[Congressional Bills 108th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1916 Introduced in House (IH)]
108th CONGRESS
1st Session
H. R. 1916
To prevent and cure diabetes and to promote and improve the care of
individuals with diabetes for the reduction of health disparities
within racial and ethnic minority groups, including the African-
American, Hispanic American, Asian American and Pacific Islander, and
American Indian and Alaskan Native communities.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
May 1, 2003
Ms. DeGette (for herself, Mr. Nethercutt, Mr. Weldon of Pennsylvania,
Mr. Becerra, Ms. Solis, Mrs. Christensen, Mr. Wu, Mr. Honda, Mr.
Kildee, Mr. Bonilla, Mr. Doyle, Mr. Kennedy of Rhode Island, Mr. Green
of Texas, Mr. Hinojosa, Ms. Norton, Mr. Lewis of Georgia, Mr. Hoeffel,
Mr. Gutierrez, Mr. Jackson of Illinois, Mr. Davis of Illinois, Mr.
Reyes, Mr. Carson of Oklahoma, Mr. Rodriguez, Mr. Stenholm, Mr. Scott
of Georgia, Mr. Wynn, Ms. Lee, Mr. Kind, Mr. Lynch, Mr. Price of North
Carolina, Mr. Crowley, Mrs. Capps, Ms. Schakowsky, Ms. Woolsey, Mr.
McIntyre, Mr. Hill, Mr. Berman, Mr. Bell, Ms. Kilpatrick, Mr. Pastor,
Ms. Watson, Ms. Waters, Mr. Lampson, Mr. Deutsch, Mr. Olver, Mr.
Pomeroy, Ms. Majette, Mr. Serrano, Mr. McDermott, Mr. Filner, Ms.
Kaptur, Mr. Cummings, Mr. Mollohan, Mr. Kanjorski, Ms. DeLauro, Mr.
Kucinich, Mr. Towns, Mr. Etheridge, Mr. Ferguson, Mr. Meeks of New
York, Mr. Thompson of Mississippi, Mr. Ford, Mr. Murtha, Mr. Levin, Mr.
Bishop of New York, and Mr. Pallone) introduced the following bill;
which was referred to the Committee on Energy and Commerce
_______________________________________________________________________
A BILL
To prevent and cure diabetes and to promote and improve the care of
individuals with diabetes for the reduction of health disparities
within racial and ethnic minority groups, including the African-
American, Hispanic American, Asian American and Pacific Islander, and
American Indian and Alaskan Native communities.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Diabetes Prevention Access and Care
Act''.
SEC. 2. FINDINGS.
The Congress finds as follows:
(1) Hispanic Americans, African-Americans, Asian Americans
and Pacific Islanders, and American Indians and Alaskan Native
populations suffer from the highest incidence of diabetes and
from the highest rates of diabetes complications, and these
rates are steadily increasing to epidemic proportions.
(2) Within the United States, diabetes increased from 6.9
percent to 7.3 percent during the period 1999 to 2000,
affecting every age group and socioeconomic level.
(3) Type 2 diabetes accounts for 90 to 95 percent of
diagnosed diabetes cases among these populations.
(4) Another 16,000,000 individuals in the United States
have a condition known as ``pre-diabetes,'' or Impaired Glucose
Tolerance (IGT). Unless treated, pre-diabetes dramatically
increases the risk for developing type 2 diabetes and increases
the risk of heart disease by nearly 50 percent. As with
diabetes, this condition also disproportionately affects
minority populations.
(5) Physical inactivity and obesity are the main
contributing risk factors to the rising numbers of diabetes
cases within these racial and ethnic minority populations.
(6) Critical facets of daily living that can contribute to
diabetes risk can be modified including poor diet, lack of
recess and physical education for children, specific eating
habits for families and adults that may be culturally
indicative to the minority group, and psychological factors
that may interfere with proper meal planning and dietary
education.
(7) For certain socioeconomic groups, unhealthy food is the
only nutritional source available within the community, such as
fast food in poor areas. Additionally, there are limited
options for physical activity within certain neighborhoods,
communities, or geographical areas.
(8) Type 2 diabetes is also being increasingly diagnosed in
adolescents in high numbers within these populations. This is
partly due to nonnutritional diets and a lack of physical
activity.
