureau RESEARCH IN CHILD LIFE The Bureau’s research staff has a major responsibility in carrying out the legislative mandate to “investigate and report * * * upon all matters pertaining to the welfare of children and childlife among all classes of our people.” In addition to its own studies and cooperating in joint studies, the Bureau stimulates other agencies to undertake research in childlife by formulating questions needing study, develop- ing research methods, and providing technical assistance. Technical Research Some of the technical research studies carried on by the Bureau are: 1. Study of Cystic Fibrosis —Studies were continued toward deter- mining the incidence and prevalence of cystic fibrosis of the pancreas, conducted in collaboration with the National Vital Statistics Division and under contract with the National Institute of Allergy and Infec- tious Diseases. The first phase of these studies provided national estimates of the number of hospitalized cases of cystic fibrosis, the number of dis- charges, and the number of deaths in hospitals resulting from the disease for each year 1952 through 1957. The second phase investi- gated on a pilot basis methodological problems connected with sample surveys of cases known to physicians and clinics and also obtained Welfare Administration 85 preliminary information on the incidence of the disease and on epi- demiologic characteristics of the patients in Massachusetts, New Hampshire, and Vermont. Reports of the first two phases have been published. The purpose of the third and final phase of the project is to derive unbiased age- and sex-specific estimates of the incidence and prey- alence of the disease for a larger area than the three New England States. Data on cases seen or treated by physicians or in hospitals and clinics during the 10-year period 1952-61 were obtained by mail questionnaire. Of the 6,200 medical sources queried in 17 contiguous Eastern States and the District of Columbia, almost 95 percent responded. The project is to be completed during fiscal year 1965. 2. Families of Mongoloid Children.—A published report of a study of 50 families of mongoloid children presents in the parents’ own words “what it meant to them to learn that they had a child with this lifelong handicap, what they did or failed to do about the child, and what their ultimate adjustment has been.” 3. Children, Problems, and Services in Child Welfare—tThe first national study of characteristics of children receiving child welfare services was undertaken by the Children’s Bureau in 1961 in coopera- tion with the Child Welfare League of America. The report pub- lished in 1963 tells (1) what problems are presented by the children receiving child welfare services from public and voluntary child wel- fare agencies, and (2) what services these agencies provide for such children. 4, Report on Child Welfare Services for Unmarried Mothers —A report on social services provided for unmarried mothers through public and voluntary child welfare agencies has been published. The kinds and amounts of service now available to unmarried mothers through child welfare programs were summarized and the extent of the need for additional services, especially public services, assessed. The findings show that only one unmarried mother in six at present receives service from a child welfare agency. 5. National Survey of Personnel Employed in Public Welfare Pro- grams—The final report was completed on the public welfare section of a nationwide survey of social welfare manpower in 1960 conducted by the Bureau of Labor Statistics under the sponsorship of the Na- tional Social Welfare Assembly. The public welfare section of the survey was a joint project of the Bureau of Family Services and the Children’s Bureau. Comprehensive information was presented on the characteristics and working conditions of social welfare personnel in State and local 86 Department of Health, Education, and Welfare, 1963 public welfare agencies. Findings were analyzed separately for public assistance and child welfare employees, with a summary con- cerning all personnel employed in public welfare programs. 6. Parent Education With Low-Income Groups.—There has been increasing emphasis on the need to help disadvantaged families break out of the cycle of defeat, despair, and social isolation in which they are entrapped. This emphasis has been especially strong in the area of parent education. The objectives of the study have been (1) to increase knowledge of background factors associated with and result- ing from poverty, and (2) to explore methods of education for home and family living with a view to deriving recommendations for pro- grams and services. The informal, but extensive, inquiry into ongoing programs in parent education with low-income families has continued, and reports are being prepared. An investigation, based on direct observation of specific programs and patterns of activity among parent educators working with low- income families in the District of Columbia, has been launched and carried through its first phase. The purpose of this investigation is to assess the techniques and methods employed by practitioners in the field. Full observation protocols will be assembled, and, on the basis of these protocols, a report will be prepared. The results of both the informal inquiry and the field investigation will provide the background and basis for planning a demonstration project on parent education among low-income families. "The demon- stration will have as its aim the testing and evaluating of specific edu- cational methods and approaches. Research and Demonstration Grants Twenty-five child welfare research and demonstration grants, in the amount of $789,958, were approved during the fiscal year. Statistical Reports During the year, the Bureau compiled and published current statis- tical data on maternal and child health services; crippled children’s services; mental retardation clinics; child welfare services, personnel, and expenditures; adoption; day care; juvenile courts; and institu- tions for delinquent children. Research Interpretation The Bureau’s most popular publication for parents, Znfant Care, was published in its completely rewritten 11th edition. A fact sheet, presenting adoption statistics in simple language, was prepared for publication. Welfare Administration 37 Bulletins and special listings of research relating to children were distributed by the Clearinghouse for Research in Child Life. MATERNAL AND CHILD HEALTH SERVICES All States, the District of Columbia, Puerto Rico, the Virgin Is- lands, and Guam received Federal funds to improve services for pro- moting the health of mothers and children. Maternal and child health programs continued to broaden and expand. During 1962, 280,000 expectant mothers were provided with medical, prenatal, and postnatal clinic services—4 percent less than in 1961. Medical and hospital care were provided 42,000 mothers who had complications of pregnancy—20 percent more than in 1961. CHART 5.—MATERNAL AND CHILD HEALTH SERVICES ARE REACHING MORE PEOPLE ‘ateoscange 700 - OTHER CHILDREN SERVED BY WELL CHILD CONFERENCES "=" INFANTS SERVED BY THOUSANDS ae WELL CHILD CONFERENCES 300 200 — acs age = ee MOTHERS SERVED SUOSs MOTHERS ATTENDING ~ Beneh cane SERVICE PRENATAL CLINICS 0 ——_+_+—"“+ 1947 1949 1951 1953 1955 1957 1959 1961 There were sizable increases in 1962 over 1961 in the numbers of children screened under school health programs: 7,503,000 children were screened for visual defects (an increase of nearly 432,000) ; 4,789,000 were screened for hearing defects (an increase of 401,000 children) ; and 3,132,000 were screened for dental needs (an increase of 59,000). There were, however, fewer children examined by physi- cians under school health programs: 2,441,000 in 1962 compared to 2,446,000 in 1961. 838 Department of Health, Education, and Welfare, 1963 Record numbers of immunizations were provided under State pro- grams. Some 4,227,000 children were immunized against diphtheria, 2,686,000 against whooping cough, 4,594,000 against tetanus, 2,926,000 against smallpox, and 6,162,000 against poliomyelitis. General health supervision, or well-child conference services, were provided for 1,506,000 babies and preschool children (a decrease from 1961). Nurses gave a hand to the mothers of 2,948,000 through home visits. Mental Retardation Services in Maternal and Child Health Programs Major staff effort has again been expended in improving services to mentally retarded children through better integration of programs for children. The special clinics for mentally retarded, supported by the maternal and child health programs, served approximately 25,000 children and their families in 1962. Despite this increase in the total number served, the requests for these services continued to mount—since 1958, there has been a 145-percent increase in applications that could not be served in the year in which they applied and which must be added to a waiting list. The pattern in the majority of States has been to start with the pro- vision of comprehensive interdisciplinary services to the mentally re- tarded through diagnostic and evaluation clinics, usually at one center. In many places now, the trend is toward extension of service from a medical center clinic to satellite clinics in local health departments (asin California) or with regionalization of clinics. West Virginia in 1961 began with a central “developmental and evaluation clinic” whose patients came from one city or county area. Now plans are underway to establish regional clinics and to have special sessions for mentally retarded children. Urine testing for phenylketonuria (PKU) is carried out in well-child conferences, pediatric clinics, and during home visits of public health nurses. Virginia began its services to mentally retarded children with three clinics located in Richmond, Arlington, and Norfolk. In a reorgani- zation, the Richmond clinic at the Medical College of Virginia is to become the master clinic where training of professional personnel as well as direct services will be available. The Arlington clinic is ex- tending its services to include a day-care program for children 2-8 years of age. The Maryland State Health Department has embarked on an im- portant expansion of community services for mental retardation made possible by a State appropriation of $264,132. Joint activities with States to find young infants with PKU Welfare Administration 89 to get affected babies under treatment early, and to follow them to obtain facts regarding the results of therapy have continued. The “Guthrie inhibition assay,” a test designed to screen infants be- fore they leave the newborn nursery, was field tested to determine its effectiveness. Results from screening 240,000 infants confirmed 24 cases of phenylketonuria by August 1963. These infants all came from families in which there was no known retardation or previous case of PICU. Genetics Recognition of the importance of genetics to health is evidenced by the popularity of short courses on genetics for physicians, by the prom- inence given to genetic aspects of disease in medical journals, the in- terest in genetic counseling, and the paucity of services. In recent years, the most rapid progress in genetics has been made in the fields of biochemical genetics and cytogenetics, knowledge of which are of fundamental significance to the health of children and families. In the advance guard which is attempting to incorporate genetic knowledge into maternal and child health programs are: Minnesota State Department of Health with its new human genetics unit; the New York State Department of Health which is paying the salary of a geneticist on the faculty of Albany Medical College who will make family studies and offer genetic counseling ; the Connecticut State De- partment of Health with a twin register and a geneticist studying cystic fibrosis; New York City’s Health Department with its multiple birth register; the California School of Public Health with its course in genetics; and the University of Michigan with a geneticist who will study the families of children in the area Child Amputee Center at Grand Rapids. Maternity Care Awareness and concern regarding gaps in services and unmet needs of maternity patients has been growing. The needs are so overwhelm- ing that communities are unable to provide necessary public maternity care as evidenced by reports of lack of prenatal care from various cities: In Atlanta’s Grady Hospital, 23 percent of the women delivered there had no prenatal care. In Dallas, approximately one-third of low-income patients re- ceived no prenatal care. In Los Angeles County Hospital, 20 percent had no prenatal care. In D.C. General Hospital, 45 percent had no prenatal care. In the Bedford Stuyvesant section of Brooklyn, N.Y., 41 percent had little or none. 711-845—64——_7 90 Department of Health, Education, and Welfare, 1963 Fourteen State maternal and child health programs in State health departments provide some hospitalization for maternity patients. Special studies and projects and planning for services are continuing, but their execution is hampered by lack of funds. The most urgent problem in maternity care is that of providing comprehensive services to the many women in large urban areas who are dependent on public resources. Present resources of public agen- cies, including personnel, facilities, and funds, are inadequate to meet the demand for medical care which is required by an increasing num- ber and proportion of low-income families in central cities. Studies show that many women in urban areas have no or little prenatal care. Because of crowded public hospitals, these women may be sent home 1, 2, or 3 days after delivery. Incidence of pre- maturity among them, with its accompanying high mortality and dis- ability, is much above the national average and contributes to the rising infant mortality rate of large cities. Pediatric Clinics Trends toward provision of “total” pediatric care are emerging, especially in areas of tremendous unmet needs, such as in West Vir- ginia, which has established a regional diagnostic center in Mercer County. Plans are underway to start a second center in the Hunting- ton area. The program to provide total care for the child includes a pediatric clinic, a public health dental program, consultation from medical specialists and allied disciplines (speech and hearing, etc.), laboratory studies and diagnostic procedures, hospitalization, therapy, followup care, etc. Children with any medical condition are eligible. CRIPPLED CHILDREN’S SERVICES All States (except Arizona), the District of Columbia, Puerto Rico, the Virgin Islands, and Guam participated in the crippled chil- dren’s program during fiscal year 1963. A total of 385,000 children received care under the crippled chil- dren’s program in 1962, about 13,000 more than in 1961. Of these, 140,000 were receiving services for the first time. Averaging a little more than 2 visits each, 289,000 children came to clinics. More than 86,000 children were seen by physicians during office and home visits. More than 65,000 children received hospital inpatient care in 1962 with an average length of stay of 21 days. A little over 3,400 children received convalescent care, totaling over 299,000 days of such care. The number of children with congenital heart disease receiving care under the States’ crippled children’s programs increased from Welfare Administration 91 CHART 6.—CHILDREN SERVED IN THE CRIPPLED CHILDREN’S PROGRAM, 1937-61 400 350 wo =] o 250 200 150 number of children (in thousands) TZ Jepun QooT sed ajze1 1937 39 41 43 45 47 49 51 53 55 57 59 61 some 2,200 in 1950 to about 23,000 in 1962. The cost of care for children with congenital heart disease is high, averaging $2,500 per case. Speech and Hearing Defects In 1962, 44 State health departments tested the hearing of 4,556,696 children, and 97,661 who appeared to have medically significant losses were referred for further evaluation and treatment. State crippled children’s agencies reported giving services to 25,592 children with hearing impairments and to 18,660 children with cleft lip or palate in 1962. The growth of the programs represents a trend toward extending a broader range of services. Some State programs that have been lim- ited to hearing testing are beginning to provide treatment services, both medical and nonmedical. Some States that have previously not promoted hearing testing programs are now doing so. There are inadequate services available for children with com- munication problems stemming from subtle neurological impairments. The gap in services can be attributed, for the most part, to lack of trained specialists. The Children’s Bureau supported a workshop held at St. Christopher’s Hospital in Philadelphia for speech and 92 Department of Health, Education, and Welfare, 1963 hearing specialists on the subject of communication problems asso- ciated with cerebral dysfunction. Cystic Fibrosis Beginning in the New England area and spreading west and south, 21 States now provide services for cystic fibrotic children through their State crippled children’s programs; in 5 of these States, pro- grams are just now being organized. Five other States have no formal cystic fibrosis program but offer some services to a limited number of selected cases. In all, about 1,570 children have received some help for the condition through their State program. Physical Therapy A trend to decentralize direct physical therapy patient care to local health departments and district offices is emerging. On the local level, the city or city-county physical therapists provide care for all age groups. On the district level, the physical therapists usually provide direct care only for crippled children. On the State level, physical therapists are employed as consultants for the various di- visions and programs. One result of decentralization is closer super- vision of patient care by the physical therapists. State crippled children’s agencies are continuing to expand their programs to include children with cystic fibrosis, neurological impair- ments, multiple malformations, mental retardation, and asthma. This expansion has resulted in a marked change in the diagnostic groups referred for physical therapy services, and there has been a change in the physical therapy procedures used as well as an increase in the frequency of physical therapy supervision of patient care. CHILD WELFARE SERVICES All States, the District of Columbia, Puerto Rico, the Virgin Is- lands, and Guam received Federal funds to improve child welfare services. It is estimated that 583,100 children were served by public and voluntary child welfare agencies and institutions in the United States on March 31, 1962, a rise of nearly 6 percent over the number of chil- dren served 1 year earlier. Of the total number of children served, 378,400, or 65 percent, were served primarily by public agencies; and 204,700, or 35 percent, were served primarily by voluntary agencies. Of all children served by public and voluntary child welfare agen- cies and institutions, 40 percent were living in homes of parents or relatives or in independent living arrangements, 30 percent in foster- family homes, 18 percent in institutions, 10 percent in adoptive homes, Welfare Administration 93 CHART 7.—CHILD WELFARE AGENCIES PROVIDE SERVICES FOR CHILDREN, 1962 TOTAL VOUNTARY AGENCIES IN OWN HOMES \| PUBLIC AGENCIES IN FOSTER FAMILY HOMES IN INSTITUTIONS IN ADOPTIVE HOMES ELSEWHERE 0 100,000 200,000 300,000 400,000 500,000 600,000 and the remaining 2 percent were elsewhere (as in temporary shel- ters, hospitals, or boarding schools). Approximately 8,725 persons were employed in full-time profes- sional positions in the child welfare programs of State and local pub- lic welfare agencies on June 30, 1962. Even though this is a rise of 7 percent over the number employed a year earlier, all States are hay- ing difficulty in obtaining and retaining staff adequate either in num- bers or in educational background. Implementation of the 1962 Public Welfare Amendments The most far-reaching legislative changes in public child welfare programs, since passage of the Social Security Act in 1935, were made by the 1962 amendments. Tremendous interest was evidenced in this Federal legislation by the States. While the delay in congressional action on appropria- tions (until May 1963) prevented some States from moving rapidly on new programing, many reviewed their current program strengths and gaps and identified specific legislative or administrative steps needed to implement the Federal legislation. Under the training-grants provision, $64,697 was awarded for teaching grants, $130,010 for scholarships, and $4,424 for short-term training. In spite of the delay in appropriations, 31 States had day-care serv- ice plans in operation by June 30, 1963. 