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they generally live. Environmental problems are extremely serious because they account for a large proportion of the preventable illness and premature death suffered by Indians. We already know how these problems can be attacked.

Sanitation for the Indian population has been neglected for so long that the sanitary conditions under which thousands of Indians live are nothing short of primitive. No other group of persons in the United States lives under comparable conditions. The Indian population is, in fact, about half a century in arrears with respect to the application of sanitary science to disease prevention.

Dysentery, diarrhea, and other enteric disesase account for a high proportion of all illness and hospital admissions for Indians and Alaska natives. The incidence of certain gastrointestinal diseases among Indians is nine times that of the general population. In consequence, the Indians are retarded in their progress toward health and economic levels equal to those enjoyed by other citizens while the Federal Government must bear the cost of meeting excessive medical care requirements.

The enteric disease problem among Indians stems directly from the insanitary environment in which they have been usually forced to live. Inadequate disposal of human, animal, and other wastes results in the spread of filth-borne disease by flies, food, and contaminated water. The scarcity of water itself contributes to the spread of disease through preventing adoption of minimum personal hygiene practices. Domestic water supply sources are usually streams, irrigation ditches, stock watering ponds, springs, or poorly constructed dug wells. Such sources are frequently highly polluted by human or animal wastes and frequently located a mile or more from Indian homes.

Sanitation improvements at reservation areas depend first upon acceptance by the Indians of modern concepts of the interrelationship between disease and insanitary living conditions and, second, upon provision and use of basic sanitation facilities-safe water supplies, safe sewage disposal and refuse disposal facilities adequate for insect and rodent control. The first element is now being approached through the medium of health education and the promotional efforts of native sanitarian aids. The second element must also be achieved if the Indian environment is to be raised to a state comparable with standards of the present century. Few families and few communities are able to utilize their new understanding and to provide essential sanitation facilities from their own resources. The majority of Indian families and communities, because of the prevalent low economy of reservation areas, are unable to afford the basic sanitary necessities. This Department believes that enactment of H.R. 849 would provide the improved legislative base necessary for the correction of gross deficiencies in basic sanitation facilities for Indians.

The Bureau of the Budget advises that it perceives no objection to the submission of this report to your committee.

Sincerely yours,

ARTHUR S. FLEMMING, Secretary.

CHANGES IN EXISTING LAW

In compliance with clause 3 of rule XIII of the Rules of the House of Representatives, changes in existing law made by the bill, as passed by the Senate, are shown as follows (existing law proposed to be omitted is enclosed in black brackets, new matter is printed in italic, existing law in which no change is proposed is shown in roman):

ACT OF AUGUST 5, 1954 (68 STAT. 674)

AN ACT To transfer the maintenance and operation of hospital and health facilities for Indians to the Public Health Service, and for other purposes

Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled, That all functions, responsibilities, authorities, and duties of the Department of the Interior, the Bureau of Indian Affairs, Secretary of the Interior, and the Commissioner of Indian Affairs relating to the maintenance and operation of hospital and health facilities for Indians, and the conservation of the health of Indians, are hereby transferred to, and shall be administered by, the Surgeon General of the United States Public Health Service, under the supervision and direction of the Secretary of Health, Education, and Welfare: Provided, That hospitals now in operation for a specific tribe or tribes of Indians shall not be closed prior to July 1, 1956, without the consent of the governing body of the tribe or its organized council.

SEC. 2. Whenever the health needs of the Indians can be better met thereby, the Secretary of Health, Education, and Welfare is authorized in his discretion to enter into contracts with any State, Territory, or political subdivision thereof, or any private nonprofit corporation, agency or institution providing for the transfer by the United States Public Health Service of Indian hospitals or health facilities, including initial operating equipment and supplies.

It shall be a condition of such transfer that all facilities transferred shall be available to meet the health needs of the Indians and that such health needs shall be given priority over those of the non-Indian population. No hospital or health facility that has been constructed or maintained for a specific tribe of Indians, or for a specific group of tribes, shall be transferred by the Secretary of Health, Education, and Welfare to a non-Indian entity or organization under this Act unless such action has been approved by the governing body of the tribe, or by the governing bodies of a majority of the tribes, for which such hospital or health facility has been constructed or maintained: Provided, That if, following such transfer by the United States Public Health Service, the Secretary of Health, Education, and Welfare finds the hospital or health facility transferred under this section is not thereafter serving the need of the Indians, the Secretary of Health, Education, and Welfare shall notify those charged with management thereof, setting forth needed improvements, and in the event such improvements are not made within a time to be specified, shall immediately assume management and operation of such hospital or health facility.

SEC. 3. The Secretary of Health, Education, and Welfare is also authorized to make such other regulations as he deems desirable to carry out the provisions of this Act.