(9) The most effective prevention and control strategies
include: increased physical activity, improved nutrition,
quality diabetes care, and improved self-management practice.
(10) Multiple acute and chronic complications result from
poor diabetes diagnosis, care, and management. There is a need
for prevention strategies and measures in order to educate
individuals about diabetes and its complications, and to
decrease current numbers within these populations.
(11) Recent discoveries regarding disparities in health
care among these populations have identified a need for
culturally sensitive modes of treatment that are conducive to
the lifestyle of the patient: Patients and consumers should be
guaranteed effective, understandable, and respectful care that
is provided in a manner that properly addresses their cultural
health beliefs, practices, and preferred language.
(12) Effective communication, cultural conflict resolution,
and cultural differences on health promotion and disease
prevention should be addressed.
TITLE I--RESEARCH
SEC. 101. RESEARCH.
Part P of title III of the Public Health Service Act (42 U.S.C.
280g et seq.) is amended by inserting after section 399N the following
section:
``SEC. 399O. DIABETES; MINORITY HEALTH AND HEALTH DISPARITIES RESEARCH.
``(a) National Institutes of Health.--
``(1) In general.--The Director of the National Institutes
of Health shall expand, intensify, conduct, coordinate, and
support research and other activities with respect to pre-
diabetes and diabetes, particularly type 2, in minority
populations, including research to identify clinical,
socioeconomic, geographical, cultural, and organizational
factors that contribute to type 2 diabetes in such populations.
``(2) Certain activities.--Activities under paragraph (1)
regarding type 2 diabetes in minority populations shall include
the following:
``(A) Research on behavior and obesity, including
research through the obesity research center that is
sponsored by the National Institutes of Health.
``(B) Research on the causes and effects of health
care access disparities and racial discrimination,
including research to identify the following:
``(i) Linguistic difficulties and language
barriers of diabetes diagnosis, treatment, and
care within these populations.
``(ii) Environmental barriers in accessing
transportation to health centers and health
care providers.
``(iii) Financial difficulties of health
care financing and delivery to receive
treatment.
``(iv) Diabetes care and treatment
discrimination against individuals with
diabetes in prisons, the workplace, and
schools.
``(v) The manner in which racial
stereotypes evolve, persist, shape
expectations, and affect interpersonal
interactions with diabetes diagnosis,
treatment, and education.
``(vi) The manner in which patient and
provider relationships can be strengthened by
greater diversity in the health professions for
diabetes care.
``(C) Research on environmental factors that may
contribute to the increase in type 2 diabetes, which
shall be conducted or supported through the National
Institute of Environmental Health Sciences and the
National Human Genome Research Institute.
``(D) Support for new methods to identify
environmental triggers and genetic interactions that
lead to the development of type 1 and type 2 diabetes
in minority newborns with a high genetic susceptibility
to the disease. Such research should follow the
newborns through puberty, which is a high-risk period
for developing type 1 diabetes, and--increasingly--type
2 diabetes.
``(E) Research to identify genes that predispose
individuals to the onset of developing type 1 and type
2 diabetes and to develop complications with the goal
of developing improved prevention and treatment
strategies.
``(F) Research to prevent complications in
individuals who have already developed diabetes, such
as attempting to identify the genes that predispose
individuals with diabetes to the development of
complications, as well as methods and alternative
therapies to control blood glucose.
``(G) The support of ongoing research efforts
examining the level of glycemia at which adverse
outcomes develop during pregnancy and to address the
many clinical issues associated with minority mothers
and fetuses during diabetic and gestational diabetic
pregnancies.
``(b) Centers for Disease Control and Prevention.--
``(1) In general.--The Secretary, acting through the
Director of the Centers for Disease Control and Prevention,
shall conduct and support research and other activities with
respect to diabetes in minority populations.
``(2) Certain activities.--Activities under paragraph (1)
regarding diabetes in minority populations shall include the
following:
``(A) Expanding the National Diabetes Laboratory
for translational research, and the identification of
genetic and immunological risk factors associated with
diabetes.
``(B) Enhancing the National Health and Nutrition
Examination Survey on eating and dietary habits, with a
focus, including cultural and socioeconomic factors, on
Hispanic American, African-American, American Indian
and Alaskan Native, and Asian American and Pacific
Islander communities.
