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DEPARTMENTS OF LABOR AND HEALTH, EDUCATION. AND WELFARE APPROPRIATIONS FOR FISCAL YEAR 1977 IPRm.~Y~ FF.BRUARY 20~ 1976. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE WITNESSES DR. THEODORE COOPER, ASSISTANT SECRETARY FOR DR. DA~ ~. SENC~R, DIRECTOR, CENTER ~0R DISEASE CONTR0~ DR. J0~ ~. FINK~ DIR~CTOR, NATION~ INSTI~U~ 0~ 0CC~- PATIO~AL S~ETY ~ HEATH DR. D0~ALD S. ~REDRIKSON, DIRECTOR, NA~0N~ INSTITUTES DR. ROBERT VAN ~OEK, ~CT~G ~NIST~TOR, H~TH SBV- ICES ~M~ST~TION 3AMES D. ISBISTER, AD~STRATOB~ ~COHOL, DRUG ABUSE, MENTAL ~ALTH AD~STRATION D~. KENNETH M. ~NDICOTT~ ADMINISTRATOR, H~LTH RESOURCES ~INISTRAT~ON C~RL~S MILLER, DEPUTY ~SISTANT SECRETARY, CO~PTROLLER PETR~ J. BERSAN0, DIRECTOR, OF~I~ 0~ R~0~RC~ MENT, PUBLIC ~TH SERVICE A~r. FL0OV. The subcommit~e will come to order. %Ve have the Depa~ment o~ Health~ Education, and ~Vel~are. are pleased ~ hay6 I)r. Theodore Ceoper, the Assistant Secre~ry for Health. ~o do you haw~ w~th you that you want us to know ~ Dr. C~P~,. We have a very dis}in,fished panel~ Mr. Chairman, and mem~rs of the committee, and I would ]ike to go around from left right. Dr. Donald Frcdr~ckson, the D~rcctor of the National Institute~ Health; Dr. Kenneth Endicott, th~ Administrator o~ the Health sources Administration ; Mr. James lsblster~ the Administrator of the Alcohol Drug Abuse~ and A[entai ~Tealth Administration? Dr. Rob6rt van Hock, tim Ac~h~g Administrator of the Health Administration. Then to my right, Mr. Peter ~¢,rsano, the Direclor of our 0~ Resource Management in the Public Health Service, and t~ his right Dr. David J. Renter, Director of the Center for Disea~ Contxol ~nd at the far right, our distinguished colleague from tim Sec~etaryt~ 0ffice, Mr. Charles Miller. Mr. F~ou. Well, we have your biographlc~l sketch of Cooer, and, of court, we will place that in the ~cord ~t t~is point. [The information follows:] (1) TI06652355

I)EPARTMEI~TS OF LABOR ANI) HEALI~I, EDUCATIOH, AlqD WEI£ARE APPROPRIATIONS FOR 1977 HEARINGS III~I,'ORE A SUI~COMMITTEE 0F TilE C0~IMI'I:TEE 0R h~£R0PRIATIONS ROUSE 0F REPRESENTATIVES NINETY-FOURTtf CONGRESS SUBCOM.MI'~['EE ON TII~] DEPAItTMP~NT8 OF LABOR AND HEALTH, EDUCATION, A~D WELFARE DANIEL J. FLOOD, Pennsylvania, Ch~rm~ I,;I)WARD a. PaL'ffI'I,]N. New Jersey 81LVIO O. CONTE, Massachu~ett3 DAVID R. OBEY. Wisconsin El)WARD R. ROYIIAL, California JO~BPI[ D. EARLY, Massachusetts PART 3 DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE: HEALTF[ ACTIVITIES (Excluding National Institutes of Health) Printed for the use nf the Committee on Appvopritttions U.S. G4~VERN~,lt~NT PRINTINR OFFICE WASIIINGTO14 : 1976 T106652356

