hose areas, rural or urban, where the resources are poorest and the eeds the greatest.

The most potent combination of established programs and new proosals still won't provide all the answers on rural poverty.

We must address these problems with newer proposals, imaginative nd daring ideas.

We need to consider, for example, how to apply the concept of neighorhood service centers to the unique problems of sparsely populated ural communities. OEO has made a valuable start in this area; its experience must be built upon.

We must think about how to raise income levels among the poor, for his can clearly have an impact on the problems of the rural poor. In is economic message, President Johnson announced that he is appointng a national commission on income maintenance to conduct a 2-year study into the range of methods available to help us assure a decent evel of living to all Americans. Proposals for guaranteeing minimum incomes range from a "negative income tax" to a residual public employment program for those who lack private jobs. Some of these may be useful in our society; others may prove impractical. This study should help us determine what are the most effective paths to pursue.

In addition, the President has appointed a National Advisory Committee on Rural Poverty to take a broad view and national leadership in this area of major concern. And each of the departments and agencies must continue to seek new approaches in their particular areas of experience and knowledge.

The Department welcomes this Committee's activities and interest in what is being done for the rural poor.

Mr. Chairman, that concludes my testimony. I will be happy to answer any questions the committee may have.

Mr. RESNICK. The appendix to your statement, appendix A, will be made a part of the record at this point.

(App. A follows:)

APPENDIX A-PROGRAMS OF THE DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE IN RURAL AREAS

The Department of Health, Education, and Welfare administers a number of programs which relate rather specifically to the problem of rural poverty. These include:

The Migrant Health Program is a program directly related to rural poverty through its grant-in aid assistance to local sponsors of migrant health projects. The kinds of health services and facilities which can be assisted under this program range from the establishment and operation of facilities to improve the health of migratory farm workers to assistance for projects to eliminate environmental hazards to migratory farm workers. Funding of this program has increased from $3 million in fiscal year 1966 to $8 million in fiscal year 1967 and is budgeted at $9 million in fiscal year 1968.

The Community Health Services program of the Public Health Service has been the leader in the identification of rural health needs and provision of rural health consultation over the years. Furthermore, during the past thirty-one years (beginning in 1936) the Public Health Service has made a total of $371,341,000 available to States under the General Health Grant program. Approximately fifty-six percent of this money has been supporting health services in rural areas.

The Rural Health Program of the Public Health Service has been developed for the purpose of providing technical assistance to small towns and rural areas, particularly to give them the ability to marshall existing and potential resources-public and private-local, State, and National— to meet their health needs. In many rural areas the resources are already available but the need is for the "know-how" to organize and adapt these

resources to meet the rural problems. The Public Health Service is supporting, on a pilot project basis, rural health workers to help the people in small towns and rural areas make use of resources already actually or potentially available, and to enable the community to qualify for other grant support programs to supplement their limited financial tax base. With a beginning appropriation of $155,000 for the purposes of developing this new program in FY 67, technical assistance in the form of full-time professional personnel has been given to local rural towns in three States, and consultation has been given to several others. Working in concert with other Federal agencies (e.g., Departments of Agriculture, Interior, Commerce, Labor, OEO, etc.) through an Interagency Task Force, steps are currently being taken to support full-time technical personnel in pilot projects in three areas of the country. These modest beginnings have stimulated a flood of requests from other States. A sum of $1,000,000 was requested for FY 68 to meet these appeals for help by support of technical assistance to small towns and rural areas.

Title I of the Elementary and Secondary Education Act has an identified category of funds for special migrant and Indian education programs. Under this provision some $9 million are available to the States during the current fiscal year for migrant education projects and $5 million for Indian education projects. The budget for the migrant program increases to approximately $28 million in Fiscal Year 1968, while Indian education is budgeted at $5 million. We hope to support a variety of innovative projects under this program and we have already witnessed substantial interest in it by States having large migratory farm worker population.

The Allied Health Professions Act contains special provisions for loan forgiveness for doctors, dentists, and optometrists practicing in poor rural

areas.