``(C) Establishing and implementing model
demonstration projects to design, implement, and
evaluate effective diabetes prevention and control interventions.
``(D) Increased funding for the Translating
Research Into Action for Diabetes study to conduct
interventions for improving the quality of diabetes
care received by these populations in managed care
settings.
``(E) Prevention research within the Division of
Diabetes Translation to better understand how to
influence healthcare systems changes to improve quality
of care being delivered to such populations.
``(F) Within the Division of Diabetes Translation,
carrying out model demonstration projects to design,
implement, and evaluate effective diabetes prevention
and control intervention for these populations.
``(G) Carrying out culturally appropriate
community-based interventions within the Division of
Diabetes Translation designed to address issues and
problems experienced by these populations.
``(H) Conducting applied research within the
Division of Diabetes Translation on health systems,
community, and communication interventions to reduce
those barriers of discrimination, and reduce health
disparities within these populations with diabetes.
``(I) Conducting applied research on primary
prevention within the Division of Diabetes Translation
to reduce those barriers within various arenas of
discrimination, and reduce diabetes-related health
disparities within these populations with diabetes.
``(c) Additional Programs.--
``(1) In general.--In addition to activities under
subsections (a) and (b), the Secretary shall conduct and
support research and other activities with respect to diabetes
within minority populations.
``(2) Certain activities.--Activities under paragraph (1)
regarding diabetes in minority populations shall include the
following:
``(A) Through the National Institutes of Health and
the Centers for Disease Control and Prevention,
identifying culturally sensitive approaches to
research, including the clinical, cultural,
socioeconomic, and organizational factors that
contribute to high levels of diabetes within such
populations.
``(B) Expanding the National Diabetes Education
Program.
``(C) Through the National Center on Minority
Health and Health Disparities, the Office of Minority
Health under section 1707, the Health Resources and
Service Administration, the Centers for Disease Control
and Prevention, and the Indian Health Service,
establishing partnerships within minority populations
to conduct studies on cultural, familial, and social
factors that may influence health promotion, diabetes
management, and prevention.
``(D) Through the Indian Health Service, in
collaboration with other appropriate Federal agencies,
conducting research on ethnic and culturally
appropriate diabetes treatment, care, prevention, and
services by health care professionals to the American
Indian population.
``(d) Definition.--For purposes of this section, the term `minority
populations' means racial and ethnic minority groups within the meaning
of section 1707.
``(e) Authorization of Appropriations.--
``(1) National institutes of health.--For the purpose of
carrying out subsection (a), there are authorized to be
appropriated such sums as may be necessary for fiscal year 2004
and each subsequent fiscal year.
``(2) Centers for disease control and prevention.--For the
purpose of carrying out subsection (b), there are authorized to
be appropriated such sums as may be necessary for fiscal year
2004 and each subsequent fiscal year.
``(3) Additional programs.--For the purpose of carrying out
subsection (c), there are authorized to be appropriated such
sums as may be necessary for fiscal year 2004 and each
subsequent fiscal year.''.
SEC. 102. DIABETES MELLITUS INTERAGENCY COORDINATING COMMITTEE.
Section 429 of the Public Health Service Act (42 U.S.C. 285c-3) is
amended by adding at the end the following subsection:
``(d)(1) In addition to other duties established in this section
for the Diabetes Mellitus Interagency Coordinating Committee, such
Committee shall--
``(A) assess the current activities of all current Federal
health programs to determine their adequacy as a systemic
method of addressing the impact of diabetes mellitus on
minority populations;
``(B) undertake strategic planning activities to develop an
effective and comprehensive Federal plan to address diabetes
mellitus within communities of color which will involve all
appropriate Federal health programs; and
``(C) conduct the implementation of such a plan throughout
all Federal health programs.
``(2) The Federal plan under paragraph (1)(B) shall--
``(A) include steps to address issues including, but not
limited to, type 1 and type 2 diabetes in children and the
disproportionate impact of diabetes mellitus on minority
populations; and
``(B) remain consistent with the programs and activities
identified in sections 399O through 399R, as well as remaining
consistent with the intent of the Diabetes Prevention Access
and Care Act.