1 2 3 4 5 6 7 9 10 11 12 13 14 15 16 17 18 19 2O 21 72 next year's funding. These have to do with setting up smoking education and smo}:ing cessation clinics, and to assist Dr. Callan on community programs. This is the end of the second year of the program. Last year, we had a report on the activities that were funded, what happened and so on, and this year we have asked for an annual report again, to review perhaps the entire 2 years, and describe for us what has happened. Are there any questions on this? If not, then we can go ahead with Mr. Horace Ogden, who is here as Director of the Mr. Ogden is ~e Director of it, and he will lead off and will introduce ~e other ~ree m~m~ers of the staff, ~.;ho will also present some short reports. ~. Ogden. 5~. OGDEN: Tha~ you very much, Bob. i am going to try to do a very brief sort of stage=setting, and then let the people who are really involved in the progr~s that you are closely associated with talk about their a~eas of activity. The B~reau of Health Education was formally est~!ished just this past Septe~er, so we are about 8 months old, and the Clearinghouse was organizationi-lly &ncorpornted into i~ and moved geographically in October. The move was completed by the T[06652357

I 2 3 4 5 6 7 8 9 10 11 12 14 15 16 17 18 '19 20 21 73 end of October. • he Bureau os sort of a strange fledgling, creature which is just beginning to, I thinh, find some of its ways of doing business. We have about three different functions, and I thought I would try to spell those out rather quickly, and then get on to the substance of the cancer education, with which you are most concerned. We were created as an offshoot, first of all, of the President's Committee on Health Education, and secondly, of a task force within the Department which proposed to Secretary Weinberger a three-part program to respond to what seemed to be identified needs in health 4ducation of the public across the country. One piece of the recommendations was to encoura e~.and explore the real feasibility of creating a private-sector-based national center for health education. We have contracted With the National Health Council, and they are in the late stages now of developing their recommendations for the creation of such an entity, which would be primarily privately initiated and financed on a basis of ongoing private support plus federal contract involvement. I have. been very pleased with the way the Council has gone at this assignment, and I think that in the meeting we are ~aving at the end of this week in Atlanta we will have quite an affirmative report to deal with. I was very skeptical about the concept at the beginning. I bel'ieve now, after they have been at it a year and have developed a lot of TI06652358

1 2 4 6 8 9 10 11 12 13 14 15 16 17 18 19 20 21 74 interest and a lot of support, I thir~ it may be for real. The second piece of the recom~mendation was to create a high-level advisory board within HEW to serve as an inter- departmental panel on health education, chaired by the Assistant Secretary and with membership from the directors, the actual decision-making directors, of the various components of HEW, the six health agencies, the Office of Education, the Director of the Medical Services Administration, the Director of the Medicare program, and several de@endencies within the Office of ~the Secretary. This panel has thus far only met once, owing to the fact that we had a change of horses at the Assistant SEcretary level just at the time we were about to have our second meeting. We are meeting later this month. The concept here is that there should be some high level and decision-capable group lqoking at overall problems of health education in the Department, becaus there are "at least 50 or 60 programs which have a clear-cut. education mission in health. Some of them are doing perhaps too much. Some of them are clearly doing not enough. In any case, they are fragmented and diffused. The third piece of the action was to create a Bureau of Health Education someplace, and it was established at the Center for Disease Control in Spetember, as I said. Our mission is kind of in three pieces. We are, first of all, a liaison operation for trying to begin to make some sense out of and to TI06652359

I 4 5 6 7 8 9 10 11 i:2 13 14 15 16 17 18 19 20 21 make some interagency combinations that will do a ~ore effective job of health education of the public than the strictly every- man-for-himself, disease-of-the-week-clubkind of thing that has characterized health education activities in the past in the Department. Our first job, which we are about nine-tenths through with, is to really take a look at where the action is around HEW, and w~ have been startled to find the number of different programs and the number of different projects within programs, all of which have some sort of at least educational intent with respect to health', some of w~ich seem to be making a lot of noise and doing very little, some-of which seem to be working • very quietly and doing some quite exciting things. " So our first job is a survey, really, of these things, and we are in the process of getting that together, working very closely with liaison people that have been designated to us by their bosses, who are the administrators of the various agencies. In NIH, Storm Whaley in the Director's. Office is our designated liaison, but because of the close working relationships with both Cancer and Heart and Lung Ins-titutes we have also had the benefit of a great deal of help and support from individuals in this room, in this group, and also their counterparts on the Heart and Lung side. So our first job, really, is to find out where the action is in HEW, and begin to recommend how programs can be TI08652360