94 Department of Health, Education, and Welfare, 1963 i ee Day-Care Services Planning for day-care services has gained momentum, and there is activity in almost every State. Within the past year, five States have obtained day-care licensing laws, leaving only four States with no provision for licensing day- care facilities. However, in a few States, the licensing authority is’ being challenged. In many States, the law is not comprehensive and leaves many children unprotected. Although funds were not appropriated until late in the fiscal year, eight States provided for establishing day-care facilities under public agency auspices. A number of States have appointed advisory com- mittees for day care. A serious problem facing public welfare departments is the lack of staff trained to provide day-care services. Homemaker Services At the request of the Committee on New and Expanded Services of the President’s Committee on the Status of Women, the Children’s Bureau helped to prepare a background paper on homemaker services. Because of the many requests for a National Conference on Home- maker Services, plans were initiated for a national conference in 1964, Washington, Idaho, Illinois, Nebraska, and Minnesota included, for the first time, the provision of homemaker services under the auspices of the public child welfare agency in their fiscal year child welfare services plans. Abused Child Attention was given in fiscal year 1963 to the needs of the severely abused child and how the Bureau might offer leadership in developing protective measures. Two groups—composed of social workers, physicians, attorneys, judges, hospital administrators, roentgenologists, medical school per- sonnel, law-enforcement officials, and law-school personnel—met with Bureau staff in January and May 1962. These groups urged the Chil- dren’s Bureau to develop model State legislation requiring reporting of the abuse of children. In cooperation with the Office of the General Counsel, a draft guide was prepared and sent out for wide review. The States were sent the suggested legislative language which requires that all cases of sus- pected child abuse be reported to the appropriate police authority by the doctor who sees the child. As an additional step toward better understanding the nature of this problem, the Bureau approved a grant for a research study of 25 families in which parents are known to have abused their children. Welfare Administration 95 Emphasis will be on discovering common denominators among these families which may partially explain their sick behavior and on learn- ing more about what kinds of services are needed to protect these defenseless children. Mental Retardation Services in the Child Welfare Program Recent activities within State welfare departments, national welfare organizations, and schools of social work reflect a stimulating impact on program development stemming from the work of the President’s Panel on Mental Retardation and the President’s message on “Mental Illness and Mental Retardation.” States are recognizing the need for interagency cooperation and for more refined studies and surveys of available resources and unmet needs. Technical assistance has been provided to States in the development of standards for residential and day-care facilities for retarded children and to voluntary agencies in formulating special research and demonstration projects. The American Public Welfare Association has established a subcom- mittee on mental retardation to develop a position statement on wel- fare’s role. A Community Day Care Services Act was enacted by the 1961 Wisconsin Legislature to provide services for mentally retarded, emotionally disturbed, and epileptic children, usually between the ages of 4 and 16 years. A 2-day seminar for faculty representing eight schools of social work in New York and adjacent States was held in February 1963 under the sponsorship of the Children’s Bureau and the Association for the Help of Retarded Children. Unmarried Mothers Services for unmarried mothers continue to be insufficient. Only about one-sixth of the unmarried mothers receive services from public and voluntary child welfare agencies. In some cities, newly organized or reorganized public services and citizens’ committees are trying to alleviate the problem of lack of services, and States are making progress in increasing services. A serious lack continues in services to Negro unmarried mothers. Child Welfare Report No. 12, Social Services for Unmarried Mothers and Their Children Provided Through Public and Voluntary Child Welfare Agencies, showed that three-fourths of the total mothers served were white and one-fourth were nonwhite, usually Negro. On the other hand, only a little more than one-third of all reported births out of wedlock are to white mothers. The report also showed serious problems in the provision of medical care to unmarried mothers. As 96 Department of Health, Education, and Welfare, 1963 an overall estimate, 6,500 unmarried mothers were served on a single day throughout the country. The American Medical Association in March 1963 sponsored a meet- ing of national medical organizations, the American Bar Association, the Child Welfare League of America, and the Children’s Bureau on services to unmarried mothers. The American College of Obstetri- cians and Gynecologists has developed a draft statement concerning cooperative work among the professions in respect to services to un- married mothers. Adoption The number of adoptions increased—the figure going from an esti- mate of 107,000 in 1960 to 114,000 in 1961. The preliminary estimate for the year 1962 is about the same as for 1961. Nevertheless, many agencies in all parts of the country have reported a decrease in the number of adoptive applicants. A variety of reasons have been given: Advances in the study of infertility; early marriages and more “natu- ral” children; publicity about agencies’ rigid requirements; unstable world conditions. The Children’s Bureau awarded a grant to the Child Welfare League of America to study this apparent decline in adoptive applicants. Homes for minority groups, handicapped children, older children, or those in family groups remain hard to find. The process of adop- tive placement takes longer for these children. Adoption is being increasingly recognized as a child welfare func- tion of interdisciplinary interest. A meeting was held in Texas in regard to adoption and unmarried parenthood and was attended by representatives of State medical societies, attorneys representing bar associations, nurses, and others. They came from all parts of the State and discussed the complexity of adoption as well as plans and methods for alleviating illegitimacy. Intercountry adoptions have declined in number. The reason is not known. Foster Family and Group Care of Children Chicago, Baltimore, New York, Philadelphia, the District of Co- lumbia, and other large cities have reported a critical shortage of foster families for neglected and dependent Negro and Puerto Rican children. Abandoned, but healthy, infants are kept in municipal hospitals. Outmoded public institutional care has been reestablished for infants, toddlers, and preschool children. Adoptive homes are not being made available. Public welfare officials in these cities are appealing to their legisla- tive bodies for increased staff to find foster and adoptive homes and Welfare Administration 97 for increased funds to reimburse foster families for their expenditures in behalf of foster children. Many public welfare departments limit their reimbursement to about $50 to $75 a month, which is less than the foster parents spend for the child. More services for adolescents are urgently needed, especially for homeless, disturbed, retarded, and delinquent adolescents. In June 1963, the California Governor’s Advisory Committee on Children and Youth recommended development under public auspices of “pro- fessional group foster homes for adolescent court wards 16 years of age and over.” In Colorado, the State department of public welfare has recently helped seven county welfare departments develop small group care facilities for adolescents. New York, Florida, Texas, Washington, and Utah are now operating such public facilities, and at least 20 other States have reported plans for similar facilities to be operated by voluntary or public child welfare agencies. Providing public welfare services for emotionally disturbed chil- dren has become increasingly difficult because of the shortage of public and voluntary child guidance clinics, family and child counsel- ing services, specialized foster families for disturbed children, inade- quate State mental hospital care for children, and high costs of care. Various efforts are being made to meet these needs. Maryland, New York, Ohio, Texas, and other States have increased their public wel- fare appropriations to help parents shoulder the heavy costs of private residential treatment ($15 to $25 daily) for their disturbed child. Public child welfare agencies purchasing care have asked for fuller accounting by institutions of their costs and services. This, in turn, has stimulated widespread interest in uniform cost-accounting meth- ods for institutions. The California State Department of Public Welfare has contracted with the Child Welfare League of America to make the services of a technical consultant available to California children’s institutions wishing to undertake standardized cost-analysis studies. The Children’s Bureau and the Child Welfare League of America are cosponsoring a 3-year project aimed at developing nation- wide use of a uniform cost-accounting method for institutions. The Bureau and the League are cooperating with the California State Department of Public Welfare in developing similar uniform cost- accounting methods for agencies providing foster-family and adoption services. Children of Migratory Workers Day care is still one of the most needed child welfare services for the migrant group. According to the report of the hearings in April 1963 of the Senate Subcommittee on Migratory Labor, there are 93 Department of Health, Education, and Welfare, 1963 approximately 100,000 to 150,000 children under age 14 in migrant families. Often the oldest of these children works with parents in the fields. The next oldest often stays at home and cares for the toddlers and infants. The report concludes, “Children of migratory farmworkers should be provided better care and protection while their parents are at work in the fields. The Federal Government should stimulate estab- lishment and maintenance of day-care facilities for children of mi- gratory agricultural workers by making financial assistance available for this purpose to States.” Unaccompanied Cuban Refugee Children Since the regular commercial flights from Havana were stopped on October 23, 1962, there has been a very gradual decrease from the peak of 4,098 unaccompanied Cuban refugee children in care on Sep- tember 30, 1962. Neither unaccompanied children nor the parents of children already in care have been able to come to the United States in significant numbers. By May 31, 1963, a total of 8,057 unaccompanied Cuban children had been provided foster care, either in foster-family homes or in children’s institutions. Fifty-five percent of these children had been discharged from care, the great majority having been reunited with parents or close relatives. The 3,621 children remaining under care on May 31, 1963, were in 109 communities in 39 States, the District of Columbia, and Puerto Rico. Sixty-three percent were boys, 69 percent were teenagers, and only 15 percent were under 11 years of age. JUVENILE DELINQUENCY SERVICES National interest and concern in the problem of juvenile delinquency are reflected in the numerous and varied requests received by the Bureau for information, technical assistance, and consultation from a great variety of sources such as training personnel from police or- ganizations, researchers and professors, staff from national organiza- tions and State agencies. During the year, these requests were not limited to the United States but also came from such distant areas as Turkey, Japan, and Australia. The range of subjects of con- sultation was equally broad, ranging from glue sniffing to police procedures. Roughly 1.5 to 2 million children “get into trouble with the law” each year. Of these, more than 1 million are arrested, and about half of those arrested are referred for delinquent behavior to the courts. Welfare Administration 99 CHART 8.—TRENDS IN JUVENILE COURT DELINQUENCY CASES AND CHILD POPULATION 10 TO 17 YEARS OF AGE, 1940-61 500 > DELINQUENCY CASES (including traffic) DELINQUENCY CASES (excluding traffic) 1 30,000 \ | | ! 7 | | ' { 720,000 SCN Ses eae eee | | | DELINQUENCY CASES (in thousands) CHILD POPULATION (10-17 years of age) | 1 H \ ! | | | | I | CHILD POPULATION 10-17 YEARS OF AGE (in thousands) 100 t + —}—_______—___}-_—__ 10,000 1940 1945 1950 1955 1960 Although in 1961, for the first time since 1948, there was a slight overall decrease in the number of juvenile delinquency cases referred to juvenile courts, the number of such cases handled by urban juvenile courts continued to increase—by 2 percent. Boys are referred to juvenile courts for delinquency more than four times as often as girls, and they are referred for considerably different offenses than girls, as indicated by reports from large-city courts. More than half of the offenses committed by girls were for conduct which characterizes juvenile misbehavior but which is not ordinarily considered a crime—runaway, truancy, curfew, and ungovernable be- havior. On the other hand, almost half of the offenses of boys were against property—larceny, auto theft, vandalism, robbery, and burglary. Approximately 39,000 children were living in public training schools for delinquent children on June 30,1962. This is an 8-percent increase over 1958, with increases occurring in every region in the country. An estimated $121 million was spent during the fiscal year 1962 by public institutions for delinquents. The average annual per capita 100 Department of Health, Education, and Welfare, 1963 operating expenditure for caring for a child was $2,625, with con- siderable variation among individual institutions and among different regions. Training-school staff turnover continues to be high. About one- fifth of all employees left their jobs in 1962; the majority of these were treatment and educational personnel. Structural Integration of Services The trend toward the structural integration of State services for delinquent children continues. A new department of family and children’s services was established in Georgia to administer the gen- eral child welfare program, the training schools, as well as other State services for delinquent children. In Ohio a new State com- mission has been patterned after the “Youth Authority” concept. This new department will have responsibility for services to delinquent children only. Services for delinquent children are not generally the primary re- sponsibility of a single State or local agency. Although training schools for delinquent children are administered at the State level, there is a great variety of patterns in the States’ structures. In less than one-third of the States, they are administered by the welfare departments; and in the balance of the States, they are administered by independent boards, departments of institutions, departments of education, departments of corrections, etc. An even greater diffusion of responsibility exists with aftercare supervision (parole). With few exceptions, most of the other services and facilities for delinquent children are under local administration. The trend of establishing governmental planning units for youth services at municipal and metropolitan levels continues. Some of the local ad hoc youth committees created to apply for grants funds available under the Juvenile Delinquency and Youth Offenses Con- trol Act of 1961 may eventually evolve into youth commissions. School Dropouts and Youth Unemployment National concern regarding school dropouts and youth unemploy- ment resulted in a number of short-term courses being designed to assist school personnel. In several sections of the country, teachers and school guidance counselors were offered training designed (1) to understand and to assist the culturally deprived; (2) to gain knowl- edge of the problems facing employers and employment service personnel; (3) to recognize the basis for the decisions that adolescents make which determine their attitudes and behavior; (4) to assist them in using the school as a cultural matrix for the rehabilitation Welfare Administration 101 of delinquents; and (5) to acquaint them with the agency and organi- zational resources of the community and State. Short-Term Training The emphasis placed on short-term training and the support of these programs by the President’s Committee on Juvenile Delinquency and Youth Crime resulted in more and more educators and practi- tioners asking: For what levels of competence should personnel be prepared? How can extension courses or undergraduate programs be enriched to help meet the need for personnel? What percent need to have professional training—and how can this training be improved ? While such questions drew academicians and practitioners closer, the problems of communication remained. The development of core curriculum materials by interdisciplinary faculty proceeded slowly. Police Work With Children Over 6,000 copies of the standard-setting Police Work With Chil- dren were distributed throughout the United States, as well as to a large number of police in foreign countries. Individual requests for copies are increasing. Several police training institutes located at academic centers have indicated extensive use of the publication. YOUTH DEVELOPMENT SERVICES The Youth Development Unit, in the Office of the Chief, functions as a technical assistance arm of the President’s Committee on Juvenile Delinquency and Youth Crime. Functions of the Unit are to expand further, with emphasis on youth, the already established activities of the Bureau and to assist in implementing the provisions of the Juvenile Delinquency and Youth Offenses Control Act of 1961 (Pub- lic Law 87-274). Grants for planning youth development programs were made to 7 communities in 1963, bringing the total to 16. Thirty-eight grants for training personnel were made, making a total of 63. The ongoing, and as yet unmet, needs of the Nation’s youth con- tinue to be focused around employment, education, job training, and recreation. National economic trends reflected in the growing dollar gap between average income and the income of the poorest citizens aggravate these conditions and underscore the need for intensive ac- tion to combat the effects of poverty and cultural deprivation on the development of youth. INTERNATIONAL ACTIVITIES International Research The program of cooperative research with other countries made pos- sible by the Agricultural Trade Development and Assistance Act 102 Department of Health, Education, and Welfare, 1963 of 1954, as amended, through use of counterpart funds has moved forward slowly. Although the Congress did not appropriate funds for 1963, funds remained available under the 1962 appropriation. The five projects approved in 1962—three in maternal and child health, one in juvenile delinquency, and one in child welfare—are underway. In addition, a study of institutionalized delinquent youth in Israel is underway. Visits were made by Children’s Bureau staff to India, Yugoslavia, and Egypt to explain the cooperative research program, review proj- ect proposals, and provide consultation on research design. International Training The Children’s Bureau carried responsibility for developing and implementing the training programs of 54 foreign professional stu- dents from 23 countries during fiscal year 1963—11 fewer students than in 1962. Policy changes within countries and in the Agency for International Development, the agency responsible for financing the programs of the majority of the students, accounted for much of the decrease. Requests for training in the health field still predominate, continu- ing a trend that has been evident for several years. During the year, 32 physicians, 6 nurses, and a physical therapist followed programs in maternal and child health and pediatrics; the major interest of 9 was child welfare; and 5 were interested in juvenile delinquency. The students continued to represent countries all over the world, with the largest proportion coming, as they have for recent years, from the newly developing countries. Foreign visitors who participated in short-term programs (from 1 hour to several weeks) totaled 229. They came from 60 countries. Some of these visitors had a single interest, limited time, and wished only consultation relating to a specific problem with a Bureau special- ist. Many, however, were interested in all aspects of the Bureau’s work and wanted to visit local agencies also. The fiscal year 1963 has been a year of movement in the Bureaw’s programs. Major changes occurring during the year broadened the scope of Bureau programs and increased their potential for effective services to children. Among these, three were of great importance: The enactment of the 1962 amendments to title V of the Social Security Act; the formation of the Welfare Administration within the Department of Health, Education, and Welfare; and the mounting nationwide emphasis on mental retardation. In addition, the Bureau’s activities highlighted certain efforts to meet special needs. The continuing population mobility and the shift Welfare Administration 103 to more urban areas brought new and increased needs for services to children and their families. The mounting needs of mothers and children for health services were of major concern to State and city health departments. More mothers in low-income families continued to work; more children needed day-care services; and more families, homemaker services. Services for mentally retarded children were in short supply and inadequate to meet increased demands. The importance of the prevention of school dropouts continued, and education and employment for the young have been of increasing concern to the Department and to the Bureau. Citizens, Federal, State, and local public and voluntary organiza- tions were continuing to work together to find new and better ways of advancing the well-being of all the Nation’s children. All of these developments held great promise for advancements in children’s services. Cuban Refugee Program During the 414 years since the Castro regime came to power in Cuba, on January 1, 1959, the United States has become the haven for large numbers of Cuban refugees. This has represented the first time in history that our Nation has served as a country of first asylum. In previous refugee programs, the refugees were screened in Euro- pean camps and carefully selected and processed for immigration to the United States. A place of residence and a job awaited the refugee on his arrival in this country. The Cubans, however, simply came— by commercial airline when they could obtain permission to leave, il- legally by small boat when they could not. And the United States found itself a country of first asylum—a situation well known to Western European and other countries. The first refugees to flee from Cuba early in 1959 were the political and business elite; these were few in number. As the activities of the Cuban government began to affect the society as a whole, and as the Communist character of the regime became increasingly clear, other groups joined the exodus. For more than 2 years, every so- cloeconomic group on the island has been significantly represented in the refugee stream. The vast majority of the refugees have had to sacrifice everything in order to leave Cuba. They have arrived in the United States— usually in Miami, Fla.