``(3) For purposes of this subsection, the term `minority
populations' means racial and ethnic minority groups within the meaning
of section 1707.
``(4) For the purpose of carrying out this subsection, there are
authorized to be appropriated such sums as may be necessary for fiscal
year 2004 and each subsequent fiscal year.''.
TITLE II--TREATMENT
SEC. 201. TREATMENT.
Part P of title III of the Public Health Service Act, as amended by
section 101 of this Act, is amended by inserting after section 399O the
following section:
``SEC. 399P. DIABETES; TREATMENT FOR MINORITY POPULATIONS.
``(a) In General.--The Secretary shall conduct and support programs
to treat diabetes in minority populations.
``(b) National Institutes of Health.--With respect to the National
Institutes of Health, activities under subsection (a) regarding the
treatment of diabetes in minority populations shall include the
following:
``(1) Through the National Institute of Mental Health,
providing for comprehensive mental health services and
treatment for individuals within such populations who
experience mental barriers to proper diabetes care.
``(2) Through the National Center on Minority Health and
Health Disparities, recommending and disseminating the
guidelines of the American Diabetes Association for nutrition
exercise and diet for diabetes treatment and prevention.
``(c) Other Agencies.--Activities under subsection (a) regarding
the treatment of diabetes in minority populations shall include the
following:
``(1) Through the Substance Abuse and Mental Health
Services Administration and the National Institute of Mental
Health, providing for comprehensive mental health services and
treatment for minorities who experience mental barriers to
proper diabetes care.
``(2) Promoting early detection as a cost-saving mechanism,
including making grants to community health centers and clinics
to specifically treat type 2 diabetes and complications,
including eye disease, kidney failure, heart disease and
stroke, nerve damage, and limb amputations.
``(3) Through the Health Resources and Services
Administration and the Centers for Disease Control and
Prevention, carrying out a collaborative program to encourage
preventive care. Such program shall not be limited to primary
prevention, and shall include secondary and tertiary
prevention. Such program shall include the award of grants to
community health centers and clinics to specifically treat
diabetes, with an emphasis on type 2 diabetes, and diabetic
complications, including eye disease, kidney failure, heart
disease and stroke, nerve damage, and limb amputation.
``(d) Definition.--For purposes of this section, the term `minority
populations' means racial and ethnic minority groups within the meaning
of section 1707.
``(e) Authorization of Appropriations.--
``(1) In general.--For the purpose of carrying out
subsections (a) and (c), there are authorized to be
appropriated such sums as may be necessary for fiscal year 2004
and each subsequent fiscal year.
``(2) National institutes of health.--For the purpose of
carrying out subsection (b), there are authorized to be
appropriated such sums as may be necessary for fiscal year 2004
and each subsequent fiscal year.''.
TITLE III--EDUCATION
SEC. 301. EDUCATION.
Part P of title III of the Public Health Service Act, as amended by
section 201 of this Act, is amended by inserting after section 399P the
following section:
``SEC. 399Q. DIABETES; EDUCATION REGARDING MINORITY POPULATIONS.
``(a) In General.--The Secretary shall conduct and support programs
to educate the public on the causes of effects of diabetes in minority
populations.
``(b) National Institutes of Health.--With respect to the National
Institutes of Health, activities under subsection (a) regarding
education on diabetes in minority populations shall include the
following:
``(1) Through the National Center on Minority Health and
Health Disparities--
``(A) making grants to programs funded under
section 485F (relating to centers of excellence) for
the purpose of establishing a mentoring program for
health care professionals to be more involved in weight
counseling, obesity research, and nutrition;
``(B) providing for the participation of minority
health professionals in diabetes-focused research
programs; and
``(C) providing for the participation of minority
health professionals in diabetes-focused research
programs.
``(2) Making grants for programs to establish a pipeline
from high school to professional school that will increase
minority representation in diabetes-focused health fields by
expanding Minority Access to Research Careers (MARC) program
internships and mentoring opportunities for recruitment.
``(c) Centers for Disease Control and Prevention.--With respect to
the Centers for Disease Control and Prevention, activities under
subsection (a) regarding education on diabetes in minority populations
shall include the following:
``(1) Making grants for diabetes-focused education classes
or training programs on cultural sensitivity and patient care
within such populations for health care providers.