Under the Indian Health Program the Public Health Service provides direct health services to Indians residing in some of the poorest circumstances in the Nation. This program serves approximately 380,000 Indians and is budgeted at over $104 million for Fiscal Year 1968.

In addition to the programs relating directly to the problems of rural poverty, our Department administers another group of programs which have been effective in rural areas.

These include:

Title V of the Economic Opportunity Act, which we administer, provides work experience and training to low-income persons. Recent figures show that 40 percent of the training openings are located in rural areas. Title V expenditures in the 182 poorest counties, largely rural, are greater than any other Office of Economic Opportunity Program.

The Library Services and Construction Program, until 1964, was restricted to public library services in rural areas or communities of less than 10,000 population. The program was expanded to an urban-rural services and construction program under which State library plans govern the distribution of assistance. Under the State plan concept, some outstanding efforts in rural areas have been initiated such as the New York State ChantauguaCattaraugus Library System which provides for bookmobile services to 35-40 communities too small to support a public library or which have a population which seasonally varies.

The Hill-Burton Hospital and Medical Facility Construction Program has generally had a favorable rural balance of distribution of Federal matching funds. Seventy-six percent of the program's over 3,000 hospital projects have been developed in communities of less than 50,000 population. Construction costs for hospitals in these communities represented 64 percent of a total Federal expenditure in excess of $1 billion. Another 70 percent of the more than 600 long-term care projects have been in communities of less than 50,000 and represent more than 30,000 beds in these facilities. This represents more than 60 percent of the Federal expenditure of in excess of $150 million.

Several other HEW programs operate favorably in rural areas. These include Community Mental Health Centers Construction and Mental Re tardation Facilities Construction. Another set of programs are weighted toward areas of financial need which would generally tend to assist poorer rural areas. This include: General Health Grants and Heart Disease Control Grants.

Vocational Rehabilitation services are provided through the 91 State rehabilitation agencies in each of the States and territories. This program has

been expanded sharply since 1966 both in number of staff and offices which will facilitate vocational rehabilitation services throughout the Nation.

The Vocational Rehabilitation Administration program effectively serves the rural disabled. For the Fiscal Year ending June 1959, which was the last year data was secured on rehabilitants by place of residence, 10,900 out of the 80,700 rehabilitants or 14 percent resided on farms. In addition there were 15,156 rehabilitants or 18 percent who resided in rural non-farm areas or a total of 32 percent who were rural residents.

The Vocational Rehabilitation Administration has, through the means of its Research and Demonstration, Innovation and Expansion, and Workshop Improvement Grants Program supported a number of projects seeking new ways of providing services more effectively in rural areas. Some of these sought to determine the feasibility of serving migrants, others were directed to Mexican-Americans and Indians living in rural areas. In several States demonstrations were supported to determine how rehabilitation centers and workshops could provide services to the surrounding rural populations.

Traditionally, particularly because of the emphasis on agriculture in the early Acts, a large portion of the vocational education programs were developed in the rural areas. The majority of schools having vocational agriculture programs also had home economic programs, with the trade and industrial programs largely located in urban centers.

Funding of construction of area vocational schools under the Vocational Education Act of 1963 has made possible many such schools which serve rural areas with broad vocational offerings. The new Act emphasis to serve persons with academic, socioeconomic, and other handicaps has resulted in the identification of poverty in rural areas and the development of additional programs to meet the needs. With over 40 percent of the poverty found in rural areas, training for employment through these vocational education programs has an impact on rural poverty.

The Welfare Administration public assistance program has a direct relationship to rural poverty. In addition, Title V of the Social Security Act authorizes grants to State health agencies for maternal and child health services and for services for crippled children, and grants to State public welfare agencies for child welfare services.

The maternal and child health services program and that of services for crippled children, conducted by the Welfare Administration, have had a rural emphasis with the authorizing legislation specifying "especially in rural areas and in areas suffering from severe economic distress." Thus Federal funds for these programs in the past have been largely directed toward providing services in rural areas.