—with only the clothes on their backs, a few changes of undergarments, and no money. By late 1960, it was clear that many of the more than 30,000 refugees who were in the Miami area were in desperate economic straits. State 104. Department of Health, Education, and Welfare, 1963 and local officials, the public schools, churches, and voluntary organi- zations had done a splendid job of welcoming and aiding the refugees, but the growing numbers had exceeded their capacity for effective help. It was against this background that President Eisenhower took initial emergency steps to deal wth the situation in November 1960 and President Kennedy formally established the Cuban Refugee Program in February 1961. The program has two basic objectives: (1) To provide necessary health, educational, and welfare assistance to Cuban refugees in the United States, primarily in Miami; and (2) to arrange for the re- settlement of the refugees from Miami to other parts of the Nation where they will have opportunities to become self-supporting, to put their skills to use, and to build new lives for themselves and their children during exile from their homeland. As it has developed, the program provides the following: Financial assistance and health services to needy refugees in Miami and the surrounding area of Dade County; funds to cover 50 percent of the costs incurred by the Dade County public schools in accommodating the refugee children; funds to enable the Dade County public schools to provide English instruction and vocational courses designed to increase the potential of refugee adults for resettlement and employ- ment; the cost of foster care of refugee children who have come to the United States unaccompanied by parents or relatives; and loans to needy Cuban college students in the United States. The fullest possible use of existing agencies has been made to carry out various aspects of the refugee program. For example, the Bureau of Family Services and the Children’s Bureau, units of the Welfare Administration, have major operating responsibility for the financial assistance and unaccompanied children’s programs. The Office of Education is concerned with assistance to the Dade County public schools and with loans to Cuban college students, and the Public Health Service provides overall supervision of the program of medical care for needy refugees. State and local welfare departments also cooperate in the refugee program, as do many other public and voluntary agencies. The resettlement program is carried out by four national voluntary agencies working under contract with the Federal Government: Catholic Relief Services of the National Catholic Welfare Conference; Church World Service of the National Council of Churches (Protes- tant) ; United HIAS Service of the Hebrew Immigrant Aid Society ; and the International Rescue Committee ( nonsectarian). The Cuban Refugee Program provides funds to cover the following: A portion Welfare Administration 105 of the administrative expenses of these agencies; transportation costs of refugees to the city of resettlement; and, for refugees who are receiving public assistance in Miami at the time of resettlement, a transition allowance of $100 for a family or $60 for a single person. If a resettled refugee should require financial assistance because of loss of job or severe medical expenses, public assistance is made avail- able in the city of resettlement through the local office of the State or county welfare department which is then reimbursed from Fed- eral funds. The assistance to needy Cuban refugees is based on the same standards of need as apply to American citizens. Developments During 1963 A major change in the refugee situation occurred on October 23, 1962, when all commercial air flights from Cuba to the United States were suspended by the Castro government following the President’s public statement on missiles in Cuba. As a result, the arrival of new refugees declined markedly, and continued resettlement operations led to the first decrease in Miami’s refugee population in over 4 years. Between October 23, 1962, and June 30, 1963, resettlements away from Miami exceeded new arrivals there by about 10,000 persons. By the end of fiscal 1963, a total of 166,323 refugees had registered at the Cuban Refugee Center in Miami. Of these, 62,488 had been resettled—in more than 1,600 communities in every State, the Dis- trict of Columbia, the Commonwealth of Puerto Rico, the Virgin Islands, and several foreign countries. Registrations during the year amounted to 41,357 refugees, as com- pared with 95,338 during fiscal] 1962. Resettlements totaled 32,255, as compared with 30, 233 during fiscal 1962. The proportion of the total caseload resettled rose from 25.8 percent at the end of fiscal 1962 to 37.6 percent at the end of fiscal 1963. New Directions for 1964 Despite the success of the resettlement program to date, the fact that approximately 60,000 refugees in Miami required public assistance in June 1963 because of the lack of job opportunities indicates the task remaining. During the first half of fiscal 1964, a comprehensive study is ex- pected to be completed of the characteristics of the refugees receiving public assistance in Miami in relation to their potential for resettle- ment. The information will be recorded on punchcards for auto- matic data-processing equipment. 711-845—64——8 106 Department of Health, Education, and Welfare, 1963 This study will provide an analysis of the problems which must be resolved in order to complete the resettlement of the refugees. It will provide the resettlement agencies with information which will enable them to identify and deal first with those cases where there is no obstacle to resettlement, to handle individually those cases having special problems, and to determine immediately those resettleable refugees who meet the occupational and other requirements of specific resettlement opportunities. By enabling the resettlement agencies to deal systematically with the refugees who are receiving public assistance in Miami, this study will fulfill two important needs: (1) These are the refugees who most urgently require resettlement; and (2) this is the most immediate and effective way of reducing Federal expenditures for the assistance program. Office of Aging Fiscal year 1963 was a period of change and development, of sub- stantial accomplishments, and of great promise. Some major im- provements were recorded in the status of the elderly, and at the end of the year there was evidence of a new national regard and a clearer focus on the needs and situation of older Americans, The Office of Aging began this year as the Special Staff on Aging in the Office of the Secretary. On January 28, 1963, the Special Staff officially became the Office of Aging within the new Welfare Administration. This relocation was to strengthen the operating potential of the Office, but in no way to limit or affect adversely its broad responsibil- ity, concern, and activity for the well-being of all older men and women in the Nation. Mission and Responsibilities There are today nearly 18 million Americans past the age of 65. They make up a greatly varied group. It includes men and women just reaching 65 and some 12,000 others who have passed their 100th birthday. Within these ages, it includes the well and the ill, the inde- pendent and the dependent, the well-to-do and the poor, the college graduate and the untaught, the highly skilled and the average. The Office of Aging is interested in all of them and in all their inter- ests—their health, their housing, their incomes and employment oppor- tunities, their education, recreation, and participation in community life, their role and status. It seeks to strengthen and extend existing Welfare Administration 107 services, to develop new knowledge, to stimulate new programs, and to inform the general public of the needs, and the elderly of the serv- ices available to them. How Does It Do These Things? More than half of all Federal programs for the aging are centered in the agencies of the Department of Health, Education, and Welfare. The Office of Aging acts as coordinator for all of these Department activities. The Office cooperates also with other Federal agencies having pro- grams in aging. In specialty areas, the Office of Aging works with the Federal agency assigned major responsibility in a field—to make certain that the needs of the elderly are included in its general program and that necessary special services or opportunities are provided. Where there is a combination or overlapping of services, the Office of Aging serves as coordinator. It has special competency of its own in the areas of State and community organization, leisure-time activity, preretire- ment preparation, and development of education and training in social gerontology. The Office has a specialist in aging as a regional representative on aging in each of the nine regional offices of the Department. Through these representatives and through its Washington professional stafi, it provides consultative and technical assistance to States, communi- ties, organizations, and individuals. It is the Federal contact point for State commissions on aging, for national and local voluntary agencies, and for colleges, universities, and other educational institu- tions with regard to programs in gerontology. It provides background information on effective methods of com- munity action and organization so that other communities may follow or adapt successful patterns. It develops guides for training courses for persons working in administrative and service capacities with older people. It assists in initiation of adult educational opportunities for older people; aids business, labor, and education in developing pre- retirement counseling. It develops statistics of importance in aging; analyzes trends; pre- pares bibliographies and reference lists; contributes to the literature and reviews current publications in the field; sponsors an annual national conference of State executives on aging, cosponsors other National, regional, and State meetings, seminars, institutes, and work- shops; provides major speakers for national and international con- ferences. It serves the President, his Cabinet, and the Congress in work on legislation, staffing studies, message content; serves the Presi- 108 Department of Health, Education, and Welfare, 1963 dent’s Council on Aging and the Secretary’s Panel of Consultants on Aging as a source of resource personnel; publishes a monthly news- magazine and a number of series publications; and answers hundreds of queries each month. In short, it is the focal point on aging within the Department. Highlights of the Year Two major events of the year were the special message on needs of the elderly sent to the Congress by President Kennedy on February 22, the first such message by a President, and the proclamation of May as National Senior Citizens Month. The Office of Aging participated in development of policy and legislative recommendations, provided technical information, and served as coordinator. It spearheaded departmental participation in the nationwide observance of the special month. Both the special message and the proclamation aroused national interest in the needs and situations of older people and placed in per- spective their value as a resource of experience, skills, and wisdom. Stronger State Ties Relationships with State commissions on aging were strengthened by a 3-day conference with 150 representatives of these agencies in Washington in April, by increased consultation, assistance to them in developing State and regional meetings, and by the development and dissemination of new publications and informational materials. At the end of the 1963 fiscal year, 38 States, Puerto Rico, and the Virgin Islands had permanent State commissions on aging and 6 additional States had temporary but active State commissions. There was more action at the local community level on behalf of the elderly in 1963 than heretofore. There were more than 800 local councils on aging in existence and continuing efforts were being made by State executives on aging to stimulate interest in creation of additional com- munity-based units. For example, in Indiana the State Commission on Aging is seeking to increase the number of county commissions on aging from its present 33 to 92—1 in each county of the State. This same objective is shared by many other States. Departmental Committee The Office of Aging provides direction and staff assistance to the Departmental Committee on Aging. This Committee brings together representatives of all programs in aging in the Welfare Administra- Welfare Administration 109 tion, the Public Health Service, the Social Security Administration, the Office of Education, Vocational Rehabilitation Administration, Saint Elizabeths Hospital, and the Food and Drug Administration. The Committee was particularly active in promoting observances of Senior Citizens Month and in developing of background papers for a meeting of the Secretary’s Panel of Consultants late in June. New Publications In an effort to meet the increasing number of requests for informa- tion and assistance, the Office initiated three new publication series in 1963. These were: Facts on Aging—statistical leaflets on varied subjects; Selected Teferences on Aging—brief, annotated bibliog- raphies; and Highlights of Legislation—reports on the introduction and progress of Federal and State legislation of importance to older people. The earlier Patterns for Progress series, case histories of a wide variety of effective community projects for older people reported in sufficient detail to enable other communities to adapt them to their use in establishing similar projects, was continued with publication of Case Study No. 15, the story of Hodson Day Center, pioneer multi- purpose activity center in New York City. Aging, the Office’s monthly newsmagazine, published its 100th issue in February 1963. Several special theme-centered issues were pub- lished, notably the May 1963 issue on Senior Citizen Month and the June 1963 special issue on employment opportunities. Circulation at the end of the fiscal year had increased to more than 10,000 and in- cluded subscribers in every State and 23 foreign countries. Increased Emphasis on Education and Training Because there is a critical shortage of trained—and even of un- trained—personnel in this field, the Office of Aging placed major em- phasis upon development of training programs and the establishment of university courses and institutes of gerontology. To make possible better preparation for future researchers, teachers, administrative and service staff, it worked directly with universities, colleges, and professional schools which have research and training in aging to assist them in expansion of their programs. The Office of Aging also developed curriculum and program guides for those wish- ing to develop courses in gerontology. Thirty universities were assisted during the year. 110 Department of Health, Education, and Welfare, 1963 Work With Voluntary Organizations Marked progress was made during the year in establishing liaison with religious and voluntary organizations. Stimulation and assist- ance to church groups and theological schools were given special at- tention. At the end of the year, a kit of materials on The Older Person and Organized Religion was in process of production to assist theological schools, ministerial associations, and individual ministers and churches to move in this important area. Consultation and discussion were held with approximately 75 lay groups including women’s clubs, men’s and women’s service clubs, professional groups, and health and welfare associations, all of which have programs in the field of aging. Meeting of Panel of Consultants The Office of Aging gave direction and staff assistance to a meeting late in June of the Secretary’s Panel of Consultants on Aging. The Panel discussed six major policy questions affecting Department pro- grams for the aging: Implementation of a possible grants program; criteria for group residential housing; development of protective services; the problem of relative responsibility; manpower and train- ing needs; and the responsibility of community health and welfare agencies in establishing and maintaining adequate health and safety standards in housing for the elderly. Cooperative Relationships The work of the Office as coordinator of the Departmental Committee has already been described. In addition, participation of the Washington staff in departmental groups and in task force projects of the President’s Council increased during the year, major service being rendered on group residential housing, homemaker services, preretirement training, and activity centers. During the year, the Office prepared text and design for the Council publication of a unique booklet, Homes for the A ged in Sweden Offer Ideas for Americans. A closer relationship with the Bureau of Family Services during the year made it possible for the Office to assist in promotion of services under new welfare provisions. Cooperative arrangements with the Public Health Service, the Of- fice of Education, and the Department of Agriculture in development of information material were entered into during the year. Welfare Administration 111 Highlights in the Field The nine regional representatives of the Office of Aging are special- ists in aging who serve as first contact point and source of assistance for State commissions on aging and institutions and organizations within their regional jurisdiction. They implement a two-way flow of information between Washington and the field. During fiscal 1963, two interesting publications grew out of regional activity: A Pilot Survey of Personnel and Training Needs in the Field of Aging, developed by the regional representative of Region IV (in collaboration with the head, Department of Sociology, Univer- sity of Tennessee) ; and 7'he Hole of Education in the Field of Aging, a report of a Maryland Commission on Aging conference sponsored by the Office of Aging and the Office of Education. The Maryland meet- ing was one of several such jointly sponsored conferences on the role of education. More than a thousand requests for consultation and technical help were answered by the regional representatives in 1963. In addition, they attended or took part in some 100 meetings, seminars, institutes, and conferences. Outstanding regional projects underway during the year included: @ A traveling seminar in gerontology, reaching 13 universities of the Denver region. @ Service by Regional Representative of the Kansas City region in aconcerted services housing program. © Cooperation in development of a model recreational activity center in the Dallas region. @ Initiation of a radio series on aging in cooperation with Emory University by the Regional Representative in the Atlanta region. @ Assistance in organizing the Maryland educational conference by the Regional Representative of the Charlottesville region. @ Initiation of State and regional meetings in aging by New York, Boston, Chicago, and San Francisco Regional Repre- sentatives. The Future At the end of fiscal 1963, the Office of Aging was completing a pilot checklist useful to communities in evaluating both services and gaps in their programs for older people and was working with the Office of the Commissioner of Welfare and the Housing and Home Finance Agency toward initiation of a cooperative program of services for the elderly in public housing. 