``(2) Carrying out public awareness campaigns directed
toward such populations to aggressively emphasize the
importance and impact of physical activity and diet in regard
to diabetes and diabetes-related complications.
``(d) Health Resources and Services Administration.--With respect
to the Health Resources and Services Administration, activities under
subsection (a) regarding education on diabetes in minority populations
shall include the following:
``(1) Providing additional funds for the Health Careers
Opportunity Program, Centers for Excellence, and the Minority
Faculty Fellowship Program to partner with the Office of
Minority Health under section 1707 and the National Institutes of
Health to strengthen programs for career opportunities within minority
populations focused on diabetes treatment and care.
``(2) In partnership with the Health Resources and Services
Administration, develop a diabetes focus within, and provide
additional funds for, the National Health Service Corps
Scholarship program to place individuals in areas that are
disproportionately affected by diabetes, to provide health care
services.
``(3) Establishing a diabetes ambassador program for
recruitment efforts to increase the number of underrepresented
minorities currently serving in student, faculty, or
administrative positions in institutions of higher learning,
hospitals, and community health centers.
``(4) Establishing a loan repayment program that focuses on
diabetes care and prevention.
``(e) Additional Programs.--Activities under subsection (a)
regarding education on diabetes in minority populations shall include
the following:
``(1) Through collaboration between the Health Resources
and Services Administration and the Indian Health Service,
establishing a joint scholarship and loan-repayment program for
American Indians health profession students.
``(2) Providing funds for new and existing diabetes-focused
education grants and programs for present and future students
and clinicians in the medical field from minority populations,
including the following:
``(A) Federal and State loan repayment programs for
health profession students within communities of color.
``(B) Providing funds to the Office of Minority
Health under section 1707 for training health
profession students to focus on diabetes within such
populations.
``(C) Providing funds to State and local entities
to establish diabetes awareness week or day every month
in schools, nursing homes, and colleges through
partnerships with the Office of Minority Health under
section 1707 and the Health Resources and Services
Administration.
``(f) Definition.--For purposes of this section, the term `minority
populations' means racial and ethnic minority groups within the meaning
of section 1707.
``(g) Authorization of Appropriations.--
``(1) In general.--For the purpose of carrying out
subsections (a) and (e), there are authorized to be
appropriated such sums as may be necessary for fiscal year 2004
and each subsequent fiscal year.
``(2) National institutes of health.--For the purpose of
carrying out subsection (b), there are authorized to be
appropriated such sums as may be necessary for fiscal year 2004
and each subsequent fiscal year.
``(3) Centers for disease control and prevention.--For the
purpose of carrying out subsection (c), there are authorized to
be appropriated such sums as may be necessary for fiscal year
2004 and each subsequent fiscal year.
``(4) Health resources and services administration.--For
the purpose of carrying out subsection (c), there are
authorized to be appropriated such sums as may be necessary for
fiscal year 2004 and each subsequent fiscal year.''.
TITLE IV--HEALTH PROMOTION, PREVENTION ACTIVITIES, AND ACCESS
SEC. 401. HEALTH PROMOTION, PREVENTION ACTIVITIES, AND ACCESS.
Part P of title III of the Public Health Service Act, as amended by
section 301 of this Act, is amended by inserting after section 399Q the
following section:
``SEC. 399R. DIABETES; HEALTH PROMOTION, PREVENTION ACTIVITIES, AND
ACCESS REGARDING MINORITY POPULATIONS.
``(a) National Institutes of Health.
``(1) In general.--The Secretary, acting through the
Director of the National Institutes of Health, shall provide
access to proper care of diabetes for minority populations.
``(2) Certain activities.--Activities under paragraph (1)
regarding proper care of diabetes in minority populations shall
include the following:
``(A) Providing funds for research to assess and
identify the number of individuals affected by
socioeconomic and environmental barriers to diabetes
health care access, including research regarding
language, transportation, daily routine, lifestyle, and
housing.
``(B) Through the National Center on Minority
Health and Health Disparities, identifying the manner
in which health care providers, community health
centers, and hospitals provide proper options and
education on available services for diabetes care,
management, and prevention, including identifying the
effects of differences in the cultures of staff and
patients on clinical and other workforce encounters.