States use their maternal and child health services funds, together with mothers are examined by physicians and get medical advice; for visits by public health nurses to homes before and after babies are born to help mothers care for their babies; for well-child clinics for examination and immunizations, where they can get competent advice on how to prevent illnesses and where their many questions about the care of babies can be answered. Such measures have been instrumental in the reduction of maternal and infant mortality, especially in rural areas. Funds are used to make available doctors, dentists, and nurses to the schools for health examinations of school children. They are also used for immunizations.

From the first, the public child welfare program was concerned with the welfare of rural children. Early studies of infant and maternal mortality, child dependency and mental retardation pointed to the unevenness and, in some States, the total lack of facilities and social services for rural children.

Child welfare grants-in-aid were established, therefore, to assist State public welfare agencies to develop public child welfare services in areas predominantly rural.

The 1962 Amendments to the Social Security Act require the extension of child welfare services to all parts of the State by July 1, 1975, and the provision of these services to the extent feasible by fully trained child welfare personnel.

From 1958 through 1965 the number of rural counties in the United States having the services of a full-time public child welfare worker increased from 1,160, or only about 47 percent of all rural counties, to 1,409, or 60 percent of all rural counties. During the same period the proportion of all urban counties having the services of a full-time child welfare worker rose more slowly, from about 70 percent to just over 80 percent of all urban counties. The 1,092 counties without full-time child welfare services in 1965 were

mostly rural counties, 924, compared with 168 urban counties. Many of these 924 rural counties did have public welfare workers who spent part of their time providing child welfare services, a type of program organization more common in less populous than in urban areas.

There are five aspects of day care services which have made considerable impact on rural areas since passage of the 1962 Amendments. These are licensing and consultation of day care centers and family day care homes, community organization and planning to develop day care services, the establishment and operation by the rural public welfare department of small day care centers in rural areas, the development of family day care homes by county public welfare offices and training of day care personnel to develop and operate rural day care services.

The Administration on Aging administers the Foster Grandparents Program under a contractual agreement with the Office of Economic Opportunity. Out of 37 projects now operating under the program, 15 are rural in character in which organized personal care is provided to handicapped children through the employment of qualified older persons.

The majority of HEW programs apply to problems found throughout the Nation in both rural and urban areas. A number of these have substantial impact in rural areas. These are:

Virtually all program elements of the Office of Education have some relationship to rural poverty whether in the matter of higher education facilities and student loans and other assistance to needy youngsters or in the gener alized effort under the Elementary and Secondary Education Act to improve education for disadvantaged children. In Title I of the Elementary and Secondary Education Act, for example, over one-third or more than $300 million of its funds have been directed to rural areas with a high concentration of low income families.

Projects under this program tend to stress the improvement of language arts skills and the development of reading. The Title III program of the ESEA, assistance for supplementary education centers, provided some $16 million or over 20 percent of its funds to meet the special needs of rural areas. Under the Adult Education Act of 1966 a total of $26.28 million was appropriated for basic programs in Fiscal Year 1967. Of this amount, $10,512,000 was directed to rural areas.

Under the National Defense Education Act guidance and counseling institutes for teachers of disadvantaged youth have drawn heavily from rural areas. In addition, other special and regular teacher training programs have been developed in relation to the needs of all teachers but in which rural teachers participate on approximately an equal basis with their colleagues. The Experienced Teacher Fellowship Program of the Higher Education Act, indicates that of over 50 institutes funded, 11 will have participants from primarily rural areas, while another three will be about equally divided between urban and rural representation.

The Teacher Corps program is providing some 1,200 Corpsmen to schools for special work with disadvantaged children. Over 400 of these specially trained Corpsmen will be working in rural areas this year. And, we would expect to maintain this ratio.

The Office of Education is sponsoring quite a variety of research related specifically to the special educational problems of rural areas. We hope, of course, that research will yield greater insights into the problems in this

area.

Under Title IV of the ESEA four learning laboratories to improve rural education have been funded with $6 million and over $1 million in research and development projects for Fiscal Year 1966 and Fiscal Year 1967.