112 Department of Health, Education, and Welfare, 1963 The volume of mail and telephone queries had so increased by the end of the year that the Office’s reference library and public inquiries personnel were giving service to from 800 to 1,000 persons per month. It is the increased national interest reflected in these queries that has led the Office to plan publications directly addressed to older indi- viduals, and to make a beginning in development of subject matter informational kits to assist in meeting requests. And it is this in- creased interest also which the Office—believing in the elderly as a resource as well as a responsibility—sees as the real highlight of the year. Office of Juvenile Delinquency. and Youth Development The Office of Juvenile Delinquency and Youth Development was set up January 28, 1963, with the establishment of the Welfare Administration, to administer the Juvenile Delinquency and Youth Offenses Control Act of 1961. The act authorizes $10 million a year for 3 years, to be made avail- able for demonstration and evaluation projects, and training person- nel, and for technical assistance services. The act was passed to help local communities stem the rising tide of juvenile delinquency and to meet the great shortages of trained personnel working with youth. The Office of Juvenile Delinquency and Youth Development, work- ing closely with the President’s Committee on Juvenile Delinquency and Youth Crime, has viewed delinquency as a multifaceted problem. Unemployment, school dropouts, poor housing, family breakdown, racial discrimination are all closely related to delinquency. These problems are especially serious in the slum areas of our large cities. It is in these areas, therefore, that the Office of Juvenile Delinquency and Youth Development has concentrated its efforts. However, rural areas have not been neglected. During fiscal years 1962 and 1963, 16 communities have received grants to develop demon- stration projects to give those young people from deprived areas an opportunity to lead useful, constructive lives. These grants were awarded to communities judged to have the capacity for developing innovative programs and able to meet the basic criteria of (a) comprehensiveness in scope of planning; (0) wide involvement of important local groups such as public and private agencies, universities, and neighborhood leadership; (¢) financial commitment; (d) transferability to other areas; and (e) built-in Welfare Administration 113 evaluation. These communities have gathered staffs competent in research and program planning to develop integrated programs of social action and social services. Three of these communities—New York’s lower East Side, Cleve- land, and New Haven—are now engaged in large-scale action pro- grams to deal with these problems and to coordinate the activities of governmental and voluntary organizations which deal with children and youth. The other communities given grants are in the process of mobilizing their resources and developing new youth services. They are defining their youth problems, planning new programs, and providing a means of evaluating the success or failure of these programs. These com- munities are now completing this preparatory phase for demonstration projects. Closely connected to the demonstration project efforts are the train- ing projects being supported under the act. The training program is seeking to help fill the shortages of trained workers by improving both the quality and quantity of training, by building new knowledge, and by organizing and communicating more effectively the knowledge that is currently available. To date, 12 grants have been made to establish university-based training centers for a wide variety of professions working with youth, 27 grants for curriculum development, and 24 for short-term work- shops and institutes. Technical assistance services provided by the Office of Juvenile Delinquency and Youth Development have been geared to help com- munities and institutions to design and carry out these programs. The Office has supplied intensive consultation to all communities which have received grants, as well as to numerous communities which have requested assistance, but which could not be given grants. In providing consultation, the Office works closely with the Youth Development Unit of the Children’s Bureau, the Delinquency Unit of the Office of Education, the President’s Committee on Juvenile Delinquency, the Departments of Labor and Justice, and other Fed- eral organizations having programs concerned with youth. A bill to extend the Juvenile Delinquency Act is currently before Congress. The new legislation request a 3-year extension in order to achieve an orderly completion of at least six to eight major demon- stration projects in a variety of communities, each designed on the basis that a complex problem like delinquency requires a compre- hensive, coordinated community approach. 114 Department of Health, Education, and Welfare, 1963 —_— ————————————eeeeeeeeeSSSSESEEEEEEESEeESESESESESESSESFSFSFSesseF Table 1.—Public assistance: Recipients under Federal-State programs, by program and State, June 1963 Medical Aid to the | Aid to fami- Old-age assistance Aid to permanently lies with assistance for the the blind and totally | dependent aged disabled children ! Wiad ties se Ie = meee BC 2, 198, 896 98, 390 461, 537 3, 934, 542 106, 158 1, 702 13, 583 91, 484 LET a) eee ee 104.)...325 3 4,459 i bes Sy i eae ee, 858 1, 821 41, 146 57. 260 1,989 8. 849 27.085 263. 845 12, 333 33. 500 357, 695 49. 803 }j23%% sees = 266 5. 848 455 8. 707 295 6, 512 49, 092 LOO | ie Sees ar 283 436 8. 835 2.719 185 2.929 19, 061 MOLTOLL |S eeee er re 2, 580 14, 713 105, 236 O20 tate see) Et 3, 087 25, 541 61, 416 156 7 ae 906 1,144 83 1.016 13 524 5. 224 130 2. 426 9. 631 62 042 2.775 28, 081 263 127 23 999 1. 801 245 48 380 30. 067 1, 285 935 43.150 24. 572 540 4.316 28. 299 53.418 2. 371 9.217 78. 865 oe te een ete 128, 099 2, 797 18, 209 97, 796 Sa ap oe popes aise» aa A 11, 228 409 2.378 22. 000 Sidese eet SS east ee 9. 34 413 6.613 59. 373 ar anes 56, 425 2, 222 10, 708 78. 212 Oe, ee a ae 50. 851 1,671 6, 780 128. 487 Minnesota... 215 2 See es 43, 634 1,035 3.104 42 705 M deeliprl + ioe 76, 558 3, 154 15, 346 80 8°98 Missouri__..__ 105, 738 4, 664 14, 786 103 064 Montana--___ 5,77 266 1, 255 7,050 Nebraska____ 12, 860 71 2.197 13 534 Nevada s. erica hen te 2, 556 164 Jovereo. cee 4,915 New; Wampshire__.._.-.2<......- 4,591 260 516 4, 223 New Jersey__.--__- 18’ 460) ee ee 960 7. 988 90 111 New Mexico-.. OP SAR eee tee 348 3 195 30. 187 New York.22. 2-2 56 705 3. 227 35 108 433, 616 North Carolina____ Ne BD | Pie na ie 5, 109 21, 854 117. 451 North Dakota____- = 5.740 84 1, 280 6.776 ORio 22 8 = BAD hee ce ed 3.440 17.744 153 644 Oklahoma___ fa 83 672 1, 706 11, 802 70 813 Oreron 752-2 15. 006 402 4,990 31. 299 Pérnsylivania tees.) 155. f35 os 48, 164 17, 860 19, 254 337, 694 Puerto Rico 34, 292 1, 607 21, 824 217, 875 Rhode Island 6. O56 2 ee et 105 2. 576 21, 349 South Carolina 7.104 1, 691 8 329 33, 519 South Dakota 002 En a ea 137 1.097 10 212 Tennessee 47. 87: 2.370 12. 133 79. 200 TD 3: Cp Repti, pap diletit , sehta p52, 96t | JN . ape al Ai 5,078 8. 454 79.678 LT Ving eel PRR a! PT Ee I 5, 463 17 4,645 18 881 enaLNylt ween cones eee _ Seas 5, 440 110 961 4,904 Wars nisisrds. 200 Bos Was 492 15 92 1, 032 (916i els SA ce eS TRUELY LIE ryt i (See i gD 1,140 6, 445 44, 223 Washington 25 Le cM es 34, 547 661 17,152 42 808 WES Vireiiias 3 oi 2 te oN 871 6, 749 130 668 Wisconsin... - thine S154 837 5, 342 43 277 Wi Oningoee 2: Steere. STE 54 586 3, 222 1 Ineludes as recipients the children and 1 or both parents or 1 caretaker relative other than a parent in families in which the requirements of such adults were considered in determining the amount of assistance, 2 Program in operation but no payments made in June 1963. Welfare Administration 115 Table 2.—Public assistance: Average payments to recipients under Federal- State programs, by program and State, June 1963 Medical Aid to the Aid to State Old-age assistance Aid to permanently | families with assistance for the aged the blind and totally | dependent disabled children WO) Re $77. 05 $195. 22 $81. 72 $74. 80 $30. 95 Alabama 67. 67 257. 93 48. 03 45. 69 11. 62 Alaska_--.---- 84x81. |2 Set Foe LSE el pe Se 34. 35 (Arizona_= =.=. 62.63. losezeseeeeee 72. 89 68. 21 29. 06 Arkansas. 66. 33 63. 89 69. 92 58. 75 17. 92 California 106. 89 285.15 126, 21 108. 44 43. 69 Colorado 103:.72,)| 3 22.85 ce 101. 31 73. 33 36. 68 Connecticut. -_- 83. 54 248. 55 121.79 64. 75 44. 60 Delaware O2a81.|..3-862.288_ 5... 75. 54 72.14 22. 45 District of Columbia 113. 72 345. 48 72. 80 77. 98 32. 47 CRISS Se ee 6305: |-4-298.8.....- 67. 22 69.13 16. 66 02 ee 64.87 |-2-088.8.-.=-. 58, 82 58. 21 23. 33 Guam__--- 30. 42 2. 54 1 24, 08 12.70 Hawaii____-- 66. 73 260. 15 123. 83 117. 66 34. 33 Tdaho....... 72.18 143. 65 69. 78 55. 66 40.95 Tinois_-.-.. 86.14 387. 26 93. 85 97. 51 43. 58 diana... 0. G4, | Se 8 79.77 93. 39 27.81 Bowe. ....- Ue il ef oe 100. 60 80. 99 37. 03 Kansas____-- 80) 93] 2 Oat ew 91. 50 97.12 36. 39 Kentucky 60.10 27.71 69. 01 72. 24 24.79 Louisiana 83. 72 169. 55 81. 29 57. 46 22. 82 Maine...-- 79. 66 273. 48 82. 40 90. 84 29. 82 Maryland-_ 71. 93 38. 84 70. 00 70. 00 31. 88 Massachusetts... 83. 28 176.15 136. 95 131. 89 43. 20 Michigan..__-.-- 79.15 339, 16 95. 44 114. 93 36. 66 Minnesota 209) 23) 25 ee Ba 115. 29 61.12 47. 40 Mississippi-_--- 35; 20. |S 255 Fe 37.98 34, 23 8.91 issouri_-__-- (igi) et oe 2 ees 70. 00 67. 64 24. 32 Montana_-_-__-_ 68.37 [25 28 28 eet. 77. 76 75.71 33. 71 Nebraska... 81.87 |-c Ab ASR... 100.18 81. 46 29. 96 Np ad Gee one 2 Oe 88:99) |-S002 Se. 2 BA Bae ae ae Sale 29. 80 New Hampshire.__-----_-------- 100. 48 115. 40 105. 85 112. 23 40. 48 Nryulersey! fos. 22 | 2sae3-- 96:00} See Sele 86. 08 94. 25 47.07 Ife cd Wha fe ae CU Se: See ae 93. 50 91. 47 33 74 Rewiy Ork=> wie... 1bel.- 86. 88 269. 41 104. 84 116. 34 41. 38 Worth: Caroling 2.2 ~-.-1~22: 22. 57525 ij o2 ees eS 62. 24 67. 7. 23. 27 Worth, Dakota jz........1.c2c-i1. 90. 52 219. 56 80. 98 111.99 41. 54 nie ee Ss 84850} 3 Ue Ee 81. 92 79.99 29. 90 OrIshoma ss see 2... 1-122 ae 91. 74 190. 28 115. 45 105. 00 34 14 On ee - SE Se oe 84. 35 154. 79 92. 42 91. 69 37. 53 Pennsyivaniaied =~ -.-{20s_28. 77.16 254. 36 74. 45 63. 68 27. 46 PMIOEGO MiCGes ese. SPELL E LL 9. 29 32. 33 8. 37 8. 67 3. 69 minlode Tslandees os. .--80L_822 83106" | 22880 e+. 87. 42 88. 09 39 37 South Carolina = 55. 68 205. 84 68. 29 57. 74 17. 07 Ue DEG Cr, i a a 81.62: Fee Be. 65. 75 66. 92 34. 85 CEG TS 5_- | See 48. 31 71.01 48, 33 47.54 18. 66 LOG ee 4 7 2 10, 24 | 2845 225 68. 66 57. 50 18. 69 UU See eee ST ee oe 69.17 127.11 77.74 72 32. 64 Mermiontsoee en 2. be et 83. 20 336. 76 67.11 67. 96 30. 28 Margin telandeet 2.206 17, 757 7, 980 501 27, 691. | $6 080, 617 |. Lee Washington). se ee. eo 2 82, 626 46, 813 Weost Vitpiniay == ea een 56, 770 SWSco nist ee ee eres 64, 040 35, 647 |__ Wyoming Se aie na 4, 676 Aid to families with dependent children #1, 425, 876 12, 462 13, 724 116, 160 Aid to the blind Aid to the totally disabled 7,349 12, 276 5, 402 14, 570 Welfare Administration 117 Table 4.—Public assistance: Aid to families with dependent children, unem- ployed-parent segment, recipients and average payment, June 1963, and total payments, by State, fiscal year 1963 Average Total pay- State Recipients payment ments, fiscal June 1963 June 1963 | year 1963 (in thousands) ory eerste ee oe ee 300, 552 $28. 89 $108, 856 ee? Soe a ee ee ee (1) (1) 2 Monnecticut! 202.1) _..-. 12,097 29.25 4,324 ielaweare...2222402.4..- 2 1, 434 22.35 503 HER ee SS 2,212 28. 63 719 LS SY ae 53, 818 40.34 27, 949 Maryland . =.2)2.2.2+<.- 2, 584 28. 39 1,278 Massachusetts 2, 388 39. 41 1, 139 ew York... /.._. 78,007 30. 03 27,009 North Carolina 41 (2) let PERSONA Q 25sec 178 27. 69 65 Mreconetr =. 0529S 3, 606 38. 53 1, 453 Pennsylvania_--_.-_..-. 72, 374 21.22 22, 728 Rhode Island_---------- 2,978 33.35 1, 086 CG ae TS ae 4,472 20. 65 832 Beaestay ire iriineeee wee Ae. SUP Pet | ee A esd 64, 363 26. 10 19, 756 1 Program in operation but no payments made in June 1963. 2 Average payment not computed on fewer than 50 recipients. Table 5.—Public assistance: Aid to families with dependent children receiving foster care, number of children and average payments per child, June 1963, and total payments fiscal year 1963, by State State Riche ES. 2 8 it A eh 2 ae ee Vitginiads ..) 222 West Virginia____- Rnaietsi see Seer eee -. 2 EA BOP... Oe ee Sd SY Number of children receiving foster care, June 1963 1 Average payment not computed on fewer than 50 children. 2 Less than $500. Average payment per child, June 1963 $66. 97 () Total payments, fiscal year 1963 (in thousands) (?) 118 Department of Health, Education, and Welfare, 1963 Table 6.—Public assistance: Federal grants to States, by program, fiscal year Medical Aid to the | Aid to fam- State Total Old-age assistance | Aid to the |permanently| ilies with assistance for the aged blind and totally | dependent isabled children Total-Sses-ss-- $2, 671, 271, 192 |$1, 342, 633. 266 |$138, 778, 317 |$48, 869, 630 |$239, 059, 697 |$901, 930, 282 BNA RINGS os cannes 83, 614.170 65, 876, 819 422, 425 749, 924 5, 732,180 | 10, 832, 822 Alaska tee 2. bo =-, 2, 009, 390 825,040 05 eae en §9, 473 .|- = eon eee 1,124, 877 Arizona__..-.--22.8s._ 18, 891, 622 Mp BOG 810 | ta cen ea 554, 180 673,017 | 10,308,115 Arkansas__----------- 42, 610, 319 31, 986, 766 899,185 | 1,142,700 4,170,197 4,411, 471 California__..._----___ 319, 219. 531 169,579,128 | 25,950,927 | 7,407,378 | 18.048,458 | 98, 233.640 @olormdo.. __. 2.42... 44,124, 552 80.395, 404 foe ees 150, 581 3, 439, 266 10, 139, 301 Connecticut___--_---- 28, 021, 114 6, 020. 547 6, 840, 880 173, 480 2,5°9,598 | 12,416,609 Delaware... 22-52 3, 025, 354 588,058) == ee 164, 960 254, 397 2, 017, 039 District of Columbia__ 9, 203, 863 1, 995. 641 100, 000 114, 203 1, 803, 671 5, 190, 348 Mlorida..s-- 4.7.2.2" 68, 187, 785 $0), 412, 400 eo nee 1, 441, 775 8,391,035 | 17,942,545 Georgia sao feos, .- 76, 529, 730 47, 237, 044 |--_---------- 1,606,939 | 13,388,720 | 14,297, 027 ua... .... -o8.25-- 138, 824 29, 480 10, 389 921 16, 366 81, 668 Howat... eee 6, 141, 559 707, 174 803, 889 60, 991 618, 034 3,951, 471 foaho.-...--2-02 oe 9, 221, 380 3, 431, 805 1,557, 011 81, 973 1, 369, 388 2, 781, 203 Tinois.... 138, 750, 793 42, 317. 513 1, 966, 161 1,686,300 | 16, 352, 659 76, 428, 160 Indiana-.- 27, 718, 304 14,441 0870) 23-2 cess 1, 130, 702 158,963 | 11,987, 602 Towa... 22 33, 448, 462 pa NV Sat Wy Sl ape ea eee 809, 731 537,316 | 10,897,242 Kansas. ---- 28, 361, 389 17,\998; 380;| Sieben ee 339, 807 2, 665, 333 7, 452, 869 Kentucky-- 55, 795, 691 28, 756, 895 808, 889 1, 463, 364 5, 551, 769 19, 214, 774 Louisiana 128, 391, 600 94, 43054144) 2 oe anne 1, 768, 866 | 10,255,573 | 21,936, 747 Main i. - nase scene 15, 788, 643 7, 520,077 472, 042 254, 869 1, 495, 011 6, 046, 644 Maryland --_---- 26, 140. 147 5, 529, 851 1, 677, 824 236, 610 3, 713, 751 14, 982, 111 Massachusetts__ 90, 982, 966 38, 354,430 | 23, 791, 220 1, 332, 407 6, 769, 561 20, 735, 348 Michigan_---_--_ 79, 121, 192 31, 028, 546 11, 132,172 959, 322 3, 612, 861 32, 388, 291 Minuesota__ 44, 157, 560 30, 040, 078 650. 258 1, 646, 798 11, 820, 426 Mississippi_ 42, 068, 711 27, 843. 470 1, 231, 755 5,144, 522 7, 848. 964 Missouri. 93, 781, 252 59, 351, 522 2, 356, 398 8, 347.153 | 23,726,179 Mentana 6, 485, 474 8, 473, Al 183, 845 811, 649 2, 016, 369 Nebrask: 13. 912, 628 8, 636, 659 423, 041 1, 270, 155 3, 582, 773 Nevada__- 3, 031, 354 1, 687, 488 108, 017,,)....2- eee 1, 235, 849 New Hampshire-_-_---- 4, 842, 220 3, 219. 280 156, 404 346, 148 1, 098. 307 New Jersey___-------_ 39, 257, 713 11, 945, 891 578, 488 4,618,495 | 22,114. 839 New Mexico__ 18, 770, 157 7, 909, 340 233, 029 2,045, 607 8. 582.161 NewiyYork#2_5..._._.- 216, 608, 622 38. 427, 380 47, 930, 829 2,135, 488.) 21,025,873 | 107. 089, 052 North Carolina___-__- 63, 986, 207 23, 396, 579 |-..---------- 2,905.146 | 13,018,868 | 24, 65, 614 North Dakota-_------ 9,141, 927 4,501,911 1, 738, 032 61, 623 860, 605 1, 999. 756 Ohigt a= ..- 3-5 ----| 102,801,854 53, 1900830 ih 5 ene 2, 226, 321 9,904,550 | 37. 471.153 Oklahoma__ =ome 92. 002. 354 62. 475, 195 1, 052, 890 1, 083, 546 7, 348, 787 | 20,041,936 Oregon )2-4 25 naked 22, 038, 415 LO, 620,945 Ase. eee 208, 955 2, 946, 676 8, 562, 439 Pennsylvania___--_-.- 128, 447, 981 29, 109, 520 5, 283,794 | 3,123.380 | 10,368,364 | 80, 562, 923 Puerto Rico. <2. 52_- 9, 533, 275 2, 087, 594 358, 322 101, 929 1, 398, 053 5, 607,377 Rhode Island_-_-_---- 11, 377, 463 a OS ene ee 78, 381 1, 621, 4€9 5. 563, 600 South Carolina______- 24, 494, 443 12, 982, 732 1,126, 109 919, 863 4, 044, 853 5. 420. 886 South Dakota__-____- 9, 281, 411 5, G55, O98 wt. 2 oe 92, 005 672, 513 2, 860, 895 ‘Tennessee -_ -_-_-- =... 46, 306, 640 23. 061, 752 803, 041 1, 148, 312 5, 543, 297 15, 750, 238 MexaS. os004 aahse 159, 170, 975 186,842,876 oo 2, 923, 509 4, 247, 698 15, 146, 895 Utah. -s ce... 12, 843, 613 3, 621, 372 1, 436. 804 106, 084 2, 708, 867 4, 970, 486 Vermont____---- 1 A 6, 129, 102 3, 896, 169 194, 352 65, 591 567, 306 1, 405, 684 Virgin Islands_---__-- 315, 019 133, 475 21, 384 4,071 22, 554 133, 635 Warginia ...._ 1.0223... 22, 763, 716 B10, DOS mes mamomtahe 697, 823 3, 896,166 | 10,294,164 Washington _-_-------- 49, 534, 956 28, 869, 412 1, 643, 547 395, 658 6, 344, 637 | 12,281, 702 West Virginia_-_ 43, 648, 602 7, 559, 595 734, 118 415, 535 3, 158, 539 31, 780, 815 Wisconsin -__--_ 36, 057, 552 20700; 205. |aaeacenaneces 529, 147 3, 194, 921 11, 633, 216 Wivomingis, oo 2. Sk 3, 021, 616 13785; 469; 42-225 sogset. 34, 572 337, 450 864, 125 1 Based on cash advanced for the year; may differ slightly from fiscal year expenditures from Federal funds reported by the States. ee a ee See Welfare Administration 119 Table 7.—Public assistance: Selected fiscal data relating to payments, fiscal year 1963 Expenditures for assistance payments from Stateand | Percent of local funds, fiscal year | assistance Average 1963 payments State per capita from Fed- income, era] funds, 1962 Per $1,000 fiscal year Per inhab- of personal 1963 itant income, 1962 $2, 366 $8. 7: $3.77 60. 4 1, 567 7.47 4.74 76.3 2, 667 4, 86 1.84 61.4 2, 097 4.18 2. 07 73.9 1,504 6. 65 4.50 77 5 2, 898 18. 84 6.75 46.9 2, 370 18 25 7.95 55.4 3, 089 9. 73 3. 23 49.4 3, 102 2. 26 74 72.1 3,219 7.00 2.21 60.5 2,044 3. 65 1.85 76.0 1,759 5.10 2.93 77.4 (?) 1. 64 (?) 50.0 2, 403 5.69 2. 61 56.1 1,941 6. 46 3. 40 65. 8 2, 844 12.29 4.30 49.3 2, 350 2. 75 a6 67.4 2,189 7.04 3. 22 62.6 2, 188 7. 82 3. 59 60.5 1,712 5.45 3. 20 76. 2 1,705 12.73 7. 64 74. 0 1,917 6.17 3.15 72.1 2, 683 4.15 1.59 64.3 2, 769 15. 96 5. 80 50.0 2, 416 7. 32 3. 08 55.4 2, 236 11. 08 4. 96 52.5 BV REsRIGtI ree ae See oe AE ee 1, 285 3.77 2.99 82.1 VRC ee ee. oe eS eee. 2, 384 8. 82 3. 67 70.4 A ee ee eee 2,207 4.39 1.98 66 0 OSES DEVS Seo) es 3 ee 2.270 4. 49 1.95 67.1 NP Te SSS OE ee ae ee 3, 278 4, 42 1.52 62.8 ENowmeriamnenine tee 2. ee Ree 2, 206 6.13 2. 76 55.0 BN GLU O OF ie Vena amet no ee ee 8 2, 887 6. 06 2.18 48.2 SMG wr 2 oe a ee 1, 824 6. 97 3. 81 714 RECT Gig SS ee a 2,930 11. 92 4.16 49. 4 Oreo arolinn se e062 252.2 a 1, 732 3. 84 2.23 77.0 ENGR NIDA KOtaNE weer | See 2.273 7. 66 3. 32 63.9 Oy 2 ES eee 2. 392 5.75 2. 13 62.8 QUIS ate! - Bs > 2 ee ee 1,905 19. 39 10. 39 65.1 Wier Bae, OS SI See Sn a 2, 333 8. 37 3. 61 67.4 OS abe hi 22 Sees ee ee eee 2, 363 7.01 2. 98 61.4 Puerto Rico ) 3. 44 (2) 48.8 Rhode Island 2, 372 9. 33 4.01 56.0 South Carolina_____- 1,545 2.41 1.59 79.4 South Dakota 2, 065 4. 58 2. 27 72.5 ‘ennessee_._.-_...--.- 1, 702 3.05 1, 82 79.5 Uk eC ee Soa 2,013 5. 23 2. 66 74.3 hed 2, 084 5.48 2. 69 69.5 Wermontoncoss, o..-5. 2, 005 5. 61 2. 76 72.9 Virgin Islands 2 7. 07 (?) 49.2 Se ee 2, 018 1.47 76 76.9 Washington 2, 485 12.10 4.96 55.2 West Virginia 1,810 7. 46 4.11 76.8 VASontii = ae 2, 283 7.53 3. 26 52.4 WOR 2 aS Ses See See ee 2, 164 5. 59 2. 36 60. 2 1 Excludes Guam, Puerto Rico, and the Virgin Islands, data on per capita and personal income not available. 2 Data not available. 120 Department of Health, Education, and Welfare, 1963 EEE Eee Table 8.—Maternal and child health and welfare services: Grants for maternal and child health services, services for crippled children, and child welfare services under the Social Security Act, by program and State, fiscal year 1963 + {In thousands] Maternal and} Crippled Child wel- State child health | children’s | fare services services services ‘United States eth. o Hee Bee te $23, 871. 5 $23, 830. 1 $25, 703. 8 Alabama oo ote ee ee wees TR pa eA ee 733. 6 650. 6 657.7 YN) ee, ES Re OS eee Se Os ond 119.9 130. 4 166. 5 APIZona..... + 5 ee 2 ee i a Pea 212.52... eee 248. 7 ATK ANS 2-52) = oor ee ae ae pac ab een ee tel oe 366. 