Speech #910169519

Many of their temporary communities look upon them as transients for whom the community feels no responsibility. These communities often lack enough physicians. dentists. and nurses to meet the needs of local residents. let alone the needs of people "just passing through." The result is a heavy burden of illness and disability. Tuberculosis is 17 times more frequent and infestation with worms 35 times more frequent among migrants than among ordinary patients. Mortality from tuberculosis and other infectious diseases is 21/2 times the national average. Mortality from accidents is nearly 3 times the national average. Infant mortality is at the national rate of 20 years ago. As late as 1966. in two Texas border countiesCameron and Hidalgowhich are home for many thousands of MexicanAmerican migrants29 percent of the births occurred outside of hospitals. compared with 2 percent for the Nation as a whole. At the fiscal 1969 appropriation level of $8 million. the amount available nationally per migrant is $8. Even when contributions from other than migrant health sources are added. the total average health expenditure per migrant is little more than $12. This can be compared with the national average per capita health expenditure of over $250. Because of these great needs. the conferees have agreed to legislation which would extend the Migrant Health Act for 3 years and increase the appropriation authorization from $15 million in 1970 to $30 million in 1973. The House bill provided that the Secretary may use funds under the Migrant Health Act to provide health services to nonmigrants the same as to migrants if the Secretary of Health. Education. and Welfare determines that the expenditure would improve the health of migrants. The managers on the part of the Senate have agreed to this amendment recognizing that. in some circumstances. it is difficult to achieve the purpose of the act without improving health conditions for all persons when living and working together. Sanitation programs. water supply improvement. and rat control efforts are examples of this fact. We agreed that in using funds appropriated to carry out the purposes of this provision. the Secretary shall be reasonably assured that this will not result in a reduction of effort or unduly discourage an expansion of the effort by any State. county. or municipaj body to provide health care services to migrants. We wish to emphasize that in providing services under the Migrant Health Act. under all circumstances. all other resources should be exhausted and responsibilities assumed for nonmigrants should be transferred to appropriate local bodies whenever possible. The Senate amendment provided that the Secretary must be satisfied that persons representative of the population served and others in the community knowledgeable of migrant health needs have been given an opportunity to participate in the development and implementation of each program. The House bill contained no provision on this subject. The managers on the part of the House have agreed to this amendment. Two years ago. when this act was last extended. the conferees agreed that it "should also be considered as a permantnt and separately identifiable program." Because residency requirements still exclude migrants from many State health programs and because there continues to be a lack of willingness or financial ability to include migrants in State and local programs for the general population. we wish to restate this position and express concern that the 1968 Public Health Service reorganization may have seriously compromised the separately identifiable status of the program. contrary to the intent expressed in last extending the act. The extension. the increases in funds. and the improvements in the act agreed to by both Houses are absolutely necessary if we are ever to meet such great needs.