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Litigation concerning sources of evidence (title VII)—

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Protected facilities for housing Government witnesses (title V)—

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Protective orders_

Racketeer influenced and corrupt organizations (title IX)-

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Recalcitrant witnesses (title III)-

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Title V-Protected facilities for housing Government witnesses.
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Title IX-Racketeer influenced and corrupt organizations.

Separability clause (title XI).

Special grand jury (title I)—

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Syndicated gambling (title VIII)—

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DECEMBER 18 (legislative day DECEMBER 16), 1969.-Ordered to be printed

Mr. YARBOROUGH, from the Committee on Labor and Public Welfare, submitted the following

REPORT

[To accompany S. 2660]

The Committee on Labor and Public Welfare, to which was referred the bill (S. 2660) to extend and otherwise amend certain expiring provisions of the Public Health Service Act for migrant health services, having considered the same, reports favorably thereon with amendments and recommends unanimously that the bill as amended do pass.

SUMMARY

As reported by the Committee on Labor and Public Welfare, S. 2660 would extend until June 30, 1973, the authority of the Public Health Service Act to improve health services and the health conditions of domestic agricultural migratory workers and their families.

The bill, as amended, would extend the existing program authorized by section 310 of the Public Health Service Act with increased funding authorizations.

AMENDMENTS

As introduced, S. 2660 would have expanded and extended to June 30, 1975, the health services program for migratory agricultural workers that is scheduled to expire on June 30, 1970. The committee agreed that it would be desirable to reexamine this program at an earlier date. Thus, the committee recommends that this program be extended to June 30, 1973.

Recent hearings in Washington and in the Rio Grande Valley of Texas pointed up the need to involve the consumer population in project development and implementation. It is recommended, therefore, that the Secretary must be satisfied on the basis of evidence supplied by each applicant, that persons in the community knowledgeable

about the health needs of migrants and that persons broadly representative of all elements of the population to be served be given an opportunity to participate in the development and implementation of programs to improve migrant health services.

HEARINGS COST

Hearings were held before the Subcommittee on Health in Washington, D.C., on October 21 and 22 and in Edinburg, Tex., on November 24. Testimony favorable to the extension and expansion of the migrant health program was presented by representatives of the Department of Health, Education, and Welfare, the AFL-CIO, the American Medical Association, the American Public Health Association, the Association of State and Territorial Health Officers, church-sponsored organizations, and other groups and individuals. The administration witness testified that the Department of Health, Education, and Welfare supported full funding of the 1970 authorization.

The annual appropriation authorizations shown in the bill are as follows: Section 310-Domestic agricultural migrants:

1971

1972 1973

$20,000,000 25, 000, 000 30,000,000

THE PROBLEM

Hundreds of the Nation's communities with an annual influx of migrants still lack an organized program to provide health services to workers and families for the duration of their stay.

Nationwide, the migrant population continues to total approximately 1 million persons, including workers and their families; 900 of the Nation's 3,000 counties are annually temporary homes to numbers ranging from 100 to 40,000 or more.

Every year the migrant health grant funds available are inadequate to respond to the need and requests from communities for grant assistance. As a result, the present program has temporary contact with only about one-third of the Nation's migrants each year.

Contact is made to the extent that the people happen to live or work in the 300 counties which offer personal health care through migrant health projects. Care for migrants in most of the other 600 counties continues to be sporadic and crisis oriented.

Even for the people with whom the program makes contact, the breadth of services is typically less than adequate. Dental care is often limited or entirely lacking. A sampling of the medical conditions among patients reported by migrant health projects during the past year was compared with a sampling of medical conditions among patients seen in private physicians' offices during a comparable period. The sampling of medical conditions among patients seen in private physicians' offices was reported in the National Disease and Therapeutic Index.

The comparison showed that infective and parasitic diseases, diseases of the respiratory system, and digestive system diseases were from two to five times as large a proportion of the total conditions seen among migrants as among the general population. Among the

S. Rept. 91-618

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