0 372.7 423.1 Galifornia.- -2 32 3-2. = Sse ee Fe a Be 1, 378. 4 906. 6 1, 569.8 Colorado..2:: 422 ee ee ey 427.4 286. 3 320.8 Connecticut. 2250-22 ee ee 376. 7 301.3 267.9 Delaware-2 243. es ae ee 130. 3 127.6 107.9 District of 'Colutibia..- 35 aah eee eae ee Se 284. 8 222. 2 123.3 lorida 2-4 ie Se ee eo 826. 9 569. 2 654. 2 Georgia. .=.2. 2ae Me. 20 aie, 3 a 5 717.6 779.0 707.7 Lp eae 2 See eee "a TR ee Se eee 59. 7 27.3 12.7 Hawaii. ..--2 30S. 5... 2) we ee 5S a tS ae 179.3 192.1 166.5 Wdsho. ost Se ee Oy ae 199.3 201.5 95.0 ToS, «3 oe acne se oo Se a a eS Sea 711.4 823.2 937.5 Indiana..___- 444.8 594. 5 6 TOWS---w cohen 333.3 489.6 539.0 Kunsas...2.- 4 3 261.8 282.0 366. 1 Kentucky ---___- 536. 4 602.4 633. 1 Hotisiana. 3 386. 6 434.9 384.3 Massachusetts_____________ 416.4 454.1 600. 6 Michigan-22 tas. 5. >. Ses 877.3 995.0 974.8 Rinnhesota: 4 Sas Ss 510. 1 663.6 523.7 Mississippi----.--__-_-___- 581.0 546.7 494.1 Missouricg =. 53.825 516.7 475.9 566.0 Montana. ..5 S23 e 147.2 189.5 157.3 Nebraska_-___._- 162.3 194.7 240.6 Nevada...__.. Fe 125.0 138.7 93.9 New. Hampshirés.$._ 2... 5288 382 J” 89.3 125.6 103. 6 Wew, Jersey: 3:9 Se. ee 23 377.0 358.0 569.0 New: Mexico.c2.6.-0.:. 2) B aes. 266. 8 235.3 237.2 INGWSY Onks > ae 3. Se Ae 1,119.1 936.0 1,342.6 Worth: Carolitia 2.8.20 2 2) See eases 876.0 977.4 895.9 Worthy Dekotel 2 = se ee 140.9 139.5 170.5 [NOES oe ot ae SSC eee ee 915.1 968. 5 1, 236. 4 Oklahomasc2.. 3-2-5. Lee ee ee 364.0 320.5 420.5 Oreyon. .--.-2 es Siok ee eee eS 195.3 236.2 258.3 Pennevyivania © 3 24+ See Bee ee | 1, 122.6 1, 233. 4 1, 245.0 Puerto Rico. £24 5.5. . a Sh See tS Se ee 601.1 677.5 9. 2 MHOde Island. OSs 5. - 2). Wes 8 ae 5” eh ee ae 223.1 157.3 172.5 Bouth' Caroling 222-2207 5 ee ee re 515.1 568.9 544.3 Sorith, Dakotahee S.-i ee ey ee ee 88.9 96.0 176.3 sLennessee 5 POE 2 2 ee eee ae ee 711.8 674.4 640.7 ROXAS Syne tee. ee a ee 1,077.7 1, 338.5 1, 156.7 Utah. fs ee es 8 eee 165. 1 172.6 227.4 Wermonbes <2. J-25-bu- S.A ee oe A ce 128.7 125.3 129.6 Wirgin Islandsl:_ 20) sain Bes tae 108.7 108.1 76.5 Witginia-—- wee eee Se ee ee et 695. C 665. 6 634.7 WVeshington-. Se a San eee Ree) ee 407.3 346.3 392.4 WWGSty Virginia’ S2LS 0 i eae > Eee eT Ee 363. 8 381.3 345.2 BSCONSIN = =k aeu es .-o ee Eoe T 492.1 501.1 557.1 Wyong vss.) Me ece =e 3. Sie Ss eee PCy 123.1 117.0 110.6 1 Based on checks-issued basis. Additional payments were made for special project grants to institutions of higher learning and to public or other nonprofit agencies and organizations as follows: Maternal and child health services, $1,016.0; services for crippled children, $897.3; and research and demonstration projects in child welfare, $738.9. +. | Public Health Service Health of the Nation From THE point of view of public health, 1963 has been a good year. There were a number of significant achievements in the protection and advancement of the health of the American people. In addition, several developments hold great promise for the future. During the year, President Kennedy discussed vital health issues in four separate messages to the Congress. In his general-health message, Mr. Kennedy emphasized the need for Federal aid in the education of the health professions, for new medical facilities, for a unified and intensified attack on environmental pollution, and for improving the communication of science information. The President also urged bold action programs to develop community facilities for the study and treatment of mental illness and mental retardation, to improve the physical fitness of American youth, and to provide health insurance for the aged under social security. As in other years, many agencies and individuals contributed to the gains in health. These include official agencies—local, State, and Federal—as well as professional organizations, foundations, volun- tary agencies, universities, industry, and other institutions. As a result of the President’s recommendations, and of growing public interest in health matters, several significant new programs were enacted into law by the Congress. The Health Professions Educational Assistance Act of 1963 (Public Law 88-129), for ex- ample, is a major step toward meeting the Nation’s critical shortage of health manpower. The legislation provides for Federal aid in the construction of teaching facilities for training physicians, dentists, nurses, pharmacists, optometrists, podiatrists, and other profes- sional public health personnel. The act also authorizes loans to stu- dents of medicine, dentistry, and osteopathy. 121 711-845—64——_9 122 Department of Health, Education, and Welfare, 1963 CHART 1.—PUBLIC HEALTH SERVICE, 1963 Chief Professional Officers Immediate Office of the External Advisory Groups Surgeon Genero! Internal Advisory Groups Surgeon General ond Special Staff Office of Deputy Surgeon Generol Surgeon Genero! Assistont Surgeons General wee ne i ol icine Office of Information and Publications Eacitve Circe Office of International Health Office of Personnel Divisions: Administrative Services Finance Health Mobilization Public Health Methods National Center for Health Statistics 1/ fs Bureou of Notlono! Institutes Bureau of State Services Medical Services Of Health National Institutes: Allergy & Infectious Diseases Community Heclth Environmental Health Divisions: Divisions 2/ H Divisions 2/ Forelgn Quarantine Arthritis & Metabolic Diseases sesnneneseessnarsarensracrecsnnaseandeuacsnsvsnsnaneasenssessecenneenansee tees] Hospitals Concer Accident Prevention 2 Air Pollution Indion Health i Enwi ouseanseansectverovennsees Child Health and Chronic Diseases Environmental Engineering ond So everenaen rnin fe Communicable Disease 3 Food Protection luman Development eared oo cm eae al Medical Sc’ Heart Occupational Health Center : Community Health Services ¢ Radiological Health Medical Director, Dento! Hie Health and 3 Woter Supply and Bureau of Prisons serie aoe 3 Pollution Control Medical Director, Mental Health Hospitol a1 lo FH Bureau of Employees’ Neurological Diseases Facilities H Compensation cd Wipdoeal Nursing H Clinical Center i Divisions: : Biologics Standards H Research Grants H 9 PHS Regional Offices Research Facilities and Resources +. Research Services 1/Seporate organizotional status similor to the National Librory of Medicine is proposed ~ under the reorgonization plan. 2/These groupings would become bureaus under the reorganization plon. Another major health measure enacted by the 88th Congress was the Mental Retardation Facilities and Community Mental Health Cen- ters Construction Act of 1963 (Public Law 88-164). The act au- thorizes (1) a 4-year program of project grants for the construction of research centers on mental retardation; (2) a 4-year program of project grants for the construction of university-affiliated facilities for the mentally retarded; (3) a 4-year program of grants to the States for the construction of community facilities for the mentally retarded; (4) a 3-year program of grants to the States for the con- struction of community mental health centers; and (5) a training pro- gram for teachers of handicapped children. Two important programs authorized by the 87th Congress came into being by the appropriation of funds in 1963. These programs provide project grants to the States for intensive community vaccina- tion against polio, diphtheria, whooping cough and tetanus, and for establishing and operating health service clinics for migratory farm- workers and their families. Gains in medical research contributed substantially to the health strides made in 1963. Much of the progress in research stemmed from investigations conducted or supported by the Public Health Service— OO Public Health Service 123 the largest single source of support for medical research in the country. Among the year’s research developments was the discovery that human viruses can cause cancer in laboratory animals—further evi- dence that viruses may be the cause of some forms of cancer in man. Also in the field of virology, a major victory was scored over childhood disease with the development of vaccines against measles. The total research program of the Service was strengthened in 1963 as two new institutes began operations. The National Institute of Child Health and Human Development, authorized in legislation signed October 17, 1962 (Public Law 87-838) , was established January 30, 1963. Its mission is to launch a major research attack on problems of child and maternal health and on the special health problems of children, including mental retardation, and to gather information about the process of human development throughout life. Public Law 87-838 also authorized the establishment of an institute for research and research training in the basic medical and related sciences. Pursuant to this authority, the National Institute of General Medical Sciences was established in 1963, elevating to Institute status the former Division of General Medical Sciences at NIH. In recent years, the administration, the Congress, and many pro- fessional groups—both in and out of Government—have expressed concern over the need to improve the communication of scientific in- formation developed through biomedical research. Concomitantly there has been a steadily growing public interest in health matters, reflected, for example, in the volume of inquiries being received in the Service. In the central office alone, these inquiries were in excess of 156,000 in 1963, an increase of over 100 percent in the past 10 years. In an effort to achieve wider application of research findings in medical and public health practice, increased emphasis was given in 1963 to the improvement of communications from scientist to scientist and from scientists to the health professions. Activities during the year stemmed, in part, from a PHS-sponsored conference on health com- munications in the fall of 1962. Through demonstrations, professional and public education, and technical assistance to the States, the Public Health Service seeks to bring knowledge gained through research into the widest possible use by medical practitioners, health workers, and the general American public. During the year, the Service, among other things, awarded grants to develop new or improved out-of-hospital health services in 68 com- munities, ranging from rural counties to large metropolitan areas. 124 Department of Health, Education, and Welfare, 1963 These grants, made under the Community Health Services and Facili- ties Act of 1961, are stimulating the development of better techniques for providing home nursing care, dental care for the homebound, rehabilitation and other services needed by the chronically ill and aged. In the area of environmental health, more municipal waste-treat- ment facilities were contracted for in fiscal 1963 than in any previous fiscal year, in large part under the aid programs authorized by the Federal Water Pollution Control Act and the accelerated public works program. The Service also provides direct health services for legally specified beneficiaries and for certain Federal agencies; operates a nationwide system of hospitals; and administers the Nation’s foreign quarantine program. Especially noteworthy during the past year was the re- cruitment of four surgical teams to aid the civilian population of South Vietnam. Each team includes two surgeons, three nurses, and a medical technician. The 1963 programs of the Public Health Service—in community health, environmental health, medical and hospital services, research and training, health data and information, and international health— are described in detail in subsequent pages. Health Record Latest estimates from the health interview phase of the National Health Survey indicate that 74 million Americans have one or more chronic conditions or impairments. This represents 42 percent of the Nation’s civilian noninstitutional population. Fourteen million of these persons—or 8 percent of the population exclusive of those in resident institutions—are limited in their major activity (the ability to work, keep house, or attend school) because of chronic illness. About 6 million (40 percent) of those limited have had this limitation for 5 years or more. Heart conditions and arthritis or rheumatism were the most frequently named causes of limitation. Acute illness requiring medical attention or resulting in restriction of usual activity for a day or more continues to occur at an annual rate of about two conditions per person. Of the 402 million acute illnesses and injuries included in the recent annual estimate, 231 mil- lion (57 percent) were conditions affecting the respiratory system, and 52 million (13 percent) were injuries. About 50.5 million persons were involved in injuries, with 43 percent being injured in home accidents. As for disability, chronic and acute illnesses (including injuries) were responsible during the year for the average person experiencing Ss Public Health Service 125 16.3 days of restricted activity. Of this total, 6.4 days were spent in bed. Employed persons, 17 years of age and older, lost an average of 5.8 days of work, and the average child (6-16 years) was absent from school 5.7 days during the year because of illness. In 1962 there were 1,756,720 registered deaths, giving a rate of 9.5 deaths per 1,000 total population, as compared with rates of 9.3 in 1961 and 9.5 in 1960.1 In recent years, the death rate has flucuated in a relatively narrow range, with deaths due directly or indirectly to respiratory conditions largely influencing the exact level of the rate. Over the last 10 years the rate has been 9.5 or 9.6 in years when respi- ratory disease was more than usually prevalent (1962, 1960, 1958 and the latter part of 1957, and 1953). Other years in this period have had lower rates, but never under the 9.2 rate of 1954, when there were almost no influenza outbreaks. The leveling off of the crude death rate is not confined to the United States. It has been characteristic over recent years of such widely separated countries as England and Wales, Norway, Sweden, Den- mark, the Netherlands, Chile, and Japan. Provisional death rates lower than the U.S. rate of 9.5 in 1962 were reported for Canada, the Netherlands, Norway, Australia, New Zealand, and Japan. In 1962, so far as the United States is concerned, in addition to a significant increase in the death rate for influenza and pneumonia there were increases for diseases of the heart (the leading cause of death) and for other diseases of the circulatory system. An unusual feature in 1962 was an increase in the rate for each of the categories of violent deaths—accidents, suicides, and homicides. The last time this occurred was in 1945. Since the age distribution of populations affects the death rate, “age-adjusted death rates” are calculated by weighting the death rate for each age group in a population in proportion to the size of the age group. Using our 1940 population as a base, the age-adjusted death rate for 1962 was 7.5 deaths per 1,000 population, with a corresponding 1961 rate of 7.3 (a record low) and a 1960 rate of 7.6. Thus it is evident that one reason why the country’s crude death rate has been relatively stable over recent years is that the population contains pro- portionately more older people than previously. Although 1962 had about 3 percent fewer people aged 55-64 in proportion to the total population than did 1952, it has 5 percent more aged 65-74, and 21 percent more aged 75 years and over. In 1952 the age-adjusted rate was 8.1, so that this rate declined about 6 percent between 1952 and 1962. The rate did not decline 1 All vital data are for calendar years. 126 Department of Health, Education, and Welfare, 1963 CHART 2.—BIRTH RATES BY AGE OF MOTHER: UNITED STATES, 1940-62 (Rates per 1,000 female population in each age group. Trend lines for 1959-60 based on registered live births; trend lines for 1940-59 based on live births adjusted for underregistration) 300 20-24 years 25-29 years 150 30-34 years = eo” mit [ sou =" = it 15-19 years 100 35-39 years 40-44 years ie} 1940 1950 1960 §=:1962, equally for each of the sex-color groups. The 1962 rate of 5.4 for white females was about 13 percent lower than it had been in 1952; the nonwhite female rate of 8.7 was 16 percent under its 1952 rate; the white male rate of 9.0 had gone down only 4 percent; and the nonwhite male rate of 12.0 had dropped 9 percent. About 1 infant in 40 died within a year of birth in 1962, as compared with 1 in 10 during 1915. But while the infant death rate declined Public Health Service 127 CHART 3.—BIRTH RATES BY LIVE-BIRTH ORDER: UNITED STATES, 1940-62 (Rates per 1,000 female population aged 15-44 yeurs. Trend lines for 1959-60 based on registered live births; trend lines for 1940-59 based on live births adjusted for underregistration) 50 50 Ist child 2nd child 3d child 4th child Sth child —_ ooo--" 6th or 7th child 1960 1962 by 25 percent or more for every 10-year period until 1950, the curve has been going down more slowly in recent years. In 1962 there were 25.3 deaths under 1 year per 1,000 live births, equaling the alltime low for the United States recorded last year, as compared with 26.0 in 1960. For white infants the 1962 rate was 16.9; for nonwhite infants it was 26.1. The maternal death rate, which stood at 317 deaths per 100,000 live births in 1941, reached a low of 35.2 in 1962, as compared with 36.9 in 1961 and 37.1 in 1960. The rate for white mothers in 1962 was 23.8: for nonwhite mothers, 95.9. In 1962 the expectation of life at birth was 70.0 years, slightly under the 70.2 figure of 1961, again because of the greater incidence of 128 Department of Health, Education, and Welfare, 1963 CHART 4.—DEATH RATES: DEATH-REGISTRATION STATES, 1900-62 1900-1962 (RATES PER 1,000 POPULATION) 1Ig00 1910 1920 1930 1940 1950 1962 CHART 5.—AGE-ADJUSTED DEATH RATES: DEATH-REGISTRATION STATES, 1900-62 (RATES PER 1,000 POPULATION) = 15 1900 1910 1920 1930 1940 1950 1962 Public Health Service 129 respiratory disease in 1962. The 1962 expectancies by color and sex were as follows: White males, 67.6 years; white females, 74.4 years; nonwhite males, 61.5 years; nonwhite females, 66.8 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 4,167,362 live births registered in 1962 were about 100,000 fewer than the 1961 total of 4,268,326. Since the number of births has not changed greatly during the past 6 years, while the population has continued to grow, the crude birth rate has declined somewhat each year since 1957. The rate was 25.0 in 1950 as compared with 23.3 in 1961 and 22.4 in 1962. The fertility rate, or number of live births per 1,000 women 15-44 years of age, also has declined somewhat each year since 1957. The 121.2 rate for 1957 was higher than any rate since World War I, which indicates that the changes under discussion are going on at a level well above the rates of the middle 1930’s. In 1962 the fertility rate was 112.1 as compared with 117.2 in 1961 and 118.0 in 1960. In 1962, an estimated 1,580,000 marriages were performed, as com- pared with 1,547,000 in 1961. The marriage rate remained at 8.5 per 1,000 population, unchanged since 1959. There were an estimated 393,000 divorces in 1960, as compared with 895,000 in 1959. The 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 $2,140.2 million. (See table 1, p. 210.) Appro- priations and authorizations accounted for about $1,593.2 million of this amount. The balance was made up of repayments for services given to other agencies and of unobligated balances from previous years. Approximately 50 percent of the total funds available was obligated to others, in the form of grants and research contracts to State and local agencies, private institutions, universities, hospitals, and individ- uals outside the Federal Government. The remainder was used to support the direct responsibilities of the Public Health Service, such as hospital and medical care for legally designated beneficiaries, for- eign and interstate quarantine, and Indian health services. 