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10 ppromotiorn and disease prevention demands. C that sophisticated personnel be associated with program evaluation to assure maintenance of high levels of quality in the programs. There is considerable experience in come national clinical trials recently sponsored by '_'+dNIL°I (MRFIT and HDFP) which can serve as important partial models for evaluationn of co:mmunity programs. Alliedl Health Personnel. Health pro^iotion and disease preventio-rr w11l require in-the future many more trained nutritionists, substance af.:-~se specialists, and high blood pressure treatment technicians than are . currently available in the United States. The MRFIT program e~~_en.i- plifies the effective use of allied health professionals to effect control of coronary heart disease. I therefore recommend that the Office of the Surgeon General undertake a joint study with NHLBI to better understand the toles of allied health professionals in chronic disease prevention as~exemplified by I4'T_RFIT, HDFP, and LRC. CONCLUS ION' Interest in prevention in the United States now occurs widely. There will undoubtedly in the future be new lead'ership which arises fromm universities, private foundations, state and local governments, and .various citizens groups. None of these will be able to speak, however, with the authority of the Federal Government with respect to primary disease prevention. It is simply a question of resources. No other source exists for resources of comparable magnitude. As I stated at the beginning of this testimony, the timing is scienti- fically right to begin to implement a national preventio strategy. With the marshalling of federal support and resources that are embodied - in S. 3115, such alcourse of'action is now possible. I do not think

7 have allowed the states flexibility in designing programs to meet local needs, funding f©r such programG has been fixed at a meager $90, million since 1971. At the same time, grants for categorical disease control programs have tied many states by requiring them to only use such funds for programs which may not be needed in their Title I under S. 3115 incorporates the best attributes of these two types of programs while avoiding their shortcomings. By allowing the states to use.their funds for the five lead'ing causes of mortality and morbidity within their own boundaries,-states will be able to design these programs to meet*their own unique needs. On the other hand, the limitation of programs to those concerned with pri^iary and secondary prevention in these five areas will provide accountability in the use of federal funds. While the orevention services formula etrant provision of S. 3115will provide the onnortunitv to make great headway, Ti am pleased that this leg,islation continues and expand's support under Section 314(d)' of the Public Health Service Act. By providing stable generic support for public health activities that will also be an incentive to additional investment by states and localities,this provision will greatly assist local 3urisdictions in carrying out the~r responsibilities for enforcement of control over environmental as well as other types ofhealth hazards. Before concludina mv comments on Tit1eI of S. 3115, 1 would~like to, comment briefly on one additional provision, that authorizing project