SEC. 4. The personnel, property, records, and unexpended balances of appropriations, allocations, and other funds (available or to be made available), which the Director of the Bureau of the Budget shall determine to relate primarily to the functions transferred to the Public Health Service of the Department of Health, Education, and Welfare hereunder, are transferred for use in the administration of the functions so transferred. Any of the personnel transferred pursuant to this Act which the transferee agency shall find to be in excess of the personnel necessary for the administration of the functions transferred to such agency shall be retransferred under existing law to other positions in the Government or separated from the service. SEC. 5. The Act of April 3, 1952 (66 Stat. 35), and all other laws or parts of laws in conflict herewith, are hereby repealed.

SEC. 6. [This] Sections 1 to 5, inclusive, of this Act shall take effect July 1, 1955.

SEC. 7. (a) In carrying out his functions under this Act with respect to the provision of sanitation facilities and services, the Surgeon General is authorized

(1) to construct, improve, extend, or otherwise provide and maintain, by contract or otherwise, essential sanitation facilities, including domestic and community water supplies and facilities, drainage facilities, and sewage- and waste-disposal facilities, together with necessary appurtenances and fixtures, for Indian homes, communities, and lands;

(2) to acquire lands, or rights or interests therein, including sites, rights-of-way, and easements, and to acquire rights to the use of water, by purchase, lease, gift, exchange, or otherwise, when necessary for the purposes of this section, except that no lands or rights or interests therein may be acquired from an Indian tribe, band, group, community, or individual other than by gift or for nominal consideration, if the facility for which such lands or rights or interests therein are acquired is for the exclusive benefit of such tribe, band, group, community, or individual, respectively;

(3) to make such arrangements and agreements with appropriate public authorities and nonprofit organizations or agencies and with the Indians to be served by such sanitation facilities (and any other person so served) regarding contributions toward the construction, improvement, extension and provision thereof, and responsibilities for maintenance thereof, as in his judgment are equitable and will best assure the future maintenance of facilities in an effective and operating condition; and

(4) to transfer any facilities provided under this section, together with appurtenant interests in land, with or without a money consideration, and under such terms and conditions as in his judgment are appropriate, having regard to the contributions made and the maintenance responsibilities undertaken, and the special health needs of the Indians concerned, to any State or Territory or subdivision or public authority thereof, or to any Indian tribe, group, band, or community or, in the case of domestic appurtenances and fixtures, to any one or more of the occupants of the Indian home served thereby. (b) The Secretary of the Interior is authorized to transfer to the Surgeon General for use in carrying out the purposes of this section such interest and rights in federally owned lands under the jurisdiction of the Department of the Interior, and in Indian-owned lands that either are held by

the United States in trust for Indians or are subject to a restriction against alienation imposed by the United States, including appurtenances and improvements thereto, as may be requested by the Surgeon General. Any land or interest therein, including appurtenances and improvements to such land, so transferred shall be subject to disposition by the Surgeon General in accordance with paragraph (4) of subsection (a): Provided, That, in any case where a beneficial interest in such land is in any Indian, or Indian tribe, band, or group, the consent of such beneficial owner to any such transfer or disposition shall first be obtained: Provided further, That where deemed appropriate by the Secretary of the Interior provisions shall be made for a reversion of title to such land if it ceases to be used for the purpose for which it is transferred or disposed.

(c) The Surgeon General shall consult with, and encourage the participation of, the Indians concerned, States and political subdivisions thereof, in carrying out the provisions of this section.

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86TH CONGRESS HOUSE OF REPRESENTATIVES 1st Session

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REPORT No. 590

EXTENSION OF TRAINEESHIP PROGRAMS FOR PUBLIC HEALTH PERSONNEL AND PROFESSIONAL NURSES

JUNE 29, 1959.-Committed to the Committee of the Whole House on the State of the Union and ordered to be printed.

Mr. ROBERTS, from the Committee on Interstate and Foreign Commerce, submitted the following

REPORT

[To accompany H.R. 6325]

The Committee on Interstate and Foreign Commerce, to whom was referred the bill (H.R. 6325) to extend certain traineeship provisions of the Health Amendments Act of 1956, having considered the same, report favorably thereon without amendment and recommend that the bill do pass.

PURPOSE OF THE LEGISLATION

The bill extends for a period of 5 years programs which provide for (1) the graduate training of professional public health personnel and (2) the advanced training of professional nurses. These two programs which were authorized by titles I and II of Public Law 911 of the 84th Congress expire on June 30, 1959.

The cost estimates submitted by the Department of Health, Education, and Welfare for the two 5-year programs are as follows:

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Title I (sec. 306): Public health training..... $2,000,000 $3,000,000 $3,000,000 $4,000,000 $4,000,000 Title II (sec. 307): Professional nurses training..

6,000,000 6,000,000 ,000,000 6,000,000 6,000,000

The Subcommittee on Health and Safety held hearings on the bill and other bills related to public health training on June 8, 9, and 10. In the course of these hearings the subcommittee heard testimony from representatives of the Association of Schools of Public Health; National Conference on Public Health Training; American Nurses Association; Association of State and Territorial Health Officers;

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