130 Department of Health, Education, and Welfare, 1963 Office of Personnel Significant progress was made during the year on a major reorga- nization to improve the PHS personnel system. Responding to the 1962 recommendations of the Advisory Committee on Public Health Service Personnel Systems, a program has been developed and exten- sively implemented to strengthen staff services, improve operations, equitably adjust pay and rank, and generally provide a more efficient, responsive staff. The continuing goals of the Office of Personnel are to better utilize “on board” personnel; to attract more top-quality individuals at all levels; to further integrate Civil Service and Commissioned Corps personnel systems, to establish closer “top-to-bottom” coordination throughout the Service; and to acquire and train the manpower essen- tial for the ever-broadening PHS responsibilities of the future. Personnel On June 30, 1963, the Public Health Service had a total staff of 34,799, an increase of more than 6 percent over June 30, 1962. (See table 2, page 211.) This number included 4,929 Commissioned Corps Officers, 28,337 full-time and 1,533 part-time Civil Service em- ployees. (See table 3, page 213.) Commissioned officers on duty included 2,067 members of the Regular Commissioned Corps, and 2,862 members of the Reserve Corps on Active duty, of which 169 were on temporary training duty. National Center for Health Statistics The National Center for Health Statistics in the past year devoted major attention to improving its publications program. Publications activities were centralized in the Office of the Director. Previous mailing lists maintained in the National Health Survey and the Na- tional Vital Statistics Divisions were discontinued and a new consoli- dated mailing key was established for the Center. A new publication Series was initiated, placing most of the Center’s publications under a Single system. Another major development during the year was the establishment of a new training program for statisticians, mathematicians, and social science analysts. The aim of the program is to stimulate the recruit- ment of qualified personnel in these professional areas. Under the program, qualified college and university graduates are selected to serve for approximately a year in specially developed training assign- ments in the Center’s various program areas. Trainees participate in MPublic Health Service 131 a series of seminars and are encouraged to further their academic preparation by part-time attendance at local colleges and universities. NATIONAL HEALTH SURVEY DIVISION An historic “first” was scored during the year; namely, the comple- tion of the first cycle of 6,672 health examinations of adult Americans (ages 18 through 79 years). The survey was the first of its kind ever undertaken in the Nation. From the data collected, health offi- cials will have information on the prevalence of cardiovascular dis- eases, arthritis, diabetes, and dental conditions, and the levels of acuity of hearing and vision in the population. In addition, data on a variety of physical and physiological measure- ments will aid health officials and private agencies in making decisions to improve the health of the people. Later in the year, planning and pilot testing of a “second cycle” of health examinations for children (ages 6 through 11 years) were completed for a 3-year program with emphasis on collection of data related to growth and development. Work on the Division’s newest data-collection program, the Health Records Survey, resulted in the collection of data for all types of resi- dent institutions and hospitals in the Nation. These data are being tabulated and analyzed in preparation for a report describing facili- ties which provide nursing, residential, or personal care. Meanwhile, planning and pretesting were started for a new hospital discharge survey to obtain from hospital discharge records detailed information on the volume, kinds, and characteristics of hospital stays. The National Health Survey Division continued its research and developmental activities, including quality control and surveillance of all operating programs, special research studies in methodology on household interview reports concerning hospital experiences, a special oral glucose tolerance test, a measurement of health expendi- tures, and the calibration of testing equipment for visual acuity. The Health Interview Survey produced its 50th report by the end of the year. The year’s output of reports included publication of new information on the volume of X-ray visits and types of accidental injuries. Data was collected to evaluate the reliability of reporting on the volume of medical visits. Another major project was the evaluation and interpretation of data on chronic diseases. NATIONAL VITAL STATISTICS DIVISION The Division continued to reduce the timelag between the receipt of data from the States and its publication. An advance natality report for 1962 was published within 8 months of the end of the data year, and an advance mortality report a month later. At the close of the fiscal year, plans were being carried out to prepare all birth 132 Department of Health, Education, and Welfare, 1963 a and death tabulations for 1962 for printing within 12 months of the close of the data year. Extensive tabulations on occupational mortality were completed, drawing upon data from vital records and from 1950 census records. The Division also completed a major part of the tabulations needed for a series of monographs sponsored by the American Public Health Association to synthesize data of concern to public health and demography. A national natality sample survey was inaugurated, based on a sample of births occurring throughout the country. (A similar national mortality sample survey is in its third year of operation. ) The new survey will use information contained on birth certificates in order to obtain additional data of interest to public health and demography. The major topic under study for the first year is the exposure of mothers to ionizing radiation during the year before birth of a child. A color film, “Medical Certification of Causes of Death,” was made under the Division’s direction. The film will be shown in hospitals, medical schools, schools of nursing, and health departments to en- courage more complete reporting on death certificates. Extensive activities involving study-group meetings and the cireu- lation and analysis of questionnaires to numerous governmental and nongovernmental agencies and individuals were initiated to carry through revisions of the standard certificates of live birth, death, and fetal death and the standard records of marriage and divorce or annulment. A series of regional institutes was established to train State person- nel in new operational techniques. The first series of these institutes was concerned with vital-records management. The institutes feature relatively short conference-seminar sessions and are led by outstanding experts in fields of particular interest. OFFICE OF ELECTRONIC SYSTEMS By the end of the fiscal year, several statistical programs of the National Health Survey and National Vital Statistics Divisions had been transferred from the Remington-Rand UNIVAC computers to the IBM 1401-1410 computer system. The changeover resulted in elimination of the backlog in processing and placed the data programs on a current schedule in the National Vital Statistics Division. The effect on the National Health Survey Division’s programs was to con- vert to the more powerful IBM system the data-processing systems and data files which are used in processing health characteristics of sample households to produce estimates and rates for the national population. | | Public Health Service 133 OFFICE OF HEALTH STATISTICS ANALYSIS The Office continued its study of changes in the general mortality and infant mortality trends in the United States. Contracts were negotiated in several foreign countries for studies to determine the possible factors responsible for changing mortality trends in various parts of the world. Studies of the mortality trend for pneumonia and for selected causes in this Nation and in Chile were completed. A study to develop an index of health is underway. Analysis of multiple causes of death in 1955 is proceeding, and the eighth revision of the international classification of diseases is nearing completion. National Library of Medicine The constantly increasing medical research effort has required the development by the National Library of Medicine of a system which can accommodate the vast amounts of information being generated. This requirement is being met by the Medical Literature Analysis and Retrieval System. MEDLARS, which will become fully opera- tional in early 1964, is founded on an understanding of indexing technology derived from the Library’s 80 years of bibliographical experience with the literature of medicine and public health. MED- LARS will handle a larger volume of published literature than any existing system. The 250,000 citations it will handle annually repre- sent a large proportion of the total scientific literature. MEDLARS comes into being at a time when computer technology and the availability of computers in medical research institutions throughout the United States will permit the multiplication of its search potential by the duplication of searchable tapes. The Library intends to make this new electronic retrieval power available generally to other medical libraries over the next 5 years. The first pilot program to extend the MEDLARS facility to the medical research community is proposed for 1965 and would equip selected medical libraries to search the organized store of information which has been centrally compiled at the Library. The extension of MEDLARS search capabilities, when coupled with photoduplication services to provide physical access to medical literature, will enable libraries to meet modern research requirements for information with unprece- dented effectiveness. BOARD OF REGENTS The Board of Regents held two meetings, on November 5, 1962, and on March 29, 1963. New members appointed to the Board were Dr. Henry N. Harkins and Dr. Alfred A. Gellhorn. Items on the agenda 134 Department of Health, Education, and Welfare, 1963 for the Board’s two meetings included the Library’s publications program, budget projections, extramural program plans, the develop- ment of the MEDLARS system, and the role of the National Library of Medicine in training and research in the area of science communica- tions. SECOND INTERNATIONAL CONGRESS ON MEDICAL LIBRARIANSHIP The staff of the National Library of Medicine provided major planning and management services for the Second International Con- gress on Medical Librarianship, held in Washington, D.C., June 16-22, 1963, under the sponsorship of the Medical Library Association. The purpose of the Congress was to foster the development and improve- ment of medical library services throughout the world. More than 1,000 medical librarians from sixty countries attended. PROGRAM STATISTICS In fiscal year 1963 the Library acquired 16,151 books, 67,832 serial pieces, and added 956 new serial titles, increasing its collections to 1,098,006 items. The History of Medicine collection was increased by 300 old and rare items. The staff cataloged 15,273 titles, and 876 pictures and other items were added to the Prints and Photo- graphs Collection. There were 205,709 volumes circulated, and 13,418 reference questions answered. Main entries published in the Vational Library of Medicine Catalog totaled 15,592. The Indea Medicus pub- lished 139,462 items from 2,244 journal titles. Interlibrary loans increased to 135,344. Microfilm production amounted to 3,215,649 pages, of which 821,989 were for preservation purposes and 2,333,686 pages for interlibrary loan. Division of Public Health Methods The Division of Public Health Methods conducts studies to identify emerging national health problems and to assess the significances of social, scientific, economic, and educational developments of health services and resources. In these areas, the Division provides advisory and consultative services within the Service, to other governmental agencies, and to national professional and voluntary agencies. HEALTH MANPOWER Three additional sections of the Health Manpower Source Book Series were published during the year: Section 14, “Medical Specialists,” presents basic data on the num- bers, distribution, and characteristics of physicians engaged full- or part-time in medical specialties. Information on physicians by type Public Health Service 135 of practice and by type of specialty is shown for selected years be- tween 1931 and 1962. For 1961 there are separate sections for each of the 26 specialties with detailed findings on certification, type of prac- tice, age, sex, State location, and medical schools from which the specialists graduated. Section 15, “Pharmacists,” gives information on the numbers, loca- tion, and characteristics of pharmacists in the United States in 1962. Its appendix presents statistics on undergraduate student enrollments 1958-63, and graduates of U.S. schools of pharmacy from 1932 to 1962. Section 16, “Sanitarians,” compiled in cooperation with the Office of Resource Development, presents basic data on the numbers, loca- tions, and characteristics of sanitarians in the United States as of mid-1962. A projection of the number of physicians to 1975, prepared in the Division and published in the American Journal of Public Health, showed that there will be a decline of the physician-population ratio from present levels despite the addition of graduates from the new medical schools now proposed and of foreign-educated physicians. ECONOMIC STUDIES Long-range work on the economic impact of health services was begun, with twin objectives: (a) Identification of those aspects of the topic which should be studied by the Public Health Service or under its auspices, and (6) appraisal and further development of method- ology for use in such studies by the various levels of government. The most promising aspect of the topic thus far appears to be costs-versus- benefits studies, limited to geographic area or disease entities, or both. As a means of stimulating interest in such research, the Division co- operated with the American Public Health Association in planning a panel on economic benefits for the November 1963 meeting of the association in Kansas City. TECHNICAL AND STAFF ASSISTANCE In connection with the Division’s responsibility for the coordina- tion, analysis, and review of PHS survey projects, which includes liaison with the Bureau of the Budget on the clearances required by the Federal Reports Act, an informal working agreement was reached with the Bureau of the Budget for waiving clearance on certain classes of forms and for abbreviating procedures on others. The arrange- ment is being tested and developed further. The Division has provided staff services for the Surgeon Gen- eral’s Committee on Urban Health Affairs, a newly constituted public advisory group under the chairmanship of the Assistant Surgeon Gen- eral for Plans; for the Surgeon General’s annual conference with 136 Department of Health, Education, and Welfare, 1963 State and territorial health officers; and for the PHS Committee on Aging. A compilation of PHS laws in effect on December 31, 1962, was prepared for the Committee on Interstate and Foreign Commerce of the House of Representatives. Other activities have included preparation of the Surgeon Gen- eral’s quarterly report to the Secretary, a newly assigned respon- sibility; collection within the Public Health Service of the monthly revisions for “HEW Indicators” and the annual revisions for “Trends”; preparation of the PHS portion of the annual edition of the “Handbook on Programs”; participation in a PHS mission to Yugoslavia vis-a-vis projects using Public Law 480 funds; review, in collaboration with the PHS Executive Officer, of internal audit activi- ties of PHS and the preparation of a report; membership on the HE W Waiver Review Board, the National Science Foundation’s Advisory Council on Scientific Manpower, the Task Force on Tax Policy and Educational Expenditures, and the Task Force on Federal Education Programs; assistance to the Pan American Sanitary Bureau in plan- ning for a conference on the development of methods for studying the medical education and health manpower requirements of Latin America; technical assistance to the Mayor’s Advisory Committee on the Establishment of a Medical School in Norfolk; and continuing staff services in support of the Assistant Surgeon General for Plans. Office of International Health The Secretary approved a reorganization elevating international health activities to the status of an Office of International Health. During the year, the Office arranged the official U.S. representation at the 16th World Health Assembly in Geneva, Switzerland (May 1963) ; the 31st and 32d sessions of the Executive Board of the World Health Organization, also in Geneva; the XVI Meeting of the Pan American Sanitary Conference in Minneapolis (August 1962) and the 47th and 48th meetings of the Pan American Health Organization’s Executive Committee in Minneapolis (September 1962) and in Wash- ington (April 1963). In addition, the Office was represented at the 13th meeting of the Research Council, South Pacific Commission in Papeete, Tahiti (April 29 to May 3, 1963). The Office, in consultation with the Department of State and other branches of the Service, helped to develop the official U.S. policies on the topics discussed at these international health meetings. The Office also participated in developing the U.S. position on health-related matters which came before the meetings of the Food and Agricultural Public Health Service 137 Organization, the United Nations Children’s Fund, the International Labor Organization, the Social Commission of the United Nations, and the South Pacific Commission. The Office assisted in clearing the appointment of more than 80 U.S. experts to serve as members of WHO expert advisory panels and as short-term consultants to the World Health Organization and the Pan American Health Organization. Seventy of the U.S. experts who are serving as members of WHO panels are Public Health Service officers representing 40 health and medical specialties. The Office arranged to continue the assignment of 46 Public Health Service officers to the Agency for International Development for tech- nical assistance and advisory services in 18 countries. Thirty-nine Service officers were detailed to staff the medical organization of the Peace Corps. These officers, principally responsible for the health of Peace Corps volunteers in 34 countries, also supply local health and medical service. The Office provided program guidance to 592 foreign visitors and students from 87 countries, involving more than 150 educational and training centers in the United States. Consultation was given to stu- dents and visitors in the United States, and a number of U.S. educa- tional institutions were advised on the special needs of foreign students and visitors. The Office made arrangements under a United States-U.S.S.R. agree- ment for receiving five Soviet delegations and for sending three U.S. delegations to the U.S.S.R. One joint meeting in cardiovascular dis- ease was held in the U.S.S.R. and two joint meetings in cardiovascular disease and rheumatic disease were held in the United States for ex- changing views and scientific information in these fields. Five U.S. scientists visited the Soviet Union for periods of four to ten months each, and eight Soviet scientists visited the United States for periods of four months each. Division of Health Mobilization In a national disaster, every community will be faced with the task of meeting the immediate health needs of its civilian population. Sufficient medical supplies and hospital facilities must be available, with predesignated personnel organized and trained to act in an emer- gency. By Executive order, PHS is charged with assisting the States and communities in meeting these responsibilities. The value of disaster preparation was demonstrated this year when the Division applied emergency health plans during the removal from 711-845-6410 138 Department of Health, Education, and Welfare, 1963 the Mississippi River of sunken tanks of deadly chlorine gas that were endangering the citizens of Louisiana and Mississippi. All programs were strengthened during the year by the addition to the Division field staff of 38 new State representatives, augment- ing the existing field staff of 9 regional and 7 State representatives. The staff members have been instrumental in furthering emergency — health preparedness by arranging training programs; coordinating medical stockpile inspections; assisting in the development and evalua- — tion of community plans; and securing the cooperation of medical societies, other allied health groups, and civil organizations, Quality controls and a plan of regular inspections were established to assure readiness of supplies in the emergency medical stockpile, now valued at approximately $200 million. Materials are stored in de- pots and allocated to Civil Defense Emergency Hospitals (CDEH’s). A program is underway to provide underground storage locations for bulk stocks because such space offers superior conditions for long- term preservation and protection of supplies. In carrying out this program, the Division acquired 250,000 square feet of usable space in a worked-out limestone mine at Wampum, Pa. The 200-bed CDEH’s are now pre-positioned in 1,930 State-pro- vided facilities. The Division is currently working to increase their operation capability from 3 or 4 days to 30 days. An additional 750 hospitals are being assembled which will bring the number of pre- positioned CDEH’s to 2,680. To familiarize designated staffs with contents and operation of the CDEH, 12 prototype Emergency Train- ing Hospital Units were acquired and are being field tested. Physicians, as well as members of allied health professions, must be trained to provide services in a disaster which are not a part of their usual peacetime activities. Research was begun to determine how the present functions of paramedical personnel can be adapted to meet emergency needs. Since immediate medical care will be limited to that available in shelters, the general public also must know how to provide emergency medical care. The Medical Self-Help Training Program allocated almost 30,000 training kits to instructors this year. About 388,000 people have completed formal training, and some 400,000 more have viewed the lessons on television. The ultimate goal is to train one member of every U.S. family. Bureau of Medical Services The Bureau of Medical Services operates hospitals, clinics, health centers, and other health services in this country and abroad, on land and at sea, in major ports and on remote inland reservations. Some Public Health Service 139 14,000 staff members are engaged in these activities that provide direct health care to many people and help to safeguard the Nation’s health. Medical and hospital care is provided for American seamen, mem- bers of the Coast Guard and the Coast and Geodetic Survey, and cadets at the Coast Guard and Merchant Marine Academies. Inter- national travelers arriving from foreign points are checked against any possibility of contagious disease. American Indians and natives of Alaska are given comprehensive health care. Members and retired members of the Armed Forces and their fam- ilies receive care at hospitals and clinics of the Bureau where more convenient than military hospitals; in turn, Public Health Service commissioned officers may receive care in military facilities. A special hospital is devoted to the treatment of leprosy. Treat- ment for narcotic addiction is given in two neuropsychiatric hospitals. The Bureau is responsible for medical and hospital care in the Federal prisons and correctional institutions throughout the country. Medical and hospital care for civilian employees of the Govern- ment who are injured on duty or become ill from causes related to their work is administered by personnel of the Bureau. Employee health units are operated for a number of Federal departments and agencies. The Bureau is guided by recommendations of the BMS Advisory Committee on Hospitals and Clinics, and the Indian Health Advisory Committee, made up of experts from hospitals and health programs all over the country. Division of Hospitals The mission of the Division of Hospitals—oldest organizational unit in the U.S. Public Health Service—is to provide medical care for American seamen and other beneficiaries designated by the Congress. More than 385,000 persons qualify for care. In addition to seamen, patients include Coast Guardsmen and their dependents; members of the Army, Navy, Marine Corps, and Air Force and their depend- ents; commissioned officers of the Public Health Service and the Coast and Geodetic Survey and their dependents; Federal employees in- jured in line of duty; any person having leprosy; and any person addicted to narcotic drugs. The Division is the principal source of training in the Public Health Service for physicians, dentists, pharmacists, and other paramedical personnel. Research is conducted in the clinical management of dis- ease and health problems. 