1 2 3 5 6 7 8 9 10 11 12 15 17 put together logically to reinforce each other rather th~n compete with each other for school curriculum time, for media time, for the attention of people who are being bombarded a million times a day with different kinds of random health messages and stimuli. The second part of the action has been to incorporate and continue as best we can the ongoing activities of the Nationa Clearinghouse on Smoking and Health. As with any bureaucratic upheaval which also involves a geographic transplantation, and we had both of these simultaneously in this case, there are bound to be problems of individuals' preferences in ter~.s of working situations, and we have had, I think, a reasonably typical experience in having some problems with .that. I think we are now over the worst of those. We still have some very definite gaps, and some very serious gaps, in our armamentarium that have been created by people who chose not to come to Atlant~ with us, but I think thatthe team we do have down there is digging in and doing a very ~ood job. The Clearinghou~ in effect, the old Clearinghouse, constitutes two of the three.divisions of the new Bureau. One division is still called the National Clearinghouse on Smoking and Health, and it is carrying on the scientific and technical information and also public response services that the Clearing- house initiated. This group is responsible for thi production of the annual report to the Congress on the health consequences Ti0865236t

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 '19 20 21 of smoking. It is responsible for running the Technical Info~ation Center and bibliographic and library services to the world at large, both to profassiQnal and to private citizen kinds of audiences. The second_piece is called the Community Program Development Division, which indeed is what it was called when it was within ~he Clearinghouse framework. Roy Davis, who is "here with me today and is going to take over when i stop, is the many who is now broadening out his interests, which have always been pretty broad, to spearhead the contracting we are able to do with anybody who has some innovative and kind of exciting ideas about health education. Roy will describe briefl~ the kinds of contracts that we are"involved in this year. Many of them are continuations, and somewhat broadened, of previous initiatives of the Clearinghouse. Others are some new things which we find kind of exciting, where we think some good health education may come about. The third piece of our bureau is a Division of Pro- fessional Services and Consultation, which is just what it says. People are writing us. by the thousands, many of them writing us saying, "Send money. ~henomenon to us a11. Project will follow", which is a familiar But many of them are actually asking for some help, some guidance, in designing more effective health education activities than they have had. And we do now have a small staff that is able to travel around the country or bring TI08652362

1 2 3 4 6 7 8 9 10 11 12 14 1,5 16 17 18 19 2O 21 78 people into the Center to ta~: about and try to.design better health education activities, combining different kinds of subject matter and different kinds of techniques and methodology. So we are partly, I hope, a contractor for innovation, partly a scientific resource in smoking, and partly a consul- tative source for people who feel that their.health education efforts can be better directed. In addition to that, we do have the overall kind of departmental liaison function. I resist calling it a coordinativ function, because I think "coordination" implies a degree of control and heavy-handedness. There are very few voluntary coordinatees in the world, and we think we can accomplish more by working with people and beginning to show that we can be helpful to them in developing their programs than we can if we come down with a heavy hand from the top.. I am going to quit there, while X am ahead, and ask Roy and then two of our other people, Dr. Green and Dr. Burns, to talk to you about specific portions of our activities. And then, perhaps, we should entertain questions collectively at the end, if that is satisfactory to all of you. Roy, are you indicating a different suggestion? DR. DAVIS: I think the Committee is interested in specific kinds of results, and I think the other two would be a bit more specific than I can be. DR. OGDEN: Okay. Dorothy, would you start? Dorothy T106652363

1 2 3 4. 5 6 7 8 9 10 11 12 13 14 1,5 16 17 18 19 20 21 79 Green, as you }now, is a member of the Clearinghouse staff, and is now working here with you in the Cancer Institute. We are delighted that she is also wor}~ing with us on our behalf with you. Dorothy? DR. GREEN: I am going to report very briefly on a very specific aspect of some of the work that has been done under this Inter-Agency Agreement that Dr. Woolridge has been talking about. Since 1968, there have been four surveys of teenagers. The last of these surveys, the 1974 survey, was financed and funded by the National Cancer Institute, ~at I would like to tell you tod~y is just a little smattering. You have the full report, and I would like to just tell you a little smattering of what has been happening with teenagers since our first survey, which was completed in January of 1968. These surveys were national probability samples of teenagers 12 to 18 years old, inclusive. They were conducted in the latter part of December and the first part of January in each case. These were not school surveys. These were really samples of teenagers, whether they were in school or not. We did not include any institutionalized teenagers~ During the latter part of December, most children are home. They are home from coliege, they are home from school, a~d therefore we had very few t hatwe could not reach. If you are at all interested in methodology, we used TI06652364