Special Message to the Congress on the Nation's Health Program.

To the Congress of the United States:

The Nation in recent years has made notable advances in the unending struggle against disease and disability. Human suffering has been relieved, the span of man's years has been extended. But in the light of the human and economic toll still taken by disease, in the light of the great opportunities open before us, the Nation still has not summoned the resources it properly and usefully could summon to the cause of better health.

Therefore, as a Nation, we must now take further steps to improve the health of the people. This further effort, funds for which have been included in the Budget submitted to the Congress, should be a characteristically American partnership--a partnership in which private and governmental enterprise are joined to advance the national welfare. The important role of the Federal Government is to provide assistance without interference in personal, local or State responsibilities.

Such action should be taken in several general areas, through--

A substantial increase in Federal funds for medical research.

A new program of grants for construction of medical research and training facilities.

Further steps to help alleviate health personnel shortages.

Measures which will help our people meet the costs of medical care.

Action to strengthen certain other basic health services throughout the Nation.

MEDICAL RESEARCH

Progress in medicine is dependent upon research. Intensive studies by thousands of scientists have been responsible for important advances in recent years against such major afflictions as rheumatic fever, epilepsy, high blood pressure, poliomyelitis and blindness.

The development of antibiotics has had a major share in bringing about dramatic reductions during the past ten years in the death toll from many other diseases--for example, tuberculosis 75 percent, appendicitis 69 percent, acute rheumatic fever 66 percent.

The widespread use of the Salk poliomyelitis vaccine within the past year alone has proved highly effective in reducing the threat of paralytic poliomyelitis to many of our children.

Yet much remains unknown. Despite progress in the control of cancer, its cause remains a dark mystery. Little is known about the diseases of the nervous system. Much remains to be discovered about heart disease and mental illness.

In order to facilitate the expansion of medical research, I have, therefore, proposed in the budget submitted to the Congress an appropriation to the Public Health Service for the National Institutes of Health of $126,525,000--an increase of 28 percent over the total funds appropriated for the present fiscal year.

This program is designed to give major emphasis--through an increased share of funds--to basic research. For basic research-in the biological and medical sciences--underlies all medical progress. Through increased emphasis on these fundamental studies, we bring into better balance the total medical research effort.

The appropriation I have recommended would provide a substantial increase in funds in various categories of research. The program would provide funds as follows: for cancer $32,437,000; heart disease $22,106,000; mental illness $21,749,000; arthritis and metabolic diseases $13,345,500; neurology and blindness $12,196,000; infectious and parasitic diseases $9,799,000; dental disorders $2,971,000; and $11,922,000 for the general research programs of the National Institutes of Health.

The increased funds recommended would be expended in part at the laboratories of the National Institutes of Health. But by far the major share of the increased funds would be for research grants to medical schools, hospitals and private laboratories. Funds for these research grants would be increased by 47 percent over this year's appropriation.

The increase of seven million dollars recommended for research grants by the National Science Foundation would provide for additional research in the biological and medical sciences.

These programs would permit a broader and more intensive scientific effort to develop the fundamental knowledge necessary to a better understanding of illness and to apply that knowledge more rapidly to relieve human suffering.

MEDICAL RESEARCH AND TEACHING FACILITIES

The bulk of medical research is conducted in laboratories of universities, hospitals, and other institutions outside the Federal Government. These institutions also provide the intellectual environment for training the scientists upon whom successful research depends. And they provide the training ground for medical practitioners.

Physical facilities of medical research and teaching institutions are inadequate to meet the human needs of the Nation. As we strive to achieve better health for the people, we must help to provide the needed laboratories and teaching facilities.

I, therefore, recommend that Congress enact legislation authorizing $250,000,000 for a five-year program to assist in construction of research and teaching facilities for schools of medicine, osteopathy, public health, and dentistry and other research institutions. These institutions would be required to supply at least equal amounts in matching funds.

HEALTH PERSONNEL

The rate at which physicians are being graduated from the Nation's medical schools is barely keeping pace with the increase in population. There are serious shortages in such specialized fields as psychiatry, pediatrics, and in physical medicine and rehabilitation. Relative to population, the number of dentists and nurses is diminishing. The aging of our population and the increase in the incidence of chronic disease, the anticipated continued growth of voluntary health insurance plans, and the general expansion of our economy--all will tend to increase the demand for health services.

The increase in funds which I have requested for the National Institutes of Health and the National Science Foundation will permit a major increase in trainees and research fellows. The program of construction grants for medical research and teaching facilities also offers the opportunity for medical, dental and other professional schools to expand their student capacity and provide for the training of more physicians, scientists, dentists, and other health workers.

As additional Federal aid in meeting the problem of existing personnel shortages in the health field, I recommend to the Congress, as was proposed in my Health Message of last year, enactment of legislation to provide for (a) a five-year program of grants for training practical nurses, (b) traineeships for graduate nurses, and (c) authority to establish traineeships in other public health specialties.

MEETING THE COST OF MEDICAL CARE

Since World War II the costs of medical care have been increasingly met through voluntary health insurance. More than I Go million persons are now enrolled in prepayment health insurance plans of some type. But health insurance coverage is still not available to many who need it, and the character and amount of insurance protection in important respects remains inadequate.

Health insurance protection must be made more available to older persons and those living in rural areas, to the self-employed and those working in small organizations who cannot be reached through ordinary group enrollment methods. There is particular need for much broader coverage against the cost of long term or other especially expensive illness, which can be a financial catastrophe for many families.

The need for more and better health insurance coverage can best be met by building on what many of our people have already provided for themselves--the voluntary health prepayment plans. Much can be done to encourage more rapid expansion and improvement of such plans.