140 Department of Health, Education, and Welfare, 1963 PATIENT CARE Admissions to the 15 hospitals operated by the Division in fiscal year 1963 totaled 52,346—an increase of 2.1 percent over 1962. In addition, 1,022 babies were born. ‘The average daily inpatient census declined 2.2 percent to 4,693, but the number of outpatient visits increased 5.8 percent to reach 1,352,506. Uniformed service personnel and dependents accounted for 34 per- cent of all admissions and 39 percent of all outpatient visits to Public Health Service hospitals and clinics. Outpatient visits of military personnel and dependents increased by more than 20,000 over the previous year. CARVILLE LEPROSARIUM In April 1963, the PHS hospital for leprosy patients in Carville, La., in cooperation with the American Leprosy Missions, held the fourth annual leprosy seminar, featuring some of the world’s fore- most leaders in the field of Hansen’s disease. The hospital in Car- ville is an internationally recognized center of knowledge about leprosy and has accomplished much in improving the medical treat- ment of patients and also in dispelling the erroneous psychological fears that historically have been attached to this illness. DRUG CONTROL The Division of Hospitals has had for several years a well-developed control program for investigational drugs. In addition, each hos- pital has an active pharmacy and therapeutic committee which reviews and advises the staff as to the efficacy and hazards of all therapeutic agents. In cooperation with the Food and Drug Administration, the Division has improved its reporting of adverse reactions to drugs. PROFESSIONAL TRAINING A total of 36 resident physicians completed formal training in the following specialties: Anesthesiology, internal medicine, obstetrics- gynecology, ophthalmology, ophthalmology and otolaryngology, path- ology, psychiatry, radiology, surgery, and urology. Five resident physicians completed training in general practice and two completed training in research methodology. Ninety-nine medical interns com- pleted their training in the Division’s hospitals in June 1963. In order to provide trained personnel for Service needs in areas where in-service training is not available, physicians and other health personnel are given opportunities each year to pursue specialized study outside the agency. There were 15 persons attending 10 uni- versities in the past year. ttt Public Health Service 141 RESEARCH In the interest of improved patient care, five of the general hospitals now have an established research service with a full complement of professional and technical staff. They are conducting clinical inves- tigations of a wide variety of disorders, mainly related to problems of cardiopulmonary physiology. In addition, there is a seven-hospital cooperative research program, under the auspices of the National Institutes of Health, for the study of antihypertensive drugs. Data from the first studies are being analyzed. There are also established cooperative arrangements with the National Cancer Institute for clinical trials of cancer therapeutic agents. In the Boston PHS Hospital, a 25-bed unit has been estab- lished as a part of this program. Plans are underway to set up a similar unit at the Baltimore PHS Hospital. More than 50 scientific papers were written for professional jour- nals. One of the most outstanding was “Value of Prolonged Bed Rest in Management of Cardiomegaly,” which originated in the New Orleans PHS Hospital; it was published in the Journal of the Amer- ican Medical Association. GOALS Modernization and improvement in the physical structures, and, in some areas, new construction, are needed to enable the PHS hos- pitals and outpatient clinics to carry out their mission efficiently. Because of the large number of patients seen at these facilities, and the varieties of disease entities presented, there are exceptional oppor- tunities for research. Some of the country’s leading medical schools are thus affiliating with the PHS hospitals in conducting research programs. The Division plans to expand its research program as funds and physical facilities are made available. FEDERAL EMPLOYEE HEALTH PROGRAM The Division conducts a health protection program for Federal employees by operating health units for Federal agencies on a reim- bursable basis. At present, there are 38 of these units, which serve 63,000 employees. Each unit is under the professional direction of a physician. Visits to the health units during the year totaled more than one quarter of a million. Mass immunizations against polio, smallpox, tetanus, and influenza, as well as tests for diabetes, glaucoma, and visual acuity, were given at the health units in 1963. The number of immunizations were as follows: influenza, 29,344; poliomyelitis, 7,957; smallpox, 14,671; 142 Department of Health, Education, and Welfare, 1963 tetanus, 10,685 ; diabetes, 10,237; glaucoma, 6,913; visual acuity, 14,613. Periodic health examinations are given for employees who are 40 years old or older. These examinations totaled 5,209 in 1963. The Division hopes to extend the Federal Employee Health Pro- gram to all Federal employees in the coming year and to conduct periodic health examinations for Government employees comparable to those provided in private industry. FREEDMEN’S HOSPITAL In 1963, Freedmen’s Hospital in Washington, D.C., provided care for 15,393 patients. The average daily census was 384. There were 3,564 live births recorded. Outpatient visits to clinics and emergency room totaled 100,917, an increase of 4,290 over 1962. A new 50-bed pavilion was opened in February 1963, representing a most significant and progressive step toward better patient care. The attending and consulting staffs of physicians and dentists totaled 247, with 113 members on the courtesy staff. All training accreditations of the hospital were maintained. Freed- men’s Hospital serves as the clinical teaching facility for junior and senior students of Howard University’s College of Medicine. It also offers approved medical, dental, pharmaceutical, and dietetic intern- ships; residency training in 14 medical specialties; and residency training in hospital administration. Sixty-two residency appointments were filled during the year; 21 graduates of foreign medical schools were among the residents. There were 19 medical interns, 4 of whom were foreign students; 2 dental interns; 2 pharmaceutical interns; 10 dietetic interns; 5 research fel- lows; and 2 administrative residents. The School of Nursing graduated 25 student nurses, raising the total of the school’s graduates to 1,505. The School of X-Ray Tech- nology graduated 4 students and now has 60 graduates. Fifty-five clinical research projects were in progress during the year, and nearly 50 scientific articles by staff members were published. For the fourth consecutive year the hospital participated in the Junior Red Cross volunteer program. The adult volunteer program and the women’s auxiliary provided volunteers throughout the hospital. Division of Foreign Quarantine The Division of Foreign Quarantine guards the Nation against the introduction of disease from abroad. At more than 300 ports of entry in the United States, the Division performs health inspections of international travelers, conveyances, and certain imports. At Public Health Service 143 major consulates in Europe, Canada, Hong Kong, Jamaica, and Mex- ico, visa applicants are given medical examinations. Every day 20,000 travelers are cleared through quarantine. Of these, 1,000 are arriving only a few hours or days after leaving Petree where such diseases as smallpox, yellow fever, and cholera are present. This number, moreover, is growing—and with it the danger of importing qisrantinabis diseases into the United States. The transworld jet plane has brought the quarantinable diseases to our doorstep. At no time has the need for constant vigilance been greater. QUARANTINABLE DISEASES IN THE UNITED STATES For the 16th straight year, the United States did not have an outbreak of quarantinable disease known to have been introduced from abroad. In August 1962, a 15-year-old Canadian boy with incubating small- pox—but showing no symptoms—on the way from Brazil to Canada was cleared through quarantine at New York. His certificate of vaccination against smallpox had been issued by a Brazilian district department of health and bore the signature of the vaccinating phy- sician and a stamp of that department. Later investigation, with the help of Brazilian health authorities, revealed that the boy had not been vaccinated as stated in his certificate. Fortunately, there were no secondary cases of smallpox either in the United States or Canada. This incident, which was widely publicized, alerted the country to the danger of imported disease from abroad. It also stimulated increased response to the longstanding efforts of the Division of Foreign Quarantine to promote current smallpox vaccination for per- sons having frequent contact with international travelers and for those who meet and treat the sick. Rodent plague was identified in a dead rat in San Francisco March 12, 1963. ~Aasto MON 989 ‘6c8 % 0 000 ‘eT 889 ‘TE 188 ‘O8F ‘1 662 ‘FST SF8 ‘F9 QGP ‘PIS SVP 168" lea rae eee pee oe ~omrgsdure Hy Mo NT SIZ ‘089 % 0 009 ‘8 G28 'LTE SPL GPL 'T 916 ‘681 008 ‘8 T82 ‘90 100 SOUE Me wee pe eee ae ee es ee BpBAON $99 ‘826 °¢ 0 008 ‘aI 086 ‘29 T GE8 ‘180 '€ 928 ‘96F 668 ‘SOT OFS ‘E8z $70) L605 ee te ae ape ee ae ee BysvqaN G9L ‘295 '¢ 0 OOb ‘IT 169 ‘290 ‘Z £94 ‘ZIP ‘% G89 ‘88% 900 ‘82 880 ‘91% COUPES we |e Ca ae ee ee Bue UO, 6F9 ‘EB ‘¢ 0 009 ‘OT 6LL‘PSh OEP ‘OSL E £6 ‘GFT ‘T PFO ‘IST 119 ‘208 CROSGTON mee ||P apse ge ee Soe Seen ae nae ~TaMOssT Ay $03 ‘889 ‘8 0 002 ‘Zr 866 ‘ZEL 289 ‘808 ‘T £10 ‘068 TI@ ‘2 ZLL ‘TS SEOUL rat Meo ae ae ae ee 1d dIssTssIpL ITF ‘280 “F 0 009 ‘ZI PSP ‘CPL O9T ‘O19 9FE ‘690 “T 506 ‘O9T PPI ‘18Z SOR ODL, ly a| ee aes eae ae BIOSOUUL AL 6FL ‘E81 ‘8 0 009 ‘aI 629 ‘TLE ‘% LPL ‘188 020 ‘269 ‘T PES ‘FES 66 ‘G88 OCS OSTEL Ph PRs 35 Ske | ee ee ee ae UBS 09 ‘622 ‘I 0 OOF IT PLE ‘P29 'T 066 ‘T&€ '8 GOT ‘SEL 819 ‘26 OLE ‘ZZE PES) C00" Mle so es eee ne S}osnyoesse 289 “PE6 ‘FL 0 008 ‘TT 129 ‘GL4‘T 299 “60 “IT 618 ‘c0¢ 288 ‘ZZT O0L ‘Elz SECIS i: sea Tense ses ~=see = puvypAreyy ZZ ‘$88 ‘E 0 986 ‘IT TILT ‘01 LES ‘19% % 628 ‘897 See ‘98 880 ‘82% POR SOh? . Sh aR Sa ee eee ee ouIvIT $99 ‘Tee ‘8 0 008 ‘TT 806 ‘89 0g8 ‘088 ‘T GOL ‘662 SIP ‘2ST OTF ‘222 LLESOSORe: Be gee son S Pa" e dees ea ee BuRIsSmMoyT £82 ‘298 ‘Fb 0 008 ‘6 000 ‘eg 61L ‘619 ‘T 168 ‘F00 ‘T 688 ‘Z0Z FIZ ‘ZLZ OLG SCE ee |S Se ee ee eee Ayonuey $99 ‘OEP 6 oF, OOF ‘81 $90 ‘LLP 118 ‘GIL ‘9 S8T ‘409 PSP ‘OL €8z ‘Tae 106) 16657 som (| “on See ae Pee ge a sesuey P88 ‘696 ‘8 000 ‘¢ 002 ‘FI £20 ‘FL €82 “990 ‘T 186 ‘610 ‘T 960 ‘291 PFS ‘COZ LOB.'SGF To RE oS So eee oe BMOT 996 ‘ObL ‘F 0 009 ‘aT 249 ‘GF $06 ‘9L€ ‘T O68 ‘FPL ‘T 826 ‘TZ 228 ‘OLE PSP THOS | eo eee ee ees eee vueIpuy 2P9 ‘216 ‘OL 0 000 ‘TT 966 ‘0zG 99F*180'9 ~| 802 ‘F28‘T OSF ‘bas 819 ‘6EF PIG S00'8 = Fs Se ee Co ee STOUNT[L 102 ‘P92 ‘€ 0 000 ‘81 £18 ‘28d, 02 ‘910 ‘2 99F ‘LL 620 ‘FL 898 ‘C1 GGL ‘PLE 029 ‘Sor ‘2 0 002 ‘ZI 009 “FEE ‘T 898 ‘CHF ‘S SLO ‘S61 909 ‘FS 0F0 ‘STZ TOL ‘902 86F ‘228 ‘OL 0 009 ‘ZT O89 ‘TL0‘T SIF ‘SIL ‘9 TLL ‘690‘T 999 ‘2LT E2L ‘862 006 ‘TSP ‘T PIF ‘229 ‘0% 890 “Z6L ‘L 000 ‘IT G18 ‘LOL ‘S 6FG ‘SoE‘L 89 ‘E28 029 ‘99T £69 ‘LT TLE; 890 'C cue | POT ee ae ee ae ee epHoLa TPS ‘26 0 0 0 0 688 ‘OZI 0 0 COOMLETS Gee | ge Se oo oe pre BIQUIN[OD JO 41ST 29G ‘69F ‘T 0 O0T ‘9 0 PLP ‘182 Z98 ‘88T Fle ‘19 809 ‘O1Z P78, 0G. SS |7A se Se SE ee o1VMBTOC 6ST ‘268 ‘¢ 0 6E8 ‘6 OF ‘TLE ‘T TPL ‘L09 ‘% 816 ‘OLF C28 ‘TL 092 “092 PLL OOEST ) Sh) 280°" 22> ee ae ee ce qnotjoouu0*D 290 ‘022 ‘OL 0 002 ‘ZI TL¥ ‘208 ‘T Tre “869 ‘2 690 ‘088 692 ‘G8 689 ‘ThZ S80 O8F qs figs 96° aa eo ee opei0}OD 629 ‘920 ‘89 0 TPE ‘8 OFS ‘LF9 ‘6 LLP ‘T19 ‘6F gc ‘eos ‘Z 080 ‘0sz 089 ‘E1¢ 008! 0809; se, | "Se aan see aa eee cee BIULOJTTeO, FIG ‘286 ‘8 0 009 ‘ZI 998 ‘209 PSE ‘669 ‘T 1¥6 ‘Sh9 002 ‘OFT BSF ‘ZG 003 "S894 aay |"Sa> Gano w ee a a ap SBsuByIy GCL ‘TLE ‘L 0 eee ‘2 P9E 866 ‘T 108 ‘F8F ‘¢ Shr ‘OFZ 889 ‘ZL TS6 ‘08% PST OGG? oe |S. tas ee oat | Sea eee cm BuoZzy Gl ‘SIF ‘6 0 0 2£9 ‘099 208 ‘008 ‘8 PEE ‘OT LIZ ‘68 928 ‘S0Z 96 ‘6IT eT we sea eo cae SEAS 682 “GOP ‘8 0 008 ‘IT 080 “699 ZL ‘FOB ‘G 899 ‘826 192 ‘FST L¥9‘L1Z TES BOS = | Be aie ae aa a a aie vuleqely 880 ‘gs ‘Fors | 890 ‘262 ‘24 £88 ‘opag GOL “E82 “89$ | 068 ‘9EL ‘9LZ$ es] GOE FF ‘TIFF | 088 ‘99% ‘Z$ 000 "008: RIS, “| OTS “S86: 20$'s I ai ge tae T810.L (S18 Mey (PL8 Mery, $}18 meis01d o1rqnd) oqnd) uor}Bonpes oruBvyyoul SOTILATIOV [PIOL sosNjol popiejor UWOlpon.14YSMOD STOOPS Jo [BUOTIBOOA SOOTAIOS oq} pus [euor}eonps A10V1110} Jo 97819 ueqng ATpey Ue PL jooyag uoreisdo pus] 9Atyerodo0og AIVIQVT IN} NOI3B osuIod aUBUOPUTBIAL 1961 404 poosyf IO} SoZ2TOO ‘uonvonpy {9 a1fQ *S°) eYy2 Aq pasaistunupy ‘stun oo0] puv saInig 0} a2uD\sissD pIQUDUYL 412YyI0 pub sjuDiQ— | 24P], 281 Office of Education ‘96L'SST'2$ ‘O0IOT ITY PUB ‘PEs ‘OTL'Z$ ‘AABN ‘E10'ST6'Z$ OV WOvONp| esuojoq [euoNeN oy} Jopun (saeig Woy PeYysNsuyystp Sv) SMOTyNyT}SuT ‘Autry :0781g Aq e[qeoorye A[sJedoid Jou ‘seoJ0,g poully 0} opeuUl s}uourAed Sopnpuy ¢ 0} pred syunoure Jo ssouvApe o[qeAvdol pus SUBOT JOJ pred syunoUe Opnypouy Jou saoq zg “oge*ect ‘6g ‘symsind *eeA WATS B JO} SoIn} [BUOT}CONpd UI SoosNyor UEGND ISISSv 09 Sa}VIG ULH} JOY} SUOTJOIpSTM! 09 Jo ‘ege‘g6z‘9EI$ -TpUedxo Jo S}UOUT}OTTB YILM der3e ATLIessooou jou SIO = ‘“SISBQ PONSST-SYOYO & UO 1 TS FS ‘G89 ‘ZT 0 0 0 PFS ‘G89 ‘ZT 0 0 0 0. 2 Br Sa Se eee “¢ pemnqrjsipun 96F ‘BIZ 0 0 0 1F8 ‘801 Pad ‘OF 288 ‘9 0 1 em eis ate «aks pase a SS SpuUeIsy ULSI £83 ‘060 ‘S 0 0 0 0 192 ‘F06 689 ‘SOT 9F8 ‘Gc LESSTOLS “SS | 5" sSeu ce ae a Soa --“Od1yY OJON 6¥6 ‘OIL ‘T 0 Oe. 8F0 ‘89 £08 ‘026 66 ‘6g 220 ‘IT 0 629 ‘09 "a Ss OM ae ureny ST9 ‘O9F ‘T 0 008 ‘6 198 ‘STL 80 ‘626 208 ‘SOT 186 ‘89 SF8 ‘L0G (694 ‘02) ona: ak a at ea ae eS tes ~--Buyur0£ M 220 ‘499 F 0 000 ‘eT 9g9 ‘gce 099 ‘822 026 ‘FEI ‘T 098 ‘FLT 66 ‘862 20206 RT ae | aaa gaara ee Te eo ee UISMOOST 966 ‘€F6 ‘T 0 008 “TT 009 ‘4 628 ‘99T 988 ‘66h 962 ‘2ST 026 ‘FFG PISSIO8 > Sa |io" Sek" pa ae aes 7 ee BIUTZITA SOM 960 ‘ZIP ‘8T 0 002 ‘FI 28S ‘988 O22 ‘0L8 ‘6 GPL ‘819 PLL ‘801 818 ‘L9G 988.910 50 | ser tos ae eek cae ale Sa TOISUTYSe MA PF0 ‘126 ‘FZ 0 996 ‘OT 198 ‘S18 'F S91 ‘269 OT | 989 ‘490 'T 626 ‘ZIG 063 ‘+62 99% ‘99, ‘T = | 77-7 eer acar ee ee 7" 8TUTSITA, 918 “889 0 0 0 298 ‘09 908 ‘06T 089 ‘€9 196 ‘606 828 ‘SOT oes ee eae ="===="="9OULIO A O9F ‘O19 “F 0 228 ‘IT 8IT ‘098 068 ‘922 °% 828 ‘661 G86 ‘19 691 ‘T2% 103 ‘0% qein TIZ ‘696 ‘12 0 00F ‘I TOE ‘P83 ‘% SOE ‘9P0'ST | 002 ‘610 'z 280 ‘02 869 ‘225 SOTSECO:S om fier aeae tapae ee ar er ee, ~-"sBXOL, PES ‘826 ‘G 0 008 ‘6 998 ‘961 FOP ‘£98 ‘% 886 ‘691 ‘T £90 ‘202 982 ‘F82 TR) 4 Set ial eae ~ ee age ae ae sessouud T, 210 ‘28 ‘¢ 0 009 ‘OT BIZ ‘80% LET ‘688 ‘% 629 ‘198 29 ‘08 GLI ‘91 £69 ‘962 Bjoyed INOS FC ‘008 “L 0 OOF ‘TI 166 ‘976 920 ‘886 ‘F GOL “Soh L19 ‘LET ZE9 ‘996 SG 87 Var ae | occa a ob ae oe BuyoIVD WINS gce ‘969 ‘E 0 628 ‘IT 022 ‘699 992 ‘808 ‘% 882 ‘OLT FF ‘09 6b ‘02% OSS 0L0>. | alas OS ae oes “or om ~puvisT epoyy 980 ‘81 ‘ZI 0 009 ‘21 10F ‘> 910 ‘E86 ‘¢ Gz ‘260 % £94 ‘Gog 6F0 ‘69% CPOLCTS Eee ae a 7777777 7ByuBaypAsuueg 899 ‘9ZI 'f 0 £29 ‘OI T¥6 ‘FZ 918 ‘261 ‘T OLP ‘SGP ¥19 ‘SOT 0F0 ‘ar SPL ‘SIT ‘T ~"----" 08810 GPT ‘999 ‘ZT 0 000 ‘81 402 ‘282 ‘T BPG ‘998 ‘8 686 ‘209 | SPL ‘PCT TPE ‘99 999"L0r'T [7777 piste ieg = are ee vuLoYyeTAO ELL ‘1L6 ‘CL 0 00F ‘6 T¥6 ‘126 O8L ‘91 ‘9 989 ‘T86 ‘T GLI F66 OIL ‘O&h PELLOP IG Seto 5 a: a = a org £08 ‘299 ‘¢ 0 00F ‘IT ¥LE ‘860 ‘T TOT ‘028 ‘T 769 ‘6FE 824 ‘OL ZE0 ‘91% ¥LF ‘20g Siem ees ie, yer PIONVCL ION FLL ‘ZEL ‘8 0 628 ‘TT 1€8 ‘682 TOF ‘202 ‘E GLB ‘$29 ‘T 908 ‘OTE 963 ‘808 ZAG ee a Tor romesnseneecen""-BuTTOI8O JON 711-845—64_19 282 Department of Health, Education, and Welfare, 1963 Table 2.—Funds for federally assisted programs of vocational and technical education, by source: Fiscal 1962 a Funds from Program } Federal funds} State and (HEW) _ |local sources ! Agriculture. 2) oc. -cosscecnctcnens-bewceneuranensuennsneccssenes—o=teessenw= $18, 645, 000 $59, 647, 000 Distributive occupations--- Pe 2, 565, 000 , 841, Home economics: 2 oa oe la eee a eae ote eae ae nael 8, 874, 000 71, 024, 000 Trades and industry (including fishery trades and industry) oe ii, 477, 000 73, 610, 000 Practical nursing. ...... 52..+..-cesecn.s--unesdae>>- eee eo mebe een nan = 8, 834, 000 5, 825, 000 Technical education (title VIII, NDEA)-_...---------_---.----------------- 11, 043, 000 13, 563, 000 Motel oon o . Gallaudet College GaLLAubET CoiiecE, established in 1857, is the only institution of higher learning in the world devoted exclusively to the education of the deaf. It is accredited by the Middle States Association of Col- leges and Secondary Schools. Public Law 420, 83d Congress, ap- proved June 18, 1954, clearly defines its status as a college, its relationship with the Federal Government, and its responsibility to provide education and training to deaf persons and otherwise to further the education of the deaf. The college’s principal activity is a 4-year undergraduate course of studies leading to the B.A. and B.S. degrees. In addition, Gallaudet offers a 1-year college preparatory course. Deaf children of nursery age receive training in the Hearing and Speech Center. Elementary and secondary education for deaf children of the District of Columbia and adjacent States is provided by the Kendall School, a laboratory school serving the college’s Department of Education. This department, established in 1891, trains graduate students, both deaf and hearing, for positions as teachers and administrators in schools for the deaf. The 1962-63 enrollment for the college was 602; for the Kendall School, 108; and for the nursery school, 35. The editorial offices of “dsh Abstracts” and of the “American Annals of the Deaf” are on the Gallaudet campus. 