``(b) Centers for Disease Control and Prevention.
``(1) In general.--The Secretary, acting through the
Director of the Centers for Disease Control and Prevention,
shall carry out culturally appropriate diabetes health
promotion and prevention programs for minority populations.
``(2) Certain activities.--Activities under paragraph (1)
regarding culturally appropriate diabetes health promotion and
prevention programs for minority populations shall include the
following:
``(A) Expanding the Diabetes Control Program
(currently existing in all the States and territories).
``(B) Providing funds for the Diabetes Today
program to adapt community planning tools within such
populations.
``(C) Providing funds for Racial and Ethnic
Approaches to Community Health (REACH 2010) grants to
develop and evaluate diabetes prevention and control
community programs focused on such populations.
``(D) Providing funds to community health centers
for a monthly diabetes week program of diabetes
services, including screenings.
``(E) Providing funds for free diabetes self-
management education classes in hospitals, clinics, and
community health centers.
``(F) Providing funds for education and community
outreach on diabetes.
``(G) Providing funds for the United States and
Mexico Border Diabetes project to develop culturally
appropriate diabetes prevention and control
interventions for Minority populations in the border
region.
``(H) Providing funds for an aggressive prevention
campaign that focuses on physical inactivity and diet
and its relation to type 2 diabetes within such
populations.
``(I) Providing funds for surveillance systems and
strategies for strengthening existing systems to
improve the quality, accuracy, and timelines of
morbidity and mortality diabetes data for such
populations.
``(c) Definition.--For purposes of this section, the term `minority
populations' means racial and ethnic minority groups within the meaning
of section 1707.
``(d) Authorization of Appropriations.--
``(1) National institutes of health.--For the purpose of
carrying out subsection (b), there are authorized to be
appropriated such sums as may be necessary for fiscal year 2004
and each subsequent fiscal year.
``(2) Centers for disease control and prevention.--For the
purpose of carrying out subsection (c), there are authorized to
be appropriated such sums as may be necessary for fiscal year
2004 and each subsequent fiscal year.''.
TITLE V--ADDITIONAL PROGRAMS
SEC. 501. ADDITIONAL PROGRAMS.
(a) Education Regarding Clinical Trials.--The Secretary of Health
and Human Services (referred to in this section as the ``Secretary'')
shall carry out education and awareness programs designed to increase
participation of minority populations in clinical trials.
(b) Minority Researchers.--The Secretary shall carry out mentorship
programs for minority researchers who are conducting or intend to
conduct research on diabetes in minority populations.
(c) Supplementing Clinical Research Regarding Children.--The
Secretary shall make grants to supplement clinical research programs to
assist such programs in obtaining the services of health professionals
and other resources to provide specialized care for children with type
1 and type 2 diabetes.
(d) Definition.--For purposes of this section, the term ``minority
populations'' means racial and ethnic minority groups within the
meaning of section 1707 of the Public Health Service Act.
(e) Authorization of Appropriations.--For the purpose of carrying
out this section, there are authorized to be appropriated such sums as
may be necessary for fiscal year 2004 and each subsequent fiscal year.
TITLE VI--STUDIES
SEC. 601. STUDIES.
(a) Institute of Medicine.--The Secretary of Health and Human
Services (referred to in this section as the ``Secretary'') shall
request the Institute of Medicine to conduct a study to determine the
extent and impact of the shortage of adult and pediatric
endocrinologists specializing in diabetes, and to submit a report
describing the findings of the study to the Secretary, to the Committee
on Energy and Commerce of the House of Representatives, and to the
Committee on Health, Education, Labor, and Pensions of the Senate. The
Secretary shall ensure that the report includes recommendations on
changes in Federal policies that would increase the number of adult and
pediatric endocrinologists specializing in diabetes.
(b) Agency for Healthcare Research and Quality.--The Secretary,
acting through the Director of the Agency for Healthcare Research and
Quality, shall conduct a study to determine whether minority children
with diabetes have better or worse outcomes than nonminority children.
The study shall include a determination of the extent to which minority
children have access to and participate in disease management programs,
and have access to and use medical devices such as continuous glucose
monitoring systems, insulin pumps, and artificial pancreas.
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