Title V of the same Act makes assistance available to State education agencies in order to stimulate and develop State educational plans and programs in terms of the educational needs of the State. This effort attempts. therefore, to increase the capabilities of the State agencies to deal with all the educational problems in their jurisdiction, urban and rural.

The Title III Program of the Higher Education Act, Strengthening Developing Institutions, generally supports improvement of smaller colleges in rural areas. In Fiscal Year 1966, for example, 127 rural institutions of higher learning received almost $3 million in assistance under this program or about 70 percent of all the funds available to Title III.

The public assistance program is national in character and reaches both rural and urban areas. Under State developed programs and eligibility

criteria, payments are available to all who qualify for assistance. People in rural areas, therefore, benefit in proportion to the number of needy persons living there. The basic categories of assistance are Old Age Assistance, Aid to Families with Dependent Children, Aid to the Blind, Aid to the Permanently and Totally Disabled, Medical Assistance to the Aged, and Medical Assistance.

The OASDHI also is not designed specifically as an anti-poverty weapon, but only productive work is a more important bulwark against poverty. About 37 percent of the aged beneficiaries would be poverty stricken if they did not receive benefits. Many beneficiaries in rural areas are among those affected. Data indicates that as of December 31, 1964, 29 percent of the total number of benefit payments was being made to persons residing in "rural" counties. Furthermore, among the aged poor on farms, social security benefits accounted for nearly two-thirds of the aggregate cash income in 1964.

Amendments to Title V of the Social Security Act in 1963 authorized special project grants for comprehensive health care for prospective mothers who may have conditions which increase the hazards to their health or the health of their babies and who will not receive care because they are from low-income families. Of the maternity and infant case projects approved since the initiation of the program in 1964, 10 serve the Nation's 10 largest cities, and 10 serve predominantly rural areas. The other 34 serve smaller cities or combinations of urban and rural areas.

The 1965 Amendments to the Social Security Act authorized a new program of comprehensive health services for children and youth in low-income families. In the geographic area served by a project all of the problems that are presented by children in the project are to be taken care of by the program, either through direct services or an appropriate referral to other sources which are prepared to provide at least equivalent sevices. Both medical and dental care must be included for children of school age; also children with emotional as well as physical health problems are to be accepted. The projects therefore will attempt to meet the medical needs of a given child population in a specified area.

In the health field a similar broad array of possibilities exists in the provision of assistance for the construction of facilities, training, provision of health services, and assistance for program efforts. Here are some examples of what has been done with assistance from the Department:

Grants to State agencies to assist in the construction of needed health facilities as indicated by the approved State plan.

Grants for training of professional public health workers. Project grants for studies, experiments and demonstrations in new or improved methods of providing community health services. Grants to State health agencies to help develop and maintain programs to prevent or control certain diseases and to prevent or control environmental health hazards.

Under programs to help overcome social and psychological barriers to the use of health resources, our Department has made available short-term training grants to public or nonprofit institutions prepared to provide graduate or specialized training for professional health workers to improve their knowledge and skill and thus improve their competence. Such grants have been used to provide training for professional workers engaged in migrant health projects in other health activities involving services to socioeconomic groups with important differences from the groups usually served, or those represented by health workers themselves. Through the Joint Committee on Rural Sanitation, the Department has studied sanitation problems and developed standards for distribution and anplication in rural areas. HEW has provided or arranged in-service training programs on health education and communication to improve effectiveness in reaching and motivating rural people to develop patterns of sound health action. The Administration on Aging is a new HEW unit, established by the Older Americans Act in 1965, which has broad charge of developing a wide variety of programs for the elderly throughout the Nation. Title III of the Act provides funds to the States for the development of community programs in Aging: Title IV funds research and demonstration projects which employ innovative approaches to solving the problems of aging: and Title V contracts for the training of personnel to work in the field of aging. Under each of these programs projects and activities in rural areas have been developed. In some rural counties, for example, the Older Americans Act program brings needed health services within the reach of financially-hard pressed,