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Beyond the disparity between the local population and HSA's
board composition, the rationale for an exact standard of
representation is also supported by the actual procedures
Because of the

and influences which exist in most HSA's.
absence of blacks, other minorities, and women in the ranks
of medical professions, these groups are seldom represented
as medical providers on governing boards of HSA's. Because
of the dominance of professionalism and expertise at this
stage of health planning, there is also a likelihood that
the views and influence of these affected groups will be

further diminished.

There are other obstacles to the participation of consumers especially those representing groups of minorities and the poor. Many of the meetings of deliberative committee and sub-committees of the governing boards are held during the daytime when consumers find it difficult to attend. For others, there are distances which extend to almost 200 miles and which must be travelled to attend meetings. Reimbursement is not always available. Also, there is seldom any clerical assistance available to individual board members.

The reality of how the health systems agencies actually work and the impediments which they include offer further reasons to establish by legislation a precise standard for the direct representation of the poor, blacks, other minorities, and women.

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The conclusions which we reached in our study and which we urge upon this committee today should not be read to discount every decision which a health systems agency has made under the 1974 legislation. Obviously, there is much that should be maintained and there have been decisions which are the products solely of reasoned discussion. Still, unless Congress insures that these agencies are selected in the manner which is representative and are composed of representatives reflecting the various segments of their communities, the agencies will fail to meet the most vital needs of health care for our citizens. The South and this country

have learned painfully the failures and calamities which we suffer when groups are excluded or grossly underrepresented.

I hope that this committee will heed that lesson today.

Thank you, Mr. Chairman.

ACKNOWLEDGEMENTS

This report was made possible by grants from the Carnegie Corporation, the Rockefeller Foundation and the Mary Reynolds Babcock Foundation.

The work of the Southern Governmental Monitoring Project investigative interns formed the basis of the study. They performed their tasks with persistance, dedication, and considerable skill.

G. Gail Gessell, President of Atlanta Analytics, Incorporated, served as consultant to the overall project.

Peter J. Petkas, former Executive Director of the Southern Regional Council, provided a useful critique of this report.

Kerry Tassopoulos, who provided extensive research assistance, made an invaluable contribution to the study. Carole Riley, Susan Reid, and Kathleen Keegan also provided research assistance.

Elaine Kporha-Brown drew the charts. Marge Manderson designed the cover. Betty Washington, Eugenia Surrey, and Janet Carlson provided production assistance.

study.

Robert E. Anderson, Jr. and Anne Marie Bradford edited the

Page Crosland, Director of Communications for the Southern Regional Council, released it.

SGMP STAFF FOR THIS REPORT:

Wayne A. Clark, Director

Elaine Kporha-Brown, Senior Program Officer

Earl Picard, Program Officer

Tim Johnson, Research Assistant

Kerry Tassopoulos, Research Assistant

Nevin Brown, Research Assistant

Jesus Garza, Research Assistant

Carole Riley, Research Assistant

Susan Reid, Research Assistant

Kathleen Keegan, Research Assistant

Jackie Styles, Research Assistant

Corliss Oliver, Administrative Assistant