407 i | : " f oat rie tm & / 34 7 ony nee ag . = oe P Sn = ’ 7 Cf, Fy g t. ane } 75 A : . Pd pL Eta, biG 5 ’ 4 - “s aarpsinaneijetaniietge ne —= 7 7 4 1 ae : di Wines » Lenoiet, bheow te gar . ee $ tun) figeeie aed b want nilrlnt atiotell ciherenen ’ ey ai ‘ ; y Leeder ll > j ry 13 Tail Ly orb U Teo ute i & Kn be Ors ekaAy Lae tic en ' “ +f it r 1 | tf ‘ 1 tv) They 1 , j . at? ari rhs ) 17" : 7 inDtur iad niin Y) intl wailos elt aurea fiji ¥ : +4 1% \ { deilitew ae ey : ka eeettee! ap eilaiimor FF ate iy SS4ol iediileyme soe r.adT Jbeoh ee Vrenmc wit tel baa: Hl boda fe * Lastly to low “adsetiad& feb” to meniio fas ) ad) ao own” Howard University Howarp Universiry, located in the District of Columbia, was chartered by an act of Congress, dated March 2, 1867. The uni- versity 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 de- grees 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 uni- versities, 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 edu- cation. The university admits students of both sexes, from every race, creed, and national origin, but it accepts and undertakes to dis- charge a special responsibility for the admission and training of Negro students. ENROLLMENT OF STUDENTS During the school year 1962-63, the university served a total of 9,836 students as follows: 7,119 during the regular academic year and 2,717 in the summer session of 1961. The total net enrollment, ex- cluding all duplicates, was 8,299 distributed in the 10 schools and col- leges as follows: liberal arts, 4,662; graduate school, 692; engineering and architecture, 772; fine arts, 463; social work, 158; medicine, 391; dentistry, 691; pharmacy, 173; law, 128; and religion, 74. The en- rollment of Negro professional students at Howard continues to be greater than in all the public-supported universities in all the Southern States. 409 711-845—64——_27 416 Department of Healih, Education, and Welfare, 1963 GEOGRAPHICAL DISTRIBUTION OF STUDENTS The enrollment of foreign students continued to be significant. At its peak, during the second semester of the 1962-63 school year, there were 1,050 foreign students constituting 17 percent of the enrollment. The percentage of foreign student enrollment to the total student enrollment at Howard was the highest anywhere in the United States. These 1,050 foreign students came from 77 foreign countries, including Canada, Mexico, 4 countries in the Caribbean area, 3 countries in Central America, 7 countries in Europe, 22 countries in Africa, 10 countries in the Far East, and 16 of the British, French, and Dutch possessions in the West Indies. In addition, there were students from Puerto Rico and the Virgin Islands. During the course of the school year, there were 6,510 degree- seeking students from the United States. These students were dis- tributed as follows: New England States, 133 ; Middle Atlantic States, 1,128; East North Central States, 433 ; West North Central States, 96; Mountain States, 30; South Atlantic States, 3,710; East South Cen- tral States, 509; West South Central States, 407; and Pacific States, 64. VETERANS The total enrollment of veterans and dependents of deceased veter- ans was 174. Fifteen of these students were graduated. The period during which servicemen could enter the service and be eligible for educational benefits from the Veterans’ Administration ended Janu- ary 25, 1954. Veterans now receiving benefits are those who entered the military service prior to the cutoff date but who were not dis- charged until several years later. The present veterans’ educational program, therefore, appears to be near its end. ARMY AND AIR FORCE ROTC Army ROTC.—There were 566 students enrolled in Army ROTC during the 1962-63 school year. Of this number, 279 were in the first-year course, 215 were in the second year, 35 were in the third year, and 37 were in the fourth year. There were 389 students com- missioned as Reserve Officers in the Army during the year. Air Force ROTC.—A total of 621 students were enrolled in Air Force ROTC. Of this number, 323 were in the first-year course, 231 were in the second year, 44 were in the third year, and 23 were in the fourth year. During the year, 16 students were commissioned as Reserve officers in the Air Force. Howard University 411 THE FACULTY There were 889 teachers serving the university during the school year. Of this number, there were 457 full-time teachers, while 432 were part time. The full-time equivalent of the teaching staff was 576.7. Of this full-time equivalent, 513.7 were teaching in the rank of instructor or 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 secretary of the United Nations, and a member of the U.S. Court of Appeals. The faculty continues to remain active in making a valuable con- tribution to education and the advancement of knowledge through significant research and scholarly publications. Funds allocated in the university’s budget for support of research in the social sciences and humanities have been especially helpful in the encouragement of research in those areas. GRADUATES During the 1962-63 school year, there were 870 graduates from the 10 schools and colleges. These graduates came from 32 States, the District of Columbia, Puerto Rico, the Virgin Islands, 18 foreign countries, and 11 island possessions of the British, French, and Dutch West Indies. The 870 graduates were distributed among the 10 schools and col- leges as follows: Liberal arts, 364; engineering and architecture, 100; fine arts, 19; the graduate school, 91; social work, 63; medicine, 96; dentistry, 70; dental hygiene, 18; pharmacy, 20; law, 24; and reli- gion, 5. In addition, honorary degrees were conferred upon three persons. From the date of its establishment in 1867, Howard has graduated 22,438 persons. The great majority of these graduates have been Negroes. Throughout its 96-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 412 Department of Health, Education, and Welfare, 1963 university still stands as the only one affording a complex system of undergraduate, graduate, and professional training. The largest number of graduates have entered the field of teaching, especially in the Southern States. In the field of medicine, there have been 3,380 graduates; 1,957 graduates have gone into dentistry and dental hygiene; 1,755 have entered the field of law; 427 have entered the ministry; 1,106 have gone into the fields of engineering and archi- tecture; and 646 graduates have gone into social work. Numerous graduates of the university have been engaged in government activi- ties, not only in the United States but also in many countries abroad, VARIED ACTIVITIES OF THE FACULTY AND STAFF Many members of the faculty and staff were engaged in a variety of useful activities both in the United States and abroad. A pro- fessor of anatomy was working in India on the staff of the Agency for International Development. The director of recording was on leave to serve as registrar in the establishment of a new educational institution in Sukka, Nigeria. The dean of students, as a repre- sentative from the African-American Institute, visited Africa in order to set up certain criteria and evaluate credentials of students coming to American universities in the interest of the African Scholar- ship Program of American Universities. The director of foreign student services visited Africa and administered predeparture orien- tution for foreign students coming to America. The head of the department of art went to Africa to engage in creative painting and productive research. The dean of the college of liberal arts was on leave conducting research on the “Ethiopian in the Ancient Greek and Roman World.” The head of the department of,physics was engaged in study and research on physikalisches staatsinstitut at the University of Hamburg, Germany, sponsored by the National Science Foundation. The president of the university served as a public member of the U.S. Department of Labor Review Committee for the Tobacco Industry in Puerto Rico and also served as a member of the Committee of Experts to the International Labor Office, Geneva, Switzerland. Under the sponsorship of the Ford Foundation, the director of university libraries served in Chicago as executive secre- tary of the Association of Colleges and Research Libraries. SIGNIFICANT PROGRAM DEVELOPMENTS During the course of the 1962-63 school year, the university made provision for three new degree-granting programs. ‘They were the programs leading to the master of fine arts, the master of arts in teaching, and the doctor of philosophy in government. In addition, Howard University 413 significant revisions were made in the curriculum in the college of medicine in which most of the instruction for the freshman class was related to the fields of anatomy and biochemistry and taught in their relationship to other areas of medicine. The faculty of the college of medicine also made provision to include additional instruction for the freshmen in the summer, prior to the beginning of their first academic year. The university increased its equipment and physical resources in the subcritical reactor program based in the department of mechan- ical engineering in the school of engineering and architecture. The program involving the use of this equipment is interdisciplinary in character, involving not only engineering departments but also science departments in the college of liberal arts and departments in the college of medicine. During the 1962-63 school year, various depart- ments of the university continued to develop programs involving the use of computer and data-processing equipment which had been pre- viously obtained by the university. The university continues to operate programs having the objective of assisting local neighborhood areas in solving certain of their eco- nomic, social, and cultural problems. These programs involve the cooperative efforts of the departments of sociology, psychology, and government, the school of social work, the school of law, the college of medicine, and the school of religion. The financing of these pro- grams has been based on allocations from the budget of the university, as well as grants from other sources. Of special significance were grants made by the Federal Government for a juvenile delinquency training studies program and also for the establishment of a training center for personnel working with youth. In connection with the operation of programs providing service for the local community, it is also significant to note that the college of dentistry has initiated the dental student-special patient training program project to teach dental care of the chronically ill and aged. THE BUILDING PROGRAM During the 1962-63 school year, the new home economics building was placed in operation, and renovation was begun in the old building in order that it could be placed in service as a temporary student center. Construction continued on a new building to provide for the program of physical education for men. In addition, preparations were made for the beginning of the construction of a new classroom building for the social sciences and humanities. As another aspect ot the building program, plans and specifications were in process for two proposed new dormitories, one for women students and one for men. 711-845—64——28 ; = - reece 5 7 - ® Pio . Pe . a 7 wed e% ’ . ig Fix — - ae ~ a — - > _ —- a en eae — 20 sus a Haw ried ) At ecvaneemer veriolae ris S7° Oi Aric ity 30 ebro Rey ite ‘ ‘ ras NY Sha'te Torey ne G .| OLIAIRAg » a 6 yl wi beserell te Tf i : f Lert “ave : i) trol ine ec 4 ‘ Mien weet Bigs AS i pi oe Si on aa COS berks, Jal dime: iad — 9 ‘ ote cee pera \Dapar eh yh fee jadiow jevesee Wet titel GE neagt Ge ded Peeetigateva at SS eae o> pens meakie bv iare bolted: faneetaey 195 i Veal, veo uF) Spree yom EET wit taka 4 dingo Srirhtoret gy af, sass Lengel | Wg iA ah a whic ult. a oh a ris Yee is T reve cml teggiorn ‘B bin shah gosang ay Dail aut gine fry iS, Shyer 7 ik wid, a8 ate. ded toitigsob oem i ’ “ 3 rae 5 . : » vin ie hater zit ee. he i> ~ eal a a a Me « ae z. : «% Detailed Contents THE SECRETARY’S REPORT Page OCT CSS ee ee ae ee 1 TABLE 1.—Grants to States: Total grants under all Department of Health, Education, and Welfare programs, fiscal year 1968______.___________ + SOCIAL SECURITY ADMINISTRATION Cr Sn ee ee ee ee eee Se Sees ee 5 ete PROGRAM IS DOING->2-.--22-2. 22 2 eee 8 BENEFICIARIES AND BENEFIT AMOUNTS____--______________._________ 8 a TIES al i lil lee al ci a Pn 10 AMM HORIGrTON EROVIDED..<.—.-==----47--.-42- eo —-enn-- = ae 11 ome ew oe ISBURSEMENTS..°-_..*.-Bi..... 12 eeeeerrr Tih PROGRAM... 0 oe ee eee 13 Oup-AGE aND Survivors INsuRANCE BENEFITS__._________..________. 13 ivieapiry INSURANCE BENEWTTS.._.-..-9- ---- 13 ee intLiNG TH PROGRAM. 14 REORGANIZATION oF THE SoctaL Securiry ADMINISTRATION..._________ 14 WoRrKtoapDs, MANPoWER, AND RESOURCES..---_______________________ 14 SE RTICLIVicy fe ee ee 15 prerarclopitent. 2... 6. ee 16 IE OETA MING Gam tS = 8 = mn 17 PmIeeeertye tx Ponsa \ -oL ee 1 IMPROVEMENTS IN SERVICE AND MANAGEMENT._________. 17 IO LLMeM ARCH © 2 ~ 22 > AS oe hr ee one PT A) Ba 17 Hive rmOnVELOPMENTS=. oo oe eee 18 Rdg CE NIE pnt agli eel endo iat adele ellntot ees Atala ath 19 DE CL OCeGnIng oo ee ee eee ee ee 19 uname larnings Records. 002.0022 ° ee 19 Mummen ape ROpOring.2-_.-. 2. 2. --- oe eet 20 ERMC erie es pee een Oe tee ee Oe ey es ee 20 eee Ogtant ~ ron 7 MS sh See ee ea 2a) Improvements in Processing of Disability Claims______________________ 21 MEemenOeL AND APPBAIBZ. 2i. Le te Le ee ey 22 PeoGmAM RusParcn Acrivirmms_....._..._.....-.._-...-.-.....-__-- 24 Puternational Activities... ...ca Se eed 176 URC RE ROSD COLA Met Eke g semen od. seeeenelage Bie Joes OTM. cat 176 Division or ENVIRONMENTAL ENGINEERING AND Foop PROTBHCTION_-_---- Wea PreaAncebood bran Chive <0. ec! act Saari tote 1 RO ler Smesuecanitation Branch joo: 32... Se) eee ee ee J Wid erouater@arrier, Brancilt tun oder ies Boh wee nee Soap lt Jak 178 Special) Engineering Services Branch.2:.-.2-- 22---s-2-42-sssceee5---- 178 DivtsIOnNsoneOccuPATIONAL A WALTH ..........-.-.MiL ease bee B_ see 178 DivVIsStonmOns VADIOLOGIGAL. FH WALTH.....---.--.---.---s«--<<--+—----- 179 Resear Cn Me NN 8 A ee te: ate eta tt ality sl. 2 179 Enyironmentalsenrm olan cages eeeen e045. $5 ee ee A 180 422 Department of Health, Education, and Welfare, 1963 Page (raining 22..5o.Sesle Se eS . E eee 181 Division or WatER Supply AND POLLUTION CONTROL______-_-------- 181 Rivers Basin:Studiesse 220g. 22 A ee eae 182 Researchvetyul ls. 252s sesccsssee cose be oeeen eee eee 182 Basics Datasets. 2 scene cece eR eee eee 183 SewagenLreatment sss 9s ssa ees se as Se ee ee 183 Hnforcement. Slo tee ek So et eee 184 Interagency: Coordination... 2. 25-2500 oe eee 184 Ancrrc\Hmanie Restarchy CanrERecileces 2s flee ee eee 185 THE: NATIONALAINSIITULES. OF BHALTH 22). aera 185 NAarronant CaANcur -INSTITUTE Qs .<-<-.-<..-- sce oe enn cae = 5 ee 187 Grant-Supported JResearchs... =. - 2a" S54 See Sree ee ee ee ee eee 239 Woratonaland dechnical Education... -.- 42 Joen- Soe ee eee SESE 240 Mogeorscucation: Administration.....--.-2-22.-2 2-2-2 oe sek 241 SereeNe ERIE TION 2B ELOOTAING oe os os Sora aes ogee am nee ee 244 Lilet ivains)-.. (4s Jed Bs Rig ae oe oe oe S.A eee AA 245 Pee anim eer. 4 SPS) SON wl Ss se ne ee 246 Pere LetiaC ee eee Wott Py Oe eye Ts es Dee Tee Ye 247 tC HERAT Tee BSS oa on ee ek oes ee ee 247 SPONSORED STUDIES (RESEARCH, SURVEYS, DEMONSTRATIONS)___-------- 247 BINANCLAT; ASSISTANCH PROGRAMS.-......-.22..-Jecei_ bees 252 VOCATIONAL AND TECHNICAL EDUCATION._._..---2-.L----2--22--4-.-- 253 ScHoot ASSISTANCE IN FEDERALLY AFFECTED AREAS____-_-----__--_---- 256 Programs UNDER THE NATIONAL DEFENSE EDUCATION ACT___________- 257 PCemESHUeTILA Es oe ee) Pt Seti pti) Lette sl) | 258 National Defense Graduate Fellowships__..........------------------ 258 Modern Foreign Language Fellowships__...........-.---------------- 259 Strengthening Instruction in Science, Mathematics, and Modern Foreign SWEDES is 20k a Ue ale be ee oe i nem Nee we leer 260 Boeteue lant uArey ErOgramsa— ose e. ooeeiseein te oie Semel! 261 Guidance, Counseling, and Testing (Secondary Schools) .___._-..__--_-- 262 amie brocrams: Under WAS es ee os ed Je teedbe bt 264 Savtr DnrENsH ADULT EDUCATIONG® .- ~o-o~o e Be_eo Kh... 264 PE ANE irUGHD. ASSISTANCD. 22. ccet ocean ewe ee non eeetbedte 265 Smee Gara NT OOLLEGHSi. 2. este eeeee emio) hase 265 am MOMEMOUSING LOANS=_eee cessor ewe eon ob at eee colbe 266 MEROTAT, Te DMCATION...iae. ee See) peewee! esos oss 266 Ripivelvehetarded Si SSES. coe ee ae) on roe 266 Dr meee 2 So Tie Wee ce Ree ye So a eR 267 Capronedslilms for the Deaf $s£S..5 a oe ee ole eee ee eee 267 JERR AS ao HR VICHS_22" SIMI Wc ee ae ce et ee 268 HOG OAtIONATA | HLEVISION=o2.2-ebetore een eee e an ec eeen Lea 268 OTHER PRoGRAMS oF FEDERAL ASSISTANCE. -__-.---------25----L4--- Le 269 IN-HRNAELONAT: BDUGATION&&=- =o 2 ee ee 269 424 Department of Health, Education, and Welfare, 1963 Page Teacher-Exchange, Programe. 22< 83 J.4icenseen Ao 2se- ee eee 270 TeachersDevelopmentsProgram=%- 41 e282 5 ease Sees Eee eee 270 echnicaleAssistance, Lraininge yProerai 22222 oe ee 271 Nongrant Visitor, Programs. 2 ee ee 271 International Assignments for Education Specialists_.__....__.__._.-------- 271 Consultative and Support Services to Personnel in Foreign Missions____. 271 Clearinghouse on Educational Exchange___..__._.__.___-_-----_-_-------- 272 International Studies:and ServicesS2l0 eo. oe oe 272 Studies insComparative Hducationz:..2-.-. 2eeeeee oe es eee 272 Evaluation of Foreign Academic Credentials__...-.._..._.._.-_.__--------- 273 Services Relating to International Organizations____________-_-_-------- 274 Hducational, Materials: Laboratory...---.. 20029201) Ses Bee 275 NONDISCRIMINATION IN FEDERALLY AIDED PROGRAMS.___ 275 REDERAL LEGISLATION ssiessuek. siete So cee eae ee 277 TasLE 1.—Grants and other financial assistance to States and local units, administered by the U.S. Office of Education, fiscal year 1963_________~-- 280 TasiE 2.—Funds for federally assisted programs of vocational and technical education, by source: fiscal 1962.03 seen e eee nee ee ee 282 Cuart 1.—Fall enrollment (public and private combined): 1952-62____- 22a FOOD AND DRUG ADMINISTRATION ScrencE Worxkinec TuroucH Law To Protrrecr CoNsuMERS-_--------- 283 ADMINISTRATIVD PROGRESS 2. oo 25-25 oes oe ee 287 Roop,;Davayanp: Cosmunrcelerst! a2 Saas aS ee ee 291 Onithe,EoodiFrontwese: 2:5... BM AROS BOS eee eee 291 Radioactivity.in Foods.2..=. -2eeP Aes ee ee 291 Natural; Disasters: 42208 5 1a 4 Se ee eee 291 Chemicals:in:BoodssseuetS Meena Lee. 2 eee 292 OthersHarmfuliContaminantsseeene 2 2 eee 294 ToKeep, Food Oléanve. Se. s2neeiteenies steele cee 295 Pocketbook:Protection==.. )2 2 Stee ee eee 298 Foods for Specialy DietaryaU sexe ia i Dae ek Se ee eee 299 DrucsrandsD evicesites2-o4.ees 522. oo ee ee 302 IllegaliSales of Preseription Drugs.- =... -_ -S5ee eee. sees 303 Adulterated and Misbranded Drugs___-.-..------------------ 306 Medicated, Feeds.2.22_ 2 oceeu eo asn 4 Se eee 310 Neéw: Drugs: 22: 2es2eai eee. 2. eee ite Seen SLL Devices. enn ae eee ot oe ee 314 Cosmetics and Colors. =25422 S222 eees -e 8 = ees ss eee ae eee 315 @ertificationipervices 45 eee ees eae pone. coe ae 316 FreperaL Hazarpous Susstances LABELING AcT____----------------- 317 ENFORCEMENT, OF, OTHER ACTIS22 2822.2 2--ee22- 55-5 5--5-- ee 318 Civ Dmrensisce: 2022 ee ee ee ee ee 318 New. Cournt/ INTERPRETATIONS» 2225020 oa- Seo eee: ee ee eee 319 CHANGES. IN THH. LAw AND REGULATIONS.-_._._._-.----- 5 esse 321 Régulations._ 3-2 2325-2 - 3 sess ee ease eee eee oe eS eee 321 SCrmmnrTiric, INVESTIGATIONS 222 5-22 ee ee eee. 24 Sees ae ee ees 326 ENFORCEMENT: STATISTICS: 25 J-Son ees. Cee ee eee eee 332 GONCLUSION sac ~ cee SS et ee ee eee sais Detailed Contents TasLeE 1.—Actions on foods during the fiscal year 1963_________________ Taste 2.—Number of samples on which criminal prosecutions and seizures were based and number of court actions instituted during the fiscal year Taste 3.—Import samples collected, examinations made, and lots de- Peincusoumucct be fiscal year: 19632. 22. ..i2225 2222. 2-0. 522 Cuart 1.—Retail sales of food in the United States, calendar years Cuart 4.—Budgeted positions for food and drug enforcement operations (excluding fee-supported certification services), fiscal years 1954—64____ VOCATIONAL REHABILITATION ADMINISTRATION Ventures Into New Fre.ps Drua AppictTIon 285 288 426 Department of Health, Education, and Welfare, 1963 Page Ae CHANGE IN DIRECTION 2¥2 seac tase) elt gare Se eee 363 OpricaL, AIDS: i 2..cecUseveee: taelebo dss 2 Seber 4 i eee 364 MosBInivy:.Fror-THE BLIND. Se lesesebecelies. fue tc sede Bee eee 364 RUAABILIVATION AND) PLOUSING. 2... aceseeeeec done neee eee 365 REHABILITATIONAN, RERORMATORINS Sees = eo eeeses eu ee e= ees eee 365 Racizitins: To-‘Smrvniwan DisABLEDi sess = shee es teen eee ee eee 365 RAcmITyY,CONSIRUOTIONM Mets. as Sate ee eee ee ee 367 New Curents AMONG OLDER DISABLED WORKERS_._-_--_-_------------ 368 IMPROVING DisABILITY: DETHRMINATIONS 2.222256 - « - -- ae ~ : so hes Oe leo sdsldt. sao, eae oe mental sui woo + lend iusmreiios bbe eee - BeGGe) anes) beeradl my Yo sod tia gag aS eke cain br wry bene? .oytedodh boa.enn' aie uniee sarin ool?) (001 ( onul lo ae “itt tahini ¥ P oe +4 GRO mie Hee OLS b PIUIS OY At “oH = * 1@% .Vveas saa | wees Fu y sad 7 » ome HE, fot. AZUOU. OVI A 7 A ie ChAhIGa Rem TTA vit Ghee FO --ae ee can of oc hwnd Wau BITTE HA ee ene ¢” + « ye . = th n rhe ~~. e - —sam pee chee ated a ea ‘ ee +t na PRN; Me oth iN a} —e . i pew le gh yeh Cha ae ep) See gs i iv> r “i 4 , . Heir a | wis ys ‘Laad i ont ‘me rite) MAM QO he nth iste, nit ors ; i .~--aword Eat " » | a =a a “* > Gaew © Ai" » » Lwetew- : mn Gupte: a - ' - ‘ IA Vi? - Z ’ N-~2890 Aye PDJOUSTIG. .....coecs ‘ Le parte Wests: oF Yietitet, Ms oo = ; cae ; = P Siti pans, ap Autti ge, Foe pees Le That Paths, te canteen om) ‘ps get, lee ws