Last year and the year before I urged enactment of a proposal for Federal reinsurance to encourage increased protection against the cost of medical care through voluntary prepayment plans. Since the legislation was introduced, private insurance organizations have developed new types of policies and prepayment plans and have extended coverage to groups formerly unprotected. There are now indications that the organizations writing health prepayment plans might progress more rapidly by joining together-sharing or pooling their risks--to offer broader benefits and expanded coverage on reasonable terms in fields of special needs. The Administration is considering legislative proposals which would permit such pooling. But, if practical and useful methods cannot be developed along these lines, then I will again urge enactment of the proposal made last year.

Illness and disability are among the principal problems of public assistance recipients, and are major causes of dependency. Therefore, I again recommend that the Congress authorize a separate program through which the Federal Government would match funds expended by the States and localities for medical care for the indigent aged, the blind, the permanently and totally disabled, and dependent children.

Additionally, I renew my previous recommendations for (a) providing Federal employees with the benefits of group health insurance, and (b) the improvement of medical care for the dependents of servicemen.

STRENGTHENING BASIC HEALTH SERVICES

Expansion of medical research, financial assistance for construction of research and teaching facilities, measures to increase research and health manpower, and steps to help meet the costs of medical care are essential to national progress toward better health. It is equally essential that other public health services be strengthened and improved.

I present the following further proposals for consideration by the Congress:

Sickness Surveys.--Information on the nature and extent of sickness and disability is neither accurate nor up-to-date. The last comprehensive survey of illness in the Nation was made twenty years ago. Since then American medicine has experienced the most rapid and dramatic changes in its history. Improved statistical data are essential as a guide for research and for the effective planning and operation of health programs.

I urge the Congress, therefore, to authorize the Public Health Service to secure periodically needed information on the incidence, duration and effects of illness and disability in the Nation.

Expansion of Medical Care Facilities.--The Federal-State program of aid in the construction of hospitals and other medical care facilities was broadened in 1954 to give greater emphasis to the construction of chronic disease hospitals, nursing homes, diagnostic and treatment centers, and rehabilitation facilities.

I recommend the extension for two more years of this program, which otherwise would terminate in 1957. I have also proposed in my Budget Message a $ 19,000,000 increase in funds to expand construction of these needed facilities.

I again urge the enactment of the proposal I made last year for Federal insurance of mortgage loans made by private lending institutions for the construction of hospitals, clinics, nursing homes and other types of private medical care facilities. This proposal follows the pattern developed in successful Government guaranty programs in other fields.

Indian Health Program.--As an important step toward improving health conditions among our Indian population, I recommend legislation which will authorize the Public Health Service to construct and maintain urgently needed sanitary facilities for our Indian population. For the total Indian health program, I propose a substantial increase in the funds of the Public Health Service.

Mental Illness.--Mental illness is one of our most serious national problems. Last year I recommended authorization of a new program of mental health project grants. The purpose of this program was to seek ways of improving the quality of care in mental institutions, of improving the administration of these institutions, and, most importantly, of reducing the length of stay in these institutions. I again urge that the Congress authorize this program.

Water and Air Pollution.--Problems of water pollution control grow more pressing with population growth and with industrial development and expansion. The present Water Pollution Control Act expires on June 30 of this year. I again recommend that the authority in this Act be strengthened and placed on a permanent basis. This would enable the Public Health Service to help the States and industry to deal effectively with the problems of pollution control.

I have also recommended a substantial increase in funds to broaden the research attack on problems of air pollution by nonfederal institutions and by the Public Health Service and other Government agencies. This will also permit a step-up in technical assistance to States for the control of pollution.

Poliomyelitis Vaccination Assistance Act.--Last year Congress approved an appropriation of Federal funds to assist the States in providing free poliomyelitis vaccine for many of our children and expectant mothers. This program expires February 15. I have recommended an extension to June 30, 1957, and an appropriation of $30,000,000 to complete this program.

Increased Support [or Food and Drug Administration.--Last year a committee of distinguished citizens made a thoughtful study and presented numerous recommendations for strengthening and improving the Food and Drug Administration in its important work of protecting the American consumer. I have recommended a significant increase in funds for the Food and Drug Administration to provide for an initial expansion of its inspection and related technical staff.

Public Health Aspects of Civil Defense.--The skills and resources of the Public Health Service and the Food and Drug Administration will be of great value to the Nation in dealing with any civil defense emergency that may arise. The Federal Civil Defense Administration has delegated vital responsibilities to these agencies, and I have included funds in the budget to strengthen research on the public health aspects of civil defense.

Vocational Rehabilitation.--The Congress in 1954 authorized an expansion of the Federal contribution to the Federal-State program of restoring handicapped men and women to more productive lives. I have recommended the funds needed to continue expansion of this program.

Veterans' Medical Program.--The medical care of our veterans remains a growing responsibility, and in the next fiscal year the hospitals of the Veterans Administration will have an average daily load of 111,500 patients. I have included in the Budget a request for $53 million for construction and improvements at Veterans Administration facilities, about one-half of which is for replacement of old hospitals.

CONCLUSION

The Congress has enacted enlightened and progressive legislation during recent years which represents substantial gains in the unending war against disease and disability.

I now urge the Congress to give continued support to the quest for better health. The proposals I have submitted call for a proper distribution of responsibility among the many groups which make up the health services of the Nation--health professions, educational institutions, foundations, industry, and all levels of government.

The role of the Federal Government in this great effort is that of a partner. The Federal Government should support the efforts of the States and communities and private agencies. It should encourage the individual initiative and industry inherent in our free society. The specific measures which I have placed before you are conceived in terms of these basic American principles; they provide promise for a renewed and reinvigorated attack on our health problems.

DWIGHT D. EISENHOWER